Long-Term Outcomes of Patients with Biologically Treated Psoriatic Arthritis and Atopic Dermatitis-A Single-Center Experience

(1) Background: Although the association between psoriasis and atopic dermatitis (AD) is reported in the literature, scarce data are known about the efficacy of biologic therapy (including TNF and IL-17 inhibitors) in patients with psoriatic arthritis (PsA) and concomitant AD. (2) Objective: We aimed to explore AD in patients with PsA undergoing biologics for their active disease, focusing on prevalence and clinical and potential therapeutic implications. (3) Material and methods: We performed a retrospective analysis of 64 patients with PsA receiving various biological agents, followed-up in an academic outpatient rheumatology department up to 10 years. (4) Results: Atopic diseases were reported in about one third of cases, with a higher incidence of AD (10 cases; 52.6%) vs. atopic rhinitis (6 cases; 31.6%) and allergic asthma (3 cases; 15.8%). Three morphological patterns of AD were recognized including chronic prurigo (3 cases), a chronic lichen simplex (1 case), and eczemas (6 cases). All PsA with concomitant AD displayed a late onset of skin atopy (in their adult life) and demonstrated a specific profile (younger), from urban settings, equally distributed among genders, and requiring switching to a higher number of biologics to achieve disease control. (5) Conclusion: PsA and AD may coexist, requiring special attention when selecting the optimal biologic agent.

The Prevalence of Atopy in Biologically Treated Spondyloarthropathies: A Retrospective Study of 200 Patients

(1) Background: Recent data shed light on the association between atopic disorders (ADs) (atopic dermatitis, allergic asthma, allergic rhinitis) and spondyloarthropathies (SpAs), underpinning the critical role of T helper (Th)1-Th17/Th2-T regulatory cells disbalance. We evaluated the prevalence of AD in axial SpAs (axSpAs) and psoriatic arthritis (PsA) and explored the potential association between atopic status, disease-related parameters, and biological therapy. (2) Methods: A monocentric, retrospective study was conducted that enrolled 200 patients taking biologics. Demographics, disease, and drug-related variables, along with a screening questionnaire focused on Ads, were systematically collected. (3) Results: Overall, 51 patients (25.5%) had atopy—namely, 24.4% of axSpA and 28% of PsA, with a higher frequency of rhinitis (43%) vs. atopic dermatitis (37.2%) or asthma (21.5%). We failed to demonstrate any statistically significant difference in demographics, SpA-related parameters excepting concomitant inflammatory bowel disease, and biologic drug exposure in patients with and without atopy (p > 0.05). However, significantly more non-atopic patients need only one TNF inhibitor (54%) vs. atopic patients (28%) (p < 0.05) to control active SpA. (4) Conclusions: We successfully demonstrated that AD is associated with one out of four SpA. Irrespective of the SpA subtype, atopic patients require more frequent switching among biologics, as significantly more non-atopic patients remain on their first anti-TNF.

AB0695 PATTERN OF COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES UNDERGOING BIOLOGICAL THERAPY: A COHORT EXPERIENCE

Background:

Despite emerging vaccines, the world is in the midst of a coronavirus disease 2019 (COVID-19) pandemic. Outcomes of SARS-CoV2 infection remain a major concern in patients with rheumatic and musculoskeletal diseases, especially for those with uncontrolled disease.

Objectives:

We aimed to investigate trends and outcomes of COVID-19 occurring in patients with chronic inflammatory rheumatic conditions treated with biologics and targeted synthetic disease modifying antirheumatic drugs (bDMARDs, tsDMARDs).

Methods:

We included all confirmed cases of COVID-19 regardless of severity in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) undergoing bDMARDs or tsDMARDs treatment registered in our local COVID-19 reporting database. We collected relevant information about comorbidities, rheumatologic-related clinical activity (RAPID5, SDAI, BASDAI, DAPSA), type of DMARD and glucocorticoid use, as well as COVID-19 related data as severity (ranging from asymptomatic to life-threatening forms), medication, hospitalization, intensive care unit admission, invasive mechanical ventilation and death.

We did a subgroup analysis among patients with a specific rheumatologic diagnosis, among different class of medication, patients who were or not hospitalized with COVID-19 looking how age, comorbidities, type of rheumatic condition and treatments impact COVID outcomes.

Results:

40 COVID-19 cases (positive PCR for SARS-CoV2) (4.67%) were identified during the 6-month study period among 855 patients registered in our database of patients under biologic treatment, including 20 RA, 18 SpA, 2 PsA patients. The majority were in either low disease activity or remission, only two patients had active uncontrolled disease at the onset of coronavirus infection.

16 cases (40%) were asymptomatic and were tested RT-PCR-positive during routine follow-ups for their disease, 13 cases (32.5%) had mild and 8 cases (20%) moderate illness; severe pneumonia and critical disease with acute respiratory distress syndrome were reported in only 3 cases, 2 recovered after; the only patients who died was 69 years old, had cardiac disease, hypertension and diabetes, had undertaken regular rituximab perfusion one month before coronavirus infection and developed pulmonary embolism followed by septic shock.

Extreme fatigue was the dominant COVID-19 associated symptom apart from the classical ones including fever, cough, shortness of breath, sore throat, nasal congestion, headache, anosmia and ageusia myalgias and anorexia.

No specific pattern for patients requiring intensive care unit admission.

Conclusion:

The COVID-16 infection rate in patients with inflammatory rheumatic disorders receiving biologics and tsDMARDs is pretty low; although immunosuppressed, these patients seem not to be at risk for severe COVID-19 illness and outcomes. These findings might reflect a potential protective role of certain biologics and/or JAK inhibitors for development and severity of COVID-19 in patients.

