BackgroundData regarding the prevalence and especially incidence of osteoporosis in Spondylarthritis (SPA) is scarce and very divergent among studies from different patient populations (1).ObjectivesIn this study, we aimed to compare demographic, disease and laboratory characteristics of SpA patients regarding their bone mineral densitometry (BMD) categories and find out incidence of osteoporosis in the follow-up BMD of patients who were not found to have osteoporosis at baseline.MethodsBetween 2010-2021, patients with a SPA diagnosis in the HUR-BIO database were searched. HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2010. Patients with BMD measurement were included in the study. Follow-up BMD scores were also documented. The patients were divided into 3 groups as normal, osteopenia and osteoporosis in accordance with the WHO criteria (2). Demographic characteristics, comorbidities, laboratory data and drugs in each group were documented.Results3245 patients were reviewed. BMD was measured at least once in 118 patients out of 3245 (3.6%) patients. When the groups classified, 34 patients (28.8%) were included in the normal, 49 (41.5%) osteopenia and 35 (29.7%) osteoporosis groups. Patients with normal BMD was younger than both groups. Diabetes and hypertension were more prevalent in patients with osteopenia. The BMI was significantly lower in the osteoporosis group. 25 patients with normal and osteopenia in baseline BMD measurement had at least 1 follow-up BMD measurement. During the total follow-up of 91 patient-years, 3 patients had osteoporosis, revealing a the incidence of 3.3% in 100 patient-years.ConclusionIn our study, the incidence of OP development in SPA patients was found to be 3.3%. Frequency of osteoporosis was 29.7% among SpA patients with BMD measurement (118/3245; 3.6%), however; only 40% of them had appropriate treatment. Osteoporosis seems as an overlooked and undertreated comorbidity of SpA.Table 1.Comparison of spondyloarthritis patients according to BMD scores (normal, osteopenia and osteoporosis) according to baseline BMD assessmentNORMAL Number, (%)OSTEOPENIA Number, (%)OSTEOPOROSIS Number, (%)P VALUENumber of Patients34 (28.8)49 (41.5)35(29.7)Age47,5 (27-70)63 (45-79)58 (20-75)0.00*Gender (Female)24 (70.6)34 (69.4)23 (65.7)Diabetes Mellitus3 (8.8)14 (29.2)1 (2.9)0.00*Hypertension11 (32.4)28 (58.3)5 (14.3)0.00*Chronic Renal Failure2 (6.9)1 (2.7)1 (5.3)0.81Chronic Ostructive Pulmonary Disease4 (13.8)4 (10.8)1 (5.3)0.30Coronary Artery Disease0 (0)5 (12.5)3 (15)0.27Malignancy1 (3.6)1 (2.9)1 (4.2)1.0Smoking21 (61.8)23 (47.9)21 (63.6)0.379 (26.5)13 (27.1)5 (15.2)4 (11.8)12 (25)7 (21.2)Calcium mg/dl9.4 (8.2-10.2)9.5 (8.7-10.4)9.7 (8.1-10.4)0.49Phosphorus mg/dl3.5 (3-4.4)3.4 (2.6-5)3.8 (2.9-4.9)0.25Vitamin D ng/ml16 (7.4-64.4)21.2 (5-69.6)15.8 (5.8-49.1)0.66ALP IU/ml89.5 (54-137)89.5(53-169)80 (50-239)0.43Albumin g/dl4.2 (1.7-4.7)4.2 (3.3-8.4)4.2 (2-4.8)0.43TSH mU/ml1.5 (0.8-4.1)2.3 (0.1-9.7)2 (0.7-3.3)0.71Body Mass Index (BMI) kg/m229 (17-41.2)28.3 (20-44.6)25.1(15.8-43.2)0,06*Steroids4 (11.8)8 (16.3)2 (5.7)0.33Anti-TNF25 (73.5)35 (71.4)26 (74.3)0,95D Vitamin7 (20.6)14 (28.6)10 (28.6)0.67Calcium4 (11.8)5 (10.2)6 (17.1)0.63Bisphosphonate0 (0)4 (8.2)14 (40)0,00*Data was represented as median (minimum-maximum) or n(%)References[1]Hu LY, Chen PM, Shen CC, et all. Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PoleS one 2019:6;14[2]Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield.Disclosure of InterestsNone declared
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
BackgroundIncreased cardiovascular mortality has been reported in AS patients. There are studies showing the positive effects of anti-TNF-α therapy on both cardiovascular mortality and sleep quality. (1,2)ObjectivesTo determine the changes in sleep quality and 24-hour blood pressure readings in patients with axial spondiloarthritis (axSpA) after treatment with anti- tumor necrosis factor TNF-α therapy.MethodsPatients with axSpA who were admitted to Hacettepe University Hospital Rheumatology outpatient clinic between 01.03.2021 and 01.12.2021, anti-TNF-naive and without a history of cardiovascular disease were included. Disease activitiy assesment (ESR, CRP, BASDAI and BASFI), ambulatory blood pressure measurement (AMBP) and sleep quality evaluated by pittsburgh sleep quality index questionare (PSQI) were assessed before ant-TNF therapy (0.month) and after anti-TNF-α therapy (3.month).ResultsTotally, 28 patients with axSpA (mean (SD) age 40.0 (10.4) years, female:16(57.1%) patients) were included in to this study (table-1). The 0th and 3th month ABPM measurements of the patients in our study were within the normotensive limits. Both disease activity scores and median PSQI scores [8.5 (4.0-12.8)] were high and sleep quality was poor in 71% of the patients. Although there was a significant decrease in disease activity scores and a significant improvement in sleep quality at the 3. month after anti-TNF- α therapy, no significant changes were observed in ABPM parameters such as Ambulatory Arterial Stiffness İndex (AASI), Average real Variability (ARV), Pulse Pressure İndex (PPI), Sleeptroughsurge and Prewaking surge compared to pre-treatment. While after anti- anti-TNF-α therapy the percentage of patients with dipper phenomena increased in the 3. month, this increase was not statistically significant (46.4% (0. month) vs. 60.7% (3. month); p=0.388). Furthermore, the change in nighttime systolic blood pressure reduction was statistically significant respectively ([4.8% ((-7) – 9.2) (0. month) vs. 9.2% (4.7-11.1) (3. month); p=0.020], while there was no statistically significant difference in the change in nighttime diastolic blood pressure reduction respectively ([6.4% (1.5-14.7) vs. 9.6% (5.0-15.8); p=0.112] (table-2).ConclusionThis study shows that anti-TNF-α treatment has positive effects on modifiable cardiovascular risk factors by increasing sleep quality and increasing nighttime blood pressure reduction. Prospective and long-term studies are needed.References[1]Atzeni F, et. al. Cardiovascular risk in ankylosing spondylitis and the effect of anti-TNF-α drugs: a narrative review. Expert Opin Biol Ther. 2020;20(5):517-24.[2]Karadağ O, et. al. Effect of anti-TNF-α treatment on sleep problems in ankylosing spondylitis. Rheumatol Int. 2012;32(7):1909-13.Table 1.Baseline demographic and clinical characteristics of the patientsMen/ Women n (%)12 (42.9%)/ 16 (57.1%)Age*years40.0±10.4Disease duration** years6,5 (4-11)HLA-B27 positivityn (%)13(59,1%)Peripheral manifestationsn (%)1 (3,6%) Uveitisn (%)- Psoriasisn (%)- Dactilitisn (%)- Entesithisn (%)- IBDn (%)- VAS-Pain**7.5 (5.3 – 9.0) BASDAI** (0-10)5.8 (3.5-7.1) BASFI** (0-10)6.4 (3.6-7.3) ESR**(mm/h)14.0 (6.3-30.0) CRP**(mg/dL)0.8 (0.3-2.3) BMI*(kg/m2)27.2±5.6 LDL(mg/dL)*123.7±38.4 HDL(mg/dL)*50.2±10.1Triglycerides(mg/dL)*117.7±71.9Smokingn (%)13 (46.4%)Obesen (%)9 (32,1%)Medicaitons*NSAID n (%)28 (100%)kDMARD n(%)17 (60,7%)Steroid#n(%)4 (14.3%)Mean±standard deviation **(Median 25%-75%)# <7.5 mg prednisone or equivalentBASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), IBD (Inflammatory bowel disease), ESR (Erythrocyte-Sedimentation Rate), CRP (C-reactive protein), BMI (Body mass index), NSAID (Non-steroidal anti-inflammatory drug), kDMARD (conventional DMARD), steroid (users under <7.5 mg). Those who were obese were considered as having a BMI >30.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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