Incidence and clinical manifestations of giant cell arteritis in Spain: results of the ARTESER register

OBJECTIVE

This study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season.

METHODS

We included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged ≥50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season.

RESULTS

We identified 1675 cases of GCA with a mean age at diagnosis of 76.9±8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people ≥50 years with a peak for patients aged 80-84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients.

CONCLUSIONS

This is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year.

Sex differential impact of comorbidities in spondyloarthritis: data from COMOSPA study

OBJECTIVES

To describe and compare the prevalence of comorbidities in female and male patients with spondyloarthritis (SpA) and to assess whether comorbidities had a different impact on disease outcomes in male and female patients.

METHODS

This is a post hoc analysis of the COMOrbidities in SPondyloArthritis study. Differences in comorbidities regarding sex were assessed using logistic regression models. Comorbidities were evaluated for their impact on disease outcomes (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index, European health-related quality of life questionnaire) with linear models, which included sex and comorbidity as explanatory variables and their interaction. Age and treatment with biological synthetic disease-modifying antirheumatic drugs were included as confounders.

RESULTS

We included 3982 patients with SpA (65% male, mean age 43.6 years). Male and female patients with SpA exhibited similar comorbidity profiles, except for a low prevalence of fibromyalgia in males and a higher prevalence of certain cardiovascular risk factors in males (hypertension, dyslipidaemia, renal impairment and ischaemic heart disease). Comorbidities, especially fibromyalgia, correlated with higher disease activity, decreased physical function and reduced health-related quality of life in both sexes. Some comorbidities exhibited sex-specific associations with disease outcomes. Peptic ulcers and high waist circumference had a greater impact on disease activity in females (with a higher impact in BASDAI than in ASDAS). In contrast, osteoporosis had a more pronounced effect on physical function in male patients.

CONCLUSIONS

Comorbidities exert distinct influences on disease activity, physical function and health-related quality of life in male and female patients with SpA. Understanding these sex-specific effects is crucial for improving SpA management, emphasising the importance of assessing disease activity using ASDAS when comorbidities are present to mitigate sex-related disparities in disease assessment.

Specific-cytokine associations with outcomes in knee osteoarthritis subgroups: breaking down disease heterogeneity with phenotyping

BACKGROUND

Despite existing extensive literature, a comprehensive and clinically relevant classification system for osteoarthritis (OA) has yet to be established. In this study, we aimed to further characterize four knee OA (KOA) inflammatory phenotypes (KOIP) recently proposed by our group, by identifying the inflammatory factors associated with KOA severity and progression in a phenotype-specific manner.

METHODS

We performed an analysis within each of the previously defined four KOIP groups, to assess the association between KOA severity and progression and a panel of 13 cytokines evaluated in the plasma and synovial fluid of our cohort's patients. The cohort included 168 symptomatic female KOA patients with persistent joint effusion.

RESULTS

Overall, our analyses showed that associations with KOA outcomes were of higher magnitude within the KOIP groups than for the overall patient series (all p-values < 1.30e-16) and that several of the cytokines showed a KOIP-specific behaviour regarding their associations with KOA outcomes.

CONCLUSION

Our study adds further evidence supporting KOA as a multifaceted syndrome composed of multiple phenotypes with differing pathophysiological pathways, providing an explanation for inconsistencies between previous studies focussed on the role of cytokines in OA and the lack of translational results to date. Our findings also highlight the potential clinical benefits of accurately phenotyping KOA patients, including improved patient stratification, tailored therapies, and the discovery of novel treatments.

Biological and glucocorticoids treatment impair the medium-term immunogenicity to SARS-CoV-2 mRNA vaccines in autoimmune inflammatory rheumatic diseases

BACKGROUND

This study aims to assess the sustained immunological response to the SARS-CoV-2 vaccine in patients with autoimmune inflammatory rheumatic diseases (AIRD) undergoing different treatment regimens.

METHODS

We conducted a prospective observational study involving 157 AIRD patients without prior COVID-19 infection. Treatment regimens included non-treatment or glucocorticoid-only (not-treated/GCs), non-biological drugs, biological therapy, and JAK inhibitors. All participants completed the two-dose vaccine schedule, and 110 of them received an additional booster dose. Serum samples were collected approximately 3-6 months after the second and third vaccine doses to measure antibodies against the Spike protein (antiS-AB) and neutralizing antibodies (nAB) targeting six SARS-CoV-2 variants.

RESULTS

Following the third dose, all patients exhibited a significant increase in antiS-AB (FC = 15, p < 0.0001). Patients under biological therapy had lower titres compared to the non-biological (66% decrease, p = 0.038) and the not-treated/GCs group (62% decrease, p = 0.0132), with the latter persisting after the booster dose (86% decrease, p = 0.0027). GC use was associated with lower antiS-AB levels in the biological group (87% decrease, p = 0.0124), although not statistically significant after confounders adjustment. nABs showed the highest positivity rates for the wild-type strain before (50%) and after the booster dose (93%), while the Omicron variant exhibited the lowest rates (11% and 55%, respectively). All variants demonstrated similar positivity patterns and good concordance with antiS-AB (AUCs from 0.896 to 0.997).

CONCLUSIONS

The SARS-CoV-2 vaccine booster strategy effectively elicited a sustained antibody immune response in AIRD patients. However, patients under biological therapies exhibited a reduced response to the booster dose, particularly when combined with GCs.

Metabolic and inflammatory profiles define phenotypes with clinical relevance in female knee osteoarthritis patients with joint effusion

OBJECTIVES

Osteoarthritis has been the subject of abundant research in the last years with limited translation to the clinical practice, probably due to the disease's high heterogeneity. In this study, we aimed to identify different phenotypes in knee osteoarthritis (KOA) patients with joint effusion based on their metabolic and inflammatory profiles.

METHODS

A non-supervised strategy based on statistical and machine learning methods was applied to 45 parameters measured on 168 female KOA patients with persistent joint effusion, consecutively recruited at our hospital after a monographic OA outpatient visit. Data comprised anthropometric and metabolic factors and a panel of systemic and local inflammatory markers. The resulting clusters were compared regarding their clinical, radiographic and ultrasound severity at baseline and their radiographic progression at two years.

RESULTS

Our analyses identified four KOA inflammatory phenotypes (KOIP): a group characterized by metabolic syndrome, probably driven by body fat and obesity, and by high local and systemic inflammation (KOIP-1); a metabolically healthy phenotype with mild overall inflammation (KOIP-2); a non-metabolic phenotype with high inflammation levels (KOIP-3); and a metabolic phenotype with low inflammation and cardiovascular risk factors not associated with obesity (KOIP-4). Of interest, these groups exhibited differences regarding pain, functional disability and radiographic progression, pointing to a clinical relevance of the uncovered phenotypes.

CONCLUSION

Our results support the existence of different KOA phenotypes with clinical relevance and differing pathways regarding their pathophysiology and disease evolution, which entails implications in patients' stratification, treatment tailoring and the search of novel and personalized therapies.

Validation of N Protein Antibodies to Diagnose Previous SARS-CoV-2 Infection in a Large Cohort of Healthcare Workers: Use of Roche Elecsys® Immunoassay in the S Protein Vaccination Era

The aim of this study was to validate the detection of anti-nucleocapsid protein (N protein) antibodies for the diagnosis of SARS-CoV-2 infection in light of the fact that most COVID-19 vaccines use the spike (S) protein as the antigen. Here, 3550 healthcare workers (HCWs) were enrolled from May 2020 (when no S protein vaccines were available). We defined SARS-CoV-2 infection if HCWs were found to be positive by RT-PCR or found to be positive in at least two different serological immunoassays. Serum samples from Biobanc I3PT-CERCA were analyzed by Roche Elecsys^® (N protein) and Vircell IgG (N and S proteins) immunoassays. Discordant samples were reanalyzed with other commercial immunoassays. Roche Elecsys^® showed the positivity of 539 (15.2%) HCWs, 664 (18.7%) were found to be positive by Vircell IgG immunoassays, and 164 samples (4.6%) showed discrepant results. According to our SARS-CoV-2 infection criteria, 563 HCWs had SARS-CoV-2 infection. The Roche Elecsys^® immunoassay has a sensitivity, specificity, accuracy, and concordance with the presence of infection of 94.7%, 99.8%, 99.3%, and 0.96, respectively. Similar results were observed in a validation cohort of vaccinated HCWs. We conclude that the Roche Elecsys^® SARS-CoV-2 N protein immunoassay demonstrated good performance in diagnosing previous SARS-CoV-2 infection in a large cohort of HCWs.

Uveitis in peripheral spondyloarthritis patients: an ancillary analysis of the ASAS-PerSpA study

Background:

Acute anterior uveitis (AAU) is the most frequent extra-musculoskeletal manifestation in spondyloarhtritis (SpA). Previous data on AAU focused on axial disease; therefore, it is not well known whether the clinical characteristics of patients with AAU and recurrent AAU differ between patients with axial and peripheral SpA.

Objective:

Primary objective was to compare the clinical characteristics of patients with AAU from patients without AAU in axial and peripheral spondyloarthritis (SpA) patients. Secondary objectives were to describe the clinical features of patients with AAU in the subset of patients with peripheral SpA (pSpA) and the clinical characteristics of patients with recurrent AAU in SpA patients.

Design:

This is an ancillary analysis of the ASAS-PerSpA study which included 3152 patients, 2719 patients with axSpA and 433 with pSpA according to rheumatologist judgement.

Methods:

Recurrent AAU was defined as the presence of two or more episodes of AAU ever. Univariable and multivariable binary logistic regression analyses were conducted to identify factors associated with the presence of AAU ever and the presence of recurrent AAU.

Results:

Overall, 663 patients (21%) presented AAU. Of them, 444 (66.9%) presented recurrent episodes. In patients with SpA, HLA-B27 positivity is the most important factor linked to the presence of AAU, odds ratio (OR) = 2.70 (95% CI = 2.04–3.6). In patients with pSpA, HLA-B27 positivity was also the most relevant factor linked to the presence of AAU, OR = 6.08 (95% CI = 2.72–15.68). Moreover, disease duration, younger age and higher body mass index (BMI) were the only factors slightly linked to the presence of recurrent episodes, OR = 1.03 (95% CI = 1.01–1.04), OR = 1.01 (95% CI = 1.00–1.03) and OR = 1.04 (95% CI = 1.01–1.08), respectively.

Conclusion:

HLA-B27 positivity is the most relevant factor linked to AAU risk in SpA patients, and this association is even stronger in those patients with pSpA. Moreover, our study did not find an association between HLA-B27 positivity and recurrent AAU in SpA patients.

A New Paradigm in Parkinson's Disease Evaluation With Wearable Medical Devices: A Review of STAT-ONTM

In the past decade, the use of wearable medical devices has been a great breakthrough in clinical practice, trials, and research. In the Parkinson's disease field, clinical evaluation is time limited, and healthcare professionals need to rely on retrospective data collected through patients' self-filled diaries and administered questionnaires. As this often leads to inaccurate evaluations, a more objective system for symptom monitoring in a patient's daily life is claimed. In this regard, the use of wearable medical devices is crucial. This study aims at presenting a review on STAT-ONTM, a wearable medical device Class IIa, which provides objective information on the distribution and severity of PD motor symptoms in home environments. The sensor analyzes inertial signals, with a set of validated machine learning algorithms running in real time. The device was developed for 12 years, and this review aims at gathering all the results achieved within this time frame. First, a compendium of the complete journey of STAT-ONTM since 2009 is presented, encompassing different studies and developments in funded European and Spanish national projects. Subsequently, the methodology of database construction and machine learning algorithms design and development is described. Finally, clinical validation and external studies of STAT-ONTM are presented.

POS0093 ASSESSMENT OF HISTOLOGICAL FEATURES OF CHRONICITY OF MINOR SALIVARY GLAND BIOPSY IN PATIENTS WITH PRIMARY SJOGREN’S SYNDROME

Background

The origin of the histological chronic inflammation of the salivary gland in patients with primary Sjogren’s Syndrome (pSS) is questionable. It is probably a consequence of both, the evolution of the disease itself and ageing

Objectives

This study aims to evaluate histological data of chronicity of minor salivary gland biopsy with clinical characteristics and time of evolution in a series of patients with pSS.

Methods

A cross-sectional study including 98 subjects fulfilling the ACR-EULAR 2017 classification criteria for pSS. All patients underwent a minor salivary gland biopsy requested as per clinical practice. We collected the age at diagnosis and at biopsy, xeroftalmia and xerostomia evolution time, and stimulated and unstimulated salivary flow as a clinical data. We informed the following features in the minor salivary gland biopsy: the focus score (positive if ≥ 1), atrophy, fibrosis and adiposity all graded in negative, mild, moderate, and severe stages according to pathological criteria.

Results

This study included 98 patients with pSS. the median of all recruited parameters are shown in Table 1. Only 2 patients presented severe fibrosis and adiposity, so we did not consider them for the analysis. Both, the age at diagnosis and at biopsy are significantly higher between none, mild and moderate stages in the three biopsy parameters. The age at biopsy increased in negative, mild, and moderate stages, in median, 10, 9 and 6 years in atrophy, fibrosis and adiposity respectively. Although more evolution time is observed in atrophy and fibrosis regarding classification categories, it does not reach statistical signification. Focus score is associated with atrophy as a high percentage in severe stage shows negative biopsy (78% vs 22%, p = 0.046) while in negative, mild, and moderate atrophy display a positive biopsy (61%, 73% and 64%, respectively). Furthermore, we observe a significant OR of 8.75 [1.7-68] for negative, 6 [1.25-44] in mild and 9.92 [1.8-80] in moderate compared to severe atrophy. Fibrosis and adiposity are not related to focus score. A low unstimulated salivary flow is observed in the atrophy and fibrosis stages, although differences are explained when compared negative with mild and moderate (3.5 vs 2 and 1.4 for atrophy and 3 vs 2 and 1.75 for fibrosis). Regarding adiposity, a lineal statistically significant association is observed for every stage (3.5, 1.65 and 0.7, p< 0.001). No differences in the stimulated salivary flow are shown.

Table 1.

Description of variables included in the study.

CategoriesN(%)Median(IQR)Age at diagnosis(years)55.220 (51.097, 58.407)Age at biopsy (years)57.719 (53.851, 61.333)Xerostomia (months)19.614 (10.480, 35.121)Xeroftalmia (months)21.487 (8.148, 38.735)Focus score (positive)63 (64.3%)USF (ml/15 min)2.000 (1.400, 3.000)SSF (ml/ 5min)4.500 (3.000, 5.000)AtrophyNegative28 (28.7%)Mild37 (38.1%)Moderate23 (23.7%)Severe9 (9.3%)FibrosisNegative29 (30.5%)Mild40 (42.1%)Moderate26 (27.4%)AdiposityNegative39 (41.1%)Mild38 (40%)Moderate18 (18.9%)

USF: Unstimulated salivary flow, SSF: Stimulated salivary flow

Conclusion

An older age both, at diagnosis and at biopsy are associated with a severe stage of atrophy, fibrosis, and adiposity. Patient with severe atrophy shows less positive focus score, which might be noticed for biopsy interpretation

Disclosure of Interests

None declared

POS0782 ULTRASONOGRAPHIC EVALUATION OF MAJOR SALIVARY GLANDS IN PRIMARY SJOGREN’S SYNDROME: COMPARISON OF THREE SCORING SYSTEMS AND ASSOCIATION WITH BIOPSY RESULTS

Background

Salivary glands ultrasound is an imaging technique useful for primary Sjogren’s syndrome (pSS) diagnosis. Nowadays, the use of ultrasound in diagnostic criteria is not clear. Different scoring systems have been published in recent years.

Objectives

This study aims to compare the reliability between three salivary glands ultrasound (SGUS) scores in a series of patients with pSS. Furthermore, we assessed the association of the three SGUS scores with minor salivary gland biopsy.

Methods

A cross-sectional study including 98 subjects fulfilling the ACR-EULAR 2017 classification criteria for pSS. All patients underwent an ultrasound of the salivary glands and a minor salivary gland biopsy requested as per clinical practice. An experienced Rheumatologist in SGUS evaluated systematically the previously acquired images. This Rheumatologist classified the images using three different scoring systems obtained from the grades of bilateral parotid and submandibular glands: De Vita (0-3), Salaffi (0-4) and Omeract (0-3). These three scores were performed in different days and blinded for the previous scores results. SGUS grade ≥ 2 was considered positive. Positive biopsy was deemed when focus score ≥1. We evaluated the agreement between the three scores and the individual scores with respect to the biopsy.

Results

This study included 98 patients with pSS. The distribution of the different grades according to the score system and the percentage of a positive SGUS are shown in Table 1. The reliability for a positive score for the three evaluated systems was almost perfect, with a Light’s kappa of 0.95 [0.9-1] for the De Vita-Salaffi, 0.87 [0.77-0.97] for De Vita- Omeract and 0.83 [0.71-0.94] for Salaffi-Omeract. We observed a same degree of concordance when the individual parotid and submandibular scores were evaluated. There was only a fair agreement for positivity of SGUS and a positivebiopsy in all scoring systems, specifically De Vita (kappa = 0.27 [0.09-0.45]), Salaffi (kappa = 0.26 [0.06-0.45]) and Omeract (kappa = 0.22 [0.03-0.42]). This associations with a positive biopsy did not change in magnitude when individually evaluated parotid and submandibular glands.

Table 1.

Distribution of the ultrasound grades and the percentage of positive biopsy in the different scoring systems evaluated.

01234Positive scoreVita23312618044(23.5%)(31.6%)(26.5%)(18.4%)(44.9%)Salaffi23291623746(23.5%)(29.6%)(16.3%)(23.5%)(7.1%)(46.69%)Omeract27292316039(28.4%)(30.5%)(24.2%)(16.8%)(41.1%)

Conclusion

The three SGUS scores are reliable for the evaluation of the main salivary glands in pSS. There was only weak agreement for SGUS and biopsy, so these two techniques provides complementary information and currently, SGUS cannot replace the biopsy for diagnosis purposes.

Disclosure of Interests

None declared

POS0796 TREATMENT, ADVERSE EVENTS AND FOLLOW UP IN PATIENTS WITH GIANT CELL ARTERITIS IN THE ARTESER MULTICENTER STUDY

Background

Glucocorticoids (GC) are the mainstay therapy in Giant Cell Arteritis (GCA), initially at high doses (40-60 mg/day) followed by gradual glucocorticoid tapering. This treatment, especially in older patients, is associated with numerous adverse effects (AE). In addition, there are frequent relapses. Therefore, conventional synthetic immunosuppressants such as methotrexate (MTX), leflunomide, azathioprine, cyclophosphamide or mycophenolate, have been used with controversial results. Studies with biological immunosuppressants, such as TNFi have been ineffective; in contrast, tocilizumab (TCZ) has obtained positive results and was approved for the treatment of GCA.

Objectives

In the ARTESER study we describe a) treatment with GC, synthetic or biological immunosuppressants; b) AE of CG; and c) evolution.

Methods

ARTESER is a retrospective observational study sponsored by the Spanish Society of Rheumatology. 26 Spanish centers participated and all new patients diagnosed with GCA from June 1, 2013 to March 29, 2019 were included. Data on GC and immunosuppressants were collected at the beginning and during the follow-up of GCA patients. For the calculation of the cumulative dose of GC, an application was developed that, by including the periods of time, dose and type of GC received during follow-up, performs the automatic calculation in mg of prednisone.

Results

Of the 1675 patients included, GC treatment was adequately recorded in 1650 patients (Table 1). All received oral treatment, being prednisone the most frequently drug used (N=1602, 97.09%). In addition, 426 (25.82%) patients received at least one iv pulse of methylprednisolone, being the 1000 mg regimen the most frequent (n=217; 50.9%). The total mean duration of GC treatment was 22.65 months. The mean cumulative dose per patient at the end of follow-up was 8514.98 mg of prednisone.

Table 1.

Corticosteroid treatment and immunosuppressive treatment

Patients taking oral corticosteroid1650 Prednisone, n (%)1602 (97.09) Methylprednisolone, n (%)164 (9.94) Deflazacort, n (%)64 (3.88)Patients receiving intravenous corticosteroid, n (%)426 (25.82)Mean duration of steroid treatment, mean (SD)22.65 (17.36)Mean cumulative dose at the end of follow-up per patient, mg of prednisone, mean (SD)8514.98 (6570.21)Methotrexate at diagnosis*, n (%)165 (9.9)Leflunomide at diagnosis*, n (%)2 (0.1)Azathioprine at diagnosis*, n (%)3 (0.2)Cyclophosphamide at diagnosis*, n (%)7 (0.4)Mycophenolate at diagnosis*, n (%)1 (0.1)Tocilizumab at diagnosis*, n (%)22 (1.3)Methotrexate during follow-up, n (%)532 (31.8)Leflunomide during follow-up, n (%)19 (1.2)Azathioprine during follow-up, n (%)26 (1.5)Cyclophosphamide during follow-up, n (%)10 (0.6)Mycophenolate during follow-up, n (%)10 (0.6)Tocilizumab during follow-up, n (%)153 (9.1)

The most widely used immunosuppressant was MTX both at diagnosis (n=165; 9.9%) and during follow-up (n=532; 31.8%), followed by TCZ, at diagnosis (22; 1.3%) and at follow-up (153; 9.1%).

AE with GC were described in 393 patients (23.8%), highlighting serious infections (n=67; 10.03%) followed by diabetes mellitus (n=63; 9.43%), steroid myopathy (n=53; 7.9%), vertebral fractures (n=47; 7.04%), non-vertebral fractures (n=36; 5.39%), heart failure (n=36; 5.39%), arterial hypertension (n=34; 5.09%) and neuropsychiatric alterations (n=27; 4.04%).

During the follow-up, 334 (19.9%) patients had relapses, 532 (31.8%) were hospitalized on some occasion, and 142 patients (8.48%) died. The main cause of death were infections (n=44; 30.99%), neoplasms (n=23; 16.2%), cardiovascular (n=15; 10.56%), and cerebrovascular (n=10; 7.04%).

Conclusion

The main treatment for GCA was oral GC, which were required for almost two years on average, in a quarter of patients associated with IV pulses. The cumulative steroid dose was high as well as the side effects. MTX was the most widely used immunosuppressant and TCZ was prescribed in 10%. Relapses and admissions at the hospital were relatively frequent.

Acknowledgements

This study has been funded by ROCHE Farma. The funder has not participated in the design, analysis, or interpretation of the results

Disclosure of Interests

None declared

POS1133 IRISIN LEVELS IN KNEE OSTEOARTHRITIS ARE RELATED TO GENDER, OBESITY AND LOCAL INFLAMMATION

Background

Irisin is a myokine synthesized mainly in skeletal muscle with exercise, although its secretion has also been observed in other tissues such as adipose and has been related to obesity and other metabolic alterations. Although obesity and other metabolic factors are risk factors for knee osteoarthritis and patients with this condition often do less exercise and have poor muscular state, irisin has been poorly studied.

Objectives

To measure irisin levels in synovial fluid and plasma and evaluate their relationship with clinical severity and inflammation parameters in patients with knee osteoarthritis.

Methods

Patients with symptomatic and radiographical osteoarthritis were studied. Demographic and anthropometric variables, Kellgren-Lawrence scale radiographic stage, the presence of synovial fluid and hypertrophy on ultrasound (at medial patellar line), clinical severity by Lequesne algofunctional index and physical exercise level were recorded. Levels of irisin, IL-6, TNF and hs-PCR were determined using ELISA.

