Patients' perspective, quality of life and treatment goals in Hailey-Hailey disease: Lessons learned from the German National Registry

BACKGROUND

Hailey-Hailey disease (HHD) remains a difficult-to-treat dermatosis and little is known about the patient's perception of the disease activity, the treatment success and its impact on quality-of-life (QoL).

OBJECTIVE

To obtain better understanding of HHD patients' needs regarding their medical condition, financial burden, QoL, subjective well-being and treatment thereof as well as satisfaction to evaluate common treatments' 'real-life' relevance.

METHODS

With initiation of the national registry for Darier's disease (DD; Morbus Darier, MD) and Hailey-Hailey disease (HH) MDHHgermany, patients with HHD diagnosis were included starting June 2020. To assess subjective symptoms, patients filled out questionnaires such as the DLQI (dermatological life quality index), numeric rating scale (NRS) for itch, pain and burning sensation, as well as the SWLS (satisfaction with life scale) questionnaire to quantify overall satisfaction in life. Additionally, data on therapies were collected along with the patients' satisfaction of those and their medical care. Furthermore, patients assessed financial aspects and work ability.

RESULTS

One hundred and two patients were recruited from dermatology clinics, office-based dermatologists and self-help platforms across Germany between June 2020 and February 2023, 90 were eligible and analysed (mean: 49.91 years, 73.33% females, 26.67% males). 39.77% stated according to the DLQI their life is severely/very severely affected. Satisfaction with life was mediocre. Burning sensation was most pronounced among subjective symptoms (NRS 5.85 ± 2.80). Systemic treatments were rated as ineffective according to 56.92%, 25.56% had never received one. Most prescribed systemic treatments were corticosteroids (73.8%), followed by low-dose naltrexone (LDN) (26.2%), retinoids (15.4%) and antibiotics (13.8%). Satisfaction with medical care was generally low.

CONCLUSION

Our 'real-life' data state a major disease burden and impact on the QoL for affected individuals, as well as limited disease control due to inadequate therapies. MDHHgermany can provide insights into improvement of healthcare support with this debilitating disease and improve QoL. In the long term, it aims to provide basis for further clinical trials, epidemiological studies and immunological investigations.

Prevalence of scabies worldwide-An updated systematic literature review in 2022

Scabies is a World Health Organization-defined neglected tropical disease, with continuously rising incidence worldwide in recent years. The aim of this study was to provide an update of the worldwide prevalence and new treatment approaches of scabies in population-based settings. MEDLINE (PubMed), Embase and LILACS databases were reviewed for English and German language population-based studies from October 2014 to March 2022. Two authors independently screened the records for eligibility, extracted all data and one critically appraised the quality of the studies and risk of bias. Systematic review registration: PROSPERO CRD42021247140. Overall, 1273 records were identified through database searching, of which 43 studies were included for the systematic review. Most of the studies (n = 31) examined the scabies prevalence in medium or low human development index countries. The highest prevalence of scabies reported in the general population (children and adults) was recorded in five randomly selected communities in Ghana (71.0%), whereas the highest scabies prevalence in studies, which only examined children (76.9%), was recorded in an Indonesian boarding school. The lowest prevalence was recorded in Uganda (0.18%). The systematic review highlights the prevalence of scabies worldwide, showing that scabies is still a serious, increasing disease that occurs globally and is clustered in developing countries. More transparent data on scabies prevalence are needed to identify risk factors to find new prevention measures.

The impact of stigmatization of psoriasis, atopic dermatitis and mastocytosis in different areas of life-A qualitative interview study

BACKGROUND

Stereotypes and false assumptions about chronic and visible skin diseases can determine the behaviour towards affected individuals and result in stigmatization or discrimination.

OBJECTIVE

The aim of this study was to analyze the perceived disease-related stigmatization of individuals with psoriasis, atopic dermatitis (AD) or mastocytosis. The study also aims to broaden people-centred knowledge of the effects of stigmatization in different areas of life, namely in everyday life, at work, in sports and in relationships.

METHODS

Qualitative in-depth semi-structured interviews were conducted among individuals with either psoriasis, AD or mastocytosis. Participants were recruited via self-help networks and were asked to express their experience of stigmatization in different areas of life. All interviews were audio recorded, transcribed verbatim and evaluated based on Mayring's content analysis.

RESULTS

In total, 24 individuals aged 19-79 years and living in Germany were included in the study-eight for each disease. Stigmatization was experienced in all three diseases in all mentioned areas of life as well as in interaction with medical professionals. Self-exclusion, negative self-perception and negative behaviour of others were the most frequent experiences with stigmatization.

CONCLUSION

Stigmatization, both internal and external, is an important factor contributing to the mental burden of people with chronic skin diseases. More research is needed to gain deeper insight into stigmatization and its psychological burden in various contexts to enhance people-centred care in chronic skin diseases.

POS0234 HOW CLOSELY DO GERMAN RHEUMATOLOGISTS FOLLOW THE EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF RHEUMATOID ARTHRITIS WHEN MAKING THERAPEUTIC DECISIONS?

Background

EULAR developed recommendations for the management of rheumatoid arthritis (RA) suggesting treatment escalation and changes at different stages of the disease to reach at least low disease activity with latest updates in 2013(1), 2016(2), and 2019(3). The recommendation to consider adding a biologic disease-modifying anti-rheumatic drug (bDMARD) – or, since 2016, a Januskinase inhibitor (JAKi) – after the first conventional synthetic (cs) DMARD had failed and if poor prognostic factors (PPF) are present, was strengthened 2019. Since then, it is recommended that a bDMARD or a tsDMARD should be added.

Objectives

How closely are EULAR recommendations followed in daily rheumatologic practice in Germany?

Methods

Data were used from the long-term observational cohort RABBIT, which enrols patients with RA starting a bDMARD or JAKi, or a csDMARD after at least one previous csDMARD failure. According to the publication of the recommendations, periods from [I] 01/2014 – 12/2016, [II] 01/2017 – 06/2020 and [III] 07/2020 – 04/2021 were investigated. Patients who were in at least moderate disease activity (DAS28≥3.2) were selected and analysed, if they started a csDMARD, a bDMARD or a JAKi. Patients were further stratified by prior treatments and by the presence of PPF (≥4 swollen joints, positive rheumatoid factor or ACPA, erosions).

Results

Of the 15,150 patients with RA enrolled since 2007, 2,922 treatments were initiated in period [I], 4,580 in [II] and 415 in [III] (see Table 1). The proportion of patients with 1 previous csDMARD and ≥1 PPF who – in agreement with the recommendations – switched to bDMARD or JAKi, increased from 30% (only bDMARDs) in period [I] to 68% (bDMARDs + JAKi) in [III]. The proportions were even higher in patients with 2 previous csDMARDs (86% in [I], 93% in [III]). As recommended, JAKi were used more often as first line therapy (after csDMARD) in period [III].

Table 1.

Number and percentages of treatment changes at different stages of the disease.

Patients with1 previous csDMARD & no PPF1 previous csDMARD & ≥1 PPF2 previous csDMARDs1 previous bDMARD/ JAKi≥2 previous bDMARDs/ JAKiEULAR Recommendationchange/add csDMARDadd bDMARD/ JAKi**add bDMARD/ JAKichange to another bDMARD/JAKiTotal numbers of treatment changes612073222017001863Period [I]n=25n=848n=986n=543n=52001/2014 – 12/2016*N=2,922csDMARD21 (84.0%)594 (70.0%)134 (13.6%)199 (36.6%)275 (52.9%)bDMARD4 (16.0%)254 (30.0%)852 (86.4%)344 (63.4%)245 (47.1%)Period [II]n=32n=1,090n=1,136n=1,054n=1,26801/2017 – 06/2020N=4,580csDMARD16 (50.0%)469 (43.0%)96 (8.5%)261 (24.8%)274 (21.6%)bDMARD13 (40.6%)509 (46.7%)822 (72.4%)403 (38.2%)288 (22.7%)JAKi3 (9.4%)112 (10.3%)218 (19.2%)390 (37.0%)706 (55.7%)Period [III]n=4n=135n=98n=103n=7507/2020 – 04/2021N=415csDMARD043 (31.9%)7 (7.1%)15 (14.6%)9 (12.0%)bDMARD1 (25.0%)64 (47.4%)60 (61.2%)36 (35.0%)23 (30.7%)JAKi3 (75.0%)28 (20.7%)31 (31.6%)52 (50.5%)43 (57.3%)

EULAR treatment recommendations are indicated in green. *JAKi were not available. **Recommendation in period [I]: Addition of a bDMARD should be considered; in [II]: Addition of a bDMARD or a tsDMARD should be considered, current practice would be to start a bDMARD; in [III]: a bDMARD or a tsDMARD should be added. PPF, poor prognostic factor.

Conclusion

JAKi have become more established, especially in bionaive patients, but have not reached the significance of biologics in certain patient groups. The early decision for a bDMARD or JAKi has been made more frequently in recent years, yet one third of patients did not receive the recommended treatment escalation. We cannot conclude from the data, which considerations led to the decision not to escalate. Of note, German rheumatologists should rather follow the German treatment guidelines(4), which are, however, very similar to the EULAR recommendations.

References

[1]PMID: 24161836;

[2]PMID: 28264816;

[3]PMID: 31969328;

[4]PMID: 29968101

Acknowledgements

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Fresenius-Kabi, Galapagos, Hexal, Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, VIATRIS and UCB.

Disclosure of Interests

Yvette Meissner Speakers bureau: Pfizer, Doreen Huschek: None declared, Angela Zink Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Jörg Kaufmann: None declared, Martin Bohl-Buehler Speakers bureau: Speaker for several companies in unrestricted educational programs, each of them unrestricted state-of-the-art-talks., Consultant of: PreviPharma, basic research in osteology, no overlap with rheumatological diseases, Anja Strangfeld Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, Pfizer, Roche, Sanofi, UCB.

POS0002 IS THE RHEUMATOID ARTHRITIS IMPACT OF DISEASE SCORE (RAID) AN INFORMATIVE INSTRUMENT FOR OTHER INFLAMMATORY RHEUMATIC DISEASES?

Background

The rheumatoid arthritis impact of disease score (RAID) is a patient-reported outcome measure to evaluate the impact of rheumatoid arthritis (RA) on patients’ quality of life (1). While an adapted instrument has been developed for psoriatic arthritis (2), there are no comparable instruments for other inflammatory rheumatic diseases. Since the RAID includes generic questions on pain, functional capacity, fatigue, physical and emotional well-being, sleep disturbances and coping, it could be an informative instrument beyond RA.

Objectives

To analyse the performance of the RAID in ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), polymyalgia rheumatica (PMR), primary Sjögren’s syndrome (pSS), idiopathic inflammatory myositis (IIM), and systemic sclerosis (SSc) compared to RA.

Methods

From 2015 to 2019, a total of 12,398 patients reported the RAID in the National Database of the German Collaborative Arthritis Centres. We calculated the age- and sex-adjusted partial correlation (0.3-0.5 weak, 0.5-0.7 moderate, > 0.7 strong correlation) between the RAID score and five other patient- or physician-reported outcomes, namely patient global (PtGl) health status, PtGl disease activity, physician global (PhGl) disease activity, the World Health Organisation Well-Being Index (WHO-5) and the EuroQoL-5 Dimensions (EQ-5D). Furthermore, for each of the diagnoses the mean difference between the RAID and the other outcomes was compared with the respective differences for RA. The EQ-5D and WHO-5 were rescaled to match the scale of the RAID (range 0-10). General linear regression was used to assess the age- and sex-adjusted effect of each diagnosis on the difference between the RAID and the five other scores with RA as the referent diagnosis. We defined the effect of a diagnosis as clinically relevant if the mean change of difference was at least one unit.

Results

The mean RAID score in RA (3.6) was lower than in AS (4.0) and SSc (3.8) and higher than in SLE, PMR, pSS or IIM (Table 1). Across all diagnoses, the RAID correlated strongly with PtGl health status (0.72 to 0.83), moderately to strongly with PtGl disease activity (0.55 to 0.78) and WHO-5 (0.67 to 0.83), moderately with the EQ-5D (0.61 to 0.68), and weakly with PhGl disease activity (0.25 to 0.41). Small mean differences were found between the RAID and either PtGl disease activity (0 to -0.6), PtGl health status (-0.4 to -0.9) or WHO-5 (-0.7 to -1.3). A higher deviation was observed for EQ-5D (1.1 to 1.7) and PhGl disease activity (1.4 to 2.2). However, the discrepancies between the five outcomes and the RAID turned out to be similar across all diagnoses and, more importantly, comparable to RA. Linear regression revealed no clinically relevant effect of any of the diagnoses on the difference between RAID and the other outcomes (Figure 1).

Table 1.

Characteristics and patient- and physician-reported outcomes in patients with inflammatory rheumatic diseases.

RAASSLEPMRpSSIIMSScNumber of cases7826153211421105301106386Female (%)74428964895876Age, in years (mean±SD)63±1451±1447±1573±853±1658±1458±14Disease duration, in years (mean±SD)13±1118±1315±105±612±911±812±10RAID (mean±SD)3.6±2.34.0±2.33.0±2.43.2±2.33.4±2.43.5±2.53.8±2.3PtGl health status (mean±SD)4.2±2.34.4±2.23.6±2.44.1±2.34.1±2.34.2±2.54.6±2.1PtGl disease activity (mean±SD)3.7±2.44.0±2.42.7±2.53.8±2.73.5±2.63.7±2.54.1±2.3PhGl disease activity (mean±SD)1.8±1.92.2±1.91.6±1.31.0±1.41.8±1.31.8±1.62.2±1.6EQ-5D (mean±SD)0.8±0.20.8±0.20.8±0.20.8±0.20.8±0.20.8±0.20.8±0.2WHO-5 (mean±SD)57±2553±2358±2556±2657±2560±2653±24

SD, Standard Deviation; PtGl, Patient Global; PhGl, Physician Global; EuroQoL-5 Dimensions (EQ-5D); World Health Organisation Well-Being Index (WHO-5)

Figure 1.

Conclusion

The RAID score performed comparably well across all diagnoses investigated. These findings support the use of the RAID for measuring the impact of disease not only in RA, but also in AS, SLE, PMR, pSS, IIM and SSc.

References

[1]PMID: 21540201

[2]PMID: 24790067

Acknowledgements

We thank all participating rheumatologists and patients for their valuable contributions.

The National Database of the German Collaborative Arthritis centers is supported by the Association of Regional Cooperative Rheumatology Centres, the German Society for Rheumatology and joint contributions to the Rheumatological Training Academy and the German Rheumatism Research Centre by the following members of the Working Group of Corporate Members of the German Society for Rheumatology: AbbVie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi-Aventis and UCB.

Disclosure of Interests

Katja Thiele: None declared, Katinka Albrecht: None declared, Angela Zink: None declared, Martin Aringer: None declared, Kirsten Karberg: None declared, Susanna Spaethling-Mestekemper Speakers bureau: BMS, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sanofi, UCB, Consultant of: Abbvie, Gilead, GSK, UCB, Novartis, Ulrich von Hinueber: None declared, Johanna Callhoff Paid instructor for: Rheumatologische Fortbildungsakademie GmbH, Grant/research support from: Abbvie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi, UCB

Can crowdsourced data help to optimize atopic dermatitis treatment? Comparing web search data and environmental data in Germany

BACKGROUND

Atopic dermatitis (AD) is one of the most common chronic skin diseases worldwide, showing various manifestations and having a severe impact on quality of life. As previous studies demonstrated, internet search analysis can help identify public interest in diseases and possible influencing factors on search behavior.

OBJECTIVE

To identify AD-related topics of interest in Germany using internet search volume.

METHODS

Google Ads Keyword Planner was used to identify AD-related search terms including their search volume in Germany on a national level as well as in 16 selected cities from January 2016 to December 2019. Identified keywords were qualitatively analyzed, and temporal trends as well as the influence of seasonal and environmental factors on search volume were assessed.

RESULTS

Overall, 1222 AD-related search terms with a search volume of 8 842 360 searches were identified. An increase from 2016 to 2019 and seasonal peaks from January to April of each year were observed. Nationwide, the search volume correlated with mean monthly temperature and sun duration. With increasing temperature and sun duration, a significant decrease in search queries was observed. The most populated cities showed the lowest number of searches per 100 000 inhabitants (Berlin, Hamburg, and Munich). In the eight categories formed (comorbidities, general, influential factors, localization, stage of life, symptoms/severity, therapy/information, and questions on AD), the highest proportion of search queries were assigned to the category "therapy/information" in most cities. In this category, a focus on the topics of "alternative medicine" and "home remedies" could be observed.

CONCLUSION

The overall high and increasing search volume indicates a high interest in AD-related topics, especially regarding treatment and disease education. Information provided by internet search volume analyses can optimize AD therapy and patient-centered care by providing insight into patient needs and predicting potential climatic trigger factors.

Atopic Dermatitis: Disease Characteristics and Comorbidities in Smoking and Nonsmoking Patients from the TREATgermany Registry

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke.

OBJECTIVES

In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients.

METHODS

TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers.

RESULTS

Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet.

CONCLUSIONS

German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

Addictions in patients with atopic dermatitis: a cross-sectional pilot study in Germany

BACKGROUND

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide and displays many atopic, but also non-atopic comorbidities. Among the latter, mental health disorders such as depression have been extensively studied. However, data on addictions are still rare.

OBJECTIVES

The aim of this study was to assess the prevalence of different kinds of addictions in adult AD patients using a single-centre approach.

METHODS

This non-interventional cross-sectional study was performed from 03/2020 to 05/2020 at the Department of Dermatology of a large German university hospital. Participants with a diagnosis of AD confirmed by a dermatologist answered questions about disease severity (patient-oriented eczema measure, POEM), quality of life (Dermatology Life Quality Index, DLQI) and smoking habits. They were screened for problematic alcohol consumption, drug abuse, internet addiction and pathological gambling using internationally established and validated questionnaires.

RESULTS

157 patients (56.1% female; mean age of 49.9 ± 20.4) with an average POEM of 13.7 ± 7.5 and DLQI of 6.1 ± 5.4 were evaluated. 14.1% were identified as regular smokers, 12.1% screened positive for alcohol dependency, 6.4% for drug use disorders, 4.5% for Internet addiction and 3.2% for pathological gambling. Co-occurrences of different addictions were observed, and a positive correlation was noted between DLQI scores and smoking.

CONCLUSIONS

In summary, this study hints at elevated positive screening rates for problematic alcohol consumption, drug use disorders, Internet addiction and problem gambling compared with the general population. Screening routinely for addictions may improve patient-centred health care of AD patients.

POS0026 ASSOCIATION BETWEEN RA DISEASE ACTIVITY AND TOOTH LOSS: RESULTS OF TWO NATIONAL COHORTS

Background:

Cross-sectional studies suggest an association between the presence of tooth loss and/or periodontitis, cytokine levels and disease activity in patients with rheumatoid arthritis (RA) (1).

Objectives:

To analyze the association between tooth loss and disease activity/inflammatory activity in patients with early arthritis and established RA.

Methods:

Two data sources were used for analysis. Participants of the early arthritis cohort study CAPEA, conducted between 2010 and 2013, reported their number of teeth present at baseline and were followed over 2 years. Tooth loss categories were defined according to the number of teeth present, as follows: 0, 1-19, 19-27, and all 28 teeth. Disease activity/inflammatory activity data, such as disease activity scores (DAS28-ESR) and disease activity parameters, including swollen joint count (SJC) and inflammatory markers, i.e. erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were collected longitudinally at baseline, 3, 6, 12, 18, and 24 months. We used linear mixed regression models (with negative binomial distribution for SJC) to estimate the association between tooth loss and disease activity scores, SJC and inflammatory markers (ESR, CRP), over time. We also investigated the association between tooth loss and disease activity/inflammatory markers in patients with established RA, using cross-sectional data from the German National database (NDB) collected between 2015 and 2018. All models were adjusted for age, sex, smoking (ever vs. never), rheumatoid factor and education level, defined as years in education. Models with the NDB data were additionally adjusted for disease duration, missing data were imputed using multiple imputation. In all models, number of teeth was entered as a continuous variable.

Results:

Of a total of 1,124 CAPEA participants included, those with higher tooth loss were older, more often smokers, had a lower level of education, higher inflammatory markers and higher disease activity scores at baseline (Table 1). Inflammatory markers decreased comparably across all categories of tooth loss over time (Figure 1), in particular CRP. Tooth loss was not significantly associated with CRP or SJC alone. Glucocorticoid use was higher among those with more tooth loss, however dose reduction was similar across tooth loss categories. Among 7,179 NDB participants, adjusted disease activity scores and inflammatory markers were higher across tooth loss categories (DAS28 no teeth: 2.7, all teeth: 2.4; ESR no teeth: 23 mm/h, all teeth: 17 mm/h). SJC was not relevantly associated with tooth loss (no teeth: 1.2, all teeth: 1.2). Mean disease duration in the NDB sample was 13 years.

Table 1.

Early arthritis cohort (CAPEA) baseline characteristics, stratified by number of teeth

Number of teeth presentTotaln01-1920-27All 28N893154522681,1241,124Female, %57656469651,124Age (years), mean69645445561,124ESR (mm), mean42382824311,074CRP (mg/l), mean25241515191,069SJC, mean6.16.95.65.25.91,120DAS28-ESR, mean5.55.24.74.54.9983RF positive, %63535254541,124Education, %1,020<=8 years80583521429-10 years163043463811-13 years412223320Smoking (ever), %73646156611,102

ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, DAS28: disease activity score, RF: rheumatoid factor, SJC: swollen joint count

Figure 1.

Disease activity parameters during the 24-months follow-up, stratified by the number of teeth at baseline: results from mixed models, adjusted for age, sex, smoking and education level.

Conclusion:

While we observed a significant association between tooth loss and disease activity and inflammation markers in both early arthritis and established RA, our longitudinal results suggest that tooth loss has no influence on response to therapy.

References:

[1]Rodriguez-Lozano B, Gonzalez-Febles J, Garnier-Rodriguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, et al. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther. 2019;21(1):27.

Acknowledgements:

We thank all participating rheumatologists and patients for their valuable contributions.

The CAPEA periodontitis project was funded by the Deutsche Rheuma-Liga Bundesverband e.V.

Capea was funded by an unconditional research grant from Pfizer.

The National Database of the German Collaborative Arthritis centers has been supported since 2007 by the Association of Regional Cooperative Rheumatology Centres and joint contributions to the Rheumatological Training Academy and the DRFZ by the following members of the Working Group of Corporate Members of the German Society for Rheumatology: AbbVie, Actelion, BMS, GSK, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis and UCB. The researchers have full academic freedom.

Disclosure of Interests:

None declared.

OP0116 ELDERLY PATIENTS ARE NOT AT INCREASED RISK OF SERIOUS INFECTIONS WHEN RECEIVING BDMARDS OR JAK INHIBITORS COMPARED TO CSDMARD TREATMENT

Background:

Elderly rheumatoid arthritis (RA) patients are generally at increased risk of serious infections (SI). At the same time, treatment with bDMARDs has been associated with a higher SI risk than treatment with csDMARDs (1). However, long-term use of bDMARDs did not increase the risk of SI in a small group of elderly patients over 65 (2). The extent to which elderly patients are exposed to a higher SI risk when treated with JAK inhibitors (JAKi) is an open question.

Objectives:

To assess the effects of bDMARDs and specifically JAKi on the risk of SI in elderly patients with RA.

Methods:

The German register RABBIT is a prospective, longitudinally followed cohort of RA patients enrolled with a new start of a DMARD after at least one csDMARD failure. This analysis comprises patients over 70 years of age who were enrolled between 01/2007 and 04/2020 and had at least one follow-up.

Results:

Of 13,491 patients followed-up in RABBIT, 2274 with an age > 70 years were included in the analysis. 626 SI were observed in 425 of these patients. Baseline characteristics at start of the respective DMARD are shown in Table 1. In most characteristics, patients on JAKi were more comparable to patients under bDMARDs than to those on csDMARDs. JAKi patients received glucocorticoids (GC) less frequently than patients on other treatments. The HR for SI was lower than 1 in patients receiving bDMARDs or JAKi compared to csDMARDs, but without statistical significance (Figure 1). GC use (HR 1.6, 95% CI: 1.2 – 2.2 for ≤ 10 mg/d), higher DAS28-ESR values (HR 1.1, 95% CI: 1.0 – 1.2 per 1 point increase), COPD or pulmonary fibrosis (HR 1. 8, 95% CI: 1.3 – 2.4), chronic kidney disease (HR 1.5, 95% CI: 1.2 – 1.9) and diabetes mellitus (HR 1.3, 95% CI: 1.0 – 1.7) were associated with an increased risk of SI. Better physical capacity was associated with a decreased risk of SI (HR 0.9, 95% CI: 0.88 – 0.98 for a 10 point increase).

Table 1.

Patient characteristics by treatment at baseline

ParametercsDMARDsTNFiRTXABAIL-6iJAKiN=758N=840N=209N=147N=212N=108Age (years)75.9 (3.9)75.5 (3.6)74.8 (3.6)76.1 (3.9)75.9 (3.7)76.7 (3.7)Male sex184 (24.3)220 (26.2)50 (23.9)36 (24.5)46 (21.7)28 (25.9)Ever smoker249 (32.8)287 (34.2)77 (36.8)50 (34)73 (34.4)39 (36.1)Disease duration (years)7.9 (8.8)12.3 (11.4)17 (11.1)12.8 (10)13.8 (11.7)11.9 (10.9)Seropositivity487 (64.3)671 (79.9)201 (96.2)126 (85.4)182 (85.8)79 (73.5)Number of previous DMARDs1.4 (0.7)2.5 (1.3)4.2 (1.8)3.6 (1.9)3.3 (1.8)2.6 (1.5)DAS28-ESR4.6 (1.2)5.1 (1.2)5.4 (1.3)5.3 (1.3)5.3 (1.3)5 (1.2)Proportion of full physical function64.8 (23.1)57.1 (23.6)50.4 (23.7)52.9 (23.5)55.3 (24.1)55.2 (23.7)Number of comorbidities3.1 (2.5)3.8 (2.6)4.2 (2.6)4.6 (2.9)3.6 (2.4)3.8 (2.2)No comorbidity52 (6.9)29 (3.5)4 (1.9)4 (2.7)9 (4.2)5 (4.6)Three and more comorbidities385 (50.8)528 (62.9)147 (70.3)107 (72.8)131 (61.8)76 (70.4)COPD or pulmonary fibrosis69 (9.1)89 (10.6)29 (13.9)26 (17.7)12 (5.7)11 (10.2)Chronic kidney disease94 (12.4)151 (18)28 (13.4)21 (14.3)39 (18.4)22 (20.4)Diabetes mellitus151 (19.9)172 (20.5)31 (14.8)23 (15.6)42 (19.8)25 (23.1)GCs (last 6 months)347 (45.8)526 (62.6)143 (68.8)82 (56.2)127 (59.9)44 (40.7)GCs (<5mg)447 (58.9)384 (45.7)101 (48.2)88 (60)118 (55.8)72 (66.7)GCs (5-9mg)252 (33.3)375 (44.6)81 (38.7)43 (29)72 (34.2)27 (25.1)GCs (>=10mg)59 (7.8)82 (9.8)274 (13.1)16 (11)21 (10)9 (8.2)

Results are presented as mean ± SD for continuous variables and number (percentage) for discrete variables.

Figure 1.

Hazard ratios for serious infections with 95% confidence intervals

Conclusion:

Treatment with JAKi as well as treatment with bDMARDs was not associated with an increased risk of SI in elderly patients above 70 years of age. Key comorbidities such as diabetes mellitus, chronic pulmonary and kidney diseases were associated with increased risk, as was concomitant GC use and higher disease activity.

References:

[1] Listing J et al., Rheumatology 2013; 52 (1): 53-61.

[2] Kawashima H. et al., Rheum. Intern. 2017; 37: 369-376.

Acknowledgements:

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Celltrion, Fresenius-Kabi, Gilead, Hexal, Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, UCB, and Viatris.

Disclosure of Interests:

None declared

Google search trends for itch in Europe: a retrospective longitudinal study

BACKGROUND

Itch is a common symptom in the general population. Affected individuals often do not seek medical consultation and rely on Internet searches to obtain information regarding their itch.

OBJECTIVES

The aim of this study was to attain insights into common concerns of the general population regarding itch can by analysing itch-related Internet search behaviour.

METHODS

Google AdWords Keyword Planner was used to assess search volumes for itch-related terms in 15 European countries between September 2014 and August 2018. All identified keywords were qualitatively categorized. Itch-related terms were descriptively analysed and are shown as number of searches/100 000 inhabitants.

RESULTS

The search volume for the keyword 'itch' per 100 000 inhabitants was highest in Northern Europe, followed by Eastern, Central and Southern Europe. In 4/15 countries, itch was searched for more often in the autumn/winter months compared to in the spring/summer months. Most itch-related terms were related to dermatological conditions such as inflammatory skin diseases (e.g. psoriasis, atopic dermatitis), allergic or immunologic conditions (e.g. urticaria), and infectious diseases or infestations (e.g. scabies). In terms of body location, genitoanal itch dominated the searches. Symptoms and signs related to itch, possible non-dermatological aetiologies, and treatment options were also among the most searched terms.

CONCLUSIONS

These analyses provided for the first time insights into the search behaviour patterns related to itch across Europe. People from Northern and Eastern Europe are more likely to seek online information regarding itch. Causes for the itch, especially dermatological conditions, and genitoanal itch are the most important concerns for Internet users. This unconventional and inexpensive method identifies medical needs of people beyond the medical setting, including people who do not seek medical consultation. Accordingly, the data could be used to guide public health interventions and manage respective inhabitants' medical needs.

[Should statistical significance be retired?]

In the journal Nature, under the headline "Retire statistical significance", Amrhein et al. called for the concept of statistical significance to be abolished. This appeal, which was signed by about 800 other researchers, triggered a controversial discussion. One reason for the deliberately provocative call is the scientific practice in which the concept of statistical significance is often applied in an incorrect way for yes/no decisions. The criticism is not new and has been repeatedly expressed over the last 50 years. We refer to current and previously published caveats, give an overview of different applications of the concept of statistical significance as well as possible alternatives. We agree in principle with the criticism of the concept expressed by Amrhein et al. but in the absence of agreed alternatives and insufficient consideration of the many different applications of the concept of statistical significance, we consider the demand for its abolition to be exaggerated. A more pragmatic approach to the problem, supported by targeted instructions for scientists and reviewers, seems to be a more appropriate way forward.

Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers

BACKGROUND

Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees.

OBJECTIVES

We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk.

METHODS

In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC.

RESULTS

A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected.

CONCLUSION

Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.

OP0012 TNF INHIBITORS ARE ASSOCIATED WITH A REDUCED RISK OF VENOUS THROMBOEMBOLISM COMPARED TO CSDMARDS IN RA PATIENTS

Background:

While the short-term use of bDMARDs up to 180 days has been associated with an increased risk of venous thromboembolism (VTE) compared to csDMARDs in patients with rheumatoid arthritis (RA), the long term use of more than 730 days has been associated with a decreased risk based on claims data [1]. Among patients with inflammatory bowel disease, observational data indicated that TNF inhibitors may have a protective effect regarding the VTE risk [2].

Objectives:

To assess the effects of TNF inhibitors and newer bDMARDs (including abatacept, rituximab, sarilumab, and tocilizumab) on the VTE risk based on observational data from RA patients.

Methods:

The German register RABBIT is a prospective longitudinally followed cohort of RA patients enrolled with a new start of a DMARD after at least one csDMARD failure. This analysis comprises patients who were enrolled with start of a bDMARD between 01/2009 and 04/2019 and had at least one follow-up.

Cox regression models were used to calculate hazard ratios (HRs) for VTEs, for csDMARDs, TNF inhibitors and other bDMARDs. Propensity score weighting was used to adjust for confounding by indication.

