Success of Simpler Modified Fried Frailty Scale to Predict Mortality among Nursing Home Residents

OBJECTIVE

Fried frailty scale is the very first and most commonly used assessment scale for an operational definition of frailty with its demonstrated success as a predictor of mobility limitations and mortality. However, it is impractical for use in routine clinical practice. We aimed to study whether a simpler modified Fried frailty scale could predict mortality among nursing home residents.

DESIGN

Retrospective longitudinal follow-up study.

SETTING

Nursing home. Baseline evaluation was performed in 2009. Mortality was assessed after 4 year.

PARTICIPANTS

Two hundred-twenty-four participants were included.

MEASUREMENTS

Residents were assessed for demographic characteristics, falls, dementia, the number of regular medications and chronic diseases, body composition by bioimpedance analysis, basic and instrumental activities of daily living besides frailty status by a modified Fried frailty scale. The residents were assessed for mortality after a median follow-up time of 46 months. The association of frailty with mortality was analyzed by the Kaplan-Meier Log-rank test and multivariate Cox Regression analysis.

RESULTS

Mortality occurred in 90 (40.2%) of the residents. In multivariate analysis, frailty was an independent predictor of death (Hazzard ratio= 1.4, 95% confidence interval= 1.03-2.6, p=0.03) when adjusted by age, sex, presence of malnutrition, low muscle mass, number of chronic diseases and regular medications.

CONCLUSION

Our results suggest that the simpler modified Fried frailty scale can be used as a screening tool for frailty in everyday practice as a tool to identify risky patients for mortality. Future reports studying its role in predicting other adverse outcomes associated with frailty are needed.

THU0608-HPR VALIDITY OF SIX MINUTE STEPPER TEST IN EVALUATION OF FUNCTIONAL EXERCISE CAPACITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

In most patients with ankylosing spondylitis (AS), exercise capacity decreases due to pulmonary dysfunction, chest wall restriction and peripheral muscle weakness. The six-minute walk test (6MWT) is a validated simple field, hence frequently used to evaluate exercise capacity. However, 6MWT has some limitations, especially the fact that it requires a corridor of at least 30 meters long to perform this test which can limit its use in some centers. Shorter corridors force patients to turn more frequently, slowing down the pace of walking that reduces potential walking distance. To overcome technical and spatial limitations, 6-minute stepper test (6MST) has been proposed to evaluate exercise capacity. In the literature 6MST has been suggested for a variety of diseases. Since, it requires only a limited amount of space and equipment and is feasible, easy to perform, well tolerated.

Objectives:

In the literature, there is no study in which 6MST is used to evaluate exercise capacities of patients with AS. Therefore, the aim of this study was to evaluate validity of 6MST in AS population in comparison to 6MWT.

Methods:

6MWT and 6MST were performed in 51 patients with AS (52.26±13.33 years, 30F/21M). Demographic and clinical characteristics were recorded. Functional exercise capacity was evaluated using 6MWT and 6MST. The total distance of 6MWT was compared to the total number of steps of 6MST. Before, during and after 6MWT and 6MST, heart rate (HR), oxygen saturation (SpO2), breathing frequency (BF), blood pressure (BP), dyspnea and fatigue were assessed using modified Borg scale.

Results:

The number of steps on the 6MST was significantly correlated with the distance of the 6MWT (r=0.61, p<0.0001). Dyspnea (p=0.04) and leg fatigue (p<0.0001) was significantly higher in 6MST than in 6MWT. HR, SpO2, BF, BP and fatigue were similar in both 6MST and 6MWT.

Conclusion:

The 6MST is a valid test to evaluate exercise capacity in patients with AS. It is also an appropriate alternative to the 6MWT for determining exercise capacity when the 6MWT is not feasible due to technical restrictions. The 6MST can be proposed as a new exercise capacity evaluation tool in AS, as it is valid, reliable, portable and inexpensive.

References:

[1]van der Esch, Martin, et al. Respiratory muscle performance as a possible determinant of exercise capacity in patients with ankylosing spondylitis. Australian Journal of Physiotherapy, 2004;50(1):41-46.

[2]ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117.

[3]Grosbois JM, Riquier C, Chehere B, et al. Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients. Int J Chron Obstruct Pulmon Dis. 2016;11:657–663.

Disclosure of Interests:

None declared

THU0378 DO COMORBIDITIES DECREASE THE FIRST TNF-INHIBITOR RETENTION AND TREATMENT RESPONSE IN AXIAL SPONDYLOARTHRITIS PATIENTS? DATA FROM TURKBIO

Background:

The frequency of comorbidities has increased in spondyloarthritis patients compared to the general population. The effect of comorbidities on tumour necrosis factor alpha inhibitor (TNFi) drug retention and treatment response has not been well evaluated.

Objectives:

The purpose of this study to assess the impact of comorbidities on the first TNFi drug survival and treatment response in patients with axial spondyloarthritis (axSpA) registered in theTURKBIOdatabase.

Methods:

In this study, the frequency of comorbidities, disease activity scores at baseline and month 6 and drug retention were recorded in AxSpA patients iniating first TNFi treatment between 2011 and 2019. Kaplan Meier plot and log rank tests were used for drug survival analysis. Cox regression analysis with HR was performed to evaluate the correlation between comorbidities and drug survival.