Results

We included 168 women (age 69 ±1.5 y, symptoms duration 48 ±3 m) and 31 men (age 66.5 ±4 y, symptoms duration 36 ±12 m). Significantly higher levels of irisin in synovial fluid were observed in women who did not perform any physical exercise compared to those who did exercise sporadically or regularly (p.0.05), while in plasma a non-significant trend was observed. A weakly positive correlation between intraarticular levels (r= 0.17, p .0.05) and plasma levels (r= 0.16, p. 0.05) of irisin and Lequesne index in women was also evidenced. Regarding inflammatory parameters, in female patients the synovial levels of irisin presented a weak positive correlation with the synovial levels of IL-6 (r= 0.18, p< 0.05) but not in plasma; an association was also found in women between synovial levels of irisin and synovial fluid >8 mm and severe synovial hypertrophy (p<0.05) in women, but not with plasma levels. All significant associations disappeared when adjusting by IMC except in the case of synovial hypertrophy. No statistically significant results were obtained in men.

Conclusion

Levels of irisin are related to gender and obesity in patients with knee osteoarthritis. However, the association with the intraarticular levels of IL-6 and the synovial hypertrophy could point to a possible local inflammatory effect at intraarticular level.

Disclosure of Interests

None declared

POS0935 HIGHER 5-YEAR SURVIVAL OF CERTOLIZUMAB PEGOL IN YOUNG WOMEN WITH AXIAL SPONDYLOARTHRITIS. BIOBADASER DATA

Background

Certolizumab pegol (CZP) in women of childbearing age with rheumatoid arthritis has a more favorable response, suggesting a possible distinctive effect in this group1,2.

Objectives

To evaluate the retention rate of CZP compared to other anti-TNFs and anti-IL17A in patients affected by axSpA, grouped according to gender and age

Methods

Cross-sectional study within the BIOBADASER registry. Patients older than 17 years old, with axSpA receiving anti-TNFs or anti-IL-17A were selected. Mean and standard deviations of ASDAS-CRP and BASDAI were performed at baseline, 1st and 2nd year of treatment. Patients were classified according to treatment into groups 1) CZP, 2) anti-TNF, and 3) anti-IL17A, and according to sex and age in the following groups: 1) women between 18 and 45 years old (young), 2) women over 45 years old (old), 3) men.

Results

Groups and gender distribution, treatment prescription, ASDAS-CRP and BASDAI values according to therapeutic line and demographical characteristics are shown in Table 1. Overall, young women treated with CZP showed remission or low activity during follow-up, compared to low activity for the rest of the molecules.

Table 1.

Efficacy data (BASDAI and ASDAS-CRP values)

IndexFirst lineSecond or subsequent linesAll linesBaseline1 year2 or moreBaseline1 year2 or moreBaseline1 year2 or moreAnti-TNFFemale <45 n=240BASDAI5.6 (2.3)3.3 (2.1)3.2 (2.0)5.4 (2.5)3.7 (2.3)3.5 (2.2)5.5(2.4)3.5 (2.2)3.3 (2.1)ASDAS-CRP3.7 (1.2)2.0 (0.9)2.1 (0.9)3.2 (2.0)1.9 (1.0)1.9 (1.1)3.4 (1.7)1.9 (1.0)2.0 (1.0)Female >45 n=367BASDAI6.0 (1.9)-4.2 (2.6)5.7 (2.3)--5.8 (2.2)-4.2 (2.6)ASDAS-CRP3.9 (0.9)-1.8 (0.7)3.3 (1.2)--3.6 (1.1)-1.8 (0.7)Male n=1252BASDAI5.4 (2.1)3.1 (2.1)2.9 (1.9)5.2 (2.4)3.8 (2.5)3.3 (2.3)5.3 (2.3)3.4 (2.3)3.1 (2.1)ASDAS-CRP3.3 (1.3)1.9 (0.9)1.8 (0.9)3.0 (1.3)2.0 (1.1)2.2 (1.1)3.2 (1.3)1.9 (1.0)1.9 (1.0)CZPFemale <45 n=35BASDAI5.5 (1.6)3.0 (1.7)1.3 (1.0)5.2 (2.6)3.9 (3.1)2.9 (2.2)5.3 (2.2)3.5 (2.6)2.2 (1.9)ASDAS-CRP3.3 (0.5)1.2 (0.5)1.3 (1.1)2.6 (1.1)2.2 (1.2)1.9 (0.7)2.9 (0.9)1.8 (1.1)1.7 (0.8)Female >45 n=25BASDAI6.7 (1.6)--6.4 (1.8)--6.4 (1.8)-ASDAS-CRP---3.5 (1.1)--3.5 (1.1)-Male n=86BASDAI5.6 (2.3)3.3 (2.0)1.9 (2.0)5.3 (2.4)5.8 (1.8)3.1 (2.7)5.4 (2.3)4.5 (2.3)1.4 (2.3)ASDAS-CRP2.4 (1.4)2.2 (2.0)1.5 (0.6)3.1 (0.8)2.8 (1.4)2.1 (1.8)2.8 (1.1)2.4 (1.8)1.7 (1.2)Anti-IL17AFemale <45 n=36BASDAI6.0 (1.4)4.2 (2.0)3.8 (1.7)6.8 (2.2)4.8 (2.3)4.9 (2.6)6.5 (1.9)4.5 (2.1)4.4 (2.2)ASDAS-CRP3.6 (0.89)1.8 (0.7)1.6 (0.7)3.3 (0.8)2.0 (1.1)1.8 (0.8)3.4 (0.8)1.9 (0.9)1.7 (0.7)Female >45 n=57BASDAI6.2 (1.8)--6.3 (1.8)--6.3 (1.8)ASDAS-CRP3.7 (1.2)--3.8 (2.0)--3.8 (1.8)Male n=205BASDAI5.5 (2.2)2.9 (2.3)3.7 (2.5)5.8 (2.3)4.3 (2.2)3.6 (2.4)5.7 (2.3)3.8 (2.3)3.6 (2.4)ASDAS-CRP3.2 (0.9)1.6 (1.0)1.9 (0.8)3.4 (1.2)2.5 (1.0)2.5 (1.0)3.4 (1.1)2.1 (1.1)2.3 (1.0)

A greater survival of CZP compared to other treatment groups was observed in young women. This difference was observed since the first year of treatment (71,4 (64.2-77.4) all antiTNF, 84.4 (66.4-93.2) CZP, 72.2 (53.2-84.5) antiIL17) and the magnitude was maintained during the first 5 years of follow-up (Figure 1). In older women, a higher retention rate was observed for both CZP and anti-IL17A compared to anti-TNFs (71.6 (65.4-76.8) in all antiTNF, 78.1 (54.9-90.3) in CZP, 75.3 (61.3-84.9) in antiIL17). In males there were no long-term differences (79.2(76.3-81.8) all antiTNF, 73.0 (62.0-81.4) CZP, 64.6 (57.3-71.0) antiIL17)

Figure 1.

Five years retention rate (first line treatment)

Focussed on first line treatment, the differences were greater in young women. The second and subsequent lines showed the same trends with a lesser extend. Globally, we do not observe these differences in men.

Conclusion

These data suggest a possible specific effect of Certolizumab Pegol in women with axial spondyloarthritis, especially in young women and when used as first line treatment.

References

[1]Favalli E, et al. FRI0114. ARD 2018.

[2]Favalli EG, et al. FRI0042. ARD 2019

Acknowledgements

We would like to thank all members who participated in the BIOBADASER project.

