AB0247 THE ROLE OF AUTOIMMUNITY ON THE RELATION BETWEEN EROSIONS AND BONE MINERAL DENSITY IN RHEUMATOID ARTHRITIS: A CLINICAL RESEARCH

Background

Rheumatoid arthritis (RA) is the most frequent chronic inflammatory rheumatism. It is characterized by peripheral articular destruction and it is well known that erosions are correlated with the presence and titer of anti-citrullinated peptide antibodies (ACPA)(1). RA is also known to be an independent factor of osteoporosis(2) and it has already been demonstrated that ACPA is associated with bone mineral density (BMD) at the hip and spine(3). The physiopathology of erosion and bone loss in RA is related to osteoclast activation via RANK-L pathway stimulation, that can possibly be lead by ACPA(4).

Objectives

Our aim was to determine if there is an association between local and systemic bone damage in RA, represented respectively by erosion and BMD, and whether it may be driven by ACPA and/or other autoimmunity-related antibodies.

Methods

Patients followed in the Department of Rheumatology between January 2008 and May 2019 satisfied the 1987 ACR or 2010 ACR-EULAR criteria. To be included, they had to undergo radiographs and biology at intervals of less than 2 years from DXA. Bone mineral density (BMD) was evaluated in g/cm2 and by T-score at the hip on DXA. Erosions were evaluated by the modified Sharp/van der Heidje erosion score (SHSe) on radiographs and the presence and titers of ACPA, rheumatoid factor (RF) and anti-nuclear antibodies (ANAs) were recorded.

Results

A total of 149 patients met the inclusion criteria, represented by 75.8% of women. They had a mean age of 62 (SD 9.61) and a long median disease duration of 132 [60; 240] months. A total of 61.1% patients were ACPA positive, 79.9% were erosive and 10.7% had a hip or spine T-score ≤-2.5. A higher erosion score was associated with a lower BMD (R2: 0.049 and value: -0.222; p=0.009) and T-score (R2: 0.158 and value -0.397; p<0.0001) at the hip. ACPA status, but not titer, was associated with a higher erosion score (63.0 (53.2) vs. 45.5 (44.1) for ACPA – (p= 0.04)). ACPA titers were associated with lower BMD at the hip (value -0.216; p=0.01) but not with T-score. In linear regression, erosion and bone mineral density were still associated but this association does not seem to be driven by ACPA status or titer. RF and ANA did not demonstrate any role in this association.

Figure 1.

SHSe total score and associated variables in linear regression

Conclusion

We have shown that erosions were associated with lower BMD and T-score at hip but also at spine. Nevertheless that relation does not seem to be driven by ACPA or other autoimmunity-related antibodies. However, the presence of ACPA or erosion should lead to osteoporosis assessment.

References

[1]Maddali Bongi S, Manetti R, Melchiorre D, Turchini S, Boccaccini P, Vanni L, et al. Anti-cyclic Citrullinated Peptide Antibodies are Highly Associated with Severe Bone Lesions in Rheumatoid Arthritis Anti-CCP and Bone Damage in RA. Autoimmunity. sept 2004;37(6‑7):495‑501.

[2]Adami G, Saag KG. Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis. Curr Rheumatol Rep. juill 2019;21(7):34.

[3]Tomizawa T, Ito H, Murata K, Hashimoto M, Tanaka M, Murakami K, et al. Distinct biomarkers for different bones in osteoporosis with rheumatoid arthritis. Arthritis Res Ther. déc 2019;21(1):174.

[4]Harre U, Georgess D, Bang H, Bozec A, Axmann R, Ossipova E, et al. Induction of osteoclastogenesis and bone loss by human autoantibodies against citrullinated vimentin. J Clin Invest. 1 mai 2012;122(5):1791‑802.

