Development of a vortex-assisted switchable-hydrophilicity solvent-based liquid phase microextraction for fast and reliable extraction of Zn (II), Fe (II), Pb (II), and Cd (II) from various baby food products

This manuscript describes the development of a novel liquid phase microextraction (LPME) method for the extraction and determination of Zn (II), Fe (II), Pb (II), and Cd (II) in various infant/baby food and supplements products. The method is based on vortex-assisted extraction combined with a switchable-hydrophilicity solvent (SHS) sample preparation. The SHS, which undergoes reversible phase changes triggered by pH change, enables selective extraction and easy phase separation. A flame atomic absorption spectroscopy was used in the final determination step. Optimization studies revealed, that the optimal pH of the sample solution (after digestion) during analytes extraction is 5.5. A l-proline is added to the sample (375 mM) to ensure the complexation of the target metal cations. After the complexation step, 750 µL of SHS - a N, N-Dimethylcyclohexylamine along with 0.9 mL of 2 M of acetic acid solution is added (hydrophilicity switch-on stage) and mixed manually to obtain a homogeneous solution. In the last stage, 0.45 mL of 10 M NaOH solution (hydrophilicity switch-off stage) is added to the sample solution and a vortex for 100 s is applied to ensure the effective extraction and separation of the complex containing the analytes. At this stage, a cloudy solution is immediately obtained. Finally, the effective phase separation is obtained at the centrifugation step (4000 rpm for 2 mins). The method limit of detection was as 0.03, 0.009, 0.6, and 0.2 ng/L for Zn (II), Fe (II), Cd (II), and Pb (II) respectively with RSD% below 2.0 %. The analysis of certified reference materials and real samples proved the full applicability of the method for routine analysis, contributing to the field of heavy metal analysis and ensuring the safety of baby products. According to the AGREE methodology, this method can be named as green analytical chemistry method with a score of 0.77.

A bibliometric perspective with research trends and global productivity on the modernization of andrology from the founder of modern clinical andrology Edward Martin to the present

OBJECTIVE

The number of studies in the field of andrology is increasing day by day, but a bibliometric study covering the entire literature on andrology has not yet been conducted. This bibliometric study aims to shed light on the question of where we came from and where we are going in andrology from past to present. It also aimed to summarize the intellectual structure of andrology to reveal global productivity and identify and map the latest trends of scientific articles published in the field of andrology.

MATERIALS AND METHODS

16,659 articles published between 1980 and 2022 were extracted from the Web of Science and analyzed using various statistical methods. Bibliometric network visualization maps revealed trending topics, global productivity, the most influential studies, and international collaborations. Spearman's correlation analysis was used for determining correlations.

RESULTS

The top three productive countries were United States of America (3,452; 20.7%), China (2,300; 13.8%), and Germany (1,069; 6.4%). The top two most productive authors were Agarwal A. (n=130) and Nieschlag E. (n=130). The most productive institution was the Egyptian Knowledge Bank (n=422). From past to present, the most studied subjects were testis, male infertility, spermatozoa, testosterone, infertility, erectile dysfunction, spermatogenesis, sperm, prostate cancer (PCA)/neoplasms, oxidative stress, fertility/fertilization, semen, rat(s), apoptosis, azoospermia, sperm motility, human and varicocele.

CONCLUSIONS

The trend topics that have been researched more in recent years include erectile dysfunction, oxidative stress, prostate cancer, sperm quality, sperm parameters, infertility, premature ejaculation, diabetes mellitus, obesity, prognosis, sperm DNA fragmentation/damage, antioxidant, asthenozoospermia, varicocelectomy, COVID-19, inflammation, prostatectomy, metabolic syndrome, hypogonadism, benign prostatic hyperplasia, lower urinary tract symptoms, meta-analysis, sexual dysfunction, peyronie's disease, and proliferation. We identified the research leadership of China, Japan, Turkey and India, in addition to Western countries, such as the USA and European countries.

Assessing heavy metal levels in pediatric enteral nutrition formulas available in the Turkish market: Implications for consumer health

In this study, we assessed the levels of lead (Pb), cadmium (Cd), mercury (Hg), and inorganic arsenic (iAs) in 27 pediatric enteral nutrition (EN) formulas from five international brands available in the Turkish market. Analysis was conducted using inductively coupled plasma mass spectrometry (ICP-MS). Non-carcinogenic and carcinogenic risk assessment was performed using hazard quotient (HQ), hazard index (HI), carcinogenic risk (CR), Toxicological contribution % of Provisional Tolerable Weekly Intake (PTWI) models. Our objective was to evaluate heavy metal exposure in EN formulas, specifically focusing on Cd, Pb, iAs, and Hg levels according to recommended amounts for different age groups based on their energy requirements. Average concentrations of iAs in polymeric (PC), oligomeric (OC), and monomeric (MC) EN formulas were as follows: PC: 2.13 ± 0.16 ( Collapse

Key Words

• Carcinogenic risk
• Enteral nutrition formula
• Hazard quotient
• Health risk assessment
• Heavy metal

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MESH Headings

• Female
• Child
• Humans
• Male
• Cadmium/analysis
• Enteral Nutrition
• Lead
• Metals, Heavy/analysis
• Mercury/analysis
• Risk Assessment

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Grants Collapse

Affiliation(s)

Gursel Isci Department of Nutrition and Dietetics, Faculty of Health Sciences, Agri Ibrahim Cecen University, 04100, Agri, Turkey.
Betul Orucoglu Department of Nutrition and Dietetics, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey.
Merve Ekici Department of Nutrition and Dietetics, Faculty of Health Sciences, Agri Ibrahim Cecen University, 04100, Agri, Turkey; Department of Nutrition and Dietetics, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, 34758, Istanbul, Turkey.

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CT features of pulmonary embolism in patients with COVID-19 pneumonia

OBJECTIVE

The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features.

PATIENTS AND METHODS

This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test.

RESULTS

Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures.

CONCLUSIONS

CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.

AB0278 IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING bDMARDs, THE CHARLSON COMORBIDITY INDEX IS MORE PRONOUNCED THAN PSORIATIC ARTHRITIS

Background

According to international recommendations, co-morbidities must be taken into account in the management of patients with inflammatory arthritis.

Objectives

To evaluate the distribution of pre-treatment comorbidities in the bDMARD cohort including patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods

The Hacettepe University biological database (HUR-BIO) was established in 2005, 581(75.4% female) patients with RA and 520 (69.4%female) patients with PsA enrolled up to 2021 were analyzed. Diagnosis of RA and PsA were based on the clinical evaluation of the rheumatologist who followed the patients. Comorbidities of the patients were reviewed retrospectively from the biological database, hospital electronic records, ICD-10 diagnostic codes and prescriptions of patients. Diabetes mellitus (DM), Hypertension (HT), Dyslipidemia (DL), Coronary artery disease (CAD), Body mass index (BMI) and smoking were recorded. DL was grouped in terms of lipid values ​​according to the classification of the Turkish Society of Endocrinology and Metabolism Dyslipidemia Guide(1). Detection of coronary artery disease before the age of 55 in men and of 65 in women was classified as premature - CAD. Data on Chronic Kidney Disease, obstructive pulmonary disease, Cerebro-vascular disease, Thyroid Diseases were also recorded. The Charlson comorbidity index (CCI) was calculated by summing the comorbidities in the patients’ medical history before the bDMARDs.

Results

The distribution of comorbidities in patients with RA and PsA prior to initiation of bDMARDs was given in Table 1. Patients with RA were older and smoking was more common. HT(28.5% for RA, 21.9% for PsA) and thyroid diseases (22.7% for RA, 14.7% for PsA) were the most comorbidities in both groups. Compared to PsA, patients with RA had higher rate of comorbidities (64.8% vs. 40.4%, p<0.001). Multimorbidity was detected in 231/581 (39.7%) of patients with RA, and it is significantly more common than the patients with PsA (21.8%) (p<0.001). There was no difference between the groups in terms of cardiovascular comorbidities such as BMI, DM, and dyslipidemia. When adjusted for age, the comorbidity burden according to CCI was 3.96 (2.57-6.13, p<0.001) times higher in patients with RA than in patients with PsA.

Table 1.

Comorbidities in RA and PsA patients

FeaturesRA n=581PsA n=520pGender, female n (%)438 (75.4)361 (69.4)0.027Age at PsA diagnosis, mean (SD) years46.7 (13.7)39.3 (12.0)<0.001Age at bDMARD start, mean (SD) years49.5 (13.8)42.2 (12.3)<0.001CCI-No comorbidity205/581 (35.2)290/486 (59.6)<0.001-1 comorbidity145/581 (24.9)90/486 (18.5)-≥ 2 comorbidity231/581 (39.7)106/486 (21.8)CCI mean, (SD)1.56 (1.77)0.78 (1.18)<0.001Smoking (ever), n292/581282/506<0.001BMI, mean (SD)29.3 (6.7)29.6 (5.9)0.50BMI ≥ 30 n261/577221/4980.77Diabetes Mellitus, n68/58149/4020.30Hypertension, n166/581110/5020.012Dyslipidemia* n-High TC47/27032/1610.30-High TG62/24245/1590.79-High LDL -C53/289(43/1750.38-Low HDL-C88/26757/1570.48Uric acid (>6 mg/dl), n150/554136/4370.16CAD n59/52432/4860.010Premature CAD, n39/58118/4860.030CKD, nG1 (GFR > 90)437/5230<0.001G2 (GFR 60-90)68/5230G3a (GFR 45-60)11/5230G3b (GFR 30-45)5/52328/370G4 (GFR 15-30)2/523342/370Lung disease, n-COPD15/5193/4850.007-Asthma66/52019/485<0.001Thyroid disease, n132/58165/440<0.001

*TC > 240, TG 150-499, LDL-C> 160, HDL-C erkek < 40, kadin < 50

CCI: Charlson comorbidity index, CAD: Coronary artery disease, CKD: Chronic Kidney Disease, COPD: Chronic Obstructive pulmonary disease

Conclusion

The burden of comorbidities in patients with RA before bDMARDs is more pronounced than in patients with PsA. Although, cardiovascular risk factors were similar, with the exception of hypertension and smoking, the age-adjusted CCI was 3.96 times higher in patients with RA than in patients with PsA.

References

[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021

Disclosure of Interests

None declared

AB0353 bDMARD CHOICES FOR INFLAMMATORY ARTHRITIS WITH CHRONIC KIDNEY DISEASE; HUR-BIO REAL-LIFE REGISTRY

Background

Rheumatic disesases may involve multiple systems and chronic kidney disease (CKD) can be seen during the course of diseases. Accompanying CKD affects the the choice of treatments in patients with rheumatic disease. There is limited data on the use of biological DMARDs in rheumatic patients with chronic kidney disease.

Objectives

To determine the preferred first and second bDMARDs in patients in the CKD in the bDMARD cohort.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005. A total of 2160 RA patients, 3744 SPA patients, were registered in HUR-BIO until November 2021. The CKD was confirmed and classified according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. . Patients were evaluated for the presence of CKB before the initiation of bDmard and during follow-up under bDMARDs. Age and sex matched RA patients without CKD were selected for the control group.

