POS0466 RHEUMATOID ARTHRITIS PER SE IS NOT RISK FACTOR FOR CLINICAL FRACTURES: NINE-YEAR FINDINGS OF THE TOMORROW STUDY

Background:

Patients with rheumatoid arthritis (RA) who have sarcopenia and stiff or painful joints might be at increased risk of falls and fractures.

Objectives:

The present study aimed to prospectively identify the incidence of clinical fractures and associated risk factors in patients with RA in a cohort study named the TOMORROW (UMIN000003876) that started in 2010.

Methods:

We evaluated anthropometric parameters, bone mineral density (BMD), disease activity, RA medication at baseline and observed the incidence of clinical fractures during nine years in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched non-RA volunteers (mean age, 57.4 y). We compared the incidence of clinical fractures between patients with RA and controls for nine years, and analyzed the risk factors for fractures using Cox proportional hazard model.

Results:

The incidence of clinical fractures in RA patients was significantly higher compared to controls (27.5 vs 18.3%, p=0.04). However, Cox proportional hazard model, adjusted by age, sex, smoking and body mass index, revealed that low BMD at thoracic vertebrae (< 0.7 g/cm2) significantly associated to the incidence of clinical fractures (hazard ratio [HR], 1.86, p=0.02), but not RA morbidity (HR 1.47, p=0.10) (Table 1). Among patients with RA, low BMD at the thoracic vertebrae (< 0.7 g/cm2) was the most prominent risk factor for clinical fractures (HR, 2.66, p=0.02) (Table 1). Although the use of glucocorticoid (GC) at baseline (HR, 1.68, p=0.09) was not a significant risk factor for fractures, a mean GC dose (≥ 2 mg/day) at entry increased risk for clinical fractures in the patients (HR, 1.91, p=0.04) (Table 1).

Conclusion:

RA per se was not a risk factor for clinical fractures in this cohort. Low BMD at the thoracic vertebrae and the use of GC with even low dose at entry were apparently significant risk factors for the incidence of clinical fractures among patients with RA.

Disclosure of Interests:

Kenji Mamoto: None declared, Tatsuya Koike Grant/research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation,

Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Yutaro Yamada: None declared, Tadashi Okano: None declared, Yuko Sugioka: None declared, Masahiro Tada: None declared, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd., Hiroaki Nakamura: None declared

Association of residual gastric acid secretion with persistent symptoms in gastroesophageal reflux disease patients receiving standard-dose proton pump inhibitor therapy

BACKGROUND

Although a third of gastroesophageal reflux disease (GERD) patients are refractory to proton pump inhibitor (PPI) therapy, the underlying mechanism of the refractoriness remains unclear. We compared the level of gastric acid suppression during PPI treatment between responders and non-responders by directly measuring gastric acid secretion in GERD patients taking PPIs.

METHODS

Seventy-five consecutive patients receiving standard-dose PPI therapy for GERD were prospectively recruited, irrespective of persistent GERD symptoms. They were asked about their GERD symptoms using a validated questionnaire, and simultaneously underwent both a routine endoscopic examination and a gastric acid secretory testing using an endoscopic gastrin test. Associations between residual gastric acid secretion during PPI treatment and persistent GERD symptoms were analyzed by a logistic regression analysis.

RESULTS

Overall, 26 of 75 (34.7%) patients were judged to be positive for persistent GERD symptoms. The patients with and without persistent symptoms showed similar gastric acid secretion levels (1.3 [1.3] mEq/10 min vs. 1.4 [2.0] mEq/10 min). Sufficient gastric acid suppression, defined as < 0.6, was not significantly associated with persistent GERD symptoms (odds ratio 1.1, 95% confidence interval 0.40-3.5).

CONCLUSIONS

This study provided solid evidence to support that the gastric acid suppression level during PPI treatment does not differ between patients with and without persistent GERD symptoms. The insignificant role of residual gastric acid in the persistent GERD symptoms suggests that the use of medications other than those that enhance gastric acid inhibitory effects would be an essential approach for the management of PPI-refractory GERD.