Results:

Patients receiving TNF inhibitors or other bDMARDs on average had higher CRP levels and a higher prevalence of cardiovascular diseases at baseline than patients receiving csDMARDs. They also received more often glucocorticoids (Table 1).

The HR of patients receiving TNF inhibitors for a serious VTE event was 0.53 (95% CI: 0.33 – 0.86) compared to csDMARDs, while the HR for patients receiving other bDMARDs was 0.66 (95% CI: 0.40 – 1.09). A CRP level of more than 5 mg/L (HR 2.09, 95% CI: 1.39 – 3.14) and an age above 65 years (HR 2.96, 95% CI: 1.94 – 4.52) increased the risk for a serious VTE event. Better physical function was associated with a decreased risk for VTEs (Table 2).

Table 1.

Patient characteristics at baseline for DMARD groups

Parameter (at time of event/end of observation unless specified otherwise)Hazard ratio95% confidence intervalTNF inhibitors (reference: csDMARDs)0.530.330.86Other bDMARDs (reference: csDMARDs)0.660.401.09Age ≥ 65 years (baseline)2.961.944.52CRP ≥ 5 ml2.091.393.14> 5 mg and ≤ 10 mg glucocorticoids/day1.040.551.98> 10 mg and ≤ 15 mg glucocorticoids/day2.350.816.79> 15 mg glucocorticoids/day2.030.765.41% of full physical capacity (per 10 percentage points increase, time of event)0.850.780.92Current smoking (baseline)0.980.611.55Former smoking (baseline)0.800.451.43Table 2.

Hazard ratios for VTE events

ParametercsDMARDsTNFiOther bDMARDsN350050602534VTE event38 (1.1)55 (1.1)23 (0.9)Age [years]58.8 (12.6)56.5 (12.9)58.1 (12.4)Female sex2575 (73.6)3734 (73.8)1933 (76.3)Disease duration [years]6.2 (7.2)9.4 (8.6)11.9 (9.2)Seropositivity2189 (62.6)3739 (73.9)2048 (80.8)Joint erosions1024 (31.0)2566 (52.4)1523 (63.3)Prior bDMARD therapies0 (0.2)0.3 (0.6)1.2 (1.2)CRP8.8 (8.1)11.6 (10.6)12.4 (11.8)DAS28-ESR4.4 (1.3)4.9 (1.2)5.1 (1.3)% of full physical capacity71.3 (21.8)66.2 (22.6)62.1 (23.5)Current glucocorticoid therapy2564 (73.3)3951 (78.1)2036 (80.4)Heart failure36 (1)113 (2.2)93 (3.7)Coronary artery disease196 (5.6)326 (6.4)183 (7.2)Cerebrovascular disease60 (1.7)86 (1.7)44 (1.7)Osteoporosis400 (11.4)771 (15.2)530 (20.9)Ever smoker1875 (53.6)2738 (54.1)1402 (55.3)

Results are presented as mean ± SD or number (percentage).

Conclusion:

Treatment with TNF inhibitors (compared to csDMARDs) and better physical function significantly reduced the risk of serious VTE events, while age above 65 years and high CRP levels increased this risk.

References:

[1]Kim S. C. et al. Am. J. Med. 2015; 128(5): 539.e7–539.e17.

[2]Desaj R.J. et al. CMAJ 2017; 189:E1438-47.

Acknowledgments:

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Fresenius-Kabi, Hexal, Lilly, MSD, Mylan, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, and UCB.

Disclosure of Interests:

Martin Schaefer: 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, Anett Graessler: None declared, Wolfgang Ochs: None declared, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis

SAT0088 NO INCREASED RISK OF FALLS IN PATIENTS TREATED WITH BIOLOGICS COMPARED TO THOSE UNDER CSDMARDS

Background:

Adults with rheumatoid arthritis (RA) have an increased risk of falling. Previous studies on causes of falls have neither sufficiently nor adequately considered the effects of bDMARDs. In addition, a risk analysis of the individual substances has been lacking until now.

Objectives:

To analyze the fall risk under exposure to TNFi’s, abatacept (ABA), rituximab (RTX) and tocilizumab (TOC) in comparison to csDMARDs taking co-medication and other risk factors such as disease activity, comorbidities and other biological risks into account.

Methods:

Data of RA patients observed in RABBIT from 01/2009 - 02/2018 with a follow-up of up to 5 years was used for the analysis. In accordance with consensus guidelines, a fall was defined as “an unexpected event in which participants come to rest on the ground, floor or other lower level” [1].

Effects of bDMARDs were examined using “inverse probability weighting“ (IPW) with time-varying treatment on a monthly basis. Directed acyclic graphs were applied to support causal considerations.

Results:

The percentage of patients with falls (2.7%) was significantly lower than the previously reported 10% and 50% [2]. This underreporting is explained by the fact that falls in RABBIT are reported by the physicians and are not recorded in patient diaries. In line with other studies, falls occurred with older age, longer disease duration, poorer physical function and higher DAS28. Patients with a higher number of comorbidities had a significantly higher risk of falling. The number of patients treated with analgesics was higher in the fall group and fallers had higher glucocorticoid doses. However, the values for pain and fatigue were comparable between the two groups (Table 1). The descriptive analysis showed that patients starting second / third line biologics therapy had a shorter duration from the initiation of treatment to the fall event than patients starting with csDMARDs. None of the regression models showed an increased risk for biologics compared to csDMARDs.

Table 1.

Characteristics at baseline in fallers and non-fallers

FallerNon- FallerN2639405Age, years62.9 (11.9)57.3 (12.6)BMI, kg/m227.4 (5.8)27.3 (5.5)Female, %79.574.2Disease duration, years10.8 (9.8)8.7 (8.5)ACPA+, %46.455.1RF+, %59.765.3DAS285 (1.3)4.8 (1.3)% of full physical function61.2 (24.2)67.3 (22.7)Joint replacement, yes %16.39.8Pain, 0 – 10 scale5.8 (2.3)5.8 (2.3)Fatigue, 0 – 10 scale5.1 (2.7)5.2 (2.7)No. of comorbidities3.4 (3)2.2 (2.2)Osteoporosis, %33.514.4Analgesics, yes %2415.8Glucocorticoid dose, mg/d6 (5.1)5.4 (6.3)

Values are means (SDs) unless otherwise specified

Conclusion:

None of the inferential analyses could demonstrate an increased risk of falling for any of the bDMARDs compared to csDMARDs. Although descriptive analyses pointed to an earlier fall event in patients treated with second-/third line biologics, these results could be explained by their particular characteristics. These patients tended to be older and were more affected by RA. This suggests that these risks override the effects of bDMARDs.

Table 2.

Results of weighted* Cox regression, Reference are csDMARDs

VariablesUnivariate HR95% CIWeighted HR95% CITNFi‘s1.12(0.85; 1.48)1.05(0.80; 1.39)ABA1.00(0.57; 1.74)0.98(0.57; 1.70)RTX1.39(0.88; 2.22)1.09(0.65; 1.81)TOC0.88(0.59; 1.33)0.77(0.50; 1.18)

*Include: age, disease duration, gender, education, joint replacement, fatigue, functional status, pain, stiffness, analgesics, no. of comorbidities, selected comorbidities

References:

[1] Lamb SE, et al. Journal of the American Geriatrics Society. 2005;53(9):1618-22.

[2] Brenton-Rule A, et al.Seminars in Arthritis and Rheumatism. 2015;44(4):389-98.

Acknowledgments :

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Fresenius Kabi, Hexal, Lilly, MSD, Mylan, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, and UCB.

Disclosure of Interests:

Tatjana Rudi: None declared, Martin Schaefer: None declared, Bernhard Manger Consultant of: Lilly, Celgene, Janssen, MSD, UCB, Speakers bureau: AbbVie, AstraZeneca, Alexion, Berlin-Chemie, BMS, Celgene, Chugai, Sanofi-Genzyme, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, SOBI, UCB, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis

SAT0391 DEPRESSIVE SYMPTOMS ARE ASSOCIATED WITH HIGHER DISEASE ACTIVITY AND WORSE FUNCTIONAL STATUS IN AXSPA: A CROSS-SECTIONAL ANALYSIS FROM RABBIT-SPA

Background:

Axial spondyloarthritis (axSpA) is a potentially severe chronic inflammatory disease with impact on function and quality of life. About 20-30% of axSpA patients show symptoms of depression or are diagnosed with depression [1]. Depression may influence outcome, especially patient reported outcomes.

Objectives:

To assess differences in baseline characteristics and outcome parameters between patients with and without symptoms of depression using WHO-5 score.

Methods:

RABBIT-SpA is a prospective longitudinal cohort study including axSpA patients enrolled at start of a new conventional treatment (including NSAID) or bDMARD. WHO-5 score was used to identify depressive symptoms categorised into 3 groups using validated cut-offs: moderate to severe depressive symptoms <=28, mild depressive symptoms 29-50, good well-being >50. Baseline values of patients categorised as having moderate to severe depressive symptoms were compared with the rest of the patients using t-test. Spearman correlation coefficient was calculated to analyse the relationship between WHO-5 score and other outcome parameters.

Results:

A total of 848 axSpA patients were included in this analysis (table 1). Moderate to severe depressive symptoms were found in 221 patients (30%), 226 (31%) had mild depressive symptoms and 285 (39%) reported a good well-being. Percentages of patients with inflammatory back pain, peripheral arthritis or enthesitis as well as the number of affected joints (44 JC) and entheseal sites (using SPARCC) were higher in the group of patients with moderate to severe depressive symptoms.

Table 1.ParameterWHO-5 (<=28)Moderate severeN=221WHO-5 (29-50/>50)Mild/well-beingN=511Age, mean43.844.1Female, n (%)100 (45.2)229 (44.8)Disease duration, years, mean6.86.5Inflammatory back pain, n (%)195 (88.6)416 (81.6)Enthesitis, n (%)49 (22.3)78 (15.4)Peripheral arthritis (44 JC), n (%)64 (29.1)134 (26.3)Uveitis, n (%)45 (20.4)76 (15)IBD, n (%)13 (5.9)31 (6.1)Psoriasis, n (%)35 (15.8)58 (11.4)CRP positive (≥5mg/l), n (%)115 (59)243 (55.1)HLA-B27, n (%)151 (72.6)354 (74.2)BMI≥30, n (%)66 (30)117 (23.6)Comorbidities ≥3, n (%)50 (22.6)89 (17.4)Current smoking, n (%)102 (47.2)185 (36.7)

All analysed outcome parameters (e.g. ASDAS, ASAS-HI, BASDAI, BASFI, patient global, physician global, pain, sleep) were significantly worse in the group of patients with moderate to severe depressive symptoms versus the other patients (table 2). This includes physician-reported, patient-reported and composite scores.

Table 2.ParameterWHO-5 (<=28)Moderate severeN=221WHO-5 (29-50/>50)Mild/well-beingN=511p-valuePhysGA (NRS 0-10)6.2 (1.6)5.4 (1.9)0.0001ASDAS6.1 (1.6)4.2 (1.8)0.0001BASDAI (NRS 0-10)3.5 (0.8)2.9 (0.9)0.0001BASFI (NRS 0-10)5.5 (2.2)3.2 (2.2)0.0001ASAS-HI (0-17)9.8 (3.1)5.8 (3.1)0.0001PatGA (NRS 0-10)7 (1.8)5.4 (2.3)0.0001PatPain (NRS 0-10)6.9 (1.9)5.2 (2.3)0.0001PatSleep (NRS 0-10)7.2 (2.4)4.6 (2.9)0.0001

Results are presented as mean ± SD.

WHO-5 was highly correlated with all outcome parameters regardless of gender. Figure 1 shows the correlation of BASDAI and WHO-5 stratified for gender.

Figure 1.

Conclusion:

Almost one third (30%) of axSpA patients in this analysis reported scores indicative of depressive symptoms and depression. The strong correlation of WHO-5 scores with patient and physician reported outcomes may be relevant for the management of patients with axSpA.

References:

[1]Redeker I, et al. Ann Rheum Dis 2018;0:1–8. doi:10.1136

Acknowledgments:

RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Janssen-Cilag, Lilly, MSD, Mylan, Novartis, Pfizer, and UCB.

Disclosure of Interests:

Anne Regierer Speakers bureau: Novartis, Celgene, Janssen-Cilag, Anja Weiß: 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, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Ilka Schwarze: None declared, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Joachim Sieper Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis

THU0554 COMORBIDITY AND HEALTH CARE UTILIZATION IN PERSONS WITH SJÖGREN’S SYNDROME: A CLAIMS DATA ANALYSIS

Background:

Sjögren’s syndrome (SS) can affect numerous organs, including the muscles, the peripheral nervous system, kidneys and lungs. Epidemiological studies assessing comorbidity and health care utilization are needed to improve health care for this multifaceted disease.

Objectives:

To capture comorbidity and medication of persons with SS in a population-based cohort in comparison to matched controls.

Methods:

Individuals with an outpatient diagnosis of M35.0 (ICD-10) in ≥2 quarters of a year or an inpatient diagnosis of M35.0 were identified in a German statutory health insurance fund covering 7.2 million people. Persons in rheumatologic care were grouped by incident or prevalent diagnosis and by co-existing autoimmune disease (sSS) or primary (p)SS and compared to age- and sex-matched controls regarding comorbidity (ICD-10), medical prescriptions, hospitalization and inability to work in the previous year.

Results:

In 2018, 7,374 persons (0.1%) had incident and 53,917 persons (0.73%) prevalent SS diagnosis, and 5,920 (11%) were in rheumatologic care. Of these (90% female, mean age 66 years), 3,431 (58%) had further autoimmune disease (sSS), mostly rheumatoid arthritis (80%) and systemic lupus erythematosus (13%). Compared to controls, frequent comorbid conditions in SS were hypertension, osteoarthritis, osteoporosis and depression (table 1). Systemic antirheumatic drugs were prescribed in 31% (pSS) and 66% (sSS) while < 4% received topical therapies. Glucocorticoids (7% controls/34% pSS/59% sSS), NSAIDs (28%/41%/45%), opioids (9%/15%/22%), analgesics (19%/30%/36%) and antidepressants (14%/21%/22%) were more frequently prescribed in SS than in controls, and also hospitalization (21%/32%/39%) and inability to work in persons <65 years (41%/48%/44%, median days 17/24/31) were more frequent in pSS and sSS than in controls.

Table 1

Comorbidity claims diagnoses (%) in persons with Sjögren’s syndrome and controls

ControlspSSsSSN29,9102,4893,431Age in years, mean66.065.266.6Female, %88.989.190.1Keratoconjunctivitis sicca0.527.928.3Interstitial kidney disease7.612.817.0Lung involvement0.01.21.4Myopathy0.02.43.0Polyneuropathy6.112.515.7Hypertension51.554.863.0Osteoarthritis21.939.946.9Osteoporosis10.326.638.1Fibromyalgia1.110.811.2Depression17.830.132.3Hypothyroidism12.820.819.9Solid Tumour8.810.39.9Metastatic Cancer1.11.21.8

Conclusion:

SS claims diagnosis is associated with substantial comorbidity and frequent prescription of anti-inflammatory drugs, analgesics and antidepressants. The individual and societal burden of SS shows that, in addition to effective treatment strategies, intensive attention to comorbidities is important in this disease.

Acknowledgments:

Funding The study was supported by the Wolfgang Schulze Foundation of the German Rheuma-Liga

Disclosure of Interests:

Katinka Albrecht: None declared, Thomas Dörner Grant/research support from: Janssen, Novartis, Roche, UCB, Consultant of: Abbvie, Celgene, Eli Lilly, Roche, Janssen, EMD, Speakers bureau: Eli Lilly, Roche, Samsung, Janssen, Imke Redeker: None declared, Kirsten Karberg: None declared, Ursula Marschall: None declared, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Johanna Callhoff: None declared

FRI0151 COMORBIDITY IN INCIDENT SYSTEMIC LUPUS ERYTHEMATOSUS: ANALYSIS OF A CLAIMS DATA COHORT

Background:

Systemic lupus erythematosus (SLE) targets many tissues including heart, kidney, bone and brain, causing a variety of comorbidities. Epidemiological studies assessing comorbidity in SLE facilitate earlier detection to limit its progression.

Objectives:

To analyze comorbidities in individuals with an incident diagnosis of systemic lupus erythematosus (SLE) in claims data in comparison to matched controls.

Methods:

Individuals with ≥2 outpatient or 1 inpatient SLE diagnosis (M32.1, M32.8, M32.9, ICD10) in 2016-2018 and no diagnosis in 2015 or 2014 were identified in a German statutory health insurance fund covering 7.2 million people > 18 years old. Comorbidities defined by the Elixhauser index, medical prescriptions, hospitalization and sick leave were analyzed in the year prior to diagnosis and during a two year follow-up in comparison to age and sex-matched controls without related autoimmune diseases (1:10). To account for detection bias, a second age and sex-matched control group with incident diabetes mellitus (E10-14) was drawn (1:5). To consider diagnostic uncertainty, two sensitivity analyses were performed, namely (i) excluding cases with ICD diagnosis of Sjögren’s syndrome, mixed connective tissue disease, systemic sclerosis and tubulointerstitial nephritis and (ii) excluding cases without any prescription of antimalarials.

Results:

A total of 559 persons were included (87% female, mean age 55 years). The mean Elixhauser score increased from 1.1 in 2015 to 4.2 in the index year and to 4.5 in the 2nd year after diagnosis. Hypertension (47%), depression (31%), hyperlipidemia (25%), osteoarthritis (25%) and osteoporosis (21%) were among the most frequent comorbidities in the index year. Drug prescriptions (mean 9.7, Δ+6.3), among these glucocorticoids (56%), HCQ (50%) and azathioprine (13%), and hospitalization (40%, Δ+26%) increased in the 1st year after the SLE diagnosis. The increase in comorbidity diagnoses was low in controls without related autoimmune disease, while controls with incident diabetes showed a more pronounced increase in cardiovascular risk factors and and a lesser increase in osteoporosis and cerebrovascular disease (figure 1). Comparable results were found in the sensitivity analyses, where patients with HCQ were younger and had less general comorbidity.

Figure 1.

Comorbidity claims in persons with incident systemic lupus erythematosus in 2016 (N=559, M32.1,8,9) and age and sex-matched controls (N=5,590 without related autoimmune disease, N=2,795 with incident diabetes, E10-14)

Conclusion:

Cardiovascular, bone and neurologic comorbidities are frequently detected already at the time of diagnosing SLE. High numbers of medical prescriptions and hospitalization following SLE diagnosis reflect the comprehensive disease burden. Differences to controls without autoimmune disease are overestimated by detection bias.

References:

FundingThe study was supported by the Wolfgang Schulze Foundation of the German Rheuma-Liga

Disclosure of Interests:

Katinka Albrecht: None declared, Imke Redeker: None declared, Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Ursula Marschall: None declared, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Johanna Callhoff: None declared

FRI0306 WOMEN WITH AXIAL SPONDYLOARTHRITIS HAVE COMPARABLE RATES OF COMPLICATIONS IN PREGNANCY TO WOMEN IN THE GENERAL POPULATION BUT MORE CAESAREAN DELIVERIES: RESULTS FROM NATIONWIDE CLAIMS DATA

Background:

In contrast to other rheumatic inflammatory diseases, studies on pregnancy outcomes in axial spondyloarthritis (axSpA) are scarce, despite its onset in early adulthood affecting women in their reproductive years.

Objectives:

To investigate maternal and infant pregnancy outcomes among women with axSpA compared with population-based controls.

Methods:

Taking advantage of a large health insurance dataset, comprising the period 2006 – 2018, maternal and infant pregnancy outcomes and delivery outcomes of women with axSpA were assessed and compared with population-based controls (matched by maternal age and calendar year of birth). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using generalised estimating equation analyses.

Results:

A total of 611 singleton births among 535 women with axSpA were included in the analysis. The mean age at delivery was 32.5 years. The pharmacological treatment within 12 months prior to and after conception is illustrated in the Figure. Infants of women with axSpA were only slightly more often preterm (5.2% vs 4.7%) and small-for-gestational-age (1.6% vs 1.1%) than infants of matched population-based controls, respectively. Caesarean section was performed in 36% of deliveries among women with axSpA compared with 29.5% in population-based controls, resulting in a significantly increased risk for receiving caesarean section (OR 1.35; 95% CI 1.06-1.73) (Table). The occurrence of pre-eclampsia, preterm birth, and small-for-gestational-age was moderately higher, but not significantly increased, among women with axSpA as compared to population-based controls.

Conclusion:

Women with axSpA had no significantly increased risks for adverse maternal or infant pregnancy outcomes compared to non-axSpA women. However, a significantly increased risk for receiving caesarean section and a tendency for a higher number of preterm deliveries and of small-for-gestational-age infants was observed in women with axSpA.

Table.

Acknowledgments:

We would like to thank the BARMER Statutory Health Insurance for providing data for this study.

Disclosure of Interests:

Imke Redeker: None declared, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Ursula Marschall: None declared, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, 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

OP0020 IMPACT OF BDMARDS WITH DIFFERENT MODES OF ACTION ON FATIGUE IN RA PATIENTS

Background:

Fatigue is an important patient-reported outcome. It has been reported to be potentially targetable by DMARDs with specific modes of action, particularly IL-6 inhibition [1].

Objectives:

To assess to which extent patients on DMARDs with different modes of action reach fatigue levels of 2 or less on a 0 (no fatigue) to 10 (high fatigue) scale after 6 months of treatment.

Methods:

The German register RABBIT is a prospective longitudinally followed cohort of RA patients enrolled with a new start of a DMARD after at least one csDMARD failure. This analysis comprises bionaive patients who were enrolled with start of a b/tsDMARD between 01/2009 and 04/2019, who had at least 1 follow-up, did not switch during the first 3 months and afterwards only within the same substance, and presented fatigue levels of > 2 at baseline.

Poisson regression models with a robust error variance were used to calculate risk ratios (RRs) for reaching fatigue values ≤ 2, for all DMARD modes of action. Propensity score weighting was used to adjust for confounding by indication. Multiple imputation of missing values was performed.

Results:

Baseline fatigue levels were 5.1 overall and 6.1 among patients with a fatigue level of > 2 points on average. They were comparable among different DMARD modes of action. csDMARD patients had lower values than others regarding disease duration, disease activity, or joint erosions (Table 1).

Table 1.

Patient characteristics for different DMARD modes of action

ParametercsDMARDsTNFiRTXABAIL-6JAKiN23762772115166357110Fatigue at baseline5.9 (2)6.1 (2)5.9 (2)5.9 (1.9)6.1 (2)6.3 (1.9)Age [years]58.5 (12.7)56.3 (12.4)62.7 (10.9)59.7 (12.6)57.9 (12.5)61.5 (11.5)Female sex1809 (76.1)2060 (74.3)82 (71.2)118 (71)272 (76.3)79 (70.1)Disease duration [years]6.2 (7.2)8.7 (8.1)10.8 (9.7)9.8 (9.2)7.9 (7.6)8.5 (10)Joint erosions634 (28.4)1358 (50.5)62 (56.8)91 (55.4)158 (46.4)45 (41.3)Prior csDMARD therapies1.3 (0.6)2.3 (1)2.5 (1.1)2.2 (1)2.2 (0.9)1.8 (0.8)DAS28-ESR4.6 (1.2)5 (1.2)5.3 (1.3)5.3 (1.2)5.2 (1.3)4.9 (1.3)% of full physical capacity67.4 (21.6)64.6 (22)57 (23.5)59.5 (21.3)63.8 (20.9)61.6 (23)Glucocorticoid therapy (last 6 months)1161 (48.9)1747 (63)76 (66.4)93 (56)198 (55.5)42 (38.1)Fibromyalgia73 (3.1)111 (4)6 (5.2)7 (4.2)11 (3.1)1 (0.9)Depression180 (7.6)218 (7.9)10 (8.7)14 (8.4)26 (7.3)16 (14.6)Ever smoker1252 (52.7)1497 (54)68 (59)84 (50.7)200 (56)59 (53.5)

Results are presented as mean ± SD or number (percentage). Absolute numbers may be rounded due to multiple imputation.

The RR of IL-6 inhibitors for achieving a fatigue level of ≤ 2 was 1.34 (95% CI: 1.09 – 1.64) compared to csDMARDs. Among other factors, current smoking, prevalent fibromyalgia and depression had a negative impact on achieving a low fatigue level (Table 2).

Table 2.

Risk ratios for achieving fatigue levels ≤2

Parameter (at baseline)RR95% confidence intervalFatigue (1 point higher)0.83(0.80;0.86)TNF inhibitor (vs. csDMARDs)1.11(0.99;1.24)Rituximab (vs. csDMARDs)1.10(0.71;1.68)Abatacept (vs. csDMARDs)1.13(0.82;1.54)IL-6 inhibitor (vs. csDMARDs)1.34(1.09;1.64)JAK inhibitor (vs. csDMARDs)1.19(0.81;1.75)Age (5 years more)0.97(0.95;0.99)Female sex0.83(0.74;0.92)Patient global health (1 point higher)0.97(0.94;0.997)Joint erosions1.19(1.07;1.32)Current smoking0.86(0.76;0.98)Former smoking0.92(0.82;1.04)Fibromyalgia0.56(0.35;0.90)Depression0.75(0.59;0.95)

Conclusion:

Treatment with IL-6 inhibitors significantly increases the chance of reaching low fatigue levels within half a year in RA patients, while current smoking reduces it.

References:

[1]Choy E.H.S. and Calabrese L. H Rheumatology 2018;57:1885-95.

Acknowledgments:

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Fresenius Kabi, Hexal, Lilly, MSD, Mylan, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, and UCB.

Disclosure of Interests:

Martin Schaefer: None declared, Peter Herzer Speakers bureau: AbbVie, Novartis, Sanofi, Janssen, Cornelia Kühne Grant/research support from: Novartis, Amgen, Roche/Chugai, Pfizer, Celgene, AbbVie, Sanofi, Herbert Kellner Grant/research support from: Biogen, Consultant of: Biogen, Speakers bureau: Biogen, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis

Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany

BACKGROUND

The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the 'real-life' situation of health care for patients with AD.

OBJECTIVES

Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients.

METHODS

Patients (≥18 years) with moderate-to-severe AD [objective (o)SCORAD > 20], or with current or previous anti-inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0-72), the oSCORAD (0-83) and the Investigator Global Assessment (IGA; 6-point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six-step Likert scale]. Disease symptoms were assessed by the patient-oriented eczema measure (POEM, 0-28) and numeric rating scales (NRS, 0-10). Health-related quality of life was measured using the dermatological life quality index (DLQI, 0-30).

RESULTS

A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either 'current' (12.1%) or 'prescribed' (31.4%) at baseline.

CONCLUSIONS

These 'real-life' data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate-to-severe AD.

SAT0437 GENDER DIFFERENCES IN PsA OUTCOME PARAMETERS AND THEIR CORRELATION WITH SKIN INVOLVEMENT: A CROSS-SECTIONAL ANALYSIS OF RABBIT-SpA PAtients

Background:

PsA is a complex disease characterised by a heterogeneous pattern including different clinical symptoms of musculoskeletal (MSK) inflammation like arthritis, enthesitis, dactylitis and axial involvement as well as skin and nail involvement. There are differences in these disease patterns between female and male patients which need to be taken into account.

Objectives:

To assess the differences between female and male PsA patients in the extent of psoriatic skin (body surface area, BSA) and joint (tender joint count 68, TJC68; swollen joint count 66, SJC66;) disease, composite scores (disease activity in PsA, DAPSA; disease activity score 28, DAS28), and patient-reported outcomes (PROs) and to correlate the extent of skin disease with PROs.

Methods:

RABBIT-SpA is a prospective longitudinal cohort study including PsA patients enrolled at start of a new csDMARD, bDMARD or tsDMARD. Gender specific differences in outcome parameters are compared using Wilcoxon resp. t-test at baseline visit. Spearman correlation coefficient was calculated to analyse the relationship between BSA and outcome parameters.

Results:

722 PsA patients were included in this analysis. Women were slightly older (52 vs 50 yrs), had longer disease duration (7 vs 5.8 yrs), more comorbidities and were more often obese. Men had a significantly higher skin involvement than women measured by BSA and physician skin assessment (physSk, table 1). Women had significantly higher joint involvement as measured by TJC68, DAPSA, DAS28, and patient muskuloskeletal assessment (patMSK). Impact of disease as measured by PSAID and patient global assessment (patGA) was more severe in women than in men and also physical function (HAQ) was lower in women than in men (table 1). Despite the higher skin involvement in men, the DLQI was equally high in women and men with more than 50% of patients in reduced quality of life state (table 1).

Table 1.ParameterFemaleN=424MaleN=298SJC663.4 (5)2.7 (3.8)TJC687.9 (8.7)5.7 (7)BSA (0-100)6.6 (13)10.8 (16.5)physGA (NRS 0-10)5.3 (1.9)5.2 (2)physSk (NRS 0-10)3.1 (2.7)3.7 (2.6)physMSK (NRS 0-10)5.2 (2.1)4.9 (2.3)DAPSA24.2 (13.8)20.1 (12.3)DAS28-CRP3.7 (1.2)3.4 (1.2)patGA (NRS 0-10)5.5 (2.1)4.9 (2)patSk (NRS 0-10)3.9 (3.1)3.9 (2.8)patMSK (NRS 0-10)5.8 (2.2)5 (2.5)DLQI (0-30)6.1 (6.8)5.3 (5.7)HAQ (0-3)1.1 (0.6)0.7 (0.6)PSAID (0-10)4.8 (2.3)3.9 (2.2)

Results are presented as mean ± SD.

BSA was not correlated with SJC66 or TJC68, DAPSA, DAS28, phys MSK, patGA and patMSK neither in men nor in women. BSA was however positive correlated with DLQI, patSk, and physSK and slightly with physGA in both genders. The PSAID is correlated to BSA in women only.

Conclusion:

Women and men show differences regarding many PsA criteria. Men have a more severe skin involvement, while women have higher burden of joint involvement. In addition in the patient reported parameters women show significantly higher values than men except for the skin specific parameters. Notably, although skin involvement is not correlated with most PsA activity parameters, around 50% of patients in specialised rheumatologic care are negatively affected in their quality of life by psoriatic skin disease. Therapeutic decisions need to take into account the complexity of the patients’ symptoms as well as gender differences.

Acknowledgments:

RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Janssen-Cilag, Lilly, MSD, Mylan, Novartis, Pfizer, and UCB.

Disclosure of Interests:

Anne Regierer Speakers bureau: Novartis, Celgene, Janssen-Cilag, Anja Weiß: None declared, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, Martin Feuchtenberger Consultant of: Abbvie, BMS, Chugai, Sanofi, Speakers bureau: Abbvie, BMS, Celgene, Chugai, Jansen-Cilag, Lilly, Pfizer, Roche, Sanofi, UCB, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, 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, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis

OP0238 RISK OF HERPES ZOSTER IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER BIOLOGICAL, TARGETED SYNTHETIC, AND CONVENTIONAL SYNTHETIC DMARD TREATMENT

Background:

The risk of herpes zoster (HZ) is higher in patients with rheumatoid arthritis (RA) than in the general population. This risk is further increased with biologic disease-modifying anti-rheumatic drugs (bDMARDs) such as tumour necrosis factor inhibitors (TNFi) and targeted synthetic (ts)DMARDs such as Janus kinase inhibitors (JAKi) compared to patients taking conventional synthetic (cs)DMARDs such as methotrexate (MTX).

Objectives:

To compare incidence rates of HZ in RA patients under treatment with bDMARDs, tsDMARDs and csDMARDs with different modes of action and to find potential risk factors.

Methods:

Data of patients enrolled in the German biologics register RABBIT from 2007 onwards with the start of a bDMARD, tsDMARD or a change in csDMARD treatment were analysed. Patients were included when at least one follow-up documentation was available. All HZ events reported until 30 April 2019 were identified and assigned to treatments administered within the 3 month period prior to the HZ event. Crude incidence rates (IR) of HZ were calculated per 1,000 patient years (py). Cox regression was applied to investigate risk factors for the occurrence of HZ with and without inverse probability weights (IPW) to adjust for confounding by indication.

Results:

Data of 12,470 patients (53,218 py of observation) were included in the analysis. A total of 452 HZ cases in 433 patients were reported, of which 52 events were serious. The crude IRs per 1,000 py are illustrated by Figure. Adjusted for age, sex, and glucocorticoid use, a significantly increased risk was observed for treatment with monoclonal TNF antibodies (hazard ratio [HR], 1.55 [95% CI, 1.21-2.00]), B-cell targeted therapies (HR, 1.45 [95% CI, 1.07-1.97]), and tsDMARDs (HR, 3.55 [95% CI, 2.33-5.41]). Treatment with soluble TNF receptors, T-cell co-stimulation modulator, and IL-6 inhibitors were not significantly associated (Table). Adjustment with IPW amplified the effect and treatment with T-cell co-stimulation modulator and IL-6 inhibitors were also significantly associated with a higher risk compared to csDMARD treatment (Table).

Conclusion:

This is the first analysis in a European prospective cohort study comparing the incidence rates and risk of HZ in RA patients under treatment with six different modes of action within one cohort to csDMARD treatment. We found a significant association between HZ and treatment with JAKi. Our results also confirm a higher risk for monoclonal TNF antibodies and show a similar result for the T-cell co-stimulation modulator and B-cell targeted therapies. This study clearly supports systematic HZ vaccination of RA patients.

Table.

Acknowledgments:

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Fresenius Kabi, Hexal, Lilly, MSD, Mylan, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis and UCB

Disclosure of Interests:

Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Imke Redeker: None declared, Jörn Kekow Speakers bureau: BMS, MSD, Pfizer, Roche, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB

[Medical apps-possibilities for pruritus]

BACKGROUND

Apps have become part of our daily lives. Apps for pruritus could also play a role in the management of symptoms.

AIM

The aim of this article is to review existing apps for pruritus. In addition, we will discuss whether these apps have been validated and how and which offers might still be lacking.

MATERIALS AND METHODS

The two largest app stores as well as PubMed and Google were searched for apps regarding pruritus. Relevant medical apps were documented and categorized with respect to their functions. PubMed was searched to identify validation studies.

RESULTS

In total 21 apps for pruritus were identified. Of those 12 explicitly focused on pruritus, while 8 included pruritus as a symptom of an underlying disease (especially eczema and urticaria). The following app categories were derived: medical history of chronic pruritus, assessment of pruritus in clinical trials, assessment of nocturnal pruritus, information about pruritus, and diseases with pruritus as a symptom. Three of the apps with explicit focus on pruritus have been scientifically validated.

DISCUSSION

There are different apps for pruritus available. Most apps which explicitly focus on pruritus are aimed at physicians and scientists, while apps for diseases with pruritus as a symptom are more patient-centered. Due to technological advances, apps and wearables could improve management of pruritus in the future.

Happiness in dermatology: a holistic evaluation of the mental burden of skin diseases

BACKGROUND

According to the World Health Organization, mental health is a state of well-being and not merely the absence of disease. However, studies exploring subjective well-being in patients with skin diseases are very rare.

OBJECTIVES

To assess subjective well-being, i.e. 'happiness', in patients with different skin diseases and to compare them to other patient groups and healthy controls.

METHODS

A cross-sectional study was conducted from 12/2017 to 04/2019. Patients receiving in- or outpatient care for psoriasis, atopic eczema, nummular eczema, mastocytosis, skin cancer (malignant melanoma and keratinocyte carcinoma), human immunodeficiency virus (HIV) or chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis) were recruited at two hospitals in Bavaria, Germany. Healthy individuals living in or near Munich served as a control group. All participants filled in a questionnaire assessing happiness, measured as positive affect (PA), negative affect and satisfaction with life (SWL; together representing subjective well-being) and a heuristic evaluation of one's own happiness.

RESULTS

Data from 229 dermatologic patients (53.3 ± 18.5 years, 48% women), 49 patients with inflammatory bowel diseases (48.9 ± 18.7 years, 43% women), 49 patients with HIV (46 ± 10.1 years, 10% women) and 106 healthy controls (38.4 ± 13.4 years, 49% women) were analysed. Compared to the controls, dermatologic patients reported lower heuristic happiness (P = 0.023) and PA (P = 0.001) but higher SWL (P = 0.043). Patients with psoriasis and atopic eczema reported the lowest happiness, as they reported significantly lower PA (P = 0.032 and P < 0.001) and heuristic happiness (P = 0.002 and P = 0.015) than the control group. Patients with skin cancer reported higher SWL than the control group (P = 0.003). Dermatologic patients reported lower happiness than patients with HIV but reported greater happiness than patients with IBD.

CONCLUSIONS

Dermatologic patients experience lower levels of happiness, especially PA, compared to healthy controls. As PA is linked to desirable health outcomes, targeting PA could be a promising holistic approach for the treatment of skin diseases.

[Health care and disease burden in persons with axial spondyloarthritis in Germany]

BACKGROUND

Only very few data are available on the comprehensive care in patients with axial spondylarthritis (axSpA), one of the most frequent inflammatory rheumatic disease.

OBJECTIVE

Description of the comprehensive care and common prescription patterns of medications and other therapies in patients with axSpA depending on the type of medical care by rheumatologists or nonrheumatologists.

METHODS

A cross-sectional analysis was performed based on claims data of the BARMER health insurance company (in 2015) and a questionnaire, which was sent to a representative sample of patients with axSpA (International Classification of Diseases, 10th revision, German modification, ICD-10-GM, code M45) aged 18-79 years. A stratified sample of 5000 patients was used. The patients received a postal questionnaire including questions regarding the disease, health-related and psychological parameters and socioeconomic factors. Claims data consisted of demographic factors, medicinal and nonmedicinal treatment and the extra-articular manifestations inflammatory bowel disease, psoriasis and uveitis.

RESULTS

A total of 1741 patients (mean age 55.9 years, female 46.4%, 86.2% Human Leucocyte Antigen[HLA]-B27 positive) confirmed the diagnosis and answered the questionnaire. The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.5 and the mean Bath Ankylosing Spondylitis Functional Index (BASFI) 4.1. Of the patients 46% were treated by rheumatologists. There was a substantial difference between patients in rheumatological care and those who were not in rheumatological care regarding prescriptions for drug treatment of axSpA (91.8% versus 66.4%). This difference was especially prominent for prescriptions of biologic disease-modifying antirheumatic drugs: 34.1% of patients in rheumatological care versus 3.1% of patients treated by nonrheumatologists (p < 0.0001), despite similar disease activity in both groups.

CONCLUSION

The data show that the majority of patients diagnosed with axSpA did not receive regular care from rheumatologists. This seemed to be associated with insufficient medicinal care at least in some of these patients.

Influence of antiretroviral therapy and cardiovascular disease on the immature platelet fraction in patients living with HIV

Cardiovascular disease is an important contributor to morbidity and mortality in people living with HIV . The immature platelet fraction (IPF) is increased in HIV-negative patients with cardiovascular disease and evidence suggests that an enlarged IPF is associated with adverse cardiovascular events. In this multi-center observational study, we aimed to investigate how the IPF in people living with HIV is influenced by antiretroviral therapy and cardiovascular disease. Subjects without cardiovascular disease that received antiretroviral therapy showed a smaller IPF accompanied by lower D-dimer and C-reactive protein (CRP) levels compared to therapy-naïve subjects (mean IPF: 2.9% vs. 3.9%, p = .016; median D-dimer: 252 µg/L vs. 623 µg/L, p < .001; median CRP: 0.2 mg/dL vs. 0.5 mg/dL, p = .004). No significant differences for the IPF, D-dimer or CRP were found between subjects on antiretroviral therapy with documented cardiovascular disease and therapy-naïve subjects. In conclusion, we observed a reduction in the IPF among subjects on therapy only in the absence of cardiovascular disease. In contrast, subjects receiving therapy that had documented cardiovascular disease showed an IPF comparable to therapy-naïve subjects. Future studies are needed to investigate if an enlarged IPF may serve as a biomarker in predicting adverse cardiovascular events in people living with HIV.

[Outpatient care and disease burden of rheumatoid arthritis : Results of a linkage of claims data and a survey of insured persons]

BACKGROUND

Healthcare of patients with rheumatoid arthritis (RA) in Germany has mainly been evaluated in the past in RA cohorts from specialized arthritis centers. This study investigated rheumatological care on a population basis, using claims data from a nationwide statutory health insurance fund (BARMER GEK) in combination with patient-reported outcomes from a questionnaire survey of insured persons with RA.

METHODS

Data from insurants aged 18-79 years with M05 (seropositive RA) or M06 (other RA, ICD-10) diagnoses were analyzed concerning diagnostics, medication and prescribing physician. A 31-item questionnaire covering patient reported diagnosis, healthcare utilization and burden of illness was sent to a stratified random sample of 6193 insured persons. Data from the respondents regarding rheumatological care and disease status were evaluated.

RESULTS

In 2013 and 2014, a total of 96,921 adults with M05 or M06 diagnosis were insured. The questionnaire was answered by 51% of the sample and of these 81% confirmed the RA diagnosis. RA had been diagnosed by a rheumatologist in 59% of the cases, 70% reported moderate to severe pain and 46% had functional disability. Between at least 40% (claims data) and up to 68% (respondents) were in specialized rheumatological care. Treatment with disease-modifying antirheumatic drugs (DMARDs) was 61% (claims data) and 63% (respondents) in persons in rheumatological care but only 18% outside rheumatological care.

CONCLUSION

The results indicate that specialized rheumatological care is required to provide adequate treatment for patients with RA in Germany. Patients with higher age and patients with M06 diagnosis had less drug prescriptions and were less frequently treated by rheumatologists.

Granulomatöse Dermatitis bei einem 5 Monate alten Mädchen mit Omenn-Syndrom (atypisches SCID)

In der Dermatologie sehen wir auch pädiatrische Patienten mit Syndromen im Rahmen hereditärer schwerer Immundefekte. Die unverzügliche Diagnosestellung und Überweisung in spezialisierte Zentren ist entscheidend für die Prognose. Wir beschreiben ein bei Diagnosestellung 5 Monate altes Mädchen mit Omenn-Syndrom bei atypischem schwerem kombinierten Immundefekt (SCID). Klinisch führend waren eine Dermatitis, eine chronische, antibiotikaresistente Atemwegsinfektion und eine chronisch entzündliche Darmerkrankung. Laborchemisch bestand in der Routinediagnostik eine milde Lymphozytopenie mit Eosinophilie und erhöhtem Serum-IgE. Nach Anbindung an das nationale Versorgungsprojekt Translate-NAMSE wurde in der immunologischen Spezialdiagnostik ein atypischer Tlow Blow NK + SCID, verursacht durch eine hypomorphe homozygote IL7RA-Mutation, diagnostiziert und eine kurative haploidente allogene hämatopoietische Stammzelltransplantation eingeleitet.

Translating the WHA resolution in a member state: towards a German programme on 'Destigmatization' for individuals with visible chronic skin diseases

BACKGROUND

Even today, a substantial number of individuals with visible skin diseases still suffer from incomprehension and stigmatization. About 10 million people are affected by such diseases in Germany. The WHO strongly urges member states to take measures against stigmatization in skin diseases.

OBJECTIVES

Objectives are the development of an action programme to raise awareness and address stigmatization. Therefore, conception, development and testing of interventions for the destigmatization of persons with skin diseases in Germany will be carried out.

METHODS

A series of actions addressing decision makers, politicians and the Federal Ministry of Health were initiated, all based on the World Health Assembly (WHA). Argumentation was largely based on data from health services research. Supported by the Federal Ministry of Health, a concept against stigmatization was developed by an expert consortium of researchers, dermatologists and patients. Specific strategies of structured destigmatization between those affected and those not will be developed and scientifically evaluated.

RESULTS

The activities addressed to politics were - to a large extent - successfully and financially supported by a 3-year programme (2018-2020), designed to develop interventions against stigma. It was funded by the Federal Ministry of Health. The project includes conception and development, intervention and evaluation, data analyses and development of a long-term concept.

CONCLUSIONS

The WHO's call against stigmatization in psoriasis (resolution WHA67.9 and global report on psoriasis 2016) was taken into account and developed into a destigmatization programme supported by the German government and German politicians. This has been achieved by successful collaborations between dermatologists, researchers, patients and policymakers. Next step will be the testing of interventions in situations and surroundings, where stigmatization usually occurs. The data will be used for the implementation of a long-term concept that can be used to continue destigmatization in Germany far beyond the project's initial phase.

Atopic eczema: burden of disease and individual suffering - results from a large EU study in adults

BACKGROUND

Atopic eczema (AE, atopic dermatitis) is one of the most common non-communicable inflammatory skin diseases affecting 1-5% of the adult population in Europe with marked impairment in quality of life. In spite of great progress in understanding the pathophysiology of disturbed skin barrier and immune deviation, AE still represents a problem in daily clinical practice. Furthermore, the true impact of AE on individual suffering is often not recognized.

OBJECTIVES

With a large European study, we wanted to provide insights into the actual suffering and individual burden of disease in adult patients with AE.

METHODS

A total of 1189 adult patients (18-87 years, 56% female) with moderate to severe AE were recruited in nine European countries by dermatologists or allergists together with the help of patient organizations. A computer-assisted telephone interview was performed by experienced interviewers between October 2017 and March 2018. The following instruments were used to assess severity or measure quality of life: Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS-D) and a newly developed Atopic Eczema Score of Emotional Consequences (AESEC). Patients were also asked to self-assess the severity of their disease.

RESULTS

Despite current treatment, 45% of participants still had actual moderate to very severe AE in POEM. Due to their skin disease, 57% missed at least 1 day of work in the preceding year. DLQI showed moderate to extremely large impairment in 55%. According to HADS-D, 10% scored on or above the threshold of eight points with signs of depressive symptoms. Assessed with AESEC, 57% were emotionally burdened with feelings such as 'trying to hide the eczema', 'feeling guilty about eczema', having 'problems with intimacy' and more. Of persons actually suffering from severe AE, 88% stated that their AE at least partly compromised their ability to face life.

CONCLUSIONS

This real-life study shows that adults with a moderate to severe form of AE are suffering more than what would be deemed acceptable. There is a need for increased awareness of this problem among healthcare professionals, policymakers and the general public to support research in the development of new and more effective treatments and provide access to better and affordable health care for affected patients.

50 Jahre Universitäts-Hautklinik am Biederstein in München

Die Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein der Technischen Universität München (TUM) wurde 1969 in Betrieb genommen und feiert daher im Jahr 2019 ihr 50-jähriges Bestehen. Die Ursprünge dieser Klink gehen aber wie an vielen Orten auf ältere Versorgungsstrukturen zurück. Anlässlich des 50-jährigen Bestehens soll dieser Artikel die Entwicklung und aktuelle Ausrichtung der Klinik illustrieren und dabei auch die Wertschätzung für unsere Vorgänger ausdrücken, die sich auf den verschiedenen Positionen für unsere Patienten eingesetzt und so die Basis für eine erfolgreiche Klinik in Krankenversorgung, Forschung und Lehre geschaffen haben. Die Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein gehört zum Universitätsklinikum, dem Klinikum rechts der Isar, der Technischen Universität München (TUM), sie selbst liegt jedoch links der Isar, im schönen Schwabing unweit des Englischen Gartens. Sie ist eine von 3 Hautkliniken in München, die im Rahmen der Münchner Dermatologischen Gesellschaft (MDG e. V.) regelmäßig Fortbildungen ausrichten. Die MDG am Biederstein wird sich im Jahr 2019 neben der Fortbildung auch dem Jubiläum dieser Klinik widmen.

Die Klinik als universitäre Einrichtung umfasst den Bereich medizinische Versorgung mit 74 Betten auf 4 Stationen, einen ambulanten Bereich mit einer großen Poliklinik für Allgemein- und Privatpatienten (jährlich mehr als 60 000 Patientenbesuche), den Bereich Forschung mit verschiedenen Forschungsgruppen und großen Laboratorien sowie den Bereich Lehre, Weiter- und Fortbildung. Ein Schwerpunkt in der klinischen Versorgung und in der Forschung war bereits zur Zeit der Gründung der Klinik 1969 die Allergologie. Weiterhin bestehen Schwerpunkte im Bereich der entzündlichen Hauterkrankungen, der Dermatoonkologie, der Dermatoinfektiologie, der Dermatochirurgie und der Wundversorgung. Die Klinik hat das Comprehensive Allergy Center der Technischen Universität München (ACTUM) und EU-Exzellenz-Zentrum für Allergie auf den Weg gebracht und ist Teil der Krebszentren Comprehensive Cancer Center München der Technischen Universität München (CCC MünchenTUM) und des Comprehensive Cancer Center München (CCCM). Pro Semester werden etwa 450 Studenten im Rahmen von Vorlesungen, Seminaren und Praktika betreut. Neben Kongressen wie der Jahrestagung der Arbeitsgemeinschaft Dermatologische Forschung (ADF) im Jahr 2019 oder der European Society for Dermatological Research (ESDR) im Jahre 2016 richten die Klinik und der Lehrstuhl regelmäßige Fortbildungsveranstaltungen im Rahmen des Biedersteiner Symposiums, des Biedersteiner Kolloquiums und der MDG aus.

Alopecia syphilitica diffusa − eine seltene Manifestationsform der Frühsyphilis

Die Syphilis wird als das Chamäleon der Medizin bezeichnet, da sie viele Organe befallen und insbesondere an der Haut viele Erkrankungen imitieren kann. Weniger bekannt sind die durch die Syphilis bedingten Formen des Haarausfalls. Dabei ist die diffuse Form der syphilitischen Alopezie besonders selten und kann leicht übersehen werden.

Hier berichten wir über einen jungen, HIV-positiven Mann mit der klinischen Präsentationsform einer Alopecia syphilitica diffusa. Nach erfolgreicher Therapie mit 2,4 Millionen Einheiten Benzylpenicillin i. m. zeigte sich innerhalb weniger Monate eine vollständige Normalisierung des Haarwuchses. Die Alopecia syphilitica präsentiert sich klinisch typischerweise als diffuser Haarverlust, als umschriebener Haarausfall mit fleckig imponierendem, sog. Mottenfraßmuster oder durch eine Kombination von beidem. Dabei kann die syphilitische Alopezie das einzige klinische Symptom einer Syphilisinfektion sein und sowohl klinisch als auch in der Histopathologie eine Alopecia areata imitieren. Die Dermatoskopie oder der immunhistochemische Nachweis von Treponema pallidum im Haarfollikel können weitere hilfreiche Methoden zur Diagnostik des syphilitischen Haarausfalls sein, entscheidend ist jedoch die serologische Diagnostik.

Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019

Worldwide 2-3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun-related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer-related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between 1 January 2012 and 31 December 2018. We identified 51 relevant cross-sectional studies and 22 interventional studies. Sun-related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun protection programmes using new technologies seem to have great potential to increase sun-related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by healthcare institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

BACKGROUND

Incidence of anal carcinoma is increased in people living with HIV (PLWH). Due to the improved life expectancy in PLWH, identifying appropriate prevention strategies for non-AIDS-defining cancer types such as anal carcinoma has become a priority in managing PLWH today.

OBJECTIVE

We aimed to evaluate anal cytology assessment as screening tool for anal dysplasia and/or carcinoma in PLWH, regardless of gender or sexual orientation. Additionally, we investigated the correlation between cancer risk factors and abnormal screening results in our patient cohort.

METHODS

People living with HIV from the Interdisciplinary HIV Centre of the University Hospital rechts der Isar in Munich, Germany (IZAR), were screened for anal carcinoma by single cytobrush examination and anal Papanicolaou (PAP) smear assessment from 2013 to 2015. Patients with abnormal PAP smear result were offered a follow-up examination after 12 months. Differences between two groups were tested for statistical significance using Student's t-test and Mann-Whitney U-test, as appropriate.

RESULTS

In total, 101 PLWH were included. 26.7% of subjects (n = 27) were PAP IIID, and 9.9% (n = 10) were PAP IVa. Seven female subjects had an abnormal finding at screening. Smoking was significantly associated with abnormal findings at screening (P = 0.005). In addition, our study found an association between sexually transmitted infections (STI) and anal dysplasia. Condylomata acuminata were increased in subjects with PAP IIID/PAP IVa (P = 0.045). Reactive syphilis serology was found to be significantly associated with abnormal screening results (P = 0.016), respectively.

CONCLUSION

Our results demonstrate that smoking and two common STIs, condylomata acuminata and syphilis, are risk factors associated with advanced anal intraepithelial neoplasia (AIN) stages in our PLWH cohort. While further analysis is needed to determine diagnostic guidelines concerning AIN in PLWH, these results suggest that interdisciplinary lifestyle prevention strategies are required to reduce the risk factors for AIN in PLWH in an outpatient setting.

'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer

BACKGROUND

Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks.

OBJECTIVES

To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs.

METHODS

Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis.

RESULTS

Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest.

CONCLUSIONS

Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.