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
BackgroundThe ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA.ObjectivesTo determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD).MethodsHacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-value<0.1 were re-tested in multivariable models. Forward selection was performed until the best-fit model was obtained, taking possible confounders into account. Two separate multivariable models were built, one with and one without the covariate “achievement of remission at 3-6 months”, to assess consistency of findings and to account for missing information regarding remission status between 3 and 6 months.ResultsData on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99).Table 1.Multivariable analysis (best-fit model) of predictors of sustained remissionModel 1Model 2CovariatesMultivariable Analysis (n= 541)Multivariable Analysis (n=739)OR (95% CI)p-valueOR (95% CI)p-valueAge at diagnosisNSNS0.97 (0.96-0.99)0.006Male sex2.84 (1.71-4.70)<0.0012.31 (1.60-3.35)<0.001Concomitant csDMARD use (at baseline or follow-up)2.94 (1.57-5.51)0.0011.88 (1.23-2.86)0.003Baseline PGA0.97 (0.96-0.98)<0.0010.98 (0.97-0.99)0.002Baseline BASDAINSNS0.87 (0.78-0.96)0.009Baseline symptom durationNSNS0.97 (0.94-0.99)0.021Achievement of remission at 3-6 months after baseline11.70 (7.11-19.23)<0.001NANANA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment.ConclusionThis study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition.Disclosure of InterestsBayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB
BackgroundThe incidence of co-occurrence of FMF and axial spondyloarthritis (axSpA) in adults is reported to be 0.5-7.5%. M694V mutation is the most frequent variant in patients with FMF+AxSpA (1).ObjectivesTo evaluate the association of demographic and clinical characteristics of patients with FMF+axSpA with the M694V mutation.MethodsA total of 9630 FMF patients were identified according to the ICD-10 code (E85.0) in the electronic database of Hacettepe University Hospital. 7525 patients aged <18 years old and no hospital admissions after 2014 were excluded. 2105 adult FMF patients screened for accompanying axSpA according to ICD-10 code (M45) and 241 patients detected as FMF+axSpA. FMF diagnosis was confirmed with Tel-Hashomer criteria. The diagnosis of axSpA was confirmed by the presence of sacroiliitis on sacroiliac radiography according to the Modified New York (mNY) criteria or the presence of active sacroiliitis on sacroiliac magnetic resonance imaging according to the ASAS criteria. According to these criterias, the diagnosis of FMF+AxSpA association was confirmed in 136 patients. MEFV gene result was present in 113 (83%) of 136 patients and were included in the study. Patients were divided into two groups as M694V (+) and M694V (-) according to the M694V mutation, and the demographic and clinical characteristics of the patients were compared. p<0.05 was considered statistically significant.ResultsOf 113 patients with known MEFV gene result, 91 (80.5%) were M694V (+), 22 (19.5%) were M694V (-), 45 (39.8%) were homozygous for M694V. In the M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were at an earlier age compared to M694V (-) patients (p<0.05). The frequency of radiographically proven moderate to severe hip involvement (24.2% vs. 9.1%) and total hip replacement (11% vs. 4.5%) was higher in M694V (+) patients. However, these differences were not statistically significant (p=0.12; p=0.36). In the homozygous M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were significiantly at an earlier age than in the group homozygous M694V (-) (p<0.001). Although erysipelas-like skin rash was more common in homozygous M694V (+) group (28.9% vs. 11.8% p=0.02), other symptoms and findings were similar in both groups (Table 1).Table 1.FeaturesM694V (+) (n=91)M694V (-) (n=22)P1M694V Homozygous (n=45)M694V Nonhomozygous (n=68)P2Age at FMF symptom onset [years, med (25-75)]11 (5-18)21 (8-30)0,0057 (1-42)18 (3-53)<0,001Age at FMF diagnosis [years, med (25-75)]18 (10-27)33 (27-38)<0,00112 (1-42)28 (3-59)<0,001Age at AxSpA symptom onset [years, med (25-75)]20 (15-25)29 (24-38)<0,00120 (5-50)22 (5-58)0,43Age at AxSpA diagnosis [years, med (25-75)]24 (19-33)37 (28-44)<0,00123 (11-51)29 (7-59)0,039Fever n (%)84 (92,3)21 (95,5)0,6044 (97,8)61 (89,7)0,10Abdominal pain n (%)80 (87,9)20 (90,9)0,7043 (95,6)57 (83,8)0,056Peripheral arthritis n (%)45 (49,5)7 (31,8)0,1324 (53,3)28 (41,2)0,20Erysipelas n (%)19 (20,9)2 (9,1)20,213 (28.9)8 (11,8)0,02Enthesitis n (%)21 (23,1)4 (18,2)0,6211 (24,4)14 (20,6)0,63Uveitis n (%)11 (12,1)4 (18,2)0,454 (8,9)11 (16,2)0,26Psoriasis n (%)6 (6,6)1 (4,5)0,722 (4,4)5 (7,4)0,82HLA-B27 (+) n (%)25 (27,3)4 (18,2)0,542/15 (13,3)12/40 (30)0,30Syndesmophyte n (%)20/82 (24,4)6/19 (31,6)0,527/43 (16,3)19/59 (32,2)0,07Total ankylosis n (%)4/83 (4,8)1/19 (5,3)0,941/43 (2,3)4/59 (6,8)0,39Moderate to severe hip disease*n (%)22 (24,2)2 (9,1)0,1212/45 (26,7)12 (17,6)0,25Total hip replacement n (%)10 (11,0)1 (4,5)0,364 (8,9)7 (10,3)0,80* BASRI-hip score ≥3 on any sideConclusionFMF and SpA symptoms appear at an earlier age in M694V positive patients. The M694V mutation is associated with severe disease and early disease onset.References[1]Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C. The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis. Clin Rheumatol. 2009;28(1):41-6.Disclosure of InterestsNone declared
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