BCD020 rituximab bioanalog compared to standard treatment in juvenile systemic lupus erythematosus: The data of 12 months case-control study

BACKGROUND

Systemic lupus erythematosus (SLE) is the most frequent and serious systemic connective tissue disease. Nowadays there is no clear guidance on its treatment in childhood. There are a lot of negative effects of standard-of-care treatment (SOCT), including steroid toxicity. Rituximab (RTX) is the biological B-lymphocyte-depleting agent suggested as a basic therapy in pediatric SLE.

AIM

To compare the benefits of RTX above SOCT.

METHODS

The data from case histories of 79 children from the Saint-Petersburg State Pediatric Medical University from 2012 to 2022 years, were analyzed. The diagnosis of SLE was established with SLICC criteria. We compared the outcomes of treatment of SLE in children treated with and without RTX. Laboratory data, doses of glucocorticosteroids, disease activity measured with SELENA-SLEDAI, and organ damage were assessed at the time of initiation of therapy and one year later.

RESULTS

Patients, treated with RTX initially had a higher degree of disease activity with prevalence of central nervous system and kidney involvement, compared to patients with SOCT. One year later the disease characteristics became similar between groups with a more marked reduction of disease activity (SELENA-SLEDAI activity index) in the children who received RTX [-19 points (17; 23) since baseline] compared to children with SOCT [-10 (5; 15.5) points since baseline, P = 0.001], the number of patients with active lupus nephritis, and daily proteinuria. During RTX therapy, infectious diseases had three patients; one patient developed a bi-cytopenia.

CONCLUSION

RTX can be considered as the option in the treatment of severe forms of SLE, due to its ability to arrest disease activity compared to SOCT.

A METHOD FOR IMPROVING THE PROFESSIONAL PERFORMANCE AND RELIABILITY OF PERSONS DRIVING HIGH-SPEED VEHICLES

Recently, due to the emergence of a variety of modifications of air, land, water vehicles and an increase in their speed and maneuverability, the number of people with severe manifestations of motion sickness has also increased. The relevance of this problem is dictated by the fact that, despite significant achievements in the field of preventive medicine, a significant number of people prone to motion sickness have been observed to date. Thus, among persons using land modes of transport, the percentage of sick people reaches 15.0%, air modes 20.0%, while using water modes of transport, the number of sick people reaches 30.0%. The significance of this problem is dictated by the fact that the psycho-physiological capabilities of our body do not keep pace with the rapidly increasing speed-maneuvering characteristics of vehicles.

POS1320 SAFETY AND EFFICACY OF RITUXIMAB IN PATIENTS WITH JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS: THE PRELIMINARY DATA OF RETROSPECTIVE COHORT STUDY

Background

juvenile systemic lupus erythematosus (jSLE) is the most frequent pediatric connective tissue disease with multiorgan involvement and different outcomes and prognosis. Corticosteroids remain the base treatment option and steroid-sparing treatment is strongly required to avoid steroid toxicity. Rituximab (RTX) is one of biologics, which efficacy was proved in case reports and case series of SLE, but no data from big randomized trials, confirming the efficacy have existed.

Objectives

to evaluate safety and efficiency of RTX in jSLE.

Methods

in the retrospective observation study the information of 48 jSLE patients (12 boys, 36 girls) who received at least one RTX dose before 18 years, included. Diagnosis was made using SLICC criteria. The main indications for RTX were high disease activity with lupus nephritis (LN), CNS and hematology disturbances (hemolytic anemia, thrombocytopenia) and avoiding steroid toxicity. RTX was prescribed in dosage 375 mg/m2 every week (2-4 infusions) with repeated courses every 6-12 months according disease activity, the degree of B-cell depletion and hypoIgG-emia. The dynamics of clinical, laboratory data, activity of the disease by SLEDAI, GCS doses were assessed in the onset and during RTX trial.

Results

The main patient’s characteristics were: onset age 13.0 (11.5; 15.0) years, inclusion age 18.0 (16.0; 20.0) years, LN 25 (52%)/III+IV class 9/11 (82%), CNS involvement 26 (54%). Pre-RTX non-biologic conventional treatment includes: cyclophosphamide 24 (50%), MMF 14 (29%), azathyoprine 7 (15%), methotrexate 6 (13%), cyclosporine A 2 (4%). Observation period ranged from 6 months to 6 years with median time 0.75 (0.2; 2.75) years. Initial pre-RTX treatment (GCS, hydroxychloroquine, non-biologic DMARDS) partially reduced SLE activity (SLEDAI, ANA titer, anti-dsDNA level), and median GCS dose by 25% from the initial dose, without changes in proteinuria, hematuria, C3, C4, WBC, hemoglobin, PLT and ESR levels. Administration of the RTX realized in prominent reducing of SLEDAI, anti-dsDNA level, proteinuria, hematuria, C4, ESR, number of patients with anemia, thrombocytopenia, and median GCS dose by 90% from the initial. The hemoglobin level and WBC have increased. 19 patients received IVIG for treatment of MAS (n=3), infection (n=5) and as replacement treatment in cases where IgG<4.5 g/l (n=11). 3 deaths were observed due to catastrophic SLE with MAS, accompanied severe infection (invasive aspergillosis, n=2). 6 patients realized SAE: pneumonia (n=3), transient agranulocytosis (n=1) after 3rd RTX infusion and meningitis, caused by Lysteria monocytogenis, after 1st RTX infusion (further RTX treatment continued without adverse events), patella osteomyelitis (n=1). 10 patients received antibiotics for respiratory infections. On pre-RTX 13 had antibiotics (p=1.0).

Table 1.

Dynamics of SLE features pre-RTX and during RTX trial

ParameterSLE onsetRTX (baseline)pLast visitp*SLEDAI16 (11.0; 23.5)13.5 (6.5; 21.5)0.00024 (0; 8.0)0.00002Patients with elevated anti-dsDNA n, (%)33 (69)20 (42)0.00811 (23)0.034Anti-dsDNA, U/ml (n.v.<25)112 (1; 200)24.7 (1; 130)0.0590 (0; 27)0.008Proteinuria, g/l2.6 (0.8; 4.4)3.8 (0.3; 7.5)0.6870 (0; 0.2)0.004Hematuria, # cells40 (8; 86)50 (6; 120)0.1910 (0; 1)0.0016C4, g/l0.12 (0.1; 0.24)0.12 (0.06; 0.19)0.3980.15 (0.11; 0.21)0.016Patients with leucopenia, n(%)12 (25)10 (21)0.6295 (10)0.00001Patients with anemia n (%)19 (40)16 (33)0.097 (15)0.0015Hemoglobin, g/l113 (95;131)115 (91; 132)0.830128 (107; 134)0.063Patients with thrombocytopenia n (%)17 (35)9 (19)0.0052 (4)0.00001ESR, mm/h17 (8; 31)15 (7; 22)0.1347 (2; 20)0.054Patients with GCS therapy n, (%)45 (94)45 (94)1.040 (83)0.00001GCS, mg/kg1.0 (0.6; 1.0)0.75 (0.2; 1.0)0.0350.1 (0.08; 0.28)0.000001

*compare to RTX baseline

Conclusion

RTX showed effectiveness in the cases, where previous non-biologic treatment was insufficiently effective. Randomized controlled trials are required to evaluate the efficacy and safety of RTX.

Acknowledgements

This research was funded by the Ministry of Science and Higher Education of the Russian Federation (Agreement No. 075-15-2020-901)

Disclosure of Interests

None declared

POS1297 HOW HLA B27 PREVALENCE IN THE POPULATION INFLUENCE ON FEATURES OF JUVENILE IDIOPATHIC ARTHRITIS: DATA FROM SAKHA REPUBLIC (YAKUTIA)

Background:

Sakha Republic (Yakutia) - SR(Y) is a bid arctic region of Russia with high proportion of aboriginals - Yakutians (50%), intra-national marriages, increased level of inbreeding and high distribution of HLAB27 among aboriginals – 33%, according the epidemiological studies. The main type of arthritis is ankylosing spondylitis in adults and enthesytis-related arthritis (ERA) of juvenile idiopathic arthritis (JIA) in children. The pattern of arthritis distribution in adults and children in SR(Y) is differ from Caucasians and similar to Native Americans.

Objectives:

Our study aimed to evaluate the features of JIA in aboriginals of SR(Y), associated with high prevalence of HLAB27 antigen.

Methods:

In the retrospective study we included 144 Yakutians who were admitted in the rheumatology department of Yakutsk in 2007-2016 years and 753 JIA patients Caucasian origin in Saint-Petersburg in the same years. We evaluated routine clinical and laboratorial features. HLA B27 was evaluated according the clinical judgement of the attending physicians.

Results:

ERA is a main JIA category in Yakutians. The main features the male predominance, higher onset age, high inflammatory activity, lower number of active joints, high incidence of hip and sacroiliac joints involvement, lower levels of psoriasis and uveitis. Yakutians have rare the involvement of cervical spine (6% vs 14%, p=0.0000001), TMJ (1% vs 6%, p=0.027), elbow (8% vs 16%, p=0.012), wrist (18% vs 28%, p=0.017), MCP (7% vs 21%, p=0.00005), PIP (8% vs 25%, p=0.00005). The treatment rates of methotrexate and biologics were similar between groups, but in Yakutians the biologics were administered earlier, because methotrexate failed and often was ineffective. The cumulative probability to receive biologics was higher in Yakutians compare to Caucasians: HR=3.4 [2.6; 4.4], p=0.000001 (Figure 1). The main biologic in Yakutians was etanercept (49/70; 70%). Yakutians received corticosteroids and cyclosporine A rarely, due to low incidence of systemic onset JIA and oligoarthritis with uveitis. It was observed, that the HLA B27 as a risk factors had different significance in Yakutians and Caucasians. HLA B27 presence increased the risk of ERA OR=2.72 (1.3; 5.6) p=0.01 in Yakutians and OR=69.2 (29.5; 162.3), p=0.00001 for Caucasians; for biologic administration: 0,86 (0,4; 1,8), p=0.529 and 2,45 (1,5; 4,0), p=0.0003, respectively.

Figure 1.

Cumulative probability to leave without biologics between Yakutian and Caucasian JIA patients.

Conclusion:

High distribution of HLA B27 antigene in Yakutians, lead to different pattern of JIA categories distributions and patient’s management.

This work was supported by the Project of the Ministry of Science and Higher Education of the Russian Federation (basic part of funding to M.K. Ammosov North-Eastern Federal University #FSRG-2020-0016) and by the RFBR grant #18-05-600035_Arctika.

Table 1.

Differences between Yakutian and Caucasian JIA patients.

JIA featuresYakutians, n=144 (%)Caucasians, n=723 (%)рGender, boys, n (%)85 (59.0)279 (38.6)0.000006Onset age, years10.6 (6.0; 13.4)6.0 (3.0; 10.3)0.0000001JIA categories, n (%)Oligoarthritis36 (25.0)188 (26.0)0.0000001Poly, RF (-)21 (14.6)248 (34.3)Poly, RF (+)1 (0.7)22 (3.0)Systemic onset4 (2.8)53 (7.3)ERA76 (52.8)171 (23.7)Psoriatic arthritis6 (4.2)41 (5.7)Active joints4.0 (3.0; 6.0)6.0 (3.0; 12.0)0.0000001Uveitis, n (%)16 (11.1)114/503 (22.7)0.002Psoriasis, n(%)3/143 (2.1)46/719 (6.4)0.043Hip involvement50 (34.7)146 (20.2)0.0001Sacroiliitis46 (31.9)69 (9.6)0.0000001HLA B27, n (%)76/131 (58.0)105/301 (34.8)0.00001ANA, n (%)4/46 (8.7)204/444 (46.0)0.00001RF, n (%)3/141 (2.1)22/403 (5.5)0.104Biologics, primary, n (%)70/144 (48.6)347 (48.0)0.892Time before first biologics, years0.6 (0.3; 1.4)2.6 (1.0; 5.4)0.0000001

Disclosure of Interests:

None declared

POS0080 TOFACITINIB TREATMENT IN CHILDREN WITH RHEUMATIC DISEASES: SINGLE-CENTER EXPERIENCE

Background:

While efficacy of tofacitinib (TOF) has been proven in many adult immune-mediated conditions, the information on its’ safety and efficacy in the pediatric population is limited.

Objectives:

to evaluate the safety and efficacy of TOF in children with immune-mediated diseases.

Methods:

from 23 children whom TOF has been initiated, 17 children with treatment duration of > 6 months were extracted including 16 girls and 1 boy with the following diagnosis: JIA (n=10), autoinflammatory diseases (AID) (n=5) and juvenile dermatomyositis (JDM) (n=2) due to impossibility to taper corticosteroids (CS) or previous biologic treatment failed. The treatment outcome was classified according to the opinion of the attending physicians as complete response (CR) i.e., the absence of disease activity, partial response (PR) – a significant improvement of symptoms and disease activity or no response (NR) - no changes in disease activity.

Results:

Mean duration of TOF treatment was 25.4±18.9 months. TOF was used as monotherapy in 3 cases, in combination with methotrexate (MTX) in 6, and in combination with other biologics in 3 children: tocilizumab (n=2) and canakinumab (n=1). Nine patients received CS. (Table 1). In two JIA patients with alopecia TOF induced intensive hair growth and controlled joint inflammation. 9 patients had CR: AID (n=3), JIA (n=4) and JDM(n=1): 7 patients had PR and 1 was NR. 13 patients had a previous history of several subsequent failed biologic: 4 biologics (n=1), 3 biologics (n=6), 2 biologics (n=1), 1 biologic (n=5). TOF treatment allowed discontinuation of CS in patient#6 and reducing the CS in 8/10 patients from 0.4 ±0.27 mg/kg to 0.15±0.1 mg/kg in 3.7±3.4 times: in 2 cases the tapering of steroids failed (Figure 1). 4 patients had side effects not requiring treatment discontinuation: liver enzymes elevation (n=2), hypercholesterolemia (n=1), lymphadenitis (n=1). In pt#6 after achievement of the remission the TOF dosage was decreased up to 2 times and tocilizumab intervals were increased up to 6 weeks.

Table 1.#DiagnosisIndicationPrevious biologicsCurrent treat-mentTOF, dose, mg/kgDurationof TOF treatment, monthsGeneticvariantsdetectedEfficacy1AIDSevere inflamma-tion, aortitis, colitisINX, TCZ, ADACS, TOF0.57NOD2 c.2578G>A (p.A860T); NOD2 c.2722G>C (p.G908R)ADA2 c.927G>A (p.M309I)PR2JDMrecurrent skin rashCS, TOF, MTX0.55PR3JDMskin involvement, ulcerationCS, MTX, TOF0.77NLRP12c.154G>A (p.G52S)CR4AID,IFPskin rash, recurrent inflammation, failure to thriveCAN, TCZCS, TOF, CAN0.532RNASEH2Bc.916dupA (p.I309Nfs*7)CR5JIA,polysevere arthritisETA,TCZ, ADATOF,TCZ0.2722PR6soJIAresistant to CS and biologic systemic inflammation, arthritisTCZ, ABC, CANTOF, TCZ0.423PR7JIA,poly (RF+) alopeciaSevere arthritis, lung involvement,alopeciaETA, ABC, TCZ, ADATOF, MTX, CS0.337IL1RN c.10G>C (p.A4P); NLRP3 c.2113C>A (p.Q705L); MEFV c.1105C>T (p.P369S)CR8IFP, CANDLE-likerecurrent inflammation, digital ischemia, ulcers, CS-dependencyETA, RTX, CANTOF, CS0.2543MDA5NLRP3CR9AID, IFPsystemic inflammation, ulcersETATOF, CS0.513СR10JIA, ERAarthritisETATOF, MTX0.244CR11JIA, polyarthritisABC, ETATOF, MTX0.2538CR12JIA, polyArthritis, alopeciaETATOF0.1531PR13soJIA + MASsystemic inflammation, arthritisTCZ, CAN, ETATOF, CS0.538NR14JIA, polyarthritisINX, ETA, ADA, TCZTOF, MTX0.224PR15AIDSystemic inflammation, CS-dependencyTCZTOF,CS0.521STAT3, c1343A>CPR16JIA, ERAarthritisETATOF0.2521PR17JIA, polyarthritisADA, TCZ, ETATOF0.1539СRFigure 1.

Conclusion:

Tofacitinib is a promising agent in treating pediatric rheumatic diseases. In our study the best results were in AID patients with rare alleles in interferon pathway genes, patients with arthritis and alopecia and in children with JDM. Future studies are needed to identify clear indications for treatment with JAK-inhibitors.

Acknowledgements:

This work was supported by the RSF grant №20-45-01005.

Disclosure of Interests:

None declared.

POS1299 RISK FACTORS OF TOTAL HIP ARTHROPLASTY IN JUVENILE ARTHRITIS WITH HIP INVOLVEMENT

Background:

Hip osteoarthritis (HOA) is a severe outcome of juvenile idiopathic arthritis (JIA) itself and also can be result of corticosteroid (CS) treatment, if it was used. Total hip arthroplasty (THA) is the last step in JIA treatment and indicates ineffectiveness of conservative treatment.

Objectives:

We aimed to evaluate risk factors which lead to THA in JIA patients with HOA.

Methods:

753 patients aged 2-17 years were included in our retrospective study during the last 10 years. Diagnosis was made according to ILAR criteria. Clinical, laboratory and radial examinations were evaluated. Diagnosis of HOA was made on MRI, CT and planar radiograms and confirmed by morphological examination of removed femoral heads.

Results:

Total 153/753 (20.3%) patients with JIA had hip involvement. HOA developed in 48/153 (31.4%) of JIA patients and 16/48 (33.3%) of them had THA was undergone. Prevalence of HOA and THA (%) in JIA subtypes: in polyarticular (5/32 (15.6%) and 8/16 (50%), systemic (6/32 (18.7%) and 5/16 (31.2%)), enthesitis-related (19/32 (59.4%) and 3/16 (18.8%)) and psoriatic (2/32 (6.7%) and 0/16) subtypes respectively, р=0,0000001. Patients who underwent THA initially had higher level of inflammation: elevated ESR (33 vs 5 mm/h, p=0.002) and CRP (14.7 vs 1.9 mg/l, p=0.03), more active joint, and especially involvement of joints of upper limbs: elbows (p=0.004) and proximal interphalangeal joints (p=0.001), arthritis of subtalar joint (p=0.02). Delayed biologic treatment (7.5 vs 3.4 years, p=0.043) and delayed achievement of remission (9.2 vs 5.6 years, p=0.047) were main predictors of THA. Patients with HOA without biologics had increased cumulative probability of THA: HR=1.99 (1.01; 3.98), p=0.049 (Figure 1). Patients with THA received corticosteroids (93.7 vs 50%, p=0.003) more often including high dose pulse-therapy regimes, but differences in the cumulative doses were not observed (5000 vs 4500 mg, p=0.54) between groups, CS administration was independent risk factor of HOA and THA.

Figure 1.

Cumulative probability of THA in JIA patients with hip osteoarthritis.

Conclusion:

the main risk factors of THA are systemic and polyarticular course because of their activity, systemic CS and delayed biologic treatment. Corticosteroids should be avoided in those group of patients because of risk of avascular pathway HOA formation.

This work supported by the Russian Foundation for Basic Research (grant № 18-515-57001).

Table 1.

The features of JIA patients with hip osteoarthritis depending on

JIA featuresTHA, (n=16)HOA without THA, (n=32)pTime to THA, years5.2 (3.6; 10.2)4.6 (2.2; 8.7)0.4Onset age, years7.95 (3.5; 11.1)8.3 (4.3; 13.1)0.5JIA duration, years8.5 (6.5; 13.2)5.43 (2.8; 11.1)0.07Polyarticular JIA, n (%)8 (50.0)5 (15.6)0.037Systemic JIA, n (%)5 (31.3)6 (7.0)0.037ANA, n (%)3/8 (37.5)5/16 (31.3)0.760HLA B27, n (%)3/6 (50)9/19 (47.4)0.911RF, n (%)0/9 (0)1/15 (6.7)0.429Uveitis, n (%)1/16 (6.3)3/24 (12.5)0.519ESR, mm/h33 (13; 54)5 (3; 27)0.002CRP, mg/l14.7 (2.9; 72.3)1.9 (0.3; 12.7)0.03Active joints, n21.5 (8.5; 52.5)9 (5; 16)0.02Elbows, n (%)11 (68.7)8 (25.0)0.004Proximal interphalangeal joints, n (%)10 (62.5)5 (15.6)0.001Subtalar, n(%)4 (25.0)1 (3.1)0.02Pulse-therapy GCS, n(%)11 (68.7)10 (31.3)0.014Cumulative GCS dose, mg5000 (3000; 14000)4500 (500; 20000)0.54Time to biologic, years7.6 (4.3; 11.4)3.4 (1.9; 8.6)0.04Achievement of remission, years9.2 (6.6; 15.4)5.6 (3.3; 11.4)0.047

Disclosure of Interests:

None declared

SAT0493 CLINICAL PROFILE OF JIA PATIENTS WITH THE CERVICAL SPINE INVOLVEMENT: A SINGLE CENTER RETROSPECTIVE CONTINUOUS STUDY

Background:

JIA is the most common chronic condition in pediatric rheumatology. The cervical spine (CS) involvement is associated with severe disease activity and disability and has been recognized as a factor of a poor prognosis. Data about the CS involvement is contradictory due to silent CS involvement in some patients.

Objectives:

the aim of our study was to provide a clinical profile of the patients with the CS involvement.

Methods:

753 patients for last 10 years with JIA were analyzed. Patients were divided depending on the CS involvement, which was confirmed by clinical (pain, LOM) and radiological features (effusion in the CS joints). We evaluated active joints and routine tests, such as CRP, ESR, ANA-positivity and HLA B27

Results:

The CS involvement was in 101 patients (13.4%). The data are in the table. The CS involvement was more frequently associated with joints of upper body, such as TMJ (23.7% vs 2.9%, p=0.000001), shoulder (29.7% vs 2.9%, p=0.000001), elbow (34.2% vs 12.2%, p=0.000001), wrist (61.4% vs 21.8%, p=0.0000001), MCP (43.6% vs 18.4%, p=0.0000001), PIP (52.5% vs 21.3%, p=0.0000001), DIP (23.8% vs 7.1%, p=0.0000001) and hip (44.6% vs 16.6%, p=0.0000001), and ankle (60.4% vs 40.2%, p=0.0001) from lower body.

ParametersCS, yes (n=101)CS, no (n=652)pFemale, n (%)69 (68.3)388 (59.5)0.092ANA-positivity, n (%)22/57 (38.6)190/403 (47.2)0.226HLA B27-positivity, n (%)12/33 (36.4)88/275 (32.0)0.613Onset age, years5.3 (2.7-10.1)6.1 (3.0- 10.4)0.241ESR, mm/h12.0 (5.0-31.0)7.0 (3.0- 18.0)0.0006CRP, mg/l3.9 (0.0- 20.0)1.1 (0.0-9.2)0.002Active joints, n (%)16.0 (9.0-28.0)5.0 (3.0-10.0)0.000000Time before remission, years2.9 (1.5-5.1)2.2 (1.1-4.6)0.046OligoarthritisPolyarthritisPsoriatic arthritisEnthesitis-related arthritisSystemic arthritis5 (5.0)48 (48.0)7 (7.0)22 (21.8)19 (18.9)199 (30.5)217 (33.3)33 (5.1)164 (25.2)39 (6.0)0.0000001Uveitis, n (%)9/76 (11.9)107/444 (24.1)0,018Oral glucocorticosteroids, n (%)37 (36.7)115/651 (17.7)0.00001Biologic, n (%)68 (67.3)283 (43.4)0.000007Remission, n (%)57 (56.4)428 (65.6)0.072Flare, n (%)10 (9.9)128/651 (19.7)0.018

Conclusion:

The main risk factors of CS involvement in JIA were polyarthicular and systemic arthritis, high inflammatory activity and involvement of joints of upper body. Patients with CS involvement required more often biologics.

Disclosure of Interests:

None declared

THU0511 THE RISK FACTORS OF HIP OSTEOARTHRITIS IN JIA PATIENTS: THE DATA FROM A SINGLE CENTER RETROSPECTIVE CONTINUOUS STUDY

Background:

Hip osteoarthritis (HOA) is a severe irreversible complication of patients with juvenile idiopathic arthritis (JIA) leads to intensive pain, disability and required total hip arthroplasty (THA) in childhood or in the young adults.

Objectives:

the aim of our study was to evaluate risk factors of HOA in JIA patients.

Methods:

we analyzed 753 patients with JIA for last 10 years. In each patient we observed if the HOA developed or no. We evaluated the main clinical JIA measurements, such a JIA category, CRP, ESR, WBC, PLT, active joints, initial or delayed hip involvement, ANA, HLA B27, onset age, JIA duration, time before HOA and before THA, bone metabolic markers, treatment, particularly glucocorticosteroids (GCS), their cumulative doses, route of administration (oral, intra-articular, pulse therapy). HOA was confirmed with radiological assessment (MRI and CT). For comparison analysis used nonparamentric statistics. Each possible variable was evaluated with univariate regression analysis and further multiple regression analysis was applied.

Results:

the comparative study between 2 groups shown in the table 1. HOA was detected in 48 (6.4%), in oligoarthritis-0%, in polyarthritis - 4.9%, in psoriatic arthritis - 5.0%, in enthesitis-related arthritis -11.8%, in systemic arthritis 19% (p=0.0000001), THA was performed in 16 (2.1%). Hip involvement at onset of JIA was similar in both groups (49.5% vs 41.7%, p=0.367).

Table 1.

Characteristics of JIA patients, depends on HOA development.

ParameterHOA (n=48)No HOA (n=705)pOnset age, y8.0 (4.0; 12.5)5.9 (3.0; 10.7)0.045HLA B27, n (%)13/25 (52.0)88/283 (31.1)0.033JIA duration, y7.5 (3.2; 12.1)4.2 (1.8; 7.2)0.00007CRP, mg\l2.8 (0.8; 20.9)1.3 (0; 7.1)0.006Active joints, n11.0 (6.0; 27.0)6.0 (3.0; 12.0)0.000001Oral GCS, n(%)21 (43.8)131/704 (18.6)0.00003GCS pulse-therapy, n (%)21 (43.8)114/702 (16.2)0.000002GCS, cumulative doses, mg5000 (3000; 16000)2000 (1000; 4000)0.001Biologics, n (%)43 (89.6)308 (43.7)0.0000001Remission, n (%)24 (50.0)461 (65.4)0.03Time, before remission, y7.4 (3.9; 12.3)3.0 (1.4; 6.2)0.0000001Alkaline phosphatase, U\l129.3 (84; 244)223 (147; 386)0.00001Delayed hip involvement, n (%)28 (58.3)24/87 (27.6)0.00004

We calculated cut-off and OR of variables, associated with HOA development (table 2). After selection of 26 clinically meaningful and statistical significant risk factors only 22 pass the univariate regression analysis. In multiple regression analysis the main independent risk factors of HOA development were: HLA b27 (p=0.001), oral GCS/pulse therapy GCS (p=0.03) and alkaline phosphatase≤165 U/l (p=0.00006).

Table 2.

Cutt-offs, odds ratio for HOA risk factors in JIA patients.

ParameterSeSpOR (95%CI)pActive joints > 489,642,06,2 (2,4-15,9)0,000002Alkaline phosphatase ≤ 165 U/l65,970,84,7 (2,4-9,2)0,000001GCS > 2700 mg82,658,16,6 (2,1-20,6)0,0004Time before remission>5 years66,778,97,5 (3,1-18,0)0,0000001Time before biologics >7,8 years44,286,75,2 (2,6-10,2)0,0000001

Conclusion:

the main risk factors of HOA were increased inflammatory activity, systemic arthritis, HLA B27, systemic corticosteroids, delayed remission and biologics, decreased bone metabolism. Delayed hip involvement underline the possible non-inflammatory mechanism of HOA, such as avascular necrosis.

Disclosure of Interests:

None declared

FRI0374 PLASMA LEVELS OF 14-3-3 PROTEIN, S100A8/S100A9-PROTEIN, INTERLEUKIN-6, INTERLEUKIN-18, INTERLEUKIN-4, INTERLEUKIN-17, INTERLEUKIN-1Β AND TUMOR NECROSIS FACTOR-Α IN CHRONIC NON-BACTERIAL OSTEOMYEILITIS AND NON-SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS

Background:

Chronic non-bacterial osteomyelitis (CNO) is an immune-mediated disease associated with cytokine dysbalance.

Objectives:

The aim of our study was to evaluate the cytokines levels in CNO and compare to juvenile idiopathic arthritis (JIA) – disease with immune-mediated mechanism.

Methods:

The diagnosis of CNO made with criteria, proposed by Jansson (2007, 2009), after the exclusion of other causes of bone disease [1]. We included 42 patients with NBO, 28 patients with non-systemic juvenile idiopathic arthritis (JIA). We evaluated plasma levels of 14-3-3 protein, S100A8/S100A9-protein, interleukine-6 (IL-6), interleukine-18 (IL-18), interleukine-4 (IL-4), interleukine-17 (IL-17), interleukine-1β (IL-1 β) and tumor necrosis factor-α (TNFα) in 2 groups by the ELISA. Statistical analysis was carried out with Statistica 10.0 software. We utilized descriptive statistics (Me; IQR), Mann-Whitney tests.

Results:

We have found differences in the proinflammatory biomarkers between CNO, JIA. Patients with NBO had lower levels of studied cytokines, exclude14-3-3-protein, S100A8/S100A9 and interleukin-6 compare to JIA patients (table 1).

Table 1.

Comparison the cytokine levels between CNO, JIA N

ParameterNBO (n=42)JIA (n=28)pHemoglobin, g/l112 (104; 124)120 (114.5; 126.0)0.02WBC x 109/l7.9 (7.0; 10.5)8.0 (6.7; 10.0)0.86PLT x 109/l347 (259; 408)336.5 (274.0; 390.5)0.98ESR. mm/h25.0 (9.0; 46.0)8.5 (2.5; 13.0)0.013CRP, mg/l6.1 (0.6; 2.4)1.8 (0.4; 11.9)0.02714-3-3, ng/ml21.4 (18.5; 27.1)19.9 (18.0; 27.8)0.77S100A8/S100A9, ng/ml5.9 (5.2; 6.5)5.9 (5.0; 6.2)0.76IL-6, ng/ml126,2 (112.8; 137.5)132.4 (117.4; 142.9)0.16IL-18, ng/ml270.1 (200.1; 316.1)388.3 (373.9; 405.1)0.0000001IL-4, ng/ml15.3 (11.5; 18.2)18.7 (16.2; 20.2)0.003IL-17, ng/ml83.1 (71.1; 97.3)99.2 (87.3; 115.8)0.003IL-1b, ng/ml47.4 (42.0; 51.3)70.8 (65.3; 73.6)0.0000001TNFa, ng/ml19.4 (17.8; 21.3)23.1 (20.2; 25.9)0.0006

Conclusion:

Patients with CNO had less proinflammatory activity then JIA patients, besides IL-6 and S100A8/S100A9. Further investigations required for finding new more precise biomarkers and finding possible molecular targets for treatment.

This work supported by the Russian Foundation for Basic Research (grant № 18-515-57001)

References:

[1]Jansson AF, et al. Clinical score for nonbacterial osteitis in children and adults. Arthritis Rheum. 2009;60(4):1152-9.

Disclosure of Interests:

None declared