Exploring the hidden riches: Recent remarkable faunistic records and range extensions in the bee fauna of Italy (Hymenoptera, Apoidea, Anthophila)

Background

The area sourrounding the Mediterranean basin is recognised as a major biodiversity hotspot for bees, and Italy is amongst the European countries with the highest bee species richness. Detailed knowledge of bee distribution is crucial for understanding bee biology and designing tailored conservation strategies, but is still insufficient in southern European countries, especially in Italy.

New information

We report recent finds of 48 bee species that yield significant novelties for the Italian bee fauna. Eight species, namely Andrenaconfinis Stöckhert, Anthidiellumbreviusculum Pérez, Coelioxysalatus Foerster, Lasioglossumalgericolellum Strand, Megachilelapponica Thomson, Megachileopacifrons Pérez, Megachilesemicircularis auct. nec Zanden and Trachusaintegra Eversmann are reported as new for Italy. In addition, Andrenabinominata Smith, Andrenacompta Lepeletier, Colletesacutus Pérez, Lasioglossumstrictifrons Vachal, Rhodanthidiumsiculum Spinola and Rhodanthidiumsticticum Fabricius are newly recorded from mainland Italy, Osmiaheteracantha Pérez from Sardegna and Nomadaflavopicta Kirby from Sicilia. We also report significant range extensions for other bee species and recent records of species that had long gone unrecorded in Italy. The combination of morphology and DNA barcoding provided reliable identifications even for the most challenging specimens. As several of our records come from areas neglected by bee experts in the past, this study stands out as a key indicator of a bee faunistic richness still awaiting discovery and hopefully it will stimulate the interest of taxonomists and stakeholders in pursuing bee research in Italy in the near future.

Nailfold capillaroscopy in the rheumatological current clinical practice in Italy: results of a national survey

This cross-sectional online study was designed by the study group on Capillaroscopy and Microcirculation in Rheumatic Diseases (CAP) of the Italian Society of Rheumatology (SIR) to provide an overview of the management of nailfold capillaroscopy in Italian rheumatology centers. Therefore, SIR distributed the survey to its members in July 2021, and each center's physician with the most expertise in capillaroscopy completed the questionnaire. The survey was completed by 102 centers, with at least one representative from each Italian region. Ninety-three centers perform capillaroscopy, and 52 (56) conduct more than 200 investigations annually. Seventy-eight (84%) of respondents have more than five years of experience with the technique, and 75 centers (80.6%) have received certification from specific national or international training courses. In 85 centers, a videocapillaroscope with 200x magnification is employed (91.4%). The average waiting period for the examination is 2.4 months, and less than 3 months in 64 of the locations (68.8%). The study demonstrates that capillaroscopy is an integral part of both the diagnostic phase of Raynaud's phenomenon and the monitoring of autoimmune connective tissue diseases (CTDs). However, the reporting methods and timing of patient followup are heterogeneous.

POS1382 AN OVERVIEW OF NAILFOLD CAPILLAROSCOPY IN ITALY: RESULTS FROM A NATIONAL SURVEY

Background

In May 2020, the executive committee of the Italian Society of Rheumatology (SIR) endorsed the Italian study group (SG) on capillaroscopy and microcirculation in rheumatic diseases (CAPSIR) that first convened at the virtual annual meeting the same year. Nowadays capillaroscopy is a well-established, non-invasive technique with useful clinical applications in the assessment of connective tissue diseases (CTDs) [1] and mandatory for the differential diagnosis of Raynaud’s phenomenon (Rp) [2]. Despite growing interest in the use of this imaging technique in clinical and research settings, data on its current usage to assess microcirculation in rheumatic diseases in Italy are not available.

Objectives

To obtain an insight into the current utilization of capillaroscopy in the assessment of rheumatic patients in the Italian clinical setting.

This survey aimed: 1) to obtain an overview on the usage of capillaroscopy in rheumatological clinical practice in Italy, and 2) to gauge expert’s attitudes on factors influencing its use and the potential critical issues.

Methods

This online survey was devised to evaluate the opinions of the members of the SIR about nailfold capillaroscopy. It was designed with the contributions of the steering committee of CAPSIR SG, and emails with a link to the survey were sent to physicians affiliated with the SIR between July and August 2021 on behalf of the CAPSIR SG. At the beginning of the survey, the physician most experienced in capillaroscopy was asked to complete the questionnaire on behalf of his/her center. Questions were about the use of this technique in clinical practice and its critical issues. Data were reported with a descriptive analysis.

Results

One hundred and one centers, with at least one representative for each of the twenty Italian Region, completed the survey. 51.5% of respondents were in non-university hospitals, and 70 (69.3%) centers perform more than 100 capillaroscopy per year. The respondents were mainly practicing capillaroscopy for more than 5 years (85%) and gained certification of national or international dedicated training courses (84%). 43% of respondents had at least one scientific publication on this topic. Videocapillaroscope with 200X magnification was the most used instrument (91%). In public health services, the waiting time to schedule capillaroscopy is less than 3 months in 62.4% of centers. The survey has identified attitudes toward the use of capillaroscopy in the assessment and management of CTDs. In the screening phase of Rp, it is performed every 12 (mean value) months in patients with antinuclear antibodies (ANA) negative and every 6 months for those with positive ANA. Capillaroscopy is performed every 12 months (mean value) as part of the staging of CTDs (including systemic sclerosis). In more than 60% of centers, there is no specific diagnostic program for the screening of Rp and there is no connection with the general practitioners. 70% of the centers use capillaroscopy to follow the effect of therapies at least in systemic sclerosis.

Conclusion

At least one center for each Italian Region participated in this national survey, thus ensuring good geographical coverage. Moreover, the personnel who perform the exam had certified training and experience thus supporting the reliability of results. This survey indicates that the Italian public health system allows an acceptable waiting time to schedule the exam (less than 3 months). Italian Rheumatologists prescribe capillaroscopy as part of the clinical routine in the screening of Rp and as part of the annual checkup of CTDs. Critical issues remain the lack of a specific program and network with the general practitioners. To have a wider vision on this topic, our survey could be further extended to other European countries.

References

[1]Cutolo M, Smith V. Detection of microvascular changes in systemic sclerosis. and other rheumatic diseases. Nat Rev Rheumatol 2021;17(11):665-677.

[2]van den Hoogen F, Khanna D, et al. 2013 classification criteria for systemic sclerosis: an ACR/EULAR collaborative initiative. Ann Rheum Dis 2013;72(11):1747-55.

Disclosure of Interests

None declared

LB0002 COVID-19 VACCINE SAFETY IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASE

Background:

The consequences of the COVID-19 outbreak are unprecedented and have been felt by everyone around the world, including people with rheumatic and musculoskeletal diseases (RMDs). With the development of vaccines, the future is becoming brighter. Vaccines are a key pillar of public health and have been proven to prevent many serious diseases. However, vaccination also raises questions, especially for patients with inflammatory RMDs and/or treated with drugs that influence their immune system.

Objectives:

Our aim was to collect safety data among RMD patients receiving COVID-19 vaccines.

Methods:

The EULAR COVID-19 Vaccination (COVAX) Registry is an observational registry launched on 5 February 2021. Data are entered voluntarily by clinicians or associated healthcare staff; patients are eligible for inclusion if they have an RMD and have been vaccinated against SARS-CoV-2. Descriptive statistics are presented.

Results:

As of 27 April 2021, 1519 patients were reported to the registry. The majority were female (68%) and above the age of 60 (57%). Mean age was 63 years (SD 16), ranging from 15 to 97 years. A total of 28 countries contributed to the registry, with France (60%) and Italy (13%) as the highest contributors. The majority (91%) had inflammatory RMDs. Inflammatory joint diseases accounted for 51% of cases, connective tissue diseases 19%, vasculitis 16%, other immune mediated inflammatory diseases 4%, and non-inflammatory/mechanical RMDs 9%. The most frequent individual diagnoses were rheumatoid arthritis (30%), axial spondyloarthritis (8%), psoriatic arthritis (8%), systemic lupus erythematosus (SLE, 7%) and polymyalgia rheumatica (6%). At the time of vaccination, 45% were taking conventional synthetic DMARDs, 36% biological DMARDs, 31% systemic glucocorticoids, 6% other immunosuppressants (azathioprine; mycophenolate; cyclosporine; cyclophosphamide; tacrolimus), and 3% targeted synthetic DMARDs. The most frequent individual DMARDs were methotrexate (29%), TNF-inhibitors (18%), antimalarials (10%) and rituximab (6%). The vaccines administered were: 78% Pfizer, 16% AstraZeneca, 5% Moderna and 1% other/unknown; 66% of cases received two doses and 34% one dose. Mean time from 1st and 2nd dose to case report was 41 days (SD 26) and 26 days (SD 23), respectively. COVID-19 diagnosis after vaccination was reported in 1% (18/1519) of cases. Mean time from first vaccination until COVID-19 diagnosis was 24 days (SD 17). Disease flares were reported by 5% (73/1375) of patients with inflammatory RMDs, with 1.2% (17/1375) classified as severe flares. Mean time from closest vaccination date to inflammatory RMD flare was 5 days (SD 5). The most common flare types were arthritis (35/1375=2.5%), arthralgia (29/1375=2.1%), cutaneous flare (11/1375=0.8%) and increase in fatigue (11/1375=0.8%). Potential vaccine side effects were reported by 31% of patients (467/1519). The majority were typical early adverse events within 7 days of vaccination, namely pain at the site of injection (281/1519=19%), fatigue (171/1519=11%) and headache (103/1519=7%). Organ/system adverse events were reported by 2% (33/1519) but only 0.1% (2/1519) reported severe adverse events, namely a case of hemiparesis in a patient with systemic sclerosis/SLE overlap syndrome (ongoing at the time of reporting), and a case of giant cell arteritis in a patient with osteoarthritis (recovered/resolved without sequelae).

Conclusion:

The safety profiles for COVID-19 vaccines in RMD patients was reassuring. Most adverse events were the same as in the general population, they were non-serious and involved short term local and systemic symptoms. The overwhelming majority of patients tolerated their vaccination well with rare reports of inflammatory RMD flare (5%; 1.2% severe) and very rare reports of severe adverse events (0.1%). These initial findings should provide reassurance to rheumatologists and vaccine recipients, and promote confidence in COVID-19 vaccine safety in RMD patients, namely those with inflammatory RMDs and/or taking treatments that influence their immune system.

Acknowledgements:

EULAR COVID-19 Task Force; European Reference Network on rare and Complex Connective Tissue and Musculoskeletal Diseases; European Reference Network on Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases Network; all rheumatologists contributing to the EULAR COVAX Registry.

Disclosure of Interests:

Pedro M Machado Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript., Grant/research support from: Orphazyme, unrelated to this manuscript., Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript., Saskia Lawson-Tovey: None declared, Kimme Hyrich Grant/research support from: BMS, UCB, and Pfizer, all unrelated to this manuscript., Speakers bureau: Abbvie, Loreto Carmona Consultant of: her institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH, and UCB Pharma, all unrelated to this manuscript., Laure Gossec Grant/research support from: AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, all unrelated to this manuscript., Speakers bureau: Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi, Galapagos, all unrelated to this manuscript., Elsa Mateus Grant/research support from: LPCDR received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work., Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, and Pfizer, all unrelated with this manuscript., BERND RAFFEINER: None declared, Tiphaine Goulenok: None declared, Olilvier Brocq: None declared, Martina Cornalba: None declared, José A Gómez-Puerta Speakers bureau: AbbVie, BMS, GSK, Janssen, Lilly, MSD, Roche and Sanofi., Eric Veillard: None declared, Ludovic Trefond: None declared, Jacques-Eric Gottenberg: None declared, Julien Henry: None declared, Patrick Durez: None declared, Gerd Rüdiger Burmester: None declared, Marta Mosca: None declared, Eric Hachulla: None declared, Hans Bijlsma: None declared, Iain McInnes: None declared, Xavier Mariette Consultant of: BMS, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sanofi-Aventis, UCB, and grant from Ose, all unrelated to this manuscript.

FRI0167 LONG TERM CLINICAL OUTCOME IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS FOLLOWED FOR MORE THAN 20 YEARS IN THREE ITALIAN TERTIARY REFERRAL CENTERS: THE MILAN SYSTEMIC LUPUS ERYTHEMATOSUS CONSORTIUM (SMILE) COHORT

Background:

the prognosis of Systemic lupus Erythematosus (SLE) patients has significantly improved over time, raising the need for more data about disease activity and damage accrual in the long term.

Objectives:

to investigate the risk of long term disease activity and to identify viable prognostic markers for disease flares in SLE patients with long standing disease

Methods:

data on SLE patients regularly followed at ASST PINI-CTO, Fondazione Ca’ Granda Policlinico and Ospedale San Raffaele, Milan (Milan Systemic Lupus Erythematosus Consortium, SMiLE, cohort) with disease duration ≥ 20 years, were retrospectively analyzed. Organ involvement as per the British Isles Lupus Assessment Group (BILAG) definitions was recorded along with achievement of clinical and complete remission (CR and CCR: clinical SLEDAI =0, PGA <0.5 and no prednisone or immunosuppression ± negative serology) and lupus low disease activity state (LLDAS) at 15 (T15) and 20 (T20) years of follow up. Damage accrual was estimated according to the SLE International Collaborating Clinics/American College of Rheumatology damage index (SDI).

Results:

data from 168 patients (table 1) were available for analysis. Remission (CR+CCR) and LLDAS were achieved in 22% and 61% at T15 and 25% and 71% at T20. LLDAS was not associated with a history of involvement in any BILAG domain, but it was inversely associated with treatment with mycophenolate at any time (50 vs 23% treated vs not treated; p=0.02). SDI>0 was found in 49% patients at T15 and in 71% at T20. LLDAS at T15 was associated with lower flare rates in the following five years (HR= 0.395, 95%, CI=0.239-0.653; Figure, left panel; p<0.001). The risk of flaring for LLDAS was largely comparable to CCR and CR (Figure, middle panel). In the T15-T20 timeframe, 37% of patients had a flare. Patients with both low complement and anti-dsDNA positivity at T15 had an increased risk of flaring compared to serologically inactive patients (HR=2.86, 95%, CI=1.572-5.19; Figure right panel). Flaring patients were more likely to show an increase in SDI from T15 to T20 (37% vs 9% in patients with stable SDI; p<0.001)

Table 1.

Demographic, laboratory and clinical characteristics of patients with SLE

Characteristics(n=168)Demographic characteristicsFemale, n (%)150 (89.3)Age at diagnosis years, median (IQR)24 (18-32)Clinical and serological features during 15 years follow up, n (%)Musculoskeletal140 (83)Mucocutaneous135 (80)Constitutional114 (68)Haematological103 (61)Nephritis81 (48)Cardiopulmonary49 (29)NPSLE31 (18)Positive anti-dsDNA136 (81)Hypocomplementemia136 (81)Positive antiphospholipid73 (44)CR / CCR at T1513 (8) / 23 (14)CR / CCR at T2017 (10) / 25 (15)

Conclusion:

LLDAS is common in SLE patients with long disease duration although up to 37% of patients with 15-year disease duration may experience a flare during the following 5 years. The flare risk increases with failure to attain LLDAS at T15 and with active serology. Late flares associate with damage accrual.

References:

[1]Aringer M, Ann Rheum Dis. 2019; Franklin K, Ann Rheum Dis 2019

Table 2.

therapy during the 20 year follow up

Therapy (ever)%Prednisone83Hydroxychloroquine91Mycophenolate mofetil33Azathioprine50Methotrexate23Cyclophosphamide36Fig 1:

risk of flare according to disease activity

Disclosure of Interests:

Maria Gerosa: None declared, Giuseppe Alvise Ramirez: None declared, Chiara Bellocchi: None declared, Lorenza Maria Argolini: None declared, Luca Moroni: None declared, Martina Cornalba: None declared, Nicola Farina: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Enrica Bozzolo: None declared, Lorenzo Beretta Grant/research support from: Pfizer

The cephalic labial gland secretions of two socially parasitic bumblebees Bombus hyperboreus (Alpinobombus) and Bombus inexspectatus (Thoracobombus) question their inquiline strategy

Social parasitic Hymenopterans have evolved morphological, chemical, and behavioral adaptations to overcome the sophisticated recognition and defense systems of their social host to invade host nests and exploit their worker force. In bumblebees, social parasitism appeared in at least 3 subgenera independently: in the subgenus Psithyrus consisting entirely of parasitic species, in the subgenus Alpinobombus with Bombus hyperboreus, and in the subgenus Thoracobombus with B. inexspectatus. Cuckoo bumblebee males utilize species-specific cephalic labial gland secretions for mating purposes that can impact their inquiline strategy. We performed cephalic labial gland secretions in B. hyperboreus, B. inexspectatus and their hosts. Males of both parasitic species exhibited high species specific levels of cephalic gland secretions, including different main compounds. Our results showed no chemical mimicry in the cephalic gland secretions between inquilines and their host and we did not identify the repellent compounds already known in other cuckoo bumblebees.