The systemic score may identify life-threatening evolution in Still's disease: data from the GIRRCS AOSD-study group and the AIDA Network Still's Disease Registry

OBJECTIVES

To evaluate the clinical usefulness of the systemic score in the prediction of life-threatening evolution in Still's disease. To assess the clinical relevance of each component of the systemic score in predicting life-threatening evolution and to derive patient subsets accordingly.

METHODS

A multicenter, observational, prospective study was designed including patients included in the GIRRCS (Gruppo Italiano Di Ricerca in Reumatologia Clinica e Sperimentale) AOSD-study group and AIDA (AutoInflammatory Disease Alliance) Network Still's Disease Registry. Patients were assessed if variables to derive the systemic score were available. The life-threatening evolution was defined as mortality, whichever the clinical course, and/or macrophage activation syndrome (MAS), a secondary hemophagocytic lymphohistiocytosis associated with a poor prognosis.

RESULTS

Totally 597 patients with Still's disease were assessed (age 36.6±17.3 years; male 44.4%). The systemic score, assessed as continuous variable, significantly predicted the life-threatening evolution (OR: 1.24, 95%CI:1.07-1.42; p=0.004). A systemic score ≥7 also significantly predicted the likelihood of a patient experiencing life-threatening evolution (OR: 3.36, 95%CI:1.81-6.25; p<0.001). Assessing the clinical relevance of each component of the systemic score, liver involvement (OR: 1.68, 95%CI:1.48-2.67; p=0.031) and lung disease (OR: 2.12, 95%CI:1.14-4.49; p=0.042) both significantly predicted life-threatening evolution. The clinical characteristics of patients with liver involvement and lung disease were derived, highlighting their relevance in multiorgan disease manifestations.

CONCLUSION

The clinical utility of the systemic score was shown in identifying Still's disease at higher risk of life-threatening evolution in a large cohort. Furthermore, the clinical relevance of liver involvement and lung disease was highlighted.

AB0033 T- AND B-CELL SUBSETS AS ADDITIONAL DIAGNOSTIC TOOL FOR PRIMARY SJOGREN’S SYNDROME AND SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Systemic lupus erythematosus (SLE) and primary Sjogren’s syndrome (pSS) are chronic autoimmune diseases with complex pathogenesis. T-lymphosytes are known to be prime effectors of autoimmune diseases, while B-lymphosytes play a key role as sources of antibodies and antigen presenting cells. Considering the implications of T- and B-cells in the pathophysiology of SLE ans pSS, the assessment of their distribution in the blood could be helpful in the complex process of determining a precise diagnosis.

Objectives

The study aimed to compare composition of peripheral blood T- and B-cell subsets and investigate their diagnostic utility in patients with SLE and pSS.

Methods

The study was performed with 37 patients suffering from SLE, 57 patients with pSS, and 49 apparently healthy volunteers (HVs). The diagnosis of SLE was performed according to the 2019 EULAR – ACR classification criteria, the diagnosis of pSS- according to the 2016 EULAR – ACR criteria. 11 patients in pSS group met the criteria for both pSS and SLE. The relative distribution and percentage of T- and B-cell subsets were evaluated by flow cytometry. T helper (Th) and cytotoxic T-cell subsets (Tcyt) were identified by using CD3, CD4, and CD8 antibodies. Regulatory T cells (Tregs) were characterized by the expression of CD3, CD4, and high IL-2R alpha chain (CD25high) levels. All peripheral blood B-cells were identified by using CD19 antibody, detection of subpopulations of B cells based on expression of IgD, CD38, CD27. The absolute and relative values ​​of B-lymphocyte subpopulations were evaluated using three main classifications: based on IgD / CD38 expression (classification Bm1-Bm5), co-expression of IgD / CD27 and CD38 / CD27. The statistical analysis of data was performed with STATISTICA Version 12.0 Inc. Method of discriminant analysis was performed to evaluate diagnostic utility of relative values of T- and B-cell subsets.

Results

In the discriminant model the top significance was documented while assessing the percentage of naive B-cells (Bm1, IgDdimCD38low), germinal center B-cells (Bm 3+Bm4, IgDlowCD38hi), naive B-cells (IgDdimCD27low), unswitched memory B-cells (IgDdimCD27dim), naive mature B-cells (CD27dimCD38low), transient B-cells (CD27lowCD38hi), all T-cells (CD3hi), Tregs (CD3hiCD4hiCD25hi), Tcyt (CD3hiCD8hi) and Th (CD3hiCD4hi), model percent correct was 78%, p <0,05. The discriminant function was either f1 for distinguishing HVs versus ill patients SLE and pSS (all participants are accounted) or f2 for SLE versus pSS (only participants with disease are accounted). During ROC analysis, performed for the differential diagnosis of healthy and sick patients, this discriminant model had a sensitivity of 86,5% and a specificity of 72,8%, the area under the curve (AUC) 0.94, p <0.001. Among the group of ill patients, the differential diagnosis between SLE and pSS had a sensitivity of 69,6% and specificity of 64,8%, AUC 0.87, p <0.001. Graphic representation of the discriminant analysis is performed on Figure 1. The group of patients, meeting the criteria for both pSS and SLE, is between the main groups.

Figure 1.

Graphic distribution of SLE, pSS and pSS+SLE patients, as well as HVs analyzed by discriminant analysis.

Conclusion

T- and B-cell peripheral blood subsets might provide an additional diagnostic tool for distinction SLE, pSS and HVs. Differential diagnosis between pSS and SLE is difficult, because this diseases may coexist.

References

[1]Guillermo Carvajal Alegria, Pierre Gazeau1, Sophie Hillion et al. Could Lymphocyte Profiling be Useful to Diagnose Systemic Autoimmune Diseases? Clinic Rev Allerg Immunol (2017) 53:219–236

[2]Sandra Gofinet Pasoto, Victor Adriano de Oliveira Martins, Eloisa Bonfa. Sjögren’s syndrome and systemic lupus erythematosus: links and risks. Open Access Rheumatol. 2019; 11: 33–45.

Disclosure of Interests

None declared

Prevalence, genotype and phenotype of familial hypercholesterolemia in 10,194 Finnish men

Background

Familial hypercholesterolemia (FH) is the most frequent monogenic disease with an estimated prevalence of 1:250. The prevalence of different variants varies widely between the populations. According to previous studies, the prevalence of heterozygous FH in Finland has been reported to be 1:400–650, seven Finnish LDLR founder mutations having been considered to cause 80% of FH.

Purpose

To investigate the genetics of FH in the large Finnish population-based study.

Methods

The whole exome sequencing using Next Generation Sequencing method was performed for 10,194 men from eastern Finland who participated in the METSIM (Metabolic Syndrome in Men) study. The findings were confirmed by Sanger sequencing. The coding regions of the FH causing genes LDLR, APOB and PCSK9 were sequenced. The pathogenicity of the variants was classified according to the ACMG guidelines, and using the Genome Aggregation Database (gnomAD), and the ClinVar archive.

Results

Total 22 individuals of 10,194 carry 8 different pathogenic/likely pathogenic (P/LP) FH variants (7 LDLR variants, 1 APOB variant and 0 PCK9 variants). Seven LDLR gene variants classified as P/LP were detected in 21 individuals. Two of the seven variants are founder mutations (p.Pro309Lysfs*59, p.Arg595Gln), four are other previously reported variants (p.Arg124Trp, p.Glu228*, p.Asp266Asn, p.Asp445Glu) and one is a novel variant (p.Gly396Ala). Of the 21 individuals carrying P/LP LDLR variants, 16 carry founder mutations and five other P/LP LDLR variants. Of individuals carrying any P/LP LDLR variant, 28.6% had premature (men &lt;55 years, women &lt;60 years) atherosclerotic cardiovascular disease (CVD): coronary artery disease (CAD) 28.6%, peripheral artery disease (PAD) 0.0%, and stroke or TIA 0.0%. CVD at any age was diagnosed in 38.1% (CAD 33.3%, PAD 4.8%, stroke or TIA 9.5%). Only one individual from 10,194 carry APOB variant which is classified as P/LP. The detected APOB variant is a previously reported variant (p.Gln4494del). None of the 10,194 individuals carry P/LP PCSK9 variants. Thus, the prevalence of P/LP FH variants in the population from eastern Finland was 0.22%, 1 in 463.4 (LDLR variants 0.21%, 1 in 485; APOB variants 0.01%, 1 in 10 194). Of the P/LP variant carriers, 72.7% carry founder mutation of the LDLR, and 27.3% carry other LDLR and APOB variants.

Conclusions

The prevalence of heterozygous FH in the population-based study of 10,194 men from eastern Finland was 1 in 463.4, which is about the same as previously reported. LDLR variants accounted for the majority of FH cases, and although previously reported Finnish LDLR founder mutations were common, about 30% of the mutations detected were other LDLR and APOB variants. Pathogenic/likely pathogenic APOB variants were, however, rare and PCSK9 variants were not found.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Kuopio university hospital

How do the FIFA World Cup 2018 and the 2016 UEFA championships impact a pediatric emergency department?

INTRODUCTION

In France, soccer is the most popular sport, which today attracts a huge television audience with millions of spectators in the case of international competitions. During certain games with European top clubs, the attendance of adult emergencies is impacted. However, the impact of international soccer competitions on pediatric emergency department (PED) activity has not been evaluated.

METHODS

We performed a retrospective analysis of attendance in the PED of a tertiary university hospital in Nancy (France) during the UEFA 2016 championship and the FIFA 2018 World Cup. Games were represented by 2.5-h blocks and the tournament period was compared with the same period in the previous year.

RESULTS

Considering all games, we did not observe an impact of PED attendance. The admission rate was significantly lower during the final phase (11.1 patients per match vs. 13.9, P=0.037). We observed a decrease in consultations for trauma (4.9 vs. 6.7, P=0.006). The effects were higher during games involving the national French team, with a decrease in less severe admissions (P=0.034), attendance of older children (P=0.016), and the presence of the father as accompanying adult (P=0.002). During the two final matches, we observed a decrease of 14% in the total activity.

CONCLUSION

We found significant differences in PED attendance during two international soccer tournaments. It would be interesting to study this effect in countries other than France or in countries with different sport habits.

Low Seroprevalence of Torque Teno Virus in HCV positive patients and phylogenetic analysis from Pakistani isolates

The torque teno virus (TTV) has a heterogeneous genome and its role in hepatitis C (HCV) infection is still controversial, therefore the purpose of the present study was to determine if there is any association between Hepatitis C and TTV co-infection and to determine the phylogenetic relationship between existing types in the Pakistani population. A total of 500 individuals (250 HCV positive patients and 250 healthy controls) were selected. DNA was extracted from serum samples and polymerase chain reaction (PCR) of the open reading frame 1 (ORF1) region of TTV was performed. Out of 500 samples 9 HCV positive index cases (3.6%) and 8 healthy samples (3.2%) were found to be positive for TTV. A comparison was made between TTV sequences reported from all over the world with the ones obtained in the present study by sequencing of TTV positive samples followed by phylogenetic analysis using maximum parsimony (MP) method. Our results indicated that the virus was undergoing divergent evolution as very high sequence diversity was found in the ORF1 gene. The study also shows that association between HCV and TTV was not found. Because the virus was found to be affecting both healthy individuals and HCV infected population with almost same frequency. Therefore a thorough screening of TTV virus at the population level is required in order to draw a comprehensive inference.