Quantitative sensory testing, psychological profiles and clinical pain in patients with psoriatic arthritis and hand osteoarthritis experiencing pain of at least moderate intensity

BACKGROUND

Chronic pain is the hallmark symptom of joint diseases. This study examined the differences in quantitative sensory testing between patients with psoriatic arthritis (PsA), hand osteoarthritis (hand-OA) and a pain-free control group and differences between patients with and without concomitant fibromyalgia (cFM).

METHODS

All patients and pain-free controls were assessed using pressure pain thresholds (PPT), temporal summation of pain (TSP), conditioned pain modulation (CPM) and clinical pain intensities. Psychological distress was assessed with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Pittsburgh Sleep Quality Index. Disability was assessed with the Health Assessment Questionnaire and pain quality with the painDETECT questionnaire. cFM was identified using the revised 2016 American College of Rheumatology diagnostic criteria.

RESULTS

Patients with hand-OA (n = 75) or PsA (n = 58) had statistically significant lower PPTs and CPM, greater TSP, and higher scores of psychological distress (p < 0.05) than controls (n = 20). Patients with cFM (58%) had higher scores of depression (p = 0.001), anxiety (p = 0.004), catastrophizing (p = 0.012), disability (p < 0.001), higher painDETECT score (p = 0.001), TSP (p = 0.027), and reduced sleep quality (p = 0.021) when compared to patients without cFM.

CONCLUSION

Patients with hand-OA and PsA exhibited signs of pain sensitization and a higher degree of psychological distress and disability than pain-free individuals. Patients with cFM had greater TSP, painDETECT score, disability, catastrophizing, and reduced sleep quality, than patients without, indicating greater degree of pain sensitization, psychological burden, and disability.

STATEMENT OF SIGNIFICANCE

This paper shows that a significant proportion of patients with hand osteoarthritis and psoriatic arthritis with moderate pain intensity have significantly increased signs of pain sensitization and markers of psychological distress. A large proportion of these patients fulfil the criteria for concomitant fibromyalgia and these patients show even greater propensity towards pain sensitization and psychological distress.

Treatment-related changes in serum neutrophil gelatinase-associated lipocalin (NGAL) in psoriatic arthritis: results from the PIPA cohort study

OBJECTIVES

Obesity and psoriatic arthritis (PsA) have a complicated relationship. While weight alone does not cause PsA, it is suspected to cause worse symptoms. Neutrophil gelatinase-associated lipocalin (NGAL) is secreted through various cell types. Our objective was to assess the changes and trajectories in serum NGAL and clinical outcomes in patients with PsA during 12 months of anti-inflammatory treatment.

METHOD

This exploratory prospective cohort study enrolled PsA patients initiating conventional synthetic or biological disease-modifying anti-rheumatic drugs (csDMARDs/bDMARDs). Clinical, biomarker, and patient-reported outcome measures were retrieved at baseline, and 4 and 12 months. Control groups at baseline were psoriasis (PsO) patients and apparently healthy controls. The serum NGAL concentration was quantified by a high-performance singleplex immunoassay.

RESULTS

In total, 117 PsA patients started a csDMARD or bDMARD, and were compared indirectly at baseline with a cross-sectional sample of 20 PsO patients and 20 healthy controls. The trajectory in NGAL related to anti-inflammatory treatment for all included PsA patients showed an overall change of -11% from baseline to 12 months. Trajectories in NGAL for patients with PsA, divided into treatment groups, showed no clear trend in clinically significant decrease or increase following anti-inflammatory treatment. NGAL concentrations in the PsA group at baseline corresponded to the levels in the control groups. No correlation was found between changes in NGAL and changes in PsA outcomes.

CONCLUSION

Based on these results, serum NGAL does not add any value as a biomarker in patients with peripheral PsA, either for disease activity or for monitoring.

Disease activity-guided tapering of biologics in patients with inflammatory arthritis: a pragmatic, randomized, open-label, equivalence trial

OBJECTIVE

To evaluate whether disease activity-guided tapering of biologics compared to continuation as usual care enables a substantial dose reduction while disease activity remains equivalent.

METHOD

In this pragmatic, randomized, open-label, equivalence trial, adults with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis in low disease activity on stable-dose biologics for ≥ 12 months were randomized 2:1 into either the tapering group, i.e. disease activity-guided prolongation of the biologic dosing interval until flare or withdrawal, or the control group, i.e. maintaince of baseline biologics with a possible small interval increase at the patients request. The co-primary outcome in the intention-to-treat population was met if superiority in ≥ 50% biologic reduction at 18 months was demonstrated and disease activity was equivalent (equivalence margins ± 0.5).

RESULTS

Ninety-five patients were randomized to tapering and 47 to control, of whom 37% (35/95) versus 2% (1/47) achieved ≥ 50% biologic reduction at 18 months. The risk difference was statistically significant [35%, 95% confidence interval (CI) 24%-45%], while disease activity remained equivalent [mean difference 0.05, 95% CI -0.12-0.29]. A statistically significant flare risk was observed [tapering 41% (39/95) vs control 21% (10/47), risk difference 20%, 95% CI 4%-35%]; but, only 1% (1/95) and 6% (3/47) had persistent flare and needed to switch to another biological drug.

CONCLUSIONS

Disease activity-guided tapering of biologics in patients with inflammatory arthritis enabled one-third to achieve ≥ 50% biologic reduction, while disease activity between groups remained equivalent. Flares were more frequent in the tapering group but were managed with rescue therapy.

POS0761 TIME-DEPENDENT ANALYSES OF CLINICAL MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS IDENTIFY PATIENTS AT HIGH RISK OF INCIDENT PROTEINURIA

Background

Nephritis (LN) in systemic lupus erythematosus (SLE) is still a major determinant of poor prognosis[1].

The vast majority of LN occurs in proximity to the SLE diagnosis[2]. Identification of individuals at high risk, especially early onset SLE, is therefore warranted. Inclusion of risk factors prior to the SLE diagnosis may thus be of importance to enable sufficient risk factor profiling. SLE-patients seem to cluster according to clinical and serological phenotypes suggesting distinct disease trajectories[3-5].

Objectives

To determine if incident proteinuria associated with the debut age of non-renal SLE characteristics.

Methods

Data of SLE patients from six Danish centers were obtained from the Danbio-database from 2017 – 2020. The occurrence and timing of proteinuria was compared with first time onset of any non-renal manifestations as defined by the 1997 American College of Rheumatology Classification Criteria. Cox-regression models were used to identify risk factors for incident proteinuria. Time from first occurring non-renal manifestation to incident proteinuria or censoring defined time at risk. Covariates were eliminated if p >0.01 in a ‘backwards’ manner. After the model reduction process p-values <0.05 were considered statistically significant.

Results

586 SLE patients, mainly white (94%) women (88%), mean age at inclusion of 34.6 years (standard deviation, SD = 0.6 years) and observed for a mean of 14.9 years (SD =0.5 years), were recruited. The cumulative prevalence of proteinuria was 40%. Male gender hazard ratio, HR = 1.35 (range 0.77-2.35), p=0.009, lymphopenia HR = 1.77 (range 1.24-2.52), p=0.005 were associated with incident proteinuria. In contrast, patients with discoid rash had lower risk of incident proteinuria HR 0.42 (range 0.21-0.83), p=0.01. Male patients with lymphopenia had the highest risk of proteinuria with a one-, 5- and 10-year risk of proteinuria ranging from 9-27%, 34-75% and 51-89 %, depending on the age at presentation (debut at 20, 30, 40 or 50 years). The corresponding risk-profiles for women with lymphopenia were 3-9%, 8-34% and 12-58%, respectively, as illustrated in Figure 1.

Conclusion

The occurrences of lymphopenia and discoid rash were oppositely associated with risk of incident proteinuria and the risk effects varied according to gender and patient age at onset of these manifestations. Thus, the risk of proteinuria may not be constant but could vary according to presentation of non-renal manifestations that may call for a differentiated clinical follow-up. Based on these findings, we suggest that the debut age of known prognostic factors, even prior to the SLE diagnosis should be considered when designing prognostic statistical models.

References

[1]Faurschou, M., et al., Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol, 2006. 33(8): p. 1563-9.

[2]Hanly, J.G., et al., The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford), 2016. 55(2): p. 252-62.

[3]Diaz-Gallo, L.M., et al., Four Systemic Lupus Erythematosus Subgroups, Defined by Autoantibodies Status, Differ Regarding HLA-DRB1 Genotype Associations and Immunological and Clinical Manifestations. ACR Open Rheumatol, 2022. 4(1): p. 27-39.

[4]Jacobsen, S., et al., A multicentre study of 513 Danish patients with systemic lupus erythematosus. II. Disease mortality and clinical factors of prognostic value. Clin Rheumatol, 1998. 17(6): p. 478-84.

[5]Leffers, H.C.B., et al., Smoking associates with distinct clinical phenotypes in patients with systemic lupus erythematosus: a nationwide Danish cross-sectional study. Lupus Sci Med, 2021. 8(1).

Disclosure of Interests

Martin Andersen Employee of: Novo Nordisk A/S: 2010-2014, Anders Stockmarr: None declared, Henrik Leffers: None declared, Anne Troldborg: None declared, Anne Voss: None declared, Salome Kristensen: None declared, Bent Deleuran: None declared, Lene Dreyer Speakers bureau: Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: Grant from BMS outside the present work, Laura Johnsen: None declared, Ada Colic: None declared, Søren Jacobsen: None declared

POS1192 INCIDENCE AND RISK FACTORS OF COVID‑19 IN PATIENTS WITH VASCULITIS: A DANISH NATIONWIDE COHORT STUDY

Background

Patients with small vessel vasculitis (SVV) and large vessel vasculitis (LVV, including giant cell arteritis (GCA)) are considered at higher risk of infections compared to the general population, owing to their underlying condition and the use of immunosuppressive drugs. Thus, the risk of COVID-19 infection and related outcomes during the global pandemic is of immediate concern to rheumatologists worldwide.

Objectives

To estimate the incidence of COVID-19 hospitalisation in patients with vasculitis, and to evaluate the impact of glucocorticoid treatment on the outcome between March 2020 and February 2021.

Methods

With use of the Danish nationwide registers, a cohort of patients with LVV and SVV, respectively, and general population controls (GPCs) matched on age and gender was established. Hazard ratios (HR) for COVID-19 hospitalisation was estimated. National COVID-19 surveillance data was used to calculate the odds ratio (OR) of having had a positive SARS-CoV2 PCR test. Lastly, a nested case-control design and conditional logistic regression was used to estimate the impact of glucocorticoids on the risk of hospitalisation.

Results

Patients with SVV (n=1090) had an increased incidence of COVID-19 hospitalisation compared with GPCs (comorbidity-adjusted HR 2·73; 95% CI 1·64-4·55), whereas no increased risk was seen in patients with LVV. Patients with vasculitis had similar likelihoods of having had a positive PCR test as GPCs. Glucocorticoids did not increase the HR of hospitalisation among patients with LVV or SVV.

Conclusion

Patients with SVV were more likely to be admitted with COVID-19 than the GPCs. The impact of glucocorticoid treatment on the risk of hospitalisation needs further investigation.

References

[1]Cordtz R, Lindhardsen J, Soussi BG, et al. Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark. Rheumatology. Published online 2020. doi:10.1093/rheumatology/keaa897

[2]Rutherford MA, Scott J, Karabayas M, et al. Risk factors for severe outcomes in patients with systemic vasculitis & COVID-19: a bi-national registry-based cohort study. Arthritis Rheumatol. Published online 2021. doi:10.1002/art.41728

[3]Tomelleri A, Sartorelli S, Campochiaro C, Baldissera EM, Dagna L. Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: A monocentric survey. Ann Rheum Dis. Published online 2020. doi:10.1136/annrheumdis-2020-217600

Disclosure of Interests

Salome Kristensen: None declared, René Lindholm Cordtz: None declared, Kirsten Duch: None declared, Jesper Lindhardsen: None declared, Christian Torp-Pedersen Grant/research support from: Recieved grants from Bayer and Novo Nordisk outside the present work, Lene Dreyer Grant/research support from: Received research grant/research support from BMS, and speakers bureau from EliLilly and Galderma outside the present work.

OP0257 RISK OF HAEMATOLOGICAL MALIGNANCY IN PATIENTS WITH PSORIATIC ARTHRITIS, OVERALL AND IN RELATION TO TNF INHIBITORS - A NORDIC COHORT STUDY

Background

Several autoimmune inflammatory diseases, including rheumatoid arthritis (RA), are associated with increased risk of malignant lymphomas. There is also a longstanding concern of lymphoma development with tumour necrosis factor inhibitor (TNFi) treatment, but most studies in RA to date do not indicate an additionally increased risk. Corresponding studies in psoriatic arthritis (PsA), both with respect to the underlying risks, and risks in relation to treatment with TNFi, are limited. Data on myeloid malignancies in PsA are scarce.

Objectives

To estimate the risk of haematological malignancy overall and by lymphoid and myeloid types in TNFi treated versus (vs.) biologics-naïve patients with PsA across the five Nordic countries. Additionally, we investigated the underlying risk of haematological malignancies in PsA as compared to the general population.

Methods

We identified patients with PsA starting a first ever TNFi from the clinical rheumatology registers (CRR) in Sweden (SE), Denmark (DK), Norway (NO), Finland (FI), and Iceland (ICE) from 2006 through 2019 (n=10 621). We identified biologics-naïve patients with PsA from a) the CRR (n=18 705, all countries) and b) the national patient registers (NPR, n=27 286, SE and DK only). To estimate the underlying risk of haematological malignancy in PsA, we randomly sampled general population comparators in SE and DK matched on year of birth, sex, and calendar year at start of follow-up, to the patients with PsA.

Through linkage to the mandatory national cancer registers in all five countries, we collected information on haematological malignancy overall, and categorised into lymphoid or myeloid types. By applying a modified Poisson regression, we estimated pooled incidence rate ratio (IRR) with 95% confidence intervals (CI) for TNFi treated vs. biologics-naïve PsA and for PsA vs. the general population, adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.

Results

We observed 40 events of haematological malignancies (during 59 827 person-years) among TNFi treated PsA, resulting in a crude incidence rate (IR) of 67 per 100 000 person-years. The corresponding IR was 91 (63 events) for biologics-naïve PsA from the CRR, and 118 (172 events) for biologics-naïve PsA from NPR. This resulted in a pooled IRR of 0.97 (0.69 to 1.37) for TNFi-treated vs. biologics-naïve PsA patients from the CRR, and 0.84 (0.64 to 1.10) vs. biologics-naïve PsA patients from the NPR. The pooled IRR of haematological malignancies in PsA overall vs. the general population was 1.35 (1.17 to 1.55). Throughout, the estimates were largely similar for lymphoid and myeloid malignancies (Figure 1). The crude IR of haematological malignancies were substantially akin across different TNFi agents.

Figure 1.

Pooled incidence rate ratios (IRRs) (95% CI) of haematological malignancy overall and by lymphoid and myeloid types, in first ever TNFi treated versus biologics-naïve patients with PsA, and versus general population comparators. Legend: Lymphoid malignancies include international classification of diseases (ICD) 10 codes C81-86, C88, C90-91. Myeloid malignancies include ICD10 codes C92-95, D45-D46, D47.1, D47.3-5. Incidence rate ratios adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.

