Rate of severe and fatal infections in a cohort of patients with interstitial lung disease associated with rheumatoid arthritis: a multicenter prospective study

Objective

To describe severe infection, foci of infection, microorganisms, associated factors, and impact on mortality in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD).

Patients and methods

The study was based on a multicenter prospective cohort of patients with RA-ILD followed up from 2015 to 2023. The main outcome measures were incident severe infection and fatal infection. We evaluated infectious foci, etiologic agents, vaccination status, variables associated with lung function, and clinical-therapeutic variables in RA. The incidence rate (IR) for infection and mortality was calculated per 100 person-years, and 3 multivariate models were constructed to explore factors associated with infection.

Results

We followed up 148 patients with RA-ILD for a median 56.7 months (699.3 person-years). During this period, 142 patients (96%) had at least 1 infection. A total of 368 infectious episodes were recorded, with an IR of 52.6 per 100 person-years. Of the 48 patients who died, 65% did so from infection. Respiratory infections were the most common first infection (74%), infection overall (74%), and fatal infection (80%) and were caused mostly by SARS CoV-2, Streptococcus pneumoniae, Pseudomonas aeruginosa, and influenza A virus. The factors associated with an increased risk of infection and death in patients with RA-ILD were age, inflammatory activity, and therapy with corticosteroids and immunosuppressants.

Conclusion

Patients with RA-ILD have a high risk of serious infection, especially respiratory infection. Infection develops early, is recurrent, and is frequently fatal. The presence of associated factors such as advanced age, joint inflammation, and treatment highlight the importance of integrated and preventive medical care.

Exploring the influence of baseline rheumatoid factor levels on TNF inhibitor retention rate in patients with rheumatoid arthritis: a multicentre and retrospective study

OBJECTIVE

To assess whether the retention rate of certolizumab pegol (CZP) was longer than that of other tumour necrosis factor inhibitors (TNFi) based on baseline rheumatoid factor (RF) levels.

METHODS

Longitudinal, retrospective and multicentre study including patients with RA who were treated with any TNFi (monoclonal antibodies (mAB), etanercept (ETA) or CZP). Log-rank test and Cox regressions were conducted to evaluate the retention rate in the three groups according to the level of RF, with the third quartile of the baseline levels used as cut-off: <200 (

RESULTS

A total of 638 individuals and 752 treatments (132 CZP, 439 mAB and 181 ETA) were included. In non-naïve patients with ≥200 IU/mL of RF, those treated with CZP showed a significantly longer retention rate in comparison with mAB and ETA. After matching using the propensity score, patients with ≥200 IU/mL RF levels exhibited longer retention rates with CZP than with mAB (HR 2.3 (95% CI 1.2 to 4.3), or ETA (HR 2.8 (95% CI 1.5 to 5.2). No differences were found between groups in patients with <200 UI/mL.

CONCLUSIONS

CZP showed a longer retention rate than mAB and ETA in patients with very high RF levels (≥200 IU/mL), while these differences were absent in patients with <200 IU/mL levels. The results suggest the potential effect of RF on binding the fragment crystallisable portion of certain TNFi.

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Key Words

• Arthritis, Rheumatoid
• Biological Therapy
• Rheumatoid Factor

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MESH Headings

• Humans
• Retrospective Studies
• Tumor Necrosis Factor Inhibitors/therapeutic use
• Rheumatoid Factor
• Treatment Outcome
• Arthritis, Rheumatoid/drug therapy
• Certolizumab Pegol/therapeutic use
• Etanercept/therapeutic use
• Antibodies, Monoclonal/therapeutic use

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Affiliation(s)

Clementina López-Medina Rheumatology, Reina Sofia University Hospital, Cordoba, Spain GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
Jerusalem Calvo-Gutiérrez Rheumatology, Reina Sofia University Hospital, Cordoba, Spain GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
M Carmen Ábalos-Aguilera GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
Francisco Cepas Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
Chamaida Plasencia-Rodríguez Rheumatology, La Paz University Hospital, Madrid, Spain IdiPAZ, Madrid, Spain
Ana Martínez-Feito Rheumatology, La Paz University Hospital, Madrid, Spain IdiPAZ, Madrid, Spain
Alejandro Balsa Rheumatology, La Paz University Hospital, Madrid, Spain IdiPAZ, Madrid, Spain
Regina Faré-García Rheumatology, Son Llatzer University Hospital, Palma de Mallorca, Spain
Antoni Juan-Mas Rheumatology, Son Llatzer University Hospital, Palma de Mallorca, Spain
Virginia Ruiz-Esquide Rheumatology, Clinic Hospital, Barcelona, Spain
Luis Sainz Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
César Díaz-Torné Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Francisco Javier Godoy-Navarrete Rheumatology, University Hospital of Jaen, Jaén, Spain
Isabel Añón-Oñate Rheumatology, University Hospital of Jaen, Jaén, Spain
Natalia Mena-Vázquez Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
Sara Manrique-Arija Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain Medicina, Univeristy of Málaga, Málaga, Spain
Marina Soledad Moreno-García Rheumatology, Miguel Servet University Hospital, Zaragoza, Spain
Rafaela Ortega-Castro Rheumatology, Reina Sofia University Hospital, Cordoba, Spain GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
Alejandro Escudero-Contreras Rheumatology, Reina Sofia University Hospital, Cordoba, Spain GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain

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Interstitial Lung Disease Is Associated with Sleep Disorders in Rheumatoid Arthritis Patients

OBJECTIVE

To evaluate sleep disorders and associated factors in patients with rheumatoid-arthritis-associated interstitial lung disease (RA-ILD).

METHODS

We performed an observational study of 35 patients with RA-ILD (cases) and 35 age- and sex-matched RA patients without ILD (controls). We evaluated sleep disorders (Oviedo Sleep Questionnaire), positive psychological factors (resilience using the Wagnild and Young Resilience Scale, emotional intelligence using the 24-item Trait Meta-Mood Scale), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (36-item short-form survey), and fatigue (Functional Assessment of Chronic Illness Therapy Questionnaire). Other variables studied included the Charlson Comorbidity Index (CCI) and RA activity according to the DAS28-ESR.

RESULTS

Compared to the controls, the cases were characterized by poorer sleep quality with a higher prevalence of insomnia (42% vs. 20%; p = 0.039), greater severity of insomnia (p = 0.001), and lower sleep satisfaction (p = 0.033). They also had poorer resilience and emotional recovery and more severe anxiety and depression. A diagnosis of ILD was the only factor independently associated with the three dimensions of sleep quality. The predictors of poorer sleep satisfaction in patients with RA-ILD were age (β = -0.379), DAS28-ESR (β = -0.331), and usual interstitial pneumonia pattern (β = -0.438). The predictors of insomnia were DAS28-ESR (β = 0.294), resilience (β = -0.352), and CCI (β = 0.377).

CONCLUSIONS

RA-ILD is associated with significant sleep disorders. RA-ILD seems to be an independent risk factor for sleep alterations, with a greater impact on insomnia. Age, disease activity, and comorbidity also play a role in sleep disorders in patients with RA-ILD.

Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study

OBJECTIVE

To describe the frequency of malnutrition in older patients with rheumatoid arthritis (RA) and investigate associated risk factors.

METHODS

This multicenter, cross-sectional study included participants aged ≥65 years who met the 2010 ACR/EULAR criteria for RA. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and based on variables, such as albumin level, the Geriatric Nutritional Risk Index (GNRI), and vitamin D. Data were also collected on epidemiological variables, inflammatory disease activity, quality of life, physical function, and frailty. Multivariate models were used to study factors associated with nutritional status.

RESULTS

The study population comprised 76 RA patients aged ≥65 years, of whom 68.4% had a normal nutritional status, and 31.5% had an impaired nutritional status: 28.9% were at risk of malnutrition, and 2.6% were malnourished. Additionally, 10% had albumin levels <3.8 g/L. Patients with impaired nutritional status had poorer quality of life and physical function. The factors associated with compromised nutritional status (OR [95% CI]) were age (1.0 [1.0-1.1]; p = 0.035), DAS28-ESR (1.8 [1.0-3.2]; p = 0.024), and EuroQoL-5D-5L (0.9 [0.9-0.9]; p = 0.040). Furthermore, the GNRI was associated with the MNA score (0.06 [0.0-0.1]; p = 0.014).

CONCLUSIONS

Approximately one-third of older patients with RA have impaired nutritional status. Older age, higher inflammatory disease activity, and decreased quality of life are associated with impaired nutritional status. The MNA and GNRI are valuable tools for assessing the nutritional status of patients with RA.

Sarcopenia and Nutrition in Elderly Rheumatoid Arthritis Patients: A Cross-Sectional Study to Determine Prevalence and Risk Factors

OBJECTIVE

To describe the prevalence of sarcopenia in rheumatoid arthritis (RA) patients aged ≥65 years and identify the risk factors associated with sarcopenia.

METHODS

This is a multicenter, controlled, cross-sectional study of 76 RA patients and 76 age- and sex-matched healthy controls. Sarcopenia was defined according to the revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Whole-body dual-energy X-ray absorptiometry (DXA) was performed. Binary regression was used to assess the relationship between sarcopenia and sex, age, duration of RA, Mini Nutritional Assessment (MNA) score, and Short Physical Performance Battery (SPPB) score in patients with RA.

RESULTS

Nearly 80% of participants were female, and the average age was >70 years. Patients with RA had lower muscle mass and greater adiposity (fat-to-muscle ratio mean [SD] 0.9 [0.2] vs. 0.8 [0.2]; p = 0.017) than controls, mainly in the central area (android/gynoid ratio, median [p25-p75]: 1.0 [0.9-1.2] vs. 0.9 [0.8-1.1]; p < 0.001). Twelve patients (15.8%) and three controls (3.9%) had confirmed sarcopenia (p = 0.014). Sarcopenic obesity was observed in 8/76 patients with RA (10.5%) and in 1/76 controls (1.3%) (p = 0.016). The factors associated with sarcopenia were male sex (OR [95% CI]: 9.3 [1.1-80.4]; p = 0.042), disease duration (OR [95% CI]: 1.1 [1.0-1.2]; p = 0.012), and nutritional status according to the MNA (OR [95% CI]: 0.7 [0.5-0.9]; p = 0.042).

CONCLUSIONS

Our results suggest that patients with RA aged ≥65 years may be at increased risk for sarcopenia, adiposity, and malnutrition (especially male patients with long-standing disease) and have poor nutritional status.

Inflammatory Biomarkers in the Diagnosis and Prognosis of Rheumatoid Arthritis-Associated Interstitial Lung Disease

This study aimed to identify inflammatory factors and soluble cytokines that act as biomarkers in the diagnosis and prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). We performed a nested prospective observational case-control study of patients with RA-ILD matched by sex, age, and time since the diagnosis of RA. All participants underwent pulmonary function testing and high-resolution computed tomography. ILD was defined according to the criteria of the American Thoracic Society/European Respiratory Society; the progression of lung disease was defined as the worsening of FVC > 10% or DLCO > 15%. Inflammation-related variables included the inflammatory activity measured using the DAS28-ESR and a multiplex cytokine assay. Two Cox regression models were run to identify factors associated with ILD and the progression of ILD. The study population comprised 70 patients: 35 patients with RA-ILD (cases) and 35 RA patients without ILD (controls). A greater percentage of cases had higher DAS28-ESR (p = 0.032) and HAQ values (p = 0.003). The variables associated with RA-ILD in the Cox regression analysis were disease activity (DAS28) (HR [95% CI], 2.47 [1.17-5.22]; p = 0.017) and high levels of ACPA (HR [95% CI], 2.90 [1.24-6.78]; p = 0.014), IL-18 in pg/mL (HR [95% CI], 1.06 [1.00-1.12]; p = 0.044), MCP-1/CCL2 in pg/mL (HR [95% CI], 1.03 [1.00-1.06]; p = 0.049), and SDF-1 in pg/mL (HR [95% CI], 1.00 [1.00-1.00]; p = 0.010). The only variable associated with the progression of ILD was IL-18 in pg/mL (HR [95% CI], 1.25 [1.07-1.46]; p = 0.004). Our data support that the inflammatory activity was higher in patients with RA-ILD than RA patients without ILD. Some cytokines were associated with both diagnosis and poorer prognosis in patients with RA-ILD.

Adiposity is associated with expansion of the genus Dialister in rheumatoid arthritis patients

OBJECTIVE

To analyze the intestinal microbiota of patients with rheumatoid arthritis (RA) and obesity and a higher percentage of fatty tissue.

METHODS

Nested case-control study of 80 RA patients and 80 age and sex-matched controls. Obesity was defined as a body mass index ≥ 30, and body composition using dual-energy x-ray absorptiometry. The gut microbiota was analyzed using 16 S rRNA gene sequencing; bioinformatics analysis was performed using QIIME2 and PICRUSt. Other variables included averaged 28-joint Disease Activity Score (DAS28-ESR), cytokines and adipokines. Two multivariate were constructed with obesity and fat mass index (FMI).

RESULTS

Obesity was more frequent in RA patients than in controls (36.3 % vs 25.1 %; p = 0.026), as was a higher FMI value (mean [SE]=11.6 [3.9] vs 10.2 [3.9]; p = 0.032). Alpha and beta diversity analysis revealed differences in gut microbiota between RA patients with and without obesity. Dialister and Odoribacter were more abundant in RA patients with obesity than in RA patients without obesity, while the genus Clostridium was more abundant in RA patients without obesity. The factors associated with obesity in RA patients were age (OR [95 % CI], 1.09 [1.02-1.17]), mean DAS28-ESR (OR [95 % CI], 1.46 [1.12-1.67]), leptin levels (OR [95 % CI], 1.06 [1.01-1.10]), the genus Dialister (OR [95 % CI], 1.03 [1.01-1.07]), and the genus Clostridium (OR [95 % CI], 0.013 [0.00-0.36]). The associations observed for FMI were similar.

CONCLUSIONS

In patients with RA, obesity, and a higher percentage of fatty tissue, intestinal microbiota differed from that of controls and of the other patients. The genus Dialister was associated with obesity and FMI.

