Anatomical and molecular characterization of parvalbumin-cholecystokinin co-expressing inhibitory interneurons: implications for neuropsychiatric conditions

Inhibitory interneurons are crucial to brain function and their dysfunction is implicated in neuropsychiatric conditions. Emerging evidence indicates that cholecystokinin (CCK)-expressing interneurons (CCK+) are highly heterogenous. We find that a large subset of parvalbumin-expressing (PV+) interneurons express CCK strongly; between 40 and 56% of PV+ interneurons in mouse hippocampal CA1 express CCK. Primate interneurons also exhibit substantial PV/CCK co-expression. Mouse PV+/CCK+ and PV+/CCK- cells show distinguishable electrophysiological and molecular characteristics. Analysis of single nuclei RNA-seq and ATAC-seq data shows that PV+/CCK+ cells are a subset of PV+ cells, not of synuclein gamma positive (SNCG+) cells, and that they strongly express oxidative phosphorylation (OXPHOS) genes. We find that mitochondrial complex I and IV-associated OXPHOS gene expression is strongly correlated with CCK expression in PV+ interneurons at both the transcriptomic and protein levels. Both PV+ interneurons and dysregulation of OXPHOS processes are implicated in neuropsychiatric conditions, including autism spectrum (ASD) disorder and schizophrenia (SCZ). Analysis of human brain samples from patients with these conditions shows alterations in OXPHOS gene expression. Together these data reveal important molecular characteristics of PV-CCK co-expressing interneurons and support their implication in neuropsychiatric conditions.

Facile synthesis of Ni3Se4/Ni0.6Zn0.4O/ZnO nanoparticle as high-performance electrode materials for electrochemical energy storage device

To enhance the performance of transition metal chalcogenide composite electrode material, a key point is a composite design and preparation based on the synergistic effect between the oxide and selenide materials. With a facile 'one step template-annealing' step, Ni₃Se₄, Ni_0.6Zn_0.4O and ZnO are simultaneously synthesized, by 500 °C annealing. With the increase of annealing temperature from 350 °C to 600 °C, nickel selenides change from NiSe₂to Ni₃Se₄to NiSe. The charge storage capacity increases first and then decreases with the increase of annealing temperature, and the 500 °C annealing obtained three compound composite Ni₃Se₄/Ni_0.6Zn_0.4O/ZnO (NNZ-500) nanoparticle material displayed a high specific capacitance of 1089.2 F g^-1at 1 A g^-1, and excellent cycle stability of 99.8% capacitance retention after 2000 cycles at 5 A g^-1. Moreover, an asymmetric supercapacitor was assembled with NNZ-500 as the positive electrode material and activated carbon as the negative electrode material. This kind of asymmetric supercapacitor demonstrated a high energy density of 53.4 Wh kg^-1at 819.0 W kg^-1, and cycle stability with 98.6% capacitance retention after 2000 cycles. This material preparation approach provides great potential for the future development of high performance transition metal composite electrode materials in energy storage applications.

POS0966 DEVELOPMENT AND VALIDATION OF AN ANKYLOSING SPONDYLITIS RISK PREDICTION MODEL USING LONGITUDINAL REAL-WORLD DATA FROM A LARGE INTEGRATED HEALTHCARE DELIVERY SYSTEM

Background

Early detection and diagnosis of Ankylosing spondylitis (AS) is challenging due to heterogeneity in disease presentation, lack of specific biomarkers and high prevalence of mechanical back-pain that is difficult to distinguish from inflammatory back-pain. However, if diagnosed and treated early, the risk of AS complications and disease progression can be slowed.

Objectives

To develop and validate a risk prediction model for early identification of patients at high risk of AS, using a large longitudinal real-world clinical data in the US.

