Search

Background Mycophenolate mofetil (MMF) has been increasingly used in the treatment of early diffuse cutaneous Systemic Sclerosis (dcSSc) and SSc-associated interstitial lung disease (SSc-ILD), and a recent Randomized Controlled Trial confirmed its efficacy and safety in SSc-ILD. However, the safety of this drug in the long term use has not been assessed in a real life setting. Objectives We aimed to analyze the period prevalence and the type of adverse events (AEs) associated to MMF treatment in a single center large cohort. Methods Charts of all SSc patients meeting the 2013 ACR/EULAR classification criteria consecutively visited at our outpatient clinic from January 1st 2017 to December 31st 2017 were retrospectively analyzed. Demographics, clinical, serological, functional, imaging data, treatments, and AEs were recorded. Patients were subgrouped according to the immunosuppressant (IS) taken during the observation period (e.g. MMF, azathiprine- AZA, or cyclophosphamide- CYC, no IS). The period prevalence of AEs was calculated and correlations of between AEs and patient features were investigated by univariate and multivariate analyses. Results Two-hundred and thirty-seven patients were included (92.4% were females, aged 56.4±11.3 years, with a median disease duration of 17 years, range 1-60). Among them, 85 (35.9%) were taking MMF, 34 (14.3%) AZA or CYC, 118 (49.8%) had no current IS treatment. Prevalence of the dcSSc subset was higher in the MMF group (34.1% versus 17.6% in the AZA/CYC group and 5.9% in the no IS group; p Conclusion The period prevalence of AEs recorded during MMF treatment appeared as high as 71.7% in our real life setting. Even though we did not record any serious AE, our analysis suggests a close monitoring of this therapy in SSc. Disclosure of Interests Rossella Chieffo: None declared, Maria Sofia Ciliento: None declared, Veronica Giacco: None declared, GIUSEPPE SCALISE: None declared, Serena Vettori Consultant for: Boehringer Ingelheim Italia SpA

This study aims to investigate pre-clinical esophageal involvement in systemic sclerosis (SSc) by high-resolution impedance manometry (HRiM), its associations with disease features including lung involvement, and its predictivity of esophageal symptoms overtime. Charts of 45 asymptomatic (no heartburn/regurgitation/dysphagia) SSc patients (96% females; mean age 46 years) with at least one follow-up (FU) visit and complete clinical, serological, functional, and radiological assessment, including high-resolution computed tomography (HRCT) of the chest and lung function tests, that had undergone esophageal HRiM were retrospectively evaluated. Esophagogastric junction-contractile integral (EGJ-CI) and esophageal body motility, as evaluated by mean distal contractile integral (DCI), were assessed. SSc patients had a normal esophageal motility in 7/45 cases, a defective EGJ-CI in 28, an ineffective esophageal motility (IEM) in 17, and aperistalsis in 12. Defective EGJ-CI was associated with IEM/aperistalsis in 20 cases, while 9 patients had isolated IEM. Defective EGJ-CI and/or IEM/aperistalsis were associated with a diffusing lung capacity for CO < 80% of predicted value (all p < 0.05), while defective EGJ-CI was also associated with interstitial lung disease on HRCT (p = 0.03). Prevalence of any HRiM abnormality was higher in anti-centromere antibody negative patients (all p < 0.05). IEM/aperistalsis independently increased the risk of esophageal symptoms by 2.3-fold (95% CI 1.1–5.7) and was associated with their higher cumulative incidence with respect to patients with other HRiM patterns at FU (χ2= 4.63; p = 0.03). SSc patients asymptomatic for esophageal involvement can have HRiM abnormalities in up to 84% of cases. A baseline-impaired motility is a risk factor for symptomatic esophageal disease.

Background Cardiovascular events (CV) i.e. acute myocardial infarction and stroke are recognized as a leading cause of mortality in patients with Rheumatoid Arthritis (RA) [1,2]. Acetylsalicylic acid (ASA) is known to be associated with a significant decrease in the incidence of CV events in patients at high risk for atherosclerosis like patients with diabetes [3] and has been recently reported to play a primary prophylactic role of CV events in Systemic Lupus Erythematosus by our team [4]. Objectives To investigate the so far unexplored role of ASA in reducing CV morbidity in RA. Methods We analysed patients admitted to our Outpatient clinic from January to December 2015. Out of 199, 155 patients, who had been followed from January 2000 and had not experienced any CV event at the first visit, were enrolled. The incidence of CV morbidity was recorded at December 2016. Results The 155 patients had been followed-up for a median of 8 years (range 1–15 years). Out of them, 111 patients had been treated with ASA, that we currently administer to patients undergoing steroid treatment. During the 15-years of follow up, 5 CV events (2 cerebrovascular, 3 acute myocardial infarction) had occurred (Incidence rate 3.93/1000 person/year). Interestingly, only 1 CV event had occurred in ASA treated patients (Incidence rate 1.12/1000 person/year) with respect to 4 in the non-ASA group (44 patients) (Incidence rate 10.48/1000 person/year) (p=0.0146). Conclusions Our study has several limitations including the low number of patients and CV events. Nevertheless, it might suggest a primary prophylactic role of ASA in RA, that awaits to be investigated in large controlled prospective studies. References Arthritis Rheum. 2001 Dec;44(12):2737–45. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditionalcardiac risk factors. del Rincόn ID, Williams K, Stern MP, Freeman GL, Escalante A. BMC Musculoskelet Disord. 2014 Apr 29;15:142. Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature. Meek IL, Vonkeman HE, van de Laar MA. Diabetes Res Clin Pract. 2016 Oct;120:31–9. Aspirin for primary prevention of cardiovascular disease in patients with diabetes: A meta-analysis. Kokoska LA, Wilhelm SM, Garwood CL, Berlie HD. Rheumatology (Oxford). 2016 Sep;55(9):1623–30. Low-dose aspirin as primary prophylaxis for cardiovascular events in systemic lupus erythematosus: a long-term retrospective cohort study. Iudici M, Fasano S, Gabriele Falcone L, Pantano I, La Montagna G, Migliaresi S, Valentini G. Disclosure of Interest None declared

Background A reduced basal lower esophageal sphincter (LES) pressure (LES Objectives We aimed to investigate potential associations of a reduced basal LES pressure at first observation with the development of new gastrointestinal symptoms and with self-administered questionnaires devoted to assess the impact of gastrointestinal involvement on quality of life during follow-up (FU) in SSc patients. Methods SSc patients meeting the 2013 ACR/EULAR criteria for disease classification with measurement of basal LES pressure at the first observation and at least one FU visit with complete clinical evaluation were enrolled. The gastroesophageal reflux disease questionnaire (GerdQ) (2, 3) was administered to explore the impact of esophageal symptoms on patient9s disease perception and to estimate the risk for GERD. Associations between reduced basal LES pressure and new onset gastrointestinal symptoms at FU were analyzed by Fisher9s exact test, while the GerdQ score in SSc patients with or without a reduced basal LES pressure was analyzed by Mann-Whitney U test. Results Fifty-nine SSc patients, aged 47±13 years, were investigated (75% females; median disease duration 7 years, range 0.5–43). Eighty % of patients had a limited SSc subset (lcSSc); 20% had a diffuse subset (dcSSc). All patients were ANA positive (36% had anti-centromere antibodies, 39% anti-Scl70+; 5% anti-RNApolymerase III; 1.7% anti-PmScl; 1.7% anti-U1RNP). All patients were under proton pomp inhibitors ± prokinetics during FU. Forty-two % of patients had already esophageal symptoms at baseline; 32% developed new esophageal symptoms and 40% new gastric and/or intestinal symptoms during observation (median FU 4 years; range 0.5–15.5). Baseline basal LES pressure was reduced in 63% of patients. Out of these, 49% had also esophageal symptoms. Median GerdQ score at the end of FU was significantly higher in patients with baseline reduced LES pressure (7, range 3–14 versus 6, range 2–11; p Conclusions Our data suggest that evaluation at baseline of esophageal involvement in SSc patients by esophageal manometry can predict the development of more severe symptoms over time, as evaluated by the association with a higher score at GerdQ also in initially asymptomatic patients. Larger studies need to be carried out to confirm this association. References Sjogren RW. Arthritis Rheum 1994; 37: 1265–82 Jonasson C et al. Aliment Pharmacol Ther 2013; 37: 564–72 Chunlertrith K et al. Clin Exp Rheumatol 2014; 32 (6 Suppl 86): S98–102 Disclosure of Interest None declared