AB1370 MICROVASCULAR CAPILLAROSCOPIC ABNORMALITIES AND AUTOANTIBODY OCCURRENCE IN SARCOIDOSIS PATIENTS

Background

Sarcoidosis (S) is a granulomatous disease with multi-organ involvement displaying a mixed immune-mediated pathophysiology. Raynaud’s phenomenon (RP) has been occasionally reported in S patients [1] and serum positivity for autoantibodies has been detected in S patients but their significance is debated [2].

Objectives

We described nailfold videocapillaroscopy (NVC) findings and estimated the prevalence of serum anti-nuclear (ANA) and extractable nuclear antigen autoantibodies (ENA-Abs) in S patients, comparing them with age- and sex- matched healthy controls (HCs) and patients with primary Raynaud’s phenomenon (PRP). Secondarily, we analysed potential correlations between NVC findings with the occurrence of autoantibodies, immunomodulatory treatment, laboratory parameters, variables of pulmonary function and whole-body imaging.

Methods

Twenty-seven (27) S patients, classified according to WASOG criteria[3], were assessed through NVC examination, laboratory parameters (including serum concentrations of angiotensin-converting enzyme [ACE], C-reactive protein [CRP], calcium, phosphorus, albumin, 25-hydroxyvitamin D, parathormone, ANA and ENA), pulmonary function tests (PFTs), chest-X ray and positron emission tomography/computerized tomography (PET/CT).

Among NVC parameters, we analysed capillary dilations, giant capillaries, haemorrhages, nonspecific abnormalities, and capillary absolute number for mm [4].

Pulmonary involvement was classified by X-ray Scadding staging system (SSS) scoring S patients in 4 grades [5]. From PET data, the maximum standard uptake value (SUVmax) was quantified as a variable of tissue 18-fluorodeoxyglucose hyper-uptake: consequently, S patients were defined PET-positive when SUV value ≥ 2.5. NVC parameters and ANA/ENA dosage were recorded also in 30 PRPs and 30 HCs.

Results

We excluded, among the cohort of S patient, one participant having a systemic sclerosis in overlap with S. The remaining 26 S patients (mean age 56.5 ± 12.5 years, 53.8 % of females, disease duration 28.4 ± 55.1 months, 27% glucocorticoid-naïve) showed a significant higher rate of dilations and nonspecific abnormalities and a lower mean capillary absolute number than PRPs and HCs (p < 0.01 for all comparisons). (Figure 1)

The prevalence of ANA positivity was significantly higher in S patients compared with PRPs and HCs (p < 0.02 for both). Among the whole cohort of patients only one S patient displayed a positive ENA-Ab (Ro52).

In the analysis of S patients’ subgroup, a significant negative correlation was detected between serum ACE levels with the presence of capillary dilations (rho = -0.45, p = 0.04), between CRP and mean capillary absolute number (rho = -0.49, p = 0.02) and a positive correlation was also detected between the mean capillary absolute number and the forced vital capacity percentage (FVC%) (rho = 0.40, p = 0.04).

Conclusion

Our findings suggest a microvascular involvement in sarcoidosis whose investigation by NVC could be useful for the detection of an overlapping connective tissue disease and for the monitoring of the phenotypes of S patients displaying RP.

The positivity for autoantibodies in S patients is in line with literature data suggesting, at least partially, autoimmune features of the disease or the production of autoantibodies reactive to tissue damage.

The correlations between NVC findings with ACE levels and lung function variables generate hypotheses of a potential partial vascular impairment in sarcoidosis disease activity and lung involvement.

References

[1]Nigro A et al. Reumatismo 2004; 56: 278-81.

[2]Kobak S et al. Autoimmune Diseases 2014

[3]Judson M.A et al. Clin Rev Allergy Immunol 2015; 49: 63-78.

[4]Smith V et al. Autoimmun Rev 2020; 19: 102458.

[5]Scadding J.G. Br Med J 1961; 2: 1165-72.

Disclosure of Interests

None declared

AB0679 NAILFOLD VIDEOCAPILLAROSCOPY RESULTS IN COVID-19 PATIENTS RECOVERED FROM DIFFERENT DISEASE SEVERITY

Background:

COVID-19 is a multifaceted condition with a wide range of clinical manifestations, including microvascular/endothelial dysfunction, that starts in the early phase of the disease and may become dramatically harmful in the late stage, causing a massive pro-thrombotic state. Nailfold videocapillaroscopy (NVC) is the most used tool to identify microvascular status in a large spectrum of diseases [1]. Recently, non-specific NVC abnormalities have been described in a cohort of COVID-19 patients (no controls used) [2].

