Background:Some investigations indicate a higher prevalence of periodontal disease (PD) in rheumatoid arthritis (RA) patients compared to healthy individuals without RA. Significant improvements in clinical parameters and laboratory tests were demonstrated in RA patients following periodontal therapy. Periodontal diseases – gingivitis and periodontitis are inflammatory, multifactorial pathologies of periodontal tissues, which support the teeth. The factor responsible for the inflammation is a plaque with specific bacteria.In gingivitis, which is the first stage of PD, only gingiva is involved. Then in susceptible patients, periodontitis is developing and the deeper laying structures surrounding the teeth are involved and destroyed. The patients’ own observation of gingival bleeding strongly indicates gingival disease.The effectiveness of oral hygiene, including self-care, in controlling periodontal health is crucial and supported by several studies. RA patients frequently experience reduced function of fingers and wrists that makes oral hygiene troublesome.Objectives:The purpose of this study was to asses RA patient’s oral care and health based on a self-assessment questionnaire.Methods:Questionnaires were mailed to 300 patients treated for RA in a Danish rheumatology outpatient clinic.Results:A total of 164 patients completed the questionnaires. The mean age of patients was 65 years, and the average value of DAS28 was 2,31. Twelve percent were active smokers. The ”dry mouth” syndrome, as a problem when chewing or swallowing, pointed out 4% of patients. Difficulties in biting or chewing revealed 10% of patients. As much as 87% stated they regularly visit a dentist, min. one time a year.Regarding self-oral care 15% of patients answered, they brush teeth only once a day. Most of the patients (51%) used manual toothbrush vs electrical – which can be more convenient for patients with problems of the hands/wrists. Only 21% used mouth-rinsing liquid. Difficulties in performing home oral hygiene procedures were reported by 9% when brushing teeth, and by 17% using dental floss or interdental brushes. 11% of responders rated the status of their gingiva as poor. Gingival bleeding spontaneous or related to brushing was experienced by respectively 15% and 49% of patients. No patients stated knowledge of an association between oral health and RA.Conclusions:The oral care in RA patients, including self-care, seems to require improvement. Providing important information to the patients about the relationship between the oral/periodontal health and RA disease activity should raise the patient’s awareness, which may improve the course of the RA disease.References[1]Choi IA, et al. Periodontitis is associated with rheumatoid arthritis: a study with longstanding rheumatoid arthritis patients in Korea.[2]Fuggle NR, et al. Hand to mouth: a systemic review and meta–analysis of the association between rheumatoid arthritis and periodontitis.Disclosure of Interest:None declared
Background:Risk of infection is increased in patients with autoimmune inflammatory rheumatic diseases (AIRD)1. Furthermore, disease-modifying antirheumatic drug (DMARD) treatment contributes to this risk2. To reduce the risk of serious infections, it is recommended that patients are vaccinated againstStreptococcus pneumoniae3. However, some AIRD patients do not develop or maintain an adequate antibody response after pneumococcal vaccination4.Objectives:The aim of the study was to examine the proportion of patients with low antibody levels, who achieved a protective level of pneumococcal antibodies after vaccination.Methods:Pneumococcal antibodies were measured by a serological assay in patients treated with biologics in a rheumatology outpatient clinic. Vaccination with 23-valent-pneumococcal polysaccarid vaccine was then offered to patients with a protective antibody level below the defined threshold and pneumococcal antibody level was measured at follow-up 2-3 months later. The patients continued their DMARD treatment without any changes.Demographic and clinical data were collected, including age, sex, AIRD diagnosis, duration and activity (high/low), in addition to treatment (biologics, prednisolone, methotrexate) and previous vaccination history.Results:A total of 248 patients with inadequate antibody level accepted vaccination and among those, 137 patients (55%) had previously been vaccinated, 98 patients had not previously been vaccinated and for 13 patients data on vaccination status could not be obtained.At follow-up, 84 patients (34%) achieved a protective level of antibodies. Use of methotrexate as part of the DMARD regimen was associated with an unprotected level of pneumococcal antibodies (Figure 1) (p<0,001). There was no similar association with respect to use of biologics.Figure 1In the group of patients who had previously been vaccinated, time between vaccinations spanned from 20 to 111 months, median 49 months.There was an association between previous vaccination, and failure in achieving a protective antibody level (Figure 1) (p=0,02), as well as an association between less than 5 years (60 months) between vaccinations and not achieving a protective level.Conclusion:We found that only one-third of patients achieved a protective pneumococcal antibody level after vaccination. Methotrexate treatment was associated with a decreased antibody response, which was not the case for treatment with biologics or prednisolone.Among patients who had previously been vaccinated, significantly less achieved a protective level of antibodies, compared to patients who had not been vaccinated. All 248 patients had a low antibody level at baseline, despite 137 being previously vaccinated.Further studies are warranted to show whether or not a short discontinuation of methotrexate, will better the response to vaccination.References:[1]Wolfe, F. et al. The mortality of rheumatoid arthritis.Arthritis Rheum1994;37(4):481–494.[2]Ramiro, S. et al.). Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis.Ann Rheum Dis2017;76(6):1101–1136.[3]van Assen S. et al. (). EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.Ann Rheum Dis2011;70(3):414–422.[4]Hua, C. et al. Effect of methotrexate, anti-tumor necrosis factor alpha, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis.Arthritis Care Res 2014;66(7):1016–1026.Disclosure of Interests:None declared
Background:Patients diagnosed with autoimmune inflammatory rheumatic diseases (AIIRD) have higher risk of developing infections due to immunological dysfunction and immunosuppressive treatments. Current guidelines recommend annual influenza vaccination to reduce infection risk in this group of patients. However, vaccination response in these patients is uncertain.Objectives:To study influenza vaccination compliance and response in a Danish AIIRD patient population.Methods:AIIRD patients on biological treatment ± synthetic disease-modifying antirheumatic drugs (sDMARDs) in our department of rheumatology and registered in the Danish Rheumatology database (DANBIO) were included in the current study. The patients were encouraged to be vaccinated against influenza in the 2018/19 winter season. Status of influenza vaccination for the period of 1.9.2018 to 31.12.2018 was reviewed in each patient using the Danish Vaccination Register (DDV) and Danish Electronic Medicine Module (FMK). Patient data were collected by review of the medical files. Serum samples from each patient were collected on two occasions: 1) from 1.6.2017 to 15.5.2018 (before vaccination) and 2) from 1.11.2018 to 1.3.2019 (after vaccination), respectively. Antibody titers against the three antigens included in the trivalent 2018/2019 seasonal influenza vaccine were measured by hemagglutination inhibition assay followed by determination of geometric mean titers (GMT).Results:Among a total of 226 study eligible AIIRD patients, 111 (49%) had been influenza vaccinated. In the remaining group of 115 (51%) non-vaccinated patients, 50 were randomly contacted by telephone to ensure the accuracy of DDV registration. All 50 confirmed non-vaccinated status. Median age of vaccinated group was 65 years while of non-vaccinated group was 57 years (p≤0.00001). Median GMT increased from 10 to 22 in the group of vaccinated patients versus from 6 to 10 in the group of non-vaccinated patients (p<0.0001). GMT increased ≥2-fold in 79 (71%) of 111 influenza vaccinated in comparison to 60 (52%) of 115 non-vaccinated patients (p≤0.003). Among influenza vaccinated patients, median age of responders (≥2-fold increase in GMT) was 66 years versus non-responders 63 years (p=0.3). In the influenza vaccinated group, ≥2-fold increase in GMT was seen in 51 (73%) of 70 patients receiving methotrexate compared to 28 (68%) of 41 in patients not receiving methotrexate (p=0,6).Conclusion:Only half of the patients were compliant to the vaccination recommendations in the 2018/2019 influenza season despite the information campaign. Response rate of influenza vaccination (≥2-fold GMT increase) was 71% in AIIRD patients receiving immunosuppressive treatments. In contrast to other studies, concurrent methotrexate treatment did not attenuate serological response of influenza vaccination. We are still exploring the causes of increased influenza antibody titers in non-vaccinated group.References:[1] Kapetanovic MC, Kristensen LE, Saxne T, et al. Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritis. Arthritis Res Ther 2014;16:R2.[2] Hua C, Barnetche T, Combe B, et al. Effect of methotrexate, anti-tumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res 2014;66:1016–26.[3] Furer V, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020;79:39–52. doi:10.1136/annrheumdis-2019-215882Disclosure of Interests:None declared
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