Clinical Features of Behçet’s Disease Patients with Joint Symptoms in Japan: A National Multicenter Study

Objectives Approximately 30%–60% of Behçet’s disease patients exhibit joint symptoms. The aim of this study was to determine the clinical characteristics of such patients in Japan. Methods This study retrospectively analyzed 151 Behçet’s disease patients with joint symptoms who had been treated at seven cooperative medical institutions from 2007 to 2017. We investigated their clinical characteristics and treatments. Results The most commonly affected joints were the knee, ankle, and proximal interphalangeal joints. Of the cases with pain and swelling, 18 of 293 joints (11 cases) displayed narrowing of the cleft or deformity by Xray analysis. Improvement in their arthritis was observed in 80% of the patients who received steroids as initial treatment; however, the rate of improvement was lower in patients who had received prednisolone (PSL) at <10 mg/day. The recurrence of joint symptoms was significantly less common in the colchicine group than in the PSL group. Conclusions These results suggest that PSL is effective for remission induction for the treatment of joint symptoms of Behçet’s disease, though it may not be effective at low doses. Additionally, colchicine is effective in preventing the recurrence of joint symptoms in Behçet’s disease. Furthermore, joint damages like joint space narrowing or with any deformity can often be observed in Behçet’s disease patients in Japan.

Functional disability to evaluate the risk of arthritis in First-degree relatives of Rheumatoid Arthritis patients

Objective The events that occur prior to the onset of rheumatoid arthritis (RA) continue to be delineated. We examined the relationship between self-reported joint symptoms, functional disability, and anticitrullinated protein antibody (ACPA) status in a cohort of first-degree relatives (FDR) of RA patients who are at risk of future disease development. Methods We studied a cohort of 607 FDR of First Nations (FN) RA patients who are at increased risk for future RA development, and analyzed data collected at their enrollment study visit. In parallel, we analyzed data from 279 FN People with no family history of RA. A subset of FDR developed inflammatory arthritis and we analyzed longitudinal data in this group. Results The prevalence of joint symptoms and functional disability was higher in FDR compared to non- FDR (all p<0.001). Difficulty walking (37.3% vs 18.0%) and mHAQ were higher in ACPA positive FDR compared to ACPA negative FDR, and mHAQ was independently associated with ACPA seropositivity (OR: 2.79, 1.56-5.00). Longitudinally, in individuals who developed ACPA+ RA, ACPA level and mHAQ score were significantly associated (R = 0.43, p< 0.001) in the preclinical period. Conclusion Compared to population-based controls, FDR have a high burden of joint symptoms and functional disability. Functional disability was most closely associated with ACPA seropositivity in the FDR, suggesting a direct role for ACPA outside of the context of clinically detectable synovitis. mHAQ appears to be particularly valuable in the assessment of individuals at risk for future RA development.

The Effect of TNF-α Inhibitors on Nail Psoriasis and Psoriatic Arthritis—Real-World Data from Dermatology Practice

Patients with psoriatic arthritis (PsA) often develop joint symptoms years after their initial diagnosis of psoriasis disease; therefore, dermatologists should test for and detect PsA early. In this study, we focused on patients with psoriasis with both nail and joint disease being treated with tumor necrosis factor-α inhibitors by dermatologists. We performed a noninterventional, prospective, multicenter, and open-label study to evaluate the effectiveness of adalimumab, etanercept, or infliximab over 24 months of continuous therapy in patients with moderate to severe plaque-type psoriasis (Pso) and PsA. Disease assessments with the Psoriasis Area and Severity Index, Nail Psoriasis Severity Index (NAPSI), joint assessment, Dermatology Life Quality Index (DLQI), and Health Assessment Questionnaire (HAQ) instruments were performed every 3 months for the first year and twice annually thereafter. The cohort included 100 patients with Pso, nail psoriasis, and PsA. A significant reduction of NAPSI was observed 3 months after therapy initiation compared with the baseline (mean ± SD, 22.9 ± 17.8 vs. 33.8 ± 21.4; p < 0.001). Similarly, the mean ± SD number of both tender and swollen joints decreased significantly within the first 3 months of treatment, from 10.8 ± 11.5 to 6.4 ± 10.3 (p < 0.001) and from 6.4 ± 9.5 to 3.1 ± 7.2 (p < 0.001), respectively. Additionally, the distal interphalangeal joint involvement improved throughout the observation time, and DLQI and HAQ scores decreased. Improvements in control of skin, nail, and joint symptoms were seen, as well as in patients’ quality of life and functionality. Dermatologists have an important role not only in PsA diagnosis but also in PsA long-term care.

Long-term results from a randomized blinded sham- and waitlist-controlled trial of acupuncture for joint symptoms related to aromatase inhibitors in early stage breast cancer (S1200).

12018 Background: Musculoskeletal symptoms are the most common side effect of aromatase inhibitors (AIs) among breast cancer (BC) survivors. We previously reported that true acupuncture (TA) resulted in better pain outcomes than either sham acupuncture (SA) or wait-list controls (WC) at 6 weeks with durable effects through 24 weeks, with minimal toxicity. We now report the 52-week outcomes. Methods: We conducted a SWOG multicenter randomized controlled trial among postmenopausal women with early-stage BC. Patients taking an AI for ≥30 days and reporting a worst pain score of ≥3 out of 10 using the Brief Pain Inventory-Worst Pain (BPI-WP) were eligible. Subjects were randomized 2:1:1 to TA vs. SA vs. WC. Both the TA and SA protocols consisted of a 12-week intervention, with 2 sessions per week for 6 weeks, followed by 1 session per week for 6 additional weeks. At 24 weeks, all subjects remained blinded to intervention arm but were offered 10 sessions of true acupuncture. Endpoints included BPI scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for hips and knees, the Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH), PROMIS Pain Inventory Short Form (PI-SF), and Functional Assessment of Cancer therapy Endocrine Symptoms (FACT-ES). Results: Among 226 patients registered, 110 were randomized to TA, 59 to SA and 57 to WC. Baseline characteristics were similar among the arms. At 52 weeks, follow-up assessments were available for 91 (82.7%) TA, 53 (89.8%) SA, and 47 (82.5%) WC patients. In a linear regression adjusting for the baseline score and stratification factors, 52-week mean BPI-WP scores were 1.08 points lower (correlating with less pain) in the TA compared to SA arm (95% CI: 0.24-1.91, p =.01), and were 0.99 points lower in the TA compared to WC arm (95% CI: 0.12-1.86, p =.03). The proportion of patients experiencing a clinically meaningful (>2) reduction (i.e. improvement) in BPI-WP was 64% for TA compared to 45% on SA and 53% on WC. Patients randomized to TA had reduced BPI pain interference at 52 weeks compared to SA (adjusted difference = 0.58, 95% CI: 0.00-1.16, p =.05) but not compared to WC (adjusted difference = 0.33, 95% CI: -0.28-0.93, p =.29). Also, at 52 weeks, patients randomized to TA had improved PROMIS PI-SF T-scores compared to SA (adjusted difference = 2.35, 95% CI: 0.07-4.63, p =.04) but not compared to WC (adjusted difference = 1.28, 95% CI: -1.09-3.66, p =.29). No statistically significant differences were observed in other measures. Conclusions: Women with breast cancer receiving AI therapy and treated with 12 weeks of TA for joint symptoms had reduced levels of worst pain compared to control patients, an effect that was durable through one year despite completion of protocol acupuncture at 12 weeks, and the offering of acupuncture to all participants at 24 weeks. Clinical trial information: NCT01535066.

POS0980 ANALYSIS OF PRIMARY CARE CONSULTATION PATTERNS TO AID DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS – AN EXPLORATORY CASE SERIES

Background:Patients with Axial Spondyloarthritis (AxSpA) often suffer a significant delay to diagnosis. This is associated with poorer outcomes in quality of life, functional capabilities and work productivity [1]. These patients are frequent consulters to primary care in the years preceding rheumatology referral [2]. We hypothesise that analysis of primary care consultation patterns may identify as-yet undiagnosed disease, and suggest that implementing an automated diagnostic algorithm may support early action in primary care.Objectives:To undertake a preliminary exploration of primary care consultation patterns in patients with a delayed diagnosis of AxSpA and identify themes for further research.Methods:The study was run in Salford, UK, where unique linkage exists across electronic health records (EHR) from primary and secondary care. A dataset of patients with AxSpA was obtained from 2018-2020 hospital physiotherapy clinic records. Ten patients with a time to diagnosis ≥ 5 years were randomly selected for this exploratory analysis. Diagnostic delay was calculated based on rheumatology clinic letter documentation. Age, sex, and HLA-B27 status were recorded. All “Problem” codes from the primary care EHR up to the point of diagnosis were manually reviewed.Results:Age at diagnosis was 32-49 years with seven males and three females. Seven were HLA-B27 positive. The average delay to diagnosis was 15.8 years (range 5-30).On average, patients had 15 primary care consultations (range 5-24) between first coded AxSpA-related symptom and rheumatology referral. Around half of these codes were potentially AxSpA-related (for example, see Figure 1).Six patients had a coded history of back pain. Two patients presented with other axial symptoms, including: rib pain, MSK chest pain and sciatica.Five patients presented with peripheral joint symptoms, including: ankle pain, shoulder pain, knee problem, pain in arm, medial epicondylitis elbow, hip pain and groin pain. Of these, four had multiple presentations and three had a previous visit with axial pain.Two patients had uveitis preceding axial symptoms. One patient had peripheral joint symptoms (hip pain) preceding uveitis.Inconsistent codes were used for the same problem presenting at different times in nine cases, including: back pain, backache, low back pain, lower back pain.Other relevant codes were used in seven cases, including: stiffness, arthritis, saw physiotherapist and referred to pain clinic.Figure 1 illustrates the consultation pattern for a male patient who first presented to primary care with back pain at the age of 35. Despite a relatively typical presentation, his diagnosis was made incidentally 10 years later after an ESR was checked for unrelated reasons. He was significantly disabled in function at the point of being referred to rheumatology.Conclusion:Our preliminary analysis suggests that patients with a delayed diagnosis of AxSpA have repeated primary care visits with potentially recognisable symptoms of their disease. These findings support the feasibility of future automated detection, with areas of focus including recognition of non-back pain axial symptoms, extra-articular manifestations, and peripheral joint symptoms.Whilst half of presentations were not directly AxSpA-related, modern machine learning techniques have the ability to explore whether the pattern or frequency of these consultations are relevant to identifying undiagnosed disease. Such methods can also highlight patterns obscured by extensive data sets and inconsistent coding, with opportunity for implementation back into primary care.References:[1]Redeker I et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford) 2019;58:1634–8.[2]Yi E et al. Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review. Rheumatol Ther. 2020;7(1):65–87Disclosure of Interests:None declared.

P455 Tofacitinib Therapy is Effective for Arthralgias Associated with Active Inflammatory Bowel Disease

Background Tofacitinib is an oral Janus kinase (JAK) inhibitor used to treat ulcerative colitis (UC). It is generally well tolerated and safe with mild to no side effects. Tofacitinib is FDA-approved for use in multiple inflammatory conditions such as rheumatoid arthritis, psoriasis and polyarticular course juvenile idiopathic arthritis as well as for ulcerative colitis (UC). Patients with UC often have extra-intestinal manifestations (EIMs) with up to 20% of patients having arthropathy. There are limited data describing the effect of tofacitinib therapy on EIMs in UC. The aim of this study is to determine whether tofacitinib therapy improves arthralgia in this patient population. Methods This retrospective study includes consecutive patients with active UC who initiated tofacitinib at our center since 2014 and remained on the therapy for at least 8 weeks. We reviewed electronic medical records to collect demographic and clinical data. Patients diagnosed with any EIM by the treating physician were included. Improvement in EIM symptoms was determined through patient reports or physician assessment. In the UC patients, a decrease in Simple Clinical Colitis Activity Index (SCCAI) of ≥ 3 was considered response and remission as a score of ≤ 2. In the CD patients, a 3-point reduction in Harvey Bradshaw index (HBI) was considered clinical response and a score of &lt;5 remission. Results 112 patients were included in this cohort, with 36 (31 UC; 5 CD) having confirmed EIMs (32.1% of total). Basic demographic and clinical data are detailed in Table 1. 35 patients had peripheral arthralgia, 2 patients had primary sclerosing cholangitis (PSC) and 1 had pyoderma gangrenosum. 5 (13.9%) patients discontinued treatment during the induction phase due to lack of response. By 24 weeks, 26 (74.2%) out of 35 patients reported improvement in arthralgias, and 14 (40%) patients reporting resolution of joint symptoms. In terms of gastrointestinal disease activity, at week 24, 17/35 (48.6%) patients achieved clinical response and 11/35(31.4%) patients achieved clinical remission. There was no treatment effect noted on the other EIMs. Conclusion In our real world experience, treatment refractory IBD patients with peripheral arthralgia on tofacitinib showed significant improvement in joint symptoms, and this often paralleled improvement in gastrointestinal symptoms. This supports that tofacitinib is a suitable treatment for patients with IBD and concomitant peripheral arthralgia.

PREDICTION OF SYMPTOMS PROGRESSION FOR THE PATIENTS WITH KNEE OSTEOARTHRITIS BASED ON THE QUANTITATIVE STRUCTURAL FEATURES: DATA FROM THE FNIH OA BIOMARKERS CONSORTIUM

Cartilage repair can greatly alleviate the symptoms of the patients with knee osteoarthritis (KOA). However, some imaging results suggest that the patients with obvious cartilage repair may receive insignificant or even no improvement in their symptoms. This study aims to explore the possible reasons based on the structural feature of the knee joint and construct the models used to predict the progression of knee joint symptoms. 551 subjects from Osteoarthritis Biomarkers Consortium FNIH Project in the Osteoarthritis Initiative (OAI) were included and divided into training and test sets. A total of 153 structural features from five quantitative structural feature sets were included to access the structural characteristics of the knee joints. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index was used to evaluate the symptoms of the knee joints. A three-step feature selection method were used to screen the structural features. Finally, Naive Bayes (NB), logistic regression (LR), [Formula: see text]-nearest neighbor (KNN), support vector machine (SVM) and random forest (RF) models were constructed based on the selected features, and then compared using the receiver operating characteristic (ROC) curve. The distribution in the demographics and WOMAC symptoms scores of the participants was consistent in the training and test sets. Two demographic features and several structural features were selected using the three-step feature selection method. Among the constructed models, the models used for the progression prediction of pain, stiffness and total scores were better than that of physical function. The performance of RF model was the best while SVM model was the second best, and the performance of the remaining three models in predicting the progression of knee symptoms is indistinguishable. Structural feature-based models for the prediction of knee joint symptoms’ progression were constructed and compared. The constructed model showed good feasibility and accuracy, and may assist clinicians to predict the occurrence or progression of the knee joints symptoms in the evaluation and prognosis of cartilage repair.