Rheumatoid arthritis related interstitial lung disease

INTRODUCTION

Interstitial lung disease (ILD) represents a frequent extra-articular manifestation of rheumatoid arthritis (RA) deeply impacting both quality of life and overall prognosis. Areas covered: A literature search was performed including PubMed, Embase, Scopus, and Web of Science. Many retrospective studies investigated the possible risk factors for RA-related ILD (RA-ILD), aiming to identify patients at risk. Among them, males, smokers, positivity of anti-citrullinated peptide antibodies have been associated with RA-ILD, such as some genetic haplotypes. Usual interstitial pneumonia is the histologic and radiologic pattern most frequently observed, followed by nonspecific interstitial pneumonia. Since lung involvement can represent the RA onset, an early differential diagnosis with idiopathic interstitial pneumonia can be difficult or sometimes impossible. High-resolution computed tomography represents the gold standard for ILD diagnosis, while multidisciplinary discussion should be required to assess disease staging, severity and progression.  Expert opinion: Management of RA-ILD patients is challenging due to the lack of evidence-based data regarding both assessment and treatment. Moreover, the high variability of clinical presentation and evolution makes it difficult to establish the correct therapeutic strategy. Currently, multidisciplinary approach, including at least rheumatologists, pulmonologists, and radiologists, is desirable to define therapy and follow-up strategies.

The presence of both HLA-DRB1*04:01 and HLA-B*15:01 increases the susceptibility to cranial and extracranial giant cell arteritis

OBJECTIVES

To determine if patients with the predominant extracranial large-vessel-vasculitis (LVV) pattern of giant cell arteritis (GCA) have a distinctive HLA-B association, different from that reported in biopsy-proven cranial GCA patients. In a further step we assessed if the combination of HLA-B and HLA-DRB1 alleles confers an increased risk for GCA susceptibility, either for the cranial and extracranial LVV phenotypes.

METHODS

A total of 184 patients with biopsy-proven cranial GCA, 105 with LVV-GCA and 486 healthy controls were included in our study. We compared HLA-B phenotype frequencies between the three groups.

RESULTS

HLA-B*15 phenotype was significantly increased in patients with classic cranial GCA compared to controls (14.7% versus 5.8%, respectively; p<0.01; OR [95% CI] =2.81 [1.54-5.11]). It was mainly due to the HLA-B*15:01 allele (12.5% versus 4.0%, respectively; p<0.01; OR [95% CI] =3.51 [1.77-6.99]) and remained statistically significant after Bonferroni correction. Similar HLA-B*15 association was observed in patients with the LVV-GCA (11.4% versus 5.8%, p=0.04, OR [95% CI] =2.11 [1.04-4.30]). This association was also mainly due to the HLA-B*15:01 allele (10.5% versus 4.0%, respectively; p=0.0054; OR [95% CI] =2.88 [1.19-6.59]). Noteworthy, the presence of HLA-B*15:01 together with HLA-DRB1*04:01 led to an increased risk of developing both cranial and extracranial LVV-GCA.

CONCLUSIONS

Susceptibility to GCA is strongly related to the HLA region, regardless of the clinical phenotype of expression of the disease.

Immunoglobulins in systemic sclerosis management. A large multicenter experience

OBJECTIVE

To analyze the effectiveness and safety of intravenous immunoglobulin (IVIG) given in routine care to patients with systemic sclerosis (SSc).

METHODS

A retrospective multicenter observational study was conducted in SSc patients treated with IVIG. We collected data on epidemiological parameters and clinical outcomes. Firstly, we assessed changes in organ manifestations during IVIG treatment. Secondly, we analyzed the frequency of adverse effects. The following parameters were collected from baseline to the last follow-up: the patient's weight, modified Rodnan Skin Score (mRSS), modified manual muscle strength scale (MRC), laboratory test(creatine kinase(CK), hemoglobin and protein levels), The University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA GIT 2.0) questionnaire, pulmonary function tests, and echocardiography.

RESULTS

Data were collected on 78 patients (82% females; 59% with diffuse SSc). Inflammatory idiopathic myopathy was the most frequent concomitant overlap disease (41%). The time since Raynaud's phenomenon and SSc onset were 8.8 ± 18 and 6.2 ± 6.7 years respectively. The most frequent IVIG indication was myositis (38/78), followed by gastrointestinal (27/78) and cutaneous (17/78) involvement. The median number of cycles given were 5. 54, 53 and 9 patients have been treated previously with glucocorticoids, synthetic disease-modifying antirheumatic drugs and biologic therapies respectively. After IVIG use we found significant improvements in muscular involvement (MRC ≥ 3/5 92% IVIG, p = 0.001 and CK levels from 1149 ± 2026 UI to 217 ± 224 UI, p = 0.02), mRSS (15 ± 12.4 to 13 ± 12.5, p = 0.015) and improvement in total score of UCLA GIT 2.0 (p = 0.05). None Anti-RNA polymerase III patients showed an adequate response in gastrointestinal involvement (0/7) in comparison with other antibodies (0 vs. 25, p = 0,039). Cardiorespiratory involvement remained stable. A total of 12 adverse events were reported with only one withdrawn due to serious adverse effect.

CONCLUSIONS

this study suggest that IVIG may improve myositis, gastrointestinal and skin involvement in SSc patients treated in routine care and seems to have a good safety profile.

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Gitelman syndrome (GS) is an inherited salt-wasting tubulopathy characterized by hypocalciuria, hypokalemia, hypomagnesemia and metabolic alkalosis, due to inactivating mutations in the SLC12A3 gene. Symptoms may be systemic, neurological, cardiovascular, ophthalmological or musculoskeletal. We describe a 70 year-old patient affected by recurrent arthralgias, hypoesthesia and hyposthenia in all 4 limbs and severe hypokalemia, complicated by atrial flutter. Moreover, our patient reported eating large amounts of licorice, and was treated with medium-high dosages of furosemide, thus making diagnosis very challenging. Genetic analysis demonstrated a novel heterozygous mutation in the SLC12A3 gene; therefore, we diagnosed GS and started potassium and magnesium replacement. GS combined with chondrocalcinosis and neurological involvement is quite common, but this is the first case of an EMG-proven severe neuropathy associated with GS. Herein, we underline the close correlation between hypomagnesemia, chondrocalcinosis and neurological involvement. Moreover, we report a new heterozygous mutation in exon 23 (2738G>A), supporting evidence of a large genetic heterogeneity in this late-onset congenital tubulopathy.

SAT0264 LONG TERM FOLLOW-UP AND OPTIMIZATION OF INFLIXIMAB IN REFRACTORY UVEITIS DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY OF 103 CAUCASIAN PATIENTS

Background:

Biologic therapy has improved prognosis of Behçet Disease (BD) uveitis (1-5). Although infliximab (IFX) is approved in Japan, most data in Caucasian patients comes from small series. No data on optimization has been published

Objectives:

In a large series of Caucasian patients with refractory uveitis of BD, we assess:a) long-term efficacy and safety;b) IFX optimization when ocular remission was achieved

Methods:

Multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressants.103 patients were treated with IFX as 1st biologic as follows: 3-5 mg/kg i.v. at 0, 2, 6 and every 4-8 weeks. The main outcomes were anterior chamber cells, vitritis, retinal vasculitis, macular thickness, visual acuity, and glucocorticoids sparing effect; analysed at baseline, 1st week, 1st and 6th months and 1st and 2nd years. After remission, IFX optimization was performed

Results:

In whole series (n=103), main outcomes showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Severe side-effects were observed in 9 patients.

Comparative study between optimized and non-optimized groups showed:a) no differences in clinical baseline characteristics;b) similar maintained improvement in most ocular outcomes;c) lower severe adverse events andd) lower IFX cost in optimized group (4826.52 vs 9854.13 euros/patient/year)(Table)

Conclusion:

IFX seems effective and safe in Caucasian patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective

References:

[1]Martín-Varillas JL. Ophthalmology 2018;125:1444-1451.

[2]Atienza-Mateo B: Arthritis Rheumatol. 2019;71:2081-2089

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

[4]Urruticoechea-Arana A. Rheumatol Int. 2019;39:47-58.

[5]Atienza-Mateo B. Rheumatology (Oxford). 2018 1;57:856-864

Table.OptimizedN=18Non OptimizedN=42PPatients/eyes affected, n/n18/3442/77Age, mean (SD), years39.5 (9.8)38.8 (10.5)0.82Men, %55.659.50.78Duration of uveitis before IFX, median [IQR] months38 [18-119]35 [10-48]0.11Ocular features at time of IFX onset-AC cells count, median [IQR]2 [1-4]2 [1-2]0.29-Vitritis, median [IQR]2 [1.5-3]2 [1-2]0.02-BCVA, mean (SD)0.32 (0.21)0.37 (0.26)0.51-OCT, mean (SD)303.5 (23.3)397.7 (155.7)0.12-Retinal vasculitis, n (%)9 (50)26 (66.7)0.23Uveitis pattern, n (%)-Bilateral/unilateral16/2 (88.9/11.1)35/7 (83.3/16.7)0.71-Anterior0 (0)6 (14.3)0.17-Posterior5 (27.8)8 (19.0)0.50-Panuveitis13 (72.2)28 (66.7)0.67Prednisone dose at IFX onset, mean (SD), mg/d40.3 (20.6)41.4 (15.5)0.81IFX therapyMonotherapy/combined treatment, n (%)15 (83.3)30 (71.4)0.33-AZA5 (27.8)4 (9.5)0.11-CsA9 (33.3)8 (19.0)0.32-MTX4 (22.2)15 (35.7)0.30Follow-up on IFX therapy, median [IQR], months48 [33-60]24 [6-60]0.007-Relapses, median (IQR)0 [0-1]0 [0-2]-Remission, %10075.60.46-Severe side effects, n (per 100 patients/year)0 (0)3 (0.78)0.02-Cost (mean), euros per year4826.529854.130.55–

Disclosure of Interests:

José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Belén Atienza-Mateo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Emma Beltrán: None declared, Alfredo Adan: None declared, Elena Aurrecoechea: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, J. Luis Hernández: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

POS0113 BAFF-APRIL-BAFFR PATHWAY ON THE PATHOGENESIS OF IMMUNOGLOBULIN-A VASCULITIS

Background:

BAFF, APRIL and BAFFR are genes that encode cytokines with a key role in the development and survival of B-lymphocytes [1-4]: The B cell-activating factor (BAFF, also known as BLyS), a proliferation-inducing ligand (APRIL) and BAFF receptor (BAFF-R), respectively. Previous genetic studies have revealed that the BAFF-APRIL-BAFFR pathway is implicated in the genetic predisposition to several immune-mediated diseases [5].

Objectives:

To determine whether the BAFF-APRIL-BAFFR pathway represents a novel genetic risk factor for the pathogenesis of Immunoglobulin-A vasculitis (IgAV), an inflammatory disease in which IgA deposits and B-lymphocytes are crucial [6, 7].

Methods:

A functional BAFF polymorphism (rs374039502) and two tag variants within APRIL (rs11552708 and rs6608) and BAFFR (rs7290134 and rs77874543) were genotyped in 386 Caucasian IgAV patients (the largest series of Caucasian patients with IgAV ever assessed for genetic studies) and 806 sex and ethnically matched healthy controls by TaqMan assays.

Results:

No statistically significant differences in the genotype and allele frequencies between patients with IgAV and healthy controls were observed when each genetic variant of BAFF APRIL and BAFFR was analyzed independently (Table 1). Likewise, no statistically significant differences in genotype and allele frequencies of BAFF APRIL or BAFFR were found when patients with IgAV were stratified according to the age at disease onset or to the presence/absence of gastrointestinal or renal manifestations. Similar results were disclosed when haplotype frequencies of APRIL and BAFFR were compared between patients with IgAV and healthy controls as well as patients with IgAV stratified according to the age at disease onset or to the presence/absence of gastrointestinal or renal manifestations.

Conclusion:

Our results suggest that the BAFF-APRIL-BAFFR pathway does not contribute to the genetic network underlying IgAV.

References:

[1]J Exp Med 1999;190:1697-710; [2] Science 1999;285:260-3; [3] Nat Genet 2005;37:829-34; [4] Nat Immunol 2002;3:822-9; [5] N Engl J Med 2017;376:1615-26; [6] N Engl J Med 2013;368:2402-14; [7] Autoimmun Rev 2018;17:301-315.

Table 1.

Genotype and allele frequencies of BAFF, APRIL and BAFFR genes in patients with IgA vasculitis and healthy controls.

PolymorphismLocus1/2Data set1/11/22/212rs374039502BAFFT/APatients91.9 (353)8.1 (31)095.9 (737)4.1 (31)Controls91.5 (733)8.1 (65)0.4 (3)95.6 (1531)4.4 (71)rs11552708APRILG/APatients78.1 (299)20.6 (79)1.3 (5)88.4 (677)11.6 (89)Controls77.9 (625)20.4 (1641.6 (13)88.1 (1414)11.9 (190)rs6608APRILC/TPatients71.9 (277)26.0 (100)2.1 (8)84.9 (654)15.1 (116)Controls70.0 (561)27.6 (221)2.5 (20)83.7 (1343)16.3 (261)rs7290134BAFFRA/GPatients58.0 (224)36.3 (140)5.7 (22)76.2 (588)23.8 (184)Controls57.2 (459)36.4 (292)6.5 (52)75.3 (1210)24.6 (396)rs77874543BAFFRG/CPatients82.7 (316)16.0 (61)1.3 (5)90.7 (693)9.3 (71)Controls83.0 (666)16.6 (133)0.4 (3)91.3 (1465)8.7 (139)

Acknowledgements:

This study was supported by European Union FEDER funds and “Fondo de Investigaciones Sanitarias” (grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). DP-P is a recipient of a Río Hortega programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) [grant number CM20/00006]; SR-M is supported by funds of the RETICS Program co-funded by the European Regional Development Fund (ERDF) [grant number RD16/0012/0009]; VP-C is supported by a pre-doctoral grant from IDIVAL [grant number PREVAL 18/01]; BA-M is a recipient of a `López Albo´ Post-Residency Programme funded by Servicio Cántabro de Salud; LL-G is supported by funds of IDIVAL [grant number INNVAL20/06]; RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) [grant number CP16/00033].

Disclosure of Interests:

Diana Prieto-Peña 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, Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Verónica Pulito-Cueto: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Leticia Lera-Gómez: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, J. Narváez: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda-Filloy: None declared, LUIS CAMINAL MONTERO: None declared, PAZ COLLADO: None declared, Javier Sanchez Perez: None declared, Diego de Argila: None declared, Esteban Rubio-Romero: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galindez: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: 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, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD, Raquel López-Mejías: None declared

THU0311 CERTOLIZUMAB THERAPY IN REFRACTORY UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES (IMID). MULTICENTER STUDY OF 39 PATIENTS

Background:

Infliximab and adalimumab therapy has significantly improved the prognosis of patients with non-infectious refractory uveitis. However, there is not enough evidence for the use of other anti-TNF drugs such as Certolizumab Pegol (CZP).

Objectives:

To evaluate the efficacy and safety of CZP in uveitis secondary to Immune-Mediated Inflammatory Diseases (IMID).

Methods:

Multicenter study of 39 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants. Efficacy of CZP was evaluated with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, macular thickness and presence of retinal vasculitis. Efficacy of CZP was compared between baseline, 1st week, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with the STATISTICA software (Statsoft Inc. Tulsa, Oklahoma, USA).

Results:

39 patients/56 affected eyes (18 men/21 women) with a mean age of 40.5±11.9 years were studied. IMIDs included were: spondyloarthritis (n=17), psoriatic arthritis (6), Crohn (3), JIA (2), Behçet (2), reactive arthritis (2), rheumatoid arthritis (1), relapsing polychondritis (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (3). Uveitis pattern was as follows: anterior (n=30), posterior (4), panuveitis (3) and intermediate (2).

Previous CZP, patients received: oral prednisone (n=18) methylprednisolone bolus (1), methotrexate (22), azathioprine (10), cyclosporine (4), leflunomide (2), mycophenolate mofetil (2) and cyclophosphamide (1). 77% of patients had received previous biological therapy, with a mean of 1.6±1.2 biological drugs per patient. Gestational desire was the reason for prescribing CZP in 8 patients. CZP was administered in monotherapy in 16 patients and in the remaining 23 patients combined with conventional immunosuppressants.

After a median follow-up of 24 [6-36] months, most of the ocular variables analysed showed a rapid and significantly sustained improvement (Table). CZP was discontinued in 11 patients for the following reasons: remission (n=1), insufficient response of ocular symptoms (n=1) and limited response of extraocular manifestations (n=9). No serious adverse effects were reported.

Conclusion:

CZP seems to be effective and safe in patients with refractory uveitis due to IMID.

TableBaseline1stweek1stMonth6thMonth1styear2ndyearBCVA (mean±SD)0.77±0.290.77±0.30*0.82±0.29*0.85±0.26*0.86±0.27*0.88±0.23*Tyndall (median [IQR])0 [0-2]0 [0-2]0 [0-1]*0 [0-0]*0 [0-0]*0 [0-0]*OCT (mean±SD)355±61.5-284.1±40.4*-224.8±121.1*-Retinal Vasculitis (eyes affected, %)2 (3.6)0 (0)0 (0)0 (0)0 (0)0 (0)

*p<0.05

Disclosure of Interests:

José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Iñigo González-Mazón: None declared, Ignacio Torre-Salaberri: None declared, Álvaro García Martos: None declared, Amalia Sanchez-Andrade: None declared, Ángel García-Aparicio: None declared, JR De Dios-Jiménez Aberásturi: None declared, ANA URRUTICOECHEA-ARANA: None declared, Olga Maíz: None declared, Raul Veroz Gonzalez: None declared, Andrea García-Valle: None declared, Sergio Rodríguez Montero: None declared, Roberto Miguélez: None declared, Vega Jovani: None declared, Marisa Hernández-Garfella: None declared, Arantxa Conesa: None declared, Olga Martínez González: None declared, Paula Rubio Muñoz: None declared, Belén Atienza-Mateo: 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

POS0595 ABATACEPT IN USUAL AND IN NON-SPECIFIC INTERSTITIAL PNEUMONIA ASSOCIATED TO RHEUMATOID ARTHRITIS. NATIONAL MULTICENTER STUDY OF 190 PATIENTS

Background:

Interstitial lung disease (ILD) is a severe complication of Rheumatoid Arthritis (RA). Usual interstitial pneumonia (UIP) is considered to be more frequent and severe in RA than non-specific interstitial pneumonia (NSIP). Abatacept (ABA) and Rituximab have demonstrated efficacy in RA-ILD [1-3].

Objectives:

To compare the efficacy of ABA in RA-ILD patients according to radiological patterns of UIP or NSIP.

Methods:

From an observational multicenter study of 263 RA-ILD patients treated with ABA, we selected those with UIP or NSIP [2]. We analyzed in the 2 groups from baseline up to 24 months the following outcomes: a) Forced Vital Capacity (FVC), b) Carbon monoxide diffusing capacity (DLCO), c) Chest High Resolution Computed Tomography (HRCT), and d) dyspnea. Differences between final follow-up and basal visit were calculated as the average difference and 95% Confidence Interval (95% CI). Multivariable linear regression was used to assess the differences between the 2 groups.

