Bessel's disease-the first report of an IgG4-related disorder

Many aspects of IgG4-related diseases were initially described during the late 19th and early 20th century. A variety of clinical presentations caused by this common pathology have been named after the researchers who first described the disorders, such as Mikulicz, Küttner, Riedel or Ormond. However, the initial description of retroperitoneal fibrosis dates back to even 50 years earlier, when in 1846, the Prussian private practitioner Raphael Jakob Kosch described a hitherto unknown constellation of symptoms and pathological findings in a famous patient. This celebrity was the mathematician and astronomer Friedrich Wilhelm Bessel, a close friend of Alexander von Humboldt and Carl Friedrich Gauss.

["Rheuma (be-)greifen"- A multimodal teaching concept to improve rheumatology education for medical students]

BACKGROUND

The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future.

OBJECTIVE

To assess whether a combination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as a discipline.

MATERIAL AND METHODS

Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3D printing of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students.

RESULTS

The evaluation of the teaching concept with 93 students of medicine showed a consistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3D printing and virtual reality.

CONCLUSION

Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.

Neutrophils seeking new neighbors: radiotherapy affects the cellular framework and the spatial organization in a murine breast cancer model

Neutrophils are known to contribute in many aspects of tumor progression and metastasis. The presence of neutrophils or neutrophil-derived mediators in the tumor microenvironment has been associated with poor prognosis in several types of solid tumors. However, the effects of classical cancer treatments such as radiation therapy on neutrophils are poorly understood. Furthermore, the cellular composition and distribution of immune cells in the tumor is of increasing interest in cancer research and new imaging technologies allow to perform more complex spatial analyses within tumor tissues. Therefore, we aim to offer novel insight into intra-tumoral formation of cellular neighborhoods and communities in murine breast cancer. To address this question, we performed image mass cytometry on tumors of the TS/A breast cancer tumor model, performed spatial neighborhood analyses of the tumor microenvironment and quantified neutrophil-extracellular trap degradation products in serum of the mice. We show that irradiation with 2 × 8 Gy significantly alters the cellular composition and spatial organization in the tumor, especially regarding neutrophils and other cells of the myeloid lineage. Locally applied radiotherapy further affects neutrophils in a systemic manner by decreasing the serum neutrophil extracellular trap concentrations which correlates positively with survival. In addition, the intercellular cohesion is maintained due to radiotherapy as shown by E-Cadherin expression. Radiotherapy, therefore, might affect the epithelial-mesenchymal plasticity in tumors and thus prevent metastasis. Our findings underscore the growing importance of the spatial organization of the tumor microenvironment, particularly with respect to radiotherapy, and provide insight into potential mechanisms by which radiotherapy affects epithelial-mesenchymal plasticity and tumor metastasis.

Healthcare utilization and unmet needs of patients with antisynthetase syndrome: An international patient survey

Antisynthease syndrome (ASSD) is a rare, complex and understudied autoimmune disease. Internet-based studies can overcome barriers of traditional on-site research and are therefore very appealing for rare diseases. The aim of this study was to investigate patient-reported symptoms, diagnostic delay, symptoms, medical care, health status, working status, disease knowledge and willingness to participate in research of ASSD patients by conducting an international web-based survey. The multilingual questionnaire was created by an international group of rheumatologists and patients and distributed online. 236 participants from 22 countries completed the survey. 184/236 (78.0%) were female, mean age (SD) was 49.6 years (11.3) and most common antisynthetase antibody was Jo-1 (169/236, 71.6%). 79/236 (33.5%) reported to work full-time. Median diagnostic delay was one year. The most common symptom at disease onset was fatigue 159/236 (67.4%), followed by myalgia 130/236 (55.1%). The complete triad of myositis, arthritis and lung involvement verified by a clinician was present in 42/236 (17.8%) at disease onset and in 88/236 (37.3%) during the disease course. 36/236 (15.3%) reported to have been diagnosed with fibromyalgia and 40/236 (16.3%) with depression. The most reported immunosuppressive treatments were oral corticosteroids 179/236 (75.9%), followed by rituximab 85/236 (36.0%). 73/236 (30.9%) had received physiotherapy treatment. 71/236 (30.1%) reported to know useful online information sources related to ASSD. 223/236 (94.5%) were willing to share health data for research purposes once a year. Our results reiterate that internet-based research is invaluable for cooperating with patients to foster knowledge in rare diseases.

Successful Generation of CD19 Chimeric Antigen Receptor T Cells from Patients with Advanced Systemic Lupus Erythematosus

Although it has been shown that the production of functional chimeric antigen receptor T cells is feasible in patients with B-cell malignancies, it is currently unclear whether sufficient amounts of functional autologous CAR T cells can be generated from patients with autoimmune diseases. Intrinsic T-cell abnormalities and T-cell-targeted immune suppression in patients with autoimmunity may hamper the retrieval of sufficient T cells and their transduction and expansion into CAR T cells. Patients with active systemic lupus erythematosus (SLE) underwent leukapheresis after tapering glucocorticoids and stopping T-cell-suppressive drugs. This material was used as source for manufacturing anti-CD19 CAR T-cell products (CAR) in clinical scale. Cells were transduced with a lentiviral anti-CD19 CAR vector and expanded under good manufacturing practice (GMP) conditions using a closed, semi-automatic system. Functionality of these CAR T cells derived from autoimmune patient cells was tested in vitro. Six SLE patients were analyzed. Leukapheresis could be successfully performed in all patients yielding sufficient T-cell numbers for clinical scale CAR T-cell production. In addition, CAR T cells showed high expansion rates and viability, leading to CAR T cells in sufficient doses and quality for clinical use. CAR T cells from all patients showed specific cytotoxicity against CD19+ cell lines in vitro. GMP grade generation of CD19 CAR T-cell products suitable for clinical use is feasible in patients with autoimmune disease.

AB0898 Guselkumab improves dactylitis in PsA patients with inadequate response to TNFi: data from the Phase 3b COSMOS trial

Background

Dactylitis is a biomarker of disease severity in psoriatic arthritis (PsA) associated with functional disability, impaired quality of life and radiographic progression. The COSMOS study demonstrated the efficacy and safety of guselkumab (GUS), an IL-23 p19 subunit inhibitor (i), in patients (pts) with PsA who had inadequate response (IR; insufficient efficacy or intolerance) to 1–2 TNFi.1

Objectives

Evaluate the effect of GUS 100 mg Q8W on dactylitis, and assess the relationship between dactylitis resolution and improvement in other clinical outcomes, through 1 year in TNFi-IR PsA pts.

Methods

Pts received GUS or placebo (PBO); PBO pts crossed over to GUS at either Week (W) 16 (early escape [EE], n=45/96) or W24 (planned, n=51/96). Each of 20 digits was determined by the investigator to have no (0) to severe (3) dactylitis (Dactylitis Severity Scale [DSS]; total score: 0–60). Presence of dactylitis was defined by DSS score ≥1; complete or partial resolution was defined as a DSS score=0, or lower than baseline (BL), respectively. Change in DSS from BL at W24 was a secondary endpoint. Other clinical response outcomes including DAPSA LDA/remission, MDA and enthesitis resolution (Leeds Enthesitis Index score=0) were assessed by dactylitis resolution status. Both as observed and non-responder imputation (NRI; for missing data or EE) data are presented.

Results

Of 285 pts, 103 (36%; 67 GUS, 36 PBO) had dactylitis and 190 (67%) had enthesitis at BL. The majority of pts with dactylitis (76%) also had enthesitis. Pts with dactylitis had more severe joint and skin disease than those without (Table 1).

Table 1.

BL characteristics for TNFi-IR PsA pts with/without dactylitis

With dactylitisWithout dactylitisN103182Age, mean years (SD)48.3 (11.8)49.6 (12.5)Sex: male, %5048Years since PsA diagnosis; mean (SD)8.1 (7.2)8.6 (7.8)BMI, mean kg/m2 (SD)28.5 (5.8)30.1 (6.6)PsA characteristicsSwollen joint count, 0–66; mean (SD)12.3 (8.1)8.5 (4.8)Tender Joint count, 0–68; mean (SD)22.0 (12.9)19.1 (12.2)DAPSA score; mean (SD)48.6 (20.9)41.2 (16.8)Spondylitis with peripheral arthritis, %2824Enthesitis, %7662Psoriasis characteristics, mean (SD)  PASI score, 0–7214.5 (12.7)8.8 (9.6)  BSA, %23.4 (23.6)12.4 (17.1)  DLQI score, 0–3014.1 (7.0)12.6 (6.9)

In an as-observed analysis of pts with BL dactylitis, numerically more GUS- (55%) than PBO- (33%) treated pts achieved complete dactylitis resolution at W16. By W48, 80% of GUS-randomized pts achieved complete resolution (NRI: 57% at W24, 67% at W48; Figure 1).

Among 12 GUS pts with persistent dactylitis at W48, 9 (75%) had partial resolution. The 36 PBO pts with dactylitis crossed over to GUS at W16 (n=23; EE) or W24 (n=13; planned). As observed, 88% of these PBO→GUS pts had complete resolution of dactylitis at W48 (Figure 1).

Of 105 dactylitis-free pts at BL in the GUS arm, 8 (8%) developed dactylitis before W48: 4 at W4, 2 at W8 and 1 each at W16 and 36. Complete resolution was seen in 6 (75%) of the 8 pts by W48, when 1 further new-onset case occurred.

Utilizing observed data among GUS-randomized pts with and without BL dactylitis, 32% and 34%, respectively, achieved MDA at W48. Respective response rates were 59% and 55% for DAPSA LDA, and 28% and 15% for DAPSA remission. In those who did and did not achieve complete dactylitis resolution at W48, respective response rates were 38% and 0% for MDA, 68% and 13% for DAPSA LDA, and 31% and 0% for DAPSA remission. Of 69 pts with both enthesitis and dactylitis at BL who continued to receive GUS through W48, GUS resolved both manifestations in 72%, neither in 16%, only enthesitis in 4%, and only dactylitis in 7% of pts.

Conclusion

Complete dactylitis resolution was achieved in ≥80% of pts who continued to receive GUS at W48, with partial resolution seen in most remaining pts in an as-observed analysis. Response rates increased through W48. Dactylitis resolution in this difficult-to-treat TNFi-IR PsA population was frequently associated with enthesitis resolution and achievement of clinical outcomes representing low levels of disease activity.

References

[1]Coates LC et al. Ann Rheum Dis 2021

Disclosure of Interests

Helena Marzo-Ortega Speakers bureau: Abbvie, Biogen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Consultant of: Abbvie, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda, UCB, Grant/research support from: Janssen, Novartis, UCB, Elke Theander Employee of: Employed by Janssen Scientific Affairs, LLC (a subsidiary of Johnson & Johnson), Marlies Neuhold Shareholder of: Own Johnson & Johnson stock and/or stock options, Employee of: Employed by Janssen Scientific Affairs, LLC (a subsidiary of Johnson & Johnson), Paul Bergmans Shareholder of: Own Johnson & Johnson stock and/or stock options, Employee of: Employed by Janssen Scientific Affairs, LLC (a subsidiary of Johnson & Johnson), May Shawi Shareholder of: Own stock in Johnson & Johnson, Employee of: Employed by Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Michelle Perate Shareholder of: Own stock in Johnson & Johnson, Employee of: Employed by Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Christine CONTRE Shareholder of: Own Johnson & Johnson stock and/or stock options, Employee of: Employed by Janssen Scientific Affairs, LLC (a subsidiary of Johnson & Johnson), Iain McInnes Consultant of: Abbvie, Amgen, Astra Zeneca, BMS, Cabaletta, Causeway Therapeutics, Compugen, Evelo, Gilead, GSK, Janssen, Lilly, Moonlake, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: Amgen, AstraZeneca, BMS, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Georg Schett: None declared

POS0074 IMMUNOLOGICAL DIFFERENCES BETWEEN PsA PATIENTS WHO ARE TUMOR NECROSIS FACTOR INHIBITOR-NAIVE AND WHO HAVE INADEQUATE RESPONSE TO TUMOR NECROSIS FACTOR INHIBITORS

Background

A better understanding of the immunological differences between psoriatic arthritis (PsA) patients (pts) who are tumor necrosis factor inhibitor (TNFi)-naïve & who have inadequate response to TNFi (TNFi-IR) may guide treatment choices. In DISCOVER-1, benefit of the IL-23p19 subunit inhibitor guselkumab (GUS) every-four-weeks (Q4W) & Q8W vs placebo (PBO) in improving PsA signs & symptoms was seen in adults with active PsA.1 The Ph3b COSMOS study of GUS Q8W vs PBO in TNFi-IR PsA pts corroborated these findings.2

Objectives

Assess baseline (BL) molecular differences between TNFi-naïve & -IR PsA pts & investigate GUS pharmacodynamic (PD) effect on cytokine expression over time in these cohorts.

Methods

Serum samples collected from consenting biomarker substudy pts in DISCOVER-11 (TNFi-naïve [n=101] & -IR [n=17]), DISCOVER-23 (TNFi-naïve [n=150]), & COSMOS2 (TNFi-IR [n=76]) were analyzed for selected serum cytokine levels. TNFi-IR pts in this post-hoc analysis had active PsA & discontinued 1-2 TNFi due to inadequate efficacy; these pts required a TNFi-specific washout period prior to starting GUS. PD effect of GUS Q8W on cytokine levels was assessed. Differential BL cytokine expression, associations between BL cytokine levels & clinical response (Psoriasis [PsO] Area & Severity Index 75% improvement from BL [PASI75] & American College of Rheumatology 20% improvement [ACR20]), & GUS effect on cytokine levels were analyzed with a General linear model & Spearman linear regression.

Results

BL pt demographics, disease characteristics, & conventional synthetic disease-modifying antirheumatic drug (csDMARD) use were comparable between TNFi-naïve (DISCOVER-1 & -2, N=251) & -IR (DISCOVER-1 & COSMOS, N=93) pts, with differences in mean PASI score (8.9 v 12.5), swollen joint count (SJC) (11.7 v 10.3), PsA duration (5.8 v 9.8 yrs), & PsO duration (16.7 v 20.4 yrs; Table 1). BL serum IL-22 & TNFα levels for pooled treatment groups were higher in TNFi-IR than -naïve pts (p<0.05). At W24, GUS reduced IL-22, IL-17A/F, IL-6, C-reactive protein (CRP), & serum amyloid A protein to similar levels in both cohorts (p<0.05; Figure 1). W24 PASI75 responders had higher BL IL-17F levels with GUS in both cohorts (p<0.05) & higher IL-22 levels in TNFi-IR pts only (p<0.05). A trend of upregulated BL IL-22 expression in W24 ACR20 responders was seen for TNFi-IR pts with GUS (p=0.07).

Table 1.

BL demographics, disease characteristics, & drug use in TNFi-naïve & -IR cohorts with available cytokine data in DISCOVER-1&2 & COSMOS.*

TNFi-naïve (N=251)TNFi-IR (N=93)Age [yrs]47.2 (11.3)48.5 (11.1)Female, n (%)132 (52.6)46 (49.5)Body mass index [kg/m2]29.6 (6.1)30.3 (6.4)Median (range) CRP [mg/dL]0.9 (0.0-12.9)1.0 (0.0-13.2)Log2 IL-22 / TNFα [pg/mL]2.0 (1.4) / 1.1 (0.6)2.5 (1.5) / 1.9 (1.2)Log2 IL-17A / F [pg/mL]-0.4 (1.5) / 1.7 (1.5)-0.1 (1.7) / 2.0 (1.6)SJC [0-66]11.7 (7.1)10.3 (8.3)TJC [0-68]20.3 (13.1)20.6 (14.2)PsA duration [yrs]5.8 (5.9)9.8 (8.2)PsO duration [yrs]16.7 (12.8)20.4 (12.0)PsO Body surface area (%)14.8 (18.6)19.1 (21.3)Investigator’s Global Assessment score [0-4]2.3 (0.9)2.3 (1.0)PASI score [0-72]8.9 (10.6)12.5 (12.0)Enthesitis [Y], n (%)160 (63.7)58 (62.4)csDMARD use [Y], n (%)164 (65.3)62 (66.7)Corticosteroid use (Y), n (%)45 (17.9)19 (20.4)Methotrexate use [Y], n (%)136 (54.2)54 (58.1)

Data are mean (SD) unless otherwise noted. *Pts with serum CRP level ≥0.3 mg/dL, SJC ≥3, & TJC ≥3 (to mimic D1 inclusion criteria1). TJC= tender joint count

Conclusion

Elevated BL IL-22 expression & association between BL IL-22 levels & W24 PASI75 response, & a W24 trend for an association between upregulated BL IL-22 & ACR20 response, in TNFi-IR pts seen in this exploratory analysis may suggest increased involvement of the IL-23 pathway in TNFi-IR pts. GUS showed comparable & significant PD effects for TNFi-naïve & -IR pts, consistent with observed clinical responses.

References

[1]Deodhar A, et al. Lancet. 2020;395:1115-25.

[2]Coates LC, et al. Ann Rheum Dis. 2021;80:140-1.

[3]Mease P, et al. Lancet. 2020;395:1126-36.

Disclosure of Interests

Stefan Siebert Speakers bureau: AbbVie, Biogen, GSK, Janssen, Novartis, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, GSK, Janssen, Novartis, and UCB, Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Georg Schett Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, Novartis, and UCB, Siba P Raychaudhuri Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Warner Chen Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC (a wholly owned subsidiary of Johnson & Johnson), Sheng Gao Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC (a wholly owned subsidiary of Johnson & Johnson), Soumya D Chakravarty Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC (a wholly owned subsidiary of Johnson & Johnson), May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Frederic Lavie Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Elke Theander Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC (a wholly owned subsidiary of Johnson & Johnson), Marlies Neuhold Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC (a wholly owned subsidiary of Johnson & Johnson), Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC (a wholly owned subsidiary of Johnson & Johnson), Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC (a wholly owned subsidiary of Johnson & Johnson), Proton Rahman Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Grant/research support from: Janssen and Novartis, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GSK, Inmagene, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Aurinia, Bristol Myers Squibb, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB

POS0260 LONG-TERM HUMORAL RESPONSE TO SARS-CoV-2 VACCINATION IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASE

Background

The first vaccine against SARS-CoV-2 was approved in December 2020. Immunogenicity of SARS-CoV2 vaccines in patients with immune-mediated inflammatory disease (IMID) have so far been evaluated in the 2-6 weeks following complete vaccination and risk groups for poor early vaccine response have been identified leading to specific vaccination recommendations. However, data on the long-term course and persistence of vaccine response in IMID patients, as well as the outcomes of the specific recommendations are lacking.

Objectives

To evaluate the long-term course of humoral response to SARS-CoV-2 vaccination in a large prospective cohort of IMID patients and non-IMID controls with a follow-up duration of up-to to 10 months after the first vaccine dose.

Methods

We have initiated a prospective dynamic cohort of IMID patients and healthy controls in February 2020 to monitor immune response to SARS-CoV-2 and respiratory infections including COVID-19 (1). Participants who contributed data starting from the 4 weeks before their first vaccination onwards were included in this analysis. Antibodies against SARS-CoV-2 spike protein were quantified with an ELISA from Euroimmun (Lübeck, Germany) with an optical density cutoff of 0.8. We fitted linear mixed-effect models for log-transformed antibody levels using time splines with adjustment for age and sex. Marginal mean antibody levels with 95% confidence intervals (CI) were estimated at selected time points for IMID patients and controls with double vaccination. We descriptively analyzed the observed antibody levels over time in cohort participants receiving two vaccinations vs. three vaccinations.

Results

Among 5076 cohort participants, 3147 IMID patients and healthy controls (mean (SD) age 49 (16)) provided 4756 samples for this analysis between December 2020 and 2021, with a median (IQR) 28 (14-31) weeks of follow-up after the first vaccination (Table 1). 2965 (94%) participants had received at least 2 and 223 (7%) participants had received three vaccine doses by the date of their latest sampling. In IMID patients, age and sex-adjusted estimated marginal mean antibody levels waned after week 16 and were substantially reduced at all time points compared to the controls, finally dropping to the borderline range (1.01, 95%CI 0.86 to 1.19) at week 40 (Figure 1A, Table 1). A third dose was given to 128 (7%) of IMID patients with a poor response to 2 vaccine doses after a median 20 weeks of the second dose (IQR 10 to 26 weeks). After the third dose, antibody levels in IMID patients were comparable to those of healthy controls at 40 weeks who had three vaccine doses. These were also higher than that of IMID patients and controls who did not receive a third dose (Figure 1B).

Table 1.

Participant characteristics and antibody levels

Healthy controlsIMID N11991948 Age, mean (SD)40.8 (13.5)54.3 (14.8) Follow-up, weeks, median (IQR)31.1 (23.8-36.6)19.6 (12.3-26.6) Follow-up range, weeks,1.6-46.11.7-46.3Sex, n(%) Female554 (46.2)1136 (58.3)Vaccine intervals, ´median (IQR) 1st to 2nd dose4.6 (3.0-6.0)6.0 (5.0-6.1) 2nd to 3rd dose29.6 (26.9-36.4)19.9 (10.0-26.1)Diagnosis, n (%) Spondyloarthritis-713 (36.6) Rheumatoid arthritis-489 (25.1) Autoimmune disease, systemic+-420 (21.5) Inflammatory bowel disease-219 (11.2) Psoriasis-107 (5.5)Mean* antibody levels after 1st dose Week-84.16 (3.89 to 4.45)2.97 (2.83 to 3.12) Week-168.39 (7.81 to 9.02)5.04 (4.81 to 5.28) Week-325.02 (4.73 to 5.33)2.52 (2.32 to 2.74) Week-402.14 (1.95 to 2.35)1.01 (0.86 to 1.19)

+ Systemic lupus, systemic sclerosis, Sjögren’s syndrome, vasculitis

* Estimated marginal means adjusted for age and sex.

Figure 1.

Conclusion

Humoral response to vaccination against SARS-CoV-2 was weaker in IMID patients compared to controls at all time points after the first vaccine dose and practically disappeared after 1 year. IMID patients can still achieve a good antibody response with a third dose even after a weak response with two doses.

References

[1]Simon D et al Nat Commun 2020

Disclosure of Interests

None declared

POS1263 PRE-EXPOSURE PROPHYLAXIS FOR SARS-CoV-2 INFECTION WITH SUBCUTANEOUS CASIRIVIMAB/IMDEVIMAB IN PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES

Background

Patients with immune-mediated inflammatory diseases (IMID), particularly if treated with B-cell depleting therapies, show reduced humoral responses to SARS-CoV-2 vaccines and increased risk of severe COVID-19 (1,2). Since pre-exposure prophylaxis (PrEP) with monoclonal antibodies against SARS-CoV-2 proved effective in preventing infection and COVID-19 (3) in the general population, PrEP could be used for passive immunization of vaccine-refractory patients with IMIDs.

Objectives

To evaluate the persistence of serum and salivary anti-SARS-CoV-2 IgG antibodies in vaccine-refractory patients with IMID after PrEP with casirivimab/imdevimab. Secondary outcomes were safety, SARS-CoV-2 infection, and adverse COVID-19 outcomes.

Methods

We performed a longitudinal analysis on anti-SARS-CoV-2 IgG titers in IMID patients who received a PrEP with 1200 mg of subcutaneous casirivimab/imdevimab due to high infection risk, as they had not developed an adequate humoral response at least 21 days after three COVID-19 vaccinations (Table 1). Serum and salivary anti-SARS-CoV-2 Spike IgG were quantified by ELISA (EUROIMMUN, Lübeck, Germany) before PrEP and after 1, 14, and 30 days. IgG levels are given as antibody ratios by dividing the optical density of the sample by that of the calibrator. A cutoff of ≥1.1 was considered positive. Safety as well as polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection and adverse COVID-19 outcomes (hospitalization, mechanical ventilation, death) after PrEP were recorded.

Table 1.

Baseline characteristics.

N26Age, mean (SD)54 (14)Sex, n (%)Female15 (57.7)Male39 (42.3)Diagnosis, n (%)ANCA-associated vasculitis10 (38.5)Rheumatoid arthritis6 (23.1)Immunoglobulin deficiency4 (15.4)Systemic sclerosis2 (7.7)Psoriatic arthritis1 (3.8)Systemic Lupus Erythematosus1 (3.8)Non-infectious Uveitis1 (3.8)Multiple sclerosis1 (3.8)IgG4-related disease1 (3.8)Autoinflammatory syndrome1 (3.8)CD20-depletionRituximab, n (%)22 (84.6)Other therapies, n (%)Methotrexate6 (23.1)Immunoglobulins4 (15.4)Mycophenolate1 (3.8)Infliximab1 (3.8)CD19+ lymphocytes/mm3, median (IQR)0 (0-9)Serum total IgG, median (IQR)894 (745-987)

SD, standard deviation; IQR, interquartile range; ANCA, anti-neutrophil cytoplasmic antibodies.

Results

We obtained 92 serum and 75 saliva samples from 26 participants at four consecutive timepoints (Figure 1). Anti-SARS-CoV-2 IgG titers were observed in serum and saliva samples of all participants from day 1 and throughout 30 days after PrEP independently of diagnosis, therapy, total IgG, and peripheral CD19+ B-cells. Serum IgG increased rapidly at day 1 and plateaued from day 14 to 30 (Figure 1A), reaching similar levels as seen in healthy subjects after full vaccination (1), while saliva IgG increased steadily from administration up to day 14 and plateaued at day 30 (Figure 1B). No side effects were reported. Five patients (19.2%) had a close contact with a SARS-CoV-2-infected person, after which all but one remained asymptomatic and with a negative PCR test. The patient who tested positive developed mild COVID-19 with fever and cough.

Figure 1.

Temporal pattern and distribution of serum (A) and salivary (B) anti-SARS-CoV-2 IgG levels.

Results from individual participants are represented as line (top) and scatter plots (bottom). Horizontal lines represent median values, the dotted horizontal line represents the positivity cutoff of 1.1.

** p =0.0082; *** p <0.001; **** p <0.0001. mAbs: monoclonal antibodies.

Conclusion

SARS-CoV-2 PrEP induces stable serum and salivary antibody levels in IMID patients who did not respond to COVID-19 vaccination, regardless of pre-existing clinical and serological features. In IMID, PrEP with casirivimab/imdevimab is safe and has the potential to prevent infection and severe COVID-19.

References

[1]Simon D, et al. Ann rheum dis. 2021;80:1312-1316.

[2]Fagni F et al, et al. Lancet Rheumatol. 2021; e724-e736.

[3]Flonza I, et al. MedRxiv. 2021. doi: 10.1101/2021.11.10.21265889

Disclosure of Interests

None declared

OP0279 CAR-T CELL TREATMENT OF REFRACTORY SYSTEMIC LUPUS ERYTHEMATOSUS- SAFETY AND PRELIMINARY EFFICACY DATA FROM THE FIRST FOUR PATIENTS

Background

While treatment of Systemic lupus erythematosus (SLE) has substantially improved, a subset of patients experiences severe progressive disease despite T- and B cell targeted therapy. Furthermore, drug-free remission and seroconversion is difficult to achieve in SLE to date

Objectives

To study the safety, tolerability, and preliminary efficacy of deep B cell depletion using autologous CD19 chimeric antigen receptor (CAR) T cells in patients with severe and treatment-refractory SLE

Methods

The CAR product was manufactured by CliniMACS Prodigy system (Miltenyi Biotec, Bergisch Gladbach, Germany). T-cells were enriched from the patients’ peripheral blood apheresis product and 1x108 cells were used as starting cell population. The cells were transfected with a lentiviral vector encoding an anti-CD19 CAR is composed of the FMC63 scFv, a CD8- derived hinge region, TNFRSF19-derived transmembrane domain, CD3ζ intracellular domain, and 4-1BB co-stimulatory domain (Miltenyi Biotec) and expanded for 12 days. After conditioning with cyclophosphamide/ fludarabine patients received 1x106 CD19-CAR-T cells/kg body weight as a single infusion. All SLE treatments with the exception of low dose prednisolone were stopped before CAR-T cell administration. After CAR-T cell treatment, also prednisolone was stopped. Tolerability was assessed by monitoring for Cytokine-release syndrome (CRS), immune-related effector cell neurotoxicity syndrome (ICANS) and infections. Preliminary efficacy was assessed by reaching a Lupus Low Disease Activity State (LLDAS), seroconversion in dsDNA antibodies and ANA and cessation of all SLE-specific treatments

Results

As of January 22, 2022, our 4 SLE patients had been treated with CD19 CAR-T cells with a follow up of 10 months (patient 1, female aged 20, SLEDAI-2K: 16), 7 months (patient 2, male aged 22; SLEDAI-2K:8), 2 months (patient 3, female aged 22; SLEDAI 2K: 6), and 1 month (patient 4; female aged 24; SLEDAI-2K: 6), respectively. All patients had active severe SLE with failure of standard treatment including pulsed steroids, hydroxychloroquine, mycophenolate, cyclophosphamide, intravenous immunoglobulins, rituximab and belimumab before CD19 CAR-T cell administration. All patients had active kidney disease. No infections occurred. All four patients experienced fever without proof of infectious disease (CRS °I); only one patient was treated with a single dose of tocilizumab. No ICANS and no CRS of other organs occurred. In vivo, CAR-T cells rapidly expanded to a maximum of 27,6% (day 9, patient 1), 41,2% (day 9, patient 2), 11,5% (day 9, patient 3) and 59,1% (day 9, patient 4) of total circulating T cells followed by a typical decline, with circulating CAR-T cells being continuously detectable during the next months. Expansion of CAR T cells preceded the complete and sustained depletion of circulating B cells. Patient 1 experienced sustained drug-free remission (SLEDAI-2K=0) with complete loss of ANA and dsDNA antibodies despite reappearance of B cells at 6 months. Patient 2 also experienced complete loss of ANA and dsDNA antibodies with B cells not yet returned. Low-level proteinuria remained most likely due to previously accrued damage in glomerular filter function (SLEDAI-2K: 2). Patient 3 and patient 4 had a shorter observation period to date but also achieved clinical remission (both SLEDAI-2K 0). All patients met LLDAS and could successfully stop all SLE-specific medication, including glucocorticoids. No SLE flare occurred so far.

Conclusion

Taken together, these data show that CD19 CAR T-cell therapy is well tolerated and may induce rapid remission of severe refractory SLE.

References

[1]Mougiakakos D et al., CD19-Targeted CAR T Cells in Refractory Systemic Lupus Erythematosus. N Engl J Med 2021;385:567-569.

Disclosure of Interests

None declared

POS0314 IDENTIFICATION OF CIRCULATING microRNA SIGNATURES IN PATIENTS WITH PSORIASIS WITH SUBCLINICAL JOINT DISEASE AND PATIENTS WITH PSORIATIC ARTHRITIS

Background

MicroRNAs (miRNAs) are small non-coding RNAs that control gene expression. Specific miRNA signatures have been identified in numerous diseases and may serve as potential biomarkers or new drug targets. Whether certain miRNA signatures are associated with psoriatic joint disease is currently unknown.

Objectives

To search for circulating miRNA signatures in psoriasis patients with subclinical joint disease and in patients with psoriatic arthritis (PsA).

Methods

Analyses of serum miRNA were done in three groups: (1) PsA patients fulfilling CASPAR criteria (PsA), (2) healthy controls without past or present signs of musculoskeletal disease (HC) and (3) psoriasis patients with musculoskeletal pain but no signs of clinical PsA (PsO). PsO and PsA patients received a hand MRI, which was scored according to PsAMRIS method. miRNA analysis of serum samples was performed stepwise using RT-qPCR (TAmiRNA Vienna). In the discovery phase 192 miRNA assays were analyzed in 48 samples (N=16 each group). In the validation phase 17 miRNAs (Table 1) were selected and analyzed in 94 samples (N=35 PsA, N=24 PsO, N=35 HC) based on results of discovery phase and previous reports in literature. Results presented as mean±SD/median (IQR), p-values are adjusted for multiple testing.

Table 1.miRNAsPsA vs HCPsO vs HCPsA vs PsODiscovery PhaseValidation PhaseDiscovery PhaseValidation PhaseDiscovery PhaseValidation Phasep-adj.p-adj.p-adj.p-adj.p-adj.p-adj.miR-93-5p0.0001<0.0010.0080.0050.0390.947miR-29b-3p0.0001<0.00010.0040.00020.1910.522miR-19b-3p0.0070.7080.00020.0200.1380.147miR-320d0.0010.619<0.00010.1350.9410.247miR-144-5p0.0030.0060.00010.1690.3500.444miR-188-5p0.0140.9900.9750.6470.0530.839let-7b-5p0.0250.00030.8890.0260.00030.472miR-92a-3p0.0430.0010.0050.773<0.00010.0005miR-324-3p0.1381.0000.2570.3920.8140.518miR-126-3p0.0140.1690.0130.5980.9220.654miR-223-3p0.1690.8720.6170.7460.5191.000miR-130a-3p0.0390.0350.5560.0090.0060.724miR-140-3p0.3500.0530.0020.0060.1180.683miR-155-5p0.1590.9950.1690.5490.9220.604miR-21-5p0.2970.9900.0030.1160.080.014miR-146a-5p0.7060.0040.8360.0380.9050.941miR-122-5p0.9600.7340.6950.7990.9050.444

Results

51 PsA patients (age: 51.3±11.4 years; 56.9% females), 40 PsO patients (51.4±11.0; 37.5%) and 50 HC (51.0±10.5; 52.9%) were assessed. Duration of psoriasis was 12(25) years in PsA and 15(22.8) years in PsO. Duration of joint disease in PsA was 1.0(4.8) year. 51% of PsA and 5% of PsO patients were on biological disease modifying drugs (bDMARDs), 49% vs. 10% on conventional DMARDs. The most frequent findings in the MRI were erosions (PsA 59.6%; PsO 40%) and synovitis (PsA 48.9%; PsO 42.5%). PsA patients had higher number of tenosynovitis compared to PsO (p=0.04). In discovery phase 51 miRNAs in PsO and 64 miRNAs in PsA were down- or upregulated compared to HC, with an overlap of 33 miRNAs changed in PsA and PsO (p<0.05). Results of the selected 17 miRNAs are presented in Table 1. The top candidates to differentiate PsA and HC were miR-29b-3p (AUC=0.87), miR-93-5p (AUC=0.83) and let-7b-5p (AUC=0.79). For differentiating PsO and HC, they were miR-29b-3p (AUC=0.82), miR-140-3p (AUC=0.81) and miR-19b-3p (AUC=0.80) and for PsO vs. PsA miR-92a-3p (AUC=0.87), let-7b-5p (AUC=0.72) and miR-21-5p (AUC=0.70). miR-93-5p was lower in patients with erosions (p=0.01). miR-92a-3p, let-7b-5p and miR-21-5p were lower in patients with tenosynovitis, bone proliferations or erosions.

Conclusion

PsA and PsO patients show miRNA signatures different from HC. Top candidate miRNAs differentially regulated in PsA and PsO have been previously reported in alteration of bone metabolism and osteoarthritis indicating the intimate association of psoriatic inflammation with bone and cartilage changes.

References

[1]Faustini F et al. Ann Rheum Dis 2016 Dec;75(12):2068-2074

[2]Hackl, M et al. Molecular and Cellular Endocrinology Elsevier Ireland Ltd 432, pp 83–95

[3]Feichtinger X et al. Sci Rep 2018 Mar 20;8(1):4867

Disclosure of Interests

None declared

AB1528-HPR FULL BODY HAPTIC BODYSUIT - AN INSTRUMENT TO MEASURE THE RANGE AND SPEED OF MOTION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS (axSpA) - PRELIMINARY RESULTS

Background

Movement of the spine is restricted in axial spondyloarthritis (axSpA) [1]. Spine function is usually assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI), which is based on a limited set of defined motions that are measured semiquantitatively in the spatial dimension but not in the temporal dimension. Sensor-based measurement of spine function in axSpA patients is in its infancy but may provide a deeper and more detailed understanding of the impact of axSpA on the impairment of spine function [2,3]. In theory, unbiased full body assessment of spine motion may open a new dimension in function analysis in axSpA.

Objectives

To test if a of a full-body based haptic capturing of spine motion is technically feasible and can pick up the measurements of BASMI items 1-5. Furthermore, we aimed to investigate whether such measurements are accurate and reproducible comparing to BASMI scores done by rheumatologists. Lastly, we sought to measure velocity of spine movements to allow spatiotemporal analysis of motion.

Methods

For full-body haptic assessment of spine motion a full-body haptic suit (Teslasuit; VR Electronics Ltd, London) was used that consists of a smart textile two-piece bodysuit that not only captures range and speed of motion but also provides biometric and haptic feedback. This device is currently tested in clinical trials (https://teslasuit.io/rehabilitation/) but has not been tested in rheumatic diseases such as axSpA [4]. Since there is no pre-defined technical solution for measuring BASMI, we used the integrated inertial measurement units (IMUs) of the suit (Figure 1a). The suit is recording the position and rotations of its IMUs and is transforming the raw data to position coordinates and joint angle of the bones. We implemented an algorithm that is accessing the sensor data and is calculating the BASMI measurements as well as velocity. Assessment were done in healthy individuals. BASMI was obtained 3 times by teslasuit followed by standard BASMI measurement by 2 independent rheumatologists. In addition, rotational movements with their maximum torso speed to evaluate angular velocity were performed (Figure 1b). Measurements were compared using absolute values and relative standard deviation (which is the standard deviation normalized by the mean).

Results

Five healthy individuals (all males, age: 27.6 ± 1.8 years, height: 178 ± 5 cm; weight 70.0 ± 8.0 kg) were assessed. Teslasuit measurements were well tolerated. Technically, we were able to calculate BASMI item 3 and 5, finger-to-floor distance and the velocity of the spine movement using the position data of hand, talus and upper back sensors (Figure 1a, b). Due to absence of sensors at the head and the required back areas, BASMI 1, 2, 4 could only partially be captured and require further programming, which is currently performed. Only marginal differences were detected regarding the relative standard deviations of measurements between teslasuit and rheumatologists (BASMI 3: rheumatologists 8,5%: suit 10%; BASMI 5: rheumatologists 5,4%: suit 4,9%) (Figure 1c). The speed of spinal motion could be measured with an average angular velocity of 172.2 degrees/sec over the entire rotation motion and an average maximum angular velocity of 417.2 degrees/sec.

Conclusion

This study shows that full-body haptic-suits can capture spinal motion including parts of the BASMI score. In addition, they allow to measure the speed of spinal movement, which might be an important and so far unrecognized factor to test the impact of axSpA on spinal function. Based on these results, full-body haptic-suits will be tested in axSpA patients in the future. Furthermore, technical solutions are currently developed to implement the remaining BASMI scores into the suit as well as connections from the suit to virtual reality devices for patients and doctors.

References

[1]Sieper, J. and D. Poddubnyy, Axial spondyloarthritis. Lancet 2017.

[2]Gardiner, P.V., et al., Rheumatology (Oxford) 2020.

[3]Kiefer, D., et al., S J Rheumatol 2022.

[4]Caserman, P. et al Sensors (Basel) 2021.

Acknowledgements

This work was (partly) funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – SFB 1483 – Project-ID 442419336, EmpkinS.

Disclosure of Interests

None declared

AB0130 DEREGULATION OF TFAM EXPRESSION PROMOTES MITOCHONDRIAL DAMAGE AND FIBROBLAST ACTIVATION IN SYSTEMIC SCLEROSIS

Background

Transcription factor A, mitochondrial (TFAM) is a transcription factor with essential function in the mitochondrial homeostasis, such as mitochondria biogenesis and mtDNA replication. Deregulation of TFAM expression has been linked to mitochondrial dysfunction. However, its role in the pathogenesis of rheumatic diseases has not been studied so far.

Objectives

We aimed to study the role of TFAM in the pathological fibroblast activation in SSc.

Methods

The expression of TFAM in SSc skin fibroblast and skin biopsies was analyzed by immunofluorescence and Western blot. The role of TFAM in fibroblast activation was investigated by TFAM knockdown in cultured fibroblasts. The role of TFAM in skin and lung fibrosis was further studied in mice with fibroblast specific knockout of TFAM in three independent mouse models: Bleomycin-induced skin and lung fibrosis as well as TβRIact-induced skin fibrosis.

Results

Dermal fibroblasts from SSc patients express lower level of TFAM in the skin and also after prolonged culture in vitro. The downregulation of TFAM impairs mitochondria homeostasis with decreased mitochondrial number, accumulation of damaged mitochondria with release of mtDNA, accumulation of deletions in mtDNA, metabolic reshaping with impaired OXPHOS and release of the mitokine GDF15. Long time, but not acute exposure of normal fibroblasts to TGFβ mimicked the finding in SSc fibroblasts with downregulation of TFAM and mitochondrial homeostasis disruption and damage. Knockdown TFAM of normal fibroblasts promotes fibroblast activation with increased myofibroblast differentiation and collagen release in a SMAD3 dependent manner. RNA sequencing demonstrated upregulation of pro-fibrotic genes and pathways. Mice with fibroblast-specific knockout of TFAM demonstrate are more sensitive to fibrotic stimuli such as bleomycin injection and TβRIact-overexpression and even demonstrate responses to NaCl instillation.

Conclusion

Alterations in the key mitochondrial transcription factor TFAM in response to prolonged activation of TGFβ and associated mitochondrial damage induce transcriptional programs that promote fibroblast activation and tissue fibrosis.

Disclosure of Interests

Xiang Zhou: None declared, Thuong Trinh-Minh: None declared, Cuong Tran Manh: None declared, Andreas Giessl: None declared, Christina Bergmann: None declared, Andrea-Hermina Györfi: None declared, Georg Schett: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB.,, Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB.

POS0883 BIOPHYSICAL PROPERTIES OF MONOCYTES INDICATE DISEASE ACTIVITY, SEVERITY OF FIBROTIC OR MICROVASCULAR MANIFESTATIONS AND THE RISK FOR PROGRESSION IN SYSTEMIC SCLEROSIS

Background

Dysregulated immune responses are major pathogenic players in systemic sclerosis (SSc). The biophysical properties (such as cell deformation, Young’s modulus (a measure of cell stiffness) and area) of circulating immune cells reflect their states and functions, as well as their pathological activation (1-3). Thus, biophysical phenotyping can provide access to a novel, mostly unexplored layer of information that is currently not accessible with standard techniques of cellular and molecular biology. Real-time fluorescence and deformability cytometry (RT-FDC) is a novel technique that enables biophysical phenotyping of individual immune cells at a high throughput, which allows its use in a clinical setting (3-5).

Objectives

Here, we hypothesized that biophysical properties of circulating immune cells in SSc and rheumatoid arthritis (RA) might specifically reflect their distinct pathophysiological activation in the respective disease, and might indicate clinical outcomes such as disease activity or severity. We thus performed RT-FDC-based biophysical phenotyping of circulating immune cells in SSc, RA and healthy controls.

Methods

63 SSc patients, 59 RA patients fulfilling the respective ACR/EULAR classification criteria and 18 age- and sex-matched healthy controls were included in the study between 05.2019 and 09.2021. Peripheral blood mononuclear cells (PBMC) were isolated and immunolabelled. PBMC subpopulations were identified in RT-FDC by standard gating strategies based on their marker expression and their deformation, Young’s modulus and area were determined.

Results

We identified SSc-specific changes (changes in SSc, but not in RA compared to healthy controls) in the biophysical properties of NK, NKT-like cells and monocyte subpopulations in SSc. Monocytes subpopulations had a higher deformation and cross-sectional area and/or more compact intra-donor distributions of these parameters in patients with active disease and with extensive skin or lung fibrosis in comparison with patients with stable disease and limited skin or lung fibrosis, respectively. All monocytes subsets were stiffer in patients with progression of skin of lung fibrosis at the time of measurement in comparison with a previous visit. The deformation and area of intermediate monocytes could also identify patients at risk for future progression of lung fibrosis. Changes in biophysical properties of monocytes can indicate, beyond fibrotic burden, clinical manifestations of microvascular damage such as active digital ulcers and pulmonary arterial hypertension.

Conclusion

We demonstrated that changes in the biophysical properties of monocytes subsets are associated with multiple clinical outcomes in SSc such as disease activity, severity of fibrotic or microvascular manifestations and risk of progression and might thus directly reflect SSc-specific pathologic immune cell activation. Our results thus provide first evidence that RT-FDC-based biophysical phenotyping of circulating immune cells may be a useful tool for clinical evaluation of SSc patients.

References

[1]Bashant KR, Toepfner N, Day CJ, Mehta NN, Kaplan MJ, Summers C, et al. The mechanics of myeloid cells. Biol Cell. 2020;112(4):103-12.

[2]Toepfner N, Herold C, Otto O, Rosendahl P, Jacobi A, Krater M, et al. Detection of human disease conditions by single-cell morpho-rheological phenotyping of blood. Elife. 2018;7.

[3]Kubankova M, Hohberger B, Hoffmanns J, Furst J, Herrmann M, Guck J, et al. Physical phenotype of blood cells is altered in COVID-19. Biophys J. 2021;120(14):2838-47.

[4]Otto O, Rosendahl P, Mietke A, Golfier S, Herold C, Klaue D, et al. Real-time deformability cytometry: on-the-fly cell mechanical phenotyping. Nat Methods. 2015;12(3):199-202, 4 p following

[5]Rosendahl P, Plak K, Jacobi A, Kraeter M, Toepfner N, Otto O, et al. Real-time fluorescence and deformability cytometry. Nat Methods. 2018;15(5):355-8.

Disclosure of Interests

Alexandru-Emil Matei: None declared, Kubánková Markéta: None declared, Liyan Xu: None declared, Andrea-Hermina Györfi: None declared, Evgenia Boxberger: None declared, Despina Soteriou: None declared, Maria Papava: None declared, Julia Prater: None declared, Xuezhi Hong: None declared, Martin Kräter: None declared, Georg Schett: None declared, Jochen Guck: None declared, Jörg H.W. Distler Shareholder of: JHWD is stock owner of 4D Science., Consultant of: JHWD has consultancy relationships with Actelion, Active Biotech, Anamar, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB, Grant/research support from: JHWD has received research funding from Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB

POS0699 SIMILAR EFFICACY AND DRUG SURVIVAL RATES OF BARICITINIB MONOTHERAPY AND BARICITINIB/METHOTREXATE COMBINATION THERAPY IN REAL-LIFE TREATMENT OF RHEUMATOID ARTHRITIS - RESULTS FROM A PROSPECTIVE COHORT OF BARICITINIB-TREATED PATIENTS

Background

In clinical trials, baricitinib (BARI), in combination with methotrexate (MTX), demonstrated efficacy in patients with rheumatoid arthritis (RA) who have not responded adequately to conventional (cs)or biologic (b) DMARDs [1]. Since MTX is often not tolerated very well [2], BARI monotherapy may be preferable over BARI/MTX combination in some patients with RA. Therefore, real-life data on BARI mono- vs. combination therapy are needed to support such decisions.

Objectives

The aim of our study was to evaluate the efficacy of BARI as mono- or combination therapy in a prospective, open label cohort of RA patients failing previous cs/bDMARD therapy.

Methods

Patients with active RA (DAS28-ESR >3.2), fulfilling the ACR/EULAR 2010 classification criteria and failing previous cs/bDMARD therapy were included. All patients received BARI either as monotherapy or in combination with MTX based on the judgement of the treating physician. Demographics, medical history, disease activity parameters such as 66/68 TJC/SJC, composite scores such as DAS28-ESR, HAQ-DI, as well as medication were prospectively recorded every 3 months according to a pre-defined protocol. Informed consent and ethics approval (19_18 B) were obtained. To evaluate clinical efficacy, DA28 ESR responses was recorded at respective visit dates (until week 96). We estimated least-square mean DAS-28 scores over time using linear mixed effects models including time-group interactions. Kaplan-Meier method was used to estimate baricitinib survival and probability of remission over time.

Results

139 patients (98 women/41 men; aged 58.4 (12.8) years; mean disease duration of 9.7 years) were included between 4/2017-10/2021. Of these, 46 patients received a combination of BARI with MTX (BARI/MTX) and 93 patients BARI monotherapy. Baseline demographic and disease-specific characteristic were comparable between BARI/MTX and BARI patients (Table 1). Median follow up was 53.1 weeks (IQR 23.0-109.3). Decrease in DAS28-ESR showed a similar dynamics in BARI/MTX (baseline DAS28-ESR: 4.2+/-1.3; 48 weeks: 2.9 (95%CI 2.6 to 3.2)) and BARI (4.3+/-1.3; 48 weeks: 3.0 (95%CI 2.8 to 3.3)) with numerical but no significant differences (Figure 1a). 62% (95%CI 40 to 76%) patients in the BARI/MTX group and 51% (95%CI: 37 to 61%) patients in the BARI attained DAS28ESR remission after 48 weeks. Drug survival was comparable among BARI/MTX and BARI patients. (69 vs.67% at 1 year and 62 vs 56% at 2 years) (Figure 1b).

Conclusion

These data show that BARI monotherapy is efficacious in real life treatment in RA patients with insufficient response to MTX. Clinical efficacy and drug survival is comparable between BARI monotherapy and BARI/MTX combo in a real-life setting.

References

[1]Genovese, M.C., et al., Baricitinib in Patients with Refractory Rheumatoid Arthritis. N Engl J Med, 2016.

[2]Michaud, K., et al., Real-World Adherence to Oral Methotrexate Measured Electronically in Patients With Established Rheumatoid Arthritis. ACR Open Rheumatol, 2019

Acknowledgements

The analysis of the data of this study is partially financially supported by Elli Lilly.

Disclosure of Interests

None declared

POS1340 BASELINE CLINICAL DISEASE ACTIVITY IS NOT CRITICAL FOR PREDICTING REMISSION OF ADULTS ONSET STILL´S DISEASE

Background

The clinical course of adult-onset Still’s disease (AoSD) is highly variable, ranging from subtle constitutional symptoms to life-threatening complications such as macrophage activation syndrome. Therefore, it is of interest whether baseline disease activity in AoSD predicts the clinical course, i.e. clinical and serological remission.

Objectives

The aim of this study was to compare whether two instruments to measure AoSD disease activity, Pouchot-Score and Still-Activity-Score (SAS), at baseline predict later remission of disease. We also assessed whether serum levels of calprotectin (S100A8/A9) are associated with clinical disease activity as measured by SAS at follow up.

Methods

AoSD was diagnosed according to the Yamaguchi criteria. In all patients Pouchot-Score and Still-Activity Score (SAS) were assessed at baseline and SAS score also at follow-up. Clinical remission was defined as absence of all AoSD symptoms (i.e. fever and arthralgia), while serological remission was defined as normalization of Ferritin, IL-18 and S100A8/A9 (calprotectin) levels. To investigate the prediction accuracy of the baseline Pouchot-Score and SAS for clinical and serological remission, a calculation of the areas under the receiver operating characteristic (ROC) curves was performed.

Results

42 AoSD patients (19 males/23 females; mean+/-SD age:41+/-17 years) were assessed. Baseline Pouchot-Score was 5.3 +/- 1.6, baseline SAS was 5.7 +/- 1.0. With treatment of AoSD, clinical disease activity decreased reaching a mean SAS of 2.2 +/- 1.8 after a mean follow up time of 48 +/- 90 months. Glucocorticoids were used by 33%, methotrexate by 21%, IL-1 inhibitors by 33% and IL-6 inhibitors by 29% of the patients. 62% (N=26) of the 42 patients obtained clinical remission and 36% (N=15) serological remission. Neither Pouchot-Score (0.57) nor SAS (0.51) at baseline predicted clinical remission of AoSD. Furthermore, also serological remission was not predicted by baseline SAS (0.62) or Pouchot-Score (0.56) (Figure 1). With respect to activity of AoSD during treatment serum calprotectin levels were closely associated with SAS disease activity (r = 0.54, p < 0.0003) (Figure 2).

Conclusion

Baseline AoSD disease activity as measured by Pouchot-Score and SAS does not predict clinical or serological remission. Serum calprotectin level is closely related to AoSD disease activity during the treatment phase.

Figure 1.

ROC for baseline SAS and Pouchot-Score and clinical remission

Figure 2.

Association between S100A8/A9 protein measured by the ELISA method and disease activity by the SAS at follow-up

Acknowledgements

The research project was supported by SOBI and Novartis.

Disclosure of Interests

Jennifer Groetsch: None declared, Koray Tascilar: None declared, Georg Schett: None declared, Dirk Foell: None declared, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Sobi, Novartis

OP0292 CLASSIFICATION OF PSORIATIC ARTHRITIS, SERONEGATIVE RHEUMATOID ARTHRITIS, AND SEROPOSITIVE RHEUMATOID ARTHRITIS USING DEEP LEARNING ON MAGNETIC RESONANCE IMAGING

Background

While MRI evaluation of joints has been primarily used to quantify inflammation at a cross-sectional and longitudinal level, less is known about the potential of MRI in distinguishing different patterns of inflammation in the various forms of arthritis.

Objectives

To evaluate (i) whether deep learning using neural networks can be trained to distinguish between seropositive rheumatoid arthritis (RA+), seronegative RA (RA-), and psoriatic arthritis (PsA) based on structural inflammatory patterns on hand magnetic resonance imaging and (ii) to assess if psoriasis patients with subclinical inflammation fit into such patterns.

Methods

ResNet 3D [1] neural networks were trained to distinguish (i) RA+ vs. PsA, (ii) RA- vs. PsA and (iii) RA+ vs. RA- with respect to hand MRI data. Diagnosis of patients was determined using the following guidelines: ACR/EULAR 2010 [2] for RA and CASPAR [3] for PsA. Results from T1 coronal, T2 coronal, T1 coronal and axial fat suppressed contrast-enhanced (CE) and T2 fat suppressed axial sequences were used. The performance of such trained networks was analyzed by the area-under-the-receiver-operating-characteristic curve (AUROC) with and without imputation of demographic and clinical parameters (Figure 1A). Additionally, the trained networks were applied to psoriasis patients without clinical signs of PsA.

Figure 1.

(A) Neural network combining MR sequences with optional additional clinical data. The prediction for a single case is formed by averaging the prediction of all sequences and the clinical data. (B) Plot of the AUROC for increasing percentages (0.6 – 60%) of training data for the differentiation between RA+ and PsA by the neural network. The light blue area around the dark blue mean indicates the uncertainty measured using a 5-fold cross-validation.

Results

MRI scans from 649 patients (135 RA-, 190 RA+, 177 PsA, 147 psoriasis) were included (Table 1). The AUROC for differentiation between disease entities was 75% (SD 3%) for RA+ vs. PsA, 74% (SD 8%) for RA- vs. PsA, and 67% (6%) for RA+ vs. RA-. All MRI sequences were relevant for classification, however, when deleting CE sequences, the loss of performance was only marginal. The addition of patient-specific data to the networks did not provide significant improvements. Increasing amounts of training data demonstrated improved performance of the networks (Figure 1B). Psoriasis patients were mostly assigned to PsA by the neural networks, suggesting that PsA-like MRI pattern may be present early in the course of psoriatic disease.

Table 1.

Overview of demographic and clinical information.

RA+RA-PsAPsoriasisTotal Number (N)649Number (N)190135177147Age (years), mean±SD56.9±12.660.5±10.356.3±12.049.6±13.8Sex (female/male)126/6493/4292/8571/76BMI (kg/m2), mean±SD26.6±10.527.6 ±9.329.1±11.326.7±6.9Disease duration (years), mean±SD2.6±4.91.3±2.30.8±2.34.2±5.1DAS28, mean±SD3.3±1.33.4±1.23.2±1.3-CRP (mg/L), mean±SD0.9±2.50.7±1.20.5±0.80.5±1.3HAQ, mean±SD0.8±0.60.9±0.80.6±0.60.3±0.4MedicationbDMARD88.46%83.87%81.32%35.01%csDMARD89.52%88.89%80.54%12.28%

Conclusion

Deep learning can be successfully applied to differentiate MRI inflammatory patterns related to RA+, RA-, and PsA. Early changes in psoriasis patients can be recognized by neural networks and are characterized by a pattern that allowed the networks to classify them as PsA.

References

[1]Kensho Hara, Hirokatsu Kataoka, and Yutaka Satoh 2018. Can Spatiotemporal 3D CNNs Retrace the History of 2D CNNs and ImageNet? In Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition (CVPR) (pp. 6546–6555).

[2]Aletaha D, Neogi T et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 Sep;62(9):2569-81.

[3]Helliwell PS, Taylor WJ. Classification and diagnostic criteria for psoriatic arthritis. Annals of the Rheumatic Diseases 2005;64:ii3-ii8.

Acknowledgements

The study was supported by the Deutsche Forschungsgemeinschaft (DFG-FOR2886 PANDORA and the CRC1181 Checkpoints for Resolution of Inflammation). Additional funding was received by the Bundesministerium für Bildung und Forschung (BMBF; project MASCARA), the ERC Synergy grant 4D Nanoscope, the IMI funded projects HIPPOCRATES and RTCure, the Emerging Fields Initiative MIRACLE of the Friedrich-Alexander-Universität Erlangen-Nürnberg and the Else Kröner-Memorial Scholarship (DS, no. 2019_EKMS.27). Furthermore, infrastructural and hardware support was provided by the d.hip Digital Health Innovation Platform.

Disclosure of Interests

None declared

AB0385 BARICITINIB LEADS TO RAPID AND PERSISTENT RESOLUTION OF SYNOVITIS AS MEASURED BY HAND MRI IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS (RA) FAILING cs/bDMARD THERAPY

Background

RA is characterized by synovial inflammation resulting in local bone loss [1]. Inhibitors of JAK/Stat pathways, such as baricitinib, demonstrated efficacy in reducing signs and symptoms of RA in clinical trials, however, little is known about their effects on synovitis and bone structure [2]. Preclinical and clinical observations suggest a positive effect JAK inhibitors on bone mass and microstructure, however no prospective, interventional clinical trial has been performed so far [3].

Objectives

The aim of this study is to evaluate the effect of baricitinib on local inflammation (synovitis and osteitis) and bone structure (erosions) in RA patients failing on cs/bDMARD therapy using hand MRI.

Methods

BAREBONE is a prospective, interventional, open label, monocentric single center study (EUDRACT 2018-001164-32 / NCT03701789) to assess the effect of baricitinib (4mg/day) on local MRI inflammation and structure in patients with active RA. Besides demographic and clinical characteristics, hand joint inflammation was assessed by magnetic resonance imaging (MRI) using a 1.5 Tesla scanner (Siemens Magnetom Aera T1w TSE cor, T2w TIRM cor, T2w TSE fat-sat trans, T1w TSE fat-sat trans + cor after KM;). at baseline, week 24 and week 48. Scans were assessed for synovitis, osteitis and bone erosions using the RAMRIS scoring system using two independent blinded readers (SK and SB). Intraclass correlation coefficients were calculated for total RAMRIS and synovitis, erosion and osteitis subscores and in a second step differences between cs and bDMARD failure were elaborated. Variables are summarized descriptively using means and 95% bootstrap confidence intervals for continuous outcomes and as number and percentages for categorical outcomes.

Results

Thirty- two RA patients were screened and 30 patients were included (age: 53.4 [SD 12.6] years; sex: f/m N 24/6; disease duration: 3 [IQR 2.0 – 8.0] years; biologic naïve/bDMARD failure 16/14). 27 patients completed the trial while MRI data was available for 24 patients at week 48. Demographics and clinical characteristics can be seen in Table 1. Total RAMRIS scores slightly decreased from 20.6 (95% CI 14.4 -27.8) at baseline (BL) to 18.3 (11.5 -26.5) at week 48. The synovitis subscore mainly contributed to total RAMRIS reduction by significantly improving from 5.3 (4.0 - 6.8) at BL to 2.7 (1.5 - 4.0) at week 48 with a score change of -2.9 (-4.0 to -1.8). At week 48, 12 patients (44.4%) had no signs of synovitis compared to only 3 patients at BL. In contrast, RAMRIS osteitis subscores only marginally decreased from 4.9 (2.2 - 8.4) at BL to 4.0 (1.9 - 6.7) at week 48. RAMRIS erosion score remained stable over the 48-week observation time. A significant difference in RAMRIS synovitis change for biologic naïve -3.8 (-5.2 to -2.6) vs biologic failure -1.0 (-2.2 to 0.4 could be observed at week 48).

With respect to clinical disease activity, DAS 28 score decreased from 4.8 (4.5 – 5.1) at BL to 2.9 (2.5 – 3.3) at week 48. Detailed results can be found in Table 1 and Figure 1. Intraclass coefficient (95%CI) for RAMRIS scoring was high for both readers 0.997 (0.994 to 0.998).

Table 1.

Demographics, DAS 28 ESR, RAMRIS total score and RAMRIS subset scores at baseline, week 24 and week 48 are shown as well as number of patients with improvement and resolution of synovitis.

BaselineWeek 24Week 48N303027AgeMean [SD]53.5 (12.6)Genderfemalen [%]24 (80.0)malen [%]6 (20.0)Disease duration, yearsMedian (IQR)3.0 (2.0-8.0)DAS-28 ESRMean [95%CI]4.8 (4.5 to 5.1)3.0 (2.7 to 3.3)2.7 (2.4 to 3.0)MRI availablen [%]30 (100.0)28 (93.3)24 (88.9)RAMRIS totalMean [95%CI]20.6 (14.4 to 27.6)18.4 (12.6 to 25.4)18.3 (11.5 to 26.5)RAMRIS total changeMean [95%CI]0.0 (0.0 to 0.0)-2.1 (-4.0 to -0.4)-3.9 (-7.2 to -0.5)RAMRIS synovitisMean [95%CI]5.3 (3.9 to 6.9)3.5 (2.2 to 4.9)2.7 (1.5 to 4.0)RAMRIS synovitis changeMean [95%CI]0.0 (0.0 to 0.0)-1.8 (-2.5 to -1.0)-2.9 (-4.0 to -1.8)RAMRIS synovitis improvedpatients n [%]10 (33.3)13 (48.1)RAMRIS synovitis resolvedpatients n [%]10 (33.3)12 (44.4)RAMRIS osteitisMean [95%CI]4.9 (2.2 to 8.4)3.7 (1.5 to 6.2)4.0 (1.9 to 6.7)RAMRIS osteitis changeMean [95%CI]0.0 (0.0 to 0.0)-0.9 (-3.1 to 1.0)-1.9 (-5.7 to 1.1)RAMRIS osteitis improvedpatients n [%]2 (6.7)4 (14.8)RAMRIS erosionMean [95%CI]10.4 (7.3 to 14.6)11.2 (7.7 to 15.0)11.6 (7.5 to 16.6)RAMRIS erosion changeMean [95%CI]0.0 (0.0 to 0.0)0.6 (0.1 to 1.2)0.9 (0.0 to 2.1)RAMRIS erosion worsenedpatients n [%]2 (6.7)3 (11.1)

Conclusion

Our study shows that baricitinib primarily reduces MRI synovitis in RA patients that have previously failed csDMARD and bDMARD therapy and particularly in patients who are biologic naïve.

References

[1]McInnes, I.B. and G. Schett, The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011.

[2]Genovese, M.C., et al., Baricitinib in Patients with Refractory Rheumatoid Arthritis. N Engl J Med, 2016

[3]Adam, S., et al., JAK inhibition increases bone mass in steady-state conditions and ameliorates pathological bone loss by stimulating osteoblast function. Sci Transl Med, 2020.

Acknowledgements

Lilly Deutschland GmbH funded the Barebone trial

Disclosure of Interests

Stephan Kemenes: None declared, Sara Bayat: None declared, David Simon Speakers bureau: Lilly Pharma Deutschland GmbH, Janssen, Consultant of: BMS, Pfizer, Sanofi, Abbvie, Janssen, Medac, Novartis,

Lilly Deutschland GmbH, GileaBMS, Pfizer, Sanofi, Abbvie, Janssen, Medac, Novartis,

Lilly Deutschland GmbH, Gilead, Amgen

d,

, Grant/research support from: Novartis, Gilead, Abbvie, Lilly, Gerhard Krönke Speakers bureau: GSK, Novartis, Consultant of: GSK, Lilly, Novartis, Janssen, Grant/research support from: Lilly, Novartis, BMS, Janssen, Daniela Bohr: None declared, Larissa Valor: None declared, Fabian Hartmann: None declared, Louis Schuster: None declared, Koray Tascilar Speakers bureau: Gilead speaker, Consultant of: UCB, Lilly, Georg Schett Speakers bureau: Janssen, Abbvie, BMS, Lilly, Novartis, Roche, AMGEN, Gilead, UCB, Consultant of: Lilly, Novartis, Abbvie, Grant/research support from: Chugai, Lilly, Novartis, Arnd Kleyer Speakers bureau: Lilly, Novartis, Abbvie, Consultant of: BMS, Pfizer, Sanofi, Abbvie, Janssen, Medac, Novartis,

Lilly Deutschland GmbH, Gilead, Amgen

, Grant/research support from: Novartis, Lilly Deutschland GmbH, Gilead

POS0344 O-GlcNAcylation ON NUP153 REGULATES THE EARLY STAGES OF OSTEOCLASTOGENESIS THROUGH MYC NUCLEAR TRANSLOCATION

Background

Bone homeostasis is maintained by the balance between bone formation and resorption. In inflammatory arthritis, such as rheumatoid arthritis (RA), the pro-inflammatory environment promotes osteoclast differentiation and skews this balance towards bone resorption, leading to destructive bone erosion and bone loss. O-GlcNAcylation is one of the most common post-translational modifications, which attaches a single N-acetylglucosamine (GlcNAc) molecular to the serine or threonine of the target protein. O-GlcNAcylation is controlled by the activities of a single pair of enzymes: OGT, which facilitates the transfer of GlcNAc onto proteins; OGA, which removes GlcNAc from proteins. The activity of O-GlcNAcylation has been reported to be involved in several cellular events, such as transcription, translation, intracellular trafficking, and differentiation. We previously showed that the dynamics of O-GlcNAcylation are essential for osteoclast differentiation. TNF-α, a key pro-inflammatory factor in RA, intensified the O-GlcNAcylation dynamics. Inhibition of OGT arrests osteoclast precursors at early stages, whereas OGA inhibition blocks osteoclast maturation. However, the molecular mechanism of these regulations remains unclear.

Objectives

We aimed to identify the O-GlcNAcylation targets in osteoclast precursors in a pro-inflammatory milieu and to decipher the molecular mechanism of O-GlcNAcylation mediated regulation of osteoclastogenesis.

Methods

We first identify the O-GlcNAc-dependent molecular pathways in osteoclast precursors with pharmacological OGT and OGA inhibition by RNA sequencing. Then, we identified the O-GlcNAcylated proteins by mass spectrometry-based proteomics analysis and confirmed by immunoprecipitation. We found the potential molecular mechanism by combining the data from transcriptomics and proteomics. The proposed mechanism was further validated through siRNA-mediated knockdown and high-content screening analysis.

Results

Our transcriptomics data showed that OGT inhibition arrested osteoclast differentiation at early stages through interfering the cytokine signaling and metabolic adaption. The upstream analysis proposed MYC as the most potent regulator for the transcriptomic profile under OGT inhibition. Recent studies proposed MYC as a master regulator for metabolic reprograming during osteoclast differentiation. However, O-GlcNAcylation of MYC was not detected by mass spectrometry, suggesting indirect effects of O-GlcNAcylation on MYC signaling in osteoclast precursors. We detected upregulated levels of O-GlcNAc on NUP153, MTDH, RBM27, IFI207 upon RANKL+TNFα stimulation. An integrated analysis of transcriptomic and proteomic data by Ingenuity Pathway Analysis indicated that NUP153 might regulate the most DEGs among all the identified targets and indicated potential of NUP153 to regulate nuclear shuttling of MYC. Subcellular fractionation and confocal microscopy showed enhanced MYC nuclear translocation upon RANKL+TNFα stimulation, which could be blocked by NUP153 knockdown or OGT inhibition. Functionally, knockdown of NUP153 arrested cells at similar stages to OGT inhibition and reduced bone resorption ability. Together, these results suggest a model, in which O-GlcNAcylation regulates the shuttling activity of the nuclear pore component NUP153 to control the access of MYC to the nucleus during osteoclast differentiation.

Conclusion

Our results indicated that OGT inhibition arrests osteoclastogenesis at early stages through hampering MYC-dependent metabolic adaption. NUP153 was proposed as the most potent O-GlcNAcylation target by multi-omics data integration. NUP153-mediated MYC nuclear trafficking is required for osteoclast differentiation. These findings reveal the molecular mechanism of O-GlcNAcylation-dependent osteoclastogenesis and provide therapeutic insights on targeting O-GlcNAcylation in pathologic bone resorption.

Disclosure of Interests

Yi-Nan Li: None declared, Chih-Wei Chen: None declared, Thuong Trinh-Minh: None declared, ZHU Honglin: None declared, Philipp Hubel: None declared, Jens Pfannstiel: None declared, Georg Schett: None declared, Jörg H.W. Distler Shareholder of: 4D Science, Speakers bureau: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB, Employee of: FibroCure

OP0076 L-ARGININE REPROGRAMS OSTEOCLAST PURINE METABOLISM AMELIORATING BONE LOSS IN RHEUMATOID ARTHRITIS

Background

Bone erosion is a clinical feature of rheumatoid arthritis related to disease severity and poor functional prognosis. Excessive osteoclast differentiation and insufficient osteoblast function are the main reasons for the erosive process in RA. Our previous investigation indicated that L-arginine supplementation not only diminished arthritic inflammation in the serum-induced arthritis (K/BxN) model but also decreased inflammatory joints osteoclast numbers (1).

Objectives

In the present study, we aim to investigate the metabolic action of L-arginine supplementation in RA, especially on periarticular bone erosion and systemic bone loss. We plan to depict the metabolic features of TNFα induced inflammatory osteoclasts after in vitro L-arginine supplementation.

Methods

Three murine arthritis models (serum-induced arthritis (K/BxN) model, collagen-induced arthritis model, and hTNFtg mice model) were analysed in this study. L-arginine was supplemented within the drinking water after the onset of arthritis. Bone parameters for axial skeleton (spine) and peripheral skeleton (tibia) from the respective group were quantified by μCT. HE and TRAP staining were performed to address further the erosion area and osteoclast numbers in periarticular sites. In vitro osteoclast differentiation was conducted with or without L-arginine treatment, in the presence or not of TNFα activation. Seahorse and SCENITH analyses were adopted to delineate the metabolic features. JC-1 staining and transmission electron microscopy (TEM) were used to depict the mitochondria metabolism. RNA-seq and mass spectrometry (MS) were performed to investigate the underlying molecular mechanism.

Results

Inflammation was diminished in all three arthritis models after L-arginine supplementation with a significant reduction in arthritic score. Moreover, an amelioration of periarticular bone erosion, systemic bone loss, and decreased osteoclast numbers in periarticular sites were observed in arthritic mice after L-arginine treatment. L-arginine also inhibited osteoclastogenesis in vitro, particularly under TNFα activation. Seahorse and SCENITH analyses indicated TNFα promoted glycolysis while blocking mitochondria-driven oxidative phosphorylations (OXPHOS) in pre-osteoclasts. Meanwhile, JC-1 staining and TEM images also showed that TNFα decreased mitochondria membrane potential and prompted damage of mitochondria. Surprisingly, L-arginine rescued the TNFα inhibition of OXPHOS while promoting ATP production.

RNA-seq and MS data confirmed the boost of OXPHOS after L-arginine treatment under TNFα activation. To interfere with OXPHOS, L-arginine inhibited cJun thus altered arginase-1 and arginase-2 expression. Moreover, the increased ATP in L-arginine treated cells facilitated purine metabolism, especially the production of inosine and hypoxanthine, contributing to the inhibition of osteoclastogenesis. Increasing Adenosine deaminase (ADA) is essential for the production of inosine and hypoxanthine due to the decreased inhibitory regulation of the transcription factor c-Jun.

Conclusion

These data strongly demonstrated that L-arginine ameliorates bone erosion in RA through metabolic reprogramming and perturbation of purine metabolism in osteoclasts. L-arginine might therefore benefit RA therapy by reducing joint inflammation and also ameliorating bone destruction.

References

[1]Hannemann, Nicole, et al. “Transcription factor Fra-1 targets arginase-1 to enhance macrophage-mediated inflammation in arthritis.” The Journal of clinical investigation 129.7 (2019): 2669-2684.

Disclosure of Interests

Shan Cao: None declared, Rui Song: None declared, Xianyi Meng: None declared, Katerina Kachler: None declared, Maximilian Fuchs: None declared, Xinyu Meng: None declared, Yixuan Li: None declared, Verena Taudte: None declared, Meik Kunz: None declared, Ursula Schloetzer-Schrehardt: None declared, Ulrike Schleicher: None declared, Xiaoxiang Chen Speakers bureau: AbbVie, Roche and Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Aline Bozec: None declared.

POS0409 INTESTINAL HIF1α EXPRESSION PROTECTS AGAINST EPITHELIAL CELL DEATH IN ARTHRITIS

Background

While a so-called gut-joint axis is supported by many clinical observations, the current knowledge on such axis is mostly confined to descriptive and correlative data, e.g. showing the microbiota changes are associated with arthritis. In contrast, mechanistic data on how molecular changes in the intestinal epithelium influence the development of arthritis are scarce.

Objectives

To investigate, whether the mucosal barrier in the intestine dependent of the epithelial cell survival maintenance, influences the development of arthritis.

Methods

Intestinal hypoxia inducible factor (HIF)-1α expression was assessed before, at onset and during experimental arthritis and human rheumatoid arthritis (RA). Intestinal epithelial cell-specific HIF1α conditional knock-out mice were generated (HIF1αΔIEC) and subjected to collagen-induced arthritis (CIA). Clinical and histological courses of arthritis were recorded, and T and B cell subsets were analyzed in the gut and secondary lymphatic organs, and intestinal epithelial cells were subjected to molecular mRNA sequencing in HIF1αΔIEC and littermate control mice. Furthermore, pharmacologic HIF1α stabilization by PHD inhibitor was used for the treatment of arthritis.

Results

Intestinal HIF1α expression peaked at onset and remained high in experimental arthritis and RA. Conditionally deletion of HIF1α in gut epithelial cells strongly exacerbate arthritis and was associated with increased gut epithelial cell death, intestinal and lymphatic Th1 and Th17 activation. Mechanistically, HIF1α inhibits the transcription of necroptotic and apoptotic markers, which leads to a defect in the intestinal barrier integrity. Furthermore, treatment with HIF1α stabilization reinforced the gut epithelial cell survival and inhibited arthritis.

Conclusion

These findings show that the HIF1α regulating epithelial cells survival is critical for the breakdown of the intestinal barrier function in arthritis highlighting the functional link between intestinal homeostasis and arthritis.

Disclosure of Interests

None declared.

OP0256 FIBROBLAST ACTIVATION PROTEIN (FAP) PET-CT IMAGING ALLOWS TO DEPICT INFLAMMATORY JOINT REMODELING IN PATIENTS WITH PSORIATIC ARTHRITIS

Background

Psoriatic arthritis (PsA) is characterized by substantial mesenchymal tissue activation in the context of inflammation leading to structural damage. Measuring mesenchymal tissue activation in humans in vivo is challenging but may represent a possibility to detect regions at risk for structural damage. Recently, theranostic ligands have been developed that selectively bind Fibroblast Activation Protein (FAP) and allow recognition of activated mesenchymal cells in vivo. Accumulation of such FAP-based tracers can be visualized by positron-emission tomography (PET) (1).

Objectives

In this study, we analyzed whether FAP tracer-based PET-CT can detect mesenchymal tissue activation in patients with PsA and whether this signal is associated with joint damage.

Methods

120 consecutive PsA patients fulfilling CASPAR criteria and 100 healthy controls without musculoskeletal disease received full-body PET-CT investigation using a 68Ga-labelled FAP inhibitor (68Ga-FAPI-04) tracer, specifically binding FAP. For all visually identified pathological tracer-positive lesions the mean and maximum standardized uptake value (SUV mean, SUV max) was assessed. Tracer uptake was quantified in peripheral and axial joints and correlated to various composite scores of PsA. Hand MRI scans were performed in parallel to assess inflammation and structural lesions. Follow-up 68Ga-FAPI-04 PET-CT scans were obtained in a subset of patients treated with cytokine inhibitors (follow-up between 3-6 months) to assess joint damage over time. In addition, FAP related tissue responses in synovial biopsy samples were evaluated on a molecular level by high-resolution slide RNA-sequencing in a subset of patients.

Results

68Ga-FAPI-04 accumulated at synovial and enthesial sites in patients with PsA compared to healthy controls (p < 0.0001). Active pain in peripheral as well as axial joints as measured on a visual analogue scale highly correlated with an increased 68Ga-FAPI-04 uptake (peripheral pain: R = 0.718, p < 0.0001; back pain: R = 0.875, p < 0.0001). Disease Activity in PSoriatic Arthritis (DAPSA) score also correlated with the SUV mean and SUV max of FAP expression (R = 0.774; p = 0.0001). Increased 68Ga-FAPI-04 uptake at baseline was associated with progression of joint damage 3-6 months later as assessed by PsAMRIS score (R = 0.778, p < 0.0001). Treatment with cytokine inhibitors partially reduced FAP expression which was associated with arrest of joint damage in MRI. In contrast, persistent FAP expression was associated with a rapid progression of joint damage in MRI. Molecular analysis of synovial biopsy samples from FAP+ lesions revealed interactions between FAP+ fibroblasts and T cells, innate lymphoid cells and macrophages, which was correlated to a strong upregulation of NF-kB related pathways fostering cartilage and bone destruction.

Conclusion

Our study presents the first in-human evidence that fibroblast activation correlates with disease progression and joint damage in patients with PsA. FAP related imaging might therefore improve the risk assessment of rapidly emerging joint damage in PsA and open new options of treat-to-target strategies in PsA.

References

[1]Schmidkonz C, Rauber S, Atzinger A, Agarwal R, Gotz TI, Soare A, Cordes M, Prante O, Bergmann C, Kleyer A, Agaimy A, Kuwert T, Schett G, Ramming A, Disentangling inflammatory from fibrotic disease activity by fibroblast activation protein imaging. Ann. Rheum. Dis. 79 (2020), 1485-1491.

Disclosure of Interests

None declared

POS1078 COMPARISON OF PATIENTS WITH AXIAL PsA AND PATIENTS WITH axSpA AND CONCOMITANT PSORIASIS

Background

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the peripheral and axial musculoskeletal system as well as skin and nails. Diagnostic criteria of axial PsA (axPsA) are not well defined. Treatment strategy is mostly based on evidence generated for axial spondyloarthritis (axSpA), as only rare clinical trial data for axPsA exist. However, it is still unclear whether axSpA with concomitant psoriasis (axSpA/pso) is the same as axPsA.

Objectives

To compare PsA patients with axial manifestations with axSpA patients with concomitant psoriasis.

Methods

RABBIT-SpA is a prospective longitudinal cohort study including PsA and axSpA patients enrolled at start of a new conventional treatment or b/tsDMARD treatment. Two definitions of axPsA were used:

Clinical definition: documentation of axial manifestation as diagnosed by a rheumatologist

Radiographic definition: presence of sacroiliitis according to modified NY criteria (mNYc).

axSpA patients were stratified into axPsA/pso (with psoriasis either in patient history or present) and axSpA.

Results

Psoriasis was documented in 182/1407 axSpA patients (13%). Of 1355 PsA patients, 295 (22%) fulfilled the clinical definition of axPsA. Using the radiographic definition, 127 (9%) PsA patients fulfilled mNYc, 230 (17%) did not fulfil mNYc and 998 (74%) did not undergo radiographic evaluation.

AxSpA/pso patients differed from axPsA regardless of the definition (Table 1). axPsA patients were older, less often HLA-B27 positive, and peripheral manifestations were much more often present in axPsA than in axSpA/pso. Uveitis and inflammatory bowel disease were more common in axSpA/pso.

Table 1.

Baseline characteristics of axSpA/pso patients and clinical resp. radiographic defined axPsA.

axSpA/psoaxPsA/clinaxPsA/radN182295127female gender, n (%)80 (44)178 (60.3)80 (63)age, mean (SD)47 (12.8)51.1 (11.3)51.6 (11.4)HLA-B27 positive, n (%)106 (67.1)44 (22.7)28 (32.9)CRP mg/l, mean (SD)8.7 (14.6)7.1 (11.8)6.9 (11.5)CRP ≥5 mg/l, n (%)70 (42.4)106 (40)50 (45.9)uveitis ever, n (%)26 (14.3)10 (3.4)7 (5.5)IBD ever, n (%)13 (7.1)14 (4.7)7 (5.5)≥3 comorbidities, n (%)48 (26.4)117 (39.7)48 (37.8)peripheral manifestations, n (%)65 (36.3)251 (85.1)109 (85.8)enthesitis, n (%)29 (16.2)77 (26.4)32 (25.4)number of sites with enthesitis, mean (SD)0.5 (1.6)0.9 (2.2)0.9 (1.9)affected joints, n (%)53 (29.6)234 (80.1)102 (80.3)number of affected joints, mean (SD)1.4 (3.7)6.8 (8.4)5 (5.9)physician global disease activity, mean (SD)5.6 (2.1)5.6 (1.9)5.6 (2)patient global disease activity, mean (SD)5.4 (2.6)5.9 (2.3)5.8 (2.2)patient pain, mean (SD)5.5 (2.6)5.7 (2.3)5.7 (2.2)sakroiliitis, n (%)124 (84.4)97 (56.1)127 (100)clinical axial definition, n (%)n.d.295 (100)97 (76.4)

In contrast, disease activity measured by physician global as well as patient global, and patient pain were similar in axSpA/pso and axPsA.

Conclusion

Regardless whether clinical or radiographic definitions of axPsA were used, differences to axSpA/pso patients were identified. These data indicate a need for a specific diagnostic, and a potentially more targeted treatment approach for axPsA.

Disclosure of Interests

Anne Regierer Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Weiß Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Xenofon Baraliakos: None declared, Frank Behrens: None declared, Denis Poddubnyy: None declared, Georg Schett: None declared, Hanns-Martin Lorenz: None declared, Matthias Worsch: None declared, Anja Strangfeld Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.

POS0517 IgA ACPA ARE ASSOCIATED WITH PROGRESSION TO RHEUMATOID ARTHRITIS IN INDIVIDUALS AT-RISK AND DECLINE IN LEVELS AROUND THE DISEASE ONSET

Background

Anti-citrullinated protein antibodies (ACPA) can precede the diagnosis of rheumatoid arthritis (RA) up to a decade. However, while some ACPA-positive individuals rapidly develop the disease, a considerable proportion are not progressing to RA, and the events triggering the disease outbreak are still poorly understood. While a lot is known about ACPA of IgG class, the role of IgA ACPA is still not defined.

Objectives

We aimed to look into IgA ACPA isotypes in individuals at-risk for RA and their role in RA development.

Methods

IgA1 and IgA2 ACPA were measured cross-sectionally in 30 seropositive (IgG ACPA-positive) RA patients, 29 seronegative RA patients, 63 individuals at-risk for RA (positive for IgG ACPA and/or anti-modified citrullinated vimentin antibodies and with joint complaints) and 32 healthy controls. In addition, IgA ACPA levels were compared in 24 RA at-risk individuals who developed RA during a follow-up of 14 months and in 21 individuals who did not. Furthermore, longitudinal measurements of IgA1 and IgA2 ACPA levels 1-28 months prior to, at and 1-18 months after the onset of RA were performed in 14 at-risk individuals and in 9 individuals from a confirmation retrospective cohort of RA patients from the Medical University of Vienna. Cut-offs were set based on the comparison of IgA ACPA levels in RA patients versus healthy controls. Rather than prioritizing specificity, as is done for diagnostic tests, we aimed to define reliably detectable amounts of IgA ACPA, with both sensitivity and specificity not under 70% – 3 µg/ml for total IgA ACPA; 2.46 µg/ml for IgA1 and 0.6 µg/ml for IgA2 ACPA.

Results

Serum levels of both IgA ACPA subclasses were elevated in individuals at-risk, with no significant difference to patients with established IgG ACPA-positive RA. Interestingly, 41.4% of IgG ACPA-negative patients had detectable amounts of IgA ACPA. IgA1 ACPA, but not IgA2 ACPA levels were higher in individuals at-risk who developed RA in the next 14 months than in those who did not (4.54 vs. 2.05 µg/mL, p=0.03); and the percentage of those developing RA was higher in IgA1 ACPA-positive at-risk individuals (64.3% versus 35.3%). Interestingly, during the transition to RA, in the majority of IgA ACPA-positive individuals a decline in IgA1 ACPA levels at the time of RA diagnosis (-26%; p=0.085), as well as in the first months after the RA diagnosis (-38%; p=0.0002) was observed. This observation was confirmed in an independent cohort. IgA2 ACPA declined only after the diagnosis (33%; 10-64%; p=0.0237), and no significant change was observed for IgG ACPA.

Conclusion

Both IgA ACPA subclasses were elevated in individuals at-risk for RA. Positivity for IgA1 ACPA was associated with the progression to RA in the next 14 months. IgA1 ACPA levels declined in the months preceding the diagnosis of RA and in the months after the diagnosis, which might reflect pathophysiological events happening at the time of the disease outbreak.

Acknowledgements

We thank Holger Bank from Orgentec Deiagnostika, Mainz for the supply of CCP-coated plates.

Disclosure of Interests

Maria V Sokolova: None declared, Fabian Hartmann: None declared, Daniela Sieghart: None declared, Günter Steiner: None declared, Arnd Kleyer Speakers bureau: Novartis, Lilly, Consultant of: Lilly, Gilead, Novartis,Abbvie, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Ulrike Steffen (née Harre): None declared.

POS0450 TEMPORAL MIGRATION OF IMMUNE CELLS FROM PSORIATIC SKIN TO JOINTS INITIATING SYNOVIAL INFLAMMATION IN PSORIATIC ARTHRITIS

Background

Spreading of inflammation from skin to joint is a key question behind the pathogenesis of psoriatic arthritis (PsA). Psoriasis (PsO), being one of the most prevalent skin diseases, usually anticipates joint manifestations, suggesting spreading of skin to joint disease, which happens in about 30% of the patients with psoriasis.1 To date, it is still obscure why the inflammatory process in some patients with PsO remains restrained to the skin, whereas in other patients it extents to tendons and joints.

Objectives

Using a pre-clinical model of PsA, we aimed to unveil the skin-joint axis, i.e. the spreading of psoriatic inflammation from the skin to the joints.

Methods

KAEDE transgenic mice expressing a photo-convertible fluorescent reporter were used to assess cell trafficking from inflamed skin to other organs in the mouse model of IL-23 overexpression (IL-23OE) induced PsA. Psoriatic skin lesions were irradiated with UV light to trigger the photoswitch from KAEDEGREEN to KAEDERED. Migration to different organs was determined by flow cytometry. Imaging flow cytometry was used to characterize the type of cells migrating from the skin to the joints. Migrating cells were further characterized by single-cell RNA-sequencing (scRNAseq) and functional analyses.

Results

MRI imaging and histological evaluation of IL-23OE mice revealed skin inflammation preceding joint inflammation in both wild-type and KAEDE-transgenic mice. Specific leukocyte migration from the skin to the joints started shortly after the onset of skin inflammation and before onset of inflammation within the joints of KAEDE transgenic mice. No migration was observed in healthy control animals. Other organs such as spleen or lymph nodes showed no model-dependent migration. Imaging flow cytometry revealed that the cells migrating to the joints were predominantly CD45+ CD11b+ cells. ScRNAseq analysis of sorted KAEDERED cells from inflamed joints confirmed that approximately 80% of the migrating cells were macrophages. Differential gene expression and pathway analysis revealed an imbalance between pro- and anti-inflammatory macrophages in the joints of experimental psoriatic arthritis.

Conclusion

We describe IL-23-mediated migration of skin-derived macrophages from the skin to the joints during the onset of experimental psoriatic arthritis. This process may explain the spreading from psoriatic skin to joint disease as these cells foster the development by local cytokine production once arrived in the joints.

References

[1]Veale, D.J. & Fearon, U. The pathogenesis of psoriatic arthritis. Lancet391, 2273-2284 (2018).

Disclosure of Interests

None declared.

POS1545-HPR PATIENT SELF-SAMPLING IN RHEUMATOID ARTHRITIS: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL

Background

Rheumatoid arthritis (RA) requires early diagnosis and tight surveillance of disease activity. Patient self-sampling of blood for the analysis of autoantibodies and inflammation markers could facilitate the identification of patients at-risk for RA and improve tight disease monitoring [1].

Objectives

A randomized, controlled trial to evaluate the feasibility, acceptability and accuracy of an upper arm self-sampling device (UA) and finger prick-test (FP) to measure capillary blood from RA patients for C-reactive protein (CRP) levels and the presence of IgM rheumatoid factor (RF IgM) and anti-cyclic citrullinated protein antibodies (anti-CCP IgG).

Methods

50 RA patients were randomly assigned in a 1:1 ratio to self-collection of capillary blood via UA or FP. Venous blood sampling (VBS) was performed as gold standard in both groups to assess the concordance of CRP levels as well as RF IgM and CCP IgG. General acceptability and pain during sampling were measured and compared between UA, FP and VBS. The number of attempts for successful sampling, requests for assistance, volume and duration of sample collection were also assessed.

Results

49/50 (98%) patients were able to successfully collect capillary blood. Overall agreement between capillary and venous analyses for CRP (0.992), CCP IgG (0.984) and RF IgM (0.994) were good. In both groups 4/25 (16%) needed a second attempt and 8/25 (32%) in the UA and 7/25 (28%) in the FP group requested assistance. Mean pain scores for capillary self-sampling (1.7/10 ± 1.1 (UA) and 1.9/10 ± 1.9 (FP)) were lower on a numeric rating scale compared to venous blood collection (UA: 2.8/10 ± 1.7; FP: 2.1 ± 2.0). UA patients were more likely to promote the use of capillary blood sampling (net promoter score: +28% vs. -20% for FP) and were more willing to perform blood collection at home (60%) vs. 32% for FP).

Conclusion

This study shows that self-sampling is accurate, feasible and well accepted among patients. The implementation could allow tight remote monitoring of disease activity as well as identifying patients at-risk for RA and potentially other rheumatic diseases.

References:

[1]Knitza J, Knevel R, Raza K, Bruce T, Eimer E, Gehring I, et al. Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project. JMIR Mhealth Uhealth. 2020;8:e17507.

Acknowledgements

We thank all patients for their participation in this study. This study is part of the PhD thesis of the first author JK (AGEIS, Université Grenoble Alpes, Grenoble, France). We thank Josefine Born and Deniz Krämer for their help recruiting patients.

Disclosure of Interests

Johannes Knitza Grant/research support from: Thermo Fisher Scientific, Novartis, Koray Tascilar: None declared, Nicolas Vuillerme: None declared, Ekaterina Vogt Employee of: Thermo Fisher Scientific, Paul Matusewicz Employee of: Thermo Fisher Scientific, Giulia Corte: None declared, Louis Schuster: None declared, Timothée Aubourg: None declared, Gerlinde Bendzuck: None declared, Marianne Korinth: None declared, Corinna Elling-Audersch: None declared, Arnd Kleyer: None declared, Sebastian Boeltz: None declared, Axel Hueber: None declared, Gerhard Krönke: None declared, Georg Schett: None declared, David Simon: None declared

OP0293 PHOTOREALISTIC DEPICTION OF RHEUMATIC PATHOLOGIES BY CINEMATIC RENDERING FACILITATES DISEASE UNDERSTANDING OF PATIENTS WITH RHEUMATIC DISEASES

Background

Treatment success of a rheumatic disease crucially depends on whether a patient is sufficiently informed about the disease[1]. Visual methods are suitable for explaining diseases[2]. Cinematic rendering (CR) is a new method that allows to segment standard medical images into images that illustrate disease pathologies in a photorealistic way. As such, CR provides new opportunities to visualize diseases and but could therefore be a valuable tool for patients with rheumatic and musculoskeletal disease (RMD).[3]

Objectives

We questioned, if it is possible to apply CR on images from structural lesions of patients with rheumatoid arthritis (RA), Psoriatic Arthritis (PsA) and axial Spondyloarthritis (axSpA) and to test whether such images are helpful to patients with RMDs to understand their disease process. application in doctor-patient communication.

Methods

We selected conventional computed tomography (CT) and high-resolution peripheral CT (HR-pQCT) from patients with rheumatoid arthritis (RA), Psoriatic Arthritis (PsA) and axial Spondyloarthritis (axSpA) that showed typical changes of the respective disease. HR-pQCT measurements were performed in RA and PsA at the Rheumatology Department. CT Measurements of the spine in an axSpA patient was provided from AH. All images were segmented to CR images using a prototype software by the manufacturer Siemens Healthineers. In a prospective study on consecutive patients with RA, PsA, axSpA these images were used to explain the depicted pathognomonic pathologies and compared to conventional imaging in a structured doctor-patient interview. In the last step, patients filled in a quantitative questionnaire (Likert Scale 1-5) about their perspectives answering following questions: Did you understand your disease in the provided Cinematic Rendering images? Did you understand your disease better through the presentation using Cinematic Rendering images than with a normal X-ray image? Do you think it would be reasonable to use this type of Cinematic Rendering to improve patients’ understanding of their disease? Descriptive statistical methods were used.

Results

CR images of rheumatic diseases were successfully generated from above mentioned imaging data (CT, HR-pQCT). Bone erosions, osteophytes, enthesiophytes, osteoporosis and ankylosis of the spine could be visualized in photorealistic detail. Figure 1 shows examples of a images of a patient with RA and axSpA with typical bone changes.

65 patients (23 RA/23 PsA/19 axSpA; f 55%) were guided through CR images of their respective disease by an experienced rheumatologist, followed by completing the questionnaire mentioned above. Patients stated that CR was very helpful to understand their disease process (4.39±0.15), that understanding diseases by CR was better than the one obtained by conventional radiographs (4.43±0.20) and that they considered such technology helpful for improving disease understanding (4.35±0.09).

Conclusion

CR seems to be a promising teaching tool for RMD patients facilitating an improved understanding of their disease process and in consequence my also improve adherence of RMD patients to their anti-rheumatic treatment.

References

[1]Ritschl, V., et al., 2020 EULAR points to consider for the prevention, screening, assessment and management of non-adherence to treatment in people with rheumatic and musculoskeletal diseases for use in clinical practice. Ann Rheum Dis, 2020.

[2]Kleyer, A., et al., Development of three-dimensional prints of arthritic joints for supporting patients’ awareness to structural damage. Arthritis Res Ther, 2017. 19(1): p. 34.

[3]Berger, F., et al., Application of Cinematic Rendering in Clinical Routine CT Examination of Ankle Sprains. AJR Am J Roentgenol, 2018. 211(4): p. 887-890.

Acknowledgements

Siemens Healthineers /Dr.Klaus Engel for providing CR expertise

Disclosure of Interests

None declared

AB0113 A MINIMAL-INVASIVE METHOD TO RETRIEVE AND IDENTIFY ENTHESEAL TISSUE FROM PSORIATIC ARTHRITIS PATIENTS

Background

Enthesitis represents a hallmark feature of spondyloarthritis, including psoriatic arthritis (PsA).1 So far, most of the data on enthesitis in PsA are based on clinical assessment of tenderness as well as MRI or ultrasound examinations.2 These approaches, however, do not allow molecular analysis of entheses, which will require acquisition of entheseal tissue. Up today, it is unknown, which entheseal structure in humans would qualify for a feasible biopsy and how correct sampling of entheseal structures could be ascertained within such biopsy material. These technical challenges have led to substantial lack of knowledge on human entheseal tissues.

Objectives

To establish a minimally invasive biopsy technique of human entheses for the analysis of entheseal tissue in patients with PsA.

Methods

Human cadavers were used for establishing the technique to retrieve tissue from the lateral humeral epicondyle enthesis (cadaveric biopsies). After biopsy, the entire entheses was surgically resected (cadaveric resections). Biopsies and resections were assessed by label-free second-harmonic-generation (SHG) microscopy. The same biopsy technique was then applied in PsA patients with subsequent definition of entheseal tissue by SHG.

Results

Entheseal biopsies were performed in five cadavers and allowed the retrieval of entheseal tissue, validated by analysis of the resection material. Thus, microscopy of biopsy and resection sections allowed differentiation of entheseal, tendon and muscle tissue by SHG and definition of specific intensity thresholds for entheseal tissue. The same method was then successfully applied to 10 PsA patients. Hence, the fraction of entheseal tissue within the PsA biopsy specimens was high (65%) and comparable to the fraction retrieved in cadaveric biospies (68%) as assessed by SHG microscopy.

Conclusion

Entheseal biopsy of the tendon plate of the lateral epicondyle is feasible in PsA patients allowing reliable retrieval of entheseal tissue and its identification by SHG microscopy.

References

[1]Schett, G, Lories D, D´Agostino MA, Elewaut E, Kirkham B, Soriano ER, McGonagle D. Enthesitis: from pathophysiology to treatment Nat Rev Rheumatol 2017 Nov 21;13(12):731-741.

[2]Groves C, Chandramohan M, Chew NS, et al. Clinical Examination, Ultrasound and MRI Imaging of The Painful Elbow in Psoriatic Arthritis and Rheumatoid Arthritis: Which is Better, Ultrasound or MR, for Imaging Enthesitis? Rheumatol Ther 2017;4:71-84.

Disclosure of Interests

None declared

POS1476-HPR FEASIBILITY OF USING OPTOELECTRONIC MEASUREMENT OF HAND MOVEMENT FOR CHARACTERIZING HAND FUNCTION IN RHEUMATOID ARTHRITIS

Background

Physical function is an important factor determining disease burden in arthritis. Monitoring function in rheumatoid arthritis (RA) patients is essential for effective treatment [1]. The currently used tools to assess physical function (e.g. patient reported outcomes) have limitations with respect to sensitivity and specificity to measure functional impairment in RA [2,3]. A marker-based optoelectronic measurement of hand function enables detailed analysis of hand movements such as spatial-temporal parameters and joint angles [4]. This may provide new possibilities to quantitatively and qualitatively analyze the changes of hand function in patients with RA in so far unprecedented way.

Objectives

To test the feasibility of optoelectronic measurement of hand function in RA patients and healthy controls (HC) when performing standard functional tests such as the Moberg Pick-Up-Test (MPUT) as well as standard movements such as finger flexing and to detect disease specific patterns.

Methods

RA patients (ACR/EULAR 2010 criteria [1]) recruited from the Internal Medicine 3 outpatient clinic, Erlangen, Germany and HC were included (Ethics #125_16B). Participants were asked to perform the MPUT and a simple movement of flexing the interphalangeal (DIP) and proximal interphalangeal joint (PIP). Spatial-temporal data of hand movements and hand segment kinematics were captured using an optoelectronic measurement system (Qualisys AB, Sweden) with 29 retroreflective markers (Figure 1). Transport time for each of the 12 MPUT objects was divided into a grasping phase (GP) (first touch to safe grip) and a manipulation phase (MP) (safe grip to drop) using the video recording or marker trajectories. For the flexing movement, the ratios between the flexion angle of the DIP and PIP joint (DIPPIP) were calculated. We used linear mixed-effects models accounting for within-participant clustering of hands and adjusting for age and sex differences to compare RA with controls.

Figure 1.

Marker setup and the 12 objects transported during the MPUT.

Results

Twenty-four RA patients and 23 healthy controls were evaluated (Table 1). Mean GP times across all objects showed higher absolute differences between the groups (RA 0.43 [0.35-0.52]; HC 0.33 [0.27-0.40] sec) while MP times were identical (RA 0.36 [0.30-0.44]; HC 0.36 [0.30-0.44] sec) showing a significant group-phase interaction (p<0.001). Objects safety pin, key, and paper clip showed the highest absolute between-group mean differences for unadjusted time data (0.41, 0.36, 0.34 sec respectively). Measured angle ratios (RA 0.60±0.15; HC 0.68±0.17 (DIPPIP)) and their linear fit (RA 0.96±0.05; HC 0.97±0.03 R2) were similar for RA and controls (p>0.05).

Table 1.

Subject characteristics; mean (SD)

RAHCmale: female [N]7: 1711: 12Age [years]62.3 (9.1)50.2 (16.1)Disease duration [years]11.8 (10.8)Disease Activity Score (DAS28)2.5 (1.3)

Conclusion

Optoelectronic measurement of hand function is feasible and allows to gain a more detailed picture of impairment in hand function in RA patients. For instance, tasks like reaching for an object are significantly impaired. Further, objects causing the greatest difficulty for RA patients in the GP were identified. The previously described linear relationship of angle ratios for the distal finger joints in healthy individuals [5] seems also valid for RA patients in our cohort and no significant group differences for the ratio could be observed. This may reflect that DIP and PIP joints are less affected in RA compared to e.g. psoriasis arthritis [6]. In conclusion, optoelectronic hand movement analysis allows a more accurate and differentiated analysis of hand function in RA patients.

References

[1]Aletaha, D. et al. Arthritis Rheum. 2010, 62, 2569-2581

[2]Günay, S. M. Reumatismo. 2016, 68, 183-187

[3]Liphardt, A.M. et al. ACR Open Rheumatol. 2020, 2, 734-740

[4]Sancho-Bru, J. et al. Proc. Inst. Mech. Eng. Part H J. Eng. Med.2014, 228, 182-189

[5]Lee, J. & Kunii, T. IEEE Comput. Graph. Appl. 1995, 77-86

[6]Veale DJ, et al. RMD Open 2015, 1: e000025

Acknowledgements

The study was supported by the German Research Foundation (DFG) under Grant SFB 1483 – Project-ID 442419336 and the major instruments at the Institute of Applied Dynamics, FAU Erlangen-Nürnberg were used in this study – reference number INST 90 / 985-1 FUGG.

Disclosure of Interests

None declared

OP0260 RESPONSIVENESS OF A COMBINED POWER DOPPLER AND GREYSCALE ULTRASOUND SCORE FOR ASSESSING SYNOVITIS AT JOINT LEVEL IN PSORIATIC ARTHRITIS PATIENTS WITH INADEQUATE RESPONSE TO csDMARDs: DATA FROM THE ULTIMATE TRIAL

Background

Power Doppler ultrasound (PDUS) is a sensitive non-invasive imaging tool that allows the visualisation of articular and periarticular inflammation in patients with psoriatic arthritis (PsA).1 ULTIMATE (NCT02662985) was the first large randomised clinical trial that showed the responsiveness of the Global OMERACT-EULAR ultrasound synovitis score (GLOESS) in PsA and confirmed the rapid and continued benefits of secukinumab through 52 weeks.2,3

Objectives

To report the distribution of ultrasound-detected synovitis at joint level, by degree of severity at baseline and over time, and the contribution of each core component of GLOESS, synovial hypertrophy (SH) by greyscale (GS; B-mode) and power Doppler (PD) signal, to responsiveness.3

Methods

This was a 52-week study with a 12-week double-blind, placebo-controlled treatment period followed by a 12-week open-label period and a 6-month open-label extension secukinumab treatment period.3 The number of joints with synovitis measured by GLOESS2 was assessed up to Week 52. The assessments included distribution of synovitis based on composite PDUS score across 24 pairs of joints (with worse score of the pair of the joints used) by grade of severity (0-3) and change from baseline to Week 52 in each core component of GLOESS.3-5 Data are presented as observed.

Results

A total of 166 patients (mean age, 46.7 years; males, 45.2%) were enrolled, of which 90% (75/83) of secukinumab and 83% (69/83) of placebo-secukinumab participants completed 52 weeks. The mean (SD) number of PDUS detected synovitis at baseline was 9.2 (4.9) and 10.2 (5.2) in the secukinumab and placebo group, respectively. The most frequent locations with synovitis at baseline were: wrist, metatarsophalangeal (MTP), knees and metacarpophalangeal (MCP) joints (Table 1). An early and continued improvement in GLOESS was observed in both secukinumab and placebo-secukinumab groups after switching to active therapy, as previously reported at Week 12 and through Week 52.2,3 Among the two core components of GLOESS, SH was mainly responsible for the change in GLOESS from baseline to Week 52, in contrast with PD signal in this dataset. The distribution of synovitis by grade of severity showed that MTP joints, wrist, knee, MCP1/2 and tibiotalar joints mostly contributed to the composite PDUS at Week 12 (Figure 1). Similar patterns were observed through 52 weeks.

Table 1.

Proportion of patients with PDUS detected synovitis at baseline*

Synovitis joint, data presented as n (%)Secukinumab (N=83)Placebo (N=83)Wrist66 (80)66 (80)MTP256 (68)65 (78)MTP158 (70)60 (72)MTP352 (63)60 (72)MTP446 (55)59 (71)Knee50 (60)47 (57.)MCP136 (43)52 (63)MCP235 (42)41 (49)MTP530 (36)41 (49)

*Data for top nine pairs of joints with most frequently detected power Doppler ultrasound (PDUS) synovitis are presented here. Synovitis was scored by a OMERACT-EULAR synovitis composite score >0 for each paired joint (irrespective of right or left side). The OMERACT-EULAR composite PDUS score (for individual joints) ranged from 0 to 3 and was composed of the two core components synovial hypertrophy and power Doppler.

N, total number of randomised patients; n, number of evaluable patients

Conclusion

The distribution of synovitis at baseline reflected a predominance of small joints (feet and hands) and large joints (wrist and knee) and were mostly responsive to secukinumab over time in the ULTIMATE trial. Synovial hypertrophy was the most responsive core component of GLOESS driving an early and continued reduction of synovitis with secukinumab through Week 52. This finding could be useful to select a restricted number of joints in future ultrasound trials in PsA.

References

[1]D’Agostino MA and Coates LC. J Rheumatol. 2019;46:337–9.

[2]D’Agostino MA et al. Arthritis Rheumatol. 2021;73(10).

[3]D’Agostino MA, et al. Rheumatology (Oxford) 2021;keab628.

[4]D’Agostino MA and Coates LC. RMD Open 2017;3:e000428.

[5]Uson J, et al. Rheumatol Clin. 2018;14:27–35.

Disclosure of Interests

Maria-Antonietta D’Agostino Speakers bureau: Sanofi, Novartis, BMS, Janssen, Celgene, Roche, AbbVie, UCB, and Eli Lilly, Consultant of: Sanofi, Novartis, BMS, Janssen, Celgene, Roche, AbbVie, UCB, and Eli Lilly, Maarten Boers Consultant of: Novartis, Corine Gaillez Shareholder of: Novartis and BMS, Employee of: Novartis, Carlos Gamez: None declared, LUCIO VENTURA: None declared, Javier Rosa Speakers bureau: Abbvie, Pfizer, Lilly, Janssen, Novartis and BMS, Ilaria Padovano: None declared, Peter Mandl Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Roche and UCB, Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Roche and UCB, Arnd Kleyer Speakers bureau: Abbvie, Lilly, Novartis, MEDAC; Janssen, Consultant of: Abbvie, Lilly, UCB, Novartis, BMS, Sanofi, Galapagos, Catherine Bakewell Speakers bureau: AbbVie, Novartis, Pfizer, Janssen, UCB, and Sanofi Genzyme/Regeneron, Consultant of: AbbVie, Novartis, Pfizer, Janssen, UCB, and Sanofi Genzyme/Regeneron, Weibin Bao Shareholder of: Novartis, Employee of: Novartis, Punit Goyanka Employee of: Novartis, Philip G Conaghan Speakers bureau: AbbVie, Amgen, AstraZeneca, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer and UCB, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Roche and UCB

POS1384 NON-INVASIVE IN VIVO METABOLIC PROFILING OF INFLAMMATION IN JOINTS AND ENTHESES BY OPTOACOUSTIC IMAGING

Background

An in-depth metabolic characterization of joints and entheses at the tissue level can help in the early diagnosis and treatment selection for patients with inflammatory arthritis [1]. However, current knowledge about the metabolic profiles of synovitis and enthesitis is limited. Multispectral optoacoustic tomography (MSOT), a novel metabolic imaging technology, could be used to undertake metabolic profiling of joints and entheses non-invasively using near-infrared multispectral laser to stimulate tissues and detect the emitted acoustic energy, enabling quantification of tissue components in vivo based on differential absorbance at multiple wavelengths [2, 3].

Objectives

To explore the metabolic characteristics of arthritis and enthesitis using MSOT.

Methods

We performed a cross sectional study on healthy controls (HC) and patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) (Table 1). Participants underwent clinical, ultrasound (US), and MSOT examination of metacarpophalangeal joints, wrists, entheses of lateral epicondyles, patellar, quadriceps and Achilles tendons. MSOT-derived hemoglobin, oxygen saturation, collagen and lipid levels were measured. We calculated scaled mean differences (SMD) between affected and unaffected joints and entheses as defined by clinical examination or US using linear mixed effects models.

Table 1.

Baseline characteristics.

OverallHealthyPsARAN87363417Age, mean (SD)47.0 (15.7)34.7 (12.0)52.4 (11.5)62.5 (9.1)Sex, n (%) Female48 (55.2)18 (50.0)17 (50.0)13 (76.5) Male39 (44.8)18 (50.0)17 (50.0)4 (23.5)Tender joints, median (IQR)0 (0-2)0 (0-0)1 (0-5)2 (1-6)Swollen joints, median (IQR)0 (0-1)0 (0-0)0 (0-2)2 (1-6)Tender entheses, median (IQR)0 (0-2)0 (0-0)1 (0-3)0 (0-0)csDMARD, n (%)22 (25.3)-13 (38.3)9 (53.0)b-tsDMARD, n (%)31 (35.6)-20 (58.8)11 (64.7)

SD, standard deviation; IQR, interquartile range; csDMARD, conventional synthetic disease modifying anti-rheumatic drug; b-tsDMARD, biologic or targeted synthetic disease modifying anti-rheumatic drug.

Results

We obtained 1535 MSOT and 982 US scans from 87 participants (36 HC, 34 PsA, 17 RA). Entheseal tenderness was not associated with metabolic changes, whereas US enthesitis was associated with increased total hemoglobin, oxygen saturation and collagen content. In contrast, clinical and US arthritis showed increased hemoglobin levels but reduced oxygen saturation and reduced collagen content. Synovial hypertrophy was associated with increased lipid content in the joints (Figure 1).

Figure 1.

Scaled differences and 95% confidence intervals of MSOT-measured metabolite values by clinical and ultrasonographic findings of enthesitis (A-C) and arthritis (D-F). Two differences are plotted for each metabolite indicating two multispectral processing algorithms used for estimation. P values were adjusted for multiple testing using a false discovery rate of 5%. NS, not significant. sO2, oxygen saturation.

Conclusion

MSOT allows a non-invasive characterization of metabolic changes in arthritis and enthesitis. These findings can be interpreted as a reflection of increased synovial cellularity, collagen degradation, and metabolic demand in synovitis, and of an increased tissue apposition and vascularization in enthesitis. Our results suggest that synovitis and enthesitis do not only differ at the clinical and anatomical-functional level, but also exhibit divergent metabolic changes.

References

[1]Falconer J, et. al. Arthritis Rheumatol. 2018;70(7):984-99.

[2]Regensburger AP, et. al. Biomedicines. 2021;9(5).

[3]Regensburger AP, et al. Nature Medicine. 2019;25(12):1905-15.

Conflict of Interest

AR., FK, MW are co-inventors, together with iThera Medical GmbH, Germany on an EU patent application (no. EP 19 163 304.9) relating to a device and a method for analysis of optoacoustic data, an optoacoustic system and a computer program. All other authors declare no conflict of interest.

Acknowledgements

We thank Ms. Nairouz Al Ahmad, assistant medical technician (Department of Internal Medicine 3), for her assistance in conducting the study and Dr. Yi Qiu, PhD (iThera Medical GmbH) for her assistance in data analysis and interpretation.

Disclosure of Interests

None declared

POS1485-HPR DIGITALLY ENHANCED TREAT-TO-TARGET AND SHARED DECISION-MAKING APPROACH WITH A DIGITAL HEALTH APPLICATION: INTERIM RESULTS FROM A RANDOMIZED CONTROLLED TRIAL

Background

Digital health applications (DHA) became indispensable patient companions accelerated by the current COVID pandemic [1]. In 2020, for the first time worldwide, a regulatory framework to reimburse DHA was established in Germany. To get listed as a DHA, preliminary evidence needs to be generated – next to fulfilling highest standards in quality and safety. The DHA ABATON RA consists of two parts; 1) digital shared-decision-making (SDM) including choosing an appropriate electronic patient reported outcome (ePRO) instrument and the respective ePRO target for the next visit, 2) remote patient monitoring and ePRO tracking by the patient. Hereby, ABATON RA supports a digitally guided Treat-to-Target (T2T) approach.

Objectives

The objective of this study is to evaluate a potentially beneficial effect for the patient by using ABATON RA.

Methods

Three-armed, partially blinded multicenter trial (RCT) including RA patients who regularly use a smartphone. Patients attend 3 visits, 3 months apart (T0, T3, T6), with one follow-up visit (T9). Intervention group (IG): Patients use ABATON RA. Via SDM patients and rheumatologists choose a specific ePRO and respective treatment target for the next visit in three months, e.g. RAID ≤4. Control group (CG): Standard of care treatment (no DHA). Placebo group (PG): Usage of a placebo version of ABATON RA providing only Regensburger Insomnie Skala (RIS) and Epworth Sleepiness Scale (ESS) as ePROs. No SDM is conducted and ePRO results are not presented to HCP.

Results

This interim analysis evaluated the first 38 patients that completed T3. IG: 13 patients (Av. age 55.9, 61.5% females); PG: 12 (Av. age 50.7, 66.7% females); CG: 13 (Av. age 56.1, 76.9% females). We observe a significant improvement in the mean over time in a pairwise comparison within the intervention group for the following: Pt-GA mean difference of 2.98 (p = 0.025, partial η2 = 0.353), pain mean difference of 1.46 (p = 0.049, partial η2 = 0.286) whereas all pairwise comparisons for the two parameters were non-significant in PG and CG. The patient reactions assessment (PRA) score, measuring patient perceived quality of the patient-provider relationship, increased by a mean of 4.15 points in IG, compared to a slight decrease of 1.92 for PG and 2.77 for CG.

Conclusion

These preliminary findings show beneficial differences among the groups in favor of IG: 1) for quality of life and 2) the physician-patient-relationship. A digitally enhanced therapy is non-inferior to the gold-standard of exclusive in-person treatment. Patients seem willing and able to get involved in an enhanced treat-to-target and shared decision-making approach.

References

[1]Kernder A, Morf H, Klemm P, Vossen D, Haase I, Mucke J, et al. Digital rheumatology in the era of COVID-19: results of a national patient and physician survey. RMD Open. 2021;7:e001548.

Disclosure of Interests

Johannes Knitza Consultant of: ABATON GmbH, Vila Health, Grant/research support from: ABATON GmbH, Manuel Grahammer Shareholder of: ABATON GmbH, Employee of: ABATON GmbH, Sebastian Boeltz: None declared, Judith Lang: None declared, Markus Detert: None declared, Maram Bader Employee of: ABATON GmbH, Arnd Kleyer: None declared, David Simon: None declared, Gerhard Krönke: None declared, Georg Schett: None declared, Jacqueline Detert: None declared

POS0809 CHARACTERIZATION OF RELAPSES IN PATIENTS WITH GIANT CELL ARTERITIS (GCA) PATIENTS- DATA FROM THE REAL-LIFE TREATMENT AND SAFETY (REATS)-GCA COHORT

Background

Giant cell arteritis (GCA) has the tendency to relapse once treatment is tapered or stopped. Such relapses represent a potential threat to GCA patients as they can lead to severe symptoms and organ damage.

Objectives

To assess the frequency and type of relapses in patients with GCA

Methods

The Real-Life Treatment and Safety (REATS)-GCA cohort has been established by extracting the data on clinical presentation, inflammatory markers, imaging, comorbidities, treatments and serious adverse events of GCA patients from 6 specialized centres in Germany. We undertook descriptive and survival analyses (Kaplan-Meier), and compared baseline characteristics of participants with vs. without relapse. Ethical approval for the cohort was obtained.

Results

We included 395 patients with a mean age of 71 years, including 264 (66.8 %) females and 129 (32.7%) males. Diagnosis of GCA was supported by temporal artery ultrasound in 37%, 18F-FDG-PET/CT in 29%, temporal artery biopsy in 14% of patients and by MRI or clinically in the remaining patients. 31% of patients presented with an isolated cranial manifestation and 18% with isolated extracranial manifestations. Most common presenting symptoms were headache (57%), fatigue (55%), weight loss (42%) and polymyalgia (38%) (Table 1). The most common comorbidities at the time of study inclusion were arterial hypertension (68%), followed by osteoporosis (26%). Within a median total follow-up duration of 22.2 (11.7-40.6) months, 97 of the 395 patients relapsed including 15 patients who relapsed more than once. The median (IQR) time to first relapse was 12.5 (7.1-21.8) months. Median relapse-free survival was 7.8 years with a relapse risk of 12% (CI, 9 to 15%) at 1 year and 38% (CI, 30 to 45%) at 5 years (Figure 1). Most common symptoms at relapse were headache (35%), polymyalgia (23%), fatigue (19%) and night sweats (12%) (Table 1). Three patients relapsed with sudden loss of vision. Among the 114 relapses observed, 94 (83%) occurred under prednisolone treatment with a median dose of 7.0 mg/day (IQR 4.0-12.5). 26 (23%) occurred under methotrexate and 14 (12%) under tocilizumab treatment. Comparing the baseline characteristics that were documented in this study, we did not find a statistically significant difference in relapsing versus non-relapsing GCA patients.

Table 1.Symptom at disease onsetN=395 (%)Symptom at relapseN=97 (%)Headache216 (54.7)Headache35 (30.7)Fatigue208 (52.7)Polymyalgia (PMR)23 (20.2)Weight loss159 (40.3)Fatigue19 (16.7)Polymyalgia (PMR)144 (36.5)Vision impairment13 (11.4)Night sweats140 (35.4)Night sweats12 (10.5)Headache in the temple area125 (31.6)Headache in the temple area12 (10.5)Jaw pain121 (30.6)Jaw pain11 (9.6)Vision impairment118 (29.9)Morning stiffness7 (6.1)Morning stiffness89 (22.5)Weight loss7 (6.1)Fever80 (20.3)Claudication upper limb6 (5.3)Swelling temporal arteries77 (19.5)Arthralgia6 (5.3)Vision loss57 (14.4)Claudication lower limb5 (4.4)Scalp tenderness38 (9.6)Vision loss3 (2.6)Claudication upper limb38 (9.6)Arthritis3 (2.6)Claudication lower limb34 (8.6)Scalp tenderness2 (1.8)Arthralgia28 (7.1)Fever2 (1.8)Arthritis3 (0.8)Swelling temporal arteries2 (1.8)Figure 1.

Conclusion

About one fourth of GCA patients relapsed and the overwhelming majority of relapses occurred before patients were able to stop glucocorticoids. The leading symptoms at relapse are headache and fatigue, while loss of vision is rare (0.76%). Baseline characteristics seem to be poorly informative about the risk of relapse, therefore regular monitoring of GCA patients is necessary.

Acknowledgements

This research was financially supported by Roche Pharma Ag and Chugai Pharma Europe Ltd.

Disclosure of Interests

Verena Schönau Speakers bureau: Novartis, Janssen, Grant/research support from: Roche, Chugai, Giulia Corte: None declared, Sebastian Ott: None declared, Koray Tascilar: None declared, Fabian Hartmann: None declared, Bernhard Manger: None declared, Bernhard Hellmich: None declared, Alexander Pfeil: None declared, Peter Oelzner: None declared, Wolfgang A. Schmidt: None declared, Andreas Krause: None declared, Marc Schmalzing: None declared, Matthias Fröhlich: None declared, Michael Gernert: None declared, Nils Venhoff: None declared, Jörg Henes: None declared, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB,, Consultant of: Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Sobi, Novartis, Georg Schett: None declared

POS1028 GUSELKUMAB MAINTAINS RESOLUTION OF DACTYLITIS AND ENTHESITIS IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS THROUGH 2 YEARS FROM A PHASE 3 STUDY

Background

Guselkumab (GUS), a selective inhibitor of IL-23, significantly improved the diverse manifestations of active psoriatic arthritis (PsA), including dactylitis and enthesitis, in DISCOVER (D)-1 & 2 trials of patients (pts) with active PsA1,2, with maintenance of response rates through 1 year (yr).3,4 Dactylitis and enthesitis, extra-articular manifestations of PsA, can be difficult to treat and cause significant disease burden.5,6

Objectives

To evaluate the ability of GUS to provide long-term resolution of dactylitis and enthesitis in pts with PsA through 2 yrs of D-2.

Methods

D-2 biologic naïve pts with active PsA were randomized 1:1:1 to GUS 100 mg every 4 weeks (Q4W); GUS 100 mg at W0, W4, Q8W; or placebo (PBO). At W24, PBO pts crossed over to GUS Q4W. Independent assessors evaluated dactylitis (total score: 0-60) and enthesitis (Leeds Enthesitis Index [LEI]; total score 0-6). These post hoc analyses assessed baseline (BL) frequency and severity of enthesitis in pts with dactylitis and dactylitis frequency in pts with enthesitis. Post BL, changes in dactylitis and LEI scores over time (least squares [LS] mean changes; analysis of covariance [ANCOVA]) and rates of resolution of dactylitis and enthesitis (Chi square correlation test) were determined in pts with these manifestations at BL (missing data imputed as no change/response).

Results

At BL, more D-2 pts had enthesitis (68%) than dactylitis (45%). At BL, 78% of pts with dactylitis vs 61% without (w/o) dactylitis had enthesitis and 51% of pts with enthesitis vs 32% w/o enthesitis had dactylitis. Among pts with enthesitis at BL, a higher percentage of pts with dactylitis (52%) had severe enthesitis (LEI score ≥3) vs pts w/o dactylitis (44%). Among those with the condition at BL, resolution rates of dactylitis (57%, Q4W; 64%, Q8W) and enthesitis (44%, Q4W; 54%, Q8W) at W24 increased through W52 (dactylitis: 74%, Q4W; 78%, Q8W; enthesitis: 57%, Q4W; 61%, Q8W) and were maintained at W100 (dactylitis: 72%, Q4W; 83%, Q8W; enthesitis: 62%, Q4W; 70%, Q8W). Consistent results were observed when evaluating mean changes in dactylitis and LEI scores and in pts who crossed over from PBO to GUS Q4W at W24 (Table 1). In pts with dactylitis and enthesitis at BL, GUS-treated pts showed significant correlations between resolution of enthesitis and dactylitis at W24 (p=0.004), W52 (p<0.001) and W100 (p=0.039), with nearly 90% of pts with enthesitis resolution also achieving dactylitis resolution at W52 and W100 (Figure).

Table 1.

LS mean change from baseline over time in dactylitis and LEI scores in pts with manifestation at baseline

GUS 100 mg Q4WGUS 100 mg Q8WPBO → GUS 100 mg Q4WDactylitis score (0-60)Pts, N12111199W24a-5.9 (-6.7, -5.0)-6.0 (-6.8, -5.1)-4.0 (-5.0, -3.1)W52a-6.5 (-7.2, -5.8)-7.2 (-7.9, -6.5)-6.9 (-7.6, -6.2)W100a-6.5 (-7.1, -5.8)-7.5 (-8.1, -6.8)-6.9 (-7.6, -6.2)LEI score (1-6)Pts, N170158178W24a-1.5 (-1.8, -1.3)-1.6 (-1.8, -1.4)-1.0 (-1.3, -0.8)W52a-1.8 (-2.0, -1.6)-1.9 (-2.1, -1.7)-2.0 (-2.2, -1.8)W100a-1.9 (-2.1, -1.7)-2.1 (-2.3, -1.8)-2.1 (-2.3, -1.9)

aResults are LS mean change (95% confidence interval [CI]); LS mean change determined by ANCOVA; missing data was imputed as no change for pts who discontinued treatment and using multiple imputation for remaining missing data

GUS, guselkumab; LEI, Leeds Enthesitis Index; LS, least squares; PBO, placebo; pts, patients; Q4W, every 4 weeks; Q8W, every 8 weeks; W, week

Conclusion

Pts with PsA often present with concurrent enthesitis and dactylitis, both of which can be recalcitrant to treatment. GUS resolved enthesitis and dactylitis in substantial proportions of pts through W100. GUS-treated pts who achieved enthesitis resolution were more likely to achieve dactylitis resolution and vice versa.

References

[1]Deodhar A et al. Lancet. 2020;395:1115

[2]Mease PJ et al. Lancet. 2020;395:1126

[3]Ritchlin C et al. RMD Open. 2021;7(1):e001457

[4]McInnes IB et al. Arthritis Rheumatol. 2021;73:604

[5]Kaeley GS et al. Semin Arthritis Rheum. 2018;48:35

[6]McGonagle D et al. Nat Rev Rheumatol. 2019;15:113

Disclosure of Interests

Proton Rahman Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Janssen and Novartis, Iain McInnes Consultant of: AbbVie, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Gilead, Janssen, Novartis, and UCB, Grant/research support from: AstraZeneca, Bristol Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, and UCB, Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, and UCB, Georg Schett Speakers bureau: Abbvie, Janssen, and Novartis, Philip J Mease Speakers bureau: AbbVie, Aclaris, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Grant/research support from: AbbVie, Aclaris, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, May Shawi Shareholder of: Janssen Global Services, LLC, Employee of: Janssen Global Services, LLC, Daniel Cua Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Jonathan Sherlock Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Alexa Kollmeier Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Xie L Xu Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Yusang Jiang Consultant of: Janssen, Employee of: Cytel Inc, Shihong Sheng Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Amgen, and UCB Pharma, Dennis McGonagle Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB

POS0864 ASSESSMENT OF SYSTEMIC SCLEROSIS RELATED MYOCARDIAL FIBROSIS BY 68Ga-FAPI-04 PET/CT

Background

Myocardial fibrosis is a poor prognostic factor and a relevant cause of SSc-related mortality. Current non-invasive screening methods for myocardial fibrosis (MF) include echocardiography, electrocardiography and serum Nt-pro-BNP, which are not specific for MF and not sensitive for early changes. Cardiac MRI predominately visualizes extracellular space changes as consequence of long-standing fibroblast activation. Direct visualization of the remodeling fibrotic remodeling process has not been feasible so far.

Objectives

Here, we use a tracer labeled probe directed against Fibroblast-Activation-Protein (FAP) to visualize activated fibroblasts in the myocardium of SSc patients and healthy individuals to test the hypothesis that FAPI-based PET imaging might enable the assessment of disease activity in SSc-related MF.

Methods

In this exploratory trial, 7 patients with SSc-related myocardial fibrosis (MF) confirmed by cardic MRI and 8 SSc patients without myocardial involvement were enrolled. All participants underwent 68Ga-FAPI-04 PET/CT imaging and cardiac MRI as well as echocardiography, electrocardiogram, and serum NT-pro-BNP. Patients were followed for at least 6 months including a follow-up cardiac MRI. Regional mapping of 68Ga-FAPI-04-uptake, late gadolinium enhancement (LGE) and T1-relaxation times were performed according to the American Heart Association 17 regions model. Myocardial tissue was analysed by immunofluorescence- (aSMA and FAP) and Sirius-Red staining.

Results

Myocardial FAPI-04-accumulation was significantly increased in SSc patients with myocardial fibrosis as defined by LGE in MRI compared to SSc patients without LGE. Consistent with the previously reported widespread remodeling in SSc-associated myocardial disease, the distribution of FAPI uptake was observed across multiple areas and did not correspond to the supply areas of the coronary arteries. Histological analyses of myocardial tissue biopsied from a LGE and 68Ga-FAPI-04-positive region revealed the accumulation of FAP+; SMA+ myofibroblasts in regions of pronounced collagen deposition. Slightly increased 68Ga-FAPI-04 -uptake values were observed in SSc patients without LGE, but with cardiovascular risk factors.

Comparing 68Ga-FAPI-04-uptake with cardiac MRI based mapping techniques, we observed a partial overlap for certain regions and differences in others. These observations suggest, that 68Ga-FAPI-PET/CT and cMRI could visualize different aspects of the disease process.

To confirm that 68Ga-FAPI-04-uptake assesses current molecular fibroblast activity rather than accumulating disease damage, we analyzed associations of 68Ga-FAPI-04-uptake with changes of clinical parameters of SSc-MF on follow-up: Here we observed different dynamics of change of 68Ga-FAPI-04-uptake and cardiac MRI-based, e.g. in response to start of immunosuppressive therapy.

Conclusion

Our study presents first in human evidence on a limited number of patients that FAPI-04-uptake correlates with fibrotic activity in SSc-associated myocardial fibrosis and that 68Ga-FAPI-04-PET/CT may thus improve risk stratification in this population.

Disclosure of Interests

None declared

OP0294 REDUCED JOINT SYNOVITIS ASSESSMENT VERSUS THE GLOBAL EULAR OMERACT SYNOVITIS SCORE (GLOESS) TO PREDICT THE RESPONSE TO SECUKINUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AND INADEQUATE RESPONSE TO CONVENTIONAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS: EXPLORATORY RESULTS FROM THE ULTIMATE TRIAL

Background

The combined use of B-mode ultrasound (US) and Power Doppler (PD; combination termed as PDUS) allows visualisation of morphological and pathophysiological changes of the synovium. ULTIMATE (NCT02662985) was the first large, randomised, double-blind, placebo-controlled PDUS phase IIIb study in psoriatic arthritis (PsA), to demonstrate that Global OMERACT EULAR Synovitis Score (GLOESS), a US score at patient level, was sensitive to detect the early and continuous decrease in synovitis in a multicenter setting using different US devices and examiners.1 However, the US assessment for GLOESS was time-consuming owing to the number of joints assessed.

Objectives

To investigate the value of various reduced joint sets to predict the validated GLOESS score.

Methods

ULTIMATE was a 52-week study with a 12-week double-blind, placebo-controlled period followed by 12-week open-label (OL) treatment and 6-month OL extension period.1 In the ULTIMATE trial, GLOESS for the 24 paired joints was calculated, with a potential score ranging between 0 to 144.1 A Spearman’s rank correlation matrix and a Cluster Image Map were constructed to identify highly correlated joint clusters based on the composite PDUS scores. Based on the different approaches (best correlation, model optimization, etc.), representative joints were then selected from each group, which yielded several corresponding combinations of joints. Linear models were developed with these reduced joint sets as predictors of GLOESS, using data from 60% of patients randomly selected from the ULTIMATE study. The remaining 40% data were used for model validation and diagnostics.

Results

Five models were established with reduced pairs of joint sets (9–13 pairs). The joints included in each linear model are summarized in Table 1. All five models of reduced joint sets showed high correlation with GLOESS score of R2 ~ 0.95. Figure 1 depicts all the 5 models of reduced joint sets for PDUS-detected synovitis versus the actual GLOESS in secukinumab and placebo-secukinumab groups, with modified GLOESS scores using reduced PDUS joint sets demonstrating changes very close to that of validated GLOESS.

Table 1.

Joints included across five linear models, indicated by green shading

Joint pairsModel 1 (N=9)Model 2 (N=9)Model 3 (N=9)Model 4 (N=13)Model 5 (N=12)ElbowKneeMTP2WristMCP1DIP4MTP4MCP2MCP4MCP5PIP3PIP4PIP1, PIP5DIP2DIP3, DIP5MTP1MTP5ShoulderTibiotalar

N, number of joint pairs used in model. DIP, distal interphalangeal; MCP, metacarpophalangeal; MTP, metatarsophalangeal;

PIP, proximal interphalangeal

Figure 1.

Reduced set of joints synovitis score vs GLOESS score

Conclusion

All models of reduced joint sets for PDUS-detected synovitis predicted GLOESS well. The next steps will be to document responsiveness and ability to discriminate between active and placebo treatment.

References

[1]D’Agostino MA, et al. Rheumatology (Oxford) 2021;keab628.

Disclosure of Interests

Maria-Antonietta D’Agostino Speakers bureau: AbbVie, BMS, Celgene, Eli Lilly, Janssen, Novartis, Roche, Sanofi, and UCB, Consultant of: AbbVie, BMS, Celgene, Eli Lilly, Janssen, Novartis, Roche, Sanofi, and UCB, Maarten Boers Consultant of: BMS, GSK, Novartis, Pfizer, Consultant of: BMS, GSK, Novartis and Pfizer, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Roche and UCB, Philip G Conaghan Speakers bureau: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, Gilead, Novartis and Pfizer, Consultant of: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, Gilead, Novartis and Pfizer, Esperanza Naredo Speakers bureau: AbbVie, BMS, Celgene GmbH, Janssen, Lilly, Novartis, Pfizer, Roche, UCB, Grant/research support from: Honoraria for clinical trials from Abbvie, BMS and Novartis; Research Grants from Lilly, Peter Mandl Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Roche and UCB., Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Roche and UCB., Philippe Carron Speakers bureau: AbbVie, Bristol Myers Squibb, Celgene Corporation, Eli Lilly, Gilead, Merck Sharp Dohme, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol Myers Squibb, Celgene Corporation, Eli Lilly, Gilead, Merck Sharp Dohme, Novartis, Pfizer, and UCB, Grant/research support from: Merck Sharp Dohme, Pfizer and UCB, Marina Backhaus Speakers bureau: BMS, Gilead, Jonsson, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: BMS, Gilead, Jonsson, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: BMS, Gilead, Jonsson, MSD, Novartis, Pfizer, Roche, UCB, Alejandra López-Rodríguez Speakers bureau: Eli Lilly, GSK, Janssen, Novartis, Roche and UCB, Consultant of: Eli Lilly, GSK, Janssen, Novartis, Roche and UCB, Petra Hanova: None declared, Punit Goyanka Employee of: Novartis, Braja Gopal Sahoo Employee of: Novartis, Corine Gaillez Shareholder of: Shareholder of Novartis and BMS, Employee of: Novartis, Weibin Bao Employee of: Novartis

POS0009 SUBJECTIVE ASSESSMENT OF PHYSICAL FUNCTION DOES NOT SUFFICIENTLY EXPLAIN VARIANCE OF MEASURED HAND FUNCTION AND GRIP STRENGTH IN ARTHRITIS PATIENTS AND NON-ARTHRITIS CONTROLS

Background

Monitoring disease activity in patients with inflammatory arthritis is essential for effective treatment. While the health assessment questionnaire (HAQ) is commonly used to assess physical function, additional functional tests, such as isometric grip strength and the Moberg Pick-Up-Test (MPUT), provide objective measures for hand function and allow assessing hand function across different diseases (1). It remains unclear to date, if measured hand function is already reflected by the HAQ, as the most widely used patient reported outcome measure of physical function in arthritis.

Objectives

To estimate the proportion of hand function and grip strength variability explained by HAQ, patient-reported hand function, and between-person variation in patients with inflammatory arthritis and non-arthritic controls.

Methods

Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis without PsA (PsO) and healthy controls (HC) were investigated. Subject characteristics (age, sex, disease) and HAQ were recorded. Hand function was assessed by vigorimetric grip strength, MPUT, and a patient-reported tool (Michigan Hand Questionnaire, MHQ). Mixed pure-random-effect linear regression models were used to estimate the proportion of variance in measured hand function or grip strength explained by subject characteristics (age, hand dominance, sex, reported hand function, disease group).

Results

299 subjects were tested, 101 with RA (Age: 59.1±13.3 years, BMI: 27.2±5 kg/m2, HAQ-DI score: 0.9±06), 92 with PsA (Age: 58.8±11.6 years, BMI: 29±6.1kg/m2, HAQ-DI score: 0.6±0.7) and 106 non-arthritic controls (51 with Pso (Age: 47.3±14.1 years, BMI: 29.8±7.3 kg/m2, HAQ-DI score: 0.4±06) and 55 HC (Age: 54.6±16.5 years, BMI: 25.2±3.3 kg/m2, HAQ-DI score: 0.1±0.2). Overall variation of MPUT is mostly accounted for by between-person variation (43.1%), followed by HAQ (20.3%) and MHQ (20.2%) (Figure 1A). Overall variation in grip strength is mostly accounted for by sex (59.8%), between-person variation (21.1%) and HAQ (11.3%) (Figure 1B). Overall variation in MHQ is mostly accounted for by HAQ (59.2%) and residual variation (28.3%). Study group specific result are summarized in Table 1.

Table 1.

Variance proportions for each of the four study groups.

Variance proportions (%)Hand function (MPUT)Grip strengthGroupControlPsAPsORAControlPsAPsORAMHQ3.439.00.00.00.02.10.00.0ID34.836.251.652.816.112.921.327.9Age0.013.80.00.78.48.40.00.0HAQ35.810.834.316.43.83.110.312.0Dominant hand0.60.20.00.03.50.61.30.2Sex12.10.00.04.364.268.963.755.0Residual13.30.014.125.83.94.03.45.0

Conclusion

While the variance variation in grip strength is mainly explained by sex and between-person variation for all subject groups, the proportions of explained variance for measured hand function is not similar between diseases. In all groups > 50% of the variation in measured hand function remains unexplained by the variables used. Especially in arthritis patients, HAQ explained less than 25% of the variance in measured hand function. Grip-strength can be considered a poor surrogate for hand function in this context due to its large gender dependence. The explainability of MHQ variation largely by HAQ indicates that it has limited potential to provide further information beyond overall functional impairment. In contrast, the large between-person variation in MPUT likely indicates unexplored movement patterns of hand motion that may be further dissected using sensor-based analyses (2) and can help identify movement components a potential for an in-depth assessment of subtle hand-function alterations in inflammatory arthritis.

References

[1]Liphardt AM et al. ACR Open Rheumatol 2020, 2, 734-740. 2. Phutane U et al. Sensors (Basel) 2021, 21.

Acknowledgements

This study was supported by the German Research Council (SFB 1483 – Project-ID 442419336, INST 90 / 985-1 FUGG, FOR2438/2886; SFB1181), the German Ministry of Science and Education (project MASCARA), the European Union (H2020 GA 810316 - 4D-Nanoscope European Research Council Synergy Project) and Novartis Germany GmbH.

Disclosure of Interests

None declared

POS0308 EFFECT OF GUSELKUMAB ON SERUM BIOMARKERS IN PSORIATIC ARTHRITIS PATIENTS WITH INADEQUATE RESPONSE OR INTOLERANCE TO TUMOR NECROSIS FACTOR INHIBITORS: RESULTS FROM THE COSMOS STUDY

Background

Guselkumab (GUS), a selective IL-23 inhibitor, is efficacious in treating bio-naïve and TNFi-experienced active PsA patients (pts).1.2 In the COSMOS study of active PsA pts with lack of efficacy/intolerance, i.e., inadequate response (IR), to 1-2 TNFi, GUS demonstrated significantly greater response rates and mean improvements in PsA signs and symptoms vs. placebo (PBO) at Week (W) 24.3

Objectives

Evaluate baseline (BL) serum levels of pro-inflammatory biomarkers (CRP, serum amyloid A [SAA], TNFα, IFNɣ, IL-6, IL-10, IL-17F, IL-17A, IL-22) and their relationship to BL disease activity, GUS treatment (tx), and clinical response in COSMOS TNFi-IR pts.

Methods

TNFi-IR pts ≥18 yrs with active PsA (≥3 swollen & ≥3 tender joint counts [SJC/TJC]) were randomized 2:1 to GUS 100 mg every 8 W (Q8W) through W44 or PBO with early escape (W16) or crossover (W24) to GUS Q8W. Samples for serum biomarker analyses, collected at W0, 4, 16, 24, and 48 from consenting pts, were compared with healthy controls (HC; independent of COSMOS). Associations between early biomarker changes and BL disease activity, GUS tx, and clinical response at W24 were assessed.

Results

Among 285 COSMOS pts, 50/95 PBO and 100/190 GUS pts had available biomarker data. BL characteristics of the biomarker cohort were similar to the overall COSMOS population and well balanced across tx arms. At BL, levels of TNFα, IFNɣ, IL-6, IL-10, IL-17A, IL-17F, and IL-22 were significantly upregulated in TNFi-IR pts vs. HC (Table 1). IL-6, CRP, and SAA levels were associated with BL joint disease severity per Disease Activity Score (DAS) 28-CRP (but not with SJC [0-66]/TJC [0-68]). IL-17A and IL-17F levels were associated with BL PASI score. Through W24, significant decreases from BL in levels of CRP, SAA, IL-6, IL-17A, IL-17F, and IL-22 were seen in GUS-, but not PBO-tx pts. Reductions in IL-17A, IL-17F and IL-22 with GUS were significant by W4, decreased further by W16, and were sustained through W24 and W48. In GUS-tx pts, serum levels of IL-17F (from W16) and IL-22 (from W4) were not significantly different vs. HC. At W48, reductions in these same markers were seen in PBO-tx pts who crossed over to GUS at W16/24 (Figure 1; IL-17A, IL-17F, & IL-22 data shown). In these TNFi-IR pts, GUS-tx pts achieving ACR20 at W24 exhibited higher IL-22 and IFNɣ levels at BL than nonresponders (NR). All other biomarkers evaluated were not significantly associated with ACR20 response to GUS. In the subset of pts with IGA of psoriasis assessed, BL IL-6 and SAA levels were upregulated in W24 IGA 0/1 responders (R) vs. NR in the GUS arm. ACR20 and IGA 0/1 R at W24 exhibited an early greater reduction in IL-6 expression (at W4) than did respective NR in the GUS arm. No BL biomarkers were associated with ACR50 or PASI75 responses to GUS at W24.

Table 1.

Select Serum Biomarkers at BL in TNFi-IR pts vs. HC▫

Biomarker, pg/mLHC N=24TNFi-IR N=150Fold differencep-valueCRP22.1 (1.5)22.8 (2.2)1.60.2895SAA21.7 (1.2)22.8 (2.4)2.10.0794IL-60.07 (1.1)0.98 (1.7)1.90.0314*IL-10-2.3 (1.1)-1.7 (1.0)1.50.0272*IL-17A-2.1 (1.3)-0.3 (1.5)3.3<0.0001*IL-17F0.05 (1.1)1.3 (1.5)2.40.0007*IL-221.9 (1.1)3.1 (1.3)2.40.0002*TNFα0.5 (0.75)1.4 (1.1)1.80.0002*IFNɣ2.4 (0.84)2.9 (1.3)1.50.0259*

Data are mean (SD); *p<0.05 and |fold difference| >1.4; ▫adjusted for confounding factors age & sex.

Conclusion

GUS-tx TNFi-IR pts showed response-specific associations with BL biomarkers (IL-22, IFNɣ, IL-6, and SAA). GUS resulted in decreased levels of elevated CRP, SAA, IL-6, IL-17A, IL-17F, and IL-22, while no significant change was observed with PBO tx. Reductions in these biomarkers were evident as early as W4 and approximated levels seen in HC from W16 onward (W4 for IL-22), suggesting apparent normalization of effector cytokines associated with the IL-23/Th17 axis following GUS tx.

References

[1]Deodhar A et al. Lancet 2020;395:1115-25.

[2]Mease PJ et al. Lancet 2020;395:1126-36.

[3]Coates LC et al. doi:10.1136/annrheumdis-2021-220991.

Disclosure of Interests

Georg Schett Speakers bureau: Amgen, AbbVie, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, Novartis and UCB, Warner Chen Shareholder of: Janssen, Employee of: Janssen, Sheng Gao Shareholder of: Janssen, Employee of: Janssen, Soumya D Chakravarty Shareholder of: Janssen, Employee of: Janssen, May Shawi Shareholder of: Janssen, Employee of: Janssen, Frederic Lavie Shareholder of: Janssen, Employee of: Janssen, Elke Theander Shareholder of: Janssen, Employee of: Janssen, Marlies Neuhold Shareholder of: Janssen, Employee of: Janssen, Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Stefan Siebert Speakers bureau: AbbVie, Biogen, GSK, Janssen, Novartis, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, GSK, Janssen, Novartis, UCB

gagCEST imaging at 3 T MRI in patients with articular cartilage lesions of the knee and intraoperative validation

OBJECTIVE

The aim of this study was to compare glycosaminoglycan chemical exchange saturation transfer (gagCEST) of knee cartilage with intraoperative results for the assessment of early osteoarthritis (OA) and to define gagCEST values for the differentiation between healthy and degenerated cartilage.

DESIGN

Twenty-one patients with cartilage lesions or moderate OA were examined using 3 T Magnetic Resonance Imaging (MRI). In this prospective study, regions of interest (ROIs) were examined by a sagittal gagCEST analysis and a morphological high-resolution three-dimensional, fat-saturated proton-density space sequence. Cartilage lesions were identified arthroscopically, graded by the International Cartilage Repair Society (ICRS) score in 42 defined ROIs per patient and consecutively compared with mean gagCEST values using analysis of variance and Spearman's rank correlation test. Receiver operating characteristics (ROC) curves were applied to identify gagCEST threshold values to differentiate between the ICRS grades.

RESULTS

A total of 882 ROIs were examined and graduated in ICRS score 0 (67.3%), 1 (25.2%), 2 (6.2%) and the merged ICRS 3 and 4 (1.0%). gagCEST values decreased with increasing grade of cartilage damage with a negative correlation between gagCEST values and ICRS scores. A gagCEST value threshold of 3.55% was identified to differentiate between ICRS score 0 (normal) and all other grades.

CONCLUSIONS

gagCEST reflects the content of glycosaminoglycan and might provide a diagnostic tool for the detection of early knee-joint cartilage damage and for the non-invasive subtle differentiation between ICRS grades by MRI even at early stages in clinical practice.

OP0201 DYNAMIC CHANGES IN O-GLCNACYLATION REGULATE OSTEOCLAST DIFFERENTIATION AND BONE LOSS IN ARTHRITIS

Background:

Bone remodeling is a constant process maintained by the balance between osteoclast-triggered bone resorption and osteoblast-mediated bone formation. In inflammatory arthritis, such as rheumatoid arthritis (RA), the pro-inflammatory environment favors osteoclast differentiation and skews the balance towards resorption, leading to progressive bone erosion and bone loss. O-GlcNAcylation is a post-translational modification, which transfers a single N-acetylglucosamine molecule to the serine or threonine of the target protein. The modification is accomplished by a single pair of enzymes, O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Unlike other glycosylation, O-GlcNAcylation occurs in multiple cellular compartments, including the nucleus. Although O-GlcNAcylation is one of the most common modifications, its role in bone homeostasis is still poorly understood.

Objectives:

We aimed to investigate the role of O-GlcNAcylation in osteoclastogenesis under pro-inflammatory milieus. We also focused on dissecting the signaling pathways affected by O-GlcNAcylation during osteoclast differentiation.

Methods:

We examined the levels of O-GlcNAc during in vitro osteoclastogenesis by western blotting. The levels of O-GlcNAc in tissue from RA patients and experimental arthritis were detected by immunofluorescence. Pharmacological inhibition and genetic knockout were used to manipulate O-GlcNAcylaiton during osteoclastogenesis. RNA sequencing was performed to study O-GlcNAc-mediated pathways.

Results:

We demonstrate the dynamic changes in O-GlcNAcylation during osteoclastogenesis. The elevated O-GlcNAcylation was found in the early differentiation stages, whereas its downregulation was detected in the maturation process. TNFα elaborates the dynamic changes in O-GlcNAcylation, which further intensifies osteoclast differentiation.

Targeting OGT by selective inhibitor and genetic knockout restrain O-GlcNAcylation and hinder the expression of the early differentiation marker Nfatc1. Inhibition of OGA, which forces high levels of O-GlcNAcylation throughout the differentiation, reduces the formation of multinucleated mature osteoclasts. Consistent with our in vitro data, suppressing OGT and OGA both ameliorate bone loss in experimental arthritis. We detected a reduced number of TRAP-expressing precursors and mature osteoclasts in the mice subjected to OGT inhibition. While inhibiting OGA only lowers the number of TRAP+F4/80– mature osteoclasts without affecting the number of TRAP+F4/80+ precursors.

Transcriptome profiling reveals that O-GlcNAcylation regulates several biological processes. Increased O-GlcNAcylation promotes cytokine signaling and oxidative phosphorylation. The downregulation of O-GlcNAcylation is essential for cytoskeleton organization and cell fusion.

Conclusion:

We demonstrate that the dynamic changes of O-GlcNAcylation are essential for osteoclast differentiation. These findings reveal the therapeutic potential of targeting O-GlcNAcylation in pathologic bone resorption.

Disclosure of Interests:

Chih-Wei Chen: None declared, Yi-Nan Li: None declared, Thuong Trinh-Minh: None declared, ZHU Honglin: None declared, Alexandru-Emil Matei: None declared, Xiao Ding: None declared, Cuong Tran Manh: None declared, Xiaohan Xu: None declared, Christoph Liebel: None declared, Ruifang Liang: None declared, Min-Chuan Huang: None declared, Neng-Yu Lin: None declared, Andreas Ramming Speakers bureau: Boehringer Ingelheim, Roche, Janssen, Consultant of: Boehringer Ingelheim, Novartis, Gilead, Pfizer, Grant/research support from: Pfizer, Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Jörg H.W. Distler Shareholder of: 4D Science, Speakers bureau: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB, Employee of: FibroCure

POS1394 ACCURACY AND PERFORMANCE OF A HANDHELD ULTRASOUND DEVICE TO ASSESS ARTICULAR AND PERIARTICULAR PATHOLOGIES IN PATIENTS WITH INFLAMMATORY ARTHRITIS

Background:

Handheld ultrasound (HHUS) devices have increasingly found their way into clinical practice due to several advantages (e.g. portability, significantly lower purchase cost). However, there is no evidence to date on the accuracy and performance of HHUS in patients with inflammatory arthritis (IA).

Objectives:

To assess accuracy and performance of a new HHUS machine in comparison to a conventional cart-based sonographic machine in patients with IA.

Methods:

Consecutive IA patients of our outpatient clinic with at least one tender and swollen joint in the 66/68 joint count were enrolled. US was performed on clinically affected joints with corresponding tendons/entheses using a cart-based sonographic device (“Samsung HS40”) and a HHUS device (“Butterfly iQ”) in standard scan positions. One blinded reader scored all images for the presence of following pathologic findings: erosions, bony enlargement, synovial hyperthrophy, joint effusion, bursitis, tenosynovitis and enthesitis. In addition, synovitis was graded (B Mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale [1]. To avoid bias by the blinded reader, who otherwise would have been tempted to identify pathological findings for each examined joint, we also included 67 joints of two healthy volunteers into the evaluation. We calculated the overall concordance and the concordance by type of joint and type of pathological finding between the two devices (percentage of observation pairs in which the same rating was given by both devices). The Cohen’s kappa coefficient (κ) with 95% bootstrap confidence intervals was used to assess the agreement between the two US devices. We also measured the time required for the US examination of one joint with both devices.

Results:

32 patients (20 rheumatoid arthritis, 10 psoriatic arthritis, 1 gouty arthritis, 1 systemic lupus erythematosus) were included in this study. Mean age of patients was 58.2±13.7 years, 63% were females. In total 186 joints were examined. The overall raw concordance in B-mode between the two devices was 97 %, with an overall κappa for agreement of 0.90, 95% CI (0.89, 0.94). No significant differences were found in relation to type of joint or pathological finding examined. The PD-mode of the HHUS device did not detect any PD-signal, whereas the cart-based device detected a PD-signal in 61 joints (33%). The portable device did not offer any time saving compared to the cart-based device (mean time in seconds per examined region: 47 seconds for the HHUS device versus 46.3 seconds for the cart-based device).

Conclusion:

The HHUS device “Butterfly iQ” has been shown to be accurate in the assessment of structural joint damage and inflammation in patients with IA, but only in B-mode. Significant improvements are still needed to reliable demonstrate blood flow detection by PD mode.

References:

[1]D’Agostino, M.A., et al., RMD Open, 2017. 3(1): p. e000428.

Table 1.

Concordance between a handheld and a conventional cart-based US device in B-mode

Agreement by siteN joints (%)Concordance (%)Kappa 95%CIOverall186970.90 (0.89 to 0.94)Wrist32 (17.2)960.86 (0.77 to 0.93)Finger/toe joint (MCP, PIP, DIP, MTP)114 (61.3)970.92 (0.88 to 0.95)Elbows11 (5.9)950.87 (0.75 to 0.97)Shoulder4 (2.2)1001.00 (NA to NA) *Knee20 (10.7)980.96 (0.90 to 1.00)Ankle5 (2.7)1001.00 (NA to NA) *Agreement by pathological findingJoint effusion950.81 (0.68 to 0.92)Synovitis940.87 (0.79 to 0.93)Synovitis OMERACT grade (0– 3)900.84 (0.76 to 0.91)Bone enlargement980.88 (0.71 to 1.00)Erosion980.89 (0.77 to 0.89)Tenosynovitis980.83 (0.61 to 0.96)Entheseopathy1001.00 (NA to NA) *Bursitis970.90 (0.89 to 0.94)

* unreliable kappa statistics because of small number of shoulders/ankles examined and small number of entheseopathies

Figure 1.

Pathological US findings in MCP joints (1, 2, 3) and wrist (4) depicted by the two different ultrasound devices

B-mode erosive (arrow) and synovial (asterisk) changes could be detected by both devices (1-2), while PD changes of different grades only by the conventional US device (3-4).

Acknowledgements:

This study was supported by the Deutsche Forschungsgemeinschaft (DFG- FOR2886 PANDORA and the CRC1181). Additional funding was received by the Bundesministerium für Bildung und Forschung (BMBF; project METARTHROS, MASCARA), the H2020 GA 810316 - 4D-Nanoscope ERC Synergy Project, the IMI funded project RTCure, the Emerging Fields Initiative MIRACLE of the Friedrich-Alexander-Universität Erlangen-Nürnberg, the Else Kröner-Memorial Scholarship (DS, no. 2019_EKMS.27) and Innovationsfond Lehre / FAU Erlangen-Nürnberg 2019.

Disclosure of Interests:

None declared

AB0016 THE IMPACT OF IL-17A THERAPY ON IGG SIALYLATION IN HUMANS

Background:

Rheumatoid arthritis (RA) is characterized by autoreactive B- and T cells. Autoantibodies are a hallmark of RA and contribute to synovial inflammation. We have recently demonstrated that Th17 cells suppress the enzyme ST6 a-galactoside b-2,6-sialyltransferase (ST6GAL1) in developing plasma cells. Thereby, Th17 cells regulate the degree of autoantibody sialylation leading to the increased inflammatory activity of autoantibodies. These events correlate with the onset of RA, arguing for a crucial role of the IL-23/Th17 axis during the transition of asymptomatic autoimmunity into active RA. Therefore, treatment against the IL-23/TH17-axis might present an attractive therapeutic approach to halt or delay RA’s onset. However, the effects of Th17 cytokines like IL-17 on IgG glycosylation in humans are so far poorly studied.

Objectives:

To explore whether anti-IL17A treatment can inhibit pro-inflammatory IgG glycosylation patterns in humans.

Methods:

Total IgG from patient cohorts suffering from psoriatic arthritis (PsA) treated with Secukinumab (anti-IL-17 blockade, n=26) or Ustekinumab (anti-IL12/23 blockade, n=14) was compared with patients treated with anti-TNFa blockade as a control (n=20). The cohorts were age- and sex-matched and included patients being on therapy for at least six months. Total IgG was isolated using Protein G columns, and IgG glycopeptides of IgG1, IgG2, and IgG4 were analyzed using the LC-MS technique. The effect of IL-17 depletion on IgG glycosylation was analyzed in psoriatic arthritis patients who have been treated with secukinumab for at least six months. Furthermore, in a longitudinal approach, IgG1, IgG2, and IgG4 glycosylation were analyzed from samples, isolated before the beginning of anti-IL-17 blockade and after at least six months of therapy (n=16).

Results:

Cross-sectional comparison of cohorts treated with Ustekinumab, Sekukinumab, and anti-TNFa therapy did not show any significant differences in sialylation, galactosylation, or fucosylation of IgG1 and IgG2. IgG4 from anti-TNFa treated patients displayed a small increase of sialylation when compared to the Ustekinumab treated cohort.

Longitudinal analyses, however, showed that IL-17A blockade during Secukinumab therapy caused a significant increase of sialic acid-rich IgG glycoforms on IgG1, IgG2 IgG4 patients, while the galactosylation, fucosylation remained unaffected.

Conclusion:

This data indicates that IL-17A blockade specifically affects IgG sialylation, while other Fc-glycan modifications remain unaltered. This data confirms our recent findings in mice, where cytokines of the IL-23/Th17 axis specifically induce the production of hypo-sialylated, proinflammatory autoantibodies in rheumatoid arthritis (RA) [2]. Therefore, neutralizing IL-17 might be a therapeutic option during the asymptomatic autoimmune prodromal phase in autoimmune diseases like RA, where TH17 cytokines orchestrate the emergence of a pro-inflammatory autoantibody response and the transition into active RA.

References:

[1]McInnes IB, G. Schett, The pathogenesis of rheumatoid arthritis. N Engl J Med 2011; 365: 2205-19.

[2]Pfeifle R et al, Regulation of autoantibody activity by the IL-23-Th17 axis determines the onset of autoimmune disease. Nat Immunol. 2017, Jan;18(1):104-113.

Disclosure of Interests:

Rene Pfeifle Grant/research support from: Novartis AG., Julia Kittler: None declared, Manfred Wuhrer: None declared, Georg Schett: None declared, Gerhard Krönke Grant/research support from: Novartis AG

POS0423 NCOA3 AMPLIFIES PROFIBROTIC TRANSCRIPTIONAL PROGRAMS IN SYSTEMIC SCLEROSIS

Background:

Excessive activation of fibroblasts with a TGFβ-biased gene signature and deposition of extracellular matrix are key features of fibrotic diseases. The mechanisms underlying these transcriptional changes remain poorly understood. Deregulation, mutations and malfunctions of transcriptional co-regulators, which can interact with multiple transcription factors and enable a broad-spectrum regulation of transcriptional networks, have been implicated as driving factors in a large number of diseases and pathologies.

Objectives:

In the present study, we aimed to analyze the role of the co-regulator Nuclear Receptor Co-Activator 3 (NCOA3) in fibroblast activation and tissue fibrosis, and to evaluate a potential interaction of NCOA3 with fibrosis-relevant transcription factors.

Methods:

NCOA3 was inhibited genetically by siRNA transfection and pharmacologically by the SRC3 inhibitor-2 (SI-2). We performed bulk RNASeq of human dermal fibroblasts and in silico transcription factor binding site screening of differentially expressed genes (DEGs). The interaction of NCOA3 and TGFβ-SMAD signaling was analyzed by reporter and CoIP assays.

Results:

The expression of NCOA3 in skin biopsies of SSc patients compared to normal controls demonstrated that SSc fibroblasts express modestly, but significantly reduced levels of NCOA3, which persisted in cultured SSc fibroblasts. Stimulation of normal fibroblasts with chronically high levels of TGFβ as they also occur in fibrotic tissue remodeling strongly decreased NCOA3 expression to a similar extent as in SSc fibroblasts. Furthermore, NCOA3 expression is also deregulated in different murine models of skin fibrosis. To investigate the functional effects of decreased NCOA3 levels, we targeted the expression of NCOA3 in normal fibroblasts. SiRNA-mediated knockdown of NCOA3 ameliorated TGFβ-induced gene expression, collagen release, myofibroblast differentiation and cell proliferation. In contrast, knockdown of NCOA3 had no effects on collagen release, expression of contractile proteins or gene expression in unstimulated fibroblasts, suggesting that NCOA3 is not required for cellular homeostasis. To characterize the molecular mechanisms, we performed RNASeq upon NCOA3 knockdown. We identified 343 significant differentially expressed genes (220 downregulated and 123 upregulated with a Benjamini-Hochberg false discovery rate FDR < 0.25 and fold change > 1.5) between TGFβ-stimulated fibroblasts with and without NCOA3 knockdown (NCOA3-DEGs) including the fibrosis-relevant genes EDNRB, COL5A3, HES1, IL11 or IL33. Functional analysis of the NCOA3-DEGs showed enrichment of pathway terms such as collagen binding and extracellular matrix organization. In silico screening of the promoters of the NCOA3-DEGs for potential transcription factor binding motifs revealed binding motifs of core transcription factors of fibroblast activation and tissue fibrosis such as SMAD2/3/4, RBPJ, ZEB1, TCF4, REL, and SNAIL2 amongst the downregulated NCOA3-DEGs. Experimental validation of our biostatistical results using SMAD3 as example demonstrated a higher percentage of NCOA3-pSMAD3 double-positive fibroblasts in skin sections of SSc patients compared to healthy controls. In addition, knockdown of NCOA3 reduced TGFβ-induced SMAD-reporter activity. Furthermore, stimulation with TGFβ increased the interaction of NCOA3 with SMAD3 as analyzed by co-immunoprecipitation. Simultaneous knockdown of NCOA3 and SMAD3 showed no additional reductions compared to the single knockdowns, suggesting that NCOA3 controls SMAD3-dependent gene transcription under fibrotic conditions. Finally, inhibition of NCOA3 showed anti-fibrotic effects in different murine models of experimental skin and lung fibrosis.

Conclusion:

Our findings characterize NCOA3 as regulator of multiple pro-fibrotic transcription programs. Pharmaceutical inhibition of NCOA3 might be a strategy to interfere simultaneously with several core pro-fibrotic mediators in fibrotic diseases such as SSc.

Acknowledgements:

We thank Lena Summa, Vladyslav Fedorchenko, Wolfgang Espach and Regina Kleinlein for excellent technical assistance.

The study was funded by grants DI 1537/7-1, DI 1537/8-1, DI 1537/9-1 and -2, DI 1537/11-1, DI 1537/12-1, DI 1537/13-1, DI 1537/14-1, DI 1537/17-1, DE 2414/2-1, DE 2414/4-1, and RA 2506/3-1 of the German Research Foundation, SFB CRC1181 (project C01) and SFB TR221/ project number 324392634 (B04) of the German Research Foundation, grants J39, J40 and A64 of the IZKF in Erlangen, grant 2013.056.1 of the Wilhelm-Sander-Foundation, grants 2014_A47, 2014_A248 and 2014_A184 of the Else-Kröner-Fresenius-Foundation, grant 14-12-17-1-Bergmann of the ELAN-Foundation Erlangen, BMBF (Era-Net grant 01KT1801), MASCARA program, TP 2 and a Career Support Award of Medicine of the Ernst Jung Foundation.

Disclosure of Interests:

Clara Dees: None declared, Sebastian Poetter: None declared, Maximilian Fuchs: None declared, Christina Bergmann: None declared, Alexandru-Emil Matei: None declared, Andrea-Hermina Györfi: None declared, Alina Soare: None declared, Andreas Ramming: None declared, Paolo Ceppi: None declared, Georg Schett: None declared, Meik Kunz: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, ARXX, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB

OP0225 DEPRESSIVE SYMPTOMS IN PSA: A CROSS-SECTIONAL ANALYSIS FROM THE NATIONAL GERMAN RABBIT-SPA REGISTRY

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system as well as skin and nails. The prevalence of depression in psoriasis and PsA is high and ranges from 7-40% [1]. Persistent depressive mood may influence disease activity outcome in PsA, especially patient-reported outcomes.

Objectives:

To assess the correlation of depressive symptoms with PsA-specific outcome parameters.

Methods:

RABBIT-SpA is a prospective longitudinal cohort study including PsA patients enrolled at start of a new conventional treatment or b/tsDMARD treatment. In regularly provided follow-up questionnaires, physician- and patient-reported information on the disease course including the depression screening tool WHO-5 to assess mental health is collected. For the current analysis, the WHO-5 score was categorised into 4 groups using validated cut-offs: severe depressive symptoms <13, moderate depressive symptoms 13-28, mild depressive symptoms 29-50, well-being >50. Spearman correlation coefficient was calculated to analyse the relationship between the WHO-5 score and various PsA related outcome parameters.

Results:

936 PsA patients were included. Baseline characteristics are shown in Table 1. In 411 patients (43.9%) the WHO-5 score indicated well-being, 249 (26.6%) had mild depressive, 203 (21.7%) moderate depressive and 73 patients (7.8%) severe depressive symptoms. WHO-5 results correlated with patient reported skin involvement (DLQI: -0.25, patient assessment skin: -0.17), and the composite scores DAPSA (-0.33) and DAS28 (-0.28) as well as with patient reported pain (-0.43) and patient global disease assessment (-0.42). The highest correlation was found for physician assessed global health status (-0.51) and PSAID (-0.62). No significant correlation was found with CRP, swollen joint count and physician assessed skin involvement including body surface area (BSA).

Table 1.

Baseline characteristics of patients included in the analysis stratified by WHO-5 categories.

ParameterWHO-5 (<13) severeN=73WHO-5 (13-28) moderateN=203WHO-5 (29-50) mildN=249WHO-5 (>50) well-beingN=411TotalN=936Age, mean (SD)52.6 (11.4)51 (11.3)51.4 (12.5)52.8 (12.7)52 (12.2)Female, n (%)52 (71.2)127 (62.6)157 (63.1)227 (55.2)563 (60.1)Disease duration, years, mean (SD)8.3 (8.7)6 (7.9)6.2 (6.7)6.4 (7.5)6.4 (7.5)Dactylitis, n (%)14 (19.7)31 (15.5)46 (18.5)77 (18.8)168 (18.1)Axial involvement, n (%)14 (19.7)54 (26.9)49 (19.7)71 (17.3)188 (20.2)Nail involvement, n (%)34 (47.2)85 (42.3)106 (42.6)158 (38.6)383 (41.1)BMI>=30, n (%)37 (51.4)75 (37.1)98 (39.5)125 (30.9)335 (36.2)CRP of >=5 mg/L, n (%)33 (51.6)84 (45.4)99 (46.5)138 (39.1)354 (43.4)BSA (0-100), mean (SD)10.1 (18.3)9.5 (16.8)8.5 (14.9)8.1 (14.6)8.7 (15.5)Physician assessed global health (NRS 0-10), mean (SD)6.3 (1.5)5.6 (1.8)5.2 (1.7)4.9 (1.9)5.2 (1.9)TJC68, mean (SD)9.9 (7.1)8.6 (7.6)8.2 (7.6)7.3 (8.2)8 (7.8)SJC66, mean (SD)6 (5.2)4.8 (4.9)4.7 (4.4)4.3 (3.8)4.6 (4.4)DAPSA, mean (SD)29.3 (11.1)25.1 (12.9)23.4 (12.1)18.9 (12.4)22.3 (12.8)DAS28-CRP, mean (SD)4.1 (1)3.8 (1.2)3.7 (1.1)3.2 (1.1)3.6 (1.2)Patient assessed global health (NRS 0-10), mean (SD)7.9 (2.1)6.6 (2.1)5.9 (2)4.8 (2.3)5.7 (2.4)Patient assessed pain (NRS 0-10), mean (SD)7.8 (1.8)6.4 (2.1)5.8 (2)4.6 (2.4)5.5 (2.4)DLQI (0-30), mean (SD)8.5 (8.2)7.8 (7.2)5.4 (5.7)4.1 (4.9)5.6 (6.2)PSAID (0-10), mean (SD)6.9 (1.8)5.5 (1.8)4.4 (1.7)3 (1.7)4.2 (2.2)

Conclusion:

The impact of depressive symptoms on outcome parameters used in rheumatology is increasingly being recognised. Interestingly, direct measures of inflammatory disease activity of joint and skin disease such as BSA, CRP, and swollen joint count were not correlated with depressive symptoms. The highest correlation was found for broader assessments like global health status and PSAID.

References:

[1]Haugeberg et al. Arthritis research & Therapy, 2020, 22:198

Acknowledgements:

RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.

We thank all participating rheumatologists and patients.

Disclosure of Interests:

Anne Regierer Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Weiß Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Martin Bohl-Buehler: None declared, Xenofon Baraliakos: None declared, Frank Behrens: None declared, Georg Schett: None declared, Anja Strangfeld Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.

OP0074 A FRAMEWORK OF POTENTIAL INTERVENTIONS TO ACCELERATE GENDER-EQUITABLE CAREER ADVANCEMENT IN ACADEMIC RHEUMATOLOGY

Background:

A growing number of professional societies in clinical and medically related disciplines investigate evidence, make recommendations, and take action to advance gender equity. Evidence on women’s advancement and leadership in the context of the European Alliance of Associations for Rheumatology, EULAR, is limited [1].

Objectives:

The objective of the EULAR Task Force on Gender Equity in Academic Rheumatology was to establish the extent of the unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology and develop a framework to address this through EULAR and Emerging EULAR Network (EMEUNET).

Methods:

Potential interventions to accelerate gender-equitable career advancement in academic rheumatology were gathered from a narrative review of the relevant literature, expert opinion of a multi-disciplinary Task Force (comprised of 23 members from 11 countries), data from the surveys of EULAR scientific member society leaders, EULAR and EMEUNET members, and EULAR Executive Committee members. These interventions were rated by Task Force members, who ranked each according to perceived priority on a five-point numeric scale from 1 = very low to 5 = very high.

Results:

A framework of 29 potential interventions was formulated, which covers six thematic areas, namely, EULAR policies, advocacy and communication, EULAR Congress and associated symposia, training courses, mentoring/peer support, and EULAR funding (Figure 1).

Figure 1.

A framework of potential interventions with the levels of priority, mean and standard deviation (SD)

Conclusion:

The framework provides structured interventions for accelerating gender-equitable career advancement in academic rheumatology.

References:

[1]Andreoli L, Ovseiko PV, Hassan N, et al. Gender equity in clinical practice, research and training: Where do we stand in rheumatology? Joint Bone Spine 2019;86(6):669-72.

Acknowledgements:

The task force is grateful to EULAR for funding this activity under project number EPI 024.

Disclosure of Interests:

None declared

OP0147 RHEUMATIC? - A DIGITAL DIAGNOSTIC DECISION SUPPORT TOOL FOR INDIVIDUALS SUSPECTING RHEUMATIC DISEASES: A MULTICENTER VALIDATION STUDY

Background:

Digital diagnostic decision support tools promise to accelerate diagnosis and increase health care efficiency in rheumatology. Rheumatic? is an online tool developed by specialists in rheumatology and general medicine together with patients and patient organizations for individuals suspecting a rheumatic disease.1,2 The tool can be used by people suspicious for rheumatic diseases resulting in individual advise on eventually seeking further health care.

Objectives:

We tested Rheumatic? for its ability to differentiate symptoms from immune-mediated diseases from other rheumatic and musculoskeletal complaints and disorders in patients visiting rheumatology clinics.

Methods:

The performance of Rheumatic? was tested using data from 175 patients from three university rheumatology centers covering two different settings:

A.Risk-RA phase setting. Here, we tested whether Rheumatic? could predict the development of arthritis in 50 at risk-individuals with musculoskeletal complaints and anti-citrullinated protein antibody positivity from the KI (Karolinska Institutet)

B.Early arthritis setting. Here, we tested whether Rheumatic? could predict the development of an immune-mediated rheumatic disease in i) EUMC (Erlangen) n=52 patients and ii) LUMC (Leiden) n=73 patients.

In each setting, we examined the discriminative power of the total score with the Wilcoxon rank test and the area-under-the-receiver-operating-characteristic curve (AUC-ROC).

Results:

In setting A, the total test score clearly differentiated between individuals developing arthritis or not, median 245 versus 163, P < 0.0001, AUC-ROC = 75.3 (Figure 1). Also within patients with arthritis the Rheumatic? total score was significantly higher in patients developing an immune-mediated arthritic disease versus those who did not: median score EUMC 191 versus 107, P < 0.0001, AUC-ROC = 79.0, and LUMC 262 versus 212, P < 0.0001, AUC-ROC = 53.6.

Figure 1.

(Area under) the receiver operating curve for the total Rheumatic? score

Conclusion:

Rheumatic? is a web-based patient-centered multilingual diagnostic tool capable of differentiating immune-mediated rheumatic conditions from other musculoskeletal problems. A following subject of research is how the tool performs in a population-wide setting.

References:

[1]Knitza J. et al. Mobile Health in Rheumatology: A Patient Survey Study Exploring Usage, Preferences, Barriers and eHealth Literacy. JMIR mHealth and uHealth. 2020.

[2]https://rheumatic.elsa.science/en/

Acknowledgements:

This project has received funding from EIT Health. EIT Health is supported by the European Institute of Innovation and Technology (EIT), a body of the European Union that receives support from the European Union’s Horizon 2020 Research and Innovation program.

This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777357, RTCure.

Disclosure of Interests:

Rachel Knevel: None declared, Johannes Knitza: None declared, Aase Hensvold: None declared, Alexandra Circiumaru: None declared, Tor Bruce Employee of: Ocean Observations, Sebastian Evans Employee of: Elsa Science, Tjardo Maarseveen: None declared, Marc Maurits: None declared, Liesbeth Beaart- van de Voorde: None declared, David Simon: None declared, Arnd Kleyer: None declared, Martina Johannesson: None declared, Georg Schett: None declared, Thomas Huizinga: None declared, Sofia Svanteson Employee of: Elsa Science, Alexandra Lindfors Employee of: Ocean Observations, Lars Klareskog: None declared, Anca Catrina: None declared

POS0328 ENGRAILED 1 COORDINATES CYTOSKELETAL ORGANIZATION TO PROMOTE MYOFIBROBLAST DIFFERENTIATION AND FIBROTIC TISSUE REMODELING

Background:

Engrailed 1 (EN1) is a homeodomain-containing transcription factor with essential roles in embryonic development. In most cell types, the expression of EN1 is restricted to embryonic development. However, under pathological conditions, EN1 can be re-expressed to promote phenotypical adaptation. En1 is transiently expressed in the developing dermis of murine embryos in a distinct fibroblast lineage and silenced before birth (1). Former EN1-expressing cells give rise to a subpopulation of fibroblasts that has a high capacity for extracellular matrix production in adult murine skin. The role of EN1 in systemic sclerosis (SSc) was previously not explored.

Objectives:

To study the role of EN1 in the pathological activation of fibroblasts in tissue fibrosis.

Methods:

Bulk RNA-Seq and EN1 or SP1 ChIP-Seq were performed from cultured human dermal fibroblasts. The expression of EN1 was inhibited by siRNA. Cytoskeletal drugs paclitaxel, vinblastin and ROCK inhibitor (Y27632) were used to modulate the cytoskeleton in EN1 knockdown or overexpressing dermal fibroblasts. The role of EN1 in fibroblast activation was evaluated by functional experiments with EN1 knockdown or overexpression in standard 2D culture systems as well as in 3D skin equivalent models. The role of EN1 in skin fibrosis was further studied in En1fl/fl X Col6Cre mice, with fibroblast-specific knockout of En1 in three complementary mouse models: overexpression of a constitutively active TGFß-receptor I (TBRICA), bleomycin-induced skin fibrosis and TSK1 mice.

Results:

Pathologically activated dermal fibroblasts from SSc patients express higher levels of EN1 compared with age and sex matched healthy individuals in the skin and in vitro. TGFβ induces EN1 expression in fibroblasts in a SMAD3-dependent manner both in cultured fibroblasts and in murine skin. Knockdown of EN1 prevents TGFβ-induced fibroblast activation, whereas overexpression of EN1 fosters the pro-fibrotic effects of TGFβ with increased expression of αSMA, stress fibers and collagen. RNA sequencing demonstrates that EN1 induces a pro-fibrotic gene expression profile functionally related to cytoskeleton organization and ROCK activation. In silico analyses of the promoters of En1 target genes coupled with siRNA-mediated knockdown demonstrated that EN1 regulates these pro-fibrotic target genes by modulating the activity of regulatory modules that contain transcription factors of the specificity protein (SP) family. Functional experiments with selective modulators of ROCK and of microtubule polymerization confirm the coordinating role of EN1 on ROCK activity and the re-organization of cytoskeleton during myofibroblast differentiation in both conventional culture systems and 3D skin equivalents. Consistently, mice with fibroblast-specific knockout of En1 demonstrate impaired fibroblast-to-myofibroblast transition, reduced dermal thickening and impaired collagen deposition in the TBRICA, bleomycin-induced and TSK1 models.

Conclusion:

We characterize the homeodomain transcription factor EN1 as a molecular amplifier of TGFβ signaling in myofibroblast differentiation that coordinates cytoskeletal organization in a SP-dependent manner. EN1 might thus be a novel candidate for molecular targeted therapies to interfere with myofibroblast differentiation in fibrotic diseases.

References:

[1]Rinkevich Y, Walmsley GG, Hu MS, Maan ZN, Newman AM, Drukker M, et al. Skin fibrosis. Identification and isolation of a dermal lineage with intrinsic fibrogenic potential. Science. 2015;348(6232):aaa2151.

Disclosure of Interests:

Andrea-Hermina Györfi: None declared, Alexandru-Emil Matei: None declared, Maximilian Fuchs: None declared, Aleix Rius Rigau: None declared, Xuezhi Hong: None declared, ZHU Honglin: None declared, Markus Luber: None declared, Christina Bergmann: None declared, Clara Dees: None declared, Ingo Ludolph: None declared, Raymund Horch: None declared, Oliver Distler Consultant of: Actellion, AbbVie, Acceleron Pharma, Anamar, Amgen, Blade Therapeutics, CSL Behring, ChemomAb, Ergonex, Glenmark Pharma, GSK, Inventiva, Italfarmaco, iQvia, Medac, Medscape, Lilly, Sanofi, Target BioScience, UCB, Bayer, Boehringer Ingelheim, Catenion, iQone, Menarini, Mepha, Novartis, Mitsubishi, MSD, Roche, Pfizer, Georg Schett: None declared, Meik Kunz: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB., Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB

OP0226 TOWARDS DEVELOPMENT OF AN ULTRASOUND ENTHESITIS SCORE IN PSORIATIC ARTHRITIS: 24-WEEK RESULTS FROM THE PHASE III RANDOMISED ULTIMATE STUDY

Background:

Enthesitis is a key clinical domain and imaging hallmark of psoriatic arthritis (PsA). Ultrasound (US) is a highly sensitive tool for detecting synovitis and enthesitis in PsA. The Outcome Measures in Rheumatology Initiative (OMERACT) has developed an US definition and scoring system of enthesitis for clinical studies.1 The ULTIMATE study (NCT02662985) is the first large double-blind (DB), placebo-controlled phase IIIb study designed to demonstrate a rapid and significant benefit of subcutaneous secukinumab vs. placebo on US detected synovitis in patients with PsA.2

Objectives:

To report the enthesitis response to secukinumab over 24 weeks using two novel US composite enthesitis scores.

Methods:

This was a 52-week study consisting of a 12-week DB, a 12-week open-label (OL) and a 6-month extension period.2 Inclusion criteria required ≥1 clinical enthesitis as per SPARCC enthesitis index, but not US-assessed enthesitis.2 Patients were randomised (1:1) to either weekly secukinumab (300 or 150 mg according to severity of skin psoriasis) or placebo followed by 4-weekly dosing thereafter. All placebo patients switched to OL secukinumab (placebo-secukinumab) at Week 12. Throughout the study, enthesitis was assessed with SPARCC and US. Six anatomical sites were assessed bilaterally with US: insertions of lateral epicondyle tendons, quadriceps, patellar ligaments (distal and proximal insertions), Achilles tendons and plantar fascia. Two exploratory global OMERACT-US enthesitis scores were tested: Definition 1 combining power Doppler (PD; 0–3) and Grey Scale (0–1) inflammation and Definition 2 rating PD only (0–3) across the six anatomical sites. Data were analysed with mixed-effect model repeated measures (MMRM) up to Week 12 and as observed from Week 12 to 24. The comparison of OMERACT-US enthesitis score within treatment groups was tested with paired and between treatment groups with unpaired t-tests.

Results:

Of 166 patients enrolled, 93% completed 24 weeks of treatment (secukinumab, 95%; placebo-secukinumab, 92%). The average clinical enthesitis count at baseline was 4. Since the presence of PD was not a mandatory inclusion criterion, a higher proportion of patients met Global OMERACT-US enthesitis score with Definition 1 vs. Definition 2 (81% vs. 33%) at baseline (Table). Mean reduction from baseline to Week 24 in SPARCC enthesitis index was 3 each for initial secukinumab and placebo-secukinumab groups. Resolution of enthesitis (SPARCC) was 46% for initial secukinumab and 54% for placebo-secukinumab groups at Week 24. A comparable decrease in OMERACT-US enthesitis (Definition 1 and 2) score was observed from baseline to Week 24 for initial secukinumab and placebo-secukinumab groups (Figure).

Table 1.

Distribution of US detected enthesitis at baseline according to OMERACT enthesitis score Definition 1 and 2

SecukinumabPlaceboDef 1 >0Def 2 >0Def 1 >0Def 2 >0N=73346120Anatomical sites, %Achilles tendon4912452Lateral epicondyle49214621Patellar ligament distal insertion348294Patellar ligament proximal insertion3410184Plantar fascia360280Quadriceps insertion5512402

Proportion of patients is irrespective of the enthesitis site left or right side. N, total number of patients

Conclusion:

A consistent clinical and US response on enthesitis was shown through 24 weeks across initial secukinumab and placebo switcher groups. While ULTIMATE has demonstrated the responsiveness of these global OMERACT-US enthesitis scores, further work is required to test these scores in PsA cohorts with inclusion criteria for both clinical and US enthesitis.

References:

[1]Balint PV, et al. Ann Rheum Dis. 2018;77:1730-5.

[2]D’Agostino MA, et al. Arthritis Rheumatol. 2020;72(suppl 10).

Disclosure of Interests:

Maria-Antonietta D’Agostino Speakers bureau: Sanofi, Novartis, BMS, Janssen, Celgene, AbbVie, UCB pharma and Eli Lilly, Consultant of: Sanofi, Novartis, BMS, Janssen, Celgene, AbbVie, UCB pharma and Eli Lilly, Philip G Conaghan Speakers bureau: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, Gilead, Novartis and Pfizer, Consultant of: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, Gilead, Novartis and Pfizer, Corine Gaillez Shareholder of: Novartis and BMS, Employee of: Novartis, Maarten Boers Consultant of: BMS, Novartis, Pfizer, and GSK, Esperanza Naredo Speakers bureau: AbbVie, Roche, BMS, Pfizer, UCB, Eli Lilly, Novartis, Janssen and Celgene, Consultant of: AbbVie, Novartis and BMS, Grant/research support from: Eli Lilly, Philippe Carron Speakers bureau: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Consultant of: Pfizer, MSD, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene, Grant/research support from: UCB, MSD and Pfizer, Petra Hanova: None declared, Tomás Cazenave: None declared, Catherine Bakewell Speakers bureau: AbbVie, Novartis, Sanofi Genzyme, and consulting honoraria from Pfizer, UCB, and Janssen, Consultant of: AbbVie, Novartis, Sanofi Genzyme, and consulting honoraria from Pfizer, UCB, and Janssen, Anne-Marie Duggan Employee of: Novartis, Punit Goyanka Employee of: Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Roche and UCB pharma

OP0272 68GA-FAPI-04 PET/CT STUDY EXTENSION FOR THE ASSESSMENT OF FIBROBLAST ACTIVATION AND RISK EVALUATION IN SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is the most common cause of death in systemic sclerosis (SSc). To date, the progression of SSc-ILD is judged by the accrual of lung damage on computed tomography (CT) and functional decline (forced vital capacity). However, this approach does not directly assess the activity of tissue remodeling. Moreover, prediction of the course of ILD in individual SSc patients remains challenging. Fibroblast Activation Protein (FAP) is a specific, ex vivo validated marker for activated fibroblasts.

Objectives:

The aims of this study were: 1. To assess differences in the uptake of 68GA-FAPI 04 in SSc-ILD patients compared to controls, to analyze 2. whether 68GA-FAPI 04 uptake at baseline correlates with other risk factors of disease progression and 3. Whether 68GA-FAPI 04 uptake is associated with the course of SSc-ILD.

Methods:

Between September 2018 and April 2020, 21 patients with SSc-ILD confirmed by HRCT and onset of SSc-ILD within ≤ 5 years or signs of progressive ILD and 21 controls without ILD were consecutively enrolled. All participants underwent 68Ga-FAPI-04 PET/CT imaging and standard-of-care procedures including HRCT and lung function testing (PFT) at baseline. Patients with SSc-ILD patients were followed-up for 6 months with HRCT and PFT. Follow-up 68Ga-FAPI-04 PET/CT scans were obtained in a subset of patients treated with nintedanib. We compared baseline 68Ga-FAPI-04 PET/CT uptake to standard diagnostic tools and currently used predictors of ILD progression. The association of 68Ga-FAPI-04 uptake with changes in FVC was analyzed using mixed-effects models.

Results:

68Ga-FAPI-04 accumulated in fibrotic areas of the lungs in SSc-ILD compared to controls with a median (q1-q3 interval) wlSUVmean of 0.8 (0.6 to 2.1) in the SSc-ILD group and 0.5 (0.4 to 0.5) in the control group (p<0.0001 with Mann-Whitney test) and a median whole lung maximal standardized uptake value (wlSUVmax) of 4.4 (3.05 to 5.2) in the SSc-ILD group compared to 0.7 (0.65 to 0.7) in the control group (p<0.0001). wlFAPI-MAV and wlTL-FAPI were not measurable in control subjects, as no 68Ga-FAPI-04 uptake above background level was observed. In the SSc-ILD group the median wlFAPI-MAV was 254cm3 (163.4 to 442.3) and the median wlTL-FAPI was 183.6 cm3 (98.04 to 960.7). 68Ga-FAPI-04 uptake was higher in patients with extensive disease, with previous ILD progression or high EUSTAR activity scores. Increased 68Ga-FAPI-04 uptake at baseline was associated with progression of ILD independently of extent of involvement on HRCT scan and the forced vital capacity at baseline. In consecutive 68Ga-FAPI-04-PET/CTs, changes in 68Ga-FAPI-04 uptake was concordant with the observed response to the fibroblast-targeting antifibrotic agent nintedanib.

Conclusion:

Our study presents first in human evidence that 68Ga-FAPI-04-fibroblast uptake correlates with fibrotic activity and disease progression in the lungs of SSc-ILD patients and that 68Ga-FAPI-04-PET/CT may be of potential to improve risk assessment of SSc-ILD.

Figure 1.

A and B:68Ga-FAPI-04 PET/CT scan from a patient with SSc-ILD with selective 68Ga-FAPI-04 uptake in fibrotic areas of the left- and right lower lung lobes (red arrows), but not in non-fibrotic areas such as the middle lobe (green arrow). B Corresponding CT component.

Acknowledgements:

We gratefully acknowledge Prof. Uwe Haberkorn (University Hospital Heidelberg and DKFZ, Heidelberg, Germany) and iTheranostics Inc. (Dulles, VA, USA) for providing the precursor FAPI-04.

Disclosure of Interests:

Christina Bergmann: None declared, Jörg H.W. Distler Speakers bureau: Actelion, Anamar, ARXX, Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, ARXX, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB, Christoph Treutlein: None declared, Koray Tascilar Speakers bureau: Gilead sciences GmbH, Pfizer Turkey, UCB Turkey, Anna-Theresa Mueller: None declared, Armin Atzinger: None declared, Alexandru-Emil Matei: None declared, Johannes Knitza: None declared, Andrea-Hermina Györfi: None declared, Anja Lueck: None declared, Clara Dees: None declared, Alina Soare: None declared, Andreas Ramming: None declared, Verena Schönau: None declared, Oliver Distler Speakers bureau: Arxx Therapeutics, Baecon Discovery, Blade Therapeutics,Bayer, Böhringer Ingelheim, Catenion,Competitive Drug Development International Ltd, Corbuspharma, CSL Behring, ChemomAb, Horizon Pharmaceuticals, Ergonex, Galaapagos NV, Glenmark Pharmaceuticals,GSK, Inventiva, Italfarmaco, IQvia, Kymera, Lilly, Medac, Medscape, MSD, Novartis, Pfizer, Roche, Sanofi, Taget Bio Sciencec, UCB, Grant/research support from: Bayer,Böhringer Ingelheim, Mitsubishi Tanabe Pharma, Olaf Prante: None declared, Philipp Ritt: None declared, Theresa Ida Goetz: None declared, Markus Koehner: None declared, Michael Cordes: None declared, Tobias Baeuerle: None declared, Torsten Kuwert Speakers bureau: Honoraria for occasional lectures by Siemens Healthineers, Grant/research support from: Research grant to the Clinic of Nuclear Medicine by this entity covering projects in the field of SPECT/CT, Georg Schett: None declared, Christian Schmidkonz: None declared