AB0838 The Impact of Comorbidities on Patients with Axial Spondyloarthritis: A Cluster Analysis

Background

Previous study using cluster analysis technique analyzed the association between comorbidities and various outcome measures in patients with axial spondyloarthritis (axSpA). Due to the cross-sectional nature of the study, however, prognostic information about each group were not provided.

Objectives

This study aims to perform cluster analysis to differentiate axSpA patients in terms of comorbidities and to examine the differential treatment outcomes of these groups using the data retrieved from Korean College of Rheumatology Biologics (KOBIO) registry which includes longitudinal data of axSpA patients using anti-TNF agents.

Methods

Clinical characteristics and demographic data of axSpA patients in KOBIO registry were analyzed using an agglomerative hierarchical cluster analysis. The optimum number of clusters was determined by the pseudo-F statistic. After clustering, baseline clinical characteristics and treatment outcomes were compared between isolated axSpA and classified comorbidity groups using multivariable linear models and mixed linear models, respectively.

Results

1,207 patients were included in the study. At least one comorbidity was seen in 464 (38%) axSpA patients. Compared with those with isolated axSpA, patients with comorbidity were older, longer disease duration, and reported higher PtGA (p = 0.019), and BASFI (p <0.001), but did not have significantly different BASDAI, ESR, and CRP levels. The most common comorbidities were hypertension (14.4%), hyperlipidemia (13.0%), and obesity (4.5%). The hierarchical cluster analysis classified patients in 21 groups. We combined clusters 17-21 for further evaluation due to the small size of clusters (<5 patients). In multivariable linear models for baseline clinical characteristics, we found that patients in the hypothyroidism, asthma, and headache clusters reported poorer PtGA, BASDAI, or BASFI, and the weight loss cluster had higher level of CRP, compared with patients with isolated axSpA even after adjustment of patient demographic data. After 1-year treatment of anti-TNF agents, the patients in the hypothyroidism and weight loss clusters decreased greater amounts of BASDAI and BASFI scores and ESR/CRP levels, respectively, compared with patients with isolated axSpA (Table 1). However, the degree of improvement in asthma and headache clusters, which had higher disease activities at baseline, was similar with isolated axSpA. Therefore, they still had higher disease activity scores at the 1-year follow-up.

Table 1.

Comparing each cluster to patients with isolated axSpA (i.e. no comorbidity) using multivariable linear mixed models for each treatment outcome measure at 1-year follow-up as the dependent variable.

Cluster/descriptionPtGABASDAIBASFIESRCRP2isolated axSpA-----3Obesity0.233 (-0.57 - 1.036)0.098 (-0.648 - 0.844)-0.078 (-0.811 - 0.656)9.005 (0.481 - 17.529)†0.358 (-0.553 - 1.269)10Hypothyroidism-1.243 (-3.139 - 0.653)-2.147 (-3.908 - -0.385)†-2.38 (-4.076 - -0.684)†2.234 (-18.11 - 22.578)-0.087 (-2.123 - 1.95)11Weight loss-0.618 (-2.804 - 1.568)-0.901 (-2.932 - 1.131)-1.93 (-3.886 - 0.026)-26.891 (-50.351 - -3.431)†-4.197 (-6.544 - -1.849)†15Asthma0.049 (-2.138 - 2.235)0.833 (-1.199 - 2.864)0.254 (-1.702 - 2.209)-1.058 (-24.517 - 22.402)2.018 (-0.552 - 4.589)16Headache-0.103 (-1.052 - 0.846)0.169 (-0.713 - 1.051)0.463 (-0.387 - 1.312)0.344 (-9.693 - 10.382)-0.046 (-1.132 - 1.04)

† p-value < 0.05

. Only clusters including significant results were shown due to the limitation oft he number of characters.

Conclusion

Comorbidity could affect the treatment outcomes in patients with axSpA in certain subgroups. Thus, we should also pay attention to the comorbidities when treating axSpA.

Disclosure of Interests

None declared

AB0418 INCREASED THROMBOEMBOLIC RISK OF JAK INHIBITORS AFTER SWITCHING FROM BIOLOGIC DMARDs IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Safety concerns regarding JAK inhibitors have grown since the ORAL surveillance trial reported that their use was associated with an increase in major adverse cardiovascular events compared to TNF inhibitors. However, real-world data on the association between JAKi and thromboembolic events are sparse.

Objectives

We compared the incidence of thromboembolic events (TEs) before and after switching to Janus kinase inhibitors (JAKi) from biologic disease-modifying anti-rheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA).

Methods

Among patients with a diagnostic code for RA taking bDMARDs, patients who switched to JAKi or another bDMARD between March 2015 and December 2020 were included in this self-controlled case series study. The outcome was the occurrence of TEs. The incidence rate ratios (IRRs) for TEs in the period after switching to JAKi or another bDMARD compared with the period before switching were calculated based on an assumed Poisson distribution.

Results

There were 1,150 and 2,254 patients who switched to JAKi and another bDMARD, respectively. The mean follow-up duration was 4.5 ± 1.8 years. In the JAKi group, the IRR for TE after drug switching was 1.56 (95% confidence interval [CI] 1.22–1.98, P < 0.001) compared with the period before the drug switch; in the bDMARD group, the IRR was 1.16 (95% CI 0.98–1.38, P = 0.079).

Conclusion

Switching from bDMARDs to JAKi was associated with an increase in TE incidence in RA patients in a real-world setting.

Disclosure of Interests

None declared

OP0271 INCREASED RISK OF DEMENTIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE POPULATION-BASED COHORT STUDY

Background

There have been conflicting results of previous studies on the association between rheumatoid arthritis (RA) and the risk of dementia.

Objectives

In this study, we aimed to investigate the association between RA and dementia in a large nationwide population-based cohort.

Methods

Among patients diagnosed with RA between 2010 and 2017, patients who had undergone a national health examination within two years prior to RA diagnosis were included in the study (n = 138,592). Control group included age- and sex-matched non-RA controls who received a health check-up at the same time as RA patients (n = 692,960). The primary outcome of the study was incident dementia, which was defined by an ICD-10 code and the use of dementia medications. Kaplan-Meier curves and Cox proportional hazards regression analysis were used for the analysis.

Results

Mean follow-up duration of the study was 4.7 ± 2.2 years. RA patients had a 1.2 times higher risk of dementia than controls (adjusted hazard ratio [aHR] 1.19, 95% CI 1.16–1.23). In patients with RA, the aHR for Alzheimer’s disease (AD) was 1.21 (95% CI 1.67-1.25) and the aHR for vascular dementia (VD) was 1.10 (95% CI 0.99-1.21). In a stratified analysis according to age, gender, lifestyle factors and comorbidities, the association between RA and dementia was consistently found.

Conclusion

In a large nationwide population-based cohort, RA was associated with an increased risk of incident dementia. Appropriate evaluation of dementia is required when cognitive impairment occurs in RA patients. Further studies are warranted to identify mechanisms of increased risk of dementia in RA patients.

Disclosure of Interests

None declared

POS0211 ASSOCIATION BETWEEN CARDIOVASCULAR OUTCOME AND RHEUMATOID ARTHRITIS: NATIONWIDE POPULATION-BASED COHORT STUDY

Background

Many studies have shown increased risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA). Despite a growing burden posed by CVD in RA patients, large scale studies which examined the association between characteristic of RA patients and CVD risks, and studies which adjusted for various confounding factors are lacking.

Objectives

This study aimed to investigate the association between CVD risk and RA in large-scale, nationwide cohort of Korean population, and to examine which characteristics of RA patients are associated with increased CVD risk.

Methods

We enrolled 136,469 patients with RA who participated in national health examinations within 2 years of RA diagnosis between 2010 and 2017 and non-RA controls matched by age and sex (n= 682,345). The cohort was followed until the end of 2019. The outcome was occurrence of myocardial infarction (MI) or stroke. MI was defined as one hospitalization or two outpatient visit with ICD-10-CM codes I21 or I22. Stroke was defined as one hospitalization with ICD-10-CM codes I63 or I64 and a claim for brain imaging (CT or MRI). The Cox proportional hazard model and Kaplan Meier curve were used for the analysis.

