Comparison of the SLE Risk Probability Index (SLERPI) scale against the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria

INTRODUCTION

Timely diagnosis and proper recognition of Systemic Lupus Erythematosus (SLE) is essential to establish early management in inpatients and outpatients. There are different classification scales to identify SLE, which include various clinical and serological aspects. In 2021, the SLE Risk Probability Index (SLERPI) was published, which focuses predominantly on the clinical characteristics of patients with suspected SLE and uses a simple algorithm for early recognition of the disease. The aim of this study is to compare the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) classification criteria, the Systemic Lupus International Collaborating Clinics (SLICC) criteria, and the SLERPI criteria in a cohort of Colombian patients with SLE and to analyze the correlations observed between their absolute scores.

METHODS

A registry of SLE patients from two referral hospitals in Bogotá, Colombia, was used. 2021 SLERPI, 2019 ACR/EULAR, and 2012 SLICC scores were calculated for each patient and the correlations found between the scales were analyzed. The sensitivities of each were compared, and frequency analyses were conducted among different clinical and laboratory variables.

RESULTS

Between 2016 and 2019, 146 patients diagnosed with SLE were registered, including inpatients and outpatients. The median age was 36 years (interquartile range 26-51), and 82.2% were women. According to the SLERPI criteria, a high prevalence of antinuclear antibodies (92%), immunological disorders (71%), and arthritis (64%) were observed. The most used treatments were corticosteroids (87.6%) and chloroquine (67.8%). A Spearman evaluation analysis was performed, with a moderately strong correlation of 0.76 (p = .000) between the SLERPI and ACR/EULAR scales and very strong correlation of 0.80 (p = .000) between the SLERPI and SLICC. Patients classified with SLE according to the SLERPI scale exhibited a higher incidence of hematological compromise, along with elevated levels of serological markers such as anti-DNA antibodies. Additionally, this group more commonly received treatments involving corticosteroids and azathioprine, and displayed a higher prevalence of hypertension.

CONCLUSION

The SLERPI scale could be useful in the diagnosis of SLE, especially in early stages, given its good correlation with other classification scales and its good sensitivity.

Usefulness of Lung Ultrasound as a Method for Early Diagnosis of Interstitial Lung Disease in Patients with Rheumatoid Arthritis

Purpose

To determine the value of lung ultrasound (LUS) compared to high-resolution computed tomography (HRCT) in the early diagnosis of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA).

Patients and Methods

An observational prospective study was performed. Were included patients with respiratory symptoms or/and, patients with crackles in auscultation during medical consultation. All patients underwent to chest X-rays, LUS, HRCT,and respiratory function tests.

Results

A total of 192 patients with RA were included. Mean disease duration was 16.8 ± 11.1 years. 72% were positive for rheumatoid factor or anti-citrullinated antibodies. Of the total number of subjects, 54.7% had respiratory symptoms. The other patients did not have respiratory symptoms, but they did have had crackles on pulmonary auscultation. B lines > 11.5 on the ROC curve predicted ILD (AUC 0.63; CI 95%: 0.55-0.71; p < 0.003). A DLCO value of <7.13 significantly predicted the presence of ILD (AUC 0.61; 95% CI: 0.52-0.70; p < 0.028).

Conclusion

The findings of this study suggest that LUS is a valuable tool for the early diagnosis of ILD in patients with RA, and together with DLCO, can adequately predict the presence of ILD in this population. LUS also helps to determine which patients with respiratory symptoms and signs suggestive for ILD are undergo to HRCT.

Operational characteristics of ultrasound in the diagnosis of Sjögren's syndrome

BACKGROUND AND OBJECTIVE

To determine the operational characteristics of salivary gland ultrasound (SGU) in the diagnosis of Sjögren's syndrome (SS) in a population of colombian patients with dry symptoms.

MATERIALS AND METHODS

Study of diagnostic tests in patients with dry symptoms who consecutively attended the rheumatology consultation (2018-2020). Sociodemographic and clinical data were obtained through a survey, paraclinical and ophthalmological tests, minor salivary gland biopsy, unstimulated salivary flow and SGU (score 0-6 based on De Vita) were done. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (Stata 15®) were calculated. The receiver operating characteristics (ROC) curve was developed.

RESULTS

102 patients were included (34 SS and 68 non-SS), mean age 55.69 (±11.93) years, 94% women. Positive ultrasound (score of 2 or more) was more frequent in the SS group, (70.6% vs. 22.1%, P<0.0001). The sensitivity was the same for grade 2 and 3 (70.59%), with a higher specificity (89.71%) for grade 3 (PPV 77.42% NPV 85.92). The ROC curve from the sum of the glands by means of ultrasound was better than those of the independent glands. The ROC curve of the ultrasound presented a greater area under the curve (0.72 [0.61-0.82]) than that of the histological analysis (focus score) (0.68 [0.59-0.78]), P=0.0252.

CONCLUSION

Salivary gland ultrasound is a useful and reliable method for the classification of SS. Its use could be considered in the future within the SS classification criteria.

Burden of Other Musculoskeletal Disorders in Latin America and the Caribbean: Findings of Global Burden of Disease Study 2019

OBJECTIVE

To describe the results from the Global Burden Disease (GBD) study 2019 on the burden of other musculoskeletal (MSK) disorders in Latin America and the Caribbean (LAC).

METHODS

In this cross-sectional study, we analyzed data from all LAC region in the GBD study from 1990 to 2019. Other MSK (other than rheumatoid arthritis, osteoarthritis, gout, low back pain, and neck pain) burden was measured as prevalence, mortality, years lived with disability (YLD), and disability-adjusted life (DALY), by year, sex, and country. We show the counts, rates, and 95% uncertainty intervals (95% UI). Joinpoint regression analysis was used to estimate the average annual percentage change (AAPC) from 1990 to 2019. A correlational analysis between the burden parameters and sociodemographic index (SDI) was performed.

RESULTS

In 2019, there were 52.0 million (95% UI, 44.8-60.1 million) individuals with other MSK disorders in LAC. The age-standardized mortality rate in 2019 was 1.2 (95% UI, 0.8-1.6) per 100,000 inhabitants. The AAPC was estimated as 0.1% (95% confidence interval [CI], 0.1-0.2) and 0.2% (95% CI, 0.1-0.3) for prevalence and mortality rates, respectively. The age-standardized DALY rate was 685.4 (95% UI, 483.6-483.6) per 100,000 inhabitants, representing an AAPC of 0.2% (95% CI, 0.1-0.3). The burden was larger in women and the elderly. The SDI was positively correlated with the prevalence of YLD in 2019.

CONCLUSIONS

LAC region has experienced a significant burden of other MSK disorders over the last three decades. To challenge this growing burden, population-based strategies designed to reduce the burden of other MSK and strengthen health systems to contribute effective and cost-efficient care are necessary.

Polyautoimmunity in systemic lupus erythematosus patients: New insights from a cross-sectional study

Objective

To assess the frequency of polyautoimmunity (PolyA) in a cohort of Colombian patients with systemic lupus erythematosus (SLE) and to identify associated factors.

Methods

This is an analytical cross-sectional study in a specialized center., a comprehensive review of the medical records of SLE patients was performed from 2015 to 2020 in order to obtain demographic, clinical data, laboratory, and treatment information. Associations between PolyA, demographic, and characteristics of the disease were explored.

Results

A total of 463 patients were included in the analysis. The average age was 47.3 ± 15 years. Most of this population were female (87.4%), whom were diagnosed with SLE in a long-term SLE (10.6 ± 10.1 years). Out of the total patients, 34.7% were diagnosed with PolyA. Among the most frequent clinical criteria for SLICC, arthritis (65%), kidney impairment (39.5%), and alopecia (34.8%) were found. The most frequent SLE-associated PolyA were antiphospholipid syndrome (APS) and Sjögren's syndrome (SS) (16.63% and 10.58%, respectively). PolyA-associated factors were age, xerophthalmia, central nervous system occlusion, and deep vein thrombosis (DVT). In contrast, renal impairment was significantly less frequent in PolyA patients after multivariate analysis.

Conclusion

The results have showed associated factors with PolyA like age, xerophthalmia, central nervous system occlusion, and deep vein thrombosis in this cohort. On the other hand, lupus nephritis was less frequent in patients with PolyA. This study provides a spotlight of a specific SLE population as real-life evidence for a better characterization of PolyA in the future.

Adherence to Subcutaneous Anti-Tumour Necrosis Factor Treatment in a Cohort of Patients with Rheumatoid Arthritis Before and After the Implementation of a Comprehensive Care Model

PURPOSE

To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM).

PATIENTS AND METHODS

An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar's Chi² test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure.