Disclosure of Interests

None declared

An updated review of anti-Ro52 (TRIM21) antibodies impact in connective tissue diseases clinical management

Anti-Ro52 (or anti-TRIM21) antibodies are part of the family of anti-Ro/SSA antibodies, historically markers of Sjögren syndrome and systemic lupus erythematosus. Anti-Ro52 antibodies represent one the most frequently encountered autoantibodies in patients with connective tissue disease (primary Sjögren syndrome, systemic lupus erythematosus, systemic sclerosis and idiopathic inflammatory myopathies). Because of their lack of specificity and detection in patients with non-autoimmune disorders, the usefulness of anti-Ro52 testing in connective tissue diseases is still matter of debate among clinicians and immunologists. Autoantibodies are mainly diagnostic markers for autoimmune diseases but some of them can also be directly involved in the generation of tissue damage. Over the past decade several authors reported associations of anti-Ro52 antibodies with some clinical features - especially interstitial lung disease - and survival in patients with connective tissue diseases. There is also a growing evidence of the role of anti-Ro52 antibodies in the pathogenesis of connective tissue diseases. In this review, we comprehensively discuss the clinical associations of anti-Ro52 antibodies in the different connective tissue diseases and the recent advances on their potential role in the inflammatory response.

THU0097 PREDICTIVE VALUE OF IMMUNOLOGICAL AND IMAGING BIOMARKERS ON ACHIEVING GOOD CLINICAL RESPONSE AT 6 MONTHS IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY INTRAVENOUS BDMARDS

Background:

RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.

Objectives:

To investigate the value of biological and imaging biomarkers on predicting good clinical response at 6 months, in RA patients initiating IV bDMARD.

Methods:

From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence for the analysis. On 173 patients eligible to the study, 4 were loss to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data were collected when available at baseline. US examination was performed on 12 joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Good clinical response was defined by a DAS 28 < 3.2 and/ or DAS 28 decrease > 1.2 at 6 months. Only variables with a p<0.2 in univariate analysis were included in the multivariate model.

Results:

On 155 RA patients, 11 present a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).

Table 1.

Characteristics of the patients (n=155) at baseline

VariablesN (%)Mean (SD)Clinical characteristicsAge (years)54.8 (12.2)Female113 (72.9)Disease duration (months)166.9 (118.8)DAS 285.2 (1)TreatmentCorticosteroids / dose (mg/day)99 (85.3)10.9 (6)Monotherapy56 (36.1)IV bDMARDAbatacept27 (17.4)Infliximab11 (7.1)Rituximab84 (54.2)Tocilizumab33 (21.3)ImmunologyACPA + /titer(IU)132 (85.2)618.5 (791.0)RF + /titer (IU/ml)114 (74.5)184.7 (351.3)ANA + / level87 (56.1)1453 (3836)RadiographySharp’s erosion score (n=110)49.4 (46.2)USNb Erosion (n=95)3.0 (2.3)Nb B mode Synovitis (n=128)6.0 (4.1)Nb PD+ Synovitis (n=130)4.8 (3.8)Nb B mode Tenosynovitis (n=129)1.6 (2)Nb PD+ Tenosynovitis (n=129)1.3 (2.1)

At 6 months, 87 patients (56.1%) were in good clinical response. Predictive values of biomarkers are presented in table 2.

Table 2.

Variables predictive of a good clinical response at 6 months

BiomarkersResponseMultivariate Logistic regression AnalysisAllN = 101Response(N=60)OR (CI95%)P valueImmunology RF +7551 (68.0%)5.1 (1.8-14.4)0.002 ACPA +8756 (64.4%) ANA +5536 (65.5%)Radiography Erosive RA7448 (64.9%)Ultrasonography Erosive RA8855 (62.5%) Nb B mode synovitis10160 (59.4%)1.2 (1.1-1.4)0.002 Nb PD+ synovitis10160 (59.4%)

All qualitative variables with a p value <0.2 on bivariate analysis were incorporated in the multivariate model (RF +, ACPA +, US erosive RA, Nb B mode synovitis, Nb PD+ synovitis, RX erosive RA). Only patients with all data available are incorporated in the multivariate logistic regression analysis (n=101/155)

Conclusion:

We showed that positive RF was predictive of good clinical response to IV bDMARDs. For the first time, we demonstrated that number of US B-mode synovitis was also predictive to good clinical response.

Disclosure of Interests:

Stephane Giuliani Grant/research support from: BMS, Benjamin Laurent Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

SAT0042 PREDICTIVE VALUE OF IMMUNOLOGICAL AND IMAGING BIOMARKERS ON ACHIEVING REMISSION AT 6 MONTHS IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY INTRAVENOUS BDMARDS

Background:

RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.

Objectives:

To investigate the value of biological and imaging biomarkers on predicting DAS 28 remission at 6 months, in RA patients initiating IV bDMARD.

Methods:

From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence. On 173 patients eligible to the study, 4 were lost to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data, were collected when available at treatment initiation. US examination was performed on 12 targeted joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Remission was defined by a DAS 28 < 2.6 at 6 months. Only variables with a p<0.2 in univariate analysis were included in the multivariate model.

Table 1.

Characteristics of the patients (n=155) at baseline

Table 2.

Variables predictive of a DAS 28 remission at 6 months for IV bDMARDs

BiomarkersUnivariateAnalysisBivariate Logistic regression AnalysisDAS 28 remission(n= 33)No Remission(n=122)p valueOR (CI95%)Clinical dataNb of sequence >119 (57.6%)92 (75.4%)0.0520.4 (0.2-1.0)Radiography (n=110)Erosive RA22 (88.0%)61 (71.8%)0.1180.3 (0.1-1.3)US (n=127)Erosive RA28 (96.6%)82 (83.7%)0.1170.2 (0.0-1.4)Nb B mode synovitis7.7 (4.5)5.5 (3.9)0.0130.9 (0.8-1.0)Nb PD+ synovitis6.5 (5.0)4.3 (3.3)0.0310.9 (0.8-1.0)

All qualitative variables with a p value <0.2 on bivariate analysis were incorporated in the multivariate model (RF +, ACPA +, US erosive RA, Nb B mode synovitis, Nb PD+ synovitis, RX erosive RA). Only patients with all data available were incorporated in the multivariate logistic regression analysis (n=103/155). In multivariate analysis only the number of B mode synovitis was still significant with OR =1.1 (CI 95%: 1.0-1.3) (p<0,019).

Results:

On 155 RA patients, 11 had a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).

Conclusion:

In RA patients treated by IV bDMARDs, number of PD+ synovitis on ultrasonography was the only predictive biomarker of DAS 28 remission.

Disclosure of Interests:

Benjamin Laurent Grant/research support from: BMS, Stephane Giuliani Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

Early vedolizumab trough levels predict mucosal healing in inflammatory bowel disease: a multicentre prospective observational study

BACKGROUND

The correlation between vedolizumab trough levels during induction therapy and mucosal healing remains unknown.

AIM

To compare early vedolizumab trough levels in patients with and without mucosal healing within the first year after treatment initiation.

METHODS

We prospectively collected vedolizumab trough levels in all inflammatory bowel disease patients at weeks 2, 6 and 14 of vedolizumab treatment in three French referral centres between 1 June 2014 and 31 March 2017. Results of every patient that underwent mucosal assessment by magnetic resonance imaging and/or endoscopy in the first year after treatment initiation were analysed.

RESULTS

Median vedolizumab trough levels in the overall population (n = 82) were 27 μg/mL (interquartile range, IQR 21.2-33.8 μg/mL) at week 2, 23 μg/mL (IQR 15-34.5 μg/mL) at week 6 and 10.7 μg/mL (IQR 4.6-20.4 μg/mL) at week 14. Only median vedolizumab trough levels at week 6 differed between patients with and without mucosal healing within the first year after treatment initiation (26.8 vs 15.1 μg/mL, P = 0.035). A cut-off trough level of 18 μg/mL at week 6 predicted mucosal healing within the first year after the start of vedolizumab with an area under the receiver operating curve of 0.735 (95% confidence interval 0.531-0.939). A vedolizumab trough level above 18 μg/mL at week 6 was the only independent variable associated with mucosal healing within the first year of treatment (odds ratio 15.7, 95% confidence interval 2.4-173.0, P = 0.01).

CONCLUSION

Early therapeutic drug monitoring might improve timely detection of vedolizumab-treated patients in need for an intensified dosing regimen.