Results

Mean follow up duration was 4.7 years. The incidence rate of CVD was higher in RA group than control (MI: 3.20 vs 2.08; stroke: 2.84 vs 2.33 per 1,000 person-years). The risk of CVD was higher in RA patients. (MI: adjusted HR 1.54, 95% CI 1.46-1.61; Stroke: adjusted HR 1.22, 95% CI 1.16-1.28). The association between RA and CVD was prominent in female (MI: adjusted HR 1.41 in male, 1.60 in female, p for interaction = 0.0293; Stroke: adjusted HR 1.13 in male, 1.27 in female, p for interaction = 0.03) and younger-age subgroups (MI: adjusted HR 2.9 in <40 years, 1.52 in 40-64 years, 1.51 in ≥65 years, p for interaction<0.0001; Stroke: adjusted HR 2.35 in <40 years, 1.21 in 40-64 years, 1.21 in ≥65 years, p for interaction = 0.0100) after adjusting for confounding variables. The association between RA and risk of MI was significant in those without DM. (adjusted HR 1.30 in DM, 1.61 in non-DM, p for interaction = 0.0005)

Conclusion

RA patients had increased risk of CVD events compared to age- and sex-matched control group, and this association was stronger in female and younger-age subgroups. Therefore appropriate screening for CVD would be important in all RA patients including female and younger patients.

Disclosure of Interests

None declared

POS1176 EFFECT OF LIFESTYLE CHANGE ON INCIDENT GOUT: A NATIONWIDE POPULATION-BASED COHORT OF YOUNG MEN

Background

Although gout in young people is increasing, studies on the risk factors for gout in these people are lacking.

Objectives

In this study, we explored the risk factors of gout and effect of lifestyle change on the development of gout in large nationwide population-based cohort of young men.

Methods

Between 2009–2012, men aged 20–39 years who participated in two national health examinations at 2-year intervals were included in the study. The outcome was occurrence of gout, which was defined using the diagnosis code of gout (ICD-10 code M10) in the claims database. Cox proportional hazard model was used to evaluate the association between incident gout and baseline factors or lifestyle change.

Results

A total of 1,977,849 subjects were included in the study, and the mean follow-up period was 5.5 ± 4.3 years. Gout occurred in 38,839 subjects (incidence rate = 3.59/1,000 person-years). A high body mass index, alcohol drinking, and comorbidities such as hypertension, diabetes mellitus, and hyperlipidemia were associated with an increased risk of gout. Among lifestyle factors, change in obesity had the greatest impact on gout, followed by drinking. Development of obesity increased the risk of gout by 1.75 times (95% CI 1.68–1.81), and recovery from obesity decreased the risk of gout by 40% (aHR 0.60, 95% CI 0.57–0.64). Heavy drinking increased the risk of gout by 38% (aHR 1.38, 95% CI 1.33–1.43), and stopping heavy drinking decreased the risk of gout by 11% (aHR 0.89, 95% CI 0.85–0.94). The effect of obesity on gout was evident in the younger age group, and the effect of heavy drinking on gout was weak in the severely obese group.

Conclusion

Obesity and heavy drinking in young men are important modifiable risk factors for gout. Therefore, the management of these risk factors in young men should be emphasized.

Disclosure of Interests

None declared

POS0803 INCREASED RISK OF MALIGNANCY IN PATIENTS WITH TAKAYASU’S ARTERITIS: A POPULATION-BASED COHORT STUDY IN KOREA

Background

Recent studies have identified neoplasms as the second most common cause of death in patients with Takayasu’s arteritis (TAK) [1,2]. Various autoimmune diseases are related to the increased rates of malignancies. Despite conflicting data, most studies concluded that there is no increase in the risk of malignancies in giant cell arteritis [3]. In the case of TAK, there have been few reports of malignancies [4]. However, only one study compared the risk of malignancies in TAK to that of the general population [5]. Because the previous study only included 180 patients with TAK from single center, no definite conclusion could be drawn. Here, we evaluated the relative risk of malignancies in patients with TAK and compared them with the general population using the medical insurance data of South Korea.

Objectives

This study aimed to evaluate the relative risk of malignancy in patients with TAK compared to that in the general population.

Methods

This retrospective nationwide cohort study used data from the Korean Health Insurance Review and Assessment Service database. All newly diagnosed patients with Takayasu’s arteritis were identified between January 2009 and December 2019. They were observed until the diagnosis of malignancy, death, or end of the observational period, December 2020. The occurrence of malignancy was regarded as the first claim under ICD-10 codes, including C00–97, D46, and D47.1, according to the incidence of malignancy classification published by the National Cancer Registry (NCR). The incidence of malignancy in the general population was retrieved from the 2014 NCR, which collects the annual incidence of malignancies in the entire population of South Korea. The standardized incidence ratios (SIRs) of the overall and site-specific malignancies were estimated and compared with the incidence of cancer in the general population.

