Determination of inorganic anions in uranium ore concentrate reference materials

The determination of inorganic anions in uranium ore concentrates (UOCs) is useful to nuclear forensics for establishing the provenance of sample materials. In this collaborative study, quantitation of inorganic anions was carried out on three UOC reference materials from the National Research Council Canada: UCLO-1 (https://doi.org/10.4224/crm.2020.uclo-1), UCHI-1 (https://doi.org/10.4224/crm.2020.uchi-1), and UPER-1 (https://doi.org/10.4224/crm.2020.uper-1). The analytes were extracted into water and characterized by ion chromatography with combined standard uncertainties (uc) between 1.6 and 11%. The highest contributor to uc was homogeneity. Sulfate was the most abundant anion (2000–12,000 mg/kg SO42−). Other anions were in the 15–500 mg/kg range.

Propagation and variation of material characteristics during the uranium ore concentrate production at Dolní Rožinka, Czech Republic

In the framework of the European Commission Support Programme to the International Atomic Energy Agency (EC SP task A1753) 20 samples were obtained from the Dolní Rožínka (DIAMO, Czech Republic) uranium milling facility. The sampling procedure followed stepwise the uranium production and purification from the U ore to uranium ore concentrate (yellow cake) end-product. Elemental concentrations, rare-earth elemental pattern, anion concentrations, morphology and isotope abundance ratios of S, Sr, Pb and U were measured at each sampling stage. The purpose of the measurements was to investigate the applicability of various material characteristics for authentication, propagation and variation of these parameters, and to identify the relevant signatures for nuclear forensics and safeguards during the uranium production.

AB1434 PREGNANCY AND RHEUMATIC DISEASES – COMBINING BIOLOGICAL MATERIAL AND CLINICAL DATA FOR FUTURE RESEARCH

Background

Rheumatic diseases affect women in fertile age. There is an increased risk for disease flares and pregnancy complications, especially for patients with systemic rheumatic diseases. Improving knowledge of immunological changes that happen during and after pregnancy in women with rheumatic diseases is of great importance. The Norwegian National Advisory Unit for Pregnancy and Rheumatic Diseases (NKSR) therefore established a biobank in 2012 with material from this patient group. NKSR also administers RevNatus, a nation-wide pregnancy quality register including women with inflammatory rheumatic diseases, with comprehensive clinical data.

Objectives

To facilitate high quality research by developing a possibility to combine biobank material and comprehensive clinical data. We aim to increase current knowledge in this field, with the ultimate goal of making pregnancies safer for women with rheumatic diseases.

Methods

The RevNatus biobank is part of the Regional Biobank of Central Norway (Biobank1). Biobank1 is a research facility established to provide an organizational framework for all research, which involves biological material from patients in any of the public hospitals of the region. The collection of biologic material is approved by the regional committees for medical and health research ethics. Patients are included after having signed a consent form. Blood samples are collected before pregnancy, in each trimester, 6 weeks, 6 months and 12 months postpartum. So far, serum, plasma, buffy-coat and Tempus Blood RNA tubes have been collected. At the same time points when blood samples are collected, clinical data is registered in RevNatus. Serum, plasma, buffy-coat and Tempus Blood RNA tubes from 32 healthy pregnant women have also been collected as control group material.

Results

310 donors are so far included in the RevNatus biobank. These include systemic lupus erythematosus (36), rheumatoid arthritis (61), juvenile idiopathic arthritis (40), spondyloarthritis (96), Sjögren’s syndrome (8), granulomatosis with polyangiitis (5), MCTD (5), healthy controls (32) and others (27).

Table 1.

Number of donors in the biobank at each time point

Time pointNumber of donorsBefore pregnancy135 donors1st trimester123 donors2nd trimester124 donors3rd trimester117 donors6 weeks postpartum175 donors6 months postpartum166 donors12 months postpartum129 donors

Conclusion

Collections of biological samples from pregnant women with rheumatic diseases are hard to come by, and therefore research is scarce. RevNatus with its biobank has the potential to make a substantial impact combining clinical and biological material, and take an important role in further molecular research in the field of rheumatic disease and pregnancy.

Disclosure of Interests

None declared

AB0789 What drives the BASDAI in pregnant patients with axial spondyloarthritis? A pooled analysis of four European pregnancy registries

Background

The patient reported Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) includes the six components fatigue, neck, back or hip pain, pain or swelling in other joints, tenderness, morning stiffness severity and duration on a 0-10 scale.

Objectives

To explore the driving factors for the BASDAI in pregnant patients with axial spondyloarthritis (axSpA).

Methods

Anonymized pooled data of the European Network of Pregnancy Registries in Rheumatology (EuNeP) were used. The four participating registries are located in France, Germany, Norway and Switzerland, and collect data of women with child wish, during and after pregnancy prospectively and nationwide on regular time points. For the analysis, women who fulfilled ASAS classification criteria for axSpA and for whom a pregnancy outcome was reported until 12/2019 or 07/2020, depending on the registry, were selected. Mean BASDAI and its components were analysed descriptively.

Results

A total of 332 pregnancies from 304 women with axSpA were eligible. The Norwegian registry contributed half of the pregnancies (50.3%), followed by Germany (26.2%), France (15.4%) and Switzerland (8.1%). Mean maternal age was 31 years, the average disease duration 5 years.

Mean BASDAI was 3.0 before conception, 3.4, 3.4 and 3.5 in the 1st, 2nd and 3rd trimester, and 3.4 within 6 months postpartum. The figure shows mean values of the BASDAI and its individual components in the different time periods. Fatigue was higher than the mean score during all phases, and especially elevated in the 1st and 3rd trimester. Furthermore, values for neck, back or hip pain were higher than the mean score, especially from 2nd trimester on. All other components were lower than the mean score.

