In situ 3D X-ray imaging of water distribution in each layer of a membrane electrode assembly of a polymer electrolyte fuel cell

In situ 3D computed tomography imaging with statistical analysis successfully revealed the water accumulation and drainage characteristics in the stacked gas diffusion layers (GDLs) and membrane electrode assembly (MEA) of a polymer electrolyte fuel cell. Efficient water drainage at the interface between the cathode GDL and MEA was confirmed upon supplying oxygen to the cathode.

Three-Dimensional Visualization of Adsorption Distribution in a Single Crystalline Particle of a Metal-Organic Framework

Many unique adsorption properties of metal-organic frameworks (MOFs) have been revealed by diffraction crystallography, visualizing their vacant and guest-loaded crystal structures at the molecular scale. However, it has been challenging to see the spatial distribution of the adsorption behaviors throughout a single MOF particle in a transient equilibrium state. Here, we report three-dimensional (3D) visualization of molecular adsorption behaviors in a single crystalline particle of a MOF by in situ X-ray absorption fine structure spectroscopy combined with computed tomography for the first time. The 3D maps of water-coordinated Co sites in a 100 μm-scale MOF-74-Co crystal were obtained with 1 μm spatial resolution under several water vapor pressures. Through the visualization of the water vapor adsorption process, 3D spectroimaging revealed the mechanism and spatial heterogeneity of guest adsorption inside a single particle of a crystalline MOF.

Induced chirality at the surface: fixation of a dynamic M/P invertible helical Co3 complex on SiO2

Dynamic M/P invertible helicity was successfully induced at a SiO2 surface immobilized with a dynamic helical trinuclear cobalt complex, [LCo3(NHMe2)6](OTf)3, using chiral ((R) or (S))-1-phenylethylamine. Solid-state CD spectra and theoretical calculations suggested that the fixation of the M/P helical complex on the surface via coordination interactions was the key factor of the induced chirality at the surface.

Vanadium Alumanyl Complex: Synthesis, Characterization, Reactivity, and Application as a Catalyst for C-H Alumanylation of Alkenes

A complex containing a V-Al bond is described. This species can be prepared by either transmetalation of a previously disclosed alumanylpotassium with Cp2VCl or photolytic oxidative alumination of Cp2V using the corresponding dialumane. Reaction of the resulting V-Al complex with H2 gave a Cp2V-dihydridoaluminate complex. These complexes were studied with X-ray crystallography, vanadium K-edge XANES spectroscopy, and DFT calculations. Finally, the reactivity of these molecules was studied opening the way to a catalytic C-H alumanylation of alkenes.

Mechanochemical Synthesis of Non-Solvated Dialkylalumanyl Anion and XPS Characterization of Al(I) and Al(II) Species

A non-solvated alkyl-substituted Al(I) anion dimer was synthesized by a reduction of haloalumane precursor using a mechanochemical method. The crystallographic and theoretical analysis revealed its structure and electronic properties. Experimental XPS analysis of the Al(I) anions with reference compounds revealed the lower Al 2p binding energy corresponds to the lower oxidation state of Al species. It should be emphasized that the experimentally obtained XPS binding energies were reproduced by delta SCF calculations and were linearly correlated with NPA charges and 2p orbital energies.

5D Analysis of Capacity Degradation in Battery Electrodes Enabled by Operando CT-XANES

For devices encountering long-term stability challenges, a precise evaluation of degradation is of paramount importance. However, methods for comprehensively elucidating the degradation mechanisms in devices, particularly those undergoing dynamic chemical and mechanical changes during operation, such as batteries, are limited. Here, a method is presented using operando computed tomography combined with X-ray absorption near-edge structure spectroscopy (CT-XANES) that can directly track the evolution of the 3D distribution of the local capacity loss in battery electrodes during (dis)charge cycles, thereby enabling a five-dimensional (the 3D spatial coordinates, time, and chemical state) analysis of the degradation. This paper demonstrates that the method can quantify the spatiotemporal dynamics of the local capacity degradation within an electrode during cycling, which has been truncated by existing bulk techniques, and correlate it with the overall electrode performance degradation. Furthermore, the method demonstrates its capability to uncover the correlation among observed local capacity degradation within electrodes, reaction history during past (dis)charge cycles, and electrode microstructure. The method thus provides critical insights into the identification of degradation factors that are not available through existing methods, and therefore, will contribute to the development of batteries with long-term stability.

Measurements of neutrino oscillation parameters from the T2K experiment using 3.6×1021 protons on target

The T2K experiment presents new measurements of neutrino oscillation parameters using 19.7 ( 16.3 ) × 10 20 protons on target (POT) in (anti-)neutrino mode at the far detector (FD). Compared to the previous analysis, an additional 4.7 × 10 20 POT neutrino data was collected at the FD. Significant improvements were made to the analysis methodology, with the near-detector analysis introducing new selections and using more than double the data. Additionally, this is the first T2K oscillation analysis to use NA61/SHINE data on a replica of the T2K target to tune the neutrino flux model, and the neutrino interaction model was improved to include new nuclear effects and calculations. Frequentist and Bayesian analyses are presented, including results on sin 2 θ 13 and the impact of priors on the δ CP measurement. Both analyses prefer the normal mass ordering and upper octant of sin 2 θ 23 with a nearly maximally CP-violating phase. Assuming the normal ordering and using the constraint on sin 2 θ 13 from reactors, sin 2 θ 23 = 0 . 561 - 0.032 + 0.021 using Feldman-Cousins corrected intervals, and Δ m 32 2 = 2 . 494 - 0.058 + 0.041 × 10 - 3 eV 2 using constant Δ χ 2 intervals. The CP-violating phase is constrained to δ CP = - 1 . 97 - 0.70 + 0.97 using Feldman-Cousins corrected intervals, and δ CP = 0 , π is excluded at more than 90% confidence level. A Jarlskog invariant of zero is excluded at more than 2 σ credible level using a flat prior in δ CP , and just below 2 σ using a flat prior in sin δ CP . When the external constraint on sin 2 θ 13 is removed, sin 2 θ 13 = 28 . 0 - 6.5 + 2.8 × 10 - 3 , in agreement with measurements from reactor experiments. These results are consistent with previous T2K analyses.

Oxidation and phase transfer of individual Cr-doped dendritic FeOx particles visualized by full-field nano-XAFS spectroimaging

Iron oxides with various compositions and polymorphs have been widely used as compounds that require reversible redox properties, such as catalysts. However, partial decomposition during phase transitions often causes irreversible degradation of the redox properties of iron oxides. Cr doping into the crystalline framework of iron oxide dendrites improves the stability of the structural transformation of iron oxides. We spatially visualized the FeO_x-dendrite phase distribution during oxidation in crystalline dendritic FeO_x and Cr-FeO_x particles by full-field nano-X-ray absorption fine structure spectroimaging. The spectroimaging visualized propagation in the phase transitions in the individual FeO_x particles and changes in the phase transition behaviors of the Cr-FeO_x particles. The statistical analysis of the spectroimaging data revealed the phase transition trends in parts of the FeO_x and Cr-FeO_x particles in three Fe density zones (particle thicknesses) and the probability densities of the phase proportions in the dendrites.

Cap analogs with a hydrophobic photocleavable tag enable facile purification of fully capped mRNA with various cap structures

Starting with the clinical application of two vaccines in 2020, mRNA therapeutics are currently being investigated for a variety of applications. Removing immunogenic uncapped mRNA from transcribed mRNA is critical in mRNA research and clinical applications. Commonly used capping methods provide maximum capping efficiency of around 80-90% for widely used Cap-0- and Cap-1-type mRNAs. However, uncapped and capped mRNA possesses almost identical physicochemical properties, posing challenges to their physical separation. In this work, we develop hydrophobic photocaged tag-modified cap analogs, which separate capped mRNA from uncapped mRNA by reversed-phase high-performance liquid chromatography. Subsequent photo-irradiation recovers footprint-free native capped mRNA. This approach provides 100% capping efficiency even in Cap-2-type mRNA with versatility applicable to 650 nt and 4,247 nt mRNA. We find that the Cap-2-type mRNA shows up to 3- to 4-fold higher translation activity in cultured cells and animals than the Cap-1-type mRNA prepared by the standard capping method.

Coordination-Induced Trigger for Activity: N-Heterocyclic Carbene-Decorated Ceria Catalysts Incorporating Cr and Rh with Activity Induction by Surface Adsorption Site Control

A coordination-induced trigger for catalytic activity is proposed on an N-heterocyclic carbene (NHC)-decorated ceria catalyst incorporating Cr and Rh (ICy-r-Cr_0.19Rh_0.06CeO_z). ICy-r-Cr_0.19Rh_0.06CeO_z was prepared by grafting 1,3-dicyclohexylimidazol-2-ylidene (ICy) onto H₂-reduced Cr_0.19Rh_0.06CeO_z (r-Cr_0.19Rh_0.06CeO_z) surfaces, which went on to exhibit substantial catalytic activity for the 1,4-arylation of cyclohexenone with phenylboronic acid, whereas r-Cr_0.19Rh_0.06CeO_z without ICy was inactive. FT-IR, Rh K-edge XAFS, XPS, and photoluminescence spectroscopy showed that the ICy carbene-coordinated Rh nanoclusters were the key active species. The coordination-induced trigger for catalytic activity on the ICy-bearing Rh nanoclusters could not be attributed to electronic donation from ICy to the Rh nanoclusters. DFT calculations suggested that ICy controlled the adsorption sites of the phenyl group on the Rh nanocluster to promote the C-C bond formation of the phenyl group and cyclohexenone.

POS0681 DRUG RETENTION RATE AND EFFECTIVENESS OF JAK INHIBITOR IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS

Background

Recently, the disease activity of rheumatoid arthritis (RA) was improved due to the ‘treat-to-target’ strategy. However, some patients remain various symptoms despite recommended treatment was performed. Then, the term of ‘difficult-to-treat RA (D2TRA)’ is widely recognized. Janus kinase inhibitor (JAKi) might be effective for D2TRA patients, because JAKi can simultaneously block the function of multiple cytokines.

Objectives

The aim of this study was to evaluate drug retention rate and effectiveness of JAKi in patients with D2TRA.

Methods

This study included 220 RA patients (tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14, filgotinib 2) treated with JAKi. Sixty-two patients were treated as first line bDMARDs/JAKi (1st group), 57 patients were treated as second line bDMARDs/ JAKi (2nd group), 101 patients were treated as third and more bDMARDs/ JAKi. In these 101 patients, 25 patients did not met D2TRA criteria (non-D2TRA group) and 76 patients met D2TRA criteria (D2TRA group). Drug retention rate and effectiveness of JAKi were evaluated during 24 weeks in each group.

Results

Usage rate of methotrexate was lower and dosage of glucocorticoid was higher in D2TRA group than in other groups (Table 1). Drug retention rate at 24 weeks was 87.1% (54/62) in 1st group, 80.1% (46/57) in 2nd group, 88% (22/25) in non-D2TRA group, 61.8% (47/76) in D2TRA group. Drug retention rate was lower in D2TRA group compared to 1st group, 2nd group and non-DT2RA group (p<0.01, p=0.03, p=0.01). DAS28-CRP was 4.4, 4.0, 3.9, 4.4 at baseline, 3.0, 3.0, 3.3, 3.5 at 4 weeks, 2.5, 2.9, 2.7, 3.3 at 12 weeks, 2.5, 3.0, 2.9, 3.2 at 24 weeks in 1st group, 2nd group, non-D2TRA group and D2TRA group, respectively. Improvement ratio of DAS28-CRP was 32.9, 27.6, 20.4, 19.3 % at 4 weeks, 40.8, 26.5, 28.1, 19.5 % at 12 weeks, 40.8, 24.6, 18.7, 24.7 % at 24 weeks. DAS28-CRP was improved in all groups. Altough 1st group showed higher improvement ratio of DAS28-CRP at 24 weeks compared to 2nd group, non-DT2RA group and D2TRA group (p<0.01, p<0.01, p<0.01), there was no differences between DT2RA group and 2nd group or non-D2TRA group (p=0.95, p=0.48). SDAI was 22.9, 19.9, 18.3, 23.9 at baseline, 11.8, 11.9, 13.3, 14.4 at 4 weeks, 7.9, 11.3, 8.4, 13.3 at 12 weeks, 8.5, 11.5, 9.7, 12.6 at 24 weeks. CDAI was 21.3, 18.8, 17.6, 21.8 at baseline, 11.3, 11.2, 12.5, 13.9 at 4 weeks, 7.5, 10.9, 8.0, 12.3 at 12 weeks, 8.1, 10.7, 8.6, 12.1 at 24 weeks. HAQ was 1.15, 0.99, 0.89, 1.39 at baseline, 0.84, 0.76, 0.93, 1.22 at 4 weeks, 0.79, 0.84, 0.77, 1.17 at 12 weeks, 0.76, 0.79, 0.76, 1.14 at 24 weeks. Improvement rate of HAQ at 24 weeks were 44.3%, 23.9%, 21.2%, 8.1%.

Table 1.

Baseline characteristics of RA patients

1st group (n=62)2nd group (n=57)non-D2TRA group (n=25)D2TRA group (n=76)Age (years)64.9 ± 14.866.1 ± 11.564.6 ± 16.163.0 ± 15.0Female (%)75.879.096.080.3Disease durations (years)10.4 ± 11.717.6 ± 17.622.6 ± 22.416.3 ± 15.7RF (IU/ml)296.3 ± 1153.8314.9 ± 1037.7262.4 ± 375.9305.9 ± 819.6RF positive ratio (%)81.878.479.275.7Anti CCP antibody (U/ml)221.8 ± 327.2157.8 ± 258.795.9 ± 101.6191.8 ± 250.6Anti CCP antibody positive ratio (%)79.679.672.283.3CRP (U/ml)1.5 ± 2.11.1 ± 2.01.6 ± 1.61.8 ± 2.9MMP-3 (ng/ml)185.7 ± 167.6146.7 ± 122.1190.1 ± 152.6268.0 ± 451.2DAS28-CRP4.3 ± 1.24.1 ± 1.33.9 ± 1.44.4 ± 1.3SDAI21.8 ± 12.221.7 ± 13.118.4 ± 13.023.9 ± 12.8CDAI20.3 ± 11.320.7 ± 12.717.6 ± 12.822.1 ± 12.2HAQ1.1 ± 0.81.2 ± 1.00.9 ± 0.81.4 ± 1.1MTX use (%)69.463.25647.4MTX (mg/day)10.7 ± 3.410.4 ± 3.58.8 ± 3.59.0 ± 4.3Glucocorticoid use (%)29.136.81646.1Glucocorticoid dose (mg/day)3.3 ± 2.13.0 ± 1.53.5 ± 1.95.1 ± 2.8

Conclusion

Drug retention rate of JAKi in treatment of D2TRA group were lower than that of 1st group, 2nd group, and non-D2TRA group. Clinical efficacy of JAKi in D2TRA group were not significantly different to 2nd group and non-D2TRA group. However, HAQ improvement was weak in D2TRA group.

Disclosure of Interests

None declared

AB0188 ULTRASONOGRAPHIC RESIDUAL INTRA-ARTICULAR SYNOVITIS IS MORE SEVERE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH PREDNISOLONE

Background

The treatment option including biological DMARDs (BIO) and JAK inhibitor (JAK) was expanded, and the number of patients reached to the treatment target are increasing in rheumatoid arthritis (RA). On the other hand, it is also true that some patients are still using prednisolone (PSL). Recently, ultrasound has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA. It is known that residual synovitis was found in ultrasound even in patients with clinical remission.

Objectives

We investigated the differences of ultrasonographic intra-articular synovitis findings between treatment drugs in patients with RA.

Methods

From January 2017 to August 2020, 750 RA patients who underwent ultrasound examination were included. A US examination was performed at the bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three part of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18-6 MHz). The gray scale and power Doppler findings were assessed by the semi-quantitative method (0-3). All patients were divided into with or without BIO / JAK, methotrexate (MTX) and PSL. Then, patients were matched using the propensity score adjusted for gender, age, RA disease duration, disease activity, CRP value, and MMP-3 value. The total gray scale and power Doppler score (GSUS / PDUS) were compared between treatment drugs of RA by using propensity score matching methods.

Results

The average age of 750 RA patients were 64.5 years and an average disease duration of RA was 13.9 years and females were 581 (77.5%). There were 517 patients (68.9%) treated with BIO/JAK and 233 patients treated without BIO/JAK. The 205 patients in each group were matched. GSUS were 10.6±11.1 vs 9.2±10.4 (p=0.218) and PDUS 7.4±9.2 vs 6.5±9.0 (p=0.328). Ultrasound residual synovitis was not different between with or without BIO/JAK in matched patients. There were 525 patients (70.0%) treated MTX, the average MTX dose was 9.3 mg, and 225 patients treated without MTX. The 203 patients with or without MTX in each group were matched. GSUS were 9.7±10.6 vs 11.4±12.0 (p=0.119) and PDUS 6.6±8.8 vs 8.1±10.1 (p=0.117). Ultrasound residual synovitis was not different between with or without MTX in matched patients. There were 111 patients (14.8%) treated PSL, the average dose was 4.0mg, and 639 patients treated without PSL. The 105 patients with or without PSL in each group were matched. GSUS were 15.7±13.9 vs 11.6±10.6 (p=0.018) and PDUS 11.5±11.4 vs 8.1±9.6 (p=0.021). Ultrasound residual synovitis was more severe treated with PSL than without PSL in matched patients.

Conclusion

In a comparison between RA patients matched backgrounds such as disease activity, there was no difference in ultrasound residual synovitis between patients with or without BIO/JAK and MTX. However, there was significant difference in patients with or without PSL. This suggests that PSL use suppresses clinical symptoms but does not improve synovitis. Thus, it should be noted that joint destruction may progress in patients treating with PSL.

References

[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.

[2]Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford). 2014;53:2110-8.

Acknowledgements

We wish to thank Atsuko Kamiyama, Tomoko Nishimura for clinical assistant, Setsuko Takeda, Emi Yamashita, Yuko Yoshida, Emi Ohtani, Yuka Domae, Asami Yagami, Shingo Washida for their special efforts as a sonographer and collecting data.

Disclosure of Interests

Tadashi Okano Speakers bureau: Asahi Kasei, Astellas, Abbvie, Amgen, Ayumi, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi Tanabe, Novartis, Ono, Pfizer, Sanofi, Takeda, UCB, Grant/research support from: Asahi Kasei, Abbvie, Chugai, Eisai, Mitsubishi Tanabe, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Masahiro Tada: None declared, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Tatsuya Koike Speakers bureau: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Hiroaki Nakamura: None declared

AB0229 ACHIEVING GLUCOCORTICOID FREE MIGHT DECREASE RISK FOR CLINICAL FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS - TEN-YEAR FINDINGS FROM THE TOMORROW STUDY

Background

Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falls and fractures.

Objectives

The present study prospectively investigates correlations between decreasing doses of glucocorticoid (GC) and the incidence of clinical fractures in patients with RA based on the ten-year findings of the TOMORROW study (UMIN000003876) that started in 2010.

Methods

We evaluated anthropometric parameters, bone mineral density, disease activity, RA medication, and the incidence of clinical fractures over a period of ten years in 202 patients with RA (mean age, 58.6 years; mean disease duration, 14.0 years). We also investigated the effects of GC doses on the incidence of clinical fractures over the same period in patients with RA using multivariate regression analysis.

Results

The incidence of clinical fractures for ten years in patients with RA was 0.036/person-year. There were 89 patients (44.1%) treated with GC at least once during ten years. The incidences of clinical fractures in patients with RA treated with and without GC during ten years were 0.052 and 0.026/person-year, respectively. After adjusting for fracture risk factors including age, sex, smoking, and body mass index, cox proportional hazard model revealed that GC dose of ≥ 2 mg/day at baseline was a significant risk factor for clinical fractures (Hazard ratio [HR]:2.430; 95%CI, 1.040-5.675, p=0.040). Although the risk for clinical fractures did not decrease by just reducing the dose of GC (HR:4.505; 95%CI, 0.589-34.457, p=0.147), it was significantly lower if the dose of GC could be reduced to zero during ten years (HR:0.407; 95%CI, 0.194-0.857, p=0.018).

Conclusion

Medication with even low dose of GC are apparently significantly associated with an increased frequency of clinical fractures among patients with RA. However, if the dose of GC was reduced to free during ten years, the clinical fracture risk could become lower. We concluded that we should decrease the dose of GC to free after controlling disease activity of RA.

Disclosure of Interests

None declared

AB1096 THE INFLUENCE OF THE BEHAVIORAL RESTRICTION OF COVID-19 PANDEMIC FOR THE FRAILTY OF PATIENTS WITH RHEUMATOID ARTHRITIS

Background

We previously reported the prevalence of frailty and relation of disease activity at patients with rheumatoid arthritis (RA)1. The behavioral restriction of COVID-19 pandemic influenced for the lifestyle of people included patients with RA.

Objectives

The relationship between the behavioral restriction of COVID-19 pandemic and frailty was investigated.

Methods

We used the date from prospective observational study (CHIKARA study: UMIN000023744). 70 from 100 patients with RA were followed-up and evaluated the frailty and subcategories (social, physical, mental, nutrition, and cognitive) by frailty checklist. The prevalence of frailty and the change of exercise and daily life activities by visual analog scale were investigated at pre- and post-behavioral restriction. The correlation of frailty and change of amount of exercise and daily life activity examined by univariate analysis.

Results

Mean age was 69.7 years (women n=57, men n=13). The prevalence of frailty at post-behavioral restriction increased compared that at pre-behavioral restriction (post:35.8% vs pre:30.0%). Especially, cognitive and total score at post-behavioral restriction increased significantly. The rate of decrease of exercise by <25%, 26~50%, and 51%< were 70%, 21%, and 9%, respectively (mean:20% decrease). Whereas, the rate of decrease of daily life activities by <25%, 26~50%, and 51%< were 37%, 27%, and 36%, respectively (mean:44% decrease). The change of exercise was significantly negatively correlated with the change of nutrition (R=-0.245, P=0.041) at Table 1. There was no correlation between the change of daily life activities and subcategories.

Table 1.

Univariate analysis of the changes in daily living activities or exercise and those in frailty and subcategories

Change of daily living activitiesChange of exerciseR valueP valueR valueP valueΔ Social0.0990.417-0.0060.962Δ Physical0.1820.130-0.0050.965Δ Mental-0.2000.097-0.2340.051Δ Nutrition-0.2040.091-0.2450.041Δ Cognitive-0.0870.476-0.0340.778Δ Total-0.0910.454-0.1780.140

Δ, change from pre- to post-behavioral restriction.

Analyzed by Spearman’s rank correlation coefficient

Conclusion

The exercise slightly decreased and the daily life activities decreased almost 50% by the behavioral restriction of COVID-19 pandemic. The prevalence of frailty increased 5.8%, and cognitive and total score were significantly high at post-behavioral restriction of COVID-19 pandemic. The decrease of exercise correlated with the worse of nutrition.

References

[1]Tada M, Yamada Y, Mandai K, Hidaka N. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr Gerontol Int 2019; 19:1220-5.

Disclosure of Interests

None declared

POS0290 THE EFFECTS OF TREATMENT RESPONSE AND RISK FACTOR TO INHIBIT THE CLINICAL RESPONSE IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS TREATED WITH IL-6 RECEPTOR INHIBITOR, ABATACEPT AND JAK INHIBITOR

Background

Recently, the disease activity of rheumatoid arthritis (RA) was improved due to the ‘treat-to-target’ strategy. However, some patients remain various symptoms despite recommended treatment was performed. Then, the term of ‘difficult-to-treat RA (D2TRA)’ is widely recognized. It is unknown how the difference of type of biological disease-modifying anti rheumatic dugs (bDMARDs)/Janus kinase inhibitor (JAKi) will affect clinical efficacy in patients with D2TRA. Moreover, the risk factor to inhibit the clinical response in patients with D2TRA is unknown.

Objectives

The aim of this study was to evaluate the treatment response in patients with D2TRA who were treated with interleukin 6 receptor inhibitor (IL-6Ri), abatacept and JAKi.

Methods

This study used the multicenter database included 673 RA patients treated with bDMARDs/JAKi (tocilizumab 240, sarilumab 67, abatacept 146, tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14, filgotinib 2). Two hundred forty-two patients were treated as first line bDMARDs/JAKi (IL-6Ri 117, abatacept 63, JAKi 62), 211 patients were treated as second line bDMARDs/JAKi (IL-6Ri 117, abatacept 37, JAKi 57), 220 patients were treated as third and more bDMARDs/JAKi. In these 220 patients, 82 patients did not meet D2TRA criteria (IL-6Ri 42, abatacept 15, JAKi 25) and 138 patients met D2TRA criteria (IL-6Ri 31, abatacept 31, JAKi 76). In all patients, we analyzed 138 patients with D2TRA (113 female, mean age was 63.1 ± 13.7 years). Drug retention rate and effectiveness of bDMARDs/JAKi in patients with D2TRA were evaluated for 24 weeks. Multivariate linear regression analysis was performed to clarify the risk factors to inhibit the clinical response.

