Advanced High-Temperature CO2 Sorbents with Improved Long-Term Cycling Stability

Developing novel sorbents with maximum carbonation efficiency and good cycling stability for CO₂ capture is a promising route to sequester anthropogenic CO₂. In this work, we have employed a green synthesis method to synthesize CaO-based sorbents suitably stabilized by MgO and supported by in situ generated carbon under inert atmosphere. The varied amounts (10-30 wt %) of MgO were used to stabilize the CaO. The supported mixed metal oxide (MMO) sorbents were screened for high-temperature CO₂ capture under CO₂ rich (86% CO₂) and lean (14% CO₂) gas streams at 650 °C and atmospheric pressure. The MMO sorbents captured 53-63 wt % of CO₂ per gram of sorbent under 86 and 14% CO₂, accounting for about 98% carbonation efficiency, which outperforms the CO₂ capture capacity of limestone derived CaO (L-CaO) sorbents (22.8 wt %). All of the synthetic MMO sorbents showed greater capture capacity and cyclic stability when compared to benchmark L-CaO. Because of the high carbonation efficiency and cycling stability of g-Ca_0.69Mg_0.3O sorbent, it was tested for 100 carbonation/regeneration cycles of 5 min each under CO₂ lean conditions. The g-Ca_0.69Mg_0.3O sorbent showed exceptional CO₂ capture capacity and cycling stability and retained about 65% of its initial capture capacity after 100 cycles.

SAT0320 BONE MINERAL DENSITY AND FRACTURE RISK IN A COHORT OF PORTUGUESE SYSTEMIC SCLEROSIS PATIENTS

Background:

Although poorly understood, patients with Systemic Sclerosis (SSc) seem to have higher prevalence of low bone mineral density (BMD) and an increased spine fracture risk.

Objectives:

We aim to determine, by conventional densitometry (DXA) and using the fracture risk assessment tool (FRAX), the prevalence of low BMD and the fracture risk, respectively, in our SSc cohort and its potential determinants.

Methods:

Observational transversal study was performed including consecutive patients with the diagnosis of SSc. We collected data regarding demographics, BMD (lumbar spine and femoral neck) and occurrence of fracture. Ten-year risk of osteoporotic fracture was estimated using FRAXv4.1with the Portuguese population reference. Statistical analysis was performed using SPSS 23.0; p<0.01 was considered statistically significant.

Results:

Median age of patients (n=97) was 62 years old [56, 70], 88.7% females (n=86). Seventy-eight patients (80.4%) had limited cutaneous form, 5 (5.2%) presented a diffuse cutaneous form and 13 (13.4%) an overlap syndrome. Regarding clinical features: digital ulcers in 30 patients (30.9%), interstitial lung disease (ILD) in 16 (6.5%), gastrointestinal involvement in 16 (16.5%), miositis in 4 (4.1%) and pulmonary arterial hypertension in 3 (3.1%). Anti-topoisomerase I antibody (anti-Scl70) positivity was present in 15 patients (15.5%) and anti-centromere antibody (ACA) positivity in 63 (64.9%). Nine patients (9.3%) were smokers and 6 (6.2%) reported an alcohol consumption of 3 or more units/day. Median body mass index (BMI) was 25.4 Kg/m2[21.4, 29.1], with 5 patients (5.2%) being underweight. Vitamin D insufficiency was reported in 19 patients (19.6%). Twenty-one patients (21.6%) have been exposed to oral glucocorticoids (GCT) for more than 3 months at a dose of 5mg daily or more. Eleven patients (11.3%) had previous low impact fractures: 10 of which were vertebral and 1 wrist fracture. Regarding the prescribed anti-osteoporotic treatment (AOP), we found: alendronate (n=7, 7.2%), zoledronic acid (n=7, 7.2%), denosumab (n=2, 2.1%) and teriparatide (n=1, 1%).

Low BMD was present in 45 patients (46.4%); median femoral neck BMD (FN-BMD) was 0.827 [0.709, 0.893].Ten year probability of fracture (%) was: median risk for major fracture was 5.1 [3.5, 9.7] and 3.8 [2.5, 8], with and without FN-BMD, respectively; for hip fracture the estimated risk was 1.2 [0.6, 3.1] and 1.0 [0.4, 2.5], with and without FN-BMD, respectively. According to FRAX thresholds for the Portuguese population, 25 patients (25.8%) met criteria to start AOP treatment. Among them, only 10 patients (40%) started it, as the agreement between the indication to treat by FRAX and the onset of treatment was weak (k= 0.338). A strong agreement was found between FRAX risk threshold with DXA and World Health Organization (WHO) threshold for starting AOP (k= 0.814) and no agreement was found between FRAX risk without DXA and WHO threshold.

FN-BMD presented a weak correlation with BMI (r = 0.393), a moderate inverse correlation with major fracture risk with and without FN-BMD (r = -0.704, r=-0.412, respectively) and with hip fracture risk with and without FN-BMD (r = -0.799, r=-0.412, respectively). Major fracture risk with and without FN-BMD presented a moderate correlation with spine fractures (r = 0.350; r=0.397, respectively).

No correlation was found between WHO threshold and spine fractures. No correlations were found between FN-BMD or fracture risk estimated by FRAX and disease manifestations, anti-Scl70 or ACA positivity, vitamin D insufficiency, smoking or GCT use.

Conclusion:

In our cohort, low BMD was prevalent and had correlation with BMI. FRAX appears to be an useful instrument as it correlated with spine fractures, contrary to what was verified when we used the WHO threshold. Early monitoring of BMD and estimating fracture risk using FRAX appear to be useful tools for the prevention of fractures in this population.

Disclosure of Interests:

Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

FRI0062 THE USE OF A COMORBIDITY INDEX FOR PREDICTING CLINICAL RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING THEIR FIRST BIOLOGICAL AGENT

Background:

Several studies in Rheumatoid arthritis (RA) have suggested that a greater number of comorbidities is associated with worse functional status and disease activity measures. However, it is useful to use a composite comorbidity index, such as Rheumatic Disease Comorbidity Index (RDCI) that is validated for the use in patients with rheumatic diseases, to better understand the overall role of comorbidities in treatment outcomes.

Objectives:

To evaluate the impact of comorbidities on 12-month clinical response in a cohort of patients with RA treated with a first-line biologic disease-modifying antirheumatic drug (bDMARD), by using the RDCI.

Methods:

Observational retrospective study was performed including consecutive patients with the diagnosis of RA followed at our Rheumatology Department. The prevalence of comorbidities was computed, and patients were stratified according to RDCI for evaluating its role in clinical response disease activity at baseline and follow up (6 and 12 months). Correlations between variables were studied using Spearman correlation analysis, comparison between groups was performed using Kruskal-Wallis and Chi-square. A multivariate logistic regression model was developed to examine the role of RDCI along with other baseline factors as potential predictor of achieving remission, low disease activity (LDA), and EULAR good/moderate response. Statistical analyses were performed using SPSS statistical software, version 23.0.

Results:

A total of 251 patients were included: 83.7% (n=210) females, mean age of 58 (± 11.10) years old, with a median disease duration of 16.11 years [10.79 - 23.04]. The majority exhibited a very high or high disease activity at baseline (median DAS28 3V 5.48 [4.70 – 6.19]) and 90% (n=226) of them were concomitantly using corticosteroids and/or other disease-modifying anti-rheumatic drugs (129 with methotrexate (MTX), 96 with leflunomide and 35 with sulfasalazine). The most frequently reported comorbidities were cardiovascular disorders (37.5%), osteoporosis (7.6%) and depression (6.8%). The median RDCI score was 1.0 [0.0 – 2.0] and the majority of patients (63.6%) carried at least one comorbidity. When comparing baseline demographic and clinical characteristics of the 4 subgroups, stratified according to RDCI score (RDCI=0, 1, 2, or ≥3), we found statistically significant differences in age, age at diagnosis, sex and the prescribed anti-TNF agent (p<0.05). There was a progressive increase in the mean age as the RDCI score increased between the subgroups.

RDCI strongly correlates with the number of comorbidities (NC) (r=0.764, p<0.01). NC was weakly correlated with patient and physician global assessment of disease activity (pVAS and phVAS) (r=0.183, p<0.01 and r=0.196, p=0.019, respectively), DAS28 3V (r=0.192, p=0.046) and HAQ-DI (r=0.301, p<0.01) at 6 months. Moreover, RDCI poorly correlated with CRP (r=0.192, p=0.01), pVAS (r=0.183, p=0.02) and HAQ-DI (r=0.202, p<0.01). Weaker correlations were also found at 12 months: NC with pVAS (r= 0.196, p=0.02), DAS28 3V (r=0.216, p=0.01) and HAQ-DI (r=0.187, p=0.04); RDCI with phVAS (r= 0.196, p=0.04).

The 12-month DAS28 remission rate was 37.8% (n=95); 6.7% (n=17) achieved EULAR good response and 54.4% (n=137) a moderate EULAR response. RDCI was not an independent predictor of DAS remission (OR 0.794, 95% CI 0.561- 1.125,p =0.194) nor it was of EULAR good/moderate response (OR 0,720, 95% CI 0.430- 1.206, p= 0.212).

Conclusion:

Although our data point to a weak association between morbidities, assessed by the RDCI, and response to a first bDMARD, it is important to consider this simple and useful tool in future prospective and broader studies, since information bias regarding comorbidities may have been responsible for our results.

Disclosure of Interests:

Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

AB0825 TIME-COURSE CHANGE IN AXIAL MOBILITY IN PSORIATIC ARTHRITIS PATIENTS UNDER bDMARD

Background:

Spinal mobility is assessed frequently in patients with psoriatic arthritis (PsA) usingBath Ankylosing Spondylitis Metrology Index(BASMI) to provide baseline measurement, monitor changes over time and to assess the impact of clinical interventions. BASMI comprises 4 measures of spinal mobility (cervical rotation, tragus-to-wall distance, modified Schober’s test and lumbar lateral flexion) and one hip mobility measurement (intermalleolar distance).

Objectives:

The aim of this study is to investigate the time-course change of BASMI in PsA patients after 6 months ofBiologic Disease-modifying Antirheumatic Drug(bDMARD) therapy. The authors also pretend to evaluated, at baseline and after 6 months of treatment, the association between BASMI, disease activity scores and physical function.

Methods:

An observational retrospective study was performed in patients with PsA under bDMARD followed in the Rheumatology department of a tertiary university hospital. Were included patients treated with only one bDMARD. Demographic and clinical data were collected from the Rheumatic Diseases Portuguese Register. For spinal mobility calculation BASMI was used. Disease activity was evaluated withAnkylosing Spondylitis Disease Activity Score(ASDAS) andBath Ankylosing Spondylitis Activity Index(BASDAI). Physical function was assessed withBath Functional Index(BASFI). The variation of BASMI, ASDAS, BASDAI and BASFI was calculated as the difference between values registered at 6 months and at baseline and presented as Δ. Correlations between ΔBASMI, ΔASDAS and ΔBASFI was calculated using Pearson test.

Results:

A total of 55 patients were included. Thirty patients were males (54.5%). The mean age at diagnosis was 44.6 ± 12.6 years and the median disease duration at start of bDMARD was 5.4 years (min: 0.30; max: 25.5). In total, 19 (34.5%) patients had predominant axial involvement, 36 (65.5%) peripheric and 36 (65.5%) enthesopathic. Almost all patients fulfilled the CASPAR criteria for PsA (n=50, 90.9%). According to ASDAS criteria, at the baseline 20 patients (36.4%) had high disease activity and 34 (61,8%) very high. The most used bDMARD was etanercept (n=21, 38,3%) followed by golimumab (n=19, 34.5%) and adalimumab (n=8, 14.5%). Three patients were treated with infliximab, two with certolizumab and other two with secukinumab. Forty-one patients (75.9%) were concomitantly treated with conventional synthetic DMARDs. Axial PsA patients had more limitations in spinal mobility (BASMI mean 4.5 ± 1.5) and more functional limitation (BASFI mean 6.8±1.9) than patients with predominant peripheric involvement (BASMI mean 3.3± 1.2, p=0.004; BASFI mean 5.4±3, p=0,0048). Statistically significant differences in ASDAS and BASDAI in these two groups were not observed (p=0.332 and p=0.605, respectively). For all patients, BASMI did not vary significantly (p=0.691) at baseline (mean 3.7± 1.4) and after 6 months (mean 3.8±1.3) of treatment. Although the ΔBASMI for etanercept was negative (mean -0.12±0.9) and for golimumab positive (0.14±0.8), it was not statistically significant. At baseline there is a significant positive association between BASMI and ASDAS (r=0.435, p=0.001), BASMI and BASDAI (r=0.567, p<0.001) and BASMI and BASFI (r=0.510, p<0.001). However, there was not a statistically significant association between ΔBASMI and: ΔASDAS, ΔBASDAI and ΔBASFI (r=0.158; p=0.269, r=0.019; p=0.096 and r=0.121; p=0.397, respectively).

Conclusion:

In PsA patients treated with bDMARDs, at least in short-term follow-up, BASMI does not improve with time. Changes in BASMI did not correlate with changes in activity disease and in functional outcome. Studies with longer follow-up and with more patients are needed to better evaluate these associations.

Disclosure of Interests:

Maria Rato: None declared, Filipe Pinheiro: None declared, Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Rita Gaio: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Alexandra Bernardo: None declared, Lúcia Costa: None declared

AB0769 THE IMPACT OF BODY MASS INDEX ON DISEASE ACTIVITY AND ENTHESITIS IN PSORIATIC ARTHRITIS

Background:

Overweight/obesity has increased exponentially in the last decades, becoming a huge Public Health problem. Moreover, an increase in adipose tissue is associated with an increased production of several proinflammatory cytokines and acute phase reactants. Higher BMI has been related with new bone formation including syndesmophytes and enthesophytes. In fact, besides rheumatologic conditions including Psoriatic Arthritis (PsA), enthesopathy can be a consequence of several clinical conditions including metabolic syndrome, mechanical injuries and degeneration.

Objectives:

To evaluate the effect of body mass index (BMI) on disease activity scores and enthesitis scores in Psoriatic Arthritis.

Methods:

Retrospective study including all the patients with PsA meeting the CASPAR criteria, beginning first-line biologic therapy at our centre. Demographic and clinical data were collected from the Portuguese database Reumapt. Statistical analysis was performed with SPSS. Continuous variables were compared through Spearman/Pearson correlations.

Results:

The mean BMI was 26.8 (SD 0.5). In our sample of 119 PsA patients, 21.5% were overweight and 8.3% were obese. The mean age of patients was 46.3 ± 1.03 years; 60 female and 59 male. The median disease duration was 6.8 (0.3-33.8) years. At baseline mean (SD) disease activity variables were: DAS 28 4vESR 4.9 (0.2), ESR 33.2 (2.3) mm/h; CRP 2.35 (0.3) mg/dL, BASDAI 6.6 (0.2), ASDAS 3.9 (0.1), BASMI 3.7 (0.2), BASFI 5.8 (0.3), MASES 1.9 (0.3), SPARCC 2.3 (0.3). There were statistically significant positive correlations between BMI and MASES at baseline (p=0.024, r=0.411) but there weren’t with SPARCC, DAS 28 4vESR, ESR, CRP, BASDAI, ASDAS, BASMI and BASFI.

Conclusion:

The data showed that patients with higher BMI values had higher enthesitis scores suggesting that overweight/obesity may have a negative impact on enthesopathy. Further studies are still needed to further understand that possible relationship.

References:

[1]Bakirci S, Dabague J, Eder L, McGonagle D, Aydin SZ. The role of obesity on inflammation and damage in spondyloarthritis: a systematic literature review on body mass index and imaging. Clin Exp Rheumatol. 2019 Apr 29.

Disclosure of Interests:

Sara Ganhão: None declared, Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Filipe Pinheiro: None declared, Maria Rato: None declared, Eva Mariz: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

SAT0478 OSTEOPOROSIS TREATMENT IN PORTUGUESE PATIENTS WITH PSORIATIC ARTHRITIS – WHAT IS THE VALUE OF THE FRACTURE RISK ASSESSMENT TOOL (FRAX)?

Background:

Few studies have evaluated the prevalence and treatment of osteoporosis (OP) in patients with psoriatic arthritis (PsA), and many of these patients are not screened using dual-energy X-ray absorptiometry (DXA). FRAX makes it possible to stratify the risk and define which patients may benefit from anti-osteoporotic treatment, but its usefulness in this population is not well established.

Objectives:

The aim of this study was to determine whether the application of FRAX changes the indication for anti-osteoporotic treatment in PsA patients, according to the Portuguese guidelines.

Methods:

In this cross-sectional study, we evaluated PsA patients from a tertiary hospital, registered in a national database (Reuma.pt), aged between 40 and 90 years and with a last consultation in 2019. FRAX was applied in all of them, regardless of being under anti-osteoporotic treatment and, when DXA was available, the femoral neck bone mineral density was used. Patients were stratified according to the risk of fracture, and those at high risk were considered candidates for anti-osteoporotic treatment, according to national guidelines [FRAX ≥11% for major osteoporotic fracture (MOF) or ≥ 3% for hip fracture (HF) without DXA; FRAX ≥9% for MOF or ≥ 2.5% for HF, with DXA].

Results:

We included 100 patients, 52 females, with a mean age of 54,4 ±8,9 years and a median disease duration of 10 (6-17) years. Only 43 had already performed DXA and 6 had OP according to World Health Organization criteria. Seven patients were identified as having a high risk of fracture; applying femoral neck bone mineral density, 2 more patients with indication for treatment were recognized, totalizing 9 patients. There was a low agreement between the indication for treatment based only on DXA and FRAX (Cohen’s k 0.066). There was a moderate and significant correlation between percentage of risk of MOF by FRAX with and without DXA (Spearman’s ρ 0.804, p <0.001); for the risk of HF by FRAX with and without DEXA the correlation was weaker but still significant (Spearman’s ρ 0.439, p = 0.004). There was no association between the indication for treatment by FRAX and the performance of DXA (chi-square test, p = 0.597), nor the fact of performing DXA significantly affected the risk of MOF (Wilcoxon test, p = 0.185) or of HF (Wilcoxon test, p = 0.785) by FRAX.

Conclusion:

In line with Portuguese guidelines, FRAX seems to be, in itself, a very useful tool in patients with PsA, and the performance of DXA does not significantly alter the indication for anti-osteoporotic treatment.

References:

[1]Rodrigues AM, Canhao H, Marques A, Ambrosio C, Borges J, Coelho P, et al. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update. Acta Reumatol Port. 2018;43(1):10-31.

[2]Del Puente A, Esposito A, Parisi A, Atteno M, Montalbano S, Vitiello M, et al. Osteoporosis and psoriatic arthritis. J Rheumatol Suppl. 2012;89:36-8.

[3]Gulati AM, Michelsen B, Diamantopoulos A, Grandaunet B, Salvesen O, Kavanaugh A, et al. Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population. RMD Open. 2018;4(1):e000631.

[4]Adami G, Fassio A, Rossini M, Caimmi C, Giollo A, Orsolini G, et al. Osteoporosis in Rheumatic Diseases. Int J Mol Sci. 2019;20(23).

[5]Kanis JA, Harvey NC, Johansson H, Oden A, Leslie WD, McCloskey EV. FRAX Update. J Clin Densitom. 2017;20(3):360-7.

Disclosure of Interests:

Filipe Pinheiro: None declared, Maria Rato: None declared, Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Pedro Madureira: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

THU0387 THE IMPACT OF TREATMENT WITH A BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUG ON SPINAL MOBILITY AND ITS CORRELATION WITH DISEASE ACTIVITY IN PATIENTS WITH SPONDYLOARTHRITIS

Background:

Bath Ankylosing Spondylitis Metrology Index (BASMI) is an instrument developed to assess spinal and hip mobility. The relationship between BASMI and disease activity is not always linear and, above all, the data that correlate the variation in BASMI values (ΔBASMI) with the variation in disease activity scores and response to treatment are not unanimous.

Objectives:

Explore the effect of biological disease-modifying antirheumatic drugs (bDMARD) in spine mobility (as assessed by BASMI) and the associations between ΔBASMI and disease activity.

Methods:

Observational retrospective study was performed including consecutive patients with the diagnosis of Spondyloarthritis (SpA) followed at our Rheumatology Department. Demographic, clinical, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASMI, Ankylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate and C-reactive protein (ASDAS ESR and ASDAS CRP, respectively), and laboratorial data were collected from our national database at baseline, 6 and 12 months after initiation of a bDMARD. The variation of each parameter was calculated as the difference between the levels recorded at 6 and 12 months and the reference level and presented in the form of Δ. Statistical analysis was performed using SPSS 23.0. Correlations between variables were studied using Spearman correlation analysis and comparison between groups was performed using Wilcoxon and Kruskal-Wallis tests.

Results:

Median age of patients (n=178) was 42 years old [34, 50], 92 (51.7%) were males with a median disease duration of 4.9 [1.0, 10.3] years. One hundred and twenty-six patients (70.8%) had Ankylosing Spondylitis, 15 (8.4%) Inflammatory Bowel Disease related SPA and 30 (16.9%) Undifferentiated SpA. Fifty four (30.3%) patients were taking glucocorticoids and regarding conventional synthetic disease-modifying anti-rheumatic drugs use before starting the bDMARD: Sulfasalazine (52, 29.2%), Methotrexate (31, 17.4%) and Leflunomide (3, 1.7%). Regarding the bDMARD, only one patient started Secukinumab and the others a Tumor necrosis factor inhibitor (TNFi) [Golimumab (n= 64, 36.0%), Adalimumab (n=36, 20.2%), Infliximab (n= 35, 19.7%), Etanercept (n= 32, 18.0%) and Certolizumab (n= 10, 5.6%)].

The majority of the patients had very high disease activity at baseline (86.0%, n=153); median ESR was 29 mm/h [15, 47], median CRP was 13.7 mg/L, [6.60, 27.3], median ASDAS CRP was 7.6 [6.0, 9.0] and median BASMI was 8.0 [7-0, 9.0]. After 6 and 12 months of treatment, mean ESR, CRP, ASDAS-CRP and BASMI were significantly lower than mean baseline values (p<0.01), with median ASDAS-CRP at 12 months of 2.20 [1.50, 2.90] and median ΔBASMI of -4.10 [-5.50, -2.40].

BASMI at baseline showed a moderate correlation with ASDAS CRP (r=0.468, p<0.01), BASDAI (r=0.496, p<0.01) and patient visual analogic scale (VAS) (r=0.563, p<0.01). No correlations were found between BASMI and CRP, ESR, physician VAS or the consumption of nonsteroidal anti inflammatory drugs at baseline.

A significant positive correlation was found between ΔBASMI and ΔASDAS at 6 months and 12 months (r=0.243, p=0.02; r=0.286; p<0.01) and also between ΔBASMI and ΔBASDAI at 6 and 12 months (r=0.183, p=0.04; r=0.291, p=0.02). No correlations were found between ΔBASMI and ΔCRP or ΔESR. No differences were observed in ΔBASMI, regarding the bDMARD of choice.

Conclusion:

In our cohort, starting a bDMARD improved BASMI scores through a 12 month period and there was a correlation between the variation of BASMI and disease activity improvement. As such, a TNFi may retard the progression of spinal mobility dysfunction in SpA patients. We cannot draw conclusions regarding differences between TNFi and interleukin 17 inhibitors and further work is needed to clarify possible differences in their impact in improving spine mobility.

Disclosure of Interests:

Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

SAT0465 FRACTURE RISK ASSESSMENT BY FRAX IN A SYSTEMIC LUPUS ERYTHEMATOSUS PORTUGUESE COHORT

Background:

Osteoporosis is commonly seen in patients with Systemic Lupus Erythematosus (SLE), even in pre-menopausal patients. The etiology is multifactorial and chronic glucocorticoid therapy seems to play a central role.

Objectives:

To investigate the ten-year risk of fracture assessed by Fracture Risk Assessment Tool (FRAX), with and without dual-energy X-ray absorptiometry (DXA) and to determine possible demographic or clinical factors associated with an increased risk of fracture in a SLE population.

Methods:

Retrospective study including all the over 40 years-old patients with the diagnosis of SLE (2012 SLICC classification criteria) followed at our Rheumatology Department registered in our national database. Demographic, clinical and laboratorial data were collected at the last follow-up visit. Data from the last DXA (until 3 years prior to the last visit) were collected. Indication for pharmacological treatment by FRAX was assessed according to the national recommendations: estimated fracture risk, without DXA, ≥11% for major osteoporotic fracture or ≥3% for hip fracture and/or estimated fracture risk, with DXA, ≥9% for major osteoporotic fracture or ≥2.5% for hip fracture.

Results:

We included 104 patients, 101 (97.1%) females, aged 54.5±9.9 years, with a median disease duration of 19.3 years [4.3-51.6]. Twelve patients (11.5%) were current smokers, 31 (29.8%) had elevated anti-dsDNA antibodies (≥100 IU/mL) and 27 (26.0%) had complement consumption (C3c<83mg/dL or C4<12mg/dL). 73 patients (70.2%) were taking glucocorticoids with a mean daily prednisolone equivalent dosage of 4.4±5.2 mg/day. Regarding SLE treatment, 69 patients (66.3%) were under hydroxychloroquine, 22 (21.2%) under azathioprine, 16 (15.4%) under mycophenolate mofetil, 5 (4.8%) under belimumab, 4 (3.8%) under methotrexate, 1 (1.0%) under leflunomide and 1 (1.0%) under rituximab.

Ten patients (9.6%) had previous fragility fractures, 54 patients (51.9%) had DXA in the last 3 years and 81 (77.9%) were taking calcium and/or vitamin D supplements.

Sixteen (15.4%) had indication for treatment by FRAX without DXA and 8 of these (50%) were under treatment. Moreover, thirteen (12.5%) had indication for treatment by FRAX with DXA and 8 of these (61.5%) were under treatment.

Five patients (4.8%) were reclassified in FRAX with DXA: 3 patients (2.9%) had no indication for treatment by FRAX without DXA but conquered it by FRAX with DXA and 2 patients (1.9%) had indication for treatment by FRAX without DXA but lost it by FRAX with DXA. We found a good level of agreement in the indication for treatment between FRAX with and without DXA (kappa=0.741; p<0.001).

There was no significant difference in the risk of fracture estimated by FRAX with or without DXA, both for major osteoporotic fracture and for hip fracture. Correlations between fracture risk and some clinical variables can be seen in table 1.

Table 1.

Correlations between the risk of fracture estimated by FRAX and disease related features.

Age at SLE diagnosisDisease DurationESRSLEDAIEstimated fracture risk by FRAX:without DXAmajor osteoporotic fracturer=0.483p<0.001n.s.r=0.249p=0.012r=-0.586p=0.028hip fracturer=0.481p<0.001n.s.r=-0.552p=0.041n.s.with DXAmajor osteoporotic fracturer=0.386p=0.005r=0.299p=0.033n.s.n.s.hip fracturer=0.338p=0.015n.s.n.s.n.s.

Conclusion:

A higher number of patients had indication for pharmacological treatment by FRAX with DXA in comparison with FRAX without DXA. However, we found no statistically significant difference in the estimated fracture risk with and without DXA. This, together with the good level of agreement between FRAX with and without DXA, suggests that the fracture risk estimation, even without DXA, may be an appropriate approach. The low number of patients with indication for pharmacological treatment by FRAX, with and without DXA, may be explained by their low mean age and the high number of them under vitamin D/calcium supplementation.

Disclosure of Interests:

Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

SAT0416 ENTHESITIS AND CLINICAL RESPONSE IN PSORIATIC ARTHRITIS: REAL-LIFE DATA

Background:

Psoriatic arthritis (PsA) is an inflammatory arthritis that is characterized by a broad spectrum of clinical conditions, including axial skeletal involvement, enthesitis, dactylitis, uveitis and arthritis. Among those, enthesitis, the inflammation of the junction where the tendon, ligament or joint capsule inserts into the bone, is assigned to be the hallmark, affecting 35–50% of patients. Several clinical methods have been developed to measure it, including The Maastricht AS Enthesitis Score (MASES) index, which tests 13 entheses and the Spondyloarthritis Research Consortium of Canada (SPARCC) index that assesses 16.

Objectives:

To assess the relationship between enthesitis and clinical response in psoriatic arthritis.

Methods:

Retrospective study including all the patients with PsA meeting the CASPAR criteria, beginning first-line biologic therapy at our centre. Demographic and clinical data including age, gender, body mass index (BMI), smoking status, physical examination findings such as presence of enthesitis, dactylitis, chronic back pain, tender and swollen joint counts (TJC/ SJC), ESR, CRP, DAS 28 4vESR, BASDAI, BASFI, BASMI, ASDAS, HAQ, patient VAS score, MASES and SPARCC were collected from the Portuguese database Reumapt. Statistical analysis was performed with SPSS. Continuous variables were analysed through Spearman correlations.

Results:

We included 119 patients with PsA (60 female), of which 14.9% were active smokers. The mean age of patients was 46.3 ± 1.03 years. The median disease duration was 6.8 (0.3-33.8) years and the mean BMI was 26.8 ± 0.5 Kg/m2.

Enthesitis, dactylitis, inflammatory back pain, peripheral arthritis, ungueal distrophy, and psoriasis were present in 53 (45.7%), 45 (38.8%), 76 (65.5%), 109 (94%), 45 (38.8%), 104 (89.7%) patients, respectively.

At baseline, mean (SD) disease activity parameters were: DAS 28 4vESR 4.9 (0.2), ESR 33.2 (2.3) mm/h; CRP 2.35 (0.3) mg/dL, HAQ 1.3 (0.1), BASDAI 6.6 (0.2), ASDAS 3.9 (0.1), BASMI 3.7 (0.2), BASFI 5.8 (0.3), MASES 1.9 (0.3), SPARCC 2.3 (0.3). Median (min-max) values of TJC, SJC and patient VAS score at baseline were 4 (0-28), 3 (0-19), 76 (0-100), respectively.

There were statistically significant positive correlations (0-12 months) between ΔMASES and ΔDAS 28 4vESR (p=0.02, rho=0.432), Δpatient VAS score (p=0.027, rho=0.307), ΔHAQ (p=0.02, rho=0.411), ΔBASDAI (p=0.025, rho=0.326), ΔBASFI (p=0.037, rho=0.315), ΔASDAS (p=0.023, rho= 0.331). Correlations between ΔSPARCC and ΔDAS 28 4vESR (p=0.023, rho=0.332), Δpatient VAS score (p=0.003, rho=0.402), ΔHAQ (p=0.012, rho=0.440), ΔBASDAI (p=0.011, rho=0.368), ΔBASFI (p=0.001, rho=0.445), ΔASDAS (p=0.002, rho= 0.437), ΔCDAI (p=0.039, rho=0.320) and ΔSDAI (p=0.039, rho=0.319), were also significant. However, there weren’t strong correlations between ΔMASES neither ΔSPARCC and PsARC response at 12 months.

Conclusion:

Our results suggest that enthesitis is correlated with clinical response in PsA, supporting the idea that it is a major determinant of disease activity. It should be given more importance, namely by incorporating it in daily clinical practice, due to its major role, both in establishing an early diagnosis and in assessing treatment response.

References:

[1]Sunar I, Ataman S, Nas K, Kilic E, Sargin B, Kasman SA, et al. Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi‑center study. Rheumatol Int. 2019 Nov 26. doi: 10.1007/s00296-019-04480-9.

Disclosure of Interests:

Sara Ganhão: None declared, Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Eva Mariz: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

First-trimester fasting glycemia as a predictor of gestational diabetes (GDM) and adverse pregnancy outcomes

AIMS

Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes.

METHODS

A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose > 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM.

RESULTS

Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/m² and mean FPG 83.0 ± 7.3 mg/dL. Glucose quartiles were: ≤ 78, 79-83, 84-87 and ≥ 88 mg/dL. First-trimester FPG predicted the risk of GDM (7%, 8%, 10.2% and 16% in each quartile, p < 0.001) and the risk of second-trimester glucose > 92 mg/dL (2.6%, 3.8%, 6.3% and 11.4% in each quartile, p < 0.001). FPG was significantly associated with LGA (8.2%, 9.3%, 10% and 11.7% in each quartile, p = 0.011) but not with other obstetrical outcomes. In a multivariate analysis including age, BMI, tobacco use, number of pregnancies and weight gained during pregnancy, first-trimester FPG was an independent predictor of LGA.

CONCLUSIONS

First-trimester FPG is an early marker of GDM and LGA.

SAT0449 SPONDYLOARTHRITIS AND FRACTURE RISK: DOES DXA REALLY HAVE AN IMPACT IN THE RISK OF FRACTURE ESTIMATED BY FRAX?

Background:

Low bone mineral density (BMD) is common in ankylosing spondylitis (AS). The fracture risk (FR) is increased and its reduction with pharmacologic therapy is not clearly defined in this population. However, early screening and bisphosphonates as first-line treatment are recommended.

Objectives:

To investigate the influence of dual-energy X-ray absorptiometry (DXA) in the ten-year risk of fracture assessed by FR Assessment Tool (FRAX) and to determine possible demographic or clinical factors associated with an increased FR in a spondyloarthritis (SpA) population.

Methods:

Retrospective study including all the over 40 years-old SpA patients (ASAS classification criteria) followed at our Rheumatology Department and registered in the national database. Demographic, clinical and laboratorial data were collected at the time of the last follow-up visit. Data from the last DXA (until 3 years prior to the last visit) were collected. Indication for pharmacological treatment by FRAX was assessed according to the national recommendations.

Results:

A total of 231 SpA patients were included: 126 males (54.5%), 53 (22.9%) smokers; 171 (74%) had AS, 23 (10%) had Inflammatory Bowel Disease Associated SpA and 37 (16%) had Undifferentiated SpA. At the last follow-up visit, the mean age was 52.9 years (±9.6) and the median disease duration was 21.9 years [1.0-55.5]. The mean ASDAS-CRP was 2.5 (±0.9) and the majority of patients had moderate (25.5%) or high (48.5%) disease activity (according to ASDAS). One hundred and thirty patients (56.3%) were taking NSAIDs, 45 (19.5%) were taking glucocorticoids, 85 (36.8%) were under csDMARDs and 170 (73.6%) under bDMARDs [157 (68%) under TNFi, 11 (4.8%) under secukinumab and 2 (0.9%) under ustekinumab].

Eleven patients (4.8%) had previous fragility fractures, 118 (51.1%) had DXA in the last 3 years and 167 (72.3%) were taking calcium and/or vitamin D supplements.

Sixteen patients (6.9%) had indication for treatment by FRAX without DXA and 9 of these (56.3%) were already under treatment. Similarly, 16 (6.9%) had indication for treatment by FRAX with DXA and 13 of these (81.3%) were already under treatment. Ten patients (4.3%) were reclassified in FRAX with DXA: 7 (3%) had no indication for treatment by FRAX without DXA but obtained it by FRAX with DXA and 3 (1.3%) had indication for treatment by FRAX without DXA but they lost it by FRAX with DXA. We found a moderate level of agreement in the indication for treatment between FRAX with and without DXA (kappa=0.595; p<0.001). The use of DXA in FRAX estimated a significant higher median FR, both for major osteoporotic fracture (2.4% [0.8-31.0] vs 1.8% [0.6-20.0]; p<0.001) and for hip fracture (0.5% [0.0-23.0] vs 0.2% [0.0-14.0]; p<0.001).

We found significant correlations between FR and some disease-related variables (table 1).

Table 1.

Correlations between the risk of fracture estimated by FRAX and disease-related variables.

Disease durationBASDAIASDAS-CRPBASMIBASFIEstimated fracture risk by FRAX:without DXAmajor osteoporotic fracturer=0.352p<0.001r=0.204p=0.002r=0.214p=0.001r=0.301p<0.001r=0.317p<0.001hip fracturer=0.389p<0.001r=0.142p=0.034r=0.170p=0.011r=0.305p<0.001r=0.275p<0.001with DXAmajor osteoporotic fracturer=0.227p=0.014r=0.314p=0.001r=0.356p<0.001r=0.293p=0.002r=0.379p<0.001hip fracturen.s.r=0.197p=0.036r=0.269p=0.004r=0.271p=0.004r=0.258p=0.006

Conclusion:

Our results showed that a similar number of patients had indication for pharmacological treatment by FRAX both with and without DXA. Although the inclusion of DXA resulted in a higher estimated FR by FRAX, the observed moderate level of agreement between FRAX with and without DXA suggests that the FR estimation by FRAX, even without DXA, may be a reasonable approach in SpA patients. In line with literature, we found significant associations between the estimated risk fracture by FRAX and some disease activity and function measures.

Disclosure of Interests:

Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

SAT0482 FRAX 10-YR FRACTURE RISK IN RHEUMATOID ARTHRITIS ASSESSED WITH AND WITHOUT BONE MINERAL DENSITY – ARE WE TREATING OUR PATIENTS UNDER bDMARDs?

Background:

Patients with rheumatoid arthritis (RA) have a higher risk of osteoporosis not only due to chronic inflammation status, but also due to the treatment with glucocorticoids. FRAX is a computer-based algorithm developed by the World Health Organization for estimation of the 10-year risk of a hip or major osteoporotic fracture. Inclusion of femoral neck bone mineral density (BMD) in the estimation is optional.

Objectives:

The study aimed to identify the RA patients under treatment with biological disease-modifying antirheumatic drug (bDMARD), who have FRAX scores, calculated with and without BMD, classified as high fracture risk and evaluate if they are receiving treatment for osteoporosis. The authors also investigated the intra-individual agreement between FRAX fracture risk calculated with and without BMD.

Methods:

Demographic and clinical data and BMD results from RA patients followed in a tertiary university hospital and registered in the Rheumatic Diseases Portuguese Register were used for analysis. Patients under 40 years of age at the last visit were excluded. McNemar test was applied for the identification of discordance of risk categories. The Wilcoxon test was used to characterize the intraindividual differences between paired FRAX risks with and without BMD. Correlations between pairs of variables were evaluated by the Spearman test. For independent variables Mann-Whitney test was used.

Results:

A total of 303 patients were included, 244 were females (80.5%) and 49 current smokers (16.2%). Mean age was 59.5 ± 9.54 years and mean disease duration 18.5 ± 10.4 years. Two hundred and twenty patients (72.4%) and 243 (80.2%) were RF and ACPA positive, respectively, and 51.5% had erosive disease. Mean disease activity score (DAS28-4V-CRP) was 3.08 ± 1.18 and mean femoral neck BMD 0.84 ± 0.12 g/cm2. One hundred and seventy nine patients (58.9%) were concomitantly treated with conventional synthetic DMARDs and 215 (70.7%) with glucocorticoids. Among all the patients, 35 (11.6%) had previous fractures and 19 (6.3%) have family history of fracture. The median 10-year risk of a major fracture and a hip fracture, calculated without BMD, was 6.0 (1.2-50) and 1.5 (0.1-39), respectively; with BMD it was 6.9 (1.3-61) and 1.7 (0-49). When FRAX score is calculated without BMD (n=303), 76 (25.1%) patients were categorized as high fracture risk. Among them, only 41 (54%) were receiving osteoporosis treatment. FRAX assessment with BMD (n=231) identified 99 (32.7%) patients with high fracture risk, 51 (51,5%) in treatment for osteoporosis. Thirty patients (21%) previously classified as low fracture risk using FRAX without BMD were recategorized as high risk (p<0.001). Despite that, there was a strong correlation between fracture risks assessed with and without BMD for both major and hip fracture (r = 0.867, p < 0.0001 and r = 0.728, p < 0.0001, respectively). ACPA and RF positive patients did not have higher FRAX scores (including or not BMA). Patients with erosive disease had a higher 10-year probability of major fracture evaluated by FRAX when it includes BMD (p=0.041).

Conclusion:

It is very important to accurately assess the risk of osteoporotic fractures in RA patients to treat them properly. The authors highlight the high number of patients who are not receiving treatment according to FRAX categorization. In spite of the correlation between estimated fracture risk by FRAX with and without BMD, there is a discordance in fracture risk categorization, as one fifth of patients of low risk were reclassified as high risk. For the RA population treated with bDMARDS, our findings raise the need to request a DXA not only for patients classified as having an intermediate risk of fracture, but also for low-risk patients.

Disclosure of Interests:

Maria Rato: None declared, Filipe Pinheiro: None declared, Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Rita Gaio: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Alexandra Bernardo: None declared, Lúcia Costa: None declared

FRI0299 EVALUATION OF ENTHESITIS INDICES AND RESPONSE TO BDMARD THERAPY IN PORTUGUESE PATIENTS WITH SPONDYLOARTHRITIS

Background:

Enthesitis is a hallmark clinical feature of spondyloarthritis (SpA), but to date, few studies have investigated how the overall response to biological treatment relates to the evolution of enthesitis counts.

Objectives:

Assess whether the variation in enthesitis indices reflects the overall response to bDMARD therapy in SpA.

Methods:

This longitudinal, retrospective study included patients who met Assessment of Spondyloarthritis international Society (ASAS) criteria for SpA followed at the Rheumatology Department of a tertiary hospital, under bDMARD therapy. Demographic, laboratorial and clinical data were collected, including Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada (SPARCC) scores. All were evaluated at baseline and at 6, 12, 18 and 24 months after starting the first biological therapy. The variation in each parameter compared with the baseline values was calculated at 6, 12, 18 and 24 months and represented in the form of delta. Correlations between variables were assessed using Spearman test and comparison between groups using Wilcoxon, Mann-Whitney U and Kruskal-Wallis tests.

Results:

We included 273 patients, 123 (45,1%) females, aged 42,0±12,3 years and with diagnosis of SpA for 15,4±11,2 years at the start of bDMARD therapy. Eighteen (6,6%) had depression. At baseline, mean BASDAI was 6,43 ±1,62, ASDAS-CRP was 4,01 ± 0,86, median MASES was 1 (0-4), LEI 0 (0-1,75) and SPARCC 1 (0-4). Seventy-two patients (26,4%) started golimumab, 71 (26,0%) adalimumab, 66 (24,2%) infliximab, 54 (19,8%) etanercept, 9 (3,3%) certolizumab and 1 (0,4%) secukinumab. Enthesitis indices were significantly higher at baseline in females [median MASES-females 2 (0-5) vs 0 (0-2), p<0,001; LEI-females 0 (0-2) vs 0 (0-1), p=0,03; and SPARCC-females 2 (0-5) vs 0 (0-2), p<0,001], and remained so at 24 months [median MASES-females 1 (0-3,5) vs 0 (0-0), p<0,001; LEI-females 0 (0-0,5) vs 0 (0-0), p<0,001; and SPARCC-females 1 (0-3) vs 0 (0-0), p<0,001]. MASES and SPARCC, but not LEI, at baseline were significantly higher in patients with depression [median MASES-depression 3,5 (2-6) vs 1 (0-4), p=0,01; SPARCC-depression 4 (0-8) vs 1 (0-3), p=0,03], but at 24 months no differences were observed. There was a significant difference between each of the 3 scores of enthesitis when assessed at 6, 12, 18 and 24 months, compared to baseline (p <0.004). No differences were observed regarding the choice of bDMARD. At baseline, MASES had a significant correlation with patient visual analogic scale (VAS) (r=0,18; p=0,01), BASDAI (r=0,36; p<0,001) and BASFI (r=0,21; p=0,003); LEI had a significant correlation with BASDAI (r=0,31; p<0,001) and BASFI (r=0,21; p=0,003); SPARCC had a significant correlation with patient VAS (r=0,19; p=0,01), BASDAI (r=0,37; p<0,001) and BASFI (r=0,26; p<0,001). ΔLEI at 6 months had a significant correlation with ΔBASDAI (r=0,25; p=0,005), ΔASDAS (r=0,190; p=0,03), Δpatient VAS (r=0,23; p=0,01) and Δphysician VAS (r=0,25; p=0,01), but not with ΔESR, ΔCRP and ΔBASMI; no correlation was found at 6 months for ΔMASES or ΔSPARCC. At 12 months, ΔMASES had a significant correlation with ΔBASDAI (r=0,18; p=0,03); ΔLEI with ΔBASDAI (r=0,23; p=0,01) and Δpatient VAS (r=0,19; p=0,03); for ΔSPARCC no significant correlations were found. At 18 months and 24 months, no correlations were found.

Conclusion:

The initiation of bDMARD led to improved enthesitis indices over a 24-month period. ΔLEI correlates better with SpA activity scores and measurements than the other indices, especially at the first 12 months of initiation of bDMARD therapy.

Disclosure of Interests:

Filipe Pinheiro: None declared, Maria Rato: None declared, Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Pedro Madureira: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

[Evolution of followed renal oncocytomas]

INTRODUCTION

Oncocytomas are primitive kidney tumours, considered benign but their evolution is not fully established. The local progression is generally admitted but few data explain what makes a oncocytoma to grow more or less quickly. The objective of our study is to analyse the evolution of followed renal oncocytomas after histologic confirmation and to identify factors that can influence their growth.

MATERIAL AND METHODS

This is a retrospective study in two centers (North Hospital and Hospital of the Conception of Marseille). All patients with renal oncocytoma diagnosed with percutaneous biopsy from September 2010 to April 2016 and followed for more than one year were included. Epidemiological, histological, and morphological data were collected at diagnosis, during follow-up and in case of strategy change (intervention). Statistical analysis of factors influencing oncocytomes growth was based on the Pearson correlation test.

RESULTS

Fifty-three patients were included. The median age for diagnosis was 65 years [39-85]. The sex ratio H/F was 6/5. The median follow-up was 34 months [12-180]. The average diagnosis size was 29 mm [12-90]. Thirteen patients (25%) were treated secondarily, including 70% by conservative treatment. The average growth was 0.25 (±0.23) cm/yr. The patients treated were younger and had a higher growth rate than the untreated (0.48±0.23cm/yr versus 0.18±0.18cm/yr, P<0,001). According to Pearson's analysis, there was a positive linear relationship (R=0.27, P=0.047) between velocity and initial size and a negative linear relationship (ρ=-0.44, P<0.001) between velocity and age at diagnosis. So tumor growth was faster if the patients were young and the tumor voluminous at diagnosis.

DISCUSSION

Rapid growth often leads to a cessation of surveillance in favour of an intervention strategy. For young patients, conservative treatment (partiel nephrectomy or ablative treatment) in the medium term is likely to be preferred, but for elderly patients or with important comorbidities follow-up is an alternative to an invasive attitude.

LEVEL OF EVIDENCE

3.

No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches

BACKGROUND

to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF).

METHODS

spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m.

RESULTS

All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800.

CONCLUSIONS

as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

G. Comment constituer, au sein de la population générale, un échantillon de sujets cyclothymiques ? Expérience à Strasbourg dans le cadre du projet PSYCHE

Contrairement au trouble cyclothymique qui est défini par une labilité affective ayant un impact fonctionnel mais d’intensité et d’une durée insuffisantes pour répondre aux critères d’épisodes thymiques [2], le tempérament cyclothymique se caractérise par les mêmes variations thymiques en l’absence de répercussions [1]. Malgré la prévalence – trouble et tempérament confondus – estimée à 0,4 et 2,5 % de la population générale [3], les études concernant la cyclothymie restent négligées. Dans une revue épidémiologique des troubles bipolaires, parmi une centaine d’études, seules huit concernent la cyclothymie [4]. Peut-on expliquer cette négligence par des difficultés de recrutement de sujets cyclothymiques ? Nous présentons, ici, notre procédure de recrutement de huit sujets avec tempérament ou trouble cyclothymique dans le contexte du projet PSYCHE. Ce projet vise à évaluer un système personnalisé et interactif permettant la surveillance et l’évaluation de variables physiologiques afin de prédire des changements d’humeur. Une annonce a été publiée sur le site Internet et Intranet des hôpitaux universitaires de Strasbourg (HUS). La version brève de la sous-échelle de cyclothymie du TEMPS-A y était proposée. Les coordonnées des sujets dont le score était supérieur ou égal à 9/12 nous étaient envoyées automatiquement. En onze jours, 95 personnes ont eu un score supérieur à 9/12. Des scores de 12, 11, 10 et 9 ont été obtenus respectivement par 19, 15, 24 et 42 % au sein de cette sous-population. Huit sujets ont été recrutés dont sept étaient des collaborateurs des HUS (à rapporter au nombre de collaborateurs en 2011:11962). Notre démarche témoigne de la rapidité et de la facilité d’accessibilité de ce type de population – notamment au sein même des HUS – pour participer à des études cliniques.

How does gatekeeper training improve suicide prevention for elderly people in nursing homes? A controlled study in 24 centres

Background

The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training “gatekeepers”.

Methods

In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide.

Results

The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level.

Conclusions

Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures.

Prognostic impact of tumour-infiltrating lymphocytes and cancer-associated fibroblasts in patients with pancreatic adenocarcinoma of the body and tail undergoing resection

BACKGROUND

The prognosis of patients with pancreatic cancer remains poor and novel therapeutic targets are required urgently. Treatment resistance could be due to the tumour microenvironment, a desmoplastic stroma consisting of cancer-associated fibroblasts and tumour-infiltrating lymphocytes (TILs). The aim of the study was to evaluate the prognostic value of TILs and cancer-associated fibroblasts (CAFs) in pancreatic cancer of the body and tail.

METHODS

Using tissue microarray from resected left-sided pancreatic cancer specimens, the immunohistochemistry of TILs (cluster of differentiation (CD) 45, CD3, CD4, FoxP3 and CD8), CAFs (vimentin and α-smooth muscle actin (αSMA)) and functional markers (PD-L1 and Ki-67) was examined, and the association with disease-free (DFS) and overall (OS) survival investigated using a computer-assisted quantitative analysis. Patients were classified into two groups, with low or high levels or ratios, using the 75th percentile value as the cut-off.

RESULTS

Forty-three patients were included in the study. Their median DFS and OS were 9 and 27 months respectively. A high CD4/CD3 lymphocyte ratio was associated with poorer DFS (8 months versus 11 months for a low ratio) (hazard ratio (HR) 2·23, 95 per cent c.i. 1·04 to 4·61; P = 0·041) and OS (13 versus 27 months respectively) (HR 2·62, 1·11 to 5·88; P = 0·028). A low αSMA/vimentin ratio together with a high CD4/CD3 ratio was correlated with poorer outcomes. No significant association was found between Ki-67, PD-L1 and survival.

