Splenic torsion mistaken for an ovarian cyst: a case report

BACKGROUND

Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed.

CASE PRESENTATION

A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days.

CONCLUSION

Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.

Interactive effects of hydrogen sulphide and silicon enhance drought and heat tolerance by modulating hormones, antioxidant defence enzymes and redox status in barley (Hordeum vulgare L.)

Recent changes in climate have reduced crop productivity throughout much of the world. Drought and heat stress, particularly in arid and semi-arid regions, have seriously affected barley production. This study explored the separate and interactive effects of silicon (Si) and hydrogen sulphide (H₂ S) on plant growth and mitigation of the adverse effects of heat stress (DS) and drought stress (HS) in a barley pot experiment. The impacts of simultaneous DS + HS were more severe than individual stresses due to increased ROS production, malondialdehyde (MDA) content and higher electrolyte leakage (EL), thereby leading to reduced water, protein and photosynthetic pigment content. Exogenously applied Si and H₂ S alleviated the DS-, HS- and DS + HS-induced effects on barley by reducing ROS production, MDA and EL. A single application of H₂ S or Si + H₂ S increased plant biomass under all stress conditions, which can be ascribed to higher Si accumulation in barley shoots. A single application of Si or H₂ S significantly increased plant biomass. However, Si + H₂ S was the most effective treatment for metabolite accumulation and elevating activity of antioxidant enzymes to prevent toxicity from oxidative stress. This treatment also modulated osmolyte content, enhanced antioxidant activity and regulated the stress signalling-related endogenous hormones, abscisic acid (ABA) and indole acetic acid (IAA). Exogenous treatments regulated endogenous H₂ S and Si and resulted in higher tolerance to individual and combined drought and heat stress in barley.

Synthesis and evaluation of 2-phenylamino-1,4-naphthoquinones derivatives as potential hypoglycaemic agents

Due to the severe side effects revealed by most of the currently used antidiabetic medicines, search for finding new and safe drugs to manage diabetes is continued. Naphthoquinones possessing strong antioxidant properties have been employed as candidates for diabetes therapy. Present study is aimed at finding the antioxidant and hypoglycaemic potential of some novel derivatives of 2-phenylamino-1,4-naphthoquinones (PAN) including chloro, nitro, methyl and bromo (5a-d) derivatives synthesized by single pot experiment. Product crystals were purified by TLC and characterized by FT-IR. The antioxidant potential of the compounds was assayed through DPPH radical scavenging and reducing power activities noted as UV-vis. absorbance. The DPPH assay has showed the powerful antioxidant activity of nitro and bromo derivatives, while the nitro derivative showed the significant reduction potential towards FRAP assay. Hypoglycaemic potential of the compounds was studied in rat animal model. All synthesized compounds revealed better hypoglycaemic activity; however, the chloro-derivative exhibited the more potent hypoglycaemic activity showing about 43% reduction in the mean blood glucose levels of the treated animals. As the bioreduction of naphthoquinones may be influenced by changing its redox properties, it has been noticed that the e-donating resonance effect (+R) of 'chloro' group has shown the significant effects on biological activity through stabalization of its imine form which limits the potential of generation of free radicals during bioreduction of quinones and thus has been proposed as the reason of its hypoglycaemic activity. Future studies employing the properties of e-donating groups of PAN may optimize the drug-receptor interaction for better drug designing and drug development strategies against diabetes and also for the clinical trials.

Development, Characterization, and Evaluation of SLN-Loaded Thermoresponsive Hydrogel System of Topotecan as Biological Macromolecule for Colorectal Delivery

BACKGROUND

Chemotherapeutic drugs cause severe toxicities if administered unprotected, without proper targeting, and controlled release. In this study, we developed topotecan- (TPT-) loaded solid lipid nanoparticles (SLNs) for their chemotherapeutic effect against colorectal cancer. The TPT-SLNs were further incorporated into a thermoresponsive hydrogel system (TRHS) (TPT-SLNs-TRHS) to ensure control release and reduce toxicity of the drug. Microemulsion technique and cold method were, respectively, used to develop TPT-SLNs and TPT-SLNs-TRHS. Particle size, polydispersive index (PDI), and incorporation efficiency (IE) of the TPT-SLNs were determined. Similarly, gelation time, gel strength, and bioadhesive force studies of the TPT-SLNs-TRHS were performed. Additionally, in vitro release and pharmacokinetic and antitumour evaluations of the formulation were done.

