Epidemiological risk factors associated with high global frequency of inapparent dengue virus infections

Dengue is a major international public health concern, and the number of outbreaks has escalated greatly. Human migration and international trade and travel are constantly introducing new vectors and pathogens into novel geographic areas. Of particular interest is the extent to which dengue virus (DENV) infections are subclinical or inapparent. Not only may such infections contribute to the global spread of DENV by human migration, but also seroprevalence rates in naïve populations may be initially high despite minimal numbers of detectable clinical cases. As the probability of severe disease is increased in secondary infections, populations may thus be primed, with serious public health consequences following introduction of a new serotype. In addition, pre-existing immunity from inapparent infections may affect vaccine uptake, and the ratio of clinically apparent to inapparent infection could affect the interpretation of vaccine trials. We performed a literature search for inapparent DENV infections and provide an analytical review of their frequency and associated risk factors. Inapparent rates were highly variable, but “inapparent” was the major outcome of infection in all prospective studies. Differences in the epidemiological context and type of surveillance account for much of the variability in inapparent infection rates. However, one particular epidemiological pattern was shared by four longitudinal cohort studies: the rate of inapparent DENV infections was positively correlated with the incidence of disease the previous year, strongly supporting an important role for short-term heterotypic immunity in determining the outcome of infection. Primary and secondary infections were equally likely to be inapparent. Knowledge of the extent to which viruses from inapparent infections are transmissible to mosquitoes is urgently needed. Inapparent infections need to be considered for their impact on disease severity, transmission dynamics, and vaccine efficacy and uptake.

Reactive oxygen species and NADPH oxidase 4 involvement in osteoarthritis

Osteoarthritis (OA) is a degenerative chronic disease affecting >300,000 million people around the world as of 2016. Symptomatic measures exist, but there are hardly any curative treatments available. Disruption of the cartilage homeostasis in favor of catabolism leads to cartilage destruction. ROS-macromolecular-induced damage is significantly greater in OA cartilage and OA is described as low-grade chronic systemic inflammation. This review aimed to assess the critical role of cartilage ageing and oxidative stress in the OA process, focusing in particular on NADPH oxidase and especially Nox4 involvement. With age, hypertrophic senescent cells with an altered redox cell profile accumulated. Chondrocytes are more sensitive to oxidant-mediators and the serum level of pro-inflammatory mediators increases. Age-related advanced glycation end products impact on extra cellular matrix (ECM) properties leading to the apoptosis of chondrocytes. A focus on NADPH oxidase-mediated-ROS signaling highlighted the very specific Nox4 isoform, which plays a role on the final common pathway targeting chondrocyte cells. IL-1β-mediated Nox4 stimulation induced an increase in the levels released by the chondrocyte of MMP-1 and MMP-13 proteins, which are involved in ECM degradation. In comparison with the other Nox isoforms, Nox4 remains unusual, since it is constitutively active, does not depend on cytosolic activator proteins and seems to generate H₂O₂ thanks to the specific conformation of the Nox4 E-loop. Nox4-induced ROS production appears an essential actor in the OA process and it could be relevant to focus on this target in the aim of discovering and developing new therapeutic strategies.

The shared epitope is a marker of severity associated with selection for, but not with response to, infliximab in a large rheumatoid arthritis population

OBJECTIVE

To determine whether joint destruction, indication for, and response to infliximab in rheumatoid arthritis are associated with the shared epitope (SE) or selected cytokine gene polymorphisms (interleukin (IL) 1B, IL1-RN, and tumour necrosis alpha).

METHODS

In a large rheumatoid arthritis population of 930 patients from the same area (Rhône-Alpes, France), patients with (n = 198) or without infliximab treatment (n = 732) were compared according to their genetic status. Clinical, biological, and radiological data were collected. Typing for SE status and cytokine polymorphisms was carried out using enzyme linked oligosorbent assay. Statistical analysis was by chi(2) testing and calculation of odds ratios (OR).

RESULTS

A dose relation was observed between the number of SE copies and joint damage in the whole rheumatoid population (OR, 1 v 0 SE copy = 2.38 (95% confidence interval, 1.77 to 3.19), p<0.001; OR 2 v 0 SE copy = 3.92 (2.65 to 5.80), p<0.001. The SE effect increased with disease duration but was not significant before two years. Selection for infliximab treatment (n = 198) was associated with increased disease activity, joint damage, and the presence of the SE with a dose effect. In all, 66.2% patients achieved an ACR20 improvement. No clinical or genetic factors were able to predict the clinical response to infliximab.

CONCLUSIONS

This post-marketing study in a large cohort of rheumatoid arthritis patients indicates a linkage between rheumatoid arthritis severity, selection for treatment with infliximab, and the presence and dose of the SE.

IL-1beta mediates MMP secretion and IL-1beta neosynthesis via upregulation of p22(phox) and NOX4 activity in human articular chondrocytes

OBJECTIVES

Osteoarthritis (OA) is characterized by a progressive alteration of the biochemical properties of the articular cartilage. Inflammation plays a major role in OA, particularly through the cytokine Interleukine-1β, promoting reactive oxygen species (ROS) generation and matrix metalloproteinases (MMP) synthesis by the chondrocytes, orchestrating matrix proteolysis. NADPH oxidases (NOX) are membrane enzymes dedicated to the production of ROS. Role of oxidative stress is well established in OA; however, contribution of NOX in this process is still poorly documented. In this study, we addressed the role of NOX in primary human articular chondrocytes (HAC) upon inflammatory conditions--namely IL-1β and OA.

DESIGN

HAC were collected from patients undergoing hip surgery. Chondrocytes were treated with IL-1β and NOX inhibitors Diphenylene Iodonium, GKT136901, Tiron and Heme oxygenase-1 before MMP expression and NOX activity assessment. Finally, NOX4 expression was compared between OA and non OA parts of hip cartilage (n = 14).

RESULTS

This study establishes for the first time in human that NOX4 is the main NOX isoform expressed in chondrocytes. We found a significant upregulation of NOX4 mRNA in OA chondrocytes. Expression of NOX4/p22(phox) as well as ROS production is enhanced by IL-1β. On the other hand, the use of NOX4 inhibitors decreased IL-1β-induced collagenase synthesis by chondrocytes. Moreover, our study support the existence of a redox dependant loop sustaining pro-catabolic pathways induced by IL-1β.

CONCLUSIONS

This study points out NOX4 as a new putative target in OA and suggests that NOX-targeted therapies could be of interest for the causal treatment of the pathology.

The usefulness of bone remodelling markers in predicting the efficacy of pamidronate treatment in SAPHO syndrome

OBJECTIVES

Pamidronate has recently been used in SAPHO syndrome due to its anti-osteoclastic effect. The aim of this study is to determine the usefulness of bone remodelling markers for determining the efficacy of pamidronate treatment.

METHODS

Thirteen patients with SAPHO syndrome were treated with pamidronate. The treatment evaluation was done using a visual analogue scale (VAS) and also erythrocyte sedimentation rate, C-reactive protein, serum crosslaps (sCTX) and osteocalcin initially and after 3 months. A relevant clinical response was defined as an improvement in VAS of at least 40%.

RESULTS

At 3 months, 7 of 13 patients had a good clinical response, as previously defined. Five of the seven patients maintained the good response over 6 months. Before the first perfusion 6 of the 13 patients had increased sCTX (upper 3250 pmol/l). In this small cohort we tried to analyse whether the increase in bone remodelling markers was associated with a good clinical response. In the responders group the mean levels of sCTX and osteocalcin at baseline were 6783.17 and 24.66, respectively, and in the non-responders group the levels were 2152 and 11.8, respectively. There was a significant difference in sCTX between the responders and the non-responders (P = 0.0044).

CONCLUSION

Infusion of pamidronate is effective in SAPHO in some patients. Increased sCTX might be a prognostic marker for a good clinical response but results have to be confirmed in a larger cohort.

Plasmodium copy number variation scan: gene copy numbers evaluation in haploid genomes

BACKGROUND

In eukaryotic genomes, deletion or amplification rates have been estimated to be a thousand more frequent than single nucleotide variation. In Plasmodium falciparum, relatively few transcription factors have been identified, and the regulation of transcription is seemingly largely influenced by gene amplification events. Thus copy number variation (CNV) is a major mechanism enabling parasite genomes to adapt to new environmental changes.

METHODS

Currently, the detection of CNVs is based on quantitative PCR (qPCR), which is significantly limited by the relatively small number of genes that can be analysed at any one time. Technological advances that facilitate whole-genome sequencing, such as next generation sequencing (NGS) enable deeper analyses of the genomic variation to be performed. Because the characteristics of Plasmodium CNVs need special consideration in algorithms and strategies for which classical CNV detection programs are not suited a dedicated algorithm to detect CNVs across the entire exome of P. falciparum was developed. This algorithm is based on a custom read depth strategy through NGS data and called PlasmoCNVScan.

RESULTS

The analysis of CNV identification on three genes known to have different levels of amplification and which are located either in the nuclear, apicoplast or mitochondrial genomes is presented. The results are correlated with the qPCR experiments, usually used for identification of locus specific amplification/deletion.

CONCLUSIONS

This tool will facilitate the study of P. falciparum genomic adaptation in response to ecological changes: drug pressure, decreased transmission, reduction of the parasite population size (transition to pre-elimination endemic area).

The SRC-family tyrosine kinase HCK shapes the landscape of SKAP2 interactome

The SRC Kinase Adaptor Phosphoprotein 2 (SKAP2) is a broadly expressed adaptor associated with the control of actin-polymerization, cell migration, and oncogenesis. After activation of different receptors at the cell surface, this dimeric protein serves as a platform for assembling other adaptors such as FYB and some SRC family kinase members, although these mechanisms are still poorly understood. The goal of this study is to map the SKAP2 interactome and characterize which domains or binding motifs are involved in these interactions. This is a prerequisite to finely analyze how these pathways are integrated in the cell machinery and to study their role in cancer and other human diseases when this network of interactions is perturbed. In this work, the domain and the binding motif of fourteen proteins interacting with SKAP2 were precisely defined and a new interactor, FAM102A was discovered. Herein, a fine-tuning between the binding of SRC kinases and their activation was identified. This last process, which depends on SKAP2 dimerization, indirectly affects the binding of FYB protein. Analysis of conformational changes associated with activation/inhibition of SRC family members, presently limited to their effect on kinase activity, is extended to their interactive network, which paves the way for therapeutic development.

High number of previous Plasmodium falciparum clinical episodes increases risk of future episodes in a sub-group of individuals

There exists great disparity in the number of clinical P. falciparum episodes among children of the same age and living in similar conditions. The epidemiological determinants of such disparity are unclear. We used a data-mining approach to explore a nineteen-year longitudinal malaria cohort study dataset from Senegal and identify variables associated with increased risk of malaria episodes. These were then verified using classical statistics and replicated in a second cohort. In addition to age, we identified a novel high-risk group of children in whom the history of P. falciparum clinical episodes greatly increased risk of further episodes. Age and a high number of previous falciparum clinical episodes not only play major roles in explaining the risk of P. falciparum episodes but also are risk factors for different groups of people. Combined, they explain the majority of falciparum clinical attacks. Contrary to what is widely believed, clinical immunity to P. falciparum does not de facto occur following many P. falciparum clinical episodes. There exist a sub-group of children who suffer repeated clinical episodes. In addition to posing an important challenge for population stratification during clinical trials, this sub-group disproportionally contributes to the disease burden and may necessitate specific prevention and control measures.

[Osteofluorosis caused by excess use of toothpaste]

BACKGROUND

Osteofluorosis is caused by chronic fluoride intoxication. Fluoride is used in toothpaste for the prevention of dental caries, and dental fluorosis has often been reported among children and attributed to ingestion of fluoride toothpaste. We report a case of chronic fluoride intoxication caused by excess use of toothpaste in an adult.

CASE

A 45-year-old woman consulted a rheumatologist for painful swelling of the fingers, phalangeal rather than articular. She also had brown staining on her teeth. Radiography of the hands showed periosteal apposition on the phalanges. Further work-up ruled out tumoral or thyroid causes. Laboratory tests showed elevated fluoride levels in the blood (50.9 micromol/L, normal<1.5 micromol/L) and in the urine (721 micromol/L, normal<46 micromol/L). On questioning, we found only one cause for chronic fluoride intoxication: excess and unusual use of toothpaste. The patient brushed her teeth 18 times a day and swallowed the toothpaste, because she liked the taste. She consumed a tube of toothpaste every 2 days, thereby swallowing 68.5 mg of fluoride every day. Suspecting fluorosis from toothpaste, we asked the patient to use a toothpaste without fluoride. Sixteen weeks later, the pain had ceased, and laboratory tests showed massively reduced but still elevated fluoride levels in the blood (6.9 micromol/L) and urine (92.7 micromol/L).

CONCLUSION

In this rare case of fluoride intoxication, misuse of a normally innocuous product caused osteofluorosis.

Filter-free exhaustive odds ratio-based genome-wide interaction approach pinpoints evidence for interaction in the HLA region in psoriasis

Background

Deciphering the genetic architecture of complex traits is still a major challenge for human genetics. In most cases, genome-wide association studies have only partially explained the heritability of traits and diseases. Epistasis, one potentially important cause of this missing heritability, is difficult to explore at the genome-wide level. Here, we develop and assess a tool based on interactive odds ratios (I_OR), Fast Odds Ratio-based sCan for Epistasis (FORCE), as a novel approach for exhaustive genome-wide epistasis search. I_OR is the ratio between the multiplicative term of the odds ratio (OR) of having each variant over the OR of having both of them. By definition, an I_OR that significantly deviates from 1 suggests the occurrence of an interaction (epistasis). As the I_OR is fast to calculate, we used the I_OR to rank and select pairs of interacting polymorphisms for P value estimation, which is more time consuming.

Results

FORCE displayed power and accuracy similar to existing parametric and non-parametric methods, and is fast enough to complete a filter-free genome-wide epistasis search in a few days on a standard computer. Analysis of psoriasis data uncovered novel epistatic interactions in the HLA region, corroborating the known major and complex role of the HLA region in psoriasis susceptibility.

Conclusions

Our systematic study revealed the ability of FORCE to uncover novel interactions, highlighted the importance of exhaustiveness, as well as its specificity for certain types of interactions that were not detected by existing approaches. We therefore believe that FORCE is a valuable new tool for decoding the genetic basis of complex diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s12863-015-0174-3) contains supplementary material, which is available to authorized users.

Efficacy of self-management program associated with a spa therapy for knee osteoarthritis patients (GETT 2): a research protocol for a randomized trial

INTRODUCTION

Osteoarthritis is a chronic pathology that involves multidisciplinary management. Self-management for patients is an essential element, present in all international guidelines. During the time of the spa therapy, the patient is receptive to take the advantage of self-management workshops. The aim of this study is to assess the effects of 18 days spa therapy associated with a self-management intervention in patients with knee osteoarthritis in comparison with spa therapy alone on a priority objective, personalized and determined with the patient, chosen in the list of 5 objectives determined during the self-management initial assessment.

METHODS AND ANALYSIS

Two hundred fifty participants with knee osteoarthritis will participate to this multicenter, prospective, randomized, controlled study. All patients will benefit 18 days of spa therapy and patients randomized in the intervention group will participate to 6 self-management workshops. Randomization will be centralized. The allocation ratio will be 1:1. Data analysts and assessor will be blinded. The primary outcome is the effectiveness of the educational workshops associated with spa therapy in comparison with spa therapy alone on a priority objective, measured by Goal Attainment Scaling (GAS). The secondary outcomes are disability, health-related quality of life, and pain intensity.

ETHICS AND DISSEMINATION

Ethics were approved by the CPP Sud-Méditerranée II. The results will be disseminated in a peer-reviewed journal and disseminated at PRM, rheumatology, and orthopedics conferences. The results will also be disseminated to patients.

TRIAL REGISTRATION

Trial registration number NCT03550547. Registered 8 June 2018. Date and version identifier of the protocol. Version N°6 of March 12, 2018.

PARE0011 AFLAR’S (FRENCH LEAGUE AGAINST RHEUMATISM) NEW ACTIONS TO HELP PEOPLE WITH RHEUMATIC DISEASES TO GET AND STAY EMPLOYED

Background:

Accessing jobs and being able to stay in a paid work position are a personal issue for people with rheumatic diseases, as well as for society. AFLAR, French league against rheumatism, has been acting towards patients and employers since 2014 in this field.

Objectives:

After a preparatory work with a panel of all types of professionals and institutions working on the subject, key messages on means to improve the professional situation of people with rheumatic diseases have been published. These messages were used as a basis for an awareness training designed for human resources training and employers’ managers, and in a guidance booklet designed for patients and published in 2016: «At work, even if affected by chronic rheumatic diseases ». This booklet, rather than gathering administrative and social resources in favour of patients, was based on patients’ and experts’ expression, written with them and proposed gradual guidance along their path from their professional choices to the disabled worker certification when needed.

Two new actions have been seen as necessary in 2019 in order to go on with our actions: updating our booklet after 2 new laws had been issued in the field of labour law, and additions seemed necessary because of new work methods are developing (distant work from home, independent work); and the need of a new widely spreadable tool to accompany patients from the diagnosis stage, especially on the diagnosis disclosure to the work group issue.

The specific characteristics of rheumatic diseases: diversity, growing invisibility of diseases’ effects and aftereffects to new treatments such as biologics and early rehabilitation, variation in time and personal impact, make them hard to understand by employers and even untrained social workers. This is what we noted from our experience in patient education workshops. Patients have a tendency to hide their pathology, and thus cannot benefit from social advantages as disabled workers, with motivation based on keeping personal image and an idea of normality, and fear of negative reactions from the work group, such as depreciation, pity, idea of negative impact on team’s productivity).

Patients have to build a real strategy, taking into account these criteria and their personal choices, while preparing their job’s adaptation or social requests when needed. AFLAR chose to create a new patient information tool: free short widely spreadable videos, available on line. These will also invite patients to get in touch with expert patients on the specialized hotline, participate to chats of patient education workshops.

Methods:

Videos will show witness patients and experts, who will be asked about their experience and advice based on four questions:

- Should we speak about our disease (and when, how?), or not speak about our disease at work?

- What means « disablement », « being disabled » for you as a person affected by a rheumatic disease?

- What have you been able to do to get a paid position, or keep your job, that you could quote as an advice for other people in the same situation?

- If you had been given, or were given now a magic wand to make it easier to get or keep a job, or get/keep the job you dreamed of, what would you change?

At the end, videos will deliver further advice, tools and resources taken from the booklet, such as a model of decisional scale, or reference institutional website addresses.

Results:

AFLAR wishes to contribute actively to rheumatic patients’, and especially young people’s information on the topic thanks to these more innovative and interactive tools.

Conclusion:

Furthermore, wishes, solutions and ideas of witness patients and users will be gathered for advocacy towards employers, institutions and decision makers.

Disclosure of Interests:

None declared

Revue exhaustive de la littérature sur le bon usage des AINS, dont l’ibuprofène, en période de Covid-19

Introduction

Le GRAINS, groupe de réflexion sur les AINS, est composé d’experts pluridisciplinaire hospitalier et de ville qui regroupe plusieurs médecins spécialistes. Il s’est constitué en vue de réfléchir sur le bon usage des anti-inflammatoires non-stéroïdiens (AINS) dans le contexte de la pandémie de COVID-19, et est soutenu par GlaxoSmithKline Santé Grand Public. Les travaux effectués par le GRAINS ont été publiés dans une revue de littérature exhaustive. L’objectif du GRAINS est d’avoir une discussion ouverte sur l’utilisation des AINS dans la gestion de la douleur dans le contexte de la COVID-19 et des infections en général, considérant les progrès réalisés dans la production de connaissances et les preuves de la littérature scientifique.

Matériels et méthodes

Ce groupe pluridisciplinaire d’experts constitué de rhumatologues, infectiologues, pédiatre, médecin généraliste, pharmacologue et pharmaciens, a pointé l’inquiétude et le manque d’informations énoncés par les patients à leur pharmacien. Les experts du GRAINS se sont réunis au travers de différentes assemblées et se sont accordés sur la nécessité de mettre à disposition des professionnels de santé une information synthétique de la littérature scientifique et des outils pour vulgariser cette information pour le grand public. La revue de littérature réalisée par les experts du GRAINS porte sur plus de 40 études internationales récentes concernant l’utilisation des AINS dans un contexte de la COVID-19.

Résultats

Le recours aux anti-inflammatoires non stéroïdiens (AINS) en général, et à l’ibuprofène en particulier, n’expose pas à un risque accru de la Covid-19 ni à des formes grave de cette infection.

Discussion

Encourager la discussion sur le bon usage des AINS en automédication. Les experts pointent l’inquiétude et le manque d’information énoncés par les patients à leur pharmacien. Par leur action ils souhaitent alerter sur les risques liés au surdosage d’alternatives aux AINS en particulier dans le traitement de la fièvre et de la douleur. Ils encouragent à ne pas se priver davantage de l’arsenal thérapeutique des AINS et militent pour une utilisation raisonnée de ces traitements.

Conclusion

Il n’existe actuellement aucune preuve scientifique établissant un lien entre l’ibuprofène et l’aggravation de l’infection due au SARS-CoV-2.

POS0084-PARE IMPACT OF OSTEOARTHRITIS ON PATIENT QUALITY OF LIFE: IS THERE AN EVOLUTION BETWEEN THE 2013 AND 2021 LARGE-SCALE SURVEYS “STOP OSTEOARTHRITIS” CONDUCTED IN FRANCE AND BELGIUM?

Background

Osteoarthritis (OA) is the most common form of arthritis, affecting more than 500 million people globally. OA is characterized by chronic mechanical pain and stiffness in the joints, limiting patient physical activities, leading to sedentarism, and disability. The results of the French web-based survey “Stop OA” (N=4227 participants) conducted in 2013 were presented at EULAR 2014. They evidenced the heavy burden of OA in France.

Objectives

The survey was repeated in France/Belgium between 2019 and 2021 (N=3465). This study aimed at assessing the impact of OA on patient quality of life and looking at a potential evolution between the two surveys.

Methods

Participants were invited to complete the survey questionnaire online via the website www.stop-arthrose.org. The questions focused on demographic and socio-economic aspects, history of the disease, physical activities, beliefs about OA, its impact on daily life, assessment of health status and the consequences, as well as the needs and expectations of the participants.

Results

3465 questionnaires (France N = 2822, Belgium N = 643) were thus collected between September 2019 and January 2021. The average filling time of the survey was 40 minutes. In the 2021 survey, 80.8% of participants (mean age 60 years, 80.3% women) declared that OA had a negative impact on their morale and 64.1% that they had a deteriorated self-image due to the disease. 25% of participants thought that difficulties in their couple were caused by OA and 33% reported problems in sexual life. 24.8% found it hard to cope with the discouragement generated by the disease. Even if psychological repercussions were observed in 21.2%, less than 5% consulted a psychologist. The impact on leisure (78.1%) and family life (61.9%) was also significant, as well as on social activities (58.0%) and professional life (43.7%). The disease also hindered walking (67.4%) and prevented daily actions (32.0%). Some help was necessary, mainly for gardening or tinkering (28.7%), picking up or opening objects (22.9%) as well as shopping and household chores (17.7%). 50% reported difficulty falling asleep and 67.6% were being woken up at night during their sleep because of pain caused by OA. Fatigue was difficult to live with for 47.9% of the participants. Compared to the results of the 2013 survey, there was no significant improvement evidenced in any of the areas studied.

Conclusion

OA represents a real burden that affects the mental health of patients, their relationships and the quality of their sleep. There has been no improvement of OA impact in patient’ quality of life between the two surveys (i.e., 8 years). This reflects the lack of resources for research to find new treatments and implement evidence-based therapeutic strategies in the current medical practice. A better understanding of these repercussions will allow effective strategies to be adopted in order to deal with these issues.

References

[1]L. Grange, F. Rannou, F. Berembaum, P. Richette, F. Beroud, A. Chaussier-Delboy, X. Chevalier, C. Dreux, P.A. Joseph, C. Roques, A. Sautet, F. Srour, J. Giraud, D.R. Bertholon, F. Nock, H. Servy, First national osteoarthritis patients survey in France: patients insights first, 2014 PARE00022.

Acknowledgements

Acknowledgements to expanscience, Labhra, UBSA, and Tilman laboratory for their institutional support

Disclosure of Interests

LAURENT GRANGE Speakers bureau: Expanscience, IBSA, Consultant of: Lohmann & Rauscher, Grunenthal, MSD, Grant/research support from: Thuasne, Sublimed, Remedee, Celine Mathy: None declared, Francoise Alliot Launois: None declared, Gerard Chales: None declared, Laurence Seidel: None declared, Adelin Albert: None declared, Rik Lories Speakers bureau: Abbvie, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Janssen, Kabi-Fresenius, MSD, Novartis, Pfizer, Sandoz, Biosplice (Samumed) and UCB., Consultant of: Abbvie, Amgen (formerly Celgeneà, Eli-Lilly, Galapagos, Janssen, Kabi-Fresenius, MSD, Novartis, Pfizer, Sandoz, Biosplice (Samumed) and UCB., Yves Henrotin Consultant of: Tilman, Nestlé, Wobenzym, Genequine, Expanscience, Lahra, Biose

AB0677 GENDER DIFFERENCES ON THE IMPACT OF THE COVID-19 PANDEMIC AND LOCKDOWN IN PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs).

Objectives:

The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes.

Results:

1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, p<0.001), higher risk of anxiety (59.5% vs 48.1%, p<0.001), and depression (48.0% vs 37.2%, p<0.001). Females reported a greater increase in smoking (26.5% vs 17.5%, p=0.001), although they were less likely to drink alcohol (34.5% vs 25.4%, p=0.013), and also engaged less in physical activity (53.0% vs 60.3%, p=0.045). Overall, females were more likely to keep their scheduled rheumatology appointment (43.3% vs 34.1% of males (p=0.049; Table 1) with a higher proportion of females having their rheumatic treatment changed (17.0% vs 10.7%, p=0.005).

Conclusion:

The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments.

Table 1.

Bivariate analysis by gender (N= 1,797 unless specify)

Mean ± SD or n (%)P- valueMale(N= 355)Female(N= 1,442)Sociodemographic characteristicsDiseaseInflammatory arthritis1290 (81.7)1,064 (73.8)Fibromyalgia25 (7.0)287 (19.9)Connective tissue disease218 (5.1)195 (13.5)Osteoarthritis52 (14.6)255 (17.7)Osteoporosis10 (2.8)104 (7.2)Vasculitis37 (2.0)29 (2.0)SAPHO1 (0.3)14 (1.0)Age, years52.8 ± 14.252.5 ± 12.90.896Educational levelUniversity162 (45.6)711 (49.3)0.215Marital statusMarried or in relationship269 (75.8)983 (68.2)0.002*Member of a Patient organisation, N=1,795Yes188 (53.0)559 (38.8)<0.001*Patient-reported outcomesHADS Anxiety, N=1,766Risk168 (48.1)843 (59.5)<0.001*HADS Depression, N=1,766Risk130 (37.2)680 (48.0)<0.001*Wellbeing, N=1,774WHO-5 ≤ 50188 (53.4)681 (47.9)0.064Self-perceived health, N=1,783Fair or bad182 (51.4)958 (67.0)<0.001*Change in health status during COVID-19 pandemic, N=1,783Worse333 (94.1)1,339 (93.7)0.799Life style during COVID-19 pandemicSmoking, N=555More than before20 (17.5)117 (26.5)0.001*Alcohol consumption, N=1,083Quit drinking71 (25.4)277 (34.5)0.013Physical activity, N=1,126Yes144 (60.3)470 (53.0)0.045*Treatment and healthcareAble to meet rheumatologist, N= 721No89 (65.9)332 (56.7)0.049*Access to GP, N=688No43 (39.4)248 (42.8)0.512

1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, LAURENT GRANGE: None declared, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB., Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB