Anti-SAE dermatomyositis: clinical and histologic characteristics from a monocentric Italian cohort

OBJECTIVES

Multiple myositis-specific antibodies have been identified, each associated with different clinical subsets of dermatomyositis (DM). Anti-SAE associated DM is considered the least studied subset. Our study aimed to evaluate the clinical and histological characteristics of DM patients with anti-SAE antibodies. As reference, patients with anti-Mi2 antibodies associated DM, representing a well-characterised subset, were analysed.

METHODS

We recorded data from our DM cohort in the INflammatory MYositis REgistry (INMYRE). Patients were divided into two groups: those positive for anti-SAE and those positive for anti-Mi2 antibodies. Clinical characteristics, including skin, muscle, and extra-muscular involvements, were recorded. Available muscle biopsies were compared between the two groups.

RESULTS

Of 92 DM patients, 10 (10.9%) were positive for anti-SAE and 17 (18.5%) for anti-Mi2. Anti-SAE positive DM patients showed classic DM findings but were characterised by a higher prevalence of skin itching (60% vs. 11.8%, p<0.01), shawl sign (40% vs. 5.9%, p<0.05) and lung involvement (30% vs. 0%, p<0.05) compared to anti-Mi2 positive patients. Furthermore, anti-SAE positive DM patients showed lower creatine kinase levels than those with anti-Mi2 (median [IQR]: 101 [58-647] vs. 1984 [974-3717], p<0.05) and a lower percentage of muscle fibre degeneration and necrosis (1.5%±1.7 vs. 5.9%±3.2, p<0.05) in muscle biopsies. No other differences were observed.

CONCLUSIONS

Anti-SAE DM represents a disease subset characterised by classic cutaneous involvement often associated with itching, less severe muscle involvement, but potential pulmonary involvement that should always be investigated in these patients.

Clinical, histologic and prognostic features of clinically amyopathic dermatomyositis

OBJECTIVES

To characterise clinical amyopathic dermatomyositis (CADM) from a clinical, histological, and prognostic perspective.

METHODS

We retrospectively recorded data from our DM cohort. Patients were categorised into three groups: classic DM, hypomyopathic DM (HDM), characterised by normal muscle strength and evidence of muscle involvement in laboratory tests and/or instrumental examinations and CADM, featured by normal muscle strength and unremarkable findings in both laboratory tests and instrumental examinations. Available muscle biopsies from each group were also compared.

RESULTS

Our cohort included 63 DM (69.2%), 12 HDM (13.2%) and 16 CADM (17.6%) patients. Compared to DM, CADM patients were younger at onset and diagnosis (45.5±17 vs. 57±18, and 46±17 vs. 58±18 years, respectively; p<0.05). They were more likely to test positive for anti-MDA5 (37.5% vs. 4.8%) and anti- TIF1-γ (31.3% vs. 6.3%), had a higher incidence of arthritis (37.5% vs. 12.6%) and interstitial lung disease (ILD) (43.8% vs. 15.9%) (all comparisons with p<0.05). Muscle biopsies were available for 44 DM, 7 CADM, and 11 HDM patients, revealing similar sarcolemma MHC-I expression rates. Five-year survival rates were comparable across groups (DM: 74.6%, CADM: 75%, HDM: 83.3%). Cox analysis indicated the main mortality predictors in overall cohort were ILD (HR: 3.57, CI: 1.11-11.5) and cancer (HR: 3.67, CI: 1.17-11.5), not CADM (HR: 1.46, CI: 0.33-6.68).

CONCLUSIONS

CADM patients differ in disease onset, autoantibody profiles, joint and lung involvement. While laboratory and instrumental tests have not shown muscle involvement in CADM, many muscle biopsies have shown MHC-I overexpression.

Plasma pentraxin 3 in idiopathic inflammatory myopathies: a possible new biomarker of disease activity

Pentraxin-3 (PTX3) is a component of humoral innate immunity with essential functions both in promotion and resolution of inflammation. We aimed to study the PTX3 in the plasma and in the muscle of patients with idiopathic inflammatory myopathies (IIM) and whether PTX3 may correlate with disease activity. Plasma PTX3 levels were assessed in 20 patients with IIMs, 10 dermatomyositis (DM), and 10 polymyositis (PM), compared to 10 patients with rheumatoid arthritis (RA) and 10 healthy donors (HDs) aged, sex, and body mass index matched. Disease activity in IIMs was assessed by Myositis Disease Activity Assessment Visual Analog Scale (MYOACT), while disease activity score on 28 joints (DAS28) was used for RA patients. Muscle histopathology and immunohistochemical (IHC) analyses were also performed. Mean plasma PTX3 levels were significantly higher in IIM patients than HDs (518 ± 260 pg/ml vs. 275 ± 114 pg/ml, P = 0.009). Linear regression analysis adjusted for age, sex, and disease duration showed a direct correlation between PTX3 and CPK levels (β: 0.590), MYOACT (β: 0.759), and physician global assessment of disease activity (β: 0.832) in IIMs. No association between PTX3 levels and DAS28 was found in RA. Global PTX3 pixel fraction was higher in IIM than HDs muscle, but a lower PTX3 expression was found in perifascicular areas of DM and in myofibers with sarcolemmal staining for membrane attack complement. PTX3 plasma levels were increased in IIMs and correlated with disease activity suggesting a possible role as biomarker of disease activity. PTX3 showed a different distribution in DM or PM muscle.

Similarities and differences between younger and older disease onset patients with newly diagnosed systemic lupus erythematosus

OBJECTIVES

Several studies show that age at onset has an impact on the clinical-serological presentation, comorbidities and disease course of patients with systemic lupus erythematosus (SLE). We evaluated whether, in patients with recent onset SLE, the age at onset correlates with clinical-serological manifestations and with comorbidities.

METHODS

We analysed 171 patients with a SLE diagnosis obtained within 12 months of diagnosis enrolled in the Early Lupus project. Based on the age of onset of the first disease symptom, they were stratified into 2 groups: early onset (18-45 years) and late onset (>45 years). The analysis was replicated by stratifying patients based on age at diagnosis (fulfillment of ACR classification criteria). Each comparison was made at baseline and at 36 months of follow-up.

RESULTS

Baseline: patients with late onset displayed comorbidities (hypertension, dyslipidemia and osteoporosis) more frequently than early onset group. 11.4% of late onset patients had a malignancy in medical history, not recorded in the early onset cohort. The two groups differed neither in organ involvement (domain BILAG) nor in disease activity (ECLAM). Patients with early onset showed a disease with signs of higher serologic activity (higher frequency of anti-dsDNA positivity and lower mean C3 and C4 levels) and had malar rash more frequently than the late onset group (36.2% vs. 18.2%, p=0.042). Similar results were obtained by stratifying patients by age of diagnosis (18-45 years and >45 years), except for the higher frequency of discoid rash in the group with age at diagnosis >45 years (18% vs. 6.6%, p=0.045). 36 months: the 2 groups of patients independently of the stratification applied did not differ in the accumulation of damage, but showed a different pattern of 8 organ involvement. Musculoskeletal involvement was more frequent both in the late onset group (18.6% vs. 7.3%, p=0.043) and in the group with age at diagnosis >45 years (20.4% vs. 5.9%, p=0.009) compared to their counterparts, while renal involvement was more frequent in the group with age at diagnosis 18-45 years (21.4% vs. 6.1%, p=0.03).A sub analysis at 36 months on patients without hypertension and osteoporosis at enrollment showed that patients with older age at onset had a higher frequency of these comorbidities, compared to their counterparts.

CONCLUSIONS

In our cohort, younger disease SLE onset seems to correlate with a more active immunological profile, while late onset with a higher incidence of comorbidities.

Glucocorticoid tapering and associated outcome in patients with newly diagnosed systemic lupus erythematosus: the real-world GULP prospective observational study

OBJECTIVE

A subanalysis of the multicentre Early Lupus inception cohort was performed to investigate the real-world Glucocorticoids (GCs) Use in newly diagnosed systemic lupus erythematosus (SLE) Patients (GULP).

METHODS

Patients starting prednisone (PDN) ≥5 mg/day and concomitant hydroxychloroquine or immunosuppressant within 12 months of SLE classification were enrolled. Core set variables were recorded at baseline and every 6 months, including changes in PDN dose, European Consensus Lupus Activity Measurement (ECLAM) and Systemic Lupus International Collaborating Clinics damage index. Regression models analysed predictors of tapering PDN<5 mg/day at any time and outcomes associated with different patterns of GCs tapering.

RESULTS

The GULP study included 127 patients with SLE; 73 (57.5%) tapered and maintained PDN <5 mg/day, and 17 (13.4%) discontinued PDN within a 2-year follow-up. Renal involvement (HR: 0.41; p=0.009) and lower C3 serum levels (HR: 1.04; p=0.025) predicted a lack of PDN tapering below 5 mg/day. High ECLAM scores were associated with a greater probability of increasing PDN dose (OR: 1.6; p=0.004), independently of daily intake. Disease relapse rate did not statistically differ (p=0.706) between patients tapering PDN <5 mg/day (42/99, 42.4%) and those tapering PDN without dropping below 5 mg/day (13/28, 46.4%). Every month on PDN <5 mg/day associated with lower damage accrual (IRR: 0.96; p=0.007), whereas never tapering PDN <5 mg/day associated with a higher risk of developing GC-related damage (OR 5.9; p=0.014).

CONCLUSION

Tapering PDN <5 mg/day was achieved and maintained in half of newly diagnosed patients with SLE and may represent a good balance between the need to prevent damage accrual and the risk of disease relapse.

POS0928 THE IDENTIFICATION OF PENTRAXIN 3 AS BIOMARKER OF DISEASE ACTIVITY IN IDIOPATHIC INFLAMMATORY MYOPATHIES

Background

Muscle involvement is only one feature of idiopathic inflammatory myopathies (IIM). Muscle enzymes do not always represent the best marker of disease activity and other inflammation markers such as ESR and CRP may be normal even with an active disease. Pentraxin-3 (PTX3) is an inflammatory marker produced in many inflammatory and non-inflammatory cells and serum level has been related to higher risk of major cardiovascular events and atherosclerosis1. PTX3 levels have been examined in various rheumatic and autoimmune diseases2, but data of PTX3 levels in patients affected with IIM have not been reported.

Objectives

The aim of the current study was to identify whether serum PTX3 level could be a marker of disease activity in patients affected with IIM.

Methods

Twenty patients affected with IIM (13 Dermatomyositis and 7 Polymyositis), 10 rheumatoid arthritis patients and 10 healthy controls (HC) aged, sex and BMI matched were evaluated. PTX3 levels was assessed using a commercially available enzyme-linked immunosorbent assay (Human Pentraxin3 ELISA Kit, Abcam) kit. Three different cardiovascular risk scores were used to estimate the 10-years CV risk. Carotid intima media thickness (cIMT) was measured with a My Lab XPro80 (Esaote SpA, Genova, Italy) using a linear array ultrasound probe small parts broadband transducer (5–15 MHz) both in right and left carotid. Myositis disease activity was evaluated by using myositis disease activity assessment visual analog scales (MYOACT) [19] established by the International Myositis Assessment and Clinical Studies (IMACS) group. Manual muscle test (MMT8) was used to assess muscle impairment. Exclusion criteria were a diagnosis of diabetes or a history of previous major CV events.

Results

Demographic and disease characteristics of our cohort are showed in Table 1. IIM patients showed higher levels of PTX3 compared to HCs (518±260 pg/ml vs 275±114 pg/ml, p<0.05), while no difference was observed compared to RA patients (383±260 pg/ml). PTX3 levels do not correlate with lipid levels, QIMT and cardiovascular risk scores both in IIM, RA and HC. No correlation was found between DAS28-ESR and PTX3 levels in RA patients. Of note, a direct correlation was found between PTX3 levels and MYOACT-GLOBAL DISEASE ACTIVITY (r=0.675, p=0.002), PTX3 levels and MYOACT- GLOBAL-EXTRA-SKELETAL MUSCLE DISEASE ACTIVITY (r=0.542, p=0.013), while an inverse correlation was found between PTX3 levels and MMT8 (r=-0.510, p=0.02).

