Is the international physical activity questionnaire (IPAQ) a valid assessment tool for measuring physical activity of patients with axial spondyloartritis?

BACKGROUND

Determining the level of physical activity (PA) is an essential part of patient evaluation in axial spondylarthritis (axSpA). Subjective and objective methods are both frequently used methods for evaluating PA. Although subjective methods are cost-effective and easy to use, their accuracy for measuring PA is still questionable.

OBJECTIVE

To investigate the concurrent criterion validity of a self-reported questionnaire (IPAQ-Short Form) when compared to an accelerometer (Actigraph wGT3X-BT) for measuring PA level in patients with axSpA.

DESIGN

Cross-sectional design.

METHODS

Fifty-eight patients with axSpA with a median age of 39.0 (IQR 25/75: 30.0/46.0) years were included in the study. An accelerometer (Actigraph wGT3X-BT) was attached to the waist of patients at their first visits and was removed at their second visits, seven days later. Patients were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ) at their second visits.

RESULTS

No significant correlations were determined between IPAQ and accelerometer (p > 0.05), except for the moderate PA (rho: 0.367, p < 0.05), and total PA (rho: 0.330, p < 0.05). It was also observed that IPAQ was underestimating energy expenditure for all types of PA.

CONCLUSION

IPAQ might not be a valid tool for measuring PA level in patients with axSpA. Disease-specific subjective methods for determining the PA should be developed and validated for those patients.

POS0929 FACTORS ASSOCIATED WITH THE DEVELOPMENT OF ANTI-DRUG ANTIBODIES TO TUMOUR NECROSIS FACTOR INHIBITORS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS; A TWO YEAR FOLLOW-UP STUDY

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting sacroiliac joints and spine as well as peripheral joints and entheses. Tumour necrosis factor inhibitors (TNFi) are widely used in patients with persistently high disease activity despite non-steroidal anti-inflammatory drugs. Some patients fail to respond or loose responsiveness during therapy with TNFi. The development of anti-drug antibodies (ADA) might play a role in non-response or some adverse events. However it has never been evaluated for 2-years period.

Objectives:

Therefore, the aim of the present study was to evaluate the development of ADA against TNFi longitudinally during 2-years period in axSpA patients and factors associated with it.

Methods:

In total 180 axSpA patients according to ASAS classification criteria with a new TNFi prescription in the last two weeks period were included in this observational study. Clinical data and serum samples were collected at baseline and at every 12 weeks. Serum drug levels and ADAs were measured on 12, 24, 52 and 104 weeks of treatment by ELISA in one center to avoid inter-assay variability. The development of ADA over time was investigated by using generalized estimating equations (GEE) which is a technique for longitudinal data analysis allowing the use of all available data even deviated from normality.

Results:

180 biologic naive axSpA patients (116 male, median [IQR] 44,5 [14,5] years) who started anti-TNF agents (infliximab [20%], adalimumab [27,2%], etanercept [32,2%] and golimumab [20,6%]) were included in the analysis. In comparison to baseline values BASDAI, ASDAS-CRP and CRP values were significantly decreased in third months of follow-up (Figure 1). In total 172 patients had at 12 weeks, 154 at 24, 121 at 52, and 73 at 104 week serum samples available for ADA determination. In longitudinal analysis; baseline age and TNFi type, as well as longitudinal BASDAI, ASDAS, serum CRP levels and the development of adverse events and discontinuation of the drug were found to be associated with the development of ADA. In order to determine independent association/s with the development of ADA two longitudinal multivariable models were run; (a) with ASDAS as an activity measure, (b) with BASDAI and CRP levels and produced that all the variables were independently associated with longitudinally development of anti-drug antibodies (Table 1). Antibodies to adalimumab were related with lower serum drug levels.

Conclusion:

The results of the present study with up to 2 years of follow-up, revealed that the development of ADA against TNFi therapy is associated with high disease activity, the development of adverse events and treatment discontinuation in patients with axSpA. And etanercept might be negatively associated with the development of ADA.

Table 1.

Factors associated with the development of anti-drug antibodies

Model 1Model 2B95% CIPB95% CIPAge years-0.061-0.109;-0.0120.015-0.058-0.107;-0.0100.018TNFi Treatment ETN-1.981-4.369; -0.1340.104-2.475-4.791; -0.0760.036 ADA1.438-0.002; 0.4070.0731.275-0.119; -0.1600.064 INF1.5503.010; 3.1020.0501.2552.666; 2.6290.073 GOL0a0aPresence of advers event, no-0.824-1.451; -.01980.010-0.835-1.461; -0.2080.009TNF treatment discontinuation1.2890.043;2.5340.0431.248-0.075; 2.5710.065BASDAI0.0350.015; 0.0550.001CRP0.020-0.035; 0.0050.008ASDAS-CRP0.8520.466; 1.2380.000

0a:set to zero because this parameter is redundant.

Figure 1.

Mean change in disease activity and CRP levels during follow-up duration. (P values for 3rd months BASDAI<0.0001, CRP<0.001, ASDAS-CRP<0.001 respevtively)

Disclosure of Interests:

None declared

POS1165 Lifestyle And Mood Changes In Axspa Patients During The Quarantine Period

Background:

On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) as a pandemic, and mandatory quarantine was applied in Turkey between April and June 2020. With this sanction, sudden changes occurred in a routine lifestyle.

Objectives:

This study aimed at evaluating physical activity changes, presence of anxiety and depression, altered eating habits and their relationship with disease activity in axial spondyloarthritis (AxSpA) patients during the quarantine period.

Methods:

AxSpA patients, who were examined in the rheumatology clinic in the last year before the pandemic period and their relatives were included in this study and were contacted by phone to participate. A structured questionnaire form was performed which included the following data: questions about demographic characteristics, medication use, disease activity scales; BASDAI, BASFI, Patient acceptable symptom state (PASS), patient-reported physical activity state, Short Questionnaire to Assess Health enhancing physical activity (SQUASH), Three-Factor Eating Questionnaire (TFEQ-21), and Hospital Anxiety and Depression Scale (HADs).

Results:

204 AxSpA patients and 106 patients’ relatives were contacted in the study (Figure 1). The frequency of male sex and alcohol consumption was higher in the AxSpA compared to the relatives and, other demographic features were summarized in Table 1. 30% of AxSpA patients and 37% of patient relatives were gained weight with mean 4.5±2.4 and 4.4±3.4 kilograms, respectively. Weight gain were similar male and female in AxSpA (26.2% vs 37.2%, p>0.05). However, the men in the AxSpA group gained more weight than relatives group (26.2% vs 7%, p<0.05). Weight gain group had decreased physical activity than stable group in AxSpA patients (54.8% vs 37.8%, p<0.05). We showed mild negative correlation between BASDAI and BASFI scores with SQUASH- total activity score (r:-0.15, p<0.05; r:-0.25, p<0.001, respectively). Anxiety prevalence were found slightly higher in patients group but not significantly (40.2% vs 32.1%; p>0.05). Depression were much higher in AxSpA group than relatives (43.6% vs 28%, p<0.001). Depression and anxiety were correlated with disease activity (HADs Depression vs BASDAI r:0.380, p<0.001; HADs Anxiety vs BASDAI r:0.418, p<0.001) and function (HADs Depression vs BASFI r:0.342, p<0.001; HADs Anxiety vs BASFI r:0.313, p<0.001). Among eating habits, uncontrolled and emotional eating scores were showed low correlation with anxiety (r:0.169, p<0.05; r:0.163, p<0.05, respectively).

Conclusion:

One third of our patients were weight gain and approximately half of them had decreased physical activity but we did not show relation between these parameters and disease related factors in the limited period. In addition to that depression and anxiety were detected significant part of AxSpA patients and both of them were correlated with disease activity.

Table 1.

Study Population Characteristics

AxSpa n:204 Controls n:106 p valueAge (years) mean ± SD43.1±11.440.6±12.6>0.05Male n(%)125(61.3)26(24.5)<0.001Education time (years) mean ± SD9.8±4.39.7±4.0>0.05Current smoker n(%)77(37.7)31(29.2)>0.05Alcohol consumption n(%)60(29.4)9(8.5)<0.001Current BMI kg/m2 mean ± SD26.8±4.626.5±4.7>0.05Weight gain group n(%)62 (30.4)40(37.7)>0.05Weight stable group n(%)142 (69.6)66(62.3)Current BASDAI mean ± SD1.8±1.5N/ACurrent BASFI mean ± SD1.5±1.8N/APatients treated with biologic drugs n(%)118(57.8)N/APatients treated with conventional drugs n(%)84(41.1)N/APresence of Anxiety n(%)82(40.2)34(32.1)>0.05Presence of Depression n(%)89(43.6)30(28.0)<0.001TFEQ-R21emotional eating mean ± SD5.2±3.15.6±2.7<0.05TFEQ-R21uncontrolled eating mean ± SD14.7±6.317.5±5.4<0.001TFEQ-R21cognitive restraint mean ± SD14.3±4.315±4.2>0.05Stable physical activity n(%)117(57.4)49(46.2)>0.05Decreased physical activity n(%)87(42.6)57(53.8)

Acknowledgements:

Special thanks to our clinical nurse Alev Vayni for her devoted assistance in interviewing patients to fill out the questionaire.

Disclosure of Interests:

None declared.

AB0669 DEPRESSION AND ANXIETY MIGHT NOT BE INCREASED DURING COVID-19 PANDEMIC IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:

Anxiety and depression are most common psychiatric disorders in chronic inflammatory rheumatic condition as well as axial spondyloarthritis (axSpA) (1). The prevalence of depression has been reported as 11-64% depending on the criteria used. Also self-reported depression and anxiety were found to be associated with disease activity and function in axSpA (1,2). It is observed that mental health is affected among healthy subjects during the COVID-19 pandemic, but this condition has not been systematically reviewed in axSpA patients.

Objectives:

We aimed to compare frequency of self-reported depression and anxiety before and during the Covid-19 pandemic in patients with axSpA.

Methods:

Seventy-six axSpA patients who were evaluated for the presence of depression and anxiety by using Hospital Anxiety and Depression scale (HADs) before pandemic were included in this study. All participants were classified according to the ASAS axSpA classification criteria. Patients were contacted by phone to participate and complete the HADS questionnaire. Demographic and disease related characteristics including BASDAI, BASFI and Patient Acceptable Symptom State (PASS) were recorded during interview. The HADs cut off value was taken as >7 in both groups to define the presence of anxiety or depression. Before and during pandemic period anxiety and depression scores were statistically compared.

Results:

The demographic and disease related characteristics of axSpA patients with and without anxiety/depression were summarized in Table 1. The frequency of anxiety (43.4% vs %43.4; p>0.05) and depression (46.1% vs 44.7%; p>0.05) were found to be similar before and during pandemic period. Patients with anxiety (HADs>7) and depression (HADs>7) had higher BASDAI and BASFI scores and much less PASS positivity (Table 1). Although the frequency of depression was similar between before and during the pandemic period, symptom severity in depression was slightly increased during the pandemic (Figure 1).

Table 1.

Patients’ demographics and characteristics according to the presence of anxiety and depression

VariablesPresence of depressionn:35Absence of depressionn:41PPresence of anxiety n:33Absence of anxiety n:43PAge (years) mean ± SD41.8±11.244.1±9.3>0.0542.0±10.943.6±10.0>0.05Male n(%)21(60.0)26(63.4)>0.0518(54.5)29(67.4)>0.05Education time (years) mean ± SD9.6±4.811.0±4.2>0.059.7±5.010.6±4.1>0.05Current smoker n(%)18(51.4)15(36.6)>0.0515(45.5)18(41.9)>0.05Alcohol consumption n(%)12(34.3)12(29.3)>0.0510(30.3)14(32.6)>0.05Current BMI kg/m2 mean ± SD26.0±4.826.8±4.5>0.0526.4±5.026.5±4.3>0.05Sleep time (hours) mean ± SD7.6±1.77.6±1.3>0.057.5±1.67.7±1.4>0.05Current BASDAI mean ± SD2.5±1.61.4±1.6<0.052.7±1.81.3±1.3<0.001Current BASFI mean ± SD2.4±2.11.1±1.3<0.052.4±2.01.2±1.4<0.05PASS positivity n(%)16(45.7)29(70.7)<0.0514(42.4)31(72.1)<0.05

Current depression and anxiety scores were correlated with disease activity (HADs Depression vs BASDAI r:0.530, p<0.001; HADs Anxiety vs BASDAI r:0.500, p<0.001) and function (HADs-Depression vs BASFI r:0.519, p<0.001; HADs-Anxiety vs BASFI r:0.391, p<0.001). These relationships were also observed in the pre-pandemic period (HADs-Depression vs BASFI r:0.326, p<0.05; HADs-Anxiety vs BASDAI r:0.342, p<0.05).

Conclusion:

Depression and anxiety symptoms seems to be comparable before and after the COVID-19 pandemic. Regardless of this period, the presence of both depression and anxiety are associated with disease activity, function and less patient acceptable symptom state.

References:

[1]Zhao S, Thong D, Miller N, et al. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther. 2018;20:140.

[2]Barişan E, Bayir D, Solmaz D. Aksiyel spondiloartrit hastalarinda anksiyete düzeyinin çeşitli ölçeklerle değerlendirilmesi ve anksiyete ile ilişkili faktörler. Dokuz Eylül Üniversitesi Tip Fakültesi Dergisi. 2019; 129-137.

Figure 1.

Disclosure of Interests:

None declared

POS0935 DO PERIPHERAL AND EXTRA MUSCULOSKELETAL MANIFESTATIONS HAVE AN IMPACT ON BIOLOGIC DMARD PRESCRIBING PATTERNS IN AXIAL SPONDYLOARTHRITIS: THE RESULTS OF TREASURE EXPERIENCE

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease mainly affecting sacroiliac joints and spine. Peripheral arthritis, dactylitis and enthesitis may also occur. Extra musculoskeletal manifestations (EMMs; uveitis [AAU], inflammatory bowel disease [IBD] and psoriasis [Pso] are among the most common ones) are important features and might have an impact on the disease burden in patients with axSpA. The presence of EMM, in particular IBD and AAU could influence the choice of TNFi however little is known regarding the role of peripheral manifestations together with the EMM on the prescribing patterns in axSpA patients.

Objectives:

To examine the frequency of peripheral and EMMs in a real-world axSpA cohort and their effect on the choice of first advanced treatment.

Methods:

In total 1687 axSpA patients (58% male and the mean age (±SD) was 38.5 ± 10.9) who initiated his/her first biologic were included in the present analysis. The data for the current study was obtained from the TReasure web-based registry; in which RA and SpA patients treated with bDMARDs from different regions of Turkey. Baseline demographic, disease related characteristics, peripheral and EMMs were extracted. Characteristics of patients with and without peripheral/extra-musculoskelatal involvement were compared as well as factors/covariates associated with the choice of first TNFi and secukinumab was analysed.

Results:

Enthesis (28.2%) was found the most common peripheral manifestations and peripheral arthritis (26.4%) and hip arthritis (24.4%) followed it. Symptom duration to the first advanced treatment initiation was significantly shorter in axSpA patients with peripheral arthritis, enthesitis, dactylitis and psoriasis and longer in hip arthritis and AAU. HLA-B27 positivity was significantly lower in patients with arthritis, psoriasis and IBD and higher with hip arthritis and AAU. In multivariate analysis the presence of IBD is significantly associated with the preference of monoclonal TNFi (mab) over etanercept (ETA) (OR 5,770; 95%CI 1.788-18.616). However ETA was preferred in patients with hip arthritis (p=0.003), longer symptom duration (p=0.049), and using sulfasalazine (p=0.043). In comparison with mabs, secukinumab (SEC) prescription was found to be significantly associated with higher age (p=0.001), sulfasalazin (p=0.001) and methotrexate usage (p=0.053) among axSpA patients need their first advanced treatment.

Conclusion:

The results of the current study confirm the pathophsyologic associations of peripheral involvement and EMM in axSpA patients. Apart from hip arthritis the presence of IBD has an impact on the prescription of advanced treatment in real-life.

Table 1.

Clinical characteristics of patients in cohort

All patients(n=1678)Peripheral arthritis(n=445)Dactilitis(n=81)Enthesis(n=476)Uveitis(n=193)Psoriazis(n=152)IBD(n=78)Hip involvemet(n=412)Age, mean±SD38,5±10,938,3±11,637,4±11,137,9±10,741,3±11,439,9±11,341,6±12,239,2±11,2Male sex,n (%)974 (57,7)184 (41,3)34 (42)238 (50)96 (49,7)54 (35,5)43 (55,1)272 (66)Symptom duration, mean month±SD108,5±98,996,9±92,979,1±76,5100,4±92,7144,7±110,287,7±9494,5±98133,3±108,2HLA B27 positivity, n (%)621 (53,7)142 (46,3)27 (51,9)174 (49,4)104 (77)34 (36,2)16 (27,1)186 (59,8)Concomitant cDMARD usage (yes), n (%)420 (24,9)170 (38,2)39 (48,1)133 (27,9)53 (27,5)58 (38,2)24 (30,8)99 (24)BASDAİ,mean±SD5,1±2,55,1±35,3±3,15,3±2,94,7±2,55,6±2,44,8±2,35,3±2,1ASDAS-CRP, mean±SD3,1±1,52,6±1,92,5±1,82,8±1,72,9±1,73,4±1,33,1±1,53,7±1,4

Disclosure of Interests:

None declared

POS0922 NON-STEROIDAL ANTI-INFLAMMATORY DRUG USE IS ASSOCIATED WITH DISEASE ACTIVITY AND REDUCED SIGNIFICANTLY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS TREATED WITH TUMOR NECROSIS FACTOR INHIBITORS; DATA FROM A REAL LIFE EXPERIENCE

Background:

Non-steroidal anti-inflammatory drugs (NSAIDs) is the first line treatment option in axial spondyloarthritis (axSpA) patients suffering from pain and stiffness. However there is only limited data regarding the concomitant use of NSAIDs during tumour necrosis factor inhibitor (TNFi) treatment.

Objectives:

To evaluate longitudinal concomitant NSAIDs use with the TNFi treatment and the determinant of the ASAS-NSAID index in patients with axSpA.

Methods:

In total 429 axSpA patients (253 [59%] male; 272 [63%] with AS and 157 [37%] with non-radiographic (nr)-axSpA) who have followed up one year were included in this observational study. The data regarding disease activity and serum CRP levels were collected on 12, 24 and 52nd week. At each visit NSAID usage, type, dosage and frequency were recorded in order to calculate ASAS-NSAID index. The longitudinal relationship between NSAID-index and other factors tested by using generalized estimating equations (GEE) which is a technique for longitudinal data analysis allowing the use of all available data even deviated from normality.

Results:

At baseline 127/138 (92%) patients starting TNFi and 239/291 (82%) conventionally treated patients were using NSAID. Both the rate (p=0.007) and the median (IQR) ASAS-NSAID index were higher in biologic treatment group (100 [50] vs 70.8 [89.4]; p<0.001). During follow-up ASAS-NSAID index was decreased significantly in patients treated with TNFi (median 100 to 8.0;p<0.001), however ASAS-NSAID index was not changed in conventionally treated patients (p=0.154) (Figure 1). In univariate longitudinal analysis revealed that ASAS-NSAID index was significantly associated with BASDAI, ASDAS, BASFI scores and patient global assessment of disease activity, serum levels of CRP and education. We established two multivariable models (Table 1) to assess the associated factors/covariates with ASAS-NSAID index over time (one with ASDAS and the other BASDAI+CRP as disease activity index) and showed that BASDAI and patient global assessment of disease activity were independent determinants of NSAID dosage in biologic treated patients. However, in multivariate analysis there was no significant predictor for NSAID index in conventional treatment group.

Conclusion:

Our results showed that NSAID prescription was significantly higher in axSpA patients who have TNFi indication. NSAID use was decreased significantly over time with TNFi and still independently determined by disease activity. However, it is stable in conventionally treated axSpA patients.

Table 1.

The factors associated with ASAS-NSAII index in biologic treated patients

Model 1Model 2B95%CIpB95% CIpBASFI-0.55-4.384; 4.2750.9800.943-3.795; 5.6820.696BASMI0.951-1.511; 3.4130.449-0.098-2.430; 2.2340.934PGA0.5350.210; 0.8600.0010.7590.432; 1.0860.000CRP-0.068-0.220; 0.0840.380BASDAI5.7182.487; 8.9490.001ASDAS-CRP1.771-6.571; 10.1130.677

PGA:Patient global assessment

Disclosure of Interests:

None declared

AB0456 HYDROXYCHLOROQUINE MIGHT REDUCE MORTALITY IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Systemic sclerosis (SSc) is a devastating disease that has a profound impact on life expectancy, reflected by a standardised mortality ratio of 3,5. There is still limited data regarding the predictive factors for mortality in patients with SSc. Determining those factors could guide in disease management and follow up.1

Objectives:

We aimed to identify the predictive factors for death in SSc.

Methods:

Patients followed in a tertiary rheumatology clinic in the last 5 years were included in this retrospective study. All of the patients met the ACR / EULAR SSc 2013 criteria. Medical records of the patients were reviewed. Follow up time was defined as the time period from the first admission of the patient to our rheumatology clinic until the date of death or the date on which the study was performed. Candidate predictive factors for mortality were tested by Kaplan-Meier (with Log rank) and Cox-regression analyses.

Results:

In total 146 patients (mean age 55.6±12.3 years, female 89.7%, diffuse cutaneous type SSc 45.2%) were included in the study (Table 1). The mean age at diagnosis of study group was 48±13.7 years. The median duration of follow up was 71 (6-228) months. Fourteen (10%) patients died during follow-up. The causes of death were: pulmonary (7), renal (2) and cardiac diseases (1), infection (3) and cancer (1).

Univariate analysis revealed that age at diagnosis (p=0.028), SSc subtype (p=0.035), the presence of interstitial lung disease (p=0.002), oesophageal involvement (on computed tomography) (p=0.030), pulmonary artery systolic pressure of ≥35 mmHg (measured by transthoracic echocardiography) (p=0.004), glucocorticoid (p=0.029), hydroxychloroquine (p=0.002) and cyclophosphamide (p=0.006) usage at any time were associated with mortality (Figure 1). Multivariate analyses model formed with age at diagnosis (B: 0.055, 95% CI, 1.005-1.112; p=0.033), SSc subtype (B: 0.963, 95% CI 0.541-12.684; p=0.231), glucocorticoid (B: 1.396, 95% CI, 0.487-33.507; p=0.196) and hydroxychloroquine usage (B: -1.50, 95% CI, 0.061-0.816; p=0.023) showed that age at diagnosis and hydroxychloroquine usage were independent predictive factors for mortality in patients with SSc.

Conclusion:

The results of the study revealed for the first time that apart from the age at diagnosis hydroxychloroquine might reduce mortality in patients with SSc. Further studies are needed to prove of this information.

References:

[1]Elhai M, et al. Ann Rheum Dis 2017;0:1–9. doi:10.1136/annrheumdis-2017-211448

Table 1.

The demographic and clinical features in patients with systemic sclerosis.

CharacteristicBaselineAge at diagnosis*48±13.7Female sex, n (%)131 (89.7)Duration of follow-up, months**71 (6-228)Disease subtype, n (%)Diffuse / Limited66 (45.2) / 80 (54.8)Autoantibodies, n (%)Anti-Scl70 antibody50/143 (35.0)Anti-Centromere antibody62/143 (43.4)Immunsuppresive medication, ever, n (%)Hydroxychloroquine91/143 (63.6)Mycophenolate mofetil18/145 (12.4)Azathioprine47/145 (32.4)Cyclophosphamide24/145 (16.6)Glucocorticoid80/140 (57.1)Others, n (%)ILD68/130 (52.3)Pericardial effusion, ever26/133 (19.5)Esophageal dilation (detected by CT)51/128 (39.8)sPAP ≥35mmHg, ever (measured by ECHO)46/142 (32.4)

*Parameter presented as mean±SD

**Parameter presented as median (min-max)

CT, computed tomography; ECHO, echocardiogram; ILD, interstitial lung disease; sPAP, systolic pulmonary artery pressure

Figure 1.

Disclosure of Interests:

None declared.

AB1155 WORK DISABILITY AND PREDICTORS OF POOR WORK OUTCOME IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease which may lead substantial functional limitation. The disease more commonly affects men in their third decade of life. For patients with chronic disease participation in paid work may be the result of series factors like disease severity, effectiveness of the health care, availability and the type of work. Previously it was reported that ankylosing spondylitis may cause adverse work outcome.

Objectives:

To understand the impact of axSpA on work disability and the factors associated with poor work outcome.

Methods:

A cross-sectional survey was performed among323 patients withaxSpA according to ASAS classification criteriafrom one tertiary center. In total 219 (67.8%) patients were working age at the time study. The others were student, housewife or retired. Demographic, social and disease related characteristics were collected. Characteristic that might be associated with premature work loss were evaluated byunivariable and multivariable logistic regression analysis.

Results:

Out of 219 axSpA patients (155 [71%] r-axSpA and 64 nr-axSpA, 69% HLA-B27 positive) who have a work at least once 47 (22%) was either withdrawn from work (n=35) or retired due to disability (n=12) during median (IQR) 12 (12) years symptom duration. Demographic and disease related characteristics of the patients with or without work diasbilitywere summarized in the table. In univariate analysis gender, smoking, education levels, the presence of peripheral arthritis, BASMI score and radiographically presence of syndesmophyte and hip involvement were found to be associated with poor work outcome. However poor work outcome were similar between r- and nr-axSpA patients. In regression analysis low education level (HR:3.4 [95%CI:1.4-8.6], P=0.007), peripheral arthritis (HR:2.7[95%CI:1.07-6.8], P=0.035), and ever smoking (HR:4.9 [95%CI:1.3-18.0], P=0.02) were independent predictors of work disability.

Conclusion:

Our results suggest that there is still remarkable poor work outcome among axSpA patients and work disability might be similar in r- and nr-axSpA. Patients who are smoker, with low education levels, and peripheral arthritis seem to be at risk for premature work loss.

Table.

Demographics and diseases related characteristics of study population

VariablesAll population(n=219)No work disability(n=172)Work disability(n= 47)Male, n (%)161 (73.5)122 (70.9)39 (83)Age, years*41.5 (9.4)43.1 (12.4)Ever smoking, n (%)155 (71.4)115/171 (67.3)40/46 (87)Education duration ≤8 years, n (%)82/212 (61.3)53/165 (32.1)29/47 (61.7)Disease duration, years6.7 (8.3)5.5 (6.3)10.7 (12.6)BASDAI*4.3 (2.4)4 (2.3)5.3 (2.6)BASFI*3.4 (2.8)2.9 (2.5)5.4 (3.0)ASDAS-CRP*2.8 (1.2)2.7 (1.1)3.3 (1.4)BASMI*2.3(2.0)2 (1.8)3.5 (2.4)ASQOL*9 (5.5)8 (5.3)12 (4.9)Peripheral arthritis, n (%)81/207 (39.1)54/163 (33.1)27/44 (61.4)Hip arthritis, n (%)39/205 (19)26/163 (16)13/42 (31)Presence of syndesmophyte, n (%)92/164 (56.1)63/125 (50.4)29/39 (74.4)

* Variables presented as mean (SD).

Disclosure of Interests:

None declared

THU0607-HPR COMPARISON OF THE PATIENT REPORTED PHYSICAL ACTIVITY LEVEL ACCORDING TO KINESIOPHOBIA PRESENCE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:

Many factors such as poor functional or emotional status might play a role in participating physical activity for people with rheumatic diseases. There is a lack for evidence regarding to the effect of kinesiophobia presence on the physical activity levels of axSpA patients.

Objectives:

The primary objective was to compare the patient reported physical activity levels in axSpA patients with kinesiophobia and those without. Evaluating disease related and physical characteristics, quality of life and emotional status according to presence of kinesiophobia were also aimed.

Methods:

One-hundred forty-eight consecutive axSpA patient were allocated to Kinesiophobia+ group (n: 90, 66% males) or Kinesiophobia- group (n: 58, 64% males). The presence of kinesiophobia was defined as having a score of >37 in Tampa Scale for Kinesiophobia. All patients were evaluated regarding to physical characteristics (age, body-mass index), functional status (Bath Ankylosing Spondylitis Functional Index), disease activity (Bath Ankylosing Spondylitis Disease Activity Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index), patient reported physical activity (International Physical Activity Questionnaire Short Form), emotional status (Hospital Anxiety and Depression Scale), and quality of life (Assessment of SpondyloArthritis International Society Health Index).

Results:

Physical characteristics and spinal mobility were similar in patients with and without kinesiophobia (p>0.05, Table). Disease activity, function, quality of life, depression and anxiety scores were poorer in Kinesiophobia+ group compared to Kinesiophobia- group (p<0.05, Table). Patient reported physical activity level was found to be lower in patients with kinesiophobia (p<0.05, Table).

Table.

Comparison of groups according to kinesiophobia presence

Kinesiophobia+ Group(n: 90)Median (IQR 25/75)Kinesiophobia- Group(n: 58)Median (IQR 25/75)p*Physical CharacteristicsAge (years)41.0 (37.0/52.0)44.0 (36.0/53.0)0.850Body-Mass Index (kg/m2)26.8 (24.6/30.1)26.0 (22.7/29.0)0.364Disease Related CharacteristicsBASDAI (score)2.7 (1.3/4.6)1.8 (0.6/3.5)0.036BASMI (score)3.3 (1.9/5.0)2.7 (1.6/3.5)0.114BASFI (score)2.5 (1.2/4.4)1.2 (0.5/2.7)0.003Patient Reported Physical Activity LevelIPAQ (MET/week)505.5 (169.0/1653.0)858.0 (330.0/2772.0)0.042Quality of LifeASAS-HI (score)7.0 (5.0/9.1)4.0 (2.0/7.9)0.001Emotional StatusHAD Anxiety (score)7.0 (4.0/9.0)5.0 (3.0/8.0)0.006HAD Depression (score)7.0 (4.0/10.0)3.0 (1.0/7.0)0.001Fear of MovementTAMPA (score)41.0 (39.0/44.0)34.0 (31.0/36.0)p<0.001

*Mann-Whitney U Test, IQR 25/75: Interquartile range 25/75, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, BASFI: Bath Ankylosing Spondylitis Functional Index, IPAQ: International Physical Activity Questionnaire Short Form, HAD: Hospital Anxiety and Depression Scale, ASAS-HI: Assessment of SpondyloArthritis International Society Health Index, TAMPA: The Tampa Scale for Kinesiophobia, p<0.05.

Conclusion:

It seems that the presence of kinesiophobia may have a negative impact on patient reported physical activity level, and disease related parameters. However, it is also possible that kinesiophobia might occur as result of poor disease activity or disability. Strategies such as patient education should be included in axSpA management for preventing kinesiophobia development or improving kinesiophobia related consequences.

Disclosure of Interests:

None declared

SAT0543 PREVALENCE OF FABRY’S DISEASE IN MILD AND SEVERE FMF PATIENTS

Background:

Fabry disease (FD) is a rare metabolic disorder caused by the mutations in the α-galactosidase A (GLA) gene. FD patients present with heterogeneous clinical manifestations, which may overlap with systemic diseases including familial Mediterranean fever (FMF). Recurrent episodes of fever, abdominal pain, and arthralgias can be observed in both disorders and this may lead to misdiagnosis.

Objectives:

To investigate FD prevalence in mild and severe FMF patients.

Methods:

A total of 66 FMF patients, according to the Tel-Hashomer criteria, were included in the study. Patients were grouped into mild (Group 1) and severe (Group 2) subsets according to the severity score. α-GLA enzyme activity and mutations in the GLA gene were performed. Demographic features, clinical findings, MEFV mutations and treatments were recorded.

Results:

The clinical and demographical characteristics of the patients were given in Table 1. In severe form, 27 patients were using biological drug and 40.7% had amyloidosis. Symptoms related to FD including hypohidrosis, acroparesthesias, and painful neuropathies, were not different between the groups. Only one patient in group 1 had a low GLA enzyme activity (0.1 nmol/h/ml;Normal >2.5) which also had mutations in the GLA gene but MEFV mutation test was negative. (Table 2). This patient was a 39-year-old female with recurrent abdominal pain, distal extremity pain and the presence of fever during the attacks. She was heterozygous for R301Q. In detailed history, she reported mild acroparesthesias, hypohidrosis, and tinnitus.

Table 1.

Demographic and clinical findings

All patientsn: 66Group 1n: 32Group 2n: 34p-valueAge, median (min./max.)34 (17/64)27 (17/59)36 (18/64)0.192Male, n (%)36 (54.5)14 (43.8)22 (64.7)0.137Disease duration, median (min./max.)20.5 (1/57)12.5 (2/50)25 (1/57)0.006Family history of FMF, n (%)41 (62.1)22 (68.8)19 (57.6)0.443Alpha-galactosidase A (nmol/h/ml), median (min./max.)5.9 (0.1/16)5.6 (0.1/9.6)6 (3.1/16)0.330Abdominal pain, n (%)58 (87.9)31 (96.9)27 (79.4)0.030Fever, n (%)54 (81.8)25 (78.1)29 (85.3)0.532Arthritis, n (%)34 (51.5)10 (31.3)24 (70.6)0.003Pleuritis, n (%)31 (47)19 (59.4)12 (35.3)0.083Painful neuropathy, n (%)23 (34.8)13 (40.6)10 (29.4)0.440Acroparesthesias, n (%)9 (13.6)6 (18.8)3 (8.8)0.240Angiokeratomas, n (%)0 (0)0 (0)0 (0)-Cardiac abnormalities1 (1.5)1 (3,1)0 (0)0.485Tinnitus, n (%)4 (6.1)3 (9.4)1 (2.9)0.274Hearing loss, n (%)2 (3)2 (6.2)00.086Hypohydrozis, n (%)2 (3)1 (3.1)1 (2.9)0.965Cornea verticillata, n (%)0 (0)0 (0)0 (0)-Proteinüria, n (%)13 (19.7)2 (6.3)11 (32.4)0.012Colchine dosing (mg/day), median (min./max.)2 (1/3)1 (1/2)2 (1/3)<0.001Table 2.

MEFV mutant alleles and GLA mutations

All patientsn: 66Group 1n: 32Group 2n: 34Alpha -galactosidase A (GLA) gene mutations, n (%)1 (1.5)1 (3.1)0 (0)M694V mutations, n (%)47 (35.6)17 (26.5)30 (44.1)Non-M694V mutations, n(%)36(27.2)20 (31.2)16 (23.5)

Conclusion:

In this study, we showed the following: 1) the FD rate in the total FMF group was 1.5% (3.1% in group 1), 2) none of the patients in the severe FMF subset had abnormal enzyme activity or mutations related with FD, 3) symptoms related with FD such as hearing loss, hypohidrosis, acroparesthesias, and painful neuropathies also noted in FMF patients particularly in the milder group. Based on our results, FD should be considered in the differential diagnosis of FMF particularly in patients with atypical symptoms.

Disclosure of Interests:

None declared

AB1287-HPR INVESTIGATION OF THE RELATIONSHIP BETWEEN GRIP ENDURANCE, DISABILITY OF UPPER EXTREMITY AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Upper extremity functions affect the quality of life at different levels in patients with rheumatoid arthritis (RA). In the current literature; it has been shown that grip endurance is associated with upper limb functions (1). However, there is no study investigating the relationship between grip endurance and quality of life in patients with RA.

Objectives:

To investigate relationship between grip endurance, disability of upper extremity and quality of life in patients with RA.

Methods:

In our cross sectional study, 23 RA patients [Mean age; 52.7±12.6, BMI;26.9±5.7 kg/m2, Women;20(87.0%)] who were classified according to the ACR 2010 criteria. Demographics and clinical characteristics of patients were recorded (Table 1). Das28 for disease activity score, Static and dynamic grip endurance measurements using Hand Dynamometer (Lafayette Proffessional Hand Dynamometer, USA) for grip endurance, Disability of Arm, Shoulder and Hand Survey (DASH) for disabilities and symptoms of upper extremity and Short Form-36 Health Survey for quality of life were performed. Spearman’s Rank Correlation Coefficient was used for data analysis.

Table 1.

Demografic and Clinical Characteristics of Patients

Variables (n=23)Median(IQR 25/75)Age (year)56(41/62)BMI (kg/m2)27,5(21.4/32.0)Disease Duration(year)8(5/15)Morning Stiffness (VAS/mm)38(23/48)Perceived Disability of Hand (VAS,mm)47(25/67)Clinician Disability of Hand (VAS,mm)30(20/39)Number Of Tender Hand Joint2(0/6)Number Of Swollen Hand Joint0(0/1)CRP(mg l)3,3(1.8/7.1)ESR(nm/h)13(6/21)n(%)Morning Stiffness Duratton0-15 minutes8 (34.8)15-30 minutes5 (21.7)30-60 minutes3 (13.0)Longer than 1 hours7 (30.4)Das28Remission11(47.8)Low Activity2(8.7)Moderate Activity7(30.4)High Activity3(13.0)

Data is presented median (interquantile range) or percentile (%).

Results:

Grip endurance was negatively correlated with DASH and positively correlated with many different quality of life parameters, especially physical function, on both the dominant and non-dominant sides (p <0.05). DASH was correlated negatively with SF-36 physical function, rol limitataion due to physical health, pain subparameters and positively correlated with Das28 score (p<0.05).

Conclusion:

In our study, it was concluded that grip endurance was related to upper extremity functions and quality of life in patients with RA. This result shows that; assessment of grip endurance can be a guide for clinicians who have designed an upper limb rehabilitation program for patients with RA.

References:

1. VERMA, Chhaya, et al. Correlation of functional ability of the hand with upper limb function and quality of life in patients with rheumatoid arthritis.J Assoc Physicians India, 2017, 65: 20-4.

Disclosure of Interests:

None declared

AB0544 EVALUATION OF MACULAR AND OPTIC DISC MICROVASCULAR NETWORK IN PATIENTS WITH SYSTEMIC SCLEROSIS: AN OPTICAL COHORENCE TOMOGRAPHY ANGIOGRAPHY STUDY

Background:

Systemic sclerosis (SSc) is characterized by fibrosis of the skin, internal organs and vasculopathy. Invivo, the retina provides a unique opportunity to assess the microcirculation in the eye. Previous studies have been evaluated the changes in the retinal and choroid layer and showed thinning of the choroid layer and reduced retinal microvascular density.

Objectives:

To analysis the retinal and optic disc capillary network in patients with SSc without clinical signs of retinal involvement by using optical coherence tomography angiography (OCTA).

Methods:

In total 40 SSc patients who classified according to the ACR/EULAR criteria and 40 healthy control subjects were included in the analysis. All patients underwent a detailed ophthalmologic examination by the same ophthalmologist. After pupil dilatation, macular angiography was performed with 6x6 mm area scanning using standardized system and images of the retinal capillary plexus were analyzed by Cirrus OCTA software. Mean macular thickness, retinal nerve fiber layer (RNFL) and the Ganglion cell inner plexiform layer (GC-IPL), vessel density (VD), perfusion density (PD), optic disc PD, reflux index and foveal avascular zone (FAZ) parameters were measured by the same experienced operator.

Results:

There was no significant difference between SSc and controls in terms of age, sex, spherical equivalent (SE), intra ocular pressure (IOP), and axial length (AL). Central and mean macular thickness, nasal and inferior RNFL thicknesses were significantly thinner in SSc patients (Table). Additionally GC complex thicknesses were significantly thinner in all quadrants compared to controls.

Central vessel density (CVD) and central perfusion density (CPD) values were found significantly decreased in all regions in patients with SSc. Optic disc perfusion density values were also decreased in SSc group. An inverse correlation was found between central macular thickness, FAZ area and perimeter values (rho:-0.300, p:0.007; rho:-0.276, p:0.013, respectively).There was no relationship between the disease duration and the OCTA measures.

Conclusion:

Vascular and perfusion density were found decreased in patient with SSC at the results of OCTA measures. These findings may help to understand vasculopathy in the pathogenesis of the disease and OCTA may be a new method providing objective and non-invasive information about capillary network in SSc.

Table

Demographic and ocular parameters of study population

ParametersSSc(n = 40)Control(n = 40)pAge, years; mean (SD)47.2 (8.6)47.5 (8.1)0.631Male sex, n (%)24(60)16 (40)0.087Disease duration, months; mean (SD)81.3 (38.0)N/A-Foveal MT(µ)246.3 ± 19.4252.6 ± 15,30.033Average MT(µ)280.8 ± 12,4286.5± 8.70.008Vessel density (mm-1), 6 mm total area; mean (SD)17.60 ± 1.3118.66 ± 0.640.006Perfusion density, 6 mm total area; mean (SD)43.25 ± 3.3245.94 ± 1.520.002Circularity index; mean (SD)0.72 ±0.090.73 ± 0.060.049RNFL nasal (µ); mean (SD)74.37±12.3674.05±8.480.011RNFL inferior (µ); mean (SD)122.62±17.87127.40±12.630.023Inferior nasal GCC(µ); mean (SD)85.72 ± 8.5385.82 ± 4.840.001Inferior temporal GCC(µ); mean (SD)82.70 ± 8.6284.95 ± 4.150.001Superior nasal GCC(µ); mean (SD)86.35 ± 7.7386.8 ± 5.700.012Superior temporal GCC(µ); mean (SD)47.2 (8.6)47.5 (8.1)0.631

MT: Maculer thickness; RNFL: Retinal nerve fiber layer; GCC: Ganglion cell complex

Disclosure of Interests:

None declared

AB0657 IMPROVEMENT IN DISEASE ACTIVITY IS ASSOCIATED WITH ENHANCEMENT IN THE QUALITY OF LIFE DURING TUMOUR NECROSIS ALPHA INHIBITOR TREATMENT; A PROSPECTIVE COHORT EXPERIENCE IN AXIAL SpA

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition affecting mainly axial skeleton. The disease usually starts in early adulthood and cause considerable impact on physical function, work ability and quality of life (QoL). With the introduction of tumour necrosis factor inhibitors (TNFi) significant improvement in articular and extra-articular manifestations of disease was shown in randomized controlled trials and several registries. However, there is limited data about the effects of TNFi therapy on QoL and the relationship between inflammation and QoL in cohort studies before.

Objectives:

To evaluate the influence of TNFi agents on different aspects of QoL which might be a significant determinant of patient burden in axSpA patients in parallel with disease activity.

Methods:

In total 83 TNFi naïve axSpA patients (62.7% male; mean age 40.6 ± 12 years) according to the ASAS criteria were included in this prospective observational cohort study between 2014-2018. Demographic and disease related characteristics were collected at baseline. Disease activity (BASDAI, ASDAS-CRP), function (BASFI) and QoL (SF-36 and ASQoL) were evaluated at baseline and 24thand 52ndweeks of follow-up. The changes in disease activity, function and QoL were assessed with Wilcoxon test and relationship between changes in QoL and activity on week 24 was evaluated by Spearman’s correlation analysis.

Results:

Baseline disease related characteristics, disease activity and QoL scores were presented in table 1. Both disease activity and QoL were significantly improved at 24thand 52thweeks (Figure 1). The change of SF-36 subscales and summary scores at weeks 24 were correlated with the change in disease activity and function (Table 2). The SF-36 scale and summary scores were found to be similar at 24 and 52 weeks of TNFi treatment (Figure 2).

Conclusion:

The results of the present study suggest that TNFi treatment have a substantial influence on QoL in parallel to the control of disease activity at 24thweeks of treatment and this effect was sustained at 52 weeks not only randomized controlled trials but also real life experience.

Table 1.

Demographic and clinical features in patients with axial spondyloarthritis at baseline

ParametersDuration of disease, years*9 (10)Ever smoking, n(%)36 (43.4)Body mass index, kg/m2 *26 (4.9)HLA-B27 positivity, n(%)39/57 (68)Peripheral arthritis, n(%)39 (47)BASFI*5.1 (2.3)BASDAI*5.8 (1.7)ASQOL*12 (8)ASDAS-CRP*3.6 (1.1)PCS*32.5 (7.9)MCS*37.3 (10.9)

*All parameters presented as mean (SD)

Table 2.

Correlation with changing of disease activity scores and quality of life parameters at 24 weeks

ΔBASDAIΔBASFIΔASDAS-CRPΔASQOLprprPrprΔPCS<0.001-.60<0.001-.43<0.001-.45.002-.39ΔMCS.001-.42.012-.31.019-.29<0.001-.50ΔPF<0.001-.48<0.001-.52.008-.31.021-.28ΔRP<0.001-.48.028-.25.001-.38.002-.35ΔBP<0.001-.60.004-.33<0.001-.45<0.001-.46ΔGH<0.001-.58.026-.27<0.001-.45<0.001-.54ΔVT<0.001-.48.001-.39.004-.33.003-.34ΔSF.001-.38.064-.21.098-.19.008-.31ΔRE.003-.34.013-.28.012-.29.004-.34ΔMH.003-.34.016-.28.044-.23<0.001-.43

BASDAI Bath Ankylosing Spondylitis Activity Index; BASFI Bath Ankylosing Spondylitis Functional Index; ASDAS-CRP Ankylosing Spondylitis Disease Activity Score with CRP; ASQOL Ankylosing Spondylitis Quality of Life Questionnaire; PCS Physical Component Summary Sscore; MCS Mental Component Summary Score.; PF Physical Functioning; RP Role Physical; BP Bodily Pain; GH General Health; VT vitality; SF Social Functioning; RE Role Emotional; MH Mental Health

Δ Changing according to basal values at week 24

Figure 1.

Improvement in disease activity and quality of life during the follow-up time

Figure 2.

Mean change in Short Form 36 scores for patients with axial spondyloarthritis following anti-TNF therapy

Disclosure of Interests:

None declared

AB1141 EVALUATION OF INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SPONDYLOARTHRITIS, AND THE AWARENESS OF RHEUMATOLOGISTS ABOUT VACCINATION

Background:

Patients with inflammatory arthritis have increased risk of infections which may lead to morbidity and mortality. Some of those infections could be prevented by vaccination.

Objectives:

The main objectives of the present study were to investigate (a) the uptake rate of influenza and pneumococcal vaccination among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) attending a rheumatology outpatient clinic, (b) the factors associated with their vaccination rate and, (c) the attitudes of Turkish rheumatologists about vaccination.

Methods:

Patients, followed-up in a tertiary rheumatology outpatient clinic with the diagnosis of RA and SpA, volunteered for participating to study, were included in this cross-sectional study. Data regarding the socio-demographic and disease-related characteristics (including disease duration, medications used, and comorbid conditions) of the patients, vaccination history, the knowledge about the vaccination, and the factors potentially associated with the uptake of vaccination were collected by face-to-face interview using a standardized questionnaire. 102 out of 345 rheumatologists have participated in a web-based survey.

Results:

In total, we collected data from 387 patients (260 with SpA and 114 with RA; 204 [52.8%] female and mean age 46.6 ± 12.7 years). Only 123 (32.3%) of our patients were responded that their disease or treatment might be related to the increased risk for infectious diseases. Influenza and pneumococcal vaccines were administered to 71 (21.4%) and 21 (6.1%) patients, respectively. Vaccination for influenza was recommended by family physicians in 26 patients and by rheumatologists in 12 patients. Rate of influenza vaccination was significantly higher in patients >65 years (p=0.021) and with any co-morbid conditions (p=0.002). The main reasons reported by patients regarding not to be vaccination were (a) the belief that they did not need the vaccine (49.4% for influenza and 26.2% for pneumococcal vaccine), (b) the absence of recommendation from their physicians (24.1% for influenza and 26.2% for pneumococcal vaccine), (c) fear of adverse event of vaccination (28.8% for influenza and 3.2% for pneumococcal vaccine), and (d) lack of knowledge about vaccination (6.1% for influenza and 12.5% for pneumococcal vaccine). Even though 50% of rheumatologists who responded to the survey were aware of the presence of national vaccination recommendations, all of them stated that patients with inflammatory arthritis need to be vaccinated for both influenza and pneumococcal infections. Influenza and pneumococcal vaccines were administered to 23 (22.5%) and 4 (3.9%) rheumatologists, respectively.

Conclusion:

Although the knowledge and awareness about influenza and pneumococcal vaccinations were seemed to be high among rheumatologists, vaccination rates for both were insufficient in RA and SpA patients. There remains significant effort to improve vaccination rates and to prevent morbidity and mortality due to vaccine-preventable infections in inflammatory rheumatic diseases.

References:

[1]Van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22.

[2]MTT Nguyen, H Lindegaard, O Hendricks & N Friis-Møller. Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA), Scandinavian Journal of Rheumatology 2017;1–8.

Disclosure of Interests:

None declared

SAT0394 CAN FECAL CALPROTECTIN PREDICT FUTURE DEVELOPMENT OF INFLAMMATORY BOWEL DISEASE IN AXIAL SPONDYLOARTHRITIS PATIENTS? – TREASURE REAL-LIFE DATA

Background:

Patients with active inflammatory bowel diseases (IBD) fecal calprotectin (FC) levels are high and FC can be used for diagnosis [1].

Objectives:

This study aimed to investigate whether fecal calprotectin levels could predict future development of IBD in axSpA patients.

Methods:

This study was practiced in three centers using TReasure database and that are able to measure FC. Fecal calprotectin levels were measured in 137 axSpA patients as of September 2018 and FC level ≥200 µg/g was considered significant. All study subjects were evaluated for IBD symptoms (loose defecation, mucous diarrhea, bloody defecation, bloody diarrhea, abdominal pain, obstruction, or pseudo-obstruction) at beginning of the study and every 3 months for the first year. 25 RA patients and 24 healthy volunteers were included as a control group. Disease activity was evaluated by the ASDAS CRP, BASDAI,BASFI, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS)-pain, VAS-fatigue, and tender and swollen joint count for axSpA patients.

Results:

This study included 137 axSpA patients and all patients followed for 1 year. Of the 137 axSpA patients 33.6% were females and median (Q1-Q3) age was of 43 years (33-50 years), median (Q1-Q3) disease duration was 8.9 years (5.0-13.9 years). The median (Q1-Q3) fecal calprotectin level was 48 µg/g (30-122 µg/g) and FC level was ≥200 µg/g in 23/137 (16.8%) in axSpA patients. FC level was elevated in 15/24 (62.5%) RA patients and none of the healthy volunteers. Patients median (Q1-Q3) BASDAI was 2.2 (1.0-3.6) / 1.4 (0.4-2.2), median (Q1-Q3) BASFI 1.55 (0.4-3.4) / 1.5 (0.3-3.0) and median (Q1-Q3) ASDAS CRP 1.63 (1.3-2.2) / 1.5 (1.3-1.9) at baseline and first year respectively and there was no difference regarding fecal calprotectin level. In 1 year follow-up 9 (6.5%) patient had abdominal pain, 2 (1.4%) had bloody defecation, 1 (0.7%) had loose defecation and Crohn disease developed in an axSpA patient with high FC (266 µg/g) (Table 1). IBD occurrence rate was 0.73/100 patient-year for all SpA patients, and IBD occurrence rate was 4.34/100 patients year for SpA patients with ≥200 µg/g FC level.

Table 1.

IBD symptom inquiry and development of IBD in the first year

n (%)Loose defecation1 (0.73)Mucous diarrhea0Bloody defecation2 (1.45)Bloody diarrhea0Abdominal pain9 (6.56)Obstruction0Pseudo-obstruction0Inflammatory bowel disease1 (0.73)

Conclusion:

In one year follow-up, IBD occurrence rate was 0.73/100 patient-year, at a similar rate with DESIR cohort [2]. However, FC level may be a predictor for the development of IBD in SpA patients (occurrence rate 4.34/100 patients year). Further follow up duration and more patients may be needed to make conclusion in these field.

References:

[1]Simioni, J., et al.,Fecal Calprotectin, Gut Inflammation and Spondyloarthritis.Arch Med Res, 2019.50(1): p. 41-46.

[2]Wendling, D., et al.,Effect of Gut Involvement in Patients with High Probability of Early Spondyloarthritis: Data from the DESIR Cohort.J Rheumatol, 2019.

Disclosure of Interests:

Gözde Kübra Yardimci: None declared, Ozan Cemal İçaçan: None declared, Gokhan Kabadayi: None declared, Bayram Farisoğullari: None declared, Berkan Armagan: None declared, Cemal Bes: None declared, Servet Akar: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

High expression of mesothelin in advanced serous ovarian cancer is associated with poor prognosis

PURPOSE

Mesothelin is a cell surface glycoprotein which is highly expressed in various types of epithelial cancers. Its expression level is associated with poor prognosis in many cancer types. The aim this study was to evaluate the association of the level of mesothelin expression with clinicopathological characteristics and its prognostic significance in patients with advanced serous ovarian cancer (SOC).

METHODS

Tissue blocks from a total 42 patients with advanced SOC treated at the medical oncology clinic of Izmir Katip Celebi University Ataturk Training and Research Hospital between 2006 and 2013 were evaluated. Immunohistochemical staining for mesothelin was performed. Clinical characteristics, optimal or suboptimal operation, response to platinum-based chemotherapy, and overall survival (OS) were analyzed.

RESULTS

The cut-off value of 45 for mesothelin H-score determined by ROC analysis predicted survival with 86% sensitivity and 75% specificity (p=0.020). We found a notable negative correlation between mesothelin H-score and OS (r = -0.570, p=0.0001). The median OS was 67 months (95%CI, 36.114 to 97.886) in the low-staining mesothelin H-score group and 27 months (95%CI, 22.238 to 31.762) in the high-staining mesothelin H-score group (p=0.002). Univariate analysis showed that the clinical stage IV disease (p=0.023), platinum chemoresistance (p=0.001), higher mesothelin H-score (p=0.002), and suboptimal surgery (p=0.024) were associated with worse OS. In the multivariate Cox regression model, mesothelin H-score (B=1.15, 95%CI=1.016 to 9.850, p=0.047) and the status of platinum sensitivity (B=-.916, 95%CI=.185 to -.864, p=0.020 were statistically significant predictors for OS.

CONCLUSION

These results indicated that high mesothelin H-scores were significantly associated with poor prognosis in patients with advanced SOC.