Disclosure of Interests

None declared

OP0289 SHORT- AND LONG-TERM EFFICACY OF ULTRASOUND-GUIDED NEEDLE FRAGMENTATION OR LAVAGE (BARBOTAGE) IN SYMPTOMATIC SHOULDER CALCIFIC TENDONITIS REFRACTORY TO SUBACROMIAL STEROID INJECTION. PROSPECTIVE LONGITUDINAL STUDY OF 181 PATIENTS

Background

Rotator cuff calcific tendinopathy is a common cause of shoulder pain and disability in young patients. Despite analgesics or steroid injection some patients still experience symptoms and may require surgery. Ultrasound-guided fragmentation or lavage are minimally invasive techniques that can be used instead of surgery to remove calcification and improve symptoms. However, evidence is poor because of most of published studies are retrospective or with few patients.

Objectives

To assess the short and long-term efficacy of ultrasound guided needle fragmentation or lavage (barbotage) in a large cohort of patients with symptomatic shoulder calcific tendonitis refractory to previous subacromial steroid injection.

Methods

Prospective study, including all consecutive patients referred to a Rheumatology out-patient clinic between Jul 2008-Dec 2020 because of symptomatic (visual analog scale or VAS≥4) calcific tendonitis of the rotator cuff refractory to at least one subacromial corticosteroid injection. After informed consent, all patients were treated with minimally invasive ultrasound-guided technique: fragmentation between Jul 2008-Dec 2013 or lavage (barbotage) between Jan 2014-Dec 2020. Corticoids were injected in the subacromial-subdeltoid bursa in all patients after procedure. Shoulder pain (VAS) and shoulder X-ray were assessed at baseline and after 4 months since the intervention. A new clinical assessment was made after 12 months or when clinical relapse occurred.

Results

One hundred and eighty-one subjects (56 men and 125 women), were included in the study. Mean age was 49.7 years (range 29 -72). Mean duration of symptoms was 33.0 months (2-150), with mean VAS 7.6±1.5. Right shoulder was the location most frequently affected (66,3%). Mean size of calcification by X-ray was 13.7 mm (5-40). 55 patients (30.4%) underwent fragmentation, 115 (63.5%) lavage and 11 (6.1%) both techniques. There were not significant differences between groups at baseline. 4 months after procedure, mean VAS pain was 4.5±3.8 and 82.9% of subjects experienced a X-ray resolution (56.8%) or size reduction (26.1%) of the calcification. A clinical relapse occurred in 73 patients (40.3%) in the first 4 months of follow up, and in 33 patients (18.2%) between months 4 and 12. Symptoms disappeared in most of patients with a new steroid injection. Only 31 patients (17.1%) required a second fragmentation or lavage, and 13 patients (7.2%) a rotator cuff surgery. Any patient suffered local or systemic complications after fragmentation or lavage. Patients treated with lavage had higher shoulder pain when clinical relapse (mean VAS 6.5 vs 4.0; p=0.01) and needed more frequently a new steroid injection (54.8% vs 34%; p=0.004) or ultrasound guided-procedure (17.5% vs 13.1%; p=0.008). There were no significant differences between both techniques in the radiographic resolution or size decrease of the calcification.

Conclusion

Ultrasound guided needle fragmentation and lavage (barbotage) are effective and safe at short and long-term to treat patients with symptomatic shoulder calcific tendonitis, avoiding surgery in more than 90% of cases. Fragmentation seems to have better clinical outcomes than lavage.

References

[1]Lafrance S, Doiron-Cadrin P, Saulnier M, et al. Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials. BMJ Open Sport Exerc Med. 2019;5:e000506.

Disclosure of Interests

None declared

POS1398 ASSOCIATION OF FUNCTIONAL SALIVARY TESTS WITH SALIVARY GLAND ULTRASOUND AND BIOPSY IN PATIENTS WITH PRIMARY SJOGREN’S SYNDROME

Background

Salivary gland ultrasonography is useful to assess salivary gland involvement in primary Sjögren Syndrome. Different publications have describes the association between decreases salivary flow and the degree of involvement with ultrasound.

Objectives

This study aims to assess the association of functional salivary tests evaluated by stimulated and unstimulated salivary flow (SSF and USF) with salivary major gland ultrasound scores (SGUS) and a positive focus score in a minor salivary gland biopsy.

Methods

A cross-sectional study including 98 subjects fulfilling the ACR-EULAR 2017 classification criteria for pSS. All patients underwent salivary functional tests, an ultrasound of salivary glands and a minor salivary gland biopsy requested as per clinical practice. The ultrasound images were graded using three different scoring systems: De Vita (0-3), Salaffi (0-4) and Omeract (0-3), obtained as the highest score achieved in the four evaluated glands, left and right parotid and submandibular. Positive biopsy was considered if focus score ≥1

Results

This study included 98 patients with pSS. We evaluated the different ultrasound scoring systems and each score individually assessed in parotid and submandibular gland with the salivary functional tests. USF is associated with all SGUS independently of the measurement, with a 2.5 ml/15min higher in negative compared to positive SGUS. Similar results were shown for SSF, with a 3 ml/5 min higher in negative compared to positive SGUS (Table 1). We observed no association between USF or SSF and a positive focus score in the minor salivary gland biopsy.

Table 1.

Association between salivary flows and ultrasound scoring systems.

Unstimulated Salivary FlowStimulated Salivary FlowUltrasound scoreGroupN(%)Means[95%CI]p-valN(%)Means[95%CI]p-valVitaN54 (55.1%)4.076[3.056, 5.096]0.00454 (55.1%)6.745[5.042, 8.447]0.011P44 (44.9%)1.839 [0.709, 2.969]44 (44.9%)3.436[1.550, 5.322]Vita ParotidN60 (61.2%)3.886[2.912, 4.861]0.00860 (61.2%)6.575 [4.961, 8.190]0.011P38 (38.8%)1.784[0.560, 3.008]38 (38.8%)3.182 [1.153, 5.210]Vita SubmandibularN55 (56.1%)4.002[2.986, 5.017]0.00755 (56.1%)6.668[4.977, 8.358]0.014P43 (43.9%)1.881[0.733, 3.030]43 (43.9%)3.458[1.546, 5.370]SalaffiN52 (53.1%)4.050 [3.005, 5.095]0.00752 (53.1%)6.754[5.015, 8.493]0.014P46 (46.9%)1.965 [0.854, 3.076]46 (46.9%)3.570[1.721, 5.419]Salaffi ParotidN58 (59.2%)3.857[2.861, 4.853]0.01658 (59.2%)6.578[4.931, 8.225]0.014P40 (40.8%)1.932 [0.733, 3.132]40 (40.8%)3.347[1.365, 5.330]Salaffi SubmandibularN54 (55.1%)4.011[2.985, 5.037]0.00754 (55.1%)6.689[4.982, 8.396]0.014P44 (44.9%)1.918[0.782, 3.054]44 (44.9%)3.505[1.614, 5.395]OmeractN56 (58.9%)3.727[2.727, 4.726]0.0156 (58.9%)6.313 [4.612, 8.014]0.043P39 (41.1%)1.854[0.656, 3.051]39 (41.1%)3.574[1.536, 5.613]Omeract ParotidN61(64.2%)3.562 [2.598, 4.526]0.04061 (64.2%)6.227[4.599, 7.854]0.036P34 (35.8%)1.874 [0.582, 3.165]34 (35.8%)3.326[1.147, 5.506]Omeract SubmandibularN57 (60.0%)3.661[2.667, 4.656]0.02857 (60.0%)6.246[4.557, 7.935]0.052P38 (40.0%)1.903[0.685, 3.120]38 (40.0%)3.603[1.534, 5.671]

N: Negative, P: Positive

Conclusion

USF and SSF are associated with SGUS system independently of the salivary gland evaluated but not with positivity in the biopsy, pointing to salivary ultrasound as a good technique to evaluate functionality. Neither USF nor SSF are associated with positivity in the biopsy indicating no link between histology and functionality.

Disclosure of Interests

None declared

AB1119 GLUCOCORTICOIDS’ TREATMENT IMPAIRS THE MEDIUM-TERM IMMUNOGENIC RESPONSE TO SARS-CoV-2 mRNA VACCINES IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Patients with rheumatic diseases are at an increased risk for community infections (1,2). There still exists lack of data regarding SARS-CoV-2 vaccines’ efficacy in vulnerable collectives with a compromised immune system, either due to a chronic pathology or to therapies targeting an autoimmune disease (3).