RESULTS

TPT-SLNs have uniformly distributed particles with mean size in nanorange (174 nm) and IE of ~90%. TPT-SLNs-TRHS demonstrated suitable gelation properties upon administration into the rat's rectum. Moreover, drug release was exhibited in a control manner over an extended period of time for the incorporated TPT. Pharmacokinetic studies showed enhanced bioavailability of the TPT with improved plasma concentration and AUC. Further, it showed significantly enhanced antitumour effect in tumour-bearing mice as compared to the test formulations.

CONCLUSION

It can be concluded that SLNs incorporated in TRHS could be a potential source of the antitumour drug delivery with better control of the drug release and no toxicity.

POS0310 EXPOSURE TO MAJOR PSYCHOLOGICAL TRAUMA OR STRESS IN THE PRECEDING ONE YEAR SIGNIFICANTLY CONTRIBUTES TO POOR DISEASE CONTROL IN PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background:

Stress response is considered to involve the activation of both the hypothalamus-pituitary-adrenal axis and the autonomic nervous system, along with its communication with the immune system. Because many rheumatic diseases are characterized by immune-mediated joint inflammation, stressful events might contribute to the aetiology, maintenance and exacerbation of rheumatic diseases.

Objectives:

We aimed to examine whether real-life major stressful events lead to poor disease control among patients with Rheumatoid arthritis (RA). We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the registry data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts (SJC), tender joint counts (TJC), deformed joint counts, and DAS-28. Major psychological trauma or stress was defined if the patient has experienced any of the following in the past year: a) major personal injury or illness; b) death/major illness of a close relative; c) marital separation/divorce; d) loss of job; e) major financial loss; f) mass casualty incident loss.

Results:

The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Thirty-six percent of the cohort reported to have major psychological stress and trauma in the preceding one year. No statistical association of age, gender, and marital status was noted, but statistical association of low education status (p=0.042), longer disease duration (p=0.044), higher DAS-28 values (p<0.001) and other markers of RA disease activity (SJC, TJC, ESR, patient global health) was found. On multiple logistic regression analysis, a significant association of major psychological stress and trauma in the preceding one year was noted with active disease (DAS-28; OR 1.67, CI 1.17-2.4, p=0.005). Following variables were included in the full regression model, disease duration, gender, age, marital status, education status, and DAS-28 value (also used models with SJC, TJC, deformed joint counts, ESR, patient global health, but the results remained unchanged).

Conclusion:

Major psychological stress and trauma in the preceding one year is associated with high disease activity among patients with RA. Therapies that focus on stress management may be important adjuncts to traditional pharmacotherapy in the treatment of inflammatory rheumatic diseases.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared

POS0663 SAFETY AND EFFICACY OF COMBINING METHOTREXATE AND LEFLUNOMIDE AMONG PATIENTS WITH INFLAMMATORY ARTHROPATHIES: FINDINGS FROM THE PRIME REGISTRY

Background:

Currently, conventional synthetic DMARDs (csDMARDs) are the most commonly prescribed drugs as first-line treatment for peripheral arthritis. In resource-constrained settings where biologic agents are not widely available, there are limited therapeutic options for patients with rheumatoid arthritis (RA) and seronegative inflammatory arthropathies refractory to other csDMARD therapies. Hence, in our practice, we are inclined to use combination of potent DMARDs after MTX failure, prior to considering biologic therapies. We believe that combination of DMARDs, especially combining MTX and Leflunomide (LEF) provides a potent and valuable low-cost treatment option. Efficacy of MTX and LEF is very well established, but there have been lot of concern as regards their combination use due to potential risk of hepatotoxicity.

Objectives:

We aimed to review our inflammatory arthropathies cohort data especially examining the safety, efficacy and drug retention of the combination usage of MTX and Leflunomide. We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. A number of clinical variables were recorded. Detailed history was gathered from every patient regarding their present and past medications usage. Questions were asked directly about the usage or otherwise of all available DMARDs and biologics. The duration of usage, any adverse events, or the reasons for discontinuation were recorded. Evaluation of disease activity and severity was made as per internationally agreed definitions.

Results:

The data of 766 inflammatory arthritis patients (RA=663, PsA=103) was reviewed. Among them, 241 patients (RA=196, PsA=45) were using combination therapy of MTX and LEF (combo MTX+LEF) with mean age 42.3±6 years; 42% male]. These patients had failed MTX or LEF monotherapy. Among these 241 patients, 49 patients were also on concomitant hydroxychloroquine therapy. It was noted that median drug retention of combo MTX+LEF therapy has been 9.5 months (IQR 6-16). Regarding any adverse events of combo MTX+LEF therapy, hepatotoxicity (ALT ≤3 times the upper limit of normal) was noted among 15 (6.2%) patients, hepatotoxicity (ALT ≥3 times the upper limit of normal) was noted among 8 (3.3%) patients, and troublesome gastrointestinal upset (nausea, or vomiting, or diarrhoea) in 3 (1.2%). Overall, only 13 (5.4%) patients had to discontinue this combo MTX+LEF therapy due to adverse events. Disease activity among combo MTX+LEF users was as follows: 64% (n=29) of PsA patients had achieved MDA; 42% (n=83) of RA cohort were in DAS28 remission, 46% (n=91) of RA patients were having DAS low disease activity.

Conclusion:

Combination of MTX and LEF was well tolerated and had good drug retention time, with 94.6% of patients having ongoing treatment to date. In low-income countries, where bDMARD availability is limited, financial arguments significantly influence decision making process, and our data provides initial evidence that MTX and LEF combination therapy could be an effective treatment option.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared

AB0581 NAIL PSORIASIS AMONG PATIENTS WITH PSORIATIC ARTHRITIS IS MORE ASSOCIATED WITH THE SEVERITY OF SKIN PSORIASIS THAN WITH FEATURES OF SEVERE ARTHRITIS

Background:

Nail disease is an important feature of psoriasis arthritis (PsA), and has been recognised as one of the 6 important clinical domains by GRAPPA. Little is known about how patients with PsA and nail disease compare to patients without nail disease. Nail disease has been found to associate with severe PsA.

Objectives:

The objective of this study was to examine the association of nail disease with patient demographics and features of active psoriasis and PsA.

Methods:

For this cross-sectional study, data from 3 PsA cohorts was studied (St Vincent’s University Hospital Dublin, Ireland; University Hospital Kerry, Ireland; and Fatima Memorial Hospital Lahore, Pakistan). Following informed consent, patients underwent detailed skin and rheumatologic assessments including disease activity measures. Since a large number of patients were in clinical remission at the time of assessment, we made 2 documentations of reversible clinical variables (e.g., current skin scores (PASI), current nail disease, current tender and swollen joint counts, current enthesitis, current dactylitis) at the time of study entry and, through extensive medical record review, we identified patient’s maximum skin and joints disease activity scores ever documented, e.g., maximum skin scores (PASI max), TJC max, SJC max, nail disease ever, dactylitis ever, enthesitis ever. Nail disease was stratified by the presence or absence of nail psoriasis.

Results:

Data on 476 PsA patients was assessed (age 53.8±10.8, PsA duration 13.9±10 years, BMI 29±5; current PASI 2.5±3.2, current TJC 1.8±2.6 years, current SJC 1.4±2.2 years; 37% of the cohort had enthesitis ever, 46% had dactylitis ever, 30.7% had current dactylitis, and 28% with current enthesitis). 63.4% (n=302) of the cohort ever had nail disease, and 45.4% (n=216) had current nail disease at the time of assessment. On univariate analysis, significant or marginally significant statistical association of current nail disease was noted with current PASI (p<0.001), enthesitis ever (p=0.004), current enthesitis (p=0.11), dactylitis ever (p=0.027), current dactylitis (p=0.07), MDA not achieved (p<0.001), current SJC (p=0.08), and current TJC (p=0.32); however, no statistical association was noted with age, gender, disease duration, smoking status, low education status.The following variables were included in multiple stepwise regression analysis: current PASI, current enthesitis, current dactylitis, current TJC, current SJC, MDA not achieved, and low education status; a significant association of current nail disease was noted with current PASI (OR 2.2, CI 1.83-2.54, p<0.001) with a borderline association of current dactylitis (OR 1.6, CI 0.94-2.58, p=0.083). When we used nail disease ever as a dependent variable in the multiple regression model using covariates of PASI max, TJC max, SJC max, dactylitis ever, enthesitis ever, MDA not achieved and low education status, a significant association of nail disease ever was noted with PASI max (OR 1.09, CI 1.01-1.17, p=0.01), TJC max (OR 1.08, CI 1.02-1.14, p=0.005) and borderline association with dactylitis ever (OR 1.74, CI 0.96-3.15, p=0.067)

Conclusion:

The presence of nail disease among patients with PsA is significantly associated with severity of skin psoriasis with only borderline associations with measures of active musculoskeletal involvement.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, shehla farrukh: None declared., Shabnam Batool: None declared., Sadia Asif: None declared., Oliver FitzGerald Speakers bureau: Abbvie, Janssen, Pfizer, Consultant of: BMS, Celgene, Eli Lilly, Janssen, Pfizer, Grant/research support from: Abbvie, BMS, Eli Lilly, Novartis, Pfizer.

POS0589 PREVALENCE AND SEVERITY OF STRESS AT HOME AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background:

In chronic inflammatory diseases like rheumatoid arthritis (RA), psychological stress is widely recognised as an important risk factor to negatively affect the disease course. Stress activates the hypothalamic-pituitary adrenal axis and the autonomic nervous system, which associate with the release of neurotransmitters (i.e. norepinephrine), hormones (i.e. cortisol) and activation of immune cells. Perceived stress can potentially induce the disease exacerbation, but on the other hand, the disease itself might produce significant stress to patients thus the vicious circle is formed and maintained.

Objectives:

We aimed to examine the prevalence of mental/emotional stress at home and its associations among patients with Rheumatoid arthritis. We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts, tender joint counts, deformed joint counts, and DAS-28. All participants were directly inquired at the interview during the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and to rate it from 1-3 (mild, moderate, severe). For better understanding and ease of statistical analysis, dichotomous variable was made with moderate-to-severe stress patients were categorised into one group and none-to-mild stress patients into second group.

Results:

The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Forty-eight percent of patients accepted to have moderate-severe stress at home (moderate stress=29.9%, severe stress=18.3%). On univariate analysis, significant association of moderate-severe stress at home was noted with deformed joint counts (p=0.036), higher DAS-28 scores (p<0.001), and being married (p=0.001). Weak statistical association of age (p=0.11), disease duration (p=0.13), low education status (p=0.14), female gender (p=0.24) was noted. On multiple logistic regression analysis, a significant association of moderate-severe stress at home was observed with higher DAS-28 scores (OR 1.76, CI 1.29-2.41, p<0.001) and deformed joint counts (OR 1.15, CI 1.00-1.31, p=0.040). Following variables were included in multiple stepwise regression analysis: age, disease duration, low education status, married, Das-28 scores, and deformed joint counts. However, when gender was included in the regression analysis, a significant association of moderate-severe stress at home was observed with female gender (OR 3.99, CI 1.47-10.83, p=0.007), higher DAS-28 scores (OR 1.8, CI 1.31-2.51, p<0.001), with marginal association with deformed joint counts (OR 1.13, CI 0.99-1.30, p=0.061).

Conclusion:

Stress at home is common among patients with RA, and nearly half of the cohort was noted to have moderate-severe level of stress at home. Ongoing stress at home has significant association with higher RA disease activity and deformities suggesting a bidirectional relationship. These findings demonstrate an important need for integration of rheumatologic, social workers and mental health services

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared

AB0533 COMBINATION OF METHOTREXATE AND LEFLUNOMIDE IS SAFE AND HAS GOOD DRUG RETENTION AMONG PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Among patients with psoriatic arthritis (PsA), there remains a considerable confusion regarding the effectiveness of conventional synthetic DMARDs (csDMARDs), especially methotrexate (MTX). The availability of biologic DMARDs and targeted synthetic DMARDs have revolutionised the management of psoriatic disease; however, it comes with a significant cost burden. We believe that combination of DMARDs, especially combining MTX and Leflunomide (LEF) provides a valuable low-cost treatment option for patients with PsA after failure of MTX monotherapy. Hence, in our practice, we are inclined to use combination of potent DMARDs after MTX failure, prior to considering biologic therapies. Little is known about the combination use of LEF and MTX in PsA, especially in the context of drug retention time and tolerability.

Objectives:

We aimed to review our PsA cohort data especially examining the drug retention of first-line csDMARD monotherapy and combination csDMARDs.

Methods:

In our centre, MTX is a preferred first line csDMARD, unless contraindicated, and patients are followed up with a protocol on 4-6 weekly basis unless complete remission is achieved. MTX if needed is escalated to the maximum tolerated dose (up to 25mg/week), and if PsA is still active then preferably LEF is added (usual starting dose for add-on therapy is 10mg a day and if needed escalated to 20mg a day, without any loading dose). Other csDMARDs, such as sulphasalazine are used, if needed. For this study, after written-informed consent, only those adult patients were included who had a follow up of at least 6 months with our rheumatology services, and were fulfilling CASPAR criteria. Moreover, only patients who were DMARD-naïve (no prior DMARD therapy for any cause, including psoriasis), and initiated DMARD as monotherapy after 1 April 2018 were included. If any patient had already been on any DMARDs prior to attending our rheumatology services was excluded.

Results:

A total of 81 PsA patients [mean age 45.6±6 years; 52% male; mean PsA disease duration=9±4 years; 35% with dactylitis, 42% with enthesitis, 17% with sacroiliitis, median current PASI=2.6, median number of swollen joints=8.0, median number of tender joints= 11.0] fulfilled the inclusion and exclusion criteria. As regards first-line csDMARD monotherapy, 88% (n=71) of patients were commenced on MTX. In total, 79% (n=56 out of 71) of patients who were started on MTX as their first-line csDMARD therapy failed this monotherapy during follow-up (51=ineffective, 5=intolerance). After a median follow-up of 22 months, MTX median drug retention among all MTX monotherapy users (n=71) was only 7 months (IQR 5-7); and among MTX failures (n=56), MTX monotherapy median drug retention was 6.0 months (IQR 4-8). Eighty percent (n=45 out of 56) of the MTX monotherapy failure cohort was started on combination therapy of MTX and LEF (combo MTX+LEF); among them, only 7 patients needed escalation of therapy to bDMARDs, and the rest are still using combo MTX+LEF. It was noted that to date median drug retention time of combo MTX+LEF has been 8 months (IQR 7-11), and 84% (n=38 out of 45) of these patients are still using this combo therapy. Significantly more patients managed to continue the combo MTX+LEF therapy compared to MTX monotherapy (84% vs. 21%, p<0.001)

Conclusion:

Among csDMARD naïve PsA patients, 79% of patients failed MTX monotherapy with median drug retention time of only 6 months. Combination of MTX and LEF was well tolerated and had good drug retention time, with 84% of patients having ongoing treatment to date. Our data provides initial evidence that MTX and LEF combination therapy could be an effective treatment option for PsA

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Shabnam Batool: None declared., Sadia Asif: None declared., Farzana Hashmi: None declared., Saadat Ullah: None declared.

