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.

Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries

OBJECTIVES

In bio-naïve patients with PsA initiating a TNF inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries.

METHODS

Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes were defined as common predictors.

RESULTS

In the pooled cohort (n = 13 369), 6-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6954, n = 5275 and n = 13 369, respectively). Five common baseline predictors of remission, moderate response and 12-month drug retention were identified across all three outcomes. The odds ratios (95% CIs) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (<2 years as reference): 2-3 years: 1.20 (0.89-1.60), 4-9 years: 1.42 (1.09-1.84), ≥10 years: 1.66 (1.26-2.20); men vs women: 1.85 (1.54-2.23); CRP of >10 vs ≤10 mg/l: 1.52 (1.22-1.89) and 1 mm increase in patient fatigue score: 0.99 (0.98-0.99).

CONCLUSION

Baseline predictors of remission, response and adherence to TNFi therapy were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalizable from country level to disease level.

Still's disease continuum from childhood to elderly: data from the international AIDA Network Still's disease registry

OBJECTIVE

Still's disease is more frequently observed in the paediatric context, but a delayed onset is not exceptional both in the adulthood and in the elderly. However, whether paediatric-onset, adult-onset and elderly-onset Still's disease represent expressions of the same disease continuum or different clinical entities is still a matter of controversy. The aim of this study is to search for any differences in demographic, clinical features and response to treatment between pediatric-onset, adult-onset and elderly-onset Still's disease.

METHODS

Subjects included in this study were drawn from the International AutoInflammatory Disease Alliance Network registry for patients with Still's disease.

RESULTS

A total of 411 patients suffering from Still's disease were enrolled; the disease occurred in the childhood in 65 (15.8%) patients, in the adult 314 (76.4%) patients and in the elderly in 32 (7.8%) patients. No statistically significant differences at post-hoc analysis were observed in demographic features of the disease between pediatric-onset, adult-onset and elderly-onset Still's disease. The salmon-coloured skin rash (p=0.004), arthritis (p=0.009) and abdominal pain (p=0.007) resulted significantly more frequent among paediatric patients than in adult cases, while pleuritis (p=0.015) and arthralgia (p<0.0001) were significantly more frequent among elderly-onset patients compared with paediatric-onset subjects. Regarding laboratory data, thrombocytosis was significantly more frequent among paediatric patients onset compared with adult-onset subjects (p<0.0001), while thrombocytopenia was more frequent among elderly-onset patients although statistical significance was only bordered. No substantial differences were observed in the response to treatments.

CONCLUSIONS

Despite some minor difference between groups, overall, demographic, clinical, laboratory and treatments aspects of Still's disease were similarly observed in patients at all ages. This supports that pediatric-onset, adult-onset and elderly-onset Still's disease is the same clinical condition arising in different ages.

Clinical and laboratory features associated with macrophage activation syndrome in Still's disease: data from the international AIDA Network Still's Disease Registry

To characterize clinical and laboratory signs of patients with Still's disease experiencing macrophage activation syndrome (MAS) and identify factors associated with MAS development. Patients with Still's disease classified according to internationally accepted criteria were enrolled in the AutoInflammatory Disease Alliance (AIDA) Still's Disease Registry. Clinical and laboratory features observed during the inflammatory attack complicated by MAS were included in univariate and multivariate logistic regression analysis to identify factors associated to MAS development. A total of 414 patients with Still's disease were included; 39 (9.4%) of them developed MAS during clinical history. At univariate analyses, the following variables were significantly associated with MAS: classification of arthritis based on the number of joints involved (p = 0.003), liver involvement (p = 0.04), hepatomegaly (p = 0.02), hepatic failure (p = 0.01), axillary lymphadenopathy (p = 0.04), pneumonia (p = 0.03), acute respiratory distress syndrome (p < 0.001), platelet abnormalities (p < 0.001), high serum ferritin levels (p = 0.009), abnormal liver function tests (p = 0.009), hypoalbuminemia (p = 0.002), increased LDH (p = 0.001), and LDH serum levels (p < 0.001). At multivariate analysis, hepatomegaly (OR 8.7, 95% CI 1.9-52.6, p = 0.007) and monoarthritis (OR 15.8, 95% CI 2.9-97.1, p = 0.001), were directly associated with MAS, while the decade of life at Still's disease onset (OR 0.6, 95% CI 0.4-0.9, p = 0.045), a normal platelet count (OR 0.1, 95% CI 0.01-0.8, p = 0.034) or thrombocytosis (OR 0.01, 95% CI 0.0-0.2, p = 0.008) resulted to be protective. Clinical and laboratory factors associated with MAS development have been identified in a large cohort of patients based on real-life data.

Derivation and validation of four patient clusters in Still's disease, results from GIRRCS AOSD-study group and AIDA Network Still Disease Registry

BACKGROUND

Different patient clusters were preliminarily suggested to dissect the clinical heterogeneity in Still's disease. Thus, we aimed at deriving and validating disease clusters in a multicentre, observational, prospective study to stratify these patients.

METHODS

Patients included in GIRRCS AOSD-study group and AIDA Network Still Disease Registry were assessed if variables for cluster analysis were available (age, systemic score, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and ferritin). K-means algorithm with Euclidean metric and Elbow plot were used to derive an adequate number of clusters.

RESULTS

K-means clustering assessment provided four clusters based on means standardised according to z-scores on 349 patients. All clusters mainly presented fever, skin rash and joint involvement. Cluster 1 was composed by 115 patients distinguished by lower values of age and characterised by skin rash myalgia, sore throat and splenomegaly. Cluster 2 included 128 patients identified by lower levels of ESR, ferritin and systemic score; multiorgan manifestations were less frequently observed. Cluster 3 comprised 31 patients categorised by higher levels of CRP and ferritin, they were characterised by fever and joint involvement. Cluster 4 contained 75 patients derived by higher values of age and systemic score. Myalgia, sore throat, liver involvement and life-threatening complications, leading to a high mortality rate, were observed in these patients.

CONCLUSIONS

Four patient clusters in Still's disease may be recognised by a multidimensional characterisation ('Juvenile/Transitional', 'Uncomplicated', 'Hyperferritinemic' and 'Catastrophic'). Of interest, cluster 4 was burdened by an increased rate of life-threatening complications and mortality, suggesting a more severe patient group.

Vascular Involvement in Behcet's Disease: An Evaluation of 147 Cases and Literature Review

Objectives

Behcet's disease (BD) is characterized by systemic vasculitis with inflammation that can affect various body organs. In BD, vasculitis primarily manifests with venous involvement, distinguishing it from other forms of systemic vasculitis.

Methods

We retrospectively analyzed the demographic and clinical characteristics of 147 patients diagnosed with vascular BD in our center.

