Implementation of a hybrid healthcare model in rheumatic musculoskeletal diseases: 6-months results of the multicenter Digireuma study

OBJECTIVES

Rheumatic and musculoskeletal diseases (RMDs) require a tailored follow-up that can be enhanced by the implementation of innovative tools. The Digireuma study aimed to test the feasibility of a hybrid follow-up utilizing an electronic patient reported outcomes (ePROs)-based monitoring strategy in patients with RMDs.

METHODS

Adult patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) were recruited for a 6-month bicentric prospective follow-up consisting of face-to-face and digital assessments. Patients were asked to report disease-specific ePROs on a pre-established basis, and could also report flares, medication changes, and recent infections at any time. Four rheumatologists monitored these outcomes and contacted patients for interventions when deemed necessary. Results from face-to-face and digital assessments were described.

RESULTS

Of 56 recruited patients, 47 (84%) submitted any ePROs to the digital platform. Most patients with RA were female (74%, median age of 47 years), while 48% of patients with SpA were female (median age 40.4 years). A total of 3,800 platform visits were completed, with a median of 57 and 29 visits in patients with RA and SpA, respectively. Among 52 reported alerts, 47 (90%) needed contact, of which 36 (77%) were managed remotely. Adherence rates declined throughout the study, with around half of patients dropping out during the 6 months follow-up.

CONCLUSION

The implementation of a hybrid follow-up in clinical practice is feasible. Digital health solutions can provide granular knowledge of disease evolution and enable more informed clinical decision making, leading to improved patient outcomes. Further research is needed to identify target patient populations and engagement strategies.

AB1469 SPANISH TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE mSQUASH

Background

Regular physical activity is recommended for all patients in the ASAS/EULAR recommendations for the management of axial spondyloarthritis (axSpA). However, there is a lack of outcome measures that assess the amount and type of physical activity in patients with axSpA. For this matter, the modified Short QUestionnaire to Assess Health enhancing physical activity (mSQUASH) was developed and validated, originally in Dutch1.

Objectives

To translate and cross-culturally adapt the mSQUASH into Spanish and to test the equivalence of the translated version in patients with axSpA.

Methods

The mSQUASH was translated into Spanish and then back-translated into Dutch, following forward-backward procedure as described by Beaton2 (Figure 1). Two bi-lingual translators (native speakers for European Spanish) produced independent forward translations of the item content, response options, and instructions of the mSQUASH into Spanish. Both versions were harmonized in a meeting among the Spanish translators, a methodologist and a rheumatologist into a consensual version. Another translator (native speaker for Dutch), blinded for the original version, back translated the synthesized version into Dutch. An expert committee, including all translators, one methodologist and a rheumatologist, reached consensus on discrepancies, ensuring equivalence between the Dutch and Spanish versions, and developed a pre-final version of the Spanish mSQUASH. The field test with cognitive debriefing involved a sample of 10 patients with axSpA covering the full spectrum of the disease -radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA)- with different gender, age, disease duration, and educational background. Each patient was interviewed to check understandability, interpretation and cultural relevance of the translation.

Figure 1.

Cross-cultural adaptation of the mSQUASH

Results

The translation process of the mSQUASH was completed without major complications following the forward-backward procedure. The first translation needed several iterations due to small discrepancies in the wording. Back-translation was performed without difficulties, and the expert committee agreed upon a final version of the questionnaire. A total of 10 patients with axSpA participated in the field test (Table 1). Seven were male, mean age (SD) was 38.9 (14.4) years; 6 patients had r-axSpA, 9 were HLA-B27+. Cognitive debriefing showed the Spanish questionnaire to be, relevant, understandable and comprehensive. The preliminary version was accepted with minor modifications. As a result of the interviews, minor spelling errors were corrected, and the wording of the response categories was homogenized (“despacio/ligero”). Besides, the term “colegio”- translated literally from the Dutch “school”- was found not comprehensive enough to reflect possibilities on education (i.e. it does not include university), so it was adapted to “el lugar de estudio”.

Table 1.

Patients’ characteristics

#GenderAgeWorking statusEducationaxSpA subtypeDisease durationHLA-B27DrugBASDAI1Male63WorkingUniversityr-axSpA35 y+NSAIDs2.32Male24StudentSecondaryr-axSpA6 y+NSAIDs03Male37WorkingUniversityr-axSpA5 y+ADA2.54Male66RetiredUniversityr-axSpA23 y+IFN3.15Male29WorkingUniversityr-axSpA11 y+ADA06Female26WorkingUniversitynr-axSpA2 y+NSAIDs-7Male24StudentUniversitynr-axSpA1 y+ETA4.58Male35WorkingUniversityr-axSpA12 y+GOL09Female40WorkingSecondarynr-axSpA4 y+NSAIDs-10Female45UnemployedPrimarynr-axSpA9 y-GOL8.2

Conclusion

The resulting Spanish version of the mSQUASH showed good linguistic and face validity according to the field test, revealing potential for use in both clinical practice and research settings. In order to conclude the cross-cultural adaptation of the mSQUASH into Spanish, the next step is the assessment of psychometric properties of the Spanish version.

References

[1]Beaton DE, et al. Spine. 2000; 25:3186-91

[2]Carbo et al. Semin Arthritis Rheum. 2021; 51:719-27

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis, Andrea Jochems: None declared, DORA PASCUAL-SALCEDO Speakers bureau: Pfizer, Menarini, Takeda, Abvvie., Grant/research support from: Pfizer, Menarini, Takeda, Abvvie., Gijs Jochems: None declared, Chamaida Plasencia Speakers bureau: Pfizer, Abbvie, Lilly, Sandoz, Sanofi, Biogen, Roche and Novartis, Grant/research support from: Pfizer and Abbvie, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Suzanne Arends: None declared, Anneke Spoorenberg Consultant of: AbbVie, Novartis, Pfizer; UCB, Lilly, Grant/research support from: AbbVie, Pfizer, Alejandro Balsa Speakers bureau: Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis

POS0972 MOST DISEASE OUTCOME MEASURES BUT NOT ASDAS ARE INFLUENCED BY GENDER IN PATIENTS WITH AXIAL SpA: RESULTS FROM ASAS-PerSpA

Background

There is growing evidence revealing that females report worse patient-reported outcomes compared to males in axial spondyloarthritis (axSpA). However, in which precise outcomes there is a meaningful difference across gender and whether this also occurs in patients with peripheral spondyloarthritis (pSpA) and psoriatic arthritis (PsA) is not fully understood.

Objectives

To investigate the influence of gender on disease outcomes in patients with SpA, including axSpA, pSpA and PsA, in a worldwide setting.

Methods

Data from 4185 patients with axSpA, pSpA or PsA from the ASAS-PerSpA study were analysed. The ASAS-PerSpA is a cross-sectional study that recruited consecutive patients with SpA (according to their rheumatologist) from 24 countries. Associations between gender and disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)], function [Bath Ankylosing Spondylitis Functional Index (BASFI)], and overall health [ASAS-Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)] were investigated. Multilevel (country) univariable and multivariable linear mixed models were used. Interactions between gender and disease phenotype (SpA, pSpA and PsA) were analysed, and if relevant, models were stratified by disease subtype. Models were adjusted for relevant confounders (Table 1).

Table 1.

Multivariable multilevel model by disease phenotype

OutcomeDeterminant of interestDisease phenotypeAxSpApSpAPsAASDAS +Gender (female vs male)0.02 (-0.07, 0.11)0.36 (0.15, 0.58)0.25 (0.12, 0.38)BASDAI *0.39 (0.20, 0.58)1.22 (0.77, 1.69)0.88 (0.59, 1.16)BASFI -0.01 (-0.14, 0.17)0.30 (-0.12, 0.71)0.46 (0.20, 0.72)CRP^-1.36 (-3.17, 0.44)ASAS-HI#0.90 (0.70, 1.10)EQ-5D°-0.02(-0.03, -0.01)

All models are adjusted by age, gender and education.

+Also adjusted for marital status, BMI, smoking, axial involvement, peripheral arthritis, enthesitis, fibromyalgia, NSAIDs, steroids, csDMARDs, bDMARDs

* Also adjusted for marital status, BMI, smoking, axial involvement, peripheral arthritis, enthesitis, psoriasis, fibromyalgia, NSAIDs, bDMARDs

- Also adjusted for marital status, BMI, ASDAS, radiographic damage, fibromyalgia, NSAIDs, bDMARDs

^ Also adjusted for marital status, BMI, radiographic damage, concomitant NSAIDs, steroids, csDMARDs

# Also adjusted for smoking, ASDAS, BASFI, peripheral arthritis, enthesitis, fibromyalgia

° Also adjusted for BMI, smoking, ASDAS, BASFI, radiographic damage, HLA-B27, enthesitis, fibromyalgia

Results are expressed in β (95% CI). Estimates with p<0.05 are highlighted in bold

Results

In total, 4185 patients were included, of which 2719, 1033 and 433 had a diagnosis of axSpA (mean age 42 years, 32% female), PsA (mean age 52 years, 52% female) and pSpA (mean age 44 years, 53% female), respectively. A significant interaction between gender and disease phenotype was found for ASDAS, BASDAI and BASFI. Multivariable models for each outcome are shown in Table 1 (stratified by disease phenotype). While being female independently contributed to higher BASDAI across the three disease phenotypes (though with varying magnitude), female gender was only associated with higher ASDAS in pSpA [β (95% CI): 0.36 (0.15, 0.58)] and PsA [0.25 (0.12, 0.38)] but not in axSpA [0.016 (-0.07, 0.11)]. Female gender was associated with higher BASFI in PsA [0.46 (0.20, 0.72)]. No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS-HI [0.90 (0.70, 1.10)] and EQ5D [-0.02 (-0.03, -0.01)], without significant differences across disease phenotype.

Conclusion

Female gender was associated with less favorable outcomes across the SpA spectrum, except for CRP in which there were no differences between gender. While female gender influenced BASDAI across disease phenotypes, ASDAS was not associated with gender in axSpA. These results suggests that ASDAS should be the preferred instrument in clinical practice both for females and males with axSpA.

Acknowledgements

We would like to thank all ASAS-perSpA investigators and members of the scientific committee.

Disclosure of Interests

Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Anna Moltó Consultant of: Abbvie, UCB, Novartis, Gilead, Pfizer, Lilly y Janssen, Grant/research support from: UCB, Clementina López-Medina Speakers bureau: Lilly, Novartis, Janssen, UCB and Abbvie, Maxime Dougados: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis

AB1472 TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE CORS INTO SPANISH

Background

Rheumatic diseases substantially affect the lives of patients, with complex associations between disease severity and self-perceived health status. In this regard, the Coping with Rheumatic Stressors (CORS) questionnaire was developed to measure how patients with rheumatoid arthritis cope with stressors such as pain or dependence. There is no validated instrument to measure coping in axial spondyloarthritis (axSpA) and therefore the adaptation of the CORS would be of great value.

Objectives

To cross-culturally adapt the CORS into Spanish and to test the conceptual equivalence of the translated version in patients with axSpA.

Methods

A translation of the CORS into Spanish was performed, followed by a back-translation into Dutch, following forward-backward procedure as described by Beaton1(Figure 1). Two bi-lingual translators (native speakers for Spanish), one of them informed of the content of the questionnaire and the other not informed, produced independent forward translations of the item content, response options, and instructions of the CORS into Spanish. Both versions were harmonized in a consensual version. Another translator (native speaker for Dutch), not informed of the concepts used in the questionnaire, back translated the synthesized version into Dutch. An expert committee including all translators, one methodologist and a rheumatologist, held a meeting and reached consensus on discrepancies to develop a pre-final version of the Spanish CORS. The field test with cognitive debriefing involved a sample of 10 patients with axSpA covering the full spectrum of the disease and with different sociodemographic backgrounds.

Figure 1.

Cross-cultural adaptation of the CORS

Results

The translation process of the CORS was completed following the forward-backward procedure, after discussion of the discrepancies throughout the process. The first translation was done without major complications. However, several discrepancies appeared in the back-translation, in which there were minor modifications in the wording in one response option (“muchas veces” to “muy a menudo”) and 15 questionnaire items. As an example, “Ik ga de deur uit”, literally meaning “I go out by the door”, was initially translated as such (“salgo por la puerta”); however, it conceptually represents “I go away”, and it was adapted like this (“me voy a la calle”). Thus, a pre-final consensus version of the CORS was agreed by the expert committee. This pre-final version was field tested in 10 patients with axSpA: mean age (SD) was 38.9 (14.4) years, 7 patients were male, 6 had radiographic axSpA, and 9 were HLA-B27+. The Spanish questionnaire appeared clear and understandable to all patients. However, some minor modifications were proposed in some items (Table 1). As a result of the cognitive debriefing, two changes were implemented (one instruction and one item), whereas two other suggestions did not lead to any change due to minor wording discrepancies with similar conceptual equivalence. The final version of the Spanish CORS is shown at shorturl.at/cimC6.

Table 1.

Cognitive debriefing queries and decisions from the expert committee

Original Dutch itemSpanish translation pre-final# Patient queriesQueriesFinal version(….) aan te geven hoe vaak u het beschreven gedrag uitvoert.(…) indique cuán a menudo usted ha llevado a cabo dicho comportamiento.1Literal discrepancies(…) indique la frecuencia con que usted ha tenido dicho comportamiento.Ik rust op tijd uitMe voy a tiempo a descansar1Literal discrepanciesNo changesIk probeer er het beste van te makenIntento aprovechar al máximo1Literal discrepanciesNo changesIk houd rekening met anderenTengo en cuenta a los demás2Meaning doubtsTengo en consideración a los que me ayudan/cuidan

Conclusion

The Spanish version of the CORS showed good cross-cultural validity and good face validity in patients with axSpA according to the field test. Before the Spanish CORS is implemented, further validation is in progress to test the psychometric properties of the instrument.

References

[1]Beaton DE, et al. Spine. 2000; 25:3186-91

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis, Andrea Jochems: None declared, DORA PASCUAL-SALCEDO Speakers bureau: Pfizer, Menarini, Takeda, Abvvie., Grant/research support from: Pfizer, Menarini, Takeda, Abvvie., Gijs Jochems: None declared, Chamaida Plasencia Speakers bureau: Pfizer, Abvvie, Lilly, Sandoz, Sanofi, Biogen, Roche, Novartis., Grant/research support from: Pfizer, Abvvie., Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UC, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Wim van Lankveld: None declared, Alejandro Balsa Speakers bureau: Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis

POS0302 TREATING SPONDYLOARTHRITIS EARLY: DOES IT MATTER? RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

Background

So far, no consensus has been reached on a definition of early SpA. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims to develop a consensual definition. Therefore, it is important to know whether treatment earlier in the disease course compared to treatment of established disease leads to better outcomes in axSpA.

Objectives

To summarize the evidence on the relationship between symptom duration or the presence of radiographic damage and clinical response in patients with axSpA treated with NSAIDs, bDMARDs or tsDMARDs.

Methods

A SLR was conducted using Medline, EMBASE and the Cochrane Library (April 28, 2021), supplemented by hand-searches in the FDA website. Randomized controlled trials (RCTs) and cohort studies in patients with axSpA addressing the impact of symptom duration or disease duration and presence of radiographic damage on treatment response (to NSAIDs, b/tsDMARDs) were included. Based on a cut-off of symptom/disease duration or the absence/presence of radiographic damage, groups of ‘early’ and ‘established’ disease were compared. Treatment outcomes were measures of disease activity, function or quality of life.

Two reviewers independently identified eligible studies and extracted the data, including the risk of bias (RoB) assessment. For categorical outcomes we calculated relative risk (RR), relative risk ratio (RRR) and number needed to treat (NNT), and differences in differences (DID) for continuous outcomes.

Results

From the 8769 articles retrieved, 23 were included and 3 added by hand-search, most of them with low RoB. Nineteen studies (9 RCTs) compared groups based on symptom (n=6)/disease duration (n=13) and 7 studies (4 RCTs) based comparisons on absence/presence of radiographic damage in posthoc analyses.

When early axSpA was defined by symptom duration in RCTs (n=4), in patients with nr-axSpA, early treatment was associated with higher RR and RRR and lower NNT for ASAS40 in two studies (Table 1); a third study showed that patients achieving ASDAS-ID and ASAS-PR had shorter symptom duration than those not achieving this. Lastly, in one study including patients with axSpA patients, no difference in treatment response was observed based on symptom duration. In most of the cohort studies using a definition based on symptom/disease duration (n=10), no association was found between symptom/disease duration and treatment response (n=8). Only in one cohort study, disease duration was a significant predictor of quality of life, and in another cohort study, it was a predictor of functional improvement.

Table 1.

Assessment of treatment response in RCTs based on symptom duration

StudyPopulationEarly vs established (years)RR (early vs established)RRR (95%IC)NNTs (early vs established)ASAS20Landewé 2014axSpA<5 vs ≥51.5 vs 1.50.96 (0.53-1.73)5.5 vs 4.8ASAS40Sieper 2012nr-axSpA<5 vs ≥58.2 vs 1.65.24 (1.12-24.41)2.4 vs 9.1Kay 2019nr-axSpA<5 vs ≥55.0 vs 3.31.52 (0.60-3.87)2.1 vs 3.93.6 vs 3.51.01 (0.46-2.20)2.1 vs 2.9ASDAS-MIKay 2019nr-axSpA<5 vs ≥55.1 vs 6.50.78 (0.19-3.16)2.7 vs 4.97.1 vs 6.41.11 (0.34-3.66)2.1 vs 3.0StudyPopulationSymptom durationp valueRespondersNon respondersASDAS-IDSieper 2019nr-axSpA6.1±6.28.3±8.1<0.001ASAS-PRSieper 2019nr-axSpA5.3±5.78.0±7.8<0.001Cell coloursIn favor of early diseaseIn favor of establish diseaseNon significant

When early axSpA was defined based on disease duration or the presence of radiographic damage, there was no significant difference in response to treatment between early and established axSpA.

Conclusion

Studies addressing treatment response based on symptom duration or radiographic damage in axSpA are scarce.

When defining early axSpA based on symptom duration, in nr-axSpA, treatment with bDMARDs may lead to better outcomes compared to established axSpA whereas in axSpA there is no difference in response to treatment between early and established disease.

When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found between early and established disease.

Acknowledgements

The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work.

Disclosure of Interests

Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma

Director of Imaging Rheumatology bv., Robert Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB

POS0374 MONITORING CHRONIC INFLAMMATORY MUSCULOSKELETAL DISEASES WITH A PRECISION DIGITAL COMPANION PLATFORM(TM)–RESULTS OF THE DIGIREUMA FEASIBILITY STUDY

Background

Patients with rheumatic and musculoskeletal diseases (RMDs) require a tailored follow-up that is limited by the capacity of healthcare professionals. Innovative tools need to be implemented effectively in the clinical care of patients with RMDs.

Objectives

To test the feasibility of a Precision Digital Companion Platform™ for real-time monitoring of disease outcomes in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Methods

Digireuma was a prospective study including patients with RA and SpA, using the digital Precision Digital Companion Platform, Adhera for Rheumatology (ISRCTN11896540). During a follow-up of 3 months, patients were asked to report disease specific electronic patient reported outcomes (ePROs) on a regular basis in the mobile solution. Two rheumatologists monitored these ePROs and, patients were contacted for online or face-to-face interventions when deemed necessary by clinicians (Figure 1). Assessment measures included patient global assessment (PGA) of disease activity, tender joint count (TJC), swollen joint count (SJC), Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), for patients with RA; VAS, PGA, TJC, SJC, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and ASAS Health Index (ASAS-HI), for patients with SpA. In addition, flares, changes in medication and recent infections were asked. Usability of the digital solution was measured by the Net-Promoter Score (NPS).

Figure 1.

Digital monitoring in the study powered by Adhera for Rheumatology. Screenshots in top depict the mobile interface (left) and clinical web application (right)

Results

Forty-six patients were recruited of whom 22 had RA and 24 SpA. Mean age was 48 ± 12 and 42 ± 9 years in the RA and SpA groups, respectively. 18/22 (82%) patients with RA and 9/24 (38%) with SpA were female. Among the total included patients, 41 (89%) completed the onboarding (18/22 (82%) RA, 23/24 (96%) SpA) and 37 (80%) submitted at least one entry. In the RA group who completed the onboarding (n=18) there were a total of 4019 total interactions (2178 questionnaire items, 648 accesses to educational units, 105 quizzes, 1088 rated messages), while patients with SpA (n=23) had a total of 3160 interactions (1637 questionnaire items, 684 accesses to educational units, 77 quizzes, 762 rated messages). ePROs measurements completion rates for RA and SpA patients that completed any data during follow-up are shown in Table 1. Patients with RA completed a median of 9.5 ePROs during follow-up, whereas patients with SpA completed a median of 3. Regarding alerts, 15 patients generated a total of 26 alerts, of which 24 were flares (10 RA, 14 SpA) and 2 were problems with the medication (1 RA, 1 SpA). 18 (69%) of the alerts were managed remotely, 5 (19%) required a face-to-face intervention and in 3 (12%) patients did not respond before the consultation. Regarding usability and patient satisfaction, 14 patients provided feedback. According to the NPS, 9/14 were considered promoters, 4/14 passives and 1/14 detractor. The overall rating of these 14 patients for the app was 4.3 out of 5 stars.

Table 1.

Onboarded patient engagement with regards to e-PROs

Rheumatoid Arthritis (n=18)PGATJCSJCVASHAQTotalePROs completed1.5 (0.25, 3)2 (0.25, 3)2 (0.25, 3)2 (0, 3)2 (1, 3)9.5 (4.3, 15.8)Patients with ≥ 1 entry13 (72.2)13 (72.2)13 (72.2)12 (66.7)16 (88.9)16 (88.9)Spondyloarthritis (n=23)PGATJCSJCBASDAIASAS-HITotalePROs completed1 (0,3)1 (0,3)1 (0,3)1 (0,2)1 (0,2)3 (1, 12)Patients with ≥ 1 entry16 (69.5)16 (69.5)16 (69.5)14 (60.8)14 (60.8)21 (91.3)

Follow-up period was 3 months. Results are expressed in median (Q1, Q3) and n (%)

Conclusion

This study shows that the use of a digital health solution is feasible in clinical practice. Based on these preliminary results, the next step will be to further implement the Precision Digital Companion Platform, Adhera for Rheumatology, in a multicentric setting to analyze the added value for monitoring patients.

Acknowledgements

This study was funded with an unrestricted grant from Abbvie.

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis, Abbvie, Francisco J. Núñez-Benjumea Employee of: AdheraHealth Inc, Luis Fernández-Luque Employee of: AdheraHealth Inc, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis, María Sanz: None declared, Enrique Calvo Aranda Speakers bureau: Abbvie, LETICIA LOJO: None declared, Alejandro Balsa Speakers bureau: Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Chamaida Plasencia Speakers bureau: Pfizer, Abbvie, Lilly, Sandoz, Sanofi, Biogen, Roche, Novartis, Grant/research support from: Pfizer y Abbvie

POS0963 HOW IS EARLY SPONDYLOARTHRITIS DEFINED IN THE LITERATURE? RESULTS FROM A SYSTEMATIC REVIEW

Background

The term “early spondyloarthritis (SpA)” has been frequently used to refer to the first phase of the disease, however, no standardized definition on “early” has been established. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims at developing a consensual definition on what is meant by “early SpA”. In order to inform the ASAS-SPEAR working group, it is highly relevant to assess the current meaning of “early SpA” in the literature.

Objectives

To identify all possible definitions of “early SpA” employed in the literature, including “early axial SpA (axSpA)” and “early peripheral SpA (pSpA)”.

Methods

A systematic literature review was conducted in Medline, EMBASE and the Cochrane Library (through April 28th, 2021). The eligibility criteria were studies with any design, in adults that included any mention of “early SpA” or its subtypes in the title or abstract. Two reviewers independently identified eligible studies and extracted data, including the literal definition of early SpA used in each of them. The proportion of studies reporting a definition was calculated, and the different definitions were assessed, including the core of the definition: whether they were based on symptom duration, disease duration, radiographic damage, a combination of them or any other aspects, and their boundaries.

Results

Out of 9,651 titles identified, 355 publications reporting data from 186 studies were included (291 full papers, 64 conference abstracts). Among them, 217 (61%) were cohort studies, 72 (20%) were reviews and 46 (13%) were clinical trials. Over time, an increasing number of publications on early SpA were identified: <2005 (n=34), 2005-2010 (n=48), 2011-2015 (n=109) and 2016-2020 (n=164). Overall, 63 studies (34%) included the term “early axSpA”, 60 (32%) “early ankylosing spondylitis (AS)”, 58 (31%) “early SpA”, 4 (2%) “early non-radiographic axSpA (nr-axSpA)” and 1 (1%) “early pSpA”. In total, 116 (62%) studies reported a specific definition: 40 (34%) based it on symptom duration, 35 (30%) on radiographic damage, 32 (28%) on disease duration, 6 (5%) on both symptom/disease duration and radiographic damage, and 3 (3%) on other aspects. Symptom duration was defined as the time since the onset of low back pain in 21/40 (53%) studies, whereas in 14/40 (35%) the symptom of onset was not specified. Thirty-five of 116 studies (30%) included a definition referred to “early SpA”, 38 (33%) to “early axSpA”, 38 (33%) to “early AS”, 4 (3%) to “early nr-axSpA”, and 1 (1%) to “early pSpA”. Figure 1 shows the 18 distinct definitions that were identified (after combining some similar categories). The three most used definitions per subtype of disease are shown in Table 1. Regarding the studies that referred to “early axSpA”, the most used definition was symptom/disease duration <5 years, whereas for “early AS” was symptom/disease duration <10 years. After 2010, the definition of “early axSpA” based on the absence of radiographic sacroiliitis was less used compared to before 2010 (5/30, 17% vs 3/8, 38%).

Table 1.

Top 3 candidate definitions for “early SpA” and subtypes

Core of the definitionNumber of studies, n (%)SpA (n= 35)nr-axSpA10 (29%)< 2 years duration10 (29%)< 1 year duration6 (17%)AxSpA (n=38)< 5 years duration12 (34%)< 3 years duration9 (24%)nr-axSpA duration8 (21%)AS/r-axSpA (n=38)<10 years duration9 (24%)nr-axSpA7 (18%)< 2 years duration6 (16%)nr-axSpA (n=4)nr-axSpA2 (50%)< 1 year & nr-axSpA1 (25%)< 5 years & nr-axSpA1 (25%)pSpA (n=1)< 12 weeks duration1 (100%)

“Duration” refers to symptom duration or disease duration.

Figure 1.

Number of studies stratified by the core of the definition.

Conclusion

Over time, the term “early SpA” and its subtypes are increasingly used. Despite addressing early SpA, more than one third of the studies did not include a clear definition of the term. The studies reporting a definition of early SpA showed a large heterogeneity, with two out of three of them based on the duration of symptoms or disease. These results emphasize the need for a standardised definition of early SpA.

Acknowledgements

The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work.

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis., Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma., Employee of: Director of Imaging Rheumatology bv., Robert B.M. Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: Abbvie and Novartis

AB0376 DIFFERENCES IN IMMUNOGLOBULIN LEVELS IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS AND RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB

Background

Hypogammaglobulinemia (HGGS) is one of the adverse effects of Rituximab (RTX), a chimeric monoclonal antibody directed against the CD20 receptor, frequently observed in ANCA-associated vasculitis (AAV) patients.

Objectives

To study the characteristics of patients with AAV on RTX treatment and to analyze the factors associated with HGGS, as well as to compare them with patients with rheumatoid arthritis (RA) on the same treatment.

Methods

Retrospective descriptive study of patients with a diagnosis of AAV or RA treated with RTX who had immunoglobulin levels prior to treatment and after each cycle were included. Demographic, clinical and analytical variables were analyzed. Patients who developed HGGS versus those who did not were compared using Student’s t and Mann-Whitney U for continuous variables and chi-square for categorical variables.

Results

Ninety-five patients were included, 19 (20%) with AAV and 76 (80%) with RA. Of the 34 (35.8%) who developed HGGS, 19 had RA (25%) and 15 AAV (79%) (p<0.001). The 6 patients who presented with severe HGGS (IgG<500) belonged to the AAV group.

The overall sample was divided into patients with HGGS and patients without (Table 1). Significant differences were obtained in relation to diagnosis (p<0.001), age at diagnosis and at the start of treatment, being higher in patients with HGGS (p 0.005 and p 0.001) and years of disease evolution (p 0.036). Patients with HGGS had a lower mean baseline IgG (p<0.001). The HGGS group had more severe infections (infections requiring admission) (p 0.005) and the time from RTX administration to the development of infection was shorter in this group (p 0.017). The frequency of abdominal infection was higher in the HGGS group (p 0.050), and there were no significant differences with the other types of infection.

Table 1.Total sample (n= 95)HGGS IgG (n= 34)No HGGS IgG (n= 61)PWomen n/N(%)70/95(73.7)23/34(67.6)47/61(77)0.318Age (m±SD)64±1268±1062±120.005Age at start of treatment (m±SD)57±1262±1054±120.001Years of evolution (m±SD)11±98±912±100.036RA n/N(%)76/95(80)19/34(55.9)57/61(93.4)<0.001AAV n/N(%)19/95(20)15/34(44.1)4/61(6.6)<0.001Glomerular filtration rate <60 n/N(%)7/91(7.7)4/34(11.8)3/61(4.9)0.164GCS AD in the previous year (m±SD)2918±31023265±30502690±31550.238GC AD during treatment (m±SD)4656±177132889±27785576±217750.271Total GC AD (m±SD)56411±326716117050±4841865879±60890.159CFM AD (m±SD)0.51±2.251.1±3.10.2±1.50.032Baseline IgG (m±SD)1107±340933±3461203±297<0.001Infection n/N(%)58/95(61.1)23/34(67.6)35/61(57.3)0.325Severe infection n/N(%)19/95(20)12/34(35.3)7/61(11.5)0.005Time to infection (months)(m±SD)43±4330±3657±450.017Exitus n/N(%)8/95(8.4)2/34(5.9)6/61(9.9)0.270

Conclusion

A significantly higher percentage of HGGS is observed in patients with AAV treated with RTX compared to patients with RA. The development of HGGS seems to be influenced by age at diagnosis and at the start of treatment, years of disease evolution and low levels of IgGs prior to the start of treatment. In addition, there is a higher frequency of severe infections in the HGGS group. Studies with larger sample sizes are needed to confirm these results.

References

[1]Roberts DM, Jones RB, Smith RM, Alberici F, Kumaratne DS, Burns S, Jayne DR. Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun. 2015 Feb;57:60-5. doi: 10.1016/j.jaut.2014.11.009.

Disclosure of Interests

None declared

OP0132 PREVALENCE AND COMORBIDITIES OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE IN SPAIN: A RETROSPECTIVE ANALYSIS OF ELECTRONIC HEALTH RECORDS USING NATURAL LANGUAGE PROCESSING

Background

Interstitial lung disease (ILD) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA) and leads to a significantly increased risk for morbidity and mortality compared with RA alone [1]. The analysis of Electronic Health Records (ERHs) using machine learning (ML) and Natural Language Processing (NLP) holds great promise to better characterize the disease in real-world settings.

Objectives

This study aims to a) estimate the prevalence of RA in Spain, b) determine the frequency of RA-ILD among RA patients, and c) describe the demographic and clinical characteristics in RA/RA-ILD patients.

Methods

Observational, retrospective, and multicenter study based on the secondary use of unstructured clinical data in EHRs from 6 Spanish hospitals between January 1, 2014 and December 31, 2019. The free-text information from patients’ records was captured with SAVANA’s EHRead, a validated NLP technology which extracts clinical information from EHRs and standardizes it into a SNOMED-CT-based clinical terminology [2]. The study population comprised all adult patients ≥18 years with RA in the selected period and sites. Descriptive statistics were presented in summary tables. Prevalence was calculated dividing the total number of patients with RA over the total number of attended patients. This analysis was performed by age and sex.

Results

Among all attended patients in the participating hospitals within the study period, 11,163 patients with RA were identified; of these, 8.6% (n = 959) had RA-associated ILD (RA-ILD). The age-adjusted prevalence of RA is shown in Figure 1. The estimated prevalence (95% CI) in the overall population was 0.49 (0.37-0.60), being 0.26 (0.19-0.32) in males and 0.71 (0.54-0.87) in females. Most patients in the RA (73.9%; n = 8,250) and RA-ILD populations (63.3%, n = 607) were female (Table 1). The median age (Q1, Q3) was 60.8 (49, 74) and 67 (56, 77) years in the RA and RA-ILD groups, respectively. Regarding disease course, the time from RA to ILD diagnosis was 27.6 (3.7, 73.2) months. Most comorbidities presented higher rates in the RA-ILD population, as shown in Table 1. Among patients with available ILD subtype information (n = 618), the most common was usual interstitial pneumonia (29.8%; n = 184).

Table 1.

Demographics and comorbidities in the RA and RA-ILD patient populations

RA* N=11,163RA-ILD N=959Gender, n (%) Female8,250 (73.9)607 (63.3) Male2,913 (26.1)352 (36.7)Age at first mention of disease (years)1  Median (Q1, Q3)61 (49, 74)67 (56, 77)Comorbidities, n (%)Dyslipidaemia4369 (39.1)316 (33)Hypertension3851 (34.5)320 (33.4)Diabetes mellitus2970 (26.6)248 (25.9)Infections2129 (19.1)328 (34.2)Bone fracture1875 (16.8)210 (21.9)Osteoporosis1275 (11.4)150 (15.6)Malignancies1004 (9)169 (17.6)Kidney failure1006 (9)156 (16.3)Heart failure993 (8.9)184 (19.2)Depression825 (7.4)99 (10.3)Psoriasis773 (6.9)39 (4.1)Obesity732 (6.6)90 (9.4)Asthma740 (6.6)82 (8.6)Atrial Fibrillation729 (6.5)102 (10.6)

*RA includes patients in the RA-ILD population. 1Patients’ age when either RA or ILD was first detected in the EHRs. RA = rheumatoid arthritis; ILD = interstitial lung disease

Conclusion

This pioneering study is the first to characterize RA-ILD using NLP methodology in a multicenter setting. By analyzing readily available real-world data in patients EHRs, we were able to estimate the prevalence of RA in the Spanish population and describe the demographic and clinical characteristics of patients with RA/RA-ILD.

References

[1]Bongartz T, Nannini C, Medina-Velasquez YF et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis and rheumatism 2010; 62: 1583-1591.

[2]Canales L, Menke S, Marchesseau S et al. Assessing the Performance of Clinical Natural Language Processing Systems: Development of an Evaluation Methodology. JMIR Med Inform 2021; 9: e20492.

Acknowledgements

RA-W-ILD Study Group

Disclosure of Interests

Jose Andrés Román Ivorra Speakers bureau: AbbVie, Bristol Myers Squibb, FER, Galápagos, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, FER, Galápagos, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Grant/research support from: AbbVie, Bristol Myers Squibb, FER, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Isabel de la Morena Speakers bureau: Pfizer, Novartis, Janssen, AbbVie, MSD, UCB, Sanofi, Roche, Nordic, Lilly, NEREA COSTAS TORRIJO Speakers bureau: UCB, Novartis, Pfizer, Belen Safont Speakers bureau: AstraZeneca, Roche, Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, J. Fernández-Melón Speakers bureau: Bristol Myers Squibb, UCB, Galapagos, Belen Nuñez Speakers bureau: Boehringer Ingelheim, Roche, Bristol Myers Squibb, Grant/research support from: Boehringer Ingelheim, Roche, Lucía Silva Fernández Speakers bureau: Bristol Myers Squibb, Consultant of: Novartis, MSD, Laura Cebrián Méndez Speakers bureau: Pfizer, Lilly, Gebro, Novartis, Consultant of: Pfizer, Leticia Lojo Consultant of: UCB, Belén López-Muñiz Speakers bureau: Boehringer Ingelheim, Roche, AstraZeneca, Novartis, Mundipharma, Gebro, GlaxoSmithKline, Ernesto Trallero Speakers bureau: Amgen, MSD, Maria Lopez Lasanta: None declared, Raul Maria Veiga Cabello: None declared, Maria Del Pilar Ahijado Guzman: None declared, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Employee of: Savana, David Vilanova Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Celgene, Raul Castellanos Moreira Speakers bureau: Lilly, Pfizer, Roche, Sanofi, UCB, Bristol Myers Squibb, Consultant of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sara Lujan Valdés Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

AB0500 IMPACT OF COVID-19 PANDEMIC IN OVERALL HEALTH AND FUNCTIONING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

Evidence on the impact of the COVID-19 pandemic on the overall health and functioning in patients with axial spondyloarthritis (axSpA) is scarce.

Objectives:

To analyse the impact of the COVID-19 pandemic on the overall health and functioning in patients with axSpA.

Methods:

Data from axSpA patients participating in the first phase of the REUMAVID study were analysed. REUMAVID is a cross-sectional, observational study collecting data through an online questionnaire of unselected patients with rheumatic and musculoskeletal diseases (RMDs), recruited by patient organizations. The survey was disseminated during the beginning of the COVID-19 pandemic (April-July 2020) in seven European countries (Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom). Patients with axSpA who completed the ASAS health index (ASAS-HI) questionnaire were included in this analysis. Descriptive analyses were used to present socio-demographic and clinical characteristics, as well as daily habits. Overall health and functioning were defined according to the ASAS-HI (0-17), as follows: good health (ASAS-HI ≤5), acceptable health (ASAS-HI 6-11), and poor health (ASAS-HI ≥12). As secondary outcomes, well-being (WHO-5), self-perceived health status, and HADS for anxiety and depression were assessed.

Results:

Out of 670 axSpA patients, 587 (87.6%) completed ASAS-HI. Of these, 70.4% were female, 72.6% were married or in a relationship, 46.7% had university studies and 37.6% were currently employed. Mean age was 49.9±12.8 years and mean BMI was 26.7±5.5. Regarding extraarticular manifestations, 13.6% had psoriasis, 12.1% inflammatory bowel disease and 18.7% uveitis. Before the COVID-19 pandemic, 50.9% were receiving biological drugs, 46.3% NSAIDs, 26.4% painkillers, 24.7% conventional DMARDs, and 11.9% oral corticosteroids. According to the ASAS-HI, 19.6 % of patients were classified as having poor health, with the most affected aspects being pain (92.0%), movement (86.5%), maintenance of body position (80.6%), energy (79.0%) and sleep (75.3%). Regarding self-perceived health status, 14% reported their health status as “bad” or “very bad”, and 46.8% reported worsening health during the pandemic (Table 1). A distribution of the results of the total ASAS-HI scores can be seen in Figure 1.

Table 1.

Overall health and well-being, disease activity, and mental health.

Primary Outcome (ASAS-HI)Mean ± SD orn (%)ASAS-HI (0-17), n=5878.0 (±3.9)ASAS-HI <5 (good health)159 (27.1) 5-12 (acceptable health)313 (53.3) ≥12 (poor health)115 (19.6)Secondary OutcomesWHO-5 WHO-5, (0-100), n=58446.3 (±23.1) WHO- 5 Poor wellbeing WHO- ≤50330 (56.5)Self-perceived health status, n=585 Very good33 (5.6) Good214 (36.6) Fair256 (43.8) Bad69 (11.8) Very bad13 (2.2)Change in health status during lockdown, n=587 Much worse than before54 (9.2) Moderately worse220 (37.6) Same as before270 (46.0) Moderately better35 (6.0) Much better than before6 (1.0)HADSHADS Anxiety (0-21), n=5878.4 (±4.1)HADS Anxiety No case (0-7)248 (42.7) Borderline case (8-10)151 (26.0) Case (11-21)182 (31.3) HADS Depression (0-21), n=5877.0 (±4.3)HADS Depression No case (0-7)329 (56.6) Borderline case (8-10)134 (23.1) Case (11-21)118 (20.3)Figure 1.

Distribution of the result of ASAS-HI scores (N= 587)

Conclusion:

One out of five patients with axSpA reported poor health and functioning according to the ASAS-HI, and almost half of patients reported worsening self-perceived health status during the first wave of the COVID-19 pandemic.

Keywords: COVID-19, axial spondyloarthritis, ASAS-HI, health

Disclosure of Interests:

Diego Benavent Grant/research support from: Abbvie, Novartis and Roche, Marco Garrido-Cumbrera: None declared., Chamaida Plasencia Grant/research support from: Pfizer, Sanofi, Novartis, Roche and Lilly, Laura Christen Employee of: Novartis Pharma AG, Helena Marzo-Ortega Grant/research support from: Abbvie, Celgene, Janssen, Elli-Lilly, Novartis, Pfizer, UCB and Takeda Pharmaceutical Company, José Correa-Fernández: None declared., Pedro Plazuelo-Ramos: None declared., Dale Webb: None declared., Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, UCB.

POS0181 HOW FIT ARE THE SOCIAL SUPPORT INSTRUMENTS USED IN RMDS: A SYSTEMATIC REVIEW OF VALIDATION STUDIES

Background:

Rheumatic and musculoskeletal diseases (RMDs) diminish psychosocial well-being. Social support (SS) is considered to improve this psychosocial wellbeing. Therefore, SS is an important construct to measure in RMDs.

Objectives:

To systematically review and summarize the psychometric properties of SS instruments developed or validated in RMDs.

Methods:

A comprehensive search in Medline, Embase, PsycINFO, CINAHL and Epistemonikos was performed from inception to June 8, 2020, with the aid of an experienced librarian (LF). Two researchers (DDC and DB) independently screened articles on title+abstract and next on full text. Reference lists of included studies were reviewed for additional references. Articles were included if covering psychometric properties (detailed in the Table 1) of SS instruments used in RMDs. Studies on questionnaires lacking an English version, unpublished material, case reports, editorials, letters, or reviews were excluded. Risk of bias of studies and instruments was assessed via the COSMIN checklist.

Table 1.

psychometric properties per social support instrument

InstrumentFace validityContent ValidityStructural validityCriterion validityInternal consistencyReliabilityMeasurement errorHypothesis testing for construct validityCross-cultural validity/Measurement invarianceResponsivenessAIMS44444 AIMS2444444 AIMS2-SF444Brief Screening Questions444Dyadic Efficacy Scale4444EIS4444Flanagan QOL4444FS4444444IRGL44444ISSI444LISRES444MEPS444444MWA444OAKHQOL4444444 e-OAKHQOL444 Mini-OAKHQOL444444PFSSADI4444RASP4444SIP44SPQ4444SSQT44444

Arthritis Impact Measurement Scales (AIMS); Short Form (SF); Emotional Intimacy Scale (EIS); Quality of Life (QOL); Friendship Scale (FS); Impact on Rheumatic diseases and General health and Lifestyle (IRGL); Interview Schedule for Social Interactions (ISSI); Life Stressors and Social Resources Inventory (LISRES); Medical Issues, Exercise, Pain, and Social Support (MEPS); Modified Work APGAR (MWA); Osteoarthritis Knee and Hip Quality of Life (OAKHQOL); preferences for formal social support of autonomy and dependence in pain inventory (PFFSADI); Responses and Attitudes to Support during Pain questionnaire (RASP); Sickness Impact Profile (SIP); Social support and Pain Questionnaire (SPQ); Social Support Questionnaire for Transactions (SSQT).

Results:

From 4986 articles captured, 30 met the predefined inclusion criteria. These articles included 21 SS instruments used in 8 RMDs, mainly rheumatoid arthritis and osteoarthritis.

Table 1 shows the psychometric properties per instrument. Construct validity, structural validity, and internal consistency were assessed for most instruments, while measurement invariance, measurement error, criterion validity and responsiveness in ≤3 instruments each. Development and content validity of the instruments gave consistently high risk of bias by the COSMIN checklist.

The most widely validated instruments were the Arthritis Impact Measurement Scales (AIMS) and the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL), with their respective derived instruments (AIMS2, AIMS2-SF, mini-OAKHQOL and e-OAKHQOL). For the AIMS SS scale, internal consistency ranged between 0.33-0.69 (Cronbach’s α) and test-retest reliability was estimated 0.92 (Guttman reproducibility coefficient). For the OAKHQOL SS scale, internal consistency ranged between 0.78-0.81 (Cronbach’s α) and test-retest reliability ranged between 0.5-0.85 (ICC). Responsiveness was only investigated in AIMS and the Sickness Impact Profile (SIP) instrument. Relative efficiency for SS for the SIP was considerably higher than for AIMS (0.74 vs 0.18).

Conclusion:

This review gives a summary of the psychometric properties of SS instruments in RMDs. Most instruments show sufficient structural validity internal consistency and reliability, but some psychometric properties such as criterion validity, measurement error and invariance, need to be investigated before choosing an optimal SS instruments.

Disclosure of Interests:

None declared

POS0969 UNVEILING AXIAL INVOLVEMENT IN PSORIATIC ARTHRITIS: AN ANCILLARY ANALYSIS OF THE ASAS-perSpA STUDY

Background:

Heterogeneity in psoriatic arthritis (PsA) is a current matter of discussion, especially concerning axial involvement.

Objectives:

To determine the profile of axial PsA (axPsA) in a worldwide setting. Secondly, to identify predictive factors associated with the development of axial involvement in patients with PsA.

Methods:

Data from 3684 patients with axial spondyloarthritis (axSpA) or PsA from the ASAS-PerSpA study were analysed. The ASAS-PerSpA is an observational, cross-sectional study that recruited consecutive patients with SpA from 68 centers worldwide. For this analysis, 367 PsA patients ever presenting axial involvement according to their rheumatologist were defined as axPsA and compared with 2651 axSpA patients, using logistic regression to later identify predictive factors for rheumatologist diagnosis of axPsA. In addition, the axPsA patients were also compared with 666 PsA patients without axial involvement (pPsA) and the characteristics associated with axial manifestations were determined by logistic regression analysis.

Results:

Among all patients, 2651 were identified as axSpA and 1033 patients as PsA. Among those with axial involvement, 2651 were identified as axSpA (100% of axSpA) and 367 as axPsA (35.5 % of PsA). In comparison with axSpA, axPsA patients were less frequently males, older, less frequently HLA-B27 positive and had a higher body mass index (Table 1). Additionally, while patients with axPsA had more peripheral manifestations and psoriasis, concomitant IBD and uveitis were higher in axSpA. In the multivariable analysis, older age at diagnosis (OR= 1.04), peripheral arthritis (OR= 7.32) and dactylitis (OR= 2.82) were significantly associated with a diagnosis of axPsA. However, uveitis (OR= 0.22), IBD (OR= 0.12) or HLA*B27 carriership (OR= 0.26) were inversely associated with axPsA diagnosis as compared to axSpA. Furthermore, axial involvement in patients with PsA was significantly associated with male gender (OR= 1.68), elevated CRP (OR= 2.87), and the absence of psoriasis (OR= 0.33).

Conclusion:

In this worldwide setting, axPsA was defined by rheumatologists as a unique phenotype, with disease features lying between axSpA and pure pPsA. Male gender, elevated CRP and the absence of psoriasis were associated with axial involvement in patients with PsA.

Table 1.

Demographic and disease characteristics of patients with axial involvement included in the ASAS PerSpA study. Results shown as absolute numbers (percentages) or as the mean ± standard deviation

axSpAn= 2651axPsAn= 367p-valueSex (male)1816 (68.5) 196 (53.4)<0.001Age at study visit42.1(13.0)50.0 (12.7)<0.001Body Mass Index25.9 (5.1)27.4 (5.7)<0.001Family history of SpA944 (35.6)135 (36.8)0.684Past history or current symptoms of back pain2625 (99.0)358 (97.5)0.04Inflammatory back pain (ASAS definition), n/N(%)2500/2632 (94.9)317/362 (87.6)<0.001Sacroiliitis on imaging, n/N (%) by: xRay mNY criteria1997/2586 (77.2)185/298 (62.1)<0.001 MRI-SIJ, ASAS definition1449/1757 (82.4)141/225 (62.6)<0.001 mNY criteria or ASAS definition2446/2634 (92.9)243/339 (71.7)<0.001HLA B27 positive1674 /2126 (78.7)54/182 (29.6)<0.001Elevated CRP (>5 mg/dL)1863/2569 (72.5)274/356 (76.9)0.2Classification criteria ASAS criteria2339 (88.2)185 (50.4)<0.001 CASPAR criteria123 (4.6)274 (74.4)<0.001Peripheral Arthritis946 (35.7)318 (86.6)<0.001Enthesitis1086 (41.0)198 (54.0)<0.001Dactylitis155 (5.8)125 (34.1)<0.001Psoriasis185 (7.0)324 (88.3)<0.001IBD129 (4.9)3 (0.8)<0.001Uveitis576(21.7)13 (3.5)<0.001csDMARD (ever)1359 (51.3)339 (92.4)<0.001bDMARD (ever)1585 (59.8)263 (71.7)<0.001Specific drug for axial involvementNSAIDs2465 (98.6)317 (96.1)0.002csDMARD828 (33.1)187 (56.7)<0.001bDMARD1288 (51.5)180 (54.4)0.32

axSpA: axial spondyloarthritis; axPsA: axial psoriatic arthritis; IBD: Inflammatory Bowel Disease; CRP: C-Reactive Protein; mNY: modified New York; csDMARDs: conventional synthetic DMARDs; bDMARDs: biological DMARDs; NSAID: Non-steroidal anti-inflammatory drugs

Disclosure of Interests:

Diego Benavent: None declared, Chamaida Plasencia: None declared, Denis Poddubnyy: None declared, Mitsumasa Kishimoto Consultant of: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma., Fabian Proft Grant/research support from: AbbVie, AMGEN, BMS, Celgene, MSD, Novartis, Pfizer, Roche, UCB, Haruki Sawada: None declared, Clementina López-Medina: None declared, Maxime Dougados: None declared, Victoria Navarro-Compán: None declared.

Unveiling axial involvement in psoriatic arthritis: An ancillary analysis of the ASAS-perSpA study

OBJECTIVE

To determine the clinical profile of axial psoriatic arthritis (PsA) in a worldwide setting. Secondly, to identify factors associated with the development of axial involvement in patients with PsA.

METHODS

Data from 3684 patients with axial spondyloarthritis (axSpA) or PsA from the ASAS-perSpA study were analysed. The ASAS-perSpA is a cross-sectional study that recruited consecutive patients with SpA (as diagnosed by their rheumatologist) from 68 centers worldwide and collected patient and disease data. First, 2651 axSpA patients and 367 PsA patients with any history of axial involvement (axPsA) were compared using logistic regression to later identify predictive factors for rheumatologist diagnosis of axPsA. Secondly, 367 axPsA patients were compared with 666 PsA patients lacking axial involvement (peripheral PsA [pPsA]) and the characteristics associated with axial manifestations were explored by logistic regression analysis.

RESULTS

Patients with axPsA were older and less frequently males or HLA*B27 positive in comparison with axSpA patients. Additionally, while patients with axPsA had more peripheral manifestations and psoriasis, other extra-musculoskeletal manifestations (IBD and uveitis) were more frequent in those with axSpA. In the multivariable analysis, older age at diagnosis (OR = 1.04), peripheral arthritis (OR = 7.32) and dactylitis (OR = 2.82) were significantly associated with the diagnosis of axPsA. However, uveitis (OR = 0.22), IBD (OR = 0.12), HLA*B27 carriership (OR = 0.26) or sacroiliitis on imaging (OR = 0.5) were inversely associated with axPsA diagnosis as compared to axSpA. Axial involvement in patients with PsA was significantly associated with male gender (OR = 1.68), elevated CRP (OR = 2.87) and the absence of psoriasis (OR = 0.33).

CONCLUSION

In this worldwide setting axPsA was defined by rheumatologists as a unique phenotype, with disease features lying between axSpA and pure pPsA.

AB0670 AXIAL MANIFESTATIONS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS: ARE THEY SIMILAR?

Background:

Spondyloarthritis (SpA) is a group of heterogeneous diseases that includes axial SpA (axSpA), such as ankylosing spondylitis and axial non-radiographic SpA, and Psoriatic Arthritis (PsA) with peripheral and/or axial involvement (axPsA). Currently, it is not well known if the characteristics and burden of the disease in patients with axPsA are similar to that of patients with axSpA.

Objectives:

To compare the demographic, clinical and structural features between patients with axSpA and axPsA.

Methods:

Data from an observational prospective cohort including all patients with SpA initiating biological therapy because of predominant axial manifestations from 2002-2019 in a university hospital were analyzed. AxSpA and axPsA were defined in clinical practice according to the prescribing rheumatologist, based on clinical features and complementary examinations. Demographic information, laboratory tests, disease presentation, sacroiliitis according to modified New York criteria in the pelvis X-ray, disease activity indexes (ASDAS and BASDAI) and concomitant treatment before starting biological drug were collected from the electronic medical record and biologic database. In the statistical analysis, chi square or the exact Fisher’s test was used for categorical and t-student or U-Mann Whitney for continuous variables, according to the distribution of the data. Then, the association between demographic and clinical features and each disease was analysed using univariable and multivariable logistic regression models.

Results:

Out of 352 included patients, 287 (81.5%) had axSpA, and 65 had axPsA (18.5%). Baseline characteristics are shown in Table 1. Mean baseline ASDAS was 3.3±0.9 and 3.1±1.0 for axSpA and axPsA, respectively. Biological therapies initiated can be seen in Figure 1. No significant differences at baseline were observed between axSpA and axPsA for most of the characteristics including: gender, age at diagnosis, age at starting biologic, disease duration before biologic, smoking habit, CRP, disease activity, enthesitis, dactylitis, inflammatory bowel disease (IBD), patient global assessment and sulfasalazine use. However, there were differences between diseases in some relevant characteristics. AxSpA patients had less peripheral involvement (41.5 vs. 78.5 %, p=0.004), more uveitis (15.3 vs. 3.1 %, p=0.03) and were more frequently HLA-B*27 positive (72.3 vs 34.1 %, p<0.001), in comparison to axPsA patients. They also had better physician global assessments (PhGA) (37.4 vs 44.4, p=0.02), and a higher grade of radiographic sacroiilitis. AxSpA patients used less global baseline concomitant therapy (p=0.001), methotrexate (p<0.001) and prednisone (p<0.01), whereas they used more sulfasalazine (p=0.003) than axPsA patients in our cohort. After running multivariate analyses, the absence of peripheral manifestations (OR=4.7; p<0.001) and the positivity of HLA-B27 (OR=5.4; p<0.001) were independently associated with axSpA.

Table 1. Baseline stratified characteristics. Results are shown as absolute numbers (percentages) or mean ± standard deviation.

Conclusion:

Despite being spondyloartrithis with many common traits, axSpA and axPsA present some differences in clinical practice. Whereas axSpA patients are more frequently HLA-B27 positive, axPsA have more peripheral involvement. These differences in clinical presentation between both diseases may contribute to variances in therapeutic management, such as increased use of baseline concomitant therapy in axPsA patients who initiate biological therapy.

Figure 1.

Biological therapies initiated in axSpA and axPsA

Disclosure of Interests:

Diego Benavent: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Chamaida Plasencia: None declared, Diana Peiteado: None declared, Alejandro Villalva: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

AB0526 DIFFERENCES IN IMMUNOGLOBULIN LEVELS IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS AND RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB

Background:

Rituximab (RTX) is a chimeric monoclonal antibody against CD20 receptor, used in the treatment of rheumatic diseases. Hypogammaglobulinemia has been described as an adverse event. It has been reported that hypogammaglobulinemia is more frequent in patients with ANCA-associated vasculitis (AAV).

Objectives:

To study the basal characteristics of patients with AAV and rheumatoid arthritis (RA) in treatment with RTX and to analyze the risk factors of hypogammaglobulinemia.

Methods:

Retrospective observational study of patients treated with RTX. Patients diagnosed with AAV and RA with immunoglobulin levels prior to treatment and after each cycle were included. Clinical and demographic variables were analyzed. Both populations were compared using t-Student for continuous and chi-squared for categorical variables. The influence of the basal characteristics of the patients was analyzed using univariate and multivariate logistic regression models.

Results:

Among the 86 included patients, 10 (11.6%) had AAV and 76 (88.4%) RA. Patient’s characteristics stratified by disease are included in Table 1.

Table 1.

Characteristics of patients treated with RTX, according to their underlying disease.

Overall sample n=86ARn=76VAAn=10pAge at diagnosis, yearsm±SD57 ± 1256 ± 1263 ± 110,11Disease progression, yearsm±SD11,5 ± 913 ± 91 ± 1< 0,001Femalen/N (%)66/86 (76,6)60/76 (78,9)6/10 (60)0,18IGG <725 prior to initiation of treatmentn/N (%)10/86 (11,6)4/76 (5,3)6/10 (60)< 0,001IgG < 600n/N (%)12/86 (14)4/76 (5,3)8/10 (80)<0,001IgG <400n/N (%)2/86 (2,3)02/10 (20)<0,001IgM Hipogamaglobulinemian/N (%)26/86 (30,2)17/76 (22,4)9/10 (90)<0,001Pretreatment with non-antiTNF biologicsn/N (%)25/86 (29,1)24/76 (31,6)1/10 (10)0,15Pretreatment with antiTNFn/N (%)60/86 (69,8)59/76 (77,6)1/10 (10)<0,001Pretreatment with FAMESn/N (%)80/86 (93)72/74 (94,7)8/10 (80)0,08Pre-treatment with JAK inhibitorsn/N (%)11/86 (12,8)11/76 (14,5)00,19Cyclophosphamide pretreatmentn/N (%)3/86 (3,5)03/10 (30)< 0,001Infectionsn/N (%)21/86 (24,4)15/76 (19,7)6/10 (60)0,02Severe infectionn/N (%)7/86 (4,6)1/76 (1,3)3/10 (30)< 0,001Cumulative dose of steroids one year priorm±SD2923 ± 30032227 ± 18986199 ± 4621< 0,001Cumulative dose of steroids during treatmentm±SD2626 ± 23532303 ± 19135668 ± 39970,002

The overall sample was divided into two groups, patients who developed hypogammaglobulinemia and patients who did not. Of the 12 patients who developed hypogammaglobulinemia, 4 had RA and 8 AAV (p<0.001). In the univariate analysis, patients who developed hypogammaglobulinemia presented higher age at diagnosis (61 ± 15 vs 43 ± 11 years, OR=1.14 p<0.001), shorter time of disease progression (4.9 ± 8 vs 12.6 ± 9 years, OR=0.86 p0.02) and lower gammaglobulin rates at baseline (744 ± 504 vs 1145 ± 295 OR=0.16 p0.006). There were more severe infections in the group of patients with hypogammaglobulinemia than in the group without it (1/4 [25%] vs 1/74 [1.4%], OR=0.42 p<0.001). Patients with hypogammaglobulinemia received a higher cumulative dose of steroids during treatment (OR=1,000 p 0.019). Within the RA group, patients with hypogammaglobulinemia also received a higher cumulative dose of steroids (p 0.009).

In the multivariate study, only age at the beginning of treatment (OR=1.1 p=0.020) remained a risk factor for the appearance of hypogammaglobulinemia.

Conclusion:

A significantly higher percentage of hypogammaglobulinemia is observed in patients with AAV treated with Rituximab, compared to patients with RA. The development of hypogammaglobulinemia seems to be influenced by age at diagnosis, years of disease progression, IgG levels prior to initiation of treatment and a higher cumulative dose of glucocorticoids (targeted in both the overall sample and the RA group). In addition, there is a higher frequency of severe infections in the hypogammaglobulinemia group. Studies with larger sample sizes are needed to confirm these results.

Disclosure of Interests:

María Sanz: None declared, Gemma Bonilla: None declared, Diana Peiteado: None declared, Diego Benavent: None declared, Chamaida Plasencia: None declared, Laura Nuño: None declared, Irene Monjo: None declared, Alejandro Villalva: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

AB0646 IS IT FEASIBLE TO ACHIEVE RECOMMENDED THERAPEUTICAL TARGET IN PATIENTS WITH AXIAL SPONDYLARTHRITIS IN CLINICAL PRACTICE? DATA FROM THE SpA-Paz COHORT

Background:

Current ASAS/EULAR recommendations for the management of patients with axial spondylarthritis (axSpA) establish that the therapeutic goal to achieve in clinical practice is remission, defined as the absence of both clinical and laboratory disease activity evaluated by BASDAI&CRP or preferably ASDAS and if this is not possible, low disease activity may be an alternative. Recently, ASDAS nomenclature has been modified, calling now low disease activity to what was previously called moderate activity. To this day we do not know if this target is feasible in clinical practice.

Objectives:

To analyze the frequency of patients with axSpA achieving maintained remission (R) or low disease activity (LDA) after receiving biological therapy. Secondary objectives included: i) to assess if the activity index used influences the frequency of maintained R/LDA, ii) analyze the prognostic factors for achieving maintained R/LDA.

Methods:

An observational, longitudinal study of a prospective cohort (SpA-Paz) including all patients with axSpA who initiated their first biological treatment between the years 2003-2017. Demographic, clinical and analytical data were collected at the beginning of treatment and clinical disease activity measured by BASDAI&CRP and ASDAS every 6 months for 2 years. Maintained R was defined as (BASDAI<2 & normal CRP and/or ASDAS <1.3) and maintained LDA (BASDAI <4 & normal CRP and/or ASDAS <2.1) on at least 3 consecutive visits. Statistical analysis: i) measures of central tendency and dispersion for quantitative variables and frequencies for qualitative variables; ii) univariate and multivariate analysis of binomial logistic regression model and calculation of OR and 95% CI.

Results:

Out of 186 patients with axSpA who started treatment during the study period, 63% were men with a mean age of 54 ± 14.1 years. 75.3% of the patients had radiographic axSpA and 74.7% were HLA-B27 positive. Other baseline characteristics (not shown due to space restrictions). Overall, 80% of the patients achieved ASDAS R/LDA (R36%/LDA44%) in at least one of the visits after 2 years of follow-up, but only 40% (R27%/LDA13%) fulfilled the maintained ASDAS R/LDA state. On the other hand, 73% of patients were classified as BASDAI&CRP R/LDA (R31%/LDA42%) in at least one of the visits, but only 31% (R21%/LDA10%) obtained the maintained BASDAI&CRP R/LDA state. In the multivariate analysis, we observed an independent statistically significant association with male sex (OR=3.19; 95% CI=1.46-6.99), younger age at the beginning of the biological treatment (OR=0.97; 95% CI=0.95-0.99) and the use of methotrexate (OR=3.07; 95% CI=1.39-6.78) in patients who achieved maintained BASDAI&CRP R/LDA and with male sex (OR=4.01; 95% CI=1.83-8.77), younger age at the beginning of the biological therapy (OR=0.96; 95% CI=0.94-0.99) and HLA B27 presence (OR=4.30; 95% CI=1.68-11.01) in patients who achieved maintained ASDAS R/LDA.

Conclusion:

Although the majority of patients with axSpA who initiate biological therapy achieve the recommended therapeutic goal in the first two years of treatment, the percentage of patients who manage to maintain the R/LDA status is limited. In our study, maintained R was more frequent than maintained LDA, being somewhat higher when measured by ASDAS. This fact may suggest that patients who achieve maintained R have a greater inhibition of their inflammatory activity and, therefore, it remains in time. Male sex and younger age at the beginning of the biological therapy were the main baseline predictors for achieving maintained R/LDA.

Graphics:

Disclosure of Interests:

Karen Nathalie Franco Gomez: None declared, Chamaida Plasencia: None declared, Marta Novella-Navarro: None declared, Diego Benavent: None declared, Patricia Bogas: None declared, Romina Nieto: None declared, Irene Monjo: None declared, Laura Nuño: None declared, Alejandro Villalva: None declared, Diana Peiteado Grant/research support from: AbbVie, Lilly, MSD, and Roche, Speakers bureau: AbbVie, Roche, and MSD, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

FRI0364 PREVALENCE OF THE METABOLIC SYNDROME IN PSORIATIC ARTHRITIS: SYSTEMATIC LITERATURE REVIEW AND RESULTS OF THE CARMA COHORT

Background:

The cardiovascular burden in psroriatic arthritis (PsA) is well recognized1.

Objectives:

To analyze the prevalence of metabolic syndrome (MetS) in patients with PsA.

Methods:

We conducted a systematic literature review (SLR) and a sub-analysis of the CARMA cohort. In the SLR, we searched in Pubmed, Embase, the Cochrane Central Library, and the ClinicalTrial until March 2019 using Mesh terms and free text words. We included SLR, clinical trials and observational studies analyzing the prevalence or frequency of MetS in PsA. Two reviewers selected articles, assessed the quality of the studies and collected data independently. The CARMA cohort was designed to establish the cardiovascular (CV) morbidity and associated risk factors for CV disease. It includes data from patients with chronic inflammatory rheumatic diseases (including PsA) of 67 Spanish hospitals. A sub-analysis of the prevalence of metS in PsA was performed using the National Cholesterol Education Program Adult Treatment Panel III criteria updated in 2005, which requires the presence of ≥3 of the following: high waist circumference, low HDL cholesterol level, high triglyceride level, high blood pressure and high fasting glucose values.

Results:

A total of 18 articles of moderate to high quality, were selected in the SLR. The included patients presented a balanced distribution by sex, with an average age ranging from 42 to 59 years. The frequency of MetS varied from 23.5% to 62.9% depending on the definition of MetS. The most widely used classification method was the National Cholesterol Education Program, followed by the method recommended by the International Diabetes Federation in 2009. A total of 724 patients with PsA were included in the CARMA study, of whom 327 (45.4%) were women and 157 (21.8%) smokers. The mean age at baseline was 51 ± 12 years and the mean duration of PsA disease 9 (4-16) years. Hypertension was the most frequently altered parameter (66.8%), followed by fasting glucose (42.6%) and hypertriglyceridemia (30.6%). Table 1 shows the frequency of patients according to the number of MetS components. A total of 222 (30.6%) PsA patients presented metabolic syndrome.

Table 1.

Prevalence of metabolic syndrome.

Number of componentsN 0-5Patients (n)CARMA studyPercentage of patients, SLR(%)010113,95120828,73219326,66315120,864598,155121,66Total724100

Conclusion:

The frequency of the individual components of the MetS is variable according to the method of classification, which makes it difficult to compare between studies. In the CARMA study, the prevalence of MetS was around 30%, which supports the control of individual factors to prevent CV disease.

References:

[1]Liew JW, et al. Best Pract Res Clin Rheumatol. 2018;32(3):369-389.

Disclosure of Interests:

ANA URRUTICOECHEA-ARANA: None declared, Santos Castañeda: None declared, Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi, Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Diego Benavent: None declared, Maria Auxiliadora Martin-Martinez: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

AB0741 IS THE THERAPEUTIC TARGET ACHIEVEMENT INCREASING OVER TIME IN PATIENTS WITH PSORIATIC ARTHRITIS STARTING BIOLOGICAL THERAPY? DATA FROM 15 YEARS

Background:

Treatment in Psoriatic Arthritis (PsA) has undergone a major revolution in recent years, with the development of new targets and molecules. Despite these advances, data from clinical practice demonstrating a change in management success are scarce.

Objectives:

To evaluate if the proportion of patients (pts) with PsA maintaining an acceptable medium-term control of the disease activity after starting a first biologic agent is increasing over time.

Methods:

Prospective cohort including 101 patients (pts) with PsA starting a 1st biologic (TNF inhibitor, anti-IL 17 inhibitor) in a tertiary hospital between 2002-2018. Demographic, clinical and laboratory data were collected at the beginning of treatment. Disease activity indexes (ASDAS for axPsA and DAPSA for pPsA) were collected before starting biologic, six and twelve months later (baseline, 6m and 12m visit, respectively). Low disease activity (LDA) was defined as ASDAS < 2.1 (axPsA) and DAPSA ≤14 (pPsA). Three groups were established according to biologic initiation date: period 1 (p1) (between 2002-2007), (p2) 2008-2013 and (p3) 2014-2018. Each period had a minimum follow-up of 1 year for every patient. For each interval, the percentage of pts achieving persistent (at both follow-up visits) LDA was determined, as a marker of acceptable medium-term control of the disease. All collected variables were compared between groups by ANOVA and Chi-Squared test.

Results:

Out of the 101 pts initiating biological therapy, 46 % were males and 57 % had peripheral PsA. At the biologic treatment start, mean ± SD age was 48.5 ± 12 years and disease duration was 9.9 ± 10 years. Biological therapies initiated included etanercept in 38 % of pts, infliximab in 24 %, adalimumab in 25 %, golimumab in 7 %, secukinumab in 3 % and certolizumab in 3 %.

Stratified by time intervals, 36 (35.6%) pts started in p1, 36 (35.6%) in p2 and 29 (28.8%) in p3. Baseline characteristics of pts by periods are shown in Table 1. For patients in p3, compared to the previous intervals, a significant lower CRP (p=0.03) and ESR (p=0.004) were found at baseline, whereas there were no significant differences on baseline disease activity indices. Fifty-one (50%) pts achieved persistent-LDA after one year of starting biologic. Figure 1 reports the total number of patients that were in LDA in all the visits in the 1styear, stratified per period of time and predominant manifestation. A lower percentage of patients in LDA (33% in p1 vs, 67% in p2 vs 52% in p3, p = 0.02) was found in the first interval, in comparison to the most recent periods. The difference in response between p2 and p3 is mainly due to the group of patients with pPsA, whereas the improvement in the group of patients with axPsA remains constant in both periods.

Table 1.

Baseline patient’s characteristics by periods of time

Figure 1.

Patients achieving persistent-LDA during the 1styear of biological therapy, stratified by period of time and by disease.* Statistically significant difference with respect to p1.

Conclusion:

The percentage of pts with PsA achieving LDA status after one year of initiating a biological therapy has substantially increased over time. A lower threshold of inflammation at biological therapy start and a broader spectrum of therapies might explain this better management on PsA.

Disclosure of Interests:

Diego Benavent: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Irene Monjo: None declared, Marta Novella-Navarro: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Chamaida Plasencia: None declared

SAT0366 CLINICAL RESPONSE TO BIOLOGIC DMARDS IN AXIAL SPONDYLOARTHRITIS AND AXIAL PSORIATIC ARTHRITIS. DIFFERENT DISEASES, SAME OUTCOMES?

Background:

Patients with psoriatic arthritis may present predominant axial involvement. Currently, it is unclear whether these patients should be considered as axial spondyloarthritis (axSpA) with psoriasis or psoriatic arthritis with axial involvement –also known as axial PsA (axPsA). Data comparing medium-term treatment response to biological drugs in axSpA and axPsA would add relevant information to answer this question.

Objectives:

To compare the clinical response and predictor factors after one year of biological therapy in patients with axSpA and axPsA.

Methods:

One-year follow-up data from all patients (pts) with axSpA or axPsA (defined by the treating rheumatologist) included in a prospective cohort of pts receiving biological therapy from la Paz University Hospital between 2002 and 2019 were analysed. Demographic information, laboratory tests, concomitant treatments and disease status were collected at baseline. Clinical disease activity was measured by PhGA and ASDAS criteria at baseline, 6 and 12 months. According to ASDAS, disease activity was defined as: inactive disease (ID) (ASDAS <1.3), low disease activity (LDA) (ASDAS 1.3-2.1), high disease activity (HDA) (ASDAS 2.1-3.5) and very high disease activity (VHDA) (ASDAS >3.5). Clinical important improvement and major improvement were defined by ASDAS (delta-ASDAS ≥ 1.1 and ≥ 2.0, respectively). According to PhGA, disease activity was assorted by consensus of 3 expert rheumatologists in: ID with PhGA<5, LDA with PhGA 5-30, HDA with PhGA >30-60 and VHDA with PhGA >60. Clinical improvement by PhGA was defined as an improvement of 30 % compared to baseline. In the statistical analysis, the frequency of pts achieving each clinical activity status and clinical improvement at 6m and 12m were compared using Fisher test, separately for axSpA and axPsA. Baseline predictor factors for achieving clinical response and clinical improvement were identified using univariable and multivariable binary regression.

Results:

Out of 352 included pts, 287 (81.5%) had axSpA and 65 (18.5%) axPsA. Sixty percent were males, 158 (45%) smokers, with mean (SD) baseline disease activity of ASDAS (bASDAS): 3.3 (0.9) and PhGA: 39.1 (21.5). Biological therapies initiated included TNF inhibitors in 93.8 % and secukinumab in 6.2%. In comparison to axPsA, pts with axSpA were more HLA B27 positive (p<0.001) and had better PhGA at baseline (p=0.02). They also had more uveitis (p=0.03) and were more radiographically affected (p<0.001).

Response rates at 6m and 12m in both diseases according to ASDAS are shown in Figure 1, and to PhGA in Figure 2. Both diseases presented a similar clinical response, and no statistically significant differences were observed for any disease activity interval between them for ASDAS or PhGA. There were no differences between both diseases on clinical improvement, regardless the type of measurement.

Figure 1.

Response rates (in percentage) by ASDAS at 6m and 12m in axSpA and PsA

In the group of axSpA, the univariate analysis observed that LDA (by ASDAS) at 12m was associated with bASDAS (OR=0.67, p=0.02), male gender (OR=2.8, p=0.001) and HLA B27 positive (OR=2.3, p=0.01). In the multivariate analysis, these variables remained significantly associated with LDA (bASDAS: OR= 0.67; p<0.05; male gender: OR=2.7, p<0.01; and HLA B27 positivity OR=2.6, p<0.01). In the group of axPsA, the univariate analysis showed a tendency that male pts achieved LDA more frequently at 6m (OR=3.0, p=0.05) and at 12m (OR=2.75, p=0.09). In the multivariable analyses, none of the factors was significantly associated neither with clinical improvement nor with LDA in pts with axPsA.

Conclusion:

In clinical practice, pts with axSpA and axPsA present a similar clinical response to biological therapy within the first year of treatment. Male pts seem to have better medium-term outcomes in both diseases, and HLA B27 pts respond better in axSpA.

Disclosure of Interests:

Diego Benavent: None declared, Chamaida Plasencia: None declared, Karen Nathalie Franco Gomez: None declared, Laura Nuño: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB