[Frequency and severity of sarcopenia in patients with inflammatory and noninflammatory musculoskeletal diseases : Results of a monocentric study in a tertiary care center]

INTRODUCTION

Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is a clinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria.

OBJECTIVE

To investigate the prevalence and severity of SP in patients with RMD.

METHODS

A total of 141 consecutive patients over 65 years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in a cross-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP 1 and 2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as a parameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in a standardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student's T-test and the χ2-test were used for statistics.

RESULTS

Of the patients included 73% were female, the mean age was 73 years and 80% had an inflammatory RMD. According to EWGSOP 2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP.

DISCUSSION

This study showed a relatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in a standardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP.

AB1190 SOURCES OF INFORMATION ABOUT SARS-CoV-2 USED BY PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES (CIRD)

Background

Patients with chronic inflammatory rheumatic diseases (CIRD) may be at increased risk of Corona Virus Disease 2019 (COVID-19).1 The quality of information obtained plays a crucial role for patients’ decision to be vaccinated. Knowing patients’ needs for information and which sources are used is important for the management of CIRD patients by rheumatologists and other physicians.

Objectives

To identify main sources of information on SARS-CoV-2 used by patients with CIRD and to analyze their influence on opinions and willingness to be vaccinated.

Methods

CIRD patients presenting to our tertiary rheumatology hospital were, after informed consent, consecutively included in the study once the vaccination campaign in Germany had started, to fill out a questionnaire. Next to sociodemographic and disease-specific data, vaccination willingness and knowledge regarding SARS-CoV-2 were assessed. Furthermore, patients’ sources of information and their concerns about accuracy of information were evaluated. A numerical rating scale (NRS) ranging from 0 (completely disagree) to 10 (completely agree) was used. Values between ≥7 were taken as positive answer. Nonparametric tests and multivariate linear regression analyses were performed.

Results

In early 2021, a total of 514 patients were interviewed (Table 1). The majority (63.9 %) reported to be well-informed (NRS ≥7), whereas 18% had doubts regarding information on SARS-CoV-2. The most often used source of information was television, and only 8.6% reported to have been informed by a rheumatologist (Figure 1). About 20% of patients were no longer interested in receiving any information on SARS-CoV-2 through media. Information from rheumatologists, general practitioners, public health authorities or health related web sites did not reach 30.5% of patients. Of interest, 16% of subjectively well-informed patients were hesitant towards vaccination. As many as 43.6% of patients with doubts regarding information about SARS-CoV-2 indicated that they were not willing to be vaccinated. No source of information showed a strong correlation with SARS-CoV-2 vaccination willingness or with knowledge on SARS-CoV-2. Weak positive correlations were found between age and education level on the one hand and information sources about SARS-CoV-2 on the other hand. A weak negative correlation was found between doubts about information and health authorities, whereas positive correlations were found with social networks, friends and family.

Table 1.

Sociodemographic and disease characteristics

Age (years)54.7 ± 12.8Women, No.* (%)315 (61.3%)Educational level, No.* (%) < 8 years50 (10.4 %) 8-12 years275 (57.4 %) >12 years154 (32.2 %)Occupation, No.* (%) Full time198 (38.5 %) Pensioner157 (30.5 %) Part-time80 (15.6 %) Housewife/husband37 (7.2 %) Occupational incapacity29 (5.6 %) In training7 (1.4 %) Healthcare5 (1 %)CIRD, No.* (%)Rheumatoid arthritis192 (37.3 %)Axial spondyloarthritis134 (26.1 %)Connective tissue disease and vasculitis106 (22.6 %)Psoriatic arthritis72 (14.0 %)Disease duration, mean (years)Therapy, No.* (%)9.8 ± 8.9 bDMARD316(61.5 %) csDMARD147(28.6 %) tsDMARD33 (6.4 %) no DMARDs18 (3.5 %)

*Number of patients

Figure 1.

Sources of information of CIRD patients about SARS-CoV-2

Conclusion

Most CIRD patients think that they are well-informed about SARS-CoV-2. However, their information rarely comes from expert-based sources and rarely from rheumatologists. Thus, there is an unmet need for CIRD patients to receive appropriate and comprehensive information about SARS-CoV-2, its influence on rheumatic diseases, and about vaccination of patients with CIRD.

References

[1]Strangfeld A et al. Ann Rheum Dis 2021

Disclosure of Interests

None declared

AB1400 ARE COMORBIDITIES IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES ASSOCIATED WITH TREATMENT NON-ADHERENCE TO BIOSIMILARS IN A NON-MEDICAL SWITCH SCENARIO?

Background

The availability of biosimilars has created a financial incentive to encourage non-medical switching if cheaper products are on the market. In patients with chronic inflammatory rheumatic diseases (CIRD), we have previously reported a relatively high retention rate after switching from originator etanercept to its biosimilar. However, this has been different in other studies and the reasons for non-adherence are poorly understood. Comorbidity has recently gained much attention in patients with CIRD and might be a reason for non-adherence.

Objectives

The aim of this study was to analyse the effectiveness and safety of systematic non-medical switching from originator adalimumab (ADA) to ADA ABP501 biosimilar (ABP) over 6 months in patients with CIRD and to investigate the influence of comorbidities on retention rates.

Methods

Patients with CIRD on originator ADA who switched to ABP subsequently from October 2018 onwards were identified from a large routine database and then followed for 6 months. The presence of comorbidities and disease characteristics as well as measures of disease activity, physical function and changes in treatment were documented at baseline (the time of switching from originator ADA to ABP), and at months 3 and 6. Longitudinal data including information on the clinical efficacy and safety of ABP, and the reasons for discontinuation were documented.

Results

A total of 111 CIRD patients on treatment with originator ADA were switched to the biosimilar ABP (Table 1). More than half of the patients (62%) had a Charlson comorbidity score of 0, though there were differences between disease subtypes. RA patients were comparatively older (mean age 65 years) and had the highest mean Charlson score (1.8). Treatment retention varied only slightly between patients with a Charlson score of 0 and those with ≥0 (Figure 1). In both groups, the majority of patients (90% vs 95%) continued therapy with ABP, while only a small proportion either switched back to originator ADA (6% vs 5%), switched to a different biologic (3% vs 0%), or dropped out (1% vs 0%). The main reason for back switch was the occurrence of adverse events, mostly subjective complaints, most frequently pain. Patients with a Charlson comorbidity score > 0 tended to have poorer scores in trajectories of scores for disease activity and physical function stratified by disease subtype.

Figure 1.

Treatment retention after 6 months stratified by the Charlson comorbidity score

Table 1.

Patients and disease characteristics

RAaxSpAPsAOtherN=23N=68N=15N=5Age (years), mean (SD)65.1 (12.0)47.3 (13.1)51.1 (11.2)41.8 (14.2)Women60.9% (14)32.4% (22)53.3% (8)40.0% (2)Disease duration (years), median (IQR)4.0 (3.0-8.0)5.0 (2.0-8.0)4.0 (2.0-13.0)7.0 (4.0-7.0)Duration originator ADA therapy (month), mean (SD)43.8 (28.6)39.4 (26.9)34.7 (29.0)60.9 (27.7)Charlson score, mean (SD)1.8 (2.1)0.6 (1.1)0.7 (1.2)0.2 (0.4)Gastroenterological comorbidities26.1% (6)22.1% (15)6.7% (1)0Hepatic comorbidities17.4% (4)2.9% (2)13.3% (2)0Hematological conditions8.7% (2)2.9% (2)13.3% (2)0Cardiovascular comorbidities60.9% (14)32.4% (22)33.3% (5)60.0% (3)Neurological and psychological comorbidities8.7% (2)17.6% (12)33.3% (5)0Metabolic comorbidities21.7% (5)7.4% (5)26.7% (4)40.0% (2)Osteoporosis43.5% (10)11.9% (8)6.7% (1)20.0% (1)Lung diseases21.7% (5)8.8% (6)040.0% (2)Skin diseases26.1% (6)26.5% (18)80.0% (12)20.0% (1)Eye diseases8.7% (2)23.5% (16)6.7% (1)60.0% (3)Kidney diseases13.0% (3)10.3% (7)040.0% (2)

Conclusion

Comorbidity had no influence on the biosimilar retention rate after 6 months in this study but the majority of patients did not have Charlson scores > 0. However, disease activity and physical function tended to be worse among CIRD patients with comorbidity. Cardiovascular disease and osteoporosis were more often present in RA patients than in axSpA or PsA patients, while neurological and psychological comorbidities were more often observed in the latter.

Disclosure of Interests

Imke Redeker: None declared, Stefan Moustakis: None declared, Styliani Tsiami: None declared, Xenofon Baraliakos Speakers bureau: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Paid instructor for: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Consultant of: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Grant/research support from: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Ioana Andreica Speakers bureau: UCB, MSD, Novartis, Abbvie, Lilly, Janssen, SOBI, Consultant of: Lilly, Novartis, Galapagos, Amgen, Takkeda, SOBI, Grant/research support from: Lilly, Bjoern Buehring Speakers bureau: UCB, Amgen, Gilad/Galapagos, Biogen, Sanofi/Genzyme, Consultant of: UCB, Theramex, Gilead/Galapagos, Amgen, Abbvie, Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Grant/research support from: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Uta Kiltz Speakers bureau: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Fresenius, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer.

POS1281 DIFFERENT HUMORAL BUT SIMILAR CELLULAR RESPONSES OF PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES UNDER DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS AFTER COVID-19 VACCINATION

Background

The interplay between humoral and cellular response after vaccination against SARS-CoV-2 in patients (pts.) with autoimmune inflammatory rheumatic diseases (AIRD) remains unknown.

Objectives

To investigate the impact of different immunosuppressive therapies on the development of humoral and cellular immune responses to full 2-dose SARS-CoV-2 vaccination in AIRD pts. with stable low disease activity.

Methods

The immune reactivity to COVID-19 vaccination was investigated in a prospectively recruited AIRD cohort with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis which received a therapy with IL-17i, TNFi, JAKi or MTX (alone or in combination). Almost all patients received mRNA-based vaccine, only 4 patients had a heterologous scheme. Anti-spike(S) antibodies(ab.) and sera neutralizing capacity (neutralization dilution 50; ND50) were measured 4 weeks after the first (prime+4w) and 4 weeks after the second vaccination (boost+4w). Vaccine-specific cellular immunity was evaluated by quantifying expression of activation markers on T cells as well as their production of key cytokines, at prime+4w and boost+4w.

Results

Overall, a total of 92 pts. were included in the final cohort. 31 (33.7%) pts. were on TNFi, 24 (26.1%) on IL-17i, 24 (26.1%) on JAKi, each group encompassing pts. receiving drug inhibitors alone or in combination with MTX.13 (14.1%) were treated with MTX alone. The median time between the vaccination and blood sampling was 31 [IQR: 28-34] days after prime+4w and 28 [IRQ: 28-28] days after boost+4w. Although at prime+4w only 34/90 (37.8%) of pts. presented neutralizing ab., the majority (86/91, 94.5%), developed them at boost+4w. The highest neutralization titer developed the pts. on IL-17i both at prime+4w (74 [IQR: 13-91]) and boost+4w (798 [IQR: 511-1344]), while no statistically significant differences were found in the neutralization titer at boost+4w for the TNFi, JAKi, and MTX groups: 207 ND50 [IQR: 120-576], 319 [IQR: 133-461] and 749 [IQR: 264-1920], respectively. 81/90 (90.0%) pts. developed IgG ab. against SARS-CoV-2 S-protein at prime+4w and 91/92 (98.9%) at boost+4w. Pts. receiving IL-17i developed higher ab. titers (8295 U/mL [IQR: 4586-11,237]) compared to the other three groups: JAKi (4405 U/mL [IQR: 1436-7265], TNFi (2313 [IQR: 1156-3630] U/mL) and MTX (2010 U/mL [IQR: 693-9254]). Neutralization capacity correlated well with the titer of anti-S ab. at both timepoints. Co-administration of biologic/tsDMARDs and MTX led to lower titers compared to biologic/tsDMARDs monotherapy. All therapies left frequencies of CD154+CD137+ CD4+ T cells and CD137+ CD8+ T cells at prime+4w and boost+4w unchanged. Polyfunctionality and T cell cytokine profiles across therapies did not significantly vary at boost+4w.

Conclusion

Even after insufficient seroconversion for neutralizing capacity and ab. response against SARS-CoV-2 S-proteins between pts. of different mod of action agents, particularly for MTX and JAKi after first vaccination, a second vaccination covered almost all pts. regardless of DMARDs therapy, with better outcomes in those on IL-17i. T cell immunity revealed similar frequencies of activated T cells in all modes of action after the second vaccination.

Table 1.

Demographics and therapy

AllIL-17iIL-17i+MTXTNFiTNFi+MTXJAKiJAKi+MTXMTXPatients (n)9219527418613Age (years)50 [39-56]42 [36-53]37 [32-38]51 [42-56]58 [54-61]50 [43-56]55 [49-59]54 [37-64]Female sex46 (50.0%)6 (31.6%)3 (60.0%)10 (37.0%)3 (75.0%)13 (72.2%)3 (50.0%)8 (61.5%)Patients with concomitant glucocorticoids (n)13 (14.1%)1 (5.3%)1 (20.0%)0 (0.0%)0 (0.0%)5 (27.8%)3 (50.0%)3 (23.1%)Prednisolone dosage (mg)5.0 [2.5-5.0]5.0[5.0-5.0]3.0 [3.0-3.0]5.0 [2.5-5.0]2.0 [2.0-4.0]5.0 [4.0-5.0]

IL interleukin, i inhibitor, MTX methotrexate: TNF tumor necrosis factor, JAK janus kinase. For quantitative variables, data are provided as median [IQR], for categorical variables the count (% frequency)

Acknowledgements

We thank all the patients who participated in this study. We thank the study nurses Gordana Brnos and Silke Kunkel for their support in the implementation of the study. We thank Toralf Roch, Sarah Skrzypczyk, Jan Zapka, Julia Kurek and Eva Kohut for their technical assistance

Disclosure of Interests

None declared

AB1114 VACCINATION OF PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: AN ANALYSIS OF BARRIERS AND FACILITATORS IN A PROSPECTIVE COHORT

Background

Patients (pts.) with chronic inflammatory rheumatic diseases (CIRD) are often not adequately protected against infectious diseases. As shown in an earlier study, less than 50% of CIRD pts. were vaccinated against pneumococci and influenza before the SARS-CoV2 pandemic started 1. High vaccination rates are critical to achieve herd immunity. Knowledge on barriers and facilitators of vaccine uptake in CIRD pts. is limited.

