Global epidemiology of rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease that predominantly affects the joints. The prevalence of RA varies globally, with generally a higher prevalence in industrialized countries, which may be explained by exposures to environmental risk factors, but also by genetic factors, differing demographics and under-reporting in other parts of the world. Over the past three decades, strong trends of the declining severity of RA probably reflect changes in treatment paradigms and overall better management of the disease. Other trends include increasing RA prevalence. Common risk factors for RA include both modifiable lifestyle-associated variables and non-modifiable features, such as genetics and sex. A better understanding of the natural history of RA, and of the factors that contribute to the development of RA in specific populations, might lead to the introduction of specific prevention strategies for this debilitating disease.

AB1436 INFECTIONS IN PATIENTS WITH RHEUMATIC DISEASES IN TREATMENT WITH BIOLOGIC THERAPY

Background

Patients with rheumatic diseases (RD) have a higher risk of developing infections due to disease and immunosupressor treatment factors1. Biologic disease -modifying antirheumatic drugs (bDMARD) have been associated with the development of opportunistic infections, nevertheless their impact on severe infections has not been consistent2.

Objectives

To describe the sociodemographic and clinical characteristics of patients with RD on bDMARD treatment with and without infections, using data from the Mexican Adverse Events Registry (BIOBADAMEX), as well as to identify factors associated with the presence of infections.

Methods

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs. In this analysis we included all patients registered in Biobadamex from 2016 to 2021. We compared sociodemographic, clinical and treatment characteristics between patients who developed infections with to those who did not. We used descriptive statistics, Chi square and Kruskal Wallis tests to analyze differences between the groups.

Results

A total of 780 patients registered in Biobadamex were included in this study, among them 42 (5%) patients presented infections and 738 (95%) did not. At baseline, patients had a median (IQR) age of 50 (40-58) years and median disease duration of 7 (3-15) years. The most common diagnosis was rheumatoid arthritis with 512 (66%) patients, followed by ankylosing spondylitis in 115 (15%), psoriatic arthritis in 44 (6%), systemic lupus erythematosus in 30 (4%) and idiopathic juvenile arthritis in 27 (3%) patients. Comorbidities were present in 351 (45%) of the patients. Conventional DMARD (cDMARD) were used by 626 (80%) patients, and 290 (37%) used steroids. The most frequently used bDMARDs were adalimumab in 166 (21%) patients, certolizumab in 129 (16%), tocilizumab in 103 (13%) and abatacept 94 (12%).

Table 1 shows baseline characteristics in the groups with and without infections. Patients with infections presented more severe adverse events 3 (7%) compared to those who did not 11 (2%), p=0.007, with a complete recovery without sequels. Most common infection site was skin (21%) followed by superior airways (12%). Most common infectious agents were gram negative bacteria. Only 2 patients presented bacteremia.

Table 1.

Patients baseline characteristics

Infectionn=42Without infectionn=738pFemale, n(%)33 (79)595 (80)0.74Age, median(IQR)50.9 (43-59)49.8 (40-58)0.58Disease duration (years), median (RIC)7.5 (2-16)7.0 (3-15)0.9Diagnostic, n(%): Rheumatoid arthritis25 (59)487 (66)0.42 Idiopathic Juvenile Arthritis0 (0)27 (4) Ankylosing Spondylitis6 (14)109 (15) Others11 (26)115 (15)Comorbidities, n(%):22 (52)329 (44.6)0.32Previous bDMARD, n(%):15 (36)271 (37)0.89Use of steroids, n(%):16 (38)274 (37)0.9cDMARD, n(%)33 (79)593 (80)0.77Severe Adverse Events, n(%)3 (7)11 (2)0.007  Outcome, n(%)Recovered without sequels3 (100)6 (55)p=0.34*Not recovered03 (27)Unknown02 (18)Infection site, n(%)Skin9 (21)Superior airways5 (12)Urinary tract4 (10)Agent, n(%)Gram- bacteria9 (21)Gram+ bacteria0 (0)Virus4 (14)

*Chi2

Conclusion

The frequency of infections in patients using bDMARD in Biobadamex is low compared to the frequency reported in similar studies in other countries3. The presence of infections was associated with more severe adverse events in general, which recovered completely without sequels.

References

[1]Wallis D. Curr Opin Rheumatol. 2014;26(4):404-9.

[2]Singh JA et al. Lancet. 2015;386(9990):258-65.

[3]Pérez-Sola MJ, et al. Med Clin (Barc). 2011;137(12):533-40.

Disclosure of Interests

VIJAYA RIVERA TERAN: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos: None declared, Miguel A Saavedra: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Angel Castillo Ortiz: None declared, Omar Eloy Muñoz-Monroy: None declared, Sergio Duran Barragan: None declared, Azucena Ramos: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Alfonso Torres: None declared, Samara Mendieta: None declared, Daniel Xavier Xibille Friedmann: None declared, Francisco Guerrero: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor for GSK, unrelated to this study., Employee of: Scientific advisor for GSK, unrelated to this study.

POS1447 SOCIODEMOGRAPHIC, CLINICAL AND TREATMENT DIFFERENCES OF RHEUMATIC DISEASES IN THREE MEXICAN REGIONS

Background

Rheumatic diseases prevalence and characteristics in Mexico may vary depending on the country´s region1. To acknowledge these differences is needed to develop focused strategies for early diagnosis and treatment2.

Objectives

Identify the sociodemographic, clinical and treatment characteristics of the rheumatic diseases in the different regions in Mexico using data from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods

In this analysis we included all patients registered from 2016 to 2021. We described the prevalence in the northern region of Mexico (NR), central (CR) and southern region (SR). We compared sociodemographic, clinical and treatment characteristics between these three regions. We used descriptive statistics, Chi square and Kruskal Wallis tests to analyze differences between the groups.

Results

A total of 780 patients were included in this study, 248 patients (32%) were from the NR, 471 (60%) were from the CR and 61 (8%) from the SR. At baseline, patients had a median (IQR) age of 50 (40-58) years and median disease duration of 7 (3-15) years. NR patients had longer disease duration (9.7 years, p <0.001) and SR patients had higher BMI (29, p 0.001). Overall, 351 (45%) had comorbidities. In CR and SR more than the half of the patient had comorbidities, while in NR only 29% (p 0.001).

The most common diagnosis was rheumatoid arthritis with 512 (66%) patients, followed by ankylosing spondylitis in 115 (15%), psoriatic arthritis in 44 (6%), systemic lupus erythematosus in 30 (4%) and idiopathic juvenile arthritis in 27 (3%), this proportions were maintained when analyzed by regions. We found SR had higher DAS 28 and higher BASDAI (Table 1).

Table 1.

Baseline characteristics by region.

Northern regionn=248Central regionn=471Southern regionn=61pAge, median(IQR)49.7 (42-58)49.9 (38-58)51.6 (43-61)0.4Female, n(%)193 (78)383 (81)52 (85)0.33Body Mass Index, median (IQR)28 (25-32)26 (22-29)29 (26-32)0.001Disease duration (years), median (RIC)9.7 (5-16)5.9 (2-14)4.5 (1-10)0.001Diagnostic, n(%): Rheumatoid arthritis173 (70)300 (64)39 (64)0.001 Idiopathic Juvenile Arthritis3 (1)23 (5)1 (2) Ankylosing Spondylitis47 (19)59 (13)9 (15)Laboratory studies, n(%)Rheumatoid factor97 (39)274 (58)38 (62)0.001ACPA15 (6)68 (14)12 (19)0.001Disease activity scores, median (IQR) DAS284.8 (3-6)5.1 (4-6)5.2 (5-7)0.001 BASDAI2.8 (0-7)4.9 (2-7)8.0 (5-9)0.003Comorbidities, n(%)72 (29)247 (52)32 (52)0.001Previous bDMARD, n(%):136 (55)149 (32)1 (2)0.001Steroids, n(%):93 (38)155 (33)42 (69)0.001cDMARD, n(%)200 (81)373 (79)53 (87)0.4Cause of bDMARD discontinuation, n(%) aLack of efficacy85 (62)45 (33)2 (22)0.001Adverse Event4 (3)25 (18)3 (33)Pregnancy1 (1)3 (2)0(0)Loss of patient follow up10 (7)0 (0)2 (22)Remission23 (17)5 (4)0 (0)Others14 (10)59 (43)2(22)

a) 238 patients.

Glucocorticoids were used by 290 (37%) patients, SR had the highest use rate (69%, p <0.001) and 80% of the patients used conventional DMARDs (cDMARDs) with no differences between regions. Overall, the most used bDMARDs were adalimumab, certolizumab, tocilizumab and abatacept.

At the time of the analysis 238 (36%) had discontinued bDMARDs treatment, 132 (47%) due to lack of response, being this the most frequent cause reported overall, with the highest rate in NR (62%, p <0.001). All NR patients have social security compared to 83% in CR and 79% in SR.

Conclusion

There are regional differences between patients with rheumatic diseases registered in Biobadamex. It was remarkable that all patients form NR had social security, which may impact in the access to treatment. There were differences in the treatments between regions. The data from this analysis may be useful to policy makers, pharmaceutical companies and physicians. Differences in size samples between regions could have influenced in the results, further analyses will be performed in the future including more patients.

References

[1]Peláez-Ballestas I et al. J Rheumatol 2011;86;3-8.

[2]Chopra A et al. Best Pract Res Clin Rheumatol 2008;22:583-604.

Disclosure of Interests

VIJAYA RIVERA TERAN: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos: None declared, Miguel A Saavedra: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Angel Castillo Ortiz: None declared, Omar Eloy Muñoz-Monroy: None declared, Sergio Duran Barragan: None declared, Azucena Ramos: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Alfonso Torres: None declared, Samara Mendieta: None declared, Daniel Xavier Xibille Friedmann: None declared, Francisco Guerrero: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor for GSK, unrelated to this study., Employee of: Scientific advisor for GSK, unrelated to this study.

AB1461 IMPACT OF BASELINE DISEASE ACTIVITY ON DISCONTINUATION OF BIOLOGICAL DMARDS IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE MEXICAN ADVERSE EVENTS REGISTRY (BIOBADAMEX)

Background

Decrease treatment persistence in rheumatoid arthritis (RA) patients has been associated with several factors, including number of previous biological DMARDs (bDMARDs), female gender and higher disease activity or lower function at baseline [1].

Objectives

Determine if drug discontinuation of bDMARDs differs by disease activity level at baseline in patients with RA in the Mexican Adverse Events Registry (BIOBADAMEX).

Methods

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs. In this analysis we included all patients with RA registered from 2016 to 2021 with at least two assessments. Survival on bDMARDs was estimated using Kaplan-Meier analysis. Predictors of discontinuation, including high disease activity defined as DAS28-ESR>5.1, were investigated by Cox regression analyses.

Results

Among 528 RA patients in the registry, 302 had at least two assessments. Of patients analyzed, 276 (91%) were women. At baseline, patients had a median (IQR) age of 52.7 (44-60) years old, median disease duration of 9.3 (4-16) months. A total of 142 (47%) had comorbidities, 34 (11%) had more than 2 morbidities. At baseline DAS28-ESR was 4.8 (4-6), 59 (20%) patients had low (DAS28-ESR<=3.2) and 130 (43%) had high disease activity. The most common bDMARDs received at baseline were abatacept 68 (23%), tocilizumab 59 (20%), adalimumab 50 (17%) and certolizumab 41 (14%). At the time of analysis, the median bDMARDs treatment duration was 17.2 (12-27) months. Overall, 130 (43%) patients had discontinued treatment, the most common causes of discontinuation were inefficacy in 64 patients, 15 for remission, 12 for adverse events and 26 for others. Figure 1 shows discontinuation rate curves in patients by disease activity. Cox proportional hazards demonstrated significant difference in bDMARD discontinuation between patients with baseline high disease activity (HR 1.3, 95% CI 1.1-1.7, p=0.03), but not differences were found regarding baseline age (HR 1.0, 95% CI 0.9-1.0, p=0.16), sex (HR 0.9, 95%CI 0.6-1.4), disease duration (HR 1.0, 95%CI 0.9-1.0, p=0.92), smoking (HR 1.2, 95% CI 0.7-2.1, p=0.44), number of comorbidities (HR 1.0, 95%CI 0.9-1.2, p=0.51) or other factors. The significant association of baseline high disease activity remained after adjusting by baseline age, sex, smoking, disease duration and number of comorbidities (HR 1.3, 95% CI 1.1-1.7, p=0.02).

Figure 1.

Discontinuation rate curves in RA patients with high disease activity (DAS28 >5.1) and DAS28<=5.1

Conclusion

In Mexican RA patients registered in BIOBADAMEX, we found that baseline high disease activity is associated with the discontinuation of bDMARDs. Further longitudinal analyses will be performed including more patients to assess retention rate of specific bDMARDs and identify predictive variables of discontinuation in Mexican population.

References

[1]Lauper K, Finckh A. Predictive factors of treatment persistence in rheumatoid arthritis. Joint Bone Spine. 2020 Dec;87(6):531-534.

Disclosure of Interests

VIJAYA RIVERA TERAN: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos: None declared, Miguel A Saavedra: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Angel Castillo Ortiz: None declared, Omar Eloy Muñoz-Monroy: None declared, Sergio Duran Barragan: None declared, Azucena Ramos: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Daniel Xavier Xibille Friedmann: None declared, Francisco Guerrero: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor for GSK, unrelated to this study., Employee of: Scientific advisor for GSK, unrelated to this study.

POS0726 HEALTH RELATED QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: DATA AND POTENTIAL APPLICATIONS OF THE MEXICAN REGISTER OF LUPUS

Background

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, characterized by a wide variety of clinical manifestations, as well as continuous relapses and exacerbation of symptoms. This complex panorama complicates an early and proper diagnosis, treatment, and follow-up of the people with SLE and therefore has a significant impact on their health-related quality of life (HRQoL). Although the importance of assessing HRQoL in SLE has become evident in recent years, in Mexico there is no epidemiological surveillance system nor national registry that conveys this information.

Objectives

To evaluate health related quality of life (HRQoL) in Mexican individuals with SLE using the data from the Mexican Register of Lupus (Lupus RGMX).

Methods

The Mexican Lupus Registry (Lupus RGMX) is an ongoing online register. This cohort includes sociodemographic and clinical data of Mexican individuals with SLE. In this study we assessed and compared HRQoL in patients with SLE and a matched control group of Mexican individuals without SLE diagnosis. We estimated QoL using the World Health Organization Quality of Life (WHOQOL-bref) and Short Form-36 (SF36) questionnaires. For both WHOQOL-bref and SF36, higher scores mean better HRQoL. Statistical analysis was performed using R 4.1.2 (R Core Team, 2021).

Results

A total of 631 SLE and 272 control registers were analyzed (Table 1). Significant lower scores on HRQoL were observed on participants with SLE for both SF36 and WHOQOL-bref questionnaires, compared with the matched control group. All score components were lower in SLE individuals. Physical role functioning, bodily pain and general health exhibited the lowest scores among the SF36 factors, whereas physical factor was the lowest for WHOQOL-bref (Table 1).

Table 1.

SF36 and WHOQOL-bref median scores (25-75 IQR) of SLE participants and controls.

ControlsSLEp-value(n=272)(n=631)Female sex211 (77.6%)596 (94.4%)<0.001n (%)#Age*28 (24-35)35 (28-43)<0.001SF36 (max 100 points per function) *Physical functioning100 (95-100)65 (45-85)<0.001Physical role functioning100 (100-100)25 (0-100)<0.001Bodily pain84 (61-100)31 (22-52)<0.001General health77 (62-100)35 (20-47)<0.001Vitality65 (50-100)40 (25-55)<0.001Social functioning100 (62.5-100)50 (37.5-75)<0.001Emotional role functioning100 (66.7-100)66.7 (0-100)<0.001Mental health76 (60-100)56 (42-74)<0.001WHOQOL-bref (max 20 points per function) *Physical16.6 (14.8-17.7)11.4 (9.1-13.1)<0.001Psychological15.3 (13.3-19.3)12.7 (10.7-14.7)<0.001Social relations14.7 (12-16)12 (9.3-14.7)<0.001Environmental15.5 (14-17)13 (11-15)<0.001

# Chi-square test, *U Mann-Whitney test

Conclusion

In Mexican people with SLE, a significant decrease in HRQoL was detected compared with controls. The implementation of a national register in Mexico (Lupus RGMX) will provide additional psychosocial and clinical information to deepen our knowledge of this disease.

References

[1]Louthrenoo, W., et al. Arthritis Res Ther 2020; 22, 8.

[2]Shi Y, et al. Autoimmun Rev. 2021 Jan;20(1):102691.

Acknowledgements

ALHL is a doctoral student from Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM) and recieved fellowship 790972 from CONACYT (CVU 711015).

AMR was supported by CONACYT-FORDECYT-PRONACES grant no [11311], and Programa de Apoyo a Proyectos de Investigación e Innovación Tecnológica-Universidad Nacional Autónoma de México (PAPIIT-UNAM) grant nos. IA203021

Disclosure of Interests

Ana Laura Hernández-Ledesma: None declared, Karen Julia Nuñez-Reza: None declared, Andrea Yojany Tapia-Atilano: None declared, Víctor Flores-Ocampo: None declared, Juan Ernesto Villarreal del Moral: None declared, Talía V. Román-López: None declared, Sandra Valentina Vera del Valle: None declared, Donaji Domínguez-Zúñiga: None declared, Estefania Torres-Valdez: None declared, Gabriel Frontana-Vázquez: None declared, Sarael Alcauter: None declared, Miguel Enrique Rentería: None declared, Alejandra Evelyn Ruíz-Contreras: None declared, Deshire Alpizar-Rodriguez Consultant of: Scientific advisor GKS, Alejandra Medina-Rivera: None declared

OP0249 CHARACTERISTICS ASSOCIATED WITH POOR COVID-19 OUTCOMES IN PEOPLE WITH PSORIASIS AND SPONDYLOARTHRITIS: DATA FROM THE COVID-19 PsoProtect AND GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRIES

Background

Some factors associated with severe COVID-19 outcomes have been identified in patients with psoriasis (PsO) and inflammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specificities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifically licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking.

Objectives

To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA.

Methods

This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defined as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, leflunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects.

Results

A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56; other CVD alone: 1.89, 1.22-2.94; vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71; DM alone: 1.85, 1.39-2.47; obesity and DM: 1.89, 1.34-2.67; vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82; moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72; moderate/severe disease activity and GC intake 2.30, 1.41-3.74; vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51; 1 January 2021 onwards: 0.52, 0.41-0.67; vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65; vs PsA), and exposure to TNFi (0.58, 0.45-0.75; vs no DMARDs), IL17i (0.63, 0.45-0.88; vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997; vs no DMARDs) and NSAIDs (0.77, 0.60-0.98; vs no NSAIDs).

Conclusion

More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.

Acknowledgements

We thank all the contributors to the COVID-19 PsoProtect, GRA and EULAR Registries.

Disclosure of Interests

None declared

POS1245 MORTALITY OF COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES: COMPARISON TO THE GENERAL POPULATION IN MÉXICO

Background:

COVID-19 outcomes in Mexican patients with rheumatic diseases (RDs) in comparison to general population patients are unknown.

Objectives:

To compare mortality and hospitalization of COVID-19 patients with RDs and those without.

Methods:

We included for this study all the Mexican patients with RDs and COVID-19 registered from April 17th to October 30th, 2020 in the COVID-19 Global Rheumatology Alliance registry. We compare clinical and demographic characteristics of patients with RDs and COVID-19 to patients with COVID-19 that were selected randomly from the Mexican Epidemiology database (1:3). A logistic regression analysis was performed to adjust for confusion variables.

Results:

We included 322 patients with COVID-19 and RDs and 969 controls without RDs. Table 1 shows the demographic characteristics and comorbidities of both groups. Bivariate analysis showed that patients with RDs had higher mortality, were older, and were more frequently hospitalized. Comorbidities, such as diabetes, hypertension, cardiovascular and renal diseases were also more frequent in patients with RDs. In the multivariate analysis, having a RD was no longer associated with mortality (Figure 1).

Figure 1.

Multivariate analysis of mortality

Conclusion:

Patients with RDs had higher comorbidities, hospitalizations, and mortality than the general population in the bivariate analysis. However, adjusted multivariate analysis showed that the odds for mortality were not increased because of having a RD. These findings suggest that the increased mortality of Mexican patients with RDs may be explained by the higher frequency of comorbidities in this population.

Table 1.

Comparison of patients with COVID-19 with and without RDs

COVID-19 patients without RDsCOVID-19 patients with RDsp-valueN969323Age (mean (SD))42.6 (17.4)51.2 (13.9)<0.001Sex = Male (%)455 (47.0)55 (17.0)<0.001Deceased = Yes (%)55 (5.7)43 (13.3)<0.001Hospitalization = Hospitalized (%)164 (16.9)152 (47.1)<0.001Intubation = Yes (%)27 (2.8)32 (11.8)<0.001COPD_Asthma = Yes (%)37 (3.8)15 (4.6)0.522Diabetes = Yes (%)114 (11.8)49 (15.2)0.116Obesity = Yes (%)128 (13.3)21 (6.5)0.001Hypertension = Yes (%)152 (15.8)88 (27.2)<0.001Cardiovascular disease = Yes (%)19 (2.0)14 (4.3)0.02CRF = Yes (%)22 (2.3)17 (5.3)0.007Pregnancy = Yes (%)5 (0.5)2 (0.6)0.827Smoker = Yes (%)86 (8.9)10 (3.1)0.001

Abbreviations: RDs, rheumatic diseases; COPD, chronic obstructive pulmonary disease; CRF, chronic renal failure.

Disclosure of Interests:

None declared

AB0808 A SYSTEMATIC REVIEW ON SYNDEMICS IN RHEUMATIC AND MUSCULOESKELETAL DISEASES (RMDs)

Background:

Syndemics comprises the interaction of two or more biological diseases in different socio-cultural situations and in the context of varying healthcare standards that exacerbates their deleterious effects on the health of individuals, communities, and societies (1). There is increasing interest in using syndemics in the study of RMDs.

Objectives:

To identify quantitative and qualitative RMDs studies focused on syndemics through a systematic review and synthesize the available evidence.

Methods:

Inclusion criteria were using a syndemic framework in methods in RMDs studies. A systematic search of studies published from 2003 up to January 2021 was conducted in two electronic databases (SCOPUS and Web of Science). The systematic search was implemented (Figure 1): 1) the word syndemic(s) was searched using the advanced query string search, in the title, abstract, keywords, and text, to identify the relevant studies; 2) the publications were screened by three peer review groups; 3) the group evaluated each title and abstract and reviewed full-text articles to identify those relevant for review; 4) synthesis focused on identifying the variables of each study and integrating findings.

Results:

The initial search yielded 658 unique articles, from which ten studies were identified as syndemics in RMDs. After full-text review, six studies were excluded due to not inclusion of a syndemic framework. Four studies were included (Figure 1). The first quantitative study was on eight Latin-American (LatAm) indigenous communities (n=6,155). RMD´s were highly prevalent in the indigenous people (34.5%), RA prevalence was 2.4% in the Qom group of Argentina, and low back pain (LBP) being the most prevalent RMD (13.3%). RMDs were strongly associated with other comorbidities, unhealthy habits, low education levels, rural areas, socioeconomic conditions, and health inequality. The network analysis was the analytical approach using the Syndemic and Syndemogenesis Elements Modeler (SSEM). The second quantitative study focused on six urban/rural LatAm countries (n=55,724). LBP was significantly associated with comorbidities, unhealthy habits, low educational level, rural areas, and indigenous status. SSEM and cluster analysis showed a significant association between LBP prevalence and social variables. One qualitative study in fisher rural families (n=7) with three fisher rural generations from the Netherlands. A case study using life course theory. The first two generation reported syndemic vulnerability (psychological distress, cardiometabolic conditions, or musculoskeletal pain), and the third generation report less syndemic vulnerability, including musculoskeletal pain. A mixed study was identified focused on osteoarthritis with multimorbidities (cardiovascular, hypertension, diabetes mellitus) in an African American population (n=110) in the USA. The methodology was a descriptive secondary analysis and qualitative interviews. The study found that patients with hypertension (80.9%) reported greater chronic pain than those without. The lack of education added to the incorrect use of nonsteroidal anti-inflammatory drugs might contribute to the worst outcomes in this population, a significant burden of cardiovascular disease.

Conclusion:

There is growing interest and urge for integrating syndemics in the study of RMDs. This review has demonstrated that there are only a few publications to date. The statistical power and the analytical approach (SSEM-Syndemic and Syndemogenesis Elements Modeler) in the two quantitative studies are relevant. The qualitative study demonstrated less syndemic vulnerability with better health conditions linked to better socioeconomic advantages. The mixed qualitative study did not show a syndemic framework. It is necessary to carry out studies in RMDs from the syndemic perspective to document the complexity of the clinical and social determinants related to these diseases.

References:

[1]Singer M, Bulled N, Ostrach B, et al. Syndemics and the biosocial conception of health. The Lancet 2017;389:941–50.

Disclosure of Interests:

None declared

AB0852 BREAKING THE GLASS CEILING IN MEXICAN RHEUMATOLOGY

Background:

The term “glass ceiling” has been used since the late eighties, to designate an invisible barrier that prevents highly qualified women from reaching positions of responsibility in the organizations they work. (1) At first, this concept was used to analyze the career of women who, having a professional career and a high level of competition in their workplaces, encountered an interference when trying to advance in their careers. (2). The so-called “glass ceiling” refers to a last barrier based on prejudice towards women that prevents them from advancing to high-level positions.

Currently, there is almost the same number of men and women affiliated to the Mexican College of Rheumatology (CMR). The position of president is the highest directorial position, we undertook the task of evaluating the percentage of women who have historically held that leadership position.

Objectives:

To assess the percentage of woman who have occupied the position of president of the Mexican College of Rheumatology.

Methods:

Observational, cross-sectional study. We evaluated the number of man and women who have historically held the position of president of the CMR.

Results:

Currently, the CMR has 630 active members, 308 women (48.9%) and 322 men (51.1%). Among rheumatologists younger than 40 years of age, women represent 58% (n=128). We found that historically the CMR has had 48 presidents, of which only 4 (8.3%) are women.

Conclusion:

There is a big gender gap between presidents of the CMR. It is important to talk about the gender perspective and recognize the causes that have originated this gap. Incorporating the gender perspective in senior management is a pending issue for our CMR.

References:

[1]Barberá E, Ramos A, Sarrió M, et al. Laberinto de cristal en el liderazgo de las mujeres. Psicothema 2011;23(2):173-179.

[2]Bustos O. Mujeres rompiendo el techo de cristal: el caso de las universidades. OMNIA - Revista de la Coordinación de Estudios de Posgrado 2002(41);1-7.

Acknowledgements:

We have no acknowledgements to declare.

Disclosure of Interests:

None declared

AB0871-HPR WOMEN IN RHEUMATOLOGY: BARRIERS, LIMITATIONS, AND GENDER INEQUALITY

Background:

In the last decades there has been a great progress towards gender equality in medicine, and this can be reflected in the proportion of women in Rheumatology, which has been on the rise recently. However, there continues to be a need for women to be able to succeed on equal opportunities with men (1).

Objectives:

The aim of this study was to recognize the professional limitations and barriers that Mexican female rheumatologists must face.

Methods:

Female rheumatologists were invited to participate. An online survey was applied anonymously, consisting of questions regarding demographic characteristics, professional, academic and research activities, as well as perceptions of gender discrimination and limitations of their profession.

Results:

A total of 127 female rheumatologists voluntarily answered the electronic survey. Most of them were aged between 30 and 35 years (40.9%) and had 1-5 years of professional practice (40.2%) (Table 1); 52% have children and 42.4% of them consider that motherhood has had a negative impact on their professional life; 75.6% of female rheumatologists do not work on research activities and only 20.5% have participated in international congresses in the last 5 years; 80.5% report not participating in medical colleges (as leaders or board members). The three main reasons female rheumatologists refer as limitations on their profession are: having other priorities (34.6%), lack of time (32.3%) and lack of support from their peers/bosses (23.6%). Almost half women (45.7%) consider not being discriminated because of their gender in their profession, while the rest of them consider that they are or may be.

Table 1.

Demographic characteristics.

Age, n (%)Younger than 35 years52 (40.9%)From 35 to 40 years29 (22.8%)From 40 to 45 years16 (12.6%)From 45 to 50 years12 (9.4%)Older than 50 years18 (14.2%)Marital status, n (%)Married66 (52%)Single38 (29.9%)Free union13 (10.2%)Divorced8 (6.3%)Widowed2 (1.6%)Years of professional practice, n (%)From 1 to 5 years51 (40.2%)From 5 to 10 years31 (24.4%)From 10 to 15 years16 (12.6%)From 15 to 20 years10 (7.9%)More than 20 years19 (15%)

Conclusion:

We found that most female rheumatologists are young and with a few years of professional practice, which coincides with the recent increase in the proportion of women in Rheumatology; and perhaps this is the reason why there is low participation in research activities and medical colleges. It is relevant that almost half of them perceive their gender as a reason of discrimination in their professional life. We consider that initiating the conversation of gender equality in Rheumatology, in national and international forums, and to actively search for a strategy to support and encourage our colleagues, are priorities at this moment.

References:

[1]Andreoli L, Ovseiko PV, Hassan N, et al. Gender equity in clinical practice, research and training: Where do we stand in rheumatology? Joint Bone Spine 2019;86(6):669-72. doi: 10.1016/j.jbspin.2019.05.005.

[2]Colunga-Pedraza IJ, Arvizu-Rivera RI, Serna-Pena G, et al. Women’s journey in Mexican rheumatology. Comment on ‘Gender gap in rheumatology: speaker representation at annual conferences’ by Monga et al. Ann Rheum Dis 2020 doi: 10.1136/annrheumdis-2020-218541.

Acknowledgements:

We have no acknowledgements to declare.

Disclosure of Interests:

None declared

POS0642 THE IMPACT OF AGE ON DISCONTINUATION OF BIOLOGIC DMARDs IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is the most common autoimmune disease. Older patients treated with biologic DMARDs (bDMARDs) are at a significantly greater risk of adverse effects (AEs) [1]. However, the rate of drug discontinuation because of adverse effects caused by bDMARDs has not differed in elderly compared to younger patients in different registries.

Objectives:

Determine if drug discontinuation of bDMARDs differs by age in patients with rheumatoid arthritis in the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican ongoing cohort of patients using bDMARDs since 2016. In this analysis we included all patients with diagnosis of RA with at least two assessments. Survival on bDMARDs was estimated using Kaplan-Meier analysis. Predictors of discontinuation, including age older than median age in the sample were investigated by Cox regression analyses.

Results:

Among 743 patients in the registry, 497 had RA diagnosis, from which, 214 had at least two assessments. At baseline, patients had a median (IQR) age of 53.4 (45-61) years old, median disease duration of 10.7 (6-17) months and median DAS28 of 4.7 (3-6). Conventional DMARDS were used by 185 (87%) patients and 94 (44%) patients used corticosteroids. Comorbidities were present in 194 (91%). The most common bDMARDs received at baseline were abatacept 59 (27%), tocilizumab 45(21%), adalimumab 31 (15%) and certolizumab 30 (14%). At the time of analysis, the median bDMARDs treatment duration was 21.0(13-34) months, 128 (59%) had discontinued treatment, 66 for inefficacy, 32 for adverse events and 30 for others. Fig 1 shows discontinuation rate curves in patients younger and older than median age. Cox proportional-hazards demonstrated no significant differences regarding age older than median age (HR 1.1, 95% CI 0.8-1.4, p=0.7), female sex (HR 1.2, 95% CI 0.7-1.9, p=0.44), use of corticosteroids (HR 1.2, 95% CI 0.9-1.6, p=0.20), comorbidities (HR 0.9, 95% 0.6-1.5, p=0.78), DAS28 (HR 0.9, 95% 0.9-1.1, p=0.93) or other factors.

Figure 1.

Discontinuation rate curves in patients younger and older than median age (< 53.4 and >=53.4 years old)

Conclusion:

This analysis did not show a role of age on discontinuation of bDMARDs in Mexican RA patients. Further longitudinal analyses will be performed including more patients to assess retention rate of bDMARDs and identify predictive variables of discontinuation in Mexican population.

References:

[1]Akter R, et al. Can Geriatr J. 2020 May 1;23(2):184-189.

[2]Ikari Y, et al. Medicine (Baltimore). 2020 Dec 24;99(52):e23861.

Disclosure of Interests:

None declared

POS1242 FACTORS ASSOCIATED WITH MORTALITY IN PATIENTS WITH RHEUMATIC DISEASES AND COVID-19 IN MEXICO

Background:

As of the 25th of January 2021, more than 150 thousand deaths as consequence of COVID-19 have been reported in Mexico [1]. Advanced age, male gender and comorbidities have been described as risk factors for severe disease and mortality in general population [2]. COVID-19 mortality in Mexican patients with rheumatic and musculoskeletal diseases (RMDs) is unknown.

Objectives:

To describe characteristics of Mexican patients with RMDs and COVID-19, and to analyse factors associated with mortality.

Methods:

The Global Rheumatology Alliance COVID-19 (GRA) physician reported registry, is an international effort to collect information on COVID19 in adult patients with RMDs. GRA is an observational registry. The first patient from Mexico was registered on April 17, 2020. All Mexican patients registered in GRA until October 30, 2020 were included in this analysis. The association of mortality with demographic and clinical variables was estimated using logistic regression analysis.

Results:

A total of 323 patients were registered, with a median age of 52 (IQR 41-61) years old, 166 (51.4%) patients lived in Mexico City. The most frequent RMDs were rheumatoid arthritis, 149 (46.1%) and systemic lupus erythematosus, 24 (19.8%). Over a third of patients with RMDs and COVID-19 (119 (36.8%)) were hospitalized, and 43 (13.3%) died. Table 1 shows clinical and demographic characteristics. In the univariable analysis, the absence of comorbidities was a protective factor, OR 0.3 (95% CI 0.1-0.6). Factors associated with mortality at COVID-19 diagnosis were age over 65 years old, having type 2 diabetes, chronic renal insufficiency, treatment at COVID-19 diagnosis with corticosteroids or with CD20 inhibitors. In the multivariable adjusted analysis, these factors remained independently associated with mortality. No associations with other treatments or comorbidities at COVID-19 diagnosis were found.

Conclusion:

Mexican patients with RMDs and COVID-19 in the GRA physician reported registry had a mortality of 13.3%. Factors associated with mortality were those described in the general population, such as older age and being on corticosteroids and CD20 inhibitors treatment at COVID-19 diagnosis.

References:

[1]WHO. Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. (accessed 26 January, 2021).

[2]Zhou F, et al. Lancet 2020;395(10229):1054-62.

Table 1.

Clinical and demographic characteristics of patients with rheumatic diseases and COVID-19 in Mexico and mortality.

Characteristics at COVID-19 diagnosisTotalN=323Death43 (13.3)Survivors280 (86.7)UnivariableOR (95% CI)MultivariableOR (95% CI)Women, n(%)268 (82.9)33 (76.7)235 (83.9)0.6 (0.3-1.4)0.5 (0.2-1.3)Age >65 years old, n(%)62 (19.2)18 (41.9)44 (15.7)3.9 (1.9-7.7)3.9 (1.9-8.3)RMDs* n(%)-Rheumatoid arthritis149 (46.1)23 (53.5)126 (45.0)1.6 (0.7-3.7)-Systemic Lupus Erythemathosus64 (19.8)10 (23.3)54 (19.3)1.6 (0.6-4.3)-Spondyloarthritis (axial and others)33 (10.2)2 (4.7)31 (11.1)0.1 (0.1-2.8)-Others77 (23.8)8 (18.6)69 (24.6)1-Moderate/High disease activity1, n(%)57 (18.6)7 (17.9)50 (18.7)1.0 (0.4-2.5)-None comorbidities, n(%)136 (42.1)8 (18.6)128 (45.7)0.3 (0.1-0.6)-Hypertension*, n(%)88 (27.2)12 (27.9)76 (27.1)1.0 (0.5-2.1)-Type 2 Diabetes*, n(%)49 (15.2)13 (30.2)36 (12.9)2.9 (1.4-6.1)2.4 (1.1-5.4)Obesity*, n(%)21 (6.5)3 (6.9)18 (6.4)1.1 (0.3-3.9)-Chronic obstructive pulmonary disease*, n(%)15 (4.6)1 (2.3)14 (5.0)0.5 (0.1-3.5)-Chronic renal insufficiency*, n(%)17 (5.2)6 (13.9)11 (3.9)3.9 (1.4-11.4)3.4 (1.1-10.4)Cardiovascular diseases*, n(%)14 (4.3)2 (4.7)12 (4.3)1.1 (0.2-5.0)-Corticosteroids*, n(%)171 (52.9)30 (69.7)141 (50.3)2.3 (1.1-4.5)3.0 (1.4-6.5)CsDMARD*, n(%)247 (76.5)33 (16.3)214 (76.4)1.0 (0.5- 2.2)-CD20 inhibitor*, n(%)21 (6.5)7 (16.3)14 (5.0)3.7 (1.4-9.9)4.9 (1.7-14.5)

*Overlapped, 1 307 patients.

Disclosure of Interests:

None declared

Identification of biological pathways specific to phases preceding rheumatoid arthritis development through gene expression profiling

The etiopathogenesis of rheumatoid arthritis is partially understood; however, it is believed to result from a multi-step process. The immune onset followed by pre-clinical phases will eventually lead to the development of symptomatic disease. We aim at identifying differentially expressed genes in order to highlight pathways involved in the pre-clinical stages of rheumatoid arthritis development. The study population consisted of first-degree relatives of patients with rheumatoid arthritis, known to have an increased risk of developing disease as compared to the general population. Whole transcriptome analysis was performed in four groups: asymptomatic without autoantibodies or symptoms associated with possible rheumatoid arthritis (controls); having either clinically suspect arthralgias, undifferentiated arthritis or autoimmunity associated with RA (pre-clinical stages of RA: Pcs-RA); having subsequently developed classifiable RA (pre-RA); and early untreated rheumatoid arthritis patients (RA). Differentially expressed genes were determined, and enrichment analysis was performed. Functional enrichment analysis revealed 31 pathways significantly enriched in differentially expressed genes for Pcs-RA, pre-RA and RA compared to the controls. Osteoclast pathway is among the seven pathways specific for RA. In Pcs-RA and in pre-RA, several enriched pathways include TP53 gene connections, such as P53 and Wnt signalling pathways. Analysis of whole transcriptome for phenotypes related to rheumatoid arthritis allows highlighting which pathways are requested in the pre-clinical stages of disease development. After validation in replication studies, molecules belonging to some of these pathways could be used to identify new specific biomarkers for individuals with impending rheumatoid arthritis.

AB1229 SAFETY OF BIOSIMILAR ETANERCEPT IN THE TREATMENT OF RHEUMATIC DISEASES: DATA FROM THE MEXICAN ADVERSE EVENTS REGISTRY (BIOBADAMEX)

Background:

Access to biosimilar drugs in Mexico started on 2014. Although biosimilar drugs safety has proved comparability to originator drugs on trials, information about its safety on real-life data is limited.

Objectives:

To compare safety in terms of adverse events of biosimilar etanercept (BEt) to originator etanercept (OEt) using information from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican cohort that collects the information of biologic and biosimilar drugs used in patients with rheumatic diseases in public and private practice since 2016. Patients enrolled are followed- up yearly. For this study we included patients from 18 to 65 years old who were or are currently in treatment with OEt or BEt and analyzed the frequency of adverse events (AE), the severity and the outcome of these. Baseline time was considered at enrolment to the cohort. We used logistic regression to analyze univariable and multivariable associations.

Results:

At the time of analysis a total of 119 have received treatment with OEt, 38 with BEt. Mean follow up time was 1.35 years. Rheumatoid arthritis (RA) was the most common disease for all the groups followed by ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Both groups had similar baseline characteristics (Table 1). AE occurred in 4 (3.4%) patients with OEt and in 6 (15.8%) with BEt (OR 0.2, 95% CI 0.04-0.7). The most frequent AE in OEt group was allergic reaction, (2(2.5%) of patients), and infections were the most frequent AE in BEt group (2 (5.3%)). Of patients with BEt, 2(5.3%) had severe AE compared to none in the OEt (p=0.012). In the multivariable adjusted analysis comparing development of AE vs no AE including BEt, comorbidities and glucocorticoids, we found that use of BEt (OR 4.6, 95%CI 1.1-19.5) and presence of comorbidities (OR 4.6, 95%CI 1.01-20.5), were associated with AE. Use of glucocorticoids was not significantly associated.

Table 1.

Baseline characteristics

Originator etanercept (n=119)Biosimilar Etanercept(n=38)UnivariableAnalysisaOR(95%CI)Sex (female), n(%)98 (82.4)27 (71.0)1.9 (0.8-4.4)Age, median (IQR)53.6 (45-61)51.3 (43-58)1.0 (0.9-1.0)Body Mass Index, median (IQR)27.5 (23.4-32.5)26.7 (24-29)1.0 (0.9-1.1)Diagnosis, n(%): Rheumatoid arthritis98 (82.4)26 (68)1 Ankylosing spondylitis13 (10.9)9 (24.0)0.3 (0.1-0.9) Psoriatic arthritis8 (6.9)3 (8.0)0.7 (0.1-2.8)Comorbidities, n(%):41 (34.5)14 (40.0)0.3 (0.3-1.5)Use of previous biologic, n(%):95 (79.8)16 (42.1)5.4 (2.5-11.9)Use of steroids, n(%):45 (37.8)22 (57.8)0.4 (0.2-0.9)Use of DMARD, n(%):94 (78.9)35 (92.1)0.3 (0.1-1.1)Adverse eventsb, n(%):4 (3.4)6 (15.8)0.2 (0.04-0.7)Infectionsb, n(%):1 (0.8)2 (5.3)0.15 (0.1-1.7)Allergic reactionsb, n(%):3 (2.5)1 (2.6)0.9 (0.1-9.5)Severeb, n(%):0 (0)2 (5.3)p=0.012c

aUnivariable logistic regression analysis.bCumulative at time of analyses,cChi-square test.

Conclusion:

This preliminary study showed that AE with BEt were more frequent as well as more severe compared to AE presented with OEt in patients with rheumatic diseases using BIOBADAMEX data. Our study suggests that use of BEt and comorbidities are associated with the development of AE. Follow up and inclusion of more participants is going on and will allow us to perform further analyses.

References:

[1]Rugo HS et al. Future Oncol. 2019;15(7):777-790

[2]Moots RJ BioDrugs. 2018;32(3):193-199

Disclosure of Interests:

Vijaya Rivera Teran: None declared, Marcela Pérez Rodríguez: None declared, Deshire Alpizar-Rodriguez: None declared, Fedra Irazoque-Palazuelos Consultant of: Bristol-Myers Squibb, Janssen, Pfizer Inc, Roche and UCB, Sandra Carrilo: None declared, Sandra Sicsik: None declared, David Vega-Morales: None declared, Dafhne Miranda: None declared, angel castillo: None declared, Julio Cesar Casasola: None declared, Cesar Francisco Pacheco Tena: None declared, José Francisco Moctezuma: None declared, Francisco Aceves: None declared, Aleni Paz: None declared, Sergio Duran Barragan: None declared, Leonor Barile: None declared, Natalia Santana: None declared, Daniel Xavier Xibille Friedmann Consultant of: Lilly, Abbvie, Speakers bureau: Lilly, Abbvie

SAT0595 INTERSTITIAL LUNG DISEASE IN SOUTH AFRICAN ADULTS PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES

Background:

Interstitial lung disease (ILD) is prevalent in patients with autoimmune rheumatic diseases (ARD), leads to significant morbidity and mortality, and is poorly characterized in South Africa.

Objectives:

To describe the clinical, serological and radiological features of ILD associated with ARD in a tertiary referral hospital.

Methods:

A cross-sectional study of outpatients attending the rheumatology and respiratory clinics of Groote Schuur Hospital between October 2018 and September 2019. Clinical, serological and radiological features were documented. We compared features of 3 groups of patients: rheumatoid arthritis (RA), systemic sclerosis (SSc) and “Other” autoimmune rheumatic diseases (OARD) which included Idiopathic Inflammatory Myopathies, Mixed Connective Tissue Disease, Systemic Lupus Erythematous, ANCA-associated vasculitis, Sjogren’s Syndrome and overlap syndromes. Factors associated with Usual Interstitial Pneumonia (UIP) were sought by univariate and multivariate analysis. P-values ≤ 0.05 were considered statistically significant. Analyses was performed with STATA 14.0 (Stata Corp LP, USA).

Results:

Of 124 patients, 29.8 % had RA, 25,8 % SSc and 44.4 % OARD. Most patients were female (86.3%), of mixed racial ancestry (75.0%), and the median (IQR) age was 55 (46-66). Over one-third were smokers, 22.6% had emphysema, and one third had previous pulmonary tuberculosis (PTB) infection. Smoking, emphysema, and previous PTB were higher in RA group but the difference was not statistically significant. All SSc patients and more than two-thirds of RA and OARD patients had gastroesophageal reflux disease (GORD).

Similar to reports elsewhere, Nonspecific interstitial pneumonia (NSIP) was the commonest ILD (63.7 %), followed by UIP (26.6%) and other patterns (9.7%). Contrary to other reports, we found similar frequencies of NSIP and UIP patterns in patients with RA. RA patients were significantly older (median (IQR)) age at ILD onset 62 (55-68) years, compared to SSc (49 (38-56) and OARD (42 (33-56) (p < 0.001). The percentage of predicted Forced Vital Capacity (FVC) were significantly worse in SSc and OARD groups and DLCO in OARD. RA diagnosis (OR 3.8, 95% CI 1.5-9.5), older age (0R 1.1, 95% CI 1.0-1.1), COPD (OR 3.2, 95% CI 1.4-8.0), longer ARD-ILD interval, higher FVC (OR 1.0, 95% CI 1.0-1.1) and previous Methotrexate (MTX) use (OR 2.6, 95% CI 1.1-6.0) were significantly associated with UIP. Multivariable analysis showed that only COPD and previous MTX use was associated with UIP (OR 2.8 (95% CI 1.0 – 8.0) and 1.0 (95% CI 1.0 – 1.0) respectively).

Regarding MTX exposure, 37.1% of patients were prescribed MTX before ILD diagnosis, and 33.9% continued, started or restarted after ILD diagnosis. No case of acute pneumonitis was documented.

Conclusion:

ILD was most commonly diagnosed in RA and SSc, with NSIP seen most frequently overall. RA patients presented better Pulmonary function tests despite higher frequency of UIP. The use of MTX seems to not be associated with the development of acute pneumonitis in patients with ILD

References:

[1]Wallace, B., D. Vummidi, and D. Khanna,Management of connective tissue diseases associated interstitial lung disease: a review of the published literature.Current Opinion in Rheumatology, 2016.28(3): p. 236-245.

[2]Dellaripa, P.F.,Interstitial lung disease in the connective tissue diseases; a paradigm shift in diagnosis and treatment.Clinical Immunology, 2018.186: p. 71-73.

Disclosure of Interests:

None declared

AB1218 MATERNAL-FETAL MORBIDITY AND MORTALITY AMONG PREGNANT PATIENTS WITH RHEUMATIC DISEASES IN THE CLINIC OF PREGNANCY AND ARTHRITIS OF THE SALVADORAN SOCIAL SECURITY INSTITUTE

Background:

Connective tissue diseases are more frequent among women in childbearing age. In the past, it was not recommended for these women to get pregnant because of the risk of adverse pregnancy outcomes.

Objectives:

The aim of this study is to compare the morbidity and mortality between pregnant patients with rheumatic diseases and pregnant patients without rheumatic diseases in El Salvador.

Methods:

A case control study was conducted atthe Clinic of Pregnancy and Arthritisand the1° de Mayo Hospital, both centers belong to theSalvadoran Social Security Institute. Clinical files were reviewed retrospectively and some of the data were collected during the clinical visit to each center. We included pregnant patients with rheumatic diseases of the Clinic of Pregnancy and Arthritis; the control group was randomly selected with a ratio 1:1 within pregnant patients without rheumatic diseases of the 1° de Mayo Hospital, between January 2016 and June 2019. A complication was defined as any event that required hospital admission. We used logistic regression to analyze univariable and multivariable associations to compare pregnancy outcomes between groups.

Results:

During the study period, 230 patients were randomly included in both, the study group and the control group, with a ratio 1:1. The mean age for the study group was 32 (27-35) years, which was relatively older than the control group, 28 (24-32) years. The mean pregnancy among both groups was 2 per patient. The most common rheumatic diseases in the study group were Rheumatoid arthritis (39.1%), Antiphospholipid Syndrome (31.3%) and Generalized Lupus Erythematosus (20%). The average visit to the Rheumatologist during pregnancy in the study group was 3.2. The visits started at a mean of 15.2 + 7.6 weeks of gestational age.

Thirty three point nine percent (33.9%) of the study group presented complications during pregnancy (vs 20.9%). Among the patients who presented complications, 9 of them (7.8%) had more than one complication during pregnancy. There were 44.3% cesarean deliveries in the study group compared with 22.6% in the control group, OR 2.1 (1.5-4.8) p=0.001. There were 16% of preterm deliveries between 34-37 weeks of gestational age in the study group compared to 10% in the control group, OR 2.2 (0.9-4.8) p=0.063. Preterm deliveries before 34 weeks of gestational age in the study group were 18% compared to 3% in the control group, OR 6.9 (2.3-20-9) p=0.001. There were 6 cases of spontaneous abortion in the study group and none in the control group. Thirty four percent (34%) of cases with low birth weight (<2.5kg) were found in the study group compared to 14% in the control group, OR 3.4 (1.6-6.1) p=0.001.

Conclusion:

The most common rheumatic diseases among pregnant patients were Rheumatoid Arthritis, Antiphospholipid syndrome and Generalized Lupus Erythematosus.

Having a rheumatic disease was more associated with cesarean delivery, preterm delivery between 34 and 37 weeks of gestational age, and low birth weight.

References:

[1]M. Gayed, C. Gordon. Pregnancy and rheumatic diseases. Rheumatology 2007;46:1634–1640.

[2]Y A de Man, et al. Annals of Rheumatic Diseases. 2008. 10.1136

Disclosure of Interests:

None declared

FRI0546 GENDER DIFFERENCES OF RHEUMATIC DISEASES IN MEXICAN POPULATION: DATA FROM THE MEXICAN BIOLOGICS REGISTRY

Background:

Most autoimmune diseases are more prevalent in women. Symptom severity, disease progression, response to therapy and overall survival differ between males and females with rheumatic diseases.

Objectives:

To identify the characteristics of autoimmune diseases presentation and treatment between male and female population using information from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods:

BIOBADAMEX is a Mexican ongoing cohort that collects the information of patients using biologic and biosimilar drugs since 2016. For this study we included all patients enrolled in the registry and compared baseline clinical and disease characteristics, treatment and presence of adverse events between genders. We used logistic regression to analyze univariable associations.

Results:

A total of 655 participants were analysed, of which 82% were female (Table 1). We found women were older with a median of 53 years compared to 46 years in men (OR 1.02, CI 1.0-1.1). Smoking was higher in men (16%) compared to women (5%), (OR 0.3, CI 0.2-0.6). Women had longer disease duration, 9 years compared to 7 years in men (OR 1, CI 1.0-1.1). Rheumatoid arthritis (RA) was more prevalent in women (OR 2.7, CI 1-6.9), while ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were more prevalent in men (OR 0.2, CI 0.1-0.4, and OR 0.3, CI 0.1-0.9 respectively). Women had more comorbidities than men (OR 1.8, CI 1.1-2.8) and used steroids more frequently (OR 1.7, CI 1.1-2.7). Differences in disease activity were not found, however we noticed high activity scores among participants.

Table 1.

Baseline characteristics in the cohort by sex

Womenn=532 (82%)Menn=123 (18%)UnivariableaOR(95%CI)Age, median (IQR)53 (44-60)47 (34-55)1.02 (1.0-1.1)*Body Mass Index, median (IQR)27 (23-31)26 (23-30)1.0 (0.9-1.1)Smoking, n(%)28 (5)18 (16)0.3 (0.2- 0.6)*Disease duration, median (IQR)9 (4-16)7 (2-13)1.0 (1.0-1.1)*Diagnosis, n(%): RA414 (78)37 (30)2.4 (1.0-5.7)* AIJ12 (2)5 (4)0.5 (0.1-1.9) AS37 (7)56 (46)0.1 (0.1-0.4)* PsA19 (4)15 (12)0.3 (0.1-0.8)* SLE17 (3)3 (2)1.2 (0.3-5.2) Others33 (6)7 (6)1Disease Activity indexes, median (IQR) DAS28a4.9 (3.6-5.9)4.9 (3.0-5.9)1.1 (0.9-1.3) BASDAIb4.8 (2.9-8)5.3 (2.8-7.5)0.9 (0.8- 1.1) ASDASc3.2 (1.9-4.5)3.9 (2.5-4.7)0.8 (0.6-1.2) SLEDAId14.5 (5.0-19.5)25 (25.0-31.0)0.6 (0.4-1.1)High blood pressure, n(%)77 (15)14 (12)1.3 (0.7-2.4)Diabetes mellitus, n(%)46 (9)7 (6)1.5 (0.7-3.5)High cholesterol, n(%)41 (8)8 (7)1.2 (0.4-2.6)Other comorbidities, n(%):173 (33)26 (21)1.8 (1.1 -2.8)*Use of previous biologic, n(%):216 (40)44 (36)1.2 (0.8- 1.8)Use of steroids, n(%):215 (42)34 (29)1.7 (1.1 -2.7)*Use of DMARD, n(%):418 (79)89 (72)1.4 (0.9-2.2)Adverse eventsb, n(%):69 (13)14 (11)1.2 (0.7-2.1) Severeb, n(%):12 (17)3 (21)0.8 (0.2-3.1)

Univariable logistic regression analysis. *p<0.05.an=469,bn=99,cn=71,dn=19,

Table 1.

Analysis of association between change (Δ) in FMD and relevant parameters by univariate and multivariate linear regression analysis.

UnivariateRho (p)MultivariateBeta (p)Δ FMD (%)(r2=0.30)ChangeADMA (µmol/l)-0.63 (<0.001)-0.25 (0.01)MDA (nmol/ml)-0.58 (<0.001)-0.18 (0.02)SOD (U/ml)0.48 (<0.001)NSGSH (U/ml)0.02 (0.75)NSHOMA-0.21 (0.001)NSeGFR (ml/min/ 1.73 m2)-0.03 (0.62)NShsCRP (mg/l)-0.45 (<0.001)NSPTX3 (ng/ml)-0.49 (<0.001)-0.21 (0.01)SBP (mmHg)-0.26 (<0.001)NSDBP (mmHg)-0.11 (0.12)NSHemoglobin (g/dl)0.07 (0.32)NSTotal Cholesterol (mg/dl)-0.05 (0.49)NSTriglyceride (mg/dl)-0.11 (0.12)NSLDL (mg/dl)-0.12 (0.07)NSHDL (mg/dl)0.02 (0.82)NSHbA1c (%)-0.26 (<0.001)NSFigure 1.

Scatter-plot graphs between FMD and ADMA, MDA, CuZn-SOD, PTX-3.

Conclusion:

In our study we found sex differences regarding age and disease duration, being higher in women. As expected, the prevalence of RA was higher in women and AS and PsA in men. Overall, women used more steroids than men. An interesting finding was that patients had high disease activity. Future longitudinal analyses will allow us to analyse sex differences in disease progression and treatment response.

References:

[1] Ortona E et al. Ann Ist Super Sanita 2016;52(2):205-12

[2] Ngo ST et al. Front Neuroendocrinol 2014;3(3):347-69

Disclosure of Interests:

Vijaya Rivera Teran: None declared, Deshire Alpizar-Rodriguez: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos Consultant of: Bristol-Myers Squibb, Janssen, Pfizer Inc, Roche and UCB, Dafhne Miranda: None declared, David Vega-Morales: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, angel castillo: None declared, Sergio Duran Barragan: None declared, Omar Muñoz: None declared, Aleni Paz: None declared, Angélica Peña: None declared, Alfonso Torres: None declared, Daniel Xavier Xibille Friedmann Consultant of: Lilly, Abbvie, Speakers bureau: Lilly, Abbvie, Azucena Ramos: None declared, José Francisco Moctezuma: None declared, Francisco Aceves: None declared, Estefania Torres: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Erick Zamora: None declared, Francisco Guerrero: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Cesar Francisco Pacheco Tena: None declared

Is the prevention of rheumatoid arthritis possible?

Preclinical phases of rheumatoid arthritis (RA) have been described, genetic and environmental risk factors for RA development have been identified, and several biomarkers of RA have been detected long before the clinical onset of the disease; all of which have opened the possibility for preventive interventions. Several studies are currently exploring pharmacological and non-pharmacological interventions to prevent the development of RA. We will review the evidence for prevention of RA and discuss key challenges for preventive interventions, including identification of the adequate target population, the risks of applying potentially harmful and expensive therapies to asymptomatic at-risk individuals, and the importance of taking into account the preferences of individuals at risk regarding preventive treatment options.

Value of Biomarkers in the Prevention of Rheumatoid Arthritis

Recent diagnostic advances allow to identify persons in a pre-symptomatic stage of rheumatoid arthritis (RA), opening the way for a preventive therapeutic intervention, which may potentially be curative. We review and discuss existing biomarkers predictive of future onset of RA. A responsible use of biomarkers in clinical settings will require an integration of blood-based tests, imaging techniques, clinical history, environmental risk factors, and family history.

Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study

Background

Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD).

Methods

Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes.

Findings

We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p = 0.03), and EULAR good or moderate responses at 1 year was much higher among ‘rapid responders’ (p < 0.001).

Interpretation

Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.

•

This study examined disease activity trajectories in a multinational cohort of 3898 rheumatoid arthritis patients.

•

Growth mixture models identified three groups: gradual, rapid, and inadequate responders (GR: 91·7%, RR: 5·6%, IR: 2·6%).

•

At baseline, groups were similar in demographic and clinical characteristics, and moderately different in function and disease activity.

•

The groups had large difference in drug retention and in good or moderate response rate.

Using nine national registries, this study of 3898 established RA patients initiating a new bDMARD identified distinct types of responders: gradual, rapid and inadequate responders. Neither socio-demographic nor clinical characteristics at baseline allowed the prediction of the type of response trajectory after treatment initiation, but effectiveness outcomes strongly differed, suggesting that these empirically derived subgroups have clinical relevance.

As a major aim of precision medicine is to make anti-rheumatic therapy more personalized, the detection of responder types following initiation of a specific bDMARD underscores the need to find reliable predictors of trajectories to identify patients needing a distinct treatment strategy.