OP0139 IMPACT OF CHRONIC JOINT DISEASES ON THE SEXUAL SPHERE WITH REGARDS TO A HEALTHY POPULATION: A MULTICENTER STUDY

Background

Chronic joint diseases impair the quality of life. This occurs not only by the deformity generated, but also by the pain and disability produced by them (1, 2). There are a limited number of studies on joint diseases and sexuality (3, 4). Besides, many lack a control group and do not explore the different areas of sexuality(1-4).

Objectives

To describe the prevalence of sexual dysfunction (SD) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PA). To compare the results obtained between the two diseases and a healthy population. To analyse the factors associated with SD in the 3 populations.

Methods

Cross-sectional observation study. Patients diagnosed of PA (CASPAR criteria) and RA (EULAR/ACR 2010 criteria), followed in outpatient Rheumatology offices of two different university hospitals of the same geographical area, were consecutively included. The following variables were collected: (age, gender, year of diagnoses, perceived health, marital status, level of education, employment situation and the annual level of income), as well as (history of depression and active treatment of mental health disease). The results were compared against healthy individuals, acting as a control group. Only adult patients, of any sexual orientation, were included. The CSFQ-14 questionnaire, which evaluates changes in sexual function due to the disease or its medication, was applied. This questionnaire studies 4 different domains in both genders (pleasure, desire, arousal, orgasm and pain during orgasm) and in addition, it evaluates orgasm completion in women and erection in men. A regression model was created to estimate the influence of the collected variables on the obtained results.

Results

188 patients were included (52.7% women and 47.3% men); 72 of them were diagnosed of PA and 27 of RA. Moreover, 30.43% of the patients with PA, 48.15% of the patients with RA and 5.88% of the control group had scores on the CSFQ-14 test in the SD range.

SD was found related to being diagnosed of PA and RA (p < 0.001), age (p < 0.001), employment status (p < 0.001) and the annual level of income (p = 0.002). On the CSFQ-14 test, men had a mean score 7.5 points higher than women, although this score decreased to 6.15 points in men with PA. Furthermore, patients with PA and RA had a mean score 8.2 points lower than the control goup. All of the domains of the CSFQ-14 questionnaire were negatively affected by having PA or RA (p < 0.001). The estimated odds ratio of having SD was 8.7 times higher in patients diagnosed of PA and 10 times higher in patients diagnosed of RA.

Conclusion

Patients with RA or PA have a deteriorated sexual life when compared to a healthy population. This detriment affects all of the domains of the sexual sphere (pleasure, desire, arousal and orgasm). As shown in previous studies, age, gender, perceived health, employment situation and economic status, are related to the risk of suffering from SD. Therefore, these factors must be considered when attending this area of our patient’s health. The CSFQ-14 questionnaire provides a complete approach to sexual health and can be a tool for the management of chronic joint diseases.

References

[1]Hill J, Bird H, Thorpe R. Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatol Oxf Engl. 2003 Feb;42(2):280–6.

[2]van Berlo WTM, van de Wiel HBM, Taal E, Rasker JJ, Weijmar Schultz WCM, van Rijswijk MH. Sexual functioning of people with rheumatoid arthritis: a multicenter study. Clin Rheumatol. 2007 Jan;26(1):30–8.

[3]Kurizky PS, Mota LMH da. Sexual dysfunction in patients with psoriasis and psoriatic arthritis--a systematic review. Rev Bras Reumatol. 2012 Dec;52(6):943–8.

[4]Zhao S, Li E, Wang J, Luo L, Luo J, Zhao Z. Rheumatoid Arthritis and Risk of Sexual Dysfunction: A Systematic Review and Metaanalysis. J Rheumatol. 2018 Oct;45(10):1375–82.

Disclosure of Interests

None declared

HLA-B*08 Identified as the Most Prominently Associated Major Histocompatibility Complex Locus for Anti-Carbamylated Protein Antibody-Positive/Anti-Cyclic Citrullinated Peptide-Negative Rheumatoid Arthritis

OBJECTIVE

Previously, only the HLA-DRB1 alleles have been assessed in rheumatoid arthritis (RA). The aim of the present study was to identify the key major histocompatibility complex (MHC) susceptibility factors showing a significant association with anti-carbamylated protein antibody-positive (anti-CarP+) RA.

METHODS

Analyses were restricted to RA patients who were anti-cyclic citrullinated peptide antibody negative (anti-CCP-), because the anti-CCP status dominated the results otherwise. Therefore, we studied samples from 1,821 anti-CCP- RA patients and 6,821 population controls from Spain, Sweden, and the Netherlands. The genotypes for ~8,000 MHC biallelic variants were assessed by dense genotyping and imputation. Their association with the anti-CarP status in RA patients was tested with logistic regression and combined with inverse-variance meta-analysis. Significance of the associations was assessed according to a study-specific threshold of P < 2.0 × 10^-5 .

