AB0638 INTRAVENOUS IMMUNOGLOBULIN IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS. STUDY OF 28 CASES FROM A SINGLE UNIVERISTARY HOSPITAL AND LITERATURE REVIEW

Background

Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) or microscopic polyarteritis (MPA). Standard treatment is often accompained by significant adverse events. Intravenous immunoglobulins (IVIG) may constitute a therapeutic alternative, however, the data are scarce.

Objectives

To assess the utility and safety of IVIG in AAV.

Methods

Observational study of patients with AAV from Spanish referral center treated with IVIG. AAV diagnosis was based on a compatible clinical presentation and/or positive ANCA serology and/or histology. Disease activity was assessed with the Birmingham Vasculitis Activity Score (BVAS).

Results

We included a total of 28 patients; GPA (n=15), MPA (10), and EGPA (3). The main features are summarized in Table 1. The reasons for using IVIG were: a) relapse/refractory disease (n=20), or presence/suspicion of infection (8). We observed a rapid and maintained Clinical improvement, since first month of IVIG onset, yielding a BVAS score of zero in 56.5% of patients at 24 months (Figure 1). Serious Adverse event was only observed in 1 patient who developed congestive cardiac failure and had to stop the IVIG therapy.

Table 1.

Main general features of 28 patients with antineutrophil cytoplasmic antibody-associated vasculitis treated with intravenous immunoglobulins.

GENERAL FEATURESRESULTSGENERAL FEATURES (Continuation)RESULTS (Continuation)DEMOGRAPHIC FEATURESANALITICAL FINDINGSAge of Diagnosis of AAV, mean±SD57.1±18CRP (mg/dL), median [IQR]13.02Men/ Women; n, (% men)15/13 (53.6%)ESR, mm/1st hour, median [IQR]70.4AAV Subtype, n (%)PR3-ANCA, n (%)11 (39.3)GPA15(53.6%)MPO-ANCA, n (%)12 (42.8)EGPA3(10.7%)ANCA negative, n(%)5 (17.8)MPA10(35.7%)FFS at AAV diagnosis, n (%)CLINICAL MANIFESTATIONS, n (%)010 (35.7)Fever15 (53.6%)111 (39.3)Constitutional symptoms26 (92.85%)27 (25)ORL involvement7 (25%)PREVIOUS TREATMENT, n (%)Pulmonary involvement19 (67.9%)Cyclophospamide13 (46.4%)Renal involvement25 (89.3%)Methotrexate6 (21.4%)Cutaneous involvement)6 (21.5%)Azathioprine3 (10.7%)Ocular involvement4 (14.3%)Cyclophosphamide13 (46.4%)Joint involvement4 (14.3%)Mycophenolate mofetil4 (14.3%)Neurologic involvement8 (28.57%)Rituximab5 (17.9%)

Abbreviations: ANCA:antineutrophil cytoplasmic antibody; EGPA: eosinophilic granulomatosis with polyangiitis; FFS: Five-Factors Score; GPA: granulomatosis with polyangiitis; MPA: microscopic polyangiitis

Figure 1.

BVAS Evolution with IVIG treatment of all our patients.

Conclusion

IVIG seems to be an effectiveness and relative safe therapeutic option in relapse/refractory AAV or in presence of a concomitant infection.

Disclosure of Interests

None declared

POS0997 CLINICAL FEATURES OF UVEITIS ASSOCIATED TO SPONDYLOARTHRITIS. SINGLE CENTER UNIVERSITY STUDY

Background

Uveitis is a frequent extraarticular manifestation of spondyloarthritis (SpAs). It has been classically reported that whereas uveitis in axial spondyloarthritis (ax-SpA) is predominantly anterior, unilateral, acute, and non-recurrent; in psoriatic arthritis (PsA) and in inflammatory bowel disease (IBD) it has been described as posterior, bilateral, insidious, and continuous [1,2].

Objectives

In a large unselected series of SpAs, our aim was to assess the epidemiology and clinical features of SpAs-associated uveitis.

Methods

Study of consecutive patients from a single University Hospital with a) ax-SpA, b) PsA, and c) IBD (Crohn’s disease and Ulcerative colitis). We have selected patients with uveitis that were classified according to Standarization Uveitis Nomenclature (SUN) Working Group. Main general features, and uveitis pattern, location and onset were recorded.

Results

We studied 2156 (1038 women/118 men) patients with SpAs: IBD (n= 1449; 67.2%); PsA (n= 406; 18.8%); and ax-SpA (n= 301; 14%).

Uveitis was present in 87 (4%) (102 eyes) of 2156 patients with SpAs. However, uveitis occurs with varying frequency according to the SpAs subtype:14.6% of axSpA (n=44), 4.9% of PsA (n=20), and 1.6% of IBD (n=23) (Table 1).

In the global SpAs, the most common pattern of uveitis was typically anterior (n=78; 89.7%), unilateral (n=72; 82.8%), acute (n=19; 82.6%), and non-recurrent (n=83; 95.4%).

The comparative study between these three groups of SpAs showed a significant greater frequency of HLA-B27 positive, anterior location and acute onset in ax-SpA-related uveitis (Table 1).

Table 1.

Main clinical features and uveitis pattern.

Ax-SpA (n=44)PsA (n=20)IBD (n=23)pMain general featuresAge, years, mean ±SD45.6 ± 10.343.1 ± 14.549.1 ± 14.60.472Sex, w/m, n, (% of women)25/19 (56.8)12/8 (60)17/6 (73.9)0.382Disease Duration, years, mean±SD18.6 ± 10.59.9 ± 8.217.4 ± 10.20.067HLA-B27 positive, n (%)37 (84.1)9 (45)5 (2.8)0.001*Uveitis locationAnterior, n (%)44 (100)16 (80)18 (78.3)0.006*Posterior, n (%)0 (0)0 (0)4 (17.4)-Panuveitis, n (%)0 (0)0 (0)1 (4.5)-Uveitis patternUnilateral, n (%)37 (84.1)16 (80)19 (82.6)0.922Uveitis onsetAcute, n (%)44 (100)20 (100)19 (82.6)0.003*

Conclusion

Although SpAs associated uveitis have different frequencies depending on the underlying disease, they share the same clinical pattern: anterior, unilateral, acute, and non-recurrent, in contrast with published data from selected series.

References

[1]Paiva ES, et al. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis. 2000; 59:67-70.

[2]Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol. 1997;115:61-4.

Disclosure of Interests

None declared

POS1351 CERTOLIZUMAB PEGOL VS ADALIMUMAB IN THE TREATMENT OF REFRACTORY CYSTOID MACULAR EDEMA DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY

Background

Cystoid Macular Edema (CME) is the leading cause of blindness in non-infectious uveitis. Behçet’s disease (BD) is one of the diseases most frequently associated with CME [1-4].

Objectives

to compare the efficacy and safety of Certolizumab (CZP) and Adalimumab (ADA) in CME due to BD refractory to conventional therapy.

Methods

multicenter study of patients with CME secondary to BD refractory to glucocorticoids (GC) and at least 1 conventional immunosuppressant. All patients had CME (OCT>300µ) at baseline. Efficacy was assessed with the following ocular parameters: macular thickness (µm), visual acuity (BCVA) and GC-sparing effect. The efficacy of CZP vs. ADA was compared between the baseline visit, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with IBM SPSS Statistics v.23.

Results

We studied 21 patients/38 affected eyes were studied. 10 patients were treated with CZP (200 mg c/2 weeks) and 11 with ADA (loading dose of 80 mg and subsequently 40 mg c/2 weeks).

No statistically significant baseline differences were observed in both groups (CZP vs. ADA) in sex (♂/♀; 3/7 vs 5/6; p=0.65) and mean age (36.1±8.0 vs 42.2±8.6; p=0.10). However, CZP group was more severe with a longer time between EB diagnosis and biologic initiation (91.6±71.4 vs 34.4±21.3 months, p=0.02), and a greater median [IQR] number of previous biologic drugs (2 [0.75-3] vs 0 [0-0]). In CZP group, 8 patients were previously treated with ADA.

Combined therapy with conventional DMARDs was used with ADA in 81.8% vs. 18.2% of CZP patients.

Regarding the efficacy outcomes analyzed, a rapid and maintained improvement in macular thickness, measured by OCT, was observed after 2 years of follow-up in both groups with no statistically significant differences between them (Table 1). Improvement in visual acuity and a GC-sparing effect was also observed (Table 1).

Table 1.

main ocular parameters compared in the CZP-treated group and in the ADA-treated group.

CZP(n=10)ADA(n=11)PBaseline  OCT (µm, mean±SD)380.7±96.4416.9±171.10.56 BCVA (mean±SD)0.72±0.300.57±0.200.21 Prednisone (mg/dl, mean±SD)13.1±11.434.1±18.90.071st month  OCT (µm, mean±SD)333.7±60.4302±44.20.19 BCVA (mean±SD)0.80±0.270.72±0.180.45 Prednisone (mg/dl, mean±SD)8.1±5.5112.1±6.40.316th month  OCT (µm, mean±SD)284.4±45.5272.8±38.90.53 BCVA (mean±SD)0.82±0.230.86±0.160.65 Prednisone (mg/dl, mean±SD)6.8±6.66.1±2.80.921st year  OCT (µm, mean±SD)269.0±46.8260.9±39.50.67 BCVA (mean±SD)0.82±0.230.89±0.170.48 Prednisone (mg/dl, mean±SD)6.2±3.05.8±2.10.872nd year  OCT (µm, mean±SD)289.4±49.3248.0±42.00.16 BCVA (mean±SD)0.87±0.200.87±0.171.0 Prednisone (mg/dl, mean±SD)3.7±1.23.1±2.30.90

No serious adverse events were observed in either group.