Results

Drug retention rate of patients with D2TRA at 24 weeks was 67.7% in IL-6Ri group, 74.2% in abatacept group, 61.8% in JAKi group. Drug retention rate in patients with D2TRA was not different between groups (IL-6Ri vs abatacept: p=0.86, IL-6Ri vs JAKi group: p=0.39, abatacept vs JAKi group: p=0.33). DAS28-CRP at 4, 12, 24 weeks decreased in all group (Figure 1). Abatacept showed lower improvement ratio of DAS28-CRP at 24 weeks compared to IL-6Ri group (IL-6Ri vs abatacept: p<0.01, IL-6Ri vs JAKi: p=0.1, abatacept vs JAKi: p=0.07). Good responder (defined as decrease in DAS28-CRP score > 1.2 with a score < 3.2) was 52.4% patients in IL-6Ri, 17.4% patients in abatacept, 29.8% patients in JAKi. SDAI and CDAI at 4, 12, 24 weeks decreased in all group (Figure 1). There were no diferences between the groups in improvement ratio of SDAI (IL-6Ri vs abatacept: p=0.11, IL-6Ri vs JAKi: p=0.81, abatacept vs JAKi: p=0.08) and CDAI (IL-6Ri vs abatacept: p=0.31, IL-6Ri vs JAKi: p=0.82, abatacept vs JAKi: p=0.13) at 24 weeks. HAQ was 1.42, 1.15, 1.39 at baseline, 1.27, 1.07, 1.22 at 4 weeks, 1.17, 1.07, 1.17 at 12 weeks, 1.26, 1.06, 1.14 at 24 weeks in IL-6Ri group, abatacept and JAKi, respectively. Multivariate linear regression analysis revealed that high HAQ (β=0.28, p=0.02) and high dosage of glucocorticoid (β=0.67, p<0.01) inhibited the improvement of DAS28-CRP. Type of bDMARDs/JAKi (β=-0.09, p=0.36) did not affect the DAS28-CRP improvement for 24 weeks.

Table 1.

Multivariate linear regression analysis of risk factor to inhibit the clinical response in patients with D2TRA.

β95% CIpAge (years)-0.037-0.025, 0.0170.74male-0.047-0.788, 0.4860.64Disease durations (years)-0.048-0.028, 0.0170.63RF (IU/ml)-0.082-0.0004, 0.00020.41Anti CCP antibody (U/ml)0.111-0.0005, 0.0020.26DAS28-CRP-0.063-0.265, 0.1420.55HAQ0.2790.059, 0.7170.02MTX (mg/day)0.136-0.018, 0.0810.21Glucocorticoid dose (mg/day)0.6690.174, 0.324< 0.01Type of bDMARDs/JAKi-0.088-0.415, 0.1510.36

Conclusion

Drug retention rate and clinical efficacy of D2TRA patients were not different among IL-6Ri, abatacept and JAKi. DT2RA patient with functional disorder and high dosage of glucocorticoid were risk factor to inhibit the clinical response.

Disclosure of Interests

None declared

OP0133 THE DECREASE OF MUSCLE MASS BY THE BEHAVIORAL RESTRICTION OF COVID-19 PANDEMIC IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

We previously reported the prevalence of sarcopenia and body compositions at patients with rheumatoid arthritis (RA)1. The behavioral restriction of COVID-19 pandemic influenced for the lifestyle of people included patients with RA.

Objectives

The change of exercise and daily life activity of patients with RA were investigated and body composition and muscle function were compared pre- and post-behavioral restriction.

Methods

We used the date from prospective observational study (CHIKARA study: UMIN000023744). 70 from 100 patients with RA were followed-up and evaluated the change of exercise and daily life activity by visual analog scale. They were measured the muscle mass, fat mass, basal metabolic rate by body composition analyzer and grip strength as muscle function. The relationship between the change of exercise and daily life activity and body composition was investigated by univariate analysis.

Results

Mean age was 69.7 years (women n=57, men n=13). The rate of decrease of exercise by <25%, 26~50%, and 51%< were 70%, 21%, and 9%, respectively (mean:20% decrease). Whereas, the rate of decrease of daily life activities by <25%, 26~50%, and 51%< were 37%, 27%, and 36%, respectively (mean:44% decrease). Muscle mass at post-behavioral restriction decrease significantly compared that at pre-behavioral restriction activities (34.0kg vs 34.7kg, P<0.001). Fat mass at post-behavioral restriction increase significantly compared that at pre-behavioral restriction (16.2kg vs 15.5kg, P=0.014). Grip strength at post-behavioral restriction decrease significantly compared that at pre-behavioral restriction (16.2kg vs 17.2kg, P=0.026). The change of exercise was significantly positively correlated with the change of muscle mass and basal metabolic rate (R=0.273, P=0.021 and R=0.256, P=0.033, relatively) at Table 1. Whereas, the change of daily living activities was not significantly correlated with the change of muscle mass and muscle function.

Table 1.

Univariate analysis of the changes in daily living activities or exercise and those in body composition or muscle function

Change of daily living activitiesChange of exerciseR valueP valueR valueP valueΔ Weight (kg)-0.1230.311-0.1310.279Δ BMI (kg/m2)-0.1080.397-0.1130.345Δ Muscle mass (kg)0.1400.3110.2730.021Δ Fat mass (kg)-0.0610.614-0.0750.539Δ Fat percentage (%)-0.0030.982-0.0180.884Δ Basal metabolic rate (kcal)0.2010.0950.2560.033Δ Grip strength (kg)0.1170.3360.0370.762Δ Walk speed (m/s)0.1690.1610.1390.250

Δ, change from pre- to post-behavioral restriction; BMI, body mass index

Analyzed by Spearman’s rank correlation coefficient

Conclusion

Muscle mass and grip strength decrease and fat mass increase in patients with RA by the behavioral restriction of COVID-19 pandemic. Muscle mass and basal metabolic rate decrease in patients without exercise habits. Maintenance of muscle mass might be important during the COVID-19 pandemic.

References

[1]Tada, M., Yamada, Y., Mandai, K. & Hidaka, N. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis 21, 1962-1969, doi:10.1111/1756-185X.13335 (2018).

Disclosure of Interests

None declared

AB0225 FRAX ASSESSMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS PREDICTED THE REAL INCIDENCE OF CLINICAL FRACTURES FOR 10 YEARS FROM THE RESULTS OF THE 10-YEAR TOMORROW STUDY

Background

To investigate if FRAX in patients with RA can predict the incidence of new clinical fractures for 10 years by using the 10-year data of the TOMORROW study (UMIN000003876) which is a prospective cohort study.

Objectives

To investigate if FRAX in patients with RA can predict the incidence of new clinical fractures for 10 years by using the 10-year data of the TOMORROW study (UMIN000003876) which is a prospective cohort study.

Methods

We calculated ten-year probability of major osteoporotic fracture (FRAX) in 208 RA patients and 205 sex- and age-matched volunteers (Vo), and compared FRAX with the incidence of clinical fractures for 10 years.

Results

The mean FRAX were 14.5 and 8.8% in 175 RA patients and 168 Vo, respectively, in whom we could calculate FRAX at baseline and complete to investigate the incidence of clinical fractures for 10 years from baseline. The mean FRAX in RA patients was significantly higher than that in Vo (P<0.001). The actual incidence of clinical fractures for 10 years in RA patients was significantly higher than that in Vo (33.9 vs 22.9%, P=0.031). In both groups, the actual incidence of clinical fractures was higher than FRAX prediction. Logistic regression analysis revealed that FRAX and FRAX≧15% were the significant risk factors for clinical fractures for 10 years in both groups (Odds ratio (OR), 1.055, P<0.001, 2.943, P=0.043, respectively). The mean FRAX in RA patients with and without clinical fractures for 10 years were 18.5 and 12.5%, respectively (P=0.002). In RA patients, FRAX was also the significant risk factor for clinical fractures (OR, 1.046, P=0.004).

Conclusion

FRAX and the incidence of clinical fractures for 10 years were significantly higher in RA patients than them of Vo. We confirmed that FRAX was the risk factor for clinical fractures in actual clinical practice.

Disclosure of Interests

None declared

AB0405 JAK INHIBITORS IMPROVE PATIENT-REPORTED OUTCOMES SUCH AS PAIN AND HAQ EARLIER THAN ANTI-IL-6 INHIBITORS

Background

Clinical feature of Janus kinase (JAK) inhibitor is recognized as not only suppress inflammation but also improve patient-reported outcomes (PRO) such as pain and health assessment questioner (HAQ) in patients with rheumatoid arthritis (RA). This representative clinical feature was known as a results of phase 3 trial compared to TNF inhibitor. One of the mechanisms of JAK in RA is to suppresses interleikin-6 (IL-6). However, the effect for PRO in JAK inhibitor compared to IL-6 inhibitor have not been known.

Objectives

We investigated the effect for patient-reported outcomes such as pain and HAQ in patients with RA treated with JAK inhibitor compared to IL-6 inhibitor.

Methods

This study was analysed a multicenter database included RA patients treated with biological disease-modifying anti rheumatic dugs (bDMARDs) and JAK inhibitors. In 307 patients treated with IL-6 inhibitor (tocilizumab 240 and sarilumab 67) and 220 patients with JAK inhibitor (tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14 and filgotinib 2), 155 patients were treated as first-line bDMARDs/JAK inhibitor (IL-6R inhibitor 104 and JAK inhibitor 51). In this first-line patients, patients treated with IL-6R inhibitor and JAK inhibitor were matched using the propensity score adjusted for gender, age, RA disease duration, baseline charactristics of disease activity, CRP level, and MMP-3 level. The beaseline data and the change of clinical and laboratory data at 4, 12 and 24 weeks were compared between IL-6 inhibitor and JAK inhibitor.

Results

Thirty-six patients in each group were matched and analyzed. The average age was 62.4 and 62.6 years and the average disease duration of RA was 13.2 and 10.1 years in IL-6 inhibitor and JAK inhibitor. The baseline characteristics were not significantly different in both groups. At week 4, tender joint count (TJC) was significantly improved in JAK inhibitor than IL-6 (IL-6: -1.86 vs JAK: -4.12, p= 0.036) and HAQ was significantly improved in JAK inhibitor than IL-6 (IL-6: -0.04 vs JAK: -0.27, p= 0.041). Moreover, Clinical Disease Activity Index (CDAI) was also improved in JAK inhibitor than IL-6 (IL-6: -6.6 vs JAK: -10.9, p= 0.026) at week 4. However, pain VAS and patient global VAS were not significantly different in each group in week4. TJC, HAQ and CDAI was not different in both groups at week 12 and week 24. On the other hand, ESR was significantly decreased in IL-6 inhibitor than JAK inhibitor at week 4, 12 and 24 (IL-6: -26.6 vs JAK: -14.1, p=0.018 at week 4, IL-6: -32.7 vs JAK: -16.5 p=0.004 at week 12, IL-6: -31.3vs JAK: -17.7 p=0.014 at week 24).

Conclusion

In a comparison between IL-6 inhibitor and JAK inhibitor as a first-line molecular-targeted drug matched baseline charactristics of disease activity, TJC and HAQ was improved in JAK inhibitor earlier than IL-6 inhibitors. JAK inhibitor suppress multi cytokine that might be the reason why JAK inhibitor improve pain. Improvement of patient reported outcome in JAK inhibitor was found also in comparison with IL-6 inhibitor.

References

[1]Taylor PC, Keystone EC, van der Heijde D, et al. Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis. N Engl J Med. 2017;376:652-62.

[2]Fleischmann R, Pangan AL, Song IH, et al. Upadacitinib Versus Placebo or Adalimumab in Patients with Rheumatoid Arthritis and an Inadequate Response to Methotrexate: Results of a Phase III, Double-Blind, Randomized Controlled Trial. Arthritis Rheumatol. 2019;71:1788-1800.

Acknowledgements

We wish to thank Atsuko Kamiyama and Tomoko Nishimura for clinical assistant, and all member of Team RA.

Disclosure of Interests

Tadashi Okano Speakers bureau: Asahi Kasei, Astellas, Abbvie, Amgen, Ayumi, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi Tanabe, Novartis, Ono, Pfizer, Sanofi, Takeda, UCB, Grant/research support from: Asahi Kasei, Abbvie, Chugai, Eisai, Mitsubishi Tanabe, Tatsuya Koike Speakers bureau: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd., Masahiro Tada: None declared, Kenji Mamoto: None declared, Yutaro Yamada: None declared, kazuki Orita: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Takahiro Iida: None declared, Hiroaki Nakamura: None declared

AB0262 PATIENTS WITH RHEUMATOID ARTHRITIS WHO DEVELOP SARCOPENIA FALL FREQUENTLY: 5-YEAR DATA FROM THE CHIKARA STUDY

Background

Patients with rheumatoid arthritis (RA) are likely to have sarcopenia due to decreased muscle mass and physical function. Some patients develop sarcopenia even if disease activity is well-controlled. We previously reported that 13.2% of RA patients without sarcopenia at baseline developed sarcopenia over a year1.

Objectives

The aim was to longitudinally investigate sarcopenia status and the characteristics of RA patients using data from the prospective, observational CHIKARA study.

Methods

Body composition, laboratory data, disease activity, physical function (HAQ), treatment, and history of falls and fractures were investigated in 100 RA patients who participated in the CHIKARA study at baseline and at 5 years. They were divided into 4 groups depending on their sarcopenia status: no sarcopenia developed (N group; sarcopenia absent at baseline and 5 years); sarcopenia developed (S group; sarcopenia absent at baseline, but present at 5 years); cured (C group; sarcopenia present at baseline, but absent at 5 years); and persistent (P group; sarcopenia present at baseline and at 5 years).

Results

Seventy RA patients completed the survey. There were no differences among the 4 groups in disease activity, physical function, and treatment. The N group, accounting for 67.1% of all patients, was young and had high body mass index, muscle mass, fat mass, estimated bone mass, and body metabolic rate at baseline. On the other hand, the S group, accounting for 4.3% of all patients, fell significantly more frequently (p=0.035), 3.3 times during 5 years. The P group, accounting for 18.6% of all patients, had significantly higher MMP-3 at baseline (p=0.006). The C group accounted for 10.0% of all patients (Table 1).

Table 1.

Characteristics of 77 RA patients by sarcopenia status at baseline and at 5-year follow-up

no development (n=47)development (n=3)cured (n=7)persisted (n=13)p valueage, years63 (57.5, 70)76 (74.5, 81)66 (54, 70)73 (65, 82)0.006disease duration, years6.5 (1.1, 10.7)15.2 (14.9, 20.7)11.4 (7.2, 14.8)3.5 (1.1, 6.5)0.021MTX dose, mg/day8.1 ± 3.76.0 ± 2.07.4 ± 3.86.2 ± 4.80.406biologics use, %36.266.728.623.10.513GC use, %23.4028.615.40.701average GC dose, mg/day3.5 ± 1.103.7 ± 1.86.3 ± 1.80.833CRP, mg/dl0.1 (0.04, 0.18)0.04 (0.04, 0.23)0.2 (0.12, 0.47)0.19 (0.08,0.82)0.22MMP-3, ng/ml62.2 (50.3, 98.6)58.9 (47.8, 71.3)74.9 (58.3,147.2)160 (90.8,262)0.006DAS28ESR3.34 ± 0.914.11 ± 0.723.36 ± 1.383.79 ± 1.200.355mHAQ0.25 (0, 0.5)0.63 (0.56, 1.25)0.87 (0.25, 1.0)0.25 (0.13, 0.75)0.132BMI, kg/m223.22 ± 3.5121.4 ± 2.2518.69 ± 2.0819.56 ± 2.39<0.001SMI, kg/m26.73 ± 0.76.1 ± 0.25.51 ± 0.145.79 ± 0.6<0.001fat percentage, %30.39 ± 8.7730.03 ± 9.1225.04 ± 6.2323.75 ± 6.560.051estimated bone mass, kg2.2 (2, 2.4)1.9 (1.75, 1.95)1.6 (1.55, 1.9)1.9 (1.7, 2.2)0.001BMR, kcal1101 (1051, 1198)986 (934, 1010)896 (872, 994)978 (902,1107)<0.001ΔDAS28ESR-0.15 ± 0.84-0.43 ± 1.730.04 ± 0.89-0.59 ± 1.330.445ΔSMI, kg/m2-0.06 ± 0.34-0.38 ± 0.570.25 ± 0.220.08 ± 0.420.038fall, times1.63.331.290.380.045

Data are shown as mean ± standard deviation (SD) or median (25th, 75th percentile).

GC: glucocorticoids, MMP-3: matrix metalloproteinase 3, DAS: disease activity score, HAQ: health assessment questionnaire, BMI: body mass index, SMI: skeletal muscle mass index, BMR: body metabolization rate, Δ:change during 5 years.

Conclusion

Overall, 4.3% of RA patients developed sarcopenia and fell frequently during 5-year follow-up. Patients who develop sarcopenia require special care because they are at high risk of falls.

References

[1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jun;39(6):1757-1764.

Disclosure of Interests

None declared

AB0387 THE RELATIONSHIP BETWEEN JAK INHIBITORS AND CREATINE KINASE ELEVATION IN PATIENTS WITH RHEUMATOID ARTHRITIS: A REAL-WORLD CLINICAL STUDY

Background

Some cases of creatine kinase (CK) elevation caused by Janus kinase (JAK) inhibitor treatment for rheumatoid arthritis (RA) have been reported in clinical trials1. However, the frequency and patients’ background characteristics in clinical practice are unknown.

Objectives

The correlation between JAK inhibitor treatment for RA and changes in CK levels in clinical practice were investigated using a multicenter database.

Methods

The multicenter database of JAK inhibitors was used, and 103 (tofacitinib 46, baricitinib 44, upadacitinib 11, peficitinib 1, filgotinib 1) of 265 RA patients were followed up at 24 weeks, and their CK levels were evaluated. The time-dependent change of CK was evaluated by sex and analyzed by the Wilcoxon signed-rank test. The percentage abnormal from the standard titer was calculated. The factors related to an elevated CK at 24 weeks were investigated using patients’ background characteristics at the time of starting JAK inhibitors by univariate analysis.

Results

Women accounted for 85.4% of the patients, the median age was 68 years, disease duration was 15 years, and the mean DAS28ESR was 5.00. The CK levels of both men and women were significantly elevated at 4 weeks and maintained until 24 weeks (men, women: 63, 62 (0 weeks), 101, 95 (4 weeks), 119, 96 (12 weeks), 155, 99 (24 weeks), U/L, P<0.001) (Figure 1). The percentage abnormal was also significantly increased at 4 weeks and maintained until 24 weeks (5.8% (0 weeks), 20.7% (4 weeks), 26.3% (12 weeks), 24.3% (24 weeks), P=0.002). The factors significantly positively related to elevated CK levels at 24 weeks were male, CK, creatinine, and lactate dehydrogenase (LDH), and stage, class, modified health assessment questionnaire, estimated glomerular filtration rate (eGFR), and glucocorticoid use were significantly negatively correlated (Table 1). There were no significant differences in CK elevation among the agents.

Table 1.

Characteristics at the time of starting JAK inhibitors related to elevated creatine kinase levels at 24 weeks

UnivariateData at stating JAK inhibitorsR valueP valueCreatine kinase0.653<0.001Gender, men0.2470.012Steinbrocker stage-0.2150.039Steinbrocker class-0.2770.008modified health assessment questionnaire-0.2680.008Creatinine0.2890.003eGFR-0.2310.019LDH0.2010.041Glucocorticoid use-0.4090.008

Analyzed by Spearman rank correlation coefficient

Figure 1.

Time-dependent changes of CK in all RA patients

Conclusion

CK was significantly elevated at 4 weeks and maintained until 24 weeks. However, no patients complained of muscle pain and stopped JAK inhibitors. Patients with high CK, low eGFR, high LDH, or maintained activities of daily living at the time of starting JAK inhibitors tended to have high CK levels at 24 weeks.

References

[1]Fleischmann, R. et al. Upadacitinib Versus Placebo or Adalimumab in Patients With Rheumatoid Arthritis and an Inadequate Response to Methotrexate: Results of a Phase III, Double-Blind, Randomized Controlled Trial. Arthritis & rheumatology (Hoboken, N.J.) 71, 1788-1800, doi:10.1002/art.41032 (2019).

Disclosure of Interests

None declared

POS0631 EVEN LOW-DOSE GLUCOCORTICOID USE IS A RISK FACTOR FOR CLINICAL FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS: TEN-YEAR FINDINGS OF THE TOMORROW STUDY

Background

Patients with rheumatoid arthritis (RA) who have sarcopenia and stiff or painful joints might be at increased risk of falls and fractures.

Objectives

The present study aimed to prospectively identify the incidence of clinical fractures and associated risk factors in patients with RA in a cohort study named the TOMORROW (UMIN000003876) that started in 2010.

Methods

We evaluated anthropometric parameters, bone mineral density (BMD), disease activity, RA medication at entry and observed the incidence of clinical fractures during ten years in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched non-RA volunteers (Vo) (mean age, 57.4 y). We compared the incidence of clinical fractures between patients with RA and Vo for ten years, and analyzed the risk factors for clinical fractures using Cox proportional hazard model.

Results

The incidences of clinical fractures were 0.036 and 0.024/person-year in patients with RA and Vo, respectively. Cox proportional hazard model revealed that low BMD at the thoracic vertebrae (< 0.7 g/cm2) and history of fractures at entry were significantly associated with the incidence of clinical fractures (Hazard ratio [HR]1.737, p=0.020 and HR1.514, p=0.047, respectively) in all participants. RA morbidity, however, was not (HR1.398, p=0.112). In patients with RA, medication with GC at entry was a significant risk factor for clinical fractures (HR1.898, p=0.017). Additionally, a mean GC dose (≥ 2 mg/day) at entry and during the ten-year period increased risk for fractures (HR 2.189, p=0.004, 1.866, p=0.022, respectively).

Conclusion

RA per se was not a risk factor for clinical fractures in this cohort. Low BMD at the thoracic vertebrae at entry and the use of GC with even low dose at entry and during ten years were significantly associated with an increased frequency of clinical fractures among patients with RA.

Disclosure of Interests

None declared

Operando Imaging of Ce Radical Scavengers in a Practical Polymer Electrolyte Fuel Cell by 3D Fluorescence CT-XAFS and Depth-Profiling Nano-XAFS-SEM/EDS Techniques

There is little information on the spatial distribution, migration, and valence of Ce species doped as an efficient radical scavenger in a practical polymer electrolyte fuel cell (PEFC) for commercial fuel cell vehicles (FCVs) closely related to a severe reliability issue for long-term PEFC operation. An in situ three-dimensional fluorescence computed tomography-X-ray absorption fine structure (CT-XAFS) imaging technique and an in situ same-view nano-XAFS-scanning electron microscopy (SEM)/energy-dispersive spectrometry (EDS) combination technique were applied for the first time to perform operando spatial visualization and depth-profiling analysis of Ce radical scavengers in a practical PEFC of Toyota MIRAI FCV under PEFC operating conditions. Using these in situ techniques, we successfully visualized and analyzed the domain, density, valence, and migration of Ce scavengers that were heterogeneously distributed in the components of PEFC, such as anode microporous layer, anode catalyst layer, polymer electrolyte membrane (PEM), cathode catalyst layer, and cathode microporous layer. The average Ce valence states in the whole PEFC and PEM were 3.9+ and 3.4+, respectively, and the Ce³⁺/Ce⁴⁺ ratios in the PEM under H₂ (anode)-N₂ (cathode) at an open-circuit voltage (OCV), H₂-air at 0.2 A cm^-2, and H₂-air at 0.0 A cm^-2 were 70 ± 5:30 ± 5%, as estimated by both in situ fluorescence CT-X-ray absorption near-edge spectroscopy (XANES) and nano-XANES-SEM/EDS techniques. The Ce³⁺ migration rates in the electrolyte membrane toward the anode and cathode electrodes ranged from 0.3 to 3.8 μm h^-1, depending on the PEFC operating conditions. Faster Ce³⁺ migration was not observed with voltage transient response processes by highly time-resolved (100 ms) and spatially resolved (200 nm) nano-XANES imaging. Ce³⁺ ions were suggested to be coordinated with both Nafion sulfonate (Nf_sul) groups and water to form [Ce(Nf_sul)_x(H₂O)_y]³⁺. The Ce migration behavior may also be affected by the spatial density of Ce, interactions of Ce with Nafion, thickness and states of the PEM, and H₂O convection, in addition to the PEFC operating conditions. The unprecedented operando imaging of Ce radical scavengers in the practical PEFCs by both in situ three-dimensional (3D) fluorescence CT-XAFS imaging and in situ depth-profiling nano-XAFS-SEM/EDS techniques yields intriguing insights into the spatial distribution, chemical states, and behavior of Ce scavengers under the working conditions for the development of next-generation PEFCs with high long-term reliability and durability.

POS1456-HPR THE SERUM IRON LEVEL MIGHT BE USEFUL IN DETERMINING THE SEVERITY OF MALNUTRITION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The Global Leadership Initiative on Malnutrition (GLIM) criteria, the first international criteria for diagnosis of malnutrition, was released in 2018 [1]. Patients with rheumatoid arthritis (RA) are thought to be prone to malnutrition due to decreased food intake and increased muscle catabolism caused by chronic inflammation or pain. However, there has been no report to assess the nutritional status of RA patients in accordance with the GLIM criteria. In addition, commonly used blood nutrient indicators such as albumin might not be appropriate as nutritional indicators for RA because these values are affected by inflammation.

Objectives:

This study aims to examine the rates of malnutrition in RA patients according to GLIM criteria, and the relationship between blood nutrient indicators and the severity of malnutrition.

Methods:

In this study, we conducted a cross-sectional survey of 135 female RA patients in 2020. According to the GLIM criteria, patients were considered to be malnourished if patients had one of the following phenotypic: (1) low body mass index, (2) non-volitional weight loss, (3) reduced muscle mass, and one of the following etiologic: (1) reduced food intake or assimilation, (2) disease burden/inflammatory condition. Reduced muscle mass was evaluated by measuring calf circumference, and inflammatory condition was evaluated by Disease Activity Score (DAS) 28. In accordance with the GLIM criteria, the severity of malnutrition was judged as three levels: no problem, moderate, and severe malnutrition. Albumin, transthyretin, transferrin, retinol binding protein, zinc, iron, ceruloplasmin, and total cholesterol were assessed as blood nutrition indicators. Also grip strength was assessed. We compared each nutritional indicator among the three groups according to the severity of malnutrition using age-adjusted analysis of covariance, and examined the relationship between each nutritional indicator and the severity of malnutrition using receiver operating characteristic (ROC) analysis.

Results:

In RA patients, 20% were classified as severe malnutrition, and 40% were moderate or more. Serum iron levels were significantly lower in the severe malnutrition group compared to the no problem group (p = 0.001). In ROC analysis, serum iron, zinc, albumin, and grip strength (area under curve; AUC; 0.680, 0.696, 0.636, 0.790, respectively) were significant parameters for classification of moderate and severe malnutrition. Serum iron and grip strength (AUC for respective parameters were 0.741, 0.747) were significant parameters for classification of severe malnutrition.

Conclusion:

Evaluation based on the GLIM criteria showed that about 40% of RA patients were under moderate or severe malnutrition. It was suggested that serum iron and grip strength might be useful to predict the severity of malnutrition.

References:

[1]Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clinical Nutrition 2019; 38: 1-9.

Acknowledgements:

We thank to Tomoko Nakatsuka, and the Center for Drug & Food Clinical Evaluation, Osaka City University Hospital, for management and collection of the study data. We also thank to study participants.

Disclosure of Interests:

Yoshinari Matsumoto Grant/research support from: Yamada Research Grant, Yuko Sugioka: None declared, Masahiro Tada: None declared, Tadasi Okano Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Kenji Mamoto: None declared, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co., Ltd., Chugai Pharmaceutical Co., Ltd, Grant/research support from: anssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co., Ltd., Daiki Habu: None declared, Tatsuya Koike Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB

AB0813 DEVELOPING SARCOPENIA IS A RISK FACTOR FOR FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS: 4-YEAR DATA FROM THE CHIKARA STUDY

Background:

Patients with rheumatoid arthritis (RA) tend to have sarcopenia due to decreased muscle mass and function. We previously reported that 13.2% of RA patients without sarcopenia at baseline developed sarcopenia over a year using data from the prospective, observational CHIKARA study1.

Objectives:

The aim was to investigate sarcopenia status and the characteristics of RA patients longitudinally.

Methods:

Body composition, laboratory data, disease activity, physical function, treatment, and history of falls and fractures were investigated in 100 RA patients who participated in the CHIKARA study at baseline and at 4 years. The patients were divided into 4 groups depending on their sarcopenia status: no sarcopenia development (N group), sarcopenia development (S group), cured (C group), and persisted (P group).

Results:

Of the 77 RA patients who completed the survey, 48 were in the N group; their body mass index, skeletal muscle mass index, fat percentage, estimated bone mass, and body metabolization rate at baseline were significantly elevated. On the other hand, 6 patients were in the S group; 83.3% of them experienced fractures during the 4 years, significantly more than in the other groups. Ten patients were in the P group, and their baseline MMP-3 was significantly higher than in the other groups. Thirteen patients were in the C group. There were no differences among the 4 groups in disease activity and physical function (Table 1).

Table 1.

Characteristics of 77 RA patients by sarcopenia status at baseline and at 4-year follow-up.

no development(n=48)development(n=6)cured(n=10)persisted(n=13)p valueBaseline age, years64.5 (57.8, 72)70.0 (65.5, 72.3)61.0 (54.5, 68.3)72 (68, 81)0.062 disease duration, years4.6 (1.1, 9.9)11.7 (2.8, 18.9)8.1 (4.2, 14.3)4.0 (2.2, 7.7)0.427 biologics use, %37.516.730.023.10.617 GC use, %27.116.710.023.10.678 MMP-3, ng/ml66.8 (51.8, 103)52.5 (40.0, 56.7)82.8 (57.8, 186)157.5 (90.8, 250)0.001 DAS28ESR3.43 ± 0.873.48 ± 1.323.36 ± 1.083.80 ± 1.270.661 mHAQ0.31 (0, 0.50)0.19 (0.03, 0.44)0.38 (0, 0.84)0.50 (0.25, 0.88)0.383 BMI, kg/m223.4 ± 3.621.6 ± 2.419.2 ± 1.619.5 ± 2.6<0.001 SMI, kg/m26.8 ± 0.86.2 ± 0.65.8 ± 0.55.7 ± 0.6<0.001 fat percentage, %30.4 ± 8.429.1 ± 9.123.9 ± 4.025.1 ± 8.30.046 estimated bone mass, kg2.2 (2.0, 2.4)1.9 (1.8, 2.1)2.0 (1.7, 2.1)1.7 (1.7, 1.9)0.012 BMR, kcal1100 (1031, 1197)1029 (918, 1070)1012 (917, 1057)934 (894, 1006)0.005Change during 4 years ΔDAS28ESR-0.34 ± 0.97-0.52 ± 0.98-0.60 ± 1.46-0.56 ± 1.140.834 ΔmHAQ0 (-0.25, 0.16)0.19 (0, 0.56)-0.06 (-0.44, 0.94)0 (-0.38, 0.38)0.357 ΔSMI, kg/m20.0 ± 0.3-0.6 ± 0.30.3 ± 0.4-0.0 ± 0.3<0.001 fall, %43.883.330.023.10.079 fracture, %14.683.320.023.10.002

Data are shown as mean ± standard deviation (SD) or median (25th, 75th percentile).

GC: glucocorticoids, BMI: body mass index, SMI: skeletal muscle mass index, BMR: body metabolization rate.

Conclusion:

Overall, 7.8% of RA patients developed sarcopenia during the 4-year follow-up period, and they developed fractures more frequently. Evaluation of sarcopenia is important for risk assessment of fractures.

References:

[1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jun;39(6):1757-1764.

Disclosure of Interests:

Yutaro Yamada: None declared, Masahiro Tada: None declared, Koji Mandai: None declared, Noriaki Hidaka: None declared, Hiroaki Nakamura Grant/research support from: Astellas and Asahi Kasei

POS0532 AveRAGE PREDNISOLONE DOSE OF ONLY 1 MG PER DAY WAS RISK FACTOR FOR CLINICAL FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS - NINE-YEAR FINDINGS OF THE TOMORROW STUDY

Background:

Previous cohort studies showed that the use of prednisolone (PSL) was a risk factor for clinical fractures in patients with rheumatoid arthritis (RA). However, there are few reports on relationship between PSL dose and clinical fractures.

Objectives:

The present study aimed to determine the effect of PSL dose on the incidence of clinical fractures in the RA patients treated with PSL.

Methods:

We evaluated anthropoetric parameters, bone mineral density (BMD), disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR), RA medication (methotrexate (MTX) dose, use of biologic disease modified anti-rheumatic-drugs (bDMARDs), and PSL dose) and the incidence of clinical fractures during nine years in RA patients who participant the TOMORROW study (UMIN000003876), which is a 10-years prospective cohort study. Data on clinical fracture was self-reported on the questionnaires. In this analysis, the data of RA patients treated with PSL at least once during nine-year period were evaluated. We analyzed the average dose of PSL until the incidence of the clinical fractures. The risk factor for clinical fractures were analyzed by using Cox proportional hazard model with adjustment for age, sex, body mass index (BMI), and smoking history.

Results:

We analyzed the data of 67 RA patients treated with PSL. Among them, median age was 61.8 year, 56 patients (83.6%) were female, 47 patients (70.1%) were never smoker and median disease duration was 12.1 year. The number of patients treated with PSL at baseline was 48 (69.1%). During 9 years, 23 clinical fractures were observed in 67 patients, and the incidence of clinical fracture was 0.046/person-year. In 19 patients, who were not treated with PSL at baseline but treated with PSL at least once during 9 years, 5 clinical fractures were observed. In 67 RA patients, Cox proportional hazard analysis revealed that baseline disease activities, BMD at thoracic vertebrae and medication were not significant risk factors for clinical fractures. However, average PSL dose of more than only 1 mg/day was a significant risk factor for the incidence of clinical fracture (hazard ratio (HR): 2.80; p=0.03) (Table 1).

Table 1.

Adjusted hazard ratio for clinical fractures in patients with rheumatoid arthritis treated with PSL.

* Adjusted Hazard ratio95% Confidence intervalP valueCRP (mg/dL)1.290.88-1.910.19RF (IU/mL)0.990.99-1.000.07ACPA (U/mL)0.990.98-1.000.18DAS28-ESR0.990.71-1.390.97BMD at thoracic vertebrae (mg/cm2)0.020.00-1.000.05bDMARDs use0.550.23-1.320.18Bisphosphonate use2.330.95-5.710.07average dose of MTX (mg/week)1.020.92-1.120.74average score of DAS28-ESR1.150.76-1.750.52average dose of PSL more than 1mg/day2.81.09-7.240.03

*Hazard ratio was adjusted for age, sex, body mass index (BMI), and smoking history. RF, Rheumatoid factor; ACPA, Anti-cyclic citrullinated peptide antibody; DAS28-ESR, disease activity score 28-erythrocyte sedimentation rate; BMD, Bone mineral density; bDMARDs, biologic disease modified anti-rheumatic-drugs; MTX, methotrexate; PSL, prednisolone.

Conclusion:

In RA patients treated with PSL, average PSL dose of only 1mg/day significantly increased the risk for the incidence of clinical fractures. Even for established RA patients, continuous use or initiation of low PSL dose was apparently significant risk factor for clinical fractures.

Disclosure of Interests:

Hitoshi Yoshimura: None declared, Tatsuya Koike Grant/research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Kenji Mamoto: None declared, Yuko Sugioka: None declared, Tadashi Okano: None declared, Masahiro Tada: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K. and Astellas Pharma Inc, Hiroaki Nakamura: None declared

POS0517 A LONGITUDINAL STUDY OF SARCOPENIA, LOCOMOTIVE SYNDROME, AND FRAILTY IN PATIENTS WITH RHEUMATOID ARTHRITIS: FROM THE CHIKARA STUDY

Background:

Rheumatoid arthritis (RA) patients have a high frequency of sarcopenia, and they commonly have reduced physical function. We previously reported that the prevalence of sarcopenia was 28%, that of frailty was 18.9%, and that of pre-frailty was 38.9% in RA patients1,2, and 13.2% of RA patients developed sarcopenia within a year 3.

Objectives:

To investigate the risk factors for new onset of sarcopenia, locomotive syndrome, and frailty in patients with RA and the course of each disease.

Methods:

Two-year follow-up data from the rural group of the prospective, observational CHIKARA study were used. Sarcopenia was diagnosed using the criteria of the Asian Working Group for Sarcopenia 2014, locomotive syndrome was diagnosed using locomotive 5, and frailty was diagnosed using the basic checklist. New onset of the disease over the 2-year follow-up period was studied, excluding cases that had the disease at baseline. Improvement was defined as cases with disease at baseline that no longer met the diagnostic criteria after 2 years. Differences in the characteristics of each disease were tested using the Chi-squared test and the paired t-test.

Results:

The 81 patients with RA (82.7% female) had mean age 66.9±11.5 years, mean DAS28-ESR 2.9±1.2, methotrexate use in 81.5% (with a dose of 9.9±2.7 mg/week), and glucocorticoid (GC) use in 22.2% (with a dose of 3.1±1.7 mg/week). The baseline prevalence was 44.4% for sarcopenia, 35.8% for locomotive syndrome, and 25.9% for frailty, and the new onset rate was 4.4% for sarcopenia, 15.4% for locomotive syndrome, and 13.3% for frailty. Of the patients with each disease at baseline, 36.1% had sarcopenia, 20.7% had locomotive syndrome, and 33.3% had frailty, and of those with each disease at 2 years, 36.1% had sarcopenia, 20.7% had locomotive syndrome, and 33.3% had frailty. The new onset sarcopenia and locomotive syndrome groups had significantly higher rates of GC use (p=0.036, p=0.007, paired t-test) and significantly higher doses (p=0.01, p=0.001, paired t-test) than the groups without new onset sarcopenia and locomotive syndrome. High baseline disease activity was an independent predictor of new onset of locomotive syndrome on multivariate logistic regression analysis (OR=3.21, p=0.015).

Conclusion:

The new onset rates at 2 years were 4.4% for sarcopenia, 15.4% for locomotive syndrome, and 13.3% for frailty. In the new onset sarcopenia and locomotive syndrome groups, both GC use and dosage were significantly higher.

References:

[1]Tada M, et al. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis. 2018 Nov;21(11):1962-1969.

[2]Tada M, et al. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr Gerontol Int. 2019 Dec;19(12):1220-1225.

[3]Yamada Y, et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol. 2020 Jun;39(6):1757-1764.

Disclosure of Interests:

None declared

POS0514 IMPORTANCE OF BODY MASS MEASUREMENT AND THE GRIP STRENGTH TEST TO PREDICT FALLS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

We previously reported that the prevalence of sarcopenia was 28% in patients with rheumatoid arthritis (RA) in a cohort study 1. RA patients have a high risk of falls and fractures 2. However, the predictors of falls and fractures in RA patients are not known.

Objectives:

Whether evaluation of muscle mass and function at baseline could predict falls and fractures during four-year follow-up was investigated.

Methods:

The four-year follow-up data from a prospective, observational study (CHIKARA study: Correlation researcH of sarcopenIa, sKeletal muscle and disease Activity in Rheumatoid Arthritis) were used. Muscle mass was measured by a body impedance analyzer, and leg muscle mass was calculated. The leg muscle score (max: 100, min: 0) reflected the ratio of leg muscle mass to overall weight. Grip strength as an indicator of muscle function was evaluated using a digital, hand-held, isokinetic dynamometer. The correlations between muscle mass or function and falls or fractures were analyzed by survival rates and Cox hazard ratios. Leg muscle mass and grip strength were investigated by receiver operating characteristic (ROC) curve analysis for correlations with falls or fractures.

Results:

A total of 100 RA patients (female: 78%, mean age: 66.1 years) were enrolled; 35 patients had falls, and 19 patients had fractures during the four-year follow-up. The leg muscle score, grip strength, age, and fractures at baseline were significantly correlated with falls. The cut-off values of the leg muscle score and grip strength were calculated to be 84.5 points (sensitivity: 0.79, specificity: 0.43) and 15.9 kg (sensitivity: 0.56, specificity: 0.70), respectively, by ROC curve analysis. The patients were divided into four groups by their leg muscle scores and grip strength; the numbers of falls and fractures are shown in Table 1 for each group. The fall-free survival rate was significantly lower in the group with low leg muscle score and low grip strength (35.3%) than in the other groups (P=0.002) (Figure 1). The hazard ratio for the both low group was significantly increased, 3.6-fold (95%CI: 1.1-11.5), compared to that in the both high group.

Table 1.

Numbers of falls and fractures by category of leg muscle score and grip strength

LG + GS+(n=34)LG - GS+(n=12)LG + GS-(n=37)LG - GS-(n=17)P value*Falls, N6515110.010Fractures, N34660.072

LG+: leg muscle score >84.5 points, GS+: grip strength >15.9kg, LG-: leg muscle score ≤84.5 points, GS+: grip strength ≤15.9kg

*: compared in four groups by Kruskal-Walls test.

Figure 1.

Fall-free survival rate in the four groups

Conclusion:

RA patients with both low leg muscle score and low grip strength at baseline were at high risk for falls during the four-year follow-up period. Evaluation of muscle mass and function can predict falls in RA patients.

References:

[1]Tada, M., Yamada, Y., Mandai, K. & Hidaka, N. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis21, 1962-1969, doi:10.1111/1756-185X.13335 (2018).

[2]van Staa, T. P., Geusens, P., Bijlsma, J. W., Leufkens, H. G. & Cooper, C. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum54, 3104-3112, doi:10.1002/art.22117 (2006).

Disclosure of Interests:

None declared

OP0319 OSTEOSARCOPENIA INCREASES THE RISK OF FALLS IN PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS OF A FOUR-YEAR LONGITUDINAL STUDY

Background:

Osteosarcopenia is defined as osteoporosis combined with sarcopenia. Both osteoporosis and sarcopenia are risk factors for falls and fractures in healthy individuals1. The relationships of falls and fractures to osteosarcopenia in rheumatoid arthritis (RA) patients are unknown.

Objectives:

The synergistic effect of osteoporosis and sarcopenia and the impact of osteosarcopenia on falls and fractures in RA patients were investigated using four years of data from a longitudinal study.

Methods:

The data from a prospective, observational study (CHIKARA study: UMIN000023744) were examined. The patients were divided into four groups according to their baseline status: no sarcopenia and osteoporosis (SP-OP-); only sarcopenia (SP+OP-); only osteoporosis (SP-OP+); and both sarcopenia and osteoporosis (SP+OP+). Sarcopenia was diagnosed by the criteria of the Asia Working Group on Sarcopenia 20142. Patients with osteoporosis were defined as those having a therapeutic intervention for osteoporosis. The survival rate and Cox hazard ratio were analyzed using falls and fractures as endpoints, adjusted by age, sex, and body mass index.

Results:

A total of 100 RA patients (female 78%, mean age 66.1 years) were enrolled. The number of SP-OP-, SP+OP-, SP-OP+, and SP+OP+ patients was 45, 17, 27, and 11, respectively. Their baseline characteristics are shown in Table 1. A total of 35 patients had falls, and 19 patients had fractures during the four-year follow-up. The fall-free survival rate in the SP-OP-, SP+OP-, SP-OP+, and SP+OP+ groups was 75.6%, 64.7%, 51.9%, and 36.4%, respectively; that of the SP+OP+ group was significantly lower than that of the other groups (P=0.021) (Figure 1). The fracture-free survival rate in the SP-OP-, SP+OP-, SP-OP+, and SP+OP+ groups was 86.7%, 82.4%, 81.5%, and 54.5%, respectively. That of the SP+OP+ group was relatively lower than that of the other groups (P=0.121). The hazard ratio of falls was significantly increased in the SP+OP+ group by 3.32-fold (95%CI: 1.01-10.9) compared to that in the SP-OP- group, whereas that in the SP+OP- and SP-OP+ groups was 2.58-fold (95%CI: 0.75-8.8) and 2.29-fold (95%CI: 0.94-5.6) higher, respectively. There were no significant differences compared to the SP-OP- group. The hazard ratio of fractures in the SP+OP+ group was increased 2.73-fold (95%CI: 0.61-12.2) compared to that in the SP-OP- group.

Table 1.

Baseline characteristics of the four groups

SA-OP-SA+OP-SA-OP+SA+OP+P value*Female, %73.358.888.91000.027Age, years63 (49, 72)69 (60, 79)73 (64, 75)73 (65, 81)0.008Disease duration, years4.4 (1.0, 8.4)4.0 (1.3, 8.9)7.6 (1.5, 14.5)10.5 (3.2, 26.5)0.035DAS28-ESR3.14 (2.66, 3.70)3.55 (3.01, 4.65)3.93 (3.28, 4.63)3.53 (2.48, 3.89)0.01mHAQ0.25 (0, 0.375)0.375 (0.125, 0.875)0.375 (0.125, 0.875)0.5 (0.125, 0.875)0.065MTX, mg/week, rate (%)8.4 ± 2.9 (86.7)8.7 ± 3.5 (70.6)8.3 ± 2.8 (92.6)6.8 ± 1.0 (90.9)0.388Glucocorticoid, mg/day, rate (%)3.7 ± 1.9 (20.0)6.3 ± 1.8 (11.8)4.0 ± 1.7 (44.4)3.8 ± 1.8 (18.2)0.400Body mass index, kg/m223.4 ± 3.819.2 ± 2.321.7 ± 2.419.2 ± 2.0<0.001

Data are shown as mean ± standard deviation (SD) or median (25th, 75th percentile).

*: compared in four groups by Kruskal-Walls test.

Figure 1.

Fall-free survival rates of the four groups.

Conclusion:

The survival rates with the endpoints of falls and fractures in RA patients with osteosarcopenia were lower during the four-year follow-up. In particular, the risk of falls increased with the synergistic effect of osteoporosis and sarcopenia in RA patients.

References:

[1]Dennison, E. M. et al. Fracture risk following intermission of osteoporosis therapy. Osteoporos Int30, 1733-1743, doi:10.1007/s00198-019-05002-w (2019).

[2]Chen, L. K. et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc15, 95-101, doi:10.1016/j.jamda.2013.11.025 (2014).

Disclosure of Interests:

None declared.

POS0466 RHEUMATOID ARTHRITIS PER SE IS NOT RISK FACTOR FOR CLINICAL FRACTURES: NINE-YEAR FINDINGS OF THE TOMORROW STUDY

Background:

Patients with rheumatoid arthritis (RA) who have sarcopenia and stiff or painful joints might be at increased risk of falls and fractures.

Objectives:

The present study aimed to prospectively identify the incidence of clinical fractures and associated risk factors in patients with RA in a cohort study named the TOMORROW (UMIN000003876) that started in 2010.

Methods:

We evaluated anthropometric parameters, bone mineral density (BMD), disease activity, RA medication at baseline and observed the incidence of clinical fractures during nine years in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched non-RA volunteers (mean age, 57.4 y). We compared the incidence of clinical fractures between patients with RA and controls for nine years, and analyzed the risk factors for fractures using Cox proportional hazard model.

Results:

The incidence of clinical fractures in RA patients was significantly higher compared to controls (27.5 vs 18.3%, p=0.04). However, Cox proportional hazard model, adjusted by age, sex, smoking and body mass index, revealed that low BMD at thoracic vertebrae (< 0.7 g/cm2) significantly associated to the incidence of clinical fractures (hazard ratio [HR], 1.86, p=0.02), but not RA morbidity (HR 1.47, p=0.10) (Table 1). Among patients with RA, low BMD at the thoracic vertebrae (< 0.7 g/cm2) was the most prominent risk factor for clinical fractures (HR, 2.66, p=0.02) (Table 1). Although the use of glucocorticoid (GC) at baseline (HR, 1.68, p=0.09) was not a significant risk factor for fractures, a mean GC dose (≥ 2 mg/day) at entry increased risk for clinical fractures in the patients (HR, 1.91, p=0.04) (Table 1).

Conclusion:

RA per se was not a risk factor for clinical fractures in this cohort. Low BMD at the thoracic vertebrae and the use of GC with even low dose at entry were apparently significant risk factors for the incidence of clinical fractures among patients with RA.

Disclosure of Interests:

Kenji Mamoto: None declared, Tatsuya Koike Grant/research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation,

Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Yutaro Yamada: None declared, Tadashi Okano: None declared, Yuko Sugioka: None declared, Masahiro Tada: None declared, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd., Hiroaki Nakamura: None declared

Ultrafine Pt-Ni nanoparticles in hollow porous carbon spheres for remarkable oxygen reduction reaction catalysis

Ultrafine bimetallic Pt-Ni nanoparticles, which catalyze the oxygen reduction reaction (ORR) efficiently, were successfully prepared in hollow porous carbon spheres (HPCSs) under the assistance of organic molecules. 2,2'-Dipyridylamine (dpa) was found to be most effective in preparing homogeneous small Pt-Ni nanoparticles (2.0 ± 0.4 nm) without the phase separation of Pt and Ni during synthesis, and the assistance of the organic molecules was investigated for the alloy nanoparticle formation. The Pt-Ni nanoparticle/HPCS catalyst synthesized in the presence of dpa exhibited remarkable electrochemical performance in the ORR showing a high mass activity of 3.25 ± 0.14 A mg-1Pt at 0.9 VRHE (13.5-fold higher relative to a commercial Pt/C catalyst), a large electrochemical surface area of 105 ± 8 m2 g-1Pt, and high durability. After 60 000 cycles of accelerated durability testing, the mass activity was still 12.3 times higher than that of the commercial Pt/C catalyst.

Sulfur poisoning of Pt and PtCo anode and cathode catalysts in polymer electrolyte fuel cells studied by operando near ambient pressure hard X-ray photoelectron spectroscopy

We have investigated the S adsorption behaviours on Pt (average particle diameter of ∼2.6 nm) and Pt₃Co (∼3.0 nm) anode and cathode electrode catalysts in polymer electrolyte fuel cells (PEFCs) under working conditions for the fresh state just after the aging process and also the degraded state after accelerated degradation tests (ADT), by studying near ambient pressure hard X-ray photoelectron spectroscopy (HAXPES). S 1s HAXPES of both the anode and cathode electrodes shows not only the principal S species from the sulfonic acid group (-SO₃H) in the Nafion electrolyte but also other characteristic S species such as zero-valent S (S⁰) adsorbed on the carbon support and anionic S (S^2-) adsorbed on the Pt electrode. The S^2- species on Pt should be ascribed to S contamination poisoning the Pt catalyst electrode. The S^2- species on the cathode can be oxidatively removed by applying a high cathode-anode bias voltage (≥0.8 V) to form SO₃^2-, while at the anode the S^2- species cannot be eliminated because of reductive environment in hydrogen gas. The important finding is the difference in S adsorption behaviours between the Pt/C and Pt₃Co/C electrodes after ADT. After ADT, the Pt/C anode electrode exhibits much larger S^2- adsorption than the Pt₃Co/C anode electrode. This indicates that the Pt₃Co/C anode is more desirable than the Pt/C one from the viewpoint of S poisoning. The reason for more tolerance of the Pt₃Co/C anode catalyst against S poisoning after ADT can be ascribed to the more negative charge of the surface Pt atoms in the Pt₃Co/C catalyst than those in the Pt/C one, thus yielding a weaker interaction between the surface Pt and the anionic S species as S^2-, SO₃^2-, and SO₄^2-. A similar behaviour was observed also in the cathode catalyst. The present findings will nevertheless provide important information to design novel Pt-based PEFC electrodes with higher performance and longer durability.

Reversible structural transformation and redox properties of Cr-loaded iron oxide dendrites studied by in situ XANES spectroscopy

Cr-Loaded iron oxide with a dendritic crystalline structure was synthesized and the reversible crystalline phase transition during redox cycling of the iron oxide was investigated. X-ray diffraction and transmission electron microscopy analyses revealed that Cr was well dispersed and loaded in the iron oxide dendrite crystals, whose lattice constant was dependent on the Cr loading. Temperature-programmed oxidation and reduction experiments revealed the reversible redox properties of the Cr-loaded iron oxide dendrites, whose redox temperature was found to be lower than that of Cr-free iron oxide dendrites. In situ Fe K-edge and Cr K-edge X-ray absorption near-edge structure (XANES) analysis indicated that Cr loading extended the redox reaction window for conversion between Fe3O4 and γ-Fe2O3 owing to compressive lattice strain in the iron oxide spinel structures.

A dinuclear Mo2H8 complex supported by bulky C5H2tBu3 ligands

Hydride-bridged transition metal complexes have been found to serve as suitable precursors for the activation of small molecules without the use of reducing agents. In this study, we synthesized a dinuclear Mo2H8 complex supported by bulky C5H2tBu3 (Cp‡) ligands, Cp‡2Mo2H8 (1), from the reaction of Cp‡MoCl4 with KC8 under H2. The hydrides of complex 1 can be replaced with benzene at 60 °C to afford a μ-benzene complex Cp‡2Mo2H2(μ-C6H6) (2).

Synthesis of Dinuclear Mo-Fe Hydride Complexes and Catalytic Silylation of N2

Two transition-metal atoms bridged by hydrides may represent a useful structural motif for N₂ activation by molecular complexes and the enzyme active site. In this study, dinuclear Mo^IV -Fe^II complexes with bridging hydrides, Cp^R Mo(PMe₃ )(H)(μ-H)₃ FeCp* (2 a; Cp^R =Cp*=C₅ Me₅ , 2 b; Cp^R =C₅ Me₄ H), were synthesized via deprotonation of Cp^R Mo(PMe₃ )H₅ (1 a; Cp^R =Cp*, 1 b; Cp^R =C₅ Me₄ H) by Cp*FeN(SiMe₃ )₂ , and they were characterized by spectroscopy and crystallography. These Mo-Fe complexes reveal the shortest Mo-Fe distances ever reported (2.4005(3) Å for 2 a and 2.3952(3) Å for 2 b), and the Mo-Fe interactions were analyzed by computational studies. Removal of the terminal Mo-H hydride in 2 a-2 b by [Ph₃ C]⁺ in THF led to the formation of cationic THF adducts [Cp^R Mo(PMe₃ )(THF)(μ-H)₃ FeCp*]⁺ (3 a; Cp^R =Cp*, 3 b; Cp^R =C₅ Me₄ H). Further reaction of 3 a with LiPPh₂ gave rise to a phosphido-bridged complex Cp*Mo(PMe₃ )(μ-H)(μ-PPh₂ )FeCp* (4). A series of Mo-Fe complexes were subjected to catalytic silylation of N₂ in the presence of Na and Me₃ SiCl, furnishing up to 129±20 equiv of N(SiMe₃ )₃ per molecule of 2 b. Mechanism of the catalytic cycle was analyzed by DFT calculations.

Mechanistic Understanding of the Heterogeneous, Rhodium-Cyclic (Alkyl)(Amino)Carbene-Catalyzed (Fluoro-)Arene Hydrogenation

Recently, chemoselective methods for the hydrogenation of fluorinated, silylated, and borylated arenes have been developed providing direct access to previously unattainable, valuable products. Herein, a comprehensive study on the employed rhodium-cyclic (alkyl)(amino)carbene (CAAC) catalyst precursor is disclosed. Mechanistic experiments, kinetic studies, and surface-spectroscopic methods revealed supported rhodium(0) nanoparticles (NP) as the active catalytic species. Further studies suggest that CAAC-derived modifiers play a key role in determining the chemoselectivity of the hydrogenation of fluorinated arenes, thus offering an avenue for further tuning of the catalytic properties.

AB0266 ANALYSIS OF STRESS AND FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS USING A DIGITIZING DEVICE

Background:

Stress and fatigue are evaluated subjectively by patients using a visual analog scale (VAS) and questionnaires such as the SF-36 and the FACIT Fatigue Scale. Such evaluations are based on patients’ self-reported outcomes. It is difficult to evaluate stress and fatigue objectively. A digitizing device was used to quantify stress objectively.

Objectives:

To evaluate the correlations of a digitizing device and a VAS or a questionnaire about stress and fatigue, and the relationships with disease activity of patients with rheumatoid arthritis (RA).

Methods:

Data from a prospective observational study (CHIKARA study: Correlation researcH of sarcopenIa, sKeletal muscle and disease Activity in Rheumatoid Arthritis) were used. The study protocol was reported previously1. A total of 84 RA patients entered the study and were evaluated using a stress digitizing device (Smart Pulse, MEDICORE Co. LTD). This device evaluates stress based on heart rate variability theory2. The objective physical stress score (O-physical ST), mental stress score (O-mental ST), and total stress score (O-total ST) were calculated, ranging from 0 to 100 (higher score indicating greater stress). A questionnaire for stress, the Perceived Stress Scale3(PSS) 10 Japanese version (minimum 0, maximum 40), and VAS evaluations of stress (stress-VAS) and fatigue (fatigue-VAS) were carried out. The correlations between subjective and objective methods were analyzed. The relationships between stress, fatigue, and disease activity of RA patients were examined.

Results:

The patients’ mean age was 68.6 years (women n=66, men n=18), disease duration was 8.8 years, DAS28ESR was 3.24, and modified Health Assessment Questionnaire (mHAQ) was 0.5. The average PSS10 was 26.1, which was higher than in healthy individuals (20.3). The fatigue-VAS was higher than the stress-VAS (41.3 vs 34.5 mm). The O-physical ST score was similar to the O-mental ST score (39.5 vs 37.4). Correlations are shown in Table. The O-physical ST was positively correlated with the fatigue-VAS (R=0.243 p=0.026), and the O-mental ST was also positively correlated with the stress-VAS (R=0.267 p=0.014). However, there was no correlation between the PSS10 and objective stress parameters. The DAS28-ESR was correlated with the fatigue-VAS (R=0.223 p=0.041) and the O-total ST (R=0.329 p=0.002). The stress scale (O-total ST) was worse with moderate and high disease activity than in remission (Figure).

Conclusion:

The stress score obtained by an objective digitizing device was correlated with stress- and fatigue-VAS scores. However, there was no correlation with the PSS10 questionnaire. It was found that the fatigue-VAS score and the objective total stress score were high with worse disease control.

References:

[1]Tada, M., Yamada, Y., Mandai, K. & Hidaka, N. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study.Int J Rheum Dis21, 1962-1969, doi:10.1111/1756-185X.13335 (2018).

[2]Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.Circulation93, 1043-1065 (1996).

[3]Cohen, S., Kamarck, T. & Mermelstein, R. A global measure of perceived stress.J Health Soc Behav24, 385-396 (1983).

Table.

Correlation coefficients of subjective and objective evaluations of stress and fatigue in patients with RA

PSS10Stress-VASfatigue-VASO-physical STO-mental STO-total STPSS100.580**0.404**0.0660.0550.004Stress-VAS0.673**0.0070.267*0.023Fatigue-VAS0.243*0.0590.160O-physical ST-0.224*0.708**O-mental ST-0.017O-total ST

*: p<0.05, **: p,0.01, Spearman rank correlation coefficient

Disclosure of Interests:

None declared

SAT0044 ADIPOCYTOKINE FLUCTUATES WITH INFLAMMATORY MARKERS OR DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM FIVE-YEAR DATA OF TOMORROW STUDY

Background:

Leptin and adiponectin have been thought to be adipocytokines that promote or suppress inflammation, respectively.

Objectives:

The aim of this study was to investigate the relationship between adipocytokine and inflammatory markers or disease activity in patients with rheumatoid arthritis (RA) by using 5-year data of TOMORROW study which is a cohort study and started from 2010.

Methods:

We evaluated inflammatory markers, disease activity score (DAS)-CRP, medication and levels of adipocytokines in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched healthy volunteers (controls; mean age, 57.4 y). We eventually compared leptin or adiponectin concentrations in 183 RA patients and 190 controls from 2010 (BL) to 2015 (5Y) and investigated the relationship between adipocytokines and CRP or DAS in patients by using Spearman correlation analysis.

Results:

The levels of leptin and adiponectin in patients were significantly higher than controls at all time points. Adiponectin level of patients significantly increased from BL to 5Y compared to controls (Table 1). In patients, adiponectin showed significant negative correlation with CRP at both of BL and 5Y (BL:R=-0.174, 5Y:R=-0.240; p<0.05), however, not with DAS at BL and 5Y. Leptin positively correlated with CRP at 5Y(R=0.207; p<0.05), but not with CRP at BL or DAS at any time. Adiponectin levels at BL and 5Y were significantly higher in biologics users at BL and significantly increased from BL to 5Y compared to patients without biologics. No association between leptin levels and the use of biologics (Table 2).

Conclusion:

The level of adiponectin in RA patients with continuous treatments for 5 years increased, and the trend was more pronounced in biologics users. These results might indicate that adiponectin is a cytokine involved in anti-inflammatory effects.

Disclosure of Interests:

Kenji Mamoto: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Yuko Sugioka: None declared, Masahiro Tada: None declared, Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

FRI0051 RHEUMATOID ARTHRITIS PATIENTS WITH HIGH DISEASE ACTIVITY AND TREATED WITH HIGH DOSE GLUCOCORTICOID FREQUENTLY FALL: NINE YEARS OF THE TOMORROW STUDY

Background:

Falling is a multicausal phenomenon resulting from complex interactions between intrinsic and extrinsic or environmental factors. Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falling. However, little is known about the exact properties of risk factors for falling in patients with RA. Recently, the disease activity of RA has been more satisfactorily controlled by the ‘‘treat-to-target’’ strategy, including the use of biologics. Given this new era, it is important to accurately estimate the incidence of falling in patients with RA and to elucidate contributing risk factors.

Objectives:

The objective of this study was to evaluate the incidence of falling and associated risk factors in 208 patients with RA and in age- and sex-matched 205 controls (Co) who participated in the TOMORROW (TOtalManagementOfRisk factors inRheumatoid arthritis patients to lOWer morbidity and mortality) study, a 10-year cohort study that started in 2010 in Japan. This research was conducted using TOMORROW study data for 9 years.

Methods:

We evaluated the incidence of falling by self-administered questionnaire every year and confirmed them by medical records. We also collected information about general health status, body composition including bone mineral density, lean body mass, fat mass and laboratory data. We compared the frequency of the incidence of falling in RA patients and Co for 9 years and analyzed risk factors for falling.

Results:

A total of 157 patients with RA (mean age: 57.1 ± 12.5 years, female: 84.7%, mean disease duration 13.9 ± 12.0 years) and 169 Co (mean age: 57.6 ± 12.5 years, female: 84.0%) completed 9 years observation. The rate of individuals who fell did not differ between two groups (RA: 66.9%, Co: 59.2%, p=0.19). However, number of falls was higher in RA than Co (0.35 vs 0.21/person-year, p=0.03). Multivariate logistic regression analysis adjusted for age, sex and BMI, revealed that RA was not a risk factor for the incidence of falling (OR: 1.36, 95%CI: 0.8-2.32, p=0.26) and the history of falling was a risk factor for the incidence of falling (OR: 3.27, 95%CI: 1.78-7.0, p<0.001). Multivariate linear regression analysis adjusted for age, sex and BMI, revealed that mHAQ (β=0.17, p=0.04), mean DAS28-CRP over 9 years (β=0.19, p=0.02) and mean dosage of glucocorticoid over 9 years (β=0.18, p=0.03) were the risk factors for number of falls (table 1).

Table 1.

Multivariate linear regression analysis of risk factors associated with number of falls sustained by patients RA.

RAN=157Number of fallsβpAt the entryAnti-CCP antibody (U/mL)0.0160.835RF (IU/ml)0.0200.803History of falling0.1030.201DAS28-CRP0.0780.333mHAQ0.1690.039Dose of GC (mg/day)0.0280.7239 yearsAverage DAS28-CRP0.1850.024Average dose of GC (mg/day)0.1790.025

RA, rheumatoid arthritis; CCP, cyclic citrullinated peptide; RF, Rheumatoid factor; DAS28-CRP, disease activity score 28 with C-reactive protein; mHAQ, modified Health Assessment Questionnaire; GC, glucocorticoid.

Conclusion:

There was no difference in the incidence of falling between RA and Co. However, number of falls was significantly higher in RA group. High disease activity and higher dosage of glucocorticoid were the risk factors for number of falls among RA patients.

References:

[1]C Armstrong et al, Ann Rheum Dis 2005;64:1602–1604

[2]M Hayashibara et al, Osteoporos Int 2010;21:1825–1833

Acknowledgments:

We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka and all participants in this study.

Disclosure of Interests:

Shohei Anno: None declared, Yuko Sugioka: None declared, Kenji Mamoto: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Masahiro Tada: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

FRI0609-HPR NUTRIENTS INTAKE CONDITION RELATES TO MAINTENANCE LOW DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING 6 YEARS: TOMORROW STUDY

Background:

We have previously reported that nutritional intake status might relate to disease activity (1). Nutritional survey on prospective cohort study in rheumatoid arthritis (RA) patients and information about relationship between nutritional intake status and disease activity was very limited.

Objectives:

This study aimed to obtain data from a cohort study for new nutritional therapy in RA patients.

Methods:

We used TOMORROW cohort study data which conducted from years of 2010 to 2020. Two hundred and eight RA patients, and 205 non-RA sex and age matched controls were investigated, and we analyzed data from 2011 to 2017. Nutritional intake status was compared between who maintain lower disease activity during 2011 to 2017 (LDA group) and being higher disease activity even once in 2011 to 2017 (non-LDA group). Disease activity was evaluated by DAS28-ESR in every year and nutritional intake status was surveyed by brief self-administered diet history questionnaire (BDHQ) in 2011 and 2017.

Results:

In RA patients, the change value from 2011 to 2017 of iron (odds ratio; 2.37), thiamin (OR; 2.96) and folic acid (OR; 3.16) intake which adjusted by energy intake, age, rheumatoid factor and medication status were extracted as independent factors for maintain LDA by multivariate logistic regression. These nutrients intake in RA patients was significantly lower than control both in 2011 and 2017. In RA patients, iron and folic acid intake in LDA group was significantly lower than non-LDA group in 2011. Folic acid intake was increased in LDA group and decreased in non-LDA group over time, and these nutrients showed significant differences in change value between LDA group and non-LDA group (p<0.05).

Conclusion:

The overtime change value in iron, thiamin and folic acid related to maintain six years low disease activity in RA patients.

References:

[1] Matsumoto Y, Sugioka Y, Tada M, Okano T, Mamoto K, Inui K, et al. Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: The TOMORROW study. Clinical Nutrition 37:675-680, 2018

Disclosure of Interests:

Yoshinari Matsumoto Grant/research support from: Yamada Research Grant (grant No.249), Yuko Sugioka: None declared, Masahiro Tada: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Daiki Habu: None declared, Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB

AB0265 REDUCTION OF APPENDICULAR SKELETAL MASS INDEX IS A PREDICTOR OF FRACTURE IN PATIENTS WITH RHEUMATOID ARTHRITIS BASED ON THE THREE-YEAR FOLLOW-UP DATA OF THE CHIKARA STUDY

Background:

Patients with rheumatoid arthritis (RA) have lower muscle mass1and a higher risk of fragility fracture2compared with healthy individuals. The predictors for fractures among baseline data and the chronological changes of disease activity, body composition, and muscle mass are unknown.

Objectives:

The predictors for fractures were investigated over a 3-year period in a longitudinal study.

Methods:

The 3-year follow-up data from a prospective observational study (CHIKARA study: Correlation researcH of sarcopenIa, sKeletal muscle and disease Activity in Rheumatoid Arthritis) were used. The patients’ fractures were counted, and correlations between fractures and disease activity, body composition, and sarcopenia were investigated. Muscle mass, body fat mass, total body water, bone mass, and basal metabolic rate were measured using a body composition analyzer. The fracture-free survival rate was calculated. The relationships between fractures and each parameter at baseline and the changes over the 3-year period (Δ) were investigated by univariate and multivariate analyses.

Results:

A total of 100 patients (78 female, average age 68 years) were enrolled in this study; 12 patients (10 female and 2 male) had fractures during the 3-year follow-up, and the fracture-free survival rate was 86.9%. The Δmodified Health Assessment Questionnaire (mHAQ), Δweight, Δmuscle mass, Δestimated bone mass, Δbasal metabolic rate, and Δappendicular skeletal muscle index (ASMI) were predictors for fractures. On the other hand, body composition, disease activity, and sarcopenia at baseline were not correlated with fractures (Table 1). The ΔASMI was an independent predictor for fractures on multivariate analysis (odds ratio:0.015, P=0.026). The estimated cut-off value of the ΔASMI was 0.14 kg/m2on receiver operating characteristic curve analysis (Figure). When the ΔASMI decrease was greater than or equal to 0.14 kg/m2for three years, the odds ratio of fractures was significantly increased 9.8-fold, compared to a ΔASMI decrease less than 0.14 kg/m2(P=0.001).

Table 1.

Predictors for fractures in patients with RA

UnivariateR valueP valueBaselineAge, year0.1720.087DAS28-ESR-0.0830.411mHAQ0.0770.447Weight, kg0.0210.837Muscle mass, kg-0.00350.728Estimated bone mass, kg-0.0200.845Sarcopenia-0.0930.356Change of 3-year periodΔDAS28-ESR0.1870.088ΔmHAQ0.2240.040ΔWeight, kg-0.2240.045ΔMuscle mass, kg-0.2530.023ΔEstimated bone mass, kg-0.2360.034ΔBasal metabolic rate, kcal/day-0.2480.025ΔAppendicular skeletal muscle index, kg/m2-0.3520.001

Conclusion:

The fracture-free survival rate was 86.9% in this 3-year longitudinal study. It was difficult to predict future fractures from the baseline data. Reduction of the ASMI was an independent predictor for fractures. Alleviating muscle mass loss may prevent fractures.

References:

[1]Inui K., Koike T., Tada M., et al. Sarcopenia is apparent in patients with rheumatoid arthritis, especially those with biologics -TOMORROW study-.EULAR2015 abstract (AB0359).

[2]van Staa TP, Geusens P, Bijlsma JW, et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis.Arthritis Rheum.2006; 54: 3104–12.

Disclosure of Interests:

None declared

THU0138 AGEING IN RA PATIENTS DETERIORATED MODIFIED HEALTH ASSESSMENT QUESTIONNAIRE (MHAQ) OVER A 7-YEAR PERIOD INDEPENDENTLY FROM DISEASE ACTIVITY

Background:

Recent advances of treatment for rheumatoid arthritis (RA) realizes us to set the treatment goal as remission. As the results, health assessment questionnaire (HAQ) has been also becoming better in these years. On the other hand, progress in ageing has been a major issue in Japan, including the patients with RA. which is thought as one of the factors affecting HAQ.

Objectives:

To evaluate the impact of ageing on HAQ in RA patients.

Methods:

The data of 208 RA patients used in this study was collected over a 7-year period from 2010 to 2017 as part of a prospective cohort study (TOMORROW Study: UMIN000003876) that included RA patients and age- and sex-matched volunteers recruited through mass media as controls. The data of RA patients included anthropometric, blood test data, disease activity score28-CRP (DAS28) and modified HAQ (mHAQ), together with baseline (BL) characteristics. The course of mHAQ for 7 years were analyzed by repeated measure ANOVA, and association between the changes of mHAQ at year-7 from BL (ΔmHAQ) and BL factors were analyzed by multiple regression analysis.

Results:

Two hundred and eight RA patients (153 women; mean age 58.1 years) were enrolled in the present study. Modified HAQ decreased significantly over the 7-year study period in RA patients. When the patients were stratified into 3 groups (lower than 2.7, between 2.7 and 4.1, over 4.1) by DAS28 at BL, mHAQ of the patients with high disease activity (DAS28: over 4.1) at BL was significantly worse than other groups (p=0.018; repeated measure ANOVA). There was no interaction between time and 3 groups (p=0.118; repeated measure ANOVA). Multiple regression analysis with ΔmHAQ as the outcome variable and ACPA, age, BMI, CRP, DAS28, MMP-3 at BL as independent variables revealed that age (p=0.034) and DAS28 (p=0.042) were independently related with ΔmHAQ.

Conclusion:

Ageing in RA patients impacted worsening of mHAQ over a 7-year period independently from disease activity. On assessing mHAQ in elderly RA patients, we must consider the age as well as the disease activity.

Disclosure of Interests:

Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Yuko Sugioka: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Masahiro Tada: None declared, Kenji Mamoto: None declared, kazuki Orita: None declared, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

3D Operando Imaging and Quantification of Inhomogeneous Electrochemical Reactions in Composite Battery Electrodes

The performances of electrochemical systems such as solid-state batteries (SSBs) can be severely hindered by the three-dimensional (3D) and mesoscopically inhomogeneous electrochemical reactions that take place in the electrodes. However, the majority of existing methods for analyzing such inhomogeneous reactions are restricted to one- or two-dimensional observations. Herein, we performed 3D operando imaging of the mesoscopically inhomogeneous electrochemical reaction in a composite SSB electrode using hard X-ray computed-tomography with X-ray absorption near edge structure spectroscopy (CT-XANES). The 3D inhomogeneous reaction evolution during (dis)charge was successfully visualized for the first time. Furthermore, our 3D quantitative analysis unambiguously revealed the origin of the inhomogeneous reaction in the investigated electrode. Our results suggested that slow ion transport through active material particles can considerably restrict SSB performances. Our technique therefore provides new insights into the electrochemical reactions taking place in electrodes and enables us to maximize the performance of electrochemical systems.

Feed gas exchange (startup/shutdown) effects on Pt/C cathode electrocatalysis and surface Pt-oxide behavior in polymer electrolyte fuel cells as revealed using in situ real-time XAFS and high-resolution STEM measurements

The synchronizing measurements of both cyclic voltammograms (CVs) and real-time quick XAFSs (QXAFSs) for Pt/C cathode electrocatalysts in a membrane electrode assembly (MEA) of polymer electrolyte fuel cells (PEFCs) treated by anode-gas exchange (AGEX) and cathode-gas exchange (CGEX) cycles (startup/shutdown conditions of FC vehicles) were performed for the first time to understand the opposite effects of the AGEX and CGEX treatments on the Pt/C performance and durability and also the contradiction between the electrochemical active surface area (ECSA) decrease and the performance increase by CGEX treatment. While the AGEX treatment decreased both the ECSA and performance of MEA Pt/C due to carbon corrosion, it was found that the CGEX treatment decreased the ECSA but increased the Pt/C performance significantly due to high-index (331) facet formation (high-resolution STEM) and hence the suppression of strongly bound Pt-oxide formation at cathode Pt nanoparticle surfaces. Transient QXAFS time-profile analysis for the MEA Pt/C also revealed a direct relationship between the electrochemical performance or durability and transient kinetics of the Pt/C cathode.

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

Visualization and understanding of the degradation behaviors of a PEFC Pt/C cathode electrocatalyst using a multi-analysis system combining time-resolved quick XAFS, three-dimensional XAFS-CT, and same-view nano-XAFS/STEM-EDS techniques

We developed a multi-analysis system that can measure in situ time-resolved quick XAFS and in situ three-dimensional XAFS-CT in the same area of a cathode electrocatalyst layer in a membrane-electrode assembly of a polymer electrolyte fuel cell.