Results

We identified 1,449 newly diagnosed patients with Takayasu’s arteritis during the observational period (9,196 person-years). A total of 74, 66, and 8 patients had overall, solid, and hematologic malignancies, respectively. The risks of overall (SIR, 1.62; 95% confidence interval [CI], 1.27–2.03), solid (SIR, 2.04; 95% CI, 1.56–2.61), and hematologic (SIR, 4.05; 95% CI, 3.72–7.98) malignancies were increased compared to those in the general population. In solid malignancies, breast (SIR, 2.07; 95% CI, 1.16–3.42), ovarian (SIR, 4.45; 95% CI, 1.21–11.39), and major salivary gland (SIR, 19.04; 95% CI, 2.31–68.76) cancers had an increased risk. In hematologic malignancies, the risk of myelodysplasia increased (SIR, 18.02; 95% CI, 3.72–52.66). Immunosuppressive agent use was not associated with malignancy. There was no specific period when cancer more frequently occurred.

Conclusion

An increased risk of malignancy was observed in patients with Takayasu’s arteritis compared to that in the general population in this large-scale nationwide population study of Korean health insurance data.

References

[1]Garen T, Lerang K, Hoffmann-Vold A-M, Andersson H, Midtvedt Ø, Brunborg C, et al. Mortality and causes of death across the systemic connective tissue diseases and the primary systemic vasculitides. Rheumatology. 2018;58(2):313-20.

[2]Jang SY, Park TK, Kim D-K. Survival and causes of death for Takayasu’s arteritis in Korea: A retrospective population-based study. International Journal of Rheumatic Diseases. 2021;24(1):69-73.

[3]Hill CL, Cole A, Rischmueller M, Dodd T, Coleman M, Tucker G, et al. Risk of cancer in patients with biopsy-proven giant cell arteritis. Rheumatology (Oxford). 2010;49(4):756-9.

[4]Bicakcigil M, Aksu K, Kamali S, Ozbalkan Z, Ates A, Karadag O, et al. Takayasu’s arteritis in Turkey - clinical and angiographic features of 248 patients. Clin Exp Rheumatol. 2009;27(1 Suppl 52):S59-64.

[5]Park JK, Choi IA, Lee EY, Song YW, Lee EB. Incidence of malignancy in Takayasu arteritis in Korea. Rheumatol Int. 2014;34(4):517-21.

Disclosure of Interests

None declared

Female reproductive factors and risk of joint replacement arthroplasty of the knee and hip due to osteoarthritis in postmenopausal women: a nationwide cohort study of 1.13 million women

OBJECTIVES

Previous studies of the relationships between female reproductive factors and osteoarthritis (OA) have shown conflicting results. In this study, we aimed to explore the relationships between reproductive factors and joint replacement arthroplasty of the knee (TKRA) and hip (THRA) in a large nationwide population-based cohort of postmenopausal Korean women.

METHODS

We included 1,134,680 subjects who participated in national health examinations in 2009 in the study. The study outcomes were incident THRA or TKRA due to severe hip or knee OA. The relationships between reproductive factors and THRA or TKRA were evaluated using a multivariable-adjusted proportional hazards model.

RESULTS

During a mean follow-up duration of 8.2 years, 1,610 incident THRA cases and 60,670 incident TKRA cases were observed. Later age at menarche, longer breastfeeding, HRT and OC use were associated with increased risk of TKRA for severe knee OA, while later age at menopause and longer reproductive span were associated with decreased risk. With regard to THRA for severe hip OA, later menarche, longer breastfeeding, HRT more than 5 years, and OC use more than 1 year were associated with higher risk. The associations between reproductive factors and severe OA were more pronounced in underweight and younger subjects.

CONCLUSION

We found that shorter estrogen exposure was associated with higher risk of TKRA due to severe knee OA, and such associations were more pronounced in underweight and younger subjects. The association between shorter estrogen exposure and THRA was not robust.

OP0206 ASSOCIATION BETWEEN FEMALE REPRODUCTIVE FACTORS AND GOUT: NATIONWIDE POPULATION-BASED COHORT STUDY OF 1 MILLION POSTMENOPAUSAL WOMEN

Background:

Previous studies have shown that the incidence of gout differs according to gender, and its risk factors also differ according to gender. However, little research has been done on the association between reproductive factors and gout.

Objectives:

Our study attempted to determine whether there is an association between reproductive factors and the incidence of gout in a large nationwide population-based cohort of postmenopausal women.

Methods:

Postmenopausal women aged 40-69 who participated in national health screenings in 2009 were included in the study. Subjects who had been diagnosed with gout prior to medical examination were excluded from the study, and a total of 1,076,378 women were included in the study. Outcome was the occurrence of gout which was defined as a case of two outpatient visit or one hospitalization for gout using the ICD-10 code of gout (M10) in the claim database. The Cox proportional hazard model was used for the analysis, and stratified analysis according to the body mass index (BMI) and chronic kidney disease (CKD) was performed.

Results:

Mean follow-up duration was 8.1 years, and incident cases of gout were 64,052. Later menarche (adjusted HR 1.10, 95% CI 1.02-1.19 in >16 years, compared with ≤12 years), earlier menopause (adjusted HR 1.12 in <40 years, 1.06 in 40-45 years, 1.03 in 45-50 years, compared with 50-55 years), and shorter reproductive span (adjusted HR 1.10 in <30 years, 1.06 in 30-35 years, compared with ≥40 years) were associated with a high risk of gout. No association between parity and gout incidence was observed. Use of oral contraceptives (OC; adjusted HR 1.03 in <1 year, 1.05 ≥1 year, compared with non-user) and hormone replacement therapy (HRT; adjusted HR 1.16 in <2 years, 1.16 in 2-5 years, 1.18 in ≥5 years, compared with non-user) were associated with an increased risk of gout. The association between reproductive factors and gout remained in the trend without statistical significance in the low BMI group, but not in the high BMI group. The effects of use OC and HRT on gout were not significant in the CKD group.

Conclusion:

Shorter exposure to endogenous estrogen was associated with a high risk of gout. Conversely, exposure to exogenous estrogen such as OC and HRT was associated with an increase in gout risk. This association was not significant in subjects with high BMI or CKD.

Disclosure of Interests:

None declared

POS0137 CARDIOVASCULAR RISK ASSOCIATED WITH TREATMENT OF ALLOPURINOL AND BENZBROMARONE IN PATIENTS WITH GOUT

Background:

Previous studies have shown that cardiovascular risk is increased in patients with gout. There are many studies on the effect of uric acid lowering therapy on CV risk in gout patients, but few studies have compared allopurinol and benzbromarone.

Objectives:

A nationwide population-based cohort study is designed to compare cardiovascular risk according to the treatment of allopurinol and benzbromarone in Korean gout patients.

Methods:

We used South Korea’s database of the Health Insurance Review and Assessment service (HIRA) to identify gout patients 18 years of age or older who newly started allopurinol or benzbromarone between 2009 and 2015. The start date of allopurinol or benzbromarone is defined as the index date. We excluded patients who have been prescribed uric acid lowering agents or have been on dialysis for one year prior to the index date. During the study period, patients who used uric acid lowering agents other than allopurinol and benzbromarone or who used both drugs in combination were also excluded from the study. The primary outcome of the study was the occurrence of a composite cardiovascular endpoint, which included coronary revascularization, hospitalization due to MI, ischemic stroke, and transient ischemic attack (TIA). Cox proportional hazard regression analysis and Kaplan-Meier curves were used for the analysis.

Results:

257,097 allopurinol initiators and 7,868 benzbromarone initiators were included in the study. The mean age was 54.4 years, 86% were male. The mean adherence of drug administration was 68.2% for allopurinol initiators and 75.5% for benzbromarone initiators. In baseline, the benzbromarone initiator had more cardiovascular comorbidities and related drug administration than the allopurinol initiator. In allopurinol and benzbromarone initiators, the adjusted hazard ratio (aHR) of the composite CV endpoint was 1.01 (95% CI 0.83-1.21), which was not significantly different. No significant difference was found between the two groups in each of the items of the composite CV endpoint and hospitalization for heart failure. The results did not change even when 1:3 propensity score matching was performed for baseline characteristics. In subgroup analysis of high risk patients with cardiovascular disease, there was no significant difference between allopurinol and benzbromarone initiators. However, when the analysis was limited to the group taking allopurinol ≥200mg and benzbromarone ≥50mg, there was no difference in primary outcome and other outcomes, but the risk of coronary revascularization was higher in benzbromarone initiator (aHR 1.58, 95% CI 1.16-2.14).

Conclusion:

In our study, there was no significant difference in cardiovascular risk between allopurinol initiator and benzbromarone initiator. In the high risk group of cardiovascular disease, there was no difference in risk between the two drugs.

Disclosure of Interests:

None declared

POS0138 ALTERED RISK OF GOUT ACCORDING TO CHANGE OF METABOLIC PARAMETERS IN YOUNG ADULTS

Background:

Many studies have shown a link between gout and metabolic syndrome (MetS). It is well known that lifestyle modifications such as weight reduction and abstinence from alcohol are effective in the treatment of gout, but data are lacking on how exactly the change of metabolic parameters affects gout.

Objectives:

The purpose of this study was to investigate the relationship between gout risk and metabolic parameters in a nationwide population based young adult cohort, and to determine whether changes in metabolic parameters affect gout risk changes.

Methods:

Among adults aged 20-39 years who participated in national health check-up programs from 2009 to 2012, a total of 6,290,914 subjects were included in the study, excluding subjects who were previously diagnosed with gout. To determine the effect of changes in metabolic parameters on gout incidence, 2,701,138 subjects who participated in the health examination once more 2 years later were used for the analysis. Outcome was defined as the occurrence of gout, when the ICD-10 code (M10) was registered twice in the claim database. The Cox proportional hazard model and Kaplan Meier curve were used for the analysis.

Results:

The incidence rate of gout was higher in those with MetS compared to those without (10.1 vs. 3.6 per 1,000 person-years). The risk of gout in people with MetS was 85% higher (adjusted HR 1.85, 95% CI 1.83-1.87) and was more significant in men than in women (adjusted HR 1.88 in male and 1.56 in female). Each component of MetS was also associated with increased gout risk, and hypertriglyceridemia showed the highest adjusted HR. The greater the number of MetS components, the higher the gout risk. The risk of gout was 70% higher in those who had MetS consistently (adjusted HR 1.71, 95% CI 1.67-1.75) and 44% higher in those with newly developed MetS (adjusted HR 1.47, 95% CI 1.40-1.48) than those who did not have MetS at the two health examinations. Similar risk patterns were observed according to the change of each metabolic parameter. Among the metabolic parameters, the change in hypertriglyceridemia was associated with the greatest difference in the change in gout risk.

Conclusion:

In young adults, MetS was associated with a higher risk of gout, especially with more components, the higher the risk. Since the occurrence of MetS is associated with an increased risk of gout, prevention of MetS would be important to reduce gout incidence.

Disclosure of Interests:

None declared

OP0113 FEMALE REPRODUCTIVE FACTORS AND RISK OF JOINT REPLACEMENT ARTHROPLASTY OF KNEE AND HIP DUE TO OSTEOARTHRITIS IN POSTMENOPAUSAL WOMEN: A NATIONWIDE COHORT STUDY OF 1.36 MILLION WOMEN

Background:

Previous studies on the link between female reproductive factors and osteoarthritis (OA) have shown conflicting results.

Objectives:

This study attempted to explore the association between reproductive factors and joint replacement arthroplasty of knee (TKRA) and hip (THRA) in a large nationwide population-based cohort of postmenopausal women.

Methods:

1,218,257 subjects who participated in national health examination in 2009 were included in the study. The study outcomes is incident THRA or TKRA due to severe hip or knee OA. The association of reproductive factors and THRA or TKRA was evaluated using a multivariate-adjusted proportional hazards model.

Results:

During the mean follow-up duration of 8.2 years, 1,733 incident THRA cases and 65,108 incident TKRA cases were observed. Later age at menarche (aHR 1.12 in 13-14 years; aHR 1.24 in 15-16 years; aHR 1.32 in ≥ 17 years), longer breastfeeding (aHR 1.24 in < 6 months; aHR 1.24 in 6-12 months; aHR 1.50 in ≥ 12 months), HRT (aHR 1.06 in < 2 years; aHR 1.11 in 2-5 years; aHR 1.21 ≥ 5 years) and OC use (aHR 1.11 in < 1 year; aHR 1.17 ≥ 1 year) was associated with increased risk of TKRA for severe knee OA, while later age at menopause (aHR 0.93 in 45-49 years; aHR 0.89 in 50-54 years), longer reproductive span (aHR 0.91 in 30-34 years; aHR 0.87 in 35-39 years; aHR 0.91 in ≥ 40 years) was associated with decreased risk. With regard to THRA for severe hip OA, later menarche (aHR 1.21 ≥ 17 years), longer breastfeeding (aHR 1.39 in < 6 months; aHR 1.31 in ≥ 12 months), and HRT more than 5 years (aHR 1.49) were associated with higher risk. The association between reproductive factors and severe OA was more pronounced in underweight and younger subjects.

Conclusion:

Our study found that shorter estrogen exposure was associated with higher risk of joint replacement therapy due to severe OA, and such association was more pronounced in underweight and younger subjects.

Disclosure of Interests:

None declared

FRI0540 DIFFERENT ASSOCIATION BETWEEN BONE MINERAL DENSITY AND OSTEOARTHRITIS ACCORDING TO THE SITE OF OSTEOARTHRITIS

Background:

Osteoarthritis (OA) and osteoporosis (OP) are both high prevalence at old age, and there are various reports on the association between the two diseases. Some studies have shown that high bone mineral density (BMD) is a risk factor for OA incidence, while others have mentioned the possibility of OP contributing to onset of hip OA. Recent study described that higher BMD reduce the risk of hip OA and raise the risk of knee OA. So, the relationship between BMD and OA or the effects of BMD on different OA site are not clear yet.

Objectives:

In this study, we investigated the association between BMD and radiographic OA using representative sample data of Korean adults.

Methods:

The study included 6345 subjects aged 50 years or older who underwent BMD measurements using dual-energy X-ray absorptiometry and X-rays of at least one site of the spine, hip, and knee in the Korean National Health and Nutrition Examination Survey conducted in 2010-2011. OA was defined according to radiographic finding (KL grade ≥ 2). Weighted multivariable logistic regression was used to analyze the association between BMD and OA. Since gender differences are evident, men and women were analyzed separately.

Results:

Spine OA was about 60% in both men and women, and hip OA was about 35% in men but only 1% in women. Knee OA was 76% in women and 58% in men. In men, the risk of OA increased 1.24 times as BMD increased by 1 g/cm2. By site, knee and spine OA were statistically significant in relation to BMD, but hip OA was not statistically significant. In women, the association between BMD and knee and hip OA was insignificant. In spine OA, the risk of OA increased 1.2 times when BMD increased by 1 g/cm2.

Conclusion:

In conclusion, high BMD increased the risk of knee and spine OA in men, but did not affect hip OA. In women, high BMD increased the risk of spine OA. Differences in the mechanism of OA development by site are thought to be possible explanations for the differences in the association between BMD and OA.

Disclosure of Interests:

None declared

OP0201 INCREASED RISK OF DEMENTIA IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect any organ of the body. Nervous system involvement of SLE lead to a variety of neurologic and psychiatric manifestations, which are called neuropsychiatric lupus. Cognitive dysfunction may appear as part of neuropsychiatric lupus. There are several papers on the increase in dementia risk in SLE patients, but data are not sufficient and there is little data on whether SLE affects dementia differently depending on the dementia subtype.

Objectives:

We evaluate dementia incidence and risk in SLE patients in a nationwide population-based cohort and determine whether the risk is different for each dementia subtype.

Methods:

We identified patients aged 40 years or more, with systemic lupus erythematosus between 2008 and 2014 using the database of the National Health Insurance Service (NHIS) of south Korea. Patients who had previously been diagnosed with dementia were excluded from the study. A total of 11,288 SLE patients and 56,440 control subjects with a 1:5 age- and sex-matching were included in the study. The primary outcome of the study was incident dementia, which was defined by an ICD-10 code and the use of dementia medications. Kaplan-Meier curves and Cox proportional hazards regression analysis were used for the analysis.

Results:

The incidence rate of dementia was higher in SLE cohort (3.90 per 1,000 person-years) than control cohort (2.73 per 1,000 person-years). Incidence rates of Alzheimer disease and vascular dementia were also higher in SLE cohort than control. SLE patients had a higher risk of dementia compared to control cohorts without SLE (crude hazard ratio 1.43, 95% CI 1.25-1.63). In patients with SLE, the risk of Alzheimer’s disease was 1.4 times higher and the risk of vascular dementia 1.6 times higher than non-SLE control.

Conclusion:

In this nationwide population-based cohort study, SLE patients had a 1.4-fold higher risk of incident dementia compared to patients without SLE. Further studies are warranted to identify mechanisms of increased risk of dementia in SLE patients. Monitoring of dementia incidence in SLE patients is needed in clinical practice.

Disclosure of Interests:

None declared

Prognostic impact of polymorphisms of caspase genes on survival in patients with operated invasive ductal breast cancer

e22020

Background: Since the apoptosis induced by caspases may play a role in the prognosis of breast cancer, the present study analyzed the polymorphisms of caspase genes and their impact on the survival in patients with operated invasive ductal breast cancer. Methods: Two hundred eighty patients with breast cancer who underwent surgery with curative intent were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tissue, and 7 single nucleotide polymorphisms (SNPs) of 6 caspase genes were determined using a PCR-RFLP assay. Results: The median age was 49 (range, 24–82) years, and 157 (56.1%) patients were premenopause at the time of diagnosis. Thirty-six (12.9%) patients underwent breast-conserving surgery. Pathologic stages after surgery were as follows: stage I (n=86, 30.7%), stage II (n=129, 46.1%), and stage III (n=63, 22.5%). Among the target SNPs, CASP6 (rs2301717, +5095G>T) and CASP7 (rs11593766, +11G>T) were found to correlate with relapse-free survival (RFS) after curative surgery in an univariate analysis adjusted to age, stage, histological grade, and the immunohistochemical expression of estrogen receptor and HER2. Meanwhile, multivariate analysis showed that the combined GT and TT genotype of CASP6 (rs2301717) was associated with a better RFS than the GG genotype (HR=0.39; 95% CI=0.19–0.79; p=0.009). However, there was no significant association with overall survival. Conclusions: The CASP6 (rs2301717) polymorphism may be considered as a possible prognostic factor for survival in patients with operated invasive breast cancer.

No significant financial relationships to disclose.

HMPS (2-hydroxy-4-methoxyphenylstilbene), a stilbene derivative of rhapontigenin, and cell death by mitochondrial apoptotic pathway in breast cancer cells

e22130

Background: Breast cancer with resistance to clinical therapy is a significant threat to live of recurrent breast cancer patients, and chemo-resistant breast cancer is increasing rapidly. During last several decades, natural stilbenoids have been studied on anticancer effects in vitro and in vivo, and resveratrol is the most famous stilbene as a leading compound in the studies of anticancer compounds derived from plants. HMPS (2-hydroxy-4-methoxyphenylstilbene) is an analogue derived from rhapontigenin (3,5,3'-trihydroxy-4'-methoxy-trans-stilbene), which is a stilbene of herbal plant Rheum undulatum. TMS (2,3',4,5'-tetramethoxystilbene), an another stilbene analogue from rhapontigenin, was reported potent anticancer effect on tamoxifen-resistant MCF-7 cells. In this study we investigated inhibitory effect of HMPS on proliferation of breast cancer and a potential for a new therapeutic candidate. Methods: We examined cell viability of MCF-7 and MDA-MB-231 by MTT assay after exposure to various concentrations of HMPS. Apoptotic cell death induced by HMPS was investigated by florescence microscopy, cell cycle analysis and western blotting. Results: Cell viability of breast cancer cells after 24 h exposure to HMPS decreased significantly, and both ER-positive and ER-negative breast cancer cells responded to HMPS. HMPS induced nucleus fragmentation and G2/M arrest followed by sub-G1 accumulation of apoptotic cells in time- and dose-dependent manner. During the process of cell death induced by HMPS, mitochondrial membrane potential was disturbed and caspase-3 and PARP cleavage were observed. Moreover, HMPS decreased cell number of LTED MCF-7 cells(Long term estradiol deprived cell) effectively. Conclusions: Our results demonstrates that proliferation inhibitory effect of HMPS is about 50-fold more potent than those of rhapontigenin and furthermore HMPS also inhibits cell growth of LTED cells which are difficult to treat therapeutic agents. Therefore, HMPS may be a potential therapeutic candidate to treat the recurrent breast cancer by alone or combination with other conventional anticancer agents.

No significant financial relationships to disclose.