SAT0045 DISTRIBUTION AND SEVERITY OF PERIODONTITIS PREDICTS PROGRESSION TO INFLAMMATORY ARTHRITIS IN ANTI-CCP POSITIVE AT-RISK INDIVIDUALS WITHOUT CLINICAL SYNOVITIS

Background:

The prevalence of periodontal disease and the citrullinating bacteriumPorphyromonas gingivalisare increased in anti-CCP positive individuals at-risk of rheumatoid arthritis (RA) (1). This suggests periodontal inflammation may have an important role in the initiation and development of RA. Despite significant interest in the role of the periodontium and other mucosal sites in the initiation of RA-related autoimmunity, the influence of mucosal inflammation on progression to inflammatory arthritis (IA) in at-risk individuals remains unclear.

Objectives:

To investigate the association between periodontitis and progression to inflammatory arthritis in anti-CCP+ at-risk individuals without synovitis.

Methods:

Anti-CCP positive individuals with musculoskeletal symptoms but no clinical synovitis (CCP+ at-risk) were recruited as part of a national prospective cohort study. Comprehensive periodontal examination was performed at baseline by a dentist; six sites per tooth were assessed for clinical attachment level (CAL), pocket depth (PD) and bleeding on probing (BOP). Periodontal disease sites (PDD) were defined as CAL ≥2mm and PD ≥4mm. The distribution of PDD was classified in line with recent guidelines (2). The severity i.e. total burden of periodontal inflammation, was quantified at patient level using the periodontal inflamed surface area (PISA) index(3). CCP+ at-risk were monitored for progression to IA. Multivariable Cox regression was used to assess the effect of PDD distribution and PISA on progression to IA.

Results:

126 CCP+ at-risk underwent full periodontal examination and were followed up for median 23.4 months (range 0.6 – 56.8 months). Mean age was 49 years, 86 (68%) were females. At baseline, 42(33%) subjects had no PDD, 51(40%) had localised PDD (<30% teeth with one or more PDD site) and 33 (26%) had generalised PDD (≥ 30% of teeth with one or more PDD site). Mean (SD) PISA for all subjects was 267(319)mm2. 31 subjects (25%) progressed to IA after median of 12.6 months (range 0.6 – 49.5 months). Progression to IA was significantly higher in subjects with localised PDD compared with those without PDD (33% vs 16%, HR (95% CI) 2.45 (1.02, 5.94) p=0.02), figure 1. Interestingly, this association was not seen in subjects with generalised PDD (19% progression, HR 0.68 (0.20, 2.32). In addition, severity (i.e. total burden) of periodontal inflammation (PISA) was not significantly predictive of progression to IA alone (HR 1.001 (0.999-1.002), p=0.08). However, when adjusting for distribution of PDD, PISA was significantly associated with progression to IA (HR 1.0016 (1.0003- 1.003), p=0.00163).

Conclusion:

Periodontal inflammation predicts progression to IA in CCP+ at-risk individuals without clinical synovitis. The severity (i.e. total burden) of periodontitis appears to be particularly predictive of progression to IA in patients with localised periodontitis. These data suggest periodontitis may be an important factor in the development of RA and provide rationale for periodontal intervention with the aim of arthritis prevention in at-risk individuals.

References:

[1] Mankia K et al, JAMA Network Open(2019)

[2] Caton J et al, J Clin Periodontol(2018)

[3] Nesse W et al, J Clin Periodontol(2008)

Disclosure of Interests :

Kulveer Mankia: None declared, Zhain Mustufvi: None declared, Jing Kang: None declared, Aradhna Tugnait: None declared, Robert Letton: None declared, Laurence Duquenne: None declared, Alastair Speirs: None declared, Val Clerehugh: None declared, Deirdre Devine: None declared, Paul Emery Grant/research support from: AbbVie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche (all paid to employer), Consultant of: AbbVie (consultant, clinical trials, advisor), Bristol-Myers Squibb (consultant, clinical trials, advisor), Lilly (clinical trials, advisor), Merck Sharp & Dohme (consultant, clinical trials, advisor), Novartis (consultant, clinical trials, advisor), Pfizer (consultant, clinical trials, advisor), Roche (consultant, clinical trials, advisor), Samsung (clinical trials, advisor), Sandoz (clinical trials, advisor), UCB (consultant, clinical trials, advisor)

SAT0575 POSITIVE QuantiFERON-TB GOLD TEST AND SEROCONVERSION OF QunatiFERON-TB GOLD TEST IS ASSOCIATED WITH INCREASED RISK OF THE DEVELOPMENT OF ACTIVE TUBERCULOSIS IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM A REAL-WORLD DATA OVER 20 YEARS

Background:

With the promising efficacy and the prevalent use of anti-tumor necrosis factor-α (TNF) agents in managing AS, the risk for reactivation of latent tuberculosis infection (LTBI) still is a concern. Although guidelines include the screening and treatment of LTBI prior to the initiation of anti-TNF agent by QuantiFERON-TB Gold (QFT-G) or tuberculin test, there is a lack of evidence whether treatment of LTBI before initiation of anti-TNF agent may reduce the risk of reactivation to the same as LTBI patient without anti-TNF agent or anti-TNF agent users without LTBI. Furthermore, evidence on the need for follow-up testing and the association between seroconversion and the development of active tuberculosis is also limited.