FRI0363 CLINICAL PREDICTORS OF SECUKINUMAB RETENTION IN A REAL WORLD COHORT OF PATIENTS WITH PSORIATIC ARTHRITIS AND AXIAL SPONDYLOARTHRITIS

Background:

There are increasing treatment options for patients with psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA). Whilst there are several studies identifying predictors of response to TNF inhibitors1there is little data so far predicting response to the IL-17A inhibitor secukinumab which given its different mechanism of action may have different predictors of response.

Objectives:

To identify demographic or clinical factors at initiation of secukinumab associated with stopping treatment due to inefficacy in PsA and in AxSpA in a real world cohort.

Methods:

Retrospective analysis of all rheumatology patients’ notes in Glasgow who had received secukinumab. Demographics, disease activity at baseline and retention of secukinumab were collected from medical records in patients with a diagnosis of PsA or AxSpA. Patients who discontinued due to adverse events or other events (e.g. pregnancy) were excluded. Patients who remain on secukinumab but have not yet had their six-month review to assess response or who started secukinumab via a clinical trial were also excluded. Unpaired T-test of unequal variance used to assess differences between groups with p-value ≤0.05 considered significant.

Results:

352 rheumatology patients in Glasgow had ever received secukinumab. 266 had PsA, 76 had AxSpA (others: SAPHO, JIA, reactive arthritis).

77 PsA patients discontinued secukinumab, 48 due to inefficacy. 157 PsA patients remain on secukinumab and have had at least an initial six-month review.

Table 1 shows results for PsA. Inefficacy was associated with higher levels of current smoking and higher levels of ESR and CRP but not tender or swollen joints.

Table 1.

Demographics and clinical characteristics of PsA patients starting secukinumab

Stopped due to Inefficacy (n=48)Remain on Secukinumab (n=157)Significance (p value)Gender (M:F)1:1.861:2.30.24Age (years)47.850.80.078Current Smoking37%21%0.040Socioeconomic Decile4.95.00.39Weight (kg)81.685.90.11Number of Comorbidities1.721.850.31Disease Duration (years)10.411.20.24Number Previous bDMARDs1.691.400.095Tender Joint Count16.616.60.50Swollen Joint Count6.47.30.29Patient Global Score (VAS)62.467.70.19ESR (mm/hr)24.114.80.017CRP (mg/L)12.86.20.049

Values are mean unless stated

21 AxSpA patients discontinued secukinumab, 13 due to inefficacy. 49 AxSpA patients remain on secukinumab and have had at least an initial six-month review.

AxSpA patients who stopped due to inefficacy had higher mean BASDAI (8.47 vs 7.02, p=0.007) but there was no difference in mean ESR (31 vs 27.1, p=0.31) or CRP (23.6 vs 23.0, p=0.48). Surprisingly, disease duration was lower in inefficacy group (7.8 years vs 13.5, p= 0.003); this could reflect a higher proportion in the inefficacy group with non-radiographic AxSpA which is known to be associated with earlier disease and to have a lower response to biologic treatments than ankylosing spondylitis. Smoking did not show significant difference in AxSpA but numbers are small and there is numerically higher level of smoking in the inefficacy group (58% vs 32%, p=0.063). No other significant differences in demographics or clinical characteristics were noted.

Conclusion:

Smoking predicted inefficacy in secukinumab in PsA patients, with a similar trend in AxSpA patients, reinforcing the importance of promoting smoking cessation. Higher levels of ESR and CRP negatively predicted secukinumab response in PsA. High BASDAI and low disease duration in AxSpA predicted inefficacy. These clinical factors may be helpful in informing treatment decisions in PsA and AxSpA in the absence of therapeutic biomarkers.

References:

[1]Maneiro JR et al. Predictors of response to TNF antagonists in patients with ankylosing spondylitis and psoriatic arthritis: systematic review and meta-analysis.RMD Open. 2015;1(1):e000017.

Disclosure of Interests:

Alistair Tindell: None declared, Andrew McGucken: None declared, Saira Batool: None declared, Stefan Siebert Grant/research support from: BMS, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, Janssen, Novartis

AB0633 REAL WORLD EXPERIENCE OF THE IMPACT OF SECUKINUMAB ON DISEASE ACTIVITY AND FATIGUE IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Fatigue is one of the most commonly reported symptom of ankylosing spondylitis (AS). It impacts functional ability, quality of life, and ability to maintain employment1. Secukinumab, a fully human monoclonal IgG1 antibody that neutralizes IL-17A, has shown significant and sustained improvement in the signs and symptoms of active AS in the MEASURE 2 study2. It has also shown to improve fatigue scores. Despite this, the published literature on real life experience is scarce. We report our experience of Secukinumab use at Gartnavel General Hospital, Glasgow, UK.

Objectives:

We performed a retrospective review to assess the response of our AS patients to Secukinumab. We also reviewed the impact of treatment on fatigue.

Methods:

AS patients commenced on Secukinumab 150mg subcutaneously from mid-2016 to September 2019 were identified using the clinical records on our database. Response using Bath AS disease activity index (BASDAI) and Bath AS function index (BASFI) were recorded. Impact on fatigue and pain was measured using single-item fatigue and pain visual analogue scale (VAS) within the BASDAI questionnaire.

Results:

30 AS patients, 11 anti-TNF naïve and 19 anti-TNF inadequate responders (IR), on Secukinumab were identified. Retention rate was 76.66% (23/30). Sustained improvement was observed across all outcome measures over 3.5 years. Fatigue and pain improvement were somewhat lower than expected but did show slow improvement. Responses were greater in anti-TNF naïve patients. There was no significant difference in response between smokers (33.34%, 10/30) and non-smokers (36.67%, 11/30). There were 4 patients with inflammatory bowel disease, none of whom flared. No new safety signals were identified.

Table.

Clinical response to Secukinumab in patients with active AS

TimeBASADIBASFIFatigueAS painMean%changeMean%changeMean%changeMean%changeBaseline7.097.37.67.993M6.71-5%7.24-8%6.9-9%6.89-14%6M5.4-24%5.8-20%6.29-17%6.06-24%9M6.01-15%6.56-10%6.41-16%6.1-24%12M5.04-29%5.42-26%6.35-16%5.55-30%18M4.98-30%3.73-49%6.38-16%4.91-38%24M5.52-22%5.72-22%6.79-11%5.6-30%%Change from baselineAnti-TNF naïveAnti-TNF IRAnti-TNF naïveAnti-TNF IRAnti-TNF naïveAnti-TNF IRAnti-TNF naïveAnti-TNF IR3M-37%-9%-44%6%-10%-14%-53%-14%6M-34%-27%-38%-29%-28%-6%-43%-6%9M-27%-4%-30%1%-23%-6%-41%-6%12M-41%-22%-31%-29%-31%0%-44%0%18M-32%-11%-57%-22%-35%5%-34%5%24M-26%-12%-32%-1%-16%3%-32%3%

There were <3 patients in >2 years follow up group therefore results were omitted from analysis

Conclusion:

In our real-life cohort of AS patients, significant improvement was seen over 3.5 years in both BASDAI and BASFI. Fatigue was significantly improved in anti-TNF naïve group, but results were disappointing in anti-TNF IR group. This may be explained by the fact that there are older patients with established disease and background degenerative changes in anti-TNF IR group. Although fatigue data had slightly discordant results compared with the MEASURE 2 study2, considering the use of single item VAS rather than multidimensional measures such as FACEIT fatigue scale, clear improvement has been observed.

References:

[1]E. E. Schneeberger, M. F. Marengo, F. Dal Pra, J. A. Maldonado Cocco, and G. Citera, “Fatigue assessment and its impact in the quality of life of patients with ankylosing spondylitis,” Clin Rheumatol, vol. 34, no. 3, pp. 497–501, 2015.

[2]H. Marzo-Ortega, J. Sieper, A. Kivitz, R. Blanco, M. Cohen, R. Martin, A. Readie, H. B. Richards, and B. Porter, (2017) ‘Secukinumab and Sustained Improvement in Signs and Symptoms of Patients With Active Ankylosing Spondylitis Through Two Years: Results From a Phase III Study’, Arthritis Care & Research, Vol. 69, No. 7, July 2017,(DOI 10.1002/acr.23233), pp. 1020–1029.

Acknowledgments:

S. Kerr, K. Anderson and Rheumatology department, Gartnavel General Hospital, Glasgow, UK

Disclosure of Interests:

None declared

Benefits and hazards of electromagnetic waves, telecommunication, physical and biomedical: a review

OBJECTIVE

The aim of this paper is to review the current literature on electromagnetic radiation (EMR): physical, biophysical, and telecommunication. The widespread application of EMR in modern technologies requires telecommunication and healthcare professionals to possess some knowledge of its physical and biological properties. In this review article, we will discuss biophysical principles of EMR, its interactions with living organisms and its application in clinical practices. We will discuss here beneficial as well as hazardous effects of EMR. We will also discuss the safety guidelines.

Molecular diversity of Pakistani mango (Mangifera indica L.) varieties based on microsatellite markers

Understanding the genetic diversity of different Pakistani mango varieties is important for germplasm management and varietal characterization. Microsatellites are efficient and highly polymorphic markers for comparative genome mapping, and were used in the present study to determine the genetic relatedness and variability among 15 indigenous mango cultivars (Mangifera indica L.). Overall, 181 bands were produced using 12 simple sequence repeat (SSR) primers. Out of the 12 primers used, 10 were polymorphic and two were monomorphic. Genetic relatedness among cultivars was assessed by constructing a dendrogram using the unweighted pair group method of arithmetic means. The accessions exhibited coefficients of similarity ranging from 75 to 100%, indicating the frequent use of only a few parent cultivars and the presence of inbreeding. The primers used in the present study were found to be valuable for identifying genetic relationships among mango cultivars.

Evaluation of the FASTPlaqueTB assay for direct detection of Mycobacterium tuberculosis in sputum specimens

SETTING

Sputum samples were collected from suspected tuberculosis patients attending out-patient clinics at the Ojha Institute of Chest Diseases, Karachi, Pakistan.

OBJECTIVE

To evaluate the performance of the FASTPlaqueTB assay for rapid diagnosis of pulmonary tuberculosis.

DESIGN

A comparative study of 584 sputum samples using acid-fast smear microscopy, Lowenstein-Jensen culture and FASTPlaqueTB.

RESULTS

A total of 514 samples yielded complete results. Seventy specimens were lost to analysis due to the overgrowth of contaminants. The addition of antimicrobials inhibited growth of gram-positive contaminants, and reduced the overall contamination rate from 18.2% to 7.2%. Mycobacterium tuberculosis was isolated from 175 smear-positive and 70 smear-negative specimens. FASTPlaqueTB detected M. tuberculosis in 81.6% of specimens, with a specificity of 97.7%. The sensitivity and specificity of the assay for smear-positive specimens were respectively 87.4% and 88.2%. For smear-negative specimens, the sensitivity of the assay was 67.1% and the specificity was 98.4%. The combined sensitivity of smear and FASTPlaqueTB for M. tuberculosis was 90%. Test results were available in 48 hours.

CONCLUSION

FASTPlaqueTB is a sensitive and specific test for rapid diagnosis of pulmonary tuberculosis in high prevalence areas. The test is sensitive enough to confirm a large number of clinically suspected smear-negative cases and improve case finding.