Objectives:

To assess microvascular damage in recovered COVID-19 patients (range of 40-270 days from recovery) by considering the previous severity of the disease, and, as mandatory, the comparison with matched individuals suffering from primary Raynaud’s phenomenon (PRP) and healthy volunteers (HV).

Methods:

NVC investigations were performed during standard clinical assessments in forty-four recovered COVID-19 patients (mean age 58±14 years, mean days from disease onset 129±54, mean days from disease recovery 106±52), twenty-two patients with PRP (mean age 60±15 years, mean years from disease onset 11±10) and twenty-two HV (mean age 60±14 years). COVID-19 patients were divided into two subgroups, according to the need of oxygen supplementation: twenty-two patients with severe lung involvement (need of Continuous Positive Airways Pressure and/or mechanical ventilation, mean age 57±12 years) vs twenty-two patients with mild-moderate lung involvement (need of Venturi mask or no need of oxygen supplementation, mean age 59±15 years). Clinical and demographic data of all the enrolled subjects were collected, during NVC examination. The following capillaroscopic parameters were evaluated: capillary number, dilated capillaries, giant capillaries, microhemorrhages, angiogenesis, disorganization of the microvascular array. A validated semiquantitative scoring (0-3) was adopted for NVC abnormalities [3-5]. Statistical analysis was carried out by non-parametric tests.

Results:

After COVID-19 recovery, no statistically significant difference was observed between COVID-19 patients and control groups of subjects concerning the score for the following NVC parameters: dilated capillaries, giant capillaries, disorganization of the microvascular array, angiogenesis. However, the capillary number per linear millimeter was significantly lower in COVID-19 patients (8.3±0.9) than in PRP (8.8±0.7, p=0.05) and HV (9.3±0.6, p<0.0001). Surprisingly, recovered COVID-19 patients showed significantly less microhemorrhages (score 0.4±0.3) than subjects of the other groups (PRP 0.6±0.5, p=0.01; HV 0.6±0.6, p=0.05). In particular, recovered patients who had more severe COVID-19 showed less microhemorrhages than patients with mild/moderate disease (score 0.18±0.4 vs 0.36±0.5), but this didn’t reach the statistical significance (p=0.18). On the other hand, patients recovered from severe SARS-CoV-2 infection also showed higher rate of angiogenesis (0.18±0.4) than patients with mild/moderate disease (no case, p=0.04).

Conclusion:

COVID-19 doesn’t seem to significantly induce, in short-term, specific alterations in peripheral microvascular array as evaluated by NVC, despite the severity of the disease, except for a significant reduction of the absolute number of nailfold capillaries. The topic needs longer time of evaluation and larger number of COVID-19 recovered cases to also assess the role of concomitant therapies.

References:

[1]Ingegnoli F et al. Curr Rheumatol Rev. 2018;14:5-11.

[2]Natalello G et al. Microvasc Res. 2021;133:104071.

[3]Smith V et al. Autoimmun Rev 2020;19:102458.

[4]Cutolo M et al. Clin Rheumatol. 2019;38:2293-2297.

[5]Sulli A et al. Ann Rheum Dis. 2008;67:885-7.

Disclosure of Interests:

None declared

Body composition and bone status in relation to microvascular damage in systemic sclerosis patients

AIM

To evaluate, in Systemic sclerosis (SSc) patients, the body composition and the bone status according to the peripheral microcirculatory condition, assessed and scored by nailfold videocapillaroscopy (NVC, "Early", "Active", "Late" patterns).

METHODS

Body composition and bone mineral density (BMD) were assessed by Dual X-ray absorptiometry and dedicated software (GE Lunar USA) in 37 female SSc patients classified according to the 2013 EULAR/ACR criteria and 40 sex-matched healthy subjects. Clinical, laboratory, body composition and bone parameters were analyzed according to the different NVC patterns. Means were compared by the Student's t test or one-way analysis of variance; medians were compared by the Kruskal-Wallis test; and frequencies by the chi-square test.

RESULTS

Higher prevalence of vertebral (21% vs 7%) and femoral (35% vs 7%) osteoporosis (OP) was found in SSc. Particularly SSc patients with "Late" NVC pattern showed a significantly higher prevalence of vertebral (p = 0.018) and femoral OP (p = 0.016). Regional assessment of bone mass (BM) in seven different body areas showed a significantly lower BMD only at the total spine (p = 0.008) and femoral neck (p = 0.027) in advanced microvascular damage. Patients with "Late" NVC pattern showed a lower whole-body lean mass (LM) compared to "Early" and "Active" NVC patterns, particularly at upper limbs. To note, in all body sites, BMD correlates with LM and BMC according to NVC pattern severity.

CONCLUSIONS

SSc patients with most severe microvascular damage show a significantly altered body composition and bone status suggesting a strong link between microvascular failure and associated muscle/bone sufferance.

FRI0257 CAPILLAROSCOPIC VERY EARLY MORPHOLOGICAL AND QUANTITATIVE SPECIFIC ABNORMALITIES ANTICIPATE THE DEVELOPMENT OF THE “SCLERODERMA PATTERN” IN PATIENTS WITH RAYNAUD’S PHENOMENON

Background:

Nailfold videocapillaroscopy (NVC) abnormalities in subjects with isolated Raynaud’s phenomenon (RP) may be present before transition to secondary RP(SRP) and development of a NVC “scleroderma pattern” and are known to predict for evolution to a connective tissue disease (CTD) within few years [1]. In a previous study, we have demonstrated that the very early increase of capillary diameter over 30 μm is an independent predictor for development of Systemic Sclerosis (SSc) associated SRP [2].

Objectives:

Present pilot retrospective study aimed to investigate in a cohort of patients affected by CTD–related RP the presence of very early capillaroscopic morphological and quantitative abnormalities in the acquired pictures of NVC performed before the development of the NVC scleroderma-pattern. In particular, the study was addressed to identify a “very early”scleroderma pattern, in order to intercept patients with RP at high risk of evolution in a CTD, specifically SSc.

Methods:

We selected the NVCs of 273 SSc patients presenting one of the validated NVC “scleroderma patterns”. We enrolled 26 SSc patients having a NVC analysis performed before the development ofthe “very early”NVC pattern. As controls, we evaluated 26 patients affected by other CTDs with stable non-scleroderma pattern over time. The 16 images per patient obtained by NVC examination were analyzed for total number of capillaries, number and the limbs diameters of capillaries with a diameter >30 μm, and microhemorrhages. Statistical analysis was performed using non-parametric tests.

Results:

All 26 SSc patients showed dilated capillaries with a diameter >30 μm in their previous NVC. Patients later developing scleroderma pattern had statically higher number and percentage of capillaries with a diameter >30 μm (p=0.0004 and p=0.0005), as well as a larger apical dilatation >40 μm (p=0.002). A progressive and significant increase in all capillary diameters were only detected in patients later diagnosed for SSc (apical p=0.006, venous p=0.02, arterial p=0.03). A significant homogeneous and progressive dilation was observed from the apical region and then involving both venous and arterial branches, only in SSc patients (p=0.002).

Conclusion:

Present pilot study demonstrates, for the first time that, before to develop a validated NVC scleroderma-pattern, all potential SSc patients present significant very early morphological and quantitative NVC changes. In particular, the progressive and homogeneous capillary loop dilation over 40 μm in over 40% of total number capillaries significantly could contribute to identify RP patients who will develop a SSc pattern after 4-5 years.

References:

[1]Cutolo M, Sulli A, Pizzorni C, Accardo S. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000;27:155-60.

[2]Trombetta AC, et al. J Rheumatol 2016;43:599-606.

Disclosure of Interests:

Monica Pendolino: None declared, Carmen Pizzorni: None declared, Sabrina Paolino: None declared, Federica Goegan: None declared, Emanuele Gotelli: None declared, Carlotta Schenone: None declared, Francesco Cattelan: None declared, Massimo Patanè: None declared, Elisa Alessandri: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha

AB0578 LONG-TERM TOLERABILITY OF AMINAPHTONE IN A COHORT OF SYSTEMIC SCLEROSIS PATIENTS IN CONCOMITANT STANDARD THERAPY

Background:

Aminaphtone (AMI) is a bioflavonoid compound, classically used for “capillary disorders”.In vitroAMI interferes with adhesion molecules (sELAM-1 and sVCAM-1) and with vascular endothelial cadherin degradation thus defending vessels permeability. Moreover, it counteracts vasoconstriction, downregulating endothelin-1 production at a gene level (1-3).In vivoAMI ameliorates clinical symptoms of several clinical conditions, above all Raynaud’s phenomenon (RP), either primary or secondary to systemic sclerosis (SSc), as demonstrated by a recent six-month study (4).

Objectives:

To evaluate long-term tolerability of standard dosage of AMI in a real-life cohort of SSc patients with secondary RP.

Methods:

Seventy-eight SSc patients (mean age 65±13 years; mean disease duration 9±7 years) treated with AMI due to active RP were enrolled (ACR/EULAR 2013 criteria). They were taking various concomitant treatments, including aspirin, calcium-channel blockers, cyclic intravenous iloprost, immunomodulators, endothelin receptor antagonists. SSc patients performed periodic clinical assessments and blood tests on average every four months per clinical practice. Duration of AMI administration, side effects, and self-assessment of Raynaud Condition Score (RCS) in a scale from 0 (absence of pain) to 10 (intolerable pain) were retrospectively taken into account.

Results:

Duration of AMI administration was between six and sixty-seven months (mean 31±20 months). AMI was administered at 75 mgbis in diedosage, as standard initial posology. At baseline, mean RCS was 7.3±0.8. After 3 months of treatment sixty-four patients (82%) yet referred a subjective improvement of RCS (3.5±0.8, p=0.03), whereas 14 patients (18%) were clinically unsatisfied (RCS 6.1±0.4, p=1.12). In this last group, posology was increased to 75 mgtris in die, with a satisfactory amelioration in further nine patients (93,6%) (RCS 4.0±0.6 p=0.04), while five patients (6,4%) definitively discontinued therapy for subjective ineffectiveness within six months. Patients referred a sustained improvement of RCS along the observational period (31±20 months) (last RCS 3.7±0.7, p=0.03 vs baseline). During the follow-up, five patients (6,4%) referred headache as side effect: three of them had to reduce AMI posology to 75 mg per day, while maintaining clinical benefits. Periodic blood tests did not reveal any significant alteration attributable to AMI. No other side effects related to the drug appeared during the treatment period.

Conclusion:

AMI shows an acceptable medium-long-term tolerability along with sustained efficacy in the management of SSc-related RP, without disabling side effects. However, the retrospective design, the absence of a placebo-control group and the concomitant standard therapy limit the results, and a randomized controlled trial for AMI use in the management of SSc-related RP is desirable.

References:

[1]Scorza R et al. 2008.Clin Ther30(5):924-9.

[2]Felice F et al. 2018.Phlebology33(9):592-599.

[3]Scorza R et al. 2008.Drugs R D9(4):251-7.

[4]Ruaro B et al. 2019.Front Pharmacol10:293.

Disclosure of Interests:

Emanuele Gotelli: None declared, Sabrina Paolino: None declared, Federica Goegan: None declared, Francesco Cattelan: None declared, Massimo Patanè: None declared, Carmen Pizzorni: None declared, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha, Alberto Sulli Grant/research support from: Laboratori Baldacci

SAT0337 EVALUATION OF BODY COMPOSITION AND BONE STATUS ACCORDING TO MICROVASCULAR INVOLVEMENT IN SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease, characterized by autoimmune inflammatory microvascular damage with progressive loss of capillaries, fibrosis and ischemia of skin and internal organs. (1) Nailfold videocapillaroscopy (NVC) is a safe toll for early diagnosis of SSc, it identify morphological changes of vessel that are predictive for clinical disease progression and organ involvement.(2) About clinical complication the loss of bone mass and body composition abnormalities, particularly muscle mass and strength loss (sarcopenia), are recognized in advanced disease.(3)

Objectives:

To evaluated in SSc patients, the body composition and the bone status according to the microvascular condition, assessed and scored by nailfold videocapillaroscopy (NVC, “Early”,”Active”,”Late” patterns).

Methods:

Body composition and bone mineral density (BMD) were assessed by DEXA in 35 female SSc patients classified according to the 2013 EULAR/ACR criteria and 32 sex-matched healthy subjects. Clinical, laboratory, body composition and bone parameters were analysed according to the different NVC patterns. Means were compared by the Student’s t test or one way analysis of variance; medians were compared by the Kruskall Wallis test; and frequencies by the chi square test.

Results:

Higher prevalence of vertebral (26.4%vs 9.3%) and femoral (32.3% vs 9.3%) osteoporosis (OP) was found in SSc. Particularly SSc patients with “Late” NVC pattern showed a significantly higher prevalence of vertebral (p=0.018) and femoral OP (p=0.016). Regional assessment of bone mass (BM) in 7 different body areas showed a significant lower BMD only at the total spine (P=0.008) and femoral neck (p=0.027) in advanced microvascular damage. Patients with “Late” NVC pattern showed lower whole body lean mass (LM) compared to “Early” and “Active” NVC patterns, particularly at upper limbs. To note, in all body sites, BMD correlate with LM and BMC according to NVC pattern severity.

Conclusion:

SSc patients with most severe microvascular damage show a significantly altered body composition and bone status suggesting a strong link between microvascular failure and associated muscle/bone sufference.

References:

[1]Cutolo M et al. Expert Rev Clin Immunol 2019; 15(7):753-64

[2]Cutolo M et al. Clin Rheumatol 2019; 38(9):2293-7

[3]Corallo C et al. Rheumatol Int 2019;39(10):1767-75.

Disclosure of Interests:

Sabrina Paolino: None declared, Emanuele Gotelli: None declared, Andrea Casabella: None declared, Francesco Cattelan: None declared, Carlotta Schenone: None declared, Massimo Patanè: None declared, Greta Pacini: None declared, Carmen Pizzorni: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha

THU0359 GENDER IMPACT ON LOWER URINARY TRACT INVOLVEMENT IN SYSTEMIC SCLEROSIS PATIENTS

Background:

Lower urinary tract symptoms (LUTS) are an underdiagnosed but frequent manifestation in systemic sclerosis (SSc) [1]. LUTS pathogenesis in SSc is undetermined, mainly involving dysautonomia, fibrosis and a possible antibody-mediated damage [2]. Divergently from general population, female sex and advanced age are not reported to significantly impact LUTS in SSc [2].

Objectives:

To evaluate the potential influence of gender and hormone-related factors in LUTS prevalence and severity among SSc patients (Pts).

Methods:

A population of 42 SSc Pts and 50 age- and sex-matched healthy subjects (HSs) was evaluated. SSc diagnosis was based on 2013 ACR/EULAR criteria. Demographic data, medications interfering with pelvic floor dynamics and general comorbidities commonly associated with LUTS – diabetes mellitus, chronic heart failure, chronic obstructive pulmonary disease, peripheral neuropathy, pelvic organ prolapse, fecal incontinence – were recorded. Validated self-reported questionnaires derived from the International Conference on Incontinence were used to assess prevalence and severity of LUTS, namely of urinary incontinence (UI) and overactive bladder (OAB) [3]. Data were analysed using non-parametric tests. Apvalue <0.05 and a confidence interval (CI) of 95% were considered statistically significant.

Results:

There were no significant differences in main demographic data between SSc Pts and HSs. Specifically, median age was 61 years (IQR 21-85)vs57 years (IQR 28-93) and female prevalence 83%vs84% in SSc PtsvsHSs, respectively. Amongst the female population, 83% of SSc Ptsvs84% of HSs was in post-menopausal state, with a median of 1 (IQR 0-3)vs1 (IQR 0-4) pregnancy by natural route, respectively. No woman of the study had received hormone replacement therapy or local hormonal therapies prior to the study. Similarly, there were not any significant differences in analysed comorbidities, while ongoing treatment was significantly different between the two populations, SSc patients more frequently receiving calcium channel blockers and glucocorticoids than healthy subjects (p< 0.001). In SSc Pts, statistically significant correlation was observed between stress UI and sex, with an increased female-to-male ratio (p< 0.005), but any significant difference was observed in US distribution depending on parity and menopausal state, nor on other analysed variables. Interestingly, female dominance has not resulted as a significant predictive factor for LUTS prevalence or severity in SSc Pts. In fact, in the regression analysis, SSc disease was the only significant predictor for LUTS (OR 3.45, 95% CI 1.41-7.95; p< 0.01), independently of other analysed variables, particularly of gender and hormone-related factors.

Conclusion:

This study confirms the absence of pathogenic female-gender participation in LUTS prevalence among SSc Pts. However, consistently with findings on general population, a significant increased prevalence of urinary symptoms, particularly of stress UI, in SSc female Pts has emerged [4]. It is therefore conceivable that hormonal factors may act as a catalytic circumstance rather than pathogenic players in LUTS progression during SSc disease.

References:

[1]John G et al. Arthritis Care Res (Hoboken) 2018;70(8):1218–27.

[2]John G. Clin Rheumatol. 2020;39(1):5–8

[3]Abrams P et al, J Urol. 2006;175:1063–6

[4]Abelson B et al. Biol Sex Differ. 2018;9(1):45

Disclosure of Interests:

Greta Pacini: None declared, Sabrina Paolino: None declared, Federica Goegan: None declared, Pietro Francesco Bica: None declared, Elisa Alessandri: None declared, Carmen Pizzorni: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Emanuele Gotelli: None declared, Francesco Cattelan: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha