Subluxation of the first carpometacarpal joint and age are important factors in reduced hand strength in patients with hand osteoarthritis

OBJECTIVE

To investigate the determinants of hand strength in patients with hand osteoarthritis (OA).

METHOD

Pinch and cylinder grip strength were measured in 527 patients with hand OA diagnosed by their treating rheumatologist from the Hand OSTeoArthritis in Secondary care (HOSTAS) study. Radiographs of hands (22 joints) were scored 0-3 (scaphotrapeziotrapezoid and first interphalangeal joints 0-1) on osteophytes and joint space narrowing following the Osteoarthritis Research Society International atlas. The first carpometacarpal joint (CMC1) was scored 0-1 for subluxation. Pain was assessed with the Australian/Canadian Hand Osteoarthritis Index pain subscale, and health-related quality of life with the Short Form-36. Regression analysis served to investigate associations of hand strength with patient, disease, and radiographic features.

RESULTS

Hand strength was negatively associated with female sex, age, and pain. Reduced hand strength was associated with reduced quality of life, although less after adjusting for pain. Radiographic features of hand OA were associated with reduced grip strength when solely adjusted for sex and body mass index, but only CMC1 subluxation in the dominant hand remained significantly associated with pinch grip adjusted additionally for age (-0.511 kg, 95% confidence interval -0.975; -0.046). Mediation analysis showed low and not significant percentages of mediation of hand OA in the association between age and grip strength.

CONCLUSIONS

Subluxation of CMC1 is associated with reduced grip strength, whereas associations with other radiographic features seem to be confounded by age. In the relationship between age and hand strength, radiographic hand OA severity is not an important mediator.

Prolonged morning stiffness is common in hand OA and does not preclude a diagnosis of hand osteoarthritis

OBJECTIVE

Prolonged morning stiffness (>60 min) is considered a symptom of inflammatory arthritis, but has a poor discriminative ability. Knowledge about morning stiffness in patients with hand osteoarthritis (OA) is lacking. We therefore studied morning stiffness in patients with hand OA.

DESIGN

Patients with primary hand OA according to their treating rheumatologist in the Hand OSTeoArthritis in Secondary care (HOSTAS) cohort were studied. Severity of morning stiffness was examined with Australian/Canadian hand OA index (AUSCAN) and presence and duration of morning stiffness were examined with a standardized questionnaire. Association of patient and disease characteristics with prolonged morning stiffness (>60 min) were analyzed with logistic regression.

RESULTS

In total 519 of 538 patients had available data about duration of morning stiffness, of whom 89 (17%) had prolonged morning stiffness. Severity of stiffness was mild in 158 of 525 (30%), intermediate in 194 (37%), severe in 97 (18%) and extreme in 19 (4%) patients. Patients with prolonged morning stiffness reported more pain, worse physical function and had a reduced mental and physical quality of life. Patients with prolonged morning stiffness also had more severe radiographic disease, although the association did not reach statistical significance.

CONCLUSIONS

Prolonged and severe morning stiffness are frequently present in patients with hand OA. Patients with these symptoms report more pain in general and have a lower quality of life than patients that do not report these symptoms. Prolonged morning stiffness does not preclude a diagnosis of hand OA.

Test-retest precision and longitudinal cartilage thickness loss in the IMI-APPROACH cohort

OBJECTIVE

To investigate the test-retest precision and to report the longitudinal change in cartilage thickness, the percentage of knees with progression and the predictive value of the machine-learning-estimated structural progression score (s-score) for cartilage thickness loss in the IMI-APPROACH cohort - an exploratory, 5-center, 2-year prospective follow-up cohort.

DESIGN

Quantitative cartilage morphology at baseline and at least one follow-up visit was available for 270 of the 297 IMI-APPROACH participants (78% females, age: 66.4 ± 7.1 years, body mass index (BMI): 28.1 ± 5.3 kg/m², 55% with radiographic knee osteoarthritis (OA)) from 1.5T or 3T MRI. Test-retest precision (root mean square coefficient of variation) was assessed from 34 participants. To define progressor knees, smallest detectable change (SDC) thresholds were computed from 11 participants with longitudinal test-retest scans. Binary logistic regression was used to evaluate the odds of progression in femorotibial cartilage thickness (threshold: -211 μm) for the quartile with the highest vs the quartile with the lowest s-scores.

RESULTS

The test-retest precision was 69 μm for the entire femorotibial joint. Over 24 months, mean cartilage thickness loss in the entire femorotibial joint reached -174 μm (95% CI: [-207, -141] μm, 32.7% with progression). The s-score was not associated with 24-month progression rates by MRI (OR: 1.30, 95% CI: [0.52, 3.28]).

CONCLUSION

IMI-APPROACH successfully enrolled participants with substantial cartilage thickness loss, although the machine-learning-estimated s-score was not observed to be predictive of cartilage thickness loss. IMI-APPROACH data will be used in subsequent analyses to evaluate the impact of clinical, imaging, biomechanical and biochemical biomarkers on cartilage thickness loss and to refine the machine-learning-based s-score.

CLINICALTRIALS

GOV IDENTIFICATION

NCT03883568.

The association of the lipid profile with knee and hand osteoarthritis severity: the IMI-APPROACH cohort

OBJECTIVE

To investigate the association of the lipidomic profile with osteoarthritis (OA) severity, considering the outcomes radiographic knee and hand OA, pain and function.

DESIGN

We used baseline data from the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort, comprising persons with knee OA fulfilling the clinical American College of Rheumatology classification criteria. Radiographic knee and hand OA severity was quantified with Kellgren-Lawrence sum scores. Knee and hand pain and function were assessed with validated questionnaires. We quantified fasted plasma higher order lipids and oxylipins with liquid chromatography with tandem mass spectrometry (LC-MS/MS)-based platforms. Using penalised linear regression, we assessed the variance in OA severity explained by lipidomics, with adjustment for clinical covariates (age, sex, body mass index (BMI) and lipid lowering medication), measurement batch and clinical centre.

RESULTS

In 216 participants (mean age 66 years, mean BMI 27.3 kg/m², 75% women) we quantified 603 higher order lipids (triacylglycerols, diacylglycerols, cholesteryl esters, ceramides, free fatty acids, sphingomyelins, phospholipids) and 28 oxylipins. Lipidomics explained 3% and 2% of the variance in radiographic knee and hand OA severity, respectively. Lipids were not associated with knee pain or function. Lipidomics accounted for 12% and 6% of variance in hand pain and function, respectively. The investigated OA severity outcomes were associated with the lipidomic fraction of bound and free arachidonic acid, bound palmitoleic acid, oleic acid, linoleic acid and docosapentaenoic acid.

CONCLUSIONS

Within the APPROACH cohort lipidomics explained a minor portion of the variation in OA severity, which was most evident for the outcome hand pain. Our results suggest that eicosanoids may be involved in OA severity.

Neuropathic‐like pain symptoms in inflammatory hand osteoarthritis lower quality of life and may not decrease under prednisolone treatment

Background

Pain is common in hand osteoarthritis (OA) and multiple types may occur. We investigated the prevalence, associated patient characteristics, influence on health‐related quality of life (HR‐QoL) and response to anti‐inflammatory treatment of neuropathic‐like pain in inflammatory hand OA.

Methods

Data were analysed from a 6‐week, randomized, double‐blind, placebo‐controlled trial investigating prednisolone treatment in 92 patients with painful inflammatory hand OA. Neuropathic‐like pain was measured with the painDETECT questionnaire. Associations between baseline characteristics and baseline neuropathic‐like pain were analysed with ordinal logistic regression, association of baseline neuropathic‐like pain symptoms with baseline HR‐QoL with linear regression, painDETECT and visual analogue scale (VAS) change from baseline to week 6 and interaction of painDETECT with prednisolone efficacy on VAS pain change from baseline to week 6 with generalized estimating equations (GEE).

Results

Of 91 patients (79% female, mean age 64) with complete painDETECT data at baseline, 53% were unlikely to have neuropathic‐like pain, 31% were indeterminate and 16% were likely to have neuropathic‐like pain. Neuropathic‐like pain was associated with female sex, less radiographic damage and more comorbidities. Patients with neuropathic‐like pain had lower HR‐QoL (PCS‐6.5 [95% CI −10.4 to −2.6]) than those without. Neuropathic‐like pain symptoms remained under prednisolone treatment and no interaction was seen between painDETECT and prednisolone efficacy on VAS pain.

Conclusions

In this study, 16% of inflammatory hand OA patients had neuropathic‐like pain. They were more often female, had more comorbidities and had lower QoL than those without. Neuropathic‐like pain symptoms remained despite prednisolone treatment and did not seem to affect the outcome of prednisolone treatment.

Significance

Pain is the dominant symptom in hand OA, with an unclear aetiology. In this study, we found that neuropathic‐like pain may play a role in hand OA, that it showed associations with female sex, younger age and more comorbidities and that it lowered health‐related quality of life in hand OA. Neuropathic‐like pain in hand OA seems resistant to prednisolone therapy but did not seem to interfere with the treatment of inflammatory pain with prednisolone.

OP0224 DISCOVERY PROTEOMICS ANALYSIS IN THE IMI-APPROACH COHORT SHOWS THE DIFFERENTIAL MODULATION AT 24 MONTHS OF PROTEIN PROFILES ASSOCIATED WITH STRUCTURAL OR PAIN PROGRESSION IN OSTEOARTHRITIS

Background

The characterization of differential molecular endotypes in osteoarthritis (OA) is essential for enabling patient stratification to enhance clinical trials, facilitate the development of targeted and individualized treatments.

Objectives

This study aimed to characterize the profile and dynamics over 24 months (24M) of proteins present in the sera from patients in the IMI-Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort who exhibited structural (radiographic) and pain progression compared to participants who did not progressed during this period.

Methods

Forty-five patients enrolled in the IMI-APPROACH cohort were selected for the proteomic analysis. Among these, 15 showed the highest structural progression (group S) and 15 the highest pain progression (group P) at 24M, according to the APPROACH criteria [1], while 15 did not progressed neither in S nor in P. Baseline (BL) and 24M serum samples were depleted of the top 14 most abundant proteins and then analysed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) on a nanoElute-LC coupled to a high-resolution TIMS-QTOF (timsTOF Pro, Bruker Daltonics). Proteins were identified and quantified using the LFQ algorithm of MaxQuant software. Further statistical and bioinformatic analyses were performed using Perseus and OmicsAnalyst software.

Results

The proteomic analysis resulted in the identification of 558 proteins (10,466 peptides) in the serum samples. A label-free quantification algorithm was employed to quantify 468 proteins in the samples. Hierarchical clustering of the data showed the differences in protein abundance were more relevant longitudinally (BL to 24M) than in cross-sectional comparisons between the three groups under study (N, P or S). Sixty-three proteins were significantly altered (fold change >=1.5, p<0.05) when comparing BL to 24M in the N group (15 increased and 48 decreased), 53 in the P group (20 increased and 33 decreased) and 93 in the S group (19 increased and 74 decreased). Interestingly, two different endotypes were detected at baseline in the N and S groups, based on these protein modulations.

The overlapping of these proteomic profiles was analyzed between groups and is shown in the Figure 1. Proteins modulated specifically in the N group may be associated with mechanisms related with joint repair. On the other hand, six proteins (including two apolipoproteins) were increased at 24M only in the P group. Finally, 30 proteins were modulated only in the S group: five of them increased and 25 decreased. Remarkably, this latter group includes lubricin, chaperones and proteins related with proteoglycan binding, such as COMP, fibronectin or histidine-rich glycoprotein.

Figure 1.

Circulating proteins identified as modulated after 24M follow-up in 45 patients from the APPROACH cohort that progressed in structure (S group; n=15), pain (P group; n=15) or did not progressed (N group; n=15). The numbers with arrows indicate those proteins that decrease (arrow pointing down) or increase (arrow pointing up) compared to baseline.

Conclusion

The modulation of specific protein profiles in serum were identified as associated with the progression in structure, pain or non-progression in patients from the APPROACH cohort. Proteomic changes found specifically in the S group may be interesting circulating markers of the structural affectation occurring in the joint.

References

[1]van Helvoort EM, et al., BMJ Open. 2020 Jul 28;10(7):e035101. doi: 10.1136/bmjopen-2019-035101.

Disclosure of Interests

Cristina Ruiz-Romero: None declared, Patrik Önnerfjord: None declared, Valentina Calamia: None declared, Patricia Fernández Puente: None declared, Lucía Lourido: None declared, Rocío Paz González: None declared, Pawel Widera: None declared, Jaume Bacardit: None declared, Anne-Christine Bay-Jensen Shareholder of: Nordic Bioscience, Employee of: Nordic Bioscience, Francis Berenbaum Consultant of: AstraZeneca, Boehringer, Bone Therapeutics, CellProthera, Expanscience, Galapagos, Gilead, Grunenthal, GSK, Eli Lilly, Merck Sereno, MSD, Nordic, Nordic Bioscience, Novartis, Pfizer, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, 4P Pharma, 4Moving Biotech, Grant/research support from: TRB Chemedica, Ida K. Haugen Consultant of: Abbvie and Novartis, Grant/research support from: Pfizer, Margreet Kloppenburg Consultant of: Abbvie, Pfizer, Levicept, GlaxoSmithKline, Merck-Serono, Kiniksa, Flexion, Galapagos, Jansen, CHDR, Novartis, UCB, Simon Mastbergen: None declared, Jonathan Larkin Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, Ali Mobasheri Consultant of: Merck KGaA, Kolon TissueGene, Pfizer Inc., Galapagos-Servier, Image Analysis Group (IAG), Artialis SA, Aché Laboratórios Farmacêuticos, AbbVie, Guidepoint Global, Alphasights, Science Branding Communications, GSK, Flexion Therapeutics, Pacira Biosciences, Sterifarma, Bioiberica, SANOFI, Genacol, Kolon Life Science, BRASIT/BRASOS, GEOS, MCI Group, Alcimed, Abbot, Laboratoires Expansciences, SPRIM Communications, Frontiers Media and University Health Network (UHN) Toronto, Grant/research support from: Merck KGaA, Kolon TissueGene, Pfizer Inc., Galapagos-Servier, Image Analysis Group (IAG), Artialis SA, Aché Laboratórios Farmacêuticos, AbbVie, Guidepoint Global, Alphasights, Science Branding Communications, GSK, Flexion Therapeutics, Pacira Biosciences, Sterifarma, Bioiberica, SANOFI, Genacol, Kolon Life Science, BRASIT/BRASOS, GEOS, MCI Group, Alcimed, Abbot, Laboratoires Expansciences, SPRIM Communications, Frontiers Media and University Health Network (UHN) Toronto, Francisco J. Blanco Consultant of: Gedeon Richter Plc., Bristol-Myers Squibb International Corporation (BMSIC), Sun Pharma Global FZE, Celgene Corporation, Janssen Cilag International N.V, Janssen Research & Development, Viela Bio, Inc., Astrazeneca AB, UCB BIOSCIENCES GMBH, UCB BIOPHARMA SPRL, AbbVie Deutschland GmbH & Co.KG, Merck KGaA, Amgen, Inc., Novartis Farmacéutica, S.A., Boehringer Ingelheim España, S.A, CSL Behring, LLC, Glaxosmithkline Research & Development Limited, Pfizer Inc, Lilly S.A., Corbus Pharmaceuticals Inc., Biohope Scientific Solutions for Human Health S.L., Centrexion Therapeutics Corp., Sanofi, TEDEC-MEIJI FARMA S.A., Kiniksa Pharmaceuticals, Ltd., Fundación para la Investigación Biomédica Del Hospital Clínico San Carlos, Grünenthal and Galapagos, Grant/research support from: Pfizer

POS1121 HAND OSTEOARTHRITIS IS ASSOCIATED WITH LIMITATIONS IN PAID AN UNPAID WORK PARTICIPATION AND RELATED SOCIETAL COSTS: THE HOSTAS COHORT

Background

Rheumatic musculoskeletal diseases (RMDs) can cause impairment in paid and unpaid work which can contribute to societal burden and costs. However, data on this topic concerning hand osteoarthritis (OA) is scarce, while this is crucial for assessing the societal impact of this disease.

Objectives

To investigate the association of hand OA with paid and unpaid work limitations, productivity loss and costs of productivity loss.

Methods

We used data of the Dutch Hand OSTeoArthritis in Secondary care (HOSTAS) cohort, a primary hand OA cohort from a general rheumatology outpatient clinic. The treating rheumatologist defined hand OA presence. We assessed patient and OA characteristics using validated questionnaires and tests. We investigated work impairment due to hand OA with the Health and Labour Questionnaire (HLQ) which assesses the last two weeks on hand-OA related limitations, hours of sick leave and unproductiveness during paid work, and limitations and hours of the necessity of being replaced by others for unpaid work tasks.

We estimated societal costs of paid work by multiplying unproductive and sick leave hours due to hand OA by the average Dutch hourly societal costs of paid work for persons of the same age category and sex. We estimated societal costs of unpaid work by multiplying the hours of unpaid work replaced by others by the Dutch gross average hourly salary of a household help (€12.50).

Results

HLQ data was available for 382 patients (mean age 61 years, 86% women, 26% having a university degree, 41% having any comorbidity). Of these persons, 181 (47%) had paid work, 16 (4%) had full work disability due to hand OA and 117 (30%) were retired. Thirteen employed persons (7%) reported sick leave due to hand OA in the last two weeks, for whom a median of 42 working hours (interquartile range (IQR) 24 to 54) was lost. Unproductive paid work hours were present for 28 (15%) patients, with a median of 4 hours in the last two weeks (IQR 2 to 6). Hinder at work in the last two weeks was reported by 120 out of 181 working patients (66%), for whom median hinder score (score range 6-24) was 7 (IQR 6 to 8). Work production loss in the last two weeks due to hand OA (the sum of sick leave hours and unproductive hours) was present for 36 patients (19%). Patients with paid work productivity loss (n = 35, 19%) did not differ statically significantly in patient and disease characteristics from those without productivity loss (n = 146, 19%).

Unpaid work replacement in the last two weeks was reported by 171 patients (45%), with a median of three hours replaced (IQR 2 to 7). Any unpaid work hinder was reported by 297 (78%). Median unpaid work hinder score (score range: 4-16) was 8 (IQR 7 to 10) . Patients with unpaid work replacement by others due to hand OA (n=171, 45%) were statically significantly more often female and had a higher BMI than with those without any replacement (n=210, 55%).

We estimated total societal costs of hand OA related to paid work production loss at €61 (95% confidence interval (CI) 27 to 96) per two weeks, and societal costs for unpaid work at €33 (CI 27 to 40). Total estimated work-related societal costs per patient with hand OA were €94 (CI 59 to 130), translating to €2452 (CI 1528 to 3377) per year.

Conclusion

Hand OA is associated with impairment in paid and unpaid work, which translates into substantial societal costs. This highlights the social and economic importance of adequate hand OA treatment. It also highlights the importance of investigating work impairment experienced by hand OA patients visiting the outpatient clinic, for potentially more tailored treatment.

Disclosure of Interests

None declared

AB0976 Determination and characterization of patient subgroups with different pain progression in hand osteoarthritis

Background

Hand pain is common in hand osteoarthritis (OA). Previous cohort studies reported stable average pain levels on the short to midterm. Subgroups with different pain trajectories have been found in knee OA. Similar subgroups of hand OA patients may exist. Knowledge of such subgroups in hand OA patients may help inform decisions for pain treatment.

Objectives

To determine and characterize subgroups with different hand pain trajectories over four years in hand OA patients.

Methods

Data from the ongoing HOSTAS (Hand OSTeoArthritis in Secondary care) cohort were used, collected from consecutive patients at the LUMC Rheumatology outpatient clinic with primary hand OA followed for four years. Hand pain measurements were collected annually starting at baseline with the AUSCAN pain questionnaire (range 0-20).

Development of pain over time was modelled using latent class growth analysis (LCGA), dividing the cohort into subgroups based on differences in pain development. The optimal model was selected based on the AIC, BIC, entropy and likelihood ratio test for models with n vs n-1 classes. LCGA requires ≥2 measurements per case, so patients with less were excluded.

Associations of LCGA classes with baseline demographics and factors associated with hand pain were analyzed using multinomial logistic regression.

Results

Of 538 participants, 484 completed the AUSCAN at ≥2 timepoints. Data of excluded patients were missing at random. Included and excluded patients were comparable. Of included participants 86% were women, mean (SD) age was 60.8 (8.5), 29% had erosive disease, median (IQR) symptom duration was 5.2 (1.9-12.2), 91% fulfilled the ACR criteria for hand OA. Mean AUSCAN pain score was 9.3 (4.3).

LCGA yielded five classes (Figure 1). Classes were characterized by different pain levels at baseline; mean level of pain remained stable over time. Classes with more pain were associated with more erosive disease, higher tender joint count, longer symptom duration, more comorbidities, worse AUSCAN function scores and worse SF-36 and HADS scores (Table 1).

Figure 1.

LCGA trajectories.

Trajectories of AUSCAN pain identified by latent class growth analysis. Least pain to most pain, named class 1 (pink), class 2 (red), class 3 (brown), class 4 (blue) and class 5 (green).

Table 1.

Multinomial logistic regression for associations with 5 LCGA classes

OR (95% CI)Baseline1 (N=37)2 (N=104)3 (N=171)4 (N=131)5 (N=41)Erosive disease11.20 (0.45-3.18)1.48 (0.55-4.03)1.23 (0.41-3.70)1.21 (0.30-4.87)Symptom duration, years;11.05 (0.97-1.13)1.09 (1.01-1.18)1.13 (1.04-1.22)1.12 (1.03-1.23)KL sum score11.01 (0.98-1.05)1.01 (0.98-1.05)1.02 (0.99-1.06)1.03 (0.99-1.08)Tender joint count11.17 (0.98-1.39)1.20 (1.00-1.44)1.28 (1.07-1.54)1.29 (1.06-1.57)AUSCAN function10.98 (0.90-1.08)1.08 (0.99-1.18)1.17 (1.06-1.30)1.31 (1.13-1.51)SF-36-PCS10.95 (0.89-1.02)0.90 (0.84-0.97)0.84 (0.77-0.91)0.81 (0.73-0.89)-MCS10.98 (0.90-1.06)0.96 (0.89-1.04)0.95 (0.87-1.03)0.90 (0.82-0.99)HADS-Depression11.28 (0.91-1.82)1.46 (1.02-2.09)1.50 (1.04-2.16)1.54 (1.04-2.28)-Anxiety11.09 (0.85-1.38)1.19 (0.93-1.54)1.19 (0.91-1.54)1.24 (0.92-1.65)No. Comorbidities11.64 (0.77-3.47)1.84 (0.86-3.90)2.22 (1.01-4.88)2.12 (0.89-5.06)

Multinomial logistic regression of variables associated with LCGA classes adjusted for baseline AUSCAN pain, age, sex and BMI. Class 1 = least pain, class 5 = most pain. SF-36 = Short Form-36. MCS = Mental component scale. PCS = Physical component scale. HADS = Hospital anxiety and depression scale. SF-36 scores are standardized on age, sex and nationality with mean 50 and SD 10.

Conclusion

Latent class growth analysis showed five subgroups with different pain trajectories in hand OA patients, with differing baseline pain and stable pain over time. These subgroups were associated with disease characteristics, number of comorbidities, psychological distress and health-related quality of life. This knowledge can help develop treatment for hand OA patients and inform them about the disease course.

Disclosure of Interests:

None declared

GaitSmart motion analysis compared to commonly used function outcome measures in the IMI-APPROACH knee osteoarthritis cohort

Background

There are multiple measures for assessment of physical function in knee osteoarthritis (OA), but each has its strengths and limitations. The GaitSmart® system, which uses inertial measurement units (IMUs), might be a user-friendly and objective method to assess function. This study evaluates the validity and responsiveness of GaitSmart® motion analysis as a function measurement in knee OA and compares this to Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form 36 Health Survey (SF-36), 30s chair stand test, and 40m self-paced walk test.

Methods

The 2-year Innovative Medicines Initiative—Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) knee OA cohort was conducted between January 2018 and April 2021. For this study, available baseline and 6 months follow-up data (n = 262) was used. Principal component analysis was used to investigate whether above mentioned function instruments could represent one or more function domains. Subsequently, linear regression was used to explore the association between GaitSmart® parameters and those function domains. In addition, standardized response means, effect sizes and t-tests were calculated to evaluate the ability of GaitSmart® to differentiate between good and poor general health (based on SF-36). Lastly, the responsiveness of GaitSmart® to detect changes in function was determined.

Results

KOOS, SF-36, 30s chair test and 40m self-paced walk test were first combined into one function domain (total function). Thereafter, two function domains were substracted related to either performance based (objective function) or self-reported (subjective function) function. Linear regression resulted in the highest R² for the total function domain: 0.314 (R² for objective and subjective function were 0.252 and 0.142, respectively.). Furthermore, GaitSmart® was able to distinguish a difference in general health status, and is responsive to changes in the different aspects of objective function (Standardized response mean (SRMs) up to 0.74).

Conclusion

GaitSmart® analysis can reflect performance based and self-reported function and may be of value in the evaluation of function in knee OA. Future studies are warranted to validate whether GaitSmart® can be used as clinical outcome measure in OA research and clinical practice.

Administration of an adeno-associated viral vector expressing interferon-β in patients with inflammatory hand arthritis, results of a phase I/II study

OBJECTIVE

Inflammatory hand arthritis (IHA) results in impaired function. Local gene therapy with ART-I02, a recombinant adeno-associated virus (AAV) serotype 5 vector expressing interferon (IFN)-β, under the transcriptional control of nuclear factor κ-B responsive promoter, was preclinically shown to have favorable effects. This study aimed to investigate the safety and tolerability of local gene therapy with ART-I02 in patients with IHA.

METHODS

In this first-in-human, dose-escalating, cohort study, 12 IHA patients were to receive a single intra-articular (IA) injection of ART-I02 ranging 0.3 × 10¹²-1.2 × 10¹³ genome copies in an affected hand joint. Adverse events (AEs), routine safety laboratory and the clinical course of disease were periodically evaluated. Baseline- and follow-up contrast enhanced magnetic resonance images (MRIs), shedding of viral vectors in bodily fluids, and AAV5 and IFN-β immune responses were evaluated. A data review committee provided safety recommendations.

RESULTS

Four patients were enrolled. Long-lasting local AEs were observed in 3 patients upon IA injection of ART-I02. The AEs were moderate in severity and could be treated conservative. Given the duration of the AEs and their possible or probable relation to ART-I02, no additional patients were enrolled. No systemic treatment emergent AEs were observed. The MRIs reflected the AEs by (peri)arthritis. No T-cell response against AAV5 or IFN-β, nor IFN-β antibodies could be detected. Neutralizing antibody titers against AAV5 raised post-dose.

CONCLUSION

Single IA doses of 0.6 × 10¹² or 1.2 × 10¹² ART-I02 vector genomes were administered without systemic side effects or serious AEs. However, local tolerability was insufficient for continuation.

TRIAL REGISTRATION

NCT02727764.

The association of clinical and structural knee osteoarthritis with physical activity in the middle-aged population: the NEO study

OBJECTIVE

To investigate if knee osteoarthritis (OA) is associated with lower physical activity in the general middle-aged Dutch population, and if physical activity is associated with patient-reported outcomes in knee OA.

DESIGN

Clinical knee OA was defined in the Netherlands Epidemiology of Obesity population using the ACR criteria, and structural knee OA on MRI. We assessed knee pain and function with the Knee Injury and Osteoarthritis Score (KOOS), health-related quality of life (HRQoL) with the Short Form-36, and physical activity (in Metabolic Equivalent of Task (MET) hours) with the Short Questionnaire to Assess Health-enhancing physical activity. We analysed the associations of knee OA with physical activity, and of physical activity with knee pain, function, and HRQoL in knee OA with linear regression adjusted for potential confounders.

RESULTS

Clinical knee OA was present in 14% of 6,212 participants, (mean age 56 years, mean BMI 27 kg/m², 55% women, 24% having any comorbidity) and structural knee OA in 12%. Clinical knee OA was associated with 9.60 (95% CI 3.70; 15.50) MET hours per week more physical activity, vs no clinical knee OA. Structural knee OA was associated with 3.97 (-7.82; 15.76) MET hours per week more physical activity, vs no structural knee OA. In clinical knee OA, physical activity was not associated with knee pain, function or HRQoL.

CONCLUSIONS

Knee OA was not associated with lower physical activity, and in knee OA physical activity was not associated with patient-reported outcomes. Future research should indicate the optimal treatment advice regarding physical activity for individual knee OA patients.

POS0123 NEUROPATHIC PAIN SYMPTOMS IN INFLAMMATORY HAND OSTEOARTHRITIS(OA) LOWERS HEALTH RELATED PHYSICAL QUALITY OF LIFE AND MAY REQUIRE ANOTHER APPROACH THAN ANTI-INFLAMMATORY TREATMENT

Background:

Pain is a common, difficult to manage symptom in hand osteoarthritis (OA). Multiple pain mechanisms may play a role in hand OA.

Objectives:

To investigate presence of neuropathic pain symptoms in patients with inflammatory hand OA, characteristics of those patients, their impact on health related quality of life (HR-QoL), and the influence of anti-inflammatory treatment on neuropathic pain symptoms.

Methods:

Data from a randomised, double-blind, placebo-controlled trial of prednisolone including 92 patients with hand OA fulfilling ACR criteria were used. At baseline patients had signs of synovial inflammation, a VAS finger pain of ≥30 mm and who flared ≥20 mm upon NSAID washout. The primary endpoint was VAS finger pain (0-100) at week 6.

Neuropathic pain symptoms were measured at baseline and week 6 using the validated painDETECT questionnaire, consisting of questions on pain quality, pain intensity over time and radiating pain. Scores range -1 to 38 and patients are classified as having unlikely (<13), indeterminate (13-18) and likely (>18) neuropathic pain. HR-QoL was measured with physical component scale (PCS) of Short-Form 36 (SF36; 0-100), comorbidities with the Self-administered Comorbidities Questionnaire (SCQ; 0-45), radiographic severity with Kellgren-Lawrence (KL) sum score (0-120), and treatment response with OMERACT-OARSI responder criteria.

Association of patient characteristics with neuropathic pain symptoms was analysed with univariate and multivariate ordinal logistic regression, with painDETECT as dependent variable. Association of neuropathic pain symptoms with HR-QoL was analysed with multivariate linear regression, adjusted for age, sex, BMI, VAS finger pain, SCQ score and KL sum score, with PCS as dependent variable. Response of neuropathic pain symptoms and VAS pain to prednisolone was analysed with generalised estimating equations. Association of neuropathic pain symptoms at baseline with response to treatment was analysed using χ2-tests and GEE.

Results:

91 patients had complete painDETECT data at baseline (mean painDETECT score 12.8 [SD 5.9]). Scores were <13 in 53%, 13-18 in 31% and >18 in 16%. Higher painDETECT score categories were associated with less radiographic damage, more comorbidities, female sex and higher VAS finger pain in multivariate analysis. (table 1)

Table 1.

Ordinal logistic regression with painDETECT categories as dependent variable

VariablesMean (SD) N=91 (100%)Odds ratio (95% CI)Age64 (9)0.96 (0.90 to 1.02)Female sex; N (%)72 (79%)3.84 (1.19 to 12.39)*BMI; median (SD)27 (24 to 29)0.97 (0.89 to 1.06)SCQ score; median (SD)2 (1 to 5)1.04 (1.04 to 1.36)*VAS finger pain53.8 (2.1)1.02 (1.00 to 1.04)*KL sum score37 (16)0.96 (0.93 to 1.00)*

*p<0.05. BMI = body mass index. SCQ = Self-administered comorbidities questionnaire. VAS = visual analog scale. KL= Kellgren-Lawrence.

Patients with painDETECT scores >18 had a lower HR-QoL (PCS -6.5 [95%CI -10.4 to -2.6]) than those with painDETECT scores <13.

PainDETECT scores remained unchanged throughout the trial in both prednisolone-treated and placebo-treated patients, and there was no between-group difference at week 6. VAS pain improved more in the prednisolone group than in the placebo group (mean between-group difference -16.5 [95%CI -26.1 to -6.9]) (figure 1). No association between the presence of neuropathic pain symptoms at baseline and OMERACT-OARSI response to treatment was found.

Conclusion:

Patients with inflammatory hand OA and additional neuropathic pain symptoms are more often female and have more comorbidities, and report a lower QoL, than those without. Neuropathic pain symptoms seem unresponsive to anti-inflammatory therapy. Clinicians should be aware of neuropathic pain symptoms in their patients as they might benefit from additional, specific treatment.

Acknowledgements:

The authors thank all patients for their participation in the HOPE study, and participating rheumatologists for inclusion of patients in the HOPE study. We also thank research nurses B.A.M.J. van Schie-Geyer and S. Wongsodihardjo, and technicians J.C. Kwekkeboom and E.I.H. van der Voort, for their contributions.

Disclosure of Interests:

Coen van der Meulen: None declared, Lotte van de Stadt: None declared, Féline Kroon: None declared, Marion Kortekaas: None declared, Annelies Boonen Speakers bureau: Lecture for UCB; paid to department., Consultant of: Yes. Advisory board meetings at Galapagos, Eli Lilly and Abvvie; paid to department., Grant/research support from: Yes. Grants by Celgene and Abbvie; paid to department., Stefan Böhringer: None declared, Marieke Niesters: None declared, Monique Reijnierse: None declared, Frits Rosendaal: None declared, Naghmeh Riyazi: None declared, M. Starmans: None declared, Franktien Turkstra: None declared, Jende van Zeben: None declared, Cornelia Allaart: None declared, Margreet Kloppenburg Consultant of: For Abbvie, Pfizer, Levicept, GlaxoSmithKline, Merck-Serono, Kiniksa, Flexìon, Galapagos, Jansen, CHDR and local investigator of industry-driven trial (Abbvie). All fees were paid to the institution., Grant/research support from: Grant by the Dutch Arthritis Society

POS1431 THE ASSOCIATION OF CLINICAL AND STRUCTURAL KNEE OSTEOARTHRITIS WITH PHYSICAL ACTIVITY IN THE MIDDLE-AGED POPULATION: THE NEO STUDY

Background:

Lack of physical activity in individuals with knee OA has shown to be associated with increased cardiovascular risk and mortality. Consequently, physical activity is a potential target for interventions in knee OA. However, most of the available studies concerning physical activity in individuals with knee OA were performed in relatively old populations with an inactive lifestyle. It is unclear how previous results can be generalized to other populations with different lifestyle and physical activity habits.

Objectives:

To investigate if knee OA is associated with lower physical activity in a general middle-aged Dutch population. Furthermore, to investigate the association of physical activity with patient reported outcomes such as knee pain and function, and health-related quality of life in individuals with knee OA.

Methods:

We used cross-sectional data from the Netherlands Epidemiology of Obesity (NEO) study, in which participants aged 45-65 years were included. Clinical knee OA was defined using the ACR criteria. Structural knee OA was defined on MRI using the modified criteria by Hunter et al. in a random subset of 1,285 individuals of our study population.

We assessed knee pain and function with the Knee injury and Osteoarthritis Score (KOOS), and health-related quality of life (HRQoL) with the Short Form (SF)-36. Physical activity (in Metabolic Equivalent of Task (MET) hours per week) was assessed using the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH).

We used linear regression analyses to investigate 1) the association of knee OA with physical activity, and 2) of physical activity with knee pain, function, and HRQoL in participants with clinical knee OA. All analyses were adjusted for age, sex, body mass index (BMI), ethnicity, educational level and comorbidities. To account for possible information bias, we performed a sensitivity analysis to assess the association between clinical knee OA and physical activity measured by an accelerometer in a random subset of 15% of the study population.

Results:

Of 6,212 participants, we observed clinical knee OA in 14%, and structural knee OA in 12%. The general population characteristics and median physical activity of our study population are presented in Table 1. In comparison to participants without knee OA, participants with clinical knee OA had on average 9.60 (95% CI 3.70;15.50) MET hours per week more total physical activity (Figure 1). Structural knee OA was associated with 3.97 (-7.82; 15.76) MET hours per week more physical activity, compared with no structural knee OA.

Sensitivity analysis showed a weak positive association of clinical knee OA with physical activity measured by an accelerometer: 2.37 (-6.05; 10.80) MET hours per week more physical activity in participants with clinical knee OA, compared with participants without clinical knee OA.

In the subpopulation of participants with clinical knee OA, physical activity was not associated with knee pain, function or HRQoL.

Conclusion:

Knee OA was not associated with lower physical activity in this middle-aged Dutch population. This contrasts previous findings and warrants caution when generalizing physical activity outcomes to other populations. Furthermore, it stresses the need of more insight in the barriers and facilitators of physical activity in the middle-aged population.

Table 1.

Characteristics of the NEO study population

Alln = 6,214No clinical knee OA86%Clinical knee OA14%General population characteristics Age (year)55.7 (6.0)55.4 (6.1)57.5 (5.0) Sex (% women)555467 BMI (kg/m2)26.3 (4.4)26.1 (4.3)27.6 (5.1) Comorbidities (% present)242332Physical activity Total^ (MET-hours per week)118.8 (76.8;155.0)118.4 (76.6;154.4)123.5 (77.8;157.2)

Numbers represent mean (SD) or percentages. ^median (25th, 75th percentiles). Abbreviations: OA = osteoarthritis. BMI = Body Mass Index. MET = Metabolic Equivalent of Task.

Disclosure of Interests:

None declared

POS0709 LUPUS FOG IS NOT DISSOCIATIVE FOG

Background:

The presence of a ‘fog’ is frequently reported by patients with systemic lupus erythematosus (SLE). However, little is known about this lupus fog: it is thought to be a result of cognitive dysfunction, but fogs can also be the result of dissociation. The Dissociative Experience Scale-II (DES) is a standardized tool to study dissociation. In the general adult population, scores range from 4.4-14.1-3

Objectives:

We aimed to study the prevalence of dissociative symptoms including dissociative fog in patients with SLE and neuropsychiatric symptoms.

Methods:

Patients visiting the tertiary referral center for neuropsychiatric systemic lupus erythematosus (NPSLE) of the LUMC between 2007-2019 were included. All patients underwent a standardized multidisciplinary assessment. Patients were classified as NPSLE if neuropsychiatric symptoms were attributed to SLE and immunosuppressive or anticoagulant therapy was initiated, otherwise patients were classified as minor/non-NPSLE. Dissociation was studied using the DES. The DES separates different types of dissociative symptoms: amnesia, absorption/imagination and derealization/depersonalization. It also contains one question regarding evaluating the presence of a dissociative fog: “Some people sometimes feel as if they are looking at the world through a fog, so that people and objects appear far away or unclear”. All statements (n = 28) regarding dissociative symptoms are rated from ‘none of the time’ to ‘all of the time’ (0-100%); scores >25 are considered abnormal. A multiple regression analysis (MRA) were performed to compare dissociation in patients with and without NPSLE. DES results are presented as median (range) and MRA as odds ratio (OR) and 95% confidence interval (CI).

Results:

DES questionnaires were available for 337 patients, of which 97 had the diagnosis NPSLE (29%). Mean age in patients with NPSLE was 41 ± 13 years and 84% was female. In minor/non-NPSLE, median age was 44 ± 14 years and 87% was female.

Median dissociation was 7 (0-75) and did not differ between patients with minor/non-NPSLE and NPSLE (OR: 1.0 (95% CI: -0.9; 1.1)). The most common type of dissociation was absorption/imagination (median: 12, range 0-75) and depersonalization/derealization was infrequent (median: 1, range 0-84). 43 patients (13%) had an abnormal score (>25) on the dissociative fog question.

Conclusion:

Dissociative symptoms are within normal range in patients with SLE and neuropsychiatric symptoms, regardless of underlying etiology. Dissociative fog seems uncommon and therefore lupus fog is most likely not the result of dissociation.

References:

[1]Bernstein EM and Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986; 174: 727-735. 1986/12/01. DOI: 10.1097/00005053-198612000-00004.

[2]Maaranen P, Tanskanen A, Honkalampi K, et al. Factors associated with pathological dissociation in the general population. Aust N Z J Psychiatry 2005; 39: 387-394. 2005/04/30. DOI: 10.1080/j.1440-1614.2005.01586.x.

[3]van IJzendoorn MH and Schuengel C. The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review 1996; 16: 365-382. DOI: 10.1016/0272-7358(96)00006-2.

Table 1.

Presence of dissociation in patients with SLE and neuropsychiatric symptoms

Total cohort(n = 337)Minor/non-NPSLE(n = 240)NPSLE(n = 97)DES (median, range)Total questionnaire7 (0 - 75)8 (0 - 66)6 (0 – 75)Amnesia5 (0 - 76)5 (0 - 68)4 (0 - 76)Absorption/imagination12 (0 – 75)13 (0 – 75)10 (0 – 73)Depersonalization/derealization1 (0 – 84)1 (0 – 73)1 (0 – 84)Dissociative fog* 0 (0-100)0 (0-100)0 (0-100)

DES = Dissociative Experience Scale NPSLE = neuropsychiatric systemic lupus erythematosus.

*Dissociative fog is question 28 of the DES-II

Disclosure of Interests:

None declared

POS0708 PSYCHIATRIC DISORDERS IN PATIENTS WITH DIFFERENT PHENOTYPES OF NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS (NPSLE)

Background:

Patients with systemic lupus erythematosus (SLE) may present with psychiatric disorders. These are important to recognize, as they influence quality of life and treatment outcomes and strategies.

Objectives:

We aimed to study the frequency of psychiatric morbidity as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in patients with SLE and neuropsychiatric symptoms of different origins.

Methods:

In the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center, patients undergo a standardized multidisciplinary assessment by a neurologist, neuropsychologist, vascular internal medicine, rheumatologist, physician assistant and psychiatrist. After two weeks, a multidisciplinary consensus meeting takes place, in which the symptoms are attributed to SLE requiring treatment (major NPSLE) or to minor involvement of SLE or other causes (minor/non-NPSLE). Consecutive patients visiting the NPSLE clinic between 2007-2019 were included. Data of psychiatric evaluation and current medication use were extracted from medical records. The presence of cognitive dysfunction was established during formal neuropsychological assessment.

Results:

371 consecutive SLE patients were included, of which 110 patients had major NPSLE (30%). Mean age was 44 ± 14 years and 87% was female.

The most frequently diagnosed psychiatric disorders in the total group were cognitive dysfunction (42%) and depression (23%), as shown in Table 1. Furthermore, anxiety was present in 5% and psychotic disorders in 4% of patients. In patients with minor/non-NPSLE, especially depression (26% vs 15%) and anxiety (6% vs 2%) were more common than in major NPSLE. Cognitive dysfunction (54% vs 36%) and psychotic disorders (6% vs 4%) were more common in patients with major NPSLE than minor/non-NPSLE.

Psychiatric medication was used in 33% of patients, of which antidepressants and benzodiazepines the most frequently (both: 18% in both subgroups). Antipsychotics were more often used in patients with NPSLE (10% vs 7%) and benzodiazepines more often in minor/non-NPSLE (20% vs 14%).

In addition, 17 patients (5%) had a history of suicide attempt, which was more common in patients with minor/non-NPSLE than major NPSLE (6% vs 2%).

Conclusion:

Psychiatric morbidity, especially cognitive dysfunction and depression, are common in patients with lupus and differ between underlying cause of the neuropsychiatric symptoms (minor/non-NPSLE vs major NPSLE).

Table 1.

Presence of psychiatric diagnoses in patients with SLE and neuropsychiatric symptoms

All patients(n = 371)Minor/non-NPSLE(n = 261)Major NPSLE(n = 110)DSM V diagnosis, n (%)Neurodevelopmental disorder5 (1)2 (1)3 (2)Schizophrenia Spectrum and Other Psychotic Disorders16 (4)10 (4)6 (6)Bipolar and related disorders7 (2)5 (2)2 (2)Depressive disorders84 (23)68 (26)16 (15)Anxiety disorders17 (5)15 (6)2 (2)Obsessive-Compulsive and Related Disorders1 (0)1 (0)0 (0)Trauma- and Stressor-Related Disorders16 (4)12 (5)4 (3)Dissociative Disorders2 (1)2 (1)0 (0)Somatic Symptom and Related Disorders1 (0)1 (0)0 (0)Feeding and Eating Disorders0 (0)1 (0)0 (0)Elimination Disorders0 (0)0 (0)0 (0)Sleep-wake disorders2 (1)2 (1)0 (0)Sexual dysfunctions0 (0)0 (0)0 (0)Gender dysphoria0 (0)0 (0)0 (0)Disruptive, Impulse-Control, and Conduct Disorder0 (0)0 (0)0 (0)Substance-related and addictive disorders9 (2)8 (3)1 (1)Cognitive dysfunction154 (42)95 (36)59 (54)Personality disorders10 (3)9 (3)1 (1)Paraphilic disorders0 (0)0 (0)0 (0)Other mental disorders12 (3)7 (3)5 (5)Medication-Induced Movement Disorders and Other Adverse Effects of Medication0 (0)0 (0)0 (0)Unknown3 (1)3 (1)0 (0)

NPSLE = neuropsychiatric systemic lupus erythematosus.

Disclosure of Interests:

None declared

POS0258 REAL-TIME VERSUS STATIC SCORING IN MUSCULOSKELETAL ULTRASONOGRAPHY IN PATIENTS WITH INFLAMMATORY HAND OSTEOARTHRITIS

Background:

Ultrasound (US) is used in rheumatic musculoskeletal diseases (RMDs) such as hand osteoarthritis (OA) as outcome measure. Traditionally scoring is performed real-time, but central reading of static US images could avoid issues of inter-rater reliability. However, agreement between real-time and static assessment has not been studied

Objectives:

To study the agreement between real-time and static scoring of US in inflammatory hand OA.

Methods:

Ultrasound was performed of 30 joints obtained in 75 patients with hand osteoarthritis, treated with prednisolone or placebo in a randomized double-blind trial. Hand joints were assessed for synovial thickening, effusion, Doppler signal and osteophytes by ultrasound (score 0-3 per joint) at baseline and after treatment. Two ultrasonographers blinded for clinical data scored the live images together (simultaneously) in real-time. A consensus score for each joint was recorded. Representative images stored during scanning were scored by one ultrasonographer minimally 6 months after real-time scoring. For each patient, images of each visit were scored paired, with known chronological order.

Agreement between scoring methods was studied at joint level with quadratic weighted kappa. At patient level, intra-class correlations (ICC; mixed effect model, absolute agreement, with clustering taken into account) were calculated at both timepoints. ICCs were also calculated for the delta of sum scores. Responsiveness of scoring methods was analyzed with generalized estimating equations (GEE) with treatment as independent and ultrasonography findings as dependent variable.

Results:

Thirty-nine patients (52%) were treated with prednisolone and 36 (48%) were treated with placebo. Patient characteristics were well-balanced between treatment groups.

All patients had signs of synovial thickening and osteophytes as assessed by real-time ultrasonography, and almost all signs of effusion (99%) or a positive Doppler signal (95%) in at least one joint. Total ultrasonography sum score for osteophytes was high (mean 45 ±SD 12), whereas sum score was low for positive Doppler signal (mean 5.9 ±SD 4.4), with intermediate sum scores for synovial thickening and effusion (mean 16 ±SD 6.3 and 11 ±SD 6.0 respectively). Static sum scores were overall slightly higher (osteophytes mean 48 ±SD 10; Doppler mean 6.9 S±D 5.0; synovial thickening mean 20 ±SD 7.0 and effusion 13 ±SD 6.5)

Agreement at baseline was good to excellent at joint level (kappa 0.72-0.88) and moderate to excellent at patient level (ICC 0.59-0.86). Agreement for delta sum scores was poor to fair for synovial thickening and effusion (ICC 0.18 and 0.34 respectively), but excellent for Doppler signal (ICC 0.80) (Table 1).

Real-time ultrasonography showed responsiveness to prednisolone with a mean between-group difference of synovial thickening sum score of -2.5 (CI:-4.7 to-0.3). Static ultrasonography did not show a decrease in synovial thickening (Figure 1). No difference in ultrasonography scores was seen for the other ultrasonography features, neither with real-time nor static scoring.

Conclusion:

While cross-sectional agreement between real-time and static ultrasonography was good, agreement of delta sum scores was not and paired static ultrasonography measurement of synovial thickening did not show responsiveness to prednisone therapy where real-time ultrasonography did. Therefore, when using ultrasonography in clinical trials, real-time dynamic scoring should remain the standard.

Table 1.

Agreement on patient level

BaselineWeek 6Delta W6-BLICC (95% CI)ICC (95% CI)ICC (95% CI)Synovitis0.59 (0.26-0.76)0.58 (0.24-0.77)0.18 (0 - 0.40)Effusion0.84 (0.66-0.92)0.84 (0.75-0.89)0.34 (0.12-0.53)Osteophytes0.82 (0.50-0.92)0.78 (0.56-0.88)NDDoppler0.86 (0.75-0.92)0.91 (0.85-0.94)0.80 (0.70 -0.87)

ICC: intra-class correlation coefficient linear mixed model (random patient, fixed rating), absolute agreement. ND: Not Dertermined

Disclosure of Interests:

Lotte van de Stadt: None declared, Féline Kroon: None declared, Monique Reijnierse Grant/research support from: Dutch Arthritis Foundation, Désirée van der Heijde Consultant of: bbVie, Amgen, Astellas, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma, Frits Rosendaal: None declared, Naghmeh Riyazi: None declared, R. de Slegte: None declared, Jende van Zeben: None declared, Cornelia Allaart: None declared, Margreet Kloppenburg Consultant of: Abbvie, Pfizer, Levicept, GlaxoSmithKline, Merck-Serono, Kiniksa, Flexion, Galapagos, Jansen, CHDR, Grant/research support from: MI-APPROACH, Marion Kortekaas: None declared

POS0714 WHITE MATTER HYPERINTENSITIES LEAD TO REDUCED PSYCHOMOTOR SPEED IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND NEUROPSYCHIATRIC SYMPTOMS

Background:

Cognitive impairment is common in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) symptoms, but the exact underlying structural brain correlates are unknown.

Objectives:

We aimed to compare cognitive function between groups of patients with different phenotypes of (NP)SLE and assessed the association between brain volumes, white matter hyperintensity (WMH) volume and cognitive function.

Methods:

Patients who visited the NPSLE clinic of the Leiden University Medical Center between 2007-2015 were included in this study (n=151; 42 ± 13 years, 91% female). In a multidisciplinary consensus meeting, phenotypes were established and neuropsychiatric symptoms were attributed to SLE (NPSLE, inflammatory (n=24) or ischemic (n=12)) or to minor involvement of SLE or other causes (minor/non-NPSLE (n=115)). All patients underwent standardized cognitive assessment of the four cognitive domains: global cognitive functioning (GCF), learning and memory (LM), executive functioning and complex attention (EFCA) and psychomotor speed (PS)). Cognitive dysfunction was defined as a T-score <40, with age, sex, gender and education matched individuals of the Dutch population as reference. In addition, automated volume measurements on brain MRI (white matter, grey matter, white matter hyperintensities (WMH) and total brain volume (TBV)) were performed. Patients with brain infarcts >1.5 cm were excluded. Cognitive function (Z-score) was compared between different NPSLE phenotypes using multiple regression analyses corrected for age, sex and education. Associations between brain volumes, WMH and cognitive function were assessed per phenotype using multiple regression analyses corrected for age, sex and intracranial volume.

Results:

Global cognitive functioning was impaired in 5%, learning & memory in 46%, and executive functioning & complex attention in 39% and psychomotor speed in 46% of all patients. Patients with inflammatory NPSLE showed the most cognitive impairment and reduced cognitive function compared to ischemic NPSLE (all domains) and minor/non-NPSLE (EFCA) (p <0.05).

Lower total brain volume and grey matter volume were associated with lower cognitive functioning in all domains (β: 0.00/0.01 (0.00; 0.01)) and lower white matter volume associated with lower LM, EFCA and PS (β: 0.00/0.01 (0.00; 0.01)) in all patients. Higher WMH volume associated with lower psychomotor speed (β: -0.14 (-0.32; -0.02)), especially in patients with inflammatory NPSLE (β: -0.36 (-0.60; -0.12).

Conclusion:

Reduced brain volume leads to reduced cognitive function in multiple cognitive domains in all patients with SLE and neuropsychiatric symptoms. Increased WMH volume leads to reduced psychomotor speed, especially in patients with inflammatory NPSLE.

Table 1.

Prevalence of cognitive impairment in patients with minor/non-NPSLE, inflammatory NPSLE and ischemic NPSLE

Global cognitive functioningLearning &memoryExecutive functioning & complex attentionPsychomotor speedAll patients(n = 151)8 (5)70 (46)57 (39)69 (46)Inflammatory NPSLE(n = 24) 3 (13) 14 (58) 12 (50) 12 (50)Ischemic NPSLE(n = 12) 0 (0) 6 (50) 2 (17) 2 (17)Minor/non-NPSLE(n = 115) 5 (4) 50 (44) 43 (38) 55 (49)

NPSLE = neuropsychiatric systemic lupus erythematosus.

Data represent n (%) of patients with cognitive impairment in the mentioned cognitive domain. Cognitive impairment was defined as cognitive function at least 1SD lower than the mean of an age, sex and education matched general Dutch population. The percentages were calculated from total number of patients with available scores: Global functioning: 23/24 inflammatory NPSLE and 113/115 minor/non-NPSLE; psychomotor speed 113/115 minor/non-NPSLE, executive function & complex attention: also 113/115. All tests were available for ischemic NPSLE.

Disclosure of Interests:

None declared

POS1087 USING LIPIDOMICS TO PREDICT PREDNISOLONE TREATMENT RESPONSE IN PATIENTS WITH INFLAMMATORY HAND OSTEOARTHRITIS: THE HOPE STUDY

Background:

Lipidomics analysis has become a valuable technology for understanding patho-physiological mechanisms and may aid the identification of biomarkers of therapeutic responsiveness.

Objectives:

To explore the use of lipidomics for prediction of prednisolone treatment response in patients with inflammatory hand osteoarthritis.

Methods:

The Hand Osteoarthritis Prednisolone Efficacy (HOPE) study is a blinded, randomized placebo-controlled trial, that investigated the effect of prednisolone treatment in patients with painful, inflammatory hand OA, fulfilling the American College of Rheumatology criteria. The present analyses comprised only patients randomized to daily 10 mg prednisolone treatment for six weeks. Response to prednisolone treatment was defined according to the OARSI-OMERACT responder criteria at six weeks. Baseline blood samples were obtained non-fasted. Lipid species were quantified in erythrocytes with the LipidyzerTM platform (Sciex). After pre-processing of the data, 286 lipids species were available for further analyses (nmol/mL). In addition, we used an in-house LC-MS/MS platform to analyse oxylipins in plasma, identifying 25 oxylipins (area ratios). Elastic net regularized regression was used to predict prednisolone treatment response. A 10-fold cross-validation (CV) was performed for selection of the optimal tuning parameters based on the smallest CV mean prediction error. First, a model was fit with commonly assessed patient characteristics and patient reported outcomes, measured at baseline (model 1). Second, we fitted model 2 by adding the LipidyzerTM platform lipids to model 1. Third, we fitted model 3 by adding the oxylipins to model 1. The discriminatory accuracy of the model was estimated by receiver operating characteristic (ROC) analyses. The area under the curve (AUC) and corresponding 95% confidence intervals (CI) were calculated using 1,000 bootstrap replications.

Results:

Among the 40 patients included, 31 (78%) fulfilled the OARSI-OMERACT responder criteria. From the included general patient characteristics (Table 1), elastic net selected baseline hand function as only predictor of treatment response, with an AUC of 0.78 (95% CI 0.60;0.96) (Figure 1). In model 2, we added the 286 LipidyzerTM platform variables to model 1. In addition to hand function, two lipids were selected: diacylglycerol(DAG)(16:0/16:0) and phosphatidylethanolamine(PE)(O-18:0/20:4), which improved the discriminatory accuracy to an AUC of 0.92 (0.83;1.02). Lastly, model 3 was fit with patient characteristics as well as oxylipins, resulting in selection of AUSCAN function and three oxylipin predictors: 9-hydroxy-octadecatrienoic acid (HOTrE), 5-hydroxy-eicosapentaenoic acid (HEPE) and 10-hydroxy-docosahexaenoic acid (HDHA), with an AUC of 0.85 (0.69;1.02).

Conclusion:

The patients’ lipid profile improved the discriminative accuracy of the prediction of prednisolone treatment response in patients with inflammatory hand osteoarthritis compared to prediction by commonly measured patient characteristics alone. This exploratory study suggests that lipidomics is a promising field for biomarker discovery for prediction of anti-inflammatory treatment response.

Table 1.

Baseline characteristics

All prednisolone treatedn = 40Respondersn = 31 (78%)Non-respondersn = 9 (23%)General characteristicsAge, year62.4 (9.3)62.9 (9.4)60.8 (9.4)Sex, % women858489BMI, kg/m227.4 (4.4)27.8 (4.2)26.2 (5.0)Education, % high464256Disease duration6.7 (7.1)7.2 (7.4)4.9 (5.8)Erosive OA, %717456Kellgren-Lawrence sum score, 0-12035.1 (16.4)34.1 (16.5)37.5 (14.7)Ultrasound synovitis sum score, 0-9016.2 (6.6)15.5 (6.4)18.7 (7.2)VAS global assessment, 0-10052.3 (20.6)54.2 (16.8)45.6 (30.8)AUSCAN pain, 0-2011.0 (3.3)11.3 (2.4)10 (5.4)AUSCAN function, 0-3617.7 (7.6)19.6 (6.6)11 (7.5)

Numbers represent mean (SD) unless otherwise specified. AUSCAN = Australian/Canadian Hand Osteoarthritis Index, BMI = body mass index, VAS = visual analogue scale

Disclosure of Interests:

Marieke Loef: None declared, Tariq Faquih: None declared, Johannes von Hegedus: None declared, Mohan Ghorasaini: None declared, Andreea Ioan-Facsinay: None declared, Féline Kroon: None declared, Martin Giera Shareholder of: Pfizer, Consultant of: Boehringer Ingelheim Pharma, Margreet Kloppenburg: None declared.

POS0182 MINIMAL CLINICALLY IMPORTANT IMPROVEMENT (MCII) AND PATIENT ACCEPTABLE SYMPTOM STATE (PASS) FOR PAIN AND FUNCTION INSTRUMENTS IN HAND OSTEOARTHRITIS (OA)

Background:

Australian/Canadian Hand OA Index (AUSCAN), Michigan Hand Outcomes Questionnaire (MHQ), Functional Index of Hand OA (FIHOA) and visual analogue scale (VAS) are frequently used instruments to measure pain and function in hand OA research. MCII and PASS are useful to interpret results of patient reported outcomes.

Objectives:

To estimate MCII and PASS for these instruments using anchor-based methods.

Methods:

Hand OA patients participating in a six-week randomised placebo-controlled trial with prednisolone (RCT; NTR5263) and those attending the two-year follow-up visit of the observational Hand OSTeoArthritiS cohort completed AUSCAN subscales pain and function, MHQ subscales pain, activities of daily living (ADL) and overall function, FIHOA and 100mm VAS pain. RCT participants were asked to indicate whether they changed compared to baseline (improved/no change/worse) and to rate the importance of improvement (very much/moderately/slightly/not at all). MCII was defined as the minimal improvement in symptoms achieved by 75% of participants who stated a slight/moderate improvement during the RCT, calculated as the 75th percentile of the distribution of change scores from baseline in this group. Absolute and relative percentage change were evaluated. For MCII direction of effect was unified, so positive values indicate worse symptoms and vice versa. Participants from both studies rated satisfaction with their state of health (acceptable/unacceptable). PASS was defined as the minimal score considered acceptable for 75% of participants, calculated as the 75th percentile of the distribution of scores in participants who rated their health ‘acceptable’.

Results:

Demographics of the RCT (n=92, mean age 63.9, 79% women) and cohort (n=383, 60.9 years, 84% women) participants were typical for hand OA. RCT participants were more symptomatic (e.g. mean [SD] VAS pain 54.0 [20.5] versus 35.2 [19.1]). Of the function instruments, only AUSCAN had a credible MCII (relative percentage improvement 9.8%), while the (positive) MCII values for FIHOA and MHQ subscales would indicate that worsening was rated as functional improvement (table 1). MCII was negative (corresponding to improvement) for all pain instruments, with relative percentage change around 25% for VAS and MHQ, compared to only 2% for AUSCAN. PASS values of all instruments were comparable in the two populations. Most instruments had a PASS around 50% of the possible maximum score, except for MHQ ADL, in which higher is better and a relatively high PASS is thus indicative of a floor effect (table 1).

Conclusion:

The only function instrument with an acceptable threshold for MCII was AUSCAN function, while for pain MHQ and VAS performed better than AUSCAN. PASS values show a relatively high level of tolerance of 50% of the maximum of the scale.

Table 1.

MCII and PASS of pain and function instruments in hand OA patients in two settings.

MCII (95% CI) in RCT†PASS (95% CI)InstrumentAbsolute unitsPercentage[n]RCT (n=68)Cohort (n=126)MHQ Overall function, 0-100*3.4 (-2.7;9.5)3.6 (-9.1;16.3)[23]55.6 (52.6;58.5)48.1 (45.7;50.4) ADL, 0-100*1.6 (-4.4;7.6)2.8 (-9.6;15.3)[23]71.7 (68.2;75.1)62.9 (59.8;66.0) Pain, 0-100-12.2 (-17.2;-7.1)-23.1 (-35.4;-10.8)[16]47.0 (40.5;53.5)55.7 (52.0;59.5)AUSCAN Function, 0-36-3.3 (-5.7;-0.9)-9.8 (-23.9;4.2)[23]17.1 (15.3;19.0)20.9 (19.4;22.3) Pain, 0-20-1.1 (-2.6;0.4)-1.8 (-18.5;14.9)[27]9.0 (8.2;9.9)11.1 (10.3;11.8)FIHOA, 0-300.1 (-1.6;1.7)22.7 (-0.7;46.0)[23]12.4 (11.1;13.7)13.9 (12.8;15.0)VAS pain, 0-100-11.5 (-18.2;-4.7)-24.4 (-36.1;-12.8)[27]47.7 (42.2;53.3)48.8 (44.6;53.0)

Direction of effect of all instruments is higher is worse, except those with *.

†For all MCII direction of effect was unified, so positive values indicate worse symptoms and negative values values indicate improved symptoms.

Disclosure of Interests:

Féline Kroon: None declared, Lotte van de Stadt Grant/research support from: The HOSTAS and HOPE studies were sponsored by the Dutch Arthritis Society., Désirée van der Heijde: None declared, Margreet Kloppenburg Grant/research support from: The HOSTAS and HOPE studies were sponsored by the Dutch Arthritis Society.

POS0371 BIOLOGICAL REPRODUCIBILITY OF TARGETED LIPIDOME ANALYSES IN PLASMA AND ERYTHROCYTES OVER A 6-WEEK PERIOD

Background:

Lipidomics analysis has become a valuable technology for understanding patho-physiological mechanisms and the identification of candidate biomarkers in rheumatic musculoskeletal disorders. Variability in within-subject repeated measurements may lead to bias towards the null when estimating the association between biomarkers and a disease or treatment. Hence, information regarding the stability of the metabolite levels over time is essential.

Objectives:

We aimed to assess the lipid composition and biological reproducibility of lipid measurements in plasma and erythrocytes.

Methods:

Plasma and erythrocyte samples from 42 osteoarthritis patients (77% women, mean age 65 years, mean BMI 27 kg/m2), obtained non-fasted at baseline and six weeks, were used for the quantitative measurement of up to 1000 lipid species across 13 lipid classes with the LipidyzerTM platform in nmol/mL. Data was processed based on the relative standard deviation of quality controls, taking batch effects into account. Intraclass correlation coefficients (ICCs) and corresponding 95% confidence intervals (CI) were calculated to investigate the variability of the lipid concentrations between timepoints. The ICC distribution of lipid metabolites in plasma and erythrocytes were compared using two-sided paired Wilcoxon tests.

Results:

We measured 778 lipids in plasma, compared to 916 lipids in erythrocytes. After data processing, the analyses included 630 lipids in plasma, and 286 in erythrocytes. From these, 243 lipids overlapped between sample types. Major differences were observed between the sample types in the number of lipids per lipid class and the total concentration of the lipids within a class. Triacylglycerols (TAG) and cholesteryl esters (CE) were more abundant in plasma. Conversely, phosphatidylethanolamines (PE), sphingomyelins (SM) and ceramides (CER) were less abundant in plasma compared to erythrocytes (table 1). In plasma 78% of lipid measurements were good to excellently reproduced, with an overall median ICC 0.69. Compared to plasma, a considerably lower amount (35%) of lipids were well reproduced in erythrocytes. Median reproducibility of lipids in erythrocytes was 0.51. Figure 1 shows the ICC score distribution in plasma with erythrocytes, with a significantly better reproducibility in plasma (p-value<0.001). However, while overall reproducibility was better in plasma, this was not observed for all lipid classes. At class-level, reproducibility in plasma was superior for TAGs and CEs, while CERs, DAGs, (L)PEs and SMs showed better reproducibility in erythrocytes.

Table 1.

Number of individual lipids per class and class concentrations in plasma and erythrocytes

PlasmaErythrocytesNumber of lipid speciesClass concentration (nmol/mL)Number of lipid speciesClass concentration (nmol/mL)Triacylglycerols4821579.4 (1064.9-3195.2)1346.5 (5.6-9.4)Diacylglycerols913.3 (8.4-22.2)105.8 (4.7-6.2)Free fatty acids20745.3 (552.0-1202.9)20486.9 (379.2-669.2)Cholesteryl esters244571.6 (4065.1-5521.3)51.2 (0.9-1.7)Phosphatidylcholines314013.7 (3203.1-4661.6)423899.2 (3723.0-4296.6)Phosphatidylethanolamines26156.2 (120.9-180.3)423954.6 (3721.9-4323.3)Lysophosphatidylcholines9385.9 (335.6-442.9)7119.8 (109.7-168.9)Lysophosphatidylethanolamines24.2 (3.5-4.9)48.6 (6.8-9.7)Sphingomyelins121204.6 (1037.0-1351.9)82695.8 (2434.8-2815.6)Ceramides614.1 (11.9-17.4)7163.0 (133.3-186.4)Dihydroceramides21.0 (0.8-1.3)11.8 (1.4-2.1)Hexosylceramides55.1 (4.7-5.9)45.6 (5.0-7.4)Lactosylceramides23.4 (2.7-3.8)223.8 (20.6-33.5)

Numbers represent median (interquartile range) unless otherwise specified. Data represents baseline measurements.

Conclusion:

In plasma biological reproducibility was good for most lipid measurements. Although overall reproducibility was better in plasma compared to erythrocytes, notable differences were observed at individual- and lipid class-level that may favour the use of a particular sample type.

Disclosure of Interests:

Marieke Loef: None declared, Johannes von Hegedus: None declared, Mohan Ghorasaini: None declared, Féline Kroon: None declared, Martin Giera Shareholder of: Pfizer, Consultant of: Boehringer Ingelheim Pharma, Andreea Ioan-Facsinay: None declared, Margreet Kloppenburg: None declared

Reliability and agreement of proton density-weighted vs. gadolinium-enhanced T1-weighted MRI in hand osteoarthritis. An OMERACT MRI special interest group reliability exercise

OBJECTIVES

To compare reliabilities of assessing synovitis in hand osteoarthritis (OA) using Magnetic Resonance Imaging (MRI) with/without gadolinium (Gd).

METHODS

Three readers scored synovitis on non-enhanced two-dimensional (2D) proton density (PD)-weighted MRI and Gd-enhanced (3D) MRI of hand joints in 20 patients. Inter-reader reliabilities were examined.

RESULTS

Reliability was good for Gd-enhanced MRI, but poor for non-enhanced PD-weighted MRI (intraclass correlation coefficient 0.83 and 0.21, respectively). Agreement between the two sequences was poor (weighted kappa 0.18).

CONCLUSION

Gd-enhanced MRI was more reliable than PD-weighted MRI for assessing synovitis. Gd-enhancement, but also resolution and tissue contrast, might have contributed to this.

Towards developing diagnostic criteria for early knee osteoarthritis: data from the CHECK study

Objectives

There is a general consensus that a shift in focus towards early diagnosis and treatment of knee OA is warranted. However, there are no validated and widely accepted diagnostic criteria for early knee OA available. The current study aimed to take the first steps towards developing diagnostic criteria for early knee OA.

Methods

Data of 761 individuals with 1185 symptomatic knees at baseline were selected from the CHECK study. For CHECK, individuals with pain/stiffness of the knee, aged 45–65 years, who had no prior consultation or a first consultation with the general practitioner for these symptoms in the past 6 months were recruited and followed for 10 years. A group of 36 experts (17 general practitioners and 19 secondary care physicians) evaluated the medical records in pairs to diagnose the presence of clinically relevant knee OA 5–10 years after enrolment. A backward selection methods was used to create predictive models based on pre-defined baseline factors from history taking, physical examination, radiography and blood testing, using the experts’ diagnoses as gold standard outcome.

Results

Prevalence of clinically relevant knee OA during follow-up was 37%. Created models contained 7–11 baseline factors and obtained an area under the curve between 0.746 (0.002) and 0.764 (0.002).

Conclusion

The obtained diagnostic models for early knee OA had ‘fair’ predictive ability in individuals presenting with knee pain in primary care. Further modelling and validation of the identified predictive factors is required to obtain clinically feasible and relevant diagnostic criteria for early knee OA.

Variants of FOXO3 and RPA3 genes affecting IGF-1 levels alter the risk of development of primary osteoarthritis

INTRODUCTION

Pathologically high growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in patients with acromegaly are associated with arthropathy. Several studies highlight the potential role of the GH/IGF-1 axis in primary osteoarthritis (OA). We aimed to disentangle the role of IGF-1 levels in primary OA pathogenesis.

METHODS

Patients from the Genetics osteoARthritis and Progression (GARP) Study with familial, generalized, symptomatic OA (n = 337, mean age: 59.8 ± 7.4 years, 82% female) were compared to Leiden Longevity Study (LLS) controls (n = 456, mean age: 59.8 ± 6.8 years, 51% female). Subjects were clinically and radiographically assessed, serum IGF-1 levels were measured, and 10 quantitative trait loci (QTL) in the FOXO3, IGFBP3/TNS3, RPA3, SPOCK2 genes, previously related to serum IGF-1 levels, were genotyped. Linear or binary logistic generalized estimating equation models were performed.

RESULTS

Serum IGF-1 levels were increased in OA patients, with male patients exhibiting the strongest effect (males OR = 1.10 (1.04-1.17), P=0.002 vs females OR = 1.04 (1.01-1.07), P = 0.02). Independent of the increased IGF-1 levels, male carriers of the minor allele of FOXO3 QTL rs4946936 had a lower risk to develop hip OA (OR = 0.41 (0.18-0.90), P = 0.026). Additionally, independent of IGF-1 levels, female carriers of the minor alleles of RPA3 QTL rs11769597 had a higher risk to develop knee OA (OR = 1.90 (1.20-2.99), P = 0.006).

CONCLUSION

Patients with primary OA had significantly higher IGF-1 levels compared to controls. Moreover, SNPs in the FOXO3 and RPA3 genes were associated with an altered risk of OA. Therefore, altered IGF-1 levels affect the development of OA, and are potentially the result of the pathophysiological OA process.

Progression of vertebral fractures in long-term controlled acromegaly: a 9-year follow-up study

OBJECTIVE

Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess results in both reversible and irreversible musculoskeletal damage, including increased vertebral fracture (VF) risk. The prevalence of VFs is approximately 60% in controlled acromegaly patients, and these VFs can progress in time. We aimed to identify the course of VFs in a cohort of acromegaly patients in long-term remission and their associated risk factors during prolonged follow-up.

METHODS

Thirty-one patients with acromegaly (49% female, median age 60 years (IQR 53-66)), who were in remission for ≥2 years, were included in this longitudinal, prospective, follow-up study. Spine radiographs of vertebrae Th4 to L4 were assessed for VFs using the Genant score, at baseline, after 2.6 years and 9.1 years. Progression was defined as either a new fracture or a ≥1-point increase in Genant score.

RESULTS

The prevalence of VF at baseline was 87% (27/31 patients). Progression of VFs was observed in eleven patients (35.5%) during the 9.1-year follow-up period, with a total incidence rate of 65.5 per 1000 person years (males 59.8 per 1000 person years vs females 71.6 per 1000 person years). Patients treated with surgery or radiotherapy had a higher risk of VF progression in this cohort (P = 0.030).

CONCLUSIONS

In this cohort of long-term, well-controlled acromegalic patients, the prevalence and progression of VFs was high, showing that the deleterious effects of GH and IGF-1 excess on bone persist despite achievement of longstanding remission.

Effusion attenuates the effect of synovitis on radiographic progression in patients with hand osteoarthritis: a longitudinal magnetic resonance imaging study

An exploratory study to determine the role of effusion, i.e., fluid in the joint, in pain, and radiographic progression in patients with hand osteoarthritis. Distal and proximal interphalangeal joints (87 patients, 82% women, mean age 59 years) were assessed for pain. T2-weighted and Gd-chelate contrast-enhanced T1-weighted magnetic resonance images were scored for enhanced synovial thickening (EST, i.e., synovitis), effusion (EST and T2-high signal intensity [hsi]) and bone marrow lesions (BMLs). Effusion was defined as follows: (1) T2-hsi > 0 and EST = 0; or 2) T2-hsi = EST but in different joint locations. Baseline and 2-year follow-up radiographs were scored following Kellgren-Lawrence, increase ≥ 1 defined progression. Associations between the presence of effusion and pain and radiographic progression, taking into account EST and BML presence, were explored on the joint level. Effusion was present in 17% (120/691) of joints, with (63/120) and without (57/120) EST. Effusion on itself was not associated with pain or progression. The association with pain and progression, taking in account other known risk factors, was stronger in the absence of effusion (OR [95% CI] 1.7 [1.0–2.9] and 3.2 [1.7–5.8]) than in its presence (1.6 [0.8–3.0] and 1.3 [0.5–3.1]). Effusion can be assessed on MR images and seems not to be associated with pain or radiographic progression but attenuates the association between synovitis and progression.

Key Points • Effusion is present apart from synovitis in interphalangeal joints in patients with hand OA. • Effusion in finger joints can be assessed as a separate feature on MR images. • Effusion seems to be of importance for its attenuating effect on the association between synovitis and radiographic progression.

Percentile curves for the knee injury and osteoarthritis outcome score in the middle-aged Dutch population

OBJECTIVE

To improve the interpretation of the Knee injury and Osteoarthritis Outcome Score (KOOS) in individual patients, we explored associations with age, sex, BMI, history of knee injury and presence of clinical knee osteoarthritis, and developed percentile curves.

METHODS

We used cross-sectional data of middle-aged individuals from the population-based Netherlands Epidemiology of Obesity (NEO) study. Clinical knee osteoarthritis was defined using the ACR classification criteria. KOOS scores were handled according to the manual (zero = extreme problems, 100 = no problems). Patient characteristics associated with KOOS were explored using ordered logistic regression, and sex and body mass index (BMI)-specific percentile curves were developed using quantile regression with fractional polynomials. The curves were applied as a benchmark for comparison of KOOS scores of participants with knee osteoarthritis and comorbidities.

RESULTS

The population consisted of 6,643 participants (56% women, mean (SD) age 56(6) years). Population-based KOOS subscale scores (median; interquartile range) near optimum: pain (100;94-100), symptoms (96;86-100), ADL function (100;96-100), sport/recreation function (100;80-100), quality of life (100;75-100). Worse KOOS scores were observed in women and in participants with higher BMI. Clinical knee osteoarthritis was defined in 15% of participants, and was, in comparison to other patient characteristics, associated with the highest odds of worse KOOS scores. Furthermore, presence of any comorbidity and cardiovascular disease specifically, was associated with worse KOOS scores, particularly in women.

CONCLUSIONS

In the middle-aged Dutch population KOOS scores were generally good, but worse in women and with higher BMI. These percentile curves may be used as benchmarks in research and clinical practice.

AB0430 MORTALITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND NEUROPSYCHIATRIC SYMPTOMS

Background:

Little is known about mortality in patients with systemic lupus erythematosus (SLE) presenting with neuropsychiatric (NP) symptoms.

Objectives:

We aimed to evaluate all-cause and cause-specific mortality in patients with SLE and NP symptoms.

Methods:

All patients with the clinical diagnosis of SLE of 18 years and older that visited the tertiary referral NPSLE clinic of the Leiden University Medical Center between 2007-2018 and signed informed consent were included in this study. Patients were classified as NPSLE if NP symptoms were attributed to SLE and immunosuppressive or anticoagulant therapy was initiated, otherwise patients were classified as non-NPSLE. Municipal registries were checked for current status (alive/deceased). Electronical medical files were studied for clinical characteristics and cause of death. Standardized mortality ratios (SMRs) and 95% confidence intervals were calculated using data from the general Dutch population. In addition, a rate ratio (RR) was calculated using direct standardization to compare mortality in NPSLE with non-NPSLE patients.

Results:

351 patients with the clinical diagnosis of SLE were included, of which 149 patients were classified as NPSLE (42.5%). Compared with the general population, mortality was increased five times in NPSLE (SMR 5.0, 95% CI: 2.6-8.5) and nearly four times in non-NPSLE patients (SMR 3.7, 95% CI: 2.2-6.0), as shown in Table 1. Risk of death due to cardiovascular disease (CVD) was increased in non-NPSLE patients (SMR 6.2, 95% CI: 2.0-14.6) and an increased risk of death to infections was present in both NPSLE and non-NPSLE patients ((SMR 29.9, 95% CI: 3.5 – 105) and SMR 91.3 (95% CI: 18.8 – 266) respectively). However, mortality did not differ between NPSLE and non-NPSLE patients (RR 1.0, 95% CI: 0.5 – 2.0).

Table 1.

All-cause mortality in SLE patients presenting with neuropsychiatric symptoms attributed to SLE (NPSLE) or to other causes (non-NPSLE)

NPSLE(N = 149)Non-NPSLE(N = 202)Deaths (N, %)13 (8.7)17 (8.4)Age at death (median, range)49 (32 – 79)59 (20 – 89)Follow-up time (years)9061047Crude mortality rate (per 1000 PY)14.316.2All-cause mortality*Female5.5 (2.8 – 9.6)3.4 (1.9 – 5.7)Male2.3 (0.1 - 12.8)6.2 (1.3 – 18.2)Combined5.0 (2.6 – 8.5)3.7 (2.2 – 6.0)

*Standardized mortality ratio, ratio of the observed and expected number of deaths

Conclusion:

Mortality was increased in both NPSLE and non-NPSLE patients in comparison with the general population, but there was no difference in mortality between NPSLE and non-NPSLE patients. Risk of death due to infections was increased in both groups.

Disclosure of Interests:

Rory Monahan: None declared, Rolf Fronczek: None declared, Jeroen Eikenboom: None declared, Huub Middelkoop: None declared, L.J.J. Beaart- van de Voorde: None declared, Gisela Terwindt: None declared, Nic van der Wee: None declared, Frits Rosendaal: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Margreet Kloppenburg: None declared, G.M. Steup-Beekman: None declared

FRI0413 THE ASSOCIATION OF OBESITY WITH OSTEOARTHRITIS IS LIMITEDLY MEDIATED BY HYPERTENSION AND SUBCLINICAL ATHEROSCLEROSIS

Background:

Obesity-related metabolic dysregulation may lead to atherosclerotic vascular changes. It has been hypothesized that a compromised blood flow may cause detrimental changes to the subchondral bone and decrease nutrient supply to the cartilage. To which extent atherosclerosis may explain the association between obesity and OA has not been investigated.

Objectives:

To investigate the role of hypertension and subclinical atherosclerosis (carotid intima-media thickness (IMT), popliteal vessel wall thickness (VWT), aortic pulse wave velocity (PWV)) as mediators of the association of obesity with hand and knee OA.

Methods:

We used cross-sectional data from the population-based NEO study, excluding participants with concomitant rheumatic diseases (n = 323), resulting in 6,334 participants. Clinical hand and knee OA were defined by the ACR classification criteria. Popliteal VWT was assessed on MR images in a subpopulation (n = 1,095), using VesselMASS for semi-automated detection of the vessel wall boundaries. Aortic PWV was estimated on abdominal velocity-encoded MR images in a subpopulation (n = 2,580). Carotid IMT was assessed by ultrasonography. Hypertension was defined as a systolic blood pressure ≥ 130 mmHg or a diastolic blood pressure ≥ 85 mmHg, or using antihypertensive medication. Continuous variables were standardized (mean 0, standard deviation 1). Associations between BMI and OA were assessed with logistic regression analyses, adjusted for age, sex and education. Subsequently, possible mediators were added to the model and the percentage mediation was calculated.

Results:

The population consisted of 55% women, with a mean (SD) age of 56 (6) years and BMI of 26 (4) kg/m2. Hand OA was present in 8% and knee OA in 10% of participants. Hypertension was present in 61.6% of participants. Mean (SD) carotid IMT was 0.62 (0.09) mm, popliteal VWT was 0.53 (0.05) mm, and aortic PWV was 6.56 (1.30) m/s. BMI was associated with the presence of hand OA and knee OA (table 1). BMI was positively associated with hypertension and carotid IMT, but not with popliteal VWT and aortic PWV. The association between BMI and hand OA was partially mediated by hypertension (5.9%) and carotid IMT (10.6%). Hypertension (4.9%) showed a weak mediating effect for the association between BMI and knee OA.

Table 1.

Mediation of the association of BMI with OA by hypertension and atherosclerosis

Hand OAOR (95% CI)MediatorOR/β (95% CI)Hand OAOR (95% CI)Mediation% (95% CI)BMI1.21 (1.08; 1.36)1.72 (1.56; 1.90)1.20 (1.06; 1.36)5.9 (3.4; 17.4)Hypertension1.15 (0.82; 1.60)BMI1.21 (1.08; 1.36)0.23 (0.19; 0.27)1.19 (1.05; 1.34)10.6 (6.2; 30.5)Carotid IMT1.09 (0.94; 1.25)BMI1.56 (1.17; 2.08)0.01 (-0.06; 0.09)1.55 (1.16; 2.07)0.5 (0.3; 1.7)Popliteal VWT1.14 (0.84; 1.55)BMI1.41 (1.15; 1.73)0.05 (-0.01; 0.11)1.41 (1.15; 1.73)0.7 (0.4; 2.0)Aorta PWV1.04 (0.81; 1.33)Knee OAOR (95% CI)MediatorOR/β (95% CI)Knee OAOR (95% CI)BMI1.46 (1.32; 1.62)1.70 (1.55; 1.87)1.43 (1.29; 1.59)4.9 (3.7; 7.0)Hypertension1.25 (0.93; 1.67)BMI1.46 (1.32; 1.62)0.24 (0.20; 0.27)1.47 (1.33; 1.62)-1.6 (-2.4; -1.2)Carotid IMT0.97 (0.86; 1.09)BMI1.20 (0.88; 1.64)0.03 (-0.04; 0.11)1.21 (0.89; 1.64)-0.5 (-7.4; 13.3)Popliteal VWT0.95 (0.74; 1.24)BMI1.37 (1.12; 1.67)0.05 (-0.00; 0.11)1.37 (1.12; 1.67)-0.5 (-1.8; -0.3)Aorta PWV0.96 (0.76; 1.21)

Results are based on analyses weighted towards the BMI distribution of the general population (n = 6,334). Analysis regarding popliteal VWT (n = 1,095) and aorta PWV (n = 2,580) were assessed in a subpopulation Continuous variables were standardized (mean 0, SD 1), SD BMI = 4.41, SD carotid IMT = 0.09, SD popliteal VWT = 0.05, SD aorta PWV = 1.30.

Conclusion:

We assessed whether the association between BMI and OA was mediated by hypertension and atherosclerosis. Our results imply that either such mediation is absent or trivial, or that the atherosclerosis measures were too weak.

Disclosure of Interests:

None declared

AB0383 EXTREME FATIGUE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND NEUROPSYCHIATRIC SYMPTOMS

Background:

Fatigue is commonly described in chronic illnesses, especially auto-immune disorders such as systemic lupus erythematosus (SLE).

Objectives:

We aim to study the prevalence of fatigue in SLE patients with NP symptoms and compare fatigue in SLE patients with NP symptoms attributed to major organ involvement due to SLE (NPSLE) with SLE patients with NP symptoms not caused by major nervous system involvement (non-NPSLE).

Methods:

All patients visiting the tertiary referral center for NPSLE in the LUMC between 2007-2019 with the clinical diagnosis of SLE and age >18 years that signed informed consent were included in this study. Patients underwent a standardized multidisciplinary assessment, including two questionnaires: SF-36 (2007-2019) and multidimensional fatigue index (MFI, 2011-2019). Patients were classified as NPSLE in this study if NP symptoms were attributed to SLE and immunosuppressive or anticoagulant therapy was initiated, otherwise patients were classified as non-NPSLE. The vitality (VT) domain of the SF-36 domain was used to assess fatigue, which generates a score from 0-100, 100 representing the complete absence of fatigue. Patients with a score more than 1 standard deviation (SD) removed from age-related controls of the Dutch general population were classified as fatigued; patients more than 2 SD removed were classified as extremely fatigued1. The MFI was also used, which consists of 5 subdomain scores between 0-20, leading to a total score between 0-100, 100 representing the most extreme fatigue. All scores are presented as mean and standard deviation.

Results:

373 patients fulfilled the inclusion criteria and SF-36 questionnaires of 328 patients were available (88%). The majority of these patients was female (87%) and 98 were classified as NPSLE (30%). In NPSLE patients, average age was 41 ± 13 years and in non-NPSLE the average age was 45 ± 14 years. The average score of the SF-36 vitality domain was 36.0 ± 20.7 in NPSLE vs 33.9 ± 18.8. in non-NPSLE. Overall, 73.5% of the patients were fatigued and 46.9% extremely fatigued in NPSLE vs 77.8% fatigued and 45.7% extremely fatigued in non-NPSLE.

The MFI questionnaire and VAS score were available for 222 patients, of which 65 patients were classified as NPSLE (29.3%). Table 1 depicts the scores of NPSLE and non-NPSLE patients on the MFI subdomains and the VAS score.

Table.

Patient characteristics at registry entry.

NPSLE(N = 65)Non-NPSLE (N = 157)MFI(mean, sd)General Fatigue10.8 (1.8)11.1 (1.5)Physical Fatigue11.4 (2.4)12.3 (1.9)Reduced Activity9.6 (2.9)10.7 (2.2)Reduced Motivation10.7 (2.6)11.1 (1.9)Mental Fatigue9.5 (3.0)9.8 (2.7)Total score51.8 (9.9)54.9 (6.9)SF-36 Vitality (mean, sd)35 (20.7)32.7 (18.2)

Conclusion:

Nearly half of patients with SLE and NP symptoms are as extremely fatigued as only 2.5% of the general Dutch population. Extreme fatigue is not influenced by major nervous system involvement.

References:

[1]Aaronsonet al.J Clin Epidemiol. Vol. 51, No. 11, pp. 1055–1068, 1998

Disclosure of Interests:

Rory Monahan: None declared, Rolf Fronczek: None declared, Jeroen Eikenboom: None declared, Huub Middelkoop: None declared, L.J.J. Beaart- van de Voorde: None declared, Gisela Terwindt: None declared, Nic van der Wee: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Margreet Kloppenburg: None declared, G.M. Steup-Beekman: None declared

Osteoarthritis year in review 2019: epidemiology and therapy

Over the past year many studies and clinical trials have been published in the osteoarthritis (OA) field. This review is based on systematic literature review covering the period May 1^st, 2018 to April 19^th, 2019; the final selection of articles was subjective. Specifically those articles considered to be presenting novel insights and of potential importance for clinical practice, are discussed. Further evidence has emerged that OA is a serious disease with increasing impact worldwide. Our understanding of development of pain in OA has increased. Detailed studies investigating widely used pharmacological treatments have shown the benefits to be limited, whereas the risks seem higher than expected, suggesting further studies and reconsideration of currently used guidelines. Promising new pharmacological treatments have been developed and published, however subsequent studies are warranted. While waiting for new treatment modalities to appear joint replacement is an effective alternative; new data have become available on how long they might last.

Metabolomics Profile in Depression: A Pooled Analysis of 230 Metabolic Markers in 5283 Cases With Depression and 10,145 Controls

BACKGROUND

Depression has been associated with metabolic alterations, which adversely impact cardiometabolic health. Here, a comprehensive set of metabolic markers, predominantly lipids, was compared between depressed and nondepressed persons.

METHODS

Nine Dutch cohorts were included, comprising 10,145 control subjects and 5283 persons with depression, established with diagnostic interviews or questionnaires. A proton nuclear magnetic resonance metabolomics platform provided 230 metabolite measures: 51 lipids, fatty acids, and low-molecular-weight metabolites; 98 lipid composition and particle concentration measures of lipoprotein subclasses; and 81 lipid and fatty acids ratios. For each metabolite measure, logistic regression analyses adjusted for gender, age, smoking, fasting status, and lipid-modifying medication were performed within cohort, followed by random-effects meta-analyses.

RESULTS

Of the 51 lipids, fatty acids, and low-molecular-weight metabolites, 21 were significantly related to depression (false discovery rate q < .05). Higher levels of apolipoprotein B, very-low-density lipoprotein cholesterol, triglycerides, diglycerides, total and monounsaturated fatty acids, fatty acid chain length, glycoprotein acetyls, tyrosine, and isoleucine and lower levels of high-density lipoprotein cholesterol, acetate, and apolipoprotein A1 were associated with increased odds of depression. Analyses of lipid composition indicators confirmed a shift toward less high-density lipoprotein and more very-low-density lipoprotein and triglyceride particles in depression. Associations appeared generally consistent across gender, age, and body mass index strata and across cohorts with depressive diagnoses versus symptoms.

CONCLUSIONS

This large-scale meta-analysis indicates a clear distinctive profile of circulating lipid metabolites associated with depression, potentially opening new prevention or treatment avenues for depression and its associated cardiometabolic comorbidity.

The association of plasma fatty acids with hand and knee osteoarthritis: the NEO study

OBJECTIVE

To investigate the association of postprandial and fasting plasma saturated fatty acid (SFAs), monounsaturated fatty acid (MUFAs) and polyunsaturated fatty acid (PUFAs) concentrations with hand and knee osteoarthritis (OA).

DESIGN

In the population-based NEO study clinical hand and knee OA were defined by the ACR classification criteria. Structural knee OA was defined on MRI. Hand and knee pain was determined by Australian/Canadian Hand Osteoarthritis Index (AUSCAN) and KOOS, respectively. Plasma was sampled fasted and 150 min after a standardized meal, and subsequently analysed using a nuclear magnetic resonance platform. Logistic regression analyses were used to investigate the association of total fatty acid, SFA, MUFA, total PUFA, omega-3 PUFA and omega-6 PUFA concentrations with clinical hand and knee OA, structural knee OA and hand and knee pain. Fatty acid concentrations were standardized (mean 0, SD 1). Analyses were stratified by sex and corrected for age, education, ethnicity and total body fat percentage.

RESULTS

Of the 5,328 participants (mean age 56 years, 58% women) 7% was classified with hand OA, 10% with knee OA and 4% with concurrent hand and knee OA. In men, postprandial SFAs (OR (95% CI)) 1.23 (1.00; 1.50), total PUFAs 1.26 (1.00; 1.58) and omega-3 PUFAs 1.24 (1.01; 1.52) were associated with hand OA. SFAs and PUFAs were associated with structural, but not clinical knee OA. Association of fasting fatty acid concentrations were weaker than postprandial concentrations.

CONCLUSION

Plasma postprandial SFA and PUFA levels were positively associated with clinical hand and structural knee OA in men, but not in women.

The role of leptin and adiponectin as mediators in the relationship between adiposity and hand and knee osteoarthritis

OBJECTIVES

To investigate associations of leptin and adiponectin levels with knee and hand osteoarthritis, and explore whether these mediate the association between adiposity and osteoarthritis.

METHODS

This is a cross-sectional analysis of baseline data from the population-based Netherlands Epidemiology of Obesity study. Adiposity was assessed with body mass index (BMI) and percentage total body fat (%TBF). Osteoarthritis, defined as hand or knee osteoarthritis, was determined using American College of Rheumatology criteria. Fasting serum adipokine levels were measured using immunoassays. Associations between adiposity and osteoarthritis were examined with logistic regression, adjusted for age, sex, ethnicity and education, and additionally for leptin and adiponectin as potential mediators.

RESULTS

In 6408 participants (56% women, median age 56 years), prevalence of osteoarthritis was 22% (10% isolated knee and 8% isolated hand osteoarthritis). Leptin levels were positively associated with osteoarthritis, while adiponectin levels were not. Leptin partially mediated the association of adiposity with osteoarthritis (OR 1.40 (95%CI 1.30; 1.52) attenuated to 1.38 (1.24; 1.54) per 5 units BMI and OR 1.25 (1.17; 1.35) to 1.20 (1.10; 1.32) per 5 units %TBF, representing 4% and 17% mediation, respectively). Larger proportion mediation by leptin was found in knee (13%/27%) than in hand osteoarthritis (9%/18%). Sex-stratified analyses generally showed stronger associations between adiposity, leptin and osteoarthritis in women than in men.

CONCLUSIONS

Serum leptin levels were associated with osteoarthritis, and partially mediated the association between adiposity and osteoarthritis, while adiponectin levels were not associated with osteoarthritis. These findings provide evidence for systemic effects of adipose tissue in osteoarthritis.

In finger osteoarthritis, change in synovitis is associated with change in pain on a joint-level; a longitudinal magnetic resonance imaging study

OBJECTIVE

To investigate determinants of decrease and increase in joint pain in symptomatic finger osteoarthritis (OA) on magnetic resonance (MR) imaging over 2 years.

DESIGN

Eighty-five patients (81.2% women, mean age 59.2 years) with primary hand OA (89.4% fulfilling American College of Rheumatology (ACR) classification criteria) from a rheumatology outpatient clinic received contrast-enhanced MR imaging (1.5T) and physical examination of the right interphalangeal finger joints 2-5 at baseline and at follow-up 2 years later. MR images were scored paired in unknown time order, following the Hand OA MRI scoring system (HOAMRIS). Joint pain upon palpation was assessed by research nurses. Odds ratios (ORs; 95% confidence intervals) were estimated on joint level (n = 680), using generalized estimating equations (GEE) to account for the within patient effects. Additional adjustments were made for change in MR-defined osteophytes, synovitis, and bone marrow lesions (BMLs).

RESULTS

Of 116 painful joints at baseline, at follow-up: 76 had less pain, 21 less synovitis, and 13 less BMLs. A decrease in synovitis (OR = 5.9; 1.12─31.0), but not in BMLs (OR = 0.39; 0.10─1.50), was associated with less pain. Of 678 joints without maximum baseline pain, at follow-up: 115 had increased pain, 132 increased synovitis, 96 increased BMLs, and 44 increased osteophytes. Increased synovitis (OR = 1.81; 1.11─2.94), osteophytes (OR = 2.75; 1.59─4.8), but not BMLs (OR = 1.14; 0.81─1.60), was associated with increased pain. Through stratification it became apparent that BMLs were mainly acting as effect modifier of the synovitis-pain association.

CONCLUSION

Decrease in MR-defined synovitis is associated with reduced joint pain, identifying synovitis as a possible target for treatment of finger OA.

Assessment of osteoarthritic features in the thumb base with the newly developed OMERACT magnetic resonance imaging scoring system is a valid addition to standard radiography

OBJECTIVE

To investigate the construct validity of the new thumb base OA magnetic resonance imaging (MRI) scoring system (TOMS) by comparing TOMS scores with radiographic scores in patients with primary hand OA.

DESIGN

In 200 patients (83.5% women, mean (SD) age 61.0 (8.4) years), postero-anterior radiographs and MR scans (1.5 T) of the right first carpometacarpal (CMC-1) and scaphotrapeziotrapezoid (STT) joints, were scored using the OARSI atlas and TOMS, respectively. The distributions of the TOMS scores (specified in results section) were stratified for the OARSI scores of corresponding radiographic features and investigated using boxplots and non-parametric tests. Furthermore, Spearman's rank or Phi correlation coefficients (ρ/φ) were calculated.

RESULTS

For all features, especially for erosions and osteophytes, the prevalence found with MRI was higher than with radiography. TOMS osteophyte and cartilage loss scores differed statistically significant between corresponding OARSI scores in CMC-1 (0 vs 1; 1 vs 2). TOMS scores were positively correlated with radiographic scores in CMC-1 for osteophytes (coefficient [95% confidence interval], ρ = 0.75 [0.69; 0.81]), cartilage loss/joint space narrowing (ρ = 0.70 [0.62; 0.76]), subchondral bone defects (SBDs)/erosion-cyst (ρ = 0.41 [0.29; 0.52]), bone marrow lesions (BMLs)/subchondral sclerosis (ρ = 0.65 [0.56; 0.73]) and subluxation (φ = 0.65 [0.57; 0.73]); and in STT for osteophytes (ρ = 0.30 [0.17; 0.42]) and cartilage loss/joint space narrowing (ρ = 0.53 [0.42; 0.62]).

CONCLUSIONS

In patients with hand OA, TOMS scores positively correlated with radiographic scores, indicating good construct validity. However, the prevalence of features on MR images was higher compared to radiographs, suggesting that TOMS might be more sensitive than radiography. The clinical meaning of these extra MR detected cases is currently still unknown.

Exploring longitudinal associations of histologically assessed inflammation with symptoms and radiographic damage in knee osteoarthritis: combined results of three prospective cohort studies

OBJECTIVE

To explore the associations between different histologically assessed, inflammatory synovial characteristics and subsequent clinical and structural aspects in knee osteoarthritis (OA).

DESIGN

Knee OA patients, ranging in stage from early to advanced, were recruited from three different ongoing studies. Synovial tissue biopsies were taken and histologically assessed for six features (four inflammatory related aspects, fibrosis and fibrin deposition). Clinical aspects (WOMAC pain, functioning and stiffness and SF-36 vitality) and structural aspects (Kellgren and Lawrence (KL)-grade, joint space narrowing (JSN; 0-3) and osteophytes (0-3), and reception of total knee replacement (TKR)) were repeatedly assessed during follow-up. Associations between histology and clinical and structural aspects were analysed using linear mixed model analyses and cox proportional hazards analysis.

RESULTS

Biopsies of 83 patients (median complaint duration: 5 [2-8] years) were analysed. Follow-up was a median of 1.4 [0.8-2.7] years for clinical and 1.8 [0.2-5.2] years for structural aspects. Fibrosis and fibrin deposition were inversely correlated with the inflammatory features. A higher fibrosis score was associated with a lower scores for KL-grade, JSN and osteophytes, while higher scores for perivascular oedema, synovial lining thickness and vascularisation were associated with higher scores for structural aspects during follow-up. No associations were found between each of the histological features and any of the clinical aspects or the chance for TKR during follow-up.

CONCLUSIONS

Inflammatory related histological aspects are associated with subsequent increased radiological severity in knee OA, while fibrosis seems to protect against this, providing a potential therapeutic target for OA treatment.

Performance of the Michigan Hand Outcomes Questionnaire in hand osteoarthritis

OBJECTIVE

To investigate the performance of the Michigan Hand Outcomes Questionnaire (MHQ) in hand osteoarthritis (OA) by evaluating truth, discrimination and feasibility.

DESIGN

Symptomatic hand OA patients from the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort completed questionnaires (demographics, MHQ, Australian/Canadian Hand Osteoarthritis Index [AUSCAN], Functional Index for Hand Osteoarthritis [FIHOA] and visual analogue scale [VAS] pain) at baseline (n = 383), 1- and 2-year follow-up (n = 312, n = 293). Anchor questions at follow-up assessed whether pain/function levels were (un)acceptable and had changed compared to baseline. Correlations between MHQ and other pain/function questionnaires were calculated. Validity of unique MHQ domains (work performance, aesthetics, satisfaction), discrimination across disease stages, and responsiveness were assessed by categorizing patients by external anchors (employment, joint deformities, erosions, and anchor questions). Between-group differences were assessed with linear regression, probability plots and comparison of medians.

RESULTS

MHQ pain and function subscales correlated moderately-to-good with other instruments (r_s 0.63-0.81). Work performance scores were worse in patients with reduced working capacity than in employed patients. Aesthetics scores were worse in patients with more deformities. Patients with unacceptable complaints had worse satisfaction scores. All pain/function instruments discriminated between patients with acceptable vs unacceptable pain/function, while only MHQ activities of daily living (ADL), FIHOA, and MHQ aesthetics could discriminate between erosive and non-erosive disease. MHQ and AUSCAN were most responsive.

CONCLUSIONS

MHQ has several unique aspects and advantages justifying its use in hand OA, including the unique assessment of work performance, aesthetics, and satisfaction. However, MHQ, AUSCAN and FIHOA appear to measure different aspects of pain and function.

Factors associated with the orthopaedic surgeon's decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1905 patients

OBJECTIVE

To determine factors associated with orthopaedic surgeons' decision to recommend total joint replacement (TJR) in people with knee and hip osteoarthritis (OA).

DESIGN

Cross-sectional study in eleven countries. For consecutive outpatients with definite hip or knee OA consulting an orthopaedic surgeon, the surgeon's indication of TJR was collected, as well as patients' characteristics including comorbidities and social situation, OA symptom duration, pain, stiffness and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), joint-specific quality of life, Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) radiographic grade (0-4), and surgeons' characteristics. Univariable and multivariable logistic regressions were performed to identify factors associated with the indication of TJR, adjusted by country.

RESULTS

In total, 1905 patients were included: mean age was 66.5 (standard deviation [SD], 10.8) years, 1082 (58.0%) were women, mean OA symptom duration was 5.0 (SD 7.0) years. TJR was recommended in 561/1127 (49.8%) knee OA and 542/778 (69.7%) hip OA patients. In multivariable analysis on 516 patients with complete data, the variables associated with TJR indication were radiographic grade (Odds Ratio, OR for one grade increase, for knee and hip OA, respectively: 2.90, 95% confidence interval [1.69-4.97] and 3.30 [2.17-5.03]) and WOMAC total score (OR for 10 points increase: 1.65 [1.32-2.06] and 1.38 [1.15-1.66], respectively). After excluding radiographic grade from the analyses, on 1265 patients, greater WOMAC total score was the main predictor for knee and hip OA; older age was also significant for knee OA.

CONCLUSION

Radiographic severity and patient-reported pain and function play a major role in surgeons' recommendation for TJR.

Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial

OBJECTIVES

Low-dose radiation therapy (LDRT) is widely used as treatment for osteoarthritis (OA) in some countries, while relatively unknown in others. Systematic literature review displayed a lack of high-level evidence for beneficial effects in clinical practice. The aim was to assess the efficacy of LDRT on symptoms and inflammation in hand OA patients in a randomised, blinded, sham-controlled trial, using validated outcome measures.

DESIGN

Hand OA patients, ≥50 years, with pain ≥5 (scale 0-10) and non-responding to conservative therapy were included and randomised 1:1 to receive LDRT (6 × 1 Gy in 2 weeks) or sham (6 × 0 Gy in 2 weeks). Primary outcome was the proportion of OMERACT-OARSI responders, 3 months post-intervention. Secondary outcomes were pain and functioning (Australian/Canadian Hand Osteoarthritis Index; AUSCAN), quality of life (Short Form Health Survey; SF36) and inflammatory outcomes: erythrocyte sedimentation rate and C-reactive protein serum levels, effusion, synovial thickening and power Doppler signal on ultrasound (range 0-3).

RESULTS

Fifty-six patients were included. After 3 months, no significant difference in responders was observed between groups (LDRT: 8 (29%); sham: 10 (36%); difference -7% (95%CI -31-17%)). Also, differences in clinical and inflammatory outcomes between groups were small and not significant.

CONCLUSIONS

We were unable to demonstrate a substantial beneficial effect of LDRT on symptoms and inflammation in patients with hand OA, compared to sham treatment. Although a small effect can not be excluded, a treatment effect exceeding 20% is very unlikely, given the confidence interval. Therefore, in the absence of other high-level evidence, we advise against the use LDRT as treatment for patients with hand OA.

CLINICAL TRIAL REGISTRATION NUMBER

NTR4574 (Dutch Trial Register).

In thumb base osteoarthritis structural damage is more strongly associated with pain than synovitis

OBJECTIVE

Osteoarthritis in thumb base joints (first carpometacarpal (CMC-1), scaphotrapeziotrapezoid (STT)) is prevalent and disabling, yet focussed studies are scarce. Our aim was to investigate associations between ultrasonographic and magnetic resonance imaging (MRI) inflammatory features, radiographic osteophytes, and thumb base pain in hand osteoarthritis patients.

DESIGN

Cross-sectional analyses were performed in cohorts with MRI (n = 202) and ultrasound measurements (n = 87). Pain upon thumb base palpation was assessed. Radiographs were scored for CMC-1/STT osteophytes. Synovial thickening, effusion and power Doppler signal in CMC-1 joints were assessed with ultrasound. MRIs were scored for synovitis and bone marrow lesions (BMLs) in CMC-1 and STT joints using OMERACT-TOMS. Associations between ultrasound/MRI features, osteophytes, and thumb base pain were assessed. Interaction between MRI features and osteophytes was explored.

RESULTS

In 289 patients (mean age 60.2, 83% women) 139/376 thumb bases were painful. Osteophyte presence was associated with pain (MRI cohort: odds ratio (OR) 5.1 (2.7-9.8)). Ultrasound features were present in 25-33% of CMC-1 joints, though no associations were seen with pain. MRI-synovitis and BMLs grade ≥2 were scored in 25% and 43% of thumb bases, and positively associated with pain (OR 3.6 (95% CI 1.7-7.6) and 3.0 (1.6-5.5)). Associations attenuated after adjustment for osteophyte presence. Combined presence of osteophytes and MRI-synovitis had an additive effect.

CONCLUSIONS

Ultrasonographic and MRI inflammatory features were often present in the thumb base. Osteophytes were more strongly associated with thumb base pain than inflammatory features, in contrast to findings in finger OA studies, supporting thumb base osteoarthritis as a distinct phenotype.

Comparison of histological and morphometrical changes underlying subchondral bone abnormalities in inflammatory and degenerative musculoskeletal disorders: a systematic review

OBJECTIVE

Subchondral bone abnormalities (SBAs) on magnetic resonance imaging (MRI) are observed frequently and associated with disease course in various musculoskeletal disorders. This review aims to map the existing knowledge of their underlying histological features, and to identify needs for future research.

DESIGN

We conducted a systematic review following PRISMA guidelines until September 2017, including all studies correlating histological features to on MRI defined SBAs in patients with osteoarthritis (OA), rheumatoid arthritis (RA), spondyloarthritis (SpA) and degenerative disc disease (DDD). Two authors independently retrieved articles and assessed study quality.

RESULTS

A total of 21 studies (466 patients) correlated histological features to SBAs in OA (n = 13), RA (n = 3), ankylosing spondylitis (AS) (n = 1) and DDD (n = 4). Reported changes in OA were substitution of normal subchondral bone with fibrosis and necrosis, and increased bone remodeling. In contrast, in RA, AS or DDD fibrosis was not reported and SBAs correlated to an increase in inflammatory cell number. In DDD necrosis was observed. Similar to OA, increased bone remodeling was shown in RA and DDD. The risk of bias assessment showed a lack in described patient criteria, blinding and/or adequate topographic correlation in approximately half of studies. There was heterogeneity regarding the investigated histological features between the different disorders.

CONCLUSIONS

Current studies suggest that SBAs correlate to various histological features, including fibrosis, cell death, inflammation and bone remodeling. In the majority of studies most quality criteria were not met. Future studies should aim for high quality research, and consistency in investigated features between different disorders.

Acromegalic arthropathy in various stages of the disease: an MRI study

BACKGROUND

Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI).

METHODS

Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active (n = 10) and controlled acromegaly (n = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison.

RESULTS

Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, P = 0.001) and bone marrow lesions (15% vs 80%, P = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage (P < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects (P < 0.01).

CONCLUSIONS

Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.

Cross-cultural validation of the ICOAP and physical function short forms of the HOOS and KOOS in a multi-country study of patients with hip and knee osteoarthritis

OBJECTIVE

To evaluate the internal consistency and construct validity of the Physical Function short-forms for the Hip and Knee Injury Osteoarthritis Outcome Scores (HOOS-PS/KOOS-PS) and the Intermittent and Constant Osteoarthritis Pain (ICOAP) in a nine country study of patients consulting for total hip or knee replacement (THR or TKR).

METHODS

Patients completed HOOS-PS or KOOS-PS, ICOAP and Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) pain and physical function subscales at their consultation visit. Internal consistency was calculated using Cronbach's alpha. The association of HOOS-PS/KOOS-PS and ICOAP with WOMAC pain and function subscales was calculated with Spearman correlation coefficients with 95% confidence intervals.

RESULTS

HOOS-PS/KOOS-PS and ICOAP demonstrated high internal consistency across countries (alpha 0.75-0.96 (hip) and 0.76-0.95 (knee)). Both HOOS-PS and KOOS-PS demonstrated high correlations (0.76-0.90 and 0.75-0.91, respectively) with WOMAC function in all countries. ICOAP exhibited moderate to high correlations with WOMAC pain and function subscales (0.53-0.84 (hip) and 0.43-0.84 (knee)).

CONCLUSION

The psychometric properties of the HOOS-PS/KOOS-PS, and ICOAP were maintained across all countries.

No association between impaired glucose metabolism and osteoarthritis

OBJECTIVE

To investigate the association between markers of glucose metabolism and hand and knee osteoarthritis (OA).

METHODS

This is a cross-sectional analysis of baseline measurements of the Netherlands Epidemiology of Obesity (NEO) study, a population-based prospective cohort study. Fasting glucose, insulin and glycated hemoglobulin A1c (HbA1c) concentrations were measured, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) was calculated and clinical OA was defined following the American College of Rheumatology (ACR) criteria. After exclusion of participants on glucose-lowering drugs, odds ratios (ORs) with 95% confidence intervals (CIs) for either hand, knee or both hand and knee OA were calculated (no OA as reference), as a function of each marker of glucose metabolism, with logistic regression analyses. Models were adjusted for age, ethnicity, education, height, weight and total body fat, and stratified by sex.

RESULTS

In 6197 participants (age 45-65 years, 56% women, mean body mass index (BMI) 26 kg/m(2)), prevalences of hand OA, knee OA or both were 7%, 10% or 4%, respectively. In men, the adjusted OR (95%CI) for hand OA was 1.18 (1.01-1.39) per standard deviation (SD) increase in plasma glucose (0.85 mmol/L). There were no further associations of glucose, HbA1c, insulin and HOMA-IR with the different types of OA, neither in men nor in women.

CONCLUSION

An impaired glucose metabolism does not seem be related to OA. In men, an association was observed for fasting glucose concentrations and hand OA. Future studies should investigate the presence of sex differences in the pathogenesis of hand OA.