RESULTS

A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found.

CONCLUSION

A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.

Metabolic Abnormalities, Cardiovascular Disease, and Metabolic Syndrome in Adult Rheumatoid Arthritis Patients: Current Perspectives and Clinical Implications

AIM

Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multiple metabolic abnormalities that generate a higher disease burden.

OBJECTIVE

To gather the available evidence on the epidemiology, pathophysiology, current perspectives, clinical implications and prognosis of metabolic abnormalities in patients with rheumatoid arthritis.

METHODS

This is a narrative literature review. Search was conducted in PubMed, OVID, and Taylor & Francis databases, using the following MeSH terms: "Arthritis Rheumatoid", "Metabolic Diseases", and "Metabolic Syndrome".

RESULTS

This study describes the main metabolic manifestations of rheumatoid arthritis. Research has recognized that rheumatoid arthritis and metabolic abnormalities share pathophysiological mechanisms with an additive effect that increases cardiovascular risk. In that context, appropriate antirheumatic treatment can also impact on cardiovascular risk.

CONCLUSION

There are metabolic abnormalities in rheumatoid arthritis patients that increase cardiovascular risk. Therefore, it is crucial to evaluate cardiovascular risk to provide appropriate comprehensive management to reduce morbidity and mortality in patients with this disease.

Better Clinical Results in Rheumatoid Arthritis Patients Treated Under a Multidisciplinary Care Model When Compared with a National Rheumatoid Arthritis Registry

Purpose

To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management.

Patients and Methods

We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the “Treat-to-Target” strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care.

Results

We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4–6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center.

Conclusion

The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.

Efficacy and safety of intravenous immunoglobulin in patients with lupus nephritis: A systematic review of the literature

INTRODUCTION AND OBJECTIVE

Intravenous immunoglobulin (IVIg) is an anti-inflammatory drug with an unclear role in the treatment of patients with lupus nephritis (LN). This systematic review evaluates the evidence for IVIg in the care of patients with LN.

METHODOLOGY

A systematic search was done in the PubMed, EMBASE, BVS and OVID databases - All EBM Reviews following the PRISMA methodology (registration in PROSPERO CRD42021236662). The variables were extracted: indications for use, dosage, partial or complete response, adverse reactions, initiation of renal replacement therapy, reduction of proteinuria, and mortality. The quality assessment was done with the "The Joanna Briggs Institute (JBI) Critical Appraisal tools for use in Systematic Reviews Checklist". In addition, synthesis reports were prepared through the Synthesis Without Meta-analysis - SWiM guide.

RESULTS

A total of 2328 articles were obtained (28 were considered for inclusion). When the studies were evaluated, IVIg therapy was found to be between 60% to 70% effective (except for patients with class V LN) with overall responses (complete + partial) even for patients who are refractory to first line treatment. Normalization (<0.5 g) of nephrotic proteinuria occurred in 24% of cases with infrequent adverse events and a mortality plus dialysis composite of 11.5% and 24.1% (most representative study).

CONCLUSION

In patients with LN refractory to conventional treatment or co-infection situations, the reported data seem to demonstrate effectiveness of IVIg therapy. There are few adverse reactions and caution is exercised when using it on patients with class V NL. However, given the lack of controlled studies with long-term follow-up, these data should be interpreted cautiously thus encouraging the development of high-quality RCTs.

Vascular Age, Metabolic Panel, Cardiovascular Risk and Inflammaging in Patients With Rheumatoid Arthritis Compared With Patients With Osteoarthritis

Introduction

The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level. The aim of the study was to compare vascular age (VA) in RA patients under a strict treat-to-target (T2T) strategy with Osteoarthritis (OA) patients without strict follow up and to assess the influence of inflammaging (chronic, sterile, low-grade inflammation related to aging) and metabolic markers on VA.

Materials and Methods

This was an analytical cross-sectional study. Patients with RA (under a strict a T2T strategy) and OA patients without strict clinical follow-up were included. Patients with a history of uncontrolled hypertension, CVD, and/or current smoking were excluded. Sociodemographic, physical activity, and toxic exposure data were obtained. Waist-hip ratio and body mass index (BMI) were measured. DAS-28 (RA) and inflammatory markers, lipid profile, and glycaemia were analyzed. Pulse wave velocity (PWV) was measured (oscillometric method, Arteriograph-TensioMed®). VA was calculated based on PWV. Eleven components of inflammaging [six interleukins, three metalloproteinases (MMP), and two tissue inhibitors of metalloproteinases (TIMP)] were evaluated (Luminex® system). Univariate and bivariate analyzes (Mann Whitney U and chi-square) and correlations (Spearmans Rho) were done to compare the two groups.

Results

A total of 106 patients (74% women) were included, 52/RA and 54/OA. The mean age was 57 (Interquartile range - IQR 9 years). The BMI, waist circumference, and weight were higher in patients with OA (p &lt; 0.001). RA patients had low disease activity (DAS-28-CRP). There were no differences in VA, inflammaging nor in PWV between the two groups. VA had a positive, but weak correlation, with age and LDL. In group of RA, VA was higher in those who did not receive methotrexate (p = 0.013). LDL levels correlated with MMP1, TIMP1, and TIMP2.

Conclusions

When comparing RA patients with low levels of disease activity with OA patients with poor metabolic control, there are no differences in VA. Furthermore, methotrexate also influences VA in RA patients. This shows that implemented therapies may have an impact on not only the inflammatory state of the joint but also CVD risk.

Is Tofacitinib Effectiveness in Patients with Rheumatoid Arthritis Better After Conventional Than After Biological Therapy? – A Cohort Study in a Colombian Population

Purpose

Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate to severe disease activity, but there is not enough evidence on its effectiveness after conventional DMARDs vs its use after biologics. The aim was evaluating the effectiveness of tofacitinib in RA as first-line treatment (after conventional DMARDs) in a real-life setting in Colombian (Latin-American) patients.

Patients and Methods

Retrospective cohort study conducted at a specialized center for RA management. A complete statistical analysis was performed to compare the values of the change in the DAS28 at months 3, 6, and 12 in both treatment groups.

Results

A total of 152 RA patients who received tofacitinib: first-line 85 patients (55.9%) after failure on conventional DMARDs or second-line 67 patients (44.1%) after failure on biologic DMARDs. Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6, and 12 months in both study groups without statistical differences, but a higher proportion of first-line patients achieved remission (45% vs 23%). Nonresponse at three months were associated with no response at six months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR: 1.87, 95%CI: 1.06–3.30, p-value 0.028). In second-line patients, response to tofacitinib was not related to number of biologic DMARDs previously used.

Conclusion

Tofacitinib is an effective treatment option for patients with RA, maybe better after conventional DMARDs than after biologic therapy failure. Further studies are required to determine the role of tofacitinib in different lines of RA treatment and in other groups of patients.

Safety and efficacy of convalescent plasma for severe COVID-19: a randomized, single blinded, parallel, controlled clinical study

Background

Convalescent plasma (CP) has been widely used to treat COVID-19 and is under study. However, the variability in the current clinical trials has averted its wide use in the current pandemic. We aimed to evaluate the safety and efficacy of CP in severe coronavirus disease 2019 (COVID-19) in the early stages of the disease.

Methods

A randomized controlled clinical study was conducted on 101 patients admitted to the hospital with confirmed severe COVID-19. Most participants had less than 14 days from symptoms onset and less than seven days from hospitalization. Fifty patients were assigned to receive CP plus standard therapy (ST), and 51 were assigned to receive ST alone. Participants in the CP arm received two doses of 250 mL each, transfused 24 h apart. All transfused plasma was obtained from "super donors" that fulfilled the following criteria: titers of anti-SARS-CoV-2 S1 IgG ≥ 1:3200 and IgA ≥ 1:800 antibodies. The effect of transfused anti-IFN antibodies and the SARS-CoV-2 variants at the entry of the study on the overall CP efficacy was evaluated. The primary outcomes were the reduction in viral load and the increase in IgG and IgA antibodies at 28 days of follow-up. The per-protocol analysis included 91 patients.

Results

An early but transient increase in IgG anti-S1-SARS-CoV-2 antibody levels at day 4 post-transfusion was observed (Estimated difference [ED], − 1.36; 95% CI, − 2.33 to − 0.39; P = 0.04). However, CP was not associated with viral load reduction in any of the points evaluated. Analysis of secondary outcomes revealed that those patients in the CP arm disclosed a shorter time to discharge (ED adjusted for mortality, 3.1 days; 95% CI, 0.20 to 5.94; P = 0.0361) or a reduction of 2 points on the WHO scale when compared with the ST group (HR adjusted for mortality, 1.6; 95% CI, 1.03 to 2.5; P = 0.0376). There were no benefits from CP on the rates of intensive care unit admission (HR, 0.82; 95% CI, 0.35 to 1.9; P = 0.6399), mechanical ventilation (HR, 0.66; 95% CI, 0.25 to 1.7; P = 0.4039), or mortality (HR, 3.2; 95% CI, 0.64 to 16; P = 0.1584). Anti-IFN antibodies and SARS-CoV-2 variants did not influence these results.

