Determination of the optimal position of the lower extremity for femoral nerve block with ultrasonographic measurements: a prospective volunteer-based study

OBJECTIVE

The aim of the study was to determine the optimal position for femoral nerve block (FNB) under ultrasound guidance.

PATIENTS AND METHODS

We included fifty volunteers between 18-65 years of age in this study. The distances from the skin to the landmarks, which were taken as a reference for the ultrasound-guided FNB (apex point of the femoral artery = F12, lateral point = F9, and lower point = F6), were measured and compared in 3 different positions given to the lower extremity (neutral position: P1, 45° abduction: P2, and flexed knee: P3). The ease of application and the quality of the ultrasound images were evaluated at each measurement by assigning a subjective observer score and comparing them in three positions.

RESULTS

All three measurement points were found to be closest to the skin at position P3. However, the distances from F9 (p = 0.023) and F6 (p = 0.006) to the skin were significant. A significant difference was found between P1 and P3 in terms of the distance from F9 (p = 0.027) and F6 to the skin (p = 0.007). P3 was determined to be the position with the highest score for clarity of the ultrasonography images and ease of detection of the measurement points (p < 0.001). As the scores of ease of access to the femoral nerve (FN) and image clarity increased, the distance from the measurement point to the skin surface decreased, which was statistically significant.

CONCLUSIONS

The ideal position for ultrasound-guided FNB is the P3 position. As an alternative for patients with limited mobility, the P2 position can be used.

Defining and Improving Outcomes Measurement for Virtual Care: Report from the VHA State-of-the-Art Conference on Virtual Care

Virtual care, including synchronous and asynchronous telehealth, remote patient monitoring, and the collection and interpretation of patient-generated health data (PGHD), has the potential to transform healthcare delivery and increase access to care. The Veterans Health Administration (VHA) Office of Health Services Research and Development (HSR&D) convened a State-of-the-Art (SOTA) Conference on Virtual Care to identify future virtual care research priorities. Participants were divided into three workgroups focused on virtual care access, engagement, and outcomes. In this article, we report the findings of the Outcomes Workgroup. The group identified virtual care outcome areas with sufficient evidence, areas in need of additional research, and areas that are particularly well-suited to be studied within VHA. Following a rigorous process of literature review and consensus, the group focused on four questions: (1) What outcomes of virtual care should we be measuring and how should we measure them?; (2) how do we choose the "right" care modality for the "right" patient?; (3) what are potential consequences of virtual care on patient safety?; and (4) how can PGHD be used to benefit provider decision-making and patient self-management?. The current article outlines key conclusions that emerged following discussion of these questions, including recommendations for future research.

Utilizing functional cell-free extracts to dissect ribonucleoprotein complex biology at single-molecule resolution

Cellular machineries that drive and regulate gene expression often rely on the coordinated assembly and interaction of a multitude of proteins and RNA together called ribonucleoprotein complexes (RNPs). As such, it is challenging to fully reconstitute these cellular machines recombinantly and gain mechanistic understanding of how they operate and are regulated within the complex environment that is the cell. One strategy for overcoming this challenge is to perform single molecule fluorescence microscopy studies within crude or recombinantly supplemented cell extracts. This strategy enables elucidation of the interaction and kinetic behavior of specific fluorescently labeled biomolecules within RNPs under conditions that approximate native cellular environments. In this review, we describe single molecule fluorescence microcopy approaches that dissect RNP-driven processes within cellular extracts, highlighting general strategies used in these methods. We further survey biological advances in the areas of pre-mRNA splicing and transcription regulation that have been facilitated through this approach. Finally, we conclude with a summary of practical considerations for the implementation of the featured approaches to facilitate their broader future implementation in dissecting the mechanisms of RNP-driven cellular processes. This article is categorized under: RNA Structure and Dynamics > RNA Structure, Dynamics and Chemistry RNA Interactions with Proteins and Other Molecules > RNA-Protein Complexes RNA Structure and Dynamics > Influence of RNA Structure in Biological Systems.

Comparison of demographic, clinic and radiological features of patients with axial spondyloarthritis accompanying familial Mediterranean fever to patients with each condition alone

OBJECTIVE

To compare the demographic, clinical, and radiological features of patients with axial spondyloarthritis (axSpA) accompanying familial Mediterranean fever (FMF) to patients with each condition alone.

METHOD

Hacettepe University Hospital database was screened regarding ICD-10 codes for FMF (E85.0) and axSpA (M45). The diagnosis of FMF was confirmed by Tel-Hashomer criteria, and axSpA by the presence of sacroiliitis according to the modified New York criteria or active sacroiliitis on magnetic resonance imaging. As control groups, 136 gender-matched, consequent FMF patients without axSpA and 102 consequent axSpA patients without FMF previously treated with any biological agents were included in the analysis.

RESULTS

In patients with FMF + axSpA compared to the axSpA group, age at axSpA symptom onset and age at diagnosis were lower [median with interquartile range (IQR): 21 (17-30) vs 27 (21-37), p < 0.001; 23 (21-38) vs 32 (24-43) years, p = 0.001], moderate to severe hip disease and total hip replacement were more prevalent (23.4% vs 4.7%, p < 0.001; 11.2% vs 2.8%, p = 0.016). In patients with FMF + axSpA compared to the FMF group, age at FMF symptom onset and age at diagnosis were higher [13 (6-30) vs 11 (5-18), p = 0.057; 23 (13-33) vs 18 (10-31) years, p = 0.033] and amyloidosis was more prevalent (6.6% vs 2.2%, p = 0.076). Although the M694V variant (in one or two alleles) was more prevalent in the FMF + axSpA group, the difference was not statistically significant.

CONCLUSION

In patients with FMF + axSpA, the age of onset of axSpA was significantly earlier, moderate to severe hip involvement and amyloidosis were more common than in patients with each condition alone.

DNA damage and changes in oxidized biomolecules in COVID-19 patients treated in intensive care units: a single center experience

OBJECTIVE

COVID-19 is a deadly disease. Investigations are being conducted on the underlying mechanisms to predict prognosis and reduce mortality rates. In this study, the extent of DNA damage and serum levels of oxidized biomolecules were investigated. We hypothesize that malondialdehyde (MDA) and protein carbonyl (PC) serum levels and DNA damage levels may be biomarkers that can be used in prognostic decision making and prediction of mortality in COVID-19 patients.

PATIENTS AND METHODS

Patients included in the study were divided into two groups according to their survival. These groups were compared in terms of serum MDA, PC levels, DNA damage degrees and mortality on the 1st, 3rd, and 5th days of ICU admission.

RESULTS

In patients who died, MDA levels increased over time (p=0.023), PC levels peaked on the third day of admission to the intensive care units (ICU), and then decreased, while DNA damage increased gradually (p=0.013). In surviving patients, MDA levels decreased over time (p=0.018); PC levels were at their peak on the first day of admission to the ICU and then decreased (p=0.018); DNA damage decreased initially, and then increased minimally compared to Day 1.

CONCLUSIONS

For COVID-19 ICU patients, serum levels of MDA and PC and degrees of DNA damage can strengthen prognostic decision-making and contribute to reducing mortality.

Comparison of cytotoxic, reactive oxygen species (ROS) and apoptotic effects of propofol, thiopental and dexmedetomidine on liver cells at accumulative doses (AML12)

OBJECTIVE

Propofol, thiopental and dexmedetomidine are hypnotic, sedative, antiepileptic and analgesic agents used in general anesthesia and intensive care. There are many known and yet unknown side effects. Our aim in this study was to examine and compare the cytotoxic, reactive oxygen species (ROS) and apoptotic effects of propofol, thiopental and dexmedetomidine drugs, which are widely used in anesthesia, on liver cells (AML12) in vitro.

MATERIALS AND METHODS

The half-maximum inhibitory concentration (IC50) doses of the three drugs on AML12 cells were determined using the 3-[4,5-dimethylthiazol-2yl]-2,5-diphenyltetrazolium bromide (MTT) method. Then at two different doses of each of the three drugs, apoptotic effects were determined by the Annexin-V method, morphological examinations were determined by acridine orange ethidium bromide method and intracellular reactive oxygen species (ROS) levels were determined by flow cytometry.

RESULTS

The IC50 thiopental, propofol and dexmedetomidine doses were found to be 255.008, 254.904 and 34.501 μgr/mL, respectively (p<0.001). The highest cytotoxic effect on liver cells was found in the lowest dose of dexmedetomidine (34.501 μgr/mL) compared to the control group. This was followed by thiopental and propofol, respectively.

CONCLUSIONS

In this study, propofol, thiopental and dexmedetomidine drugs on AML12 cells were found to have toxic effects by increasing intracellular ROS at two different concentrations higher than clinical doses. It was determined that cytotoxic doses caused an increase in ROS and induced apoptosis in cells. We believe that the toxic effects of these drugs can be prevented by examining the values obtained from this study and the results of future studies.

Factors increasing mortality in Echinococcosis patients treated percutaneously or surgically. A review of 1,143 patients: a retrospective single center study

OBJECTIVE

While cystic echinococcosis (CE) is a serious problem in underdeveloped countries, it also becomes a serious public health problem in developed countries due to recent migration and population movements. This study aimed to investigate the relationship between pregnancy, multi-organ involvement, treatment methods, and emergency surgery (unfollowed patients), with mortality in patients with CE who underwent surgical or percutaneous treatment.

PATIENTS AND METHODS

In this study, demographic characteristics, pregnancy status, organ involvement, development of relapse and anaphylaxis, need for intensive care and mortality rates of patients with CE treated with percutaneous or surgical methods at Harran University Hospital between January 1997 to January 2022 were investigated.

RESULTS

Of the 1,143 patients who underwent surgery or percutaneous treatment for CE, 18 were pregnant. Mortality was found to be significantly higher in pregnant patients with CE (p<0.001). Mortality was significantly higher in those who developed anaphylaxis (p<0.001). In percutaneous treatment, recurrence (p<0.001) and anaphylaxis (p=0.026) were found to be significantly higher. Mortality was found to be three times higher in patients without follow-up who were operated on urgently (p=0.108).

CONCLUSIONS

CE is a disease that can occur at any age and can be fatal. Although multi-organ involvement and percutaneous treatment may be associated with recurrence, they do not directly increase mortality. The mortality is high, especially in pregnant women with pulmonary CE. Cardiac involvement, brain involvement and anaphylaxis increase mortality. Mortality is higher in patients without follow-up who are operated on urgently.

AB0278 IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING bDMARDs, THE CHARLSON COMORBIDITY INDEX IS MORE PRONOUNCED THAN PSORIATIC ARTHRITIS

Background

According to international recommendations, co-morbidities must be taken into account in the management of patients with inflammatory arthritis.

Objectives

To evaluate the distribution of pre-treatment comorbidities in the bDMARD cohort including patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods

The Hacettepe University biological database (HUR-BIO) was established in 2005, 581(75.4% female) patients with RA and 520 (69.4%female) patients with PsA enrolled up to 2021 were analyzed. Diagnosis of RA and PsA were based on the clinical evaluation of the rheumatologist who followed the patients. Comorbidities of the patients were reviewed retrospectively from the biological database, hospital electronic records, ICD-10 diagnostic codes and prescriptions of patients. Diabetes mellitus (DM), Hypertension (HT), Dyslipidemia (DL), Coronary artery disease (CAD), Body mass index (BMI) and smoking were recorded. DL was grouped in terms of lipid values ​​according to the classification of the Turkish Society of Endocrinology and Metabolism Dyslipidemia Guide(1). Detection of coronary artery disease before the age of 55 in men and of 65 in women was classified as premature - CAD. Data on Chronic Kidney Disease, obstructive pulmonary disease, Cerebro-vascular disease, Thyroid Diseases were also recorded. The Charlson comorbidity index (CCI) was calculated by summing the comorbidities in the patients’ medical history before the bDMARDs.

Results

The distribution of comorbidities in patients with RA and PsA prior to initiation of bDMARDs was given in Table 1. Patients with RA were older and smoking was more common. HT(28.5% for RA, 21.9% for PsA) and thyroid diseases (22.7% for RA, 14.7% for PsA) were the most comorbidities in both groups. Compared to PsA, patients with RA had higher rate of comorbidities (64.8% vs. 40.4%, p<0.001). Multimorbidity was detected in 231/581 (39.7%) of patients with RA, and it is significantly more common than the patients with PsA (21.8%) (p<0.001). There was no difference between the groups in terms of cardiovascular comorbidities such as BMI, DM, and dyslipidemia. When adjusted for age, the comorbidity burden according to CCI was 3.96 (2.57-6.13, p<0.001) times higher in patients with RA than in patients with PsA.

Table 1.

Comorbidities in RA and PsA patients

FeaturesRA n=581PsA n=520pGender, female n (%)438 (75.4)361 (69.4)0.027Age at PsA diagnosis, mean (SD) years46.7 (13.7)39.3 (12.0)<0.001Age at bDMARD start, mean (SD) years49.5 (13.8)42.2 (12.3)<0.001CCI-No comorbidity205/581 (35.2)290/486 (59.6)<0.001-1 comorbidity145/581 (24.9)90/486 (18.5)-≥ 2 comorbidity231/581 (39.7)106/486 (21.8)CCI mean, (SD)1.56 (1.77)0.78 (1.18)<0.001Smoking (ever), n292/581282/506<0.001BMI, mean (SD)29.3 (6.7)29.6 (5.9)0.50BMI ≥ 30 n261/577221/4980.77Diabetes Mellitus, n68/58149/4020.30Hypertension, n166/581110/5020.012Dyslipidemia* n-High TC47/27032/1610.30-High TG62/24245/1590.79-High LDL -C53/289(43/1750.38-Low HDL-C88/26757/1570.48Uric acid (>6 mg/dl), n150/554136/4370.16CAD n59/52432/4860.010Premature CAD, n39/58118/4860.030CKD, nG1 (GFR > 90)437/5230<0.001G2 (GFR 60-90)68/5230G3a (GFR 45-60)11/5230G3b (GFR 30-45)5/52328/370G4 (GFR 15-30)2/523342/370Lung disease, n-COPD15/5193/4850.007-Asthma66/52019/485<0.001Thyroid disease, n132/58165/440<0.001

*TC > 240, TG 150-499, LDL-C> 160, HDL-C erkek < 40, kadin < 50

CCI: Charlson comorbidity index, CAD: Coronary artery disease, CKD: Chronic Kidney Disease, COPD: Chronic Obstructive pulmonary disease

Conclusion

The burden of comorbidities in patients with RA before bDMARDs is more pronounced than in patients with PsA. Although, cardiovascular risk factors were similar, with the exception of hypertension and smoking, the age-adjusted CCI was 3.96 times higher in patients with RA than in patients with PsA.

References

[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021

Disclosure of Interests

None declared

AB0353 bDMARD CHOICES FOR INFLAMMATORY ARTHRITIS WITH CHRONIC KIDNEY DISEASE; HUR-BIO REAL-LIFE REGISTRY

Background

Rheumatic disesases may involve multiple systems and chronic kidney disease (CKD) can be seen during the course of diseases. Accompanying CKD affects the the choice of treatments in patients with rheumatic disease. There is limited data on the use of biological DMARDs in rheumatic patients with chronic kidney disease.

Objectives

To determine the preferred first and second bDMARDs in patients in the CKD in the bDMARD cohort.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005. A total of 2160 RA patients, 3744 SPA patients, were registered in HUR-BIO until November 2021. The CKD was confirmed and classified according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. . Patients were evaluated for the presence of CKB before the initiation of bDmard and during follow-up under bDMARDs. Age and sex matched RA patients without CKD were selected for the control group.

Results

142/5904 (2.4%) patients have CKD. 102(%71.8) patients had CKD prior to initiation of bDMARD and 40 (28.1%) patients had developed during follow-up. The median time to CKD development after starting bDMARD was 4.13 years(±4.05). Of the patients with CKD, 98 (69.0%) had RA and 44 (31.0%) had SpA. RA patients followed for CKD were older than SpA (66.0 (±11.1) vs 59.1 (±13.0) years, p=0.001), female gender was more common (73.5% vs 36.4%, p<0.001), disease duration was similar (19.3 (±13.8) vs 17.1 (±10.5) years, p=0.40). The first bDMARD choices of patients with and without CKD in RA and SpA patients were shown in Table 1. There was no difference between the SPA patients with or without CKD regarding TNF-i preferences. In patients with rheumatoid arthritis there was no difference in terms of TNFi and non-TNF-i preferences, but tocilizumab was more prefered in CKD group.

Table 1.

Relationship between remission according to bDMARD and CKD

Rheumatoid arthritispSpondyloarthritispw CKD n=98wo CKD n=91w CKD n=44(%)wo CKD n=80(%)p<0,05Etanercept, n(%)34 (34.6)30 (33.0)0.4617 (38.6)22 (27.5)P=0.14Adalimumab, n(%)17(17.3)17 (18.7)0,4810 (22.7)22 (27.5)P=0.36Infliximab,n(%)3 (3)8 (8.8)0.8514(31.8)32 (40.0)p=0.24Golimumab, n(%)4 (4)3 (3.3)0,541 (2.2)3 (3.8)p=0.55Certolizumab, n(%)0 (0)3 (3.3)0,111 (2.2)1 (1.3)p=0.58Anti-TNF therapy, n(%)58 (59.2)61 (67.0)0,6143800.352Non-TNF biologics, n(%)40 (40,8)30 (33.0)0,13100.355Rituximab, n(%)14 (14.3)12 (13.2)0,57Abatacept, n(%)14(14.3)12 (13.2)0,49Tocilizumab, n(%)6 (6.1)10.0411(2.2)p=0.35Jak-kinase inhibitors, n(%)6(6.1)5 (5.5)0.55

Conclusion

In our biologic cohort, 2% of patients with RA and SpA had accompanying CKD. In one-third of the patients with CKD, it was developed during the follow-up after bDMARDs. In patients with RA, there was no difference in terms of TNFi and non-TNF-i preferences. It should be kept in mind that CKD may develop during the follow-up of patients using bDMARDs.

References

[1]Ye W, Zhuang J, Yu Yet all Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study. BMC Nephrol. 2019 Dec 9;20

[2]Chebotareva NV, Guliaev SVet al. [Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants]. Ter Arkh. 2019 May 15;91(5)

Disclosure of Interests

None declared

POS1440 HEMATOLOGICAL MALIGNANCIES AND ANTI-TNF IN INFLAMMATORY ARTHRITIS: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY

Background

TNF inhibitors (TNFi) is highly effective in inflammatory arthritis (IA) treatment. However, concerns are raised about the possible association between TNFi and hematologic malignancies (HMs).

Objectives

To assess the incidence of HMs among IA patients receiving TNFi compared with the general Turkish population.

Methods

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA including rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) patients who had at least 1 visit after the TNFi usage were screened from 2005 to November 2021. HM diagnosis was determined from the each patient files according to the hematologists’ decision and/or bone marrow/lymph node biopsy. Demografic data, disease characteristics, and death status were recorded. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with age- and gender-specific SIR values abstracted from the 2017 Turkish National Cancer Registry (TNCR).

Results

Of the 6139 patients registered in the HUR-BIO database, 5355 [3116 female (58.2%)] used any TNFi at least once. Median follow-up duration was 2.6 years for all patients receiving TNFi. 13 patients [8 (61.5%) female] had HM on follow-up. In these patients, median age at the IA onset was 38 (range 26 to 67) and the number of patients with SpA, RA, and PsA was 7, 4, and 2, respectively. The median duration of IA was 17.7 years (range 1 to 33). The median age at the HM onset was 55.5 (range 38 to 76) and the type of HM as follow: 8 lymphoma, 2 multiple myeloma, 1 large granular lymphocytic leukemia, 1 plasma cell dyscrasia, and 1 myelodysplastic syndrome. The median duration of the TNFi usage onset to HM was 36 (range 4-112) months. The TNFi was as follows: etanercept (n=8), adalimumab (n=6), infliximab (n=4), golimumab (n=1), and certolizumab (n=1). 5 patients used more than one TNFi. Patients using TNFi had an increased incidence for HMs (SIR 4.23, 95% CI 2.35-7.05). These results were also valid for both gender. 10 patients with HMs were under the age of 65. In this group, there was a higher incidence of HMs in both men (SIR 5.15, 95% CI 1.88-11.43) and women (SIR 4.76, 95% CI 1.74-10.55). 5 patients deceased on follow-up.

Conclusion

The risk of HMs in inflammatory arthritis patients receiving TNFi being four times higher in comparison with the general Turkish population. There is a plethora of information that discusses the association between HMs and rheumatic disease. To determine whether the increased risk is from rheumatic disease or from TNFi usage, it would be ideal to compare patients receiving TNFi with bDMARD naive IA patients.

Table 1.

SIR for diferent age cut-ofs in both sexes for patients with hematologic malignancies

GenderAgeObserved/expected casesSIR%95 confidence intervalTotalAll ages*13/3.074.232.35-7.05Male20-64 years (n=2059)5/0.975.151.88-11.43≥ 65 years (n=180)0/0.39NA-Overall (n=2239)5/1.363.671.34-8.14Female20-64 years (n=2667)5/1.054.761.74-10.55≥ 65 years (n=449)3/0.664.541.15-12.37Overall (n=3116)8/1.714.672.17-8.88

*: Includes patients ≥18 years.

NA: Not applicable, SIR: standardized incidence rates

Figure 1.

Cumulative number of hematologic malignancies in function of time from start of first anti-TNF therapy

Disclosure of Interests

None declared

POS0765 IS THERE ANY DIFFERENCE IN THE CLINICAL FEATURES AND OUTCOMES OF PROLIFERATIVE AND NON-PROLIFERATIVE FORMS OF LUPUS NEPHRITIS PROVEN BY BIOPSY?

Background

Lupus nephritis (LN), which occurs in 60-70% of patients with systemic lupus erythematosus, is a major determinant of morbidity and mortality. There still are many uncertain aspects in clinical, pathological, and prognostic characteristics about LN.

Objectives

We aimed to compare clinical features, outcomes, and to define the predictive factors of complete renal response (CRR) in patients with proliferative and non-proliferative LN.

Methods

Patients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had a kidney biopsy were the subject of the study. One hundred and sixteen patients whose kidney biopsy reported as LN were evaluated retrospectively. Clinical features, laboratory values at the time of kidney biopsy, histopathological forms of LN, and renal response (complete or partial) were recorded. The predictive factors for CRR during the two-year follow-up after induction therapy were analyzed.

Results

Of 116 (93 females, 23 males) patients, 95 (81.9%) were in the proliferative (class III and IV) and 21 (18.1%) were in the non-proliferative group (class II and V). In the proliferative group, elevated basal creatinine, median daily proteinuria, anti-dsDNA positivity, low C3 and C4, the presence of active urinary sediment, and median renal SLE Disease Activity Index (SLEDAI) scores at the time of kidney biopsy were significantly higher than non-proliferative group. During the two-year follow-up after LN diagnosis, 70 patients achieved CRR and time-to-CRR was similar for the groups (p=0.64, log-rank). The Cox proportional hazards model showed that achieving CRR was associated with female gender [HR: 2.15 (1.19-3.89 95% CI), p=0.011], newly diagnosed SLE with renal biopsy [2.15 (1.26-3.67), p=0.005], hypertension [0.40 (0.27-0.94), p=0.032], eGFR increase [1.01 (1.00-1.01), p=0.046], and presence of active urinary sediment [0.46 (0.22-0.96), p=0.039].

Conclusion

Achieving CRR was similar in both the proliferative and non-proliferative LN patients although certain laboratory parameters differed at onset. Our results indicated the importance of kidney biopsy in the decision-making of treatment of SLE patients with renal involvement and that the defined factors associated with CRR achievement help to predict good renal response.

Table 1.

Demographic, clinical characteristics, and outcomes of the patients with LN

Variables*All patientsProliferative LNNon-Proliferative LNpn=116n=95n=21Age at SLE diagnosis, years18.3 (16)19.2 (15)16 (16)0.32Sex, female93 (80.2)75 (78.9)18 (85.7)0.48Age at kidney biopsy, years21 (17.7)22 (17)18 (15)0.19Patients newly diagnosed SLE with renal biopsy65 (56)53 (55.8)12 (57.1)0.91Follow-up time for LN, years5.5 (8)5.1 (8.2)6.2 (5.1)0.80SLE disease duration8 (8.7)8.1 (9.6)7.9 (7.3)0.53Hypertension31 (26.7)26 (27.4)5 (23.8)0.74Laboratory values on the kidney biopsy Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.56 (0.1)0.006 Creatinine > UNL37 (32.5)34 (36.6)3 (14.3)0.04 eGFR (mL/min/1.73m2)113 (54)107 (54)129 (45)0.04 Albumin (g/dL)3.3 (1.1)3.1 (1.2)3.5 (1)0.09 24-hour urine protein, gr/day2.3 (3.3)2.4 (3.6)0.9 (1.8)0.03 Anti-dsDNA positivity94 (81)80 (87.9)14 (70)0.04 Low C3 and C4 levels93 (80.2)81 (88)12 (57.1)0.001 Active urinary sediment91 (83.5)78 (89.8)12 (57.1)<0.001Renal SLEDAI12 (8)12 (8)4 (4)<0.001During the two-year follow-up after LN diagnosis Complete renal response70 (70.7)56 (70.9)14 (70)0.99 Partial renal response23 (23.2)17 (21.5)6 (30)0.64 No response6 (6.1)6 (7.6)0NA Relapse20 (21.5)15 (20.5)5 (25)0.84 ESRD4(4)4 (4.2)0NA Death3 (3)3 (3.2)0NA

* n (%), if otherwise specified; median (IQR) for numeric values

ESRD: End-stage renal disease, GFR: Glomerular filtration rate, LN: Lupus nephritis, SLE: Systemic lupus erythematosus, SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; UNL: Upper normal limit

Figure 1.

Kaplan-Meier survival curve for complete renal response (CRR) achievement during the two-year follow-up according to the kidney biopsy results

Disclosure of Interests

None declared

POS0991 PREDICTORS OF DEVELOPMENT OF ADVANCED SPINAL ANKYLOSIS/BAMBOO SPINE IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM REAL-LIFE DATA

Background

In axial spondyloarthritis (axSpA), intervertebral ossification bridges of consecutive vertebrae may progress to advanced spinal ankylosis and bamboo spine over the years [1].

Objectives

To identify demographic, clinical, disease activity and treatment factors associated with development of bamboo spine / advanced spinal ankylosis and bamboo spine-only in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.

Methods

HUR-BIO is a prospective, single center database of biological disease-modifying antirheumatic drug (bDMARD) treatments. 770 patients on bDMARDs treatment had both lumbar and cervical lateral radiographies at the time of the data collection, and were included in the study. Bamboo spine was defined Bath Ankylosing Spondylitis Radiologic Index (BASRI)-spine grade 4 with a complete fusion of lumbar and cervical spines. Advanced spinal ankylosis was defined as the presence of at least two intervertebral adjacent bridges and/or fusion at the lumbar and/or cervical spine without bamboo spine. We analyzed the ensemble of variables by multivariable logistic regression to identify predictors associated with bamboo spine / advanced spinal disease, and bamboo spine-only.

Results

In the study, there were 99 patients with advanced spinal ankylosis and 78 patients with bamboo spine. Older age (OR 1.12, 95% CI 1.07-1.17), male gender (OR 4.26, 95% CI 1.75-10.41), delay diagnosis ≥ 24 months (OR 2.7, 95% CI 1.27-5.74), obesity (OR 4.03, 95% CI 1.53-10.64), hip involvement (OR 4.94, 95% CI 1.94-12.6), smoking ≥ 10 package/year (OR 2.28, 95% CI 1.003-5.2) were significantly associated factors with bamboo spine / advanced spinal ankylosis. Similarly, older age (OR 1.17, 95% CI 1.09-1.3), male gender (OR 8.31, 95% CI 2.09-33.1), obesity (OR 5.15, 95% CI 1.25-21.27), hip involvement (OR 4.74, 95% CI 1.32-16.96) and smoking ≥ 10 package/year (OR 3.19, 95% CI 1.03-9.89) were showed statistical significance with bamboo spine (Table 1).

Table 1.

Predictors of Bamboo Spine and Advanced Spinal Ankyloses, and Bamboo Spine-only

Multivariable ModelCovariatesBamboo Spine and Advanced Spinal AnkylosisBamboo SpineOR (95% CI)p-valueOR (95% CI)p-valueAge1.12 (1.07-1.17)<0.001*1.17 (1.09-1.3)<0.001*Male (vs female)4.26 (1.75-10.41)0.001*8.31 (2.09-33.1)0.003*Delay Diagnosis (≥ 24 months vs <24 months)2.7 (1.27-5.74)0.01*2.39 (0.85-6.71)0.09BMI0.019*0.074- 25 to < 30 (vs <25)2.05 (0.77-5.46)0.153.37 (0.84-13.6)0.087- ≥ 30 (vs <25)4.03 (1.53-10.64)0.005*5.15 (1.25-21.27)0.024*Hip involvement (present vs absent)4.94 (1.94-12.6)0.001*4.74 (1.32-16.96)0.017Smoking (≥ 10 package/year vs <10 package/year)2.28 (1.003-5.2)0.049*3.19 (1.03-9.89)0.044*Family History of SpA (First-degree; present vs absent)1.67 (0.61-4.57)0.322.82 (0.79-10.06)0.11Uveitis History (present vs absent)1.04 (0.39-2.74)0.941.19 (0.33-4.29)0.79Use SSZ (present vs absent)0.6 (0.17-2.07)0.422.09 (0.39-11.28)0.39Use Corticosteroids (present vs absent)0.69 (0.27-1.75)0.430.73 (0.18-2.97)0.66

*p <0.05

BMI: Body mass index; SpA: Spondyloarthritis; SSZ: Sulfasalazine

Conclusion

Data on the predictors of development of advanced spinal ankylosis and bamboo spine are scarce. In this study, we showed that older age, male gender, delay in diagnosis, obesity, hip involvement and smoking are factors that predict the development of advanced spinal involvement in axSpA.

References

[1]Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskelet Dis. 2012;4(4):301-11.

Disclosure of Interests

None declared

POS1085 FREQUENCY OF DYSLIPIDEMIA AND COMPLIANCE WITH THE TREATMENT IN PsA PATIENTS USING bDMARDs

Background

Dyslipidemia is the leading treatable-modifiable factor among comorbidities in Psoriatic arthritis (PsA) patients. International treatment recommendations have left the management of dyslipidemia to national guidelines and especially to the rheumatologists.

Objectives

In this study, we aimed to determine the frequency of dyslipidemia and the rates of initiation of treatment within the indication in PsA patients using bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by therheumatologist. Lipid profiles of PsA patients were evaluated at diagnosis, during the first bDMARD initiation, and at the last visit. Total cholesterol (TC), Triglyserides (TG), HDL-C and LDL-C values were grouped as optimal, borderline, high and severely high according to the Turkish Endocrine and Metabolism society criteria (1).

Results

Lipid profile values ​​of PsA patients were known at diagnosis (n=159, 30.6%), in the initial bDMARD baseline (n=161, 30.9%), and at the last visit (n=203, 39.0%). The time to diagnosis of PsA and first bDMARD use was 2.8 years, and the time between the start of bDMARD and the last visit was 3.7 years. Accordingly, the rates of high TC, borderline TG, and high LDL increased over time. Rates at the time of PsA diagnosis, first bDMARD onset and at the last visit are as follows; high TC (14.3%, 17.1% and 28.0%), borderline TG (20.4%, 27.7% and 40.5%) and high LDL (17.0, 24.0% and 27.9%). On the other hand, low HDL-C slightly improved in men (33.3%, 29.4% and 23.1%), but did not show a significant change in women. While LDL-C level was >160 in 24.0% of patients who were started on bDMARD, anti-hyperlipidemic drug was started in only 6.2% of them. A similar situation persisted at the last visit (27.9% had LDL-C levels >160, but 10.8% received anti-hyperlipidemic therapy) (Table 1).

Table 1.

Lipid levels and changes over time

Lipid levelsAt the time of diagnosis n= 159At the time of bDMARD initiation n=161bDMARD last visit n= 203Total Cholesterol (TC) mean (SD)195 (42)201 (43)214 (47)- TC < 200 (optimal) (%)56.552.845.3- TC 200-239 (borderline) (%)27.230.125.7-- TC > 240 (high) (%)14.317.128.0Triglyceride (TG) mean (SD)115 (52)132 (90)158 (103)- TG < 150 (optimal) (%)79.671.758.0- TG 150-499 (borderline) (%)20.427.740.5- TG 500-880 (high) (%)001.0-- TG ≥ 880 (severely high) (%)00.60.5HDL-C mean (SD)51.8 (13.1)50.6 (13.0)53.2 (12.5)- ≥60 (optimal) (%)20.620.425.6- 40-59 (borderline) in men (%)54.660.852.3- 50-59 (borderline) in women (%)32.324.530.3- Male < 40 (low) (%)33.329.423.1-- Women < 50 (low) (%)32.339.633.8LDL-C mean (SD)126 (33)132 (37)139 (36)- LDL-C < 100 (optimal) (%)21.421.114.2- LDL 130-159 (borderline) (%)22.525.127.0- LDL 160-190 (high) (%)17.024.027.9-- LDL > 190 (very high) (%)4.46.38.4Anti-hyperlipidemic drug n (%)5 (3.1)10 (6.2)22 (10.8)

Conclusion

Among the modifiable risk factors for cardiovascular comorbidities in PsA patients, the leading risk factor is dyslipidemia. On the other hand, dyslipidemic drug use rates in daily practice are significantly lower. Although attention is paid to the management of comorbidities in all recommendations, there is still work to be done in real life.

References

[1]TEMD Obezite, L.M., Hipertansiyon Çalişma Grubu, TEMD DİSLİPİDEMİ TANI VE TEDAVİ KILAVUZU. 9 ed, ed. 2021, Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği. 159.

Disclosure of Interests

None declared

POS1087 THE RELATIONSHIP BETWEEN CHANGES IN PSORIATIC ARTHRITIS DISEASE ACTIVITY AND COMORBIDITIES IN PATIENTS TREATED WITH bDMARDs

Background

Comorbidities are common in psoriatic disease, needed to be recognized and managed to effectively when treating psoriatic arthritis (PsA) patients. However, the data on the impact of particular comorbidities on the disease activity in patients requiring bDMARDs are very small.

Objectives

Our aim was to understand the relationship between the disease activity and comorbidities in PsA patients under bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by the rheumatologist. DAS-28 score (at the last visit) and all comorbidities were documented after bDMARD initiation. Multivariate analysis was performed to understand comorbidities that have impact on DAS-28 remission.

Results

There were 469 patients with a known DAS-28 score median (IQR) 28 (61) months after bDMARD initiation. It was detected in 214/469 (45.6%) patients with a DAS-28 score below 2.6. Patients in remission of DAS-28 were younger, remission was less frequent in women, and comorbidities, mainly BMI, Diabetes Mellitus (DM) and hypertension, were also found less frequent (Table 1). In the multivariate analysis, no determining factor was found in male gender. On the other hand, in females, smoking, presence of comorbidity, Body mass index (BMI) at the start of bDMARDs, age at onset of bDMARDs, DM at the start of bDMARDs, HT at the start of bDMARDs, coronary artery disease, and cardiovascular risk factors were included in the analysis and revealed, bDMARD baseline BMI [OR 1.06 (95% CI 1.02-1.11), p= 0.004] and presence of bDMARD baseline DM [OR 3.08 (95% CI 1.14-8.30), p=0.026] had significant impact on DAS-28 remission.

Table 1.

Relationship between remission according to DAS-28 score and comorbidities

ParametersDAS-28 ≤ 2.6 (n=214)DAS-28 > 2.6 (n=255)pAge, mean (SD), years43.8 (11.7)47.5 (12.5)0.001Age at PsA diagnosis, mean (SD), years36.8 (11.5)41.6 (11.7)<0.001Gender, female, n(%)115 (53.7)211 (82.7)<0.001Comorbidity count1.54 (0.98)1.98 (1.31)<0.001Comorbidity (yes/no)67 (31.9)118 (47.6)0.001Comorbidity distribution0.001-No143 (68.1)130 (52.4)-1 Comorbidity38 (18.1)47 (19.0)-≥ 2 Comorbidity17 (8.1)36 (14.5)-≥ 3 Comorbidity12 (5.7)35 (14.1)Body Mass Index (BMI)28.1 (5.4)30.3 (5.9)<0.001BMI > 30, n(%)70 (32.9)123 (48.4)0.001Diabetes Mellitus, n(%)10 (4.7)35 (13.7)0.001Hypertension, n(%)29 (13.6)71 (27.8)<0.001Total cholesterol > 240, n(%)8 (10.5)22 (28.6)0.019Thyroid Disease20 (9,8)43 (17,3)0,02

Conclusion

Previous data showed that obesity, hypertension and at least 1 point from charlson comorbidity index are poor prognositc factors for treatment outcomes (1). Our data showed that BMI and presence of DM were determined as factors affecting bDMARD treatment response in female PsA patients.

References

[1]Ballegaard C, et al. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford). 2021 Jul 1;60(7):3289-3300.

Disclosure of Interests

None declared

AB1486 ASSESSMENT OF GLUCOCORTICOID-RELATED ADVERSE EVENTS BY THE GLUCOCORTICOID TOXICITY INDEX (GTI) IN RHEUMATIC PATIENTS

Background

Glucocorticoids (GCs) remain the mainstay treatment for several autoimmune and inflammatory diseases however, its long-term or high-dose usage also has many potential side effects. The glucocorticoid toxicity index (GTI) is a novel global monitoring tool (1) developed to systematically assess glucocorticoid-associated morbidity.

Objectives

To evaluate GC toxicity by using GTI in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and vasculitis receiving glucocorticoids.

Methods

This descriptive, cross-sectional study included patients who were admitted to the rheumatology clinic between January 2021 and December 2021, were diagnosed with RA, SLE or vasculitis and treated with GCs. A single measurement of GC toxicity was performed using the GTI for each patient. Baseline GTI consists of twelve domains that related to commonly recognized adverse events that result of cumulative GCs exposure: body mass index (BMI), glucose metabolism, blood pressure, lipids, GC-induced myopathy, bone mineral density, skin toxicity, neuropsychiatric effects, infection, ocular, gastrointestinal and endocrine toxicity. The total GTI score ranges from 0 to 538 depending on the increase in toxicity burden.

Results

The study included 85 patients (55.3% male) with a mean age of 47.5 (±16.0) years (Table 1). Twenty (23.5%) patients had BMI values ≥30 kg/m2 and 63% of the patients were either hypertensive or receiving medications for hypertension. While HbA1c was ≥5.7% in 30 (35.3%) patients, 17 (20.0%) patients had glycated hemoglobin (HbA1c) value of ≥5.7% despite antidiabetic medication. Low density lipoprotein cholesterol (LDL-C) value of 33 (39%) patients was not on target. The median (IQR) GTI score of the study patients was 73 (81.5). Only 10 patients had a score of 0 in the GTI assessment. GTI scores were not correlated with the cumulative steroid doses (r=0.145, p=0.198) however, age was strongly associated with GTI scores (r=0.605, p<0.001).

Table 1.

Demographics, disease characteristics, and glucocorticoid toxicities of the patients

Characteristic¶All patients (n=85)RA (n=21)SLE (n=14)Vasculitis* (n=50)Age (years), mean (±SD)47.3 (±17.2)36.4 (±11.0)50.6 (±15.5)Duration of disease (months)12 (12.5)16 (17.8)14 (13.3)Damage and activity indicesDAS-28=2.66 (2.1)SLEDAI=4.0 (6.5)BVAS**=0 (1.0)HAQ=0.07 (0.4)SLICC=0 (1.5)VDI=1.0 (1.0)Cumulative methylprednisolone dose (mg)1458 (1496.9)4646 (9053.5)5604 (5281.5)GTI toxicity domain, n (%)9 (42.8)6 (42.8)24 (48.0)✓ BMI ≥27 kg/m28 (38.1)6 (42.9)33 (68.8)✓ HbA1c ≥5.7%7 (33.3)4 (28.6)26 (53.0)✓ Blood pressure >120/856 (28.5)2 (14.2)25 (51.0)✓ LDL-C >target4 (20.0)011 (24.5)✓Osteoporosis2 (10.0)2 (14.3)13 (26.5)✓ Skin toxicity2 (10.0)3 (21.4)8 (16.3)✓ Neuropsychiatric toxicity2 (10.0)06 (12.2)✓ Ocular toxicity2 (10.0)05 (10.0)✓ Gastrointestinal toxicityGTI score65 (104.5)44 (48.0)87 (76)

¶ n (%), if otherwise specified; median (IQR) for numeric values other than age

GTI: Glucocorticoid toxicity index, RA: Rheumatoid arthritis, SLE: Systemic lupus erythematosus, BMI: Body mass index, HbA1c: Glycated hemoglobin, LDL-C: Low density lipoprotein cholesterol

*Vasculitis patients include ANCA-associated vasculitis, Giant cell arteritis, Takayasu arteritis, Behcet’s syndrome, Igg4-related disease, Polymyalgia rheumatica and Leukocytoplastic vasculitis patients.

***BVAS value given only for ANCA-associated vasculitis (n=19)

Conclusion

Our study revealed the iceberg of glucocorticoid toxicities in patients with rheumatic disease. Usage of GTI would help management of these possible toxicities. Therefore, it is important to assess GC toxicity at regular intervals during ongoing treatment in order to detect potential differences in the GTI scores.

References

[1]Miloslavsky EM, Naden RP, Bijlsma JW, Brogan PA, Brown ES, Brunetta P, et al. Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis. Ann Rheum Dis. 2017;76(3):543-6.

Disclosure of Interests

None declared

AB0275 THE FREQUENCY, PREVALENCE OF CORONARY ARTERY DISEASE AND PRE-MATURE CAD IN PsA AND RA PATIENTS

Background

An increased incidence of coronary artery disease (CAD) is known in inflammatory arthritis patients compared to the normal population. In the Veterans With Premature Atherosclerosis (VITAL) registry, the frequency of premature CAD (CAD < 55 in men, < 65 years in women) in autoimmune rheumatic diseases was 1.72 (95% CI 1.63-1.81) in Rheumatoid arthritis (RA) compared to the healthy population in approximately 135,000 patients, while a similar situation was not observed in Psoriatic arthritis (PsA) patients 1.09 (95%CI 0.98-1.21) (1).

Objectives

In this study, we aimed to compare the frequency of CAD and premature CAD in RA and PsA patients using bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), database was established in 2005 and prospective follow-up of patients using bDMARDs is being carried out. The frequency of CAD was recorded in 486 PsA and 524 RA patients using bDMARDs. CAD was determined according to the angiography reports or Coronary Computed-Tomography results. Premature CAD is defined as a history of CAD before the age of 55 in men and before the age of 65 in women. Demographic characteristics and other comorbid conditions of the patients were also noted. Disease activity (DAS-28) and functional status (HAQ-DI) of the patients before the first DMARD initiation were recorded.

Results

581 (75.4% female) RA and 520 (69.4% female) PsA patients were evaluated. The ages of the patients and the duration of the disease are as follows; RA, mean (SD) years of age 52.1 (13.9), disease duration 5.3 (2.1) years, PsA mean (SD) years of age 48.7 (12.5), disease duration 9.2 (6.4). At the time of first bDMARD initiation, 43/581 (7.4%) patients with RA and 12/486 (2.4%) patients with PsA had CAD (p<<0.001). After a median (IQR) follow-up of 32 (23) months in RA patients and 49 (88.5) months in PsA patients, CAD was detected in 59 (11.2%) patients, 32 (6.6%) in PsA patients, p=0.01. While 39/59 (66.1%) of RA patients had premature CAD, 18/32 (56.3%) PsA patients had premature CAD (Table 1).

Table 1.

Characteristics of RA and PsA patients with/without premature CAD

RAPsAPremature CADn=38Non-prematureCADn=21pPremature CADn=18Non-prematureCAD(n=14)pGender, n (%)29 (76.3)9 (42.8)0.0110 (55.5)10 (71.4)0.36Age, mean (SD), years56.6 (8.9)72.7 (7.1)<0.00159.9 (8.2)69.1 (6.3)0.002PsA duration, mean (SD), years5.5 (2.1)6.0 (1.7)0.3413.3 (8.9)12.6 (9.5)0.83Smoking (ever), n(%)22 (57.9)11 (52.4)0.8016 (88.9)5 (35.7)0.002BMI > 30, n(%)19 (52.3)7 (35.0)0.208 (44.4)11 (78.5)0.051HT (ever), n(%)23 (63.9)14 (66.7)0.8911 (61.1)13 (92.8)0.040DM (ever), n(%)20 (57.1)9 (52.9)0.774 (22.2)6 (42.8)0.45LDL > 130 (ever), n(%)29120.1311 (61.1)5 (35.7)0.14DAS-284.7 (1.1)4.2 (1.2)0.114.7 (1.4)4.5 (1.5)0.72HAQ (0-3)1.41 (0.7)1.05 (0.8)0.0790.7 (0.6)1. 3 (0.7)0.13

RA: Rheumatoid arthritis, PsA: Psoriatic arthritis, CAD; Coronary artery disease, BMI; Body-mass index, HT: Hypertension, DM: Diabetes mellitus

Conclusion

While the frequency of premature CAD is 10% in the normal population, CAD has a premature character in two-thirds of RA patients and 55% of PsA patients (2). In a large community-based study, the frequency of premature CAD was found to be increased in RA patients compared to the normal population, but no similar difference was observed in PsA patients (1). In real-life data in which we examined a large group of patients using bDMARDs, it is seen that the subtype of CAD is of pre-mature character in both RA patients and PsA patients.

References

[1]Mahtta D et al. Am J Med. 2020 Dec;133(12):1424-1432

[2]Cole JH, et al. Curr Atheroscler Rep. 2004 Mar;6(2):121-5.

Disclosure of Interests

None declared

AB0277 DYSLIPIDEMIA TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS USING bDMARDs IS BETTER THAN PsA, BUT THERE IS STILL A WAY TO GO

Background

Patients with inflammatory arthritis have an increased risk of cardiovascular disease. Dyslipidemia is one of the primary modifiable risk factors.

Objectives

Comparasion of the frequency of dyslipidemia and the use of anti-hyperlipidemic agents in patients with Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) receiving bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and 581 (75.4% female) patients with RA and 520 (69.4% female) patients with PsA enrolled up to 2021 were analyzed. Dyslipidemia was defined according to the Turkish Endocrine and Metabolism society criteria (TC > 240, Triglycerides (Tg) > 150, LDL-C > 160, HDL-C (< 40 in men, < 50 in women) (1). The anti-hyperlipidemic (anti-HL) agents used by the patients during follow-up and at their last visit were recorded.

Results

The mean (SD) age of the patients and diseases duration were as follows; RA vs. PsA [age: 52.1 (13.9) vs. 48.7 (12.5) years; disease duration: 5.3 (2.1) vs. 9.2 (6.4) years]. Lipid profiles were known in 289 (49.7%) patients with RA and in 175 (33.6%) patients with PsA at the initiaiton of bDMARD. Lipid profiles were evaluated in 356 (61.2%) patients with RA and 226 (43.4%) patients with PsA during follow-up and at the last visit. Lipid profiles were similar in patients with RA and PsA at the initiation of bDMARDs (Table 1). At the initiation of bDMARD, 29 (5.0%) of RA patients and 10 (3.2%) of PsA patients were receiving anti-HL agents. During the entire follow-up, 65 (12.6%) patients with RA and 22 (4.8%) patients with PsA have used anti-HL agents (p<0.001).

Table 1.

Lipid values in patients with RA and PsA at the initiation of bDMARD and at the last visit

Rheumatoid arthritis, n (%)Psoriatic arthritis, n (%)p1*p2**Lipid valuesbDMARD initiationLast visitbDMARD initiationLast visitTotal Cholesterol> 24047/270(17.4)98/339 (28.9)32/161(19.8)57/203 (28.1)0.300.13Triglyseride> 15062/242 (25.6)108/320 (33.7)45/159 (28.3)80/193 (41.4)0.790.20HDL-C< 40 (males),< 50 (females)88/267 (32.9)70/343 (20.4)57/157 (36.3)20/207 (9.6)0.480.001LDL-C > 16053/289 (18.3)91/356 (25.6)43/175 (24.5)65/226 (28.7)0.380.55

*p1, bDMARD initiation visit comparison

**p2, last visit comparison

Conclusion

In real-life cohort, lipid profile was not assesed in half of the patients during entire follow-up. Although, LDL-C levels are high in about a quarter of the patients in both groups, use of anti-hyperlipidemic drug was inadequate. This is even more evident in PsA patients. Despite the significant emphasis on comorbidities in treatment guidelines, there is still a long way to go in real life.

References

[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021,

Disclosure of Interests

None declared

AB0416 CARDIOVASCULAR EVENT, VENOUS THROMBOEMBOLIZM, AND INFECTION RISK WITH TOFACITINIB IN RHEUMATOID ARTHRITIS PATIENTS AGED ≥ 60 YEARS

Background

Tofacitinib is a targeted synthetic DMARD that selectively inhibits Janus kinase (JAK) and is approved for the treatment of RA by the FDA in 2012. In recent years, an important safety concern related to incidence of adverse events after treatment with tofacitinib has emerged.

Objectives

To evaluate the risk of major adverse cardiovascular events (MACE), venous thromboembolism (pulmonary embolism or deep vein thrombosis), serious infections requiring hospitalization, and herpes zoster with tofacitinib in RA patients aged ≥ 60 years.

Methods

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological and targeted synthetic DMARD registry since 2005. We analyzed RA patients aged ≥ 60 years receiving tofacitinib who had at least 1 control visit registered in the HURBIO database. Phone calls were made with these patients for the current health status information until the end of January 2022. The data of the patients who lost the follow-up in our clinic were obtained from the personal health record system of the Republic of Turkey Ministry of Health by patients’ permission. The coprimary end points were adjudicated MACE, VTE, serious infections, and herpes zoster. These events were identified using patients’ medical records. Crude incidence rates were expressed in patients with first events per 100 patient-years, with two-sided 95% confidence intervals.

Results

A total of 132 RA patients (109, 82.6% female) aged ≥ 60 years received tofacitinib at a dose of 5 mg twice daily. The median (25–75% percentiles) age was 67 (63-73) years and median duration under tofacitinib was 18 (5-33) months. Approximately 70% of patients were biologically naive. During a median follow-up of 1.5 years, the incidences of serious infection requiring hospitalization and herpes zoster were higher (5.5% [95%CI 3.12-9.86] and 3.4% [1.67-7.17], respectively) while there was no increase in the incidences of MACE and VTE. The causes for hospitalization were as follows: COVID-19 (n=4), pneumonia (n=3), soft-tissue infection (n=3), and GIS infection (n=1). Two of these patients deceased.

Conclusion

Older patients with RA are at increased infection risk because of age and comorbid conditions. Although adverse events are reported with 10 mg tofacitinib twice daily, clinicians should be careful against the risk of infection at a dose of 5 mg twice daily, especially in elderly patients.

References

[1]Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-326.

Table 1.

Clinical characteristics of the patients and incidence rates for adverse events

Characteristic*Tofacitinib, 5 mg Twice Daily (N=132)Age, years67 (63-73)Female/male109 (82.6)/23 (17.4)Smoking status-Never smoked78 (59.1)-Ever smoked54 (40.9)History of hypertension82 (62.1)History of diabetes mellitus40 (30.2)History of coronary heart disease14 (10.8)History of congestive heart failure3 (2.3)History of chronic kidney disease11 (8.3)Family history of coronary heart disease8 (6.2)RA disease duration, years10 (7-18)Biologic naïve/experienced92 (69.7)/40 (30.3)Duration under tofacitinib, months18 (5-33)No. of Patients with First EventIncidence Rate per 100 Patient-Yr (95% CI)MACE, n=10.49 (0.07-3.44)VTE, n=41.96 (0.74-5.17)Infection-Requiring hospitalization, n=115.55 (3.12-9.86)-Herpes zoster, n=73.46 (1.67-7.17)

* n (%), if otherwise specified; median (IQR) for numeric values.

CI: Confidence Interval, MACE: Major adverse cardiovascular events, VTE: Venous thromboembolism (pulmonary embolism or deep vein thrombosis)

Disclosure of Interests

None declared

POS0977 ASSOCIATION OF DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER AND AXIAL SPONDYLOARTHRITIS WITH THE M694V MUTATION

Background

The incidence of co-occurrence of FMF and axial spondyloarthritis (axSpA) in adults is reported to be 0.5-7.5%. M694V mutation is the most frequent variant in patients with FMF+AxSpA (1).

Objectives

To evaluate the association of demographic and clinical characteristics of patients with FMF+axSpA with the M694V mutation.

Methods

A total of 9630 FMF patients were identified according to the ICD-10 code (E85.0) in the electronic database of Hacettepe University Hospital. 7525 patients aged <18 years old and no hospital admissions after 2014 were excluded. 2105 adult FMF patients screened for accompanying axSpA according to ICD-10 code (M45) and 241 patients detected as FMF+axSpA. FMF diagnosis was confirmed with Tel-Hashomer criteria. The diagnosis of axSpA was confirmed by the presence of sacroiliitis on sacroiliac radiography according to the Modified New York (mNY) criteria or the presence of active sacroiliitis on sacroiliac magnetic resonance imaging according to the ASAS criteria. According to these criterias, the diagnosis of FMF+AxSpA association was confirmed in 136 patients. MEFV gene result was present in 113 (83%) of 136 patients and were included in the study. Patients were divided into two groups as M694V (+) and M694V (-) according to the M694V mutation, and the demographic and clinical characteristics of the patients were compared. p<0.05 was considered statistically significant.

Results

Of 113 patients with known MEFV gene result, 91 (80.5%) were M694V (+), 22 (19.5%) were M694V (-), 45 (39.8%) were homozygous for M694V. In the M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were at an earlier age compared to M694V (-) patients (p<0.05). The frequency of radiographically proven moderate to severe hip involvement (24.2% vs. 9.1%) and total hip replacement (11% vs. 4.5%) was higher in M694V (+) patients. However, these differences were not statistically significant (p=0.12; p=0.36). In the homozygous M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were significiantly at an earlier age than in the group homozygous M694V (-) (p<0.001). Although erysipelas-like skin rash was more common in homozygous M694V (+) group (28.9% vs. 11.8% p=0.02), other symptoms and findings were similar in both groups (Table 1).

Table 1.FeaturesM694V (+) (n=91)M694V (-) (n=22)P1M694V Homozygous (n=45)M694V Nonhomozygous (n=68)P2Age at FMF symptom onset [years, med (25-75)]11 (5-18)21 (8-30)0,0057 (1-42)18 (3-53)<0,001Age at FMF diagnosis [years, med (25-75)]18 (10-27)33 (27-38)<0,00112 (1-42)28 (3-59)<0,001Age at AxSpA symptom onset [years, med (25-75)]20 (15-25)29 (24-38)<0,00120 (5-50)22 (5-58)0,43Age at AxSpA diagnosis [years, med (25-75)]24 (19-33)37 (28-44)<0,00123 (11-51)29 (7-59)0,039Fever n (%)84 (92,3)21 (95,5)0,6044 (97,8)61 (89,7)0,10Abdominal pain n (%)80 (87,9)20 (90,9)0,7043 (95,6)57 (83,8)0,056Peripheral arthritis n (%)45 (49,5)7 (31,8)0,1324 (53,3)28 (41,2)0,20Erysipelas n (%)19 (20,9)2 (9,1)20,213 (28.9)8 (11,8)0,02Enthesitis n (%)21 (23,1)4 (18,2)0,6211 (24,4)14 (20,6)0,63Uveitis n (%)11 (12,1)4 (18,2)0,454 (8,9)11 (16,2)0,26Psoriasis n (%)6 (6,6)1 (4,5)0,722 (4,4)5 (7,4)0,82HLA-B27 (+) n (%)25 (27,3)4 (18,2)0,542/15 (13,3)12/40 (30)0,30Syndesmophyte n (%)20/82 (24,4)6/19 (31,6)0,527/43 (16,3)19/59 (32,2)0,07Total ankylosis n (%)4/83 (4,8)1/19 (5,3)0,941/43 (2,3)4/59 (6,8)0,39Moderate to severe hip disease*n (%)22 (24,2)2 (9,1)0,1212/45 (26,7)12 (17,6)0,25Total hip replacement n (%)10 (11,0)1 (4,5)0,364 (8,9)7 (10,3)0,80

* BASRI-hip score ≥3 on any side

Conclusion

FMF and SpA symptoms appear at an earlier age in M694V positive patients. The M694V mutation is associated with severe disease and early disease onset.

References

[1]Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C. The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis. Clin Rheumatol. 2009;28(1):41-6.

Disclosure of Interests

None declared

AB0940 Is psoriatic arthritis really seronegative?

Background

Psoriatic Arthritis (PsA) is a heterogeneous disease classified as a seronegative group of inflammatory arthritis.

Objectives

Our aim was to understand the real-life seropositivity rates for commonly used autoantibodies in rheumatology practice in a cohort of PsA patients treated with biologic agents.

Methods

PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for the anti-nuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (CCP) before and after the initiation of biologic agents. Demographic characteristics, the interval between the test and biologic initiation, and the rates of seropositivity for individual tests, autoantibody titers, and subtypes for ANA were determined.

Results

From 520 PsA patients registered, results of 419 patients with at least one autoantibody tested either before or after biologic treatment is presented in Table 1. From the patients tested, 69% of them had at least one autoantibody positive and 30.8 % of them were triple negative before the biologic treatment. The rates reached to 78.7% of seropositivity for at least one autoantibody and 21.2 %triple negativity after treatment. ANA showed the highest rates of seropositivity among autoantibodies with a rate of 40% before and 55.3 % after biologic treatment. Concomitant seropositivity for RF and CCP autoantibodies showed rates of 2.8% and 6.3% before and after treatment, respectively. The most common subtype was AC4-5 before and AC1-4-5 after biologic agent treatment. ANA was tested in 31 patients both before and after biologic treatment showing 6 negative patients became positive after treatment and from 12 positive patients at the baseline 6 of them became negative (p=0.452). The most common biologic agents used in patients with ANA tested after treatment, were adalimumab (ADA) (42.4%), etanercept (ETN) (18.9%), and infliximab (IFX) (18.9%). The only difference was observed in IFX treated patients (n=25) with significantly higher rates of IFX usage in ANA-positive patients (p=0.001).

Table 1.

Demographics and ANA, RF, Anti-CCP test results of patients before and after biologic treatment

ANARFAnti-CCPbDMARDs initiationBeforeAfterBeforeAfterBeforeAfterNumber of patients10413231027814497Age43.5 (12.7)46.7 (11.6)43.3 (12.5)47.9 (11.9)44.3 (12)48.6 (12.1)Female sex, n (%)84 (80.7)97 (73.5)225 (72.5)211 (75.8)110 (76.3)75 (77.3)Time interval between test and bDMARD initiation, months, median (IQR)7.4 (0.84-17.83)32.6 (14.93-72.33)4.1 (0.35-16.75)31.63 (13.10-64.08)3.23 (0.30-11.5)35.13 (12.40-75.43)Positivity, n (%)42 (40.4)73 (55.3)30 (9.6)32 (11.5)12 (8.3)11 (11.3)Titer IU/ml, median (IQR)NANA28.7 (22.35-98.5)28.9 (21.9-110)139.1 (20.38-250)67.5 (16.77-139)Titer, n (%) *28 (66.6)38 (52)N/AN/AN/AN/A1/1007 (16.7)14 (19.1)1/1607 (16.7)20 (27.3)≥1/320

bDMARD: Biologic Disease Modifying Anti-Rheumatic Drugs, ANA: Anti-nuclear antibody, RF: Rheumatoid factor, Anti-CCP: Anti- Cyclic citrullinated peptide, F:Female, M:Male, IQR: Interquartile range, IU/ml: International units per milliliter, N/A: Not available

*Subtype is not given for one patient in patients with positive ANA after biologic treatment

Conclusion

Synovial lymphoid neogenesis rates in PsA are similar to the frequency seen in rheumatoid arthritis (1). Nevertheless, PsA is classified under the group of “seronegative diseases”. On the other hand, current reports have started to define specific autoantibodies particularly in psoriasis patients (2). The real-life experience in serology results of PsA patients showed that only 20-30 % of the patients were seronegative for all three tests commonly used in practice.

References

[1]Celis R, et al. Synovial cytokine expression in psoriatic arthritis and associations with lymphoid neogenesis and clinical features. Arthritis Res Ther. 2012 Apr 27;14(2):R93.

[2]Yuan Y, et al. Identification of Novel Autoantibodies Associated With Psoriatic Arthritis. Arthritis Rheumatol. 2019 Jun;71(6):941-951.

Disclosure of Interests

None declared

AB0843 OSTEOPOROSIS IN PATIENTS WITH SPONDYLOARTHRITIS: DO WE NEED TO DO MORE?

Background

Data regarding the prevalence and especially incidence of osteoporosis in Spondylarthritis (SPA) is scarce and very divergent among studies from different patient populations (1).

Objectives

In this study, we aimed to compare demographic, disease and laboratory characteristics of SpA patients regarding their bone mineral densitometry (BMD) categories and find out incidence of osteoporosis in the follow-up BMD of patients who were not found to have osteoporosis at baseline.

Methods

Between 2010-2021, patients with a SPA diagnosis in the HUR-BIO database were searched. HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2010. Patients with BMD measurement were included in the study. Follow-up BMD scores were also documented. The patients were divided into 3 groups as normal, osteopenia and osteoporosis in accordance with the WHO criteria (2). Demographic characteristics, comorbidities, laboratory data and drugs in each group were documented.

Results

3245 patients were reviewed. BMD was measured at least once in 118 patients out of 3245 (3.6%) patients. When the groups classified, 34 patients (28.8%) were included in the normal, 49 (41.5%) osteopenia and 35 (29.7%) osteoporosis groups. Patients with normal BMD was younger than both groups. Diabetes and hypertension were more prevalent in patients with osteopenia. The BMI was significantly lower in the osteoporosis group. 25 patients with normal and osteopenia in baseline BMD measurement had at least 1 follow-up BMD measurement. During the total follow-up of 91 patient-years, 3 patients had osteoporosis, revealing a the incidence of 3.3% in 100 patient-years.

Conclusion

In our study, the incidence of OP development in SPA patients was found to be 3.3%. Frequency of osteoporosis was 29.7% among SpA patients with BMD measurement (118/3245; 3.6%), however; only 40% of them had appropriate treatment. Osteoporosis seems as an overlooked and undertreated comorbidity of SpA.

Table 1.

Comparison of spondyloarthritis patients according to BMD scores (normal, osteopenia and osteoporosis) according to baseline BMD assessment

NORMAL Number, (%)OSTEOPENIA Number, (%)OSTEOPOROSIS Number, (%)P VALUENumber of Patients34 (28.8)49 (41.5)35(29.7)Age47,5 (27-70)63 (45-79)58 (20-75)0.00*Gender (Female)24 (70.6)34 (69.4)23 (65.7)Diabetes Mellitus3 (8.8)14 (29.2)1 (2.9)0.00*Hypertension11 (32.4)28 (58.3)5 (14.3)0.00*Chronic Renal Failure2 (6.9)1 (2.7)1 (5.3)0.81Chronic Ostructive Pulmonary Disease4 (13.8)4 (10.8)1 (5.3)0.30Coronary Artery Disease0 (0)5 (12.5)3 (15)0.27Malignancy1 (3.6)1 (2.9)1 (4.2)1.0Smoking21 (61.8)23 (47.9)21 (63.6)0.379 (26.5)13 (27.1)5 (15.2)4 (11.8)12 (25)7 (21.2)Calcium mg/dl9.4 (8.2-10.2)9.5 (8.7-10.4)9.7 (8.1-10.4)0.49Phosphorus mg/dl3.5 (3-4.4)3.4 (2.6-5)3.8 (2.9-4.9)0.25Vitamin D ng/ml16 (7.4-64.4)21.2 (5-69.6)15.8 (5.8-49.1)0.66ALP IU/ml89.5 (54-137)89.5(53-169)80 (50-239)0.43Albumin g/dl4.2 (1.7-4.7)4.2 (3.3-8.4)4.2 (2-4.8)0.43TSH mU/ml1.5 (0.8-4.1)2.3 (0.1-9.7)2 (0.7-3.3)0.71Body Mass Index (BMI) kg/m229 (17-41.2)28.3 (20-44.6)25.1(15.8-43.2)0,06*Steroids4 (11.8)8 (16.3)2 (5.7)0.33Anti-TNF25 (73.5)35 (71.4)26 (74.3)0,95D Vitamin7 (20.6)14 (28.6)10 (28.6)0.67Calcium4 (11.8)5 (10.2)6 (17.1)0.63Bisphosphonate0 (0)4 (8.2)14 (40)0,00*

Data was represented as median (minimum-maximum) or n(%)

References

[1]Hu LY, Chen PM, Shen CC, et all. Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PoleS one 2019:6;14

[2]Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield.

Disclosure of Interests

None declared

POS0944 PREDICTORS OF SUSTAINED REMISSION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS TREATED WITH BIOLOGIC DRUGS

Background

The ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA.

Objectives

To determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD).

Methods

Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-value<0.1 were re-tested in multivariable models. Forward selection was performed until the best-fit model was obtained, taking possible confounders into account. Two separate multivariable models were built, one with and one without the covariate “achievement of remission at 3-6 months”, to assess consistency of findings and to account for missing information regarding remission status between 3 and 6 months.

Results

Data on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99).

Table 1.

Multivariable analysis (best-fit model) of predictors of sustained remission

Model 1Model 2CovariatesMultivariable Analysis (n= 541)Multivariable Analysis (n=739)OR (95% CI)p-valueOR (95% CI)p-valueAge at diagnosisNSNS0.97 (0.96-0.99)0.006Male sex2.84 (1.71-4.70)<0.0012.31 (1.60-3.35)<0.001Concomitant csDMARD use (at baseline or follow-up)2.94 (1.57-5.51)0.0011.88 (1.23-2.86)0.003Baseline PGA0.97 (0.96-0.98)<0.0010.98 (0.97-0.99)0.002Baseline BASDAINSNS0.87 (0.78-0.96)0.009Baseline symptom durationNSNS0.97 (0.94-0.99)0.021Achievement of remission at 3-6 months after baseline11.70 (7.11-19.23)<0.001NANA

NA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment.

Conclusion

This study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition.

Disclosure of Interests

Bayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB

AB0201 CHANGES IN THE PRESCRIPTION PATTERNS OF THE SECOND-LINE BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY

Background:

In the last 20 years, anti-tumor necrosis factor (TNF) alpha agents re-designed the management of rheumatoid arthritis (RA). Despite this, unmet needs in the management of RA brought several drugs targeting different molecules and cytokines. It is still a research question that how did these developments changed daily-practice in RA patients who are intolerant/unresponsive to the first biological disease modifying anti-rheumatic drugs (bDMARD).

Objectives:

In this study, we aimed to explore the second biologic agent trends of our 20-years of single-center experience.

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.

Results:

A total of 776 (776/2080, 37.3%) RA patients, who was prescribed a second biological agent, was registered in HUR-BIO by the end of 2020. Of these patients, 83.7% was female. Mean age at the starting of bDMARD was 53.1 ± 13.3 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptid positivity was 69.1% and 60.5%, respectively. Distribution of first-line bDMARDs was as follows: adalimumab 194 (24.9%), etanercept 209 (26.9%), infliximab 105 (13.5%), golimumab 39 (5.0%), certolizumab 35 (4.5%), abatacept 78 (10.0%), rituximab 46 (5.9%), tofacitinib 37 (4.7%), tocilizumab 33 (4.2%). 11 (1.4%), 85 (11.0%), 282 (36.3%) and 398 (51.3%) patients were prescribed with their second bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time.

Table 1.

Distribution of second biologic DMARDs in RA patients according to 5-years periods

2001-20052006-20102011-20152016-2020TotalAdalimumab3 (27.3)15 (17.6)69 (23.9)77 (18.9)164 (20.8)Etanercept8 (72.7)35 (41.2)49 (17.0)41 (10.1)133 (16.8)İnfliximab012 (14.1)13 (4.5)25 (6.2)50 (5.4)Golimumab0019 (6.6)8 (2.0)27 (3.4)Certolizumab002 (0.7)26 (6.4)28 (3.5)Anti-TNF11 (100)62 (72.9)152 (53.9)177 (44.5)402 (51.8)Tofacitinib004 (1.4)73 (17.9)77 (9.7)Tocilizumab0012 (4.2)81(19.9)93 (11.7)Rituximab022 (25.9)53 (18.3)32 (7.8)107 (13.5)Abatacept01 (1.2)61 (21.1)35 (8.6)97 (12.2)Non-Anti-TNF023 (27.1)130 (46.1)221 (55.5)374 (48.2)Total11 (100)85 (100)282 (100)398 (100)776 (100)

Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015

Conclusion:

As the choice of second-line biologic and targeted synthetic DMARD, non-Anti-TNF bDMARDs, especially tofacitinib and tocilizumab becoming more frequent year-by-year. Despite that, anti-TNF agents as a group are still highly-prescribed options as second-line bDMARD.

Disclosure of Interests:

None declared

POS0255 IMPACT OF PLASMA EXCHANGE (PLEX) IN SEVERE ANCA-ASSOCIATED VASCULITIS (AAV): A REAL-LIFE DATA FROM A PROSPECTIVE COHORT

Background:

PEXIVAS was the largest clinical trial conducted on severe AAV patients and failed to demonstrate the contribution of PLEX on the prognosis of severe AAV. This data needs to be tested with real life experiences.

Objectives:

The aim of this study was to explore the effects of PLEX on the prognosis of severe AAV in a real-life cohort.

Methods:

Hacettepe University Vasculitis Research Center (HUVAC) prospective database was established in October 2014 by registering past and newly diagnosed patients. Baseline disease characteristics, treatments and survival status were recorded. For this study, patients with granulomatosis polyangiitis (GPA) and microscopic polyangiitis (MPA) who met the inclusion criteria of PEXIVAS trial [briefly; ANCA positive MPA or GPA patients with either severe renal involvement (necrotizing glomerulonephritis or active urinary sediment, and eGFR <50 ml/min) and/or severe pulmonary involvement (pulmonary hemorrhage due to active vasculitis)] at the disease onset were included. Patients were grouped whether they had PLEX or not. Demographic and disease-specific data and immunosuppressive agents used in induction phase were compared. Primary outcome was accepted as composite index of mortality or end-stage renal disease (ESRD) at the first year and at the final visit.

Results:

Of 145 GPA and MPA patients, 49 patients had inclusion criteria and distribution of patients were as GPA (n=38), MPA (n=8) or renal-limited (n=3). 16 (32.6%) patients had PLEX. Median number of plasma exchange cycles was 6.5 (min-max; 2-12). Although severe pulmonary [10 (62.5%) vs. 5 (15.2%), p=0.001] and combined severe renal+pulmonary involvements were more prevalent [9 (56.3%) vs. 4 (12.1%), p=0.001] and baseline creatinine levels were higher in PLEX (+) group, BVAS and FFS scores were similar (Table 1). Induction immunosuppressive regimens were comparable.

At first year evaluation, primary composite outcome was observed in 11 patients (3 deceased, 8 ESRD) of PLEX (+) group whereas in 12 patients (2 deceased, 10 ESRD) of PLEX (-) group (p = 0.03, log-rank). In multivariate analysis: combined renal+pulmonary involvements (aOR: 6.5 [1.1-37.9]) and serum creatinine (for 1 mg/dl increment) (aOR: 1.3 [1.1-1.7]) were associated with primary outcome. In this model, having plasma exchange was not associated with a favorable outcome.

At the end of median follow-up [40.7 (1.2-170.3) months], outcome was observed in 12 patients (9 deceased, 3 ESRD) of PLEX (+) group and in 13 patients (6 deceased, 7 ESRD) of PLEX (-) group (p < 0.001, log-rank). In multivariate analysis: having plasma exchange (HR: 3.5 [1.4-8.5]) and combined renal+pulmonary involvements (HR: 2.4 [1.05-5.8]) were found as the predictors of primary composite outcome. In the figure 1, comparison of primary outcome according to FFS and plasma exchange status was given.

Conclusion:

In real-life plasma exchange did not have a positive impact on the composite index of mortality and ESRD, similar to PEXIVAS trial. Presence of combined severe renal and pulmonary involvement was the predictor of worse outcome at 1-year and overall follow-up.

Table 1.

Comparison of disease characteristics and composite indexes of patients

PLEX (+)(n=16)PLEX(-)(n=33)GPA/MPA/Renal-limited (n)12/3/126/5/2Female, n(%)8 (50.0)13 (39.4)Age at diagnosis, months (med,min-max)54.5 (18.8-77.8)55.6 (18.1-86.3)MPO-ANCA / PR3-ANCA (n)5 / 1116 / 17Follow-up duration, months (med, min-max)16.6 (1.2-116.5)50.5 (2.2-170.0)BVAS at diagnosis, (med, min-max)23 (14-37)23 (8-33)FFS ≥ 2 (n,%) (N=45)23 (85.7)26 (83.9)Creatinine (mg/dl) at diagnosis† (med,min-max)8.1 (4.1-8.9)3.1 (1.8-6.2)CRP (mg/dl) at diagnosis (med,min-max)21.8 (15.0-29.0)11.5 (3.6-20.0)Immunosuppressive (induction) (n,%) -Pulse steroid14 (87.5)29 (87.9) -Rituximab1 (6.3)3 (9.1) -Cyclophosphamide12 (75.0)28 (84.8)

†p = 0.005

Figure 1.

Comparison of primary outcome according to FFS and plasma exchange status

Disclosure of Interests:

None declared

POS1378 COMPARISON OF DEMOGRAPHIC AND CLINICAL FEATURES OF FAMILIAL MEDITERRANEAN FEVER PATIENTS AND PATIENTS WITH AXIAL SPONDYLOARTHRITIS ACCOMPANYING FAMILIAL MEDITERRANEAN FEVER

Background:

The rate of co-occurrence of Familial Mediterranean Fever (FMF) and axial spondyloarthritis (axSpA) in adults is reported ranging from 0.5% to 7.5%. The clinical implications of this co-occurrence in the course of FMF is still a research question.

Objectives:

To compare of demographic and clinical features of patients with FMF and FMF+axSpA.

Methods:

A total of 9630 FMF patients was detected according to the ICD-10 code (E85.0) of FMF in Hacettepe University Hospital database. 241 of these patients also had axSpA according to the ICD-10 code (M45). FMF diagnosis was confirmed by Tel-Hashomer criteria. AxSpA was diagnosis was confirmed by either presence of sacroiliitis on sacroiliac radiography according to the Modified New York Criteria (mNY) or presence of active sacroiliitis according to ASAS criteria on magnetic resonance imaging. 136 patients were confirmed according to these criterias as having FMF+axSpA. As a control group, 231 consequent FMF patients without axSpA recorded on the “FMF in Central Anatolia (FiCA) database” and followed up at our center were included in the analysis. Demographic and clinical features of those patients in both groups were compared. p<0.05 was considered as statistically significant, correction for multiple comparisons was not performed.

Results:

136 patients were included in FMF+axSpA group and 231 patients were included in FMF group. 114 (83.8%) patients in FMF+axSpA group had radiographic sacroiliitis according to mNY criteria; median cervical mSASSS was 0 (available for 49 patients, min-max, 0-36), median lumber mSASSS was 4 (available for 121 patients, min-max, 0-36), 33 (27%) patients had cervical or lumber syndesmophyte. Twenty-six (19.1%) of these patients had radiologically documented inflammatory hip disease 12 (8.8%) of these patients underwent total hip replacement. Female gender was more prevalent in FMF+axSpA group (53.7% vs 32.5%, p<0.001). Age at FMF symptom onset and diagnosis were earlier in FMF patients; however, symptom and disease durations were longer in FMF+axSpA group in our study cohort (Table 1). Frequency of FMF signs and symptoms were comparable except the rate of pleuritis was higher in FMF patients compared to FMF+axSpA group (p=0.003). Amyloidosis was more prevalent in FMF+axSpA group (6.6% vs. 1.7%, p=0.014). Results of MEFV gene analysis were available for 273 patients. Although presence of M694V mutation (either in 1 allele or 2 alleles) was comparable in 2 groups, homozygous M694V mutation was more prevalent in FMF+axSpA group (39.8% vs. 28.9%, p=0.02).

Conclusion:

The coexistence of spondyloarthritis in FMF patients appears to be associated with the increased prevalence of amyloidosis. The inflammatory burden of a second disease and the increased prevalence of the homozygous M694V mutation may explain this risk.

Table 1.

Comparison of demographic and clinical features of two groups.

FMF+AxSpA(n=136, 37.1%)FMF(n=231, 62.9%)pFemale, n(%)73 (53.7)75 (32.5)<0.001Age at FMF symptom onset, years med (IQR)12 (5-20)10 (6-18)0.046Symptom duration, years, med (IQR)24 (18-32)20 (14-29)0.007Age at FMF diagnosis, years, med (IQR)24 (13-33)20 (11-30)0.10Duration after diagnosis, years, med (IQR)16 (10-22)13 (7-17)<0.001FMF signs and symptoms, n(%)-Fever128 (94.1)204 (88.3)0.067-Abdominal pain123 (90.4)217 (93.9)0.21-Pleuritis31 (22.8)87 (37.7)0.003-Pericarditis3 (2.2)2 (1.0)0.34-Arthritis64 (47.1)92 (39.8)0.17-Erysipelas24 (17.6)38 (16.5)0.77-Febrile myalgia9 (6.6)13 (5.6)0.70Inflammatory back pain, n(%)92 (67.6)26 (11.3)<0.001Inflammatory bowel disease, n(%)6 (4.4)4 (1.7)0.12FMF family history, n(%)-Any degree66 (48.5)137 (59.8)0.04-First degree48 (35.8)97 (42.0)0.24-Second degree25 (18.7)86 (37.2)<0.001Number of attacks at recent year, med (min-max)1 (0-12)1 (0-10)0.13Amyloidosis9 (6.6)4 (1.7)0.014M694V status (N=273)-Present (one or two allels)91 (80.5)120 (75.0)0.28-Two allels45 (39.8)43 (28.9)0.02

Disclosure of Interests:

None declared

AB0200 TRENDS IN THE CHOICE OF FIRST BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY

Background:

In the last 20 years, there have been extraordinary improvements and practice-changing developments in the management of rheumatoid arthritis (RA). Exploring the pathogenetic mechanisms first enabled clinicians to use anti-tumor necrosis factor (TNF) alpha agents, then drugs targeting different molecules. Parallel to these developments, treatment guidelines have been changed accordingly. Meanwhile, how these developments have been reflected into the real-word practice is a question of interest.

Objectives:

In this study, we aimed to explore the first biologic agent trends of our 20-years of single-center experience.

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. In brief; demographic data, treatment-related data (including adverse events) and disease-related data of RA patients have been recorded in HUR-BIO. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. In this study, distribution of the first-line biologic agents was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.

Results:

A total of 2080 RA patients was registered in HUR-BIO by the end of 2020. Of these patients, 79.5% was female. Mean age at the starting of bDMARD was 53.3 ± 17.8 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptide positivity was 67.6% and 61.0%, respectively. 65 (3.2%), 335 (16.1%), 858 (41.2%) and 822 (39.5%) patients were prescribed with their first bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs over time.

Table 1.

Distribution of first biologic DMARDs in RA patients according to 5-years periods

2001-20052006-20102011-20152016-2020TotalAdalimumab15 (23.1)111 (33.0)187 (21.8)153 (18.6)466 (22.4)Etanercept30 (46.2)154 (45.8)229 (26.7)54 (6.6)467 (22.4)İnfliximab20 (30.8)58 (17.3)64 (7.5)7 (0.9)149 (7.1)Golimumab0037 (4.3)43 (5.2)80 (3.8)Certolizumab0037 (4.3)68 (8.3)105 (5.0)Anti-TNF65 (100)323 (96.4)554 (64.5)325 (39.5)1267 (60.9)Tofacitinib006 (0.7)212 (25.8)218 (10.5)Tocilizumab009 (1.0)102 (12.4)111 (5.3)Rituximab012 (3.6)136 (15.8)84 (10.2)232 (11.1)Abatacept00153 (17.8)99 (12.0)252 (12.1)Non-Anti-TNF012 (3.6)304 (35.5)497 (60.5)813 (39.1)Total65 (100)335 (100)858 (100)822 (100)2080 (100)

Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015,

Conclusion:

Real-life practice in RA seems consistent with treatment guidelines. Use of non-Anti-TNF bDMARDs becoming more frequent year-by-year. Jak kinase inhibitor has rised through the last 5 years. Next decade may be the years of Jak kinases inhibitors.

Disclosure of Interests:

None declared

POS1004 BOTH SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS PATIENTS HAVE STRONG FAMILY HISTORIES

Background:

Family history is one of the hallmarks of spondyloarthritis (SpA) and psoriatic arthritis (PsA) [1, 2]. Some patients have a strong family history that more than 2 relatives have spondyloarthritis related diseases. The effects of strong family history on SpA features were not known very well.

Objectives:

The aim of this study is to evaluate the effects of family history in SpA and PsA patients.

Methods:

HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005, and to date 3071 SpA and 526 PsA patients have been recorded. Demographic, clinical characteristics, disease activity parameters, a detailed family history of SpA and SpA features (presence of SpA including PsA, psoriasis, inflammatory bowel disease and uveitis) and laboratory data before anti-TNF treatments of the patients were noted.

Results:

2807 SpA (53.6% male) and 506 PsA (31.4% male) patients’ family history were available and analysed. A positive family history was noted in 27.6% of the SpA and 31.0% of the PsA patients (ns). 7.4% of the SpA patients and 8.9% of the PsA patients had family history in more than one relative (Table 1). In SpA patients with a family history, uveitis was more frequent than patients without (14.4% vs 10.6%, p=0.006). Except for a higher male predominance and uveitis (53% vs 32% p=0.006 and 9% vs 2% p=0.003 respectively) in patients with ≥2 relatives with SpA features, there were no differences in PsA patients regarding family history. The presence of family history and HLA-B27 (63.7% vs 37.6%, p<0.001) positivity were associated in SpA patients but not in PsA patients (31.2% vs 20.0, p=0.13).

Conclusion:

Family history was present in about one third of the patients of PsA and SpA. It is not uncommon for two or more family members to have a SpA feature. Presence of family history may be associated with some clinical conditions, such as uveitis.

References:

[1]Solmaz, D., et al., Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease. Arthritis Care Res (Hoboken), 2020. 72(1): p. 63-68.

[2]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.

Table 1.

Family history in PsA and SpA patients

PsA (n=506)SpA (n=2807)≥ 1 family history, n (%)157 (31.0)774 (27.6)≥1 first-degree relative, n (%)114 (22.5)489 (17.4)≥2 first-degree relatives, n (%)21 (4.2)77 (2.7)≥2 relatives (both first- and second-degree), n (%)45 (8.9)208 (7.4)Family history  •Psoriasis, n (%)120 (23.7)155 (5.5)  •Psoriatic arthritis, n (%)14 (2.8)9 (0.3)  •Spondyloarthritis, n (%)38 (7.5)643 (22.9)  •Inflammatory bowel disease, n (%)1 (0.2)10 (0.4)  •Uveitis, n (%)02 (0.1)

Disclosure of Interests:

None declared.

AB0535 PRESCRIPTION PATTERNS OF THE SECOND BIOLOGIC DMARD IN PSORIATIC ARTHRITIS THROUGH THE LAST DECADE: HURBIO-PsA REAL LIFE EXPERIENCE

Background:

Psoriatic arthritis (PsA) is a multi-dimensional chronic disease, which can affect joints, skin and enthesis. Extrapolation of the positive treatment results of anti-tumor necrosis factor (TNF) alpha agents on spondyloarthritis and rheumatoid arthritis to the treatment practice of PsA lead to a new era for the management of PsA. However, unmet needs in the management of PsA lead to development of several drugs targeting different molecules and cytokines. The impact of these developments on PsA patients who are intolerant/unresponsive to the first biological disease-modifying anti-rheumatic drugs (bDMARD) still needs to be defined.

Objectives:

To explore the second biologic agent trends on PsA patients of our 10-years of single-center experience.

Methods:

HURBIO-PsA (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005 on PsA patients. Until the end of the 2020, 19 different rheumatologists contributed to the development of HURBIO-PsA. Anti-TNF drugs were approved as first line bDMARD for PsA patients. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2011. Also, demographic and serologic data of RA patients were reported.

Results:

A total of 225 PsA (225/443, 50.8%) patients, who was prescribed a second biological agent, was registered in HURBIO-PsA by the end of 2020. Of these patients, 74.7% was female. Mean age at the starting of bDMARD was 47.1 ± 11.6 years. 90 (40.0%) and 135 (60.0%) patients were prescribed with their second bDMARD in 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time, especially for secukinumab.

Table 1.

Distribution of second biologic DMARDs in PsA patients according to 5-years periods

2011-20152016-2020TotalAdalimumab30 (33.3)33 (24.4)66 (29.3)Etanercept33 (36.7)8 (5.9)41 (18.2)Infliximab9 (10)15 (11.1)24 (10.6)Golimumab9 (10)5 (3.7)14 (6.2)Certolizumab5 (5.6)34 (25.2)39 (17.3)Anti-TNF86 (95.6)95 (70.4)181 (80.5)Secukinumab026 (19.3)26 (11.5)Ustekinumab010 (7.4)10 (4.4)Abatacept4 (4.4)2 (1.5)6 (2.6)Tofacitinib02 (1.5)2 (0.9)Non-Anti-TNF4 (4.4)40 (29.6)44 (19.5)Total90 (100)135 (100)225 (100)

Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, secukinumab: 2018, ustekinumab: 2018; abatacept and tofacitinib were given with the permission from the Ministry of Health of Turkey for off-label use authorization

Conclusion:

Almost half of the PsA patients switched their anti-TNF drugs to others. Non-Anti-TNF bDMARDs, especially secukinumab, becoming more frequently used as a second-line biologic agent in PsA in recent years. These bDMARD prescription trend is appropriate to EULAR PsA recommendations.

Disclosure of Interests:

None declared.

POS0251 ARE CLINICAL FEATURES AND OUTCOMES OF ANCA (+) EGPA PATIENTS DIFFERENT FROM ANCA NEGATIVE ONES?

Background:

Recent reports describe EGPA as having two subgroups as ANCA positive and ANCA negative. Furthermore, there could be differences in terms of clinical features and outcomes (1).

Objectives:

The aim of this study was to compare the clinical characteristics and outcomes of ANCA positive EGPA patients with those of ANCA negative ones.

Methods:

This retrospective, descriptive study included 50 EGPA patients (male/female:13/27) from our prospective vasculitis database from October 2014 (2). The patients had fulfilled the ACR 1990 or DCVAS criteria for EGPA. In addition to clinical features (activity index) and treatment regimens, outcomes of patients (relapse and damage) were also reviewed. For relapse-free survival analysis, time to first relapse was compared according to ANCA phenotype by Kaplan-Meier survival analysis.

Results:

Of the patients, 17 (34%) were in ANCA (+) group, 33 (66%) were in ANCA (-) group. Renal involvement and peripheral neuropathy were more frequent in ANCA (+) patients whereas ANCA (-) patients were significantly younger at the time of diagnosis and they had more nasal polyposis. The median BVAS at the EGPA diagnosis was significantly high in ANCA (+) group. All 3 of patients with cardiac involvement were in the ANCA (-) group but difference was found in terms of FFS and VDI between ANA (+) and (-) groups. However, pulse steroid and cyclophosphamide treatments were more commonly used in ANCA (+) group while mepolizumab were used in ¼ of ANCA (-) patients (Table 1). During median 47 (IQR 69.9) months follow up, about 40% of patients had at least one relapse but there was no difference for relapse-free survival rate according to the ANCA status (Figure 1).

Table 1.

Demographics and clinical characteristics of the patients with EGPA during disease course

Characteristics*ANCA (+) (n=17)ANCA (-) (n=33)PAge at the diagnosis (years)53.8 ± 16.337.9 ± 14.30.001Sex, female10 (58.8)17 (51.5)0.62Asthma12 (70.6)29 (87.9)0.13Nazal polyp2 (11.8)15 (45.5)0.017Eosinophilia (>1000/μL)11 (64.7)27 (81.8)0.18Disease duration (years)4.1 (5.9)3.7 (5.9)0.69Organ specific involvement, % - Pulmonary76.578.80.85 - ENT82.487.90.59 - Renal52.93<0.001 - PNS47.19.10.002 - Cardiac09.1N/ABVAS at the diagnosis17 (13)9 (4)0.002Revized FFS - 011 (64.7)26 (78.8)0.28 - ≥ 16 (35.3)7 (78.8)VDI1 (1)1 (1)0.41Treatment regimens for induction, % - Pulse steroid64.711.20.002 - Cyclophosphamide58.818.20.004 - Rituximab11.830.21 - Mepolizumab012.1N/ATreatment regimens for maintenance, % - Rituximab11.830.21 - Mycophenolate mofetil35.330.002 - Mepolizumab024.2N/A - Azathioprine or methotrexate47.142.40.75Relapse, n (%)7 (41.2)12 (42.9)0.66Exitus, n (%)2 (11.8)1 (3)0.26

* Med (IQR) for numerical data excluding age; mean ± SD for age

ANCA: Antineutrophil cytoplasmic antibody, BVAS: Birmingham Vasculitis Activity Score, ENT: Ear, nose, and throat, IQR: Interquartile range, med: median, N/A: Not applicable, PNS: Peripheral nervous system, VDI: Vasculit damage index

Conclusion:

Not only clinical features and disease activity but also treatments received were significantly different between ANCA (+) and (-) patients. These results could partially define two distinct subgroups of EGPA. However, these groups were similar regarding damage and relapse.

References:

[1]Comarmond C, Pagnoux C, Khellaf M, Cordier JF, Hamidou M, Viallard JF, et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): Clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis and rheumatism. 2013;65(1):270-81.

[2]Karadağ Ö, Bilgen SA, Armagan B, Sari A, Erden A, Batu E D et al. Two-year Results of a Prospective Vasculitis Cohort from Eastern Mediterranean: Demographic Characteristics and Distribution of the Vasculitides Frequencies. Rheumatology, 2017; 56(suppl_3), iii88-iii95.

Figure 1.

Kaplan-Meier relapse-free survival curve according to the ANCA status

Disclosure of Interests:

None declared

POS1070 ANXIETY IN PSORIATIC ARTHRITIS PATIENTS: RESULTS FROM THE HUR-BIO BIOLOGIC REGISTRY

Background:

Anxiety is commonly observed, underestimated problem in patients with psoriatic arthritis (PsA). Overall rate has been reported around 20% [1]. However the data on anxiety in PsA patients requiring advanced treatment and change in response to therapy is scarce.

Objectives:

Our aim was to understand the frequency of anxiety before starting biologic agents and change in the anxiety scores with the treatment.

Methods:

PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for anxiety (score ≥ 4) using the patient self-reported measure of anxiety on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12) [2]. The anxiety rate and scores were determined before starting biologic agents and at first visit in 6 months. Change in the scores were compared between patients according to the favourable treatment responses (Table 1). The correlation between the score-changes in anxiety and treatment response parameters was assessed by spearman correlation analysis.

Results:

From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score registered both at baseline and first visit in 6 months. Both the frequency and mean (SD) score of anxiety decreased at first visit [63.9% vs 41.4 %, 4.8(3.4) vs 3.2 (3.1) respectively, p<0.001 for both] after a mean (SD) follow-up of 105.7 (22.2) days. There was a statistically significant difference between changes in the anxiety scores in patients with/without treatment responses in pain, PGA, BASDAI, HAQ-DI and DAS-28. A positive correlation between the change in anxiety and all treatment response parameters was observed (Table 1, Figure 1).

Table 1.

Patient characteristics at baseline and changes in the anxiety score according to treatment response

Conclusion:

Anxiety is a more frequent problem at the time of biologic initiation compared to rates observed in general PsA population which could be related to the high disease activity. The rates are still high in 6 months under treatment, however both the frequency and score of anxiety showed a decreasing trend parallel to the treatment response.

References:

[1]Zusman EZ, Howren AM, Park JYE,et. al (2020) Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 50 (6):1481-1488.

[2]Gossec L, de Wit M, Kiltz U, Braun J, et al (2014) A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis 73 (6):1012-1019.

Figure 1.

Correlation between the score changes

Disclosure of Interests:

None declared.

POS0568 OBESITY RATES AND BMI ARE SIMILAR IN AGE AND SEX MATCHED RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS AND SPONDYLOARTHRITIS PATIENTS

Background:

Obesity has been suggested to be a chronic inflamatory condition and therefore, obesity may be considered as a risk factor for developing immune-mediated diseases, including inflammatory arthritis. In larger biologic registiries, obesity was found frequently in psoriatic arthritis than other inflammatory diseases such as rheumatoid arthritis and spondyloarthritis. [1-4]. However, obesity may be a reason of aging, moreover, there are strong sex differences between those diseases.

Objectives:

The aim of this study was to evaluate the obesity rates in sex and aged matched patients with inflammatory arthritis before the initation of biological therapy.

Methods:

HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 5635 patients have been recorded. Demographic, clinical and laboratory data before bDMARD of SpA, RA and PsA patients were noted. The patients were divided into two groups: non-obese patients (<30 kg/ m2) and obese (≥30 kg/m2) patients. When investigeting the changes in BMI by diagnosis, the effects of gender and age were adjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender and age indifferences of the relevant groups by using propensity score.

Results:

5059 patients’ (1834 RA, 2741 SpA and 484 PsA) BMI data before the bDMARD treatments were avaliable and analysed. Baseline characteristics of RA, SpA and PsA patients were given in Table 1. 72.3% of the RA patients were seropositive. HLAB27 was positive in 64.7% and 22.9% of the SpA and PsA patients. Anti-TNF therapy was started as first bDMARD in 57.2% of the RA patients, others were started with non-Anti-TNF bDMARDs. In SpA (99.2%) and PsA (100%) patients anti-TNFs were the first biologics. Overall, the proportion of obese patients was significantly higher in RA and PsA than in SpA patients (Table 1) and age and sex affected BMI significantly (p<0.001) (Figure 1). After adjusting age and sex indifference between groups, the difference between the BMI of the patients disappeared (Table 1).

Table 1.

Baseline characteristics and BMI of the patients

RASpAPsApAll bDMARD patientsN18342741484Female, n (%)1470 (80.2)1257 (45.9)334 (69.0)0.000*Age, years*52.9±13.443.1±11.447.4±12.20.000*Disease duration, years¥11 (7-17)8 (5-13)7 (3-12)0.000*Body mass index*29.6 ± 6.527.7 ± 5.429.2 ± 5.80.000*Obesity, n (%)811 (44.2)815 (29.7)199 (41.1)0.000*Age and sex matched groupN481483484Female, n (%)315 (65.7)324 (67.1)334 (69.0)0.545Age, years*47 (36-59)48 (39-57)47 (38-56)0.691Disease duration, years¥10 (6-15)5 (5-13)7 (3-12)0.000*Body mass index*28.5 ± 6.128.5 ± 5.829.2 ± 5.80.150Obesity, n (%)183 (38.0)176 (36.4)199 (41.1)0.316

* Mean ±S.D ¥Median (IQR)

Conclusion:

Although obesity was more frequently reported in RA and PsA patients, age and gender seemed to be the major factors in the occurrence of this difference rather than inflammatory arthritis subgroups. Therefore, when considering obesity as a factor in the registries, for instance biological registries, sex and age should be kept in mind.

References:

[1]Højgaard, P., et al., The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis: results from the DANBIO and ICEBIO registries. Rheumatology (Oxford), 2016. 55(12): p. 2191-2199.

[2]Liu, Y., et al., Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken), 2017. 69(2): p. 157-165.

[3]Moroni, L., N. Farina, and L. Dagna, Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clin Rheumatol, 2020. 39(4): p. 1039-1047.

[4]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.

Figure 1.

BMI regarding to sex and diseases subtypes

Disclosure of Interests:

None declared

AB0347 RENAL BIOPSY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: IS IT ONLY LUPUS NEPHRITIS?

Background:

Renal biopsy is a cornerstone in the diagnosis and management of renal involvement in patients with systemic lupus erythematosus (SLE). However, non-lupus nephritis has been also observed in SLE patients with renal disease (1).

Objectives:

The aim of this study was to draw attention to the causes of non-lupus nephritis in SLE patients with kidney biopsy.

Methods:

This retrospective, descriptive study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. All patients had fulfilled the SLICC or EULAR/ACR criteria for SLE. According to the pathology report results, 116 of the patients were diagnosed with lupus nephritis (LN), 18 patients had non-lupus nephritis, 2 biopsies were normal, and 3 biopsies were insufficient. Demographics, SLE disease duration, and renal biopsy diagnosis were derived from our hospital medical records.

Results:

Of the 23 patients (female:18/male:5), the mean age at the SLE diagnosis was 30.5 years and the median SLE disease duration was 8.5 (11.6) years. Pathologic report findings were compatible with focal segmental glomerulosclerosis in 6 patients, membranous nephropathy with no cellular proliferation and inflammation in 4 patients, thrombotic microangiopathy in 3 patients, IgM nephropathy in 2 patients, tubulointerstitial nephritis in 2 patients, and proliferative glomerulonephritis with monoclonal IgG deposits in one patient. There were no different for SLE manifestation in both gropus. LN vs other renal pathologies laboratory comparing as follow: ANA (+) ≥ 1:320 89 (76.7%) vs 14 (60.9%), APS antibodies 31 (33.7%) vs 8 (57.1), anti-Sm (+) 8 (11.8%) vs 1 (4.3%) were similar for LN and other renal pathologies, but anti-ds-DNA positivity 94 (84.7%) vs 10 (50%), median ds-DNA level 421 (591) vs 150 (340) and low level of C3 and C4 were more frequent in LN (p<0.001; p=0.005; p<0.001, respectively).In addition, the rate of active urinary sediment and renal SLEDAI score were significantly high in LN patients.

Conclusion:

Various renal lesions unrelated to lupus nephritis can be observed in SLE patients. Renal biopsy plays a critical role in identifying these lesions, which may have prognostic and therapeutic implications distinctive from those of lupus nephritis. Also, anti ds-DNA positivity/level, low C3 and C4, active urinary sediment and renal SLEDAI scores may give us some clues in terms of renal pathology for SLE patients. Moreover, almost half of the patients without LN in renal biopsy have anti ds-DNA positivity.

References:

[1]Howell DN. Renal biopsy in patients with systemic lupus erythematosus: Not just lupus glomerulonephritis! Ultrastruct Pathol. 2017 Mar-Apr;41(2):135-146.

Table 1.

Demographic, clinical characteristics and results of patients with and without lupus nephritis

Variables*Lupus nephritis(N=116)Other pathologies(N=23)PAge at the SLE diagnosis, years22.5±13.130.5±14.50.006Sex, female93 (80.2)18 (78.3)0.83SLE disease duration8 (8.7)8.5 (11.6)0.27Manifestation of SLE-Musculoscletal75 (66.4)14 (63.6)0.8-Mucocutaneous60 (52.6)9 (40.9)0.31-Hematologic47 (40.9)10 (43.5)0.49-Serosal26 (23.2)4 (17.4)0.54-Neurological6 (5.3)1 (4.3)0.85Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.9 (0.6)0.17-GFR (ml/min)110 (67)77 (65)0.06-24-hour urine protein≥ 1 gr/day72 (71.3)17 (77.3)0.63≥ 3 gr/day36 (35.6)11 (50)0.23-Active urinary sediment91 (83.5)6 (27.3)<0.001Renal SLEDAI at the biopsy12 (8)4 (4)<0.001End-stage renal disease13 (11.2)2 (8.7)0.72Renal transplantation5 (4.3)1 (4.3)0.99Exitus8 (7)1 (4.3)0.99

*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.

GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity index

Disclosure of Interests:

None declared

POS0633 DURATION OF STARTING bDMARDs ARE ALMOST 3 TIMES LONGER IN RA PATIENTS THAN PsA PATIENTS: HUR-BIO REAL LIFE RESULTS

Background:

Before using biological DMARDs, EULAR suggests the use of synthetic DMARDs (especially methotrexate) for RA and PsA [1-2].

Objectives:

It was aimed to evaluate the differences of disease duration and csDMARDs till first bDMARD in RA and PsA patients.

Methods:

HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 2070 RA and 520 PsA patients have been recorded. Demographic, clinical and laboratory data before bDMARDs of the patients were noted. When investigating the differences between groups, the effects of gender, age and disease duration wereadjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender, age and for indifference of the relevant groups by using prospensity score matching.

Results:

We incuded 481 RA, and 482 PsA age and gender matched patients in the study. Age, gender and disease duration information were given in the Table 1. 72.8% of the RA patients were RF or anti-CCP positive. Overall, 56.3, 100% of the RA, and PsA patients first biologic therapies were anti-TNFs, respectively. All RA patients started with csDMARDs before bDMARD treatments, whereas 450 of 482 (93.4%) PsA patients. Methotrexate was the anchor csDMARD for both diseases. RA patients more frequently used all csDMARDs included methotrexate, leflunomide, sulphasalazine hydroxychloroquine and corticosteroids as well. Median disease duration till bDMARD treatments in RA and PsA patients were 55 and 18.5 months respectively (p<0.001) (Table 1).

Table 1.

emographic characteristics and csDMARDs before first bDMARD

RA (n=481)PsA (n=482)P valueFemale, n (%)319 (66.3)332 (68.9)0.218Age, years (mean±SD)48.2 ± 13.547.4 ± 12.20.332Disease duration, years*10 (6-16)7 (3-12)0.000Symptom duration before diagnosis, years¥0 (0-1)1 (0-4)0.000*The period of time between diagnosis and bDMARD initiation, months¥55 (24-115)18.5 (8-58)0.000*The period of time between symptoms and bDMARD initiation, months¥70 (35-151)48 (20-124)0.000*MethotrexateEver n (%)400 (83.3)373 (77.5)0.015Just before bDMARD initiation n (%)251 (52.2)230 (47.7)0.093Hydroxychloroquine sulfateEver n (%)292 (60.8)170 (35.3)0.000*Just before bDMARD initiation n (%)262 (54.5)99 (20.5)0.000*LeflunomideEver n (%)237 (49.4)129 (26.8)0.000*Just before bDMARD initiation n (%)160 (33.3)96 (19.9)0.000*SulphasalazineEver n (%)353 (73.5)265 (55.1)0.000*Just before bDMARD initiation n (%)156 (32.4)146 (30.3)0.259*CorticosteroidsEver n (%)419 (87.3)281 (58.4)0.000*Just before bDMARD initiation n (%)335 (69.6)187 (38.8)0.000*

¥Median (IQR)

Conclusion:

According to HUR-BIO real life data, for inflammatory arthritis patients who started bDMARDs, the periods of time between diagnosis and bDMARDs were more reasonable (18 months) in PsA patients than RA patient’s periods which were approximately three times longer. RA patients were used much more and longer duration of csDMARDs. This explicit distinction may be explained by synthetic DMARDs on activity differences between the RA and PsA.

References:

[1]Gossec, L., et al., EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 700-712.

[2]Smolen, J.S., et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 685-699.

Disclosure of Interests:

None declared

POS0931 RETENTION RATE AND TREATMENT RESPONSE OF BIOLOGICAL AGENTS IN ADVANCED SPINAL ANKYLOSIS AND BAMBOO SPINE: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY

Background:

Axial spondyloarthritis (axSpA) may lead to linear radiographic progression and progress to advanced spinal disease and finally to the bamboo spine (1).

Objectives:

To assess the demographic, clinical, disease activity and retention rates of patients using biological disease-modifying antirheumatic drugs (bDMARD) with advanced spinal disease and bamboo spine in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.

Methods:

In the HUR-BIO spondyloarthritis (SpA) registry were available 2952 patients. Of these, 774 patients with lumbar and cervical radiographs were included in the study. Advanced spinal ankyloses (99 patients) was defined as the presence of at least two intervertebral adjacent bridges at the lumbar and/or cervical spine level without bamboo spine. Bamboo spine (78 patients) was defined with a complete fusion of all lumbar and cervical spines. In addition, patients who diagnosed with axSpA for at least 10 years but no develop syndesmophytes on lumbar and cervical spine (92 patients) were used as a control group.

Results:

Both the bamboo spine and advanced spinal disease had higher age, higher BMI, more smoking (ever) and hip involvement compared to the without syndesmophytes group. Acute phase reactants, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing spondylitis disease activity Score-CRP (ASDAS-CRP) parameters were similar at the beginning of bDMARD in all groups. BASFI was higher in the bamboo spine group than in the without syndesmophytes group at last visit (Table 1). There were no differences between all groups in terms of the retention rate of the first bDMARD (Log rank p=0.86) (Figure 1).

Conclusion:

Data on the use of bDMARDs in SpA patients with bamboo spine are limited. This study showed that bDMARDs are an effective treatment option in SpA patients with bamboo spine with high disease activity. Similar drug retention rates were found compared to SpA patients with no syndesmophytes. Although the disease activity decreased similar rates in the groups, functional limitation continued in approximately half of the patients in bamboo spine patients.

References:

[1]Braun J et al. Staging of patients with ankylosing spondylitis: a preliminary proposal. Annals of the rheumatic diseases, 2002, 61.suppl 3: iii19-iii23.

Table 1.

Demographic, clinical characteristics and response to treatment in SpA groups.

Without syndesmophytesn= 92Advanced spinal diseasen= 99Bamboo spinen= 78pAge, years˚42.2 ± 8.851.3 ± 10.255.5 ± 9.3< 0.001*Age at disease onset, years˜25.01 (11)36.6 (20)33.3 (18)< 0.001*Male, n (%)55 (59.8)78 (78.8)66 (84.6)< 0.001*Disease duration, years˜13.8 (5)12.3 (15)17.6 (13)< 0.001*Delay in diagnosis, months˜12.02 (43)36.01 (89)36.01 (100)0.013*HLA-B27 positivity/total, n (%)21/42 (50)31/45 (69)16/28 (57)0.19BMI˜26.3 (8)29.7 (7)29.4 (7)< 0.001*Smoking (ever), n (%)56 (61)78 (79)58 (74)0.019*Hip involvement, positivity/total (%)11/84 (13.1)34/86 (39.5)37/75 (49.3)< 0.001*OnsetLastOnsetLastOnsetLastp (onset)p (last)ESR, mm/h˜21.5 (34)12.5 (18)25.5 (29)14.5 (17)23 (31)14 (14)0.60.59CRP, mg/dL˜1.5 (4)0.4 (0.6)1.7 (2)0.65 (1)1.8 (3)0.64 (0.8)0.40.001*ASDAS-CRP˜3.6 (0.8)1.9 (1)3.4 (0.9)2 (1.2)3.4 (0.8)1.9 (1.4)0.40.23BASDAI score˜5.7 (2.6)2.4 (4.5)5.6 (3.3)2.8 (3.1)5.6 (3.2)2.4 (3.3)10.31BASFI score˜5.4 (4)2 (4)4.5 (4)3 (4)6.5 (3)3.9 (4.5)0.10.002*BASFI score > 4, n (%)29 (59)23 (25)29 (56)32 (32)27 (75)36 (46)0.10.014*ASAS PR, n (%)26 (28)15 (15)17 (22)0.09

*p <0.05, ˚mean ± SD, ˜median (IQR) SD: Standard deviation; IQR: Inter-quartile range BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BASFI: Bath Ankylosing Spondylitis Functional Index; BMI: Body mass index; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; ASAS PR: Assessment in SpondyloArthritis International Society partial remission; ASDAS: Ankylosing spondylitis disease activity score

Figure 1.

Retention rate of the first bDMARD

Disclosure of Interests:

None declared

POS0793 PREDICTORS OF END STAGE RENAL DISEASE IN THE RENAL BIOPSY PROVEN LUPUS NEPHRITIS

Background:

Although focusing on the proliferative form of lupus nephritis (LN), recent reports also highlight the importance of recognizing and treating non-proliferative forms of LN.

Objectives:

In this study, we aimed to compare the clinical features and outcomes between proliferative and non-proliferative LN and to investigate the predictor factors of end stage renal disease (ESRD).

Methods:

This retrospective study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. 116 patients were diagnosed as LN. Biopsy findings had been classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification. Demographics, disease involvements, laboratory values, treatment regimens, and outcomes in LN course were compared according to the proliferative and non-proliferative LN. Complete renal response within first 24 months was defined as ACR response criteria. Factors predicting the ESRD were analysed by the logistic regression analysis.

Results:

A total of 116 lupus nephritis patients were categorised class 3 (n=17, 14.7%) or 4 (n=77, 66.4%) as proliferative LN and class 2 (n=9, 7.8%) or 5 (n=13, 11.2%) as non-proliferative LN. Of these patients, 80.2% was female. Mean age at the SLE diagnosis and SLE manifestations were similar for both group. ANA (+) ≥ 1:320, ds-DNA level, APS antibodies, anti-Sm (+) were similar for proliferative and non-proliferative LN, but ds DNA positivity and low level of C3 and C4 were more frequent in proliferative LN. LN duration was similar. Median renal SLEDAI scores were higher in proliferative LN group. Induction treatment regimens included pulse steroid 72.3%, CyC 51.8%, MMF 24.6%, Rtx 6.1%, CsA 4.4%, and plasma exchange 12.9%. ESRD, renal transplantation and exitus were major complications of LN. Predictors of ESRD were duration of lupus nephritis (OR 1.32 [1.09-1.61]; 95% CI), decrease in GFR at the biopsy time (OR 0.97 [0.95-0.99]; 95% CI), and being in complete renal response within 24 months (OR 21.07 [2.28-194.36]; 95% CI).

Conclusion:

Unfortunately, LN patients still have worse outcomes, such as high ESRD rate, regarding to current effective immunosuppressive treatment regimens. Although patients’ number were not enough for conclusion, interestingly, worse outcomes were not related with proliferative or non-proliferative LN. Complete remission within 24 months was most relevant good prognostic factor, and clinicians should be kept in mind to these windows of opportunity period.

Table 1.

Demographic, clinical characteristics, and outcomes of the patients with lupus nephritis

Variables*All patients (n=116)Class 3 or 4 LN (n=94)Class 2 or 5 LN (n=22)pAge at the SLE diagnosis, years22.5±13.123±13.320.3±140.32Sex, female93 (80.2)74 (78.7)19 (86.4)0.42SLE disease duration8 (8.7)8 (9.7)8.3 (7.5)0.66Lupus nephritis at diagnosis time67 (58.8)54 (58.7)13 (59.1)0.97Manifestation of SLE-Musculoscletal75 (66.4)63 (68.5)12 (57.1)0.32-Mucocutaneous60 (52.6)50 (54.3)10 (45.5)0.45-Hematologic47 (40.9)38 (40.4)9 (42.9)0.83-Serosal26 (23.2)21 (23.1)5 (23.8)0.94-Neurological6 (5.3)5 (5.4)1 (4.8)0.91Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.6 (0.2)0.01-GFR (ml/min)110 (67)92 (55)145 (59)0.03-≥ 60 ml/min79 (79.8)63 (77.8)16 (88.9)-30-59 ml/min8 (8.1)7 (8.6)1 (5.6)0.55-< 30 ml/min12 (12.1)11 (13.6)1 (5.6)-24-hour urine protein≥ 1 gr/day72 (71.3)62 (76.5)10 (52.6)0.04≥ 3 gr/day36 (35.6)32 (39)4 (21.1)0.14-Active urinary sediment91 (83.5)78 (89.7)13 (59.1)0.001Renal SLEDAI at the biopsy12 (8)12 (8)8 (8)0.001Lupus nephritis duration (years)5.5 (8)5.1 (8.3)6.4 (4.8)0.73Complete renal response within 24 months69 (71.1)55 (72.4)14 (66.7)0.61End-stage renal disease13 (11.2)11 (11.7)2 (9.1)0.72Renal transplantation5 (4.3)4 (4.3)1 (4.5)0.95Exitus8 (7)7 (7.5)1 (4.5)0.62

*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.

GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity index

Disclosure of Interests:

None declared

AB0745 REAL-LIFE EXPERIENCE FOR SECUKINUMAB IN PSORIATIC ARTHRITIS FROM HURBio-PsA DATABASE

Background:

Biologic disease modifying anti-rheumatic drugs (bDMARD) are revolutionary treatment options for management of inflammatory arthritis. Secukinumab (SEC), anti-interleukin-17A monoclonal antibody, is a new alternative choice to anti-TNFs and IL-12/23 blocking agents in the therapy of psoriatic arthritis (PsA). In Turkey, government health insurance system covers secukinumab for at bDMARD-refractory PsA patients.

Objectives:

In this study, analyzing of parameters that related with effectiveness and drug survival rates for patients using SEC from Hacettepe University Rheumatology Biologic Registry (HURBio-PsA) were aimed.

Methods:

HURBio-PsA is a monocentric biologic database including 470 PsA by December 2020. Sixty-two PsA patients that recorded with prescribed SEC in the database were evaluated. Sixteen patients have no control clinical-visit were excluded. Descriptives and demographics were recorded and Kaplan-Meier analysis was used to estimate SEC drug-retention rates.

Results:

Fourty-two (26.1% male) PsA patients treated with SEC) were included. Characteristics of the patients at the baseline and the last visit were shown in Table. Last visit scores of DKYI, Patient VAS Global, VAS Fatigue, VAS Pain and BASDAI showed statistically significant improvements in comparison with first visit values. Median duration of SEC usage was 5.4 (Min-Max: 0.18-18.6) months. SEC drug-retention rate at 12 months were 69% and 54.4% for two PsA groups that were used previously 1 and ≥2 bDMARDs, respectively (p=0.743, Figure).

Conclusion:

In this real-world study derived from single center experience; there is no statistically significant difference for drug survival rates of SEC therapy in the patient groups used 1 and ≥2 bDMARDs. Effectiveness and drug-survival shoul be obviously verified by data derived from multicenter large cohorts.

Table 1.

Disclosure of Interests:

Ertugrul Cagri Bolek: None declared, Emre Bilgin: None declared, Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Emine Duran: None declared, Berkan Armagan: None declared, Levent Kiliç: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

THU0380 SECUKINUMAB IS FREQUENTLY PREFERRED IN MULTI ANTI-TNF RESISTANCE SPONDYLOARTHRITIS PATIENTS: HUR-BIO REAL LIFE RESULTS

Background:

Anti-TNF agents have been used for the last two decades. However, targeting interleukin-17 (secukinumab (SEC)) is a relatively novel treatment option for spondyloarthritis (SpA). Therefore, SEC is frequently preferred after multi anti-TNF agents, in real life.

Objectives:

The objective of this study was to assess the retention rate and response of SEC in anti-TNF naïve and anti-TNF resistance patients in real life experience.

Methods:

HUR-BIO is a monocentric database of biologics including 2886 SpA patients, since 2005. SEC is approved at May 2018 in Turkey and 147 patients have used SEC by January 2020. Demographic and clinical data were obtained from HUR-BIO registry. SpA patients were classified as ankylosing spondylitis (AS) and non-radiographic SpA (nrAxSpA). Response and retention rate of SEC were determined regarding to anti-TNF naïve vs anti-TNF resistance patients. Kaplan-Meier analysis was used to estimate SEC retention rates.

Results:

In total, 147 axial SpA patients (96 (65.3%) AS and 51 (34.7%) nrAxSpA) were analyzed. Overall, 23/147 (15.7%) patients were anti-TNF naïve, 27 (18.4%) patients were 1 anti-TNF failure and 97 (65.9%) patients were ≥2 anti-TNF failure. Baseline characteristics of patients and the main causes of discontinuation of anti-TNF agents were shown in table. Median duration of SEC usage was 7.9 (min-max, 3.0-19.8) months in AS and 6.7 (min-max, 3.0-19.8) months in nrAxSpA group (p=0.365). SEC survival at 12 months was similar between AS and nrAxSpA patients (56% vs %52, p=0.315) (not shown).SEC survival was similar among anti-TNF naïve, one anti-TNF failure and ≥2 anti-TNF failure patients (Figure). BASDAI 50 response was reached in 61.5% of anti-TNF naïve, 42.1% of one anti-TNF failure and 43.2% of ≥2 anti-TNF failure patients at the last control (p=0.452). Patients who used ≤ 1 anti-TNF agent had a higher drug survival rate (%69 vs %46, p=0.027) at 1 year, in comparison with patients who used > 1 anti-TNF agents before SEC(not shown).

Figure.

Secukinumab survival in anti-TNF naïve, one anti-TNF failure and ≥2 anti-TNF failure patients

Conclusion:

For SpA, SEC is a relatively new player in biological era. When SEC launched for new treatment option, it is preferred mostly (almost 2/3) in multi anti-TNF resistance patients. Moreover, those difficult patients’ (usually female) treatment response and retention rate were not satisfactory than biological naïve patients.

Table.

Disclosure of Interests:

Berkan Armagan: None declared, Levent Kiliç: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Bayram Farisoğullari: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Sedat Kiraz: None declared

AB0763 THE INFLUENCE OF OBESITY ON BIOLOGICAL DMARD TREATMENT RESPONSE IN PSORIATIC ARTHRITIS: HUR-BIO REAL LIFE RESULTS

Background:

Obesity could be a risk factor for response to treatment and disease severity in psoriatic arthritis (PsA) because of potential pro-inflammatory effects of cytokines produced by adipose tissue (1).

Objectives:

This study aimed to assess association of demographic, clinical and disease activity indices with obesity in patients using biological disease-modifying antirheumatic drugs (bDMARD) treatment in HUR-BIO cohort.

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. Until January 2020, HUR-BIO PsA registry enrolled 469 patients. Demographic, clinical, laboratory, therapeutic data were collected from this database which including tender/swollen joint counts, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Health Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Disease Activity Score - 28 joint (DAS28), Disease Activity index for Psoriatic Arthritis - 28 joint score (DAPSA-28), Psoriatic Arthritis Impact of Disease 12-item questionnaire (PSAID-12). BMI≥30 was defined as obesity.

Results:

HUR-BIO PsA had 469 PsA patients and 441 patients with available BMI data were enrolled. Overall, 187/441 patients (42%) had obesity. The median follow-up period of obese and non-obese PsA patients was 7 (3-12) and 8 (4-12) years, respectively (p: 0.31). Obese patients were older at the age of PsA diagnosis (43 (33 - 53) vs 36 (28 – 45) years, p<0.001), higher female gender (76% vs 64%, p: 0.008), higher comorbidities (53% vs 27%, p<0.001). While there was no difference between the two groups in uveitis, IBD, family history and smoking; HLA-B27 was higher in non-obese patients (table). DAS28, BASDAI, DAPSA-28 joints, PSAID-12 were higher in the obese group than in the non-obese group, both before the biological DMARD and at the last visit (p <0.05) (figure 1). BASDAI50% response were similar and patients with HAQ score <0.5 were less frequently in obese patients. For obese and non-obese PsA patients, first bDMARDs percentages were adalimumab 46 vs 48, etanercept 18.2 vs 17, infliximab 14 vs 18, golimumab 7 vs 7.5, certolizumab 12 vs 7, secukinumab 1 vs 0.5, ustekinumab 1 vs 1, others 1 vs 1%, respectively and were similar (p: 0.72). Retention rate for first bDMARD was higher in non-obese than obese patients. Median of the retention rate of bDMARD in obese and non-obese groups was 54.2 and 79, respectively (log rank p: 0.03) (figure 2).

Conclusion:

Obesity was associated with higher disease activity and poorer effect of bDMARD treatment in patients with PsA. In obese PsA patients with high disease activity despite bDMARD therapy, intentional weight loss may be recommended as an adjunctive therapy.

References:

[1]Klingberg E, Bilberg A, Björkman S et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study.Arthritis research & therapy, 2019, 21.1: 17.

Table.

Baseline and last visit demographic, clinical and disease activity by BMI categories

BMI > 30BMI < 30p-valueAge at PsA, years, median (Q1-Q3)43 (33-53.5)36 (28-45)0.000*Disease duration, years, median (Q1-Q3)7 (3-12)8 (4-12)0.31Gender (male/female, %)24/7636/640.008*Smoking Ever n, %102 (54.8)159 (62.8)0.091HLA B-27 (+) n, (%)7 (14)32 (35)0.006*Uveitis n, %4 (2.2)6 (2.4)0.571IBD n, %4 (2.1)6 (2.4)0.567PsA/Pso Family history n, %74 (39.6)84 (33.2)0.169Taking steroids before biological drugs n, %115 (61.5)156 (61.7)0.972BASDAI50% response n, %35 (31.8)61 (41)0.13Last HAQ score < 0.5 n, %91 (52.3)160 (68.1)0.001*Figure 1.

Baseline and last visit disease activity by BMI categories p: 0.03* p: 0.01* p: 0.001* p: 0.002* *p < 0.05 BMI: Body mass index, DAS: Disease Activity Score, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, DAPSA: Disease Activity index for Psoriatic Arthritis, PSAID: Psoriatic Arthritis Impact of Disease

Figure 2.

Retention rate for biological DMARD by BMI categories Median of retention rate of first bDMARD: BMI > 30 kg/m2and < 30 kg/m254.2 and 79, respectively. Log rank p-value between BMI > 30 kg/m2and <30 kg/m2:0.03*

Disclosure of Interests:

Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Ertugrul Cagri Bolek: None declared, Emre Bilgin: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

SAT0443 CONCOMITANT PSORIATIC ARTHRITIS AND INFLAMMATORY BOWEL DISEASE IN THE PSA BIOLOGICAL REGISTRY: HUR-BIO REAL LIFE RESULTS

Background:

Patients with spondyloarthritis (SpA) have 3 important extra-articular involvement; psoriasis, uveitis and inflammatory bowel disease (IBD). Psoriatic arthritis (PsA) patients may have IBD, as well, and clinical features of PsA + IBD patients do not assess comprehensively, yet.

Objectives:

The purpose of this study is to determine the frequency and clinical features of concomitant PSA and IBD in a PsA biological DMARD cohort.

Methods:

Hacettepe University Rheumatology Biologic (HUR-BIO) is a single center biologic registry since 2005 and include 469 psoriatic arthritis patients to date. Demographics, clinical features, co-morbidities, laboratory and disease activity parameters collected from the database. The diagnosis of IBD was accepted with colonoscopy findings and pathology.

Results:

Overall, 469 PsA patients (70% females) with the mean age 47.7±12.4 years and [median (IQR)] disease duration 7 (3-11) years included in the study. Overall, 10/469 (5 male) PsA patients (2.1%) had IBD (7 (70%) with ulcerative colitis and 3 (30%) Crohn’s disease). Mean age of the patients was 53.3±10.0 years and mean disease duration was 9.0 ± 6.1 years. Six of ten patients were diagnosed with IBD before PsA and 4 of them were diagnosed with PsA first. Patients were followed-up for 3.7±2.8 years and bDMARD switch were made in 4 patients mostly due to primary inefficacy. bDMARD was discontinued in 2 patients (one for Crohn disease with fistula and one for drug induced SLE). According to DAPSA score 44% of the patients had low disease activity and 56% of the patients had moderate disease activity at last visit (9 patients were available). Sacroiliitis (70%) and severe radiographic hip (20%) involvement were common in PsA patients with IBD. Disease characteristics and demographic data are given in table 1.

Table 1.

Disease characteristics and demographic data of PsA patients with IBD

Age (years) /sexDisease duration (years)IBD typeSacroiliitisLast visit treatments61/M16Crohn’s disease(+)Azathioprine, GC50/M5Ulcerative colitis(+), hipAdalimumab, GC59/F3Ulcerative colitis(+)Certolizumab, methotrexate40/F10Ulcerative colitis-Adalimumab, methotrexate71/M19Ulcerative colitis-Infliximab62/M13Crohn’s disease(+), hipAzathioprine, GC, sulphasalazine50/F1Ulcerative colitis-Adalimumab, GC59/M12Crohn’s disease(+)Secukinumab, GC45/F9Ulcerative colitis(+)Adalimumab, methotrexate, GC36/F5Ulcerative colitis(+)Infliximab, methotrexate, GC

Conclusion:

In our single center biological registry, relatively small portion of PsA patients had concomitant IBD, however, those cases may have severe axial involvement, particularly in hip involvement, and further studies needed for these subgroup. Physician should be aware those SpA subgroup, because treatment choices, particularly IL-17 inhibitors may have some cautions patients with PsA and IBD.

Disclosure of Interests:

Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Berkan Armagan: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

AB0742 CONVENTIONAL SYNTHETIC DMARDS IN PSORIATIC ARTHRITIS - CHANGING PRACTICE IN BIOLOGIC ERA: REAL-LIFE RESULTS FROM HURBIO-PsA REGISTRY

Background:

Conventional synthetic disease modifiying anti-rheumatic drugs (csDMARDs) are recommended as the first-line treatment options for most of the psoriatic arthritis (PsA) patients. In the last two decades, biologic drugs become more accessible and their percentage in the daily practice is increasing continuously. However, how they influenced the utilization of csDMARDs still remains unknown, yet.

Objectives:

To determine the utilization rates of PsA patients before, after and at the starting of biologic DMARDs

Methods:

We analyzed all patients who received at least 1 dose of biologic DMARDs, registered to HURBIO-PsA database, and who have complete data regarding csDMARD use before (ever), after (at last control visit) and at the starting of biologic DMARD. Methotrexate, leflunomide and sulphasalasine were the csDMARDs recorded. Demographic data of these patients were also recorded.

Results:

A total of 426 (70% female) PsA patients was included. Mean age and mean PsA disease duration were 48±12.4 and 9.3±8.3 years, respectively. Mean duration of csDMARD utilization before bDMARDs was 5.8±5.1 years, and mean follow-up duration under bDMARDs was 3.7±2.5 years. Distribution of the bDMARDs that ever-prescribed as follows: adalimumab 273 (64.2%), etanercept 125 (29.3%), certolizumab pegol 103 (24.2%), infliximab 102 (24.0%), secukinumab 63 (14.8%), golimumab 55 (12.9%), ustekinumab 24 (5.6%) and tofacitinib 11 (3.4%). Percentage of each csDMARDs used before (ever used), after (at last control visit) and at the starting of biologic DMARDs were given inFigure. Also the percentage of patients using csDMARD as monotherapy and combination therapy were given inFigure.

Conclusion:

csDMARDs particularly sulphasalazine and methotrexate were important treatment options before bDMARD period, however they (particularly SSZ) were usually discontinued after bDMARD initiation. Rate of concomitant csDMARDs use remains relatively stable after starting the bDMARDs. Besides, rate of concomitant mono/csDMARD use is significantly higher after bDMARD initiation, in contrast to pre-bDMARD period.

Figure.

Percentage of each csDMARDs, and mono or combination of csDMARDs used before (ever used), after (at last control visit) and at the starting of biologic DMARDs (com/csDMARD: combination csDMARD; mono/csDMARD: monotherapy of csDMARD; csDMARD: conventional synthetic disease modifying antirheumatic drug)

Disclosure of Interests:

Emre Bilgin: None declared, Emine Duran: None declared, Ertugrul Cagri Bolek: None declared, Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Omer Karadag: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

AB0331 EFFICACY, RETENTION RATE AND PREDICTORS OF TOFACITINIB EFFICACY AND RETENTION IN RHEUMATOID ARTHRITIS PATIENTS: HUR-BIO REAL-LIFE EXPERIENCE

Background:

Tofacitinib (TOF) is an oral Janus Kinase (JAK) inhibitor and is indicated in the treatment of rheumatoid arthritis (RA). Several interventional or observational studies demonstrated its safety and efficacy, however, its real-life retention rate and related factors need to be elucidated further and its efficacy needs to be approved in real-life.

Objectives:

To assess the real-life efficacy, retention rate and related factors of both parameter in rheumatoid arthritis patients under tofacitinib.

Methods:

We analyzed all RA patients registered to HURBIO database who received at least 1 dose of tofacitinib (for drug retention) and who had at least 1 control visit under tofacitinib (for efficacy). Drug retention rates were calculated using the Kaplan-Meier method and predictors of drug retention were determined by Cox proportional hazard model. Patients were grouped as ‘’responder’’ or ‘’non-responders according’’ to DAS28 at last control visit: DAS28-CRP≤3.2: ‘’Responders’’; DAS28-CRP>3.2: ‘’Non-responders’’. Predictors of response (DAS28-CRP≤3.2 at last visit) were determined by logistic regression analysis. Reasons for switching and discontinuation were also determined.

Results:

For drug retention;a total of 247 (210 (85%) female) patients were recruited. Mean age was 53.1±12.6 years. Mean disease duration was 11.3±8.0 years. Rheumatoid factor and anti-CCP antibodies were positive in 160/240 (66.7%) and 135/207 (65.2%) patients, respectively. Combination with DMARDs was used in 83.3% of patients. 55.5% of patients was biologic-naive. Median follow-up while receiving tofacitinib was 10.2 (IQR:4.0-24.2) months. One-year crude retention rate was 64%. Median duration of drug retention was 24.8 months. Predictors of good tofacitinib retention were (in multivariate analysis):living in Ankara (where our center is located) (HR 1.43 (0.96-2.14); 95% CI) andBMI> 25(HR 1.46 (0.97-2.29); 95% CI).

For efficacy;a total of 204 (174 (85.4%) female) patients were recruited. Mean age was 53.2±12.5 years. Mean disease duration was 11.5±8.1 years. Rheumatoid factor and anti-CCP antibodies were positive in 135/198 (68.1%) and 115/171 (67.2%) patients, respectively. Detailed demographic and clinical characteristics of participants were given in table 1. Median follow-up while receiving tofacitinib was 11.6 (IQR:5.2-26.2) months. DAS28-CRP levels at baseline and last visit were 4.8 (IQR:3.9-5.4) and 3.3 (IQR:2.5-4.6), respectively (p<0.001). At last visit, 19.6% of patients was in low-disease activity (2.6≤DAS28-CRP≤3.2), 26.0% of patients was in remission (DAS28-CRP<2.6) Predictors of good response to tofacitinib were (in multivariate analysis, adjusted for follow-up duration under tofacitinib):biologic-navie(aOR 2.38 (1.30-4.34); 95% CI) andRF negativity(aOR 2.12 (1.13-3.95); 95% CI).

The most common cause of drug discontinuation was primary failure (in 36/108 patients, 33.4%).

Conclusion:

Tofacitinib seems an effective treatment option for rheumatoid arthritis. Relationship between seronegativity and good response to tofacitinib needs to be elucidated. Also, Clinicians should keep in their mind that in addition to patient characteristics, socioeconomic factors may influence the adherence to the treatment.

Disclosure of Interests:

Emre Bilgin: None declared, Furkan Ceylan: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

FRI0336 CONCOMITANT USE OF BIOLOGIC DMARDS WITH CSDMARDS INCREASES DRUG RETENTION RATE AND IMPROVES TREATMENT RESPONSE IN THE PSORIATIC ARTHRITIS. HUR-BIO REAL LIFE RESULTS

Background:

For inflammatory arthritis, drug retention is accepted as an important indicator of the effectiveness and safety of biological drugs.

Objectives:

The objective of this study was to determine of the effects first and overall bDMARD drug retention rate during concomitant csDMARD in psoriatic arthritis (PsA).

Methods:

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. All PsA patients (469) who enrolled in HUR-BIO registry and prescribed at least once biologic DMARD (bDMARD) were included in the study. The subjects were divided into two groups depending on whether or not to use csDMARDs (methotrexate, sulphasalazine or leflunomide) at the last control visit. Demographic, clinical and therapeutic data were collected from this database. Baseline disease activity before the first bDMARD initiation was assessed with DAPSA and PsAID-12.

Table.

Demographics, baseline and follow-up clinical characteristics of PsA patients

With concomitant csDMARD n=288Without concomitant csDMARD n=167pAge (mean, SD)48.9 (12.1)45.1 (12.4)0.002Female n (%)204 (70.8)113 (67.7)0.48PsA disease duration (med, IQR)7 (13)7 (14.5)0.53Age at PsA diagnosis (mean, SD)39 (11.7)40.8 (12.9)0.81BMI (mean, SD)29.6 (6.0)29.2 (5.9)0.53Axial involvement n (%)68 (34.0)37 (44.6)0.09HLA-B 27 (+) n (%)21/76 (27.6)17/69 (24.6)0.68Duration of use first bDMARD (months) (med, IQR)22.4 (51.3)14.1 (31.4)0.003Duration of use overall bDMARD (months) (med, IQR)56.8 (69.4)24.4 (57.7)<0.001Switching bDMARD (+) n (%)148 (52.5)71 (42.8)0.04Initial DAPSA1(med, IQR)19.4 (11.7)17.3 (10.2)0.04Initial PSAID2(med, IQR)5.7 (3)5.6 (2.8)0.55Final visit PSAID3(med, IQR)2.8 (3.8)2 (5.7)0.41Final visit DAPSA4(med, IQR)Remission (n,%)Low disease activityModerate disease activityHigh disease activity10.2 (12.4)12.5 (12.5)0.01Remission (n,%)61 (23.9)111 (43.5)72 (28.2)11 (4.3)27 (17.6)59 (38.6)58 (37.9)9 (5.9)0.13Low disease activity111 (43.5)59 (38.6)Moderate disease activity72 (28.2)58 (37.9)High disease activity11 (4.3)9 (5.9)

1: n=249,2: n=214,3: n=109,4: n=408

p<0.001

p=0.003

Results:

HUR-BIO PsA registry included 469 PsA patients. Baseline, clinical characteristics and follow-up parameters were given in Table. The using overall bDMARD were adalimumab 294 (62.0%), etanercept 135 (28.8%), infliximab 119 (25.4%), certolizumab pegol 107 (22.8%), secukinumab 67 (14.3%), golimumab 58 (12.4%), ustekinumab 25 (5.3%) and tofacitinib 11 (2.3%). Two hundred eighty eight (61.4%) patients used concomitant cDMARDs [methotrexate 176 (37.5%), leflunomide 94 (20.0%), sulphasalazine 35 (7.5%) and two csDMARD combination 17 (3.6%)]. The first-year retention rate of first bDMARD with or without concomitant csDMARDs were 88% and 80%, respectively. The median duration of first bDMARD retention with or without concomitant csDMARDs were 131.7 and 91.4 months, respectively (Figure). The first-year retention rate of overall bDMARDs with or without concomitant csDMARDs were 92% and 85%, respectively. The median drug retention rate of overall bDMARD in using csDMARD and not using csDMARD were 141.5 and 131.5 months, respectively. Retention rates (both for first bDMARD and overall bDMARDs) were significantly higher in concomitant csDMARDs using group (p=0.003 for first bDMARD retention, p<0.001 for overall bDMARDs retention, log-rank; Figure). In concomitant csDMARD using group, no differences were identified methotrexate or other csDMARDs.

Conclusion:

In this study, csDMARDs, either methotrexate or leflunomide/sulphasalazine have additional effect for both retention rate and treatment response of bDMARDs. On the other hand, using bDMARD monotherapy is relatively higher than rheumatoid artritis (1).

Figure.

Drug retention rate of the first bDMARD and overall bDMARDs according to concomitant csDMARD use (csDMARD:conventional synthetic Disease Modifiying Antirheumatic Drug)

Disclosure of Interests:

Emine Duran: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Arpaş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

FRI0117 INCIDENCE RATE OF HERPES ZOSTER IN RHEUMATOID ARTHRITIS PATIENTS UNDER TOFACITINIB: REAL-LIFE DATA FROM TURKEY – HURBIO REGISTRY

Background:

Tofacitinib (TOF) is an orally administered Janus Kinase (JAK) inhibitor and is commonly used in rheumatoid arthritis. There is a heterogeneity among numbers reported from different continents about herpes zoster (HZ) incidence rate (1-3). However, data about HZ risk in our country, which stands like a bridge between Asia and Europe, is lacking.

Objectives:

To assess the real-life incidence of herpes zoster in RA patients under tofacitinib.

Methods:

We analyzed all patients who had at least 1 control visit under tofacitinib and registered to HURBIO database. We calculated incidence rate by dividing the number of patients with herpes zoster to total follow-up years, then multiplied by 100 (per 100 patient-years).

Results:

A total of 204 (174 (85.4%) female) patients were recruited. Mean age was 53.2±12.5 years. Mean disease duration was 11.5±8.1 years. Rheumatoid factor and anti-CCP antibodies were positive in 135/198 (68.1 %) and 115/171 (67.2 %) patients, respectively. Median follow-up while receiving TOF was 11.6 (IQR:5.2-26.2) months. Combination with DMARDs was used in 83.3% of patients. 55.5% of patients was biologic-naive. Eleven (5.3%, incidence rate: 3.9 (2.3-8.5; % 95 CI) per 100 patient-years) patients had zona zoster. Ten of these patients was female, median age was 59 (IQR; 52-69) and 4 of them was older than 65 years-old. Rheumatoid factor was positive in 9 patients. Only 1 of these patients had diabetes. Median follow-up of these patients under TOF was 8.1(IQR: 6-25) months. Ten of these patients had concomitant DMARDs (9 hydroxycholoroquine, 4 methotrexate, 2 leflunomide; according to last follow-up visit) and 9 of them received concomitant steroids (med(IQR); 4 (1-8) mg- at equivalant methyl-prednisolon dose). Eight of them was biologic-naive. Tofacitinib was discontinued in 4 of these patients.

Conclusion:

In this real-life data from Turkey, we found a HZ incidence rate similar to that reported from USA and global data; however, we found a lower incidence rate that reported from Japan (Figure 1).

Figure 1.

Reported herpes zoster incidence rates across different countries (numbers in paranthesis indicate reference number)

References:

[1]Winthrop KL, Curtis JR, Lindsey S, Tanaka Y, Yamaoka K, Valdez H, et al. Herpes Zoster and Tofacitinib: Clinical Outcomes and the Risk of Concomitant Therapy. Arthritis & rheumatology (Hoboken, NJ). 2017;69(10):1960-8.

[2]Curtis JR, Xie F, Yun H, Bernatsky S, Winthrop KL. Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis. Ann Rheum Dis. 2016;75(10):1843-7.

[3]Yamanaka H, Tanaka Y, Takeuchi T, Sugiyama N, Yuasa H, Toyoizumi S, et al. Tofacitinib, an oral Janus kinase inhibitor, as monotherapy or with background methotrexate, in Japanese patients with rheumatoid arthritis: an open-label, long-term extension study. Arthritis Res Ther. 2016;18:34.

Disclosure of Interests:

Emre Bilgin: None declared, Furkan Ceylan: None declared, Emine Duran: None declared, Ertugrul Cagri Bolek: None declared, Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Extended Blind End-member and Abundance Extraction for Biomedical Imaging Applications

In some applications of biomedical imaging, a linear mixture model can represent the constitutive elements (end-members) and their contributions (abundances) per pixel of the image. In this work, the extended blind end-member and abundance extraction (EBEAE) methodology is mathematically formulated to address the blind linear unmixing (BLU) problem subject to positivity constraints in optical measurements. The EBEAE algorithm is based on a constrained quadratic optimization and an alternated least-squares strategy to jointly estimate end-members and their abundances. In our proposal, a local approach is used to estimate the abundances of each end-member by maximizing their entropy, and a global technique is adopted to iteratively identify the end-members by reducing the similarity among them. All the cost functions are normalized, and four initialization approaches are suggested for the end-members matrix. Synthetic datasets are used first for the EBEAE validation at different noise types and levels, and its performance is compared to state-of-the-art algorithms in BLU. In a second stage, three experimental biomedical imaging applications are addressed with EBEAE: m-FLIM for chemometric analysis in oral cavity samples, OCT for macrophages identification in post-mortem artery samples, and hyper-spectral images for in-vivo brain tissue classification and tumor identification. In our evaluations, EBEAE was able to provide a quantitative analysis of the samples with none or minimal a priori information.

The cluster [Re6Se8I6]3- penetrates biological membranes: drug-like properties for CNS tumor treatment and diagnosis

Tumorigenic cell lines are more susceptible to [Re₆Se₈I₆]^3- cluster-induced death than normal cells, becoming a novel candidate for cancer treatment. Still, the feasibility of using this type of molecules in human patients remains unclear and further pharmacokinetics analysis is needed. Using coupled plasma optical emission spectroscopy, we determined the Re-cluster tissue content in injected mice, as a biodistribution measurement. Our results show that the Re-cluster successfully reaches different tissues, accumulating mainly in heart and liver. In order to dissect the mechanism underlying cluster biodistribution, we used three different experimental approaches. First, we evaluate the degree of lipophilicity by determining the octanol/water partition coefficient. The cluster mostly remained in the octanol fraction, with a coefficient of 1.86 ± 0.02, which indicates it could potentially cross cell membranes. Then, we measured the biological membrane penetration through a parallel artificial membrane permeability assays (PAMPA) assay. The Re-cluster crosses the artificial membrane, with a coefficient of 122 nm/s that is considered highly permeable. To evaluate a potential application of the Re-cluster in central nervous system (CNS) tumors, we analyzed the cluster's brain penetration by exposing cultured blood-brain-barrier (BBB) cells to increasing concentrations of the cluster. The Re-cluster effectively penetrates the BBB, reaching nearly 30% of the brain side after 24 h. Thus, our results indicate that the Re-cluster penetrates biological membranes reaching different target organs-most probably due to its lipophilic properties-becoming a promising anti-cancer drug with high potential for CNS cancer's diagnosis and treatment.

Gabapentin pretreatment for propofol and rocuronium injection pain: A randomized, double-blind, placebo-controlled study

AIM

This prospectively-planned, randomized, double-blind and placebo-controlled study aims to evaluate the effect of 1200 mg gabapentin premedication on the incidence and severity of propofol and rocuronium injection pain.

METHOD

One hundred patients, between 18-60 years of age and ASA I-II for elective surgery planned under general anaesthetic, were randomized and divided into two groups. Two hours before the operation, the patients were given either a placebo tablet (Group P, n = 50) or 1200 mg gabapentin tablet (Group G, n = 50). On the back of the non-dominant hand, a vein was opened using a 20 G cannula , 0.9% NaCl was begun and preoxygenation was provided. For anaesthesia induction, 1% propofol at 800 ml/hr infusion rate was administered for 20 s. Propofol injection pain was evaluated up to the 20th second and recorded using a scale between 0 and 3 developed by McCrirrick and HunteR The remaining propofol dose (2.5 mg/kg), 5 ml saline and 0.6 mg/kg rocuronium were injected in that order over 10 seconds and rocuronium injection pain response was evaluated with a four point scale.

RESULTS

Pain after propofol infusion average score (degree ≥ 1) (Group G = 0.5; Group P = 1.0) and incidence (Group G = 46%; Group P = 68%); and average withdrawal movements response score linked to rocuronium injection pain (≥ 1 response) (Group G = 0.3; Group P = 1.2) and incidence (Group G = 20%; Group P = 80%) were detected to be significantly lower in the gabapentin group compared to the placebo group (p < 0.001).

CONCLUSION

Premedication with 1200 mg gabapentin 2 hours before propofol and rocuronium injection reduced the incidence and severity of injection pain.

First description of the neuro-anatomy of a larval coral reef fish Amphiprion ocellaris

The present study described the neuro-anatomy of a larval coral reef fish Amphiprion ocellaris and hypothesized that morphological changes during the transition from the oceanic environment to a reef environment (i.e. recruitment) have the potential to be driven by changes to environmental conditions and associated changes to cognitive requirements. Quantitative comparisons were made of the relative development of three specific brain areas (telencephalon, mesencephalon and cerebellum) between 6 days post-hatch (dph) larvae (oceanic phase) and 11 dph (at reef recruitment). The results showed that 6 dph larvae had at least two larger structures (telencephalon and mesencephalon) than 11 dph larvae, while the size of cerebellum remained identical. These results suggest that the structure and organization of the brain may reflect the cognitive demands at every stage of development. This study initiates analysis of the relationship between behavioural ecology and neuroscience in coral reef fishes.