BackgroundSystemic Sclerosis (SSc) is a rare and heterogeneous connective tissue disease (CTD) characterized by skin fibrosis, vasculopathy/vascular damage and potential visceral impairment. Interstitial lung disease (ILD) constitutes the leading cause of mortality and requires close periodical assessment and follow-up. Diffuse cutaneous sclerosis and specific autoantibody profile (anti SCL70, anti Th/To, Anti U3 RNP and anti PmScl) are considered ILD development risk factors. In contrast, positivity to anticentromere has been considered as a protective factor to develop a clinical significant ILD.ObjectivesTo assess ILD frequency and severity (extension and functional impairment) in SSc patients, analyzing the association with the different autoantibodies.MethodsRetrospective, descriptive study of patients meeting EULAR/ACR 2013 SSc criteria and had a HRTC performed at a tertiary Spanish hospital from 1975 to 2018. One hundred and eight patients were included. HRCTs were graded by two radiologists according to Goh et al semiquantitative score. Three groups were established according to the presence of different autoantibodies: anticentromere (ACA), antitopoisomerase (ATA), and positivity to other ANAs (nucleolar pattern and other specificities).ResultsClinical and laboratory characteristics are presented in table 1. Thirty-three patients had pulmonary involvement, 6 were ACA+, 18 ATA+ and 9 had other ANA specificities. The probability of not having pulmonary involvement among ACA+ and of having pulmonary involvement among ATA + showed statistic significance (p<0.001 and p<0.001). Usual intestinal Pneumonia (UIP) was the most frequently reported pattern (6 patients), followed by Non-Specific Interstitial Pneumonia (NSIP 11 patients); Six patients did not meet the radiological criteria for neither UIP or NSIP. No statistical significant difference was found among radiological pattern and autoantibody profile. Regarding extension: 15 patients had non-extensive involvement (ACA: 2, ATA: 7, “other ANAs”: 6) performing Goh et al score with the FVC correction. Extensive ILD was found among 18 patients (ACA: 4, ATA: 11, “other ANAs”: 3). Despite the fact that ATA+ group was more likely to have an extensive involvement no statistical significance was met. About pulmonary function tests (PFT) the mean FVC was 98,45% on ACA group, whereas on ATA and other ANAs groups the mean FVC were 88,97% and 81,43% respectively. Statistical differences were found between first and third group, However this difference was not found when only patients with pulmonary involvement were analyzed.ConclusionIn our cohort, ATA and other ANAs groups were more likely to develop pulmonary interstitial disease and to need inmunosuppressant treatment. Although the prevalence of ILD among ACA+ was only 10%, 50%of them required, due to the functional impairment or extension, inmunosuppressant treatment. In spite of the low ILD-ACA+ incidence this complication should be kept in mind and periodical screening and assessment must be carried out as in other...
Background:Psoriatic arthritis (PsA) covers a wide spectrum of disease manifestations, including arthritis, enthesitis, dactylitis and axial spondylitis. This range of symptoms presents a challenge to the treating physician. Biologic disease-modifying antirheumatic drugs (bDMARDs) have proven effective through randomized clinical trials; and most international PsA guides include them as main option upon first-line treatment failure. However, studies regarding drug efficacy after bDMARD switching are scarce, lower response rates and drug survival on consecutive lines has been explored in previous research.Objectives:To assess bDMARDs survival after first-line failure in PsA patients treated in a third-level hospital and to determine baseline clinical and laboratory parameters associated with drug survival.Methods:We conducted a retrospective, single-centre study. 47 patients who received a second-line bDMARD were included, with diagnosis of PsA according to the criteria of an expert rheumatologist. All patients were studied according to a standard protocol. Data regarding bDMARD prescribed, baseline characteristics, axial or peripheral involvement and immunological profile (included both HLA-B27 and HLA-Cw6) were extracted. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at bDMARD start were included, as well. Kaplan-Meier, log-rank analyses and Cox regression models were applied.Results:Of 47 patients receiving a second bDMARD, 55,3% (26) were female and mean (S.D.) age was 40,6 (12,52) years. Median (interquartile range) disease duration was 10,1 (3,7-14,8) years. Prescribed drugs were Adalimumab (ADL) (36,2%, 17), Etanercept (ETN) (27,6%, 13), Infliximab (IFX) (6,4%, 3), Golimumab (GOL) (10,6%, 5), Certolizumab (CTZ) (4,3%, 2), Secukinumab (SCK) (8,5%, 4) and Apremilast (APR) (6,4%, 3). 42,3% cases suffered from axial involvement, rest of the sample (57,6%) presented a pure peripherical form of PsA. HLA-B27 and -Cw6 were assessed in 80,9% (38) and 68,1% (32), respectively; of whom, HLA-B27 carriers were 10,5% and HLA-Cw6 positive, 46,9%. Mean CRP level was 10,25 mg/L and mean ESR was 23,17 mm. Patients showed mean and median global drug retention of 44,57 (29,8-59,3) and 23 months. At 12-month visit, drug survival was 70%, 47% at 24 months, and 33% at 4 years from onset. Mean drug persistence by bDMARD prescribed was: ADL, 62,1 months; ETN, 51,9 months; IFX, 39 months; GOL, 22,8 months; CTZ, 9,5 months; SCK, 13,5 months; and APR, 16,3 months. Through log-rank analyses, differences in drug retention were investigated by several variables. Female sex (30,35m, 16,5-44,2 m.) was identified as statistically significant different than male patients (62,5m, 35,6-89,4m, p=0,021). Although not significant, other differences were remarkable: non-axial involvement, HLA-Cw6 negativity, HLA-B27 positivity and CRP level over 5 mg/L. No differences were found between altered and normal ESR patients.Conclusion:Second-line bDMARD survival is lower in female PsA patients, according to our data and previous bibliography. Despite our reduced sample and possible bias, non-axial involvement, absence of HLA-Cw6, presence of HLA-B27 and higher levels of CRP at biologic onset might be predictors of better drug persistence. Further investigations are required on this field.References:[1]Glintborg B et al. Clinical Response, Drug Survival, and Predictors Thereof Among 548 Patients With Psoriatic Arthritis Who Switched Tumor Necrosis Factor α Inhibitor Therapy. Results from the Danish Nationwide DANBIO Registry. Arthritis Rheum 2013:65(5):1213-23.[2]Stober C et al. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford) 2018:57(1):158-163.Table 1. Kaplan–Meier survival analysis of persistence according to sex.Table 2. Kaplan Meier survival analysis of persistence according to HLA-Cw6.Disclosure of Interests:None declared
Background:The occurrence of uveitis in patients with psoriatic arthritis (PsA) has been documented as the most frequent and important extra-articular manifestation, with an estimated frequency of 7 and 18%. Clinical onset may be acute or insidious, and it may be accompanied by other ocular manifestations. In contrast with spondyloarthropathy related-uveitis, PsA associated tends to be insidious, bilateral, chronic or posterior.Objectives:To describe clinic and immunological features of psoriatic arthritis patients in our centre, especially those with associated-uveitis and to define its frequency.Methods:A retrospective, descriptive and single-centre study (1985-2017) of 494 patients diagnosed with PsA according to the criteria of an expert rheumatologist was conducted. All patients were studied according to a standard protocol. The group was divided into 3 articular categories: pure axial, pure peripheric and mixed. Data regarding enthesitis and dactylitis, as well as HLA-Cw6 and HLA-B27 were extracted, from those available. Ophthalmologic and cutaneous involvement was registered. 216 patients were excluded because of data absence or alternative plausible diagnosis. Descriptive analyses were applied.Results:Eight patients had uveitis (2,9% in this series), only one case developed chronic pattern. Acute anterior uveitis was the form of presentation in 6 patients (75%). Unilateral involvement was registered in 3 (37,5%), in every case with right eye implication. One patient developed up to 13 episodes of acute anterior uveitis, every episode in the same eye. Median of age at first episode was 54 years, 3 (37,5%) patients were female. Regarding articular categories: 1(12,5%) pure axial, 3 (37,5%) pure peripheric and 4 (50%) mixed. Enthesitis was registered in 2 patients, none of our series developed dactylitis. 3 patients (37,5%) were HLA-B27 positive and 2 patients (25%), HLA-Cw6 positive. 6 cases had cutaneous psoriasis (75%). Adalimumab was prescribed to 5 PsA related-uveitis patients with optimal control of disease.Larger PsA cohort without ocular involvement (270 patients), 118 (42,4%) cases were female and median of age was 44 years. Pure axial involvement was present in 20 (7,2%), pure peripheric, 134 (48,2%) and mixed, 122 (43,8%). 31 (11,15%) cases developed enthesis involvement and 18 (6,5%), dactylitis. HLA-B27 was tested positive in 45 patients (19,7%) and HLA-Cw6, in 56 (27,4%). Cutaneous psoriasis was present in 231 cases (83,1%).Conclusion:Frequency of psoriatic arthritis-uveitis is lower in our sample than referred in bibliography. Further investigations are needed to understand the underlying reasons, although it could be related to the use of biologic treatment and narrower inflammatory activity control in comparison to previous studies. No posterior pole involvement, bilaterality, chronicity nor insidious onset are common in our data; neither axial involvement seems to be predictor for the appearance of uveitis.References:[1]Rosenbaum JT. Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. Clin Rheumatol 2015;34:999-1002.[2]Queiro R, et al. Clinical Features and Predictive Factors in Psoriatic Arthritis–Related Uveitis. Semin Arthritis Rheum 2002;31:264-270.[3]Paiva ES, et al. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis. 2000;59(1):67–70.Disclosure of Interests:None declared
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