Burden of osteoarthritis in India and its states, 1990-2019: findings from the Global Burden of disease study 2019

OBJECTIVE

To describe the burden of osteoarthritis (OA) in India from 1990 to 2019.

DESIGN

Data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA -knee OA, hip OA, hand OA, and other OA- was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, years lived with disability (YLD), and disability-adjusted life years (DALY) using methods reported in GBD 2019 study.

RESULT

Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI):4,420-5,447) in 1990-5313 (95%UI:4,799-5,898) in 2019, per 100,000 persons. Similarly, DALYs due to OA increased from 0.79 million (95%UI:0.40-1.55) to 2.12 million (95%UI:1.07-4.23); while age-standardised DALYs increased from 164 (95%UI:83-325) to 180 (95%UI:91-361) per 100,000 persons from 1990 to 2019. OA was the 20^th most common cause of YLDs in India in 2019, accounting for 1.48% (95%UI:0.88-2.78) of all YLDs; increasing from 23rd most common cause in 1990 (1.25%(95%UI:0.74-2.34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and DALYs for OA and knee OA were consistently higher in females than males.

CONCLUSION

The burden and impact of OA in India are substantial and is increasing. Adopting suitable control and preventive community measures to reduce modifiable risk factors (obesity, injuries, occupational stress) are needed to reduce the current and future burden of OA in India.

Primary pulmonary synovial sarcoma: A clinicopathological study of 22 cases

INTRODUCTION

Primary pulmonary synovial sarcoma (PPSS) is a rare mesenchymal tumour with characteristic translocation SS18-SSX1/2/rarely 4 fusion transcripts, and presents most often in adolescents and young adults. According to the World Health Organization (WHO) classification, synovial sarcoma is a malignant tumour of uncertain differentiation.

AIMS

To present a case series of PPSS with clinical, pathological and molecular analysis at a rare primary site.

SETTING AND DESIGN

Retrospective study conducted in a tertiary care hospital.

MATERIALS AND METHODS

Twenty-two cases of PPSSs were retrieved from electronic database between January 2009 to December 2018. Metastatic tumours from soft tissue primaries were excluded. Immunohistochemistry (IHC) and reverse transcription polymerase chain reaction (RT-PCR) were performed. Statistical analysis was performed using Mann-Whitney non-parametric test.

RESULTS

Among 22 patients, the male-female ratio was 3.4:1 and the median age was 31.5 years. The tumours were classified as monophasic (90.9%) and biphasic (9.1%) subtypes and graded as grade 2(77.3%) and grade 3(22.7%). IHC demonstrated expression of TLE1 (17/17 cases), Bcl-2 (7/8 cases), focal EMA (16/17 cases), CD99 (10/11 cases), focal pancytokeratin (8/12 cases) and CD56 (14/14 cases). The fusion transcripts included SYT-SSX1(4/11, 36.4%) and SYT-SSX2 (2/11, 18.2%). The remaining five cases were negative for SS18 rearrangement by RT-PCR. Only 8 patients had localised tumour. Surgical excision was performed in 5 patients. The median follow-up period was 6 months and 21 days.

CONCLUSIONS

Monophasic SS was the most common subtype. Small core biopsies pose a diagnostic challenge, in such a scenario, a combination of clinical, histomorphological, immunomarkers and genetic studies help confirm the diagnosis of PPSS.

Search for Resonances Decaying to Three W Bosons in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for resonances decaying into a W boson and a radion, where the radion decays into two W bosons, is presented. The data analyzed correspond to an integrated luminosity of 138  fb^{-1} recorded in proton-proton collisions with the CMS detector at sqrt[s]=13  TeV. One isolated charged lepton is required, together with missing transverse momentum and one or two massive large-radius jets, containing the decay products of either two or one W bosons, respectively. No excess over the background estimation is observed. The results are combined with those from a complementary channel with an all-hadronic final state, described in an accompanying paper. Limits are set on parameters of an extended warped extra-dimensional model. These searches are the first of their kind at the LHC.

Probing Charm Quark Dynamics via Multiparticle Correlations in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Multiparticle azimuthal correlations of prompt D^{0} mesons are measured in Pb-Pb collisions at a nucleon-nucleon center-of-mass energy of sqrt[s_{NN}]=5.02  TeV. For the first time, a four-particle cumulant method is used to extract the second Fourier coefficient of the azimuthal distribution (v_{2}) of D^{0} mesons as a function of event centrality and the D^{0} transverse momentum. The ratios of the four-particle v_{2} values to previously measured two-particle cumulant results provide direct experimental access to event-by-event fluctuations of charm quark azimuthal anisotropies. These ratios are also found to be comparable to those of inclusive charged particles in the event. However, hints of deviations are seen in the most central and peripheral collisions. To investigate the origin of flow fluctuations in the charm sector, these measurements are compared to a model implementing fluctuations of charm quark energy loss via collisional or radiative processes in the quark-gluon plasma. These models cannot quantitatively describe the data over the full transverse momentum and centrality ranges, although the calculations with collisional energy loss provide a better description of the data.

Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy

Optimal criteria for diagnosing and monitoring response to treatment for infectious and inflammatory medium–large vessel intracranial vasculitis presenting with stroke are lacking. We integrated intracranial vessel wall MRI with arterial spin labelling into our routine clinical stroke pathway to detect presumed inflammatory intracranial arterial vasculopathy, and monitor disease activity, in patients with clinical stroke syndromes. We used predefined standardized radiological criteria to define vessel wall enhancement, and all imaging findings were rated blinded to clinical details. Between 2017 and 2018, stroke or transient ischaemic attack patients were first screened in our vascular radiology meeting and followed up in a dedicated specialist stroke clinic if a diagnosis of medium–large inflammatory intracranial arterial vasculopathy was radiologically confirmed. Treatment was determined and monitored by a multi-disciplinary team. In this case series, 11 patients were managed in this period from the cohort of young stroke presenters (<55 years). The median age was 36 years (interquartile range: 33,50), of which 8 of 11 (73%) were female. Two of 11 (18%) had herpes virus infection confirmed by viral nucleic acid in the cerebrospinal fluid. We showed improvement in cerebral perfusion at 1 year using an arterial spin labelling sequence in patients taking immunosuppressive therapy for >4 weeks compared with those not receiving therapy [6 (100%) versus 2 (40%) P = 0.026]. Our findings demonstrate the potential utility of vessel wall magnetic resonance with arterial spin labelling imaging in detecting and monitoring medium–large inflammatory intracranial arterial vasculopathy activity for patients presenting with stroke symptoms, limiting the need to progress to brain biopsy. Further systematic studies in unselected populations of stroke patients are needed to confirm our findings and establish the prevalence of medium–large artery wall inflammation.

A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcriptionpolymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcriptionpolymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes.

First Search for Exclusive Diphoton Production at High Mass with Tagged Protons in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for exclusive two-photon production via photon exchange in proton-proton collisions, pp→pγγp with intact protons, is presented. The data correspond to an integrated luminosity of 9.4  fb^{-1} collected in 2016 using the CMS and TOTEM detectors at a center-of-mass energy of 13 TeV at the LHC. Events are selected with a diphoton invariant mass above 350 GeV and with both protons intact in the final state, to reduce backgrounds from strong interactions. The events of interest are those where the invariant mass and rapidity calculated from the momentum losses of the forward-moving protons match the mass and rapidity of the central, two-photon system. No events are found that satisfy this condition. Interpreting this result in an effective dimension-8 extension of the standard model, the first limits are set on the two anomalous four-photon coupling parameters. If the other parameter is constrained to its standard model value, the limits at 95% confidence level are |ζ_{1}|<2.9×10^{-13}  GeV^{-4} and |ζ_{2}|<6.0×10^{-13}  GeV^{-4}.

Isolated pancreatic myeloid sarcoma: A potential mimicker of pancreatic adenocarcinoma

Myeloid sarcoma (MS) is an extramedullary proliferation of immature myeloid cells which may occur as a progression of myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN), or myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) and as acute myeloid leukemia (AML) relapse. Rarely may it be de novo. Lymph nodes, skin, lungs, intestine are the commonly involved sites. However, an isolated pancreatic MS is seldom reported in the literature. Herein, we report one such case which was misdiagnosed as pancreatic adenocarcinoma on the clinico-radiological examination which misled us away from preoperative diagnostic sampling, and a Whipple pancreaticoduodenectomy was performed. Histopathological examination in conjunction with immunohistochemistry revealed the final diagnosis of isolated MS of the pancreas. We emphasize that although rare, a clinical suspicion along with preoperative histopathological examination may lead to early diagnosis, targeted management, and a better clinical outcome in such cases.

Solving the Mystery of Giant Intrathoracic Mass

Intrathoracic schwannoma are highly vascular nerve sheath benign tumors arising from neural crest derived schwann cells of the intercostal nerves. Common clinical presentation is palpable mass but in our case patient presented with shortness of breath which is rare presentation in Schwannoma. Imaging studies of the patient showed the lesion in left lung, however surgical finding showed mass to arise from chest wall and it was confirmed to be schwannoma by histopathological examination.

Observation of the B_{c}^{+} Meson in Pb-Pb and pp Collisions at sqrt[s_{NN}]=5.02 TeV and Measurement of its Nuclear Modification Factor

The B_{c}^{+} meson is observed for the first time in heavy ion collisions. Data from the CMS detector are used to study the production of the B_{c}^{+} meson in lead-lead (Pb-Pb) and proton-proton (pp) collisions at a center-of-mass energy per nucleon pair of sqrt[s_{NN}]=5.02  TeV, via the B_{c}^{+}→(J/ψ→μ^{+}μ^{-})μ^{+}ν_{μ} decay. The B_{c}^{+} nuclear modification factor, derived from the Pb-Pb-to-pp ratio of production cross sections, is measured in two bins of the trimuon transverse momentum and of the Pb-Pb collision centrality. The B_{c}^{+} meson is shown to be less suppressed than quarkonia and most of the open heavy-flavor mesons, suggesting that effects of the hot and dense nuclear matter created in heavy ion collisions contribute to its production. This measurement sets forth a promising new probe of the interplay of suppression and enhancement mechanisms in the production of heavy-flavor mesons in the quark-gluon plasma.

POS1105 EFFICACY AND SAFETY OF COLCHICINE FOR THE TREATMENT OF OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTERVENTION TRIALS

Background

Colchicine, an approved treatment for gout, has been trialled in many diseases, including osteoarthritis (OA), due to its anti-inflammatory effects. However, its efficacy and safety remain unclear in OA.

Objectives

This systematic review and meta-analysis evaluated the efficacy and safety of colchicine for the treatment of OA.1

Methods

PubMed, Web of Science, Scopus, and Cochrane Central were searched from inception through November 2020. Two reviewers independently screened for randomised controlled trials (RCTs) comparing colchicine with placebo or other active-comparators for the treatment of OA (knee, hand, or hip OA), extracted data, and performed Cochrane risk of bias assessments.

Results

The search retrieved 391 articles after removing duplicates, and 16 full-text articles were reviewed for eligibility (Figure 1A). Ten RCTs, nine in knee OA, one in hand OA, consisting of 847 patients (429 in colchicine arm, 409 in control arm) were included. RCTs were conducted between 2002 and 2021; three in India, two in Iran and Turkey, and one each in Australia, Singapore, and Iraq; follow-up period ranged 2 to 12 months. Moderate-quality evidence showed no clinically important pain reduction with colchicine compared to placebo in knee/hand OA patients (standardised mean difference [SMD], -0.17; 95% confidence interval [CI], -0.55 to 0.22) (Figure 1B). Moderate-quality evidence showed no improvement in dysfunction with colchicine compared to placebo in knee OA patients (SMD, -0.37; 95% CI, -0.87 to 0.13). Colchicine showed an acceptable safety profile with AEs/SAEs comparable to placebo (Figure 1C)

Conclusion

Current evidence does not conclusively suggest a benefit of colchicine in reducing pain and improving physical function in hand/knee OA patients. Future trials should focus on the sub-groups of OA patients with local or systemic evidence of inflammation and/or mineralisation who may benefit from colchicine.

References

[1]Rheumatology (Oxford). 2018 Jan 1;57(suppl_1):i4-i11.

Disclosure of Interests

None declared

POS1329 SECONDARY HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: A SINGLE-CENTRE EXPERIENCE

Background

Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome characterised by fever, organomegaly, cytopaenias, activated macrophages in haematopoietic organs and elevated ferritin. Primary HLH is caused by inherited defects in cytolytic pathway proteins and manifests in infancy[1]. Secondary HLH (sHLH) develops in individuals with a genetic susceptibility to hyperinflammation triggered by strongly immunogenic stimulus such as autoimmune conditions, haematological malignancy, organ transplantation or infection[2].

We present a cohort of patients with sHLH and detail their characteristics.

Objectives

To evaluate the characteristics and aetiology of sHLH patients at our Centre.

Methods

A single-centre retrospective observational study of all cases of sHLH between January 2018 and July 2021. Patients were identified from referrals and included if there was a diagnosis of HLH made by a rheumatologist with an H-score of 169 or greater. P-values were calculated using the Mann-Whitney test, unpaired t-test or Fisher exact as appropriate.

Results

30 patients (10 female) with sHLH were identified with a median age of 46, a mean H-score of 238 (range 186-317). 15 (50%) had pre-existing immunosuppression, which did not influence mortality (p=0.26). The following primary drivers were identified: lymphoma (n=8), non-HIV viral infections (n=9), first presentation of HIV/AIDS with opportunistic infections (n=4), Adult-onset Still’s disease (n=4), miliary tuberculosis (n=1), M. falciparum infection (n=1), meningococcal meningitis (n=1), checkpoint inhibitor therapy-related (n=1), and no diagnosis (n=1) - Table 1.

Table 1.

§ = Mann Whitney U test, τ = unpaired t-test, φ = Fisher exact

Total (n=30)Survived (n=18)Died (n=12)p-valueDemographicsMale2010100.78§Female1082Mean age4341470.348§Median H-score2402302540.059 τFerritin (ng/ml)4027734690484040.0949Trilineage cytopenia, n (%)9 (33%)5 (31%)4 (36%)0.28§Subgroup (not mutually exclusive)1 yr survivalLymphoma81712.5% (p=0.0025 φ)HIV/AIDS440100%AOSD440100%Transplant recipient41325%Other viral infection95444%  HSV330100%  CMV110100%  EBV1010%  Yellow fever2020%  Influenza A110100%Tuberculosis32166% with HIV220100%

Non-HIV viral infections were the most common cause overall. 6 of 9 were caused by Herpes virus family and all were primary infections. Two followed yellow fever viraemia following live vaccination and both patients died.

Mortality varied with aetiology. All four patients with AOSD survived, while 7 of 8 with lymphoma died, as per previous reports3. There was a strong association between lymphoma and mortality vs non-lymphoma sHLH (p=0.0025). Four patients post-solid organ transplantation were identified (three liver, one kidney), three with post-transplant lymphoproliferative disorder and one with CMV viraemia (50% mortality).

There was no significant difference between age, ferritin or H-score between surviving and deceased patients (Figure 1), but H-score trended higher in the deceased (p=0.059). Number of treatments given for HLH was higher in the deceased group vs survival (mean 3.41 deceased, mean 2.44 in survived). Anakinra was used in all 30 patients as treatment, including as monotherapy in one patient with HSV viraemia who survived.

Figure 1.

Conclusion

Ferritin, H-score at diagnosis or age do not appear to correlate with mortality in sHLH. Lymphoma is associated with a significantly worse outcome. Poor response to treatment and increasing numbers of treatment options is associated with increased mortality. Causes are varied and often co-exist.

References

[1]Jordan MB et al. An animal model of hemophagocytic lymphohistiocytosis (HLH): CD8+ T cells and interferon gamma are essential for the disorder. Blood. 2004.

[2]Carter SJ et al. Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatments. Rheumatology. 2019.

[3]Parikh SA et al. Prognostic Factors and Outcomes of Adults with Hemophagocytic Lymphohistiocytosis. Mayo Clin Proc. 2014.

Disclosure of Interests

None declared

POS1259 AXIAL SPONDYLOARTHRITIS, AGE AND MALE GENDER IMPACT COVID VACCINATION AEs MORE THAN RHEUMATOID ARTHRITIS

Background

Rheumatologists recommend vaccination in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) patients, but there are few studies on the occurrence of adverse events (AEs), particularly worsening disease related activity and unrelated immune reactions in these groups.

Objectives

To evaluate the uptake of COVID vaccination in RA and axSpA patients, compare the frequency of AEs, and identify risk factors associated with vaccine AEs in two prospective cohorts comprised of these patients.

Methods

The IMPACT study is a monthly survey of two prospective cohorts of established RA and axSpA patients in northern Alberta, Canada from November 2020-2021 who answered at least one or more Redcap surveys through de-identified email link surveying demographics, disease characteristics, COVID symptoms, treatment of RA and axSpA, health care utilization, vaccination status, vaccine AEs and use of cannabis. Univariate analyses evaluated independent variables associated with the dependent variables of (1) any AE, (2) any severe AE, (3) any arthritis flare, and (4) any severe arthritis flare, followed by multivariate analyses of these four dependant variables using all clinically relevant variables from the univariate analysis.

Results

773/2167 patients (RA 574, axSpA 197) responded to at least one survey. 32/663 (5%) were single vaccinated, 631 (95%) double vaccinated and 230 (54%) triple vaccinated with 80% receiving Pfizer, 24% Moderna, 28% AstraZeneca and 30% “other”. 456 (69%) reported at least one AE (Figure 1) with 21 (3%) patients seeing a physician for their AE. Increased age was associated with all AEs. RA patients had lower reported AEs versus axSpA patients for all AE definitions except for severe arthritis flares. Generally, males reported worse AEs (Table 1). “Any arthritis flare” was lower in patients reporting cannabis use.

Table 1.

Summary of Multivariate Level Mixed-Effect Logistic Regression Models Evaluating the IMPACT of RA and axSpA Disease Characteristics on Vaccine AEs

VariableAny Adverse EventOR (95 % CI) p valueSevere Adverse Event* OR 95 % CI) p valueAny Arthritis Flare or Joint Ache Adverse Event OR (95 % CI) p valueAny Severe Arthritis Flare or Joint Ache* OR (95 % CI) p valueGenderMale1.47 (0.89 – 2.43)p=0.132.10 (1.30-3.41)p=0.0032.05 (1.20 – 3.50) p=0.013.97 (1.84 – 8.57)p=0.0004FemaleAge1.06 (1.04 – 1.08)p<0.011.05 (1.03 – 1.06)p<0.011.03 (1.01 – 1.04)p=0.0031.03 (1.01 – 1.06)p=0.004Rheumatic Disease TypeRA0.42 (0.23 – 0.76)p=0.050.55 (0.31 – 0.98)p=0.040.52 (0.28 – 0.98)p=0.040.78 (0.34 – 1.78)p=0.55axSpASteroidsYes0.85 (0.40 – 1.83) P=0.680.66 (0.32 – 1.35) p=0.250.84 (0.36 – 1.95) p=0.690.38 (0.15 – 0.97)p=0.04NoNSAIDSYes1.11 (0.81 – 1.52) p=0.511.03 (0.75 – 1.41)p=0.861.05 (0.74 – 1.48)p=0.801.17 (0.73 – 1.89)p=0.52NoCurrent Disease Activity0.95 (0.88 – 1.03) p=0.230.90 (0.83 – 0.97)p=0.190.92 (0.85 – 1.00)p=0.060.82 (0.74 – 0.92)p=0.001HAQ1.08 (0.73 – 1.61) p=0.700.77 (0.52 – 1.14)p=0.010.74 (0.48 – 1.13)p=0.170.65 (0.38 – 1.11)p=0.12Nicotine productsYes1.33 (0.75 – 2.37) p=0.341.42 (0.80 – 2.52)p=0.241.15 (0.60 – 2.01)p=0.760.97 (0.43 – 2.17)p=0.94NoCannabis productsYes0.78 (0.49 – 1.25) p=0.300.87 (0.55 – 1.38)p=0.550.51 (0.31 – 0.83)p=0.070.66 (0.35 – 1.26)p=0.21NoDMARDsYes1.98 (1.28 – 3.06)p=0.0021.52 (1.01 – 2.28)p=0.051.43 (0.91 – 2.23) p=0.121.86 (1.03 – 3.36)p=0.04NoBiologic DMARDYes0.72 (0.42 – 1.25) p=0.240.79 (0.45 – 1.41) p=0.431.20 (0.66 – 2.18 p=0.541.39 (0.63 – 3.08)p=0.42No

*Severe = Any of the following: ranked moderate to severe and/or lasting more than 7 days and/or saw physician

Conclusion

RA and axSpA patients showed high uptake of COVID vaccination with largely minor AEs. Older age and male gender were associated with more general and arthritis specific AEs. The association of any AE and/or arthritis-specific AEs in SpA versus RA patients is a novel finding which may correlate with the male predominance of SpA. The association of cannabis with fewer arthritis AEs may reflect the nociceptive properties of cannabis.

Acknowledgements

Epidemiology Coordinating and Research (EPICORE) Centre provided support for the REDCAP survey and biostatistical analyses.

Disclosure of Interests

Stephanie Keeling Speakers bureau: Pfizer, Abbvie, GSK, UCB, Consultant of: Abbvie, GSK, UCB, AstraZeneca, Sandoz, Pfizer, Grant/research support from: Abbvie, Sandoz, Merck, UCB, Bo Pan: None declared, Edna Hutchings Shareholder of: BMS, Stephanie Wichuk: None declared, Mohammed Osman Speakers bureau: Boehringer Ingelheim, Takeda Pharmaceuticals, Grant/research support from: Boehringer Ingelheim and CSL-Behring, Ameeta Singh: None declared, Ashlesha Sonpar Speakers bureau: Novartis, Ilan Swartz: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celegene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB

POS1258 LESS THAN EXPECTED IMPACT OF RHEUMATOID ARTHRITIS AND AXIAL SPONDYLOARTHRITIS DISEASE ON COVID SEVERITY

Background

Throughout the pandemic, there has been ongoing concern that people with autoimmune diseases such as rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) will have more severe COVID-19 disease due to immune dysfunction associated with autoimmune diseases and their treatment.

Objectives

We aimed to compare the severity of COVID-19 in patients with RA versus axSpA and characterize the predictors of COVID-19 severity during the pre-Omicron pandemic phases.

Methods

The IMPACT (IMPact of inflammatory Arthritis on COVID Outcomes STudy) study is a monthly survey of two established northern Alberta, Canada prospective cohorts of RA and axSpA patients from November 2020-2021 who answered Redcap surveys through de-identified email link surveying patient demographics, disease characteristics, COVID-19 symptoms, treatment of RA and axSpA, health care utilization, vaccination status and vaccine adverse events. Descriptive and univariate analyses (dependent variable = severe COVID-19) were performed followed by multivariate analyses of all significant and clinically relevant independent variables from the univariate analysis. Infection severity was defined as any patient with COVID-19 symptoms who visited a doctor, ER or required hospital admission.

Results

773 of 2167 (36%) patients (RA n=574, axSpA n=197) registered in both cohorts answered at least one baseline survey, 28 (4%) reporting positive COVID-19 tests (24 positive once). Of 442 reporting COVID-19 symptoms during the survey, 11 (3%) were admitted for a mean of 4 days, 2 requiring ICU or blood clot treatment and 1 requiring advanced therapy. 116 (26%) visited a physician for Covid symptoms. Univariate analysis showed that the use of steroids, NSAIDs and increased disease activity were associated with having less severe infection but these associations were not significant in the multivariate analysis (Table 1). There were no significant impacts of RA vs axSpA, age, gender, treatment, disease activity, or smoking.

Table 1.

Multivariate Level Mixed-Effect Logistic Regression Model: IMPACT of RA and axSpA Disease Characteristics on COVID Infection Severity Defined as Patients with COVID Symptoms Requiring Visit to Doctor, Emergency Room and/or Hospital Admission.

VariableCoefficient (S.E)Odds Ratio (95 % Confidence Interval)P-valueGenderMale0.17 (0.34)1.18 (0.61 – 2.31)0.6193FemaleReferenceAge-0.01 (0.01)0.99 (0.97 – 1.01)0.2543Rheumatic Disease TypeRA0.18 (0.40)1.20 (0.58 – 2.48)0.6213SpAReferenceSteroidsYes-0.40 (0.56)0.67 (0.23 – 2.01)0.4757NoReferenceNSAIDSYes-0.20 (0.26)0.82 (0.49 – 1.37)0.4508NoReferenceCurrent Disease Activity-0.04 (0.06)0.96 (0.85 – 1.09)0.5275HAQ-0.03 (0.29)0.97 (0.55 – 1.70)0.9041Nicotine productsYes-0.67 (0.37)0.51 (0.25 – 1.06)0.0714NoReferenceCannabis productsYes-0.45 (0.31)0.64 (0.35 – 1.18)0.1510NoReferenceDMARDsYes0.26 (0.30)1.30 (0.72 – 2.35)0.3860NoReferenceBiologic DMARDYes-0.46 (0.43)0.63 (0.27 – 1.46)0.2813NoReference

Conclusion

Possible disease related risk factors for increased COVID-19 severity in RA and axSpA patients preceding the onset of the Omicron variant including use of steroids or DMARDs were not associated with severe infection. These findings are consistent with other international studies whereby other non-rheumatic disease comorbidities played a greater role in infection severity.

Acknowledgements

Epidemiology Coordinating and Research (EPICORE) Centre provided support for the REDCAP survey and biostatistical anayses.

Disclosure of Interests

Stephanie Keeling Speakers bureau: Abbvie, GSK, Pfizer, UCB, Consultant of: Abbvie, GSK, Pfizer, Sandoz, UCB, Eli-Lilly, Galapagos, Novartis, Grant/research support from: Abbvie, UCB, Sandoz, Pfizer, Merck, Bo Pan: None declared, Edna Hutchings Shareholder of: BMS, Stephanie Wichuk: None declared, Mohammed Osman Speakers bureau: Boehringer Ingelheim, Takeda Pharmaceuticals, Grant/research support from: Yes, Boehringer Ingelheim and CSL-Behring, Ameeta Singh: None declared, Ashlesha Sonpar Speakers bureau: Novartis, Ilan Swartz: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB

, Consultant of: Abbvie, Boehringer Ingelheim, Celegene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB

POS0178 ASSOCIATION BETWEEN KNEE MR IMAGING MARKERS AND KNEE SYMPTOMS OVER 7 YEARS IN YOUNG ADULTS

Background

Knee magnetic resonance imaging (MRI)-based morphological markers (quantitative biomarkers) and structural abnormalities (semi-quantitative biomarkers) are known to be associated with the progression of knee osteoarthritis (OA). However, there is conflicting evidence on the association between knee MRI-based morphological markers and knee symptoms. Besides, there is a lack of evidence on the clinical significance of MR imaging markers in the general population-based young adults. Hence, our aim was to investigate the associations between MR imaging biomarkers and knee symptoms in middle-aged adults followed over seven years.

Objectives

To describe the associations of cartilage volume, cartilage thickness, subchondral bone area, cartilage defects, and bone marrow lesions (BML) with knee symptoms in young adults followed up over 6-9 years.

Methods

Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale during Childhood Determinants of Adult Health (CDAH)-knee study at baseline (year: 2008-10, age: 30–40 years) and 6-9 year follow-up (CDAH-3; year: 2014–2019, age: 36–49 years). Knee MRI scans were obtained at baseline and were assessed quantitatively for morphological markers such as cartilage volume, cartilage thickness, subchondral bone area using semi-automated segmentation (Chondrometrics, Germany). Cartilage defects and BMLs were assessed using semi-quantitative scoring systems. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson (ZIP) regression model with random effects were used to describe the cross-sectional and longitudinal associations.

Results

The prevalence of knee pain at baseline (mean age (SD): 34 (2.7); female 49%) was 34% that increased to 50% over 6-9 year follow-up (mean age (SD): 43 (3.2)). Cross sectionally, there was a weak but statistically significant negative association between medial femorotibial compartment (MFTC) [Ratio of Mean (RoM)= 0.99971084; 95% CI: (0.9995525, 0.99986921; p<0.001], lateral femorotibial compartment (LFTC) [RoM=0.99982602; 95% CI: 0.99969915, 0.9999529; p=0.007], and patellar cartilage volume [RoM=0.99981722; 95% CI: 0.99965326, 0.9999811; p=0.029] with knee symptoms.

Similarly, there was a negative association between patellar cartilage volume (RoM=0.99975523; 95% CI: 0.99961427, 0.99989621; p=0.014), MFTC cartilage thickness (RoM= 0.72090775; 95% CI: 0.59481806, 0.87372596; p=0.001) and knee symptoms assessed after seven years.

The total bone area was consistently and negatively associated with knee symptoms at baseline [RoM= 0.9210485; 95%CI: 0.8939677, 0.9489496; p<0.001] and over seven years (RoM=0.9588811; 95% CI: 0.9313379, 0.9872388; p=0.005). Presence of any cartilage defect or BML was associated with higher knee symptoms at baseline and after seven years.

Conclusion

In the middle-aged adult population, BML and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semi-quantitative MR imaging biomarkers can be explored as a marker of the clinical progression of OA in a young adult population.

Disclosure of Interests

Benny Antony: None declared, Alison Venn: None declared, Leigh Blizzard: None declared, Lyn March: None declared, Flavia Cicuttini: None declared, Felix Eckstein Shareholder of: Shareholder of Chondrometrics, image processing company, Graeme Jones: None declared, Changhai Ding: None declared, Ambrish Singh: None declared

POS1425 THE BURDEN OF OSTEOARTHRITIS ACROSS THE STATES OF INDIA, 1990–2019: FINDINGS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2019

Background

Few studies have reported the burden of osteoarthritis (OA) in different parts of India. However, no study has reported the detailed estimates of incidence, prevalence, and years lived with disability (YLDs) and its trends for OA (and its various sites) across the states of India over a long period of time.

Objectives

We aim to describe the state-wise prevalence, incidence, and YLDs for osteoarthritis (OA) in India from 1990 to 2019 according to age and sex.

Methods

Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA –including knee OA, hip OA, hand OA, and other OA– was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, and YLDs modelled data using the methods reported in the GBD 2019 Study. All estimates are presented as counts and age-standardised rates per 100,000 population, with uncertainty intervals (UIs).

