AB0736 ASSOCIATION BETWEEN ERYTHROCYTE DISTRIBUTION WIDTH AND SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background

Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) account for 60% of deaths related to scleroderma (SSc). The erythrocyte distribution width (RDW) has been used as a marker of poor prognosis in different pathologies. In SSc, RDW has been found to be elevated in PAH and has been proposed as a predictor of cardiorespiratory compromise.

Objectives

The aim of this study is to evaluate the association between increased RDW and the presence of EPI in patients with SSc.

Methods

This is a multicenter, retrospective, cross-sectional study of patients diagnosed with SSc (ACR/EULAR 2013) from January 2011 to August 2021. Other concomitant autoimmune diseases, malignancy, active infections, iron-deficiency or pernicious anaemia and transfused patients were excluded. The diagnosis of PID was made by high-resolution computed tomography (HR-CT) and the extension evaluated by Goh criteria. A review of medical records was conducted, collecting clinical and demographic characteristics, interstitial pattern by HR-CT, assessed, acute phase reactants, capillaroscopy, functional respiratory tests (PFT) and echocardiographic resolution. Patients diagnosed with PAH by right heart catheterization were not excluded in this study but recorded.

Results

Seventy-five patients were included, with a mean age of 59.4 (SD 14.1 CI95% 56-6), from which 67 (89%) were women. A median of 8 years of disease evolution was observed RIC 8). Limited SS was observed in 50 (66%) and diffuse SS in 24 (32%). EPI was observed in 50 (66%) of which NSIP 25 (33%), NSIP-f 15 (20%) and UIP 10 (13%). The extension of the disease was limited in 25 (33%) and extensive in 19 (25%). Capillaroscopic findings were normal in 2 (3.4%), nonspecific in 1 (1.7%), early SD in 9 (15.3%), active SD in 22 (37.3%), and late SD in 25 (42.4%); in sixteen patients there was no capillaroscopy.

We observed an increase in RDW in the EPI group with a statistically significant difference OR 6.06 CI95% 2-17 (p 0.001).

The median RDW is higher in patients with ILD and PAH than in healthy people (p<0.0001).

We found a low negative correlation between RDW / FVC r (63) -.25 p 0.042 and RDW / FEV1 r (63) .30 p 0.015.

Conclusion

In the present study we have been able to evidence that there is a statistically significant relationship between the percentage of RDW and the presence of PID. When analysing the association between patients without pulmonary compromise, ILD and PAH and the percentage of RDW, we were able to find a statistically significant difference between the three groups. It is necessary to continue with studies with a larger number of patients to grant robustness to the results.

References

[1]Muangchan, et al: 15% rule in SSc. The Journal of Rheumatology 2013; 40; 9; doi:10.3899/jrheum.121380.

[2]Cottin and Brown. Interstitial lung disease associated with systemic sclerosis (Ssc-ILD) Respiratory Research (2019) 20:13

[3]Thayer, T. E. et al. Unbiased Phenome-wide Association Studies of Red Cell Distribution Width Identifies Key Associations with Pulmonary Hypertension. Annals of the American Thoracic Society. doi:10.1513/annalsats.201809-594oc.

[4]Zhao J,Mo H, Guo X,Wang Q, Xu D, Hou Y, Tian Z, Liu Y,Wang H, Lai J, Li M, ZengX (2018) Red blood cell distribution width as a related factor of pulmonary arterial hypertension in patients with systemic sclerosis. Clin Rheumatol 37:979–985.

[5]Goh NSL, Desai SR, Veeraraghavan S, et al. Interstitial Lung Disease in Systemic Sclerosis: A Simple Staging System. American Journal of Respiratory and Critical Care Medicine. 2008. June;177(11):1248–54.

[6]Hax V, Bredemeier M, Didonet Moro AL, et al. Clinical algorithms for the diagnosis and prognosis of interstitial lung disease in systemic sclerosis. Seminars in Arthritis and Rheumatism. 2017. October;47(2):228–34.

[7]Peralta S. Guías Argentinas De Consenso En Diagnóstico Y Tratamiento De La Hipertensión Pulmonar. Sociedad Argentina de Cardiología. Área de Consensos y Normas. Vol 85 Suplemento 3. Octubre 2017.

Acknowledgements

Participating centers

Disclosure of Interests

None declared

POS0655 SURVIVAL AND SAFETY OF BIOLOGICAL AND TARGETED SYNTHETIC THERAPIES AS REGARDS TO AGE GROUPS. BIOBADASAR 3.0 REGISTRY

Background

Advances in rheumatology and new therapeutic options have certainly impacted patient survival, changing the age range, from youth to seniors. The differences between the age groups could influence the evolution of the disease and the adverse events (AEs) related to the treatments. There are few real-world data on the safety and efficacy of treatments in different age groups.

