The Clinical Course of Rheumatoid Arthritis in Kazakhstani Patients

BACKGROUND: Rheumatoid arthritis (RA) prevalence according to the worldwide epidemiological data varies from 0.4% to 1.3%. The disability and mortality rate in RA is high. RA clinic is various, and compiles from articular and systemic manifestations. AIM: The aim of our study was to investigate the clinical course of RA in Kazakhstani patients living in North region of our country. METHODS: The 81 women at the age of 30–55 years with a verified diagnosis of RA who have lived in Kazakhstan for at least 10 years were recruited to the study. All participants were examined by the rheumatologist and a standard laboratory examination was carried out. Statistical analysis was conducted in IBM SPSS Statistics 26 software (IBM.USA;1). RESULTS: The statistically significant higher frequency of erosive radiological stages, bone ankylosis (χ2 = 18.070 df = 6 p = 0.005) was found in seropositive (rheumatoid factor [RF]+) anti-citrullinated protein/peptide antibody positive (ACPA+) subgroup. The correlation analysis showed strong association between certain RA form activity and inflammatory markers, as well as disease triggers. The discriminant model which predicts the stage of radiological damage was obtained. The sensitivity of model in predicting X-ray Stage I-71.6%, Stage II-29.4%, Stage III-37.5%, and Stage IV-63.6%. CONCLUSION: The debut of the RA on average occurred in the third decade of the patients’ life. The joint syndrome had a more unfavorable character RF+ACPA+ patients’ subgroup; however, RF+ACPA-negative (ACPA-) subgroup also showed a predisposition to poorer prognosis. The obtained discriminant model may be useful for RA patients’ management.

The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis

BACKGROUND: Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective. OBJECTIVE: The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA. MATERIAL AND METHODS: Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files. RESULTS: We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p< 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p= 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p< 0.001). CONCLUSIONS: According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.

POS0667 TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD SETTINGS: A NATIONAL MULTICENTER STUDY OF 167 PATIENTS FROM ARGENTINA

Background:Tofacitinib (TOF), an oral JAK inhibitor, is approved for the treatment of rheumatoid arthritis (RA) either as monotherapy or in combination with background methotrexate (MTX). Despite the current evidence of efficacy from randomized controlled trials and open-label long-term extension studies, evidence of effectiveness and safety in real-world settings is limited, not only in Argentina but also in Latin America.Objectives:To describe effectiveness, safety and persistence of TOF therapy in RA patients from public and private medical centers from Argentina. In addition, establish prognostic factors for clinical remission at 3 months and TOF monotherapy at 12 months.Methods:A retrospective, observational and multicentre study was performed from an analysis of medical records of 10 medical centers. RA patients (ACR/EULAR, 2010) and age ≥ 18 years who had received or are under treatment with TOF until June 2020 were included. The data collection was done on a standard database that included baseline data and at 3, 6 and 12 months. Clinical remission was defined as DAS28-ESR < 2,6. Adverse events, treatment duration, TOF treatment persistence at last visit and discontinuation cause were assessed. Comparison to baseline values was performed using Wilcoxon sign for numerical variables and McNemar´s test for categorical variables. Treatment persistence was analyzed using Kaplan Meier´s technique. Multivariate analysis was performed using R software and its library packages (Lme4, Tidyverse and ggpubr). A p value < 0.05 was considered significant.Results:A total of 167 patients were included (78.4% were female). At baseline, the median age was 53 years (IQR 43-63 years), median disease duration was 4 years (IQR 2-13 years). RF was positive in 85.6% of patients, ACPA in 80.8% and structural radiological damage was present in 71.8%. Previous use of MTX was 97%, leflunomide 74.8% and biologic therapy 42.5% (28.74% 1 biologic, 11.98% 2 biologics and 1.8% ≥ 3 biologics). TOF dose: 48% 11 mg/day and 52% 5 mg BID. A statistically significant difference was observed not only in disease activity (p<0.0001) but also in the requirement of MTX and PDN (p<0.0001) in the 12 months evaluated. Remission significantly increased from baseline to month 3 and to a much lesser extent to month 6 (p < 0.001). The mean duration of treatment with TOF was 20.10 ± 15.25 months. Treatment persistence was 93.84% at 3 months and 91.24% at 6 months. In those patient who achieved REM at month 3, a statistically significant differences in duration of RA (p 0.0002), structural radiological damage (p 0.011), basal disease activity (p 0.018) and prior treatment with biological therapy (p 0.017) was found when compared with patients who remained active. Furthermore, in univariate logistic regression analysis, 5 years or more of disease duration was associated with a 3 times higher risk of not achieving clinical remission at 3 months (odds ratio = 0.35, 95% CI = 0.15-0.83). In the multivariate logistic regression analysis, previous biological therapy was the only predictor associated with a decrease in the probability of clinical remission (p < 0.008). Adverse events were registered in 26 patients (herpes zoster, n = 9).Conclusion:The effectiveness of TOF was observed not only in the clinical response achieved but also in the dose titration or withdrawal of MTX and PDN. The safety profile did not show any difference from long-term extension studies. At 12 months, 86.81% of the patients persisted with TOF therapy. We found prognostic factors associated with clinical remission at 3 months but those associated with monotherapy at 12 months could not be defined due to small number of patients analyzed that could have generated lack of statistical power, although more studies are required to confirm these assumptions.Disclosure of Interests:Maria Del Rosario Maliandi: None declared, Yanina Silvia Malvano: None declared, Alejandra Cusa: None declared, María Julieta Gamba: None declared, Ramiro Gomez Speakers bureau: Abbvie, Novartis, Julio Got: None declared, Oscar Gut: None declared, Ursula Vanesa Paris: None declared, Maria Andrea Spinetto: None declared, Carolina Mariach: None declared, Alejandra Ines Abalo: None declared, Adrián Estevez Speakers bureau: Bristol-Meyer-Squibb, Jose Luis Velazco Zamora: None declared, Juan Pablo Vinicki: None declared

Concentration of survivin in children with oligo- and polyarticular juvenile idiopathic arthritis (JIA): diagnostic and prognostic value—a single-center study

Aim The goal of the study was to assess the diagnostic and prognostic utility of survivin in patients with juvenile idiopathic arthritis (JIA). Methods Seventy children with JIA—59 newly diagnosed and 11 biologically treated (46 girls and 17 boys) aged 1.5–18 years and 29 healthy children as a control group, appropriately matched in terms of sex and age, were included in the study. The disease activity was established on the basis of the JADAS-27 criteria. The concentration of survivin was assessed by an ELISA test in serum and also 18 matched synovial fluid samples collected from patients with JIA. Results Children with JIA were divided according to the subtype of the JIA. In 65.7% of patients, oligoarthritis was diagnosed. The largest group comprised children of low disease activity (62.9%) according to JADAS-27. The serum concentration of survivin was significantly higher in children with JIA compared to the controls (p < 0.001). The concentration of survivin was higher among patients positive for anti-cyclic citrullinated peptide autoantibodies (ACPA) (p = 0.001). In all synovial fluid samples, the concentration of survivin was higher than in matched serum (p = 0.003). Serum survivin concentration was not significantly associated with radiological damage status or active synovitis assessed by joint ultrasonography. Survivin level was not significantly associated with disease duration time or treatment with TNF-α inhibitors in DMARD’s non-responders. Conclusions Survivin should be considered as a biomarker of joint inflammation helpful in the diagnosis of oligo- and polyarticular JIA and probably not dependent on treatment with TNF-α inhibitors.

Concentration Of Survivin In Children With Oligo- And Poly-Articular Juvenile Idiopathic Arthritis (JIA): Diagnostic And Prognostic Value – Single Center Study.

AIM: The goal of the study was to assess the diagnostic and prognostic utility of survivin in patients with Juvenile Idiopathic Arthritis (JIA).METHODS: Seventy children with JIA – 59 newly diagnosed and 11 biologically treated (46 girls and 17 boys) aged 1.5-18 years and 29 healthy children as a control group, appropriately matched in terms of sex and age, were included into the study. The disease activity was established on the basis of JADAS-27 criteria. Concentration of survivin was assessed by an ELISA test in serum and also 18 matched synovial fluid samples collected from patients with JIA.RESULTS: Children with JIA were divided according to the subtype of the JIA. In 65.7% of patients oligoarthritis was diagnosed. The largest group comprised children of low disease activity (62.9%) according to JADAS-27. The serum concentration of survivin was significantly higher in children with JIA compared to the controls (p<0.001). Concentration of survivin was higher among patients positive for anti-cyclic citrullinated peptide autoantibodies (ACPA) (p=0.001). In all synovial fluid samples the concentration of survivin was higher than in matched serum (p=0.003). Serum survivin concentration was not significantly associated with radiological damage status or active synovitis assessed by joint ultrasonography. Survivin level was not significantly associated with disease duration time or treatment with TNF-α inhibitors in DMARD’s non-responders. CONCLUSIONS: Survivin should be considered as a biomarker of joint inflammation helpful in the diagnosis of oligo- and polyatricular JIA and probably not dependent of treatment with TNF-α inhibitors.