Artritis Reumatoide Clínica

Dra. Esmeralda Delgado FríasHospital Universitario de Canarias.Santa Cruz de Tenerife

CV diseases-other comorbities RA

THU0130. PATTERNS OF COGNITIVE DECLINE IN RA: RESULTS OF CASE CONTROL STUDY NESTED IN A POPULATION-BASED COHORT.

• Differences in cognitive function RA-controls• Disease and treatment related factors

• ACE-III: < 82

• Worst values RA in test battery (37%) no relation withdisease duration

• Trend for better values if taking DMARDs

• Pattern of cognitive deficit similar to Alzheimers profile

Controls N=29 RA N=38 ACE-III Total 95.2 (3.7) 85.2 (7.4) •Attention 17.7 (0.5) 16.5 (1.9) •Memory 24.6 (1.9) 19.8 (4.0) •Fluency 12 (1.4) 9.9 (2.6) •Language 25.5 (0.8) 24.6 (1.7) •Visuospatial 15.8 (0.5) 14.4 (1.5)

RA-comorbidity and clinical aspectsTHU0132 . ASSOCIATION OF RHEUMATOID ARTHRITIS AND DEMENTIA: A NATIONWIDE POPULATION-BASED STUDY.

• 1 m pts dementia 6028 100 RA• Risk of dementia in RA not increase vs controls

• Vascular dementia tended to increase in RA THU0134. COGNITIVE IMPAIRMENT IN RHEUMATOID ARTHRITIS.

• Rheumatoid arthritis, medication and memory study (RESIST)

• Prevalence of MCI (mild cognitive impairment)

• MoCA < 26• High prevalence of MCI in adults >55 years with moderately active RA.

• Role of chronic inflammation in cognitive dysfunction

Preclinical models of arthritis and bone disease

OP0239. WHY DOES ALCOHOL INHIBIT ARTHRITIS?-AN EXPLANATION OF ARTHRITIS INHIBITION BY ETHANOL

• Understand anti-arthritogenic effect of alcohol• CIA and SIA model, in vivo, acetate

• Analysed for T-cell linage and plasma cell diferentation, IgGlevels, IL-21..

• Significantly inhibited arthritis in CIA model of arthritis

• On TFH: impaired autoAb formation, reduced IL-21…lessarthritis

• Overexpression of IL-21 in vivo completely reversed the immune regulatory effects of alcohol.

RA- Prognosis,predictors and outcome II

OP0217 INVOLVEMENT OF LARGE JOINTS AT DISEASE PRESENTATION IS ASSOCIATED WITH DIVERSE HISTOPATHOLOGICAL FEATURES AND CLINICAL OUTCOMES IN EARLY RHEUMATOID ARTHRITIS.

• Histopathological features of synovial biopsies<-> clinical outcomes

• Before DMARDs• Large: higher CRP-HAQ/inflammatory score,

lympho-myeloid• 6 m post DMARD higher HAQ , lower

response in large joint pts• Synovial biopsy identified patients with early

RA with specific histopathological features and clinical outcomes.

Large joints# 33 (19.4%)

Medium joints# 100 (60.6%)

Small Joints# 34 (20%)

P*

Clinical features ESR mm/h, mean (SD) 48.2 (31.5) 39.6 (30.8) 29.2 (17.3) ns CRP mg/L, mean (SD) 27.9 (32.4) 20.7 (26.9) 10.4 (9.8) 0.007 DAS28 , mean (SD) 6 (1.2) 5.7 (1.4) 5.7 (1.5) ns HAQ , mean (SD) 1.8 (0.7) 1.4 (0.8) 1.2 (0.9) 0.012 ACPA-positive , % 70.9% 77.3% 83.9% ns RF-positive, % 71.9% 74.2% 80.6% ns Histology Inflammatory score, median IQR) 5 (3) 4 (4) 2 (2.75) <0.001

Pathotype, % Ungraded 6.1% 7.8% 2.9% 0.014

Fibroid 6.1% 24.3% 32.3% Myeloid 30.3% 28.1% 47.1%

Lympho-myeloid 57.6% 39.8% 17.6% Clinical outcomes at 6 months DAS28 6m, mean (SD) 4.2 (1.8) 3.4 (1.9) 3.7 (1.5) ns HAQ 6m, mean (SD) 1.2 (0.8) 0.8 (0.8) 0.8 (0.8) 0.012 DAS28 6m <3.2, % 23.3% 48.8% 37.9% 0.04

RA- Prognosis, predictors and outcome II

OP0219 MORTALITY OF RHEUMATOID ARTHRITIS PATIENTS, TREATED TO TARGET AT LOW DISEASE ACTIVITY: 17-YEARS FOLLOW-UP OF THE BEST COHORT.• BeST: 508 pts, 10 y, mortality similar

general population.• Evaluate long-term mortality (17 y)• 4 treatment arms• Died 28 % vs 21 % reference population• No difference in SV-curves between 4 arms• Mortality increased in BeST

RA- Prognosis, predictors and outcome II

• OP0222 IS REFERRING EARLY ARTHRITIS PATIENTS WITHIN 6 WEEKS ASSOCIATED WITH BETTER LONG-TERM OUTCOMES THAN REFERRING WITHIN 12 WEEKS AFTER SYMPTOM ONSET? – INVESTIGATING THE EVIDENCE FOR THE FIRST EULAR RECOMMENDATION FOR EARLY ARTHRITIS IN TWO OBSERVATIONAL COHORTS.

• If ≤6-w <-> improved long-term outcomes (DMARD-free remission, Rx progr)• 2 cohorts: 1025/514. • ≤6: more often DMARD-free remission; similar Rx prog than 7-12 w.• Visiting a rheumatologist within 6-weeks of symptom-onset had clear benefits for achieving SDFR,but not for rx progression.

RA- Prognosis, predictors and outcome

FRI0024 HOW OFTEN DOES REACHING TARGET MISS THE MARK? LONGITUDINAL PATTERNS OF REMISSION IN REAL-WORLD EARLY RHEUMATOID ARTHRITIS PATIENTS.• Patterns of remission • Predictors of sustained vs transient remission in real-

world early RA• Canadian Early Arthritis Cohort (CATCH): 1417• Sustained remission (1) or transient remission (2: REM to

LDA; 3: REM to MDA o HDA)• Only 47% remained in 1• Older age, female sex, smoking, higher comorbidity index

and + serology, were significantly associated with transient remission patterns

Comorbidity and clinical aspects II

FRI0079 CHARACTERISTICS OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS.

• Real-world

• DAS28 moderate or high after 1 y treatment

• 1693 pts

• 70 y, DMARDs 40,7%, biologic or JAK 55,8%, GC 29%.

• 22,9% unresponsiveness biologics; comorbidities 33,8%, personal 39,8%

• 14% difficult to treat in spite of intensive treatment

• Characteristics are distinct by the cause of difficulty to treat.

Infections and clinical aspects in RA

SAT0071 SUBCLINICAL SYNOVITIS IN ARTHRALGIA: HOW OFTEN DOES IT RESULT IN CLINICAL ARTHRITIS? A LONGITUDINAL STUDY TO REFLECT ON STARTING POINTS FOR DMARD TREATMENT.• Not all patients with a subclinical synovitis will

develop clinically apparent arthritis• Determine the frecuency of non-progression to

clinical arthritis• 3 cohortes:US, MRI• True + vs False +• Stratified for ACPA• ACPA + and subclinical synovitis 44-71% non

progress = False +• Overtreatment?

Infections and clinical aspects in RA

SAT0062 INCIDENCE OF STAPHYLOCOCCUS AUREUS BACTEREMIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE COHORT STUDY• Incidente rate of first-time SAB in RA• RA: IR 80,5/100000 PY vs 28,9 general • RA: women, orthopaedic implant, recent use GC• IR in RA > in all age categories• RA < 70 y had a 1,5-2 times higher IR vs general

population

RA-comorbidity and clinical aspects III

SAT0078 SAFETY OF LOW DOSE METHOTREXATE (MTX) IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION.• Systematically review literature on the safety of using MTX ≤30 mg/w in HIV.• RCT (USA): mtx on atherosclerotic disease in HIV, > adverse events• 1 Cohort Study (S.Africa): 43 RA on MTX adquired HIV, RA improved.• 1 Cohort Study (USA): 13 HIV with myositis, 1 MTX (died HIV)• Cross-sectional Study (France): 43 HIV with AI, 1 MTX (cytopenia)• 38 case-reports: 54 HIV with MTX, adverse events due to both• Careful monitoring for MTX toxicity, opportunistic infections and HIV state • Particularly if combined with other immunosuppression.