Deep ulcers are associated with increased C-reactive protein in active ulcerative colitis

BACKGROUND

Increased C-reactive protein (CRP) is used to diagnose and predict response to treatment in acute severe ulcerative colitis (UC).

AIMS

To investigate the connection between CRP elevation and deep ulcers in UC.

METHODS

Patients with active UC were enrolled in a multicenter prospective cohort and a retrospective cohort of consecutive patients undergoing colectomy from 2012 to 2019.

RESULTS

Forty-one (9 (22%) with deep ulcers) patients were included in the prospective cohort: 4/5 (80%) patients with CRP > 100 mg/L, 2/10 (20%) patients with CRP between 30 and 100 mg/L and 3/26 (12%) patients with CRP < 30 mg/L had deep ulcers (p = 0.006). In the retrospective cohort [46 patients (31 (67%) with deep ulcers)], 14/14 (100%) patients with CRP > 100 mg/L, 11/17 (65%) patients with CRP between 30 and 100 mg/l and 6/15 (40%) patients with CRP < 30 mg/L had deep ulcers (p = 0.001). Positive predictive value of CRP > 100 mg/l for presence of deep ulcers was 80% and 100% in both cohorts, respectively.

CONCLUSIONS

CRP elevation is a robust surrogate marker for presence of deep ulcers in UC. Elevated CRP or presence of deep ulcers could influence the choice of medical therapy in acute severe UC.

POS0438 IDENTIFICATION OF ANTI-CYTOKINE AUTOANTIBODIES WITH POTENTIAL TO PREDICT FLARE IN RHEUMATOID ARTHRITIS PATIENTS UNDERGOING BIOLOGICAL THERAPIES: A DISCOVERY STUDY

Background

The presence of anti-cytokine autoantibodies (ACAAs) seems to be a physiologic mechanism to control the immune response and regulate cytokine activity. Biological therapies also regulate cytokine activities and have greatly improved the quality of life of RA patients. However, alteration of the cytokine network by the use of these treatments may lead to a disbalance in the regulatory system of ACAAs. We hypothesize the ACAAs network may influence the course of immune response in RA patients and may be useful to predict the therapy efficacy.

Objectives

We aimed to explore the potential of circulating ACAAs to predict flare in a cohort of RA patients treated with biological therapy.

Methods

We employed sera at baseline from 194 RA patients of the clinical trial OPTIBIO1 (A Coruña), whose primary endpoint is to evaluate the usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologics. These patients were treated with TNF inhibitors (Etanercept, N=47; Infliximab, N=12; Adalimumab, N=35; Certolizumab (CTZ), N=17; Golimumab, N=5), Tocilizumab (TCZ, N=60) and Abatacept (ABA, N=18). Patients were in clinical remission (DAS 28 <2.6 or SDAI <5 or ACR/EULAR 2011 criteria) at least from 6 months. Patients were followed during a minimum period of one year and maximum period of 3 years. Flare was considered when remission criteria were not fulfilled. The bead-based antigen array MILLIPLEX MAP Human Cytokine Autoantibody Magnetic Bead Panel was used for the simultaneous detection and quantification in sera of anti-BAFF, anti-G-CSF, anti-IFNβ, anti-IFNγ, anti-IL-1α, anti-IL-6, anti-IL-8, anti-IL-10, anti-IL-12 (p40), anti-IL-15, anti-IL-17A, anti-IL-17F, anti-IL-18, anti-IL-22, and anti-TNFα. Non-parametrical tests, ROC curves and logistic regressions were performed for the statistical data analysis using SPSS. P-value < 0.05 was considered statistically significant.

Results

The levels of anti-17A and anti-IL-1α were increased in the sera from patients who suffered a flare during the follow-up period (N= 76), compared to those who remained in remission (N= 118), showing an area under the curve (AUC) of 0.586 and 0.594, respectively. Segregating by treatment, the levels of anti-17A were specifically increased in those relapsing patients under CTZ (N=6), ABA (N=12) and TCZ (N=20) treatment. The AUC of anti-17A within these three therapies was 0.867, 0.903 and 0.682, respectively. Logistic regression analysis also associated the levels of anti-17A with the risk of suffering a flare in TCZ-treated patients (OR=1.11; p=0.015, for 100 MFI increase). In addition, the TCZ-treated patients who suffered a flare also showed higher levels of anti-IL17F, anti-IL-1α, and anti-IL-18 compared to those that remained in remission, showing AUCs of 0.689, 0.657 and 0.698, respectively. Anti-IL-18 was also associated with the risk of flare in these patients (OR=1.65; p=0.028, for 100 MFI increase). The presence of these three ACAAs was also higher in the TCZ-treated patients who suffered a flare compared to those in remission.

Conclusion

Although further validation of our results is needed, we present a ground-breaking study showing the potential of anti-IL17A, anti-IL-1α, and anti-IL18 to predict flare in RA patients under biological therapies.

References

[1]Bejerano C, et al. Clinical evaluation usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologic therapies. The Optibio Study. Arthritis Rheumatol. 2016; 68 (suppl 10): 649.

Table 1.

Table showing a summary of the results. CI: confidence interval

• Treatments• ACAAs• AUC (CI 95%; p)Allanti-IL17A0.586 (0.504-0.668; 0.044)anti-IL-1α0.594 (0.512-0.676; 0.028)CTZanti-IL17A0.867 (0.675,1.000; 0.017)ABAanti-IL17A0.903 (0.761-1.000; 0.007)TCZanti-IL-1α0.657 (0.494-0.820; 0.049)anti-IL-17F0.689 (0.551-0.827; 0.018)anti-IL17A0.682 (0.528-0.835; 0.023)anti-IL180.698 (0.545-0.850; 0.013)

Disclosure of Interests

None declared.

AB1171 PERSISTENT POST-DISCHARGE SYMPTOMS AFTER COVID-19 IN RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

The COVID-19 pandemic continues worldwide and has had a strong impact on public health. As the pandemic evolves, efforts have been intensified to identify persistent symptoms associated with the infection once resolved have intensified.

Objectives

We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission due to Covid-19. We also compared the role of autoimmune rheumatic diseases (ARD) with that of non–autoimmune rheumatic and musculoskeletal diseases (NARD) in persistent symptoms and sequelae.

Methods

We performed an observational study of patients with RMD who attended a rheumatology outpatient clinic in Madrid and required admission to hospital due to Covid-19 (1st March-30th May 2020) and survived. The study began at discharge and ran until 1st October 2020. The main outcomes were persistence of symptoms and sequelae related to Covid19. The independent variable was the RMD group (ARD and NARD). The covariates were sociodemographic data, clinical findings, and treatment. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group.

Results

We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least 1 persistent symptom. The most frequent were dyspnea, fatigue, and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, central retinal vein occlusion (1 patient), and optic neuritis (1 patient). Two patients died. Eleven patients required readmission owing to Covid-19 problems (16.7% ARD vs 3.9% NARD; p=0.053). No statistically significant differences were found between RMD groups in the final models.

Conclusion

Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. Compared to NARD patients, ARD patients do not seem to differ in terms of persistent symptoms or sequelae, although ARD patients might generate more readmissions due to Covid-19.

References

[1]Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16–25

[2]Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA -J Am Med Assoc. 2020;323(11):1061–9

[3]Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med. 2020;35(5):1545–9.

[4]Sung HK, Kim JY, Heo J, Seo H, Jang Y, Kim H, et al. Clinical Course and Outcomes of 3, 060 Patients with Coronavirus Disease 2019 in Korea, January – May 2020. 2020;35(30):1–11.

[5]Freites Nuñez DD, Leon L, Mucientes A, Rodriguez-Rodriguez L, Font Urgelles J, Madrid García A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(11):1393–9.

Disclosure of Interests

None declared

POS1253 MORTALITY RATE RELATED TO COVID - 19 IN RHEUMATIC AND MUSCULOSKELETAL DISEASES (RMDs)

Background:

Spain has been one of the countries most impacted by the COVID-19 pandemic. Among Spanish patients, 56,799 deaths have been reported. Although we have been in this situation of pandemic for a year, studies that show risk mortality rates in patients with rheumatic diseases continue to be scarce.

Objectives:

In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid – 19, a) we want to assess the mortality rate (MR) related to COVID-19; and b) to analyze the role of RMDs in mortality risk.

Methods:

An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and SARS - CoV 2 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main outcome: death related to COVID-19 infection. Independent variable: type of RMDs including: autoimmune (systemic autoimmune conditions (SAC) and inflammatory joint disease (IJD)) and non–autoimmune (mechanical diseases and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, comorbidities, chronic use of corticoids prior to COVID-19 infection. Survival techniques were used to estimate the MR related to COVID-19, given per 1,000 persons-month with a 95% confidence interval [CI]. The time of observation comprised the elapsed time between the date of COVID-19 diagnosis of infection until the date of patient’s death, or end of study. Cox multiple regression analysis was run to examine the effect of autoimmune RMDs compared to non-autoimmune RMDs on mortality risk adjusted by sex, age and comorbidities. Results were expressed by Hazard Ratio (HR) and [CI].

Results:

406 patients were included with RMD and Covid – 19 infection with a total follow-up 642.5 patients-month. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of rheumatic disease was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic condition) had autoimmune RMD. Of the 406 patients, 45 (11%) died during the follow-up, being 12± 14 days the mean time from infection to death (P50: 6[2-12] and a maximum of 60 days). MR was estimated in 70.03 [52.28-93.79] per 1,000 persons-month. MR was higher for men (MR 105[68-163]) than for women (MR 55 [37.2-81.6]) and in older people (MR <60: 4.4, [0.6-31.7]; MR 60-75 years: 38.7[17.3-86.2]; MR >75Years: 486 [354-1668]). The HR of mortality in autoimmune RMDs compared to non-autoimmune RMDs did not achieved statistical significance (HR: 1.39 [0.77-2.5], p=0.27). After adjusting for confounders, we did not find higher risk of mortality among the different types of RMDs (HR autoimmune vs non-autoinmunes: HR: 1.12 [0.6-2.02], p=0.7; HR IJD vs SAC; 1.5 [0.6-3.6], p=0.34; HR non-autoimmune vs SAC: 1.1 [0.5-2.5], P=0.7). Age (HR: 1.12; [1.10-1.15], p<0.001), and the presence of comorbidities (HR: 2.05; [1.08-3.89], p=0.027) increased the Mortality risk.

Conclusion:

In patients with RMD and COVID-19 infection, we found a mortality rate of 7 per 100 persons-month. This study shows that the mortality risk related to COVID-19 is similar between autoimmune and non-autoimmune diseases after adjusting by confounders. We also found that age and comorbidities are risk factors for mortality related to COVID-19 infection.

References:

[1]Jorge A, et al. Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study. Lancet Rheumatol. Epub ahead of print 2021..

[2]Bonfá E, et al. How COVID-19 is changing rheumatology clinical practice. Nat Rev Rheumatol 2021; 17: 11–15.

[3]Hyrich KL, Machado PM. Rheumatic disease and COVID-19: epidemiology and outcomes. Nature Reviews Rheumatology 2020; 17: 71–72.

Disclosure of Interests:

None declared

POS1251 ROLE OF SYSTEMIC AUTOINMUNE CONDITIONS IN HOSPITAL ADMISSIONS RELATED TO COVID-19

Background:

The COVID-19 pandemic continues worldwide and has had a strong impact on public health, quality of life and economy of the general population. To date, the number of infections and deaths are still increasing. From the beginning of the pandemic, efforts were intensified to identify risk factors for development of the severe form of COVID-19. In this sense underlying medical comorbidities have been shown to have a worse prognosis in these patients.

Objectives:

In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid – 19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions.

Methods:

An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and Covid-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid -19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI).

Results:

406 patients were included with RMDs and Covid- 19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68; [1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR IJD: 0.41 [0.21-0.51], p=0.01; OR non-autoimmune: 0.33; [0.18-0.61]; p=0.000). After adjusting by confounders, autoimmune RMD had higher risk of hospital admissions compared to the rest (OR: 1.75; [1.04-2.95]; p=0.03), and specifically systemic autoimmune condition had higher risk compared to IJD (OR of IJD 0.33; [0.14-.076]; p=0.009) and compared to non–autoimmune (OR non autoimmune 0.28; [0.13-0.59], p=0.001). Advanced age (OR: 1.10; [1.07-1.12], p<0.001), male (OR 0.58; [0.33-1.02], p=0.06), and more number of comorbidities (OR 1.39; [1.02-1.90] p=0.03) also increased the risk of hospitalization related to COVID-19.

Conclusion:

One third of the RMD patients infected with COVID-19 required hospital admission. This study shows that patients with autoimmune and specifically with systemic autoimmune conditions have a higher risk of hospitalization related to COVID-19. We also show that advanced age, male sex and a higher number of comorbidities can contribute to worsen the prognosis of the COVID-19 disease.

References:

[1]Jorge A, et al. Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study. Lancet Rheumatol. Ahead of print 2021.

[2]Hyrich KL, Machado PM. Rheumatic disease and COVID-19: epidemiology and outcomes. Nature Reviews Rheumatology 2020; 17: 71–72.

[3]Bonfá E, et al. How COVID-19 is changing rheumatology clinical practice. Nat Rev Rheumatol 2021; 17: 11–15.

Disclosure of Interests:

None declared

AB0906-HPR BENEFIT OF A NURSE-LED PROGRAM OF CARE FOR MANAGEMENT OF PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS: SYSTEMATIC LITERATURE REVIEW

Background:

Nowadays, many countries experience an urgent demand for rheumatologists and greater cost-effectiveness. Thus, different alternatives to conventional outpatient physician-led follow-up have been investigated. The alternative of community-based service delivery systems is intended to meet emerging needs, reducing the costs of hospital care and morbidity. In patients with long-term conditions, such as Rheumatoid Arthritis (RA), nurses are seen as essential in the delivery of promotion in self-care and decision-making, favoring the empowerment of patients.

Objectives:

To systematically investigate if the nurse led-care management (NLCM) education programs are beneficial in patients with RA.

Methods:

This is a systematic literature research publication on the following bibliographic databases: Medline, Embase and the Cochrane Central register of Controlled Trials from the beginning until 2019.

Results:

From a yield of 116 studies, 44 were included in the review. After quality assessment and exclusion of the lowest-ranked studies, 19 studies were analyzed. Outcomes were organized into six themes (1) disease activity; (2) adherence; (3)satisfaction; (4)treatment compliance, (5) depression and (6)quality of life. All studies had significant results in at least one of the outcomes.

Conclusion:

According to our results, we can conclude that, clinicians could benefit from support conducted by nurse in the management of these patients in tasks such as metrology clinic, participation in enforcement, self-administration, the correct dosage and side effects of treatments, and link the patient and other professionals or entities. It would therefore be advisable to conduct further studies to draw more accurate and reliable conclusions in this context.

References:

[1]Bech B, Primdahl J, Van Tubergen A, et al. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2020; 79: 61–68.

[2]Uthman I, Almoallim H, Buckley CD, et al. Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East. Rheumatology International 2020; 1: 3.

[3]Garner S, Lopatina E, Rankin JA, et al. Nurse-led care for patients with rheumatoid arthritis: A systematic review of the effect on quality of care. J Rheumatol 2017; 44: 757–765.

Disclosure of Interests:

None declared

POS1225 INFLUENCE OF COLCHICINE PRESCRIPTION IN COVID19-RELATED HOSPITAL ADMISSIONS: A SURVIVAL ANALYSIS

Background:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggers the innate immune system, leading in severe cases, an excessive immune response, which can lead to high levels of pro-inflammatory cytokines promoting a “cytokine storm”.

To modulate this exaggerated inflammatory response, several clinical trials with already approved and well-known therapeutic agents that inhibit the inflammatory response, are being carried out. However, none of these drugs seems to achieve the desired results when treating COVID19.

Colchicine, a drug often used in the management of patients with Rheumatic and Musculoskeletal diseases (RMDs), is one of the several drugs that are being currently tested for efficacy in COVID19 due to its anti-inflammatory effects.

Objectives:

To analyze association between colchicine prescription and COVID19-related hospital admissions in patients with Rheumatic and Musculoskeletal diseases (RMDs).

Methods:

Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1st September 2019 to 29th February 2020 were included.

Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID19-related hospital admissions occurring between March 1st and May 20th, 2020. Secondary outcome included COVID19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes.

Results:

9,379 patients entered in the study, with 406 and 9,002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBM) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing (p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis.

Conclusion:

Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis.

References:

[1]Fernandez-Gutierrez B. COVID-19 with Pulmonary Involvement. An Autoimmune Disease of Known Cause. Reumatol Clin 2020; 16: 253–254.

[2]Coperchini F, Chiovato L, Croce L, et al. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev 2020; 53: 25–32.

[3]Shaffer L. 15 drugs being tested to treat COVID-19 and how they would work. Nat Med. Epub ahead of print 15 May 2020. DOI: 10.1038/d41591-020-00019-9.

[4]Fernandez-Gutierrez B, Leon L, Madrid A, et al. Hospital admissions in inflammatory rheumatic diseases during the COVID-19 pandemic: incidence and role of disease modifying agents. medRxiv 2020; 2020.05.21.20108696.

[5]Freites Nuñez DD, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020; 1–7.

Disclosure of Interests:

None declared

AB0881-HPR EVALUATION OF NURSING CARE PLANS FOR RHEUMATOID ARTHRITIS PATIENTS: NURSING 2.0 PROJECT

Background:

A better quality of care for chronic patients is only obtainable through multidisciplinary teams. In recent years, rheumatology nurses have been involved in the remote monitoring of aged Rheumatoid Arthritis (RA) patients, as their high levels of multi-morbidity and disability make routine contacts too complex for patients and caregivers. Nursing health care should be evidence-based and organized to optimize the professionals’ time.

Objectives:

To develop a pilot study of two Nursing Care Plans (NCP) in Rheumatology consultations for Rheumatoid arthritis patients, exploring the satisfaction, disease activity, adherence and quality of life of the patients.

Methods:

This is a non-randomised interventional study. All the stablished RA patients attending our clinics were offered one of the care plans, based on clinic characteristics, functional status, social needs, social support, preferences and health literacy. They are focused on three fundamental axes: adaptation, adherence and safety of the patient. We evaluated the two NCP that were created: (1) Elderly established RA face to face/phone visit, (2) Active young established RA face to face/phone visit. The study included a first baseline visit and a second visit at six months. Outcomes were adherence to treatment: using the Morisky Green questionnaire, disease activity; through the erythrocyte sedimentation rate (ESR), patient satisfaction; using the LOPSS questionnaire and quality of life: using the EUROQOL 5D questionnaire, Visual analog scale of the attention received and Visual analog scale of the care received. Final visit were compared to baseline visit in both groups. The paired Wilcoxon or McNemar test were used.

Results:

We included 48 patients, 16 from the NCP 1 and 32 from the NCP 2. All patients except one from the NCP 2 were followed-up and ended the study. The mean age of the participants was 56 years. 77.5% were women. 30.6% had an active smoking habit. 46% had universitary studies. 53.1 had an active labor situation. Regarding the main outcomes: a)Disease activity, a slight decrease in activity was observed between baseline and 6 months, but without statistically significant differences. b) Quality of life, we detected some improvement in all care plans in the EQ-index and in the Visual analog scale (VAE) but there were no statistically significant variations. c) Therapeutic adherence, we show the results in the Morinsky Green questionnaire. We obtained statistical significant decrease in the percentage of patients that forgot to take their prescribed medications after 6 months (p=0.04), and we also saw an increase in the percentage of patients taking medications at established times (up to 100% in all groups). d) Patient satisfaction with NCP obtained at the end of study, we used the LOPPS questionnaire. We obtained at six months a punctuation less than 1.5 (ordinal scale that 1 is good 5 is bad). e) Satisfaction of the care received by patients over the phone assessed at the end of study, it was almost 100%, being 75% of the patients scores 9 or over. f) Satisfaction with the care plans assessed at the end of study, the score given by patients was almost 90%, being 75% of the patients scores 8 or over.

Conclusion:

After applying the NCP in both groups, we found positive results after 6 months and mainly regarding the therapeutic adherence. The program was well evaluated by the patients in terms of satisfaction of the care provided.

References:

[1]Garner S, Lopatina E, Rankin JA, et al. Nurse-led care for patients with rheumatoid arthritis: A systematic review of the effect on quality of care. J Rheumatol 2017; 44: 757–765.

[2]Uthman I, Almoallim H, Buckley CD, et al. Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East. Rheumatology International 2020; 1: 3.

[3]Bech B, Primdahl J, Van Tubergen A, et al. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2020; 79: 61–68.

Disclosure of Interests:

Leticia Lopez Pedraza Grant/research support from: Pfizer, María Rodero Grant/research support from: Pfizer, Gloria Candelas Grant/research support from: Pfizer, Cristina Lajas Grant/research support from: Pfizer, Teresa Mulero López Grant/research support from: Pfizer, Ana María Perez Saez Grant/research support from: Pfizer, Leticia León Grant/research support from: Pfizer, Zulema Rosales Grant/research support from: Pfizer, Benjamin Fernandez Grant/research support from: Pfizer, Lydia Abasolo Grant/research support from: Pfizer, Luis Rodriguez Rodriguez Grant/research support from: Pfizer

Bochdalek diaphragmatic hernia with bowel incarceration

The purpose of this image is to illustrate a Bochdalek hernia diagnosis in a 39-year-old female patient treated on an emergency basis by means of CT-scan and following perioperative observation. Treatment consisted in initial laparoscopy that due to irreducible bowel incarceration was converted into hernia repair surgery through simple suture and thoracic drainage.

SAT0598 PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH MUSCULOSKELETAL DISEASES: A LONGITUDINAL ANALYSIS FROM AN ELECTRONIC HEALTH RECORD DATABASE

Background:

Musculoskeletal diseases (MSKs) are the major cause of disability, affecting the patient’s daily activities as well as their Quality of Life (QoL).

Objectives:

To analyze in a cohort of patients with MSKs the influence of demographic and clinical predictors in repeated measures of Health-Related QoL (HRQoL) obtained from a departmental electronic health record (EHR)

Methods:

Patients attending the Hospital Clínico San Carlos rheumatology outpatient clinic (HCSC-MSK cohort) from April 1st, 2007 to November 30th, 2017 who were seen at least twice were included in this study. Visits separated more than one year from previous or next visit were excluded. Our primary outcome was HRQoL collected in each patient’s visit using the Rosser Classification Index (it ranges between 0 and 1, the higher value, the higher HRQoL. It is calculated as the combination of two subscales: disability and distress). Demographic and clinical variables, such as diagnoses, treatments, and comorbidities were included as predictors. Variable selection was carried out in 4 steps. First, we developed a bivariate Generalized Estimating Equations model, selecting those variables with a p-value < 0.15. Second, those with a pair-wise absolute correlation < 0.95 were carried to the next step. Third, multivariate GEE analyses were performed including clinical related variables, and those independently associated with our primary outcome were selected with a p-value < 0.15. At least one predictor of each multivariate analyses was included even if none of them had p-value < 0.15. In this case the one, with the lowest p-value was chosen. Fourth, a grid search approach was followed to determine the penalization value and a penalized GEE model was implemented including all selected variables and using an independence correlation structure. Those with an estimate greater than 10^-3 and a z-robust > 1.96 were considered to be independently associated with the HRQoL.

Results:

A total of 18,187 patients with 95,960 outpatient visits were included in this study. From the initial 410 predictors, 289, 241, 153, and 34 were selected in the first, second, third, fourth and fifth steps. The median age was 56.4 years. The major part of the patients were women (69.4%), and the medianRosservalue was 0.986. More common diagnoses, treatments and comorbidities were back pain, tendinitis, pain in joint; analgesia, gastric protector and NSAIDs; hypertension, dyslipidemia and diabetes respectively. The predictors with a greater negative impact in HRQoL were the use of 3rd level analgesics and azathioprine, a presence of kidney failure, fibromyalgia, and ischemic heart disease. Conversely, use of symptomatic slow action drugs for osteoarthritis, statins, lowering uric acid drugs, a diagnose of mixed connective tissue disease, and better HRQoL in the past six months were independently associated with a positive impact in the HRQoL.

Conclusion:

We have identified several diagnoses, treatments and comorbidites independently associated with HRQoL in a cohort of patients followed up in a rheumatology outpatient clinic. This represent a first step in the implementation of value-based care for MSK patients, as we can now review the procedures associated with a worse HRQoL in an attempt to improve them.

References:

Predictor selection. Dx: Diagnoses. DxE: Diagnoses Episode. DxTFT: Diagnoses Total Follow-up Time.

DxTET: Diagnoses Total Episode Follow-up Time T: Treatment. DxE: Treatment Episode. DxTFT:

Treatment Total Follow-up Time. DxTET: Treatment Total Episode Follow-up Time. XM: Comorbidities

and Concomitant Treatments. DM: Demographics. HS: Health Status.

Disclosure of Interests:

None declared

AB0077 CONTRIBUTION OF NOTUM TO THE DEVELOPMENT OF OSTEOARTHRITIS

Background:

Osteoarthritis (OA) is a degenerative disease characterized by altered homeostasis of joint cartilage and bone, the functionality of which relies on chondrocytes and osteoblasts, that leads to the formation of a defective extracellular matrix (ECM). The ECM plays an essential role in bone biology as it provides the structure of cartilage which serves as a template for bone formation. Collagen X, main component of the ECM, has been described by our group as down-regulated in OA [1]. Our data also points to an important role of the Wnt pathway in OA [1,2]. Furthermore, Wnt proteins have been reported to inhibit chondrogenesis [3], and the Wnt pathway and its modulators have gained attention [4]. Glypicans (GPC1 to GPC6) and NOTUM, among others, have been identified as modulators of this pathway [5,6]. Notably, due to its highly specific inhibition of the Wnt pathway, NOTUM has been proposed as a therapeutic target in conditions with a high activity of the Wnt pathway is involved, such as OA [7].

Objectives:

We hypothesize that modulators of the Wnt pathway are involved in the development of OA. The aim of this study is to evaluate the presence of Glypicans and NOTUM in the serum of OA patients and healthy individuals in order to determine whether significant differences exist and could clarify their likely involvement in OA.

Methods:

Peripheral blood samples were obtained from OA patients during routine rheumatologist hospital visits. OA diagnosis was established according to the ACR criteria. Samples from healthy individuals were obtained from the local Blood Bank. In both cases, blood samples were centrifugated (2000g, 15 minutes, 10°C) and serum was obtained.

Quantitative ELISA assays for GPC1-6 and NOTUM were carried out using commercial kits (Human GPC1 ELISA Kit, #E-EL-H1710, Elabscience; Human GPC2 ELISA Kit, #E-EL-H1711, Elabscience; Human GPC3 ELISA Kit, #E-EL-H1712, Elabscience; Human GPC4 ELISA Kit, #E-EL-H1713, Elabscience; Human GPC5 ELISA Kit, #ELH-GPC5, RayBiotech; Human GPC6 ELISA Kit, #CSB-EL009708HU, Cusabio; Human Protein NOTUM homolog ELISA Kit, #EK3787, Sab Biotech) and measured in a plate reader (Heales MB-580,Shenzhen Heales Technology Development Co. Ltd.). Protein concentration in serum was calculated using GraphPad Prism 7 software. Differences between samples were analysed with Mann-Withney U test. Significance level set wasp<0.05.

Results:

Serum from 40 OA patients and 40 healthy donors were included in the study. There were no differences between groups (Table 1).

Table 1.

Cohort description

Control group (n=40)OA group (n=40)Age66,82±5,7569,59±11,24Women (%)32 (80%)30 (75%)

Out of 7 proteins analyzed, only NOTUM showed a significant difference between healthy and OA groups (MedianOA=0.4451ng/mL, MedianCONTROL=0.8263ng/mL,p=0.0013). Besides, GPC4 showed an approaching formal significance (MedianOA=0.1254ng/mL, MedianCONTROL=0.1596ng/mL,p=0.0767). The rest of Glypicans analyzed showed no significance differences between groups (GPC1, MedianOA=0.1346ng/mL, MedianCONTROL=0.1190ng/mL,p=0.2379; GPC2, MedianOA=2.593ng/mL, MedianCONTROL=2.955ng/mL,p=0.7489; GPC3, MedianOA=2.024ng/mL, MedianCONTROL=1.422ng/mL,p=0.3574; GPC5, MedianOA=3.663ng/mL, MedianCONTROL=5.529ng/mL,p=0.8829; GPC6, MedianOA=0.3922ng/mL, MedianCONTROL=0.3558ng/mL,p=0.3212).

Conclusion:

Our results suggest that low levels of NOTUM may contribute to the development of OA. The lack of this inhibitor promotes the activation of the Wnt pathway, high activity of which has been related with OA.

References:

[1]Lamas JRet al.Ann Rheum Dis, 2010. 69(10):1880-5.

[2]Tornero-Esteban Pet al. PLoS One, 2015. 10(9): p. e0137170.

[3]Dayet al. Dev Cell. 2005. 8(5):739-50.

[4]Monteagudo S and Lories RJ. Nat Rev Rheumatol, 2017. 13(11): p. 670-681.

[6]Li Net al. Trends Cancer. 2018 Nov;4(11):741-754.

[7]De Robertis Met al. Oncotarget, 2015. 6(38): p. 41237-57.

[8]Nusse R. Nature, 2015. 519(7542): p. 163-4.

Disclosure of Interests:

Arkaitz Mucientes: None declared, Eva Herranz: None declared, Pia Lois: None declared, Francisco J. Blanco Grant/research support from: Sanofi-Aventis, Lilly, Bristol MS, Amgen, Pfizer, Abbvie, TRB Chemedica International, Glaxo SmithKline, Archigen Biotech Limited, Novartis, Nichi-iko pharmaceutical Co, Genentech, Jannsen Research & Development, UCB Biopharma, Centrexion Theurapeutics, Celgene, Roche, Regeneron Pharmaceuticals Inc, Biohope, Corbus Pharmaceutical, Tedec Meiji Pharma, Kiniksa Pharmaceuticals, Ltd, Gilead Sciences Inc, Consultant of: Lilly, Bristol MS, Pfizer, Lydia Abasolo: None declared, Luis Rodriguez Rodriguez: None declared, José Ramón Lamas: None declared, Benjamin Fernandez: None declared

THU0001 GENOME-WIDE ASSOCIATION STUDY ON JOINT EROSIONS IN RHEUMATOID ARTHRITIS SUPPORTS DIFFERENTIAL PATHOLOGICAL MECHANISMS ACCORDING TO ANTI-CCP STATUS

Background:

Joint damage is the pathological hallmark of rheumatoid arthritis (RA). To identify the genetic variation associated with a higher level of erosions has proven elusive.

Objectives:

The objective of the present study was to perform a genome-wide association study on joint damage in a cohort of RA patients of the Spanish population. Our aims were to provide independent validation of previously reported variants and to identify new candidate risk loci. A stratified analysis was performed based on positivity to ACPA status.

Methods:

A total of 1,135 patients diagnosed with RA using the ACR-EULAR criteria recruited by the IMID Consortium were genotyped using a 550,000 single-nucleotide polymorphism array. Additional SNPs were imputed using the 1KG genome data. Joint damage was performed using the S-score, a simplified radiographic erosion score that has a high correlation with the Sharp-van der Hejde score (1). Association testing of SNPs with joint damage was performed via linear regression with the addition of the years of evolution as covariate. The two main components of genetic variation were also added to adjust for potential population stratification. A total of 50 SNPs representing previously reported loci associated with joint damage were selected. Genetic association was also performed at the pathway level using Pascal.

Results:

45 out of 50 SNPs representing 31 previously reported loci for joint damage could be satisfactorily imputed. Association testing of the whole patient cohort replicated the association withIL2RAandTRAF1. Of relevance, after stratifying for anti-CCP five new loci were replicated:KIF5AandSOSTin ACPA-positive RA andCD40, DKK1andTNFin ACPA-negative RA.IL2RAwas only significant in the ACPA-positive group andTRAF1was not significant in either strata. GWAS on the ACPA-positive cohort and on the ACPA-negative group identified n=7 and n=18 loci with P-values < 1x10-5, respectively. From these, however, only 1 SNP showed nominal significant association in the other patient group. Based on this evidence, we performed a pathway-based analysis to understand the biological mechanisms underlying this difference. Pathway analysis showed 52 biological processes associated with joint damage in ACPA-negative RA and 32 pathways in the ACPA-positive group, with only two shared biological processes between the two groups. Fc Gamma receptor mediated phagocytosis was the topmost biological process associated with erosions specifically in ACPA-negative RA and Signalling by Fibroblast Growth Factor mutants was the top process specific for ACPA-positive patients.

Conclusion:

The results from our study provide suggestive evidence that the genetic basis for joint damage is different according to the presence of ACPA. Replication of the new candidate loci in an independent patient cohort is underway.

References:

[1]Lopez-Lasanta, M., Julià, A., Maymó, J., Fernández-Gutierrez, B., Ureña-Garnica, I., Blanco, F. J., ... & Tornero, J. (2015). Variation at interleukin-6 receptor gene is associated to joint damage in rheumatoid arthritis.Arthritis research & therapy,17(1), 242.

Disclosure of Interests:

Antonio Julià: None declared, Francisco Blanco: None declared, Benjamin Fernandez: None declared, Antonio Gonzalez: None declared, Juan D: None declared, Joan Maymó: None declared, Mercedes Alperi-López: None declared, Alejandro Olive: None declared, Héctor Corominas Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Victor Martinez Taboada: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Antonio Fernandez-Nebro: None declared, Alba Erra: None declared, Simon Sánchez Fernandez: None declared, Núria Palau: None declared, Maria Lopez Lasanta: None declared, Adrià Aterido: None declared, Jesús Tornero: None declared, Sara Marsal: None declared

SAT0522 PROGRESSION OF VISION-RELATED QUALITY OF LIFE AND IDENTIFICATION OF RISK FACTORS IN NON-INFECTIOUS UVEITIS PATIENTS

Background:

Uveitis are characterized by inflammation of the middle layer of the eye wall. In developed countries uveitis are the second major treatable cause of blindness in those 20–65 years of age. Additionally, more than 50% of the subjects affected with these conditions will develop complications related to the uveitis, and more than 30% will suffer visual impairment. As a result, these conditions are associated with an important burden. The assessment of the patient’s quality of life (QoL) through standardized and validated questionnaires allows us to evaluate objectively the burden of the disease. Several studies have shown that the QoL of uveitis patients is reduced when compared with that of general population. Moreover, several socio-demographic and clinical related characteristics have been associated with impaired QoL. However, no longitudinal analysis of the vision-related (VR) QoL in clinical practice has been carried out.

Objectives:

To describe VR-QoL in non-infectious uveitis (NIU) patients during a follow-up period of two years. Furthermore, to analyse the influence of socio-demographic, clinical and treatment factors on the progression of VR-QoL.

Methods:

Longitudinal prospective study which includes patients examined in a multidisciplinary tertiary uveitis clinic, with a diagnosis of NIU. In each of these patients a yearly determination of VR-QoL was carried out following the VFQ-25 questionnaire, finally including all those who had completed at least an initial questionnaire and a second one after two years of follow-up. Analysis of risk factors at baseline in repeated VFQ-25 measurements was carried out by generalized estimating equations (GEE) models. Variables related to demographic, clinical and treatment factors with a determination of p-value <0.15 were included in multivariable models, which were then compared using theQuasi Akaike Information Criteria(qAIC). A local Ethics Committee approved the execution of this project.

Results:

128 patients were included, 117 of which also had an evaluation after the first year of follow-up. 55.5% were female with a median age of 34 years at the start of symptoms and of 37 years at the moment of attending our clinic for the first time. First evaluation of VR-QoL was determined a median (p25-p75) of 6.1 (1.8-13.1) years after that first visit. The most frequent locations of NIU were anterior (41.1%), panuveitis (27.4%), posterior (16.1%) and intermediate (15.3%). At our first evaluation, 27.3% of patients were receiving treatment with topical steroids, 22.3% oral, 49.2% immunosuppressant drugs (both synthetic and/or biological) and 19.05% biological therapies. The median (p25-p75) VFG25 determinations at baseline, first and second years of follow-up were 0.87 (0.78-0.93), 0.88 (0.80-0.93) y 0.89 (0.81-0.94), with no significant differences (first year vs. Baseline p = 0.54; 2 years vs. Baseline p = 0.61).

In the GEE multivariable models the presence at baseline of permanent incapacity due to NIU, concomitant thyroid disease, worse visual acuity, unilateral pattern, cataracts, retinal vasculitis, epiretinal membrane and use of azathioprine were independently associated with a worse VR-QoL (Table 1).

Table 1.

Risk factors related to VR-QoL in patients with NIU

VariablesCoef. (IC 95%)p-valueVisual acuity23.6 (12.3 - 34.8)<0.01Permanent incapacity-24.8 (-33.7 - -15.9)<0.01Unilateral NIU-2.9 (-5.7 - -0.006)0.05Cataracts-5.2 (-10 - -0.3)0.037Vasculitis-13.3 (-23.4 - -3.1)0.011Epiretinal membrane-6.8 (-12.7 - -0.8)0.026Azathioprine-7.5 (-14.7 - -0.3)0.041

Conclusion:

During these two years of follow-up, no significant changes have taken place regarding VR-QoL in patients with NIU assessed at a tertiary centre. Other than visual acuity at baseline, certain ocular manifestations and clinical comorbidities have also been shown to have an independent effect on the VR-QoL of these patients.

Disclosure of Interests:

None declared

SAT0051 REMISSION IN RHEUMATOID ARTHRITIS PATIENTS: A CLUSTER ANALYSIS TO IDENTIFY AND CHARACTERIZE SUBPOPULATIONS OF PATIENTS

Background:

Disease Activity Score (DAS) is a continuous measure of Rheumatoid Arthritis (RA) activity, used in clinical practice for monitoring disease progression and for documenting treatment response. According to EULAR, the clinical desired target is to achieve a remission state (or failing that, low disease activity). However, the population of RA patients in this state could be heterogenous.

Objectives:

To characterize the level of heterogeneity of RA patients in remission by identifying clusters based on the DAS28 components; and to describe inter and intra-class cluster demographic and clinical characteristics

Methods:

Patients from Hospital Clínico San Carlos cohort, stored in a departmental electronic health record from January 1st, 2000 to December 30th, 2018, diagnose with RA according ACR 1986/ 2010 criteria were eligible for this study. Only observations with a DAS28 Erythrocyte Sedimentation Rate (ESR) value < 2.6 value were considered. ESR, patient’s Global Health (GH), and tender and swollen joints were used for calculating the clusters. Different aggregation levels for joints were studied as well as the input variable types. Isolated joints, joints grouped by the type of affectation (swollen or tender) or anatomic location or laterality aggregation levels were considered. Variables expressed as present or absent (i.e. dichotomous), continuous (count of joins) and categorical (type of joints) were also studied. Gower’s distance, used for dealing with variables of different type, was employed to calculate the distance matrix. The number of suitable clusters was chosen from two to seven clusters based on the width value of a Silhouette analyses. Finally, Partitioning Around Medoids (PAM) was used as the clustering algorithm. Differences among clusters regarding demographic and clinical characteristics were analyzed using t-student chi2 test.

Results:

812 patients with 1,431 observations were analyzed in this study. The joint aggregation level which showed a highest Silhouette width value (0.708) was the anatomic one. In this aggregation level, five dichotomous variables (presence of tenderness and/or swelling in right and/or left shoulder, elbow, wrist, knee and hand (including both metacarpophalangeal and proximal interphalangeal joints) and two continuous variables (ESR and GH) were used. Two clusters were found: the cluster A) with 1,305 observations and 742 patients and the B) with 126 observations and 115 patients. Cluster b) had a statistically significant higher DAS28-ESR value (higher number of tender and swollen joints, and higher GH, but lower ESR), longer follow-up time (6.5 vs. 4.7 years), higher VAS-pain score (10 vs. 2), and higher HAQ score (0.25 vs. 0.12). In addition, the proportion of patients treated with oral corticosteroids (63% s. 50%) and biological therapy (29% vs. 12%) was higher.

Conclusion:

We have identified two clinically distinct populations of RA patients in remission according to DAS28-ESR <2.6. Each subgroup could be associated with different outcomes during follow-up, such as radiographic progression or risk of relapse.

Disclosure of Interests:

Alfredo Madrid García: None declared, Dalifer Freites Nuñez: None declared, Judit Font: None declared, Isabel Hernandez: None declared, Leticia León: None declared, Jose Ignacio Colomer: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Benjamin Fernandez: None declared, J Angel Jover: None declared, Lydia Abasolo: None declared, Luis Rodriguez Rodriguez: None declared

AB0290 HERPES ZOSTER INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS EXPOSED TO BIOLOGICAL AGENTS AND JAK INHIBITORS. REAL-WORLD EVIDENCE

Background:

The overall occurrence of Herpes zoster (HZ) infections in patients with rheumatoid arthritis (RA) is greater than in the general population although is controversial whether the use of the different disease-modifying antirheumatic drugs (DMARDs) increases this risk.

Objectives:

To investigate the incidence and factors associate to HZ infections in patients with RA exposed to biologic agents (BA) and small molecule JAK inhibitors (JAKi), and to describe RA disease features at the moment of HZ infection.

Methods:

Retrospective longitudinal study was conducted. We included RA patients seen at the rheumatology outpatient clinic of tertiary hospital, commencing BA (anti-TNF therapy and no anti-TNF therapy) or JAKi from Jan 2007 until Dec 2017, and followed up until end of study (Dec 2019). The outcome of interest was the occurrence of HZ infection, the diagnosis of HZ events was based on the rheumatologist’s report. Covariables: sociodemographic, clinical, and concomitant treatments including glucocorticoids, conventional synthetic DMARDs (csDMARDs). Survival techniques were used to estimate the incidence of HZ (IR), per 1000 patient-year (PYs) with the respective Confidence Interval [95%CI]. Cox multivariate regression model to compare the risk of HZ was performed. Results were expressed in Hazard ratio (HR).

Results:

474 RA patients were included, starting 881 different courses of treatment (1954.86 patients-years of follow-up). 382 (80.6%) were women with a mean (SD) age of 56.9 (15.0) years at first BA. Across all groups of treatments, a total 18 HZ were recorded, events were non-serious and involved 1 or 2 dermatomes. The mean age (SD) at moment of the infection was 62 (11) years and 10 cases were on prednisone > 7.5 mg/day. 13 HZ cases (72.2%) occurred on treatment with anti-TNF treatment (6 with adalimumab, 4 with certolizumab and 1 with infliximab), 4 (22.2%) cases were on treatment with rituximab one occurred during tocilizumab prescription. The overall incidence of HZ was 9.20 cases per 1000PYs [5.80-14.61]. The crude IR was similar between gender, increased with age (Patients < 46 years: 2.17 [0.3-15.4]; >70 years 14.1 [5.8-33.8]), was higher with concomitant use of two csDMARDs (IR: 15.68 [7.8-31.7], and was similar between anti-TNF and non anti-TNF therapy. None HZ event was recorded in patients exposed to JAKi. In the multivariate analysis, age (HR: 1.05, p: 0.006), prednisone dose > 7.5 mg/day (HR: 2.83, p: 0.02) and the concomitant use of two csDMARDs (HR: 2.34 p: 0.039) increase the risk for HZ. Lymphopenia (HR: 2.6; p=0.06) achieved a trend and BA therapy dropped from the model.

Conclusion:

HZ incidence rate was 9.20 cases per 1000PYs, HZ occurrence in RA patients cannot be attributed solely to the current BA or JAKi treatment and other factors involved must be taking in count as age, concomitant DMARDs prescriptions, and use of glucocorticoids. Our data suggest that preventive strategies for HZ should be developed for patients with RA.

Disclosure of Interests:

None declared

Monolithic Axial and Radial Metal-Semiconductor Nanowire Heterostructures

The electrical and optical properties of low-dimensional nanostructures depend critically on size and geometry and may differ distinctly from those of their bulk counterparts. In particular, ultrathin semiconducting layers as well as nanowires have already proven the feasibility to realize and study quantum size effects enabling novel ultrascaled devices. Further, plasmonic metal nanostructures attracted recently a lot of attention because of appealing near-field-mediated enhancement effects. Thus, combining metal and semiconducting constituents in quasi one-dimensional heterostructures will pave the way for ultrascaled systems and high-performance devices with exceptional electrical, optical, and plasmonic functionality. This Letter reports on the sophisticated fabrication and structural properties of axial and radial Al-Ge and Al-Si nanowire heterostructures, synthesized by a thermally induced exchange reaction of single-crystalline Ge-Si core-shell nanowires and Al pads. This enables a self-aligned metallic contact formation to Ge segments beyond lithographic limitations as well as ultrathin semiconducting layers wrapped around monocrystalline Al core nanowires. High-resolution transmission electron microscopy, energy dispersive X-ray spectroscopy, and μ-Raman measurements proved the composition and perfect crystallinity of these metal-semiconductor nanowire heterostructures. This exemplary selective replacement of Ge by Al represents a general approach for the elaboration of radial and axial metal-semiconductor heterostructures in various Ge-semiconductor heterostructures.

Tuning Electroluminescence from a Plasmonic Cavity-Coupled Silicon Light Source

The combination of Moore's law and Dennard's scaling rules have constituted the fundamental guidelines for the silicon-based semiconductor industry for decades. Furthermore, the enormous growth of global data volume has pushed the demand for complex and densely packed devices. In recent years, it has become clear that wired interconnects impose increasingly severe speed and power limitations onto integrated circuits as scaling slows toward a halt. To overcome these limitations, there is a clear need for optical data processing. Despite significant progress in the development of silicon photonics, light sources remain challenging owing to the indirect bandgap of group IV materials. It is therefore highly desirable to develop new concepts for a silicon light source that meets efficiency and footprint requirements similar to their electronic counterparts. Here, we demonstrate an electrically driven and tunable silicon light source by matching the resonant modes of a silver nanocavity with the hot luminescence spectrum of an avalanching p-n junction. The cavity significantly enhances phonon-assisted recombination of hot carriers by tailoring the local density of states at the size-tunable resonance. Such tunable nanoscale emitter may be of great interest for short-reach communications, microdisplays or lab-on-chip applications.

Synchrotron Bragg diffraction imaging characterization of synthetic diamond crystals for optical and electronic power device applications

Bragg diffraction imaging techniques are described, and their capabilities for studying the quality of diamond substrates and overgrown layers, and the surface damage caused by mechanical polishing, are illustrated by examples.

Bragg diffraction imaging enables the quality of synthetic single-crystal diamond substrates and their overgrown, mostly doped, diamond layers to be characterized. This is very important for improving diamond-based devices produced for X-ray optics and power electronics applications. The usual first step for this characterization is white-beam X-ray diffraction topography, which is a simple and fast method to identify the extended defects (dislocations, growth sectors, boundaries, stacking faults, overall curvature etc.) within the crystal. This allows easy and quick comparison of the crystal quality of diamond plates available from various commercial suppliers. When needed, rocking curve imaging (RCI) is also employed, which is the quantitative counterpart of monochromatic Bragg diffraction imaging. RCI enables the local determination of both the effective misorientation, which results from lattice parameter variation and the local lattice tilt, and the local Bragg position. Maps derived from these parameters are used to measure the magnitude of the distortions associated with polishing damage and the depth of this damage within the volume of the crystal. For overgrown layers, these maps also reveal the distortion induced by the incorporation of impurities such as boron, or the lattice parameter variations associated with the presence of growth-incorporated nitrogen. These techniques are described, and their capabilities for studying the quality of diamond substrates and overgrown layers, and the surface damage caused by mechanical polishing, are illustrated by examples.

The Prostacyclin Analog, Treprostinil Sodium, Provides Symptom Relief in Severe Buerger’s Disease

Buerger’s disease (thromboangiitis obliterans or TAO) is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries. The primary treatment for Buerger’s disease is cessation of cigarette smoking. In patients whose disease progresses despite smoking cessation, therapeutic options are limited. Revascularization is rarely indicated and usually not successful because of the diffuse and distal distribution of the disease. Prostacyclin, or PGI2, and its analogs have been proposed as pharmacotherapy for Buerger’s disease and studied in Europe. The authors review the prostacyclin literature in the treatment of Buerger’s disease and present a case report of a patient with progressive Buerger’s disease and the use of treprostinil sodium (Remodulin®). This case report experience suggests that subcutaneous treprostinil therapy could be clinically useful in Buerger’s disease that does not improve with smoking cessation, particularly in the presence of critical limb ischemia where other therapeutic options have failed.

Effect of Blanching and Vacuum Pulse Application on Osmotic Dehydration of Pear

Osmotic dehydration of pear cylinders (var. blanquilla) was studied by analysing the effect of blanching pre-treatment and the application of a vacuum pulse on the kinetics and yield of the process and on product quality (colour and mechanical behaviour). Fresh and stem-blanched samples were treated with 65 Brix sucrose at atmospheric pressure and by applying a vacuum pulse (50 mbar for 5 min). The influence of the sugar gain and water loss fluxes, and the tissue structural response to the vacuum pulse, on the total mass and volume losses of the samples has been discussed. Blanching implied an increase in the mass transfer rate in pear tissue. Vacuum pulse in blanched samples resulted in more volume compression than sample impregnation with the external solution due to the sample softening by thermal effect and to the partial gas release during its thermal expansion. This provoked the greatest volume losses and a reductionof the ratio of sugar gain to water loss, where the highest values reached were for non-blanched samples submitted to vacuum pulse. Mechanical changes induced by treatments were similar inall cases, but colour hue and chrome were better preserved in samples treated by PVOD. Nevertheless, this treatment implied a transparency gain due to the sample gas release and so, samples become darker.

100 EMBRYO SURVIVAL AND CONCEPTUS ELONGATION FOLLOWING ASYNCHRONOUS EMBRYO TRANSFER IN CATTLE

Maternal progesterone (P4) regulates early conceptus growth and development in ruminants. Early embryo transfer studies in sheep and cattle demonstrated a need for close synchrony between the embryo and the uterine environment of the recipient. However, manipulating P4 may be one way of strategically regulating the temporal changes that normally occur in the uterine environment in order to allow flexibility in the timing of embryo transfer. For example, previous studies have demonstrated that P4 administration during the first few days of the oestrous cycle facilitates pregnancy establishment with older embryos. The aim of this study was to examine the effect of embryo-uterine synchrony on conceptus elongation in cattle. Oestrous cycles of crossbred beef heifers were synchronised using an 8-day P4-Releasing Intravaginal Device (PRID Delta®, CEVA, Mountain View, CA, USA) with administration of a prostaglandin F2α analogue (Enzaprost®, CEVA; 5 mL equivalent to 25 mg of dinoprost) given on the day before PRID removal. Heifers were checked for signs of oestrus 4 times per day commencing 30 h after PRID withdrawal. Only those seen in standing oestrus (n = 50) were randomly assigned to 1 of 5 treatment groups to receive Day 7 in vitro-produced blastocysts (n = 10 per recipient) (1) on Day 5 post-oestrus; (2) on Day 5, with P4 supplementation via PRID from Day 3 to 5 + 750 IU of eCG at PRID insertion; (3) on Day 5, PRID Delta from Day 3 to 5 plus 3000 IU of hCG at PRID insertion; (4) on Day 7, or (5) on Day 9. At embryo age Day 14, all heifers were slaughtered and the uterus was flushed to recover and measure conceptuses. Data are summarised in Table 1. Fewer recipients yielded conceptuses (P < 0.05) and fewer conceptuses overall were recovered (P < 0.05) following transfer on Day 5 compared with Day 7 or Day 9. Supplementation with P4 resulted in short cycles (evidenced by corpus luteum regression and/or a recent ovulation at slaughter) in 33.3 to 54.5% of recipients receiving embryos on Day 5. Mean conceptus length was greater (P < 0.05) following transfer to an advanced uterus. In conclusion, transfer of embryos to a retarded (Day 5) uterine environment results in poor embryo survival. Supplementation with P4 shortened the interoestrous period in a significant number of heifers. Transfer to an advanced uterine environment promotes conceptus elongation, presumably driven by P4. Table 1.Embryo survival and conceptus length data

Pediococcus acidilactici UL5 and Lactococcus lactis ATCC 11454 are able to survive and express their bacteriocin genes under simulated gastrointestinal conditions

AIMS

The aim of this work is to study the expression of stress genes and those involved in pediocin and nisin production in Pediococcus acidilactici UL5 and Lactococcus lactis ATCC11454 under simulated gastrointestinal (GI) physiological conditions.

METHODS AND RESULTS

The two strains were fed to a dynamic GI model (TIM-1). Samples were taken from different compartments and analysed for strain survival as well as for the expression of pediocin PA-1 operon, nisin A production gene and stress genes using RT-qPCR. Ileal-delivered efflux showed a survival rate of 17 and 0·0007% for Ped. acidilactici and La. lactis, respectively. Pediocin operon genes from stressed cells were generally expressed at least at the same level as for unstressed cells. However, pedA is up-regulated in the effluent at 120 and 180 min. Nisin A genes were always up-regulated with particularly in the stomach after 70 min compared with control.

CONCLUSIONS

Bacteriocin production of Ped. acidilactici UL5 and Lc. lactis ATCC 11454 are not affected by upper GI simulated conditions and thus could be considered as relevant probiotic candidates.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study demonstrates the capacity of lactic acid bacteria to survive and express their bacteriocins genes under simulated GI conditions.