Investigation of sensory and motor functions of wrist in patients with rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a systemic and autoimmune disease that affects many tissues and organs in the body, especially the synovial joint and periarticular structures. One of the most affected joints is the hand joints, and there is also involvement in the wrist joint.

OBJECTIVES

The purpose of this study was to assess the sensory and motor functions of the wrist with a gold standard method and to determine the relationship between the motor and sensory functions of the wrist and wrist-related pain/disability level and hand grip strength in patients with RA.

METHOD

Flexor and extensor muscle strength and joint position sense of the wrist were evaluated using isokinetic dynamometer, hand grip strength was measured using dynamometer, and wrist related pain and disability was assessed by Patient Rated Wrist Evaluation (PRWE) questionnaire.

RESULTS

Thirty-one patients with RA and 31 healthy controls were included in the study. Control group had better results regarding wrist flexor and extensor muscle strength and wrist joint position sense than RA patients for both hands/wrists. A positive and strong correlation and a negative and weak correlation were found between muscle strength and joint position sense of the wrist and hand grip strength, respectively.

CONCLUSIONS

Compared to healthy subjects, RA patients showed wrist-related sensorimotor deficits. Therefore, evaluation of the wrist should not be ignored in the examination of patients with RA. In addition, when planning the treatment program of the patients, not only hand exercises but also exercises involving the wrist should be taken into consideration.

Orbital/ocular inflammatory involvement in VEXAS syndrome: Data from the international AIDA network VEXAS registry

VEXAS syndrome is a recently described monogenic autoinflammatory disease capable of manifesting itself with a wide array of organs and tissues involvement. Orbital/ocular inflammatory manifestations are frequently described in VEXAS patients. The objective of this study is to further describe orbital/ocular conditions in VEXAS syndrome while investigating potential associations with other disease manifestations. In the present study, twenty-seven out of 59 (45.8 %) VEXAS patients showed an inflammatory orbital/ocular involvement during their clinical history. The most frequent orbital/ocular affections were represented by periorbital edema in 8 (13.6 %) cases, episcleritis in 5 (8.5 %) patients, scleritis in 5 (8.5 %) cases, uveitis in 4 (6.8 %) cases, conjunctivitis in 4 (6.8 %) cases, blepharitis in 3 (5.1 %) cases, orbital myositis in 2 (3.4 %) cases. A diagnosis of systemic immune-mediated disease was observed in 15 (55.6 %) cases, with relapsing polychondritis diagnosed in 12 patients. A significant association was observed between relapsing polychondritis and orbital/ocular involvement in VEXAS syndrome (Relative Risk: 2.37, 95 % C.I. 1.03-5.46, p = 0.048). Six deaths were observed in the whole cohort of patients after a median disease duration of 1.2 (IQR=5.35) years, 5 (83.3 %) of which showed orbital/ocular inflammatory involvement. In conclusion, this study confirms that orbital/ocular inflammatory involvement is a common finding in VEXAS patients, especially when relapsing polychondritis is diagnosed. This makes ophthalmologists a key figure in the diagnostic process of VEXAS syndrome. The high frequency of deaths observed in this study seems to suggest that patients with orbital/ocular involvement may require increased attention and more careful follow-up.

Impact of HLA-B51 on Uveitis and Retinal Vasculitis: Data from the AIDA International Network Registries on Ocular Inflammatory Disorders

PURPOSE

The clinical relevance of human leukocyte antigen (HLA) subtypes such as HLA-B51 on Behçet's disease (BD)-related uveitis and non-infectious uveitis (NIU) unrelated to BD remains largely unknown.

METHODS

Data were prospectively collected from the International AIDA Network Registry for BD and for NIU. We assessed differences between groups (NIU unrelated to BD and positive for HLA-B51, BD-related uveitis positive for HLA-B51 and BD-related uveitis negative for HLA-B51) in terms of long-term ocular complications, visual acuity (VA) measured by best corrected visual acuity (BCVA), anatomical pattern, occurrence of retinal vasculitis (RV) and macular edema over time.

RESULTS

Records of 213 patients (341 eyes) were analyzed. No differences in complications were observed (p = 0.465). With regard to VA, a significant difference was detected in median BCVA (p = 0.046), which was not maintained after Bonferroni correction (p = 0.060). RV was significantly more prevalent in NIU-affected patients who tested positive for HLA-B51, irrespective of the systemic diagnosis of BD (p = 0.025). No differences emerged in the occurrence of macular edema (p = 0.99).

CONCLUSIONS

Patients with NIU testing positive for HLA-B51 exhibit an increased likelihood of RV throughout disease course, irrespective of a systemic diagnosis of BD. The rate of complications as well as VA are comparable between NIU cases unrelated to BD testing positive for HLA-B51 and uveitis associated with BD. Therefore, it is advisable to perform the HLA-B typing in patients with NIU or retinal vasculitis, even in the absence of typical BD features.

Risk for cancer development in familial Mediterranean fever and associated predisposing factors: an ambidirectional cohort study from the international AIDA Network registries

Objective

Inflammation has been associated with an increased risk for cancer development, while innate immune system activation could counteract the risk for malignancies. Familial Mediterranean fever (FMF) is a severe systemic inflammatory condition and also represents the archetype of innate immunity deregulation. Therefore, the aim of this study is to investigate the risk for cancer development in FMF.

