OP0044 CYTOKINE PROFILE, HYPERFERRITINEMIA, AND MULTI-VISCERAL INVOLVEMENT CHARACTERISE MACROPHAGE ACTIVATION SYNDROME COMPLICATING ADULT ONSET STILL’S DISEASE. RESULTS FROM A MULTIDIMENSIONAL EVALUATION

Background

Adult-onset Still’s disease (AOSD) is a rare multigenic autoinflammatory disease of unknown aetiology burdened by life-threatening, such as macrophage activation syndrome (MAS) [1]. Considering the poor outcome of MAS patients, previous works tried to assess predictive factors of its occurrence during AOSD [2-4]. However, an integrated evaluation of clinical features with biomolecules, more reflecting the pathogenic mechanisms of the disease and its complications, is still missing.

Objectives

To multidimensionally characterise MAS complicating AOSD considering cytokine profile, inflammatory markers, and multi-visceral involvement of the disease. To perform a high-dimensional phenotypic analysis of circulating immune cells in AOSD patients with and without MAS. To assess interferon (IFN)-related pathways in AOSD synovial tissues by a bulky RNA sequencing.

Methods

The present evaluation was designed to multidimensionally compare AOSD patients with or without MAS, considering cytokine profile, inflammatory markers, and multi-visceral involvement of the disease. Clinical and biologic data were collected and compared in AOSD patients with and without MAS. Sera biomolecules were analysed by Luminex multiplexing technology. Mass cytometry (CyTOF) was used to characterise circulating immune cells. A bulky RNA sequencing was performed in AOSD synovial tissues.

Results

In this study, 40 consecutive AOSD patients (47.7±15.0 years, 50.0% male gender) were assessed at the time of diagnosis before the administration of any immunosuppressive therapy. Out of those, 14 (35%) patients were complicated by MAS. Paralleling with increases of systemic score and ferritin, MAS patients were characterised by an increased concentration of IL-1α, IL-1β, IL-1Ra, IL-2Ra, IL-6, IL-10, IL-17A, IFN-γ, G-CSF, MCP-1, MIP-1α, SCF. Among these biomolecules, IL-1Ra, IFN-γ, MCP-1, and SCF were correlated with MAS.

Combining the discriminatory ability of these data in identifying MAS, the best model was composed by systemic score, ferritin, IFN-γ, and IL-10. This model was characterised by AUC=0.99 (Standard error: 0.008; 95%CI: 0.976–1.000), sensitivity=100%, specificity=95.45%. By CyTOF analysis, AOSD patients, who were complicated or not with MAS were characterised by a significant increase of circulating “classical monocytes” (CD14+CD38+). MAS patients were characterised by a significant reduction of NK cells (CD45RA+CD56dim) than AOSD patients. Finally, the transcriptomic profile, by RNA-sequencing analysis, showed that 3477 among type I, II, and III IFN-related genes (IRGs) were significantly different in AOSD synovial tissues.

Conclusion

A multidimensional characterisation of AOSD patients was provided suggesting that IFN-γ, IL-10, ferritin, and systemic score discriminated MAS, thus identifying the occurrence of the cytokine storm syndrome. The inflammatory milieu of AOSD and MAS may be associated with a signature of circulating immune cells. Finally, our results about IRGs reinforced the role of IFN-γ in these patients.

References

[1]Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still’s disease. J Autoimmun. 2018;93:24-36.

[2]Ruscitti P, et al. Macrophage Activation Syndrome in Patients Affected by Adult-onset Still Disease: Analysis of Survival Rates and Predictive Factors in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale Cohort. J Rheumatol. 2018;45:864-872.

[3]Di Benedetto P, et al. Ferritin and C-reactive protein are predictive biomarkers of mortality and macrophage activation syndrome in adult onset Still’s disease. Analysis of the multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort. PLoS One. 2020;15:e0235326.

[4]Wan L, et al. Total metabolic lesion volume of lymph nodes measured by 18F-FDG PET/CT: a new predictor of macrophage activation syndrome in adult-onset Still’s disease. Arthritis Res Ther. 2021;23:97.

Disclosure of Interests

None declared.

Women's height in several African countries in the first half of the 20th century

Height and its variations in time are considered useful indicators of living conditions in countries and in periods where no written sources are available. Majority of data refer to male stature, whereas data concerning female stature are limited and cover only a short span. This paper investigates the height of 456 women in 6 African countries, born around the end of the 19th century and the beginning of the 20th century. The objective is to provide information on the stature of females from those areas at that time and to compare the results with those from the literature, which refer to more recent times. Data were recovered from original individual forms and/or monographs of the time, and when possible, changes in mean statures were reported, considering two age classes: 20.0-29.9 years and 30.0 years and over. Individual heights were plotted according to year of birth. The main results show tendencies toward height increases in Eritrea and Ethiopia, stable values of stature in Somalia and decreasing heights in women mainly from the oases in Cyrenaica. It has been suggested that these results may reflect the synergic action, with different local modes and intensity, of a changing model of slavery in force at the time, lack of constituted states and continuing civil wars among different ethnic groups, and of an effect of severe droughts in the period under consideration. A comparison with data available on modern populations from 4 of the investigated countries shows that this trend has since changed. Further insights into this suggested trend may be gained from the study of male series.

Burnout among therapists working with persons with autism after the 2009 earthquake in L'Aquila, Italy: a longitudinal comparative study

The aim of this study was to follow up the occurrence of burnout in therapists of children and adolescents with autism experiencing the 2009 earthquake in L'Aquila, and to discuss implications for burnout prevention after disasters. A longitudinal study was carried out, measuring burnout outcomes according to the Maslach Burnout Inventory in 11 exposed and 53 unexposed therapists. Staff in the exposed group appeared to report significantly higher levels of emotional exhaustion after 1 and 2 years of follow-up than the unexposed staff. As to lack of personal accomplishment, the exposed groups shows increasingly lower scores with respect to the unexposed group, with personal accomplishment (PA) values falling from 41.0 [standard deviation (SD) 3.7] to 33.4 (SD 4.1) after 2 years, whereas PA values remain stable over time in the unexposed group. As to depersonalization, data show no significant difference between groups. Burnout occurrence is induced by the exceptional stressors related with natural disasters like earthquakes. Efforts are required to help mental health workers, including psychiatric nurses, to cope with the devastating situation determined by an earthquake. A periodical monitoring of mental health status is recommended in mental health works, especially with regard to help with post-traumatic stress disorder, coping with work and therapeutic relationships, family and social life and economic impact.

[COPD: cross-sectional study of prevalence and screening program in a risk area of the Po River delta in Italy]

Many population-based screening programs for the detection of COPD were reported and debated in the literature and public health practice. The use of portable spirometers, which minimize management costs and avoid the take in charge in housepatient or hospital centers, is now a common practice for COPD detection in the medical practitioner setting. The aim of this study was to estimate the prevalence of COPD within a population-based screening in the Po river delt area in Italy, which is characterized by high density of factories and the presence of an electric power station in Porto Tolle. The study design required a one-year follow up for a two stage questionnaire administration and spirometric examination. Anamnestic, clinical and spirometric investigations were performed by a sample of resident medical practitioners. The catchment area included 112,721 inhabitants, and a multi-stage sample of 2872 people was selected. Prevalence of overall respiratory diseases, as well as of COPD, is quite similar to the figures expected according to national and European prevalence data. COPD prevalence ranges between 1.9-5.4% in males and 1.6-3.8% in females, whereas overall respiratory diseases range between 6.2-15.4% in males and 4.9-11.1% in females. Prevalence odds ratio confirm active and passive cigarette smoking as the main determinant for COPD.

Cervical pain and headache in patients with facial asymmetries: the effect of orthognathic surgical correction

AIM

Facial asymmetries are often associated with cervicobrachial pain and headache. The aim of the study was to evaluate the influence of surgical orthognathic correction of facial asymmetries on the intensity of cervicobrachial pain and headache in the short and long term.

METHODS

Thirty-two patients affected by maxillomandibular asymmetries associated with pain referred to occipital, cervical, dorsal and scapulohumeral areas who were undergoing orthodontic surgical correction were enrolled in the study. The pain intensity at rest and on fibromyalgia trigger points was assessed using a 0-10 Visual Analogue Scale (VAS) preoperatively (T(0)) and 5 days (T(1)), 6 months (T(2)) and 12 months (T(3)) after surgery. Functional limitation was evaluated by the same method at T(0),T(2) and T(3).

RESULTS

VAS scores at rest were significantly lower at T(1), T(2) and T(3) compared to T0 in every area to which pain was referred. After 12 months (T(3)), pain at rest was completely absent in 23 patients (71.8%) in the occipital region, in 23 patients (71.8%) in the cervical area, in 22 patients (68.7%) in the dorsal area, and in 28 patients (87.5%) in the scapulohumeral area. In the other patients, the pain scores in all areas were < 1 (0.77, 0.83, 0.95, 0.5 in the occipital, cervical, dorsal, and scapulohumeral areas respectively). The VAS at neck fibromyalgia points were significantly reduced at T(1), T(2), T(3) and functional limitation was improved at T(3) and T(4) (P=0.00).

CONCLUSION

This study appears to demonstrate the utility of orthognathic surgery when facial asymmetry is associated with cranial-cervicobrachial pain syndrome, presumably through a new musculoskeletal rearrangement of stomatognathic apparatus. Indeed, the surgical correction has resulted in morphological, functional and symptomatic effects.

[Quality of health care services as perceived by the customers: issues of method or context?]

Customer satisfaction is considered an important indicator of the quality of care. Its definition as well as the identification of the variables which affect it, rise many cultural and methodological issues. In order to give a contribution to the debate on such topics, we compared the patients' satisfaction detected before and after the transferral of the San Salvatore Hospital of L'Aquila to new and functional structures. The comparison aimed at evaluating the methodological and cultural entailments involved in customers satisfaction surveys, which focus the improvements in terms of health care as well as variation of satisfaction. The presence of contradictory elements in the expression of the satisfaction referred to the technical and informative aspects, seems to indicate that patients can express an high satisfaction degree independently from the real professional and technical quality performed. Such evidences, that anyway must be interpreted according with the methodological cautions of a non validated questionnaire, should foster stronger efforts in promoting sanitary education of the customers, devoted to the specific rights involved, as well as in making use of rigorous methodologies to detect the phenomenon.

Family and disease management in young type 1 diabetic patients

The main objectives of type 1 diabetes mellitus (DM) management include keeping glycemia levels within the euglycemic range to prevent complications. Daily self-monitoring is an important problem for many diabetic patients, particularly for adolescents. The aim of this study was to evaluate the determinants of poor daily self-monitoring, focusing on the patients' parents' perception of the problem. In order to evaluate parents' awareness of their children's disease-monitoring status, we carried out a cross-sectional investigation of a sample of children and adolescents from a population-based register, with the corresponding population of parents. To collect our data, we used a 33-item questionnaire, separately administered by diabetologists to both parents and children. We estimated the concordance with respect to patients' and parents' answers. Adolescents followed their overall medical prescriptions more regularly (48.8%) than children (29.7%), but most frequently they forgot to use glycemic tests (adolescents 42.4%, children 29.7%). A major duration of disease affected HbA1c levels (values > 8%) of patients younger than 14 years (pFisher = 0.016). Our results indicate a worse compliance of adolescents with respect to children in attending to daily self-monitoring, not just regarding daily glycemic levels but also the course of daily activities such as going to school, studying, working, and simulating symptoms and signs of hypo-hyperglycemia. Parents mostly ignored their child's self-monitoring status and the related motivations.