Total expenditure elasticity of spending on self-treatment and professional healthcare: a case of Russia

The studies on the demand for healthcare in low- and middle-income countries rarely take into consideration the fact that many people spend their income on self-treatment and professional treatment. The estimation of the income elasticity of demand for self-treatment and professional treatment can show a more precise picture of the affordability of professional care. This paper contributes to the discussion around estimates of income elasticity of health spending and discussion whether professional care and self-treatment are close to a luxury good and inferior good respectively in a middle-income country. We apply the switching regression model to explain the choice between self-treatment and professional healthcare via estimates of the income elasticity. Estimates are made with the use of the Russian Longitudinal Monitoring Survey - Higher School of Economics (RLMS-HSE), a nationally representative survey. While individual expenditure on professional treatment is higher than that on self-treatment, our estimates show that expenses on professional treatment can be income inelastic except when spending on medicines prescribed by a physician that are elastic. The results also indicate that cost of self-treatment is income elastic. In all cases, the considered income elasticities are statistically insignificant between professional and self-treatment.

Factors associated with psychological distress during the COVID-19 pandemic: Data from two early waves in Russia

There is limited information about how the mental health of people has changed over time during the COVID-19 pandemic in low- and middle-income countries. In a cross-sectional study, we identified factors associated with psychological distress at two periods immediately after two peaks of the COVID-19 pandemic in Russia. Data were collected via online surveys. In May-June 2020, we surveyed 373 respondents across Russia. In January-February 2021, we surveyed 743 people, using the same approach for survey distribution. With Kessler-10 as a measure of psychological distress, we used regression analysis to determine factors associated with higher psychological distress among Russians. Levels of psychological distress were high in both time periods and did not significantly change between the surveys. Having had COVID-19, losing one's job, experiencing problems accessing healthcare, and changing drinking behaviour during the pandemic were associated with higher psychological distress. Apart from getting sick or worrying about the virus, psychological distress is affected by restrictions and the consequences of the pandemic situation. As the COVID-19 pandemic continues, actions are needed to address the mental well-being of the population in Russia.

Recurrent meningitis caused by Salmonella enterica Paratyphi B var. Java in a 3-month-old infant complicated by dilation of subarachnoid spaces, subdural effusion and right-sided hemiparesis

A 3-month-old female infant with meningo-encephalitis caused by Salmonella enterica Paratyphi B var. Java is described. The aetiological agent was confirmed in six CSF samples; however, none of the blood or faecal samples was positive for the same pathogen. The presence of the bacteria was confirmed in the CSF by culture, serology and Multiplex PCR assay. The infant developed dilated subarachnoid spaces and right-sided hemiparesis associated with the persistent bacterial meningo-encephalitis. She was re-admitted 2 weeks after recovery and initial discharge from hospital owing to recurrence of S. enterica Paratyphi B bacteria in the CSF and the development of large bilateral subdural effusions in the brain. Computed tomography and the clinical course confirmed dynamically progressive meningo-encephalitis. Following further parenteral antibiotics and symptomatic treatment, the child's condition improved. After a total of 24 days in the PICU, she was sufficiently improved to be discharged with a residual right-sided hemiparesis. However, sadly she died a week after discharge.Abbreviation: ALT: alanine aminotransferase; API: analytical profile index 20 E-test; AST: aspartate aminotransferase; CRP: C-reactive protein; CSF: cerebrospinal fluid; CT: computed tomography; EUCAST: European Committee on Antimicrobial Susceptibility Testing; MDCT: multi-detector computed tomography; PCR: polymerase chain reaction; PICU: paediatric intensive care unit; RBC: red blood cells; VITEK: automated instrument for identification/antimicrobial susceptibility testing; WBC: white blood cells.

AB0349 ANALYSIS EFFICACY OF ABATACEPT TREATMENT IN BIOLOGIC-NAÏVE AND BIOLOGIC-EXPERIENCED PATIENTS

Background

Despite the high efficacy of rheumatoid arthritis (RA) therapy, in routine clinical practice, clinicians face questions about the choice of a second biologics, as well as the possibility of biologics monotherapy. Therefore, the specialties of biologics use in these categories of patients are of great clinical interest. This work is devoted to the study of the effectiveness of abatacept (ABA) therapy in biologic-naïve and biologic-experienced patients and in the subgroup of ABA monotherapy.

