Pharmacologic Treatment Strategies in Psoriatic Arthritis

PURPOSE

The goal of this narrative review was to provide current data on psoriatic arthritis (PsA) therapeutic strategies, supporting treatment decisions with a domain-based approach.

METHODS

This narrative review of treatment strategies for PsA focused on several disease domains (ie, peripheral arthritis, enthesitis, axial disease, dactylitis, skin and nail disease), as well as the so-called "related conditions" of uveitis, Crohn's disease, and ulcerative colitis. We searched PubMed, EMBASE, international guidelines, and recent congress abstracts.

FINDINGS

Currently, multiple approved treatment options offer a wide range of options, such as tumor necrosis factor (TNF) inhibitors; inhibitors of interleukin-17 (IL-17), IL-12/23 (IL-12/23), IL-23 (IL-23), and Janus kinase; the phosphodiesterase 4 inhibitor apremilast; and the T-cell modulator abatacept. However, no treatment option shows clear superiority concerning efficacy on peripheral arthritis and dactylitis over the others, whereas limited evidence suggests that the IL-17 inhibitor ixekizumab and the IL-12/23 inhibitor ustekinumab may be superior to TNF inhibitors in treating enthesitis. Recent data on enthesitis have also shown promising results for methotrexate. Treatment of axial PsA is mostly derived from axial spondyloarthritis, and more data are needed focusing on this specific subgroup of PsA patients. Thus far, the most important finding from the only randomized controlled trial in this specific population is that the IL-17 inhibitor secukinumab was superior to placebo in terms of clinical and radiologic end-points in axial PsA. Regarding psoriatic skin involvement, head-to-head trials in PsA as well as skin psoriasis showed the superiority of IL-17, IL-23, and IL-12/23 inhibitors over TNF inhibitors. When treating PsA with concurrent uveitis, according to the existing data, monoclonal TNF inhibitor antibodies should be preferred. In PsA and concomitant inflammatory bowel disease, treatment decisions must include the consideration of which specific type of inflammatory bowel disease (Crohn's disease or ulcerative colitis) is present, as some of the agents either lack data or are ineffective in treating these 2 conditions. In both types, IL-17 inhibitors should be avoided. When determining treatment strategy, comorbidities should be carefully assessed, and the corresponding risk profile of the respective treatment modalities should be taken into consideration.

IMPLICATIONS

There are many approved therapeutic options for treating patients with PsA, and additional emerging treatment options are in the pipeline. Individualized treatment decisions for each patient, depending on the leading disease phenotype, underlying comorbidities, and patient preferences, should be made based on shared decision-making.

Comparison of demographic, clinic and radiological features of patients with axial spondyloarthritis accompanying familial Mediterranean fever to patients with each condition alone

OBJECTIVE

To compare the demographic, clinical, and radiological features of patients with axial spondyloarthritis (axSpA) accompanying familial Mediterranean fever (FMF) to patients with each condition alone.

METHOD

Hacettepe University Hospital database was screened regarding ICD-10 codes for FMF (E85.0) and axSpA (M45). The diagnosis of FMF was confirmed by Tel-Hashomer criteria, and axSpA by the presence of sacroiliitis according to the modified New York criteria or active sacroiliitis on magnetic resonance imaging. As control groups, 136 gender-matched, consequent FMF patients without axSpA and 102 consequent axSpA patients without FMF previously treated with any biological agents were included in the analysis.

RESULTS

In patients with FMF + axSpA compared to the axSpA group, age at axSpA symptom onset and age at diagnosis were lower [median with interquartile range (IQR): 21 (17-30) vs 27 (21-37), p < 0.001; 23 (21-38) vs 32 (24-43) years, p = 0.001], moderate to severe hip disease and total hip replacement were more prevalent (23.4% vs 4.7%, p < 0.001; 11.2% vs 2.8%, p = 0.016). In patients with FMF + axSpA compared to the FMF group, age at FMF symptom onset and age at diagnosis were higher [13 (6-30) vs 11 (5-18), p = 0.057; 23 (13-33) vs 18 (10-31) years, p = 0.033] and amyloidosis was more prevalent (6.6% vs 2.2%, p = 0.076). Although the M694V variant (in one or two alleles) was more prevalent in the FMF + axSpA group, the difference was not statistically significant.

CONCLUSION

In patients with FMF + axSpA, the age of onset of axSpA was significantly earlier, moderate to severe hip involvement and amyloidosis were more common than in patients with each condition alone.

Can left ventricle mass index predict pacemaker-induced cardiomyopathy in patients with dual chamber permanent pacemakers implanted due to complete atrioventricular block?

Background

Pacing induced cardiomyopathy (PICM) occurs due to high-burden right ventricular pacing. In patients with complete atrioventricular (AV) block, it is presumed to have a higher burden of right ventricular pacing. There is a lack of data regarding the relationship between PICM and pre-implantation left ventricular mass index (LVMI).

Purpose

This study aims to investigate the effect of LVMI on PICM in patients with implanted dual chamber permanent pacemakers (PPM) due to complete AV block.

Methods

PPM implanted 577 patients were divided into three groups according to admission LVMI. Mean duration of follow-up was 57±38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the groups. The independent predictors of PICM incidence and the effect LVMI on PICM were evaluated.

Results

Age, post-implantation QRS duration, left atrium anteroposterior diameter and LVMI were determined to predict long-term PICM. After adjustment for confounding baseline variables, tertile with highest LVMI had 1.9 times higher rates of long-term PICM compared to tertile with lowest LVMI, which was used as the reference group. A ROC analysis showed that the optimal cut-off value of the LVMI to predict long-term PICM was 109.8 mg/m2 with 71% sensitivity and 62% specificity (AUC: 0.68; 95% CI: 0.60–0.76; p&lt;0.001),

Conclusion

Pre-implantation LVMI plays an important prognostic role in predicting PICM in patients with implanted dual chamber PPM due to complete AV block.

Funding Acknowledgement

Type of funding sources: None.

AB0278 IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING bDMARDs, THE CHARLSON COMORBIDITY INDEX IS MORE PRONOUNCED THAN PSORIATIC ARTHRITIS

Background

According to international recommendations, co-morbidities must be taken into account in the management of patients with inflammatory arthritis.

Objectives

To evaluate the distribution of pre-treatment comorbidities in the bDMARD cohort including patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods

The Hacettepe University biological database (HUR-BIO) was established in 2005, 581(75.4% female) patients with RA and 520 (69.4%female) patients with PsA enrolled up to 2021 were analyzed. Diagnosis of RA and PsA were based on the clinical evaluation of the rheumatologist who followed the patients. Comorbidities of the patients were reviewed retrospectively from the biological database, hospital electronic records, ICD-10 diagnostic codes and prescriptions of patients. Diabetes mellitus (DM), Hypertension (HT), Dyslipidemia (DL), Coronary artery disease (CAD), Body mass index (BMI) and smoking were recorded. DL was grouped in terms of lipid values ​​according to the classification of the Turkish Society of Endocrinology and Metabolism Dyslipidemia Guide(1). Detection of coronary artery disease before the age of 55 in men and of 65 in women was classified as premature - CAD. Data on Chronic Kidney Disease, obstructive pulmonary disease, Cerebro-vascular disease, Thyroid Diseases were also recorded. The Charlson comorbidity index (CCI) was calculated by summing the comorbidities in the patients’ medical history before the bDMARDs.

Results

The distribution of comorbidities in patients with RA and PsA prior to initiation of bDMARDs was given in Table 1. Patients with RA were older and smoking was more common. HT(28.5% for RA, 21.9% for PsA) and thyroid diseases (22.7% for RA, 14.7% for PsA) were the most comorbidities in both groups. Compared to PsA, patients with RA had higher rate of comorbidities (64.8% vs. 40.4%, p<0.001). Multimorbidity was detected in 231/581 (39.7%) of patients with RA, and it is significantly more common than the patients with PsA (21.8%) (p<0.001). There was no difference between the groups in terms of cardiovascular comorbidities such as BMI, DM, and dyslipidemia. When adjusted for age, the comorbidity burden according to CCI was 3.96 (2.57-6.13, p<0.001) times higher in patients with RA than in patients with PsA.

Table 1.

Comorbidities in RA and PsA patients

FeaturesRA n=581PsA n=520pGender, female n (%)438 (75.4)361 (69.4)0.027Age at PsA diagnosis, mean (SD) years46.7 (13.7)39.3 (12.0)<0.001Age at bDMARD start, mean (SD) years49.5 (13.8)42.2 (12.3)<0.001CCI-No comorbidity205/581 (35.2)290/486 (59.6)<0.001-1 comorbidity145/581 (24.9)90/486 (18.5)-≥ 2 comorbidity231/581 (39.7)106/486 (21.8)CCI mean, (SD)1.56 (1.77)0.78 (1.18)<0.001Smoking (ever), n292/581282/506<0.001BMI, mean (SD)29.3 (6.7)29.6 (5.9)0.50BMI ≥ 30 n261/577221/4980.77Diabetes Mellitus, n68/58149/4020.30Hypertension, n166/581110/5020.012Dyslipidemia* n-High TC47/27032/1610.30-High TG62/24245/1590.79-High LDL -C53/289(43/1750.38-Low HDL-C88/26757/1570.48Uric acid (>6 mg/dl), n150/554136/4370.16CAD n59/52432/4860.010Premature CAD, n39/58118/4860.030CKD, nG1 (GFR > 90)437/5230<0.001G2 (GFR 60-90)68/5230G3a (GFR 45-60)11/5230G3b (GFR 30-45)5/52328/370G4 (GFR 15-30)2/523342/370Lung disease, n-COPD15/5193/4850.007-Asthma66/52019/485<0.001Thyroid disease, n132/58165/440<0.001

*TC > 240, TG 150-499, LDL-C> 160, HDL-C erkek < 40, kadin < 50

CCI: Charlson comorbidity index, CAD: Coronary artery disease, CKD: Chronic Kidney Disease, COPD: Chronic Obstructive pulmonary disease

Conclusion

The burden of comorbidities in patients with RA before bDMARDs is more pronounced than in patients with PsA. Although, cardiovascular risk factors were similar, with the exception of hypertension and smoking, the age-adjusted CCI was 3.96 times higher in patients with RA than in patients with PsA.

References

[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021

Disclosure of Interests

None declared

AB0353 bDMARD CHOICES FOR INFLAMMATORY ARTHRITIS WITH CHRONIC KIDNEY DISEASE; HUR-BIO REAL-LIFE REGISTRY

Background

Rheumatic disesases may involve multiple systems and chronic kidney disease (CKD) can be seen during the course of diseases. Accompanying CKD affects the the choice of treatments in patients with rheumatic disease. There is limited data on the use of biological DMARDs in rheumatic patients with chronic kidney disease.

Objectives

To determine the preferred first and second bDMARDs in patients in the CKD in the bDMARD cohort.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005. A total of 2160 RA patients, 3744 SPA patients, were registered in HUR-BIO until November 2021. The CKD was confirmed and classified according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. . Patients were evaluated for the presence of CKB before the initiation of bDmard and during follow-up under bDMARDs. Age and sex matched RA patients without CKD were selected for the control group.

Results

142/5904 (2.4%) patients have CKD. 102(%71.8) patients had CKD prior to initiation of bDMARD and 40 (28.1%) patients had developed during follow-up. The median time to CKD development after starting bDMARD was 4.13 years(±4.05). Of the patients with CKD, 98 (69.0%) had RA and 44 (31.0%) had SpA. RA patients followed for CKD were older than SpA (66.0 (±11.1) vs 59.1 (±13.0) years, p=0.001), female gender was more common (73.5% vs 36.4%, p<0.001), disease duration was similar (19.3 (±13.8) vs 17.1 (±10.5) years, p=0.40). The first bDMARD choices of patients with and without CKD in RA and SpA patients were shown in Table 1. There was no difference between the SPA patients with or without CKD regarding TNF-i preferences. In patients with rheumatoid arthritis there was no difference in terms of TNFi and non-TNF-i preferences, but tocilizumab was more prefered in CKD group.

Table 1.

Relationship between remission according to bDMARD and CKD

Rheumatoid arthritispSpondyloarthritispw CKD n=98wo CKD n=91w CKD n=44(%)wo CKD n=80(%)p<0,05Etanercept, n(%)34 (34.6)30 (33.0)0.4617 (38.6)22 (27.5)P=0.14Adalimumab, n(%)17(17.3)17 (18.7)0,4810 (22.7)22 (27.5)P=0.36Infliximab,n(%)3 (3)8 (8.8)0.8514(31.8)32 (40.0)p=0.24Golimumab, n(%)4 (4)3 (3.3)0,541 (2.2)3 (3.8)p=0.55Certolizumab, n(%)0 (0)3 (3.3)0,111 (2.2)1 (1.3)p=0.58Anti-TNF therapy, n(%)58 (59.2)61 (67.0)0,6143800.352Non-TNF biologics, n(%)40 (40,8)30 (33.0)0,13100.355Rituximab, n(%)14 (14.3)12 (13.2)0,57Abatacept, n(%)14(14.3)12 (13.2)0,49Tocilizumab, n(%)6 (6.1)10.0411(2.2)p=0.35Jak-kinase inhibitors, n(%)6(6.1)5 (5.5)0.55

Conclusion

In our biologic cohort, 2% of patients with RA and SpA had accompanying CKD. In one-third of the patients with CKD, it was developed during the follow-up after bDMARDs. In patients with RA, there was no difference in terms of TNFi and non-TNF-i preferences. It should be kept in mind that CKD may develop during the follow-up of patients using bDMARDs.

References

[1]Ye W, Zhuang J, Yu Yet all Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study. BMC Nephrol. 2019 Dec 9;20

[2]Chebotareva NV, Guliaev SVet al. [Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants]. Ter Arkh. 2019 May 15;91(5)

Disclosure of Interests

None declared

POS1440 HEMATOLOGICAL MALIGNANCIES AND ANTI-TNF IN INFLAMMATORY ARTHRITIS: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY

Background

TNF inhibitors (TNFi) is highly effective in inflammatory arthritis (IA) treatment. However, concerns are raised about the possible association between TNFi and hematologic malignancies (HMs).

Objectives

To assess the incidence of HMs among IA patients receiving TNFi compared with the general Turkish population.

Methods

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA including rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) patients who had at least 1 visit after the TNFi usage were screened from 2005 to November 2021. HM diagnosis was determined from the each patient files according to the hematologists’ decision and/or bone marrow/lymph node biopsy. Demografic data, disease characteristics, and death status were recorded. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with age- and gender-specific SIR values abstracted from the 2017 Turkish National Cancer Registry (TNCR).

Results

Of the 6139 patients registered in the HUR-BIO database, 5355 [3116 female (58.2%)] used any TNFi at least once. Median follow-up duration was 2.6 years for all patients receiving TNFi. 13 patients [8 (61.5%) female] had HM on follow-up. In these patients, median age at the IA onset was 38 (range 26 to 67) and the number of patients with SpA, RA, and PsA was 7, 4, and 2, respectively. The median duration of IA was 17.7 years (range 1 to 33). The median age at the HM onset was 55.5 (range 38 to 76) and the type of HM as follow: 8 lymphoma, 2 multiple myeloma, 1 large granular lymphocytic leukemia, 1 plasma cell dyscrasia, and 1 myelodysplastic syndrome. The median duration of the TNFi usage onset to HM was 36 (range 4-112) months. The TNFi was as follows: etanercept (n=8), adalimumab (n=6), infliximab (n=4), golimumab (n=1), and certolizumab (n=1). 5 patients used more than one TNFi. Patients using TNFi had an increased incidence for HMs (SIR 4.23, 95% CI 2.35-7.05). These results were also valid for both gender. 10 patients with HMs were under the age of 65. In this group, there was a higher incidence of HMs in both men (SIR 5.15, 95% CI 1.88-11.43) and women (SIR 4.76, 95% CI 1.74-10.55). 5 patients deceased on follow-up.

Conclusion

The risk of HMs in inflammatory arthritis patients receiving TNFi being four times higher in comparison with the general Turkish population. There is a plethora of information that discusses the association between HMs and rheumatic disease. To determine whether the increased risk is from rheumatic disease or from TNFi usage, it would be ideal to compare patients receiving TNFi with bDMARD naive IA patients.

Table 1.

SIR for diferent age cut-ofs in both sexes for patients with hematologic malignancies

GenderAgeObserved/expected casesSIR%95 confidence intervalTotalAll ages*13/3.074.232.35-7.05Male20-64 years (n=2059)5/0.975.151.88-11.43≥ 65 years (n=180)0/0.39NA-Overall (n=2239)5/1.363.671.34-8.14Female20-64 years (n=2667)5/1.054.761.74-10.55≥ 65 years (n=449)3/0.664.541.15-12.37Overall (n=3116)8/1.714.672.17-8.88

*: Includes patients ≥18 years.

NA: Not applicable, SIR: standardized incidence rates

Figure 1.

Cumulative number of hematologic malignancies in function of time from start of first anti-TNF therapy

Disclosure of Interests

None declared

POS0991 PREDICTORS OF DEVELOPMENT OF ADVANCED SPINAL ANKYLOSIS/BAMBOO SPINE IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM REAL-LIFE DATA

Background

In axial spondyloarthritis (axSpA), intervertebral ossification bridges of consecutive vertebrae may progress to advanced spinal ankylosis and bamboo spine over the years [1].

Objectives

To identify demographic, clinical, disease activity and treatment factors associated with development of bamboo spine / advanced spinal ankylosis and bamboo spine-only in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.

Methods

HUR-BIO is a prospective, single center database of biological disease-modifying antirheumatic drug (bDMARD) treatments. 770 patients on bDMARDs treatment had both lumbar and cervical lateral radiographies at the time of the data collection, and were included in the study. Bamboo spine was defined Bath Ankylosing Spondylitis Radiologic Index (BASRI)-spine grade 4 with a complete fusion of lumbar and cervical spines. Advanced spinal ankylosis was defined as the presence of at least two intervertebral adjacent bridges and/or fusion at the lumbar and/or cervical spine without bamboo spine. We analyzed the ensemble of variables by multivariable logistic regression to identify predictors associated with bamboo spine / advanced spinal disease, and bamboo spine-only.