Conclusion

Our study suggests that both CZP and ADA are effective in the treatment of CME due to BD refractory to conventional treatment. CZP was equally effective despite most patients were refractory to ADA.

References

[1]Schaap-Fogler M, et al. Graefes Arch Clin Exp Ophthalmol. 2014 Apr;252(4):633-40. doi: 10.1007/s00417-013-2552-8.

[2]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020

[3]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300

[4]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019

Disclosure of Interests

None declared

POS1350 UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES TREATED WITH CERTOLIZUMAB PEGOL. MULTICENTER STUDY OF 80 PATIENTS

Background

Adalimumab remains the only biologic approved by the EMA and FDA for the treatment of non-infectious uveitis [1-6]. The reports on efficacy of other anti-TNF drugs such as Certolizumab Pegol (CZP) are scarce.

Objectives

to determine the efficacy and safety of CZP in refractory uveitis secondary to Immune-mediated Inflammatory Diseases (IMIDs).

Methods

national multicenter study of 80 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants treated with CZP. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. The efficacy of CZP was compared between the baseline visit, 1st week, 1st and 6th month, and 1st year. Statistical analysis was performed with IBM SPSS Statistics v.23.

Results

we studied 80 patients/111 affected eyes (33 men/47 women) with a mean age of 41.6±11.7 years. The IMIDs included were: spondyloarthritis (n=43), Behçet’s disease (10), psoriatic arthritis (8), Crohn’s disease (4), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (6). Anterior was the most frequent uveitis pattern (n=61).

In 20 patients, besides the presence of refractory uveitis, desire of pregnancy was the reason for CZP initiation.

Prior to CZP, patients had received: methotrexate (n=38), sulfasalazine (28), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (4), and cyclophosphamide (1). Previous biologic therapy was administered in 52 patients (63%), with a median [IQR] of 2 [1-3] drugs per patient. The most used biologic was adalimumab (n=48), followed by infliximab (32), golimumab (15), tocilizumab (5), etanercept (7), rituximab (1), anakinra (1) and secukinumab (1). CZP was administered as monotherapy in 39 patients.

After 24 [12-36] months of follow-up, all parameters analyzed showed a rapid and maintained improvement (Table 1). A decrease in the mean number of uveitis flares was observed before and after CZP, (2.6±2.3 vs. 0.6±0.4, p<0.001). CZP was discontinued in 16 patients due to: ocular remission (n=3), insufficient ocular response (4) and incomplete response of extraocular manifestations (9). No serious adverse effects were found.

Table 1.

main ocular parameters analyzed in 80 patients with uveitis due to IMID and treated with CZP.

Baseline1st week1st month3rd month6th month1st yearBCVA (mean±SD)0.68±0.270.73±0.26*0.79±0.26*0.82±0.25*0.85±0.24*0.86±0.23*Tyndall improvement, n (%)Patients with Tyndall + at baseline (n=57)-23 (40.3)45 (78.9)47 (82.4)57 (100)57 (100)Vitritis improvement, n (%)Patients with Vitritis at baseline (n=14)-5 (35.7)8 (57.1)13 (92.8)14 (100)14 (100)OCT (µm) (mean±SD)297.5±48.1297.1±45.5286.5±39.8*277.6±43.3*271.5±38.6*269.0±38.8*Choroiditis, affected eyes, n (%)3 (2.4)3 (2.4)2 (1.6)2 (1.6)1 (0.8)1 (0.8)Retinal vasculitis, affected eyes, n (%)3 (2.4)2 (1.6)1 (0.8)0 (0)0 (0)0 (0)

*p<0.01

Conclusion

CZP seems to be effective and safe in the control of uveitis associated to different IMIDs.

References

[1]Jaffe GJ, et al. N Engl J Med 2016;375:932-43. doi: 10.1056/NEJMoa1509852.

[2]Nguyen QD, et al. Lancet 2016;388:1183-92. doi: 10.1016/S0140-6736(16)31339-3.

[3]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020

[4]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300

[5]Atienza-Mateo B. Arthritis Rheumatol. 2019;71:2081-2089. doi: 10.1002/art.41026.

[6]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019

Disclosure of Interests

None declared

AB1310 JANUS KINASE INHIBITORS IN SEVERE AND REFRACTORY INFLAMMATORY OCULAR PATHOLOGY. CASES REPORTS AND LITERATURE REVIEW

Background

Inflammatory ocular pathology (IOP) includes internal and external involvement. IOP may be severe ocular conditions refractory to conventional immunosuppressants and even biological therapy. Janus Kinase inhibitors (JAKINIB) had shown efficacy in refractory cases of different immune-mediated inflammatory diseases (IMID).

Objectives

In patients with refractory IOP treated with JAKINIB our aims were a) to assess the patients of Spanish referral centers, b) Literature review.

Methods

Multicenter study of 6 patients with refractory IOP treated with JAKINIB. For Literature review a search was conducted in PubMed, Embase and the Cochrane library from their inception to 1st January 2022, and conference proceedings from four major rheumatology conferences. In addition, a therapeutical approach of refractory IOP is proposed.

Results

We have identified 6 cases in five University Hospitals and 11 cases in the literature review. These 17 patients (14 women/ 3 men) (24 affected eyes), mean age 35.5±23.4 years had different refractory IOP (uveitis=11; scleritis= 3, PUK= 3).

Most of IOP were associated with IMID (n=13, 76.5%). The main underlying IMID were juvenile idiopathic arthritis (n=5, 29.4%), rheumatoid arthritis (n=2, 11.8%) and spondyloarthritis (n=2; 11.8%) (Table 1).

Table 1.

Cases reports and Literature review

Study, yearCasesAge/ SexUnderlying IMIDJAKINIBOcular involvementPrevious immunosuppressive treatmentOcular Improvement(Ref)Meadow et al. 2014159, FRATOFAPUKMTX, ABA, ivMPPartial (PI)(1)Bauermann et al. 2018122, FJIATOFAA. uveitis, CMEMTX, ADA, RTX, GOLI, IFX, CsA, TCZ, MMFComplete (CI)(2)Paley et al. 201921.40, F1.Idiopathic1.TOFA1.Scleritis1.MTX, MMF, AZA, CYP1.CI(3)2.45, F2.Idiopathic2.TOFA2.A. uveitis, CME2.MTX, LFN, AZA, MMF, ADA, IFX, CZP, intravitreal fluocinolone ac.2.CILiu J et al. 2020130, MBehçet disTOFAScleritisSSZ, MTX, AZA, LFN, THD, COL, GLMPI(4)Majumder et al. 2020126, FVogt-Koyanagi- Harada disTOFAP. uveitisivMPCI(5)Miserocchi et al. 202041. 9, FJIA1. TOFA1. Panuv1. IFX, ADA, LFN, ABA, RTX, TCZ.1. CI2. 1, F2. BARI2. Panuv2. MTX, ADA, IFX, RTX, ABA.2. CI(6)3. 2, F3. BARI3. Panuv3. MTX, AZA, IFX, ADA, TCZ.3. CI4. 10, M4. BARI4. Panuv4. ETN, MTX, CsA, IFX, ADA, ABA, TCZ, RTX.4. CIPyare et al. 2020145, FIdiopathicTOFANecrotizing scleritisMMFCI(7)Present study, 202261. 25, F1. Blau Syndrome1. TOFA/BARI1. Panuv1.MTX, ETN, ANA, ABA1. CI2. 85, F2. RA2. BARI2. PUK2.MTX, LFN, CZP, ADA, iv MP.2. CI3. 41, F3. Relapsing polychondritis3. BARI3. PUK3. MTX, CsA, SSZ, MMF, AZA, IFX, TCZ, CZP, ABA, ADA.3. CI4. 65, F4. Idiopathic4. BARI4. Panuv4. MTX, AZA4. CI5. 59, M5. AS5. UPA5. A. uveitis5. MTX, ADA5. CI6. 40, F6. SpA and ulcerative colitis6. TOFA6. A. uveitis6. MTX, AZA, ADA6. CI

Uveitis (n=11) followed by ocular surface pathology (n=6) were the most frequent subtypes of IOP. Patterns of uveitis were panuveitis (n=6), anterior uveitis (n=4; 2 of them with Cystoid macular edema) and posterior (n=1). Ocular surface pathology was due to scleritis (n=3) and PUK (n=3).

Besides systemic corticosteroids, before JAKINIB, conventional (n= 16; 94.1%) and biological immunosuppressive drugs (n=13; 76.5%) were required. The JAKINIB most widely used was tofacitinib (n= 10; 58.8%) followed by baricitinib (n=7; 41.2%). In only one patient with Blau Syndrome and uveitis, tofacitinib was switched to baricitinib due to severe lymphopenia.

After starting JAKINIB treatment, all patients presented clinical improvement, complete (n=15, 88.2%) or partial (n= 2; 11.8%).

Based on these data a therapeutical approach of refractory IOP was proposed (Figure 1).

Figure 1.

Therapeutical approach

Conclusion

JAKINIB may be an effective and safe therapy in IOP refractory to conventional or even biological immunosuppressive therapy.

References

[1]Meadow PB. Case Rep Rheumatol. 2014.

[2]Bauermann P. Ocul Immunol Inflamm. 2019.

[3]Paley MA. Am J Ophthalmol Case Reports. 2019.

[4]Liu J. Ann Rheum Dis. 2020.

[5]D Majumder. Indian J Ophthalmol. 2020.

[6]Miserocchi E. Clin Rheumatol. 2020.

[7]Pyare E. Indian J Ophtalmol, 2020.

Disclosure of Interests

None declared

POS1467-HPR SEVERE RESPIRATORY INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS WITH BIOLOGIC THERAPY. COMPARATIVE STUDY BETWEEN VACCINATED AND NON VACCINATED PATIENTS

Background:

Rheumatoid arthritis (RA) patients are at increased risk of severe infections due to the disease itself, and the immunosuppressive treatment. Vaccination programs are designed to decrease the risk of infections.

Objectives:

In patients with RA treated with biologic therapy (BT) our aim was to assess a) the incidence of severe respiratory infections and b) to compare the risk between vaccinated and non vaccinated patients.

Methods:

Observational study of 431 patients diagnosed with RA that iniciated BT. One group of patients participated in a vaccination program from October 2011 to October 2016 (Group 1). The other group was not included in the vaccination program (Group 2). The follow-up was made until June 2017 with a minimum follow-up period of 8 months and a maximum of 5.5 years.

Information on severe respiratory infections, defined as those that required hospitalization or at least one dose of intravenous antibiotic treatment at the emergency room, was retrieved from the hospital medical records.

Results:

We studied 431 patients (335 women/96 men); mean age 63.4±13.7 years. In the vaccination program (group 1) were included 299 (69.37%) patients and in the group 2 132 patients (30.63%). The main features of both groups are summarized in Table 1.

During the follow-up, we registered 299 hospital admissions due to severe respiratory infections in both groups (incidence density 9.9 (95% CI: 6.9-13.6).

In group 1, vaccinated patients, this incidence density was reduced to 7.1 (95% CI: 4.1-11.6). Figure 1.

The vaccination program reduced the general incidence of severe respiratory infection in 44%.

Conclusion:

RA patients with BT included in the vaccination program present a lower incidence of severe respiratory infections compared with non vaccinated patients.

Table 1.

Main general features at BT onset

Group 1Vaccination programN=299Group 2Non vaccination programN=132pAge (years) mean±SD61.32±13.0467.97±14.170.32Women, n (%)231 (77.3%)105 (79.5%)0.59Duration of RA (months) mean±SD73.24±10.4112.62±60.2Positive RF/ Positive ACPA, n (%)177(59.2)/172 (57.52%)93(70.5%)98 (74.24%)0.02/0,01Erosive disease, n (%)116 (38.8%)70 (53%)0.06Vasculitis, n (%)15 (5%)2 (1.5%)0.08Interstitial lung disease n (%)12 (4%)7 (5.3%)0.54Subcutaneous nodules n (%)16 (5.4%)6 (4.5%)0.72Corticosteroids299 (100%)132 (100%)1Number of conventional DMARDs, mean±SD1.66±0.892.03±1.050.3Figure 1.

Disclosure of Interests:

None declared

POS1407 COMPARISON OF CAROTID SUBCLINICAL ATHEROSCLEROSIS AND STRUCTURAL DAMAGE IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY WITH 886 PATIENTS. . A MULTICENTER STUDY WITH 886 PATIENTS

Background:

The prevalence of inflammatory bowel disease (IBD) in ankylosing spondylitis (AS) has been reported to range between 6%-15%. As occurs with axial spondyloarthrtitis (axSpA), patients with IBD have an increased risk of cardiovascular (CV) events because of a process of accelerated atherosclerosis1. However, it is unknown whether the presence of IBD confers an increased cardiovascular CV risk in patients with axSpA.

Objectives:

To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without IBD.

Methods:

Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant IBD. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.

Results:

A set of 886 axSpA patients were included. 829 (93.6%) of them had no concomitant IBD, which was present in 57 (6.4%) patients. Age, sex and AS/nr-axSpA ratio were comparable in both groups (Table 1. next page). Patients with IBD were characterised by a lower prevalence of HLA B27 (46% vs 72%, p=0.01) and a higher presence of concomitant psoriasis (21% vs 10%, p=0.01)

Regarding peripheral disease (history of synovitis, enthesitis, dactylitis) and hip involvement, no differences were found between both groups. There were either no differences in the structural damage found in patients with and without IBD (Table 1. next page).

With respect to the management of the disease, prednisone (21% vs 13%, p = 0.03), DMARDs (54% vs 35%, p = 0.01) and anti-TNFα therapy (54% vs 31%, p = 0.00) were more commonly used in the group with IBD, while treatment with NSAIDs was more frequent in patients without IBD (81% vs 70%, p = 0.04).

Regarding CV risk features, smoking was more frequent in patients without IBD (34% vs 21%, p = 0.045) (Table 1. next page). No differences were observed neither in the lipid profile or blood pressure at the time of the study, nor in the prevalence of CV events (5% vs 4%, p=0.99) (Table 1) and the subclinical atherogenic burden assessed both by the presence of carotid plaques (31% vs 37%, p=0.45) and the cIMT (645 ± 147 mm vs 636 ± 112 mm, p = 0.64) (Table 1. next page).

Conclusion:

The presence of IBD does not confer additional CV risk to axSpA. In our series, patients with axSpA and IBD showed a lower frequency of HLA B27 and a higher prevalence of psoriasis.

Table 1.axSpA without IBD (n=829)axSpA with IBD (n=57)pMen/Women, n272/55715/420.33Mean age (years) ±SD at the time of study49 ± 1349 ± 100.99AS/nr-AxSpa656/17345/120.97History of CV risk factors Current smoker285 (34)12 (21)0.045 Obesitty Dyslipemia280 (34)16 (28)0.42 Hypertension223 (27)16 (28)0.79 Diabetes Mellitus60 (7)4 (7)0.99 Chronic Kidney Disease20 (2)2 (4)0.65History of cardiovascular events, n (%)40 (5)2 (4)0.99Structural damage at the time of studyPresence of syndesmophytes, n (%)307 (37%)23 (49%)0.66mSASSS5 (1-15)6 (3-23)0.64Severe sacroiliitis (grade 3,4), n (%)436 (53)34 (60)0.42CV data at the time of studyCarotid plaques261 (31)21 (37)0.45IMT (mm)645 ± 147636 ± 1120.64IMT >= 0.9 mm46 (6)0 (0)0.066

Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IBD = Inflammatory bowel disease. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.

Disclosure of Interests:

None declared

AB0574 UVEITIS IN 406 PATIENTS WITH PSORIATIC ARTHRITIS. STUDY FROM A SINGLE UNIVERSITARY CENTER

Background:

Uveitis is an extraarticular manifestation of psoriatic arthritis (PsA) and it has been described as the most frequent ocular manifestation in PsA. Uveitis in PsA has been described to be more likely insidious in onset, continuous, posterior, and active bilaterally compared with uveitis in patients with Spondyloarthritis (Paiva ES, et al. Ann Rheum Dis. 2000;59: 67-7). Anti-TNF agents, especially monoclonal antibodies have been effective in prevention and treatment of refractory non-infectious uveitis.

Objectives:

Our aim was to assess a) epidemiology and clinical features of uveitis associated to PsA, b) to compare patients who developed uveitis and those who did not and c) its relationship with biological treatment used in PsA.

Methods:

We conducted a cross-sectional study of 406 patients with PsA from a single reference University Hospital with: a) PsA classified by CASPAR criteria and, b) diagnosis of uveitis by expert ophthalmologists. Demographic features, clinical findings, complementary tests, occurrence of other extraarticular manifestations and treatment were recorded.

Results:

We studied 406 (202 women/204 men) patients with PsA, mean age of 46.3±12.3 years.

Uveitis was observed in 20 (12 women/8 men) of 406 patients (prevalence 4.9%); mean age of 43.1±14.5 years. Uveitis was most frequently anterior (80%), unilateral (80%), of acute onset (100%), and recurrent (50%).

In the comparative study between patients who developed uveitis and who did not (Table 1), in patients with uveitis was more frequent the presence of HLA-B27 positive (45%), sacroiliitis in MRI (25%), ocular surface pathology (10%), and higher mean PsAID score (4.8±2.5).

Ten (50%) patients with PsA related uveitis received biological therapy, 12 (60%) of the treatments were anti-TNF monoclonal antibodies and 1 (5%) was etanercept. The 2 (10%) remaining therapies were other biological therapy non anti-TNF (Figure 1).

Figure 1.

Biologic immunosuppressive drugs in PsA patients related uveitis.

Conclusion:

Uveitis was observed in 4.9% of patients with PsA.Most of the PsA related uveitis had an acute onset with anterior and unilateral pattern. HLA-B27 positive, presence of sacroiliitis on MRI and ocular surface pathology were more frequent in patients who developed uveitis. PsAID score is higher in patients with uveitis.

Table 1.

General features of 406 patients with PsA. Comparison between with and without uveitis.

Overall(n= 406)Uveitis(n= 20)Non uveitis(n= 386)pMain general featuresAge, years, mean±SD46.3±12.343.1±14.546.5±12.20.225Sex, women/men, N (% of women)202/204(49.8)12/8 (60)218/168 (56.5)0.757HLAB-27 positive, N (%)38(9.4)9 (45)29 (7.5)0.000*PsA patternAxial pattern, N (%)48 (11.8)4 (20)44 (11.4)0.277Peripheral pattern, N (%)236 (58.1)12 (60)224 (58)0.862Mixed pattern, N (%)122 (30.1)4 (20)118 (30.6)0.315PsA ScoresPsAID, mean±SD3±2.44.8±2.52±2.60.003*Radiological featuresSacroiliitis on MRI, N (%)37 (9.1)5 (25)32 (8.3)0.027*Other extraarticular manifestationsInflammatory bowel disease, N (%)21 (5.2)2 (10)19 (4.9)0.277Ocular surface pathology, N (%)5 (1.2)2 (10)3 (0.8)0.021*Biologic treatmentsbDMARDs, N (%)280 (68.9)15 (75)265 (68.7)0.550Etanercept31 (7.6)1 (5)30 (7.8)0.999TNFi monoclonal antibodies160 (39.4)12 (60)148 (38.3)0.053

Disclosure of Interests:

A. De Vicente-Delmás: None declared., Lara Sanchez-Bilbao: None declared., David Martínez-López: None declared., Iñigo González-Mazón: None declared., Vanesa Calvo-Río Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal and UCB Pharma, Grant/research support from: MSD and Roche, Nuria Barroso García: None declared., Natalia Palmou-Fontana Speakers bureau: Celgene, AbbVie, Lilly, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD, Grant/research support from: AbbVie, MSD, and Roche.

POS0977 CARDIOVASCULAR AND DISEASE RELATED FEATURES IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT PSORIASIS. A MULTICENTER STUDY WITH 882 PATIENTS

Background:

Patients with axial spondyloarthritis (axSpA) may present with concomitant psoriasis (Ps) in approximately 10% of cases. As with axSpA, Ps is also associated with an accelerated atherosclerosis process1. However, it is unknown whether the presence of Ps confers an increased cardiovascular (CV) risk in patients with axSpA.

Objectives:

To compare factors related to the disease, CV risk factors, atherosclerotic burden, and CV events in patients with axSpA with and without Ps.

Methods:

Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA. We compared axSpA patients with and without concomitant psoriasis, focusing mainly on CV risk characteristics. Background information on CV risk factors, CV events, and disease-related factors was reviewed, and data on maximum body index, blood pressure, lipid profile, and disease status at the time of the study were also obtained. Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.

Results:

A set of 882 axSpA patients were included. 786 (89.1%) of them had no concomitant Ps, which was present in 96 (10.9%) patients. Although the mean age was similar, male sex was more prevalent in axSpA patients with Ps (79.1% Vs 66.5%, p=0.01) (Table 1).

Furthermore, it was found that axSpA with Ps had a more frequent history of synovitis (50% vs 33%, p = 0.001), dactylitis (13% vs 6%, p = 0.011) and concomitant inflammatory bowel disease (13% vs 6%, p = 0.01). AxSpA patients with Ps had a non-significant trend towards a higher prevalence of asymmetric sacroiliitis (23 vs 16%, p = 0.064) and had a lower frequency of positive HLA-B27 status (56% vs 72%, p = 0.003). Regarding the management of the disease, prednisone (23% vs 12%, p = 0.02), methotrexate (30% vs 15%, p = 0.000) and anti-TNFα therapy (50% vs 34%, p = 0.002) were more commonly used in the group with Ps.

Regarding CV risk characteristics, no differences were observed either in the prevalence of traditional CV risk factors (Table 1), nor in the total serum level, HDL and LDL, blood pressure and body mass index at that time of the study. However, axSpA patients with Ps showed a higher prevalence of CV events (9% vs 4%, p = 0.05), including ischemic heart disease (6% vs 3%, p = 0.042) and ischemic stroke (4% vs 1%, p = 0.016) (Table 1). The subclinical atherogenic burden was also more severe in the group with Ps, with a higher prevalence of carotid plaques (39% vs 31%, p = 0.098), and higher values of cIMT (0.664 ± 0.170 mm vs 0.642 ± 0.142 mm, p = 0.16), although the differences did not reach statistical significance.

Table 1.

Main sociodemographic and cardiovascular differences among axSpA patients with and without psoriasis.

axSpA without psoriasis (n=786)axSpA with psoriasis (n=96)pMen/Women, n523/26876/200.010Mean age (years) ±SD at the time of study49 ± 1349 ± 130.81AS/nr-AxSpa625/16677/190.79History of CV risk factors Current smokers267 (34)30 (31)0.60 Obesitty174 (22)26 (27)0.29 Dyslipidemia262 (33)35 (36)0.48 Hypertension211 (27)28 (29)0.57 Diabetes Mellitus56 (7)8 (8)0.65 Chronic Kidney Disease19 (2)3 (3)0.72History of cardiovascular events, n (%)33 (4)9 (9)0.023 Ischemic heart disease20 (3)6 (6)0.042 Congestive heart failure2 (0)1 (1)0.29 Ischemic stroke6 (1)4 (4)0.016 Peripheral artery disease6 (1)0 (0)0.99CV data at the time of studyCarotid plaques244 (31)38 (39)0.098IMT mm0.642 ± 0.1420.664 ± 0.1700.16IMT >= 900 mm40 (5)6 (6)0.66

Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.

Conclusion:

The presence of Ps may confer additional CV risk to axSpA patients and is associated with particular disease related factors.

References:

[1]Fang N, Jiang M, Fan Y. Association Between Psoriasis and Subclinical Atherosclerosis: A Meta-Analysis. Medicine (Baltimore). 2016;95(20):e3576.

Disclosure of Interests:

None declared.

POS1390 COMPARISON OF CAROTID SUBCLINICAL ATHEROSCLEROSIS AND STRUCTURAL DAMAGE IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT ANTERIOR UVEITIS. A MULTICENTER STUDY WITH 886 PATIENTS

Background:

Anterior uveitis (AU) is one of the most frequent extra articular manifestations of axial spondyloarthritis (axSpA), present in around 25% of patients. As with axSpA, AU has also been associated with the development of accelerated atherosclerosis1. If the presence of AU confers an increased cardiovascular (CV) risk or specific disease-related features to patients with axSpA remains unclear.

Objectives:

To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without AU.

Methods:

Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant uveitis. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.

Results:

A set of 886 axSpA patients were included. 709 (80.0%) of them had no history of concomitant AU, which was present in the remaining 177 (20.0%). The group with AU was older (50 ± 11 vs 48 ± 13 years, p=0.05), had a higher proportion of patients with AS (90.1% vs 76.3%, p=0.00) (Table 1) and a longer disease duration 13(7-23) vs 7(2-16) years, p=0.00]. The prevalence of HLA-B27 was higher in AU patients (82% vs 67%).

Remarkably, structural damage showed interesting differences between both groups (Table 1). AU patients had a higher prevalence of severe sacroiliits (69% vs 49%, p=0.00), which remained significant after adjustment for age, disease duration and AS/nr-axSpA ratio. Furthermore, a non-significant trend towards a higher prevalence of syndesmophytes (44% vs 36%, p=0.06) and hip involvement (20% vs 15%, p=0.09) was observed in the group of AU.

Regarding CV risk features, no differences were observed in the prevalence of CV risk factors and events (Table 1). Patients with AU showed a higher cIMT in the crude analysis (665 ± 156 mm vs 640 ± 142 mm, p = 0.047), but no significant differences were observed after adjustment by age and sex (p=0.6). Prevalence of carotid plaques was comparable in both groups (32% Vs 32%, p=0.84).

Table 1.axSpA without uveitis (n=709)axSpA with uveitis (n=177)pP (adjusted model)Men/Women, n477/232122/550.68Mean age (years) ±SD at the time of study48 ± 1350 ± 110.049AS/nr-AxSpa541/168160/170.000History of CV risk factors, n (%) Current smoker247 (35)50 (28)0.096 Obesitty Dyslipemia233 (33)63 (36)0.48 Hypertension188 (27)50 (28)0.63 Diabetes Mellitus50 (7)14 (8)0.69 Chronic Kidney Disease18 (3)4 (2)0.99History of cardiovascular events, n (%)29 (4)12 (7)0.13Structural damage at the time of studyPresence of syndesmophytes, n (%)253 (36)77 (44)0.063mSASSS5 (1-15)6 (0-16)0.31Severe sacroiliitis (grade 3,4), n (%)348 (49)122 (69)0.0000.000*Carotid US data at the time of studyCarotid plaques, n (%)225 (32)57 (32)0.84IMT (mm)640 ± 142665 ± 1560.0470.6**IMT >= 0.900 mm36 (5)10 (6)0.72

*: adjusted by age, disease duration and AS/nr-axSpA ratio

**: adjusted by age and sex

Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.

Conclusion:

The presence of AU does not confer additional CV risk to axSpA patients, although it is associated with a more severe structural damage in our series.

References:

[1]Conkar S, Güven Yilmaz S, Koska İÖ, Berdeli A, Mir S. Evaluation of development of subclinical atherosclerosis in children with uveitis. Clin Rheumatol. 2018 May;37(5):1305-1308.

Disclosure of Interests:

None declared

POS1357 OCULAR SCLERAL PATHOLOGY. UNDERLYING DISEASES AND SYSTEMIC TREATMENT. STUDY OF 175 PATIENTS FROM A SINGLE UNIVERSITY CENTER

Background:

Ocular scleral pathology (OSP) includes episcleritis and scleritis. Episcleritis is generally a benign disease with a self-limited course, while scleritis is a more severe ocular condition. In some severe and refractory cases systemic therapy may be required.

Objectives:

In a wide series with OSP our aim was to assess a) underlying diseases and b) systemic treatment.

Methods:

Study of unselected all consecutive patients studied in a single University Hospital during the last ten years with: a) episcleritis and b) scleritis diagnosed by clinical features and slit-lamp (Watson and Hayreh criteria). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured at diagnosis and after systemic treatment.

Results:

We studied 175 patients (106 women/ 69 men) /212 affected eyes with OSP (episcleritis=135; scleritis=40); mean age 48.9±14.2 years.

OSP was unilateral in 138 (78.9%), recurrent in 74 (42.9%) and chronic in 21 (12%). Most of them were idiopathic (n=81, 46.3%) while associated with IMID were 43.4% (Table 1). The most important underlying IMID were spondyloarthritis and inflammatory bowel disease, without significant differences between scleritis and episcleritis. Granulomatosis with polyangiits and systemic lupus erythematosus were more frequent in scleritis, not reaching statistical significance.

Regarding treatment, topical treatment was used in all patients. 41.1% received systemic treatment, including systemic glucocorticoids, cDMARDS and bDMARDs. Systemic glucocorticoids and Methotrexate were used more frequently in scleritis (Table 1). The main indication for biologic therapy was related to underlying IMID in both groups, but 7 bDMARDs in scleritis were indicated for systemic and ocular compromise.

BVCA and IOP improved significantly after systemic treatment in scleritis (Figure 1).

Figure 1.

BVCA and IOP at diagnosis and last visit.

Conclusion:

OSP is a relatively frequent entity. It is necessary to exclude an underlying systemic disease to establish correct systemic treatment.

Table 1.

Underlying diseases and systemic treatment.

Overall(n =175)Episcleritis(n=135)Scleritis(n=40)pAge (years), mean ± SD48.9 ± 14.247.8 ± 14.352.6 ± 13.90.061Sex (women), n (%)106 (60.6)81 (60)25 (62.5)0.920UNDERLYING DISEASE-Idiopathic, n (%)81 (46.3)65 (48.1)16 (40)0.364-Infectious, n (%)11 (6.3)7 (5.2)4 (10)0.276-IMID, n (%)76 (43.4)57 (42.2)19 (47.5)0.563∘Spondyloarthritis21 (12)17 (12.6)4 (10)0.787∘Crohn’s disease16 (9.1)14 (10.4)2 (5)0.469∘Rheumatoid Arthritis14 (8)12 (8.9)2 (5)0.740∘Granulomatosis with polyangiits7 (4)3 (2.2)4 (10)0.080∘Relapsing polychondritis6 (3.4)4 (3)2 (5)0.621∘Systemic lupus erythematosus5 (2.9)2 (1.5)3 (7.5)0.079∘Ulcerative colitis3 (1.7)2 (1.5)1 (2.5)0.796SYSTEMIC TREATMENT72 (41.1)37 (27.4)35 (87.5)0.000*-Systemic glucocorticoids, n (%)72 (41.1)37 (27.4)35 (87.5)0.000*-Methotrexate, n (%)39 (22.3)17 (12.6)22 (55)0.000*-Non-methotrexatecDMARD, n (%)35 (20)24 (17.8)11 (27.5)0.177-TNFibDMARD, n (%)27 (15.4)19 (14.1)8 (20)0.362-Non-TNFibDMARD, n (%)8 (4.6)5 (3.7)3 (7.5)0.386

*p<0,05

*p<0,05

Disclosure of Interests:

Lara Sanchez-Bilbao: None declared, Vanesa Calvo-Río Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal and UCB Pharma., Grant/research support from: MSD and Roche, José Luis Martín-Varillas: None declared, Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, Iñigo González-Mazón: None declared, Rosalía Demetrio-Pablo: None declared, Miguel A González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Celgene and MSD. Ricardo, Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: AbbVie, MSD and Roche

OP0060 COMPARATIVE STUDY ON ANTI-TNF VS TOCILIZUMAB FOR TREATMENT OF REFRACTORY UVEITIC CYSTOID MACULAR EDEMA DUE TO BEHCET’S DISEASE. MULTICENTER STUDY OF 49 PATIENTS

Background:

Posterior segment involvement is the most serious affection of uveitis in Behçet’s disease (BD), with cystoid macular edema (CME) being the leading cause of blindness. Anti-TNF, especially adalimumab (ADA) and infliximab (IFX), have demonstrated efficacy as first-line biologic agents in BD-related uveitis [1,2]. Moreover, the anti-IL6R tocilizumab (TCZ) has shown excellent results in highly refractory BD-uveitis and noninfectious uveitic CME [3-6].

Objectives:

To compare the efficacy of ADA vs IFX vs TCZ in patients with refractory CME due to BD.

Methods:

Observational multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. CME was defined as macular thickness > 300μm (measured by optic coherence tomography). We analyzed in the 3 groups of treatment (ADA, IFX, TCZ) from baseline up to 4 years the evolution of macular thickness (main outcome) and best-corrected visual acuity (BCVA). Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the 3 groups.

Results:

A total of 49 patients were included. ADA was used in 25 patients (40 eyes with CME), IFX in 15 (21 eyes with CME) and TCZ in 9 (11 eyes with CME). No statistically significant baseline differences were observed between the 3 groups (Table) except for previous anti-TNF therapy, which was used only in patients treated with TCZ (5 patients received ADA, 1 received IFX and 2 received both ADA and IFX, in different times). Most patients from all groups had received several conventional immunosuppressive drugs. Biological therapy was used in monotherapy or combined with azathioprine (n=10, 5 and 1 in ADA, IFX and TCZ group, respectively), cyclosporine A (n=10, 5 and 1) or methotrexate (n=4, 2 and 3). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment. Similarly, BCVA improvement and inflammatory ocular remission was reached in all groups (Figure).

Table 1.

Demographic and clinical characteristics of 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ.

ADA (n=25)IFX (n=15)TCZ (n=9)Eyes with cystoid macular edema, n402111Age, years41 ± 1138 ± 943 ± 16Sex, men/women12/137/85/4HLA–B51 +, n19106Duration of uveitis before anti-TNF/ anti-IL6R, months30 [12-82]15 [8-60]32 [24-144]Ocular features at start of anti-TNF/anti-IL6R Macular thickness, μm432 ± 118483 ± 126417 ± 113 Visual acuity, BCVA0.4 ± 0.20.3 ± 0.20.2 ± 0.2 Tyndall, inflammation grade2 [1-3]1 [0-1.5]1 [0-1.5] Vitritis, inflammation grade2.5 [1.5-3]1 [0-2]2 [1-2]Previous treatment, n Oral glucocorticoids // i.v. pulse methylprednisolone18 // 134 // 97 // 8 MTX //CsA //AZA13 // 22 // 148 // 13 // 88 // 6 // 2 ADA // IFX0 // 00 // 07 // 3Prednisone dosage at start of anti-TNF/anti-IL6R, mg/day45 [30-60]30 [20-60]30 [30-30]Combined treatment, n CsA // AZA // MTX10 // 10 // 45 // 5 // 21 // 1 // 3

Data are presented as mean ± SD or median [IQR] when data were not normally distributed. ADA, adalimumab; AZA, azathioprine; CsA, cyclosporine A; MTX, methotrexate; IFX, infliximab; TCZ, tocilizumab.

Figure 1.

Evolution of ocular parameters in 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ.

Conclusion:

Refractory CME associated to BD’s uveitis can be effectively treated with ADA, IFX or TCZ. Moreover, TCZ is effective in patients resistant to anti-TNF therapy.

References:

[1]Arthritis Rheumatol. 2019;71(12):2081-2089. doi: 10.1002/art.41026

[2]Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020

[3]Rheumatology (Oxford). 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480

[4]Am J Ophthalmol.2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019

[5]Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7. PMID: 25005576

[6]Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359

Disclosure of Interests:

None declared

POS1340 MULTICENTER STUDY OF 71 PATIENTS WITH REFRACTORY UVEITIS RELATED TO IMMUNE-MEDIATED INFLAMMATORY DISEASES ON CERTOLIZUMAB PEGOL TREATMENT

Background:

Prognosis of non-infectious refractory uveitis has improved markedly with biologic therapy (BT) (1-5). Most data are with monoclonal anti-TNF drugs, especially Adalimumab (ADA) and Infliximab (IFX). However, there is not enough evidence for the use of Certolizumab Pegol (CZP).

Objectives:

To evaluate the efficacy and safety of CZP in refractory uveitis secondary to Immune-Mediated Inflammatory Diseases (IMID).

Methods:

Multicenter study of 71 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. These outcomes were compared between baseline, 1st week, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with IBM SPSS Statistics v.23.

Results:

71 patients/100 affected eyes (29 men/42 women) with mean age of 40.0±11.3 years were studied. Underlying IMIDs were: spondyloarthritis (n=38), Behçet (10), psoriatic arthritis (8), Crohn disease (3), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (3). Uveitis pattern was anterior (n=55), posterior (6), panuveitis (6) and intermediate (4).

Prior to CZP, patients had received: methotrexate (37), sulfasalazine (26), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (3) and cyclophosphamide (1). Previous BT was administered in 48 (67.6%) patients, with a mean of 1.4±1.3 drugs per patient as follows: ADA (n=56), IFX (27), golimumab (14), tocilizumab (5) and etanercept (3). Pregnancy was the reason for prescribing CZP in 19 patients. CZP was administered in monotherapy (n=39) or combined with conventional immunosuppressants (n=32).

After a mean follow-up of 27.1±21.1 months, most of the ocular variables showed a rapid and significantly improvement (Table 1). A decrease in the median number [IQR] of flares of uveitis before and after CZP, (3 [1-4] vs. 0 [0-1], p<0.001) was observed. CZP was discontinued in 15 patients due to remission (n=2), ocular insufficient response (2) and incomplete response of extraocular manifestations (11). No serious adverse events were reported.

Conclusion:

CZP seems to be effective and safe in patients with refractory uveitis due to IMID.

References:

[1]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451. doi: 10.1016/j.ophtha.2018.02.020.

[2]Atienza-Mateo B, et al. Arthritis Rheumatol 2019; 71:2081-2089. doi: 10.1002/art.41026.

[3]Santos-Gómez M, et al. Clin Exp Rheumatol 2016; 34(6 Suppl 102):S34-S40. PMID: 27054359

[4]Vegas-Revenga N, et al. Am J Ophthalmol 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019

[5]Calvo-Río V, et al. Clin Exp Rheumatol. 2014; 32 (4 Suppl 84):S54-7. PMID: 25005576

Table 1.Baseline1stweek1stMonth6thMonth1styear2ndyearBCVA (mean±SD)0.68±0.270.72±0.27*0.79±0.25*0.84±0.24*0.85±0.25*0.87±0.22*Improvement in AC Cells, n (%)Patients with AC cells at baseline (n=48)-21 (43.7)30 (62.5)*41 (85.4)*48 (100)*48 (100)*Improvement in Vitritis, n (%)Patients with vitritis at baseline (n=13)-3 (23.1)8 (61.5)*11 (84.6)*13 (100)*13 (100)*OCT (µ) (mean±SD)292.5±47.7294±47.4286.7±41.9*274.7±38.7*272.8±38.9*266.31±36.2*Choroiditis; affected eyes, n, (%)3 (4.2)3 (4.2)2 (2.8)2 (2.8)1 (1.4)0 (0)Retinal Vasculitis; affected eyes, n, (%)2 (2.8)0 (0)1 (1.4)0 (0)0 (0)0 (0)

*p<0.001

Disclosure of Interests:

None declared

AB0771 HIGH DOSE INTRAVENOUS METHYLPREDNISOLONE INDUCES RAPID IMPROVEMENT OF VISUAL ACUITY IN NON-INFECTIOUS UVEITIS OF DIFFERENT IMMUNE MEDIATED INFLAMMATORY DISEASES

Background:

Rapid and effective remission-inducing therapy is mandatory in uveitis to avoid irreversible structural and functional damage. In some severe cases biological agents might be required (1-6).

High-dose intravenous methylprednisolone (IVMP) may achieve prompt control of inflammation in most immune mediated inflammatory diseases (IMID), including non-infectious uveitis (NIU).

Objectives:

To evaluate the efficacy and safety of IVMP pulse therapy in NIU of different IMID.

Methods:

Multicentre study of 71 patients with severe uveitis who received IVMP. The underlying diseases were: Vogt Koyanagy Harada disease (VKHD) (n=24), Behçet disease (BD) (19), Sarcoidosis (5) and idiopathic NIU (23). The main outcome variable was Best-Corrected Visual Acuity (BCVA) estimated using the Snellen chart. BCVA that was assessed at 0 (basal), 2-5, 7, 15 and 30 days after IVMP.

The results are expressed as mean ±SD in normally distributed variables, or as median [IQR] when are not. Comparison of continuous variables was performed using the Wilcoxon test.

Results:

We studied 46♀/ 25♂ patients. The main features are shown in Table 1. IVMP dose ranged from 250 to 1000 mg/day administered for 3-5 consecutive days, the dose was established according to the presence or not of other systemic manifestations apart from uveitis. All of them had active intraocular inflammation at the moment of the study. BCVA values improved considerably after 1 month (Figure 1). No major side effects were observed.

Figure 1.

Improvement of best corrected visual acuity (BCVA).

Conclusion:

High-dose IVMP pulse therapy is useful and safe for a prompt control of BCVA regardless of the underlying IMID.

References:

[1]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019

[2]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7. PMID: 25005576

[3]Santos-Gómez M, et al. Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359

[4]Atienza-Mateo B, et al. Rheumatology (Oxford) 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480.

[5]Atienza-Mateo B, et al. Arthritis Rheumatol. 2019; 71(12):2081-2089. doi: 10.1002/art.41026.

[6]Martín-Varillas JL, et al. Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020

Table 1.

Main features of 71 patients with NIU. Data are of affected eyes.

VKHD(n=24)Idiophatic(n=23)Behcet’s disease (n=19)Sarcoidosis(n=5)Overall(n=71)Men/Women, n5/199/149/102/371Mean age (years) ±SD42 ±1147 ± 1533±1042 ± 22-Unilateral/Bilateral NIU, n (%)2 (8.3)/22(91.7)10 (43.5)/13(56.5)4 (21)/15 (79)3(60)/2(40)19/52NIU patterns, n (%) Posterior uveitis6 (25)9 (39.1)3 (15.8)1 (20)19 Panuveitis18 (75)14 (60.9)16 (84.2)4 (80)52Laboratory data, n (%) ANA2 (8.34)2 (8.7)0 (0)1 (20)5 HLA B270 (0)4 (17.4)0 (0)0 (0)4 HLA B290 (0)1 (4.3)0 (0)0 (0)1 HLA B510 (0)5 (21.7)8 (42)3 (60)16 Angiotensin Converting Enzyme (ACE)1 (4.17)2 (8.7)0 (0)1 (20)4

Disclosure of Interests:

None declared

POS0934 BIOLOGICAL THERAPY IN UVEITIS ASOCIATED TO AXIAL SPONDYLOARTHRITIS. SINGLE CENTER UNIVERSITY STUDY

Background:

Uveitis is the most frequent extraarticular manifestation of axial Spondyloarthritis (axSpA). Effects of Biological Therapy (BT) on uveitis associated to axSpA are contradictory (1-3).

Objectives:

To assess in uveitis associated to axSpA a) frequency and features of uveitis, and b) efficacy and relation of BT in a single-center university study.

Methods:

Observational study from a cohort of 301 consecutive unselected patients with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Episodes of uveitis were analyzed before and after BT initiation. Likewise, uveitis incidence rate (episodes/100 patients/year) at baseline and after first BT was calculated.

Results:

Uveitis was observed in 44 (25 men/19 women) out of 301 (14.6%) patients. Mean age was 45.6 ± 10.3 years. Demographic and clinical features in patients who developed uveitis and those that did not are summarized in Table 1. After 18.6 ± 10.4 years of follow-up, 44 (14.6%) patients suffered from at least one episode of uveitis. Uveitis was anterior and acute in all cases and unilateral in 37 (84.1%) patients. Mean anterior chamber cells was 1.7 ± 1.2 cells.

Per episode of uveitis, 20 patients received BT with: secukinumab (SECU) (n=7, 35%), adalimumab (n=6, 30%), golimumab (n=3, 15%), infliximab (n=2, 10%), certolizumab (n=1, 5%), and etarnecept (ETN) (n=1, 5%). Before the initiation of BT, patients treated with SECU developed 29.7 episodes/100 patients/year while those treated with monoclonal anti-TNFα 16.3 episodes/100 patients/year and patients with ETN 5.8 episodes/100 patients/year. After 5.9 ± 3.7 years of follow-up, patients treated with SECU developed 16.1 episodes/100 patients/year while those treated with monoclonal anti-TNFα 7.6 episodes/100 patients/year and patients with ETN 0 episodes/100 patients/year (Figure 1). No serious adverse effects were observed.

Conclusion:

Uveitis was observed in 14.6% of axSpA. Most of them were HLA-B27 positive. Acute, anterior and unilateral was the most frequent pattern of uveitis in axSpA. There was a similar decrease in incidence rate between patients treated with SECU and those treated with monoclonal anti-TNFα.

References:

[1]Deodhar AA, et al. ACR Open Rheumatol. 2020; 2:294-299.

[2]Roche D, et al [abstract]. Arthritis Rheumatol 2019; 71 (suppl 10).

[3]Lindström U, et al Annals of the Rheumatic Diseases 2020;79:9-10.

Table 1.

Main general features and differences between patients with and without uveitis.

Overalln= 301Uveitisn= 44Non uveitisn= 257pAge, years (mean±SD)44.9 ± 11.845.6 ± 10.344.8 ± 12.10.47Gender, n (m/w) (%)179/122 (59.5/40.5)25/19 (56.8/43.2)154/103 (59.9/40.1)0.71HLAB27 positive,n (%)190 (63.1)37 (84.1)153 (60.0)0.00Follow-up of axSpA, year (mean±SD)13.5 ± 11.218.6 ± 10.512.6 ± 11.10.33Family history, n (%)84 (27.9)15 (34.1)69 (27.2)0.35r-axSpA, n (%)217 (72.1)36 (81.8)181 (70.4)0.12nr-axSpA, n (%)84 (27.9)8 (18.2)76 (29.6)0.12Enthesitis, n (%)108 (35.9)14 (31.8)94 (36.6)0.54Peripheral arthritis, n (%)96 (31.9)12 (27.3)84 (32.7)0.47Psoriasis, n (%)35 (11.6)6 (13.6)29 (11.3)0.65Inflammatory bowel disease, n (%)22 (7.3)2 (4.5)20 (7.8)0.45Hip involvement, n (%)20 (6.6)3 (6.8)17 (6.6)0.96Dactylitis, n (%)17 (5.7)3 (6.8)14 (5.4)0.72Cardiovascular event, n (%)7 (2.3)1 (2.3)6 (2.3)0.98Figure 1.

Uveitis incidence rate before and after biological therapy.

Disclosure of Interests:

Alba Herrero-Morant: None declared, Iñigo González-Mazón: None declared, Vanesa Calvo-Río Speakers bureau: Abbott, Lilly, Celgene, Grünenthal, UCB Pharma, Grant/research support from: MSD and Roche, Javier Rueda-Gotor: None declared, Miguel Á. González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Sanofi, Lilly and MSD, Grant/research support from: AbbVie, MSD and Roche

SAT0264 LONG TERM FOLLOW-UP AND OPTIMIZATION OF INFLIXIMAB IN REFRACTORY UVEITIS DUE TO BEHÇET’S DISEASE. MULTICENTER STUDY OF 103 CAUCASIAN PATIENTS

Background:

Biologic therapy has improved prognosis of Behçet Disease (BD) uveitis (1-5). Although infliximab (IFX) is approved in Japan, most data in Caucasian patients comes from small series. No data on optimization has been published

Objectives:

In a large series of Caucasian patients with refractory uveitis of BD, we assess:a) long-term efficacy and safety;b) IFX optimization when ocular remission was achieved

Methods:

Multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressants.103 patients were treated with IFX as 1st biologic as follows: 3-5 mg/kg i.v. at 0, 2, 6 and every 4-8 weeks. The main outcomes were anterior chamber cells, vitritis, retinal vasculitis, macular thickness, visual acuity, and glucocorticoids sparing effect; analysed at baseline, 1st week, 1st and 6th months and 1st and 2nd years. After remission, IFX optimization was performed

Results:

In whole series (n=103), main outcomes showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Severe side-effects were observed in 9 patients.

Comparative study between optimized and non-optimized groups showed:a) no differences in clinical baseline characteristics;b) similar maintained improvement in most ocular outcomes;c) lower severe adverse events andd) lower IFX cost in optimized group (4826.52 vs 9854.13 euros/patient/year)(Table)

Conclusion:

IFX seems effective and safe in Caucasian patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective

References:

[1]Martín-Varillas JL. Ophthalmology 2018;125:1444-1451.

[2]Atienza-Mateo B: Arthritis Rheumatol. 2019;71:2081-2089

[3]Santos-Gómez M. Clin Exp Rheumatol. 2016;34 (6 Suppl 102): S34-S40

[4]Urruticoechea-Arana A. Rheumatol Int. 2019;39:47-58.

[5]Atienza-Mateo B. Rheumatology (Oxford). 2018 1;57:856-864

Table.OptimizedN=18Non OptimizedN=42PPatients/eyes affected, n/n18/3442/77Age, mean (SD), years39.5 (9.8)38.8 (10.5)0.82Men, %55.659.50.78Duration of uveitis before IFX, median [IQR] months38 [18-119]35 [10-48]0.11Ocular features at time of IFX onset-AC cells count, median [IQR]2 [1-4]2 [1-2]0.29-Vitritis, median [IQR]2 [1.5-3]2 [1-2]0.02-BCVA, mean (SD)0.32 (0.21)0.37 (0.26)0.51-OCT, mean (SD)303.5 (23.3)397.7 (155.7)0.12-Retinal vasculitis, n (%)9 (50)26 (66.7)0.23Uveitis pattern, n (%)-Bilateral/unilateral16/2 (88.9/11.1)35/7 (83.3/16.7)0.71-Anterior0 (0)6 (14.3)0.17-Posterior5 (27.8)8 (19.0)0.50-Panuveitis13 (72.2)28 (66.7)0.67Prednisone dose at IFX onset, mean (SD), mg/d40.3 (20.6)41.4 (15.5)0.81IFX therapyMonotherapy/combined treatment, n (%)15 (83.3)30 (71.4)0.33-AZA5 (27.8)4 (9.5)0.11-CsA9 (33.3)8 (19.0)0.32-MTX4 (22.2)15 (35.7)0.30Follow-up on IFX therapy, median [IQR], months48 [33-60]24 [6-60]0.007-Relapses, median (IQR)0 [0-1]0 [0-2]-Remission, %10075.60.46-Severe side effects, n (per 100 patients/year)0 (0)3 (0.78)0.02-Cost (mean), euros per year4826.529854.130.55–

Disclosure of Interests:

José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Belén Atienza-Mateo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Emma Beltrán: None declared, Alfredo Adan: None declared, Elena Aurrecoechea: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, J. Luis Hernández: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

THU0311 CERTOLIZUMAB THERAPY IN REFRACTORY UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES (IMID). MULTICENTER STUDY OF 39 PATIENTS

Background:

Infliximab and adalimumab therapy has significantly improved the prognosis of patients with non-infectious refractory uveitis. However, there is not enough evidence for the use of other anti-TNF drugs such as Certolizumab Pegol (CZP).

Objectives:

To evaluate the efficacy and safety of CZP in uveitis secondary to Immune-Mediated Inflammatory Diseases (IMID).

Methods:

Multicenter study of 39 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants. Efficacy of CZP was evaluated with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, macular thickness and presence of retinal vasculitis. Efficacy of CZP was compared between baseline, 1st week, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with the STATISTICA software (Statsoft Inc. Tulsa, Oklahoma, USA).

Results:

39 patients/56 affected eyes (18 men/21 women) with a mean age of 40.5±11.9 years were studied. IMIDs included were: spondyloarthritis (n=17), psoriatic arthritis (6), Crohn (3), JIA (2), Behçet (2), reactive arthritis (2), rheumatoid arthritis (1), relapsing polychondritis (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (3). Uveitis pattern was as follows: anterior (n=30), posterior (4), panuveitis (3) and intermediate (2).

Previous CZP, patients received: oral prednisone (n=18) methylprednisolone bolus (1), methotrexate (22), azathioprine (10), cyclosporine (4), leflunomide (2), mycophenolate mofetil (2) and cyclophosphamide (1). 77% of patients had received previous biological therapy, with a mean of 1.6±1.2 biological drugs per patient. Gestational desire was the reason for prescribing CZP in 8 patients. CZP was administered in monotherapy in 16 patients and in the remaining 23 patients combined with conventional immunosuppressants.

After a median follow-up of 24 [6-36] months, most of the ocular variables analysed showed a rapid and significantly sustained improvement (Table). CZP was discontinued in 11 patients for the following reasons: remission (n=1), insufficient response of ocular symptoms (n=1) and limited response of extraocular manifestations (n=9). No serious adverse effects were reported.

Conclusion:

CZP seems to be effective and safe in patients with refractory uveitis due to IMID.

TableBaseline1stweek1stMonth6thMonth1styear2ndyearBCVA (mean±SD)0.77±0.290.77±0.30*0.82±0.29*0.85±0.26*0.86±0.27*0.88±0.23*Tyndall (median [IQR])0 [0-2]0 [0-2]0 [0-1]*0 [0-0]*0 [0-0]*0 [0-0]*OCT (mean±SD)355±61.5-284.1±40.4*-224.8±121.1*-Retinal Vasculitis (eyes affected, %)2 (3.6)0 (0)0 (0)0 (0)0 (0)0 (0)

*p<0.05

Disclosure of Interests:

José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Iñigo González-Mazón: None declared, Ignacio Torre-Salaberri: None declared, Álvaro García Martos: None declared, Amalia Sanchez-Andrade: None declared, Ángel García-Aparicio: None declared, JR De Dios-Jiménez Aberásturi: None declared, ANA URRUTICOECHEA-ARANA: None declared, Olga Maíz: None declared, Raul Veroz Gonzalez: None declared, Andrea García-Valle: None declared, Sergio Rodríguez Montero: None declared, Roberto Miguélez: None declared, Vega Jovani: None declared, Marisa Hernández-Garfella: None declared, Arantxa Conesa: None declared, Olga Martínez González: None declared, Paula Rubio Muñoz: None declared, Belén Atienza-Mateo: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB1055 CERTOLIZUMAB PEGOL: A SAFE AND EFFICIENT TREATMENT IN PATIENTS WITH UVEITIS DURING PREGNANCY

Background:

Anti-TNFα agents are useful in uveitis(1-5).Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer.

Objectives:

To assess efficacy and safety of CZP in women with uveitis during pregnancy.

Methods:

Multicenter study of women with uveitis under CZP during pregnancy and their neonates.

Results:

14 women (23 eyes); mean age 34.3±5.5 yrs (TABLE 1). Pattern of uveitis: 10 anterior, 2 posterior, 1 intermediate, 1 panuveitis. Uveitis was bilateral in 9 and chronic in 7. CZP was started before conception in 10 patients and after in 4. All patients obtained or maintained ocular remission throughout pregnancy (FIGURE). Prednisone was reduced from a mean dose of 21.7±19.7 mg/day to 4.1±3.8 mg/day at 6 months (p=0.03), leading to complete discontinuation in 4. 15 healthy infants were born. Only 1 woman presented a mild infection. No infections or malformations were found in neonates after a follow-up of 6 months. 6 infants were breastfed and all received scheduled vaccinations without complications (TABLE 2).

TABLE 1.AgeUnderlying diseaseImmunosuppressants before CZPCombined treatment134SpAMTX, AZA, ADAAZA237SpAMTX, AZA, IFX, ADA, GOLI339SpAAZA, ADAAZA446SpACyA, ETN, ADA, IFX, GOLI532SpASSZ, ADASSZ636SpAMTX, HCQ, ADA740SpAMTX, LFN, HCQ, IFX, ADA, GOLIHCQ831IdiopathicMTX, MMF, CyA, ADA933IdiopathicMTX, AZA, ADA, ETN1032RAMTXAZA1123Vogt-Koyanagi-HaradaAZA, ADAAZA1236Juvenil Idiopathic ArthritisADA1332Punctate inner choroidopathyADA1429BehcetCyA, IFX, ADA

Conclusion:

CZP seems to be effective and safe in female patients with uveitis during pregnancy and neonates.

References:

[1]Llorenç V et al. Certolizumab Pegol, a New Anti-TNF-α in the Armamentarium against Ocular Inflammation. Ocul Immunol Inflamm. 2016;24(2):167-72. doi: 10.3109/09273948.2014.967779

[2]Urruticoechea-Arana A et al. Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review. Rheumatol Int. 2019 Jan;39(1):47-58. doi: 10.1007/s00296-018-4193-z

[3]Martín-Varillas JL et al. Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet’s Disease Ophthalmology. 2018 Sep;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020

[4]Santos-Gómez M et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet’s disease: results of a multicentre open-label study. Clin Exp Rheumatol. 2016. Sep-Oct;34(6 Suppl 102): S34-S40

[5]Calvo-Río V et al. Golimumab in refractory uveitis related to spondyloarthritis. Multicenter study of 15 patients.Semin Arthritis Rheum. 2016 Aug;46(1):95-101. doi: 10.1016/j.semarthrit.2016.03.002

Disclosure of Interests:

D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Alfredo Adan: None declared, Lillian Chamorro-López: None declared, Olga Maiz: None declared, JR De Dios-Jiménez Aberásturi: None declared, Raul Veroz Gonzalez: None declared, Soledad Blanco: None declared, José M Santos: None declared, Francisco Navarro: None declared, Adela Gallego: None declared, Senen González-Suárez: None declared, Arantxa Conesa: None declared, Andrea García-Valle: None declared, Miguel Cordero-Coma: None declared, Nieves Pardiñas-Barón: None declared, Rosalía Demetrio-Pablo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Victor Manuel Mora-Cuesta: None declared, Santos Castañeda: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD

AB0242 SURVIVAL ANALYSIS IN THE DEVELOPMENT OF SERIOUS INFECTIONS AND SERIOUS RESPIRATORY INFECTIONS IN AR PATIENTS INCLUDED IN A VACCINATION PROGRAM

Background:

Rheumatoid arthritis is an autoimmune disorder in which patients have an increased risk of developement of serious infections. This risk may be augmented due to RA itself and to immunosuppressive drugs, specially biologic therapy. Vaccination programs may change this condition.

Objectives:

Our aim in this study was to evaluate the incidence of serious infections in a vaccinate RA patients cohort.

Methods:

Prospective study of 401 patients diagnosed with RA who were invited to participate in the vaccination program of the Preventive Medicine department of our hospital from October 2011 to October 2016. The follow up was made until June 2017 with a minimun follow-up period of 8 months and maximun of 5.5 years. Serious infections were defined as those that required hospitalization or at least one dose of intravenous antibiotic treatement at emergency room. Information was retrieved from dthe hospital records.

Only 7 patients refused vaccination (2%). Information was not obtained in 4 of the remaining 394 patients. Therefore, these 4 patients were not incuded in the assessment.

Survival análisis was assessed by Kaplan-Meier method.

Results:

We finally studied 390 patients (307♀/83♂) mean age±SD 61,28 ± 12,9 years that participate in the vaccination program and followed-up. The main features at the time of vaccination were: median disease duration (4years), positive rheumatoid factor (56,7%), subcutaneous nodules (4.9%), erosive arthritis (36.9%), pulmonary fibrosis (3.8%), secondary Sjögren syndrome (5.1%), other extraartocular manifestations (14.6%) and rheumatoid vasculitis (5.6%) Most patients had received imunosuppressive drugs before the vaccination program. The most frequently used were systemic corticosteroids (n=228), methotrexate (n=362) and biologic agents (40.3%).

During the follow-up, 42 patients (10.7%) had required hospital admissions due to infections, 17 of them were severe respiratory infections (4.35%). The remaining 25 admissions were in the setting of urinary tract infections (n=12), intraabdominal infections (7), skin and soft tissues (12) and articular (1). Also 12 of these patients had a zoster herpes.

Afeter a median follow-up of 1061,89 ± 417 days, the incidence of serious infection, with a CI (95%), was 4.00 (2.95-5.41) for 100 patients yearly. Concerning to admissions due to serious respiratory infections, with a CI (95%), was 1.55 (0.9-2.47) for 100 patients yearly.Images 1 and 2.

Image 1.

Survival analysis on serious infections

Image 1.

Survival analysis on serious respiratory infections

Conclusion:

In this stydy we can concluded that our RA vaccinated patients present a dicrease of the incidence of serious infeccions, similar to other published cohorts. The incidence of serious respiratory infections shows a dicrease even lower to other published cohorts. The vaccination program seems to be effective to prevent hospital admissions due to infections.

Disclosure of Interests:

Lucia Domínguez: None declared, Paz Rodriguez Cundin: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Nuria Vegas-Revenga Grant/research support from: AbbVie, Roche, Pfizer, Lilly, Gebro Pharma, MSD, Novartis, Bristol-Myers, Janssen, and Celgene, Virginia Portilla: None declared, Francisco Manuel Antolin-Juarez: None declared, Maria Henar Rebollo Rodriguez: None declared, Alfonso Corrales Speakers bureau: Abbvie, Natalia Palmou-Fontana: None declared, D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review

OBJECTIVES

Non-infectious aortitis often presents with non-specific symptoms leading to inappropriate diagnostic delay. We intend to describe the clinical spectrum and outcome of patients with aortitis diagnosed at a single centre.

METHODS

We reviewed the clinical charts of patients diagnosed with non-infectious aortitis between January 2010 and December 2013 at the Rheumatology Division from a 1.000-bed tertiary teaching hospital from Northern Spain. The diagnosis of aortitis was usually based on FDG-PET-CT scan, and also occasionally on CT or MRI angiography or helical CT-scan.

RESULTS

During the period of assessment 32 patients (22 women and 10 men; mean age 68 years [range, 45-87]) were diagnosed with aortitis. The median interval from the onset of symptoms to the diagnosis was 21 months. FDG-PET CT scan was the most common tool used for the diagnosis of aortitis. The underlying conditions were the following: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren's syndrome (n=2), Takayasu arteritis (n= 1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and large-vessel vasculitis that also involved the aorta (n=2). The most common clinical manifestations at diagnosis were: PMR features, often with atypical clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory low back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). Acute phase reactants were increased in most cases (median erythrocyte sedimentation rate 46 mm/1st hour, and a median serum C-reactive protein 1.5 mg/dL).

CONCLUSIONS

Aortitis is not an uncommon condition. The diagnosis is often delayed. Atypical PMR features, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered 'red flags' to suspect the presence of aortitis.

Applicability of the 2006 European League Against Rheumatism (EULAR) criteria for the classification of Henoch-Schönlein purpura. An analysis based on 766 patients with cutaneous vasculitis

OBJECTIVES

In 2006 the European League Against Rheumatism (EULAR) proposed new classification criteria for Henoch-Schönlein purpura (HSP). We aimed to establish the applicability of these criteria in patients with primary cutaneous vasculitis (CV). We also compared these criteria with previously established classification criteria for HSP.

METHODS

A series of 766 (346 women/420 men; mean age 34 years) consecutive unselected patients with CV was assessed. One hundred and twenty-four of them with secondary CV or with CV associated with other well defined entities were excluded from the analysis. The 2006 EULAR criteria for HSP were tested in the remaining 642 patients with primary CV. Two sets of criteria for HSP were used for comparisons: a) the 1990 American College of Rheumatology (ACR-1990), and b) the ACR modified criteria proposed by Michel et al. in 1992 (Michel-1992).

RESULTS

451 (70.2%) of 642 patients were classified as having HSP according to the EULAR-2006 criteria, 405 (63.1%) using the ACR-1990 criteria, and 392 (61.1%) by the Michel-1992 criteria. However, only 336 patients (52.3%) met at the same time the EULAR-2006 and the ACR-1990 criteria, and only 229 patients (35.7%) fulfilled both the EULAR-2006 and Michel-1992 criteria. It is noteworthy that only 276 (43%) patients met the three set of criteria. Children fulfilled all the sets of criteria more commonly than adults (215 [66.6%] of 323 vs. 61 [19%] of 319, respectively; p<0.0001).

CONCLUSIONS

According to our results, the EULAR-2006 criteria show low concordance with previous sets of classification criteria used for HSP.

Cutaneous vasculitis associated with severe bacterial infections. A study of 27 patients from a series of 766 cutaneous vasculitis

OBJECTIVES

To assess the clinical spectrum of severe bacterial infections presenting as cutaneous vasculitis (CV) in a defined population.

METHODS

Unselected series of 766 patients with CV diagnosed at a single university referral center.

RESULTS

An underlying severe bacterial infection was diagnosed in 27 (22 men/5 women; mean age ± standard deviation [SD]: 53 ± 18 years) of 766 cases presenting with CV (3.5%). These infections were: pneumonia (n=8), endocarditis (n=6), meningitis (n=4), intra-abdominal infections (n=3), septic arthritis (n=2), septicaemia (n=2), septic bursitis (n=1), and urinary tract infection (n=1). All the patients were admitted for suspected CV. The median delay from admission to the diagnosis of infection was 4 days. A typical palpable purpura without relevant visceral vasculitic involvement was the main clinical manifestation. Patients with severe bacterial infections were older, with male predominance, had more frequently fever, constitutional symptoms, focal infectious features, and leukocytosis with left shift and anaemia than the remaining patients with CV. Although antibiotics were prescribed in all the patients, seven also required the use of low-dose corticosteroids to achieve complete resolution of the cutaneous lesions. Most patients experienced full recovery but two of them underwent prosthetic cardiac valve replacement, and another two died due to infection-related complications.

CONCLUSIONS

CV may be the presenting manifestation of a severe underlying bacterial infection. Physicians should keep in mind this fact to make an early diagnosis of infection and, consequently, prevent life-threatening complications.