Conclusion

CP was not associated with viral load reduction, despite the early increase in IgG anti-SARS-CoV-2 antibodies. However, CP is safe and could be a therapeutic option to reduce the hospital length of stay.

Trial registration NCT04332835

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07560-7.

AB0020 COMPARATIVE DESCRIPTION OF CYTOKINES AND MATRIX METALLOPROTEINASES IN A GROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHROSIS UNDER A STRICT FOLLOW-UP COMPARED WITH COVID-19 PATIENTS

Background

COVID-19, rheumatoid arthritis (RA) and osteoarthrosis (OA) are diseases characterized by the secretion of cytokines related to the stimulation of the inflammatory response.

Objectives

To identify the differences in the cytokine and matrix metalloproteinases (MMP) profile within one acute infectious disease and two chronic inflammatory rheumatic diseases.

Methods

Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months), OA patients without strict clinical follow-up, evaluated once or twice a year, and Severe (mortality) COVID-19 patients were included. Eleven proteins (cytokines, MMPs and its tissue inhibitors) were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes were performed. Approval of Ethics Committee and informed consent were obtained.

Results

A total of 108 patients with RA and OA were compared with 20 severe COVID-19 patients. There were no significant differences through the method of Kruskall–Wallis, between RA and OA patients. IL1-B and MMP-2 were significantly lower in COVID-19 patients. Levels of IL-10, IL-1RA, IL-6, MMP-1, MMP-9, and TIMP-1 were significantly higher in COVID-19 patients. There were no differences in TNF-A, TIMP-2 and INF-G. (Table 1)

Table 1.

Significant correlations between cytokines related to Covid-19, RA and OR.

Cytokine (pg/ml) Median valuesRA (%)OACOVID-19P-valueIL-1054.9254.49116.38<0.0001aIl1-RA62.1951.82110.08<0.0001aIL1-B67.0955.3046.170.045IL-656.0951.3484.98<0.0001b 0.003cTNF-A17.514.616.3NSMMP-1d57.8454.8490.81<0.0001b 0.045cMMP-2 d70.3870.5948.560.040MMP-9 d66.2558.1686.40.007 bTIMP-1 d51.5960.99111.67<0.0001aTIMP-2 d45.247.749.6NSINF-G5.755.323.07NS

a Between RA and Covid-19 and OA and Covid-19, without differences between RA and OA. b Between OA and Covid-19.

C Between RA and Covid-19. d ng/ml.

Conclusion

Compared with RA and OA patients, severe COVID-19 patients have a great impact on the cytokines and MMPs addressed in this study, proving that COVID-19 patients suffer from a cytokine storm [1] when severely infected.

References

[1]R. Mulchandani, T. Lyngdoh, and A. K. Kakkar, “Deciphering the COVID-19 cytokine storm: Systematic review and meta-analysis,” Eur. J. Clin. Invest., vol. 51, no. 1, pp. 1–21, 2021, doi: 10.1111/eci.13429.

Disclosure of Interests

None declared

AB0250 DESCRIPTION OF ARTERIAL STIFFNESS, INFLAMMAGING AND VASCULAR AGE IN A GROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS UNDER A STRICT FOLLOW-UP COMPARED WITH UNCONTROLLED OSTEOARTHRITIS PATIENTS

Background

The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than in individuals in the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level, called vascular aging reflected by arterial stiffness and endothelial dysfunction

Objectives

The aim of the study was to compare vascular age and arterial stiffness (PWV-Pulse Wave Velocity) in two groups of patients with RA and with osteoarthritis (OA) and to assess the influence of inflammaging (persistent low-grade inflammation that develops with age) and metabolic markers in these outcomes.

Methods

Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months) and OA patients without strict clinical follow-up, evaluated once or twice a year, were included. Patients with history of uncontrolled hypertension, CVD and/or current smoking were excluded. Waist-hip ratio, body mass index (BMI), DAS28 (RA), C-Reactive protein (CRP), Erythrocyte sedimentation rate (ESR), glycemia and lipid profile were measured. PWV and vascular age (in years) were evaluated through oscillometric method, arteriograph-TensioMed. Eleven proteins components of the inflammaging (cytokines, Matrix metalloproteinases - MMPs and its tissue inhibitors), were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes (Chi-square and non-parametric correlations) were performed. Approval of Ethics Committee and informed consent were obtained.

Results

A total of 106 patients (74% women) were included (52/RA and 54/OA). Mean age was 57±5.6 years without differences between groups. There were significant differences in CRP and ESR (higher in RA) and in BMI, waist circumference and weight (higher in OA). RA patients had low disease activity level (DAS28: Median 2.6, IQR 1.3). There were no differences in PWV, vascular age or inflammaging (except for MMP-1, higher in RA), between the groups. PWV had a positive correlation with LDL (Rho Coef. 0.218 p=0.025). Patients who performed physical activity had a lower vascular age than those who did not [43 Interquartile range (IQR)23 vs 60 IQR 17, p=0.032). Vascular age was higher in RA patients who did not receive methotrexate 60 (IQR 19.3) compared with patients under methotrexate treatment 44.5 (IQR 23) (p = 0.017). Also, vascular age was lower in OA patients under prescribed physical activity (43 IQR 24.8 vs 56.5 IQR 20, p=0.03). MMP-9 in RA patients (Rho 0.283, p=0.042) and IL-10 in OA patients (Rho 0.290, p= 0.036) correlated with diastolic pressure. The components of inflammaging did not correlate with vascular age. The Framingham Risk Score was strongly associated with vascular age.

Table 1.

Significant correlations with vascular age

VariableSpearman’s Rhop-valueLDL levels0.2000.040Systolic blood pressure0.3000.002Mean arterial blood pressure0.2100.031Daily coffee cups intake-0.2120. 045Framingham Risk Score0.340<0.0001MDHAQ score in RA patients0.4170.002

LDL: low density lipoprotein; MDHAQ: multidimensional health assessment questionnaire.

Conclusion

In RA strictly controlled patients, there are no differences in endothelial dysfunction, vascular age or inflammaging, when comparing with uncontrolled overweight OA patients. Physical activity, LDL levels and coffee consumption corelate with vascular age in OA and RA patients. OA patients under physiatrists follow-up and RA patients under methotrexate treatment or with low MDHAQ levels have lower vascular age levels.

References

[1]Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis. Santos-Moreno P, Burgos-Angulo G, Martinez-Ceballos MA, et al Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis. RMD Open. 2021 Jan;7(1):e001470

Disclosure of Interests

None declared

Asymptomatic coronary artery disease assessed by coronary computed tomography in patients with systemic lupus erythematosus: A systematic review and meta-analysis

BACKGROUND

Coronary artery disease (CAD) assessed by coronary computed tomography (CT) in patients with systemic lupus erythematosus (SLE) has been investigated in several studies, but with conflicting results. The aim of this systematic review and meta-analysis of the literature was synthesize the evidence on this topic.

METHODS

The relevant literature was identified and evaluated from inception until January 2021 in PubMed, Embase, Web of Science and Cochrane library. Studies reporting coronary artery calcification (CAC), and its prevalence and extent using the coronary calcium score (CCS) were included. Data extracted from eligible studies were used to calculate effect estimates (ESs) and 95% confidence intervals (95%CI) and weighted mean differences (WMD) with 95%CI.

RESULTS

Twenty-four studies were eligible for inclusion. For the CAC prevalence, 11 studies were included (918 SLE patients and 3952 controls) and the pooled prevalence for the random effect was 29.8% (95%CI 25.7-32.9%) for SLE patients and 11.8% (95%CI 16.2-20.4%) in controls (RR 2.22, 95%CI 1.42 to 3.48; p= 0.0005) and no significant increase in the WMD for CCS (MD= 0.32, 95%CI -5.55 to 6.20, p= 0.91) compared with controls in seven studies. Greater organ damage and glucocorticoid use has been associated with a higher CCS. According to two studies, the coronary CT angiography calcified and non-calcified plaque burden were increased in SLE patients compared with controls.

CONCLUSIONS

In SLE, asymptomatic CAD by CAC is more prevalent and there is more multivessel disease compared with controls without lupus. However, the extent of CAC was not increased in SLE patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021228710.

Artritis reumatoide y telemedicina en tiempos de COVID-19

La artritis reumatoide es una afección autoinmune, crónica y multisistémica que requiere manejo multidisciplinar, siendo la supervisión continua fundamental para controlar su progresión. Tanto la artritis como el tratamiento generan un estado inmunosupresor que predispone a sufrir infecciones. Por la actual emergencia sanitaria ocasionada por el Sars-Cov2, los pacientes con estas enfermedades crónicas e inmunológicas son más susceptibles de contagio, por ello se ha requerido el uso de nuevas tecnologías como la telemedicina, que en los años previos a la pandemia venía incrementándose su uso, para permitir el control de patologías crónicas. El objetivo del presente estudio es revisar qué implicaciones ha tenido el uso de la telemedicina en el manejo de la artritis reumatoide durante la actual pandemia COVID-19 y cuál ha sido la importancia de la implementación de estas tecnologías en la enfermedad.  

Factors Associated With Diagnostic Delay of Axial Spondyloarthritis in Colombian Patients

BACKGROUND/OBJECTIVE

The diagnostic delay of axial spondyloarthritis (axSpA) is globally reported to be between 3 and 11 years. Early diagnosis and treatment have long-term benefits for patients and the health care system. Several international studies have evaluated some factors associated with diagnostic delay, but there are no known studies in the Colombian population. This study assesses the factors associated with diagnostic delay of axSpA in a rheumatology center in Bogota, Colombia.

METHODS

This monocentric analytical cross-sectional study was done in a specialized rheumatology center. Patients who fulfilled the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA were included. Information was obtained from medical records and a phone call. Bivariate and multivariate analyses were done to assess the associated factors with diagnostic delay.

RESULTS

One hundred one patients were included, 54 were women (53.5%). The median diagnostic delay was 2 years (interquartile range, 1-7). The bivariate analysis showed that a younger age at diagnosis (p = 0.042) and previous diagnosis of lumbar degenerative disease (p = 0.029) were associated with a longer diagnostic delay. The logistical regression showed that previous lumbar degenerative disc disease (odds ratio, 2.8; 95% confidence interval, 1.09-7.53) and fibromyalgia (odds ratio, 4.0; 95% confidence interval, 1.2-13.1) diagnosis were both associated with a longer diagnostic delay.

CONCLUSIONS

Factors associated with a longer diagnostic delay were previous diagnosis of lumbar degenerative disc disease and fibromyalgia. Additional studies are needed so that the reasons for diagnostic delay are understood and early diagnosis and management of axSpA are enabled.

Helicobacter pylori and its association with autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis and Sjögren syndrome

Helicobacter pylori (H. pylori) is a gram-negative bacterium that adapts to the gastric mucosa and provokes symptoms associated with gastritis. Chronic H. pylori infection in patients with a genetic predisposition can trigger autoimmune diseases due to the immune interaction of cellular and humoral responses. Infections are a triggering factor for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren syndrome (SS), although the association between H. pylori and these diseases is unclear. Therefore, we reviewed this interaction and its clinical importance.

Comparison of the sensitivity of the EULAR / ACR 2019 and SLICC 2012 classification criteria in a Colombian population with systemic lupus erythematosus

BACKGROUND

/Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a wide range of clinical manifestations. The latest classification criteria, EULAR/ACR 2019, have not been validated in a Latin American population of Amerindian ancestry. The objective of this study is to compare the sensitivity of the EULAR/ACR 2019 and SLICC 2012 classification criteria in a group of SLE patients with the above ancestry.

METHODS

A cross-sectional study was done. Data were obtained from the review of medical records of patients who met the inclusion criteria. The overall sensitivity of the criteria was calculated and compared to each other using the McNemar test.

RESULTS

146 medical records of patients from two referral centers were included. There were no differences in the sensitivity of the EULAR/ACR and SLICC 2012 criteria (84.9% versus 85.6% p = 0.79) nor were differences found when the groups based on disease duration were compared: less than 5 years (91.0% versus 92.5% p = 0.70), between 5 and 10 years (82.8% versus 82.8% p = 1), and 10 years or more (76.7% versus 76.7% p = 1). However, SLICC 2012 criteria was found to better classify patients with a less than 5-year disease duration compared to those with 10-year duration or more (92.5% versus 76.4% p = 0.024).

CONCLUSIONS

There are no statistically significant differences between the EULAR/ACR and SLICC 2012 criteria in the population studied. Nor were differences found when evaluating them by age at diagnosis and duration of the disease except when the group with less than 5 years of duration was compared to those with 10 years or more using the SLICC 2012 criteria.

Certolizumab Can Also Be Effective in Monotherapy for the Treatment of Rheumatoid Arthritis Patients

OBJECTIVE

Although it is known that methotrexate (MTX) increases the effectiveness of biological drugs (mainly anti-TNFs) in patients with rheumatoid arthritis (RA), in real life, it is known that many patients using anti-TNFs are on monotherapy due to many causes. This article compares the effectiveness of certolizumab as monotherapy as combined with MTX or leflunomide (LFN) in RA patients with failure to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in a real-world setting.

METHODS

A retrospective observational cohort study was conducted at a specialized centre for RA management in Colombia. Patients treated with certolizumab as monotherapy or in combination with MTX, LFN, or MTX+LFN, between 2011 and 2020 with a minimum 3-month follow-up were included. Demographics and RA clinical characteristics were recorded; effectiveness was assessed as the improvement in Disease Activity Score (DAS28) getting remission or low disease activity at 3, 6, and 12 months of treatment.

RESULTS

A total of 181 patients were included, 24 received certolizumab as monotherapy, 62 certolizumab plus MTX, 47 certolizumab plus LFN and 48 certolizumab plus MTX+LFN. At 3 months of follow-up, 80% of the patients showed decreased disease activity, with no significant differences between groups; at 12 months of treatment, response in certolizumab monotherapy group was 94.4% compared to 81.8% in combination with MTX, 80.5% in combination with LFN and 51.4% in combination with MTX+LFN. Response at 3 months (OR 4.04; 95% CI 1.28-12.69) and positive anti-CCP (OR 3.83; 95% CI 1.11-13.21) were associated with 12-month response.

CONCLUSION

Certolizumab seems to be effective as monotherapy in the treatment of RA patients with failure to csDMARDs.

[SARS-CoV-2 (COVID-19) in Patients with some Degree of Immunosuppression]

Antecedentes

No es claro si los pacientes con algún grado de inmunosupresión tienen peores desenlaces en la infección por SARS-CoV-2, en comparación con la población sana.

Objetivo

Realizar una revisión narrativa de la información disponible sobre infección por SARS-CoV-2 en pacientes inmunosuprimidos, especialmente pacientes con cáncer, trasplantados, con patologías neurológicas, inmunodeficiencias primarias y secundarias.

Resultados

Los pacientes con cáncer y tratamiento reciente del mismo (quimioterapia o cirugía) e infección por SARS-CoV-2 tienen mayor riesgo de peores desenlaces. En los pacientes trasplantados (renal, cardiaco y hepático), con patologías neurológicas (esclerosis múltiple [EM], neuromielitis óptica [NMODS], miastenia grave [MG]), inmunodeficiencias primarias e infección por virus de inmunodeficiencia humana (VIH) en asociación con uso de inmunosupresores, los estudios no han mostrado tendencia a peores desenlaces.

Conclusión

Dada la poca evidencia con que contamos hasta el momento no es claro el comportamiento de la infección por SARS-CoV-2 en pacientes con inmunosupresión, pero los estudios actuales no han mostrado peores desenlaces en este tipo de pacientes, a excepción de los pacientes con cáncer.

Coronary calcium in autoimmune diseases: A systematic literature review and meta-analysis

BACKGROUND AND AIMS

Autoimmune diseases (AID) share various clinical signs and symptoms and pathophysiological mechanisms including the increased risk of cardiovascular disease. The coronary artery calcium score (CACS) is potentially useful in improving the cardiovascular risk assessment. The aim of this study was to evaluate CACS in six AIDs analyzed as a group compared with controls through a systematic literature review (SLR) and meta-analysis.

METHODS

A literature search (Medline/OVID, Lilacs, Embase, and Cochrane/OVID) up to January 6, 2021 was made (PROSPERO CRD42020197182). Observational studies (patients with six AIDs: rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], Sjögren's syndrome, systemic sclerosis, dermatopolymyositis, and antiphospholipid syndrome) compared with controls were included. CACS, reported in Agatston units, was the primary outcome in both groups. Mean differences and a random-effects model (DerSimonian and Laird) were calculated.

RESULTS

Nineteen articles were meta-analyzed (4568 subjects: 2142 AID and 2426 controls). Mean age was 48.1 and 44.2 years, respectively and 75.6% and 84.9% were women, respectively. Of cases, 52.9% had RA, 44.4% SLE and 2.7% had systemic sclerosis. The pooled analysis showed a higher CACS in patients with AIDs (7.42; 95% CI 1.79 to 13.05; chi²-p = 0.01) compared with controls. Meta-regression models showed that age in cases and controls reduced the difference in CACS between groups (p < 0.05), HDL had an inverse relationship (p = 0.04), and CRP levels had a directly proportional relationship with CACS in cases (p = 0.036).

CONCLUSIONS

The quantitative results of this meta-analysis suggest that CACS is higher in patients with AID, possibly due to chronic exposure to pro-inflammatory molecules. These results have clinical implications since the finding of highly elevated CACS in patients with AID will enable physicians and researchers to develop a risk stratification model that includes CACS as one of the screening tools for detecting coronary atherosclerosis in these patients.

Prevalence of hospital readmissions and related factors in patients with autoimmune diseases

Objective

Autoimmune diseases generate an impact on the morbidity and mortality of patients and are a burden for the health system through hospital admissions and readmissions. The prevalence of readmission of patients with these diseases has not yet been described as a group, but rather as sub-phenotype. The objective of this study is to determine the prevalence of hospital readmissions in a Colombian population with autoimmunity and the factors related to readmission.

Methods

All patients with autoimmune diseases who were evaluated by the rheumatology service and hospitalized between August 2018 and December 2019 at the Fundación Hospital Infantil Universitario De San José de Bogotá were described. A bivariate analysis was done, and three multivariate logistic regression models were built with the dependent variable being readmission.

Results

Of the total 199 admissions, 131 patients were evaluated and 32% were readmitted. The most frequent sub-phenotype in both groups (readmission and no readmission) was SLE (51% and 59%). The most frequent cause of hospitalization and readmission was disease activity (68.7% and 64.3%). History of hypertension was associated with readmission (adjusted OR: 2.98-95% CI: 1.15-7.72). In a second model adjusted for confounding variables, no factor was associated. In a third model analyzing the history of kidney disease and previous use of immunosuppressants (adjusted for confounding variables), the previous use of immunosuppressants was related to readmission (OR: 2.78-95% CI 1.12-6.89).

Conclusion

Up to a third of patients with autoimmunity were readmitted and arterial hypertension was an associated factor. This suggested a greater systemic compromise and accumulated damage in patients who have these two conditions that may favor readmission. A history of immunosuppressant use may play a role in readmission, possibly by increasing the risk of developing infections.

Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis

Currently, traditional and non-traditional risk factors for cardiovascular disease have been established. The first group includes age, which constitutes one of the most important factors in the development of chronic diseases. The second group includes inflammation, the pathophysiology of which contributes to an accelerated process of vascular remodelling and atherogenesis in autoimmune diseases. Indeed, the term inflammaging has been used to refer to the inflammatory origin of ageing, explicitly due to the chronic inflammatory process associated with age (in healthy individuals). Taking this into account, it can be inferred that people with autoimmune diseases are likely to have an early acceleration of vascular ageing (vascular stiffness) as evidenced in the alteration of non-invasive cardiovascular tests such as pulse wave velocity. Thus, an association is created between autoimmunity and high morbidity and mortality rates caused by cardiovascular disease in this population group. The beneficial impact of the treatments for rheumatoid arthritis at the cardiovascular level has been reported, opening new opportunities for pharmacotherapy.

Colchicine: A potential therapeutic tool against COVID-19. Experience of 5 patients

COVID-19 is a newly emerged disease that has become a global public health challenge. Due to a lack of knowledge about the virus, a significant number of potential targets for using a particular drug have been proposed. Five cases with a clinical history of biopolymers in the gluteal region that developed iatrogenic allogenosis (IA) are presented here. The 5 cases were put under colchicine treatment for IA crisis and had non-specific symptoms (headache, cough without dyspnea, and arthralgias) with a positive SARS-CoV-2 test. Their close contacts had mild to severe symptoms and three of them died. In the SARS-CoV-2 infection different inflammatory pathways are altered where colchicine reduces cytokine levels as well as the activation of macrophages, neutrophils, and the inflammasome. The possible mechanisms that colchicine may use to prevent acute respiratory distress syndrome (ARDS) in patients with COVID-19 infection are also reviewed in this article.

Colchicine: A potential therapeutic tool against COVID-19. Experience of 5 patients

COVID-19 is a newly emerged disease that has become a global public health challenge. Due to a lack of knowledge about the virus, a significant number of potential targets for using a particular drug have been proposed. Five cases with a clinical history of biopolymers in the gluteal region that developed iatrogenic allogenosis (IA) are presented here. The 5 cases were put under colchicine treatment for IA crisis and had non-specific symptoms (headache, cough without dyspnea, and arthralgias) with a positive SARS-CoV-2 test. Their close contacts had mild to severe symptoms and three of them died. In the SARS-CoV-2 infection different inflammatory pathways are altered where colchicine reduces cytokine levels as well as the activation of macrophages, neutrophils, and the inflammasome. The possible mechanisms that colchicine may use to prevent acute respiratory distress syndrome (ARDS) in patients with COVID-19 infection are also reviewed in this article.

SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression

BACKGROUND

It is not clear whether patients with some degree of immunosuppression have worse outcomes in SARS-CoV-2 infection, compared to healthy people.

OBJECTIVE

To carry out a narrative review of the information available on infection by SARS-CoV-2 in immunosuppressed patients, especially patients with cancer, transplanted, neurological diseases, primary and secondary immunodeficiencies.

RESULTS

Patients with cancer and recent cancer treatment (chemotherapy or surgery) and SARS-CoV-2 infection have a higher risk of worse outcomes. In transplant patients (renal, cardiac and hepatic), with neurological pathologies (multiple sclerosis (MS), neuromyelitis optica (NMODS), myasthenia gravis (MG)), primary immunodeficiencies and infection with human immunodeficiency virus (HIV) in association with immunosuppressants, studies have shown no tendency for worse outcomes.

CONCLUSION

Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer.

AB0907-HPR UNEXPECTED DIFFERENCE IN ACCEPTANCE OF TELECONSULTATION BETWEEN PATIENTS WITH LUPUS AND RHEUMATOID ARTHRITIS WHO UNDERWENT TO A DEVELOPED AND IMPLEMENTED TELEMEDICINE INNOVATIVE PROGRAM AFTER THE DECLARATION OF QUARANTINE DUE TO THE COVID-19 PANDEMIC IN COLOMBIA

Background:

The Covid-19 pandemic has generated restrictions in the mobility of people, affecting the face-to-face care of patients with chronic diseases, including autoimmune. The health emergency has created the need to establish follow-up alternatives, giving rise to telemedicine.

Objectives:

To evaluate the level of attendance to teleconsultation and the face-to-face usual care in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who underwent to a developed innovative telemedicine program after the declaration of quarantine due to the Covid-19 pandemic.

Methods:

The present cross-sectional descriptive study reports retrospective data collected from patients with RA and SLE from March to June, 2020;. Since the beginning of March 2020 when Covid-19 was declared in Colombia as a health emergency establishing specific standards for outpatient care, our center has made the necessary legal and technical adjustments to develop an innovative telemedicine service to prevent the epidemiological risk. To all contacted patients were offered the option of teleconsultation or face-to-face consultation; a standardized protocol was set with clinimetry measures evaluated in both groups. Continuous variables were described using mean and standard deviation, and categorical variables were described using numbers and percentages. We performed chi-square tests of independence to determine differences between teleconsulting and conventional face-to-face consultation.

Results:

A total of 5745 RA patients were followed-up, 5292 (92.1%) by teleconsulting and 453 (7.9%) by conventional face-to-face consultation; among the group of SLE patients, a total of 646 were assessed, of which there were 386 (60%) by teleconsultation and 260 (40%) by face-to-face consultation; this highlights an important difference in the level of acceptance of the teleconsultation between patients with RA and SLE, being much lower in patients with SLE (p value< 0.0001). Regarding gender differences, in men, there were 33 (12.7%) SLE and 89 (19.6%) RA face-to-face consultations, while in women there were 227 (87.3%) SLE and 364 (80.4%) RA in a face-to-face consultation. Regarding patients who were attended through telemedicine, 45 (11.7%) SLE and 966 (18.3%) RA were men, while 341 (88.3%) SLE and 4326 (81.7%) RA were women; that means, in the RA cohort, a greater number of men prefer the face-to-face consultation than in the SLE cohort (p value< 0.0185). 10 RA patients were diagnosed with the Covid-19 in teleconsultation; in all cases, close contact with infected relatives was verified as the probable cause.

Table 1.

Differences by gender in the level of teleconsultation acceptance and face-to-face assistance in patients with SLE and RA

RA PatientsGenderTeleconsulting (%a)Face-to-face consultation (%a)Male105596691,57%898,43%Female4690432692,23%3647,77%SLE PatientsGenderTeleconsulting (%a)Face-to-face consultation (%a)Male784557,69%3342,31%Female56834160,03%22739,97%

a Total percentage of patients by gender. RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus.

Conclusion:

Telemedicine may provide a viable option for the follow-up of patients with rheumatological diseases even beyond the pandemic. But unexpectedly, data showed an important difference in the acceptance of teleconsultation between patients with RA and SLE, being much higher in older and/or male patients with RA compared to patients with SLE; however, further studies are needed to support this conclusion.

Disclosure of Interests:

None declared

AB0275 TOFACITINIB EFFECTIVENESS IN PATIENTS WITH RHEUMATOID ARTHRITIS AFTER CONVENTIONAL OR BIOLOGICAL THERAPY - IT REAL ROLE IN DIFFERENT LINES OF TREATMENT

Background:

rheumatoid arthritis (RA) is a chronic and disabling autoimmune disease, with a high clinical and economic burden. This implies the need to investigate therapies that maximize clinical results. Tofacitinib is recommended as a different alternative to biologic therapy when a patient remains with moderate or high disease activity after conventional DMARDs use, or as an option after failure to biologic therapy.

Objectives:

to evaluate the effectiveness of Tofacitinib in RA as first-line (after conventional DMARDs failure) or second-line treatment (after biologic therapy failure) in a real-life cohort of RA patients and its differences.

Methods:

this is a descriptive retrospective cohort study conducted at a specialized center for RA in Bogota, Colombia; databases from 2017 to 2019 were used to select and study patients with indication of Tofacitinib, regardless of their previous treatment or disease status. The indication and initiation of Tofacitinib (5 mg BID or 11 mg once daily) was an independent medical decision made as part of the individualized management of every patient. Effectiveness was evaluated in those patients who met the high adherence criteria (at least three visits with a rheumatologist per year), with no change or addition of other conventional DMARDs. Frequencies and proportions in baseline characteristics, differences in disease activity were calculated between the first and second line tofacitinib treatment. Comparisons of continuous variables data between the two patient groups were made using the t-test; the chi-square test and Fisher’s exact test were used for statistical analysis of categorical variables. Logistic regressions were performed to analyze related factors with therapeutic response outcomes.

Results:

we included 152 RA patients who received tofacitinib: first-line (T1) (n= 85, 55.9%) or second-line (T2) (n= 67, 44.1%). T1 first-line group was younger than the T2 second-line patients (53±12.8 years and 59±11.4 years, p-value 0.01) and they had a shorter disease duration than T2 patients (11.8 vs. 12.8 years, p-value 0.01). Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6 and 12 months in both study groups. The response in disease activity at 3 months was a major factor related to 6-month response (OR 13.4, 95% CI 4.5-39.4, p value 0.000), while non-response at 3 months were associated with no response at 6 months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR 1.9, 95% CI 1.11-3.25, p-value 0.028). At 12 months of treatment, both groups showed disease response and control according to the DAS28 from baseline, but a higher proportion of T1 patients achieved remission (45% vs 23%). A subgroup analysis to evaluate T2 second-line Tofacitinib therapy showed no statistically significant differences in any response criteria according to the number of previously received biologicals.

Table 1.

Regression analysis (risk of response of the disease at 6 and 12 months of treatment with Tofacitinib)

FactorResponse at Month 6Response at Month 12*ORIC95%P valueORIC95%P valueAge1.000.97-1.030.7881.020.98-1.060.211Male1.820.65-5.080.2510.810.27-2.380.709Duration of RA0.990.94-1.040.9081.020.96-1.080.444Positive Rheumatoid Factor0.81026-2.560.7300.630.17-2.260.485Positive Anti-CCP0.340.068-1.60.189Initial DAS281.611.04-2.490.0331.91.11-3.250.018First line0.440.19-1.010.0541.470.56-3.830.423Treatment period1.120.80-1.550.4921.10.75-1.610.607Dose: 11 mg.0.950.42-2.130.9040.750.258-1.90.565Response at Month 313.424.57-39.40.0002.320.87-6.180.091

*Positive Anti-CCP at month 12 was omitted because of collinearity

Conclusion:

Tofacitinib is an effective treatment option for patients with RA after conventional DMARDs and in patients after biologic therapy failure, but maybe is better used it as a T1 first-line of treatment. Further studies are required to determine the real role of tofacitinib in different lines of RA treatment.

Disclosure of Interests:

Wilberto Rivero: None declared, Linda Ibata: None declared, Susan Martinez: None declared, Adriana Rojas-Villarraga: None declared, Pedro Santos-Moreno Speakers bureau: Pedro Santos-Moreno has received fees for conferences from: Abbvie, Biopas-UCB, Bristol, Janssen, Pfizer, Sanofi., Consultant of: Pedro Santos-Moreno has received fees for counseling and advisory boards from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi., Grant/research support from: Pedro Santos-Moreno has received research grants from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi.

AB0242 CERTOLIZUMAB IN MONOTHERAPY AS EFFECTIVE THAN IN COMBINATION IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Tumour necrosis factor-a (TNFa) inhibitors are one of the most used biological therapy for rheumatoid arthritis (RA) patients without response to conventional disease-modifying antirheumatic drugs (cDMARDs). There is scarce information about biological DMARDs (bDMARDs) effectiveness as monotherapy in real life.

Objectives:

To assess the effectiveness of Certolizumab pegol in real-life clinical practice in a cohort of patients with RA and previous failure to cDMARDs who received certolizumab as monotherapy, combined with Methotrexate (MTX), combined with leflunomide (LFN), or both MTX and LFN.

Methods:

A retrospective cohort study was conducted at a specialized center for RA management in Colombia. Patients treated with Certolizumab as monotherapy or in combination with MTX, or LFN, or both MTX plus LFN, (2012 – 2020) were included. The indication of certolizumab was a independent decision based on disease activity. Patients could be taking adjuvant medications for pain and/or corticosteroids. Certolizumab was administered 400 mg SC monthly after three induction doses at weeks 0, 2 y 4, as monotherapy or in combination with MTX (until 25 mg/week), LFN (20 mg/day) or both as a first-line treatment after failure with cDMARDs or as a second-line treatment after failure with one or more bDMARDs. Effectiveness was assessed at three, six, and twelve months according to the change in DAS28. Exploratory comparisons of numeric variable data between groups were done (ANOVA). Chi-square test and Fisher’s exact test were used for categorical variables. Multivariate analyses (logistic regressions) were performed to analyse factors related to the response at 6 and 12 months.

Results:

Of 181 enrolled patients, 24 received certolizumab as monotherapy, 62 combined with MTX, 47 in combination with LFN and 48 in combination with MTX and LFN. 55.2% of patients were first-line treatment, without significant differences between groups. Mean age of subjects included was 57.87 ± 12.33 with a mean age of around 60 years in patients treated with CERTO+MTX and CERTO+LFN (p=0,014). Women predominated in all groups (84% of the total) (p=0,275). The duration of arthritis on average was 8.27 ± 8.73 years, without significant differences between treatment groups (p=0,871). In terms of disease activity, 78.5% of patients were in moderate or high disease activity, according to DAS28, without significant differences between the groups (p=0,787). Differences in the number of biologicals and corticoid use were observed, patients in the combination groups had used in a higher proportion two or more biological (p=0,046) than in the monotherapy group and had used corticosteroids (p=0,042) more frequently. Overall, there were decreased disease activity, at 3 and 6 months with no significant differences between groups (p=0,08). At 12 months of treatment, there was a higher maintenance in mild activity/remission response in monotherapy group compared to the others (p=0,01). In the multivariate analysis, no differences were observed in the response at 6 and 12 months between the treatment groups. The response at three months was the only variable associated with the 6-month response (OR 5.46; CI 95% 2.08 – 14.32). The response at three months (OR 4.04; CI 95% 1.28-12.69) and positive anti-CCP (OR 3.83; CI 95% 1.11-13.21) were associated with 12-month response.

Conclusion:

These exploratory results show a clear trend of Certolizumab being effective as monotherapy in patients previously treated with cDMARDs and even after being treated with one bDMARD. Although results are not statistically different, it seems that certolizumab in monotherapy could be as least as effective as combination therapy. Prospective studies with larger sample size and with a structured follow-up are needed to confirm these findings.