Data were not reported for all pregnancies and all time periods. Availability was highest in the 2nd and 3rd trimester with reported BASDAI in 60% and 62% of the pregnancies, respectively. Lowest reporting was 24% in the preconception period because only a part of the women was also observed before pregnancy.

Conclusion

The BASDAI is a validated instrument for assessing disease activity in patients with axSpA. Since the calculation of the score also includes factors that can be influenced by pregnancy, it may only be of limited value for measuring disease activity in pregnancy. This analysis shows that mainly fatigue and back pain in particular have an impact on the mean BASDAI. A limitation of this analysis is that data were not available for all measured time points of the individual pregnancies. Therefore, the results should be confirmed by other studies.

Figure 1.

Means of BASDAI components before, during and after pregnancy (the table presents means ± standard deviation).

Acknowledgements

This work was supported by a research grant from FOREUM Foundation for Research in Rheumatology.

Disclosure of Interests

Yvette Meissner Speakers bureau: Pfizer, Anna Moltó Consultant of: UCB and BioGen, Grant/research support from: UCB, Nathalie Costedoat-Chalumeau Grant/research support from: to my institution (UCB), Rebecca Fischer-Betz: None declared, Frauke Förger Speakers bureau: UCB pharma, GSK, Consultant of: UCB pharma, GSK, Roche, Grant/research support from: UCB pharma, GSK, Marianne Wallenius: None declared, Anja Strangfeld Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, Pfizer, Roche, Sanofi, UCB.

POS0968 CESAREAN SECTION IN WOMEN WITH SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS

Background

There is sparse documentation on pregnancy outcomes in women with spondyloarthritis (SpA) and psoriatic arthritis (PsA). Data on disease activity is often lacking, preventing the direct investigation of the effect of inflammation on pregnancy outcomes. A cesarean section (CS) implies a higher risk for the mother than vaginal delivery. It delays mobilization after birth necessary to counteract inflammatory pain and stiffness as well as the (re)start of disease modifying medication.

Objectives

To explore the possible association of disease activity (inflammation) and occurrence of cesarean section in women with SpA and PsA.

Methods

Data from the Medical Birth Registry of Norway (MBRN) were linked with data from RevNatus, a nationwide observational register recruiting women with inflammatory rheumatic diseases. Singleton births in women with SpA and PsA included in RevNatus 2010 to 2019 were cases. All other singleton births registered in MBRN during this time served as population controls.

Results

CS occurred more frequently in both SpA (21.9%) and PsA (29.4%) compared to population controls (15.6%), with even higher frequencies in active SpA (23.5%) and active PsA (30.1%). Women with SpA had higher risk for elective CS (risk difference 4.1%, 95% CI 1.4% to 7.9%, p=0.002), while women with PsA had higher risk for emergency CS (risk difference 9.8%, 95% CI 3.8% to 17.6%, p<0.001) as compared to population controls.

Conclusion

Women with SpA and PsA had increased odds for elective and emergency CS, respectively. Further analysis will explore the role of active inflammation.

References

[1]Mørk, S et al. Spondyloarthritis and Outcomes in Pregnancy and Labor: A Nationwide Register-Based Cohort Study. Arthritis Care Res (Hoboken). 2021 Feb;73(2):282-288

Table 1.

Characteristics of population controls, total patient groups and patient active disease groups, reported as n (%) unless specified as mean (SD)

CharacteristicPopulation controlsSpondylo arthritis SpASpA active BASDAI≥4Psoriatic Arthritis PsAPsA active DAS28>2.6Number singleton births 2010 - 2019575 79831911512629Maternal age (years), mean (SD)30.6 (5.1)31.7(4.3)131.8 (4.3)32.0 (4.7)431.8 (4.4)<35460 720 (80.0)242 (77.6)89 (78.1)87 (71.9)20 (74.1)≥35115 077(20.0)70 (22.4)25 (21.9)34 (28.1)7 (25.9)ParityNo children244 354 (42.4)141 (45.2)43 (37.7)48 (39.7)10 (37.0)≥ 1 child331 444 (57.6)171 (54.8)71 (62.3)73 (60.3)17 (63.0)Smoking in pregnancy34 237 (6.7)19 (6.3)10 (9.3)9 (7.1)5 (20.0)BMI first trimester, mean (SD)24.4 (4.8)25.1 (5.0)26.5 (5.8)26.9 (5.6)528.8 (4.9)Cesarean section, CS89 840 (15.6)70 (21.9)227 (23.5)37 (29.4)69 (31.0)Elective32 114 (5.6)31 (9.7)315 (13.0)12 (9.5)2 (6.9)Emergency57 691 (10.0)39 (12.2)12 (10.5)25 (19.9)77 (24.1)Earlier caesarean section55 992 (9.7)32 (10.0)16 (13.9)15 (11.9)3 (10.3)Disease activityInactive 3rd trimna134 (53.8)na67 (69.8)naActive 3rd trimna115 (46.2)11529 (30.2)29

1-7 Group compared to population controls 1p<0.001 2 p=0.002 3 p=0.002 4 p=0.001 5 p<0.001 6 p<0.001 7 p<0.001

Disclosure of Interests

None declared

POS0215 PHENOTYPES AND DISEASE CHARACTERISTICS OF IgG4-RELATED DISEASE IN NORWAY

Background

Milestones in the field of IgG4-related disease (IgG4-RD) include the 2011 Comprehensive Diagnostic Criteria (CDC) (1), the 2019 ACR/EULAR classification criteria (2), and the recent identification of four distinct clinical phenotypes (3). Performance of the criteria and phenotypic disease expression in Scandinavian populations are largely unknown.

Objectives

Describe disease characteristics, phenotypes, and performance of the 2011 CDC and 2019 ACR/EULAR classification criteria in patients with IgG4-RD in Norway.

Methods

Consenting, adult patients with a clinical diagnosis of IgG4-RD, seen at the Department of Rheumatology, Oslo University Hospital were included. Two experts (JV, ØMi) assigned patients to phenotypes (”Pancreato-Hepato-Biliary”, “Retroperitoneum and Aorta”, “Head and Neck-Limited” or “Mikulicz and Systemic”) based on pattern of organ involvement. Fulfillment of the CDC and classification criteria were assessed. Disease activity and damage were scored with the IgG4-RD responder index (IgG4-RD RI). We used descriptive statistics.

Results

We identified 60 patients with IgG4-RD (Table 1). Clinical characteristics were as expected, with approximately equal number of patients in each phenotype group. Of all patients diagnosed by expert opinion, 42 (70%) fulfilled the ACR/EULAR classification criteria. Reasons for not fulfilling the criteria were (i) failure to meet the inclusion criterium (n = 3) due to “atypical” organ involvement: tonsils (n = 1), nasal cavity (n = 1); coronary artery (n = 1); (ii) presence of ≥ 1 exclusion criterium (n = 5): fever (n = 1), leukopenia (n = 1), thrombocytopenia (n = 1), positive anti-MPO-ANCA (n = 3), anti-SSA (n = 1) and/or anti-RNP (n = 1) antibody; and (iii) score < 20 points (n = 10). In the latter group, 8 (80%) were not biopsied, and 1 (10%) had only performed fine needle biopsy. Among the patients not meeting the inclusion criterium or having ≥ 1 exclusion criteria, 1 (33%) and 4 (80%) scored ≥ 20 points, respectively. Of all patients, 56 (93%) fulfilled CDC, with 32 (53%), 10 (17%) and 14 (23%) patients characterized as “definite”, “probable” and “possible” IgG4-RD, respectively. Of the 18 patients not fulfilling the ACR/EULAR classification criteria, 15 (83%) fulfilled CDC (4 “definite”, 3 “probable”, 8 “possible”). Of the 4 patients not fulfilling CDC, 1 fulfilled the ACR/EULAR classification criteria.

Table 1.All (60)Pancreato-Hepato-Biliary (14)Retroperitoneum and aorta (12)Head and Neck-Limited (17)Mikulicz and Systemic (17)Male, n (%)44 (73)11 (79)9 (75)10 (59)14 (82)Caucasian, n (%)52 (87)14 (100)11 (92)13 (77)14 (82)Age at diagnosis, years (SD)60 (14)66 (9)64 (10)50* (17)61 (11)Time from onset to diagnosis, years (SD)2 (3)2 (3)2 (4)1 (1)4 (5)Serum IgG4, g/L (SD) (n=51)8 (9)5 (5)3 (2)7 (5)16* (13)Elevated baseline serum IgG4, n (%) (n=51)44 (86)9 (69)10 (91)11 (92)14 (93)CRP, mg/dL (SD)11 (26)4 (7)36* (52)9 (17)5 (4)ESR, mm/h (SD)35 (32)16 (11)63* (36)29 (29)39 (30)Eosinophilia, n (%) (n=46)17 (37)2 (22)06 (38)9 (64)CDC definite, n (%)32 (53)10 (71)3 (25)8 (47)11 (65)CDC probable, n (%)10 (17)3 (21)1 (8)5 (29)1 (6)CDC possible, n (%)14 (23)06 (50)4 (24)4 (24)ACR/EULAR classification criteria, n (%)42 (70)13 (93)5 (42)8 (47)16 (94)Number of involved organs (SD)Active, all4 (2)3 (2)2 (2)3 (1)6* (2)Active, symptoms2 (1)2 (1)1 (0)2 (1)3* (1)Active, urgent1 (1)1 (1)1 (1)0* (0)1 (1)Damage2 (1)2* (1)1 (1)1 (1)2* (2)IgG4-RD RI (SD)10 (5)9 (4)7 (4)7 (3)15* (4)

*p < 0,05 by one-way ANOVA

Conclusion

Despite expected clinical characteristics, phenotype distribution and fulfilment of CDC in our cohort, the performance of the ACR/EULAR classification criteria was lower than expected, especially in the “Retroperitoneum and Aorta” and “Head and Neck-Limited” phenotypes. This may have important implications for the comparability across studies and inclusion in future clinical trials.

References

[1]Umehara et al. Mod Rheumatol. 2012;22(1):21-30.

[2]Wallace et al. Ann Rheum Dis. 2020;79(1):77-87.

[3]Wallace et al. Ann Rheum Dis. 2019;78(3):406-412

Disclosure of Interests

Jens Vikse Speakers bureau: Novartis, Consultant of: Novartis, Jupiter Life Science Consulting, Øyvind Midtvedt: None declared, Øyvind Molberg: None declared, Bjørg Tilde Svanes Fevang: None declared, Øyvind Palm: None declared, Torhild Garen: None declared, Katrine Brække Norheim: None declared, Gunnstein Bakland: None declared, Marianne Wallenius: None declared, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim

POS1366 RITUXIMAB IN IgG4-RD: AN OPEN-LABEL NON-RANDOMIZED OBSERVATIONAL STUDY

Background

IgG4-related disease (IgG4-RD) is a rare, heterogenous and potentially severe disease. An open-label trial demonstrated efficacy of rituximab (RTX) in IgG4-RD [1]. Recently, four distinct phenotypes of IgG4-RD were identified [2]. There is a paucity of studies investigating RTX efficacy across these phenotypes.

Objectives

Investigate efficacy and safety of RTX in IgG4-RD and segregated by phenotypes.

Methods

This is an open-label non-randomized single center observational study. All patients with IgG4-RD (diagnosed by expert opinion) at the Oslo University Hospital treated with ≥ 1 dose of RTX with 12 months follow-up were included. Two experts (JV, ØMi) assigned patients to phenotypes. Glucocorticoid (GC) treatment was allowed. We measured disease activity by the IgG4-RD Responder Index (IgG4-RD RI) at baseline, 6 months, and 12 months. We defined a composite primary outcome consisting of two measures; (i) reduced disease activity (i.e., ≥2 points improvement in IgG4-RD RI from baseline and/or IgG4-RD RI score 0 at follow-up), and (ii) no disease flares (i.e., no ≥2 points worsening of IgG4-RD RI and no need to increase GC dose) at 6 months. Secondary outcomes were (a) reduced disease activity at months 6 or 12, (b) remission (IgG4-RD RI score 0 and GC dose ≤ 7.5 mg) at 6 or 12 months and (c) safety. Descriptive statistics were applied.

Results

We included 40 patients, of which 30 (75%) were male and 35 (88%) Caucasian. Mean age and disease duration at time of first RTX infusion was 58 and 3 years, respectively. Seventeen of the 40 patients (43%) received RTX as add-on therapy (following GC for > 3 months), while 13 (33%) received RTX as upfront combination therapy with GC, and 10 (25%) received RTX as upfront monotherapy. All 40 patients received an infusion of 1000 mg RTX at study baseline (dose 1A at week 0) and 39 of these 40 patients (98%) received a second RTX infusion (dose 1B) at week 2. Additional infusions of 500-1000 mg RTX were administered at weeks 26 (dose 2A) and 28 (dose 2B) in 24 (60%) and 7 (18%) patients, respectively. The composite primary endpoint was met by 31/40 patients (78%). Reduced disease activity at 6 and 12 months were seen in 34 (87%) and 35 (90%) patients, respectively. Fifteen patients (38%) were in remission at 6 months, and 22 (56%) were in remission at 12 months. “Retroperitoneum and Aorta” showed lowest response rates, while “Head and Neck-Limited” had the highest rate of flares (Table 1). Mild infusion reaction occurred in 8 (20%) patients. Hypogammaglobulinemia was observed in 4 (10%). Infection requiring hospitalization occurred in 6 (15%), including one fatal infection which was the only death in the study period.

Table 1.All40 (100)Pancreato-Hepato-Biliary9 (23)Retroperitoneum and Aorta 6* (15)Head and Neck-Limited 14 (35)Mikulicz and Systemic 11 (28)Baseline (n=40)Male, n (%)30 (75)8 (89)5 (83)8 (57)9 (82)Caucasian (%)35 (88)9 (100)6 (100)12 (86)8 (73)Age, years (SD)58 (14)63 (9)66 (3)49 (18)60 (11)Disease duration, years (SD)3 (4)4 (3)3 (4)2 (2)5 (6)2019 ACR/EULAR classification criteria (%)28 (70)8 (89)3 (50)6 (43)11 (100)IgG4-RD RI at diagnosis (SD)10 (6)10 (5)7 (4)7 (3)17 (4)IgG4-RD RI at RTX 1A, (SD)8 (6)9 (4)5 (4)6 (4)12 (7)6 months (n=39)*IgG4-RD RI (SD)2 (2)3 (3)2 (2)1 (1)1 (2)Primary outcome, n (%) (n=40)31 (78)9 (100)3 (50)9 (64)10 (91)Reduced disease activity, n (%)34 (87)9 (100)3 (60)12 (86)10 (91)Remission, n (%)15 (38)4 (44)06 (43)5 (46)Flare, n (%)3 (8)003 (21)012 months (n=39)*IgG4-RD RI (SD)1 (1)1 (1)0 (1)1 (1)1 (2)Reduced disease activity, n (%)35 (90)9 (100)4 (80)12 (86)10 (91)Remission, n (%)22 (56)7 (78)3 (60)7 (50)5 (45)Flare, n (%)4 (10)1 (11)1 (20)2 (14)0

*One patient died shortly after 1A, and is not included in secondary efficacy outcomes

Conclusion

In our observational study, RTX appears safe and effective in IgG4-RD, with the highest response in patients with Pancreato-Hepato-Biliary phenotype. Relatively low remission rates across all phenotypes indicate an unmet need for improved treatment.

References

[1]Carruthers MN et al. Ann Rheum Dis. 2015;74(6):1171-1177.

[2]Wallace ZS et al. Ann Rheum Dis. 2019;78(3):406-412.

Disclosure of Interests

Jens Vikse Speakers bureau: Novartis, Consultant of: Novartis, Jupiter Life Science Consulting, Øyvind Midtvedt: None declared, Øyvind Molberg: None declared, Bjørg Tilde Svanes Fevang: None declared, Øyvind Palm: None declared, Torhild Garen: None declared, Katrine Brække Norheim: None declared, Gunnstein Bakland: None declared, Marianne Wallenius: None declared, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim

POS1337 BEHÇET`S DISEASE AND COURSE OF PREGNANCY - RESULTS FROM THE NATIONWIDE PREGNANCY REGISTER REVNATUS

Background:

Behçets disease (BD) is a complex and multisystemic disorder of unknown etiology. It is characterized by recurrent oral and genital ulcers and inflammatory eye involvement. It can also affect the cardiovascular, pulmonary and skeletal system. BD is commonly diagnosed in women in reproductive age. Pregnancy outcomes are reported in previous studies with discrepancies in the rate of pregnancy-related complications.

