AB1172 POSTER: SARS-COV 2 INFECTION AND ANTI TNF THERAPY IN RHEUMATOID ARTHRITIS PATIENTS

Background

High levels of tumor necrosis factor (TNF), a key proinflammatory cytokine, is associated with SARS-CoV-2 infection. In rheumatoid arthritis patients with SARS-CoV-2 infection, anti TNF therapy reduces not only TNF but other cytokines responsible for high morbidity and mortality.

The severe systemic inflammation in COVID-19 causes respiratory symptoms, fever, fatigue, neurological and gastrointestinal manifestations.

Objectives

We followed the evolution of SARS-CoV-2 infection in rheumatoid arthritis patients who received anti TNF blockers.

Methods

Our study included 95 rheumatoid arthritis patients who were diagnosed with SARS CoV-2 infection through a positive RT-PCR-SARS-CoV2 test. 21 patients were men and 74 were women. Mean age was 58 ±11,5. 24 patients received monotheraphy with anti TNF blockers (Adalimumab/ Infliximab), 48 received TNF blockers in combination with Methotrexate (10 mg per week) and 23 received TNF blockers in combination with Leflunomide (20 mg per day).

We followed serum ferritin, C reactive protein and D-dimer in all patients. 59 patients were vaccinated with two doses of Pfizer-BioNtech (64.1 %).

The study group was analyzed from 30th December 2021 to 1st of January 2022. From 95 patients, 35 (36,8%) were hospitalized and 60 received ambulatory care.

Results

Our patients with COVID-19 presented with asimptomatic forms, forms with mild symptoms and complicated forms that required hospitalization. No patients had died.

Milder forms were associated with the use of TNF blockers and Methotrexate and patients with monotherapy – TNF blockers. They presented with mild symptoms (fever, arthralgia, odynophagia, dysgeusia/ageusia, anosmia). Hospitalization rate in patients who received monotheraphy with TNF blockers was 29,1%, 31,2% in patients who received TNF blockers and Methotrexate and 56,5% in patients with TNF blockers and Leflunomide (69,3%). Factors associated with higher odds of hospitalization included older age (p=0,001), active disease (p=0,02), obesity (p=0,005), pulmonary chronic disease (p=0,02), diabetes (p=0,001) and concomitent dose of Leflunomide (p=0,0006).

Female sex was associated with milder forms of the disease. Patients with high levels of D-dimer had a higher odd of hospitalization (p<0,001). Strong positive correlation was observed between elevated D-dimers and hospitalization odds.

Conclusion

TNF blockers in monotheraphy or associated with Methotrexate were correlated with lower odds of hospitalization and milder forms of COVID-19. No significant difference of hospitalization odd was observed between vaccinated and unvaccinated patients.

References

[1]Brito CA, Paiva JG, Pimentel FN, et al. COVID-19 in patients with rheumatological diseases treated with anti-TNF. Annals of the Rheumatic Diseases 2021;80:e62.

[2]Alesi M, Shojaie B, Farajzadegan Z, Salesi N, Mohammadi E. TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case-Control Study. Rheumatol Ther. 2021 Jul 23:1-16. doi: 10.1007/s40744-021-00342-8. Epub ahead of print. PMID: 34316436.

[3]Baslilar S, Pehlivan O. Evaluation of factors affecting the frequency and clinical course of COVID-19 in patients using anti-TNF-alpha agents. Rev Assoc Med Bras (1992). 2021 Sep;67(9):1286-1292. doi: 10.1590/1806-9282.20210568. PMID: 34816922.

Disclosure of Interests

None declared

SAT0220 BIOLOGICAL PREDICTORS OF ECHOGRAPHIC SALIVARY GLAND INVOLVEMENT SEVERITY IN PATIENTS WITH SJÖGREN’S SYNDROME

Background:

Echographic evaluation of salivary gland increasingly became a routine imaging modality in patients with Sjogren’s syndrome (SS). However, predictive parameters associated with the severity of echographic features are still incomplete evaluated.

Objectives:

The aim of this study was to evaluate the predictors for severe echographic involvement in patients with SS followed in a tertiary center.

Methods:

We included 63 patients with SS (mean age: 52.3±11.9; 59 female). The complete laboratory workup, clinical manifestations and treatment were reviewed and the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was calculated for each patients. We performed the standard echographic evaluation of salivary gland in all patients and used a 4 grade system for severity staging.

Results:

The distribution of echographic grade was: no any echographic features – 4 pts (6.3%); grade 1 - 24 pts (38.1%); grade 2 – 20 pts (31.7%); grade 3 – 10 pts (15.9%); grade 4 – 5 pts (7.9%). The ESSDAI and the hydroxichloroquine use were similar in these subgroups. We didn’t find differences regarding CRP and fibrinogen and echographic features. The age of the patients, the anti-SSA and anti-SSB, ESR, total protein, IgA, IgG and rheumatoid factor levels were significantly higher and lymphocyte count was lower in patients with echographic severity above grade 2 when compared with patients with no or mild echographic features. However, using ANOVA test and post-hoc analysis, the only parameters associated with the severity of echographic features were high ESR (53 vs 17 in grade 4 vs 1, p=0.02), IgA (363 vs 190 in grade 4 vs 1, p=0.004) and IgG (1985 vs 1191 U/l in grade 4 vs 1, p=0.001) levels.

Conclusion:

Parameters linked to polyclonal hypergammaglobulinemia (IgA and IgG levels; and ESR) seem to be linked to the severity of echographic appearance of salivary gland in patients with SS. Further studies are needed in order to better characterize this link.

Disclosure of Interests:

Ancuta MIHAI: None declared, DENISE MARDALE: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Ciprian Jurcut: None declared

AB0429 NEUTROPHIL TO LYMPHOCYTE RATIO INDEPENDENTLY PREDICTS CUTANEOUS MANIFESTATIONS IN PATIENTS WITH SJÖGREN’S SYNDROME

Background:

Various cutaneous manifestations are described in patients with Sjogren’s syndrome (SS). However, the predictors for its occurrence are not fully investigated. Recently, data regarding the role of hematological parameters ratios in patients with rheumatic diseases were reported. However, routine hematological parameters and the derived ratios were not studied in SS patients.

Objectives:

The aim of this study was to evaluate the predictors for cutaneous manifestations in a large cohort of patients with SS followed in a tertiary center.

Methods:

We included 114 patients with SS (mean age: 53.1±12.1; 94.7% female). We divided the patients in group A – patients with cutaneous manifestations and group B – without cutaneous manifestations. The complete laboratory workup [including the calculation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) to platelet ratio, platelet distribution width (PDW) to platelet ratio], clinical manifestations and treatment were reviewed and the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was calculated for each patients.

Results:

Cutaneous manifestations were diagnosed in 11 patients (9.6%). The age of the patients, the levels of anti-SSA, complement, inflammatory markers (ESR, CRP), immunoglobulins and vitamin D levels, the ultrasonographic score of salivary glands and the ESSDAI value were similar in both groups. The patients with cutaneous manifestations were more frequently treated with hydroxychloroquine (9/11 vs 49/103, p=0.03) but the mean doses were similar in both groups. The values of anti-SSB were marginally higher in patients with cutaneous manifestations (102.3±83.1 vs 53.6±79.9, p=0.07). The lymphocyte, neutrophil count, MPV and PDW were similar in both groups, while platelet count was lower in patients with cutaneous manifestations (224090.9±59528.9 vs 264339.8±60669.0, p=0.03). The MPV/Plt ratio tended to be higher in patients with cutaneous manifestations (0.051±0.017 vs. 0.043±0.013, p=0.07), but the values of PDW/Plt ratio (0.064±0.022 vs 0.051±0.018, p=0.03) and of NLR (3.82±2.30 vs 2.35±0.92, p=0.001) were found to be significantly higher in these patients. In multivariate analysis, only the NLR remains independently associated with cutaneous manifestations (p=0.001). Using the ROC curve analysis, a cutoff of 2.70 for NLR had a 63% sensitivity and 69% specificity for cutaneous manifestations.

Conclusion:

The hematological parameters related to platelets appear to be modified in patients with SS and cutaneous manifestations. However, only neutrophil to lymphocite ratio is independently associated with cutaneous involvement in these patients.

Disclosure of Interests:

Ancuta MIHAI: None declared, DENISE MARDALE: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Ciprian Jurcut: None declared

Self-reported disease severity in women with systemic lupus erythematosus

Systemic lupus erythematosus (SLE), pathology with net feminine predominance, is one of the most complex autoimmune diseases and has major impact on patients' life. The aim is to identify patient and disease-related factors associated with self-perceived disease severity in female SLE patients. This cross-sectional study enrolled 73 women fulfilling the 2012 Systemic Lupus International Collaborating Clinic (SLICC) criteria. SLE disease activity was assessed by the Systemic Lupus Activity Measure (SLAM) score and overall damage by the SLICC/American College of Rheumatology (ACR) index. Patients' general characteristics, associated conditions as well as SLE specific clinical involvements and therapeutic principles were also noted. Fatigue was assessed by FACIT-fatigue scale. Self-perceived disease severity was assessed using numerical rating scales (1-10 NRSs), to evaluate the disease severity at inclusion (1-10 NRS now) and worst severity anytime during disease history (1-10 NRS worst ever). In regard to worst ever lupus severity, 54.8% of patients responded with 9 or 10, while none with 1 or 2 even if only 22.9% of the patients responded with 7 or more for disease severity at inclusion (1-10 NRS now). Women with higher 1-10 NRS now answers had also higher 1-10 NRS worst ever, SLAM, SLICC, and FACIT-fatigue scores. They associated more frequently anxiety/depression diagnosis, antiphospholipid syndrome, joint involvement as well as treatments with corticosteroids. Self-reported disease severity worst ever, anxiety/depression diagnosis, fatigue, and the daily dose of corticosteroids were independently associated with patients' perception on lupus severity at inclusion: OR (95% CI), 2.13 (1.15-3.94) p = 0.017, 6.67 (1.11-39.97) p = 0.038, 1.10 (1.02-1.19) p = 0.018, and 1.11 (1.02-1.21) p = 0.020, respectively. The vast majority of patients identified severe and very severe events during their disease history, results that raise awareness of burden concerning lupus occurrence in women's life. Self-perceived lupus severity is multifactorial, influenced also by factors less considered in the SLE management like fatigue and the depression/anxiety disorders, but also by the previous patient's experience.

Is there still a place for erythrocyte sedimentation rate and C-reactive protein in systemic lupus erythematosus?

The inflammatory response during systemic lupus erythematosus (SLE) flares is known to be atypical, characterized by a disproportionately lower C-reactive protein (CRP) elevation when compared with erythrocyte sedimentation rate (ESR). Thus, in these patients, the analysis of inflammatory markers might be challenging in daily clinical practice. Clinicians need frequently to distinguish lupus reactivations and infectious conditions, and the significance of ESR and CRP seems to be different. Even though a non-specific marker of inflammation, ESR utility in SLE should not be neglected and it appears to be a useful biomarker for SLE activity assessment. Describing a specific cut-off for ESR in SLE is important for patients' follow-up, and levels up to 25-30 mm/h have been proposed as an upper limit of the normal range. Regarding CRP, even though higher baseline levels are described in SLE when compared with controls, including in remission periods, its response during flares seems to be incomplete and not always correlated with disease activity; while CRP values greater than 10 mg/l could be indicative for severe flares, when there is no serositis or arthritis, higher CRP levels above 50-60 mg/l may be associated with infection.

Extended Antiphospholipid Antibodies Screening in Systemic Lupus Erythematosus Patients

BACKGROUND

The antiphospholipid syndrome (APS) is one of the most encountered autoimmunity in systemic lupus erythematosus (SLE) patients and pathogenesis of these two seems to be intricate.

AIM

To investigate the association of antiphospholipid antibodies (APLAs) titer with the presence of secondary APS diagnosis in SLE patients.

METHODS

65 patients fulfilling the 2012 Systemic Lupus Collaborating International Clinics (SLICC) SLE's criteria were included. The APS diagnosis was sustained according to the 2006 Sydney APS's criteria. Three groups of patients were defined: SLE patients with secondary APS, SLE with history of positive "criteria" APLAs but without APS clinical features, respectively SLE patients without positive APLAs or clinical APS criteria. An extended APLAs panel was searched in all cases: both IgM and IgG of anticardiolipin antibodies (aCL), anti-P2 glycoprotein I antibodies (aβ2GPI), antiphosphatidylethanolamine antibodies (aPE), antiphosphatidylserine antibodies (aPS), respectively antiprothrombin antibodies (aPT). Results. Only the aβ2GPI, both IgM and IgG serotypes, had significantly higher titers in patients with SLE and secondary APS compared to no APS (with/ without positive APLAs): median (min; max) 7.0 (0.0-300.0) vs. 1.0 (0.0-28.0) vs. 1.0 (0.0-12.0), respectively 3.0 (0.0-79.0) vs. 1.0 (0.0-3.0) vs. 1.0 (0.0-12.0) (p<0.001, Kruskal-Wallis test)]. Also, in regression logistic models, only the aβ2 GPI (IgG and IgM ) were identified as risk factors for secondary APS diagnosis in the SLE patients: OR(95%CI) 5.9 (2.2-15.7), respectively 1.3 (1.1-1.5). In regard with the SLE markers, the IgG serotypes of the "non-criteria" APLAs analyzed (aPS, aPT, aPE) were correlated with the antiDNA titers while the IgM serotypes inversely associated with the complement C3 levels.

CONCLUSIONS

IgG aβ2 GPI are accompanied by almost 6-fold increase risk of secondary APS when screening SLE patients. On the contrary, the "non-criteria" APLAs do not seem associated with the APS diagnosis in SLE patients. Some correlates of the "non-criteria" APLAs with the antiDNA and complement C3 levels were also observed.

Polycystic hepatic disease

Polycystic hepatic disease is a very rare hereditary disease. Most of the patients have no symptoms but sometimes they present abdominal discomfort, fever, jaundice. Almost half of the patients associate renal cysts. Rarely, the cysts may appear in other organs such as the pancreas, the spleen or the lung. We present a case of polycystic hepatic disease. In our patient the cysts replace almost the entire hepatic structure. However, the hepatic functional tests were normal.

Hypertension in obese patients: a dysmetabolic hypertension with a possible adipocyte dysfunction mechanism

Large longitudinal studies showed the epidemiological link between obesity and hypertension. During last years, multiple possible mechanisms involved in this association were identified. Adipose tissue has an important role in the genesis of hypertension in obese patients through several pathways: insulin resistance, leptin, renin-angiotensin-aldosteron system and mediators of inflammation (TNF-alpha, IL-6). Adipocyte may be the major player in the development of insulin resistance and hypertension, elements of the metabolic syndrome, responsible for the cardiovascular complications.

Pulse pressure and inflammatory markers in apparently healthy premenopausal women

Several epidemiological studies showed that pulse pressure (PP), as a marker of large arterial stiffness, is an independent predictor of cardiovascular risk. A high pulse pressure may induce lesions of the vessel walls and of the endothelium of the large arteries. Now, inflammation represents one of the most extensively studied pathways involved in the pathogenesis of cardiovascular disease. The aim of the present study was to evaluate if usual markers of systemic inflammation were correlated with pulse pressure. In fifty-four apparently healthy premenopausal women, without any known disease, we performed anthropometrical and blood chemistry measurements, together with the standard measurements of blood pressure. Mean values of fibrinogen are significantly more elevated in PP > 50 mmHg group than in PP < 50 mmHg group (364.79 +/- 71.07 vs. 329.31 +/- 57.81, P < 0.05). Fibrinogen was also significantly correlated with PP (r = 0.27, P < 0.05). However, after controlling for age the correlation between PP and fibrinogen was not significant (r = 0.18, P = NS). ESR was significantly correlated with PP (r = 0.31, P < 0.05) and systolic blood pressure (SBP) (r = 0.32, P < 0.05) but not with diastolic blood pressure (DBP). After controlling for age the correlation between PP and erythrocyte sedimentation rate (ESR) was not significant (r = 0.20, P = NS), but after controlling for body mass index (BMI) this correlation became significant (r = 0.28, P < 0.05). White blood cell (WBC) was not correlated with age, SBP, DBP, PP, age and BMI and the mean values of WBC were increased in the PP > 50 mmHg group, but not significantly (6637.93 +/- 1615.19 vs. 6416.67 +/- 1427.57, P = NS). In our study we found that ERS and fibrinogen values are related to pulse pressure values. Otherwise, blood pressure values, including pulse pressure, were correlated with the age of the subjects and the correlation between pulse pressure and inflammatory markers (ESR and fibrinogen) was not significant after controlling for age. After controlling for BMI, the correlation between ESR and PP remains significant.