Intravenous iloprost in systemic sclerosis and its effect in cardiopulmonary function: a retrospective observational study

OBJECTIVE

This study aims at evaluating the disease progression, specifically in terms of cardiopulmonary function, in a group of consecutively enrolled systemic sclerosis (SSc) patients treated with the approved iloprost regimen.

PATIENTS AND METHODS

A retrospective observational study was performed on 68 SSc patients treated with 5-6 infusions of iloprost per month for 6 hours per day at a dosage of 0.5-2.0 ng/kg/min through a portable syringe pump. All patients were evaluated for modified Rodnan skin score, systolic pulmonary arterial pressure, tricuspid annular plane systolic excursion, diffusing capacity of the lungs for carbon monoxide, forced vital capacity, alveolar volume, diffusing capacity of the lungs for carbon monoxide/alveolar volume, pro-brain natriuretic peptide (pBNP), New York Heart Association class, and the presence or absence of digital ulcers (DUs).

RESULTS

After a follow-up period of 9.9±2.9 years, all patients improved in frequency and severity of the Raynaud phenomenon and showed a stabilization or improvement of cardiopulmonary parameters. The pulmonary arterial pressure and pBNP improved significantly from baseline (30.91±6.4 mmHg vs. 27.36±7.1 mmHg, and 97.20±69.3 pg/ml vs. 66.65±44.3 pg/ml, respectively; p<0.0001 for both). A significant improvement was observed in the modified Rodnan skin score in 57 patients who continued the treatment during the entire follow-up (5.09±5.7 vs. 3.30±4.2, p<0.0001).

CONCLUSIONS

Despite the retrospective design and the lack of a control group, the regular and continued administration of iloprost maintained the stability of the cardiopulmonary and cutaneous parameters in SSc. It significantly reduced pBNP levels, a prognostic cardiac biomarker of SSc. Future research should be addressed to demonstrate a stronger causality of this effect.

POS1494-HPR INCIDENCE OF PSYCHIATRIC DISORDERS AND FIBROMYALGIA IN PATIENTS WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS DURING COVID 19 PANDEMIC: THE ROLE OF TELEMEDICINE

Background

The management of patients with immuno-rheumatological diseases has profoundly changed during the COVID 19 pandemic and telemedicine has played an important role in the disease follow-up.

In addition to monitoring disease activity and any adverse events, especially infectious events, assessing the psychological situation of the patient can be fundamental in particular considering that COVID-19 has also a serious impact on mental health and it has been demonstrated a significantly higher incidence of anxiety disorders and depressive symptoms especially in younger people

Objectives

The aim of this study is to evaluate the incidence of depressive disorders, anxiety and fibromyalgia in our patients with rheumatoid arthritis and psoriatic arthritis during the lockdown period due to the COVID 19 pandemic and validate the use of telemedicine in the clinical management of these patients.

Methods

Patients affected by rheumatoid and psoriatic arthritis treated with biological disease-modifying drugs were contacted to evaluate the state of health and the presence of any adverse events and a nurse administered the clinimetric questionnaires assessment to evaluate the disease activity, the impact of rheumatic disease on the health status and the presence of anxiety, depression and fibromyalgia. In particular the following scales have been used: The Rheumatoid Arthritis Impact of Disease (RAID), the Psoriatic arthritis impact of disease (PsAID), Beck Depression Inventory BDI-II, State-Trait Anxiety Inventory (STAI) and The Fibromyalgia Rapid Screening Tool questionnaire (FIRST), The VAS scale for the assessment of pain. Patients who reported disease flare-up or adverse events underwent an outpatient visit and during visit Disease Activity Score (DAS 28) and Disease Activity Index for Psoriatic Arthritis (DAPSA) were used.

Results

171 patients with rheumatoid arthritis (RA) and 129 patients with psoriatic arthritis were enrolled. The incidence of fibromyalgia was increased in the two groups during the lockdown compared to the previous evaluations and in particular in patients with psoriatic arthritis (AR p =0.013, AP p= 0.001).Our analysis did not report significant differences between the two groups for the presence of fibromyalgia and anxiety-related disorders during lockdown, but a prevalence of depressive disorders in patients with rheumatoid arthritis was observed.During lockdown in RA patients, (n=50), no correlation was found between DAS28 and RAID score (r=0.112, p=0.438) and in PsA patients (n=34), no correlation was found between DAPSA and PSAID score (r=0.131, p=0.459) while median value of RAID was higher in STAI I and II positive and median value of PSAID was higher in STAI I and II positive. Patients positive at BDI had higher RAID score (median 6.28 vs 1.14) and PSAID (median 4.95 vs 2.85) score (Mann Whitney p<0.001 and p=0.003)

Conclusion

In conclusion, mental and physical stress during COVID-19 pandemic can greatly worsen FM symptoms and intensify the patients’ suffering without a clinical flare of the inflammatory disease for patients affected by rheumatoid arthritis.

Telemedicine has allowed us to identify patients who needed a face-to-face approach for therapeutic reevaluation even if not related to a flare of the disease.

References

[1]Coletto LA DermatolTher. 2020 Apr 14:e13415. doi: 10.1111/dth.13415.

[2]Lurie N JAMA Intern Med 2018;178:745–6

[3]Matteo Piga Seminars in Arthritis and Rheumatism 47 (2017) 121–128123

Disclosure of Interests

None declared

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[Experiences with sclerostomy with the Holmium laser]

The THC-YAG laser (holmium laser) war used to perform ab externo sclerostomies in patients affected by various types of glaucoma. This approach was employed in 48 eyes with diagnoses of medically uncontrolled chronic open angle glaucoma, plateau iris or neovascular glaucoma. Post-operatively, 5-FU was injected. At the tend of the follow-up (mean 10.22 +/- 3.4 months), in 25 eyes (52.1%) the IOP was under control without medical therapy. In 12 eyes (25.0%) it was necessary to use antiglaucomatous topical therapy, and in 11 eyes (22.9%) the IOP was uncontrolled despite therapy. The authors stress the importance of a correct pharmacological protocol before and after operation and describe the surgical technique. They confirm the validity of this approach, owing to its minical invasiveness, the possibility of repeating the procedure, and the low complication rate.