POS0742 DISCRIMINATIVE POWER OF SALIVARY GLAND ULTRASOUND IN RELATION TO ENDOTYPES IN SUSPECTED AND DEFINITE PRIMARY SJÖGREN’S SYNDROME

Background

Primary Sjögren’s Syndrome (pSS) is an auto-immune disease with characteristic complaints of oral and ocular dryness, typically affecting adult women. In addition, up to 30-40% of patients suffers from systemic manifestations and lymphoma risk is increased 15-20 fold. pSS is thus highly heterogenous both in presentation and pathophysiology. In an attempt to address this issue Tarn et al. applied cluster analysis based on patient reported outcomes assessing dryness, fatigue, pain and features of anxiety and depression, on a population of pSS patients. This resulted in four groups: low symptom burden (LSB), pain dominant with fatigue (PDF), dryness dominant with fatigue (DDF) and high symptom burden (HSB). These groups, referred to as endotypes, also seemed to have different biological profiles.(1)

Objectives

The aim of this study was to explore salivary gland ultrasound (SGUS) in relation to symptom-based endotypes in a cohort of patients with definite and suspected pSS.

Methods

Data from the Belgian Sjögren’s Syndrome Transition Trial (BeSSTT) were used in which patients positive for at least one of the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, were enrolled. Patients were considered ‘definite pSS’ when fulfilling these criteria and ‘suspected pSS’ otherwise.

The Newcastle Sjögren’s Stratification Tool, developed and provided by J. Tarn and colleagues, was applied to stratify the cohort into endotypes. Hocevar score (0-48) was used to assess SGUS abnormalities. Scores of at least 17 were considered positive.

Results

Stratification of the BeSSTT (n=241) cohort resulted in 4 endotypes, both in definite (n=141) and suspected pSS (n=100). The proportion of anti-SSA positive patients was high in definite pSS in all endotypes (91.9%; p=0.239). This proportion was significantly lower in suspected pSS patients in all endotypes (27.6%; p=0.064) albeit that the difference was less pronounced in LSB (50.0%) and, to a lesser degree, in PDF (32.7%) endotypes.

SGUS scores were higher in definite than suspected pSS (22 (12-37) vs 10 (2-16); p<0.001) in all endotypes (Figure 1). In definite pSS, Hocevar scores were highest in DDF compared to other endotypes (35 (24-43); p<0.001) and SGUS had a very strong discriminating power in this endotype (PPV=94.1%, NPV=76.2%). Salivary gland function was poorest in the definite pSS DDF endotype.

Figure 1.

Scatter plot of Hocevar score (0-48) by endotype. The upper plot represents patients with definite and the lower with suspected pSS. The colour of the dots indicates presence or absence of anti-SSA antibodies. The horizontal line is drawn at a Hocevar score of 17 and represents cut-off for positive SGUS.

In the suspected pSS subgroup, Hocevar scores tended to be higher in the LSB endotype (17 (6-26); p=0.053) and were significantly higher in anti-SSA positive than negative patients (12 (6-26) vs 8 (1-14); p=0.017) (Figure 1). Of the 24 suspected pSS patients (24.0%) with a positive SGUS, 12 (50.0%) were anti-SSA positive. Anti-SSA positive suspected pSS patients with an aberrant SGUS were markedly younger than the rest of the BeSSTT cohort (mean±SD age of 36 ±15 years vs 52 ±14 years) suggesting they may represent an early at-risk population.

Conclusion

These results show prominent SGUS differences between endotypes in pSS, supporting its potential as biomarker. Hocevar scores are highest in patients with DDF endotypes, further suggesting a different biological profile. SGUS is a powerful tool to identify definite pSS patients from a group of patients with DDF endotypes who fulfil at least one of the ACR/EULAR classification criteria. In addition, a subset of young anti-SSA positive patients without overt dryness (LSB and PDF endotype) reveals high SGUS scores. We would thus propose SGUS in all anti-SSA positive patients, regardless of symptoms, to reveal this glandular involvement.

References

[1]Tarn JR et al, Lancet Rheumatol. 2019

Disclosure of Interests

None declared

Unexplained fever in a young man with Crohn's disease: a case report and review of literature

A 23-year-old man with a known history of Crohn's disease (CD), who underwent an ileocaecal resection for localized disease activity three months ago, suffered from persistent fever with chills since 10 days. Despite the empirical antibiotic therapy that was started, his fever remained. A computed tomography (CT) angiography of the thorax and abdomen revealed a thrombosis of the iliacal veins bilateral and a pulmonary embolism (PE) in the right lower lobe with adjacent infiltrate. Venous thromboembolism (VTE) can be a life-threatening extraintestinal manifestation of inflammatory bowel disease (IBD). The risk that IBD patients develop a VTE is three times higher in comparison with healthy controls. They have a higher risk of recurrence and a higher mortality ratio. The pathogenesis of VTE in IBD is complex and until now not fully understood. More awareness should be raised, given the fact that it can be prevented by appropriate thromboprophylaxis.

FRI0312 ANTI-CD74 IGA ANTIBODIES ARE MOST SENSITIVE AND SPECIFIC TO IDENTIFY YOUNG MALE AXIAL SPONDYLOARTHRITIS PATIENTS

Background:

CD74 is involved in the assembly of and the prevention of premature peptide-binding to major histocompatibility complex (MHC) class II. IgG autoantibodies directed against CD74 have been shown to be highly prevalent in patients with ankylosing spondylitis (AS). In contrast, conflicting results have been reported on the sensitivity and specificity of anti-CD74 IgA both in patients with non-radiographic axial spondyloarthritis (nr-axSpA) as well as AS.

Objectives:

To assess the performance of anti-CD74 IgA for identification of patients classified as nr-axSpA or AS compared to non-SpA controls.

Methods:

Serum samples of patients who were classified as having axial SpA according to the ASAS classification criteria, were collected at inclusion in the Be-Giant (a Belgian observational cohort enrolling patients in 7 peripheral and an academic hospital). Patients with chronic back pain of non-inflammatory origin and rheumatoid arthritis patients without back pain served as a control group. Serum aliquots were stored immediately after sampling at -80°C until further analysis. Anti-CD74 IgA antibodies were measured using the AESKULISA SpA Detect Kit (AESKU Diagnostics, Wendelsheim, Germany) as described in (1); values are expressed in U/mL. Analyses were restricted to patients ≤ 45 years of age who were anti-TNF naïve prior to inclusion.

Results:

Table 1 shows the patients’ demographic and clinical characteristics. Mean±SD anti-CD74 IgA concentration was significantly higher in AS (18.3±11.20) and nr-axSpA (19.3±12.6) compared to controls (9.8±6.35) (Figure 1). However, anti-CD74 IgA levels were higher in males than in females (p = 0.01) and in old (≥32 y/o) vs. younger patients (p = 0.13). Anti-CD74 IgA yielded an adjusted OR (95% CI) of 1.10 (1.03 – 1.19) for discrimination of nr-axSpA from controls. Table 2, which shows the performance of anti-CD74 IgA in 4 subgroups of patients divided by age and sex, shows that the highest AUC was seen in young male nr-axSpA patients. Similar results were found on the discrimination between AS patients and controls (AUC 0.827 in young males).

Table 1.

Demographic and clinical characteristics

nr-axSpAAScontroln = 150n = 58n = 14Age, y (mean, SD)31 (6.9)32 (7.4)30 (7.0)Male, n (%)68 (45.3)26 (44.8)4 (28.5)Symptom duration, m (median, IQR)35 (13 - 98)111 (27 - 176)-HLA B27 positive, n (%)103 (68.7)48 (82.8)-Peripheral manifestations, n (%)41 (27.3)18 (31.0)-Extra-articular manifestations, n (%)32 (21.3)19 (32.8)-BASDAI (mean, SD)4.4 (1.97)4.1 (2.03)-CRP > ULN, n (%)45 (30.0)33 (56.9)-Table 2.

Performance of anti-CD74 IgA in discriminating nr-axSpA from controls, according to sex and age (young: <32 y/o). AUC= area under the curve, PPV/NPV = positive/negative predictive value, LR+ = positive likelihood ratio.

Cut-off (U/mL)AUCSensitivity (%)Specificity (%)PPV (%)NPV (%)LR+Male & young16.90.80665.892.396.248.08.6Male & old17.40.79555.692.393.850.07.2Female & young16.70.64750.092.394.441.46.5Female & old16.90.74146.892.395.742.26.0Figure 1.

Univariate comparison of anti-CD74 IgA concentrations between nr-axSpA, AS and control patients (<45 y/o).

Conclusion:

In this study, mean anti-CD74 IgA concentrations were higher in axial SpA patients compared to non-SpA controls. Application of this biomarker in young (<32 y/o) male nr-axSpA or AS patients yielded the highest sensitivity and specificity.

References:

[1]Riechers E, Baerlecken N, Baraliakos X, et al. Sensitivity and Specificity of Autoantibodies Against CD74 in Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019;71(5):729-35.

Acknowledgments:

Aesku.Diagnostics (Wendelsheim, Germany) provided the ELISA kits.

Disclosure of Interests:

Ann-Sophie De Craemer: None declared, Torsten Witte: None declared, Liselotte Deroo: None declared, Thomas Renson: None declared, Philippe Carron: None declared, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Dirk Elewaut: None declared

FRI0304 SERUM IGG-UNDERGALACTOSYLATION PROFILES REFLECT CUMULATIVE EXPOSURE TO SYSTEMIC INFLAMMATION IN SPONDYLOARTHRITIS PATIENTS

Background:

Inflammation in spondyloarthritis (SpA) is often not reflected by elevated acute phase reactants such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). It has been shown that IgG glycosylation patterns are subject to specific alterations (i.e. undergalactosylation) in chronic inflammatory diseases. Since these changes only occur in persistent inflammatory processes, lasting at least one to two t1/2of IgG (24 days), it was hypothesized that IgG-glycan profiles could serve as a surrogate marker for chronic inflammation in SpA patients.

Objectives:

To assess the value of serum IgG-undergalactosylation in SpA patients in relation to outcome measures for disease activity, determined by patient reported outcomes, serum inflammatory markers and imaging outcomes.

Methods:

Serum samples were obtained from SpA patients at the baseline visit of Be-Giant: a Belgian observational cohort including SpA patients who fulfill the ASAS classification criteria for axial or peripheral SpA. IgG Fc N-glycans were released directly in whole serum by endo-β-N-acetyl-glucosaminidase fromStreptococcus pyogenes(EndoS), fluorescently labeled with ATPS and analyzed by capillary electrophoresis, rendering glycan profiles with six peaks (Figure 1). Relative peak heights were combined in the undergalactosylation score (UGS), capturing the relative upregulation of non-galactosylated glycans normalized to the total peak height (1). Baseline radiographs (X-SIJ) and magnetic resonance images (MRI) of the sacroiliac joints (SIJ) were assessed by three calibrated readers for sacroiliitis (fulfillment of the modified New York criteria; grading 0 to 4 per SIJ) and for inflammatory lesions according to the Spondyloarthritis Research Consortium of Canada (SPARCC) method (score from 0 – 72) respectively. Grades and inflammatory lesions that were seen by at least 2 readers were used for further analysis.

Figure 1.

Example of a serum IgG-specific glycan profile. Adapted from (1), with permission.

Results:

Glycan profiles were obtained from 376 SpA patients; UGS was scaled (mean = 0, SD = 1) for further analysis. UGS was independently associated with ASDAS-CRP (β1= 0.15, 95% CI 0.04 – 0.26, p = 0.006) and BASFI (β1= 0.44, 95% CI 0.16 – 0.72, p = 0.002) but not with BASDAI (β1= 0.12, 95% CI -0.13 – 0.38, p = 0.34). UGS showed a weak to moderate correlation with CRP (Rs= 0.30, p < 0.001) and ESR (Rs= 0.27, p <0.001). In axial SpA, UGS was significantly higher in patients with ankylosing spondylitis compared to non-radiographic axial SpA (OR = 2.41, 95% CI 1.60 – 3.73, p < 0.001) and showed an independent association with the total grading of the SIJ (β1= 0.44, 95% CI 0.09 – 0.80, p = 0.01, Figure 2) and SPARCC score (β1= 2.64, 95% CI 0.98 – 4.31, p = 0.002). All models were adjusted for age, gender, BMI, CRP, anti-TNF treatment and symptom duration.

Conclusion:

This study shows and independent association of serum IgG undergalactosylation with disease activity and functional impairment in SpA patients. Moreover, UGS was significantly higher in advanced compared to early-stage axial disease and therefore may reflect the cumulative exposure to systemic inflammation.

References:

[1]Vanderschaeghe D, Meuris L, Raes T, et al. Endoglycosidase S Enables a Highly Simplified Clinical Chemistry Procedure for Direct Assessment of Serum IgG Undergalactosylation in Chronic Inflammatory Disease. Mol Cell Proteomics. 2018;17(12):2508-17.

Figure 2.

Correlation between UGS and X-SIJ total grading of sacroiliitis. R = Spearman’s correlation coefficient.

Disclosure of Interests:

Ann-Sophie De Craemer: None declared, Zuzanna Lukasik: None declared, Leander Meuris: None declared, Liselotte Deroo: None declared, Thomas Renson: None declared, Manouk de Hooge: None declared, Philippe Carron: None declared, Annelies Van Hecke: None declared, Nico Callewaert: None declared, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Dirk Elewaut: None declared

The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review

AIMS

To examine the effectiveness of brief behavioral interventions adapting the principles and techniques of Motivational Interviewing (MI) to four behavioral domains: substance abuse, smoking, HIV risk and diet/exercise.

DESIGN

We conducted a systematic review of 29 randomized trials of MI interventions. Data on methodological quality were extracted and tabulated. Between-group behavior change effect sizes and confidence intervals were calculated for each study.

FINDINGS

Due to varying intervention time lengths, targeted problem behaviors, settings and interventionists' backgrounds and skill levels, outcomes were not combined meta-analytically. Sixty per cent of the 29 studies yielded at least one significant behavior change effect size. No significant association between length of follow-up time and magnitude of effect sizes was found across studies. There was substantial evidence that MI is an effective substance abuse intervention method when used by clinicians who are non-specialists in substance abuse treatment, particularly when enhancing entry to and engagement in more intensive substance abuse treatment treatment-as-usual. Data were inadequate to judge the effect of MI in the other domains. Client attribute-treatment interactions were understudied and the sparse and inconsistent findings revealed little about the mechanism by which MI works or for whom it works best.

CONCLUSION

To determine more effectively how well MI works in domains other than substance abuse and for whom it works best in all domains, researchers should study MI with risk behaviors other than substance abuse, while examining both interactions and the theoretical components of MI.