Thresholds for unacceptable work state in radiographic axial Spondyloarthritis of four presenteeism and two clinical outcome measurement instruments

OBJECTIVES

To a) identify threshold values of presenteeism measurement instruments that reflect unacceptable work state in employed r-axSpA patients; b) determine whether those thresholds accurately predict future adverse work outcomes (AWO) (sick leave or short/long-term disability); c) evaluate the performance of traditional health-outcomes for r-axSpA; d) explore whether thresholds are stable across contextual factors.

METHODS

Data from the multinational AS-PROSE study was used. Thresholds to determine whether patients consider themselves in an 'unacceptable work state' were calculated at baseline for four instruments assessing presenteeism and two health-outcomes specific for r-axSpA. Different approaches derived from the receiver operating characteristic methodology were used. Validity of the optimal thresholds was tested across contextual factors and for predicting future AWO over 12 months.

RESULTS

Of 366 working patients, 15% reported an unacceptable work state; 6% experienced at least one AWO in 12 months. Optimal thresholds were: WPAI-presenteeism ≥40 (AUC 0.85), QQ-method <97 (0.76), WALS ≥0.75 (AUC 0.87), WLQ-25 ≥ 29 (AUC 0.85). BASDAI and BASFI performed similarly to the presenteeism instruments: ≥4.7 (AUC 0.82) and ≥3.5 (AUC 0.79), respectively. Thresholds for WALS and WLQ-25 were stable across contextual factors, while for all other instruments they overestimated unacceptable work state in lower educated persons. Proposed thresholds could also predict future AWO, although with lower performance, especially for QQ-method, BASDAI and BASFI.

CONCLUSIONS

Thresholds of measurement instruments for presenteeism and health status to identify unacceptable work state have been established. These thresholds can help in daily clinical practice to provide work related support to r-axSpA patients at risk for AWO.

Looking through the window of opportunity in axial spondyloarthritis?

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that affects the spine and sacroiliac joints, that can lead to irreversible structural damage. Early detection and timely intervention are crucial for preventing long-term structural damage, improving quality of life, and reducing the burden of the disease. The concept of a window of opportunity suggests that an early intervention in the reversible stage of the disease can lead to improved long-term outcomes. However, it is unclear whether this concept applies in axSpA. Recent advances in axSpA management, including the use of diagnostic techniques such as magnetic resonance imaging as well as the use of advanced therapies, have shown promise in improving outcomes. However, studies investigating the potential window of opportunity in axSpA by assessing the impact of an early treatment on clinical outcomes have yielded inconclusive results. One of the reasons behind this is the lack of a standardized definition of early axSpA. The Assessment of Spondyloarthritis International Society (ASAS)-SPEAR (SPondyloarthritis EARly) project has set the ground for it by working on a consensus definition of early axSpA. Randomized controlled trials specifically focused on the comparison between treating axSpA in the early and late stages of the disease and using the standardised definition of early axSpA are essential to understand better the potential benefits of an early treatment on clinical outcomes. Additionally, it would be relevant to assess the long-term outcomes of early axSpA treatment, especially regarding structural damage, to better grasp the concept of the window of opportunity in axSpA.

ASAS consensus definition of early axial spondyloarthritis

OBJECTIVES

To develop a consensual definition for the term 'early axial spondyloarthritis-axSpA'-and 'early peripheral spondyloarthritis-pSpA'.

METHODS

The ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting).

RESULTS

Following the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151-164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA 'early axSpA' should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour).

CONCLUSIONS

Early axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.

Treating spondyloarthritis early: does it matter? Results from a systematic literature review

OBJECTIVE

To summarize evidence on the relationship between early treatment (definition based on symptom/disease duration or radiographic damage) and treatment clinical response in patients with SpA.

METHODS

A systematic literature review was conducted in studies on SpA patients treated with NSAIDs or b/tsDMARDs addressing the impact of symptom/disease duration or presence of radiographic damage on treatment response assessed by any disease activity outcome. For categorical outcomes, relative risk, relative risk ratio (RRR) and number needed to treat were calculated, and for continuous outcomes, differences in differences, to compare groups stratified based on symptom/disease duration or the presence of radiographic damage.

RESULTS

From the 8769 articles retrieved, 25 were included and 1 added by hand-search, all in axSpA, most of them with low risk of bias. Twenty-one studies compared groups based on symptom duration (n = 6) or disease duration (n = 15) and 7 studies based on absence/presence of radiographic damage (2 studies used two comparisons). When early axSpA was defined by symptom duration (<5 years) in RCTs, early treatment was associated with better outcomes in patients with nr-axSpA (n = 2, ASAS40 RRR 5.24 (95%CI 1.12-24.41) and 1.52 (0.60-3.87)) but not in r-axSpA (n = 1) [ASAS20 0.96 (0.53-1.73)]. When early axSpA was defined based on disease duration or radiographic damage, no differences were found between groups.

CONCLUSION

Evidence towards better outcomes in early axSpA is very limited and restricted to nr-axSpA and <5 years symptom duration. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found.

Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study

OBJECTIVES

To investigate the influence of gender on disease outcomes in patients with spondyloarthritis (SpA), including across SpA subtypes.

METHODS

Data from 4185 patients of 23 countries with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or psoriatic arthritis (PsA) from the Assessment of SpondyloArthritis International Society (ASAS)-perSpA study were analysed. Associations between gender and disease activity (Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)), function (Bath Ankylosing Spondylitis Functional Index (BASFI)) and overall health (ASAS Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)) outcomes were investigated. Multilevel multivariable linear mixed models adjusted for relevant confounders (and stratified by disease subtype in case of a relevant interaction) were used.

RESULTS

In total, 65%, 10% and 25% of patients had axSpA, pSpA and PsA, respectively. axSpA was more frequent in males (68%), whereas pSpA and PsA were more frequent in females (53% and 52%, respectively). A significant interaction between gender and disease subtype was found for ASDAS, BASDAI and BASFI. While being female independently contributed to higher BASDAI across the three disease subtypes (with varying magnitude), female gender was only associated with higher ASDAS in pSpA (β (95% CI): 0.36 (0.15 to 0.58)) and PsA (0.25 (0.12 to 0.38)) but not in axSpA (0.016 (-0.07 to 0.11)). No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS HI and EQ-5D, without differences across disease subtype.

CONCLUSION

Female gender is associated with less favourable outcome measures across the SpA spectrum. However, while female gender influences BASDAI across the three subtypes, ASDAS is associated with gender only in pSpA and PsA but not in axSpA. Therefore, ASDAS is an appropriate instrument both for females and males with axSpA.

POS0972 MOST DISEASE OUTCOME MEASURES BUT NOT ASDAS ARE INFLUENCED BY GENDER IN PATIENTS WITH AXIAL SpA: RESULTS FROM ASAS-PerSpA

Background

There is growing evidence revealing that females report worse patient-reported outcomes compared to males in axial spondyloarthritis (axSpA). However, in which precise outcomes there is a meaningful difference across gender and whether this also occurs in patients with peripheral spondyloarthritis (pSpA) and psoriatic arthritis (PsA) is not fully understood.

Objectives

To investigate the influence of gender on disease outcomes in patients with SpA, including axSpA, pSpA and PsA, in a worldwide setting.

Methods

Data from 4185 patients with axSpA, pSpA or PsA from the ASAS-PerSpA study were analysed. The ASAS-PerSpA is a cross-sectional study that recruited consecutive patients with SpA (according to their rheumatologist) from 24 countries. Associations between gender and disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)], function [Bath Ankylosing Spondylitis Functional Index (BASFI)], and overall health [ASAS-Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)] were investigated. Multilevel (country) univariable and multivariable linear mixed models were used. Interactions between gender and disease phenotype (SpA, pSpA and PsA) were analysed, and if relevant, models were stratified by disease subtype. Models were adjusted for relevant confounders (Table 1).

Table 1.

Multivariable multilevel model by disease phenotype

OutcomeDeterminant of interestDisease phenotypeAxSpApSpAPsAASDAS +Gender (female vs male)0.02 (-0.07, 0.11)0.36 (0.15, 0.58)0.25 (0.12, 0.38)BASDAI *0.39 (0.20, 0.58)1.22 (0.77, 1.69)0.88 (0.59, 1.16)BASFI -0.01 (-0.14, 0.17)0.30 (-0.12, 0.71)0.46 (0.20, 0.72)CRP^-1.36 (-3.17, 0.44)ASAS-HI#0.90 (0.70, 1.10)EQ-5D°-0.02(-0.03, -0.01)

All models are adjusted by age, gender and education.

+Also adjusted for marital status, BMI, smoking, axial involvement, peripheral arthritis, enthesitis, fibromyalgia, NSAIDs, steroids, csDMARDs, bDMARDs

* Also adjusted for marital status, BMI, smoking, axial involvement, peripheral arthritis, enthesitis, psoriasis, fibromyalgia, NSAIDs, bDMARDs

- Also adjusted for marital status, BMI, ASDAS, radiographic damage, fibromyalgia, NSAIDs, bDMARDs

^ Also adjusted for marital status, BMI, radiographic damage, concomitant NSAIDs, steroids, csDMARDs

# Also adjusted for smoking, ASDAS, BASFI, peripheral arthritis, enthesitis, fibromyalgia

° Also adjusted for BMI, smoking, ASDAS, BASFI, radiographic damage, HLA-B27, enthesitis, fibromyalgia

Results are expressed in β (95% CI). Estimates with p<0.05 are highlighted in bold

Results

In total, 4185 patients were included, of which 2719, 1033 and 433 had a diagnosis of axSpA (mean age 42 years, 32% female), PsA (mean age 52 years, 52% female) and pSpA (mean age 44 years, 53% female), respectively. A significant interaction between gender and disease phenotype was found for ASDAS, BASDAI and BASFI. Multivariable models for each outcome are shown in Table 1 (stratified by disease phenotype). While being female independently contributed to higher BASDAI across the three disease phenotypes (though with varying magnitude), female gender was only associated with higher ASDAS in pSpA [β (95% CI): 0.36 (0.15, 0.58)] and PsA [0.25 (0.12, 0.38)] but not in axSpA [0.016 (-0.07, 0.11)]. Female gender was associated with higher BASFI in PsA [0.46 (0.20, 0.72)]. No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS-HI [0.90 (0.70, 1.10)] and EQ5D [-0.02 (-0.03, -0.01)], without significant differences across disease phenotype.

Conclusion

Female gender was associated with less favorable outcomes across the SpA spectrum, except for CRP in which there were no differences between gender. While female gender influenced BASDAI across disease phenotypes, ASDAS was not associated with gender in axSpA. These results suggests that ASDAS should be the preferred instrument in clinical practice both for females and males with axSpA.

Acknowledgements

We would like to thank all ASAS-perSpA investigators and members of the scientific committee.

Disclosure of Interests

Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Anna Moltó Consultant of: Abbvie, UCB, Novartis, Gilead, Pfizer, Lilly y Janssen, Grant/research support from: UCB, Clementina López-Medina Speakers bureau: Lilly, Novartis, Janssen, UCB and Abbvie, Maxime Dougados: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis

POS0508 PREDICTORS OF PERSISTENT DISEASE IN EARLY ARTHRITIS: 12 MONTHS RESULTS

Background

Early arthritis is an inflammatory disease with the potential to progress to persistent arthritis, such as established Rheumatoid Arthritis (RA) or other articular disease, to resolve spontaneously or remain undifferentiated for indefinite periods of time.

Objectives

To identify predictors of persistent RA after 12 months follow up in the Argentinean early arthritis clinic (CONAART).

Methods

We conducted an observational, prospective longitudinal study, including patients with early arthritis (at least 1 swollen joint with <2 years of evolution) who had at least one year of follow-up.

Sociodemographic and clinical data and characteristics of the disease were recorded at baseline, at 3, 6 and 12 months. After 1 year of follow-up, each patient was classified according to diagnosis: self-limited arthritis, persistent non-erosive arthritis, or persistent erosive arthritis.

The association between the different predictors of diagnosis at 12 months was evaluated using multiple logistic regression, adjusted by potential confounders. Rheumatoid Factor (RF) and Anti Citrullinated Peptide Antibodies (ACPA) were included in separate models in order to avoid multicollinearity. A value of p<0.05 was considered significant.

Results

We included 839 patients, 83% females, mean age of 57±14 years and mean disease duration of 8.2±6.2 months; 67.5% were rheumatoid factor positive and 59% ACPA positive. Disease characteristics at baseline were DAS28 5.1±1.4, swollen joints 6±5, erythrocyte sedimentation rate (ESR) 34±25 mm/h, C Reactive Protein (CRP) 4±6 and Health Assessment Questionnaire-Argentinean (HAQ-A) 1.2±0.8.

After 12 months follow up, 11% of the patients were diagnosed as self-limited disease, whereas 89% were diagnosed as persistent disease. For the persistent disease, 34% presented radiograph erosions and therefore were catalogued as persistent erosive disease.

The seropositivity for both, RF and ACPA, together with baseline DAS28, were the variables independently associated with the development of persistent disease at 12 months. [Model 1a: RF OR 2.33 (95% CI 1.44, 3.78) and DAS28 1.27 (1.06, 1.52); Model 2a: ACPA 2.61 (1.38, 4.93) and DAS28 1.59 (1.24, 2.04)]. (Table 1).

Table 1.

Predictors of Persistent Rheumatoid Arthritis at 12 months

OutcomesPersistent RAPersistent RAPersistent RAPersistent RAOR (95 IC)OR (95 IC)OR (95 IC)OR (95 IC)Model 1aModel 1bModel 2aModel 2bn708708507507Age (years)0.99 (0.98, 1.01)0.99 (0.98, 1.01)0.99 (0.97, 1.01)0.99 (0.97, 1.01)Female gender1.06 (0.57, 2.00)1.06 (0.56, 1.99)0.72 (0.30, 1.71)0.72 (0.30, 1.70)RF positive2.33 (1.44, 3.78)***2.45 (1.52, 3.98)***--ACPA positive--2.61 (1.38, 4.93)**2.63 (1.39, 4.98)**DAS28 at baseline1.27 (1.06, 1.52)**1.59 (1.24, 2.04)***Categorical DAS28  MDA (vs LDA)-1.81 (0.85, 3.86)^-2.86 (1.68, 6.99)*  HDA (vs LDA)-2.83 (1.30, 6.15)^-6.39 (2.42, 16.82)***

^ p<0.1, * p<0.05, ** p<0.01, *** p<0.001

RF, Rheumatoid Factor; ACPA, Anti Citrullinates Protein Antigen; DAS28, Disease activity Score-28; LDA, low disease activity; MDA, moderate disease activity; HDA, high disease activity.

In the patient prediction model, it can be observed that a patient with female gender, ACPA negative, and a low activity at baseline (DAS28 <3.1) presents a 62.3% of likelihood of developing persistent arthritis after 12 months, while a male patient, ACPA positive, with a high baseline activity level, the probability of having persistent disease rises to 97.5%. (Figure 1)

Figure 1.

Matrix prediction model. Probability of diagnosis of Persistent Rheumatoid Arthritis after 12 months of follow-up. Colors represents predictive probability of achieving the outcome as follow: grey: 0-69.9%; blue: 70.0-89.9%; purple: 90.0-100%.

DAS28, Disease Activity Score 28; LDA, low disease activity; MDA, Moderate Disease Activity; HDA, High Disease Activity.

Conclusion

Predictors of persistent arthritis after 12 months of follow up since AT diagnosis were RF and ACPA seropositivity and higher baseline disease activity level.

Disclosure of Interests

None declared.

POS0302 TREATING SPONDYLOARTHRITIS EARLY: DOES IT MATTER? RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

Background

So far, no consensus has been reached on a definition of early SpA. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims to develop a consensual definition. Therefore, it is important to know whether treatment earlier in the disease course compared to treatment of established disease leads to better outcomes in axSpA.

Objectives

To summarize the evidence on the relationship between symptom duration or the presence of radiographic damage and clinical response in patients with axSpA treated with NSAIDs, bDMARDs or tsDMARDs.

Methods

A SLR was conducted using Medline, EMBASE and the Cochrane Library (April 28, 2021), supplemented by hand-searches in the FDA website. Randomized controlled trials (RCTs) and cohort studies in patients with axSpA addressing the impact of symptom duration or disease duration and presence of radiographic damage on treatment response (to NSAIDs, b/tsDMARDs) were included. Based on a cut-off of symptom/disease duration or the absence/presence of radiographic damage, groups of ‘early’ and ‘established’ disease were compared. Treatment outcomes were measures of disease activity, function or quality of life.

Two reviewers independently identified eligible studies and extracted the data, including the risk of bias (RoB) assessment. For categorical outcomes we calculated relative risk (RR), relative risk ratio (RRR) and number needed to treat (NNT), and differences in differences (DID) for continuous outcomes.

Results

From the 8769 articles retrieved, 23 were included and 3 added by hand-search, most of them with low RoB. Nineteen studies (9 RCTs) compared groups based on symptom (n=6)/disease duration (n=13) and 7 studies (4 RCTs) based comparisons on absence/presence of radiographic damage in posthoc analyses.

When early axSpA was defined by symptom duration in RCTs (n=4), in patients with nr-axSpA, early treatment was associated with higher RR and RRR and lower NNT for ASAS40 in two studies (Table 1); a third study showed that patients achieving ASDAS-ID and ASAS-PR had shorter symptom duration than those not achieving this. Lastly, in one study including patients with axSpA patients, no difference in treatment response was observed based on symptom duration. In most of the cohort studies using a definition based on symptom/disease duration (n=10), no association was found between symptom/disease duration and treatment response (n=8). Only in one cohort study, disease duration was a significant predictor of quality of life, and in another cohort study, it was a predictor of functional improvement.

Table 1.

Assessment of treatment response in RCTs based on symptom duration

StudyPopulationEarly vs established (years)RR (early vs established)RRR (95%IC)NNTs (early vs established)ASAS20Landewé 2014axSpA<5 vs ≥51.5 vs 1.50.96 (0.53-1.73)5.5 vs 4.8ASAS40Sieper 2012nr-axSpA<5 vs ≥58.2 vs 1.65.24 (1.12-24.41)2.4 vs 9.1Kay 2019nr-axSpA<5 vs ≥55.0 vs 3.31.52 (0.60-3.87)2.1 vs 3.93.6 vs 3.51.01 (0.46-2.20)2.1 vs 2.9ASDAS-MIKay 2019nr-axSpA<5 vs ≥55.1 vs 6.50.78 (0.19-3.16)2.7 vs 4.97.1 vs 6.41.11 (0.34-3.66)2.1 vs 3.0StudyPopulationSymptom durationp valueRespondersNon respondersASDAS-IDSieper 2019nr-axSpA6.1±6.28.3±8.1<0.001ASAS-PRSieper 2019nr-axSpA5.3±5.78.0±7.8<0.001Cell coloursIn favor of early diseaseIn favor of establish diseaseNon significant

When early axSpA was defined based on disease duration or the presence of radiographic damage, there was no significant difference in response to treatment between early and established axSpA.

Conclusion

Studies addressing treatment response based on symptom duration or radiographic damage in axSpA are scarce.

When defining early axSpA based on symptom duration, in nr-axSpA, treatment with bDMARDs may lead to better outcomes compared to established axSpA whereas in axSpA there is no difference in response to treatment between early and established disease.

When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found between early and established disease.

Acknowledgements

The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work.

Disclosure of Interests

Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma

Director of Imaging Rheumatology bv., Robert Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB

POS0963 HOW IS EARLY SPONDYLOARTHRITIS DEFINED IN THE LITERATURE? RESULTS FROM A SYSTEMATIC REVIEW

Background

The term “early spondyloarthritis (SpA)” has been frequently used to refer to the first phase of the disease, however, no standardized definition on “early” has been established. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims at developing a consensual definition on what is meant by “early SpA”. In order to inform the ASAS-SPEAR working group, it is highly relevant to assess the current meaning of “early SpA” in the literature.

Objectives

To identify all possible definitions of “early SpA” employed in the literature, including “early axial SpA (axSpA)” and “early peripheral SpA (pSpA)”.

Methods

A systematic literature review was conducted in Medline, EMBASE and the Cochrane Library (through April 28th, 2021). The eligibility criteria were studies with any design, in adults that included any mention of “early SpA” or its subtypes in the title or abstract. Two reviewers independently identified eligible studies and extracted data, including the literal definition of early SpA used in each of them. The proportion of studies reporting a definition was calculated, and the different definitions were assessed, including the core of the definition: whether they were based on symptom duration, disease duration, radiographic damage, a combination of them or any other aspects, and their boundaries.

Results

Out of 9,651 titles identified, 355 publications reporting data from 186 studies were included (291 full papers, 64 conference abstracts). Among them, 217 (61%) were cohort studies, 72 (20%) were reviews and 46 (13%) were clinical trials. Over time, an increasing number of publications on early SpA were identified: <2005 (n=34), 2005-2010 (n=48), 2011-2015 (n=109) and 2016-2020 (n=164). Overall, 63 studies (34%) included the term “early axSpA”, 60 (32%) “early ankylosing spondylitis (AS)”, 58 (31%) “early SpA”, 4 (2%) “early non-radiographic axSpA (nr-axSpA)” and 1 (1%) “early pSpA”. In total, 116 (62%) studies reported a specific definition: 40 (34%) based it on symptom duration, 35 (30%) on radiographic damage, 32 (28%) on disease duration, 6 (5%) on both symptom/disease duration and radiographic damage, and 3 (3%) on other aspects. Symptom duration was defined as the time since the onset of low back pain in 21/40 (53%) studies, whereas in 14/40 (35%) the symptom of onset was not specified. Thirty-five of 116 studies (30%) included a definition referred to “early SpA”, 38 (33%) to “early axSpA”, 38 (33%) to “early AS”, 4 (3%) to “early nr-axSpA”, and 1 (1%) to “early pSpA”. Figure 1 shows the 18 distinct definitions that were identified (after combining some similar categories). The three most used definitions per subtype of disease are shown in Table 1. Regarding the studies that referred to “early axSpA”, the most used definition was symptom/disease duration <5 years, whereas for “early AS” was symptom/disease duration <10 years. After 2010, the definition of “early axSpA” based on the absence of radiographic sacroiliitis was less used compared to before 2010 (5/30, 17% vs 3/8, 38%).

Table 1.

Top 3 candidate definitions for “early SpA” and subtypes

Core of the definitionNumber of studies, n (%)SpA (n= 35)nr-axSpA10 (29%)< 2 years duration10 (29%)< 1 year duration6 (17%)AxSpA (n=38)< 5 years duration12 (34%)< 3 years duration9 (24%)nr-axSpA duration8 (21%)AS/r-axSpA (n=38)<10 years duration9 (24%)nr-axSpA7 (18%)< 2 years duration6 (16%)nr-axSpA (n=4)nr-axSpA2 (50%)< 1 year & nr-axSpA1 (25%)< 5 years & nr-axSpA1 (25%)pSpA (n=1)< 12 weeks duration1 (100%)

“Duration” refers to symptom duration or disease duration.

Figure 1.

Number of studies stratified by the core of the definition.

Conclusion

Over time, the term “early SpA” and its subtypes are increasingly used. Despite addressing early SpA, more than one third of the studies did not include a clear definition of the term. The studies reporting a definition of early SpA showed a large heterogeneity, with two out of three of them based on the duration of symptoms or disease. These results emphasize the need for a standardised definition of early SpA.

Acknowledgements

The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work.

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis., Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma., Employee of: Director of Imaging Rheumatology bv., Robert B.M. Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: Abbvie and Novartis

Baseline predictors of different types of treatment success in rheumatoid arthritis

OBJECTIVE

To perform a comprehensive analysis on predictors of achieving disease activity outcomes by change, response and state measures.

METHODS

We used data from three rheumatoid arthritis (RA) trials (one for main analysis, two for validation) to analyse the effect of patient and disease characteristics, core set measure and composite indices on the achievement of different outcomes: response outcomes (% of patients achieving a relative response margin); state outcomes (remission or low disease activity, LDA) and change outcomes (numerical change on metric scales).

RESULTS

We included patients from the ASPIRE trial (for analysis) and from the ATTRACT and GO-BEFORE trials (for validation). While lower disease activity components at baseline-except acute phase reactants-were associated with achievement of state outcomes (such as LDA by the Simplified Disease Activity Index, SDAI), higher baseline values were associated with change outcomes (such as SDAI absolute change). A multivariate analysis of the identified predictors of state outcomes identified best prediction by a combination of shorter disease duration, male gender and lower disease activity. For prediction of response, no consistently significant predictors were found, again, with exception of C reactive protein, for which higher levels at baseline were associated with better responses.

CONCLUSION

Prediction of treatment success is limited in RA. Particularly in early RA, prediction of state targets can be achieved by lower baseline levels of diseases activity. Gender and disease duration may improve the predictability of state targets. In clinical trials, included populations and choice of outcomes can be coordinated to maximise efficiency from these studies.

Depression Is a Major Determinant of Functional Capacity in Rheumatoid Arthritis

OBJECTIVE

The aim of this study was to determine the prevalence of depression among rheumatoid arthritis (RA) Argentinean patients and its association with sociodemographic and clinical factors.

METHODS

We performed a cross-sectional study of consecutive adults with RA. Sociodemographic data, comorbidities, RA disease activity, and current treatment were assessed. The following instruments were used to evaluate quality of life (EQ-5D-3 L [EURO Quality 5-dimension 3 lines], QOL-RA [Quality of Life-Rheumatoid Arthritis]), functional capacity (HAQ-A [Health Assessment Questionnaire-Argentinean version]), and depression (PHQ-9 [Patient Health Questionnaire 9]; scores 5-9: mild, 10-14: moderate, 15-19: moderate-severe, and ≥20: severe depression, a cutoff value ≥10 is diagnostic of major depression).

RESULTS

Two hundred fifty-eight patients were included, with a median disease duration of 9 years (interquartile range, 3.6-16.7 years). The m PHQ-9 score was 6 (interquartile range, 2-12.3 years). The prevalence of major depression was 33.8%. The frequency of mild, moderate, moderate/severe, and severe depression was 66 (25.6%), 42 (16.3%), 27 (10.5%), and 18 (7%), respectively. Patients with major depression had worse functional capacity (HAQ-A: mean ± SD, 1.6 ± 0.8 vs. 0.7 ± 0.7; p < 0.0001), poorer quality of life (QOL-RA: mean ± SD, 5.4 ± 1.8 vs. 7.3 ± 1.6; p < 0.0001), greater pain (visual analog scale: mean ± SD, 56.2 ± 27.5 mm vs. 33.4 ± 25.7 mm; p < 0.0001), higher disease activity (Disease Activity Score in 28 joints: mean ± SD, 4.3 ± 1.4 vs. 3.3 ± 1.3; p < 0.0001), higher frequency of comorbidities (67% vs. 33%; p = 0.017), and lower frequency of physical activity (22% vs. 35%; p = 0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (odds ratio, 2.1; 95% confidence interval, 1.6-4.3; p < 0.0001) and quality of life (odds ratio, 0.7; 95% confidence interval, 0.5-0.8; p < 0.0001), independently of disease activity.

CONCLUSIONS

A third of RA patients in this Argentinean cohort had major depression. In those patients, depression was associated with worst functional capacity and quality of life.

Individual and country-level socioeconomic factors and health outcomes in spondyloarthritis: analysis of the ASAS perSpA study

OBJECTIVES

To investigate the association between individual and country-level socioeconomic (SE) factors and health outcomes across spondyloarthritis (SpA) phenotypes.

METHODS

Patients with axial SpA, peripheral SpA or psoriatic arthritis (PsA) from the ASAS-perSpA study (23 countries) were included. The effect of individual (age, gender, education and marital status) and country-level (e.g. Gross Domestic Product [GDP]) SE factors on health outcomes (ASDAS ≥ 2.1, ASDAS, BASFI, fatigue and ASAS-HI) was assessed in mixed-effects models, adjusted for potential confounders. Interactions between SE factors and disease phenotype were tested. A mediation analysis was conducted to explore whether the impact of country-level SE factors on ASDAS was mediated through b/tsDMARD uptake.

RESULTS

In total 4185 patients (61% males, mean age 45) were included (65% axSpA, 25% PsA, 10% pSpA). Female gender (β = 0.14 (95%CI 0.06-0.23)) lower educational level (0.35 (0.25-0.45)) and single marital status (0.09 (0.01-0.17)) were associated with higher ASDAS. Living in lower GDP countries was also associated with higher ASDAS (0.39 (0.16-0.63)) and 7% of this association was mediated by b/tsDMARD uptake. Higher BASFI was similarly associated with female gender, lower education and living alone, without effect of country-level SE factors. Female gender and lower educational level were associated with worse ASAS-HI, while more fatigue was associated with female gender and higher country-level SE factors (lower GDP, -0.46 (-0.89 to -0.04)). No differences across disease phenotype were found.

CONCLUSIONS

Our study shows country-driven variations in health outcomes in SpA, independently influenced by individual and country-level SE factors and without differences across disease phenotypes.

Myositis-specific antibodies and clinical characteristics in patients with autoimmune inflammatory myopathies: reported by the Argentine Registry of Inflammatory Myopathies of the Argentine Society of Rheumatology

INTRODUCTION/OBJECTIVES

To describe clinical features in patients with inflammatory myopathies (IMs) from the Argentine Registry of Inflammatory Myopathies, and their relationship with myositis-specific antibodies (MSAs).

METHODS

This cross-sectional study included 360 adult patients with dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. Demographics, clinical, and serological characteristics were retrospectively recorded (2016-2019). MSAs were determined by immunoblotting. Patients who were positive for anti-Jo-1, Mi-2, and MDA5 were compared against a group of patients, taken as reference group, who were negative for all MSAs.

RESULTS

Women 72%, median age at diagnosis was 47.3 years (18-82). The most frequent subtypes were DM (43.9%) followed by PM (30%).The most frequent MSAs were anti-Jo-1 (51/317), 16.1%; MDA5 (12/111), 10.8%, and Mi-2 (23/226), 10.2%. Anti-Jo-1 was associated (p < 0.05) with a higher frequency of chronic disease course, interstitial lung disease (ILD), arthritis, and mechanic's hands. Anti-Mi-2 was found in patients who had higher frequency of skin manifestations and higher CK values (p < 0.001). Patients with anti-MDA5 had normal or low CK levels. Anti-MDA5 was associated (p < 0.05) with skin manifestations, arthritis, and ILD. The rest of MSAs had frequencies lower than 8%. Anti-TIF1ϒ was found in eight DM patients and one had cancer. Anti-SRP was found in seven patients who had PM and elevated CK.

CONCLUSION

Anti-Jo-1 was the most frequent MSA, and was associated with ILD; MDA5 was associated with CADM and ILD, and Mi-2, with classical DM. Despite the different prevalence with respect to other cohorts, the clinical characteristics for each MSA group were similar to the data reported in other studies. Key Points • This study describes the prevalence of MSAs in the Argentine Registry of IMs. • Anti-Jo-1 and anti-MDA5 were associated with ILD. • Anti-Mi-2 was the third most frequent MSA, associated with classical DM.

POS0951 ASSOCIATION BETWEEN INDIVIDUAL AND COUNTRY-LEVEL SOCIOECONOMIC FACTORS AND HEALTH OUTCOMES IN AXIAL AND PERIPHERAL SPONDYLOARTHRITIS: ANALYSIS OF THE ASAS PERSPA STUDY

Background:

Health outcomes in spondyloarthritis (SpA) are largely determined by socioeconomic (SE) factors, leading to the great inequity observed between countries across the world. However, the impact of these SE factors on health outcomes across the different SpA phenotypes (axSpA, pSpA and PsA), is less well known.

Objectives:

To investigate (1) the association between individual and country-level SE factors and health outcomes in different SpA phenotypes, and (2) to explore whether any effect of these SE factors is mediated by the use of b/tsDMARD therapy.

Methods:

Patients with axSpA, pSpA or PsA from the multinational cohort ASAS-perSpA were included in the analysis. The effect of individual (age, gender, education and marital status) and country-level SE factors (Gross Domestic Product [GDP], Healthcare Expenditure [HCE], Human Development Index [HDI], Gini Index) over health outcomes (ASDAS≥2.1, continuous ASDAS, BASFI, fatigue and ASAS-HI) were assessed in multivariable mixed-effects logistic and linear regression models (as appropriate), adjusting for confounders. Interactions between each individual and country-level SE factors and disease phenotype and between both levels of SE factors, were tested. Finally, a mediation analysis was conducted to explore whether the impact of country-level SE factors on ASDAS is mediated through b/tsDMARD uptake.

Results:

A total of 4185 patients from 23 countries were included: 61% males, mean age 45 (SD 14), 65% axSpA, 10% pSpA and 25% PsA. Female gender, lower educational level and marital status (single vs married) were associated with higher ASDAS, without significant differences across disease phenotype. Living in lower-(vs higher) GDP countries was also associated with higher ASDAS (β=0.39 [95%CI 0.16; 0.63], with similar results for other economic indicators (Figure 1). 7% of the association between GDP and ASDAS was mediated by b/tsDMARD uptake. The above-mentioned individual and country-level SE factors remained significant to discriminate active disease (ASDAS≥2.1), with greater impact of gender (OR=1.32 [1.13; 1.54]), educational level (primary vs university OR=1.76 [1.40;2.20]) and lower GDP (OR= 1.74 [1.22;2.46]). Higher BASFI was also associated with gender (female vs male: β=0.12 [0.01; 0.24]), lower education (primary vs university: β=0.29 [0.11; 0.46], and marital status (single vs married: β=0.23 [0.09; 0.38]), without effect of country-level SE factors, and no differences across SpA phenotype. Gender and lower educational level were similarly associated with worse ASAS-HI scores (female vs male β=0.88 [0.68;1.09], and primary vs university β=0.61 [0.31;0.91]), while more fatigue was only associated with female gender and, in an opposite direction, with higher country-level SE factors (Figure 1). No interactions were found between individual and country-level SE factors for any of the outcomes.

Conclusion:

Individual (female gender and lower education) and country-level SE factors are independently associated with higher disease activity in SpA. Uptake of b/tsDMARD had a small mediating effect on the association between GDP and ASDAS. Lower education and female gender are also associated with worse outcomes of functional disability, global functioning and fatigue. Country-level SE factors are not associated with functional disability or global functioning; in contrast, there is a paradoxical effect with fatigue: living in a country with a higher SE status is independently associated with higher levels of fatigue. Management of disease outcome in SpA requires also awareness of the role of individual and country level SE-factors.

Figure 1.

Effect of individual and country-level socioeconomic factors on ASDAS and fatigue, derived from multivariable mixed-effects models adjusted by clinical confounders.

Disclosure of Interests:

Dafne Capelusnik Speakers bureau: BMS, Grant/research support from: Pfizer, Sizheng Steven Zhao: None declared, Annelies Boonen: None declared, Nelly Ziade Speakers bureau: Roche, Abbvie, Eli Lilly, Pfizer, Janssen, Novartis, Pierre Fabre, Apotex, Pharmaline, Paid instructor for: Abbvie, Eli Lilly, Sanofi-Aventis, Pfizer, Janssen, Consultant of: Roche, Abbvie, Eli Lilly, Pfizer, Janssen, Novartis, Gilead, NewBridge, Grant/research support from: Abbvie, NewBridge, Algorithm/Celgene, Clementina López-Medina: None declared, Maxime Dougados: None declared, Elena Nikiphorou Speakers bureau: Pfizer, Lilly, AbbVie, Sofia Ramiro Speakers bureau: Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Lilly, MSD, Novartis, UCB, Sanofi, Grant/research support from: MSD

POS0953 PERIPHERAL ARTHRITIS AND HIGHER DISEASE ACTIVITY LEAD TO MORE FUNCTIONAL IMPAIRMENT IN AXIAL SPONDYLOARTHRITIS: LONGITUDINAL ANALYSIS FROM ESPAXIA

Background:

Preserving functional ability is among the main goals when treating patients with axSpA. Higher disease activity, reduced axial mobility, and increase spinal radiographic damage, and smoking status have shown to be longitudinally associated with functional worsening. The presence of peripheral arthritis has also been associated with worse functional ability during follow-up, though not in a true longitudinal analysis.

Objectives:

To investigate whether peripheral arthritis together with disease activity independently contribute to functional impairment over time in patients with axSpA and to evaluate if there are contextual factors modifying this relationship.

Methods:

Patients with axSpA from the ESPAXIA cohort were followed-up annually over 7 years. Physical function was assessed by the self-reported questionnaire BASFI, disease activity by ASDAS and peripheral arthritis was also recorded. The association between BASFI (outcome), peripheral arthritis and ASDAS (main variables of interest) over time was tested in generalized estimating equations (GEE) models. Models were autoregressive, i.e. adjusted for BASFI 1 year earlier, to allow for a truly longitudinal interpretation. Interactions between each of ASDAS and peripheral arthritis with contextual factors were tested.

Results:

185 patients were included (77 % male, mean age 42 (SD 13), mean disease duration 9.4 (SD 9.6) years. Mean baseline ASDAS was 2.3 (1.4), mean BASFI 3.9 (2.7) and 17% presented peripheral arthritis during the first visit. After a mean of 3.7 (2.4) years of follow-up, ASDAS and peripheral arthritis independently contributed to explaining BASFI changes over time. Contextual factors did not modify either of the relationships. A true longitudinal relation was proved with the autoregressive GEE model, showing that, adjusted for age, gender, spinal mobility and use of NSAIDs, an increase of one ASDAS unit led to a BASFI 0.48 units higher (ß 0.48 [95% CI 0.39-0.57]), and the presence of peripheral arthritis, to a BASFI 0.44 units higher (ß 0.44 [0.08-0.8]) (Table 1). A gradient was found for ASDAS disease activity states: ASDAS low disease activity (vs ASDAS inactive disease) with an increase in BASFI of 0.67 (0.35-0.98) units compared to ASDAS very high disease activity (vs ASDAS inactive disease) with a BASFI increase of 2.30 (1.90-2.72) units. (Figure 1) No interaction was found between peripheral arthritis and disease activity on BASFI, and similarly, no interactions were found between either ASDAS or peripheral arthritis with age, gender, educational level, smoking status, job type or comorbidities on BASFI.

Table 1.

Factors longitudinally associated with BASFI

AssessmentModel with ASDAS continuousß (95% CI)n=179Model with ASDAS categoricalß (95% CI)n=179Previous BASFI (0-10)0.47 (0.41 to 0.52) †0.44 (0.39 to 0.50)†Age (years)0.007 (-0.005 to 0.02)0.008 (-0.004 to 0.02)Male gender (vs female gender)-0.42 (-0.79 to -0.06) †-0.38 (-0.74 to -0.02)†Peripheral arthritis0.44 (0.08 to 0.80) †0.38 (0.03 to 0.74) †ASDAS-CRP0.48 (0.39 to 0.57) †-ASDAS-CRP categoricalModerate vs inactive disease-0.67 (0.35 to 0.98) †High vs inactive disease-1.70 (1.37 to 2.02) †Very high vs inactive disease-2.30 (1.90 to 2.72) †BASMI (0-10)0.32 (0.24 to 0.41) †0.32 (0.23 to 0.40) †NSAIDs (%)0.38 (0.09 to 0.66) †0.37 (0.09 to 0.64) †

† Significant at p<0.05.

Figure 1.

Longitudinal relationship between ASDAS and BASFI

Conclusion:

Peripheral arthritis and higher disease activity independently lead to more functional impairment in axSpA. Contextual factors do not modify these relationships.

Disclosure of Interests:

Dafne Capelusnik Speakers bureau: BMS, Grant/research support from: Pfizer, Sofia Ramiro Speakers bureau: Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Lilly, MSD, Novartis, UCB, Sanofi, Grant/research support from: MSD, Emilce Edith Schneeberger Speakers bureau: Abbvie, BMS, Janssen, Eli Lilly, Boehringer Ingelheim, Pfizer, Grant/research support from: Pfizer, Gustavo Citera Speakers bureau: Abbvie, BMS, Janssen, Pfizer, Grant/research support from: Pfizer, BMS, Janssen

POS0312 HOW DOES THE PRESENCE OF DEPRESSION IMPACT ON DISEASE ACTIVITY SCORES IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Background:

Depression is present in up to half of patients with Rheumatoid Arthritis (RA). The association between this mood disorder and disease activity scores, including DAS28, SDAI and CDAI, has previously been described by various authors.

Objectives:

The aim of our study was assessed the effect of depression on the components of different disease activity scores.

Methods:

We performed a cross-sectional study of consecutive adults with RA, according to ACR/EULAR 2010 criteria. Sociodemographic data, comorbidities and current treatment were recorded. Disease activity was evaluated using DAS28-ESR, DAS28-CRP, SDAI and CDAI. Depression was assessed using PHQ-9 questionnaire. The PHQ-9 values were categorized in 4 groups as follows: 5 to 9, 10 to 14, 15 to 19, 20 or greater, represents mild, moderate, moderate/severe, and severe depression, respectively. A cutoff value of 10 or greater was set to define major depression. Statistical analysis: Student´s T, ANOVA and Chi2 tests. Multiple logistic regression.

Results:

Two hundred fifty eight patients were included, with a median (m) disease duration of 9 years (IQR 3.6-16.7). The m PHQ-9 score was 6 (IQR 2-12.3) and the prevalence of major depression was 33.7%. Patients with major depression had more tender and swollen joint count (TJC and SJC) (mean 4.9±4.3 vs 2.3±3.7, p<0.0001 and 2.9±3.3 vs 1.7±3.4, p=0.009), more pain (VAS [cm] mean 5.6±2.7 vs 3.3±2.6, p<0.0001), higher patient and physician global assessment (PGA and PhGA) (VAS [cm] mean 5.4±2.9 vs 3.1±2.5, p<0.0001 and 4.4±2.7 vs 2.4±2.4, p<0.0001) and CRP (mean 1.7±3.3 vs 0.7±1.1 mg/dl, p=0.01). ESR values were higher in the group with major depression, but the difference did not reach significance. Disease activity was higher in the depression group by all scores: DAS28-ESR (mean 4.3±1.4 vs 3.3±1.3, p<0.0001), DAS28-CRP (mean 3.9±1.4 vs 2.8±1.7, p<0.0001), SDAI (mean 19.2±12.7 vs 10.3±10.1, p<0.0001) and CDAI (mean 17.6±10.9 vs 9.6±9.9, p<0.0001). While 41 (15.9%) patients had high disease activity according to DAS28-ESR, only 34 (13.2%) had SDAI>26.

In the multivariate analysis, evaluating the association of major depression with the different components of DAS28-ESR, DAS28-CRP, SDAI and CDAI, we observed that the presence of this mood disorder remained significantly associated with higher PGA in all the scores. In addition, a significant association was seen with higher TJC in both DAS28 scores.

Conclusion:

Patients with major depression had higher disease activity. It´s presence has a significantly association with the subjective items of the disease activity scores, particularly PGA. CRP value was the only objective component associated with depression.

Disclosure of Interests:

Carolina Ayelen Isnardi Speakers bureau: Bristol Myers Squibb, Janssen, Grant/research support from: Pfizer, Emilce Edith Schneeberger Speakers bureau: Abbvie, Amgen, Bristol Myers Squibb, Janssen, Eli Lilly, Boehringer Ingelheim, Pfizer, Genzyme, Grant/research support from: Pfizer, Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Grant/research support from: Pfizer, Marcela Bazzarelli: None declared, Laura Barloco: None declared, Eliana Soledad Blanco: None declared, Alejandro Benitez Speakers bureau: Abbvie, Novartis, Amgen, Federico Benavidez: None declared, SANTIAGO SCARAFIA: None declared, María Alicia Lazaro Speakers bureau: Abbvie, Rodolfo Perez Alamino Speakers bureau: Pfizer, Abbvie, Amgen, Bristol-Myers-Squibb, Lilly, Janssen, Novartis, Federico Colombres: None declared, María Paula Kohan: None declared, Julia Sosa: None declared, Luciana Gonzalez Lucero: None declared, Ana Lucía Barbaglia: None declared, Hernan Maldonado Ficco Speakers bureau: Pfizer, Abbvie, Jansen, Novartis, Bago, Bristol, Eli Lilly., Consultant of: Pfizer, Abbvie, Novartis, Jansen, Bago, Eli Lilly., Gustavo Citera Speakers bureau: Abbvie, Bristol-Myers-Squibb, Lilly, Jansen, Gema, Pfizer, Roche, Grant/research support from: Pfizer

Peripheral arthritis and higher disease activity lead to more functional impairment in axial spondyloarthritis: Longitudinal analysis from ESPAXIA

OBJETIVE

The aim of this study was to investigate whether peripheral arthritis together with disease activity independently contribute to functional impairment over time in patients with axSpA and to evaluate if there are contextual factors modifying this relationship.