Results:

There were 2428 patients with AxSpA (39.3% female) who used their first TNFi during the study period. Among them, a total of 770 (31%) had at least one comorbid disease. Hypertension was the most common comorbidity (9.7%), followed by the affective disorders (8%) and chronic lung disease (5.8%). The baseline characteristics of patients are shown in Table 1.The presence of any comorbidity did not impact the first TNFi retention (Figure 1). When comorbidities were analysed seperately, we found that only history of cerebrovascular event was negatively associated with drug retention rate (HR: 6.9, p:0.008). There was no statistically significant difference in Bath AS Disease Activity Index 50% (BASDAI50) response between patients with and without comorbidity at 6 months. Less axSpA patients with comorbidity achieved a ASDAS score ≤ 2.1 compared to patients without comorbidity at 6 months.

Table 1.

Baseline Characteristics of Patients

Radiographic Spondyloarthritis, n (%)2318 (95.5)Female, n(%)954 (39.3)Age, year42.2±11.8Age at diagnosis, years32.5± 11.3Age at initial TNFi, years39.4 ± 11.1Symptom duration, years9.7± 7.5Time to initial TNFi, years7±6.8HLA-B27- positivity, n (%)1144 (47.1)Smokers, n (%)1068 (44)Baseline BASDAI35.5±22.2Baseline ASDAS-CRP2.8±1.1Baseline CRP (mg/L)15.7±24.4VAS global patient46.6±28.7

-Quantitative variables are presented as mean ± SD, and qualitative variables are presented as frequency and percentage

-ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score using C-reactive protein VAS, visual analogue scale

Conclusion:

The results of this study demonstrated that the presence of previous cerebrovascular event decreased the first TNFi survival in patients with axSpA. It also suggested that comorbidities might decrease TNFi treatment response.

Disclosure of Interests:

None declared

THU0390 THE INFLUENCE OF OBESITY ON RETENTION AND TREATMENT RESPONSE OF SECUKINUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: REAL LIFE DATA FROM THE TURKBIO REGISTRY

Background:

Axial spondyloarthritis (axSpA) is a chronic, inflammatory disease that primarily affects the axial skeleton. Secukinumab is a human monoclonal antibody that binds to the protein interleukin (IL)-17A. Although some studies showed that obesity had a negative effect on the efficacy of tumor necrosis factor alpha inhibitor (TNFα -i) treatment in AS patients (1), no data is available for secukinumab.

Objectives:

To evaluate the effect of obesity on the treatment response and drug survival of secukinumab in patients with axSpA.

Methods:

We performed an observational cohort study based on the TURKBIO between 2018-2020. A total of 185 patients were included in the study. The patients were divided into three groups as obese (BMI≥30 kg/m2), overweight (BMI:25-30 kg/m2), and normal (BMI<25 kg/m2). Disease activity was evaluated at baseline and 3, 6 and 12 months of secukinumab therapy. Clinical response was evaluated as achievement of BASDAI50, ASAS20/40, and ASDAS-Clinical and improvement (CII and MI) rates.

Results:

185 axSpA patients were identified in the registry; 135 (72%) had available BMI data. Thirty nine (28.8%) patients were obese. The mean age of obese patients was higher (p=0.002). The frequency of HLA-B27 and male gender was lower in obese group (p=0.012 and p=0.013, respectively). There was no significant difference between groups in terms of clinical response parameters at 3, 6 and 12 months (Table 1). Drug retention rates were higher in biologic naive patients(p=0.007) (Figure 1).

Table 1(BMI <25) (n=33)(BMI 25-30)(n=63)(BMI ≥ 30)(n=39)PAll patients (n=185)Age (years)40.2±11.345.7±11.750.0±10.60.002 *45.2±11Male Gender n (%)25 (75.8)34 (54.0)16 (41.1)0.012 **104 (56.2)HLA-B27 (+) n (%)14 (73.6)37 (84.0)11 (44.0)0.013 **76 (64.3)Prior Naive/1/≥2 bDMARD n (%)12 (36.3)/9 (27.3)/12 (36.3)17 (26.9)/13 (20.6)/33 (52.4)10 (25.6)/14 (35.8)/27 (69.2)0.30256 (30.3)/ 49 (26,5)/ 80 (43,2)ASAS20 response¶13 (61.9)/11 (57.9)/4 (57.1)19 (48.7)/16 (59.3)/8 (42.1)11 (40.7)/7 (29.1)/3 (50.0)0.345/0.073/0.88659 (518)/47 (49.5)/20 (42.6)ASAS40 response¶9 (42.9)/7 (36.8)/3 (42.9)15 (39.5)/10 (37)/1 (5.3)6 (24)/5 (20,8)/3 (50.0)0.334/0.386/0.01240 (35.0)/29 (30.5)/11 (23.4)BASDAI50 response ¶10 (47.6)/9 (47.4)/4 (57.1)15 (39.5)/11 (40.5)/3 (15.8)9 (34.6)/5 (21.7)/3 (50.0)0.634/0.192/0.07748 (42.1)/37 (38.9)/16 (34.0)ASDAS-CII ¶3 (14.3)/5 (26.3)/1 (14.3)6 (17.6)/8 (30.8)/5 (27.8)6 (23.1)/5 (21.7)/2 (33.3)0.237/0.162/0.53123 (21.4)/22 (23.6)/11 (23.9)ASDAS-MI ¶5 (23.8)/3 (15.8)/0 (0)8 (23.5)/6 (23.1)/2 (11.11 (3.8)/1 (4.3)/1 (16.7)0.237/0.162/0.53118 (16.8)/18 (19.3)/8 (17.4)

§; Mean±SD. ¶; at 3/6/12 Months, n (%),*One-way ANOVA test, ** Pearson Chi-Sqaure Test

Figure 1

Conclusion:

This study demonstrated that obesity had no impact on the efficacy and retention of secukinumab treatment in patients diagnosed with axSpA. The drug survival was found to be higher among biologic-naive axSpA patients compared to biologic-experienced.

References:

[1]Ottaviani S.et al. ‘’Body mass index influences the response to infliximab in ankylosing spondylitis’’,Arthritis Res Ther 2012; 14: R11

Disclosure of Interests:

None declared

AB1065 VISIT COMPLIANCE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: RESULTS FROM A GAZI UNIVERSITY FMF COHORT

Background:

Follow-up in all rheumatologic patients is critical, particularly Familial Mediterranean Fever (FMF). Current recommendations for all experts by the EULAR state that patients with FMF should be evaluated 6-monthly intervals to monitore the character and frequency of the attacks and the acute phase response. Disease-related complications such as amyloidosis can beasymptomaticand need only a careful follow-up.

Objectives:

to quantify this phenomenon and to find predictive factors of visit compliance in patients with FMF.

Methods:

The study included 474 adult patients with a diagnosis of FMF who followed at the outpatient rheumatology clinic of tertiary university hospital, from January 2018 to December 2018. . Demographic, socioeconomic data, familiy history, comorbid disease, medication history, characteristics, the International Severity Score for FMF (ISSF),autoinflammatory disease damage index (ADDI) were recorded. Visit compliance was defined as the presence of two visits in the outpatient rheumatology clinic for FMF last one year for the purposes set out in EULAR suggestion.Those who had fewer than two visits in the last one year were considered noncompliant.

Results:

230 (48.5%) were compliant while 244 (51.5 %) patients were noncompliant with their rheumatology visit. Both compliant and noncompliant patients had similar median age and disease duration. Female sex and being married was increased the visit compliance.The results of the logistic regression model exploring factors associated with compliance indicated that presence of family history in parents, absence of family history in sibling, treatment with biologic agents, other drug using,presence of more than 2 attacks except fever and adequate medical care were important predictors of visit compliance.

Conclusion:

In conclusion, if FMF patients visit compliance increase, their functionality, medication adherence and quality of life will increase and flares and complication of disease can decrease. Thus, we highlight some recommendations for FMF specialist, patients and health care providers to improve outcomes.

Table 2.

Multivariate logistic regression analysis for predictive factors of visit compliance of the patients with FMF, n=430

Adj. OR%95 CI**pFamily history in parents(positive history vs negative)1,81,0-3,10.03Family history in sibling(negative history vs positive)1,91,2-3,10.004Comorbid disease status1,30,7-2,50.32Treatment(anakinra&canakinumab vs colchicine)3,71,7-8,20.001Drug using(other drugs vs FMF drugs)2,21,1-4,40.01More than 2 attacks except fever2,31,2-4,00.004Chronic peripheral arthritis2,30,8-6,60.10Proteinuria2,20,7-6,70.14Adequate medical care1,91,2-3,10.003Number of index flare within last 12-month0,90,9-1,00.38ISSF severity score0,80,7-1,10,30

Disclosure of Interests:

None declared

AB0548 ASSESMENT OF THE PHYSICAL ACTIVITY IN SYSTEMIC SCLEROSIS PATIENTS BY USING COMMERCIAL SMART BANDS AND ITS ASSOCIATION WITH DISEASE CHARACTERISTICS: A PILOT STUDY

Background:

Systemic sclerosis (SSc) is a complex disease, characterized by multi-system organ involvement including interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). The decrease in physical activity in SSc patients with lung involvement has been demonstrated by self-reported physical capacity and 6 min-walking test (6MWT) (1, 2). Commercial smart bands can provide data on daily physical activity, sleep characteristics, blood oxygen concentration and heart rate measurement, therefore may aid in monitoring disease activity.

Objectives:

The aim of this study is to evaluate physical activity in SSc patients by using a commercial smart band and investigate its association with clinical characteristics and patient-reported outcome measures of disease activity

Methods:

This prospective observational study included SSc patients with having a smartphone. Patients characteristics including age, sex, and organ involvements were recorded. Each participant was subjected to pulmonary function tests and 6MWT. All of patients answered Scleroderma Health Assessment Questionnaire (SHAQ, consisting of HAQ-Disability Index (DI) and visual analog scales (VAS) domains). All patients received Fitbit inspire HR smart band® which records the number of steps, heart rate, distance and was instructed to wear it continuously for one week. Tracked data was collected from smartphones via Fitbit application.

Results:

Fifteen SSc patients (14 females and 1 male) participated in the study, 8 (53.3%) had limited SSc and 7 (46.7) had diffuse SSc. The mean age was 48.5±15.5 and the median disease duration was 4 (min-max:1-9) years. Eleven (73.3%) patients had ILD and one patient had PAH. Musculoskeletal complaints were evident in two patients. Forced vital capacity (FVC, % predicted), diffusion capacity of lung for carbon monoxide (DLCO, %) in patients with ILD were significantly lower than patients without ILD median (IQR) 102 (30) vs 80 (27) p= 0.026, 57 (20) vs 95 (13), p= 0.002, respectively. The median distance of 6MWTs were 450 (225) vs 568 (102) in ILD and non-ILD groups. The median total weekly step counts of ILD patients were remarkably lower in ILD patients compared to non-ILD 36.137 (17.879) vs 58.114 (80.681) steps/week, (p= 0.01). Patients with ILD had a bit higher median heart rate compared to non-ILD, 73 (9) vs 67.5 (12). The total weekly step counts were correlated with pulmonary function tests, including forced expiratory volume in one second (FEV1%) (r= 0.57, p= 0.025), FVC (%) (r= 0.65, p= 0.009), and DLCO (%) (r= 0.70, p= 0.005), patient-reported disease severity (r=-0.66, p= 0.007), and breathing problem (r= -0.55, p= 0.03) domains of SHAQ. There was no correlation between weekly step counts and 6MWT

Conclusion:

The assessment of physical activity with smart activity bands may help to identify SSc patients with ILD. Tracked physical activity using smart bands correlates with pulmonary function tests and performs better than 6MWT, suggesting it as a useful tool for the assessment of disease activity.

References:

[1]Battaglia S, Bellia M, Serafino-Agrusa L, Giardina A, Messina M, Cannizzaro F, et al. Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement.Clin Respir J(2017) 11(1):36-42.

[2]Mainguy V, Provencher S, Maltais F, Malenfant S, Saey D. Assessment of daily life physical activities in pulmonary arterial hypertension.PLoS One(2011) 6(11):e27993.

Disclosure of Interests:

None declared

THU0633-HPR CORE MUSCLE ENDURANCE IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

It is stated that the muscles responsible for spinal stability around the trunk show long-term activity at low intensity in daily life, therefore, endurance insufficiency can cause loss of functionality and spinal stabilization and may induce pain (1).

Objectives:

The primary purpose of this study was to compare the core muscle endurance of individuals with AS with the core muscle endurance of healthy individuals. The secondary aim of the study was to examine the association between core muscle endurance and balance, disease activity, spinal mobility, functional status, physical activity level and fatigue in individuals with AS.

Methods:

The research is a cross-sectional study. 41 patients with AS and 40 healthy controls were included in the study. The core muscle endurance of both groups was assessed with trunk extension test, trunk flexion test, right and left side plank tests (2). In addition, in the AS group relationship between core endurance and balance, thoracic kyphosis angle, disease activity, functionality, spinal mobility, physical activity and fatigue was examined. Balance was evaluated with BIODEX Balance Systems and thoracic kyphosis angle was evaluated with a digital inclinometer. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), International Physical Activity Questionnaire (IPAQ), Fatigue Severity Scale (FSS) were used to assess disease activity, functionality, spinal mobility, physical activity and fatigue respectively.

Results:

Significant differences were found between AS group and control group in core endurance were summarized in Table 1. Additionally, significant relationships were observed between core endurance and all the assessed parameters except thoracic kyphosis angle (p<0.05), (Table 2).

Table 1.

Comparision of Core Endurance between AS and Control Groups

AS Group (n=41)Median (IQR)Control Group (n=40)Median (IQR)PTrunk Extensor Test (sec)44.0 (12.0–77.5)98.25 (63.75-120.0)<0.001Trunk Flexor Test (sec)41.0 (15.0–66.0)93.0 (55.85-120.0)<0.001Dominant Side Plank Test (sec)29.0 (9.8–62.0)43.27 (28.57–68.25)0.046Non-Dominat Side Plank Test (sec)32.0 (10.0–61.32)41.25 (25.0- 62.37)0.092

p>0.05, Mann-Whitney U Test; AS: Ankylosing Spondylitis, IQR: Interquartile Range sec: seconds

Table.2

Association between core endurance and other parameters

Trunk Extensor TestTrunk Flexor TestDominant Side Plank TestNon-Dominant Side Plank TestPain (VAS)-0.535*-0.339*-0.369*-0.203Stiffness (VAS)-0.496*-0.234-0.377*0.224Overall Stability Index-0.480*-0.488*-0.725*-0.702*BASFI-0.505*-0.441*-0.562*-0.574*BASMI-0.587*-0.390*-0.613*-0.501*BASDAI-0.468*-0.202-0.433*-0.345*Kyphosis Angle(o)-0.262-0.287-0.215-0.258IPAQ-0.354*-0.355*-0.523*-0.451*FSS-0.545*-0.445*-0.542*-0.502*

*: Spearman’s Correlation Coefficient (rho), p<0.05; VAS: Visual Analog Scale, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BASFI: Bath Ankylosing Spondylitis Functional Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, IPAQ:International Physical Activity Questionnaire, FSS: Fatigue Severity Scale

Conclusion:

Core muscle endurance is lower in patients with AS and it is in relation with many factors regarding the disease. The use of these tests may provide additional information about the patients’ situation for clinicians.

References:

[1]Özyürek, S., D. Bayraktar, and A. Genç,Are the alterations in body posture related to decreased trunk muscleendurance in healthy young adults? Journal of back and musculoskeletal rehabilitation, 2018. 31(3): p. 431-436.

[2]McGill, S.M., Low back stability: from formal description to issues for performance and rehabilitation. Exercise and sport sciences reviews, 2001. 29(1): p. 26-31.

Disclosure of Interests:

None declared

AB1013 CYCLOPHOSPHAMIDE VS AZATHIOPRINE FOR THE TREATMENT OF CONNECTIVE TISSUE RELATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is a common morbidity and mortalitiy reason for connective tissue disorders (CTD). Data related to treatment options in the literature is limited

Objectives:

To describe the role of azathiopurine (AZA) in the first line treatment of connective tissue disease related interstitial lung disease CTD-ILD, comparing with cyclophosphamide (CYC)

Methods:

Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated. Among those patients,as an first line regimen treated with either azathiopurine or cyclophospamide were included. Primary end point was FVC percentage change at 6th month.

Results:

Among 328 CTD-ILD, 57 patients had AZA treat and 79 patients had CYC for the first line treatment. Patients treated with AZA tend to have limited disease and older age. CYC treatment had a mean of 2,41% increase in FVC but in AZA -1,44% decrease in FVC predicted (p:0,041) 5 major CTD groups were defined (systemic sclerosis (SSc), rheumatoid arthritis (RA), primer sjögren syndrome (pSS), dermatomyositis/ polimyositis (PM/DM), autoimmune features of intestitial lung disease (IPAF)). AZA had similar efficacy in, PM/DM and IPAF groups but worse outcome in SSc, RA and pSS compared to CYC.

Conclusion:

AZA treatment might be an option patients with limited disease extent and the diagnosis of PM/DM or IPAF. CYC was a better treatment in SSc, RA and pSS patients

References:

[1]Kocheril, S.V., et al.,Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.Arthritis Care & Research: Official Journal of the American College of Rheumatology, 2005.53(4): p. 549-557.

Table 1.

CYC: treatment responses of cyclophosphamide and azathiopurine regimens AZA: azathiopurine CYC: cyclophosphamide, AZA: azathiopurine CTD: connective tissue disease, SSc:Systemic Sclerosis, RA: Rheumatoid Arthritis, pSS: primary sjogren syndrome, DM/PM/ASS: Dermatomyositis / Polimyositis/Antisynthetase Syndrome, IPAF: Idiopahtic interstital fibrosis with autoimmune feautres, FVC: forced vital capacity

AZA(n:43)CYC (n:72)pProgression(overall)39,3%15,3%0,013SSc (n:47)60%11,9%0,029RA(n:16)62,5%25%>0,05pSS(n:16)71,4%11,1%0,035DM/PM/ASS(n:14)11,1%->0,05IPAF(n:20)28,6%23,1%>0,05FVC change (overall) (lt)-,129±0,7410,024±0,2490,189SSc (n:47)-0,086±1810,025±0,3510,286RA(n:16)-0,553±1,521-022±0,2620,341pSS(n:16)-0,328±0,2420,014±0,3130,167DM/PM/ASS(n:14)-0,0089±0,3700,120±0,0370,316IPAF(n:20)0,123±0,3200,120±0,1010,981FVC change (overall) (%)-1,44±10,652,41±7,550,041SSc (n:47)-3,00±3,672,23±8,270,031RA(n:16)-3,50±9,65-1,75±4,650,654pSS(n:16)-6,71±15,973,33±8,350,027DM/PM/ASS(n:14)0,00±11,854,40±2,700,313IPAF(n:20)2,06±9,045,28±6,700,380

Disclosure of Interests:

None declared

FRI0109 TEMPORAL CHANGES IN LUNG NODULES DETECTED IN INDIVIDUALS WITH RHEUMATOID ARTHRITIS WITH BIOLOGIC DMARD TREATMENTS

Background:

Lung nodules in rheumatoid arthritis (RA), patients impose diagnostic and therapeutic challenges due to unpredictable outcome of these nodules. biologic (b) disease-modifying anti-rheumatic drugs (bDMARDs) are important therapeutic agents used in treatment of RA. There is hesitation about use of conventional synthetic DMARDs (csDMARD) and bDMARDs due to increased risk of nodules although their association remains unclear. There are scarce data on lung nodules observed in RA patients and systematic studies are needed.

Objectives:

The aim of this study is to evaluate effects of biologic treatments and conventional synthetic DMARDS on pulmonary nodules observed in rheumatoid arthritis patients.

Methods:

Electronic health records of RA patients who had had thorax computed tomography (CT) confirmed lung nodules in the last 5 years were retrospectively evaluated. Pre-treatment and post-treatment follow up CT images were meticulously examined for the number, size, attenuation, calcification, and cavitary formation. Demographic features, smoking status, disease characteristics and used medications were retrieved from file records. Clinical and laboratory findings, demographic features, treatment and follow-up duration, number of solid and cavitary nodules were compared between groups.

Results:

There were 21 patients in both biologic (11 females, mean age; 59.7±8.4) and csDMARD (12 females, mean age; 71.4±8.3) treated groups. There was no difference in frequency of nodule types and sizes between csDMARD and bDMARDs groups(table) despite csDMARD users were remarkably older. Administered biologic treatments were anti-TNF-alpha in 8, tofacitinib in 7, rituximab in 4, and abatacept in 2 patients. The most common types of nodules were solid and cavitary nodules, observed in 17 and 8 patients, respectively in biologic users. Calcific nodules were present in three patients, and ground glass nodules were observed in a single patient. Nodules were multiple in 12 patients and solitary in 9 patients. Calcific and ground glass nodules were all solitary in our study. Cavitary and solid nodules were concurrent in five patients. Median follow duration was 14(5-55) months. Progression was observed in small number of patients; three patients in receiving aTNFα, and one in rituximab(figure) and one in abatacept users. Interestingly none of patients receiving tofacitinib did not show progression. There was no difference regarding number of patients who progressed with either csDMARD or bDMARDs. None of the nodules showed malignant transformation within the observation period.

Conclusion:

In conclusion, risk of progression in lung nodules with biologic treatments is seem to be low, at least not more than csDMARD in short term and any malignant transformation was not observed in our study.

References:

[1]Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med. 2019 Sep;40(3):545-560. doi:10.1016/j.ccm.2019.05.003. Epub 2019 Jul 6. Review. PubMed PMID: 31376890.

Table.

Changes in nodule characteristics with respect to treatment groups.

csDMARDbDMARDsSOLID NODULESPre-treatmentTotal number of nodules, n7254Post-treatmentCompletely diminished, n514Regressed, n512Stable, n3320Enlarged, n234Cavitary transformation64De novo solid nodules267CAVITARY NODULESPre-treatmentTotal number of nodules1016Post-treatmentCompletely diminished, n01Regressed05Stable48Enlarged, n62Newly formed cavitary nodules69**

*number less than calculated due to cavitation,**de novo 5 nodules, 4 transformation from solid nodules

Figure.

Nodule progression in a patient receiving rituximab (white arrow)

Disclosure of Interests:

None declared

FRI0507 COLCHICINE INTOLERANCE IN FMF PATIENTS AND PRIMARY OBSTACLES FOR OPTIMAL DOSING

Background:

Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in substantial number of patients, due to its side effects.

Objectives:

It was aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and permanent discontinuation.

Methods:

All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adult subjects with minimum follow up time of 6 months and had compliance of treatment were included. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications and treatment features were recorded on a web based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed.

Results:

Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows; diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in 5 (0.5%) and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male gender and obesity were found to be associated with liver toxicity and having normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine intolerant patients and they had reported more frequent attacks compared to those tolerating optimal doses.

Conclusion:

Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing associated with complications.

References:

[1] Sönmez, H.E., E.D. Batu, and S. Özen,Familial Mediterranean fever: current perspectives.Journal of inflammation research, 2016.9: p. 13.

[2] Sari, İ., M. Birlik, and T. Kasifoğlu,Familial Mediterranean fever: an updated review.European journal of rheumatology, 2014.1(1): p. 21.

[3] Ozen, S., et al.,EULAR recommendations for the management of familial Mediterranean fever.Annals of the rheumatic diseases, 2016.75(4): p. 644-651.

Table 1.

Prevalence of all side effects of colchicine and reasons for drug discontinuation

Side effectAll side effectsN=172*Permanent cessationN=18*Diarrhea9911Liver toxicity544Leukopenia101Muscle toxicity52Skin reaction2-Nausea4-Infertility2-

* some patients had more than one clinically significant side effect

Table 2.

Disease course in colchicine tolerant and intolerant patients

Colchicine TolerantN=743Colchicine IntolerantN=172p valueChronic inflammation115 (15.4%)45 (26.1%)<0.001Number of attacks in the last year4.05±6.087.60±9.6<0.001Proteinuria44 (5.9 %)20 (11.6%)0.025Amyloidosis33 (% 4.4)23 (13.3%)<0.001ADDI (median)1 (1)1 (1)<0.001

ADDI: auto-inflammatory disease damage index, FMF: familial Mediterranean fever

Disclosure of Interests:

Hasan Satiş: None declared, Berkan Armagan: None declared, Erdal Bodakci: None declared, Nuh Atas: None declared, Alper Sari: None declared, Dilek Yapar: None declared, Nazife Sule Yasar Bilge: None declared, reyhan bilici salman: None declared, Gözde Kübra Yardimci: None declared, Hakan Babaoglu: None declared, Levent Kiliç: None declared, mehmet akif ozturk: None declared, Berna Goker: None declared, seminur haznedaroglu: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Timuçin Kaşifoğlu: None declared, abdurrahman tufan: None declared

AB0743 DISEASE CHARACTERISTICS OF PSORIATIC ARTHRITIS PATIENTS MAY DIFFER ACCORDING TO AGE AT PSORIASIS ONSET: CROSS-SECTIONAL ANALYSIS OF PSORIATIC ARTHRITIS-INTERNATIONAL DATABASE

Background:

Psoriasis and psoriatic arthritis (PsA) are heterogenous diseases with various disease manifestations and phenotypes. Psoriasis has a bimodal age of onset being early (before the age of 40, type 1) and late. The impact of this classification on the PsA features is not well understood.

Objectives:

To compare the PsA characteristics of patients with early- and late-onset psoriasis in a large, multicenter database

Methods:

PSART-ID (Psoriatic Arthritis-International Database) is a prospective, multicenter web-based registry (www.trials-network.org) of patients with PsA. A detailed data collection was performed including demographics (sex, age, duration of education, smoking status, BMI), skin features (psoriasis onset date, type, initially involved site of skin, nail involvement (ever) and family history) and PsA characteristics (type of articular involvement and presence of axial, dactylitis (ever), enthesitis (ever), family history) and indices for disease activity and function (DAPSA, Leeds enthesitis index, BASDAI, BASFI, patient and physician global assessment, pain, HAQ-DI). We grouped according to the age at psoriasis onset (early onset, psoriasis before the age of 40 (EOPsO); late-onset, psoriasis after the age of 40 (LOPsO)), patient and disease characteristics of the groups were compared (1). Due to the differences among groups, following adjustments weer made: BMI for age, nail involvement for PsO disease duration, axial PsA for PsA disease duration.

Results:

A total of 1634 (62.8% females; EOPsO, 1108 (67.8%); LOPsO, 526 (32.2%)) patients with PsA was recruited. Rate of over-weight patients was higher in LOPsO group (66.8% vs. 86.8%, p<0.001; adjusted for age - aOR 1.55 (1.11-2.20; % 95 CI)). The EOPsO group had the scalp involvement as the initial site of skin disease more often than the LOPsO group (56.7% vs. 43.0%, p<0.001), whereas extremity involvement was more frequent as the initial finding in the LOPsO group (EOPsO vs. LOPsO 63.8% vs. 74.2%, p<0.001). Nail involvement (ever) was more prominent in EOPsO group, however, the significance was disappeared when adjusted for psoriasis duration. Interaction between gender and both axial disease and psoriatic disease family history were found (axial disease in man; EOPsO vs LOPsO; 38.0% vs. 25.4%; p=0.005; adjusted for PsA duration - aOR 0.56 (0.38-0.84; %95 CI) // psoriatic disease family history in females; EOPsO vs LOPsO; 39.5% vs. 30.1%; p=0.003; OR 0.65 (0.50-0.86; %95 CI)). Duration between PsO and PsA was significantly longer in EOPsO group (148 vs. 24 months, p<0.001). In EOPsO group, more patients had PsO preceeding PsA than LOPsO group (81.8% vs. 60.6%, p<0.001), however, synchronous disease -defined as the diagnosis of PsO and PsA within the same year- was more common in LOPsO group (16.6% vs. 30.3%, p<0.001) (Table 1). Psoriatic disease activity parameters, patient and physician reported outcomes and HAQ-DI scores were similar in both groups.

Table 1.

Comparison of psoriatic arthritis patients‘ characteristics according to age at psoriasis onset

Conclusion:

Clinical features of PsA may be affected by the age at the onset of psoriasis. As the genetic background is different in early and late-onset psoriasis, this may suggest a different pathogenetic mechanism based on the psoriasis phenotype, also affecting the PsA features. Further prospective studies are needed to define whether the classification of PsA requires including psoriasis phenotypes as well.

References:

[1]Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450-6.

Disclosure of Interests:

Emre Bilgin: None declared, Özün Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Şule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

AB0761 DEMOGRAPHIC AND CLINICAL FEATURES OF JUVENILE-ONSET PSORIATIC ARTHRITIS: RESULTS FROM PsART-ID REGISTRY

Background:

Although psoriatic arthritis (PsA) may be seen at any decades, juvenil onset PsA is relatively rare. Moreover, there were no more data about clinical features, treatments, and course in juvenile PsA when they reached to adult age.

Objectives:

The objective of this study was to assess and compare demographic and clinical features for juvenile onset PsA and adult onset PsA.

Methods:

PsART-ID is a multicenter, international database, investigating the disease characteristic in real life (1). Briefly, demographic data, PsA subtypes, uveitis, enthesitis, dactylitis, Co-morbidities, disease activity scores (TJC, SJC, VAS-pain, VAS patients and physician global assessments, VAS-fatigue, BASDAI), and functional status (HAQ-DI, BASFI) were recorded. Psoriasis and PsA starting age were noted, as well. Patients were classified as juvenile PsA or juvenile PsO (under 18 years old). Results were compared regarding to juvenile versus adult onset age.

Results:

Overall, 1644 PsA patients were included to study, 301/1644 (18.3%) patients had juvenile onset psoriasis. Of 39/1644 (2.4%) patients had juvenile onset PsA, as well. As expected, juvenile onset PsA patients were younger, however PsA disease duration were longer than adult onset PsA patients. There were no any difference between demographic and clinical data, except BMI and enthesitis were less frequently at the juvenile onset PsA groups. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used more frequently bDMARDs.

Table.

Comparison of demographic and clinical characteristics of juvenile and adult-onset psoriatic arthritis

Juvenile onsetAdult onsetpN (%)39 (2.4)1605 (97.6)Female Sex n (%)24 (61.5)1006 (62.7)0.884PsA beginning age mean (SD)13.3 ± 3.8542.3 ± 12.9<0.001Current age mean (SD)26.6 ±10.747.3 ±13.07<0.001Duration of psoriasis (years)17.10 ± 11.2614.75 ± 11.780.124Duration of psoriatic arthritis (years)13.5 ±115.06 ± 6.7<0.001Cigarette smoking (ever) n (%)15/38641/14940.72Education duration/year (mean,SD)10.09 ± 3.679.52 ± 4.810.464BMI (kg/m2) (mean, SD)24.5 ±5.128.3 ± 5.21<0.001Family history of PsO/PsA n (%)15 (38.5)559 (34.9)0.642Nail involvement n (%)18 (46.2)762 (47.5)0.864Dactilitis n (%)9 (23.7)367 (24)0.958Entesitis n (%)3 (7.9)384 (25.7)0.013Uveitis n (%)-13 (4.3)0.713Axial involvement (%)15 (38.5)464 (29)0.199Methotrexate36 (92.3)1348 (84)0.162Sulfasalazine17 (43.6)612 (38.1)0.488Leflunomide14 (35.9)379 (23.6)0.076Biologic DMARDs102 (33.9)358 (26.8)0.013

Conclusion:

Although psoriasis may be seen frequently in the juvenile age, juvenile onset PsA was not so frequent in our PsA cohort. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used bDMARDs more frequently.

References:

[1]Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.

Disclosure of Interests:

Serpil ERGULU EŞMEN: None declared, Ozun Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Sule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Mehmet Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

SAT0509 MYCOPHENOLATE MOFETIL VERSUS AZATHIOPURINE FOR THE MAINTENANCE TREATMENT OF CONNECTIVE-TISSUE RELATED INTERSTITIAL LUNG DISEASE FOLLOWING CYCLOPHOSPHAMIDE TREATMENT

Background:

Cyclophosphamide (CYC) had a good response rates when used as an induction regimen for the treatment of connective tissue related interstitial lung disease (CTD-ILD). But the safety profile of CYC necessitates the usage of a second line treatment for maintenance

Objectives:

To compare the effect of mycophonetil (MMF) and azatiyopurin (AZA) for maintanance therapy following cyclophsphomide treatment in CTD-ILD

Methods:

Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated and patients treated with cyclophospamide as an induction regimen and having not progression were selected. Among those, as a second line regimen treated with MMF or AZA were included. Primary end point was treatment responses at 6th months

Results:

68 patients treated with CYC for the first line treatment. 46 patients treated with either MMF (n:22) or AZA (n:24) for the maintenance. Scleroderma patients were the largest group and consituted 63% of the population. MMF group had worse FVC values and more involvement in lung paranchyme at the begining of the treatment. In univariate analysis FVC (lt) values and lung involvement (%) on HRCT at the start of the treatment, and disease subtype were associated significantly with treatment responses.After adjusted with these factors, in multivariate analysis, AZA treatment was associated with the increased risk of progression (odds ratio 5,8, 95% CI 1,061-31,09) as compared with MMF treatment

Conclusion:

MMF had better results compared to AZA in the treatment of CTD-ILD,after the usage of CYC treatment.

References:

[1]Barnes, H., et al.,Cyclophosphamide for connective tissue disease-associated interstitial lung disease.Cochrane Database Syst Rev, 2018.1(1): p. Cd010908.

Table 1.

Patient and disease characteristics at the start of the treatment and treatment responses at the 6th months of the treatment: FVC forced vital capacity

MMF (22)AZA (24)pLung involvement (%)36%23,3%0,022FVC (lt)1,962,550,021FVC (%)71%81%<0,001FVC change at 6th month (lt)-,02-0,190,051FVC change at 6th month (%)-0,42-5,810,068Progression23,8%50%0,118

Disclosure of Interests:

None declared

Frequency, characteristics, and clinical determinants of 'prodrome' in familial Mediterranean fever patients

Objective: Prodrome is defined by manifestations that precede a familial Mediterranean fever (FMF) attack and predict its emergence. We aimed to determine the frequency, characteristics, and clinical determinants of prodrome in patients with FMF.Method: This cross-sectional study was conducted in a tertiary rheumatology clinic. During the clinical interview, all patients completed a standardized questionnaire about the pre-attack period. Prodrome was defined as the presence of any recurrent pre-attack manifestation occurring at least 4 h before an attack. Patients were classified according to whether they had prodrome of any kind of attack.Results: The study enrolled 401 patients aged 37.7 ± 11.0 years (mean ± sd). Male gender, M694V/M694V, homozygous MEFV mutation, peritonitis, pleuritis, and arthritis were more frequent in prodrome-positive patients. Altogether, 141 patients (35.2%) had prodrome. Male gender and ever having attack types of peritonitis or arthritis were independent clinical determinants of prodrome [relative risk (95% confidence interval): 1.72 (1.07-2.76), p = 0.02; 4.27 (1.80-10.1), p = 0.001; 1.77 (1.04-3.04), p = 0.04, respectively]. Age, MEFV mutations, pleuritis, and erysipelas-like erythema were not clinical determinants.Conclusions: All FMF patients, particularly males and patients who had peritonitis or arthritis at any time, should be questioned about prodrome. Prodrome should be analysed in terms of elucidating the pathogenesis of FMF and as an opportunity for a secondary prevention strategy for impending attacks. This study may shed light on prodrome for future cytokine or drug studies with the purpose of developing new cost-effective treatment protocols irrespective of colchicine resistance.

Chronic inflammation in adult familial Mediterranean fever patients: underlying causes and association with amyloidosis

Background: Chronic inflammation, as determined by persistently elevated acute-phase reactants in attack-free periods, can occasionally be observed in patients with familial Mediterranean fever (FMF) and is suggested to be a risk factor for the development of amyloidosis. We aimed to investigate the underlying causes of chronic inflammation in FMF patients and its association with amyloidosis in long-term follow-up. Method: Electronic medical records of FMF patients who had regular follow-up for ≥ 5 years in our cohort were utilized. As part of routine evaluation, detailed history, physical examination, and pertinent laboratory and radiographic investigations were performed in all patients to determine potential causes of elevated C-reactive protein (CRP) levels. Results: The study included 146 FMF patients who had no evidence of amyloidosis at baseline and had regular follow-up for ≥ 5 years. Thirty-seven patients (25.3%) were found to have chronic inflammation in the disease course. Twenty-five (67.5%) of them had either very frequent attacks or chronic manifestations of disease. In the entire study group, amyloidosis developed in five patients (3.42%) during the 5 year follow-up, four in the FMF with chronic inflammation group (10.8%), and only one of the 109 patients without chronic inflammation (odds ratio 13.09, 95% confidence interval 1.41-121.2). Conclusions: The results suggest that persistently high CRP levels during the attack-free periods may be a strong risk factor for the development of amyloidosis in patients with FMF. The vast majority of FMF patients with chronic inflammation had active FMF.

Cervical cerclage in advanced prolapsed fetal membranes - Case presentation

The case presentation of a transvaginal cervical cerclage performed at a 7 cm dilation in a patient in the 22nd week of pregnancy, followed by a prolongation of the pregnancy until the gestational age of 38 weeks, was reported in the context of many similar cases managed by the authors of the article during a program of screening and prevention of preterm birth. The particularity of the case was the lack of a preterm birth in the medical history of the patient and the installation of the isthmus-cervix incompetence in the second pregnancy, after an on term pregnancy. What should be evidenced is the importance transvaginal cervical ultrasound evaluation has in the early diagnosis of this pathology during pregnancy, this being the only method of determining the efficacy of the content of the internal cervical os. Transvaginal cervical exploration has to be implemented as a screening method both in the high-risk patients and in the absence of a suggestive medical history.

Myasthenia gravis due to hydroxychloroquine

No abstract available