Methods

This retrospective study included all members aged ≥ 21 years with back pain symptoms who were enrolled in the Kaiser Permanente Southern California health plan between 01/2009-12/2013. Patients who presented with back pain symptoms at a physician visit were followed until 12/2020 to see if they subsequently developed AS. The cohort was randomly divided into a training (60%) and a validation (40%) sample. A proportional odds model was specified to create a risk score for AS in the training sample. Best fit model was determined based on Area Under the Curve (AUC) and Akaike Information Criterion (AIC). The cut off threshold of “high-risk” was based on Youden’s (1950) index.1 We assessed the model performance for internal validity using split-samples. The model was further validated using manual chart review of 900 patient records. These 900 records were selected such that 70% (N=630) met the high-risk cut-off and the remainder had scores below the cut-off. We also derived the probability of AS in each chart reviewed case using the method proposed by Feldtkeller et al. (2013) and Rudwaleit et al. (2006).2,3

Results

The cohort comprised 527,509 members with mean age 54 years and majority female (58%). Sixty-six percent were White race and 33% were Hispanic ethnicity. The crude incidence of AS was 1% and increased steadily during the follow-up period (Figure 1). The final risk prediction model included 15 risk factors and had an AUC of 0.72 (Table 1). Using Youden’s index, a cut-off value of 11 or higher was identified as the threshold to define high-risk. No evidence of overfitting to our training sample was observed based on the split-sample analysis. The model validation based on manual chart review of 900 records showed sufficient ability to discriminate between those at high-risk vs those not identified to be high-risk. When a concrete rule out or rule in determination could be made using Feldtkeller et al. approach, our model correctly classified 75% of such records.

Table 1.

Final Model Coefficients and Derived Risk Score

Model CoefficientPr(>|z|)Risk ScoreAge above 45 years0.1460.0111.46Male Sex-0.292<0.001-2.92White Race0.259<0.0012.59Non-Hispanic Ethnicity0.177<0.0011.77Corticosteroid Use (Yes/No)0.235<0.0012.35*NSAID User (Yes/No)0.202<0.0012.02Opioid Analgesic User (Yes/No)0.416<0.0014.16Had Enthesitis (Yes/No)0.298<0.0012.98Had Disorders of the Back (Yes/No)0.973<0.0019.73Had Fatigue and/or Malaise (Yes/No)0.1550.0561.55Had Psoriasis (Yes/No)0.2880.0082.88Had Spondylosis (Yes/No)0.838<0.0018.38Had Synovitis (Yes/No)0.1430.0661.43Had Uveitis (Yes/No)0.6210.0076.21Depression Diagnosis (Yes/No)0.0990.0170.99

* NSAID: Non-steroidal anti-inflammatory drugs

Figure 1.

Cumulative Incidence Over Time (in Days)

Conclusion

To aid early detection, we have developed and validated an AS risk prediction model with an easy to implement scoring system using demographics, medication use and diagnosis data that is routinely collected in clinical practice.

References:

[1]Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32-35.

[2]Feldtkeller E, Rudwaleit M, Zeidler H. Easy probability estimation of the diagnosis of early axial spondyloarthritis by summing up scores. Rheumatology (Oxford, England). 2013;52(9):1648-1650

[3]Rudwaleit M, Feldtkeller E, Sieper J. Easy assessment of axial spondyloarthritis (early ankylosing spondylitis) at the bedside. Ann Rheum Dis 2006;65:1251-2.

Disclosure of Interests

Aniket Kawatkar Grant/research support from: Novartis, Medac, Esther Yi Employee of: Novartis, Erika Estrada Grant/research support from: Novartis, Jose Pio Grant/research support from: Novartis, Cecilia Portugal Grant/research support from: Novartis, David Yi Grant/research support from: Novartis, Talar Habeshian Grant/research support from: Novartis, David Wei Employee of: Novartis, Steven Lee Grant/research support from: Novartis

POS1474-HPR PERSONAL EXPERIENCES WITH DIAGNOSTIC DELAY AMONG AXIAL SPONDYLOARTHRITIS PATIENTS – A QUALITATIVE STUDY

Background:

The estimated prevalence of axial Spondyloarthritis (axSpA) in the U.S. is 0.4 to 1.3 percent. Undiagnosed axSpA patients suffer from symptoms on average 7 to 10 years, which can also contribute to psychological suffering and healthcare burden due to the prolonged search for diagnosis and treatment.

Objectives:

To explore the experiences of diagnostic delay of axSpA patients as part of the SpondyloArthritis Screening and Early Detection (SpA-SED) Study.

Methods:

We conducted exploratory semi-structured patient focus groups. English-speaking participants ≥18 years of age with a rheumatologist-verified clinical diagnosis of axSpA were recruited from three rheumatology practices in Massachusetts, Colorado, and Pennsylvania. Six focus groups were conducted with 26 total participants (16 men, 10 women, age range 21-76 years). Discussions ranged from 1.33 to 2.13 hours. Verbatim transcripts were deidentified, cleaned and coded using NVivo qualitative software. A coding list was generated and summary themes were constructed.

Results:

Participants described meandering and frustrating journeys in search of a diagnosis. When doctors gave up, it was experienced by patients as profoundly negative. Intermittent axSpA symptoms confused some physicians and caused some patients to either delay seeking medical care (e.g., sporadic flare-up) or use dramatic language to convey the magnitude of the impact on their symptoms. Patients explained their experiences where physicians presumed that patients were trying to obtain narcotics or were “imagining/exaggerating” symptoms. Early symptom stories fell into five areas of importance for patients: pain, stiffness and lack of mobility, impact on sleep, impact on daily life, and changes with weather. Tenacity on the part of the patient and/or their family, patient research and confidence to challenge their physicians were important. Self-advocacy was challenging but necessary and particularly difficult when patients were sick. During the typically lengthy time that participants waited to be diagnosed, they experienced frustration and mental suffering due to lack of answers and/or not being heard, believed, or taken seriously. Some participants described the fatigue they experienced after trying without success to obtain a diagnosis or receive treatment. Early administration of a definitive diagnostic test or screening tools for axSpA would have alleviated both physical and emotional suffering for these participants.

Conclusion:

Overall, participants expressed satisfaction with physicians who sought to understand them and believed them, took them seriously, and did not give up even with long delays. Patients with axSpA described significant suffering prior to diagnosis which could have been prevented and treated. Further research is needed with axSpA patients who are early in their diagnostic journey to determine best practices to support patients and reduce diagnostic delay.

Disclosure of Interests:

Catherine Dubé Grant/research support from: Novartis, as personnel on such studies, Kate Lapane: None declared, Katarina Ferrucci: None declared, Ariel Beccia: None declared, Sara Khan: None declared, Esther Yi Employee of: Novartis Pharmaceuticals, Jonathan Kay Consultant of: AbbVie, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Jubilant Radiopharma; Merck & Co.,Inc.; Pfizer Inc.; Samsung Bioepis; Sandoz Inc.; Scipher Medicine; UCB, Inc., Grant/research support from: (paid to UMass Medical School) Gilead Sciences Inc.; Novartis Pharmaceuticals Corp.; Pfizer Inc., Kristine A. Kuhn Consultant of: UCB, Eli Lilly, Novartis, Grant/research support from: Pfizer, Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Shao-Hsien Liu Grant/research support from: Novartis

POS1060 A PROSPECTIVE, LONGITUDINAL STUDY TO EVALUATE REAL-WORLD PATIENT EXPERIENCES AND TREATMENT SATISFACTION WITH SECUKINUMAB FOR PSORIATIC ARTHRITIS

Background:

Psoriatic arthritis (PsA) is an inflammatory disease that impairs quality of life. Despite therapeutic advances, up to a third of patients do not respond or are unable to sustain a treatment response. Thus, data on patient treatment experience in PsA is critical.

Objectives:

To assess real-world experiences of patients with PsA treated with secukinumab.

Methods:

This is an ongoing 12-month, prospective, longitudinal, web-based survey study of patients with PsA initiating secukinumab. Patient demographics and medical history are collected at baseline using a rheumatologist case report form. Patient experience data are collected at baseline, 3, 6, 9, and 12 months by patient surveys. The primary endpoint is change in the Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID12) from baseline to 3 months. In addition, this study will explore other changes at 3 months, including PsA symptoms, treatment satisfaction with secukinumab, and other patient-reported outcome measures. Baseline and available month 3 data from patients enrolled to date were analyzed descriptively.

Results:

Baseline demographic and medical history data were available for 72 patients; 32 (44.4%) were male, 59 (81.9%) were White, and 15 (20.8%) reported modifying their diet because of PsA. The mean (SD) time since symptom onset (n = 29) and since PsA diagnosis (n = 53) was 56.3 (45.6) and 34.4 (44.7) months, respectively. More than half of the patients who started treatment with secukinumab were biologic experienced (38/62; 61.3%). Primary and secondary loss of effectiveness were the main reasons for previous biologic discontinuation (Table 1). At 3 months (n = 49), the mean (SD) PsAID12 change from baseline was –1.8 (1.8) points. Additionally, 24.5% of patients reported their PsA symptoms to be “much better,” 40.8% reported “moderately better,” and 32.7% “a little better” compared with baseline; none reported “no change” or worsened symptoms. On a scale of 1-10, patients rated their overall satisfaction with secukinumab treatment at month 3 with a mean (SD) score of 6.8 (2.1). Patients were also highly satisfied with their symptom improvement, speed to symptom improvement, and the mode and frequency of secukinumab administration (Table 1).

Table 1.

Summary of Prior PsA Treatment and Treatment Satisfaction with Secukinumab at Month 3

Physician-reported treatment characteristicsBaseline measure(N = 62)Most recent PsA biologic prior to secukinumab, n (%)n = 31Adalimumab12 (38.7)Certolizumab pegol8 (25.8)Etanercept6 (19.4)Infliximab, including -dyyb3 (9.7)Golimumab1 (3.2)Unknown/not sure1 (3.2)Primary reasons for discontinuing previous PsA biologic treatment, n (%)an = 30Primary and secondary loss of effectiveness25 (83.3)Disease progression6 (20.0)Worsening of or new comorbidities1 (3.3)How the medication was taken2 (6.7)Adverse effects/intolerance4 (13.3)Otherb1 (3.3)Patient-reported treatment satisfaction with secukinumab, mean (SD)cMonth 3 (N = 49)Symptom improvement6.7 (2.3)Speed of symptom improvement6.9 (2.0)Dose frequency7.4 (1.9)cMethod of administration7.2 (1.5)Ease of use8.2 (1.5)Side effects, if any7.9 (1.9)Patient support services by manufacturer8.3 (1.7)

PsA, psoriatic arthritis.

a Rheumatologists may list > 1 reason. Data tabulated based on the number of case report forms received from rheumatologists at analysis cutoff (n = 30).

b Other reasons included availability of new treatment, patient request, or family history of disease.

c n = 48.

Conclusion:

Most patients were biologic experienced and reported primary or secondary loss of effectiveness as the main reason for discontinuation of their previous biologic. Patients reported overall symptom improvement and satisfaction with secukinumab treatment at 3 months after initiation.

Disclosure of Interests:

M Elaine Husni Consultant of: AbbVie, Amgen, Janssen, Novartis, Eli Lilly, UCB, and Regeneron, Michael Bozyczko Employee of: National Psoriasis Foundation, Daniel Wolin Employee of: RTI Health Solutions, Carolyn Sweeney Employee of: RTI Health Solutions, Eric Davenport Employee of: RTI Health Solutions, Steven Hass Employee of: Novartis, Esther Yi Employee of: Novartis, Peter Hur Employee of: Novartis, Linda Grinnell-Merrick Consultant of: AbbVie, Amgen (previously Celgene), Novartis, Pfizer, and Regeneron.

AB0892-HPR PATIENT PERSPECTIVES ON PROVIDER PRACTICES LEADING TO AN AXIAL SPONDYLOARTHRITIS DIAGNOSIS: A QUALITATIVE STUDY

Background:

People with Axial Spondyloarthritis (axSpA) experience a diagnostic delay between 7 to 10 years. (1-5) This delay contributes to increased depression and desperation in searching for an appropriate diagnosis. (6) Consequently, people with axSpA experience impaired physical function, structural damage, and overall worsened quality of life than those who experience a timely diagnosis. (7)

Objectives:

To gain knowledge and understand patients’ experiences with healthcare providers in diagnosis of axSpA.

Methods:

Using qualitative study design, we conducted six focus groups, with a total of 26 participants with a confirmed diagnosis of axSpA by rheumatologists from three different geographic locations: Worcester, MA, Aurora, CO and Philadelphia, PA. Focus groups were audio recorded and approximately 2 hours in duration. The focus groups were transcribed, deidentified, cleaned and stored in a secure location. NVivo software was used to code the data using a coding scheme which emerged from the focus group discussion topics. For intercoder reliability, two researchers coded the data and generated summary reports for data analysis.

Results:

Patients described their frustrating journeys to diagnosis and attributed the lengthy diagnosis delays to a multitude of factors. These elements include, lack of definitive diagnostic test, disease characteristics, lack of primary care providers’ awareness of axSpA, time, and trust. Patients felt that their physicians dismissed their complaints or would describe their symptoms as psychosomatic. The health care system also contributed to their diagnostic delays, including the lengthy referral process to a rheumatologist and the short clinical appointments. Patients believe that to reduce diagnostic delay, physicians must work with their patients; listening and believing their patients while allotting time for patients to discuss their experiences. In addition, patients believe earlier referral to a rheumatologist, and HLA-B27 genetic testing would decrease the diagnostic delay of axSpA.

Conclusion:

In this study, patients desire definitive testing in clinical practice for earlier diagnosis of axSpA. Additionally, more education regarding the guidelines to diagnose axSpA and earlier referral to rheumatologists might be needed. Until this is feasible, patients seek clinicians who will work with them until a diagnosis is made, listening, and believing their experiences and symptoms.

References:

[1]Deodhar A, Mease P, Reveille J, Curtis J, Karunaratne P, Malhotra K. Prevalence of axial spondyloarthritis among undiagnosed chronic back pain patients in the United States [abstract]. Ann Rheum Dis. 2014;73:198-199.

[2]Deodhar A, Mease PJ, Reveille JD, et al. Frequency of Axial Spondyloarthritis Diagnosis Among Patients Seen by US Rheumatologists for Evaluation of Chronic Back Pain. Arthritis Rheumatol. 2016;68(2326-5205 (Electronic)):1669–1676.

[3]Garrido-Cumbrera M, Poddubnyy D, Gossec L, et al. The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective-an Analysis of 2846 Patients Across 13 Countries. Curr Rheumatol Rep. 2019;21(1534-6307 (Electronic)):19.

[4]Redeker I, Callhoff J, Hoffmann F, et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford) 2019;58(1462-0332 (Electronic)):1634–1638.

[5]Strand V, Singh JA. Evaluation and Management of the Patient With Suspected Inflammatory Spine Disease. Mayo Clin Proc 2017;92(1942-5546 (Electronic)):555–564.

[6]Martindale J. The impact of delay in diagnosing ankylosing spondylitis/axial SpA. . Rheumatology. 2014;53.

[7]Yi EA-O, Ahuja A, Rajput T, George AT, Park Y. Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review. Rheumatol Ther 2020(2198-6576 (Print)):65-87.

Disclosure of Interests:

Kate Lapane: None declared, Catherine Dubé Grant/research support from: Novartis, as personnel on such studies, Katarina Ferrucci: None declared, Sara Khan: None declared, Kristine A. Kuhn Consultant of: UCB, Eli Lilly, Novartis, Grant/research support from: Pfizer, Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Esther Yi Employee of: Novartis Pharmaceuticals, Jonathan Kay Consultant of: AbbVie, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Jubilant Radiopharma; Merck & Co.,Inc.; Pfizer Inc.; Samsung Bioepis; Sandoz Inc.; Scipher Medicine; UCB, Inc., Grant/research support from: (paid to UMass Medical School) Gilead Sciences Inc.; Novartis Pharmaceuticals Corp.; Pfizer Inc., Shao-Hsien Liu Grant/research support from: Novartis

FRI0269 CHARACTERIZATION OF PATIENTS WITH ANKYLOSING SPONDYLITIS WHO INITIATED SECUKINUMAB: ELECTRONIC HEALTH RECORDS DATA FROM THE COLUMBUS REPOSITORY

Background:

Secukinumab was the first anti-interleukin 17A monoclonal antibody treatment approved by the FDA for ankylosing spondylitis (AS). There is scarce information on the characteristics of secukinumab vs other biologic initiators with AS.

Objectives:

To describe real-world physician and patient characteristics, and treatment patterns of secukinumab and tumor necrosis factor inhibitor (TNFi) initiators.

Methods:

Electronic health records (EHR) data from adult patients with AS who initiated a biologic therapy between January 2018 and March 2019 (index date) were included from the Columbus Repository, a network capturing EHR data from 120 US rheumatology providers. Physician and patient characteristics, and treatment patterns were reported for patients who were prescribed secukinumab and TNFis (adalimumab, etanercept, certolizumab pegol, infliximab, infliximab-abda, and golimumab). Categorical variables were summarized using frequency counts and percentages and continuous variables were presented using means and standard deviations. Standardized mean differences andPvalues were used to compare treatment groups.

Results:

As of March 2019, AS treatment data were available for 82 secukinumab initiators and 160 TNFi initiators. Regarding overall practice size, 33% of practices had a single physician, and 65% of physicians were located in the South US region. Secukinumab initiators were younger than TNFi initiators (47.4 vs 49.8 years) and had a similar prevalence of HLA-B27 positivity (≈ 55%; Table 1). Comorbid psoriatic arthritis (PsA) was more commonly reported among secukinumab initiators vs TNFi initiators (17% vs 9%), while hypertension (5% vs 11%), obesity (2% vs 11%), and uveitis (2% vs 9%) were less common (Figure 1). Secukinumab initiators were more likely to have prior opioid use vs TNFi initiators but were less likely to have prior methotrexate use (Figure 2A); 67% of secukinumab initiators and 49% of TNFi initiators were biologic experienced, of whom 73% and 76%, respectively, used 1 prior biologic, 25% and 20% used 2 prior biologics, and 2% and 4% used ≥ 3 prior biologics (Figure 2B). The most common reasons for discontinuation of prior biologics among secukinumab and TNFi initiators were because the biologic was no longer required (47% vs 41%) and lack of efficacy (20% vs 24%) (Figure 2C).

Table 1.

Baseline Demographics and Disease Characteristics Among Patients With AS at the Index Date.

.CharacteristicSecukinumab(N = 82)TNFi(N = 160)SMD*PValueAge, mean (SD), years47.4 (12.8)49.8 (14.6)0.170.21Female, n (%)43 (52)90 (56)0.080.57Race/ethnicity, n (%)N = 65N = 1290.200.66White52 (80)106 (82)Hispanic8 (12)13 (10)Black3 (5)8 (6)Asian1 (2)2 (2)Other1 (2)0Geographic distribution, n (%)0.370.05South49 (60)113 (71)Midwest27 (33)28 (18)West5 (6)16 (10)Northeast1 (1)3 (2)Health insurance, n (%)N = 79N = 1560.410.39Commercial57 (72)94 (60)Medicare8 (10)33 (21)Medicaid2 (3)4 (3)Other12 (15)25 (16)HLA-B27 positivity, n (%) [N]14 (54) [N = 26]31 (56) [N = 55]0.051.00Body mass index, mean (SD), kg/m230.6 (6.1)30.9 (7.7)0.030.82

SMD, standardized mean difference.

* Comparisons with SMD > 0.1 were suggestive of clinically relevant differences.

Conclusion:

Secukinumab initiators with AS were younger and more opioid and biologic experienced, were more likely to have a PsA diagnosis, and were more likely to discontinue their previous biologic because the biologic was no longer required compared to patients who initiated TNFis.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Support for third-party writing assistance for this abstract, furnished by Kheng Bekdache, PhD, of Health Interactions, Inc, was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Howard Busch Speakers bureau: AbbVie, Amgen, Crescendo, Exagen, Genentech, Mallinckrodt, Novartis, Primus, Sanofi/Regeneron, and UCB, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation

SAT0385 CAN MISCLASSIFICATION BETWEEN SPONDYLOARTHRITIS (SPA) AND RHEUMATOID ARTHRITIS (RA) OCCUR? SPA-RELATED CLINICAL MANIFESTATIONS AMONG RA AND SPA PATIENTS - A SYSTEMATIC LITERATURE REVIEW

Background:

Delayed diagnosis is associated with worse outcomes and poor treatment responses in patients with SpA, including psoriatic arthritis (PsA) and axial spondyloarthritis.1Misclassification may be associated with this delay, as SpA and RA, especially seronegative RA, may present with similar manifestations such as joint pain, swelling, fatigue, and disability. Key features that typically distinguish SpA from RA include spine pain, dactylitis, enthesitis, psoriasis, and nail psoriasis.2Increased physician awareness of the potential overlap and distinctions between SpA and RA manifestations is needed for the early diagnosis and appropriate treatment for SpA.

Objectives:

To identify and summarise the published literature on the prevalence of SpA-related clinical manifestations among patients with RA and SpA.

Methods:

Publications were retrieved from Embase®, Cochrane, MEDLINE®, and MEDLINE® In-Process databases. Studies were included if they were non-interventional, recruited patients with RA and SpA, or patients with seronegative/seropositive RA, and reported the following manifestations: enthesitis, dactylitis, axial symptoms, psoriasis, or nail psoriasis. Two reviewers assessed each citation against predefined eligibility criteria, with discrepancies reconciled by a third independent reviewer.

Results:

Of the 4479 publications retrieved, 18 studies were included (Figure 1). All studies compared SpA populations to patients with RA. Of the 18 studies, 11 studies reported patients with only PsA, 2 studies reported patients with only ankylosing spondylitis (AS), and 5 studies reported mixed SpA populations. Three studies each reported data pertaining to seropositive/seronegative RA and early RA, defined as symptom onset <1 year. The majority (N=12) of studies used ultrasound imaging to identify manifestations of interest. Enthesitis (N=17) was the most frequently evaluated manifestation while axial symptoms (N=2) was least evaluated. Of the studies reporting enthesitis, the majority (N=14) reported a higher prevalence of enthesitis in the SpA cohort compared to the RA cohort. The remaining studies (N=3) reported no significant difference in enthesitis between the SpA and RA cohorts. Notably, these 3 studies comprised of the 2 studies evaluating only AS patients, and all 3 studies evaluated late RA patients. In contrast, the 3 studies that reported early RA and PsA patients found a significantly higher prevalence of enthesitis in early PsA vs. early RA cohort. Two of the 3 studies reporting RA serostatus found a higher prevalence of enthesitis, psoriasis, and/or nail psoriasis in the SpA population compared to seronegative and seropositive RA cohorts. All studies reporting axial symptoms, dactylitis, psoriasis, and nail psoriasis found a higher prevalence of the corresponding manifestation in the SpA vs. RA cohort.

Conclusion:

While this review found a higher prevalence of key SpA-related clinical manifestations in SpA vs. RA, overlap was present suggesting that misclassification could occur. Differences in the prevalence of manifestations were also seen in the early vs. late RA populations as well as by RA serostatus. This suggests that an earlier and comprehensive evaluation, including advanced imaging of peripheral manifestations such as enthesitis, dactylitis, axial symptoms, and skin signs such as psoriasis and nail disease, among RA and SpA patients may reduce misclassification and inappropriate treatment. Further research is needed to confirm these findings.

References:

[1]Seo et al. Clin Rheumatol. 2015;34:1397-1405.

[2]Merola et al. RMD. 2018;4:e000656.

Acknowledgments:

This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Mohit Kumar Bhutani Employee of: Novartis Healthcare Pvt Ltd, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Nina Kim Employee of: Postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation

THU0560 PRIMARY CARE PHYSICIAN PERSPECTIVES ON DELAYS IN DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: A QUALITATIVE STUDY

Background:

The average delay in diagnosis for patients with any form of spondyloarthritis (SpA) ranges from 7 to 10 years [1–5]. In axial spondyloarthritis (axSpA), a subgroup of SpA, it is 5 to 14 years [4, 6, 7]. Factors that contribute to this delay include the lack of diagnostic criteria for axSpA and the difficulty in distinguishing inflammatory back pain (IBP), a key symptom of axSpA, from other highly prevalent forms of low back pain [8–10]. This impedes timely referral of these patients to rheumatologic care and initiation of appropriate treatment.

Objectives:

Describe understanding of, attitudes towards, and practices regarding axSpA among primary care physicians.

Methods:

We recruited 18 primary care physicians practicing in the United States as part of a larger qualitative study: theSpondyloArthritisScreening andEarlyDetection (SpA-SED) Study. We used purposive sampling with a goal of including an equal number of family medicine and internal medicine physicians who were balanced by gender. Physicians provided informed consent to participate in an in-depth interview (up to 60 minutes), conducted in person (n = 3) or over the phone (n = 15), between February and May 2019. The interview guide was developed by a multidisciplinary team, with input from rheumatologists. Topics included the physicians’ approaches to evaluating back pain, their awareness about axSpA, their differential diagnosis of axSpA, the laboratory tests and imaging studies ordered when axSpA is suspected, their referral patterns for patients with presumed axSpA, their thoughts about factors contributing to diagnostic delay in axSpA, and their opinions about an Inflammatory Back Pain Assessment – ASAS criteria screening tool [5].

Results:

Barriers to early diagnosis included patient factors (eg, multiple complaints, back pain not being the chief complaint), disease characteristics (eg, slow rate of disease progression), physician characteristics (eg, lack of rapport between patients and their primary care physicians), and structural/system issues (eg, lack of time). Most physicians reported that they would perform laboratory tests before referring a patient to a rheumatologist.

Conclusion:

Primary care physicians were surprised to learn of the average delay to axSpA diagnosis, considered that this lengthy delay was problematic, and agreed that improvements are needed in screening for and early detection of axSpA. Physicians believed that there would be a role for using a screening tool in the primary care setting to improve diagnostic delay, but that evidence to support its implementation is needed.

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[7]Redeker I et al.Rheumatology (Oxford).2019;58:1634–8.

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Acknowledgments:

We thank the participants for sharing their insights as part of this study. This abstract was written using data from a research study originally funded by Novartis (Principal Investigator: Shao-Hsien Liu, Co-Investigators: Jonathan Kay, Kate Lapane, Catherine Dubé).

Disclosure of Interests:

Shao-Hsien Liu Grant/research support from: Novartis Pharmaceuticals Corporation, Kate Lapane Grant/research support from: Novartis Pharmaceuticals Corporation, Divya Shridharmurthy Grant/research support from: Novartis Pharmaceuticals Corporation, Sara Khan Grant/research support from: Novartis Pharmaceuticals Corporation, Katarina Ferrucci Grant/research support from: Novartis Pharmaceuticals Corporation, Catherine Dubé Grant/research support from: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Jonathan Kay Grant/research support from: Gilead Sciences, Inc., Pfizer, Novartis Pharmaceuticals Corporation, Consultant of: Alvotech Suisse AG; Arena Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Merck Sharp & Dohme Corp.; Mylan Inc.; Novartis AG; Samsung Bioepis; Sandoz, Inc; UCB, Inc.

Pesky trachoma suspect finally caught

AIM

Face seeking flies have long been thought to transmit Chlamydia trachomatis, the causative agent of trachoma, but this has never been proven. The four criteria proposed by Barnett, previously used to incriminate other arthropods suspected of transmitting disease, were examined. One of these criteria remains unmet: the repeated demonstration of the presence of C trachomatis on flies. The authors used polymerase chain reaction (PCR) to look for the presence of C trachomatis DNA on flies in the Gurage Zone of Ethiopia.

METHODS

Using sticky paper, one fly was collected from the face of each of 103 children aged 1-10 years. The piece of fly paper to which the fly was attached was cut out, followed by the collection of an empty piece from an arbitrary area of the fly paper, which served as control. Roche Amplicor PCR kits were used to detect C trachomatis DNA.

RESULTS

Evidence of C trachomatis by PCR was found on 15 of 103 flies versus 0 of 103 controls (p = 0.0001).

CONCLUSION

These results meet the final criterion needed to incriminate flies as a vector of trachoma. However, interventional studies will be needed to show the importance of fly control.

Yeast (Saccharomyces cerevisiae) methionine aminopeptidase I: rapid purification and improved activity assay

Methionine aminopeptidase (MetAP), in two isoenzymic forms, is responsible for hydrolysis of the initiator methionine residues from the majority of newly synthesized proteins. It is an essential gene product and is ubiquitously found in archaea, eubacteria, and lower and higher eukaryotes. MetAP also has a potentially important role in the production of recombinant proteins, since failure to correctly remove initiator methionine residues can result in a product that is inactive or immunogenic. A rapid two-step purification of recombinant yeast (Saccharomyces cerevisiae) MetAP I that produces a product that is more than 95% pure and maintains a high level of activity (kcat 320-1556 min-1) has been developed. In addition, a versatile, accurate and sensitive assay for MetAP activity is presented. In contrast with previous methods, which usually use short tripeptides and require a post-reaction derivatization step, this assay uses peptides ranging in size from four to eight residues and utilizes UV detection of a tryptophan residue at the C-terminus. As little as 1 pmol of yeast MetAP I can be detected, with 5 microM peptide in a 100 microl reaction. The combination of a rapid purification protocol and a significantly improved activity assay will allow for a detailed examination of MetAP structure-function relationships and may lead to improved enzyme reagents for use in recombinant-protein production.

[Ocular involvements in chronic inflammatory diseases in children]

Children uveitis represents 2-6% of all cases of uveitis in an ophthalmology clinic. Uveitis can be due to a specific ophthalmic disease or to a systemic disease: juvenile chronic arthritis. Sarcoidosis, Behçet's disease, and connective tissue diseases. Visual function, in these young patients, may be compromised by severe complications such as band keratopathy, posterior synechiae, cataract, glaucoma, and retinal oedema. In some cases, delayed diagnosis and severity of the uveitis are due to its insidious onset, and to the absence of any complaint from the child. Therapeutic approach based on local and general corticoids in complicated cases, must balance the necessity of controlling ocular inflammation and the secondary effects of this treatment in a growing child.