Objectives:

This study aims to investigate the real-world impact of QFT-G test on the development of active tuberculosis in patients with AS.

Methods:

This retrospective study investigated 2,930 patients who had a diagnosis of AS and conducted QFT-G testing during the period of March 1998 to June 2019. 191 patients with history of treatment for LTBI or acute tuberculosis prior to the first QFT-G test and 157 patients whose hospital visits or prescription was less than 3 were excluded. Observational period was defined from the firs QFT-G test to the last hospital visit of development of active tuberculosis. The screening for development of active tuberculosis was conducted by reviewing the diagnosis, prescription of anti-tuberculosis medication, chest images and electronic medical record. Treatment of LTBI was defined when a patient was prescribed isoniazid for at least 220 for 12 months, rifampin for at least 90 days for 6 months, or concurrently prescribed isoniazid and rifampin for at least 70 days for 4 months. Wilcoxon rank-sum test, chi-square test and cox-proportional hazard analysis were performed.

Results:

A total of 2687 patients (median age 32.7 years, 78.4% male, anti-TNF agent user 16.7%) were included. Baseline QFT-G was positive in 426 (20.3%) patients, and 15 active tuberculosis was observed [Incidence rate 1.5/1000 person years (PY)]. Compared with baseline QFT-G (-) patients, baseline QFT-G (+) patients were older (41.2 years vs. 31.3 years, p<0.001) and they were accompanied with more active tuberculosis (4.4/1000PY vs. 1.0/1000PY) despite the less usage of anti-TNF agents (38.5% vs 45.8%, p=0.006). The observational period, sex, and medication utilization pattern except anti-TNF agent were similar between two groups. Multivariable analysis showed that QFT-G (+) test increases the risk of active tuberculosis more than 10 times [adjusted hazard ration 17.0, 95% confidence interval (CI) 5.1-56.8, p<0.001] after adjusting age, sex and the usage of anti-TNF agents.

Then we conducted subgroup analysis on 965 patients with baseline QFT-G (-) and follow-up QFT-G tests. Seroconversion was documented in 65 patients (6.7%). Active tuberculosis was observed in 4 patients, and seroconversion was occurred before the development of active tuberculosis in all patients. The incidence of active tuberculosis in seroconversion patients were 10.5/1000PY.

Conclusion:

QFT-G (+) and QFT-G seroconversion is associated with increased risk of the development of active tuberculosis in patients with AS.

Figure 1.

Overview of patient flow

Disclosure of Interests:

None declared

THU0429 THE ASSOCIATION OF SERUM VITAMIN A, VITAMIN E, AND FOLATE WITH HYPERURICEMIA: AN ANALYSIS OF POPULATION-BASED NATIONALLY REPRESENTATIVE DATA

Background:

Hyperuricemia is an important risk factor for gout as well as hypertension, type 2 diabetes and renal impairment. Although previous studies investigated the association of questionnaire-based micronutrient intake with serum uric acid levels, limited data on serum micronutrients levels in relation to the risk of hyperuricemia especially in Asian population.

Objectives:

This study aimed to evaluate the association of serum vitamin A, vitamin E and folate level with hyperuricemia in the Korean general population.

Methods:

The present study included 6023 participants (2722 men and 3301 women) aged ≥19 years with available data on serum vitamin A, vitamin E, folate and serum uric acid. General characteristics of participants were compared using the Chi-square test and Student’s t test. The association between serum vitamin A, E and folate and serum uric acid levels were evaluated using general linear regression model. Multivariate logistic regression analyses were performed to estimate the effects of these micronutrients on hyperuricemia.

Results:

Serum uric acid levels were increased from the lowest quintile of vitamin A levels to the highest quintile after adjustment for covariates (Ptrend< 0.001 in both sexes). In addition, dose-dependent relationship was observed between vitamin A levels and the risk of hyperuricemia in fully-adjusted analyses (Ptrend< 0.001 in both sexes). However, neither serum vitamin E nor serum folate was associated with hyperuricemia across analyses models.

Conclusion:

This study suggested that vitamin A could be a risk factor of hyperuricemia and further studies are warranted to elucidate underlying mechanism of the observed findings.

References:

[1]Choi, Woo-Joo, et al. “Independent association of serum retinol and β-carotene levels with hyperuricemia: A national population study.”Arthritis care & research64.3 (2012): 389-396.

Disclosure of Interests: :

None declared

0073 Left Anterior Cingulate Hyperarousal During Sleep Anxiety-Inducing Emotional Tasks Performance in Patients with Insomnia Disorder

Introduction

Patients with insomnia frequently experience sleep/insomnia-related anxiety; this anxiety has been associated with hyperarousal. We investigated the underlying brain function changes in patients with insomnia during emotional task performance that induced sleep/insomnia-related anxiety.

Methods

Functional magnetic resonance imaging (fMRI) was performed during emotional task performance in healthy individuals and patients with insomnia who met the diagnostic criteria of insomnia disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and had chronic insomnia for more than 6 months. The participants underwent fMRI scanning during three types of emotional task performance—insomnia-anxiety task, reading sentences that cause insomnia-related anxiety; general-anxiety task, reading sentences that cause anxiety for everyone; and neutral task, reading neutral sentences that do not cause emotional anxiety. The images obtained from fMRI and blood oxygen level-dependent (BOLD) signal changes were compared between patients with insomnia and healthy controls. Interim analysis was performed with the data of 13 patients with insomnia and 9 controls.

Results

The brain activity in the left anterior cingulate was higher during insomnia-anxiety task performance than that during general-anxiety task performance in the insomnia group (voxel-wise uncorrected p &lt; 0.05; cluster size, 100). In the insomnia group, the brain activity during insomnia-anxiety task performance was not lower in any brain area than that during general-anxiety task performance.

Conclusion

We show that patients with chronic insomnia experience sleep anxiety related with hyperarousal in the left anterior cingulate area. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.

Support

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).

The effect of platelet-rich plasma as a scaffold in regeneration/revitalization endodontics of immature permanent teeth assessed using 2-dimensional radiographs and cone beam computed tomography: a randomized controlled trial

AIM

To assess the outcomes of platelet-rich plasma as a scaffold in regenerative/revitalization endodontics (RET) using cone beam computed tomography (CBCT) and 2-dimensional radiographs.

METHODOLOGY

Twenty-six healthy patients with mean age of 12.66 ± 4.47, and immature permanent anterior teeth with necrotic pulps, were randomly allocated to two groups, whereby RET was performed using platelet-rich plasma (PRP, test group) and blood clot (BLC, control group). Changes in root length (RL), root dentinal thickness (RDT), apical foramen width (AFW) and radiographic root area (RRA), were assessed using both radiographic methods, whilst changes in periapical area diameter (PAD) were assessed using CBCT, over a period of 12 months. T-test and chi-square/Fisher's exact tests were used to compare continuous and categorical data between BLC and PRP groups, respectively. Changes in RL, RDT, AFW, RRA and PAD were examined by comparing the two groups (PRP versus BLC) using multilevel modelling, considering the clustering effect of repeated measures of several teeth originating from the same participant.

RESULTS

Changes in RL, RDT, AFW, RRA and PAD, over time, were found to be significant for both groups. There was, however, no difference between the RET techniques (PRP versus BLC), using both radiographic and CBCT methods. The results of both assessment techniques (CBCT and 2-dimensional radiographic methods) were highly consistent (overall ICC ranged between 0.80 and 0.94). In addition, a significant effect of baseline PAD was found on RL, RRA and AD at 12 months (RL effect = -0.68, P < 0.001; RRA effect = -1.91, P = 0.025; AD effect = 0.08, P = 0.024).

CONCLUSION

The current study highlights successful and comparable clinical and radiographic outcomes of RET techniques using PRP and BLC. Standardized and calibrated 2-dimensional radiographic assessment was as effective as CBCT in assessing RET outcomes; therefore, the routine use of CBCT in RET is not recommended. Although an effect of baseline periapical lesion diameter on root development outcomes, at 12 months, were observed, more studies are recommended in order to assess such an effect.

Alteration of Exon Definition Causes Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a collection of genetic disorders affecting the quality and/or quantity of tooth enamel. More than 20 genes are, so far, known to be responsible for this condition. In this study, we recruited 3 Turkish families with hypomaturation AI. Whole-exome sequence analyses identified disease-causing mutations in each proband, and these mutations cosegregated with the AI phenotype in all recruited members of each family. The AI-causing mutations in family 1 were a novel AMELX mutation [NM_182680.1:c.143T>C, p.(Leu48Ser)] in the proband and a novel homozygous MMP20 mutation [NM_004771.3:c.616G>A, p.(Asp206Asn)] in the mother of the proband. Previously reported compound heterozygous MMP20 mutations [NM_004771.3:c.103A>C, p.(Arg35=) and c.389C>T, p.(Thr130Ile)] caused the AI in family 2 and family 3. Minigene splicing analyses revealed that the AMELX missense mutation increased exonic definition of exon 4 and the MMP20 synonymous mutation decreased exonic definition of exon 1. These mutations would trigger an alteration of exon usage during RNA splicing, causing the enamel malformations. These results broaden our understanding of molecular genetic pathology of tooth enamel formation.

Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial

BACKGROUND

The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis.

METHODS

The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178.

FINDINGS

Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population.

INTERPRETATION

The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis.

FUNDING

Boehringer Ingelheim.

[The efficacy and safety of tiotropium/olodaterol fixed-dose combination in Chinese patients with chronic obstructive pulmonary disease: a pooled subgroup analysis of TONADO 1+2]

Objective: To compare the efficacy and safety profiles of tiotropium/olodaterol with the mono-components in Chinese and total study population from TONADO trial. Methods: In the replicate, double-blind, parallel-group, active-controlled, randomized, 52-week, Phase Ⅲ TONADO studies (TONADO 1+2), patients received tiotropium/olodaterol, tiotropium, or olodaterol via the Respimat(®) Inhaler (Boehringer Ingelheim, Germany). Primary end points were forced expiratory volume in 1 second (FEV(1)) area under the curve from 0 to 3 hours (AUC(0-3h)) response and trough FEV(1) response, and St George's respiratory questionnaire (SGRQ) total score at 24 weeks. Adverse events were also collected. This subgroup analysis only focused on the efficacy and safety of the drug at the approved dose in China. Results: 548 Chinese patients were randomized, aged 41 to 82 years [mean age, (63±8) years] and most were male (526, 96%), 111 received tiotropium/olodaterol 5/5 μg, and 127 received tiotropium 5 μg and 95 received olodaterol 5 μg. The baseline characteristics of these groups were similar. After 24 weeks, treatment with tiotropium/olodaterol 5/5 μg, tiotropium 5 μg and olodaterol 5 μg resulted in an adjusted mean FEV(1) AUC(0-3h) response of 0.240, 0.157 and 0.079 L, and trough FEV(1) response of 0.117, 0.068 and-0.001 L, respectively. Tiotropium/olodaterol 5/5 μg significantly improved SGRQ scores in Chinese patients compared with olodaterol 5 μg (32.729 and 37.202, respectively). Generally, the safety profile of tiotropium/olodaterol was comparable with mono-components in 52 weeks. Conclusion: Compared with tiotropium or olodaterol, tiotropium/olodaterol in Chinese patients provided significant improvement in lung function and quality of life, and the safety profiles were similar.

P6534Prognostic implication of serum cystatin C and creatinine-based glomerular filtration rate ratio in coronary disease patients receiving PCI: a surrogate of low muscle mass and a predictor of mortality

Background

Low muscle mass results in impaired exercise capacity and is related with poor prognosis in chronic diseases. Although the ratio of serum creatinine (Scr) to cystatin C (Scys) is known as a surrogate marker of body muscle mass, the value of this marker is unclear in the patients with coronary artery disease (CAD).

Purpose

We assessed the clinical significance of two markers representing body muscle mass, the ratio of Scr to Scys (Scr/Scys), and ratio of estimated glomerular filtration rate by Scys to Scr (eGFRcys/eGFRcr).

Methods

We analyzed patients enrolled in a single tertiary center prospective percutaneous coronary intervention (PCI) registry that had Scr and Scys levels simultaneously measured before PCI. Optimal cut-off values of Scr/Scys and eGFRcys/eGFRcr, and their prognostic impact on 3-year mortality after PCI were analyzed. Subgroup analysis according to various demographics and risk factors was performed.

Results

A total of 1,928 patients who underwent PCI for significant CAD were analyzed (age 65.2±9.9 years, 70.8% men). Both Scr/Scys and eGFRcys/eGFRcr showed strong correlation with estimated proportion of muscle mass. Cut-off values of Scr/Scys discriminating 3-year death were 1.0 for men and 0.8 for women, while those of eGFRcys/eGFRcr were 1.1 for men and 1.0 for women. Both Scr/Scys- and eGFRcys/eGFRcr-based low muscle mass groups showed significantly higher risk of death, after adjusting for 7 selected covariates including age. The additional discriminative power of low muscle mass group on the predictive model was greater in the group determined by eGFRcys/eGFRcr than Scr/Scys. Low eGFRcys/eGFRcr values showed additional prognostic impact especially in patients older than 65 years, non-obese, men, chronic kidney disease, and current smokers.

Conclusions

Low muscle mass was an independent prognostic indicator in the patients who underwent coronary stenting. eGFRcys/eGFRcr was identified as a useful surrogate of muscle mass, which may be used to detect vulnerable patients with low muscle mass at high risk for future events.

Acknowledgement/Funding

None