RESULTS

The HLA-B*08 allele and its correlated amino acid variant Asp-9 showed a significant association with anti-CarP+/anti-CCP- RA (P < 3.78 × 10^-7 ; I² = 0). This association was specific when assessed relative to 3 comparator groups: population controls, anti-CarP-/anti-CCP- RA patients, and anti-CCP- RA patients who were positive for other anti-citrullinated protein antibodies. Based on these findings, anti-CarP+/anti-CCP- RA patients could be separated from other antibody-defined subsets of RA patients in whom an association with the HLA-B*08 allele has been previously demonstrated. No other MHC variant remained associated with anti-CarP+/anti-CCP- RA after accounting for the presence of the HLA-B*08 allele. Specifically, the reported association of HLA-DRB1*03 was observed at a level comparable to that reported previously, but it was attributable to linkage disequilibrium.

CONCLUSION

These results identify HLA-B*08 carrying Asp-9 as the MHC locus showing the strongest association with anti-CarP+/anti-CCP- RA. This knowledge may help clarify the role of the HLA in susceptibility to specific subsets of RA, by shaping the spectrum of RA autoantibodies.

AB0807 VITAMIN D ROLE IN VASCULAR DAMAGE PROGRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Psoriatic arthritis (PsA) is associated with insufficent levels of vitamin D (25OHD) and an increased cardiovascular risk. Several studies, have shown an inverse relationship between 25OHD levels and cardiovascular damage.

Objectives:

To study the relationship between 25OHD and vascular damage, as well as its possible influence on its progression, in patients with PsA.

Methods:

Pre-post longitudinal study with analytical components. PsA patients with peripheral joint involvement were included. Demographic (sex, age), clinical [follow-up time, DAPSA, current treatment, body mass index (BMI), classic vascular risk factors, vascular events] and analytical variables [atherogenic index, glomerular filtration (GF-MDRD), glycosylated hemoglobin (HbA1c), CRP, ESR, 25OHD] were collected. We considered deficient level of 25OHD <20 ng/ml and insufficient <30 ng/ml. Basal vascular risk was estimated through SCORE tool. Extracranial carotid artery was explored with an Esaote MyLab70XVG ultrasound with linear probe (7-12mHz) and an automated program that measures intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques was evaluated following Mannheim consensus. Pulse wave velocity (PWV) was measured through Mobil o graph® dispositive. IMT≥900 µ and PWV≥ 10m/s were considered as pathological values. We repeat vascular study 3 years later. Vascular damage progression was defined as the appearance of atheroma plaques during the follow-up and/or an increase in their number. Statistical analysis was performed using SPSS 22.0 program.

Results:

78 patients were included. Eighteen patients were excluded due to high vascular risk [previous event, diabetes type II or type I with target organ injury and/or GF-MDRD< 60 ml/min]. 57.5% were women with a mean age of 54.2 (SD 10.9) years. The mean follow-up time was 96.8 (SD 163.6) months and mean DAPSA was 10.2 (SD 8.3). 96.2% of patients had received DMARDs and 42.3% biologicals, and 42.3% took calcium and 25OHD supplements. Mean BMI was 27.5 (SD 4.7) kg/m2. 42.3% had tobacco exposure, 29.5% were hypertensive and 32% dyslipidemic. Mean SCORE was 1.6 (SD 1.8) and mean 25OHD was 27.6 (DSD 11.6) ng/ml. 28.2% patients had 25OHD deficit and 60.3 % insufficiency. At the beginning, 32.1 % of patients had atheromatous plaques with a number of plaques around 1.7 (SD 1.2), and 6.7% and 19.7% had a pathological IMT or PWV, respectively. Baseline, we had not observed any association between 25OHD and the presence of atheroma plaques, IMT or PWV. Three years later, we detected progression of vascular damage in 31.2% patients. In these patients, the existence of hypovitaminosis D was associate with the appearance of atheroma plaques (p=0.043). This association desappeared in the multivariate analysis, in which only the CRP influenced the appearance of atherome plaques (OR: 1.4, IC 95% 1.04-1.98, p=0.025).

Conclusion:

Low 25OHD levels are not related to vascular damage or influence a posible progression of it in our serie. As might be expected, the progression of vascular damage depends on the inflammatory load in these patients.

Disclosure of Interests:

L Montolio-Chiva: None declared, M Robustillo-Villarino: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis