POS1083 PSORIATIC DISEASE – A HETEROGENOUS DISEASE WHO NEEDS A MULTIDISCIPLINARY CARE!

Background:Rheumatologists and Dermatologists usually manage Psoriatic Arthritis (PsA) and Psoriasis (PsO) separately, but early diagnosis and integrated management could achieve better outcomes with gains in quality of life of the patients. A multidisciplinary care is essential to achieve these goals.Objectives:The aim of this study is to describe a model of integrated multidisciplinary approach for early diagnosis of PsA and the multidisciplinary management of PsA patients.Methods:A retrospective study including patients that attended the multidisciplinary clinical from January 2019 to December 2020 was performed. Patients with PsO complaining articular symptoms and patients with articular symptoms with cutaneous lesions suspected to be PsO was referred to this clinical. Demographic, clinical data and disease activity measures were collected. Descriptive, Student’s t and Fisher test and Odds Ratio were estimated.Results:A total of 50 patients were referred to multidisciplinary clinical. Of these, 40 patients met criteria for psoriatic arthritis according to CASPAR criteria: 22 (55%) were male and median age was 49.5 ± 11.5 years. Family history of psoriasis was present in 19 (47.5%) and 7 (17.5%) had spondyloarthritis family history. Obesity and overweight were the comorbidities most found, 42.9% and 37.1%, respectively, followed by hypertension 25%, dyslipidaemia and depression 22.5% and metabolic syndrome 15%. Thirty-three patients (84.6%) were under topical treatment, 23 (59%) were under csDMARDs and 13 (32.5%) were under bDMARDs. After multidisciplinary clinical evaluation, treatment change was made - switch to another bDMARDs in 5 patients and bDMARD was started in 7 patients. All patients had a previous evaluation for infection risk assessment and 11 patients performed 9 months isoniazid for latent tuberculosis treatment.Eleven patients (28.9%) presenting moderate to severe PASI. Thirty-one patients presenting prolonged disease duration (> 10 years) with cutaneous (74.2%) and articular (61.3%) involvement. Peripheral disease without axial involvement was present in 28 patients (90%) while the others (10%) had both axial and peripheral involvement. Severe or moderate articular disease activity (DAS28) was present in 52.6% of the patients. The most frequent extra-articular manifestation was dactylitis (23.3%) and enthesitis (19.4%). The average number of multidisciplinary clinical consultations for these patients was 2.There was a statistically significant difference at the mean age, gender and disease duration > 10 years between patients with psoriatic disease with and without arthritis (p= 0.047; p=0.01 and p=0.03, respectively); there was no statistically significant differences in family history of psoriasis (p=0.711) and spondyloarthritis (p=0.174), nutritional status (p=0.732) and comorbidities such as diabetes mellitus (p=0.545), hypertension (p=0.404), dyslipidaemia (p=0.394) and depression (p=0.089).In the remaining 10 patients screened, the osteoarthritis and/or tendonitis were responsible for the articular complaints in 6 patients and scalp seborrhoea and eczema were responsible for the cutaneous complaints in the rest.Conclusion:Despite the small number of patients observed in our multidisciplinary clinical, we found that this kind of clinical care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA.References:[1]Luchetti MM, Benfaremo D, Campanati A, Molinelli E, Ciferri M, Cataldi S, Capeci W, Di Carlo M, Offidani AM, Salaffi F, Gabrielli A. Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol. 2018 Oct;37(10):2741-2749. doi: 10.1007/s10067-018-4238-4[2]Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? Dermatol Ther. 2020 May;33(3):e13283. doi: 10.1111/dth.13283Disclosure of Interests:None declared.

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AB0656 IMPACT OF A FAMILY HISTORY OF SPONDYLOARTHRITIS ON TNFi DRUG SURVIVAL AND TREATMENT RESPONSE IN PATIENTS WITH ANKYLOSING SPONDYLITIS AND PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1665 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1622-1622

Author(s):

M. Morin ◽

K. Hellgren ◽

U. Lindström ◽

T. Frisell

Keyword(s):

Family History ◽

Disease Activity ◽

Treatment Response ◽

Disease Duration ◽

Positive Family History ◽

Drug Discontinuation ◽

Disease Development ◽

Drug Survival ◽

Hazard Ratios ◽

History Of

Background:Spondyloarthritis (SpA) is known to have high familial aggregation, with a positive family history of SpA being a strong risk factor for disease development, in particular for ankylosing spondylitis (AS). Despite this well-known characteristic of the disease, whether family history is associated with disease prognosis and treatment outcome has been much less studied. Patient characteristics predicting response to tumour necrosis factor alpha inhibitors (TNFi) in SpA include age, sex and high disease activity, but whether family history is predictive of TNFi treatment outcomes remains unclear.Objectives:To assess if a family history of psoriatic arthritis (PsA), AS, or SpA in general is associated with a different drug survival and treatment response to TNFi in patients with AS and PsA.Methods:Patients diagnosed with AS (N=1688) or PsA (N=3216) starting their first TNFi treatment between January 2006 and December 2017 were identified in the Swedish Rheumatology Quality Register (SRQ). Disease activity measures were extracted from SRQ at treatment start and at 3 and 12 months of treatment. Data on demographics and comorbidities were available through linkage to other national registries. Multiple imputation was applied to address missing data. Family history was defined as having at least one first-degree relative diagnosed with AS, PsA or any form of SpA in the National Patient Register at start of first TNFi. Analyses were made for AS and PsA index patients separately. Kaplan-Meier plots were used to compare drug survival, and hazard ratios for drug discontinuation were estimated with Cox regression adjusting for age, sex, disease duration and baseline disease activity. The change in disease activity from baseline to 3 months of treatment, and the proportion of patients remaining on treatment at 12 months and reaching low disease activity (LDA) with BASDAI (for AS) and DAS28-CRP (for PsA), were analysed in linear regression adjusting for age, sex, disease duration and baseline disease activity.Results:A positive family history of AS was found in 14% of AS patients, and 12% of PsA patients had a family history of PsA. Characteristics such as age, sex and baseline disease activity were similar in AS patients with and without a family history of AS. Among PsA patients, those with a family history of PsA were to a larger extent female, with lower CRP but longer disease duration. No significant differences were seen in drug survival among patients with and without a family history of their respective disease (Figure 1), with hazard ratios for drug discontinuation of 1.03 (95% CI 0.84 to 1.27) in AS patients and 1.08 (95% CI 0.94 to 1.25) in PsA patients. Using family history of any form of SpA as exposure did not change this conclusion. The changes in disease activity at 3 months of treatment compared to baseline were similar between groups. At 12 months, 55.2% of AS patients with a family history were still on treatment and had a BASDAI corresponding to LDA, compared to 56.4% of AS patients without a family history. Among PsA patients, 38.7% of patients with a family history had reached DAS28-CRP LDA, compared to 42.6% for those without a family history. For both AS and PsA, these differences were non-significant.Conclusion:While family history of SpA is a strong predictor of disease development, family history was not found to affect neither TNFi drug survival nor treatment response in patients with AS and PsA in this register-based study.Figure 1.Survival plots for time to TNFi discontinuation in patients diagnosed with AS and PsA respectively, by family history statusDisclosure of Interests:Matilda Morin: None declared, Karin Hellgren Speakers bureau: KH has received speakers fee from Abbvie and UCB Nordic., Ulf Lindström: None declared, Thomas Frisell: None declared

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AB0743 DISEASE CHARACTERISTICS OF PSORIATIC ARTHRITIS PATIENTS MAY DIFFER ACCORDING TO AGE AT PSORIASIS ONSET: CROSS-SECTIONAL ANALYSIS OF PSORIATIC ARTHRITIS-INTERNATIONAL DATABASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.519 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1667.2-1668

Author(s):

E. Bilgin ◽

Ö. Bayindir ◽

E. Kasapoğlu ◽

S. Bakirci ◽

D. Solmaz ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Family History ◽

Disease Duration ◽

Late Onset ◽

International Database ◽

Psoriatic Disease ◽

Disease Characteristics ◽

Axial Disease ◽

Disease Family ◽

Nail Involvement

Background:Psoriasis and psoriatic arthritis (PsA) are heterogenous diseases with various disease manifestations and phenotypes. Psoriasis has a bimodal age of onset being early (before the age of 40, type 1) and late. The impact of this classification on the PsA features is not well understood.Objectives:To compare the PsA characteristics of patients with early- and late-onset psoriasis in a large, multicenter databaseMethods:PSART-ID (Psoriatic Arthritis-International Database) is a prospective, multicenter web-based registry (www.trials-network.org) of patients with PsA. A detailed data collection was performed including demographics (sex, age, duration of education, smoking status, BMI), skin features (psoriasis onset date, type, initially involved site of skin, nail involvement (ever) and family history) and PsA characteristics (type of articular involvement and presence of axial, dactylitis (ever), enthesitis (ever), family history) and indices for disease activity and function (DAPSA, Leeds enthesitis index, BASDAI, BASFI, patient and physician global assessment, pain, HAQ-DI). We grouped according to the age at psoriasis onset (early onset, psoriasis before the age of 40 (EOPsO); late-onset, psoriasis after the age of 40 (LOPsO)), patient and disease characteristics of the groups were compared (1). Due to the differences among groups, following adjustments weer made: BMI for age, nail involvement for PsO disease duration, axial PsA for PsA disease duration.Results:A total of 1634 (62.8% females; EOPsO, 1108 (67.8%); LOPsO, 526 (32.2%)) patients with PsA was recruited. Rate of over-weight patients was higher in LOPsO group (66.8% vs. 86.8%, p<0.001; adjusted for age - aOR 1.55 (1.11-2.20; % 95 CI)). The EOPsO group had the scalp involvement as the initial site of skin disease more often than the LOPsO group (56.7% vs. 43.0%, p<0.001), whereas extremity involvement was more frequent as the initial finding in the LOPsO group (EOPsO vs. LOPsO 63.8% vs. 74.2%, p<0.001). Nail involvement (ever) was more prominent in EOPsO group, however, the significance was disappeared when adjusted for psoriasis duration. Interaction between gender and both axial disease and psoriatic disease family history were found (axial disease in man; EOPsO vs LOPsO; 38.0% vs. 25.4%; p=0.005; adjusted for PsA duration - aOR 0.56 (0.38-0.84; %95 CI) // psoriatic disease family history in females; EOPsO vs LOPsO; 39.5% vs. 30.1%; p=0.003; OR 0.65 (0.50-0.86; %95 CI)). Duration between PsO and PsA was significantly longer in EOPsO group (148 vs. 24 months, p<0.001). In EOPsO group, more patients had PsO preceeding PsA than LOPsO group (81.8% vs. 60.6%, p<0.001), however, synchronous disease -defined as the diagnosis of PsO and PsA within the same year- was more common in LOPsO group (16.6% vs. 30.3%, p<0.001) (Table 1). Psoriatic disease activity parameters, patient and physician reported outcomes and HAQ-DI scores were similar in both groups.Table 1.Comparison of psoriatic arthritis patients‘ characteristics according to age at psoriasis onsetConclusion:Clinical features of PsA may be affected by the age at the onset of psoriasis. As the genetic background is different in early and late-onset psoriasis, this may suggest a different pathogenetic mechanism based on the psoriasis phenotype, also affecting the PsA features. Further prospective studies are needed to define whether the classification of PsA requires including psoriasis phenotypes as well.References:[1]Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450-6.Disclosure of Interests:Emre Bilgin: None declared, Özün Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Şule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

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Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease

Arthritis Care & Research ◽

10.1002/acr.23836 ◽

2019 ◽

Vol 72 (1) ◽

pp. 63-68 ◽

Cited By ~ 7

Author(s):

Dilek Solmaz ◽

Sibel Bakirci ◽

Gezmis Kimyon ◽

Esen K. Gunal ◽

Atalay Dogru ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Family History ◽

Psoriatic Disease ◽

History Of

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SAT0432 EFFECT OF SEX ON DISEASE CHARACTERISTICS AND DISEASE IMPACT IN PATIENTS WITH PSORIATIC ARTHRITIS (PsA): INSIGHTS FROM THE REAL-WORLD, OBSERVATIONAL MULTINATIONAL PsABio COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2771 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1171.1-1173

Author(s):

M. T. Nurmohamed ◽

I. Van der Horst-Bruinsma ◽

A. W. Van Kuijk ◽

S. Siebert ◽

P. Bergmans ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Physical Functioning ◽

Real World ◽

Comprehensive Treatment ◽

Diagnosis Delay ◽

Health State ◽

Research Support ◽

Disease Characteristics ◽

Disease Impact

Background:Female sex has been associated with more severe disease and poorer treatment outcomes in PsA. These observations are often based on small populations or national cohorts/registries.Objectives:To investigate the effects of sex on disease characteristics and disease impact in PsA, using data of 929 consecutive patients (pts) from PsABio.Methods:PsABio is a real-world, non-interventional European study in PsA pts treated with UST or TNFi based on their rheumatologist’s choice. Observed male and female baseline (BL) data were described and compared using 95% CI.Results:Women in PsABio (n=512 [55%]) were numerically older than men (mean [SD]: 50.5 [12.7] / 48.7 [12.3] years, respectively). Women were more obese (BMI >30), % (95% CI): F: 35 (30, 39), M: 24 (20, 29), men more overweight (BMI >25–30): F: 31 (27, 36), M:51 (46, 57). Age at diagnosis, delay from first symptom to diagnosis, and disease duration were similar for both sexes.Women entered PsABio more often on 3rd line treatment, whereas men started on 1st-line biologic treatment more often (F/M 1st line 47%/55%; 2nd line 34%/33%; 3rd line 20%/12%). Numerically, concomitant MTX was given more often to women vs men (32% vs 27%). At BL, 60% of women and 64% of men were on NSAIDs; 7.9% and 2.5% on antidepressant drugs. Women had significantly more comorbidities, with numerically more cardiovascular disease and anxiety/depression, and 3 times more IBD.Women had significantly higher 68 tender joint counts (TJC): 13.0 vs 10.4, while 66 swollen joint counts were not significantly different: 5.8 vs 5.5. Axial or combined axial-peripheral disease was similarly frequent, in 29% of women and 26% of men (Figs. 1, 2).Clinical Disease Activity index for PSoriatic Arthritis (cDAPSA) was higher in women (31.8 vs 27.3); pt-reported levels of pain, global disease activity (VAS scales) and higher TJC contributed to this. While enthesitis prevalence (based on Leeds Enthesitis Index) was comparable, men had significantly more frequent dactylitis, nail disease and worse skin psoriasis. At BL, 3.4% of women vs 7.1% of men, were in MDA.Regarding physical functioning (HAQ-DI), impact of disease (PSAID-12) and quality of life (EQ5D-3L health state), women with PsA starting a biologic (b)DMARD, expressed significantly greater negative impact and more limitations due to their disease (Fig. 2).Conclusion:In routine care, women with PsA starting a bDMARD presented with worse outcomes over a range of assessments compared with men (higher pt-reported pain and disease activity, TJC, and worse physical functioning and QoL), while men had worse dactylitis and psoriasis. Follow-up analysis will report whether the effects of biologic therapy are different in both sexes. The increased prevalence of associated features related to pain and impact on functioning and QoL may indicate the need for a more comprehensive treatment approach for women to avoid unnecessary and premature bDMARD stop or switch.Acknowledgments:This study was funded by Janssen.Disclosure of Interests:Michael T Nurmohamed Grant/research support from: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Consultant of: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Speakers bureau: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Arno WR van Kuijk Grant/research support from: Janssen, Stefan Siebert Grant/research support from: BMS, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, Janssen, Novartis, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Consultant of: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – consultant, Speakers bureau: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – speakers bureau and honoraria, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Wim Noel Employee of: Janssen Pharmaceuticals NV, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Elke Theander Employee of: Janssen-Cilag Sweden AB, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB

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AB0747 SPECIFIC ULTRASOUND LESIONS IN PSORIATIC ARTHRITIS: PREVALENCE AND CORRELATION WITH DISEASE ACTIVITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4839 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1670.2-1670

Author(s):

K. Ben Abdelghani ◽

H. Boussaa ◽

S. Miladi ◽

A. Fazaa ◽

K. Ouenniche ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Soft Tissue ◽

Disease Activity ◽

Disease Duration ◽

Extensor Tendon ◽

Biological Data ◽

Dorsal Aspect ◽

Tissue Edema ◽

Linear Probe ◽

The Mean

Background:Psoriatic arthritis (PsA) is a systemic inflammatory disease with articular and extra-articular features. In recent years, Ultrasonography (US) is playing an important role in the diagnosis and monitoring of this disease. Specific US features of PsA have been reported such as enthesitis, peritenon extensor tendon inflammation (PTI) and soft tissue edema.Objectives:The aims of this study were to evaluate the prevalence of these US signs in PsA patients and to determine their association with disease duration and activity.Methods:Patients with peripheral PsA responding to the Classification Criteria for Psoriatic Arthritis (CASPAR) were enrolled. Clinical and biological data were extracted, and then US examination was performed by an experimented rheumatologist blinded to clinical data using a machine type Esaote MyLAb 60 with a linear probe of 6-18 MHz. The following US features were evaluated: PTI at the dorsal aspect of metacarpo-phalangeal (MCP) joints, soft edema at the volar aspect of MCP joints and enthesitis of the digitorum extensor at the dorsal aspect of distal inter-phalangeal (DIP) joints.A p<0.05 was considered statistically significant.Results:We included twenty PsA patients, 8 men and 12 women, with a mean age of 55 ± 11 [33-77] years old. The mean disease duration was of 10±8 [1-34] years. A family history of PsA or psoriasis was reported in 53% of cases.Oral corticosteroids were used in 21% of patients, at a mean daily posology of 7 mg [5-10] of Prednisone equivalent, Methotrexate in 84% of cases at a mean posology of 15 mg [10-20] per week, Sulfasalazine in 10% of cases and a biological DMARD in 32% of cases (Etanercept=4, Infliximab=1, Adalimumab=1).The mean number of tender and swollen joints were respectively of 8 [0-16] and 2 [0-8]. The mean rate of patient global evaluation and visual analogue scale was of 5 [0-9].The mean DAPSA (Disease Activity in PSoriatic Arthritis) score was of 32±27 [4-112].US examination demonstrated that all patients had at least one of the three specific signs that we were looking for. At MCP level, PTI was noted in 11% of joints with Power Doppler (PD) signal in one case and soft tissue edema was noted in 3% of joints.At DIP level, enthesitis of digitorum extensor tendon was noted in 39% of joints. The elementary lesions reported were: enthesophyte in 25%, erosion in 8%, calcification in 5% and thickened or hypoecoic tendon in 4% of joints. However, no PD signal was detected at the enthesis.A positive association was found between DAPSA score and soft tissue edema (p=0.000), but not with PTI (0.668) and enthesitis (0.137). No relation was found between these three lesions and the disease duration.Conclusion:The presence of soft tissue edema, enthesitis and/or PTI on US can be an argument for the diagnosis of PsA. Soft tissue edema is shown to be associated with disease activity.Disclosure of Interests:None declared

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Does a family history of RA influence the clinical presentation and treatment response in RA?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-207670 ◽

2015 ◽

Vol 75 (6) ◽

pp. 1120-1125 ◽

Cited By ~ 6

Author(s):

Thomas Frisell ◽

Saedis Saevarsdottir ◽

Johan Askling

Keyword(s):