Objectives

To evaluate the effectiveness of ABA therapy between biologic-naïve and patients who had experienced an inadequate response to biological agents and in the subgroup of ABA monotherapy.

Methods

We prospectively enrolled and followed 91 patients with high RA activity (SDAI=28±13.4, CDAI=25±12) and an inadequate response of conventional synthetic DMARDs (mainly methotrexate, 70.3%) and biologics (mainly TNF-α blockers, 93%) were included in the study. Most of the patients were middle-aged (49±13.5), positive for RF (72.5%) and ACCP (77%) with moderate functional impairment - 1.4 (0.9-2). Patients were divided into two groups: biologic-naïve (48.4%, n=44) and biologic-experienced patients (51.6%, n=47). 18% (n=17) of patients had a history of an inadequate response of 2 or more biologics. The ABA monotherapy group (13%, n=12) was assessed separately. ABA were administered IV, 10 mg/kg according to the standard scheme. The evaluation of the effectiveness of the therapy was carried out according to the EULAR/ACR 2011 criteria using the intention-to-treat approach and SDAI, CDAI and the functional state using the HAQ.

Results

ABA led to a significant (p<0.05) decrease in RA activity after 3 months of ABA therapy in all groups. After 6 months of treatment, there was a tendency towards an increase in the number of patients who achieved remission and low RA activity in the group of biologic-naïve patients, which continued to 12 months of therapy. So, after 6 months and 12 months in the group of biologic-naïve patients, the frequency of remission and low disease activity was 71% (n=25) and 76% (n=19) by SDAI, 75.6% (n=28) and 81.5% (n=24) by CDAI, respectively. Whereas, in the group of biologic-experienced patients - SDAI - 61.8% (n=21) and 69.2% (n=18), CDAI - 64.8% (n=22) and 77.8% (n=21), respectively. However, these differences didn’t reach significance. Similar results were obtained according to the EULAR criteria: after 12 months of treatment, the percentage of patients with a good response in both groups did not differ, 38% (n=14) in biologic-naïve and 38.4% (n=15) in biologic-experienced patients. ABA significantly improved functional status of patients, after 12 months the median HAQ of biologic-naïve and biologic-experienced patients were 0.7 (0.2–0.8) and 1.18 (0.7–1.6), respectively. More biologic-naïve patients achieved functional remission by HAQ after 6 and 12 months compared with biologic-experienced patients: 67% (n=23) vs. 33% (n=17), 62.5% (n=11) vs. 37.5% (n=9), respectively, but these differences didn’t reach significance. In the ABA monotherapy group after 6 months treatment, a good response by EULAR criteria was achieved in 10% (n=1) patients, while in the group of ABA+csDMARDs therapy in 43.5%, p=0.04. After 12 months the trend towards a more pronounced response in the combination therapy group persisted (11%, n=1 and 42%, n=28, respectively), but no significant differences were obtained.

Conclusion

Abatacept has shown significant improvement clinical and functional status in all studied groups. There were no significant differences in response to ABA therapy between biologic-naïve and biologic-experienced patients. ABA monotherapy were significantly worse compared with the combination therapy of ABA and csDMARDs after 6 months. After 12th month observation, this tendency continued, but no significant differences were achieved. This is probably due to the small number of patients on ABA monotherapy and, as a result, to the insufficient statistical representativeness of the sample.

Disclosure of Interests

None declared

AB0170 AMCV POSITIVITY AND HIGHER SERUM IP-10 (CXCL-10) LEVEL ARE ASSOCIATED WITH A MORE PRONOUNCED EFFECT OF ABATACEPT THERAPY

Background

With the advent of medications with different mechanisms of action in the treatment of rheumatoid arthritis (RA), clinicians face the challenge of personalizing the approach to the treatment of RA patients. One of the steps in this direction is to identify predictors of the effectiveness of the therapy. This work is devoted to the identification of predictors of the therapy effectiveness with the blocker of T cells co-stimulation - abatacept (ABA).