Results

Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI): 4,420–5,447) in 1990 to 5313 (95%UI: 4,799–5,898) in 2019, per 100,000. OA was the 20th most common cause of YLDs in India in 2019, accounting for 1·48% (95%UI: 0·88–2·78) of all YLDs; increasing from 23rd most common cause in 1990 (1·25% (95%UI: 0·74–2·34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and YLDs for OA and knee OA were consistently higher in females than males. Uttar Pradesh (8.53 million (95%UI: 7.63–9.53), Maharashtra (6.37 million (95%UI: 5.75–7.06), and West Bengal (4.90 million (95%UI: 4.39–5.46) had the three highest levels of OA prevalence. Goa (5689 (95%UI: 5,125–6,282)), Rajasthan (5667 (95%UI: 5,097–6,305)), and Kerala (5658 (95%UI: 5,107–6,263)) had the highest age-standardised prevalence of OA in 2019, per 100,000 (Figure 1 A and B).

Conclusion

The burden and impact of OA in India are substantial and is increasing; however, it varied among states. Females were affected more commonly than males. Knee OA was the most prevalent site. With improvement in life expectancy and population ageing, greater increases are expected. Adopting suitable control and preventive community measures to reduce modifiable risk factors (such as obesity, injuries, occupational stress) are needed now to reduce the current and future burden of OA in India.

Disclosure of Interests

None declared

Association between osteoarthritis-related serum biochemical markers over 11 years and knee MRI-based imaging biomarkers in middle-aged adults

OBJECTIVE

To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years.

METHODS

Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06; n = 156) and 10-13 year follow-up at CDAH-3 (n = 167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10; n = 313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML.

RESULTS

In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070; 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548; 95%CI:-254.917,-28.179) and total bone area (β:-0.729; 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years); a significant negative association of patellar cartilage volume (β:-0.001; 95%CI:-0.002,-0.00004), and total bone area (β:-0.158; 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001; 95%CI:-0.001,-0.0001) and total bone area (β:-0.373; 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA.

CONCLUSION

COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.

Evaluation of dentinal crack propagation, amount of gutta percha remaining and time required during removal of gutta percha using two different rotary instruments and hand instruments - An In vitro study

Background

One of the most important goal of non surgical endodontic retreatment is the successful removal of gutta percha and sealers from the root canal system. A variety of techniques have been recommended for retreatment procedures for the removal of gutta-percha and sealers with or without the help of adjunctive chemical solvents, by using stainless steel hand files or nickel-titanium rotary files, gate glidden burs, heated instruments, ultrasonic instruments, and lasers 1,3. The current advancements in the design of NiTi instruments have proved efficacious in the removal of filling materials from the root canal wall and various studies have also confirmed their cleaning ability and efficacy 4,5. Nevertheless, the use of rotary instrumentation can lead to the formation of dentinal cracks in the root canal dentin. Many researchers have reported the incidence of crack formation and propagation after the procedure with manual, rotary and reciprocating instruments. The behavior of rotary instruments in the generation of defects have been the point of greatest interest during many years 6. These dentinal cracks can be defined as defects with a complete crack line extending from inner root canal space up to the outer surface of the root when the tensile stress in the root canal wall exceeds the tensile stress of dentin 7.

Aim

This study was conducted to investigate and to compare the amount of dentinal microcracks formation with various new instrumentation methods and conventional hand filing method. It also looks into amount of gutta-percha removed after retreatment from the canal and the time required for all the instrumentation technique.

Methodology

Sixty extracted human maxillary first molars with curved roots were mounted on addition silicone impression material incorporated in an aluminium hollow block, then instrumented using step-back preparation with 35 size K files. Obturation was done using gutta-percha with AH plus sealer. These were stored for 14 days and divided into three groups Mani GPR, Endostar Re Endo and H file and were subjected to retreatment procedures. Retreatment was considered complete when no filling material was observed on the canal wall and the canal was smooth and free of visible debris. The samples were examined under scanning electron microscope and the number of cracks were calculated. The percentage of root canal filling material and time taken was recorded.

Statistical Analysis

The data obtained were analyzed by using descriptive statistics, ANOVA (Analysis of Variance), chi-square test and Scheffe's post hoc test through SPSS for window (version 22.0).

Result

All the techniques showed similar amount of crack propagation, with no statistical difference between the group. Retreatment done using H Files required more time and removed less material. The coronal third showed less amount of gutta-percha remnants than the apical third in all groups.

Conclusion

All the groups showed a similar amount of crack propagation. Less number of cracks were observed in the coronal one third and more amount of cracks were found at the apical third. Endostar RE Endo rotary instrument proved to be most effective and least time-consuming. Hedstrom Files required more time and removed less material.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.