Refracture following vertebral fragility fracture when bone fragility is not recognized: summarizing findings from comparator arms of randomized clinical trials

PURPOSE

Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent vertebral and non-vertebral fragility fractures (nVFFs) in untreated patients with a previous VFF.

METHODS

We systematically searched PubMed, Embase, and Cochrane Library up to February 2022 for randomized clinical trials (RCTs) that analyzed the occurrence of subsequent fractures in untreated patients with prior VFFs. Two authors independently extracted data and appraised the risk of bias in the selected studies. Primary outcomes were subsequent VFFs, while secondary outcomes were further nVFFs. The outcome of refracture within ≥ 2 years after the index fracture was measured as (i) rate, expressed per 100 person-years (PYs), and (ii) risk, expressed in percentage.

RESULTS

Forty RCTs met our inclusion criteria, ranging from medium to high quality. Among untreated patients with prior VFFs, the rate of subsequent VFFs and nVFFs was 12 [95% confidence interval (CI) 9-16] and 6 (95% CI 5-8%) per 100 PYs, respectively. The higher the number of previous VFFs, the higher the incidence. Moreover, the risk of VFFs and nVFFs increased within 2 (16.6% and 8%) and 4 years (35.1% and 17.4%) based on the index VFF.

CONCLUSION

The highest risk of subsequent VFFs or nVFFs was already detected within 2 years following the initial VFF. Thus, prompt interventions should be designed to improve the detection and treatment of VFFs, aiming to reduce the risk of future FFs and properly implement secondary preventive measures.

Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS)

INTRODUCTION

Paget's disease of bone is a focal skeletal disorder causing bone deformities and impairing bone quality. Despite the prevalence of asymptomatic cases is increasing, the progression of the disease can lead to invalidating complications that compromise the quality of life. Doubts on clinical and therapeutic management aspects exist, although beneficial effects of antiresorptive drugs, particularly bisphosphonates are known. However, limited information is available from randomized controlled trials on the prevention of disease complications so that somewhat contrasting positions about treatment indications between expert panels from the main scientific societies of metabolic bone diseases exist. This task force, composed by expert representatives appointed by the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases and members of the Italian Association of Paget's disease of bone, felt the necessity for more specific and up to date indications for an early diagnosis and clinical management.

METHODS

Through selected key questions, we propose evidence-based recommendations for the diagnosis and treatment of the disease. In the lack of good evidence to support clear recommendations, available information from the literature together with expert opinion of the panel was used to provide suggestions for the clinical practice.

RESULTS AND CONCLUSION

Description of the evidence quality and support of the strength of the statements was provided on each of the selected key questions. The diagnosis of PDB should be mainly based on symptoms and the typical biochemical and radiological features. While treatment is mandatory to all the symptomatic cases at diagnosis, less evidence is available on treatment indications in asymptomatic as well as in previously treated patients in the presence of biochemical recurrence. However, given the safety and long-term efficacy of potent intravenous bisphosphonates such as zoledronate, a suggestion to treat most if not all cases at the time of diagnosis was released.

A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS

PURPOSE

Preventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients.

METHODS

PubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Forty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men.

CONCLUSION

The task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.

The integrated structure of care: evidence for the efficacy of models of clinical governance in the prevention of fragility fractures after recent sentinel fracture after the age of 50 years

Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline.

PURPOSE

After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines.

METHODS

PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance.

RESULTS

Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures.

CONCLUSIONS

Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.

Hydrological, thermal and chemical influence of an intact rock glacier discharge on mountain stream water

Rock glaciers are the most prominent permafrost-related mountain landforms. This study investigates the effects of the discharge from an intact rock glacier on the hydrological, thermal and chemical dynamics of a high-elevation stream in the NW Italian Alps. Despite draining only 39 % of the watershed area, the rock glacier sourced a disproportionately large amount of discharge to the stream, with the highest relative contribution to the catchment streamflow occurring in late summer - early autumn (up to 63 %). However, ice melt was estimated to be only a minor component to the discharge of the rock glacier, due to its insulating coarse debris mantle. The sedimentological characteristics and internal hydrological system of the rock glacier played a major role in its capability to store and transmit relevant amounts of groundwater, especially during the baseflow periods. Besides the hydrological influence, the cold and solute-enriched discharge from the rock glacier significantly lowered the stream water temperature (especially during warm atmospheric periods) as well as increased the concentrations of most solutes in the stream. Furthermore, in the two lobes forming the rock glacier, different internal hydrological systems and flowpaths, likely driven by different permafrost and ice content, caused contrasting hydrological and chemical behaviours. Indeed, higher hydrological contributions and significant seasonal trends in solute concentrations were found in the lobe with higher permafrost and ice content. Our results highlight the relevance of rock glaciers as water resources, despite the minor ice melt contribution, also suggesting their potential, increasing hydrological importance in the light of climate warming.

Secukinumab retention rate is greater in patients with psoriatic arthritis presenting with axial involvement

Psoriatic arthritis (PsA) is an inflammatory disease characterized by peripheral and axial involvement. Biological disease-modifying antirheumatic drugs (bDMARDs) are the mainstream treatment for PsA and bDMARDs retention rate is a proxy for the drug's overall effectiveness. However, it is unclear whether IL-17 inhibitors can have a higher retention rate than tumor necrosis factor (TNF) inhibitors, in particular in axial or peripheral PsA. A real-life observational study was conducted on bDMARD naïve PsA patients initiating TNF inhibitors or secukinumab. Time-to-switch analysis was carried out with Kaplan-Meyer curves (log-rank test) truncated at 3 years (1095 days). Sub-analyses of Kaplan-Meyer curves between patients presenting with prevalent peripheral PsA or prevalent axial PsA were also conducted. Cox regression models were employed to describe predictors of treatment switch/swap. Data on 269 patients with PsA naïve to bDMARD starting either TNF inhibitors (n=220) or secukinumab (n=48) were retrieved. The overall treatment retention at 1 and 2 years was similar for secukinumab and TNF inhibitors (log-rank test p NS). We found a trend towards significance in the Kaplan-Meyer at 3 years in favor of secukinumab (log-rank test p 0.081). Predominant axial disease was significantly associated with a higher chance of drug survival in secukinumab users (adjusted hazard ratio 0.15, 95% confidence interval = 0.04-0.54) but not in TNF inhibitor users. In this real-life, single-center, study on bDMARD naïve PsA patients, axial involvement was associated with longer survival of secukinumab but not of TNF inhibitors. Drug retention of secukinumab and TNF inhibitors were similar in predominantly peripheral PsA.

The prognostic role of metastatic lymph node ratio in colon cancer: a retrospective cohort study on 241 patients in a single center

BACKGROUND

The detection of nodal status is based on examination of lymph nodes (LN) after the tumor surgical resection and the current guidelines recommend examining at least 12 regional LN. An inadequate number of examined LN may lead to a lower N stage or to a false-negative nodal disease. To overcome these issues, many authors proposed to consider the metastatic lymph node ratio (mLNR). MLNR is the ratio of the number of metastatic LN to the number of examined LN.

METHODS

Two hundred forty-one colon cancer (CC) specimens from patients who had undergone surgical resection between January 2010 and December 2015 at the General Surgery Unit of Parma University Hospital were analyzed. mLNR, which is defined as the ratio of the number of positive LN to the number of examined LN, was calculated in CCs with LN metastasis. In this study we focused on the following mLRN cutoffs: <0.15, 0.15-0.3 and >3 and we evaluated the prognostic implication of mLNRs.

RESULTS

Regarding the impact of examined LN on involved LN in CC, our results showed that the number of involved LN increased with the increasing number of examined LN (P=0.03). We found a significant correlation between OS and RFS rate of patients with CCs and mLNR. Patients with mLNR<0.15 were associated with better OS and RFS rate whereas patients with mLNR>0.3 were associated with worse OS and RFS rate. OS rate for patients with a mLNR<0.15 was 95.24% (89-100%) at 1 year, 83.27% (72.7-95.4%) at 3 years and 68.07% (55.1-84.1%) at 5 years whereas patients with a mLNR>0.3 had an OS rate of 51.7% (34.6-77.3%) at 1 year, 36.55% (20.08-64.3%) at 3 years and 31.33% (16.5-59.4%) at 5 years. RFS rate for patients with a mLNR<0.15 was 100% (100-100%) at 1 year, 92.2% (84-100%) at 3 years and 85.2% (73.8-98.31%) at 5 years whereas patients with a mLNR>0.3 had a RFS of 63.2% (42.8-93.58%) at 1 year and 54.2% (33.1-88.93%) at 3 and 5 years.

CONCLUSIONS

The prognostic value of pN stage could be more accurate if we consider both the number of LN metastasis and harvested LN. This can be achieved by using the mLNR that can be a useful tool in daily practice to predict the prognosis of patients who undergone surgery for CC.

Impact of Covid-19 pandemic on children with special needs requiring general anaesthesia for the treatment of dental disease: the experience of the Brescia Children's Hospital, Lombardy, Italy

PURPOSE

Special needs children presenting with dental problems were penalised during the Covid-19 pandemic due to the reduction of clinical activity and the risks of nosocomial infection. The aim of this study is to evaluate the impact of the pandemic on oral healthcare in paediatric special needs patients.

METHODS

We retrospectively assessed and compared the outpatient clinic activity and dental procedures performed under general anaesthesia in children with special needs at Brescia Children's Hospital (Italy) in 2019, 2020, and 2021. Any delay between expected waiting time based on assigned priority and surgery was recorded. The efficacy of the protocol adopted to reduce the spread of Covid-19 was evaluated by reporting any infections in patients, parents, and health care providers.

RESULTS

In 2020, 270 outpatient visits were performed, and 40 patients were treated under general anaesthesia, with a 26% and 65% reduction, respectively, compared to 2019. In 2021, 362 visits were performed (similar to 2019) and 48 patients were treated under general anaesthesia (58% compared to 2019). The mean delay in the planned treatment was 1.0 month in 2019 (pre-pandemic period), 2.1 months in 2020, and 1.1 month in 2021. No cases of Covid-19 infection were reported in the cohort of patients and parents or among the operators related to nosocomial infection.

CONCLUSIONS

The Covid-19 pandemic has profoundly reduced the activity of general anaesthesia in paediatric special need patients during 2020, with a gradual return to normal pre-pandemic activity in 2021. The adopted protocol prevented the spread of COVID-19 during hospitalisation.

The gut microbiome as possible mediator of the beneficial effects of very low calorie ketogenic diet on type 2 diabetes and obesity: a narrative review

Several studies have shown a strong correlation between the different types of diets and gut microbiota composition on glycemia and weight loss. In this direction, low-carbohydrate and ketogenic diets have gained popularity, despite studies published so far leading to controversial results on subjects with diabetes. In this narrative review, firstly, we aimed to analyze the role of very-low-calorie ketogenic diets (VLCKDs) in type 2 diabetes (T2DM) and obesity management. Secondly, in this context, we focused attention on gut microbiota as a function of VLCKD, particularly in T2DM and obesity treatment. Finally, we reported all this evidence to underline the importance of gut microbiota to exalt new nutritional strategies for "tailor-made" management, treatment, and rehabilitation in subjects with T2DM and obesity, even with diabetic complications. In conclusion, this narrative review outlined the beneficial impact of VLCKD on gut microbiota even in subjects with T2DM and obesity, and, despite inner VLCKD short-duration feature allowing no sound-enough provisions for long-term outcomes, witnessed in favor of the short-term safety of VLCKD in those patients.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

OP0071 ASSOCIATION BETWEEN LONG-TERM EXPOSURE TO AIR POLLUTION AND IMMUNE-MEDIATED DISEASES: A POPULATION-BASED COHORT STUDY

Background

Environmental air pollution has been associated with disruption of the immune system at a molecular level.

Objectives

The primary aim of the present study is to describe the association between long-term exposure to air pollution and risk of developing immune-mediated conditions.

Methods

We conducted a retrospective observational study on a nation-wide dataset of women and men. Diagnoses of various immune-mediated diseases were retrieved. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (ISPRA). The long-term average PMs concentrations were the exposure of interest. Every study subject was linked to a PMs exposure value, which resulted from the average concentration of urban, rural and near-traffic stations of the subject residency from January 2013 to November 2020. Patients were linked to the nearest air quality station through ZIP code centroids. Generalized linear models were employed to determine the relationship between autoimmune diseases prevalence and PM. The fully adjusted model included age, body mass index (BMI), menopause, glucocorticoid treatment, treatment with adjuvant hormone therapy for breast or prostate cancer, specialty of the physician that entered the data and macro-area of residency (stratified as a categorical variable: northern Italy, central Italy and southern Italy.

Results

81,363 subjects were included in the study. We found a positive association between PM10 and the risk of autoimmune diseases (ρ +0.007, p 0.014). Every 10 µg/m3 increase in PM10 concentration was associated with an incremental 7% risk of having autoimmune disease. Exposure to PM10 above 30 µg/m3 and PM2.5 above 20 µg/m3 was associated with a 12% and 13% higher risk of autoimmune disease pooled together, respectively (aOR 1.12, 95% CI 1.05-1.20 and aOR 1.13, 95% CI 1.06-1.20). Exposure to PM10 was associated with an increased risk of rheumatoid arthritis (aOR 1.408, 95% CI 1.271-1.560) but no other autoimmune diseases, whereas exposure to high levels of PM2.5 were associated with an increased risk of rheumatoid arthritis (aOR 1.559, 95% CI 1.401-1.734), CTDs (aOR 1.147, 95% CI 1.024-1.286) and IBDs (1.206, 95% CI 1.028-1.415) but no other autoimmune diseases.

Conclusion

Long-term exposure to air pollution was associated with higher risk of developing autoimmune diseases, in particular rheumatoid arthritis, CTDs and IBD. Chronic exposure to levels above the threshold for human protection was associated with a 10% higher risk of developing immune-mediated diseases.

Disclosure of Interests

Giovanni Adami Shareholder of: Galapagos, Theramex, Marco Pontalti: None declared, Camilla Benini: None declared, Angelo Fassio: None declared, Eugenia Bertoldo: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

AB1019 THE EFFECTS OF THREE DIFFERENT VITAMIN D3 SUPPLEMENTATION REGIMENS IN DEFICIENT SUBJECTS ON INFLAMMATORY CYTOKINES – A RANDOMISED OPEN-LABEL PARALLEL GROUPS STUDY

Background

The effects of cholecalciferol supplementation on the regulation of inflammatory cytokines are still unclear.

Objectives

This is a preliminary analysis on exploratory outcomes the DIBA/11 RCT [1,2] and aimed to compare the effects on serum inflammatory cytokines of three different regimes of cholecalciferol supplementation in vitamin D-deficient subjects.

Methods

We evaluated, in healthy subjects affected by vitamin D deficiency (defined as 25OHD<20 ng/mL), 18 to 60 years of age, the efficacy of three different oral supplementation regimens: daily 10,000Iu administered for 8 weeks (group A), weekly 50,000Iu (group B) for 12 weeks and biweekly 100,000Iu (group C) for 12 weeks.

Serum TNFα, interleukin-6 (IL6), interleukin-17 (IL17) and interleukin-10 (IL10) were dosed at baseline, Day 28, 53, 84 and 112. This study was approved by the institutional research committee (protocol identification: DIBA/11,EudraCT Number:2017-000194-36). Supported by Abiogen Pharma, Italy).

Results

A total of 75 subjects were randomized to receive one supplementation regimen. The descriptive of the sample at baseline and relative cytokines levels at the various observation points are reported in Table 1. The absolute changes of IL6, IL17 and IL10 are depicted in Figure 1. No significant differences were found among the three groups. TNFα was undetectable at baseline and at any time point.

Table 1.

anthropometrics and laboratory parameters at baseline (mean values ± standard deviation)

ParameterAll patients (N=75)Daily 10.000 Ui(N = 25)Weekly 50.000 Ui(n = 25)Biweekly 100.000 Ui(N = 25)p-value (ANOVA)M:F31:4412:137:1812:13NSAge (years)34.1 ± 10.230.2 ± 9.936.7 ± 8.735.4 ± 11.00.059Body Weight (kg)66.7 ± 12.465.8 ± 13.267.8 ± 10.866.6 ± 13.7NSBMI23.1 ± 2.622.55 ± 2.723.8 ± 2.222.8 ± 2.7NSBaseline 25OHD (ng/mL)13.5 ± 3.714.6 ± 3.912.8 ± 313.5 ± 4.1NSBaseline IL-6 (pg/mL)1.3 ± 1.20.9 ± 0.61.4 ± 1.61.6 ± 1.3NSBaseline IL-17 (pg/mL)0.4 ± 1.80.7 ± 30.2 ± 1.10.2 ± 0.7NSBaseline IL-10 (pg/mL)0.9 ± 0.90.8 ± 0.71.2 ± 1.20.8 ± 0.7NSFigure 1.

absolute changes of IL17, IL6 and IL10. *p<0.05 vs baseline.

Conclusion

In the overall cohort we found slight decreases in serum IL6 and IL17 serum levels. No differences were found among groups.

References

[1]Fassio A, Adami G, Rossini M, et al. Pharmacokinetics of Oral Cholecalciferol in Healthy Subjects with Vitamin D Deficiency: A Randomized Open-Label Study. Nutrients. 2020;12(6).

[2]Fassio A, Gatti D, Rossini M, et al. Pharmacodynamics of Oral Cholecalciferol in Healthy Individuals with Vitamin D Deficiency: A Randomized Open-Label Study. Nutrients. 2021;13(7):2293.

Disclosure of Interests

Angelo Fassio: None declared, Davide Gatti Speakers bureau: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Paid instructor for: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Matteo Gatti: None declared, Maurizio Rossini Speakers bureau: Abiogen, Amgen, Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Grunenthal, MSD, Novartis, Pfizer, Sanofi, Sandoz, Theramex, UCB., Eugenia Bertoldo: None declared, Giovanni Adami: None declared

POS1140 SHORT-TERM EXPOSURE TO FINE PARTICULATE MATTER AND RISK OF FRAGILITY HIP FRACTURES, A CASE-CROSSOVER STUDY ON 1,042 HIP FRACTURES

Background

Fragility femoral fracture is a common, world-spread, medical condition, that has a relevant impact both clinically and economically. Chronic exposure to environmental air pollution has been linked with a higher risk of developing osteoporosis. However, little is known regarding the relationship between short-term exposure to air pollution and bone fractures.

Objectives

Our study aims to investigate the link between short-term exposure to fine particulate matters and fragility hip fractures

Methods

We retrieved data of patients suffering of hip fractures admitted to the Orthopedic Unit of the University of Verona Hospital from 2015 to 2020. We retrieved data on the monitoring of PM10 concentrations from the Italian institute of environment protection and research (ISPRA). We designed a case-crossover study to compare the exposure to particulate matters (PM10) in the 30-day period immediately before the fracture (hazard period) referent to a 30-day control period (from day -30 to -60 from the fracture). Exposure to PM10 was evaluated as mean value and AUC. Case-crossover is a peculiar study design applied to longitudinal datasets that controls for within-person time-invariant and between-patient confounders such as indoor air pollution, chronic comorbidities or concomitant medications and have been used extensively to study the effects of transient, short-term exposures on the risk of acute events (Figure 1A)

Results

1042 patients (73.7% female n=768), with a hip fracture admitted to the hospital were included in the study. Mean age of the cohort was 82.6 years (±9.55). Average exposure to PM 10 in the control period was 33,84 ug/mm3, cumulative exposure (AUC) was 952,42 ug/mm3 compared 31,72 ug/mm3 and AUC of 920,24 ug/mm3 in the hazard period (Figure 1B) The difference between levels of PM10 in the two periods was statistically significant as levels of PM10 was higher in the hazard period compared to control period, with a p-value = 0,027 (α <0,05) when comparing average concentrations in the two groups and a p-value = 0,024 (α <0,05), when comparing AUCs.

Conclusion

Our study suggests that the short-term exposure to environmental air pollution might increase the risk of femoral fragility fractures. Further studies should be taken to further investigate the biological mechanisms underlining this finding.

Disclosure of Interests

Giovanni Adami Shareholder of: Theramex, Galapagos, Marco Pontalti: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Davide Gatti: None declared, Stefano Negri: None declared, Pietro Olivi: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

AB0441 PREDICTORS OF CLASI RESPONSE OVER TIME IN A MULTICENTRIC REAL LIFE COHORT OF SLE PATIENTS TREATED WITH BELIMUMAB

Background

Over 80% of patients affected with SLE experience skin involvement. The anti-BLyS drug belimumab was shown effective in ameliorating mucocutaneous SLE manifestations in clinical trials and real-life studies. Cutaneous response is quantified through the CLASI (cutaneous lupus erythematosus area and severity index). Clinically relevant improvements are defined as decreases of ≥50% (CLASI50) or 70% (CLASI70) from baseline values.

Objectives

To assess rates and predictors of CLASI50 and CLASI70 in the Berliss multicentric SLE cohort1 of patients treated with belimumab.

Methods

Baseline and ongoing features of patients with baseline active skin involvement (CLASI>0) were assessed in relationship to the chosen outcomes CLASI50 and CLASI70 at 24 and 52 weeks. A subanalysis on patients with CLASI≥5 was as well conducted. Logistic regression was employed to identify predictors of response.

Results

172 patients displayed skin involvement at baseline (CLASI>0). Of those, 124 displayed at least a 12-month-follow-up and were included in the analysis. Seventy-seven (62.1%) patients reached CLASI50 at 24 weeks and 91 (77.8%) at 52 weeks; 87 (70.2%) reached CLASI70 at 24 and 99 (79.8%) at 52 weeks. Baseline predictors of CLASI50 at 24 weeks were CLASI-damage (CLASI-d) (OR [95%CI], p; 0.79 [0.65-0.98] 0.03) and disease duration (0.93[0.86-0.99], 0.011). No baseline predictors of CLASI70 at 24 weeks emerged, however having achieved a CLASI50 response at 24 weeks portended CLASI50 and 70 response through week 52 (p<0.01, Table 1). In the subgroup of patients with CLASI≥5, longer disease and increased CLASI-d at baseline confirmed as negative predictors of CLASI50 at 24 weeks. In this subset, use of antimalarials and active smoking at baseline predicted CLASI70 at 24 weeks (Table 1).

Table 1.

Predictors of CLASI-A Response at Week 24 and 52 by Baseline CLASI-A at 50% and 70% Response Thresholds

TimepointOutcomeVariableOR[95%CI] pCLASI>024 weeksCLASI50CLASI-d0.79 [0.65-0.98] 0.030Disease duration0.93[0.86-0.99], 0.011CLASI70CLASI-d0.93 [0.74-1.16], 0.51Disease duration0.97 [0.97-1.02], 0.1852 weeksCLASI50CLASI50 at 24 weeks14.3[4.88-44.42], <0.001CLASI70CLASI50 at 24 weeks6.22 [2.00-19.34], 0.002CLASI≥524 weeksCLASI50CLASI-d0.72 [0.53-0.98], 0.037Disease duration0.93 [0.66-1.00], 0.071CLASI70Antimalarials6.61 [1.20-36.29] 0.032Smoking0.15 [0.03-0.83], 0.03452 weeksCLASI50CLASI50 at 24 weeks22.0 [2.47-196.05], 0.006CLASI70CLASI50 at 24 weeks1.24 [0.06-25.08], 0.88

CLASI, cutaneous lupus erythematosus area and severity index; CLASI-d, CLASI damage; CLASI50 and CLASI70: decrease ≥50% or ≥70% in CLASI from baseline. OR and 95%CIs are estimated using a logistic regression model with stratification factors as covariates (SLEDAI-2K at baseline, baseline prednisone dosage).

Conclusion

Earlier use of belimumab favors achievement of skin response among SLE patients and attainment of a prompt response predicts further response. Use of antimalarials reinforces while smoking hampers a more profound CLASI improvement over time.

References:

[1]Gatto M, et al. Arthritis Rheumatol. 2020 Aug;72(8):1314-1324

Disclosure of Interests

Mariele Gatto Speakers bureau: GSK, Grant/research support from: GSK, Roberto Depascale: None declared, Angela Tincani: None declared, Giacomo Emmi: None declared, Salvatore Scarpato: None declared, Fabrizio Conti: None declared, Marcello Govoni: None declared, Marta Mosca: None declared, Maria Gerosa: None declared, Enrica Bozzolo: None declared, Valentina Canti: None declared, Armando Gabrielli: None declared, Elisa Gremese: None declared, Salvatore De Vita: None declared, francesco ciccia: None declared, Carlo Salvarani: None declared, Maurizio Rossini: None declared, Paola Faggioli: None declared, Antonella Laria: None declared, Amato De Paulis: None declared, Roberto Gerli: None declared, Enrico Brunetta: None declared, Alessandro Mathieu: None declared, Carlo Selmi: None declared, Rossella De Angelis: None declared, Simone Negrini: None declared, Margherita Zen: None declared, Andrea Doria Speakers bureau: GSK, Eli Lilly, Roche, Grant/research support from: GSK, Luca Iaccarino Speakers bureau: GSK, Grant/research support from: GSK

AB1017 RADIOFREQUENCY ECHOGRAPHIC MULTI-SPECTROMETRY (REMS) AND DUAL-ENERGY X-RAYS ABSORPTIOMETRY FOR THE EVALUATION OF BONE MINERAL DENSITY IN A PERITONEAL DIALYSIS SETTING

Background

Radiofrequency echographic multi-spectrometry (REMS) is a novel ultrasound-based technique that has shown good reliability in the assessment of bone mineral density (BMD).

Objectives

The aim of this study was to compare the performance of the REMS BMD assessment with dual-energy X-rays absorptiometry (DXA) in a cohort of patients affected by end-stage renal disease undergoing peritoneal dialysis (PD).

Methods

Consecutive patients referring to the PD clinic of our hospital were enrolled. Lumbar spine and proximal femur REMS scans were performed, and lumbar spine (anteroposterior and laterolateral) and proximal femur DXA scans were performed as well. Clinical data were extracted from medical records. The risk assessment outputs of two fracture risk algorithms (FRAX and DeFRA), calculated upon the worst BMD obtained from either technique were compared as well. Analysis of variance (ANOVA) with post hoc analysis (Bonferroni) and a two-sided Student’s t-test were used to estimate the absolute differences between groups.

Written informed consent was obtained from all participants included (protocol 1483 CESC).

Results

41 total patients were enrolled (Table 1). No significant differences were documented between the BMD T-scores measured through DXA or REMS at the proximal femur. At the lumbar spine, the DXA laterolateral T-score was not significantly different from that of REMS, while the DXA anteroposterior T-score was significantly higher than both the anteroposterior DXA and the REMS measurements (Figure 1, panel A and B). When either DXA or REMS was adopted, no significant difference in the fracture risk estimate was found for both algorithms (Figure 1, panel C and D).

Table 1.

anthropometrics, clinical and biochemical characteristics of the enrolled sample. CKD, chronic kidney disease; PTH, parathyroid hormone; ALP, alkaline phosphatase; IQR, interquartile range; VFA, vertebral fracture assessment.

Sample size (M)41 (29)Age (y)Median [IQR]62 [52-73]Height (cm)Median [IQR]170 [165-176]Body weight (Kg)Median [IQR]74 [61-83]Body mass index (Kg/m2)Median [IQR]25 [22-27.8]Disease duration – CKD (months)Median [IQR]132 [48-140]Dialysis duration (months)Median [IQR]10 [3-24]S-calcium (mg/dL)Median [IQR]9.1 [8.6-9.4]S-phosphorous (mg/dL)Median [IQR]5.4 [4.6-6.4]PTH (pg/mL)Median [IQR]31.4 [22.8-46.8]25OH Vitamin D (nmol/L)Median [IQR]53 [36-72]Patients with morphometric fractures (VFA)15%Patients with femoral fractures2.4%Total n° of morphometric fractures12Figure 1.

comparison of the mean T-scores (error bars represent 95%CI) measured with DXA and REMS at the lumbar spine (panel A), and at the femur (panel B). Comparison between the DeFRA DXA and REMS-derived outputs (panel C) and FRAX DXA and REMS-derived outputs (panel D) raw and after correction for TBS. DeFRA, FRAX-derived risk assessment tool; FRAX, Fracture Risk Assessment tool; AP, anteroposterior; LL, latero-lateral; TH, total hip; FN, femoral neck; TBS, trabecular bone score.

Conclusion

Our data showed a good agreement, in a real-life PD setting, between the DXA and REMS-derived BMDs and in the consequent fracture risk assessment obtained with the FRAX or DeFRA tools.

Disclosure of Interests

Angelo Fassio: None declared, Stefano Andreola: None declared, Davide Gatti Paid instructor for: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Consultant of: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB., Matteo Gatti: None declared, Giovanni Gambaro Speakers bureau: Vifor Pharma, Maurizio Rossini Speakers bureau: Abiogen, Amgen, Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Grunenthal, MSD, Novartis, Pfizer, Sanofi, Sandoz, Theramex, UCB., Ombretta Viapiana: None declared, Giulia Zanetti: None declared, Francesca Pistillo: None declared, Valeri Messina: None declared, Giovanni Adami: None declared

AB1365 PROPOSAL FOR A STANDARDIZED ULTRASOUND SCANNING PROTOCOL OF THE NAIL PLATE

Background

Ultrasonography of the nails with high frequency linear transducers can properly perform morphological images, achieving highly descriptive power but the lack of standardization may hesitate in lack of reproducibility and scarce usefulness.

Objectives

The aim of this study was to provide a detailed scan protocol of nail plate, including comparison of scan planes and probe positioning.

Methods

Transversal and longitudinal ultrasound scans were performed on each fingernail of both hands in healthy subjects. Nail plate thickness and Power Doppler of the nail bed were recorded. All the images were acquired using Canon Aplio i800 with a linear transducer of 22 MHz (i22LHB). Two different operators performed evaluation of thickness at distal, middle and proximal portion of nail in longitudinal view and at 0°, -45° and +45° for transverse view (Figure 1). ANOVA for repeated measures was used to determine differences between nail of the different digits.

Figure 1.

Longitudinal and transverse view of the nail. In yellow the position and angles of the caliper used for acquiring the measures

Results

The study sample was composed of 27 healthy subjects between 25- and 40- year old with no rheumatological or dermatological nail issues. A total of 270 nails were scanned; none of them was excluded due to comorbidity, trauma or other conditions which can interfere in the evaluation. A decrease in nail thickness was observed from first to fifth digit, regardless the hand (dominant or not), that resulted significant for the ANOVA. No differences were found regarding the thickness in the different segments of nail plate and this occurred both for longitudinal and transverse scans.

