AB0694 VITAMIN D LEVELS IN SERUM OF PATIENTS WITH SYSTEMIC SCLEROSIS AND VERY-EARLY SYSTEMIC SCLEROSIS (VEDOSS)

Background

Systemic sclerosis (SSc) is a chronic disease characterized by autoimmunity, vasculopathy, and visceral and cutaneous fibrosis and very-early systemic sclerosis VEDOSS is characterized by Raynaud’s phenomenon with SSc marker autoantibodies and typical capillaroscopic finding. Vitamin D has several functions in the immunological system, and different studies have suggested a potential role in triggering autoimmune diseases. (1,2)

Objectives

Our goal was to verify the difference of Vitamin D levels causal in SSC definite and VEDOSS population, and relationship between hypovitaminosis D and SSc characteristics

Methods

42 adults with SSc were recruited: 24 with American College of Rheumatology criteria were affected by diffuse systemic sclerosis (4) and limited systemic sclerosis (20); 18

with VEDOSS criteria.

Patients were evaluated from medical history and physical examination (modified Rodnan skin score and the presence / number of ulcers), biohumoral evaluation of routine, electrocardiogram, echocardiogram, pulmonary function tests, high resolution computed tomography of the chest, capillaroscopy. For the determination of total vitamin D levels (25-OH), the serum samples were suitably centrifuged at 4 ° C at 3500g. Vitamin D levels were then determined by a two-step chemiluminescence enzyme immunoassay (CLIA), with a maximum limit of 100 ng / ml.

Results

The 42 subjects recruited (4 men and 38 women); age 48.2 ± 11.5 years (mean ± SD). All subjects were ANA positive, with anti-Scl70 positivity in dcSSc patients (4) and anti-centromere lcSSc patients (18). Patients with VEDOSS showed optimal serum levels of vitamin D (33.93 ± 3.5 ng / ml). Conversely, patients with systemic sclerosis showed serum levels of vitamin D at the limit of sufficiency (21.75 ± 4.0 ng / ml). (Figure 1) In particular, in the group of patients with systemic sclerosis, vitamin D levels were significantly reduced by 1.5 times (P <0.05) compared to VEDOSS group. In patients with SSc the serum levels of vitamin D were inversely proportional to the presence of mega capillaries. Furthermore, a directly proportional correlation of the serum levels of vitamin D with the age of the patient. It is therefore possible to assume that higher levels of vitamin D delay the onset of the disease, while lower levels of vitamin D favor the onset of the same.

Conclusion

Considering our findings from this work, it is possible to consider the Vitamin D supplement in patients suffering from sclerosis, especially as an adjuvant in the initial phase of the disease, thus hypothesizing a slowdown in the progression of the disease and an improvement in prognosis.

References

[1]S. Bellando-Randone, F.Del Galdo, G. Lepri, t al. Progression of patients with Raynaud’s phenomenon to systemic sclerosis: a five-year analysis of the European Scleroderma Trial and Research group multicentre, longitudinal registry study for Very Early Diagnosis of Systemic Sclerosis (VEDOSS). Lancet Rheumatol 2021; 3: e834–43

[2]Rosen Y, Daich J, Soliman I, Brathwaite E, Shoenfeld Y. Vitamin D and autoimmunity. .Scand J Rheumatol. 2016 Nov;45(6):439-447.

Figure 1.

Disclosure of Interests

None declared

Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update

Background

It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up.

Methods

In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)].

Results

In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P &lt; 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%).

Conclusion

Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.

Four years trial in elderly people of appraisal and comparison by geriatric assessment instruments: Use of high potency opioids for cancer pain control and quality of life

