Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society

INTRODUCTION

Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking.

OBJECTIVE

To establish recommendations for CTD-ILD screening based on the current evidence.

METHOD

Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD.

RESULTS

The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous.

CONCLUSIONS

Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.

POS0901 INTERSTITIAL LUNG DISEASE IN MIXED CONNECTIVE TISSUE DISEASE: CLINICAL AND SEROLOGICAL ASSOCIATIONS

Background

Mixed connective tissue disease (MCTD) is a rare systemic rheumatic disease characterized by the expression of autoantibodies targeting the U1-ribonucleoprotein and overlapping clinical features of systemic sclerosis, systemic lupus erythematosus, and inflammatory myopathies. Interstitial lung disease (ILD) is present in 47% to 78% of patients and has been associated with higher mortality rates. Associations of ILD with Raynaud’s phenomenon, dysphagia, anti-Ro52 antibodies, and a scleroderma pattern on nailfold capillaroscopy have been reported in MCTD patients.

Objectives

This study aims to identify clinical and serological associations and independent predictors of ILD for patients with MCTD.

Methods

Multicenter retrospective study using data collected from clinical records. Adult patients who underwent lung computed tomography (CT) and met at least one of four MCTD diagnostic criteria (Sharp, Alarcón-Segovia, Kasukawa, or Kahn criteria) were included. Univariate analysis was performed using Chi-Square, Fischer’s Exact, and Mann-Whitney tests, as appropriate. Multivariate analysis was performed using binary logistic regression modelling. The linearity of the continuous variables concerning the logit of the dependent variable was assessed via the Box-Tidwell procedure. Cases with missing information and outliers were excluded from the multivariate analysis to fulfil all assumptions necessary to assure the validity of the regression.

Results

Fifty-seven patients, of whom 37 were Caucasian (64.9%) and 48 were females (84.2%), with a mean age of 39.4±14.0 years, were included. Twenty-seven patients had ILD (47.4%), of whom 22 had nonspecific interstitial pneumonia (81.5%), 4 had usual interstitial pneumonia (14.8%), and 1 had lymphoid interstitial pneumonia (3.7%) pattern on CT. Among patients with ILD, 13 were asymptomatic (48.1%), while 14 had respiratory symptoms (51.9%), including dyspnea (N=13, 48.1%), cough (N=7, 25.9%), and pleuritic chest pain (N=1, 3.7%). Pulmonary function tests were performed in 22 patients (81.5%), 20 of whom had a restrictive pattern (90.9%).

In the univariate analysis, lymphadenopathy at disease onset (22.2% vs 3.3%, p=0.045) and esophageal involvement at any time point (40.7% vs 16.7%, p=0.043), were associated with ILD.

The binary logistic regression model predicting ILD included 56 patients, and the model explained 36.5% (Nagelkerke R2) of the variance in ILD and correctly classified 75% of all cases. Older age at diagnosis (OR 1.10/year, 95%CI: 1.00-1.12, p=0.046) and lymphadenopathy at disease onset (OR 19.65, 95%CI: 1.91-201.75, p=0.012) were identified as predictors of ILD in MCTD patients, irrespective of sex and esophageal involvement.

Conclusion

Older age at diagnosis and lymphadenopathy at disease onset were independent predictors of ILD in MCTD. Therefore, these factors should be considered when evaluating MCTD patients, especially at the time of diagnosis. To the best of our knowledge, this is the largest study ever describing predictors of ILD for MCTD patients.

References

[1]Fagundes MN, Caleiro MT, Navarro-Rodriguez T, Baldi BG, Kavakama J, Salge JM, Kairalla R, Carvalho CR. Esophageal involvement and interstitial lung disease in mixed connective tissue disease. Respir Med. 2009 Jun;103(6):854-60. doi: 10.1016/j.rmed.2008.12.018. Epub 2009 Feb 6. PMID: 19201182.

[2]Gunnarsson R, Aaløkken TM, Molberg Ø, Lund MB, Mynarek GK, Lexberg AS, Time K, Dhainaut AS, Bertelsen LT, Palm O, Irgens K, Becker-Merok A, Nordeide JL, Johnsen V, Pedersen S, Prøven A, Garabet LS, Gran JT. Prevalence and severity of interstitial lung disease in mixed connective tissue disease: a nationwide, cross-sectional study. Ann Rheum Dis. 2012 Dec;71(12):1966-72. doi: 10.1136/annrheumdis-2011-201253. Epub 2012 May 1. PMID: 22550317

Disclosure of Interests

None declared

AB0501 COMPREHENSIVE ASSESSMENT OF PATIENTS WITH SUSPECTED SJÖGREN’S SYNDROME: 5-YEAR RESULTS OF A MULTIDISCIPLINARY SJÖGREN’S SYNDROME CLINIC

Background

Primary Sjögren’s syndrome (pSS) is a systemic rheumatic disease that affects several organ systems, most frequently the ocular, oral and musculoskeletal domains. Multidisciplinary care is thus crucial in the optimal management of SS patients.

Objectives

To report the clinical impact of a Multidisciplinary SS Clinic (MSSC) over a 5-year period.

Methods

We prospectively included patients assessed in the MSSC from September 2015 to October 2020. All patients had a full clinical evaluation, including disease-related questionnaires, specialized oral/ocular assessment, salivary gland biopsy (SGB) and ultrasound (SGUS), tear and salivary flow and ocular staining scores. We compared the results of patient-reported outcomes, comprehensive clinical assessments and specialized complementary exams in patients with pSS and other diagnoses.

Results

445 patients (96% women, mean age 57±14 years) with sicca symptoms underwent complete multidisciplinary evaluation. Patients were most frequently referred from Rheumatology (91%), but also from Stomatology (5%), Ophthalmology (2%), Internal Medicine (1%) and other medical specialties (1%). Most patients were diagnosed with pSS (n=221; 50%), followed by non-Sjögren sicca syndrome (nSSS, n=134; 30%), secondary SS (sSS, n=60; 13%) and undifferentiated connective tissue disease (n=30; 7%). Positive sicca tests were present in 217/385 patients (56%): unstimulated whole salivary flow (UWSF) ≤0.1ml/min in 84/317 (27%); Schirmer’s test ≤5mm/5min in 163/354 (46%); van Bijsterveld score ≥4 in 42/349 (12%); Ocular Staining Score (OSS) ≥5 in 36/343 (11%). Subjective complaints assessed by the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), the EULAR Sicca Score (ESS), the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI), the Xerostomia Inventory (XI), and the Ocular Surface Disease Index (OSDI) did not differ between patients with pSS and other diagnoses. However, objective dryness measures such as UWSF (31vs20%, p=0.028), Schirmer’s test (51vs40%, p=0.040) and OSS (14vs7%, p=0.048) were significantly associated with pSS. A positive SGB (focus score≥1) was seen in 48% of patients with a clinical diagnosis of pSS (p<0.001 vs. other diagnoses), with a mean focus score of 1.1±1.6. Instead, 94% of patients with nSSS had grade 0-1 biopsies. Mean SGUS scores (p=0.006) and the frequency of moderate/severe changes (p<0.001) were higher in pSS patients.

Conclusion

Multidisciplinary evaluation was crucial in the assessment of patients with similar sicca complaints and in the management of ocular/oral/systemic involvement. Objective measurements and specialized complementary exams greatly contribute to establishing or confirming the diagnosis of pSS.

Disclosure of Interests

None declared

AB0655 Clinical and immunological features of a Portuguese cohort of Mixed Connective Tissue Disease

Background

Various nationwide studies have been already published to better understand Mixed Connective Tissue Disease (MCTD) (1,2). However, Portuguese data is not available.

Objectives

To characterize clinical and immunological features of a Portuguese cohort of patients with MCTD.

Methods

Retrospective, multicenter study including adult-onset patients with clinical diagnosis of MCTD and fulfilling at least one of the following classification criteria: Sharp, Kasukawa, Alarcón-Segovia or the Kahn’s criteria. Positivity to other autoantibodies besides anti-U1-RNP were allowed. SPSS was used for statistical analysis and significance level was defined as 2-sided p<.05.

Results

A total of 98 patients were included, with a mean age at diagnosis and disease duration of 40.5±13.7 and 7.0±6.5 years, respectively. Most patients were female (87.8%) and Caucasian (70.4%). Raynaud’s phenomenon (96.9%), arthralgia/arthritis (94.9/74.5%) and puffy fingers (60.2%) were the most common and early manifestations. Gastroesophageal (GE), respiratory and muscular involvement were also prevalent, mostly during the follow up, affecting 30.6%, 34.7% and 43.9% of the patients, respectively. Clinical and immunological characteristics are described in Table 1. Males were older at symptom’s onset (65.0 VS 46.7, p=.035), having more respiratory involvement (OR=4.5, 95% CI 1.3-16.4), and positivity to anti-ACPA (OR=20.0, 95% CI: 3.1-129.4). GE involvement occurred more often in Caucasian patients (OR=3.8; 95% CI: 1.0-14.1), while anemia of chronic diseases (OR=2.7; 95% CI: 1.0-7.2), myositis (OR=3.6; 95% CI: 1.3-9.9) and constitutional symptoms (OR=3.2; 95% CI: 1.2-8.3) were more frequent in Afro-American patients, whose were also younger at disease (34.1 VS 50.6, p=.01). After a median follow-up time of 4 (IQR 8) years, 4 deaths occurred (4.1%), mostly (75%) due to infectious complications.

Table 1.

Clinical and immunological characteristics

Clinical ManifestationsAt presentationFollow-upMucocutaneous systemRaynaud’s phenomenon, n (%)85 (86.7)95 (96.9)Puffy hands, n (%)48 (49.0)59 (60.2)SSc-like, n (%)43 (44.8)59 (60.8)SLE-like, n (%)28 (28.9)35 (35.7)Musculoskeletal systemArthralgia/Arthritis, n (%)/n (%)81 (82.7) / 56 (57.1)93 (94.9) / 73 (74.5)Myositis, n (%)26 (25.6)43 (43.9)Hematological system, n (%)46 (46.9)70 (71.4)Respiratory system, n (%)14 (14.3)34 (34.7)Cardiovascular system3 (3.1)4 (4.1)Pulmonary hypertension*2 (2.0)15 (15.3)Gastroesophageal involvement, n (%)11 (11.2)30 (30.6)Renal involvement, n (%)2 (2.0)10 (10.2)Neurological involvement, n (%)6 (6.3)14 (14.3)Constitutional symptoms, n (%)26 (26.5)30 (30.6)Immunological characteristicsAnti-dsDNA, n (%)21 (21.4)Anti-smith antibody, n (%)21 (21.4)Anti-Ro/SSA, n (%)31 (31.6)Anti-La/SSB, n (%)7 (7.1)Anti-centromere, n (%)3 (4.1)Rheumatoid Factor, n (%)39 (39.8)Anti- anti-citrullinated protein antibodies, n (%)6 (6.1)Antiphospholipid antibodies, n (%)7 (7.1)Myositis antibodies, n (%)9 (9.2)Complement activation, n (%)27 (27.6)Hypergammaglobulinemia, n (%)51 (52.0)

Legend: Anti-dsDNA: anti-double stranded deoxyribonucleic acid antibody; SLE: systemic lupus erythematosus, SSc: systemic sclerosis. *No information regarding cardiac catheterism, then compatible alterations in the echocardiogram.

Conclusion

Raynaud’s phenomenon, puffy fingers and arthritis were the most common manifestations in Portuguese patients, with similar proportions found in literature (1,2). However, we reported some differences in mucocutaneous, renal and serosa involvement and higher prevalence of probable pulmonary hypertension (1,2), which may be explained by the heterogeneity of the inclusion criteria. Except for respiratory, myositis, GE and constitutional symptoms, there were no differences regarding gender and ethnicity.

Here, we characterize the largest cohort of MCTD in Portugal.

References

[1]Cappelli S, et al. Semin Arthritis Rheum. 2012 Feb;41(4):589–98.

[2]Alves MR et al. Clin Exp Med. 2020 May;20(2):159–66.

Disclosure of Interests

None declared

POS0273 THE ROLE OF FACIAL, OCCIPITAL, SUBCLAVIAN AND CAROTID ARTERIES ULTRASOUND IN THE DIAGNOSTIC ASSESSMENT OF GIANT CELL ARTERITIS

Background

Giant cell arteritis (GCA) is the most common form of primary systemic vasculitis in patients aged >50 years. It predominantly affects the cranial arteries; however, extra-cranial disease involving the aorta and its major branches can also be present. Currently, ultrasound of the temporal (TA) and axillary (AX) arteries is the first imaging modality recommended in patients with suspected predominantly cranial GCA. Nevertheless, other arteries such as facial (FA), occipital (OC), subclavian (SC), and common carotid (CC) arteries can also show vasculitic changes on ultrasound. However, there are still conflicting data to support the inclusion of these arteries in the routine ultrasound assessment of patients with suspected GCA.

Objectives

To assess the value of adding the evaluation of the FAs, OCs, SCs and CCs in the ultrasonographic diagnosis of patients with GCA.

Methods

Single-center observational retrospective study, using data from patients diagnosed with GCA registered at the Rheumatic Diseases Portuguese Registry (Reuma.pt). All patients underwent ultrasound of the TAs and AXs ± FAs, OCs, SCs or CCs at the time of diagnosis. The halo sign was considered a positive ultrasonographic finding for GCA. Only patients with the presence of halo sign in at least one of the arterial segments evaluated were included. Binary logistic regression modelling was performed to explore associations between the presence of halo sign in different arterial segments.

Results

We included 84 patients, 57 (67.9%) females, with a mean ± standard deviation age at diagnosis of 75.6 ± 8.8 years. Halo sign was found in the TAs of 66/84 (78.6%) patients, AXs of 40/84 (47.6%) patients, FAs of 37/74 (50.0%) patients, OCs of 15/61 (24.6%) patients, SCs of 30/49 (61.2%) patients and CCs of 13/60 (21.7%) patients. Of the 18/84 patients with GCA without the presence of TA halo, 17/18 (94.4%) showed halo in the AXs, 1/18 (5.6%) in the FAs, 3/18 (16.7%) in the OCs, 15/17 (88.2%) in the SCs and 6/16 (37.5%) in the CCs. Of the 44/84 patients with GCA without the presence of AX halo, 43/44 (97.7%) showed halo in the TAs, 24/39 (61.5%) in the FAs, 12/32 (37.5%) in the OCs, 4/18 (22.2%) in the SCs and 3/33 (9.1%) in the CCs. A total of 83/84 (98.8%) patients had halo sign on the ultrasound of either the TA or AX arteries. The patient with normal TA and AX ultrasound had the presence of halo sign in the SCs. Table 1 shows the proportion of patients with positive TA and AX ultrasounds according to the presence of halo in the FA, OC, SC or CC arteries. Patients with involvement of the cranial arteries were more likely to have a TA halo (FA: OR 30.6, 95%CI 3.8-247.3; OC: OR not applicable) and less likely to have an AX halo (FA: OR 0.37, 95%CI 0.14-0.95; OC: OR 0.19, 95%CI 0.05-0.77). As opposed to patients with involvement of the extra-cranial arteries in whom the halo sign was more frequently found in the AXs (SC: OR 18.2, 95%CI 4.2-78.9; CC: OR 5.9, 95%CI 1.4-24.4) but not in the TAs (SC: OR 0.12, 95%CI 0.02-0.60; CC: OR 0.32, 95%CI 0.09-1.15).

Table 1.

Differences in the presence of halo sign in the temporal and axillary arteries according to the arterial segment affected.

Arterial segment with haloTemporal arteries with haloAxillary arteries with haloFacial arteries (n=37)36/37 (97.3%)13/37 (35.1%)Occipital arteries (n=15)15/15 (100.0%)3/15 (20.0%)Subclavian arteries (n=30)15/30 (50.0%)26/30 (86.7%)Common carotid arteries (n=13)7/13 (53.8%)10/13 (76.9%)

Conclusion

Our results support the need to assess both TAs and AXs in patients with suspected GCA, resulting in a diagnostic sensitivity of 99%. Only by adding the evaluation of the SCs to the already recommended TAs and AXs increased the diagnostic sensitivity of ultrasound to 100%. All patients with a positive FA, OC or CC ultrasound for GCA also showed a halo sign in either the TAs or AXs. Hence, the additional assessment of these arteries did not improve the diagnostic yield of ultrasound and, therefore, should not be recommended in routine practice.

Disclosure of Interests

None declared

POS0815 DIFFERENCES IN GIANT CELL ARTERITIS MANIFESTATIONS ACCORDING TO THE ULTRASOUND PATTERN OF DISEASE INVOLVEMENT

Background

Giant cell arteritis (GCA) is the most common form of primary systemic vasculitis in patients aged >50 years. It predominantly affects the cranial arteries; however, extra-cranial disease involving the aorta and its major branches, known as large-vessel GCA (LV-GCA), can be present in 20-80% of cases, depending on the imaging modality used for screening the disease.

Objectives

We aim to compare the clinical features and outcomes of GCA patients with exclusive cranial, exclusive LV and combined cranial and LV involvement.

Methods

Single centre retrospective study, using data from patients diagnosed with GCA registered at the Rheumatic Diseases Portuguese Registry (Reuma.pt). All patients underwent ultrasound of both temporal (TA) and axillary (AX) arteries ± facial (FA), occipital (OC), subclavian (SC) or common carotid (CC) arteries at the time of diagnosis. Only patients with the presence of “halo sign” in at least one of these arterial segments were included. Three groups of patients were established according to their ultrasound results: i) exclusive cranial-GCA in cases of TA, FA, or OC involvement; ii) exclusive LV-GCA in cases of AX, SC, or CC involvement; and iii) cranial- and LV-GCA in cases of both cranial and LV involvement. Univariate analysis was performed using T-test, Chi-square and ANOVA, as appropriate. Multivariate analysis was performed using logistic regression modelling.

Results

We included 81 patients with GCA, 55 (67.9%) females, with a mean ± SD age of 75.8 ± 8.6 years. Halo sign was found in the TAs of 66/81 (81.5%) patients, AXs of 38/81 (46.9%) patients, FAs of 37/71 (52.1%) patients, OCs of 15/58 (25.9%) patients, SCs of 27/46 (58.7%) patients and CCs of 12/57 (21.1%) patients. A total of 37 (45.7%) cases had exclusive cranial-GCA, 14 (17.3%) had exclusive LV-GCA and 30 (37.0%) had cranial- and LV-GCA. Regarding clinical manifestations, temporal headache was more frequently found in cases of exclusive cranial-GCA than in the other groups (67.6% vs 7.1% vs 56.7%, p=0.001). By contrast, patients with exclusive LV-GCA were less likely to experience temporal and frontal headache (67.6% vs 7.1% vs 56.7%, p=0.001; 48.6% vs 0% vs 40.0%, p=0.007; respectively), jaw claudication (67.6% vs 14.3% vs 60.0%, p=0.004), scalp tenderness (32.4% vs 0% vs 23.3% p=0.037) or a cranial ischemic event (54.1% vs 21.4% vs 66.7%, p=0.020). Concerning physical examination, exclusive LV-GCA was associated with abnormalities of the upper limb arteries (0% vs 15.4% vs 3.3%, p=0.042) and lack of TA changes (37.8% vs 0% vs 30.0%, p= 0.023). No significant differences were found between groups regarding demographics, comorbidities and occurrence of relapses or mortality in the first two years of disease (p>0.05). Multivariate analysis, adjusted for jaw claudication, scalp tenderness, frontal and temporal headache, cranial ischemic events, abnormalities of the TA and upper limb arteries on examination, was performed to assess the association between these variables and the three GCA groups. The occurrence of a cranial ischemic event was independently associated with a lower probability of exclusive LV-GCA [OR: 0.069 95%CI: 0.009-0.526, p=0.010]. No other independent predictors were found.

Conclusion

GCA can encompass various patterns of vascular disease on ultrasound. LV involvement was frequently found in these patients, including in cases without evidence of cranial disease, highlighting the need to incorporate LV assessment in the diagnosis of GCA. Patients with exclusive LV-GCA had fewer cranial manifestations and more abnormalities on upper limb arteries on examination than the other groups. The occurrence of a cranial ischemic event was an independent negative predictor for exclusive LV-GCA. No differences were found between groups regarding the clinical outcomes at two years. Further studies with longer time of follow-up are needed.

References

[1]Ponte C, Martins-Martinho J, Luqmani RA. Diagnosis of giant cell arteritis. Rheumatology (Oxford). 2020 May;59(Suppl 3):iii5-iii16. doi: 10.1093/rheumatology/kez553.

Disclosure of Interests

None declared

AB0688 Predictors of muscle involvement in Portuguese patients with mixed connective tissue disease

Background

Mixed connective tissue disease (MCTD) is a rare heterogeneous disease, characterized by overlapping features of classic connective tissue diseases. Myositis may be present in up to two-thirds of patients with MCTD and it is included in all diagnostic criteria available. Although some possible associations have been reported, to the best of our knowledge, no independent predictors of MCTD-related myositis have been described.

Objectives

To identify clinical and laboratorial predictors for muscular involvement in a cohort of Portuguese patients with MCTD.

Methods

Multicentre retrospective cohort study including adult-onset patients with a clinical diagnosis of MCTD and fulfilling at least one of the following diagnostic criteria: Sharp, Kasukawa, Alarcón-Segovia or Kahn criteria. Myositis was defined as proximal muscle weakness, creatine kinase elevation, electromyography (EMG) suggestive changes or a positive muscular biopsy. Univariate analysis was performed using Chi-Square, Fischer’s Exact Test and Mann-Whitney Test, as appropriate. Multivariate analysis was performed using binary logistic regression modelling. The linearity of the continuous variables concerning the logit of the dependent variable was assessed via the Box-Tidwell procedure. Cases with missing information and outliers were excluded from the multivariate analysis to fulfil all assumptions necessary to assure the validity of the regression.

Results

A total of 98 patients were included, 43 (44.3%) of whom had muscular involvement at any time of the disease course. Concerning patients with MCTD-related myositis, the mean age at diagnosis was 34.8±12.5 years and the mean disease duration of 4.1±4.9 years. The majority of patients were female (90.7%) and of European ancestry (66.7%).

EMG was performed in 24 patients, of whom 10 (41.7%) had a myopathic pattern. Seventeen patients were submitted to a muscular biopsy, of whom 8 (47.1%) had histological myositis features. Capillaroscopy was performed in 24 patients and 12 (50%) had a scleroderma pattern.

African ancestry and leukopenia were positively associated with myositis at disease onset. Furthermore, fever at the onset of disease, younger age at diagnosis and shorter disease duration were positively associated with the occurrence of myositis at any phase of the disease.

The multivariate analyses predicting myositis at diagnosis included 54 patients and at any time of the disease included 90 patients. These models explained 37.8% and 26.9% (Nagelkerke R2) of the variance in myositis and correctly classified 79.6% and 73.3% of all cases, respectively.

African ancestry (OR 8.39, 95%CI: 1.43-49.37, p=0.019), leukopenia (OR 6.24, 95%CI: 1.32-29.48, p=0.021) and younger age at diagnosis (OR 1.07/year, 95%CI: 1.01-1.14, p=0.035) were identified as independent predictors of myositis at diagnosis. Fever (OR 6.51, 95%CI: 1.23-34.37, p=0.027) was an independent predictor of muscular involvement at any time of the disease in MCDT patients.

Conclusion

African ancestry, leukopenia and younger age at diagnosis are independent predictors of myositis at presentation in MCTD patients, while fever is an independent predictor of myositis at any time of the disease. While evaluating patients with MCTD, these predictive factors should be considered.

References

[1]Ciang NCO, Pereira N, Isenberg DA. Mixed connective tissue disease-enigma variations? Rheumatol. 2017 Mar 1;56(3):326–33.

[2]Hall S, Hanrahan P. Muscle involvement in mixed connective tissue disease. Rheum Dis Clin North Am. 2005 Aug;31(3):509–17, vii.

Disclosure of Interests

None declared

OP0055 ULTRASOUND HALO SIGN AS A POTENTIAL MONITORING TOOL FOR PATIENTS WITH GIANT CELL ARTERITIS: A PROSPECTIVE ANALYSIS

Background:

Ultrasound of the temporal ± axillary arteries showing a non-compressible halo sign is recommended for diagnosing patients with giant cell arteritis (GCA); however, its value for monitoring disease activity is still poorly understood.

Objectives:

To assess the sensitivity to change of ultrasound halo features and their association with disease activity and glucocorticoid (GC) treatment in patients with newly diagnosed GCA.

Methods:

Two centre prospective study of new patients with ultrasound confirmed-GCA who underwent serial ultrasound assessments of the temporal (TA) and axillary (AX) arteries at fixed time-points. The number of arterial segments with halo and the maximum halo intima-media thickness (IMT) per segment was recorded at each visit. Only time-points in which >80% of patients were assessed were considered for analysis. Sensitivity to change of the halo sign was calculated as standardised mean difference (SMD) for each time-point separately. Correlation between ultrasound findings and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Birmingham Vasculitis Activity Score (BVAS), and GC treatment was performed using Spearman’s correlation coefficient. Logistic regression was used to determine the probability of being in remission for each unit increase (standardised) of the halo feature of interest. Remission was defined as the absence of relapse with a prednisolone dose <30 mg/day, and relapse as the recurrence of GCA-related symptoms or rise of CRP/ESR values not otherwise explained and requiring GC increase. Halo features at disease onset and first relapse were compared using Wilcoxon test.

Results:

A total of 49 patients (73.5% females) with a mean age of 78.2 ± 7.4 years at baseline were assessed at 354 visits. TA involvement was reported in 47 (95.9%) patients and AX involvement in 11 (22.4%); 220 arterial segments with halo were recorded (201 TA, 19 AX). Halo sensitivity to change was calculated for weeks 1, 3, 6, 12 and 24, and showed a significant SMD between all time-points and baseline for the TA halo features, but only after week 6 for the AX halo features (Table and Figure). The number of TA segments with halo, sum of TA halo IMT and maximum TA halo IMT showed a significant correlation with ESR (0.41; 0.44; 0.48), CRP (0.34; 0.39; 0.41), BVAS (0.29; 0.36; 0.35) and GC cumulative dose (-0.34; -0.37; -0.32). The likelihood of achieving disease remission was lower in patients with a higher number of TA segments with halo (OR 0.39, p<0.05) and increased values of sum and maximum TA halo IMT (OR 0.34, p<0.05). By contrast, AX halo features showed no correlation with disease activity, nor any association with attaining clinical remission. During the study period, 32 relapses were observed (mean time for first relapse of 31.8 weeks ± 18.5 days). Halo sign was present in 16/17 (94.1%) cases of first disease relapse, all showing an increased halo IMT (sum and maximum) in relation to the previous ultrasound assessment performed. When compared to disease onset, a lower mean number of segments with halo and mean sum of halo IMT was reported for patients presenting with their first clinical relapse (2.93 ± 1.59 vs. 4.85 ± 1.51, p=0.0012; 2.01 ± 1.13 vs. 4.49 ± 1.95 mm, p=0.0012).

Table 1.

SMD of halo features between baseline and different time-points

Week 1Week 3Week 6Week 12Week 24N of arterial segmentsSum of all segments with halo (n=49)-0.51-0.78-1.13-1.69-1.52Sum of TA segments with halo (n=47)-0.49-0.78-1.18-1.87-1.69Sum of AX segments with halo (n=11)-0.35--0.62-0.73-0.91Halo thickness (mm)Sum of all halo IMT (n=49)-0.98-1.44-1.37-1.60-1.48Sum of TA halo IMT (n=47)-1.01-1.55-1.54-1.81-1.69Sum of AX halo IMT (n=11)-0.15-0.45-0.81-0.84-0.98Max. TA halo IMT (n=47)-1.07-1.32-1.47-1.91-2.19Max. AX halo IMT (n=11)-0.04-0.29-0.94-1.13-1.01

In bold p<0.05; n=n at baseline

Conclusion:

Ultrasound is a reliable imaging tool to assess disease activity and response to treatment in patients with GCA. Future clinical trials in GCA should evaluate direct treatment effect on halo features as an outcome measure of interest.

Acknowledgements:

The first two authors contributed equally to this work

Disclosure of Interests:

None declared

AB0445 FIRST CLINICAL ANALYSIS OF MYOSITIS PATIENTS REGISTERED AT REUMA.PT/MYOSITIS PROTOCOL: DATA FROM A SINGLE-CENTER

Background:

Idiopathic inflammatory myopathies are a group of rare heterogeneous diseases that require a multidisciplinary and standardized approach.

Objectives:

To clinically characterize patients with inflammatory myopathies followed at an hospital’s Rheumatology Department, using the Rheumatic Diseases Portuguese Register (Reuma.pt).

Methods:

An observational transversal study was performed. Data on demographic variables, clinical features, antibodies and treatment were collected.

Results:

Of the 121 included patients, 78% were female, with a median age of 56 [44-68] years and a median disease duration of 2 [0-4] years. The most frequent diagnosis was dermatomyositis (DM; n=28, 23%) followed by antisynthetase syndrome (ASyS; n=21, 17.4%). At the time of the analysis, the median Manual Muscle Test (MMT-8) was 80 [78-80], the median modified skin Disease Activity Score was 0 [0-2] and global disease activity was 0.5 [0-0.75]. Calcinosis was found in 6% of the patients (n=7), mostly DM cases. Interstitial lung disease (ILD) was present in 29 patients (24%), of those, 52% (n=15) had antisynthetase syndrome (ASyS). Three patients presented as a paraneoplastic syndrome. Ninety-nine patients (82%) had a myositis autoantibody identified: antisynthetase autoantibodies were the most commonly identified (n=20, 16%). 62% of the patients were treated with steroids and 35% with ≥2 disease-modifying anti-rheumatic drugs.

Table 1 depicts the main clinical characteristics and the immunologic profile for each diagnosis

Conclusion:

In our cohort the most frequent myositis subtype was DM. Almost a quarter of patients had associated ILD, which is an important cause of morbidity and mortality. ILD was more frequent in ASyS patients and was most commonly related to anti-Jo1 antibodies, which is consistent with the literature.

Table 1.

Clinical characteristics and immunological profile of the patients.

Diagnosis (n)Clinical featuresMyositis antibodies (n)Skin disease, median [IQR]/ (n)MMT-8, median [IQR]Lung disease (n)Others (n)Malignancy (n)Definite DM (28)DAS Skin 2 [0-2]Calcinosis (3)Mechanic hands (2)80 [75-80]NSIP (2);COP (1)Arthritis (6)Breast cancer (1)anti-Ro52 (6); anti-Mi2b (5); anti-PmScl100 (4); anti-MI2a (3); anti-NXP2 (3); anti-SAE (2); anti-MDA5 (2); anti-Ku (2); anti-Tif1g (1)Antisynthetase syndrome (21)DAS Skin 0 [0-0]Calcinosis (1)Mechanic hands (4)80 [80-80]NSIP (11);UIP (3);LIP (1)Arthritis (15);RP (10)–anti-Jo1 (14); anti-Ro52 (12); anti-Mi2b (1); anti-PL7 (3); anti-PL12 (1)Probable DM (19)DAS Skin 0 [0-0]80 [78-80]COP (1)Arthritis (5);RP (6)–anti-Mi2a (4); anti-Mi2b (2); anti-Tif1g (2); anti-Ku (2); anti-PmScl75 (2)CADM (16)DAS Skin 1 [0-2]Calcinosis (1)Mechanic hands (1)80 [77-80]NSIP (1); COP (1)Arthritis (5);RP (4)–anti-Mi2b (5); anti-Ro52 (2); anti-Mi2a (1); anti-MDA5 (1); anti-EJ (1); anti-SAE (1); anti-SRP (1); anti-Ku (1); anti-Tif1g (1)MCTD (12)DAS Skin 0 [0-1]80 [79-80]NSIP (1)Arthritis (8);RP (10)–anti-U1 RNP (12); anti-Ro52 (7)PM (7)DAS Skin 0 [0-0]Calcinosis (1)80 [72-80]NSIP (1)Arthritis (1)Ovarian cancer (1); non-Hodgkin lymphoma (1)anti-Ro52 (2); anti-SRP (1)UCTD (5)DAS Skin 0 [0-2]Calcinosis (1)Mechanic hands (1)80 [79-80]NSIP (2)Arthritis (1);RP (5)–anti-ThTo (2); anti-SRP (1); anti-PL12 (1)Overlap syndromes (12)DAS Skin 0 [0-2]Mechanic hands (2)80 [77-80]NSIP (3);UIP (1)Arthritis (4);RP (8)–anti-PmScl75 (4); anti-PmScl100 (1); anti-Ro52 (1); anti-Ro60 (1); anti-RNAPIII (1); anti-NOR90 (1); anti-MDA5 (1); anti-Ku (1)Necrotizing myopathy (1)DAS Skin 080––––

DM – dermatomyositis; CADM – clinically amyopathic dermatomyositis; MCTD – mixed connective tissue disease; PM – polymyositis; UCTD – undifferentiated connective tissue disease; ILD – interstitial lung disease; NSIP – nonspecific interstitial pneumonia; LIP – lymphocytic interstitial pneumonitis; UIP – usual interstitial pneumonia; COP – cryptogenic organizing pneumonia; RP – Raynaud phenomenon

Disclosure of Interests:

None declared.

POS0870 CLINICAL CHARACTERIZATION OF PORTUGUESE PATIENTS WITH ANTISYNTHETASE SYNDROME

Background:

Antisynthetase syndrome (ASyS) may have different clinical phenotypes and outcomes associated with different anti-aminoacyl RNA-synthetase (anti-ARS) antibodies. Its wide clinical spectrum can include inflammatory myopathy, interstitial lung disease (ILD), arthritis, fever, mechanic’s hands, and Raynaud phenomenon (RP).

Objectives:

To describe a nationwide, multicentre cohort of Portuguese patients with ASyS.

Methods:

Retrospective analysis of patients with ASyS from nine Portuguese Rheumatology centers. Data on patients’ signs and symptoms, laboratory results, pulmonary radiological findings (computed tomography) and treatment (immunomodulators) were collected.

Results:

Among the 70 patients included, 42 patients (60%) were anti-Jo1–positive, 11 (15.7%) were anti-PL12–positive, 10 (14.3%) were anti-PL7–positive, 4 (5.7%) were anti-EJ–positive and 2 (2.9%) were anti-OJ positive. In one patient it was not possible to identify the type of antibody. Antibody overlap was found in 15 patients (21.4%), who were positive for anti-Ro52 antibodies. The general clinical characteristics are shown in Table 1. The diagnostic delay was greater in patients positive for anti-OJ, followed by anti-Jo-1 and anti-PL12. The follow-up was shorter for anti-PL7 and anti-OJ-positive patients. Anti-PL7-positive patients had lower rates of arthritis when compared to anti-Jo1 (p< 0.01). When compared with anti-Jo-1 ARS, myositis was less common in anti-PL12 (p < 0.01). ILD prevalence was similar in the different ARS subgroups. Glucocorticoids (GCs) were the most frequently used class of drugs. A more conservative treatment plan (e.g. GCs plus methotrexate or azathioprine) was the treatment of choice in ASyS with myositis and/or arthritis involvement. Rituximab or mycophenolate mofetil were preferred when lung involvement occurred. Only two deaths were reported, being one associated with lung neoplasia.

Conclusion:

This is the first study investigating the clinical phenotypes of Portuguese patients with ASyS. These results are generally concordant with data retrieved from international cohorts.

References:

[1]Mahler M, Miller FW, Fritzler MJ. Idiopathic inflammatory myopathies and the anti-synthetase syndrome: a comprehensive review. Autoimmun Rev 2014;13:367–71.

Table 1.

Patient characteristics according to the anti-ARS. ILD - interstitial lung disease; IQR- interquartile range; NSIP - Non-specific interstitial pneumonia; UIP - Usual interstitial pneumonia; yrs - years

VariablesOverall, n=70Jo-1, n=42(60%)PL-12, n=11 (15.7%)PL-7, n=10 (14.3%)EJ, n=4 (5.7%)OJ, n=2 (2.9%)Mean age at onset, yrs52 ± 1546.6 ± 14.455.2 ± 14.756.5±12.556.3±11.273.5±2.1Female, n (%)49 (70)29 (69)9 (81.8)7 (70)2 (50)2 (100)Median age in years at disease onset (IQR)52 (15-75)48 (15-70)59 (20-70)62 (39-73)60 (40-65)73.5 (72-75)Median follow-up time in yrs (IQR)3 (0-32)5 (0-32)3 (0-13)1 (1-4)4 (2-21)1 (0-2)Median diagnostic delay in yrs (IQR)6 (1-33)7 (1-33)7 (2-19)4 (1-23)1.5 (1-2)12.5 (2-21)Myositis, n (%) and Comparison Anti-Jo.1 ARS vs PL-12 and PL-736 (51.4)25 (59.5)3 (27.3)*p < 0.014 (40)p=0.73 (75)-0-ILD, n (%) and Comparison Anti-Jo.1 ARS vs PL-12 and PL-753 (75.7)33 (78.6)8 (72.7)p = 0.986 (60) p=0.564 (100)-1 (50)- ILD pattern - NSIP, n (%)30 (56.6)18 (54.5)6 (75)3 (50)1 (25)0 ILD pattern - UIP, n (%)6 (11.3)3 (9.1)1 (12.5)1 (16.7)1 (25)0 ILD pattern - other specific pattern, n (%)6 (11.3)4 (12.1)02 (33.3)1 (25)0 ILD pattern - non-specific pattern, n (%)11 (15.7)8 (24.2)1 (12.5)01 (25)1 (100)Mechanic’s hands (%), n (%)23 (32.9)14 (33.3)3 (27.3)2 (20)01 (50)General impairment, n (%)18 (25.7)11 (26.2)3 (27.3)2 (20)2 (50)0Fever, n (%)7 (10)4 (9.5)2 (20.2)01 (25)0Raynaud phenomenon, n (%)22 (31.4)11 (26.2)7 (63.6)02 (50)0Arthritis, n (%) and Comparison Anti-Jo.1 ARS vs PL-12 and PL-743 (61.4)29 (69)5 (45.4)p=0.072 (20)*p < 0.012 (50)-1 (50)-Malignancy, n (%)4 (5.7)3 (7.1)1 (9.1)000Deaths, n (%)2 (2.9)2 (2.4)0001 (50)

Disclosure of Interests:

None declared

POS0055 SARS-COV-2 OUTBREAK IN AUTOIMMUNE DISEASES: THE EURO-COVIMID STUDY

Background:

Coronavirus disease 2019 (COVID-19), has raised several questions in patients with immune-mediated inflammatory diseases (IMID). Whether the seroprevalence and factors associated with symptomatic COVID-19 are similar in IMID patients and in the general population is still unknown.

Objectives:

To assess the serological and clinical prevalence of COVID-19 in European IMID patients, along with the factors associated with its risk and the impacts the pandemic had on the IMID management.

Methods:

Prospective multicentre cross-sectional study among patients with five IMID (i.e. systemic lupus erythematous, Sjögren’s syndrome, rheumatoid arthritis, axial spondylarthritis or giant cell arteritis) from six tertiary-referral centers from France, Germany, Italy, Portugal, Spain and United Kingdom. Demographics, comorbidities, IMID, treatments, flares and COVID-19 details were collected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological tests were systematically performed.

Results:

Between June 7 and December 8, 2020, 3028 patients were included (median age 58 years, 73.9% females). SARS-CoV-2 antibodies were detected in 166 (5.5%) patients. Symptomatic COVID-19 was seen in 122 patients (prevalence: 4.0%, 95% CI 3.4-4.8%); 23 (24.2%) of them were hospitalized and four (3.2%) died. In multivariate logistic regression analysis, symptomatic COVID-19 was more likely to be observed in patients with higher levels of C-reactive protein (OR: 1.18; 95% CI 1.05-1.33; p = 0.006), and increased with the number of IMID flares (OR: 1.27; 95% CI 1.02-1.58; p = 0.03). Conversely, it was less likely to occur in patients treated with biological therapy (OR: 0.51; 95% CI 0.32-0.82; p = 0.006). During the pandemic, at least one self-reported disease flare was seen in 654 (21.6%) patients. Also, 519 (20.6%) patients experienced changes in their treatment, with 125 of these (24.1%) being due to COVID-19.

Conclusion:

The SARS-CoV-2 prevalence in IMID patients over the study period seems to be similar to that of the general population1. The IMID inflammatory status seems to be independently associated with the development of COVID-19.

References:

[1]Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Hernán MA, Pérez-Olmeda M, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet Lond Engl. 2020 Aug 22;396(10250):535–44.

Disclosure of Interests:

None declared.

POS0781 PERFORMANCE OF MAJOR SALIVARY GLAND ULTRASOUND FOR THE DIAGNOSIS OF SJÖGREN’S SYNDROME IN CLINICAL PRACTICE

Background:

There is no specific test to diagnose Sjögren’s Syndrome (SS) although available classification criteria intended for research purposes help guide the diagnosis. Major salivary gland ultrasound (MSGUS) may contribute to SS diagnosis.

Objectives:

To study the performance of MSGUS for the clinical diagnosis of SS and its relationship with other relevant markers of disease.

Methods:

We included patients with a clinical suspicion of SS that underwent MSGUS evaluation at our Department. Parotid and submandibular glands were classified bedside on a 0-4 scale, based on tissue inhomogeneity. The score of the highest graded gland was considered and a score ≥2 was defined as a positive MSGUS. Minor salivary gland biopsy (mSGB) was considered positive if a focus score ≥1 was reported. We compared MSGUS findings across diagnoses and against mSGB result and anti-SSA status. Categorical variables were compared using the chi-square test. Continuous variables were compared using Student’s t-test, Mann-Whitney U test, or ANOVA. P-value was considered significant at <0.05.

Results:

A total of 219 patients were included (Table 1). MSGUS was positive in a higher proportion of patients with primary and secondary SS, in comparison to non-Sjögren’s sicca syndrome (nSSS) and undifferentiated connective tissue disease (UCTD; p<0.001). Mean MSGUS score was higher in SS patients in comparison to nSSS and UCTD (p<0.001). A positive MSGUS was associated with anti-SSA positivity (61.4% vs 38.6% in anti-SSA negative patients; p<0,001). Patients positive for anti-SSA had a higher mean MSGUS score (2.12 ± 1.03) in comparison with anti-SSA negative patients (1.31 ± 0.97, p<0.001). While MSGUS and mSGB were not significantly associated (p=0.237), the mean MSGUS score was higher in patients with a positive mSGB (1.95 ± 1.17) in comparison with those with a negative mSGB (1.61 ± 0.99; p=0.027).

Table 1.

General sample characteristics

Overall(n=219)pSS(n=131)sSS(n=17)nSSS(n=62)UCTD(n=9)p-valueAge, years (mean ± sd)60 ± 1458 ± 1756 ± 1960 ± 1348 ± 160.07Female, n (%)210 (95.9)127 (97.0)15 (88.2)59 (95.2)9 (100)<0.001Anti-SSA positive, n (%)105 (47.9)91 (69.5)10 (5.8)3 (4.8)1 (11.1)<0.001Positive mSGB, n (%)85 (46.4)69 (63.3)7 (46.7)8 (15.7)1 (12.5)<0.001MSGUS score, mean ± sd1.70 ± 1.091.98 ± 1.091.76 ± 1.111.13 ± 1.091.44 ± 1.12<0.001Grade 0, n (%)35 (16.0)17 (13.0)3 (17.7)15 (24.2)0 (0.0)<0.001Grade 1, n (%)62 (28.3)25 (19.1)4 (23.5)27 (43.6)6 (66.7)Grade 2, n (%)62 (28.3)39 (29.8)4 (23.5)17 (27.5)2 (22.2)Grade 3, n (%)54 (24.7)44 (33.6)6 (35.3)3 (4.9)1 (11.1)Grade 4, n (%)6 (2.7)6 (4.6)0 (0.0)0 (0.0)0 (0.0)MSGUS score ≧ 2, n (%)122 (55.7)89 (67.9)10 (58.8)20 (32.3)3 (33.3)<0.001

Conclusion:

MSGUS is a valuable resource in the investigation of SS. It is associated with clinical diagnosis, anti-SSA and MSGB findings. Together with these other complementary exams, it can be used to assist in the diagnosis of patients presenting with sicca features suggestive of SS.

References:

[1]Jousse-Joulin S, Milic V, Jonsson MV, Plagou A, Theander E, Luciano N, et al. Is salivary gland ultrasonography a useful tool in Sjögren’s syndrome? A systematic review. Rheumatology (Oxford). 2016 May;55(5):789–800.

[2]Zhou M, Song S, Wu S, Duan T, Chen L, Ye J, et al. Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren’s syndrome: a systematic review and meta-analysis. Sci Rep. 2018 Dec;8(1):17128.

[3]Cornec D, Jousse-Joulin S, Pers J-O, Marhadour T, Cochener B, Boisramé-Gastrin S, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjögren’s syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013 Jan;65(1):216–25.

Disclosure of Interests:

Maria Catarina Tenazinha: None declared, Vasco C Romão: None declared, Joaquim Polido-Pereira: None declared, Nikita Khmelinskii Speakers bureau: GSK, Rita Barros: None declared, FERNANDO MANUEL DIAMANTINO SARAIVA: None declared, Joao Eurico Fonseca: None declared

AB0036 CHILDREN WITH EXTENDED OLIGOARTICULAR AND POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS HAVE A CYTOKINE PATTERN FAVOURING B CELL ACTIVATION IN CIRCULATION

Background:

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. The majority of polyarticular JIA (pJIA) and a large fraction of extended oligoarticular JIA (oJIA) patients fulfil classification criteria for rheumatoid arthritis (RA) in adulthood. B-cells play several important roles in RA pathogenesis, but it is still unclear if the pattern of B-cell involvement in pJIA and extended oJIA follows what has been described for adults with RA.

Objectives:

The main goal of this study was to determine the concentration of cytokines potentially relevant for B-cell activation in serum from children with pJIA and extended oJIA when compared to children with persistent oJIA, adult JIA, early and established RA.

Methods:

Serum samples were collected from children with extended oJIA (n=8), persistent oJIA (n=6), pJIA (n=6), adult JIA (n=8), untreated early RA (<1 year of disease duration, n=12), established RA patients treated with synthetic disease-modifying anti-rheumatic drugs (DMARDs) (n=10) and two groups of age- and sex-matched healthy donors (children, n=6 and adults, n=10). A proliferation-inducing ligand (APRIL), B-cell activating factor (BAFF), interleukin (IL)-6 and IL-21 serum levels were measured by enzyme-linked immunosorbent assay (ELISA).

Results:

Children with extended oJIA, early and established RA patients had significantly higher BAFF serum levels when compared to controls, but no significant differences were observed in children with persistent oJIA, pJIA and adult JIA when compared to all groups included. APRIL serum levels were significantly increased in early and established RA patients when compared to both controls and children with persistent oJIA. No significant differences were found in APRIL concentrations between children with JIA, adult JIA and controls. IL-6 serum levels were significantly increased in children with extended oJIA, pJIA, early and established RA when compared to controls, but no significant differences were found in children with persistent oJIA and adult JIA patients. IL-21 serum levels were significantly increased in early RA when compared to controls, but no significant differences were observed between any of the other groups included.

Conclusion:

The similarity in B-cell cytokine pattern found between extended oJIA, pJIA, early and established RA patients, contrarily to what was observed in persistent oJIA, suggests an early B-cell involvement in the pathogenesis of extended oJIA and pJIA as described for RA.

Disclosure of Interests:

None declared

AB0590 CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH ANTISYNTHETASE AUTOANTIBODIES: DATA FROM A PORTUGUESE TERTIARY OUTPATIENT CLINIC

Background:

Antisynthetase syndrome (AS) may have different clinical phenotypes and outcomes associated with different anti-aminoacyl RNA-synthetase (anti-ARS). Patients may also present with incomplete/early phenotypes that do not fulfil the classification criteria.

Objectives:

To evaluate the clinical and demographic characteristics of patients positive for anti-ARS in our Myositis clinic.

Methods:

Observational study using data from the Portuguese Rheumatic Diseases Register (Reuma.pt/Myositis protocol). Data extracted included demographic variables, clinical features and immunological expression of the disease.

Results:

17 patients were identified. All met the criteria for AS according to Connors criteria, while 3 did not met according to the Solomon criteria. Mean age at diagnosis was 60.1 years (26 - 80) and 76.5% were female. Mean follow-up time was 2.8 (0.5-9) years. Only 3 patients had history of smoking in the past. The autoantibodies expressed were anti-Jo1 (n=12), anti-PL12 (n=2), anti-OJ (n=2) and anti-PL7 (n=1). 4 patients positive for anti-Jo-1 also expressed anti-Ro52. The clinical information and treatment are described in table 1. One patient presented as a paraneoplastic syndrome associated with anti-Jo-1.

Table 1.

Demographic and clinic characteristics of our cohort. AZA – azathioprine; CYC – Cyclophosphamide; DM – dermatomyositis; GS – Gottron’s sign; ILD – Interstitial lung disease; PM – Polymyositis; NSIP - Nonspecific interstitial pneumonia; MH – mechanic hands; MMF - Mycophenolate mofetil; MTX – Methotrexate; PDN – prednisolone; RP – Raynaud phenomenon; RTX – Rituximab; UIP - Usual interstitial pneumonia; Y – yes; N – no. Connors criteria – anti-ARS plus one or more of RP, MH, arthritis, ILD, fever. Solomon criteria – anti-ARS plus 2 major criteria or 1 major and 2 minor criteria. *induction therapy.

CaseSerologyMajor criteria (ILD [NSIP/UIP/non-specific] or PM/DM)Minor criteria (Arthritis, MH, RP)Other manifestationsConnors (2010)/ Solomon (2011) criteriaPDNDMARDcs (MTX/MMF/AZA)CYC/RTX1Jo1PMMH, arthritisGSY/YYMMF-2Jo1NSIPRP, MHAstheniaY/YYAZA-3Jo1NSIPMH, arthritisCalcinosis, astheniaY/YYAZA-4Jo1NSIP; DM-GSY/YY--5Jo1/Ro52PMMH, arthritisGS, astheniaY/YYMTX-6Jo1UIPRP, arthritisAstheniaY/YY-RTX7Jo1/Ro52NSIP; PMarthritis-Y/YYMMFCYC*8Jo1NSIP; PM--Y/YYMMF-9Jo1/Ro52NSIP; PM--Y/YYAZA-10PL7-RP, arthritis, MHDysphagiaY/NY--11Jo1-RPAstheniaY/N---12Jo1/Ro52PMMH, arthritisGS, astheniaY/YYMMF-13PL12PMRP, arthritisGS, astheniaY/YYMMF-14Jo1UIPRP, arthritisWeight loss, astheniaY/YY-RTX15OJNon-specific pattern--Y/NYMMF-16OJNSIP--Y/YY--17PL12PMRP, MH-Y/Y---

Conclusion:

The most frequent autoantibody was anti-Jo-1, which is consistent with the literature. Interestingly, patients with anti-PL, usually described as having severe lung disease, in our series do not have it. Additionally, we found a trend for a younger age at diagnosis in Jo1 positive patients and remarkably more than half of these patients have been diagnosed with ILD, being the NSIP pattern the most frequently reported.

Disclosure of Interests:

None declared