Results:

We studied 190 patients with UIP (n=106) and NSIP (n=84). Patients with UIP were older, had more positivity for rheumatoid factor and had received more sulfasalazine (Table 1). ILD duration up to ABA initiation was relatively short in both groups, with a median [IQR] of 16 [4-50] and 11 [2-36] months in UIP and NSIP patterns, respectively. Mean baseline values of FVC and DLCO were > 80% and > 60%, respectively, in the 2 groups, with a lower FVC in UIP (82% vs 89% in NSIP, p<0.05). The evolution of FVC and DLCO is shown in Figure 1. Both parameters remained stable during 24 months of ABA therapy. Available chest HRCT images improved/ stabilized in 73.1% and 72.9% of UIP and NSIP patterns, respectively. With multivariable linear regression analysis, no differences were found in the changes of FVC, DLCO, or HRCT images. Stabilization or improvement of dyspnea was found in 91% and 95% of UIP and NSIP patterns, respectively.

Conclusion:

ABA seems to be equally effective in stabilizing of DLCO, FVC and HRCT in UIP and NSIP in RA-ILD. Our results suggest that an early administration of ABA in ILD, before significant structural lung damage development, may be preferable to prevent interstitial progression, regardless of the radiological pattern.

References:

[1]Fernández-Díaz C, et al. Semin Arthritis Rheum. 2018 Aug;48(1):22-27. doi: 10.1016/j.semarthrit.2017.12.012

[2]Fernández-Díaz C, et al. Rheumatology (Oxford). 2020 Dec 1;59(12):3906-3916. doi: 10.1093/rheumatology/keaa621

[3]Atienza-Mateo B, et al. J Clin Med. 2020 Sep 23;9(10):3070. doi: 10.3390/jcm9103070

Table 1.

Main general features at baseline.

UIP (n=106)NSIP (n=84)p valueAge, years mean±SD66±1063±100.049Women, n (%)59 (56)49 (58)0.71Smoker ever, n (%)51 (48)45 (54)0.46ILD duration up toABA, months, median [IQR]16 [4-50]11 [2-36]0.57RF100 (94)71 (85)0.041ACPA, n (%)96 (91)75 (89)0.83FVC (% of the predicted), mean±SD82±2189 ±190.025DLCO (% of the predicted), mean±SD63 ±1965 ±160.46ABA monotherapy, n (%)45 (42)41 (49)0.38ABA combined+ MTX // + other cDMARD, n (%)15 (14) // 46 (43)16 (19) // 27 (32)0.17Prednisone at baseline, mg/day, median [IQR]7.5 [5-10]10 [5-10]0.20Previous immunosuppressive therapy, n (%)MTX81 (76)68 (81)0.45Leflunomide48 (45)31 (37)0.25Sulfasalazine16 (15)5 (6)0.046Hydroxychloroquine24 (23)16 (19)0.55Anti-TNF drugs37 (35)30 (36)0.80Rituximab19 (18)15 (18)0.99Tocilizumab12 (11)12 (14)0.54

ABA, abatacept; ACPA, anti-citrullinated protein antibodies; DMARD, disease-modifying antirheumatic drug, ILD, Interstitial lung disease; MTX, methotrexate; NSIP, non-specific interstitial pneumonia; RA, rheumatoid arthritis; TNF, tumor necrosis factor; UIP, usual interstitial pneumonia.

Figure 1.

Evolution of pulmonary function tests in RA-ILD patients with UIP and NSIP patterns. FVC and DLCO are expressed as mean (95%CI) and compared between the 2 groups.

Acknowledgements:

the Spanish Collaborative Group of Abatacept in Interstitial Lung Disease Associated with Rheumatoid Arthritis

Disclosure of Interests:

Belén Atienza-Mateo: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Myers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, FRANCISCO ORTIZ SANJUAN: None declared, Ivette Casafont-Solé: None declared, Sebastián C Rodriguez-García: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay: None declared, Ricardo Blanco Speakers bureau: Brystol Myers Squibb

SAT0014 ENDOTHELIAL PROGENITOR CELLS: ROLE IN ENDOTHELIAL DAMAGE OF INTERSTITIAL LUNG DISEASE ASSOCIATED TO RHEUMATOID ARTHRITIS

Background:

Interstitial lung disease (ILD) is one of the most significant comorbidities of rheumatoid arthritis (RA), increasing the mortality in these patients [1,2]. Although the pathogenesis of ILD associated to RA (RA-ILD+) remains poorly defined [1], it is known that vascular tissue plays a crucial role in lung physiology [3]. In this context, a population of cells termed endothelial progenitor cells (EPC) are involved in vasculogenesis and endothelial tissue repair [4]. Previous reports suggest the implication of EPC in different conditions such as RA and idiopathic pulmonary fibrosis (IPF), the most common and destructive ILD [5,6]. Nevertheless, little is known about their specific role in RA-ILD+.

Objectives:

The purpose of this study was to shed light on the potential role of EPC in endothelial damage in RA-ILD+.

Methods:

Peripheral venous blood was collected from a total of 68 individuals (18 with RA-ILD+, 17 with RA-ILD-, 19 with IPF and 14 healthy controls). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of EPC was analyzed by the expression of surface antigens by flow cytometry. The combination of antibodies against the stem cell marker CD34, the immature progenitor marker CD133, the endothelial marker VEGF receptor 2 (CD309) and the common leukocyte antigen CD45 was used. EPC were considered as CD34+, CD45Low, CD309+and CD133+. All statistical analyses were performed using Prism software 5 (GraphPad).

Results:

EPC frequency was significantly increased in patients with RA-ILD+, RA-ILD-and IPF compared to controls (p=0.001, p=0.002, p< 0.0001, respectively). Nevertheless, patients with RA, both RA-ILD+and RA-ILD-, showed a lower frequency of EPC than those with IPF (p= 0.048, p= 0.006, respectively).

Conclusion:

Our results provide evidence for a potential role of EPC as a reparative compensatory mechanism related to endothelial damage in RA-ILD+, RA-ILD-and IPF patients. Interestingly, EPC frequency may help to establish a differential diagnostic between patients with IPF and those who have an underlying autoimmune disease (RA-ILD+).

References:

[1] J Clin Med 2019; 8: 2038;

[2] Arthritis Rheumatol 2015; 67: 28-38;

[3] Nat Protoc 2015; 10: 1697-1708;

[4] Science 1997; 275: 964-966;

[5] Rheumatology (Oxford) 2012; 51: 1775-1784;

[6] Angiogenesis 2013; 16: 147-157.

Acknowledgments:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: PI18/00042 (ISCIII-ERDF); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Sonia Fernández-Rozas: None declared, Leticia Lera-Gómez: None declared, Pilar Alonso Lecue: None declared, Javier Rodriguez Carrio: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, David Merino: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD, Alfonso Corrales Speakers bureau: Abbvie, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

THU0150 INTERSTITIAL LUNG DISEASE RELATED TO RHEUMATOID ARTHRITIS. WHAT DO WE DON’T KNOW? THE LIRA STUDY (LUNG INVOLVEMENT IN RHEUMATOID ARTHRITIS)

Background:

Interstitial lung disease (ILD) is one of the more frequent and potentially severe extra-articular manifestation of rheumatoid arthritis (RA). ILD significantly decreases the survival and quality of life of patients and influences the treatment approach to the patient.

Despite its clinical relevance, the prevalence, incidence and survival of RA-ILD is unknown and supposed on the base of retrospective data or registry-based studies.

Objectives:

For the first time, the Lung Involvement in Rheumatoid Arthritis (LIRA) study aims to investigate epidemiology, features and prognosis of RA-ILD patients in a prospective international multicentre study.

Methods:

All RA patients referring to the involved centres will be evaluated every six months with a digital stethoscope and a software able to identify velcro crackles with a diagnostic accuracy of 83.9% (VECTOR). In fact, velcro crackles are virtually identified in all stages of fibrosing alveolitis like RA-ILD, and their search is as a simple and reliable method to screening patients to be undergone to high resolution computed tomography (HRCT).

For each patient, clinical and serological data are recorded at baseline and every six months; when velcro crackles or other conditions suspicious for ILD, such as cough or dyspnoea, are detected, a HRCT is requested to confirm ILD. Patients with ILD periodically perform pulmonary function tests to monitor lung function evolution.

Results:

At now, 205 RA patients have been enrolled (female/male 161/44, mean age 64.8±12.9 years, mean disease duration 14.2±8.9 years), anti-citrullinated peptides antibodies (ACPA) and rheumatoid factor (RF) were positive in 77.1% and 78.1%, respectively. The prevalence of ILD was 21% (43 patients). In other 13 patients the HRCT is ongoing; therefore, we could suppose up to a prevalence of 27.3%. Patients with ILD were symptomatic in 53.5% of cases (23 patients), they are more frequently males and were older than patients without ILD (mean age 73.2±7.4 and 62.7±13.2; p<0.0001, female/male ratio 139/23 vs 22/21; p<0.0001) without significant differences regarding disease duration, positivity for ACPA or RF.

Conclusion:

The prevalence and the incidence of RA-ILD is still not well defined. Preliminary data of our study confirm a prevalence of ILD higher than 20%, patients are asymptomatic in almost the half of cases and more frequently males and elderly. Our study can help to define the clinical history of these patients, the possible association with clinical and serological features and the supposed role of some drugs.

References:

[1]Manfredi A, et al. Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device). BMC Pulm Med. 2019;19:111.

[2]Bendstrup E, et al. Interstitial Lung Disease in Rheumatoid Arthritis Remains a Challenge for Clinicians. J Clin Med. 2019:8

Disclosure of Interests:

Marco Sebastiani: None declared, Caterina Vacchi: None declared, Giulia Cassone: None declared, Fabiola Atzeni: None declared, Martina Biggioggero: None declared, Antonio Carriero: None declared, Gian Luca Erre: None declared, Anna Laura Fedele: None declared, Federica Furini: None declared, Paola Tomietto: None declared, Vincenzo Venerito: None declared, Belén Atienza-Mateo: None declared, Giovanni Della Casa: None declared, Stefania Cerri: None declared, Gilda Sandri: None declared, Adalgisa Palermo: None declared, Elena Galli: None declared, Fabrizio Pancaldi: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Carlo Salvarani: None declared, Andreina Manfredi: None declared

POS0426 CIRCULATING MICRORNA PROFILING IN PATIENTS WITH ANTI-SYNTHETASE SYNDROME AND INTERSTITIAL LUNG DISEASE

Background:

Anti-synthetase syndrome (ASSD) is an autoimmune disease characterized by autoantibodies against one of many aminoacyl transfer RNA (tRNA) synthetases. Interstitial Lung Disease (ILD) in ASSD patients is frequent, often severe and rapidly progressive, causing much of the increased morbidity and mortality associated with ASSD as compared to other idiopathic inflammatory myopathies [1].

Objectives:

In this study, we hypothesized that immune-related miRNAs may be associated with presence/absence of lung involvement in patients with ASSD and help predict disease course.

Methods:

A total of 15 ASSD patients were enrolled: 11 with ILD and 4 without ILD. Differentially expressed miRNAs were identified in plasma derived-exosome, using miRNA PCR array (MIHS-111ZG, Qiagen) including 84 miRNAs involved in activation and differentiation of T and B cells.

Results:

Among all miRNAs analyzed we found that miR-15b-5p, miR-23a-3p, miR-25-3p, miR-30a-5p and miR29c-3p were up-regulated in ASSD-ILD patients (p<0.05) as compared to patients without lung involvement (Figure 1). To evaluate the effectiveness of the five miRNAs for predicting ILD among ASSD patients, ROC curves were constructed. The AUCs of miR-15b-5p, miR-25-3p, miR-30a-5p and miR29c-3p were 0.83, 0.87, 0.86 and 0.89, respectively (p= 0.05 for miR-25-3p and p<0.05 for all other curves). The prediction of the biologic targets and pathways as well as cellular processes by DIANA-mirPath analysis showed that all miRNAs associated with ILD presence are involved in PI3K-Akt signaling pathway.

Conclusion:

Our study shows that, in ASSD patients with ILD, miR-15b-5p, miR-23a-3p, miR-25-3p, miR-30a-5p and miR29c-3p were up-regulated compared to patients without evidence of ILD. A clear involvement in immune and inflammatory diseases was documented for the miRNAs identified [2] and, for many of these, studies in the literature indicate a possible role in pulmonary fibrosis [3]. It is notable that these miRNAs were related to PI3K-Akt signaling pathway that regulate cell proliferation, differentiation and apoptosis [4]. It has also been demonstrated that in lung fibroblast the PI3K–Akt signals can be aberrantly activated [5]. The identification of markers could be important in the early identification of the disease and for its treatment.

References:

[1]Kalluri M, Oddis CV. Pulmonary manifestations of the idiopathic inflammatory myopathies. Clinics in chest medicine. 2010; 31:501–512.

[2]Prabahar A, Natarajan J, ImmunemiR-a database of prioritized immune miRNA disease associations and its interactome. MicroRNA, 2017; 6: 71–78.

[3]Sessa R, Hata A. Role of microRNAs in lung development and pulmonary diseases. Pulm Circ. 2013; 3:315-28.

[4]Ersahin T, Tuncbag N, Cetin-Atalay R. The PI3K/AKT/mTOR interactive pathway. Mol Biosyst. 2015;11:1946-54.

[5]Zhang XL, Xing RG, Chen L, Liu CR, Miao ZG. PI3K/Akt signaling is involved in the pathogenesis of bleomycin-induced pulmonary fibrosis via regulation of epithelial-mesenchymal transition. Mol Med Rep. 2016;14:5699-5706.

Figure 1.

Comparison of relative levels of five miRNAs among patients with and without lung involvement were expressed as log2 transformed values. *p<0.05; **p<0.01

Disclosure of Interests:

None declared

AB0365 CLINICAL, LABORATORY AND IMAGING OUTCOMES IN TOCILIZUMAB-TREATED PATIENTS WITH LARGE VESSEL-GIANT CELL ARTERITIS ACCORDING TO EARLY ONSET THERAPY

Background:

Tocilizumab (TCZ) has shown efficacy in large vessel vasculitis (LVV)-Giant Cell Arteritis (LVV-GCA) (1-2). 18F-fluodeoxyglucose positron emission tomography (18F-FDG PET/CT) is useful to assess LVV disease activity (3-5). It is unknown if early treatment with TCZ may have an influence on clinical, laboratory and imaging outcomes.

Objectives:

To assess clinical, laboratory and PET/CT activity improvement in LVV-GCA patients treated with TCZ according to the time from disease diagnosis to TCZ onset.

Methods:

Comparative single-center study of 30 LVV-GCA patients treated with TCZ who were divided into 2 groups depending on the time of onset of TCZ: a) early onset (≤ 6 months; n=15) and b) late onset (> 6 months; n=15). All patients had a baseline and a follow-up PET/CT scan. Complete clinical improvement and normalization of laboratory markers (CRP ≤0.5mg/dL and/or ESR ≤ 20 mm/1st hour) was assessed. For imaging evaluation, normalization of total visual score (TVS) was considered when TVS = 0 and normalization of semiquantitative activity if the target to background ratio (TBR) at the thoracic aorta was <1.34.

Results:

30 patients were included (24 women/6 men); mean age 65.7± 9.8 years. Patients in the TCZ early-onset group were receiving higher doses of prednisone (10.0[5.9-15.0] vs 5.0 [5.0-7.5] mg/day; p< 0.01) and had higher TVS scores (7.0 [4.0-9.0] vs 3.0 [2.0-5.0]; p< 0.01) at baseline (Table 1). Following TCZ initiation, after a mean of 10.8±3.7 months, most patients achieved complete clinical improvement and normalization of ESR and CRP in both groups. Uncoupling with imaging outcomes was observed in both groups. Although non-significant statistical differences were observed, complete TBR normalization (TBR <1.34) and complete TVS normalization (TVS=0) tended to be more frequent in the group of patients who received early-onset TCZ therapy (Figure 1).

Table 1.Early-onset TCZ therapy(n= 15)Late-onset TCZ therapy(n=15)pGeneral featuresAge (years), mean ± SD65.8 ± 9.965.5 ± 10.10.94Sex (female), n (%)11 (73.3)13 (86.7)0.65GCA evolution before TCZ onset, median [IQR]2.0 [1.0-5.0]18.0 [9.0-34.0]< 0.01LaboratoryESR (mm/1st hour), mean ± SD34.7 ± 26.330.8 ± 28.70.70CRP (mg/dL), median [IQR]1.1 [0.6-2.3]0.8 [1.8 -2.5]0.28Prednisone dose (mg/day), mean ± SD10.0 [5.9-15.0]5.0 [5.0-7.5]0.01TCZ therapyIntravenous, n (%)10 (66.7)11(73.3)0.99Combined with MTX, n(%)6 (40)8 (53.3)0.46PET /CT activityTBR at thoracic aorta1.86 ± 0.691.54 ± 0.180.09TVS7.0 [4.0-9.0]3.0 [2.0-5.0]< 0.01Complete clinical improvement, n (%)13 (86.7)12 (80)0.99Normalization of ESR and CRP, n (%)15 (100)15 (100)0.99PET/CT improvementComplete TBR normalization6 (40)3 (20)0.23Complete TVS normalization2 (13.3)1 (6.7)0.54

CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; TBR: target-to-background ratio. * Normalization of TBR was considered when TBR < 1.34. ** Normalization of TVS was considered when TVS=0.

Conclusion:

TCZ was effective in patients with LVV-GCA regardless the time from disease diagnosis to TCZ onset. However, complete normalization of vascular activity in PET/CT scans tended to occur more likely in patients who receive early-onset TCZ therapy within the first 6 months of the disease.

References:

[1]Calderón-Goercke M et al. Semin Arthritis Rheum. 2019; 49:126-135. PMID: 30655091

[2]Prieto Peña D et al. Clin Exp Rheumatol. 2020. PMID: 33253103

[3]González-Gay MA et al. Expert Rev Clin Immunol. 2018; 14:593-605. PMID: 29877748

[4]Martínez-Rodríguez et al. Semin Arthritis Rheum.2018; 47(4): 530-537. PMID: 28967430

[5]Prieto-Peña D et al. Semin Arthritis Rheum. 2019; 48:720-727. PMID: 28967430

Disclosure of Interests:

Diana Prieto-Peña Grant/research support from: UCB Pharma, Roche, Sanofi, Pfizer, AbbVie and Lilly, Isabel Martínez-Rodríguez: None declared, Belén Atienza-Mateo: None declared, Oriana Cuenca-Vera: None declared, Francisco Javier Gomez de la Fuente: None declared, Aida Sanchez-Salmón: None declared, Miguel A González-Gay Grant/research support from: Abbvie, MSD, Jansen and Roche and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD

POS0513 ABATACEPT IN MONOTHERAPY VERSUS COMBINED IN INTERSTITIAL LUNG DISEASE OF RHEUMATOID ARTHRITIS. MULTICENTER STUDY OF 263 CAUCASIAN PATIENTS

Background:

Interstitial lung disease (ILD) is a severe complication of RA. Abatacept (ABA) have demonstrated efficacy in RA-ILD [1,2], although combined treatment with MTX or others DMARDs remain controversial.

Objectives:

To assess the efficacy and safety of ABA in monotherapy (ABAMONO) versus combined-ABA, ABA plus MTX(ABAMTX) or ABA plus other non-MTX DMARDs (ABANON-MTX), in RA-ILD.

Methods:

Observational multicenter study of RA-ILD caucasian patients treated with ABA. We analyzed in three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcomes: a) Dyspnea, b) FVC and DLCO, c) HRCT, d) DAS28-ESR, e) corticosteroid-sparing effect. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used between the three groups.

