THU0280 IMPACT ON PHYSICIAN GLOBAL ASSESSMENT ON REMISSION RATES IN SLE. ANALYSIS FROM A GERMAN SLE-COHORT

Background:

Defining remission for SLE as a suitable target for a treat to target (T2T) approach has been a major challenge in the past years. A few years back, four definitions of remission were presented by the international DORIS task force.[1] Parameters included in the definition are clinical activity (cSLEDAI), steroid dose, immunosuppressive therapy, serology and physician global assessment (PGA). In particular the PGA, its threshold and general utility have been and still are discussed controversially.

Objectives:

It was our aim to evaluate the added value of PGA in remission assessment.

Methods:

In this monocentric cross-sectional study, patients with SLE according to the 1997 American College of Rheumatology (ACR) criteria were enrolled and assessed between September 2016 and December 2017. Two different definitions of remission were applied. The internationally accepted DORIS remission and a modified DORIS remission excluding PGA. Factors influencing PGA were assessed in the entire cohort. Regression analyses were used to assess differences between patients in DORIS and modified DORIS remission.

Results:

A total of 233 patients were included (87.6% female). 98 patients (41.9%) fulfilled any of the four DORIS remission definitions, while 154 patients (66.1%) were in any modified remission in which PGA was excluded. In general, PGA rating was associated with disease activity (clinical SLEDAI; p=<0.0001), depression (Center for Epidemiological Studies Depression Scale; p=0.049), pain reported by the patient (numeric rating scale; p=<0.0001) and hypocomplementemia (p=<0.0001). Damage (SLICC damage index, SDI) did not influence PGA (p=0.98). Both, DORIS and modified DORIS remission were associated with lower damage (p=0.026; p=0.003), lower pain on NRS (p=0.001; p=0.013), normal complement (p=0.0005; p=0.005) and better illness perception (p=0.006; p=0.023). Patients in modified DORIS remission had a tendency for more immunosuppressive therapy (p=0.046).

Conclusion:

Exclusion of PGA in remission assessment led to an increased number of patients in remission. Clinical parameters and factors associated with DORIS remission vs. modified DORIS remission were similar, hence the added value of PGA in our cohort regarding remission assessment is questionable. The use and especially the correct threshold of PGA for remission still has to be discussed.

References:

[1]van Vollenhoven, Ronald; Voskuyl, Alexandre; Bertsias, George; Aranow, Cynthia; Aringer, Martin; Arnaud, Laurent et al. (2017): A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). In:Annals of the rheumatic diseases76 (3), S. 554–561. DOI: 10.1136/annrheumdis-2016-209519.

Disclosure of Interests:

Johanna Mucke: None declared, Christina Duesing: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Gamal Chehab Grant/research support from: Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study.

FRI0361 CARTILAGE DEGRADATION IN PSORIATIC ARTHRITIS IS ASSOCIATED WITH INCREASED SYNOVIAL PERFUSION AS DETECTED BY MAGNETIC RESONANCE IMAGING

Background:

Even though cartilage loss is a known feature of psoriatic arthritis (PsA), research is sparse on its role in the pathogenesis of PsA and its potential use for disease detection and monitoring. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and dynamic contrast-enhanced MRI (DCE MRI), research has shown that early cartilage loss is strongly associated with synovial inflammation in rheumatoid arthritis (RA). The aim of this study was to determine if acute inflammation is associated with early cartilage loss in small finger joints of patients with PsA.

Objectives:

Is local perfusion in PsA patients measured by dynamic MRI associated to local cartilage loss?

Methods:

Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution 3 Tesla dGEMRIC and DCE MRI using a dedicated 16-channel hand coil. Semi-quantitative and quantitative perfusion parameters were calculated. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), total cartilage thickness (TCT), and joint space width (JSW).

Results:

We found significant negative correlations between perfusion parameters (except Kep) and dGEMRIC indices, with the highest value at the MCP joints (KTrans: τ = -0.54, p = 0.01; Kep: τ= -0.02, p = 0.90; IAUC: τ = -0.51, p = 0.015; Initial Slope: τ = -0.54, p = 0.01; Peak: τ = -0.67, p = 0.002). Heterogeneous correlations were detected between perfusion parameters and both, total PsAMRIS and PsAMRIS synovitis sub-scores. No significant correlation was seen between any perfusion parameter and JSW and/or TCT.

Conclusion:

As examined by DCE MRI and dGEMRIC, there is a significant association between early cartilage loss and acute synovial inflammation in small finger joints of PsA patients.

Figure 1.

dGEMRIC maps (third digit) and perfusion maps (peak parameter) of MCP, PIP, and DIP joints in 26-year-old male (A and B) and a 59-year-old female (C and D) with PsA. Lower dGEMRIC values are illustrated in D, indicating more proteoglycan loss than in A. Higher peak values are depicted in C, indicating a higher severity of synovitis than in B. Peak parameter is illustrated in mM/l per second, dGEMRIC indices in ms.

Disclosure of Interests:

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Anja Müller-Lutz: None declared, Miriam Frenken: None declared, Karl Ludger Radke: None declared, Stefan Vordenbäumen: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared

FRI0174 THE LONGER THE DELAY IN DIAGNOSIS, THE WORSE THE OUTCOME IN SLE – CROSS SECTIONAL ANALYSIS OF A GERMAN LONG-TERM STUDY (LULA COHORT)

Background:

Patients with systemic lupus erythematosus (SLE), even compared to those with other rheumatic diseases, are thought to often experience a long delay from the onset of symptoms to diagnosis.

Objectives:

Our aim was to study the association of this delay to the long-term outcome of the disease.

Methods:

Information on demographics, onset of first symptoms, first physicians visit, time of diagnosis and organ involvement was assessed by self-reported questionnaires among SLE patients in Germany in 2011 (LuLa cohort, n=585). Disease related damage (Brief Index of Lupus Damage; BILD), disease activity (Systemic Lupus Activity Questionnaire; SLAQ) and health related quality of life (SF-12) were chosen as proxies for outcome. The association to the outcome of the disease was analyzed by linear regression analysis, adjusted for age, disease duration, organ involvement and sex.

Results:

In our cohort, the mean reported duration between the onset of symptoms and the diagnosis of SLE was 46 months (SD 73), which includes 13 months (SD 41) between the onset of symptoms and the first physicians visit. The participating patients were diagnosed between 1960 and 2004.

