Exploring candidate biomarkers for rheumatoid arthritis through cardiovascular and cardiometabolic serum proteome profiling

Introduction

RA patients are at higher risk of cardiovascular disease, influenced by therapies. Studying their cardiovascular and cardiometabolic proteome can unveil biomarkers and insights into related biological pathways.

Methods

This study included two cohorts of RA patients: newly diagnosed individuals (n=25) and those with established RA (disease duration >25 years, n=25). Both cohorts were age and sex-matched with a control group (n=25). Additionally, a longitudinal investigation was conducted on a cohort of 25 RA patients treated with methotrexate and another cohort of 25 RA patients treated with tofacitinib for 6 months. Clinical and analytical variables were recorded, and serum profiling of 184 proteins was performed using the Olink technology platform.

Results

RA patients exhibited elevated levels of 75 proteins that might be associated with cardiovascular disease. In addition, 24 proteins were increased in RA patients with established disease. Twenty proteins were commonly altered in both cohorts of RA patients. Among these, elevated levels of CTSL1, SORT1, SAA4, TNFRSF10A, ST6GAL1 and CCL18 discriminated RA patients and HDs with high specificity and sensitivity. Methotrexate treatment significantly reduced the levels of 13 proteins, while tofacitinib therapy modulated the expression of 10 proteins. These reductions were associated with a decrease in DAS28. Baseline levels of SAA4 and high levels of BNP were associated to the non-response to methotrexate. Changes in IL6 levels were specifically linked to the response to methotrexate. Regarding tofacitinib, differences in baseline levels of LOX1 and CNDP1 were noted between non-responder and responder RA patients. In addition, response to tofacitinib correlated with changes in SAA4 and TIMD4 levels.

Conclusion

In summary, this study pinpoints molecular changes linked to cardiovascular disease in RA and proposes candidate protein biomarkers for distinguishing RA patients from healthy individuals. It also highlights how methotrexate and tofacitinib impact these proteins, with distinct alterations corresponding to each drug's response, identifying potential candidates, as SAA4, for the response to these therapies.

POS0619 CLINICAL AND SUBCLINICAL INTERSTITIAL LUNG DISEASE IN RHEUMATOID ARTHRITIS: ASSOCIATED FACTORS

Objectives

To evaluate the differences between patients with rheumatoid arthritis (RA) with and without interstitial lung disease (ILD), to identify factors associated with the development of ILD and to evaluate subclinical ILD; prevalence and factors associated with its development.

Methods

Observational and cross-sectional study of a cohort of patients with RA (ACR/EULAR 2010) and with ILD and a control group of patients without ILD. Both groups with HRCT performed in the last 18 months. The date of the last HRCT was considered as the study date. The % of patients who had subclinical ILD was retrospectively evaluated, defining this as pulmonary involvement due to a requested HRCT without any previous respiratory symptoms. Demographic variables, activity data (DAS28VSG, SDAI and CDAI on the study date), RF and ACPA levels, RA severity data and treatments they were receiving were collected. Descriptive analysis, χ2 or t-Student and multivariate logistic regression analysis was performed to find predictive variables of the development of ILD.

Results

66 patients with RA (41 with ILD and 25 without ILD) were included. The main differences between both groups are shown in Table 1. In the group of patients with ILD, the male sex predominated, they were older, with a longer duration of the disease and a longer diagnostic delay of RA. They made more use of biological therapies with better control of the disease by DAS28, SDAI and CDAI. Pulmonary function preserved by respiratory function tests. Of the total number of patients with ILD, 15 (36.6%) did not present any respiratory symptoms when the HRCT was requested. The reasons for their request were: finding abnormalities on chest X-ray (66.7%) and dry crackles on examination (33.3%). Subclinical ILDs were diagnosed with less evolution time of RA than clinical ones. In the rest of the variables there were no differences with the clinical ILD. The variables independently associated with the development of ILD, adjusted for age, tobacco use and ACPA at high titers, were male sex [OR = 4.2 (95% CI 1.05-19.7), p = 0.049] and time of evolution of RA [OR = 1.08 (95% CI 1.02-1.17), p = 0.014].

Conclusion

In our cohort, the prevalence of subclinical ILD was high (36%). Clinical characteristics, disease activity and ILD data (PFT and HRCT patterns) were similar between clinical and subclinical ILD, but prospective studies are needed to assess whether the course and prognosis in both groups is also similar. Bearing in mind that ILD is an important cause of death in our patients, we must actively search for this condition in order to treat it early and improve its prognosis.

Disclosure of Interests

None declared

AB0264 ASSOCIATION BETWEEN DIFFERENT HLADRB1 ALLELES AND SEVERITY IN RHEUMATOID ARTHRITIS

Objectives

To evaluate the association between different HLADRB1 alleles and the development of serious complications in patients with rheumatoid arthritis (RA).

Methods

We performed an observational, longitudinal and retrospective study of a cohort of 134 patients with established RA (ACR/EULAR 2010) from the registry of our department, older than 18 years and without other associated autoimmune pathologies except secondary Sjogren’s syndrome and who had the requested HLADRB1 genotype. Patients with ≥ 1 of the following HLA-DRB1 alleles were considered positive shared epitope carriers (SE+): *01:01, *01:02, *04:01, *04:04, *04:05, * 10:01, *03:01 or *07:01. The remaining patients without any of these alleles were considered shared epitope negative (SE-). Serious complications of RA were included: interstitial lung disease, cardiovascular events, cancer, admissions for serious infections, vasculitis, Felty’s syndrome, or death. Other severity data: erosions, rheumatoid nodules, multiple resistance to biologicals (3 or more biologicals), secondary Sjogren’s syndrome or osteoporosis. Descriptive and bivariate analysis was performed between the different alleles (χ2/ANOVA). Cox regression analysis was performed to estimate the influence of the different alleles on mortality.

Results

A total of 134 patients (91 SE+ and 43 SE-) were included. The main differences between the different alleles are shown in Table 1. The most frequent alleles were *0101 (n=18), *0301 (n=15) and *0701 (n=17). When the different alleles were compared, it was seen that the carriers of the alleles *04:05 presented positive ACPA more frequently (100%), rheumatoid nodules (50%) and showed higher mortality (50%) together with the carriers of *07:01 (41.2%), in a statistically significant way. There was no difference in the rest of the complications or severity data. The causes of death were varied in patients with both alleles (cardiovascular events, cancer, interstitial lung disease, and infections). There were no differences in age at death [mean 82.8 years (SD 3.8) vs 84.5 (6.6); p= 0.836, respectively]. Cox regression analysis adjusted for sex, age and ACPA showed that patients with alleles *04:05 (HR 9.1 (95% CI 1.1-72.3; p=0.036) and *07:01 (HR 10.9 (95% CI 1.5-81.2; p= 0.019) had a higher risk of mortality from any cause.