Results

142/5904 (2.4%) patients have CKD. 102(%71.8) patients had CKD prior to initiation of bDMARD and 40 (28.1%) patients had developed during follow-up. The median time to CKD development after starting bDMARD was 4.13 years(±4.05). Of the patients with CKD, 98 (69.0%) had RA and 44 (31.0%) had SpA. RA patients followed for CKD were older than SpA (66.0 (±11.1) vs 59.1 (±13.0) years, p=0.001), female gender was more common (73.5% vs 36.4%, p<0.001), disease duration was similar (19.3 (±13.8) vs 17.1 (±10.5) years, p=0.40). The first bDMARD choices of patients with and without CKD in RA and SpA patients were shown in Table 1. There was no difference between the SPA patients with or without CKD regarding TNF-i preferences. In patients with rheumatoid arthritis there was no difference in terms of TNFi and non-TNF-i preferences, but tocilizumab was more prefered in CKD group.

Table 1.

Relationship between remission according to bDMARD and CKD

Rheumatoid arthritispSpondyloarthritispw CKD n=98wo CKD n=91w CKD n=44(%)wo CKD n=80(%)p<0,05Etanercept, n(%)34 (34.6)30 (33.0)0.4617 (38.6)22 (27.5)P=0.14Adalimumab, n(%)17(17.3)17 (18.7)0,4810 (22.7)22 (27.5)P=0.36Infliximab,n(%)3 (3)8 (8.8)0.8514(31.8)32 (40.0)p=0.24Golimumab, n(%)4 (4)3 (3.3)0,541 (2.2)3 (3.8)p=0.55Certolizumab, n(%)0 (0)3 (3.3)0,111 (2.2)1 (1.3)p=0.58Anti-TNF therapy, n(%)58 (59.2)61 (67.0)0,6143800.352Non-TNF biologics, n(%)40 (40,8)30 (33.0)0,13100.355Rituximab, n(%)14 (14.3)12 (13.2)0,57Abatacept, n(%)14(14.3)12 (13.2)0,49Tocilizumab, n(%)6 (6.1)10.0411(2.2)p=0.35Jak-kinase inhibitors, n(%)6(6.1)5 (5.5)0.55

Conclusion

In our biologic cohort, 2% of patients with RA and SpA had accompanying CKD. In one-third of the patients with CKD, it was developed during the follow-up after bDMARDs. In patients with RA, there was no difference in terms of TNFi and non-TNF-i preferences. It should be kept in mind that CKD may develop during the follow-up of patients using bDMARDs.

References

[1]Ye W, Zhuang J, Yu Yet all Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study. BMC Nephrol. 2019 Dec 9;20

[2]Chebotareva NV, Guliaev SVet al. [Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants]. Ter Arkh. 2019 May 15;91(5)

Disclosure of Interests

None declared

POS1440 HEMATOLOGICAL MALIGNANCIES AND ANTI-TNF IN INFLAMMATORY ARTHRITIS: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY

Background

TNF inhibitors (TNFi) is highly effective in inflammatory arthritis (IA) treatment. However, concerns are raised about the possible association between TNFi and hematologic malignancies (HMs).

Objectives

To assess the incidence of HMs among IA patients receiving TNFi compared with the general Turkish population.

Methods

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA including rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) patients who had at least 1 visit after the TNFi usage were screened from 2005 to November 2021. HM diagnosis was determined from the each patient files according to the hematologists’ decision and/or bone marrow/lymph node biopsy. Demografic data, disease characteristics, and death status were recorded. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with age- and gender-specific SIR values abstracted from the 2017 Turkish National Cancer Registry (TNCR).

Results

Of the 6139 patients registered in the HUR-BIO database, 5355 [3116 female (58.2%)] used any TNFi at least once. Median follow-up duration was 2.6 years for all patients receiving TNFi. 13 patients [8 (61.5%) female] had HM on follow-up. In these patients, median age at the IA onset was 38 (range 26 to 67) and the number of patients with SpA, RA, and PsA was 7, 4, and 2, respectively. The median duration of IA was 17.7 years (range 1 to 33). The median age at the HM onset was 55.5 (range 38 to 76) and the type of HM as follow: 8 lymphoma, 2 multiple myeloma, 1 large granular lymphocytic leukemia, 1 plasma cell dyscrasia, and 1 myelodysplastic syndrome. The median duration of the TNFi usage onset to HM was 36 (range 4-112) months. The TNFi was as follows: etanercept (n=8), adalimumab (n=6), infliximab (n=4), golimumab (n=1), and certolizumab (n=1). 5 patients used more than one TNFi. Patients using TNFi had an increased incidence for HMs (SIR 4.23, 95% CI 2.35-7.05). These results were also valid for both gender. 10 patients with HMs were under the age of 65. In this group, there was a higher incidence of HMs in both men (SIR 5.15, 95% CI 1.88-11.43) and women (SIR 4.76, 95% CI 1.74-10.55). 5 patients deceased on follow-up.

Conclusion

The risk of HMs in inflammatory arthritis patients receiving TNFi being four times higher in comparison with the general Turkish population. There is a plethora of information that discusses the association between HMs and rheumatic disease. To determine whether the increased risk is from rheumatic disease or from TNFi usage, it would be ideal to compare patients receiving TNFi with bDMARD naive IA patients.

Table 1.

SIR for diferent age cut-ofs in both sexes for patients with hematologic malignancies

GenderAgeObserved/expected casesSIR%95 confidence intervalTotalAll ages*13/3.074.232.35-7.05Male20-64 years (n=2059)5/0.975.151.88-11.43≥ 65 years (n=180)0/0.39NA-Overall (n=2239)5/1.363.671.34-8.14Female20-64 years (n=2667)5/1.054.761.74-10.55≥ 65 years (n=449)3/0.664.541.15-12.37Overall (n=3116)8/1.714.672.17-8.88

*: Includes patients ≥18 years.

NA: Not applicable, SIR: standardized incidence rates

Figure 1.

Cumulative number of hematologic malignancies in function of time from start of first anti-TNF therapy

Disclosure of Interests

None declared

POS1184 EPIDEMIOLOGICAL CHARACTERISTICS OF VIRAL HEPATITIS IN PATIENTS WITH RHEUMATIC DISEASES – IMPLICATIONS FROM TREASURE DATABASE

Background

Recent epidemiological data on HBV and HCV in Turkey revealed that the seroprevalence rates of hepatitis B surface antigen and antibody against HCV were 4% and 1%, respectively, and seropositivity rates for hepatitis B surface antibody and hepatitis B core antibody were 31.9% and 30.6%, respectively. A previous multicenter nationwide study conducted in Turkey reported that the HBsAg positivity was determined in 2.3% of patients with rheumatoid arthritis (RA) and 3% of patients with ankylosing spondylitis (AS), and the anti-HCV positivity was detected in 1.1% of patients in each group. Given these rates, viral hepatitis is still considered a potential threat to patients with rheumatic diseases, specifically for the treatment-related viral reactivation.

Objectives

This study aimed to evaluate the serologic HBV and HCV frequency and clinical characteristics among our patients with RA or SpA and receive biological treatments based on this background.

Methods

The prospective TReasure database, which observationally collects data of patients with rheumatic diseases from fifteen centers across Turkey, was analyzed for viral hepatitis, patient characteristics, and treatments used. TReasure registry study protocol, and the data collection was started on December 2017. At the time of the analysis for this study was performed, the registry database included 3147 patients with RA and 6071 patients with SpA. For hepatitis B; Hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and anti-HBV surface antibody (Anti-HBs) tests were evaluated. HBV-DNA was studied in HBsAg positive patients. Anti-HCV antibody has been studied for HCV. The clinical and serological HBV reactivation in the follow-up of the patients was evaluated by looking at the HBV-DNA viral loads.

Results

A total of 9218 patients (3147 RA and 6071 patients with SpA) were included in the analyses. The screening rate for HBV was 97% in RA and 94.2% in SpA groups. HBsAg positivity rates were 2.6% and 2%, anti-HBs positivity rates were 32.3% and 34%, anti-HBc positivity rates were 20.3% and 12.5%, HBV DNA positivity rates were 3.5% and 12.5%, and anti-HCV positivity rates were 0.8% and 0.3% in these groups, respectively (Table 1).

Table 1.

Serological analyses in the study group

RASpApNn (%)Nn (%)Hepatitis testing28962809 (97.0)54445130 (94.2)<0.001HBsAg positivity275071 (2.6)501799 (2)0.080Anti-HBs positivity2708876 (32.3)48931663 (34)0.147Anti-HBc positivity2362480 (20.3)4194524 (12.5)<0.001HBV-DNA positivity45416 (3.5)63735 (5.5)0.129Anti-HCV positivity260222 (0.8)462716 (0.3)0.005

The HBsAg (+) patients were older and had higher comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, RF positivity was more in HBsAg(+) cases. The most frequently prescribed bDMARDS were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group, whereas adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. HBV reactivation was observed in one patient with during RA treatment, who received rituximab and prophylaxis with tenofovir.

Figure 1.

Prescription proportions of medications in the rheumatoid arthritis (RA) and spondyloarthritis (SpA) groups

Conclusion

The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the most comprehensive registries in rheumatology practice. According to the results of our study; It can be thought that there is no risk in the choice of treatment by the rheumatologist in patients who receive appropriate prophylaxis.

Disclosure of Interests

None declared

POS0602 PULMONARY RHEUMATOID NODULES: DOES SEROLOGIC STATUS MATTER?

Background

The frequency of pulmonary rheumatoid nodules closely relates to the diagnostic modality and changes from <0.4% to 32%. Also, it is known that seropositive RA patients tend to have more extra-articular disease.

Objectives

We aimed to compare the disease and pulmonary rheumatoid nodule characteristics of seropositive and seronegative RA patients.

Methods

In this study, all RA patients - according to ICD-10 code - and had at least one chest computerized tomography (CT) were examined and revealed 4117 individual patients. First, RA diagnosis was confirmed according the patients’ history, physical examination, radiography and laboratory assessment. Then, chest CTs were examined by an experienced radiologist. To classify pulmonary nodules as ‘’pulmonary rheumatoid nodule’’, following inclusion and exclusion criteria were used; For inclusion: 1) nodules with changing dimension on follow-up, 2) At least two nodules with different dimensions, 3) Cavitary nodule at any chest CT. For exclusion: 1) Solitary nodules OR all nodules ≤ 5mm and without follow-up OR no change on follow-up. Biggest nodule was named as dominant nodule. Then, patients were grouped according to rheumatoid factor and anti-CCP status as seropositive (RF ± anti-CCP) and seronegative. Demographics, comorbidities, RA-spesific treatments and nodule characteristics were compared.

Results

Of 680 RA patients who had pulmonary nodule in chest CT, 208 (30.6%) patients were classified as having pulmonary rheumatoid nodule. 167 (80.3%) patients were seropositive. Demographic and comorbidity characteristics were similar among seronegative and seropositive patients (Table 1). Regarding RA-spesific treatments, methotrexate, leflunomide and rituximab were prescribed more frequently in seropositive patients. For nodule characteristics, seropositive patients had higher number of nodules (5 [1-48] vs 3 [1-27]; p=0.004), bigger dominant nodule (8 [3-95] vs 6 [3-45] mm; p=0.011), and higher percentage of cavitary nodule (28.7% vs 12.2%; p=0.03). Localization of the nodule was compareble.

Table 1.

Comparison of demographic, disease and nodule characteristics of seropositive and seronegative patients (n=208)

Seropositive (n=167, 80.3%)Seronegative (n=41, 19.7%)P valueFemale, n(%)113 (67.7)28 (68.3)0.94Age at the time of CT (median, min-max)61 (24-83)59.7 (20-83)0.28Smoking (n=73)26 (43.3)4 (30.8)0.40- Never smoked34 (56.7)9 (69.2)- Ever smokedComorbidity (n=188)127 (84.7)30 (78.9)0.40- Hypertension72 (55.0)18 (58.1)0.91- Diabetes (n=166)25 (18.5)7 (22.6)0.79- CAD (n=165)30 (22.6)7 (21.9)0.93- Heart Failure (n=164)15 (11.4)6 (18.8)0.41- COPD (n=163)20 (15.2)1 (3.2)0.13- Asthma (n=160)15 (11.6)5 (16.1)0.54- CKD (n=169)20 (14.5)8 (25.8)0.22- ILD (n=202)54 (33.1)10 (25.6)0.37RA-spesific treatments (ever)90 (72.6)16 (55.2)0.07- Methotrexate (n=153)105 (64.0)12 (30.8)0.001- Leflunomide (n=208)117 (70.5)25 (61.0)0.06- Hydroxchloroquine (n=169)65 (47.4)11 (36.7)0.28- Sulfasalazine (n=167)39 (39.0)6 (27.3)0.30- TNFi (n=122)41 (39.8)2 (9.5)0.008- Rituximab (n=124)11 (9.9)2 (8.0)0.77- Tofacitinib (n=136)12 (11.9)2 (10.5)0.86- Abatacept (n=120)9 (8.5)2 (8.7)0.98- Tocilizumab (n=129)Number of nodules at baseline CT (median, min-max)5 (1-48)3 (1-27)0.004Diameter of dominant nodule (median, min-max) (mm)8 (3-95)6 (3-45)0.011Localization of dominant nodul64 (38.3)15 (36.6)0.84- Left or right?64 (38.3)12 (29.3)0.48◦ Left51 (30.5)16 (39.0)0.28- Upper, middle or lower?52 (31.1)13 (31.7)◦ Upper69 (41.3)21 (51.2)◦ Middle22 (13.2)7 (17.1)◦ Lower76 (45.5)13 (31.7)-Peripheral, central or subpleural◦ Peripheral◦ Central◦ SubpleuralCavitation48 (28.7)5 (12.2)0.03Calcification54 (32.5)12 (29.3)0.69

CAD: Coronary artery disease, CKD: Chronic kidney disease,; ILD: Interstitial Lung Disaese,

Conclusion

Autoantibodies seem to have impact on the characteristics of pulmonary rheumatoid nodules. As there were different prescription patterns were seen in our study, effects of these treatment differences need to be determined.

References

Disclosure of Interests

None declared

POS0991 PREDICTORS OF DEVELOPMENT OF ADVANCED SPINAL ANKYLOSIS/BAMBOO SPINE IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM REAL-LIFE DATA

Background

In axial spondyloarthritis (axSpA), intervertebral ossification bridges of consecutive vertebrae may progress to advanced spinal ankylosis and bamboo spine over the years [1].

Objectives

To identify demographic, clinical, disease activity and treatment factors associated with development of bamboo spine / advanced spinal ankylosis and bamboo spine-only in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.

Methods

HUR-BIO is a prospective, single center database of biological disease-modifying antirheumatic drug (bDMARD) treatments. 770 patients on bDMARDs treatment had both lumbar and cervical lateral radiographies at the time of the data collection, and were included in the study. Bamboo spine was defined Bath Ankylosing Spondylitis Radiologic Index (BASRI)-spine grade 4 with a complete fusion of lumbar and cervical spines. Advanced spinal ankylosis was defined as the presence of at least two intervertebral adjacent bridges and/or fusion at the lumbar and/or cervical spine without bamboo spine. We analyzed the ensemble of variables by multivariable logistic regression to identify predictors associated with bamboo spine / advanced spinal disease, and bamboo spine-only.

Results

In the study, there were 99 patients with advanced spinal ankylosis and 78 patients with bamboo spine. Older age (OR 1.12, 95% CI 1.07-1.17), male gender (OR 4.26, 95% CI 1.75-10.41), delay diagnosis ≥ 24 months (OR 2.7, 95% CI 1.27-5.74), obesity (OR 4.03, 95% CI 1.53-10.64), hip involvement (OR 4.94, 95% CI 1.94-12.6), smoking ≥ 10 package/year (OR 2.28, 95% CI 1.003-5.2) were significantly associated factors with bamboo spine / advanced spinal ankylosis. Similarly, older age (OR 1.17, 95% CI 1.09-1.3), male gender (OR 8.31, 95% CI 2.09-33.1), obesity (OR 5.15, 95% CI 1.25-21.27), hip involvement (OR 4.74, 95% CI 1.32-16.96) and smoking ≥ 10 package/year (OR 3.19, 95% CI 1.03-9.89) were showed statistical significance with bamboo spine (Table 1).

Table 1.

Predictors of Bamboo Spine and Advanced Spinal Ankyloses, and Bamboo Spine-only

Multivariable ModelCovariatesBamboo Spine and Advanced Spinal AnkylosisBamboo SpineOR (95% CI)p-valueOR (95% CI)p-valueAge1.12 (1.07-1.17)<0.001*1.17 (1.09-1.3)<0.001*Male (vs female)4.26 (1.75-10.41)0.001*8.31 (2.09-33.1)0.003*Delay Diagnosis (≥ 24 months vs <24 months)2.7 (1.27-5.74)0.01*2.39 (0.85-6.71)0.09BMI0.019*0.074- 25 to < 30 (vs <25)2.05 (0.77-5.46)0.153.37 (0.84-13.6)0.087- ≥ 30 (vs <25)4.03 (1.53-10.64)0.005*5.15 (1.25-21.27)0.024*Hip involvement (present vs absent)4.94 (1.94-12.6)0.001*4.74 (1.32-16.96)0.017Smoking (≥ 10 package/year vs <10 package/year)2.28 (1.003-5.2)0.049*3.19 (1.03-9.89)0.044*Family History of SpA (First-degree; present vs absent)1.67 (0.61-4.57)0.322.82 (0.79-10.06)0.11Uveitis History (present vs absent)1.04 (0.39-2.74)0.941.19 (0.33-4.29)0.79Use SSZ (present vs absent)0.6 (0.17-2.07)0.422.09 (0.39-11.28)0.39Use Corticosteroids (present vs absent)0.69 (0.27-1.75)0.430.73 (0.18-2.97)0.66

*p <0.05

BMI: Body mass index; SpA: Spondyloarthritis; SSZ: Sulfasalazine

Conclusion

Data on the predictors of development of advanced spinal ankylosis and bamboo spine are scarce. In this study, we showed that older age, male gender, delay in diagnosis, obesity, hip involvement and smoking are factors that predict the development of advanced spinal involvement in axSpA.

References

[1]Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskelet Dis. 2012;4(4):301-11.

Disclosure of Interests

None declared

POS1085 FREQUENCY OF DYSLIPIDEMIA AND COMPLIANCE WITH THE TREATMENT IN PsA PATIENTS USING bDMARDs

Background

Dyslipidemia is the leading treatable-modifiable factor among comorbidities in Psoriatic arthritis (PsA) patients. International treatment recommendations have left the management of dyslipidemia to national guidelines and especially to the rheumatologists.

Objectives

In this study, we aimed to determine the frequency of dyslipidemia and the rates of initiation of treatment within the indication in PsA patients using bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by therheumatologist. Lipid profiles of PsA patients were evaluated at diagnosis, during the first bDMARD initiation, and at the last visit. Total cholesterol (TC), Triglyserides (TG), HDL-C and LDL-C values were grouped as optimal, borderline, high and severely high according to the Turkish Endocrine and Metabolism society criteria (1).

Results

Lipid profile values ​​of PsA patients were known at diagnosis (n=159, 30.6%), in the initial bDMARD baseline (n=161, 30.9%), and at the last visit (n=203, 39.0%). The time to diagnosis of PsA and first bDMARD use was 2.8 years, and the time between the start of bDMARD and the last visit was 3.7 years. Accordingly, the rates of high TC, borderline TG, and high LDL increased over time. Rates at the time of PsA diagnosis, first bDMARD onset and at the last visit are as follows; high TC (14.3%, 17.1% and 28.0%), borderline TG (20.4%, 27.7% and 40.5%) and high LDL (17.0, 24.0% and 27.9%). On the other hand, low HDL-C slightly improved in men (33.3%, 29.4% and 23.1%), but did not show a significant change in women. While LDL-C level was >160 in 24.0% of patients who were started on bDMARD, anti-hyperlipidemic drug was started in only 6.2% of them. A similar situation persisted at the last visit (27.9% had LDL-C levels >160, but 10.8% received anti-hyperlipidemic therapy) (Table 1).

Table 1.

Lipid levels and changes over time

Lipid levelsAt the time of diagnosis n= 159At the time of bDMARD initiation n=161bDMARD last visit n= 203Total Cholesterol (TC) mean (SD)195 (42)201 (43)214 (47)- TC < 200 (optimal) (%)56.552.845.3- TC 200-239 (borderline) (%)27.230.125.7-- TC > 240 (high) (%)14.317.128.0Triglyceride (TG) mean (SD)115 (52)132 (90)158 (103)- TG < 150 (optimal) (%)79.671.758.0- TG 150-499 (borderline) (%)20.427.740.5- TG 500-880 (high) (%)001.0-- TG ≥ 880 (severely high) (%)00.60.5HDL-C mean (SD)51.8 (13.1)50.6 (13.0)53.2 (12.5)- ≥60 (optimal) (%)20.620.425.6- 40-59 (borderline) in men (%)54.660.852.3- 50-59 (borderline) in women (%)32.324.530.3- Male < 40 (low) (%)33.329.423.1-- Women < 50 (low) (%)32.339.633.8LDL-C mean (SD)126 (33)132 (37)139 (36)- LDL-C < 100 (optimal) (%)21.421.114.2- LDL 130-159 (borderline) (%)22.525.127.0- LDL 160-190 (high) (%)17.024.027.9-- LDL > 190 (very high) (%)4.46.38.4Anti-hyperlipidemic drug n (%)5 (3.1)10 (6.2)22 (10.8)

Conclusion

Among the modifiable risk factors for cardiovascular comorbidities in PsA patients, the leading risk factor is dyslipidemia. On the other hand, dyslipidemic drug use rates in daily practice are significantly lower. Although attention is paid to the management of comorbidities in all recommendations, there is still work to be done in real life.

References

[1]TEMD Obezite, L.M., Hipertansiyon Çalişma Grubu, TEMD DİSLİPİDEMİ TANI VE TEDAVİ KILAVUZU. 9 ed, ed. 2021, Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği. 159.

Disclosure of Interests

None declared

POS1087 THE RELATIONSHIP BETWEEN CHANGES IN PSORIATIC ARTHRITIS DISEASE ACTIVITY AND COMORBIDITIES IN PATIENTS TREATED WITH bDMARDs

Background

Comorbidities are common in psoriatic disease, needed to be recognized and managed to effectively when treating psoriatic arthritis (PsA) patients. However, the data on the impact of particular comorbidities on the disease activity in patients requiring bDMARDs are very small.

Objectives

Our aim was to understand the relationship between the disease activity and comorbidities in PsA patients under bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by the rheumatologist. DAS-28 score (at the last visit) and all comorbidities were documented after bDMARD initiation. Multivariate analysis was performed to understand comorbidities that have impact on DAS-28 remission.