Conclusion

We demonstrated the absence of a statistically significant difference between thickness at proximal, middle and distal portion of the nail in longitudinal view or at any different angle in transverse view, concluding the fastest and easiest way to measure the nail plate thickness is in the longitudinal view at the middle segment, avoiding potential issues in positioning the probe in the transverse view or in positioning the caliper at proximal or distal segment in longitudinal view. All the nails should be scanned per protocol, since the thickness is variable and the fifth may be the most interesting in order to consider its highest variance.

References

[1]Fassio A. et al.; Clin Rheumatol. 2020 May;39(5):1391-1404. doi: 10.1007/s10067-019-04748-2. Epub 2019 Aug 22.

Table 1.

ANOVA for repeated measures of the nail plate thickness. A trend in decreasing P value is clearly visible from first to fifth. P considered statistically significant when ≤ 0.05

LONGITUDINALTRANSVERSEPROXIMAL-45°Row-mean1234Row-mean123421.00020.73130.7651.00030.2641.00040.0280.8881.00040.0000.0560.18750.0000.0010.0030.15850.0000.0050.0231.000MIDDLE0°Row-mean1234Row-mean123421.00020.71931.0001.00030.0561.00040.0701.0001.00040.0000.1581.00050.0000.0010.0020.09550.0000.0250.3891.000DISTAL+45°Row-mean1234Row-mean123421.00021.00030.8541.00030.7651.00040.0060.0930.75440.0500.5831.00050.0000.0000.0000.11450.0000.0010.0160.323

Disclosure of Interests

None declared

AB1167 THE USE OF ORAL AMINO-BISPHOSPHONATES AND CORONAVIRUS DISEASE 2019 (COVID-19) OUTCOMES

Background

The determinants of the susceptibility to SARS-CoV-2 infection and severe Coronavirus Disease 19 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-inflammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events and cancer.

Objectives

We conducted a population-based retrospective observational case control study with the primary objective of determining if oral N-BPs treatment can play a role in thesusceptibility to the development of severe COVID-19.

Methods

Administrative ICD-9-CM and ATC data, representative of Italian population (9% sample of the overallpopulation), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis. Patients treated with bisphosphonates (cases) were randomly matched (1:1 ratio) for age, sex and for other clinically relevant variables (presence of treatments other than bisphosphonates and hospitalizations) with all the health-assisted population without this treatment (controls).

Results

Incidence of Covid-19 hospitalization was 12.32 [95%CI 9.61-15.04] and 11.55 [95%CI 8.91-14.20], of ICU utilization due to COVID-19 was 1.25 [95%CI 0.38-2.11] and 1.42 [95%CI 0.49-2.36] and of all-cause death was4.06 [95%CI 2.50-5.61] and 3.96 [95%CI 2.41-5.51] for oral N-BPs users and non-users, respectively (Figure 1A). Figure 1B Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated subjects with anti-osteoporotic drugs and without corticosteroids. C. Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated without previous vertebral or hip fragility fractures. D. Incidence of COVID-19related events in bisphosphonates treated and untreated patients without previous vertebral or hip fracture without corticosteroid prescriptions.

Conclusion

In conclusion, we found that the incidence of COVID-19 hospitalization, intensive care unit (ICU) utilization and COVID-19 potentially related mortality were similar in N-BPs treated and non-treated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provided real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results strongly support national and international guidelines that advocate against the discontinuation of oral bisphosphonates only for the fear of COVID-19.

Disclosure of Interests

None declared

AB0900 A temporary antirheumatic drugs withdrawal does not cause an excess of disease flares in patients with psoriatic arthritis undergoing Covid-19 mRNA vaccination

Background

The best way to manage disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatic and musculoskeletal diseases (RMDs) undergoing the Coronavirus disease (Covid)-19 vaccination and the recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination are still a matter of debate, due to the difficulties in balancing the vaccination efficacy and safety.

Objectives

To assess the impact of different strategies of antirheumatic treatment management on disease activity around the time of vaccination for Coronavirus disease (Covid)-19 in patients with psoriatic arthritis (PsA).

Methods

We prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines. Methotrexate (MTX) and leflunomide were withheld 7 days after each dose, whilst biological DMARDs (bDMARDs), were either continued (46.8% of the patients) or withheld (53.2%) from the day of the first dose until 7 days after the second dose. Patients were reassessed after 3 months from enrollment or in case of disease flare.

Results

After the second dose of Covid-19 vaccination 7 patients (5.6%) (6 females) had an articular disease flare each (mean involved joints: 1.29), one patient presented a concomitant worsening of psoriasis, and four patients had an isolated worsening of their psoriasis. All patients received additional treatments with oral GC (n=2) or non-steroidal anti-inflammatory drugs (n=5). Two flares lasted more than one week and required a modification of the ongoing bDMARD. Articular flare incidence (6.8% vs 3%, p=0.259), involved joints (1.4 vs 1.5, p=0.846), disease flare severity, and changes in antirheumatic therapies (1 vs 1, p=0.928) did not differ significantly between the two different bDMARD management strategy groups (continued vs temporary withheld). There was no significant difference in disease activity score for psoriatic arthritis (DAPSA) and C-reactive protein (CRP) after vaccination, but patients who flared up had a higher mean basal DAPSA (7.3 vs 4.1, p=0.046). On binomial logistic regression analysis, we did not find any significant association with gender, age, basal CRP, basal DAPSA, active psoriasis, conventional synthetic DMARDs, or bDMARDs and disease flare.

Conclusion

Our findings suggest that a temporary short halt of bDMARDs could be a viable option in patients with well-controlled PsA undergoing Covid-19 vaccination without increasing the risk of flares, which could be useful to increase T cell response and antibody titres after Covid-19 vaccination.

Disclosure of Interests

None declared

AB1018 RELATIONSHIP BETWEEN AORTIC CALCIFICATIONS AND DXA AND RADIOFREQUENCY ECHOGRAPHIC MULTI-SPECTROMETRY (REMS) ACQUISITIONS

Background

Data on the relationship between peritoneal dialysis (PD), BMD and aortic calcifications (AOC) are lacking.

Objectives

to study the relationship between the degree of AOC and DXA and Radiofrequency Echographic Multi-Spectrometry (REMS) acquisitions.

Methods

Consecutive patients referring to the PD our clinic were enrolled. Lumbar spine (LS) and proximal femur REMS scans were performed, and LS (anteroposterior and laterolateral) and proximal femur DXA scans were performed as well. The degree of AOC was assessed through the semiquantitative score described by Kauppila et al, and applied to the laterolateral LS DXA scans. To test for correlations between different variables, we used the Pearson’s correlation for continuous variables and Spearman’s rho for discrete variables. Multiple regression analysis was performed to adjust for age and body mass index (BMI) the correlation between BMD and the CKD duration. Written informed consent was obtained from all participants (protocol 1483CESC).

Results

41 total patients were enrolled (29 males, 19 females). Median disease duration of CKD [IQR]: 132 months [48-140]. 15% had vertebral fractures at the DXA Vertebral Fracture Assessment (VFA). The median calcification score [IQR] was 2 [0-6] (min-max 0-20).

We found a statistically significant positive correlation of moderate strength between the total calcification score and the difference between the DXA AP T-score and the DXA LL T-score at the LS (p<0.01, Spearman’s rho = 0.402), Figure 1.

Figure 1.

scatter plot reporting the relationship between the difference between the AP and LL T-scores and the aortic calcifications score.

After adjustment for confounders, we found a significant negative between the LS and femoral neck BMD measured through REMS and CKD duration (Table 1). The same correlation was not significant then BMD was assessed with DXA.

Table 1.

multiple linear regression analysis for REMS T-score at each site after adjustment for age and BMI. BMI, body mass index; β, standardised coefficient.

REMS lumbar spine T-scoreβpCKD duration (months)-0.2280.035Age (years)-0.511<0.01BMI (kg/m2)0.566<0.01REMS femoral neck T-scoreβpCKD duration (months)-0.2100.04Age (years)-0.612<0.01BMI (kg/m2)0.484<0.01REMS total hip T-scoreβpCKD duration (months)-0.1530.219Age (years)-0.523<0.01BMI (kg/m2)0.560<0.01

Conclusion

Our study confirmed that the overestimation of DXA BMD assessed with the anteroposterior scan is indeed influenced by AOC. Furthermore, our data suggest that REMS might be an interesting tool for the investigation of bone changes in CKD.

Disclosure of Interests

Angelo Fassio: None declared, Stefano Andreola: None declared, Davide Gatti Speakers bureau: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB, Paid instructor for: Amgen, Celgene Eli-Lilly, MSD-Italia, Organon, UCB, Matteo Gatti: None declared, Giovanni Gambaro Speakers bureau: Vitor Pharma, Ombretta Viapiana: None declared, Valeri Messina: None declared, Giulia Zanetti: None declared, Francesca Pistillo: None declared, Maurizio Rossini Speakers bureau: Abiogen, Amgen, Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Grunenthal, MSD, Novartis, Pfizer, Sanofi, Sandoz, Theramex, UCB., Giovanni Adami: None declared

POS1409 ASSOCIATION BETWEEN SHORT-TERM EXPOSURE TO ENVIRONMENTAL AIR POLLUTION AND PSORIASIS FLARE

Background

Psoriasis is a chronic inflammatory disease with a relapsing-remitting course. Selected environmental factors such as infections, stressful life events or drugs may trigger disease flares. Whether the air pollution could trigger psoriasis flares is still unknown.

Objectives

To investigate whether the short-term exposure to environmental air pollution is associated to psoriasis flares.

Methods

Observational study with both case-crossover and cross-sectional design was conducted. We retrospectively analyzed longitudinal data from 2013 to 2020 of patients with psoriasis attending the outpatient dermatologic clinic of the University Hospital of Verona. For the case-cross over analysis patients with at least one disease flare, defined as PASI increase ≥5 between 2 consecutive assessments in a time frame of 3-4 months, were considered. In the case-crossover analysis each patient serves as its own control; the exposure of interest is compared in two different periods in the same group of patients followed longitudinally (Figure 1). For the cross-sectional analysis, patients receiving any systemic treatment for ≥6 months, with ≥2 consecutive PASI assessment were included. We compared the mean and cumulative (area under the curve) concentrations of several air pollutants (CO, NO2, NOx, C6H6, PM10 and PM2.5) in the 60 days preceding the psoriasis flare and the control visits.

Results

A total of 957 patients with plaque psoriasis with 4,398 follow-up visits were included in the study. More than 15,000 measurements of air pollutants concentration from the official, open-source, bulletin of the Italian Institute for Environmental Protection and Research (ISPRA) were retrieved. Among the overall cohort, 369 (38.6%) patients with psoriasis flare were included in the case-crossover study. We found that concentrations of all pollutants were significantly higher in the 60 days before psoriasis flare (median PASI at the flare 12, IQR 9-18), compared to the control visit (median PASI 1, IQR 1-3, p <0.0001). In the cross-sectional analysis, exposure to mean PM10 over 20 μg/m3 and mean PM2.5 over 15 μg/m3 in the 60 days before assessment were associated with a higher risk of PASI ≥5 point worsening, aOR 1.55, 95% CI 1.21-1.99 and aOR 1.25, 95% CI 1.0-1.57, respectively (Figure 1). Sensitivity analyses that stratified for trimester of evaluation, with various lag of exposure and adjusting for type of treatment yielded similar results.

Conclusion

Air pollution may be a trigger factor for psoriasis flare.

Disclosure of Interests

Giovanni Adami Speakers bureau: Galapagos, Theramex, Francesco Bellinato: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Giampiero Girolomoni Shareholder of: AbbVie, Abiogen, Almirall, Amgen, Biogen, Bristol-Meyers Squibb, Eli-Lilly, Galderma, Genzyme, Leo Pharma, Pfizer, Regeneron, Samsung and Sanofi, Paolo Gisondi Shareholder of: Abbvie, Almirall, Amgen, Biogen, Eli Lilly, Jansenn, Novartis, Sanofi, UCB, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb

AB0627 Evaluation of internal consistency, feasibility, and reliability of the Italian version of ANCA-associated vasculitis patient-reported outcome (AAV-PRO_ita) questionnaire: preliminary results from a multicenter study on a large cohort of Italian patients

Background

The ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire is a 29-item disease-specific PRO measure for AAV[1]. The Italian version of the AAV-PRO questionnaire (AAV-PRO_ita) was translated in collaboration with Oxford and Bristol University (UK) and was preliminarily tested on a single-center Italian cohort[2].

Objectives

The main objective of this multicentric study was to assess the internal consistency, feasibility, and reliability of the AAV-PRO_ita in a large cohort of Italian AAV patients. The secondary objective was to investigate the clinical characteristics of AAV patients associated with AAV-PRO_ita domains.

Methods

The AAV-PRO_ita is describes the following disease domains: (1) organ-specific and systemic symptoms and signs (SSS); (2) physical function (PF); (3) social and emotional impact (SEI). In this study, Italian-speaking AAV patients were recruited from Italian Centres (N=13) with a large experience in the diagnosis and treatment of systemic vasculitis, belonging to the Vasculitis Study Group of the Italian Society of Rheumatology. Inclusion criteria were: a confirmed diagnosis of GPA, MPA, or EGPA; ANCA positivity in at least once occasion or biopsy-proven AAV; and age ≥18 years old. Participants completed the AAV-PRO_ita at three different time-points: baseline, after 5-7 days, and at month 3.

Results

229 AAV-patients (56.3% women) with a median age of 61 (IQR 51-72) were recruited and completed the questionnaires. The subtype of AAV was mainly GPA (131, 57.2%), followed by EGPA (58, 25.3%), and MPA (40, 17.5%). Median BVASv3 at baseline was 0 (IQR 0-3), whereas the median BVASv3 at the onset of disease was 14 (IQR 9-20). Participants had a median duration of disease of 67 (IQR 24-126) months. Patients who experienced at least one relapse, one hospitalization, and one severe infection were 40.2%, 53.3%, and 24%, respectively. 83% of the patients were on immunosuppressant therapy and 71.6% were still receiving glucocorticoids (GC).

AAV-PRO_ita questionnaire had good internal consistency (Cronbach’s Alpha range 0.81-0.93) and good test-retest reliability (ICCs range 0.93-0.96). Item response rates were high overall (maximum 0.87% missing data), supporting the feasibility of the questionnaire.

Concerning the domains of the questionnaire, female AAV patients scored higher (i.e. worse) in all three domains, especially in the SEI domain (p-value<0.001). Older participants (≥65 years) scored higher in the PF domain (p-value<0.05) in all three times of self-completions of the questionnaire. The ongoing treatment also influenced the results. In fact, patients on GC showed higher scores in the PF domain (p-value=0.003) and SEI domain (p-value=0.021). The VDI value seemed to be related to AAV-PRO_ita scores more than disease duration or disease activity, especially in the SSS domain (ρ>0.3, p-value<0.001). Conversely, subtype of AAV did not influence the item scores.

Conclusion

The AAV-PRO_ita questionnaire is a new 29-item, disease-specific PRO measure for use in AAV in the Italian language. It is a self-administered Italian questionnaire with good internal consistency, feasibility, and reliability. AAV-PRO_ita proved to be a useful tool to explore the AAV patient’s perception of quality of life, and it could become an important way of measuring the unmet needs of AAV patients.