Table 1.IIM 20pz (13 DM, 7 PM)RA 10pzHealthy Control 10pzFemale, n. (%)18 (90%)9 (90%)9 (90%)Age55,3 (7,8)58,3 (5,9)54,6 (6,5)BMI25,5 (4,1)23,9 (3,1)24,6 (3,5)Duration of disease, median (IQR)7,3 (4 – 12,8)13,5 (10,5 – 18,5)*Physician Global Assessment2,1 (2,1)2 (2,2)Patient Global Assessment4 (3,6)2,7 (2,3)Health Assessment Questionnaire0,7 (0,8)0,9 (0,9)Manual Muscle Testing 876,2 (6,6)DAS282,6 (1,1)Skin involvement, n. (%)13 (65)Lung involvement, n. (%)7 (35)Dysphagia, n. (%)11 (55)Arthritis, n. (%)4 (20)Malignancies, n. (%)0 (0)0 (0)0 (0)Arterial hypertension, n. (%)6 (30)2 (20)1 (10)Current steroid therapy2,5 (0 – 5)0 (0 – 3,8)Smoking, n. (%)6 (30)2 (20)3 (30)Total cholesterol, mg/dl203,3 (28,6)215,0 (29,5)216,2 (27,3)HDL cholesterol, mg/dl62,7 (14,7)62,6 (14,2)65,1 (18,2)ESR, mm/h16,7 (12,2)19 (11,7)PCR, mg/l2,9 (2,1)4,1 (5)SCORE median (IQR)0,5 (0 – 2)1 (0 – 3)1 (0,8 – 1,3)CUORE median (IQR)1,9 (0,6 – 3,5)1,6 (1 – 4)1,7 (1,2 – 2,8)QRISK3 median (IQR)4,7 (2,1 – 11,3)7,5 (3,2 – 13,6)4,2 (3,1 – 5,5)QIMT Max, median (IQR)742,5 (636,8 – 804)833 (685,3 – 961) *756 (711 – 820)Mean QIMT, median (IQR)679 (613,1 – 736,3)764,3 (664,5 – 854,1) *703,3 (697,3 – 742,8)Pentraxin 3, pg/ml518 (260)383 (146)275 (114)*

Data are expressed as “mean (SD)” where not otherwise specified.

*p<0.05, **p<0.01, ***p<0.001 vs IIM

Conclusion

In IIM patients, PTX3 levels are higher than HC and correlate with disease activity, both for muscular and extra-muscular manifestations, being a possible biomarkers of disease activity.

References

[1]Front Immunol. 2019; 10: 823

[2]Arch Med Sci. 2020; 16(1): 81–86

Disclosure of Interests

None declared

Validity of Machine Learning in Predicting Giant Cell Arteritis Flare After Glucocorticoids Tapering

Background

Inferential statistical methods failed in identifying reliable biomarkers and risk factors for relapsing giant cell arteritis (GCA) after glucocorticoids (GCs) tapering. A ML approach allows to handle complex non-linear relationships between patient attributes that are hard to model with traditional statistical methods, merging them to output a forecast or a probability for a given outcome.

Objective

The objective of the study was to assess whether ML algorithms can predict GCA relapse after GCs tapering.

Methods

GCA patients who underwent GCs therapy and regular follow-up visits for at least 12 months, were retrospectively analyzed and used for implementing 3 ML algorithms, namely, Logistic Regression (LR), Decision Tree (DT), and Random Forest (RF). The outcome of interest was disease relapse within 3 months during GCs tapering. After a ML variable selection method, based on a XGBoost wrapper, an attribute core set was used to train and test each algorithm using 5-fold cross-validation. The performance of each algorithm in both phases was assessed in terms of accuracy and area under receiver operating characteristic curve (AUROC).

Results

The dataset consisted of 107 GCA patients (73 women, 68.2%) with mean age ( ± SD) 74.1 ( ± 8.5) years at presentation. GCA flare occurred in 40/107 patients (37.4%) within 3 months after GCs tapering. As a result of ML wrapper, the attribute core set with the least number of variables used for algorithm training included presence/absence of diabetes mellitus and concomitant polymyalgia rheumatica as well as erythrocyte sedimentation rate level at GCs baseline. RF showed the best performance, being significantly superior to other algorithms in accuracy (RF 71.4% vs LR 70.4% vs DT 62.9%). Consistently, RF precision (72.1%) was significantly greater than those of LR (62.6%) and DT (50.8%). Conversely, LR was superior to RF and DT in recall (RF 60% vs LR 62.5% vs DT 47.5%). Moreover, RF AUROC (0.76) was more significant compared to LR (0.73) and DT (0.65).

Conclusions

RF algorithm can predict GCA relapse after GCs tapering with sufficient accuracy. To date, this is one of the most accurate predictive modelings for such outcome. This ML method represents a reproducible tool, capable of supporting clinicians in GCA patient management.

Severe muscle damage with myofiber necrosis and macrophage infiltrates characterize anti-Mi2 positive dermatomyositis

OBJECTIVE

The aim of our study was to investigate clinical and histopathological findings in adult DM patients positive for anti-Mi2 (anti-Mi2+) antibodies compared with DM patients negative for anti-Mi2 (anti-Mi2-).

METHODS

Clinical data of adult DM patients, who fulfilled EULAR/ACR 2017 classification criteria, were gathered from electronic medical records of three tertiary Rheumatology Units. Histopathological study was carried out on 12 anti-Mi2+ and 14 anti-Mi2- muscle biopsies performed for diagnostic purpose. Nine biopsies from immune mediated necrotizing myopathy (IMNM) patients were used as control group.

RESULTS

Twenty-two anti-Mi2+ DM [90.9% female, mean age 56.5 (15.7) years] were compared with 69 anti-Mi2- DM patients [71% female, mean age 52.4 (17) years]. Anti-Mi2+ patients presented higher levels of serum muscle enzymes than anti-Mi2- patients [median (IQR) creatine-kinase fold increment: 16 (7-37)vs 3.5 (1-9.9), P <0.001] before treatment initiation. Moreover, a trend towards less pulmonary involvement was detected in anti-Mi2+ DM (9.1% vs 30.4%, P =0.05), without any case of rapidly progressive interstitial lung disease. At muscle histology, anti-Mi2+ patients showed more necrotic/degenerative fibres than anti-Mi2- patients [mean 5.3% (5) vs 0.8% (1), P <0.01], but similar to IMNM [5.9% (6), P >0.05]. In addition, the endomysial macrophage score was similar between anti-Mi2+ and IMNM patients [mean 1.2 (0.9) vs 1.3 (0.5), P >0.05], whereas lower macrophage infiltration was found in anti-Mi2- DM [mean 0.4 (0.5), <0.01].

CONCLUSIONS

Anti-Mi2+ patients represent a specific DM subset with high muscle damage. Histological hallmarks were a higher prevalence of myofiber necrosis, endomysial involvement and macrophage infiltrates at muscle biopsy.

AB0380 MACHINE LEARNING CAN PREDICT GIANT CELL ARTERITIS RELAPSE AFTER GLUCOCORTICOID TAPERING

Background:

To date reliable biomarkers and risk factors for relapsing giant cell arteris (GCA) after glucocorticoid (GC) tapering are still lacking.

In an increasing number of social and clinical scenarios, machine learning (ML) is emerging as a promising tool for the implementation of complex multi-parametric decision algorithms. A ML approach allows to handle complex non-linear relationships between patient attributes that are hard to model with traditional statistical methods, merging them to output a forecast or a probability for a given outcome.

Objectives:

To assess whether ML algorithms can predict GCA relapse after glucocorticoid tapering.

Methods:

GC-naïve GCA patients who presented to 4 tertiary care centers between January 2015 and January 2019, who underwent GC therapy and regular follow up visits for at least 12 months were retrospectively analyzed and used for training and validation (through 10-fold cross-validation) of n.2 ML algorithms, namely Decision Trees (DT) and Random Forest (RF).

Test of the algorithms was carried out GCA patients referred to the same centers from March 2019 to September 2020 whose data was longitudinally recorded during the 12 months after presentation.

Demographic, clinical an laboratory characteristics (Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) levels) were gathered.

The outcome of interest was the GCA relapse within 12 months after induction of remission, during GC tapering.

The accuracy of the algorithms in both validation and test phases was assessed.

Results:

The training and validation dataset consisted of n.85 GCA patients (59 female, 69.4%) with mean age 73.8 (±8.7) years at presentation. They were treated with 27.1 (±17.4) mg prednisone (PDN) equivalent at first visit. During GC tapering 34 of them (40%) experienced a disease relapse within 12 months. The test dataset consisted of n.22 patients (14 female, 63.4%) with mean age 75.5 (±8.7) years at presentation, who underwent GC induction therapy with a mean dose of 30.3 (±17.3) mg PDN equivalent. Nine of them (40.9%) had a GCA flare during GC tapering, within 12 months. Accuracy of DT and RF in predicting the outcome of interest on the training dataset was 68.3% and 73.4% respectively. On testing datasets DT and RF accuracy was 57.1 and 72.4%, respectively.

As shown in Figure 1, the most important patient attributes for RF forecast were found to be CRP and ESR baseline levels as well as age and symptom duration (months) at first visit.

Conclusion:

RF algorithm can predict GCA relapse after glucocorticoid tapering with fairly good accuracy. To date this is one of the most accurate predictive modeling for such outcome. This ML method represents a reproducible tool executable on computers as well as mobile devices and capable of supporting clinicians in GCA patient management.

References:

[1]Hellmich B., Agueda A., Monti S., et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis Annals of the Rheumatic Diseases 2020;79:19-30.

[2]Venerito, V., Angelini, O., Cazzato, G. et al. A convolutional neural network with transfer learning for automatic discrimination between low and high-grade synovitis: a pilot study. Internal and Emergency Medicine 2021.

Disclosure of Interests:

None declared

Risk factors of damage in early diagnosed systemic lupus erythematosus: results of the Italian multicentre Early Lupus Project inception cohort

OBJECTIVE

To investigate risk factors for damage development in a prospective inception cohort of early diagnosed SLE patients.

METHODS

The Early Lupus Project recruited an inception cohort of patients within 12 months of SLE classification (1997 ACR criteria). At enrolment and every 6 months thereafter, the SLICC/ACR Damage Index was recorded. The contribution of baseline and time-varying covariates to the development of damage, defined as any SLICC/ACR Damage Index increase from 0 to ≥1, was assessed using univariate analysis. Forward-backward Cox regression models were fitted with covariates with P < 0.05 to identify factors independently associated with the risk of damage development.

RESULTS

Overall, 230 patients with a mean (s.d.) age of 36.5 (14.4) years were eligible for this study; the mean number of visits per patient was 5.3 (2.7). There were 51 (22.2%) patients with SLICC/ACR Damage Index ≥1 after 12 months, 59 (25.6%) after 24 months and 67 (29.1%) after 36 months. Dyslipidaemia [P = 0.001; hazard ratio (HR) 2.9; 95% CI 1.5, 5.6], older age (P = 0.001; HR 3.0; 95% CI 1.6, 5.5), number of organs/systems involved (P = 0.002; HR 1.4; 95% CI 1.1, 1.8) and cardiorespiratory involvement (P = 0.041; HR 1.9; 95% CI 1.0, 3.7) were independently associated with an increased risk of developing damage. Risk profiles for damage development differed for glucocorticoid-related and -unrelated damage. HCQ use (P = 0.005; HR 0.4; 95% CI 0.2, 0.8) reduced the risk of glucocorticoid-unrelated damage.

CONCLUSION

We identified risk factors of damage development, but little effect of glucocorticoids, in this early SLE cohort. Addressing modifiable risk factors from the time of SLE diagnosis might improve patient outcomes.

THU0344 CLINICAL AND HISTOLOGICAL SPECTRUM OF ANTI-MI2 DERMATOMYOSITIS: A MULTICENTRE RETROSPECTIVE COHORT

Background:

Dermatomyositis (DM) shows a wide clinical spectrum that seems to be different based on the type of autoantibody status. Furthermore, less is known regarding to the histopathology of different serological subsets of DM

Objectives:

The aim of our study was to investigate clinical and histopathological hallmarks in adult DM patients positive for anti-Mi2 (Mi2+) antibody compared to DM patients negative for anti-Mi2 (Mi2-)

Methods:

All clinical data of adult DM patients admitted in three tertiary Rheumatology Units, who fulfilled EULAR/ACR 2017 classification criteria1, were included in this study. Overlap syndrome and antisynthetase syndrome were exclusion criterion. Serum samples were tested in the local reference laboratories using line immunoassays methods for Myositis specific and associated antibodies. Histopathological study was carried out from muscle biopsies performed for diagnostic purpose in outpatient clinic of Bari (Italy) University. Quantitative analysis was performed for myofiber and capillary features, whereas semi-quantitative analysis (score from 0 to 3) was performed for inflammatory cells infiltrate, both at endomysial and perimysial sites

Results:

A total of 95 DM patients, followed for a median (IQR) follow-up of 28 (9-85) months, were analyzed. Of these, 23 (24.2%) patients (87% female, mean age at onset 55.4±16.2 years) were anti-Mi2+, while 72 (75.8%) patients were Mi2- (72.2% female, mean age at onset 55.2±17 years). All Mi2+ patients showed muscle involvement. Moreover, Mi2+ DM showed higher levels of serum creatine kinase (CK) at onset compared to Mi2- (CK (IQR): 2649 UI/l (1130-6000) vs 575 UI/l (164-1617), p<0.001). Prevalence of interstitial lung disease (ILD) was lower in Mi2+ patients (8.7% vs 30.6%, p=0.05), and no case of rapidly progressive ILD (RP-ILD) was found. Survival analysis at 5-years follow-up highlighted good survival for Mi2+ patients, but not different from Mi2- (95.7% vs 83.1%, p=0.151). Multivariate analysis showed that age at onset (HR:1.07), RP-ILD (HR:36.2) and cancer associated myositis (HR:6.1) correlated with a poor prognosis. Finally, a total of 26 biopsies (12 Mi2+ and 14 Mi2-) were included into the histological analysis showing higher prevalence of necrotic/degenerating myofibers (median (IQR) 2.6 (0.7-11)% vs 0.6 (0.4-1.1)%, p=0.009) and sarcoplasmic deposit of membrane attack complex (MAC) (median (IQR) 0.2 (0-1.2)% vs (0(0-0)%,p=0.009) in Mi2+ patients. In addition, the endomysial macrophage score was higher in Mi-2+ patients (median 1.5 (0.25-2) vs (0.5 (0-1), p=0.031)

Conclusion:

Mi2+ patients represent a specific DM subset with higher muscle damage, sarcoplasmic MAC deposits and endomysial macrophages infiltration as histological hallmarks

References:

[1]Ann Rheum Dis. 2017 Dec;76(12):1955-1964

Disclosure of Interests:

Marco Fornaro: None declared, Francesco Girolamo: None declared, Lorenzo Cavagna: None declared, Franco Franceschini: None declared, margherita giannini: None declared, Giovanni Zanframundo: None declared, Micaela Fredi: None declared, Marilin Tampoia: None declared, Angela Amati: None declared, Luigi Serlenga: None declared, Anna Lia: None declared, Liala Moschetti: None declared, Dario Dabbicco: None declared, Laura Coladonato: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD

Early Lupus Project: one-year follow-up of an Italian cohort of patients with systemic lupus erythematosus of recent onset

Objective

To describe the clinical and serological features of a prospectively followed cohort of early diagnosed systemic lupus erythematosus (SLE) patients during a one-year follow-up period.

Methods

SLE patients with disease duration less than 12 months were consecutively enrolled in a multicentre, prospective study. At study entry and then every 6 months, a large panel of data was recorded.

Results

Of 260 patients enrolled, 185 had at least 12 months of follow-up; of these, 84.3% were female, 92.4% were Caucasians. Mean diagnostic delay was about 20 months; higher values of European Consensus Lupus Activity Measurement (ECLAM) and of organs/systems involved were both associated with shorter diagnostic delay. Clinical and serological parameters improved after study entry. However, patients' quality of life deteriorated and cardiovascular risk factors significantly increased. About one-third of patients with active disease at study entry went into remission (ECLAM = 0). Negative predictors for remission were: oral ulcers, arthritis, low C4, anti-SSB (Ro) antibodies and therapy with mycophenolate. There was a widespread use of glucocorticoids both at baseline and during follow-up.

Conclusion

Clinical symptoms and serological parameters improve during the first period after diagnosis. However, patients’ quality of life deteriorates. The widespread use of glucocorticoids is probably the reason for the early significant increase of some cardiovascular risk factors.

Evaluation of differences in carotid intima-media thickness in patients affected by systemic rheumatic diseases

The objective of this study is to investigate whether rheumatic autoimmune diseases, systemic sclerosis (SSc) in particular, are associated with increased carotid intima-media thickness (C-IMT). A total of 108 clinical outpatients (93 females), mean age 51 ± 14 years suffering from CTD were consecutively enrolled. Patients were subdivided into the following two groups: (1) Systemic Sclerosis (SSc, 60 patients); (2) non-Systemic Sclerosis (NoSSc, 48 patients). No randomization was managed. All patients underwent structured clinical interview, physical examination, laboratory evaluation and two-dimensional echo-color Doppler of the carotid arteries to measure C-IMT and atherosclerotic plaques. Framingham risk score was also calculated. We also enrolled 108 healthy controls (HC), matched by sex and age. The primary outcome was to stratify cardiovascular risk of CTD patients. There were no significant differences between SSc and NoSSc patients regarding any of the demographics and traditional cardiovascular risk factors. Mean C-IMT was not significantly different between the whole CTD patients (0.86 ± 0.13 mm) and HC (0.83 ± 0.13 mm). C-IMT was significantly higher in SSc than in NoSSc group (0.91 ± 0.1 mm vs 0.80 ± 0.14 mm, p < 0.001). Furthermore, C-IMT in SSc group was significantly higher than C-IMT in controls (0.91 ± 0.1 mm vs 0.83 ± 0.13 mm, p < 0.001). C-IMT did correlate neither with disease activity nor with drug intake. SSc patients had a significant increase in C-IMT as compared to NoSSc patients and healthy controls.

Early Lupus Project – A multicentre Italian study on systemic lupus erythematosus of recent onset

Background

Systemic lupus erythematosus (SLE) is an autoimmune disease with a high degree of variability at onset that is problematic for a correct and prompt diagnosis. We undertook this project with the purpose of collecting an inception cohort of Italian patients with recent-onset SLE, in order to obtain information on the main clinical and serological characteristics at the beginning of the disease. In this first report we describe the characteristics of this cohort at study entry.

Methods

All patients with a diagnosis of SLE (1997 ACR criteria) and a disease duration less than 12 months were consecutively enrolled between 1 January 2012 and 31 December 2013 in a multicentre prospective study. Information on clinical and serological characteristics at study entry and then every six months was collected into a specific electronic database. Statistical analysis was performed by means of the Openstat program.

Results

Among 122 patients enrolled (103 F) 94.3% were Caucasians. Mean age (SD) of patients at study entry was 37.3 (14.3) years, mean age at disease onset was 34.8 (14.3) years, mean age at diagnosis was 36.9 (14.3) years, and mean disease duration was 2.9 (3.9) months. The frequency of the manifestations included in the 1997 ACR criteria was as follows: ANA 97.5%, immunologic disorders (anti-dsDNA, anti-Sm, antiphospholipid antibodies) 85.2%, arthritis 61.8%, haematologic disorders 55.7%, malar rash 31.1%, photosensitivity 29.5%, serositis 27%, renal disorders 27%, oral/nasal ulcers 11.5%, neurologic disorders 8.2%, and discoid rash 5.7%. The cumulative frequency of mucocutaneous symptoms was 77.8%. At enrolment, autoantibody frequency was: ANA 100%, anti-dsDNA 83.6%, anti-SSA 28%, anticardiolipin 24.5%, anti-nRNP 20.4%, anti-beta2GPI 17.2%, lupus anticoagulant 16.3%, anti-Sm 16%, and anti-SSB 13.1%.

Conclusions

In this paper we describe the main clinical and serological characteristics of an Italian inception cohort of patients with recent-onset SLE. At disease onset, mucocutaneous manifestations, arthritis and haematologic manifestations were the most frequent symptoms; ANA, anti-dsDNA and complement reduction were the most frequent laboratory findings. Our data confirm that the diagnosis of SLE is a challenging one, and that SLE is a severe disease even at onset, since the majority of patients require at least a hospitalization before the diagnosis.

Bone and kidney toxicity induced by nucleotide analogues in patients affected by HBV-related chronic hepatitis: a longitudinal study

OBJECTIVES

Nucleotide analogues may promote renal and bone toxicity. The aim of the present study was to evaluate markers of osteorenal toxicity in patients affected by hepatitis B virus-related chronic hepatitis treated with lamivudine plus adefovir who were switched to tenofovir.

PATIENTS AND METHODS

We evaluated 60 consecutive patients at the time of the switch of treatment and after 1, 3, 6, 9 and 12 months. The mean baseline estimated glomerular filtration rate (eGFR) was 89.3 ± 19.0 mL/min/1.73 m(2).

RESULTS

During the study period we observed a reduction in mean eGFR up to 6 months after switching to tenofovir, and this remained stable for the last two timepoints. At the end of study, the mean eGFR was 82.6 ± 21.5 mL/min/1.73 m(2), a reduction of 7.5%. The mean baseline proteinuria was 202.6 ± 237.6 mg/24 h. Microhaematuria was observed in 22.6% of patients and hypophosphataemia in 18.6%. After 1 month of tenofovir, we observed a worsening of serum phosphate and parathyroid hormone levels, haemoglobinuria and 24 h proteinuria. After 3 and 12 months of tenofovir, these data tended to recover to baseline levels. A total of 92.6% of patients at baseline had hypovitaminosis D. After supplementation with cholecalciferol, this percentage decreased significantly. We observed a reduced bone mineral density (BMD) in 52.7% of patients at baseline; this increased to 77.8% after 6 months of tenofovir, but at the last timepoint the percentage of patients with a reduced BMD had fallen to a level above the baseline.

CONCLUSIONS

In conclusion, patients exposed to lamivudine plus adefovir showed relevant osteorenal damage. The switch to tenofovir provoked a slight reduction in eGFR that stabilized after 6 months. The reduced BMD at baseline did not worsen under tenofovir treatment.