Objectives

To evaluate the frequency of AEs and the survival of treatments according to the age in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).

Methods

Retrospective, observational, multicenter study of real-life data of patients included in the BIOBADASAR 3.0 registry; exposed and not exposed to original biological treatments (b-DMARDs), biosimilars, targeted synthetic drugs (ts-DMARDs). The unexposed group received treatment with conventional disease-modifying drugs (cDMARDs). A Kaplan-Meier and Log Rank Test analysis was performed to study AEs-free survival and treatment in different age groups (young people <25; young adults 25-34; mature adults 34-65; old adults >65). Factors related to treatment survival were evaluated using Cox regression models.

Results

5,297 patients were included, 80.3% female, mean age 43.7 years (SD 15.6) and median disease progression 14.3 [IQR 11.5]. RA 4658 (87.9%); APs 490 (9.25%) and EA 149 (2.8%). The main reason for treatment discontinuation was ineffectiveness, in 624 patients in the exposed group and in 53 (2.5%) patients in control group, followed by the presence of AEs in 352 (11.2%) and 83 (3.9%), respectively (p=0.001).

A mean Charlson Score of 0.268 (SD 0.6) in the exposed group and 0.306 (SD 0.7) in the control group (p=0.095). Median EAs-free survival in the exposed group was 12.5 years [IQR 16.6] while in controls was 28 years [IQR 11], p<0.0001. Median AEs-free survival was 12 years (IQR 11) in young people, 11.5 years [IQR: 4.9] in young adults, 10 years [IQR: 3.25] in mature adults and 7.6 years [IQR: 6] in old adults with a difference statistically significant (p>0.017). The exposed group presented a median treatment survival in years of 11.25 years [IQR: 10] in young people; 12.5 years [IQR: 4.7] in young adults, 7.5 years [IQR: 12.1] in mature adults and 4.5 years [IQR: 1.14] in old adults (p>0.0001). Considering only the first line of treatment, a median survival of 11.5 years [IQR: 10] was evidenced in the age group <25; 12 years [IQR: 2.6] between 25-34 years old, 10 years [IQR: 12] in the group between 34-65 years old and 5.5 years [IQR: 1.14] in the group > 65 years old (p>0.004). (Figure 1). Considering the second line of treatment, the differences between the groups were not statistically significant (p=0.57). In the multivariate regression model for patients with RA, the factors with the greatest impact on treatment survival were female sex (HR 1.3, 95% CI 1.2-1.4), old age (HR 1.01, 95% CI 1.008-1.01), treatment with steroids (HR 1.19, 95% CI1.1-1.2) and longer disease duration (HR 1.01, 95% CI1.01 – 1.02).

Conclusion

In the present study we were able to demonstrate a greater occurrence of AEs in old adults and mature adults compared to young people and young adults. Conversely, survival for b-DMARDs and ts-DMARDs were greater in youth and young adults. In patients with RA, female sex, corticosteroid therapy, old aged and longer disease duration were associated with treatment discontinuation.

References

[1]Souto A, et al. Rate of discontinuation and drug survival of biologic therapies in rheumatoid arthritis: a systematic review and meta-analysis of drug registries and health care databases. Rheumatology (Oxford). 2016;55(3):523–34.

[2]Ray D, et al. Immune senescence, epigenetics and autoimmunity. Clin Immunol. 2018 Nov;196:59-63. doi: 10.1016/j.clim.2018.04.002. Epub 2018 Apr 11.

[3]Vela P, et al. Influence of age on the occurrence of adverse events in rheumatic patients at the onset of biological treatment: data from the BIOBADASER III register. Arthritis Res Ther. 2020 Jun 15;22(1):143. doi: 10.1186/s13075-020-02231-x.

Disclosure of Interests

None declared

OP0266-HPR WORK PRODUCTIVITY IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS

Background:

Work disability is an important outcome in the treatment of Spondyloarthritis (SpA) since this disease affects people in the most productive stage of life.

Objectives:

The aim of this study is to investigate the working status and the factors associated with work productivity loss (WPL) in patients with axial (axSpA) and peripheral SpA (pSpA).

Methods:

Patients with SpA according to ASAS criteria were included consecutively in this multicentric cross-sectional study. Evaluation of activity through a visual analogue scale (0-100), enthesitis (LEI), functional capacity (HAQ and BASFI), disease activity (DAS28 and BASDAI), health status (ASAS Health Index) and quality of life (ASQoL) were calculated. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was recorded. The Work Productivity and Activity Impairment Spondyloarthritis (WPAI SpA) questionnaire was used to assess work productivity.

Spearman’s correlation coefficient (ρ) was used to assess the correlation with the percentage of WPL.

Results:

274 patients with SpA were recruited, 129 (47.1%) with axSpA and 145 (52.9%) with pSpA. 56.6% were women and 33.2% stopped working due to the underlying disease.

Among axSpA patients, 70% were radiographic and 30% non radiographic, mean age 45.5 (SD14) yrs, median disease duration 72 (IQR 36-144) months and diagnosis delay 20 (IQR 11-70) months. 45.7% were employed, median hours worked in the last week was 40 (IQR 25-45), median scores for absenteeism was 0% (IQR 0-2), presenteeism 30% (IQR 5-40), WPL 30% (IQR 10-52.5) and activity impairment 30% (IQR 10-50). A positive correlation was found between WPL and the following variables: HAQ (ρ:0.40, p<0.001), BASDAI (ρ:0.48, p<0.001), ASDAS (ρ:0.46, p<0.001), BASFI (ρ:0.59, p<0.001), ASQoL (ρ:0.60, p<0.0001), LEI (ρ:0.31, p:0.02) and ASAS health index (ρ:0.54, p<0.001).

Among pSpA patients, mean age was 52.3 (SD13) yrs, median disease duration 60 (IQR 14-120) months and diagnosis delay 12 (IQR 3-24) months. 46.9% were employed, median hrs worked in the last week was 30 (IQR 14-40), absenteeism 0% (IQR 0-7), presenteeism 30% (IQR 2.5-58), WPL 30% (IQR 5-52) and activity impairment 20% (IQR 0-40). A positive correlation was found between WPL and: HAQ (ρ:0.49, p<0.001), ASDAS (ρ:0.58, p<0.001), ASQoL (ρ:0.57, p<0.0001), DAS28 (ρ:0.50, p<0.001), LEI (ρ:0.36, p:0.04) and ASAS health index (ρ:0.52, p<0.001). No statistically significant differences were found in absenteeism, presenteeism, WPL and activity impairment between axSpA and pSpA.

Conclusion:

Our study showed that WPL in this national cohort was 30% in both groups of patients and is associated with disease activity, enthesitis, health status, quality of life and functional ability.

Disclosure of Interests:

None declared

Epidemiology of inflammatory bowel disease in Mexico and Colombia: Analysis of health databases, mathematical modelling and a case-series study

BACKGROUND AND AIMS

Ulcerative Colitis (UC) and Crohn's Disease (CD) have a major impact on quality of life and medical costs. The aim of the study was to estimate the prevalence, incidence and clinical phenotypes of Inflammatory Bowel Disease (IBD) cases in Mexico and Colombia.

METHODS

We analyzed official administrative and health databases, used mathematical modelling to estimate the incidence and complete prevalence, and performed a case-series of IBD patients at a referral center both in Mexico and Colombia.

RESULTS

The age-adjusted complete prevalence of UC per 100,000 inhabitants for 2015/2016 ranged from 15.65 to 71.19 in Mexico and from 27.40 to 69.97 in Colombia depending on the model considered. The prevalence of CD per 100,000 inhabitants in Mexico ranged from 15.45 to 18.08 and from 16.75 to 18.43 in Colombia. In Mexico, the age-adjusted incidence of UC per 100,000 inhabitants per year ranged from 0.90 to 2.30, and from 0.55 to 2.33 in Colombia. The incidence for CD in Mexico ranged from 0.35 to 0.66 whereas in Colombia, the age-adjusted incidence of CD ranged from 0.30 to 0.57. The case-series included 200 IBD patients from Mexico and 204 patients from Colombia. The UC/CD prevalence ratio in Mexico and Colombia was 1.50:1 and 4.5:1 respectively. In Mexico, the female/male prevalence ratio for UC was 1.50:1 and 1.28:1 for CD, while in Colombia this ratio was 0.68:1 for UC and 0.8:1 for CD. In Mexico the relapse rate for UC was 63.3% and 72.5% for CD, while those rates in Colombia were 58.2% for UC and 58.3% for CD.

CONCLUSIONS

The estimated burden of disease of IBD in Mexico and Colombia is not negligible. Although these findings need to be confirmed by population-based studies, they are useful for decision-makers, practitioners and patients with this condition.

Digital subtraction arthrography of the prosthetic hip

Digital subtraction techniques are easily adapted to the evaluation of loosening in total hip prostheses, allowing real time review of injection dynamics and data manipulation after the study. We have successfully used both standard radiographic and digital imaging techniques in the evaluation of 15 prosthetic hip joints. The digital results are comparable to and often better than those of standard radiographic techniques for the evaluation of loosening in total hip prostheses.