Disclosure of Interests:

Paola Osorio: None declared, Laura Villarreal: None declared, Wilberto Rivero: None declared, Linda Ibata: None declared, Susan Martinez: None declared, Adriana Rojas-Villarraga: None declared, Pedro Santos-Moreno Speakers bureau: has received fees for conferences from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Consultant of: has received fees for counseling, advisory boards from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Grant/research support from: has received fees for research grants from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi

Is there any relationship between massive ascites and elevated CA-125 in systemic lupus erythematosus? Case report and review of the literature

Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease of variable presentation. Massive ascites in the context of SLE is infrequent. Even so, it has been reported that ascites may be the first manifestation of SLE. It is difficult to diagnose due to the multiple possible aetiological causes of ascites. There is a rare entity called Pseudo-Pseudo Meigs Syndrome (PPMS) in patients with SLE who have ascites, pleural effusion, and CA-125 elevation unrelated to malignancy. We present two cases of massive ascites, pleural effusion and elevation of CA-125 with a history of SLE diagnosis. One of these cases was diagnosed with PPMS and another associated with neoplasm of ovarian origin.

Human mesenchymal stem cells for the management of systemic sclerosis. Systematic review

INTRODUCTION

Sistemic Sclerosis (SSc) is a heterogeneous autoimmune disease with a high rate of progression and therapeutic failure, and treatment is a challenge, new therapeutic proposals being needed, being mesenchymal stem cells (MSCs) considered as alternative therapy for SSc for its immunomodulatory capacity. We evaluated the efficacy and safety of human MSC (hMSC) in patients with SSc through a systematic literature review (SLR).

METHODS

SLR (PRISMA guideline) on MEDLINE/OVID, LILACS, EMBASE, and Cochrane/OVID bases (until July 2020, without limits). All types of clinical studies were considered: patients ≥18 years old with SSc and treatment with hMSC.

EXCLUSION CRITERIA

animal models, autologous/allogenic hematopoietic stem cell transplants, narrative reviews, letters to the editor. MeSH and "Key word" terms were used. The level of evidence and the quality rating were rated [Joanna Briggs Institute (JBI) lists]. Registration in PROSPERO repository (ID CRD42020185245) The Synthesis Without Meta-analysis (SWiM) guideline was followed.

RESULTS

We initially identified 508 articles, of which 11 were finally included (8 case series and 3 case reports). The 11 articles included 101 patients (85 female, age range 18-75 years). The level of evidence was mostly 4 (JBI); the quality of evidence was met (≥50% of JBI items). SWiM showed that vascular skin involvement (digital ulcers, necrosis, and gangrene) and associated pain were the predominant outcomes, while improvements were found in almost all cases. One patient died in the first month, and the frequency of complications was low. Expanded hMSCs were used in 24 patients and other cell sources in the remaining patients.

CONCLUSION

There is too little reported data to reach definite conclusions about the use of hMSC in SSc. Further studies with better epidemiological designs are needed to evaluate the benefit of hMSCs in SSc patients.

T Helper 17 Response to Severe Acute Respiratory Syndrome Coronavirus 2: A Type of Immune Response with Possible Therapeutic Implications

The initial immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) includes an interferon-dependent antiviral response. A late and uncontrolled inflammatory response characterized by high activity of proinflammatory cytokines and the recruitment of neutrophils and macrophages develops in predisposed individuals and is potentially harmful in some cases. Interleukin (IL)-17 is one of the many cytokines released during coronavirus disease 2019 (COVID-19). IL-17 is crucial in recruiting and activating neutrophils, cells that can migrate to the lung, and are heavily involved in the pathogenesis of COVID-19. During the infection T helper 17 (Th17) cells and IL-17-related pathways are associated with a worse outcome of the disease. All these have practical consequences considering that some drugs with therapeutic targets related to the Th17 response may have a beneficial effect on patients with SARS-CoV-2 infection. Herein, we present the arguments underlying our assumption that blocking the IL-23/IL-17 axis using targeted biological therapies as well as drugs that act indirectly on this pathway such as convalescent plasma therapy and colchicine may be good therapeutic options.

Unstimulated whole salivary flow in Sjögren's Syndrome: systematic literature review and meta-analysis

BACKGROUND

Sjögren's Syndrome compromises the exocrine function, producing xerostomia and xerophthalmia. It can appear as an isolated condition or associated with other autoimmune diseases (polyautoimmunity). The Unstimulated Salivary Flow rate (UWSF) is used to quantify saliva production. There is no objective evidence to differentiate the values in patients with Sjögren's versus healthy people or patients with non-Sjögren's sicca. The objective of the present review was to evaluate the UWSF in patients with Sjögren's syndrome in comparison to controls (healthy and non-Sjögren's sicca patients).

METHODS

A systematic literature review was carried out (PRISMA guidelines). Analytical observational studies of cases and controls, cross-sectional studies, cohort studies and randomized clinical trials (including healthy controls) were considered. The Medline/OVID, Lilacs, Embase, and Cochrane/OVID databases were consulted. MeSH, DeCS, keywords, and Boolean operators were used. The meta-analysis (RevMan 5.2) was done through the random-effects model [mean difference (MD)]. Level and quality of evidence were evaluated by the Oxford Center Levels of Evidence and Joanna Brigs list respectively.

RESULTS

Thirty-two articles were included (20 were case-control studies, 6 were cross-sectional, 2 prospective cohort, 2 retrospective cohort, and 2 studies were abstracts) and 28 were meta-analyzed. The unstimulated whole salivary flow rate in the Sjögren's group was lower than in controls (healthy and patients with non-Sjögren Sicca syndrome) (MD-0.18 ml/min; 95% CI, - 0.24 to - 0.13; chi²-P-value < 0.00001). Heterogeneity was 97% and there was publication bias (funnel plot). The level of evidence was mostly 3 or 4. The quality of evidence was met (97% of items valued).

CONCLUSION

For the first time, the unstimulated whole salivary flow rate is found to be lower in patients with Sjögren's syndrome compared to controls (healthy and non-SS sicca) through a meta-analysis.

TRIAL REGISTRATION

PROSPERO CRD42020211325 .

ASIA syndrome symptoms induced by gluteal biopolymer injections: Case-series and narrative review

Background

The number of plastic surgery procedures have been rising in the last few years. The morbi-mortality due to illegal use of biopolymers is a public health problem. One of the clinical consequences, foreign body modelling reaction, may be a precursor of ASIA (Autoimmune/Inflammatory disease induced by adjuvants) syndrome.The objective of this article is to present a case-series study of patients who developed ASIA syndrome following gluteal injection with biopolymers and emphasize the importance of toxic exposure in triggering autoimmune responses. A surgical technique used on some of the patients in the study is described.

Methods

A group of thirteen patients, diagnosed with foreign body modelling reaction, who developed ASIA syndrome confirmed by approved criteria was followed between May 2016 and May 2018. The "Butterfly Wings Technique," a new surgical procedure for patients who have medium to severe compromise, was used on five of them.A narrative literature review was done to look for subjects with ASIA syndrome and gluteal biopolymer infiltration.

Results

All the patients in the present case-series with foreign body modelling reaction developed ASIA syndrome. Some of them had a background of familial autoimmunity. Five of the patients were surgically treated and saw a clinical improvement after the extraction of the biopolymer with the proposed technique.The narrative literature review identified 7 articles related to the disease through the database search.

Conclusions

We suggest that foreign body modelling reaction should be considered a precursor to ASIA syndrome. New research projects will be needed in the future to evaluate the factors that determine when ASIA syndrome is triggered in a patient with this reaction.

The use of digital tomosynthesis in rheumatology: a systematic review of the literature focused on four diseases

BACKGROUND AND AIMS

Digital tomosynthesis has proven useful in the evaluation of damage to joints. This study aims to describe the most common digital tomosynthesis findings for four rheumatological entities and to compare the usefulness of this technique with that of other imaging techniques.

MATERIALS AND METHODS

Following the PRISMA guidelines, we systematically searched the literature for articles about the use of digital tomosynthesis in rheumatoid arthritis, osteoarthritis, spondyloarthritis, and gout. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria to evaluate the quality of the articles included.

RESULTS

We included 13 articles. For rheumatoid arthritis, osteoarthritis, and spondyloarthritis, digital tomosynthesis detected bone abnormalities better than plain-film X-rays; however, for gout, the results were variable.

CONCLUSIONS

Digital tomosynthesis can play an important role in the evaluation of skeletal abnormalities in rheumatological disease, especially compared to plain-film X-rays.

