ToRaRI (Tofacitinib in Rheumatoid Arthritis a Real-Life experience in Italy): Effectiveness, safety profile of tofacitinib and concordance between patient-reported outcomes and physician's global assessment of disease activity in a retrospective study in Central-Italy

INTRODUCTION

The use of Janus Kinase Inhibitors (JAK-Is) in rheumatoid arthritis (RA) has entered in daily practice. In consideration of ORAL-Surveillance trial and the new EULAR recommendations, real-world data are needed to assess Jak-Is safety and effectiveness. The multicenter study presented here aimed to evaluate effectiveness and safety of tofacitinib in a real-life cohort.

METHODS

A retrospective analysis was performed from September 2021 to December 2022. Data were collected when tofacitinib was started (T0) and after 3 (T3), 6 (T6) and 12 (T12) months of treatment. The primary objective was to analyze the efficacy and safety of tofacitinib. Safety was assessed by recording adverse events (AEs) with and without discontinuation. The secondary objective was to assess the difference between Patient-Reported Outcomes (PROs) and Physician's Global Assessment of disease activity (PhGA).

RESULTS

122 patients were included in the study from the following rheumatology Centers: Pisa, Ancona, Florence (two Centers), Siena, and Sardinia. A statistically significant improvement in DAS-28-CRP, CDAI and SDAI score was observed at T3, T6, compared to baseline (p < 0.001). Improvement was confirmed in patients who reach T12. Patients naïve to bDMARDs showed a shorter remission time and higher remission rates. There was also a statistically significant improvement in PROs compared to baseline (p < 0.001). The improvement was rapid and was consistent with PhGA. The 12-month retention rate for tofacitinib was 89.35%. Reasons to stop tofacitinib were: insufficient response (7), gastrointestinal symptoms (2), infection (1), malignancy (1), Zoster (1), pruritus sine materia (1).

CONCLUSIONS

Tofacitinib is safe and effective in our RA cohort. It induces higher remission rates in patients naive to bDMARDs, suggesting that there may be a benefit using it as first-line therapy. Additionally, improvement in PROs was consistent with PhGA scores, demonstrating how tofacitinib affects both the objective and subjective components of disease activity. Key Points 1. JAK inhibitors are considered at a similar level as biologic agents in terms of effectiveness. 2. After ORAL-Surveillance results, real-world data are needed to assess the benefit/risk profile of Jaki. 3. Disagreement between patients and physicians has been previously reported with biologic therapy among patients with rheumatoid arthritis, with patients rating disease activity higher than physicians. 4. Jak inhibitors could reduce this discrepancy, due to their mechanism of action.

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

BACKGROUND

The INBUILD study demonstrated the efficacy of nintedanib in the treatment of progressive fibrosing interstitial lung disease different to idiopathic pulmonary fibrosis, including rheumatoid arthritis (RA)-related ILD. Nevertheless, the prevalence of RA-ILD patients that may potentially benefit from nintedanib remains unknown.

OBJECTIVES AND METHODS

The aim of the present multicentre study was to investigate the prevalence and possible associated factors of fibrosing progressive patterns in a cross-sectional cohort of RA-ILD patients.

RESULTS

One hundred and thirty-four RA-ILD patients with a diagnosis of RA-ILD, who were confirmed at high-resolution computed tomography and with a follow-up of at least 24 months, were enrolled. The patients were defined as having a progressive fibrosing ILD in case of a relative decline in forced vital capacity > 10% predicted and/or an increased extent of fibrotic changes on chest imaging in a 24-month period. Respiratory symptoms were excluded to reduce possible bias due to the retrospective interpretation of cough and dyspnea. According to radiologic features, ILD was classified as usual interstitial pneumonia (UIP) in 50.7% of patients, nonspecific interstitial pneumonia in 19.4%, and other patterns in 29.8%. Globally, a fibrosing progressive pattern was recorded in 36.6% of patients (48.5% of patients with a fibrosing pattern) with a significant association to the UIP pattern.

CONCLUSION

We observed that more than a third of RA-ILD patients showed a fibrosing progressive pattern and might benefit from antifibrotic treatment. This study shows some limitations, such as the retrospective design. The exclusion of respiratory symptoms' evaluation might underestimate the prevalence of progressive lung disease but increases the value of results.

ReLiFiRa (Real Life Filgotinib in Rheumatoid Arthritis): Retrospective Study of Efficacy and Safety in Common Clinical Practice

BACKGROUND

Filgotinib (FIL) is a selective JAK1 inhibitor with an affinity 30-fold higher than JAK2, approved to treat moderate to severe active rheumatoid arthritis (RA), in adults with inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs).

METHODS

We conducted a retrospective, multicentric study in order to evaluate efficacy and safety of FIL 200 mg daily therapy, after 3 and 6 months, in 120 patients affected by RA, managed in Tuscany and Umbria rheumatological centers. The following clinical records were analyzed: demographical data, smoking status, previous presence of comorbidities (Herpes zoster -HZ- infection, venous thromboembolism -VTE-, major adverse cardiovascular events -MACE-, cancer, diabetes, and hypertension), disease duration, presence of anti-citrullinated protein antibodies (ACPA), rheumatoid factor (RF), number of biological failures, and prior csDMARDs utilized. At baseline, and after 3 (T3) and 6 (T6) months of FIL therapy, we evaluated mean steroid dosage, csDMARDs intake, clinimetric indexes (DAS28, CDAI, HAQ, patient and doctor PGA, VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and body mass index (BMI).

RESULTS

At baseline, the mean disease duration was 9.4 ± 7.5 years; the prevalence of previous HZ infection, VTE, MACE, and cancer was respectively 4.12%, 0%, 7.21%, and 0.83%, respectively. In total, 76.3% of patients failed one or more biologics (one biological failure, 20.6%; two biological failures, 27.8%; three biological failures, 16.5%; four biological failures, 10.3%; five biological failures, 1.1%). After 3 months of FIL therapy, all clinimetric index results significantly improved from baseline, as well as after 6 months. Also, ESR and CRP significatively decreased at T3 and T6. Two cases of HZ were recorded, while no new MACE, VTE, or cancer were recorded during the observation time.

CONCLUSION

Despite the limitations of the retrospective study and of the observational period of only 6 months, real-life data on the treatment of RA patients with FIL demonstrate that this Jak inhibitor therapy is safe in terms of CV, VTE events, and occurrence of cancer, and is also effective in a population identified as "difficult to treat" due to failure of previous b-DMARD therapy.

AB0731 Thyroid disorders assessment: an unmet need in patients with idiopathic inflammatory myopathies?

Background

Thyroid diseases (TD) might compromise health status of patients, in particular owing to their possible impact on cardiovascular risk, bone mineral density (BMD) and muscle function. The prevalences of Hashimoto thyroiditis (HT), multinodular goiter (MNG) and Graves’ disease (GD) in general population correspond respectively to about 12%, 10% and 1.3%; it is well known HT represents a risk factor for the development of thyroid papillary cancer (TPC). Idiopathic inflammatory myopathies (IIMs) are rare systemic autoimmune disorders, with a pleiotropic clinical picture. TD are a known comorbidity of patients with connective tissue diseases; in particular, they might increase the risk of osteoporosis (OP) and fragility fractures (FF) in patients with SLE1. A recent study described the association between IIMs and both hyper- and hypo-thyroidism2.

Objectives

To evaluate the prevalence of TD in a monocentric cohort of patients with IIMs, exploring possible correlations with serology, organ involvement and comorbidities.

Methods

We retrospectively analyzed medical records of consecutive patients diagnosed with IIM according the EULAR/ACR 2017 criteria and regularly followed at our specialistic outpatient Myositis Clinic from January 2018 to December 2021. We collected data about demography, subset and duration of disease, organ involvement, serology, thyroid dysfunction and other comorbidities. As TD, we took into account the occurrence of HT, MNG and GD. Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values <0.05 were considered significant.

Results

The clinical charts of 151 patients were examined: 101 (66,9%) were female, the mean age was 65,1±14,0 years and the mean disease duration was 8,5±6,5 years. Clinical diagnosis were the following: 69 (45.7%) polymyositis, 59 (39.1%) dermatomyositis, 11 (7.3%) clinically amyopathic dermatomyositis, 10 (6.6%) inclusion body myositis, 2 (1.3%) juvenile dermatomyositis. Seventy-five patients (49.7%) had a TD; in particular, 39/151 (25.8%) had MNG, 34/151 (22.6%) had HT and 2/151 (1.3%) GD. The presence of a TD was significantly related with esophagus’ involvement (p=0.037), Raynaud’s phenomenon (RP) (p=0.045), sicca syndrome (SiS) (p<0,001), OP (p<0,001) and cataract (p=0,017). In particular, HT and MNG occurrence was respectively associated with a higher risk of OP (p<0,001) and of sicca syndrome (p<0,001). Interestingly, TD were significantly less frequent in patients with anti-Mi2beta autoantibodies (p=0,003) and anti-Jo1 autoantibodies (p=0,026). No further significant correlations emerged.

Conclusion

Our study showed nearly half of our IIMs patients had a TD, with a prevalence of both MNG and HT significantly higher than in general population; besides, owing to the retrospective nature of our study, these data could be underestimated. In addition to correlating with RP and SiS, TD showed a significant association with esophagus involvement; this result should be confirmed and clarified with future analyses. Moreover, in our cohort, TD were confirmed as a risk factor for a compromised BMD; in particular, HT was significantly associated with the occurrence of OP. Further studies are needed to corroborated our data in other cohorts of IIM patients and to explore if TD represent a risk factor for FF also in IIM; finally, since HT is a risk factor for TPC, an evaluation of its occurrence in our cohort should be designed. However, our data seem sufficient to underline the need to regularly screen IIM patients for thyroid function, aiming at optimizing their quality of care, both for activity and damage domains of their autoimmune disease.

References

[1]Carli L, et al. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med. 2016 Jan 19;3(1):e000098.

[2]Watad A, et al. Dysthyroidism in dermato/polymyositis patients: A case-control study. Eur J Clin Invest. 2021;51:e13460.

Disclosure of Interests

None declared

AB1152 COVID-19 mRNA VACCINE BOOSTER IN PATIENTS WITH SYSTEMIC AUTOIMMUNE DISEASES

Background

Patients with systemic autoimmune diseases (SADs) are often treated with drugs that interfere with the immune system and previous data showed a reduced seroconversion rate after anti-SARS-CoV2 vaccine in these subjects compared to healthy controls1. Administration of a booster dose of the vaccine could be particularly important in these patients, but data available to date are still scarce.

Objectives

To evaluate the antibody response to the booster dose of mRNA SARS-CoV2 vaccine in patients with SADs and to compare it to the response after completion of the first vaccination course. Secondly, to find possible correlations between a low antibody titre and patients’ clinical features, with special regard to ongoing immunosuppressive therapies.

Methods

Consecutive patients with an established diagnosis of SADs undergoing SARS-CoV2 vaccine were prospectively enrolled from January 2021; among them, we selected the patients who received the third vaccination dose between September and December 2021. Demographic and clinical data were collected at enrolment (sex, age, diagnosis, disease duration, ongoing therapies, previous SARS-CoV2 infection, presence of hypogammaglobulinemia); the last three elements were reassessed at each follow-up visit. Blood samples were collected 4 weeks both after the second (W4a) and the third (W4b) dose of the vaccine; a minority of patients was also tested 12 weeks after the second dose (W12). IgG antibodies to SARS-CoV2 receptor-binding domain (RBD) and neutralizing antibodies inhibiting the interaction between RBD and angiotensin converting enzyme 2 were evaluated. IgG anti-RBD were detected by solid phase assay on plates coated with recombinant RBD, while neutralising antibodies by using the kit SPIA (Spike Protein Inhibition Assay). Cut-off values were defined as the 97.5th percentile of a pre-vaccine healthy population. Statistical analysis was performed using IBM SPSS Statistics 20 and GraphPad Prism statistical packages. P values <0.05 were considered significant.

Results

Forty-five patients (95.6% female; mean age ±SD 55.6±14.1 years; mean disease duration 12.9±10.6 years) were enrolled. Diagnosis was in most cases connective tissue disease (31/45, 68.9%), followed by inflammatory arthritis (11/45, 24.4%) and systemic vasculitis (3/45, 6.7%). Two patients (4.4%) had a previous SARS-CoV2 infection and three had hypogammaglobulinemia (6.7%). At the time of the second dose, 18/45 patients were treated with glucocorticoids (GCs) [mean daily 6-methylprednisolone (6MP) dose 3.9 mg (min. 2, max. 14)], 17/45 with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and 12/45 with biologic DMARDs (bDMARDs). At the third dose administration, 19/45 patients were treated with GCs [mean daily 6MP dose 4.1 mg (min. 1.5, max. 10)], 18/45 with csDMARDs and 13/45 with bDMARDs. Anti-RBD IgG were positive in 42/45 patients (93.3%) at W4a, in 16/18 (88.9%) at W12 and in 42/45 (93.3%) at W4b. Neutralizing antibodies were present in 38/45 patients (84.4%) at W4a, in 14/18 (77.8%) at W12 and in 42/45 (93.3%) at W4b. Both anti-RBD IgG titers and neutralizing antibody titers significantly increased after the third dose if compared to W4a (p<0.0001 both) (Figure 1). Interestingly, of the 7 patients who had not developed an adequate neutralizing antibody response after the first vaccination course, 5 mounted an adequate titer after the booster. Two non-responder patients were both on combination therapy (one with low dose of GCs plus mycophenolate mofetil, the other with methotrexate and infliximab).

Conclusion

Our data suggest that in patients with SADs there is a decline in the antibody titers developed after COVID-19 vaccination, however the booster dose is effective in restoring an adequate antibody titre. These data consolidate the importance of a booster dose of COVID-19 vaccination in patients with SADs to aid in the generation of an immune response.

References

[1]Jena A et al. Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: systematic review and meta-analysis. Autoimmun Rev. 2022

Acknowledgements

The authors would like to thank all the patients who participated in the study and the nurses Sabrina Gori, Rosanna Lo Coco, Lucia Pedrocco, Carla Puccini, Pasqualina Semeraro, Manuela Terachi, Maria Tristano, Valentina Venturini and Catiuscia Zoina who took care of the patients.

Disclosure of Interests

None declared

POS1232 LONG-TERM OUTCOMES OF COVID-19 VACCINATION IN PATIENTS WITH RARE AND COMPLEX CONNECTIVE TISSUE DISEASES: AN AD-INTERIM ANALYSIS OF ERN-ReCONNET VACCINATE STUDY

Background

Since the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefits of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group).

Objectives

To evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://brightoncollaboration.us/wp-content/uploads/2021/01/SO2_D2.1.2_V1.2_COVID-19_AESI-update-23Dec2020-review_final.pdf)

Methods

The first ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defined as at least one of the following: new manifestations attributable to disease activity, hospitalization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants.

Results

A cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren’s syndrome (SS,12%), idiopathic inflammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Danlos’s syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the first and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%).

Conclusion

This preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the first month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.

Table 1.

AEs and disease exacerbations per disease

DiagnosisPatients enrolled (%) (n=300)EAs after 1st and 2nd dose (%)Exacerbations (%)APS25714EDS45033IIM10527MCTD44225SS12598SLE44698SSC16492UCTD850-

Acknowledgements

VACCINATE is a study promoted by the European Reference Network on rare and complex connective tissue diseases, ERN ReCONNET. This publication was funded by the European Union’s Health Programme (2014-2020)

Disclosure of Interests

None declared

POS0909 THE ROLE OF IMACS CORE SET MEASURES TO ROUTINELY EVALUATE THE QUALITY OF LIFE OF IDIOPATHIC INFLAMMATORY MYOPATHIES PATIENTS IN CLINICAL PRACTICE

Background

Idiopathic Inflammatory Myopathies (IIMs) are rare, multisystemic and complex diseases, often impacting on patients’ quality of life (QoL). Patient Reported Outcomes (PROs) assess the overall health status of patients, particularly for emotional and functional domains. In clinical practice the administration of PROs might have some limitations, because they tend to be time-consuming and sometimes difficult to be filled in by patients. The International Myositis Assessment & Clinical Studies Group Disease Activity Core Set Measures (IMACS-CSM) are a tool created to specifically assess disease activity and QoL in IIMs.

Objectives

To evaluate the ability of IMACS-CSM in assessing IIMs patients’ QoL in comparison with both generic and IIMs specific PROs.

Methods

Consecutive adult patients with an established diagnosis of IIM (2017 EULAR/ACR criteria) followed at our Myositis Clinic were enrolled and evaluated during scheduled follow-up visits. Demographic and clinical data (age, sex, disease subset and duration, organ involvement) were collected. IMACS-CSM [Physician Global Activity (PhGA), Patient Global Activity (PGA), 8-items Manual Muscle Testing (MMT8), Health Assessment Questionnaire (HAQ), CPK values, Myositis Disease Activity Assessment Tool (MDAAT)] were used to evaluate both disease activity and QoL. Patients’ perspective was evaluated also by administration of PROs not included in the IMACS-CSM: Short-Form 36 Items Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F), Myositis Activity Profile (MAP), MD Anderson Dysphagia Inventory (MDADI). Results were expressed as mean±SD for continuous variables and as percentage for categorical variables. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. Pearson coefficient was used to analyse the correlations between IMACS-CSM variables and the other PROs. P values <0.05 were considered significant.

Results

Sixty patients (65% female, mean age 59.9±13.5 years, mean disease duration 7.7±6.1 years), 37 (61.7%) with polymyositis, 20 (33.3%) with dermatomyositis and 3 (5%) with inclusion body myositis, were enrolled. Among IMACS-CSM, the mean HAQ and PGA scores were significantly worse in case of muscle (p=0.017) and oesophageal involvement (p=0.017), respectively; as expected, MMT8 score was associated with muscle involvement (p=0.017); MDAAT score was instead associated with oesophageal dysfunction (p<0.001). No associations were found between IMACS-CSM and others clinical and demographic parameters. FACIT-F correlated positively with MMT8 (r 0.432, p=0.001) and negatively with PhGA, PGA, HAQ and MDAAT (all r <-0.404 and p≤0.002 except for PhGA with r=-0.338 and p=0.016). SF-36 domains correlated positively with MMT8 (all r >0.259, p≤0.05) and negatively with PGA (all r <-0.393, p≤0.001), HAQ (all r <-0.422, p≤0.001) and MDAAT (all r <-0.276, p≤0.05). Opposite correlations were found for MAP domains: MMT8 all r <-0.297, p≤0.05; PGA all r >0.326, p≤0.05; HAQ all r >0.483, p≤0.001; MDAAT all r >0.268, p≤0.05. Similarly, MDADI scores correlated negatively with MMT8 (r <-0.363, p=0.005) and positively with PGA, HAQ and MDAAT (all r >0.318, p≤0.015). Notably, no correlations emerged between these PROs and CPK values.

Conclusion

Even if IMACS-CSM offer a partial evaluation of patients’ perspective, our data show how not only HAQ and PGA, but also PhGA, MMT8 and MDAAT (expressing rheumatologist’s point of view) seem to adequately reflect overall health status of IIMs patients, thus giving to clinicians a reliable assessment of their QoL. Therefore, the core set should be routinely used in clinical practice during every outpatient visit, while more accurate and complex PROs might be administered at larger time intervals or during disease flares, to optimize IMACS-CSM’s analysis.

Disclosure of Interests

None declared

AB0259 THE IMPACT OF LOCKDOWN IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

The COVID-19 pandemic has impacted on face to face assessments of patients with rheumatic diseases, including rheumatoid arthritis (RA) and telemedicine has offered a valid opportunity to follow these patients. DEDICARE is a Patient Support Program (PSP) which has been active at our center since 2016, which allows the telemonitoring of PROs (Patient Reported Outcomes) for patients being treated with abatacept. Since 2016, 98 RA patients followed at out Unit entered the DEDICARE program. During COVID19 pandemic these patients continued their monitoring using this PSP.

Objectives

To evaluate the impact of the first COVID wave on PROs and CROs (Clinical Reported Outcomes) in patients with RA included in the DEDICARE programme

Methods

Data collected in the dedicated platform three months before (from December 2019 to February 2020, pre-lockdown), during (from March 2020 to May 2020, lockdown) and after (from June 2020 to August 2020, post-lockdown) the first lockdown period in Italy were compared. In detail DAS28 (CRP, ESR), CDAI and SDAI were evaluated before and after the lockdown period; while VAS-pain, Global Health (GH); Patient Global Assessment of Disease Activity (PGA); Health Assessment Questionnaire (HAQ); Functional Assessment Chronic Illness Therapy (FACIT) were evaluated pre, during e post lockdown with the DEDICARE platform.

Results

36 RA patients, all females, were included in the study; mean age was 62.4 (32-85) years; mean disease duration 15.5 (5-38) years; 18 were ACPA and RF+. All patients were treated with abatacept, 13 as monotherapy and 23 in association with csDMARDs. No patients had COVID19 disease during the evaluated period.

A significant worsening of global health and patient global assessment of disease activity was observed; while no differences were observed regarding the CROs and other PROs (Figure 1)

Figure 1.

Conclusion

In the present study we were able to compare PROs in patients with RA before and after the first COVID wave in Italy. While no significant changes in disease activity were observed, patients experienced an increased perception of disease activity and a decline in their overall health status which began during the lockdown and continued over the following 3 months.

This may highlight a discordance between the patient and the physician perception of the disease, which may partly due to the psychological impact of pandemic on the general perception of health particular in patients with chronic diseases.

Since this discrepancy may have consequences on disease management, and particularly on treatment adherence, there is a need to promote studies to better understand the reasons for these discrepancies and to improve the patient perception of their disease particularly in difficult situations such as COVID 19 pandemic.

References

[1]Lockwood MM, et al Telemedicine in Adult Rheumatology: In Practice and In Training. Arthritis Care Res (Hoboken). 2021 Feb 8. doi: 10.1002/acr.24569.

[2]D’Silva KM, Wallace ZS. COVID-19 and rheumatoid arthritis. Curr Opin Rheumatol. 2021 May 1;33(3):255-261. doi: 10.1097/BOR.0000000000000786. PMID: 33625043; PMCID: PMC8784188.

[3]Sloan M,et al. Telemedicine in rheumatology: A mixed methods study exploring acceptability, preferences and experiences among patients and clinicians. Rheumatology (Oxford). 2021 Oct 26:keab796. doi: 10.1093/rheumatology/keab796.

Disclosure of Interests

None declared

Efficacy of anti-SARS-CoV-2 mRNA vaccine in systemic autoimmune disorders: induction of high avidity and neutralising anti-RBD antibodies

OBJECTIVES

In patients with systemic autoimmune rheumatic disorders (SARDs), vaccination with SARS-CoV-2 mRNA vaccines has been proposed. The aim of this study is to evaluate the immune response elicited by vaccination with mRNA vaccine, testing IgM, IgA and IgG antibodies to SARS-CoV-2 receptor-binding domain (RBD) and measuring neutralising antibodies.

METHODS

IgG, IgM and IgA anti-RBD antibodies were measured in 101 patients with SARDs. Antibodies inhibiting the interaction between RBD and ACE2 were evaluated. Antibody avidity was tested in a chaotropic ELISA using urea. Twenty-one healthcare workers vaccinated with mRNA vaccine served as control group.

RESULTS

Anti-RBD IgG and IgA were produced after the first dose (69% and 64% of the patients) and after the boost (93% and 83%). Antibodies inhibiting the interaction of RBD with ACE2 were detectable in 40% of the patients after the first dose and 87% after boost, compared with 100% in healthy controls (p<0.01). Abatacept and mycophenolate had an impact on the titre of IgG anti-RBD antibodies (p<0.05 and p<0.005, respectively) and on the amount of neutralising antibodies. No effect of other therapies was observed. Vaccinated patients produce high avidity antibodies, as healthy controls.

CONCLUSIONS

These data show that double-dose vaccination induced in patients with SARDs anti-RBD IgG and IgA antibodies in amounts not significantly different from controls, and, most interestingly, characterised by high avidity and endowed with neutralising activity.

The pathophysiology of urinary incontinence among institutionalized elderly persons

Although 1 million institutionalized elderly persons have urinary incontinence, little is known about the causes of this problem. We conducted clinical and physiologic studies to determine the causes of established incontinence in a representative sample of 605 institutionalized elderly persons (mean age, 89 years), of whom 40 percent were chronically incontinent of urine. Detailed urodynamic studies in 94 of the 245 incontinent patients (77 women and 17 men; 38 percent) showed that detrusor overactivity was the predominant cause in 61 percent, with concomitant impaired detrusor contractility present in half these patients. Other causes among women were stress incontinence (21 percent), underactive detrusor (8 percent), and outlet obstruction (4 percent). Among the relatively few men in this sample, outlet obstruction accounted for 29 percent of the cases. In 35 percent of the patients, at least two coexisting probable causes of incontinence were identified. Diagnoses among patients with impaired mobility or mentation differed little from those in unimpaired patients. We conclude that the pathophysiology of incontinence in this population is complex; that detrusor hyperreflexia with normal contractility ("uninhibited bladder") accounts for the minority of cases (29 percent), even among patients with dementia; and that the causes of incontinence are as diverse in severely impaired elderly persons as in those who are unimpaired.