Conclusion

In this large five-country cohort study, we did not observe any increased risk of haematological malignancies overall, nor for lymphoid and myeloid types, in patients with PsA treated with TNFi. By contrast, there were signals of a moderately increased underlying risk of haematological malignancies, both of lymphoid and myeloid types, in patients with PsA overall as compared to the general population. The findings are of importance from a patient information perspective.

Acknowledgements

We would like to acknowledge the NordForsk and FOREUM, and especially the patient representatives of the NordForsk collaboration for their valuable contribution to this study.

Disclosure of Interests

René Cordtz: None declared, Johan Askling Consultant of: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Bénédicte Delcoigne: None declared, Karin Ekström Smedby: None declared, Eva Baecklund: None declared, Christine Ballegaard: None declared, Pia Isomäki Speakers bureau: AbbVie, Eli Lilly and Pfizer, Consultant of: AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma, Grant/research support from: Pfizer, Kalle Aaltonen: None declared, Björn Gudbjornsson Speakers bureau: Novartis, not related to this work, Consultant of: Novartis, not related to this work, Thorvardur Love Speakers bureau: Celgene, Sella Aa. Provan: None declared, Brigitte Michelsen Grant/research support from: Novartis, not related to this work, Joe Sexton: None declared, Lene Dreyer Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: BMS not related to this work, Karin Hellgren: None declared

POS1021 THE EFFECT OF CANNABIDIOL ON QUANTITATIVE SENSORY TESTING PARAMETERS IN PATIENTS WITH HAND OSTEOARTHRITIS AND PSORIATIC ARTHRITIS: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL

Background

Cannabidiol (CBD) has been proposed as an analgesic/anti-inflammatory treatment modality for joint pain. This study is based on a randomised, placebo controlled, double blind study (NORDCAN), investigating the effect of CBD in patients with painful hand osteoarthritis or psoriatic arthritis [1].

Objectives

The aim of the present study was to investigate the effect of CBD on quantitative sensory testing (QST) parameters.

Methods

The present randomised, placebo controlled, double blind study included 128 patients with hand osteoarthritis or psoriatic arthritis with chronic pain of moderate intensity. The trial compared 12 weeks of 20-30 mg CBD treatment with placebo. The QST parameters were assessed at baseline and after treatment. Pressure pain thresholds was measured at the most painful finger joint (local site) and the shin of the right leg (distal non-painful site). Temporal summation of pain and conditioned pain modulation were assessed using computer-controlled cuff algometry with the tourniquets on lower leg at the level of the upper portion of the gastrocnemius.

Results

Baseline characteristics (demographics and pain) for the CBD treated group and placebo group were comparable. No significant differences were observed in QST variables between baseline and end of treatment when comparing CBD and placebo.

Conclusion

No differences in modulation in QST parameters were demonstrated in patients in treatment with 20-30 mg CBD compared to placebo. Further studies of patients with rheumatic diseases treated with different dosage of CBD are needed to clarify the effect of CBD on pain in this patient group.

References

[1]Vela J, Dreyer L, Petersen KK, Nielsen LA, Duch KS, Kristensen S. Cannabidiol treatment in hand osteoarthritis and psoriatic arthritis. Pain 2021;Publish Ah. doi:10.1097/j.pain.0000000000002466.

Figure 1.

Flow-diagram of participant in the NORDCAN study

Table 1.

Difference in QST outcomes after 12 weeks of treatment with CBD or placebo.

Placebo groupCBD groupDifference95% CIpDifference95% CIpPPT Joint, kPa*18.62-19 to 56.760.3242.561.95 to 86.310.03PPT Shin, kPa*35.02-8.72 to 78.760.115.88-30.12 to 41.890.75CPM, kPa3.23-2.11 to 8.580.173.92-1.75 to 9.590.17TSP0.18-0.58 to 0.940.640.12-0.41 to 0.650.63

* Assessed using handheld algometer.

Abbreviations: CPM, Conditioned pain modulation; PPT, Pressure pain threshold; TSP, Temporal summation of pain

Acknowledgements

The authors thank patients, research personnel, the patient research partners, the Danish Rheumatism Association and the Psoriasis Association for their contribution to the NORDCAN trial.

Disclosure of Interests

Jonathan Vela: None declared, Kristian Kjær Petersen: None declared, Lene Dreyer Grant/research support from: Has received research grants from BMS and honorariums from Eli Lilly, Galderma, and Janssen, Lars Arent-Nielsen Speakers bureau: Has received speaker and advisory fees from GSK, Pfizer and Grünenthal., Salome Kristensen: None declared

POS1018 DRUG SURVIVAL AND TREATMENT RESPONSE RATES IN PSORIATIC ARTHRITIS PATIENTS SWITCHING TO FIRST- OR SECOND-LINE IL-17 INHIBITOR TREATMENT: A DANISH POPULATION-BASED COHORT STUDY

Background

Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy associated with psoriasis [1]. It is defined as a multifaceted chronic inflammatory disease with chronic peripheral and/or axial arthritis, enthesopathy and dactylitis. PsA patients also experience fatigue, decreased physical functions and sleep disturbances, which may result in impaired social activity and decreased work productivity [2, 3]. All of these disease associated symptoms can cause substantial functional and mental impairment and thereby result in decreased quality of life [4-5]. Patient impacting factors are important when trying to further understand the disease and when choosing a treatment option to properly manage the symptoms of PsA [2].

Objectives

The objective of this study was to assess the effectiveness of switching to a first- or second-line IL-17 inhibitor treatment in patients with PsA from 2014 to 2021, using data from the Danish Rheumatology registry (DANBIO) by investigating drug survival and treatment response rates.

Methods

PsA patients recorded in DANBIO who switched to a first- or second-line IL-17 inhibitor treatment from a previous biologic disease-modifying antirheumatic drugs (bDMARD) between 2014 and 2021 were included in this study. Baseline characteristics were analyzed in subgroups: first-line IL-17 inhibitor treatment and second-line IL-17 inhibitor treatment and presented as median and interquartile ranges or number and percentage. Visual analog scale (VAS) fatigue 50% improvement and VAS pain 50% improvement, Disease Activity Scores-28 C-reactive protein (DAS-28-CRP) remission and ΔDAS28 scores at 6- and 12-months follow-up was reported. Drug survival of first- or second-line IL-17 inhibitor treatment was reported as a Kaplan Meier plot.

Results

583 patients were identified and included in the study. Baseline characteristics (Table 1) showed that the age, percentage of females, CRP, HAQ, VAS patient pain, VAS global and DAS28CRP in both first- and second-line IL-17 inhibitor treatment was comparable. First- and second-line IL-17 inhibitor treatment had almost identical drug survival (Figure 1).

Table 1.First-line IL-17 inhibitor n= 434Second-line IL-17 inhibitor n= 97Age, years51.0 (49.6-52.3)51.9 (46.4-54.7)Female, % (n)59.0 (256)53.6 (52)Disease duration, years6.8 (6.1-7.8)8.2 (6.5-12.6)CRP, mg/dl4.0 (4.0-5.2)3.0 (2.9-5.3)HAQ1.1 (1.1-1.3)1.0 (0.9-1.3)VAS pain, 100 mm68 (65-72)73 (66-76)VAS global, 100 mm75 (73-78)80 (75-88)DAS28-CRP4.0 (3.8-4.1)4.2 (3.7-4.6)Previous bDMARD2.0 (1.0-3.0)4.0 (2.0-5.5)

CRP: C-reactive protein, HAQ: Health Assessment Questionnaire, VAS: Visual analog scale, DAS28: 28-joint Disease Activity Score, DMARD: disease-modifying antirheumatic drug.

Figure 1.

Conclusion

PsA patients switching to a first- or second-line IL-17 inhibitor showed comparable baseline characteristics and an almost identical drug survival. Thus, treatment failure of a first-line IL-17 inhibitor treatment, should not block for a second-line IL-17 inhibitor treatment.

References

[1]Ritchlin, C.T., R.A. Colbert, and D.D. Gladman, Psoriatic Arthritis. N Engl J Med, 2017. 376(21): p. 2095-6.

[2]Ogdie, A., L.C. Coates, and D.D. Gladman, Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford), 2020. 59(Suppl 1): p. i37-i46.

[3]Orbai, A.M., et al., International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis, 2017. 76(4): p. 673-680.

[4]Kristensen, L.E., et al., Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden. J Rheumatol, 2016. 43(1): p. 81-7.

[5]Jørgensen, T.S., et al., Relation Between Fatigue and ACR Response in Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitor Therapy: A Population-based Cohort Study. J Rheumatol, 2020.

Disclosure of Interests

Rebekka L. Hansen: None declared, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Alexander Egeberg Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Consultant of: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, Nana Lippert Rosenoe: None declared, Marie Skougaard Grant/research support from: Eli Lilly and Pfizer, Zara Rebecca Stisen: None declared, Lene Dreyer Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Consultant of: MSD, UCB and Janssen Pharmaceuticals, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals

OP0022 DISEASE ACTIVITY-GUIDED TAPERING OF BIOLOGICS IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A RANDOMISED, OPEN-LABEL, EQUIVALENCE TRIAL

Background

Traditionally, biologics are maintained lifelong at standard dose in patients with inflammatory arthritis (IA) when sustained low disease activity (LDA) is reached. However, evidence of possible tapering is emerging but data on the optimal approach is lacking.

Objectives

The primary outcomes at 18 months follow-up are:

Methods

The BIODOPT trial was a randomised, open-label, equivalence trial (EudraCT 2017-001970-41). Eligible patients were adults with RA, PsA, or axSpA in LDA on stable biologic doses during ≥12 months. The randomisation ratio was 2:1 (tapering:continuation) stratified by diagnosis, centre, and repeated biologic failures. In the tapering group, the biologic dosing interval was prolonged by 25% every four months until flare or discontinuation. The continuation group was kept on their baseline biologic dosing interval; however, a small increase was allowed (as usual practise) if requested by the patient. The sample size calculation was based on a pre-defined equivalence margin of ±0.5 disease activity points (<half of the minimal important difference in DAS28-CRP [>1.2] or ASDAS [>1.1]) yielding a power of 87% for 180 enrolled patients. All analyses were based on the intention-to-treat population. Continuous outcomes were analysed with repeated-measures linear mixed-effects models with group, diagnosis, centre, repeated biologic failures, time point, and the interaction between group and time as fixed factors and the baseline value of the relevant variable as a covariate. Categorical outcomes were analysed using logistic regression with missing data imputed as trial failures.

Results

Between May, 2018, and March, 2020, 142 patients were enrolled of which 95 were randomised to tapering and 47 to continuation; inclusion was closed in April 2020 due to national implications of the coronavirus pandemic.

At 18 months, significantly more patients in the tapering group (35 patients [(37%]) achieved a significant reduction in their biologic dose (≥50%) compared to the continuation group (one patient [2%]), absolute risk difference (RD) 35%, 95%CI: 24% to 45%, p<0.0001, Table 1. Furthermore, disease activity at 18 months was within the equivalence margins of ±0.5, mean difference between groups 0.08, 95%CI: -0.12 to 0.29; Table 1 and Figure 1. Flares were more frequent in the tapering group (39 [41%] vs 10 [21%], RD 0.20, 95%CI: 0.04 to 0.35, p=0.011) but managed with rescue therapy (e.g. biologic dose escalation or glucocorticoids) as only one patient (1%) in the tapering group and three patients (6%) in the continuation group lost therapeutic response and were switched to another biological agent.

Table 1.

Comparison at 18 months in the ITT population

OutcomeTapering group N = 95Continuation group N = 47Group difference (95%CI)p-valuePrimary outcome:Biologics reduced to ≤50%, n (%)35 (37%)1 (2%)0.35 (0.24 to 0.45)<0.001Disease activity, LSMeans (SE)1.84 (0.15)1.75 (0.16)0.08 (-0.12 to 0.29)0.428Key secondary outcomes:Remission1, n (%)63 (66%)33 (70%)-0.04 (-0.20 to 0.12)0.637Low disease activity2, n (%)79 (83%)41 (87%)-0.04 (-0.16 to 0.08)0.511Flares3, n (%)39 (41%)10 (21%)0.20 (0.04 to 0.35)0.011

N: number, CI: confidence interval, LSMeans: Least squares means, SE: Standard error.

1: RA or PsA: DAS28-CRP <2.6. AxSpA: ASDAS <1.3.

2: RA or PsA: DAS28-CRP <3.2. AxSpA: ASDAS <2.1.

3: RA or PsA: ΔDAS28-CRP >1.2 or ΔDAS28-CRP >0.6 AND current DAS28-CRP ≥3.2. AxSpA: inflammatory back pain AND ΔASDAS ≥0.9 and/or ≥1 swollen joint.

Conclusion

Across IA conditions, a significant reduction of biologic dose is possible with disease activity-guided tapering while maintaining a similar disease activity state compared to continuation of biologic as usual care.

Acknowledgements

The authors thank patients, research personnel, and the patient research partners for their contribution to the BIODOPT trial, data manager JHW for technical support and for uploading the concealed allocation sequence, and CCH for data management. The Parker Institute, Bispebjerg and Frederiksberg Hospital is supported by a core grant from the Oak Foundation (OCAY-18-774-OFIL).

Disclosure of Interests

Line Uhrenholt Speakers bureau: Abbvie, Eli Lilly, Janssen, and Novartis, Robin Christensen: None declared, Lene Dreyer Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: BMS (outside the present work), Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, and SynACT Pharma, Grant/research support from: Roche, Novartis, and Novo Nordic Foundation (outside the present work), Annette Schlemmer Speakers bureau: Eli Lilly, Anne Gitte Loft Speakers bureau: AbbVie, MSD, Novartis and UCB, Consultant of: Eli-Lilly, Janssen-Cilag, MSD, Novartis, and UCB, Mads Nyhuus Bendix Rasch Speakers bureau: Sobi, Hans Christian Horn: None declared, Katrine Gade: None declared, Peter C. Taylor Consultant of: AbbVie, Biogen, Eli Lilly, Fresenius, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Inc, Roche, and Sanofi, Grant/research support from: Celgene, and Galapagos (outside the present work), Salome Kristensen: None declared.

POS0076 DRUG SURVIVAL OF BIOLOGICS AND NOVEL IMMUNOMODULATORS FOR RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS, PSORIATIC ARTHRITIS, AND PSORIASIS - A NATIONWIDE COHORT STUDY FROM THE DANBIO AND DERMBIO REGISTRIES

Background

Drug survival is an important proxy measure for effectiveness of treatments for inflammatory diseases such as rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA), psoriatic arthritis (PsA), and psoriasis [1-4].

Objectives

The objective of this study was to examine the real-life drug survival of biologics and novel small-molecule therapies across various disease entities such as RA, AxSpA, PsA, and psoriasis.

Methods

We performed a nationwide cohort study using the prospective nationwide registries DANBIO and DERMBIO, comprising all patients treated with biologics or novel small-molecule therapies for RA, AxSpA, PsA, and psoriasis between January 2015 through May 2021 (DANBIO) and November 2009 to November 2019 (DERMBIO). Drug survival was visualized using Kaplan-Meier curves, and Cox proportional hazards models were used to calculate adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs) for risk of discontinuing therapy.

