AB0443 BIOMARKER SUCH AS IL-17, IL-21 AND TIMP-1, IS USEFUL FOR PREDICTING THE PATHOPHYSIOLOGY OF CONNECTIVE TISSUE DISEASE-ASSOCIATED PULMONARY HYPERTENSION

Background:

Connective tissue disease-associated pulmonary hypertension (CTD-PH) is constructed by a variety of pathologies, including cardiac, pulmonary, and vascular involvement, as well as immune abnormalities. Because of its various constructs, it is difficult for many respiratory physicians, cardiologists, and rheumatologists to determine a treatment strategy for CTD-PH. In addition, CTD-PH has different pathologies from iPAH, and there are cases in which immunosuppressive therapy is effective. These suggests that the two PAHs may have different pathogenesis, including inflammation in the pulmonary artery. However, there are not enough biomarkers to distinguish pathologies. On the other hand, it has been reported that various cytokines such as TIMP-1, Interleukin (IL)-6, IL-17, and IL-21 are involved in the pathogenesis of CTD-PH or vasculitis. (1,2) However, the relationship between these cytokine expression and the pathogenesis or treatment of CTD-PH has not been fully clarified.

Objectives:

To clarify the relationship between cytokine profile and clinical features, change in cytokines and hemodynamics by treatment, association with the effectiveness of immunosuppressive therapy.

Methods:

Patients suspected PH was included. At the time of cardiac catheterization(RHC), sera in pulmonary pre and post-capillary were collected and TIMP-1, MCP-1, IL-17 and IL-21, IL-12p70 and IL-6 were analyzed by ELISA(ABCAM UK, Ella simple plex USA). The following clinical data were collected: age, gender, underlying disease, complication of interstitial lung disease, treatment (immunosuppressant and pulmonary vasodilator), hemodynamics. Furthermore, we investigated the relationship between cytokines and clinical data.

Results:

15 cases of CTD-PH, 13 cases of non-CTD-PH, and 6 cases of non-PH were analyzed. (SSc 12 cases, MCTD 7cases, SLE 2 cases, and others 13 cases) 28 cases were diagnosed with PH by RHC. There was a positive correlation between IL-6 and mean pulmonary arterial pressure in all PH case. In addition, MCP-1, IL-6, and TIMP-1 tend to be high in SSc-PH cases. On the other hand, in Non-SSc-PH, IL-12p70 and IL-17 were high. In cases who pulmonary vascular hemodynamics improved by treatment, IL-17, IL-21, and TIMP-1 decreased.

Conclusion:

Biomarker profiles in pulmonary capillaries may differ depending on the disease. Furthermore, it suggested that IL-17, IL-21 and TIMP-1 may be biomarkers of therapeutic effect.

References:

[1]Hashimoto-Kataoka T. et al. Proc Natl Acad Sci U S A. 2015 May 19;112(20):E2677-86.

[2]Jun Ishizaki et al. Arthritis Res Ther. 2017 Sep 29;19(1):218.

Disclosure of Interests:

None declared.

AB0287 EFFECTS OF HYDROXYCHLOROQUINE ON PERIPHERAL BLOOD CYTOKINE EXPRESSION ASSOCIATED WITH ATHEROSCLEROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

In systemic lupus erythematosus(SLE), a higher frequency of atherosclerotic lesions is associated with a poor life prognosis (1). Hydroxychloroquine (HCQ) has been reported to improve the prognosis of life and dyslipidemia in SLE (2), and the mechanism has been unclear.

Objectives:

To determine the effect of HCQ treatment on serum cytokines associated with atherosclerosis in SLE.

Methods:

SLE patients who received additional HCQ and maintained low disease activity between January 2016 and September 2020 were included in this study. Disease activity was assessed by SLEDAI, CLASI and LLDAS, and serum complement titers, anti-ds-DNA antibodies, serum insulin and serum cytokines (adiponectin, resistin and leptin) were analyzed before and after HCQ treatment.

Results:

Fifty-four patients (3 males, 51 females, mean age 41.9±12.8 years) were included (Table 1). Thirty-two patients achieved LLDAS at baseline. Serum adiponectin and insulin levels were significantly increased after 3 months of HCQ treatment compared to baseline, and serum resistin levels were significantly lower (Figure 1). Patients with a history of renal disease had greater degree of changes in serum adiponectin and resistin levels. Among SLE patients who did not achieve LLDAS at baseline, those who still did not achieve LLDAS after 3 months had significantly lower serum leptin levels before HCQ treatment than those who achieved it after 3 months.

The change of serum resistin levels correlated with those of serum S100A8 levels (r=0.5, p=0.0001).

Conclusion:

Additional HCQ treatment in SLE patients improves lipid abnormalities. HCQ may improve prognosis by controlling disease activity in SLE and reducing risk factors for atherosclerosis.

References:

[1]Gregory Katz, et al. Systemic Lupus Erythematosus and Increased Prevalence of Atherosclerotic Cardiovascular Disease in Hospitalized Patients. Mayo Clin Proc. 2019; 94:1436-1443.

[2]Laura Durcan, et al. Longitudinal Evaluation of Lipoprotein Parameters in Systemic Lupus Erythematosus Reveals Adverse Changes with Disease Activity and Prednisone and More Favorable Profiles with Hydroxychloroquine Therapy. J Rheumatol. 2016; 43: 745–750.

Table 1.

Characteristics of SLE patients enrolled in this study

Characteristicsn=54, no.(%)Female, no(%)51(94)Age, years, mean±SD41.9±12.8Disease duration, years, mean±SD15.1±11.1Past involvementRenal involvement23 (43)NPSLE5 (9)ComplicationAPS10 (19)Dyslipidemia2 (4)Diabetes 1 (2)Concomitant immunosuppressive treatmentsPrednisone No.(%)46 (85) Median Dosage, mg/day (range)5.0 (1-10)Disease activitySLENA-SLEDAI score3.9±2.0 Current skin involvement30 (56) anti-dsDNA positive, no(%)21 (39)low complement, no(%)29 (54)

Anti-dsDNA positive means anti ds-DNA titer increases over 12 IU/ml

Low complement means any of C3, C4 and CH50 decreases to less 68mg/dl, less 12mg/dl, 30U/ml.

APS: Anti-phospholipid antibody syndrome, NPSLE: neuropsychiatric SLE,

Disclosure of Interests:

None declared

AB0390 CHARACTERISTICS AND PROGNOSIS OF AGE-DEPENDED ANCA-ASSOCIATED VASCULITIS IN JAPAN

Background:

It is known that most of ANCA-associated vasculitis (AAV) patients are elderly. A cohort study showed that the mean age of onset was 71.1 years, especially in patients with microscopic polyangiitis (MPA)1). However, the characteristics and prognosis of age-depended AAV patients are still unclear.

Objectives:

To clarify the differences in age-related characteristics and prognosis between Japanese patients with AAV.

Methods:

We enrolled 44 patients with AAV who underwent remission induction therapy at our hospital from January 2016 to December 2020. They were divided with under 70 years old group (<70 yo group, n=12) and over 70 years old group (≥70 yo group, n=32). We investigated between two groups as follows; clinical characteristics and laboratory data at diagnosis, rates of complete remission (CR) at 6 months, defined as Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone ≤7.5 mg/day, adverse events, and relapse free survival.

Results:

Mean age were 61.9 ± 9.74 years old in <70 yo group and 77.5 ± 4.61 years old in ≥70 yo group (p<0.01). There were significantly fewer newly diagnosed cases in the <70 yo group, and half of the patients with relapsing disease. There was no difference in the type of ANCA, organ involvement, or BVAS. Remission induction therapy was performed with CY or RTX, and no difference was observed between these two groups. In addition, there was also no difference in maintenance therapy (Table 1). CR rate in <70 yo group and in ≥70 yo group were 55% and 46 % respectively (p=0.73). Severe infections occurred with no patient (0%) in <70 yo group and with 5 patients (16%) in ≥70 yo group (p=0.30). 5 patients of relapse were observed in the <70 yo group and 1 patient in the ≥70 yo group, and relapse free survival was significantly lower in the <70 yo group (p=0.001) (Figure 1).