Objectives

To evaluate neutralizing antibodies (nAB) to SARS-CoV-2 vaccine after 3 to 5 months from administration in Systemic Lupus Erythematosus (SLE) patients, as a surrogate of sustained-immunological response.

Methods

This cross-sectional study compared nAB titre of 39 SLE patients and 37 Healthy individuals with no previous SARS-CoV-2 infection, who had all received two doses of a mRNA SARS-CoV-2 vaccine within the last 3 to 6 months. SLE patients included 10 Not-treated subjects, 10 patients with Hydroxychloroquine (First-Line), 10 subjects with immunosuppressive drugs (Second-Line) and 9 patients under biological treatment (Third-Line). Glucocorticoids were permitted in all patient groups. Neutralization assay were used to determine nAB titre according previously validated protocol (4).

Results

Neutralizing antibody titres were assessed for a total of 76 serum samples from 39 (51%) Lupus patients and 37 (49%) healthy Controls. Healthy individuals showed the highest levels of nAB (1638.0 titre median), which were like not treated SLE subjects (1361.5 titre median). Treated patients presented substantially lower nAB titres compared to Healthy subjects: a 73% decrease for First-Line patients (p-value = 0.0135), 56% for patients received a Second-Line treatment (p-value = 0.2218) and 72% for Third-Line treated patients (p-value = 0.0104). A multivariate analysis pointed to Glucocorticoids as the most associated factor with declining nAB levels (75% decrease, p-value = 0.0037), and the one explaining, to a large extent, the lower acquired response in treated SLE patients. Furthermore, a significant reduction in nAB titres was observed for patients treated with Rituximab compared to Healthy subjects (89% decrease, p-value= 0.0008) (Figure 1).

Figure 1.

Neutralizing antibody (nAB) titre after SARS-CoV-2 vaccination in Healthy individuals (Controls) and Systemic Lupus Erythematosus (SLE) patients under different therapy regimes. Estimations are derived from a linear model in which sex, age, time from vaccination, vaccine type and corticoids therapy were included as covariates for statistical control.

Conclusion

Medium-term response of SLE patients to SARS-CoV-2 vaccination, as measured by the titre of nABs, may be compromised by Glucocorticoids and Rituximab users. This reduced response likely translates into a higher probability of COVID-19 infection These findings might help to inform recommendations in vaccination protocols for SLE patients.

References

[1]Strangfeld A, et al. Ann Rheum Dis. 2021; 80(7):930-42.

[2]Kroon FPB, et al. Ann Rheum Dis. 2021.

[3]Ostrov BE, et al. Immunol Invest. 2021;50(7):833-56.

[4]Trinité B, et al. Sci Rep. 2021;11(1):2608.

Disclosure of Interests

None declared

Evaluation of a single-shot of a high-density viscoelastic solution of hyaluronic acid in patients with symptomatic primary knee osteoarthritis: the no-dolor study

BACKGROUND

Pronolis®HD mono 2.5% is a novel, one-shot, high-density sterile viscoelastic solution, recently available in Spain, which contains a high amount of intermediate molecular weight hyaluronic acid (HA), highly concentrated (120 mg in 4.8 mL solution: 2.5%). The objective of the study was to analyze the efficacy and safety of this treatment in symptomatic primary knee osteoarthritis (OA).

METHODS

This observational, prospective, multicenter, single-cohort study involved 166 patients with knee OA treated with a single-shot of Pronolis®HD mono 2.5% and followed up as many as 24 weeks.

RESULTS

Compared with baseline, the score of the Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC) pain subscale reduced at the 12-week visit (primary endpoint, median: 9 interquartile range [IQR]: 7-11 versus median: 4; IQR: 2-6; p < 0.001). The percentage of patients achieving > 50% improvement in the pain subscale increased progressively from 37.9% (at 2 weeks) to 66.0% (at 24 weeks). Similarly, WOMAC scores for pain on walking, stiffness subscale, and functional capacity subscale showed significant reductions at the 12-week visit which were maintained up to the 24-week visit. The EuroQol visual analog scale score increased after 12 weeks (median: 60 versus 70). The need for rescue medication (analgesics/nonsteroidal anti-inflammatory drugs) also decreased in all post-injection visits. Three patients (1.6%) reported local adverse events (joint swelling) of mild intensity.

CONCLUSIONS

In conclusion, a single intra-articular injection of the high-density viscoelastic gel of HA was associated with pain reduction and relief of other symptoms in patients with knee OA.

TRIAL REGISTRATION

ClinicalTrial# NCT04196764.

Sustained low disease activity measured by ASDAS slow radiographic spinal progression in axial spondyloarthritis patients treated with TNF-inhibitors: data from REGISPONSERBIO

Background

To evaluate the influence of the disease activity on radiographic progression in axial spondyloarthritis (axSpA) patients treated with TNF inhibitors (TNFi).

Methods

The study included 101 axSpA patients from the Spanish Register of Biological Therapy in Spondyloarthritides (REGISPONSERBIO), which had clinical data and radiographic assessment available. Patients were classified into 2 groups based on the duration of TNFi treatment at baseline: (i) long-term treatment (≥4 years) and (ii) no long-term treatment (< 4 years). Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. Disease activity differences between patients’ groups at each time point were assessed using a linear mixed-effect model.

Results

Radiographic progression was defined as an increase in ≥2 mSASSS units. At inclusion, approximately half of the patients (45.5%) were receiving long-term treatment with TNFi (≥4 years). In this group of subjects, a significant difference in averaged Ankylosing Spondylitis disease Activity Score (ASDAS) across follow-up was found between progressors and non-progressors (2.33 vs 1.76, p=0.027, respectively). In patients not under long-term TNFi treatment (54.5%) though, no significant ASDAS differences were observed between progressors and non-progressors until the third year of follow-up. Furthermore, no significant differences were found in progression status, when disease activity was measured by Bath Ankylosing spondylitis Disease Activity Index (BASDAI) and C reactive protein (CRP).

Conclusions

Patients on long-term TNFi treatment with a mean sustained low disease activity measures by ASDAS presented lower radiographic progression than those with active disease.

Synovial Adiponectin Was More Associated with Clinical Severity than Synovial Leptin in Women with Knee Osteoarthritis

OBJECTIVE

Different adipokines have been reported to play a role in the development, progression, and severity of knee osteoarthritis, but this association may be mediated by obesity. The aim of this study was to evaluate separately the associations of leptin and adiponectin with clinical severity and inflammatory markers in nonobese and obese women with knee osteoarthritis.

DESIGN

Cross-sectional study with systematic inclusion of 115 women with symptomatic primary knee osteoarthritis. Age, physical exercise, symptoms duration, and body mass index were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales. Two adipokines (leptin and adiponectin) and 3 inflammatory markers (TNF-α, hsCRP, and IL-6) were measured by ELISA in synovial fluid and serum.

RESULTS

Synovial fluid adiponectin was associated with WOMAC pain, function, and total and with synovial fluid IL-6 in nonobese female knee osteoarthritis after controlling by confounders (partial correlation coefficient [PCC] = 0.395, 0.387, 0.427, and 0.649, respectively). Synovial fluid and serum leptin were significantly associated with IL-6 (PCC = 0.354) after controlling by confounders but associations with clinical severity and the rest of inflammatory markers were mitigated after control.

CONCLUSIONS

Adiponectin in synovial fluid was associated with clinical severity and local inflammatory markers in knee osteoarthritis women, while leptin relation was attenuated when controlled by confounders.

POS0242 ROLE OF HLA-B27 CARRIERSHIP IN PERIPHERAL SPONDYLOARTHRITIS: DATA FROM ASAS PERSPA STUDY

Background:

HLA-B27 is well known for its role in conferring susceptibility to spondyloarthritis (SpA), and several studies evaluating its association to axial SpA phenotype have been published. However, there is few evidence about its influence in patients affected with peripheral SpA (pSpA). In this sense we find ASAS perSpA registry suitable for this purpose.

Objectives:

To identify phenotypical differences in pSpA patients regarding HLA-B27 status.

Methods:

Data from all patients fulfilling ASAS pSpA criteria with HLA-B27-testing result available included in the ASAS perSpA study were used for this analysis. Socio-demographic and disease characteristics were collected. A descriptive and comparative analysis was performed between HLA-B27 positive and negative patients, using a simple logistic regression for all variables to assess their association to HLA-B27 positivity. Results were considered significant when p <0.05. A multivariate model was also performed including significant (p<0.1) and the most relevant clinical variables in agreement of medical criteria.

Results:

Among the 4465 patients included in the registry, 555 fulfilled ASAS pSpA criteria and of them 286 had the HLA-B27 typing available. HLA-B27 was positive in 118 (41.3%) and negative in 168 (58.7%). Results are listed in Table 1. No differences were observed for gender distribution (males 55.1% in HLA-B27 positive vs 49.4% in HLA-B27 negatives). HLA-B27 positive patients were significantly younger, presented a younger disease onset, had significantly higher prior axial involvement, radiographic sacroiliitis and higher root joint involvement. On the other hand, HLA-B27 negative patients showed longer disease duration with a higher diagnosis delay. Around half of the patients in both groups showed a mono or oligoarticular pattern without differences regarding HLA-B27 status, however, psoriatic arthritis (PsA) and peripheral joint damage was significantly higher in HLA-B27 negative patients. Also psoriasis and inflammatory bowel disease (IBD) were more frequent in HLA-B27 negative patients compared to positive ones, and acute anterior uveitis (AAU) was significantly more frequent in HLA-B27 positive patients without differences in number of AAU episodes lifelong. Finally, obesity and concomitant fibromyalgia were both more common in HLA-B27 negatives. No significant differences were found for the rest of variables evaluated.

Table 1.HLA-B27+ (N = 118)HLA-B27- (N = 168)N/mean%/SDN/mean%/SDpObesity (BMI >30)1411,9%4426,3%0,003Men6555,1%8349,4%0,344Family history4437,3%5231,0%0,265Axial involvement6252,5%4225,0%<0.001Radiographic sacroilitis3028,3%2516,8%0,029Psoriathic arthritis2319,5%11272,6%<0.001Reactive arthritis54,2%31,8%0,229IBD arthritis10,9%84,8%0,098Mono/oligoarticular pattern5954,6%7651,0%0,566Root joint involvement5244,1%5432,1%0,04Tarsitis2218,6%169,5%0,028Enthesitis6252,5%6941,1%0,056Dactylitis3126,3%5130,4%0,452Peripheral structural damage97,6%4124,4%<0.001Psoriasis2117,8%12574,4%<0.001AAU2117,8%74,2%<0.001IBD21,7%137,7%0,039Fibromyalgia1513,2%4326,7%0,008Age (y)42,714,852,213,4<0.001Age onset (y)33,913,738,314,50,013Dx delay (m)4,78,27,79,80,009Disease duration (y)9,0610,214,211,6<0.001BASDAI3,92,24,42,40,06CRP16,925,11227,30,148ASDAS-CRP2,71,22,71,10,876AAU number of episodes6,88,42,11,70,265

In the multivariate analysis, age at disease onset (OR 0.96, CI95% 0.94-0.98), disease duration (OR 0.96, CI95% 0.92-0.99), PsA (OR 0.28, CI95% 0.09-0.85), presence of psoriasis (OR 0.22, CI95% 0.07-0.64), IBD related arthritis (OR 0.03, CI95% 0.01-0.19), AAU (OR 3.63, CI95% 1.22-11.9) and tarsitis (OR 2.61, CI95% 1.01-6.98) were the most important variables independently associated to HLA-B27 status.

Conclusion:

Presence of HLA-B27 in pSpA patients was associated to a higher axial and root joint involvement, an earlier disease onset and presence of AAU, but not to PsA, psoriasis and IBD that were higher in HLA-B27 negative patients.

Disclosure of Interests:

Marta Arévalo Speakers bureau: Abbvie, Nordic Pharma, Clementina López-Medina: None declared, Victoria Navarro-Compán: None declared, Mireia Moreno Speakers bureau: Abbvie, Novartis, UCB, Bristol and AMGEN, María LLop Vilaltella Speakers bureau: Novartis, Joan Calvet: None declared, Jordi Gratacos-Masmitja Speakers bureau: During the course of the year, I have received funding for courses and conferences or as an advisor and speaker from MSD, Pfizer, AbbVie, Janssen Cilag, Novartis, Celgene, and Lilly., Maxime Dougados: None declared

Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

Objectives

This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE.

Methods

RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity.

Results

Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)].

Conclusion

Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies.

Correction to: Influence of HLA-B27 on the Ankylosing Spondylitis phenotype: results from the REGISPONSER database

An amendment to this paper has been published and can be accessed via the original article.

CD4 and CD8 Lymphocyte Counts as Surrogate Early Markers for Progression in SARS-CoV-2 Pneumonia: A Prospective Study

BACKGROUND

COVID-19 pathophysiology and the predictive factors involved are not fully understood, but lymphocytes dysregulation appears to play a role. This paper aims to evaluate lymphocyte subsets in the pathophysiology of COVID-19 and as predictive factors for severe disease.

PATIENT AND METHODS

A prospective cohort study of patients with SARS-CoV-2 bilateral pneumonia recruited at hospital admission. Demographics, medical history, and data regarding SARS-CoV-2 infection were recorded. Patients systematically underwent complete laboratory tests, including parameters related to COVID-19 as well as lymphocyte subsets study at the time of admission. Severe disease criteria were established at admission, and patients were classified on remote follow-up according to disease evolution. Linear regression models were used to assess associations with disease evolution, and Receiver Operating Characteristic (ROC) and the corresponding Area Under the Curve (AUC) were used to evaluate predictive values.

RESULTS

Patients with critical COVID-19 showed a decrease in CD3+CD4+ T cells count compared to non-critical (278 (485 IQR) vs. 545 (322 IQR)), a decrease in median CD4+/CD8+ ratio (1.7, (1.7 IQR) vs. 3.1 (2.4 IQR)), and a decrease in median CD4+MFI (21,820 (4491 IQR) vs. 26,259 (3256 IQR)), which persisted after adjustment. CD3+CD8+ T cells count had a high correlation with time to hospital discharge (PC = -0.700 (-0.931, -0.066)). ROC curves for predictive value showed lymphocyte subsets achieving the best performances, specifically CD3+CD4+ T cells (AUC = 0.756), CD4+/CD8+ ratio (AUC = 0.767), and CD4+MFI (AUC = 0.848).

CONCLUSIONS

A predictive value and treatment considerations for lymphocyte subsets are suggested, especially for CD3CD4+ T cells. Lymphocyte subsets determination at hospital admission is recommended.

Ultrasound Findings in Patients With Femoracetabular Impingement Without Radiographic Osteoarthritis: A Pilot Study

OBJECTIVES

To assess ultrasound (US) abnormalities in patients with clinical and radiographic features of femoracetabular impingement (FAI) without radiologic osteoarthritis.

METHODS

This study included patients aged 50 years or younger with hip pain and clinical and radiographic signs suggestive of FAI but without radiographic hip osteoarthritis. Demographic characteristics, the symptom duration, and the radiologic type of FAI were recorded. Ultrasound examinations assessed for anterior labral abnormalities, osteophytes, bone cortex irregularities, capsular distension, and acetabulofemoral and femoral head-to-neck distances. A balanced group of healthy volunteers was used as control participants.

RESULTS

Forty-four patients with FAI were evaluated. Ultrasound changes were found in 93.2% of patients, with 63.6% showing some kind of labral abnormality, 40.9% showing articular cartilage abnormalities, 38.6% showing bone contour irregularities, and 29.5% showing osteophytes. The cartilage width and symptom duration were inferior in patients with a damaged articular surface compared with those without (P = .005 and .012, respectively). Patients showing osteophytes on US examinations were slightly older (P = .048). Patients with cam-type FAI were more frequently male (P = .0001) and younger (P = .022) compared with those who had pincer-type FAI and also had a shorter symptom duration (P < .05). Patients with symptoms for 2 years or less had a shorter femoral cartilage width (P = .027). Femoral head-to-neck distances were shorter in patients compared with controls (P = .0005). Only 1 patient in the control group showed some US abnormality.

CONCLUSIONS

Ultrasound showed detected abnormalities in a significant proportion of patients with symptomatic FAI in early phases of the disease. Additional longitudinal studies are warranted to establish the prognostic importance of these US changes.© 2018 by the American Institute of Ultrasound in Medicine.

Influence of HLA-B27 on the Ankylosing Spondylitis phenotype: results from the REGISPONSER database

OBJECTIVE

To assess HLA-B27 influence on the clinical phenotype of Ankylosing Spondylitis (AS) patients.

METHOD

An observational, cross-sectional and descriptive study of AS patients from the Spanish REGISPONSER database was performed. Demographic, clinical, disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)), and radiographic data (Bath Ankylosing Spondylitis Radiology Index (BASRI) score) were compared regarding HLA-B27 status. A univariate and multivariate analysis was performed to identify variables independently related to the presence of HLA-B27.

RESULTS

Data from 1235 patients (74.8% male) were analyzed; 1029 were HLA-B27 positive (83%). HLA-B27-positive patients showed higher family aggregation and an earlier onset of disease compared with those who were HLA-B27 negative. HLA-B27-negative patients presented statistically higher BASDAI and BASFI scores and higher prevalence of arthritis, dactylitis, and extra-articular manifestations (psoriasis and inflammatory bowel disease (IBD)) but not anytime uveitis compared with those who were HLA-B27 positive. In the multivariate analysis, family history (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.27-3.49), younger age at diagnosis (OR 0.97, 95% CI 0.96-0.98), presence of peripheral arthritis (OR 0.53, 95% CI 0.32-0.89), dactylitis (OR 0.16, 95% CI 0.05-0.56), psoriasis (OR 0.45, 95% CI 0.26-0.78), and IBD (OR 0.22, 95% CI 0.12-0.40) were the main variables independently related to the presence or not of HLA-B27.

CONCLUSION

In Caucasian AS patients, the presence of HLA-B27 is related to an earlier disease onset and higher family aggregation. Absence of HLA-B27 is related to a higher frequency of peripheral arthritis, dactylitis, and extra-articular manifestations. Being HLAB27 positive is not related to a higher burden of disease or anytime uveitis.

Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion

OBJECTIVES

Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion.

METHODS

One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm.

RESULTS

One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year.

CONCLUSIONS

The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.

Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

OBJECTIVES

To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort.

METHODS

All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection.

RESULTS

A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999).

CONCLUSIONS

Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.

Synovial fluid adipokines are associated with clinical severity in knee osteoarthritis: a cross-sectional study in female patients with joint effusion

Background

Adipokines are related to knee osteoarthritis, but their exact role is not well known. The aim of this study was to evaluate the association between adipokines in synovial fluid and clinical severity in patients with knee osteoarthritis with joint effusion.

Methods

Cross-sectional study with systematic inclusion of female patients with symptomatic primary knee osteoarthritis with ultrasound-confirmed joint effusion. Age, physical exercise, knee osteoarthritis symptoms duration, classical cardiovascular risk factors and different anthropometric measurements were collected. Metabolic syndrome was defined in accordance to National Cholesterol Education Program-Adult Treatment Panel III. Radiographic severity was evaluated according to Kellgren-Lawrence scale and Lequesne index was used to assess clinical severity. Seven adipokines (leptin, adiponectin, resistin, visfatin, osteopontin, omentin and chemerin) and three inflammatory markers (tumor necrosis factor α, interleukin 6 and high sensitivity C-reactive protein) were measured by enzyme-linked immunosorbent assay in synovial fluid.

Results

Kellgren-Lawrence grade, physical exercise, all anthropometric measurements (especially waist circumference), tumor necrosis factor α, and high levels of leptin, resistin, and ostepontin were related to knee osteoarthritis severity. After adjustment for clinical confounders (age, symptom duration, and radiology), anthropometric measurements, inflammatory markers, and all evaluated adipokines, there were independent associations with clinical severity for resistin (directly associated) and visfatin (inversely associated). No other adipokines or inflammatory markers were independently associated with Lequesne index. The association of radiological parameters, physical exercise, and waist circumference with Lequesne index remained after adjustment.

Conclusions

Resistin was directly associated, and visfatin was inversely associated, with clinical severity in female patients with knee osteoarthritis with joint effusion. These associations were more important after adjustment for confounders, especially when all adipokines were evaluated.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-016-1103-1) contains supplementary material, which is available to authorized users.

Induction of Acute Lung Injury after Intranasal Administration of Toxin Botulinum A Complex

The inhalation of aerozolized botulinum toxin may represent a potential significant hazard to both military and civilian personnel. Since the lung is the primary target organ for inhaled toxin, the investigation reported herein was conducted to examine lung function in mice exposed to botulinum toxin A complex by intranasal route. Data includes lethality, symptomatology, measurement of respiratory function (minute ventilation, respiratory frequency, and tidal volume), and histopathology of the lungs. The clinical signs of intoxication are similar to those observed in foodborne botulism. Plethysmography revealed severe impairment of all respiratory parameters tested from 7 hours postexposure. Severe lung lesions, possibly secondary to the intoxication, were observed in mice who survived 14 days after the toxin challenge. These included intra-alveolar hemorrhage and interstitial edema. Mice immunized by the pentavalent (ABCDE) toxoid were protected against the neurotoxin (4 LD50) as revealed by the decrease of lethality and severity of nervous signs of intoxication, but not against histopathological changes in the lungs. These effects are nonspecific and require further experiments in order to specify the relationships between the pathology and the inflammatory process in the lung due to mediators such as cytokines, and possibly permanent physiological sequelae.

Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER)

The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.

Alopecia areata as another immune-mediated disease developed in patients treated with tumour necrosis factor-α blocker agents: Report of five cases and review of the literature

BACKGROUND

Tumour necrosis factor antagonists (anti-TNF-α) have demonstrated the efficacy in different chronic immune inflammatory disorders. Within the spectrum of adverse events, autoimmune diseases have been observed, including cases of alopecia areata (AA).

OBJECTIVES

The objective of the study is to characterize AA developed during anti-TNF-α therapy.

METHODS

We present five new cases and review all the cases reported in the literature (eleven).

RESULTS

One third of the cases had a positive (personal or family) history of AA. Most of them presented with rapid extensive AA, usually involving the ophiasis area. Prognosis was usually poor, with slight response to treatments. In the cases where anti-TNF-α therapy was maintained, the course did not seem to change.

CONCLUSIONS

Although rare, AA developed during anti-TNF-α therapy might be more frequent than suggested by reports of isolated cases. Personal and family history of autoimmune disease might alert clinicians to their possible development or relapse once the anti-TNF-α therapy is started.

[Vertebral osteonecrosis and percutaneous vertebroplasty]

Vertebral osteonecrosis is characterized by the presence of the intravertebral vacuum phenomenon. It is a relatively uncommon disease and although it may be caused by different pathologies, the most frequent cause is posttraumatic. The explanation for the presence of intravertebral gas is not known completely. We present the case of a 74-year-old patient who after suffering a vertebral traumatism, to complain of intense vertebral pain. A simple radiological study, CT scan, and magnetic resonance confirmed the presence of intravertebral vacuum phenomenon. We studied this radiological sign and then commented on its evolution after percutaneous vertebroplasty.