POS1334 OCULAR CICATRICIAL PEMPHIGOID: IS THERE AN ASSOCIATION WITH AUTOIMMUNE DISEASES?

Background

Ocular Cicatricial Pemphigoid (OCP) is an infrequent, systemic cicatricial immune-mediated disease, belonging to the group of membranous-mucosal pemphigoids (MMP). Due to the possibility of coexistence of multiple autoimmune diseases (ADs), OCP could be associated with other diseases. In the literature, association of OCP and ADs is reported in 9-35% of patients, but most reports correspond to MMP.

Objectives

To assess the prevalence of autoimmune diseases associated with OCP and to analyse clinical, laboratorial and treatment associations between these entities.

Methods

A multicentre cross-sectional study of patients with a diagnosis (clinical and/or by biopsy) of OCP derived from ophthalmology was performed.

The population was divided into two groups according to their association or not with other ADs. Clinical, laboratorial and treatment variables were described and compared between both groups. In addition, a multivariate descriptive logistic regression analysis was performed to identify variables that could suggest the association between OCP and ADs.

Results

A total of 88 patients were recruited, 66 (75%) females, with a mean age at diagnosis of 64.3 years (SD 11.9). The median follow-up time was 1 year. The diagnosis was done by biopsy in 86,8%. Ocular bilateral disease was present in 95,3% of patients. There was a median delay from symptoms onset to diagnosis of 2 years. A history of malignancy was reported in 13,6%. Extraocular involvement was evidenced in 11,5% (4% compromised skin and 9,1% other mucous membranes). Regarding the previous clinical findings, no statistically significance was found between the groups with and without ADs. Systemic treatment was depicted as follows: oral corticosteroids (60,2%) (p-value < 0.001), corticosteroids pulses (5,7%), dapsone (3,4%), methotrexate (79,5%), mycophenolate (15,9%), azathioprine (23,9%), rituximab (5,7%), immunoglobulin (1,1%); topical corticosteroids (96,6%) and ocular infiltration (2,3%). The group associated ADs included 24 patients (27.3%). Within them, the most prevalent diagnosis was Sjogren’s syndrome (13.6%), followed by Hashimoto´s thyroiditis (9,1%) and rheumatoid arthritis (3,4%). Most of the patients presented Foster stages 1 (45.3%) and 2 (29.3%) at diagnosis. In the ADs group, statistically significant associations were observed with ANA, SS-A and SS-B antibodies, rheumatoid factor, and hypergammaglobulinemia. In the descriptive multivariate logistic regression model, it was detected that hypergammaglobulinemia was associated with ADs and OCP, adjusted for age, sex, smoking, skin and mucosal involvement, and erythrocyte sedimentation rate (OR 8.7; 95% CI 1.6 to 46.8; p= 0.012), Table 1.

Table 1.

Multiple logistic regression analysis with OCP associated with ADs as dependent variable.

ORCI95P valueGender0.20.04 - 1.10.07Age at diagnosis1.020.9 - 1.10.25Smoking0.50.1 - 1.70.26Skin and mucosa compromise1.20.2 - 8.20.83ESR0.980.95 - 1.020.58Hypergammaglobulinemia8.71.6 - 46.80.012

ESR: Erythrocyte Sedimentation Rate. OR: Odd Ratio. CI95: confidence interval

Conclusion

Due to the autoimmune nature of OCP, it could coexist with other ADs. In this research, it was observed that more than a quarter of the population presented with such association and hypergammaglobulinemia could suggest it. A systematic search for this coexistence should be carried out to avoid sequelae or incomplete treatment in pathologies that are currently potentially treatable.

References

[1]Lamberts A et al. European guidelines on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part I. 2021;1750–64.

[2]Schmidt E et al. European Guidelines on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part II. 2021;1926–48.

[3]Narla S, Silverberg JI. Associations of pemphigus or pemphigoid with autoimmune disorders in US adult inpatients. J Am Acad Dermato. 2019;15-25.

Acknowledgements

On behalf of the Study Working Group of Rheumatological Ocular Diseases, Argentinian Society of Rheumatology.

Disclosure of Interests

None declared

POS0025 PREVALENCE OF ATTENTION DEFICIT HYPERACTIVITY DISORDER AMONG ADULT PATIENTS WITH FIBROMYALGIA

Background

Fibromyalgia (FM) and attention deficit hyperactivity disorder (ADHD) share some clinical features, and a reduced dopamine function has been proposed for both disorders. ADHD is a chronic condition, marked by persistent inattention, impaired concentration, hyperactivity, impulsivity, emotional lability, anxiety and disorganized behaviour. High rates of comorbidity between ADHD and FM have been reported, as well as some evidence that patients with both conditions experience heightened disease severity.

Objectives

Our purpose was to determine the prevalence of ADHD symptoms in patients with FM and to assess the relationship with disease impact.

Methods

Consecutive patients, older than 18 years, with diagnosis of FM (ACR 2016 criteria) without known cognitive impairment, seen at the Rheumatology Unit between April 2018 and December 2019, were included. At inclusion visit the collected data included Revised Fibromyalgia Impact Questionnaire (FIQ-R) and Health Assessment Questionnaire, Argentine version (HAQ-A). During the Neurology visit, the following tests were performed: Montreal Cognitive Assessment (MoCA) test for evaluating the presence of cognitive impairment, Conners Continuous Performance Test II (CPT II) for the assessment of ADHD, and Wender-Utah Rating Scale (WURS) to retrospectively assess childhood ADHD symptoms. Univariate analysis was performed using t-tests for normally distributed continuous variables, and Wilcoxon rank sum test for non-normally distributed continuous variables. A chi-square or Fisher test was used when appropriate for categorical variables. Predictors that were found to be related to ADHD (p ≤ 0.20) were then entered into a multivariable logistic regression model.

Results

60 patients with FM and 71 matched controls without FM or known cognitive impairment were included. FM patients’ characteristics are shown in Table 1. 61.7% (n=37) of the patients with FM tested positive for adult ADHD. In 48.6% (18/37) of them, the diagnosis had been missed in childhood. Participants with both FM and a positive adult ADHD screening test did not score significantly higher on the FIQ-R (52.3, SD= 16.1 vs. 47.9, SD= 12.3; p= 0.2693) and HAQ-A (0.693, SD= 0.455 vs. 0.521, SD= 0.428; p=0.1523) compared with patients without ADHD. Retrospectively assessed childhood ADHD was significantly associated with adult persistence (OR 55.1, CI=3.6 to 842.6, p=0.004).

Table 1.

Clinical and demographic characteristics of patients with FM.

Characteristicsn=60Female, n (%)53 (88.3)Age (years), mean (SD)58.3 (14.2)Time from diagnosis (years), mean (SD)5.2 (5)Scholarity (years), mean (SD)12.9 (3.4)HAQ-A, mean (SD)0.627 (0.449)FIQ-R, mean (SD)50.6 (14.8)Cognitive complaint, n (%)34 (56.7)Depression, n (%)35 (58.3)Anxiety, n (%)27 (45)Concomitant personality disorders39 (65)

Patients with FM had significantly higher prevalence of cognitive impairment (43.3% vs. 16.9%; p<0.0001), childhood ADHD symptoms (31.7% vs. 14.1%; p=0.016) and adult ADHD symptoms (61.7% vs. 23.9%; p<0.0001) than the control group (Figure 1).

Figure 1.

Percentage of FM patients with cognitive impairment, childhood and adult ADHD. Comparison with the control population.

Conclusion

The co-occurrence of adult ADHD in FM was highly prevalent. In nearly half of the patients the diagnosis had been overlooked during childhood and it was associated with adult persistence. The prevalence of cognitive impairment, and childhood and adult ADHD was higher in patients with FM compared with the control group. ADHD was not associated with the FM impact. Evaluation of ADHD symptoms in patients with FM is important for recognition and treatment of this comorbidity.

References

[1]Stefano P et al. J Psychiatr Res. 2021 Apr;136:537-542.

[2]Karas H et a.l Int J Psychiatry Clin Pract. 2020 Sep;24(3):257-263.

[3]Kessler RC et al. Biol Psychiatry. 2005 Jun 1;57(11):1442-51.

Acknowledgements

The authors thank the patients who agreed to participate in

this study.

Disclosure of Interests

None declared

Prognostic value of static and dynamic biomarkers in COVID-19 patients: a prospective cohort study

OBJECTIVE

The aim of this study was to analyze in a prospective cohort of hospitalized COVID-19 patients the relationship between biomarkers levels and their variation within the first 4 days since admission, and prognosis.

METHODS

Prospective cohort study. Individuals with confirmed diagnosis of covid-19 admitted in our hospital were included. Blood samples were obtained systematically on days 1 and 4 of hospitalization. Levels of RCP, LDH, Ferritin and D-dimer, together with platelets, lymphocytes and neutrophils counts were measured. A combined outcome that included ICU admission and death was considered the primary outcome. Logistic regression analysis was performed.

RESULTS

We included 335 patients with confirmed COVID-19. During their hospitalization, 23 (6.8%) needed ICU admission, and 10 (2.9%) died. In the multivariate analysis, a value of RCP greater than 10 mg/dl (OR 8.69, CI95% 1.45-52), an increase in RCP greater than 20% (OR 26.08, CI 95% 3.21-211.3), an increase in LDH greater than 20% (OR 6.29, CI 95% 1.84-21.44), a count of lymphocytes lower than 1500/mm3 (OR 2.74, CI 95% 1.04-7.23), a D-dimer value greater than 550 ng/ml (OR 9.8, CI 95% 1.78-53.9) and a neutrophil/lymphocyte index greater than 3(OR 4.5, CI 95% 1.43-14.19) were all associated with the primary outcome.

CONCLUSIONS

Our study shows that the utilization of static and dynamic biomarkers may represent an important tool to assess prognosis of COVID-19 patients.