BackgroundRheumatic disesases may involve multiple systems and chronic kidney disease (CKD) can be seen during the course of diseases. Accompanying CKD affects the the choice of treatments in patients with rheumatic disease. There is limited data on the use of biological DMARDs in rheumatic patients with chronic kidney disease.ObjectivesTo determine the preferred first and second bDMARDs in patients in the CKD in the bDMARD cohort.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005. A total of 2160 RA patients, 3744 SPA patients, were registered in HUR-BIO until November 2021. The CKD was confirmed and classified according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. . Patients were evaluated for the presence of CKB before the initiation of bDmard and during follow-up under bDMARDs. Age and sex matched RA patients without CKD were selected for the control group.Results142/5904 (2.4%) patients have CKD. 102(%71.8) patients had CKD prior to initiation of bDMARD and 40 (28.1%) patients had developed during follow-up. The median time to CKD development after starting bDMARD was 4.13 years(±4.05). Of the patients with CKD, 98 (69.0%) had RA and 44 (31.0%) had SpA. RA patients followed for CKD were older than SpA (66.0 (±11.1) vs 59.1 (±13.0) years, p=0.001), female gender was more common (73.5% vs 36.4%, p<0.001), disease duration was similar (19.3 (±13.8) vs 17.1 (±10.5) years, p=0.40). The first bDMARD choices of patients with and without CKD in RA and SpA patients were shown in Table 1. There was no difference between the SPA patients with or without CKD regarding TNF-i preferences. In patients with rheumatoid arthritis there was no difference in terms of TNFi and non-TNF-i preferences, but tocilizumab was more prefered in CKD group.Table 1.Relationship between remission according to bDMARD and CKDRheumatoid arthritispSpondyloarthritispw CKD n=98wo CKD n=91w CKD n=44(%)wo CKD n=80(%)p<0,05Etanercept, n(%)34 (34.6)30 (33.0)0.4617 (38.6)22 (27.5)P=0.14Adalimumab, n(%)17(17.3)17 (18.7)0,4810 (22.7)22 (27.5)P=0.36Infliximab,n(%)3 (3)8 (8.8)0.8514(31.8)32 (40.0)p=0.24Golimumab, n(%)4 (4)3 (3.3)0,541 (2.2)3 (3.8)p=0.55Certolizumab, n(%)0 (0)3 (3.3)0,111 (2.2)1 (1.3)p=0.58Anti-TNF therapy, n(%)58 (59.2)61 (67.0)0,6143800.352Non-TNF biologics, n(%)40 (40,8)30 (33.0)0,13100.355Rituximab, n(%)14 (14.3)12 (13.2)0,57Abatacept, n(%)14(14.3)12 (13.2)0,49Tocilizumab, n(%)6 (6.1)10.0411(2.2)p=0.35Jak-kinase inhibitors, n(%)6(6.1)5 (5.5)0.55ConclusionIn our biologic cohort, 2% of patients with RA and SpA had accompanying CKD. In one-third of the patients with CKD, it was developed during the follow-up after bDMARDs. In patients with RA, there was no difference in terms of TNFi and non-TNF-i preferences. It should be kept in mind that CKD may develop during the follow-up of patients using bDMARDs.References[1]Ye W, Zhuang J, Yu Yet all Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study. BMC Nephrol. 2019 Dec 9;20[2]Chebotareva NV, Guliaev SVet al. [Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants]. Ter Arkh. 2019 May 15;91(5)Disclosure of InterestsNone declared
BackgroundIt is known that genetic and environmental factors play a role in the pathogenesis of spondyloarthritis (SpA). [1] It can be thought that spouses living in the same house are exposed to similar environmental factors.ObjectivesThis study aimed to investigate whether common living space increases the frequency of SpA development in unrelated spouses of SpA patients.MethodsBetween November 2021 and June 2022, 680 SpA patients who applied to the Hacettepe University rheumatology outpatient clinic were included. Patients were divided into ankylosing spondylitis (AS), non-radiographic SpA, and peripheral SpA. The patients were asked whether their spouses had SpA, and if they had SpA diagnosis, they were called to the outpatient clinic, and their diagnosis was confirmed. The family history of the patients and their use of bDMARDs were also noted. It was also checked whether the patients whose spouses had SpA findings fulfilled the AS criteria.Results680 SpA patients were evaluated. There were 582(85.6%) AS, 72(10.6%) nr AxSpA, and 26 only peripheral SpA (3.8%). 49.4% of the patients were male, and the mean age was 45.6 (10.4). The mean follow-up period of the patients was 10.6 (7.9) years. Of all patients, 468 (55.1%) were using a bDMARD at the time of evaluation. 12 SpA patients stated that their spouses had SpA. In the review of these patients, it was found that four patients did not have SpA, and one of them had PsA. Spouses of patients with nr AxSpA and peripheral SpA did not have AS/SpA AS was detected in the spouses of 7 patients. The incidence of AS in the entire SpA patient group was calculated as 7/695 (1.01% (0.4-2.1)). The incidence of AS in spouses of AS patients are 7/582 (1.20% (0.5-2.5)) calculated. 2 of 7 wives were cousins’ children. The incidence of AS in unrelated spouses of AS patients are 5/580 (0.86% (0.3-2)). Only one of the spouses with AS knew her spouse’s diagnosis at the time of marriage, while the other six were diagnosed after marriage. The median time for these patients to be diagnosed after marriage is 22 (7-32) years.ConclusionIn the Turkish population, the frequency of AS was 0.49%, and the frequency of SpA was 1.05%. [2] The incidence of AS in the spouses of SpA patients has increased approximately two times compared to the average Turkish population. A 2.4-fold increased risk was found in AS patients. This situation may be related to environmental factors that play a role in the pathogenesis of SpA disease. However, the fact that half of the patients were using bDMARDs suggests that they were analyzed in the group with the potential for more severe disease. The results require confirmation in more extensive studies.References[1]Hwang, M.C., L. Ridley, and J.D. Reveille,Ankylosing spondylitis risk factors: a systematic literature review.Clinical Rheumatology, 2021.40(8): p. 3079-3093.[2]Onen, F., et al.,Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey.The Journal of rheumatology, 2008.35(2): p. 305-309.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundLupus nephritis (LN), which occurs in 60-70% of patients with systemic lupus erythematosus, is a major determinant of morbidity and mortality. There still are many uncertain aspects in clinical, pathological, and prognostic characteristics about LN.ObjectivesWe aimed to compare clinical features, outcomes, and to define the predictive factors of complete renal response (CRR) in patients with proliferative and non-proliferative LN.MethodsPatients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had a kidney biopsy were the subject of the study. One hundred and sixteen patients whose kidney biopsy reported as LN were evaluated retrospectively. Clinical features, laboratory values at the time of kidney biopsy, histopathological forms of LN, and renal response (complete or partial) were recorded. The predictive factors for CRR during the two-year follow-up after induction therapy were analyzed.ResultsOf 116 (93 females, 23 males) patients, 95 (81.9%) were in the proliferative (class III and IV) and 21 (18.1%) were in the non-proliferative group (class II and V). In the proliferative group, elevated basal creatinine, median daily proteinuria, anti-dsDNA positivity, low C3 and C4, the presence of active urinary sediment, and median renal SLE Disease Activity Index (SLEDAI) scores at the time of kidney biopsy were significantly higher than non-proliferative group. During the two-year follow-up after LN diagnosis, 70 patients achieved CRR and time-to-CRR was similar for the groups (p=0.64, log-rank). The Cox proportional hazards model showed that achieving CRR was associated with female gender [HR: 2.15 (1.19-3.89 95% CI), p=0.011], newly diagnosed SLE with renal biopsy [2.15 (1.26-3.67), p=0.005], hypertension [0.40 (0.27-0.94), p=0.032], eGFR increase [1.01 (1.00-1.01), p=0.046], and presence of active urinary sediment [0.46 (0.22-0.96), p=0.039].ConclusionAchieving CRR was similar in both the proliferative and non-proliferative LN patients although certain laboratory parameters differed at onset. Our results indicated the importance of kidney biopsy in the decision-making of treatment of SLE patients with renal involvement and that the defined factors associated with CRR achievement help to predict good renal response.Table 1.Demographic, clinical characteristics, and outcomes of the patients with LNVariables*All patientsProliferative LNNon-Proliferative LNpn=116n=95n=21Age at SLE diagnosis, years18.3 (16)19.2 (15)16 (16)0.32Sex, female93 (80.2)75 (78.9)18 (85.7)0.48Age at kidney biopsy, years21 (17.7)22 (17)18 (15)0.19Patients newly diagnosed SLE with renal biopsy65 (56)53 (55.8)12 (57.1)0.91Follow-up time for LN, years5.5 (8)5.1 (8.2)6.2 (5.1)0.80SLE disease duration8 (8.7)8.1 (9.6)7.9 (7.3)0.53Hypertension31 (26.7)26 (27.4)5 (23.8)0.74Laboratory values on the kidney biopsy Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.56 (0.1)0.006 Creatinine > UNL37 (32.5)34 (36.6)3 (14.3)0.04 eGFR (mL/min/1.73m2)113 (54)107 (54)129 (45)0.04 Albumin (g/dL)3.3 (1.1)3.1 (1.2)3.5 (1)0.09 24-hour urine protein, gr/day2.3 (3.3)2.4 (3.6)0.9 (1.8)0.03 Anti-dsDNA positivity94 (81)80 (87.9)14 (70)0.04 Low C3 and C4 levels93 (80.2)81 (88)12 (57.1)0.001 Active urinary sediment91 (83.5)78 (89.8)12 (57.1)<0.001Renal SLEDAI12 (8)12 (8)4 (4)<0.001During the two-year follow-up after LN diagnosis Complete renal response70 (70.7)56 (70.9)14 (70)0.99 Partial renal response23 (23.2)17 (21.5)6 (30)0.64 No response6 (6.1)6 (7.6)0NA Relapse20 (21.5)15 (20.5)5 (25)0.84 ESRD4(4)4 (4.2)0NA Death3 (3)3 (3.2)0NA* n (%), if otherwise specified; median (IQR) for numeric valuesESRD: End-stage renal disease, GFR: Glomerular filtration rate, LN: Lupus nephritis, SLE: Systemic lupus erythematosus, SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; UNL: Upper normal limitFigure 1.Kaplan-Meier survival curve for complete renal response (CRR) achievement during the two-year follow-up according to the kidney biopsy resultsDisclosure of InterestsNone declared
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