Jonathan Wollman

Efficacy and safety of vaccination against pandemic 2009 influenza A (H1N1) virus among patients with rheumatic diseases.

To assess the efficacy and safety of vaccination against pandemic H1N1 virus in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) compared with healthy controls.

The Effect of the Presence of Fibromyalgia on Common Clinical Disease Activity Indices in Patients with Psoriatic Arthritis: A Cross-sectional Study

Objective. To study the effect of the presence of fibromyalgia (FM) on common clinical disease activity indices in patients with psoriatic arthritis (PsA). Methods. Seventy-three consecutive outpatients with PsA (mean age 51.7 yrs; 42 females, 57.5%) were enrolled in a prospective cross-sectional study. FM was determined according to American College of Rheumatism criteria (2010 and 1990). All patients underwent clinical evaluation of disease activity and completed the Health Assessment Questionnaire (HAQ), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Dermatology Life Quality Index, and the Leeds Enthesitis Index (LEI). Disease activity was evaluated using the Composite Psoriatic Disease Activity Index (CPDAI), minimal disease activity (MDA), and the Disease Activity Index for Psoriatic Arthritis (DAPSA) scores. Results. The overall prevalence of FM was 17.8% (13 patients), and all but 1 were women (12 patients, 92.3%, p = 0.005). CPDAI and DAPSA scores were significantly higher in patients with coexisting PsA and FM (9.23 ± 1.92 and 27.53 ± 19.23, respectively) than in patients with PsA only (4.25 ± 3.14 and 12.82 ± 12.71, respectively; p < 0.001 and p = 0.003). None of the patients with FM + PsA met the criteria for MDA, whereas 26 PsA-only patients did (43.3%, p = 0.003). HAQ, BASDAI, and LEI scores were significantly worse in patients with PsA and associated FM. Conclusion. Coexisting FM is related to worse scores on all tested measures in patients with PsA. Its influence should be taken into consideration in the treatment algorithm to avoid unnecessary upgrading of treatment.

Implementation of recommendations for the screening of hydroxychloroquine retinopathy: poor adherence of rheumatologists and ophthalmologists

The American Academy of Ophthalmology published in 2011 revised recommendations regarding screening for hydroxychloroquine (HCQ) toxicity. We aimed to assess implementation of these recommendations by rheumatologists and ophthalmologists. A questionnaire regarding screening practices for HCQ toxicity was distributed among all members of the Israeli societies of Rheumatology and Ophthalmology. A total of 128 physicians responded to the questionnaire (rheumatologists: 60, ophthalmologists: 68). Only 5% of the rheumatologists and 15% of the ophthalmologists are aware of ophthalmologic assessments recommended for baseline and follow-up evaluation. When an abnormal test is detected, even if inappropriate for HCQ toxicity screening, 60% of the responders recommend cessation of therapy. Only 13% of the responders recommend first follow-up after five years for patients without risk factors; the remainder recommend more frequent testing. Ninety-six percent of the responders are not aware of all of the known risk factors for HCQ toxicity. Use of inappropriate tests to detect HCQ retinal toxicity may lead to unnecessary cessation of beneficial treatment with risk of disease flare, while lack of consideration of risk factors may put patients at risk for toxicity. These results emphasize the importance of implementing the recommendations to ensure safe and effective use of this drug.

Retinal nerve fiber layer thickness and neuropsychiatric manifestations in systemic lupus erythematosus

Background Cognitive impairment is frequent in systemic lupus erythematosus. Atrophy of the corpus callosum and hippocampus have been reported in patients with systemic lupus erythematosus, and diffusion tensor imaging studies have shown impaired white matter integrity, suggesting that white matter damage in systemic lupus erythematosus may underlie the cognitive impairment as well as other neuropsychiatric systemic lupus erythematosus manifestations. Retinal nerve fiber layer thickness, as assessed by optical coherence tomography, has been suggested as a biomarker for white matter damage in neurologic disorders such as multiple sclerosis, Alzheimer’s disease and Parkinson’s disease. Retinal nerve fiber layer thinning may occur early, even in patients with mild clinical symptoms. Aim The objective of this study was to assess the association of retinal nerve fiber layer thickness, as a biomarker of white matter damage in systemic lupus erythematosus patients, with neuropsychiatric systemic lupus erythematosus manifestations, including cognitive impairment. Methods Twenty-one consecutive patients with systemic lupus erythematosus underwent neuropsychological testing using a validated computerized battery of tests as well as the Rey-Auditory verbal learning test. All 21 patients, as well as 11 healthy, age matched controls, underwent optical coherence tomography testing to assess retinal nerve fiber layer thickness. Correlations between retinal nerve fiber layer thickness and results in eight cognitive domains assessed by the computerized battery of tests as well as the Rey-Auditory verbal learning test were assessed in patients with systemic lupus erythematosus, with and without neuropsychiatric systemic lupus erythematosus, and compared to retinal nerve fiber layer thickness in healthy controls. Results No statistically significant correlation was found between retinal nerve fiber layer thickness in patients with systemic lupus erythematosus as compared to healthy controls. When evaluating by subgroups, no correlation was found between patients with or without neuropsychiatric systemic lupus erythematosus or cognitive impairment and retinal nerve fiber layer thickness. Conclusion Retinal nerve fiber layer thickness of systemic lupus erythematosus patients was not found to be statistically different compared to controls. Within systemic lupus erythematosus patients there was no correlation between retinal nerve fiber layer thickness and cognitive impairment or other neuropsychiatric systemic lupus erythematosus manifestations.

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

Objective. To evaluate the effect of pregnancy on disease activity in psoriatic arthritis (PsA). Methods. This is a retrospective case series. Review of the medical files of all female patients followed at the PsA clinic of 2 medical centers identified those with at least 1 pregnancy during followup and 1 visit during or soon after pregnancy. Results. Twenty-five women with PsA (out of 107 women of reproductive age followed up in our PsA clinics) and 35 pregnancies were enrolled. Thirty-three pregnancies resulted in live healthy babies. In the whole group, there was no significant change in disease activity throughout pregnancy, while in 16 (48%) of pregnancies, patients worsened during the first postpartum year. In 15 out of 21 pregnancies, in which the women had been treated before conception with biologics, treatment was discontinued close to pregnancy or during the first trimester. Five of those 15 patients had been classified as having mild to severe PsA activity prior to pregnancy. That number increased to 8, 9, and 14 during the first and second trimesters and postpartum period, respectively. There was no significant change in degree of disease activity in 6 patients whose biologics were continued beyond the first trimester. Improvement in disease activity was observed during pregnancy among the nonbiologics-treated patients. Corticosteroids were initiated or the dosage was increased during 6 pregnancies, all involving patients whose biologics were stopped before pregnancy. Conclusion. Continuation of biologics therapy was associated with a low level of disease activity and a low probability of flare during pregnancy. Stopping treatment with biologics before pregnancy is associated with flare during pregnancy and the postpartum period.

Expression levels of selected genes can predict individual rheumatoid arthritis patient response to tumor necrosis factor alpha blocker treatment

Abstract Objectives: Rheumatoid arthritis (RA) patients have many therapeutic options; however, tools to predict individual patient response are limited. The Genefron personal diagnostic kit, developed by analyzing large datasets, utilizes selected interferon stimulated gene expressions to predict treatment response. This study evaluates the kit’s prediction accuracy of individual RA patients’ response to tumor necrosis alpha (TNFα) blockers. Methods: A retrospective analysis was performed on RA patients reported in published datasets. A prospective analysis assessed RA patients, before and 3 months after starting a TNFα blocker. Clinical response was evaluated according to EULAR response criteria. Blood samples were obtained before starting treatment and were analyzed utilizing the kit which measures expression levels of selected genes by quantitative real time polymerase chain reaction (PCR). ROC analysis was applied to the published datasets and the prospective data. Results: The Genefron kit analysis of retrospective data predicted the response to a TNFα blocker in 53 of 61 RA patients (86.8% accuracy). In the prospective analysis, the kit predicted the response in 16 of 18 patients (89% accuracy) achieving a EULAR moderate response, and in 15 of 18 patients achieving a EULAR good response (83.3% accuracy). ROC analysis applied to the two published datasets yielded an AUC of 0.89. ROC analysis applied to the prospective data yielded an AUC of 0.83 (sensitivity – 100%, specificity – 75%) The statistical power obtained in the prospective study was .9. Conclusion: The diagnostic kit predicted the response to TNFα blockers in a high percentage of patients assessed retrospectively or prospectively. This personal kit may guide selection of a suitable biological drug for the individual RA patient.

FRI0679 Whole spine and SIJ MRI of psoriatic arthritis patients: descriptive study of the spine, and sacroiliac joints involvement in a cross sectional large cohort

Background Detection of axial disease has important implications. Data on the structural changes of the spine and SIJ in PsA is mainly based on plain XR and MRI of SIJ. The prevalence and distribution of spinal changes in PsA as detected by MRI is largely unknown. Objectives To evaluate acute and structural changes in spine and SIJ by whole spine MRI performed in a consecutive clinical cohort of PsA. Methods Adult PsA (CASPAR criteria) patients were enrolled in the study. All underwent clinical exam, CRP, HLA-B27 tests, and MRI of the entire spine and SIJ. Spinal sagittal T1-W, STIR and semi-coronal T1-W and T2-W with fat saturation sequences of the SIJ were performed. The spine was scored for the presence of syndesmophytes, bone marrow edema (BME)/fatty corners and enthesitis. SIJS were scored (Berlin score) for the presence of BME, fatty replacement, erosions, sclerosis, and ankylosis. Findings were further categorized into active sacroiliitis (ASAS1), structural sacroiliitis, and spinal findings compatible with SpA (≥3 BME or ≥4 fatty corners2). All MRIs were evaluated by an experienced musculoskeletal radiologist, blinded to clinical data. Data were analyzed by SPSS Version 20.0. Results Ninety six patients completed the study.(Table1) Active/structural/total sacroiliitis was detected in 26%/11.5%/37.5% of patients, respectively. Spinal SpA was demonstrated in 15.6%.(Table 2) Isolated spinal changes were detected in 2.1% of the cohort. Presence of inflammatory back pain (IBP) by ASAS correlated with the prevalence of active sacroiliitis (p 0.024) and SpA (axial/SIJ) (p 0.003). The extent of psoriasis severity (PASI) correlated with both SIJ and whole spine SpA changes. (p 0.02 for both) Gender differences or biologic therapy did not affect the prevalence of SIJ or spine involvement.Table 1. Demographic and clinical data Age (mean, yr) 50±13 Gender M:F 50:46 Psoriasis/PsA duration (mean, yr) 19±13.6/9±8 PASI 3.9±8.9 ASDAS-CRP 2.2±1 Back pain (%)/Inflammatory back pain by ASAS (%) 70%/30% HLA-B27 (%) 4.4% Current DMARD Tx (%)/Current biologic Tx (%) 45%/35%Table 2. Whole spine MRI findings N (%) patients Active Inflammatory Lesions  ≥1 BME corner 22 (23%)  ≥1 posterior elements enthesitis 4 (4%) Structural Lesions  ≥1 corner erosion 10 (10.4%)  ≥1 fatty corner 30 (31%)  ≥1 syndesmophytes 30 (31%) Distribution of inflammatory lesions:  Cervical 2.1%, Thoracic 18.8%, Lumbar 14.6% Distribution of structural lesions:  Cervical 10.4%, Thoracic 32.3%, Lumbar 25% Conclusions In the present PsA cohort, active and structural sacroiliitis was more prevalent vs typical spinal SpA changes. In particular, there was a paucity of SpA changes in the cervical spine. The most prominent axial findings included fatty corners and syndesmophytes. IBP presence and extensive skin disease correlated with SpA axial and SIJ changes. References Lambert RG. Ann Rheum Dis. 2016,75. Hermann KG. Ann Rheum Dis 2012.71. Disclosure of Interest None declared