Results

The study comprised a total of 12,089 patients (17,903 treatment series), including 5,104 RA patients (7,867 series), 2,157 AxSpA patients (3,016 series3), 2,551 PsA patients (3,313 series), and 2,577 psoriasis patients (3,707 series). In confounder-adjusted models drug survival in RA was highest for rituximab followed by baricitinib, etanercept and tocilizumab respectively. For AxSpA drug survival was high for golimumab compared to all other drugs, followed by secukinumab and etanercept and lowest for infliximab. For PsA tofacitinib and infliximab had the lowest drug survival compared to all other drugs. All other drugs performed almost equally well with a tendency of a generally higher drug survival for golimumab, followed by secukinumab and ixekizumab. For psoriasis drug survival was generally highest for guselkumab.

Figure 1.

Conclusion

Differing treatment responses to drugs with various types of action across RA, AxSpA, PsA and psoriasis emphasize that although these diseases have many overlaps in their pathogenesis, there is a need for an individualized treatment approach that considers the underlying disease, patient profile, and treatment history.

References

[1]Egeberg A, Ottosen MB, Gniadecki R, et al. Safety, efficacy and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis. Br J Dermatol 2018; 178(2): 509-19.

[2]Gron KL, Glintborg B, Norgaard M, et al. Comparative Effectiveness of Certolizumab Pegol, Abatacept, and Biosimilar Infliximab in Patients With Rheumatoid Arthritis Treated in Routine Care: Observational Data From the Danish DANBIO Registry Emulating a Randomized Trial. Arthritis Rheumatol 2019; 71(12): 1997-2004.

[3]Lindstrom U, Glintborg B, Di Giuseppe D, et al. Comparison of treatment retention and response to secukinumab versus tumour necrosis factor inhibitors in psoriatic arthritis. Rheumatology 2020.

[4]Glintborg B, Lindstrom U, Di Giuseppe D, et al. One-year treatment outcomes of secukinumab versus tumor necrosis factor inhibitors in Spondyloarthritis. Arthritis Care Res (Hoboken) 2020.

Acknowledgements

We acknowledge the substantial contribution of the academic hospitals and private clinics and their physicians that report data to DANBIO and DERMBIO.

Disclosure of Interests

Alexander Egeberg Speakers bureau: AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Paid instructor for: AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Consultant of: AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Grant/research support from: Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, Nana Lippert Rosenoe: None declared, David Aagaard: None declared, Erik Lørup: None declared, Lea Nymand: None declared, Lars Erik Kristensen Speakers bureau: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Paid instructor for: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Grant/research support from: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Jacob Thyssen Speakers bureau: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Paid instructor for: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Consultant of: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Grant/research support from: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Simon F. Thomsen Speakers bureau: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., Paid instructor for: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., Consultant of: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., Grant/research support from: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., René Lindholm Cordtz: None declared, Nikolai Loft Speakers bureau: speaker for Eli Lilly and Janssen Cilag., Lone Skov Speakers bureau: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Paid instructor for: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Consultant of: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Grant/research support from: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Lars Erik Bryld: None declared, Mads Rasmussen Speakers bureau: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Paid instructor for: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Consultant of: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Grant/research support from: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Pil Højgaard: None declared, Salome Kristensen: None declared, Lene Dreyer Speakers bureau: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma., Paid instructor for: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma., Consultant of: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma., Grant/research support from: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma.

AB0006 ESTABLISHED RISK LOCI FOR SYSTEMIC LUPUS ERYTHEMATOSUS AT NCF2, STAT4, TNPO3, IRF5 AND ITGAM ASSOCIATE WITH DISTINCT CLINICAL MANIFESTATIONS: A DANISH GENOME-WIDE ASSOCIATION STUDY

Background

Systemic lupus erythematosus (SLE) has been associated with more than 100 genetic loci. This parallels positively to the clinical diversity that is reflected by the classification of SLE.

Objectives

We aimed to investigate associations between disease manifestations of SLE and risk gene variants relevant to Danish subjects of European ancestry.

Methods

We included 427 SLE patients of European ancestry similar to previous reports.[1] We also included 89,699 controls from the Danish Blood Donor Study Genomic Cohort. SLE risk loci in this population were identified by genome-wide association methodology and hereafter correlated to cumulative occurrence of SLE classification items.

Results

Fourteen variants mapped to the following genes: NCF2, STAT4, TNPO3/TPI1P2, IRF5, and ITGAM, were significantly associated (p<5E-8) with SLE.

The five lead variants were associated (p<0.05) with the following manifestations; NCF2: proteinuria and anti-phospholipid antibodies, STAT4: arthritis, serositis, neurologic disorder, lymphopenia, and anti-Smith antibodies, IRF5: seizures and proteinuria, TNPO3: proteinuria, and ITGAM: photosensitivity (Table 2).

Conclusion

Our findings support the future use of select, relevant genetic markers in predicting various SLE phenotypes.

References

[1]Leffers HCB, Troldborg A, Voss A, et al. Smoking associates with distinct clinical phenotypes in patients with systemic lupus erythematosus: a nationwide Danish cross-sectional study. Lupus Sci Med 2021;8(1).

Table 1.

Associations between five SLE risk loci and specific disease manifestations in 427 Danish patients with SLE*.

NCF2STAT4IRF5TNPO3ITGAMrs17849502_Trs7574865_Trs4728142_Ars13239597_Ars11860650_TN (%)Malar rash233 (55%)1.28 (0.84-1.96)0.83 (0.62-1.11)1.01 (0.74-1.38)1.44 (0.97-2.12)1.14 (0.80-1.61)Discoid rash46 (11%)1.49 (0.81-2.73)0.90 (0.56-1.45)1.01 (0.62-1.66)1.16 (0.63-2.12)0.76 (0.42-1.41)Photosensitivity219 (51%)0.96 (0.63-1.46)1.09 (0.81-1.47)0.98 (0.71-1.34)0.84 (0.57-1.25)0.67 (0.47-0.97)Oral ulcers132 (31%)0.96 (0.61-1.50)0.90 (0.65-1.23)0.83 (0.60-1.16)1.30 (0.87-1.96)1.43 (0.99-2.05)Non-erosive Arthritis342 (80%)0.84 (0.52-1.37)1.49 (1.02-2.18)0.93 (0.63-1.36)1.04 (0.64-1.68)1.16 (0.74-1.80)Serositis-Pleuritis124 (29%)0.63 (0.38-1.05)1.38 (1.01-1.89)1.22 (0.87-1.72)0.85 (0.56-1.29)0.84 (0.57-1.24)-Pericarditis72 (17%)0.75 (0.41-1.40)1.35 (0.93-1.96)1.05 (0.70-1.58)1.15 (0.70-1.89)1.09 (0.70-1.72)Persistent proteinuria158 (37%)1.63 (1.07-2.49)1.08 (0.80-1.46)0.68 (0.49-0.94)1.74 (1.16-2.61)1.09 (0.76-1.57)Neurologic disorder-Seizures23 (5%)1.58 (0.75-3.35)1.49 (0.80-2.76)2.10 (1.04-4.25)0.61 (0.26-1.44)0.93 (0.42-2.06)-Psychosis8 (2%)0.76 (0.097-5.87)2.77 (0.94-8.15)0.35 (0.10-1.23)0 (0)2.96 (0.85-10.3)Haematologic disorder-Haemolytic anaemia38 (9%)0.78 (0.34-1.76)1.37 (0.85-2.22)0.75 (0.44-1.29)1.11 (0.57-2.19)1.24 (0.70-2.20)-Leukopenia130 (30%)1.04 (0.67-1.61)1.19 (0.87-1.63)1.00 (0.72-1.39)0.90 (0.60-1.37)0.94 (0.64-1.37)-Lymphopenia228 (53%)0.95 (0.63-1.44)1.35 (1.01-1.81)0.95 (0.70-1.29)1.16 (0.79-1.70)1.09 (0.77-1.54)-Thrombocytopenia102 (24%)1.42 (0.91-2.22)0.84 (0.60-1.18)0.83 (0.58-1.18)1.35 (0.86-2.11)0.91 (0.60-1.37)Immunologic disorder-anti-DNA ab.330 (77%)0.69 (0.44-1.09)1.02 (0.72-1.44)0.94 (0.65-1.35)0.97 (0.62-1.53)1.08 (0.71-1.65)-anti-Smith ab.44 (10%)1.44 (0.79-2.64)1.58 (1.00-2.49)1.23 (0.73-2.07)1.47 (0.80-2.69)1.07 (0.61-1.84)-anti-phospholipid ab.183 (43%)1.63 (1.07-2.49)1.05 (0.79-1.41)0.84 (0.61-1.14)1.14 (0.77-1.68)1.14 (0.80-1.62)

* Logistic regression models for each manifestation included all five lead variants (multivariate) and were adjusted for age and sex

Disclosure of Interests

Henrik Leffers: None declared, David Westergaard: None declared, Saedis Saevarsdottir: None declared, Ingileif Jonsdottir: None declared, Ole Birger Pedersen: None declared, Anne Troldborg: None declared, Anne Voss: None declared, Salome Kristensen: None declared, Jesper Lindhardsen: None declared, Prabhat Kumar: None declared, Asta Linauskas: None declared, Lars Juul: None declared, Niels Steen Krogh: None declared, Bent Deleuran: None declared, Lene Dreyer Speakers bureau: Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: from BMS outside the present work, Michael Schwinn: None declared, Lise wegner Thørner: None declared, Lotte Hindhede: None declared, Christian Erikstrup: None declared, Henrik Ullum: None declared, Søren Brunak Shareholder of: SB has ownerships in Intomics A/S, Hoba Therapeutics Aps, Novo Nordisk A/S, Lundbeck A/S, Kari Stefansson: None declared, Karina Banasik: None declared, Søren Jacobsen: None declared

OP0173 INCIDENCE OF COVID-19 INFECTION AND HOSPITALISATION ACCORDING TO VACCINATION STATUS AND DMARD TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE MATCHED COHORT STUDY FROM DENMARK

Background

Patients with rheumatoid arthritis (RA) may have impaired immunogenicity to COVID-19 vaccines.

Objectives

To investigate the incidence of COVID-19 infection and hospitalisation in unvaccinated and vaccinated patients with RA compared with matched individuals; and secondarily in patients with RA according to DMARD treatment.

Methods

Danish nationwide matched cohort study from January to October 2021. Patients with RA were identified in DANBIO and matched 1:20 with individuals from the general population on age, sex, and vaccination status (month and exact type of vaccination). Primary and secondary outcomes were COVID-19 hospitalisation (Danish National Patient Register) and positive SARS-CoV2 PCR test (Danish COVID-19 Surveillance Register), respectively. Stratified by vaccination status, incidence rates (IRs) per 1000 person years (PY) and comorbidity-adjusted hazard ratios (aHRs) in cause-specific Cox models were calculated with 95% confidence intervals. Using the Aalen-Johansen estimator, the cumulative incidence of COVID-19 hospitalisations was visualised according to RA and vaccine exposure status.

Results

Regardless of vaccination status, patients with RA had increased incidence of COVID-19 hospitalisation compared to matched individuals (Table 1). However, the absolute risk was 0.20% for unvaccinated patients at 60 days and 0.08% for comparators, whereas it remained below 0.05% at 180 days of follow-up in both groups when fully vaccinated (Figure 1). Increased SARS-CoV2 infection rates were seen only among unvaccinated patients with RA (Table 1). Unadjusted analyses showed increased incidence of COVID-19 hospitalisation among rituximab-treated compared with conventional DMARD treated: unvaccinated HR 4.71 (1.98 to 11.18) and vaccinated HR 11.69 (2.07 to 66.06). However, the proportions of patients with previous cancer and treated with prednisolone were higher among the rituximab treated.

Table 1.UnvaccinatedPartially vaccinatedFully vaccinatedRAControlsRAControlsRAControlsN28 447568 94027 154542 61026 217523 826Women, %71.371.371.271.271.071.0Age in years, median [IQR]67.7 [34.2 to 88.3]67.8 [34.2 to 88.4]68.4 [36.4 to 88.6]68.4 (36.5 to 88.6)68.9 [40.9 to 88.7]68.9 (41.0 to 88.7)Methotrexate /55.5 /0.5 /55.4 /1.2 /55.7 /1.3 /Sulfasalazine /14.2 /0.1 /13.7 /0.3 /13.5 /0.3 /Hydroxychloroquine /10.4 /0.1 /10.3 /0.0 /10.3 /0.0 /Other csDMARD,11.0 /0.2 /10.7 /0.3 /10.6 /0.3 /Prednisolone,all in %12.52.012.20.512.20.5TNFi /16.9 /0.1 /17.2 /2.9 /17.1 /3.1 /abatacept /1.5 /0.0 /1.5 /0.5 /1.5 /0.5 /tocilizumab /3.0 /0.0 /3.0 /0.0 /2.9 /0.0 /rituximab, all in %2.20.12.10.12.10.1COVID-19 hospitalisationN65727119511131Median [IQR] days of follow-up102 [62 to 137]115 [88 to 146]28 [22 to 35]30 (21 to 39)150 [111 to 189]150 (111 to 189)Rate per 1000 PY10.4 (8.0 to 13.4)4.7 (4.3 to 5.1)5.5 (3.0 to 10.0)2.2 (1.8 to 2.7)0.9 (0.5 to 1.6)0.5 (0.4 to 0.6)Adjusted HRa1.88 (1.44 to 2.46)1 (Ref.)2.47 (1.25 to 4.89)1 (Ref.)1.94 (1.03 to 3.66)1 (Ref.)SARS-CoV2 infectionRate per 1000 PY37.8 (33.6 to 42.6)33.9 (33.1 to 34.8)27 (20.7 to 35.1)28.5 (27 to 30.2)11.3 (9.2 to 13.9)10.4 (9.9 to 10.9)Adjusted HRa1.22 (1.09 to 1.57)1 (Ref.)0.87 (0.95 to 1.74)1 (Ref.)1.09 (0.92 to 1.14)1 (Ref.)

IQR, Interquartile range. a Adjusted for cancer history, cardiovascular disease, diabetes mellitus, chronic kidney disease, and chronic lung disease.

Figure 1.

Cumulative incidence of COVID-19 hospitalisation (%) as a function of follow-up time (days) for (A) unvaccinated, (B) partially vaccinated and (C) fully vaccinated patients and comparators.

Conclusion

The incidence of COVID-19 hospitalisation was increased for both unvaccinated and vaccinated patients with RA compared with controls. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination. Less favourable outcomes among rituximab-treated warrant that this drug should be considered with extra care.

Acknowledgements

The authors wish to acknowledge The Danish Departments of Clinical Microbiology and Statens Serum Institut for carrying out laboratory analysis, registration, and release of the national SARS-CoV-2 surveillance data use in the present study. Further, the authors wish to thank all the Danish departments of rheumatology for reporting to the DANBIO register.

Disclosure of Interests

René Cordtz: None declared, Salome Kristensen: None declared, Rasmus Westermann: None declared, Kirsten Duch: None declared, Fiona Pearce Grant/research support from: Pearce reports a grant from Vifor Pharma outside the submitted work., Jesper Lindhardsen: None declared, Christian Torp-Pedersen Grant/research support from: Torp-Pedersen reports grants from Bayer and Novo Nordisk outside the submitted work., Mikkel Porsborg Andersen: None declared, Lene Dreyer Speakers bureau: Dreyer has received speakers bureau from Eli Lilly and Galderma., Grant/research support from: Dreyer has received research grant/support from BMS.

Incidence and prevalence of rheumatoid arthritis in Denmark from 1998 to 2018: a nationwide register-based study

Objective: To investigate the incidence and prevalence of rheumatoid arthritis (RA) in the adult Danish population.Method: In this nationwide register-based cohort study, patients with incident RA between 1998 and the end of 2018 were identified using Danish administrative registries. The age- and sex-standardized incidence rate (IR), incidence proportion (IP), lifetime risk (LR), and point prevalence (PP) of RA were calculated. RA was defined as a first-time RA diagnosis registered in the Danish National Patient Registry combined with a redeemed prescription of a conventional synthetic disease-modifying anti-rheumatic drug in the following year. In addition, three different case definitions of RA were explored.Results: The overall age- and sex-standardized IR of RA from 1998 to 2018 was 35.5 [95% confidence interval (CI) 35.1-35.9] per 100 000 person-years while the IP was 35.2 (95% CI 34.8-35.5) per 100 000 individuals. The IR was two-fold higher for women than for men. The LR of RA ranged from 2.3% to 3.4% for women and from 1.1% to 1.5% for men, depending on the RA case definition used. The overall PP of RA was 0.6% (95% CI 0.5-0.6%) in 2018: 0.8% (95% CI 0.7-0.8%) for women and 0.3% (95% CI 0.3-0.4%) for men. The prevalence increased about 1.5-fold from 2000 to 2018.Conclusion: The IR and PP were approximately two-fold higher for women than for men. The prevalence of RA in Denmark increased significantly from 2000 to 2018. The RA case definition had more impact on the results than the choice of denominator.

Using a novel smartphone application for capturing of patient-reported outcome measures among patients with inflammatory arthritis:A randomized, crossover, agreement study

Objectives: In Denmark, patients with inflammatory arthritis (IA) have completed patient-reported outcome measures (PROMs) via touchscreens in the outpatient clinic since 2006. However, current technology makes it possible for patients to use their own smartphone via an application (app) developed for the Danish Rheumatology Database (DANBIO). This study aims to evaluate the agreement of PROMs between the DANBIO app and outpatient touchscreen in patients with IA.Method: Patients with IA (rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis) were enrolled in a randomized, crossover, agreement study. Participants answered PROMs through the two device types in a randomized order. Differences in PROM scores with 95% confidence intervals (CIs) were evaluated for similarity according to prespecified equivalence margins.Results: The touchscreen invitation was accepted by 138 patients. Sixty patients (20 with each diagnosis) were included. The difference in Health Assessment Questionnaire Disability Index between the two device types was -0.007 (95% CI -0.043 to 0.030); thus, equivalence was demonstrated. In addition, all other PROMs obtained with the two device types were equivalent, except for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which was within the limits of minimally clinically important difference (MCID). In total, 78.3% preferred the DANBIO app.Conclusion: In patients with IA, equivalence was demonstrated between two device types for all PROMs except BASDAI; however, BASDAI was within the limits of the MCID. Implementation of the DANBIO app is expected to optimize outpatient visits, thereby improving healthcare for the individual patient and society.

Revealing x-ray and gamma ray temporal and spectral similarities in the GRB 190829A afterglow

Gamma-ray bursts (GRBs), which are bright flashes of gamma rays from extragalactic sources followed by fading afterglow emission, are associated with stellar core collapse events. We report the detection of very-high-energy (VHE) gamma rays from the afterglow of GRB 190829A, between 4 and 56 hours after the trigger, using the High Energy Stereoscopic System (H.E.S.S.). The low luminosity and redshift of GRB 190829A reduce both internal and external absorption, allowing determination of its intrinsic energy spectrum. Between energies of 0.18 and 3.3 tera-electron volts, this spectrum is described by a power law with photon index of 2.07 ± 0.09, similar to the x-ray spectrum. The x-ray and VHE gamma-ray light curves also show similar decay profiles. These similar characteristics in the x-ray and gamma-ray bands challenge GRB afterglow emission scenarios.

POS0313 INCIDENCE AND PREVALENCE OF POLYAUTOIMMUNITY IN SEROPOSITIVE COMPARED WITH SERONEGATIVE PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE COHORT STUDY

Background:

Rheumatoid arthritis (RA) is categorized as seropositive or seronegative referring to the presence or absence of IgM rheumatoid factor (IgM-RF) and/ or anti-citrullinated protein antibodies (ACPA).

Patients with an autoimmune disease are more likely to develop additional autoimmune conditions than individuals without pre-existing autoimmune disease.

Objectives:

The aims of this study were to examine patterns of polyautoimmunity in seropositive compared with seronegative patients with recent-onset RA.

Methods:

The study was register-based and used the nationwide DANBIO register (identification of recent-onset (<1 year) seropositive, ICD-10 M05, and seronegative, M06, RA patients) linked to the Danish National Patient Registry and the Danish National Prescription Registry to obtain information on additional autoimmune diseases (see Table 1 for autoimmune conditions).

Table 1.

Characteristics, prevalence, and incidence of polyautoimmunity in incident RA patients.

SeropositiveSeronegativeN79834534Age in years59.4 (48.6 to 69.1)63.0 (51.5 to 72.3)Women5476 (69 %)2856 (63 %)HAQ-DI0.857 (0.375 to 1.375)0.875 (0.375 to 1.375)DAS28-CRP4.3 (3.3 to 5.2)4.6 (3.6 to 5.5)CRP, mg/mL10 (4 to 23)10 (3 to 26)VAS physician, 0-100mm27 (15 to 45)30 (16 to 47)Treated with methotrexate86 %84 %-other csDMARD, %24 %24 %-Biological DMARD, %5 %6 %Smoking status:Current / previous / never / unknown, %13 / 11 / 17 / 59 %9 / 9 / 23 / 59 %Prevalence of polyautoimmunity / diabetes mellitus type 1 / autoimmune thyroid disease / inflammatory bowel disease549 (10.6 %) / 1.4 % / 6.7 % / 1.4 %349 (12.8 %) / 1.5 % / 7.8 % / 1.5 %Age and sex adjusted odds ratio0.79 (0.71 to 0.89)1 (ref.)Incident cases of polyautoimmunity373 (4.7 %)242 (5.3 %)Adjusted hazard ratio0.86 (0.71 to 1.05)1 (ref.)

Continuous variables shown as median with interquartile ranges. Autoimmune conditions included:

autoimmune thyroid disease (redeemed prescriptions of ATC=H03A); diabetes mellitus type 1 (ICD-10 diagnosis E10 combined with redeemed prescriptions of insulin, ATC=A10A); pernicious anaemia (D51.0); autoimmune haemolytic anaemia (D59.1); idiopathic thrombocytopenic purpura (D69.3); Autoimmune adrenalitis (E27.1B); multiple sclerosis (G35); neuromyelitis optica (G36.0); Guillain-Barré syndrome (G61.0); myasthenia gravis (G70); inflammatory bowel disease (K50-1); primary biliary cirrhosis (K74.3); primary sclerosing cholangitis (K83.0); autoimmune hepatitis (K75.4); celiac disease (K90.0); pemphigus vulgaris (L10.0); bullous pemphigoid (L12.0); dermatitis herpetiformis (L13.0); alopecia areata (L63); vitiligo (L80); lichen sclerosis (L90.0); chronic interstitial cystitis (N30.1).

Using age and sex adjusted logistic regression analysis, the odds ratio (OR) of prevalent polyautoimmunity in seropositive compared with seronegative patients at the time of RA diagnosis was calculated.

To estimate the hazard ratio (HR) for developing yet another autoimmune disease in the 5 years after RA diagnosis, adjusted cause-specific Cox regression models were performed. Several sensitivity analyses were carried out including alternative exposure and outcome definitions.

Results:

In total, 12,517 patients with recent-onset RA were included. The groups were similar in terms of disease characteristics and DMARD treatment, but seropositive patients were younger and included more women, see Table 1. Patients with seropositive RA had an OR of 0.79 (95% CI 0.71-0.89) for baseline presence of polyautoimmunity compared with seronegative patients, whereas the 5-year HR was 0.86 (95% CI 0.71-1.05) for incident polyautoimmunity. The results remained similar in all sensitivity analyses.

Conclusion:

Patients with seropositive RA had a slightly lower prevalence and incidence of polyautoimmunity compared to seropositive patients. The results were somewhat surprising, yet very robust, and thus raises the question if seronegative RA is in fact “more autoimmune” despite the absence of (identified) autoantibodies.

Acknowledgements:

We acknowledge all patients and all Danish departments of rheumatology contributing to the DANBIO registry.

Disclosure of Interests:

Amalie Hagelskjær: None declared, René Cordtz: None declared, Sofie Bliddal: None declared, Anders Sandermann Mortensen: None declared, Salome Kristensen: None declared, Claus Henrik Nielsen: None declared, Ulla Feldt-Rasmussen: None declared, Christian Torp-Pedersen: None declared, Lene Dreyer Grant/research support from: Grants from BMS, Galderma, and Eli Lilly

OP0140 BIOLOGIC REFRACTORY DISEASE IN AXIAL SPONDYLOARTHRITIS - DEFINITION, PREVALENCE AND PATIENT CHARACTERISTICS. A COLLABORATION BETWEEN FIVE NORDIC BIOLOGIC REGISTRIES

Background:

In clinical practice, some patients with axial spondyloarthritis (axSpA) fail several consecutive biological treatments (bDMARDs). How this group of ”refractory” patients should best be defined, how common they are, and what their characteristics are, is poorly understood.

Objectives:

To explore the point prevalence of bDMARD refractory disease in axSpA over time, according to different definitions, and to describe the characteristics of refractory vs. not-refractory patients upon start of their first bDMARD.

Methods:

Observational prospective cohort study. Patients with axSpA (ankylosing spondylitis/non-radiographic axial SpA) starting a first bDMARD 2009-2018 were identified in biologic registries in Denmark, Sweden, Finland, Norway and Iceland. Clinical characteristics and treatments were retrieved, and data were pooled for analysis.

Refractory disease was defined based on the number of different bDMARD treatments started in individual patients: mild (≥3 bDMARDs), moderate (≥4), and strict (5 or more). Restart of same bDMARD with another bDMARD in between counted as separate courses whereas switch from originator to corresponding biosimilar was ignored.

Proportions of patients fulfilling each definition of refractory disease at 2 and 5 years after the start of 1st bDMARD were calculated.

Point-prevalence per calendar-year was calculated as the number of patients with refractory disease at the end of each year, divided by the total number of patients ever having starting a first bDMARD before that time-point, and who were still alive and resident in the country.

Results:

The point prevalence of refractory axSpA increased with calendar-time (Figure). Among 12,037 included axSpA patients (64% male), the point-prevalence of bDMARD refractory disease in 2018 was 16%/7%/3% according to mild/moderate/strict definitions (Table).

Table 1.

Biologic refractory axSpA according to three definitions

A.Baseline characteristics upon start 1st bDMARDRefractory definitionOverall cohortMILDMODERATESTRICTN120371969832351Age, years42 (13)41 (12)41 (12)41 (12)Male, %64%57%54%56%Disease duration, years7 (10)6 (9)6 (8)5 (8)BASDAI, 0-10053 (28)60 (29)63 (27)66 (35)ASDAS3.3 (1.1)3.5 (1.2)3.6 (1.0)3.7 (1.1)CRP, mg/L16 (23)18 (26)21 (28)23 (32)Patient global, VAS, 0-10059 (25)65 (22)66 (22)67 (23)Patient Pain, VAS, 0-10057 (24)62 (22)63 (22)63 (22)Fatigue, VAS, 0-10059 (27)66 (26)66 (26)68 (25)B.Proportions of patients having refractory disease 2 and 5 years after start of their first bDMARD2 years, %5%1%0%5 years, %13%4%1%

Numbers are means (SD) unless otherwise stated

Upon start of their 1st bDMARD, patients later fulfilling the definitions for refractory axSpA were more frequently women, had shorter disease duration, higher C-reactive protein and higher patient reported outcomes.

Overall, 5%/1%/0% had mild/moderate/strict refractory disease 2 years after start of first bDMARD, after 5 years it was 13%/4%/1% (Table).

Conclusion:

In this large Nordic observational cohort of axSpA patients treated in routine care, we could demonstrate that a substantial proportion of all patients had used multiple bDMARDs. In 2018, one in six patients had received ≥3 bDMARDs, indicating a bDMARD refractory disease. Multiple switching was more frequent during later years, probably due to more bDMARDs becoming available. The characteristics of refractory axSpA, including sex and disease activity, will have to be further explored, as will the impact of refractory disease on long-term outcomes.

Acknowledgements:

the DANBIO, SRQ, ICEBIO, ROB-FIN and NOR-DMARD registries.

Partly sponsored by Nordforsk and Foreum.

Disclosure of Interests:

Daniela Di Giuseppe: None declared, Ulf Lindström: None declared, Kalle Aaltonen: None declared, Heikki Relas Speakers bureau: Abbvie, Celgene, MSD, Roche, Sella Aarrestad Provan: None declared, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Merete L. Hetland Grant/research support from: AbbVie, Biogen, BMS, Celtrion, Eli Lilly Denmark A/S, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopis, Sandoz. MLH chairs the steering committee of the Danish Rheumatology Quality Registry (DANBIO), which receives public funding from the hospital owners and funding from pharmaceutical companies. MLH co-chairs the EuroSpA research collaboration, which generates real-world evidence of treatment of psoriatic arthritis and axial spondyloarthritis based on secondary use of quality data and is partly funded by Novartis., Johan Askling: None declared, Tanja Schjødt Jørgensen: None declared, Lene Dreyer Speakers bureau: Eli-Lilly and Galderma, Grant/research support from: BMS, Dan Nordström: None declared, Brigitte Michelsen: None declared, Arni Jon Geirsson: None declared, Lennart T.H. Jacobsson: None declared, Bente Glintborg Grant/research support from: Abbvie, BMS, Pfizer, Lundbeck foundation

POS0093 HETEROGENEITY IN ADVERSE EVENT ASSESSMENT BETWEEN COUNTRIES PARTICIPATING IN AN INTERNATIONAL COLLABORATION OF REGISTRIES OF RHEUMATOID ARTHRITIS PATIENTS USING JANUS KINASE INHIBITORS (THE JAK-POT STUDY)

Background:

Industry, regulators, and the rheumatology community have recognized the need for observational studies to monitor the safety of new antirheumatic agents. Registries provide a unique opportunity to understand the safety of newer therapies, but pharmacovigilance studies require large number of patients to evaluate rare drug-related adverse-events (AEs). Because JAK-inhibitors (JAKi) have only recently been approved for the treatment of rheumatoid arthritis, it makes sense to combine data from several registries in order to obtain a sufficiently large sample size to promote earlier detection of adverse events.

Objectives:

The purpose of this analysis was to evaluate how AEs are assessed in the various registries in preparation for a collaborative pharmacovigilance analysis, and present preliminary results.

Methods:

The “JAK-pot” collaboration includes 19 RA registries. The principal investigators of the participating registries were sent a structured questionnaire on AE assessment and 18 (94%) provided complete responses on the AE assessment procedures of their registries. We present simple descriptive statistics of the AE assessment procedures employed by the participating registries.

Results:

The 19 registries represent 7186 patients initiating a JAKi (Table 1), who are on average 57 years old, with a mean disease duration 11 years, seropositive (83%), female (82%) and with moderate disease activity at treatment initiation.

Table 1.Country, registryN° of patients on JAKi includedAustria, BIOREG87Belgium, TARDIS2113Canada, RHUMADATA363Czech Republic, ATTRA197Denmark, DANBIO506Finland, ROB-FIN229Germany, RABBIT620Italy, GISEA244Israel, I-RECORD96Netherlands, METEOR4Norway, NOR-DMARD97Portugal, REUMA.PT44Romania, RRBR252Russia, ARBITER428Slovenia, biorx.si141Spain, BIOBADASER139Switzerland, SCQM738Turkey, TURKBIO404UK, BSRBR484

After ineffectiveness, AEs was the second most common reason for JAKi discontinuation (25.5%), with large differences between registries (Figure 1).

Of the participating registries, 2 registries do not collect AEs, while 16 (89%) assess incident AEs, by means of a pre-specified extraction form (3 registries), by free text (5 registries), by a combination of both (6 registries) and/or the use of linkage to external electronic records (3registries). AEs are coded using a predefined coding system by 11 registries (MeDRA (8), other (3)), but nearly all are recording the severity of the AE (15, 94%), AE related-death (15, 94%), or AE-related hospitalisation (15, 94%). AEs of special interest, such as serious infections (15, 94%), thromboembolic events (15, 94%), or shingles (9, 56%), are recorded by most registries. Incident AEs are linked by the treating physician to specific therapies in 11 registries (69%), while the other 5 registries extrapolate potential causal associations based on therapy start and stop dates. A pre-specified adjudication process for AEs is made only by 5 registries (31%).

Conclusion:

Substantial heterogeneity exists among registries regarding AE assessment within the JAK-pot collaboration. These differences must be taken into account when analysing the safety of JAKi across different countries in collaborative studies. For comparative analyses, stratified analyses by country are required to account for differential AE assessment and varying degrees of potential under-reporting.

Disclosure of Interests:

Kim Lauper: None declared, Denis Mongin: None declared, Sytske Anne Bergstra: None declared, Denis Choquette: None declared, Catalin Codreanu: None declared, Diederik De Cock: None declared, Lene Dreyer: None declared, Ori Elkayam: None declared, Kimme Hyrich: None declared, Florenzo Iannone: None declared, Nevsun Inanc: None declared, Eirik kristianslund: None declared, Tore K. Kvien: None declared, Burkhard Leeb: None declared, Galina Lukina: None declared, Dan Nordström: None declared, Karel Pavelka: None declared, Manuel Pombo-Suarez: None declared, Ziga Rotar: None declared, Maria Jose Santos: None declared, Anja Strangfeld: None declared, Delphine Courvoisier: None declared, Axel Finckh Speakers bureau: Eli-Lilly, Pfizer, Consultant of: Eli-Lilly, Pfizer, Grant/research support from: BMS, Pfizer.

POS0025 INCIDENCE RATES AND POINT PREVALENCE OF SEROPOSITIVE AND SERONEGATIVE RHEUMATOID ARTHRITIS IN DENMARK: A NATIONWIDE REGISTER-BASED STUDY FROM 1998 TO 2018 USING FOUR DIFFERENT CASE CRITERIA

Background:

Few previous studies have investigated the incidence rate (IR) and point prevalence (PP) of seropositive and seronegative rheumatoid arthritis (RA), and further, the estimates remain unknown in the Danish population.

Objectives:

To investigate the IR and PP of seropositive and seronegative RA in the adult Danish population from 1998 to 2018 using four register-based case definitions of RA.

Methods:

Nationwide register-based cohort study. Using the Danish administrative registers, patients with RA between 1998 and end of 2018 were identified. ICD-10 codes for RA were identified in the Danish National Patient Registry and information on DMARD prescriptions were obtained through the Danish National Prescription Registry using ATC codes. The used case definitions were1: Criteria A, first time M05/M06 RA diagnosis and redemption of a DMARD in the following year; Criteria B, two RA diagnoses within 90 days of each other, originating from department of rheumatology or general internal medicine, where the latest registered M05/M06 diagnosis defined the serologic status; Criteria C, a M05/M06 diagnosis recorded at any time preceded or followed by redemption of a DMARD prescription within one year, where the M05/M06 diagnosis recorded determined the serologic status; Criteria D, as Criteria A, but with the additional requirements that cases had no registration for other selected inflammatory diseases.

In calculation of IRs the total Danish population from 1998 to 2018 was used as reference population for standardisation. The PP was calculated for years 2000, 2009, 2011 and 2018.

Results:

From 1998 to 2018 the overall IR was 18.0 (95%CI 17.7 to 18.3) per 100,000 person years (PY) for seropositive RA and 16.7 (95%CI 16.4 to 16.9) per 100,000 PY for seronegative RA using Criteria A. A higher IR for seropositive RA than for seronegative RA was found regardless of the case criteria used. Figure 1 shows the temporal IRs of seropositive and seronegative RA.

Regardless of case criteria used, the PP increased from 2000 to 2018 for both seropositive and seronegative RA, and the estimates were higher for seropositive RA than for seronegative RA (Table 1).

Table 1.

Point prevalence of rheumatoid arthritis in Denmark in year 2000, 2009, 2011 and 2018 using four different case definitions

2000200920112018SeropositiveSeronegativeSeropositiveSeronegativeSeropositiveSeronegativeSeropositiveSeronegativeCriteria AN3029274174747127871281211243711662Population3964040416629842028914269677PP, % (95%CI)0.08 (0.08 to 0.08)0.07 (0.07 to 0.07)0.18 (0.18 to 0.19)0.17 (0.17 to 0.18)0.21 (0.20 to 0.21)0.19 (0.19 to 0.20)0.27 (0.27 to 0.28)0.26 (0.25 to 0.26)Criteria BN7507489311565903312710100111633413340PP, % (95%CI)0.20 (0.19 to 0.20)0.13 (0.12 to 0.13)0.28 (0.28 to 0.29)0.22 (0.21 to 0.22)0.30 (0.30 to 0.31)0.24 (0.23 to 0.24)0.36 (0.35 to 0.36)0.29 (0.29 to 0.30)Criteria CN6701457011174912512417101491588113712PP, % (95%CI)0.18 (0.17 to 0.18)0.12 (0.12 to 0.12)0.27 (0.27 to 0.28)0.22 (0.22 to 0.23)0.29 (0.29 to 0.30)0.24 (0.24 to 0.25)0.35 (0.34 to 0.35)0.30 (0.30 to 0.31)Criteria DN272423906612598476956759108309452PP, % (95%CI)0.07 (0.07 to 0.07)0.06 (0.06 to 0.07)0.16 (0.16 to 0.16)0.15 (0.14 to 0.15)0.18 (0.18 to 0.19)0.16 (0.16 to 0.17)0.24 (0.23 to 0.24)0.21 (0.20 to 0.21)

PP = Point prevalence

Conclusion:

In Denmark, the IR and PP estimates were higher for seropositive compared to seronegative RA during the study period. However, when applying stricter case criteria for RA (Criteria A and D) the differences in IR and PP estimates were smaller, than when using less strict criteria (Criteria B and C). The findings of such small differences between seropositive and seronegative IRs warrant further investigation.

References:

[1]Soussi BG et al. Incidence and prevalence of rheumatoid arthritis in Denmark: a nationwide population based study investigating the effect of four different case definitions [abstract]. Ann Rheum Dis. 2020;79(supplement 1):46

Acknowledgements:

The authors will like to thank The Danish Rheumatism Association for supporting this work.

Disclosure of Interests:

Bolette Gylden Soussi: None declared, René Lindholm Cordtz: None declared, Salome Kristensen: None declared, Christian Sørensen Bork: None declared, Jeppe Christensen: None declared, Erik Berg Schmidt: None declared, Daniel Prieto-Alhambra Grant/research support from: Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organised by DPA’s department and open for external participants, Lene Dreyer Grant/research support from: Grants from BMS, Galderma and Eli Lilly.

OP0231 COMPARATIVE EFFECTIVENESS OF JAK-INHIBITORS, TNF-INHIBITORS, ABATACEPT AND IL-6 INHIBITORS IN AN INTERNATIONAL COLLABORATION OF REGISTERS OF RHEUMATOID ARTHRITIS PATIENTS (THE “JAK-POT” STUDY)

Background:

In many countries, JAK-inhibitors (JAKi) have only recently been approved as treatment for patients with rheumatoid arthritis (RA).

Objectives:

To evaluate the effectiveness of JAKi compared to bDMARDs in RA patients in the real-world population in an international collaboration of registers (the “JAK-pot” collaboration).

Methods:

Patients initiating either JAKi, TNFi, IL-6i or abatacept (ABA) during a time period when JAKi were available in each country (19 registers, Table) were included. We compared the effectiveness of JAKi and bDMARDs in terms of retention using crude and adjusted survival analysis. Missing covariates were imputed using multiple imputation.

Results:

Among 25521 included patients, 6063 initiated a JAKi, 13879 a TNFi, 2348 ABA, and 3231 an IL-6i. Patients were on average 55 years old, with a mean disease duration 10 years, mostly seropositive (67%), female (77%) and with moderate disease activity at treatment initiation. The main reason of stopping treatment was ineffectiveness (49%), followed by adverse events (21%). Patients on JAKi were treated more often as monotherapy, had higher CRP and disease activity at baseline and had experienced more previous ts/bDMARDs. Crude median retention was 1.4 (95% CI 1.2-1.5) years for JAKi, 1.6 (1.6-1.7) for TNFi, 1.5 (1.3-1.7) for IL6i and 1.1 (1.0-1.3) for ABA. After adjustment, the hazard ratio (HR) for discontinuation tended to be lower for JAKi (HR 0.86 (0.65-1.13)) compared to TNFi, but comparable for ABA (1.02 (0.94-1.10)) and IL6i (0.99 (0.88-1.10)) (Figure 1). HRs differed notably between countries (Figure 2).

Table 1.

Registers

Country, registerNJAKi, n (%)Austria, BIOREG*Belgium, TARDIS62882113 (33.6)Canada, RHUMADATA528114 (21.6)Czech Republic, ATTRA374253 (67.6)Denmark, DANBIO4721506 (10.7)Finland, ROB-FIN807234 (29.0)Germany, RABBIT*Italy, GISEA757250 (33.0)Israel, I-RECORD40094 (23.5)Netherlands, METEOR16424 (0.2)Norway, NOR-DMARD50799 (19.5)Portugal, REUMA.PT79744 (5.5)Romania, RRBR593328 (55.3)Russia, ARBITER526483 (91.8)Slovenia, BIORX.SI583146 (25.0)Spain, BIOBADASER781139 (17.8)Switzerland, SCQM2956796 (26.9)Turkey, TURKBIO2150397 (18.5)UK, BSRBR111163 (5.7)

*Registers planning to participate in future studies but not included yet

Conclusion:

The adjusted overall drug retention of JAKi tended to be higher than for TNFi, with large variation between countries. Other measures of effectiveness, such as the evaluation of CDAI remission and low disease activity are planned to shape a more comprehensive picture of JAKi effectiveness in the real world.

Disclosure of Interests:

Kim Lauper: None declared, Denis Mongin: None declared, Sytske Anne Bergstra: None declared, Denis Choquette Grant/research support from: Rhumadata is supported by grants from Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Consultant of: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Speakers bureau: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Diederik De Cock: None declared, Lene Dreyer: None declared, Ori Elkayam Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Novartis, Jansen, Kimme Hyrich Grant/research support from: Pfizer, UCB, BMS, Speakers bureau: Abbvie, 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, Nevsun Inanc: None declared, Eirik kristianslund: None declared, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Burkhard Leeb Grant/research support from: chairman of BioReg, Consultant of: AbbVie, Pfizer, Roche, Lilly, Grünenthal, Gebro,, Paid instructor for: Lilly, Biogen, Speakers bureau: Biogen, Lilly, Pfizer, Grünenthal, Astropharma,, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Dan Nordström Consultant of: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Speakers bureau: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Maria Jose Santos Speakers bureau: Novartis and Pfizer, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Delphine Courvoisier: None declared, Axel Finckh Grant/research support from: Pfizer: Unrestricted research grant, Eli-Lilly: Unrestricted research grant, Consultant of: Sanofi, AB2BIO, Abbvie, Pfizer, MSD, Speakers bureau: Sanofi, Pfizer, Roche, Thermo Fisher Scientific

FRI0586 HOW TO GET FROM THE MULTIDIMENSIONAL HEALTH ASSESSMENT QUESTIONNAIRE TO STANFORD HEALTH ASSESSMENT QUESTIONNAIRE DISABILITY INDEX SCORES IN PATIENTS WITH RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS AND AXIAL SPONDYLOARTHRITIS: DEVELOPMENT AND VALIDATION OF A CONVERSION ALGORITHM

Background:

In the DANBIO quality registry in Denmark, patients with rheumatoid arthritis (RA) psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have reported Patient Reported Outcomes (PROs) including the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) for nearly twenty years as part of routine care. Patients’ feedback have stressed a need for a shorter registration of disability (1). While the shorter Multidimensional Health Assessment Questionnaire (MDHAQ) is preferred by patients, the original HAQ-DI is the preferred tool in observational studies. Thus, a conversion algorithm between the MDHAQ and HAQ-DI scores is warranted.

Objectives:

To develop and validate a simple conversion algorithm between MDHAQ and HAQ-DI scores in RA, PsA and axSpA patients.

Methods:

Patients registered in DANBIO with a diagnosis of RA, PsA or axSpA who had completed both HAQ-DI and MDHAQ simultaneously at a visit +/- 30 days from start of conventional synthetic (cs)DMARD or biological (b)DMARD were eligible for the analysis, and randomly divided into development and validation cohorts stratified by diagnosis. The conversion algorithm was developed in the RA development cohort using linear regression with HAQ-DI as the dependent variable and MDHAQ as the independent variable. The predicted HAQ (pHAQ) scores were then calculated by applying the conversion algorithm to the MDHAQ scores in the RA, PsA and axSpA validation cohorts. The pHAQ was validated against the HAQ-DI in the validation cohorts regarding criterion, correlational and construct validity.

Results:

We included 8983/4410/1760 patients with RA/PsA/axSpA, respectively. The conversion algorithm pHAQ=0.15+MDHAQ*1.08 had the best fit (R2=0.83) in the RA development cohort.

Criterion validity: The correlation coefficients between HAQ-DI/pHAQ and patient global score at baseline were 0.66/0.65. In groups of patients with high and low disability (defined as patient global score ≥50), standardized mean difference was -1.4 for HAQ-DI, and -1.4 for pHAQ.

Correlational validity: Correlation coefficients between HAQ-DI/pHAQ and ΔHAQ-DI/ΔpHAQ between baseline and first follow-up visit were r=0.91 and r=0.87, respectively. Correlation coefficients between HAQ-DI/pHAQ and pain score, DAS28CRP and physician global score were 0.63/0.64, 0.55/0.55 and 0.34/0.34, respectively. A Bland-Altman plot showed good agreement of HAQ-DI and pHAQ across all functional states.

Construct validity: HAQ-DI/pHAQ at the first follow-up visit after baseline was comparable between Patient Acceptable Symptom State groups (PASS=No: mean 1.17 vs 1.18/PASS=Yes: 0.55 vs 0.60). Similar results were seen for the external anchor (Figure 1).

In PsA and axSpA validation cohorts, similar results were found.

Conclusion:

A conversion algorithm from MDHAQ to HAQ-DI was developed in ≈ 4500 RA patients. In separate large validation cohorts of RA, PsA and axSpA patients, the predicted HAQ calculated from the MDHAQ scores showed good criterion, correlational and construct validity comparable to the original HAQ-DI. The results suggest that for research purposes the MDHAQ can be converted to HAQ-DI if a full HAQ-DI has not been performed.

References:

[1] Primdahl J. et al. Arthritis Care Res 2019 (in press).

Acknowledgments:

The authors thank all Danish patients and Departments of Rheumatology, who conscientiously report to the DANBIO registry.

Disclosure of Interests:

Elisabeth Svensson: None declared, Katja Løngaard: None declared, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Rikke Meincke: None declared, Jens Kristian Pedersen: None declared, Lene Dreyer: None declared, Niels Steen Krogh: None declared, Dorte Vendelbo Jensen: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis

OP0068 INCIDENCE AND PREVALENCE OF RHEUMATOID ARTHRITIS IN DENMARK: A NATIONWIDE POPULATION-BASED STUDY INVESTIGATING THE EFFECT OF FOUR DIFFERENT CASE DEFINITIONS

Background:

The incidence rate (IR) and point prevalence (PP) of rheumatoid arthritis (RA) in Denmark is largely unknown. Two challenges in estimating the “true” IR and PP using nationwide registry data are the choice of the RA case definition, and the denominator used, i.e. the exact amount of person years (PY) or census count data.

Objectives:

To investigate the incidence and prevalence of RA in the adult Danish population using four different case definitions and two different denominator strategies.

Methods:

Nationwide register-based cohort study. Patients with RA between 1996 and the end of 2016 were identified using the Danish National Patient Registry (DNPR) and information on DMARD prescriptions were obtained through linkage with the Danish National Prescription Registry. Age and sex standardised incidence and prevalence of RA were calculated in different ways: we estimated the IR (denominator = actual recorded number of PY in each year using migration and vital data) and the incidence proportion (IP) (denominator = census count data); and the PP (%) of RA was calculated for years 2000, 2009, 2011 and 2016. The four case definitions were: Model A, a first time RA diagnosis (ICD-10: M05-06) in DNPR and a redeemed prescription of a conventional DMARD in the following year1; Model B, an RA diagnosis recorded twice in DNPR within 90 days with both records originating from a department of rheumatology or general internal medicine2; Model C, any RA diagnosis recorded in DNPR with a DMARD prescription redeemed in the year before or after the diagnosis; Model D, similar to Model A but with the additional requirement that cases had no registered ICD code for inflammatory diseases prior to the RA diagnosis1.

Results:

The overall IR of RA from 1996 to 2016 based on model A was 35.2 (95%CI 34.8 to 35.6) per 100,000 PY while the IP was 34.7 (95%CI 34.3 to 35.1) per 100,000 individuals. The age standardised IR was higher for women than for men (Figure 1), and this was observed across all age groups. The IR peaked at age 70 to 74 in both men and women. Regardless of which case definition was used, the temporal trend showed a peak in IR in 2010 followed by a plateau (Figure 2). The overall PP estimate for all four models increased from 2000 to 2016, data shown for Model A in Table 1.

Table 1.

Point prevalence (PP) of rheumatoid arthritis in years 2000, 2009, 2011 and 2016 based on Model A

2000N = 590670.3 % women2009N = 1503770.9 % women2011N = 1736371.0 % women2016N = 2299170.3 % womenPP (%) (95% CI)PP (%) (95% CI)PP (%) (95% CI)PP (%) (95% CI)All0.16 (0.15 to 0.16)0.37 (0.36 to 0.37)0.41 (0.41 to 0.42)0.52 (0.51 to 0.52)Women0.21 (0.20 to 0.22)0.50 (0.49 to 0.51)0.57 (0.56 to 0.58)0.71 (0.70 to 0.72)Men0.10 (0.10 to 0.11)0.23 (0.22 to 0.23)0.25 (0.25 to 0.26)0.32 (0.31 to 0.33)

Conclusion:

A peak in the IR of RA was observed in 2010, regardless of which case definition was used. We believe this was due to introduction of the new EULAR/ACR diagnostic criteria at that time. IP estimates were systematically lower than IRs calculated using exact migration and vital data as denominator. The PP increased over time regardless of which case definition we used. We conclude that the choice of RA case definition had a larger influence than the choice of denominator.

References:

[1]inauskas A et al. Positive predictive value of first-time rheumatoid arthritis diagnoses and their serological subtypes in the Danish National Patient Registry. Clin Epidemiol. 2018;10:1709-1720.

[2]Ibfelt E et al. Validity and completeness of rheumatoid arthritis diagnoses in the nationwide DANBIO clinical register and the Danish National Patient Registry. Clin Epidemiol. 2017:627-632.

Acknowledgments:

The study is funded by the Danish Rheumatism Association.

Disclosure of Interests:

Bolette Gylden Soussi: None declared, René Lindholm Cordtz: None declared, Salome Kristensen: None declared, Christian Sørensen Bork: None declared, Jeppe Christensen: None declared, Erik Berg Schmidt: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Lene Dreyer: None declared

FRI0648-HPR OUTPATIENT FOLLOW-UP ON DEMAND IN RHEUMATOID ARTHRITIS HAS SAME CLINICAL AND RADIOGRAPHIC OUTCOMES BUT FEWER VISITS THAN SCHEDULED ROUTINE CARE

Background:

Medical treatment and care are often life-long in patients with rheumatoid arthritis (RA). During periods of stable disease, patients typically attend routine visits every 3–8 months at the rheumatology outpatient clinic. Between scheduled medical visits, it may be difficult to get acute appointments with the rheumatologist. Scheduled routine visits may be in a stable period without any symptoms and with no need for control and adjustment of treatment. Consequently, there is a demand for developing outpatient control procedures that cater to the needs of the individual patient and which support the patient‘s experience of active participation in the control and treatment of their own disease.

Objectives:

To compare a patient self-controlled outpatient follow up system (Open Outpatient Clinic System (OOCS)) with traditional scheduled routine visits at a rheumatology outpatient clinic.

Methods:

A two-year randomised controlled trial with RA patients aged 18 to 80 years with a disease duration of at least one year. Patients were recruited consecutively from the rheumatology outpatient clinic of a major university hospital in the Copenhagen region of Denmark from February 2015 to January 2017. Patients were randomised electronically. Joints were examined by a blinded rheumatologist. Patients in the OOCS group had no scheduled appointments but were allowed to book acute appointments with their contact rheumatologist within 5 days and had access to nurse-led consultations without pre-booking, and a nurse-led telephone helpline. Appointments for the control group were scheduled according to routine procedures. Outcome measures were collected at baseline, year 1 and year 2. Clinical parameters: DAS28, CRP, VAS pain, 28-tender and swollen joint count (28-TJC and 28-SJC), HAQ score and radiographs of hands and feet. Psychological parameters: VAS patient satisfaction (Pt satisfact) and quality of life (EQ-5D).

Results:

Of 282 patients, 266 completed the first year, 239 the second year. Patient characteristics (OOCS/controls): age 61.4±10.5/60.9±12.2 years, females 77/74%, ACPA positive 66/65%, treatment with synthetic DMARDs 67/65% and/or biologics 33/35%. Clinical and psychological parameters are shown in Table 1. OOCS at year one and two was comparable to traditional scheduled routine procedures regarding clinical and psychological outcome measures. Radiographic progression was detected in 2.9% (4/138) and 2.1% (3/140) of the OOCS and control group, respectively (p=0.69; Chi-squared test).

Table 1.

Outcome measures in patients with RA randomised to on demand Open Outpatient Clinic System (OOCS) or traditional follow-up (control group) in a rheumatology out-patient clinic. Results are shown as mean±SD.

OOCSControlsOOCSControlsOOCSControlsTimeBaselineBaselineYear 1Year 1Year 2Year 2Visits3.2±1.93.8±1.6*2.6±1.63.5±2.2**Phone calls1.8±3.30.4±0.8**0.7±1.40.1±0.3**DAS283.0±1.22.9±1.02.6±1.12.6±1.02.7±1.22.5±1.0CRP10.2±7.210.1±8.08.2±9.95.7±5.1*9.6±8.85.5±8.9*28-SJC0.6±1.50.6±1.20.2±0.50.3±1.00.3±0.90.4±1.228-TJC3.3±5.72.4±4.22.4±4.72.1±3.72.4±4.92.3±4.7VAS pain27±2526±2128±2628±2432±2729±25HAQ-score0.6±0.60.6±0.60.7±0.60.6±0.60.8±0.70.6±0.7EQ-5D0.8±0.20.8±0.10.8±0.20.8±0.20.8±0.20.8±0.1Pt satisfact88±2187±1984±2582±2382±2483±23

*p<0.05; **p<0.0005, OOCS vs. control group (Student’s t-test).

Conclusion:

The patient self-controlled outpatient follow up system OOCS was associated with fewer visits, but more phone calls to the nurse, and was comparable with traditional scheduled routine procedures regarding clinical, psychological and radiographic outcomes after two years. Thus, organisation of outpatient care according to OOCS may be applied to strengthen patient-centred care in patients with RA.

Disclosure of Interests:

René Panduro Poggenborg Speakers bureau: Novartis, Ole Rintek Madsen: None declared, Lene Dreyer: None declared, Annette Hansen Consultant of: AbbVie, Speakers bureau: Eli Lily

OP0232 TREATMENT WITH METHOTREXATE AND RISK OF LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE POPULATION-BASED COHORT STUDY FROM DENMARK

Background:

Methotrexate (MTX) is the recommended first-line drug in EULAR and ACR treatment guidelines for rheumatoid arthritis (RA) and hence the most commonly prescribed DMARD in the treatment of this group of patients. However, lung disease is considered a potential adverse effect of MTX treatment.

Objectives:

To investigate the risk of interstitial lung disease (ILD) and acute and chronic respiratory failure in RA patients treated with MTX and other medications.

Methods:

From the Danish National Patient Register (DNPR) and the clinical DANBIO Register for rheumatic diseases, we retrieved data on RA patients registered between 1997 and 2015. Information on ILD and respiratory failure outcomes was obtained from DNPR, and information on redeemed prescriptions for MTX and other medications was obtained through linkage to the Danish Prescription Register. Associations between MTX and lung disease outcomes were analyzed in Cox regression models adjusted for age, calendar time, sex and use of other medications possessing the potential for pulmonary toxicity. Standardized Incidence Ratios (SIRs) of lung disease were calculated to compare RA patients to the general population.

Results:

Of the 30,512 RA patients identified, 60% patients had redeemed at least one prescription for MTX, 35% had redeemed a prescription for sulphasalazine, 6% had redeemed a prescription of either amiodarone or nitrofurantoin, and 27% had not received any of the included drugs at the end of the 5-year follow-up for ILD and respiratory failure. MTX treatment was not associated with an increased risk of lung disease (≥1 redeemed prescription(s) compared to no prescriptions), HR 1.00 (95% CI 0.78 to 1.27) for ILD and 0.54 (95%CI 0.43 to 0.67) for respiratory failure at 5-year follow-up (Table). The SIR was 3-4 times increased for ILD in MTX-treated RA patients, but this was no different from the RA population in general compared to the background population.

Table.

Hazard ratios (HR) with 95% confidence intervals (95%CI) for the risk of interstitial lung disease (ILD) and acute or chronic respiratory failure in 30,512 patients with rheumatoid arthritis up to 5 years after diagnosis.

ILD (incl. drug-induced cases)1 year of follow up5 years of follow upEvents, NHR (95% CI)Events, NHR (95% CI)Methotrexate, ≥1 redeemed prescription(s) vs. none621.03 (0.71 to 1.48)1661.00 (0.78 to 1.27)Sulphasalazine, ≥1 redeemed prescription(s) vs. none210.88 (0.54 to 1.43)901.14 (0.89 to 1.48)Amiodarone and/or nitrofurantoin, ≥1 redeemed prescription(s) vs. none10.57 (0.08 to 4.10)70.65 (0.31 to 1.38Women72Ref.155Ref.Men551.51 (1.06 to 2.16)1301.74 (1.38 to 2.21)Acute or chronic respiratory failure1-year of follow up5-years of follow upEvents, NHR (95% CI)Events, NHR (95% CI)Methotrexate, ≥1 redeemed prescription(s) vs. none360.48 (0.32 to 0.73)1580.54 (0.43 to 0.67)Sulphasalazine, ≥1 redeemed prescription(s) vs. none140.70 (0.39 to 1.26)991.09 (0.86 to 1.38)Amiodarone and/or nitrofurantoin, ≥1 redeemed prescription(s) vs. none63.01 (1.31 to 6.94)221.33 (0.86 to 2.06)Women71Ref.239Ref.Men381.07 (0.72 to 1.59)1201.04 (0.83 to 1.29)

Conclusion:

RA patients had an increased risk of ILD compared to the general population, but that risk was not further increased in patients treated with MTX compared to non-MTX treated.

Disclosure of Interests:

None declared

FRI0583 VALIDATION OF THE MODIFIED FATIGUE IMPACT SCALE IN DANISH PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Patients with systemic lupus erythematosus (SLE) experience significant fatigue, a debilitating symptom associated with reduced quality of life. A simple, reliable multidimensional method for assessing fatigue has not yet been validated for Danish patients with SLE.

Objectives:

The primary objective was to study the internal consistency, test-retest reliability, and construct validity (convergent and discriminant validity) of the multidimensional Modified Fatigue Impact Scale (MFIS) in patients with SLE. The secondary objective was to investigate the contribution of disease activity and organ damage to fatigue.

Methods:

Data from the ”Bio and Genome Bank Study in Centre for SLE and Vasculitis” obtained through routine visits were used. Fatigue was assessed using the MFIS and Short Form 36 (SF36). Internal consistency of the MFIS was assessed with Cronbach’s alpha (α). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). Construct validity was studied using Spearman’s rank correlation coefficient (rs) and Principal Component Analysis (PCA) between MFIS and SF36 vitality (VT-SF36) and mental health (MH-SF36) subscales. Association between MFIS and disease activity and organ damage was estimated with Spearman’s rank correlation coefficient.

Results:

The study included 30 patients with SLE. Internal consistency of the MFIS was excellent with Cronbach’s α = 0.97 for the complete scale. Excellent test-retest reliability was found with ICC = 0.95 (95% confidence interval: 0.88-0.98, p < 0.05). Construct validity was confirmed by Spearman’s correlation (VT-SF36: rs= −0.73, p < 0.001 (Fig. 1). MH-SF36: rs= −0.74, p < 0.001 (Fig. 2)) and PCA with explained variance from the first two principal components (PC) (VT-SF36: PC1 = 60.2%, PC2 = 8.5%. MH-SF36: PC1 = 58.5%, PC2 = 7.4%). No significant correlation was found between the MFIS and SLEDAI (rs= 0.04, p = 0.84) or SLICC Damage Index (rs= 0.32, p = 0.08).

Figure 1.

Scatter plot of the Modified Fatigue Impact Scale (MFIS) and the Short Form 36 vitality (VT-SF36) subscale.

Figure 2.

Scatter plot of the Modified Fatigue Impact Scale (MFIS) and the Short Form 36 mental health (MH-SF36) subscale.

Conclusion:

The present study found the multidimensional assessment of fatigue with MFIS to be a reliable and valid instrument in SLE. The MFIS might provide more detailed information about fatigue in future studies. In agreement with some previous studies we found no association between fatigue and SLEDAI or SLICC which raises questions about the cause of this symptom. Further and larger studies are needed to investigate if any association between fatigue and disease components exist.

Disclosure of Interests:

None declared

OP0172 EFFECT OF WEIGHT LOSS AND LIRAGLUTIDE ON SERUM URATE LEVELS AMONG OBESE KNEE OSTEOARTHRITIS PATIENTS: SECONDARY ANALYSIS OF A RANDOMISED CONTROLLED TRIAL

Background:

There is a strong association between gout and obesity. Lowering urate is the cornerstone of gout management [1] and urate levels correlate strongly with central obesity. Previous studies suggest that weight loss has a positive effect on serum urate, however, the studies are sparse and small [2].

Objectives:

To assess the impact of an initial low-calorie diet-induced weight loss and subsequent randomisation to the body weight-lowering drug liraglutide (a glucagon-like peptide 1 receptor agonist) or placebo on serum urate levels.

Methods:

In the LOSE-IT trial (NCT02905864), a randomised, double-blinded, placebo-controlled, parallel group, single-centre trial [3], 156 obese individuals with knee osteoarthritis, but without gout, were offered an initial 8-week intensive diet intervention (week -8 to 0) on Cambridge Weight Plan (800-1000 kcal/day) followed by a weight loss maintenance period in which participants were randomised to either liraglutide 3 mg/day or placebo for 52 weeks. We conducted a secondary analysis of blood samples collected at week -8, 0 and 52. The primary outcome measure was change in serum urate. We used paired t-test for the change from week -8 to 0, and for change from week 0 to 52 we used an ANCOVA model adjusted for stratification factors (sex, age category and obesity class), and the level of the outcome at baseline. Data were analysed as observed (i.e. no imputation of missing data).

Results:

156 individuals were randomised and 155 had blood samples taken at baseline. In the initial intensive diet intervention period (week -8 to 0) they lost a mean of 12.5 kg (95% CI -13.1 to -11.9, n 156). In the following 52 weeks, the liraglutide group lost an additional 4.1 kg (SE 1.2, n 71) whereas the control group was almost unchanged with a weight loss of 0.2 kg (SE 1.2, n 66). Looking at the main outcome of serum urate levels change, the initial intensive diet resulted in a mean decrease of 0.21 mg/dL (95% CI 0.35 to 0.07, n 155) for the entire cohort. In the following year (week 0 to 52) the liraglutide group exhibited a further mean decrease in serum urate of 0.48 mg/dL (SE 0.11, n 69), whereas the placebo group exhibited a slight decrease in mean serum urate of 0.07 mg/dL (SE 0.12, n 65) resulting in a significant between-group difference of -0.40 mg/dL (95% CI -0.69 to -0.12, n 134) – see Figure 1. Four participants in each group experienced serious adverse events; no deaths were observed.

Conclusion:

This secondary analysis of the LOSE-IT trial suggests that liraglutide provides a potential novel serum urate lowering drug mechanism in obese patient populations, with potential implication for gout treatment.

References:

[1]Richette P et al. 2016.Ann Rheum Dis2017;76:29–42.

[2]Nielsen SM et al.Ann Rheum Dis2017 76(11):1870-1882.

[3]Gudbergsen H et al.BMJ2019. 71–2.

Disclosure of Interests:

Kristian Zobbe: None declared, Sabrina Mai Nielsen: None declared, Robin Christensen: None declared, Anders Overgaard: None declared, henrik gudbergsen Speakers bureau: Pfizer 2016, Marius Henriksen: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Lene Dreyer: None declared, Lisa Stamp: None declared, Filip Krag Knop Shareholder of: Minority shareholder in Antag Therapeutics Aps, Grant/research support from: AstraZeneca, Gubra, Novo Nordisk, Sanofi and Zealand Pharma, Consultant of: Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, MSD/Merck, Mundipharma, Novo Nordisk, Sanofi and Zealand Pharma., Speakers bureau: AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, MedImmune, MSD/Merck, Mundipharma, Norgine, Novo Nordisk, Sanofi and Zealand Pharma., Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

THU0619-HPR PREVALENCE OF DISTAL INTERPHALANGEAL JOINT ULTRASONOGRAPHY FEATURES IN PSORIATIC ARTHRITIS, SKIN PSORIASIS, OSTEOARTHRITIS AND HEALTHY INDIVIDUALS: A CROSS-SECTIONAL STUDY

Background:

Distal interphalangeal (DIP) joint involvement is a feature of both psoriatic arthritis (PsA) and hand osteoarthritis (OA), and nail-changes are features seen both in PsA and nail psoriasis patients without joint involvement (PsO). In both PsA and OA, ultrasonography (US) is used to quantify DIP joint inflammation.

Objectives:

To explore disease-specific US-detected characteristics in the DIP-joints and extensor tendon entheses in patients with DIP-joint OA, PsA, PsO with nail involvement, and healthy controls (HC).

Methods:

In PsA, PsO, OA and HC US examination of DIP joints 2-5 and the extensor tendon were performed. The US images were scored for DIP joint grey-scale synovitis, DIP joint Doppler, osteophytes and erosions (grade 0-3) and presence/absence of enthesitis and peritendonitis of the extensor tendon according to OMERACT standards. Prevalences were calculated on all included fingers (i.e. four fingers per participant), and differences in prevalences were tested using Chi-square statistics.

Results:

Fifty PsA patients (44% females; mean age: 55y), 13 PsO patients (38% females; mean age 54y), 12 OA patients (100% females, mean age 71y), and 29 HC (52% females, mean age 48y) participated. The prevalences across the diagnosis groups are shown in figure 1, and the distribution of US outcomes was significantly different (highest Chi-square P-value: 0.0127). The PsA group had the largest prevalence of extensor tendon enthesitis (45.5%), peritendonitis (15%), and DIP joint erosions (11%), but also exhibited a considerable prevalence of osteophytes (46%). In the PsO group, the most marked findings were synovitis (33%) and enthesitis (35%). The OA group had the largest prevalence of DIP joint synovitis (67%) and osteophytes (88%) but also 25% prevalence of enthesitis. 24% of the HC group had a grade 1 synovitis.

Conclusion:

This cross-sectional study found significant patterns of US findings distributed dependent on the underlying condition. PsA patients were mainly differentiated by the presence of extensor tendon enthesitis and peritendonitis. A high prevalence of enthesitis and synovitis was seen in patients with DIP joint OA. The high prevalence of enthesitis in PsO is consistent with a preclinical phase of PsA in this group.

Disclosure of Interests:

Jørgen Guldberg-Møller Speakers bureau: Novartis, Ely Lilly, AbbVie, BK Ultrasound, Marius Henriksen: None declared, Mikael Boesen Speakers bureau: Image Analysis Group, AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Lene Dreyer: None declared, Karen Ellegaard: None declared, Marie Skougaard: None declared, Christine Ballegaard: None declared, Ai Lyn Tan: None declared, Richard Wakefield Speakers bureau: Novartis, Janssen, GE, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

AB1255 AGREEMENT BETWEEN PATIENT-REPORTED OUTCOME MEASURES COLLECTED VIA A SMARTPHONE APPLICATION VS A TOUCHSCREEN SOLUTION IN AN OUTPATIENT CLINIC AMONG PATIENTS WITH INFLAMMATORY ARTHRITIS: A RANDOMISED, WITHIN-PARTICIPANT TRIAL

Background:

Patient-reported outcome measures (PROMs) are essential to understand the patient’s perception of arthritis activity. In Demark, PROMs are registered on a touchscreen in the outpatient clinic. However, some patients find it inconvenient due to e.g. waiting in queue, lack of privacy, uncomfortable seating position, reduced upper limb strength and dexterity with seeing the touchscreen due to deformity of the cervical spine. The widespread use of smartphones makes it possible for patients to register PROMs via an application (app) on their own device.

Objectives:

The primary aim is to evaluate the agreement (i.e. similarity) between the two devices assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI) status among patients with inflammatory arthritis.

Methods:

The study was a randomised, crossover, agreement trial (NCT03486613) conducted at Aalborg University Hospital, Denmark. Participants were recruited through an invitation on the touchscreen in the outpatient clinic. Patients with an established diagnosis (≥ 12 months) of rheumatoid arthritis (RA), psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) and experience with the PROM questionnaires (≥ 3 previous registrations) were enrolled and randomised in ratio 1:1 (stratified by diagnosis) to PROM registration through the DANBIO app and the touchscreen in random order. Figure 1A and 1B shows the two devices.

The sample size calculation was based on a prespecified equivalence margin of ±0.11 HAQ-DI points (i.e. ≤ half of the minimal important difference of 0.22 points) yielding a power of 99.2% for 60 enrolled patients. There was a wash-out period of 1-2 days between the two device registrations to minimise the potential carryover effect.

A paired t-test was used to calculate the mean HAQ-DI score for the two devices and the difference in HAQ-DI score with a 95% confidence interval (CI). A Bland-Altman plot was used to assess limits of agreement (LoA).

Results:

60 patients (20 with RA, 20 with PsA and 20 with axSpA) were randomised of whom 51.7% were male. Mean age was 53.7 years (range 22-77) and mean disease duration was 12.5 years (range 1.0-34.8).

Mean HAQ-DI was 0.608 (95%CI 0.437;0.779) for the DANBIO app and 0.614 (95%CI 0.446;0.783) for the touchscreen (Table 1). Agreement between scores obtained with the two devices is illustrated with Bland-Altman plots in figure 2A and 2B. The paired mean difference of HAQ-DI between the two devices was -0.006 (95%CI -0.0424; 0.030); thus the 95% confidence interval for the mean difference was within the prespecified equivalence margin of ±0.11 HAQ-DI points.

Table 1.

HAQ-DI scores, difference and LoA for the two devices.

App, mean (SD)Touchscreen, mean (SD)Difference, mean (95%CI)LoAMissing valuesHAQ-DI (0-3)0.608 (0.656)0.614 (0.646)-0.006 (-0.042;0.030)-0.277;0.2641

Conclusion:

The current study showed no statistical or clinically important difference in HAQ-DI measurement captured by a smartphone app or outpatient touchscreen. Therefore, we feel confident that the two devices perform similarly enough to be used interchangeably in patients with inflammatory arthritis.

Disclosure of Interests:

Line Uhrenholt Speakers bureau: Abbvie, Eli Lilly and Novartis (not related to the submitted work), Robin Christensen: None declared, Lene Dreyer: None declared, Annette Mortensen Speakers bureau: MSD and Eli Lilly (not related to the submitted work)., Ellen-Margrethe Hauge Speakers bureau: Fees for speaking/consulting: MSD, AbbVie, UCB and Sobi; research funding to Aarhus University Hospital: Roche and Novartis (not related to the submitted work)., Niels Steen Krogh: None declared, Mikkel Kramme Abildtoft: None declared, Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, Salome Kristensen: None declared

THU0473 IS PAIN INTENSITY ASSOCIATED WITH EARLY MORTALITY IN PATIENTS WITH PSORIATIC ARTHRITIS?

Background:

Studies regarding excess mortality among patients with psoriatic arthritis (PsA) are conflicting due to the heterogenous nature of the disease. Thus, identifying risk factors for mortality is crucial, but few studies have examined these in PsA. Presence of chronic pain can cause excess mortality and since pain is prevalent among patients with PsA this association should be explored.

Objectives:

To investigate whether higher cumulative pain intensity is associated with an excess mortality ratio in patients with PsA.

Methods:

A nested case-control study was performed using data from the national Danish healthcare registers and the DANBIO rheumatology register. Cases were patients who died while followed in routine care. Cases were matched on sex, year of birth and calendar period of DANBIO entry with up to five controls. The main exposure of interest was the mean pain intensity (all causes) reported during the time followed in routine rheumatology practice. The pain intensity was measured on a visual analogue scale (VAS) ranging from 0 (no pain) to 100 (worst imaginable pain). Conditional logistic regression was used to calculate the odds of mortality per 5 unit increase in VAS pain while adjusting for inflammatory markers.

Results:

The Danbio PsA cohort consisted of 8019 patients. In total, 266 cases, i.e. PsA patients who died during the observational period, were identified and matched with 1198 controls (4.5 controls per case). Increasing pain intensity was associated with increased odds of mortality (OR 1.05, 95%CI 1.01 to 1.09) in the crude model, but the association disappeared when adjusting for age, sex, calendar time, socioeconomic status, average c-reactive protein and swollen joint count during the observation period (OR 0.98, 95%CI 0.93-1.03).

Age, average CRP, biological DMARD use, glucocorticoid use, and comorbidities (see table) increased the odds of mortality.

Table

regression estimates from fully adjusted model

Odds Ratio95% CIAge2,731,60-4,68C-reactive protein1,051,03-1,07Swollen joint count1,080,97-1,22Health assessment questionnaire1,250,84-1,86bDMARD use2,621,51-4,57cDMARD use0,690,46-1,03Glucocorticoid use3,902,51-6,05Chronic obstructive pulmonary disease2,191,20-4,02Diabetes mellitus2,651,62-4,31Cancer6,153,88-9,76Cardiovascular disease2,611,71-3,97

Conclusion:

These results indicate that experienced pain in itself is not associated with excess mortality. Age, recent glucocorticoid use, biological DMARD use, chronic pulmonary disease, diabetes, cancer and cardiovascular disease were all associated with an increased mortality.

Disclosure of Interests: :

None declared

THU0288 CANCER RISK IN PATIENTS WITH CUTANEOUS LUPUS ERYTHEMATOSUS AND SYSTEMIC LUPUS ERYTHEMATOSUS COMPARED TO THE GENERAL POPULATION: A DANISH NATIONWIDE COHORT STUDY

Background:

Research suggesting an elevated risk of cancer among patients with Systemic Lupus Erythematosus (SLE) has increased in recent years. Yet, the size of the overall cancer risk and the risk of respective cancer sites varies. Research examining the cancer risk of Cutaneous Lupus Erythematosus (CLE) patients remains limited. Therefore, in order to further guide and monitor patients with SLE and CLE, additional research estimating the risk of cancer is needed.

Objectives:

To determine if patients with SLE or CLE have an increased risk of cancer compared to the general population, and furthermore to identify specific cancer types associated with increased risk.

Methods:

This was an observational cohort study of 3424 SLE and 1886 CLE patients identified in The Danish National Patient Register (DNPR) from 1stJanuary 1995 to 31stDecember 2014. The cohorts were followed up for cancer by linkage to The Danish Cancer Registry (DCR). Based on the age, sex, and calendar specific cancer rates from Denmark, standardized incidence ratios (SIRs) were calculated for the SLE and CLE groups, respectively.

Results:

The SLE and CLE cohorts were followed for 27,676 and 13,048 person years, each group’s average duration of follow-up being 8.1 and 6.9 years, respectively. Compared to the general population, the SIRs for the overall cancer (except non-melanoma skin cancer) risk was 1.45 (95%CI 1.30 to 1.62) in the SLE group and 1.35 (95%CI 1.15 to 1.58) in the CLE group. Both CLE and SLE patients had increased risks of hematological, pancreas and lung cancers. Liver, tongue/mouth/pharynx, non-melanoma skin cancer, oesophagus and meninges cancers were only increased in the SLE group.

Table 1.

SIR for overall cancer in Danish SLE patients according to gender, time since diagnosis and age

Overall cancer except NMSCObserved no. cancersExpected no. cancersPYRSSIR (95% CI)All308212.027,6761.45 (1.30 to 1.62)Female246170.023,9251.45 (1.27 to 1.64)Male6242.037511.48 (1.13 to 1.89)Time since SLE diagnosis< 1 year5220.332132.56 (1.91 to 3.36)1 to 4 years10370.310,2701.47 (1.20 to 1.78)4 to 9 years8364.481631.29 (1.03 to 1.60)10+ years7057.060301.23 (0.96 to 1.55)Age at SLE diagnosis< 40 years119.072011.23 (0.61 to 2.20)40 to 60 years9467.012,3091.41 (1.14 to 1.73)60+ years203137.081661.49 (1.29 to 1.71)

SLE = Systemic lupus erythematosus, NMSC = Non-melanoma skin cancer, PYRS = Person years, SIR = Standardized Incidence Ratio, CI = Confidence Interval

Table 2.

SIR for overall cancer in Danish CLE patients according to gender, time since diagnosis and age

Overall cancer except NMSCObserved no. cancersExpected no. cancersPYRSSIR (95% CI)All155114.713,0481.35 (1.15 to 1.58)Female11987.510,0921.36 (1.13 to 1.63)Male3627.229561.32 (0.93 to 1.83)Time since CLE diagnosis< 1 year2912.816812.26 (1.51 to 3.24)1 to 4 years5340.249551.32 (0.99 to 1.72)4 to 9 years4134.237971.20 (0.86 to 1.63)10+ years3227.426151.17 (0.80 to 1.65)Age at CLE diagnosis< 40 years62.923692.04 (0.75 to 4.43)40 to 60 years4931.459621.56 (1.15 to 2.06)60+ years10080.347171.24 (1.01 to 1.51)

CLE = Cutaneous lupus erythematosus, NMSC = Non-melanoma skin cancer, PYRS = Person years, SIR = Standardized Incidence Ratio, CI = Confidence Interval

Graphs

SLE cancer sites: Standardized incidence ratios and corresponding 95% confidence intervals

CLE cancer sites: Standardized incidence ratios and corresponding 95% confidence intervals

Conclusion:

The risk of overall cancer was significantly increased in patients with SLE and CLE. Hematological, pancreas and lung cancers were elevated in both groups, while certain virus-associated cancers and other sites were increased only among SLE patients. Awareness of cancer in patients with SLE and CLE should be considered, especially of symptoms from high-risk sites.

Disclosure of Interests:

None declared

SAT0632-HPR PATIENTS VIEW ON CONSULTATION IN OUTPATIENT CLINIC – FROM SATISFACTION TO DEMAND OF GUIDANCE INTO MORE SELF-MANAGEMENT

Background:

Patients with rheumatic diseases, routinely consult the outpatient clinic 1-2 times a year to see their rheumatologist. Many of the patients also attend nurse-led consultations to receive instructions, regarding treatment in association to their intravenous treatment, or DMARD dispensing in the clinic. As clinicians we have an assumption of what the ”good practice” is in relation to the patients, but we have little insight, into the patients’ own experience and satisfaction.

Objectives:

To investigate the patients views on the level of information, and their experience and satisfaction with the doctor and nurse-led consultations in the outpatient clinic.

Methods:

The approach of the survey was both quantitative and qualitative. A questionnaire was designed with four questions on a matrix scale concerningtheir information level on their disease/symptoms;their treatment;if they had received written material and if so, it’s value; andtheir possibility to talk about subjects that matters for them during consultations. To gain a qualitative approach with focus on the patients’ experiences and comments, every question was constructed with space for comments. Comments were transcribed, indexed, analysed, and thematically divided. The inclusion of patients were all patients visiting the clinic within a specific week in January 2019.

Results:

The results from the four questions, are shown in the figures below, measured in percentage. In total, 283 participated (response rate 60%).

Four themes covered from the analysis of patients’ comments.“Seeking own answers”, “Own coping – effort”, “Conversation with doctor/nurse”and“Treatment/medication”.Comments revealed many descriptions and stories of patients, showered with all types of suggestions of taking control or managing the disease by them self, from their family or media. It also revealed their interest in discussing, these subjects and matters with the doctor/nurse, without being rejected. The feeling of rejection resulted in some patients trying other treatments or introducing changes in their lifestyle, without involving the doctor. The patients also called for more knowledge about physical training, and not only medical treatment.

Conclusion:

In general, the patients had a very positive perception towards the consultations, and the information from the outpatient clinic. Despite that, the themes indicated a pattern, that needs to be considered, so clinicians acknowledge the patients wish for guidance, besides the medical treatment. To support the patient, without leaving them with a feeling of being rejected, we need to consider how to articulate the subjects the patients are exposed to outside our clinic, so the patients feel free to inform or involve the clinic instead of being silent, in risk of counteracting the medical treatment.

Acknowledgments:

We are grateful to the participants who shared their experiences. We also thank an internal research group taking part of the investigation.

Disclosure of Interests:

Ida Lund: None declared, Annette Hansen Consultant of: AbbVie, Speakers bureau: Eli Lily, Betina Stampe: None declared, René Cordtz: None declared, Lene Dreyer: None declared

AB0202 GENETIC SUSCEPTIBILITY AND PHENOTYPE OF RHEUMATOID ARTHRITIS IN DANISH AND TURKISH PATIENTS

Background:

Previous studies indicate that genetic susceptibility and phenotype of rheumatoid arthritis (RA) differ between the populations.

Objectives:

To compare the clinical, serologic expression and the presence of shared epitopes (SE) of incident RA in two different populations, one from Northern and the other from Southern Europe.

Methods:

Data on incident RA patients fulfilling EULAR/ACR 2010 classifications criteria for RA were collected at Rheumatology Departments in Denmark and Turkey in 2015-2016. Patients were assessed using the same standardized protocol in both populations. SE carrier status were assigned, according to the du Montcel classification based, into six allele groups:S1, S2,S3D,S3PandX, where S2 and S3P are RA risk-enhancing alleles and S1 and S3D are RA protective alleles of the shared epitope(1).

Results:

109 incident RA patients from Denmark and 114 incident RA patients from Turkey were enrolled. Genetic data were available from 87% of the patients.

Table 1.

Characteristics of incident rheumatoid arthritis patients in Denmark and Turkey

Danish patientsn=109Turkish patientsn=114P-valueAge at diagnosis, years60 (49-69)52 (43-64)0.003Female, %64740.12Symptom duration, months7 (4-21)6 (2-22)0.6Smoking status Never smoker, %43440.98 Former smoker, %28310.68 Current smoker, %29250.54VAS pain (0-100 mm)45 (28-66)60 (41-72)0.01VAS fatigue (0-100 mm)51 (29-69)50 (20-70)0.32VAS global, patient (0-100 mm)60 (31-80)60 (41-73)0.77Swollen joint count (0-28)7 (4-11)3 (1-6)<0.00001Tender joint count (0-28)7 (3-11)5 (2-8)0.04HAQ score (0-3)0.75 (0.34-1.25)1.0 (0.25-1.75)0.02DAS284.7 (4.1-5.5)4.3 (3.3-5.2)0.01CRP, mg/l7 (3.0-18.5)8 (3.1-22.6)0.54IgM RF positive, %70660.58ACPA positive, %63750.1

Medians (interquartile range) for continuous variables

VAS – Visual Analog Scale, HAQ - Health Assessment Questionnaire, DAS28 - Disease Activity Score 28 joints, CRP – C-reactive protein, RF – Rheumatoid Factor, ACPA - Anti-Citrullinated Protein Antibodies.

Table 2.

Shared epitope allele carrier frequencies.

AlleleDanish patientsn=98Turkish patientsn=95P-valueS1, % (n)19 (37)22 (42)0,43S2, % (n)26 (51)8 (16)<0,00001S3D, % (n)6 (12)21 (39)0,000029S3P, % (n)27 (52)29 (56)0,52X, % (n)22 (44)19 (37)0,47

We found no associations between the risk-enhancing alleles and the presence of IgM rheumatoid factor or ACPA.

Conclusion:

The Turkish patients were younger and had lower disease activity than Danish at the time of diagnosis. Our study found an enhanced genetic susceptibility to RA in Danish compared to Turkish patients with a higher prevalence of risk-enhancing RA alleles and a lower prevalence of protective alleles.

References:

[1]Tezenas du Montcel S, Michou L, Petit-Teixeira E, Osorio J, Lemaire I, Lasbleiz S, et al. New classification of HLA–DRB1 alleles supports the shared epitope hypothesis of rheumatoid arthritis susceptibility.Arthritis Rheum2005; 52: 1063–8.

Disclosure of Interests:

None declared

Tricho-hepatic-enteric syndrome (THES) without intractable diarrhoea

Tricho-hepatic-enteric syndrome (THES) is a genetically heterogeneous rare syndrome (OMIM: 222470 (THES1) and 614602 (THES2)) that typically presents in the neonatal period with intractable diarrhoea, intra-uterine growth retardation (IUGR), facial dysmorphism, and hair and skin changes. THES is associated with pathogenic variants in either TTC37 or SKIV2L; both are components of the human SKI complex, an RNA exosome cofactor. We report an 8 year old girl who was diagnosed with THES by the Undiagnosed Disease Program-WA with compound heterozygous pathogenic variants in SKIV2L. While THES was considered in the differential diagnosis, the absence of protracted diarrhoea delayed definitive diagnosis. We therefore suggest that SKIV2L testing should be considered in cases otherwise suggestive of THES, but without the characteristic diarrhoea. We expand the phenotypic spectrum while reviewing the current knowledge on SKIV2L.

Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities

OBJECTIVE

Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies. The study objective was in a controlled setting to describe cardiac abnormalities by noninvasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM) and to identify predictors for cardiac dysfunction.

METHODS

In a cross-sectional study, 76 patients with PM/DM and 48 matched healthy controls (HCs) were assessed by serum levels of cardiac troponin I, electrocardiography, Holter monitoring, echocardiography with tissue Doppler imaging, and quantitative cardiac (99m) Tc-pyrophosphate ((99m) Tc-PYP) scintigraphy.

RESULTS

Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% versus 0%; P = 0.02) and longer QRS and QT intervals (P = 0.007 and P < 0.0001, respectively). In multivariate analysis, factors associated with LVDD were age (P = 0.001), disease duration (P = 0.004), presence of myositis-specific or -associated autoantibodies (P = 0.05), and high cardiac (99m) Tc-PYP uptake (P = 0.006). In multivariate analysis of the pooled data for patients and HCs, a diagnosis of PM/DM (P < 0.0001) was associated with LVDD.

CONCLUSION

Patients with PM or DM had an increased prevalence of cardiac abnormalities compared to HCs. LVDD was a common occurrence in PM/DM patients and correlated to disease duration. In addition, the association of LVDD with myositis-specific or -associated autoantibodies and high cardiac (99m) Tc-PYP uptake supports the notion of underlying autoimmunity and myocardial inflammation in patients with PM/DM.

Social Network Behavior and Engagement Within a Smoking Cessation Facebook Page

Background

Social media platforms are increasingly being used to support individuals in behavior change attempts, including smoking cessation. Examining the interactions of participants in health-related social media groups can help inform our understanding of how these groups can best be leveraged to facilitate behavior change.

Objective

The aim of this study was to analyze patterns of participation, self-reported smoking cessation length, and interactions within the National Cancer Institutes’ Facebook community for smoking cessation support.

Methods

Our sample consisted of approximately 4243 individuals who interacted (eg, posted, commented) on the public Smokefree Women Facebook page during the time of data collection. In Phase 1, social network visualizations and centrality measures were used to evaluate network structure and engagement. In Phase 2, an inductive, thematic qualitative content analysis was conducted with a subsample of 500 individuals, and correlational analysis was used to determine how participant engagement was associated with self-reported session length.

Results

Between February 2013 and March 2014, there were 875 posts and 4088 comments from approximately 4243 participants. Social network visualizations revealed the moderator’s role in keeping the community together and distributing the most active participants. Correlation analyses suggest that engagement in the network was significantly inversely associated with cessation status (Spearman correlation coefficient = −0.14, P=.03, N=243). The content analysis of 1698 posts from 500 randomly selected participants identified the most frequent interactions in the community as providing support (43%, n=721) and announcing number of days smoke free (41%, n=689).

Conclusions

These findings highlight the importance of the moderator for network engagement and provide helpful insights into the patterns and types of interactions participants are engaging in. This study adds knowledge of how the social network of a smoking cessation community behaves within the confines of a Facebook group.

Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

Systemic lupus erythematosus (SLE) is a well-known cardiovascular risk factor. Less is known about cutaneous lupus erythematosus (CLE) and the risk of developing cardiovascular disease (CVD). Therefore, we investigated the risk of mortality and adverse cardiovascular events in patients diagnosed with SLE and CLE. We conducted a cohort study of the entire Danish population aged ≥ 18 and ≤ 100 years, followed from 1997 to 2011 by individual-level linkage of nationwide registries. Multivariable adjusted Cox regression models were used to estimate the hazard ratios (HRs) for a composite cardiovascular endpoint and all-cause mortality, for patients with SLE and CLE. A total of 3282 patients with CLE and 3747 patients with SLE were identified and compared with 5,513,739 controls. The overall HR for the composite CVD endpoint was 1.31 (95% CI 1.16–1.49) for CLE and 2.05 (95% CI 1.15–3.44) for SLE. The corresponding HRs for all-cause mortality were 1.32 (95% CI 1.20–1.45) for CLE and 2.21 (95% CI 2.03–2.41) for SLE. CLE and SLE were associated with a significantly increased risk of CVD and all-cause mortality. Local and chronic inflammation may be the driver of low-grade systemic inflammation.

Cognitive Profiles of Reading-Disabled Children: Comparison of Language Skills in Phonology, Morphology, and Syntax

A comprehensive cognitive appraisal of elementary school children with learning disabilities showed that within the language sphere, deficits associated with reading disability are selective Phonological deficits consistently accompany reading problems whether they occur in relatively pure form or in the presence of coexisting attention deficit or arithmetic disability Although reading-disabled children were also deficient in production of morphologically related forms, this difficulty stemmed in large part from the same weakness in the phonological component that underlies reading disability In contrast, tests of syntactic knowledge did not distinguish reading-disabled children from those with other cognitive disabilities, nor from normal children after covarying for intelligence