COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study

OBJECTIVES

We investigated coronavirus disease 2019 (COVID-19) vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS

Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares and AID-related treatment modifications were analysed upon diagnosis of AID vs healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine.

RESULTS

Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, P = 0.01; minor AE 40% vs 25.9%, P = 0.03; major AE 17.5% vs 4.6%, P < 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a disease flare were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively.

CONCLUSION

This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and for the fetus by passive immunization appear to outweigh potential risks.

Characteristics of emerging new autoimmune diseases after COVID-19 vaccination: A sub-study by the COVAD group

BACKGROUND

Despite the overall safety and efficacy of COVID-19 vaccinations, rare cases of systemic autoimmune diseases (SAIDs) have been reported post-vaccination. This study used a global survey to analyze SAIDs in susceptible individuals' post-vaccination.

METHODS

A cross-sectional study was conducted among participants with self-reported new-onset SAIDs using the COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 study dataset-a validated, patient-reported e-survey-to analyze the long-term safety of COVID-19 vaccines. Baseline characteristics of patients with new-onset SAIDs and vaccinated healthy controls (HCs) were compared after propensity score matching based on age and sex in a 1:4 ratio.

RESULTS

Of 16 750 individuals, 74 (median age 52 years, 79.9% females, and 76.7% Caucasians) had new-onset SAID post-vaccination, mainly idiopathic inflammatory myopathies (IIMs) (n = 23, 31.51%), arthritis (n = 15; 20.53%), and polymyalgia rheumatica (PMR) (n = 12, 16.40%). Higher odds of new-onset SAIDs were noted among Caucasians (OR = 5.3; 95% CI = 2.9-9.7; p < .001) and Moderna vaccine recipients (OR = 2.7; 95% CI = 1.3-5.3; p = .004). New-onset SAIDs were associated with AID multimorbidity (OR = 1.4; 95% CI = 1.1-1.7; p < .001), mental health disorders (OR = 1.6; 95% CI = 1.3-1.9; p < .001), and mixed race (OR = 2.2; 95% CI = 1.2-4.2; p = .010), where those aged >60 years (OR = 0.6; 95% CI = 0.4-0.8; p = .007) and from high/medium human development index (HDI) countries (compared to very high HDI) reported fewer events than HCs.

CONCLUSION

This study reports a low occurrence of new-onset SAIDs following COVID-19 vaccination, primarily IIMs, PMR, and inflammatory arthritis. Identified risk factors included pre-existing AID multimorbidity, mental health diseases, and mixed race. Revaccination was well tolerated by most patients; therefore, we recommend continuing COVID-19 vaccination in the general population. However, long-term studies are needed to understand the autoimmune phenomena arising post-vaccination.

Expanding the role of CAR T-cell therapy: From B-cell hematological malignancies to autoimmune rheumatic diseases

Chimeric antigen receptor (CAR) T-cell therapy is a form of immunotherapy where the lymphocytes, mostly T-cells, are redirected to specifically recognize and eliminate a target antigen by coupling them with CARs. The binding of CAR and target cell surface antigens leads to vigorous T cell activation and robust anti-tumor immune responses. Areas of implication of CAR T-cell therapies include mainly hematological malignancies (i.e., advanced B-cell cancers); however, recent studies have proven the unprecedented success of the new immunotherapy also in autoimmune rheumatic diseases. We aim to review the recent advances in CAR T-cell therapies in rheumatology but also to address the limitations of their use in the real clinical practice based on the data on their efficacy and safety.

Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies. In this narrative review, we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease, immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following. We focused on the anti-gliadin antibodies, antibodies to different isoforms of tissue transglutaminase (TG) (anti-TG2, 3, and 6 antibodies), anti-glycine receptor antibodies, anti-glutamine acid decarboxylase antibodies, anti-deamidated gliadin peptides antibodies, etc. Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction, presented as different neurological disorders. We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

New Biomarkers for Systemic Necrotizing Vasculitides

Systemic necrotising vasculitides (SNVs) pose significant challenges due to their diverse clinical manifestations and variable outcomes. Therefore, identifying reliable biomarkers holds promise for improving precision medicine in SNVs. This review explores emerging biomarkers aiming to enhance diagnostic accuracy, prognostic assessment, and disease monitoring. We discuss recent advances in immunological biomarkers, inflammatory indicators, and other parameters that exhibit potential diagnostic and prognostic utility. A comprehensive understanding of these biomarkers may facilitate earlier and more accurate SNV detection, aiding in timely intervention and personalized treatment strategies. Furthermore, we highlight the evolving landscape of disease monitoring through innovative biomarkers, shedding light on their dynamic roles in reflecting disease activity and treatment response. Integrating these novel biomarkers into clinical practice can revolutionize the management of SNVs, ultimately improving patient outcomes and quality of life.

Characteristics and risk factors of COVID-19 breakthrough infections in Idiopathic Inflammatory Myopathies: Results from the COVAD study

OBJECTIVES

To explore prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIM) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS

A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after 2 vaccine doses. We compared BIs characteristics and severity among IIMs, other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HC). Multivariable Cox regression models assessed the risk factors for BI, severe BI and hospitalisations among IIMs.

RESULTS

Among 9449 included response, BIs occurred in 1447 (15.3%) respondents, median age 44 years (IQR 21), 77.4% female, and 182 BIs (12.9%) occurred among 1406 IIMs. Multivariable Cox regression among IIMs showed age as a protective factor for BIs [Hazard Ratio (HR)=0.98, 95%CI = 0.97-0.99], hydroxychloroquine and sulfasalazine use were risk factors (HR = 1.81, 95%CI = 1.24-2.64, and HR = 3.79, 95%CI = 1.69-8.42, respectively). Glucocorticoid use was a risk factor for severe BI (HR = 3.61, 95%CI = 1.09-11.8). Non-White ethnicity (HR = 2.61, 95%CI = 1.03-6.59) was a risk factor for hospitalisation. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIM = 6.0% vs AIRD = 1.8%, nrAID = 2.2%, and HC = 0.9%), intensive care unit admission (IIM = 2.2% vs AIRD = 0.6%, nrAID, and HC = 0%), advanced treatment with antiviral or monoclonal antibodies (IIM = 34.1% vs AIRD = 25.8%, nrAID = 14.6%, and HC = 12.8%), and had more hospitalisation (IIM = 7.7% vs AIRD = 4.6%, nrAID = 1.1%, and HC = 1.5%).

CONCLUSION

Patients with IIMs are susceptible to severe COVID-19 BI. Age and immunosuppressive treatments were related to the risk of BIs.

Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys

OBJECTIVES

Disease flares in the post-coronavirus disease 2019 (COVID-19) vaccination period represent a prominent concern, though risk factors are poorly understood. We studied these flares among patients with idiopathic inflammatory myopathies (IIMs) and other autoimmune rheumatic diseases (AIRDs).

METHODS

The COVAD-1 and -2 global surveys were circulated in early 2021 and 2022, respectively, and we captured demographics, comorbidities, AIRDs details, COVID-19 infection history and vaccination details. Flares of IIMs were defined as (a) patient self-reported, (b) immunosuppression (IS) denoted, (c) clinical sign directed and (d) with >7.9-point minimal clinically significant improvement difference worsening of Patient-Reported Outcomes Measurement Information System (PROMIS) PROMISPF10a score. Risk factors of flares were analysed using regression models.

RESULTS

Of 15 165 total respondents, 1278 IIMs (age 63 years, 70.3% female, 80.8% Caucasians) and 3453 AIRDs were included. Flares of IIM were seen in 9.6%, 12.7%, 8.7% and 19.6% patients by definitions (a) to (d), respectively, with a median time to flare of 71.5 (10.7-235) days, similar to AIRDs. Patients with active IIMs pre-vaccination (OR 1.2; 95% CI 1.03, 1.6, P = 0.025) were prone to flares, while those receiving rituximab (OR 0.3; 95% CI 0.1, 0.7, P = 0.010) and AZA (OR 0.3, 95% CI 0.1, 0.8, P = 0.016) were at lower risk. Female gender and comorbidities predisposed to flares requiring changes in IS. Asthma (OR 1.62; 95% CI 1.05, 2.50, P = 0.028) and higher pain visual analogue score (OR 1.19; 95% CI 1.11, 1.27, P < 0.001) were associated with disparity between self-reported and IS-denoted flares.

CONCLUSION

A diagnosis of IIMs confers an equal risk of flares in the post-COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.

Pathogenic Mechanisms and Therapeutic Approaches in Obesity-Related Knee Osteoarthritis

The knee is the joint most frequently involved in osteoarthritis, a common joint disorder in the adult population that is associated with significant chronic joint pain, reduced mobility and quality of life. Recent studies have established an association between obesity and the development of knee osteoarthritis that goes beyond the increased mechanical load on the knees as weight-bearing joints. This link is based on the maintenance of a chronic low-grade inflammation, altered secretion of adipokines by the adipose tissue and development of sarcopenia. Major adipokines involved in the pathogenesis of obesity-related knee osteoarthritis include adiponectin, which appears to have a protective effect, as well as leptin, resistin and visfatin, which are associated with higher pain scores and more severe structural damage. Joint pain in knee osteoarthritis may be both nociceptive and neuropathic and is the result of complex mechanisms driven by nerve growth factor, calcitonin gene-related peptide and pro-inflammatory cytokines. The role of endogenous cannabinoids and gut microbiota in common mechanisms between obesity and knee pain has recently been studied. The aim of the present review is to highlight major pathogenic mechanisms in obesity-related knee osteoarthritis with special attention on pain and to comment on possible therapeutic approaches.

Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys

OBJECTIVE

Flares of autoimmune rheumatic diseases (AIRDs) following COVID-19 vaccination are a particular concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs, using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys.

METHODS

The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details for patients with AIRDs. Flares following vaccination were identified as patient-reported (a), increased immunosuppression (b), clinical exacerbations (c) and worsening of PROMIS scores (d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs.

RESULTS

Of 15 165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5% and 26.7% by definitions a-d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K = 0.403, P = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P = 0.013), mental health disorders (MHDs) (P < 0.001) and autoimmune disease multimorbidity (AIDm) (P < 0.001).In regression analysis, the presence of AIDm [odds ratio (OR) = 1.4; 95% CI: 1.1, 1.7; P = 0.003), or a MHD (OR = 1.7; 95% CI: 1.1, 2.6; P = 0.007), or being a Moderna vaccine recipient (OR = 1.5; 95% CI: 1.09, 2.2; P = 0.014) were predictors of flares. Use of MMF (OR = 0.5; 95% CI: 0.3, 0.8; P = 0.009) and glucocorticoids (OR = 0.6; 95% CI: 0.5, 0.8; P = 0.003) were protective.A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared with before vaccination (OR = 1.3; 95% CI: 1.1, 1.5; P < 0.001).

CONCLUSION

Flares occur in nearly 1 in 10 individuals with AIRDs after COVID vaccination; people with comorbidities (especially AIDm), MHDs and those receiving the Moderna vaccine are particularly vulnerable. Future avenues include exploring flare profiles and optimizing vaccine strategies for this group.

Vaccine hesitancy decreases in rheumatic diseases, long-term concerns remain in myositis: a comparative analysis of the COVAD surveys

OBJECTIVE

COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs); however, hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs), using data from the two international COVID-19 Vaccination in Autoimmune Diseases (COVAD) e-surveys.

METHODS

The first and second COVAD patient self-reported e-surveys were circulated from March to December 2021, and February to June 2022 (ongoing). We collected data on demographics, comorbidities, COVID-19 infection and vaccination history, reasons for hesitancy, and patient reported outcomes. Predictors of hesitancy were analysed using regression models in different groups.

RESULTS

We analysed data from 18 882 (COVAD-1) and 7666 (COVAD-2) respondents. Reassuringly, hesitancy decreased from 2021 (16.5%) to 2022 (5.1%) (OR: 0.26; 95% CI: 0.24, 0.30, P < 0.001). However, concerns/fear over long-term safety had increased (OR: 3.6; 95% CI: 2.9, 4.6, P < 0.01). We noted with concern greater skepticism over vaccine science among patients with IIMs than AIRDs (OR: 1.8; 95% CI: 1.08, 3.2, P = 0.023) and HCs (OR: 4; 95% CI: 1.9, 8.1, P < 0.001), as well as more long-term safety concerns/fear (IIMs vs AIRDs - OR: 1.9; 95% CI: 1.2, 2.9, P = 0.001; IIMs vs HCs - OR: 5.4 95% CI: 3, 9.6, P < 0.001). Caucasians [OR 4.2 (1.7-10.3)] were likely to be more hesitant, while those with better PROMIS physical health score were less hesitant [OR 0.9 (0.8-0.97)].

CONCLUSION

Vaccine hesitancy has decreased from 2021 to 2022, long-term safety concerns remain among patients with IIMs, particularly in Caucasians and those with poor physical function.

Long-term safety of COVID vaccination in individuals with idiopathic inflammatory myopathies: results from the COVAD study

Limited evidence on long-term COVID-19 vaccine safety in patients with idiopathic inflammatory myopathies (IIMs) continues to contribute to vaccine hesitancy. We studied delayed-onset vaccine adverse events (AEs) in patients with IIMs, other systemic autoimmune and inflammatory disorders (SAIDs), and healthy controls (HCs), using data from the second COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. A validated self-reporting e-survey was circulated by the COVAD study group (157 collaborators, 106 countries) from Feb-June 2022. We collected data on demographics, comorbidities, IIM/SAID details, COVID-19 history, and vaccination details. Delayed-onset (> 7 day) AEs were analyzed using regression models. A total of 15165 respondents undertook the survey, of whom 8759 responses from vaccinated individuals [median age 46 (35-58) years, 74.4% females, 45.4% Caucasians] were analyzed. Of these, 1390 (15.9%) had IIMs, 50.6% other SAIDs, and 33.5% HCs. Among IIMs, 16.3% and 10.2% patients reported minor and major AEs, respectively, and 0.72% (n = 10) required hospitalization. Notably patients with IIMs experienced fewer minor AEs than other SAIDs, though rashes were expectedly more than HCs [OR 4.0; 95% CI 2.2-7.0, p < 0.001]. IIM patients with active disease, overlap myositis, autoimmune comorbidities, and ChadOx1 nCOV-19 (Oxford/AstraZeneca) recipients reported AEs more often, while those with inclusion body myositis, and BNT162b2 (Pfizer) recipients reported fewer AEs. Vaccination is reassuringly safe in individuals with IIMs, with AEs, hospitalizations comparable to SAIDs, and largely limited to those with autoimmune multimorbidity and active disease. These observations may inform guidelines to identify high-risk patients warranting close monitoring in the post-vaccination period.

Serum miR-21 and miR-29a expression in systemic sclerosis patients

OBJECTIVES

The aim of our study was to evaluate the expression levels of miR-21 and miR-29a in the serum of systemic sclerosis (SSc) patients and to determine their correlation with clinical and immunological parameters.

METHODS

34 patients fulfilling the ACR/EULAR 2013 classification criteria for SSc were included in the study. miR-21 and miR-29a expression levels in the serum were determined by PCR (SYBR Green technology). 2-ΔΔCt method was used for analysis. 14 healthy donors were used as controls (HCs).

RESULTS

Expression levels of miR-21 were upregulated in the serum of 17 (50.0%) of the patients. The expression of miR-29a was downregulated in 15 (44.12%) of the SSc patients. Receiver operating characteristic (ROC) curve analysis was conducted in order to evaluate the diagnostic accuracy of the expression levels of the studied miRNAs in the serum. Area under the curve (AUC) for miR-21 was 0.634 (95% CI=0.479-0.790), p=0.147 with 64.7% sensitivity and 64.3% specificity. AUC for miR-29a was 0.605 (95% CI=0.420-0.790), with 64.3% sensitivity and 52.9% specificity but without statistical significance (p=0.257). The multimarker analysis of the ROC curves for both miRNAs showed AUC=0.714 (95% CI=0.569-0.860), p=0.021 with 79.4% sensitivity and 42.9% specificity. Levels of miR-29a correlated with the levels of miR-21 in the serum (with Spearman correlation coefficient 0.517, p=0.00017) and with the presence of anti-Scl70 antibodies in the serum (with Spearman correlation coefficient 0.438, p=0.010).

CONCLUSIONS

Our data showed a deregulation of miR-21 and miR-29a in the serum of patients with SSc which could suggests their potential role in the disease pathogenesis. Further analysis with higher number of patients is needed to confirm if these miRNAs could be used in the clinical practice as diagnostic biomarkers as well as biomarkers for both disease activity and progression.

Obesity-Related Knee Osteoarthritis-Current Concepts

The knee is the joint most frequently involved in osteoarthritis and represents a significant contributor to patient morbidity and impaired functional status. Major risk factors include genetics, age, sex, mechanical load and obesity/metabolic syndrome. Recent studies highlighted the role of obesity and metabolic syndrome in the pathogenesis of knee osteoarthritis not simply through increased mechanical loading but the systemic effects of obesity-induced inflammation. The current concept of knee osteoarthritis is that of a 'whole joint disease', which highlights the involvement not only of articular cartilage but also the synovium, subchondral bone, ligaments and muscles. Obesity and metabolic syndrome are associated with higher levels of pro-inflammatory cytokines, increased production of adipokines with both protective and destructive effects on articular cartilage, an up-regulation of proteolytic enzymes such as matrix metalloproteinases and aggrecanases and an increase in free fatty acids and reactive oxygen species induced by dyslipidemia. These findings underscore that the adequate management of knee osteoarthritis needs to include an optimization of body weight and a beneficial mobility regimen. The possible introduction of pharmacological therapy targeting specific molecules involved in the pathogenesis of obesity-related osteoarthritis will likely also be considered in future therapeutic strategies, including personalized treatment approaches.

EULAR study group on ‘MHC-I-opathy’: identifying disease-overarching mechanisms across disciplines and borders

The ‘MHC-I (major histocompatibility complex class I)-opathy’ concept describes a family of inflammatory conditions with overlapping clinical manifestations and a strong genetic link to the MHC-I antigen presentation pathway. Classical MHC-I-opathies such as spondyloarthritis, Behçet’s disease, psoriasis and birdshot uveitis are widely recognised for their strong association with certain MHC-I alleles and gene variants of the antigen processing aminopeptidases ERAP1 and ERAP2 that implicates altered MHC-I peptide presentation to CD8+T cells in the pathogenesis. Progress in understanding the cause and treatment of these disorders is hampered by patient phenotypic heterogeneity and lack of systematic investigation of the MHC-I pathway.

Here, we discuss new insights into the biology of MHC-I-opathies that strongly advocate for disease-overarching and integrated molecular and clinical investigation to decipher underlying disease mechanisms. Because this requires transformative multidisciplinary collaboration, we introduce the EULAR study group on MHC-I-opathies to unite clinical expertise in rheumatology, dermatology and ophthalmology, with fundamental and translational researchers from multiple disciplines such as immunology, genomics and proteomics, alongside patient partners. We prioritise standardisation of disease phenotypes and scientific nomenclature and propose interdisciplinary genetic and translational studies to exploit emerging therapeutic strategies to understand MHC-I-mediated disease mechanisms. These collaborative efforts are required to address outstanding questions in the etiopathogenesis of MHC-I-opathies towards improving patient treatment and prognostication.

AB0961 UVEITIS IN PATIENTS WITH PSORIATIC ARTHRITIS

Background

Psoriatic arthritis (PsA) is a common disease in Departments of rheumatology. PsA affects from 5 % to 30 % of patients with psoriasis. The arthritis associated with psoriasis follows different patterns, including oligoarticular disease, polyarticular disease, distal interphalangeal disease, arthritis mutilans and axial disease. The axial disease often overlaps with the other four groups. Psoriatic arthritis belongs to the group of spondyloarthropathies in which uveitis is an associated disease. The prevalence of uveitis among PsA patients is not well established.

Objectives

The aim of this study is to describe the clinical characteristics of uveitis related to psoriatic arthritis.

Methods

Uveitis is described as an inflammation of the tissues that comprise the uveal tract (i.e., iris, ciliary body, and choroid). It can be classified either according to the anatomic parts of uvea that are involved or according to its underlying etiological cause. Anterior uveitis involves the iris and/or the ciliary body, intermediate uveitis involves the vitreous humor, while posterior uveitis is characterized by inflammation of the uvea and the choroid. A retrospective database study was conducted on 164 (96 female, 68 male, mean age 52,36±16,14 years) adult PsA patients with ocular symptoms. Demographic variables, smoking status, socioeconomic status (SES), body mass index (BMI), presence of selected chronic comorbidities, and medication use, including conventional and biologic disease modifying anti-rheumatic drugs (c/b DMARD) were extracted. We collected data about psoriasis type, uveitis laterality, onset type, human leukocyte antigen types, visual acuity, ocular inflammation localization, anterior segment findings, funduscopy findings, complications, recurrence, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis, and medical treatments for uveitis and skin diseases. Descriptive statistics was applied as appropriate. Cox proportional hazard regression time dependent models were used to calculate the risk of uveitis given demographic variables, SES, smoking, selected comorbidities, and c/bDMARD. P values of ≤ 0.05 were considered statistically significant.

Results

This study included a broad spectrum of ocular inflammation associated with PsA. We found that conjunctivitis was the most common problem, affecting 53 patients (32,32 %). Iritis (anterior uveitis) was found in 10 (6,1%), episcleritis - in 3 (1,83 %) and keratoconjunctivitis sicca - in 5 (3,05 %) patients. 14 patients were with axial involvement, seven of them with anterior uveitis.

Patients with PsA and uveitis were more often female (7), of a younger age (48,25±15,4 years). In our cohort of patients uveitis is bilateral in 7 patients, all cases had acute non-granulomatous anterior uveitis. Anterior uveitis is usually accompanied by pain and redness of the eye without vision loss, while intermediate (1 patients) and posterior (2 patients) uveitis are mainly associated with visual symptoms such as floaters or blind spots and may affect central vision.Patients with uveitis had a previous history of uveitis and were more often treated with cDMARDS, monoclonal anti-Tumor Necrosis Factor-a (antiTNF-a) agents and etanercept. No difference in uveitis occurrence was noted regarding demographic characteristics and comorbidities.

Conclusion

Uveitis, in particular, is being considered as a relatively rare but very serious ocular complication of psoriasis. Patients with psoriasis should be educated about the increased risk and manifestations of uveitis. An ophthalmological consultation is needed when patients present with eye symptoms.

Disclosure of Interests

None declared

POS0036 CORRELATION BETWEEN SYSTEMIC AND LOCAL EXPRESSION LEVELS OF MIR-146а, MIR-155 AND MIR-223 AND THE ONGOING TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS

Background

MicroRNAs (miRNAs) comprise a class of small, non-coding RNAs that serve as important negative regulators of gene expression at posttranscriptional level. Studies have shown remarkable changes in miRNA expression in autoimmune diseases, such as rheumatoid arthritis (RA) which makes them a potential systemic as well as local biomarkers for disease activity (1-3). On the other hand, regulation of miRNA on transcriptional and posttranscriptional level, as well as the effects of endogenous and exogenous factors on miRNA expression is under investigation. Of importance is the possible effect of the ongoing treatment on miRNA expression in the clinical practice.

Objectives

To analyze the expression levels of miR-146a, miR-155 and miR-223 in peripheral blood (PB) and synovial fluid (SF) from RA patients in regard to the ongoing treatment regimen.

Methods

A total number of 63 RA patients according to the 1987 ACR criteria were included in the study. Expression levels of miR-146a, miR-155 and miR-223 in 63 PB samples and matched 48 SF samples were determined by qPCR (SybrGreen technology) and compared to healthy controls (HCs). Relative changes of gene expression levels of the studied miRNAs were calculated by 2-ΔΔCt method. 45 of the studied patients were on systemic treatment, which included non-steroidal antiinflammatory drugs (NSAIDs), glucocorticosteroids (GCS), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and original biological DMARDs. There were no patients treated with conventional target DMARDs or biosimilar DMARDs. SPSS was used for statistical analysis.

Results

RA PB showed statistically significant overexpression of miR-223 (58.73%) when compared to HCs and only miR-223 expression levels could be used to differentiate RA patients from HCs (p=0.008). RA SF showed overexpression of miR-146a (in 70.83%, p=0.007), miR-155 (in 79.17%, p=1.63x10-4) and of miR-223 (in 79.17%, p=1.64x10-3) when compared to HCs and the studied miRNAs could be used to differentiate RA patients from HCs (p=4.8x10-4, р=8.0х10-5 and р=2.8х10-4, respectively). When we analyzed the correlation between the expression of miRNAs and the ongoing treatment we found a statistically significant correlation between the PB expression levels of miR-223 and the use of NSAIDs and GCS (р=0.015 and р=0.04, respectively) and the SF expression levels of miR-146a and miR-155 and the use of NSAIDs (р=0.011 and 7.98х10-4, respectively) and GCS (р=0.039 and р=0.009, respectively). The use of csDMARDs and bDMARDs didn’t show correlation with the PB nor the SF expression of the studied miRNAs.

Conclusion

The correlation between the systemic miR-223 and the local miR-146a and miR-155 expression with the NSAIDs and GCS treatment could be due to the effect of these treatment compounds on the cells lines from which the studied miRNAs origin. In our study there was no correlation between miRNA expression and the use of biological and conventional DMARDs. Further analysis with larger sets including pre- and posttreatment samples is needed to confirm if altered miRNA expression could be influenced by the treatment regimen as well as if miRNAs could serve as biomarkers for treatment response in the clinical practice.

References

[1]Filková M, Aradi B, Šenolt L et al. Association of circulating miR-223 and miR-16 with disease activity in patients with early rheumatoid arthritis. Annals of the Rheumatic Diseases 2014;73:1898-1904.

[2]Filkova M, Ospelt C, Vettori S et al. Circulating Mir-223 Is Associated with Disease Activity and May Predict the Response to Therapy in Treatment naive Patients with Early Rheumatoid Arthritis, Arthritis Rheum., 2012; 64 Suppl. 10: 2123.

[3]Kriegsmann M, Randau TM, Gravius S et al. Expression of miR-146a, miR-155, and miR-223 in formalin-fixed paraffin-embedded synovial tissues of patients with rheumatoid arthritis and osteoarthritis. Virchows Arch 469, 93–100 (2016).

Acknowledgements

The study was supported by Grant 14-D/2012 and Grant 60/2013 funded by Medical University-Sofia.

Disclosure of Interests

Russka Shumnalieva: None declared, Darina Kachakova: None declared, Radka Kaneva: None declared, Zlatimir Kolarov Speakers bureau: Abbvie, Pfizer, MSD, UCB, Amgen, Simeon Monov Speakers bureau: Abbvie, Pfizer, MSD, UCB, Amgen

AB1138 SAFETY OF SARS - COV- 2 VACCINES IN PATIENTS WITH AUTOIMMUNE DISEASES

Background

Patients (pts) with autoimmune diseases are at higher risk of infections, including those by SARS-COV-2. There is no general agreement regarding priority criteria for anti-COVID vaccine access for pts with autoimmune rheumatic diseases (ARD). Few studies have addressed the issue of anti-COVID vaccination in these pts, but many are available on the safety, immunogenicity, efficacy, and possible contraindications of traditional vaccines in pts with ARD. These studies may represent the basis on which to recommend the anti-COVID-19 vaccines.

Objectives

Patients (pts) with autoimmune diseases are at higher risk of infections, including those by SARS-COV-2. There is no general agreement regarding priority criteria for anti-COVID vaccine access for pts with autoimmune rheumatic diseases (ARD). Few studies have addressed the issue of anti-COVID vaccination in these pts, but many are available on the safety, immunogenicity, efficacy, and possible contraindications of traditional vaccines in pts with ARD. These studies may represent the basis on which to recommend the anti-COVID-19 vaccines.

Methods

A telephone survey investigating the AE of SARS-CoV-2 vaccinations on pts with systemic lupus erythematosus, systemic sclerosis, inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis), idiopathic inflammatory myopathies, ANCA-associated vasculitis was administered. Data extraction included diagnosis, disease activity status, demographics, disease duration, therapy, comorbidities, and laboratory tests. Vaccinated participants are asked to report whether they experienced any local or systemic AE following vaccination, and if so, to report on the severity and duration of the AE. Mild AE were defined as unpleasant reactions that did not limit daily activities, moderate AE as those that limited daily activities, and severe AE - required medical attention. Serious AE were defined as reactions that resulted in hospital admission.

Results

ChAdOx1 nCoV-19 and BNT162b2 are the most common vaccines in our pts. 98 (39,84 %) of 246 pts received the BNT162b2 vaccine, 95 (38,62 %) - ChAdOx1 nCoV-19 vaccine, 47 (19,10%) - CX-024414 and 6 (2,44 %) were vaccinated with Ad26.COV2-S. 127 (51,63%) pts had at least one mild AE and 51 (20,73 %) pts reported moderate AE. Severe AE were rare - 4 (1,63 %) pts and no serious AE were reported. The most commonly reported AE is pain (40,24 %), redness (30,49 %), swelling (18,7 %) at the injection site, which was consistent across all vaccines for both first and second doses. Systemic AE occurred in 104 (43,27 %) pts, most frequently fatigue (29,67 %), headache (27,13 %) and muscle ache (24,39 %). The symptoms started mostly during the first day post-vaccination and lasted for no more than two days. Joint complaints were reported in 8,94 %, but only a small proportion of pts (2,84 %) reported a deterioration of their autoimmune disease up to 3 months after COVID-19 vaccination. Age was a significant effect modifier in the association between autoimmune status and the risk of moderate or severe AE. Vaccination with ChAdOx1 nCoV-19, female sex, age between 35 - 50 years were independently associated with an increased likelihood of reporting any AE. The current results support the safety of different COVID-19 vaccines in pts with ARD. This information can help fight vaccine hesitancy in this population.

Conclusion

Our data indicated that COVID-19 vaccines are well tolerated by pts with ARD. We did not observe any serious AE, but the number of pts included in our study is too low to draw conclusions about rare serious events. Additionally, our data suggest that COVID-19 vaccinations do not seem to trigger autoimmune disease flares, which is in accordance with data from previous small studies that assessed consequences of vaccines in pts with ARD.

Disclosure of Interests

None declared

MO111: Hyperuricaemia and Risk of Simple Renal Cysts

BACKGROUND AND AIMS

The relationship between hyperuricaemia and renal cysts is still insufficient. Simple renal cysts (SRCs) are the most common non-hereditary type of benign renal cysts in adults. The prevalence of SRC varies by population, geographic region and the imaging modality used. The overall prevalence of SRC is 4–12% in general populations. Most SRCs are asymptomatic, being accidentally detected by abdominal ultrasonography or computed tomography during a medical check-up. However, some cysts tend to increase in size and can be sufficiently large to cause pain, haematuria and/or urinary obstruction.

The aim of this study is to compare the risk of SRC in patients with and without hyperuricaemia.

METHOD

We retrospectively collected data on 246 non-smoking males (age 30–70 years) with SRC without hypertension, obesity and renal stones. In this study, patients with previous therapy with uric acid-lowering medication; patients with current acute complications of diabetes or urinary tract infections; and patients with cancer, blood disease, polycystic kidney disease, solitary kidney, urinary tract stenosis or kidney diseases were excluded. Albuminuria was defined as 24-h urine microalbuminuria of 30 mg and higher. SRCs were detected by ultrasonography. The sonographic criteria for the diagnosis of SRC included absent internal echoes, a smooth, sharply defined wall and posterior acoustic enhancement, indicating posterior through transmission that was not suspicious for a malignant renal mass. SPSS 22 for windows was used for analysing the study data. Chi-square and exact Fisher's tests were utilized, while continuous variables were assessed by Student's t-test. A P value of less than .05 was considered statistically significant.

RESULTS

SRC prevalence was significantly higher in hyperuricaemic (174 patients) than normouricemic subjects. Age (OR 1042, 95% CI 1032–1061, P &lt; .001) and albuminuria (OR 1189, 95% CI 1176–1892, P &lt; 05) are independent risk factors for SRC development. Patients with SRC and hyperuricaemia were more likely to be elderly males, and exhibited a longer duration of lower eGFR and higher serum uric acid, γ-glutamyl transferase, low-density lipoprotein cholesterol and plasma glucose level compared with those without SRC. The risk of SRC increased when the serum uric acid is more 460 μmol/L.

CONCLUSION

Of the 246 non-smoking males with SRC, 176 have hyperuricaemia. Patients who had a SRC were significantly older than patients without SRC (mean 58.27 versus 43.18 years), with lower glomerular filtration rate, more often suffer from coronary heart disease. Therefore, even asymptomatic hyperuricaemia requires standardized uric acid-lowering treatment to prevent the occurrence of SRC. According to our results, SRC patients should be careful to use uricosuric drugs.

POS0578 CORRELATION BETWEEN EXPRESSION LEVELS OF MIR-155 AND MIR-223 IN SYNOVIAL FLUID AND ULTRASOUND SCORES FOR ACTIVE SYNOVITIS IN RHEUMATOID ARTHRITIS PATIENTS

Background:

MicroRNAs (miRNAs) are a class of small, non-coding RNAs that negatively regulate gene expression at posttranscriptional level. In rheumatoid arthritis studies have shown that miRNA are differentially expressed systemically as well as locally in the inflamed joints [1,2]. The correlation between their systemic or local expression levels and scores for disease activity and progression in RA make them possible candidate for biomarkers in the clinical practice.

Objectives:

To analyze the expression levels of miR-155 and miR-223 in synovial fluid (SF) from RA patients in regard to the ultrasound scores for disease activity.

Methods:

A total number of 48 RA patients according to the 1987 ACR criteria were included in the study. Expression levels of miR-155 and miR-223 SF were determined by qPCR (SybrGreen technology) and compared to healthy controls (HCs). Relative changes of gene expression levels of the studied miRNAs were calculated by 2-ΔΔCt method. Musculoskeletal ultrasound (MSUS) examination was performed by two independent examiners on ESAOTE, MyLab60 using both grey scale and power Doppler technic. A semi-quantitative assessment of the peripheral joints was performed for detecting joint inflammation and determining the grade of synovial thickening and the degree of vascularization. Ultrasound features for active disease were correlated to the local expression of the studied miRNAs. SPSS was used for statistical analysis.

Results:

RA SF showed overexpression of miR-155 (in 79.17%, p=1.63x10-4) and of miR-223 (in 79.17%, p=1.64x10-3) when compared to HCs and both miRNAs could be used to differentiate RA patients from HCs (р=8.0х10-5 and р=2.8х10-4, respectively). When we analyzed the correlation between the diagnosis, the expression of miRNAs and the changes on the musculoskeletal ultrasound examination we found a statistically significant correlation between the presence of synovitis and the degree of the power Doppler signal on MSUS and the local expression of miR-223 (p=6.19 x 10-4 and p=0.003, respectively). SF levels of miR-223 correlated also with the degree of synovial hypertrophy on MSUS (p=0.013). The results for miRNA-155 were not statistically significant.

Conclusion:

The correlation between the local expression of miR-223 and the ultrasound features of active joint inflammation shows that this miRNA might be a better candidate for local disease biomarker than miR-155. Further analysis with larger sets is needed to confirm if altered local miRNA expression could be used in the clinical practice as biomarker for disease activity especially in cases with subclinical synovitis.

References:

[1]Filková M, Aradi B, Šenolt L, et al. Association of circulating miR-223 and miR-16 with disease activity in patients with early rheumatoid arthritis. ARD, 2014; 73: 1898-1904.

[2]Kriegsmann, M., Randau, T.M., Gravius, S. et al. Expression of miR-146a, miR-155, and miR-223 in formalin-fixed paraffin-embedded synovial tissues of patients with rheumatoid arthritis and osteoarthritis. Virchows Arch, 2016; 469, 93–100.

Acknowledgements:

The study was supported by Grant 14-D/2012 and Grant 60/2013 funded by Medical University-Sofia.

Disclosure of Interests:

Russka Shumnalieva: None declared, Darina Kachakova: None declared, Radka Kaneva: None declared, Zlatimir Kolarov Speakers bureau: Amgen, Pfizer, Novartis, Abbvie, Roche, Astra-Zeneka, Simeon Monov Speakers bureau: Amgen, Pfizer, Novartis, Abbvie, Roche, Astra-Zeneka

POS1184 AUTOIMMUNE SYSTEMIC DISEASES AND COVID-19 INFECTION

Background:

Covid-19 infection poses a serious challenge for immune-compromised patients. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. Little is known about the impact of Coronavirus disease 2019 (COVID-19) in patients with inflammatory autoimmune systemic diseases.

Objectives:

The aim of this study is to describe clinical characteristics of patients with autoimmune systemic diseases and COVID-19, and to identify baseline variables associated with a severe infection requiring hospitalization.

Methods:

A telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis), idiopathic inflammatory myopathies (IIM), ANCA-associated vasculitis (AAV) was administered. Data extraction included diagnosis, disease activity status, demographics, disease duration, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test. Comparisons between patients with or without hospitalization were performed.

Results:

512 patients (median age 53,4 ± 14,3 years) with autoimmune systemic diseases (234 IA, 182 SLE, 42 SSc, 31 IIM, 23 AAV) were included in the study. 89 patients (58 woman, 31 men) developed at least one symptom (fever, asthenia, chills, cough, sore throat, dyspnea, chest pain, headaches, arthralgias, myalgias, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. Of patients with COVID – 19 infection 54 patients were treated with methylprednisolone, 36 – with methotrexate, 34 – with hydroxychloroquine, 26- with biologics, 10 - with azathioprine, 6 - with cyclophosphamide prior to their COVID-19 illness.

Conclusion:

Covid-19 is more frequent in the subgroup of patients without therapy with modifying anti-rheumatic drugs, which might play some protective role against the most harmful manifestations of Covid-19. 21 patients required hospitalization - these were more frequently men, older and with comorbidities (cardio-respiratory illness, renal diseases, diabetes mellitus). Male sex, previous coronary and lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization. Patients with inflammatory arthritis do not seen to be at higher risk for infection or a severe course of COVID-19.

References:

[1]Monova, D., S. Monov. Mechanisms of kidney injury in patients with COVID-19. Nephrology, dialysis and transplantation, 2020; 26 (4): 5-15.

[2]Monova, D., S. Monov. Kidney injures in COVID-19. Nephrology, dialysis and transplantation, 2020; 26 (4): 16-34.

Disclosure of Interests:

Simeon Monov Speakers bureau: AMGEN, PFIZER, NOVARTIS, ABBVIE, ROCHE, ASTRA-ZENECA, Russka Shumnalieva: None declared, Daniela Monova: None declared.

AB0162 OCULAR MANIFESTATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and is associated with a number of extra-articular organ manifestations, including ocular complications.

Objectives:

The aim of this study is to evaluate the frequency and characteristics of ocular manifestation in patients with rheumatoid arthritis (RA).

Methods:

The study involved 87 patients with RA. All the study subjects underwent complete ophthalmological examination involving visual acuity assessment, examination of anterior and posterior eye segments, Schirmer’s test, diameter and mobility of pupils, as well as eyeball mobility assessment of intraocular pressure. Data regarding age, gender, disease duration, age at diagnosis, systemic corticosteroid use, blood pressure, ocular symptoms and detailed ophthalmic history were recorded. The presence of rheumatoid factor in serum was evaluated by standard test methods based on principle of agglutination. All patients were seropositive.

Results:

87 patients (26 male, 59 female, mean age 45,6 ± 13,1 years; mean disease duration 7,4 ± 6,2 years) with RA were enrolled in this study. 31 (35,63 %) of them had no ocular symptoms. Among the patients with ocular symptoms, 39 (69,64 %) complained of decreased vision, 33 (58,93 %) - of dry eye, 32 (57,14 %) - of burning, 29 (51,78 %) -photophobia, 28 (50 %) - of gritty sensation, 27 (48,21 %) - of itching, 18 (32,14 %) - of redness, 13 (23,21 %) - of ocular pain, 3 (5,36 %) - of floaters. Ophthalmological examination revealed higher incidence of the following abnormalities in the study group: myopic astigmatism - in 10 (5,74 %) eyes, vascular abnormalities within fundus - in 22 (12,64 %) eyes, increased intraocular pressure (> 21 mm Hg) - in 11 (6,32 %) eyes. Mean IOP values were 17,34 ± 5,12 mm Hg. In 48 eyes Schirmer’s test results were below 10 mm, and in 18 eyes - below 5 mm. Keratoconjunctivitis sicca was present in 31 (35,63 %) of all patients. Episcleritis was diagnosed in 4 patients (4,6 %), scleritis – in 3 (3,45 %). Retinal vasculitis was present in 2 (2,3 %) patients and involves veins and arteries peripheral branches. Lens opacity was found in 13 (14,94 %) patients (21 eyes), mostly in the form of posterior subcapsular cataract (in 16 eyes) and nuclear cataract (in 5 eyes). The mean age of patients with cataracts was 52,3 ± 14,2 years. 13 of the patients with cataracts were either currently taking or had previously taken systemic corticosteroids.

Conclusion:

In patients with RA numerous abnormalities within the vision of organ may be found. Ocular symptoms are relatively common complications of RA, and may result in irreversible changes in the organ of vision. Regular ophthalmological examinations are essential among the patients with RA.

Disclosure of Interests:

None declared

MO645BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH TYPE 2 DIABETES MELLITUS WITH AND WITHOUT DIABETIC NEPHROPATHY

Background and Aims

Diabetes mellitus and osteoporosis are both common human diseases. Diabetic nephropathy is characterized by the presence of pathological quantities of urine albumin excretion, diabetic glomerular lesions, and loss of glomerular filtration rate in diabetics. Little evidence has been reported on relationships between BMD and albuminuria.

The aim of this study is to compare the bone mineral density (BMD) in postmenopausal women with type 2 diabetes mellitus (T2DM) with and without diabetic nephropathy.

Method

We retrospectively analyze the BMD of the lumbar spine and femur using dual-energy X-ray absorptiometry in 84 postmenopausal women with T2DM with (39) and without (45) diabetic nephropathy. The serum levels of calcium, phosphorus, total alkaline phosphatase, and urine albumin excretion were measured in all participants. Diagnosis of albuminuria was based on albumin-creatinine ratio (ACR).

Results

Age, body mass index (BMI) and time since menopause were not significantly different between the two groups. The T-scores of basal BMD at L4 were significantly lower in patients with diabetic nephropathy (-0,94 ± 0,40) compared to patients without nephropathy. No significant differences in serum creatinine were detected between two groups of patients. Our data suggest that ACR was negatively associated with lumbar spine and femoral neck BMD.

Conclusion

Our results suggest that postmenopausal women with diabetic nephropathy have a lower BMD and are at increased risk of osteoporosis in the lumbar spine compared with postmenopausal women without diabetic nephropathy. ACR was negatively associated with lumbar spine and femur neck BMD. One of the explanations that has been proposed for the association between albuminuria and osteoporosis is that albuminuria is associated with reduced bone blood flow, resulting in a decreased rate of bone remodeling and the development of osteoporosis.

EULAR/eumusc.net standards of care for rheumatoid arthritis: cross-sectional analyses of importance, level of implementation and care gaps experienced by patients and rheumatologists across 35 European countries

Objective

As part of European League against Rheumatism (EULAR)/European Musculoskeletal Conditions Surveillance and Information Network, 20 user-focused standards of care (SoCs) for rheumatoid arthritis (RA) addressing 16 domains of care were developed. This study aimed to explore gaps in implementation of these SoCs across Europe.

Methods

Two cross-sectional surveys on the importance, level of and barriers (patients only) to implementation of each SoC (0–10, 10 highest) were designed to be conducted among patients and rheumatologists in 50 European countries. Care gaps were calculated as the difference between the actual and maximum possible score for implementation (ie, 10) multiplied by the care importance score, resulting in care gaps (0–100, maximal gap). Factors associated with the problematic care gaps (ie, gap≥30 and importance≥6 and implementation<6) and strong barriers (≥6) were further analysed in multilevel logistic regression models.

Results

Overall, 26 and 31 countries provided data from 1873 patients and 1131 rheumatologists, respectively. 19 out of 20 SoCs were problematic from the perspectives of more than 20% of patients, while this was true for only 10 SoCs for rheumatologists. Rheumatologists in countries with lower gross domestic product and non-European Union countries were more likely to report problematic gaps in 15 of 20 SoCs, while virtually no differences were observed among patients. Lack of relevance of some SoCs (71%) and limited time of professionals (66%) were the most frequent implementation barriers identified by patients.

Conclusions

Many problematic gaps were reported across several essential aspects of RA care. More efforts need to be devoted to implementation of EULAR SoCs.

AB0020 CORRELATION BETWEEN SERUM AND SYNOVIAL CONCENTRATION OF IL-17A AND MIRNA EXPRESSION IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Interleukin 17 (IL-17) is a proinflammatory cytokine, which overproduction promotes the autoimmune reaction in rheumatoid arthritis (RA). Posttranscriptional regulation of IL-17 by specific microRNAs (miRNAs) is of great interest in the recent years. 146a was associated with IL-17 expression in IL-17 producing T-cells in the synovium when miR-155 enhanced Treg and Th17 cells differentiation and IL-17A production by directly targeting the suppressor of cytokine signaling (SOCS) 1 [1, 2]. It has been shown that IL-17 production in lymphocytes or its function could be regulated by miR-223 by targeting Roquin ubiquitin ligase or its receptors [3].

Objectives:

To examine a possible correlation between systemic and local concentrations of IL-17A and systemic and local miR-146a, miR-155 and miR-223 expression in RA patients.

Methods:

Expression levels of three miRNAs were determined in matched peripheral blood (PB) and synovial fluid (SF) samples of RA patients by relative quantitation method 2-ΔΔCt. As reference control for normalization RNU6B gene was used. Concentrations of IL-17A were compared between matched serum and SF samples from 20 RA patients by Human IL-17A ELISA kit (Gene probe, Diaclone, France). Healthy donors were used as controls.

Results:

miR-146a, miR-155 and miR-223 showed overexpression in RA SF when compared to HCs SF (in 70.83%, p=0.007; in 79.17%, p=1.63x10-4and in 79.17%, p=1.64x10-3, respectively). The ROC curve analysis showed diagnostic accuracy for miR-146a in SF with AUC=0.769, p=0.006, AUC for SF miR-155 was 0.858, p=2.3x10-4and AUC for SF miR-223 was 0.841 p=4.6x10-4. SF levels of miR-146a and miR-155 were overexpressed in 52.17% and in 76.09% of the RA patients compared to its systemic levels. SF miR-223 was underexpressed in 58.7% of the patients compared to its systemic levels. Levels of IL-17A were higher in RA SF compared to serum (8.645 pg/ml versus 0.315 pg/ml, p=0.012). ROC curve analysis for SF IL-17A showed area under the curve (AUC) = 0.885, p<0.000.

Conclusion:

The difference between the systemic and local concentration of IL-17A and miRNAs expression shows that the inflammatory disease process leads to their altered expression with a possible role of these molecules in the disease pathogenesis. The higher local levels of miR-155, miR-146 and IL-17A confirm the data about the possible role of these miRNAs in regulating IL-17A production. The opposite changes of IL-17A and miR-223 systemic and local levels confirm the data about the possible role of miR-223 in regulating IL-17 function. Further analysis with larger sets is needed to confirm these results.

References:

[1]Niimoto T, Nakasa T, Ishikawa M, Okuhara A, Izumi B, Deie M, et al. MicroRNA-146a expresses in interleukin-17 producing T cells in rheumatoid arthritis patients. BMC Musculoskelet Disord. 2010; 11:209.

[2]Yao R, Ma YL, Liang W, Li HH, Ma ZJ, Yu X. et al. MicroRNA-155 modulates Treg and Th17 cells differentiation and Th17 cell function by targeting SOCS1. PLoS ONE 2012; 7(10):e46082.

[3]Schaefer J, Nakra N, Montufar-Solis D, Vigneswaran N, Klein J. Role for miR-223 and Roquin in IL-10 mediated regulation of IL-17. J Immunol. 2013; 190 (1 Supplement) 171.9.

Acknowledgments:

The study was supported by Grant 14-D/2012, Grant 60/2013 and Grant 61/2015 from Medical University-Sofia, Bulgaria

Disclosure of Interests:

None declared

Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries

Objectives

To describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system’s performance, across European countries.

Methods

We conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates.

Results

Forty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (β=−0.5 (95% CI −0.9 to −0.2) and β=−0.5 (95% CI −1.0 to −0.1), respectively). The Scandinavian and Bismarckian system scored best on patients’ and rheumatologists’ perceptions of regulations and system performance.

Conclusions

There is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country’s wealth.

Whole peripheral blood miR-146a and miR-155 expression levels in Systemic lupus erythematosus patients

Objective: To evaluate the diagnostic value of peripheral blood microribonucleic acid (miRNA, miR)-146a and miR-155 expression in systemic lupus erythematosus (SLE). Methods: Expression levels of miR-155 and miR-146a in whole peripheral blood samples from 40 SLE patients and 32 healthy controls (HCs) were determined by quantitative reverse transcription-polymerase chain reaction qRT-PCR (SYBR Green technology) and 2-∆∆Ct method was used for analysis. SPSS v20 was used for receiver operating characteristic (ROC) curve and Spearman correlation analysis. Results: Whole peripheral blood expression levels of miR-146a and miR-155 were overexpressed in 62.5% and 50%, respectively, of the SLE patients compared to HCs. The ROC curve analysis showed that the expression levels of miR-146a could discriminate SLE patients from HCs with area under the curve (AUC)=0.711 (95% CI: 0.585÷0.837, p=0.002, with 82.5% sensitivity and 56.2% specificity. The diagnostic accuracy of miR-155 was lower with AUC=0.691 (95% CI: 0.566÷0.817, p=0.005, with 77.5% sensitivity and 50.0% specificity. The diagnostic accuracy did improve when combination of the studied miRNAs was used in multimarker ROC curve analysis (AUC=0.716, 95% CI: 0.590÷0.842, p=0.002, 82.5% sensitivity and 56.2% specificity). miR-146a and miR-155 showed correlation with the diagnosis (rs=0.363 and 0.330, respectively) and the age of the patients (rs =0.239 and 0.366, respectively), and miR-155 showed correlation with the presence of secondary Raynaud syndrome (Spearman correlation coefficient=0.250) Conclusions: Our data showed that the expression levels of miR-146a and miR-155 in PB could be used as diagnostic biomarkers for SLE patients but larger study is needed to confirm these results. Key words: peripheral blood, miRNA, expression, systemic lupus erythematosus, biomarker.

Acute necrotizing retinal vasculitis as onset of systemic lupus erythematosus: A case report

RATIONALE

Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by autoantibody production, complement activation, and deposition of immune complexes in tissues and organs. SLE can involve any region of the visual system. Although ocular manifestations are not part of the classification criteria for SLE, they can be observed in up to one-third of the patients with SLE. They are rarely reported at the time of disease onset. Retinal vasculitis is usually associated with active generalized disease. Due to its low frequency, we report a case of acute necrotizing retinal vasculitis as onset of SLE.

PATIENT CONCERNS AND DIAGNOSIS

A 25-year-old white female was referred to the rheumatology clinic with gradually and rapid deterioration of the vision due to abnormal vessel permeability in the right fundus with edema along the vessels, occlusion of arterial branches in the middle periphery with leakage of the dye in these areas and indentical but less prominent changes with cotton wool spots in the papillomacular area and extensive hemorrhages in the left eye. The onset of malar rash, arthralgias and positive antinuclear, anti-double stranded DNA, anti-ribosomal P and anti-β2 glycoprotein I antibodies with decreased C4 complement levels, as well as the positive lupus-band test confirmed the diagnosis of SLE.

INTERVENTIONS

Aggressive immunomodulating therapy with high-dose methylprednisolone, intravenous immunoglobulin, and cyclophosphamide was used for suppression of the disease activity followed by azathioprine as maintaince therapy.

OUTCOMES

Substantial improvement and partial resorption of the vasculitic changes, including central retinal artery and vein, was achieved prominently in the left eye. The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from the patient. Because of this, there is no need to conduct special ethic review and the ethical approval is not necessary.

LESSONS

Inclusion of ocular manifestations among the classification criteria for SLE would enable earlier establishment of the diagnosis and therapeutic interventions in some instances of SLE.

Angioid streaks in aagenaes syndrome

Aagenaes syndrome, also called lymphoedema cholestasis syndrome 1 (LSC1), is characterized by neonatal intrahepatic cholestasis, often lessening and becoming intermittent with age and severe chronic lymphoedema, mainly affecting the lower extremities. The condition is autosomal recessively inherited, and the gene is located on chromosome 15q. The locus, LCS1, was mapped to a 6.6 cM region on chromosome 15. Angioid streaks are visible irregular crack-like dehiscences in bruch's membrane that are associated with atrophic degeneration of the overlying retinal pigment epithelium. Angioid streaks have been described to be associated with pseudoxanthoma elasticum, paget's disease, sickle-cell anaemia, acromegaly, Ehlers-Danlos syndrome, and diabetes mellitus, but also appear in patients without any systemic diseases. Patients with angioid streaks are generally asymptomatic, unless the lesions extend towards the foveola or develop complications such as traumatic bruch's membrane rupture or macular choroidal neovascularization.

Adult Niemann-Pick disease type B with myositis ossificans: a case report

Niemann-Pick Disease (NPD) is a rare autosomal recessive lysosomal lipid storage disorder. The disease is caused by gene mutations that affect the metabolism of sphingolipids. The dysfunctions cause sphingomyelin to accumulate in different organs. NPD includes forms with low and high levels of sphingomyelin. We report a case of a 34 year-old man with a family history of NPD type B who presented with hepatosplenomegaly, neurological deficiency, bone abnormalities, and myositis ossificans. The clinical, biochemical, and imaging data confirmed the combined diagnosis of NPD type B with myositis ossificans.

[The influence of pregnancy on the systemic lupus erythematosus]

Systemic lupus erythematosus (SLE) is an autoimmune disease caused by the interaction between genetic and environment factors which leads to abnormal immune responses. SLE affects more commonly women of childbearing age which raises the following questions--the influence of the disease activity on pregnancy and the influence of pregnancy on disease activity. On the one hand physiological changes occurring during pregnancy could lead to increased SLE activity, on the other hand the latter could mimic SLE activity. Differentiating these manifestations is important for the clinical practice--pregnancy and delivering guidance and SLE therapy.