P112 Teriparatide versus anti-resorptive treatment in rheumatoid arthritis patients with severe osteoporosis: an observational study

Abstract Background/Aims Patients with rheumatoid arthritis (RA) are at increased risk of developing osteoporosis (OP) and have a twofold increased risk of vertebral fracture compared with the general population. There is increasing evidence that teriparatide (TPTD) is superior to anti-resorptive medication in patients with severe spinal OP.The aim of this study was to compare the efficacy of TPTD with anti-resorptive treatment (ART) in RA patients with severe spinal OP. Methods Observational study of RA patients and controls with severe OP who were referred to a specialist osteoporosis clinic. Patients with a history of two vertebral fractures or a spinal BMD Tscore < -4 were offered either TPTD or standard care with either oral or parenteral ART. After completion of TPTD treatment patients were advised to commence ART. DEXA re-evaluation was usually performed after 1, 2 and 5 years. Results We studied 59 postmenopausal women with RA who had severe spinal OP. In the RA group 29 patients received TPTD treatment and 30 patients were started on ART (12 Zoledronic acid, 11 Alendronate, 3 Risedronate, 2 Denosumab, 1 Etidronate and 1 unknown).RA patients who were started on TPTD were on average 5 years younger (65.4 ±10.6) than patients who were started on ART (70.6±8.2; p = 0.041). Slightly more than half of TPTD RA patients (55.2%) had previously received bisphosphonates and 10.3% received low dose Prednisolone (mean± SD dose = 5.5 ± 3.3 mg). Baseline lumbar spine T-score was -4.25±0.57 in the RA TPTD group. Patients with RA who elected to have ART as opposed to TPTD had higher BMD values as compared with those who chose to have TPTD (T-score = -3.39±1.09; p = 0.001, from RA TPTD group).We found that increase in BMD with TPTD treatment was superior to ART in the RA group at increasing spine BMD after 2 years (+17.59% ± 9.63% vs 3.19 % ± 4.99% , p value<0.001). Assessment after 5 years following commencement of ART showed that spine BMD remained higher in the RA TPTD group than in the RA ART group alone (18.0% ± 11.6% vs 6.36 % ± 8.95%; p = 0.019). However, there was no significant difference between TPTD and ART on hip BMD change at 2 years (+ 3.6% ± 12.2 % vs -0.57% ± 5.96%, p = 0.237) or 5 years (+1.0% ± 10.9% vs -0.3% vs ± 7.8%, p = 0.724). Conclusion This real-world study confirms that TPTD treatment is more effective in treating severe spinal OP in RA patients than antiresorptive medication alone. Despite the fact that the majority of RA patients had been pre-treated with bisphosphonates the TPTD treatment effect in RA patients was robust. Anabolic treatment with TPTD is a good option for RA patients with severe spinal OP. Disclosure B. Hauser: Other; Dr Hauser has received fees for a promotional article from Gedeon Richter. K.M. Berg: None. J.A. Lambert: None. S.H. Ralston: Grants/research support; Prof Ralston has received grant funding from Lilly for an observational study and donation of Teriparatide for the TOPAZ trial in Osteogenesis Imperfecta.

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The Latent Tuberculin Test after 1-year Therapy with Anti-TNF in Babylon, Iraq

Journal of University of Babylon for Pure and Applied Sciences ◽

10.29196/jubpas.v26i8.1680 ◽

2018 ◽

Vol 26 (8) ◽

pp. 144-150

Author(s):

Ali Alkazzaz ◽

Murtadha Najah Jawad ◽

Zeyad Tareq Kareem

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Medical History ◽

Demographic Data ◽

Latent Tuberculosis ◽

Tuberculin Test ◽

P Value ◽

Cross Sectional ◽

Increased Risk ◽

Significant Difference

Background: Rheumatoid arthritis (RA) patients receiving receive anti-TNF agents are at increased risk of reactivation of latent tuberculosis infection (LTBI). The tuberculin skin test (TST) is widely used to screen LTBI and providing preventive treatment, in an effort to meet the WHO target of a 90% reduction in TB by 2035. Objectives: To determine the proportion of TST conversion among RA patients after 1 year of anti-TNF treatment and association of positive TST result with patients’ socio-demographic characteristics and medical history. Methods: This community-based cross-sectional study was conducted at the Department of Rheumatology of Marjan Teaching Hospital in Iraq, for a period of 1 year. Patients with RA/and spondyloarthropathy, and who received anti-TNF therapy for >1 year, underwent TST. Their demographic data and medical history were also obtained. All statistical analysis was performed using SPSS (Version 20) and, p < 0.05 was considered as a sign. Data from the baseline and 1 year follow-up was subjected to the Kolmogorov-Smirnov test to determine whether they were normally distributed. Chi-Square test used to test significance of TST among etanrecept and infliximab at the end of the study. Results: A total of 96 patients were enrolled, including 55 (57.3%) males and 41 (42.3%) females with an average age of 41.1, and mostly 68 (70.8%) from Babylon Governorate of Iraq. A total of 40 (41.7%) patients had rheumatoid arthritis alone, and the remaining 56 (58.3%) had a comorbidity of spondyloarthropathy. Majority of the patients 65 (67.7%) received the biological agent infliximab, while 31 (32.3%) patients received Etanercept for RA for a period of 1 year. There was a statistically significant decreasing in the median ESR and disease activity from the baseline to the end of the study (p-value <0.01). There was no significant difference in TST results based on gender or age. Both infliximab and etanercept were significantly associated with a decreasing in ESR and disease activity Conclusion: This study has shown that there was very low TST conversion among RA patients after 1 year of anti-TNF treatment and, age and gender were not associated with TST.

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Association of MTR A2756G Gene Polymorphism with Risk of Head and Neck Cancer

Life and Science ◽

10.37185/lns.1.1.82 ◽

2020 ◽

Vol 1 (3) ◽

pp. 6

Author(s):

Muhammad Tahir ◽

Aamer Ali Khattak ◽

Erum Monis ◽

Sana Gul

Keyword(s):

Head And Neck ◽

Age Groups ◽

P Value ◽

Chi Square ◽

Normal Individuals ◽

Increased Risk ◽

Significant Difference ◽

Pcr Rflp ◽

Chi Square Test ◽

History Of

Objective: To perform genotyping for MTR A2756G polymorphism and identification of risk factors associated with head and neck squamous cell carcinoma (HNSCC). Study Design: Cross section, comparative study. Place and Duration of Study: The study was carried out at the Department of Biochemistry of Quaid-i- Azam University, Islamabad from October 2014 to August 2015. Materials and Methods: In this study, 292 diagnosed patients HNSCC and 324 normal individuals without any history of cancer were enrolled. Blood samples of patients and controls were collected in ethylenediamine tetra acetic acid (EDTA) and DNA was extracted using conventional method. All samples were genotyped for the MTR A2756G polymorphism using PCR-RFLP. Frequency of polymorphism was compared between HNSCC patients andcontrols. MultipleLogisticRegression(MLR)andchi-squaretestwasperformedtoexaminetheassociation of MTR A2756G polymorphism with risk factor. Results: Chi-square test of independence showed statistically significant difference among the variables of age, smoking and MTR A2756G genotype (p-value<0.05). Multivariate analysis showed that smoking (adjusted OR, 3.7; 95% CI, 2.3 – 6.0), age groups 41 – 50 years (adjusted OR, 3.6; 95% CI, .9 – 6.7) and > 60 years (adjusted OR, 3.5; 95% CI, 1.7 – 7.3), MTR 2756 AG genotype (adjusted OR, 2.1; 95% CI, 1.3 – 3.5) is associated with increased risk of HNSCC. Conclusion: The results suggest that the genetic polymorphism MTR A2756G is associated with the occurrence of HNSCC in the Pakistani population while the individuals between 40 to 50 years of age and those who are smokers are at a greater risk of developing HNSCC.

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Methotrexate induced lung diseases in rheumatoid arthritis patients

QJM ◽

10.1093/qjmed/hcab116.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Gamal Zaki ◽

Ahmad Mohamed El Yasaky ◽

Rana Ahmed El Hilaly ◽

Mayada Taha Mostafa

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Lung Disease ◽

Disease Activity Score ◽

Pulmonary Function Tests ◽

Activity Score ◽

P Value ◽

Female Ratio ◽

Increased Risk ◽

Significant Difference

Abstract Background Rheumatoid arthritis (RA) is a progressive, systemic autoimmune disorder characterized by articular and extra-articular manifestations. The lung is commonly a site of extra-articular disease. The lung manifestations of RA vary and may include airways, parenchymal, vascular, and pleural disease. Manifestations of lung disease in RA typically follow the development of articular disease. Methotrexate (MTX)has shown efficacy for the treatment of several diseases, especially RA. Methotrexate has also been implicated as a causative agent in interstitial lung disease. Objective to find any association between MTX intake and lung abnormalities in RA patients. Patients and Methods This study included sixty adult RA patients, recruited from Ain Shams University Hospitals. Patients were divided into thirty patients on MTX therapy, and another thirty patients on non-methotrexate therapy. All underwent history, clinical examination, chest examination, evaluation of RA by modified disease activity score 28 (DAS 28) and pulmonary function tests(PFT). Results The age of patients receiving MTX ranged from 35-65 years and the non-MTX group was 35-57 years with a mean ±SD of 47.733±5.265 and 40.700 ±5.187, respectively. Male to female ratio of MTX group was about 1:3, while Non MTX group was about 1:9.There was no significant difference regarding age and sex. There was no difference between both group regarding modified DAS score and chest manifestations. There was no difference in PFT findings between patients on high or low dose of MTX therapy .Similarly, no association was found between disease activity score and PFT findings in both groups. On the other hand, a significant association between chest symptoms and PFT, P value<0.05 . Also a strong significant association was found between anticitrullinated protein antibodies (ACPA) status and PFT in both group, p value <0.05. Conclusion MTX treatment was not associated with an increased risk of RA-ILD diagnosis. On the contrary, evidence showed that MTX may delay the onset of ILD. There seems no reason to confuse the association of MTX and hypersensitivity pneumonitis with the onset of RAILD.ACPA antibody is considered a major risk factor in RA-ILD, ACPA titers constitute an independent factor associated not only with the presence but also with the severity of RA-ILD

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Does Depression Increase Risk for Noncompliance with Warfarin Therapy?

Blood ◽

10.1182/blood.v124.21.5096.5096 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5096-5096

Author(s):

Urmeel H Patel ◽

Mitchell Veith ◽

Yijin Wert ◽

Pramil Cheriyath

Keyword(s):

Adverse Events ◽

Therapeutic Range ◽

Warfarin Therapy ◽

Conflicts Of Interest ◽

Categorical Variables ◽

P Value ◽

Increased Risk ◽

Significant Difference ◽

History Of ◽

History Of Depression

Abstract Introduction Management of warfarin therapy in an outpatient setting has been proven to be challenging despite specialized anticoagulation clinics. It is estimated that 40-50% of INR values are outside and, most commonly, below the therapeutic range. Extended periods of time spent outside the therapeutic INR range have been associated with an increased risk for morbidity and mortality. Sub-therapeutic INRs are associated with a higher risk for thromboembolism, which can lead to ischemic stroke and myocardial infarction; while supra-therapeutic INRs are associated with warfarin-induced hemorrhage, both of which can lead to an increased mortality. Furthermore, it has been found that patients with depressive symptoms have been associated with decreased adherence to any medical management when compared to non-depressed patients and patients with psychosocial or emotional factors are more often found to be outside therapeutic range while on warfarin therapy. However, whether depression has a direct effect on noncompliance with warfarin therapy has yet to be studied. This study intends to prove depression does increase the risk for noncompliance with warfarin therapy and, subsequently, increase their risk of adverse events due to decreased time-in-therapeutic range (TTR). Method A retrospective study was conducted on 91 patients from an outpatient anticoagulation clinic. INR data, past medical history of depression, demographics, and history of complications secondary to warfarin therapy were collected. Patients with history of depression were compared to patients without history of depression on their demographic variables, risk factors and the study outcomes. Chi-square tests were used to determine the significant difference between the two groups on categorical variables. The student t-tests were used to determine the significant difference between the two groups on continuous variables. A p-value ≤ 0.05 was regarded as significant. A logistic regression model was used to determine whether depression had an impact on keeping the patient’s INRs within the therapeutic range 70% of the time while on therapy. All the statistical analyses were completed by SAS version 9.2. Results We found that the group of patients with a history of depression were 67% less likely to have patients who had their INRs within the therapeutic range 70% of the time while on therapy when compared to patients without a history of depression (odds ratio=0.33, CI 0.116 – 0.935, p-value = 0.0370). Additionally, we found that patients with a history of depression had, on average, a lower TTR than patients without a history of depression (p-value = 0.0399). Conclusion The results reveal patients with a history of depression are at an increased risk for noncompliance with warfarin therapy when compared to patients without a history of depression. Furthermore, patients with a history of depression and on warfarin therapy would likely benefit from further interventions to increase their TTR and decrease their risks for adverse events. Disclosures No relevant conflicts of interest to declare.

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Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

10.2196/preprints.23937 ◽

2020 ◽

Author(s):

Dr. Animesh Ray ◽

Dr. Komal Singh ◽

Souvick Chattopadhyay ◽

Farha Mehdi ◽

Dr. Gaurav Batra ◽

...

Keyword(s):

Tertiary Care ◽

Age Groups ◽

Hospitalized Patients ◽

North India ◽

P Value ◽

Care Hospital ◽

Igg Antibodies ◽

Igg Antibody ◽

Increased Risk ◽

Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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POS0441 DEVELOPMENT OF RHEUMATOID ARTHRITIS AMONG ANTI-CITRULLINATED PROTEIN ANTIBODIES POSITIVE ASYMPTOMATIC INDIVIDUALS: A PROSPECTIVE OBSERVATIONAL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.344 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 449.1-449

Author(s):

S. Mizuki ◽

K. Horie ◽

K. Imabayashi ◽

K. Mishima ◽

K. Oryoji

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Observational Study ◽

Rheumatoid Factor ◽

Prospective Observational Study ◽

Enzyme Linked Immunosorbent Assay ◽

P Value ◽

Healthy Population ◽

Asymptomatic Individuals ◽

Citrullinated Protein

Background:In the idividuals with genetic and enviromental risk factors, immune events at mucosal surfaces occur and may precede systemic autoimmunity. Anti-citrullinated protein antibodies (ACPA) are present in the serum for an average of 3-5 years prior to the onset of rheumatoid arthritis (RA) during an asymptomatic period. In ACPA-positivite individuals, the additional presence of RA-related risk factors appears to add significant power for the development of RA. To date, there have been few reports in which clinical courses of ACPA-positive asymptomatic individuals were investigated prospectively.Objectives:To observe the clinical time course of ACPA-positive healthy population for the development of RA.Methods:Healthy volunteers without joint pain or stiffness, who attended the comprehensive health screening of our hospital, were enrolled in this prospective observational study. The serum ACPA levels were quantified by Ig-G anti-cyclic citrullinated peptide enzyme-linked immunosorbent assay with levels > 4.4 U/mL considered positive. ACPA-positive subjects were followed by rheumatologists of our department clinically or a questionnaire sent by mail for screening to detect arthritis.Results:5,971 healthy individuals without joint symptons were included. Ninty-two (1.5%) were positive for ACPA. Of these, 19 (20.7%) developed RA and two were suspected as RA by mail questionnaire. Their average age were 58-years, and women were 68%. The average duration between the date of serum sampling and diagnosis was 10.7 months. ACPA-positive individuals who developed to RA had higher serum ACPA and Ig-M rheumatoid factor levels than ACPA-positive individuals who did not (P value by Mann-Whitney U test: 0.002, 0.005, respectively).Conclusion:Among ACPA-positive asymptomatic individuals, 20% developed RA. The higher titer of ACPA and Ig-M rheumatoid factor levels are risk factors for devoloping RA.Disclosure of Interests:None declared

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An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Journal of Personalized Medicine ◽

10.3390/jpm11030178 ◽

2021 ◽

Vol 11 (3) ◽

pp. 178

Author(s):

Noah R. Delapaz ◽

William K. Hor ◽

Michael Gilbert ◽

Andrew D. La ◽

Feiran Liang ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Previous History ◽

Current Treatment ◽

Careful Consideration ◽

P Value ◽

Post Traumatic Stress ◽

Increased Risk ◽

History Of ◽

Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

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Effect of janus kinase inhibitors and methotrexate combination on malignancy in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

Autoimmunity Highlights ◽

10.1186/s13317-021-00153-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Vinod Solipuram ◽

Akhila Mohan ◽

Roshniben Patel ◽

Ruoning Ni

Keyword(s):

Rheumatoid Arthritis ◽

Combination Therapy ◽

Randomized Controlled Trials ◽

Random Effect ◽

Janus Kinase ◽

Controlled Trials ◽

Randomized Controlled ◽

Increased Risk ◽

Significant Difference ◽

Risk Of Malignancy

Abstract Background Rheumatoid arthritis (RA) is a systemic autoimmune disease. The combination therapy of methotrexate (MTX) and Janus kinase inhibitor (JAKi) is commonly used. Patients with RA are at increased risk of malignancy, however, it remains unclear whether the combination therapy is associated with a higher risk. Objective To assess the malignancy risk among patients with RA receiving combination therapy of JAKi and MTX compared to MTX alone. Methods PubMed, Cochrane and Embase were thoroughly searched for randomized controlled trials (RCTs) in patients with RA receiving JAKi and MTX, from inception to July 2020. Primary endpoints were malignancy events, Non melanomatous skin cancer (NMSC) and malignancy excluding NMSC and secondary endpoints were serious adverse events (SAE), deaths. Risk ratio (RR) and 95% CI were calculated using the Mantel–Haenszel random-effect method. Results 659 publications were screened and 13 RCTs with a total of 6911 patients were included in the analysis. There was no statistically significant difference in malignancy [RR = 1.42; 95% CI (0.59, 3.41)], neither NMSC [RR = 1.44 (0.36, 5.76)] nor malignancies excluding NMSC [RR = 1.12 (0.40, 3.13)]. No statistically significant difference between the two groups for SAE [RR = 1.15 (0.90, 1.47)] and deaths [RR = 1.99 (0.75, 5.27)] was found. Conclusion The adjunction of JAKi to MTX is not associated with an increased risk of malignancy when compared to MTX alone. There is no increased risk of SAE and deaths when compared to MTX alone in patients with RA.

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Association of interleukin-17A rs2275913 polymorphism with rheumatoid arthritis susceptibility in Sudanese population

SAGE Open Medicine ◽

10.1177/20503121211020207 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110202

Author(s):

Rgda Mohamed Osman ◽

Mounkaila Noma ◽

Abdallah Elssir Ahmed ◽

Hanadi Abdelbagi ◽

Rihab Ali Omer ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Confidence Interval ◽

Statistical Tests ◽

Demographic Data ◽

Control Group ◽

P Value ◽

Case Group ◽

Molecular Technique ◽

Interleukin 17A ◽

Significant Difference

Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis

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AB1119 U9: A NOVEL CLINICALLY ORIENTED ULTRASONOGRAPHIC SCALE AS A USEFUL MARKER FOR MONITORING THERAPEUTIC RESPONSE IN RHEUMATOID ARTHRITIS (MULTI CENTERS STUDY)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2733 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1848.2-1849

Author(s):

M. A. Mortada ◽

H. Eitta ◽

R. Elmallah ◽

A. Radwan ◽

A. Elsaman

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Laboratory ◽

Pearson Correlation ◽

Response To Treatment ◽

P Value ◽

Clinical Parameters ◽

Biologic Dmards ◽

Das 28 ◽

Significant Difference

Background:Musculoskeletal Ultrasonography (MSUS) is now a widely used tool for monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA, which affects many joints and tendons in different presentations. In previous study (1) U9 score was proven to be correlated with disease activity parameters.Objectives:To determine whether US assessment using U9 score is useful for monitoring response to treatment for RA or not?Methods:A prospective, multicenter study were conducted in period from July 2019 to December 2019. All recruited RA patients were subjected to: Disease activity assessment by clinical disease activity indices (CDAI and DAS28 ESR). Functional status assessment by (HAQ) and ultrasonographic assessment using U9 score which include 8 joints (bilateral wrists,2ndMCP,3RDMCP and knees) plus most clinically affected joint or tendon (one joint or one tendon). Most clinically affected joints from 48 joints. Any affected tendons could be choosing. All targeted joints were evaluated according to EULAR guidlines and by EULAR/ OMERACT combined score (0-3). Targeted tendons were scored (0-3).All patients received their treatment (biologic and non biologic DMARDs) according to the decision of the treating physicians. No specific therapy is needed. CDAI and DAS28 ESR, HAQ and U9 score were repeated after 3 months to detect the response to change after receiving the therapy.Results:One hundred and forty patients (23.6% were male) with mean age 39.26±11.30 were recruited from 4 tertiary referral university hospitals.There was a significant difference (<0.001) between the first and second visits as regards clinical, laboratory and ultrasonographic parameters. DAS 28 decreased form (5.29±1.21) to (3.95±0.99), ESR decreased from (42.12±15.24) to (26.84±12.32), HAQ2 improved from (0.652±0.350) to (0.510±0.237) and U9 total US score decreased from (13.56±5.18) to (8.02±4.28).There was significant correlation between U9 ultrasonographic score and clinical parameters at both visits (table 1).Table 1.correlation between U9 ultrasonographic score and clinical parameters.U9 at 1stvisitU9 at 2ndvisitDAS-28Pearson Correlation(P value)0.806<0.0010.790<0.001CDAIPearson Correlation(P value)0.787<0.0010.773<0.001HAQPearson Correlation(P value)0.431<0.0010.317<0.001We found that the most suitable cut-off value of U9 score to predict high disease activity was 11.5 (sensitivity 85.7% and specificity 80.6%), cut off value for moderate disease activity was 5.5(sensitivity 83.2% and specificity 88%) and cut off value for low disease activity was 3.5 (sensitivity of 83.3% and specificity 57.1%). These results are summarized in the following table:Conclusion:U9 ultrasonographic score is very useful method for evaluating the monitoring the response of treatment.References:[1]Mortada, et al. Annals of the Rheumatic Diseases 2019;78:1009.Disclosure of Interests:None declared

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