Search

Objectives To test the ability of an established traditional cardiovascular (CV) risk prediction score [Systematic COronary Risk Evaluation (SCORE)] and its EULAR modified version (mSCORE) to identify antisynthetase syndrome (ASyS) patients at high CV risk and to examine for the first time associations of CV and cerebrovascular surrogate markers with clinical and immunological ASyS parameters. Methods SCORE/mSCORE and the gold standard marker of aortic stiffness [carotid-femoral pulse wave velocity (cfPWV)] were examined in ASyS patients and healthy controls. Moreover, sonography of the common- (CCA) and internal- (ICA) carotid arteries was performed in subsets of both groups, evaluating carotid intima-media thickness (cIMT), plaques and Doppler sonographic cerebrovascular surrogates [resistance (RI) and pulsatility (PI) indices]. Results We recruited 66 ASyS patients and 88 controls. According to mSCORE, 10% of the patients had high CV risk. However, cfPWV and carotid sonography revealed an increased CV risk in 21.2% and subclinical carotid atherosclerosis (SCA) in 85.7% of the patients, respectively. cfPWV and cIMT were higher in patients compared with controls (Padj=0.021 and Padj=0.003, respectively). In the ASyS group, cfPWV and cIMT correlated significantly with age (r = 0.679; P Conclusion ASyS patients had higher aortic stiffness and SCA compared with controls, even after adjustment for confounders. SCORE/mSCORE performed poorly in identifying high-risk patients compared with cfPWV and carotid sonography. Thus, cfPWV and carotid sonography may improve CV and cerebrovascular screening in ASyS.

Objective.To examine the value of optical spectral transmission (OST) in detecting joint inflammation in patients with rheumatoid arthritis (RA) and to evaluate whether OST correlates with certain patient characteristics.Methods.OST measurements were performed in the metacarpophalangeal, proximal intraphalangeal, and wrist joints of 168 patients with RA and 114 controls. OST difference between the 2 groups was statistically examined and subsequently controlled for the effect of possible confounding factors. Diagnostic OST performance was tested by receiver-operating characteristics. Moreover, associations of OST with clinical and serological activity markers (patient group), joint ultrasound (US; patient subgroup) and various anthropometric and epidemiologic parameters (patient and control group) were evaluated by Spearman correlation coefficient and a generalized linear statistical adjustment model.Results.OST was significantly higher in the RA group than in the control group, even after adjustment for confounding factors (1.89; 95% CI 0.709–3.070, padj = 0.002). Taking US as a reference, area under the curve for all 1251 joints simultaneously was 0.67 (95% CI 0.631–0.709). In the patient group, correlation and adjustment analyses showed associations of OST with various disease activity markers [28-joint count Disease Activity Score (rho 0.313), swollen joint counts (rho 0.361), C-reactive protein (rho 0.389); all, padj = 0.001], age (rho 0.276, p < 0.001), and osteoarthritis (p = 0.022). Moreover, OST associated with a power Doppler US score (rho 0.442; p = 0.001) and a greyscale US score (rho 0.591; p < 0.001). In both groups males had significantly higher OST values than females and OST associated moderately weakly with body mass index (rho patients 0.316, rho controls 0.24; all, p < 0.001).Conclusion.Patients with RA showed higher OST values in comparison to controls. Moreover, OST associated with clinical, US, and laboratory disease activity markers.