References:

[1]WHO, COVID-19 clinical management, Living Guidance, 25 Jan 2021

Disclosure of Interests:

CODRINA ANCUTA Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Cristina Pomirleanu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Georgiana Strugariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Luiza Petrariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Eugen Ancuta: None declared, Codruta Bran Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Rodica Chirieac Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Claudia Mihailov Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz

AB0181 EXPLORING THE ROLE OF IL-6 BLOCKADE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHTITIS AND CHRONIC PERIODONTITIS

Background:

Recent data have renewed the interest in common pathobiologic pathways in autoimmune rheumatic conditions and periodontal disease, especially on dual impact of innovative anti-rheumatic drugs in modulating both inflammatory and immune articular as well as periodontal damage. Although consistent data about TNF inhibitors and chronic periodontitis are already published, the influence of IL-6 blockade.

Objectives:

We aimed to explore the influence of weekly subcutaneously IL-6 receptor inhibitor tocilizumab on periodontal health in a local cohort of patients with rheumatoid arthritis (RA) and chronic periodontitis (PD).

Methods:

We performed a prospective longitudinal 6 months study in 68 patients with moderate-to-severe RA starting tocilizumab (TCZ) in accordance to local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and dental (plaque index PI, gingival index GI, bleeding on probing BOP, pocket probing depth PPD, clinical attachment level CAL) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months.

Results:

51 RA and concomitant t of 68 patients in our initial cohort were finally analyzed. Aggressive periodontal disease was reported particularly in disease subsets with excessive inflammatory (serum C reactive protein level) and serologic biomarkers (anti-citrullinated peptide antibodies ACPA). Furthermore, significant correlations between periodontal status, clinical disease activity and ACPA levels were also demonstrated (p<0.05). We also noticed consistent improvement was noticed in both RA-related parameters sand periodontal inflammation (GI and sites with bleeding of probing) after only 3 months (p < 0.05), while PPD improved after 6 months; overall, CAL presented only slight changes without statistical any significance as well as teeth count and plaque levels (p > 0.05).

Conclusion:

IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, essentially related to dramatic decrease in serum inflammatory mediators.

References:

[1]de Molon Scaf, R., Rossa, C.; Thurlings, R.M.; Cirelli, J.A.; Koenders, M.I. Linkage of Periodontitis and Rheumatoid Arthritis: Current Evidence and Potential Biological Interactions, Int. J. Mol. Sci. 2019, 20, 4541.

[2]Genco, R.J.; Sanz, M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodont. 20002020, 83 (1), 08 May.

[3]Rinaudo-Gaujous, M.; Blasco-Baque, V.; Miossec, P. et al. Infliximab induced a dissociated response of severe periodontal biomarkers in rheumatoid arthritis patients. J Clin Med2019. 8, 751.

[4]Eezammuddeen, N.N.; Vaithilingam, R.D.; Mohamad Hassan, N.H.; Bartold, IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, essentially related to dramatic decrease in serum inflammatory mediators.

Disclosure of Interests:

CODRINA ANCUTA Speakers bureau: ABBVIE, PFIZER, UCB, NOVARTIS, LILLY, SANDOZ, Consultant of: ABBVIE, PFIZER, UCB, NOVARTIS, LILLY, SANDOZ, EUGEN ANCUTA: None declared, Rodica Chirieac Speakers bureau: ABBVIE, PFIZER, UCB, NOVARTIS, LILLY, SANDOZ, OANA TANCULESCU: None declared, CRISTINA IORDACHE: None declared

Efficacy of baricitinib on periodontal inflammation in patients with rheumatoid arthritis

OBJECTIVE

Despite a widely recognized bidirectional pathobiologic relationship between rheumatoid arthritis (RA) and periodontal disease, the impact of innovative anti-rheumatic drugs in modulating not only inflammatory and immune articular damage, but also periodontal microenvironment remains debatable. We aimed to evaluate the periodontal status in RA with and without baricitinib, a Janus kinase (JAK) inhibitor, and to better describe association between these entities.

METHODS

We performed a prospective longitudinal 24-weeks study in 21 active RA initiating baricitinib. Standard assessments included a dual rheumatologic (RA activity, disability, serological, inflammatory profile) and dental evaluation comprising plaque index, gingival index, bleeding on probing, probing depth, clinical attachment level.

RESULTS

More than half of RA presented at baseline with chronic periodontitis, as suggested by high prevalence of sites with dental plaque, abnormal bleeding on probing, probing depth and clinical attachment level. Aggressive periodontal disease was reported particularly in disease subsets with excessive inflammatory (serumC reactive protein level) and serologic biomarkers (anti-citrullinated peptide antibodies). Furthermore, significant correlations between dental pathology, disease activity and ACPA levels were also reported (P<0.05). Consistent improvement was noticed in both rheumatoid arthritis characteristics and periodontal status after 24 weeks of baricitinib (P<0.05).

CONCLUSION

RA, particularly severe active ACPA-positive disease, is basically associated with altered periodontal health. JAK blockade through oral baricitinib may be efficient in patients with active RA and potentially able to modulate the inflammatory process in the periodontal tissue.

Volumetric Cone Beam Computed Tomography for the Assessment of Oral Manifestations in Systemic Sclerosis: Data from an EUSTAR Cohort

Background: Oral health issues are commonly reported in systemic sclerosis (SSc), comprising a broad spectrum of manifestations, e.g., reduced mouth opening, periodontal disease, increased periodontal ligament (PDL) space width, and mandibular resorption. We aimed to assess oral radiographic abnormalities, particularly PDL space widening and erosions, and to identify potential relations with disease measures. Methods: cross-sectional study in 43 SSc and matching controls receiving systematic oral assessments (full mouth dental/periodontal) and imaging (radiographs and cone beam computed tomography (CBCT)). Associations between disease variables and radiologic findings were investigated by univariate and multivariate analysis (SPSS-v.20, p < 0.05). Results: CBCT demonstrated generalized PDL space widening in up to half SSc, with at least one tooth involved, essentially in the posterior region (p < 0.05). Significant correlations between number of teeth with PDL space widening and disease severity, skin score, disease subset, topoisomerase I specificity, age, and disease duration were reported (p < 0.05). Additionally, mandibular erosions were described in one out of four patients, commonly condylar erosions. Conclusions: Tridimensional CBCT approach confirmed widening of PDL and mandibular erosions as common dental findings in scleroderma. Furthermore, widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile.