Objectives

Search for clinical and immunological predictors of the effectiveness of ABA therapy.

Methods

91 patients were included in the study, most of them women, with high disease activity of RA (DAS28=5.1±1.0, SDAI=28±13.4, CDAI=25±12) and failure of previous biologics (51, 6%) and DMARDs (100%). Moreover, in 20% (n=18) of patients the inefficiency more than 2 biologics were recorded. The average duration of the disease was 3.0 (1.4–12) years, most patients were positive for RF 72.5%, ACCP 77%, AMCV 86%. In 44 patients the levels of RF, ACCP, AMCV and MMP-3 were assessed after 24 weeks of ABA therapy. In 36 patients enzyme-linked immunoassay was used to measure serum concentrations of biomarkers IL-1β, IL-6, IL-17AF, TNF-α, VEGF-A, IP-10, YKL-40 at baseline and after 24 weeks of ABA therapy. The effectiveness of therapy was assessed according to the EULAR criteria. ABA IV infusions were performed according to the standard schedule. Methods of parametric and non-parametric statistics were used in statistical analysis.

Results

ABA treatment led to a significant decrease of disease activity assessed by DAS28, SDAI, CDAI starting from 3 months of therapy (p<0.05). More than half of the patients were in remission and had low disease activity according to the DAS28 (65.7%, n=35) after 48 weeks of treatment. After 48 weeks, the highest percentage of patients with RA remission was registered by the DAS28 (37.4%, n=20), the lowest — SDAI (21.6%, n=11). After 24 weeks of therapy, ABA led to a significant decrease in the serum levels of IL-6 from 2.4 [1.1 - 6,4] to 1.29 [0.9-2.2] pg/ml, (p=0.0006), IP-10 from 21 [12,9-49,8] to 14 [7.5-28] pg/ml, (p=0.007) and matrix metalloproteinase 3 (MMP3) from 30.1 [13-82] pg/ml to 10 [7.4-55] pg/ml, (p = 0.0003). A decrease in the serum level of IL-6 significantly correlated with a decrease in the DAS28 and SDAI (r=0.5 and r=0.479, p<0.05), IP-10 with DAS28 (r=0.326, p<0.05). Initially, the serum level of TNF-α was significantly lower in patients who achieved low disease activity by the SDAI (72.6%, n=37) after 48 weeks of therapy, compared with the rest. On the contrary, a significantly higher level of IP-10 before treatment was recorded in patients with a good response according to the EULAR criteria (39%, n=29) after 48 weeks of ABA treatment (Figure 1). The ROC-analysis revealed that an initially high concentration of TNF-α may indicate with 71% sensitivity and 77% specificity about the possible ineffectiveness of ABA therapy after 48 weeks of treatment, the area under the curve was 0.7, 95% CI (0.5– 0.9). In patients initially positive for AMCV, low RA activity by SDAI was significantly more often registered after 24 (p=0.04) and 48 weeks. (p=0.01). 89% (n=34) of AMCV-positive patients achieved low disease activity after 48 weeks therapy by the SDAI and CDAI. It is noteworthy that a cohort of patients with insufficient effect after 48 weeks consisted entirely of AMCV-negative patients.

Conclusion

ABA therapy led to a significant decrease in disease activity according to the main indices (DAS28, SDAI, CDAI). During ABA treatment, there was a decrease of important immunoinflammatory markers - IL-6, IP-10, MMP-3. AMCV positivity is significantly associated with higher efficacy of ABA therapy. Also, a high basal concentration of TNF-α could use as a predictor of possible failure of ABA therapy, and a high initial level of IP-10, on the contrary, indicates the possible efficacy of ABA therapy.