Results

In the study, there were 99 patients with advanced spinal ankylosis and 78 patients with bamboo spine. Older age (OR 1.12, 95% CI 1.07-1.17), male gender (OR 4.26, 95% CI 1.75-10.41), delay diagnosis ≥ 24 months (OR 2.7, 95% CI 1.27-5.74), obesity (OR 4.03, 95% CI 1.53-10.64), hip involvement (OR 4.94, 95% CI 1.94-12.6), smoking ≥ 10 package/year (OR 2.28, 95% CI 1.003-5.2) were significantly associated factors with bamboo spine / advanced spinal ankylosis. Similarly, older age (OR 1.17, 95% CI 1.09-1.3), male gender (OR 8.31, 95% CI 2.09-33.1), obesity (OR 5.15, 95% CI 1.25-21.27), hip involvement (OR 4.74, 95% CI 1.32-16.96) and smoking ≥ 10 package/year (OR 3.19, 95% CI 1.03-9.89) were showed statistical significance with bamboo spine (Table 1).

Table 1.

Predictors of Bamboo Spine and Advanced Spinal Ankyloses, and Bamboo Spine-only

Multivariable ModelCovariatesBamboo Spine and Advanced Spinal AnkylosisBamboo SpineOR (95% CI)p-valueOR (95% CI)p-valueAge1.12 (1.07-1.17)<0.001*1.17 (1.09-1.3)<0.001*Male (vs female)4.26 (1.75-10.41)0.001*8.31 (2.09-33.1)0.003*Delay Diagnosis (≥ 24 months vs <24 months)2.7 (1.27-5.74)0.01*2.39 (0.85-6.71)0.09BMI0.019*0.074- 25 to < 30 (vs <25)2.05 (0.77-5.46)0.153.37 (0.84-13.6)0.087- ≥ 30 (vs <25)4.03 (1.53-10.64)0.005*5.15 (1.25-21.27)0.024*Hip involvement (present vs absent)4.94 (1.94-12.6)0.001*4.74 (1.32-16.96)0.017Smoking (≥ 10 package/year vs <10 package/year)2.28 (1.003-5.2)0.049*3.19 (1.03-9.89)0.044*Family History of SpA (First-degree; present vs absent)1.67 (0.61-4.57)0.322.82 (0.79-10.06)0.11Uveitis History (present vs absent)1.04 (0.39-2.74)0.941.19 (0.33-4.29)0.79Use SSZ (present vs absent)0.6 (0.17-2.07)0.422.09 (0.39-11.28)0.39Use Corticosteroids (present vs absent)0.69 (0.27-1.75)0.430.73 (0.18-2.97)0.66

*p <0.05

BMI: Body mass index; SpA: Spondyloarthritis; SSZ: Sulfasalazine

Conclusion

Data on the predictors of development of advanced spinal ankylosis and bamboo spine are scarce. In this study, we showed that older age, male gender, delay in diagnosis, obesity, hip involvement and smoking are factors that predict the development of advanced spinal involvement in axSpA.

References

[1]Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskelet Dis. 2012;4(4):301-11.

Disclosure of Interests

None declared

POS1085 FREQUENCY OF DYSLIPIDEMIA AND COMPLIANCE WITH THE TREATMENT IN PsA PATIENTS USING bDMARDs

Background

Dyslipidemia is the leading treatable-modifiable factor among comorbidities in Psoriatic arthritis (PsA) patients. International treatment recommendations have left the management of dyslipidemia to national guidelines and especially to the rheumatologists.

Objectives

In this study, we aimed to determine the frequency of dyslipidemia and the rates of initiation of treatment within the indication in PsA patients using bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by therheumatologist. Lipid profiles of PsA patients were evaluated at diagnosis, during the first bDMARD initiation, and at the last visit. Total cholesterol (TC), Triglyserides (TG), HDL-C and LDL-C values were grouped as optimal, borderline, high and severely high according to the Turkish Endocrine and Metabolism society criteria (1).

Results

Lipid profile values ​​of PsA patients were known at diagnosis (n=159, 30.6%), in the initial bDMARD baseline (n=161, 30.9%), and at the last visit (n=203, 39.0%). The time to diagnosis of PsA and first bDMARD use was 2.8 years, and the time between the start of bDMARD and the last visit was 3.7 years. Accordingly, the rates of high TC, borderline TG, and high LDL increased over time. Rates at the time of PsA diagnosis, first bDMARD onset and at the last visit are as follows; high TC (14.3%, 17.1% and 28.0%), borderline TG (20.4%, 27.7% and 40.5%) and high LDL (17.0, 24.0% and 27.9%). On the other hand, low HDL-C slightly improved in men (33.3%, 29.4% and 23.1%), but did not show a significant change in women. While LDL-C level was >160 in 24.0% of patients who were started on bDMARD, anti-hyperlipidemic drug was started in only 6.2% of them. A similar situation persisted at the last visit (27.9% had LDL-C levels >160, but 10.8% received anti-hyperlipidemic therapy) (Table 1).

Table 1.

Lipid levels and changes over time

Lipid levelsAt the time of diagnosis n= 159At the time of bDMARD initiation n=161bDMARD last visit n= 203Total Cholesterol (TC) mean (SD)195 (42)201 (43)214 (47)- TC < 200 (optimal) (%)56.552.845.3- TC 200-239 (borderline) (%)27.230.125.7-- TC > 240 (high) (%)14.317.128.0Triglyceride (TG) mean (SD)115 (52)132 (90)158 (103)- TG < 150 (optimal) (%)79.671.758.0- TG 150-499 (borderline) (%)20.427.740.5- TG 500-880 (high) (%)001.0-- TG ≥ 880 (severely high) (%)00.60.5HDL-C mean (SD)51.8 (13.1)50.6 (13.0)53.2 (12.5)- ≥60 (optimal) (%)20.620.425.6- 40-59 (borderline) in men (%)54.660.852.3- 50-59 (borderline) in women (%)32.324.530.3- Male < 40 (low) (%)33.329.423.1-- Women < 50 (low) (%)32.339.633.8LDL-C mean (SD)126 (33)132 (37)139 (36)- LDL-C < 100 (optimal) (%)21.421.114.2- LDL 130-159 (borderline) (%)22.525.127.0- LDL 160-190 (high) (%)17.024.027.9-- LDL > 190 (very high) (%)4.46.38.4Anti-hyperlipidemic drug n (%)5 (3.1)10 (6.2)22 (10.8)

Conclusion

Among the modifiable risk factors for cardiovascular comorbidities in PsA patients, the leading risk factor is dyslipidemia. On the other hand, dyslipidemic drug use rates in daily practice are significantly lower. Although attention is paid to the management of comorbidities in all recommendations, there is still work to be done in real life.

References

[1]TEMD Obezite, L.M., Hipertansiyon Çalişma Grubu, TEMD DİSLİPİDEMİ TANI VE TEDAVİ KILAVUZU. 9 ed, ed. 2021, Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği. 159.

Disclosure of Interests

None declared

POS1087 THE RELATIONSHIP BETWEEN CHANGES IN PSORIATIC ARTHRITIS DISEASE ACTIVITY AND COMORBIDITIES IN PATIENTS TREATED WITH bDMARDs

Background

Comorbidities are common in psoriatic disease, needed to be recognized and managed to effectively when treating psoriatic arthritis (PsA) patients. However, the data on the impact of particular comorbidities on the disease activity in patients requiring bDMARDs are very small.

Objectives

Our aim was to understand the relationship between the disease activity and comorbidities in PsA patients under bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by the rheumatologist. DAS-28 score (at the last visit) and all comorbidities were documented after bDMARD initiation. Multivariate analysis was performed to understand comorbidities that have impact on DAS-28 remission.

Results

There were 469 patients with a known DAS-28 score median (IQR) 28 (61) months after bDMARD initiation. It was detected in 214/469 (45.6%) patients with a DAS-28 score below 2.6. Patients in remission of DAS-28 were younger, remission was less frequent in women, and comorbidities, mainly BMI, Diabetes Mellitus (DM) and hypertension, were also found less frequent (Table 1). In the multivariate analysis, no determining factor was found in male gender. On the other hand, in females, smoking, presence of comorbidity, Body mass index (BMI) at the start of bDMARDs, age at onset of bDMARDs, DM at the start of bDMARDs, HT at the start of bDMARDs, coronary artery disease, and cardiovascular risk factors were included in the analysis and revealed, bDMARD baseline BMI [OR 1.06 (95% CI 1.02-1.11), p= 0.004] and presence of bDMARD baseline DM [OR 3.08 (95% CI 1.14-8.30), p=0.026] had significant impact on DAS-28 remission.

Table 1.

Relationship between remission according to DAS-28 score and comorbidities

ParametersDAS-28 ≤ 2.6 (n=214)DAS-28 > 2.6 (n=255)pAge, mean (SD), years43.8 (11.7)47.5 (12.5)0.001Age at PsA diagnosis, mean (SD), years36.8 (11.5)41.6 (11.7)<0.001Gender, female, n(%)115 (53.7)211 (82.7)<0.001Comorbidity count1.54 (0.98)1.98 (1.31)<0.001Comorbidity (yes/no)67 (31.9)118 (47.6)0.001Comorbidity distribution0.001-No143 (68.1)130 (52.4)-1 Comorbidity38 (18.1)47 (19.0)-≥ 2 Comorbidity17 (8.1)36 (14.5)-≥ 3 Comorbidity12 (5.7)35 (14.1)Body Mass Index (BMI)28.1 (5.4)30.3 (5.9)<0.001BMI > 30, n(%)70 (32.9)123 (48.4)0.001Diabetes Mellitus, n(%)10 (4.7)35 (13.7)0.001Hypertension, n(%)29 (13.6)71 (27.8)<0.001Total cholesterol > 240, n(%)8 (10.5)22 (28.6)0.019Thyroid Disease20 (9,8)43 (17,3)0,02

Conclusion

Previous data showed that obesity, hypertension and at least 1 point from charlson comorbidity index are poor prognositc factors for treatment outcomes (1). Our data showed that BMI and presence of DM were determined as factors affecting bDMARD treatment response in female PsA patients.

References

[1]Ballegaard C, et al. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford). 2021 Jul 1;60(7):3289-3300.

Disclosure of Interests

None declared

AB0938 A new screening tool for Psoriatic Arthritis in Psoriasis Patients: TurPAS

Background

Psoriatic arthritis (PsA) is a heterogenous disease with different disease manifestations. Several tools have been developed for screening of PsA in patients with psoriasis with variable performances. An optimal screening tool for PsA is still an unmet need.

Objectives

We aimed to develop a new screening tool in Turkish which could detect different domains involved.

Methods

A core group was determined including 11 rheumatologists/10 dermatologist and a systematic literature review on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis` was performed. The review revealed tools named PEST, PASE, EARP, STRIPP, SIPAS, SIPAT, TOPAS-II, GEPARD, PASQ, CONTEST, A novel, short, and simple screening questionnaire. Each item of those tools were included in the Delphi set. After the 3 rounds of Delphi, a new set of screening questionss was developed.

Results

Overall 85 items were inquired, including questions on joint, dactylitis, enthesitis, back, skin-nail domains as well as morning stiffness, function, treatment and others for the first round of Delphi. Seventeen experts (9 dermatologists/ 8 rheumatologists from the core group) and fifteen patients (Female/Male= 9/6) answered the Delphi (mean (SD) age of 39.3 (10.9) participated to the first round. The involvemet types were peripheral (73.4%), axial (40%), entheseal (33.4) and dactylitis was present in 14% of the patients. As a result of this first evaluation, 44 out of 85 questions were selected and carried to second round The distribution of these questions was as follows; joint question n=13, skin and nail involvement n=6, dactylitis n=5, morning stiffness n=5, axial n=3, enthesitis n=2, general questions n=5. These questions were sent to the members through rheumatology and dermatology societies. In total, 85 rheumatology specialists and 48 dermatology specialists answered the questions in the second round. At the second tour, the number of questions was reduced from 44 to 22. The distribution of the questions was as follows; Skin and nail involvement n=5, dactylitis n=3, joint question n=2, axial involvement n=2, morning stiffness n=2, axial involvement and morning stiffness n=2, enthesitis n=1, general questions n=5. A consensus meeting was held to discuss 22 questions determined at the end of the second round within the initial core group. Each question was handled one by one, some of the questions were combined, if necessary, adapted to Turkish. The tool was given its final form. The final version of the questionnaire consists of 6 questions. (Table 1).

Table 1.

The new screening tool

DomainTurkish versionEnglish versionJointEl/ayak parmaklarinizda ya da herhangi bir ekleminizde hiç şişlik veya ağri oldu mu?Have you ever had swelling or pain in your fingers/toes or any of your joints?DactylitisResimde gösterildiği gibi el veya ayak parmağinizda sosis şeklinde şişlik oldu mu?Have you had a sausage-shaped swelling on your fingers or toes as shown in the picture?EnthesitisTopuk ağriniz olur mu?Do you have heel pain?Axial involvement and morning stiffnessBelinizde, sirtinizda veya boynunuzda istirahatle artan, özellikle sabaha karşi kötüleşen veya sabahlari hareketinizi kisitlayan ağriniz olur mu?Do you have pain in your lower back, back, or neck that increases with rest, worsens especially in the morning, or restricts your movement in the morning?Drug useEklem şikayetleriniz için zaman zaman ilaç kullanir misiniz?Do you take medication for your joint complaints from time to time?History of rheumatic diseaseSize daha önce iltihapli romatizma tanisi konuldu mu?Have you ever been diagnosed with a rheumatic disease before?

Conclusion

A new screening tool targeting different domains in Psoriatic disease was developed in Turkish. While cultural differences play an important role in screening, we believe that the first tool developed in Turkish will be helpful in clinical practice and research settings. Further assessments will be done to understand its validity and reliability within a large cohort of psoriatic patients.

Disclosure of Interests

None declared

AB0912 Swollen and tender joints improvement in the randomized controlled trials of psoriatic arthritis

Background

The ACR response is used to evaluate peripheral joints in psoriatic arthritis. However the main component in ACR treatment response is swollen (SJ) and tender joints (TJ), therewithal patient and physician global assessment, acute phase response, pain and function are included in this treatment response. Therefore, it can be thought that peripheral arthritis can best evaluated over SJ and TJ. Although ACR treatment responses are generally found to be similar between anti-TNF and anti-IL17/anti-IL23 in PsA, there is a general opinion that anti-TNF treatments may be more effective on the peripheral joint. (1).

Objectives

In this study, it was aimed to evaluate the efficacy on SJ and TJ in RCTs performed in PsA.

Methods

We was searched with the keywords ‘psoriatric arthritis’ and ‘randomized controlled trial’ in Pubmed. All studies between 1975 and 31.10.2021 were screened for TJ count (SD) and SJ count (SD) values at treatment initiation and primary endpoint. The 2 studies with anti-TNFs and the SPIRIT-1 study comparing ixekizumab with placebo and adalimumab showed the number of SJ and TJ at baseline and primary endpoint. Effect size calculated separately according to Morris and Klauer formula. (2,3) We can interpret the effect size according to Cohen as follows: 0-0,1 no effect; 0,2-0,4 small effect; 0,5-0,7 intermediate effect; 0,8-≥1 large effect. (4)

Results

Certolizumab study, ES was found at a good level in the number of TJ and SJ at 200 and 400 mg doses. (ES 0.84 for SJ). The study comparing ixekizumab with adalimumab and placebo, it was observed that administration of ixekizumab every 4 weeks was minimally more effective in the number of TJ (ES 0.16) and SJ (ES 0.13) than adalimumab. The effect of ixekizumab over placebo is also slightly better than that of Adalimumab over placebo. (0.51 vs 0.36 in TJ, 0.38 vs 0.29 in SJ)

Table 1.

Effect size analysis of studies

Tender Joint CountReferenceWeek (w)InterventionControlBaseline (Intervention vs Control)ES (Morris)ES (Klauer)Spirit-112Ixekizumab 4 w (n=107)Adalimumab (n=101)20,5 (13,7) vs 19,3 (13,0)0.160.9112Ixekizumab 2 w (n=103)Adalimumab (n=101)21,5 (14,1) vs 19,3 (13,0)0.120.2912Ixekizumab 4 w (n=107)Plasebo (n=106)20,5 (13,7) vs 19,2 (13,0)0.515.112Ixekizumab 2 w (n=103)Plasebo (n=106)21,5 (14,1) vs 19,2 (13,0)0.473.912Adalimumab (n=101)Plasebo (n=106)19,3 (13,0) vs 19,2 (13,0)0.364.1GENOVESE, Mark C., et al. M02-570 Study Group12Adalimumab (n=51)Plasebo (n=49)25,3 (18,3) vs 29,3 (18,1)0.190.30RAPID-PsA24Certolizumab 200 mg (n=138)Plasebo (n=136)21,5 (15,3) vs 19,9 (14,7)0.670.7524Certolizumab 400 mg (n=135)Plasebo (n=136)19,6 (14,8) vs 19,9 (14,7)0.490.61Swollen Joint CountSpirit-112Ixekizumab 4 w (n=107)Adalimumab (n=101)11.4 (8.2) vs 9.9 (6.5)0.130.6312Ixekizumab 2 w (n=103)Adalimumab (n=101)12,1 (7,2) vs 9,9 (4,7)0.191.1812Ixekizumab 4 w (n=107)Plasebo (n=106)11,4 (8,2) vs 10,6 (7,3)0.383.812Ixekizumab 2 w (n=103)Plasebo (n=106)12,1 (7,2) vs 10,6 (7,3)0.453.212Adalimumab (n=101)Plasebo (n=106)9.9 (6.5) vs 10.6 (7.3)0.294.4GENOVESE, Mark C., et al. M02-570 Study Group12Adalimumab (n=51)Plasebo (n=49)18.2 (10.9) vs 18.4 (12.1)0.330.29RAPID-PsA24Certolizumab 200 mg (n=138)Plasebo (n=136)11.0 (8.8) vs 11.0 (8.8)0.840.8324Certolizumab 400 mg (n=135)Plasebo (n=136)10.5 (7.5) vs 11.0 (8.8)0.840.87

Conclusion

Changes in the number of SJ and TJ that directly assess the peripheral joint have not been reported enough in RCTs in PsA patients. According to a limited number of reports, Anti-TNFs (eg, certolizumab) cause significant improvement in the number of SJ and TJ in the primary endpoint. On the other hand, Ixekizumab has as much effect on SJ and TJ as Adalimumab. The effect of anti-IL 17 treatments on the peripheral joint is not less than that of anti-TNFs, as thought.

References

[1]Noviani M et at. Ther Adv Musculoskelet Dis. 2020

[2]Klauer, K. J. Handbuch kognitives Training

[3]Morris, S. B. Estimating Effect Sizes From Pretest-Posttest-Control Group Designs.

[4]Cohen, J. Statistical power analysis for the behavioral sciences (2. Auflage)

Disclosure of Interests

None declared

AB0766 Biologic Drug Preferences of Turkish Rheumatologists in Spondiloartropathy Patients with Advanced Chronic Renal Disease

Background

Biological therapies are the main treatment options for patients with active spondyloarthropathy (SpA) who do not respond to nonsteroidal anti-inflammatory drugs or conventional synthetic disease-modifying drugs. Kidney diseases are not a contraindication to biologic therapies. However, there are some safety concerns for these drugs for patients with advanced chronic kidney disease. De novo infection or recurrence of infections are the main challenges in patients with multiple comorbidities during biologic treatments. Neverthless, physicans should initiate these treatments in active and resistant diseases.

Objectives

Here, we evaluated which biologic therapies clinicians’ first option to initiate in SpA patients with advanced chronic kidney disease (CRD).

Methods

Total 140 patients of TREASURE database who fullfield axial and/or peripheral ASAS SpA criteria with glomerular filtration rate < 60 ml/dk (stage 3,4 or 5 CRD according to The National Kidney Foundation classification) were included to the study. Renal stages of the patients were evaluated when biologic therapy was initiated. Five anti-TNF (adalimumab, certolizumab, etanercept, golimumab, infliximab) and an interleukin-17A blocker (secukinumab) were on the market during the study. We evaluated physicans’ first choice for biologic therapy for patients with stage 3,4 and 5 CRD respectively.

Results

More than two thirds of the patients had stage 3 CRD. Anti-TNF drugs were the first choice of biologic treatment in the patients with advanced CRD. Etanercept was started at most to the patients in general, in stage 3 and in stage 5 CRD groups. However, adalimumab was the first choise in stage 4 CRD. Both etanercept and adalimumab were the first drug of choise in three fourth of the stage 4 and stage 5 patients. All two patients on Il-17A blocker had stage 3 CRD (Table 1).

Table 1.

Drug of choise in the SpA patients with advanced chronic renal diseases

NTotal n (%)NStage 3 n (%)NStage 4 n (%)NStage 5 n (%)Adalimumab14044 (31.4)10830 (27.8)209 (45.0)125 (41.6)Etanersept52 (37.1)41 (38.0)5 (25.0)6 (50.0)Golimumab9 (6.0)7 (6.5)2 (10.0)0 (0)Infliksimab28 (20.0)23 (21.3)4 (20.0)1 (8.4)Secukinumab3 (2.1)3 (2.8)0 (0)0 (0)Sertolizumab4 (2.8)4 (3.7)0 (0)0 (0)

Conclusion

We show that rheumatologists in the TREASURE group prefer to initiate anti-TNF drugs first in all advanced CRD stages. Etanercept was the first choice in these patients.

References

[1]Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun;68 Suppl 2:ii1-44. doi: 10.1136/ard.2008.104018. PMID: 19433414.

[2]Antoni C, Braun J. Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S152-7. PMID: 12463468.

[3]Kalyoncu U, et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018 Aug 16;48(4):856-861. doi: 10.3906/sag-1807-200. PMID: 30119164.

Disclosure of Interests

None declared

AB0946 Pelvis radiography findings and progression rates in patients with Psoriatic Arthritis under biologic treatment

Background

Psoriatic arthritis (PsA) is a heterogenous disease that can present with various musculokeletal manifestations. Several studies have assessed the rate of sacroileitis in PsA population, however data on the involvement of other pelvic structures that may cause symptoms, such as major entheseal or hip involvevement, and progression rates during follow-up is scarce.

Objectives

This study aimed to understand overall pelvis radiography findings and progression rates during follow-up in a cohort of patients with PsA under biologic treatment.

Methods

PsA patients from the Hacettepe University biological database (HUR-BIO), were retreospectively analyzed for their pelvis radiographs. All radiographs for individual patient were consecutively scored. Modified New York (mNY) criteria was used to assess sacroileitis and ischium/ iliac wing/ greater-lesser trochanteric enthesopathy and symphysis pubis osteitis assessments were done using a grade 0, no changes, 1, minimal changes and grade 2 and more counted as significant changes (1). Hip involvement was scored using BASRI-hip score and data on prosthesis were noted (2). All of the assessments were done by an experienced rheumatologis (UK) and in cases with suspicion, another experienced rheumatologist reviewed the cases (LK) and a consensus was reached.

Results

Overall 273 patients (69.6% of females) with the mean (SD) age at the time of first radiography 43.3 (12) years were included. At their initial radiographic assessment, the median (IQR) PsA duration was 2 (7) years. Baseline radiographs showed 10 (%3.7) of the patients had transitional vertebra and 137 (50.2%) patients had sacroiletis according to mNY criteria. From patients without sacroileitis (n=136), 67 patients had following radiographs. After a mean (SD) 47.1 (37) months, 16 (23.8%) of them progressed to sacroiletitis according to mNY criteria. Regarding the major enthesopathies, Regarding significant changes, 26.8 % of the patients had ischium enthesopathy, 19.3% of the patients ad symphysis pubis involvement and 13.2% of the patients had iliac wing enthesopathy. Trochantor major enthesopathy rates were 2.4% and 1.4 % at right and left sites respectively. Only one patient had trochanter minor enthesitis on the left site (Table 1). Prosthesis requirement was observed in 4 hip joints and 4 hip joints had prosthesis. There was no correlation between meeting mNY criteria and having iliac, ischium, and pubis involvement ≥ 2. On the other hand, patients with when there is ischium enthesopathy ≥2 (17/46 (36.9%) vs 18/96 (18.7%), p=0.013) or iliac wing enthesopathy ≥2 above (10/18 (55.5%) vs. 26/129 (20.1%), p=0.001), any syndesmophyte in the spine is more commonly seen.

Table 1.

Distribution of major entheseal involvement and BASRI-hip socres and progression rates

LocationGradesFirst assessmentN (%)Progression rate*Ischium (n=164)409/65 (13.8)311 (6.7)233 (20.1)174 (45.1)046 (28)Symphysis Pubis408/78 (10.2)(n=191)35 (2.6)232(16.8)160 (31.4)094 (49.2)Iliac wing403/72 (4.1)(n=174)39 (5.2)214 (8.0)128 (16.1)0124 (71.3)BASRI score43 (1.4)0(right)32 (0.9)(n=220)21 (0.5)100214 (97.3)BASRI score400(left)34 (1.8)(n=219)22 (0.9)100213 (97.3)

*Defined as one unit increase in the grade

Conclusion

Half of the patients with PsA requiring advanced treatment modalities, had sacroileitis in a median 2 years of disease duration and the rest may progress to sacroileitis during the follow-up period. Major enthesopathy involvement was also seen in more than half of the patients. Ischium, iliac wing enthesopathies and spinal syndesmophytes may be all a part of the osteoproliferative process. Further assessment is needed to correlate those radiographic changes to clinical symptoms.

References

[1]van der Linden S, et al. Arthritis Rheum. 1984 Apr;27(4):361-8.

[2]Calin A, et al. J Rheumatol 1999;26:988-92

Disclosure of Interests

None declared

AB1446 TRANSLATION AND CROSS-CULTURAL ADAPTATION OF COPING WITH RHEUMATIC STRESSORS (CORS) INTO TURKISH LANGUAGE

Background

Coping with Rheumatic Stressors (CORS) is a valid and reliable instrument that measures eight coping strategies directed at pain, limitations and dependency as the most prominent chronic stressors of Rheumatoid Arthritis (RA) (1). This questionnaire has also been used in axial Spondyloarthritis (ax-SpA) previously (2).

Objectives

To describe the translation and cross-cultural adaptation process of the CORS into Turkish as well as its cognitive debriefing to test the conceptual equivalence of the translated version among patients with RA, radiographic (r) and non-radiographic (nr) axSpA.

Methods

The CORS was firstly translated into Turkish (by 2 bilingual translators who are native speaker for Turkish) and then back-translated into Dutch (by 2 bilingual translators who are native speaker for Dutch) following the Beaton’s method (Figure 1) (3). Back-translation procedure was done totally blinded to the original version. After the review of the Turkish version by an expert committee that included translators, two patients and the research team, a consensus was reached on the pre-final version. Using the pre-final version, the field test with cognitive debriefing involved a sample of 10 RA and 10 axSpA patients with different gender, age, disease duration, and educational background. After some small changes resulting from the feedback from patients the final version was obtained.

Figure 1.

Flow-chart of the translation and cross-cultural adaptation process

Results

The CORS was translated into Turkish following the forward-backward procedure. Minor incompatibilities arose from the translation process of CORS which have been easily resolved by the expert committee meetings. For example, `Ik concentreer me op iets anders` was translated as `Başka seylere odaklanirim` which is in English `I concentrate on something else`. The discrepancy was raised whether to use a word equivalent `to concentrate` or `to focus` and decision was made to use `to focus` while there was no exact Turkish word of `to concentrate`. A total of 10 patients with RA [9 females, mean (SD) age of 49 (13)] and 10 patients with axSpA [7 females, mean (SD) age of 38 (10), r-AxSpA, n=7, nr-AxSpA, n= 3] participated in the field test. Mean (SD) time to complete the CORS was 8.3 (3.4) minutes. Cognitive debriefing showed that items of the CORS are clear, relevant, understandable, and easy to complete. Cognitive debriefing revealed that the wording of one item had to be changed to provide better understanding (Section B, item 22 the word `stop` in Dutch and `stop` in English which was translated as `durdurmak` in Turkish changed to `sonlandirmak`.

Conclusion

The final Turkish version of the CORS showed acceptable linguistic validity and can be used in both clinical practice and for research purposes, in patients with RA and in patients with axSpA. However, to implement Turkish-CORS, further assessment is ongoing to test its psychometric properties (validity and reliability).

References

[1]van Lankveld W, et al. Br J Rheumatol. 1994;33(11):1067-73.

[2]Boonen A, et al. Ann Rheum Dis. 2004;63(10):1264-8.

[3]Beaton DE, et al. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91

Disclosure of Interests

Gizem Ayan: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Fernando M Pimentel-Santos Speakers bureau: Abbvie, Novartis, UCB, Tecnimed, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, Tecnimed, UCB, Grant/research support from: AbbVie, Janssen, Novartis, Wim van Lankveld: None declared, Levent Kiliç: None declared

AB0275 THE FREQUENCY, PREVALENCE OF CORONARY ARTERY DISEASE AND PRE-MATURE CAD IN PsA AND RA PATIENTS

Background

An increased incidence of coronary artery disease (CAD) is known in inflammatory arthritis patients compared to the normal population. In the Veterans With Premature Atherosclerosis (VITAL) registry, the frequency of premature CAD (CAD < 55 in men, < 65 years in women) in autoimmune rheumatic diseases was 1.72 (95% CI 1.63-1.81) in Rheumatoid arthritis (RA) compared to the healthy population in approximately 135,000 patients, while a similar situation was not observed in Psoriatic arthritis (PsA) patients 1.09 (95%CI 0.98-1.21) (1).

Objectives

In this study, we aimed to compare the frequency of CAD and premature CAD in RA and PsA patients using bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), database was established in 2005 and prospective follow-up of patients using bDMARDs is being carried out. The frequency of CAD was recorded in 486 PsA and 524 RA patients using bDMARDs. CAD was determined according to the angiography reports or Coronary Computed-Tomography results. Premature CAD is defined as a history of CAD before the age of 55 in men and before the age of 65 in women. Demographic characteristics and other comorbid conditions of the patients were also noted. Disease activity (DAS-28) and functional status (HAQ-DI) of the patients before the first DMARD initiation were recorded.

Results

581 (75.4% female) RA and 520 (69.4% female) PsA patients were evaluated. The ages of the patients and the duration of the disease are as follows; RA, mean (SD) years of age 52.1 (13.9), disease duration 5.3 (2.1) years, PsA mean (SD) years of age 48.7 (12.5), disease duration 9.2 (6.4). At the time of first bDMARD initiation, 43/581 (7.4%) patients with RA and 12/486 (2.4%) patients with PsA had CAD (p<<0.001). After a median (IQR) follow-up of 32 (23) months in RA patients and 49 (88.5) months in PsA patients, CAD was detected in 59 (11.2%) patients, 32 (6.6%) in PsA patients, p=0.01. While 39/59 (66.1%) of RA patients had premature CAD, 18/32 (56.3%) PsA patients had premature CAD (Table 1).

Table 1.

Characteristics of RA and PsA patients with/without premature CAD

RAPsAPremature CADn=38Non-prematureCADn=21pPremature CADn=18Non-prematureCAD(n=14)pGender, n (%)29 (76.3)9 (42.8)0.0110 (55.5)10 (71.4)0.36Age, mean (SD), years56.6 (8.9)72.7 (7.1)<0.00159.9 (8.2)69.1 (6.3)0.002PsA duration, mean (SD), years5.5 (2.1)6.0 (1.7)0.3413.3 (8.9)12.6 (9.5)0.83Smoking (ever), n(%)22 (57.9)11 (52.4)0.8016 (88.9)5 (35.7)0.002BMI > 30, n(%)19 (52.3)7 (35.0)0.208 (44.4)11 (78.5)0.051HT (ever), n(%)23 (63.9)14 (66.7)0.8911 (61.1)13 (92.8)0.040DM (ever), n(%)20 (57.1)9 (52.9)0.774 (22.2)6 (42.8)0.45LDL > 130 (ever), n(%)29120.1311 (61.1)5 (35.7)0.14DAS-284.7 (1.1)4.2 (1.2)0.114.7 (1.4)4.5 (1.5)0.72HAQ (0-3)1.41 (0.7)1.05 (0.8)0.0790.7 (0.6)1. 3 (0.7)0.13

RA: Rheumatoid arthritis, PsA: Psoriatic arthritis, CAD; Coronary artery disease, BMI; Body-mass index, HT: Hypertension, DM: Diabetes mellitus

Conclusion

While the frequency of premature CAD is 10% in the normal population, CAD has a premature character in two-thirds of RA patients and 55% of PsA patients (2). In a large community-based study, the frequency of premature CAD was found to be increased in RA patients compared to the normal population, but no similar difference was observed in PsA patients (1). In real-life data in which we examined a large group of patients using bDMARDs, it is seen that the subtype of CAD is of pre-mature character in both RA patients and PsA patients.

References

[1]Mahtta D et al. Am J Med. 2020 Dec;133(12):1424-1432

[2]Cole JH, et al. Curr Atheroscler Rep. 2004 Mar;6(2):121-5.

Disclosure of Interests

None declared

AB1359 DO LATERAL AND AP RADIOGRAPHS TELL DIFFERENT STORY IN PATIENTS WITH PSORIATIC ARTHRITIS?

Background

The conventional radiography score that is frequently used in spondyloarthritis patients is mSSASS. This score was developed for Anylosing Spondylitis patients and is also frequently used in Psoriatic arthritis (PsA) (1). The mSSASS score takes into account lateral imaging of the lumbar and cervical radiographs. On the other hand, syndesmophytes can be detected on lumbar anterior-posterior (AP) radiographs, which may not be seen on lateral assessment.

Objectives

The aim of this study is to determine whether lumbar AP radiographs have an additional contribution to the evaluation of syndesmophytes in PsA patients.

Methods

Lumbar lateral radiographs and AP radiographs of 274 PsA patients receiving bDMARD therapy were evaluated. A total of 182 lateral lumbar radiographs and 144 AP radiographs were evaluated. On lateral lumbar radiographs each lumbar vertebral unit was evaluated between T12 lower and S1 upper ends. Areas between L1-L5 as AP, right-left, upper and lower vertebral units were evaluated. Syndesmophytes are classified as follows; corner and/or non-marginal syndesmophytes and bridging syndesmophytes. All of the assessments were done by an experienced rheumatologis (UK) and in cases with suspicion, another experienced rheumatologist reviewed the cases (LK) and a consensus was reached.

Results

182 patients had lumbar radiographs with the mean (SD) age of 44.9 (12.7) years and the mean (SD) PsA duration of 4. 8(6.1) years at the time of the radiographs were taken. The rate of females was 70.3%. When the lateral lumbar radiographs were evaluated, 42/182 (23.1%) patients had at least one syndesmophyte. These 42 patients had a total of 80 syndesmophytes, 41 of which were bridging and 39 were corner syndesmophytes. The distribution of syndesmophytes is shown in the Table 1. The mean number of syndesmophytes in patients with at least one syndesmophyte on the lumbar lateral radiograph is 80/42 (1.9). In patients with at least one syndesmophyte, 14/42 (33.3%) patients had additional syndesmophytes not seen on lateral radiographs but on AP X-ray. Their distribution is as follows: L1 (4 patients), L2 (3 patients), L3 (2 patients), L4 (6 patients) and L5 (1 patient). In addition, 11 corner syndesmophytes and 5 bridging syndesmophytes were detected in the lumbar AP radiograph. When lumbar and AP radiographs are evaluated together, 44/182 (24.2%) patients have at least one syndesmophyte. When the lumbar lateral and AP radiographs are evaluated together, there are 96 syndesmophytes in 44 patients with syndesmophytes, 46 of which are bridging and 50 are corner syndesmophytes. Average number of syndesmophytes were 96 in 44 patients (2.2 per-patient).

Table 1.

The distribution of syndesmophytes on lateral lumbar radiographs

Lateral Lumbar X-rayPatients with syndesmophytesTotal syndesmophyte count n(%)Number of bridging syndesmophyteNumber of corner syndesmophyteN (%)n(%)n(%)L1 lower-L2 upper border14291613L2 lower-L3 upper border1421129L3 lower-L4 upper border15211011L4 lower-L5 upper border4624L5 lower-S1 upper border2312

Conclusion

AP radiographs are not taken into account in conventional radiograph scores accepted as mSSASS. PsA patients have syndesmophytes in approximately one-quarter of patients on lateral radiograph, with an average syndesmophyte number of about 2. On the other hand, when AP radiographs are evaluated, new syndesmophytes that are not seen on lateral radiographs are seen in one-third of patients with at least one syndesmophyte. Although it does not cause a significant change in the number of patients with syndesmophytes, it should be kept in mind that the use of AP radiographs in PsA patients may cause an increase in the total score. Whether there is a difference between PsA and SpA patients should be investigated in further studies.

References

[1]Creemers MC, et al. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis. 2005 Jan;64(1):127-9.

Disclosure of Interests

None declared

AB0277 DYSLIPIDEMIA TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS USING bDMARDs IS BETTER THAN PsA, BUT THERE IS STILL A WAY TO GO

Background

Patients with inflammatory arthritis have an increased risk of cardiovascular disease. Dyslipidemia is one of the primary modifiable risk factors.

Objectives

Comparasion of the frequency of dyslipidemia and the use of anti-hyperlipidemic agents in patients with Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) receiving bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and 581 (75.4% female) patients with RA and 520 (69.4% female) patients with PsA enrolled up to 2021 were analyzed. Dyslipidemia was defined according to the Turkish Endocrine and Metabolism society criteria (TC > 240, Triglycerides (Tg) > 150, LDL-C > 160, HDL-C (< 40 in men, < 50 in women) (1). The anti-hyperlipidemic (anti-HL) agents used by the patients during follow-up and at their last visit were recorded.

Results

The mean (SD) age of the patients and diseases duration were as follows; RA vs. PsA [age: 52.1 (13.9) vs. 48.7 (12.5) years; disease duration: 5.3 (2.1) vs. 9.2 (6.4) years]. Lipid profiles were known in 289 (49.7%) patients with RA and in 175 (33.6%) patients with PsA at the initiaiton of bDMARD. Lipid profiles were evaluated in 356 (61.2%) patients with RA and 226 (43.4%) patients with PsA during follow-up and at the last visit. Lipid profiles were similar in patients with RA and PsA at the initiation of bDMARDs (Table 1). At the initiation of bDMARD, 29 (5.0%) of RA patients and 10 (3.2%) of PsA patients were receiving anti-HL agents. During the entire follow-up, 65 (12.6%) patients with RA and 22 (4.8%) patients with PsA have used anti-HL agents (p<0.001).

Table 1.

Lipid values in patients with RA and PsA at the initiation of bDMARD and at the last visit

Rheumatoid arthritis, n (%)Psoriatic arthritis, n (%)p1*p2**Lipid valuesbDMARD initiationLast visitbDMARD initiationLast visitTotal Cholesterol> 24047/270(17.4)98/339 (28.9)32/161(19.8)57/203 (28.1)0.300.13Triglyseride> 15062/242 (25.6)108/320 (33.7)45/159 (28.3)80/193 (41.4)0.790.20HDL-C< 40 (males),< 50 (females)88/267 (32.9)70/343 (20.4)57/157 (36.3)20/207 (9.6)0.480.001LDL-C > 16053/289 (18.3)91/356 (25.6)43/175 (24.5)65/226 (28.7)0.380.55

*p1, bDMARD initiation visit comparison

**p2, last visit comparison

Conclusion

In real-life cohort, lipid profile was not assesed in half of the patients during entire follow-up. Although, LDL-C levels are high in about a quarter of the patients in both groups, use of anti-hyperlipidemic drug was inadequate. This is even more evident in PsA patients. Despite the significant emphasis on comorbidities in treatment guidelines, there is still a long way to go in real life.

References

[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021,

Disclosure of Interests

None declared

AB0548 A COMPARATIVE STUDY BETWEEN THE NEUROPSYCHIATRIC INVOLVEMENTS IN ADULT-ONSET AND CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Neuropsychiatric(NP) manifestations in systemic lupus erythematosus(SLE) encompass a wide spectrum of neurologic and psychiatric features.The nervous system is frequently affected by adult-onset and childhood-onset SLE patients,but disease course and clinical features may differ between both groups.

Objectives

The aim of this study is to evaluate and compare NP manifestations in adult-onset and childhood-onset SLE patients.

Methods

The study included a retrospective analysis of medical records of adult-onset SLE patients and childhood-onset SLE patients following at Hacettepe University from Jan 2015 to Jan 2021.NP events were identified using the ACR established case definitions seen in SLE.Additionally, posterior reversible encephalopathy syndrome, cerebral venous thrombosis, small fiber neuropathy and pseudotumor cerebri were evaluated as having NPSLE in this study.NP were also divided into three categories:neurologic syndromes of the central nervous system, neurologic syndromes of the peripheral nervous system,and diffuse neuropsychological syndromes.

Results

1062 adult-onset and 161 childhood-onset SLE patients were followed-up median 150 (84-227) months.At least one neuropsychiatric event occurred in 101 (9.51%) adult-onset and 29 (18.01%) childhood-onset SLE patients (p=0.002). NP events were present before or around the time of SLE diagnosis 64.6% of the adult-onset patients and 72.4% of the childhood-onset patients.One-third of the patients in both groups were diagnosed with NPSLE during the follow-up.At the time of NPSLE diagnosis, 60.4% of adult-onset and 86.2% of childhood-onset patients had additional involvement other than neurologic manifestations and overall disease activity(SLEDAI-2k)was higher in childhood-onset patients (17vs.14p=0.036).

Almost all patients in the pediatric group and half of the adult patients were given pulse corticosteroids.Cyclophosphamide was the most preferred regimen and was given to 36.6% of the adult patients and 75.9% of the pediatric patients.Rituximab (11.9% and 27.6%) and mycophenolate mofetil (13.9% and 3.4%) were other induction treatments.The adult-onset and childhood-onset NPSLE patients were followed-up median 105(54-165) and 80(40-132) months, respectively.On the last follow-up visit, disease damage scores (SLICC) were similar in both groups,with a median score of 2.

Conclusion

The nervous system was more commonly involved in childhood-onset patients, and disease presentations vary significantly between adult-onset and childhood-onset NPSLE patients.Disease activity appeared to be more severe in children at diagnosis, but permanent organ damage was similar in both groups on follow-up.

Table 1.

Demographics, clinical features of adult-onset and childhood-onset NPSLE patients

Adult-onset NPSLE (n=101)Childhood-onset NPSLE (n=29)P valueCerebrovascular disease63 (62.4)8 (27.6)0.001Arterial cerebrovascular events44 (43.6)5 (17.2)0.007Central nervous system vasculitis25 (24.8)10 (34.5)0.209Parenchymal involvement18 (17.8)3 (10.3)0.256Demyelinating syndrome14 (13.9)2 (6.9)0.221Transient ischemic attack5 (5.0)-0.277Cerebral venous sinus thrombosis4 (4.0)6 (20.7)0.008Meningeal involvement5 (5.0)-0.277Posterior reversible encephalopathy syndrome3 (3.0)2 (6.9)0.310Pseudotumor cerebri7 (6.9)3 (10.3)0.393Idiopathic intracranial hypertension2 (2.0)3 (10.3)0.073Lupus headache38 (37.6)18 (62.1)0.017Acute confusional state13 (12.9)4 (13.8)0.555Cognitive dysfunction9 (8.9)1 (3.4)0.299Seizure disorders31 (30.7)11 (37.9)0.302Movement disorder (chorea)4 (4.0)2 (6.9)0.402Myasthenia gravis3 (3.0)-0.466Cranial neuropathy7 (6.9)3 (10.3)0.393Optic neuritis4 (4.0)1 (3.4)0.690Peripheral polyneuropathy9 (8.9)5 (17.2)0.173Mononeuritis multiplex1 (1.0)-0.777Myelopathy5 (5.0)2 (6.9)0.489Autonomic dysfunction---Small fiber neuropathy1 (1.0)-0.777Figure 1.

Distribution of adult-onset and childhood-onset NPSLE patients

Disclosure of Interests

None declared

AB0416 CARDIOVASCULAR EVENT, VENOUS THROMBOEMBOLIZM, AND INFECTION RISK WITH TOFACITINIB IN RHEUMATOID ARTHRITIS PATIENTS AGED ≥ 60 YEARS

Background

Tofacitinib is a targeted synthetic DMARD that selectively inhibits Janus kinase (JAK) and is approved for the treatment of RA by the FDA in 2012. In recent years, an important safety concern related to incidence of adverse events after treatment with tofacitinib has emerged.

Objectives

To evaluate the risk of major adverse cardiovascular events (MACE), venous thromboembolism (pulmonary embolism or deep vein thrombosis), serious infections requiring hospitalization, and herpes zoster with tofacitinib in RA patients aged ≥ 60 years.

Methods

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological and targeted synthetic DMARD registry since 2005. We analyzed RA patients aged ≥ 60 years receiving tofacitinib who had at least 1 control visit registered in the HURBIO database. Phone calls were made with these patients for the current health status information until the end of January 2022. The data of the patients who lost the follow-up in our clinic were obtained from the personal health record system of the Republic of Turkey Ministry of Health by patients’ permission. The coprimary end points were adjudicated MACE, VTE, serious infections, and herpes zoster. These events were identified using patients’ medical records. Crude incidence rates were expressed in patients with first events per 100 patient-years, with two-sided 95% confidence intervals.

Results

A total of 132 RA patients (109, 82.6% female) aged ≥ 60 years received tofacitinib at a dose of 5 mg twice daily. The median (25–75% percentiles) age was 67 (63-73) years and median duration under tofacitinib was 18 (5-33) months. Approximately 70% of patients were biologically naive. During a median follow-up of 1.5 years, the incidences of serious infection requiring hospitalization and herpes zoster were higher (5.5% [95%CI 3.12-9.86] and 3.4% [1.67-7.17], respectively) while there was no increase in the incidences of MACE and VTE. The causes for hospitalization were as follows: COVID-19 (n=4), pneumonia (n=3), soft-tissue infection (n=3), and GIS infection (n=1). Two of these patients deceased.

Conclusion

Older patients with RA are at increased infection risk because of age and comorbid conditions. Although adverse events are reported with 10 mg tofacitinib twice daily, clinicians should be careful against the risk of infection at a dose of 5 mg twice daily, especially in elderly patients.

References

[1]Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-326.

Table 1.

Clinical characteristics of the patients and incidence rates for adverse events

Characteristic*Tofacitinib, 5 mg Twice Daily (N=132)Age, years67 (63-73)Female/male109 (82.6)/23 (17.4)Smoking status-Never smoked78 (59.1)-Ever smoked54 (40.9)History of hypertension82 (62.1)History of diabetes mellitus40 (30.2)History of coronary heart disease14 (10.8)History of congestive heart failure3 (2.3)History of chronic kidney disease11 (8.3)Family history of coronary heart disease8 (6.2)RA disease duration, years10 (7-18)Biologic naïve/experienced92 (69.7)/40 (30.3)Duration under tofacitinib, months18 (5-33)No. of Patients with First EventIncidence Rate per 100 Patient-Yr (95% CI)MACE, n=10.49 (0.07-3.44)VTE, n=41.96 (0.74-5.17)Infection-Requiring hospitalization, n=115.55 (3.12-9.86)-Herpes zoster, n=73.46 (1.67-7.17)

* n (%), if otherwise specified; median (IQR) for numeric values.

CI: Confidence Interval, MACE: Major adverse cardiovascular events, VTE: Venous thromboembolism (pulmonary embolism or deep vein thrombosis)

Disclosure of Interests

None declared

AB1360 DISTRIBUTION OF INFLAMMATORY/DEGENERATIVE/AMBIGUOUS LESIONS ON CONVENTIONAL LUMBAR LATERAL RADIOGRAPHS IN PSORIATIC ARTHRITIS PATIENTS

Background

Psoriatic arthritis (PsA) patients are relatively older than spondyloarthritis patients, and accordingly, degenerative changes on spine are more frequent and confusing.

Objectives

The aim of this study is to determine the distribution, relation of different type of lesions on the lumbar spine in PsA patients receiving bDMARD therapy.

Methods

182/274 (66.4%) patients had lateral lumbar radiographs. Two and three lumbar radiographs were present in 53 (19.3%) 14 (5.1%) patients respectively. The upper and lower regions of each vertebra were evaluated between T12, S1 (total of 2184 regions). Lesions were determined as osteophyte (O) (grade 0-3), vertebral corner erosion, sclerosis, squaring, corner syndesmophyte (SP), bridging SP. While osteophyte was determined according to the degenerative character of new bone formations, the definition of SP was made according to mSSASS. Lesions that the clear distinction of cannot be made were defined as ambigious. For patients with follow-up radiographs, the change of lesions defined as ambigious was also recorded. All of the assessments were done by an experienced rheumatologis (UK) and in cases with suspicion, another experienced rheumatologist reviewed the cases (LK) and a consensus was reached.

Results

The mean (SD) age of 182 PsA (69.2% female) patients was 47.6 (12.7), the age at diagnosis of PsA was 39.7 (12.7). Of the patients, 112 (61.5%) met the criteria for mNY. There was at least one abnormality in 111 (61.0%) patients with lumbar spine radiograph. O was the most frequently detected lesions (42.3%), with 18.1% of patients having O grade 2 and above. While SP was present in 24.2% of all patients, ambigious lesions were detected in 13 (4.7%) patients. While O were most frequently grouped between L2 upper and L4 upper regions, SPs were distributed in a similar ratio between L4 upper and T12 lower regions. Ambigious lesions were anywhere between T12 sub-L5. Patients with ambigious lesions were older (55.7 (9.8) vs 47.0 (12.7), p=0.017), lumbar mSSASS score was higher (5.4 (8.1) vs 1.6 (3.8), p=0.002) corner SPs (46.1% vs. %) 17.7, p=0.013) and bridging SPs (30.7% vs 7.7%, p=0.006) were more common, while no difference was found in terms of O grade 2 (23.1% vs 17.7%, p=0.63). Changes were observed in 5 ambigious lesions in patients with follow-up lumbar radiography, 4 of them transformed into corner SP at follow-up, and one was evaluated as osteophyte grade 2.

Conclusion

Approximately one-fifth of patients presenting with significant degenerative new bone formation and SP was found in one fourth. In approximately 5% of all patients, lesions in the lumbar vertebrae could not be differentiated. The frequency of SPs in other vertebral areas are more prominent in patients with ambigious lesions. It is seen that ambigious lesions turn into SPs in a small group of patients with follow-up data. The nature of these lesions needs to be evaluated in further imaging studies.

Table 1.

The distribution of the lesions on lumbar spine

LocationOsteophyteOsteophyte ≥ 2Corner SPBridging SPAll SPErosion,AmbigiousSclerosis,SquaringT12 L, n (%)7 (3.8)1 (0.5)9 (4.9)5 (2.7)14 (7.7)3 (1.6)2 (1.1)L1, U n (%)6 (3.3)0 (0)10 (5.5)5 (2.7)15 (8.2)2 (1.1)2 (1.1)L1, L, n (%)10 (5.5)6 (3.3)8 (4.4)6 (3.3)14 (7.7)4 (2.2)0 (0)L2, U, n (%)15 (8.2)8 (4.4)8 (4.4)7 (3.8)15 (8.2)4 (2.2)4 (2.2)L2, L n (%)16 (8.8)6 (3.3)5 (2.7)6 (3.3)11 (6.0)4 (2.2)0 (0)L3,U n (%)31 (17.0)13 (7.1)4 (2.2)6 (3.3)10 (5.5)10 (5.5)2 (1.1)L3,L n (%)17 (9.3)8 (4.4)3 (1.6)5 (2.7)8 (4.4)5 (2.7)2 (1.1)L4,U, n (%)37 (20.3)14 (7.7)8 (4.4)5 (2.1)13 (7.1)11 (6.0)4 (2.2)L4, L n (%)10 (5.5)1 (0.5)3 (1.6)1 (0.5)4 (2.2)6 (3.3)4 (2.2)L5, U n (%)24 (13.2)8 (4.4)1 (0.5)1 (0.5)2 (1.1)1 (0.5)1 (0.5)L5,L n (%)8 (4.4)3 (1.6)1 (0.5)1 (0.5)2 (1.1)0 (0)0 (0)S1, U, n (%)3 (1.6)3 (1.6)0 (0)1 (0.5)1 (0.5)0 (0)0 (0)All vertebral corners (n=2184)184 (8.4)75 (3.4)60 (2.7)49 (2.2)109 (4.9)50 (2.2)21 (1.0)All patients77 (42.3)33 (18.1)36 (19.8)17 (9.3)44 (24.2)22 (12.1)13 (4.7)

SP:Syndesmophyte, L:Lower, U:Upper

Disclosure of Interests

None declared

POS0977 ASSOCIATION OF DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER AND AXIAL SPONDYLOARTHRITIS WITH THE M694V MUTATION

Background

The incidence of co-occurrence of FMF and axial spondyloarthritis (axSpA) in adults is reported to be 0.5-7.5%. M694V mutation is the most frequent variant in patients with FMF+AxSpA (1).

Objectives

To evaluate the association of demographic and clinical characteristics of patients with FMF+axSpA with the M694V mutation.

Methods

A total of 9630 FMF patients were identified according to the ICD-10 code (E85.0) in the electronic database of Hacettepe University Hospital. 7525 patients aged <18 years old and no hospital admissions after 2014 were excluded. 2105 adult FMF patients screened for accompanying axSpA according to ICD-10 code (M45) and 241 patients detected as FMF+axSpA. FMF diagnosis was confirmed with Tel-Hashomer criteria. The diagnosis of axSpA was confirmed by the presence of sacroiliitis on sacroiliac radiography according to the Modified New York (mNY) criteria or the presence of active sacroiliitis on sacroiliac magnetic resonance imaging according to the ASAS criteria. According to these criterias, the diagnosis of FMF+AxSpA association was confirmed in 136 patients. MEFV gene result was present in 113 (83%) of 136 patients and were included in the study. Patients were divided into two groups as M694V (+) and M694V (-) according to the M694V mutation, and the demographic and clinical characteristics of the patients were compared. p<0.05 was considered statistically significant.

Results

Of 113 patients with known MEFV gene result, 91 (80.5%) were M694V (+), 22 (19.5%) were M694V (-), 45 (39.8%) were homozygous for M694V. In the M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were at an earlier age compared to M694V (-) patients (p<0.05). The frequency of radiographically proven moderate to severe hip involvement (24.2% vs. 9.1%) and total hip replacement (11% vs. 4.5%) was higher in M694V (+) patients. However, these differences were not statistically significant (p=0.12; p=0.36). In the homozygous M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were significiantly at an earlier age than in the group homozygous M694V (-) (p<0.001). Although erysipelas-like skin rash was more common in homozygous M694V (+) group (28.9% vs. 11.8% p=0.02), other symptoms and findings were similar in both groups (Table 1).

Table 1.FeaturesM694V (+) (n=91)M694V (-) (n=22)P1M694V Homozygous (n=45)M694V Nonhomozygous (n=68)P2Age at FMF symptom onset [years, med (25-75)]11 (5-18)21 (8-30)0,0057 (1-42)18 (3-53)<0,001Age at FMF diagnosis [years, med (25-75)]18 (10-27)33 (27-38)<0,00112 (1-42)28 (3-59)<0,001Age at AxSpA symptom onset [years, med (25-75)]20 (15-25)29 (24-38)<0,00120 (5-50)22 (5-58)0,43Age at AxSpA diagnosis [years, med (25-75)]24 (19-33)37 (28-44)<0,00123 (11-51)29 (7-59)0,039Fever n (%)84 (92,3)21 (95,5)0,6044 (97,8)61 (89,7)0,10Abdominal pain n (%)80 (87,9)20 (90,9)0,7043 (95,6)57 (83,8)0,056Peripheral arthritis n (%)45 (49,5)7 (31,8)0,1324 (53,3)28 (41,2)0,20Erysipelas n (%)19 (20,9)2 (9,1)20,213 (28.9)8 (11,8)0,02Enthesitis n (%)21 (23,1)4 (18,2)0,6211 (24,4)14 (20,6)0,63Uveitis n (%)11 (12,1)4 (18,2)0,454 (8,9)11 (16,2)0,26Psoriasis n (%)6 (6,6)1 (4,5)0,722 (4,4)5 (7,4)0,82HLA-B27 (+) n (%)25 (27,3)4 (18,2)0,542/15 (13,3)12/40 (30)0,30Syndesmophyte n (%)20/82 (24,4)6/19 (31,6)0,527/43 (16,3)19/59 (32,2)0,07Total ankylosis n (%)4/83 (4,8)1/19 (5,3)0,941/43 (2,3)4/59 (6,8)0,39Moderate to severe hip disease*n (%)22 (24,2)2 (9,1)0,1212/45 (26,7)12 (17,6)0,25Total hip replacement n (%)10 (11,0)1 (4,5)0,364 (8,9)7 (10,3)0,80

* BASRI-hip score ≥3 on any side

Conclusion

FMF and SpA symptoms appear at an earlier age in M694V positive patients. The M694V mutation is associated with severe disease and early disease onset.

References

[1]Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C. The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis. Clin Rheumatol. 2009;28(1):41-6.

Disclosure of Interests

None declared

AB0940 Is psoriatic arthritis really seronegative?

Background

Psoriatic Arthritis (PsA) is a heterogeneous disease classified as a seronegative group of inflammatory arthritis.

Objectives

Our aim was to understand the real-life seropositivity rates for commonly used autoantibodies in rheumatology practice in a cohort of PsA patients treated with biologic agents.

Methods

PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for the anti-nuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (CCP) before and after the initiation of biologic agents. Demographic characteristics, the interval between the test and biologic initiation, and the rates of seropositivity for individual tests, autoantibody titers, and subtypes for ANA were determined.

Results

From 520 PsA patients registered, results of 419 patients with at least one autoantibody tested either before or after biologic treatment is presented in Table 1. From the patients tested, 69% of them had at least one autoantibody positive and 30.8 % of them were triple negative before the biologic treatment. The rates reached to 78.7% of seropositivity for at least one autoantibody and 21.2 %triple negativity after treatment. ANA showed the highest rates of seropositivity among autoantibodies with a rate of 40% before and 55.3 % after biologic treatment. Concomitant seropositivity for RF and CCP autoantibodies showed rates of 2.8% and 6.3% before and after treatment, respectively. The most common subtype was AC4-5 before and AC1-4-5 after biologic agent treatment. ANA was tested in 31 patients both before and after biologic treatment showing 6 negative patients became positive after treatment and from 12 positive patients at the baseline 6 of them became negative (p=0.452). The most common biologic agents used in patients with ANA tested after treatment, were adalimumab (ADA) (42.4%), etanercept (ETN) (18.9%), and infliximab (IFX) (18.9%). The only difference was observed in IFX treated patients (n=25) with significantly higher rates of IFX usage in ANA-positive patients (p=0.001).

Table 1.

Demographics and ANA, RF, Anti-CCP test results of patients before and after biologic treatment

ANARFAnti-CCPbDMARDs initiationBeforeAfterBeforeAfterBeforeAfterNumber of patients10413231027814497Age43.5 (12.7)46.7 (11.6)43.3 (12.5)47.9 (11.9)44.3 (12)48.6 (12.1)Female sex, n (%)84 (80.7)97 (73.5)225 (72.5)211 (75.8)110 (76.3)75 (77.3)Time interval between test and bDMARD initiation, months, median (IQR)7.4 (0.84-17.83)32.6 (14.93-72.33)4.1 (0.35-16.75)31.63 (13.10-64.08)3.23 (0.30-11.5)35.13 (12.40-75.43)Positivity, n (%)42 (40.4)73 (55.3)30 (9.6)32 (11.5)12 (8.3)11 (11.3)Titer IU/ml, median (IQR)NANA28.7 (22.35-98.5)28.9 (21.9-110)139.1 (20.38-250)67.5 (16.77-139)Titer, n (%) *28 (66.6)38 (52)N/AN/AN/AN/A1/1007 (16.7)14 (19.1)1/1607 (16.7)20 (27.3)≥1/320

bDMARD: Biologic Disease Modifying Anti-Rheumatic Drugs, ANA: Anti-nuclear antibody, RF: Rheumatoid factor, Anti-CCP: Anti- Cyclic citrullinated peptide, F:Female, M:Male, IQR: Interquartile range, IU/ml: International units per milliliter, N/A: Not available

*Subtype is not given for one patient in patients with positive ANA after biologic treatment

Conclusion

Synovial lymphoid neogenesis rates in PsA are similar to the frequency seen in rheumatoid arthritis (1). Nevertheless, PsA is classified under the group of “seronegative diseases”. On the other hand, current reports have started to define specific autoantibodies particularly in psoriasis patients (2). The real-life experience in serology results of PsA patients showed that only 20-30 % of the patients were seronegative for all three tests commonly used in practice.

References

[1]Celis R, et al. Synovial cytokine expression in psoriatic arthritis and associations with lymphoid neogenesis and clinical features. Arthritis Res Ther. 2012 Apr 27;14(2):R93.

[2]Yuan Y, et al. Identification of Novel Autoantibodies Associated With Psoriatic Arthritis. Arthritis Rheumatol. 2019 Jun;71(6):941-951.

Disclosure of Interests

None declared

AB0830 Turkish translation and cross-cultural adaptation of the modified Short QUestionnaire to Assess Health-enhancing physical activity (mSQUASH)

Background

The Short Questionnaire to Assess Health-enhancing physical activity (SQUASH) is a validated tool measuring the duration, frequency, and intensity of physical activity. The modified version of the SQUASH (mSQUASH) has been developed, in collaboration between spondyloarthritis (SpA) experts and axial (ax)SpA patients, to better address the needs of these patients in the assessment physical activity (1).

Objectives

To translate and cross-cultural adapt the mSQUASH into Turkish as well as its cognitive debriefing to test the conceptual equivalence of the translated version among patients with axSpA.

Methods

The mSQUASH was translated into Turkish by 2 bilingual translators, native speakers of Turkish one from medical (informed) and the other is without medical background (uninformed). The consensus on forward-translation was reached by the team included two rheumatologist (GA and LK) and the translators. Backward-translation into Dutch was performed by 2 bilingual translators, native speakers of Dutch and who were blinded to the original mSQUASH version. After the review of the Turkish version by an expert committee that included translators, two patients and the research team a pre-final version was prepared. This version was used in a field-test with cognitive debriefing and involved a sample of 10 axSpA patients (7 radiographic- and 3 non-radiographic axSpA patients) with variation in gender, age, disease duration, and educational background. The final Turkish mSQUASH version was reached after the patients were interviewed to check understandability, interpretation and cultural relevance of the translation. The whole process was performed according to the Beaton method (Figure 1) (2).

Figure 1.

Flow-chart of the translation and cross-cultural adaptation process

Results

After the forward-backward translation process, small incompatibilities were resolved during the expert committee meeting. For example: `Ander transport (heen en terug)` was translated as `Diğer hedeflere (gidip gelmek)`. The meaning in English is `Other transport (round trip)’. This item questions the way of going to other places and the discrepancy raised whether to use `transportation` or the `target` as the title. To make it culturally adaptable consensus reached to use a word equivalent to `the target` which is semantically equal to the Dutch version. A total of 10 patients with axSpA [7 females, mean (SD) age of 38 (10)] participated in the field test. Mean (SD) time to complete the mSQUASH was 6.1 (2.4) minutes. Cognitive debriefing showed that items of the mSQUASH are clear, relevant, understandable, and easy to complete. None of the patients indicate any important aspect of physical activity that is missing from the questionnaire items. During the cognitive debriefing, 2 patients suggested a change in the wording of one item to make it more suitable to the Turkish culture. This item inquires after sport activities and patients raised the concern that the example activities, ice-skating, tennis, handball are not culturally suitable. According to their comments these items were replaced by other examples such as football.

Conclusion

The final Turkish version of the mSQUASH showed acceptable linguistic validity and can be used in both clinical practice and for research purposes. However, to implement the Turkish version of the mSQUASH, further assessment of its psychometric properties (validity and reliability) is needed.

References

[1]Carbo MJ, et al. Semin Arthritis Rheum. 2021 Aug;51(4):719-727.

[2]Beaton DE, et al.. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91

Disclosure of Interests

Gizem Ayan: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Fernando M Pimentel-Santos Speakers bureau: Abbvie, Novartis, UCB, Tecnimed, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, Tecnimed, UCB, Grant/research support from: Abbvie, Janssen, Novartis, Anneke Spoorenberg Speakers bureau: AbbVie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Consultant of: AbbVie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Grant/research support from: AbbVie, Novartis Pharma, Pfizer, Suzanne Arends: None declared, Levent Kiliç: None declared

AB0843 OSTEOPOROSIS IN PATIENTS WITH SPONDYLOARTHRITIS: DO WE NEED TO DO MORE?

Background

Data regarding the prevalence and especially incidence of osteoporosis in Spondylarthritis (SPA) is scarce and very divergent among studies from different patient populations (1).

Objectives

In this study, we aimed to compare demographic, disease and laboratory characteristics of SpA patients regarding their bone mineral densitometry (BMD) categories and find out incidence of osteoporosis in the follow-up BMD of patients who were not found to have osteoporosis at baseline.

Methods

Between 2010-2021, patients with a SPA diagnosis in the HUR-BIO database were searched. HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2010. Patients with BMD measurement were included in the study. Follow-up BMD scores were also documented. The patients were divided into 3 groups as normal, osteopenia and osteoporosis in accordance with the WHO criteria (2). Demographic characteristics, comorbidities, laboratory data and drugs in each group were documented.

Results

3245 patients were reviewed. BMD was measured at least once in 118 patients out of 3245 (3.6%) patients. When the groups classified, 34 patients (28.8%) were included in the normal, 49 (41.5%) osteopenia and 35 (29.7%) osteoporosis groups. Patients with normal BMD was younger than both groups. Diabetes and hypertension were more prevalent in patients with osteopenia. The BMI was significantly lower in the osteoporosis group. 25 patients with normal and osteopenia in baseline BMD measurement had at least 1 follow-up BMD measurement. During the total follow-up of 91 patient-years, 3 patients had osteoporosis, revealing a the incidence of 3.3% in 100 patient-years.

Conclusion

In our study, the incidence of OP development in SPA patients was found to be 3.3%. Frequency of osteoporosis was 29.7% among SpA patients with BMD measurement (118/3245; 3.6%), however; only 40% of them had appropriate treatment. Osteoporosis seems as an overlooked and undertreated comorbidity of SpA.

Table 1.

Comparison of spondyloarthritis patients according to BMD scores (normal, osteopenia and osteoporosis) according to baseline BMD assessment

NORMAL Number, (%)OSTEOPENIA Number, (%)OSTEOPOROSIS Number, (%)P VALUENumber of Patients34 (28.8)49 (41.5)35(29.7)Age47,5 (27-70)63 (45-79)58 (20-75)0.00*Gender (Female)24 (70.6)34 (69.4)23 (65.7)Diabetes Mellitus3 (8.8)14 (29.2)1 (2.9)0.00*Hypertension11 (32.4)28 (58.3)5 (14.3)0.00*Chronic Renal Failure2 (6.9)1 (2.7)1 (5.3)0.81Chronic Ostructive Pulmonary Disease4 (13.8)4 (10.8)1 (5.3)0.30Coronary Artery Disease0 (0)5 (12.5)3 (15)0.27Malignancy1 (3.6)1 (2.9)1 (4.2)1.0Smoking21 (61.8)23 (47.9)21 (63.6)0.379 (26.5)13 (27.1)5 (15.2)4 (11.8)12 (25)7 (21.2)Calcium mg/dl9.4 (8.2-10.2)9.5 (8.7-10.4)9.7 (8.1-10.4)0.49Phosphorus mg/dl3.5 (3-4.4)3.4 (2.6-5)3.8 (2.9-4.9)0.25Vitamin D ng/ml16 (7.4-64.4)21.2 (5-69.6)15.8 (5.8-49.1)0.66ALP IU/ml89.5 (54-137)89.5(53-169)80 (50-239)0.43Albumin g/dl4.2 (1.7-4.7)4.2 (3.3-8.4)4.2 (2-4.8)0.43TSH mU/ml1.5 (0.8-4.1)2.3 (0.1-9.7)2 (0.7-3.3)0.71Body Mass Index (BMI) kg/m229 (17-41.2)28.3 (20-44.6)25.1(15.8-43.2)0,06*Steroids4 (11.8)8 (16.3)2 (5.7)0.33Anti-TNF25 (73.5)35 (71.4)26 (74.3)0,95D Vitamin7 (20.6)14 (28.6)10 (28.6)0.67Calcium4 (11.8)5 (10.2)6 (17.1)0.63Bisphosphonate0 (0)4 (8.2)14 (40)0,00*

Data was represented as median (minimum-maximum) or n(%)

References

[1]Hu LY, Chen PM, Shen CC, et all. Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PoleS one 2019:6;14

[2]Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield.

Disclosure of Interests

None declared

POS0944 PREDICTORS OF SUSTAINED REMISSION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS TREATED WITH BIOLOGIC DRUGS

Background

The ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA.

Objectives

To determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD).

Methods

Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-value<0.1 were re-tested in multivariable models. Forward selection was performed until the best-fit model was obtained, taking possible confounders into account. Two separate multivariable models were built, one with and one without the covariate “achievement of remission at 3-6 months”, to assess consistency of findings and to account for missing information regarding remission status between 3 and 6 months.

Results

Data on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99).

Table 1.

Multivariable analysis (best-fit model) of predictors of sustained remission

Model 1Model 2CovariatesMultivariable Analysis (n= 541)Multivariable Analysis (n=739)OR (95% CI)p-valueOR (95% CI)p-valueAge at diagnosisNSNS0.97 (0.96-0.99)0.006Male sex2.84 (1.71-4.70)<0.0012.31 (1.60-3.35)<0.001Concomitant csDMARD use (at baseline or follow-up)2.94 (1.57-5.51)0.0011.88 (1.23-2.86)0.003Baseline PGA0.97 (0.96-0.98)<0.0010.98 (0.97-0.99)0.002Baseline BASDAINSNS0.87 (0.78-0.96)0.009Baseline symptom durationNSNS0.97 (0.94-0.99)0.021Achievement of remission at 3-6 months after baseline11.70 (7.11-19.23)<0.001NANA

NA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment.

Conclusion

This study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition.

Disclosure of Interests

Bayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB

AB0201 CHANGES IN THE PRESCRIPTION PATTERNS OF THE SECOND-LINE BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY

Background:

In the last 20 years, anti-tumor necrosis factor (TNF) alpha agents re-designed the management of rheumatoid arthritis (RA). Despite this, unmet needs in the management of RA brought several drugs targeting different molecules and cytokines. It is still a research question that how did these developments changed daily-practice in RA patients who are intolerant/unresponsive to the first biological disease modifying anti-rheumatic drugs (bDMARD).

Objectives:

In this study, we aimed to explore the second biologic agent trends of our 20-years of single-center experience.

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.

Results:

A total of 776 (776/2080, 37.3%) RA patients, who was prescribed a second biological agent, was registered in HUR-BIO by the end of 2020. Of these patients, 83.7% was female. Mean age at the starting of bDMARD was 53.1 ± 13.3 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptid positivity was 69.1% and 60.5%, respectively. Distribution of first-line bDMARDs was as follows: adalimumab 194 (24.9%), etanercept 209 (26.9%), infliximab 105 (13.5%), golimumab 39 (5.0%), certolizumab 35 (4.5%), abatacept 78 (10.0%), rituximab 46 (5.9%), tofacitinib 37 (4.7%), tocilizumab 33 (4.2%). 11 (1.4%), 85 (11.0%), 282 (36.3%) and 398 (51.3%) patients were prescribed with their second bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time.

Table 1.

Distribution of second biologic DMARDs in RA patients according to 5-years periods

2001-20052006-20102011-20152016-2020TotalAdalimumab3 (27.3)15 (17.6)69 (23.9)77 (18.9)164 (20.8)Etanercept8 (72.7)35 (41.2)49 (17.0)41 (10.1)133 (16.8)İnfliximab012 (14.1)13 (4.5)25 (6.2)50 (5.4)Golimumab0019 (6.6)8 (2.0)27 (3.4)Certolizumab002 (0.7)26 (6.4)28 (3.5)Anti-TNF11 (100)62 (72.9)152 (53.9)177 (44.5)402 (51.8)Tofacitinib004 (1.4)73 (17.9)77 (9.7)Tocilizumab0012 (4.2)81(19.9)93 (11.7)Rituximab022 (25.9)53 (18.3)32 (7.8)107 (13.5)Abatacept01 (1.2)61 (21.1)35 (8.6)97 (12.2)Non-Anti-TNF023 (27.1)130 (46.1)221 (55.5)374 (48.2)Total11 (100)85 (100)282 (100)398 (100)776 (100)

Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015

Conclusion:

As the choice of second-line biologic and targeted synthetic DMARD, non-Anti-TNF bDMARDs, especially tofacitinib and tocilizumab becoming more frequent year-by-year. Despite that, anti-TNF agents as a group are still highly-prescribed options as second-line bDMARD.

Disclosure of Interests:

None declared

POS1378 COMPARISON OF DEMOGRAPHIC AND CLINICAL FEATURES OF FAMILIAL MEDITERRANEAN FEVER PATIENTS AND PATIENTS WITH AXIAL SPONDYLOARTHRITIS ACCOMPANYING FAMILIAL MEDITERRANEAN FEVER

Background:

The rate of co-occurrence of Familial Mediterranean Fever (FMF) and axial spondyloarthritis (axSpA) in adults is reported ranging from 0.5% to 7.5%. The clinical implications of this co-occurrence in the course of FMF is still a research question.

Objectives:

To compare of demographic and clinical features of patients with FMF and FMF+axSpA.

Methods:

A total of 9630 FMF patients was detected according to the ICD-10 code (E85.0) of FMF in Hacettepe University Hospital database. 241 of these patients also had axSpA according to the ICD-10 code (M45). FMF diagnosis was confirmed by Tel-Hashomer criteria. AxSpA was diagnosis was confirmed by either presence of sacroiliitis on sacroiliac radiography according to the Modified New York Criteria (mNY) or presence of active sacroiliitis according to ASAS criteria on magnetic resonance imaging. 136 patients were confirmed according to these criterias as having FMF+axSpA. As a control group, 231 consequent FMF patients without axSpA recorded on the “FMF in Central Anatolia (FiCA) database” and followed up at our center were included in the analysis. Demographic and clinical features of those patients in both groups were compared. p<0.05 was considered as statistically significant, correction for multiple comparisons was not performed.

Results:

136 patients were included in FMF+axSpA group and 231 patients were included in FMF group. 114 (83.8%) patients in FMF+axSpA group had radiographic sacroiliitis according to mNY criteria; median cervical mSASSS was 0 (available for 49 patients, min-max, 0-36), median lumber mSASSS was 4 (available for 121 patients, min-max, 0-36), 33 (27%) patients had cervical or lumber syndesmophyte. Twenty-six (19.1%) of these patients had radiologically documented inflammatory hip disease 12 (8.8%) of these patients underwent total hip replacement. Female gender was more prevalent in FMF+axSpA group (53.7% vs 32.5%, p<0.001). Age at FMF symptom onset and diagnosis were earlier in FMF patients; however, symptom and disease durations were longer in FMF+axSpA group in our study cohort (Table 1). Frequency of FMF signs and symptoms were comparable except the rate of pleuritis was higher in FMF patients compared to FMF+axSpA group (p=0.003). Amyloidosis was more prevalent in FMF+axSpA group (6.6% vs. 1.7%, p=0.014). Results of MEFV gene analysis were available for 273 patients. Although presence of M694V mutation (either in 1 allele or 2 alleles) was comparable in 2 groups, homozygous M694V mutation was more prevalent in FMF+axSpA group (39.8% vs. 28.9%, p=0.02).

Conclusion:

The coexistence of spondyloarthritis in FMF patients appears to be associated with the increased prevalence of amyloidosis. The inflammatory burden of a second disease and the increased prevalence of the homozygous M694V mutation may explain this risk.

Table 1.

Comparison of demographic and clinical features of two groups.

FMF+AxSpA(n=136, 37.1%)FMF(n=231, 62.9%)pFemale, n(%)73 (53.7)75 (32.5)<0.001Age at FMF symptom onset, years med (IQR)12 (5-20)10 (6-18)0.046Symptom duration, years, med (IQR)24 (18-32)20 (14-29)0.007Age at FMF diagnosis, years, med (IQR)24 (13-33)20 (11-30)0.10Duration after diagnosis, years, med (IQR)16 (10-22)13 (7-17)<0.001FMF signs and symptoms, n(%)-Fever128 (94.1)204 (88.3)0.067-Abdominal pain123 (90.4)217 (93.9)0.21-Pleuritis31 (22.8)87 (37.7)0.003-Pericarditis3 (2.2)2 (1.0)0.34-Arthritis64 (47.1)92 (39.8)0.17-Erysipelas24 (17.6)38 (16.5)0.77-Febrile myalgia9 (6.6)13 (5.6)0.70Inflammatory back pain, n(%)92 (67.6)26 (11.3)<0.001Inflammatory bowel disease, n(%)6 (4.4)4 (1.7)0.12FMF family history, n(%)-Any degree66 (48.5)137 (59.8)0.04-First degree48 (35.8)97 (42.0)0.24-Second degree25 (18.7)86 (37.2)<0.001Number of attacks at recent year, med (min-max)1 (0-12)1 (0-10)0.13Amyloidosis9 (6.6)4 (1.7)0.014M694V status (N=273)-Present (one or two allels)91 (80.5)120 (75.0)0.28-Two allels45 (39.8)43 (28.9)0.02

Disclosure of Interests:

None declared

AB0200 TRENDS IN THE CHOICE OF FIRST BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY

Background:

In the last 20 years, there have been extraordinary improvements and practice-changing developments in the management of rheumatoid arthritis (RA). Exploring the pathogenetic mechanisms first enabled clinicians to use anti-tumor necrosis factor (TNF) alpha agents, then drugs targeting different molecules. Parallel to these developments, treatment guidelines have been changed accordingly. Meanwhile, how these developments have been reflected into the real-word practice is a question of interest.

Objectives:

In this study, we aimed to explore the first biologic agent trends of our 20-years of single-center experience.

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. In brief; demographic data, treatment-related data (including adverse events) and disease-related data of RA patients have been recorded in HUR-BIO. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. In this study, distribution of the first-line biologic agents was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.

Results:

A total of 2080 RA patients was registered in HUR-BIO by the end of 2020. Of these patients, 79.5% was female. Mean age at the starting of bDMARD was 53.3 ± 17.8 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptide positivity was 67.6% and 61.0%, respectively. 65 (3.2%), 335 (16.1%), 858 (41.2%) and 822 (39.5%) patients were prescribed with their first bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs over time.

Table 1.

Distribution of first biologic DMARDs in RA patients according to 5-years periods

2001-20052006-20102011-20152016-2020TotalAdalimumab15 (23.1)111 (33.0)187 (21.8)153 (18.6)466 (22.4)Etanercept30 (46.2)154 (45.8)229 (26.7)54 (6.6)467 (22.4)İnfliximab20 (30.8)58 (17.3)64 (7.5)7 (0.9)149 (7.1)Golimumab0037 (4.3)43 (5.2)80 (3.8)Certolizumab0037 (4.3)68 (8.3)105 (5.0)Anti-TNF65 (100)323 (96.4)554 (64.5)325 (39.5)1267 (60.9)Tofacitinib006 (0.7)212 (25.8)218 (10.5)Tocilizumab009 (1.0)102 (12.4)111 (5.3)Rituximab012 (3.6)136 (15.8)84 (10.2)232 (11.1)Abatacept00153 (17.8)99 (12.0)252 (12.1)Non-Anti-TNF012 (3.6)304 (35.5)497 (60.5)813 (39.1)Total65 (100)335 (100)858 (100)822 (100)2080 (100)

Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015,

Conclusion:

Real-life practice in RA seems consistent with treatment guidelines. Use of non-Anti-TNF bDMARDs becoming more frequent year-by-year. Jak kinase inhibitor has rised through the last 5 years. Next decade may be the years of Jak kinases inhibitors.

Disclosure of Interests:

None declared

POS1004 BOTH SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS PATIENTS HAVE STRONG FAMILY HISTORIES

Background:

Family history is one of the hallmarks of spondyloarthritis (SpA) and psoriatic arthritis (PsA) [1, 2]. Some patients have a strong family history that more than 2 relatives have spondyloarthritis related diseases. The effects of strong family history on SpA features were not known very well.

Objectives:

The aim of this study is to evaluate the effects of family history in SpA and PsA patients.

Methods:

HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005, and to date 3071 SpA and 526 PsA patients have been recorded. Demographic, clinical characteristics, disease activity parameters, a detailed family history of SpA and SpA features (presence of SpA including PsA, psoriasis, inflammatory bowel disease and uveitis) and laboratory data before anti-TNF treatments of the patients were noted.

Results:

2807 SpA (53.6% male) and 506 PsA (31.4% male) patients’ family history were available and analysed. A positive family history was noted in 27.6% of the SpA and 31.0% of the PsA patients (ns). 7.4% of the SpA patients and 8.9% of the PsA patients had family history in more than one relative (Table 1). In SpA patients with a family history, uveitis was more frequent than patients without (14.4% vs 10.6%, p=0.006). Except for a higher male predominance and uveitis (53% vs 32% p=0.006 and 9% vs 2% p=0.003 respectively) in patients with ≥2 relatives with SpA features, there were no differences in PsA patients regarding family history. The presence of family history and HLA-B27 (63.7% vs 37.6%, p<0.001) positivity were associated in SpA patients but not in PsA patients (31.2% vs 20.0, p=0.13).

Conclusion:

Family history was present in about one third of the patients of PsA and SpA. It is not uncommon for two or more family members to have a SpA feature. Presence of family history may be associated with some clinical conditions, such as uveitis.

References:

[1]Solmaz, D., et al., Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease. Arthritis Care Res (Hoboken), 2020. 72(1): p. 63-68.

[2]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.

Table 1.

Family history in PsA and SpA patients

PsA (n=506)SpA (n=2807)≥ 1 family history, n (%)157 (31.0)774 (27.6)≥1 first-degree relative, n (%)114 (22.5)489 (17.4)≥2 first-degree relatives, n (%)21 (4.2)77 (2.7)≥2 relatives (both first- and second-degree), n (%)45 (8.9)208 (7.4)Family history  •Psoriasis, n (%)120 (23.7)155 (5.5)  •Psoriatic arthritis, n (%)14 (2.8)9 (0.3)  •Spondyloarthritis, n (%)38 (7.5)643 (22.9)  •Inflammatory bowel disease, n (%)1 (0.2)10 (0.4)  •Uveitis, n (%)02 (0.1)

Disclosure of Interests:

None declared.

AB0535 PRESCRIPTION PATTERNS OF THE SECOND BIOLOGIC DMARD IN PSORIATIC ARTHRITIS THROUGH THE LAST DECADE: HURBIO-PsA REAL LIFE EXPERIENCE

Background:

Psoriatic arthritis (PsA) is a multi-dimensional chronic disease, which can affect joints, skin and enthesis. Extrapolation of the positive treatment results of anti-tumor necrosis factor (TNF) alpha agents on spondyloarthritis and rheumatoid arthritis to the treatment practice of PsA lead to a new era for the management of PsA. However, unmet needs in the management of PsA lead to development of several drugs targeting different molecules and cytokines. The impact of these developments on PsA patients who are intolerant/unresponsive to the first biological disease-modifying anti-rheumatic drugs (bDMARD) still needs to be defined.

Objectives:

To explore the second biologic agent trends on PsA patients of our 10-years of single-center experience.

Methods:

HURBIO-PsA (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005 on PsA patients. Until the end of the 2020, 19 different rheumatologists contributed to the development of HURBIO-PsA. Anti-TNF drugs were approved as first line bDMARD for PsA patients. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2011. Also, demographic and serologic data of RA patients were reported.

Results:

A total of 225 PsA (225/443, 50.8%) patients, who was prescribed a second biological agent, was registered in HURBIO-PsA by the end of 2020. Of these patients, 74.7% was female. Mean age at the starting of bDMARD was 47.1 ± 11.6 years. 90 (40.0%) and 135 (60.0%) patients were prescribed with their second bDMARD in 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time, especially for secukinumab.

Table 1.

Distribution of second biologic DMARDs in PsA patients according to 5-years periods

2011-20152016-2020TotalAdalimumab30 (33.3)33 (24.4)66 (29.3)Etanercept33 (36.7)8 (5.9)41 (18.2)Infliximab9 (10)15 (11.1)24 (10.6)Golimumab9 (10)5 (3.7)14 (6.2)Certolizumab5 (5.6)34 (25.2)39 (17.3)Anti-TNF86 (95.6)95 (70.4)181 (80.5)Secukinumab026 (19.3)26 (11.5)Ustekinumab010 (7.4)10 (4.4)Abatacept4 (4.4)2 (1.5)6 (2.6)Tofacitinib02 (1.5)2 (0.9)Non-Anti-TNF4 (4.4)40 (29.6)44 (19.5)Total90 (100)135 (100)225 (100)

Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, secukinumab: 2018, ustekinumab: 2018; abatacept and tofacitinib were given with the permission from the Ministry of Health of Turkey for off-label use authorization

Conclusion:

Almost half of the PsA patients switched their anti-TNF drugs to others. Non-Anti-TNF bDMARDs, especially secukinumab, becoming more frequently used as a second-line biologic agent in PsA in recent years. These bDMARD prescription trend is appropriate to EULAR PsA recommendations.

Disclosure of Interests:

None declared.

AB0579 INSTRUMENTS FOR SCREENING PSORIATIC ARTHRITIS AMONG PATIENTS WITH PSORIASIS: A SYSTEMATIC LITERATURE REVIEW

Background:

Timely diagnosis is essential for the optimal management of psoriatic arthritis (PsA). Several instruments have been developed for screening PsA among patients with psoriasis. However, a delay in diagnosis is still frequently reported, possibly due to the lack of a wide use of these instruments.

Objectives:

We aimed to identify and compare the reported performance of these instruments with special emphasis on the PsA phenotypes.

Methods:

We conducted a systematic literature search on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis’. Two independent reviewers identified all studies published in English, that report on the validation, psychometric evaluation or use of an instrument for screening PsA. Any disagreements were resolved by the third investigator. Data on sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were extracted or calculated for each instrument. Additionally, instruments were assessed for their performance in patients with different disease phenotypes.

Results:

A total of 10754 references were screened, and 42 were identified that reported on 15 different screening instruments. Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST), Early Arthritis for Psoriatic Patients questionnaire (EARP) were the most commonly used instruments. There was important variability across studies regarding the sensitivity, specificity, PPV and NPV of these instruments based on the cut-offs for positivity, setting, patient population and disease phenotypes (Table 1). Specificity was higher when patients with a previous diagnosis of other rheumatic diseases were excluded. Lower sensitivity was reported among patients with shorter disease duration and when patients with a prior diagnosis of PsA were excluded from the study, whereas higher sensitivity was reported among patients with prior NSAID use. Screening tools showed differences in sensitivity in different domains (Figure 1).

Figure 1.

Performance Among Patients with Each Domain

Conclusion:

This systematic literature review revealed wide variability in the diagnostic estimates of currently available questionnaire-based screening instruments for identifying PsA among psoriasis patients, depending on study populations and disease phenotypes. There is an unmet need for a screening instrument with a better performance in all disease domains.

Table 1.

Diagnostic estimates of screening tools in different studies

InstrumentNumber of studiesSensitivity%Specificity%PPV%NPV%PASE1824-9138-9518-8813-96PEST1140 – 8537.2-98.623-9647.1-99.3EARP941-97.234-97.214-93.357.5-100TOPAS641-89.129.7-9025.7-91.868-81.6TOPAS-II444-95.880.5-9863.4-95.891-98PsA-Disk questionnaire187.246.458.678.5CONTEST270-76.556.5-9116-8968-95STRIPP191.593.379.697.5SiPAS179877390PASQ267-92.764-81.84383GEPARD277706680Swedish- Psoriasis Assessment Questionnaire163724585PAQ160622687.5SiPAT169699169A novel, short, and simple screening questionnaire186.971.35393.6

PASE: Psoriatic Arthritis Screening and Evaluation, PEST: Psoriasis Epidemiology Screening Tool, EARP: Early Arthritis for Psoriatic Patients questionnaire, TOPAS: Toronto Psoriatic Arthritis Screening Questionnaire, STRIPP: Screening Tool for Rheumatologic Investigation,

SIPAS: Simple Psoriatic Arthritis Screening questionnaire, PASQ: Psoriasis and Arthritis Screening Questionnaire, GEPARD: German Psoriatic Arthritis Diagnostic Questionnaire, PAQ: Psoriatic and Arthritic Questionnaire, SiPAT: Siriraj Psoriatic Arthritis Screening Tool

Disclosure of Interests:

None declared.

AB0446 DEMOGRAPHIC AND CLINICAL FEATURES OF IDIOPATHIC INFLAMMATORY MYOSITIS AND PREVALENCE OF MYOSITIS-RELATED ANTIBODIES

Background:

Idiopathic inflammatory myopathies (IIM) are heterogeneous groups of connective tissue diseases. Diagnosis of IIM is sometimes challenging, but newly defined myositis specific autoantibodies (MSAs) are helpful in diagnosing of IIM and revealing the clinical signs [1].

Objectives:

To describe demographic and clinical features of IIMs and to evaluate the frequency and clinical associations of myositis-specific and myositis associated antibodies (MAAs) in IIM.

Methods:

Samples obtained from patients tested for MSA/MAA as of 2017 to 2020 were retrospectively evaluated. Patients were diagnosed with IIM according to clinician diagnosis. The prevalence and clinical associations of myositis-related antibodies were assessed with univariate and multivariate analysis.

Results:

152 patients (70.4% female) were tested for myositis-related antibodies during the study period. 81 patients were diagnosed with IIM (38 DM, 43PM). DM patients were diagnosed at an earlier age and its association with malignancy was more relevant, although the relationship with malignancy was not statistically significant. Differences of clinical characteristics between DM and PM patients were skin features which were more frequent in DM, and interstitial lung disease which was more common in PM patients.

MSAs/MAAS were found in 65.4% and 43.2% in IIM patients, more frequently than patients without IIM (p=0.000 and 0.0225, respectively). MSAs were equally frequent in both IIM groups, whereas MAAs were more common in the PM group (although no significant difference in overlap with other connective tissue diseases within these two diseases). The most common MSAs in DM were anti-TIF1-γ (23%), anti-MDA5 (16%), anti-NXP2 (13%) and in PM were anti-Jo-1 (28%), anti-MDA5 (12%), anti-ku (12%), anti-PL7 (12%) respectively. Predictors of ILD in IIM were Anti-Jo-1 positivity and age (RR:10 [CI:2-41] p=0.003 and RR:1.07 [CI:1.02-1.12] p=0.04 respectively)

Conclusion:

The general characteristics of DM and PM patients and the frequencies of myositis-specific autoantibodies were similar to the literature, except that anti-TIF1-γ antibodies (14%) were more common in our Turkish cohort [2].

References:

[1]Cruellas, M.G., et al., Myositis-specific and myositis-associated autoantibody profiles and their clinical associations in a large series of patients with polymyositis and dermatomyositis. Clinics (Sao Paulo), 2013. 68(7): p. 909-14.

[2]Gonzalez-Bello, Y., et al., Myositis-Specific Antibodies and Myositis-Associated Antibodies in Patients With Idiopathic Inflammatory Myopathies From the PANLAR Myositis Study Group. J Clin Rheumatol, 2020.

Table 1.

Baseline characteristics of the patients with DM and PM

DM (n=38)PM (n=43)PFemale, n (%)27 (71.1)29 (67.4)0.457Age at onset, years33 (15-48)47 (38-58)0.002Skeletal muscle features Muscle weakness, n (%)34 (89.5)37 (86.0)0.451 Myalgia, n (%)23 (60.5)30 (69.8)0.261 Artritis, n (%)8 (21.1)9 (20.9)0.601Skin features, n (%) Heliotrope rash, n (%)18 (47.4)0 (0)<0.001 Gottron papules, n (%)25 (65.8)0 (0)<0.001 Gottron sign, n (%)18 (47.4)0 (0)<0.001 Generalize erythema, n (%)10 (26.3)0 (0)<0.001Calcinosis, n (%)4 (10.5)1 (2.3)0.143Dysphagia, n(%)10 (26.3)12 (27.9)0.537Interstitial lung disease (ILD), n (%)8 (21.1)20 (47.6)0.012Other connective tissue diseases overlap, n (%)6 (15.8)13 (30.2)0.102Malignancies, n (%)5 (13.5)3 (7)0.275Laboratory data Creatine kinase (IU/L)505 (110-3616)801 (402-1868)0.655 C-reactive protein (mg/dl)0.3 (0.1-0.8)1.2 (0.5-2.8)<0.001 ESR (mm/h)19 (8-27)25 (17-48)0.005MAAs (Ro-52, pm-scl 100, pm-scl75), n (%)11 (28.9)24 (55.8)0.013MSAs, n (%)28 (73.7)25 (58.1)0.108 Anti- TIF1- γ, n (%)9 (23.7)2 (4.7)0.014 Anti-Jo-1, n (%)2 (5.3)12 (27.9)0.007 Anti-PL-7, n (%)05 (11.6)0.038

Disclosure of Interests:

None declared.

POS1070 ANXIETY IN PSORIATIC ARTHRITIS PATIENTS: RESULTS FROM THE HUR-BIO BIOLOGIC REGISTRY

Background:

Anxiety is commonly observed, underestimated problem in patients with psoriatic arthritis (PsA). Overall rate has been reported around 20% [1]. However the data on anxiety in PsA patients requiring advanced treatment and change in response to therapy is scarce.

Objectives:

Our aim was to understand the frequency of anxiety before starting biologic agents and change in the anxiety scores with the treatment.

Methods:

PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for anxiety (score ≥ 4) using the patient self-reported measure of anxiety on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12) [2]. The anxiety rate and scores were determined before starting biologic agents and at first visit in 6 months. Change in the scores were compared between patients according to the favourable treatment responses (Table 1). The correlation between the score-changes in anxiety and treatment response parameters was assessed by spearman correlation analysis.

Results:

From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score registered both at baseline and first visit in 6 months. Both the frequency and mean (SD) score of anxiety decreased at first visit [63.9% vs 41.4 %, 4.8(3.4) vs 3.2 (3.1) respectively, p<0.001 for both] after a mean (SD) follow-up of 105.7 (22.2) days. There was a statistically significant difference between changes in the anxiety scores in patients with/without treatment responses in pain, PGA, BASDAI, HAQ-DI and DAS-28. A positive correlation between the change in anxiety and all treatment response parameters was observed (Table 1, Figure 1).

Table 1.

Patient characteristics at baseline and changes in the anxiety score according to treatment response

Conclusion:

Anxiety is a more frequent problem at the time of biologic initiation compared to rates observed in general PsA population which could be related to the high disease activity. The rates are still high in 6 months under treatment, however both the frequency and score of anxiety showed a decreasing trend parallel to the treatment response.

References:

[1]Zusman EZ, Howren AM, Park JYE,et. al (2020) Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 50 (6):1481-1488.

[2]Gossec L, de Wit M, Kiltz U, Braun J, et al (2014) A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis 73 (6):1012-1019.

Figure 1.

Correlation between the score changes

Disclosure of Interests:

None declared.

POS1076 APICAL FIBROSIS AND INTERSTITIAL LUNG DISEASE IN PATIENTS WITH PSORIATIC ARTHRITIS: DO WE UNDERESTIMATE?

Background:

Extra-articular manifestation (EAMs) definition is not clearly defined in psoriatic arthritis (PsA). Nail involvement, enthesitis, dactylitis has been widely studied however, data are needed on pulmonary involvement in PsA.

Objectives:

We aimed to understand real-life results of lung involvement in PsA patients.

Methods:

From the PsA cohort followed in our outpatient clinic, patients who have been requested a chest computed tomography (CT) for any reason by any department were retrieved from medical records and included in this retrospective cross-sectional analysis. All CTs were assessed by a radiologist who is blinded to the patients` clinical history and findings were categorized as parenchymal, airway, pleural findings and lymphadenopathy (LAM). Moreover, any findings that are radiologically attributed to a specific entity such as previous tuberculosis (Tb) infection were noted. Demographic/clinic data including smoking status, concomitant lung problems, disease characteristics (duration, axial/ peripheral involvement) were collected and analyzed.

Results:

A total of 80/1072 (7.4 %; 65% female) PsA patients with mean (SD) age 56.1 (13.2) years were included in the study. Median (IQR) PsA duration was 23.5 (55.75) months and 36 (45%) patients had peripheral, 29 (36.3%) patients had axial involvement. For the rest of 15 (18.7 %) patients, radiographic assessment was missing. Smoking status could be retrieved in 47 patients (never=40.4%, ex-smoker= 19.1%, current smoker=40.4%). There were 14 concomitant lung problem in 12 (15%) patients. CT findings showed that 68.8% of patients had at least one lung pathology. Parenchymal findings were seen in 65% of the patients as both non-spesific changes (atelectasis, n= 35; nodules, n=24; ground glass opacity, n= 9; sequelae fibrosis, n= 9; emphysema, n= 7; consolidation, n= 5, interstitial thickening, n= 5; pulmonary cyst, n =4) and specific pathologies as apical fibrosis (AF) (n=5) and intersititial lung disease (ILD) (n=5, NSIP=3, LIP=2). AF was linked to previous Tb infection in 1 patient and radiotherapy in another (Table 1). However, there is no specific pathology in the rest of 3 (3.7%) patients that AF could be attributed to and all of them were male. Other pathologies were seen as airway findings in 28.8% patients (bronchiectasis, n= 17, bronchial wall thickness, n= 10, air trapping n= 7, centrilobular opacity, n= 4,) and pleural findings in 13.8 % of the patients (pleural plaque, n= 5, effusion, n= 3, thickness, n=3). LAM was observed in around 4% of the patients.

Table 1.

Patient characteristics with apical fibrosis, interstitial lung disease

InvolvementGenderAgePsA duration, monthsAxialDisease(yes/no)SmokingStatusSmoking package-yearsConcomitantLung Disease(yes/no)Linked toanother problemby radiologist(yes/no)ID-1AFM582NoCurrent40NoNoID-2AFM611NoCurrent40NoNoID-3AFM73122YesEx30NoNoID-4AFF551YesNANANoYes*ID-5AFF65#NANever-Yes€Yes€ID-6NSIPF96NANANever-NoNoID-7NSIPM69NANAEx15Yes$NoID-8NSIPF66156NoNANAYes$NoID-9LIPM61200YesNever-NoNoID-10LIPF8014YesNANANoNo

AF= Apical fibrosis; NSIP= Non-spesific interstitial pneumonia, LIP= Lymphocytic interstitial pneumonia; PsA= Psoriatic Arthritis, NA= Not available*radiotherapy sequelae; # tomography was done prior to PsA diagnosis; € previous tuberculosis infection; $ chronic obstructive pulmonary disease

Conclusion:

The real-life experience of our PsA cohort showed that pulmonary findings included variable spesific, non-spesific findings. As a limitation results represent the CT findings of around 8% of our PsA cohort. Within the scope of previous reports male predominant AF and ILD come forward in PsA that requires further attention in future studies [1,2].

References:

[1]Peluso R, Iervolino S, Vitiello M, et al (2015) Extra-articular manifestations in psoriatic arthritis patients. Clin Rheumatol 34 (4):745-753.

[2]Bargagli E, Bellisai F, Mazzei MA, et al (2020) Interstitial lung disease associated with psoriatic arthritis: a new disease entity? Intern Emerg Med.

Disclosure of Interests:

None declared.

POS0568 OBESITY RATES AND BMI ARE SIMILAR IN AGE AND SEX MATCHED RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS AND SPONDYLOARTHRITIS PATIENTS

Background:

Obesity has been suggested to be a chronic inflamatory condition and therefore, obesity may be considered as a risk factor for developing immune-mediated diseases, including inflammatory arthritis. In larger biologic registiries, obesity was found frequently in psoriatic arthritis than other inflammatory diseases such as rheumatoid arthritis and spondyloarthritis. [1-4]. However, obesity may be a reason of aging, moreover, there are strong sex differences between those diseases.

Objectives:

The aim of this study was to evaluate the obesity rates in sex and aged matched patients with inflammatory arthritis before the initation of biological therapy.

Methods:

HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 5635 patients have been recorded. Demographic, clinical and laboratory data before bDMARD of SpA, RA and PsA patients were noted. The patients were divided into two groups: non-obese patients (<30 kg/ m2) and obese (≥30 kg/m2) patients. When investigeting the changes in BMI by diagnosis, the effects of gender and age were adjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender and age indifferences of the relevant groups by using propensity score.

Results:

5059 patients’ (1834 RA, 2741 SpA and 484 PsA) BMI data before the bDMARD treatments were avaliable and analysed. Baseline characteristics of RA, SpA and PsA patients were given in Table 1. 72.3% of the RA patients were seropositive. HLAB27 was positive in 64.7% and 22.9% of the SpA and PsA patients. Anti-TNF therapy was started as first bDMARD in 57.2% of the RA patients, others were started with non-Anti-TNF bDMARDs. In SpA (99.2%) and PsA (100%) patients anti-TNFs were the first biologics. Overall, the proportion of obese patients was significantly higher in RA and PsA than in SpA patients (Table 1) and age and sex affected BMI significantly (p<0.001) (Figure 1). After adjusting age and sex indifference between groups, the difference between the BMI of the patients disappeared (Table 1).

Table 1.

Baseline characteristics and BMI of the patients

RASpAPsApAll bDMARD patientsN18342741484Female, n (%)1470 (80.2)1257 (45.9)334 (69.0)0.000*Age, years*52.9±13.443.1±11.447.4±12.20.000*Disease duration, years¥11 (7-17)8 (5-13)7 (3-12)0.000*Body mass index*29.6 ± 6.527.7 ± 5.429.2 ± 5.80.000*Obesity, n (%)811 (44.2)815 (29.7)199 (41.1)0.000*Age and sex matched groupN481483484Female, n (%)315 (65.7)324 (67.1)334 (69.0)0.545Age, years*47 (36-59)48 (39-57)47 (38-56)0.691Disease duration, years¥10 (6-15)5 (5-13)7 (3-12)0.000*Body mass index*28.5 ± 6.128.5 ± 5.829.2 ± 5.80.150Obesity, n (%)183 (38.0)176 (36.4)199 (41.1)0.316

* Mean ±S.D ¥Median (IQR)

Conclusion:

Although obesity was more frequently reported in RA and PsA patients, age and gender seemed to be the major factors in the occurrence of this difference rather than inflammatory arthritis subgroups. Therefore, when considering obesity as a factor in the registries, for instance biological registries, sex and age should be kept in mind.

References:

[1]Højgaard, P., et al., The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis: results from the DANBIO and ICEBIO registries. Rheumatology (Oxford), 2016. 55(12): p. 2191-2199.

[2]Liu, Y., et al., Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken), 2017. 69(2): p. 157-165.

[3]Moroni, L., N. Farina, and L. Dagna, Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clin Rheumatol, 2020. 39(4): p. 1039-1047.

[4]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.

Figure 1.

BMI regarding to sex and diseases subtypes

Disclosure of Interests:

None declared

AB0347 RENAL BIOPSY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: IS IT ONLY LUPUS NEPHRITIS?

Background:

Renal biopsy is a cornerstone in the diagnosis and management of renal involvement in patients with systemic lupus erythematosus (SLE). However, non-lupus nephritis has been also observed in SLE patients with renal disease (1).

Objectives:

The aim of this study was to draw attention to the causes of non-lupus nephritis in SLE patients with kidney biopsy.

Methods:

This retrospective, descriptive study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. All patients had fulfilled the SLICC or EULAR/ACR criteria for SLE. According to the pathology report results, 116 of the patients were diagnosed with lupus nephritis (LN), 18 patients had non-lupus nephritis, 2 biopsies were normal, and 3 biopsies were insufficient. Demographics, SLE disease duration, and renal biopsy diagnosis were derived from our hospital medical records.

Results:

Of the 23 patients (female:18/male:5), the mean age at the SLE diagnosis was 30.5 years and the median SLE disease duration was 8.5 (11.6) years. Pathologic report findings were compatible with focal segmental glomerulosclerosis in 6 patients, membranous nephropathy with no cellular proliferation and inflammation in 4 patients, thrombotic microangiopathy in 3 patients, IgM nephropathy in 2 patients, tubulointerstitial nephritis in 2 patients, and proliferative glomerulonephritis with monoclonal IgG deposits in one patient. There were no different for SLE manifestation in both gropus. LN vs other renal pathologies laboratory comparing as follow: ANA (+) ≥ 1:320 89 (76.7%) vs 14 (60.9%), APS antibodies 31 (33.7%) vs 8 (57.1), anti-Sm (+) 8 (11.8%) vs 1 (4.3%) were similar for LN and other renal pathologies, but anti-ds-DNA positivity 94 (84.7%) vs 10 (50%), median ds-DNA level 421 (591) vs 150 (340) and low level of C3 and C4 were more frequent in LN (p<0.001; p=0.005; p<0.001, respectively).In addition, the rate of active urinary sediment and renal SLEDAI score were significantly high in LN patients.

Conclusion:

Various renal lesions unrelated to lupus nephritis can be observed in SLE patients. Renal biopsy plays a critical role in identifying these lesions, which may have prognostic and therapeutic implications distinctive from those of lupus nephritis. Also, anti ds-DNA positivity/level, low C3 and C4, active urinary sediment and renal SLEDAI scores may give us some clues in terms of renal pathology for SLE patients. Moreover, almost half of the patients without LN in renal biopsy have anti ds-DNA positivity.

References:

[1]Howell DN. Renal biopsy in patients with systemic lupus erythematosus: Not just lupus glomerulonephritis! Ultrastruct Pathol. 2017 Mar-Apr;41(2):135-146.

Table 1.

Demographic, clinical characteristics and results of patients with and without lupus nephritis

Variables*Lupus nephritis(N=116)Other pathologies(N=23)PAge at the SLE diagnosis, years22.5±13.130.5±14.50.006Sex, female93 (80.2)18 (78.3)0.83SLE disease duration8 (8.7)8.5 (11.6)0.27Manifestation of SLE-Musculoscletal75 (66.4)14 (63.6)0.8-Mucocutaneous60 (52.6)9 (40.9)0.31-Hematologic47 (40.9)10 (43.5)0.49-Serosal26 (23.2)4 (17.4)0.54-Neurological6 (5.3)1 (4.3)0.85Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.9 (0.6)0.17-GFR (ml/min)110 (67)77 (65)0.06-24-hour urine protein≥ 1 gr/day72 (71.3)17 (77.3)0.63≥ 3 gr/day36 (35.6)11 (50)0.23-Active urinary sediment91 (83.5)6 (27.3)<0.001Renal SLEDAI at the biopsy12 (8)4 (4)<0.001End-stage renal disease13 (11.2)2 (8.7)0.72Renal transplantation5 (4.3)1 (4.3)0.99Exitus8 (7)1 (4.3)0.99

*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.

GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity index

Disclosure of Interests:

None declared

POS0633 DURATION OF STARTING bDMARDs ARE ALMOST 3 TIMES LONGER IN RA PATIENTS THAN PsA PATIENTS: HUR-BIO REAL LIFE RESULTS

Background:

Before using biological DMARDs, EULAR suggests the use of synthetic DMARDs (especially methotrexate) for RA and PsA [1-2].

Objectives:

It was aimed to evaluate the differences of disease duration and csDMARDs till first bDMARD in RA and PsA patients.

Methods:

HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 2070 RA and 520 PsA patients have been recorded. Demographic, clinical and laboratory data before bDMARDs of the patients were noted. When investigating the differences between groups, the effects of gender, age and disease duration wereadjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender, age and for indifference of the relevant groups by using prospensity score matching.

Results:

We incuded 481 RA, and 482 PsA age and gender matched patients in the study. Age, gender and disease duration information were given in the Table 1. 72.8% of the RA patients were RF or anti-CCP positive. Overall, 56.3, 100% of the RA, and PsA patients first biologic therapies were anti-TNFs, respectively. All RA patients started with csDMARDs before bDMARD treatments, whereas 450 of 482 (93.4%) PsA patients. Methotrexate was the anchor csDMARD for both diseases. RA patients more frequently used all csDMARDs included methotrexate, leflunomide, sulphasalazine hydroxychloroquine and corticosteroids as well. Median disease duration till bDMARD treatments in RA and PsA patients were 55 and 18.5 months respectively (p<0.001) (Table 1).

Table 1.

emographic characteristics and csDMARDs before first bDMARD

RA (n=481)PsA (n=482)P valueFemale, n (%)319 (66.3)332 (68.9)0.218Age, years (mean±SD)48.2 ± 13.547.4 ± 12.20.332Disease duration, years*10 (6-16)7 (3-12)0.000Symptom duration before diagnosis, years¥0 (0-1)1 (0-4)0.000*The period of time between diagnosis and bDMARD initiation, months¥55 (24-115)18.5 (8-58)0.000*The period of time between symptoms and bDMARD initiation, months¥70 (35-151)48 (20-124)0.000*MethotrexateEver n (%)400 (83.3)373 (77.5)0.015Just before bDMARD initiation n (%)251 (52.2)230 (47.7)0.093Hydroxychloroquine sulfateEver n (%)292 (60.8)170 (35.3)0.000*Just before bDMARD initiation n (%)262 (54.5)99 (20.5)0.000*LeflunomideEver n (%)237 (49.4)129 (26.8)0.000*Just before bDMARD initiation n (%)160 (33.3)96 (19.9)0.000*SulphasalazineEver n (%)353 (73.5)265 (55.1)0.000*Just before bDMARD initiation n (%)156 (32.4)146 (30.3)0.259*CorticosteroidsEver n (%)419 (87.3)281 (58.4)0.000*Just before bDMARD initiation n (%)335 (69.6)187 (38.8)0.000*

¥Median (IQR)

Conclusion:

According to HUR-BIO real life data, for inflammatory arthritis patients who started bDMARDs, the periods of time between diagnosis and bDMARDs were more reasonable (18 months) in PsA patients than RA patient’s periods which were approximately three times longer. RA patients were used much more and longer duration of csDMARDs. This explicit distinction may be explained by synthetic DMARDs on activity differences between the RA and PsA.

References:

[1]Gossec, L., et al., EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 700-712.

[2]Smolen, J.S., et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 685-699.

Disclosure of Interests:

None declared

POS0931 RETENTION RATE AND TREATMENT RESPONSE OF BIOLOGICAL AGENTS IN ADVANCED SPINAL ANKYLOSIS AND BAMBOO SPINE: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY

Background:

Axial spondyloarthritis (axSpA) may lead to linear radiographic progression and progress to advanced spinal disease and finally to the bamboo spine (1).

Objectives:

To assess the demographic, clinical, disease activity and retention rates of patients using biological disease-modifying antirheumatic drugs (bDMARD) with advanced spinal disease and bamboo spine in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.

Methods:

In the HUR-BIO spondyloarthritis (SpA) registry were available 2952 patients. Of these, 774 patients with lumbar and cervical radiographs were included in the study. Advanced spinal ankyloses (99 patients) was defined as the presence of at least two intervertebral adjacent bridges at the lumbar and/or cervical spine level without bamboo spine. Bamboo spine (78 patients) was defined with a complete fusion of all lumbar and cervical spines. In addition, patients who diagnosed with axSpA for at least 10 years but no develop syndesmophytes on lumbar and cervical spine (92 patients) were used as a control group.

Results:

Both the bamboo spine and advanced spinal disease had higher age, higher BMI, more smoking (ever) and hip involvement compared to the without syndesmophytes group. Acute phase reactants, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing spondylitis disease activity Score-CRP (ASDAS-CRP) parameters were similar at the beginning of bDMARD in all groups. BASFI was higher in the bamboo spine group than in the without syndesmophytes group at last visit (Table 1). There were no differences between all groups in terms of the retention rate of the first bDMARD (Log rank p=0.86) (Figure 1).

Conclusion:

Data on the use of bDMARDs in SpA patients with bamboo spine are limited. This study showed that bDMARDs are an effective treatment option in SpA patients with bamboo spine with high disease activity. Similar drug retention rates were found compared to SpA patients with no syndesmophytes. Although the disease activity decreased similar rates in the groups, functional limitation continued in approximately half of the patients in bamboo spine patients.

References:

[1]Braun J et al. Staging of patients with ankylosing spondylitis: a preliminary proposal. Annals of the rheumatic diseases, 2002, 61.suppl 3: iii19-iii23.

Table 1.

Demographic, clinical characteristics and response to treatment in SpA groups.

Without syndesmophytesn= 92Advanced spinal diseasen= 99Bamboo spinen= 78pAge, years˚42.2 ± 8.851.3 ± 10.255.5 ± 9.3< 0.001*Age at disease onset, years˜25.01 (11)36.6 (20)33.3 (18)< 0.001*Male, n (%)55 (59.8)78 (78.8)66 (84.6)< 0.001*Disease duration, years˜13.8 (5)12.3 (15)17.6 (13)< 0.001*Delay in diagnosis, months˜12.02 (43)36.01 (89)36.01 (100)0.013*HLA-B27 positivity/total, n (%)21/42 (50)31/45 (69)16/28 (57)0.19BMI˜26.3 (8)29.7 (7)29.4 (7)< 0.001*Smoking (ever), n (%)56 (61)78 (79)58 (74)0.019*Hip involvement, positivity/total (%)11/84 (13.1)34/86 (39.5)37/75 (49.3)< 0.001*OnsetLastOnsetLastOnsetLastp (onset)p (last)ESR, mm/h˜21.5 (34)12.5 (18)25.5 (29)14.5 (17)23 (31)14 (14)0.60.59CRP, mg/dL˜1.5 (4)0.4 (0.6)1.7 (2)0.65 (1)1.8 (3)0.64 (0.8)0.40.001*ASDAS-CRP˜3.6 (0.8)1.9 (1)3.4 (0.9)2 (1.2)3.4 (0.8)1.9 (1.4)0.40.23BASDAI score˜5.7 (2.6)2.4 (4.5)5.6 (3.3)2.8 (3.1)5.6 (3.2)2.4 (3.3)10.31BASFI score˜5.4 (4)2 (4)4.5 (4)3 (4)6.5 (3)3.9 (4.5)0.10.002*BASFI score > 4, n (%)29 (59)23 (25)29 (56)32 (32)27 (75)36 (46)0.10.014*ASAS PR, n (%)26 (28)15 (15)17 (22)0.09

*p <0.05, ˚mean ± SD, ˜median (IQR) SD: Standard deviation; IQR: Inter-quartile range BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BASFI: Bath Ankylosing Spondylitis Functional Index; BMI: Body mass index; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; ASAS PR: Assessment in SpondyloArthritis International Society partial remission; ASDAS: Ankylosing spondylitis disease activity score

Figure 1.

Retention rate of the first bDMARD

Disclosure of Interests:

None declared

POS0793 PREDICTORS OF END STAGE RENAL DISEASE IN THE RENAL BIOPSY PROVEN LUPUS NEPHRITIS

Background:

Although focusing on the proliferative form of lupus nephritis (LN), recent reports also highlight the importance of recognizing and treating non-proliferative forms of LN.

Objectives:

In this study, we aimed to compare the clinical features and outcomes between proliferative and non-proliferative LN and to investigate the predictor factors of end stage renal disease (ESRD).

Methods:

This retrospective study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. 116 patients were diagnosed as LN. Biopsy findings had been classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification. Demographics, disease involvements, laboratory values, treatment regimens, and outcomes in LN course were compared according to the proliferative and non-proliferative LN. Complete renal response within first 24 months was defined as ACR response criteria. Factors predicting the ESRD were analysed by the logistic regression analysis.

Results:

A total of 116 lupus nephritis patients were categorised class 3 (n=17, 14.7%) or 4 (n=77, 66.4%) as proliferative LN and class 2 (n=9, 7.8%) or 5 (n=13, 11.2%) as non-proliferative LN. Of these patients, 80.2% was female. Mean age at the SLE diagnosis and SLE manifestations were similar for both group. ANA (+) ≥ 1:320, ds-DNA level, APS antibodies, anti-Sm (+) were similar for proliferative and non-proliferative LN, but ds DNA positivity and low level of C3 and C4 were more frequent in proliferative LN. LN duration was similar. Median renal SLEDAI scores were higher in proliferative LN group. Induction treatment regimens included pulse steroid 72.3%, CyC 51.8%, MMF 24.6%, Rtx 6.1%, CsA 4.4%, and plasma exchange 12.9%. ESRD, renal transplantation and exitus were major complications of LN. Predictors of ESRD were duration of lupus nephritis (OR 1.32 [1.09-1.61]; 95% CI), decrease in GFR at the biopsy time (OR 0.97 [0.95-0.99]; 95% CI), and being in complete renal response within 24 months (OR 21.07 [2.28-194.36]; 95% CI).

Conclusion:

Unfortunately, LN patients still have worse outcomes, such as high ESRD rate, regarding to current effective immunosuppressive treatment regimens. Although patients’ number were not enough for conclusion, interestingly, worse outcomes were not related with proliferative or non-proliferative LN. Complete remission within 24 months was most relevant good prognostic factor, and clinicians should be kept in mind to these windows of opportunity period.

Table 1.

Demographic, clinical characteristics, and outcomes of the patients with lupus nephritis

Variables*All patients (n=116)Class 3 or 4 LN (n=94)Class 2 or 5 LN (n=22)pAge at the SLE diagnosis, years22.5±13.123±13.320.3±140.32Sex, female93 (80.2)74 (78.7)19 (86.4)0.42SLE disease duration8 (8.7)8 (9.7)8.3 (7.5)0.66Lupus nephritis at diagnosis time67 (58.8)54 (58.7)13 (59.1)0.97Manifestation of SLE-Musculoscletal75 (66.4)63 (68.5)12 (57.1)0.32-Mucocutaneous60 (52.6)50 (54.3)10 (45.5)0.45-Hematologic47 (40.9)38 (40.4)9 (42.9)0.83-Serosal26 (23.2)21 (23.1)5 (23.8)0.94-Neurological6 (5.3)5 (5.4)1 (4.8)0.91Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.6 (0.2)0.01-GFR (ml/min)110 (67)92 (55)145 (59)0.03-≥ 60 ml/min79 (79.8)63 (77.8)16 (88.9)-30-59 ml/min8 (8.1)7 (8.6)1 (5.6)0.55-< 30 ml/min12 (12.1)11 (13.6)1 (5.6)-24-hour urine protein≥ 1 gr/day72 (71.3)62 (76.5)10 (52.6)0.04≥ 3 gr/day36 (35.6)32 (39)4 (21.1)0.14-Active urinary sediment91 (83.5)78 (89.7)13 (59.1)0.001Renal SLEDAI at the biopsy12 (8)12 (8)8 (8)0.001Lupus nephritis duration (years)5.5 (8)5.1 (8.3)6.4 (4.8)0.73Complete renal response within 24 months69 (71.1)55 (72.4)14 (66.7)0.61End-stage renal disease13 (11.2)11 (11.7)2 (9.1)0.72Renal transplantation5 (4.3)4 (4.3)1 (4.5)0.95Exitus8 (7)7 (7.5)1 (4.5)0.62

*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.

GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity index

Disclosure of Interests:

None declared

AB0763 THE INFLUENCE OF OBESITY ON BIOLOGICAL DMARD TREATMENT RESPONSE IN PSORIATIC ARTHRITIS: HUR-BIO REAL LIFE RESULTS

Background:

Obesity could be a risk factor for response to treatment and disease severity in psoriatic arthritis (PsA) because of potential pro-inflammatory effects of cytokines produced by adipose tissue (1).

Objectives:

This study aimed to assess association of demographic, clinical and disease activity indices with obesity in patients using biological disease-modifying antirheumatic drugs (bDMARD) treatment in HUR-BIO cohort.

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. Until January 2020, HUR-BIO PsA registry enrolled 469 patients. Demographic, clinical, laboratory, therapeutic data were collected from this database which including tender/swollen joint counts, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Health Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Disease Activity Score - 28 joint (DAS28), Disease Activity index for Psoriatic Arthritis - 28 joint score (DAPSA-28), Psoriatic Arthritis Impact of Disease 12-item questionnaire (PSAID-12). BMI≥30 was defined as obesity.

Results:

HUR-BIO PsA had 469 PsA patients and 441 patients with available BMI data were enrolled. Overall, 187/441 patients (42%) had obesity. The median follow-up period of obese and non-obese PsA patients was 7 (3-12) and 8 (4-12) years, respectively (p: 0.31). Obese patients were older at the age of PsA diagnosis (43 (33 - 53) vs 36 (28 – 45) years, p<0.001), higher female gender (76% vs 64%, p: 0.008), higher comorbidities (53% vs 27%, p<0.001). While there was no difference between the two groups in uveitis, IBD, family history and smoking; HLA-B27 was higher in non-obese patients (table). DAS28, BASDAI, DAPSA-28 joints, PSAID-12 were higher in the obese group than in the non-obese group, both before the biological DMARD and at the last visit (p <0.05) (figure 1). BASDAI50% response were similar and patients with HAQ score <0.5 were less frequently in obese patients. For obese and non-obese PsA patients, first bDMARDs percentages were adalimumab 46 vs 48, etanercept 18.2 vs 17, infliximab 14 vs 18, golimumab 7 vs 7.5, certolizumab 12 vs 7, secukinumab 1 vs 0.5, ustekinumab 1 vs 1, others 1 vs 1%, respectively and were similar (p: 0.72). Retention rate for first bDMARD was higher in non-obese than obese patients. Median of the retention rate of bDMARD in obese and non-obese groups was 54.2 and 79, respectively (log rank p: 0.03) (figure 2).

Conclusion:

Obesity was associated with higher disease activity and poorer effect of bDMARD treatment in patients with PsA. In obese PsA patients with high disease activity despite bDMARD therapy, intentional weight loss may be recommended as an adjunctive therapy.

References:

[1]Klingberg E, Bilberg A, Björkman S et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study.Arthritis research & therapy, 2019, 21.1: 17.

Table.

Baseline and last visit demographic, clinical and disease activity by BMI categories

BMI > 30BMI < 30p-valueAge at PsA, years, median (Q1-Q3)43 (33-53.5)36 (28-45)0.000*Disease duration, years, median (Q1-Q3)7 (3-12)8 (4-12)0.31Gender (male/female, %)24/7636/640.008*Smoking Ever n, %102 (54.8)159 (62.8)0.091HLA B-27 (+) n, (%)7 (14)32 (35)0.006*Uveitis n, %4 (2.2)6 (2.4)0.571IBD n, %4 (2.1)6 (2.4)0.567PsA/Pso Family history n, %74 (39.6)84 (33.2)0.169Taking steroids before biological drugs n, %115 (61.5)156 (61.7)0.972BASDAI50% response n, %35 (31.8)61 (41)0.13Last HAQ score < 0.5 n, %91 (52.3)160 (68.1)0.001*Figure 1.

Baseline and last visit disease activity by BMI categories p: 0.03* p: 0.01* p: 0.001* p: 0.002* *p < 0.05 BMI: Body mass index, DAS: Disease Activity Score, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, DAPSA: Disease Activity index for Psoriatic Arthritis, PSAID: Psoriatic Arthritis Impact of Disease

Figure 2.

Retention rate for biological DMARD by BMI categories Median of retention rate of first bDMARD: BMI > 30 kg/m2and < 30 kg/m254.2 and 79, respectively. Log rank p-value between BMI > 30 kg/m2and <30 kg/m2:0.03*

Disclosure of Interests:

Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Ertugrul Cagri Bolek: None declared, Emre Bilgin: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

The transcultural adaptation and the validity and reliability of the Turkish Version of Perroca's Patient Classification Instrument

AIM

This study examines the transcultural adaptation and the reliability and validity of the Turkish version of Perroca's Patient Classification Instrument.

BACKGROUND

Nurse managers need valid and reliable patient classification tools for determining patients' acuity or dependency levels on nursing care for measuring nursing workloads.

METHODS

This study was conducted in two stages in a private hospital in Istanbul, Turkey. First, the instrument was translated, and its content validation was analysed. In the second stage, data were gathered from 300 hospitalized patients and were analysed by factor analyses, Cronbach's alpha and Cohen's kappa.

RESULTS

Validity testing with ten experts revealed a scale-content validity index of 0.93. Exploratory factor analysis revealed a two-dimensional instrument with distinct factor loadings and a variance of 66.97%. The confirmatory factor analysis revealed that the fit indices were satisfactory. This instrument had an overall Cronbach's alpha coefficient of .86 and Cohen's kappa coefficient of .826.

CONCLUSION

The study provides evidence that the Turkish version of Perroca's Patient Classification Instrument is a valid and reliable tool to determine patients' acuity levels on nursing care.

IMPLICATIONS FOR NURSING MANAGEMENT

This instrument may be used by nurse managers to determine acuity levels of patients and measure nursing workload.