Serum Lipid Profile in Diffuse versus Limited Systemic Sclerosis Data from the SASS cohort

Data about lipoprotein changes and their link with cardiovascular disease and atherosclerosis in systemic sclerosis (SSc) are still challenging. We aimed to evaluate serum lipid profile of patients with SSc and to identify potential relation with different disease specific characteristics (clinical, serological, inflammatory tests) in a cross-sectional study. Standard assessments comprised SSc-related parameters (disease subtype, clinical spectrum, immunological tests) and lipid metabolism (total cholesterol and fractions, triglycerides). Impaired lipid profile (low serum HDL- and high LDL-cholesterol, increased serum triglycerides, slightly modification in total cholesterol level) significantly correlated with diffuse SSc, activity (EUSTAR) and severity (MEDSGER), as well as seropositivity for specific antibodies (anti-centromere and anti-topoisomerase 1). The dyslipidemic profile might represent a pathobiological pathway for atherosclerosis in SSc.

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders accounting for significant disability and impaired quality of life. The aim of our study was to assess inflammatory and immune parameters in patients with TMJ arthritis related to rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify potential relation with severity and dysfunction of TMJ pathology. We performed a cross-sectional study in a cohort of 433 consecutive RA, 32 JIA, 258 AS, and 103 PsA. Only patients presenting with clinically significant TMJ involvement (273) related to their rheumatic condition were included in the final analysis. TMJ involvement is traditionally described in chronic inflammatory rheumatic disorders, particularly in patients with higher levels of inflammation as detected in rheumatoid arthritis and psoriatic arthritis. Disease activity and severity, as well as biological and positive serological assessments (rheumatoid factor, anti-cyclic citrullinated peptide, IL-1) remain significant determinants of the severity of TMJ arthritis.

Specific Sialochemical and Sialometric Changes and Cariogenic Risk in Patients with Primary Sjogren`s Syndrome

The main aim of our study was to perform a biochemical analysis of the saliva and to assess potential impact on oral health, particularly cariogenic issues, in patients with salivary secretory dysfunction such as primary Sjogren�s syndrome (pSSj). Consecutive pSSj and healthy age-matched controls were prospectively assessed for (i) whole saliva flow rates (unstimulated, RFR, and stimulated, RFS), pH and composition; (ii) cariogenic scores - decayed, missing and filled tooth surfaces (DMFS index), Silnes and Loe bacterial plaque index (PI). Salivary flow rates were significantly lower in pSSj for both unstimulated and stimulated tests (p[0.05), with a drop in pH as compared to healthy controls (p[005). Abnormal inorganic and organic saliva composition was reported in all cases comprising higher sodium, lower potassium and chloride concentrations, higher amylase activity and lower total protein (p[0.05). Statistically significant higher cariogenic scores particularly DMFS, were demonstrated in all pSSj (p[0.05). In conclusion, patients with pSSj are at increased risk to develop cariogenic issues due to both quantitative and qualitative salivary changes.

TNF Inhibitors and Periodontal Inflammation in Psoriatic Arthritis

The link between immune mediated rheumatic disorders and oral health, particularly periodontal disease, is widely accepted, based on shared immune and inflammatory processes as well as local (articular, gingival) damage mediated by similar pro-inflammatory cytokine and destructive mediators. We aimed to evaluate periodontal status in psoriatic arthritis (PsA) before and after 24-weeks treatment with TNF inhibitors and to identify potential relation between disease activity, inflammatory parameters, therapeutic response and chronic periodontitis. Patients were prospectively assessed according to a standard protocol comprising a complex rheumatologic (PsA activity, inflammatory prolife) and dental evaluation (plaque and gingival index, bleeding on probing, periodontal pocket depth, clinical attachment level). Up to one third PsA presented with moderate to severe periodontitis at baseline, with high prevalence of sites with dental plaque, abnormal bleeding, increased periodontal pocket depth and clinical attachment loss. Higher levels of inflammatory parameters were described in the subset of PsA presenting with aggressive periodontal diseases, while significant correlation between dental pathology and CRP (p[0.05). A significant improvement in both PsA-related parameters and periodontal status was demonstrated after 24 weeks of anti-TNF therapy (p[0.05). Periodontal disease may develop in PsA and should be commonly evaluated, particularly patients with active disease. Benefits of TNF inhibitors, with significant response in articular and periodontal parameters, suggest common inflammatory pathways in both entities.

Periodontal Disease in Patients with Ankylosing Spondylitis: myth or reality?

Although the relation between periodontitis (PD) and systemic disorders (e.g. cardiovascular diseases, diabetes and rheumatoid arthritis) is widely accepted, the association with ankylosing spondylitis (AS) is inconsistently mentioned. We prospectively examined the relationship between periodontal disease and AS, focusing on the rate and course of PD, factors associated with severity and the impact of anti-TNF-a treatment on inflammatory status. Standard assessments performed twice (week 0, week 24) included an extensive dental evaluation (plaque index, gingival index, bleeding on probing, periodontal pocket depth, clinical attachment loss), inflammatory parameters and AS activity scores (BASDAI, ASDAS-CRP). More than half of AS presented with impaired periodontal health at baseline (mild to moderate PD) meaning increased sites with dental plaque, abnormal bleeding, increased periodontal pocket depth and clinical attachment loss. Significant positive correlation between presence and severity of PD, AS activity and systemic inflammation (CRP) was reported at baseline (p[0.05). A final analysis performed at 24 weeks revealed significant improvement in periodontal status, inflammatory parameters and AS activity, suggesting efficacy of TNF inhibitors directed not only against systemic, but also on local (articular, periodontal) inflammation (p[0.05). Patients with AS are at risk to develop periodontal disease, particularly those with high levels of systemic inflammation. Benefits of anti-TNFa therapy in the particular settings of AS patient and concomitant periodontal disease should be validated through further studies in larger cohorts.

