Increased Prolonged Sitting in Patients with Rheumatoid Arthritis during the COVID-19 Pandemic: A Within-Subjects, Accelerometer-Based Study

BACKGROUND

Social distancing measures designed to contain the COVID-19 pandemic can restrict physical activity, a particular concern for high-risk patient groups. We assessed rheumatoid arthritis patients' physical activity and sedentary behavior level, pain, fatigue, and health-related quality of life prior to and during the social distancing measures implemented in Sao Paulo, Brazil.

METHODS

Post-menopausal females diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24 May to 7 July 2020) social distancing measures to contain COVID-19 pandemic, using a within-subjects, repeated-measure design. Physical activity and sedentary behavior were assessed using accelerometry (ActivPAL micro). Pain, fatigue, and health-related quality of life were assessed by questionnaires.

RESULTS

Mean age was 60.9 years and BMI was 29.5 Kg/m². Disease activity ranged from remission to moderate activity. During social distancing, there were reductions in light-intensity activity (13.0% [-0.2 h/day, 95% CI: -0.4 to -0.04; p = 0.016]) and moderate-to-vigorous physical activity (38.8% [-4.5 min/day, 95% CI: -8.1 to -0.9; p = 0.015]), but not in standing time and sedentary time. However, time spent in prolonged bouts of sitting ≥30 min increased by 34% (1.0 h/day, 95% CI: 0.3 to 1.7; p = 0.006) and ≥60 min increased by 85% (1.0 h/day, 95% CI: 0.5 to 1.6). There were no changes in pain, fatigue, and health-related quality of life (all p > 0.050).

CONCLUSIONS

Imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sedentary behavior, but did not change clinical symptoms sitting among patients with rheumatoid arthritis.

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Objectives

To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases.

Methods

Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients.

Results

The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively).

Conclusion

The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.

Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

OBJECTIVES

To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA.

METHODS

In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs.

RESULTS

Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation.

CONCLUSIONS

The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

POS0259 A RANDOMIZED CLINICAL TRIAL OF 2-WEEK METHOTREXATE DISCONTINUATION IN RHEUMATOID ARTHRITIS PATIENTS VACCINATED WITH INACTIVATED SARS-COV-2 VACCINE

Background

Patients with rheumatoid arthritis (RA) on methotrexate have reduced vaccine responses. Temporary discontinuation has improved immunogenicity of anti-influenza vaccine, but this strategy has not been evaluated in anti-SARS-CoV-2 vaccines.

Objectives

To evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in rheumatoid arthritis (RA) patients.

Methods

This was a single-center, prospective, randomized, investigator-blinded, intervention study (#NCT04754698, CoronavRheum), including adult RA patients (stable CDAI≤10, prednisone ≤7.5mg/day), randomized (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at D0, D28 and D69. Co-primary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion(SC) and neutralizing antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titers (GMT) and flare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and, for safety reasons, those who flared at D28 (CDAI>10) and did not withdraw MTX twice.

Results

Randomization included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 (MTX-hold) and 69 (MTX-maintain) patients. Further exclusions: 27 patients [13 (21.7%) vs. 14 (20.3%), p=0.848] with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI>10 at D28. At D69, MTX-hold (n=37) had a higher rate of seroconversion than MTX-maintain (n=55) group [29 (78.4%) vs 30 (54.5%), p=0.019], with parallel augmentation in GMT [34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006]. No differences were observed for NAb positivity [23 (62.2%) vs 27 (49.1%), p=0.217]. At D28 flare, rates were comparable in both groups (CDAI, p=0.122; DAS28-CRP, p=0.576), whereas CDAI>10 was more frequent in MTX-hold at D69 (p=0.024).

Figure 1.

Conclusion

We provide novel data that 2-week MTX withdrawal after each Sinovac-CoronaVac vaccine dose improves anti-SARS-CoV-2 IgG response. The increased flare rates after second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of flares.

References

[1]​​Jara A, Undurraga EA, González C, et al. Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile. N Eng J Med. 2021 Sep 2;385(10):875-84. doi: 10.1056/NEJMoa2107715

[2]Furer V, Eviatar T, Zisman D, et al. Lb0003 Immunogenicity and Safety of the BNT162B2 mRNA Covid-19 Vaccine in Adult Patients with Autoimmune Inflammatory Rheumatic Diseases and General Population: a Multicenter Study. Ann Rheum Dis. 2021;80:200-201. doi: 10.1136/annrheumdis-2021-220647

[3]Medeiros-Ribeiro AC, Aikawa NE, Saad CG, et al. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat. Med. 2021 Jul 30:1-8. doi: 10.1038/s41591-021-01469-5.

[4]Park JK, Lee MA, Lee EY, et al. Effect of methotrexate discontinuation on efficacy of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2017 Sep 1;76(9):1559-65. http://dx.doi.org/10.1136/annrheumdis-2017-211128

[5]Park JK, Lee YJ, Shin K, et al. Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2018 Jun 1;77(6):898-904. http://dx.doi.org/10.1136/annrheumdis-2018-213222

Acknowledgements

This protocol is part of a larger study of immunosuppressed patients with ARD (Clinicaltrials.gov#NCT04754698)

Disclosure of Interests

None declared

Bone erosions and osteophytes in premenopausal women with long-standing rheumatoid arthritis: association with systemic bone involvement by HR-Pqct

OBJECTIVE

To evaluate premenopausal women with long-standing RA and to explore the relationship between parameters of systemic and localized bone involvement.

METHODS

Eighty consecutive RA premenopausal women were evaluated. Volumetric bone mineral density (vBMD), microarchitecture and finite element analysis were performed using high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius (DR) and tibia (DT) and compared with parameters from 160 female healthy controls matched by age and body mass index. Localized bone involvement was also analyzed using HR-pQCT in the metacarpophalangeal and proximal interphalangeal joints to identify erosions and osteophytes.

RESULTS

The mean age of RA patients was 39.4±6.7years and disease duration 9.8±5.3years. RA patients had impaired trabecular, cortical and bone strength parameters, at DR and DT, compared with healthy controls (p<0.05). Bone erosions and osteophytes were found in 75% and 41.3% of patients, respectively. Comparing patients with and without erosions, at DR and DT, a lower cortical vBMD (DR: 980±72 versus 1021±47mgHA/cm³ , p=0.03; DT:979±47 versus 1003±34 mgHA/cm³ , p=0.04) and higher cortical porosity (DR:2.8±2.5 versus 1.8±1.6%, p=0.04; and DT:3.7±1.6 versus 2.7±1.6%, p=0.01) were observed in patients with erosions. At the DR, osteophyte volume was positively correlated with trabecular vBMD (0.392, p=0.02), trabecular number (0.381, p=0.03) and stiffness (0.411, p=0.02), and negatively with trabecular separation (-0.364, p=0.04).

CONCLUSION

Our findings showed that premenopausal women with long-standing RA had systemic bone fragility at peripheral sites. Moreover, erosions were associated mainly with cortical bone fragility at the DR and DT, and osteophytes correlated with repair of trabecular bone at the radius.

Methotrexate and rheumatoid arthritis associated interstitial lung disease

QUESTION ADDRESSED BY THE STUDY

Methotrexate (MTX) is a key anchor drug for rheumatoid arthritis (RA) management. Fibrotic interstitial lung disease (ILD) is a common complication of RA. Whether MTX exposure increases the risk of ILD in patients with RA is disputed. We aimed to evaluate the association of prior MTX use with development of RA-ILD.

METHODS

Through a case-control study design with discovery and international replication samples, we examined the association of MTX exposure with ILD in 410 patients with chronic fibrotic ILD associated with RA (RA-ILD) and 673 patients with RA without ILD. Estimates were pooled over the different samples using meta-analysis techniques.

RESULTS

Analysis of the discovery sample revealed an inverse relationship between MTX exposure and RA-ILD (adjusted OR 0.46, 95% CI 0.24-0.90; p=0.022), which was confirmed in the replication samples (pooled adjusted OR 0.39, 95% CI 0.19-0.79; p=0.009). The combined estimate using both the derivation and validation samples revealed an adjusted OR of 0.43 (95% CI 0.26-0.69; p=0.0006). MTX ever-users were less frequent among patients with RA-ILD compared to those without ILD, irrespective of chest high-resolution computed tomography pattern. In patients with RA-ILD, ILD detection was significantly delayed in MTX ever-users compared to never-users (11.4±10.4 years and 4.0±7.4 years, respectively; p<0.001).

