AB1103 AUTOMATIC FINGER JOINT BONE EROSION SCORE PREDICTION CONSIDERING 2-TIME-POINT X-RAYS OF PATIENTS WITH RHEUMATOID ARTHRITIS BY DEEP LEARNING

Background:

Medical image analysis using deep learning (DL) has been attracting attention. In previous research, we proposed a DL method for detection of joint region and evaluation for bone destruction at a single point in time in hand X-rays of patients with rheumatoid arthritis (RA) [1-2]. However, in the score of van der Heijde-modified total Sharp scores (mTSS) in X-rays, it is difficult to apply the method as it is. In mTSS, score difference between 2-time points is important, and there is a problem that the score at each time varies depending on the doctor who evaluates.

Objectives:

We aimed at developing an mTSS scoring method considering 2-time-point difference with a DL method.

Methods:

A total of 104 X-ray image sets of both hands at two time points with an interval of ≥1 year were randomly obtained from patients with RA who had visited our clinic in 2015. Well-trained doctors determined the erosion scores of MP and PIP/IP joints of each hand in X-rays according to mTSS. These evaluations of hand joints were performed using our developed annotation software tool. In the learning phase, joint images were randomly divided into five sets for 5-fold cross-validation. We utilized a convolutional neural network model, such as SSD [3], for detecting joint regions and classifying the scores (Fig 1).

Figure1.

The models for classification were designed in consideration of the difference in erosion scores of each patient between the 2-time points of X-rays. The loss function of the DL model was defined bellow;

Here, the coefficient γ is designed to reduce the error for another set of scores with equal differences. The first term of the loss function works to optimize the score at each time point, and the second term works to optimize the score difference at both time points. Thus, our method can be trained without being affected by characteristic training data.

Results:

The number of joints with differences in erosion score between the former and latter time points was 1 (-2 points), 9 (-1), 2015 (0), 32 (+1), 17 (+2), and 6 (+3). There were no joints with score changes of -5, -4, -3, +4, and +5 points.

As a performance of predicting the difference in erosion score between the 2-time points of each patient’s X-ray, our models presented a mean error of 0.412 per each joint in one set for 5-cross validation as compared with physicians’ evaluation (Fig 2).

Figure 2.

Conclusion:

Our DL-based models to predict hand joint erosion scores in X-rays were developed with relatively small samples. This suggests that the predictive performance may increase by collecting more training dataset. Next, we will apply our method to the prediction of joint space narrowing score.

References:

[1]Izumi K, Hashimoto M, Suzuki K, et al. Detecting Hand Joint Ankylosis in Radiographic Images Using Deep Learning: A Step in Developing Automatic Radiographic Scoring System for Bone Destruction.Arthritis Rheumatol2018;70 (suppl 10).

[2]Izumi K, Suzuki K, Hashimoto M, et al. SAT0543 AUTOMATIC DETECTION OF HAND JOINT REGION, ANKYLOSIS AND SUBLUXATION IN RADIOGRAPHIC IMAGES USING DEEP LEARNING: DEVELOPMENT OF ARTIFICIAL INTELLIGENCE-BASED RADIOGRAPHIC EVALUATION SYSTEM FOR BONE DESTRUCTION.Annals of the Rheumatic Diseases2019;78 (suppl 2), pp. 1364-1364.

[3]Liu W, Anguelov D, Szgedy C, et al. SSD: single shot multibox detector.European Conference on Computer Vision (ECCV) 2016.

Acknowledgments:

Izumi and Suzuki are contributed equally.

Disclosure of Interests:

Keisuke Izumi Grant/research support from: Asahi Kasei Pharma, Takeda Pharmaceutical Co., Ltd., Speakers bureau: Asahi Kasei Pharma Corp, Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma Co., Kanata Suzuki Employee of: Fujitsu Laboratories Ltd., Masahiro Hashimoto: None declared, Toshio Endoh Employee of: Fujitsu Laboratories Ltd., Kentaro Doi Employee of: Fujitsu Ltd., Yuki Iwai Employee of: Fujitsu Ltd., Yuko Kaneko Speakers bureau: AbbVie, Eisai Pharmaceutical, Chugai Pharmaceutical Co., Ltd., Bristol Myers Squibb, Astellas Pharma Inc., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Janssen Pharmaceutical K.K., Eli Lilly Japan K.K., Santen Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co. Ltd. and UCB Japan Co. Ltd., Masahiro Jinzaki: None declared, Shigeru Ko Grant/research support from: Fujitsu Ltd., Tsutomu Takeuchi Grant/research support from: Astellas Pharma Inc, Chugai Pharmaceutical Co, Ltd., Daiichi Sankyo Co., Ltd., Takeda Pharmaceutical Co., Ltd., AbbVie GK, Asahikasei Pharma Corp., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Eisai Co., Ltd., AYUMI Pharmaceutical Corporation, Nipponkayaku Co. Ltd., Novartis Pharma K.K., Teijin, Consultant of: Astra Zeneca K.K., Eli Lilly Japan K.K., Novartis Pharma K.K., Mitsubishi Tanabe Pharma Co., Abbivie GK, Nipponkayaku Co.Ltd, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Taiho Pharmaceutical Co. Ltd., Chugai Pharmaceutical Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., GlaxoSmithKline K.K., UCB Japan Co. Ltd., Speakers bureau: Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd., AbbVie GK, Asahi Kasei Pharma Corp., Taisho Toyama Pharmaceutical Co., Ltd., SymBio Pharmaceuticals Ltd., Janssen Pharmaceutical K.K., Celltrion Inc., Nipponkayaku Co. Ltd., and UCB Japan

SAT0349 CTLA4-IG DECREASES TH17 CELL LEVELS BUT MAINTAINS ILC3S WITH AN INCREASE IN THE ILC3/ILC1 RATIO IN THE GUT OF SKG MICE AS A MODEL OF SPONDYLOARTHRITIS

Background:

SKG mice have been known for their autoreactive Th17 cells resulting from the insufficient thymic negative selection due to a Zap70 mutation1,2). Under specific pathogen-free conditions, they acquire features of spondyloarthritis (SpA) by intraperitoneal injection of curdlan, a (1,3)-β-glucan3). Several reports have shown that Th17 cells also increase in human SpA4). However, CTLA4-Ig, which ameliorates rheumatoid arthritis by suppressing pathogenic cells such as effector T cells, was unable to show adequate efficacy as much as expected in SpA patients5). Around the same time, innate lymphocytes began to be focused on, in the pathogenesis of SpA, including innate lymphoid cells (ILCs), which abundantly reside in the gut6).

Objectives:

This study aimed to clarify the effects of CTLA4-Ig on the pathogenesis of SpA by using curdlan-treated SKG mice, focusing on type 3 immunity such as Th17 cells and ILC3s.

Methods:

Two- to three-month-old female SKG mice were injected intraperitoneally with 3mg of curdlan or PBS at the beginning and with 500 µg of CTLA4-Ig or PBS every other week (n=5 per group). The body weight and arthritis score were measured weekly for a month. Then, the changes in the proportion of T cells and ILCs in the spleen and Peyer’s patches (PPs) were analysed by flow cytometry (FCM). BALB/c mice, without treatment, were also examined by FCM as a control cohort. In addition, a next-generation analysis of their feces was performed on 16S ribosomal coding genes before curdlan and CTLA4-Ig treatment.

Results:

SKG mice contained not only more Th17 cells but also more ILC1s and ILC3s than BALB/c mice, in their guts (the PPs). The feces of SKG mice intrinsically showed a decrease in the number of bacterial species, suggesting a dysbiosis. Then, in curdlan-treated SKG mice, CTLA4-Ig administration decreased the proportion of both Th17 cells and ILC3s in the spleen, but did not decrease the proportion of ILC3s in the PPs. Moreover, the ILC3/ILC1 ratio in the PPs was from low to high in the order of SKG mice without treatment, SKG mice injected with curdlan, and SKG mice injected with both curdlan and CTLA4-Ig. The phenotype corresponding to SpA features, in curdlan-treated SKG mice, continued after repeated CTLA4-Ig administration.

Conclusion:

Curdlan provoked SpA features in SKG mice with an intrinsic dysbiosis. Additional CTLA4-Ig injection decreased the proportion of Th17 cells but maintained that of ILC3s with increased ILC3/ILC1 ratio in the gut. This result supports the hypothesis that in the SpA pathophysiology, a weakened acquired immunity in the gut might lead to ILC3 activation, via dysbiosis, and its continuous disease progression, suggesting that ILC3s are a promising therapeutic target in SpA.

References:

[1]Sakaguchi N, Sakaguchi S, et al. Altered thymic T-cell selection due to a mutation of the ZAP-70 gene causes autoimmune arthritis in mice.Nature2003;426:454-460.

[2]Hirota K, Sakaguchi S, et al. T cell self-reactivity forms a cytokine milieu for spontaneous development of IL-17+ Th cells that cause autoimmune arthritis.J Exp Med2007;204:41-47.

[3]Ruutu M, Thomas R, et al. β-glucan triggers spondylarthritis and Crohn’s disease–like ileitis in SKG mice.Arthritis Rheum2012;64:2211-2222.

[4]Shen H, Gaston JS, et al. Frequency and phenotype of peripheral blood Th17 cells in ankylosing spondylitis and rheumatoid arthritis.Arthritis Rheum2009;60:1647-1656.

[5]Song I-H, Sieper J, et al. Treatment of active ankylosing spondylitis with abatacept: an open-label, 24-week pilot study.Ann Rheum Dis2011;70:1108-1110.

[6]Ciccia F, Triolo G, et al. Type 3 innate lymphoid cells producing IL-17 and IL-22 are expanded in the gut, in the peripheral blood, synovial fluid and bone marrow of patients with ankylosing spondylitis.Ann Rheum Dis2015;74:1739-1747.

Disclosure of Interests:

Yuya TABUCHI Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Syuji Akizuki: None declared, Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

THU0285 ANALYSIS OF THE RELATIONSHIP BETWEEN ORGAN DAMAGE AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disease that can not only cause systemic symptoms, such as fever and arthritis, but can also damage important organs, such as those of the central nervous system and the kidneys. Prevention of irreversible organ damage is important for better prognosis [1]. Additionally, the importance of maintaining the quality of life (QOL) of patients has recently been emphasized. However, only a few studies have examined the relationship between irreversible organ damage and patient QOL.

Objectives:

To assess the relationship between organ damage and QOL, and to survey which organs have more significant effects on QOL.

Methods:

We conducted a questionnaire-based survey of 183 patients with SLE at Kyoto University Hospital from September to December 2019. We used the SLICC/ACR Damage Index (SDI) to evaluate organ damage [2]. The following five scales were employed to evaluate QOL: the physical (PCS) and mental component summary (MCS) of the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey version 2.0 (SF-36v2) [3], health (HRQOL) and non-health-related QOL (N-HRQOL) of LupusPRO [4], and SLE Symptom Checklist (SSC) [5].

Results:

Linear regression analysis showed significant correlation between the SDI score and all QOL scales except for N-HRQOL, suggesting negative effects of organ damage on QOL (Table 1). Next, we analysed whether there was a significant difference in the SF-36 score between those who were positive and negative for each SDI item (41 in total), using the Wilcoxon rank sum test. Muscle atrophy or weakness (p= 3.0×10-10), osteoporosis with fracture or vertebral collapse (p= 9.7×10-8), claudication (p= 7.4×10-5), and cognitive impairment or major psychosis (p= 9.9×10-5) significantly correlated (p< 1.2×10-3) with PCS, and scarring chronic alopecia (p= 3.4×10-4) with MCS (Table 2). In addition, the five SDI items significantly correlated with the remaining three QOL scales (HRQOL, N-HRQOL, and SSC;p< 0.05).

Table 1.

Relationship between the SDI score and QOL

SF-36LupusPROSSCPCSMCSHRQOLN-HRQOLp-value<2.0×10-161.7×10-32.2×10-110.231.9×10-8Table 2.

Relationship between each SDI item and the SF-36 score (p< 1.2×10-3

SDI itemPCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Muscle atrophy/weakness33 (19-45)50 (43-54)3.0×10-10Osteoporosis with fracture/vertebral collapse24 (12-32)49 (38-54)9.7×10-8Claudication31 (19-35)49 (38-54)7.4×10-5Cognitive impairment/psychosis27 (17-33)49 (38-54)9.9×10-5SDI itemMCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Scarring chronic alopecia42 (29-51)49 (39-54)3.4×10-4

Conclusion:

We demonstrated that organ damage has negative effects on patient QOL, indicating the importance of preventing irreversible organ damage for maintaining QOL. Moreover, muscle atrophy/weakness, osteoporosis with fracture/vertebral collapse, claudication, cognitive impairment/major psychosis, and scarring chronic alopecia significantly correlated with QOL deterioration, suggesting that these items should be examined with special care in clinical practice.

References:

[1]Lopez R, et al. Rheumatology (Oxford). 2012; 51:491-498.

[2]Gladman D, et al. Arthritis Rheum. 1996; 39:363-369.

[3]Fukuhara S, et al. J Clin Epidemiol. 1998; 51:1037-1044.

[4]Inoue M, et al. Lupus. 2017; 26:849-856.

[5]Grootscholten C, et al. Qual Life Res. 2003; 12:635–644.

Disclosure of Interests:

Yudai Takase: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Ryuta Inaba: None declared, Tomohiro Kozuki: None declared, Masashi Taniguchi: None declared, Yuya Tabuchi Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma. (Outside the field of the present study.), Koji Kitagori: None declared, Syuji Akizuki: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Wataru Yamamoto: None declared, Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

THU0107 OBESITY PREDICTS RESPONSE TO NOT ALL BUT CERTAIN BIOLOGICAL / TARGETED DISEASE MODIFYING ANTI-RHEUMATIC DRUGS FOR RHEUMATOID ARTHRITIS - RESULTS FROM KANSAI CONSORTIUM FOR WELL-BEING OF RHEUMATIC DISEASE PATIENTS (ANSWER COHORT)

Background:

A number of previous reports suggested that obesity is one of the baseline factors indicates refractory to biologic disease-modifying antirheumatic drugs (bDMARDs). However, difference of the significant responses appears on obesity patients depending on each kind of drug is yet unclear. However, it is yet unclear how the significant responses on obesity patients vary on each kind of drug.

Objectives:

To assess whether obesity affects clinical outcome in rheumatoid arthritis (RA) treated with each molecular-targeted agent including bDMARDs and tofacitinib.

Methods:

In Kansai consortium for well-being of rheumatic disease patients (ANSWER) cohort, which was the real-world retrospective cohort of clinical database for rheumatic diseases, RA patients who initiated biological / targeted disease modifying anti-rheumatic drugs were included and consecutively followed. Obesity was defined as BMI over than 25, and patients were divided between obese (“Ob”) and non-obese (“non-Ob”) patients. SDAI (simplified disease activity index) was compared between non-Ob and Ob at month 0, 3, 6, 9, 12 after the indicated drugs were administered. Using logistic regression analysis, odds ratio (OR) and their corresponding 95% confidence intervals (95% CIs) were further calculated to estimate achievement rate of SDAI remission defined as lower than 3.3 by obesity and other relevant clinical parameters. Once after the drugs were discontinued by any unfavorable reason, disease activities were no more scored and the Last Observation Carried Forward (LOCF) imputation method was used for SDAI at month 3 and thereafter.

Results:

A total of 1936 patients met in the inclusion criteria were under the analysis. In each drug, SDAI remission rate (non-Ob, Ob, p-value by Chi-square test) at month 12 was as follows; Infliximab (IFX, n=135): 43%, 38%, NS (not significant); Etanercept (ETN, n=188): 44%, 19%, p=0.0122; Adalimumab (ADA, n=169): 50%, 56%, NS; Golimumab (GLM, n=315): 36%, 30%, NS; Certolizumab pegol (CZP, n=131): 33%, 56%, p=0.0287; Tocilizumab (TCZ, n=423): 41%, 29%, p=0.0456; Abatacept (ABT, n=144): 26%, 23%, NS; Tofacitinib (TOF, n=69): 27%, 23%, NS. In multivariate analysis to predict SDAI remission at month 12, obesity was an independent protective factor in CZP (OR: 0.29, 95% CIs: 0.10 – 0.83), but was an independent risk factor in TCZ (OR: 1.9, 95% CIs: 1.01 – 3.61) irrespective of age, sex, disease duration, SDAI at month 0 or number of previous bDMARDs. Any other drug including ETN did not show significant result between non -Ob and Ob in the multivariate analysis.

Conclusion:

Obese patients were more resistant to TCZ but more effective in CZP than non-obese patients.

References:

[1]Ann Rheum Dis. 2018;77(10):1405-1412. Joint Bone Spine. 2019;86(2):173-183.

Disclosure of Interests:

Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Wataru Yamamoto: None declared, Ryota Hara Speakers bureau: RH received a speaker fee from AbbVie, Masaki Katayama: None declared, Akira Onishi Speakers bureau: AO received a speaker fee from Chugai, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Asahi-Kasei, and Takeda, Kengo Akashi: None declared, Koji Nagai: None declared, Yonsu Son: None declared, Hideki Amuro: None declared, Toru Hirano Grant/research support from: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Speakers bureau: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Kosuke Ebina Grant/research support from: KE has received research grants from Abbie, Asahi-Kasei, Astellas, Chugai, Eisai, Ono Pharmaceutical, and UCB Japan., Employee of: KE is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho., Speakers bureau: KE has received payments for lectures from Abbie, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Sanofi, and UCB Japan., Kohei Nishitani Grant/research support from: KN belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Hiromu Ito: None declared, Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

AB0197 INCREASED CIRCULATING ADIPONECTIN IS AN INDEPENDENT DISEASE ACTIVITY MARKER IN PATIENTS WITH RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY USING THE KURAMA DATABASE

Background:

Adiponectin is a major adipokine with pleiotropic effects on inflammatory conditions including rheumatoid arthritis (RA). Adiponectin generally has anti-atherogenic effects, and its serum level inversely correlates with body mass index (BMI) and visceral fat area (VFA). On the other hand, several studies have indicated a deleterious role of adiponectin in RA progression [1]. Recently, both low BMI and increased serum adiponectin have been reported as poor prognostic factors of RA [2, 3]. However, large-scale surveys have not been done focusing on both BMI and serum adiponectin, and it is unclear which factor provides further contribution to RA disease activity. In addition, the effects of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase (JAK) inhibitors on serum adiponectin are largely unknown.

Objectives:

To clarify the relationship among serum adiponectin, body composition, current disease activity and therapeutic agents of RA.

Methods:

We conducted a cross-sectional study in RA patients under treatment with agents including bDMARDs and JAK inhibitors. A total of 351 subjects from the Kyoto University RA Management Alliance cohort (KURAMA) were enrolled. We classified the participants into five body composition groups (overweight with or without visceral adiposity, normal with or without visceral adiposity, and underweight), according to the cut-off points for obesity and visceral fat used in Japan: BMI, 18.5 kg/m2for underweight and 25.0 kg/m2for obesity, and VFA, 100 cm2for visceral adiposity. Differences of continuous variables among the five groups were assessed by the Steel-Dwass test or one-way analysis of variance (ANOVA). We adopted a multiple standardized linear regression model to analyze effects of serum adiponectin level on DAS28-ESR.

Results:

Serum adiponectin levels (20.9±12.5 vs. 14.7±8.4 µg/ml, p < 0.001) and DAS28-ESR (3.04±1.0 vs. 2.63±0.9,p= 0.017) in the underweight group were significantly higher than those in the others. In multiple regression analysis, serum adiponectin level, but not BMI, was positively correlated with DAS28-ESR (estimate = 0.0127,p= 0.0258). Subanalysis also showed that the use of bDMARD or JAK inhibitor did not have an obvious influence on circulating adiponectin.

Conclusion:

In the multiple regression analysis we revealed a positive and independent correlation between serum adiponectin and DAS28-ESR in Japanese RA patients. Thus, serum adiponectin is an potential marker reflecting high disease activity of RA regardless of current medications.

References:

[1]Frommer KW, Zimmermann B, Meier FM, Schroder D, Heil M, Schaffler A, et al. Adiponectin-mediated changes in effector cells involved in the pathophysiology of rheumatoid arthritis. Arthritis Rheum. 2010;62(10):2886-99.

[2]Kaufmann J, Kielstein V, Kilian S, Stein G, Hein G. Relation between body mass index and radiological progression in patients with rheumatoid arthritis. Journal of Rheumatology. 2003;30(11):2350-5.

[3]Ebina K, Fukuhara A, Ando W, Hirao M, Koga T, Oshima K, et al. Serum adiponectin concentrations correlate with severity of rheumatoid arthritis evaluated by extent of joint destruction. Clin Rheumatol. 2009;28(4):445-51.

Acknowledgments:

We would like to thank to Ms. Sumie Nakagawa for management of blood specimens, Ms. Noriko Kitayama and Ms. Maki Yoneyama for support of the patients. We also thank Drs. Takao Fujii, Chicashi, Terao, Masahide Hamaguchi, Hiroyuki Yoshitomi, and Masahiro Ishikawa for their thoughtful comments.

Disclosure of Interests:

Masao Katsushima: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Mirei Shirakashi: None declared, Tamami Yoshida: None declared, Wataru Yamamoto: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Kohei Nishitani Grant/research support from: KN belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Hiromu Ito: None declared, Shuichi Matsuda: None declared

OP0025 DRUG RETENTION OF 7 BIOLOGICS AND TOFACITINIB IN BIOLOGICS-NAÏVE AND BIOLOGICS-SWITCHED PATIENTS WITH RHEUMATOID ARTHRITIS -THE ANSWER COHORT STUDY

Background:

EULAR recommendation announced that biological disease-modifying antirheumatic drugs (bDMARDs) and janus kinase inhibitors (JAKi) are considered as equivalent in the treatment of rheumatoid arthritis (RA). However, we still lack reliable evidence of direct comparison between these agents’ retention, which may reflect both effectiveness and safety.

Objectives:

The aim of this multi-center (7 university-related hospitals), retrospective study is to clarify retention rates and reasons for discontinuation of 7 bDMARDs and tofacitinib (TOF), one of the JAKi, in both bDMARDs-naïve and bDMARDs-switched cases.

Methods:

This study assessed 3,897 patients and 4,415 treatment courses of with bDMARDs and TOF from 2001 to 2019 (2,737 bDMARDs-naïve patients and 1,678 bDMARDs-switched patients [59.5% switched to their second agent], female 82.3%, baseline age 57.4 years, disease duration 8.5 years; rheumatoid factor positivity 78.4%; DAS28-ESR 4.3; concomitant prednisolone [PSL] 6.1 mg/day [42.4%] and methotrexate [MTX] 8.5 mg/week [60.9%]). Treatment courses included abatacept (ABT; n=663), adalimumab (ADA; n=536), certolizumab pegol (CZP; n=226), etanercept (ETN; n=856), golimumab (GLM; n=458), infliximab (IFX; n=724), tocilizumab (TCZ; n=851), and TOF (n=101/only bDMARDs-switched cases). Reasons for discontinuation were classified into four categories by each attending physician: 1) lack of effectiveness, 2) toxic adverse events, 3) non-toxic reasons, and 4) remission. Retention rates of each discontinuation reason were estimated at 36 months using the Kaplan-Meier method and adjusted for potential clinical confounders (age, sex, disease duration, concomitant PSL and MTX, starting date and number of switched bDMARDs) using Cox proportional hazards modeling.

Results:

Adjusted drug retention rates for each discontinuation reason were as follows: lack of effectiveness in the bDMARDs-naïve group (from 70.8% [CZP] to 85.1% [ABT]; P=0.001 between agents) and the bDMARDs-switched group (from 52.8% [CZP] to 78.7% [TCZ]; P<0.001 between agents). Toxic adverse events in the bDMARDs-naïve group (from 86.9% [IFX] to 96.3% [ABT]; P<0.001 between agents) and the bDMARDs-switched group (from 81.1% [ADA] to 95.4% [ETN]; P=0.01 between agents). Finally, overall retention rates excluding discontinuation for non-toxic reasons or remission ranged from 64.2% (IFX) to 82.0% (ABT) (P<0.001 between agents) in the bDMARDs-naïve group (figure a) and from 44.2% (ADA) to 66.8% (TCZ) (P<0.001 between agents) in the bDMARDs-switched group (figure b).

Conclusion:

Remarkable differences were observed in drug retention of 7 bDMARDs and TOF between bDMARDs-naïve and bDMARDs-switched cases.

Disclosure of Interests:

Kosuke Ebina Grant/research support from: KE has received research grants from Abbie, Asahi-Kasei, Astellas, Chugai, Eisai, Ono Pharmaceutical, and UCB Japan., Employee of: KE is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho., Speakers bureau: KE has received payments for lectures from Abbie, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Sanofi, and UCB Japan., Toru Hirano Grant/research support from: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Speakers bureau: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Yuichi Maeda Grant/research support from: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Speakers bureau: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Wataru Yamamoto: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Tohru Takeuchi Grant/research support from: TT received a research grant from Chugai, CoverLetter and a speaker fee from Astellas, Chugai, Eisai, Mitsubishi-Tanabe, Abbvie, Bristol-Myers Squibb, Ayumi, Daiichi Sankyo, Eisai, Takeda, and Asahi-Kasei, Employee of: TT is affiliated with a department that is financially supported by six pharmaceutical companies (Mitsubishi-Tanabe, Chugai, Ayumi, Astellas, Eisai, and Takeda), Hideyuki Shiba: None declared, Yonsu Son: None declared, Hideki Amuro: None declared, Akira Onishi Speakers bureau: AO received a speaker fee from Chugai, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Asahi-Kasei, and Takeda, Kengo Akashi: None declared, Ryota Hara Speakers bureau: RH received a speaker fee from AbbVie, Masaki Katayama: None declared, Keiichi Yamamoto: None declared, Atsushi Kumanogoh Grant/research support from: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer, Speakers bureau: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer, Makoto Hirao Speakers bureau: MHirao received a speaker fee from Astellas, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Pfizer, Ayumi, and Takeda

THU0174 ANTI-IL-6 RECEPTOR ANTIBODY AMELIORATES DISEASE ACTIVITY OF RHEUMATOID ARTHRITIS PATIENTS WITH KNEE JOINT INVOLVEMENT -ANSWER COHORT STUDY-

Background:

It has been reported that rheumatoid arthritis (RA) patients who have large joint involvement associated with higher serological inflammatory markers and more functional disability1. Moreover, a previous report showed that these patients were more difficult to achieve clinical remission. However, it remains unclear which biologics are effective in the patients with RA who have large joint involvement.

Objectives:

The aim of this study is to investigate the efficacy of anti-IL-6 receptor antibody (aIL-6) or TNF-inhibitor (TNFi) in the treatment of RA patients who have knee joint involvement.

Methods:

We enrolled the 784 patients who visited our hospitals in 2003 to 2019 and were treated with aIL-6 or TNFi more than 12 weeks. We divided the patients into 2 groups with or without knee joint involvement for further analysis. Knee joint involvement was defined as the patients had at least one swelling joint of knee at baseline. We investigated the CDAI levels at baseline and 12 weeks after the initiation of biologics.

Results:

Interestingly, the patients who had knee joint involvement with aIL-6 significantly ameliorated ΔCDAI (n=95, 15.0±10.8; mean±SD) compared to those with TNFi (n=148, 11.4±10.3) at 12 weeks (P=0.003). aIL-6 group consists of 95 tocilizumab treated patients. TNFi group includes 25 adalimumab, 25 certolizumab pegol, 14 etanercept, 54 golimumab and 30 infliximab treated patients. Baseline clinical characteristics of the 243 RA patients who had knee joint involvement were shown in Table 1. Mean ages, sex and disease durations were not significantly different between the two groups. Baseline CDAI levels of aIL-6 group (24.8±11.8) were slightly elevated compared to those of TNFi group (21.7 ±10.9). Multivariate analysis adjusted for age, gender and baseline CDAI levels revealed that aIL-6 significantly improved ΔCDAI levels compared to TNFi (P=0.04). By contrast, in the RA patients who had no swelling of knee joints, there was no significant difference of ΔCDAI improvement between aIL-6 group (n=156, 5.5±7.4) and TNFi group (n=385, 6.7±8.9).

Table 1.

Baseline clinical characteristics of 243 RA patients who had knee joint involvement

aIL-6 group(n=95)TNFi group(n=148)p ValueAge (mean±SD)60.7±15.261.9±14.40.58Gender (female, %)80.079.10.97Duration (year)9.3 ±10.38.4±10.50.56DAS28ESR (mean±SD)5.3±1.25.2 ±4.80.03CDAI (mean ±SD)24.8±11.821.7 ±10.90.04MTX use, (%)45.462.20.02MTX dose (mg/day)8.7 ±3.39.0 ±3.50.61PSL use, (%)44.345.60.74PSL dose (mg/day)5.5 ±3.55.1 ±2.90.55

Conclusion:

Thus, these findings suggest that anti-IL-6 receptor antibody was more effective in the RA patients with knee joint involvement compared to TNF- inhibitor.

References:

[1]Burgers LE, et al.Ann Rheum Dis. 2018;77:e33.

Disclosure of Interests:

Yuichi Maeda Grant/research support from: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Speakers bureau: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Toru Hirano Grant/research support from: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Speakers bureau: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Ryota Hara Speakers bureau: RH received a speaker fee from AbbVie, Kosuke Ebina Grant/research support from: KE has received research grants from Abbie, Asahi-Kasei, Astellas, Chugai, Eisai, Ono Pharmaceutical, and UCB Japan., Employee of: KE is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho., Speakers bureau: KE has received payments for lectures from Abbie, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Sanofi, and UCB Japan., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Wataru Yamamoto: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Takuya Kotani: None declared, Kenichiro Hata: None declared, Yonsu Son: None declared, Hideki Amuro: None declared, Akira Onishi Speakers bureau: AO received a speaker fee from Chugai, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Asahi-Kasei, and Takeda, Jinno Sadao: None declared, Masaki Katayama: None declared, Atsushi Kumanogoh Grant/research support from: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer, Speakers bureau: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer

Spectroscopic Evidence for Electron-Boson Coupling in Electron-Doped Sr_{2}IrO_{4}

The pseudogap, d-wave superconductivity and electron-boson coupling are three intertwined key ingredients in the phase diagram of the cuprates. Sr_{2}IrO_{4} is a 5d-electron counterpart of the cuprates in which both the pseudogap and a d-wave instability have been observed. Here, we report spectroscopic evidence for the presence of the third key player in electron-doped Sr_{2}IrO_{4}: electron-boson coupling. A kink in nodal dispersion is observed with an energy scale of ∼50  meV. The strength of the kink changes with doping, but the energy scale remains the same. These results provide the first noncuprate platform for exploring the relationship between the pseudogap, d-wave instability, and electron-boson coupling in doped Mott insulators.

Band-dependent superconducting gap in SrFe2(As0.65P0.35)2 studied by angle-resolved photoemission spectroscopy

The isovalent-substituted iron pnictide compound SrFe₂(As_1−xP_x)₂ exhibits multiple evidence for nodal superconductivity via various experimental probes, such as the penetration depth, nuclear magnetic resonance and specific heat measurements. The direct identification of the nodal superconducting (SC) gap structure is challenging, partly because the presence of nodes is not protected by symmetry but instead caused by an accidental sign change of the order parameter, and also because of the three-dimensionality of the electronic structure. We have studied the SC gaps of SrFe₂(As_0.65P_0.35)₂ in three-dimensional momentum space by synchrotron and laser-based angle-resolved photoemission spectroscopy. The three hole Fermi surfaces (FSs) at the zone center have SC gaps with different magnitudes, whereas the SC gaps of the electron FSs at the zone corner are almost isotropic and k_z-independent. As a possible nodal SC gap structure, we propose that the SC gap of the outer hole FS changes sign around the Z-X [(0, 0, 2π) − (π, π, 2π)] direction.

Oral steroid decreases the progression of joint destruction of large joints in the lower extremities in rheumatoid arthritis

To identify the risk factors for destruction of large joints in the lower extremities in patients with rheumatoid arthritis (RA) during a 4-year follow-up period in a prospective study.We enrolled consecutive patients who participated in both 2012 and 2016. Clinical data, disease activity, and types of medication were collected in 2012. Standard anteroposterior radiographs of weight-bearing joints (hips, knees, and ankles) were taken in 2012 and 2016. Radiographic progression was defined as progression in the Larsen grade or the need for joint arthroplasty or arthrodesis. The association between baseline characteristics and the incidence of radiographic progression was statistically assessed.A total of 213 patient were enrolled, and, after exclusion, 186 patients were analyzed. Sixty 9 patients (37.1%) showed radiographic progression in 1 of the large joints in the lower extremities. Multivariate regression analysis showed that radiographic progression was associated with older age, higher disease activity, and the presence of radiographic destruction at the baseline. The lower dosage of oral prednisolone was a significant risk factor compared with higher dosage when used.Patients with the risk factors should be followed closely to limit the progression of large joint destruction in the lower extremities.

Momentum Dependence of the Nematic Order Parameter in Iron-Based Superconductors

The momentum dependence of the nematic order parameter is an important ingredient in the microscopic description of iron-based high-temperature superconductors. While recent reports on FeSe indicate that the nematic order parameter changes sign between electron and hole bands, detailed knowledge is still missing for other compounds. Combining angle-resolved photoemission spectroscopy with uniaxial strain tuning, we measure the nematic band splitting in both FeSe and BaFe_{2}As_{2} without interference from either twinning or magnetic order. We find that the nematic order parameter exhibits the same momentum dependence in both compounds with a sign change between the Brillouin center and the corner. This suggests that the same microscopic mechanism drives the nematic order in spite of the very different phase diagrams.

Distinct biomarkers for different bones in osteoporosis with rheumatoid arthritis

Background

Rheumatoid arthritis (RA) is known to cause secondary osteoporosis and fragility fractures. This study aimed to identify biomarkers predictive of bone mineral density (BMD) change at three anatomical sites in patients with RA.

Methods

We conducted a prospective longitudinal study in patients with RA. In 2012, we recruited 379 patients from an RA cohort, 329 of whom underwent evaluation of blood and urine biomarkers together with measurement of BMD in the lumbar spine, proximal femur, and distal forearm. The BMD in these three regions was reassessed in 2014. We performed multivariate linear regression analysis to identify those factors associated with BMD change.

Results

The averages of age, body mass index, and disease activity score in 28 joints (DAS28) at baseline were 63.2 (minimum to maximum, 32–85), 21.3 (12.3–30.0), and 3.2 (0.1–5.9), respectively. Univariate analysis showed that the annual BMD change was significantly associated with the use of steroid, bisphosphonate (BP) or vitamin D (VitD), and serum homocysteine in the lumber spine; DAS28, the use of BP or VitD, CRP, and anti-cyclic citrullinated peptide antibody (ACPA) in the proximal femur; and the dosage of MTX, the use of BP or VitD, and serum tartrate-resistant acid phosphatase 5b (TRACP-5b) in the distal forearm, respectively.

Conclusions

Predictive biomarkers for BMD change in RA patients differ at each anatomical site. Practitioners should treat each anatomical site with different markers and prescribe osteoporosis drugs to prevent fractures for RA patients.

Band-Resolved Imaging of Photocurrent in a Topological Insulator

We study the microscopic origins of photocurrent generation in the topological insulator Bi_{2}Se_{3} via time- and angle-resolved photoemission spectroscopy. We image the unoccupied band structure as it evolves following a circularly polarized optical excitation and observe an asymmetric electron population in momentum space, which is the spectroscopic signature of a photocurrent. By analyzing the rise times of the population we identify which occupied and unoccupied electronic states are coupled by the optical excitation. We conclude that photocurrents can only be excited via resonant optical transitions coupling to spin-orbital textured states. Our work provides a microscopic understanding of how to control photocurrents in systems with spin-orbit coupling and broken inversion symmetry.

Intrahepatic cholangiocarcinoma and portal hypertension developing in a patient with multicystic biliary microhamartomas

INTRODUCTION

We report a case of intrahepatic cholangiocarcinoma and portal hypertension developing in a liver with biliary microhamartomas (von Meyenburg's complex).

CASE REPORT

The patient was a 55-year-old man who had a past medical history of diffuse multiple liver abscesses. During follow-up examination, a hypovascular nodule measuring 2.1 cm in diameter was incidentally found in segment 8 of the liver. Surgical resection was performed based on a suspected diagnosis of hepatocellular carcinoma. A gastrofiberscopy examination detected characteristic findings of portal hypertensive gastropathy. During the laparotomy, multiple tiny cystic lesions were observed in a diffuse pattern across the liver surface. The liver parenchyma was slightly fibrotic and haemorrhagic. A histopathological examination revealed intrahepatic cholangiocarcinoma with vascular invasions in von Meyenburg's complex. Multiple biliary adenomas were also observed among the biliary microhamartomas adjacent to the main tumour, suggesting that the malignant transformation of the biliary adenomas might have been responsible for the development of the intrahepatic cholangiocarcinoma. The histopathologic examination also revealed sinusoidal dilation and abnormal spacing of the portal tracts and central veins as evidence of portal hypertension.

Three-dimensional collective charge excitations in electron-doped copper oxide superconductors

High-temperature copper oxide superconductors consist of stacked CuO₂ planes, with electronic band structures and magnetic excitations that are primarily two-dimensional^1,2, but with superconducting coherence that is three-dimensional. This dichotomy highlights the importance of out-of-plane charge dynamics, which has been found to be incoherent in the normal state^3,4 within the limited range of momenta accessible by optics. Here we use resonant inelastic X-ray scattering to explore the charge dynamics across all three dimensions of the Brillouin zone. Polarization analysis of recently discovered collective excitations (modes) in electron-doped copper oxides^5-7 reveals their charge origin, that is, without mixing with magnetic components^5-7. The excitations disperse along both the in-plane and out-of-plane directions, revealing its three-dimensional nature. The periodicity of the out-of-plane dispersion corresponds to the distance between neighbouring CuO₂ planes rather than to the crystallographic c-axis lattice constant, suggesting that the interplane Coulomb interaction is responsible for the coherent out-of-plane charge dynamics. The observed properties are hallmarks of the long-sought 'acoustic plasmon', which is a branch of distinct charge collective modes predicted for layered systems^8-12 and argued to play a substantial part in mediating high-temperature superconductivity^10-12.