References

None

Disclosure of Interests

None declared

AB1475 SERUM LEVELS OF INFLAMMATORY BOWEL DISEASE-SPECIFIC ANTIBODIES IN ANKYLOSING SPONDYLITIS

Background

Ankylosing spondylitis (AS) is an immune-mediated inflammatory disease of the musculoskeletal system, that is often accompanied with a subclinical intestinal inflammation. Inflammatory bowel diseases (IBD), including, Crohn’s disease (CD) and ulcerative colitis (UC), are the most frequent extra-articular manifestation in patients (pts) with AS. Several autoantibodies and antimicrobial antibodies are used as additional non-invasive serological markers for the diagnosis of CD and UC [1]. The evaluation of IBD-associated antibodies in AS pts provided conflicting results [2, 3].

Objectives

The aim of the study was to determine the serum levels of IBD-specific antibodies in AS.

Methods

We studied 51 pts with AS fulfilled modified New York criteria (1984); (40M/11F); median and interquartile range (25th—75th percentile) of age 44.0; 34.0-49.0 years; disease duration 12.0; 5.0-20.0 years; BASDAI - 5.3; 4.5-6.4; ASDAS ESR - 3.6; 3.0-4.4; ASDAS CRP - 3.7; 2.8-4.5; 40% HLA-27 positive. In 22% of pts with AS, IBD (CD and UC) were diagnosed. The control group included 44 healthy donors (HC). Atypical perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) were detected using indirect immunofluorescence. The serum levels of IgA/IgG antibodies to Saccharomyces cerevisiae (ASCA), IgA/IgG antibodies to glycoprotein 2 (GP2), IgG antibodies to cathepsin G, lactoferrin, elastase and bactericidal permeability-increasing protein (BPI) were detected by ELISA.

Results

AS pts without signs of IBD and AS with IBD (AS/IBD) pts had significantly higher serum levels of IgA ASCA, IgA anti-GP2, anti-elastase antibodies than HC (4.5; 2.6-6.4 U/ml and 4.9; 3.7-7.3 U/ml vs 1.9; 0.6-2.6 U/ml, p=0.0008, p=0.001; 1.2; 0.8-5.5 U/ml and 1.2; 0.9-11.8 U/ml vs 0.7; 0.6-1.3 U/ml, p=0.007, p=0.02; 8.2; 5.9-9.9 U/ml and 9.1; 8.5-10.5 U/ml vs 5.6; 4.7-8.3 U/ml, p=0.01, p=0.003). The median concentration of anti-cathepsin G antibodies was greater for AS/IBD pts than AS pts (0.8; 0.5-1.0 U/ml vs 0.4; 0.3-0.6 U/ml, p=0.02). In AS and AS/IBD, the occurrence of anti-elastase antibodies (23.0%, 33.0%) was higher than for HC (0%, p=0.05, p=0.01). The positivity rate of IgA anti-GP2 in AS/IBD exceeded that in HC (27.0% vs 0%, p=0.025). AS/IBD pts demonstrated a higher prevalence of pANCA (36.0%), and anti-BPI antibodies (36.0%), when compared to AS alone (4.8%, p=0.005, and 8.0%, p=0.02) and HC (0%, p=0.0001, and 0%, p=0.008).

Conclusion

Our findings indicate that elevated serum levels of IgA ASCA, IgA anti-GP2, anti-elastase antibodies in AS did not differ from those in AS/IBD and may serve as potential biomarkers for predicting intestinal inflammation at an early stage. For AS/IBD, the most useful diagnostic markers were atypical pANCA, IgA ASCA, IgA anti-GP2, anti-elastase and anti-BPI antibodies.

References

[1]Prideaux L, De Cruz P, Ng SC, Kamm MA. Serological antibodies in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2012; 18(7):1340-55.

[2]Benfaremo D, Luchetti M, Gabrielli A. Biomarkers in inflammatory bowel disease-associated spondyloarthritis: state of the art and unmet needs. J Immunol Res. 2019 May 30; 2019:8630871.

[3]De Vries M, Van Der Horst-Bruinsma I, Van Hoogstraten I., et al. pANCA, ASCA, and OmpC antibodies in patients with ankylosing spondylitis without inflammatory bowel disease. J Rheumatol. 2010; 37(11):2340–4.

Disclosure of Interests

None declared

First population norms for the EQ-5D-3L in the Russian Federation

Purpose

The EQ–5D survey instrument is routinely applied to general and patient specific populations in many countries, as a means of measuring Health Related Quality of Life (HRQOL) and/or informing Health Technology Assessment. The instrument is the subject of growing interest in the Russian Federation, as too is Health Technology Assessment. This research is the first to systematically present the EQ–5D–3L nationally representative population norms and to examine the socioeconomic and socio-demographic characteristics of the instrument among a representative sample of the Russian population.

Methods

Based on a nationally representative health and well-being survey of the Russian population, conducted in November 2017, we establish the descriptive results, including the EQ-VAS and the EQ-5D Index, by age and gender, examine the correspondence between the EQ–5D health classifications and the separate EQ-VAS scores, and draw on a set of augmented logistic regressions to evaluate the association between the presence of problems in each dimension and various socio-economic and health-related characteristics.

Results

We find strong evidence that the EQ-5D instrument is sensitive to underlying observed and latent health experiences, that it mirrors many of the characteristics familiar from other settings but that there are Russian specificities which merit further research, particularly with respect to the anxiety/depression dimension of the instrument.

Conclusion

This research represents an important landmark for HRQOL studies in Russia as well as for the prospects of continuing to develop the scholarly and practical infrastructure necessary for Russian Health Technology Assessment to advance.

Health Behaviors During the COVID-19 Epidemic: Perspectives From Studying International Coping and Compliance

Control of the COVID-19 pandemic requires significant changes in people's health behaviors. We offer this multidisciplinary perspective on the extent of compliance with social distancing recommendations and on coping with these measures around the globe in the first months of the pandemic. We present descriptive data from our survey of 17,650 respondents across 18 countries and territories in June 2020. The majority of respondents worried about contracting the virus. Nearly all engaged in at least some preventive behaviors, particularly handwashing, mask wearing, and avoiding social events. Most reported that it would be difficult to continue these behaviors for more than a few months, and about half reported feeling more anxious since the start of the pandemic. Commonly reported coping behaviors included news consumption, watching television, and sleeping. Our cross-national study highlights areas for developing and implementing health behavior interventions in the global fight to stop the spread of COVID-19.

AB0837 SERUM YKL-40 LEVELS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS: RELATION TO DISEASE ACTIVITY AND JOINT DESTRUCTION

Background:

YKL-40 (chitinase-3-like 1 protein, human cartilage glycoprotein 39) is one of the major proteins secreted locally in the arthritic joint by activated macrophages, chondrocytes, synoviocytes and neutrophils, YKL-40 an important marker for inflammation, cartilage remodelling and synovial hyperplasia is recognized as a possible auto-antigen in rheumatoid arthritis (RA).

Objectives:

The aims of the study were to determine the serum level of YKL-40 in early RA and investigate his relationship with biomarkers of disease activity and joint destruction.

Methods:

We studied 22 patients with early RA (ACR/EULAR 2010 classification criteria); 4 males, 18 females; median and interquartile range (25th—75th percentile) of age 55,0 (43,0-64,0) years, disease duration 7,0 (5,0-11,0) months, DAS28 4,9 (4,3-5,8); 86% IgM rheumatoid factor (IgM RF) +; 91% anti-cyclic citrullinated peptide antibody (anti-CCP) +. All patients were treated with methotrexate (MTX). Three (14 %) patients received low oral doses of steroids and intra-articular injections. The control group included 22 healthy donors (HC). Radiographs were scored according to the van der Heijde-modified Sharp score. YKL-40, matrix metalloproteinase-3 (MMP-3), anti-CCP were detected using commercially available enzyme-linked immunosorbent assays (ELISA). The serum levels of IgM RF, C-reactive protein (CRP), serum amyloid A (SAA) were measured by immunonephelometry.

Results:

RA patients had significantly higher serum level of YKL-40 than HC (92,1; 68,5-153,1 pg/ml vs 54,0; 41,7-83,2 pg/ml, p<0.01). Serum YKL-40 concentration was positively correlated with DAS 28 (r=0,5; p<0,05), erythrocyte sedimentation rate (ESR) (r=0,5; p<0,05), CRP (r=0,8; p<0,05), SAA (r=0,6; p<0,05) and MMP-3 (r = 0,6; p<0,05). We found no relationship between the level of YKL-40 and articular radiographic changes.

Conclusion:

Elevated serum concentration of YKL-40 in early RA is associated with clinical and laboratory indicators of disease inflammatory activity and increased level of MMP-3 - an immunological marker of joint destruction.

Disclosure of Interests:

Elena Aleksandrova: None declared, Alexander Novikov: None declared, Elena Luchikhina Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Consultant of: Abbvie, Biocad, Sanofi, Celgene, Dmitriy Karateev Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Lilly, Bayer, Paid instructor for: Abbvie, Pfizer, Biocad, Sanofi, Novartis, Lilly, Galina Lukina Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Paid instructor for: Abbvie, Biocad, Sanofi, Celgene

Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia

This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in supplemental private health insurance. Applying a range of methodologies to data from the Russian Longitudinal Monitoring Survey-Higher School of Economics we exploit a selection mechanism in the data to compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling policy-relevant evidence of ex-post moral hazard that confirms a theoretical prediction and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.

FRI0564 SERUM LEVELS OF IL-6 AND IL-8 IN ANKYLOSING SPONDYLITIS PATIENTS: ASSOCIATIONS WITH DISEASE ACTIVITY

Background:

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine and sacroiliac joints characterized by new bone formation (syndesmophytes) and ankyloses. In AS cases, along with the damage to the musculoskeletal system, impairment of other organs and systems is often observed (uveitis, inflammatory bowel and heart diseases). Pro-inflammatory cytokines (TNF-α, IL-6,-17,-23,-21,-22,-31) and chemokines (IL-8) are key pathogenic markers in AS.

Objectives:

The aims of the study were to determine the serum levels of IL-6 and IL-8 in AS and investigate their relationship with disease activity.

Methods:

We studied 140 patients (pts) with AS fulfilled modified New York criteria (1984); (102M/38F); median and interquartile range (25th—75th percentile) of age 43.0; 35.0-51.0 years; disease duration 6.0; 4.0-12.0 years; BASDAI - 5.4; 4.1-6.6; ASDAS ESR - 3.6; 2.6-4.4; ASDAS CRP - 3.8; 2.7-4.5; 86% HLA-27 positive. In 50% of pts with AS, inflammatory bowel diseases (IBD) (Crohn’s disease and ulcerative colitis) were diagnosed. The control group included 17 healthy donors (HC). The serum concentrations of IL-6 and IL-8 were detected by chemiluminescence immunoassay using IMMULATE 1000 analyzer (Siemens Healthcare Diagnostics, USA).

Results:

AS pts had significantly higher serum level of IL-6 than HC (4.3; 0.1-8.0 pg/ml vs 2.3; 0.1-2.7 pg/ml, p <0.006). The median concentration of IL-8 didn’t differ between AS pts and HC (10.5; 8.3-18.0 pg/ml vs 11.9; 8.2-18.3 pg/ml, p>0.05). The same levels of IL-6 and IL-8 were detected in AS with IBD and AS without signs of IBD (p>0.05). In AS pts, serum IL-6 concentration was positively correlated with ASDAS ESR (r = 0.3), ASDAS CRP (r = 0.3), ESR (r = 0.3) and CRP (r = 0.5) (p <0.05); IL-8 was negatively associated with presence of fecal calprotectin (r = -0.3) (p <0.05).

Conclusion:

Elevated serum concentration of IL-6 in AS is associated with clinical and laboratory markers of high inflammatory activity of the disease. The levels of IL-8 in the sera of AS patients were negatively correlated with the concentration of fecal calprotectin. Data on the relationship of IL-8 with the activity of the pathological process in AS require further study.

Disclosure of Interests:

Elena Aleksandrova: None declared, Alexander Novikov: None declared, Polina Kulakova: None declared, Aleksey Dorofeev: None declared, Nadezhda Savenkova: None declared, Evgeniy Volnukhin: None declared, Anton Kovshik: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche

FRI0541 TEN-YEAR OUTCOME OF DIFFERENT SUBTYPES OF UNDIFFERENTIATED INFLAMMATORY ARTHRITIS

Background:

A group of patients with recent onset of arthritis always presents a certain difficulty for the practitioner due to its marked heterogeneity. This especially concerns the patients with undifferentiated inflammatory arthritis (UIA).

Objectives:

To characterize the long-term nosological outcome of clinical and immunological subtypes of early UIA.

Methods:

A cohort study of patients with recent onset of arthritis with a duration of not more than 12 months (n = 761, 82.8% females, 55.2% RF +) was initiated in 2003. All patients were referred to rheumatologist from GP with suspicion on inflammatory arthritis. Inclusion criteria: age 18 years or more, at least 1 swollen joint at 1stvisit and/or positive squeeze test or morning stiffness for at least 30 minutes. 243 patients were initially classified as having UIA: 46 (18,9%) males, 197 (81,1%) females, age (median, quartiles)- 44 [29;53] years, duration of symptoms- 3 [2;5] months, swollen joints count (66/68)- 2 [1;4], tender joints count 3 [2;6], 85 (35%) rheumatoid factor (RF)+, 63 (25,9%) anti-CCP+. Patients with UIA were followed up for at least 10 years.

Results:

28 (11,5%) of patients were lost to follow up. Long-term observation was conducted in 215 patients. 22 (10,2%) of them developed persistent spontaneous (without use of DMARDs) remission. Other patients were finally classified as having: rheumatoid arthritis (RA) 138 (64,2%) and non-RA (25,6%). The spectrum of diagnoses in non-RA group included: ankylosing spondylitis, osteoarthritis, gout, psoriatic arthritis, polymyalgia rheumatica, systemic lupus, mixed connective tissue disease, sarcoidosis, paraneoplastic syndromes. The following characteristics at baseline positively correlated with the development of RA: arthritis of 3 or more joints (p=0,011), arthritis of hand (p=0,005), high ESR (p<0,001), high CRP (p=0,003), PF-positivity (p<0,001), anti-CCP-positivity (p<0,001), older age of onset (p=0,019), higher levels of RF IgM (p=0,027) and anti-CCP (p<0,001). Development of persistent spontaneous remission negatively correlated with polyarthritis (p=0,033), PF-positivity (p=0,034), anti-CCP-positivity (p=0,001). Positive seroconversion was observed: of RF in 10 (4,7%) patients, 8 developed RA, of anti-CCP – in 3 (1,4%) patients, all developed RA.

Table.

Outcome of different subtypes of patients with UA after 10 years of follow up (n=215).

Subtypes of UAOutcomeP (Pearson chi-squared test)Non-RA (n=55)RA (n=138)Spontaneous remission (n=22)Mono- and oligo arthritis (n=140)40 (28,6%)81 (57,9%)19 (13,6%)0,016Polyarthritis (n=75)15 (20%)57 (76%)3 (4%)RF-negative AND anti-CCP-negative (n=90)34 (37,8%)41 (45,6%)15 (16,7%)<0,001RF+ OR anti-CCP+ OR low levels (<3 ULN) (n=92)20 (21,7%)65 (70,7%)7 (7,6%)High RF+ AND High anti-CCP+ (n=33)1 (3%)32 (97%)0

Conclusion:

Seronegative oligoarticular disease and highly seropositive disease are different subtypes of UIA. Combination of seronegativity and oligoarticular disease (n=52) associated with relatively rare development of RA (36,2%) and high proportion of spontaneous remission (22,4%). Patients who were highly positive (>3 ULN) for both RF and anti-CCP developed RA in 97% of cases and never remitted spontaneously.

Disclosure of Interests:

Elena Luchikhina Consultant of: Abbvie, Biocad, Sanofi, Celgene, Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Dmitry Karateev Consultant of: Abbvie, Pfizer, Biocad, Sanofi, Novartis, Lilly, Speakers bureau: Abbvie, Roche, Pfizer, Biocad, MSD, Sanofi, Johnson & Johnson, Glaxo, UCB, Celgene, Novartis, Lilly, Bayer, Alexander Novikov: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Elena Aleksandrova: None declared, Natalia Demidova: None declared

Investigation of Salmonella enteritidis outbreak in four kindergartens

In June 2018, in the city of Sofia, Bulgaria, 40 children from four different kindergartens suffered from salmonellosis caused by S. enteritidis. They were reported to have consumed food prepared and delivered by a private catering service. The patients had fever, diarrhea, and some had vomiting and abdominal pain. Sixteen of them were treated in hospital, and the other 24 received home treatment. Some of the outpatients received antibiotic treatment despite WHO recommendations. All 40 isolates were positive for O: D, H: gm and H: m, and were confirmed to be Salmonella enteritidis, respectively. Using conventional and molecular methods, such as serotyping, Multiplex-PCR and PFGE, it was confirmed that the strains were epidemiologically related. Based on molecular genetic methods, we established that the epidemic outbreak had a common origin: contaminated food delivered by a private catering service, which was consumed at all four kindergartens.

[MICROSATELLITE INSTABILITY IN ENDOMETRIAL CANCER]

Microsatellite instability (MSI) is involved in the pathogenesis of about 30% of endometrial cancer cases. In accumulating data from the past few years MSI is shown to have both clinical and prognostic value. In the present work we are discussing the components and molecular mechanisms of functioning of the mismatch repair system (MMR). MSI is a hallmark of endometrial tumors with DNA MMR deficiency. We summarized the main pathways for accumulating mutations in coding and non-coding DNA sequences, which is a result of errors during replication of microsatellite tandem repeats. A few studies rising valuable conclusions about the correlation between MSI and endometrial cancer are revised.

Spatial distribution and dynamics of proton conductivity in fuel cell membranes: potential and limitations of electrochemical atomic force microscopy measurements

The proton conductivity of a Nafion 112 membrane is measured with a high spatial resolution using electrochemical atomic force microscopy. Image analysis reveals an inhomogeneous conductivity distribution which is attributed to the limited connectivity of hydrophilic domains. This information relates to the micro-morphology which is due to phase separation of the hydrophobic polymer backbone and the hydrophilic pendant groups. The direct images relate to a different length scale and are complementary to the x-ray diffraction investigations which provide only average information. Furthermore, the measured current values reveal an interesting correlation with the size of the conductive areas. A bimodal conductivity distribution suggests that there are different mechanisms which contribute to the proton current in Nafion. Additionally, time dependence in local conductivity is found and interpreted in terms of redistribution of water in the membrane. A statistical analysis of the current distribution is performed and compared with theoretical simulations. Evidence is found for the existence of a critical current density. On a timescale of seconds the response of the conductive network is probed by applying voltage steps to the atomic force microscope tip.

[The feeding of newborns with low birth weight with milk formula "Nenatal" and "Nutrilon-premium"]

The aim of the study is to make retrospective analysis of 9 years experience in the feeding of praematuries and high risk newborn in that ward in First City Hospital-Sofia with formula milks "Nenatal" and "Nutrilon-premium". 721--42.4% from all babies in this period were feed with those formulas. With Nenatal only--11.8%, with Nutrilon-premium 88.2%. This the fact is due that all babies under 2000 gr. were fed with Nenatal, and after reaching 2000 gr.--with Nutrilon-premium. The results confirm that Nenatal is right formula for feeding of low and very low birth weight infant, due to its special content and qualities. The results from Nutrilon-premium illustrated that mean gain weight is the biggest in I grade of prematurity--33 grams, followed by matures--30 gr, after them II grade--29 gr., III grade--27 gr., IV grade--26 gr. As a conclusion we may say that mean gain weight for all groups is 29 grams. Consuming all gain weight of the babies feeding with Nutrilon-premium data appear that the biggest is in III of prematurity--1499 grams, followed by IV grade--1418 gr., I grade--1341 spama, II grade--1219 gr., and last matures--745 gr.