CONCLUSION

In patients with resected left-sided pancreatic cancer, a tumour microenvironment characterized by a high CD4/CD3 lymphocyte ratio along with a low αSMA/vimentin ratio is correlated with poorer survival.

P212 Computed tomography derived left ventricular outflow tract area downgrades severity of prosthesis-patient mismatch after transcatheter aortic valve replacement

Background

Prosthesis-patient mismatch (PPM) is associated with poor outcomes after surgical aortic valve replacement, but evidence in the era of transcatheter aortic valve replacement (TAVR) is small. Although PPM is conventionally defined by transthoracic echocardiogram (TTE) derived indexed effective orifice area (EOAi), TTE may underestimate left ventricular outflow tract (LVOT) area when compared with cardiac computed tomography angiography (CTA).

Purpose

To evaluate the inter-modality (TTE vs CTA) agreement and inter-valve (balloon-expanding valve (BEV) vs. self-expandable valve (SEV)) differences in EOAi and the severity of PPM after TAVR.

Methods

We analyzed all patients who underwent TAVR between 2015 to 2017and who had both of CTA and TTE at 30-days after TAVR. EOAi was calculated using the continuity equation and then indexed to body surface area as per guidelines using TTE derived LVOT diameter (EOAi-TTE) or post-procedure CTA derived LVOT area (EOAi-CTA). The external LVOT diameter was measured at inflow of TAVR bioprosthetic stent frame as per recommendations. The EOAi was used to define the grading severity of PPM: None (&gt; 0.85 cm²/m²); Moderate (0.65 to 0.85 cm²/m²); and Severe (&lt; 0.65 cm²/m²). Paired or Student t-test and Chi-square test were used to assess the inter-modality and inter-valve difference.

Results

A total of 280 patients were included (the mean age, 81.2 ± 8.1 years; 48%, female). BEV was used in 150 patients (54%). The mean EOAi-TTE vs. EOAi-CTA was 1.00 ± 0.32 and 1.41 ± 0.50 cm²/m², respectively, p &lt; 0.001. Prevalence of severe (TTE 9% versus CTA 4%, p &lt; 0.01) and moderate (TTE 28% versus CTA 7%, p &lt; 0.01) PPM was lower when adjudicated by CTA (Figure-Panel A). There was a trends towards smaller EOAi by either TTE (0.97 ± 0.31 vs. 1.04 ± 0.33, p = 0.07) or CTA (1.38 ± 0.45 vs. 1.46 ± 0.56, p = 0.21) for BEV vs. SEV (Figure-Panel B). There was no significant difference in the severity of PPM defined by either EOAi-TTE (Figure-Panel C) or EOAi-CTA (Figure-Panel D) between these patients.

Conclusion

EOAi-CTA was larger and downgraded the severity of PPM than the EOAi-TTE. There was no significant difference in the severity of PPM defined by post-procedure CT between patients treated with BEV and those with SEV.

Abstract P212 Figure.

Single-Shot Nondestructive Detection of Rydberg-Atom Ensembles by Transmission Measurement of a Microwave Cavity

We present an experimental realization of single-shot nondestructive detection of ensembles of helium Rydberg atoms. We use the dispersive frequency shift of a superconducting microwave cavity interacting with the ensemble. By probing the transmission of the cavity, we determine the number of Rydberg atoms or the populations of Rydberg quantum states when the ensemble is prepared in a superposition. At the optimal microwave probe power, determined by the critical photon number, we reach single-shot detection of the atom number with 13% relative precision for ensembles of about 500 Rydberg atoms with a measurement backaction characterized by approximately 2% population transfer.

Dissimilar molecular and morphological patterns in an introgressed peripheral population of a sand dune species (Armeria pungens, Plumbaginaceae)

Introgression is a poorly understood evolutionary outcome of hybridisation because it may remain largely undetected whenever it involves the transfer of small parts of the genome from one species to another. Aiming to understand the early stages of this process, a putative case from the southernmost border of the Armeria pungens range from its congener A. macrophylla is revisited following the discovery of a subpopulation that does not show phenotypic signs of introgression and resembles typical A. pungens. We analysed morphometrics, nuclear ribosomal DNA ITS and plastid DNA (trnL-trnF) sequences, genome size, 45S and 5S rDNA loci-FISH data and nrDNA IGS sequences. Within the study site, most individuals match morphologies of either of the two hybridising species, particularly the new subpopulation, with intermediate phenotypes being scarce. This pattern does not fully fit molecular evidence revealing two ITS ribotypes co-occurring intragenomically in most plants from the study site and one single plastid haplotype. Genome size and structural features of the IGS sequences both indicate that A. pungens from the study site is genetically more similar to its sympatric congener than to the remainder of its conspecifics. Introgression of A. macrophylla into A. pungens and plastid capture explain all the evidence analysed. However, important features to understand the origin and fate of the introgressed population, such as the degree and direction of introgression, which are important for understanding early stages of hybridisation in plants with low reproductive barriers, should be addressed with new data.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

P5568Disease stages of structural and functional cardiac changes associate with outcomes in patients with mitral regurgitation receiving mitral valve intervention

Background/Introduction

Severe mitral regurgitation (MR) produces volume overload resulting in progressive cardiac dysfunction that can extend beyond the left-sided chambers. It is unknown whether a specific MR staging system, that would quantify the extent of structural and functional cardiac changes, would be associated with outcomes in severe MR patients receiving mitral valve (MV) intervention.

Purpose

To examine the clinical utility of a novel MR staging system, based on the extent of cardiac damage, for prediction of clinical outcomes for patients with severe MR who underwent surgical or transcatheter therapy.

Methods

Patients were categorized into five stages using pre-procedural echocardiography; Stage 0: no other cardiac damage detected; Stage 1: Left atrium (LA) abnormality, as defined by the presence of atrial fibrillation or LA chamber enlargement; Stage 2: LV dysfunction, as defined by LV ejection fraction <60%; Stage 3: Pulmonary artery vasculature or tricuspid valve abnormality, as defined by the presence of systolic pulmonary arterial pressure ≥60 mmHg) or ≥grade 2 tricuspid regurgitation; and Stage 4: Right ventricular (RV) disease as defined by the presence of >mild RV dysfunction. The primary outcomes were all-cause mortality, and the combined endpoint of death or heart failure rehospitalization at one-year follow-up.

Results

A total of 696 patients with MR (age 70±14 years; 60% men) who underwent MV surgery (69%) or transcatheter MV repair with MitraClip device (31%) were examined. Prevalences of stage 0, 1, 2, 3, and 4 were 6.6%, 34.6%, 20.0%, 26.6%, and 12.2%, respectively. The median follow-up time was 15 months (IQR, 6.4, 24.4 months). At one-year, there was graded increase in all-cause death and in the combined endpoint of death or heart failure rehospitalization with each MR stage (Figure). In multivariate models, these associations remained independently associated with both one-year endpoints for patients receiving either surgical or transcatheter interventions.

Figure 1

Conclusion

This novel MR staging system is practical and may improve clinical risk stratification of patients with severe MR being considered for MV interventions.