Results:

We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABAMONO (n=111), ABAMTX (n=46) and ABANON-MTX (n=106)]. At baseline, ABAMONO patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). There was no statistically significant differences in sex, seropositivity, ILD patterns, FVC, DLCO or disease duration. In all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnea, HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in ABAMTX or ABANON-MTX(Figure 1). However, in the multivariable analysis, there were no differences in any outcome between the three groups(Table 1).

Table 1.

Effect in FVC, DLCO, dyspnea (mMRC) and HRCT pulmonary scan after abatacept.

ABAMONON=111ABAMTXN=46ABANON-MTXN=106ABAMTXvs ABAMONOABANON-MTXvs ABAMONOpppp*UnadjustedAdjusted**UnadjustedAdjusted**Follow-up, median [IQR] months12 [6-36]12 [6-36]18[12-36]0.400.670.17Differences between basal and final follow-upFVC, %-0.5 (-2.5, 1.5)0.641.2(-0.6, 3.1)0.17-1.2 (-2.9, 0.5)0.170.330.300.390.590.90DLCO, %1.8 (-0.7, 4.34)0.160.5 (-3.8, 4.8)0.82-1.5 (-4.1, 1.1)0.260.200.580.800.070.32mMRC, n (%)Worsening5 (5)3 (8)5 (5)0.830.470.99Stable or improving93 (95)36 (92)87 (95)HRCT pulmonary scan, n (%)Worsening13 (28)2 (11)15 (25)0.240.100.78Stable or improving34 (72)19 (89)44 (75)DAS28-ESR-1.5 (-1.9, -1.0)0.000-1.2 (-1.8, -0.6)0.000-1.5 (-1.8, -1.2)0.0000.740.580.92Prednisone, mg/day-3.8 (-8.3, 0.8)0.10-2.7 (-4.6, -0.8)0.006-4.8 (-6.3, -3.4)0.0000.690.670.65

Differences in DAS28-ESR, prednisone, FVC and DLCO are expressed as mean difference (95%CI) comparing final follow-up minus basal values.

*Differences between the 3 groups.

**Differences between ABAMTX vs. ABAMONO, and between ABANON-MTX vs ABAMONO are adjusted for age, disease duration until abatacept treatment, and DAS28 and prednisone dose at baseline.

Abbreviations(DAS28-ESR: Disease activity score-erythrocyte sedimentation rate; DLCO: Carbon Monoxide Diffusing Capacity; HRCT: High resolution computed tomography; FVC: Forced vital capacity, mMRC: modified Medical Research Council scale

Figure 1.

Conclusion:

In caucasian individuals with RA-ILD, ABAMONO or ABAMTX or ABANON-MTX seems to be equally effective and safe. However, a corticosteroid-sparing effect is only observed in combined-ABA.

References:

[1]Fernández-Díaz C, et al. Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients. Semin Arthritis Rheum. 2018 Aug;48(1):22-27. doi: 10.1016/j.semarthrit.2017.12.012.

[2]Fernández-Díaz C, et al. Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients. Rheumatology (Oxford). 2020 Dec 1;59(12):3906-3916. doi: 10.1093/rheumatology/keaa621.

Acknowledgements:

Spanish Collaborative Group of Interstitial Lung Disease Associated to Rheumatoid Arthritis

Disclosure of Interests:

Carlos Fernández-Díaz Speakers bureau: Roche, bristol myers squibb, Belén Atienza-Mateo: None declared, Santos Castañeda: None declared, Rafael Melero: None declared, Francisco Ortiz-Sanjuán: None declared, Ivette Casafont-Solé: None declared, J. Loricera: None declared, Sebastián C Rodriguez-García: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay: None declared, Ricardo Blanco Speakers bureau: bristol myers squibb

AB0430 CONTRIBUTION OF SCLERODERMA/MYOSITIS-RELATED ANTIBODIES DETECTED BY IMMUNOBLOT TO THE DIAGNOSIS OF SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES IN 134 PATIENTS FROM A SINGLE REFERRAL CENTER

Background:

Immunoblot assays are increasingly used in clinical practice as part of the diagnostic armamentarium of systemic autoimmune rheumatic diseases (SARDs).

Objectives:

To assess the contribution of an extended scleroderma/myositis-related antibodies (Ab) determination by immunoblot to the diagnosis of patients with SARDs.

Methods:

We reviewed all medical records of patients with positive scleroderma/myositis-related Ab line blot determinations (Euroimmune AG, Lübeck, Germany) in our center from November 2017 to September 2020. These assays were requested due to high suspicion of SARDs in patients presenting with non-specific symptoms.

Results:

134 patients (37men/97women; mean age 59.6 ± 14.8 years) were positive for at least 1 Ab, 25 of them were positive for 2 Abs. Main clinical features at the time of immunoblot requests were: arthralgia/arthritis (n=88), Raynaud’s phenomenon (n=59), rash (n=27), sicca syndrome (n=14.9%), myopathy (n=18). During follow-up, 28 patients were diagnosed with undifferentiated connective tissue disease (UCTD), 26 scleroderma, 23 overlap myositis, 18 interstitial pneumonia with autoimmune features (IPAF), 8 other inflammatory diseases, 8 Sjögren’s syndrome, 7 systemic lupus erythematosus, 5 dermatomyositis, 1 necrotizing myositis. In 10 patients the diagnosis of SARD was finally ruled out (Figure 1). Interstitial lung disease (ILD) was present in 50 patients, being particularly frequent in those with anti-PL12, anti-PL7 and anti-MDA5 Abs. Cancer was detected in 9 (6.7%) patients, 6 of them were anti-Ro52 + (Table 1).

Conclusion:

Immunoblot assays are of great help in the diagnosis of patients with high clinical suspicion of SARDs. While some Abs, such as anti-Ro52, anti-Ku and anti-PMScl75/100, remain to be nonspecific, other Abs including anti-PL12, anti-PL7 or anti-MDA5 are particularly helpful in detecting SARDs patients with associated ILD.

References:

Table 1.Mi-2 (n=5)PL-7(n=6)PL-12(n=4)Jo-1(n=6)MDA5(n=1)antiRo52(n=57)SRP (n=3)Scl-70(n=12)CENP(n=14)Th(n=2)Ku(n=14)Fibrilarina (n=2)PM-Scl75/100 (n=23)NOR90(n=8)RNA pol(n=2)ILD04 (66.7)4 (100)3 (50)1 (100)19 (33.3)07 (58.3)1 (7.1)07 (50)1 (50)9 (39.1)5 (62.5)0Cancer1 (20)00006 (10.5)1 (33.3)0001 (7.1)0000

Disclosure of Interests:

None declared

AB1431 EPIDEMIOLOGICAL AND GENETIC FEATURES OF ANTI-3-HYDROXY-3-METHYLGLUTARYL-COA REDUCTASE NECROTIZING MYOPATHY IN NORTHERN SPAIN: SINGLE-CENTER EXPERIENCE

Background

Anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) immune-mediated necrotizing myopathy (IMNM) is an entity of growing interest. However, data on epidemiology and clinical spectrum are still scarce and there is a need for the identification of its potential risk factors.

Objectives

To characterize the demographic, genetic, clinical, and serological features of patients with anti-HMGCR IMNM in a region of northern Spain.

Methods

Study of all patients diagnosed with anti-HMGCR IMNM during a 5-year period at a reference hospital in Northern Spain. Besides clinical and laboratory data, we analyzed the genetic influence of HLA genes and the rs4149056 (c.521T>C) single nucleotide polymorphism (SNP) in the SLCO1B1 gene.

Results

8 patients (5 women, 3 men) with a mean ± SD age of 64.9±7.3 years, fulfilled the criteria for anti-HMGCR IMNM. The incidence rate was 0.6 per 100.000 person-years and the prevalence 3 per 100.000 population. All patients had dyslipidemia and had been exposed to statins. Seven of the 8 of cases complained of myalgia. All of them had predominant lower limb proximal and symmetric muscle weakness that was severe in 2 of them. None of the patients had extra-muscular involvement. No evidence of malignancy was found. All patients had elevated serum CK levels with a median [IQR] of 4488 [2538-9194] IU/L. Serum 25-hydroxy vitamin D levels were decreased in all patients in whom it was determined. The 3 patients with a previous diagnosis of hypothyroidism had abnormal levels of TSH at the time of diagnosis. All patients experienced improvement with different schemes of immunosuppressive therapy. Noteworthy, 7 of 8 patients carried the HLA-DRB1*11 allele. The frequency of the rs4149056 C allele in the SLCO1B1 gene (12.5%) was similar to that of the general population.

Conclusion

In northern Spain, the IMNM anti-HMGCR preferentially affects people over 50 years of age who are carriers of the HLA-DRB1*11 allele and take statins. Both low vitamin D levels and hypothyroidism may play a potential predisposing role in the development of this disease

Table 1.PatientAge/SexHLA DRB1*11rs4149056 genotypeMRC at the weakest muscle group*DysphagiaCK (IU/L) at diagnosisAnti-HMGCR titer (CU)Induction therapy*Maintenance therapyClinical improvement**CK (IU/L) at last follow-up visit156/MYesTT2No8963277.8GC. IVIG.MTXGC. IVIG. MTX. RTXMarked134269/FYesTT0Yes9271235.9GC iv bolus. IVIG.GC. MTX. RTX.Marked890364/FYesTT3No4000242.6IVIG.IVIG.RTXMarked1284479/MYesTT4No4977145.6GC. IVIG.GC. IVIG.Complete92562/FNoTT3No2116210.0GCGC.MTX.Marked236657/FYesTC4No2294259.3IGIVIGIVComplete235768/FYesTT3No3273236.0GC. IGIV. AZA.GC. AZAComplete249864/MYesTC4Yes11000179.0GC iv bolus. AZA.GC. AZAComplete161

AZA: azathioprine; CK: creatinine kinase; CU: chemiluminescence units; F: female; GC: glucocorticoids; IVIG: intravenous immunoglobulins; M: male; MRC: medical research council scale; MTX: methotrexate; RTX: rituximab; ** Induction therapy initiated within 3 months of diagnosis. **Clinical improvement: no improvement (no improvement in MRC grade), mild improvement (improvement of MRC grade but still requiring assistance for activities of daily living), marked improvement (persistence of mild weakness without functional limitation), and complete improvement (return to baseline with no symptoms or signs of weakness).

Disclosure of Interests

None declared

POS0405 INCREASED LEVELS OF CELLULAR ADHESION MOLECULES ARE LINKED TO THE PRESENCE OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH AUTOIMMUNE DISEASES

Background

Intercellular adhesion molecule-1 (ICAM-1) and E-Selectin are adhesion molecules considered as markers of underlying endothelial activity and damage. These molecules are known to play an important role in autoimmune disease (AD) [1]. Accordingly, they may contribute to the development of interstitial lung disease (ILD), one of the main causes of death in patients with AD [2]. In fact, they have been proposed as prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) [3]. However, studies on the role of ICAM-1 and E-Selectin in AD-ILD+ are scarce.

Objectives

To study the role of ICAM-1 and E-Selectin in the pathogenesis of AD-ILD+.

Methods

Peripheral venous blood was collected from 57 patients with AD-ILD+ and three comparative groups: 45 AD-ILD- patients, 21 IPF patients and 21 healthy controls (HC). All the subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. ICAM-1 and E-Selectin levels were measured in serum samples by enzyme-linked immunosorbent assay.

Results

Higher levels of ICAM-1 and E-Selectin were found in patients with AD-ILD+ compared to AD-ILD- patients (p<0.001 and p=0.001, respectively) and HC (p<0.001 in both cases). Likewise, IPF patients showed increased levels of ICAM-1 and E-Selectin in relation to AD-ILD- patients (p<0.001 and p=0.002, respectively) and HC (p<0.001 in both cases). However, no statistically significant difference in ICAM-1 and E-Selectin concentrations was observed between AD-ILD+ and IPF patients.

Conclusion

Our study suggests that increased levels of ICAM-1 and E-Selectin are associated with the presence of ILD in AD patients.

References

[1]Int J Mol Sci 2014;15(7):11324-49;

[2]Expert Rev Clin Immunol 2018;14(1):69-82;

[3]Eur Respir J 2019;54(3):1900295

Acknowledgements

VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01); SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from `Instituto de Salud Carlos III´ (ISCIII), co-funded by the European Regional Development Fund; 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

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Leticia Lera-Gómez: None declared, Diana Prieto-Peña: 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, Alfonso Corrales: None declared, Oreste Gualillo: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche.

AB0146 BAFF, APRIL y BAFFR: DIFFERENTIAL BIOMARKERS BETWEEN IgA VASCULITIS AND IgA NEPHROPATHY?

Background

IgA vasculitis (IgAV) and IgA nephropathy (IgAN) are inflammatory conditions [1, 2], that share pathogenic mechanisms [1], in which B-lymphocytes are described as key cells implicated in these processes. BAFF, APRIL and BAFF-R are cytokines implicated in the development of B-lymphocytes [3, 4] and in autoimmune processes [5, 6]. In this regard, an influence of BAFF, APRIL and BAFFR polymorphisms was observed on several immune-mediated conditions, being BAFF GCTGT>A a shared insertion-deletion variant for inflammatory conditions [7, 8].

Objectives

To determine whether BAFF, APRIL and BAFFR could be used as differential biomarkers between IgAV and IgAN.

Methods

BAFF rs374039502 (which colocalizes with BAFF GCTGT>A), two tag variants within APRIL (rs11552708 and rs6608) and two tag variants within BAFFR (rs7290134 and rs77874543) were genotyped in 394 Caucasian IgAV patients, 95 patients with IgAN and 832 matched healthy controls.

Results

Similar genotype and allele frequencies were observed in the whole cohort of patients with IgAV when compared to those with IgAN when BAFF, APRIL and BAFFR variants were analyzed independently (Table 1). In accordance with that, no BAFF, APRIL and BAFFR genotype or allele differences were detected between IgAV patients who developed nephritis and patients with IgAN (Table 1). Additionally, no statistically significant differences were observed between the whole cohort of patients with IgAV and healthy controls as well as between patients with IgAN and healthy controls when each when BAFF, APRIL and BAFFR genetic variant was also analyzed independently (Table 1). Similar results were disclosed when haplotype frequencies of APRIL and BAFFR were compared between the different comparative groups above mentioned (data not shown).

Table 1.

Genotype and allele frequencies of BAFF, APRIL and BAFFR in the whole cohort of patients with IgAV, patients with IgAV who developed nephritis, patients with IgAN and healthy controls.

PolymorphismChangeData setGenotypes, % (n)Alleles, % (n)1/21/11/22/212BAFF rs374039502T/AIgAV92.1 (363)7.9 (31)0.096.1 (757)3.9 (31)IgAV with nephritis90.1 (128)9.9 (14)0.095.1 (270)4.9 (14)IgAN91.6 (87)8.4 (8)0.095.8 (182)4.2 (8)Controls91.8 (764)7.8 (65)0.4 (3)95.7 (1593)4.3 (71)APRIL rs11552708G/AIgAV78.7 (310)20.1 (79)1.3 (5)88.7 (699)11.3 (89)IgAV with nephritis81.1 (116)18.9 (27)0.090.6 (259)9.4 (27)IgAN75.8 (72)23.2 (22)1.1 (1)87.4 (166)12.6 (24)Controls78.7 (655)19.7 (164)1.6 (13)88.6 (1474)11.4 (190)APRIL rs6608C/TIgAV72.6 (286)25.4 (100)2.0 (8)85.3 (672)14.7 (116)IgAV with nephritis75.5 (108)23.1 (33)1.4 (2)87.1 (249)12.9 (37)IgAN65.3 (62)30.5 (29)4.2 (4)80.5 (153)19.5 (37)Controls71.0 (591)26.6 (221)2.4 (20)84.3 (1403)15.7 (261)BAFFR rs7290134A/GIgAV58.9 (232)35.5 (140)5.6 (22)76.6 (604)23.4 (184)IgAV with nephritis60.1 (86)32.2 (46)7.7 (11)76.2 (218)23.8 (68)IgAN57.9 (55)38.9 (37)3.2 (3)77.4 (147)22.6 (43)Controls58.7 (488)35.1 (292)6.3 (52)76.2 (1268)23.8 (396)BAFFR rs77874543G/CIgAV83.2 (328)15.5 (61)1.3 (5)91.0 (717)9.0 (71)IgAV with nephritis83.1 (118)16.9 (24)0.091.5 (260)8.5 (24)IgAN86.3 (82)13.7 (13)0.093.2 (167)6.8 (13)Controls83.7 (696)16.0 (133)0.4 (3)91.6 (1525)8.4 (139)

IgAV: IgA vasculitis; IgAN: IgA nephropathy.

Conclusion

Our results reveal a similar BAFF, APRIL and BAFFR genetic distribution in IgAV and IgAN, suggesting that these genes could not be used as differential biomarkers between these pathologies.

References

[1]N Engl J Med 2013;368:2402-14;

[2]Am J Kidney Dis 1988;12:373-7;

[3]J Exp Med 1999;189:1747-56;

[4]Nat Genet 2005;37:793-4;

[5]Arthritis Res Ther 2018;20:158;

[6]Arthritis Res Ther 2020;22:157;

[7]Engl J Med 2017;376:1615-26;

[8]Sci Rep 2018;8:8195.

Acknowledgements

This study was supported by the European Regional Development Fund (ERDF) and “Fondo de Investigaciones Sanitarias” (grant PI18/00042 and PI21/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). DP-P is a recipient of a Río Hortega programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) [grant number CM20/00006]; SR-M is supported by funds of the RETICS Program co-funded by ERDF [grant number RD16/0012/0009]; VP-C is supported by a pre-doctoral grant from IDIVAL [grant number PREVAL 18/01]; RL-M is a recipient of a Miguel Servet type II programme fellowship from the ISCIII, co-funded by ESF `Investing in your future´ [grant number CPII21/00004].

Disclosure of Interests

Diana Prieto-Peña: None declared, Fernanda Genre: None declared, Sara Remuzgo Martinez: None declared, Verónica Pulito-Cueto: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda Fillloy: None declared, J. Narváez: None declared, LUIS CAMINAL MONTERO: None declared, PAZ COLLADO: None declared, Antonio Fernandez-Nebro: None declared, Gisela Díaz-Cordoves: None declared, Secundino Cigarrán: None declared, Jesús Calviño: None declared, Carmen Cobelo: None declared, Diego de Argila: None declared, Esther F. Vicente-Rabaneda: None declared, Esteban Rubio-Romero: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galíndez-Agirregoikoa: None declared, Oreste Gualillo: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: 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, Miguel A González-Gay Speakers bureau: Abbvie, MSD, Jansen, and Roche, Grant/research support from: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD and GSK, Raquel López-Mejías: 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

AB0094 INCREASE OF ENDOTHELIAL PROGENITOR CELLS IN SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background:

Endothelial progenitor cells (EPC), involved in vasculogenesis and endothelial tissue repair, have been described as relevant players in vascular and connective tissue diseases [1-2]. In this regard, a previous study of our group disclosed that the degree of EPC frequency may help to identify the presence of interstitial lung disease (ILD) in rheumatoid arthritis patients [3]. Given that ILD is the main cause of mortality in patients with systemic sclerosis (SSc) [1, 4-6], the understanding of the role of EPC in the mechanism of SSc-ILD+ vasculopathy is crucial.

Objectives:

To assess the potential role of EPC on vascular dysfunction associated with the presence of ILD in patients with SSc.

Methods:

Peripheral venous blood was collected from a total of 39 patients with SSc, 20 with ILD (SSc-ILD+) and 19 without ILD (SSc-ILD-). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of EPC was analyzed by flow cytometry. EPC were considered as CD34+, CD45Low, CD309+ and CD133+.

Results:

Statistically significant differences in EPC frequency between patients with SSc-ILD+ and patients with SSc-ILD- were disclosed. Specifically, an increase of EPC frequency was observed in SSc-ILD+ patients when compared to patients with SSc-ILD- (mean ± standard deviation: 0.033 ± 0.012 versus 0.021 ± 0.017, respectively, p=0.012).

Conclusion:

Our results suggest a potential role of EPC on vascular damage associated with the manifestation of ILD in patients with SSc.

References:

[1]Eur J Rheumatol 2020;7(Suppl 3):S139-S146.

[2]Arthritis Rheum 2009;60(11):3168-79.

[3]J Clin Med 2020;9(12):4098.

[4]Ann Rheum Dis 2007;66(7):940-4.

[5]Rheumatology (Oxford) 2010;49(12):2375-80.

[6]Eur Respir Rev 2015;24(135):102-14.

Acknowledgements:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: INNVAL20/06 (IDIVAL); RP-F: START PROJECT (FOREUM); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe-Fernández: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Diana Prieto-Peña: None declared, Virginia Portilla: 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, Alfonso Corrales: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD

AB0069 ASSOCIATION OF NUCLEAR FACTOR OF ACTIVATED T CELLS CYTOPLASMIC 1 (NFATc1) EXPRESSION WITH CARDIOVASCULAR RISK IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

Background

Nuclear factor of activated T cells (NFAT) is a transcription factor family that plays a crucial role in physiological and immune processes, modulating intracellular and extracellular signaling pathways related with several diseases1,2. In this regard, it has been involved in the pathogenesis of rheumatoid arthritis (RA) and in the development of cardiovascular (CV) disease3-5. Given that CV disease is one of the main causes of morbidity and mortality in patients with RA6, functional studies focused on the implication of NFAT in CV disease in RA are of potential interest.

Objectives

To study the role of the gene expression of two members of the NFAT family, NFATc1 and NFATc2, in the risk of developing CV disease in patients with RA.

Methods

A total of 79 disease-modifying antirheumatic drug-naïve patients with early RA7 from Hospital Universitario Marqués de Valdecilla (Santander, Spain) were included in this study. The relative mRNA expression of NFATc1 and NFATc2 in peripheral blood was determined by qPCR. Carotid ultrasound data were used as surrogate markers of subclinical atherosclerosis. The association between NFATc1 and NFATc2 expression in RA patients and their clinical characteristics was evaluated. Results were adjusted by sex, age at the time of the study and traditional CV risk factors.

Results

A statistically significant increase of NFATc1 mRNA expression was found in women compared to men (fold change=+1.18, p=0.035). In addition, a higher NFATc1 mRNA expression was observed in patients with dyslipidemia compared to those with normal lipid profile (fold change=+1.18, p=0.006). With respect to this, we also disclosed a positive correlation between NFATc1 mRNA expression and low-density lipoprotein cholesterol levels (r=0.27, p=0.039). No significant associations were detected between NFATc2 mRNA expression and clinical characteristics of our RA patients. Carotid ultrasound findings were not related to NFATc1 and NFATc2 expression.

Conclusion

Our study suggests that a higher expression of NFATc1 in peripheral blood is associated with abnormalities in the lipid profile and, consequently, with an increased risk of CV disease in patients with early RA.

References

[1]Annu Rev Immunol.1997;15:707-747;

[2]Nat Rev Immunol.2005;5:472-484;

[3]Autoimmun Rev.2006;5:106-110;

[4]Immunol Rev. 2010;233:286-300;

[5]Front Cardiovasc Med. 2021;8:635172;

[6]Arthritis Rheumatol. 2019;71:351-360;

[7]Arthritis Rheum.2010;62:2569-2581.

Acknowledgements

Study supported by NVAL 19/18 awarded to SR-M (IDIVAL) and partially supported by PI18/00043 (ISCIII). Personal funds, SR-M: RD16/0012/0009 (ISCIII-ERDF); VP-C: PREVAL18/01 (IDIVAL); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests

Fernanda Genre: None declared, Verónica Pulito-Cueto: None declared, Alfonso Corrales: None declared, Virginia Portilla: None declared, Leticia Lera-Gómez: None declared, Belén Atienza-Mateo: None declared, Oreste Gualillo: 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, Iván Ferraz-Amaro: None declared, Santos Castañeda: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD and GSK, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Sara Remuzgo-Martínez: None declared

AB0026 DECREASE OF ANGIOGENIC T CELLS IN CONNECTIVE TISSUE DISEASE-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is one of the most significant complications of connective tissue diseases (CTD), leading to an increase of the morbidity and mortality in patients with CTD [1]. A specific T cell subset termed angiogenic T cells (TAng), that promote endothelial repair and revascularization, have been involved in the pathogenesis of CTD [2-4]. However, to the best of our knowledge, no information regarding the role of TAng in CTD-ILD+ is available.

Objectives:

To study, for the first time, the potential role of TAng related to vascular damage in CTD-ILD+.

Methods:

Peripheral venous blood was collected from 40 patients with CTD-ILD+ and three comparative groups: 44 CTD-ILD- patients, 21 idiopathic pulmonary fibrosis (IPF) patients and 20 healthy controls (HC). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of TAng was performed by flow cytometry. TAng were considered as triple-positive for CD3, CD31 and CXCR4.

Results:

Patients with CTD-ILD+ exhibited a significantly lower TAng frequency than CTD-ILD- patients (p<0.001). Similar results were obtained when patients with CTD-ILD+ were compared with HC (p=0.004) although no difference was observed between CTD-ILD+ and IPF. In addition, a significant increase of TAng frequency was shown in patients with CTD-ILD- in relation to IPF patients (p<0.001), while no difference was observed between CTD-ILD- and HC.

Conclusion:

Our results reveal a decrease of TAng frequency related to vascular damage in CTD-ILD+. Furthermore, we disclose that the presence of ILD is associated with lower TAng frequency.

References:

[1]Expert Rev Clin Immunol 2018;14(1):69-82.

[2]Circulation 2007;116(15):1671-82.

[3]Ann Rheum Dis 2015 74(5):921-7.

[4]PLoS One 2017;12(8):e0183102.

Acknowledgements:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: INNVAL20/06 (IDIVAL); RP-F: START PROJECT (FOREUM); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe-Fernández: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Pilar Alonso Lecue: None declared, Javier Rodriguez Carrio: None declared, Diana Prieto-Peña: None declared, Virginia Portilla: 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, Alfonso Corrales: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD

POS0052 ANGIOGENIC T CELLS AS RELEVANT PLAYERS IN THE LUNG VASCULOPATHY OF RHEUMATOID ARTHRITIS, SYSTEMIC SCLEROSIS AND OTHER AUTOIMMUNE DISEASES

Background

Interstitial lung disease (ILD) is a common and life-threatening complication in patients with autoimmune diseases (AD), mainly in those with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Growing evidence indicate that vascular abnormalities constitute the early phase in the pathogenesis of these inflammatory diseases [1]. We recently reported a decrease of angiogenic T cells (TAng), that promote endothelial repair and revascularization cooperating with endothelial progenitor cells (EPC) [2], in patients with AD-ILD+ [3]. Nevertheless, no studies have been conducted on the role of TAng in the presence of ILD in RA, SSc or other AD.

Objectives

To determine the contribution of TAng in the pathogenic processes of vasculopathy and lung fibrosis in RA-ILD+, SSc-ILD+ and other AD-ILD+, as well as their relationship with EPC in all the AD-ILD+ patients.

Methods

Peripheral venous blood was collected from 21 RA-ILD+ patients, 21 SSc-ILD+ patients and 15 patients with other AD-ILD+. Furthermore, we included 4 comparative groups: 25 RA-ILD- patients, 20 SSc-ILD- patients, 21 idiopathic pulmonary fibrosis (IPF) patients and 21 healthy controls (HC). TAng were considered as CD3+CD184+CD31+ cells by flow cytometry. Additionally, EPC data were previously published by Pulito-Cueto et al. [4-5].

Results

Regarding the role of TAng in vasculopathy, the frequencies of these cells were significantly lower in patients with RA-ILD+, SSc-ILD+ and other AD-ILD+, as well as with IPF in relation to HC (p=0.007, p=0.016, p=0.005 and p<0,001, respectively, Figure 1). No differences between RA-ILD- patients, SSc-ILD- patients and HC were found (Figure 1). With respect to TAng involvement in fibrosis, TAng frequencies were similar in patients with RA-ILD+, SSc-ILD+, other AD-ILD+ and those with IPF (Figure 1). Nevertheless, patients with RA-ILD+ and SSc-ILD+ showed significantly lower TAng frequencies than those with RA-ILD- and SSc-ILD-, respectively (p=0.006 and p=0.044, respectively, Figure 1). In this line, a higher frequency of TAng was found in SSc-ILD- and RA-ILD- patients in relation with those with IPF (p<0.001 and p=0.003, respectively, Figure 1). Moreover, TAng frequency did not show significant correlation with EPC frequency in the whole cohort of AD-ILD+ patients.

Figure 1.

Quantification of TAng population by flow cytometry in all individuals included in the study.

Conclusion

TAng play a relevant role in the lung vasculopathy of RA-ILD+, SSc-ILD+ and other AD-ILD+. Interestingly, circulating TAng may be considered as a useful biomarker of the presence of ILD in patients with RA and SSc.

References

[1]Expert Rev Clin Immunol 2018;14(1):69-82.

[2]Rheum Dis 2015;74(5):921–927.

[3]Ann Rheum Dis 2021;80(1):1047-1048.

[4]J Clin Med 2020;9(12):4098.

[5]Biomedicines 2021;9(7):847.

Acknowledgements

VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01); SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from `Instituto de Salud Carlos III´ (ISCIII), co-funded by the European Regional Development Fund; 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

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Leticia Lera-Gómez: None declared, Javier Rodriguez Carrio: None declared, Diana Prieto-Peña: 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, Alfonso Corrales: None declared, Oreste Gualillo: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche

AB0012 ROLE OF IRF5 GENE ON THE PATHOGENESIS OF IMMUNOGLOBULIN-A VASCULITIS

Background:

Interferon signaling pathway plays a relevant role in autoimmunity. Genetic variants in theinterferon regulatory factor (IRF) 5gene, that encodes the major regulator of the type I interferon induction [1], have been related to the development of several inflammatory diseases [2].

Objectives:

To determine the influence ofIRF5on Immunoglobulin-A vasculitis (IgAV), an inflammatory vascular disease.

Methods:

ThreeIRF5polymorphisms (rs2004640, rs2070197 and rs10954213) representative of 3 different haplotype blocks were genotyped in 372 Caucasian patients with IgAV and 876 sex and ethnically matched healthy controls.

Results:

No statistically significant differences between patients with IgAV and controls were observed when eachIRF5polymorphism was analyzed independently. Similarly, no statistically significant differences between patients with IgAV and controls were found whenIRF5polymorphisms were evaluated combined conforming haplotypes. Additionally, there were no statistically significant differences in genotype, allele and haplotype frequencies ofIRF5when patients with IgAV were stratified according to the age at disease onset or to the presence/absence of gastrointestinal or renal manifestations.

Conclusion:

Our results do not support an influence ofIRF5on the pathogenesis of IgAV.

References:

[1]Nat Immunol 2011; 12: 231-8;

[2]Arthritis Res Ther 2014; 16: R146.

Acknowledgments:

This study was supported by European Union FEDER funds and “Fondo de Investigaciones Sanitarias” (grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) (grant CP16/00033). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) (ISCIII, co-funded by the European Regional Development Fund (ERDF)). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). LL-G is supported by funds of PI18/00042 (ISCIII, co-funded by ERDF).

Disclosure of Interests:

Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Verónica Pulito-Cueto: None declared, D. Prieto-Peña: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Leticia Lera-Gómez: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, María Jesús Cabero: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda-Filloy: None declared, Antonio Navas Parejo: None declared, Javier Sanchez Perez: None declared, Maximiliano Aragües: None declared, Esteban Rubio: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galindez: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Raquel López-Mejías: None declared

AB0011 INFLUENCE OF IL17A GENE ON THE PATHOGENESIS OF IMMUNOGLOBULIN-A VASCULITIS

Background:

Cytokines signaling pathway genes represent a key component of the genetic network implicated in the pathogenesis of Immunoglobulin-A vasculitis (IgAV) [1], an inflammatory vascular pathology.Interleukin (IL)17Ais a genetic risklocusfor autoimmune diseases, such as giant cell arteritis [2] and spondyloarthritis [3].

Objectives:

To determine the potential influence ofIL17Aon IgAV.

Methods:

FiveIL17Atag polymorphisms (rs4711998, rs8193036, rs3819024, rs2275913 and rs7747909) were genotyped in 360 Caucasian patients with IgAV and 1,003 sex and ethnically matched healthy controls.

Results:

No statistically significant differences between patients with IgAV and healthy controls were observed when eachIL17Agenetic variant was analyzed independently. Similarly, no statistically significant differences between patients with IgAV and healthy controls were found when the fiveIL17Apolymorphisms were evaluated combined conforming haplotypes. In addition, there were no statistically significant differences in genotype, allele and haplotype frequencies ofIL17Awhen patients with IgAV were stratified according to the age at disease onset or to the presence/absence of gastrointestinal or renal manifestations.

Conclusion:

Our results do not support an influence ofIL17Aon the pathogenesis of IgAV.

References:

[1]Autoimmun Rev 2018; 17: 301-15

[2]Ann Rheum Dis 2014; 73: 1742-5

[3]Mediators Inflamm 2018; 2018: 1395823.

Acknowledgments:

This study was supported by European Union FEDER funds and “Fondo de Investigaciones Sanitarias” (grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) (grant CP16/00033). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) (ISCIII, co-funded by the European Regional Development Fund (ERDF)). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). LL-G is supported by funds of PI18/00042 (ISCIII, co-funded by ERDF).

Disclosure of Interests:

Fernanda Genre: None declared, Sara Remuzgo Martinez: None declared, Verónica Pulito-Cueto: None declared, D. Prieto-Peña: None declared, Belén Atienza-Mateo: None declared, Belén Sevilla: None declared, Javier Llorca: None declared, Norberto Ortego: None declared, Leticia Lera-Gómez: None declared, Maite Leonardo: None declared, Ana Peñalba: None declared, María Jesús Cabero: None declared, Luis Martín-Penagos: None declared, Jose Alberto Miranda-Filloy: None declared, Antonio Navas Parejo: None declared, Diego de Argila: None declared, Maximiliano Aragües: None declared, Esteban Rubio-Romero: None declared, MANUEL LEON LUQUE: None declared, Juan María Blanco-Madrigal: None declared, E. Galindez: None declared, Javier Martin Ibanez: None declared, Santos Castañeda: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Raquel López-Mejías: None declared

AB1341 ASSESSMENT OF COMMON FEMORAL VEIN INTIMA-MEDIA THICKNESS BY ULTRASOUND IN BEHÇET’S DISEASE: COMPARATIVE STUDY OF PATIENTS WITH OR WITHOUT VASCULAR INVOLVEMENT IN A NATIONAL REFERRAL CENTER

Background

Vascular manifestations are frequent in Behçet’s disease (BD). However, they have been less studied than other manifestations, such as uveitis [1]. Increased venous wall thickness assessed with ultrasound (US) has been reported in BD [2]. However, it remains unclear if US findings correlate with vascular involvement in BD.

Objectives

To assess vascular Doppler US findings in patients with BD with and without clinical vascular manifestations.

Methods

Observational study of unselected consecutive patients with BD assessed in a national referral center, from March 2021 to May 2021. All patients fulfilled the 2014 ICBD criteria [3]. They were evaluated sequentially with a scheduled clinic visit after signing an informed consent. Demographic and clinical variables were collected. Patients were considered to have vascular involvement if they had history of deep vein thrombosis, pulmonary thromboembolism, superficial thrombophlebitis, arterial thrombosis (peripheral arterial thrombosis, stroke, transient ischemic attack), aneurysms, acute myocardial infarction or Raynaud’s disease. Wall thickness of bilateral common femoral vein was measured by assessing the intima-media thickness (IMT) with a high-resolution Doppler US [2]. Statistical analysis was performed with SPSS. Student´s t test or Mann-Whitney U test was used to compare continuous variables, and Chi-squared test or Fisher´s exact test for categorical variables, as appropriate.

Results

We evaluated 17 BD patients with vascular manifestations and 25 BD patients without vascular manifestations. Main clinical and demographic characteristic are described in Table 1. The vascular manifestations were deep vein thrombosis (n=4), superficial thrombophlebitis (n=1), arterial aneurysms (n=2), acute myocardial infarction (n=3), arterial thrombosis (n=1) and Raynaud’s disease (n=10). The median [IQR] value of the common femoral vein IMT was significantly higher in patients with vascular manifestations (0.65 [0.45-0.82] vs 0.49 [0.39-0.55]; p= 0.028). A significant increase in vascular manifestations was observed in patients with arterial hypertension (p=0.003). HLA B51 presence was more frequent in patients with no vascular manifestations.

Table 1.Vascular manifestations (n=17)Without vascular manifestations (n=25)P valueSex (men), n (%)10 (41.2)13 (48)0.663Age (years), mean ± SD51.24±12.845.56±12.880.133HLA B51 positive, n/tested cases4/1714/25-Evolution time (years) from diagnosis, mean ± SD13.35 ± 10.4513.04 ± 8.520.891Cardiovascular risk factorsHypertension, n (%)7 (41.2)1 (4)0.003Diabetes mellitus, n (%)1 (5.9)2 (8)0.794Dyslipidemia, n (%)6 (35.3)5 (20)0.268Smoking habit (current or former smokers), n (%)10 (58.8)12 (48)0.067Clinical manifestationsOral ulcers, n (%)16 (94.1)25 (100)0.220Genital ulcers, n (%)12 (70.6)16 (64)0.657Erythema nodosum like, n (%)9 (52.9)6 (24)0.055Pseudofolliculitis, n (%)9 (52.9)19 (76)0.120Uveitis, n (%)7 (41.2)9 (36)0.735Arthralgia, n (%)14 (82.4)17 (68)0.299Neurological manifestations, n (%)2 (11.8)2 (8)0.683Ultrasound findingsFemoral vein IMT (mm), median [IQR]0.65 [0.45-0.82]0.49 [0.39-0.55]0.028

IMT: intima-media thickness. IQR: interquartile range.

Conclusion

Patients with BD and vascular involvement present higher values of common femoral vein IMT. The assessment of venous wall thickness with Doppler US constitutes a useful technique to evaluate clinical vascular involvement in BD patients.

References

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

[2]Alibaz-Oner F, Ergelen R, Yildiz Y, Aldag M, Yazici A, Cefle A, et al. Femoral vein wall thickness measurement: A new diagnostic tool for Behçet’s disease. Rheumatology (Oxford). 2021 01 5;60(1):288-96.

[3]International Team for the Revision of the International Criteria for Behçet’s Disease (ITR-ICBD). J Eur Acad Dermatol Venereol. 2014 Mar;28(3):338-47.

Disclosure of Interests

None declared