Results

There were 469 patients with a known DAS-28 score median (IQR) 28 (61) months after bDMARD initiation. It was detected in 214/469 (45.6%) patients with a DAS-28 score below 2.6. Patients in remission of DAS-28 were younger, remission was less frequent in women, and comorbidities, mainly BMI, Diabetes Mellitus (DM) and hypertension, were also found less frequent (Table 1). In the multivariate analysis, no determining factor was found in male gender. On the other hand, in females, smoking, presence of comorbidity, Body mass index (BMI) at the start of bDMARDs, age at onset of bDMARDs, DM at the start of bDMARDs, HT at the start of bDMARDs, coronary artery disease, and cardiovascular risk factors were included in the analysis and revealed, bDMARD baseline BMI [OR 1.06 (95% CI 1.02-1.11), p= 0.004] and presence of bDMARD baseline DM [OR 3.08 (95% CI 1.14-8.30), p=0.026] had significant impact on DAS-28 remission.

Table 1.

Relationship between remission according to DAS-28 score and comorbidities

ParametersDAS-28 ≤ 2.6 (n=214)DAS-28 > 2.6 (n=255)pAge, mean (SD), years43.8 (11.7)47.5 (12.5)0.001Age at PsA diagnosis, mean (SD), years36.8 (11.5)41.6 (11.7)<0.001Gender, female, n(%)115 (53.7)211 (82.7)<0.001Comorbidity count1.54 (0.98)1.98 (1.31)<0.001Comorbidity (yes/no)67 (31.9)118 (47.6)0.001Comorbidity distribution0.001-No143 (68.1)130 (52.4)-1 Comorbidity38 (18.1)47 (19.0)-≥ 2 Comorbidity17 (8.1)36 (14.5)-≥ 3 Comorbidity12 (5.7)35 (14.1)Body Mass Index (BMI)28.1 (5.4)30.3 (5.9)<0.001BMI > 30, n(%)70 (32.9)123 (48.4)0.001Diabetes Mellitus, n(%)10 (4.7)35 (13.7)0.001Hypertension, n(%)29 (13.6)71 (27.8)<0.001Total cholesterol > 240, n(%)8 (10.5)22 (28.6)0.019Thyroid Disease20 (9,8)43 (17,3)0,02

Conclusion

Previous data showed that obesity, hypertension and at least 1 point from charlson comorbidity index are poor prognositc factors for treatment outcomes (1). Our data showed that BMI and presence of DM were determined as factors affecting bDMARD treatment response in female PsA patients.

References

[1]Ballegaard C, et al. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford). 2021 Jul 1;60(7):3289-3300.

Disclosure of Interests

None declared

AB0912 Swollen and tender joints improvement in the randomized controlled trials of psoriatic arthritis

Background

The ACR response is used to evaluate peripheral joints in psoriatic arthritis. However the main component in ACR treatment response is swollen (SJ) and tender joints (TJ), therewithal patient and physician global assessment, acute phase response, pain and function are included in this treatment response. Therefore, it can be thought that peripheral arthritis can best evaluated over SJ and TJ. Although ACR treatment responses are generally found to be similar between anti-TNF and anti-IL17/anti-IL23 in PsA, there is a general opinion that anti-TNF treatments may be more effective on the peripheral joint. (1).

Objectives

In this study, it was aimed to evaluate the efficacy on SJ and TJ in RCTs performed in PsA.

Methods

We was searched with the keywords ‘psoriatric arthritis’ and ‘randomized controlled trial’ in Pubmed. All studies between 1975 and 31.10.2021 were screened for TJ count (SD) and SJ count (SD) values at treatment initiation and primary endpoint. The 2 studies with anti-TNFs and the SPIRIT-1 study comparing ixekizumab with placebo and adalimumab showed the number of SJ and TJ at baseline and primary endpoint. Effect size calculated separately according to Morris and Klauer formula. (2,3) We can interpret the effect size according to Cohen as follows: 0-0,1 no effect; 0,2-0,4 small effect; 0,5-0,7 intermediate effect; 0,8-≥1 large effect. (4)

Results

Certolizumab study, ES was found at a good level in the number of TJ and SJ at 200 and 400 mg doses. (ES 0.84 for SJ). The study comparing ixekizumab with adalimumab and placebo, it was observed that administration of ixekizumab every 4 weeks was minimally more effective in the number of TJ (ES 0.16) and SJ (ES 0.13) than adalimumab. The effect of ixekizumab over placebo is also slightly better than that of Adalimumab over placebo. (0.51 vs 0.36 in TJ, 0.38 vs 0.29 in SJ)

Table 1.

Effect size analysis of studies

Tender Joint CountReferenceWeek (w)InterventionControlBaseline (Intervention vs Control)ES (Morris)ES (Klauer)Spirit-112Ixekizumab 4 w (n=107)Adalimumab (n=101)20,5 (13,7) vs 19,3 (13,0)0.160.9112Ixekizumab 2 w (n=103)Adalimumab (n=101)21,5 (14,1) vs 19,3 (13,0)0.120.2912Ixekizumab 4 w (n=107)Plasebo (n=106)20,5 (13,7) vs 19,2 (13,0)0.515.112Ixekizumab 2 w (n=103)Plasebo (n=106)21,5 (14,1) vs 19,2 (13,0)0.473.912Adalimumab (n=101)Plasebo (n=106)19,3 (13,0) vs 19,2 (13,0)0.364.1GENOVESE, Mark C., et al. M02-570 Study Group12Adalimumab (n=51)Plasebo (n=49)25,3 (18,3) vs 29,3 (18,1)0.190.30RAPID-PsA24Certolizumab 200 mg (n=138)Plasebo (n=136)21,5 (15,3) vs 19,9 (14,7)0.670.7524Certolizumab 400 mg (n=135)Plasebo (n=136)19,6 (14,8) vs 19,9 (14,7)0.490.61Swollen Joint CountSpirit-112Ixekizumab 4 w (n=107)Adalimumab (n=101)11.4 (8.2) vs 9.9 (6.5)0.130.6312Ixekizumab 2 w (n=103)Adalimumab (n=101)12,1 (7,2) vs 9,9 (4,7)0.191.1812Ixekizumab 4 w (n=107)Plasebo (n=106)11,4 (8,2) vs 10,6 (7,3)0.383.812Ixekizumab 2 w (n=103)Plasebo (n=106)12,1 (7,2) vs 10,6 (7,3)0.453.212Adalimumab (n=101)Plasebo (n=106)9.9 (6.5) vs 10.6 (7.3)0.294.4GENOVESE, Mark C., et al. M02-570 Study Group12Adalimumab (n=51)Plasebo (n=49)18.2 (10.9) vs 18.4 (12.1)0.330.29RAPID-PsA24Certolizumab 200 mg (n=138)Plasebo (n=136)11.0 (8.8) vs 11.0 (8.8)0.840.8324Certolizumab 400 mg (n=135)Plasebo (n=136)10.5 (7.5) vs 11.0 (8.8)0.840.87

Conclusion

Changes in the number of SJ and TJ that directly assess the peripheral joint have not been reported enough in RCTs in PsA patients. According to a limited number of reports, Anti-TNFs (eg, certolizumab) cause significant improvement in the number of SJ and TJ in the primary endpoint. On the other hand, Ixekizumab has as much effect on SJ and TJ as Adalimumab. The effect of anti-IL 17 treatments on the peripheral joint is not less than that of anti-TNFs, as thought.

References

[1]Noviani M et at. Ther Adv Musculoskelet Dis. 2020

[2]Klauer, K. J. Handbuch kognitives Training

[3]Morris, S. B. Estimating Effect Sizes From Pretest-Posttest-Control Group Designs.

[4]Cohen, J. Statistical power analysis for the behavioral sciences (2. Auflage)

Disclosure of Interests

None declared

AB0275 THE FREQUENCY, PREVALENCE OF CORONARY ARTERY DISEASE AND PRE-MATURE CAD IN PsA AND RA PATIENTS

Background

An increased incidence of coronary artery disease (CAD) is known in inflammatory arthritis patients compared to the normal population. In the Veterans With Premature Atherosclerosis (VITAL) registry, the frequency of premature CAD (CAD < 55 in men, < 65 years in women) in autoimmune rheumatic diseases was 1.72 (95% CI 1.63-1.81) in Rheumatoid arthritis (RA) compared to the healthy population in approximately 135,000 patients, while a similar situation was not observed in Psoriatic arthritis (PsA) patients 1.09 (95%CI 0.98-1.21) (1).

Objectives

In this study, we aimed to compare the frequency of CAD and premature CAD in RA and PsA patients using bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), database was established in 2005 and prospective follow-up of patients using bDMARDs is being carried out. The frequency of CAD was recorded in 486 PsA and 524 RA patients using bDMARDs. CAD was determined according to the angiography reports or Coronary Computed-Tomography results. Premature CAD is defined as a history of CAD before the age of 55 in men and before the age of 65 in women. Demographic characteristics and other comorbid conditions of the patients were also noted. Disease activity (DAS-28) and functional status (HAQ-DI) of the patients before the first DMARD initiation were recorded.

Results

581 (75.4% female) RA and 520 (69.4% female) PsA patients were evaluated. The ages of the patients and the duration of the disease are as follows; RA, mean (SD) years of age 52.1 (13.9), disease duration 5.3 (2.1) years, PsA mean (SD) years of age 48.7 (12.5), disease duration 9.2 (6.4). At the time of first bDMARD initiation, 43/581 (7.4%) patients with RA and 12/486 (2.4%) patients with PsA had CAD (p<<0.001). After a median (IQR) follow-up of 32 (23) months in RA patients and 49 (88.5) months in PsA patients, CAD was detected in 59 (11.2%) patients, 32 (6.6%) in PsA patients, p=0.01. While 39/59 (66.1%) of RA patients had premature CAD, 18/32 (56.3%) PsA patients had premature CAD (Table 1).

Table 1.

Characteristics of RA and PsA patients with/without premature CAD

RAPsAPremature CADn=38Non-prematureCADn=21pPremature CADn=18Non-prematureCAD(n=14)pGender, n (%)29 (76.3)9 (42.8)0.0110 (55.5)10 (71.4)0.36Age, mean (SD), years56.6 (8.9)72.7 (7.1)<0.00159.9 (8.2)69.1 (6.3)0.002PsA duration, mean (SD), years5.5 (2.1)6.0 (1.7)0.3413.3 (8.9)12.6 (9.5)0.83Smoking (ever), n(%)22 (57.9)11 (52.4)0.8016 (88.9)5 (35.7)0.002BMI > 30, n(%)19 (52.3)7 (35.0)0.208 (44.4)11 (78.5)0.051HT (ever), n(%)23 (63.9)14 (66.7)0.8911 (61.1)13 (92.8)0.040DM (ever), n(%)20 (57.1)9 (52.9)0.774 (22.2)6 (42.8)0.45LDL > 130 (ever), n(%)29120.1311 (61.1)5 (35.7)0.14DAS-284.7 (1.1)4.2 (1.2)0.114.7 (1.4)4.5 (1.5)0.72HAQ (0-3)1.41 (0.7)1.05 (0.8)0.0790.7 (0.6)1. 3 (0.7)0.13

RA: Rheumatoid arthritis, PsA: Psoriatic arthritis, CAD; Coronary artery disease, BMI; Body-mass index, HT: Hypertension, DM: Diabetes mellitus

Conclusion

While the frequency of premature CAD is 10% in the normal population, CAD has a premature character in two-thirds of RA patients and 55% of PsA patients (2). In a large community-based study, the frequency of premature CAD was found to be increased in RA patients compared to the normal population, but no similar difference was observed in PsA patients (1). In real-life data in which we examined a large group of patients using bDMARDs, it is seen that the subtype of CAD is of pre-mature character in both RA patients and PsA patients.

References

[1]Mahtta D et al. Am J Med. 2020 Dec;133(12):1424-1432

[2]Cole JH, et al. Curr Atheroscler Rep. 2004 Mar;6(2):121-5.

Disclosure of Interests

None declared

AB1076 IS THERE AN ADDITIONAL IMPACT OF STIMULATING CD8+ LYMPHOCYTES TO DETECT LATENT TUBERCULOSIS IN PATIENTS WITH RHEUMATIC DISEASES?

Background

Purified protein derivative skin test (PPD) or interferon gamma release assays (IGRAs) are used as diagnostic tools to detect latent tuberculosis. QuantiFERON-TB Gold Plus (QFT-Plus) is a new test that detects latent tuberculosis. Antigens of Mycobacterium tuberculosis (ESAT-6 and CFP-10) are used. The test contains two tubes: TB1 and TB2. TB1 tube contains peptides of these antigens that induce CD4+T cell response while TB2 tube contains peptides designed to stimulate both CD4+ and CD8+ T cells. The amount of interferon gamma releases from those cells are determined by ELISA method. In patients with recent exposure to tuberculosis, there is an increased amount of CD8+ expression in comparison to patients with past exposure to tuberculosis.

Objectives

To investigate the additional impact of stimulating CD8+ lymphocytes with QFT-Plus test in order to detect latent tuberculosis in patients with inflammatory rheumatic diseases.

Methods

Hacettepe University Rheumatology Biologic Registry Database (HURBIO) database was used in this study. QFT-Plus test of patients with rheumatoid arthritis (RA) and spondyloarthritis (SPA) between January 2018 and March 2021 during work up before biologic/targeted therapy were analysed, retrospectively. Positivity of any of tubes has been reported as QFT (+). The impact of each tube on QFT positivity is analysed.

Results

1480 patients (946 (64%) SPA, 534 (36%) RA) were enrolled. 957 patients were women. The median age was 45 (min-max:18-82). Totally 12.2% of patients had been reported as QFT(+). In 6% of QFT (+) patients only TB2 tube is positive (Table 1).

Table 1.

The impact of each tube on QFT-Plus positivity

QFT-Plus test (n=1480)Negative86.2%Indeterminate1.5%PositiveOnly TB1 tube positivity8% of positively reported patients12.2% of all patientsOnly TB2 tube positivity6% of positively reported patientsTB1 and TB2 positivity86% of positively reported patients

Conclusion

Disease inflammatory cascades along with ongoing usage of immunosuppressive agents could affect results of QFT-plus assay in rheumatic diseases. TB2 tubes stimulating CD8(+) T lymphocytes have additional impact in detecting latent TB infection in patients with RA and SpA.

Disclosure of Interests

None declared

AB0277 DYSLIPIDEMIA TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS USING bDMARDs IS BETTER THAN PsA, BUT THERE IS STILL A WAY TO GO

Background

Patients with inflammatory arthritis have an increased risk of cardiovascular disease. Dyslipidemia is one of the primary modifiable risk factors.

Objectives

Comparasion of the frequency of dyslipidemia and the use of anti-hyperlipidemic agents in patients with Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) receiving bDMARDs.

Methods

The Hacettepe University biological database (HUR-BIO), was established in 2005 and 581 (75.4% female) patients with RA and 520 (69.4% female) patients with PsA enrolled up to 2021 were analyzed. Dyslipidemia was defined according to the Turkish Endocrine and Metabolism society criteria (TC > 240, Triglycerides (Tg) > 150, LDL-C > 160, HDL-C (< 40 in men, < 50 in women) (1). The anti-hyperlipidemic (anti-HL) agents used by the patients during follow-up and at their last visit were recorded.

Results

The mean (SD) age of the patients and diseases duration were as follows; RA vs. PsA [age: 52.1 (13.9) vs. 48.7 (12.5) years; disease duration: 5.3 (2.1) vs. 9.2 (6.4) years]. Lipid profiles were known in 289 (49.7%) patients with RA and in 175 (33.6%) patients with PsA at the initiaiton of bDMARD. Lipid profiles were evaluated in 356 (61.2%) patients with RA and 226 (43.4%) patients with PsA during follow-up and at the last visit. Lipid profiles were similar in patients with RA and PsA at the initiation of bDMARDs (Table 1). At the initiation of bDMARD, 29 (5.0%) of RA patients and 10 (3.2%) of PsA patients were receiving anti-HL agents. During the entire follow-up, 65 (12.6%) patients with RA and 22 (4.8%) patients with PsA have used anti-HL agents (p<0.001).

Table 1.

Lipid values in patients with RA and PsA at the initiation of bDMARD and at the last visit

Rheumatoid arthritis, n (%)Psoriatic arthritis, n (%)p1*p2**Lipid valuesbDMARD initiationLast visitbDMARD initiationLast visitTotal Cholesterol> 24047/270(17.4)98/339 (28.9)32/161(19.8)57/203 (28.1)0.300.13Triglyseride> 15062/242 (25.6)108/320 (33.7)45/159 (28.3)80/193 (41.4)0.790.20HDL-C< 40 (males),< 50 (females)88/267 (32.9)70/343 (20.4)57/157 (36.3)20/207 (9.6)0.480.001LDL-C > 16053/289 (18.3)91/356 (25.6)43/175 (24.5)65/226 (28.7)0.380.55

*p1, bDMARD initiation visit comparison

**p2, last visit comparison

Conclusion

In real-life cohort, lipid profile was not assesed in half of the patients during entire follow-up. Although, LDL-C levels are high in about a quarter of the patients in both groups, use of anti-hyperlipidemic drug was inadequate. This is even more evident in PsA patients. Despite the significant emphasis on comorbidities in treatment guidelines, there is still a long way to go in real life.

References

[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021,

Disclosure of Interests

None declared

AB0416 CARDIOVASCULAR EVENT, VENOUS THROMBOEMBOLIZM, AND INFECTION RISK WITH TOFACITINIB IN RHEUMATOID ARTHRITIS PATIENTS AGED ≥ 60 YEARS

Background

Tofacitinib is a targeted synthetic DMARD that selectively inhibits Janus kinase (JAK) and is approved for the treatment of RA by the FDA in 2012. In recent years, an important safety concern related to incidence of adverse events after treatment with tofacitinib has emerged.

Objectives

To evaluate the risk of major adverse cardiovascular events (MACE), venous thromboembolism (pulmonary embolism or deep vein thrombosis), serious infections requiring hospitalization, and herpes zoster with tofacitinib in RA patients aged ≥ 60 years.

Methods

HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological and targeted synthetic DMARD registry since 2005. We analyzed RA patients aged ≥ 60 years receiving tofacitinib who had at least 1 control visit registered in the HURBIO database. Phone calls were made with these patients for the current health status information until the end of January 2022. The data of the patients who lost the follow-up in our clinic were obtained from the personal health record system of the Republic of Turkey Ministry of Health by patients’ permission. The coprimary end points were adjudicated MACE, VTE, serious infections, and herpes zoster. These events were identified using patients’ medical records. Crude incidence rates were expressed in patients with first events per 100 patient-years, with two-sided 95% confidence intervals.

Results

A total of 132 RA patients (109, 82.6% female) aged ≥ 60 years received tofacitinib at a dose of 5 mg twice daily. The median (25–75% percentiles) age was 67 (63-73) years and median duration under tofacitinib was 18 (5-33) months. Approximately 70% of patients were biologically naive. During a median follow-up of 1.5 years, the incidences of serious infection requiring hospitalization and herpes zoster were higher (5.5% [95%CI 3.12-9.86] and 3.4% [1.67-7.17], respectively) while there was no increase in the incidences of MACE and VTE. The causes for hospitalization were as follows: COVID-19 (n=4), pneumonia (n=3), soft-tissue infection (n=3), and GIS infection (n=1). Two of these patients deceased.

Conclusion

Older patients with RA are at increased infection risk because of age and comorbid conditions. Although adverse events are reported with 10 mg tofacitinib twice daily, clinicians should be careful against the risk of infection at a dose of 5 mg twice daily, especially in elderly patients.

References

[1]Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-326.

Table 1.

Clinical characteristics of the patients and incidence rates for adverse events

Characteristic*Tofacitinib, 5 mg Twice Daily (N=132)Age, years67 (63-73)Female/male109 (82.6)/23 (17.4)Smoking status-Never smoked78 (59.1)-Ever smoked54 (40.9)History of hypertension82 (62.1)History of diabetes mellitus40 (30.2)History of coronary heart disease14 (10.8)History of congestive heart failure3 (2.3)History of chronic kidney disease11 (8.3)Family history of coronary heart disease8 (6.2)RA disease duration, years10 (7-18)Biologic naïve/experienced92 (69.7)/40 (30.3)Duration under tofacitinib, months18 (5-33)No. of Patients with First EventIncidence Rate per 100 Patient-Yr (95% CI)MACE, n=10.49 (0.07-3.44)VTE, n=41.96 (0.74-5.17)Infection-Requiring hospitalization, n=115.55 (3.12-9.86)-Herpes zoster, n=73.46 (1.67-7.17)

* n (%), if otherwise specified; median (IQR) for numeric values.

CI: Confidence Interval, MACE: Major adverse cardiovascular events, VTE: Venous thromboembolism (pulmonary embolism or deep vein thrombosis)

Disclosure of Interests

None declared

AB0940 Is psoriatic arthritis really seronegative?

Background

Psoriatic Arthritis (PsA) is a heterogeneous disease classified as a seronegative group of inflammatory arthritis.

Objectives

Our aim was to understand the real-life seropositivity rates for commonly used autoantibodies in rheumatology practice in a cohort of PsA patients treated with biologic agents.

Methods

PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for the anti-nuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (CCP) before and after the initiation of biologic agents. Demographic characteristics, the interval between the test and biologic initiation, and the rates of seropositivity for individual tests, autoantibody titers, and subtypes for ANA were determined.

Results

From 520 PsA patients registered, results of 419 patients with at least one autoantibody tested either before or after biologic treatment is presented in Table 1. From the patients tested, 69% of them had at least one autoantibody positive and 30.8 % of them were triple negative before the biologic treatment. The rates reached to 78.7% of seropositivity for at least one autoantibody and 21.2 %triple negativity after treatment. ANA showed the highest rates of seropositivity among autoantibodies with a rate of 40% before and 55.3 % after biologic treatment. Concomitant seropositivity for RF and CCP autoantibodies showed rates of 2.8% and 6.3% before and after treatment, respectively. The most common subtype was AC4-5 before and AC1-4-5 after biologic agent treatment. ANA was tested in 31 patients both before and after biologic treatment showing 6 negative patients became positive after treatment and from 12 positive patients at the baseline 6 of them became negative (p=0.452). The most common biologic agents used in patients with ANA tested after treatment, were adalimumab (ADA) (42.4%), etanercept (ETN) (18.9%), and infliximab (IFX) (18.9%). The only difference was observed in IFX treated patients (n=25) with significantly higher rates of IFX usage in ANA-positive patients (p=0.001).

Table 1.

Demographics and ANA, RF, Anti-CCP test results of patients before and after biologic treatment

ANARFAnti-CCPbDMARDs initiationBeforeAfterBeforeAfterBeforeAfterNumber of patients10413231027814497Age43.5 (12.7)46.7 (11.6)43.3 (12.5)47.9 (11.9)44.3 (12)48.6 (12.1)Female sex, n (%)84 (80.7)97 (73.5)225 (72.5)211 (75.8)110 (76.3)75 (77.3)Time interval between test and bDMARD initiation, months, median (IQR)7.4 (0.84-17.83)32.6 (14.93-72.33)4.1 (0.35-16.75)31.63 (13.10-64.08)3.23 (0.30-11.5)35.13 (12.40-75.43)Positivity, n (%)42 (40.4)73 (55.3)30 (9.6)32 (11.5)12 (8.3)11 (11.3)Titer IU/ml, median (IQR)NANA28.7 (22.35-98.5)28.9 (21.9-110)139.1 (20.38-250)67.5 (16.77-139)Titer, n (%) *28 (66.6)38 (52)N/AN/AN/AN/A1/1007 (16.7)14 (19.1)1/1607 (16.7)20 (27.3)≥1/320

bDMARD: Biologic Disease Modifying Anti-Rheumatic Drugs, ANA: Anti-nuclear antibody, RF: Rheumatoid factor, Anti-CCP: Anti- Cyclic citrullinated peptide, F:Female, M:Male, IQR: Interquartile range, IU/ml: International units per milliliter, N/A: Not available

*Subtype is not given for one patient in patients with positive ANA after biologic treatment

Conclusion

Synovial lymphoid neogenesis rates in PsA are similar to the frequency seen in rheumatoid arthritis (1). Nevertheless, PsA is classified under the group of “seronegative diseases”. On the other hand, current reports have started to define specific autoantibodies particularly in psoriasis patients (2). The real-life experience in serology results of PsA patients showed that only 20-30 % of the patients were seronegative for all three tests commonly used in practice.

References

[1]Celis R, et al. Synovial cytokine expression in psoriatic arthritis and associations with lymphoid neogenesis and clinical features. Arthritis Res Ther. 2012 Apr 27;14(2):R93.

[2]Yuan Y, et al. Identification of Novel Autoantibodies Associated With Psoriatic Arthritis. Arthritis Rheumatol. 2019 Jun;71(6):941-951.

Disclosure of Interests

None declared

POS1187 DO IMMUNOSUPPRESSIVE AGENTS AFFECT IGRA TESTS IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Background

Tuberculin skin test (PPD) or interferon gamma release assays (IGRAs) are used to detect latent tuberculosis infection. Induration of 15 mm or more is considered positive in any person whereas this cut-off is ≥5 mm for immunosuppressed individuals such as Rheumatoid arthritis. Since IGRAs are dependent on normal T-cell function, it may result in false-negatives for among RA patients due to disease itself and immunosuppressive drugs.

Objectives

We aimed to compare IGRA results of RA patients using high dose DMARDS vs. not using any of them.

Methods

Totally 534 RA patients among Hacettepe University Rheumatology Biologic Registry Database (HURBIO) database was enrolled into this study. QFT-Plus test of patients with rheumatoid arthritis (RA) between January 2018 and March 2021 during work up before biologic/targeted therapy were analysed, retrospectively. The patient group was divided into two according to the drugs have been using at the time of IGRA test. Patients using methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥7.5 mg prednisolone) or any combination thereof were classified as the “High Dose” group. The other group consisted of patients who did not take these drug doses. Demographic characteristics, comorbidities, drugs and doses used, and hemogram, sedimentation, and CRP values of the patients were recorded. QuantiFERON test was recorded as positive, negative, indeterminate.

Results

353(66.1%) RA patients were in the high dose patient group and also 287(81.3%) of these patients were female, the median age was 55 years (min:19- max:82). The high dose group was older than the other group. When the two groups were compared, no statistically significant difference was found between comorbidity, and smoking (Table 1). While QFT positivity was detected in 37 (10.5%) patients in the high-dose group, it was found to be positive in 37 (20.4%) patients in the other group (p<0.001). However, there was no significant difference regarding acute phase reactants, hemogram including lymphocyte counts and IFN-gamma levels in the tubes between these two groups.

Table 1.

Comparison of RA patients’ groups using high-dose immunosuppressives and not using any of them

High Dose Methotrexate or Leflunomide or Steroid (+), (%)66.1High Dose Methotrexate or Leflunomide or Steroid (-), (%)33.9P ValueFemale81.375.10.09Age, med (min-max)55 (19-82)52 (19-81)0.01Diabetes Mellitus1110.50.84Hypertension30.624.90.16Chronic Renal Failure0.300.66Chronic Obstructive Pulmonary Disease4.23.30.59Coronary Artery Disease3.76.10.20History of malignancy0.81.70.40SmokingNever4952.50.19Ever24.127.6Quit26.318.8Leukocyte,*103/mlMedian (min-max)7.6 (2.8-28.8)7.9 (3.5 – 20.8)0.26Neutrophil,*103/ml4.8 (0.2-23.0)5.0 (1.5-19.1)0.18Lymphocyte,*103/ml1.9 (0.4-5.9)1.8 (0.5-5.3)0.67Thrombocyte,*103/ml285 (117-669)285.5 (60-724)0.79Hemoglobine,g/dL12.8 (7.7-17.9)12.8 (9.3-16.6)0.41Sedimentation,mm/saat30 (2-294)28 (2-104)0.27C Reactive Protein,mg/dl1.1 (0.1-62.8)1.1 (0-20.7)0.96QuantiFERON-TB Gold-Plus (QFT-Plus)10.520.40.00Nil med (min-max)0.07 (0-2.7)0.05 (0-0.85)0.48QFT-Plus TB-1 med (min-max)1 (0->10)0.99 (0->10)0.25QFT-Plus TB-2 med (min-max)1 (0->10)1.1 (0->10)0.42Mitogen med (min-max)10 (0->10)9.5 (0->10)0.27MethotrexateNot Taking31.433.7Less than 10 mg44.266.310 mg and more24.40LeflunomideNot Taking25.8100Taking74.20HydroxychloroquineNot Taking25.240.9Taking74.859.1SulfasalazineNot Taking62.661.9Taking37.438.1SteroidsNot Taking4.219.9Less than 7.5 mg66.380.17.5 mg and more29.50

Conclusion

Our results confirmed a significantly lower QFT-Plus positivity in patients with RA taking methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥7.5 mg prednisolone). Physicians should be careful in interpretation of QFT-Plus in patients with rheumatoid arthritis. Further analysis including flow cytometry analysis is required to better identifying cut-offs for immunosuppressive individuals and patients with inflammatory rheumatic diseases.

Disclosure of Interests

None declared

AB0843 OSTEOPOROSIS IN PATIENTS WITH SPONDYLOARTHRITIS: DO WE NEED TO DO MORE?

Background

Data regarding the prevalence and especially incidence of osteoporosis in Spondylarthritis (SPA) is scarce and very divergent among studies from different patient populations (1).

Objectives

In this study, we aimed to compare demographic, disease and laboratory characteristics of SpA patients regarding their bone mineral densitometry (BMD) categories and find out incidence of osteoporosis in the follow-up BMD of patients who were not found to have osteoporosis at baseline.

Methods

Between 2010-2021, patients with a SPA diagnosis in the HUR-BIO database were searched. HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2010. Patients with BMD measurement were included in the study. Follow-up BMD scores were also documented. The patients were divided into 3 groups as normal, osteopenia and osteoporosis in accordance with the WHO criteria (2). Demographic characteristics, comorbidities, laboratory data and drugs in each group were documented.

Results

3245 patients were reviewed. BMD was measured at least once in 118 patients out of 3245 (3.6%) patients. When the groups classified, 34 patients (28.8%) were included in the normal, 49 (41.5%) osteopenia and 35 (29.7%) osteoporosis groups. Patients with normal BMD was younger than both groups. Diabetes and hypertension were more prevalent in patients with osteopenia. The BMI was significantly lower in the osteoporosis group. 25 patients with normal and osteopenia in baseline BMD measurement had at least 1 follow-up BMD measurement. During the total follow-up of 91 patient-years, 3 patients had osteoporosis, revealing a the incidence of 3.3% in 100 patient-years.

Conclusion

In our study, the incidence of OP development in SPA patients was found to be 3.3%. Frequency of osteoporosis was 29.7% among SpA patients with BMD measurement (118/3245; 3.6%), however; only 40% of them had appropriate treatment. Osteoporosis seems as an overlooked and undertreated comorbidity of SpA.

Table 1.

Comparison of spondyloarthritis patients according to BMD scores (normal, osteopenia and osteoporosis) according to baseline BMD assessment

NORMAL Number, (%)OSTEOPENIA Number, (%)OSTEOPOROSIS Number, (%)P VALUENumber of Patients34 (28.8)49 (41.5)35(29.7)Age47,5 (27-70)63 (45-79)58 (20-75)0.00*Gender (Female)24 (70.6)34 (69.4)23 (65.7)Diabetes Mellitus3 (8.8)14 (29.2)1 (2.9)0.00*Hypertension11 (32.4)28 (58.3)5 (14.3)0.00*Chronic Renal Failure2 (6.9)1 (2.7)1 (5.3)0.81Chronic Ostructive Pulmonary Disease4 (13.8)4 (10.8)1 (5.3)0.30Coronary Artery Disease0 (0)5 (12.5)3 (15)0.27Malignancy1 (3.6)1 (2.9)1 (4.2)1.0Smoking21 (61.8)23 (47.9)21 (63.6)0.379 (26.5)13 (27.1)5 (15.2)4 (11.8)12 (25)7 (21.2)Calcium mg/dl9.4 (8.2-10.2)9.5 (8.7-10.4)9.7 (8.1-10.4)0.49Phosphorus mg/dl3.5 (3-4.4)3.4 (2.6-5)3.8 (2.9-4.9)0.25Vitamin D ng/ml16 (7.4-64.4)21.2 (5-69.6)15.8 (5.8-49.1)0.66ALP IU/ml89.5 (54-137)89.5(53-169)80 (50-239)0.43Albumin g/dl4.2 (1.7-4.7)4.2 (3.3-8.4)4.2 (2-4.8)0.43TSH mU/ml1.5 (0.8-4.1)2.3 (0.1-9.7)2 (0.7-3.3)0.71Body Mass Index (BMI) kg/m229 (17-41.2)28.3 (20-44.6)25.1(15.8-43.2)0,06*Steroids4 (11.8)8 (16.3)2 (5.7)0.33Anti-TNF25 (73.5)35 (71.4)26 (74.3)0,95D Vitamin7 (20.6)14 (28.6)10 (28.6)0.67Calcium4 (11.8)5 (10.2)6 (17.1)0.63Bisphosphonate0 (0)4 (8.2)14 (40)0,00*

Data was represented as median (minimum-maximum) or n(%)

References

[1]Hu LY, Chen PM, Shen CC, et all. Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PoleS one 2019:6;14

[2]Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield.

Disclosure of Interests

None declared

POS0944 PREDICTORS OF SUSTAINED REMISSION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS TREATED WITH BIOLOGIC DRUGS

Background

The ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA.

Objectives

To determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD).

Methods

Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-value<0.1 were re-tested in multivariable models. Forward selection was performed until the best-fit model was obtained, taking possible confounders into account. Two separate multivariable models were built, one with and one without the covariate “achievement of remission at 3-6 months”, to assess consistency of findings and to account for missing information regarding remission status between 3 and 6 months.

Results

Data on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99).

Table 1.

Multivariable analysis (best-fit model) of predictors of sustained remission

Model 1Model 2CovariatesMultivariable Analysis (n= 541)Multivariable Analysis (n=739)OR (95% CI)p-valueOR (95% CI)p-valueAge at diagnosisNSNS0.97 (0.96-0.99)0.006Male sex2.84 (1.71-4.70)<0.0012.31 (1.60-3.35)<0.001Concomitant csDMARD use (at baseline or follow-up)2.94 (1.57-5.51)0.0011.88 (1.23-2.86)0.003Baseline PGA0.97 (0.96-0.98)<0.0010.98 (0.97-0.99)0.002Baseline BASDAINSNS0.87 (0.78-0.96)0.009Baseline symptom durationNSNS0.97 (0.94-0.99)0.021Achievement of remission at 3-6 months after baseline11.70 (7.11-19.23)<0.001NANA

NA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment.

Conclusion

This study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition.

Disclosure of Interests

Bayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB

Measuring optic nerve sheath diameter using ultrasonography in patients with idiopathic intracranial hypertension

BACKGROUND

Idiopathic intracranial hypertension (IIH) is primarily a disorder of obese young women characterized by symptoms associated with raised intracranial pressure in the absence of a space-occupying lesion.

OBJECTIVE

To compare the mean optic nerve sheath diameter (ONSD) measured using ultrasonography (USG) in patients with idiopathic intracranial hypertension (IIH) and normal healthy individuals.

METHODS

A prospective study. Ninety-seven participants aged 18-80 years were divided into two groups as patients with IIH (n=47) and the control group (n=50). The ONSD was measured using ultrasound with a 10-MHz probe. ONSD was measured 3 mm behind the optic disc. Receiver operating characteristic (ROC) curve analysis was performed to determine patients with IIH using ONSD.

RESULTS

Body mass index was higher in the IIH group compared with the control group (p=0.001). The mean ONSD was statistically significantly thicker in the IIH group (6.4 mm) than in the control group (4.90 mm). The cut-off value of ONSD in patients with IIH was measured as 5.70 mm. There was a significant negative correlation between ONSD and age (r:-0.416 and p<0.001). There was a positive correlation between BMI and ONSD (r: 0.437 and p<0.001).

CONCLUSIONS

Ultrasound can be a reliable, non-invasive and rapid tool to measure ONSD in monitoring patients with IIH. After the first diagnosis of IIH, based on neuroimaging and measuring intracranial pressure using invasive methods, ONSD can be used in treatment and follow-up.

Pulmonary embolism in patients with dyspnea after COVID-19 infection

OBJECTIVE

Pulmonary embolism as a potential complication that may occur late in the course of COVID-19 cases. The aim of our study is to evaluate the frequency of pulmonary embolism in patients with new or ongoing dyspnea after a COVID-19 infection.

PATIENTS AND METHODS

This is a single-center, prospective observational study to evaluate the clinical and radiological outcomes of consecutive patients presenting outpatient clinic diseases to the chest and a new or ongoing dyspnea after a COVID-19 infection. Demographic, clinical and laboratory data were collected. Dyspnea was evaluated according to the New York Heart Association (NYHA) classification.

RESULTS

Pulmonary embolism was detected in 23.8% (25/105) of patients with new or ongoing dyspnea after a COVID-19 infection. Proportion of pulmonary embolism in patients with NYHA classes I, II, III and IV were respectively 8.7%, 20.0%, 30.0% and 35.3% (p for trend=0.02). Compared to NYHA class I and II patients with dyspnea, those in NYHA classes III and IV showed a higher rate of pulmonary embolism [31.6% vs. 14.6%, OR: 2.7 (1.0 to 7.1), p=0.04, respectively]. In Logistic Procedures, NYHA classes of dyspnea (OR: 4.3, 95% CI: 1.2 to 16.6, p=0.03) (NYHA class III and IV vs. NYHA class I and II) determine the likelihood of pulmonary embolism after COVID-19 infection.

CONCLUSIONS

Pulmonary embolism is common in patients with new or ongoing shortness of breath after a COVID-19 infection. Pulmonary embolism is more likely to develop in patients with higher NYHA classes.

AB0195 FACTORS RELATED TO RADIOGRAPHIC PROGRESSION IN PATIENTS WITH RHEUMATOID ARTHRITIS-RELATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease is an important cause of mortality and morbidity for RA. Lung computerized tomography (CT) is a valid method for the detection of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. Besides, CT may have a role in the detection of progression in RA-ILD.

Objectives:

To compare the clinical and radiological features of RA-ILD patients with and without radiographic progression according to lung CT.

Methods:

From the hospital database, all patients recorded as having RA according to ICD-10 code and had a lung CT examination were recruited. RA was confirmed in 822 of 2305 (35.6%) records. Three radiologists re-evaluated lung CTs and 156/822 (18.9%) patients with had RA-ILD. Of these 156 patients, 101 (64.7%) had at least 1 follow-up long CT and these patients were included to analysis. Demographic and clinical data of the patients were recorded. ILD was divided into 3 main groups by radiologists: Usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP) and airway disease (AD) (bronchiectasis and/or bronchiolitis without parenchymal involvement). Avila et al reported a grading system to assess the severity of ILD using HRCT (1). In our study we utilized a similar method using interlobular septal thickening, ground glass opacities, reticulations, traction bronchiectasis and honeycomb appearance as elementary findings to evaluate the RA associated ILD. Septal thickening, reticulations and ground glass opacities were considered as relatively mild features whereas traction bronchiectasis and honey comb appearance were considered as severe findings as those frequently result from advanced fibrosis. The lungs were divided into upper, middle and lower zones each with equal number of slices. Progression was defined as involvement of more zones in vertical extent by the same elementary findings or emergence of more severe findings (i.e traction bronchiectasis or honey comb appearance) in the same zones compared to previous exam. For the multivariate analysis, the possible factors identified with univariate analyses were further entered into the logistic regression analysis to determine independent predictors of radiographic progression.

Results:

In this study, 101 patients with 215 lung CT were included to analysis. 67 (66.3%) patients had 3 CTs, 30 (29.9%) patients 4 CTs and 17 (16.9%) patients had 5 CTs. Mean duration between first and last CT was 47.7±38.8 months. Of 101 patients, radiographic progression was seen in 42 (41.6%) patients. Univariate comparison of demographic, clinical and radiographic features of patients with or without radiographic progression were given in Table. In multivariate analysis (adjusted for ILD disease duration)having ground-glass opacity(aOR 8.6; CI: 1.65-44.9; p=0.011),male gender(aOR 2.9; CI: 1.13-7.4; p=0.026) were found as independent risk factors radiographic progression, whiletaking methotrexate (ever) (aOR 0.21; CI: 0.07-0.6; p=0.04) was found as an independent protector factor for radiographic progression.

Conclusion:

The prediction of ILD progression in RA patients were a challenge for clinicians. According to lung CT, baseline ground-glass opacities looks like prominent factor for ILD progression, particularly at male RA patients. Using methotrexate in ILD patients is a dilemma in routine practice, our results demonstrate that methotrexate (not other cs or bDMARDs) is protective drugs for ILD progression, however these results should be confirmed in the further studies.

References:

[1]Avila NA. AJR Am J Roentgenol. 2002;179(4): 887-892

Disclosure of Interests:

Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Mustafa Ekici: None declared, Emre Bilgin: None declared, Alper Sari: None declared, Yusuf Baytar: None declared, Ertugrul Cagri Bolek: None declared, Berkan Armagan: None declared, Bayram Farisoğullari: None declared, Omer Karadag: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Levent Kiliç: None declared, Şule Apraş Bilgen: None declared, Gamze Durhan: None declared, Ali Akdoğan: None declared, Macit Ariyürek: None declared

Epidemiology and Clinical Features of Peritonsillar Abscess: Is It Related to Seasonal Variations?

Objective

Peritonsillar abscess (PTA) is defined as pus accumulation between the tonsillar capsule and constrictor pharyngeal muscle. It can be seen as a complication of acute tonsillitis, but other mechanisms have also been proposed. In this study we aimed to reveal the seasonal variations and epidemiologic features of PTA.

Methods

This is a retrospective, observational study. We reviewed 221 patients, and together with 24 recurrent cases, 245 admissions were reviewed in total. Age, gender, the duration of admission, seasonal and monthly distribution of cases, diabetes and smoking status, white blood cell count, and C-reactive protein (CRP) levels were recorded. Monthly and seasonal incidences of PTA were reviewed to see if there is any association of climate variations and PTA incidence rate. Features associated with the length of hospitalization and recurrence were also analyzed.

Results

A total of 245 PTA cases were admitted to our clinic between June 2014 and June 2017. The highest amount of cases was observed in spring and winter. The C-reactive protein and white blood cell count (WBC) levels were found to be positively correlated with the length of hospitalization. There was no statistically significant correlation with recurrence and smoking, the WBC levels, CRP levels, and length of prior hospitalization. Diabetes status was not found to be associated with length of hospitalization and CRP levels.

Conclusion

The present study reflects the epidemiologic and clinical features of PTA in İstanbul. Our findings showed that seasonal variation was not significant, consistent with previous studies. The highest incidence rate was observed in spring and winter. Length of hospitalization was found to be positively correlated with C-reactive protein and white blood cell count (WBC) levels. Recurrence was not statistically correlated with and smoking, the WBC levels, CRP levels, and length of hospitalization. More studies are recommended to reveal the different epidemiologic factors affecting the incidence of PTA.

The effects of exhaustive swimming and probiotic administration in trained rats: Oxidative balance of selected organs, colon morphology, and contractility

The duration and intensity of exercise are significant factors in oxidative, morphological, and functional changes of the gastrointestinal tract. This study aimed to investigate the effects of both exhaustive swimming and probiotic VSL#3 on rats that had been previously trained with moderate swimming. The rats were divided into four groups labeled: control (C), probiotic (P), exercise (E), and probiotic-exercise (PE). Groups P and PE were fed with probiotic mixture VSL#3. Groups E and PE had a 5-week moderate swimming program (1 h/day for 5 days/week), followed by a 1-week exhaustive swimming program (trained like in moderate program but 3 times with 150 min resting sessions, for 5 days/week). At the end of the program, the rats were euthanized. Malondialdehyde, superoxide dismutase, catalase, and reduced glutathione levels were measured in tissue samples from the gastrocnemius muscle, heart, liver, kidney, and colon. In vitro contractile activity and histomorphology of the colon were also determined. Exercise and/or probiotic decreased the oxidative stress and also increased the level of one or more of the antioxidant enzymes in some of the organs. Probiotics had more pronounced effects on colon morphology than exercise but unexpectedly this effect was non-trophic. In the colon, the thickness of the tunica muscularis and the number of goblet cells were not affected; however, probiotic administration decreased the crypt depth and tunica mucosa thickness. Exercise increased the E_max value of acetylcholine (ACh), while decreased its sensitivity. These findings suggest that exhaustive swimming does not cause oxidative stress and that probiotic consumption improves oxidative balance in trained rats. The probiotic intake does not alter the effect of exercise on the contractile activity of the colon. Colon mucosal changes induced by probiotics are independent of exercise.

Disorders of glucose metabolism and insulin resistance in patients with obstructive sleep apnoea syndrome

OBJECTIVE

Insulin resistance (IR) and disorders of glucose metabolism (DGM) are risk factors for cardiovascular diseases. There are different reasons for development of DGM in patients with obstructive sleep apnoea syndrome (OSAS) and this association is controversial. We investigated the frequency of DGM and IR in patients with OSAS and determining factors for these disorders.

METHOD

One hundred and twelve untreated patients with OSAS and 19 non-apnoeic snoring subjects upon polysomnography were included in this study. Oral glucose tolerance test (OGTT) was performed in all subjects who had fasting blood glucose < 125 mg/dl. IR method was analysed using homeostasis assessment model (HOMA-IR). Diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were defined according to values of OGTT. DGM was defined as having one of the diagnoses of DM, IGT or IFG. Subjective sleepiness of all subjects was assessed with Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was described as ESS score ≥ 10.

RESULTS

Fasting glucose and the rate of DGM in patients with OSAS were higher than in non-apnoeic snoring subjects. DGM were shown in % 15.7 of non-apnoeic snoring subjects, 29.6% of mild sleep apnoea, 50% of moderate sleep apnoea and 61.8% of severe sleep apnoea. The rate of DGM in patients with moderate and severe OSAS was higher than in non-apnoeic snoring subjects and in patients with severe OSAS higher than in patients with mild OSAS. DGM are associated with body mass index (BMI), severity of OSAS, arousal index and EDS. In addition, IR is associated with apnoea hypopnoea index, BMI, arousal index and ESS score.

CONCLUSION

Obstructive sleep apnoea syndrome is associated with high frequency of DGM. In addition, the progression of disease from simple snoring and mild OSAS to severe OSAS increases the rate of DGM. Thus, DGM especially in patients with severe OSAS should be examined in regular periods.

Karyotype analyses of ten sections of Trigonella (Fabaceae)

Karyotypes of ten sections of genus Trigonella Linnaeus, 1753 (Fabaceae) from Turkey were investigated. Somatic chromosome numbers of examined species were determined as 2n=14 and 16. The karyotype analyses of the species were carried out and somatic chromosome numbers of Trigonella plicata Boiss., 1872, Trigonella brachycarpa (Fisch.) Moris, 1833, Trigonella rostrata Boiss., 1872, Trigonella lunata Boiss., 1843, Trigonella isthmocarpa Boiss. et Balansa 1856, Trigonella rhytidocarpa Boiss. et Balansa, 1859, Trigonella spicata Sibth. et Sm., 1813, Trigonella cephalotes Boiss. et Balansa 1856, Trigonella capitata Boiss., 1843 and Trigonella gladiata Steven, 1808 were reported for the first time. Two pairs of satellite metaphase chromosomes were observed in Trigonella cariensis Boiss., 1843 and one pair in Trigonella lunata.Moreover, 2 B-chromosomes were found only in Trigonella procumbens Rchb., 1830 among all studied species. The aims of this study are to provide karyological data for a significant pool of the taxa, to show differences among them in the number, size and morphology of somatic chromosomes, to verify previous reports or represent numbers which are different from those cited previously.

Species diversity of ixodid ticks feeding on humans in Amasya, Turkey: seasonal abundance and presence of Crimean-Congo hemorrhagic fever virus

Ticks (Acari:Ixodidae) are important pests transmitting tick-borne diseases such as Crimean-Congo hemorrhagic fever (CCHF) to humans. Between 2002 and 2009, numerous CCHF cases were reported in Turkey, including Amasya province. In the current study, species diversity, seasonal abundance of ticks, and presence of CCHF virus (CCHFV) in ticks infesting humans in several districts of Amasya province were determined. In the survey, a total of 2,528 ixodid ticks were collected from humans with tick bite from April to November 2008 and identified to species. Hyalomma marginatum (18.6%), Rhipicephalus bursa (10.3%), Rhipicephalus sanguineus (5.7%), Rhipicephalus (Boophilus) annulatus (2.2%), Dermacentor marginatus (2.5%), Haemaphysalis parva (3.6%), and Ixodes ricinus (1.6%) were the most prevalent species among 26 ixodid tick species infesting humans in Amasya province. Hyalomma franchinii Tonelli & Rondelli, 1932, was a new record for the tick fauna of Turkey. The most abundant species were the members of Hyalomma and Rhipicephalus through summer and declined in fall, whereas relative abundances of Ixodes and Dermacentor ticks were always low on humans in the province. Of 25 Hyalomma tick pools tested, seven pools were CCHFV positive by reverse transcription-polymerase chain reaction. Results indicated diversity of ixodid tick species infesting humans was very high, abundance of ticks changed by season, and ticks infesting humans had potential for transmitting CCHFV.

Treatment characteristics in elderly asthmatics

In this study, we evaluated the effect of ageing on treatment response by comparing two groups of patients with asthma. All asthmatic patients in the study were assessed on repeated occasions once admitted to the hospital: soon after admission (0 h), and then at 5th, 10th, 24th, 48th, 72nd hour, 7th day and in stable period. We compared two groups of patients: younger asthmatics, which had 33 younger aged <60, and elderly asthmatics, comprised of 29 elderly aged >or=60 years. The Asthma Quality of Life Questionnaire (AQLQ) was used to assess health-related quality of life in study. The increases in FEV1% values observed soon after the hospital admission (0 h), and at 5th, 10th, 24th, 48th, 72nd hour, 7th day and in stable period in younger group were similar that in elderly group. The Borg scores observed soon after the hospital admission (0 h), and 5th, 10th, 24th, 48th and 72nd hour in elderly asthmatics was usually higher than that in younger asthmatics. However, symptom scores observed in elderly asthmatics soon after the hospital admission and at 72nd hour were higher than those in younger asthmatics. Furthermore, decreases in the total AQLQ score and asthma severity score from exacerbation to stable period in both asthmatics were not different. Present study indicated that the airways obstruction, AQLQ and other diseases characteristics of younger and elderly asthmatics could improve at similar rates with treatment. In addition, similar exacerbation severity in elderly asthmatics was perceived more intense than younger asthmatics.

Effect of chronic diseases and associated psychological distress on health-related quality of life

BACKGROUND

The purpose of this study was to clarify the correlations between the presence of comorbidities and psychological distress and health-related quality of life (HRQL). This was a population-based cross-sectional study.

METHODS

Parents and grandparents of students from seven randomly selected primary schools in the city centre were asked to answer questionnaires sent by their children. All subjects were questioned for somatic diseases, psychological distress and HRQL by Health Questionnaire, Hospital Anxiety and Depression scale and short-form-12 health survey, respectively.

RESULTS

Out of 5024 parents and grandparents (mean age 52.3 +/- 14.3 years, range 20-104 years) of primary school students 4605 returned the questionnaires, a figure that corresponds to the overall response rate of 91.6%. Chronic diseases substantially reduced HRQL and this effect did not differ markedly with the type of chronic disease. Association of comorbidities with psychological distress further impaired HRQL. As the number of chronic diseases was increased, HRQL and physical and mental functioning declined. The worst HRQL was observed in subjects who had five or more comorbidities associated with psychological distress.

CONCLUSION

The present study indicates significant adverse effects of chronic diseases and psychological distress on HRQL in adults, the effect of psychological distress being the most important. Our results lead us to suggest that in the management of comorbidities, the detection of the presence and severity of associated psychological distress and its treatment, besides the specific treatment of comorbidities, may provide dramatic improvement in HRQL of the patients.

Irritable bowel syndrome in young and elderly patients with stable asthma

BACKGROUND

It has been speculated that asthma and irritable bowel syndrome may share common pathophysiological processes.

AIM

To estimate the prevalence of irritable bowel syndrome in young and elderly patients with stable asthma.

PATIENTS AND METHODS

Sixty-five young (age < 60 years) and 66 elderly (age > or = 60 years) stable asthmatics, and 119 age-matched healthy volunteers were enrolled. In all participants, presence of irritable bowel syndrome, quality of life and psychological status were evaluated.

RESULTS

The prevalence of irritable bowel syndrome in asthmatic group was higher than that in the control group (27.5% versus 16.8%; odds ratio, 1.8 [1.0-3.4]; p=0.04). The prevalence of irritable bowel syndrome was significantly higher in young asthmatics than in age-matched healthy controls (36.9% versus 20.3%; odds ratio, 2.2 [1.0-5.1]; p=0.04) and than in elderly asthmatics (36.9% versus 18.2%; odds ratio, 0.3 [0.1-0.8]; p=0.01). Logistic regression analysis identified the younger age (odds ratio, 2.1 [1.1-3.8]; p=0.01), and the presence of asthma (odds ratio, 1.9 [1.0-3.5]; p=0.03) as independent risk factors for irritable bowel syndrome in all participants after adjusting for gender. We also found impaired quality of life to be associated with the presence of irritable bowel syndrome and asthma in all participants after adjusting for age and gender.

CONCLUSION

The prevalence of irritable bowel syndrome appears to be significantly higher in young asthmatics, but not in elderly asthmatics, compared to age-matched healthy counterparts. Potential pathogenic mechanisms of higher irritable bowel syndrome prevalence in young asthmatics need to be explained by further studies.

Perception of bronchoconstriction in elderly asthmatics

The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37, group 2, > or = 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, > or = 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 +/- 0.17; group 2, PS20 = 1.37 +/- 0.12, p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (IA, 2.63 +/- 0.30 and IB, 2.07 +/- 0.16, p = 0.101; 2A, 1.36 +/- 0.19 and 2B, 1.59 +/- 0.120, p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and % FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.

CT-guided pleural needle biopsy in the diagnosis of malignant mesothelioma

OBJECTIVE

Our goal was to determine the sensitivity of CT-guided closed pleural needle biopsy (CPNB) for the histopathologic diagnosis of diffuse malignant pleural mesothelioma (DMPM).

MATERIALS AND METHODS

Thirty patients with DMPM were studied with CT-guided CPNB. Tumor specimens were classified according to their cell types.

RESULTS

In 25 (83.3%) patients, the diagnosis was made by CT-guided CPNB. The remaining five patients were diagnosed by thoracoscopy, thoracotomy, or excisional biopsy of the chest wall mass. Pneumothorax was observed in 9.5% of patients and local seeding of tumor in 21.7% of patients who underwent CPNB.

CONCLUSION

Properly performed CPNB under CT guidance may yield an increased sensitivity for the diagnosis of diffuse malignant pleural mesothelioma.

Chromosome analysis in pleural effusions. Efficiency of this method in the differential diagnosis of pleural effusions

Various laboratory methods are being used to acquire diagnosis in pleural effusions. However, about 20% of the effusions cannot be diagnosed reliably. Cytogenetic analysis in pleural effusion is not used routinely, although many numerical and/or structural chromosome abnormalities have been observed in malignant pleural effusions. In this study, a total of the 61 pleural effusion samples, 34 malignant which included 19 diffuse pleural malignant mesothelioma, 15 metastatic malignant pleural effusions and 27 benign, were analyzed by direct chromosome analysis method. To the findings obtained in the study, 85.3% (29/34) of the 34 patients with malignant pleural effusion had numerical and/or structural abnormalities, and 3 of them had no mitosis. The patients who had benign pleural effusion indicated no numerical and/or structural abnormalities. We have concluded that if a pleural effusion cannot be reliably differentiated by the usual laboratory methods and especially malignancy is strongly suspected, cytogenetic analysis can be used to differentiate malignant effusions from benign effusions with a small rate of error, and also it can indicate that more invasive diagnostic procedures are necessary.