Objectives:

To describe the course of pregnancy in patients with BD.

Methods:

We prospectively collected data on pregnancy outcome in women with BD through the nationwide Norwegian registry on pregnancy and rheumatic diseases (RevNatus) from 2016-2020. All women were diagnosed with ICD-10 code M35.2. 13 pregnancies in 11 women were recorded. One women had two pregnancies including one twin birth.

Results:

Median age at conception was 30 years (range 25-32), with median disease duration 7 years (range 1-15). There were no serious organ manifestations. Tnf-alpha-inhibitors were used in 2nd trimester in 3 pregnancies. All pregnancies resulted in live births with median gestational age at delivery of 38 weeks (range 36-41). No preeclampsia or HELLP were recorded.

Table 1.

Pregnancy outcome in 13 BD pregnancies

Patient #Pregnancy #Medication at 2.nd trimesterOral or genital ulcers during pregnancyDisease activity during pregnancyCRP value at 2nd trimesterGestational age at delivery, weekMode of deliveryBirth weight, gramA1Azathioprine Colchicine LMWHnopersistent*1338SVD3475B2Adalimumab Colchicine LDPrednisolonyespersistent *440SVD3215C3noyespersistent*541SVD3355D4Adalimumab LDPrednisolonyespersistent*2336SVD1940E5Etanercept ASAno241SVD34106a (twin)Etanercept ASAno537Elective Sectio24006b (twin)2410F7LDPrednisolonyesflare**1538SVD31808Adalimumab LDPrednisolonyesflare**437Acute Sectio3049G9nonoremission***141SVD3150H10LDPrednisolonyespersistent *1038SVD2480I11ASAnopersistent*339SVD3410J12noyespersistent*137SVD3115K13Ciklosporinenoremission***337SVD3130

SVD = spontaneous vaginal delivery, ASA = acetylsalicylic acid, LDPrednisolon = Low dose Prednisolon <10 mg/day, *= persistent throughout pregnancy, **= flare once during pregnancy, ***= remission throughout pregnancy

Conclusion:

Pregnancies in women with BD in this cohort were uncomplicated. We did not reveal any serious events, and they all resulted in live births. However, BD is a very heterogeneous disease, and the women in our cohort did not have any serious organ manifestations. Larger cohorts representing the heterogeneity are needed to study the course and outcome of pregnancies in BD.

Disclosure of Interests:

None declared

POS1424 PREGNANCY COURSE IN A COHORT OF WOMEN WITH MYOSITIS - RESULTS FROM REVNATUS

Background:

Myositis is a rare autoimmune disease characterized by proximal and symmetrical muscle weakness and inflammatory infiltrates on muscle biopsy, and may affect women in reproductive age. Only few reports exist on pregnancy outcomes in women with myositis. Well-controlled disease at time of conception seems to give better outcome for the mother and the fetus (1). Inflammatory active disease before and during pregnancy has been associated with preterm birth and infant small for gestational age (1).

Objectives:

To describe the course of pregnancy in patients with myositis.

Methods:

We prospectively collected data on pregnancy in women with myositis in the nationwide Norwegian quality registry - RevNatus. ICD-10 codes: ICD-10 M33.0 (5), M33.1 (2), M33.2 (1), M33.9 (3). Eleven pregnancies in ten women with a known pregnancy outcome from 2016 – 2020 were included.

Results:

Median disease duration was 10 years (range 3-26), and median age at conception was 29 years (range 25-43). Five women had juvenile myositis. Two pregnancies ended in spontaneous abortions, one in 1st trimester and one in 2nd trimester. Nine pregnancies ended with live birth at median pregnancy week 39 (range 35-41) and a median birth weight of 3355 gram (range 2580-4750). None of the women experienced preeclampsia or HELLP. Three women was positive for ANA. Median CRP in second trimester was three (range 0-7). Among nine women with live births, seven were in remission, and two women had persistent disease in second trimester, defined by rheumatologist. Seven women used DMARDs in pregnancy, and two women used prednisolone 5 mg throughout pregnancy.

Patient #Pregnancy #Maternal age at conceptionDisease duration yearsMedication during pregnancyDisease activity 2nd trimesterGestational age at deliveryInfant birth weight (gram)Delivery modeA12925noneRemission383355Standard vaginal deliveryB2347azathioprinePersistent393725Standard vaginal deliveryC32915azathioprineSpontaneous abortion week 7D4353ciclosporinprednisolone 5mgPersistent403000Standard vaginal deliveryE52813noneRemission372765Operational vaginal deliveryF62510azathioprinehydroxy-chloroquineRemission414085Standard vaginal deliveryF72713azathioprinehydroxy-chloroquineRemission413815Standard vaginal deliveryG83613prednisolone 5mgSpontaneous abortion > week 12H9299azathioprineRemission352580Standard vaginal deliveryI10435azathioprineprednisolone 5mgRemission373140SectioJ113628noneRemission414750Acute sectio

Conclusion:

We did not observe disease flare during pregnancy and no serious adverse outcomes in the pregnancies ending with live births. However, data are sparse, and larger cohorts are necessary to evaluate possible risk factors.

References:

1. Munira S, Christopher-Stine L. Pregnancy in myositis and scleroderma. Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:59-67. doi: 10.1016/j.bpobgyn.2019.10.004. Epub 2019 Oct 18. PMID: 31928915.

Disclosure of Interests:

None declared

AB0302 USE OF TNF-INHIBITORS BEFORE, DURING AND THE FIRST YEAR AFTER PREGNANCY AMONG WOMEN WITH RHEUMATOID ARTHRITIS

Background:

Treat to target is a goal, also in pregnant women with Rheumatoid arthritis (1). There is increasing evidence on safe use with TNF inhibitors during pregnancy. Adjusted use of TNF inhibitors preconception and throughout pregnancy may stabilize disease activity and prevent flares (2). Low disease activity is also beneficial for the fetus.

Objectives:

To study the use of TNF-inhibitors among women with Rheumatic arthritis during and after pregnancy.

Methods:

RevNatus is a Norwegian, nationwide quality register that monitors treatment of inflammatory rheumatic diseases before, during and after pregnancy. Data from RevNatus in the period October 2017 to October 2019 was used to map the use of all types of TNF inhibitors among 208 women with rheumatoid arthritis, diagnosed by the ACR/EULAR criteria. The use of medication was reported at the time of visit in outpatient clinic. The frequency of use of TNF inhibitors registered at seven timepoints from pre-pregnancy to twelve months after delivery.

Results:

The use of medication was reported at each visit for all the women with rheumatoid arthritis. Most of the women were not using TNF inhibitors before and beyond conception. Most of the women continuing TNF inhibitors beyond conception used certolizumab or etanercept. Adalimumab and infliximab were used in pregnancy (tabell 1).

Tabell 1.certoliz-umabetane-rceptadalim-umabgolim-umabinflixi-mabNo TNF-inhibitorBefore pregnancyn=10521% (22)9% (10)3% (3)1% (1)66% (69)1.trimestern=8119% (15)10% (8)71% (58)2.trimestern=8810% (9)10% (9)80% (70)3.trimestern=9111% (10)5% (5)83% (76)6 weeks post partum n=9622% (21)13% (13)1% (1)1% (1)63% (60)6 months post partum n=8824% (21)18% (16)4% (4)1% (1)53% (46)12 months post partum n=8421% (18)17% (15)7% (6)2% (2)53% (43)

Conclusion:

Most of the women with rheumatic arthritis were not treated with TNF inhibitors before or in pregnancy. Women with rheumatic arthritis that continuing treatment with TNF inhibitors through pregnancy were using certilozumab and etanercept.

References:

[1]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. 2016;75(5):795-810.

[2]van den Brandt S, Zbinden A, Baeten D, Villiger PM, Ostensen M, Forger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther. 2017;19(1):64.

Disclosure of Interests:

None declared

FRI0558 PREGNANCY OUTCOMES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS – A FIRST JOINT ANALYSIS OF A EUROPEAN COLLABORATION OF PREGNANCY REGISTERS

Background:

Axial spondyloarthritis (axSpA) can affect women in their childbearing age. But data on pregnancy in axSpA patients are mainly retrospective and highly heterogeneous [1].

Objectives:

The aim of this analysis was to investigate pregnancy outcomes and health of live born children in women with axSpA in four prospective cohort studies.

Methods:

Data of European pregnancy registries that collaborate in the European Network of Pregnancy Registries in Rheumatology (EuNeP) were analysed: EGR2 (France), RePreg (Switzerland), RevNatus (Norway) and Rhekiss (Germany). Eligible women had a diagnosis of axSpA and a pregnancy outcome reported until June-September 2019. Data were analysed descriptively by every registry and provided to the coordinating centre.

Results:

A total of 328 pregnancies in 288 women were investigated. Mean age of patients ranged from 31 to 33 years. Disease duration (3-8 years) and proportion of patients with a positive HLA-B27 (64-74%) varied (Table 1). The axSpA diagnosis was either classified by ASAS criteria (fulfilment in EGR2: 93%, RePreg: 65%, RevNatus: 86%) or by ASAS criteria for axial/ peripheral SpA (Rhekiss: 81/ 34%). Rates for preterm birth were ≤5%, and congenital malformations were reported in 4 out of 287 neonates (Table 2).

Table 1.

Maternal and disease characteristics

EGR2 (FR)RePreg (CH)RevNatus (NO)Rhekiss (DE)# Pregnancies453116092# Patients443112588Age in years32.0 ± 4.231.4 ± 4.030.5 ± 4.533.2 ± 4.4Disease duration in years6.0 ± 5.67.7 ± 4.63.2 ± 3.36.2 ± 5.3HLA-B27 positive26 (66.7)23 (74.2)79 (71.2)54 (73.0)Pre-gestational diabetes001 (0.6)1 (1.4)IBD004 (2.6)5 (7.2)Uveitis003 (1.9)3 (4.3)BMI26.5 ± 4.822.6 ± 2.524.4 ± 4.323.4 ± 4.3

Results as mean ± SD or number (percentage)

Table 2.

Pregnancy characteristics, obstetric and neonatal outcomes

EGR2 (FR)RePreg (CH)RevNatus (NO)Rhekiss (DE)WGA at 1stvisit in pregnancy11.9 ± 8.219.7 ± 9.412.9 ± 5.713.4 ± 5.4Patients with 1 pregnancy43 (95.5)31 (100.0)101 (80.8)84 (95.5)Primigravidae18 (40.0)15 (48.4)47 (29.4)37 (45.1)Adverse events of interestPreeclampsia1 (4.4)04 (2.6)0Gestational diabetes4 (8.9)2 (6.5)n.a.5 (6.2)Pregnancy outcomes(5 Outcomes missing)(1 Outcome missing)Elective termination1 (2.2)02 (1.3)0Miscarriage (< WGA 20)2 (4.4)013 (8.4)4 (4.4)Pregnancy loss >WGA 202 (4.4)000Live birth40 (88.9)31 (100.0)140 (90.3)87 (95.6)Outcomes of live births# Neonates, singleton pregn.403013978$# Neonates, multiple pregn.0224Neonatal outcomes, only singleton pregnanciesWGA at delivery39.1 ± 1.239.5 ± 1.538.9 ± 2.339.4 ± 2.0Preterm birth006 (4.3)4 (5.4)Birth weight in g3253 ± 3953314 ± 5193446 ± 5263377 ± 522Congenital malformation00n.a.#4 (5.1)

Results as mean ± SD or number (percentage). WGA: gestational age in weeks

#Malformations can be retrieved by national birth registry with a lag time of 2 years.

$Missing information for 7 infants.

Conclusion:

Differences in study design and classification criteria result in slightly different patient populations in each registry. The outcome of pregnancies was favourable. Preterm birth rates are within rates reported by the WHO for the EU general population. However, a selection bias of rather planned and well-controlled pregnancies cannot be ruled out. This is the first collaborative analysis of the EuNeP registries. Descriptive data were combined, and will be – as a next step – pooled together.

Funding: This work was supported by a research grant from FOREUM Foundation for Research in Rheumatology.

References:

[1] Giovannopoulou E et al. Curr Rheumatol Rev. 2017;13(3):162-9.

Disclosure of Interests:

Yvette Meißner Speakers bureau: Pfizer, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution, Frauke Förger Grant/research support from: Unrestricted grant from UCB, Consultant of: UCB, GSK, Roche, Speakers bureau: UCB, GSK, Doreen Goll: None declared, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB, Rebecca Özdemir: None declared, Marianne Wallenius: None declared, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Rebecca Fischer-Betz Consultant of: UCB, Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Chugai, GSK, Janssen, Lilly, Medac, MSD, Novartis, Roche, UCB, Pfizer.

FRI0279 USE OF TNF-INHIBITORS BEFORE, DURING AND THE FIRST YEAR AFTER PREGNANCY IN WOMEN WITH SPONDYLOARTHRITIS

Background:

Treat to target is a goal in pregnant women with spondyloarthristis. There is increasing evidence on safe use with TNF inhibitors during pregnancy (1). Adjusted use of TNF inhibitors preconception and throughout pregnancy may stabilize disease activity and prevent flares (2). Low disease activity is also beneficial for the fetus.

Objectives:

To study the use of TNF-inhibitors among women with spondyloarthritis in Norway before, during and after pregnancy.

Methods:

RevNatus is a Norwegian, nationwide quality register that monitors treatment of inflammatory rheumatic diseases before, during and after pregnancy. Data from RevNatus in the period October 2017 to October 2019 were used to map the use of all types of TNF inhibitors among 208 women with spondyloarthitis, fulfilling the ASAS criteria.

The use of medication was reported at the time of visit in outpatient clinic. The frequency of use of TNF inhibitors is registered at seven timepoints from pre-pregnancy to twelve months after delivery.

Results:

The use of TNF-inhibitors was reported at each visit for all the women with spondyloarthritis. Most women are not using TNF inhibitors before and beyond conception. Most of the women continuing TNF inhibitors beyond conception, used certolizumab, etanercept, or adalimumab. Infliximab or golimumab were not used in pregnancy (tabell 2).

Table 2:SPACertoli-zumabEtaner-ceptAdali-mumabGolim-umabInflik-simabNo TNF -inhibitorBefore Pregnancyn=13910% (14)8% (11)6% (9)6% (9)69% (96)1.trimestern=1027% (7)7% (7)2 % (2)84% (86)2.trimestern=1047% (7)6% (6)1% (1)87% (90)3. trimestern=953% (3)2% (2)1% (1)94% (89)6 weeks post partumn=10015% (15)10% (10)8% (8)3% (3)64% (64)6 months post partumn=8219% (16)12% (10)7% (6)2% (2)2% (2)55% (46)12 months post partumn=7422% (16)15% (11)7% (5)4% (3)5% (4)47% (35)

Conclusion:

A majority of the women with spondyloarthritis were not treated with TNF inhibitors before or during pregnancy. Only a few of the women with spondylosthritis continued treatment with TNF inhibitors during pregnancy.

References:

[1]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. 2016;75(5):795-810.

[2]van den Brandt S, Zbinden A, Baeten D, Villiger PM, Ostensen M, Forger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther. 2017;19(1):64.

Disclosure of Interests:

None declared

Image texture analysis and colorimetry for the classification of uranium ore concentrate powders

In the context of nuclear security, uranium ore concentrates (UOCs) play an important role: they are traded in large quantities and this makes their use “out of regulatory control” a possible scenario.

Once an incident of illicit trafficking o f n uclear m aterial is detected, an understanding of its origin and production process is required; this implies the necessity to use analytical techniques able to measure characteristic parameters (e.g. physical, chemical, isotopic characteristics of the nuclear materials) which are referred to, in the field o f t he n uclear f orensics, a s signatures.

The present study investigates the potential of image texture analysis (i.e. the angle measure technique), combined with the spectrophotometric determination of colours for the evaluation of the origin of several UOCs. The use of different multivariate statistical techniques allows the categorization of about 80 different samples into a few groups of UOCs powders, which makes this approach a promising method complementing the already established methods in nuclear forensics.

Spatially-resolved uranium isotopic analysis of contaminated scrap metal using laser ablation multi-collector ICP-MS

LA-MC-ICP-MS is a fast and quasi non-destructive technique to reveal possible U isotopic inhomogeneity in scrap metal samples, filling the gap between bulk isotopic analysis and particle analysis.

Nuclear forensics on uranium fuel pellets

Nuclear forensic analysis of uranium oxide fuel pellets and the respective data interpretation have proven to be important elements of the investigative process when such material is found out of regulatory control. Uranium oxide fuel pellets are produced at industrial scale and have to meet tight technical specifications. Variations in the production process of different manufacturers or fuel fabrication facilities offer an additional source of information. The compilation of such information in a nuclear materials database has proven to be a highly valuable resource. In consequence, measureable material properties (referred to as “signatures”) such as the isotopic composition, the physical dimensions, the chemical impurities, the products of the radioactive decay of uranium and the microstructure allow establishing the processing history of the material. To this end, dedicated analytical methods have to be developed and suitable methods for data evaluation and interpretation need to be utilised. The successful application of these nuclear forensic tools is illustrated with two case studies on real incidents of illicit nuclear trafficking of uranium oxide fuel pellets.

Identification of uranium signatures relevant for nuclear safeguards and forensics

The paper describes the applicability of different characteristics (signatures) in nuclear safeguards and forensics for assessment of uranium material provenance in terms of production process. The study follows a uranium ore concentrate production from an ore to a U₃O₈ product. It turned out that rare-earth elemental pattern, radiochronometry (age of ore body and material production date), sulphur and organic impurities are useful to find out the origin or history of the material, while certain trace-elements and isotopics of Pb or Sr were found to be inconclusive. The results will be important to understand the signatures in nuclear safeguards and forensics.

Plutonium age dating (production date measurement) by inductively coupled plasma mass spectrometry

This paper describes rapid methods for the determination of the production date (age dating) of plutonium (Pu) materials by inductively coupled plasma mass spectrometry (ICP-MS) for nuclear forensic and safeguards purposes. One of the presented methods is a rapid, direct measurement without chemical separation using ²³⁵U/²³⁹Pu and ²³⁶U/²⁴⁰Pu chronometers. The other method comprises a straightforward extraction chromatographic separation, followed by ICP-MS measurement for the ²³⁴U/²³⁸Pu, ²³⁵U/²³⁹Pu, ²³⁶U/²⁴⁰Pu and ²³⁸U/²⁴²Pu chronometers. Age dating results of two plutonium certified reference materials (SRM 946 and 947, currently distributed as NBL CRM 136 and 137) are in good agreement with the archive purification dates.

Remeasurement of (234)U Half-Life

The half-life of (234)U has been measured using a novel approach. In this method, a uranium material was chemically purified from its thorium decay product at a well-known time. The ingrowth of the (230)Th daughter product in the material was followed by measuring the accumulated (230)Th daughter product relative to its parent (234)U nuclide using inductively coupled plasma mass spectrometry. Then, the (234)U decay constant and the respective half-life could be calculated using the radioactive decay equations based on the n((230)Th)/n((234)U) amount ratio. The obtained (234)U half-life is 244 900 ± 670 years (k = 1), which is in good agreement with the previously reported results in the literature with comparable uncertainty. The main advantages of the proposed method are that it does not require the assumption of secular equilibrium between (234)U and (238)U. Moreover, the calculation is independent from the (238)U half-life value and its uncertainty. The suggested methodology can also be applied for the remeasurement of the half-lives of several other long-lived radionuclides.

Pre-concentration of trace levels of rare-earth elements in high purity uranium samples for nuclear forensic purposes

This paper describes the development of a method for the pre-concentration and analysis of trace-level amounts of rare-earth elements (REE) in high purity uranium (U) samples. The method comprises pre-concentration and subsequent group separation of REEs from the uranium matrix followed by their quantitative determination using inductively coupled plasma mass spectrometry. The achieved detection limit of the method (in the low pg/g range) in combination with the high chemical recovery (around 90%) enabled the investigation of REE patterns in high purity refined uranium oxides. Applying this method one could follow the REE pattern along the entire front-end of the nuclear fuel cycle.

Uranium from German Nuclear Power Projects of the 1940s--A Nuclear Forensic Investigation

Here we present a nuclear forensic study of uranium from German nuclear projects which used different geometries of metallic uranium fuel. Through measurement of the (230)Th/(234)U ratio, we could determine that the material had been produced in the period from 1940 to 1943. To determine the geographical origin of the uranium, the rare-earth-element content and the (87)Sr/(86)Sr ratio were measured. The results provide evidence that the uranium was mined in the Czech Republic. Trace amounts of (236)U and (239)Pu were detected at the level of their natural abundance, which indicates that the uranium fuel was not exposed to any major neutron fluence.

Development of a versatile sample preparation method and its application for rare-earth pattern and Nd isotope ratio analysis in nuclear forensics

An improved sample preparation procedure for trace-levels of lanthanides in uranium-bearing samples was developed. The method involves a simple co-precipitation using Fe(III) carrier in ammonium carbonate medium to remove the uranium matrix. The procedure is an effective initial pre-concentration step for the subsequent extraction chromatographic separations. The applicability of the method was demonstrated by the measurement of REE pattern and ¹⁴³Nd/¹⁴⁴Nd isotope ratio in uranium ore concentrate samples.

Characterization and classification of uranium ore concentrates (yellow cakes) using infrared spectrometry

In this work the applicability of Fourier-transform infrared spectrometry (FTIR) for nuclear forensic studies of uranium ore concentrates (UOC) are investigated. The technique was used for the identification of the type of uranium compound and various process-related impurities, which can give information on the production method of the material. The measured spectra were evaluated also by statistical means, using the soft independent modelling of class analogy (SIMCA) technique to reveal less apparent similarities between the measured UOC samples.