Methods

The risk ratio (RR) for malignancies was separately compared between FMF patients and fibromyalgia subjects, Still's disease patients and Behçet's disease patients. Clinical variables associated with cancer development in FMF patients were searched through binary logistic regression.

Results

580 FMF patients and 102 fibromyalgia subjects, 1012 Behçet's disease patients and 497 Still's disease patients were enrolled. The RR for the occurrence of malignant neoplasms was 0.26 (95% Confidence Interval [CI.] 0.10-0.73, p=0.006) in patients with FMF compared to fibromyalgia subjects; the RR for the occurrence of malignant cancer was 0.51 (95% CI. 0.23-1.16, p=0.10) in FMF compared to Still's disease and 0.60 (95% CI. 0.29-1.28, p=0.18) in FMF compared to Behçet's disease. At logistic regression, the risk of occurrence of malignant neoplasms in FMF patients was associated with the age at disease onset (β1 = 0.039, 95% CI. 0.001-0.071, p=0.02), the age at the diagnosis (β1 = 0.048, 95% CI. 0.039-0.085, p=0.006), the age at the enrolment (β1 = 0.05, 95% CI. 0.007-0.068, p=0.01), the number of attacks per year (β1 = 0.011, 95% CI. 0.001- 0.019, p=0.008), the use of biotechnological agents (β1 = 1.77, 95% CI. 0.43-3.19, p=0.009), the use of anti-IL-1 agents (β1 = 2.089, 95% CI. 0.7-3.5, p=0.002).

Conclusions

The risk for cancer is reduced in Caucasic FMF patients; however, when malignant neoplasms occur, this is more frequent in FMF cases suffering from a severe disease phenotype and presenting a colchicine-resistant disease.

Colchicine-intolerant familial mediterranean fever patients: A comparative study between different colchicine doses and IL-1 inhibitor monotherapy

OBJECTIVE

Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Colchicine is the primary treatment for FMF, although some patients do not respond well or are unable to tolerate it. For these patients, the addition of interleukin-1 (IL-1) antagonists is the preferred option. However, the impact of colchicine treatment alongside the use of IL-1 antagonists remains unclear.

METHODS

We recruited adult FMF patients who satisfied the Eurofever and Pediatric Rheumatology International Trials Organization classification criteria and were receiving IL-1 antagonist treatment from our FMF cohort. All the patients exhibited colchicine intolerance or resistance. As per the FMF cohort protocol, the patients were longitudinally followed up, including assessments of their C-reactive protein, erythrocyte sedimentation rate, autoinflammatory disease activity index (AIDAI), and autoinflammatory damage index (ADDI).

RESULTS

Among the 125 patients (68 female and 57 male), 96 received a combination of IL-1 antagonists and the maximum tolerated dose of colchicine, whereas 29 were treated exclusively with IL-1 antagonists due to colchicine intolerance. The patients' inflammatory markers, AIDAI activity, and ADDI damage scores did not differ significantly between the two groups during the follow-up period. Notably, the drug retention rates were significantly higher in the patients treated solely with IL-1 antagonists.

CONCLUSION

While the typical approach is to maintain colchicine treatment alongside the use of IL-1 antagonists, for patients who cannot tolerate effective colchicine doses, IL-1 antagonists alone may effectively control FMF disease activity.

Effects of interleukin-1 antagonists on de novo and pre-existing damage in patients with familial Mediterranean fever

OBJECTIVES

Colchicine is the mainstay of familial Mediterranean fever treatment and interleukin (IL-1) antagonists are the treatment of choice in resistant patients. We aimed to investigate efficacy of IL-1 antagonists in the prevention of damage, as well as the causes of treatment failure.

METHODS

A total of 111 patients fulfilling Euro fever and Tel-Hashomer criteria and treated with IL-1 antagonists were included in the study. Patients were grouped according to their recent damage status: no damage, pre-existing damage and de novo damage that developed under IL-1 antagonist treatment. The degree of damage was determined using the Auto Inflammatory Disease Damage Index (ADDI). Total damage score was calculated separately as its original definition and with excluding chronic musculoskeletal pain, creating the modified ADDI (mADDI).

RESULTS

Forty-six patients (43,2 %) had damage according to the mADDI. Damage was commonly observed at musculoskeletal, renal and reproductive domains. Median duration of treatment was forty-five months. Two patients developed de novo damage: one musculoskeletal and one reproductive in this time-period. Five patients had a worsening of their damage while using IL-1 antagonists. De novo damage with IL-1 antagonist treatment was associated with acute phase protein levels.

CONCLUSIONS

We evaluated change in damage accrual while using IL-1 antagonists in patients with FMF. Physicians should pay attention to controlling inflammation to prevent further damage, especially in those with pre-existing damage.

Could serum HMGB1 levels be a predictor associated with psoriatic arthritis?

Background/aim: Psoriasis is a chronic autoimmune disease that predominantly affects the skin and musculoskeletal system. We hypothesized that HMGB1, an inflammatory nuclear protein, may play a role in the musculoskeletal involvement of psoriasis. Methods: Forty patients with psoriasis and 45 with psoriatic arthritis were involved in the study; the results were compared with 22 healthy controls. Serum HMGB1 levels were evaluated from peripheral blood samples. Results: Serum HMGB1 levels were found to be significantly higher in patients with psoriasis regardless of joint involvement (p < 0.001). Also, HMGB1 levels were correlated with the extent of psoriasis. Conclusion: Serum HMGB1 levels may contribute to the progression of psoriasis to psoriatic arthritis and correlate with the severity of skin involvement.

Vexas Syndrome Presenting As Long Covid-19

Objective VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described systemic inflammatory syndrome caused by somatic mutations of UBA1. COVID-19 is a viral infection that was described in 2019 and spread widely and quickly all around the world. Constitutional, thrombotic and pulmonary symptoms of these two conditions are similar, which is why cases of VEXAS syndrome may be misdiagnosed as a COVID infection.

Case report We introduced a case report of a 72-year-old male patient with VEXAS syndrome who had fever, fatigue, deep vein thrombosis and a cough and was thought to have a long COVID-19 infection for one year. Then we diagnosed him with VEXAS syndrome with vacuoles in myelomonocytic cells, skin lesions and a mutation of the UBA-1 gene.

Conclusion VEXAS and long COVID are two new conditions with overlapping clinical presentations. Physicians must be aware of these clinical conditions because of their different treatment strategy and prognosis.

The Autoinflammatory Diseases Alliance Registry of monogenic autoinflammatory diseases

Objective

The present manuscript aims to describe an international, electronic-based, user-friendly and interoperable patient registry for monogenic autoinflammatory diseases (mAIDs), developed in the contest of the Autoinflammatory Diseases Alliance (AIDA) Network.

Methods

This is an electronic platform, based on the Research Electronic Data Capture (REDCap) tool, used for real-world data collection of demographics, clinical, laboratory, instrumental and socioeconomic data of mAIDs patients. The instrument has flexibility, may change over time based on new scientific acquisitions, and communicate potentially with other similar registries; security, data quality and data governance are corner stones of the platform.

Results

AIDA project will share knowledge and expertise on mAIDs. Since its start, 118 centers from 24 countries and 4 continents have joined the AIDA project. Fifty-nine centers have already obtained the approval from their local Ethics Committees. Currently, the platform counts 337 users (122 Principal Investigators, 210 Site Investigators, 2 Lead Investigators, and 3 data managers). The Registry collects baseline and follow-up data using 3,748 fields organized into 21 instruments, which include demographics, patient history, symptoms, trigger/risk factors, therapies, and healthcare information for mAIDs patients.

Conclusions

The AIDA mAIDs Registry, acts both as a research tool for future collaborative real-life studies on mAIDs and as a service to connect all the figures called to participate. On this basis, the registry is expected to play a pivotal role in generating new scientific evidence on this group of rare diseases, substantially improving the management of patients, and optimizing the impact on the healthcare system. NCT 05200715 available at https://clinicaltrials.gov.

COVID-19 in Familial Mediterranean Fever: Clinical Course and Complications Related to Primary Disease

Objectives

To evaluate the impact of familial Mediterranean fever (FMF) features on the clinical course and outcomes of coronavirus disease 2019 (COVID-19) and clinical course of FMF after COVID-19.

Methods

Consecutive FMF patients with COVID-19 were enrolled from three referral hospitals. Clinical features of FMF and detailed COVID-19 information were obtained from patient interviews and medical records.

Results

Seventy-three FMF patients were included in the study. 94.5% of patients had clinical symptoms of COVID-19. We found 24.7% hospitalization, 12.3% respiratory support, 4.1% intensive care unit admission, 6.8% complication, and 1.4% mortality rate in patients. The risk factors of hospitalization for respiratory support were male gender [OR: 7.167 (95% CI: 1.368–37.535)], greater age [OR: 1.067 (95% CI: 1.016–1.121)], and non-adherence to colchicine treatment before the infection [OR: 7.5 (95% CI: 1.348–41.722)]. One-third of patients had reported attacks after COVID-19. The patterns of triggered attacks were fever, peritonitis, pleuritis, transient arthritis, chronic knee mono-arthritis, and protracted febrile myalgia.

Conclusions

FMF characteristics were not associated with worse outcomes of COVID-19. Colchicine non-adherence was the risk factor of hospitalization for oxygen support. The rate of FMF attacks after COVID-19 is prominently increased, with some of them being protracted and destructive.

Development and Implementation of the AIDA International Registry for Patients With VEXAS Syndrome

Objective

The aim of this paper is to present the AutoInflammatory Disease Alliance (AIDA) international Registry dedicated to Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome, describing its design, construction, and modalities of dissemination.

Methods

This Registry is a clinical, physician-driven, population- and electronic-based instrument designed for the retrospective and prospective collection of real-life data. Data gathering is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain real-world evidence for daily patients' management. The Registry may potentially communicate with other on-line tools dedicated to VEXAS syndrome, thus enhancing international collaboration and data sharing for research purposes. The Registry is practical enough to be easily modified to meet future needs regarding VEXAS syndrome.

Results

To date (April 22^nd, 2022), 113 Centers from 23 Countries in 4 continents have been involved; 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) are currently able to access the registry for data entry (or data sharing) and collection. The Registry includes 4,952 fields organized into 18 instruments designed to fully describe patient's details about demographics, clinical manifestations, symptoms, histologic details about skin and bone marrow biopsies and aspirate, laboratory features, complications, comorbidities, therapies, and healthcare access.

Conclusion

This international Registry for patients with VEXAS syndrome will allow the achievement of a comprehensive knowledge about this new disease, with the final goal to obtain real-world evidence for daily clinical practice, especially in relation to the comprehension of this disease about the natural history and the possible therapeutic approaches. This Project can be found on https://clinicaltrials.gov NCT05200715.

Development and Implementation of the AIDA International Registry for Patients With Undifferentiated Systemic AutoInflammatory Diseases

Objective

This paper points out the design, development and deployment of the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to pediatric and adult patients affected by Undifferentiated Systemic AutoInflammatory Diseases (USAIDs).

Methods

This is an electronic registry employed for real-world data collection about demographics, clinical, laboratory, instrumental and socioeconomic data of USAIDs patients. Data recruitment, based on the Research Electronic Data Capture (REDCap) tool, is designed to obtain standardized information for real-life research. The instrument is endowed with flexibility, and it could change over time according to the scientific acquisitions and potentially communicate with other similar tools; this platform ensures security, data quality and data governance.

Results

The focus of the AIDA project is connecting physicians and researchers from all over the world to shed a new light on heterogeneous rare diseases. Since its birth, 110 centers from 23 countries and 4 continents have joined the AIDA project. Fifty-four centers have already obtained the approval from their local Ethics Committees. Currently, the platform counts 290 users (111 Principal Investigators, 179 Site Investigators, 2 Lead Investigators, and 2 data managers). The Registry is collecting baseline and follow-up data using 3,769 fields organized into 23 instruments, which include demographics, history, symptoms, trigger/risk factors, therapies, and healthcare information access for USAIDs patients.

Conclusions

The development of the AIDA International Registry for USAIDs patients will facilitate the online collection of real standardized data, connecting a worldwide group of researchers: the Registry constitutes an international multicentre observational groundwork aimed at increasing the patient cohort of USAIDs in order to improve our knowledge of this peculiar cluster of autoinflammatory diseases. NCT05200715 available at https://clinicaltrials.gov/.

AB1317 SERUM INTERLEUKIN 37 LEVELS IN FAMILIAL MEDITERRANEAN FEVER PATIENTS AND ASSOCIATION WITH CLINICAL FEATURES

Background

Familial Mediterranean Fever (FMF) is the most common form of autoinflammatory diseases that is characterized by febrile episodes of serositis, arthritis and skin rash (1). Mutations in MEFV gene causes dysfunction of pyrin inflammasome, ultimately resulting in over-activation of Caspase-1 which is responsible for catalytic activation of interleukin (IL)-1 beta and gasdermin-D (2). IL-37 is also one of the IL-1 cytokines activated by caspase-1 acting as natural inhibitor of inflammation (3).

Objectives

IL-37 has pathogenetic roles for certain inflammatory diseases. We aimed to investigate serum IL-37 levels and its relationship with clinical and laboratory features of disease.

Methods

58 adult patients diagnosed with FMF according to Tel Hashomer criteria were included. Thirty subjects were served as healthy control subjects. Demographic, genetic, clinical and laboratory features and treatment responses of patients were recorded. Twenty-nine patients were colchicine responsive whereas 29 were colchicine refractory. Serum IL-37 levels were measured by ELISA from blood samples obtained at attack free periods.

Results

Peritonitis was the most common attack type (81%) followed by fever (80%) and arthritis (67%). There was no difference between FMF patients and healthy subjects for their serum IL-37 levels. A negative correlation was found between IL-37 values ​​and erythrocyte sedimentation rate in FMF patients (r: -0,31; p:0.015). IL -37 level was found to be significantly lower in patients who suffer from arthritis (median [IQR] 119 [396] ng/L vs 53 [164] ng/L, p= 0.03), myalgia (147 [364] ng/L vs 53 [84] ng/L, p= 0.05) or skin rash (102 [360] ng/L vs 54 [130] ng/L, p= 0.05) compared to those who did not have these attacks.

Conclusion

Although there was no difference in serum IL-37 levels between FMF patients and healthy subjects, IL-37 seem to be associated with musculoskeletal and skin attacks of FMF. Further research is needed to determine whether IL-37 have relationships with other features of FMF such as spondyloarthritis and febril myalgia.

References

[1]El-Shanti H, Majeed HA, El-Khateeb M. Familial mediterranean fever in Arabs.Lancet. 2006;367(9515):1016–24.

[2]Kanneganti A, Malireddi RKS, Saavedra PHV, Vande Walle L, Van Gorp H, Kambara H, Tillman H, Vogel P, Luo HR, Xavier RJ, Chi H, Lamkanfi M. GSDMD is critical for autoinflammatory pathology in a mouse model of Familial Mediterranean Fever. J Exp Med. 2018 Jun 4;215(6):1519-1529. doi: 10.1084/jem.20172060

[3]Nieman DC, Ferrara F, Pecorelli A, Woodby B, Hoyle AT, Simonson A, Valacchi G. Postexercise Inflammasome Activation and IL-1β Production Mitigated by Flavonoid Supplementation in Cyclists. Int J Sport Nutr Exerc Metab. 2020 Sep 15:1-9. doi: 10.1123/ijsnem.2020-0084.

Acknowledgements

No financial support is obtained from any company

Disclosure of Interests

None declared

AB1272 FACTORS AFFECTING PATIENT-ACCEPTABLE SYMPTOM STATES IN FAMILIAL MEDITERRANEAN FEVER

Background

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever, serositis, and musculoskeletal symptoms (1, 2). Arthritis is the most common musculoskeletal symptom of attacks and also included in diagnostic criteria of FMF (3). If it is specifically queried, myalgia may be detected in up to 20-25% of the patients with FMF.(4,5).

Objectives

In our study, we aim to assess the localization of attack-related myalgia and associated parameters in patients with FMF.

Methods

A total of 349 consecutive patients followed by FMF in our clinic were enrolled in the study and asked for attack-induced myalgia and if present, localization of muscle groups on the mannequin body parts diagram.

Attack frequency, duration, and disease activity were evaluated with the AutoInflammatory Diseases Activity Index (AIDAI) scoring system (6). Patients were also asked for work/study day loss during attacks and patient acceptable symptom state (PASS) status (7).

Results

126 patients showed attack myalgia (36%); attack duration, frequency, severity were significantly higher in patients with attack-myalgia (p<0,005). Most common muscle groups were calves, lower back, and latissimus dorsi muscles in order. Myalgia was most commonly accompanied by arthritis (p<0,002). Patients with myalgia have a higher frequency of colchicine resistance and work/study day loss due to attacks.

Conclusion

Our results conclude that myalgia is an important domain of attacks and causes absenteeism and uncontrolled disease activity. Treatment of myalgia attacks may provide controlled disease activity, and prevent absenteeism from work/school.

References

[1]El-Shanti H, Majeed HA, El-Khateeb M. Familial mediterranean fever in Arabs.Lancet. 2006;367(9515):1016–24.

[2]Majeed HA, Al-Qudah AK, Qubain H, Shahin HM. The clinical patterns of myalgia in children with familial Mediterranean fever. Semin Arthritis Rheum. 2000;30(2):138–43.

[3]Gattorno M, Hofer M, Federici S, Vanoni F et al. Eurofever Registry and the Paediatric Rheumatology International Trials Organisation (PRINTO). Classification criteria for autoinflammatory recurrent fevers. Ann Rheum Dis. 2019 Aug;78(8):1025-1032. doi: 10.1136/annrheumdis-2019-215048.

[4]Zemer D. Muscle pains in familial Mediterranean fever. Harefuah 1984; 106: 232-233.

[5]Majeed HA. Differential diagnosis of fever of unknown origin in children. Curr Opin Rheumatol 2000; 12: 439-444.

[6]Piram M, Frenkel J, Gattorno M et al. EUROFEVER and EUROTRAPS networks. A preliminary score for the assessment of disease activity in hereditary recurrent fevers: results from the AIDAI (Auto-Inflammatory Diseases Activity Index) Consensus Conference. Ann Rheum Dis. 2011 Feb;70(2):309-14. doi: 10.1136/ard.2010.132613.

[7]Salaffi F, Carotti M, Gutierrez M, Di Carlo M, De Angelis R. (2015) Patient Acceptable Symptom State in Self-Report Questionnaires and Composite Clinical Disease Index for Assessing Rheumatoid Arthritis Activity: Identification of Cut-Off Points for Routine Care. Biomed Res Int. 2015:930756. doi: 10.1155/2015/930756.

Table 1.

Comparison of clinical and laboratory parameters between patients with /without myalgia attacks

Patients with myalgia attackPatients without myalgia attackp valueAge (years)36,33 ±10, 6837,9±11, 48>0,05Sex (female/male)78/43138/87>0,05Follow-up time (years)16,117,6>0,05Dominant attack(number)Peritonitis4255>0,05Arthritis11390,012Pleuritis1310>0,05Only fever47>0,05AIDAI score (mean, 0-175)127,4080,68<0,05VAS score for pain (median score, during attack. 0-10)85<0,05Colchicine resistance (number ofpatients)69250,003Colchicine-resistant29840,002Colchicine-sensitivePASS status (number)Need additional treatment4160,016Satisfied from treatment34740,010Work/study day loss (number)4860,003

Acknowledgements

All study population signed informed consent for both participation and publication. Local Ethical Committee of the university approved the study.

Disclosure of Interests

None declared

AB1088 COVID-19 VACCINATION OF SPONDYLOARTHRITIS PATIENTS RECEIVING BIOLOGICAL THERAPY: REAL-LIFE DATA

Background

Considering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.

Objectives

Vaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.

Methods

Adult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.

Results

A total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).

It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization.

The rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, anaphylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination.

Conclusion

During the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.

References

[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.

[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496

Disclosure of Interests

None declared

Individual differences in the experience of meta-mood and internalizing psychopathology

Introduction

Emotional competencies such as attention to emotion and emotional clarity have been extensively studied in the literature. Depending on the context, their role shows different patterns of association with emotion regulation and psychopathological states.

Objectives

In the current study, we aim to understand when and how attention to emotion and emotional clarity are related to the co-occurrence of anxiety and depression.

Methods

Data were collected on attention to emotion, emotional clarity, anxiety, and depression. A sample of 258 adolescents aged 12 to 18 years (M = 14.6, SD = 1.7, 54.5% girls) was examined to investigate the moderating role of attention to emotion and emotional clarity on the relationship between anxiety and depression after controlling for age, gender, and socioeconomic status.

Results

showed that high levels of attention to emotion and low levels of emotional clarity were associated with increased risk for anxiety and depression. Balanced levels of attention to emotion and emotional clarity were also associated with increased risk for anxiety and depression. However, low levels of attention to emotion and high levels of emotional clarity showed no statistically significant association with the occurrence of anxiety and depression.

Conclusions

Overall, this positive imbalance of low attention to emotion and high emotional clarity appears to be the most favorable emotional states for coping with internalizing problems, suggesting less harmful effects of attention to emotion.

Disclosure

No significant relationships.

AB1301 DETERMINING THE RELATIONSHIP BETWEEN SERUM INTERLEUKIN 33 LEVELS AND CLINICAL FEATURES OF THE DISEASE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background

Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent fever, serositis, arthritis and erysipelas-like erythema caused by mutations over activating caspase-1. As Interleukin (IL)-1 beta, IL-33 is a nuclear cytokine from IL-1 family which is activated by caspase-1. IL-33 is known to take part in pathogenesis of several rheumatic diseases.

Objectives

The aim of this research is determining the relationship between serum IL-33 levels and clinical features of the disease in patients with FMF disease.

Methods

The research involved 54 FMF patients and 29 healthy volunteers. Serum IL-33 levels were evaluated in both patients and healthy individuals, and its relationship between clinical and laboratory features of FMF.

Results

28 out of 54 patients (%51.8) had favorable response to colchicine while 26 patients (%48.2) had colchicine resistant disease. FMF patients had lower IL-33 levels compared to healthy control group (p= 0.06). There were no difference between colchicine responsive and resistant patients (p=0.12) and no association was found between clinical features and serum IL-33 levels. Additionally, IL-33 did not correlated with C-reactive protein and disease activity assessed by autoinflammatory disease activity index.

Conclusion

No association was found between serum IL-33 levels and FMF disease features and laboratory findings. This may be due to the small size of our patient group, the involvement of IL-33 in tissue homeostasis as well as inflammation, and the use of higher doses of colchicine in the resistant disease group than in the remission group. Additional research is needed to determine IL-33’s role in FMF pathogenesis and its relationship with clinical and laboratory features.

References

[1]Ozdogan, H. and S. Ugurlu, Familial Mediterranean Fever. Presse Med, 2019. 48(1 Pt 2): p. e61-e76.

[2]Cayrol, C. and J.P. Girard, Interleukin-33 (IL-33): A nuclear cytokine from the IL-1 family. Immunol Rev, 2018. 281(1): p. 154-168.

[3]Duan, L., et al., The role of IL-33 in rheumatic diseases. Clin Dev Immunol, 2013. 2013: p. 924363.

Acknowledgements

None of the authors obtained any financial support.

Disclosure of Interests

None declared

AB1302 EVALUATING THE CLINICAL UTILITY OF PATIENT ACCEPTABLE SYMPTOM STATE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background

Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever, serositis, arthritis and erysipelas-like erythema. Patient acceptable symptom state (PASS) is a disease evaluation method to assess disease activity with a simple question especially in rheumatic diseases.

Objectives

We aimed to investigate clinical utility of PASS in FMF patients.

Methods

The research involved 54 FMF patients. Patient acceptable symptom state was applied to all patients in the study. The answers to PASS were compared with the patients clinical and laboratory features.

Results

28 out of 54 patients (51.8%) were colchicine responsive whereas, 26 patients (48.2%) had colchicine resistant disease. The number of patients who answered yes to PASS (I’m happy with my current disease condition) was 32 (59%), while answered no (I need further treatment options) was 22 (41%). Considering the disease severity assessed with International severity scoring FMF (ISSF) of those who answered yes, 22 (68%) patients had mild disease, 10 patients had moderate (32%) disease, and there was no patient with severe disease in this group. Among those who answered no, 3 (14%) had mild disease, 14 (63%) had moderate disease, and 5 (23%) had severe disease (p <0.001). When the CRP levels of the patients were compared, the median CRP value of those who answered yes was found to be 4.45 mg/L, and the median value of CRP for those who answered no was 11.25 mg/L (p= 0.04).

Sensitivity and specificity of PASS for detecting patients in remission was 78% and 61% respectively. Moreover, PASS had a positive and negative predictive value of %68 and %72 respectively, for determining patients in remission. If cut off level of CRP was chosen as 6.5 mg/L for answering “yes” to PASS, sensitivity of test has been found to be 62.5% while the specificity is 59.1%. On the other hand, if cut off level of CRP is selected as 9.35 mg/L; sensitivity and specificity of the test was found as 75% and 72.7% respectively (p=0.045).

Conclusion

Patient acceptable symptom state is found beneficial in evulation these patients simply and swiftly especially in terms of distinguishing severe FMF disease. In FMF, laboratory remission is as important as clinical remission, therefore, PASS by alone, is not sufficient for making treatment decisions and should be supported by inflammatory markers.

References

[1]Ozdogan, H. and S. Ugurlu, Familial Mediterranean Fever. Presse Med, 2019. 48(1 Pt 2): p. e61-e76.

[2]Lubrano, E., et al., Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices. RMD Open, 2020. 6(1).

[3]Salaffi, F., et al., Patient Acceptable Symptom State in Self-Report Questionnaires and Composite Clinical Disease Index for Assessing Rheumatoid Arthritis Activity: Identification of Cut-Off Points for Routine Care. Biomed Res Int, 2015. 2015: p. 930756.

[4]Maksymowych, W.P., et al., Evaluation and validation of the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Arthritis Rheum, 2007. 57(1): p. 133-9.

Acknowledgements

None of authors obtained any financial support

Disclosure of Interests

None declared

POS1328 DO IL-1 ANTAGONISTS DEFINITELY PROTECT FROM THE DEVELOPMENT OF NEW DAMAGE: A SINGLE-CENTER STUDY

Background

Ongoing inflammatory episodes of familial Mediterranean fever (FMF) disease can cause damage in nearly all organ systems. Colchicine and interleukin1β blocking agents are successfully used to control the disease activity [1]. Although the effect of IL-1 blockers are known for controlling disease activity and amyloidosis [2], it is unclear whether they prevent organ damage

Objectives

In our study, we assessed the organ damage in patients with FMF treated with colchicine and IL-1 antagonists (IL-1A). It was evaluated whether new damage occurred after IL-1 antagonist treatment.

Methods

A total of 111 patients fulfilling Tel-Hashomer criteria and treated with IL-1A due to colchicine resistance were included in the study. All patients were also treated with colchicine with a maximum-tolerable dose. Patients were grouped according to their recent damage status (no damage, pre-existing damage, and damage developed under IL-1A treatment). The degree of damage was determined using Autoinflammatory Disease Damage Index (ADDI) and modified form of ADDI (mADDI) [3, 4].

Results

44 patients (42,3%) had damage according to the modified ADDI (mADDI) index; three patients experienced new damage under IL-1 antagonist treatment while four patients showed progression of damage and mADDI score.

In patients with a positive mADDI score, the most common damage was amyloidosis (n=28, 63%), the second most frequent was musculoskeletal findings (N=14, 31%), and the third was infertility (N=2, 0,04%). The most common domains of FMF-related damage with IL-1 antagonist treatment were musculoskeletal (n=4), renal (n=2) and reproductive system (n=2)

Conclusion

Our study was the first study to evaluate the progression of damage in patients with FMF and treated- with IL-1 antagonists. Although it is known that IL-1A is effective in colchicine-resistant patients, physicians should be aware that damage can still develop under IL-1A treatment.

References

[1]Chae JJ, Aksentijevich I, Kastner DL. Advances in the understanding of familial Mediterranean fever and possibilities for targeted therapy. Br J Haematol 2009; 146:467–78.

[2]Ozcakar ZB, Ozdel S, Yilmaz S, Kurt-Sukur ED, Ekim M et al. Anti-IL-1 treatment in familial Mediterranean fever and related amyloidosis. Clinical Rheumatology 2016; 35 (2): 441- 446. doi: 10.1007/s10067-014-2772-2

[3]Ter Haar NM, Annink KV, Al-Mayouf SM et al.: Development of the autoinflammatory disease damage index (ADDI). Ann Rheum Dis 2017; 76: 821-30

[4]Babaoglu H, Armagan B, Bodakci E, Satis H, Atas N, Sari A, Yasar Bilge NS, Bilici Salman R, Yardimci GK, Avanoglu Guler A, Karadeniz H, Kilic L, Ozturk MA, Goker B, Haznedaroglu S, Kalyoncu U, Kasifoglu T, Tufan A. Factors associated with damage in patients with familial Mediterranean fever. Clin Exp Rheumatol. 2020 Sep-Oct;38 Suppl 127(5):42-48.

Table 1.

Comparison of clinical and laboratory parameters between groups according to damage

No damageNew damageAny damageP valueAge (years)48,456,467,50,002Sex (K/E)34/332/525/19NSFollow-up time (years)4043560,33Dominant attack typePeritonitis(63,7%)NAArthritis(34,1%)NSPersistent inflammation33,642,344,30,05AIDAI score394048NSMutationsM694V/M694V26214NSM694V/any44438M694V/M680I314M680I/any119

•SAIDAI: Auto-Inflammatory Diseases Activity Index

Acknowledgements

All participants were confirmed for both participation and publication. Local Ethical Committee approved the study

Disclosure of Interests

None declared

Is there a threshold for red cell distribution width to predict malignancy in breast masses?

Background

Red cell distribution width (RDW) has been shown to have predictive properties in different diseases as well as solid cancers.

Aim

We aimed to investigate the discriminative properties of RDW in benign and malignant breast lesions.

Subjects and Methods

In a retrospective cohort study the files of patients who underwent surgery for fibroadenomas (Group A) and breast cancer with axillary lymph node metastasis (Group B) were reviewed. The pathology reports and laboratory parameters and demographics of the patients were recorded for comparison. The patients were later excluded if they had an hemoglobin level below 12 mg/dl and the outliers were removed for a comparison. Seventy-six patients in the fibroadenoma group and 62 patients in the breast malignancy group were compared for the RDW levels to predict the presence of malignancy. Receiver operating characteristic curves were plotted for RDW and a threshold for prediction of malignancy was calculated.

Results

The difference in RDW levels between group A and group B was found to be significant, 13,10% (IQR 12.60 -13.70) versus 13,80% (IQR 13.10-14.40) respectively, P = 0,00. The area under the curve was 0.71 (95% confidence interval 0.62 to 0.79), P = 0,00. For the threshold of 13,75 the positive predictive value was 67.35 (95% CI 55.72 to 77.17) and negative predictive value was 67.42 (95% CI 60.76% to 73.44).

Conclusion

The RDW levels, after adjusted for anemia, were found to have a positive prediction for malignancy in more than two thirds of the patients for the level of 13.75%.

Role of autophagy and evaluation the effects of microRNAs 214, 132, 34c and prorenin receptor in a rat model of focal segmental glomerulosclerosis

AIMS

Focal segmental glomerulosclerosis (FSGS) is the common cause of chronic renal disease worldwide. Although there are many etiologic factors which have common theme of podocyte injury conclusive etiology is not clearly understood. In this study, we aimed to explore the role of autophagy in the pathogenesis of podocyte injury, which is the key point in disease progression, and the roles of intrarenal microRNAs and the prorenin receptor (PRR) in the 5/6 nephrectomy and adriamycin nephropathy models of FSGS.

MAIN METHODS

For experimental FSGS model, 5/6 nephrectomy and adriamycin nephropathy models were created and characterized in adult Sprague Dawley rats. Microarray analysis was performed on FSGS and control groups that was confirmed by q-RT-PCR. Beclin1, LC3B, PRR, ATG7 and ATG5 expression were evaluated by western blotting and immunohistochemistry. Also, Beclin1 and PRR expression were measured by ELISA. Glomerular podocyte isolation was performed and autophagic activity was evaluated in podocytes before and after transfection with miRNA mimic and antagonists.

KEY FINDINGS

Glomerular expression of Beclin1, LC3B, PRR, ATG7 and ATG5 were significantly lower in the 5/6 nephrectomy than adriamycin nephropathy group and in both groups lower when compared to control groups. Western blot results were consistent with immunohistochemical data. Electron microscopy revealed signs of impaired autophagy in FSGS. Autophagic activity decreased significantly after miR-214, miR-132 and miR-34c mimics and increased after transfection with antagonists.

SIGNIFICANCE

These results showed that the role of autophagic activity and decreased expression of PRR in FSGS pathogenesis and miR-34c, miR-132 and miR-214 could be a potential treatment strategy by regulating autophagy.

Preoperative appendix diameter obtained by computerized tomography scanning predicts conversion from laparoscopic to open appendectomy

Background

Open appendectomy (OA) has been the gold standard for a long time. Laparoscopic appendectomy (LA) has gained wide acceptance and popularity, outdoing open approach. Yet, conversion may be required when laparoscopic approach fails.

Aims

To predict conversion from laparoscopic appendectomy to open appendectomy sing Oreo-ratio radiological appendices diameter.

Materials and Methods

This is a retrospective cohort study conducted on 320 (included) patients who underwent appendectomy between January 2018 and August 2018 in the General Surgery departmentof Haseki Training and Research Hospital, Istanbul, Turkey. Appendiceal diameter obtained during preoperative radiological screening was evaluated about its relationship to conversion from LA to OA. Age, sex, inflammatory serum parameters and pathology reports were also investigated.

Results

A total of 269 (84%) cases were started LA and 17 (6,3%) laparoscopic cases were converted to open. The appendix diameter, the grade of inflammation (perforated or gangrenous), age, and c-reactive protein (CRP) were found to have significant importance in conversion, P = 0.003, P = 0.000, P = 0.042, and P = 0.018, respectively. When a cutoff of 50 years was chosen for age, the odds ratio (OR) was 3. For the appendiceal diameter of 14 mm, the OR was 3.0286.

Conclusion

Preoperative evaluation of appendix diameter is a quick and useful method for a surgeon to distinguish cases with risk of conversion in the emergency department. The other risk factors associated with conversion of LA to OA are grade of inflammation, age and CRP levels.

Cervical vertebral maturation assessment on lateral cephalometric radiographs using artificial intelligence: comparison of machine learning classifier models

OBJECTIVES

This study aimed to develop five different supervised machine learning (ML) classifier models using artificial intelligence (AI) techniques and to compare their performance for cervical vertebral maturation (CVM) analysis. A clinical decision support system (CDSS) was developed for more objective results.

METHODS

A total of 647 digital lateral cephalometric radiographs with visible C2, C3, C4 and C5 vertebrae were chosen. Newly developed software was used for manually labelling the samples, with the integrated CDSS developed by evaluation of 100 radiographs. On each radiograph, 26 points were marked, and the CDSS generated a suggestion according to the points and CVM analysis performed by the human observer. For each sample, 54 features were saved in text format and classified using logistic regression (LR), support vector machine, random forest, artificial neural network (ANN) and decision tree (DT) models. The weighted κ coefficient was used to evaluate the concordance of classification and expert visual evaluation results.

RESULTS

Among the CVM stage classifier models, the best result was achieved using the ANN model (κ = 0.926). Among cervical vertebrae morphology classifier models, the best result was achieved using the LR model (κ = 0.968) for the presence of concavity, and the DT model (κ = 0.949) for vertebral body shapes.

CONCLUSIONS

This study has proposed ML models for CVM assessment on lateral cephalometric radiographs, which can be used for the prediction of cervical vertebrae morphology. Further studies should be done especially of forensic applications of AI models through CVM evaluations.