18610

Background: Pain is probably under-recognized and under-treated in the Elderly with advanced cancer disease but the effect of a therapy with high potency opioids is not studied so much in geriatric age people. To evaluate efficacy and tollerability of escalating doses of Transdermal Fentanyl (TTS-F) or equipollent doses of oral morphine long acting with Immediate Release Oral Morphine (IROM) as rescue medication for treatment of moderate-severe cancer pain, we have started a Multicentric Observational Analysis in four cancer centres of north-western Italy. Studies of oncological palliation using valid measures of quality of life show that patients may be willing to accept some side effects of treatment as long as they gain relief from tumor-related symptoms Methods: -TIQ (Therapy Impact Questionnaire) -VAS (Visual Analogic Scale): 0 to 10 -Toxicity (WHO criteria) -Geriatric Assessment for pts aged >70 yrs (only at time 0): CIRS (Comorbility Index) IADL/ADL (Instrumental Activities Daily Living/Activities Daily Living). Patients characteristics -159 pts -Total Median Age: 66 yrs (range 38–86) -Median ECOG PS: 1 (range 0–2) -Elderly (>70 yrs): 75. Pain Starting situation -Median starting VAS: 5.5 (range 3–9) -TIQ: depression 70 pts, cachexia 55 pts, dispnoea 40 pts -CIRS (Comorbidity index): comorbidity were present among 66 pts. TTS-Fentanyl starting dose: 25 mcg/h every 72 h (range 25–50 mcg) or oral morphine long acting 60–90 mg plus IROM 10 mg every 4–6 hours for breakthrough pain present in 38 pts Results: -Quickly pain VAS downloading during first two weeks of treatment (median VAS 1) -Analgesic doses were not significantly increased after two months and not exceeded WHO grade 2 -IROM rescue was similar to that observed for the overall population -TIQ, ADL and IADL were not influenced by therapy. Conclusions: High potency opioids (TTS-F or long acting morphine equipollent doses, plus Rescue-IROM) offers durable long term maintenance pain relief wild acceptable toxicity also in elderly people, is particularly useful for cancer pts with compliance problems and may be considered as first-line treatment for moderate/severe cancer pain.

No significant financial relationships to disclose.

Efficacy and safety of mitoxantrone-based chemotherapy as adjuvant treatment in elderly patients (EP) with node positive and high risk node negative breast cancer (BC)

10738

Background: Breast cancer is a very frequent malignancy among EP. Adjuvant chemotherapy improves survival for patients with early breast cancer, but older woman at high risk of recurrence are frequently not offered adjuvant chemotherapy and few data are available on efficacy, compliance and safety of adjuvant chemotherapy when indicated in EP. Objective: the aim of our study was to determine the efficacy, compliance and safety of adjuvant mitoxantone-based chemotherapy (FNC) in high risk BC patients older than 70. Methods and Results: From July 1994 to July 2005 we treated 30 patients >70 years, who had diagnosed with early BC in our institution. The treatment (mitoxantrone 10 mg/m2, 5-Fluorouracil 600 mg/m2, Cyclophosphamide 600 mg/m2, i.v. on day 1 every 3 weeks for 6 cycles) was indicated if patients had no severe comorbidity and a high risk of recurrence. All the patients had undergone mastectomy (56%) or quadrantectomy plus axillary lymphadenectomy (44%). Patients undergoing conservative surgery were scheduled for radiotherapy that was planned immediately after the end of chemotherapy. Study population age ranged from 70–78 years, mean age of 74 years.PS (ECOG) was 0 in 74% of patients, 1 in 26%. Comorbid conditions were detected in 38% of patients (64% hypertension, 8% arythmia, 10% depression syndrome, 14% arthrosis) Main histologic types were invasive ductal carcinoma (87%) and lobular carcinoma (13%). Stage was IIA in 20%, IIB in 37%, IIIA in 43%. Grading was 2 in 51%, G3 in 49%.Sixty-seven percent of tumors were ER+ PGR+, 20% were ER- PGR-, 8% ER-PGR+, 5% ER+ PGR-. Seventy-five percent of patients received adjuvant endocrine therapy, after the end of chemotherapy. Toxicity was very manageable with grade 3–4 haematological toxicity in 1 patient, nausea and vomiting appeared as grade 0 and 1 severity in 10%, alopecia was extremely mild and appeared as grade 0 and 1 in 12%. Only 1 patient disrupted treatment because of toxicity. The overall and relapse free survival rates were 70% and 73% at the 60-month follow up, respectively. Conclusion: FNC is an effective and well-tolerated combination regimen suitable as adjuvant chemotherapy for high risk breast cancer EP.

No significant financial relationships to disclose.