Disease activity and functional outcomes in non-radiographic spondyloarthritis versus ankylosing spondylitis – preliminary results

Introduction. Spondyloarthritis (SpA) represent a heterogeneous group of chronic inflammatory conditions sharing clinical, genetic, imaging and therapeutic features. Objectives. To analyze the clinical and biological characteristics, disease activity and functional impact in non-radiographic axial SpA (nr-axSpA) versus ankylosing spondylitis (AS). Material and method. Cross-sectional observational 12 months study on 46 patients with axial SpA; disease related parameters (clinical, biological, activity and functionality indices) and treatment options were compared in disease categories (nr-axSpA and AS). Outcomes. AS was diagnosed in 73.9%, and nr-axSpA in 26.1% cases. The majority of patients with nr-axSpA were women (72% vs 28%), with a younger age at onset (35.2±9.5 years vs 41±0.6 years) and a shorter time to diagnosis (3±0.5 vs 5.5±3.2 years). C-reactive protein levels were significantly higher in AS compared to nr-axSpA (2.2±0.5 vs 1.28±0.7)(p<0.05). However, there were no significant differences between activity (ASDAS-CRP: 3.4±1.2 vs 3.2±0.9; BASDAI: 5.8±1.3 vs 5.6±1.1) and functionality measures (BASFI: 5.8±1.4 vs 5.7±1.2) in (p >0.05) in AS vs nr-axSpA. Conclusions. Although nr-axSpA occurs frequently in women and may present with lower CRP levels, there are similar trends in disease activity and functional outcomes in both disease categories of the ax-SpA spectrum. Both nr-axSpA and AS patients experience high disease burden.

Comorbidities of rheumatoid arthritis: A cross-sectional retrospective study

Objective. Understanding comorbidities of rheumatoid arthritis (RA) and their burden definitely redefines the holistic approach of RA in daily practice. This study aimed to explore a range of comorbidities in patients with RA and to analyze their involvement in the choice of individualized treatment in real-life to achieve better disease outcomes. Material and method. A retrospective cross-sectional observational study in a cohort of 201 consecutive adult RA (diagnosed by either ACR 1987 or EULAR/ACR 2010 criteria) examining the association between comorbidities and different drug prescriptions for RA. Results. Comorbidities were recognized in 90% of patients; top five associated disorders were hypertension (n=106; 52.72%), osteoporosis (n=73; 36.32%), dyslipidemia (n=58; 28.86%), interstitial lung disease (n=43; 21.39%), chronic kidney disease (n=35; 17.41%). Antimalarials were the most commonly prescribed drugs (n=84; 41.79%) followed by methotrexate (n=76; 36.81%) and biologics (n=63; 31.34%) with a comparable distribution between TNF inhibitors (n=27; 13.43%) and anti-IL-6 drugs (n=28; 13.93); only 13 cases (6.47%) received tsDMARDs. 16% patients with concomitant hypertension, 11% with diabetes, 15% with osteoporosis and 15.52% with dyslipidemia received intermittent low doses of glucocorticoids. Reported in 24 cases (11.94%), hepatitis B and C significantly affect the use of medication, including bDMARDs (only 4 cases on etanercept given together with antivirals), while RA with interstitial lung disease received biologics in one third of cases. Conclusion. Exploring RA journey from the perspective of comorbidities in real-life underpins management challenges related to associated conditions as comorbidities of RA patients may impact treatment regimens of RA and/or the prescribed drugs may worsen associated disorders.

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

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

Serum Lipid Profile in Diffuse versus Limited Systemic Sclerosis Data from the SASS cohort

Data about lipoprotein changes and their link with cardiovascular disease and atherosclerosis in systemic sclerosis (SSc) are still challenging. We aimed to evaluate serum lipid profile of patients with SSc and to identify potential relation with different disease specific characteristics (clinical, serological, inflammatory tests) in a cross-sectional study. Standard assessments comprised SSc-related parameters (disease subtype, clinical spectrum, immunological tests) and lipid metabolism (total cholesterol and fractions, triglycerides). Impaired lipid profile (low serum HDL- and high LDL-cholesterol, increased serum triglycerides, slightly modification in total cholesterol level) significantly correlated with diffuse SSc, activity (EUSTAR) and severity (MEDSGER), as well as seropositivity for specific antibodies (anti-centromere and anti-topoisomerase 1). The dyslipidemic profile might represent a pathobiological pathway for atherosclerosis in SSc.

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders accounting for significant disability and impaired quality of life. The aim of our study was to assess inflammatory and immune parameters in patients with TMJ arthritis related to rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify potential relation with severity and dysfunction of TMJ pathology. We performed a cross-sectional study in a cohort of 433 consecutive RA, 32 JIA, 258 AS, and 103 PsA. Only patients presenting with clinically significant TMJ involvement (273) related to their rheumatic condition were included in the final analysis. TMJ involvement is traditionally described in chronic inflammatory rheumatic disorders, particularly in patients with higher levels of inflammation as detected in rheumatoid arthritis and psoriatic arthritis. Disease activity and severity, as well as biological and positive serological assessments (rheumatoid factor, anti-cyclic citrullinated peptide, IL-1) remain significant determinants of the severity of TMJ arthritis.

Periodontal Disease in Patients with Ankylosing Spondylitis: myth or reality?

Although the relation between periodontitis (PD) and systemic disorders (e.g. cardiovascular diseases, diabetes and rheumatoid arthritis) is widely accepted, the association with ankylosing spondylitis (AS) is inconsistently mentioned. We prospectively examined the relationship between periodontal disease and AS, focusing on the rate and course of PD, factors associated with severity and the impact of anti-TNF-a treatment on inflammatory status. Standard assessments performed twice (week 0, week 24) included an extensive dental evaluation (plaque index, gingival index, bleeding on probing, periodontal pocket depth, clinical attachment loss), inflammatory parameters and AS activity scores (BASDAI, ASDAS-CRP). More than half of AS presented with impaired periodontal health at baseline (mild to moderate PD) meaning increased sites with dental plaque, abnormal bleeding, increased periodontal pocket depth and clinical attachment loss. Significant positive correlation between presence and severity of PD, AS activity and systemic inflammation (CRP) was reported at baseline (p[0.05). A final analysis performed at 24 weeks revealed significant improvement in periodontal status, inflammatory parameters and AS activity, suggesting efficacy of TNF inhibitors directed not only against systemic, but also on local (articular, periodontal) inflammation (p[0.05). Patients with AS are at risk to develop periodontal disease, particularly those with high levels of systemic inflammation. Benefits of anti-TNFa therapy in the particular settings of AS patient and concomitant periodontal disease should be validated through further studies in larger cohorts.

Periodontal Diseases and Lipid Profile in Systemic Sclerosis: an EUSTAR Cohort Experience

Dental pathology is commonly described among patients with systemic sclerosis (SSc), a multisystem autoimmune disorder, and assumed to be multifactorial. We aimed to evaluate the periodontal status and to identify potential relation with SSc-specific parameters as well as serum lipid profile in a cross-sectional study on consecutive SSc. Standard assessments comprised dual, rheumatologic (disease subtype, clinical spectrum, inflammatory, immunological, lipid metabolism - total cholesterol and fractions, triglycerides), and dental evaluation (plaque index, bleeding on probing, pocket depth, clinical attachment level). 70.96% SSc developed oral manifestations, 51.61% periodontal disease, while one third severe aggressive periodontitis, particularly in diffuse SSc (p[0.05). Abnormal lipid pattern (low serum HDL- and high LDL-cholesterol, increased serum triglycerides, without significant modification in total cholesterol level) significantly correlated with diffuse SSc and skin involvement, disease duration, anti-topoisomerase 1 positivity, SSc activity and severity, as well as periodontitis (p[0.05). Our results clearly define an association between the presence and severity of periodontal disease and lipid anomalies in SSc, suggesting a potential link with early atherosclerosis via gingival inflammation and altered lipid metabolism.

A predictive model for remission and low disease activity in patients with established rheumatoid arthritis receiving TNF blockers

The objective of this study was to identify predictors for remission or low disease activity (LDA) in established rheumatoid arthritis (RA) at 12 months of anti-TNF-α therapy. We have performed a prospective observational study in 90 consecutive patients with active RA receiving TNF-α inhibitors. Baseline and standard assessments were done every 3 months, including individual parameters (clinical and biological) and composite activity scores (28-joint disease activity score, DAS28). The primary outcome measure was DAS28-based EULAR response criteria. The multivariate logistic regression was used to analyze the association between disease activity and several RA baseline characteristics. Of the RA, 78.8 % was classified as good responders based on the EULAR-DAS28 criteria, 44.4 % RA achieving remission (DAS28 ≤ 2.6) and 34.4 %, LDA (DAS28 ≤ 3.2). Parameters associated with an increased likelihood of remission and LDA were initial DAS28-erythrocyte sedimentation rate ≤ 7 (odds ratio (OR) 3.3, 95 % confidence interval (CI) 2.03-5.81; OR 1.8, 95 % CI 1.09-6.68), Health Assessment Questionnaire Disability Index ≤  2 (OR 7.0, 95 % CI 1.56-31.91; OR 1.3, 95 % CI 1.03-5.79), C-reactive protein level ≤ 20 mg/l (OR 1.5, 95 % CI 0.29-8.22; OR 0.5, 95 % CI0.08-2.97), rheumatoid factor ≤ 20 IU/ml (OR 18.9, 95 % CI 10.79-38.36; OR 32.9, 95 % CI 4.03-269), anti-cyclic citrullinated peptide antibodies ≤ 40 IU/ml (OR 3.5, 95 % CI 0.67-18.19; OR 1.2, 95 % CI 1.02-1.59), concurrent prednisolone (OR 0.2, 95 % CI 0.05-0.36; OR 0.2, 95 % CI 0.06-0.63), methotrexate or leflunomide (OR 1.6, 95 % CI 1.2-13.53; OR 2.9, 95 % CI 1.20-4.36). A predictive matrix for remission and LDA in established active RA patients receiving TNF-α inhibitors was proposed. Further studies are necessary to confirm the value of such matrix in particular RA settings, leading to optimization of the use of anti-TNF-α therapy.

[Prospective study of the efficiency and safety of adalimumab in treatment of active established rheumatoid arthritis]

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by synovial pannus formation leading to cartilage destruction, bone erosion, and disability.

AIM

To evaluate the efficiency and safety of adalimumab (ADA) in association with one or more classic remissive drugs in active established RA.

MATERIAL AND METHODS

Prospective observational 12 months study in 33 consecutive active RA treated with ADA. Patients were assessed according to a complex protocol including both individual parameters (clinical, biological) and composite disease activity scores (DAS28, CDAI, SDAI), while response to therapy was evaluated based on EULAR and ACR response criteria.

RESULTS

Statistical significant improvement has been demonstrated in all patients under ADA (p < 0.05); after 3 months of treatment 51.5% RA fulfilled ACR20, 39.3% ACR50 and 9% ACR70 criteria; after 6 months of treatment 66.6% of patients and 33.3% fulfilled ACR20 and, respectively, ACR50 criteria. Moreover, 30.3% of all patients had good response after 6 months, 66.6% moderate response and only 3.03% displayed no response in the same period. 24.2% and 45.4% of RA achieved remission (DAS28 < or = 2.6) after 9 and 12 months of ADA, while 39.3% and 21.2% had moderate activity. Rate and type of adverse events demonstrated the safety and good tolerance of ADA.

CONCLUSIONS

Our data support the efficacy and safety of ADA in active established RA in the settings of the real-life clinical practice.

The Protective Effect of IL-6 Blockade on Glucose and Cardiovascular Risk in Patients with Active Rheumatoid Arthritis

Considering the multivalent role of interleukin-6 (IL-6) both in rheumatoid arthritis (RA) and in the metabolic processes, we aimed to evaluate the positive effect of subcutaneous tocilizumab (TCZ) on the probability of developing diabetes mellitus (DM). We recruited 56 consecutive patients with definite and active RA and assessed demographics, RA-related parameters and metabolic biomarkers, including the Homeostasis Model Assessment for insulin resistance (HOMA-IR) and the Quantitative Insulin Sensitivity Check Index (QUICKI). After 52 weeks of treatment, most of the patients showed a statistically significant reduction of HOMA-IR (3.61 � 1.21 at baseline vs. 2.45 � 1.46 at the end of the study, p[0.001), while QUICKI registered only a slight increase (0.32 � 0.01 at baseline vs. 0.33 � 0.01 at final evaluation, p[0.001). Our results strongly suggest that long-term IL-6 blockade has a beneficial effect in slowing the atherosclerotic process and reducing CV risk in active RA.