POS0597 EFFECTS OF RITUXIMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS-RELATED INTERSTITIAL LUNG DISEASE: A SINGLE-CENTRE EXPERIENCE FROM TURKEY

Background:

Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is the most common type of lung involvement in rheumatoid arthritis (RA). The existence of RA-ILD is associated with worse survival. There is no mainstay treatment for RA-ILD. However, in recent studies, rituximab (RTX) seems to be effective in RA-ILD.

Objectives:

To determine the effects of RTX in patients with RA-ILD from a single-centre.

Methods:

In our biological treatment outpatient clinic, a retrospective study was conducted in patients with RA who were treated with RTX. Among them, patients with RA-ILD were analysed. For lung response to RTX, progression was defined as a decline of 10% ≥ in forced vital capacity (FVC) and/or a decline of 15% ≥ in diffusion capacity of carbon monoxide (DLCO). Computed tomography of the chest (chest-CT) were integrated to lung response so as to constitute missing data of pulmonary function tests (PFTs).

Results:

A total of 165 patients who are followed-up in our biological treatment outpatient clinic have been using RTX for their RA diagnosis. Among 165 patients, 26 (15.8%) patients with RA-ILD were initiated RTX. Five patients were diagnosed with RA-ILD while using RTX (incidence rate 3%). Patients‘ characteristics were demonstrated in table 1. Of 26 patients, the most commonly used concomitant disease-modifying antirheumatic drugs was leflunomide (46.2%) followed by mycophenolate mofetil (11.5), methotrexate (11.5%) and azathioprine (3.8%). Twenty-four (92.3%) patients used steroids. For the evaluation of lung response, 20 patients who had follow-up PFTs and/or chest-CT were compared. Median DLCO values for pre- and post RTX were 71.0% (60.0-77.0) and 63.0% (47.0-74.0), respectively (p= 0.061). Median pre and post-RTX FVC were 74.0% (61.0-99.0) and 84.0% (63.0-100.0), respectively (p= 0.28). After a median of 2.7 years, 11 (55.0%) patients had stable disease, 2 (10.0%) patients had regression of RA-ILD and 7 (35.0%) patients had progressive disease. Sex, age, seropositivity and radiographic patterns were not associated with progression. In total, 23 adverse events were detected in 11 (42.3%) patients. Five of them were serious infections requiring hospitalization, mostly pneumonia. Other adverse events were simple infections and surgeries such as arthroplasty. RTX was stopped in 4 (15.4%) patients due to infections secondary to hypogammaglobulinemia in 2, malignancy in 1 and allergic reaction in 1.

Conclusion:

RTX seems to achieve stabilization/improvement of RA-ILD with fewer adverse events. However, given that RA-ILD develops post-RTX, it is not a panacea; therefore, we need more effective treatment modalities in the case of RA-ILD.

Table 1.

Characteristics of 26 patients with RA-ILD treated with rituximab

Age at first RTX infusion, median (IQR), years61.2 (57.1-65.1)RA disease duration at first RTX, median (IQR), years10.1 (4.3-29.7)ILD disease duration at first RTX, median (IQR), years1.9 (0.1-4.5)Age at RA diagnosis, median (IQR), years51.1 (40.0-60.6)Age at ILD diagnosis, median (IQR), years58.3 (53.9-63.3)Male patient, n (%)16 (61.5)RF positivity, n (%)25 (96.2)ACPA positivity, n (%)20 (90.9)CRP levels,mg/L, mean (SD)40.3 (58.9)ESR levels, mean (SD)37.7 (18.2)Smoking status, n (%)16 (64.0)Prior TNF inhibitor treatment, n (%)5 (19.2)DAS28 at first RTX infusion, mean (SD)5.3 (1.5)Radiographic pattern, n (%)UIP7 (26.9)NSIP8 (30.8)OP2 (7.7)Indeterminate8 (30.8)Others1 (3.8)Follow-up duration, median (IQR), years2.5 (1.2-3.7)

RA-ILD= Rheumatoid arthritis-related interstitial lung disease, RTX= rituximab, RA= rheumatoid arthritis, RF= rheumatoid factor, ACPA= anti-citrullinated protein antibody, TNF= tumor necrosis factor, CRP= C-reactive protein, ESR= erythrocyte sedimentation rate, UIP= usual interstitial pneumonia, NSIP= non-specific interstitial pneumonia, OP= organizing pneumonia

Disclosure of Interests:

None declared

POS1335 CLINICAL CHARACTERISTICS OF THE PULMONARY ARTERY INVOLVEMENT IN PATIENTS WITH BEHÇET’S SYNDROME: A SINGLE-CENTRE EXPERIENCE OF 61 PATIENTS

Background:

Behçet’s Syndrome (BS) is a vasculitis of unknown origin. Vascular involvement, so-called vascular Behçet’s syndrome (VBS), may involve blood vessels of all sizes belonging to both venous and arterial system, with pulmonary artery involvement (PAI) being the most frequent form of arterial involvement. PAI in BS occurs in the form of aneurysms or thrombosis, and results in significant mortality.

Objectives:

To report the clinical characteristics of PAI in patients with BS and to define the predictors of relapses.

Methods:

We performed a retrospective analysis of BS patients with PAI who fulfilled international study group criteria. Among 460 patients with VBS, 66 were diagnosed with PAI. For final analyses, 61 patients with PAI, who had at least 2 follow-up visits (72.1% male, mean age at BS diagnosis 29.34 (SD 10.1) years), were included. The data of the patients were recorded. Relapse was defined as the reoccurrence of vascular event at any vascular structure. Factors associated with relapse were assessed by logistic regression analysis.

Results:

There were not any differences considering demographic and clinical features of the patients with and without PAI in VBS group except for that intracardiac thrombosis was more common in the patients with PAI than the patients without (19.7% vs 0.3%, respectively) (Figure 1). Among 61 patients with PAI, 50 (82.0%) had isolated pulmonary artery thrombosis (PAT), whereas 11 (18.0%) had pulmonary artery aneurysm (PAA) with or without PAT. The characteristics of 61 patients with PAI were shown in Table 1. A total of 37 relapses occurred in 24 (39.3%) patients during follow-up a median of 65.9 (IQR 20.1-109.0) months. To define the factors associated with relapses, the patients with isolated PAT were analysed. In multivariable logistic regression analysis, older age at BS diagnosis and anticoagulation usage seemed to be protective, even though they could not reach statistical significance (OR: 0.92 95% CI 0.86-1.02, OR: 0.34 95% CI 0.09-1.33, respectively).

Table 1.

Characteristics of the patients with pulmonary artery involvement

Alln= 61Isolated PATn= 50PAAn= 11Sex (male), n (%)44 (72.1)35 (70.0)9 (81.8)Age at diagnosis of BS, years (SD)29.3 (10.1)28.8 (10.4)31.9 (8.0)Age at diagnosis of PAI, years (SD)36.3 (12.83)36.7 (13.8)34.7 (6.7)Symptoms, n (%)Dyspnea28 (45.9)23 (46.0)5 (45.5)Hemoptysis26 (42.6)19 (38.0)7 (63.6)Vascular event before PAI, n (%)21 (34.4)20 (40.0)1 (9.1)Other vascular events at PAI, n (%)33 (54.1)28 (56.0)5 (45.5)Thrombophlebitis, n (%)7 (21.2)6 (21.4)1 (20.0)Upper and/or lower extremity DVT, n (%)20 (60.6)16 (57.1)4 (80.0)SVCS, n (%)1 (3.0)1 (3.6)0 (0)IVCS, n (%)3 (9.1)1 (3.6)2 (40.0)Intracranial thrombosis, n (%)4 (12.1)4 (14.3)0 (0)Intracardiac thrombosis, n (%)8 (24.2)7 (25.0)1 (20.0)Arterial event other than PAI, n (%)4 (12.1)3 (10.7)1 (20.0)Relapse, n (%)24 (39.3)20 (40.0)4 (36.4)Time to the first relapse, median (IQR), month49.8 (13.2-102.6)54.1 (24.4-117.9)3.9 (1.7-67.9)Death, n (%)2 (3.3)0 (0)2 (18.2)

BS= Behçet Syndrome, PAI= pulmonary artery involvement, PAT= pulmonary artery thrombosis, PAA= pulmonary artery aneurysm, DVT= deep vein thrombosis, SVCS= superior vena cava syndrome, IVCS= inferior vena cava syndrome

Figure 1.

A) Axial CT image shows thrombus formation in the left upper lobe pulmonary artery branch. B) Giant thrombus is seen in the right ventricle (black arrow). Note the thrombus formation in the left lower lobe pulmonary artery branches (white arrows).

Conclusion:

Our results indicate that there is a higher frequency of intracardiac thrombosis in BS patients with PAI and an increasing current trend of PAT in patients with PAI. In addition, there might be a possible efficacy of anticoagulation usage in preventing relapses, which needs confirmation with further studies.

Disclosure of Interests:

None declared

Investigation of hearing in patients with allergic rhinitis

The aim of the current study is to investigate hearing function in patients with allergic rhinitis. Fifty-eight patients with positive skin prick test (Group 1) (116 ears) and 31 subjects with negative skin prick test (62 ears) as group 2 were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 8000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in both groups. There was statistically significant difference between pure-tone threshold of the group 1 and group 2 at 8000 Hz (p< 0.05). Based on our study, the patients with allergic rhinitis had better hearing than the control group at 8000 Hz.

Comparison of Minimally Invasive Techniques in Tongue Base Surgery in Patients with Obstructive Sleep Apnea

Objective. To compare the effectiveness and morbidity of 3 microinvasive tongue base surgical procedures combined with uvulopalatopharyngoplasty (UPPP) in supine-dependent obstructive sleep apnea (OSA) patients.

Study Design. A prospective, randomized clinical study.

Setting. A tertiary referral center.

Methods. Fifty OSA patients were randomly advised to undergo UPPP combined with low-temperature bipolar radiofrequency (group 1), submucosal minimally invasive lingual excision with radiofrequency (SMILE-R; group 2), or submucosal minimally invasive lingual excision with a harmonic scalpel (SMILE-H; group 3). The Epworth Sleepiness Scale, the visual analog scale (VAS) for snoring, the pre- and postoperative 3-month polysomnography (PSG) findings, and the decrease in tongue volume using magnetic resonance imaging (MRI) were compared. The operation times, the postoperative pain VAS score, the analgesic requirement, and the time in commencing a normal diet were compared in the 3 groups.

Results. The decrease in apnea-hypopnea index (AHI) and supine AHI values at the postoperative 3-month time point was significant in group 2 ( P < .05). The decrease in tongue volume at the 3-month postoperative time point according to the MRI evaluations was higher in groups 1 and 2 ( P < .05). In the subjective comparison of effectiveness, there was no significant difference. The operation time was significantly lower in group 3. In the assessment of postoperative pain, no significant difference was found between the groups.

Conclusion. When the PSG findings and MRI were evaluated, UPPP + SMILE-R were found to be more effective. No significant difference was found between the 3 techniques when morbidity and complications were compared.

Allergic rhinitis (AR) in geriatric patients

Allergic rhinitis (AR) can be defined as an inflammatory disease of the nose and the paranasal sinuses, characterized by a specific IgE-mediated hypersensitivity reaction. The aim of this study was to evaluate the correlation between the symptoms of AR and the prick test results in geriatric patients presenting with symptoms of AR by comparing these with those of a young control group. Thirty-two geriatric patients (Group 1) were analyzed retrospectively, and 37 patients (Group 2) were selected as the control group. Diagnosis of AR was made based upon the physical examination findings, nasal endoscopic examination findings and the skin prick test results. While the skin prick test positivity was 50% in Group 1, this rate was found as 75.7% in Group 2. The difference was found to be statistically significant (p=0.044). A statistically significant difference was found between the two groups in terms of susceptibility to mugwort pollen and fish (p=0.048, p=0.033). In conclusion, in geriatric patients presenting with AR symptoms, systemic treatment should not be initiated before performing skin prick test, due to the adverse effects of the drugs.

Vitamin K deficiency--late onset intracranial haemorrhage

A retrospective study is presented of the clinical features and outcome of late onset haemorrhagic disease due to vitamin K deficiency in 11 babies who were admitted to the emergency or child neurology unit during a 4-year period (January 1994-December 1997). The disease occurred in infants between 30 and 119 days of age (mean: 56+/-24 days). None of them received vitamin K after birth and all were breastfed. The presenting complaints were seizures (91%), drowsiness (82%), poor sucking (64%), vomiting (46%), fever (46%), pallor (46%), acute diarrhoea (27%), irritability and high-pitched cry (18%). On examination, tense or bulging fontanelle (73%), anisocoria (36%), weak neonatal reflexes (18%), cyanoses (18%) were the most frequent findings. The localizations of the intracranial haemorrhage were as follows: intracerebral (91%), subarachnoid (46%), subdural (27%), and intraventricular (27%). No fatality was observed. However, after a follow-up period ranging from 6 to 48 months (mean: 21+/-13 months), only three (27%) infants remained neurologically normal. Seizure disorders (73%), severe psychomotor retardation (46%), cerebral palsy (46%) and microcephaly (46%) were observed in the remainder. Hydrocephalus developed in three (27%) babies but none of them required shunt replacement. The value is emphasized of vitamin K prophylaxis in the newborn to reduce the incidence of late onset intracranial haemorrhage and handicap in children.