Table 1.

Characteristics of the patients with the different alleles

VariablesSE- (n= 43)*01:01 (n= 18)*01:02 (n= 10)*04:01 (n= 12)*04:04 (n=10)*04:05 (n= 4)*10:01 (n= 5)*03:01 (n= 15)*07:01 (n= 17)pAge at diagnosis (years), mean (SD)54.1 (16.2)48.5 (14.8)55.5 (10.7)45.7 (12.9)50 (11.4)56.8 (20.9)55.1 (21.2)50.5 (11.3)59.7 (17.9)0.336Female sex, n (%)30 (69.7)12 (66.6)7 (70)10 (83.3)9 (90)03 (60)12 (80)12 (70.6)0.096Time since diagnosis (years), mean (SD)12.8 (7.8)15.3 (3.6)11.8 (7.6)14.1 (6)11.03 (7.9)9.3 (6.8)11.8 (7.4)16.4 (6.9)12.3 (7.3)0.420RF +, n (%)32 (74.4)17 (94.4)9 (90)12 (100)10 (100)4 (100)4 (80)12 (80)13 (76.5)0.216ACPA +, n (%)27 (62.7)16 (88.8)9 (90)11 (91.6)10 (100)4 (100)5 (100)9 (60)8 (47)0.004Erosions, n (%)12 (27.9)9 (50)3 (30)8 (66.7)5 (50)2 (50)2 (40)7 (46.7)7 (41.2)0.422Noduls, n (%)01 (5.5)01 (8.3)1 (10)2 (50)1 (20)01 (5.9)0.003Osteoporosis, n (%)14 (32.5)3 (16.7)4 (40)1 (8.3)3 (30)001 (6.6)4 (23.5)0.194Sjogren S., n (%)4 (9.3)001 (8.3)0002 (13.3)00.515ILD, n (%)5 (11.6)1 (5.5)1 (10)2 (16.7)2 (20)002 (13.3)2 (11.8)0.937CVD, n (%)11 (25.6)4 (22.2)1 (10)1 (8.3)1 (10)1 (25)1 (20)2 (13.3)4 (23.5)0.872Serious infections, n (%)11 (25.6)1 (5.5)1 (10)02 (20)2 (50)02 (13.3)2 (11.8)0.646Cancer, n (%)4 (9.3)3 (16.7)1 (10)1 (8.3)2 (20)1 (25)1 (20)2 (13.3)2 (11.8)0.972Multiresistants, n (%)2 (4.6)2 (11.1)01010200.465Deaths, n (%)12 (27.9)2 (11.1)0002 (50)01 (6.6)7 (41.2)0.005

Conclusion

Our results suggest that RA patients carrying the *0405 and *0701 alleles have an increased risk of mortality. Studies with larger numbers of patients are needed to confirm these results.

Disclosure of Interests

None declared

POS0886 EFFICACY AND SAFETY OF RITUXIMAB IN AUTOIMMUNE DISEASE–ASSOCIATED INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Background

Interstitial lung disease (ILD) is a common condition in patients with connective tissue disease (CTD). It is associated with increased morbidity and mortality. Rituximab (RTX) has been approved for treatment of RA and some recent retrospective studies suggest that it could be an alternative treatment for patients with CTD-ILD, even in cases that prove refractory to conventional immunosuppressants.

Objectives

To analyze the efficacy and safety of RTX in connective tissue disease associated with interstitial lung disease (CTD-ILD).

Methods

We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving RTX between 2015 and 2020. Patients who had worsening of respiratory symptoms or decline in the pulmonary function tests (PFT) compared to the time of ILD diagnosis were treated with rituximab. The patients were assessed using high-resolution computed tomography and PFT baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC)>10% or diffusing capacity of the lungs for carbon monoxide (DLCO)>15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening of ILD.

Results

We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7-69.0) months (Table 1). At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in 7 (18.9%); 7 patients (18.9%) died. Mean PFT values decreased significantly at the start of RTX compared to the date of ILD diagnosis in FVC (72.2[21.3]vs 73.5 [16.9] mg/l;p=0.040) and DLCO-SB (55.9 [15.7] vs 58.3 [16.1] mg/l; p=0.041). No significant decline was observed in median FVC (72.2 vs 70.8; p=0.530) or DLCO (55.9 vs 52.2; p=0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR [95% CI], 0.904 [0.8-0.9]; p=0.015), time to initiation of RTX (1.01 [1.001-1.02]; p=0.029), and mycophenolate (0.202 [0.04-0.8]; p=0.034). The infection incidence rate was 0.21 patient-years.

Table 1.

Baseline demographic and clinical characteristics of 37 patients with CTD-ILD receiving rituximab.

VariableTotal n=37RAn=19SSn=14IMn=4p ValueFemale sex, n (%)27 (73.0)13 (68.4)11 (78.6)3 (75.0)0.806Age in years, mean (SD)62.8 (9.9)67.7 (9.7)57.9 (7.9)56.6 (5.5)0.001Smoking0.147Never smoked, n (%)20 (54.1)9 (47.4)7 (50.0)4 (100.0)Smoked at some time, n (%)17 (45.9)10 (52.6)7 (50.0)0 (0.0)Duration of CTD, months, median (IQR)107.8 (49.5-188.8)151.0 (8.,0-240.5)89.6 (51.3-184.4)35.1 (25.1-49.0)0.017Duration of ILD, months, median (IQR)65.4 (31.1-110.3)82.2 (37.4-120.1)64.5 (35.5-107.1)25.9 (25.0-36.0)0.136Time to initiation of RTX, median (IRQ)12.0 (6.5-48.2)25.1 (7.0-57.6)11.4 (3.9-43.6)7.4 (7.0-10.4)0.455Duration of treatment with RTX, median (IQR)38.2 (23.4-69.9)45.3 (22.2-79.9)52.5 (24.7-63.3)22.8 (17.7-36.2)0.291Combined with csDMARDs, n (%)15 (40.5)9 (47.4)5 (35.7)1 (25.0)0.637Methotrexate, n (%)5 (13.5)2 (10.5)3 (21.4)0 (0.0)0.468Leflunomide, n (%)2 (5.4)2 (10.5)0 (0.0)0 (0.0)0.367Sulfasalazine, n (%)1 (2.7)1 (5.3)0 (0.0)0 (0.0)0.615Hydroxychloroquine, n (%)7 (18.9)4 (21.1)2 (14.3)1 (25.0)0.840Combination with immunosuppressants, n (%)20 (54.1)7 (36.8)9 (64.3)4 (100.0)0.044Mycophenolate, n (%)19 (51.4)6 (31.6)9 (64.3)4 (100.0)0.021Azathioprine, n (%)1 (2.7)1 (5.3)0 (0.0)0 (0.0)0.615Corticosteroids, n (%)25 (67.6)14 (73.7)7 (50.0)4 (100.0)0.121Doses of corticosteroids, median (IQR)5.0 (0.0-10.0)5.0 (0.0-10.0)2.5 (0.0-7.5)10.0 (8.1-10.5)0.519

Conclusion

Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. No significant increase in infection rates was observed. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.