ANSWER TO THE QUESTION

Our results suggest that MTX use is not associated with an increased risk of RA-ILD in patients with RA, and that ILD was detected later in MTX-treated patients.

Increased sympathetic and haemodynamic responses to exercise and muscle metaboreflex activation in post-menopausal women with rheumatoid arthritis

KEY POINTS

Rheumatoid arthritis (RA) patients present exacerbated blood pressure responses to exercise, but little is known regarding the underlying mechanisms involved.  This study assessed autonomic and haemodynamic responses to exercise and to the isolated activation of muscle metaboreflex in post-menopausal women with RA.  Participants with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These responses were associated with multiple pro- and anti-inflammatory cytokines and with pain.  The results of the present study support the suggestion that an abnormal reflex control of circulation is an important mechanism underlying the exacerbated cardiovascular response to exercise and increased cardiovascular risk in RA.

ABSTRACT

Studies have reported abnormal cardiovascular responses to exercise in rheumatoid arthritis (RA) patients, but little is known regarding the underlying mechanisms involved. This study assessed haemodynamic and sympathetic responses to exercise and to the isolated activation of muscle metaboreflex in women diagnosed with RA. Thirty-three post-menopausal women diagnosed with RA and 10 matched controls (CON) participated in this study. Mean arterial pressure (MAP), heart rate (HR) and muscle sympathetic nerve activity (MSNA frequency and incidence) were measured during a protocol of isometric knee extension exercise (3 min, 30% of maximal voluntary contraction), followed by post-exercise ischaemia (PEI). Participants with RA showed greater increases in MAP and MSNA during exercise and PEI than CON (ΔMAP_exercise  = 16 ± 11 vs. 9 ± 6 mmHg, P = 0.03; ΔMAP_PEI  = 15 ± 10 vs. 5 ± 5 mmHg, P = 0.001; ΔMSNA_exercise  = 17 ± 14 vs. 7 ± 9 bursts min^-1 , P = 0.04; ΔMSNA_PEI  = 14 ± 10 vs. 6 ± 4 bursts min^-1 , P = 0.04). Autonomic responses to exercise showed significant (P < 0.05) association with pro- (i.e. IFN-γ, IL-8, MCP-1 and TNFα) and anti-inflammatory (i.e. IL-1ra and IL-10) cytokines and with pain. In conclusion, post-menopausal women with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These findings provide mechanistic insights that may explain the abnormal cardiovascular responses to exercise in RA.

Changes to Body Composition in Women With Long-Standing Established Rheumatoid Arthritis: Differences by Level of Disease Activity

INTRODUCTION

Few studies on rheumatoid arthritis have investigated disease activity and body composition by dual-energy X-ray absorptiometry including evaluation of visceral adipose tissue. Thus, we sought to verify the association between body composition by dual-energy X-ray absorptiometry, including visceral adipose tissue, and inflammatory activity in long-standing established rheumatoid arthritis.

METHODS

Seventy-eight postmenopausal women with rheumatoid arthritis (American College of Rheumatology 2010) were studied. Disease activity was assessed by composite indexes (DAS28, CDAI, SDAI) and C-reactive protein. Potential association between body composition and disease activity was analysed by Pearson correlation and Tukey´s test (p < 0.05).

RESULTS

There was significant negative correlation between C-reactive protein and appendicular lean mass index (r = -0.234, p = 0.039). After adjusting for confounding variables, women with C-reactive protein >10 mg/L had a lower appendicular lean mass index than those with C-reactive protein 5-10 mg/L and <5 mg/L (6.3 ± 0.8 kg/m² vs 7.2 ± 1.2 kg/m² vs 6.8 ± 1.0 kg/m², respectively; p = 0.013). Women with moderate inflammation (C-reactive protein 5-10 mg/L) had more fat than those with C-reactive protein >10 mg/L and C-reactive protein <5 mg/L (12.4 ± 3.5 kg/m² vs 9.9 ± 3.6 kg/m² vs 10.5 ± 2.8 kg/m², respectively; p = 0.040), as well as more visceral adipose tissue than women with higher and lower C-reactive protein (812.5 ± 266.4 cm³ vs 604.3 ± 236.3cm³ vs 658.9 ± 255.6 cm³; p = 0.009).

CONCLUSIONS

High inflammatory activity that persists after a long disease duration was associated with both lower muscle and fat mass (including visceral adipose tissue), which is suggestive of more exuberant rheumatoid cachexia. Conversely, moderate activity was associated with greater visceral adipose tissue, which is associated with increased cardiovascular risk. These results point to the existence of different body composition profiles according to inflammatory status and the importance of individualized approaches to muscle mass and adiposity according to disease activity level in long-standing rheumatoid arthritis.

SAT0086 THE PRESENCE OF COMORBIDITIES IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH BAD PATIENT-REPORTED OUTCOMES (PROS)

Background:

Patients with rheumatoid arthritis have more cardiovascular comorbidities which contributes to hospitalization and mortality.

Objectives:

.This study aims to investigate whether there is an association between cardiovascular comorbidities in RA with subgroup of patients and clinical findings of the disease

Methods:

This study is a cross-sectional part of Rheumatoid Arthritis in Real Life (REAL), which is a multicenter prospective study conducted in Brazil, involving 13 centers specialized in the care of patients with RA. All subjects met the ARA (1987) or ACR/EULAR (2010) RA classification criteria. Subjects were submitted to clinical interview with physical exam and review of medical records. A sample of 1116 patients was selected for convenience. The association between cardiovascular comorbidities (systemic arterial hypertension (HA), diabetes mellitus (DM) type2, dyslipidemia, stroke and heart failure), the clinical characteristics and laboratory parameters of RA was evaluated through chi-square hypothesis tests, Student`s t-test, Fischer exact test, correlations test and ANOVA. Also, correction Bonferoni test was used for multiple comparisons. Differences were considered statistically significant only when p ≤ 0.05.

Results:

89% of the patients were female, with a mean age of 58 years. 62% of patients with RA had comorbidities, with HA the most prevalent. There were statistically significant association between cardiovascular comorbidities with age (61.71±9.69years old vs 53.03±12.10) (p <0.001), lower educational level (n=282±66.5vs 143±33,5) (p <0.001), lower physical activity (n=132±73.3 vs 48±26.7) (p <0.001), disease duration (18.5±9.75 years vs 14.4±8.61) (p <0.001), positive anti-CCP test (60.5% vs 39.5%) (p = 0.027), high clinical disease activity index CDAI) (65.9%vs 34.1%) (p <0.001), DAS28VHS (3.72±1.46 vs 3.45±1.58) (p = 0.008) and HAQ score (1.00±0.76) vs 0.83±0.77 (p <0.001).

Conclusion:

The frequency of cardiovascular comorbidities is high in RA patients and is associated with age, disease duration and positive anti-CCP test. It is also important to see that these comorbidities are more common in patients with lower frequency of physical activity and lower functional capacity, higher disease activity score and lower level of education. Better control of disease activity and extensive information to patients about the importance of exercise should be parallel objectives in RA.

Disclosure of Interests:

Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Thayse Coan: None declared, G Castro: None declared, Geraldo Castelar Grant/research support from:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Paid instructor for:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi: None declared, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Maria Fernanda Guimarães: None declared, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Maria de Fátima Sauma: None declared, Claiton Brenol: None declared, Evandro Coutinho: None declared, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB.

AB0191 DECREASING DELAY TO DIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITIS: STILL DIFFICULT TO TREAT WITHIN THE WINDOW OF OPPORTUNITY

Background:

The need for early rheumatoid arthritis (RA) treatment for better outcomes is widely accepted. Is that goal being achieved in real-life settings?

Objectives:

To evaluate changes in the delay to RA diagnosis and treatment, and in the proportions of patients being treated early along the last decades in Brazil.

Methods:

This study was drawn from the REAL cohort, designed to assess RA management under real-life conditions. Patients ≥ 18 years old attending public hospitals in Brazil and meeting RA classification criteria were included. Subjects were stratified according to the year their symptoms began. Delays from symptoms onset to RA diagnosis and treatment were inquired. Early RA diagnosis and treatment was assessed using three different cut points: ≤3, ≤6 and ≤12 months of symptoms onset. Mann-Kendall’s trend test, chi-square tests, Welch’s ANOVA and Games-Howell’s post-hoc tests were used to test hypotheses, at 0.05 significance level.

Results:

1116 RA patients were included; 89.4% female; 56.8% white; mean (SD) age 57.1 (11.5) years. A downward trend was found in the delay to RA diagnosis (tau = -0.677, p < 0.001) and treatment (tau = -0.695, p < 0.001) from 1990 to 2015 (Figures 1 and 2). The year of symptoms onset was associated with the frequency of early treatment for all defined cut points: ≤3 months (χ2= 11.25, p = 0.001), ≤6 months (χ2= 34.84, p < 0.001), and ≤12 months (χ2= 64.79, p<0.001). The more recent the year of symptoms onset, the higher the proportions of individuals treated early (Table 1). Groups stratified according to successive periods of symptoms onset differed in the mean delay to RA treatment [F(5, 372.8) = 41.9; p < 0.001]. Patients with symptoms initiated more recently (2011-2015) had significantly lower delays compared to all other groups. Nonetheless, only 36.3% of these patients with more recent disease started treatment within 6 months of symptoms onset, and 17.2% within 3 months.

Table 1.

Proportions of individuals with RA receiving the first DMARD within different time intervals from symptoms onset, according to the year their symptoms began.

Symptoms beginning (year)Interval from symptoms onset to first DMARDN≤ 3 months≤ 6 months≤ 12 months≤ 1990 8.5%14.9%33.3%1411991 – 1995 5.3%15.8%34.7% 951996 – 200012.3%24.7%44.5%1462001 – 200511.5%26.3%49.8%2172006 – 201017.2%38.9%61.1%2392011 – 201517.2%36.3%72.0%157Figure 1.

Rheumatoid arthritis diagnostic delay according to the year of symptoms beginning, from 1990 to 2015 in Brazil

Figure 2.

Rheumatoid arthritis treatment delay according to the year of symptoms beginning, from 1990 to 2015 in Brazil.

Conclusion:

Delays to RA diagnosis and treatment have decreased, and more patients have been treated within defined windows for early RA management in the last decades in Brazil. Despite all improvements, it was still difficult to attain early RA treatment. Additional efforts are warranted in pursuit of that goal.

Disclosure of Interests:

Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Claiton Brenol: None declared, Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Maria Fernanda Guimarães: None declared, Maria Sauma: None declared, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Geraldo Castelar Grant/research support from:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Paid instructor for:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche

THU0183 ABATACEPT AND LOW GAMMA-GLOBULIN LEVELS: NO ASSOCIATION WITH INFECTIOUS RISK OR RA DISEASE ACTIVITY CONTROL

Background:

Abatacept (ABA) can induce decrease in gamma-globulins, but the long-term safety of such reduction is unknown. Moreover, it is suggested that such decrease is dissociated from disease activity response.

Objectives:

To evaluate ABA-induced gamma-globulins reduction and its correlation with disease activity control and the risk of infection in rheumatoid arthritis(RA) patients.

Methods:

This is a retrospective inception cohort of RA patients undergoing ABA for the first time in a large single tertiary cohort (2007 to 2019). Patients were evaluated regarding clinical and inflammatory data, total and specific (IgG, IgM, IgA) gamma-globulins assessed before, at 3 and 6 months, and then every 6 months up to discontinuation/censoring. The occurrence of severe or recurrent infections as cause of discontinuation of treatment was recorded. All patients were submitted to a systematic infectious screening protocol before and during treatment.

Results:

One hundred seventy-nine RA patients were included. They were predominantly female (93%;n=167) and had a positive rheumatoid factor (RF, 84%; n=151). Median(range) age and disease duration were 55.1(17-81.3) and 14(1.6-39.8) years, respectively. ABA was used in median as the 3rd(1-8) bDMARD. Most patients (74.3%, n=134) had already used a TNFi previously and 34.1% (n=61) had failed to rituximab. Baseline DAS28 [median(range)] was 4.9 (2-8.62), CDAI 27(5-66), HAQ 1.5 (0-3), ESR 18(2-111), and CRP 8.1(0.1 -135.7). Levels of total gamma-globulins(TGG) were 1.2 (0.5-2.8g/dL), IgG 1,094(422-2,785mg/dL), IgM104(19-405 mg/dL), and IgA 324 (100-739mg/dL). Forty-five patients (25.1%) had low IgG before ABA, but only 8(4.5%) had IgG<600mg/dL and low TGG. At 3 months, remarkable decreases were observed in total gamma-globulin(1.2vs.1.1g/dL), IgG(1,094vs.992mg/dL), IgM(104vs.93mg/dL), and IgA(324vs.302mg/dL), in comparison to baseline(p<0.05). Longitudinal measurements demonstrated that levels of gamma-globulins remained stable for subsequent evaluations(p>0.05). At baseline, TGG, IgG, IgM and IgA correlated positively to all disease activity parameters: DAS28(r=+0.33; r=+0.31;r=+0.24 and r=+0.37, respectively; p<0.02 for all), SDAI (r=+0.35; r=+0.37; r=+0.43; r=+0.34, respectively; p<0.04 for all), CDAI (r=+0.32; r=+0.29; r=+0.39; r=+0.31, respectively; p<0.03 for all, except IgA), swollen joints (r=+0.24; r=+0.23; p<0.01 only for TGG and IgG, respectively); tender joints (r=+0.18; r=+0.21; p<0.04 only for IgG and IgM respectively), ESR (r=+0.35; r=+0.24; r=+0.41; p<0.02 for TGG, IgG and IgA, respectively) and CRP (r=+0.20; r=+0.16; r=+0.27; p<0.05 for TGG, IgG and IgA, respectively). Longitudinally, most of these correlations were lost(p>0.05). Moreover, at 6 months, 25 patients (14%) achieved DAS28 ≤ 2.6 and 49 (27.4%) had low disease activity (DAS28 ≤ 3.2). Baseline or longitudinal measures of TTG and subtypes were similar among patients who responded and those who did not, regardless of the cut-off used(p>0.05. Only 14 patients (9.4%) had the medication discontinued due to infections: 3 due to recurrent infections and 11 to severe infections. One patient died. The frequencies of low IgG (under the normal limit of normality) at baseline and all time points(p>0.05) were similar among patients with and without severe/recurrent infections. None of these patients had low TGG or very low IgG(<600mg/dL) at baseline or during treatment and the levels of TGG and all subtypes were comparable at all time points (p>0.05).

Conclusion:

This cohort of real-world RA patients shows that reduction in gamma-globulin levels induced by ABA is safe, non-progressive and not associated to a higher risk of infection, even in patients with low IgG or TGG. Additionally, it is not associated to clinical response.

Disclosure of Interests: None declared

THU0333 CARDIOVASCULAR COMORBIDITIES ARE COMMON IN RHEUMATOID ARTHRITIS PATIENTS WHO PRACTICE LESS PHYSICAL ACTIVITY AND WHO HAVE WORSE FUNCTIONAL CAPACITY

Background:

Patients with rheumatoid arthritis have more cardiovascular comorbidities which contributes to hospitalization and mortality.

Objectives:

This study aims to investigate whether there is an association between cardiovascular comorbidities in RA with subgroup of patients and clinical findings of the disease

Methods:

This study is a cross-sectional part of Rheumatoid Arthritis in Real Life (REAL), which is a multicenter prospective study conducted in Brazil, involving 13 centers specialized in the care of patients with RA. All subjects met the ARA (1987) or ACR/EULAR (2010) RA classification criteria. Subjects were submitted to clinical interview with physical exam and review of medical records. A sample of 1116 patients was selected for convenience. The association between cardiovascular comorbidities (systemic arterial hypertension (HA), diabetes mellitus (DM) type2, dyslipidemia, stroke and heart failure), the clinical characteristics and laboratory parameters of RA was evaluated through chi-square hypothesis tests, Student`s t-test, Fischer exact test, correlations test and ANOVA. Also, correction Bonferoni test was used for multiple comparisons. Differences were considered statistically significant only when p ≤ 0.05.

Results:

89% of the patients were female, with a mean age of 58 years. 62% of patients with RA had comorbidities, with HA the most prevalent. There were statistically significant association between cardiovascular comorbidities with age (61.71±9.69years old vs 53.03±12.10) (p <0.001), lower educational level (n=282±66.5vs 143±33,5) (p <0.001), lower physical activity (n=132±73.3 vs 48±26.7) (p <0.001), disease duration (18.5±9.75 years vs 14.4±8.61) (p <0.001), positive anti-CCP test (60.5% vs 39.5%) (p = 0.027), high clinical disease activity index CDAI) (65.9%vs 34.1%) (p <0.001), DAS28VHS (3.72±1.46 vs 3.45±1.58) (p = 0.008) and HAQ score (1.00±0.76) vs 0.83±0.77 (p <0.001).

Conclusion:

The frequency of cardiovascular comorbidities is high in RA patients and is associated with age, disease duration and positive anti-CCP test. It is also important to see that these comorbidities are more common in patients with lower frequency of physical activity and lower functional capacity, higher disease activity score and lower level of education. Better control of disease activity and extensive information to patients about the importance of exercise should be parallel objectives in RA.

Disclosure of Interests:

Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Gabriela Ribas: None declared, G Castro: None declared, Geraldo Castelar Grant/research support from:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Paid instructor for:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi: None declared, Maria Fernanda Guimarães: None declared, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Maria de Fátima Sauma: None declared, Claiton Brenol: None declared, Evandro Coutinho: None declared, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB.

AB0190 DO IT FAST! EARLY ASSESSMENT BY A RHEUMATOLOGIST INCREASES THE CHANCES OF RHEUMATOID ARTHRITIS BEING TREATED WITHIN THE “WINDOW OF OPPORTUNITY”

Background:

The current concept of treating rheumatoid arthritis RA patients emphasizes the importance of early diagnosis and early initiation of disease-modifying drugs (DMARD) for a better prognosis of these patients.

Objectives:

To evaluate the impact of rheumatologic evaluation on the diagnosis of RA patients, as well as on the initiation of DMARD and on the clinical control of disease activity of these patients under real-life conditions.

Methods:

The REAL study included RA patients attending eleven public hospitals, from different regions of Brazil. All subjects met the ARA (1987) or ACR/EULAR (2010) RA classification criteria. Subjects were submitted to clinical interview with physical exam and review of medical records. Specialized assessment was defined as sequentially “early”, when the rheumatologist was the 1stor 2ndconsulted physician, and sequentially “late”, when the rheumatologist was consulted after two or more other doctors. Welch’st, Mann-Whitney’s U, chi-square and Spearman’s rho tests were used to test hypotheses, at significance level of 0.05. The study was approved by local ethics committees and all participants granted informed consent.

Results:

1057 RA patients were assessed; 89.4% (n=945) female; 56.5% (n=597) white; mean (SD) age of 56.9 (11.5) years; mean (SD) disease duration of 173.1 (114.5) months. Median [IQR] delay from symptoms onset to RA diagnosis and to the first DMARD both equaled 12 [6, 36] months. Only 28.7% received a DMARD within 6 months of symptoms onset, and 13.1% within 3 months. Most patients (64.6%) sought a general practitioner first, but 80.7% were finally diagnosed only upon rheumatologist consultation. For 28.8%, the rheumatologist was consulted after two or more other doctors. Early specialized assessment resulted in higher chances of receiving a DMARD within 6 months (OR 2.77; 95%CI [1.93, 3.97]) and within 3 months (OR 2.57; 95%CI [1.54, 4.27]) of RA onset. Late assessment was associated with lower chances of being in remission or low disease activity upon study inclusion (OR 0.53; 95%CI [0.39, 0.72]). Patients assessed early by the rheumatologist, compared to those assessed late, showed lower (mean [SD]) HAQ scores (0.877 [0.715] vs. 1.074 [0.857]; p<0.001) and DAS28-CRP scores (3.20 [1.32] vs. 3.45 [1.48]; p=0.02), and shorter delays to RA diagnosis (26.9 [46.7] vs. 44.6 [60.1] months; p<0.001) and to use the first DMARD (32.5 [58.5] vs. 50.6 [69.9] months; p<0.001). The delay to initiate a DMARD was strongly correlated to that of diagnosing RA (rho 0.816; p < 0.001).

Conclusion:

Most RA patients missed the window of opportunity to early treatment. Treatment delay strongly correlated with delay in diagnosis, which critically depended on the input from the rheumatologist. Late rheumatologist assessment was associated with lower chances of early RA treatment and with worse outcomes. Failure in direct transition from primary to specialized care was a common problem that needs to be solved.

Disclosure of Interests:

Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Claiton Brenol: None declared, Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Consultant of: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Maria Fernanda Guimarães: None declared, Maria Sauma: None declared, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Geraldo Castelar-Pinheiro Grant/research support from: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche

Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis

BACKGROUND

Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality rates. Better characterization of progressive interstitial changes and identification of risk factors that are associated with progression may enable earlier intervention and improved outcomes.

RESEARCH QUESTION

What are baseline characteristics associated with RA-ILD progression?

STUDY DESIGN AND METHODS

We performed a retrospective study in which all clinically indicated CT chest scans in adult individuals with RA from 2014 to 2016 were evaluated for interstitial changes, and the data were further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semiquantified.

RESULTS

Those individuals with a spectrum of interstitial changes (64 of 293) were older male smokers and less likely to be receiving biologics/small molecule disease-modifying antirheumatic drugs. Of 44% of the individuals with ILA, 46% had had chest CT scans performed for nonpulmonary indications. Of the 56 individuals with ILA/ILD with sequential CT scans, 38% had evidence of radiologic progression over 4.4 years; 29% of of individuals with ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement.

INTERPRETATION

Of 293 individuals with RA with clinically indicated CT scans, interstitial changes were observed in 22%, one-half of whom had had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, one-half had had baseline CT scans performed for nonpulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longitudinal studies of RA-ILA are necessary.

A randomized controlled trial to reduce sedentary time in rheumatoid arthritis: protocol and rationale of the Take a STAND for Health study

Background

Patients with rheumatoid arthritis spend most of their daily hours in sedentary behavior (sitting), a predisposing factor to poor health-related outcomes and all-cause mortality. Interventions focused on reducing sedentary time could be of novel therapeutic relevance. However, studies addressing this topic remain scarce. We aim to investigate the feasibility and efficacy of a newly developed intervention focused on reducing sedentary time, and potential clinical, physiological, metabolic and molecular effects in rheumatoid arthritis.

Methods

The Take a STAND for Health study is a 4-month, parallel-group, randomized controlled trial, in which postmenopausal patients with rheumatoid arthritis will set individually tailored, progressive goals to replace their sedentary time with standing and light-intensity activities. Patients will be recruited from the Clinical Hospital (School of Medicine, University of Sao Paulo) and will be assessed at baseline and after a 4-month follow up. Outcomes will include objectively measured sedentary behavior (primary outcome) and physical activity levels, clinical parameters, anthropometric parameters and body composition; aerobic fitness, muscle function, blood pressure, cardiovascular autonomic function, vascular function and structure, health-related quality of life, and food intake. Blood and muscle samples will be collected for assessing potential mechanisms, through targeted and non-targeted approaches.

Discussion

Findings will be of scientific and clinical relevance with the potential to inform new prescriptions focused on reducing sedentary behavior, a modifiable risk factor that thus far has been overlooked in patients with rheumatoid arthritis.

Trial registration

ClinicalTrials.gov, NCT03186924. Registered on 14 June 2017.

Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease

OBJECTIVE

The objective of this study was to determine the prevalence and distribution of bone erosions detectable by US in patients with early RA (ERA) in comparison with long-standing RA (LSRA), other erosive diseases and healthy controls.

METHODS

Thirty patients with ERA and 80 patients with LSRA were consecutively recruited. Thirty patients with PsA, 15 with primary OA, 10 with gout and 20 healthy subjects were included as controls. Bone erosions were investigated at the following anatomical sites: the second and fifth metacarpal heads, the ulnar head and the first and fifth metatarsal heads, bilaterally. Dorsal, volar and lateral aspects were explored on longitudinal and transverse views.

RESULTS

At least one US bone erosion was found in 20 (66.7%) of 30 patients with ERA and in 10 (33%) of them it was found on the fifth metatarsal head. Bone erosions were most frequently found on the lateral quadrants of all scanned anatomical sites. If the second and fifth metacarpal heads and the fifth metatarsal head were scanned, an erosive disease could be found in 60% of ERA patients. The first metatarsal head was most frequently involved in the disease control group.

CONCLUSION

This study found a high percentage of ERA patients with US bone erosions, with the fifth metatarsal head and the lateral aspects the most frequently involved site and quadrants. US scanning for bone erosions on a few target joints was found feasible and provided information not obtainable with clinical examination.