Untreated obstructive sleep apnea (OSA) increases healthcare utilization and is associated with reduced work performance and occupational injuries. The economic burden related to untreated OSA is substantial, accounting for billions of dollars per year. Furthermore, therapy of OSA is an extremely cost-efficient use of healthcare resources, comparing highly favorably with other commonly funded medical therapies. Governments, transportation agencies, industry, and insurance companies need to be better informed concerning the economic impact of untreated OSA and the benefits of therapy.

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Objective Hydroxychloroquine (HCQ) has been used during the coronavirus disease 2019 (COVID-19) pandemic because of its reported anti-viral activity. This study examined the association of chronic HCQ use with the incidence and complications of COVID-19. Methods This retrospective cohort study included adults with rheumatoid arthritis and/or systemic lupus erythematosus who visited rheumatology clinics in three tertiary hospitals in Riyadh, Saudi Arabia between January 2019 and December 2020. Patients were categorized into two groups based on HCQ use. Data were obtained from the electronic health record and by interviews with patients. The primary study objective was the incidence of COVID-19 and its complications from March 2020 to February 2021. Results Almost 11% of the study cohort was positive for COVID-19, and the incidence of COVID-19 was similar between HCQ users (11.11%) and nonusers (10.86%). Disease complication rates were similar in the study arms, and they mainly included fever, dry cough, fatigue, and breathing difficulty. Conclusions This study revealed no significant association between chronic HCQ use and the incidence of COVID-19, and disease complications were similar in the study arms.

Background Epidemiological studies have noted excess paternal transmission in psoriasis and psoriatic arthritis. To date, there has been no molecular explanation to account for this observation. Differential methylation patterns have long been implicated as a potential mechanism to account for excess paternal transmission. Objectives In this pilot study, we investigated the differential methylation pattern among paternally and maternally transmitted PsA. Methods Twenty-four (24) patients with maternally transmitted PsA were compared with 24 paternally transmitted PsA cases. For maternally transmitted PsA, the proband's mother had either psoriasis or PsA, and for paternally transmitted PsA, the proband's father had either psoriasis or PsA. Genome-wide DNA methylation profiling was performed on all these 48 samples by using Illumina HumanMethylation450k Beadchip, which measures up ∼480,000 different CpG sites per sample and covers 96% of RefSeq genes. The methylation level at each CpG site was measured by β values varying from 0 (no methylation) to 1 (100% methylation). Results Maternally transmitted PsA cases were predominantly females (19/24) with mean age of onset of PsA at 30.6 years. For paternally transmitted PsA, there were slightly more females (13/24) and age of onset of PsA was 22.2 years. Methylation data were normalized using BMIQ method and no batch effects were detected by PCA analysis. Methylation analysis was performed on 382,024 of the 485,512 CpG sites after filtering and revealed 90 significant CpG sites (p<0.05). The three most significant CpG sites were hypermethylated regions located on chromosome 8 that did not reside on or adjacent to a gene, with p values ranging from 9x10–7 to 5x10–6. Many genes of interest based on current understanding of psoriatic disease were identified including hypermethylation of CPG sites on MICA (diff 10.22%; p=0.014), IRIF1 (diff 10.3%; p=0.016), PSORS1C3 (diff 11.1%; p=0.005); and TNFS4 (diff 15.2%; 0.004). Excess hypomethylation at CPG sites was noted on PSORS1C1 (18.9% diff. p=0.027). Conclusions These preliminary results demonstrate that the global DNA methylation pattern in paternally transmitted PsA differs from maternally transmitted PsA. High priority candidate regions and genes identified in this study need further validation. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3309

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Background:Psoriatic arthritis (PsA) is a chronic inflammatory condition associated with psoriasis. The common clinical features of PsA include peripheral arthritis, dactylitis, enthesitis, spondylitis, skin and nail disease1. Considering the heterogeneous course of disease and the different patient characteristics, there is a need to standardize management of PsA patients. At present, no established guidelines are available on PsA care pathway in Saudi Arabia.Objectives:To provide consensus-based guidance to all Saudi health care providers (HCPs) on the management of PsA patients including referral pathway, definition of remission and treat-to-target approach.Methods:A Delphi technique was used to understand PsA patient care pathway. In first step, a targeted literature review was conducted and a survey questionnaire including 16 questions was developed to explore PsA patient journey. In second step, this questionnaire was submitted to 127 HCPs and 33 of them provided their response. In third step, a panel of 12 experts including 10 rheumatologists, 1 dermatologist and 1 general physician reviewed the available evidence along with survey results to align on final recommendations.Results:The most common management guidelines recommended for PsA were European League against Rheumatism (EULAR, 100% agreed) and American College of Rheumatology (ACR, 100% agreed). Psoriasis Epidemiology Screening Tool (PEST) was recommended by 67% of experts as validated screening tool for PsA in dermatology clinic. The laboratory investigations included were C-reactive protein (CRP, 100%), erythrocyte sedimentation rate (ESR, 100%), complete blood count (92%), urea and creatinine (92%), liver function (92%), rheumatoid factor (56%) and X-ray of affected joints (75%). For patients with additional symptoms of back pain, X-ray of sacroiliac joints and human leukocyte antigen B27 (HLA-B27) test to be included. Only rheumatologists should recommend a magnetic resonance imaging based on the individual clinical picture. The agreement criteria for HCPs for referring patient to a rheumatologist were presence of psoriasis (100%) and one of the following features: dactylitis [100%], joint pain [100%], arthritis [100%], nail dystrophy [91%]. Patient with active arthritis should be referred to rheumatologist within 4 weeks. The referral pathway agreed by the experts for PsA patients is presented in Figure 1. Majority of experts (57%) defined clinical remission as absence of disease activity in all facets of disease assessed using the disease activity in psoriatic arthritis (DAPSA) or minimal disease activity (MDA) index. For treat-to-target, 71% of experts agreed on EULAR recommendations2. For remission and treat-to-target, experts identified a need for more clear definition.Conclusion:This expert consensus aimed to provide guidance to Saudi HCPs on standardizing diagnosis and care of PsA patients. Most experts recommended PEST as validated screening tool for PsA along with laboratory investigations such as CRP, ESR, X-ray, etc. Referral to a rheumatologist should be considered for patient with presence of psoriasis and one of the other defining features for PsA. There is a need for more clear definition of remission and treat-to-target.References:[1]Ogdie A, et al. Rheum Dis Clin North Am. 2015;41(4):545–568.[2]Gossec L, et al. Ann Rheum Dis. 2020;79:700–712.Figure 1.Referral pathway for psoriatic arthritis patients CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; CBC: Complete blood count; HLA-B27: Human leukocyte antigen B27; PEST: Psoriasis Epidemiology Screening ToolAcknowledgements:This project was supported by Novartis Saudi Ltd., Saudi Arabia and the Saudi Society for Rheumatology. We would also like to thank Dr. Xenofon Baraliakos for his support.Disclosure of Interests:Hanan Alrayes: None declared., Mansour Alazmi Speakers bureau: Pfizer, Abbvie, Khaled Alderaan: None declared., Mushabab Alghamdi: None declared., Nayef Alghanim: None declared., Ahmed Alhazmi: None declared., Nadeer Alkhadhrawi: None declared., Mohammad Almohideb Speakers bureau: Novartis, Abbvie, Celgene, Lilly, Jansen and Sanofi, Grant/research support from: Sanofi and Abbvie, Suzan Attar Speakers bureau: Lectures in symposium about different diseases in rheumatology and management, Grant/research support from: Research in recruiting patient, Zyad ahmed Alzahrani Speakers bureau: Pfizer, Novartis, MSD, Janssen, Abbvie, Lilly, Consultant of: Pfizer, Novartis, MSD, Janssen, Abbvie, Lilly, Mohamed Bedaiwi: None declared., Nancy Zakaria Employee of: Novartis, Hussein Halabi: None declared.

Background Ankylosing spondylitis (AS) is an inflammatory spinal disease characterized by ankylosis of the spine. A subset of patients develops significant ankylosis resulting in mobility issues. Objectives To determine if epigenetic modifications may account for differences in the degree of ankylosis of the axial spine in ankylosing spondylitis. Methods AS patients satisfying the New York criteria with advanced ankylosing (characterized clinically with spinal flexion) and radiographically with at least 4 continuous ankylosed vertebrae were categorized as advanced ankylosis. Control AS patients had normal posture on clinical evaluation and had absence of syndesmophytes on plain radiographs. All patients were Caucasians of Northern European Ancestry. Genome-wide DNA methylation profiling was performed on the blood DNA samples from 23 AS patients with advanced ankylosis and 25 patients with no syndesmophytes. The profiling was performed using Illumina HumanMethylation450k Beadchip, which measures up ∼480,000 different CpG sites per sample and covers 96% of RefSeq genes. The methylation level at each CpG site was measured by β values varying from 0 (no methylation) to 1 (100% methylation). Results Advanced ankylosis patients were predominantly males (22/23), with mean of disease onset at age 21.9 years and age at time of assessment was 43.72. Meanwhile, AS patients with no syndesmophytes were also predominantly males (24/25), with mean of disease onset at age 24.6 years and age at time of assessment was 44.1 years. Methylation data were normalized using BMIQ method and no batch effects were detected by PCA analysis. Methylation analysis was performed on 382,232 autosomal CpG sites after quality controls. One outlier was identified and excluded in the subsequent analysis. Analysis revealed 100 locations where there was a difference between patients with and without spinal ankylosis. The three locations that differentiated the most included CPG sites in KIAA0319 (hypomethylated) (p=1.7×10-5); JAKMIP3 (p=6.4×10-5) and LYG2 (p=9.6×10-4). Based on functional relevance to AS pathogenesis, particularly antigen presentation, cytokine signalling, and bone remodeling, 5 candidate genes (4 hypomethylated; 1 hypermethylated) emerged: IL18RAP (beta diff=-0.1473; p=0.01), SMAD3 (beta diff=-0.16664; p=0.047), MCF2L (beta diff=-0.10894; p=0.009), DDAH2 (beta diff=0.11494; p=0.007), and NLRC5 (beta diff=-0.11542; p=0.052). Conclusions These preliminary results demonstrate that the global DNA methylation pattern in advanced ankylosis differs from AS patients with no spinal damage. High priority candidate genes identified in this study warrants further validation. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3270