AB0740 INTERSTITIAL LUNG DISEASE SYSTEMIC SCLEROSIS: AN EAST-EUROPEAN EUSTAR CENTER EXPERIENCE

Background

Systemic sclerosis (SSc) is a complex autoimmune connective tissue disorder defined by multifaceted visceral involvement. Still considered the leading cause of morbidity and mortality, interstitial lung disease (ILD) remains one the most common complication of SSc that involves vascular, immunological, and fibrotic processes.

Objectives

We aimed to assess the relationship between demographic, clinical features and risk factors for the development of lung fibrosis in patients with SSc as well as the specific management.

Methods

We performed a retrospective observational study in a series of 45 patients with SSc and ILD followed-up in East-European EUSTAR center (Department of Rheumatology 2, Clinical Rehabilitation Hospital, Iasi, Romania). We analyzed the frequency of known risk factors associated with progressive interstitial lung disease such as diffuse cutaneous SSc, male sex, presence of anti-topoisomerase I and absence of anti-centromere antibodies as well as risk factors for mortality in SSc-ILD including older age, male sex, extent of disease on high-resolution computed tomography (HRCT), lower pulmonary function tests (PFTs), lower diffusing capacity of the lung for carbon monoxide (DLCO).

Results

The study included 35 females, 10 males, with the mean age of 55.5 years. The diagnosis of interstitial lung disease was based on HRCT findings (bibasilar ground glass opacities, crazy-paving pattern, nodules, honeycombing and traction bronchiectasis, mosaic pattern, air trapping, pulmonary artery and lymph node enlargement). Symptoms of the ILD (dry cough, different stages of dyspnea, VELCRO crackles) were reported in 14 cases (25.45%). Furthermore, 25 patients had a significant decline in PFTs and DLCO, being associated with extensive pulmonary fibrosis on HRCT (p<0.05%). Almost all patients with SSc-ILD had diffuse cutaneous involvement and anti-Scl-70 antibodies positivity. Despite identifying a higher percentage of women with ILD (35/45, 63.63%), the extent and progression of pulmonary fibrosis was more significant in males. The treatment for SSc-ILD with ongoing evidence of disease progression based on PFT decline or radiographic deterioration has focused on immunosuppressive therapies, particularly cyclophosphamide and only in selected cases on antifibrotic agents.

Conclusion

It is important to identify the risk factors for developing ILD, in order to complete the diagnostic and staging parameters early so that the treatment can be initiated as soon as possible in progressive pattern. Our data showed that the extent of pulmonary fibrosis in HRCT was associated with low values of PFTs and DLCO, and men had a more severe prognostic than women. ILD-SSc was more frequent in patients with diffuse cutaneous involvement than limited cutaneous subtype, and in those with anti-Scl-70 positivity.

References

[1]Perelas A, Silver RM, Arrossi A et al, Systemic-sclerosis associated interstitial lung disease, Lancet Respir Med 2020, https://doi.org/10.1016/S2213-2600(19)30480-1

[2]N Tanaka, Y Kunihiro M Kubo et al, HRCT findings of collagen vascular disease-related interstitial pneumonia (CVD-IP): a comparative study among individual underlying diseases, Clinical Radiology 73 (2018) 833.e1-833.e10, https://doi.org/10.1016/j.crad.2018.04.017

[3]Dinesh Khanna, Donald P. Tashkin, Etiology, Risk Factors, and Biomarkers in Systemic Sclerosis with Interstitial Lung Disease, Am J Respir Crit Care Med. 2020 Mar 15; 201(6): 650–660. DOI: https://dx.doi.org/10.1164%2Frccm.201903-0563CI

[4]Vincent Cottin, Kevin K. Brown, Interstitial lung disease associated with systemic sclerosis (SSc-ILD), Cottin and Brown Respiratory Research (2019) 20:13 https://doi.org/10.1186/s12931-019-0980-7

[5]Padmini Khedoe, Emiel Marges, Pieter Hiemstra, Interstitial Lung Disease in Patients With Systemic Sclerosis: Toward Personalized-Medicine-Based Prediction and Drug Screening Models of Systemic Sclerosis-Related Interstitial Lung Disease (SSc-ILD).

Front Immunol. 2020 Sep 4;11:1990, doi: 10.3389/fimmu.2020.01990.

Disclosure of Interests

None declared

AB0695 PATTERN OF COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES UNDERGOING BIOLOGICAL THERAPY: A COHORT EXPERIENCE

Background:

Despite emerging vaccines, the world is in the midst of a coronavirus disease 2019 (COVID-19) pandemic. Outcomes of SARS-CoV2 infection remain a major concern in patients with rheumatic and musculoskeletal diseases, especially for those with uncontrolled disease.

Objectives:

We aimed to investigate trends and outcomes of COVID-19 occurring in patients with chronic inflammatory rheumatic conditions treated with biologics and targeted synthetic disease modifying antirheumatic drugs (bDMARDs, tsDMARDs).

Methods:

We included all confirmed cases of COVID-19 regardless of severity in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) undergoing bDMARDs or tsDMARDs treatment registered in our local COVID-19 reporting database. We collected relevant information about comorbidities, rheumatologic-related clinical activity (RAPID5, SDAI, BASDAI, DAPSA), type of DMARD and glucocorticoid use, as well as COVID-19 related data as severity (ranging from asymptomatic to life-threatening forms), medication, hospitalization, intensive care unit admission, invasive mechanical ventilation and death.

We did a subgroup analysis among patients with a specific rheumatologic diagnosis, among different class of medication, patients who were or not hospitalized with COVID-19 looking how age, comorbidities, type of rheumatic condition and treatments impact COVID outcomes.

Results:

40 COVID-19 cases (positive PCR for SARS-CoV2) (4.67%) were identified during the 6-month study period among 855 patients registered in our database of patients under biologic treatment, including 20 RA, 18 SpA, 2 PsA patients. The majority were in either low disease activity or remission, only two patients had active uncontrolled disease at the onset of coronavirus infection.

16 cases (40%) were asymptomatic and were tested RT-PCR-positive during routine follow-ups for their disease, 13 cases (32.5%) had mild and 8 cases (20%) moderate illness; severe pneumonia and critical disease with acute respiratory distress syndrome were reported in only 3 cases, 2 recovered after; the only patients who died was 69 years old, had cardiac disease, hypertension and diabetes, had undertaken regular rituximab perfusion one month before coronavirus infection and developed pulmonary embolism followed by septic shock.

Extreme fatigue was the dominant COVID-19 associated symptom apart from the classical ones including fever, cough, shortness of breath, sore throat, nasal congestion, headache, anosmia and ageusia myalgias and anorexia.

No specific pattern for patients requiring intensive care unit admission.

Conclusion:

The COVID-16 infection rate in patients with inflammatory rheumatic disorders receiving biologics and tsDMARDs is pretty low; although immunosuppressed, these patients seem not to be at risk for severe COVID-19 illness and outcomes. These findings might reflect a potential protective role of certain biologics and/or JAK inhibitors for development and severity of COVID-19 in patients.

References:

[1]WHO, COVID-19 clinical management, Living Guidance, 25 Jan 2021

Disclosure of Interests:

CODRINA ANCUTA Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Cristina Pomirleanu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Georgiana Strugariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Luiza Petrariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Eugen Ancuta: None declared, Codruta Bran Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Rodica Chirieac Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Claudia Mihailov Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz

POS0569 LONG-TERM OUTCOMES OF CHILDREN BORN TO WOMEN WITH RHEUMATOID ARTHRITIS

Background:

Children born to women with rheumatoid arthritis (RA) have increased incidences of adverse neonatal outcomes and a potential excess risk of specific diseases during childhood and adolescence [1]. Further studies aimed at confirming long-term consequences in the offspring are needed.

Objectives:

To evaluate whether maternal RA has an impact on the health and developmental outcomes of the offspring.

Methods:

A retrospective descriptive study was conducted on data regarding 43 children born to mothers diagnosed with either RA or juvenile idiopathic arthritis (JIA) prior to conception. Participants were recruited from several Clinics of Rheumatology located across Romania. Data on neonatal outcomes, lactation, developmental milestones, childhood illnesses, and hospitalizations was collected using a patient-reported questionnaire completed by maternal participants in 2020.

Results:

Favorable neonatal outcomes were found in 81% of the participants; however, children of mothers with RA had a higher occurrence of favorable outcomes than those with JIA (p = 0.009). Adverse neonatal outcomes reported include the following: small for gestational age (11.6%), intrauterine growth restriction (4.65%), and preterm births (2.75%). There were no incidences of congenital malformations. The mean birth weights of offspring born to mothers with RA are higher than those with JIA (p = 0.00829).

While the majority of the children were breastfed (88.4%), those who were not breastfed were hospitalized more often than those who were breastfed for any period of time (p = 0.03). Mothers who experienced a postpartum flare up within the first 4 months breastfed their children significantly less than those who did not have a flare up (14.62 versus 48 weeks, p = 0.00011).

The mean age of the children at inclusion was 7.6 ± 5.5 years.

Developmental milestones were considered to be within the expected average limits, except for an increased incidence of delayed speech (12%).

51.2% of the children were hospitalized at some point during their childhood, with viral enterocolitis, tonsilitis, bronchiolitis, and pneumonia being the most frequently encountered reasons for admission. Surprisingly, children with favorable neonatal outcomes were hospitalized more often than those with unfavorable outcomes (p = 0.0000436). Additionally, children born to mothers under the age of 35 were hospitalized more often than those over 35 (p = 0.02).

77.3% of offspring experienced recurrent ear/nose/throat (ENT) infections, 55.8% had allergies, and 39.5% were diagnosed with atopic dermatitis. Childhood allergies were strongly associated with an increased incidence of atopic dermatitis (p = 0.0000585), as was a concurrent maternal thrombophilia diagnosis (p = 0.03).

Of the remaining childhood afflictions that were assessed asthma/chronic respiratory diseases (4.65%), juvenile idiopathic arthritis (2.33%), ulcerative colitis (2.33%), diabetes, anxiety/personality disorders, thyroid diseases, febrile seizures, and epilepsy did not yield statistically significant results.

Conclusion:

Maternal RA was found to be associated with increased incidences of adverse neonatal outcomes, childhood hospitalizations, recurrent ENT infections, allergies, and atopic dermatitis. However, overall health outcomes of offspring did not show alarmingly significant excess morbidities.

References:

[1]Rom AL, Wu CS, Olsen J, et al. Parental rheumatoid arthritis and long-term child morbidity: a nationwide cohort study. Annals of the Rheumatic Diseases. 2016;75(10):1831–1837. doi:10.1136/annrheumdis-2015-208072

Disclosure of Interests:

None declared

POS0512 DIFFERENCES IN TREATMENT SATISFACTION, PATIENT PREFERENCES, AND TREATMENT PATTERNS BETWEEN EUROPEAN, SOUTH AMERICAN, AND JAPANESE PATIENTS WITH SUBOPTIMALLY CONTROLLED RHEUMATOID ARTHRITIS: A SUBGROUP ANALYSIS OF THE SENSE STUDY

Background:

Despite the availability of advanced therapies, many patients with rheumatoid arthritis (RA) do not achieve their treatment goals. Understanding geographic influence on patient perspectives and physicians’ attitudes toward treatment adjustments may inform region-specific strategies to improve outcomes in RA.

Objectives:

To explore differences in treatment satisfaction, patient preferences, and treatment strategies between patients from Europe (EU), South America (SA), and Japan (JP) with suboptimal control of RA.

Methods:

This is a subgroup analysis of SENSE, a non-interventional cross-sectional study in adults with RA who had moderate/high disease activity as measured by Disease Activity Score in 28 joints with erythrocyte sedimentation rate (DAS28[ESR]) >3.2, despite disease-modifying antirheumatic drug (DMARD) treatment. Patient satisfaction and preferences, treatment adherence, patient-reported outcomes, and physicians’ plans for DMARD switch were assessed as previously described.1 Predictors of good treatment satisfaction and physician’s decision not to switch DMARDs were identified using multiple logistic regression analyses.

Results:

Of 1234, 272, and 118 patients enrolled from EU, SA, and JP, respectively, 13.9%, 15.4%, and 5.9% reported good treatment satisfaction. Irrespective of region, patients reported impaired quality of life and good treatment adherence, and around one-third of patients received targeted synthetic (ts) or biologic (b) DMARDs. Among patients treated with ts/bDMARDs, monotherapy was most common in SA (45.3%), followed by EU (26.3%) and JP (18.8%), consistent with a greater acceptance of combination therapy in JP. More than 80% of JP patients preferred oral treatments versus <60% of EU/SA patients. DMARD switches were planned in 51.8% (EU), 57.4% (SA), and 38.1% (JP) of patients, most commonly to a tumor necrosis factor inhibitor. Predictors for good treatment satisfaction included treatment with ts/bDMARDs and the presence of psychiatric disorders in EU and SA; however, current disease activity was not a common predictor (Table 1). Reluctance to switch treatments was predicted by lower disease activity assessed by DAS28(ESR) (all regions) and current treatment with ts/bDMARDs (EU/SA).

Table 1.

Predictors for good treatment satisfaction and no treatment switch planned

OR (95% CI)Europe(n=1234)South America(n=272)Japan(n=118)Good treatment satisfaction (TSQM global treatment satisfaction ≥80)Current treatment with ts/bDMARDs3.8 (2.7, 5.4)****4.9 (2.2, 10.8)****—Psychiatric disorders2.4 (1.3, 4.6)**3.1 (1.2, 8.4)*—Number of comorbidities——2.3 (1.2, 4.3)*Worst joint pain—1.3 (1.1, 1.5)**SF-36 MCS1.0 (1.0, 1.1)****—1.3 (1.1, 1.5)**SF-36 PCS1.1 (1.0, 1.1)****——Work Productivity and Activity Impairment–Rheumatoid Arthritis:Total activity impairment—1.0 (1.0, 1.0)***—DAS28(ESR) >5.1—0.3 (0.1, 0.7)**—Female——0.1 (0.0, 0.9)*No treatment switch plannedCurrent treatment with ts/bDMARDs3.9 (3.0, 5.2)****2.4 (1.4, 4.2)**—Number of comorbidities1.2 (1.1, 1.4)****——Age——1.0 (1.0, 1.1)*TSQM effectiveness subscore1.0 (1.0, 1.0)***1.0 (1.0, 1.0)***—Number of concomitant medications0.9 (0.8, 1.0)**——DAS28(ESR)0.5 (0.5, 0.6)****0.6 (0.5, 0.8)***0.6 (0.4, 0.9)*

X2 test: ****p<0.0001, ***p<0.001, **p<0.01, *p<0.05

CI, confidence interval; OR, odds ratio; SF-36 M/PCS, 36-Item Short-Form Survey mental/physical component summary; TSQM, Treatment Satisfaction Questionnaire for Medication

Conclusion:

In patients with moderate to high RA disease activity, current disease control was a common determinant of treatment switches. Predictors for good treatment satisfaction revealed region-specific patient attitudes to treatment acceptance despite poor disease control.

References:

[1]Taylor PC, et al. Ann Rheum Dis 2020;79:996–7

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of this abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Peter C. Taylor Speakers bureau: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Consultant of: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Prodromos Sidiropoulos Speakers bureau: AbbVie, Amgen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant of: AbbVie, Amgen, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: AbbVie, Amgen, MSD, Novartis, Pfizer, Roche, and UCB., CODRINA ANCUTA Speakers bureau: AbbVie, Eli Lilly, Ewopharma, MSD, Novartis, Pfizer, Roche, and UCB., Consultant of: AbbVie, Eli Lilly, Ewopharma, MSD, Novartis, Pfizer, Roche, and UCB., Ivan Lagunes-Galindo Employee of: AbbVie employee and may own stocks or options, Maria DeLaVega: None declared, Umut Kalyoncu Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB., Consultant of: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB., Orsolya Nagy Employee of: AbbVie employee and may own stocks or options, Atsushi Kawakami Speakers bureau: AbbVie, Actelion, Asahi Kasei, Astellas, Boehringer Ingelheim, Celltrion, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, GSK, Janssen, Kowa, MedPeer, Mitsubishi Tanabe, Novartis, ONO, Pfizer, Taisho, and Takeda, Grant/research support from: AbbVie, Actelion, Asahi Kasei, Astellas, AYUMI, Boehringer Ingelheim, Bristol-Myers Squibb, Celltrion, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Kyowa Hakko Kirin, MSD, Neopharma, Novartis, ONO, Sanofi, Taisho, Takeda Science Foundation, and Teijin.

AB0181 EXPLORING THE ROLE OF IL-6 BLOCKADE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHTITIS AND CHRONIC PERIODONTITIS

Background:

Recent data have renewed the interest in common pathobiologic pathways in autoimmune rheumatic conditions and periodontal disease, especially on dual impact of innovative anti-rheumatic drugs in modulating both inflammatory and immune articular as well as periodontal damage. Although consistent data about TNF inhibitors and chronic periodontitis are already published, the influence of IL-6 blockade.

Objectives:

We aimed to explore the influence of weekly subcutaneously IL-6 receptor inhibitor tocilizumab on periodontal health in a local cohort of patients with rheumatoid arthritis (RA) and chronic periodontitis (PD).

Methods:

We performed a prospective longitudinal 6 months study in 68 patients with moderate-to-severe RA starting tocilizumab (TCZ) in accordance to local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and dental (plaque index PI, gingival index GI, bleeding on probing BOP, pocket probing depth PPD, clinical attachment level CAL) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months.

Results:

51 RA and concomitant t of 68 patients in our initial cohort were finally analyzed. Aggressive periodontal disease was reported particularly in disease subsets with excessive inflammatory (serum C reactive protein level) and serologic biomarkers (anti-citrullinated peptide antibodies ACPA). Furthermore, significant correlations between periodontal status, clinical disease activity and ACPA levels were also demonstrated (p<0.05). We also noticed consistent improvement was noticed in both RA-related parameters sand periodontal inflammation (GI and sites with bleeding of probing) after only 3 months (p < 0.05), while PPD improved after 6 months; overall, CAL presented only slight changes without statistical any significance as well as teeth count and plaque levels (p > 0.05).

Conclusion:

IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, essentially related to dramatic decrease in serum inflammatory mediators.

References:

[1]de Molon Scaf, R., Rossa, C.; Thurlings, R.M.; Cirelli, J.A.; Koenders, M.I. Linkage of Periodontitis and Rheumatoid Arthritis: Current Evidence and Potential Biological Interactions, Int. J. Mol. Sci. 2019, 20, 4541.

[2]Genco, R.J.; Sanz, M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodont. 20002020, 83 (1), 08 May.

[3]Rinaudo-Gaujous, M.; Blasco-Baque, V.; Miossec, P. et al. Infliximab induced a dissociated response of severe periodontal biomarkers in rheumatoid arthritis patients. J Clin Med2019. 8, 751.

[4]Eezammuddeen, N.N.; Vaithilingam, R.D.; Mohamad Hassan, N.H.; Bartold, IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, essentially related to dramatic decrease in serum inflammatory mediators.

Disclosure of Interests:

CODRINA ANCUTA Speakers bureau: ABBVIE, PFIZER, UCB, NOVARTIS, LILLY, SANDOZ, Consultant of: ABBVIE, PFIZER, UCB, NOVARTIS, LILLY, SANDOZ, EUGEN ANCUTA: None declared, Rodica Chirieac Speakers bureau: ABBVIE, PFIZER, UCB, NOVARTIS, LILLY, SANDOZ, OANA TANCULESCU: None declared, CRISTINA IORDACHE: None declared

SAT0123 TREATMENT SATISFACTION, EXPECTATIONS, PATIENT PREFERENCES AND CHARACTERISTICS, INCLUDING DIGITAL HEALTH LITERACY (DHL), AND THE IMPACT OF SUBOPTIMAL DISEASE CONTROL IN A LARGE INTERNATIONAL COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS (RA): THE SENSE STUDY

Background:

Patient characteristics, their treatment preferences and goals are important determinants of treatment success in rheumatoid arthritis (RA).

Objectives:

SENSE study aimed at assessing the impact of inadequate response to disease-modifying anti-rheumatic drugs on disease outcomes, and analyze their attitude, their treatment and disease.

Methods:

Non-interventional, cross-sectional study conducted in 18 countries in Europe, Asia, and America. Adult RA patients with moderate/high disease activity were eligible. Patient satisfaction was assessed by Treatment Satisfaction Questionnaire for Medication, Version 1.4 (TSQM v1.4). Treatment adherence, patient preferences, and expectations were evaluated by visual analog scale. eHealth Literacy Scale was employed for evaluating DHL. Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis, v2.0 (WPAI-RA) was used to assess workability and patient documentation for healthcare resource utilization (HRU).

Results:

1624 patients were included in this analysis; most were female (84.2%), middle-aged, and had a mean (standard deviation [SD]) disease duration of 10.5 (9.3) years. 11.9% of the patients had retired early and 6.0% were unemployed due to RA. Mean (SD) total WPAI-RA score was 55.1% (26.7). In the previous 3 months, the mean (SD) number of healthcare professional and emergency room visits were 2.2 (2.5) and 1.6 (1.3), respectively. Mean (SD) TSQM v1.4 global satisfaction subscore was 60.9 (20.9), with only 13.5% reporting good treatment satisfaction (TSQM global ≥80). The leading treatment expectations were ‘general improvement of arthritis’, ‘less joint pain’, and ‘lasting relief of RA symptoms,’ with mean (SD) scores of 5.7 (1.6–1.7) for each. 60.7% of patients preferred oral administration and 31.3% preferred not to use drug combinations for RA. Preferred time to effect was predominantly ‘up to one week’ (71.1%). Least frequently side effects rated ‘acceptable’ were ‘increased risk for malignancies’ (3.5%) and ‘increased risk for cardiovascular diseases’ (3.3%). Most patients (67.4%) had poor DHL. Good adherence (in 87.4% of patients) was significantly associated with lower levels of joint pain.

Conclusion:

Suboptimal disease control has a significant impact on satisfaction, workability, and HRU. Our results can support shared decision-making when setting RA treatment strategy.

Disclosure of Interests: :

Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, CODRINA ANCUTA Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Orsolya Nagy Shareholder of: AbbVie, Employee of: AbbVie, Maria DeLaVega: None declared, Andrey Gordeev Speakers bureau: AbbVie, Eli Lilly, Pfizer, Sanofi, Bristol-Myers Squibb, Merck Sharpe and Dohme, Roche, and UCB., Radka Jankova Speakers bureau: AbbVie, Eli Lilly, Pfizer, Sanofi, Bristol-Myers Squibb, Merck Sharpe and Dohme, Roche, and UCB, Umut Kalyoncu Consultant of: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB., Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB., Ivan Lagunes-Galindo Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jadranka Morovic-Vergles Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi, Mariana Peixoto GU e Silva de Souza Grant/research support from: AbbVie, UCB, Bristol-Myers Squibb, Pfizer, and GSK, Consultant of: AbbVie, Roche, UCB, Pfizer, and Jansen, Speakers bureau: AbbVie, Roche, UCB, Pfizer, and Jansen, Bernadette Rojkovich: None declared, Prodromos Sidiropoulos: None declared, Atsushi Kawakami: None declared

AB1269 REGIONAL DIFFERENCES IN THE PATIENTS’ UNDERSTANDING OF TREATMENT STRATEGY IN RHEUMATOID ARTHRITIS

Background:

The treat-to target (T2T) concept is the standard for treating rheumatoid arthritis (RA) patients worldwide1. However, difficulties that patients encounter in achieving disease control may differ between regions, which may impact the type of support needed for successful T2T implementation.

Objectives:

To compare differences in patient-reported challenges to controlling RA-related issues between Romanian and US patients.

Methods:

A cross-sectional study that recruited 403 RA patients was conducted in six centers in Romania. Patients were invited to complete an RA-related questionnaire. We compared their responses to those from a previous published study that included patients with RA from the US2. The survey included items on subjective beliefs about RA treatment (e.g. adherence, cost, adverse events) and knowledge about T2T strategy. Approval for US data use was given by the study coordinator2.

Results:

All patients in the Romanian cohort were Caucasian, with a mean age of 58.7 years (SD 11.6). 78% were females and the mean disease duration was 11.2 years (SD 8.3). Data was concordant with results from the previously published study. More patients from US had college education (60% vs 43.9%).

Among the respondents, 93.3% Romanians were on a synthetic DMARD versus 97.7% Americans and 64.01% were currently on a biologic of choice compared to 74% patients in the US. More than half of the patients in both regions had a history of biologic DMARD use.

Asked to grade (0very good, 10very bad) their disease activity on the survey day, a large category of patients (37.4%, SD 14.1) marked an average state (4-6), while 19.08% (SD 11.2) were feeling poorly related to their disease.

Patients were asked to define their adherence to RA treatment in the last 30 days. While the US study reported that 93% of patients were adherent2, in our study only 62.5% of the Romanian patients reported adherence (p<0.01). A significantly lower proportion of Romanian patients were aware of T2T strategy (35 %, p 0.04).

Regarding patient beliefs on their disease, statements were grouped into categories such as difficulty managing pain, medication safety, adherence, lifestyle. Most European patients would agree to change treatment to lower pain. Almost 82% stated they would accept rare adverse events in order to avoid invalidity, to confirm a better future outcome. US patients were more prone to stick to current therapy than escalade to increase clinical response. However, asked about novel therapies, Romanians were reluctant to changing treatment despite insufficient benefit, if the risk of cancer was noted. There was a high agreement that a delay in treatment would be unsatisfactory for both familial and professional chores.

Conclusion:

There are regional differences in knowledge and perceptions about RA treatment. Romanian patients know less on T2T algorithm. Improving awareness of the T2T strategy among RA patients may need different types of support depending on the patient’s place of residence.

References:

[1]Smolen, J. S.et al.EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update.Ann. Rheum. Dis.76,960–977 (2017).

[2]Owensby, J. K.et al.Patient- and Rheumatologist- Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis.Arthritis Care Res. (Hoboken).0–2 (2019).

Disclosure of Interests:

CLAUDIA COBILINSCHI Speakers bureau: novartis, Maria Danila Speakers bureau: as personally stated, Daniela Opris-Belinski Speakers bureau: as declared, Ioana Saulescu Speakers bureau: Eli-Lilly, Pfizer, Laura Groseanu Speakers bureau: novartis, eli-lilly, ucb, pfizer,sandoz, Sanziana Daia-Iliescu Speakers bureau: sandoz, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Razvan Ionescu Speakers bureau: as personally stated, Magda Parvu Consultant of: Speaker fee and consultant: Pfizer, Novartis, Roche, Abbvie, UCB, Eli-Lilly, Speakers bureau: Speaker fee and consultant: Pfizer, Novartis, Roche, Abbvie, UCB, Eli-Lilly, Horatiu Popoviciu Speakers bureau: as personally stated, CODRINA ANCUTA Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Elena Rezus: None declared, Claudia Mihailov Speakers bureau: as personally stated, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz

SAT0111 THE RELATIONSHIP BETWEEN THE ADMINISTRATION OF IL-6 INHIBITORS AND INSULIN RESISTANCE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) risk, due not only to the traditional risk factors (hypertension, insulin resistance/diabetes, obesity, smoking), but to the inflammatory status as well. The blockade of interleukin-6 (IL-6) can regulate the glucose metabolism, reducing the glucose level and insulin resistance (IR). This beneficial effect is seen more in patients with normal values of body mass index (BMI), compared to the obese population.

Objectives:

Given the mentioned existing data, we aim to demonstrate the positive effect of IL-6 inhibitors in active RA patients with normal or increased BMI.

Methods:

We recruited 56 consecutive patients with definite and active RA, non-responders/partial responders to conventional synthetic Drug Modifying Anti-Rheumatic Drugs (csDMARDs)/biological therapy. For a period of 52 weeks, patients received subcutaneous Tocilizumab (TCZ) in a dose of 162mg once a week, according to European League Anti Rheumatism (EULAR) recommendation and National Protocol. We assessed demographics, RA-related parameters (clinical, inflammatory and immune) and metabolic markers, as well as the peripheral response to insulin, quantified by Homeostasis Model Assessment for insulin resistance (HOMA-IR) and the Quantitative Insulin Sensitivity Check Index (QUICKI). We did not include in the study the patients known with diabetes mellitus (DM) and those undergoing glucocorticoids.

Results:

After 52 weeks of treatment, most of the patients showed a statistically significant reduction of HOMA-IR (3.61 ± 1.21 at the onset vs. 2.45 ± 1.46 at the end of the study, p<0.001), while QUICKI registered a slight increase (0.32 ± 0.01 at the onset vs. 0.33 ± 0.01 at the end of the study, p<0.001). Also, the decrease in insulin and glucose levels were more obvious in patients with normal BMI, strictly related to disease activity.

Conclusion:

Long-term administration of TCZ in active RA is associated with a significant reduction of disease activity and IR, especially in normal weight patients. This confirms that obesity, as a CV risk factor, represents one of the main causes of IR.

References:

[1]Castañeda S, Remuzgo-Martínez S, López-Mejías R et al. Rapid beneficial effect of the IL-6 receptor blockade on insulin resistance and insulin sensitivity in non-diabetic patients with rheumatoid arthritis.Clin Exp Rheumatol. 2019; 37(3):465-473.

[2]Lehrskov LL, Christensen RH. The role of interleukin-6 in glucose homeostasis and lipid metabolism.Semin Immunopathol. 2019; 41(4):491-499.

[3]Ursini F, Russo E, Ruscitti P, Giacomelli R, De Sarro G. The effect of non-TNF-targeted biologics and small molecules on insulin resistance in inflammatory arthritis.Autoimmun Rev. 2018 Apr;17(4):399-404.

Disclosure of Interests:

Alexandra Jitaru: None declared, Cristina Pomirleanu: None declared, Maria-Magdalena Leon-Constantin: None declared, Florin Mitu: None declared, CODRINA ANCUTA Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly

McKenzie training in patients with early stages of ankylosing spondylitis: results of a 24-week controlled study

BACKGROUND

It is widely accepted that patient education and regular exercises could improve pain, function and maintain posture in ankylosing spondylitis (AS).

AIM

The main aim of our study was to demonstrate the benefits of a specific, McKenzie training focusing on pain, spine flexibility, disease activity and function, as well as chest expansion in AS.

DESIGN

Controlled study.

SETTING

Rheumatology and Rehabilitation Department.

POPULATION

Patients with early AS.

METHODS

Prospective 24-week controlled study in 52 patients with early AS (modified 1984 New York criteria) randomly assigned to perform either McKenzie training (28 AS) or classic kinetic exercises (24 AS). Efficacy parameters comprising pain, lumbar spine mobility (modified Schober test, mST; finger-to-floor distance, FFD; BASMI), chest expansion (CE), disease activity (BASDAI) and function (BASFI) were evaluated during three visits (week 0, 12 and 24 after the initiation of the kinetic program). The exercise protocol consisted of 50-minute sessions performed 3 times weekly for 24 weeks, with a 12-week learning module assisted by a trained physical therapist in the outpatient rheumatology and rehabilitation department, and a 12-week module performed individually at home. Only subjects attending the kinetic program on a regular basis (at least 2 times weekly, at least 60 attended sessions during the study) were and accepted for the final evaluation.

RESULTS

After 12 and 24 weeks of exercises we reported significant improvement in pain (P=0.015 and P=0.003), metrology (mST: P=0.001 and P=0.001; FFD: P=0.002 and P=0.001; BASMI: P=0.001 and P=0.001), disease activity (BASDAI: P=0.004 and P=0.001) and function (BASFI: P=0.001 at both visits) in the McKenzie group. mST, BASDAI, BASFI and BASMI also improved at both visits in controls (P<0.05), while CE and FFD significantly changed only in long-term assessment (P<0.05). Intergroup analysis demonstrated significant differences in all measurements including favoring AS in the McKenzie exercises (P=0.001).

CONCLUSION

A specific McKenzie training should be included in the standard-care of AS aiming to improve pain, posture and function, especially in early axial disease.

CLINICAL REHABILITATION IMPACT

A specific McKenzie training should be included in the standard-care of AS.

The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program

OBJECTIVES

The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA).

METHODS

Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (<24.000 USD) participated in the Quantitative Standard monitoring of Patients with RA (QUEST-RA) study. The prevalence of 31 comorbid conditions, fatigue (0-10 cm visual analogue scale [VAS] [10=worst]), disease activity in 28 joints (DAS28), and physical disability (Health Assessment Questionnaire score [HAQ]) were assessed. Univariate and multivariate linear regression analyses were performed to assess the association between fatigue and comorbidities, disease activity, disability and GDP.

RESULTS

Overall, patients reported a median of 2 comorbid conditions of which hypertension (31.5%), osteoporosis (17.6%), osteoarthritis (15.5%) and hyperlipidaemia (14.2%) were the most prevalent. The majority of comorbidities were more common in high-GDP countries. The median fatigue score was 4.4 (4.8 in low-GDP countries and 3.8 in high-GDP countries, p<0.001). In low-GDP countries 25.4% of the patients had a high level of fatigue (>6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant.

CONCLUSIONS

Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.

Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database

OBJECTIVE

To determine the prevalence of and independent factors associated with joint involvement in a large population of patients with systemic sclerosis (SSc).

METHODS

This study was cross-sectional, based on data collected on patients included in the European League Against Rheumatism (EULAR) Scleroderma Trials and Research (EUSTAR) registry. We queried this database to extract data regarding global evaluation of patients with SSc and the presence of any clinical articular involvement: synovitis (tender and swollen joints), tendon friction rubs (rubbing sensation detected as the tendon was moved), and joint contracture (stiffness of the joints that decreased their range of motion). Overall joint involvement was defined by the occurrence of synovitis and/or joint contracture and/or tendon friction rubs.

RESULTS

We recruited 7286 patients with SSc; their mean age was 56 +/- 14 years, disease duration 10 +/- 9 years, and 4210 (58%) had a limited cutaneous disease subset. Frequencies of synovitis, tendon friction rubs, and joint contractures were 16%, 11%, and 31%, respectively. Synovitis, tendon friction rubs, and joint contracture were more prevalent in patients with the diffuse cutaneous subset and were associated together and with severe vascular, muscular, renal, and interstitial lung involvement. Moreover, synovitis had the highest strength of association with elevated acute-phase reactants taken as the dependent variable.

CONCLUSION

Our results highlight the striking level of articular involvement in SSc, as evaluated by systematic examination in a large cohort of patients with SSc. Our data also show that synovitis, joint contracture, and tendon friction rubs are associated with a more severe disease and with systemic inflammation.