Objectives

The aim of this study was to characterize barriers and facilitators towards vaccines in general and specifically against pneumococci, influenza and SARS-CoV-2 in adult CIRD pts.

Methods

In early 2021, consecutive CIRD pts. completed a structured questionnaire including knowledge on vaccination, attitudes, and perceived barriers and facilitators towards vaccination. A total of 12 facilitators and 11 barriers towards vaccination was assessed in general, and specifically for vaccination against pneumococci, influenza and SARS-CoV2. The Likert scales had 4 response options, ranging from 1 (completely disagree) to 4 (completely agree). Patient and disease characteristics, their vaccination history and attitudes towards vaccination against SARS-CoV-2 were assessed.

Results

Of 514 prospectively recruited pts., 441 responded (85.8%) to the questionnaire (table 1). Self-reported vaccine uptake was 48.8% against pneumococci and 66.2% against seasonal influenza. The majority (82.2%) was willing to be vaccinated against SARS-CoV-2. The majority (≥70%) had decent knowledge about vaccination, and only <10% doubted its effectiveness. The level of knowledge did not differ between the studied 3 vaccinations. Pts. were more likely to rate statements about facilitators favorably compared to statements about barriers. Facilitators for SARS-CoV-2 vaccination did not different from vaccination in general (Figure 1). Societal and organizational facilitators such as public vaccine campaigns or protection for high-risk pts. were more commonly named compared to inter- or intrapersonal facilitators. Protection of high-risk pts. was by far the most frequently cited facilitator. Most pts. indicated that they were likely to receive a vaccine if their health care professional would recommend it – without preference for GP or rheumatologist. The frequency of barriers was much lower compared to facilitators and more barriers towards SARS-CoV-2 vaccination were reported in comparison to vaccination in general or pneumococci and influenza, respectively. However, pts. frequently cited intrapersonal issues as barriers against vaccination. Importantly, the major barrier was an inadequate risk perception between the severity of COVID-19 and the potential adverse events of the vaccine.

Table 1.

Patient and disease characteristics

Age, y54.1 (12.6)Women, No. (%)272 (61.7)Rheumatoid Arthritis, No. (%)156 (35.4)Axial Spondyloarthritis, No. (%)120 (27.2)Psoriatic Arthritis, No. (%)61 (13.8)Other diagnoses, No. (%)104 (23.6))Treatment, csDMARD, No. (%)121 (27.4)Treatment, bDMARD, No. (%)280 (63.5)Treatment, tsDMARD, No. (%)24 (5.4)CDAI, n=19411.1 (9.0)CRP, mg/L, n=4400.4 (0.7)HAQ score, n=3171.1 (0.7)BASDAI, n=1183.8 (2.2)BASFI, n=1183.8 (2.3)Patient global, NRS 0-104.1 (2.5)HADS-A, n=4366.6 (4.0)HADS-D, n=4365.8 (4.3)

variables as mean (SD)

Figure 1.

Facilitators of vaccine uptake in general and for SARS-CoV-2

Conclusion

A relatively high number of pts. was vaccinated against pneumococci and influenza, – a probable campaign success during the last years. In addition, more than 80% of pts. were willing to be vaccinated against SARS-CoV2. Facilitators were of greater significance than barriers in this scenario. The high number of societal and organizational facilitators enables the implementation of effective strategies to increase future vaccination rates.

References

[1]Kiltz et al. RMD Open 2021

Disclosure of Interests

Ioana Andreica Speakers bureau: UCB, MSD, Novartis, Abbvie, Lilly, Janssen, Sobi, Consultant of: Novartis, Lilly, Sobi, Galapagos, Amgen, Takeda, Grant/research support from: Lilly, Iulia Roman: None declared, Xenofon Baraliakos Speakers bureau: Abbvie, Lilly, Pfizer, UCB, MSD, Novartis, Galapagos, Hexal, Paid instructor for: Abbvie, Lilly, Pfizer, UCB, MSD, Novartis, Galapagos, Hexal, Consultant of: Abbvie, Lilly, Pfizer, UCB, MSD, Novartis, Galapagos, Hexal, Grant/research support from: Abbvie, MSD; Novartis, Lilly, Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, FResenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Pfizer, UCB, Novartis, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, FResenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Pfizer, UCB, Novartis, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, Hexal, Janssen, Lilly, MSD, Pfizer, UCB, Novartis, Uta Kiltz Consultant of: AbbVie, Chugai, Eli Lilly, Fresenius, Hexal, Janssen, MSD, Novartis, onkowissen.de, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Hexal, Fresenius, Novartis und Pfizer.

AB1402 FACILITATORS AND BARRIERS OF VACCINE UPTAKE IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE: A SCOPING REVIEW

Background

Patients with chronic inflammatory rheumatic diseases (CIRD) remain underrepresented in receiving vaccinations despite being disproportionately affected by infectious complications.

Objectives

To systematically review the literature regarding vaccination willingness and vaccination hesitancy in CIRD patients with focus on the perspective of patients and physicians.

Methods

A scoping review was conducted in PUBMED, EMBASE and the Cochrane Library through 2021. Study selection was performed by two independent reviewers, data were extracted using a standardized form and risk of bias was assessed using instruments from the McMaster University. Identified barriers and hurdles were synthesized by categorizing them into the WHO’s Measuring Behavioural and Social Drivers of Vaccination (BeSD) conceptual model.

Results

The search yielded 1,644 hits, of which 30 were included (cross-sectional studies (n=27) based on interviews and 3 intervention studies). The majority of studies reported barriers to influenza and pneumococcal vaccination (n=11), or influenza vaccination only (n=9) from the patients perspective. Two studies assessed the attitudes towards COVID-19 vaccinations. Only one study assessed the view of rheumatologists. Patients mainly mentioned behavioral and social factors that negatively influence their willingness to be vaccinated while physicians see deficits in the organization and lack of time as a major barrier. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians (Figure 1).

Figure 1.

Coverage of domains matched to the WHO BeSD Model

Conclusion

The view of vaccination in CIRD patients diverges between patients and rheumatologists. Our results show that in-depth counseling on vaccines is important for patients, whereas physicians need support in implementing specific immunization recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in CIRD patients.

Disclosure of Interests

None declared

AB1452 EVALUATION OF HEPATITIS E VIRUS INFECTION DURING JAK INHIBITOR THERAPY IN AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES

Background

Although impacting hundreds of thousands of people in Western nations each year, hepatitis E virus (HEV) is an under-reported health problem (1). HEV usually is a self-limiting disease, but especially immunocompromised individuals are at risk to develop a chronic course of infection, with rapid progression to fibrosis, cirrhosis or even the development of liver failure. Janus kinase (JAK) inhibitors are a novel drug class for the treatment of autoimmune inflammatory rheumatic disease (AIRD). As JAKs play a key role in innate immunity, viral infections and reactivation are frequently reported during JAK inhibitor treatment in AIRD patients (2).

Objectives

To characterize the influence of JAK inhibitors on HEV replication ex vivo and assess the risk for the development of symptomatic HEV infection during JAK Inhibitor therapy in vivo.

Methods

To determine the effect of JAK inhibitors on HEV replication we performed infection experiments with primary human hepatocytes (PHH) followed by immunofluorescence analysis and RNAseq. To evaluate the risk of HEV infection during JAK Inhibitor therapy, we monitored HEV RNA and HEV IgG/IgM of 111 AIRD patients, receiving JAK inhibitors. Moreover, we conducted a retrospective analysis of liver enzymes of patients which were anti-HEV IgG/IgM positive.

Results

Transcriptomic analysis of PHH revealed an upregulation of innate immunity components during HEV infection. This induction was perturbed in the presence of a JAK inhibitor, concomitant with strong elevation of HEV RNA levels. In line, infection experiments displayed an up to 50-fold increase of progeny virus production during JAK inhibitor treatment indicating that JAK signaling is critical to control HEV infection. Monitoring of seroprevalence identified 17 patients which were anti-HEV IgG and/or IgM positive, while no patient hat detectable HEV RNA levels. Five patients had detectable anti-HEV IgM levels suggesting a recent HEV infection. Three of 17 had a period with elevated liver enzymes (f.e. GGT> 200 U/L) during time of retrospective analysis (ranging from 10 to 23 months).

Conclusion

Obtained ex vivo data suggest that JAK inhibition facilitates HEV life cycle progression. Considering that JAK inhibitors are routinely applied for the treatment of AIRD, these patients may be at higher risk for a symptomatic course and outcome of HEV infection. In addition to established protocols, screening for HEV seroprevalence and HEV RNA should be considered prior starting JAK inhibitor treatment and in case of elevated liver enzymes during JAK inhibitor therapy.

References

[1]Faber M., Willrich N., Schemmerer M., Rauh C., Kuhnert R., Stark K., Wenzel J.J. Hepatitis E virus seroprevalence, seroincidence and seroreversion in the German adult population. J. Viral Hepat. 2018;25:752–758.

[2]Winthrop KL. The emerging safety profile of JAK inhibitors in rheumatic disease. Nat Rev Rheumatol. 2017;13:234–243.

Disclosure of Interests

None declared

AB0184 IDENTIFYING TRAJECTORIES OF REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED IN A TERTIARY CARE CENTRE

Background

The main goal of treatment for patients (pts) with rheumatoid arthritis (RA) is remission to preserve physical function and prevent radiographic damage. However, less than 50% of pts with early RA have achieved remission in clinical studies and inception cohorts 1. Little is known about the course of disease and the clinical patterns when remission is tried to be achieved in pts with RA.

Objectives

To identify subgroups with distinct trajectories of DAS28-CRP in pts with RA.

Methods

Longitudinal data from adult RA pts presenting to a tertiary centre were used. Socio-demographic data, disease characteristics and standard assessments including established outcome parameters for disease activity (DAS28-CRP) and physical function (FFbH) were retrospectively analysed. Group-based trajectory modelling (GBTM) was used to identify homogeneous classes of DAS28-CRP trajectories, where the number of classes was selected using Nagin’s Bayesian information criterion (BIC). Differences between the identified classes and clinical variables were studied.

Results

Data of 134 pts with 849 DAS28-CRP values were analysed. Retrospective chart data were available for a follow-up of 33.7 (SD 18.0) months. One third of pts already had erosions and severe limitations in physical functioning. About half of the pts were on bDMARDS and <20% on steroids. Five distinct classes of DAS28-CRP trajectories were identified (Figure 1). These groups were subsequently categorized as 1) high-increasing, 2) high-stable, 3) low-increasing, 4) low-decreasing disease activity, and 5) remission. Pts.’ characteristics at baseline in each trajectory group are shown in Table 1. Group 4 had a shorter disease duration but more erosions, a better function and a higher educational level than seen in other groups. The increase of disease activity in group 3 was modest.

Table 1.

Patients demographics and disease characteristics at baseline in trajectory groups

Class 1(N=10)Class 2(N=36)Class 3(N=56)Class 4(N=23)Class 5(N=9)Age, years65.8 (12.7)60.6 (10.6)56.7 (16.0)50.5 (15.4)56.8 (12.0)Gender, female80.0% (N=8)77.8% (N=28)82.1% (N=46)52.2% (N=12)66.7% (N=6)Education level university0.0% (N=0)11.1% (N=4)16.1% (N=9)21.7% (N=5)0.0% (N=0)Employment10.0% (N=1)33.3% (N=12)53.6% (N=30)69.6% (N=16)33.3% (N=3)Body mass index30.6 (5.4)27.8 (4.3)27.1 (4.7)25.2 (4.2)29.0 (6.4)Symptom duration, years12.8 (7.3)10.4 (8.3)9.5 (9.6)6.7 (3.6)12.4 (13.2)Anti-CCP49.2 (63.9)101.3 (89.7)98.6 (95.6)94.9 (78.2)114.5 (84.6)CRP1.0 (1.1)0.7 (0.9)0.4 (0.4)0.4 (0.5)1.2 (1.1)Erosions20.0% (N=2)36.1% (N=13)28.6% (N=14)45.5% (N=10)44.4% (N=4)At least one Comorbidity100.0% (N=10)94.4% (N=34)78.6% (N=44)65.2% (N=15)88.9% (N=8)Charlson Comorbidity Index (0-29)1.1 (1.4)1.1 (1.3)0.6 (0.9)0.4 (0.7)1.2 (1.3)No. of patients on steroids0.0% (N=0)0.0% (N=0)2.9% (N=1)15.4% (N=2)0.0% (N=0)No. of patients on bDMARD77.8% (N=7)45.8% (N=11)41.2% (N=14)30.8% (N=4)71.4% (N=5)No. of patients on tsDMARD0.0% (N=0)0.0% (N=0)5.9% (N=2)7.7% (N=1)0.0% (N=0)Pain (NRS 0-10)6.1 (1.8)5.8 (1.8)4.2 (2.0)2.3 (2.6)4.2 (2.0)Patient Global (NRS 0-10)5.8 (2.8)5.3 (1.7)3.7 (2.1)2.8 (3.0)6.3 (2.2)DAS28-CRP5.3 (1.2)3.9 (0.7)2.5 (0.7)2.1 (1.0)4.6 (0.9)FFbH38.5 (29.0)48.8 (21.8)74.2 (18.9)90.4 (8.8)61.1 (19.4)RAID (0-10)6.5 (2.0)5.3 (2.1)3.8 (1.9)1.8 (1.8)4.6 (1.8)Figure 1.

Longitudinal DAS-28-CRP in trajectory groups

Conclusion

Using GBTM five distinct trajectories in pts with RA were identified. Only a small proportion of pts showed a reduction in disease activity over time, whereas the largest proportion of pts showed rather constant high or constant low disease activity. The cohort size may have impacted the modelling and further analyses in larger cohorts are needed. Importantly, even though well established in our hospital it is unclear how consequent the T2T strategy was followed and which intervention was successful to reach remission. The impact of pts global assessment on DAS28 values also needs further study.

References

[1]Nikiphorou Rheumatol 2020

Disclosure of Interests

None declared

AB0823 TREATMENT WITH ADALIMUMAB IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A STUDY OF TREATMENT TRAJECTORIES ON A PATIENT LEVEL IN CLINICAL PRACTICE

Background:

There is evidence that drug retention rates to adalimumab (ADA) in patients (pts.) with chronic inflammatory rheumatic diseases (CIRD) are impaired by loss of efficacy and adverse events, and that about 50% of users had discontinued ADA within 5 years (1). With the introduction of ADA biosimilars in October 2018, non-medical switching from originator to ADA biosimilars is now increasingly part of daily practice in rheumatologic care.

Objectives:

The aim was to study treatment trajectories over two years in pts. with CIRD receiving originator ADA.

Methods:

Pts. with CIRD on originator ADA who switched to ADA biosimilar from October 2018 onwards were identified and followed until 2020. Disease activity (ASDAS), physical function (HAQ, BASFI), and changes in treatment were documented every 3 months. The four predefined treatment trajectories “continued ADA biosimilar therapy”, “back-switch to originator ADA therapy”, “switch to other biological (b) disease modifying anti-rheumatic drug (DMARD) therapy”, and “stopped bDMARD therapy /death /drop out” were used to compare characteristics of pts. with different trajectories.

Results:

A total of 111 CIRD pts. on treatment with originator ADA were switched to ADA biosimilar (Table 1). The majority of pts. 75 continued therapy with ADA biosimilar (Figure 1 next page) while 16% switched back to originator ADA, 7% switched to a different bDMARD, and 9% either stopped treatment (n=9) or died (n=1). Pts. who continued ADA biosimilar were more frequently male, older or with a longer disease duration than those who switched therapy back to originator ADA and those who switched to a different bDMARD (Table 1). The previous duration on originator ADA treatment was increased in patients who continued ADA biosimilar compared to those who switched therapy back to originator ADA and those who switched to a different bDMARD. There was more functional impairment (HAQ, BASFI) and higher disease activity (ASDAS) in pts. who switched compared to those who continued ADA biosimilar therapy (Table 1). Treatment with csDMARDs and glucocorticoids was increased in pts. who continued ADA biosimilar therapy, while pts. who switched therapy had more previous bDMARD therapies (Table 1).

Table 1.

Characteristics of patients at baseline for the entire group and stratified by treatment trajectory

Total groupN=111 (100%)Treatment trajectorycontinued ADA biosimilar therapyN=75 (67.6%)back-switch to originator ADA therapyN=18 (16.2%)switch to different bDMARD therapyN=8 (7.2%)no bDMARD therapy /death /drop outN=10 (9.0%)Age, y51.2 (14.5)51.5 (13.6)50.6 (16.8)43.5 (9.5)56.4 (19.0)Women, No. (%)46 (41.4)27 (36.0)9 (50.0)6 (75.0)4 (40.0)RA23 (20.7)17 (22.7)2 (11.1)1 (12.5)3 (30.0)axSpA68 (61.3)47 (62.7)11 (61.1)6 (75.0)4 (40.0)PsA15 (13.5)7 (9.3)4 (22.2)1 (12.5)3 (30.0)Other diagnoses5 (4.5)4 (5.3)1 (5.6)0 (0.0)0 (0.0)Disease duration, median (IQR), y5.0 (2.0-8.0)5.0 (2.0-9.0)3.5 (2.0-6.0)2.0 (1.0-5.5)4.5 (2.0-8.0)Duration previous originator ADA therapy40.7 (27.7)45.3 (27.8)35.0 (25.2)20.3 (24.7)32.3 (25.1)DAS283.0 (1.0)2.9 (1.0)3.4 (1.0)-3.3 (1.2)CRP, median (IQR), mg/L0.2 (0.1-0.3)0.1 (0.1-0.2)0.2 (0.0-0.5)0.2 (0.2-1.3)0.3 (0.2-0.4)HAQ score1.3 (0.8)1.1 (0.7)1.7 (0.8)-1.8 (1.0)ASDAS2.2 (1.1)2.0 (1.0)3.0 (1.2)2.7 (0.9)2.3 (0.2)BASFI3.5 (2.6)3.0 (2.5)5.4 (2.4)3.4 (1.6)5.4 (1.6)

+values are given as mean (SD)

Conclusion:

Two thirds of pts. who switched to ADA biosimilar remained on this therapy for 2 years. As many as 16% of pts. switched back to ADA originator. Whether or to what degree this was influenced by nocebo effects needs further study. The same is true for the effect of functional impairment – it would be interesting to know whether this was due to inflammation or structural damage.

References:

[1]Neovius M et al. Ann Rheum Dis 2015; 74:354-360

[2]The study was funded by Hexal Germany.

Figure 1.

Treatment trajectories of ADA therapy in patients with CIRD during two years ADA: adalimumab; bDMARD: biological disease modifying anti-rheumatic drug.

Disclosure of Interests:

None declared

POS0301 NO MAJOR DIFFERENCES BETWEEN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE WHO UNDERWENT MONO- OR MULTISWITCHING OF BIOSIMILARS IN ROUTINE CARE (PERCEPTION STUDY)

Background:

The increasing availability of biosimilars (bsDMARDs) has created a financial incentive to encourage switching to cheaper products (“non-medical switch”) leading to different switching scenarios. While the clinical efficacy and safety of multiswitching seems to be established (1), limited data on patients’ knowledge about bsDMARDs and satisfaction with care are available.

Objectives:

The aim of our study was to learn more about the outcome of mono- and multiswitching scenarios in routine care with respect to patients’ attitudes towards bsDMARDs in chronic inflammatory rheumatic diseases (CIRD) such as rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).

Methods:

Consecutive patients with CIRD who were planned to switch treatment of one adalimumab biosimilar (ADA-bsDMARD) to another ADA-bsDMARD were recruited. The number of previous ADA-bsDMARD categorized the patients into: monoswitch = 1 and multiswitch = >1. Demographics and standard assessments using validated outcome parameters for disease activity, physical function, and patient satisfaction with care (Leeds Satisfaction Questionnaire (LSQ) were documented. LSQ contains items on five subscales (provision of information; empathy with the patient; attitude to the patient; access to and continuity with the care giver; and technical competence) and a general satisfaction scale. Knowledge about bsDMARDs was recorded using a structured questionnaire.

Results:

Out of 90 patients in total, there were 42 with a monoswitch and 48 with a multiswitch scenario (Table 1). Patients were satisfied with care irrespective of the switching scenario. However, the knowledge about bsDMARDs was generally rather low (Figure 1). Less than one third of patients was able to identify correct answers about manufacturing, efficacy/safety issues, approval status and costs of bsDMARDs. However, when comparing the two switch scenarios, no differences in disease characteristics nor in satisfaction with care were found. Also the number of switches had not increased the knowledge about bsDMARDs.

Table 1.

Patients and disease characteristics stratified by switch scenario

Variables*Monoswitch (n=42)Multiswitch (n=48)P-WertSex, male, n (%)23 (54.7)26 (54.2)Age, years44 (14)51 (11)Rheumatoid Arthritis, n (%)14 (33.3)7 (14.6)Axial Spondyloarthritis, n (%)23 (54.8)31 (64.6)Psoriatic arthritis, n (%)5 (11.9)10 (20.8)Disease duration, years9.2 (2.5)10.6 (6.7)0.48DAS282.2 (1.2)2.9 (0.7)0.13HAQ1.2 (0.6)1.2 (0.5)0.91ASDAS2.1 (1.2)1.6 (1)0.70BASFI4.6 (2.9)3.7 (2.9)0.87Patient satisfactionLSQ-General (1-5) #3.7 (0.7)3.9 (0.6)0.58LSQ-Information (1-5)3.7 (0.6)3.6 (0.4)0.20LSQ-Empathy (1-5)3.6 (0.6)3.5 (0.5)0.57LSQ-Technical (1-5)4.1 (0.5)4.1 (0.5)0.51LSQ-Attitude (1-5)3.8 (0.7)3.9 (0.5)0.62LSQ-Access (1-5)3.7 (0.6)3.8 (0.6)0.70

*values in mean (SD)

# values of 1 indicate dissatisfaction

Conclusion:

This study shows that multiswitching did not lead to reduced satisfaction with care in patients on treatment with bsDMARDs. Especially, the number of switches did have no negative impact on patients satisfaction. The observation that patients who underwent multiple switches had no more knowledge about bsDMARDs than patients who just had one switch may just be explained by the positive experience most patients had with switching.

References:

[1]Kiltz U et al. Ann Rheum Dis 2020;79 (supplement 1):1872

Figure 1.

Knowledge about biosimilars bsDMARDs: biosimilar disease-modifying anti-rheumatic drugs

Disclosure of Interests:

None declared

POS0055 SARS-COV-2 OUTBREAK IN AUTOIMMUNE DISEASES: THE EURO-COVIMID STUDY

Background:

Coronavirus disease 2019 (COVID-19), has raised several questions in patients with immune-mediated inflammatory diseases (IMID). Whether the seroprevalence and factors associated with symptomatic COVID-19 are similar in IMID patients and in the general population is still unknown.

Objectives:

To assess the serological and clinical prevalence of COVID-19 in European IMID patients, along with the factors associated with its risk and the impacts the pandemic had on the IMID management.

Methods:

Prospective multicentre cross-sectional study among patients with five IMID (i.e. systemic lupus erythematous, Sjögren’s syndrome, rheumatoid arthritis, axial spondylarthritis or giant cell arteritis) from six tertiary-referral centers from France, Germany, Italy, Portugal, Spain and United Kingdom. Demographics, comorbidities, IMID, treatments, flares and COVID-19 details were collected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological tests were systematically performed.

Results:

Between June 7 and December 8, 2020, 3028 patients were included (median age 58 years, 73.9% females). SARS-CoV-2 antibodies were detected in 166 (5.5%) patients. Symptomatic COVID-19 was seen in 122 patients (prevalence: 4.0%, 95% CI 3.4-4.8%); 23 (24.2%) of them were hospitalized and four (3.2%) died. In multivariate logistic regression analysis, symptomatic COVID-19 was more likely to be observed in patients with higher levels of C-reactive protein (OR: 1.18; 95% CI 1.05-1.33; p = 0.006), and increased with the number of IMID flares (OR: 1.27; 95% CI 1.02-1.58; p = 0.03). Conversely, it was less likely to occur in patients treated with biological therapy (OR: 0.51; 95% CI 0.32-0.82; p = 0.006). During the pandemic, at least one self-reported disease flare was seen in 654 (21.6%) patients. Also, 519 (20.6%) patients experienced changes in their treatment, with 125 of these (24.1%) being due to COVID-19.

Conclusion:

The SARS-CoV-2 prevalence in IMID patients over the study period seems to be similar to that of the general population1. The IMID inflammatory status seems to be independently associated with the development of COVID-19.

References:

[1]Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Hernán MA, Pérez-Olmeda M, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet Lond Engl. 2020 Aug 22;396(10250):535–44.

Disclosure of Interests:

None declared.

AB0684 LESS THAN 20% OF PATIENTS WITH A CHRONIC INFLAMMATORY RHEUMATIC DISEASE CHANGED THEIR IMMUNOSUPPRESSIVE MEDICATION BECAUSE OF THE COVID 19 PANDEMIC

Background:

The best treatment options of patients with chronic inflammatory rheumatic diseases (CIRD) in the pandemic have not been completely clear, especially in the beginning of the lockdown. Whether and to which degree pandemic-related therapy changes have occurred, has not been studied in detail.

Objectives:

To study the behaviour of patients with CIRD initially facing the COVID 19 pandemic related to their disease status and medication.

Methods:

Patients with CIRD were contacted by telephone to assess their health status and ask for changes in medication. Standardized assessment tools were used to assess disease activity, depression and anxiety. High disease activity was assumed if RADAI-5 ≥ 3.2 and BASDAI ≥ 4. Anxiety (HADS-A) and depression (HADS-D) of patients were assessed using HADS. A score < 8 was taken as indication of no major problem in this regard.

Results:

A total of 886 patients was interviewed between April 15 and June 15 of 2020. Here we report on 550 patients with complete information on standard assessments (62%). About 60% were female, mean age 54.4±13.7, mean disease duration 12.2±10.5 years. Most had spondyloarthritis (SpA, n=287) including axial SpA (axSpA, n=172) and psoriatic arthritis (PsA, n=116), in total 52.2%, while 40.2% had rheumatoid arthritis (RA, n=221), and 7.6% connective tissue diseases (CTD, n=42). Most RA patients were on methotrexate (48.8%), while 43.8% took glucocorticoids. In addition, 61.0% of patients were on bDMARDs, mostly on TNF inhibitors (59.6%). More SpA than RA patients were on bDMARDs: 71.0% vs 49.7% respectively. A recent change in medication was reported by 182 patients (33.1%): 89 with RA (40.2%), 88 with SpA (30.6%) and 5 with CTD (11.9%). Half of those who changed (n=92; 50.5%) admitted that the change was mainly made due to fear of the pandemic (16.7% of all patients). Altogether, significantly more patients changed bDMARDs (68.5%) than csDMARDs (57.3%). The data of patients who changed vs patients who didn’t change is shown in the Table 1, including subgroup analyses. The median HADS scores were < 8.

Table 1.

RA and SpA patients who changed and who did not change their medication

Group (N) / ReasonNActive disease (%)HADS-D≥ 8 (%)HADS-A≥ 8 (%)bDMARD therapy (%)Rheumatoid arthritis221134 (60.6)76 (35.0) [4]94 (43.3) [4]110 (50.9) [5]Spondyloarthritis287130 (45.4)83 (29.5) [6]109 (38.8) [6]204 (72.6) [6]  Pa (RA vs SpA)<0.0010.2280.354<0.001Patients did not change their medication Rheumatoid arthritis (%)132 (59.7)84 (63.6)46 (35.9) [4]58 (45.3) [4]62 (48.4) [4] Spondyloarthritis (%)199 (69.3)88 (44.2)58 (30.1) [6]69 (35.8) [6]137 (71.0) [6]  P (RA vs SpA)0.031<0.0010.3580.101<0.001Patients changed their medication Rheumatoid arthritis89 (40.3)50 (56.2)30 (33.7)36 (40.4)48 (54.5) [1]  P (vs no change)0.3310.8460.5670.457  Reason[9] Pandemic41 (51.3)15 (36.6)11 (26.8)14 (34.1)24 (60.0) [1] Inactive disease23 (28.8)12 (52.2)6 (26.1)10 (43.5)12 (52.2) Active disease b16 (20.0)14 (87.5)6 (37.5)7 (43.8)7 (43.8)  P (reasons)0.0030.6870.6870.526 Spondyloarthritis88 (30.7)42 (47.7)25 (28.4)40 (45.5)67 (76.1)  P (vs no change)0.6730.8890.1570.451  Reason[6] Pandemic50 (61.0)22 (44.0)13 (26.0)22 (44.0)42 (84.0) Inactive disease15 (18.3) 7 (46.7)4 (26.7)7 (46.7)10 (66.7) Active disease b17 (20.7)11 (64.7)6 (35.3)6 (35.3)11 (64.7)  P (reasons)0.3310.7560.7740.156  P (RA vs SpA)0.0310.2940.9500.6030.004

Data are presented as numbers (percentage proportions; across rows except for column N) or medians (interquartile ranges). Missing values are in square brackets.

a P values calculated using χ2 test or Mann-Whitney rank sum test.

b Self-reported claim of disease activity.

Conclusion:

Two thirds of patients did not change medication but one third changed. A relatively high number of patients did so due to fear of the pandemic, mostly those on biologics. There were no major differences between RA and SpA. Anxiety and depression do not seem to play an important role for the decision to change medication (Table 1 below).

Disclosure of Interests:

None declared

[Standardized documentation of health-related quality of life in patients with psoriatic arthritis : Validation of the German version of the psoriatic arthritis quality of life (PsAQoL) questionnaire]

BACKGROUND

The standardized assessment of health-related quality of life is becoming increasingly more important. The English questionnaire on psoriatic arthritis quality of life (PsAQoL) is a disease-specific instrument for measuring the quality of life of patients with psoriatic arthritis (PsA). The aim of the present study was to translate the PsAQoL into German and to validate the German version in a cohort of PsA patients recruited from routine care.

METHOD

The translation and validation of the PsAQoL questionnaire was carried out in a stepwise procedure involving affected patients with PsA. After translation of the original English questionnaire the German version was evaluated in a field test. The psychometric features of the questionnaire were then examined in a PsA cohort from routine care. In addition to the construct and group validity, the reliability of the questionnaire was tested using test-retest reliability and internal consistency. The physical functioning was measured with the health assessment questionnaire (HAQ) and domains of the quality of life with the Nottingham health profile (NHP).

RESULTS

In a field test with 10 patients the German version of the PsAQoL questionnaire proved to be relevant, easily understandable and feasible (processing time 4.7 ± 2.1 min). A total of 126 patients (37.3% male, age 55.6 ± 11.3 years) were included in the validation cohort. The PsAQoL showed moderate correlation with the HAQ (r = 0.65) and moderate to good correlation with the NHP (subdomains r = 0.58-0.75). The internal consistency was high (Cronbach's α 0.92) and reliability in patients with stable disease course was very good (Spearman correlation coefficient 0.94). The PsAQoL can differentiate between different patient groups.

CONCLUSION

The German translation of the PsAQoL provides a valid disease-specific instrument for the standardized assessment of health-related quality of life in patients with PsA. The psychometric characteristics of this questionnaire are comparable with the original English version. The German PsAQoL can therefore be recommended for clinical and scientific application.

[How well are patients with inflammatory rheumatic diseases protected against measles?]

Hintergrund

Patienten mit entzündlich rheumatischen Erkrankungen haben aufgrund ihrer Autoimmunerkrankung, aber auch bedingt durch die immunsuppressive Medikation ein erhöhtes Infektrisiko. Obwohl Impfungen in der Primärprophylaxe von Infektionen bekanntermaßen effektiv sind, ist die Impfrate in Deutschland generell zu niedrig. Wegen des zuletzt zunehmenden, teils epidemieartigen Auftretens von Masern ist die Lebendimpfung gegen Masern in Deutschland seit Kurzem gesetzlich vorgeschrieben.

Fragestellung

Wie viele Patienten mit entzündlich rheumatischen Erkrankungen sind aktuell ausreichend gegen Masern geschützt?

Methode

Patienten mit entzündlich rheumatischen Erkrankungen des Rheumazentrums Ruhrgebiet wurden zwischen Dezember 2017 und Oktober 2018 prospektiv und konsekutiv eingeschlossen. Dabei wurden Daten zu Erkrankung und Therapie auf Ebene von Substanzklassen sowie die Impf- und Infektanamnese erhoben. Alle Angaben zu Impfungen wurden im Impfpass kontrolliert. Antikörpertiter gegen Masern wurden mit ELISA bestimmt. Als Schwellenwert für einen ausreichenden Schutz gegen Masern wurden 150 mIU/ml festgelegt.

Ergebnis

Von 975 Patienten konnten 540 (55,4 %) einen Impfausweis vorlegen. Bei 201 Patienten mit Ausweis (37,2 %) lagen dokumentierte Impfungen seit Geburt vor. Insgesamt hatten 45 von 267 nach 1970 geborene Patienten (16,9 %) einen suffizienten Impfschutz gegen Masern. Die anamnestischen Angaben zu einer Masernerkrankung in der Kindheit differenzierten nicht zwischen Patienten mit und ohne protektiven Masern-IgG-Antikörpern. Protektive Masern-IgG-Antikörper wurden bei 901 Patienten von 928 Patienten mit Messung der Masern-IgG-Antikörperspiegel (97,1 %) nachgewiesen. Die unterschiedlichen Wirkprinzipien der aktuellen immunsuppressiven Therapie hatten darauf keinen Einfluss.

Diskussion

Diese Daten zeigen, dass mindestens 2,9 % der Patienten keinen ausreichenden Schutz gegen Masern haben. Interessanterweise hatte die Mehrheit der nach 1970 geborenen Patienten protektive Antikörper trotz fehlenden Impfschutzes gegen Masern. Die Anstrengungen sowohl im primär- als auch im fachärztlichen Bereich sollten dringend verstärkt werden, um eine adäquate Infektionsprophylaxe bei besonders gefährdeten Patienten gewährleisten zu können.

SAT0579 SYSTEMATIC GERIATRIC ASSESSMENT IN OLDER PATIENTS WITH RHEUMATIC DISEASES - THE RheuMAGIC PILOT STUDY

Background:

Current demographic data predict that the number of older adults with rheumatic diseases will considerably increase in the coming years. Geriatric patients differ from younger adults in many ways including their clinical presentation, co-morbidities and response to medication. The management of such patients is often challenging due to the presence of multi-morbidity, polypharmacy and geriatric syndromes (i.e. conditions in which symptoms result from impairments in multiple systems rather than a discrete disease). To systematically assess geriatric patients, specific tools have been developed; however, they are not routinely utilized by rheumatologists. Using these tools could improve patient management and satisfaction in rheumatologic care.

Objectives:

To examine the prevalence of 17 common geriatric health problems using validated geriatric assessment tools in older patients with rheumatic and musculoskeletal diseases.

Methods:

Adults 65 years and older who presented to a tertiary rheumatologic hospital were included after informed consent. All patients recruited were assessed using theMAngableGeriatrICAssessment (MAGIC) which addresses 14 common geriatric health problems. In addition, polypharmacy (≥ 5 medication), muscle function using the Short Physical Performance Battery and frailty applying the Fried definition were assessed. Disability was quantified with the “Funktionsfragebogen Hannover” (FFbH), a validated tool for patients with rheumatologic diseases that can be easily converted to Health Assessment Questionnaire (HAQ) scores. Primary outcome was the frequency of the selected 17 geriatric health problems; the correlation of the total number of problems with HAQ scores was a secondary outcome.

Results:

Of the 300 individuals included 67% were female with a mean age of 73±6.6 years; 85% (> 50% with rheumatoid arthritis) had a rheumatologic diagnosis. The remaining participants had either a chronic pain syndrome or degenerative joint/spine disease. On average participants had 7 out of 17 assessed geriatric problems. Females had more such problems than males (8 vs. 6, p<0.0001). Chronic pain and polypharmacy were most common but several others were also seen in more than 50% of patients (see Table). The mean HAQ Score was 1.67±0.79. There was a positive correlation (see Graph) between the number of problems and the HAQ Score (R2= 0.44, p<0.0001).

Conclusion:

A systematic geriatric assessment can be successfully used to discover and quantify geriatric health problems in older patients with rheumatic and musculoskeletal diseases. These problems appear to be very common and importantly, patients with more problems had poorer functional status. Frailty, depression, incomplete vaccination status, cognitive impairment or polypharmacy are all known to negatively impact patient care. Recognizing and addressing geriatric problems has the potential to lead to health care improvements including adherence and medication side effects and might increase patient satisfaction and functional status independent of disease activity.

References:

[1]Buehring, B. and S. Barczi, Assessing the Aging Patient, in Spine Surgery in an Aging Population, N. Brooks and A. Strayer, Editors. 2019, Thieme: New York. p. 208.

[2]Cleutjens F, Boonen A, van Onna MGB. Geriatric syndromes in patients with rheumatoid arthritis: a literature overview. Clin Exp Rheumatol 2019;37(3):496-501

Geriatric Problem% presentProblems with Daily Activities67Problems with Vision28Problems with Hearing38Problems with Falls11Problems with Urinary Incontinence38Problems with Depression57Lack of Social Support10Incomplete Vaccinations53Problems with Cognition31Problems with Chronic Pain90Problems with Dizziness44Problems with Mobility41Problems with Unintentional Weight Loss30Inappropriate Medications present17Polypharmacy present81Frailty present46Short Physical Performance Battery low57

Acknowledgments:

None

Disclosure of Interests:

Anna Berrisch: None declared, Ioana Andreica: None declared, Styliani Tsiami: None declared, David Kiefer Grant/research support from: Novartis, Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Bjoern Buehring Grant/research support from: GE/Lunar, Kinemed, Consultant of: Gilead, Abbvie, Lilly, GE/Lunar, Janssen, Amgen, Speakers bureau: UCB

[Clinical significance of determination of DFS70 antibodies to rule out connective tissue diseases]

BACKGROUND

Connective tissue diseases (CTD) are autoimmune diseases highly associated with the presence of antinuclear antibodies (ANA). Since ANA and musculoskeletal symptoms are not uncommon in the general population, differential diagnostic challenges frequently occur for the treating physician. Dense fine speckled antibodies (DFS70) were recently discovered but their presence appeared to be rare in CTD.

METHODS

In this cross-sectional study a total of 270 patients treated in the Rheumatism Center of the Ruhr Area (Rheumazentrum Ruhrgebiet) were preferentially included, when they were ANA+ (≥1:80). Other autoantibodies and DFS70 antibodies were also investigated. The diagnosis of CTD was confirmed by rheumatologists. The sensitivity, specificity and the positive predictive value of DFS70 antibodies were differentially evaluated for various ANA titers.

RESULTS

In 91 (33.7%) of the ANA+ patients (33.7%) the diagnosis of CTD was confirmed and in 84 (92.3%) the ANA titer was ≥1:160. The DFS70 antibodies were detected in 17 out of 130 ANA+ patients without CTD (13.1%) versus 2 ANA+ patients (2.2%) with CTD (p = 0.027). None of the patients with ANA 1:80 had DFS70 antibodies. The specificity of DFS70 antibodies to detect the absence of CTD was 97.6%, the sensitivity was 13.1% and the positive predictive value was 89.5%. There was almost no effect of the strength of the different ANA titers.

CONCLUSION

It was found that DFS70 antibodies are rarely present in ANA+ patients with CTD but the diagnosis of CTD cannot be reliably ruled out solely by the presence of DFS70 antibodies; however, the high specificity of DFS70 antibodies can be of clinical importance in unclear situations and in cases of anxious patients.