<70 yo (n=12)≥70 yo (n=32)p valueAge (year)61.9 ± 9.7477.5 ± 4.61< 0.01*Female, n (%)10 (83)28 (87)0.66AAV typeMPA, n (%) / GPA, n (%)6 (50) / 6 (50)26 (81) / 6 (19)0.06Newly diagnosed, n (%)6 (50)27 (84)0.045*ANCA positivity MPO, n (%) / PR3, n (%)11 (92) / 0 (0)30 (94) / 3 (9)1 / 0.55 negative, n (%)1 (8)1 (3)0.48CRP (mg/dl)3.34 ± 4.018.15 ± 6.860.03*eGFR (mL/min)55.8 ± 25.357.7 ± 24.70.93BVAS12.0 ± 8.014.8 ± 6.80.23Remission induction therapyCY, n (%) / RTX, n (%)5 (42) / 7 (58)16 (50) / 16 (50)0.74Maintenance therapy AZA, n (%)7 (58)14 (44)0.50 RTX, n (%)1 (8)6 (19)0.65 others, n (%)2 (17)3 (9)0.60 without IS, n (%)2 (17)9 (28)0.70

The p-value was estimated using Fisher’s exact or Wilcoxson rank sum test. yo, years old; AAV, ANCA-associated vasculitis; MPA, microscopic polyangiitis; GPA, granulomatosis with polyangiitis; CY, cyclophosphamide; RTX, rituximab; AZA, azathioprine; IS, immunosuppressants. *p<0.05

Conclusion:

There was no difference in remission rate between two groups. Severe infections were observed only in the ≥70 yo group. We suggest that younger AAV patients need attention to relapse after the remission because of lower relapse free survival in <70 yo group.

References:

[1]Sada KE, et al. Arthritis Res Ther 2014; 16: R101.

Figure 1.

Relapse free survival Relapse free survival was calculated by Kaplan-Meier method and compared by log-rank test. *p<0.05

Disclosure of Interests:

None declared

AB0826 IMPORTANCE OF PRECONCEPTION CARE AND PLANNING FOR PREGNANCY IN WOMEN OF CHILDBEARING AGE COMPLICATED WITH CONNECTIVE TISSUE DISEASES

Background:

Previous reports showed that connective tissue disease (CTD) have a high risk for adverse pregnancy outcomes (APOs) such as preterm birth, light-for-date, or preeclampsia1). It was revealed that these APOs were associated with high disease activity or treatment agents, particularly in glucocorticoid2). Some patients, who have no or insufficient preconception care and became unplanned pregnant, exacerbate the underlying disease, and lead to disappointing pregnancy outcomes. Therefore, preconception care and planning for pregnancy is very important to control disease activities and manage the appropriate treatment agents, including glucocorticoid, immunosuppressants, biologics, hydroxychloroquine, and anticoagulants3).

Objectives:

We investigate whether the presence or absence of preconception care before pregnancy affects clinical disease course and pregnancy outcomes.

Methods:

We examined 200 CTD women who delivered their newborns in our institution from March 2006 to January 2021. We analyzed the association between preconception care and the clinical course of underlying diseases during pregnancy or pregnancy outcomes.

Results:

Of all 200 cases, 133 (55.9%) cases had preconception care in our institution, while the others had no or insufficient preconception care. We showed the comparison of treatment agents and pregnancy outcomes between the cases with and without preconception care in Table 1. There was no significant difference in the rate of glucocorticoid use and the mean prednisolone dose during pregnancy between these two groups. However, the rate of increased dose of glucocorticoid or pulse therapy was significantly higher in the cases without preconception care. As for pregnancy outcomes, there was no significant difference in the live birth rate. On the other hand, the gestational weeks at delivery were significantly shorter, and the rate of preterm birth was higher in the cases without preconception care. In addition, the rate of the hospitalization of neonatal intensive care unit (NICU) was also significantly higher in the cases without preconception care.

Conclusion:

We revealed that preconception care before pregnancy reduced the need for intensified treatment such as increasing dose of glucocorticoid or pulse therapy. The rate of preterm birth and NICU hospitalization was also shown to decrease. Therefore, it is important for our rheumatologists to provide an appropriate preconception care for CTD women of childbearing age and to make a plan for pregnancy.

References:

[1]Tsuda S, Sameshima A, Sekine M, Kawaguchi H, Fujita D, Makino, et al. Mod Rheumatol 2019:24;1-10.

[2]Clowse ME, Magder LS, Petri M. J Rheumaotol 2011;38:1012-1016.

[3]Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. Arthritis Care Res 2020;72:461-488.

Table 1.

Comparison of treatment agents and pregnancy outcomes between the cases with and without preconception care

Preconception care (+) (n=113)Preconception care (-) (n=89)P valueTreatment agents during pregnancy Glucocorticoid use (n (%))64 (56.6)50 (56.2)1.00  Mean glucocorticoid dose (mg/day)6.3±3.98.4±6.10.09  Dose-up of glucocorticoid (n (%))11 (9.7)26 (29.2)<0.01*  Glucocorticoid pulse therapy (n (%))0 (0)8 (9.0)0.01* Immunosuppressant (n (%))14 (12.5)4 (4.5)0.08 Hydroxychloroquine (n %))7 (6.2)6 (6.7)1.00 Anticoagulant therapy (n (%))21 (18.8)16 (17.8)1.00Pregnancy outcome Spontaneous abortion (n (%))8 (7.1)6 (6.7)1.00 Live birth (n (%))100 (88.5)78 (87.6)1.00  Gestational weeks at delivery (week)38.7±1.437.3±3.50.01*  Birth weight of newborn (gram)2888.8±453.72678.4±732.60.25 Adverse pregnancy outcomes (n (%))26 (26.0)28 (35.0)0.20  Preterm birth (n (%))5 (5.0)19 (23.8)<0.01*  Light-for-date (n (%))10 (10.0)9 (11.3)0.81  Hypertensive disorder (n (%))5 (5.0)8 (10.0)0.25  NICU management (n (%))13 (13.0)24 (30.0)<0.01*

Disclosure of Interests:

None declared

Anti-pruritic effect of nemolizumab in hemodialysis patients with uremic pruritus: a phase II, randomized, double-blind, placebo-controlled clinical study

BACKGROUND

The pathophysiology of uremic pruritus (UP), which is characterized by systemic and intractable itching, remains unclear. As interleukin (IL)-31 may be involved, we conducted a phase II, randomized, controlled study to evaluate nemolizumab (anti-IL-31 receptor A antibody) in Japanese hemodialysis patients with UP.

METHODS

Patients were randomly assigned (1:1:1:1:1) to one of four double-blind groups (receiving a single subcutaneous injection of nemolizumab 0.125, 0.5, or 2.0 mg/kg, or placebo on Day 1) or an open-label reference group (receiving oral nalfurafine hydrochloride 2.5-5 μg once daily for 12 weeks). The primary endpoint was the difference in the absolute change in pruritus visual analog scale (VAS) at Week 4 between placebo and each nemolizumab group.

RESULTS

The primary efficacy endpoint was not met. The mean change from baseline with all three nemolizumab doses at Week 1, and with 0.5 mg/kg at Week 4, was greater than with placebo. Least square mean differences (95% confidence intervals) in the absolute changes between the placebo arm and each nemolizumab arm were - 2.4 (- 19.7, 14.9) for 0.125 mg/kg, - 8.7 (- 26.6, 9.2) for 0.5 mg/kg, and 0.4 (- 17.0, 17.8) for 2.0 mg/kg. Secondary efficacy parameters including the Shiratori severity score and 5-D itch score failed to show between-group differences. Patients with higher serum IL-31 levels at screening tended to have greater pruritus VAS reductions following nemolizumab treatment.

CONCLUSIONS

In this phase II study in patients with UP, the primary efficacy parameter was not met. Nemolizumab was generally well tolerated with no clinically significant safety concerns.

CLINICAL TRIAL REGISTRATION

JAPIC: JapicCTI-152961, https://www.clinicaltrials.jp/cti-user/trial/ShowDirect.jsp?japicId=JapicCTI-152961 .

Effects of the Once-Weekly DPP4 Inhibitor Omarigliptin on Glycemic Control in Patients with Type 2 Diabetes Mellitus on Maintenance Hemodialysis: A 24-Week Open-Label, Multicenter Randomized Controlled Study

INTRODUCTION

Dipeptidyl peptidase 4 (DPP4) inhibitors are widely used in patients with type 2 diabetes mellitus (T2DM) on maintenance hemodialysis (HD), but the efficacy of the once-weekly DPP4 inhibitor omarigliptin is not known.

METHODS

This prospective, randomized, open-label, parallel-group, non-inferiority/superiority, once-daily DPP4 inhibitor linagliptin-controlled, multicenter study examined glycemic control and safety of omarigliptin (UMIN000024284). Sample size was calculated to confirm non-inferiority in terms of changes in glycated hemoglobin (HbA1c). We enrolled 33 patients with T2DM on maintenance HD who had been treated with linagliptin for at least 3 months. The patients were randomized to receive omarigliptin (12.5 mg/week; n = 16) or linagliptin (5 mg/day; n = 17). Primary endpoints were changes in HbA1c and glycoalbumin (GA) over 24 weeks.

RESULTS

Differences in the mean change in primary endpoint values between the omarigliptin and linagliptin groups were - 0.61% [- 1.14, - 0.09] for HbA1c, with a two-tailed upper 95% limit (i.e., one-tailed 97.5% upper limit) of 0.25%, below the non-inferiority limit, and - 1.67% [- 4.23, + 0.88] for GA, with a two-tailed upper 95% limit of 0.75%, above the non-inferiority limit. At 24 weeks, the omarigliptin group showed significantly greater reduction in HbA1c than the linagliptin group (- 0.2% ± 0.6% vs. 0.4% ± 0.8%, two-tailed p = 0.024) and significantly greater reduction in blood glucose after a single HD session (- 18.4 ± 31.4 mg/dL vs. 25.2 ± 59.5 mg/dL, respectively, two-tailed p = 0.019). No subjects in the omarigliptin group developed hypoglycemia.

CONCLUSIONS

Our data showed that omarigliptin was non-inferior to linagliptin in glycemic control. Omarigliptin is feasible for glycemic control in patients with T2DM on maintenance HD.

CLINICAL TRIALS REGISTRATION

UMIN000024284.

Association between Sarcopenia, Its Defining Indices, and Driving Cessation in Older Adults

OBJECTIVES

Driving a car is essential for older adults to support their activities of daily living and maintain their quality of life. However, physical function - which often declines with age - is a key factor to determine whether older adults can continue driving safely. As such, we sought to examine the association between sarcopenia and driving cessation in older adults.

DESIGN

A prospective study.

SETTING

A community setting.

PARTICIPANTS

We conducted a study including 2,874 older adult participants from the community (mean age: 71.0 ± 4.7 years [range: 65-93 years], women: 36.3%).

MEASUREMENTS

We assessed whether they were still driving at baseline examination as well as their degree of sarcopenia. Sarcopenia was assessed according to the clinical definition provided by the EWGSOP2 by measuring muscle mass, muscle strength, and physical performance represented by gait speed. Driving cessation was determined based on driving status at the initial visit and at a follow-up examination approximately 15 months later.

RESULTS

At the baseline assessment, there were 62 participants (2.2%) with confirmed sarcopenia and 23 participants (0.8%) with severe sarcopenia. Participants were classified into either the ongoing driving (n = 2816) or driving cessation (n = 58) group. Low muscle strength and low muscle mass were associated with driving cessation (low muscle strength: odds ratio [OR] 2.09, 95% confidence interval [CI] 1.13-3.87; low muscle mass: OR 2.00, 95% CI 1.04-3.85). Slow gait was not associated with driving cessation (OR 1.35, 95% CI 0.68-2.69). Significantly, sarcopenia was associated with driving cessation (confirmed sarcopenia: OR 4.48, 95% CI 1.63-12.29; severe sarcopenia: OR 4.46, 95% CI 1.21-16.41).

CONCLUSIONS

Sarcopenia is associated with an increased likelihood of driving cessation in community-dwelling older adults. Evaluation of physical function related to sarcopenia would be useful for judgment of the ability to drive safely among older adults.

Physio-Cognitive Decline Syndrome as the Phenotype and Treatment Target of Unhealthy Aging

In this era of unprecedented longevity, healthy aging is an important public health priority. Avoiding or shortening the period of disability or dementia before death is critical to achieving the defining objectives of healthy aging, namely to develop and maintain functional capabilities that enable wellbeing in older age. The first step is to identify people who are at risk and then to implement effective primary interventions. Geriatricians have identified a distinct clinical phenotype of concurrent physical frailty and cognitive impairment, which predicts high risk of incident dementia and disability and is potentially reversible. Differing operational definitions for this phenotype include "cognitive frailty", "motoric cognitive risk syndrome" and the recently proposed "physio-cognitive decline syndrome (PCDS)". PCDS is defined as concurrent mobility impairment no disability (MIND: slow gait or/and weak handgrip) and cognitive impairment no dementia (CIND: ≥1.5 SD below the mean for age-, sex-, and education-matched norms in any cognitive domain but without dementia). By these criteria, PCDS has a prevalence of 10-15% among community-dwelling older persons without dementia or disability, who are at increased risk for incident disability (HR 3.9, 95% CI 3.0-5.1), incident dementia (HR 3.4, 95% CI 2.4-5.0) and all-cause mortality (HR 6.7, 95% CI 1.8-26.1). Moreover, PCDS is associated with characteristic neuroanatomic changes in the cerebellum and hippocampus, and their neurocircuitry, which are distinct from neuroimaging features in normal aging and common dementia syndromes. Basic research and longitudinal clinical studies also implicate a hypothetical muscle-brain axis in the pathoetiology of PCDS. Most important, community-dwelling elders with PCDS who participated in a multidomain intervention had significant improvements in global cognitive function, and especially in the subdomains of naming and concentration. Our proposed operational definition of PCDS successfully identifies an appreciable population of at-risk older people, establishes a distinct phenotype with an apparently unique pathoetiology, and is potentially reversible. We now need further studies to elucidate the pathophysiology of PCDS, to validate neuroimaging features and muscle-secreted microRNA biomarkers, and to evaluate the effectiveness of sustained multidomain interventions.

Prediction for cardiac prognosis in patients with congestive heart failure by machine learning on dual-isotope myocardial semiconductor SPECT

Background

Dual-isotope (low doze 201TlCl and 123I-β-methyl-P-iodophenyl-pentadecanoic acid (BMIPP)) single photon emission computed tomography (SPECT) is utilized to estimate myocardial damage in patients with congestive heart failure (CHF). However, predictive model construction on the SPECT for cardiac death by machine learning was not studied.

Purpose

To elucidate predictive value of machine learning model on dual-isotope SPECT for CHF.

Methods

We enrolled consecutive 310 patients who admitted with CHF (77.1±3.1 years, 164 males). After initial treatment, they underwent electrocardiography gated SPECT and observed in median 507 days [IQR: 165, 1032]. Multivariate Cox regression analysis for cardiac death was performed, and predictive model was constructed by ROC curve analysis and machine learning (Random Forest and Deep Learning). The accuracies (= [True positive + True negative] / Total) of the prediction models were compared with ROC curve model.

Results

Thirty-six patients fell into cardiac death. Cox analysis showed Age, left ventricular ejection fraction (LVEF), summed rest score (SRS) of BMIPP, and mismatch score were significant predictors (Hazard ratio: 1.068, 0.970, 1.032, 1.092, P value: &lt;0.001, 0.014, 0.002, &lt;0.001, respectively). ROC curve analysis of them revealed the accuracy of the cut-off value was 0.479–0.773. Conversely, machine learning model demonstrated higher accuracy for cardiac death (Random Forest: 0.895, Deep Learning: 0.935). The top 4 feature importance of the random forest were LVEF (0.299), SRS BMIPP (0.263), Age (0.262), and mismatch score (0.160).

Conclusion

Machine learning model on SPECT was superior to conventional statistic model for predicting cardiac death in patients with CHF.

Funding Acknowledgement

Type of funding source: None

The comparison of the chronic-phase vascular healing between bioabsorbable and durable polymer drug eluting stent by using optical coherence tomography

Background

Bioabsorbable polymer drug eluting stents (BP-DESs) were designed to reduce a vascular inflammatory reaction compared to durable polymer drug eluting stents (DP-DESs). However, few studies have compared vascular responses to BP-DESs and DP-DESs.

Methods

We enrolled 88 consecutive patients with single culprit coronary artery lesions (31 lesions with acute coronary syndrome) undergoing a single stent-implantation. BP-DESs and DP-DESs were implanted in 50 (57%) and 38 patients (43%), respectively. All lesions underwent optical coherence tomography examination at chronic phase and intrastent OCT findings at the follow-up were evaluated in every 1-mm cross-sections (CSs).

Results

A total of 1887 CSs (BP-DES: 1096, DP-DES: 791) were analyzed. The median period of follow-up OCT was 293 (250–374) days. There were no differences in the patient, lesion, and initial clinical presentation of acute coronary syndrome (ACS). BP-DESs had significantly higher percent neointimal hyperplasia area, defined as neointimal hyperplasia area divided by stent area x 100 (18.4±9.0% vs. 16.1±9.9%, p&lt;0.001), fewer malapposed struts (1.7% vs. 3.9%, p=0.005), fewer uncovered struts (3.6% vs. 5.8%, p=0.02) but higher frequency of superficial low intensity neointima (LIN) (7.7% vs. 3.4%, p&lt;0.001). Multivariate logistic analysis showed that BP-DES (OR: 2.5, 95% CI: 1.49–4.08, p&lt;0.001) and the initial clinical presentation of ACS (OR: 2.31, 95% CI: 1.47–3.62, p&lt;0.001) are independent predictive factors for LIN.

Conclusion

BP-DESs showed homogenous neointimal growth and complete stent coverage quantitatively. Meanwhile, the significant relationships of BP-DES with LIN may suggest that the neointimal quality remains immature in BP-DESs in this period.

Funding Acknowledgement

Type of funding source: None

Optical coherence tomography findings in healed vulnerable plaques in patients with coronary artery disease

Background

Histopathological analysis or intracoronary image assessment of healed plaques (HPs) has been reported both in acute coronary syndrome (ACS) and stable angina pectoris (SAP) patients. However, background characteristics or lesion morphologies of HPs could not be fully clarified and their differences according to the clinical status remain undetermined.

Purpose

We sought to investigate the clinical and morphological characteristics and compare their differences among ACS and SAP patients in order to clarify the clinical significance in HPs lesions.

Methods

We enrolled consecutive 201 patients with 213 native coronary artery lesions (139 lesions with SAP, 42 ST elevation-ACS (STE-ACS) and 32 non-ST elevation ACS (NSTE-ACS) undergoing pre-intervention optical coherence tomography (OCT). HPs was defined as layered phenotype on OCT. Clinical and angiography characteristics and lesion morphologies on OCT were assessed.

Results

HPs were observed in 110 lesions (51.6%) and their prevalence were not different according to the clinical status (SAP:55.1%, STE-ACS:38.1%, NSTE-ACS:56.3%, p=0.14). Lesions with HPs had higher frequencies of angiography-eccentric lesions (62.7% vs. 35.9%, p&lt;0.001) and OCT-macrophages (65.5% vs. 43.1%, p&lt;0.001), and greater OCT-lumen area stenosis (%-AS) (77.1±10.2% vs. 73.6±10.6%, p=0.01) than those without HPs. Of lesions with HPs, OCT-thin-cap fibroatheroma (SAP 14.4%, STE-AC43.8%, NSTE-ACS 16.7%, p=0.03), plaque rupture (5.3%; 37.5%; 11.1%, p&lt;0.001) and thrombus (6.6%, 75.0%, 22.2%, p=0.007) were more frequently observed in STE-ACS than in SAP patients, whereas OCT-microvessels were more frequent in SAP than in ACS patients (19.7%, 0.0%, 0.0%, p=0.02). Other OCT findings such as macrophages, cholesterol crystal, multiple layered phenotype, and %-AS were not significantly different according to the clinical status. Multivariate logistic regression analysis identified the angiography-eccentric lesions (odds ratio (OR): 2.97, 95% confidence intervals (CI): 1.68–5.25, p&lt;0.001) and OCT macrophages (OR 2.41, 95% CI 1.36–4.27, p=0.003) as independent related factors for the existence of HPs.

Conclusions

The present study showed that HPs lesions had eccentric and large plaque burden, and persistent plaque inflammations regardless of clinical status, which might lead to future coronary events.

Funding Acknowledgement

Type of funding source: None

Optical coherence tomography and coronary angioscopy assessment of healed vulnerable plaque components in patients with coronary artery lesions undergoing elective percutaneous coronary intervention

Background

Many vulnerable plaques would progress without clinical events and might result in healed plaques (HPs). Histopathological or intracoronary image assessment of HPs has been reported. However, the morphological characteristics of HPs remain unclear yet.

Purpose

We sought to assess the healed vulnerable plaque components in patients with coronary artery lesions using optical coherence tomography (OCT) and coronary angioscopy (CAS).

Methods

We enrolled 47 patients with 50 native coronary artery lesions with angiographical severe stenosis (&gt;90% diameter-stenosis) and without severe calcification (36 lesions with stable angina pectoris (SAP) and 14 acute coronary syndrome (ACS)) undergoing pre-intervention OCT and CAS. HPs was defined as layered phenotype on OCT. Lesion morphologies and plaque characteristics in lesions with HPs were assessed using OCT and CAS images.

Results

HPs were observed in 27 lesions (54.0%) and their prevalence were similar among each clinical status (SAP 52.8%, ACS 57.1%, p=1.00). Lesions with HPs had higher prevalence of OCT-macrophage (88.0% vs. 52.0%, p=0.01), CAS-red thrombus (88.8% vs. 52.2%, p=0.004) and CAS-low grade-yellow plaque (grade 1) (55.6% vs. 21.7%, p=0.02) than those without. SAP lesions with HPs had higher prevalence of CAS-yellow plaque (35.3% vs. 5.9%, p=0.09) and OCT-thin-cap fibroatheroma (42.1% vs. 5.9%, p=0.04) than SAP without HPs. ACS lesions with HPs had less CAS-red thrombus (0.0% vs. 50.0%, p=0.03) and OCT-plaque rupture (12.5% vs. 66.7%, p=0.04) than ACS without HPs. Multivariate logistic regression analysis revealed that OCT-macrophages (odds ratio (OR): 6.65, 95%-confidence intervals: 1.07–41.5, p=0.043), CAS-red thrombus (OR 8.77, 95% CI 1.33–57.8, p=0.02), and low grade-yellow plaque (OR 13.05, 95% CI 1.97–86.5, p=0.008) were independently related with the existence of HPs lesions. Combination of these 3 factors showed a high predictive value of OCT-HPs lesions (90.9%).

Conclusions

HPs lesions showed the lower lesion vulnerability than common ACS lesions but had more intraplaque inflammatory condition compared with common SAP lesions. Combined CAS and OCT examination might be useful to clarify the plaque components of HPs lesions in vivo, leading to help us understand the clinical significance of HPs.

Funding Acknowledgement

Type of funding source: None

Differences of ST level at J-point on 12-lead electrocardiography can distinguish takotsubo syndrome and acute anterior myocardial infarction

Background

Qualitative difference of ST elevation/depression on 12-leads electrocardiography (ECG) at onset was reported in patients with Takotsubo syndrome (TTS) and acute anterior myocardial infarction (ant AMI). However, quantitative difference of those was not elucidated.

Purpose

To investigate differences of ST level at J point on ECG between TTS and ant AMI by automated calculating system.

Methods

We firstly enrolled consecutive 40 patients of TTS, and among 500 ant AMI patients, one to two random matching was done by their age and gender. Finally, 40+80 patients (74.5±11.2 years, 87 females) were enrolled. ECG at onset of both group was measured by automated system (ECAPs12c: Nihon-Koden).

Results

ST level of TTS at J-point in I/II/V4–6 lead was significantly elevated comparing to that of ant AMI. Conversely, Conversely, significant ST depression in aVR and no ST elevation in V1 of TTS was observed in TTS. Logistic regression analysis revealed that ST elevation in I lead and no ST elevation in V1 lead showed high odds ratio and low P value.

Conclusion

Automated measured ST level at J-point was a powerful tool to distinguish TTS and ant AMI at onset.

Funding Acknowledgement

Type of funding source: None

Diagnostic performance of 18-leads electrocardiography to distinguish takotsubo syndrome and acute anterior myocardial infarction

Background

Electrocardiographic (ECG) features on acute phase of Takotsubo syndrome (TTS) is recognized to mimic that of acute anterior myocardial infarction (ant AMI). However, the difference of synthesized 18-leads ECG of both diseases was not elucidated.

Purpose

To elucidate diagnostic performance of 18-leads ECG to distinguish TTS and acute anterior AMI.

Methods

We firstly enrolled consecutive 40 patients of TTS, and among 500 ant AMI patients, one to two matching was done by their age and gender. Finally, 40+80 patients (74.5±11.2 years, 87 females) were enrolled, and ECG at onset of both group was estimated. Because of multicollinearity, all significant differences were compared by machine learning (Random Forest method).

Results

Prevalence of Q wave had no difference. Conversely, ST depression in TTS and ST elevation in ant AMI were significant differences in V7–9 leads. T-wave polarity of V3R-V9 leads were significantly different (flat T-wave in TTS and positive in ant AMI). Machine learning revealed T wave polarity in V7 lead had the highest feature importance.

Conclusion

18-leads ECG at onset had powerful diagnostic performance to distinguish the two diseases.

Funding Acknowledgement

Type of funding source: None

AB0787 EFFECTIVENESS OF IL-17 INHIBITORS REVEALED BY MINIMAL DISEASE ACTIVITY (MDA) ACHIEVEMENT OF PSORIATIC ARTHRITIS PATIENTS

Background:

Recently, several type of biologics such as TNF inhibitors, IL-17 inhibitors, IL-12/23 (p40) inhibitors and IL-23 (p19) inhibitors are approved for PsA. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2015 Treatment Recommendation suggests the treat-to-target strategy for PsA1), however, this recommendation does not indicate how to determine which biologics to use. Recent reports revealed that IL-17 inhibitors were as effective as TNF inhibitors2). On the other hand, based on the Tight Control of Psoriatic Arthritis (TICOPA) study, present treatment strategies for PsA aim to reach on minimal disease activity (MDA)3).

Objectives:

We investigate the effectiveness of IL-17 inhibitors focusing on MDA achievement which were administered for the Psoriatic Arthritis (PsA) patients in our institution.

Methods:

We examined 46 patients whom were diagnosed and treated in our institution. We analyzed DAS28-CRP as the evaluation of arthritis and Minimal Disease Activity (MDA) achievement as that of overall disease activity.

Results:

Biologics were administered in 30 cases (65.2%) of all 46 cases. In 30 cases, 19 cases (63.3%) initiated TNF inhibitors (TNFi) and 7 cases (23.3%) were IL-17 inhibitors (naïve group). In 9 cases, TNFi were switched into Il-17 inhibitors (switch group), 7 cases continued TNFi (TNFi group). Patients characteristics in the cases which could collect the data were shown in Table 1. As for arthritis, DAS28-CRP has significantly improved at fourth weeks in naïve and TNFi group. In switch group, DAS28-CRP has not demonstrated significant improvement, however, IL-17 inhibitors were effective for the cases to which they were initiated for arthritis. As for MDA, 71% and 78% have also achieved MDA at twentieth weeks in both naïve and switch groups. In the TNFi group, 67% have not achieved MDA at twentieth weeks because of no improvement of rash (Figure 1). In switch group, all cases to which IL-17 inhibitors were initiated for either arthritis or rash have achieved MDA, however, 40% of cases which were introduced for both arthritis and rash have not achieved MDA.

Table 1.

Comparison of clinical characteristics at baseline in 3 groups.

Il-17 naïve group (n=7)IL-17 switch group (n=9)TNF group (n=7)p valueAge, year60.7 ± 18.953.8 ± 15.450.7 ± 13.6N.SDisease duration, year20.3 ± 25.817.4 ± 9.59.9 ± 12.4N.SMale, n (%)3 (43)6 (67)5 (71)N.SMTX, n (%)2 (29)4 (44)5 (71)N.SCRP(mg/dl)0.41 ± 0.501.87 ± 3.131.07 ± 1.77N.SSwollen joint count6.7 ± 7.33.6 ± 4.26.2 ± 6.9N.STender joint count6.6 ± 7.02.2 ± 2.66.9 ± 9.0N.SPatient pain VAS55.7 ± 22.347.1 ± 34.935.4 ± 13.6N.SBSA (%)12.5± 17.37.7 ± 14.87.4 ± 7.2N.SBiologics, nSecukinumab: 2Ixekizumab: 5secukinumab: 3Ixekizumab: 5Brodalumab: 1Infliximab: 3Adalimumab:3Etanercept:1

TNF: Tumor Necrosis Factor, MTX: Methotrexate, VAS: visual analog scale, BSA: body surface area, N.S: not significant

Conclusion:

In our study, IL-17 inhibitors could bring high rate of MDA achievement for both naïve and switch from TNFi. We suggest that TNFi should be switched into IL-17 inhibitors rapidly in the case of ineffective for TNFi.

References:

[1]Coates LC, Kavanaugh A, Mease PJ, et al. Arthritis Rheumatol. 2016;68:1060-71.

[2]Miyagawa I, Nakayamada S, Tanaka Y. Curr Rheumatol Rep. 2019 20;21:21.

[3]Coates LC, Moverley AR, McParland L, et al. Lancet. 2015 19;386:2489-98.

Disclosure of Interests:

None declared

FRI0065 CLINICAL FEATURES OF METHOTREXATE ASSOCIATED LYMPHOPROLIFERATIVE DISORDER IN RHEUMATOID ARTHRITIS PATIENTS AND INFLUENCE OF CD8 POSITIVE LYMPHOCYTE INFILTRATION

Background:

Lymphoproliferative disorders (LPD) that develop in rheumatoid arthritis (RA) patients treated with MTX (MTX-LPD) is one of the important complications for RA patients. We have previously epidemiologically demonstrated an association between MTX and the development of LPD in RA patients1). MTX-LPD has varied pathologies including various clinical symptom and histological finding. Therefore, we need more information about MTX-LPD. In addition, it is one of the characteristics for MTX-LPD that spontaneous regression (SR) after MTX discontinuation. However, the mechanism of SR is not clarified.

Objectives:

We collect the information such as clinical symptom and histological finding of MTX-LPD with RA patients, and clarify the clinical features of MTX-LPD. In addition, we investigated the difference between SR cases and cases that treated with chemotherapy after MTX discontinuation (CTx cases).

Methods:

We enrolled 90 MTX-LPD patients from Kagawa Prefecture, Japan between June 2005 and December 2019. Patients were diagnosed according to American College of Rheumatology (ACR) 1987 classification criteria or ACR/European League Against Rheumatism (EULAR) 2010 classification criteria, and treated with disease modifying antirheumatic drugs (DMARDs) including MTX. We collected as follow information; age, gender, duration of RA, laboratory data (lymphocyte counts and sIL-2R) and treatment of MTX-LPD. In addition, we divided 16 MTX-LPD cases diagnosed histological into two groups (SR:CTx group; n=10:6), and analyzed the histological findings (CD4, CD8, CD163 and CD47) using the staining in immunohistochemistry (IHC) between the two groups. Each positive cell analyzed using virtual viewer soft ImageScope.

Results:

Characteristics of 90 MTX-LPD patients are as follow; mean age 66.5±11.2 years,63 female, duration of RA 18.5±19.4 years. 65 patients (72.2%) were spontaneously improved by discontinuing MTX. 58 patients (64.4%) were proven MTX-LPD histologically. In these patients, diffuse large B-cell lymphoma (DLBCL) was the most frequent histological type of MTX-LPD (56.9%). Infiltration of CD8 positive lymphocyte in the lesion was significant less in the SR cases than in the CTx cases (Figure 1). However, CD4, CD163 and CD47 positive cells had no significant difference between two groups.

Figure 1.

CD8 positive lymphocytes in the specimen of lesion using the staining in immunohistochemistry (IHC) between SR and CTxgroup.

Conclusion:

We revealed clinical features of MTX-LPD with RA patients. In addition, CD8 positive lymphocytes are involved in tumor immunity. In this study, we suggested that the extent of CD8 positive lymphocyte infiltration may predict SR of MTX-LPD. Further study is necessary on revealing the mechanism of SR in MTX-LPD.

References:

[1]Kameda T. et al. Arthritis Care Res (Hoboken). 2014 Sep;66(9):1302-9.

Disclosure of Interests:

None declared

P1401THE REMOVAL EFFICIENCY OF PHOSPHATE FROM INTRACELLULAR FLUID DURING HEMODIALYSIS

Background and Aims

In hemodialysis (HD) patients without residual renal function, almost all of phosphate (P) absorbed through intestine is eliminated with HD. To avoid hyperphosphatemia, which is major risk for mortality in HD patients, reduced P absorption and /or improved P removal efficiency should be required. The P elimination during HD from intracellular fluid (ICF) remarkably differs from that from extracellular fluid (ECF). Because the total P removal is too complicate to analyze, few studies about P removal efficiency have been performed. In this study, we tried to separately estimate the amount of P removal from ICF and ECF.

Method

Fifty-eight patients undergoing 4-hour HD with BMI 22±3 were enrolled this study. ECF and ICF volumes were considered respectively as 20% and 40% of body weight (BW). The amount of urea nitrogen (UN) removal (Run) was calculated using the values of serum UN concentration (UN0, UN4) and total body fluid (60% of BW) at pre and post HD as 0.6(UN0 x pre BW – UN4 x post BW). The amount of intradialytic total P removal (Rp) was calculated using the formula previously reported. At starting phase of HD, P is considered to be removed only from ECF, and from ECF and ICF at later stage. In initial hours, when P is removed only from ECF, serum P concentration change exponentially (P = KptP0) as serum UN concentration (UN = KuntUN0). (Where, Kun and Kp are exponential coefficient of UN and P respectively, t is time (min), P0 is serum P concentration before HD). If P outflow from ICF is disregarded, the exponential change in P persists, and serum P concentration at the end of 4-hour HD is Kp240P0. Consequently, the amount of P removal from ECF (Rp(ex)) was calculated as 0.2(P0 x preBW - Kp240P0 x postBW). The exponential coefficient in P change was reported to be 0.997788 times of that in UN. The amount of P removal from ICF (Rp(in)) was calculated as difference between Rp and Rp(ex). Each removal efficiency was calculate as Run/UN0, Rp(ex)/P0 or Rp(in)/P0. Intradialytic removal of P from ECF and ICF were compared with that of UN. Regression analysis was performed on 24 factors which might affect the efficiency. The relationship between drug administration and the removal efficiency was investigated as for 22 drugs.

Results

UN removal and P removal from ECF were closely related. Run and Rp(ex) had positive correlation (0.564, p&lt;0.001). And Run/UN0 also correlated positively to Rp(ex)/P0 (R=0.970, p&lt;0.001). Rp(ex)/P0 and P0 had a positive correlation (R=0.334, p&lt;0.01) as well as Run/UN0 and UN0 (R=0.382, p&lt;0.01). P removal from ICF showed different pattern. In comparison between P removal from ECF and ICF, removal amount showed positive correlation (R=0.634, p&lt;0.001), but removal efficiency showed no correlation(R=0.006, ns). Notably, Rp(in)/P0 and P0 had negative correlation (R=0.315, p&lt;0.02). Rp(in) accounted for 44.6±6.2% of Rp. On regression analysis concerning the 24 factors, only P0 and its confounding factors showed correlation with Rp(ex), Rp(in), Rp(ex)/P0 or Rp(in)/P0. Rp(ex)/P0 or Rp(in)/P0 were not affected with administration of 22 investigated drugs. To exclude the influence of P0 on Rp(in)/P0, adjusted Rp(in)/P0 (removal efficiency of P from ICF not affected by P0) was calculated. Investigation on iron containing P binders and ion exchange resins revealed each drug groups ameliorated adjusted Rp(in)/P0.

Conclusion

This is the first report to analyze separately P removal from ECF and ICF during HD. Increased UN removal efficiency results in increased the removal efficiency of P from ECF, but did not improved that from ICF. Rp(in) accounts for about half of Rp. For improving total P removal efficiency, removal efficiency of P from ICF should be increased. Some drugs were suggested to increase removal efficiency of P from ICF.

AB0391 EFFECT OF HCQ ON LLDAS ACHIEVEMENT IN SLE PATIENTS

Background:

HCQ for SLE in Japan has been administered in many cases after approval. Therefore, the effect of additional administration of HCQ on low disease activity of SLE was considered to be clearer.

Objectives:

To clarify the effect of HCQ treatment on the control of disease activity in SLE patients.

Methods:

All SLE patients with low disease activity (LDA) enrolled in this study started additional HCQ treatment from January 2016. All patients with LDA enrolled in this study started HCQ treatment and had been receiving oral HCQ continuously for at least 3 months without using other immunosuppressive treatments or glucocorticoids. Disease activity was evaluated by SLEDAI, CLASI, and LLDAS, and serum complement values, anti-DNA antibodies, and pro-inflammatory cytokines were analyzed as immunological biomarkers before and after HCQ treatment.

Results:

52 of 100 patients were enrolled in this study (M:F; 4:48, average age; 40.6±13.4). 24 lupus nephritis patients were in sustained remission. 29 patients (56%) achieved LLDAS and 3 patients (6%) achieved clinical remission (CR) before HCQ administration.

Of the 20 patients (38%) who did not achieve LLDAS before HCQ administration, the LLDAS achievement rates at 3, 6, and 12 months after additional HCQ were 47%, 59%, and 81% (including 12.5% of CR achievement rates), respectively.

Serum levels of MRP8, MRP14, TNF-α, IL-6, VEGF-A, IL-1ra, MIP-1a and IL-2 decreased significantly 3 months after additional HCQ treatment. In addition, serum levels of MRP8, MRP14, TNF-α, IL-6 and IL-2 also decreased significantly 3 months after additional HCQ treatment despite achieving LLDAS or CR. The expressions of IFN-α didn’t decrease significantly in 9 cases that could be detected.

The magnitude of the changes in serum MRP8, MRP14, IL-8 and Il-1ra levels in patients with a history of LN was significantly higher than in those without a history of LN. The magnitude of the reduction in serum MCP-1 levels in patients not achieving LLDAS with a history of LN was significantly higher than in those without a history of LN(p=0.046).

The change of CLASI activity score was correlated with the change in serum levels of MRP14 and MCP-1 with univariate analysis (MRP14: r=-0.41, p=0.017, MCP-1: r=-0.58, p=0.0006). The change of serum C3 levels had a negative correlation with MCP-1(r=-0.33, p=0.022).

The magnitude of the change in serum levels of MRP14, TNF-α, IL-8, MCP-1, MIP-1a and IL-1ra in patients achieving LLDAS were correlated with the change of CLASI activity score with univariate analysis (MRP14: r=-0.49, p=0.041, TNFα: r=0.74, p=0.0038, IL-1ra: r=0.66, p=0.038, MIP-1a: r=0.63, p=0.037, Figure 1). Moreover, the change of serum C3 and C4 levels in them had a negative correlation with the change of serum MCP-1 levels (Figure 2).

Figure 1.

Correlation between change of CLASI activity scores and serum MCP-1 levels in SLE patients with LLDAS (IL-8: r=0.77,p=,0.0007, MCP-1: r=0.80,p=,0.0001).

Figure 2.

Correlation between change of serum C3 and C4 levels and serum MCP-1 levels in SLE patients with LLDAS (C3: r=-0.40, p=0.028, C4: r=-0.37, p=0.047).

Conclusion:

Additional administration of HCQ is useful for cytokine control even in LLDAS-achieved cases, and particularly contributes to the improvement of skin lesion.

In addition, regulation of IL-8 and MCP-1 is important for control of renal lesions of SLE, and more control of the activity of SLE

The effect of HCQ on IL-8 and MCP-1 is related to the control of renal lesions in SLE, so that disease activity of more SLE patients might be more controlled disease activity.

References:

[1]R Wakiya, et al. Hydroxychloroquine modulates elevated expression of S100 proteins in systemic lupus erythematosus. Lupus. 2019;28:826-833

Disclosure of Interests:

None declared

FRI0254 SERUM IL-17 AND IL-21 AFFECT THE HEMODYNAMICS IN CONNECTIVE TISSUE DISEASE ASSOCIATED-PULMONARY HYPERTENSION

Background:

Pulmonary hypertension associated with connective tissue disease (CTD-PH) has complicated pathology including immune abnormalities, cardiac and pulmonary lesions. Therefore, it is difficult for rheumatologist to manage CTD-PH. We hesitate to use immunosuppressants in addition to pulmonary vasodilators to treat CTD-PH. Although there is a report that the cytokine such as Interleukin (IL)-6, IL-17 and IL-21 are involved in the development of PH1), changes in the hemodynamics of theses cytokines with treatment are not clear.

Objectives:

We investigate serum cytokine profile and clinical appearance in CTD-PH, and clarify the relationship between change in cytokines and hemodynamics before and after treatment.

Methods:

14 cases of CTD-PH (8 cases in Scleroderma; SSc-PH group, 4 cases in Mixed connective tissue disease; MCTD-PH group, 2 cases in Systemic lupus erythematosus; SLE-PH group), 6 cases in Other-PH group, and 2 cases of SSc without PH as controls were included. The following clinical data were collected: age, gender, underlying disease, complication of interstitial lung disease, treatment (immunosuppressant and pulmonary vasodilator). Serum samples in pre- and post-capillary before and after treatment were collected during cardiac catheterization examination. Serum cytokines (MCP-1, IL-6, IL-17 and IL-21) of these samples were measured by ELISA (ABCAM, UK).

Results:

Serum MCP-1, IL-6, and IL-21 levels were higher in SSc-PH group than in the other groups. Conversely, serum IL-17 levels tended to be higher in non-SSc group compared to SSc-PH group. Additionally, serum MCP-1 levels in SSc-PH group decreased in post-capillary as compared to pre-capillary. Furthermore, patients with decreased serum IL-17 and IL-21 levels before and after treatment showed improved pulmonary hemodynamics.

Conclusion:

SSc-PH had a different cytokine profile compared with non-SSc-PH. We suggested that the serum IL-17 and IL-21 levels effect the hemodynamics in CTD-PH.

References:

[1]Hashimoto-Kataoka T. et al. Proc Natl Acad Sci U S A. 2015 May 19;112(20):E2677-86.

Disclosure of Interests:

None declared

AB0392 THE EFFECT OF HYDROXYCHLOROQUINE ON THE RISK FACTORS FOR ATHEROSCLEROSIS DEVELOPMENT

Background:

Systemic lupus erythematosus(SLE) patients, especially patients with lupus nephritis have poor vascular endothelial function and increased cardiovascular(CV) mortality.

Meanwhile, several studies showed hydroxychloroquine(HCQ) has effect on reduction in lipids and thrombosis(1), but the mechanism is unclear.

Objectives:

We examined effect of HCQ on adipocytokine expression in SLE patients.

Methods:

52 SLE patients with low disease activity started with HCQ were analyzed before and 3 months after HCQ treatment. 21 SLE patients has past history of lupus nephritis. Serum S100 proteins and adipocytokines were measured by ELISA, and serum inflammatory ctytokine levels were evaluated by Multiplex assay (TNF-α, IL-6, VEGF-A).

Results:

Serum adiponectin level was increased significantly 3 months after HCQ treatment compared with those at baseline (mean change 1.35, Figure 1). SLE patients who achieved LLDAS had a greater increase than those who did not. Additionally, the changes of serum adiponectin levels were associated with those of TNF-α, IL-6, VEGF-A and S100A9 protein, which plays an important role of SLE pathogenesis.

Figure 1.

Serum adiponectin levels at baseline were compared with levels after 3 months of HCQ treatment. Serum adiponectin levels significantly decreasing during HCQ treatment in SLE patients. For statistical analyses *p<0.0001,Pvalue: Wilcoxon signed-rank test

Conclusion:

A HCQ could reduce the risk factors for atherosclerosis along with control of SLE disease activity.

References:

[1]Wallace DJ, et al. Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids. Am J Med. 1990; 89: 322-6.

Disclosure of Interests:

None declared

AB0493 COMPARISON OF EFFICACY AND SAFETY BETWEEN RITUXIMAB AND CYCLOPHOSPHAMIDE IN REMISSION INDUCTION THERAPY FOR JAPANESE ANCA-ASSOCIATED VASCULITIS(AAV) PATIENTS; A SINGLE CENTER RETROSPECTIVE ANALYSIS

Background:

Rituximab(RTX) and Cyclophosphamide(CY) has been indicated for ANCA-associated vasculitis(AAV) as remission induction therapy. However, older age and renal disfunction were independent predictor of treatment related adverse effects in remission induction with CY in recent reports1). Japanese AAV patients are characterized by the predominance of elderly, and the study about comparison of efficacy and safety between RTX and CY in elderly Japanese AAV patients are limited.

Objectives:

To compare the efficacy and safety between RTX versus CY as remission induction therapy in Japanese AAV patients.

Methods:

We analyzed 40 cases (20 cases received RTX and 20 cases received CY) who received remission induction therapy in our hospital between January 2016 and August 2019. Clinical and laboratory variables at diagnosis, rates of complete remission(CR) at 6 months, defined as Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone 7.5 mg/day, AAV relapse at 12 months, and adverse effects were investigated.

Results:

Of 40 patients, mean age was 73.5±9.6 years (6 males and 34 females). Diagnosis of MPA and GPA were 30 cases and 10 cases, respectively. 37 cases (93%) were positive for MPO-ANCA. Treatment regimen was determined by attending physician. Baseline characteristic of each group (RTX group and CY group) are shown in Table1. Baseline charactor, disease activity, organ involvement, and the proportion of patients with relapsing disease were similar in the two treatment groups. At 6 months, there was no difference of remission rate between two groups (RTX: CY = 62%: 44%, p=0.35) (Figure 1). However, mean PSL dosage at 3 months was significantly lower in RTX group (10.0±4.6mg/day) as compared to CY group (15.8±9.5mg/day; p=0.025) (Figure 2). At 12 months, 1 case in CY group and no case in RTX group had relapse. Adverse effects through 12 months are shown in Table 2. 8 infections (30%) in CY group and 7 infections (35%) occurred in RTX group (p=0.64), respectively. 1 case in RTX group had died due to renal failure.

Table 1.

Comparison of clinical characteristics at baseline between RTX and CY groups.

RTX(n=20)CY(n=20)p valueDeath, n (%)1 (5)0 (0)0.50Infections, n (%)7 (35)8 (30)0.46Serious (grade 3), n (%)4 (15)3 (10)0.50Malignancy, n (%)1 (5)0 (0)0.50VTE, n (%)1 (5)0 (0)0.50AMI, n (%)1 (5)0 (0)0.50Leukopenia, n (%)3 (15)3 (10)0.70Necrosis of femoral head, n (%)0 (0)1 (5)0.50Mediastinal emphysema0 (0)1 (5)0.50

VTE: venous thrombotic emboli, AMI: acute myocardial infarction

Conclusion:

We indicated that PSL was tapered more rapidly in RTX group, although there was no difference of remission rate at 6 months and infection at 12 months between RTX and CY therapy. Therefore, remission induction therapy with RTX might be more safety for elderly Japanese AAV patients.

References:

[1]Little MA, Nightingale P, Verburgh CA, Hauser T, et al. Ann Rheum Dis 2010; 69:1036–1043.

Table 2.

Adverse effects through 12 months. % = patients with 1 effects

RTX(n=20)CY(n=20)p valueAge, year72.3 ± 11.074.8 ± 8.010.55female, n (%)16 (80)18 (90)0.33AAV type0.14 MPA, n (%)13 (65)17 (85) GPA, n (%)7 (35)3 (15)Newly diagnosis, n (%)7 (35)4 (20)0.24ANCA positivity MPO, n (%)20 (100)17 (85)0.12 PR3, n (%)1 (5)2 (10)0.50 negative, n (%)0 (0)2 (10)0.24 eGFR (mL/min)55.0 ± 29.558.1 ± 21.50.45Organ involvement General, n (%)14 (70)19 (95)0.046* Cutaneous, n (%)1 (5)3 (15)0.30 Eyes, n (%)4 (20)1 (5)0.17 ENT, n (%)5 (25)5 (25)1.00 Pulmonary, n (%)14 (70)15 (75)0.50 Renal, n (%)14 (70)13 (65)0.50 Neurologic, n (%)8 (40)4 (20)0.15BVAS13.8 ± 6.614.1 ± 7.60.73

RTX: Rituximab, CY: Cyclophosphamide, ANCA: antineutrophil cytoplasmic autoantibody, AAV: ANCA-associated vasculitis, GPA: granulomatosis with polyangiitis, MPA: microscopic polyangiitis, ENT: Ear, Nose, and Throat, BVAS Birmingham Vasculitis Activity Score, * p <0.05

Disclosure of Interests:

None declared

AB0592 NAILFOLD CAPILLARY ABNORMALITIES PREDICT INTERSTITIAL LUNG DISEASE (ILD) COMPLICATION IN SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic sclerosis (SSc) have various organ involvements including pulmonary hypertension (PH), digital ulcers (DU), and interstitial lung disease (ILD). On the other hand, Nailfold capillary (NFC) abnormalities (enlarged/giant capillaries, fresh or old hemorrhages, avascular areas, ramified/bushy capillaries) detected by capillaroscopy are included in ACR/EULAR classification criteria for SSc as one of important findings. In addition, many studies have reported the relationship between NFC abnormalities and organ involvements (DU, PH) [1][2]. However, there are a few reports about the relationship between NFC abnormalities and ILD.

Objectives:

We clarify the association with NFC abnormalities and ILD in SSc patients.

Methods:

We enrolled SSc patients without PH from January 2016 to December 2019 in our institution. SSc patients were diagnosed according to EULAR classification criteria in 2013. ILD was detected by chest CT scans. We assessed severity of ILD with pulmonary function tests (PFT). Abnormal PFT was defined as vital capacity (%VC) or diffusion capacity (DLCO) < 70%. NFC abnormalities were detected with “OptiPiX capillaroscopy Clinic 1.7.x” and the number of capillaries was measured per 1mm in 2nd to 5th fingers of both hand. We defined enlarged and giant capillaries as >30 µm and >50 µm, respectively.

Results:

We enrolled 59 SSc patients (54 females, 5 males). Mean age is 65.0 ± 8.0 years. Thirty-one patients (52.5%) were complicated with ILD. Mean capillary counts are 6.6/mm. The number of patients with each NFC abnormalities (enlarged capillaries, giant capillaries, microhemorrhages, ramified, avascular areas) are 42, 32, 48, 38, and 33 cases, respectively. Two cases did not have NFC abnormalities. SSc patients with giant capillaries had fewer ILD complications (p <0.05, odds ratio 0.183 [0.059 – 0.57]). Other NFC abnormalities were not associated with ILD in SSc patients. We inspected %VC of 23 patients and DLCO of 20 patients with ILD. Eleven patients had abnormal PFT (5 patients had abnormal %VC and 9 patients had abnormal DLCO). Most of them had not enlarged capillaries than patient with normal PFT (odds ratio 0.11 [0.016 – 0.81]). Other NFC abnormalities including giant capillaries were not associated with abnormal PFT.

Conclusion:

We investigated the relationship between NFC abnormalities and ILD conplications in SSc patients. NFC abnormalities are associated with ILD complicacion and severity of ILD. It was suggested that no giant capillary in SSc patients may predict ILD complication. Moreover, no enlarged capillary may predict the severe ILD.

References:

[1]Valeria Riccieri et al. Systemic sclerosis patients with and without pulmonary arterial hypertension: a nailfold capillaroscopy study. Rheumatology, Volume 52, Issue 8, 1 August 2013, Pages 1525–1528

[2]Maurizio Cutolo et al. Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study. Arthritis Rheumatol. 2016 Oct; 68(10): 2527–2539.

Disclosure of Interests:

None declared

High Peritoneal Clearance of Small Molecules Did Not Provide Low Serum β2–Microglobulin Concentrations in Peritoneal Dialysis Patients

Objective

Although early reports demonstrated that serum β2-microglobulin (s-β2m) concentrations in patients on peritoneal dialysis (PD) were lower than those in patients on hemodialysis (HD), more recent studies demonstrated lower s-β2m concentrations in HD patients treated mainly with high-flux synthetic membranes. We therefore compared s-β2m concentrations between patients on PD and on HD, and also analyzed the relationship between s-β2m concentrations and other parameters in patients on PD.

Patients and Methods

We investigated 24 patients who had been undergoing PD [11 on continuous ambulatory peritoneal dialysis, 13 on continuous cycling peritoneal dialysis] for 4.3 ± 2.7 years, and 24 patients who had been undergoing HD with high-flux synthetic membranes for 6.1 ± 3.2 years. Concentrations of s-β2m in the PD patients were compared to concentrations in the HD patients. In patients on PD, we also analyzed the relationship between s-β2m concentration and other parameters, including residual renal function, total weekly Kt/V urea, total weekly creatinine clearance (CCr), and dialysis schedules.

Results

We found no significant difference in s-β2m concentrations between the PD and HD patients (33.6 ± 10.4 mg/L vs 30.3 ± 10.5 mg/L respectively). Concentrations of s-β2m in PD patients rose with PD duration and were significantly inversely correlated with residual renal function ( r = –0.71, p < 0.0001). Unexpectedly, concentrations of s-β2m in anuric PD patients rose as peritoneal CCr increased. And most of the patients with high s-β2m levels fell into the high or high-average transport categories according to a peritoneal equilibration test.

Conclusions

Concentrations of s-β2m in patients on PD did not differ significantly from concentrations in HD patients who were using high-flux synthetic membranes. The contribution of residual renal function to removal of β2m was more important than the contribution of peritoneal clearance. High peritoneal clearance of small molecules did not result in low s-β2m concentrations, especially in anuric patients with accelerated peritoneal permeability.

Visceral Fat Accumulation Is Associated with Mild Cognitive Impairment in Community-Dwelling Older Japanese Women

OBJECTIVES

Visceral fat accumulation is detrimental for brain health and is associated with cognitive impairment in older adults. The objectives of the present study were to examine the association between visceral fat accumulation and prevalence of mild cognitive impairment and its subtypes.

DESIGN

a cross-sectional study.

PARTICIPANTS

This study enrolled 6,109 community-dwelling older adults, including 3,434 women (mean age: 74.4 years) and 2,675 men (mean age: 74.3 years). Individuals with dementia, Parkinson's disease, stroke, Mini-Mental State Examination scores ≤23, and who could not perform basic activities of daily living independently were excluded.

MEASUREMENTS

Participants underwent neurocognitive assessments to assess mild cognitive impairment (MCI) and its subtypes. Visceral fat area (VFA) was measured using abdominal bioelectrical impedance analysis. Participants were divided into quartile groups by VFA.

RESULTS

There were 731 (21.3%) women and 562 (21.0%) men with MCI, and the median VFA values were 63.3 cm2 and 96.3 cm2, respectively. Women participants in the second (adjusted odds ratios [aOR], 0.71; 95% confidence interval [95% CI], 0.54-0.94), third (aOR, 0.66; 95% CI, 0.47-0.92), and fourth quartiles of VFA (aOR, 0.62; 95% CI, 0.41-0.93) had a significantly lower risk of MCI than those in the first quartile. Higher VFA quartiles in women were associated with lower risk of non-amnestic MCI. There were no significant differences in men between quartiles.

CONCLUSIONS

Visceral fat accumulation was associated with MCI, especially non-amnestic MCI, in community-dwelling older Japanese women. These results suggest that visceral fat accumulation is partially protective against cognitive impairment.