AB0609 Gaps in the diagnosis of Takayasu Arteritis: a Romanian cohort

Background

The diagnosis of Takayasu arteritis still represents a big challenge, even though the disease was first described more than 100 years ago. Proof of that is the continuing effort to develop criteria with high specificity and sensitivity.1

Objectives

The aim of the study was to describe the clinical and paraclinical aspects of the disease at the time of diagnosis. Additionally, we wanted to evaluate the damage score in view of the diagnosis delay.

Methods

We retrospectively studied the clinical chart of 17 consecutive patients admitted to the Rheumatology Clinic of Emergency County Hospital from Cluj-Napoca, Romania between 2003 and 2021.

Results

There was just one man in the cohort (0.05%). The average age at the time of diagnosis was 37.5 years old. The average delay in the diagnosis was 33 months, while the biggest delay was of 240 months. The diagnosis was made by rheumatologists in 58% of the cases, while 29% by cardiologists and 11.7% by internal medicine specialists. The most frequent symptoms were limb claudication (64.7%), fatigue (52.9%) and headache (52.9%). Vascular bruits were found in most of the patients at the time of diagnosis (70.5%), as well as blood pressure and pulse difference between arms (52.9%). Unobtainable blood pressure was seen in 5 patients (29.4%). There was a discrepancy in 3 patients (17.6%) between inflammatory markers and inflammation in the vessels’ walls, as confirmed by imaging techniques (angioMRI or angioCT). Most of the patients were classified as type V arteritis (35%), followed by type IV (18%), type I (17%), type IIA, respectively type IIB (12% each) and type III (6%). Stenosis of the involved arteries occurred 4.3 times more than aneurysm formation. Eight patients required vascular interventions at the time of diagnosis – four were treated by balloon angioplasty and six by stent placing. The average TADS (Takayasu Arteritis Damage Score) was 1.5 and it was not associated with delay in diagnosis (p>0.05).

Conclusion

Takayasu arteritis is a disease with heterogenous and nonspecific symptoms. For those reasons the delay in diagnosis is usually long, the treatment is started late and damage appears early in the course of the disease. This is reflected by the high amounts of vascular procedures needed at the time of diagnosis. We need better diagnostic criteria and specific monitoring scores.

References

[1]Keser G, Aksu K. Diagnosis and differential diagnosis of large-vessel vasculitides. Rheumatol Int. 2019;39(2):169-185.

Disclosure of Interests

None declared

Evaluation of several serum interleukins as markers for treatment effectiveness in naïve HIV infected patients: A pilot study

In this observational pilot study, we investigated the impact of Dolutegravir, Raltegravir, Elvitegravir (Integrase Strand Transfer Inhibitors, INSTIs), or boosted Darunavir (a Protease Inhibitor, PI) in combination with two nucleoside reverstranscriptase inhibitors (Emtricitabine/Tenofovir disoproxil or Lamivudine/Tenofovir disoproxil, NRTI) on four interleukins (IL-4, IL-10, IL-13, and IL-21) as immune activation markers in naïve HIV(Human Immunodeficiency Virus)-infected patients during the first six months of combined standard-of-care antiretroviral therapy (cART). Newly diagnosed with HIV-infected subjects and without any disease that could affect the immune activation markers were evaluated. The patients’ physicians recommended the cART as standard-of-care and the ILs were measured before cART and six months of cART. The levels of CD4⁺ T-cells count and CD4⁺/CD8⁺ ratio significantly increased at six months (P-value<0.02) regardless of the drugs, INSTIs or PI. However, a CD4⁺/CD8⁺ >1 was observed in 25% of patients treated with Raltegravir and half of those treated with Dolutegravir. At six months of cART, viral load was detectable in only 6/31 individuals. IL-21 had an undetectable level in 30/31 patients after six months of cART. Our results suggest the potency in restoring immune markers in HIV-infected patients with all investigated drugs. Dolutegravir showed a tendency to statistically significant changes in IL-4 and IL-10. A clinical trial with random allocation of medication and an extensive follow-up is needed to replicate this research and validate the usefulness of evaluated ILs as markers of cART effectiveness.

Continuum of Care UNAIDS Fast-Track Targets Evaluation of Patients Living with Human Immunodeficiency Virus Infection

The current study evaluated the progress of continuum healthcare for patients living with human immunodeficiency virus (HIV) infection from Cluj County in two moments, 2016 and 2020, and compared the results to the Fast-Track targets (FTTs) proposed by the Joint United Nations Programme (UNAIDS) on HIV/AIDS. By the end of 2020, 368 out of 385 confirmed HIV-positive patients from Cluj County were under surveillance in our center, representing almost 95% of the patients living with HIV and knowing their diagnosis, compared to 87.9% in 2016. Nearly 97% of those in active follow-up from Cluj County were under antiretroviral therapy (ART) in 2020, compared to 89% in 2016. The number of virally suppressed patients from those under ART was almost 94% in 2020, compared to 82.7% in 2016, and the increase is observed regardless of the ART regime. A shift towards integrase strand transfer inhibitors, with a higher efficacy, fewer adverse effects, and fewer drug interactions, is observed, which could contribute to the decrease in HIV transmission.

OP0017 VALIDATION OF GWAS-IDENTIFIED VARIANTS FOR ANTI-TNF DRUG RESPONSE IN RHEUMATOID ARTHRITIS: A META-ANALYSIS OF THREE LARGE COHORTS

Background:

The interplay between genetics and drug response in rheumatoid arthritis (RA) has shown that response to biologics varies between individuals and that a large proportion of patients show no clinical improvement (Plenge and Bridges, 2011). Despite the disappointing scenario, to date, only a few genetic markers have been consistently identified and we are far from being able to optimize drug dosing or prioritize drug combinations based on genetic findings.

Objectives:

With this background, we sought to validate the association of GWAS-identified variants for response to TNF inhibitors (TNFi) in a two-stage case control association study and to shed some light into the functional role of the most interesting markers.

Methods:

The discovery population consisted of 1361 RA patients ascertained through the REPAIR consortium and the DANBIO registry. RA patients fulfilled the 1987 revised American College of Rheumatology (ACR) and the ACR/EULAR 2010 classification criteria. The validation cohort included 706 Dutch RA patients from the DREAM registry. The study followed the Declaration of Helsinki and study participants gave their written informed consent to participate in the study, which was approved by the ethical review committee of participant institutions. Twenty-seven single-nucleotide polymorphisms (SNPs) were selected through a literature search of relevant GWAS. Linear regression analysis adjusted for age, sex and country of origin was used to determine the association between GWAS-identified SNPs and changes in DAS28 (ΔDAS28) after 3 or 6 months of treatment. The meta-analysis of both populations was performed using a fixed effect model. Correction for multiple testing was performed using the Bonferroni method but also considering the number of inheritance models tested (P=0.0009). To assess the role of the most interesting markers in modulating immune responses, stimulation experiments in whole blood, peripheral mononuclear cells (PBMCs) and monocyte-derived macrophages using a large number of pathogens and microbiome bacteria were performed in 408 subjects from the Human Functional Genomic Project cohort. We also evaluated the correlation of these SNPs with plasmatic levels of 108 inflammatory proteins, 7 serum steroid hormones and counts of 91 blood-derived immune cell populations.

Results:

The meta-analysis of the discovery cohort and DREAM registry including 2067 RA patients treated with TNFi revealed an overall association of the LINC02549rs7767069 SNP with a decreased drop in DAS28 that remained significant after correction for multiple testing (per-allele ORMeta=0.83, PMeta=0.000077; PHet=0.61). In addition, the meta-analysis of these large cohorts showed that each copy of the LARRC55rs717117G allele significantly decreased the drop in DAS28 in RF-positive patients (per-allele ORMeta=0.67, P=0.00058; PHet=0.06) whereas an opposite but not significant effect was found in RF-negative subjects (per-allele ORMeta=1.38, P=0.10; PInteraction=0.00028; PHet=0.45). Interestingly, the meta-analysis also showed potentially interesting but not statistically significant overall and RF-specific associations for the MAFBrs6071980 and CNTN5rs1813443 SNPs with ΔDAS28 (per-allele ORMeta_rs6071980=0.84, P=0.0059; PHet=0.63 and ORMeta_rs1813443_RF+=0.81, P=0.0059; PHet=0.69 and ORMeta_rs1813443_RF-=1.00, P=0.99; PHet=0.12; PInteraction=0.032). Although analysis of functional data is ongoing, so far, we found that carriers of the LARRC55rs717117G allele showed decreased levels of IL6 after stimulation of PBMCs with Borrelia burgdorferi and Escherichia Coli bacteria (P=0.00046 and 0.00044), which suggested a reduced IL6-mediated anti-inflammatory effect of this marker to worsen the response to TNFi.

Conclusion:

This study confirmed the influence of the LINC02549 and LARRC55 loci to determine the response to TNFi in RA patients and a weak effect of the MAFB and CNTN5 loci that needs to be further investigated.

References:

[1]Plenge RM et al 2011. Arthritis Rheum 63, 590-3.

ACKNOWLEDGEMENTS:

We thank all participants who have agreed to participate in this study. Authors also thank María Dolores Casares, Ángeles Molina, Carmen Oloriz for the collection of Spanish samples and Hans Jurgen Hoffmann, Marianne Thomsen, Vibeke Østergaard Thomsen, Malene Rohr Andersen, Lise Lotte B. Laursen, Helle Jørgensen, Ram Benny Christian Dessau, Niels Steen Krogh, Ulla Vogel, Paal Skytt Andersen, Ivan Brandslund, Steffen Bank, Frederik Trier Møller, Nikolai Toft and Niels Møller Andersen for the participation in collection and purification of Danish samples. We also thank the Danish Departments of Rheumatology for their implication in the collection of clinical data from RA patients included in the DANBIO cohort and the Danish Rheumatologic Biobank. Likewise, we would like to thank Teun van Herwaarden for steroid hormone measurements in serum samples from subjects ascertained through the HFGP initiative.

Disclosure of Interests:

None declared

AB0656 SARS-CoV-2 INFECTION IN PATIENTS WITH RHEUMATIC DISEASE: A TERTIARY SINGLE-CENTER EXPERIENCE

Background:

In the context of the coronavirus (SARS-CoV-2) pandemic, several studies looked at the relation between rheumatic disease and SARS-CoV-2. It remains unclear whether these patients are at increased risk of developing more severe cases of coronavirus disease (COVID-19) or not.

Objectives:

The objective of this descriptive study is to report the characteristics and outcomes of rheumatic patients that had a history of confirmed SARS-CoV-2 infection. Findings have also been compared to some of the existing publications on COVID-19 in these patients.

Methods:

Between November 17, 2020 and January 18, 2021, a single-centre observational study was conducted in the rheumatology department of the Emergency Clinical County Hospital and the University of Medicine and Pharmacy “Iuliu Hatieganu” in Cluj-Napoca, Romania. The sample consisted of 62 rheumatic patients with a positive polymerase chain reaction test from nasopharyngeal/oral swab. Data on both systemic autoimmune disease and COVID-19 was collected using a survey, by means of telephone or in the outpatient clinic setting. Data on the patient rheumatologic condition was also collected from the electronic health records available within our department

Results:

62 patients were included, with 85.48% females and 14.51% males, and a median age of 52 years (SD +/- 14).

The most frequent comorbidities were high blood pressure (HBP) 46.77%, dyslipidaemia 19.35%, liver disease 17.74%, and interstitial lung disease (ILD) 12.90%. Recurrent COVID-19 symptoms included: cough (62%), fever (46,77%), anosmia (46.77%), ageusia (30.64%), headache (29.03%), gastrointestinal symptoms (27.41%) and myalgia (25.80%).

Out of the entire 62 sample, 41 patients had an inflammatory arthritis (IA) diagnosis, with the most frequent being rheumatoid arthritis (RA) - 68.29%, followed by ankylosing spondylitis - 21.95%, psoriatic arthritis - 7.31% and 2.43% with Still disease. Only 10 patients suffered from connective tissue disease (CTD): 3 systemic lupus erythematosus, 2 poli/dermatomyositis, 2 Sjogren syndrome (SjS), 2 mixed connective tissue disease, 1 systemic sclerosis (SSc). Another 10 patients had overlapping syndromes with the most frequent (40%) overlap between RA and SSc. One patient had osteoarthritis.

49 patients followed a treatment with conventional synthetic disease-modifying anti-rheumatic drugs with 51.2% of them being treated with Methotrexate.

14 of our patients received glucocorticoids (GC), but no relation between the GC dose and COVID-19 severity could be observed. Only 3 patients with doses greater than 10mg/day were present in the cohort and 2 developed mild while 1 developed an asymptomatic COVID-19 course.

22 patients had received biological treatment. Anti TNF alpha medication was administered to 13 of these, and mostly consisted of Adalimumab, Etanercept and Golimumab. The anti TNF alpha patients were asymptomatic or had mild forms of COVID-19 (93.30%).

8 cases had ILD: 3 RA patients, 3 overlapping syndromes, 1 SSc and 1 SjS. The median age was 59,5 years (SD +/- 10). 25% exhibited severe, 37,5% moderate, 25% mild and 12.5% asymptomatic COVID-19.

The COVID-19 severity in our sample was as follows: 12.90% of the patients were asymptomatic, 59.67% exhibited a mild form, 19.35% a moderate one, and out of the 8.06% with a severe case of COVID-19, 1 patient died. The median age in the severe cases of COVID-19 was 66 years (SD +/- 12) and HBP was the most common comorbidity.

Conclusion:

Most patients in this sample were either asymptomatic or had a mild COVID-19 evolution. Although the research design has multiple limitations, rheumatic pathology does not seem to be a higher risk factor for severe COVID-19 than other associated comorbidities. With that in mind, ILD patients should be closely monitored as even in on our limited sample size a worse evolution of COVID-19 has been observed. Biological treatments, especially anti TNF alpha might help in reducing the severity of COVID-19, but this outcome could have been associated in our sample with other factors like lower median age and less comorbidities.

Disclosure of Interests:

None declared.

POS0768 THE IMPACT OF ANTI-RO ANTIBODIES IN PREGNANT PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND SJÖGREN’S SYNDROME

Background:

The presence of anti-Ro antibodies in female patients diagnosed with systemic lupus erythematosus (SLE) and primary Sjögren syndrome (SS) in their fertile years raises concern among the medical team due to the risk of neonatal lupus in their newborns (NB).(1)

Objectives:

The aim of this study was to determine whether there are differences between the outcome of anti-Ro positive pregnancies in SLE and SS.

Methods:

This is a retrospective observational study carried out in a Rheumatology tertiary center. We included anti-Ro positive female SLE and SS patients, who were diagnosed before or during pregnancy and followed in our clinic between 2003-2020. The diagnosis of SLE or SS was established according to the 2012 SLICC criteria and the 2016 EULAR/ACR criteria, respectively. Clinical, immunological and pregnancy parameters were recorded before (where available), during and after pregnancy, as well as maternal risk factors (smoking, BMI, disease and medication history). Statistical analysis for continuous variables were performed with T-student test and categorical variables with Person Chi-square test, using IBM SPSS Statistics version 20.

Results:

Eleven out of 65 anti-Ro positive SLE patients and 10 out of 153 anti Ro-positive SS patients met the inclusion criteria and had 13 and 12 pregnancies, respectively. The mean age at diagnosis was 24,75 ± 5,19 years for SLE and 31,92 ± 4,05 years for SS, and the mean pregnancy age was 28,33 ± 4,05 years for SLE and 33,17 ± 3,63 years for SS. Nine (81,81%) SLE patients were diagnosed before pregnancy, while 6 (60%) of the SS patience were diagnosed during pregnancy.

Two (18,18%) SLE and 1 (10%) SS were smokers, median BMI was 21 for both SLE and SS (1 SS patient was obese), 2 (18,18%) had a history of lupus nephritis, 6 (54.54%) LES patients had secondary antiphospholipid syndrome, out of which 1 had a previous miscarriage. In the SS group there were 3 previous miscarriages, one patient had a history of parotid lymphoma. The majority of both SLE and SS patients had moderate anti-Ro antibody titers (<200 U/ml) before as well as during pregnancy: 6 (46.5%) and 8 (61.53%) in SLE, 5 (41.6%) and 7 (58.3%) in SS.

More preterm NB and stillbirths were encountered in SLE mothers, possibly due to the association of secondary antiphospholipid syndrome, both groups encountered 1 pregnancy loss, and cesarean delivery outweighed vaginal ones in both SLE and SS patients. (Table 1)

Table 1.

Gestational age and delivery type according to maternal disease

Gestational ageSLEnumber (%)SSnumber (%)Full-term pregnancy4 (30.76%)10 (83.33%)Late preterm births4 (30.76%)1 (8.33%)Very preterm births2 (15.38%)0Stillbirth2 (15.38%)0Pregnancy loss1 (7.69%)1 (8.33%)Delivery typeVaginal3 (25%)4 (36.36%)Cesarean9 (75%)7 (63.63%)

Distribution of pregnancy outcome is exhibited in figure 1. There were 4 (33.33%) NB with cutaneous neonatal lupus all from SS mothers, 3 of whom used HCQ before and/or during pregnancy; and there were 5 NB with complete fetal atrioventricular block (AVB), 3 (25%) from SS mothers and 2 (15.38%) from SLE mothers. A history of HCQ usage was recorded in 3 out of these 5 mothers, and all 5 NB with complete fetal AVB were treated with dexamethasone, without success. Two NB died (both from SLE mothers) and 3 NB (all from SS mothers) needed pacemaker implantation. From the latter, 1 developed pacemaker cardiomyopathy and 1 developed sepsis.

Conclusion:

Neonatal lupus seems to be more prevalent in anti-Ro positive SS patients than SLE patients, even though no difference was seen in anti-Ro titer between the two diseases. Fetal cardiac arrhythmia may lead to SS diagnosis. Dexamethasone did not improve the outcome of the fetal AVB.

References:

[1]Mollerach FB, Scolnik M, Catoggio LJ, Rosa J, Soriano ER. Causes of fetal third-degree atrioventricular block and use of hydroxychloroquine in pregnant women with Ro/La antibodies. Clin Rheumatol. 2019 Aug;38(8):2211-2217.

Disclosure of Interests:

None declared

AB0605 CLINICAL PROFILE AND CHEST HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) FINDINGS IN PATIENTS WITH CONNECTIVE TISSUE DISEASES AND INTERSTITIAL LUNG DISEASE: EXPERIENCE OF A SINGLE REFERENCE RHEUMATOLOGY CENTER

Background:

Interstitial lung disease (ILD) is a common manifestation of connective tissue diseases (CTDs), and is associated with significant morbidity and mortality. Chest high-resolution computed tomography (HRCT) play an important role in the diagnosis of ILD and may provide prognostic information.

Objectives:

We aimed to characterize the clinical profile and chest HRCT abnormalities and patterns of patients diagnosed with CTDs and ILD.

Methods:

In this retrospective, observational study we included 80 consecutive patients with CTDs and ILD referred to a tertiary rheumatology center between 2015 and 2019. From hospital charts we collected clinical data, immunologic profile, chest HRCT findings. HRCT patterns were defined according to new international recommendations.

Results:

Out of 80 patients, 64 (80%) were women, with a mean age of 55 years old. The most common CTD associated with ILD was systemic sclerosis (38.8%), followed by polymyositis (22.5%) and rheumatoid arthritis (18.8%). The majority of patients had dyspnea on exertion (71.3%), bibasilar inspiratory crackles were present in 56.3% patients and 10% had clubbing fingers. Antinuclear antibodies (ANA) were present in 78.8% patients, and the most frequently detected autoantibodies against extractable nuclear antigen were anti-Scl 70 (28.8%), followed by anti-SSA (anti-Ro, 17.5%), anti-Ro52 (11.3%) and anti-Jo (7.5%). Intravenous cyclophosphamide therapy for 6-12 months was used in 35% of patients, while 5% of patients were treated with mycophenolate mofetil.

The most frequent HRCT abnormalities were reticular abnormalities and ground glass opacity. Non-specific interstitial pneumonia (NSIP) was identified in 46.3% CTDs patients. A pattern suggestive of usual interstitial pneumonia (UIP) was present in 32.5% patients, mainly in patients with systemic sclerosis. In 21.3% patients the HRCT showed reticulo-nodular pattern, micronodules and other abnormalities, not diagnostic for UIP or NSIP pattern.

Conclusion:

Nonspecific interstitial pneumonia (NSIP) is the most common HRCT pattern associated with CTDs. Further prospective longitudinal studies are needed in order to determine the clinical and prognostic significance of various HRCT patterns encountered in CTD-associated ILD and for better patient management.

References:

[1]Ohno Y, Koyama H, Yoshikaua T, Seki S. State-of-the-Art Imaging of the Lung for Connective Tissue Disease (CTD). Curr Rheumatol Rep. 2015;17(12):69.

[2]Walsh SLF, Devaraj A, Enghelmeyer JI, Kishi K, Silva RS, Patel N, et al. Role of imaging in progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150)

Disclosure of Interests:

None declared

THU0456 THE “JOINT CRITERIA” FOR FIBROMYALGIA DIAGNOSIS IN RHEUMATOID ARTHRITIS PATIENTS: RELIABILITY COMPARED TO THE 2010 ACR CLASSIFICATION CRITERIA FOR FIBROMYALGIA

Background:

A significant proportion of rheumatoid arthritis (RA) patients have concomitant fibromyalgia (FM) (1). Associated FM diagnosis in RA patients can determine worse treatment outcomes compared to patients without FM (1). A difference between tender joint count (TJC) and swollen joint count (SJC) ≥7, also named the ”joint criteria” was proposed as being diagnostic for FM in patients with RA. The ”joint criteria” were validated against the 1990 ACR Classification Criteria for FM and are easy to apply to patients with RA (2). Since then, the 2010 ACR Classification criteria for FM, which include somatic symptoms besides pain sensitivity, were developed and validated.

Objectives:

We aimed to determine the reliability of the joint criteria for fibromyalgia in RA compared to the ACR 2010 Classification Criteria for FM and to compare RA patients diagnosed with FM (FRA) to those without FM in terms of clinical variables.

Methods:

We performed a cross-sectional study on RA patients who presented in our department during a 3 months period. Tender joint count (TJC), swollen joint count (SJC), patient global assessment of disease activity (PGA) were determined. DAS28 scores were calculated using CRP. We applied the 2010 ACR Classification Criteria and the joint criteria for FM diagnosis. Kappa agreement coefficient was used to determine the reliability of the joint criteria against the 2010 ACR Classification Criteria for FM in patients with RA. Differences between groups were assessed using Mann-Whitney U test for numerical data or Chi square test for ordinal data.

Results:

We included 100 consecutive RA patients, 84% female, with a mean age of 57.3(12) years and mean disease duration of 14(9) years. Twenty-four patients (24%) had associated FM according to the ACR 2010 Classification Criteria and 22 (22%) patients satisfied the joint criteria for associated FM. The level of agreement between the joint criteria and the ACR 2010 classification criteria for FM was kappa=0.66, p< 0.001, with a sensitivity of 70% and a specificity of 93%. FRA patients had similar demographic and disease characteristics compared to RA patients. Patients with FRA according to the joint criteria had significantly higher PGA, DAS28, and HAQ scores, but similar CRP values and SJC compared to RA patients (Table 1).

Table 1.

Demographic and clinical data of FRA and RA patients

VariableFRAn=22RAn=78p-valueAge (years)60 (10.7)59 (12.2)0.093Disease Duration (years)13.3 (13)12.2 (7.5)0.589ACPA seropositivity(%)69550.1SJC2(4)2(4)0.7CRP (g/dl)12.8(14.2)8.1(13.7)0.06DAS28CRP4 (1.7)3.5 (1.2)0.009HAQ1.75 (0.5)1 (0.7)<0.001PGA (mm)70(11)44(23)<0.001

Data are expressed as mean (SD) or median (IQR)

FRA- Fibromyalgic Rheumatoid Arthritis; RA- Rheumatoid Arthritis;

ACPA- Anti- citrullinated Protein Antibodies; CRP- C-reactive Protein; SJC- Swollen Joint Count;

DAS28CRP- Disease Activity Score; HAQ- Health Assessment Questionnaire; PGA- Patient Global Assessment

Conclusion:

The joint criteria are diagnostic for FM in RA patients with moderate reliability compared to the ACR 2010 Classification criteria. When diagnosed with the joint criteria, FRA patients have higher disease activity scores despite having similar clinical and laboratory inflammatory markers compared to RA patients.

References:

[1]Wolfe F, Michaud K. Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize RA patients with fibromyalgia. J Rheumatol. 2004;31(4):695–700.

[2]Pollard LC, Kingsley GH, Choy EH, Scott DL. Fibromyalgic rheumatoid arthritis and disease assessment. Rheumatology 2010;49(5):924–8.

Disclosure of Interests: :

None declared

SAT0343 NUTRITIONAL STATUS OF SYSTEMIC SCLEROSIS PATIENTS: A PILOT STUDY

Background:

Gastrointestinal involvement (GI) in systemic sclerosis (SSc) is one of the major disease burdens. Its consequences on the nutritional status of SSc patients and their quality of life is poorly evaluated during routine check-ups. Since malnutrition is an important cause of morbidity and mortality, addressing this issue seems necessary.

Objectives:

The aim of this study was to evaluate the risk of malnutrition in SSc patients and to identify potential associations between the risk of malnutrition and clinical features or laboratory parameters.

Methods:

All patients aged >18 years old with a definite diagnosis of SSc according to the 2013 ACR/EULAR classification criteria from the EUSTAR Center 16 and ERN ReCONNET cohort of the County Emergency Clinical Hospital Cluj-Napoca were included in the study. Patients with localized scleroderma, scleroderma sine scleroderma, overlap syndromes and mixed connective tissue disease were excluded. Clinical and laboratory data was collected from the EUSTAR database and medical charts. A telephone survey was conducted and patients were interviewed using the Malnutrition Universal Screening Tool (MUST) questionnaire.

Results:

75 patients were eligible for the study. Female to male ratio was 10:1 with an almost equal distribution among limited (57%) and diffuse (43%) SSc subtypes. The most prevalent autoantibodies were anti-TOPO-I and anti-centromere. GI symptoms were reported in 48.6% patients out of which 86% SSc patients underwent further evaluation by upper GI endoscopy. Abnormal endoscopic findings, such as esophagitis, Barret esophagus and gastritis were identified in 80% patients. Most patients had a low risk of malnutrition (93%) with only a minority carrying a medium (6%) or high (1%) risk. No significant association was demonstrated between MUST score and the extend of cutaneous involvement (limited SSc versus diffuse SSc; p=0.39), presence of GI symptoms (p=0.35), presence of abnormal endoscopic findings (p=0.45) or presence of anemia (p=0.83).

Conclusion:

The majority of SSc patients from this cohort exhibited a low risk of malnutrition. These results are contradictory to previous literature reports. A possible explanation is that the MUST score is a dynamic screening tool and therefore interviewing patients with a stable disease (outpatient care) versus patients with active disease (inpatient care) might lead to different results. Another limitation of this study is the small number of patients included. This is a pilot study. We aim to further extend the study population to the other EUSTAR cohorts and to prospectively evaluate these patients in an inpatient care setting.

References:

[1]Dupont R et al. Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review. Autoimmun Rev. 2018 Nov;17(11):1081-1089;

[2]Caimmi C et al. Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis. Clin Rheumatol. 2018 Apr;37(4):987-997;

[3]Türk İ et al. Malnutrition, associated clinical factors, and depression in systemic sclerosis: a cross-sectional study. Clin Rheumatol. 2020 Jan;39(1):57-67.

Disclosure of Interests:

None declared

AB0615 MORTALITY AND CAUSES OF DEATH AMONG ROMANIAN SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic sclerosis (SSc) is associated with an increased risk of death compared to the general population. Survival in SSc patients has improved significantly over the last 20 years with a decrease in renal involvement as a cause of early death and an increase in death caused by cardiopulmonary involvement (1,2). Causes of death in SSc patients have not been described in a Romanian cohort so far.

Objectives:

To study the causes of death in patients with SSc prospectively followed-up from 2002 to 2018 in a single tertiary centre from Romania.

Methods:

The cohort consists of 197 patients who fulfill the American College of Rheumatology /EULAR 2013 criteria for SSc. We examined the data of patients who had died during follow up. Patients were reviewed at least twice a year and the cause of death was classified as SSc-related or nonSSc-related. SSc-related deaths were then attributed to the major organ involved. A univariate Cox proportional hazard (PH) regression was used to examine the association between each variable and mortality. Variables reported in the literature to associate with mortality were considered in the multiple Cox PH regression model.

Results:

Of 197 SSc patients (87.8% females), 47.7% had diffuse SSc and 52.2% had limited SSc. The mean age at diagnosis was 47 (SD 12) years and mean follow up duration was 6.75 years. There were 41 deaths (20.8%). Survival rate was substantially lower in men (P <0.003). The mean age at the time of death in those with diffuse SSc was lower compared to limited SSc (55.8 years vs 68.7 years). Sixty percent of deaths were SSc-related (pulmonary cause[n=11], cardiac cause[n=6], gastrointestinal involvement [GI, n=3], renal crisis [n=2] and others [n=4]). Deaths no related to SSc were associated with cancer and infections. Age at onset of Raynaud phenomenon [HR 1.05], male gender [HR 3.41], diffuse SSc [HR 0.48], presence of tendon friction rub [HR 4.54], digital ulceration [HR 3], esophagitis [HR 2.07] and cardiovascular involvement [HR 3.68], use of corticosteroids[HR 2.13] and cyclophosphamide [HR 2.02] were associated with poor prognosis in multivariate analysis.

Conclusion:

In our cohort the main causes of death were lung and cardiovascular involvement. Deaths occurred early after the onset of the disease and the survival rate was significantly reduced among men. Multivariate analysis showed that age at onset of Raynaud phenomenon, male gender, diffuse disease form, presence of tendon friction rub, digital ulceration, esophagitis and cardiovascular history, use of corticosteroids and cyclophosphamide were independently associated with mortality.

References:

[1]Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010 Oct;69(10):1809–15.

[2]Rubio-Rivas M, Royo C, Simeon CP, Corbella X, Fonollosa V. Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Oct;44(2):208–19.

Disclosure of Interests:

None declared

A View of Human Immunodeficiency Virus Infections in the North-West Region of Romania

Background and objectives: In Romania, the human immunodeficiency virus (HIV) epidemic is almost the same as it is in Central Europe, with some differences; particularity the following one: people with nosocomial HIV infection, also known as Romanian cohort. Aim: The study aimed to present a local view of HIV infection in the North-West part of Romania, and to identify the particularities of patients under medical care in the Cluj AIDS Center. Materials and Methods: The demographic characteristics (age and gender), and medical and epidemiological data (stage of HIV infection and mode of transmission) of patients in a medical care in the Cluj Acquired Immunodeficiency Syndrome (AIDS) Center were evaluated. Data from the first patients admitted between 1989 and 2018, and the statuses of the infected persons as per 31 December 2018 were analyzed. Results: Nine hundred and fourteen patients were included in the study. The patients' ages varied from 0 (newborns from HIV-infected mothers) to 72 years old, and most patients were men (596 men vs. 318 women). The main mode of transmission was sexual (>50%), with an increased number of men who have sex with men (MSM) in the last years (from two cases in 2006 to thirty-four cases in 2018), and a very small percentage of intravenous drug users (IDU; <1%). The patients from the Romanian cohort were more frequently women as compared with men (p-value <0.0001), women were more frequently later presenters than men (p-value <0.0001), and the women more frequently had candidosis (p-value = 0.0372), cerebral toxoplasmosis (p-value = 0.0404), and co-infection with hepatitis B virus (p-value = 0.0018). One hundred and sixty patients died by the end of 2018 (17.5%). Sixty-eight children had been born from HIV-infected mothers, and 17 were HIV infected (25%). Conclusion: The main mode of HIV transmission in our sample was sexual, with an increased number of MSM over the last years and a low number of cases of intravenous drug users. A quarter of children borne from HIV-infected mothers were HIV infected.

Capillaroscopic findings in a case of Hajdu-Cheney syndrome

Hajdu-Cheney syndrome (HCS) is a rare disease which causes osteoporosis, digit shortening, and early tooth loss. In a young HCS female patient, the nailfold capillaroscopy showed reduced capillary height and reduced density in all affected fingers. Capillaroscopy could improve follow-up and therapy assessment in HCS. Hajdu-Cheney syndrome (HCS) is a very rare connective tissue disease characterized by osteoporosis, early dentition loss and a particular phenotype as a result of enhanced NOTCH2 signaling. The pathogenesis of bone resorption and osteoporosis is not fully understood. The altered angiogenesis may play a role in acroosteolysis. We performed capillaroscopy in order to assess the microvascular involvement in a 21-year-old female patient with sporadic HCS. The patient presented with severe parodontopathy, acroosteolysis, and clubbing of four fingers and three toes. Hand radiographs showed periarticular osteoporosis and asymmetric bony involvement with acral resorption and/or transversal lucency bands in several fingers. Early collagen-vascular diseases were ruled out by clinical and ancillary examinations, including immunology and immunoblot for systemic sclerosis. Nailfold capillaroscopy showed reduction of capillary height and density in all affected fingers. Notably, in the fingers with acral resorption, many capillaries were dilated, while in the ones with radiolucency band, capillary dilation was a rare finding. In clinically unaffected fingers, the capillaroscopic findings were normal.To our knowledge, this is the first report of capillaroscopic findings in HCS. The nailfold capillaroscopic aspect reflects the involvement of acral vessels in HCS; thus, capillaroscopy may represent an early diagnostic tool as well as a means of therapeutical assessment. Repeated capillaroscopy in HCS may also add to the understanding of its pathogenesis.

Predictors of first recurrence in Clostridium difficile-associated disease. A study of 306 patients hospitalized in a Romanian tertiary referral center

BACKGROUND & AIMS

Clostridium difficile is recognized as the major cause of nosocomial gastroenteritis usually related to antibiotic treatment. Although treatable, C. difficile--associated disease (CDAD) tends to recur in many patients. The purpose of the study was to analyze the risk factors for recurrence in patients with CDAD after the first treatment with vancomycin, metronidazole or both.

METHOD

We conducted a retrospective study of all patients admitted to the Teaching Hospital of Infectious Diseases Cluj-Napoca, Romania, between January 2011 and October 2012 with the diagnosis of CDAD or who developed diarrhoea after admission. A clinical diagnosis was made and culture and toxin A and B detection were carried out. We performed a statistical analysis taking into consideration: age, gender, previous hospital exposure, previous antibiotic treatment, and treatment duration. The patients were followed-up for at least 60 days.

RESULTS

We included 306 patients (177 women and 129 men) with a median age of 71 years; 208 patients (68%) had prior hospitalization and 195 (64%) had received prior antibiotic treatment. Actual treatment consisted of vancomycin in 76 (25%) patients, metronidazole in 132 (43%) and both combined in 98 (32%) patients. The average duration of treatment was 10 days. Sixty patients (20%) experienced 95 recurrences and 9 patients died (3%). Treatment with metronidazole, vancomycin or both for 10 or more days did not prevent recurrences. Age over 70 (RR 1.5, CI 95%: 1.055-2.71) and use of PPI (RR 1.3, CI 95%: 1.16-3.1) significantly increased the risk of first recurrence of CDAD.

CONCLUSIONS

CDAD recurrence rates were similar to those reported in the literature. The risk of first recurrence was significantly higher in patients older than 70 who also received PPI treatment.