References

[1]Robson, J.C. et al. Validation of the ANCA-Associated Vasculitis Patient-Reported Outcomes (AAV-PRO) Questionnaire. Ann. Rheum. Dis.2018, 77, 1157–1164, doi:10.1136/annrheumdis-2017-212713.

[2]Treppo, E.; Palese, A.; Vita, S.D.; Quartuccio, L. AB0392 PRELIMINARY VALIDATION OF THE ITALIAN VERSION OF ANCA-ASSOCIATED VASCULITIS PATIENT-REPORTED OUTCOME (AAV-PRO_ita) QUESTIONNAIRE: FATIGUE AND CHRONIC PAIN AS UNMET NEEDS BY CURRENT TREATMENTS. Ann. Rheum. Dis.2021, 80, 1224–1224, doi:10.1136/annrheumdis-2021-eular.2123.

Acknowledgements

We thank the Italian Study Group on Systemic Vasculitis.

Disclosure of Interests

None declared

POS0634 SAFETY PROFILE OF b/tsDMARD IN RHEUMATOID ARTHRITIS PATIENTS WITH IMPAIRED GLOMERULAR FILTRATION RATE. AN ANALYSIS FROM THE GISEA REGISTRY

Background

In real-life setting, a greater number of elderly rheumatoid arthritis (RA) patients with impaired glomerular filtration rate (GFR) needs treatment with biologic or target synthetic disease-modifying anti-rheumatic drugs (b/tsDMARD) to achieve disease control and reduce NSAIDs intake. Long-term observational data from the real-life on the use of b/tsDMARD in these patients are scarce.

Objectives

The aim of this study was to evaluate the retention rate of b/tsDMARD in RA patients with impaired GFR in real-life setting.

Methods

Data of RA patients treated with at least one b/tsDMARD were retrospectively analyzed form the national Italian GISEA registry from January 2016 to December 2021. Estimated-GFR (eGFR) was calculated with the Cockcroft-Gault equation at the time of any b/tsDMARD prescription. For the purpose of this study, patients were divided in two groups, patients with impaired GFR (eGFR ≤60) and patients with normal GFR (eGFR >60). The retention rate was calculated by the Kaplan-Meier method and compared between these two groups by a log-rank test.

Results

The study population included 2443 treatment-line with b/tsDMARD from 1888 patients (female 80.4%, age 57±12 years, mean baseline CDAI 17±12, FR/ACPA+ 69.5%) who started a new b/tsDMARD. Disease characteristics are shown in Table 1. 288 treatments with b/tsDMARD were started in patients with impaired eGFR and 2155 in patients with normal eGFR. Compared to patients with eGFR >60, patients with eGFR ≤60 showed higher HAQ-DI (1.3±0.8 vs 1±0.8, p<0.001) at the start of b/tsDMARD treatment. Glucocorticoids were more prescribed in patients with impaired eGFR (80.2% vs 72.8%, p<0.01), while csDMARDs were more prescribed in association with b/tsDMARD in patients with normal eGFR (83.1% vs 76.4%, p<0.01). Of note, CTLA4-Ig treatment was more prescribed in patients with impaired eGFR (26% vs 17.1%, p<0.05), while no difference in b/tsDMARD prescription was observed for other mechanism of actions. Drug survival was similar between RA patients with impaired eGFR [58.2%, mean survival time 35 months (CI95% 31-39)]and RA patients with normal eGFR [55%, mean survival time 34.4 months (CI95% 33-36), log rank: 0.88] (Figure 1). Cox regression model adjusted for age, sex and b/tsDMARD showed no impact of eGFR on drug survival [HR: 0.9 (CI95%: 0.7-1.2).

Conclusion

Our data show that impaired eGFR seems to not influence the persistence of b/tsDMARD treatment in RA patients.

Disclosure of Interests

None declared

OP0242 ASSOCIATION BETWEEN EXPOSURE TO FINE PARTICULATE MATTER AND OSTEOPOROSIS: A POPULATION-BASED COHORT STUDY

Background

Environmental air pollution has been associated with disruption of bone health at a molecular level. Particulate matter (PM) exposure can simultaneously stimulate bone resorption and halt bone formation.

Objectives

The primary aim of the present study is to describe the association between long-term exposure to PM and osteoporosis in a large cohort of women at high risk of fracture.

Methods

Clinical, demographic and densitometric data were extracted from the DeFRAcalc79 dataset, which gathers data on women at risk for osteoporosis. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (Istituto Superiore per la Protezione e la Ricerca Ambientale, ISPRA). Every study subject was linked to a PM exposure value, which resulted from the average concentration of urban, rural and near-traffic stations of the subject residency (ZIP code centroids 25 km) from January 2013 to December 2019. Generalized linear models with robust estimators were employed to determine the relationship between BMD and PM long-term exposure. We sequentially adjusted for confounders. Model 1 included age, body mass index (BMI), presence of prevalent fragility fractures, family history of vertebral or hip fractures, and menopause. Model 2 was further adjusted for glucocorticoid treatment and comorbidities. Model 3 (main model) added to model 2 the macro-area of residency (stratified as a categorical variable: northern Italy, central Italy and southern Italy).

Results

59,950 women from 110 Italian provinces were included in the study. PM 2,5 exposure was negatively associated with T-score levels at the femoral neck (β -0.005, 95 CI -0.007 to -0.003) and lumbar spine (β -0.003, 95% CI -0.006 to -0.001). Chronic exposure to PM2.5 above 25 μg/m3 was associated with a 16% higher risk of having osteoporotic T-score at any site (aOR 1.161, 95% CI 1.105 to 1.220), exposure to PM10 above 30 μg/m3 was associated with a 15% higher risk of having osteoporotic T-score at any site (aOR 1.148, 95% CI 1.098 to 1.200).

Conclusion

Long-term exposure to air pollution was associated with higher risk of osteoporosis. Femoral neck site seemed to be more susceptible to the detrimental effect of PM exposure than lumbar spine site.

Disclosure of Interests

Giovanni Adami Shareholder of: Galapagos, Theramex, Camilla Benini: None declared, Angelo Fassio: None declared, Eugenia Bertoldo: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

POS0629 PREVALENCE AND FACTORS ASSOCIATED WITH SARCOPENIA IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Sarcopenia is a progressive and generalized skeletal muscle loss associated with falls, fractures, physical disability, and mortality, described as age-related or secondary. Systemic inflammatory diseases, such as rheumatoid arthritis (RA), are well-known causes of secondary sarcopenia. However, the exact prevalence of sarcopenia in patients with RA is still unknown, partly due to the heterogeneous definitions of sarcopenia adopted in different studies.

Objectives

To assess the prevalence of sarcopenia in a cohort of patients affected by RA, and to evaluate the influence of age, sex, comorbidity, disease duration and activity, antibody status and therapies on sarcopenia.

Methods

We conducted a retrospective observational study on adult patients affected by RA undergoing evaluation at our outpatient clinic from January 2009 and July 2021. All patients underwent dual-energy X-ray absorptiometry (DXA) for assessment of body composition; diagnosis of sarcopenia was defined using Skeletal Muscle Mass Index (SMI), as proposed by consensus EWGSOP2 (1). We collected relevant demographic, clinical, therapeutic, and laboratory data at the time of DXA. We excluded patients affected by neoplastic disorders and/or malnutrition. Binary logistic regression analysis was employed to define predictors and protective factors of developing sarcopenia.

Results

A total of 266 patients (82.7% women) with a median age of 58.4 (IQR 14.4) years were included in the study. The prevalence of sarcopenia was 27.44%. From the binary logistic regression analysis, we found that the use of oral glucocorticoids (GCs) at a daily dose > 3.25 mg of prednisone-equivalent was significantly associated with sarcopenia (β 0.68, p = 0.047, aOR 1.98, 95% CI 1.009 – 3.881) (Figure 1). We found a significant inverse correlation between conventional disease-modifying antirheumatic drug (c-DMARDs) and sarcopenia (β -0.71, p = 0.027) as well. Age, sex, disease duration, mean disease activity - expressed as disease activity score based on 28 joints (DAS-28), erosive and seropositive disease - and biologic disease-modifying antirheumatic drug (b-DMARDs) therapy were not predictors of sarcopenia, albeit seropositive status showed a correlation trend with increased prevalence of sarcopenia (p = 0.092).

Figure 1.

Conclusion

Our study showed that sarcopenia is a common complication in RA. Glucocorticoid therapy was associated with an increased prevalence of sarcopenia, while c-DMARDs acted as protective factors, possibly decreasing chronic inflammation. No correlation was found with b-DMARDs, possibly due to association with longer and more aggressive rheumatic disease.

References

[1]Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31

Disclosure of Interests

None declared

AB0930 Psoriatic arthritis disease flares: is Covid-19 vaccination just an innocent bystander?

Background

So far, few studies provided detailed data for the incidence of disease flare after the vaccination against Coronavirus (Covid)-19 in patients with psoriatic arthritis (PsA). Results from small cohorts report an incidence of flares after Covid-19 vaccination of 0-7.7% and disease activity does not seems to be influenced by Covid-19 vaccination in patients with PsA. However, since PsA is a highly fluctuating disease with prolonged remission and irregular reactivation, it is difficult to establish a causal relationship between the Covid-19 vaccination and disease flares.

Objectives

To define the impact of Covid-19 vaccination and disease activity on the incidence of disease flare in patients with psoriatic arthritis (PsA).

Methods

We prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines, collecting demographic, clinical, and therapeutic data and assessing DAPSA 28, PCR before and after vaccination. We assessed flares using patients and clinician concordance. We retrospectively evaluated flare incidence in the same timeframe of the previous year. We performed statistical analysis to find possible predictors of flares after vaccination.

Results

A total of 57 patients with PsA were prospectively evaluated, and retrospective analysis was possible for 53 of them. DAPSA 28 and CRP did not differ significantly before and after the vaccination. The incidence of flares in the two periods (2020 vs 2021) did not differ significantly (18.8% vs 8.8%, p=0.166). We found a higher basal mean DAPSA 28 in patients who flared up after vaccination (7.3 vs 4.1, p-value 0.046). Only having a flare in the previous year was associated with a higher chance of recurrence after Covid-19 vaccination (p=0.02) in the logistic regression analysis, while other predictors (age, gender, disease activity, ongoing DMARD therapy, ongoing bDMARD therapy) did not.

Conclusion

Our findings suggest that, in patients with PsA, disease activity could be the main driver of disease flares rather than Covid-19 vaccination.

References

[1]Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study. Ann Rheum Dis. 2021, 10:1330-1338.

[2]Geisen UM, Berner DK, Tran F, et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort. Ann Rheum Dis. 2021, 10:1306-1311.

[3]Machado PM, Lawson-Tovey S, Strangfeld A, et al. Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry. Ann Rheum Dis 2021 Epub ahead of print.

[4]Braun-Moscovici Y, Kaplan M, Braun M, et al (2021) Disease activity and humoral response in patients with inflammatory rheumatic diseases after two doses of the Pfizer mRNA vaccine against SARS-CoV-2. Ann Rheum Dis 80:1317–1321.

[5]Spinelli FR, Favalli EG, Garufi C, et al. Low frequency of disease flare in patients with rheumatic musculoskeletal diseases who received SARS-CoV-2 mRNA vaccine. Arthritis Res Ther 2022, 24:21.

Disclosure of Interests

None declared

POS0386 A NOVEL ECHOCARDIOGRAPHY METHOD FOR THE DETECTION OF SUBCLINICAL MYOCARDIAL FIBROSIS IN PATIENTS WITH SYSTEMIC SCLEROSIS: A CROSS-SECTIONAL STUDY

Background

Scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) is a novel technique allowing detection of myocardial scars. eSCAR has never been explored in patients with systemic sclerosis (SSc).

Objectives

The aim of our study was to examine whether eSCAR may detect subclinical myocardial fibrosis in SSc.

Methods

In this cross-sectional study conducted between 11/2020 and 02/2021, consecutive SSc patients from the University of Verona underwent cardiovascular disease (CVD) screening procedures including standard transthoracic echocardiography (TTE) and myocardial scars detection through the eSCAR technique. We excluded patients with prior history of structural heart disease and pulmonary hypertension. To validate eSCAR findings, we assessed myocardial function through global longitudinal strain (GLS) analysis by speckle tracking echocardiography (STE). We also conducted a case-control study comparing eSCAR findings in randomly selected SSc patients and non-SSc controls matched 1:1 for age, sex and number of CVD risk factors. The primary outcome was the proportion of patients with myocardial scars. Principal component analysis (PCA) was used to determine main eSCAR patterns. Multivariable linear regression analysis was used to minimise confounding.

Results

Scar imaging echocardiography revealed that 42/92 (44%) SSc patients had myocardial scars involving a median [25th-75th percentile] of 4 [1-7] segments. PCA identified that myocardial scars localised mostly at the inferior and septal segments (inferoseptal pattern; Figure 1). STE validation confirmed that GLS was significantly reduced in SSc patients with inferoseptal scars (Table 1). Otherwise, all standard echocardiography measures were normal in both groups. In multivariable regression analysis, prior digital ulcerations (B=0.41, 95% CI 0.008 to 0.809, p=0.045) and body mass index (B=-0.06, 95% CI -0.113 to -0.015, p=0.012) were both significantly and independently associated with inferoseptal myocardial scars. Myocardial scars were found in 38% of SSc patients and no matched controls (p<0.0001).

Table 1.

Comparison of speckle tracking echocardiography (longitudinal myocardial strain) in eSCAR-positive (inferoseptal pattern) and eSCAR-negative (no inferoseptal pattern) patients.

Speckle tracking echocardiographyeSCAR-positive (n= 8)eSCAR-negative (n=31)P-valueGLS global (%)- 20.24 (2.39)- 20.42 (3.65)0.895GLS 4-chambers (%)- 20.66 (1.91)- 20.09 (4.12)0.720GLS 2-chambers (%)- 23.02 (5.23)- 21.97 (3.89)0.924GLS 3-chambers (%)- 17.11 (2.60)- 19.31 (5.26)0.015GLS apical- anterior- 19.60 (6.12)- 17.72 (4.42)0.857- inferior- 26.89 (7.79)- 23.65 (5.46)0.581- lateral- 18.91 (2.04)- 18.13 (5.12)0.508- septal- 22.68 (7.14)- 21.76 (7.04)0.844GLS basal- anterior- 23.35 (3.82)- 22.75 (8.36)0.752- anteroseptal- 14.09 (4.74)- 18.66 (7.46)0.109- inferior- 22.69 (8.49)- 22.78 (6.94)0.818- lateral- 19.99 (7.68)- 22.55 (7.01)0.218- septal- 14.26 (4.63)- 18.07 (8.79)0.081GLS mid- inferior- 23.09 (6.12)- 22.58 (5.07)0.917- septal- 14.80 (5.69)- 17.50 (7.53)0.056- anterior- 20.54 (3.28)- 19.73 (6.520.026- anteroseptal- 14.70 (4.96)- 18.13 (5.20)0.010- lateral- 18.64 (5.79)- 20.09 (5.73)0.270

Data are reported as mean (S.D.). GLS, global longitudinal strain.

Figure 1.

Conclusion

This simple ultrasound technique allows detection of myocardial dysfunction associated with scars in SSc patients, or its absence in matched controls. Patients with prior digital ulcerations and low body weight have the strongest association with inferoseptal myocardial scars. eSCAR may help detect subclinical myocardial fibrosis in SSc.

Disclosure of Interests

None declared

POS0111 MORE METICULOUSLY FOLLOWING TREAT-TO-TARGET IN RA DOES NOT LEAD TO LESS RADIOGRAPHIC PROGRESSION: A LONGITUDINAL ANALYSIS IN BIODAM

Background

A Treat-to-Target approach (T2T) is broadly considered to lead to better clinical outcomes and recommended in patients with RA. However, very few studies have analyzed the effect of T2T on radiographic progression, and any such studies have provided inconsistent results.

Objectives

To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice leads to lower radiographic progression in RA.

Methods

Patients from the multicenter RA-BIODAM cohort with ≥2 consecutive visits with radiographs available were included. In RA-BIODAM patients were enrolled as they were initiating a new csDMARD/bDMARD treatment were followed-up with the intention to benchmark and intensify treatment. The primary outcome of this analysis was the change in Sharp-van der Heijde score (SvdH, 0-448), assessed every 6 months, using average scores from 2 readers (scores with known chronological order). Following a DAS44-T2T remission strategy, which was defined at each 3-month visit, was the main variable of interest. Patients were categorized based on the proportion of visits in which T2T was followed according to our definition: very low (≤40% of the visits, low (>40%, <62.5%), high (≥62.5%, ≤75%) and very high (>75%). Radiographic progression at 2 years was visualized across groups by cumulative probability plots. Per 3-month interval T2T could be followed zero, one or two times (in a total of 2 visits). Associations between the number of visits with T2T in an interval and radiographic progression, both in the same and in the subsequent 6-month interval, were analysed by generalised estimating equations, adjusted for age, gender, disease duration and country.

Results

In total, 511 patients were included (mean (SD) age: 56 (13) years; 76% female). After 2 years, patients showed on average 2.2 (4.1) units progression (median:1 unit). Mean (SD) 2-year progression was not significantly different across categories of T2T: very low: 2.1 (2.7)-units; low: 2.8 (6.0); high: 2.4 (4.5), very high: 1.6 (2.2) (Figure 1). Meticulously following-up T2T in a 3-month interval neither reduced progression in the same 6-month interval (parameter estimates (for yes vs no): +0.15 units (95%CI: -0.04 to 0.33) for 2 vs 0 visits; and +0.08 units (-0.06;0.22) for 1 vs 0 visits) nor did it reduce progression in the subsequent 6-month interval (Table 1).

Table 1.

Effect of following DAS44-remission-T2T strategy on 6-month radiographic progression over 2 years

Change in radiographic damage(regression coefficient (95% CI))N=506T2T during 3 months on radiographic progression in the same 6-month period 2 visits vs 0 followed0.15 (-0.04; 0.33) 1 visit vs 0 followed0.08 (-0.06; 0.22)T2T during 3 months on radiographic progression in the subsequent 6-month period 2 visits vs 0 followed-0.09 (-0.28; 0.10) 1 visit vs 0 followed-0.10 (-0.24; 0.05)Figure 1.

Cumulative probability plot with 2-year radiographic progression according to the proportion of 3-monthly visits with T2T followed

Conclusion

In this daily practice cohort, more meticulously following T2T principles did not result in more reduction of radiographic progression than a somewhat more liberal attitude toward T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.

Acknowledgements

BIODAM was financially supported by an unrestricted grant from AbbVie

Disclosure of Interests

Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Robert B.M. Landewé Speakers bureau: AbbVie, BMS, Gilead, Galapagos, GSK,Janssen, Lilly, Novartis, Pfizer, UCB, Consultant of: AbbVie, BMS, Gilead, Galapagos, GSK,Janssen, Lilly, Novartis, Pfizer, UCB

Dr Landewé owns Rheumatology Consultancy BV, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. Director of Imaging Rheumatology bv., Alexandre Sepriano Speakers bureau: Novartis, Consultant of: UCB, Oliver FitzGerald Speakers bureau: Biogen, Novartis, AbbVie, BMS, Pfizer, Grant/research support from: BMS, Novartis, UCB, Pfizer, Lilly, Janssen, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Orion, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, Amgen, BMS, Merck, Celgene and Novartis, Joanne Homik: None declared, Ori Elkayam Speakers bureau: Pfizer, Lilly, Novartis, Abbvie, BI, Janssen, Consultant of: Pfizer, Lilly, Novartis, Abbvie, BI, Janssen, Grant/research support from: Pfizer, Abbvie, Janssen, Carter Thorne Consultant of: Abbvie, Organon, Pfizer, Sandoz, Maggie Larché Speakers bureau: AbbVie, Actelion, Amgen, BMS, Boehringer-Ingelheim, Fresenius-Kabi, Gilead, Janssen, Mallinckrodt, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Sobi, UCB, Grant/research support from: Abbvie, BMS, Gianfranco Ferraccioli Speakers bureau: SOBI, Consultant of: Abbivie, Marina Backhaus: None declared, Gilles Boire Speakers bureau: Abbvie Canada, BMS Canada, Lilly Canada, Janssen Canada, Merck Canada, Pfizer Canada, Viatris, Consultant of: Abbvie Canada, Amgen Canada, BMS Canada, Celgene, GileadSciences, Janssen Canada, Lilly Canada, Merck Canada, Mylan Canada, Novartis Canada, Pfizer Canada, Roche Canada, Samsung Bioepis, Sanofi Canada, Teva, Grant/research support from: Lilly Canada, BMS Canada, Pfizer, Sandoz Canada, UCB Canada, Merck Canada, Novartis Canada, Roche Canada, Bernard Combe Speakers bureau: Abbvie, BMS,Celltrion,Galapgos-Gilead, Janssen, Lilly, MERCK, Pfizer,Roche-Chugai, Consultant of: Abbvie, Celltrion,Galapgos-Gilead, Janssen, Lilly, MERCK, Roche-Chugai, Grant/research support from: Pfizer, Roche-chugai, Thierry Schaeverbeke: None declared, Alain Saraux Speakers bureau: Abbvie, Lilly, Nordic, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Consultant of: Abbvie, Lilly, Nordic, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Novartis, Fresenius, Lilly, Maxime Dougados Consultant of: Pfizer, AbbVie, UCB, Merck, Lilly, Novartis, BMS, Galapagos, Biogen, Roche, Grant/research support from: Pfizer, AbbVie, UCB, Merck, Lilly, Novartis, BMS, Galapagos, Biogen, Roche, Maurizio Rossini Speakers bureau: Amgen, Abbvie, BMS, Eli-Lilly, Galapagos,MSD, Novartis, Pfizer, Sandoz, Theramex, UCB, Marcello Govoni Speakers bureau: Abbvie, Pfizer, Galapagos, BMS, Eli-Lilly, Paid instructor for: Pfizer, Consultant of: Abbvie, BMS, Novartis, Astrazeneca, Pfizer, Luigi Sinigaglia: None declared, Alain Cantagrel Speakers bureau: Abbvie, Amgen, Biogen, BMS, Janssen, Lilly France, Médac, MSD France, Nordic-Pharma, Novartis, Pfizer, Sanofi Aventis, UCB, Consultant of: BMS, Janssen, Lilly France, MSD France, Sandoz, Grant/research support from: MSD France, Novartis, Pfizer, Cornelia Allaart: None declared, Cheryl Barnabe Speakers bureau: Sanofi Genzyme, Pfizer, Fresenius Kabi, Janssen, Consultant of: Gilead, Celltrion Healthcare, Clifton Bingham Consultant of: AbbVie, BMS, Eli Lilly, Janssen, Moderna, Pfizer, Sanofi, Grant/research support from: BMS, Dirkjan van Schaardenburg: None declared, Hilde Berner Hammer Speakers bureau: AbbVie, Novartis, Lilly, Rana Dadashova: None declared, Edna Hutchings: None declared, Joel Paschke: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celgene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer

AB0692 Predictors of iloprost infusion tolerance in patients with systemic sclerosis

Background

Systemic Sclerosis (SSc) is an autoimmune disease characterized by vasospasm and microvascular involvement. Iloprost (ILO), a prostaglandin analogous, is used for the treatment of SSc-related Raynaud’s Phenomenon and digital ulcers. The indicated dosage is 0-5-2 ng/kg/min for 6-8 hours and the maximum dose is decided upon the patient’s tolerance.

Objectives

Our study aims to analyse ILO infusion tolerance and possible predictive factors in patients with SSc.

Methods

We evaluated patients with SSc beginning ILO iv treatment between 2004 and 2021. We assessed the maximum tolerated ILO iv infusion rate, the incidence of adverse events (AEs) and the need for symptomatic therapy during the dose-finding sessions. We collected relevant demographic and medical data at the beginning of ILO iv treatment. Statistical analysis were performed to assess possible predictors of maximum tolerated ILO infusion rate and AEs.

Results

We retrospectively analysed 113 patients. The median ILO infusion rate at the end of the dose-finding process was 0.88 ng/kg/min (IQR 0.37). We found a significant inverse correlation between ILO infusion rate and body mass index (BMI) at the beginning of treatment. BMI was negatively associated with ILO infusion rate (β -0.29, p = 0.001) after correction for relevant confounding factors. Subjects in the upper BMI tertile (BMI above 25) had a lower tolerance to ILO compared with subjects in the lower BMI tertile BMI below 22 (p=0.002). Disease pattern, disease duration, age at the onset of disease, mean blood pressure, gender, smoking habits, combination therapy with calcium channel blocker or endothelin inhibitors were not predictors of ILO tolerance. AEs during ILO titration occurred in 47.8% of patients, of whom 22.2% presented concomitant hypotension. The most common AEs were headache, nausea, vomiting, diarrhoea, oedema, hypotension, and symptomatic therapy was needed in half of the patients at least once. Overweight patients (BMI >26) presented a 13-fold increased risk of developing AEs during ILO titration (adjusted odd ratio 13.979 95% CI 2.359-82.845).

Conclusion

Our study showed that only a higher BMI was associated with lower ILO infusion rate tolerance and higher AEs rate, underlying a possible BMI-dependent endothelial dysfunction possibly mediated by endothelin receptor expression. Individual ILO regimens still need to be tailored to the patient.

Disclosure of Interests

None declared

Case study on simulation analysis of a logistics network with multiple products by applying lateral transshipments algorithms

Purpose

The purpose of this paper is to develop a simulation model to evaluate inventory and distribution decisions like lateral transshipments in a network with multiple products.

Design/methodology/approach

Data are collected from a company, and a discrete-event simulation in Python is developed to support the decision-making process of managers through different algorithms of lateral transshipments.

Findings

The numerical results show that the periodic delivery-continuous reorder policy is more robust than the others because the reorder process is not affected by the higher saturation that is achieved by periodic reorder–based policies. The new lateral transshipment algorithm will lead to huge savings in logistics costs for any company and increase truck saturation without causing a decrease in the service level.

Research limitations/implications

This paper provides a novel institutional perspective on a complex logistics issue where COVD-19 is believed to complicate the context.

Practical implications

This solution is devised for any company to achieve even greater benefits in terms of customer service improvement and logistics costs reduction.

Originality/value

The main contribution of this paper is the proposal of a new lateral transshipment algorithm that shows performance improvement by simulating distribution network processes according to different configurations.

OP0239 REAL-LIFE SHORT-TERM EFFECTIVENESS OF ANTI-OSTEOPOROTIC TREATMENTS: A LONGITUDINAL COHORT STUDY

Background

Data from randomized clinical trials showed that anti-osteoporotic treatments increase bone mineral density (BMD) and reduce the risk of fragility fractures. However, data on the real-life effectiveness of such medications is still scarce.

Objectives

The primary objective of the present study is to assess the real-life effectiveness of anti-osteoporotic treatment in a representative cohort of Italian women at high risk of fracture

Methods

We conducted a cohort study on women at high risk of fracture. We retrieved clinical and densitometric data from the DeFRA database, which derives from the DeFRA tool, a web-based fracture risk assessment tool. Multivariable Cox regression survival models were employed to analyze the effectiveness of different anti-osteoporotic drugs on fracture. In sensitivity analyses we generated 1:1 matched cohorts of patients with prescription of bisphosphonates, denosumab, teriparatide or without any pharmacological prescription at baseline and 1:1 matched cohort based on the T-score variation over the time (increase in T-score vs decrease or stability in T-score values).

Results

Data from 50,862 women were available. Among these, 3,574 individuals had at least 2 consecutive visits. The crude fracture rate was 91.9/1,000 person-year for non-treated patients. The crude fracture rate in bisphosphonate users was 72.1/1,000 person-year, in denosumab users was 58.2/1,000 person-year and in teriparatide users was 19.3/1000 person-year. Overall, we found that bisphosphonates were associated with a 30% lower risk of fracture compared to no treatment (aHR 0.70, 95% CI 0.50-0.98), denosumab and teriparatide were associated with 60% and 90% lower risk of fracture, respectively (aHR 0.43, 95% CI 0.24-0.75 and aHR 0.09, 95% CI 0.01-0.70). Bisphosphonate use was associated with a lower risk of fracture only after one year of treatment. In Figure 1 are presented the Kaplan Meier curves free from fragility fracture after propensity score matching.

Conclusion

In conclusion, we found that all anti-osteoporotic medications effectively reduced the risk of fracture in the real-life. Bisphosphonate’s effect on fracture risk was apparent only after the first year of treatment. Our findings do not support the use of bisphosphonates in patients at imminent risk of fracture.

Disclosure of Interests

Giovanni Adami Shareholder of: Theramex, Galapagos, IRENE GAVIOLI: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Eugenia Bertoldo: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

Intraoperative Neuromonitoring, Nerves at Risk and Staged Thyroidectomy, our Experience on 377 Consecutive Cases

PURPOSE

The aim of this study was firstly to report the experience of intermittent intraoperative neuromonitoring (I-IONM) and evaluate the impact of loss of signal (LOS) in staged thyroidectomy management.

METHODS

We retrospectively reviewed patients who underwent total thyroidectomy, performed by a single surgeon in two years. All patients have been subjected to I-IONM. In case of intraoperative loss of signal (LOS), planned total thyroidectomy was always aborted. Six-month follow-up was performed. Postoperative dysphonia was evaluated with VHI-10 score in 3 time settings T1, during hospital stay, T2 after 30 days, T3 after 6 months. Dysphonia has been compared to IONM results to evaluate sensitivity and specificity.

RESULTS

377 patients were included. Incidence of dysphonia was calculated based on the number of nerves at risk (NAR). We evaluated a total of 724 NAR. LOS encountered were 43 cases (5.9% of total NAR), of these 14 were LOS 1 while 29 were LOS 2. 27 patients (3.7% of NAR) presented early post-operative dysphonia with VHI-10 score > 13 (T1), among these 16 had presented LOS at IONM (true positives) while11 had no LOS (false negatives). In T2 and T3 we reported a decrease in true positive cases increasing false positives. Sensitivity at T3 reached 85.7% while specificity and odds ratio were respectively 94.8% and 110.

CONCLUSIONS

Given the high sensitivity and specificity, IONM should be considered a useful tool for thyroid surgery and its use should be suggested for patients undergoing planned total thyroidectomy. Its right application may cancel the risk of bilateral paralysis.

Association between exposure to fine particulate matter and osteoporosis: a population-based cohort study

Long-term environmental air pollution exposure was associated with osteoporosis' risk in a cohort of women at high risk of fracture. Cortical sites seemed to be more susceptible to the exposure's effect.

INTRODUCTION

Environmental air pollution has been associated with disruption of bone health at a molecular level. Particulate matter (PM) exposure can simultaneously stimulate bone resorption and halt bone formation. The primary aim of the present study is to describe the association between long-term exposure to PM and osteoporosis in a large cohort of women at high risk of fracture.

METHODS

Clinical, demographic, and densitometric data were extracted from the DeFRAcalc79 dataset, which gathers data on women at risk for osteoporosis. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (Istituto Superiore per la Protezione e la Ricerca Ambientale, ISPRA). Generalized linear models with robust estimators were employed to determine the relationship between BMD and PM long-term exposure.

RESULTS

A total 59,950 women from 110 Italian provinces were included in the study. PM 2.5 exposure was negatively associated with T-score levels at the femoral neck (β -0.005, 95 CI -0.007 to -0.003) and lumbar spine (β -0.003, 95% CI -0.006 to -0.001). Chronic exposure to PM2.5 above 25 μg/m3 was associated with a 16% higher risk of having osteoporotic T-score at any site (aOR 1.161, 95% CI 1.105 to 1.220), and exposure to PM10 above 30 μg/m3 was associated with a 15% higher risk of having osteoporotic T-score at any site (aOR 1.148, 95% CI 1.098 to 1.200).

CONCLUSION

Long-term exposure to air pollution was associated with higher risk of osteoporosis. Femoral neck site seemed to be more susceptible to the detrimental effect of PM exposure than lumbar spine site.

KEY MESSAGE

Exposure to air pollution is associated with osteoporosis, mainly at femoral site.

Efficacy of mud plus bath therapy as compared to bath therapy in osteoarthritis of hands and knees: a pilot single-blinded randomized controlled trial

The primary objective of this study was to assess the efficacy of mud plus bath therapy in comparison to bath therapy alone in hand and knee osteoarthritis (HOA and KOA). We conducted a single-blinded randomized controlled trial (RCT). Patients were randomly assigned to either mud plus bath therapy (group 1) or balneotherapy (group 2). The primary outcome was a change in AUSCAN questionnaire for HOA and in WOMAC for KOA at month 12. Evaluations were performed at baseline (B), immediately after the interventions (week 2, W2) and after 3 (M3), 6 (M6), 9 (M9) and 12 (M12) months. 37 patients with KOA and 52 with HOA were randomized in the study. In HOA patients, AUSCAN pain improved more in group 1 compared to group 2 at M3, M6 and M12 (p<0.001, p=0.001 and p=0.038, respectively). AUSCAN stiffness improved more in group 1 at M3 (p=0.001). AUSCAN function improved more at M3, M6, M9 and M12 (p=0.001, p=0.001, p=0.014 and p=0.018, respectively). Regarding, KOA, WOMAC function decreased more prominently in group 1 compared to group 2 at M9 (p=0.007). The absolute values of WOMAC function at M6 and M9 were lower in group 1 compared to group 2 (p=0.029 and p=0.001, respectively). WOMAC pain absolute values were lower in group 1 at W2 (p=0.044) and at M9 (p=0.08). We conducted a RCT on the efficacy of mud plus balneotherapy over balneotherapy alone in HOA and KOA. We found that mud plus balneotherapy was more effective than balneotherapy alone on clinical outcomes of HOA. Differences in clinical outcomes of KOA were not significant, yet numerically higher.

How COVID-19 pandemic has changed elective surgery: the experience in a general surgery unit at a COVID-hospital

Objective:

Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in a General Surgery Unit of a tertiary Covid-Hospital.

Methods:

We report and compared all the surgical procedures performed between two periods (March and April 2019 and March and April 2020) at General Surgery Department of Parma University Hospital, a tertiary Covid-Hospital.

Results:

Between March and April 2019, a total of 232 surgical procedures were performed. Between March and April 2020 only 61 surgical procedures were performed. In 2019 84 patients underwent surgery for cancer and 171 underwent surgery for benign diseases. In 2020 only 37 patients underwent surgery for oncological reasons and 24 underwent surgery for benign diseases.

Conclusions:

During pandemic Covid-19 the access to health services was limited and poor. Limited access to health services and the fear of Covid-19 infection can explain the lower number of elective surgical procedures for cancer in 2020 compared to the same period in the 2019. (www.actabiomedica.it)

Multifocality in patients treated for papillary Thyroid Carcinoma: a preliminary analysis of related risk factors

Background:

Multifocality is usually detected afterwards surgery for papillary thyroid cancer (PTC) and has been reported in 18-87% of PTC.

Methods:

This is a retrospective single-center study involving a series of 238 patients that underwent thyroidectomy or lobectomy after preoperative fine needle aspiration (FNA) diagnosis of Thyr 5 or Thyr 6, according to Bethesda classification, from January 2015 to December 2019 at the General Surgery Unit of the University - Hospital of Parma. We divided patients into two main groups: patients with multifocal papillary thyroid cancer at postoperative diagnosis and patients with unifocal papillary thyroid cancer. The aim of the study is to identify demographic or preoperative radiological risk factors for the presence of multifocal PTC and to verify the presence of cyto-histological features of greater aggressiveness in multifocal tumors than in unifocal ones.

Results:

Out of our sample, 176 patients were females (73,9%) and 62 males (26,1%) with a mean age of 50,45 ±14,41. Preoperative cytological diagnosis resulted Thyr 5 in 47 cases (19,7%) and Thyr 6 in 191 cases (80,3%). Multifocal cancer was reported in 35,8% of the females and in 32,3% of the males. Older age was significatively related to the presence of multifocal papillary carcinoma (p<0.05). Preoperative bilateral thyroid nodules were associated with a higher finding of multifocal disease at histological examination (p<0.05). The presence of multifocal disease was related with a higher soft tissue invasion at the histological specimen (p<0.05). Tumor size was not related to multifocal PTC in our study.

Conclusions:

Older age of patient and preoperative bilateral thyroid nodules are significantly associated to multifocal thyroid cancer. In add to this, multifocal disease is related to higher finding of perithyroidal tissue invasion at histological exam. In case of predictive factors for multifocal PTC, surgeons should take total/near-total thyroidectomy always into consideration. (www.actabiomedica.it)

Wounds morphologic assessment: application and reproducibility of a virtual measuring system, pilot study

BACKGROUND AND AIMS

Assessment of wounds morphology can be considered, in the everyday medical activity, the first step for the correct pathway of diagnosis. Authors present a pilot study focused on the statistical analysis of 32 cases of wounds measurements conducted by both the traditional method (paper ruler) both the digital smartphone analysis.

MATERIALS AND METHODS

32 lesions were morphologically evaluated. All the enrolled patients were evaluated by both the traditional method (paper ruler) both a digital smartphone analysis based on the app imitoMeasure. The extracted data were compared to the traditional measurements and a statistical analysis was based on intraclass correlation coefficients (ICC).

RESULTS

Three morphological parameters were evaluated: width (expressed in cm), length (expressed in cm) and area (expressed in cm2). The area (expressed in cm2) was found to be the less comparable, but the data were close in this case, too.

CONCLUSION

The present study shows that the digital measuring systems should be easily addressed as versatile tools that could be applied in daily clinical practice in the future.

Relationship between surgeon experience and adverse events in thyroid surgery

In scientific literature there are numerous authors that have highlighted how the outcome of patients undergoing surgical treatment, such as intraoperative or postoperative complications, surgical time, mean hospital stay, is related to the surgeon’s experience based on the number of cases treated per year for a specific disease. In our study we decided to verify if, in our clinical practice, there are significant differences in postoperative outcomes between procedures performed by a senior surgeon, a young specialist or a surgical resident, evaluating if surgical experience affects positively either on intraoperative complications such as bleeding, hypocalcemia, dysphonia, or on surgical time, mean hospital stay and postoperative complications. In this retrospective study we examined all cases of patients that underwent surgery for thyroid disease at our Operative Unit, from January 1, 2015 to December 31, 2019. The analysis of our data highlights how the surgeon’s experience affects the surgical outcome of patients undergoing lobectomy or total thyroidectomy. Our conclusion was that a high volume center, like the one we are working in, with a correct selection of the patients, allows to train a surgical resident guaranteeing both the surgical training of the doctor and the patients safety. (www.actabiomedica.it)

The modified TIME-H scoring system, a versatile tool in wound management practice: a preliminary report

Background and Aims:

The concept of WBP (wound bed preparation) has revolutionized the way to diagnose and correctly identify the best therapeutic path about the widespread clinical problem of difficult wounds. Starting from the modified TIME-H, authors conducted a preliminary study with the aim of assessing the impact of skin lesions and soft tissues for the surgical patient.

Materials and Methods:

38 patients were preliminarily evaluated. The patients were classified according to the lesion examined, in particular among those who had an infectious or vascular etiology (SSTIs), and patients with surgical site lesions (SSI) and assigned to one of three categories prognosis: favorable (with healing expected within 12 weeks) (0-3A, 0-1B), intermediate (with healing expected over 12 weeks) (4-6A, 2-4B) and uncertain healing (7-8A, 5-8B).

Results:

At the end of the one-year observation period, authors established the healing prediction rate among the studied lesions: the surgical site lesions presented the highest percentage of predictivity (88%), followed by the mixed etiology (72%) and the infectious/vascular injuries (63%).

Conclusion:

This modified-TIME-H can be considered as a versatile and useful scoring tool that should be used in daily clinical practice for the study and treatment of chronic wound diseases.

Thyroid nodules with indeterminate cytology: association between nodule size, histopathological characteristics and clinical outcome in differentiated thyroid carcinomas - a multicenter retrospective cohort study on 761 patients

A great number of surgical diagnostic procedures are performed every year for thyroid nodules that are included in undetermined cytological classes that reveal to be malignant thyroid carcinomas in one-third of cases. In the most recent guidelines, lobectomy is the most recommended surgical approach for this classes of nodules, but total thyroidectomy is the recommended treatment for undetermined nodules larger than 4 cm. The main study aim is to support or question the dimensional criteria as an independent clinical decision element for undetermined thyroid nodules management. We examined data regarding 761 patients undergoing thyroid surgery for undetermined thyroid nodules at two high-volume endocrine surgery units in Italy. Patients were divided into three groups based on the preoperative size of the nodules (N < 1, 1 < N < 4, N > 4 cm). Among the patients belonging to the different groups, we analyzed: differences in malignancy rate, histological characteristics of invasiveness and neoplastic aggressiveness, rates of recurrence and response to therapy. Nodule size (evaluated as a categorical variable and as a continuous variable) did not show any statistically significant correlation with the rate of malignancy, histopathological characteristics of tumor aggressiveness and the patient’s clinical outcome. Most of the tumors found were included in the low risk class (79.2%) and only one was classified as high risk. Follow up of cancer cases showed excellent results in terms of survival, response to therapy and disease recurrence. Malignant thyroid tumors of any size resulting from a nodule identified as cytologically indeterminate are usually characterized by a low risk follicular pattern, well-differentiated and with an excellent outcome. As a result, preferring an extended surgical attitude for undetermined nodules based on tumor size, in absence of other risk factors, can lead to overtreatment in a significant percentage of cases.

POS1102 TEMPORAL TRENDS AND FACTORS ASSOCIATED WITH VITAMIN D PRESCRIPTION AND INTAKE

Background:

Vitamin D has proven skeletal effects and its administration is recommended in patients with osteoporosis by many national and international guidelines. Nevertheless, the compliance to treatment of patients with osteoporosis is scarce. Understanding the factors associated with low vitamin D intake and prescription might help design future intervention aimed to improve adherence.

Objectives:

This study aims to investigate the temporal trends and factors associated with vitamin D prescription and intake.

Methods:

Using a web-based fracture risk-assessment tool, we collected demographic, densitometric and clinical data of women at high risk for fractures. To determine the factors associated with low vitamin D intake we ran a multivariable logistic regression analysis. We described the public general interest in the term “vitamin D” using the Google Trends tool.

Results:

12,419 women were included in the study. 6,748 (54.4%) individuals had a prevalent fragility fracture and 8,950 (72.1%) individuals were on <800 IU of vitamin D per day and 11,434 (92.1%) were taking <1,200 IU of vitamin D per day. The factors associated with vitamin D intake were evaluated with a multivariable logistic regression analysis, which results are presented in Table 1. We found that low BMD levels, the presence of associated comorbidities and glucocorticoid utilization were associated with greater vitamin D intake. Falls were associated only with lower risk of receiving very low dose of vitamin D (<250 IU day). Smoking status was associated with lower vitamin D intake. Overall, the internet interest in vitamin D was higher during the winter season Figure 1.

Figure 1.

Google trends interest in the term “vitamin D” from January 2010 to October 2020

Conclusion:

Low vitamin D intake (<800 IU day) was common in our cohort of women at high risk for fractures. The factors associated with greater vitamin D intake were: having low BMD levels, associated rheumatic diseases and glucocorticoid use. Falls were associated with lower risk of receiving very low dose of vitamin D (<250 IU day). Smoking status was associated with lower vitamin D intake.

Table 1.

Binary logistic regression to predict the risk of low vitamin D intake (<800 IU/day)

>800 IU day REFaOR (95% CI)p value400-800 IU dayAge1.001 (0.995-1.007)NST-score1.422 (1.342-1.508)<0.001No comorbiditiesREFRheumatoid arthritis0.732 (0.583-0.920)<0.001Psoriatic arthritis0.362 (0.218-0.607)<0.001Connective tissue disease0.630 (0.486-0.816)<0.001No cigarette smokingREFCigarette smoking1.040 (0.893-1.212)NSAlcohol <3 unit dayREFAlcohol ≥3 unit day1.201 (0.660-2.187)NSNo glucocorticoidsREFGlucocorticoids 2.5-5 mg/day0.688 (0.550-0.860)<0.001Glucocorticoids ≥5 mg/day0.739 (0.554-0.986)<0.001No fallsREFFalls0.875 (0.754-1.015)NS250-400 IU dayAge0.994 (0.985-1.002)NST-score1.223 (1.117-1.339)<0.001No comorbiditiesREFRheumatoid arthritis0.670 (0.463-0.970)<0.001Psoriatic arthritis0.300 (0.119-0.752)<0.001Connective tissue disease0.651 (0.435-0.975)<0.001No cigarette smokingREFCigarette smoking1.371 (1.104-1.702)<0.001Alcohol <3 unit dayREFAlcohol ≥3 unit day1.824 (0.865-3.887)NSNo glucocorticoidsREFGlucocorticoids 2.5-5 mg/day0.930 (0.666-1.297)NSGlucocorticoids ≥5 mg/day0.743 (0.464-1.189)NSNo fallsREFFalls0.934 (0.741-1.176)NS<250 IU dayAge0.993 (0.988-0.998)<0.01T-score1.139 (1.079-1.202)<0.001No comorbiditiesREFRheumatoid arthritis0.645 (0.522-0.795)<0.001Psoriatic arthritis0.553 (0.376-0.812)<0.001Connective tissue disease0.697 (0.558-0.871)<0.001No cigarette smokingREFCigarette smoking1.339 (1.171-1.532)<0.001Alcohol <3 unit dayREFAlcohol ≥3 unit day1.267 (0.749-2.145)NSNo glucocorticoidsREFGlucocorticoids <5 mg/day0.964 (0.796-1.168)NSGlucocorticoids ≥5 mg/day0.946 (0.736-1.215)NSNo fallsREFFalls0.615 (0.530-0.712)<0.001

Disclosure of Interests:

None declared.

AB0389 A COMBINED RHEUMATOLOGY-OPHTHALMOLOGY CLINIC IMPROVED DIAGNOSIS AND TREATMENT OF IMMUNE-MEDIATED AND INFLAMMATORY DISEASES AMONG PATIENTS PRESENTING WITH INFLAMMATORY EYE DISEASES

Background:

Patients presenting with an inflammatory eye disease may have underlying immune-mediated and inflammatory diseases (IMIDs). However, IMIDs are challenging to diagnose. A combined rheumatology-ophthalmology evaluation could enhance detection of IMIDs in this group.

Objectives:

To investigate whether the implementation of a combined rheumatology-ophthalmology clinic could increase the sensibility of IMIDs diagnosis.

Methods:

A combined rheumatology-ophthalmology clinic started in January 2020. A rheumatologist with expertise in IMIDs assessed outpatients of a tertiary care ophthalmologic clinic specialised in inflammatory eye disease consecutively referred between 01/01/20 and 31/12/20. Two separate visits confirmed both ophthalmology and rheumatology diagnoses. The same period of the year 2019 was used as a comparator.

Results:

We noticed a three-fold increase in the number of ophthalmology patients who underwent an evaluation with a rheumatologist in 2020 compared to 2019 (41 vs 13, +315%; Table). There were no differences in sex distribution or age between the two years. However, the median time before rheumatology assessment was shorter in 2020 than 2019 (median days 0 [range 0-6] vs 12 [range 0-91]). IMIDs diagnoses increased by 27% in 2020 compared to 2019 (29/41 vs 7/13, 71% vs 54%), mainly driven by new diagnoses of systemic vasculitis and Behcet’s disease (Figure 1). There was also an increase in diagnoses of non-IMIDs systemic conditions (3 cancers and one infection in 2020 vs none in 2019). After rheumatology evaluation, immune-modulating therapy was initiated in 18/41 (44%) vs 3/13 (23%).

Ophthalmology assessment and referrals to rheumatologyReferrals2019(n=13)Referrals2020(n=41)Inflammatory eye disease, n (%)6 (46)36 (88)Uveitis, n621Vasculitis, n24AION, n35Conjunctivitis, n10Scleritis, episcleritis, n01Other, n15

Conclusion:

An integrated approach with rheumatologist appeared to remarkably increase the likelihood to detect IMIDs among patients presenting with inflammatory eye diseases.

Disclosure of Interests:

None declared

POS1173 A SHORT DELAY IN ARTHRITIS CARE IS ASSOCIATED WITH HIGHER DISEASE ACTIVITY - LESSONS FROM THE CORONAVIRUS DISEASE 19 (COVID-19) PANDEMIC

Background:

Although disease activity is a significant outcome in rheumatology, few studies have investigated the relationship between routine care of rheumatic conditions and disease activity control.

Objectives:

To determine the association between delay in routine care of chronic inflammatory arthritides (CIAs) and disease activity during the first wave of coronavirus disease 19 pandemic in Verona, Italy.

Methods:

This study enrolled patients with an established diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA). Between 01/04/2020 and 30/06/2020, participants were emailed an online questionnaire. Items comprised multiple or single-choice questions evaluating routine rheumatology care disruptions/delays and disease characteristics, treatments, comorbidities, and demographics. Compliance to anti-rheumatic medications was evaluated with I-CQR5. Disease activity was assessed with RAPID3, and active disease was defined as a RAPID3 score>1. Study period referred to the time between the last rheumatology assessment and the date of enrolment.

Results:

Of 1210 patients contacted, 450 participated, of whom 219 CIAs patients were included (RA 55.3%, PsA 35.2%, AS 15.1%, UA 3.7%). One hundred twenty-five patients (57.1%) had their routine clinical assessment delayed (median days 68.4; IQR 66.8, 85.9). Patients in this group had significantly higher MDHAQ (p=0.001) and RAPID3 (p=0.031) scores, while they did not differ for disease severity, medications or compliance. Most (87.7%) reported good compliance to therapy; only 5.9% had difficulties in supplying anti-rheumatic medications, and 13.2% discontinued medications for at least four weeks for any reason. However, several patients (37.9%) reported moderate-to-high worse disease activity perception due to routine care delay, and 31.1% self-reported a disease flare (median RAPID3 score 3.8; IQR 2.0, 5.4). One hundred one patients (46.1%) had high disease activity, while only 15.1% were in remission. In logistic regression, active disease was significantly associated with delay of scheduled routine care visit, independent of disease duration, time from last rheumatology assessment, therapy with b/tsDMARDs, and compliance (Table 1, Figure 1 below).

Table 1.PredictorActive(n=186)Remission(n=33)ORP-value95% CIInf.95% CISup.Routine care delay (yes vs no)113(60.8%)12(36.4%).0302.4591.0915.543Disease duration (years)10(4.0, 20.0)10.5(7.0, 19.8).6951.007.9721.044Time since last rheumatology assessment (days)68.4(66.8, 75.8)71.2(66.9, 74.9).8541.002.9781.027b/tsDMARDs (yes vs no)105(56.5%)15(45.5%).6531.202.5382.687I-CPR5 (likely low vs likely high adherent)36(19.4%)10(30.3%).187.563.2401.321Figure 1.

Conclusion:

In patients with established CIAs, a relatively short delay in routine assessment by a rheumatologist resulted in higher disease activity. Frequent rheumatology referrals appear to be a critical factor for disease activity control in CIAs.

Disclosure of Interests:

None declared.

OP0112 FACTORS ASSOCIATED WITH OSTEOPOROSIS CARE OF MEN: A REAL-LIFE STUDY ON A NATION-WIDE DATASET

Background:

Male osteoporosis is associated with an important clinical and economic burden worldwide. Notwithstanding that, undertreatment of men with osteoporosis is common. Understanding the factors associated with less osteoporosis care utilization might help define future intervention to improve access of men to osteoporosis care.

Objectives:

The aim of the study was to describe the factors associated with osteoporosis care in men.

Methods:

We conducted a retrospective analysis of a nation-wide cohort (DeFRACalc79 database). DeFRACalc79 is a tool that estimates the fracture risk considering clinical and densitometric risk factors, including the presence of prior hip or vertebral and non-vertebral or non-hip fractures. We compared the clinical characteristics of male individuals with an age matched cohort of women. Propensity score generation with 2:1 matching for female and male patients was performed matching the cohorts for age, generating propensity estimates with a logistic regression model.

Results:

We analyzed a sample of 4,902 men at high risk of osteoporosis. We found that the factors associated to osteoporosis care utilization in men were: the presence of comorbidities (OR 1.939, 95% CI 1.799-2.090), adjuvant hormonal therapy for prostate cancer (OR 1.482, 95% CI 1.315-1.670), the presence of vertebral or hip fractures (OR 1.490, 95% CI 1.378-1.611) and glucocorticoid treatment (OR 2.573, 95% CI 2.274-2.832) (Table 1)

Table 1.

Clinical and densitometric characteristics of the study population and age-matched cohort of women

Men (n=4,902)Women (n=9,804)OR (95% CI) – p valueAge (±SD)65.1 (±14.2)65.1 (±14.2)NSBMI (±SD)25.31 (±4.91)24.07 (±4.85)<0.0001Lumbar spine T-score (±SD)-2.13 (±1.37)-2.51 (±1.15)<0.0001Osteoporosis at lumbar spine (%)2,601 (53.1%)5,948 (60.7%)0.733 (0.684-0.785)Femoral neck T-score (±SD)-1.93 (±1.04)-2.19 (±0.91)<0.0001Osteoporosis at femoral neck (%)1,412 (28.8%)3,936 (40.1%)0.603 (0.560-0.649)% 10-year risk of fracture (±SD)22.77 (±21.05)20.26 (±4.85)<0.0001Family history of fragility fracture (%)891 (18.2%)2,379 (24.3%)0.693 (0.636-0.756)Secondary osteoporosis (%)2,415 (49.3%)3,092 (31.5%)2.108 (1.965-2.262)Glucocorticoids ≥5 mg/day >3 months (%)768 (17.4%)694 (7.7%)2.573 (2.274-2.832)Glucocorticoids ≥5 mg/day ≥3 months <12 months (%)74 (2.0%)72 (0.9%)2.357 (1.700-3.267)Glucocorticoids ≥5 mg/day ≥12 months (%)119 (3.2%)138 (1.6%)1.977 (1.543-2.534)Adjuvant hormonal therapy for breast cancer or prostate cancer (%)495 (12.0%)766 (8.4%)1.482 (1.315-1.670)Comorbidities (%)1,778 (36.3%)2,225 (22.7%)1.939 (1.799-2.090)Rheumatoid arthritis (%)303 (8.8%)511 (6.3%)1.439 (1.241-1.668)Psoriatic arthritis (%)59 (1.9%)103 (1.3)1.390 (1.006-1.919)Systemic lupus erythematosus (%)22 (0.7%)77 (1.0%)0.693 (0.431-1.115)Systemic sclerosis (%)9 (0.3%)60 (0.8%)0.364 (0.180-0.734)Other rheumatic diseases (%)173 (5.2%)310 (3.9%)1.354 (1.119-1.638)Inflammatory bowel diseases (%)144 (2.7%)126 (1.6%)2.773 (2.175-3.534)Chronic obstructive pulmonary disease (%)281 (8.3%)277 (3.5%)2.461 (2.074-2.920)Diabetes (%)441 (12.4%)478 (5.9%)2.238 (1.954-2.564)Neurological diseases (%)236 (7.0%)260 (3.3%)2.202 (1.837-2.639)HIV infection (%)110 (3.4%)23 (0.3%)11.603 (7.389-18.221)Vertebral or hip fractures (%)1,434 (29.3%)2,130 (21.7%)1.490 (1.378-1.611)Non-vertebral, non-hip fractures (%)534 (10.9%)1,477 (15.1%)0.689 (0.620-0.766)

Conclusion:

We found that men accessed osteoporosis care with more severe osteoporosis and/or with a diagnosis of secondary osteoporosis. Male osteoporosis remains largely underdiagnosed with a dramatic latency in osteoporosis care utilization compared to women.

Disclosure of Interests:

None declared

OP0178 ASSOCIATION BETWEEN ENVIRONMENTAL AIR POLLUTION AND RHEUMATOID ARTHRITIS FLARES

Background:

Environmental air pollution has been linked to the pathogenesis of Rheumatoid Arthritis (RA). Nevertheless, evidence linking higher concentrations of air pollutants with the risk of RA reactivations is missing.

Objectives:

The objective of the present study was to determine the association between RA flares and air pollution.

Methods:

We collected longitudinal data of patients affected by RA and of the daily concentration of air pollutants in the Verona area. We designed a case-crossover study. In case-crossover studies, instead of obtaining information from two groups (cases and controls), the exposure information is obtained comparing two different periods of time in the same group of patients followed longitudinally. We compared the exposure to pollutants in the 30-day and 60-day periods preceding an arthritic flare referent to the 30-day and 60-day preceding a low-disease activity visit. Flare was defined as an increase in DAS28-CRP of >1.2 points with current DAS28-CRP ≥3.2 (OMERACT definition).

Results:

888 patients with RA with 3,396 follow-up visits were included in the study. 13,636 daily air pollution records were retrieved. We found an exposure-response relationship between the concentration of air pollutants and the risk of having abnormal CRP levels (Figure 1). Patients exposed to greater concentrations of air pollutants were at higher risk of having CRP levels ≥5 mg/L. Patients exposed to PM10 concentrations ≥50 μg/m3 had a 70% higher risk of having CRP levels ≥5 mg/L (OR 1.696 95% CI, 1.245-2.311). Among RA patients, 440 patients (49.5%) had at least 2 follow-up visits with a difference in DAS28-CRP of more than 1.2 points (with current DAS28-CRP ≥3.2), serving as our sample for the case-crossover study. Concentrations of CO, NO, NO2, NOx, PM10, PM2.5 and O3 were higher in the 60-day period preceding a flare (Table 1). Sensitivity analyses considering geometric mean and cumulative concentrations yielded similar results (data not shown). Remarkably, we found that the cumulative exposure to NO2 in the 60 days preceding a flare was approximately 500 µg/m3 higher than the low disease activity visit, an exposure that equates to approximately to 200 passively smoked cigarettes (3.5 cigarettes per day on a 60-day period).

Table 1.

Case-crossover study. Mean concentrations (mean and Area Under the Curve) of air pollutants in the 60 days before low-disease activity visit and flare visit (DAS28-CRP difference >1.2)

PollutantControl period (low disease activity, n=440)Hazard period (flare, n=440)p valueCO μg/m3Mean0.380.420.001AUC22.0024.530.001NO μg/m3Mean19.2324.110.002AUC1,120.531,403.880.002NO2μg/m3Mean30.9132.440.042AUC1,800.961,892.050.040NOxμg/m3Mean60.3469.350.004AUC3,515.774,041.060.004PM10 μg/m3Mean31.2133.650.011AUC1,789.221,942.520.005O3μg/m3Mean31.0833.790.002AUC1,776.371,934.350.001PM2.5 μg/m3Mean23.0824.740.018AUC1,272.611,403.60<0.001Figure 1.

Odds of having abnormal CRP serum levels (≥5 mg/L) at different exposures of PM10 and PM2.5 (mean concentration in the 60 days before assessment)

Conclusion:

We found a striking association between air pollution and RA disease severity and reactivations in a cohort of patients followed over a 5-year period. The exposure to high levels of air pollutants was associated with increased CRP levels and a higher risk of experiencing a flare of arthritis. This excessive risk was evident at very low levels of exposure, even below the proposed threshold for the protection of human health. Our study has important and direct consequences. In order to reduce the burden of RA, public and environmental health policy makers should aim to diminish gaseous and PM emissions to a larger extent as currently recommended.

Disclosure of Interests:

None declared

POS0218 TUMOR-NECROSIS FACTOR INHIBITORS IMPROVE AORTIC STIFFNESS IN PATIENTS WITH LONGSTANDING RHEUMATOID ARTHRITIS

Background:

Major cardiovascular disease (CVD) benefits of disease-modifying anti-rheumatic drugs (DMARDs) therapy occur in early RA patients with treat-to-target strategy. However, it is unknown whether long-term DMARDs treatment in established RA could be useful to improve CVD risk profile.

Objectives:

The aim of this study was to comparatively describe aortic stiffness progression in patients with longstanding and established RA treated with tumor necrosis factor inhibitors (TNFi) or conventional synthetic DMARDs (csDMARDs).

Methods:

Ultrasound aortic stiffness index (AoSI) has to be considered a proxy outcome measure in established RA patients. We measured AoSI in a group of RA patients on long-term treatment with TNFi or csDMARDs. Eligible participants were assessed at baseline and after 12 months; changes in serum lipids, glucose and arterial blood pressure were assessed. All patients were on stable medications during the entire follow-up.

Results:

We included 107 (64 TNFi and 43 csDMARDs) RA patients. Most patients (74%) were in remission or low disease activity and had some CVD risk factors (45.8% hypertension, 59.8% dyslipidemia, 45.3% smoking; table 1). The two groups did not differ significantly for baseline AoSI (5.95±3.73% vs 6.08±4.20%, p=0.867). Follow-up AoSI was significantly increased from baseline in the csDMARDs group (+1.00%; p<0.0001) but not in the TNFi group (+0.15%, p=0.477). Patients on TNFi had significantly lower follow-up AoSI from baseline than the csDMARDs group (-1.02%, p<0.001; ANCOVA corrected for baseline AoSI, age and systolic blood pressure). Furthermore, follow-up AoSI was significantly lower in TNFi users with 1-2 or >2 CVD risk factors than in those without (figure 1).

Conclusion:

Long-term treatment with TNFi was associated with reduced aortic stiffness in patients with established RA and several CVD risk factors.

Baseline characteristics of the study population.csDMARDs(n=43)TNFi(n=64)P valueAge, median years (IQR)58.6 (53.0, 66.0)58.1 (49.3, 67.0)0.839Female sex33 (76.7)54 (84.4)0.321Obesity5 (11.6)7 (10.9)0.999Hypertension19 (44.2)30 (46.9)0.784Anti-hypertensive drug17 (39.5)28 (43.8)0.784Smoking status, ever18 (42.9)30 (46.9)0.684Dyslipidemia30 (40.2)34 (59.8)0.085Current statin use13 (34.2)10 (15.9)0.033Diabetes mellitus3 (7.0)3 (4.7)0.676Anti-diabetic medication1 (2.3)1 (1.5)0.999CVD risk factors, median (IQR)2 (1, 3)2 (1, 3)0.199RF and/or ACPA positive28 (65.1)33 (51.6)0.165Disease duration, median years (IQR)14.1 (11.5)15.4 (10.5)0.538Methotrexate38 (88.4)52 (81.3)0.192Leflunomide5 (17.9)12 (19.0)0.999Hydroxychloroquine9 (31.0)5 (7.8)0.009Prednisone > 5 mg daily7 (7.7)5 (5.5)0.823NSAIDs6 (20.7)22 (34.4)0.227

ACPA, anti-citrullinated peptides antibodies; csDMARDs, conventional synthetic disease-modifying anti-rheumatic drugs; IQR, interquartile range; NSAIDs, non-steroidal anti-inflammatory drugs; RF, rheumatoid factor; TNFi, tumor necrosis factor inhibitors. All data reported as absolute numbers (percentage) otherwise specified. P-value refers to Chi-squared or Fisher test for categorical variables or ANOVA for continuous variables.

Disclosure of Interests:

None declared

POS0693 EFFICACY AND SAFETY OF BELIMUMAB IN PATIENTS WITH LUPUS NEPHRITIS IN REAL-LIFE SETTING: RESULTS FROM A LARGE, NATIONWIDE, MULTICENTRIC, PROSPECTIVE COHORT

Background:

LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarget therapy is needed to control the disease especially in refractory cases.

Objectives:

To evaluate renal response in SLE patients with glomerulonephritis (GN) treated with Belimumab in real-life setting.

Methods:

Patients with proteinuria >0.5 g/24 h and/or active sediment at baseline enrolled in a multicentre Italian cohort of SLE patients (BeRLiSS study), treated with monthly iv Belimumab 10 mg/kg plus standard of care were considered in this study. Complete renal response (CRR) was defined as proteinuria <0.5 g/24 h, estimated glomerular filtration rate (eGFR)≥90ml/min/1.73m2 and no rescue therapy. Primary efficacy renal response (PERR) was defined as proteinuria ≤0.7 g/24 h, eGFR ≥60ml/min/1.73m2 and no rescue therapy. Prevalence and predictive factors of CRR and PERR at 12 and 24 months after Belimumab initiation were analyzed by multivariate logistic regression analysis.

Results:

A total of 91 patients were considered in this study, 79 female, mean age 40.51±9.03 years, mean disease duration 12.18±8.15 years, median follow-up time after Belimumab initiation 22 months. Twenty patients had baseline proteinuria ≥0.5 <1 g/day, 17 ≥1 <2 g/day, 13 ≥2 g/day. Belimumab was started at GN onset in 20 (22%) patients and at the time of a renal flare in all other cases. Seventy-five patients underwent a renal biopsy: 1 class I, 4 class II, 14 class III, 47 class IV and 9 class V. Baseline serum creatinine was 82.44±29.26 umol/L; 15 patients showed eGFR<60ml/min/1.73m2 at baseline. Immunosuppresants were taken by 70 (76.9%) patients: 47 micofenolate, 15 azathioprine and 5 ciclosporine. Sixty patients (65.9%) were on antimalarials. During follow-up 34 (37.4%) patients achieved CRR. Among them 5 (14.7%) patients relapsed and 29 (85.3%) patients maintained remission. Mean time to achieved CRR was 9.71±5.91 months.

High levels of baseline proteinuria were a negative independent predictor of CRR and PERR at 6 months (OR 0.044 CI95% 0.006-0.320 p=0.002 and OR 0.232 CI95% 0.091-0.596 p=0.002) and 12 months (OR 0.029 CI95% 0.002-0.556 p=0.019 and OR 0.056 CI95% 0.009-0.327 p=0.001). High levels of baseline creatinine were a negative independent predictor of renal response. Renal response at 6 months was a strong predictive factor of renal response at 12 and 24 months.

Conclusion:

Belimumab is an effective add-on therapy in the treatment of GN in real-life practice setting.

Disclosure of Interests:

None declared

POS0675 THE COMPARATIVE 3-YEAR RETENTION RATE OF TARGETED-SYNTHETIC AND BIOLOGIC DRUGS FOR RHEUMATOID ARTHRITIS: REAL-LIFE DATA FROM THE ITALIAN GISEA REGISTRY

Background:

Long-term observational data on the real-life use of JAK inhibitors (JAKis) for rheumatoid arthritis (RA) and their comparison with biological drugs are still very limited. Large population-based registries have been increasingly used to investigate the performance of targeted drugs in a real-life setting.

Objectives:

The aim of this study is to evaluate and compare the 3-year retention rate of JAKis, TNF inhibitors (TNFis) and biologic drugs with other mechanisms of action (OMAs) in the large cohort of RA patients included in the Italian national GISEA registry.

Methods:

Data of all RA patients treated with targeted synthetic or biologic drugs were prospectively collected in the Italian multicentric GISEA registry. The analysis was limited to patients who started a first- or second-line targeted drug in the period after the first JAKi was marketed in Italy (1st December 2017). The 3-year retention rate was calculated by the Kaplan-Meier method and compared between different drug classes by a log-rank test. A descriptive analysis of reasons for discontinuation was performed.

Results:

The study population included 1027 RA patients (79.8% females, mean age [±SD] 56.9 [±13.5] years, mean disease duration 9.8 [±9] years, mean baseline SDAI 17.5 [±11.9], ACPA positive 67.4%, RF positive 62.7%) who received JAKis (baricitinib or tofacitinib, n=297), TNFis (n=365), or OMAs (n=365) as first or second targeted drug. Main baseline characteristics of study population were overall well balanced between treatment groups. Retention rate was numerically but not statistically higher (p=0.18) in patients treated with JAKis compared with TNFis or OMAs (80.6, 78.9 and 76.4% at 1 year and 73, 56.8 and 63.8% at 3 years, respectively) (Figure 1). Drug survival was significantly higher in patients receiving concomitant methotrexate (MTX) compared with monotherapy only in TNFis (66.8 vs 47.1%, p=0.04) but not in JAKis (76.1 vs 70.1%, p=0.54) and OMAs (66.1 vs 61.9%, p=0.41) group. Therapy was discontinued in a total of 211 patients because of ineffectiveness (n=107), adverse events (n=88), or compliance/other reasons (n=16). The most frequent reason for treatment withdrawal was ineffectiveness in both JAKis (n=30 out of 56) and TNFis (n=45 out of 74) groups, whereas OMAs were discontinued more frequently because of adverse events (n=41 out of 81).

Conclusion:

Our data confirmed in a real-life setting a favorable 3-year retention rate of all available targeted mechanisms of action for RA therapy. As expected, concomitant MTX significantly impacted persistence on therapy of TNFis only. Discontinuations of JAKis for adverse events were infrequent overall, confirming the safety profile observed in randomized clinical trials.

Figure 1.

Three-year retention rate by treatment group

Disclosure of Interests:

None declared

AB0488 SPONDYLOARTHRITIS DISEASE BURDEN AS PERCEIVED BY PATIENTS: BASELINE PATIENT-REPORTED OUTCOME DATA FROM THE ITALIAN PROSPECTIVE SIRENA STUDY

Background:

Previous studies have compared Patient-Reported Outcomes (PROs) in Spondyloarthritis (SpA); a recent one has found similarity in Psoriatic Arthritis (PsA) and axial patients1.

Objectives:

To describe PROs at SpA diagnosis (new or confirmed), by type of SpA and by gender.

Methods:

SIRENA is an Italian, prospective Registry of SpA patients diagnosed according to ASAS criteria and naïve to any DMARDs. At inclusion, patients were classified as predominant axial (AxSpA) or mainly peripheral (pSpA). PROs showed in the Table 1 were collected and analysed descriptively.

Table 1.

PhGA and PROs at diagnosis*

AxSpA*pSpAAll(n=123)Women(n=64)Men(n=58)All(n=227)Women(n=109)Men(n=118)PhGA, n1156054222105117mean (SD)50.2 (28.6)54.8 (26.7)45.0 (30.1)45.4 (25.9)49.9 (25.6)41.3 (25.6)median (min, max)52.0 (0-100)62.0 (0-100)43.5 (0-100)48.5 (0-100)50.0 (1.0-100)40.0 (0-95.0)PtGA, n1125952209102107mean (SD)56.4 (27.8)61.5 (25.8)50.3 (29.2)50.3 (26.2)56.4 (23.1)44.5 (27.7)median (min, max)63.0 (0-100)70.0 (2.0-100)50.0 (0-100)50.0 (0-100)58.5 (7.0-100)47.0 (0-100)Pain VAS score, n1136052207101106mean (SD)56.7 (28.3)61.1 (26.6)50.6 (29.1)51.9 (26.8)57.4 (25.3)46.8 (27.3)median (min, max)60.0 (0-100)69.5 (2.0-100)50.0 (0-100)53.0 (0-100)61.0 (0-100)48.5 (0-100)Sleep VAS score, n1136052211103108mean (SD)55.3 (29.3)57.4 (29.5)52.3 (29.2)44.0 (30.1)50.4 (29.8)37.9 (29.2)median (min, max)59.0 (0-100)61.5 (0-100)53.0 (0-100)44.0 (0-100)53.0 (0-100)34.0 (0-100)BASFI, n11058511336568mean (SD)4.6 (2.8)5.2 (2.6)3.9 (2.8)3.5 (2.6)4.0 (2.6)3.1 (2.4)median (min, max)5.1 (0-9.7)5.8 (0-9.4)3.6 (0-9.6)2.9 (0-10.0)3.9 (0-10.0)2.45 (0-8.9)BASDAI, n11259521397069mean (SD)5.2 (2.4)5.8 (2.3)4.5 (2.3)5.2 (2.3)5.8 (2.1)4.6 (2.3)median (min, max)5.5 (0-9.3)6.2 (0-9.3)4.5 (0.3-9.2)5.5 (0.2-10.0)6.1 (1.0-10.0)4.8 (0.2-9.2)HAQ-DI score, n109585020399104mean (SD)0.9 (0.7)1.1 (0.7)0.6 (0.6)0.7 (0.7)0.9 (0.7)0.6 (0.6)median (min, max)0.8 (0.0-2.5)1.1 (0-2.5)0.5 (0-2.3)0.6 (0.0-2.8)0.8 (0-2.8)0.4 (0-2.6)WPAI% work time missed, n4919301074562mean (SD)7.3 (21.4)4.2 (9.5)9.2 (26.3)8.8 (24.7)8.6 (25.6)8.9 (24.3)median (min, max)0 (0-100)0 (0-35.1)0 (0-100)0 (0-100)0 (0-100)0 (0-100)% impairment at work, n6733341346173mean (SD)48.2 (31.9)58.5 (26.6)38.2 (33.7)39.7 (31.4)45.4 (30.9)34.9 (31.2)median (min, max)50.0 (0-100)60.0 (0-100)25.0 (0-100)40.0 (0-100)50.0 (0-100)30.0 (0-100)% overall work impairment, n4819291064561mean (SD)44.1 (33.0)52.4 (27.9)38.7 (35.3)40.1 (33.0)45.1 (33.1)36.4 (32.7)median (min, max)45.0 (0-100)60.0 (0-100)20.0 (0-100)40.0 (0-100)50.0 (0-100)30.0 (0-100)% activity impairment, n10053461839390mean (SD)56.7 (28.6)63.4 (23.9)48.0 (31.0)48.5 (30.3)55.3 (28.7)41.4 (30.4)median (min, max)60.0 (0-100)70.0 (0-100)50.0 (0-100)50.0 (0-100)60.0 (0-100)40.0 (0-100)

* The sum does not add up to the total because of some missing values.

Results:

From 23 sites, 123 AxSpA and 227 pSpA patients were analysed. Diagnosis was new in 58% of AxSpA and 77% of pSpA. 85.5% of the pSpA had PsA, while in AxSpA the most frequent type was Ankylosing Spondylitis (48.8%). Time from symptom onset to diagnosis was higher in AxSpA than in pSpA (median 36 vs 24 months, respectively). At inclusion, composite disease activity measures showed high disease activity for AxSpA (mean ASDAS-CRP 3.1) and moderate disease activity for pSpA (mean DAS28 3.6; mean DAPSA 22.5). AxSpA patients had numerically worse values than pSpA in all the PROs collected, except for BASDAI score that was similar (mean 5.2). For both AxSpA and pSpA, all PROs were worse in women than men, except for the % of work time missed. PtGA scores were higher than PhGA, in each group and gender.

Conclusion:

At diagnosis, SpA patients perceive a slightly higher disease burden than assessed by Physicians. For PROs other than BASDAI, AxSpA reported a worse impact than pSpA. Overall, women showed a higher disease impact than men.

References:

[1]Michelsen B. et al. PLoS ONE 2015; 10(4): e0123582.

Disclosure of Interests:

Rosario Foti Speakers bureau: Speaker bureau honoraria from Eli Lilly, Sanofi, MSD, Janssen, AbbVie, Bristol-Myers Squibb, Celgene, Roche, Consultant of: Consultancy fees from Eli Lilly, Sanofi, MSD, Janssen, AbbVie, BMS, Celgene, Roche, Gabriella Cardinale: None declared., Luisa Costa: None declared., Franco Franceschini: None declared., Francesco Ciccia Speakers bureau: Speaker bureau honoraria from AbbVie, Abiogen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Pfizer, Novartis, Roche, Consultant of: Consultancy fees from Novartis, Pfizer, Janssen, Eli Lilly, Roche, Celgene, Grant/research support from: Grant/research support from Pfizer, Novartis, Celgene, Janssen, Roche, Antonio Marchesoni: None declared., Giuliana Guggino Speakers bureau: Speaker bureau honoraria from Celgene, Sandoz, Pfizer, Grant/research support from: Grant/research support from Pfizer, Celgene, Maurizio Rossini: None declared., Ennio Lubrano Di Scorpaniello: None declared., Bruno Frediani: None declared., Maria Sole Chimenti: None declared., Gerolamo Bianchi: None declared., Giuseppe Galfo: None declared., Silvia Marelli Employee of: Employee of Janssen-Cilag SpA Italy, Ennio Favalli Speakers bureau: Consulting fees and/or speaking engagements from AbbVie, Bristol-Myers Squibb, Lilly, Merck Sharp & Dohme, Pfizer, Galapagos, Sanofi-Genzyme, and UCB.