Sex differences in cardiovascular and disease-related features in axial spondyloarthritis. A multicenter study of 912 patients

OBJECTIVES

To determine the potential impact of sex-specific disease-related characteristics on cardiovascular (CV) disease in axial spondyloarthritis (axSpA).

METHODS

Cross-sectional study of the Spanish AtheSpAin cohort to study CV disease in axSpA. Data on carotid ultrasound and CV disease and disease-related features were collected.

RESULTS

611 men and 301 women were recruited. Classic CV risk factors were significantly less prevalent in women, who also showed a lower frequency of carotid plaques (p = 0.001), lower carotid intima-media thickness (IMT) values ​​(p<0.001) and CV events (p = 0.008). However, after adjustment for classic CV risk factors, only the differences with respect to carotid IMT remained statistically significant. Women showed higher ESR at diagnosis (p = 0.038), and more active disease (ASDAS, p = 0.012, and BASDAI, p<0.001). They had shorter disease duration (p<0.001), lower prevalence of psoriasis (p = 0.008), less structural damage (mSASSS, p<0.001), and less mobility limitation (BASMI, p = 0.033). To establish whether these findings could lead to sex differences in CV disease burden, we compared the prevalence of carotid plaques in men and women with the same level of CV risk stratified according to the Systematic Coronary Risk Evaluation (SCORE). Men included in the low-moderate CV risk SCORE category had more carotid plaques (p = 0.050), along with longer disease duration (p = 0.004), higher mSASSS (p = 0.001) and psoriasis (p = 0.023). In contrast, in the high-very high-risk SCORE category, carotid plaques were observed more frequently in women (p = 0.028), who were characterized as having worse BASFI (p = 0.011), BASDAI (p<0.001) and ASDAS (p = 0.027).

CONCLUSION

Disease-related features may influence the expression of atherosclerosis in patients with axSpA. This may be especially applicable to women at high CV risk, characterized by greater disease severity and more severe subclinical atherosclerosis than men, suggesting a stronger interaction between disease activity and atherosclerosis in women with axSpA.

Irisin as a Novel Biomarker of Subclinical Atherosclerosis, Cardiovascular Risk and Severe Disease in Axial Spondyloarthritis

Introduction

Patients with axial spondyloarthritis (axSpA) have a high disease burden mainly due to the rheumatic disease itself, and also exhibit accelerated atherosclerosis, that leads to a higher incidence of cardiovascular (CV) disease. Accordingly, the identification of biomarkers of CV risk and inflammation in axSpA patients is clinically relevant. In this sense, given the beneficial functions exerted by the adipomyokine irisin in processes related to CV disease and inflammation, our aim was to assess, for the first time, the role of irisin as a genetic and serological biomarker of subclinical atherosclerosis, CV risk and disease severity in axSpA patients.

Methods

A large cohort of 725 Spanish patients with axSpA was included. Subclinical atherosclerosis (presence of plaques and abnormal carotid intima-media thickness values) was evaluated by carotid ultrasound. Four irisin polymorphisms (rs16835198 G/T, rs3480 A/G, rs726344 G/A, and rs1570569 G/T) were genotyped by TaqMan probes. Additionally, serum irisin levels were determined by ELISA.

Results

Low irisin levels were linked to the presence of plaques (p=0.002) and atherogenic index values ≥4 (p=0.01). Serum irisin were positively correlated with C-peptide levels (p<0.001) and negatively correlated with visual analogue scale and Bath Ankylosing Spondylitis Metrology Index (p<0.05 in all the cases). Moreover, lower irisin levels were observed in patients with sacroiliitis and in those with a negative HLA-B27 status (p<0.001 and p=0.006, respectively), as well as in those treated with non-steroidal anti-inflammatory drugs and conventional disease-modifying antirheumatic drugs (p<0.001 and p=0.002, respectively). Interestingly, the TT genotype and the T allele of rs16835198 were less frequent in axSpA patients with ASDAS >2.1 (Odds Ratio (OR): 0.48 [0.28-0.83] and OR: 0.73 [0.57-0.92], respectively, p=0.01 in both cases). Additionally, the frequency of rs1570569 T allele was higher in these patients (OR: 1.46 [1.08-1.97], p=0.01). Furthermore, the GGGT haplotype was more frequent in patients with ASDAS values >2.1 (OR: 1.73 [1.13-2.66], p=0.01).

Conclusions

Our results indicate that low serum irisin levels could be indicators of the presence of subclinical atherosclerosis, high CV risk and more severe disease in axSpA patients. In addition, irisin may also constitute a genetic biomarker of disease activity in axSpA.

AB0279 HERPES ZOSTER IN RHEUMATOID ARTHRITIS. PROSPECTIVE SINGLE UNIVERSITY CENTER STUDY

Background

Patients with Rheumatoid arthritis (RA) have an increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The risk of herpes zoster (HZ) including disseminated HZ is also increased(1)

Objectives

In an unselected series of RA patientswe assessa)prevalence, b)general features and c) predictive factors of HZ.

Methods

Study of 393 RA patients included in the prospective vaccination program of the Preventive Medicine and Rheumatology department of a University hospital, from October 2011 to October 2016. The minimum follow-up was of 12 months; therefore, it was made until December 2020. HZ vaccination is not included in our vaccination program.

RA was diagnosed according to the ACR/EULAR 2010 criteria. HZ was diagnosed if presented: characteristic skin rash and blisters, paresthesia and local pain, in one (localized) or more dermatomes (generalized).

Information on patients and HZ characteristics was retrieved from the hospital and general physician records.

Results

We studied 393 patients (310 women), mean age 61.5±11.9 years. They were followed-up during a mean period of 82.6±15.2 months(range; 50 months-9 years).

HZ infection was observed in 31 of 393 patients (7.9%) (26 women); mean age 67.5±11.6ys. Prevalence of HZ in this period (122months) was 7.88% with an annual incidence rate of 0.73/100 patients/year. A comparison between patients with and without HZ was performed (Table 1).

Table 1.

Main features of different groups

VariablesRA patientsN= 393RA with HZN=31RA without HZN=362PHZ vs noHZVariables (continued)RA patientsN= 393RA with HZN=31RA without HZN=362PHZ vs noHZAge (years) (men±SD)59.4±12.964.7±11.859.1±12.90.02MTX365 (92.87)29 (93.54)336 (92.81)0.87Sex (women)(%)309(78.62)25 (80.6)284 (78.5)0.95LFN127 (32.31)12 (38.70)115 (31.76)0.42RA Evolution(months) (mean±SD)136.9±109.8155.3±117.0135.30±109.20.33SSZ94 (23.91)7 (22.58)87 (24.03)0.78Hypertension, n(%)165 (42.0)19 (61.3)146 (40.3)0.04Anti-TNFa, n (%)Diabetes Mellitus, n(%)55 (14.0)7 (22.6)48 (13.3)0.24ADA144 (36.6)15 (48.4)129 (35.6)0.22Dislypidemia, n(%)149 (37.9)15 (48.4)134 (37.0)0.29ETN139(35.4)16 (51.6)123 (33.9)0.05RAfeatures, n(%)IFX40 (10.1)5 (16.1)35 (9.7)0.25PositiveRF224 (57.0)17 (54.8)207 (57.2)0.95GLM33 (8.4)3 (9.7)30 (8.3)0.74PositiveACPA207 (52.7)13 (41.9)194 (53.6)0.29CZP13 (3.3)1 (3.2)12 (3.3)0.97Erosions145 (36.9)10 (32.3)135 (37.3)0.71Non anti-TNFa n (%)Subcutaneousnodules22 (5.6)1 (4.6)21 (5.8)0.85TCZ134 (34.1)16 (51.6)118 (32.6)0.05Pulmonary fibrosis20 (5.1)3 (9.7)17 (4.7)0.20RTX69 (17.5)9 (29.0)60 (16.7)0.13Associated Sjögren Syndrome20 (5.1)1 (3.2)19 (5.3)0.95ABA55 (13.9)6 (19.3)49 (13.5)0.41Vasculitis23 (5.9)2 (6.5)21 (5.8)0.7SARI2 (5.1)1 (3.2)1 (0.3)0.03RATreatment, n (%)JAK inhibitors n (%)Prednisone139 (35.4)19 (61.3)120 (33.1)0.04BARI32 (8.14)3 (9.67)29 (8.01)0.73Prednisona>5mg/d13 (3.30)5 (16.1)8 (2.20)0.001TOFA17 (4.32)3 (9.67)14 (3.87)0.14ConventionalDMARDsUPA4 (1.01)1 (3.22)3 (0.83)0.20

HZ locations were intercostal (n=6), dorsal (5), abdominal (3), lumbar (3), facial (3), cervical (1), gluteus (1), submmamary fold (1), intermmamary fold (1) and upper extremity (1). Main HZ complications were post-herpetic neuralgia (n=7), visual alteration in facial HZ (n=1) and disseminated HZ(n=1).

HZ treatment was anitiviral agents (n=23) (brivudine=7; acyclovir 6; famciclovir6; valaciclovir4), topic (n=2) and none (n=6).

Predictive factors for HZ(Figure 1) were older age (>65 years), hypertension and treatment with high prednisone dose and antiTNF.

Figure 1.

Predictive factors for Herpes zoster

Conclusion

HZ is a relative frequent complication of RA. In our series, although are usually localized, post-herpetic neuralgia is relatively frequent. Probably to include HZ vaccine in our vaccination program of RA may be useful.

References

[1]Robert Harrington et al., J Inflamm Res, 2020 14;13:519-531

Disclosure of Interests

None declared

AB0280 SERIOUS INFECTIONS-RELATED HOSPITALIZATION IN RHEUMATOID ARTHRITIS. OBSERVATIONAL STUDY OF 392 PATIENTS FROM A SINGLE UNIVERSITY CENTER

Background

Patients with Rheumatoid Arthritis (RA) have an increased risk of infections. This may belinked to disease-related, the immunosuppressive therapy and the co-morbidities.

Objectives

in an unselected group of RA patients, our aim was to assess the a)incidence b)features of disease and c)predictive factors of serious infections-related hospitalization.

Methods

Observational study of all patients diagnosed with RA that were included in the vaccination program of our university hospital between October2011 and October 2016.The minimum follow-up was of 12 months; therefore, it was made until December 2020.

Patients with serious infections-related hospitalization were a) compared with those not requiring hospital admission and, b)identified predictive factors (multivariate analysis adjusted by age and sex).

Vaccination program in our hospital includes vaccination for Influenza, Streptococcus pneumoniae and Haemophilus influenzae.

Information on patients, infections and hospitalizations was retrieved from the hospital and general physician records.

Results

We studied 392RApatients (309women/83men); mean age 63.1±13.7 years.

After a mean follow-up of 71.8±20.6 months, in 88 of 392patients (22.4%) (60 women) 187serious infections-related hospitalizations were required. The median [IQR] number of hospitalizations were 1.5 [1-2]. The main serious infections were respiratory (44 patients; 78 hospitalizations), urinary (33 patients; 48 hospitalization), cutaneous (19 patients; 28 hospitalizations), abdominal (17 patients, 20 hospitalizations), septic arthritis (7 patients; 8 hospitalizations), maxillofacial(2 patients, 2 hospitalizations), bacterial endocarditis (2 patients, 2 hospitalizations) and genital (1 patient, 1 hospitalization).

Patients with serious infections-related hospitalization were older, with a longer RA, with more co-morbidities (hypertension, hypercholesterolemia diabetes mellitus, and Interstitial lung disease) and with more conventional and biological DMARDS (Table 1).

Table 1.

Comparative study of different groups

Patientswithserious infections-related hospitalization N=88Patients without serious infections-related hospitalization N=304pDemographic features and comorbiditiesAge (years),mean±SD69.7±11.259.2±12.60.005Women, n (%)60 (68.2)249 (81.9)0.33Active smokers, n (%)41 (46.6)114 (7.5)0.32Hypertension, n (%)56 (63.6)109 (35.8)0.004Hypercholesterolemia, n(%)47 (53.4)101 (33.2)0.02Diebetes Mellitus, n(%)25 (28.4)30 (9.9)0.0002RA featuresDuration of RA (months) mean±SD165.8±130.1128.6±102.60.005Positive RF, n (%)52(59.1)171(56.2)0.80Positive ACPA, n (%)48 (54.5)158 (52.6)0.81Erosive disease, n (%)32 (36.4)113 (51.9)0.89Associated Sjögren Syndrome, n (%)4 (4.5)16 (5.3)0.79Interstitial lung disease n (%)11 (12.5)9 (2.9)0.0008Subcutaneousnodules n (%)6 (6.8)16 (5.3)0.57Prednisone (or equivalent) dose mg/day, mean±SD5.3±4.53.3±3.80.001Number of convencional DMARDs, mean±SD1.9±1.41.5±1.30.05Number of biologic DMARDs, mean±SD0.1±0.20.1±0.40.03Number of JAK inhibitors, mean±SD69.7±11.259.2±12.60.1

The predictive factors for hospitalization were hypertension and Diabetes Mellitus, RA related interstitial lung disease and treatment with biologic DMARDs. (Figure 1)

Figure 1.

Predictive factors for serious infections-related hospitalization

Conclusion

Despite to be included in a vaccination program up to 22% of patients required hospitalization due to serious infection. The main predictive factors were co-morbidities, interstitial lung disease and treatment with biologic DMARDs. Serious infections in RA remain to be an unmet need.

Disclosure of Interests

None declared

POS0537 MORTALITY IN RHEUMATOID ARTHRITIS: CHANGING CAUSES AND PREDICTIVE FACTORS. STUDY OF A COHORT FOLLOWED PROSPECTIVELY

Background

Patients with Rheumatoid Arthritis (RA) present an increased risk of mortality. In the last decades, mortality rates tended to decrease but cardiovascular (CV) events remained as the leading cause of death in most series (1).

Objectives

To assess mortality rates and leading causes of death, as well as predictors of mortality related to disease activity in a prospectively followed-up cohort of RA patients.

Methods

We conducted a prospective longitudinal study that included 673 RA patients from a single tertiary center. Univariate and multivariate Cox proportional hazards regression were used to identify predictors of mortality.

Results

We studied 673 patients with RA (75% women), mean age 61±13 years. The main general characteristics, CV risk factors, RA disease activity data and current treatment are summarized in the Table 1.

Table 1.

Baseline characteristics of 673 RA patients

Age, years, (mean±sd)61 ± 13Female/Male, n (%)505 (75) /168 (25)Past or Current smoker, n (%)338 (50)Obesity, n (%)226 (34)Hypertension, n (%)310 (46)Diabetes Mellitus, n (%)85 (13)Dyslipidemia, n (%)310 (46)BMI, kg/m2 (mean±sd)28 ± 6Abdominal circumference, cm (mean±sd)97 ± 15Total/HDL/LDL cholesterol, mg/dl (mean±sd)204±38/62±18/120 ± 31Disease duration, years (median, [IQR])13 [10-20]CRP, mg/l (median, [IQR])3.0 [0.8-7.0]ESR, mm/ 1º hour (median, [IQR])12 [5-21]Rheumatoid factor/ ACPA, n (%)376 (56) / 314 (48)DAS28-ESR/ DAS28-PCR (mean±sd)3.18 ± 1.41/3.00 ± 1.23NSAIDs / Prednisone, n (%)265 (39) /341 (51)Prednisone dose, mg/day (median, [IQR])5 (2.5-5)c-DMARDS: Metotrexate/ Leflunomide/ Hydroxychloroquine/ Salazopyrin, n (%)406 (60) /52 (8) / 178 (26) / 10 (1)b-DMARDS: TNFi/ Tocilizumab/ Rituximab/ Abatacept, n (%)88 (13) / 43 (6) / 13 (2) / 8 (1)JAK inhibitors, n (%)12 (2)

After a follow-up of 4,367 person-years (mean 6.4±1.4), 67 deaths were recorded. Considering all causes of mortality, the cumulative incidence was 14% (95% CI 11-18) with a mortality incidence rate of 0.015 (95% CI 0.012-0.020) patient/year. The main causes of mortality in decreasing order of frequency were infections (N=23) (34%), incidence rate-IR: 0.005 [95% CI 0.003-0.008]), cancer (N=18) (27%), IR: 0.004 [95% CI 0.002-0.007]), CV events (N= 12) (18%), IR: 0.003 [95% CI 0.001-0.005]), respiratory diseases (N=2) (3%), IR: 0.0005 [95% CI 0.00007-0.002] and other causes (N=12) (18%), IR: 0.003 [95% CI 0.001-0.005I].

The statistically significant predictive factors of mortality in the univariate analysis were male gender (HR 1.97[95%CI 1.20-3.21, p=0.007), abdominal circumference (HR 1.03 [95% CI 1.01-1.05], p=0,0006), diabetes (HR 2.85 [95%CI 1.68-4.86], p<0.001) and hypertension (HR 2.92 [95%CI 1.73-4.94], p<0.001). Also, baseline data of variables associated with disease activity such as increased CRP, ESR, DAS28-CRP, DAS28-ESR were predictors of mortality (Figure 1). Disease related parameters were adjusted by CV risk factors in a multivariate analysis. Following this procedure, the predictive factors that reached statistical significance; (Hazard Ratio [95%CI]), were an increased in DAS28-VSG (1.40 [1.07-1.83], p=0.016), DAS- 28-PCR (1.40 [1.07-1.83], p=0.016), CRP (1.02 [1.01-1.05] p=0.002), and ESR (1.03 [1.01- 1.05], p=<0.001) (Figure 1).

Figure 1.

Forest Plot of mortality (Univariate and multivariate analysis).

Results expressed in logarithmic scale. Multivariate analysis: Disease activity related parameters adjusted by age, gender, disease duration, smoker, diabetes, hypertension and abdominal circumference. CDAI, ESR and CPR expressed value/10. (*) p<0.05.

Conclusion

In a cohort of patients with RA followed prospectively in a tertiary hospital, infections and malignancies are the main cause of mortality rather than CV events. Disease activity parameters are associated with an increased risk of mortality in these patients with RA.

References

[1]Avina-Zubieta JA et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008,59:1690–97.

Disclosure of Interests

None declared.

POS0623 SUBCLINICAL ATHEROSCLEROSIS IS NOT RELATED WITH ACID URIC IN RHEUMATOID ARTHRITIS. STUDY OF 1005 PATIENTS OF A SINGLE UNIVERSITY HOSPITAL

Background

Rheumatoid Arthritis (RA) and Gout are associated with an increase of cardiovascular (CV) disease (1,2). Carotid plaques and increased carotid intima-media thickness (cIMT) are surrogate markers of CV mortality (3). The association of serum uric acid (SUA) levels as an independent factor of subclinical Atherosclerosis and mortality in RA remains not fully clarified (4,5).

Objectives

In a wide cohort of patients with RA our aims were to assess the relationship of SUA with a) CV risk factors and b) presence of atherosclerosis.

Methods

Cross-sectional study including 1005 patients with RA from a Single University Center. The presence of Atherosclerosis (c-IMT and carotid plaque) was explored by Carotid Ultrasonography. The relationship between SUA and markers of subclinical atherosclerosis was studied through linear regression and logistic multivariate analysis.

Results

We studied 1005 RA patients (741 women, 74%), mean age 61±13. The main general features, CV risks factors, RA activity data and current therapy are summarized in Table 1.

Table 1.

Main features of 1005 RA patients

GENERAL FEATURESRESULTSGENERAL FEATURES (CONTINUATION)RESULTS (CONTINUATION) Age, years, mean±SD60±13RA features Female/ Male, n (%)741 (74) / 264 (26)RA duration, years; mean±SD17±12CRP, mg/L, median, [IQR]3.0 [0.9-7.5]CV risk factorsESR, mm/ 1st hour; median, [IQR]14 [6-24] Past or Current smoker, n (%)539 (54)Rheumatoid factor, n (%)528 (53) Obesity/ Dyslipidemia, n (%)307 (31)/ 560 (56)ACPA, n (%)492 (50) Hypertension, n (%)453 (45)DAS28-ESR; mean±SD3.3 ± 1.5 Diabetes Mellitus, n (%)127 (13)DAS28-CRP; mean±SD3.1 ± 1.3 BMI, kg/m2, mean±SD28±5/93±15Uric acid Abdominal circumference cm;  mean±SDUric acid level (mg/dl); mean±SD4.8 ± 1.4 Previous CV Events, n (%)125 (12) Chronic Kidney Disease,  n (%)58 (6)Carotid Ultrasonography Gout / using drugs for  hyperuricemia; n (%)20 (2)cIMT microns; mean±SD708 ± 157 Total cholesterol, mg/dl;  mean±SD201±39Carotid plaque¸ n (%)617 (62) HDL cholesterol, mg/dl;  mean±SD61±17 LDL cholesterol, mg/dl;  mean±SD119 ± 32

Abbreviations: ACPA: Anti–citrullinated protein antibody; BMI: Body mass index; CV: Cardiovascular; cIMT: carotid intima-media thickness; cm: centimeter; CRP: C Reactive protein; DAS28-ESR: Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate; DAS28-PCR: Disease Activity Score-28 for Rheumatoid Arthritis with C reactive protein; dl: deciliter; ESR: Erythrocyte Sedimentation Rate; HDL: high-density lipoprotein; IQR: Interquartile range; Kg: kilogram; LDL: Low-density lipoprotein; mg: milligram; m2: square meter; n: number; RA: Rheumatoid Arthritis; SD: Standard Deviation.

SUA as a dependent variable was significantly correlated with age, male gender and most of CV risk factors (body mass index, abdominal circumference and obesity) (single-variable analysis). Similarly, a significative beta coef. [95%CI] positive relationship with SUA was observed with hypertension (0.7 [0.5-0.8], p<0.001), diabetes (0.5 [0.2-0.7], p<0.001), dyslipidemia (0.2 [0.04-0.4], p=0.016), renal chronic insufficiency (1.5 [95CI 1.1-0.8], p<0.001) and previous CV events (0.8 [0.4-1.2], p<0.001).

Subclinical Atherosclerosis, as dependent variable, was significantly correlated with SUA (single-variable analysis). In addition, SUA showed a positive significative beta coef. [95%CI] relationship with cIMT (18 [12-25], p<0.001) and the presence of carotid plaques (1.29 [17-1.42], p<0.001). However, statistical significance was not observed in the multivariable analysis adjusted by Classic CV Risk Factors.

Conclusion

In RA, SUA is related with most of CV risk factors. However, SUA is not associated with Subclinical Atherosclerosis.

References

[1]Aviña-Zubieta JA, et al. Arthritis Rheum. 2008,15;59:1690-7.

[2]Klein R, et al. Arch Intern Med 1973, 132:401–410.

[3]de Groot E, et al. Circulation, 2004,109:33–38.

[4]Lauren Shahin, et al Cureus 2021. 5; 13.:e14855.

[5]Chiou A, et al. Arthritis Care Res (Hoboken). 2020, 72:950-958.

Disclosure of Interests

None declared

POS0327 IRISIN: A NEW MARKER OF SUBCLINICAL ATHEROSCLEROSIS, CARDIOVASCULAR RISK AND DISEASE ACTIVITY IN AXIAL SPONDYLOARTHRITIS?

Background

Axial spondyloarthritis (axSpA) is an inflammatory disease with detrimental effects on the health status of the individuals affected by this condition [1]. axSpA patients also exhibit high cardiovascular (CV) risk, mainly due to accelerated atherosclerosis [2]. Interestingly, the adipomyokine irisin was described to play a beneficial role in several physiological and pathophysiological processes such as inflammation, angiogenesis, oxidative stress, as well as lipid and bone metabolism [3]. However, studies on the role of irisin in CV risk in the setting of axSpA or in the pathogenesis of axSpA are limited [4].

Objectives

In this study we evaluated the role of irisin as a genetic and serological biomarker of subclinical atherosclerosis and CV risk in a large cohort of patients with axSpA. We also assessed its role as a marker of axSpA susceptibility and severity.

Methods

725 patients who fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axSpA were included in this study [5]. In these patients, the presence of subclinical atherosclerosis (plaques and/or abnormal carotid intima-media thickness values) was assessed by carotid ultrasound. Four irisin polymorphisms (rs16835198 G/T, rs3480 A/G, rs726344 G/A and rs1570569 G/T) were genotyped by TaqMan probes in all the patients and in 656 age, sex and ethnically-matched healthy controls. Additionally, serum irisin levels were determined by ELISA in all the patients. All analyses were performed using STATA v.11.1 statistical software, adjusting for potential confounding factors. The strength of associations is indicated as odds ratios (OR) [95% confidence intervals].

Results

Low levels of serum irisin were linked to the presence of plaques (p=0.002) and with atherogenic index values indicative of an adverse lipid profile (p=0.01). Serum irisin levels also negatively correlated with visual analogue scale (VAS) patient, VAS physician and Bath Ankylosing Spondylitis Metrology Index (BASMI) values (p<0.05). Moreover, the presence of sacroiliitis was related to lower serum irisin levels (p<0.001). Furthermore, the minor alleles of rs3480 (G) and rs1570569 (T) were associated with higher values of Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA patients (p≤0.01 in both cases). In this line, the frequency of the minor allele of rs1570569 (T) was higher in patients with ASDAS values >2.1 (indicative of high disease activity) (OR: 1.46 [1.08-1.97], p=0.01), while the minor allele of rs16835198 (T) was less frequent in this group of patients (OR: 0.73 [0.57-0.92], p=0.01).

Conclusion

Low serum irisin levels could be indicators of the presence of subclinical atherosclerosis, high CV risk and more severe disease in axSpA patients. In addition, irisin may also constitute a genetic biomarker of disease activity in axSpA.

References

[1]Packham J. Rheumatology (Oxford). 2018;57(6):vi29-vi34.

[2]Szabo SM, et al. Arthritis Rheum. 2011;63(11):3294–304.

[3]Korta P, et al. Medicina (Kaunas). 2019;55(8):485.

[4]Nam B, et al. Ann Rheum Dis. 2020;79:1358.

[5]Sieper J, et al. Ann Rheum Dis. 2009;68(2):ii1–44.

Acknowledgements

This work was partially supported by grants from Instituto de Investigación Sanitaria IDIVAL (NVAL17/10), from the `Asociación Cántabra de Reumatología’ awarded to FG. FG and JR-G are beneficiaries of a grant funded by `Instituto de Salud Carlos III´ (ISCIII) (PI20/00059). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from ISCIII, co-funded by the European Regional Development Fund. VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01). RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future´ (grant CP16/00033).

Disclosure of Interests

Sara Remuzgo-Martínez: None declared, Javier Rueda-Gotor: None declared, Verónica Pulito-Cueto: None declared, Raquel López-Mejías: None declared, Alfonso Corrales: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Virginia Portilla: None declared, Iñigo Gonzalez-Mazon: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Rosa Expósito: None declared, Cristina Mata: None declared, Javier Llorca: None declared, Vanessa Hernández-Hernández: None declared, Carlos Rodríguez-Lozano: None declared, Nuria Barbarroja Puerto: None declared, Rafaela Ortega Castro: None declared, Esther F. Vicente-Rabaneda: None declared, Cristina Fernández-Carballido: None declared, Maria Paz Martínez-Vidal: None declared, David Castro-Corredor: None declared, Joaquín Anino-Fernández: None declared, Diana Peiteado: None declared, Chamaida Plasencia: None declared, E Galindez: None declared, María L. García Vivar: None declared, Nuria Vegas-Revenga: None declared, Irati Urionaguena: None declared, Oreste Gualillo: None declared, Juan Carlos Quevedo-Abeledo: None declared, Santos Castañeda: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche, Fernanda Genre: None declared

Intravenous methylprednisolone induces rapid improvement in non-infectious uveitis: a multicentre study of 112 patients

OBJECTIVES

Rapid control of intraocular inflammation in non-infectious uveitis (NIU) is mandatory to avoid irreversible structural and functional damage. In this study, we assessed the efficacy and safety of intravenous methylprednisolone (IVMP) pulses in the treatment of NIU.

METHODS

A retrospective case series of 112 patients who received IVMP for the treatment of NIU, either isolated or associated with different underlying diseases, was studied. Intraocular inflammation (anterior chamber cells and vitritis) was the primary outcome measure. Secondary outcome measures were macular thickness and best corrected visual acuity (BCVA). Patients were assessed at baseline visit, and at days 2-5, 7, 15 and 30 after initiation of IVMP pulse therapy.

RESULTS

A total of 112 patients (mean age 42±14.5 yrs) were assessed. An underlying immune-mediated disease was diagnosed in 73 patients. Inflammatory ocular patterns were panuveitis (n=68), posterior uveitis (n=30), anterior uveitis (AU) (n=12), and intermediate uveitis (n=2). Additionally, patients presented cystoid macular oedema (CME) (n=50), retinal vasculitis (n=37), and exudative retinal detachment (n=31). Therapies used before IVMP included intraocular glucocorticoids (n=4), high-dose oral systemic glucocorticoids (n=77), and conventional (n=107) or biologic (n=40) immunosuppressive drugs. IVMP dose ranged from 80 to 1,000 mg/day for 3-5 consecutive days. Improvement was observed in AU, vitritis, BCVA, CME, and retinal vasculitis. At first month evaluation, total remission was achieved in 19 patients. Side effects of IVMP were respiratory infections (n=3), uncontrolled hyperglycaemia (n=1), herpes zoster (n=1), and oral candidiasis (n=1).

CONCLUSIONS

IVMP pulse therapy was effective and safe, and achieved rapid control of NIU.

SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD.

Moderate and High Disease Activity Predicts the Development of Carotid Plaque in Rheumatoid Arthritis Patients without Classic Cardiovascular Risk Factors: Six Years Follow-Up Study

Patients with rheumatoid arthritis (RA) have a higher incidence of subclinical atherosclerosis and cardiovascular (CV) disease. It is postulated that the appearance of accelerated atherosclerosis in these patients is a consequence of the inflammation present in the disease. In this study, we aim to determine if baseline disease activity in patients with RA predicts the future development of carotid plaque. A set of consecutive RA patients without a history of CV events, cancer or chronic kidney disease, who did not show carotid plaque in a carotid ultrasound assessment, were prospectively followed up for at least 5 years. At the time of recruitment, CV risk factors and disease-related data, including disease activity scores, were assessed. At the end of the follow-up, a carotid ultrasound was repeated and patients were divided into two groups; those who developed carotid plaque, and those who did not. A multivariable regression analysis was performed to define the predictors for the development of carotid plaque. One hundred and sixty patients with RA were followed up for an average of 6 ± 1 years. After this time, 66 (41%) of the patients had developed carotid plaque, and 94 (59%) did not. Patients with carotid plaque were significantly older (47 ± 13 vs. 55 ± 9 years, p < 0.001) at baseline, were more frequently diabetic (0% vs. 6%, p = 0.028), and had higher total cholesterol (197 ± 36 vs. 214 ± 40 mg/dL, p = 0.004) and LDL cholesterol (114 ± 35 vs. 126 ± 35 mg/dL, p = 0.037) at the beginning of the study. After multivariable adjustment, patients who were in the moderate and high disease activity (DAS28-CRP) categories displayed a higher odds ratio for the appearance of carotid plaque (OR 2.26 [95% CI 1.02-5.00], p = 0.044) compared to those in the DAS-28-CRP remission category. Remarkably, when patients were divided in patients within the low-risk SCORE category, and patients included in the remaining SCORE categories (moderate, high and very high), the relation between DAS28-CRP and the development of carotid plaque was only significant in the low-risk SCORE category. In conclusion, disease activity predicts the future development of subclinical atherosclerosis in patients with RA.

Combined use of QRISK3 and SCORE as predictors of carotid plaques in patients with rheumatoid arthritis

OBJECTIVE

Because carotid plaques predict the development of cardiovascular events in RA, we aimed to assess if the combined use of the systematic coronary risk evaluation (SCORE) and the QRISK3 algorithms allows for the identification of RA patients with carotid plaques in a defined population-based RA inception cohort.

METHODS

A set of consecutive RA patients without a history of diabetes, chronic kidney disease or cardiovascular events were studied by carotid US between 2012 and 2019. Modified SCORE (mSCORE) for RA based on the 2015/2016 updated EULAR recommendations and QRISK3 algorithms were retrospectively tested using baseline data obtained at the time of the carotid US assessment.

RESULTS

A total of 466 (54%) of 865 patients had carotid plaques. Using dichotomized QRISK3 and EULAR mSCORE, 73.2% (95% CI: 68.4.8, 77.6) of patients with QRISK ≥ 10% and EULAR mSCORE < 5% had plaque. In this group, the diagnostic odds ratio was 5.79 (95% CI: 4.14, 8.10). However, if both algorithms were above their thresholds of high cardiovascular risk (QRISK ≥ 10% and EULAR mSCORE ≥ 5%), the sensitivity increased up to 83.3% (95% CI: 72.1, 91.4) and the diagnostic odds ratio up to 10.6 (95% CI: 5.13, 22.0). When the risk charts scales were used as continuous variables, both QRISK3 and EULAR mSCORE were found positively associated with plaque. For each 1% QRISK3 or EULAR mSCORE increase, the probability of having plaques multiplied by 1.14 and 1.22, respectively. However, the effects of both algorithms did not multiply by each other.

CONCLUSIONS

. The combined use of QRISK3 and EULAR mSCORE allows for the identification of most RA patients at high risk of carotid plaques.

Disease activity influences the reclassification of rheumatoid arthritis into very high cardiovascular risk

BACKGROUND

Previous studies have shown that risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the actual cardiovascular (CV) risk of patients with rheumatoid arthritis (RA). In contrast, carotid ultrasound was found to be useful to identify RA patients at high CV. In the present study, we aimed to determine if specific disease features influence the CV risk reclassification of RA patients assessed by SCORE risk charts and carotid ultrasound.

METHODS

1279 RA patients without previous CV events, diabetes, or chronic kidney disease were studied. Disease characteristics including disease activity scores, CV comorbidity, SCORE calculation, and the presence of carotid plaque by carotid ultrasound were assessed. A multivariable regression analysis was performed to evaluate if the reclassification into very high CV risk category was independently associated with specific features of the disease including disease activity. Additionally, a prediction model for reclassification was constructed in RA patients.

RESULTS

After carotid ultrasound assessments, 54% of the patients had carotid plaque and consequently fulfilled definition for very high CV risk. Disease activity was statistically significantly associated with reclassification after fully multivariable analysis. A predictive model containing the presence of dyslipidemia and hypertension, an age exceeding 54 years, and a DAS28-ESR score equal or higher than 2.6 yielded the highest discrimination for reclassification.

CONCLUSION

Reclassification into very high CV risk after carotid ultrasound assessment occurs in more than the half of patients with RA. This reclassification can be independently explained by the activity of the disease.

POS1467-HPR SEVERE RESPIRATORY INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS WITH BIOLOGIC THERAPY. COMPARATIVE STUDY BETWEEN VACCINATED AND NON VACCINATED PATIENTS

Background:

Rheumatoid arthritis (RA) patients are at increased risk of severe infections due to the disease itself, and the immunosuppressive treatment. Vaccination programs are designed to decrease the risk of infections.

Objectives:

In patients with RA treated with biologic therapy (BT) our aim was to assess a) the incidence of severe respiratory infections and b) to compare the risk between vaccinated and non vaccinated patients.

Methods:

Observational study of 431 patients diagnosed with RA that iniciated BT. One group of patients participated in a vaccination program from October 2011 to October 2016 (Group 1). The other group was not included in the vaccination program (Group 2). The follow-up was made until June 2017 with a minimum follow-up period of 8 months and a maximum of 5.5 years.

Information on severe respiratory infections, defined as those that required hospitalization or at least one dose of intravenous antibiotic treatment at the emergency room, was retrieved from the hospital medical records.

Results:

We studied 431 patients (335 women/96 men); mean age 63.4±13.7 years. In the vaccination program (group 1) were included 299 (69.37%) patients and in the group 2 132 patients (30.63%). The main features of both groups are summarized in Table 1.

During the follow-up, we registered 299 hospital admissions due to severe respiratory infections in both groups (incidence density 9.9 (95% CI: 6.9-13.6).

In group 1, vaccinated patients, this incidence density was reduced to 7.1 (95% CI: 4.1-11.6). Figure 1.

The vaccination program reduced the general incidence of severe respiratory infection in 44%.

Conclusion:

RA patients with BT included in the vaccination program present a lower incidence of severe respiratory infections compared with non vaccinated patients.

Table 1.

Main general features at BT onset

Group 1Vaccination programN=299Group 2Non vaccination programN=132pAge (years) mean±SD61.32±13.0467.97±14.170.32Women, n (%)231 (77.3%)105 (79.5%)0.59Duration of RA (months) mean±SD73.24±10.4112.62±60.2Positive RF/ Positive ACPA, n (%)177(59.2)/172 (57.52%)93(70.5%)98 (74.24%)0.02/0,01Erosive disease, n (%)116 (38.8%)70 (53%)0.06Vasculitis, n (%)15 (5%)2 (1.5%)0.08Interstitial lung disease n (%)12 (4%)7 (5.3%)0.54Subcutaneous nodules n (%)16 (5.4%)6 (4.5%)0.72Corticosteroids299 (100%)132 (100%)1Number of conventional DMARDs, mean±SD1.66±0.892.03±1.050.3Figure 1.

Disclosure of Interests:

None declared

POS0533 EFFECT OF CAROTID ULTRASOUND ON THE ACHIEVEMENT OF LDL-CHOLESTEROL TARGETS IN THE ROUTINE CLINICAL CARE OF PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is substantially elevated compared to the general population. In RA, as in the general population, CVD control includes the detection and treatment of CV risk factors based, among others, on blood pressure, smoking, diabetes, and lipid profiles. Little is known about the real impact of the use of carotid ultrasound in the prevention of CVD in patients with RA.

Objectives:

To determine whether the use of carotid ultrasound in the routine clinical care of patients with RA can improve the achievement of LDL-cholesterol targets over time.

Methods:

We conducted a retrospective, real-world study of 327 RA patients in which a carotid ultrasound was performed as part of routine clinical care. Participants were followed from 2012 to 2018. LDL-c levels were measured before and after the carotid ultrasound intervention. The achievement of the LDL-c goals recommended by the international guidelines was compared before and after the carotid ultrasound. Predictive factors of achievement of LDL-cholesterol targets were studied.

Results:

When considering the 2010 EULAR RA SCORE risk categories, serum LDL-c levels in the moderate CV risk category was significantly lower when follow-up finished (126 ± 33 to 109 ± 29 mg/dl, p=0.000) (Table 1). This was not the case for other CV risk categories. Similarly, LDL-c goal attainment in the moderate CV risk category was significant higher at the end of the study compared to baseline. Based on the 2016 European Society of Cardiology LDL-c targets, the achievement of a LDL-cholesterol inferior to 115 mg/dl for the moderate CV risk category significantly increased from 35 to 64% (p=0.000) after follow-up. However, significant changes were not observed in this regard for the low, high, and very-high CV risk categories.

Table 1.

LDL cholesterol serum levels and LDL goals differences between baseline and final follow-up

LDL, mg/dlLDL (mg/dl) ESC 2016 goalsn%BaselineFinal follow-upGoalBaselineFinal follow-upp2010 EULAR RA SCORELow12037116 ± 37119 ± 320.081< 13068%66%0.99Moderate19560126 ± 33109 ± 290.000< 11535%64%0.000High72121 ± 26104 ± 220.14< 10014%33%0.99Very High50131 ± 41115 ± 460.080< 700%20%0.99

ESC: European Society of Cardiology; EULAR: European League Against Rheumatism. SCORE: Systematic COronary Risk Evaluation; RA: Rheumatoid Arthritis; LDL: low-density lipoprotein. Significant ‘p’ value are depicted in bold.

When patients with RA, regardless the SCORE risk they had, were divided between those that attained LDL-cholesterol target or not, those that achieved their LDL goal, were more frequently female and had less diabetes mellitus. Moreover, the probability of achieving LDL-cholesterol goal was higher in those with an inferior total cholesterol, LDL-c and atherogenic index at baseline. Interestingly, no differences were observed in both populations regarding the baseline use of statins, aspirin or hypertension treatment at baseline. Concerning disease related data when study started, no differences about disease duration and activity or treatments were observed between dose that reached LDL-cholesterol goal and those that did not.

Those that achieved LDL-c objectives had a higher decrease in smoking quit and a superior control of hypertension. Besides, in those that attained objectives a superior increase in statins prescription was observed (36% vs. 13%, p=0.000), as well in hypertension and aspirin treatment. However, no differences were noticed in the changes in disease-related data that occur during the time the study was carried out.

Conclusion:

This real-world study demonstrates that incorporating carotid ultrasound into routine clinical practice in RA patients is effective in achieving LDL-cholesterol targets for the prevention of cardiovascular disease. This effect is not only mediated by the increase in the prescription of statins, but also by the better control of other cardiovascular risk factors that occurred after carotid ultrasound evaluation.

Disclosure of Interests:

None declared

AB0771 HIGH DOSE INTRAVENOUS METHYLPREDNISOLONE INDUCES RAPID IMPROVEMENT OF VISUAL ACUITY IN NON-INFECTIOUS UVEITIS OF DIFFERENT IMMUNE MEDIATED INFLAMMATORY DISEASES

Background:

Rapid and effective remission-inducing therapy is mandatory in uveitis to avoid irreversible structural and functional damage. In some severe cases biological agents might be required (1-6).

High-dose intravenous methylprednisolone (IVMP) may achieve prompt control of inflammation in most immune mediated inflammatory diseases (IMID), including non-infectious uveitis (NIU).

Objectives:

To evaluate the efficacy and safety of IVMP pulse therapy in NIU of different IMID.

Methods:

Multicentre study of 71 patients with severe uveitis who received IVMP. The underlying diseases were: Vogt Koyanagy Harada disease (VKHD) (n=24), Behçet disease (BD) (19), Sarcoidosis (5) and idiopathic NIU (23). The main outcome variable was Best-Corrected Visual Acuity (BCVA) estimated using the Snellen chart. BCVA that was assessed at 0 (basal), 2-5, 7, 15 and 30 days after IVMP.

The results are expressed as mean ±SD in normally distributed variables, or as median [IQR] when are not. Comparison of continuous variables was performed using the Wilcoxon test.

Results:

We studied 46♀/ 25♂ patients. The main features are shown in Table 1. IVMP dose ranged from 250 to 1000 mg/day administered for 3-5 consecutive days, the dose was established according to the presence or not of other systemic manifestations apart from uveitis. All of them had active intraocular inflammation at the moment of the study. BCVA values improved considerably after 1 month (Figure 1). No major side effects were observed.

Figure 1.

Improvement of best corrected visual acuity (BCVA).

Conclusion:

High-dose IVMP pulse therapy is useful and safe for a prompt control of BCVA regardless of the underlying IMID.

References:

[1]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019

[2]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7. PMID: 25005576

[3]Santos-Gómez M, et al. Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359

[4]Atienza-Mateo B, et al. Rheumatology (Oxford) 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480.

[5]Atienza-Mateo B, et al. Arthritis Rheumatol. 2019; 71(12):2081-2089. doi: 10.1002/art.41026.

[6]Martín-Varillas JL, et al. Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020

Table 1.

Main features of 71 patients with NIU. Data are of affected eyes.

VKHD(n=24)Idiophatic(n=23)Behcet’s disease (n=19)Sarcoidosis(n=5)Overall(n=71)Men/Women, n5/199/149/102/371Mean age (years) ±SD42 ±1147 ± 1533±1042 ± 22-Unilateral/Bilateral NIU, n (%)2 (8.3)/22(91.7)10 (43.5)/13(56.5)4 (21)/15 (79)3(60)/2(40)19/52NIU patterns, n (%) Posterior uveitis6 (25)9 (39.1)3 (15.8)1 (20)19 Panuveitis18 (75)14 (60.9)16 (84.2)4 (80)52Laboratory data, n (%) ANA2 (8.34)2 (8.7)0 (0)1 (20)5 HLA B270 (0)4 (17.4)0 (0)0 (0)4 HLA B290 (0)1 (4.3)0 (0)0 (0)1 HLA B510 (0)5 (21.7)8 (42)3 (60)16 Angiotensin Converting Enzyme (ACE)1 (4.17)2 (8.7)0 (0)1 (20)4

Disclosure of Interests:

None declared

Long-term Follow-up and Optimization of Infliximab in Refractory Uveitis Due to Behçet Disease: National Study of 103 White Patients

OBJECTIVE

In a large series of White patients with refractory uveitis due to Behçet disease (BD) being treated with infliximab (IFX), we assessed (1) long-term efficacy and safety of IFX, and (2) IFX optimization when ocular remission was achieved.

METHODS

Our multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressant agents treated 103 patients/185 affected eyes with IFX as first biologic therapy in the following intervals: 3-5 mg/kg intravenous at 0, 2, 6, and then every 4-8 weeks. The main outcome variables were analyzed at baseline, first week, first month, sixth month, first year, and second year of IFX therapy. After remission, based on a shared decision between patient and clinician, IFX optimization was performed. Efficacy, safety, and cost of IFX therapy were evaluated.

RESULTS

In the whole series (n = 103), main outcome variables showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Serious adverse events were observed in 9 patients: infusion reactions (n = 4), tuberculosis (n = 1), Mycobacterium avium pneumonia (n = 1), severe oral ulcers (n = 1), palmoplantar psoriasis (n = 1), and colon carcinoma (n = 1). In the optimization subanalysis, the comparative study between optimized and nonoptimized groups showed (1) no differences in clinical characteristics at baseline, (2) similar maintained improvement in most ocular outcomes, (3) lower severe adverse events, and (4) lower mean IFX costs in the optimized group (€4826.52 vs €9854.13 per patient/yr).

CONCLUSION

IFX seems to be effective and relatively safe in White patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective.

AB0242 SURVIVAL ANALYSIS IN THE DEVELOPMENT OF SERIOUS INFECTIONS AND SERIOUS RESPIRATORY INFECTIONS IN AR PATIENTS INCLUDED IN A VACCINATION PROGRAM

Background:

Rheumatoid arthritis is an autoimmune disorder in which patients have an increased risk of developement of serious infections. This risk may be augmented due to RA itself and to immunosuppressive drugs, specially biologic therapy. Vaccination programs may change this condition.

Objectives:

Our aim in this study was to evaluate the incidence of serious infections in a vaccinate RA patients cohort.

Methods:

Prospective study of 401 patients diagnosed with RA who were invited to participate in the vaccination program of the Preventive Medicine department of our hospital from October 2011 to October 2016. The follow up was made until June 2017 with a minimun follow-up period of 8 months and maximun of 5.5 years. Serious infections were defined as those that required hospitalization or at least one dose of intravenous antibiotic treatement at emergency room. Information was retrieved from dthe hospital records.

Only 7 patients refused vaccination (2%). Information was not obtained in 4 of the remaining 394 patients. Therefore, these 4 patients were not incuded in the assessment.

Survival análisis was assessed by Kaplan-Meier method.

Results:

We finally studied 390 patients (307♀/83♂) mean age±SD 61,28 ± 12,9 years that participate in the vaccination program and followed-up. The main features at the time of vaccination were: median disease duration (4years), positive rheumatoid factor (56,7%), subcutaneous nodules (4.9%), erosive arthritis (36.9%), pulmonary fibrosis (3.8%), secondary Sjögren syndrome (5.1%), other extraartocular manifestations (14.6%) and rheumatoid vasculitis (5.6%) Most patients had received imunosuppressive drugs before the vaccination program. The most frequently used were systemic corticosteroids (n=228), methotrexate (n=362) and biologic agents (40.3%).

During the follow-up, 42 patients (10.7%) had required hospital admissions due to infections, 17 of them were severe respiratory infections (4.35%). The remaining 25 admissions were in the setting of urinary tract infections (n=12), intraabdominal infections (7), skin and soft tissues (12) and articular (1). Also 12 of these patients had a zoster herpes.

Afeter a median follow-up of 1061,89 ± 417 days, the incidence of serious infection, with a CI (95%), was 4.00 (2.95-5.41) for 100 patients yearly. Concerning to admissions due to serious respiratory infections, with a CI (95%), was 1.55 (0.9-2.47) for 100 patients yearly.Images 1 and 2.

Image 1.

Survival analysis on serious infections

Image 1.

Survival analysis on serious respiratory infections

Conclusion:

In this stydy we can concluded that our RA vaccinated patients present a dicrease of the incidence of serious infeccions, similar to other published cohorts. The incidence of serious respiratory infections shows a dicrease even lower to other published cohorts. The vaccination program seems to be effective to prevent hospital admissions due to infections.

Disclosure of Interests:

Lucia Domínguez: None declared, Paz Rodriguez Cundin: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Nuria Vegas-Revenga Grant/research support from: AbbVie, Roche, Pfizer, Lilly, Gebro Pharma, MSD, Novartis, Bristol-Myers, Janssen, and Celgene, Virginia Portilla: None declared, Francisco Manuel Antolin-Juarez: None declared, Maria Henar Rebollo Rodriguez: None declared, Alfonso Corrales Speakers bureau: Abbvie, Natalia Palmou-Fontana: None declared, D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

Carotid plaques as predictors of cardiovascular events in patients with Rheumatoid Arthritis. Results from a 5-year-prospective follow-up study

OBJECTIVE

To investigate if the Systematic Coronary Risk Evaluation (SCORE) and the QRISK3 algorithms as well as the carotid ultrasound are useful predictors of cardiovascular (CV) events and death in a prospectively defined population-based rheumatoid arthritis (RA) inception cohort.

METHODS

A set of 327 consecutive RA patients without history of diabetes, chronic kidney disease or CV events were studied by carotid ultrasound between 2012 and 2013. At that time, CV risk was calculated according to the modified EULAR systematic coronary risk evaluation (mSCORE) for RA. A five-year prospective follow-up study was conducted by survival analysis models. The EULAR mSCORE based on the 2015/2016 updated EULAR recommendations and the QRISK3 algorithms were retrospectively tested using baseline data.

RESULTS

After 1,984.25 patient-years of follow-up, 23 had died and 27 had experienced CV events. Linearized mortality rate was 1.16/100 patient-years (95% confidence interval [CI]: 0.74--1.73). Adjusting for age, gender and disease duration, a model with carotid plaques (Hazard ratio [HR]: 6.10 [95% CI:0.74--50.0]; p = 0.09) and another model with carotid plaques and QRISK3 (HR for carotid plaques: 6.12 [95% CI: 0.74--50.5]; p = 0.09 and HR for each 1% in QRISK3: 1.03 [95% CI: 0.99--1.07], p = 0.11, respectively were the best predictors of death whereas a model with carotid plaques (HR: 5.25 [95% CI:1.41--19.50]; p = 0.01) and another model with carotid plaques and QRISK3 (HR for carotid plaques: 5.13 [95% CI: 1.36--19.3]; p = 0.02 and HR for each 1% in QRISK3: 1.03 [95% CI: 0.99--1.07], p = 0.12, respectively, were the best predictors of CV events. In contrast, the mSCORE was a weaker predictor of the risk of death or CV events.

CONCLUSIONS

The presence of carotid plaques predicts the development of CV events and death in patients with RA. The predictable capacity of carotid plaques and QRISK3 is higher than that of mSCORE in RA patients.

Anti-interleukin 6 receptor tocilizumab in refractory uveitis associated with Behçet's disease: multicentre retrospective study

Objective

To assess the efficacy of tocilizumab (TCZ) in refractory uveitis of Behçet's disease (BD).

Methods

Multicentre study of patients with BD-associated uveitis. Patients were refractory to conventional and biologic immunosuppressive drugs. The main outcome measures were intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects.

Results

We studied 11 patients (7 men) (20 affected eyes); median age 35 years. Uveitis was bilateral in nine patients. The patterns of ocular involvement were panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1). Cystoid macular oedema was present in seven patients. The clinical course was recurrent (n = 7) or chronic (n = 4). Before TCZ, patients had received systemic corticosteroids, conventional immunosuppressants and the following biologic agents: adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1). TCZ was used as monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1). At TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2). TCZ yielded rapid and maintained improvement in all ocular parameters of the patients, with complete remission in eight of them. However, this was not the case for the extraocular manifestations, since TCZ was only effective in three of them. After a mean (s.d.) follow-up of 9.5 (8.05) months, TCZ was withdrawn in two cases, due to a severe infusion reaction and arthritis impairment, respectively.

Conclusion

TCZ could be a therapeutic option in patients with BD and refractory uveitis.