Observation of Coulomb-Assisted Nuclear Bound State of Ξ^{-}-^{14}N System

In an emulsion-counter hybrid experiment performed at J-PARC, a Ξ^{-} absorption event was observed which decayed into twin single-Λ hypernuclei. Kinematic calculations enabled a unique identification of the reaction process as Ξ^{-}+^{14}N→_{Λ}^{10}Be+_{Λ}^{5}He. For the binding energy of the Ξ^{-} hyperon in the Ξ^{-}-^{14}N system a value of 1.27±0.21  MeV was deduced. The energy level of Ξ^{-} is likely a nuclear 1p state which indicates a weak ΞN-ΛΛ coupling.

Eicosapentaenoic acid enhances skeletal muscle hypertrophy without altering the protein anabolic signaling pathway

This study aimed to examine the effect of eicosapentaenoic acid (EPA) on skeletal muscle hypertrophy induced by muscle overload and the associated intracellular signaling pathways. Male C57BL/6J mice were randomly assigned to oral treatment with either EPA or corn oil for 6 weeks. After 4 weeks of treatment, the gastrocnemius muscle of the right hindlimb was surgically removed to overload the plantaris and soleus muscles for 1 or 2 weeks. We examined the effect of EPA on the signaling pathway associated with protein synthesis using the soleus muscles. According to our analysis of the compensatory muscle growth, EPA administration enhanced hypertrophy of the soleus muscle but not hypertrophy of the plantaris muscle. Nevertheless, EPA administration did not enhance the expression or phosphorylation of Akt, mechanistic target of rapamycin (mTOR), or S6 kinase (S6K) in the soleus muscle. In conclusion, EPA enhances skeletal muscle hypertrophy, which can be independent of changes in the AKT-mTOR-S6K pathway.

SAT0044 ADIPOCYTOKINE FLUCTUATES WITH INFLAMMATORY MARKERS OR DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM FIVE-YEAR DATA OF TOMORROW STUDY

Background:

Leptin and adiponectin have been thought to be adipocytokines that promote or suppress inflammation, respectively.

Objectives:

The aim of this study was to investigate the relationship between adipocytokine and inflammatory markers or disease activity in patients with rheumatoid arthritis (RA) by using 5-year data of TOMORROW study which is a cohort study and started from 2010.

Methods:

We evaluated inflammatory markers, disease activity score (DAS)-CRP, medication and levels of adipocytokines in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched healthy volunteers (controls; mean age, 57.4 y). We eventually compared leptin or adiponectin concentrations in 183 RA patients and 190 controls from 2010 (BL) to 2015 (5Y) and investigated the relationship between adipocytokines and CRP or DAS in patients by using Spearman correlation analysis.

Results:

The levels of leptin and adiponectin in patients were significantly higher than controls at all time points. Adiponectin level of patients significantly increased from BL to 5Y compared to controls (Table 1). In patients, adiponectin showed significant negative correlation with CRP at both of BL and 5Y (BL:R=-0.174, 5Y:R=-0.240; p<0.05), however, not with DAS at BL and 5Y. Leptin positively correlated with CRP at 5Y(R=0.207; p<0.05), but not with CRP at BL or DAS at any time. Adiponectin levels at BL and 5Y were significantly higher in biologics users at BL and significantly increased from BL to 5Y compared to patients without biologics. No association between leptin levels and the use of biologics (Table 2).

Conclusion:

The level of adiponectin in RA patients with continuous treatments for 5 years increased, and the trend was more pronounced in biologics users. These results might indicate that adiponectin is a cytokine involved in anti-inflammatory effects.

Disclosure of Interests:

Kenji Mamoto: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Yuko Sugioka: None declared, Masahiro Tada: None declared, Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

AB0215 EARLY IMPROVEMENT OF THE POWER DOPPLER SIGNAL CAN PREDICT TO CONTINUE THE BIOLOGICAL DMARDS AFTER 1 YEAR

Background:

In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. On the other hand, the effects of biologics cannot be obtained satisfactorily in all patients, and there are some cases in which treatment is interrupted due to ineffective or adverse events. However, the useful predictive markers of the biologics have not been found in the early phase of treatment in RA. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA.

Objectives:

In this study, we investigated whether continuation of biologics treatment can be predicted by ultrasonographic findings in the early phase.

Methods:

Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included. All the patients were performed clinical examination, blood tests and US examination of hand and foot at baseline, 4, 12, 24, 36 and 52 weeks. US examination was performed on MCP joints, PIP joints, wrist and MTP joints.

Results:

Among 54 cases, 42 cases were able to continue treatment until one year later, and the continuation rate was 80.8%. Of the 12 patients who discontinued first biologics treatment, 5 were changes to other biologics due to inadequate response, 4 were their wishes, and 3 were adverse events. Multiple regression analysis was performed with treatment continuation as the dependent variable and improvement of CRP, MMP-3, DAS28-CRP, grayscale score and power Doppler score in 4 weeks as explanatory variables. Only improvement of power Doppler score was extracted as a significant predictor (p = 0.045). In the continuation group, the improvement of the power Doppler signal at week 4 was 36% compared with the baseline, compared with 10% in the discontinuation group.

Conclusion:

The early improvement of power Doppler signal in 4 weeks could be a predictive factor for the continuation of 1-year biological treatment.

References:

[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.

[2]Atzeni F, Talotta R, Masala IF, Bongiovanni S, Boccassini L, Sarzi-Puttini P. Biomarkers in Rheumatoid Arthritis. Isr Med Assoc J. 2017;19:512-6.

Table 1.

Multivariate regression analysis of predictive factors for continuation of biologics treatment in 1-year.

Improvement ratio of 0 to 4 weeksbetaP valueCRP-0.1220.465MMP-30.2280.103DAS28 CRP0.2800.103Ultrasound grey scale score-0.3420.119Ultrasound power Doppler score0.4420.045

Acknowledgments:

We thank Emi Yamashita, Yuko Yoshida, Asami Fujii and Shingo Washida who performed ultrasound examination.

Disclosure of Interests:

Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

FRI0051 RHEUMATOID ARTHRITIS PATIENTS WITH HIGH DISEASE ACTIVITY AND TREATED WITH HIGH DOSE GLUCOCORTICOID FREQUENTLY FALL: NINE YEARS OF THE TOMORROW STUDY

Background:

Falling is a multicausal phenomenon resulting from complex interactions between intrinsic and extrinsic or environmental factors. Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falling. However, little is known about the exact properties of risk factors for falling in patients with RA. Recently, the disease activity of RA has been more satisfactorily controlled by the ‘‘treat-to-target’’ strategy, including the use of biologics. Given this new era, it is important to accurately estimate the incidence of falling in patients with RA and to elucidate contributing risk factors.

Objectives:

The objective of this study was to evaluate the incidence of falling and associated risk factors in 208 patients with RA and in age- and sex-matched 205 controls (Co) who participated in the TOMORROW (TOtalManagementOfRisk factors inRheumatoid arthritis patients to lOWer morbidity and mortality) study, a 10-year cohort study that started in 2010 in Japan. This research was conducted using TOMORROW study data for 9 years.

Methods:

We evaluated the incidence of falling by self-administered questionnaire every year and confirmed them by medical records. We also collected information about general health status, body composition including bone mineral density, lean body mass, fat mass and laboratory data. We compared the frequency of the incidence of falling in RA patients and Co for 9 years and analyzed risk factors for falling.

Results:

A total of 157 patients with RA (mean age: 57.1 ± 12.5 years, female: 84.7%, mean disease duration 13.9 ± 12.0 years) and 169 Co (mean age: 57.6 ± 12.5 years, female: 84.0%) completed 9 years observation. The rate of individuals who fell did not differ between two groups (RA: 66.9%, Co: 59.2%, p=0.19). However, number of falls was higher in RA than Co (0.35 vs 0.21/person-year, p=0.03). Multivariate logistic regression analysis adjusted for age, sex and BMI, revealed that RA was not a risk factor for the incidence of falling (OR: 1.36, 95%CI: 0.8-2.32, p=0.26) and the history of falling was a risk factor for the incidence of falling (OR: 3.27, 95%CI: 1.78-7.0, p<0.001). Multivariate linear regression analysis adjusted for age, sex and BMI, revealed that mHAQ (β=0.17, p=0.04), mean DAS28-CRP over 9 years (β=0.19, p=0.02) and mean dosage of glucocorticoid over 9 years (β=0.18, p=0.03) were the risk factors for number of falls (table 1).

Table 1.

Multivariate linear regression analysis of risk factors associated with number of falls sustained by patients RA.

RAN=157Number of fallsβpAt the entryAnti-CCP antibody (U/mL)0.0160.835RF (IU/ml)0.0200.803History of falling0.1030.201DAS28-CRP0.0780.333mHAQ0.1690.039Dose of GC (mg/day)0.0280.7239 yearsAverage DAS28-CRP0.1850.024Average dose of GC (mg/day)0.1790.025

RA, rheumatoid arthritis; CCP, cyclic citrullinated peptide; RF, Rheumatoid factor; DAS28-CRP, disease activity score 28 with C-reactive protein; mHAQ, modified Health Assessment Questionnaire; GC, glucocorticoid.

Conclusion:

There was no difference in the incidence of falling between RA and Co. However, number of falls was significantly higher in RA group. High disease activity and higher dosage of glucocorticoid were the risk factors for number of falls among RA patients.

References:

[1]C Armstrong et al, Ann Rheum Dis 2005;64:1602–1604

[2]M Hayashibara et al, Osteoporos Int 2010;21:1825–1833

Acknowledgments:

We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka and all participants in this study.

Disclosure of Interests:

Shohei Anno: None declared, Yuko Sugioka: None declared, Kenji Mamoto: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Masahiro Tada: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

FRI0609-HPR NUTRIENTS INTAKE CONDITION RELATES TO MAINTENANCE LOW DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING 6 YEARS: TOMORROW STUDY

Background:

We have previously reported that nutritional intake status might relate to disease activity (1). Nutritional survey on prospective cohort study in rheumatoid arthritis (RA) patients and information about relationship between nutritional intake status and disease activity was very limited.

Objectives:

This study aimed to obtain data from a cohort study for new nutritional therapy in RA patients.

Methods:

We used TOMORROW cohort study data which conducted from years of 2010 to 2020. Two hundred and eight RA patients, and 205 non-RA sex and age matched controls were investigated, and we analyzed data from 2011 to 2017. Nutritional intake status was compared between who maintain lower disease activity during 2011 to 2017 (LDA group) and being higher disease activity even once in 2011 to 2017 (non-LDA group). Disease activity was evaluated by DAS28-ESR in every year and nutritional intake status was surveyed by brief self-administered diet history questionnaire (BDHQ) in 2011 and 2017.

Results:

In RA patients, the change value from 2011 to 2017 of iron (odds ratio; 2.37), thiamin (OR; 2.96) and folic acid (OR; 3.16) intake which adjusted by energy intake, age, rheumatoid factor and medication status were extracted as independent factors for maintain LDA by multivariate logistic regression. These nutrients intake in RA patients was significantly lower than control both in 2011 and 2017. In RA patients, iron and folic acid intake in LDA group was significantly lower than non-LDA group in 2011. Folic acid intake was increased in LDA group and decreased in non-LDA group over time, and these nutrients showed significant differences in change value between LDA group and non-LDA group (p<0.05).

Conclusion:

The overtime change value in iron, thiamin and folic acid related to maintain six years low disease activity in RA patients.

References:

[1] Matsumoto Y, Sugioka Y, Tada M, Okano T, Mamoto K, Inui K, et al. Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: The TOMORROW study. Clinical Nutrition 37:675-680, 2018

Disclosure of Interests:

Yoshinari Matsumoto Grant/research support from: Yamada Research Grant (grant No.249), Yuko Sugioka: None declared, Masahiro Tada: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Daiki Habu: None declared, Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB

AB0235 DENOSUMAB INCREASE THE BONE MINERAL DENSITY REGARDLESS OF DISEASE ACTIVITY, THE BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS, THE CONCOMITANT TYPE OF VITAMIN D, AND PRETREATMENT OF OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Osteoporosis is one of the major comorbidities in patients with rheumatoid arthritis (RA). There are a lot of evidence that denosumab increase bone mineral density (BMD) in patients with osteoporosis. However, there are few reports investigated the influence of denosumab in patients with RA.

Objectives:

We evaluated the BMD change in patients with RA treated denosumab and assessed the effect of various factors, such as disease activity, biological disease-modifying anti-rheumatic drugs (bDMARDs) use, concomitant medications of osteoporosis and pretreatment of osteoporosis.

Methods:

This study included 140 consecutive RA patients (135 female, mean age was 70.6 ± 8.6 years) who fullfilled the criteria of osteoporosis and treated with denosumab. BMD at the lumbar spine, proximal femoral and femoral neck were evaluated by dual energy X-ray absorptiometry at baseline and one year after treatment. We evaluated the influence of disease activity, bDMARDs use, the concomitant type of vitamin D and pretreatment of osteoporosis for BMD change.

Results:

BMD change at the lumbar spine, proximal femoral and femoral neck were 5.9% (p<0.01), 4.0% (p<0.01), and 1.2% (p=0.36) durling one year. There were no differences in improvement ratio of BMD between each parameters (fig 1). Disease activity: 75 patients in remission or low disease activity and 65 patients in moderate or high disease activity were 6.4 vs 5.3% (p=0.91), 3.0 vs 5.1% (p=0.73), 2.0 vs 0.3% (p=0.1). bDMARDs: 45 patients with bDMARDs (anti-tumor necrosis factor inhibitors (TNF): 23, tocilizmab (TCZ): 13, abatacept (ABT): 7, Tofacitinib: 2) and 93 patients without bDMARDs were 6.0 vs 5.8% (p=0.31), 4.3 vs 4.1% (p=0.57), -0.2 vs 1.8% (p=0.18). Type of vitamin D: 47 patients taking active form vitamin D and 60 patients taking native form vitamin D were 5.5 vs 6.8% (p=0.82), 3.1 vs 3.8% (p=0.93), 0.4 vs 1.9% (p=0.14). Pretreatment of osteoporosis: 74 patients with pretreatment of osteoporosis (bisphosphonate:58, teriparatide:16) and 66 patients without pretreatment of osteoporosis were 6.9 vs 5.4% (p=0.41), 0.9 vs 4.0% (p=0.22), 2.0 vs 1.2% (p=0.68). Moreover, BMD change were not different in bDMARDs type, 5.0, 6.4, 0.5% in TNF group, 4.8, 0.7, -1.9% in TCZ group, 9.7, 4.9, 0.2% in ABT group (TNF vs TCZ: p=0.83, 0.98, 0.81, TNF vs ABT: p=0.83, 0.41, 0.97, TCZ vs ABT: p=0.98, 0.43, 0.9). There were no difference between bisphosphonate and teriparatide (6.2 vs 6.9%: p=0.49, 4.8 vs 0.9%: p=0.35, 0.9 vs 2.0%: p=0.49).

Conclusion:

Denosumab improved BMD in patients with RA independently regardless of disease activity, bDMARDs, the concomitant type of vitamin D and pretreatment of osteoporosis.

References:

[1]Y Nakamura et al, Arch Osteoporos: 2017; 12:80.

[2]K Kaneko et al, Journal of Experimental Orthopaedics: 2019; 6:41.

[3]T Suzuki et al, Therapeutics and Clinical Risk Management: 2018; 14:453–459.

Acknowledgments:

We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka, Masato Uematsu and all participants in this study.

Disclosure of Interests:

Shohei Anno: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

0147 Dynamic Alterations in Functional Connectivity Between Sleep- and Wake-Promoting Regions of the Human Brain at the Sleep Onset Period

Introduction

The sleep onset period, involving so-called stage N1 sleep largely, is characterized by a reduction in the amount of alpha activity compared to wakefulness. Various kinds of physiological and psychological changes are also apparent, such as slow eye movements, changes in muscle tonus, and the hypnagogic dream-like mentation. These phenomena are thought to be the reflection of dynamic alterations in the brain during the transition period, however, details of these changes have still been uncovered.

Methods

We aimed to investigate a dynamic shift in the brain connectivity at sleep onset using the method of EEG-fMRI simultaneous recording. Twenty-three healthy subjects participated. EEG/fMRI were recorded simultaneously during an hour’s nap in a 3T-MRI scanner and real-time monitoring of EEG was performed. To record the transition period between multiple times, an experimenter inside a scanner room touched a subject’s foot for inducing arousal when a shift to NREM sleep stage 1 was observed. EEG data were scored according to the AASM criteria. Based on sleep stages defined by polysomnographic findings, we investigated alterations in functional connectivity of sleep- and wake- promoting regions within the hypothalamus and other areas including the thalamus.

Results

Posterior alpha power showed significant positive correlation with BOLD signals in the anterior and medial dorsal thalamus. Connectivity between the thalamus and cortical regions reduced sharply in the descent to sleep stage. Meanwhile, BOLD signals of the sleep- and wake- promoting regions within the hypothalamus fluctuated with certain temporal lags from fluctuations of alpha rhythm at sleep onset.

Conclusion

Present findings provide preliminary evidence of dynamics of wake- and sleep- promoting regions in the human brain in vivo. Our data also support the hypothesis that reduced thalamocortical connectivity which limits the capacity to integrate information is associated with the transition of consciousness at sleep onset.

Support

None

Non-contact and real-time measurement of heart rate and heart rate variability using microwave reflectometry

In this paper, we present noncontact and noninvasive vital signal detection using a microwave reflectometer. Elimination of noise components due to random movement of human subjects has been the biggest issue for microwave measurement. Appropriate filtering, amplitude control of the reflectometer signal, and cross correlation among multiple reflectometers together with new algorithms have enabled motion artifact elimination, signal peak detection, and data processing for various parameters related to heart rate (HR) and heart rate variability (HRV). We focus here on the real time measurements of instantaneous HR and HRV for practical use. The evaluation by microwave reflectometry is completely noninvasive and feasible even through clothing, which is extremely effective for health maintenance in daily life as well as for preventing sudden death related to, for example, coronary heart disease and ventricular arrhythmia.

Interlaboratory Evaluation of Two Enzyme-Linked Immunosorbent Assay Kits for the Determination of Crustacean Protein in Processed Foods

The labeling of foods containing material derived from crustaceans such as shrimp and crab is to become mandatory in Japan because of increases in the number of allergy patients. To ensure proper labeling, 2 novel sandwich enzyme-linked immunosorbent assay (ELISA) kits for the determination of crustacean protein in processed foods, the N kit (Nissui Pharmaceutical Co., Ltd, Ibaraki, Japan) and the M kit (Maruha Nichiro Holdings, Inc., Ibaraki, Japan), have been developed. Five types of model processed foods containing 10 and/or 11.9 g/g crustacean soluble protein were prepared for interlaboratory evaluation of the performance of these kits. The N kit displayed a relatively high level of reproducibility relative standard deviation (interlaboratory precision; 4.08.4 RSDR) and sufficient recovery (6586) for all the model processed foods. The M kit displayed sufficient reproducibility (17.620.5 RSDR) and a reasonably high level of recovery (82103). The repeatability relative standard deviation (RSDr) values regarding the detection of crustacean proteins in the 5 model foods were mostly &lt;5.1 RSDr for the N kit and 9.9 RSDr for the M kit. In conclusion, the results of this interlaboratory evaluation suggest that both these ELISA kits would be very useful for detecting crustacean protein in processed foods.

Experimental Evidence for Transverse Wobbling in ^{105}Pd

New rotational bands built on the ν(h_{11/2}) configuration have been identified in ^{105}Pd. Two bands built on this configuration show the characteristics of transverse wobbling: the ΔI=1 transitions between them have a predominant E2 component and the wobbling energy decreases with increasing spin. The properties of the observed wobbling bands are in good agreement with theoretical results obtained using constrained triaxial covariant density functional theory and quantum particle rotor model calculations. This provides the first experimental evidence for transverse wobbling bands based on a one-neutron configuration, and also represents the first observation of wobbling motion in the A∼100 mass region.

Twenty-Four Months' Resistance and Endurance Training Improves Muscle Size and Physical Functions but Not Muscle Quality in Older Adults Requiring Long-Term Care

OBJECTIVES

To assess the effects of 24 months training on muscle quality, size, strength, and gait abilities in older adults who need long-term care.

DESIGN

Non-randomized controlled trial Setting: Kawai Rehabilitation Center and Kajinoki Medical Clinic.

PARTICIPANTS

Ten older participants who needed long-term care (age, 76.7 ± 5.6 years) were participated as training group (Tr-group) and 10 older men and women who did not require long-term care (age, 72.9 ± 6.6 years) comprised the control group (Cont-group).

INTERVENTION

Tr-group performed resistive and endurance exercises once or twice a week for 24 months.

MEASUREMENTS

Using ultrasound images, echo intensity (EI) and muscle thickness were measured in the rectus femoris and biceps femoris as an index of muscle quality and size. Physical performance was measured before and after the training; performance parameters included knee extension peak torque, 5-m normal and maximal walk test, sit-to-stand and timed up and go test.

RESULTS

After the training, there was no change in EI, while BF thickness was increased (pre; 1.82 ± 0.29 cm, 24 months; 2.14 ± 0.23 cm, p < 0.05) in Tr-group. Walk-related performances were improved after the training in Tr-group (i.e. 5-m walk test and timed up and go test). The percent change of knee extension peak torque explained the percent change of EI in the rectus femoris (regression coefficient = 1.24, R = 0.91, adjusted R2 = 0.82, p < 0.001).

CONCLUSIONS

Twenty-four months' training induced muscle hypertrophy and improved physical functions. Increased muscle quality in the rectus femoris could be a key to improved knee extension peak torque, with the potential to eventually reduce the need for long-term care in older individuals.

Effect of Addition of Styrene-Ethylene/Butylene-Styrene and the Type of Mica on the Mechanical Properties of Mica-Filled Polyethylene/Polypropylene Blends

The mechanical properties of polyethylene (PE)/polypropylene (PP)/styrene-ethylene/butylene-styrene (SEBS)/mica composites were investigated as a model composition. Four types of mica with different particle sizes and different aspect ratios were used. These composites were extruded by a twin-screw extruder and subsequently injection molded, and their mechanical properties, including their tensile, bending, and impact properties were evaluated. The addition of mica to PE/PP/SEBS effectively improved its mechanical properties; the addition of SEBS as a compatibilizer likewise enhanced the mechanical properties compared with those of PE/PP composites without SEBS. The use of larger average particle size and higher aspect ratio mica, such as M-35, M-27, and P-33, effectively increased the tensile and bending properties of the PE/PP/SEBS/mica composites. The morphologies of the composites with an added mica as observed by scanning electron microscopy, showed good dispersion between the matrix polymer and the mica.

First Determination of the Level Structure of an sd-Shell Hypernucleus, _{Λ}^{19}F

We report on the first observation of γ rays emitted from an sd-shell hypernucleus, _{Λ}^{19}F. The energy spacing between the ground state doublet, 1/2^{+} and 3/2^{+} states, of _{Λ}^{19}F is determined to be 315.5±0.4(stat)_{-0.5}^{+0.6}(syst)  keV by measuring the γ-ray energy of the M1(3/2^{+}→1/2^{+}) transition. In addition, three γ-ray peaks are observed and assigned as E2(5/2^{+}→1/2^{+}), E1(1/2^{-}→1/2^{+}), and E1(1/2^{-}→3/2^{+}) transitions. The excitation energies of the 5/2^{+} and 1/2^{-} states are determined to be 895.2±0.3(stat)±0.5(syst) and 1265.6±1.2(stat)_{-0.5}^{+0.7}(syst)  keV, respectively. It is found that the ground state doublet spacing is well described by theoretical models based on existing s- and p-shell hypernuclear data.

Ozone-induced stomatal sluggishness changes stomatal parameters of Jarvis-type model in white birch and deciduous oak

Stomatal ozone flux is closely related to ozone injury to plants. Jarvis-type multiplicative model has been recommended for estimating stomatal ozone flux in forest trees. Ozone can change stomatal conductance by both stomatal closure and less efficient stomatal control (stomatal sluggishness). However, current Jarvis-type models do not account for these ozone effects on stomatal conductance in forest trees. We examined seasonal course of stomatal conductance in two common deciduous tree species native to northern Japan (white birch: Betula platyphylla var. japonica; deciduous oak: Quercus mongolica var. crispula) grown under free-air ozone exposure. We innovatively considered stomatal sluggishness in the Jarvis-type model using a simple parameter, s, relating to cumulative ozone uptake (defined as POD: phytotoxic ozone dose). We found that ozone decreased stomatal conductance of white birch leaves after full expansion (-28%). However, such a reduction of stomatal conductance by ozone fell in late summer (-10%). At the same time, ozone reduced stomatal sensitivity of white birch to VPD and increased stomatal conductance under low light conditions. In contrast, in deciduous oak, ozone did not clearly change the model parameters. The consideration of both ozone-induced stomatal closure and stomatal sluggishness improved the model performance to estimate stomatal conductance and to explain the dose-response relationship on ozone-induced decline of photosynthesis of white birch. Our results indicate that ozone effects on stomatal conductance (i.e. stomatal closure and stomatal sluggishness) are crucial for modelling studies to determine stomatal response in deciduous trees, especially in species sensitive to ozone.

Plasma Tumor Necrosis Factor α Levels and the –238* A Promoter Polymorphism in Patients with Antiphospholipid Syndrome

Objectives. To explore the possible involvement of the proinflammatory and prothrombotic cytokine TNFα in APS by determining the plasma levels in patients and to test for association of TNFA promoter polymorphisms and HLA class II genotypes with both plasma TNF and disease. Patients and Method. We studied 83 Caucasoid patients with APS and two groups of healthy controls. TNFα levels were determined in plasma from 35 patients’ and 21 controls using a highly sensitive sandwich ELISA. The full patient group was genotyped together with 95 ethnically matched healthy controls. -308 and -238 TNFA promoter polymorphisms were assessed by ARMS-PCR. HLA-DQB1, DQA1 and DRB1 genotypes were determined by PCR using sequence specific primers. Results. TNFα levels were significantly higher in patients with APS than healthy controls (median 2.95 pg/ml [range 0.51-10.75] vs. 0.95 pg/ml [0.51-1.6], respectively; p = 0.0001). Frequencies of TNFA-308*2 genotype did not differ between patients and controls. In contrast, TNFA-238*A positive genotype was more frequent in APS patients with arterial thrombosis and pregnancy loss than in controls (OR 3.7 [95% CI 1.37-10.1], p = 0.007 and OR 3.95 [95% CI 1.3-11.7], p = 0.01; respectively). DQB1*0303-DRB1*0701 haplotype was associated with TNFA-238*A in the control group (OR 96.0 [95% CI 9.6-959], p 0.0001) as well as in APS patient’s group (OR 54.2 [95% CI 9.6-306.5], p 0.0001). Conclusions. Raised plasma TNFα levels were found in patients with APS. As a prothrombotic and proinflammatory cytokine, TNFα may be involved in the development of clinical features of APS. The lack of correlation between the TNFA-238 polymorphism and plasma levels associated with disease suggests that the TNFα genetic marker may only indirectly relate to protein levels by virtue of allelic association with a functional marker which may reside in the HLA class II region.