D.P.E. Margiotta

FRI0014 Low-dose aspirin may have a role as primary prophylaxis of cardiovascular events in rheumatoid arthritis: evidence from an italian multicentric retrospective study

Background Cardiovascular (CV) morbidity and mortality are significantly greater in Rheumatoid Arthritis (RA) patients than in the general population. Acetylsalicylic acid (ASA) is known to be associated with a significant decrease in the incidence of CV events in patients at high CV risk, as we have recently demonstrated in patients with Systemic Lupus Erythematosus, but its effectiveness as primary prophylaxis in RA patients has not yet been addressed. Objectives To investigate the role of ASA in reducing the incidence of CV events in an Italian multicentre RA cohort from the GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale). Methods The clinical charts of RA patients consecutively admitted to 4 GIRRCS centres for their 1u2009st visit from November 1u2009st 2000 to December 31u2009st 2015, who, at admission, satisfied 2010 ACR/EULAR criteria for RA and had not experienced any CV event, were analysed. The incidence of CV events during follow-up was recorded at December 2016. Kaplan Meier curve and log-rank test were used to investigate differences in event-free survival. Cox regression analysis served to identify factors associated with CV event occurrence. Results Seven hundred and forty-six consecutive RA patients were enrolled and followed up for a median of 5.6 years (range 2.9–8.9 years). The incidence rate (IR) of CV events was 7.8/1000 person-years (pys) in the overall cohort. Patients were subdivided into two groups, namely ASA- (242 patients) and non-ASA-treated (504 patients). The IR of CV events was significantly lower in the ASA-treated with respect to the non ASA-treated group (IR 1.7 vs 11.5/1000 pys;p=0.0002). Furthermore, the CV event-free rate was longer in ASA-treated than in non-ASA-treated patients (log-rank test 12.3;p=0.0004). Figure 1. At multivariate analysis hypertension and metabolic syndrome (HR 5.6, 95%u2009CI:1.2–26.3;p 0.03 and HR 3.7, 95%u2009CI:1.3–9.8;p 0.009) resulted to be the only positive predictors; ASA treatment (HR 0.04, 95%u2009CI:0.06–0.33;p 0.02) the only negative one. Conclusions The incidence rate of CV events in our italian multicentric cohort was lower than that reported in other European and non European cohorts. Low-dose ASA may have a role in the primary prophylaxis of CV events in RA patients. References [1] del Rincón ID, et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum2001;44(12):2737–45. [2] Fasano S, et al. Longterm Hydroxychloroquine Therapy and Low-dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus. J Rheumatol2017;44(7):1032–1038. [3] Meek IL, et al. 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. BMC Musculoskelet Disord2014;15:142. Disclosure of Interest None declared

THU0164 Subclinical atherosclerosis and cardiovascular events in italian patients with rheumatoid arthritis: results from multicenter girrcs (gruppo italiano di ricerca in reumatologia clinica e sperimentale) study

Background Several studies showed a close relationship between Rheumatoid Arthritis (RA) and accelerated atherosclerosis [1,2]. At the best of our knowledge, no such study has been carried out in a large Italian series. Objectives To investigate the prevalence of presence of subclinical atherosclerosis and history of cardio-cerebrovascular events (CVEs), in 1266 patients consecutively admitted to Rheumatology Units throughout the whole Italy. Methods From 01/01/2015 to 31/12/2015, 1266 consecutive patients admitted to GIRRCS centres, satisfying ACR/EULAR criteria for RA were investigated for: i. traditional cardiovascular risk factors: gender, age, smoking habit, cholesterol, triglycerides, glycemia, systemic arterial hypertension (SAH), metabolic syndrome (MS), type 2 diabetes (T2D); ii. RA aspects: disease duration as assessed from the first symptom, disease activity as evaluated by DAS28, radiographic damage by joint X-ray, and joint surgery; iii. subclinical atherosclerosis, as assessed by ultrasound technique and/or atherosclerotic peripheral lesions; iv. history of CVEs. Results We evaluated 1176 patients out of 1266, that were investigated for both CVEs and subclinical atherosclerosis. They were mostly females (80.52%), with a median age of 60 years (range 18–91 years), a median disease duration of 12 years (range 0.8–25 years), seropositive in 69.21%. Nineteen percent were in remission; 17.51% presented low disease activity; 39.45% moderate disease activity, 22.61% high disease activity. Out of 1176 patients, 217 (18%) showed evidence of subclinical atherosclerosis: a figure lower than that reported worldwide (32.7%) [2]. Eighty-two patients (6.9%) had a history for CVEs (58 myocardial infarction, 38 heart failure, 10 ischemic transitory attack, 7 Stroke), too this figure is lower than that reported worldwide (8.5%) [3,4]. In multivariate analysis, older age (p=0.0001, OR:1.069, CI95%:1.05–1.09), MS (p=0.0001, OR:3.417, CI95%:2.16–5.40) and SAH (p=0.0001, OR:3.714, CI95%:2.23–6.17) and high disease activity (p=0.001, OR:2.117, CI95%:1.35–3.32) were significantly associated with the presence of subclinical atherosclerosis. Male gender (p=0.0001, OR:3.465, CI95%:1.94–6.185), MS (p=0.005, OR:2.542, CI95%:1.29–4.52), T2D (p=0.007, OR:2.324, CI95%:1.29–4.29) and SAH (p=0.001, OR:4.921, CI95%:2.14–11.45) and higher disease activity (p=0.003, OR:1.316, CI95%:1.15–1.68) were significantly associated with a history of CVEs. Conclusions This is the first Italian multicenter study on subclinical and clinical atherosclerosis in patients with RA. We pointed out a low prevalence of both subclinical atherosclerosis and history of CV events. Nonetheless, a high disease activity and presence of cardiovascular risk factors were found to play a role, similarly to other countries. References Ruscitti P, et al. PLoS One. 2017;12:e0170108. Ambrosino P, et al. Thromb Haemost. 2015;113:916–30. Solomon D et al. Ann Rheum Dis. 2010;69:1920–5. Avina-Zubieta JA, et al. Ann Rheum Dis. 2012;71:1524–9. Disclosure of Interest None declared

SAT0273 Factors related to alexithymia in systemic lupus erythematosus

Background Several evidences described a considerable prevalence of alexithymia among patients with chronic diseases, such as systemic autoimmune diseases. In patients affected by Systemic Lupus Erythematosus (SLE), alexithymia seems to be related to mood disorders and personality. Objectives In this study we evaluated alexithymia in relation to HR-QoL (Health related Quality of Life) and to factor associated to HR-QoL, such as mood disorders, fatigue, work ability, sleep quality and physical activity. Methods We consecutively enrolled SLE patients and healthy controls in a cross sectional study with a retrospective design. We wvaluated alexithymia by the Toronto Alexithymia Scale 20 (TAS-20). AHR-QoL was expressed by MOS-SF-36. Mood disorders was assessed by BDI and HAM-H. Fatigue was evaluated by Facit-Fatigue. Physical activity was quantified using International Physical Activity Questionnaire (IPAQ) and the sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Work ability was assessed by Work Productivity and Activity Impairment (WPAI). Cognitive impairment was defined according to MOCA screening test. Results Fifty-two SLE patients and 50 age-matched healthy subjects were enrolled in the study. Mean TAS-20 score was significantly higher in SLE compared to controls (p<0.01). Alexithymic patients presented increased values of BDI score and HAM-H score (p<0.01 and p<0.05) and reduced Facit-Fatigue score (p<0.05). We found increased values of Work missed due to health problems and Activity impairment in alexithymic SLE subjects (p<0.05). SF-36 summary components PCS and MCS and SF-36 individual components did not significantly differ between alexithymic and non-alexithymic SLE. A greater proportion of alexithymic SLE patients presented fibromyalgia (p<0.05), low scholastic education (p<0.01), cognitive impairment according to MOCA test (p<0.01) and mild-to-severe depression according to BDI (p<0.01). We did not find differences among alexithymic and non alexithymic in MeS, obesity and physical inactivity prevalence. TAS-20 values positively correlated with BDI score (p<0.001), HAM-H score (p<0.01) and activity impairment score (p<0.01) and negatively with Facit-Fatigue score (p<0.01). In multiple linear regression, predictors of TAS-20 values were to be fibromyalgic and to have mild-to-severe depression according to BDI. In multiple logistic regression, alexithymia was significantly associated to BDI score (OR 1.2, 95% CI 1.0–1.4) and inversely associated to cognitive impairment (OR 0.1, 95% CI 0.02–0.8). Conclusions SLE patients frequently present alexithymic tract. Alexithymia seems to be associated neither to disease feature, to disease course (activity and damage) and to SLE therapy, nor to HR-QoL expressed by SF-36. Nevertheless, alexithymia could be tightly related to QoL-associated factors as depression and fibromyalgia Disclosure of Interest None declared

AB0341 Rheumatoid Arthritis Associated Interstitial Lung Disease Progression in a Cohort of Treated to Target Patients

Background Interstitial lung disease (ILD) is the most common manifestation of rheumatoid lung disease (RA-ILD). The prevalence of RA-ILD is somewhere between 10 and 50 percent, depending on the study. In analogy with Systemic Sclerosis associated ILD (SSc-ILD), high resolution computed tomography (HRCT) has become the gold standard for diagnosis of RA-ILD. Literature data describe a strong correlation between HRCT pattern of ILD and histopathological subtypes. Moreover, different systems for evaluating SSc-ILD on HRCT and several scoring methods have been proposed for RA-ILD. Because of the uncertainty of the effect of traditional DMARDs and biologic agents on the development and course of ILD in patients with RA, careful pre-treatment assessment and subsequent monitoring are required. We present the results of the follow-up to 1 year of a cohort of patients treated with DMARDs and maintained in the therapeutic target (DAS28 low disease activity or remission). Objectives To evaluate the change in respiratory function and ILD HRTC score in a cohort of patients treated to target. Methods 24 RA patients in DMARD monotherapy and low dose steroid (dose of prednisone <7.5 mg/die), followed by treat-to-target strategy and kept in DAS28 low disease activity or remission, were enrolled. All patients were evaluated with pulmonary function tests (global spirometry, DLCO and hemogasanalysis) and HRCT at time of the enrollment and after 1 year of follow-up. All HRCT examinations were performed according to standard protocol. The parenchymal abnormalities on HRCT were coded and scored in all the images by two independent readers, blinded with respect to the results, according to Warrick et al. The severity and extent of disease were then calculated as total HRCT score (range from 0 to 30). Results 19 of 24 patients were in MTX monotherapy (mean MTX weekly dose: 12.5 mg) and 5 were in Leflunomide monotherapy. Mean RA disease duration was 4.8 yr (±0.6 SD). 20 of 24 patients presented HRCT signs of ILD with Warrick score ≥1. At time 0 mean HRTC score was 8 (±5 SD), mean extension score was 4 (±2 SD) and mean severity score was 4 (±3 SD). At time 1 yr mean HRTC score was 8,04 (±3,73 SD), mean extension score was 3,37 (±1,86 SD) and mean severity score was 4,66 (±2,11 SD) (p=NS). Mean DLCO was 74 (±21 SD) at time 0 and 66 (±18 SD) at the end of follow-up (p=NS). We found no statistically significant modification in total lung capacity (TLC) and Tiffenau index (FEV1/FVC) during follow-up. Conclusions As previously reported, we found high prevalence of RA-ILD. In our treated-to-target RA cohort in DMARD monotherapy, we have not detected neither functional nor radiological progression during 1 year follow-up. In our cohort the DMARD therapy has not worsened the ILD. We can speculate that control the activity of joint disease with a strategy to treat target may contribute to prevent lung disease progression. Disclosure of Interest None declared

SAT0542 Musculoskeletal Syndromes Related to Aromatase Inhibitor Therapy: A Clinical and Laboratory Evaluation

Background Aromatase inhibitors (AI) are widely used in the treatment of estrogen receptor-positive breast cancer in postmenopausal women. The onset of musculoskeletal symptoms related to AI therapy limits the treatment compliance. Objectives To evaluate the incidence and the clinical presentation of musculoskeletal syndromes and the prevalence of autoantibodies during AI therapy. Methods We enrolled 49 consecutive postmenopausal patients with non-metastatic breast cancer treated with third generation AI for at least three months (AI+ group) and 10 postmenopausal controls with breast cancer in adjuvant therapy but not treated with AI (AI- group). The two groups were evaluated with a rheumatological examination (tender and swollen joint count, tender points, CDAI), with PRO-CLARA, FACIT-fatigue and HAQ questionnaires and ANA, ENA screen and ACPA dosage. ANA were assayed in indirect immunofluorescence on Hep-2 cells using as a cut-off a dilution of 1:80; ENA screen and ACPA were assayed with ELISA commercial kits. Results The mean ages were 62.6±9 years for AI+ group and 58±11.8 years for AI- group (p=0.2, U=140.5). In AI+ group, 27 (55%) patients exhibited at least one tender joint and 15 (30%) patients exhibited at least one swollen joint. In AI- group, two patients exhibited at least one tender joint and one patient exhibited at least one swollen joint. 22% of AI+ group patients and 20% of AI- group patients showed more than 11 tender points (TP). When patients with more than 11 TP positivity were excluded from the analysis, tender joint count was more higher in AI+ group (p=0.037). Differences between AI+ and AI- groups regarding PRO-CLARA, FACIT-fatigue, HAQ and CDAI were summarized in Tab. 1. In AI+ group, PRO-CLARA values correlates with FACIT-fatigue values (R=-0.59, p<0.0001), swollen joint count (R=0.48, p=0.001), tender joint count (R=0.72, p<0.0001), tender points count (R=0.76, p<0.0001), HAQ values (R=0.85, p<0.0001), CDAI values (R=0.89, p<0.0001) and does not correlate with the age of the patients. 67% of the AI+ group patients showed ANA positivity vs 20% AI- group patients (p 0.01, RR 3.3).Table 1 AI+ group AI- group p PRO-CLARA 2.65±2.15 1.56±2.39 p 0.048 FACIT-fatigue 38±9 39±8 p 0.58 HAQ 0.750 0.3 p 0.030 CDAI 7±6 2±3.5 p 0.005 Conclusions In this preliminary study, we demonstrated a higher prevalence of arthralgia/arthritis in AI+ group than in AI- group. No significant difference in tender points count was detected between the two groups. In AI+ group, higher values of PRO-CLARA, HAQ and CDAI than those of AI- group were showed. A higher rate of ANA positivity was demonstrated in AI+ group. These results support the hypothesis of a possible role of an immune system dysregulation in the development of musculoskeletal syndromes during AI therapy. The expertise of a rheumatologist could help patients with estrogen receptor-positive breast cancer treated with AI to improve their quality of life and to ensure a greater compliance to AI therapy. References Lønning PE, et al. Endocr Relat Cancer. 2013 Jun 24;20(4):R183-201. Niravath P. Ann Oncol. 2013 Jun;24(6):1443-9. Shanmugam VK, et al. Breast Cancer Res Treat. 2012 Jan;131(2):699-708. Disclosure of Interest None declared