POS0332 CD71 RECEPTOR APICAL EXPRESSION IN ILEUM IS RELATED WITH HIGH LEVELS OF SERUM SIgA AND ACTIVITY DISEASE IN SpA PATIENTS

Background

Currently, mucosal immunity research has been investigated whether the serum levels of SIgA reflects the over-activation immune system in gut associated lymphoid tissues (GALT) and if the antigenic stimuli in the mucosa are responsible for inducing and maintaining the inflammatory response in Spondyloartrhitis (SpA). Based on our previous results, variances on levels of SIgA might influence in disease activity. SIgA Reverse transcytosis (retrotranscytosis) has been demonstrated as a GALT mechanism which enhance systemic inflammation in some autoimmune pathologies such as celiac disease.

Objectives

This study proposes the evaluation of receptors associated with retrotranscytosis CD71 and Dectin-1 (Dec-1) in gut tissues from SpA without IBD patients to explore a possible mechanism responsible of gastrointestinal inflammatory imbalance.

Methods

In total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=65, 36.1%) met the selection criteria and from them (n=41, 63.1%) by a gastroenterologist to perform digital chromoendoscopy with magnification for colon e ileum and histological analysis. Pregnant and lactating women, and cancer patients, patients with other autoinflammatory diseases, autoimmune diseases, immunodeficiency, chronic pancreatitis, or chronic liver disease, and those who had received antibiotic treatment in the last 3 months were excluded from the study. Furthermore, those patients with SpA and concomitant IBD were excluded. All included patients were between 18 and 65 years old. CD71 and Dec-1 apical expression were identified by indirect immunofluorescence. Fecal Calprotectin (FC), Serum SIgA in house and clinical indices BASDAI, BASFI, ASDAS-CRP, ASDAS-ESR were measured. The association were evaluated using the Chi-square or Fisher’s exact test and a multiple correspondence discriminant analysis (MCDA) was performed including those variables with significant associations from bivariate analysis and some that are considered clinically relevant to explain the impact of SIgA and CD71 in SpA.

Results

The average age of the patients included was 44,6±10.2 years, 56.1% were men, 39.0% were HLA-B*27:05 positive, 90.2% had axial involvement. Serum levels of SIgA were 62.3±24.1 gr/mL, CRP 1.7±2.4 and ESR 14.1±12.0 mm/h. Positive levels of FC (>120ng/mL) were observed in 31.7%. BASDAI >4 was found in 58.5% of patients and ASDAS-CRP >2.1 in 75.6%. Apical expression of CD71 and Dec-1 in the ileum was observed in 48.8% and 36% respectively, the expression of both receptors in colon tissues were irrelevant. CD71 expression was associated with high levels of serum SIgA (p=0.05). However, no associations were observed between retrotranscytosis receptors and any of the clinical and histological variables. The MCDA showed a Cronbach’s Alpha reliability coefficient of 0.763 and showed two dimensions: a main dimension (Dim 1) related to the presence of loss of the vascular pattern in the ileum (CC 0.325), FC + diarrhea (CC 0.695), FC + abdominal distension (CC 0.883) and FC + abdominal pain (CC 0.885) and a secondary dimension (Dim 2) that collected the variables serum SIgA (CC 0.513), ASDAS-CRP >2.1 (CC 0.311), CD71 (CC 0.424), please see Figure 1.

Figure 1.

Multiple correspondence discriminant analysis for CD71, serum SIgA and activity index in SpA patient

Conclusion

The findings reflect a possible relationship among the apical expression of CD71in ileum with high levels of serum SIgA and activity, suggesting that retrotranscytosis mediated by this receptor might be a mechanism that mediate the intestine-joint axis in SpA.

Acknowledgements

The Ministry of Science, Technology, and Innovation - MinCiencias (Grants No. 68022 and 57442). Universidad El Bosque (PCI-2018-10300), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem, in Bogota, Colombia and Biomedicina de Chihuahua, México

Disclosure of Interests

None declared

AB0117 HLA B27*SUBTYPES FREQUENCIES IN COLOMBIAN PATIENTS WITH SPONDYLOARTHRITIS AND HEALTHY SUBJECTS TYPED IN HIGH-RESOLUTION TECHNIQUE

Background:

HLA-B*27 has been identify as a susceptibility and prognostic factor associated to axial spondyloarthritis. HLA-B*27 allele has been described to be present in about 90% of patients with ankylosing spondylitis, and with a different frequency in patients with other subtypes of SpA. In contrast, this allele has been observed to be present only in 7–8% in general population. A remarkable heterogeneity in HLA-B*27 alleles has been reported. They have been determined at DNA sequence and some subtypes have been associated increasing the risk to develop the disease

Objectives:

To establish the frequencies of HLA-B27 subtypes in a group of Colombian patients with SpA and healthy population

Methods:

In total, 61 Blood samples from Colombian mestizo individuals with SpA according to ASAS classification-criteria were evaluated by Sequencing Technology: Illumina Sequencing/PacBio Sequencing with analysis of the second and third exon. Results reported with six digits (including null alleles). In total, 294 results of peripheral blood from healthy individuals without joint symptoms were analyzed. Frequencies were obtained for demographic and genetic variables. Ethic Committee approval code 2018-020/2017-023

Results:

The SpA group had a mean age of 45,88 ± 11,67, 62.3% of them were male, 6.6% reported current smoking and 37.7% reported smoking sometime in life. In total, 67.2% had inflammatory back pain, 14.8% had dactylitis, 63.9% enthesitis and 57.4% arthritis. Thirty patients were HLA-B*27 positive with a genotypic frequency of 50.8% and an allelic frequency of 24.6%. In this group of patients, the mean age was 43,5 ± 11,8, 76.6% were male, 86.7% of them were subtype B*27:05:02g and 13.3% presented the B27:02:01g. None of the SpA patients had both B*27 alleles.

On the other hand, the healthy individuals were men in 51.0% and the mean age was 37±15.4 years. Ten subjects were positive for the HLA-B*27 allele with a genotypic frequency of 3.4% and an allelic frequency of 1.7%. In this group of individuals 50.0% were male gender with a mean age of 38.4±17.9. No individuals were found to have the two alleles or homozygous for the B*27 allele. In all of them the subtype B*27:05:02g was observed in high-resolution sequencing

Conclusion:

The SpA group had a mean age of 45,88 ± 11,67, 62.3% of them were male, 6.6% reported current smoking and 37.7% reported smoking sometime in life. In total, 67.2% had inflammatory back pain, 14.8% had dactylitis, 63.9% enthesitis and 57.4% arthritis. Thirty patients were HLA-B*27 positive with a genotypic frequency of 50.8% and an allelic frequency of 24.6%. In this group of patients, the mean age was 43,5 ± 11,8, 76.6% were male, 86.7% of them were subtype B*27:05:02g and 13.3% presented the B27:02:01g. None of the SpA patients had both B*27 alleles.

On the other hand, the healthy individuals were men in 51.0% and the mean age was 37±15.4 years. Ten subjects were positive for the HLA-B*27 allele with a genotypic frequency of 3.4% and an allelic frequency of 1.7%. In this group of individuals 50.0% were male gender with a mean age of 38.4±17.9. No individuals were found to have the two alleles or homozygous for the B*27 allele. In all of them the subtype B*27:05:02g was observed in high-resolution sequencing

Acknowledgments:

Hospital Militar Central (Grant 2017-023/2018-020), the Government Institute of Science, Technology, and Innovation, Francisco Jose de Caldas—COLCIENCIAS (Grant No. 130877757442) and Colombian Rheumatology Association (Grant-Conv-2019)

Disclosure of Interests:

None declared

SAT0388 CHROMOENDOSCOPY AND MAGNIFICATION COLONOSCOPY: ANALYSIS OF THE MUCOSA OF THE COLON AND ILEUM IN PATIENTS WITH SPONDYLOARTRHITIS AND GASTROINTESTINAL SYMPTOMS WITHOUT INFLAMMATORY BOWEL DISEASE

Background:

Digital chromoendoscopy with magnification is a technique that identify microscopic inflammation, with a better characterize, highlighting specific gastrointestinal findings showing a good correlation with histopathological features. Spondyloarthritis (SpA) patients with the presence of non-specific gastrointestinal symptoms, subclinical intestinal inflammation is defined by endoscopic and histological techniques

Objectives:

To detect early structural inflammatory changes by chromoendoscopy and magnification colonoscopy in colonic/ileum digestive mucosa and establish its association with clinical variables in patients with SpA and gastrointestinal symptoms

Methods:

In total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=35) (19.4%) had an indication by a gastroenterologist to perform the chromoendoscopy, magnification colonoscopy and histological analysis. The association between clinical and colonoscopy variables were evaluated using the Chi square or Fisher’s exact test. (Ethical/Code. 2017-023)

Results:

The average age of the patients included for colonoscopy was 45.4±10.3 years, 57.1% were men and 42.9% presented the HLA-B*27 allele. Axial involvement (91.4%), inflammatory back pain (68.6%) and use of biological therapy (71.4%). High levels of calprotectin (25.7%), CRP>3 (14.3%), positive ESR (22.9%) and positive ANCA (8.6%) was observed. Regarding outcome measures of function and activity, BASDAI >4 (60%) and ASDAS-PCR >2.1 (80.0%) was observed

The loss of vascular pattern in the ileum was associated with high levels of calprotectin levels (p=0.002). At microscopic level, 80% of the patients who presented acute inflammation in the ileum had elevated calprotectin (p=0.013). Cryptitis (77.8%) in the ileum was associated with axial involvement (p=0.017). Ulcers and erosion in the ileum were associated with positive ESR (p=0.003). All patients who presented ulcerations and inflammation (64.3%) in ileum were HLA-B27 positive (p=0.029) and (p=0.052) respectively. The 50% of patients with atrophy of villi in ileum were receiving biological treatment (p=0.035)

Conclusion:

Digital chromoendoscopy and augmentation colonoscopy provided an improved and detailed contrast of the surface of the gastrointestinal mucosa. The tissue sampling showed the loss of vascular pattern as main finding in ileum with interesting associations with fecal calprotectin levels in patients with SpA. The interest of proposing the active search for symptoms, signs and biomarkers of gastrointestinal involvement in patients with SpA without IBD is to define subclinical gastrointestinal involvement and early remission through an endoscopic evaluation and objective histological and propose a specific clinical and therapeutic treatment.

Acknowledgments:

The Government Institute of Science, Technology, and Innovation, Francisco Jose de Caldas—COLCIENCIAS(Grant No. 130877757442). Universidad El Bosque (PCI-2018-10091), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem-Bogota, Colombia and Biomedicina de Chihuahua, México

Disclosure of Interests:

None declared

Association of adipokines with rheumatic disease activity indexes and periodontal disease in patients with early rheumatoid arthritis and their first-degree relatives

OBJECTIVE

To evaluate the adipokine levels in early rheumatoid arthritis (eRA) and first-degree relatives (FDR) of patients with RA and establish their association with rheumatic disease activity and periodontal variables.

METHOD

A cross-sectional study with eRA patients, FDR and a healthy population. Adipokine levels, clinical, joint radiological indexes and periodontal variables were evaluated. A descriptive, bivariate analysis was performed based on the adipokine levels by χ² , Fisher's test and Mann-Whitney U test. A logistic regression was made for associations.

RESULTS

High leptin levels were associated with the diagnosis of eRA (odds ratio [OR] = 2.79; 95% CI 1.54-5.07). Early rheumatoid arthritis with high adiponectin levels was less likely to have Multidimensional Health Assessment Questionnaire score >3, body mass index (BMI) >25 and Routine Assessment of Patient Index Data 3 score >12 (OR = 0.16; 95% CI 0.03-0.72). Early rheumatoid arthritis was more likely to present high leptin and interleukin (IL)6 levels with low adiponectin simultaneously (OR = 5.03; 95% CI 1.05-24.0). High leptin levels were associated with the FDR adjusted for IgG2 Porphyromonas gingivalis, swollen joints, P gingivalis and low IL6 (OR = 2.57; 95% CI 1.14-5.95).

CONCLUSION

High adipokine levels in eRA may modulate the disease activity. Having more than 1 adipokine at high serum levels is associated with increased disability, disease activity and BMI, indicating that RA is controlled by adiponectin levels in the early stages of the disease. High leptin levels, presence of P gingivalis and swollen joints may be the factors associated with the development of RA in FDR.

Porphyria cutanea tarda affecting a rheumatoid arthritis patient treated with methotrexate: association or coincidence?

We describe the case of a 44-yr-old woman, suffering from rheumatoid arthritis for 15 yr, who developed porphyria cutanea tarda while being treated with methotrexate. The cutaneous lesions healed and the metabolic anomalies improved after a few months, despite continuing the treatment.