BACKGROUND AND OBJECTIVE For patients with established rheumatoid arthritis and also early arthritis an increased prevalence of depression has been described. For a better understanding of depression in early arthritis patients, depression prevalences of a German early arthritis cohort were examined, with a focus on disease activity, anti-CCP status, disease duration and functional capacity over a period of 2 years. MATERIAL AND METHODS The evaluation was based on the early arthritis cohort ADAPTHERA from Rhineland-Palatinate. The inclusion criterion was a symptom duration before diagnosis of a maximum of 1 year. Data from the disease activity score 28 (DAS28), the Health Assessment Questionnaire (HAQ, functional status), the WHO-5 Well-Being Index (WHO-5, well-being and depressive symptoms) and the Patient Health Questionnaire-9 (PHQ-9, depressive symptoms) were collected. RESULTS At the beginning, 43.5% of patients had depressive symptoms (WHO-5 > 28). After the 2 year follow-up the percentage of patients with depressive symptoms had reduced to 20.8%. Correlations with disease activity according to DAS28 and the function of HAQ could be confirmed. There was no correlation between depressive symptoms and anti-CCP status (p = 0.431) or duration from symptom onset to diagnosis (p = 0.671). CONCLUSION Screening of early arthritis patients for the presence of depressive symptoms is of essential importance. Patients seem to be at high risk of developing depressive symptoms especially at the beginning of the disease and when showing high disability and poor results on disease activity score (DAS28 and visual analog scale).

Objectives To evaluate the influence of the SARS-CoV-2 pandemic on the adherence of patients with inflammatory rheumatic diseases (IRD) to their immunomodulatory medication during the three-month lockdown in Germany. Methods From 16th March until 15th June 2020, IRD patients from private practices and rheumatology departments were asked to answer a questionnaire addressing their behaviour with respect to their immunomodulating therapy. Eight private practices and nine rheumatology departments that included rheumatology primary care centres and university hospitals participated. A total of 4252 questionnaires were collected and evaluated. Results The majority of patients (54%) were diagnosed with RA, followed by psoriatic arthritis (14%), ankylosing spondylitis (10%), connective tissue diseases (12%) and vasculitides (6%). Most of the patients (84%) reported to continue their immunomodulatory therapy. Termination of therapy was reported by only 3% of the patients. The results were independent from the type of IRD, the respective immunomodulatory therapy and by whom the patients were treated (private practices vs rheumatology departments). Younger patients ( Conclusion The data show that most of the patients continued their therapy in spite of the pandemic. A significant change in behaviour with regard to their immunomodulatory therapy was not observed during the three months of observation. The results support the idea that the immediate release of recommendations of the German Society of Rheumatology were well received, supporting the well-established physician–patient relationship in times of a crisis.

The current COVID-19 pandemic inherits an unprecedented challenge for the treating rheumatologists. On the one hand, antirheumatic drugs can increase the risk of infection and potentially deteriorate the course of an infection. On the other hand, an active inflammatory rheumatic disease can also increase the risk for an infection. In the recommendations of the German Society for Rheumatology (www.dgrh.de), it is recommended that our patients continue the antirheumatic therapy to maintain remission or low state of activity despite the pandemic. In this study, patients with inflammatory rheumatic disease were asked in the first weeks of the pandemic on their opinion of their immunomodulating therapy. The result shows that over 90% of the patients followed the recommendation of the rheumatologist to continue the antirheumatic therapy, and only a small percentage of the patients terminated the therapy on their own. This result was independent of the individual anti-rheumatic therapy. Taken together, the results of this study illustrate not only the trustful patient-physician partnership in a threatening situation but also the high impact of state-of-the art recommendations by the respective scientific society.

Despite recent improvements in the treatment of systemic lupus erythematosus (SLE), disease activity, comorbidities and drug toxicity significantly contribute to the risk of progressive irreversible damage accrual and increased mortality in patients with this chronic disease. Moreover, even lupus patients in remission often report residual symptoms, such as fatigue, which have a considerable impact on their health-related quality of life. In recent decades, SLE treatment has moved from the use of hydroxychloroquine, systemic glucocorticosteroids and conventional immunosuppressive drugs to biologic agents, of which belimumab is the first and only biologic agent approved for the treatment for SLE to date. Novel therapies targeting interferons, cytokines and their receptors, intracellular signals, plasma cells, T lymphocytes and co-stimulatory molecules are being evaluated. In the context of a holistic approach, growing evidence is emerging of the importance of correct lifestyle habits in the management of lupus manifestations and comorbidities. The aim of this paper is to provide an overview of current pharmacological and non-pharmacological treatment options and emerging therapies in SLE.

Introduction The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) both in rheumatologic and non-rheumatologic rehabilitation centers. In addition, we sought to evaluate the practice value of existing screening recommendations of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO). Methods The analysis was performed in four rehabilitation clinics (rheumatology, psychosomatic medicine, oncology, and cardiology) with at least 200 patients per clinic tested for MRSA. Results Nine (1.1%) of the 842 patients were colonized with MRSA. Only five of them should have been tested according to the commission’s recommendations. The prevalence was 0.5% (n = 207) in rheumatologic, 0.9% (n = 224) in psychosomatic, 1.4% (n = 209) in oncologic and 1.5% (n = 202) in cardiologic patients. We found a greater exposure to risk factors in cardiologic and oncologic patients. Among patients with carrier status, a higher percentage was exposed to three potential risk factors not applied by the commission. Conclusions The prevalence of MRSA in our cohort correlates with data from previous studies. The low percentage among rheumatologic patients suggests that they are not more likely to reveal MRSA carrier status than other patient groups and that long-term immunosuppression does not necessarily represent a risk factor for MRSA colonization. Since only five out of nine patients with carrier status would have been detected following the recommendations of the KRINKO, further studies on potential risk factors are warranted.

Objective Arthritis, myositis and interstitial lung disease (ILD) constitute the classic clinical triad of anti-synthetase syndrome (ASSD). These patients experience other accompanying features, such as Raynaud's phenomenon, fever or mechanic's hands. Most ASSD patients develop the complete triad during the follow-up. In the present study we aimed to determine whether the subsequent appearance of accompanying features may suggest the development of triad findings lacking at the onset in anti-Jo1 positive ASSD patients. Methods Anti-Jo1 positive patients presenting with incomplete ASSD (no >2 classic triad features) were assessed. Clinical characteristics and clusters of disease manifestations were retrospectively collected and analyzed in a large international multicenter cohort of ASSD patients. Results 165 patients (123 women) with incomplete ASSD were identified. Ninety-five patients (57.5%) developed new classic triad manifestations after 15months median (IQR 9–51) and 40 (24%) developed new accompanying features after 19months median (IQR 6–56) from disease onset. During the follow-up, the ex-novo occurrence of triad features was observed in 32 out of 40 patients (80%) with new accompanying findings and in 63 out of 125 patients (50.5%) without new accompanying findings (p=0.002). In patients with at least one new accompanying feature the odds ratio for the occurrence of new triad manifestations was 3.94 with respect to patients not developing ex-novo accompanying findings (95% CI 1.68–9.21, p=0.002). Conclusion Anti-Jo1 ASSD patients with incomplete forms at disease onset are at high risk for the subsequent occurrence of lacking classic triad findings. Although all ASSD patients should be carefully assessed for the occurrence of new triad features, a closer follow-up should be considered in the subgroup of patients developing ex novo accompanying findings. These patients, indeed, have near four-fold increased risk for new classic triad manifestation occurrence with respect to patients not presenting ex novo accompanying findings.

Background: Macrovascular involvement and cardiovascular (CV) risk have not been sufficiently studied in patients with mixed connective tissue disease (MCTD). In particular, the gold standard assessment method of aortic stiffness carotid-femoral pulse wave velocity (cfPWV) (1) has never been evaluated in patients with this disease. Objectives: Aims of the present study were to examine cfPWV in MCTD and to evaluate its associations with MCTD associated parameters and traditional CV risk factors. Methods: cfPWV measurements were performed in 43 MCTD patients and 107 healthy controls. The difference between cfPWV in the two groups was statistically examined and subsequently controlled for the effect of possible confounding factors. Association of cfPWV with MCTD associated organ involvement, routine laboratory parameters and immunoserological markers was also evaluated. Finally, relationship of cfPWV with medications and traditional CV risk factors was examined. Results: Adjusted statistical analyses for confounding factors showed significantly higher cfPWV values in MCTD patients in comparison to controls (padj Conclusion: To our knowledge, this is the first study to show that patients with MCTD have significantly higher aortic stiffness and thus CV risk in comparison to controls. Except the disease itself, age and blood pressure were the main predictors of cfPWV. References [1] Bortel LM Van, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. [2] J Hypertens2012; 30: 445–448. Disclosure of interests: Konstantinos Triantafyllias: None declared, Michele De Blasi : None declared, Freya Lutgendorf: None declared, Lorenzo Cavagna: None declared, Marco Stortz: None declared, Julia Weinmann-Menke : None declared, Stavros Konstantinides : None declared, Peter Galle : None declared, andreas Schwarting Grant/research support from: GSK, Pfizer, abbVie, Novartis, Roche, Speakers bureau: GSK, Novartis

Background Rheumatoid arthritis (RA), psoriasis arthritis (PsA) and spondyloarthritis (SpA) are the most common chronic autoimmune rheumatic diseases. For all 3, the so-called “window of opportunity” [1-3] has been identified as the decisive factor affecting the outcome. Objectives The aim of the prospective study is to improve early diagnosis of RA, PsA and SpA and thus positively impact the quality of care for patients with the help of coordinating centers. The primary endpoint is the number of cases with an actual indication for immediate referral to a specialist in proportion to all reported cases. Methods The project establishes a network of the University Medical Center Mainz, the Medical School Hannover, the Center for Rheumatology Lower Saxony e.V., the University Medical Center Saarland, the ACURA Center of Rheumatology Rhineland-Palatinate, the Leibniz University Hannover and the University Medical Center Freiburg, local rheumatology specialists, the associations of statutory health insurance physicians and general practitioners and the 3 regional associations of the Deutsche Rheuma-Liga e.V. Covering 3 federal states, the network reaches approximately 13 million inhabitants. Primary care providers are given access to screening questionnaires to document potential early cases of RA, PsA, and SpA, based on characteristic symptoms. These are evaluated by multidisciplinary teams at the regional coordinating centers. If they fulfill the criteria for referral, patients get an appointment at a cooperating rheumatology specialist within weeks. If a rheumatic disease is diagnosed, physicians and patients receive questionnaires on sociodemographic data, quality of life, functionality, medication, diagnosis and psychological aspects. After 12 months, the questionnaires are completed a second time. The collected data is compared with a matched reference group of the German Rheumatism Research Center. It is planned to screen up to 8.700 people within the 30-month survey phase that started in October 2017. Results Preliminary data will be presented at the conference. Currently, 2.400 patients have been screened, of which 400 patients were included in the study and 15 already underwent their follow-up screening. Conclusion Previous studies have shown positive results of coordinated cooperation among the relevant care providers. For example, 75 percent of the patients diagnosed with early RA within the ADAPTHERA network were in remission after 2 years (DAS28 References [1] O’Dell, J.R., Treating rheumatoid arthritis early: a window of opportunity? Arthritis Rheum, 2002. 46(2): p. 283-5. [2] Boehncke, W.H. and A. Menter, Burden of disease: psoriasis and psoriatic arthritis. Am J Clin Dermatol, 2013. 14(5): p. 377-88. [3] Claudepierre, P., Spondyloarthritis: a window of opportunity? Joint Bone Spine, 2014. 81(3): p. 197-9. [4] Lauter, A., et al. ADAPTHERA - Landesweit transsektorales Versorgungsnetzwerk fur Patienten mit fruher rheumatoider Arthritis zeigt anhaltende Remissionen in der Regelversorgung. Wunder Punkt: Die Triage. (2018). Manuscript. Disclosure of Interests Matthias Dreher: None declared, Gunter Assmann: None declared, Kirsten Hoeper: None declared, Konstantinos Triantafyllias: None declared, Jan Zeidler: None declared, Harald Binder: None declared, Reinhold E. Schmitt: None declared, Andreas Schwarting Grant/research support from: GSK, Pfizer, AbbVie, Novartis, Roche, Speakers bureau: GSK, Novartis

Background Valid assessment of disease activity leads to improvement of long-term outcomes in patients with rheumatoid arthritis (RA) (1). Clinical disease activity assessment tools such as the Disease Activity Score 28 (DAS28) are partially subjective and do not always depict the real inflammatory burden. Ultrasound (US) and Hand-MRI are important diagnostic modalities which can nevertheless be time consuming (US, MRI), expensive (MRI) or usually performed unilaterally (MRI). Thus, further diagnostic tools are needed. Optical spectral transmission (OST) is a new modality able to assess the blood-specific absorption of light transmitted through a tissue promising quantification of inflammation in the finger and wrist joints of RA patients (commercial device: HandScan - Hemics, The Netherlands)(2). Objectives To examine the diagnostic value of OST in detecting inflammation in patients with RA and to evaluate for the first time its relationship with disease activity markers and various anthropometric and epidemiologic patient characteristics. Methods OST-Measurements were performed in 168 RA-patients and 114 healthy controls. The difference between OST in the two groups was statistically examined and subsequently controlled for the effect of possible confounding factors. Moreover, association of OST with clinical, ultrasound and serological RA activity markers was evaluated. Finally, relationship of OST with radiographic joint pathology and various anthropometric and epidemiologic parameters (BMI, hand-size, gender, age) was examined. Results OST was significantly higher in the patients group in comparison to the control group, even after adjustment for the effects of various confounding factors (padj Conclusion OST correlated with serological and clinical disease activity markers as well as with different anthropometric and epidemiological parameters of RA-patients. OST could therefore prove to be a good non-interventional complementary tool to assess RA activity next to well established diagnostic methods such as the US or MRI. References [1] Katchamart W, et al. Systematic monitoring of disease activity using an outcome measure improves outcomes in rheumatoid arthritis. J Rheumatol2010;37:1411–1415. [2] Onna M Van, et al. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis2016;75:511–518. Disclosure of Interests Konstantinos Triantafyllias: None declared, Caroline Heller : None declared, Michele De Blasi : None declared, Peter Galle : None declared, Andreas Schwarting Grant/research support from: GSK, Pfizer, AbbVie, Novartis, Roche, Speakers bureau: GSK, Novartis

Background Patients with rheumatoid arthritis (RA) are at a higher cardiovascular (CV) risk in comparison to the general population. CV risk associates closely with aortic stiffness. Aim of this exploration was therefore to evaluate aortic stiffness in patients with RA and to examine its association with various RA associated parameters as well as with traditional CV risk factors. Methods Measurements of carotid-femoral pulse wave velocity (cfPWV) were analyzed retrospectively in 38 RA patients and 25 controls. We investigated the statistical difference between cfPWV values in the two groups. Furthermore, we analyzed the associations of cfPWV with laboratory and clinical RA parameters including Disease Activity Score 28 and its components, rheumatoid factor, cyclic citrullinated peptide antibodies, antinuclear antibodies and RA duration. Finally, we explored the relationship of cfPWV with traditional CV risk factors in the RA group. Results cfPWV was not significantly higher in RA patients in comparison to controls in an adjusted statistical model for confounding factors [−0.587 95 % CI (−1.38 to 0.201), p = 0.144]. Among RA patients there was a statistically significant correlation of cfPWV with age (rho = 0.544, p = 0.001) and the count of tender joints [0.051 95 % CI (0.008–0.207), p = 0.034]. Finally, C-reactive protein associated only marginally with cfPWV [0.105 95 % CI (−0.410 to 0.003), p = 0.053]. Conclusions In RA patients the number of tender, rather than swollen joints correlates with stiffness of the aorta, as measured through cfPWV. Therefore, RA associated joint pain might play a role in the development of aortic stiffness and thus increase CV risk.

Background The significance of early diagnosis and early therapy initiation in patients with RA is tremendous. ADAPTHERA is a state wide rheumatology network based in Rhineland-Palatinate, Germany. ADAPTHERA aims to improve RA prognosis and quality of patients` life by reducing the time-to-RA-diagnosis. While there have been a lot of studies regarding quality of life in patients with established RA 1,2 , adequate data concerning very early rheumatoid arthritis (VERA) (disease duration Objectives To study quality of life in VERA patients and to investigate its associations with various RA associated clinical and laboratory parameters. Methods In a two center subgroup analysis from the ADAPTHERA cohort, we studied quality of life indexes such as Hannover Functional Ability Questionnaire (HFAQ), Health Assessment Questionnaire (HAQ), EuroQol-5D-3L (EQ-5D-3L), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and World Health Organisation-5 Well Being Index (WHO-5) in patients with VERA. Moreover, we examined the statistical relationship of these indexes with various clinical and laboratory RA associated parameters such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF)-/ cyclic citrullinated peptide antibodies (anti-CCP)-status and Disease Activity Score 28 (DAS28) as well as its components [counts of tender and swollen joints, Visual Analogue Scale (VAS)]. Results 74 Patients (50 females, 24 males) with a median age of 62 years (IQR 49, 71) were identified as VERA patients. 36 of them were anti-CCP positive and 34 RF positive. Median scores for HFAQ, HAQ, EQ-5D-3L, FACIT-Fatigue, and WHO-5 were 75.5 (IQR 61, 92.5), 0.75 (IQR 0.26, 1.25), 0.89 (IQR 0.79, 0.89), 40 (IQR 32, 46) and 60 (IQR 32, 76) accordingly. The results of the statistical associations between these scores and RA associated parameters are seen in Table 1. Conclusions The quality of life indexes HFAQ, HAQ, EQ-5D-3L and WHO-5 are associated with two or more markers of disease activity in patients with VERA. Therefore, improvement of patients9 quality of life is linked to the achievement of disease remission. In contrast, the FACIT-fatigue index seems to be solely associated with arthritis pain intensity. Thus, improvement of fatigue requires an effective pain management strategy. References Gossec L et al., RMD Open. 2015 Apr 2;1(1):e000019. Her M et al., Curr Opin Rheumatol, 2012 May;24(3):327–34. Disclosure of Interest None declared

Objective To evaluate clinical associations of anti-PM/Scl antibodies in patients with SSc in a multicentre international cohort, with particular focus on unresolved issues, including scleroderma renal crisis (RC), malignancies, and functional outcome of interstitial lung disease (ILD). Methods (1) Analysis of SSc patients from the EUSTAR database: 144 anti-PM/Scl+ without SSc-specific autoantibodies were compared with 7202 anti-PM/Scl−, and then to 155 anti-Pm/Scl+ with SSc-specific antibodies. (2) Case–control study: additional data were collected for 165 anti-PM/Scl+ SSc patients (85 from the EUSTAR registry) and compared with 257 anti-PM/Scl− SSc controls, matched for sex, cutaneous subset, disease duration and age at SSc onset. Results Patients with isolated anti-PM/Scl+, as compared with anti-Pm/Scl−, had higher frequency of muscle involvement, ILD, calcinosis and cutaneous signs of DM, but similar frequency of SRC and malignancies (either synchronous with SSc onset or not). The presence of muscle involvement was associated with a more severe disease phenotype. Although very frequent, ILD had a better functional outcome in cases than in controls. In patients with both anti-PM/Scl and SSc-specific antibodies, a higher frequency of typical SSc features than in those with isolated anti-PM/Scl was observed. Conclusion The analysis of the largest series of anti-PM/Scl+ SSc patients so far reported helps to delineate a specific clinical subset with muscle involvement, cutaneous DM, calcinosis and ILD characterized by a good functional outcome. SRC and malignancies do not seem to be part of this syndrome.