Disclosure of Interests

None declared

AB1112 SARS-COV-2 INFECTION AND IT VACCINATION IN AUTOINMUNE DISEASE-ASSOCIATED INTERSTICIAL LUNG DISEASE

Background

Intersticial lung disease (ILD) is a common condition in patients with systemic autoinmune diseases (SAI) that is characterized by increased morbility and mortality. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has posed huge challenges worldwide and previous studies suggest that ILD patients experience a more severe clinical course.

Objectives

To analyze COVID-19 infection effects in patients with ILD associated systemic autoinmune disease (ILD-SAI) and to describe their vaccination status.

Methods

Design

We performed a multicenter, retrospective, observational study from 6 teaching hospitals in Andalusia, Spain.

Study protocol

We included ILD-SAI patients: rheumatoid arthritis (RA), systemic sclerosis (SS) and inflammatory myopathies (IM), assisted in reumatology consultations in 2021.

Variables

COVID-19 infection was the main variable that we collected and it was confirmed by a positive result on a PCR test. Secondary variables: (1) COVID-19 severity defined as hospitalization or death; (2) vaccination status; (3) temporary relationship between infection and vaccination. Other variables included: clinical, epidemiological characteristics, treatments received, type of ILD (UIP/NSIP), pulmonary function testing and high-resolution computed tomography.

Statistic analysis

Two multivariable logistic regression analysis to indentify the “COVID-19” and “severe COVID-19” associated factors.

Results

We included 176 ILD-SAI, of whom: 105 (59.7%) had RA, 49 (27.8%) had SS and 22 (12.54%) had IM. The main baseline characteristics for the oversall simple and te 3 subgroups are shown in Table 1.

Table 1.

Clinical and epidemiological characteristics of 171 ILD-SAI patients.

VariableRheumatoid artritisn=105Systemic sclerosisn=49Inflammatory myopathies n=22p-valueSex, women, n (%)58 (55.2)42 (85.7)17 (77.3)<0.001Age in years, mean (SD)67.9 (9.6)60.9 (12.5)55.7 (18.9)<0.001SAI evolution time, month, median (IQR)46.2 (25.4-79.0)67.1 (52.2-88.2)39.1 (25.1-72.5)0.010Radiological patterns<0.001UIP, n (%)66 (62.9)8 (16.3)1 (4.5)NSIP n (%)32 (30.5)39 (79.6)20 (90.9)Last PFTFVC, mean (SD)70.7 (19.9)71.3 (21.4)73.1 (16.6)0.471FEV1, mean (SD)71.2 (19.3)72.2 (17.3)74.4 (17.9)0.345SB-DLCO, mean (DS)54.3 (16.5)52.4 (15.9)60.8 (15.2)0.140TreatmentsDMARD, n (%)88 (86.3)10 (20.4)11 (50.0)<0.001Biologic DMARD, n (%)47 (46.1)14 (28.6)6 (27.3)0.590Immunosuppressants, n (%)37 (36.3)33 (67.3)17 (77.3)<0.001Corticosteroid, n (%)72 (71.3)24 (49.0)18 (81.8)0.007COVID-19COVID-19 infection, n (%)14 (13.3)4 (8.2)4 (18.2)0.460Severe COVID-19 infection, n (%)7 (50.0)0 (0.0)0 (0.0)0.085Complete COVID-19 vaccination, n (%)94 (89.5)47 (95.9)22 (100.0)0.135

We recorded 22/179 (12.5%) SARS-CoV-2 infections, 7/22 (31.8%) of them were severe and 3/7 (42.85%) died. As to the vaccination, 163/176 (92.6%) patients received the complete dosis. Among those correctly vaccinated 18/163 (11%) had the SARS-CoV-2 infection, 4/18 (22.2%) after the vaccinated date and 14/18 (77.7%) when they still dint´t have the complete vaccination. From the 13 not vaccinated patients, 4/13 (30.7%) had COVID-19. As to frequency, COVID-19 severity and vaccination, there were no difference between subgroups of CTD-ILD patients. The risk factors associated with the COVID-19 infection were the last FVC (OR [CI 95%], 0.971 [0.944-0.998]; p=0.048), the vaccination (OR [CI 95%], 0.185 [0.049-0.691]; p=0.012) and the Rituximab treatment(OR [CI 95%], 3.172 [1.028-6.785]; p=0.045). Moreover, the only variable associated independently with the severe COVID-19 was the protective effect of vaccination (OR [CI 95%], 0.020 [0.003-0.119]; p<0.001).

Conclusion

A total of 12.5% ILD-SAI patients were COVID-19 infected, most of them without the complete vaccine. Rituximab and a deterioration of FVC were risk factors for the COVID-19 wehreas the vaccination was a protective factor for the mild and severe infection.

Disclosure of Interests

None declared

POS0654 EFFECTIVENESS OF ABATACEPT IN PATIENTS WITH INTERSTITIAL LUNG DISEASE ASSOCIATED WITH RHEUMATOID ARTHRITIS

Background

Interstitial Lung Disease (ILD) is the most common lung involvement in rheumatoid arthritis (RA) and leads to increased morbidity and mortality. Some retrospective observational studies suggest that abatacept (ABT) could be effective and safety, although there are no clinical trials and prospectively collected data are scarce.

Objectives

To evaluate prospective the effectiveness and safety of ABT in patients with ILD associated RA (ILD-RA).

Methods

Design and Protocol: We performed a multicenter, prospective, observational study of patients with interstitial lung disease secondary to rheumatoid arthritis (ILD-RA) receiving ABT between 2015 and 2021. The patients were assessed using high-resolution computed tomography and lung function tests at the beginning of treatment (V0), at 12 months (V12), and at the end of follow-up in 2021 (fV). The study was approved by the Ethics Committee (Code 1719-N-15). Main variable: effectiveness of ABT according to evolution of ILD at the end of follow-up: (1) improvement (ie improvement of FVC ≥10% or DLCO ≥15% and no radiological progression), (2) no progression (stabilization or improvement in FVC ≤ 10% or DLCO <15% and no radiological progression), (3) progression (worsening of FVC >10% or DLCO >15% and radiological progression) or (4) death. Other variables: clinical and analytical characteristics, treatments and safety (infections, hospitalization and mortality). Statistical analysis: Cox regression analysis to identify factors associated with worsening of ILD-RA treated with ABT.