Family History ◽

Disease Activity ◽

Treatment Response ◽

Clinical Presentation ◽

Degree Relative ◽

Eular Response ◽

Logistic Regression Models ◽

Drug Survival ◽

Early Ra ◽

History Of

ObjectivesTo assess whether family history of rheumatoid arthritis (RA), among the strongest risk factors for developing RA, also carries information on the clinical presentation and treatment response.MethodsThe prospective Swedish Rheumatology register was linked to family history of RA, defined as diagnosed RA in any first-degree relative, ascertained through the Swedish Multi-Generation and Patient registers. Clinical presentation was examined among patients with early RA 2000–2011 (symptom onset <12 months before inclusion, N=6869), and response to methotrexate (MTX) monotherapy in the subset starting this treatment (N=4630). Response to tumour necrosis factor inhibitors (TNFi) was examined among all patients with RA starting a TNFi as the first biological disease-modifying antirheumatic drug 2000–2011 (N=9249). Association of family history with clinical characteristics, drug survival, European League Against Rheumatism (EULAR) response and change in disease activity at 3 and 6 months was estimated using linear and generalised logistic regression models. Correlation in relatives’ response measures was also assessed.ResultsPatients with early RA with family history of RA were more often rheumatoid factor positive, but with no other clinically meaningful differences in their clinical presentation. Family history of RA did not predict response to MTX or TNFi, with the possible exception of no versus good EULAR response to TNFi at 6 months (OR=1.4, 95% CI 1.1 to 1.7). Having a relative who discontinued TNFi within a year increased the odds of doing the same (OR=3.7, 95% CI 1.8 to 7.5), although we found no significant familial correlations in change in disease activity measures.ConclusionsFamily history of RA did not modify the clinical presentation of RA or predict response to standard treatment with MTX or TNFi. Treatment response, particularly drug survival, may itself be familial.

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Isolated cortical venous thrombosis after fetal demise

BMJ Case Reports ◽

10.1136/bcr-2018-228484 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228484

Author(s):

Mohammad Al-Jundi ◽

Ghassan Al-Shbool ◽

Mohamad Muhailan ◽

Moutasem Aljundi ◽

Christian J Woods

Keyword(s):

Family History ◽

Early Diagnosis ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Presentation ◽

Young Patients ◽

Fetal Demise ◽

History Of ◽

Venous Stroke ◽

Cortical Venous Thrombosis

Isolated cortical venous thrombosis (ICVT) occurring in the absence of dural venous thrombosis, constitutes about 2%–5% of all cerebral venous thrombosis. Its vague, non-specific presentation makes it a difficult and challenging diagnosis that needs an extensive workup especially in young patients. Outcome and prognosis depend mainly on early diagnosis and treatment. Here we discuss the clinical presentation, diagnosis and the treatment of a young woman diagnosed with ICVT with acute ischaemic venous stroke, in the setting of eclampsia and family history of coagulation disease.

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P747 Adherence to ECCO guidelines for cancer surveillance is associated to the detection of early cancer: A retrospective, single-centre, cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.875 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S598-S599

Author(s):

T L PARIGI ◽

G Roda PhD ◽

M Allocca ◽

F Furfaro ◽

L Loy ◽

...

Keyword(s):

Family History ◽

Skin Cancer ◽

Disease Duration ◽

Early Cancer ◽

Cancer Surveillance ◽

Early Cancer Diagnosis ◽

Increased Risk ◽

Significant Difference ◽

History Of ◽

The Impact

Abstract Background Patients with inflammatory bowel disease (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD) are at increased risk of developing gastrointestinal (GI) malignancies. The aim of this study is to assess the risk of malignancies in IBD patients and the impact of cancer screening according to the ECCO guidelines in a tertiary referral centre. Methods We retrospectively analysed the electronic database of all IBD patients followed by the IBD Centre of Humanitas Research Hospital, Milan, from January 2010 to October 2019, and collected all new diagnoses of solid and haematological tumours since 2010. The annual standardised incidence rate (SIR), rate of mortality and early cancer diagnosis were calculated and a descriptive analysis of drug exposure, disease duration, family history of any cancer, smoking habits was made. Results We included 5239 patients, with a total 19820 patient-years follow-up. Eighty-four malignancies in 81 patients were retrieved, 71 were included in the final analysis (38 CD, 32 UC, 31 females). Average age at tumour diagnosis was 52.9 years (range 19–78). 64% of patients were former or active smokers, 31% had a family history of cancer or IBD. Sixty-two per cent of patients were previously exposed or had 5-ASA at the time of cancer, 40% azathioprine, 43% anti-TNF or vedolizumab. The annual SIR for all kinds of malignancy was 0.358%. GI malignancies were the most frequent (n = 17, 23.9%, 47% UC, 53% in CD). Six over 8 GI tract malignancies in UC patients were found in the colon or rectum (mean disease duration 22.5 years), whereas in CD patients 5/9 were in the small-bowel (mean disease duration 7.0 years). Melanoma and breast cancer (n = 8 each) were the most common non-GI cancers, followed by prostate (n = 7) and bladder (n = 6). No significant difference in incidence was found between CD or UC. Non-Hodgkin lymphomas and leukaemia (3 and 1, respectively) only occurred in CD patients. Other tumours included thyroid (n = 5), lungs (n = 4), testicle (n = 3), ovary (n = 2), kidney (n = 2), head-nose-throat (n = 2), pancreas (n = 1), brain (n = 1), and non-melanoma skin cancer (n = 1). Death occurred in 11% of patients, 8 of them for late stage cancer. Only 2 were related to the concomitant IBD (1 colo-rectal and 1 anal cancer). In patients regularly screened according to the ECCO Guidelines (GI cancer, haematological and skin cancer), there was a significantly higher number of detection of early cancer (28 vs. 1, p = 0.003), although no differences in mortality rates were reported in the two groups (2 vs. 2, p = 0.10). Conclusion The overall incidence of cancer in our cohort was not different from the current literature available. Adherence to the ECCO Guidelines for cancer surveillance improves the detection of early cancer in IBD patients.

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A family history of serious complications due to BCG vaccination is a tool for the early diagnosis of severe primary immunodeficiency

Italian Journal of Pediatrics ◽

10.1186/1824-7288-39-54 ◽

2013 ◽

Vol 39 (1) ◽

pp. 54 ◽

Cited By ~ 10

Author(s):

Pérsio Roxo-Junior ◽

Jorgete Silva ◽

Mauro Andrea ◽

Larissa Oliveira ◽

Fernando Ramalho ◽

...

Keyword(s):

Family History ◽

Early Diagnosis ◽

Primary Immunodeficiency ◽

Bcg Vaccination ◽

History Of

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Evaluation of The 10 Warning Signs In Immunodeficient Patients: Additional Suggestions

10.21203/rs.3.rs-1189503/v1 ◽

2021 ◽

Author(s):

Fadime Ceyda Eldeniz ◽

Yahya Gül ◽

Alaattin Yorulmaz ◽

Şükrü Nail Güner ◽

Sevgi Keles ◽

...

Keyword(s):

Family History ◽

Early Diagnosis ◽

Chronic Diarrhea ◽

Warning Signs ◽

Control Group ◽

Healthy Children ◽

Physician Awareness ◽

History Of ◽

And Control ◽

Immunological Evaluation

Abstract Objective: Ten warning signs of primary immunodeficiency (PID) were suggested by the Jeffrey Modell Foundation (JMF), to increase physician awareness of PID. These warning signs have not yet been evaluated for patients with secondary immunodeficiency (SID). This study investigated whether the 10 warning signs used for the diagnosis of PID are sufficient for the diagnosis of SID, and explored the possibility of additional signs.Methods: This prospective study was conducted between June and December 2020. The mothers of 162 patients with PID and SID, and mothers of 200 healthy children, were asked to complete a questionnaire about family and personal history in addition to the warning signs of PID developed by the JMF. A JMF score was created by giving one point for each “Yes” answer for the 10 warning signs of PID. Medical records of the patients were evaluated for possible additional warning signs for PID and SID. Results: The JMF scores of the PID (3.36 ± 1.65) and SID (3.72 ± 1.12) groups were significantly higher than the scores of the control group (0.34 ± 0.61) (p < 0.05). A sign for immunological evaluation in two patients without warning signs in the PID group was found to be chronic diarrhea. In addition to the 10 JMF warning signs, we found that consanguinity and a family history of tuberculosis were statistically significant in our PID group, compared with the SID and control groups. Conclusions: The JMF warning signs are important for early diagnosis of PID. Our study showed that these signs may also be used for the early diagnosis of SID in patients and, according to our results, in addition to the 10 JMF signs for PID, parental consanguinity, chronic diarrhea, and a family history of tuberculosis may also be considered warning signs for the early diagnosis of PID.

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