Microvascular status in juvenile Sjögren's disease: the first nailfold videocapillaroscopy investigation

INTRODUCTION

Juvenile Sjögren's disease (jSjD) is a rare autoimmune disease characterized by exocrine gland involvement and systemic manifestations, including small vessel vasculitis and Raynaud's phenomenon (RP). We aimed to investigate the microvascular status in jSjD patients by nailfold videocapillaroscopy (NVC) and the potential correlations with clinical and serological features.

METHODS

Clinical data from thirteen consecutive jSjD patients (11 females and 2 males), with a mean age of 16 ± 4 years, diagnosed before 16 years of age (mean age at diagnosis 12 ± 3) according to the 2016 American College of Rheumatology/EULAR criteria for adult SjD, were collected including age- and sex-matched healthy controls (HCs). Clinical, laboratory, and instrumental data were collected, together with NVC examination. Non-specific and specific NVC parameters were investigated, such as capillary density, capillary dilations, giant capillaries, microhaemorrhages and abnormal shapes. Associations between NVC findings and clinical/serological features were explored and analysed using parametrical and non-parametrical tests.

RESULTS

Capillary density reduction correlated significantly with articular involvement (arthralgias) (p = 0.024). Microhaemorrhages correlated with lower C3 levels (p = 0.034). No specific NVC pattern for jSjD was identified, whereas abnormal capillary shapes were significantly higher in jSjD patients than HCs (p = 0.005). NVC abnormalities were not associated with SjD-specific instrumental tests (biopsy, imaging, Schirmer's test). RP was present in 8% of jSjD patients.

CONCLUSIONS

The reduction of capillary density, as well as microhaemorrhages at NVC analysis, are significantly associated with some clinical aspects like articular involvement and serum biomarkers (C3 reduction). The NVC is suggested as safe and further analysis in jSjD patients.

An engineered glove to follow finger function in rheumatoid arthritis: an observational prospective study

The engineered Hand Test System (HTS) glove has shown high reliability in assessing the baseline functional status of rheumatoid arthritis (RA) hand. Starting from this achievement, the aim of the present observational prospective study was to assess the functionality of the single fingers of rheumatoid hand at follow-up. Eighty RA patients performed HTS glove tests at baseline and among these fifty-six patients were re-tested after 7 months. The HTS glove parameters [Touch Duration (TD), Movement Rate (MR), Inter Tapping Interval (ITI)] were correlated with disease activity and disability clinimetric indexes [Disease Activity Score 28 joint count-C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire-Disability Index (HAQ-DI), grip strength, visual analogue scale of pain (VAS), patient global assessment (PGA)], and with laboratory values. HTS glove parameters (TD, ITI, and MR) showed statistically significant correlations with clinimetric and clinical indexes at both time points (p < 0.05). During follow-up, a statistically significant variation of all HTS glove parameters for the fingers that have performed both the worst or best HTS test at baseline was detected (p < 0.05), while the mean HTS glove parameter values by considering all fingers did not show a statistically significant variation over time, as well as the traditional clinimetric indexes. Besides the objective role in assessing the RA hand function by integrating the traditional clinimetric indexes, the HTS glove seems a useful tool for evaluating worst or best finger function during time by measuring the movement speed.

The dichotomy of glucocorticosteroid treatment in immune-inflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

Objectives

Glucocorticosteroids (GCs) are the most used anti-inflammatory and immunosuppressive drugs due to their effectiveness in managing pain and disease modification in many immune-inflammatory rheumatic diseases (IRDs). However, their use is limited because of adverse effects (AEs).

Material and methods

The authors analyzed recent studies, including randomized controlled trials (RCTs), observational, translational studies and systematic reviews, providing an in-depth viewpoint on the benefits and drawbacks of GC use in rheumatology.

Results

Glucocorticosteroids are essential in managing life-threatening autoimmune diseases and a cornerstone in many IRDs given their swift onset of action, necessary in flares. Several RCTs and meta-analyses have demonstrated that when administered over a long time and on a low-dose basis, GC can slow the radiographic progression in early rheumatoid arthritis (RA) patients by at least 50%, satisfying the conventional definition of a disease-modifying anti-rheumatic drug (DMARD). In the context of RA treatment, the use of modified-release prednisone formulations at night may offer the option of respecting circadian rhythms of both inflammatory response and HPA activation, thereby enabling low-dose GC administration to mitigate nocturnal inflammation and prolonged morning fatigue and joint stiffness. Long-term GC use should be individualized based on patient characteristics and minimized due to their potential AEs. Their chronic use, especially at medium/high dosages, might cause irreversible organ damage due to the burden of metabolic systemic effects and increased risk of infections. Many international guidelines recommend tapering/withdrawal of GCs in sustained remission. Treat-to-target (T2T) strategies are critical in setting targets for disease activity and reducing/discontinuing GCs once control is achieved.

Conclusions

Glucocorticosteroids' use in treating IRDs should be judicious, focused on minimizing use, tapering and discontinuing treatment, when possible, to improve long-term safety. Glucocorticosteroids remain part of many therapeutic regimens, particularly at low doses, and elderly RA patients, especially with associated chronic comorbidities, may benefit from long-term low-dose GC treatment. A personalized GC therapy is essential for optimal long-term outcomes.

Systemic Sclerosis-Specific Antibodies: Novel and Classical Biomarkers

Disease-specific autoantibodies are considered the most important biomarkers for systemic sclerosis (SSc), due to their ability to stratify patients with different severity and prognosis. Anti-nuclear antibodies (ANA), occurring in subjects with isolated Raynuad's phenomenon, are considered the strongest independent predictors of definite SSc and digital microvascular damage, as observed by nailfold videocapillaroscopy. ANA are present in more than 90% of SSc, but ANA negativity does not exclude SSc diagnosis: a little rate of SSc ANA negative exists and shows a distinct subtype of disease, with less vasculopathy, but more frequent lower gastrointestinal involvement and severe disease course. Anti-centromere, anti-Th/To, and anti-Topoisomerase I antibodies could be considered as classical biomarkers, covering about 60% of SSc and defining patients with well-described cardio-pulmonary complications. In particular, anti-Topoisomerase I represent a risk factor for development of diffuse cutaneous involvement and digital ulcers in the first 3 years of disease, as well as severe interstitial lung disease (ILD). Anti-RNA polymerase III is a biomarker with new clinical implications: very rapid skin thickness progression, gastric antral vascular ectasia, the occurrence of synchronous cancers, and possible association with silicone breast implants rupture. Moreover, novel SSc specific autoantibodies have been globally described in about 10% of "seronegative" SSc patients: anti-elF2B, anti-RuvBL1/2 complex, anti-U11/U12 RNP, and anti-BICD2 depict specific SSc subtypes with severe organ complications. Many autoantibodies could be considered markers of overlap syndromes, including SSc. Anti-Ku are found in 2-7% of SSc, strictly defining the PM/SSc overlap. They are associated with synovitis, joint contractures, myositis, and negatively associated with vascular manifestation of disease. Anti-U3RNP are associated with a well-defined clinical phenotype: Afro-Caribbean male patients, younger at diagnosis, and higher risk of pulmonary hypertension and gastrointestinal involvement. Anti-PM/Scl define SSc patients with high frequency of ILD, calcinosis, dermatomyositis skin changes, and severe myositis. The accurate detection of autoantibodies SSc specific and associated with overlap syndromes is crucial for patients' stratification. ANA should be correctly identified using indirect immunofluorescent assay and a standardized way of patterns' interpretation. The gold-standard technique for autoantibodies' identification in SSc is still considered immunoprecipitation, for its high sensitivity and specificity, but other assays have been widely used in routine practice. The identification of SSc autoantibodies with high diagnostic specificity and high predictive value is mandatory for early diagnosis, a specific follow-up and the possible definition of the best therapy for every SSc subsets. In addition, the validation of novel autoantibodies is mandatory in wider cohorts in order to restrict the gap of so-called seronegative SSc patients.

AB0671 HISTOPATHOLOGICAL, CLINICAL AND SEROLOGICAL FEATURES IN IIM PATIENTS FROM A SINGLE CENTER COHORT

Background

Idiopathic inflammatory myositis (IIM) is a group of heterogeneous autoimmune diseases, characterized by myositis-specific (MSA) or myositis-associated autoantibodies (MAA). Muscle biopsy is the diagnostic gold standard, but correlations with elevated creatine level (CK) or MSA/MAA are unclear.