Results

Vascular BD cases accounted for 25.0% (147 out of 589) of all BD patients. A statistically significant correlation was found between gender and vascular involvement that was seen predominantly in males (76.9%). In 71 patients, a vascular event developed during follow-up for BD, while in 76 patients the disease was diagnosed after the occurrence of a vascular event (51.7%). The most common vascular event was deep vein thrombosis in the lower extremities (69.4%). Arterial involvement was primarily observed in the pulmonary arteries (12.9%). Patients with lower extremity deep vein thrombosis tended to be younger, while those with pulmonary artery involvement were typically older. Overall, veins were affected 4.5 times more frequently than arteries.

Conclusion

The prevalent type of venous involvement was deep vein thrombosis in the lower extremities. Thrombotic events in BD cannot be solely attributed to abnormalities in thrombotic factors. The treatment of thrombotic events in BD remains contentious, with anticoagulant efficacy being debated and immunosuppressive therapy representing the primary treatment approach. Behcet's disease should be considered when a young male patient presents with an arterial or venous vascular event, especially if it is recurrent.

Evaluation of Tuberculosis Risk under Interleukin-1 Inhibitor Agents in Patients with Autoinflammatory Diseases: Experience from a Region with Moderate Tuberculosis Prevalence

Background We aimed to investigate the rate of TBC reactivation in patients with autoinflammatory conditions who had been followed up under treatment with IL-1 antagonists in our clinic. We further aimed to evaluate whether latent TBC screening and isoniazid prophylaxis before IL-1 inhibitor treatment is beneficial in the prevention of reactivation.

Patients and Methods This study was designed as a cross-sectional and observational study. It received the approval of the local ethics committee and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Adult patients who had been followed up in our clinic under treatment with IL-1 antagonists were evaluated with regard to whether they had a TBC infection before and after these treatments and whether they had been screened for latent TBC infection before IL-1 antagonist treatment and received prophylaxis. Clinical and laboratory data were obtained from hospital records and via telephone interviews after the patients had given their verbal consent to participate.

Results Fifty-nine patients under IL-1 antagonists were consecutively enrolled. 58 were under follow-up with the diagnosis of familial Mediterranean fever and one patient with a diagnosis of adult-onset Still’s disease. 35 patients (59.3%) were treated with anakinra and 24 (40.7%) were treated with canakinumab. 12 (50%) of the canakinumab users had previously received anakinra treatment and were switched to canakinumab due to side-effects or ineffectiveness. The number of patients who underwent latent tuberculosisc infection (LTBI) screening before treatment was 37 (62.7%); the number of patients who received prophylaxis was 13 (22%). None of the patients receiving IL-1 antagonists developed active tuberculosis.

Conclusion Blocking the IL-1 pathway may be safe regarding the activation of LTBI or development of a new tuberculosis infection even in locations with a high geographical risk.

Elevated Kynurenine Levels in Patients with Primary Sjögren's Syndrome

OBJECTIVE

We aimed to investigate the plasma levels of tryptophan (Trp) and its metabolites in patients with primary Sjögren's syndrome (pSS).

METHODS

The study included 34 pSS patients and 42 healthy individuals, and serum Trp and kynurenine (Kyn) concentrations were measured by liquid chromatography with tandem mass spectrometry. Trp degradation was predicted using the ratio of Kyn and Trp concentrations (Kyn/Trp).

RESULTS

In our study, the mean serum Trp concentration was found to be considerably lower in the pSS group than in the control group (P = .001). The levels of Kyn (P = .019) and the Kyn/Trp ratio (P < .001) were significantly higher in the pSS group than in the control group. The Kyn/Trp ratio was negatively correlated with C-reactive protein (r = -0.369, P = .032).

CONCLUSION

We found that Kyn pathway metabolism was altered in patients with pSS. This suggests that Trp metabolism may be closely linked to the disease pathogenesis of pSS.

Development and implementation of the AIDA International Registry for patients with Behçet's disease

Purpose of the present paper is to point out the design, development and deployment of the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to pediatric and adult patients with Behçet's disease (BD). The Registry is a clinical physician-driven non-population- and electronic-based instrument implemented for the retrospective and prospective collection of real-life data about demographics, clinical, therapeutic, laboratory, instrumental and socioeconomic information from BD patients; the Registry is based on the Research Electronic Data Capture (REDCap) tool, which is thought to collect standardised information for clinical real-life research, and has been realised to change over time according to future scientific acquisitions and potentially communicate with other existing and future Registries dedicated to BD. Starting from January 31st, 2021, to February 7th, 2022, 110 centres from 23 countries in 4 continents have been involved. Fifty-four of these have already obtained the approval from their local Ethics Committees. Currently, the platform counts 290 users (111 Principal Investigators, 175 Site Investigators, 2 Lead Investigators, and 2 data managers). The Registry collects baseline and follow-up data using 5993 fields organised into 16 instruments, including patient's demographics, history, clinical manifestations and symptoms, trigger/risk factors, therapies and healthcare access. The development of the AIDA International Registry for BD patients will facilitate the collection of standardised data leading to real-world evidence, enabling international multicentre collaborative research through data sharing, international consultation, dissemination of knowledge, inclusion of patients and families, and ultimately optimisation of scientific efforts and implementation of standardised care.Trial registration NCT05200715 in 21/01/2022.

POS1274 A SINGLE CENTER COVID-19 VACCINE EXPERIENCE IN FAMILIAL MEDITERRANEAN FEVER PATIENTS

Background

To prevent COVID-19 disease SARS-CoV 2 vaccines put into use worldwide with emergency use authorizations despite ongoing safety concerns. Since pyrin mediated inflammasome response is dysregulated in FMF, exposure to SARS-CoV 2 proteins via vaccination may potentially trigger inflammation, leading to attacks and/or increased rate of adverse events (AE).

Objectives

Aim of this study to investigate frequency of adverse events and attacks related to vaccination in recipients of CoronaVac and BNT162b2 comparatively in our FMF patients.

Methods

Data regarding, number of vaccine doses, types of vaccines (CoronaVac or BNT162b2), presence of AEs and/or FMF attacks after any vaccine dose within a month, history of COVID-19 infection before or after vaccination, adherence to FMF treatment during vaccination were collected from hospital database or via telephone.

Results

A total of 161 vaccinated FMF patients were included. Mean ± SD age was 40.5 ± 11.7 years. 57.1% was female. 10.6% of the patients had chronic kidney disease and 9.3% had amyloidosis. Most common MEFV mutations were M694V heterozygous (27%) and M694V homozygous (21.6%). 93.2% of the patients were under colchicine, 21.8% under anti-interleukin 1 agents, 2.5% under TNF-a inhibitors. 96.3% of the patients adhered to FMF treatment during vaccination. Vaccination properties and data regarding adverse events are presented in Table 1. 57.8% of patients reported to suffer from an AE/attack after a vaccine dose. Number of patients with AE after BNT162b2 was significantly higher (p<0.001). None of the patients had severe AEs. 39 patients had COVID-19 infection prior to primary vaccination. 61.5% of these suffered from an adverse reaction/attack after vaccination, in comparison to 56.6% of the patients without prior COVID-19 infection (p=0.584). When patients with and without AEs/attacks were compared, no significant differences were observed regarding age, gender, body mass index, comorbidities, FMF treatments and total vaccine doses.

Table 1.

Adverse events and FMF attacks in a total of 161 vaccine recipients

BNT162b2CoronaVacpTotal vaccine doses, n213140Patients ever vaccinated with BNT162b2 and CoronaVac, n (%)117 (72.7)67 (41.6)Dose per patient, median (min-max)2 (1-4)2 (1-4)Patients with primary vaccination completed with BNT162b2 or CoronaVac, n (%)*88 (54.7)57 (35.4)Patients with a booster with BNT162b2 or CoronaVac, n (%)23 (14.2)14 (8.6)Patients vaccinated with BNT162b2 or CoronaVac alone, n(%)94 (58.4)44 (27.3)Patients with an adverse event after any vaccine dose of n (%)¶64/117 (54.7)20/67 (29.9)<0.001Adverse events, n (%)¶ Fever13 (11.1)6 (9.0)0.644 Malaise21 (17.9)4 (6.0)0.023 Local pain/arm pain17 (14.5)4 (6.0)0.079 Arthralgia19 (16.2)4 (6.0)0.043 Myalgia6 (5.1)0 (0.0)0.059 Headache11 (9.4)0 (0.0)0.010 Nausea6 (5.1)1 (1.5)0.215 Vomiting4 (3.4)1 (1.5)0.439 Others22 (18.9)7 (10.4)Patients with FMF attack within one month after any vaccine dose, n (%)¶26 (22.2)13 (19.4)0.653Time from vaccine dose to FMF attack, days, median (IQR)7.0 (12.5)10.0 (13.5)0.758

*9.9 % of the patients had only single dose of either vaccine, ¶Over 117 ever vaccinated with BNT162b2 and 67 ever with CoronaVac

Conclusion

We observed considerable number of FMF patients suffered from vaccine related AEs/attacks, particularly with BNT162b2. However, no serious AE was detected. Demographics, clinical characteristics and prior history of vaccination did not significantly affect AE/attack occurrence.

Acknowledgements

I have no acknowledgements to declare.

Disclosure of Interests

None declared

AB1088 COVID-19 VACCINATION OF SPONDYLOARTHRITIS PATIENTS RECEIVING BIOLOGICAL THERAPY: REAL-LIFE DATA

Background

Considering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.

Objectives

Vaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.

Methods

Adult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.

Results

A total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).

It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization.

The rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, anaphylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination.

Conclusion

During the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.

References

[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.

[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496

Disclosure of Interests

None declared

AB0552 ELEVATED KYNURENINE LEVELS IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background

Sjögren’s syndrome (SS) is a chronic autoimmune systemic inflammatory disease of unknown origin that predominantly affects the exocrine glands (mainly salivary and lacrimal glands). Primary Sjögren’s syndrome (pSS) is a disease whose etiology is not yet fully understood, as in most autoimmune diseases, where genetic, epigenetic and environmental factors are hypothesized to play to the pathogenesis of the disease. Metabolism of tryptophan (Trp) via the kynurenine (Kyn) pathway has been proposed to act a substantial role in inflammatory processes.

Objectives

In the present study, we investigated levels of Trp and its metabolites in the Kyn pathway in patients with pSS and in healthy controls. Also, the relationship between Trp metabolites and laboratory parameters, disease activity was evaluated in patients with pSS.

Methods

The study included 34 pSS patients and 42 healthy individuals, and serum Trp and Kyn concentrations were measured by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Trp degradation was predicted using the ratio of Kyn and Trp concentrations (Kyn/Trp). The EULAR Sjögren’s syndrome disease activity index (ESSDAI) and the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) were used to evaluate pSS activity.

Results

In our study, the mean serum Trp concentration was found to be considerably lower in the pSS group compared to the control group (p= 0.001). The levels of Kyn (p= 0.019) and Kyn/Trp ratio (p <0.001) were significantly higher in the pSS group compared to the control group (Table 1). Trp concentration was negatively correlated with physician global assessment (r=-0.568, p<0.001), positively correlated with albumin (r=0.384, p=0.025) and hemoglobin (p=0.396, r=0.020). The Kyn/Trp ratio was negatively correlated with CRP (r=-0.369, p=0.032). There was no correlation between the Trp pathway and disease activity parameters ESSDAI and ESRPI.

Table 1.

Comparison of the kynurenine pathway results of patients with Sjögren’s syndrome and the controls

Sjögren’s syndrome (n=34) median (IQR)Control(n=42) median (IQR)pKynurenine (ng/ml)485 (378-601)386 (356-496)0.019Tryptophan (ng/ml)10660 (9160- 12282)12258 (11442-14711)0.001Kynurenine/tryptophan ratio (%)4 (3-6)3 (3-4)<0.001

*Mann-Whitney U test

Conclusion

In conclusion, we found that kynurenine pathway metabolism was altered in patients with pSS. This suggests that tryptophan metabolism may be closely linked to the disease pathogenesis of pSS.

References

[1]Stefanski A-L, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T. The diagnosis and treatment of Sjögren’s syndrome. Deutsches Ärzteblatt International. 2017;114(20):354.

[2]Maldini C, Seror R, Fain O, Dhote R, Amoura Z, De Bandt M, et al. Epidemiology of primary Sjögren’s syndrome in a French multiracial/multiethnic area. Arthritis care & research. 2014;66(3):454-63.

[3]Moffett JR, Namboodiri MA. Tryptophan and the immune response. Immunology and cell biology. 2003;81(4):247-65.

[4]Schroecksnadel K, Winkler C, Duftner C, Wirleitner B, Schirmer M, Fuchs D. Tryptophan degradation increases with stage in patients with rheumatoid arthritis. Clinical rheumatology. 2006;25(3):334-7.

Disclosure of Interests

None declared

AB0762 Incidence Of Anterior Uveitis In Axial Spondyloarthritis During Secukinumab Treatment: TWO YEARS REAL LIFE EXPERIENCE FROM TURKBIO REGISTRY

Background

Secukinumab (SEC), a human anti-IL-17A monoclonal antibody, has similar treatment response rates to tumor necrosis factor (TNF) inhibitors in patients with axial spondyloarthritis (SpA). However, the efficacy of SEC on anterior uveitis (AU) is unclear.

Objectives

This study aimed to evaluate the risk of new-onset or relapsing AU in axial SpA patients treated with SEC.

Methods

In this prospective cohort study, 130 axial SpA patients receiving SEC at the TURKBIO registry between 2019 and 2021 were evaluated. Demographic and clinical characteristics and data about the presence of AU pre or post-treatment were collected. The univariate and multivariate logistic regression analyses were performed to evaluate the predictors of AU development.

Results

The mean age of the patients (F/M: 59/71) was 47.4±10.9 years. The median follow-up time was 540 days (IQR: 330-630). SEC was the first biological agent in 50 (38.4%) patients and 35 (26.9%) patients were using at least one concomitant conventional synthetic DMARD (Table 1). While continued SEC therapy was in 93 (71.5%) patients, treatment withdrawal was in 37 cases (in 26 due to ineffectiveness, two adverse events and nine other reasons). Overall, 15(11.5%) patients had a history of AU before the SEC. During follow-up, AU attacks were seen in the 6 cases (4 were new-onset and 2 were flare) and 5 of these patients have a history of inadequate response to TNF inhibitors. The frequency of AU was calculated as 3.42 per 100 patient-years during SEC treatment. The only significant predictor of AU development was the baseline high C-reactive protein (CRP) level on multivariate analysis (p=0.003, OR: 1.063 [95% CI 1.021-1.107]).

Table 1.

Demographics and clinical characteristics of the patients

Total (n:191)Gender (F/M)59/71Age (years) (mean±SD)47.4±10.9Diagnosis; n (%)   AS125 (96.2)   nr-axSpA5 (3.8)BASDAI (mean±SD)47.2±20.48   Missing n (%)4 (3.07)ASDAS (mean±SD)3.32±0.92   Missing n (%)14 (10.7)C-reactive protein (mg/L) median (IQR)12.6 (4.67-22.62)Sedimentation (mm/h) median (IQR)22 (9-42)Concomitant csDMARDs n (%)35 (26.9)Secukinumab dose n (%)   150 mg120 (92.3)   300 mg10 (7.7)TNFi-naive patients n (%)50 (38.5)Number of previous bDMARDs n (%)   136 (27.7)   223 (17.7)   ≥ 321 (16.1)History of previous TNFi n (%)   Monoclonal TNFi64   Etanercept16

AS; Ankylosing spondylitis, nr-axSpA; Non radiographic axial spondyloarthritis, BASDAI; Bath Ankylosing Spondylitis Disease Activity Index, ASDAS; Ankylosing Spondylitis Disease Activity Score, csDMARD; conventional synthetic disease modifying anti-rheumatic drug, TNFi; Tumor necrosis factor inhibitors, bDMARD; biological DMARD. Datas were expressed as number (%), mean±SD or median (IQR).

Conclusion

In this real-life data from the TURKBIO registry, the incidence of AU in axial SpA patients treated with SEC was calculated as 3.42 per 100 patient-years. A high baseline CRP level was an independent factor for developing AU.

Disclosure of Interests

None declared

AB0161 THE RELATIONSHIP OF TRYPTOPHAN CATABOLISM WITH RHEUMATOİD ARTHRITIS DİSEASE ACTİVİTY ABSTRACT

Background

Tryptophan (Trp) is an essential amino acid. The immunosuppressive effect caused by Kynurenine (Kyn) and its metabolites formed by the catabolism of Trp is thought to be an important physiological mechanism.

Objectives

This study aims to evaluate the relationship of Kyn and its metabolites formed in Trp catabolism with rheumatoid arthritis (RA) disease activation and to investigate the usability of these markers in the diagnosis and treatment of RA.

Methods

50 RA patients followed in our rheumatology clinic and 41 healthy controls without chronic disease were included in this study. Disease Activity Score 28 (DAS28) was used to evaluate the association of Kyn metabolites and Indolamine 2,3 dioxygenase (IDO) enzyme activity with RA disease activity. The task of this enzyme is to provide Kyn formation with Trp catabolism.

Results

In this study, lower Trp levels were found in the RA group compared to the control group (11285.47±2318.93-13320.31±3771.27, respectively) compared to the Trp mean (p<0.01). In terms of the Kyn/Trp ratio, a significantly higher Kyn/Trp ratio (4.42±1.77-3.27±0.71, respectively) was found in the RA compared to the control group (p<0.001). There was no significant difference between the study groups in terms of Kyn averages (p>0.05). A significant correlation was found between Trp levels and morning stiffness (r: -0.321, p<0.05) and the DAS28 score (r:-0.566, p<0.01). A significant positive correlation was found between the Kyn/Trp ratio and C-reactive protein (r:0.317, p<0.05), sedimentation (r:0.319, p<0.05), morning stiffness (r:0.287, p<0.05) and DAS28 score (r:0.322, p<0.01).

Table 1.

Comparison of study parameters between RA and control group.

ParameterRheumatoid arthritisControl groupP-ValueTryptophan (ng/ml)11285,47±2318,9313320,31±3771,27<0.01Kynurenine (ng/ml)477,68±158,38437,51±162,10>0.05Kyn/Trp ratio4,42±1,773,27±0,71<0.001

All values were expressed as mean ± SD. All values were calculated using independent sample t-test for normal distribution.

Figure 1.

Correlation relationship between DAS 28 and Trp levels (r: -0,321, p < 0.01)

Conclusion

In this study, we observed that RA has a significant relationship with Trp levels and Kyn/Trp ratio. In addition to the literature, we found that RA activation indicator DAS28 score and Kyn/Trp ratio and Trp level showed a statistically significant correlation. Our study has shown that the Trp catabolic pathway can be an important field of study for more effective and safe treatment of RA.

References

[1]Smolen JS, Aletaha D, Barton A, Burmester G, Emery P, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001. doi:10.1038/nrdp.2018.1

[2]Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med

[3]Murray PJ. Amino acid auxotrophy as a system of immunological control nodes. Nature immunology, 2016;17.2: 132-139. doi:10.1038/ni.3323

[4]Frumento G, Rotondo R, Tonetti M, Damonte G, Benatti U, et al. Tryptophan-derived catabolites are

[5]De Jong RA, Nijman HW, Boezen HM, Volmer M, Ten Hoor KA, et al. Serum tryptophan and kynurenine concentrations as parameters for indoleamine 2, 3-dioxygenase activity in patients with endometrial, ovarian, and vulvar cancer. International Journal of Gynecologic Cancer, 2011;21.7. doi:10.1097/IGC.0b013e31822017fb

[6]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT., et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 2010;62.9:2569-2581. doi:10.1002/art.27584.

[7]Ozkan Y, Mete G, Sepici-Dincel A, Sepici V, Simsek B. Tryptophan degradation and neopterin levels in treated rheumatoid arthritis patients. Clinical rheumatology; 2012;31.1:29-34. doi:10.1007/s10067-011-1767-5

Trp: Tryptophan, DAS28: Disease Activity Score

Acknowledgements

This study was supported by the Scientific and Technological Research Council of Turkey (TUBITAK). The authors thank TUBITAK for its financial support

Disclosure of Interests

None declared

AB1142 EFFECTS OF SULFASALAZINE USED IN AXIAL SPONDYLOARTHRITIS ON COVID-19 OUTCOMES: REAL-LIFE DATA FROM A SINGLE CENTER

Background

Compared to biologic-agents, little is known about effects of sulfasalazine used for axial spondyloarthritis(AxSpA) on COVID-19 outcomes.

Objectives

So, we aimed to understand the impact of sulfasalazine on COVID-19 in AxSpA patients.

Methods

This was a retrospective study from a single center which included 2344 AxSpA patients. We analyzed 219 of 406 confirmed COVID-19 patients from March 2020 to July 2021. The primary outcome was COVID-19 severity in terms of COVID-19 pneumonia, hospitalization rate and length of hospitalization. Analyses were stratified according to use of sulfasalazine and/or biologic-agents.

Results

Most of the patients were male(59%) with a mean age of 45.0 years. Peripheral arthritis was present in 35% and uveitis in 15%. In total, sulfasalazine was used in 42% and biologic-agent in 42%. COVID-19 pneumonia detected in 16%, hospitalization required in 14% and median(IQR) duration of hospitalization was 10(8) days. Two patients died due to COVID-19. The sulfasalazine users had higher age, more frequent COVID-19 pneumonia, hospitalization and longer hospitalization. After biologic-agent users were excluded, the sulfasalazine group had again longer hospitalization. When patients regrouped as sulfasalazine monotherapy, sulfasalazine+biologic and biologic monotherapy, in pairwise comparisons, sulfasalazine monotherapy group had a higher frequency of COVID-19 pneumonia than biologic monotherapy group(p=0.008).

Conclusion

Although sulfasalazine seemed to be related with increased rates of COVID-19 pneumonia and hospitalization, this impact diminished after exclusion of biologic-agent users. Sulfasalazine monotherapy and sulfasalazine+biologic therapy might be associated with development of COVID-19 pneumonia, compared to biologic monotherapy. Our results imply sulfasalazine may be related with worse disease course AxSpA patients with COVID-19.

Disclosure of Interests

None declared

A real-life analysis of patients with rheumatologic diseases on biological treatments: Data from TURKBIO Registry

OBJECTIVE

TURKBIO registry, established in 2011, is the first nationwide biological database in Turkey. This study aimed to provide an overview of TURKBIO data collected by June 2018.

METHODS

The registry included adult patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), nonradiographic axial spondyloarthritis (nr-AxSpA), and psoriatic arthritis (PsA). Demographic and clinical features, disease activity markers, and other follow-up parameters, current and previous treat- ments, and adverse events were registered electronically at each visit using open-source software. The registration of patient-reported outcome measures was carried out electronically by the patients using touch screens.

RESULTS

TURKBIO registry included a total of 41,145 treatment series with biologicals. There were 2,588 patients with axSpA (2,459 AS and 129 nr-axSpA), 2,036 with RA, and 428 with PsA. The total number of patients, including those with other diagnoses, was 5,718. In the follow-up period, the number of patients and also visits steadily increased by years. The yearly mean number of visits per patient was found to be 2.3. Significant improvements in disease activity and health assessment parameters were observed following the biological treatments. Biologics were often given in combination with a con- ventional synthetic disease-modifying antirheumatic drug in patients with RA. Infections were the most commonly seen adverse events, followed by allergic reactions. Tuberculosis was observed in 12 patients, malignancy in 18, and treatment-related mortality in 31.

CONCLUSION

TURKBIO provided a valuable real-life experience with the use of biologics in rheumatic diseases in Turkey.

Clinical and molecular evaluation of MEFV gene variants in the Turkish population: a study by the National Genetics Consortium

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disorder with recurrent fever, abdominal pain, serositis, articular manifestations, erysipelas-like erythema, and renal complications as its main features. Caused by the mutations in the MEditerranean FeVer (MEFV) gene, it mainly affects people of Mediterranean descent with a higher incidence in the Turkish, Jewish, Arabic, and Armenian populations. As our understanding of FMF improves, it becomes clearer that we are facing with a more complex picture of FMF with respect to its pathogenesis, penetrance, variant type (gain-of-function vs. loss-of-function), and inheritance. In this study, MEFV gene analysis results and clinical findings of 27,504 patients from 35 universities and institutions in Turkey and Northern Cyprus are combined in an effort to provide a better insight into the genotype-phenotype correlation and how a specific variant contributes to certain clinical findings in FMF patients. Our results may help better understand this complex disease and how the genotype may sometimes contribute to phenotype. Unlike many studies in the literature, our study investigated a broader symptomatic spectrum and the relationship between the genotype and phenotype data. In this sense, we aimed to guide all clinicians and academicians who work in this field to better establish a comprehensive data set for the patients. One of the biggest messages of our study is that lack of uniformity in some clinical and demographic data of participants may become an obstacle in approaching FMF patients and understanding this complex disease.

Real-world data on change in work productivity, activity impairment, and quality of life in patients with psoriatic arthritis under anti-TNF therapy: a postmarketing, noninterventional, observational study

OBJECTIVES

To understand change in work productivity, activity impairment, quality of life (QoL), and disease activity in patients with psoriatic arthritis (PsA) receiving anti-tumor necrosis factor (anti-TNF) treatment.

METHOD

One hundred twenty patients with PsA receiving anti-TNF therapy were recruited to this noninterventional, observational study. Work disability was assessed via the Work Productivity and Activity Impairment (WPAI) questionnaire and disease activity was calculated via the 28-joint Disease Activity Score using C-reactive protein (DAS28-CRP) and Disease Activity Index for Psoriatic Arthritis with 28 joints (DAPSA28) score. Patient-reported outcomes (PROs), from visual analog scores and Health Assessment Questionnaire-Disability Index scores, were evaluated to understand the clinical effectiveness at baseline and every 3 months until the month-9 final visit. The American College of Rheumatology (ACR)20/50/70 response criteria were assessed at month 9.

RESULTS

A total of 120 patients (females, n = 73) were enrolled in the study. Mean (SD) age and disease duration were 41.6 ± 11.1 years and 6.9 ± 6.5 years, respectively. The most commonly used TNFα inhibitor was adalimumab (42.4%), followed by etanercept (25.8%). All WPAI questionnaire parameters were reduced at the follow-up visits compared with baseline (p < 0.001 for all). PROs and disease activity indicators (DAS28-CRP and DAPSA28) significantly improved during the course of anti-TNF treatments (p < 0.001 for all). Additionally, ACR20/50/70 responses were determined as 86.8%, 63.7%, and 41.8% of patients at the month-9 visit.

CONCLUSIONS

The real-world data in PsA patients receiving anti-TNF treatment showed improvement in WPAI, QoL, and disease activity over 9 months of treatment.

TRIAL REGISTRATION

NCT02028169 Key Points • Psoriatic arthritis (PsA), with debilitating effects on quality of life, occurs mostly in young adults and has negative impacts on employment status and work productivity. • Early PsA diagnosis and treat-to-target treatment strategies aim to reduce pain and joint damage, as well as improve work productivity. • Real-world data on the impact of treatment with anti-tumor necrosis factor (anti-TNF) agents on work productivity in PsA in the literature is scarce. • Our study of real-world data in patients with PsA receiving anti-TNF treatment showed improvement in work productivity, as well as in clinical and patient-reported outcomes.

AB0157 PREVALENCE OF SARCOPENIA AND CLINICAL IMPLICATIONS IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS

Background:

The aim of this study is to determine the frequency of sarcopenia at the time of diagnosis in RA patients, evaluate the effects of sarcopenia on RA disease activity, prognosis and examine the factors that may be associated with sarcopenia.

Objectives:

To determine the frequency of sarcopenia at the time of diagnosis in rheumatoid arthritis (RA) patients, assessing disease activity and factors that may be associated with sarcopenia and observe effects of treatment on sarcopenia.

Methods:

A prospective study was conducted on RA patients with newly diagnosed. Patients were evaluated twice, at the time of diagnosis and three months after the initiation of treatment. Demographic data, anthropometric measurements, disease activity scores and sarcopenia status were recorded. Sarcopenia was evaluated with grip strength and bioelectric impedance. The results were also compared with healthy volunteers.

Results:

Hand grip strength (p<0.001), skeletal muscle mass (p=0.009) and skeletal muscle mass index (p=0.032) were found to be reduced in RA patients compared to the control group. The frequency of sarcopenia in RA at onset of diagnosis was found to be 31.5%. There was a significant decrease in the rate of sarcopenia after three months of treatment (31.5% versus 8.7%; p=0.046).

Conclusion:

Sarcopenia was found in approximately one third of the patients with newly diagnosed RA in our study. With treatment, sarcopenia improved significantly. RA patients should be evaluated in terms of sarcopenia besides evaluating joint and extra-articular findings at the time of diagnosis. Early detection and treatment planning may improve the quality of life.

Figure 1.

Distribution of skeletal muscle mass index (SMMI) and prevalence of sarcopenia in RA and control groups

Table 1.

Demographics, clinical features, anthropometric measurements and disease activity scores of sarcopenic and non-sarcopenic RA patients

RA without sarcopenian=37RA with sarcopenian=17pAge, mean (SD), years47,3 (12,8)58,0 (16)0,011*Gender, female, n (%)27 (73)9 (52,9)0,215Marital status, married, n (%)34 (91,9)13 (76,5)0,258Tobacco consumption, n (%) Active smoker10 (27)5 (29,4)0,086 Ex-smoker8 (21,6)8 (47,1) Never smoker19 (51,4)4 (23,5)Alcohol consumption, n (%) Active drinker2 (5,4)2 (11,8)0,244 Ex-drinker0 (0,0)1 (5,9) Never drinker35 (94,6)14 (82,4)Occupation, n (%) Worker15 (40,5)12 (70,6)0,060Height, mean (SD), meter1,6 (0,1)1,6 (0,1)0,664Weight, mean (SD), kg80,6 (17,7)65,3 (8,6)<0,001*BMI, mean (SD), kg/m231,4 (7,3)24,9 (3,2)<0,001*Obese, n (%)20 (54,1)2 (11,8)0,006*Waist circumference, mean (SD), cm97,1 (14,2)89,3 (12,8)0,058Hip circumference, mean (SD), cm108,1 (12,7)96,6 (5,1)0,001*Calf circumference, mean (SD), cm35,4 (5,1)29,6 (4,0)<0,001*Triceps skin thickness, median (min-max), mm22 (8-36)15 (6-31)0,022*Loss of muscle strength, n (%) Right10 (27,0)9 (52,9)0,076 Left12 (32,4)10 (58,8)0,081Dominant hand, right, n (%)33 (89,2)13 (76,5)0,418SMM, mean (SD)25,1 (5,8)21,9 (4,7)0,049*SMMI, mean (SD)9,6 (1,5)8,2 (1,2)<0,001*DAS 28 - CRP, median (min-max)4,4 (1,7-6,5)4,4 (2,4-6,3)0,860SDAI, median (min-max)36,1 (8,8-113)31,1 (17,1-113)0,668CDAI, median (min-max)23 (0-48)23 (6-39)0,993PrGA, median (min-max)6 (0-9)5 (2-10)0,627PtGA, median (min-max)8 (0-10)7 (4-10)0,666Presence of morning stiffness, n (%)32 (86,5)14 (82,4)0,999Swollen joint count, median (min-max)2 (0-10)4 (0-9)0,423Tender joint count, median (min-max)6 (0-20)7 (0-18)0,911

Disclosure of Interests:

None declared

AB0314 SEMAPHORIN 3A LEVELS IN LUPUS WITH AND WITHOUT SECONDARY ANTIPHOSPHOLIPID ANTIBODY SYNDROME AND RENAL INVOLVEMENT

Background:

In this study, we aimed to evaluate sema3A levels in SLE patients with and without renal involvementor secondary antiphospholipid antibody syndrome (APS), to further elucidate the contribution ofsema3A in etiopathogenesis these conditions

Objectives:

Aim of this study is to evaluate sema3A levels in systemic lupus erythematosus patients (SLE) with and without renal involvement and secondary antiphospholipid antibody syndrome (APS).

Methods:

SLE patients were grouped according to presence of secondary APS or renal involvement. The control group consisted of age-matched, non-smoker, healthy volunteers. Sema3A levels were compared among groups. All SLE patients were regrouped according to presence of thrombotic events, miscarriages and proteinuria and sema3A levels were investigated. Finally, sema3A levels of all SLE patients as a single group were compared to controls.

Results:

The mean sema3A values were 16.16±2.84 ng/dL in the control group, 11.28±5.23 ng/dL in SLE patients without nephritis and APS, 9.05±5.65 ng/dL in SLE with APS group, and 8.53±5.11 ng/dL in lupus nephritis group. When all three patient groups were examined as a single group, mean sema3A value was significantly lower than that of the control group. Sema3A was reduced in SLE patients with thromboembolism and/or miscarriage.

Conclusion:

Sema3A levels were lower in all patient groups compared to the control group. Moreover, the reduced sema3A levels in patients with a history of thromboembolism and/or miscarriage suggests that sema3A may play an important role in the pathogenesis of vasculopathy

Table 1.

Comparison of sema3A levels between SLE patient groups and control subjects

Patient groupsGroup A (N=20)Group B (N=20)Group C (N=19)Control (N=19)pSema3A, ng/dL, mean ± SD9.05 ± 5.6511.28 ± 5.238.53 ± 5.1116.16 ± 2.84Group A vscontrol<0.001Group B vscontrol<0.001Group C vscontrol<0.001Group A vs B = 0.203Group A vs C = 0.766Group B vs C = 0.106All patients (N=59)Control (N=19)<0.0019.64 ± 5.3816.16 ± 2.84Patients with thrombotic events and/or miscarriages (N=31)Patients without thrombotic events and/or miscarriages (N=48)0.0329.96 ± 5.1112.33 ± 5.84Patients with proteinuria and/or thrombotic events and/or miscarriages (N=45)Patients without proteinuria and/or thrombotic events and/or miscarriages (N=34)<0.0019.05 ± 5.0914.91± 4.50

Disclosure of Interests:

None declared

Comparison of Clinical and Demographic Features of FMF with Sacroiliitis Patients with FMF and Axial Spondyloarthritis Patients

Objectives Familial Mediterranean fever (FMF) is the most common autoinflammatory disease, characterised by recurrent fever and serositis attacks lasting 1–3 days. Musculoskeletal involvement is the second most common manifestation in FMF patients. Sacroiliitis is another musculoskeletal involvement; as there is no spinal involvement, this is called FMF with sacroiliitis. This study was designed to investigate the clinical, demographic and genetic features of FMF in sacroiliitis patients and to compare them with axial SpA and FMF patients.

Materials and Methods Forty-two FMF with sacroiliitis patients, 100 axial SpA patients and 100 FMF patients were recruited, and their demographic characteristics were recorded. Evidence of sacroiliitis was confirmed by sacroiliac joint MRI, and patients were examined for arthritis and enthesitis. MEFV gene mutations, HLA B27 positivity and ESR and CRP results were compared.

Results In the FMF with sacroiliitis group, the M694V mutation was detected in 59.5% of patients. FMF with sacroiliitis patients were largely (83.3%) negative for HLA B27. The frequency of enthesitis was similar between FMF with sacroiliitis and axial SpA, and the frequency of arthritis was higher in axial SpA patients. Inflammatory markers (ESR and CRP) were statistically higher in FMF with sacroiliitis patients compared with axial SpA and FMF patients.

Conclusion When all three groups were compared, the M694V mutation was more common, HLA B27 was largely negative and inflammatory markers were higher in the FMF with sacroiliitis group. FMF should be included in the differential diagnosis of sacroiliitis for managing treatment correctly and preventing complications.

SAT0423 LONG-TERM SURVIVAL OF THE FIRST BIOLOGIC TREATMENT IN PSORIATIC ARTHRITIS AND THE EFFECT OF THE SELECTED TREATMENT ON DRUG SURVIVAL; TURKBIO REGISTRY

Background:

Currently, biologic treatments are used effectively in patients with psoriatic arthritis (PsA).

Objectives:

The aim of this study was to evaluate and compare long-term drug survival of the first biologic treatments including adalimumab, certolizumab, etanercept, golimumab, infliximab, secukinumab and ustekinumab in patients with PsA.

Methods:

PsA patients, electronically registered at each visit in the TURKBIO database between 2011 and 2019 were included in the study. PASW 18.0 for Windows was used for statistical analysis. Drug survival rates were calculated by Kaplan Meier method.

Results:

355 patients (227 women; axial PsA = 48, peripheral PsA = 307) were included in the study (Table 1). Adalimumab was the most commonly used first biologic treatment (n=125; 37.6%). The rate of drug survival was found to be 0.75 at month 60 in patients receiving the first biologic treatment (Figure 1). There was no significant difference in drug survival rate between tumor necrosis factor alpha inhibitor (TNFi) and non-TNFi biologic drugs (p=0.56). No difference was also found in drug survival rates between each biologic treatment.

Table 1.

Initial demographic and clinical datas of patients with PsA

PsA Patients (n=355)Females, n (%)227 (63,9)Age of diagnosis, years*34,6 (27-42)CRP baseline*6 mg/ L (3-15)ESR baseline*24 mm/h (10-38)Smoking, n (%)Current99 (28,5)Never192 (55,3)Previous56 (16,2)HLA B27 positivity,n (%)41 (26,4)First biologic agent, n (%)-TNFi332 (95,4)AdalimumabEtanercept125 (37,6)80 (24,1)Golimumab52 (15,6)Certolizumab44 (13,3)Infliximab31 (9,4)- Other biologic agents16 (4,6)Secukinumab13 (81,3)Ustekinumab3 (18,7)

*median (min-max)

Conclusion:

The results of this study establish that more than half of patients with PsA can remain in their initial biologic treatment over a long term. It has been observed that the choice of biologic treatment did not effect the drug survival in PsA.

Disclosure of Interests:

None declared

Comparison of Oxidant and Antioxidant Parameters in Patients with Sjögren’s Syndrome and Healthy Subjects

Objective Oxidative stress may have an effect on the pathogenesis of diseases, including autoimmune rheumatic diseases. We aimed to investigate the serum paraoxonase activity and other oxidant/antioxidant parameters in patients with Sjögren’s syndrome (SS) and healthy controls.

Methods 85 patients with SS and 65 healthy subjects were included in the study. Groups were age and gender-matched and had no liver disease. Serum paraoxonase (PON)-1 activity, stimulated paraoxonase (SPON), PON-1 phenotypes that represent polymorphism (Q192R; QQ, QR, RR), arylesterase (ARE), total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), advanced oxidative protein products (AOPP), total thioles (TTL) and ischaemia-modified albumin (IMA) were measured in all study participants.

Results Statistically significant differences were found in the QQ and QR+RR phenotype of PON-1 for TAC, TOS and TTL (p<0.001) between SS and healthy groups. The other parameters were statistically insignificant.

Conclusion Antioxidant parameters were lower in SS patients compared with healthy controls. Conversely, oxidant parameters were higher. This imbalance may play a role in SS pathogenesis.

Comparison of the effects of stabilization exercise plus kinesio taping and stabilization exercise alone on pain and well-being in fibromyalgia

PURPOSE

To compare the effects of spinal stabilization exercise (SSE) plus kinesio taping (KT) and SSE alone on pain and well-being in women with fibromyalgia (FM).

MATERIAL AND METHODS

Patients with FM were randomly allocated into SSE (n:19) and SSE + KT (n:17) groups. Pain and fatigue with Visual Analog Scale, health status with Fibromyalgia Impact Questionnaire, quality of life (QoL) with Nottingham Health Profile, depression with Beck Depression Inventory, sleep quality with Jenkins Sleep Scale were assessed. SSE and KT with fascial correction technique were carried out 2 days a week for 6 weeks.

RESULTS

SSE + KT was more effective in decreasing pain and fatigue, and improving some parameters related to health status and the QoL compared to SSE alone (p < 0.05). After treatment, pain, depression, health status, QoL, and sleep quality improved in both groups (p < 0.05).

CONCLUSIONS

SSE with KT was superior for improving pain and general well-being compared to SSE alone.

An assessment of ocular elasticity using real time ultrasound and ocular response analyzer in active or remission rheumatoid arthritis

PURPOSE

To investigate the elasticity of ocular structures in patients with rheumatoid arthritis (RA) without ocular involvement.

METHODS

The study included 56 RA patients (study group) and 24 healthy volunteers as the control group. The rheumatoid arthritis patients were divided into two subgroups as those in active phase (Group 1, n = 25) or in remission phase (Group 2, n = 31) according to the disease activity index (DAS 28) score. The elastography values of the ratio of orbital fat-sclera (ROF/S) were measured with real-time US elastography, and corneal mechanical values were measured with the Reichert Ocular Response Analyzer in each eye.

RESULTS

The mean ROF/S value was 5.2 ± 1.8 in Group 1, 0.7 ± 0.4 Group 2, and 0.6 ± 0.1 in the control group. There was a significant difference between the Group 1 and control group with regard to ROF/S (p < 0.001), but no significant difference was determined between Group 2 and control group (p > 0.05). The mean ROF/S value was a significant difference between the Group 1 and 2 (p < 0.001). ROF/S was significantly correlated with DAS-28 and C-reactive protein (CRP) (r = 0.816, p < 0.001 and r = 0.259, p = 0.006).

CONCLUSIONS

ROF/S was significantly increased in patients in the active phase of RA. Findings revealed that ocular tissue structural changes may occur in the active phase and these could be related to ocular complications as a prognostic factor.

Do the European League Against Rheumatism (EULAR) Sjögren's syndrome outcome measures correlate with impaired quality of life, fatigue, anxiety and depression in primary Sjögren's syndrome?

INTRODUCTION

The aim of the study was to investigate whether there is a relationship between the European League Against Rheumatism (EULAR) outcome measures and quality of life (QoL), fatigue, anxiety and depression in patients with pSS and to define determinants which could affect quality of life.

MATERIAL AND METHODS

The study included 105 pSS patients and 72 age/sex-matched healthy controls (HCs). Cross-sectional clinical data were collected, including the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Assessment of Fatigue (MAF) scale, the Short Form (SF-36), EULAR Sjögren's syndrome disease activity index (ESSDAI) and EULAR Sjögren's syndrome patient reported index (ESSPRI).

RESULTS

The SF-36 scores were significantly lower and anxiety, depression and fatigue scores were significantly higher in the pSS group than in the control group (all p-value < 0.05). ESSDAI was negatively correlated with SF-36 scores and positively with MAF. ESSPRI was negatively correlated with SF-36 scores except for the mental health subdimension, and a positive correlation was determined with MAF, HADS-A and HADS-D. Multiple linear regression analysis revealed that HADS-A, HADS-D, MAF, ESSPRI and ESSDAI were associated with most SF-36 subscales.

CONCLUSIONS

The results of this study provide further evidence supporting the use of ESSDAI and ESSPRI in daily practice. Quality of life was diminished in patients with pSS and was associated with different symptoms. This should be taken into account when managing patients with pSS.

Nationwide Experience With Off-Label Use of Interleukin-1 Targeting Treatment in Familial Mediterranean Fever Patients

OBJECTIVE

Approximately 30-45% of patients with familial Mediterranean fever (FMF) have been reported to have attacks despite colchicine treatment. Currently, data on the treatment of colchicine-unresponsive or colchicine-intolerant FMF patients are limited; the most promising alternatives seem to be anti-interleukin-1 (anti-IL-1) agents. Here we report our experience with the off-label use of anti-IL-1 agents in a large group of FMF patients.

METHODS

In all, 21 centers from different geographical regions of Turkey were included in the current study. The medical records of all FMF patients who had used anti-IL-1 treatment for at least 6 months were reviewed.

RESULTS

In total, 172 FMF patients (83 [48%] female, mean age 36.2 years [range 18-68]) were included in the analysis; mean age at symptom onset was 12.6 years (range 1-48), and the mean colchicine dose was 1.7 mg/day (range 0.5-4.0). Of these patients, 151 were treated with anakinra and 21 with canakinumab. Anti-IL-1 treatment was used because of colchicine-resistant disease in 84% and amyloidosis in 12% of subjects. During the mean 19.6 months of treatment (range 6-98), the yearly attack frequency was significantly reduced (from 16.8 to 2.4; P < 0.001), and 42.1% of colchicine-resistant FMF patients were attack free. Serum levels of C-reactive protein, erythrocyte sedimentation rate, and 24-hour urinary protein excretion (5,458.7 mg/24 hours before and 3,557.3 mg/24 hours after) were significantly reduced.

CONCLUSION

Anti-IL-1 treatment is an effective alternative for controlling attacks and decreasing proteinuria in colchicine-resistant FMF patients.

Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients

PURPOSE

Impedance ratio (Imp-R) obtained by multifrequency bioimpedance analysis (BIA) has been shown to be associated with volume and nutrition status. In this prospective study, the predictive role of Imp-R for mortality in hemodialysis (HD) patients was investigated.

METHODS

Multifrequency (5-50-100-200 kHz) BIA was applied to 493 prevalent HD patients in March-April 2006. Imp-R was defined as the ratio of 200-5 kHz impedance values. Demographical, clinical and laboratory data at the time of the analysis were recorded. All-cause and cardiovascular (CV) mortality were assessed during 3 years of follow-up.

RESULTS

Mean age was 57.7 ± 13.9 years, HD duration 52.1 ± 42.6 months and prevalence of diabetes 21.7 %. Imp-R was negatively correlated with nutritional markers including albumin, creatinine and hemoglobin levels. In addition, there was a positive correlation between Imp-R and age, ratio of extracellular water to total body water and high-sensitive C-reactive protein. Over a mean follow-up period of 27.9 ± 11.1 months, 93 deaths (52 from CV reasons) were observed. In the multivariate analysis, Imp-R was significantly associated with all-cause and CV mortality after adjustments [HR 1.13, 95 % CI (1.04-1.23); p = 0.004 and HR 1.15, 95 % CI (1.03-1.27); p = 0.01, respectively]. The risk of all-cause mortality was 3.4 times higher in the fourth quartile of Imp-R (>83.5 %) compared to the first Imp-R quartile (<78.8 %) as reference. Cutoff value of Imp-R for all-cause mortality was 82.0 % with a sensitivity of 65.5 % and specificity of 64 %.

CONCLUSION

Impedance ratio measured by multifrequency in standardized conditions BIA is an independent and powerful predictor of both all-cause and CV mortality in hemodialysis patients.

Brucellosis in spondyloarthritis mimicking an exacerbation

Spondyloarthritis are a group of chronic inflammatory diseases that affect the axial skeleton, entheses and peripheral joints and may have extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Brucellosis is a systemic infectious disease, endemic in Middle East, Latin America, and Mediterranean countries, which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Some hallmarks of Brucellosis may mimic a spondyloarthritis flare. In this paper, authors present a clinical case of brucellosis occurring in a patient with spondyloarthritis. Clinical symptoms initially mimicked exacerbation of spondyloarthritis.

Co-existence of familial Mediterranean fever and multiple sclerosis in two patients

ABSTRACT Two female patients, aged 23 and 25 years-old diagnosed with Familial Mediterranean fever (FMF) were presented with ataxia and headache. Multiple sclerosis plaques were detected in their spinal and cranial MRI and diagnosis of multiple sclerosis was established. Genetic analysis demonstrated M694 V mutation (one homozygous and the other heterozygous) in both of the patients. Although it is quite rare, coexistence of familial Mediterranean fever and multiple sclerosis should be kept in the mind.