Anti-Tumor Necrosis Factor Alpha Therapy and Periodontal Inflammation in Rheumatoid Arthritis. A clinical and biochemical approach

Although the relationship between periodontal disease and rheumatoid arthritis (RA) is widely documented, centered by common pathobiologic pathways, the effect of various tumor necrosis factor alpha (TNF) antagonists in modulating not only inflammatory and immune articular damage, but also periodontal microenvironment remain debatable. We aimed to evaluate the periodontal status with and without TNF inhibitors in RA patients and to identify potential relation among these entities. We performed a prospective longitudinal 6-months analysis on 96 RA initiating their first biological therapy. Standard assessments included a dual rheumatologic (RA activity, disability, serological, inflammatory prolife) and dental evaluation such as plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), clinical attachment level (CAL). More than half of RA presented at baseline with chronic periodontitis, as suggested by high prevalence of sites with dental plaque, abnormal BOP, PD and CAL. Advanced inflammatory (CRP, ESR) and immune (anti-cyclic citrullinated peptide antibodies, ACPA) markers were described in RA subsets presenting with aggressive periodontal diseases, while significant correlations between dental pathology, RA activity and ACPA levels were also reported (p[0.05). Furthermore, we revealed significant improvement in both RA-related characteristics and periodontal status after 6 months of anti-TNF therapy (p[0.05). RA, particularly active severe, ACPA positive disease, is essentially accompanied by comorbid periodontal disease. TNF blockade is efficient in patients with active RA and potentially able to modulate the inflammatory process in the periodontal tissue.

A predictive model for remission and low disease activity in patients with established rheumatoid arthritis receiving TNF blockers

The objective of this study was to identify predictors for remission or low disease activity (LDA) in established rheumatoid arthritis (RA) at 12 months of anti-TNF-α therapy. We have performed a prospective observational study in 90 consecutive patients with active RA receiving TNF-α inhibitors. Baseline and standard assessments were done every 3 months, including individual parameters (clinical and biological) and composite activity scores (28-joint disease activity score, DAS28). The primary outcome measure was DAS28-based EULAR response criteria. The multivariate logistic regression was used to analyze the association between disease activity and several RA baseline characteristics. Of the RA, 78.8 % was classified as good responders based on the EULAR-DAS28 criteria, 44.4 % RA achieving remission (DAS28 ≤ 2.6) and 34.4 %, LDA (DAS28 ≤ 3.2). Parameters associated with an increased likelihood of remission and LDA were initial DAS28-erythrocyte sedimentation rate ≤ 7 (odds ratio (OR) 3.3, 95 % confidence interval (CI) 2.03-5.81; OR 1.8, 95 % CI 1.09-6.68), Health Assessment Questionnaire Disability Index ≤  2 (OR 7.0, 95 % CI 1.56-31.91; OR 1.3, 95 % CI 1.03-5.79), C-reactive protein level ≤ 20 mg/l (OR 1.5, 95 % CI 0.29-8.22; OR 0.5, 95 % CI0.08-2.97), rheumatoid factor ≤ 20 IU/ml (OR 18.9, 95 % CI 10.79-38.36; OR 32.9, 95 % CI 4.03-269), anti-cyclic citrullinated peptide antibodies ≤ 40 IU/ml (OR 3.5, 95 % CI 0.67-18.19; OR 1.2, 95 % CI 1.02-1.59), concurrent prednisolone (OR 0.2, 95 % CI 0.05-0.36; OR 0.2, 95 % CI 0.06-0.63), methotrexate or leflunomide (OR 1.6, 95 % CI 1.2-13.53; OR 2.9, 95 % CI 1.20-4.36). A predictive matrix for remission and LDA in established active RA patients receiving TNF-α inhibitors was proposed. Further studies are necessary to confirm the value of such matrix in particular RA settings, leading to optimization of the use of anti-TNF-α therapy.

Importance of posture assessment in ankylosing spondylitis. Preliminary study

AIM

The aim of this study is to perform a screening of patients diagnosed with ankylosing spondylitis (AS) in order to evaluate the static spinal disorders and correlate the results with the main clinical and functional parameters that characterize this disease.

MATERIAL AND METHODS

Ninety-five patients diagnosed with AS according to the 1994 New York criteria were screened, and 68 of them (all males) presenting static spinal disorders and on physical therapy programs in different outpatient physical therapy units throughout 2011 entered the study.

RESULTS

The distribution of the patients according to static spinal disorders was almost even. There were no statistically significant differences in mean age and disease duration (p>0.05). The assessment oflumbosacral pain in the morning (VAS1) and daytime lumbosacral pain (VAS2) showed a higher scores in patients suffering from kyphoscoliosis than in those with scoliosis (p=0.020), (p=0.000), or kyphosis. Ott and modified Schöber index, and chest expansion, had higher mean values in patients with scoliosis compared with the other postural disorders (p<0.001). Statistically higher mean BASFI values were recorded in patients with kyphoscoliosis (p=0.038), while the mean BASMI values were lower in scoliosis patients (p<0.001). As to the quality of life of AS patients, HAQ-DI index recorded significantly lower mean values for kyphoscoliosis compared with other postural disorders (p<0.001).

CONCLUSIONS

Our study suggests that posture assessment and implicitly the correction of possible misalignments should be part of the kinetic physical therapy program. Rigorous observing of postural recommendations can prevent the respiratory system complications.

Knee osteoarthritis, dyslipidemia syndrome and exercise

The aim of our study was to evaluate the influence of aerobic training on the dyslipedemia in patients with knee osteoarthritis (KOA).

MATERIAL AND METHODS

Prospective observational six-month study performed on 40 patients with KOA, fulfilling the inclusion criteria, classified according to their participation in specific aerobic training program (30 minutes/day, 5 days/ week) in two subgroups. A standard evaluation protocol was followed assessing lipid parameters (total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol levels) at baseline, three and six months. Statistical analysis was performed in SPSS 16.0, p < 0.05.

RESULTS

Subgroup analysis has demonstrated a statistical significant improvement in plasma lipids levels in all patients performing regular aerobic training (cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol) (p < 0.05). Although the difference reported for total cholesterol, triglycerides and LDL-cholesterol after six months between subgroups was not significant (p > 0.05), the mean level of HDL-cholesterol was significantly higher in patients performing aerobic training, reaching the cardio-vascular protective levels.

CONCLUSIONS

Regular aerobic exercise has a positive effect on plasma lipoprotein concentrations; further research is needed for the assessment of long-term effects of physical exercises for both KOA and lipid pattern.

[Identification of bone mass and bone turnover in patients with rheumatoid arthritis treated with corticosteroids in order to elaborate an optimal therapeutic approach]

Corticosteroids (CS) are currently used in Rheumatoid Arthritis (RA) in conjunction with either synthetic remissive or biologic drugs.

AIM

In our study we used have focused on bone mineral density assessment (BMD) in RA patients with and without low doses of CS in order to elaborate an optimal therapeutic approach.

MATERIAL AND METHODS

prospective observational study on 55 consecutive patients with RA (1987, ACR diagnostic criteria) classified in two groups based on CS use: group A--23 RA receiving CS and subgroup B--32 RA without CS. All patients have been evaluated according to a predefined protocol including demographics, clinical, biological and therapeutic RA characteristics, BMD and T-score assessment by DXA (Hologique QDR) (1994, WHO classification). Subgroup analysis was done in SPSS-12 software, p < 0.05.

RESULTS

No significant differences in demographics and RA related parameters (p > 0.05) have been demonstrated between subgroups. However, significant changes in BMD and T-score have been reported in RA receiving CS as follows (p < 0.05): up to 74% cases with osteoporosis, 13% with fracture and 8.7% with osteopenia (A) versus 31.3% with osteoporosis, 28.1% with fracture and 15.6% with osteopenia (B). Moreover, 90% of RA under 7.5 mg CS daily and all receiving > 10 mg daily presented with osteoporosis; also, osteoporosis has been demonstrated all postmenopausal RA in group A (75%) and only 68% of group B (76%).

CONCLUSIONS

concomitant CS use in RA, even low doses, is commonly associated with low BMD, irrespective of other risk factors.

[Clinical-functional evolution of patients with ankylosing spondylitis following physio-kinetotheraphy]

Ankylosing spondylitis enigmatic from the etiologic point of view, appears with subjects who are still in school or involved in a productive activity. If detected in its early stages, under complex, constant and long-term treatment, patients have a good evolution.

AIMS

The objectives of the study are to describe the clinical and functional profile of patients with AS, sacroiliitis stage, and the evol ution of physical and functional parameters under traditional physio-kinetotherapy.

MATERIAL AND METHODS

This retrospective study was performed on 40 patients with ankylosing spondylitis (AS), who were hospitalized in the Clinic of Rheumatology Iaşi, during 2008-1010, who satisfied the amended New York criteria for this. Subjects underwent an initial evaluation (first admission) and another one at the end of the study (second admission), after approximately 6 months.

RESULTS

The demographic characteristics, the clinical and functional elements of the study sample have indicated: the average age of 24.83 +/- 3.948, predominantly male (82.5%) and 62.5% were from rural areas. Most cases occurred at the age of 19-25 (57.5%), beginning at 18-25 (77.5%), with an average of 19.60 +/- 2.318. Following the radiological changes in the various stages of sacroiliitis, stage II prevailed (40%), then stage III (32.5%) and IV (15%). The evaluation of ASAS (Assessment of Spondylo Arthritis International Society) parameters and the respiratory system showed significant improvements of: BASDAI score with 31.53%, BASFI with 37.62%, BASMI with 20.66%, DIE % with 27.53 and of CV with 5.08% as well as a decrease in pain perception measured by VAS scale (p = 0.017).

CONCLUSIONS

In the early stages of the disease, as far as the sample involved in the study is concerned, when the spine and vertebrae joints were not blocked by the evolution of the disease, corrective gymnastics and respiratory exercises, stretching and a good posture are very important, along with other therapies used to prevent axial ankylosis.

[Prospective study of the efficiency and safety of adalimumab in treatment of active established rheumatoid arthritis]

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by synovial pannus formation leading to cartilage destruction, bone erosion, and disability.

AIM

To evaluate the efficiency and safety of adalimumab (ADA) in association with one or more classic remissive drugs in active established RA.

MATERIAL AND METHODS

Prospective observational 12 months study in 33 consecutive active RA treated with ADA. Patients were assessed according to a complex protocol including both individual parameters (clinical, biological) and composite disease activity scores (DAS28, CDAI, SDAI), while response to therapy was evaluated based on EULAR and ACR response criteria.

RESULTS

Statistical significant improvement has been demonstrated in all patients under ADA (p < 0.05); after 3 months of treatment 51.5% RA fulfilled ACR20, 39.3% ACR50 and 9% ACR70 criteria; after 6 months of treatment 66.6% of patients and 33.3% fulfilled ACR20 and, respectively, ACR50 criteria. Moreover, 30.3% of all patients had good response after 6 months, 66.6% moderate response and only 3.03% displayed no response in the same period. 24.2% and 45.4% of RA achieved remission (DAS28 < or = 2.6) after 9 and 12 months of ADA, while 39.3% and 21.2% had moderate activity. Rate and type of adverse events demonstrated the safety and good tolerance of ADA.

CONCLUSIONS

Our data support the efficacy and safety of ADA in active established RA in the settings of the real-life clinical practice.

[Observational study of a sample of patients with gonarthrosis, treated at the Hospital Clinic of Rehabilitation in Iaşi]

The aim of our descriptive study was to assess a sample of patients with knee osteoarthritis.

MATERIAL AND METHODS

A sample of 295 patients was assessed regarding demographical features, comorbidities, some laboratory investigations and therapeutically interventions.

RESULTS

The predominance of females (81.4%), urban area (51.8%), age group over 50 (90.2%), primary bilateral disease (90.1%), associated with hip osteoarthritis. coxarthrosis (13.9%), essential arterial hypertension (10.9%), osteoporosis (9.5%) or obesity (8.1%) were the most frequent features of a patient admitted for knee osteoarthritis. Among therapeutically methods, patients received ultrasounds in 61.1% of cases, and kinetotherapy in 16.6%.

CONCLUSIONS

Our study presented news aspects regarding knee osteoarthritis, in a geographical area of north-east of Romania.

Carotid intima-media thickness and plaque as surrogate biomarkers of atherosclerosis among consecutive women with systemic lupus erythematosus

BACKGROUND

In recent years, there has been a growing interest in understanding the pathogenic pathways of premature accelerated atherosclerosis (AS) in systemic lupus erythematosus (SLE). However, the role of both traditional and non-traditional, SLE-specific risk factors is still under debate.

AIM

To assess surrogate biomarkers of subclinical AS in SLE and to evaluate potential relations with cardiovascular risk factors.

PATIENTS AND METHODS

Prospective observational study on 35 consecutive SLE women (ACR 1987 diagnostic criteria) evaluated according to a standard protocol including traditional cardiovascular risk factors (hypertension, obesity, diabetes mellitus, cigarette smoking, abnormal lipid metabolism), SLE-specific risk factors (renal disease, SLE activity and duration, corticosteroid therapy) and surrogate biomarkers of subclinical AS (carotid intima-media thickness, plaque) (B-mode color Doppler ultrasound, 7-10 MHz probe). Data were analyzed in SPSS 16 software, p<0.05.

RESULTS

Significant differences (p<0.05) among subgroups (with and without plaque, thickened and normal intima) have been registered; moreover, statistical significant correlations between cIMT and age (r=0.476), age at onset (r=0.451), VLDL (r=0.382), hsCRP (r=0.436), Framingham score (r=0.421) have been reported. In addition, significant association between homocysteine and SLE-duration (r=0.460), SLEDAI (r=0.466), SLICC÷ACR (r=0.846) has been demonstrated, while hsCRP was associated with ESR (r=0.472), C3 (r=0.396), SLEDAI (r=0.569) and age (r=-0.681). Several predictors for increased cIMT have also been identified (ANOVA): hsCRP (p=0.016), VLDL (p=0.037), Framingham (p=0.012).

CONCLUSIONS

Our data advocate for increased cardiovascular burden in SLE and support the value of cIMT and carotid plaque as surrogate AS biomarkers in women with SLE.

[Clinico-biological issues of systemic lupus erythematosus patients]

AIM

To investigate clinical and biological aspects and to evaluate potential relation with activity and damage indexes in patients with Systemic Lupus Erythematosus (SLE).

MATERIAL AND METHODS

Retrospective observational study in 30 consecutive SLE patients (ACR 1997 diagnostic criteria) assessed according to a standard protocol including demographic, clinical and biological (hematology, inflammatory, immunology) data, disease activity (SLEDAI) and damage (SLICC/ACR).

RESULTS

90% SLE women with a mean age of 45.53+13.57 years and a mean age at onset of 31.10 +/- 9.20 years, presenting mainly with skin (43.33%) and small joint (56.66%) involvement, but also with renal (26.66%), cardio-vascular (26.66%) and neurological (6.66%); high anti-DNA double stranded antibodies (30% cases; mean 40.63 +/- 71.62IU/L) and low C3 levels (26.66%; mean 100.63 +/- 26.06 IU/L) have been reported, while more than 76% SLE patients displayed a low disease activity (mean SLEDAI 4 +/- 3.64) and limited damage (mean SLICC/ACR 1.4 +/- 0.85). Statistically significant correlation (p < 0.05) have been identified between SLEDAI and SLICC/ACR (r = 0.477), anti-DNA double stranded and SLEDAI (r = 0.515) respectively SLICC/ACR (r = 0.404), age at onset respectively current age and SLICC/ACR (r1 = 0.495, r2 = 0.468).

CONCLUSIONS

The clinical and biological study based on data from consecutive SLE patients has offered a comprehensive approach of different disease subtypes in North-East Romania. The predominance of currently low disease activity and minimal damage disease profile could reflect either SLE particularities or the expected effects of early individualized therapy.

[Disability assessment tools in psoriatic arthritis: VICON gait]

AIM

To evaluate health-related quality of life and disability in psoriatic arthritis (PsA) and to perform a complex biomechanical gait analysis in patients with PsA versus healthy controls.

MATERIAL AND METHODS

Preliminary prospective study on 33 consecutive PsA (2006 CASPAR criteria), with active multiple joint involvement disease. Assessments were done according to a predefined protocol and included: rheumatology-clinical evaluation and activity scores, dermatology- Psoriasis Area and Severity Index, PASI-score; functional disability- Health Assessment Questionnaire, HAQ, quality of life score- Short Form36, SF36; biomechanical gait analysis- tridimensional VICON MX optical motion capture system in PsA versus 33 age- and sex-matched healthy controls. SPSS, EPI-INFO and MS EXCEL were used for statistical analysis.

RESULTS

While the majority of PsA patients experienced a moderate impact on the quality of life as assessed by SF36 analysis, severe disease had major impact on their physical and emotional health status. The VICON gait analysis proved the statistical significant change (p < 0.05) on several gait parameters as compared to controls, including: decreased range of motion for flexion/extension of the lower limbs joins and lower cadence, decreased walking speed and step length. Statistically si gnificant correlations (Spearman, p < 0.05) between changes in PsA gait parameters and SF36 results, but no association with HAQ (p > 0.05) has been reported.

CONCLUSIONS

The PsA burden is related to both quality of life and functional impairment. Severe changes in gait parameters are essentially reflected in SF36 analysis.

A phase II, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of MDX-1100, a fully human anti-CXCL10 monoclonal antibody, in combination with methotrexate in patients with rheumatoid arthritis

OBJECTIVE

CXCL10 (also known as interferon-γ-inducible 10-kd protein [IP-10]) is a chemokine that potentially plays a role in the immunopathogenesis of rheumatoid arthritis (RA). We undertook this phase II study to evaluate the efficacy and safety of MDX-1100, a fully human, anti-CXCL10 (anti-IP-10) monoclonal antibody, in RA patients whose disease responded inadequately to methotrexate (MTX).

METHODS

Patients with active RA receiving stable doses of MTX (10-25 mg weekly) were randomized to receive intravenous doses of 10 mg/kg MDX-1100 (n = 35) or placebo (n = 35) every other week. The primary end point was the proportion of patients meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) on day 85, and patients were followed up for safety to day 141.

RESULTS

The ACR20 response rate was significantly higher among MDX-1100-treated patients than among placebo-treated patients (54% versus 17%; P = 0.0024). Statistically significant differences in the ACR20 response rate between treatments were observed starting on day 43 (P < 0.05). The ACR50 and ACR70 response rates on day 85 did not differ between the groups. Overall, 51.4% of MDX-1100-treated patients and 30.3% of placebo-treated patients experienced at least 1 adverse event (AE). No study drug-related serious AEs were reported.

CONCLUSION

MDX-1100 was well tolerated and demonstrated clinical efficacy in RA patients whose disease responded inadequately to MTX. This is the first study to demonstrate clinical efficacy of a chemokine inhibitor in RA and supports the notion of a potential role of IP-10 in the immunopathogenesis of RA.

[Bone mineral density in patients with rheumatoid arthritis]

Patients with rheumatoid arthritis (RA), an immune-mediated inflammatory rheumatic disease with peripheral and systemic involvement, are at increased risk of bone loss and fractures. There are many reasons for the high prevalence of osteoporosis (OP) in RA, including both traditional and specific risk factors such as pain and loss of joint function, medication (corticosteroids, methotrexate), and increased proinflammatory cytokines.

AIM

To evaluate bone mineral density status in RA patients, focusing on potential relation with classical risk factors for OP.

MATERIAL AND METHODS

One-year prospective observational study on 83 consecutive postmenopausal women, 43 diagnosed with RA (group I), and 40 healthy controls (group II) with no previous condition and medication known to affect bone metabolism and turnover. Bone mineral density (BMD) and T-score evaluated by dual X-ray absorbtiometry (DXA) at three standard skeletal sites (L1-L4 lumbar spine, hip and forearm) (Hologique QDR 100 device), and classical risk factors for osteoporosis were assessed in all patients according to a predefined protocol. Data were analyzed in SPSS-13 using ANOVA, t-Student, chi-square and ROC (Receiver Operator Characteristic).

RESULTS

Decreased BMD was reported in the majority of RA cases, mainly in the spine and femoral neck (86%), but also in total hip (72%); moreover, osteoporosis was commonly demonstrated in lumbar spine and osteopenia at hip level. Statistically significant differences between diagnostic categories (normal, osteopenia, osteoporosis, WHO 1994) (p<0.05), while no significant differences between mean BMD levels in women with and without RA at different skeletal sites were found (t-student, p>0.05). However, considerable BMD variation (51.7% to 102.3%) was suggested in RA as compared to non-RA patients (14.3% to 27%) (ANOVA). Significant differences in mean T-score at total hip and forearm (mainly 33% radius) were noted in patients with and without RA (p<0.05). No relation between osteodensitometric parameters and classical risk factors for OP has been identified in RA, except menopause. Indirect weak statistically significant correlations were found between mean T-score and menopause duration at all skeletal levels (Pearson's rank correlation, p<0.05), except for the femoral neck (r=+0.03, p<0.05).

CONCLUSIONS

Decreased BMD is commonly seen in RA patients. Several characteristics based on DXA assessment have been identified, including preference for distinct skeletal sites (spine, hip, distal forearm), and the particular intervention of menopause.

[Descriptive assessments of a series of rheumatoid arthritis patients admitted to rehabilitation treatment between 2008 and 2010]

AIM

To assess some demographic features in a series of 741 rheumatoid arthritis patients admitted to the Clinic Hospital of Rehabilitation at Iasi in different stages of disease in order to select the most adequate rehabilitation teratment.

MATERIAL AND METHODS

Data were collected from patients' records, hospital statistical reports, and then processed and interpreted using EPI/INFO and MS Excel.

RESULTS

Sex distribution revealed that the disease was more common in females (male/female ratio 0.2). The prevalence was higher after the age of 40, from 15.4% to 33.8% between 51 and 60, and 40.2% after 61. The most important comorbidities were related to osteoporosis (48.9%), ischemic cardiopathy and essential arterial hypertension (40.1%), impaired glucose tolerance and diabetes mellitus (36.9%), viral hepatitis B and C (24.02% of all cases).

CONCLUSIONS

In selecting the most adequate rehabilitation treatment (drug therapy, kinetotherapy, and physical therapy) patient's age, and his various associated diseases have to be considered.

Adalimumab therapy in patients with active rheumatoid arthritis

AIM

To evaluate efficacy and safety of adalimumab (ADA), a monoclonal anti-TNFalpha antibody, in rheumatoid arthritis (RA).

MATERIAL AND METHOD

5 years retrospective observational study on 70 active RA (ARA 1987 modified criteria; 48 women; mean age 52.6 +/- 11.7 years; mean disease duration 6.7 +/- 3.2 years, mean DAS28 6.5 +/- 1.3) treated with ADA (classic regimen). All patients have been assessed according to a standard protocol: (i) clinical (tender and swollen joints; pain; global disease evaluation), (ii) inflammatory and (iii) immune parameters (total antinuclear and anti-double stranded DNA antibodies), (iv) activity and functional scores, (v) response to therapy (EULAR), (vi) adverse events. Evaluation was performed at baseline and every 3 months. Statistical analysis was done in SPSS-13, p < 0.05.

RESULTS

Statistical significant improve in RA activity (mean final DAS28 3.6 +/- 0.8, p < 0.05), functional scores (mean HAQ 1.3 +/- 0.3, p < 0.05) and decreased X-ray progression (Sharp score) have been reported; 60% RA were responders (mean EULAR 2.7 +/- 1.2), 35.7% in remission, while switching to another biological agent (14.28% ADA failure) was done in 20% cases, clinical, biological and radiological efficacy and favorable safety profile of ADA have been demonstrated in real life long-term administration in active RA.

Tumor biomarkers in cervical cancer: focus on Ki-67 proliferation factor and E-cadherin expression

Despite recent advances in the immune mechanisms of cervical cancer (CC) and complex management opportunities, relapse remains still an actual issue. While predictive factors are required, current research is directed towards proliferation and tumor aggressiveness biomarkers as potential negative factors in CC. The main objectives were to assess tumor proliferation and invasiveness biomarkers (Ki-67, E-cadherin) and to identify potential correlation between biomarkers and classic prognostic factors in CC. Radical hysterectomy specimens from 61 consecutive CC were immunohistochemically investigated for Ki-67 and E-cadherin. Nuclear immunostaining for Ki-67 proliferation index was assigned scores 1 to 3, "+" meaning low (10-30%), "++" moderate (30-50%), "+++" high-proliferation rate (>50%); cell membrane E-cadherin staining was either negative or positive. Statistical analysis was performed in SPSS-13 software, p<0.05.

RESULTS

no significant correlation between Ki-67 and classical prognostic factors (p>0.05) was reported; however, in relapsed CC, Ki-67 correlates with tumor grading (r=0.386, p<0.05). Significant correlation between E-cadherin and tumor size (r=-0.280, p=0.029), relapse (r=-0.386, p=0.002) and disease free survival (r=0.374, p=0.003) were demonstrated. Indirect statistically significant moderate correlation between Ki-67 and E-cadherin (r=-0.461, p<0.00001) was shown, mainly in invasive squamous CC (r=-0.549, p=0.0001), stage IB (r=-0.578, p=0.009), IIB (r=-0.585, p=0.003), relapsed CC (r=-0.525, p<0.01), HPV-infection (r=-0.504, p=0.033).

CONCLUSIONS

CC aggressiveness, particularly in invasive squamous carcinoma, either 16 or 18 HPV-positive cases, FIGO stage IB and IIB, and cases with relapse, depends on two pivotal factors, tumor proliferation rate (Ki-67) and tumor invasiveness (E-cadherin).

Predictive value of cellular immune response in cervical cancer

Despite recent advances in the immune mechanisms of cervical cancer (CC), the relapse still remains an actual issue and recognition of new predictive biomarkers is essential.

AIM

The purpose of this retrospective study was to investigate possible differences in the primary, in situ, cellular immune response between cervical carcinoma with and without relapse.

MATERIAL AND METHODS

Paraffin-embedded tissue samples from 61 consecutive women with CC (34 with and 27 without relapse) were immunostained for CD3, CD20 and CD45 cells. Immune cell profile densities were further assessed, assigning scores between 0 and 3: "0" meaning the absence of inflammatory infiltrate, "1+" low, "2+" intense and "3+" intense infiltrate with lymphoid follicles. Statistical analysis was performed in SPSS-13 software, p<0.05.

RESULTS

Statistically significant intra- and peri-tumoral low numbers of several immune cell subtypes are strongly associated with relapse of disease within three and five years in patients with CC (p<0.05); moreover, statistical significant correlations between immune cells and both free survival (CD3: r=0.382; CD20: r=0.404; CD45: r=0.376) and relapse (CD3: r=-0.408; CD20: r=-0.355; CD45: r=-0.354) have been demonstrated. Only CD3 was reported as predictive biomarker of relapse in CC (ANOVA, t-Student, p<0.05).

CONCLUSIONS

Major differences in the cellular immune response among patients with cervical cancer with and without relapse within three and five years have been demonstrated. CD3 may be used as potential prognostic biomarkers, whereas the results are promising for adjuvant immunotherapy.

Immunohistochemical study of skeletal muscle in rheumatoid myositis

INTRODUCTION

Rheumatoid myositis (RM) represents a poorly characterized entity, immune mechanism, assessment and management remaining still unclear. The aim of this study was to investigate endothelial and inflammatory cells activation in RM muscle biopsy.

MATERIAL AND METHODS

Prospective study on 23 consecutive rheumatoid arthritis (RA) with muscle involvement as defined by clinical, biological and imagistic parameters. CD4, CD8, CD20, CD3, CD45RO and CD68 markers, HLA-DR, cytokines receptors (IL-2, TNFalpha, TGF alpha), pro-apoptotic (CD95) and adhesion molecules (CD54) were assessed by immunohistochemistry in deltoid muscle samples.

RESULTS

(1) endomysial, perivascular and perimysial inflammatory infiltrates and moderate muscle fibers involvement; predominance of activated (HLA-DR+), memory (CD45RO+) CD3+TCD8+ cells and macrophages surrounding and invading non-necrotic muscle fibers (34.78%) and TCD4+ activated cells in perivascular and perifascicular areas (65.22%); (2) up-regulation of HLA-DR, CD54 and IL-2R on both endothelial cells and lymphocytes (85%); (3) aberrant increased CD95 in endothelial cells without any other apoptotic sign (83%) have been described.

CONCLUSION

Increased expression of activation markers, adhesion molecules and cytokine receptors may indicate early endothelial activation in RM pathogenesis, while endomysial TCD8+ activation may account for further development and perpetuation of myositis.