Objectives

To evaluate the association between specific histological findings and clinical and/or serological features in IIM patients from a single tertiary Rheumatology referral center.

Methods

We retrospectively analyzed demographic and clinical data from medical charts, of 184 patients affected by IIM followed-up for >1 year. Muscle biopsies of 89 IIM patients were retrieved from deltoid, biceps or quadriceps muscle, snap-frozen and stored at -80°C and processed for routine histology and histochemistry.

Results

The majority of our muscle biopsy cohort was represented by Dermatomyositis (DM) (39.3%), Polymyositis (PM) (29.2%) and Anti-synthetase syndrome (ASS) (13.5%), whereas the rest was composed of Overlap Syndrome (OS), Immune-Mediated Necrotizing Myopathy (IMNM) and Inclusion-Body Myositis (IMB) (13.5%, 2.2% and 2.2% respectively).

DM presented perifascicular atrophy in 85% of cases and perivascular and perifascicular infiltration in only 40% of cases, similar to other types of IIMs. The overall histology finding was characterized by minimal inflammation and/or necrosis but major atrophy. In comparison, Polymyositis showed more endomysial infiltration and necrosis (Table 1). ASS was characterized by atrophy and perifascicular necrosis in 83% of cases, with perimysial and perivascular infiltration in 67% of cases. Those characteristics were observed both in anti-Jo-1+ (13.9%) as well as non-Jo-1+ ASS patients (13.2%). Non-Jo-1+ ASS patients presented endomysial infiltration, invading or enveloping the muscle fibers (not present in anti Jo-1+) (p: 0.036), with addition of rimmed vacuoles and aspecific clinical presentation. Moreover, in DM, anti-Mi2+ antibodies (9.3%) were significantly associated with perifascicular regeneration and endomysial infiltration, in comparison to both anti-TIF1γ+ (5.8%) and anti-NXP2+ patients (4.6%). No significant histopathological features were found in patients with anti-Ro52 autoantibodies (37.2%), that represented the most frequent MAA in our cohort.

Table 1.BIOPSY CHARACTERISTICSASS 12 (%)PM 35 (%)DM 26 (%)p [OR] ASS vs PMp [OR] PM vs DMdiffuse atrophy3 (25)34 (97.1)8 (30.8)<0.0001 [0.010 (0.001-0.106)]<0.0001 [76.5 (8.8-660.6)]perifascicolar degeneration----29 (82.9)15 (57.7)----0.044 [3.544 (1.09-11.5)]prevalent necrosis----10 (28.6)1 (3.8)----0.017 [10 (1.19-84)]Jo1 12 (%)PL7/PL12 5 (%)p [OR]endomysial infiltration (invading fibers)03 (60)0.015 [inf]Mi2 8 (%)TIF1γ 5 (%)NXP2 4 (%)p [OR] Mi2 vs TIF1γp [OR] Mi2 vs NXP2perifascicolar regeneration8 (100)1 (20)00.007 [inf]0.002 [inf]endomysial infiltrate (surrounding fibers)6 (75)----0----0.061

Conclusion

No significant associations emerged between CK levels, different types of IIM and MSA. Some histological features seem to define subtypes of DM. A precise definition of autoantibody profile in IIM could define not only a clinical phenotype but also the muscle damage distribution.

Disclosure of Interests

None declared

Anti-SSA/Ro positivity and congenital heart block: obstetric and foetal outcome in a cohort of anti-SSA/Ro positive pregnant patients with and without autoimmune diseases

OBJECTIVES

Neonatal lupus (NL) is an acquired disease caused by the transplacental passage of anti-SSA/Ro antibodies. The rate of congenital heart block (CHB), its most serious manifestation, ranges from 1 to 5%. The aim of this study was to retrospectively assess the prevalence of CHB in anti-SSA/Ro positive pregnant women with or without systemic autoimmune diseases from 2010 to 2020.

METHODS

Patients underwent monthly visit and a shared follow-up programme of weekly (16th-24th week) foetal heart rate assessment by obstetric ultrasound.

RESULTS

322 pregnancies in 258 anti-SSA/Ro patients were included; 314 were followed from the beginning of pregnancy because of the known presence of anti-SSA/Ro autoantibodies and 1 case of CHB occurred in an anti-SSA/Ro+ asymptomatic subject (0.3%). In the same period, 8 additional patients were referred to our clinics after in utero CHB diagnosis and subsequent discovery of anti-SSA/Ro without a disease diagnosis. Globally, 9 cases of congenital CHB (2.8%) occurred: 7 complete, 1 II-III degree and 1 rst degree CHB. Anti-SSB/La positivity was associated with a higher risk of CHB (7.8% vs. 1.2%; p=0.0071). No differences in maternal or foetal outcomes were found in comparison with a large cohort of unselected pregnancies except for caesarian section. Hydroxychloroquine (HCQ) was used in 58.3% pregnancies, with a different prevalence according with maternal diagnosis.

CONCLUSIONS

Our data suggest that anti-SSA/Ro positive patents with a de ned systemic autoimmune disease undergoing a strict follow-up since positive pregnancy test display a low risk of pregnancy complications, including but not limited to NL.

POS0107 TAPERING BELIMUMAB IN PATIENTS WITH SLE: A SINGLE CENTER EXPERIENCE

Background:

In Italy, the use of belimumab has been authorized since 2013, in patients with active systemic lupus erythematosus (SLE) with positive anti–double-stranded DNA and low C3 or C4 levels, despite standard therapy. Belimumab is effective in reducing disease activity and number of flares and in blocking damage progression. To our knowledge, no data are available on dose tapering of belimumab in SLE patients chronically treated with it.

Objectives:

The aim of this retrospective study was to analyse prevalence of tapering in a single cohort and to evaluate disease activity after tapering.

Methods:

Patients, who received intravenous belimumab (10mg/kg) for at least 12 months between June 2013 and December 2020 were enrolled. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-SDI), Physician Global Assessment (PGA), C3 and C4 levels, and prednisone daily dose were recorded at baseline and every six-months. Follow-up was stopped when patients switched to subcutaneous belimumab or when it was discontinued for more than 6 months (interrupted). Dose tapering was defined as the prolongation of the regular dose interval, after initial treatment based on the registered dosage.

Results:

Between June 2013 and December 2020, 48 patients received intravenous belimumab for at least 12 months (100% Caucasians, 94% females). All patients received standard belimumab dosage of 10mg/Kg every 4 weeks. Fourteen (29.1%) of 48 patients lengthened the dosing interval to 5 weeks; a subsequent lengthening of the interval occurred in 7 patients every 6 weeks and in 1 patient belimumab was gradually tapered to every 13 weeks.

Twelve months (T12) after belimumab introduction, 3 patients (6.2%) were receiving a tapered dosage; at T24, 9 out of the 37 (24.3%), at T36 9 out of 21 (42.8%), and at T48 8 out of 18 (44.4%). Differences in disease activity, damage, concomitant medications, disease duration at belimumab introduction (baseline) were evaluated among patients that maintained the standard interval versus the group that received a tapered dose. Notably, no differences were found among the two groups (standard dose vs tapering) concerning median age at baseline (41, IQR 31-47.5 vs 38, IQR 32.2-51.5), disease duration (median 11, IQR 7.2-16 vs 9, IQR 5.5-14.5), median prednisone daily dosage (7.1mg, IQR 5-11.9 versus 11mg, IQR 7.6-17.5) and median SLEDAI-2K (8, IQR 6-9.75 vs 8, IQR 5-10). Differences in concomitant medications or clinical manifestations are reported in Figure 1A.

Among the group that received the standard dose, 7 patients discontinued the treatment (20.6%), specifically 2 renal flares and one adverse event occurred. Whereas, in the reduced dose group, 2 discontinuations occurred (14.3%) due to a pregnancy and a renal flare. Noteworthy, the patient with the renal flare resumed subcutaneous belimumab 12 months after the flare. Finally, the disease activity was analysed in the 12 months after the first drug reduction (Figure 1B-E), with no sign of worsening of evaluated parameters (Figure 1B-1E), but with a significant reduction of steroids and SLEDAI-2K, 6 months after tapering.

Conclusion:

In our single retrospective cohort, we have demonstrated that belimumab tapering seems to be safe and not associated with a worsening disease activity over the following months. However, further studies are required to identify eligibility criteria and to determine the optimal dose-tapering strategy both for the intravenous and the subcutaneous formulations.

Figure 1.

Disclosure of Interests:

None declared

Predictive Features and Clinical Presentation of Interstitial Lung Disease in Inflammatory Myositis

Interstitial lung disease (ILD) represents one of the most severe extra-muscular features of idiopathic inflammatory myositis (IIM). We aimed to identify any clinical and serological predictors of ILD in a monocentric cohort of 165 IIM patients.

ILD+ patients were defined as having restrictive impairment in lung function tests and signs of ILD at chest high-resolution computed tomography (HRCT). Available HRCT images were centralized and classified in different ILD patterns: non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP), usual interstitial pneumonia-like (UIP), indeterminate for UIP, and interstitial lung abnormalities (ILA). Lung function test data were recorded at onset, at 1 and 5 years after ILD diagnosis.

ILD was found in 52 IIM patients (31.5%): 46.2% was affected by anti-synthetase syndrome (ARS), 21% by polymyositis (PM), 19% by dermatomyositis (DM), and 13.5% by overlap myositis. Most of ILD+ showed NSIP (31.9%), OP (19%), indeterminate for UIP (19%), and UIP (12.8%) patterns. At multivariate analysis, ILD was predicted by anti-Ro52 (p: 0.0026) and dyspnea (p: 0.015) at IIM onset. Most of ILD onset within is 12 months after IIM. In five cases, ILD occurs after 12 months since IIM diagnosis: these patients more frequently show dry cough and anti-Ku antibodies. Anti-Ro52 + ILD patients showed a significant increase of DLCO at 1 and 5 years of follow-up, compared with anti-Ro52 negative cases.

ILD occurs in about one third of IIM and was predicted by dyspnea at onset and anti-Ro52 antibodies. Anti-Ro52 defines a subgroup of ILD showing a significant improvement of DLCO during follow-up.

This retrospective study has been approved by local ethic committee (ASST-Spedali Civili of Brescia, Italy); protocol number: NP3511

AB0624 PREDICTIVE PARAMETERS FOR DEVELOPMENT OF INTERSTITIAL LUNG DISEASE IN IDIOPATHIC INFLAMMATORY MYOSITIS

Background:

Idiopathic Inflammatory Myositis (IIM) is a group of heterogeneous connective tissue diseases, primarily characterized by chronic muscle inflammation as well as myositis-specific or myositis-associated autoantibodies and a spectrum of different extra-muscular features.

The most frequent organ involment in IIM is Interstitial Lung Disease (ILD), occurring in 5-80% of different IIMs cases and considered the hallmark of morbidity and mortality in patients with IIMs.

Objectives:

To retrospectively assess the predictive factors for development of ILD in IIM patients

Methods:

We retrospectively analyzed the prevalence of ILD in a single-center cohort of 165 IIM patients. Patient data was collected from clinical charts. ILD was diagnosed by chest X-ray scan and chest CT scan. All chest CT and chest X-ray scans available and performed at our hospital were consequently re-evaluated by our expert pneumologist for uniform evaluation.

Results:

Myositis-related ILD (M-ILD) was found in 52 IIM patients (31.5%): 46.15% was affected by anti-synthetase syndrome (ARS), 21.15% by polymyositis (PM), 19.23% by dermatomyositis (DM) and 13.46% by overlap myositis. The pulmonary involvement was characterized by Non-specific interstitial pneumonia (NSIP) (30.6%), Unusual Interstitial Pneumonia (UIP) (38.77%), Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) (20.4%), overlap NSIP/BOOP (4.1%) and Undetermined/Unspecific pattern (6.12%). Eighty four percent of M-ILD consisted of non-smokers and 69.23% presented with dyspnea at onset.

ILD was diagnosed in 90.38% of patients within the first year of IIM diagnosis (early onset ILD) and was associated with dyspnea and/or cough in 70.2% and 17% respectively. On the other hand, late onset ILD presented mostly with dyspnea and/or cough in 60% of cases and was significantly associated with anti-Ku antobodies.

At onset ILD was significantly associated with: ARS (p<0.0001; OR:12.98), anti-Jo-1 (p<0.0001; OR:6.1), anti-Ro (p=0.038; OR:2.2), mechanic’s hands (p<0.0001; OR:10.41), arthritis (p=0.01; OR:2.58), polyarthritis (p=0.001; OR:4.578), dyspnea (p<0.0001; OR:9.66), and high levels of CPK (p=0.0001) and GOT (p=0.0146). By contrast, the following features: DM (p=0.012; OR:0.36), facial rash (p=0.003; OR:0.31), anti-NXP-2 (p=0.019; OR<0.0001), anti-PL-12 (p=0,03; OR<0.0001) and myositis (p<0.0001; OR:0.173) present at onset were less frequently associated with M-ILD.

At multivariate analysis M-ILD was predicted by anti-Ro (p=0.0448), polyarthritis (p=0.0093) and dyspnea (p=0.0001) at onset. On the other hand, patients presenting myositis (p=0.0383) and facial rash (p=0.0398) at onset were less likely to developed M-ILD.

Conclusion:

ILD occurs in about one third of patients with IIM, mostly affected by ARS. The presence of anti-Ro antibodies as well as polyarthritis and dyspnea at onset predict the development of ILD.

Disclosure of Interests:

None declared

AB0623 RATE AND PREDICTIVE FACTORS ASSOCIATED WITH SUSTAINED REMISSION IN IDIOPATHIC INFLAMMATORY MYOSITIS

Background:

Idiopathic inflammatory myositis (IIM) is a group of heterogeneous connective tissue diseases, characterised by chronic muscle inflammation, myositis-specific or myositis-associated autoantibodies and different extra-muscular features. Achieveing low disease activity or remission in patients with IIM has proven to be difficult due to the wide clinical spectrum of the different IIM types.

Objectives:

To retrospectively assess any predictive factors for sustained remission in IIM patients

Methods:

We retrospectively analyzed data taken from medical charts, which included age at disease onset, gender, laboratory data as well as clinical features present at onset, organ involvement and treatment history. A total of 151 adult patients with IIM followed-up for > 1 year were retrospectively enrolled. Remission was defined as no clinical and laboratory evidence of disease activity persistent for more than 6 months during follow-up, while undergoing myositis therapy or under no medication. The remission of cutaneous involvement was defined as no current activity of skin rash, absence of Gottron’s papules as well as heliotrope rash and erythema, whereas the remission of pulmonary involvement was considered as no requirement for intensification of immunosuppressive therapy during follow-up. Likewise, absence of muscle weakness or hyposthenia was taken into account for evaluating muscle involvement. Moreover, the clinical features were accompanied by normalization of myogenic enzymes such as creatine kinase (CK) and lactate dehydrogenase levels.

Results:

Among all 151 patients, 89 (58.9%) patients achieved sustained remission. By univariate analysis, overlap myositis (7.9% vs 27.4%; p=0.003; OR:0.22), cancer-associated myositis (CAM) (7.8% vs 19.35%; p=0.046; OR:0.3), as well as the presence of anti Ku (3.37% vs 12.9%; p=0.05; OR:0.23) and anti TIF-1 gamma (1.1% vs 8%; p=0.043; OR:0.13) antibodies and polyarthritis (11.2% vs 24.19%; p=0.045; OR: 0.397) at onset were significantly associated with active IIM, not achieving remission.

Out of 89 patients in remission, 79 (88.8%) achieved long-term sustained remission, lasting at least 2 years, whereas 10 patients (11.2%) showed relapse. Most of relapsed patients showed a relapse/remitting disease, with no evident trigger for the relapse. We divided our cohort of 89 patients in remission in 2 subsets: 83 patients in remission undergoing therapy (93.3%) and 6 patients in drug-free remission (6.7%). No significant differences were found between two groups, except for younger age at onset (p=0.0002) found in patients achieving drug-free remission.

Conclusion:

Sustained remission occurs in about one half of patients with IIM. The presence of anti Ku and anti TIF-1 gamma antibodies as well as polyarthritis at onset lowers the chance of achieving sustained remission. Younger age at diagnosis has proved to predict drug-free long-lasting remission.

Disclosure of Interests:

None declared

SAT0207 ANTI-SSA/RO POSITIVITY AND CONGENITAL HEART BLOCK: OBSTETRIC AND FETAL OUTCOME IN A COHORT OF ANTI-SSA/RO POSITIVE PREGNANT WOMEN WITH AND WITHOUT AUTO-IMMUNE DISEASES FROM THREE ITALIAN TERTIARY REFERRAL CENTERS

Background:

neonatal lupus syndrome (NLS) is an acquired disease caused by the trasplacental passage of anti-SSA antibodies. Congenital heart block (CHB) represents the most serious manifestation of NLS. The rate of CHB in Anti-SSA positive pregnant women ranges from 1 to 5% in different studies

Objectives:

to retrospectively assess the prevalence of CHB in a cohort of anti-SSA positive pregnant women followed in 3 Italian tertiary centers

Methods:

pregnancies of anti-SSA positive women attending the pregnancy clinic of ASST Pini CTO/Policlinico Mangiagalli, Rheumatology Division of Spedali Civili, Brescia and Rheumatology Division of Ospedale S Matteo, Pavia from 2009 to 2019 were included. Patients underwent monthly clinical examination. Fetal heart rate was assessed weekly by Doppler ultrasound from 14thto 26thgestational week. On week 14 and 26, a fetal echocardiography was performed. A EKG was performed at birth

Results:

351 prospectively followed pregnancies in 292 anti-SSA/Ro positive women were included. Table 1 reports diagnosis. None of the prospectively followed pregnancies were complicated by complete CHB. Seven additional patients were referred to our clinics after diagnosis of CHB and were subsequently found to be anti-SSA positive, reporting no symptoms of diseases. Considering the 7 additional pregnancies, the incidence of CHB was 1.9%. We observed 3 neonates (0.8%) with cutaneous NLS and 1 case of transient increase of liver enzymes. In another neonate, a 1thdegree A-V block was found after birth. A complete analysis of maternal and fetal outcome was possible in 244 cases (Table 2) and compared with 3158 unselected healthy controls. Among these 244 cases, 65% were taking hydroxychloroquine

Table 1.

patients diagnosis

n%Sjogren’s Syndrome58`20Systemic lupus erythematosus7626UCTD7425Asymptomatic Ro carriers5619Other2810292100Table 2.

maternal and fetal outcome

healthy controls N=3158Anti-SSA/Ro ptsN=244P valuePrevious CHB n (%)2 (0.8)Anti-SSB pos n (%)46 (18.8)aPL pos n (%)49 (20)PregnancyLive births3158241Preeclampsia, n (%)43 (1.1)2 (0.8)nsDeliveryDelivery <37 wks, n (%) / < 34 wks n (%)401 (12.6) /201 (6)35 (15.6) / 14 (6)ns / nsCesarean Section, n (%)897 (29.3)115 (47.5)<0.001

Conclusion:

none of the patients prospectively followed in our centers before and during pregnancy developed complete CHB. If the 7 cases of anti-SSA positivity diagnosed after CHB detection were included in the analysis, the incidence of CHB was comparable to previous reports. Our data suggest that a strict follow up and proper treatment of anti-SSA positive patients with or without an autoimmune disease before and during pregnancy can reduce the risk of NLS. Further studies are warranted to confirm a possible protective role of anti-rheumatic treatments, including HCQ

References:

[1]Fredi M. Front Cardiovasc Med. 2019

Disclosure of Interests:

Maria Gerosa: None declared, Micaela Fredi: None declared, Laura Andreoli: None declared, Cecilia Chighizola: None declared, Lorenza Maria Argolini: None declared, Davide Donzelli: None declared, Tamara Vojinovic: None declared, Véronique Ramoni: None declared, Elisa Bellis: None declared, Laura Trespidi: None declared, Federica Gazzola: None declared, Enrico Ferrazzi: None declared, Sonia Zatti: None declared, Fausta Benvenuti: None declared, Pier Luigi Meroni: None declared, Franco Franceschini: None declared, Carlomaurizio Montecucco: None declared, Rolando Cimaz: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Angela Tincani: None declared