MATERIAL AND METHODS

Patients with axial spondyloarthritis from the ESPAXIA cohort were followed-up annually over a mean of 3.7 years. Physical function was assessed by the self-reported questionnaire BASFI, disease activity by ASDAS and peripheral arthritis was also recorded. Generalized estimating equations (GEE) were used to investigate longitudinal association between peripheral arthritis, ASDAS and BASFI as the outcome. Autoregressive models (adjusted for BASFI 1 year earlier) were run to allow for a truly longitudinal interpretation. Interactions between each of ASDAS and peripheral arthritis with contextual factors (age, gender, educational level, smoking, job type) were tested.

RESULTS

185 patients (77 % male, mean (SD) age 42 (13) years old and mean disease duration (SD) of 9.4 (9.6) years) were included. ASDAS and peripheral arthritis independently contributed to explaning BASFI over time. Contextual factors did not modify either of the relationships. A true longitudinal relation was proven with the autoregressive GEE model, showing that, adjusted for age, gender, spinal mobility and use of NSAIDs, an increase of one ASDAS unit led to a BASFI 0.48 units higher (ß 0.48 [95%CI 0.39, 0.57]), and the presence of peripheral arthritis, to a BASFI 0.44 units higher (ß 0.44 [95%CI 0.08, 0.8]).

CONCLUSION

Peripheral arthritis and higher disease activity independently lead to more functional impairment in axSpA over time. Contextual factors do not modify these relationships.

Validation of the adjusted global antiphospholipid syndrome score in systemic lupus erythematosus patients in Argentina

INTRODUCTION

Assessment of risk both for pregnancy morbidity and thrombosis in the presence of anti-phospholipid antibodies (aPL) is still a challenge in Systemic Lupus Erythematosus (SLE) patients. The Global Antiphospholipid Syndrome Score (GAPSS) takes into account the aPL profile (criteria and non-criteria aPL), the conventional cardiovascular risk factors and the autoimmune antibody profile. An adjusted model of the score (aGAPSS) excluding anti-phosphatidylserine/Prothrombin (aPS/PT), suggests that the score is able to stratify patients for their rate of events making it widely applicable in daily clinical practice.

OBJECTIVE

To validate the aGAPSS in a multicentric cohort of SLE patients in Argentina.

PATIENTS AND METHODS

consecutive SLE patients with and with andwithout thrombotic events from seven Rheumatologist centers were included. Traditional cardiovascular risk factors, aPL antibodies and medications received (aspirin, hydroxychloroquine and anticoagulation) were collected. The score aGAPSS was calculated for each patient at the last visit by adding together the points corresponding to the risk factors: 1 for hypertension, 3 for dyslipidemia, 4 for LA and B2GPI (IgM or IgG) antibodies and 5 for aCL (IgM or IgG) antibodies. The discriminative ability of the aGAPSS was calculated by measuring the area under the receiver operating characteristic curve (AUC). Multivariate logistic regression analysis was performed to examine the impact of multiple cardiovascular risk factors and laboratory parameters on the occurrence of thrombosis.

RESULTS

Two hundred and ninety-six SLE patients were included. One-hundred and twenty-one patients (40.9%) presented thrombotic and/or pregnancy complications. Median aGAPSS was significantly higher in patients who experienced an event (thrombosis and/or pregnancy morbidity) compared with those without [4 (IQR 1-9) versus 1 (IQR 0-5); p < 0.001]. The best cut off point for the diagnosis of thrombosis and/or pregnancy complications was aGAPSS ≥4. Multivariate logistic regression analysis showed that aCL antibodies [OR 2.1 (95% CI 1.16-3.90); p = 0.015] were an independent risk factors for thrombotic events.

CONCLUSIONS

This score is a simple tool, easy to apply to SLE patients in daily practice. The use of the aGAPSS could change the non-pharmacologic and pharmacologic treatment in higher risk patients to improve their survival.

FRI0605-HPR MORTALITY AND SURVIVAL IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN ARGENTINA. A MULTICENTER STUDY ON BEHALF GESAR-LES

Background:

The mortality rate in patients with systemic lupus erythematosus (SLE) is 2–3 times higher than in the general population. However, survival in these patients has improved significantly and is currently 95% at 5 years according to different studies. Since the last 20 years, there are no new reports on this issue in Argentina.

Objectives:

To analyze the factors associated with mortality, survival and causes of death in patients with SLE.

Methods:

Longitudinal - multicenter study, in which 10 rheumatology centers of Argentina participated. Patients with SLE (ACR 1997 and / or SLICC 2012 criteria) with a minimum follow-up of 6 months monitored between January 2008 and December 2018 were included. Demographic, clinical, laboratory, therapeutic variables (treatments received during the evolution of the disease and within 60 days prior to death or last control); mortality, causes of death and survival at 5, 10 and 20 years were evaluated. Statistical analysis: descriptive statistics, Kaplan-Meier survival curves and Cox regression model.

Results:

Three hundred and eighty two patients were included; 90% women and 82% mestizos. The mean of evolution time of SLE was 4.1 ± 6.7 years. The mean age at the last control or death was 37.2 ± 12.7 years, SLEDAI 3.2 ± 4.2 and SLICC 1.2 ± 1.9.

Mortality was 12% (95% CI [8-15]) and the causes of death were: Infections (27), cardiovascular disease (6), SLE activity (3), catastrophic antiphospholipid syndrome (2) and other causes (8). Using the variables associated with mortality in different Cox regression models, the variables that increased the risk of death significantly were: renal involvement (RR 3.3), cardiac involvement (RR 2.7), central nervous system involvement (RR 2.1), arterial thrombosis (RR 2.3), hyperlipemia (RR 2.4), number of infections (RR 1.2) and last SLEDAI (1.1).

The time of HCQ use greater than 36 months decreased the risk of death in this cohort by 40% (p 0.03). Prednisone (maximum dose and time) was not associated with mortality (p NS). When analyzing the last treatment and adjusting it for final SLEDAI, HCQ was a mortality protection factor (RR 0.4) while the use of cyclophosphamide alone or associated with prednisone was a risk factor for death (RR 5.2).

Significant differences were found when analyzing the causes of death according to the SLE evolution time (p 0.017): patients who died from infection had less evolution time (Me 2.25 years), than those who died due to cardiovascular causes (Me 10 years) or SLE activity (Me 15 years). In this cohort of patients, survival was 93% at 5 years, 88% at 10 years and 72% at 20 years.

Conclusion:

Mortality in this series of patients was 12% and infection was the leading cause of death. The use of HCQ for a period greater than 36 months, decreased the risk of death 40%.

Disclosure of Interests:

None declared