Convalescent plasma in Covid-19: Possible mechanisms of action

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible of the coronavirus disease 2019 (COVID-19) pandemic. Therapeutic options including antimalarials, antivirals, and vaccines are under study. Meanwhile the current pandemic has called attention over old therapeutic tools to treat infectious diseases. Convalescent plasma (CP) constitutes the first option in the current situation, since it has been successfully used in other coronaviruses outbreaks. Herein, we discuss the possible mechanisms of action of CP and their repercussion in COVID-19 pathogenesis, including direct neutralization of the virus, control of an overactive immune system (i.e., cytokine storm, Th1/Th17 ratio, complement activation) and immunomodulation of a hypercoagulable state. All these benefits of CP are expected to be better achieved if used in non-critically hospitalized patients, in the hope of reducing morbidity and mortality.

Convalescent plasma in Covid-19: Possible mechanisms of action

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible of the coronavirus disease 2019 (COVID-19) pandemic. Therapeutic options including antimalarials, antivirals, and vaccines are under study. Meanwhile the current pandemic has called attention over old therapeutic tools to treat infectious diseases. Convalescent plasma (CP) constitutes the first option in the current situation, since it has been successfully used in other coronaviruses outbreaks. Herein, we discuss the possible mechanisms of action of CP and their repercussion in COVID-19 pathogenesis, including direct neutralization of the virus, control of an overactive immune system (i.e., cytokine storm, Th1/Th17 ratio, complement activation) and immunomodulation of a hypercoagulable state. All these benefits of CP are expected to be better achieved if used in non-critically hospitalized patients, in the hope of reducing morbidity and mortality.

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Coronavirus disease 19 (COVID-19) is an emerging viral threat with major repercussions for public health.

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There is not specific treatment for COVID-19.

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Convalescent plasma (CP) emerges as the first option of management for hospitalized patients with COVID-19.

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Transference of neutralizing antibodies helps to control COVID-19 infection and modulates inflammatory response.

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Other plasma components may enhance the antiviral and anti-inflammatory properties of CP.

Endothelial dysfunction and arterial stiffness in patients with systemic lupus erythematosus: A systematic review and meta-analysis

BACKGROUND AND AIMS

Non-invasive surrogates of cardiovascular (CV) disease such as endothelial dysfunction (ED) and peripheral arterial stiffness (AS) have been evaluated in systemic lupus erythematosus (SLE) patients. The aim of this study was to systematically review and meta-analyze reports of cardiovascular disease (CVD) in SLE patients, as measured by ED and AS.

METHODS

Studies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AIx], pulse wave velocity [PWV]) were systematically searched for in PubMed, Cochrane library, EMBASE, VHL, SciELO and Web of Science databases. Inclusion criteria included peer-review and English language. Mean differences (MD) and 95% confidence intervals (CIs) were estimated using the random effect model. The study was registered with PROSPERO, number CRD42019121068.

RESULTS

The meta-analysis included 49 studies. FMD data from 18 studies including 943 SLE subjects (mean age = 38.71 [95%CI 36.21, 41.21] years) and 644 unaffected controls (mean age = 38.63 [95%CI 36.11, 41.15] years) were included. When compared with unaffected controls, FMD in SLE subjects was decreased by 4.3% (95%CI: -6.13%, -2.47%): p < 0.001). However, NMD did not significantly differ between SLE patients and controls (MD = - 2.68%; 95% CI -6.00, 0.62; p = 0.11). A significantly increased AS between SLE patients and controls according to overall PWV (MD = 1.12 m/s; 95% CI 0.72-1.52; p < 0.001) was observed, but not for the brachial-ankle PWV. AIx was also increased in SLE patients compared with healthy controls (MD = 4.55%; 95% CI 1.48-7.63; p = 0.003).

CONCLUSIONS

Overall, SLE patients showed impaired FMD, an independent predictor of CV events. There was a higher degree of AS in SLE patients compared with controls. ED and AS in SLE should be considered when planning preventive strategies and therapies.

Clinical and sociodemographic factors associated with lupus nephritis in Colombian patients: A cross-sectional study

INTRODUCTION

Over the past decades, incidence of SLE (Systemic Lupus Erythematosus) has increased due to early case detection and improved survival of patients. SLE presents at an earlier age and has a more severe presentation in African-American, Native American, Asian, and Hispanic populations. Worldwide, lupus nephritis (LN) is observed in 29-60% of SLE patients, it has a negative impact in renal survival and patient mortality. Several cohorts have established potential risk factors associated with lupus nephritis, such as male sex, serological markers, and some extra-renal manifestations.

OBJECTIVES

To describe sociodemographic, clinical, immunological, and environmental risk factors in Colombian SLE patients and to compare the population with and without nephritis, in order to establish risk factors and possible associations.

MATERIALS AND METHODS

A total of 1175 SLE patients participated in this study. During medical care, an interview and structured survey was conducted and later registered in a database. Sociodemographic, clinical, immunological, and environmental exposure variables were analyzed. Bivariate and multivariate analyses were performed using presence of LN as an outcome.

RESULTS

Prevalence of LN was 38.7%. Variables significantly associated with LN included being male (OR 1.98), a duration of SLE>10 years (OR 1.48), positive anti-DNA (OR 1.34), positive anti-Sm (OR 1.45), and smoking (OR 1.66). Being non-smoker was a protective factor (OR 0.52).

CONCLUSION

This study describes potential factors associated with lupus nephritis in a Latin American population. Smoking status could be a target for intervention as it is a modifiable risk factor. The association between being male and LN is observed in Latin-American populations such as presented here. Further research in other large-scale population studies and more efforts are needed to gain better insights to explicate these relationships.

Subcutaneous abatacept in rheumatoid arthritis: A real-life experience

Objectives

To assess the effectiveness, safety, and drug survival of subcutaneous (SC) abatacept (ABA) in a cohort of rheumatoid arthritis (RA) patients in a real-world setting.

Methods

This was a retrospective cohort study from 2014 to 2018 in which patients with RA (1987 ACR criteria) were included. Patients were evaluated at a single rheumatology outpatient center in Bogotá, Colombia. The patients were classified according to their treatment background: biological-naïve (n = 65), switched from IV to SC ABA administration (125 mg-wk) (n = 32), and inadequate response to biological DMARD (n = 62). The primary endpoint was a change in DAS28-CRP and RAPID3 from baseline to 12 months. A linear mixed effect model was used to correlate repeated measures. Adverse events were assessed and recorded during each visit to the rheumatology center. Several Cox proportional hazard regression models were used to test if there were any differences in drug survival curves based on seropositivity for rheumatoid factor (RF), and anti-Cyclic Citrullinated Peptide Antibodies (anti-CCP). Statistical analysis was done using software R version 3.4.4.

Results

A total of 159 patients were included. Baseline characteristics of patients were as follows: female gender 84%, median age of 54 years (IQR 16), median disease duration 10 years (11), RF positive 96%, anti-CCP positive 89%, erosive disease 55%, median DAS28-CRP 5.0 (2), and median RAPID3 17 (10). Concomitant use of methotrexate and SC ABA monotherapy were reported at 52% and 30% respectively. Demographics and disease characteristics were similar for all groups, except for baseline DAS28-CRP, and RAPID3 in the group that switched route of administration. The interaction between time and group was significant (p = 0.0073) for RAPID3. Infections, constitutional symptoms, and headaches were the most frequent AEs. Retention rate corresponded to 60% at 48 months. The most frequent reason for drug suspension was loss of efficacy. Median time of treatment for SC ABA was 31 months (IQR 30). The only association that reached statistical significance was anti-CCP concentration [Q1–Q4] (p = 0.005). According to the Cox proportional hazard regression model, there were significant differences between survival curves for Q1 (HR 0.15; 0.03–0.64 95% CI; p = 0.0096), and Q2 (HR 0.28; 0.08–0.92 95% CI; p = 0.0363) compared to the seronegative group.

Conclusions

The results showed an improvement in RA disease activity and physical function in patients under SC ABA treatment. Patients switching from IV to SC administration of ABA had lower activity and functional impairment at baseline. SC ABA demonstrated a good safety profile consistent with previously published data. Patients with baseline levels of anti-CCP antibody concentrations had better drug survival than seronegative patients.

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Only a few studies have evaluated the effectiveness and safety of ABA in patients with RA in routine clinical practice.

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RAPID3 appears to be an attractive option for evaluating disease activity in RA patients in a real-life setting.

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SC administration of ABA demonstrates a safety profile consistent with previously published data.

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Prognostic factors for drug retention have not been explored thoroughly despite data for ABA being available from national registries.

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SC ABA survival tends to be better in a subset of anti-CCP seropositive patients with RA.