Screening criteria for interstitial lung disease associated to rheumatoid arthritis: Expert proposal based on Delphi methodology

OBJECTIVE

To develop a joint proposal for screening criteria of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and vice versa, which serves as a guidelines in patient referral between the Rheumatology and Pneumology departments to early detection of these patients.

METHODS

A systematic literature review was carried out on the risk factors for the development of ILD in RA patients, and for the referral criteria to Rheumatology for suspected early RA. Based on the available evidence, screening criteria were agreed using the Delphi method by a panel of pneumologists and rheumatologists with expertise in these pathologies.

RESULTS

Screening criteria for ILD in patients with RA and for the early detection of RA in cases with ILD of unknown etiology have been developed. In both cases, a detection strategy was based on clinical risk factors. Recommendations also included the complementary tests to be carried out in the different clinical scenarios and on the periodicity that screening should be repeated.

CONCLUSION

A selective screening strategy is recommended for the first time in the early diagnosis of patients with ILD-RA. This multidisciplinary proposal aims to solve some common clinical questions and help decision-making, although its usefulness to identify these patients with good sensitivity must be confirmed in a validation study.

Analysis of comorbidity in rheumatoid arthritis-associated interstitial lung disease: a nested case-cohort study

OBJECTIVES

To describe comorbid conditions in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to analyze factors associated with multimorbidity.

METHODS

Nested case-cohort study of 2 prospective cohorts: one with RA-ILD (cases) and another with RA but not ILD (controls). The cohorts were matched for age, sex, and time since diagnosis. Multimorbidity was defined as the co-occurrence of 2 or more chronic diseases, in addition to RA and ILD. We evaluated the comorbid conditions included in the Charlson Comorbidity Index, cardiovascular risk factors, neuropsychiatric conditions, and other frequent conditions in RA. We also recorded clinical-laboratory variables, inflammatory activity according to the 28-joint Disease Activity Score, C-reactive protein (CRP), physical function, and pulmonary function. We performed 2 multivariate analyses to identify factors associated with multimorbidity in RA and RA-ILD.

RESULTS

The final study population comprised 110 cases and 104 controls. Multimorbidity was more frequent among cases than controls (80 [72.7] vs 60 [57.7]; p = 0.021). In both groups, multimorbidity was associated with ILD (OR [95% CI] 1.92 [1.03-3.59]; p = 0.039), age (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004), CRP (OR [95% CI] 1.16 [1.05-1.29]; p = 0.003), and erosions (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004); in the cases, it was associated with CRP (OR [95% CI] 1.17 [1.01-1.35]; p = 0.027), anti-citrullinated peptide antibody (OR [95% CI] 1.23 [1.14-13.02]; p = 0.049), and forced vital capacity (OR [95% CI] 0.79 [0.96-0.99]; p = 0.036).

CONCLUSION

In patients with RA, multimorbidity was associated with ILD, systemic inflammation, and advanced age.

Inflammatory profile of incident cases of late-onset compared with young-onset rheumatoid arthritis: A nested cohort study

OBJECTIVES

To describe the characteristics of patients between late-onset rheumatoid arthritis (LORA) with young-onset (YORA), and analyze their association with cumulative inflammatory burden.

METHODS

We performed a nested cohort study in a prospective cohort comprising 110 patients with rheumatoid arthritis (RA) and 110 age- and sex-matched controls. The main variable was cumulative inflammatory activity according to the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR). High activity was defined as DAS28 ≥ 3.2 and low activity as DAS28 < 3.2. The other variables recorded were inflammatory cytokines, physical function, and comorbid conditions. Two multivariate models were run to identify factors associated with cumulative inflammatory activity.

RESULTS

A total of 22/110 patients (20%) met the criteria for LORA (≥ 60 years). Patients with LORA more frequently had comorbid conditions than patients with YORA and controls. Compared with YORA patients, more LORA patients had cumulative high inflammatory activity from onset [13 (59%) vs. 28 (31%); p = 0.018] and high values for CRP (p = 0.039) and IL-6 (p = 0.045). Cumulative high inflammatory activity in patients with RA was associated with LORA [OR (95% CI) 4.69 (1.49-10.71); p = 0.008], smoking [OR (95% CI) 2.07 (1.13-3.78); p = 0.017], anti-citrullinated peptide antibody [OR (95% CI) 3.24 (1.15-9.13); p = 0.025], average Health Assessment Questionnaire (HAQ) score [OR (95% CI) 2.09 (1.03-14.23); p = 0.034], and physical activity [OR (95% CI) 0.99 (0.99-0.99); p = 0.010]. The second model revealed similar associations with inflammatory activity in patients with LORA.

CONCLUSION

Control of inflammation after diagnosis is poorer and comorbidity more frequent in patients with LORA than in YORA patients and healthy controls.

SER-SEPAR recommendations for the management of rheumatoid arthritis-related interstitial lung disease. Part 2: Treatment

OBJECTIVE

To develop multidisciplinary recommendations to improve the management of rheumatoid arthritis-related interstitial lung disease (RA-ILD).

METHODS

Clinical research questions relevant to the objective of the document were identified by a panel of rheumatologists and pneumologists selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Specific recommendations were made.

RESULTS

Six PICO questions were selected, three of which analysed the safety and effectiveness of glucocorticoids, classical synthetic disease-modifying anti-rheumatic drugs (DMARDs) and other immunosuppressants, biological agents, targeted synthetic DMARDs, and antifibrotic therapies in the treatment of this complication. A total of 12 recommendations were formulated based on the evidence found and/or expert consensus.

CONCLUSIONS

We present the first official SER-SEPAR document with specific recommendations for RA-ILD management developed to resolve some common clinical questions, reduce clinical healthcare variability, and facilitate decision-making for patients.

Relationship between polyautoimmunity and sarcopenic obesity in rheumatoid arthritis patients

OBJECTIVE

Sarcopenia is a major cause of morbidity in rheumatoid arthritis patients. Our purpose was to determine whether polyautoimmunity is associated with sarcopenia and alterations in whole body composition in patients with rheumatoid arthritis (RA).

METHODS

We performed a cross-sectional observational study of a series of cases of RA. All patients were recruited consecutively from a rheumatology clinic. Body composition by dual-energy x-ray absorptiometry (DEXA) was assessed. The variables of interest were polyautoimmunity (RA associated with other autoimmune diseases), sarcopenia, fat mass, and body mass index (BMI). Other variables included were clinical-analytical and inflammatory cytokines and adipokines. The relationship between sarcopenic obesity and the presence of polyautoimmunity was studied using multivariate analysis.

RESULTS

Of the 94 patients with RA included in the study, 15 (16%) had polyautoimmunity. A total of 23 patients with RA (24.5%) had sarcopenia, which was more prevalent in patients with polyautoimmunity than in patients without polyautoimmunity (46.7% vs 20.3%; p = .029). Sarcopenia was not associated with body fat content (p = .870) or with BMI (p = .998). The multivariate analysis showed the factors associated with polyautoimmunity in RA to be sarcopenia (odds ratio [95% CI], 4.80 [1.49-13.95]), BMI (1.18 [1.04-1.35]), and resistin (1.249 [1.01-1.53]).

CONCLUSION

Sarcopenia and obesity were more prevalent in patients with RA and polyautoimmunity. Resistin values were also higher in this group than in patients with RA without polyautoimmunity.

SER-SEPAR recommendations for the management of rheumatoid arthritis-related interstitial lung disease. Part 1: Epidemiology, risk factors and prognosis

OBJECTIVE

To develop multidisciplinary recommendations to improve the management of rheumatoid arthritis-related interstitial lung disease (RA-ILD).

METHODS

Clinical research questions relevant to the objective of the document were identified by a panel of rheumatologists and pneumologists selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Specific recommendations were made.

RESULTS

Six PICO questions were selected, three of which analysed the incidence and prevalence of RA-ILD, associated risk factors, and predictors of progression and mortality. A total of 6 specific recommendations on these topics, structured by question, were formulated based on the evidence found and/or expert consensus.

CONCLUSIONS

We present the first official SER-SEPAR document with specific recommendations for RA-ILD management developed to resolve some common clinical questions and facilitate decision-making for patients.

Functional outcomes of patients with NORSE and FIRES treated with immunotherapy: A systematic review

OBJECTIVE

To determine the frequency of good functional outcomes in patients with NORSE and FIRES treated with immunotherapy.

METHODS

We performed a systematic search of the MedLine and EMBASE databases to gather studies including at least 5 patients with NORSE or FIRES and at least one patient treated with immunotherapy, and reporting functional outcomes. Good functional outcome was defined as a modified Rankin Scale (mRS) score ≤ 2 (or an equivalent measure) at the last available follow-up assessment. Only patients with known functional outcomes were included in the analysis.

RESULTS

We analyzed 16 studies including a total of 161 patients with NORSE. Six studies were carried out only with FIRES patients (n = 64). Of the 161 patients with NORSE, 141 (87.5%) received immunotherapy. Outcome data were available for 135, 56 of whom (41.4%) achieved good functional outcomes. Twenty-four of the 58 patients with FIRES treated with immunotherapy and for whom outcome data were available achieved good functional outcomes (41.3%). Mortality rates in patients with NORSE and FIRES treated with immunotherapy were 20/121 (16.5%) and 6/58 (10.3%), respectively. By type of immunotherapy, good functional outcomes were achieved in 36/89 patients receiving glucocorticoids (40.4%), 27/71 patients receiving IV immunoglobulins (38%), 11/37 patients treated with plasma exchange (29.7%), 5/17 patients receiving rituximab (29.4%), and 2/13 patients receiving cyclophosphamide (15.3%).

CONCLUSION

Despite the lack of randomised clinical trials, immunotherapy is frequently prescribed to patients with NORSE and FIRES. However, rates of functional dependence and mortality remain high in these patients. Second-line therapies achieved lower rates of good outcomes, probably because they were administered to patients with more severe, refractory disease.

Longitudinal Study of Cognitive Functioning in Adults with Juvenile Idiopathic Arthritis

Objective: To prospectively evaluate possible decline of cognitive functions in adult patients with juvenile idiopathic arthritis (JIA) and identify associated factors. Patients and methods: We performed a 24-month prospective observational study of adults (≥16 years) with JIA. The primary outcome measure was decline in cognitive function defined as a worsening of ≥2 points on the scales of the subsets administered to evaluate the different cognitive areas using the Wechsler Adult Intelligence Scale (WAIS) after 24 months: attention/concentration (digit span); verbal function (vocabulary); visual-spatial organization (block design); working memory (letter-number sequencing); and problem solving (similarities). Other variables included average inflammatory activity using C-reactive protein and composite activity indexes, comorbidity, and treatment. Logistic regression was performed to identify factors associated with cognitive decline. Results: The study population comprised 52 patients with JIA. Of these, 15 (28.8%) had cognitive decline at V24. The most affected functions were working memory (17.3%), attention/concentration (9.6%), verbal function (7.7%), visual-spatial organization (7.7%), and problem solving (3.8%). There were no significant differences in the median direct or scale scores for the cognitive functions evaluated between V0 and V24 for the whole sample. The factors associated with cognitive decline in patients with JIA were average C-reactive protein (OR [95% CI], 1.377 [1.060–1.921]; p = 0.039), depression (OR [95% CI], 3.691 [1.294–10.534]; p = 0.015), and treatment with biologics (OR [95% CI], 0.188 [0.039–0.998]; p = 0.046). Conclusion: Cognitive decline was detected in almost one third of adults with JIA after 24 months of follow-up. Systemic inflammatory activity in JIA patients was related to cognitive decline. Patients treated with biologics had a lower risk of decline in cognitive functions.

Safety and Effectiveness of Abatacept in a Prospective Cohort of Patients with Rheumatoid Arthritis–Associated Interstitial Lung Disease

Objective: To prospectively evaluate the safety and efficacy profile of abatacept in patients with rheumatoid arthritis–associated interstitial lung disease (RA-ILD). Methods: We performed a prospective observational multicenter study of a cohort of patients with RA-ILD treated with abatacept between 2015 and 2021. Patients were evaluated using high-resolution computed tomography and pulmonary function tests at initiation, 12 months, and the end of follow-up. The effectiveness of abatacept was evaluated based on whether ILD improved, stabilized, progressed, or was fatal. We also evaluated factors such as infection, hospitalization, and inflammatory activity using the 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR). Cox regression analysis was performed to identify factors associated with progression of lung disease. Results: The study population comprised 57 patients with RA-ILD treated with abatacept for a median (IQR) of 27.3 (12.2–42.8) months. Lung disease had progressed before starting abatacept in 45.6% of patients. At the end of follow-up, lung disease had improved or stabilized in 41 patients (71.9%) and worsened in 13 (22.8%); 3 patients (5.3%) died. No significant decreases were observed in forced vital capacity (FVC) or in the diffusing capacity of the lung for carbon monoxide (DLCO).The factors associated with progression of RA-ILD were baseline DAS28-ESR (OR [95% CI], 2.52 [1.03–3.12]; p = 0.041), FVC (OR [95% CI], 0.82 [0.70–0.96]; p = 0.019), and DLCO (OR [95% CI], 0.83 [0.72–0.96]; p = 0.018). Only 10.5% of patients experienced severe adverse effects. Conclusion: Pulmonary function and joint inflammation stabilized in 71% of patients with RA-ILD treated with abatacept. Abatacept had a favorable safety profile.

POS0440 THE ANALYSIS OF THE INFLAMMATORY PROTEOME IN RHEUMATOID ARTHRITIS IDENTIFIES COMMON SIGNATURES ASSOCIATED WITH THE CLINICAL RESPONSE TO DMARDs AND TNFi THERAPIES

Background

The clinical outcome of the most common therapeutic options of rheumatoid arthritis (RA) patients, such as conventional disease-modifying antirheumatic drugs (DMARDs) and TNF inhibitors (TNFi) is still unpredictable, since a high percentage of patients do not response to the therapy. Innovative analyses combining high-throughput technologies and thorough clinical assessments are needed to gain insight about the management of this prevalent autoimmune disorder.

Objectives

To evaluate the systemic inflammatory proteome of RA patients, to identify useful biomarkers associated with distinctive clinical outcomes.

Methods

Serum samples from 140 subjects, including 40 healthy donors (HC) and 100 RA patients with high activity disease (mean DAS28=4.7), were profiled with the innovative proteomic methodology “proximity extension assay” (Olink) which analyses one panel of 92 pro-inflammatory proteins. Samples from RA active patients included 40 from newly-diagnosed RA patients before taking conventional DMARDs and 60 from biologics-naïve patients (mean disease duration=10 years) before receiving TNFi drugs. Clinical outcomes were evaluated following EULAR criteria after 6 months of treatment and patients were classified as responders or non-responders to the different therapeutic interventions. Unsupervised hierarchical clustering methodologies were applied to identify subgroup pf patients based on the proteomic profiles. Gene ontology enrichment were used to interrogate the biological meaning of the distinctive molecular signatures identified.

Results

The inflammatory proteome analysis identified 33 proteins differentially expressed and upregulated in RA patients compared with HC including several chemokines (CCL-11, -19, -20, -23, -28; CXCL-10, -11, -9; MCP-1, -3), interleukins (IL-6, -8, -18, -10, -17c), and other relevant proinflammatory mediators (VEGFA, CD40, MMP-1, CSF-1, OPG, FGF23) among others (FDR<0.05). Most of these molecules were associated with disease activity (DAS28) and the autoimmunity profile (Rheumatoid factor and ACPAs antibodies) of RA patients.

The unsupervised clustering analysis using the proteomic profile of RA patients before TNFi identified two subgroups of patients. Cluster 1 (C1) was characterised by patients with higher levels of several pro-inflammatory mediators compared with Cluster 2 (C2), where a signature of 16 chemokines was significantly enriched (CCL-3, -4, -10, -11, -20, -23; CX3CL1; CXCL-1, -10, -11, -5, -6, -9; MCP-1, -3, -4). Clinically, 25% of the non-responders’ patients was included in C2, while 75% was located in C1, suggesting that a prominent circulating chemotaxis profile prior therapy is associated with a poor clinical outcome. These data were similarly observed in patients before receiving DMARDs, where a signature of upregulated chemokines and pro-inflammatory mediators characterised a cluster with a high % of non-responder patients.

Conclusion

A pro-inflammatory signature, where chemokines are predominantly up-regulated in the serum of RA patients before therapy, is associated with a poor clinical outcome. This newly identified signature, which deserves a more in-depth analysis, might be clinically useful guiding precision medicine and novel therapeutic approaches.

Acknowledgements

Supported by ISCIII (PI21/005991 y RICOR-RD21/0002/0033) co-financed by FEDER, Fundacion Andaluza de Reumatología (FAR) and Consejería de Conocimiento, Investigación y Universidad de la Junta de Andalucía (P20_01367).

Disclosure of Interests

None declared.

POS0886 EFFICACY AND SAFETY OF RITUXIMAB IN AUTOIMMUNE DISEASE–ASSOCIATED INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Background

Interstitial lung disease (ILD) is a common condition in patients with connective tissue disease (CTD). It is associated with increased morbidity and mortality. Rituximab (RTX) has been approved for treatment of RA and some recent retrospective studies suggest that it could be an alternative treatment for patients with CTD-ILD, even in cases that prove refractory to conventional immunosuppressants.

Objectives

To analyze the efficacy and safety of RTX in connective tissue disease associated with interstitial lung disease (CTD-ILD).

Methods

We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving RTX between 2015 and 2020. Patients who had worsening of respiratory symptoms or decline in the pulmonary function tests (PFT) compared to the time of ILD diagnosis were treated with rituximab. The patients were assessed using high-resolution computed tomography and PFT baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC)>10% or diffusing capacity of the lungs for carbon monoxide (DLCO)>15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening of ILD.

Results

We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7-69.0) months (Table 1). At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in 7 (18.9%); 7 patients (18.9%) died. Mean PFT values decreased significantly at the start of RTX compared to the date of ILD diagnosis in FVC (72.2[21.3]vs 73.5 [16.9] mg/l;p=0.040) and DLCO-SB (55.9 [15.7] vs 58.3 [16.1] mg/l; p=0.041). No significant decline was observed in median FVC (72.2 vs 70.8; p=0.530) or DLCO (55.9 vs 52.2; p=0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR [95% CI], 0.904 [0.8-0.9]; p=0.015), time to initiation of RTX (1.01 [1.001-1.02]; p=0.029), and mycophenolate (0.202 [0.04-0.8]; p=0.034). The infection incidence rate was 0.21 patient-years.

Table 1.

Baseline demographic and clinical characteristics of 37 patients with CTD-ILD receiving rituximab.

VariableTotal n=37RAn=19SSn=14IMn=4p ValueFemale sex, n (%)27 (73.0)13 (68.4)11 (78.6)3 (75.0)0.806Age in years, mean (SD)62.8 (9.9)67.7 (9.7)57.9 (7.9)56.6 (5.5)0.001Smoking0.147Never smoked, n (%)20 (54.1)9 (47.4)7 (50.0)4 (100.0)Smoked at some time, n (%)17 (45.9)10 (52.6)7 (50.0)0 (0.0)Duration of CTD, months, median (IQR)107.8 (49.5-188.8)151.0 (8.,0-240.5)89.6 (51.3-184.4)35.1 (25.1-49.0)0.017Duration of ILD, months, median (IQR)65.4 (31.1-110.3)82.2 (37.4-120.1)64.5 (35.5-107.1)25.9 (25.0-36.0)0.136Time to initiation of RTX, median (IRQ)12.0 (6.5-48.2)25.1 (7.0-57.6)11.4 (3.9-43.6)7.4 (7.0-10.4)0.455Duration of treatment with RTX, median (IQR)38.2 (23.4-69.9)45.3 (22.2-79.9)52.5 (24.7-63.3)22.8 (17.7-36.2)0.291Combined with csDMARDs, n (%)15 (40.5)9 (47.4)5 (35.7)1 (25.0)0.637Methotrexate, n (%)5 (13.5)2 (10.5)3 (21.4)0 (0.0)0.468Leflunomide, n (%)2 (5.4)2 (10.5)0 (0.0)0 (0.0)0.367Sulfasalazine, n (%)1 (2.7)1 (5.3)0 (0.0)0 (0.0)0.615Hydroxychloroquine, n (%)7 (18.9)4 (21.1)2 (14.3)1 (25.0)0.840Combination with immunosuppressants, n (%)20 (54.1)7 (36.8)9 (64.3)4 (100.0)0.044Mycophenolate, n (%)19 (51.4)6 (31.6)9 (64.3)4 (100.0)0.021Azathioprine, n (%)1 (2.7)1 (5.3)0 (0.0)0 (0.0)0.615Corticosteroids, n (%)25 (67.6)14 (73.7)7 (50.0)4 (100.0)0.121Doses of corticosteroids, median (IQR)5.0 (0.0-10.0)5.0 (0.0-10.0)2.5 (0.0-7.5)10.0 (8.1-10.5)0.519

Conclusion

Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. No significant increase in infection rates was observed. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.

Disclosure of Interests

None declared

AB1112 SARS-COV-2 INFECTION AND IT VACCINATION IN AUTOINMUNE DISEASE-ASSOCIATED INTERSTICIAL LUNG DISEASE

Background

Intersticial lung disease (ILD) is a common condition in patients with systemic autoinmune diseases (SAI) that is characterized by increased morbility and mortality. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has posed huge challenges worldwide and previous studies suggest that ILD patients experience a more severe clinical course.

Objectives

To analyze COVID-19 infection effects in patients with ILD associated systemic autoinmune disease (ILD-SAI) and to describe their vaccination status.

Methods

Design

We performed a multicenter, retrospective, observational study from 6 teaching hospitals in Andalusia, Spain.

Study protocol

We included ILD-SAI patients: rheumatoid arthritis (RA), systemic sclerosis (SS) and inflammatory myopathies (IM), assisted in reumatology consultations in 2021.

Variables

COVID-19 infection was the main variable that we collected and it was confirmed by a positive result on a PCR test. Secondary variables: (1) COVID-19 severity defined as hospitalization or death; (2) vaccination status; (3) temporary relationship between infection and vaccination. Other variables included: clinical, epidemiological characteristics, treatments received, type of ILD (UIP/NSIP), pulmonary function testing and high-resolution computed tomography.

Statistic analysis

Two multivariable logistic regression analysis to indentify the “COVID-19” and “severe COVID-19” associated factors.

Results

We included 176 ILD-SAI, of whom: 105 (59.7%) had RA, 49 (27.8%) had SS and 22 (12.54%) had IM. The main baseline characteristics for the oversall simple and te 3 subgroups are shown in Table 1.

Table 1.

Clinical and epidemiological characteristics of 171 ILD-SAI patients.

VariableRheumatoid artritisn=105Systemic sclerosisn=49Inflammatory myopathies n=22p-valueSex, women, n (%)58 (55.2)42 (85.7)17 (77.3)<0.001Age in years, mean (SD)67.9 (9.6)60.9 (12.5)55.7 (18.9)<0.001SAI evolution time, month, median (IQR)46.2 (25.4-79.0)67.1 (52.2-88.2)39.1 (25.1-72.5)0.010Radiological patterns<0.001UIP, n (%)66 (62.9)8 (16.3)1 (4.5)NSIP n (%)32 (30.5)39 (79.6)20 (90.9)Last PFTFVC, mean (SD)70.7 (19.9)71.3 (21.4)73.1 (16.6)0.471FEV1, mean (SD)71.2 (19.3)72.2 (17.3)74.4 (17.9)0.345SB-DLCO, mean (DS)54.3 (16.5)52.4 (15.9)60.8 (15.2)0.140TreatmentsDMARD, n (%)88 (86.3)10 (20.4)11 (50.0)<0.001Biologic DMARD, n (%)47 (46.1)14 (28.6)6 (27.3)0.590Immunosuppressants, n (%)37 (36.3)33 (67.3)17 (77.3)<0.001Corticosteroid, n (%)72 (71.3)24 (49.0)18 (81.8)0.007COVID-19COVID-19 infection, n (%)14 (13.3)4 (8.2)4 (18.2)0.460Severe COVID-19 infection, n (%)7 (50.0)0 (0.0)0 (0.0)0.085Complete COVID-19 vaccination, n (%)94 (89.5)47 (95.9)22 (100.0)0.135

We recorded 22/179 (12.5%) SARS-CoV-2 infections, 7/22 (31.8%) of them were severe and 3/7 (42.85%) died. As to the vaccination, 163/176 (92.6%) patients received the complete dosis. Among those correctly vaccinated 18/163 (11%) had the SARS-CoV-2 infection, 4/18 (22.2%) after the vaccinated date and 14/18 (77.7%) when they still dint´t have the complete vaccination. From the 13 not vaccinated patients, 4/13 (30.7%) had COVID-19. As to frequency, COVID-19 severity and vaccination, there were no difference between subgroups of CTD-ILD patients. The risk factors associated with the COVID-19 infection were the last FVC (OR [CI 95%], 0.971 [0.944-0.998]; p=0.048), the vaccination (OR [CI 95%], 0.185 [0.049-0.691]; p=0.012) and the Rituximab treatment(OR [CI 95%], 3.172 [1.028-6.785]; p=0.045). Moreover, the only variable associated independently with the severe COVID-19 was the protective effect of vaccination (OR [CI 95%], 0.020 [0.003-0.119]; p<0.001).

Conclusion

A total of 12.5% ILD-SAI patients were COVID-19 infected, most of them without the complete vaccine. Rituximab and a deterioration of FVC were risk factors for the COVID-19 wehreas the vaccination was a protective factor for the mild and severe infection.

Disclosure of Interests

None declared

AB1090 IMPACT OF THE COVID19 PANDEMIC ON THE SOCIAL BEHAVIOR OF PATIENTS WITH RHEUMATIC DISEASES

Background

Depression in rheumatic diseases negatively influences the support network and the perception of company of these patients (1).

Objectives

To describe how the COVID-19 pandemic affects the social activitiesn patients with chronic rheumatic diseases such as Rheumatoid arthritis (RA), Systemic Lupus Erithematosus (SLE) and Spondyloarthritis (SpA).

Methods

Design: Observational, longitudinal study of a series of patients. Patients: RA (ACR/EULAR 2010 classification), SpA (ASAS/EULAR 2010 criteria), and SLE (ACR 1997 criteria) patients, age ≥ 18 years. Questionaries for the evaluation of participation in social activities is the Patient Reported Outcomes Measurement Information Systems (PROMIS) v2.0 Short-Form (8 items, PROMIS-APS) at baseline (OCT to DEC 2019) and after 18 months of pandemic (SEP to DEC 2021) were performed. Variables evaluated were: social activities in terms of various factors, such as satisfaction with social roles mobility, depression, companiony social isolation, emotional support, instrumental support, support via information and ability to participate in social activities. All the variables were evaluated using the PROMIS questionnaire with quantitative scores. We also recorded demographic, clinical, and comorbidity data. Statistical analysis: Multivariate Linear Regression (Dependent variable: PROMIS ability to participate in social activities 18 months COVID19) was performed.

Results

We recruited 91 patients, 31 (34.1%) RA, 30 (33%) SpA y 30 (33%) SLE. The 3 groups were well balanced in terms of clinical-epidemiological characteristics, except that patients with SLE were younger (mean 45 years) than patients with RA (53 years) and SpA (55 years) (p = 0.004) and because most of the patients with RA and SLE were women (97%) compared to those with SpA (60%) (p <0.001).

There was a worsening after 18 months of the COVID19 pandemic in the mean scores of the PROMIS for: satisfaction of the social role (26.9 ± 8.7 vs 25.3 ± 8.4; 0.046), depression (14.7 ± 7, 6 vs 16.1 ± 8.4; p = 0.044) and for the ability to participate in social activities (27.7 ± 7.2 vs 26.1 ± 6.8; p = 0.020). By diagnoses, the ability to participate in social activities was very similarbetween the different groups except for worse mobility in patients with RA and SpA compared to SLE, both at baseline and at 18 months of the pandemic. SLE patients worsened more after 18 months of the COVID19 pandemic in social role satisfaction, depression, instrumental support and ability to participate in social activities.

In the multivariate analysis, the ability to participate in social activities at 18 months of the COVID19 pandemic was inversely associated with the diagnosis of SLE compared to the rest (ß [95% CI], -2.60 [-4.62 - 0.58]; p = 0.012) and depression (ß [95% CI], -0.23 [-0.39, -0.08]; p = 0.004); and directly with social role satisfaction (ß [95% CI], 0.18 [0.10-0.35]; p = 0.031), mobility (ß [95% CI], 0.13 [0.07-0.20]; p = 0.001) and company (ß [95% CI], 0.32 [0.11-0.60]; p = 0.023).

Conclusion

At baseline evaluation, social activities were affected by the impact of rheumatic disease. After 18 months of the pandemic-COVID19, patients with RA and SPA remain stable but SLE patients significantly worsened their social role and depression.

References

[1]Cano-García L, Mena-Vázquez N, Manrique-Arija S, Redondo-Rodriguez R, Romero-Barco CM, Fernández-Nebro A. Ability to Participate in Social Activities of Rheumatoid Arthritis Patients Compared with Other Rheumatic Diseases: A Cross-Sectional Observational Study. Diagnostics (Basel). 2021;11(12).

Disclosure of Interests

None declared

AB1240 PROSPECTIVE EVALUATION OF COGNITIVE FUNCTION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Objectives

Prospectively evaluate changes in the cognitive function of patients with juvenile idiopathic arthritis (JIA) and associated factors.

Methods

Design and protocol: We performed a prospective cohort study with JIA patients that participated in a previous cross-sectional study (2019) to evaluate cognitive function. After 24 months, the patients were administered the same test battery previously used through an established protocol, and data was collected from their clinical histories. The neuropsychological tests were corrected by a neurologist and neuropsychologist.

Study population: Inclusion criteria: Patients aged ≥16 years with JIA classified according to the criteria of ILAR 2001. Patients with inflammatory or rheumatic diseases other than JIA, previous neurological disease not associated with the course of JIA, and patients with scores lower than the normal in the manual skill test were excluded. Outcomes: The main variable was cognitive impairment, defined as worsening of ≥2 scaled points after 24 months (V24) in any of the subtests used to evaluate each cognitive area in the Wechsler Adult Intelligence Scale (WAIS). The evaluated cognitive domains and their respective subtests were: Attention/concentration (Digit Span); verbal function (Vocabulary); visuospatial organization (Block Design); working memory (Letter-Number Sequencing); problem-solving (Similarities). Depression was evaluated by The Beck Depression Inventory-II (BDI-II): minimal (0-13), mild (14-19), moderate (20-28), and severe (29-63). Other variables: Clinical-epidemiological characteristics; treatments; and inflammatory activity evaluated as the C-reactive protein average (CRP) and JADAS-27 along the 2 years of follow-up.

Statistical analysis: Descriptive analysis, followed by χ2 and paired T-test. Multivariate analysis to identify independent variables associated with impairment of cognitive function in JIA.

Results

Thirty patients with JIA were included. The clinical characteristics in V24 are shown in Table 1. Thirteen patients (43%) showed impairment in one or more cognitive functions. The most frequent impaired cognitive functions were verbal function (13.3%), visuospatial organization (13.3%) and problem solving (13.3%); followed by attention/concentration (10.0%) and working memory (6.7%). The variables independently associated with cognitive impairment were the mean CRP along the follow-up (OR [IC 95%], 1.510 [1.012-2.254]; p=0.044) and depression (OR [IC 95%], 1.358 [1.028-1.794]; p=0.031). This model would explain the 47% of the cognitive impairment in JIA (R2=0.470).

Table 1.

Clinical, laboratory, and treatment characteristics of 30 patients with JIA

VariableJIA n=30Age in years, mean (SD)2.4 (7.0)Sex, woman, n (%)19 (63.3%)Cultural level Basic studies, n (%)3 (12.5%) Secondary education, n (%)8 (33.3%) University studies, n (%)13 (54.2%)Dyslipidaemia, n (%)2 (6.6%)BMI, mean (±SD)22.6 (3.3)Evolution time JIA, months, mean (±SD)158.1 (88.4)Rheumatoid factor >10 U/mL., n (%)2 (6.6%)Anticitrullinated peptide antibodies >20 U/mL., n (%)1 (4.5%)HLA B27, n (%)6 (20.0%)ANA, n (%)12 (40.0%)RCP average, mean (±SD)4,9 (6.6)JADAS27, mean (±SD)8,1 (10.5)Uveitis, n (%)9 (30.0%)Current synthetic DMARDs, n (%)18 (60.0%)Previous biologic DMARDs, n (%)12 (40.0%)Corticosteroid, n (%)5 (16.6%)

BMI: Body Mass Index, JIA: Juvenile Idiopathic Arthritis, ANA: Antinuclear antibodies, CRP: C-Reactive Protein, DMARD: Disease-Modifying Antirheumatic Drugs.

Conclusion

Forty percent of the patients with JIA showed cognitive impairment after 24 months of follow-up. Cognitive impairment was associated with higher inflammatory activity and depression.

Disclosure of Interests

None declared

POS0654 EFFECTIVENESS OF ABATACEPT IN PATIENTS WITH INTERSTITIAL LUNG DISEASE ASSOCIATED WITH RHEUMATOID ARTHRITIS

Background

Interstitial Lung Disease (ILD) is the most common lung involvement in rheumatoid arthritis (RA) and leads to increased morbidity and mortality. Some retrospective observational studies suggest that abatacept (ABT) could be effective and safety, although there are no clinical trials and prospectively collected data are scarce.

Objectives

To evaluate prospective the effectiveness and safety of ABT in patients with ILD associated RA (ILD-RA).

Methods

Design and Protocol: We performed a multicenter, prospective, observational study of patients with interstitial lung disease secondary to rheumatoid arthritis (ILD-RA) receiving ABT between 2015 and 2021. The patients were assessed using high-resolution computed tomography and lung function tests at the beginning of treatment (V0), at 12 months (V12), and at the end of follow-up in 2021 (fV). The study was approved by the Ethics Committee (Code 1719-N-15). Main variable: effectiveness of ABT according to evolution of ILD at the end of follow-up: (1) improvement (ie improvement of FVC ≥10% or DLCO ≥15% and no radiological progression), (2) no progression (stabilization or improvement in FVC ≤ 10% or DLCO <15% and no radiological progression), (3) progression (worsening of FVC >10% or DLCO >15% and radiological progression) or (4) death. Other variables: clinical and analytical characteristics, treatments and safety (infections, hospitalization and mortality). Statistical analysis: Cox regression analysis to identify factors associated with worsening of ILD-RA treated with ABT.

Results

Thirty-eight ILD-RA patients started ABT treatment during prospective follow-up. A total of 22/38 (57.9%) were men and the mean (SD) age was 66.1 (9.1) years. The mean (SD) evolution of ILD was 43.9 (30.0) months and the median (IQR) time with ABT was 17.0 (12.1-34.8) months. The baseline clinical-epidemiological characteristics and pulmonary progression of the patients are shown in Table 1. At the end of follow-up (fV) 28/38 (73.6%) had improvement/stabilization and 7/38 (18.4%) progressed and 3/38 (7.8%) of them died (COVID-19 pneumonia, respiratory infection and ILD progression, respectively). There were no significant differences in FVC (75.3 [8.7] vs 77.7 [14.6]; p=0.775) or in FEV1 (83.9 [10.7] vs 84.7 [13.2]; p=0.416) nor in the DLCO (61.0 [17.4] vs 60.7 [15.2]; p=0.789) at the end of follow-up. There was a greater numberwith improvement/stabilization among the patients who were in combination with Methotrexate compared to those who were in monotherapy (83.3% vs 39.1%; p=0.046). The baseline variables that were independently associated with progression-mortality of ILD-RA in fV were: baseline FVC (OR [95% CI], 0.895 [0.805-0.996]; p=0.042) and duration of ILD-RA (OR [95% CI], 1.204 [1.148-2.112; p=0.046]). Two patients discontinued ABT during follow-up due to insufficient joint and pulmonary response.

Table 1.

Characteristics of patients with ILD-RA treated with Abatacept.

VariableILD-RA n=38Baseline clinical-epidemiological characteristics Sex, man, n (%)22 (57.9) Age in years, mean (SD)66.1 (9.1) Race, caucasian, n (%)38 (100.0) Smoking history  No smoker, n (%)23 (60.5)  Smoker, n (%)15 (39.5) Time of evolution RA, months, median (IQR)139.1 (68.1-218.7) RF, n (%)36 (94.7) Anti-CCP, n (%)32 (84.2) ANA, n (%)8 (22.9) Radiological pattern  UPI, n (%)26 (68.0)  NSIP, n (%)12 (32.0)Treatment DMARDs, n (%)33 (86.8) Methotrexate, n (%)19 (50.0) Leflunomide n (%)11 (22.9) Sulfasalazine, n (%)2 (5.3) Hydroxychloroquine, n (%)6 (15.7)Immunosuppressants, n (%)11 (297)Antifibrotic, n (%)1 (2.6)Corticosteroids, n (%)32 (84.2)Corticosteroids, median (IQR)5.0 (2.5-10.0)Pulmonary progression (fv) Improvement-Stabilization, n (%)22 (73.6) Progression-Mortality, n (%)10 (26.4)

Conclusion

More than half of the patients with ILD-RA treated with ABT manage to stabilize or improve their lung disease after a median follow-up of 17 months. Patients who worsen or die have lower baseline FVC values ​​and ILD-RA with a longer evolution time.

Disclosure of Interests

None declared

AB0255 SARCOPENIA IN PATIENTS WITH RHEUMATOID ARTHRITIS OVER 65 YEARS OF AGE: PREVALENCE AND PREDISPOSING FACTORS

Background

Sarcopenia is a muscle disease which is characterized by loss of muscle mass and function. This condition is associated with chronic disease and ageing which predicts inability, hospitalization and death.

Objectives

Describe sarcopenia prevalence and risk factors in patients with reumathoid arthritis (RA) over 65 years of age.

Methods

Design:

A case-control study.

Subjects

Cases: Recruitment was performed by random sampling between patients over 65 years of age with RA (ACR/EULAR 2010 criteria) attended at 4 Spanish University Hospitals.

Controls: Recruitment of subjects without rheumatoid disease was performed asking for case patients who attended to medical center with a similar-age (age of range +/- 5 years) and same-gender person from same social or family environment.

Variables: The main variable was sarcopenia which was defined according to European Working Group on Sarcopenia in Older People (EWGSOP) 2019. Sarcopenia risk factors assessed were: economic status, malnutrition, measured with Mini Nutritional Assessment (MNA), dual-energy x-ray absorptiometry (DEXA) in spine and hip to osteoporose screening, toxic habits, comorbidities and Charlson index, physical activity measured with Global physical activity questionnaire (GPAQ) and Short Physical Performance Battery (SPPB).

Other variables were: haemoglobin, calcium, D and B12 vitamins, total proteins, albumin, C reactive protein, body mass index (BMI), polimedication, quality of life measured with EQ-5D and RA related factors, activity disease measured with DAS28, SDAI and CDAI; physical function measured with HAQ (Health assessment questionnaire) and global functional status according ACR criteria.

Statistical analysis:

Descriptive and multivariative analysis was performed to identify factors associated to sarcopenia in RA.

Results

76 patients and 76 controls were included in the study, 120 were women (78,9%), with media ± SD of age 74,7 ±6,98 of media and 32 (21,1%) were men, with age 70,1 ±3,78 of media. In comparation with controls, RA patients presented more frequency of sarcopenia (30 [19,53%] vs 6 [3,94%]; p=0,005). RA patients who presented sarcopenia, were upper average age (p=0,001), worse results in Short Physical Performance Battery (SPPB) (p=0,037), higher DAS28 (3,55 ± 1,09 vs 2,78 ± 1,05; p=0,017), higher score HAQ (1,18 ± 0,79 vs 1,69 ± 0,68; p=0,024), worse score in EQ5D (0,27 ± 0,28 vs. 0,54 ± 0,25; p=0,001) and Visual analogic scale VAS EQ5D (45,7 ± 17,4 vs. 56,9 ± 17,6; p=0,035).

By the way, RA patients presented lower levels of total proteins (p=0,018), worse results in MNA (p=0,001) and they performed less physical activity by GPAQ (p=0,011). Multivariative models (Table 1) identified as independent predictors of sarcopenia in RA: age (p=0,014), proteins levels (p=0,044) and disease activity measured by DAS28 (p=0,030). This model could explain 37% of sarcopenia in RA (R2=0,37).

Table 1.

Multivariativeanalysis (VD: Sarcopenia)

OR(IC)pAge, years1,213 (1,041-1,414)0,014Proteins (g/dL)0,185 (0,036-0,958)0,044DAS282,146(1,076-4,881)0,030

R2=0,37

Conclusion

Sarcopenia is more prevalence in over 65 years-old RA people. Older age and higher activity disease measured by DAS28 more risk of sarcopenia. Proteins levels have a protected association with sarcopenia.

Disclosure of Interests

None declared

AB0301 ANALYSIS OF INTESTINAL MICROBIOTA IN PATIENTS WITH OSTEOPOROSIS SECONDARY TO RHEUMATOID ARTHRITIS

Objectives

To analyse of intestinal microbiota in patients with osteoporosis (OP) secondary rheumatoid arthritis (RA).

Methods

Design: A cross-sectional observational study nested in a prospective cohort of incident RA patients.

Patients: Patients with RA (ACR/EULAR 2010) from a prospective baseline cohort (incident cases between 2007-2011), >16 years, from whom information on bone mineral densitometry (BMD) was collected.

Protocol: all subjects were evaluated in a specialized outpatient unit. Clinical-analytical variables of the cut-off date and clinical history were registered. Blood, urine and faeces samples were obtained from all subjects. A BMD was done by dual energy X-ray absorptiometry (DXA) for osteoporosis diagnosis.

Variables: Dependent variable: osteoporosis according World Health Organization (WHO) definitions. The fecal microbiota (continuous var., 0-100%) was analysed using the Ion Torrent S5 next-generation sequencing platform, and the sequences obtained were processed using the QIIME2 (Quantitative Insights Into Microbial Ecology 2) software. Others variables included demographics characteristics, comorbidities, inflammatory activity measured by mean accumulated Disease Activity Score-28 (DAS-28) throughout the disease, severity variables: smoking, erosions, anticitrullinated peptide antibody (ACPA) titres, rheumatoid factor (RF) and physical function measured by HAQ. Treatment with bDMARD (biological disease-modifying antirheumatic drug) and/or sDMARD (synthetic disease-modifying antirheumatic drug).

Statistical Analysis: descriptive, bivariate using χ2 and T-Student followed by logistic multivariant regression model in patients with RA. (Vd: Osteoporosis).

Results

110 patients with RA were included. The majority of the subjects were women (80%) with an average age of 56 years. The majority of patients were seropositive (81.8% with positivity for RF and 80% with positive for ACPA) and the accumulated DAS-28 average was 3. A total of 49/110 (44.5%) had normal BMD, 46/110 patients (41.8%) had densitometric osteopenia and 15/110 OP (13.6%). Patients with OP were older (p=0.025), higher RA length (p=0.003), higher CRP (p=0.046), higher inflammatory by DAS-28 (p=0.051) and higher ACPA titres (p=0.043). Furthermore, they showed higher levels of Lentisphaerae (p=0.035), Synergistetes (p<0.001), Actinobacteria (p=<0.001) y Verrucomicrobia (p=0.034).

The variables independently associated with OP in RA were: age (OR [IC 95%],1.099 [1.012-1.193]; p=0.025), ACPA (OR [IC 95%],1.005 [1.001-1.010]; p=0.036), RA length (OR [IC 95%],1.039 [1.016-1.062]; p=0.001) y Actinobacteria (OR [95% CI] 1.124 [1.004-1.257]; p=0.042), R2=0.367.

Conclusion

Osteoporosis in Rheumatoid Arthritis is associated with severity factors as the age, the disease length or the presence of ACPA, as well as the Actinobacteria predominance in the intestinal microbiota.

Table 1.

Epidemiological, clinical and analytical characteristics of patients

VariablePatients n=110Epidemiological characteristicsAge in years, mean (IQR)55.9 (49.3-64.4)Sex, female; n (%)88 (80.0)Tobacco Never smoker, n (%)47 (42.7) Ex-smoker, n (%)30 (27.3) Active smoker, n (%)33 (30.0)Comorbidities High blood pressure, n (%)28 (25.5) Diabetes Mellitus, n (%)6 (5.5) Dyslipidemia, n (%)25 (22.7) Cardiovascular Disease, n (%)18 (16.4) BMI (Kg/m2), mean (SD)28.4 (5.1)Clinical and analytical characteristicsRA evolution time, months, median (IQR)93.2 (77.6-123.4)Diagnosis delay, months, median (IQR)8.1 (4.5-17.0)Erosions, n (%)68 (61.8)RF >10, n (%)90 (81.8)ACPA >20, n (%)88 (80.0)DAS-28 average, mean (±SD)3.0 (0.7)HAQ average, median (IQR)0.71 (0.3-0.9)sDMARD, n (%)93 (84.5)bDMARD, n (%)42 (38.1)Osteopenia, n (%)46 (41.9)Osteoporosis, n (%)15 (13.6)

Disclosure of Interests

Alba María Cabezas-Lucena: None declared, Maria Morales-Águila: None declared, Patricia Ruiz-Limon: None declared, Isabel Moreno-Indias: None declared, Natalia Mena-Vázquez: None declared, Sara Manrique Arija Speakers bureau: Abbvie, Gedeon, Jansen, Lilly, Menarini, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Consultant of: Abbvie, Jansen, Lilly, Novartis, Sanofi, Antonio Fernandez-Nebro: None declared

AB0753 REAL LIFE DOSE REDUCTION OF BIOLOGICAL THERAPY IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. UTILITY OF THE REDOSER TOOL

Background

The long-term use of standard dosing of TNFi therapy is costly and not without side effects, including infections, tuberculosis and potential malignancies(1,2,). Hence, we undertook this study to determine whether dose reduction of TNFi therapy may be possible in a realworld setting and if REDOSER tool(3) is an appropriateness criteria for reducing the dose of BT.

Objectives

Describe the percentage of patients with inflammatory rheumatic diseases (IRD) who continue with dose reduction of biological therapy (BT). Evaluate relapse in clinical practice after 2 years of follow-up. Identify factors associated with relapse.

Methods

Retrospective observational study. Patients with axial spondyloarthritis (axial SpA), psoriatic arthritis (PSA) and rheumatoid arthritis (RA) in BT dose reduction. Inclusion criteria: Axial SpA according to ASAS criteria, APS according to CASPAR criteria and RA according to ACR2010 criteria, who have started reducing the dose of BT treatment between 2009-2019 at the Hospital Regional Universitario de Málaga, Spain. Protocol: patients with TB are followed prospectively in a monographic consultation with a pre-established protocol. The day of dose reduction = baseline visit (v0). Variables:Maintained dose reduction: % of patients who maintained dose reduction from the start of optimization to the index date (data collection). Relapse at 12 and 24 months: % of patients who, after starting dose reduction, returned to the previous or usual dose. Other variables: Demographic, time to diagnosis and evolution of the disease, clinical-analytical: disease activity (DAS28, DAPSA and BASDAI) and physical function (HAQ, BASFI). Previous treatments. Appropriateness criteria for reducing the dose of BT according to REDOSER (1): 1.appropriate, 2. inappropiate, 3. uncertain. Statistical analysis: Descriptive, bivariate, multivariate logistic regression (VD: relapse).

Results

One hundred twenty-nine patients with axial SpA, PSA and RA in BT dose reduction were included. The mean time from the start of BT to dose reduction was 38.1 months (16.6-73.1). The mean time in dose optimization was 19.5(±15.7) months. At the end of follow-up, 70.2% of the patients (87pts) achieved a sustained dose reduction. At 12 months and 24 months, 12.4% and 11.6% of patients relapsed, respectively. At the end of follow-up, there were no differences between baseline inflammatory activity and after 24 months in dose reduction measured by the different indexes: DAS28 (1.9[0.7] Vs 2.1[1, 7], p=0.323; DAPSA (5.4[4.9] Vs 4.8[4. 7], p=0.718, and BASDAI (1.5[1.1] Vs 1.4[1.3], p=0.867). Retrospectively, we evaluated the appropriateness of optimization according to the REDOSER tool (1) at the end of follow-up and it was observed that 85% of patients who maintained the dose reduction had an appropriate REDOSER and 14.5% uncertain and none inappropriate p<0.001.

Conclusion

Dose reduction of BT in IRD is possible in most patients, maintaining low disease activity or remission at 24 months, compared to baseline.

Relapse was associated with a longer evolution time of the IRD, a longer diagnostic delay, a higher inflammatory activity measured by the respective indices and a uncertain or inappropriate result of the REDOSER tool. This tool can be very useful used prior to the assessment of TB dose reduction

References

[1]Galloway JB, et al. Ann Rheum Dis 2011;70:1810_4.

[2]Dixon WG, et al. Ann RheumDis 2010;69:522_8.

[3]González-Álvaro I, Blasco AJ, Lázaro et al. Heliyon. 2017 Nov 14;3(11):e00452.

Disclosure of Interests

Sara Manrique Arija Speakers bureau: Abbvie, Gedeon, Jansen, Lilly, Menarini, MSD, Novartis, Pfizer, Roche, Sanofi, UCB.

Consultant of: Abbvie, Jansen, Lilly, Novartis, Sanofi.

Alba María Cabezas-Lucena: None declared, FJavier Godoy-Navarrete: None declared, Maria Morales-Águila: None declared, Rocio Redondo: None declared, Natalia Mena-Vázquez: None declared

AB1545-HPR MALNUTRITION IN PATIENTS WITH RHEUMATOID ARTHRITIS OVER 65 YEARS OF AGE

Background

Malnutrition is one of the most important geriatric syndrome and fragility factor in older people. In adittion to being a disease sign, its presence is related with increasing of morbility, longer hospitalizations, institucionalization and mortality due to concomitant diseases.

Objectives

Describe prevalence of malnutrition risk and associated factor in patients with rheumatoid arthritis (RA) over 65 years of age.

Methods

Design:

A case-controls study.

Participants:

Cases: Recruitment was performed by random sampling between patients over 65 years of age with RA (ACR/EULAR 2010 criteria) attended at 4 Spanish University Hospitals. Controls: Recruitment of subjects without rheumatoid disease was performed asking for case patients who attended to medical center with a similar-age (age of range +/- 5 years) and same-gender person from same social or family environment.

Variables y measures:

The main variable was malnutrition risk, measured by screening of Mini Nutritional Assessment.

Other variables were: presence of sarcopenia, defined according to European Working Group on Sarcopenia in Older People (EWGSOP) 2019, economic status, dual-energy x-ray absorptiometry (DEXA) in spine and hip to osteoporose screening, toxic habits, comorbidities and Charlson index, physical activity measured with Global physical activity questionnaire (GPAQ) and Short Physical Performance Battery (SPPB), haemoglobin, calcium, D and B12 vitamins, total proteins, albumin, C reactive protein, body mass index (BMI), polimedication, quality of life measured with EQ-5D and RA related factors, activity disease measured with DAS28, SDAI and CDAI; physical function measured with HAQ (Health assessment questionnaire) and global functional status according ACR criteria.

Statistical analysis: Descriptive and multivariative analysis was performed to identify factors associated to sarcopenia in RA.

Results

152 subjects were included in the study, 76 RA and 76 controls.More patients than controls with malnutrition risk were found, although there were no significative difference (24 [31,6%] vs 17 [22,4%]; p=0,136). More women with RA were included (78,9%), with media ± SD of age 74,7 ± 3,78., sarcopenia was presented in 9/24 (37,5%) and Charlson index was 3 points in 11/24 patients (45,8%) and 4 points in 8/24 patients (33,3%). According to the treatment, almost a 40%, no DMARDs were taken and neither 25% biological DMARD. 58,3 % of patients received corticosteroids and mayority of them (95,8%) were polimedicated. RA patients who presented desnutrition risk, in comparison with the rest of patients, had a media of upper age (p=0,007), more frequency of sarcopenia (p=0,006), right tricipital skinfold thickness (p=0,043). Also, higher values were found in activity index like physical function and quality of life: DAS28 (p=0,003), HAQ (p=0,044), Vitamin D (p=0,035), IPAQ (p=0,003), SPPB (p=0,018), EQ5D (p=0,01), VAS EQ5D (p=0,044), SDAI (p= 0,006), CDAI (p=0,008). In multivariative análisis, factors associated by independent way to malnutrition risk were age (OR [CI 95%], 1,148 [1,020-1,291]; p=0,022) and inflammatory disease by DAS28 (OR [CI 95%], 2,043 [1,198-3,483]; p=0,009) (R2=0,252).

Conclusion

Even though frequency of malnutrition was similar in cases and controls, in RA was associated with inflammatory activity and older age. It´s important monitoring malnutrition risk in this kind of patients to perform correct interventions to prevent and improve nutrition.

Disclosure of Interests

None declared

Systematic Review and Metaanalysis of Worldwide Incidence and Prevalence of Antineutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis

Objective: In this study, we aimed to evaluate the worldwide incidence and prevalence of ANCA-associated vasculitis (AAV). Methods: A systematic search of Medline and Embase was conducted until June 2020 for studies that analyzed the incidence and prevalence of patients aged >16 years diagnosed with AAV in different geographical areas. A meta-analysis was undertaken to estimate the pooled incidence per million person-years and prevalence per million persons in AAV overall and for each subtype of AAV: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The 95% confidence interval (CI) and I2 for heterogeneity were calculated. Results: The meta-analysis included 25 studies that met the inclusion criteria and covered a total of 4547 patients with AAV. Frequency increased over time. The global pooled incidence (95% CI) was 17.2 per million person-years (13.3−21.6) and the global pooled prevalence (95% CI) was 198.0 per million persons (187.0−210.0). The pooled incidence per million person-years for each AAV subtype varied from highest to lowest, as follows: GPA, 9.0; MPA, 5.9; and EGPA, 1.7. The individual pooled prevalence per million persons was, as follows: GPA, 96.8; MPA, 39.2; and EGPA, 15.6. AAV was more predominant in the northern hemisphere. By continent, a higher incidence in America and pooled prevalence of AAV was observed in America and Europe. Conclusion: The pooled incidence and prevalence of AAV seem to be increasing over time and are higher in the case of GPA. AAV was generally more frequent (incidence and prevalence) in the northern hemisphere.

Importance of Vaccination against SARS-CoV-2 in Patients with Interstitial Lung Disease Associated with Systemic Autoimmune Disease

Objectives: To describe the frequency of COVID-19 and the effect of vaccination in patients with interstitial lung disease and systemic autoimmune disease (ILD-SAD) and to identify factors associated with infection and severity of COVID-19. Methods: We performed a cross-sectional multicenter study of patients with ILD-SAD followed between June and October 2021. The main variable was COVID-19 infection confirmed by a positive polymerase chain reaction (PCR) result for SARS-CoV-2. The secondary variables included severity of COVID-19, if the patient had to be admitted to hospital or died of the disease, and vaccination status. Other variables included clinical and treatment characteristics, pulmonary function and high-resolution computed tomography. Two logistic regression was performed to explore factors associated with “COVID-19” and “severe COVID-19”. Results: We included 176 patients with ILD-SAD: 105 (59.7%) had rheumatoid arthritis, 49 (27.8%) systemic sclerosis, and 22 (12.54%) inflammatory myopathies. We recorded 22/179 (12.5%) SARS-CoV-2 infections, 7/22 (31.8%) of them were severe and 3/22 (13.22%) died. As to the vaccination, 163/176 (92.6%) patients received the complete doses. The factors associated with SARS-CoV-2 infection were FVC (OR (95% CI), 0.971 (0.946−0.989); p = 0.040), vaccination (OR (95% CI), 0.169 (0.030−0.570); p = 0.004), and rituximab (OR (95% CI), 3.490 (1.129−6.100); p = 0.029). The factors associated with severe COVID-19 were the protective effect of the vaccine (OR (95% CI), 0.024 (0.004−0.170); p < 0.001) and diabetes mellitus (OR (95% CI), 4.923 (1.508−19.097); p = 0.018). Conclusions: Around 13% of patients with ILD-SAD had SARS-CoV-2 infection, which was severe in approximately one-third. Most patients with severe infection were not fully vaccinated.

Postprandial Hyperlipidemia: Association with Inflammation and Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis

OBJECTIVE

To describe postprandial lipidemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis and inflammatory activity.

METHODS

Observational study of 80 cases of RA and 80 sex- and age-matched controls. We excluded individuals with dyslipidemia. Postprandial hyperlipidemia (PPHL) was defined as postprandial triglycerides >220 mg/dL and/or postprandial ApoB48 levels >75th percentile (>p75). Plasma lipids, cholesterol, triglycerides, ApoB48, and total ApoB were evaluated at baseline and after a meal. Other variables analyzed included subclinical atherosclerosis (defined as presence of carotid atheromatous plaque), inflammatory activity (disease activity score (DAS28-ESR)), cytokines, apolipoproteins, and physical activity. A multivariate analysis was performed to identify factors associated with PPHL in patients with RA.

RESULTS

A total of 75 patients with RA and 67 healthy controls fulfilled the inclusion criteria. PPHL was more frequent in patients with RA than controls (No. (%), 29 (38.70) vs. 15 (22.40); p = 0.036), as was subclinical atherosclerosis (No. (%), 22 (30.10) vs. 10 (14.90); p = 0.032). PPHL in patients with RA was associated with subclinical atherosclerosis (OR (95% CI) 4.69 (1.09-12.11); p = 0.037), TNF-α (OR (95% CI) 2.00 (1.00-3.98); p = 0.048), high-sensitivity C-reactive protein (OR (95% CI) 1.10 (1.01-1.19); p = 0.027), and baseline triglycerides (OR (95% CI) 1.02 (1.00-1.04); p = 0.049).

CONCLUSION

PPHL was more frequent in patients with RA than in controls. PPHL in patients with RA was associated with inflammation and subclinical atherosclerosis.

Frequency of Polyautoimmunity in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus

OBJECTIVE

To describe the frequency of polyautoimmunity and multiple autoimmune syndrome in patients with rheumatoid arthritis (RA) and patients with systemic lupus erythematosus (SLE).

PATIENTS AND METHODS

This was a cross-sectional observational study of patients with RA, SLE, and controls without autoimmune rheumatic disease. Cases were those with RA according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria and SLE according to the 2019 American College of Rheumatology/European League Against Rheumatism criteria, consecutively recruited in a rheumatology clinic. Controls were subjects with no rheumatic autoimmune disease (AIDs) recruited in the same area. Patients filled out a questionnaire on polyautoimmunity. Variables of interest were polyautoimmunity (RA or SLE with other AIDs), whereas secondary variables were rheumatic, skin, endocrine, digestive, and neurological AIDs. Multiple autoimmune syndrome is defined as the presence of 3 or more AIDs and a family history of AIDs. Statistical analyses performed were descriptive, bivariate, and multivariate (dependent variable: polyautoimmunity).

RESULTS

The study population comprised 109 patients with RA, 105 patients with SLE, and 88 controls. Polyautoimmunity was recorded in 15 patients with RA (13.8%), 43 with SLE (41%), and 2 controls (2.2%). The most frequent AID in RA was Sjögren syndrome (53.3%), followed by Hashimoto thyroiditis and psoriasis; the most frequent AIDs in SLE were Sjögren syndrome (55.8%) and antiphospholipid syndrome (30.2%), followed by Hashimoto thyroiditis. Obesity was associated with polyautoimmunity in RA (odds ratio [OR], 3.362; p = 0.034). In SLE, joint damage (OR, 2.282; p = 0.038) and anti-RNP antibodies (OR, 5.095; p = 0.028) were risk factors for polyautoimmunity, and hydroxychloroquine was a protective factor (OR, 0.190; p = 0.004).

CONCLUSIONS

Polyautoimmunity is frequent in RA and even more frequent in SLE. It was associated with obesity in RA and with joint damage and anti-RNP in SLE. Hydroxychloroquine was a protector.

Effectiveness, safety and economic analysis of Benepali in clinical practice

OBJECTIVE

To assess the effectiveness, safety and cost of Etanercept biosimilar in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) compared to the standard drug in real clinical practice.

PATIENTS AND METHODS

Retrospective observational study. Case series of 138 patients with RA, SpA or PsA treated with at least one dose of Benepali® (n = 79) or Enbrel® (n = 59). Drug retention time was the primary efficacy endpoint compared to the biosimilar and the original. The proportion of patients achieving low disease activity or remission after 52 weeks was used as the secondary outcome. Safety was assessed by means of the adverse effects incidence rate. A cost minimization analysis was performed.

RESULTS

No differences were observed regarding treatment retention time between drugs (median [95% confidence interval, 95% CI] at 12.0 months [10.2-12.0] for the biosimilar and 12.0 months [12.0-12.0] for the original). Similar improvements, in terms of inflammatory activity and physical function, were obtained after 52 weeks except for patients with SpA and PsA who, in general, experienced improvements of BASDAI and ASDAS with the original compared with the biosimilar. No significant differences were observed in the total number of adverse effects (.43 events/patient-years versus the biosimilar and .53 versus the original). Using the biosimilar in place of the original drug resulted in a net savings of 118,383.55 € (1,747.20 €/patient-years) for the hospital.

CONCLUSION

The biosimilar Benepali is as effective and safe as the original and much more cost-effective.

Prevalence of Neural Autoantibodies in Paired Serum and Cerebrospinal Fluid in Adult Patients with Drug-Resistant Temporal Lobe Epilepsy of Unknown Etiology

In order to determine the prevalence of neural autoantibodies in adult patients with drug-resistant temporal lobe epilepsy (DRTLE) of unknown etiology, we compared the characteristics of patients with and without autoantibodies and applied antibody predictive scores to the patients. Patients aged ≥18 years with DRTLE of unknown etiology and ≥12 months of evolution were prospectively recruited. Neural autoantibodies in serum and CSF were systematically determined in all patients. We created the ARTE (antibody in drug-resistant temporal lobe epilepsy) score based on the variables associated with the presence of neural autoantibodies. Twenty-seven patients were included. The mean (SD) age in years at the index date was 52 (±14.2) and at epilepsy onset was 32 (±17.1). The mean epilepsy duration was 19 (±12.5) years. Neural autoantibodies were detected in 51.85% (14/27) of patients. The presence of bitemporal, independent, interictal epileptiform discharges (BIIED) had a higher frequency in patients with neural autoantibodies (57.1% vs. 15.4%; p = 0.025) as well as those patients with a previous history of status epilepticus (49.2% vs. 0.0%; p = 0.007). The ARTE score showed an area under the curve (AUC) of 0.854. Using a cut-off point of ≥1, the sensitivity was 100% and the specificity was 46.1%, whereas when using a cut-off point of ≥3, the results were 35.7% and 100%, respectively. We found a high prevalence of neural autoantibodies in patients with DRTLE of unknown etiology, indicating an autoimmune mechanism. The presence of BIIED and a history of SE in DRTLE of unknown etiology are possible markers for autoimmune-associated epilepsy. The proposed ARTE score requires future validation in larger independent cohorts.

Characteristics and Predictors of Progression Interstitial Lung Disease in Rheumatoid Arthritis Compared with Other Autoimmune Disease: A Retrospective Cohort Study

Objectives: To describe the characteristics and progression of interstitial lung disease in patients with associated systemic autoimmune disease (ILD-SAI) and to identify factors associated with progression and mortality. Patients and methods: We performed a multicenter, retrospective, observational study of patients with ILD-SAI followed between 2015 and 2020. We collected clinical data and performed pulmonary function testing and high-resolution computed tomography at diagnosis and at the final visit. The main outcome measure at the end of follow-up was forced vital capacity (FVC) >10% or diffusing capacity of the lungs for carbon monoxide >15% and radiological progression or death. Cox regression analysis was performed to identify factors associated with worsening of ILD. Results: We included 204 patients with ILD-SAI: 123 (60.3%) had rheumatoid arthritis (RA), 58 had (28.4%) systemic sclerosis, and 23 (11.3%) had inflammatory myopathy. After a median (IQR) period of 56 (29.8–93.3) months, lung disease had stabilized in 98 patients (48%), improved in 33 (16.1%), and worsened in 44 (21.5%). A total of 29 patients (14.2%) died. Progression and hospitalization were more frequent in patients with RA (p = 0.010). The multivariate analysis showed the independent predictors for worsening of ILD-SAI to be RA (HR, 1.9 [95% CI, 1.3–2.7]), usual interstitial pneumonia pattern (HR, 1.7 [95% CI, 1.0–2.9]), FVC (%) (HR, 2.3 [95% CI, 1.4–3.9]), and smoking (HR, 2.7 [95%CI, 1.6–4.7]). Conclusion: Disease stabilizes or improves after a median of 5 years in more than half of patients with ILD-SAI, although more than one-third die. Data on subgroups and risk factors could help us to predict poorer outcomes.

Genetic Polymorphisms of GGH and ABCC2 Are Associated with Methotrexate Intolerance in Patients with Rheumatoid Arthritis

OBJECTIVE

to identify new single-nucleotide polymorphisms (SNPs) in genes encoding proteins involved in methotrexate (MTX) metabolism and to evaluate the associations of these SNPs with MTX toxicity or intolerance in a southern Spanish cohort of patients with rheumatoid arthritis (RA).

METHODS

An observational, retrospective, and multicenter study was conducted at three participating hospitals in southern Spain. The main variable was intolerance to MTX (i.e., bDMARD monotherapy), defined as an interruption of treatment due to adverse events or toxicity. Patients being treated with MTX and bDMARDs (combined treatment) at the time of the study visit were considered "tolerant" of MTX. Ten polymorphisms were selected for sequencing in our patients according to a literature review. Each polymorphism was classified according to three possible genotypes (e.g., two homozygous (AA or GG) and one heterozygous (AG)), and the association of these combinations with MTX intolerance was evaluated.

RESULTS

A total of 227 patients were included in the final analysis (107 intolerant of MTX and 120 tolerant). A significant association was observed between MTX intolerance and the GGH-T401C AA/AG genotype (OR 2.13, 95% CI 1.06-4.29) in comparison with the GG genotype. On the other hand, an inverse association was observed between the ABCC2-C24T TT/TC genotype and intolerance to MTX (OR 0.59, 95% CI 0.35-1.00) in comparison with the CC genotype.

CONCLUSION

This study provides new data on the association between genetic polymorphisms and MTX intolerance, which may contribute to the development of new biomarkers and personalized medicine in patients with RA.

Hospitalization and mortality from COVID-19 of patients with rheumatic inflammatory diseases in Andalusia

Objective

To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia.

Methods

Design: Multicentre observational case-COntrol study. Patients: RID and COVID-19 from different centres in Andalusia. Controls: patients without RIS matched by sex, age and CRP-COVID.

Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case.

Variables The main outcome variable was hospital admission and mortality from COVID-19.

Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission).

Results

One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0–1.2]; P= .025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0–1.1]; P = .007) and hypertension (OR [95% CI], 3.9 [1.5–6.7]; P = .003).

Conclusion

Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission.

Adiposity Is Related to Inflammatory Disease Activity in Juvenile Idiopathic Arthritis

OBJECTIVE

To identify factors associated with the higher proportion of fatty tissue and overweight/obesity observed in patients with juvenile idiopathic arthritis (JIA).

PATIENTS AND METHODS

We performed a cross-sectional study of 80 JIA patients aged 4-15 years with 80 age- and sex-matched healthy controls. Body composition was assessed using dual-energy x-ray absorptiometry. The 27-joint Juvenile Arthritis Disease Activity score (JADAS27) was calculated. Two multivariate models were constructed to identify factors associated with overweight/obesity and fat mass index (FMI).

RESULTS

No differences were found between cases and controls in body mass index (BMI) or body composition. However, compared with controls, patients with a high inflammatory activity (JADAS27 > 4.2 for oligoarticular JIA or >8.5 for polyarticular disease) had higher values for BMI (p = 0.006); total fat mass (p = 0.003); FMI (p = 0.001); and fat in the legs (p = 0.001), trunk (p = 0.001), and arms (p = 0.002). The factors associated with overweight/obesity in patients were the duration of therapy with biological drugs, measured in months (OR [95% CI] = 1.12 [1.02-1.04]; p = 0.037), and physical activity (OR [95% CI] = 0.214 [0.07-0.68]; p = 0.010), while the factors associated with FMI were age (β [95% CI] = 0.30 [0.17-1.41]; p = 0.014), JADAS27 (β [95% CI] = 0.45 [0.16-1.08]; p = 0.009), and physical activity (β [95% CI] = -0.22 [-5.76 to 0.29]; p = 0.031).

CONCLUSION

Our study revealed no differences between JIA patients with well-controlled disease and low disability and the healthy population in BMI or body composition. Furthermore, the association observed between inflammatory activity and adiposity could be responsible for poorer clinical course.

AB0859-HPR NETWORK OF SUPPORT AND DEPRESSION IN RHEUMATIC DISEASES

Objectives:

To describe the impact that depression has on the personal support network of patients with rheumatic diseases.

Methods:

Design. Cross-sectional observational study of a series of patients with spondyloarthritis (SpA), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) selected by consecutive sampling of the Rheumatology consultations. Selection criteria: age ≥18 years with AD (ASAS criteria), RA (EULAR / ACR 2010 criteria) and SLE (ACR-EULAR criteria) capable of understanding and willing to take the questionnaires. Protocol: The reference rheumatologist offered to participate in the study to all the patients who attended the consultation between October and December 2019 and met the selection criteria. After their approval and signing the informed consent, they went to the nursing consultation to carry out a battery of questionnaires from the PROMIS platform and collect clinical data. The infirmary was in charge of explaining the questionnaires to the patients. Variables: the main endpoint variable was depression evaluated by PROMIS and the secondary endpoint variables were questionnaires that evaluate the support network in various settings: company, emotional support, instrumental support, support through information. Likewise, data on their disease, comorbidities were collected using Charlson and socio-occupational profile. Statistical analysis: Descriptive analysis, R-Pearson correlation and multivariate linear regression analysis (VD: PROMIS depression).

Results:

151 patients participated: 50 with RA (90% women, mean age 55.12 ± 13.64 years), 51 with AD (51% women, 52.59 ± 12.15 years) and 50 patients with SLE (96 % women, mean age 47.14 ± 11.3 years). The baseline characteristics and comorbidities of the included. The mean (SD) of PROMIS depression in all patients was 16.4 (8.3) and a total of 65 patients (43%) had depression according to the Charlson index. Patients with Charlson depression had a higher mean (SD) of PROMIS depression than those without Charlson depression (24.5 [6.2] vs 10.3 [2.5], p <0.001). An inverse correlation was observed between PROMIS depression with the rest of PROMIS questionnaires: company (r = -0.369, p = <0.001), emotional support (r = -0.533, p = <0.001), information support (r = -0.577, p = <0.001) and instrumental support (r = -0.362, p = <0.001). Likewise, it was observed that patients without depression by Charlson compared with patients with depression had higher mean values (SD) in all questionnaires of the support network compared to those without depression by Charlson: company (17, 8 (2.9) vs 14.7 (4.7), p <0.001), emotional support (37.2 (5.2) vs 29.0 (9.5), p <0.001) and instrumental support (35.7 (7.2) vs 29.4 (8.8), p <0.001).Finally, in the multivariate analysis, the variables that were independently associated with depression by PROMIS were information support (B = -0.390; p <0.001) and emotional support (B = -0.239; p = 0.027). (R2 = 0.340).

Conclusion:

Depression in rheumatic diseases negatively influences the support network and the perception of company of these patients. Treating depression is important for social functioning and social relationships in these patients and for any group of chronic patients.

Disclosure of Interests:

None declared

POS0521 FACTORS ASSOCIATED WITH SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objectives:

To describe the prevalence of subclinical atherosclerosis measured as carotid intima-media thickness (cIMT) in patients with rheumatoid arthritis (RA) and to analyze the associated factors.

Methods:

We performed an observational study of 60 patients with RA and 60 sex and age-matched controls. Patients with dyslipidemia were excluded. The main variable was the cIMT measured by ultrasound. The maximum cIMT was measured and atheromatous plaque was defined as focal thickening of the arterial wall protruding toward the lumen and measuring >0.5 mm or more than 50% of the neighboring cIMT. The other variables included were clinical and laboratory values, lipid metabolism, the 28-joint Disease Activity Score (DAS28), International Physical Activity Questionnaire (METs) and Adherence to a Mediterranean diet (MEDAS). Descriptive, bivariate and two multivariate models were constructed to identify factors associated with pathologic cIMT in all subjects and other in RA patients.

Results:

The baseline characteristics of both groups are shown in Table 1. The RA patients did not have differences in the mean (SD) of maximum cIMT in relation to the controls (0.77 [0.1] vs 0.75 [0.1]; p = 0.392), nor in the number of plaques (16 [26.7%] vs 10 [16.7]; p = 0.184). The factors associated with maximum cIMT in the total sample were male sex (ß= 0.182; p = 0.039), age (ß = 0.010; p <0.001), METs (ß= -2.19; p = 0.008), MEDAS (ß = -0.177; p = 0.038); While the factors associated with maximum cIMT in patients with RA were: male sex (ß = 0.155; p = 0.003), age (ß = 0.005; p = 0.007), MEDAS (ß = -0.022; p = 0.017), DAS28 (ß = 0.036; p = 0.003) and ACPA (ß = 0.082; p = 0.052).

Table 1.

Baseline characteristics of 60 patients with RA and 60 controls.

VariablePatients n=60Controls n=60p-valueAge in years, mean (SD)54.0 (11.1)54.2 (110.4)0.943Female sex; n (%)53 (88.3)51 (85.0)0.591Smoking0.300 Never smoked, n (%)27 (45.8)30 (54.5) Exsmoker, n (%)23 (39.0)14 (25.5) Active smoker, n (%)9 (15.3)11 (20,0)BMI (kg/m2), mean (SD)28.0 (5.5)27.3 (4.9)0.540MET-minute, median (IQR)533.2 (605.1)809 (716.9)0.028MEDAS, median (IQR)9.4 (1.8)9.1 (2.1)0.349Progression of RA, months, mean (SD)119.7 (84.1-170.5)--Diagnostic delay, months, median (IQR)5.7 (5.1-14.4)--Erosions, n (%)25 (43.1)--RF >10, n (%)45 (75.0)0 (0.0)<0,001ACPA >20, n (%)48 (80.0)0 (0,0)<0,001High-sensitivity CRP (mg/dl), median (IQR)8.1 (4.2)2.0 (4.5)0.009ESR (mm/h), median (IQR)21.1 (16.6)13.9 (12.3)0.008DAS28 at protocol, mean (SD)3.1 (2.2-4.2)--Synthetic DMARDs, n (%)52 (88.1)-- Methotrexate, n (%)36 (61.0)-- Leflunomide, n (%)6 (10.2)-- Sulfasalazine, n (%)7 (11.9)-- Hydroxychloroquine, n (%)4 (6.8)Biologic DMARDs, n (%)32 (54.2)-- Anti TNF-α, n (%)23 (39.0)-- Jak inhibitor, n (%)1 (1.7)-- Anti-IL-6, n (%)6 (10.2)-- Abatacept, n (%)1 (1.7)--

Abbreviations: RA, rheumatoid arthritis; ACPA, anti-citrullinated peptide antibodies; RF, rheumatoid factor; SD, standard deviation; MEDAS: Mediterranean Diet Adherence Survey; DAS28, 28-joint Disease Activity Score; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; DMARD, disease-modifying antirheumatic drug; IL-6, interleukin 6; Anti TNF, anti–tumor necrosis factor.

Conclusion:

In patients with well-controlled established RA, subclinical atherosclerosis is associated, in addition to sex, age, and mediterranean diet, with inflammatory activity and ACPA value.

Acknowledgements:

Grant for Medical Researchers from “Fundación Española de Reumatología” 2019

Grant from “Fundación Española de Reumatología” 2018 for non-funded projects.

Disclosure of Interests:

None declared

AB0865-HPR FREQUENCY OF DEPRESSION IN SYSTEMIC LUPUS ERYTHEMATOSUS

Objectives:

Cross-sectional observational study of a series of SLE patients selected from the Rheumatology consultations.

Methods:

age ≥18 years with SLE (ACR 1997 criteria) capable of understanding and willing to take the questionnaires. Protocol: All patients with SLE undergoing follow-up in the rheumatology clinic are recorded in a database. A telephone call was made to all the patients included in the database and those patients who responded to the call and gave their verbal consent for the collection of data from their clinical history and completed the Goldberg questionnaire were finally included. The nurse was in charge of explaining the questionnaire to the patients. Variables: the main outcome variable was depression assessed by Goldberg (≥2 depression) and other variables were: previous diagnosis of depression, Charlson index, polypharmacy, psychiatric medication, referral to mental health or primary care, SLEDAI and SLICC. Descriptive, bivariate statistical analysis and multivariate logistic regression analysis (VD: Goldberg depression).

Results:

89 patients with SLE were included (95.5% women, mean age 49.44 ± 13.2 years and 18.28 ± 9.19 years of disease). The mean (SD) of the Goldberg scale in all the patients was 3.2 ± 2.9 and a total of 45 patients (50.4%) met criteria of depression according to Goldberg’s screening, of which 19 (21.3%) patients had a previous diagnosis of depression. Only 9 patients (10.1%) had had a mental health follow-up and 22 patients (24.7%) were being followed by the family doctor. A total of 87 patients (97.8%) presented polypharmacy: severe polypharmacy 59 (66.3%) and 33 (37.1%) psychiatric medication. The most used psychiatric medication was: 7 (7.8%) bromazepam, 6 (6.7%) citalopram, 5 (5.6%) diazepam. Regarding comorbidities, the Charlson index was 1.82 ± 1.21, also highlighting that 34 (27%) of the sample had Sjögren syndrome. In the multivariate analysis, polypharmacy (OR, 1.8 [95% CI, 1.0-3.1]) and Sjogren’s syndrome (OR, 3.8 [95% CI, 1.0-10.7]) were independently associated with depression by Goldberg.

Conclusion:

Depression is underdiagnosed and undertreated in patients with SLE. Depression is associated with polypharmacy and the perception of patients with SLE of being ill. It is important to correctly treat depression in the context of SLE comorbidity due to its great impact on quality of life.

Disclosure of Interests:

None declared

POS0246 THE WORLDWIDE INCIDENCE AND PREVALENCE OF ANCA VASCULITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF EPIDEMIOLOGICAL STUDIES

Objectives:

To evaluate the worldwide incidence and prevalence of ANCA vasculitis through a systematic review of the literature and meta-analysis.

Methods:

A systematic search of MEDLINE and EMBASE search engines was carried out for studies that analyzed the incidence and prevalence of ANCA vasculitis in different geographical areas. Inclusion criteria: patients diagnosed with ANCA vasculitis according to ACR criteria/ Chapel Hill Consensus and adult patients (> 16 years). All ANCA vasculitis (microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis) were considered. Exclusion criteria: editorials, conference abstracts, case or cases series reports and narrative reviews; insufficient description of the methods; lack of data to compute incidence or prevalence; and duplicate studies.Variables: Main variable: the pooled prevalence measured by the number of prevalent cases per million / person-year (95% CI) and the pooled incidence measured as the number of incident cases per million / person-year (95% CI). Secondary variables: the prevalence and incidence of each vasculitis ANCA and according geographic area. A meta-analysis was undertaken to estimate the pooled incidence and the pooled prevalence per million / person-years. The 95% CI and I2 for heterogeneity were calculated.

Results:

Twenty four studies were included. The pooled incidence (95% CI) was 12.2 per million / person-year (8.4-16.5) and the pooled prevalence (95% CI) was 130 per million / person-year (67.5-213). The individual incidence for each vasculitis was: GPA (6.7), MPA (5.9) and EGPA (1.6). The individual prevalence for each vasculitis was: GPA (69.3), MPA (21.9) and EGPA (13.5).

In the analysis by continents, the pooled incidence for GPA vasculitis was higher in Europe (7.5), while the pooled incidence for MPA vasculitis was higher in America (6.9) and for EGPA vasculitis it was higher in Asia (1.8). The pooled prevalence for GPA and MPA vasculitis was higher in Europe (83.9,24.4 respectively) than in America (14.2, 12.8 respectively).

Conclusion:

The pooled incidence and the pooled prevalence are higher in the case of GPA vasculitis compared to the rest of ANCA vasculitis. In general there is a predominance of incidence and prevalence of all ANCA vasculitis in the northern hemisphere compared to the south.

Figure 1.

The pooled incidence ANCA vasculitis.

Figure 2.

The pooled prevalence ANCA vasculitis

Disclosure of Interests:

None declared

POS0475 INTEGRATIVE CLINICAL, MOLECULAR AND COMPUTATIONAL ANALYSES ALLOW THE IDENTIFICATION OF DISTINCTIVE PHENOTYPES OF RHEUMATOID ARTHRITIS PATIENTS RELATED TO THE CLINICAL INVOLVEMENT AND THE RESPONSE TO TNF INHIBITORS

Background:

TNF inhibitors (TNFi) represent an extraordinary advance in the management of Rheumatoid Arthritis (RA). Despite their benefits, there is a percentage of patients (20–40%) that do not achieve clinical improvement. Therefore, it is necessary to search for new and easily accessible biomarkers predictive of therapeutic response that might guide precision medicine.

Objectives:

1. To explore changes in the molecular profile of RA patients following TNFi therapy in serum samples. 2. To search for new and reliable biomarkers predictive of TNFi response, based on clinical and molecular profiles of RA patients, by using machine learning algorithms.

Methods:

In a prospective multicenter study, 79 RA patients undergoing TNFi and 29 healthy donors (HD) were enrolled. Twenty-two RA patients were further included as a validation cohort. Serum samples were obtained before and after 6 months of treatment, and therapeutic efficacy was evaluated. Patients’ response was determined following EULAR response criteria. Serum inflammatory profile was analyzed by a multiplex immunoassay, along with oxidative and NETotic profiles, evaluated by commercial kits. A circulating miRNA array was also performed by next-generation sequencing. Clustering analysis was carried out to identify groups of patients with distinctive molecular signatures. Then, clinical and molecular changes induced by TNFi were delineated after 6 months of therapy. Finally, integrative clinical and molecular signatures as predictors of response were assessed at baseline by supervised machine learning methods, using regularized logistic regressions.

Results:

Inflammatory, oxidative stress and NETosis-derived biomolecules were found altered in RA patients versus HD, closely interconnected and associated with several deregulated miRNAs. This altered molecular profile at baseline allowed the unsupervised division of three clusters of RA patients with distinctive clinical phenotypes, further linked to TNFi effectiveness. Cluster 1 included RA patients with low levels of pro-inflammatory cytokines, associated with a medium-low disease activity score and good clinical response. Clusters 2-3 comprised patients with high levels of pro-inflammatory cytokines, associated with a high disease activity and a non-response rate of 30%.

After 6 months of therapy the molecular profile found altered in RA patients was reversed in responder patients, who achieved a molecular phenotype similar to HDs. However, non-responder patients’ molecular profile remained significantly deregulated, including alterations in inflammatory mediators (IL-6, L-8, TNFα, VEGF, IL-1RA, IL-5, IL-15, GMCSF, GCSF, FGFb), oxidative stress markers (LPO) and NETosis-derived products (Elastase), along with specific miRNAs (miR-199a-5p). These molecular changes further correlated with changes in disease activity score. Machine-learning algorithms identified clinical (Creatinine, IgM, Vitamin D, Swollen Joints, C4, Disease Duration and Tryglicerides) and molecular (Nucleosomes, IL-10, miR-106a-5p, IL-13, IL-12p70, IL-15 and LPO) signatures as potential predictors of response to TNFi treatment with high accuracy. Furthermore, the integration of both features in a combined model increased the predictive value of these signatures (AUC: 0.91). These results were further confirmed in an independent validation cohort.

Conclusion:

1. RA patients display distinctive altered molecular profiles directly linked to their clinical status and associated with TNFi effectiveness. 2. Clinical response was associated with a specific modulation of the inflammatory profile, the reestablishment of the altered oxidative status, the reduction of NETosis and the reversion of related altered miRNAs. 3. The integrative analysis of the clinical and molecular profiles using machine learning allows the identification of novel signatures as potential predictors of therapeutic response to TNFi therapy.

Disclosure of Interests:

None declared

POS1328 HAVE THE CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS AN EXCESS OF ADIPOSITY?

Background:

In recent years, several studies show contradictory results regarding body composition in juvenile idiopathic arthritis. Adiposity in Rheumatoid Arthritis and Psoriasic Arthritis has been associated to inflammatory activity, but it is not clear what happens in JIA.

Objectives:

To describe the body composition and anthropometric parameters of patients with JIA compared with healthy controls and analyze associated risk factors in JIA patients.

Methods:

Observational cross-sectional study in spanish children aged 4-15 years with JIA compared with healthy controls matched for age and sex. We recorded epidemiological variablesanthropometric parameters, clinical data and validated physical activity questionnaires. Body composition was measured using dual-energy x-ray absorptiometry (DXA), and included total mass (kg), fat mass (g), lean mass (g), and lean mass and android and gynoid fat mass. The fat mass index (FMI) was defined as fat mass (kg)/height squared (m2) and fat-free mass index (FFMI) as fat-free mass (kg)/height squared (m2). Descriptive, bivariete and two multivariate models were constructed to identify factors associated with obesity and fat mass in JIA patients.

Results:

We analyze 160 subjects: 80 patients with JIA and 80 healthy controls.The baseline characteristics of both groups are shown in Table 1. No differences were found between both groups in BMI (p=0.936), fat mass (p = 0.449), lean mass (p = 0.793) and in fat and lean mass of legs, arms and trunk, or in physical activity questionnaire (p = 0.582). The factors associated with obesity in patients with JIA were: time with biological drug (OR [95% CI] = 1.12 [1.01-1.04]; p = 0.042) and sedentary lifestyle (OR [95% CI] = 3.50 [1.18-7.35]; p = 0.023); while the factors associated with the fat mass index were: age (ß [95% CI] = 0.30 [0.16-1.41]; p= 0.014), inflammatory activity (JDAS) (ß [95% CI] = 0.44 [0.16-1.08]; p= 0.009) and physical activity (ß [95% CI] = -0.22 [-0.10,-0.28]; p = 0.031).

Table 1.

Baseline characteristics of patients with JIA and controls

VariableJIA (n=80)Controls (n=80)P-value Sex, girls n (%)56 (70.0)57 (71.3)0.862 Age, mean (SD)10.7 (3.2)10.2 (3.2)0.893Disease duration (years) JIA, mean (SD)6.5 (3.7)JIA subtype Systemic, n (%)9 (11.3) Oligoarticular persistent, n (%)38 (47.5) Oligoarticular extended, n (%)13 (16.3) Rheumatoid Factor-positive polyarticular, n (%)1 (1.3) Rheumatoid Factor-negative polyarticular, n (%)19(23.8)CRP (mg/l), mean (SD)4,8 (9,5)ESR (mm/h), mean (SD)8.8 (7,3)JADAS27, mean (SD)2 (4.0)CHAQ, mean (SD)0.17 (0.4)Treatment DMARDs (synthetic), n (%)42 (52.5) DMARDs (biological), n (%)24 (30.0) Anti IL-1, n (%)4 (16.7) Anti IL-6, n (%)2 (8.3) Anti TNF-α, n (%)18 (75.0)Treatment duration DMARDs synthetic, (months), mean (±SD)51 (37.5) DMARDs biological, (months), mean (±SD)19.7 (28.4) DMARDs total (months), mean (±SD)55.8 (38.0)Cumulative corticoisteroids dose, median (range)11.3 (0.12-870)

Abreviaturas; JIA: juvenile idhipathic arthritis; SD: standart deviation; CRP: C-reactive protein; VSG:erytrocyte sedimentation rate; JADAS27: Juvenile Arthritis Disease Activity Score; CHAQ: Childhood Health Assessment; DMARD: disease-modifyng anti-rheumatic drug.

Conclusion:

Children with JIA have adiposity similar to healthy controls. Inflammatory activity measured by JDAS is associated with fat mass but not to anthropometric measurements such as body mass index (BMI).

References:

[1]Grönlund et al Juvenile idiopathic arthritis patients with low inflammatory activity have increased adiposity. Scand J Rheumatol 2014.

[2]Giani et al. The Influence of Overweight and Obesity on Treatment Response in Juvenile Idiopathic Arthritis. Front Pharmacol 2019

[3]Wiech et al. Body composition and phase angle as an indicator of nutritional status in children with juvenile idiopathic arthritis. Pediatric Rheumatology 2018

[4]Alvarez-Nemegyei et al. Association between Overweight/Obesity and Clinical Activity in rheumatoid arthritis. Reumatol Clin 2020

Disclosure of Interests:

None declared

POS0211 PREDICTORS OF PROGRESSION AND MORTALITY IN PATIENTS WITH PREVALENT RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Objectives:

To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) and identify risk factors associated with disease progression and mortality in patients with rheumatoid arthritis associated with interstitial lung disease (RA-ILD).

Methods:

We performed a multicenter, prospective, observational study of patients with RA-ILD receiving DMARDs between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 60 months. The main outcome measure at 60 months was worsening of FVC >10% or DLCO >15% and radiological progression or death. We recorded demographic and clinical characteristics, lung function, and the incidence of adverse events. A Cox regression analysis was performed to identify factors associated with worsening of ILD.

Results:

After 60 months, lung disease had stabilized in 66 patients (56.9%), improved in 9 (7.8%), and worsened in 23 (19.8%). Eighteen patients (15.5%) died, with a mean survival of 71.8 (1.9) months. Baseline characteristics of 116 with RA-ILD treated with DMARDs is in table 1.The Cox multivariate analysis revealed the independent predictors of worsening of RA-ILD to be usual interstitial pneumonia (HR, 2.6 [95%CI, 1.0-6.7]), forced vital capacity (%) (HR, 3.8 [95%CI, 1.5-6.7]), anticitrullinated protein antibody titers (HR, 2.8 [95%CI, 1.1-6.8]), smoking (HR, 2.5 [95%CI, 1.1-6.2]), and treatment with abatacept, tocilizumab, or rituximab (HR, 0.4 [95%CI, 0.2-0.8]). During follow-up, 79 patients (68%) experienced an adverse event, mostly infection (61%).

Conclusion:

Lung function is stable in most patients with RA-ILD receiving treatment with DMARDs, although one third of patients die. Identifying factors of worsening in RA-ILD is important for clinical management.

Table 1.

Baseline characteristics of 116 with RA-ILD treated with DMARDs

VariableTotal=116Epidemiological characteristicsFemale sex, n (%)63 (54.3)Age, years, mean (SD)68.3 (9.9)Clinical and analytical characteristicsCurrent smokerNonsmoker, n (%)57 (49.1)Smoker, n (%)23 (19.8)Exsmoker, n (%)36 (31.0)Time since diagnosis of RA, months, median (p25-p75)148.5 (71.5-217.8)Diagnostic delay, months, median (p25-p75)8.5 (4.9-16.8)Time since diagnosis of ILD, months, median (p25-p75)27.5 (9.8-60.0)Positive rheumatoid factor (>10), n (%)111 (95.7)Positive ACPA titer (>20), n (%)100 (86.2)Erosive disease, n (%)76 (65.5)Treatment Synthetic DMARD100 (86.2) Methotrexate, n (%)51 (44.0) Leflunomide, n (%)30 (25.9) Sulfasalazine, n (%)9 (7.8) Hydroxychloroquine, n (%)21 (18.1)Biologic DMARD50 (43.1) Infliximab, n (%)1 (0.9) Etanercept, n (%)6 (5.2) Adalimumab, n (%)3 (2.6) Golimumab, n (%)3 (2.6) Certolizumab, n (%)3 (2.6) Tocilizumab, n (%)6 (5.2) Abatacept, n (%)15 (12.9) Rituximab, n (%)13 (11.2) Immunosuppressants11 (9.5) Mycophenolate, n (%)7 (6.0) Azathioprine, n (%)4 (3.4) Antifibrotic agents, nintedanib, n (%)1 (0.9) Baseline corticosteroids, n (%)69 (60.0) Dose of baseline corticosteroids, median (p25-p75)5.0 (0.0-7.5)

Abbreviations. RA: rheumatoid arthritis; ILD: interstitial lung disease; ACPA: anticyclic citrullinated protein antibody; DMARD: disease-modifying antirheumatic drug; SD: standard deviation.

Acknowledgements:

Grant for Medical Researchers of the “Fundación Española de Reumatología” 2019. declare.

Disclosure of Interests:

None declared

Analysis of Clinical-Analytical Characteristics in Patients with Rheumatoid Arthritis and Interstitial Lung Disease: Case-Control Study

OBJECTIVES

To study the differences between rheumatoid arthritis (RA)-interstitial lung disease (ILD) patients and RA patients without ILD in severity markers and disease activity and to identify factors associated with the presence of ILD in RA patients.

PATIENTS AND METHODS

Patients: RA-ILD patients selected from a multicentre cohort in Andalusia, Spain.

CONTROLS

RA-patients without ILD paired by sex, age and disease duration.

PROTOCOL

RA patients are reviewed every 3-6months in rheumatology consultation. All patients are reviewed according to a predetermined protocol with systematic data collection.

OUTCOMES

description of ILD type, differences in severity markers and disease activity in both groups. Other variables: ILD type by imaging technique (HRCT): nonspecific interstitial pneumonia (NSIP)/usual interstitial pneumonia (UIP). Lung function by PTF. Activity and severity markers of arthritis by DAS28-ESR, HAQ, RF, ACPA and erosions. Treatment with DMARD.

STATISTICAL ANALYSIS

descriptive and paired T-test or Chi-square test followed by binary logistic regression (DV: ILD in patients with RA).

RESULTS

Eighty-two patients were included, 41 RA-ILD and 41 RA controls. RF and ACPA positivity, serositis and osteoporosis were more frequent in RA-ILD patients. No significant differences in DAS28 were observed (P=.145) between RA-ILD and RA control patients. RA-ILD patients presented worse HAQ scores (P=.006). All patients were treated with disease modifying antirheumatic drugs (DMARDs). The risk of developing ILD in RA patients is tripled by a history of smoking or the presence of erosive arthritis (R²=.36).

CONCLUSIONS

The results of our study support the higher frequency of UIP and NSIP in RA patients. DLCO is the most sensitive parameter to detect ILD in RA patients. Our study showed that ILD in RA patients was associated with RA severity (presence of erosions and ACPA) and with a history of smoking.

Hospitalization and Mortality from COVID-19 of Patients with Rheumatic Inflammatory Diseases in Andalusia

OBJECTIVE

To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia.

METHODS

Design: Multicentre observational case-control study.

PATIENTS

RID and COVID-19 from different centres in Andalusia.

CONTROLS

patients without RIS matched by sex, age and CRP-COVID. Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case. Variables The main outcome variable was hospital admission and mortality from COVID-19. Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission).

RESULTS

One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0-1.2]; p = 0.025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0-1.1]; p = 0.007) and hypertension (OR [95% CI], 3.9 [1.5-6.7]; p = 0.003).

CONCLUSION

Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission.

Prevalence of Neural Autoantibodies in Epilepsy of Unknown Etiology: Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of neural autoantibodies in epilepsy of unknown etiology varies among studies. We aimed to conduct a systematic review and meta-analysis to determine the pooled global prevalence and the prevalence for each antibody.

METHODS

A systematic search was conducted for studies that included prospectively patients ≥16 years old with epilepsy of unknown etiology and systematically determined neural autoantibodies. A meta-analysis was undertaken to estimate pooled prevalence in total patients with a positive result for at least one neural autoantibody in serum and/or cerebrospinal fluid (CSF) and for each autoantibody.

RESULTS

Ten of the eleven studies that met the inclusion criteria and a total of 1302 patients with epilepsy of unknown etiology were included in themeta-analysis. The global pooled prevalence (IC95%) was 7.6% (4.6-11.2) in a total of 82 patients with a positive result for any neural autoantibody. None of the controls available in the studies had a positive result. Individual pooled prevalence for each autoantibody was: glycine receptor (GlyR) (3.2%), glutamic acid decarboxylase (GAD) (1.9%), N-methyl-d-aspartate receptor (NMDAR) (1.8%), leucine-rich glioma inactivated-1 protein (LGI1) (1.1%), contactin-2-associated protein (CASPR2) (0.6%) and onconeuronal (0.2%).

CONCLUSIONS

The pooled prevalence of neural autoantibodies in patients with epilepsy of unknown etiology is small but not irrelevant. None of the controls had a positive result. There was high heterogeneity among studies. In the future, a homogeneous protocol for testing neural autoantibodies is recommended.