Linear regression analysis revealed that longer time to diagnosis was associated with (i) higher disease activity (SLAQ, p<0.0001, β=0.199), (ii) higher disease-related damage (BILD, p=0.002, β=0.137) and (iii) lower health-related quality of life (SF-12 physical p=0.004, β=-0.136, SF-12 mental p=0.004, β=-0.143) in the year 2011. The organ involvement at the time of diagnosis did not alter these results.

Conclusion:

A delay in diagnosis was associated with a worse outcome in SLE (disease activity, disease-related damage and health-related quality of life). Therefore, an early diagnosis seems to be important to improve the long-term outcome of the disease. It will be interesting to see whether adopting the new EULAR/ACR 2019 classification criteria can contribute to a faster diagnosis and a better outcome in consequence.

The LuLa study is supported by unrestricted grants from GlaxoSmithKline and UCB Pharma.

Disclosure of Interests:

Anna Kernder Grant/research support from: Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Jutta Richter Grant/research support from: Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Rebecca Fischer-Betz Consultant of: UCB, Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Chugai, GSK, Janssen, Lilly, Medac, MSD, Novartis, Roche, UCB, Pfizer., Borgi Winkler-Rohlfing: None declared, Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Gamal Chehab Grant/research support from: Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study.

AB0226 USING 3 TESLA MRI WITH A HIGH-RESOLUTION 16-CHANNEL HAND COIL TO DIFFERENTIATE BETWEEN RHEUMATOID AND PSORIATIC ARTHRITIS: A PILOT STUDY

Background:

The differentiation between rheumatoid arthritis (RA) and psoriatic arthritis (PsA) is sometimes a challenge for rheumatologists in daily clinical practice. Imaging techniques such as MRI could be a helpful tool for this purpose.

Objectives:

To examine the value of 3 Tesla (T) magnetic resonance imaging (MRI) with a high-resolution 16-channel hand coil for the differentiation between RA and PsA.

Methods:

A total of 17 patients with active PsA and 27 patients with active RA were evaluated by 3T MRI. Images were analyzed by three readers according to the outcome measures for RA clinical trials (OMERACT) and RA and PsA MRI scores for the presence and intensity of the following MRI features: synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. A receiver operating characteristics (ROC) curve was established for a calculated prediction model comprising age, gender, and the imaging features ‘periarticular inflammation’ and ‘erosion’ of the metacarpophalangeal (MCP) joint of the 5th finger.

Results:

PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score ‘periarticular inflammation’), with a minimal odds ratio (OR) for the outcome ‘not RA’ of 0.06 (p< 0.01) at all MCP joints. The calculated ROC curve had an area under the curve (AUC) of 98.1%.

Conclusion:

3T MRI showed a strong association of extracapsular inflammatory changes with PsA at the MCP joint level, and consequently allowed differentiation between PsA and RA.

Figure 1.

Receiver operating characteristics (ROC) curve with different thresholds for the calculated prediction model for the outcome RA. Area under the curve (AUC) = 98.1%.

Figure 2.

51-year-old female patient with PsA. MR images show flexor tenosynovitis (FS), synovitis (Syn), and periarticular inflammation (PI). A. Sagittal PD fat-saturation of D5. PI at the volar and dorsal aspects at the MCP, PIP, and DIP levels. FS at the PIP and DIP joint levels. Black asterisks indicate PI. Black arrow points to FS. B. Coronal STIR with bone edema (BE) at the proximal portion of PIP3 and 5 accompanied by PI at PIP3 and MCP, PIP and DIP5. Asterisks indicate BE. Arrowheads point to PI. C. Transversal T2 fat-saturation with FS and PI at MCP5. Arrowhead indicates FS, arrow points to volar PI. D. Transversal T1 fat-saturation following iv contrast, with FS and PI at MCP5. Arrowhead indicates FS, arrows points to volar PI.

Disclosure of Interests:

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Alexander Lautwein: None declared, Stefan Vordenbäumen: None declared, Ralph Brinks: None declared, Christine Goertz: None declared, Miriam Frenken: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared

AB0375 SAFETY AND BENEFICIAL EFFECTS OF HYDROXYCHLOROQUINE ON PREGNANCY OUTCOMES IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

The use of hydroxychloroquine (HCQ) has long been established in Systemic Lupus Erythematosus (SLE) and especially as applicable drug during pregnancy. Recently, beneficial effects and safety of HCQ have been re-discussed in the light of a change in the summary of product characteristics in some countries. More current studies are required to provide patients with evidence-based advice regarding this essential drug when counselling for pregnancy.

Objectives:

To examine the impact of HCQ on pregnancy outcomes of SLE women.

Methods:

Pregnancies of women with SLE from an outpatient pregnancy clinic were prospectively evaluated before and throughout gestation. Maternal and fetal outcomes in women without HCQ therapy (group A) were compared to pregnancies under HCQ treatment from 1sttrimester on (group B). A multiple logistic regression was performed with adjustment for confounding factors.

Results:

We enrolled 184 live births from singleton pregnancies in 145 women (n=77 with HCQ and n=107 w/o HCQ). One neonatal death (group B) occurred after severe preeclampsia at 24 weeks of gestation (w/g) linked to noncompliance in a woman with high-risk aPL profile. One child (group B) was born with mycophenolate mofetil embryopathy.

Women in the HCQ group had a significantly lower rate of preterm births [aOR 0.31 (95%-CI: 0.15-0.64), p = 0.026]. Regarding preeclampsia, we found a tendency towards less incidence with the use of HCQ [aOR 0.49 (95%-CI: 0.23-1.03), p = 0.24]. These improved outcomes are opposed by a higher frequency of risk factors in group B (lupus nephritis, high-risk aPL profile, slightly more hypertension) and a tendency towards more severe SLE (expressed in terms of increased use of Azathioprine) (Table 1). Nevertheless, women with HCQ therapy experienced significantly less flares during pregnancy [aOR 0.18 (95%-CI: 0.09-0.38), p = 0.013].

Table 1.

Patient characteristics

All pregnancies (n=184)No HCQ in pregnancy (n=107)HCQ during pregnancy (n=77)Age (years), median (IQR)31.0 (28.0-34.0)31.0 (29.0-34.0)30.0 (27.0-33.0)Hypertension, n (%)29 (15.8%)16 (15.0%)13 (16.9%)Preconception counselling, n (%)122 (66.3%)69 (64.5%)53 (68.8%)SLE disease & therapy characteristicsDisease duration (years), median (IQR)6.7 (2.9-10.3)7.0 (3.0-10.0)6.7 (2.1-11.0)Lupus nephritis*1, n (%)51 (27.7%)25 (23.4%)26 (33.8%)High-risk aPL profile*2, n (%)39 (21.3%)21 (19.8%)18 (23.4%)SLEDAI*1, median (IQR)2.0 (0-4.0)2.0 (0.0-4.0)2.0 (2.0-4.0)Anti-dsDNA, n (%)102 (55.7%)47 (44.3%)55 (71.4%)Anti-SSA/Ro and/or Anti-SSB/La, n (%)91 (49.7%)55 (51.9%)36 (46.8%)Azathioprine*1, n (%)38 (20.7%)18 (16.8%)20 (26.0%)Low dose Aspirin*3, n (%)74 (41.1%)34 (32.7%)40 (52.6%)Obstetrical historyNulliparous, n (%)113 (61.4%)63 (58.9%)50 (64.9%)Previous fetal loss, n (%)39 (21.2%)22 (20.6%)17 (22.1%)Previous (pre-)eclampsia or HELLP, n (%)14 (7.6%)8 (7.5%)6 (7.8%)Previous congenital heart block, n (%)1 (0.54%)-1 (1.3%)Pregnancy outcome(mild-moderate) flare*4, n (%)44 (29.5%)30 (34.9%)14 (22.2%)Preterm birth*5, n (%)46 (25%)30 (28.0%)16 (20.8%)Preeclampsia, n (%)24 (13%)15 (14.0%)9 (11.7%)Intrauterine growth restriction, n (%)3 (1.7%)1 (1.0%)2 (2.6%)Congenital heart block, n (%)1 (0.54%)-1 (1.3%)

*1last visit before pregnancy, *2according to the 2019 EULAR recommendations,*3until 16 w/g,*4increase in SLEPDAI ≥ 4 or increase in prednisolone ≥ 5mg/d,*5< 37 w/g

Conclusion:

In our cohort, SLE women with additional risk factors achieved a favourable pregnancy outcome. This encouraging result is in part attributable to pregnancy counselling with the advice to continue HCQ throughout gestation.

Disclosure of Interests:

Isabell Haase Grant/research support from: Abbvie, Medac, Hexal, Pfizer, Ralph Brinks: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Rebecca Fischer-Betz Consultant of: UCB, Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Chugai, GSK, Janssen, Lilly, Medac, MSD, Novartis, Roche, UCB, Pfizer.

THU0476 GLYCOSAMINOGLYCAN REMODELLING OF LUMBAR INTERVERTEBRAL DISCS IN ELITE ROWERS THROUGHOUT THEIR ANNUAL TRAINING CYCLE

Background:

To assess the glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVD) in elite rowers (ER) at different stages of their annual training cycle and compared to healthy volunteers (HV) using GAG chemical exchange saturation transfer (gagCEST).

Objectives:

Does GAG content of IVDs differs between ER in different stages of the training cycle from HV?

Methods:

205 lumbar IVD of 21 ER (23 ±3 years, 9 female, 11 male) and 25 HV (27 ±2 years, 13 female, 12 male) were prospectively examined with 3T magnetic resonance imaging (MRI). Standard T2 weighted (T2w) sequences were used for morphological grading according to the Pfirrmann classification. GAG content of the nucleus pulposus (NP) and annulus fibrosus was determined with gagCEST in non-degenerated discs according to Pfirrmann. ER were examined during the peak of their competition preparation (T0) and 6 months later during the peak of their post-competition recovery period (T1).

Results:

At T0 we found significantly higher gagCEST values in ER (A) compared to HV (C) (NP: 4.26 ±2.37% vs. 3.38 ±1.72%, p<0.05; confidence interval (CI) 0.32%/1.44%; AF: 2.75 ±1.7% vs.1.961 ±1.23%, p<0.01; CI 0.4%/1.2%). At T1 gagCEST values in ER (B) decreased and illustrated no significant difference compared to HV (C) (NP: 3.55 ± 2.31%, p = 0.531, CI 0.038%/0.73%; AF: 2.31 ±1.57%, p = 0.073, CI 0.03%/0.74%).

Conclusion:

Compared to HV lumbar IVD of ER show significantly higher gagCEST values during the peak of their competition preparation and similar values during the recovery period, indicating a GAG remodelling effect by training.

Figure 1.

Comparison of gagCEST values of lumbar IVD between ER (A, T0; B, T1) and HV.

Disclosure of Interests: :

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Miriam Frenken: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared

OP0182 PROTEOGLYCAN LOSS IN ARTICULAR CARTILAGE IS ASSOCIATED WITH JOINT INFLAMMATION SEVERITY IN PSORIATIC ARTHRITIS – A COMPOSITIONAL MAGNETIC RESONANCE IMAGING STUDY

Background:

Even though cartilage loss is a known feature of psoriatic arthritis (PsA), little is known about its role in the pathogenesis of PsA. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) as a non-invasive marker of the tissue’s proteoglycan content, such early (i.e. pre-morphological) changes have been associated with inflammation in rheumatoid arthritis (RA). Yet, this association has not been studied before in PsA.

Objectives:

Is the severity of local joint inflammation associated to local proteoglycan loss in PsA patients?

Methods:

Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution clinical standard morphological and dGEMRIC sequences using a 3T MRI scanner (Magnetom Skyra, Siemens) and a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS) and total cartilage thickness (TCT). Kendall-Tau correlation coefficients (τ) were calculated.

Results:

We found significant negative correlations between dGEMRIC indices and total PsAMRIS (τ = -0.5, p= 0.012), synovitis (τ = -0.56, p= 0.006), flexor tenosynovitis (τ = -0.4, p= 0.049), and periarticular inflammation (τ = -0.72, p< 0.001). Significant positive correlations were found between TCT and dGEMRIC indices in all joint levels (τ = 0.43, p<0.001). No significant correlations were determined between dGEMRIC indices and bone erosion, bone edema or bone proliferation.

Conclusion:

In PsA, proteoglycan loss as assessed by dGEMRIC is associated with periarticular inflammation, synovitis, and flexor tenosynovitis, but not with bone erosion or proliferation, thereby highlighting the need for effective anti-inflammatory treatment regimes. Beyond morphology, advanced MRI techniques may be used to assess cartilage composition in PsA and to identify early changes in cartilage as an imaging biomarker with potential application in detection and monitoring of PsA.

Figure 1

Right hand of a 26-year-old male with psoriatic arthritis Coronal STIR image (A) of digits 1-5, transversal fat-saturated (fs) T2-weighted image of digits 2-4 (B) and the corresponding transversal fs contrast-enhanced T1-weighted image (C) at the distal portion of the proximal phalanges. Horizontal white bar in (A) indicates level of transversal slices (B) & (C). Sagittal fs Proton Density-weighted image of the third digit (D). A: Increased signal at the collateral ligaments and synovitis of the proximal interphalangeal (PIP) joint of the third digit (white arrow). Periarticular inflammation around the PIP joint and the body of the proximal phalanx of the third digit (arrowhead). B & C: Extensive flexor tenosynovitis (asterix) and periarticular inflammation in the subcutaneous tissues (arrowhead) alongside thickened flexor tendon pulleys (arrow). D & E: Representative sagittal T1-weighted images of the MCP, PIP and DIP joint of the 3rd digit. Following iv contrast administration and appropriate delay of 40 min, A gives the morphological T1 map, while B gives the corresponding parameter map with dGEMRIC values [ms] overlaid. Note the significant decrease in dGEMRIC indices of the PIP joint as compared to the MCP joint.

Disclosure of Interests:

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Sven Nebelung: None declared, Miriam Frenken: None declared, Tim Ulrich: None declared, Karl Ludger Radke: None declared, Gerald Antoch: None declared, Stefan Vordenbäumen: None declared, Ralph Brinks: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared

OP0163 2019 UPDATE OF THE JOINT EUROPEAN LEAGUE AGAINST RHEUMATISM AND EUROPEAN RENAL ASSOCIATION–EUROPEAN DIALYSIS AND TRANSPLANT ASSOCIATION (EULAR/ERA-EDTA) RECOMMENDATIONS FOR THE MANAGEMENT OF LUPUS NEPHRITIS

Background:

Up to 40% of systemic lupus erythematosus (SLE) patients develop kidney disease, which represents a major cause of morbidity.

Objectives:

To update the 2012 EULAR/ERA-EDTA recommendations for the management of lupus nephritis (LN).

Methods:

We followed the EULAR standardised operating procedures for the publication of treatment recommendations. Delphi-based methodology led to 15 questions for systematic literature review (SLR), which was undertaken by three fellows.

Results:

The changes include recommendations for treatment targets, use of glucocorticoids and calcineurin inhibitors (CNI), and management of end-stage-kidney-disease (ESKD). The target of therapy is complete response (proteinuria <0.5-0.7gr/24h with [near-]normal glomerular filtration rate) by 12 months, but this can be extended in patients with baseline nephrotic-range proteinuria. Hydroxychloroquine is recommended with regular ophthalmological monitoring. In active proliferative LN, initial (induction) treatment with mycophenolate mofetil (MMF 2-3g/day, or mycophenolic acid at equivalent dose) or low-dose intravenous cyclophosphamide (CY; 500mg x6 biweekly doses), both combined with glucocorticoids (pulses of intravenous methylprednisolone, then oral prednisone 0.3-0.5mg/kg/day) is recommended. MMF/CNI (especially tacrolimus) combination and high-dose CY are alternatives, for patients with nephrotic-range proteinuria and adverse prognostic factors. Subsequent long-term maintenance treatment with MMF or azathioprine should follow, with no or low-dose (<7.5 mg/day) glucocorticoids. The choice of agent depends on the initial regimen and plans for pregnancy. In non-responding disease, switch of induction regimens or rituximab are recommended. In pure membranous LN with nephrotic-range proteinuria or proteinuria >1g/24h despite renin-angiotensin-aldosterone blockade, MMF in combination with glucocorticoids is preferred. Assessment for kidney and extra-renal disease activity, and management of comorbidities is lifelong with repeat kidney biopsy in cases of incomplete response or nephritic flares. In ESKD, transplantation is the preferred kidney replacement option with immunosuppression guided by transplant protocols and/or extra-renal manifestations.

Conclusion:

The updated recommendations intend to inform rheumatologists, nephrologists, patients, national professional societies, hospital officials, social security agencies and regulators about the treatment of LN based on most recent evidence.

Disclosure of Interests:

Antonis Fanouriakis Paid instructor for: Paid instructor for Enorasis, Amgen, Speakers bureau: Paid speaker for Roche, Genesis Pharma, Mylan, Myrto Kostopoulou: None declared, Kim Cheema: None declared, Hans-Joachim Anders: None declared, Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Ingeborg Bajema Consultant of: GSK, John N. Boletis Grant/research support from: GSK, Pfizer, Paid instructor for: GSK, Abbvie, UCB, Enorasis, Eleni Frangou: None declared, Frederic Houssiau Grant/research support from: UCB, Consultant of: GSK, Jane Hollis: None declared, Alexandre Karras: None declared, Francesca Marchiori: None declared, Stephen Marks: None declared, Gabriela Moroni: None declared, Marta Mosca: None declared, Ioannis Parodis: None declared, Manuel Praga: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Vladimir Tesar: None declared, Maria Trachana: None declared, Ronald van Vollenhoven Grant/research support from: AbbVie, Amgen, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline (GSK), Janssen Research & Development, LLC, Lilly, Pfizer, Roche, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, Crescendo Bioscience, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, UCB and Vertex, Speakers bureau: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, Crescendo Bioscience, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB, Vertex, Alexandre Voskuyl: None declared, Y.K. Onno Teng Grant/research support from: GSK, Consultant of: GSK, Aurinia Pharmaceuticals, Novartis, Bernadette van Leeuw: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim, Dimitrios Boumpas: None declared

THU0478 IS NEUROPATHIC PAIN IN INFLAMMATORY RHEUMATIC DISORDERS AN UNDERESTIMATED PROBLEM? RESULTS FROM THE GERMAN PAINDETECT DATABASE

Background:

The aim of the study was to investigate the impact and relevance of neuropathic pain in inflammatory rheumatic disorders (IRD) and osteoarthritis (OA).

Objectives:

Pain is one of the main symptoms in patients with IRD and OA. To enhance a mechanistic based treatment of pain the differentiation between nociceptive and neuropathic pain via screening tools (e.g. painDETECT questionaire) might possibly be helpful. The goal of the study was to investigate (1) if neuropathic pain is a significant burden for patients with IRD and (2) if pain patterns differs from degenerative joint diseases such as OA in over 9.000 patients in each group.

Methods:

painDETECT is a questionnaire that has been evaluated and used in numerous clinical trials to detect neuropathic pain in various diseases. The collected data is centrally managed and evaluated. In total (end of 2019) 395.984 patients have been documented. Out of the painDETECT database 9256 patients with IRD and 9436 patients with OA were extracted, analyzed and compared on their neuropathic pain pattern (screening was performed using the painDETECT-questionaire., PDQ). Secondary parameters were: intensity of pain, functional status, depression, chronicity and sleep disorder. Patients had been recruited from general practitioners (GPs), Rheumatologists, Orthopedics and Neurologists from 862 office-based physicians into the painDETECT-database. This project is an open label registry study in Germany.

Results:

The median PDQ-score of patients with inflammatory rheumatic disorders adds up to 14,2 (1-38) and of OA patients to 13,8. 28.7% of inflammatory rheumatic disorders and 27.2% of OA-patients showed signs for neuropathic pain by positive PDQ. The difference was according to this high patient numbers statistically significant (P=0.0015). VAS-Score, Depressions-Score, Chronicity -Score and Functional -Score showed no clinically relevant differences between these two groups.

Conclusion:

Nearly one third of patients with IRD as well as patients with OA showed neuropathic pain components by using PDQ. Despite increasingly better disease control through more effective therapies, pain still remains a major burden for many patients and has a profound impact on their quality of life. The present data indicate a surprisingly high symptoms of neuropathic pain even in IRD patients and should be considered in the management of our patients. A new documentation system for Rheumatologists (RheumaAssist) could help to address these questions.

Percentage of PDQ-categories (negative/unclear/positive) for patients with inflammatory rheumatic disorders (IRD) or Arthrosis (OA)

Acknowledgments:

This investigation was supported within a grant of Pfizer Deutschland GmbH.

Disclosure of Interests: :

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Rainer Freynhagen Consultant of: AOP Orphan Pharma, Grünenthal, Lilly, Merck, Mitsubishi Tanabe Pharma, Pfizer, Scilex Pharmaceutics

, Speakers bureau: AOP Orphan Pharma, Grünenthal, Lilly, Merck, Mitsubishi Tanabe Pharma, Pfizer, Scilex Pharmaceutics

, Thomas Tölle Consultant of: AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma, Speakers bureau: AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma, Michael Hammer Consultant of: Abbvie, Pfizer, Medac and Janssen, Speakers bureau: Abbvie, Pfizer, Medac and Janssen, Christoph Baerwald Consultant of: CGB received speaker or consulting fees from AbbVie, Paid instructor for: CGB received speaker or consulting fees from AbbVie, Speakers bureau: CGB received speaker or consulting fees from AbbVie, Jochen Walter Consultant of: Pfizer, Speakers bureau: AbbVie, Frauenhofer Institut, Gilead, Janssen-Cilag, Medac, Novartis, Pfizer, Ralf Schröder Shareholder of: Pfizer Pharma GmbH, Employee of: Pfizer Pharma GmbH, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Ralf Baron Consultant of: RB received speaker or consulting fees from AbbVie, Paid instructor for: RB received speaker or consulting fees from AbbVie, Speakers bureau: RB received speaker or consulting fees from AbbVie

AB0722 LOSS OF GLYCOSAMINOGLYCANS OF LUMBAR INTERVERTEBRAL DISCS IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

To evaluate the glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVD) in patients with ankylosing spondylitis (AS) using GAG chemical exchange saturation transfer (gagCEST).

Objectives:

Does local GAG content in non-degenerative IVDs measured by gagCEST MRI differs between AS patients and HC?

Methods:

195 lumbar IVD of 15 patients with AS (mean age 50 ±10 years) and 25 healthy control patients (HC) were prospectively examined with 3 T magnetic resonance imaging (MRI). MRI protocol contained morphological T2 weighted (T2w) images to grade IVD according to the Pfirrmann classification and biochemical imaging with gagCEST to calculate a region of interest (ROI) of the nucleus pulposus (NP) and annulus fibrosus (AF). Prior to statistical testing of gagCEST effects in patients and HC, IVD were classified according to Pfirrmann.

Results:

Significantly lower gagCEST values of NP and AF were found in non-degenerative IVD (Pfirrmann 1 and 2) of AS patients compared to HC (NP: 1.88 % ±1.21% vs. 3.38 % ±1.71%; p<0.01; confidence interval (CI): 0.89%/2.11%. AF: 1.11 % ± 1.07 % vs. 1.96 %± 1.23 %; p<0.01; CI 0.39%/1.3%).

Conclusion:

GagCEST analysis of morphologically non-degenerative IVDs in T2w images showed significantly lower GAG values in patients with AS in the NP and AF compared to HC. Our results potentially allow for the detection of GAG loss prior to morphological degeneration.

Figure 1.

Comparison of morphological T2 weighted (T2w) images to grade IVD according to the Pfirrmann classification and biochemical imaging with gagCEST between HC (A and C) and AS patients (B and D) showing significant lower GAG levels in AS patients.

Disclosure of Interests:

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Miriam Frenken: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared

AB1110 QUANTUM BLUE® RAPID TDM ASSAY STANDARDIZATION HIGHLY CORRELATES WITH WHO INTERNATIONAL STANDARD FOR INFLIXIMAB

Background:

Therapeutic drug monitoring of RA patients under anti-TNF therapy is based on trough level determination of the drug. Rapid assays and multiple ELISAs are available that measure anti-TNF biologics. An international standard is required to improve comparability among different assays. Recently, WHO introduced a series of anti-TNF standards for etanercept, adalimumab and infliximab. This is the first step for achieving common standardisation of assays available on the market.

Objectives:

The aim of the study was to evaluate the correlation of the WHO standard with BÜHLMANN Quantum Blue® Infliximab standardization and to compare spiking recovery in three commercially available infliximab ELISAs and one infliximab rapid test.

Methods:

Calibration curves were generated with BÜHLMANN calibrators and with calibrators made from WHO international standard for infliximab (NIBSC 16/170). Twenty-six serum samples, covering a concentration range from 0.5 µg/mL to 19 µg/mL, were analyzed with both calibration curves and compared by Bland-Altman and Passing-Bablok analysis. Furthermore, recovery of six serum samples spiked with WHO international standard for infliximab was determined in Theradiag LISA TRACKER Infliximab (a), Grifols/Progenika Promonitor-IFX (b), Immundiagnostik IDKmonitor Infliximab drug level (c) and BÜHLMANN Quantum Blue® Infliximab (d). Spiking recovery experiments were performed according to Westgard 2008.

Results:

The sample values gained with BÜHLMANN calibrators showed an excellent correlation with values gained with the WHO international standard for infliximab as calibrator. Passing-Bablok regression analysis revealed a slope of 0.96 and correlation coefficient (R) of 0.99. Bland-Altman analysis revealed a mean difference in the obtained values of less than five percent. Regarding spiking recovery analysis, all tests exhibit an excellent mean recovery of 101% (85-114%; a), 99% (91-105%; b); 101% (95-107%; c) and 94% (88-100%, d).

Conclusion:

Current standardization of Quantum Blue® Infliximab rapid test correlates very well with the WHO international standard for infliximab (NIBSC 16/170). Spiking recovery was highly comparable for ELISAs and the Quantum Blue® Infliximab assay. This rapid test represents a unique and modern analytical method, for fast time-to-result and simplicity of usage in a more patient near medical environment.

References:

[1]Westgard, James. (2008). Basic Method Validation.

Disclosure of Interests:

None declared

0044 Association Between Chronotype and Circulating Levels of Interleukin-6 in Colorectal Cancer Patients: Preliminary Results from the ColoCare Study

Introduction

Accumulating evidence suggests that chronotype, i.e., circadian topology of an individual indicating morning or evening type, is associated with inflammation. To date, no study has examined the relationship between chronotype and inflammation in colorectal cancer patients. We investigated the associations between chronotype and inflammatory and angiogenesis biomarkers in colorectal cancer patients.

Methods

We used pre-surgery serum samples from n=67 newly diagnosed colorectal cancer patients (stage I-IV) recruited at the ColoCare Study site in Heidelberg, Germany. The ColoCare Study is an ongoing, international, multisite, prospective cohort study in colorectal cancer patients. Inflammatory and angiogenesis biomarkers [c-reactive protein (CRP), interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1 (MCP-1), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1)] were measured at the Huntsman Cancer Institute, USA using the Meso Scale Discovery platform and were log transformed. Chronotype was assessed prior to surgery with the reduced Morningness-Eveningness Questionnaire (rMEQ; scale 4–25; a higher score indicates more morning-type). Patients were dichotomized, based on the median values for rMEQ, into 2 groups: rMEQ-low (score≤16.0; n=35; indicating more evening-type) or rMEQ-high (score&gt;16.0; n=32; indicating more morning-type).

Results

Using Mann-Whitney U test, we observed that rMEQ-low group (i.e., more evening-type) compared to rMEQ-high group (i.e., more morning-type) had approx. two times significantly higher levels of log transformed IL-6 (mean=2.24 vs. 1.30; U=382.0; Z=-2.23; p=0.03), but not for other inflammatory or angiogenesis biomarkers. This association between chronotype and IL-6 was maintained even after adjusting for age, sex, tumor stage, tumor site, and sleep duration using a generalized estimating equations model (adjusted mean difference=1.10; 95% confidence interval=0.33, 1.88; p=0.01; effect size, Cohen’s d=0.69).

Conclusion

These preliminary findings suggest that the evening chronotype is associated with increased IL-6 inflammatory biomarker in colorectal cancer patients. Further research is needed to confirm and understand the mechanistic underpinnings of the observed results.

Support

Funding: NCI U01 CA206110, R01 CA189184, and R01 CA207371.

[Current guidance of the German Society of Rheumatology for the care of patients with rheumatic diseases during the SARS-CoV-2/Covid 19 pandemic]

In der aktuellen SARS-CoV-2 Pandemie bestehen viele Fragen mit Blick auf die sichere Behandlung von Patienten mit entzündlich-rheumatischen Erkrankungen. Auf viele dieser Fragen gibt es zur Zeit noch keine evidenzbasierte Antwort und das macht die Betreuung der Patienten nicht leicht. Die Deutsche Gesellschaft für Rheumatologie e. V. (DGRh) will mit diesen ersten Empfehlungen Hilfestellung für spezielle Belange in der Betreuung von Rheumapatienten angesichts der aktuellen Bedrohung durch SARS-CoV-2 geben. Um den dynamischen weltweiten Erkenntnisgewinn für unsere Patienten zu nutzen, werden die Empfehlungen regelmäßig aktualisiert. Die aktualisierten Versionen der Empfehlungen werden auf der Homepage der DGRh hinterlegt.

Experiences of radiographers working alone in remote locations: A Far North Queensland non-participant observational study

INTRODUCTION

Radiographers employed in remote locations such as Far North Queensland (FNQ) can face unique sets of challenges as they often perform radiographic and sonographic diagnostic imaging without onsite radiologists' services. Additionally, the majority of patients presenting to these sites are Indigenous for whom English may be their third language. This non-participant observational study observed two FNQ radiographers' interactions with patients and interprofessional staff, and the radiographers' ability to fit into the Indigenous community during routine radiographic and sonographic examinations which to date have received little attention.

METHODS

Non-participant observations and semi-structured interviews with radiographers were held at two FNQ hospitals. Consecutive radiographer-patient interactions were observed and recorded on checklists. Interviews were audio recorded and transcribed for thematic analysis.

RESULTS

Across both remote sites, 24 patients were observed as they underwent diagnostic imaging examinations, with the majority being Aboriginal or Torres Strait Islanders (n = 17/24 (70.8%). In total, eleven general radiography and sixteen ultrasound examinations were observed. Semi-structured interviews highlighted complex issues such as the need for radiographer communication in local dialect, ongoing interprofessional collaborations, overcoming the lack of radiologists' onsite support by providing radiographic reports directly to referring doctors and midwives, and isolation with regard to professional development opportunities.

CONCLUSIONS

Radiographers working in remote hospitals need to be culturally competent, navigate local indigenous languages and possess excellent interprofessional skills as well as thorough knowledge of imaging pathology to convey findings to referring doctors and allied health professionals. These findings have implications for the entry to practice curriculum.

IMPLICATIONS FOR PRACTICE

This study provides evidence that culturally competent radiographers are capable of undertaking reporting roles to facilitate patient management in the absence of timely radiologists' reports at remote sites.

Role of in Situ Natural Organic Matter in Mobilizing As during Microbial Reduction of FeIII-Mineral-Bearing Aquifer Sediments from Hanoi (Vietnam)

Natural organic matter (NOM) can contribute to arsenic (As) mobilization as an electron donor for microbially-mediated reductive dissolution of As-bearing Fe(III) (oxyhydr)oxides. However, to investigate this process, instead of using NOM, most laboratory studies used simple fatty acids or sugars, often at relatively high concentrations. To investigate the role of relevant C sources, we therefore extracted in situ NOM from the upper aquitard (clayey silt) and lower sandy aquifer sediments in Van Phuc (Hanoi area, Vietnam), characterized its composition, and used 100-day microcosm experiments to determine the effect of in situ OM on Fe(III) mineral reduction, As mobilization, and microbial community composition. We found that OM extracted from the clayey silt (OMC) aquitard resembles young, not fully degraded plant-related material, while OM from the sandy sediments (OMS) is more bioavailable and related to microbial biomass. Although all microcosms were amended with the same amount of C (12 mg C/L), the extent of Fe(III) reduction after 100 days was the highest with acetate/lactate (43 ± 3.5% of total Fe present in the sediments) followed by OMS (28 ± 0.3%) and OMC (19 ± 0.8%). Initial Fe(III) reduction rates were also higher with acetate/lactate (0.53 mg Fe(II) in 6 days) than with OMS and OMC (0.18 and 0.08 mg Fe(II) in 6 days, respectively). Although initially more dissolved As was detected in the acetate/lactate setups, after 100 days, higher concentrations of As (8.3 ± 0.3 and 8.8 ± 0.8 μg As/L) were reached in OMC and OMS, respectively, compared to acetate/lactate-amended setups (6.3 ± 0.7 μg As/L). 16S rRNA amplicon sequence analyses revealed that acetate/lactate mainly enriched Geobacter, while in situ OM supported growth and activity of a more diverse microbial community. Our results suggest that although the in situ NOM is less efficient in stimulating microbial Fe(III) reduction than highly bioavailable acetate/lactate, it ultimately has the potential to mobilize the same amount or even more As.

Constraints on Lorentz Invariance Violation from HAWC Observations of Gamma Rays above 100 TeV

Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2×10^{31}  eV, over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.

Data compilation on the effect of grain size, temperature, and texture on the strength of a single-phase FCC MnFeNi medium-entropy alloy

This data article presents a compilation of microstructural and mechanical data regarding the ternary single-phase FCC MnFeNi medium-entropy alloy (MEA). For the analysis, interpretation, and comparison of the data to literature values, the reader can refer to the original related research article entitled "Effect of Temperature and Texture on Hall-Petch Strengthening by Grain and Annealing Twin Boundaries in the MnFeNi Medium-Entropy Alloy", see Schneider et al. (Metals 9, 2019, 84). The microstructural data reported here include: (i) raw backscatter electron (BSE) micrographs (tif-files) obtained using a scanning electron microscope (SEM) for nine different grain sizes with four images for each grain size and (ii) pdf reports and tables shown below presenting the distributions of the grain- (d, accounting for grain boundaries only) and crystallite- (c, which accounts for both grain and annealing twin boundaries) sizes and of the annealing twin thicknesses (t). These datasets may be useful to develop new algorithms for the automated evaluation of microstructural parameters in recrystallized alloys, i.e. with these benchmark data, an algorithm for image analysis could be trained to assess the above mentioned microstructural parameters. This would help to speed up the analysis of microstructures and improve its reliability. Additional tables describing the recrystallized microstructures and texture include the average number of annealing twin boundaries per grain (n), and the average Taylor factors (M). Raeisinia et al. (Model. Simul. Mater. Sc. 16, 2008, 025001) recently used a viscoplastic model to show that differences in the distribution of microstructural parameters affect the Hall-Petch parameters, but no attempt has been carried out so far to experimentally investigate this possibility since grain size distributions are rarely reported. Here, our benchmark data (e.g. distribution in grain/crystallite sizes, annealing twins per grain, distribution of annealing twin thicknesses) could be used to address these issues. The data describing the mechanical properties reported here are excel-sheets of raw stress-strain curves for temperatures ranging from 77 K to 873 K and different grain sizes. The yield stress (σ 0.2% ) and the normalized Hall-Petch parameters (σ 0 /G and k y /Gb 2) are given for all temperatures. The normalized Hall-Petch parameters are reported here since they allow to better compare the strength and the magnitude of grain boundary strengthening of different alloys with the same crystallographic structure, see Cordero et al. (Int. Mater. Rev. 61, 2016, 495-512). Moreover, the Hall-Petch parameters as well as the mechanical data reported here could be used for data mining and implemented in programs used for alloy design.

Mucosal-associated invariant T cells and Vδ2+ γδ T cells in community acquired pneumonia: association of abundance in sputum with clinical severity and outcome

Mucosal-associated invariant T (MAIT) cells and Vδ2+ γδ T cells are anti-bacterial innate-like lymphocytes (ILLs) that are enriched in blood and mucosa. ILLs have been implicated in control of infection. However, the role of ILLs in community-acquired pneumonia (CAP) is unknown. Using sputum samples from a well-characterized CAP cohort, MAIT cell and Vδ2+ T cell abundance was determined by quantitative polymerase chain reaction (qPCR). Cytokine and chemokine concentrations in sputum were measured. The capacity of bacteria in sputum to produce activating ligands for MAIT cells and Vδ2+ T cells was inferred by 16S rRNA sequencing. MAIT cell abundance in sputum was higher in patients with less severe pneumonia; duration of hospital admission was inversely correlated with both MAIT and Vδ2+ T cell abundance. The abundance of both ILLs was higher in patients with a confirmed bacterial aetiology; however, there was no correlation with total bacterial load or the predicted capacity of bacteria to produce activating ligands. Sputum MAIT cell abundance was associated with interferon (IFN)-α, IFN-γ, and sputum neutrophil abundance, while Vδ2+ T cell abundance was associated with CXCL11 and IFN-γ. Therefore, MAIT and Vδ2+ T cells can be detected in sputum in CAP, where they may contribute to improved clinical outcome.

Multiple Galactic Sources with Emission Above 56 TeV Detected by HAWC

We present the first catalog of gamma-ray sources emitting above 56 and 100 TeV with data from the High Altitude Water Cherenkov Observatory, a wide field-of-view observatory capable of detecting gamma rays up to a few hundred TeV. Nine sources are observed above 56 TeV, all of which are likely galactic in origin. Three sources continue emitting past 100 TeV, making this the highest-energy gamma-ray source catalog to date. We report the integral flux of each of these objects. We also report spectra for three highest-energy sources and discuss the possibility that they are PeVatrons.

Lurbinectedin as second- or third-line palliative therapy in malignant pleural mesothelioma: an international, multi-centre, single-arm, phase II trial (SAKK 17/16)

BACKGROUND

Systemic second- and third-line therapies for malignant pleural mesothelioma (MPM) result in a median progression-free survival (mPFS) of <2 months and median overall survival (mOS) of 6-9 months. Lurbinectedin binds to the DNA of the regulatory region while inhibiting tumour-associated macrophage transcription. In early trials, encouraging outcomes occurred in patients (pts) with MPM treated with lurbinectedin. We aimed to generate lurbinectedin efficacy and safety data among pts with progressive MPM.

PATIENTS AND METHODS

Pts with progressing MPM treated with first-line platinum-pemetrexed chemotherapy with or without immunotherapy received lurbinectedin monotherapy. Treatment was given intravenously at 3.2 mg/m² dose every 3 weeks until progression or unacceptable toxicity. Using Simon's two-stage design, the primary endpoint, progression-free survival (PFS) at 12 weeks (PFS_12wks), was met if achieved by ≥21 pts (p0 ≤35% versus p1 ≥55%).

RESULTS

Forty-two pts from nine centres across Switzerland and Italy were recruited. Histology was epithelioid in 33 cases, sarcomatoid in 5, and biphasic in 4. Overall 10/42 (23.8%) underwent prior immunotherapy and 14/42 (33.3%) had progressed ≤6 months after first-line chemotherapy. At data cut-off PFS_12wks was met by 22/42 pts (52.4%; 90% confidence interval (CI): 38.7% to 63.5%; P = 0.015) with an mPFS of 4.1 months and mOS of 11.1 months. The best response was complete and partial remission observed in one patient each and stable disease in 20 pts. The duration of disease control was 6.6 months (95% CI: 5.2-7.4). No significant difference in PFS_12wks, mPFS, and mOS was recorded in epithelioid versus non-epithelioid cases and pts with prior immunotherapy versus those without. Similar mPFS but shorter mOS were observed among pts who progressed within ≤6 months after first-line chemotherapy. Lurbinectedin-related grade 3-4 toxicity was seen in 21 pts, mostly being neutropenia (23.8%) and fatigue (16.7%).

CONCLUSIONS

The primary efficacy endpoint was reached with acceptable toxicity. Lurbinectedin showed promising activity regardless of histology, prior immunotherapy, or outcome on prior treatment. CLINICALTRIALS.

GOV IDENTIFIER

NCT03213301.

P1739 Diameter of the pulmonary artery in relation to the ascending aorta: a promising parameter for the diagnosis of pulmonary hypertension

Background

Pulmonary hypertension (PH) is a disease with significant morbidity and mortality. The first imaging modality in the diagnostic algorithm is transthoracic echocardiography (TTE). Despite significant technological advances in recent years, there are still patients with PH who are missed by TTE. The pulmonary artery to ascending aorta ratio (PA/Ao-R) has been evaluated in cardiac magnetic resonance (CMR) and computed tomography (CT) studies. The ratio was able to detect patients with PH, it correlated with hemodynamics, and it was predictive for mortality. We sought to evaluate the diagnostic accuracy of PA/Ao-R measured by TTE in the detection of PH.

Methods

We evaluated consecutive patients who received quasi-simultaneous transthoracic echocardiography and right heart catheterization (RHC) for evaluation of pulmonary hypertension between July 2015 and July 2016.

Results

A total of 84 patients fulfilled the inclusion criteria, 47 were female, mean age was 65 years. Median PA/Ao-R was 0.8 (Q1;Q3 0.69;0.94). Seventy patients had PH (median mean pulmonary artery pressure (mPAP) was 35.5 mmHg, Q1;Q3 27;47). The area under the curve for the diagnosis of PH via PA/Ao-R was 0.853. A cut-off of 1 was chosen for further analysis. Sensitivity for the diagnosis of PH was 100%, specificity was 23%. PA/Ao-R correlated with mPAP (r = 0.65, p &lt; 0.001), and pulmonary vascular resistance (r = 0.68, p &lt; 0.001). In the subgroup of patients with PH, those patients with a PA/Ao-R of ≥1 had significantly (p &lt; 0.001) higher pulmonary pressures than those below, with a mean mPAP of 53 mmHg as compared to 38.5 mmHg.

Conclusion

PA/Ao-R correlates with mPAP. A ratio of ≥1 should prompt suspicion for the presence of PH. PA/Ao-R should be reported in every patient who is evaluated for PH.

P223 Cat bite with unexpected consequences

A 25 y/o female patient with corrected tetralogy of Fallot (1995), pulmonary valve bio-prosthesis (1999) with consequent stenosis, and finally implantation of a pulmonary valve Hancock-conduit (2005), presented to our department with night sweats, shortness of breath, and fever for the past three weeks. Leukocytes and CRP were elevated, transthoracic echocardiography revealed a large vegetation on the pulmonary valve prosthesis with relevant stenosis (peak gradient 70 mmHg). The patient reported to have an 18-year-old cat as a pet, which had bit her shortly before onset of symptoms.

Blood cultures remained negative, bacterial broad spectrum PCR revealed Bartonella species. PET-CT was ordered and confirmed pulmonary valve endocarditis.

The patient was treated with antibiotics and eventually transferred to cardiac surgery due to persistently high gradients over the valve in combination with exertional dyspnea.

Bartonella is a well-known cause of blood culture negative infective endocarditis, which must be tested for specifically. This case underlines the importance of taking complete patient history, including presence of pets and especially recent bites. Comprehensive imaging must be performed timely in every patient with known valve disease and unexplained symptoms.

Abstract P223 figure 1

P1706 Trilogy of stroke

A 53 y/o female patient presented with clinical signs of stroke. Substantial cardiovascular risk factors were present with arterial hypertension, hyperlipidemia, impaired glucose tolerance, and a history of smoking. Transthoracic echocardiography revealed a suspicious structure on the aortic valve. Consequently, transesophageal echocardiography (TEE) was ordered.

In TEE, the structure proved to be highly suspicious for fibroelastoma. In addition, significant plaque of the aortic arch, and a persistent foramen ovale (PFO) were diagnosed in this examination.

The patient was referred to cardiac surgery for excision of the mass on the aortic valve and for PFO closure.

This case stresses the importance of echo in patients presenting with stroke. Apart from left atrial thrombus, several other possible embolic substrates can be diagnosed.

Abstract P1706 figure 1