Results

Thirty-eight ILD-RA patients started ABT treatment during prospective follow-up. A total of 22/38 (57.9%) were men and the mean (SD) age was 66.1 (9.1) years. The mean (SD) evolution of ILD was 43.9 (30.0) months and the median (IQR) time with ABT was 17.0 (12.1-34.8) months. The baseline clinical-epidemiological characteristics and pulmonary progression of the patients are shown in Table 1. At the end of follow-up (fV) 28/38 (73.6%) had improvement/stabilization and 7/38 (18.4%) progressed and 3/38 (7.8%) of them died (COVID-19 pneumonia, respiratory infection and ILD progression, respectively). There were no significant differences in FVC (75.3 [8.7] vs 77.7 [14.6]; p=0.775) or in FEV1 (83.9 [10.7] vs 84.7 [13.2]; p=0.416) nor in the DLCO (61.0 [17.4] vs 60.7 [15.2]; p=0.789) at the end of follow-up. There was a greater numberwith improvement/stabilization among the patients who were in combination with Methotrexate compared to those who were in monotherapy (83.3% vs 39.1%; p=0.046). The baseline variables that were independently associated with progression-mortality of ILD-RA in fV were: baseline FVC (OR [95% CI], 0.895 [0.805-0.996]; p=0.042) and duration of ILD-RA (OR [95% CI], 1.204 [1.148-2.112; p=0.046]). Two patients discontinued ABT during follow-up due to insufficient joint and pulmonary response.

Table 1.

Characteristics of patients with ILD-RA treated with Abatacept.

VariableILD-RA n=38Baseline clinical-epidemiological characteristics Sex, man, n (%)22 (57.9) Age in years, mean (SD)66.1 (9.1) Race, caucasian, n (%)38 (100.0) Smoking history  No smoker, n (%)23 (60.5)  Smoker, n (%)15 (39.5) Time of evolution RA, months, median (IQR)139.1 (68.1-218.7) RF, n (%)36 (94.7) Anti-CCP, n (%)32 (84.2) ANA, n (%)8 (22.9) Radiological pattern  UPI, n (%)26 (68.0)  NSIP, n (%)12 (32.0)Treatment DMARDs, n (%)33 (86.8) Methotrexate, n (%)19 (50.0) Leflunomide n (%)11 (22.9) Sulfasalazine, n (%)2 (5.3) Hydroxychloroquine, n (%)6 (15.7)Immunosuppressants, n (%)11 (297)Antifibrotic, n (%)1 (2.6)Corticosteroids, n (%)32 (84.2)Corticosteroids, median (IQR)5.0 (2.5-10.0)Pulmonary progression (fv) Improvement-Stabilization, n (%)22 (73.6) Progression-Mortality, n (%)10 (26.4)

Conclusion

More than half of the patients with ILD-RA treated with ABT manage to stabilize or improve their lung disease after a median follow-up of 17 months. Patients who worsen or die have lower baseline FVC values ​​and ILD-RA with a longer evolution time.

Disclosure of Interests

None declared

Association between Carotid Intima-Media Thickness and the Use of Biological or Small Molecule Therapies in Patients with Rheumatoid Arthritis

Objective: The objective of this study was to assess the association of carotid intima-media thickness (CIMT), and also the presence of atheromatous plaque, with biological and targeted synthetic disease-modifying antirheumatic drugs, in an established cohort of patients with rheumatoid arthritis (RA). Patients and Methods: We conducted a cross-sectional observational study based on a cohort of patients with RA and a registry of healthy controls, in whom the CIMT and presence of atheromatous plaque were assessed by ultrasound. Data were collected on disease activity, lab results and treatments. Descriptive and bivariate analyses were performed and two multivariate linear regression models (with CIMT as the dependent variable) were constructed to identify variables independently associated with CIMT in our sample of patients with RA. Results: A total of 176 individuals (146 patients with RA and 30 controls) were included. A higher percentage of patients than controls had atheromatous plaque (33.8% vs. 12.5%, p = 0.036), but no differences were found in terms of CIMT (0.64 vs. 0.61, p = 0.444). Compared to values in patients on other therapies, the CIMT was smaller among patients on tumour necrosis factor alpha (TNFα) inhibitors (mean [SD]: 0.58 [0.10] vs. 0.65 [0.19]; p = 0.013) and among those on Janus kinase inhibitors (mean [SD]: 0.52 [0.02] vs. 0.64 [0.18]; p < 0.001), while no differences were found as a function of the use of the other therapies considered. The multivariate linear regression analysis to identify factors associated with CIMT in our patients, adjusting for traditional cardiovascular risk factors such as hypertension, high levels of low-density lipoproteins, diabetes mellitus and smoking, showed that male sex, older age and having a greater cumulative erythrocyte sedimentation rate were independently associated with a larger CIMT, while patients on TNFα inhibitors had a CIMT 0.075 mm smaller than those on other treatments. Conclusions: The use of TNFα inhibitors may protect against subclinical atherosclerosis in patients with RA, patients on this biologic having smaller CIMTs than patients on other disease-modifying antirheumatic drugs. Nonetheless, these results should be confirmed in prospective studies with larger sample sizes.

Effectiveness, safety and economic analysis of Benepali in clinical practice

OBJECTIVE

To assess the effectiveness, safety and cost of Etanercept biosimilar in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) compared to the standard drug in real clinical practice.

PATIENTS AND METHODS

Retrospective observational study. Case series of 138 patients with RA, SpA or PsA treated with at least one dose of Benepali® (n = 79) or Enbrel® (n = 59). Drug retention time was the primary efficacy endpoint compared to the biosimilar and the original. The proportion of patients achieving low disease activity or remission after 52 weeks was used as the secondary outcome. Safety was assessed by means of the adverse effects incidence rate. A cost minimization analysis was performed.

RESULTS

No differences were observed regarding treatment retention time between drugs (median [95% confidence interval, 95% CI] at 12.0 months [10.2-12.0] for the biosimilar and 12.0 months [12.0-12.0] for the original). Similar improvements, in terms of inflammatory activity and physical function, were obtained after 52 weeks except for patients with SpA and PsA who, in general, experienced improvements of BASDAI and ASDAS with the original compared with the biosimilar. No significant differences were observed in the total number of adverse effects (.43 events/patient-years versus the biosimilar and .53 versus the original). Using the biosimilar in place of the original drug resulted in a net savings of 118,383.55 € (1,747.20 €/patient-years) for the hospital.

CONCLUSION

The biosimilar Benepali is as effective and safe as the original and much more cost-effective.

Hospitalization and mortality from COVID-19 of patients with rheumatic inflammatory diseases in Andalusia

Objective

To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia.

Methods

Design: Multicentre observational case-COntrol study. Patients: RID and COVID-19 from different centres in Andalusia. Controls: patients without RIS matched by sex, age and CRP-COVID.

Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case.

Variables The main outcome variable was hospital admission and mortality from COVID-19.

Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission).

Results

One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0–1.2]; P= .025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0–1.1]; P = .007) and hypertension (OR [95% CI], 3.9 [1.5–6.7]; P = .003).

Conclusion

Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission.

POS0529 ANTI-TNF AND METHOTREXATE PROTECT AGAINST RHEUMATOID ARTHRITIS ATHEROSCLEROSIS

Objectives:

To analyze the effect of differents anti-rheumatic treatments on the carotid intima-medial thickness (cIMT) in patients with Rheumatoid Arthritis (RA).

Methods:

Controlled cross-sectional observational study of a cohort of patients with RA. 146 patients with RA (ACR/EULAR2010).cIMT was measured by semi-automatic carotid ultrasound.Other variables: atheroma plaques, bilateral plaques, DAS28-VSG, lipid metabolism, apoB, apoA1, apoB/apoA1, uric acid, homocysteine. Biological or conventional synthetic disease-modifying antirheumatic drug therapy (bDMARDs/csDMARDs), glucocorticoids. Descriptive, bivariate, Spearman’s test and multivariate model were constructed to identify factors associated with cIMT.

Results:

The baseline characteristics are shown in Table 1.Significant positive correlation was found between cIMT and apoB (r=0.22; p=0.014), apoB/apoA1 (r=0.18; p=0.044), cholesterol(r=0.23; p=0.006),triglycerides(r=0,21, p=0.013),uric acid(r=0.26; p=0.009),age(r=0.65, p>0.001),RF(r=0.16, p=0.05) homocysteine (r=0.5, p<0.001), BMI (r=0.19, p=0.023),CRP(r=0.18, p=0.032) and negative correlation with anti-TNFα treatment time(r=-0.20, p=0.02).Patients receiving bDMARDs alone or combined with csDMARDs had less cIMT than those taking only csDMARDs[median (IQR): 0.54 (0.50-0.63), 0.57(0.53-0.65) and 0.65(0.53-0.75); p=0.046].The factors associated with cIMT were age(ß= 0.007, p<0.001),anti-tnf-α treatment ever(ß= -0.06, p=0.027) and methotrexate treatment ever(ß= -0.07, p=0,08).

Table 1.

Baseline characteristics

VariablesRA n=146Epidemiological characteristics and comorbiditiesAge (years), mean (SD)55.9 (13.1)Female sex; n (%)112 (76.7)Smoker, n (%)30 (21.6)Arterial hypertension, n (%)45 (30.8)Diabetes mellitus, n (%)5 (3.4)Previous Cardiovascular disease, n (%)10 (14.6)Hyperlipidemia, n (%)46 (31.5)BMI (kg/m2), median (IQR)26.8 (23.4-29.7)Clinical-laboratory characteristicsDisease duration, years, median (IQR)6.77 (2.2-14.2)Erosions, n (%)53 (36.6)RF positive, n (%)119 (81.55)ACPA positive, n (%)123 (84.2)CRP (mg/dl), median (IQR)4.8 (1.6-11.5)ESR (mm/h), median (IQR)12 (6-24)DAS28 at protocol, median (IQR)2.8 (2.1-3.7)HAQ, mean (SD)0.78 (0.6)ApoB (mg/dl), mean (SD)86.8 (21.8)ApoA1 (mg/dl), mean (SD)149.8 (32.7)Cholesterol (mg/dl), mean (SD)198.7 (37.3)cLDL (mg/dl), mean (SD)119.3 (30.3)cHDL (mg/dl), median (IQR)56 (47-70)Triglycerides (mg/dl), median (RIQ)92 (73-121)Homocisteyne (mg/dl), median (RIQ)2.08 (1.7-2.8)cIMT mean (mm), median (IQR)0.6 (0.53-0.7)Atherosclerotic plaques, n (%)51 (34.9)Bilateral plaques, n (%)22 (15.1)Anti-rheumatic treatmentSynthetic DMARDs ever, n (%)146 (100)Methotrexate ever, n (%)132 (90.4)Time with methotrexate (years), median (IQR)4.4 (1.04-9.5)Leflunomide ever, n (%)83 (56.8)Sulfasalazine ever, n (%)13 (8.9)Hydroxychloroquine ever, n (%)99 (67.8)Biological DMARDs ever, n (%)76 (52.05)Anti TNFα ever, n (%)47 (32.2)Time with antiTNF-α (years), mean (SD)1.18 (2.8)Jak inhibitor ever, n (%)10 (6.8)Anti-IL-6 ever, n (%)28 (19.2)Rituximab ever, n (%)15 (10.3)Glucocorticoids at protocol, n (%)82 (56.5)Glucocorticoids dose at protocol (mg), median (IQR)5 (0-5)

Abbreviations: RF: rheumatoid factor; ACPA: anti-citrullinated peptide antibodies, cIMT: carotid intima media thickness; ApoB: apolipoprotein B, ApoA1: apolipoprotein A1, LDL: low-density lipoprotein; HDL: high-density lipoprotein; DAS28: 28-joint Disease Activity Score; HAQ: Health Assessment Questionnaire; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; IL-6: interleukin 6; Anti TNF, anti–tumor necrosis factor

Conclusion:

biological disease-modifying antirheumatic drug therapy, in particular Anti TNFα, could protect against the development of atherosclerosis in RA

Disclosure of Interests:

None declared

AB0166 MORTALITY AND COMORBIDITIES IN A COHORT OF PACIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS

Background:

Patients diagnosed with Rheumatoid Arthritis (RA) have an increased risk of comorbidities and secondary mortality, in a large extent due to cardiovascular events.

Objectives:

To identify the frequency of comorbidity, mortality and variables related to its increase in a cohort of patients with rheumatoid arthritis established (RAE).

Methods:

Controlled cross-sectional observational study of a cohort of 188 patients with RAE a 10 year follow-up (5 years if not complete this period).

Results:

62.8% were women, mean age of patients at the time of inclusion was high 73.3 (+/-13.8) years and mean duration of disease was 12,8 (+/-6,99) years. Regarding CV risk factors, 26.6% smoked, 60.6% hypertension and 52.1 % diabetic. Regarding comorbidities, the most frequent were serious infections (45.2%), CVD (35.1%), Osteoporosis (31.9%), Depression (31.9%) and Kidney disease (26.6%). During follow-up, an improvement was observed inflammatory parameters and activity levels (p <0.001) Table 1. Mortality was associated to CVD and severe infection, and depression to lower mortality (p 0.05). Overall mortality was 32.4%. A logistic regression was performed in the group of patients with time greater evolution 10 years of our cohort, to be able to better represent the influence of disease carrying with her for longer, whose results are shown in Table 2. Analysand survival, men, CVD, severe infections, and Positive Rheumatoid Factor were associated with higher mortality, while treatment with Methotrexate was associated with increased survival. Among the causes of death, the most frequent were infections, CVD and solid cancer.

Conclusion:

-The incidence of comorbidities in our cohort is similar to that described in the literature.

-Relationship between mortality and CVD and severe infection is demonstrated.

-The mortality rate observed is higher than that described in the literature, which be influenced by the advanced age of the patients in the cohort and high time evolution of RA.

References:

[1]Lee YK, Ahn GY, Lee J, Shin JM, Lee TH, Park DJ, Song YJ, Kim MK, Bae SC. Excess mortality persists in patients with rheumatoid arthritis. Int J Rheum Dis. 2021 Jan 19. doi: 10.1111/1756-185X.14058. Epub ahead of print. PMID: 33463890.

[2]Mikuls, T. R. (2003). Co-morbidity in rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 17(5), 729-752.

[3]Naz, S. M., & Symmons, D. P. M. (2007). Mortality in established rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 21(5), 871-883.

Table 1.

Student’s t test for paired data.

VariablesBasal10 yearPDAS285,25 (15,08)2,89 (1,06)0,036VAS38,61 (36,45)26,93 (24,97)<0,001HAQ1,04 (0,79)0,88 (0,87)NSTJC4,96 (5,38)1,40 (2,57)<0,001SJC3,55 (3,69)0,72 (2,11)<0,001ESR (mm/h)31,47 (21,19)25,86 (18,47)<0,001CRP (mg/L)15,24 (16,13)9,41 (21,02)0,001Hemoglobin (mg/dL)13,44 (7,92)13,52 (7,64)NSGlucose (mg/dL)102,26(35,97)103,83 (37, 98)NSCholesterol (mg/dL)203,56 (46,11)195,65 (38,12)0,042LDL (mg/dL)123,91 (40,69)119,58 (33,89)NSHDL (mg/dL)56,73 (19,07)54,84 (20,38)NSTriglycerides (mg/dL)110,85 (60,77)113,44 (55,61)NSTable 2.

Logistic regression model. Hosmer-Lemeshow Chi square 9.035 Gl 7 p 0.25. Likelihood ratio test Chi square 64.658 Gl 5 p <0.001. NS, Not significant.

VariableUnivariate analysisOR (IC 95%)pMultiivariate analysisFINAL MODELOOR (IC 95%)PDyslipidemia1,02 (0,47-2,23)0,965HT4,73 (1,79-12,48)0,002DM1,42 (0,59-3,44)0,438CV disease11,25 (4,45-28,44)< 0,00112,33 (3.89-39,04)< 0,001Hyperuricemia3,27 (1,39-7,65)0,006Thyroid disease0,56 (0,15-2,11)0,393Interstitial lung disease2,48 (0,77-7,99)0,1277,37 (1,48-36,84)0,015Osteoporosis2,38 (1,07-5,29)0,033Renal disease8,25 (3,41-19,97)< 0,0014,14 (1,34-12,80)0,014Depressión0,32 (0,12-0,84)0,0210,20 (0,06-0,74)0,015Solyd CA1,12 (0,44-2,87)0,809Hematologic CA<0,001 (NS)0,999Amyloidosis2,65 (0,16-43,52)0,496Severe infecction6,22 (2,53-15,29)< 0,0015,59 (1,66-18,79)0,005COVID-19 infection1,31 (0,12-14,91)0,828

Disclosure of Interests:

None declared

AB0432 SURVIVAL AND PROGNOSIS IN SYSTEMIC SCLEROSIS: RESULTS FROM A SINGLE-CENTER COHORT

Objectives:

To analyze survival, causes of death, and risk factors associated with mortality in a cohort of patients with Systemic Sclerosis (SSc) at a single center

Methods:

We performed a retrospective observational study of a cohort of patients with SSc undergoing follow-up during 2012 and until August 2020. We used the Kaplan-Meier method to estimate survival from onset of symptoms and multivariate Cox regression analysis to obtain independent risk factors associated with mortality

Results:

The study population included 85 patients (women, 85.8%; mean age at diagnosis, 64.4 ± 12.7 years). A total of 19 patients (22.6%) died (table 1). Of these 11 (57.9%) died of a cause related to the disease itself (interstitial lung disease [ILD], 5 (26.3%); pulmonary hypertension, 2 (10.5%); or a combination of both, 3 (15.8%). The main cause of non–SSc-related death was cancer (21.1%). Survival rates at 5, 10, and 20 years were 98%, 92%, and 75%, respectively. Survival was statistically significantly poorer for the absence of ACA, the presence of antitopoisomerase I antibodies, proximal skin thickening, pulmonary hypertension, ILD, cancer and the diffuse subtype. The multivariate analysis performed to determine which factors were independently associated with mortality confirmed that older age at diagnosis of the disease, lower FVC in spirometry at diagnosis of ILD, and proximal skin thickening were associated with greater mortality

Table 1.

Clinical and immunological characteristics of patients who died and patients who lived

Dead(n=19)Alive(n=66)p-valueFemale sex, n (%)17 (89.5)55 (83.3)0.594Age at diagnosis (years), mean (SD)56.9 (13.7)50.4 (13.6)0.076Time since diagnosis (years), mean (SD)11.6 (7.3)14.2 (9.2)0.215lcSSc, n (%)6 (33.3)50 (75.7)< 0.001dcSSc, n (%)12 (66.7)10 (15.1)< 0.001Digital ulcers, n (%)9 (47.4)33 (50)0.748Calcinosis, n (%)1 (5.3)16 (24.2)0.061Telangiectasias, n (%)15 (78.9)56 (84.8)0.184ILD, n (%)15 (78.9)32 (48.5)0.021 FEV1 at diagnosis of ILD, mean (SD)78.3 (19.3)78.7 (17.7)0.955 FVC at diagnosis of ILD, mean (SD)65.2 (13.1)78.1 (20.7)0.043 DLCO at diagnosis of ILD, mean (SD)56.9 (17.5)63.9 (16.7)0.301Pulmonary hypertension, n (%)11 (57.9)14 (21.9)0.002 sPAP (mmHg), mean (SD)49.2 (24.7)30.2 (8.2)0.009Gastrointestinal involvement, n (%)13 (68.4)30 (45.4)0.125Cardiac involvement, n (%)3 (15.8)11 (16.7)0.907Muscle involvement, n (%)1 (5.3)2 (3.03)0.851Arthritis or arthralgia, n (%)5 (26.3)23 (34.8)0.436Renal crisis, n (%)02 (3.03)<0.001Cancer, n (%)5 (26.3)2 (3.03)0.001Positive ACA, n (%)5 (26.3)35 (53.03)0.034Positive ATA, n (%)10 (52.6)9 (13.6)< 0.001

Abbreviations: ILD: diffuse interstitial lung disease, SSc: systemic sclerosis, FEV1: forced expiratory volume in the first second, FVC: forced vital capacity, DLCO: diffusing capacity for carbon monoxide, sPAP: systolic pulmonary artery pressure, ACA: anticentromere antibody, ATA: antitopoisomerase I antibody.

Conclusion:

Survival at 10 years was greater than 90% in the study cohort. The main causes of death were ILD, pulmonary hypertension and cancer. The main factors associated with mortality were proximal skin thickening, older age at diagnosis, and lower forced vital capacity

Disclosure of Interests:

None declared

POS0521 FACTORS ASSOCIATED WITH SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objectives:

To describe the prevalence of subclinical atherosclerosis measured as carotid intima-media thickness (cIMT) in patients with rheumatoid arthritis (RA) and to analyze the associated factors.

Methods:

We performed an observational study of 60 patients with RA and 60 sex and age-matched controls. Patients with dyslipidemia were excluded. The main variable was the cIMT measured by ultrasound. The maximum cIMT was measured and atheromatous plaque was defined as focal thickening of the arterial wall protruding toward the lumen and measuring >0.5 mm or more than 50% of the neighboring cIMT. The other variables included were clinical and laboratory values, lipid metabolism, the 28-joint Disease Activity Score (DAS28), International Physical Activity Questionnaire (METs) and Adherence to a Mediterranean diet (MEDAS). Descriptive, bivariate and two multivariate models were constructed to identify factors associated with pathologic cIMT in all subjects and other in RA patients.

Results:

The baseline characteristics of both groups are shown in Table 1. The RA patients did not have differences in the mean (SD) of maximum cIMT in relation to the controls (0.77 [0.1] vs 0.75 [0.1]; p = 0.392), nor in the number of plaques (16 [26.7%] vs 10 [16.7]; p = 0.184). The factors associated with maximum cIMT in the total sample were male sex (ß= 0.182; p = 0.039), age (ß = 0.010; p <0.001), METs (ß= -2.19; p = 0.008), MEDAS (ß = -0.177; p = 0.038); While the factors associated with maximum cIMT in patients with RA were: male sex (ß = 0.155; p = 0.003), age (ß = 0.005; p = 0.007), MEDAS (ß = -0.022; p = 0.017), DAS28 (ß = 0.036; p = 0.003) and ACPA (ß = 0.082; p = 0.052).

Table 1.

Baseline characteristics of 60 patients with RA and 60 controls.

VariablePatients n=60Controls n=60p-valueAge in years, mean (SD)54.0 (11.1)54.2 (110.4)0.943Female sex; n (%)53 (88.3)51 (85.0)0.591Smoking0.300 Never smoked, n (%)27 (45.8)30 (54.5) Exsmoker, n (%)23 (39.0)14 (25.5) Active smoker, n (%)9 (15.3)11 (20,0)BMI (kg/m2), mean (SD)28.0 (5.5)27.3 (4.9)0.540MET-minute, median (IQR)533.2 (605.1)809 (716.9)0.028MEDAS, median (IQR)9.4 (1.8)9.1 (2.1)0.349Progression of RA, months, mean (SD)119.7 (84.1-170.5)--Diagnostic delay, months, median (IQR)5.7 (5.1-14.4)--Erosions, n (%)25 (43.1)--RF >10, n (%)45 (75.0)0 (0.0)<0,001ACPA >20, n (%)48 (80.0)0 (0,0)<0,001High-sensitivity CRP (mg/dl), median (IQR)8.1 (4.2)2.0 (4.5)0.009ESR (mm/h), median (IQR)21.1 (16.6)13.9 (12.3)0.008DAS28 at protocol, mean (SD)3.1 (2.2-4.2)--Synthetic DMARDs, n (%)52 (88.1)-- Methotrexate, n (%)36 (61.0)-- Leflunomide, n (%)6 (10.2)-- Sulfasalazine, n (%)7 (11.9)-- Hydroxychloroquine, n (%)4 (6.8)Biologic DMARDs, n (%)32 (54.2)-- Anti TNF-α, n (%)23 (39.0)-- Jak inhibitor, n (%)1 (1.7)-- Anti-IL-6, n (%)6 (10.2)-- Abatacept, n (%)1 (1.7)--

Abbreviations: RA, rheumatoid arthritis; ACPA, anti-citrullinated peptide antibodies; RF, rheumatoid factor; SD, standard deviation; MEDAS: Mediterranean Diet Adherence Survey; DAS28, 28-joint Disease Activity Score; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; DMARD, disease-modifying antirheumatic drug; IL-6, interleukin 6; Anti TNF, anti–tumor necrosis factor.

Conclusion:

In patients with well-controlled established RA, subclinical atherosclerosis is associated, in addition to sex, age, and mediterranean diet, with inflammatory activity and ACPA value.

Acknowledgements:

Grant for Medical Researchers from “Fundación Española de Reumatología” 2019

Grant from “Fundación Española de Reumatología” 2018 for non-funded projects.

Disclosure of Interests:

None declared

POS0211 PREDICTORS OF PROGRESSION AND MORTALITY IN PATIENTS WITH PREVALENT RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Objectives:

To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) and identify risk factors associated with disease progression and mortality in patients with rheumatoid arthritis associated with interstitial lung disease (RA-ILD).

Methods:

We performed a multicenter, prospective, observational study of patients with RA-ILD receiving DMARDs between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 60 months. The main outcome measure at 60 months was worsening of FVC >10% or DLCO >15% and radiological progression or death. We recorded demographic and clinical characteristics, lung function, and the incidence of adverse events. A Cox regression analysis was performed to identify factors associated with worsening of ILD.

Results:

After 60 months, lung disease had stabilized in 66 patients (56.9%), improved in 9 (7.8%), and worsened in 23 (19.8%). Eighteen patients (15.5%) died, with a mean survival of 71.8 (1.9) months. Baseline characteristics of 116 with RA-ILD treated with DMARDs is in table 1.The Cox multivariate analysis revealed the independent predictors of worsening of RA-ILD to be usual interstitial pneumonia (HR, 2.6 [95%CI, 1.0-6.7]), forced vital capacity (%) (HR, 3.8 [95%CI, 1.5-6.7]), anticitrullinated protein antibody titers (HR, 2.8 [95%CI, 1.1-6.8]), smoking (HR, 2.5 [95%CI, 1.1-6.2]), and treatment with abatacept, tocilizumab, or rituximab (HR, 0.4 [95%CI, 0.2-0.8]). During follow-up, 79 patients (68%) experienced an adverse event, mostly infection (61%).

Conclusion:

Lung function is stable in most patients with RA-ILD receiving treatment with DMARDs, although one third of patients die. Identifying factors of worsening in RA-ILD is important for clinical management.

Table 1.

Baseline characteristics of 116 with RA-ILD treated with DMARDs

VariableTotal=116Epidemiological characteristicsFemale sex, n (%)63 (54.3)Age, years, mean (SD)68.3 (9.9)Clinical and analytical characteristicsCurrent smokerNonsmoker, n (%)57 (49.1)Smoker, n (%)23 (19.8)Exsmoker, n (%)36 (31.0)Time since diagnosis of RA, months, median (p25-p75)148.5 (71.5-217.8)Diagnostic delay, months, median (p25-p75)8.5 (4.9-16.8)Time since diagnosis of ILD, months, median (p25-p75)27.5 (9.8-60.0)Positive rheumatoid factor (>10), n (%)111 (95.7)Positive ACPA titer (>20), n (%)100 (86.2)Erosive disease, n (%)76 (65.5)Treatment Synthetic DMARD100 (86.2) Methotrexate, n (%)51 (44.0) Leflunomide, n (%)30 (25.9) Sulfasalazine, n (%)9 (7.8) Hydroxychloroquine, n (%)21 (18.1)Biologic DMARD50 (43.1) Infliximab, n (%)1 (0.9) Etanercept, n (%)6 (5.2) Adalimumab, n (%)3 (2.6) Golimumab, n (%)3 (2.6) Certolizumab, n (%)3 (2.6) Tocilizumab, n (%)6 (5.2) Abatacept, n (%)15 (12.9) Rituximab, n (%)13 (11.2) Immunosuppressants11 (9.5) Mycophenolate, n (%)7 (6.0) Azathioprine, n (%)4 (3.4) Antifibrotic agents, nintedanib, n (%)1 (0.9) Baseline corticosteroids, n (%)69 (60.0) Dose of baseline corticosteroids, median (p25-p75)5.0 (0.0-7.5)

Abbreviations. RA: rheumatoid arthritis; ILD: interstitial lung disease; ACPA: anticyclic citrullinated protein antibody; DMARD: disease-modifying antirheumatic drug; SD: standard deviation.

Acknowledgements:

Grant for Medical Researchers of the “Fundación Española de Reumatología” 2019. declare.

Disclosure of Interests:

None declared

AB0451 TO EVALUATE THE PREVALENCE OF INTERSTITIAL LUNG DISEASE (ILD) AND/OR PULMONARY ARTERIAL HYPERTENSION (PAH) IN PATIENTS AFFECTED BY SYSTEMIC SCLEROSIS (SSC) AND TO DETERMINE THE FACTORS ASSOCIATED WITH ILD

Background:

Systemic sclerosis (SSc) is a chronic autoimmune disease that carries significant mortality. Despite diagnostic and therapeutic advances in recent years, there is still a significant percentage of patients who do not present a complete clinical response, with the associated increase in morbidity and mortality. Specifically, pulmonary disease is frequent and entails a poor prognosis, with interstitial lung disease (ILD) and pulmonary hypertension (PAH) being the two most important complications, the first and second cause of mortality, respectively.

Objectives:

To evaluate the prevalence of ILD and/or PAH in patients affected by SSc and to determine the factors associated with ILD.

Methods:

Cross-sectional observational study of 102 patients diagnosed with SSc (Limited, Diffuse, SSc without scleroderma or Pre-scleroderma), treated between 1975 and 2020 at the Reina Sofia University Hospital in Cordoba. A descriptive study of the cohort was carried out and factors independently associated with ILD were evaluated using a multiple logistic regression model.

Results:

102 patients were included, 87.3% of these were female with an average age of 50.8 (14) years. There were 20 deaths (19.8%), from which 55% died because of SSc and the main reason was ILD and/or PAH. Respiratory complications (as ILD or as PAH) were present in 59 patients (57.8%), of whom 52 were diagnosed with ILD (90.4% with a pattern of non-specific interstitial pneumonia) and 25 PAH, whose mean pulmonary artery systolic pressure was 47.16 (18.54) mmHg. Anti-topoisomerase I antibodies were positive in 34.6% of patients who developed ILD, while anticentromere antibodies were more frequent in SSc without interstitial lung disease (80%). Independent factors associated with ILD were type of SSc, proximal skin involvement, anticentromere antibodies, current treatment with corticoids and the death.

Conclusion:

Just over half of the patients with SSc have lung disease (as ILD or as PAH). The main risk factors associated with ILD are proximal skin involvement and treatment with glucocorticoids, probably in the context of more severe forms that require more treatment. Anticentromere antibodies are more prevalent in patients with Limited SSc and their expression decreases the risk of developing ILD in these patients.

References:

[1]Orlandi M, Barsotti S, Lepri G, et al. Clin Exp Rheumatol 2018 Jul-Aug; 36 Suppl 113: 3-23

[2]Hao Y, Hudson M, Baron M, et al. Arthritis Rheumatol. 2017;69(5):1067-1077.

[3]Furue M, Mitoma C, Mitoma H, et al. Immunol Res. 2017 Aug; 65: 790-7.

[4]Nihtyanova SI, Schreiber BE, Ong VH, et al. Arthritis Rheumatol. 2014 Jun; 66: 1625-35.

Disclosure of Interests:

None declared.

Hospitalization and Mortality from COVID-19 of Patients with Rheumatic Inflammatory Diseases in Andalusia

OBJECTIVE

To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia.

METHODS

Design: Multicentre observational case-control study.

PATIENTS

RID and COVID-19 from different centres in Andalusia.

CONTROLS

patients without RIS matched by sex, age and CRP-COVID. Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case. Variables The main outcome variable was hospital admission and mortality from COVID-19. Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission).

RESULTS

One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0-1.2]; p = 0.025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0-1.1]; p = 0.007) and hypertension (OR [95% CI], 3.9 [1.5-6.7]; p = 0.003).

CONCLUSION

Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission.