Disease Activity Variables Research Articles

Observational study of gadolinium-enhancing lesions in MRI in patients with multiple sclerosis from the Spanish Mediterranean coast: Seasonal variability and relationship with climatic factors

IntroductionEnvironmental factors appear to play an important role in the development and course of Multiple Sclerosis (MS). Seasonal variability in disease activity has been described and it is postulated that it may vary according to geographical area. The aim of this study is to analyse the monthly distribution of activity observed on Magnetic Resonance Imaging (MRI) and to look for a possible relationship with climate in patients with relapsing remitting MS. Material and methodsRetrospective observational study, carried out in the population of one hospital on the Spanish Mediterranean coast. A total of 238 MRI scans of 51 patients were evaluated. Climatological data were obtained from the Spanish State Meteorological Agency from 2012 to 2016. Activity was defined as contrast-enhancing lesions. ResultsThe distribution of gadolinium-enhancing lesions was found to be non-uniform across months (p = 0.008). Visual inspection suggests higher activity in July and August. Regarding weather, tropical nights (defined as days with a minimum temperature above 20 °C) were associated with increased risk of MRI activity (OR = 1.06, p = 0.001). ConclusionThese findings suggest a non-uniform monthly distribution of gadolinium-enhancing lesions and an association between warmer nights and increased MRI activity, pointing to a potential impact of environmental factors on multiple sclerosis activity in neuroimaging.

Group 3 innate lymphoid cells promotes Th17 cells differentiation in rheumatoid arthritis.

To investigate the correlation between innate lymphoid cell (ILC) subsets with T-helper (Th) cells and to explore the effect of ILCs on T cells in rheumatoid arthritis (RA). We analysed the frequencies of ILC subsets in RA patients with varying disease activity and their correlation with Th cell subsets. We further investigated this correlation in various organs of collagen-induced arthritis (CIA) mice. The effects of ILCs on CD4+ T cells were determined by in vitro cell co-culture experiments. ILCs were less frequent in RA patients than in healthy controls, with higher levels of group 3 ILCs (ILC3s) in RA (p<0.05). ILC3s correlated positively with Th1 and Th17 cells in RA peripheral blood (p<0.05). In the peripheral blood, spleen, and lymph nodes of CIA, ILC3s decreased and then increased during arthritis progression. ILC3s correlated positively with Th1 and Th17 cells in the spleen and lymph nodes of CIA (p<0.05). NKp46+ ILC3s in the spleen positively correlated with Th1 and Th17 cells (p<0.05). Under Th17 cell differentiation conditions, co-culturing CIA-derived ILC3s directly with naive CD4+ T cells promoted Th17 differentiation and increased IL-17 secretion. However, co-culturing through a transwell insert impeded Th17 differentiation without affecting IL-17 secretion. ILC3s positively correlated with Th1 and Th17 cells in RA. In CIA, the frequencies of ILC3s changed with disease development and showed a positive correlation with Th1 and Th17 cells. ILC3s may facilitate the differentiation of Th17 cells through direct cell-cell contact.

B-068 Plasma calprotectin as an index of draining tunnel formation in Hidradenitis suppurativa

Abstract Background Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which affects areas rich in apocrine glands. The main disease manifestations are inflammatory nodules (IN) and draining tunnels (dT). The course and progression of the disease are difficult to predict. There is currently lack of any broadly accepted biomarker which may inform on the activity of hidradenitis suppurativa (HS). Draining tunnel (dT) formation is the hallmark of HS in the affected skin. The existence of a biomarker which may predict dT formation before dTs appear in skin may become a tool for early biological treatment. Calprotectin, also known as S100 A8/A9 protein has been shown to be involved in various inflammatory conditions, including HS. Aim of this study was to evaluate circulating calprotectin as an index of dTs in the affected skin. Methods The study group consisted of 40 patients with confirmed HS and varying disease activity, assessed by number of dTs and International Hidradenitis Suppurativa Severity Score System (IHS 4 score) . Plasma samples were collected and stored at -80°C until analysis. Calprotectin was measured with GCAL® turbidimetric assay (Gentian AS, Norway). Results Fifteen patients had mild HS and 25 patients had moderate/severe HS. Positive association was found between circulating calprotectin and the absolute dT count (Pearson’s r2 = +0.750; p&amp;lt;0.0001) and the IHS4 (International HS 4 score) (Pearson’s r2 = +0.671; p&amp;lt;0.0001). Circulating calprotectin was significantly increased in patients with more than 2 dTs. Plasma calprotectin greater than 0.5 mg/L was associated with odds ratio 8.00 (1.87 to 34.22; p = 0.005) for 2 or more dTs. Conclusions Calprotectin is presented, for the first time, as a biomarker which indicates the formation of dTs in the skin. Its use as surrogate of early start of biologicals and response to treatment remains to be explored.

Evaluation of the Rheumatoid Arthritis Impact of Disease (RAID) Score in Assessing Rheumatoid Arthritis Activity in Teleconsultation.

To evaluate the relevance of the Rheumatoid Arthritis Impact of Disease (RAID) score as a disease activity marker of rheumatoid arthritis (RA) in a teleconsultation setting. A prospective, observational, 24-month, single-center study involving patients with RA who underwent teleconsultations was performed. The RAID score was sent to all patients by email and completed the day before the scheduled session. The RAID questionnaire was also completed just prior to the next scheduled face-to-face consultation. The same physician performed teleconsultation/in-person consultations and was unaware of the RAID results. We included 70 patients (mean age 50 [SD 14] yrs, mean disease duration 10 [SD 9] yrs). The RAID score correlated with the following items: patient global assessment (r 0.55, P < 0.001), patient-reported swollen joint count (r 0.50, P < 0.001), and Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP) calculated with patient self-reported tender/swollen joints (r 0.74, P < 0.001). The RAID score completed during the next face-to-face consultation for 45 patients also correlated with the DAS28-CRP performed by the clinician (r 0.65, P < 0.001). A RAID score > 2 was associated with the best combination of sensitivity (94%) and specificity (43%) for the indication of rapid in-person consultation because of insufficiently controlled disease activity, with an area under the curve of 0.74. All 23 patients with RAID < 2 had no intercurrent flares; overall physician global assessment was 1.6 of 10 (SD 1.4), DAS28-CRP 1.5 (SD 0.2), and CRP 1.8 (SD 1.4) mg/L. Our findings reinforce the RAID score as a valuable tool in teleconsultation, exhibiting a good correlation with disease activity variables. Using a RAID score threshold of 2 during teleconsultations could distinguish patients with good disease control and those with the potential need for an in-person visit.

The Risk of Depressive Symptoms Increases in Radiographic Axial Spondyloarthritis Patients with Acute Anterior Uveitis

Abstract Background This study aimed to assess the psychological status of radiographic axial spondyloarthritis (r-axSpA) patients with/without acute anterior uveitis (AAU) and to investigate whether the emotional status was different and associated with disease activity and other clinical variables. Patients and Methods This cross-sectional study included a total of 145 r-axSpA in-patients who fulfilled the modified New York criteria for ankylosing spondylitis. AAU was established by ophthalmologists. Clinical variables were collected from patient charts. All patients received a comprehensive rheumatologic assessment for disease activity, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS). The Short Form (SF)-36 Health Survey, the revised Self-Rating Anxiety Scale (SAS) and the revised Self-Rating Depression Scale (SDS) were applied to all participants by psychiatrists. Results Fifty-seven patients were diagnosed as having the first onset of AAU. Compared with the group of r-axSpA without AAU, the risk of depressive symptoms was higher in the group of r-axSpA with AAU (p=0.008). However, there was no significant difference in terms of the risk of anxious symptoms between these groups (p=0.868). In addition, r-axSpA patients with AAU had higher scores of ASDAS-C-reactive protein (ASDAS-CRP) but lower scores of ASDAS-erythrocyte sedimentation rate (ASDAS-ESR) (p=0.032 and p=0.019). Furthermore, there was a negative correlation between SDS scores and duration in r-axSpA patients with AAU. Among all patients, the group of r-axSpA with depressive symptoms had increased CRP levels and ASDAS-CRP scores and lower vitality in SF-36. Conclusion The risk of depressive symptoms increases in r-axSpA patients with AAU. Moreover, r-axSpA patients with uveitis had a higher disease activity as measured by ASDAS-CRP. Physicians should pay more attention to depressive symptoms and AAU in addition to the disease of r-axSpA itself.

Physical Activity Levels and Social Cognitive Theory Correlates among Adults with Crohn's Disease: Preliminary Results from a Cross-Sectional Analysis.

There is increasing research and clinical interest in physical activity (PA) as an adjuvant therapy for improving health outcomes among persons with Crohn's disease. To date, little is known regarding PA behavior and its cognitive and behavioral correlates in Crohn's disease. Thus, we assessed self-reported PA and its social cognitive theory (SCT) correlates in a sample of persons with Crohn's disease. Data on demographic and clinical characteristics, disease activity, leisure-time PA, and SCT variables were collected from 30 participants with Crohn's disease (90% White, 60% female) through an online survey. SCT variables assessed included exercise self-efficacy, social support, outcome expectations, goal setting, and planning. Analyses involved comparing PA levels and SCT survey scores using independent sample t-tests and non-parametric bivariate correlations. The majority of participants were in clinical remission (60%) and over half (57%) were classified as physically active, yet the mean PA level was lower than normative values for adults. Females (n = 18) and participants who reported previous surgery for Crohn's disease (n = 18) were almost twice as physically active as male participants and those without a history of Crohn's disease-related surgery, respectively (p's < 0.05). Overall, participants who reported greater exercise goal setting behaviors had higher levels of PA (rs = 0.34; p < 0.05). These findings highlight lower overall levels of PA in persons with Crohn's disease, and exercise goal setting represents a potential target of behavior change interventions for increasing PA in this population.

P291 Longitudinal assessment of Illness Identity in patients with Inflammatory Bowel Disease

Abstract Background The concept of Illness Identity (IID) describes the way a patient integrates a chronic illness into the self-concept and has been examined in several chronic diseases. We distinguish four IID dimensions: acceptance, enrichment, engulfment and rejection. In patients with Inflammatory Bowel Diseases (IBD) IID engulfment has been shown to be associated with quality of life (QoL) and important psychosocial factors like anxiety and depression. As IBD often show a relapsing course with varying disease activity and symptom burden, it is unclear whether IID is a stable concept or whether it changes over the disease course. Methods In 2018 we started to recruit patients with active Crohn´s Disease or Ulcerative Colitis before the beginning of a new therapy with biologics (t1) and did follow-up examinations 6- 12 months (t2) and 2-3 years (t3) after the baseline examination. Until now we were able to reassess 71 of 83 at t2 and 16 of 83 patients at t3 We assessed IID with the Illness Identity Questionnaire (Oris et al.). Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale and QoL was assessed with the IBDQ. We analysed correlations between these factors at t1, t2 and t3 and calculated linear mixed-effects models to analyse the stability of IID over time. Pearson correlation between changes in IID and changes in disease activity were also examined. Results IID engulfment is associated with poorer QoL (r= -0.696, p= 0.003) at t3. Higher anxiety scores are linked to poorer QoL (r= -0.630, p=0.009) and higher depression scores are linked to poorer QoL (r= -0.502, p= 0.048) at t3. In the linear mixed-effects models of IID dimensions we found no significant changes in IID over time (IID enrichment : mean difference of 1.03, p= 0.297; IID acceptance : mean difference of -0.19, p= 0.824; IID rejection : mean difference of 0.69, p= 0.259; IID engulfment : mean difference of -0.22, p= 0.771. Changes in IID engulfment correlated positively with changes in disease activity (r= 0.626; p = .0095), whereas no significant correlations were found for the other IID dimensions (Fig 1.)) Conclusion Our preliminary results suggest stability of IID in patients with IBD over a period of up to 3 years. These results confirm our previous findings, demonstrating that especially IID engulfment is linked with a poorer QoL and changes in IID engulfment correlate with changes in disease activity.

Fatigue, Physical Activity, and Quality of Life in Patients with Inflammatory Bowel Disease: A Cross-Sectional Study.

The benefits of physical activity (PA) are widely recognized, but the intensity of PA in inflammatory bowel disease (IBD) patients with varying disease activity levels remains controversial. We aimed to investigate the relationship between PA levels, fatigue, and other health-related quality of life (QoL) in Chinese IBD patients. The study is a cross-sectional investigation conducted at a comprehensive IBD diagnosis and treatment facility in East China, spanning from August 2022 to February 2023. A total of 245 participants were initially enrolled, and after excluding individuals with incomplete data about crucial exposure and outcome variables, the final sample size amounted to 237. Participants were provided with a questionnaire encompassing sociodemographic factors, clinical information, the International Physical Activity Questionnaire (IPAQ), the Multidimensional Fatigue Inventory (MFI-20), and the Inflammatory Bowel Disease Questionnaire (IBDQ). Correlation analysis was employed to assess the relationship between variables. A majority of participants (144) exhibited low levels of PA. Furthermore, 40.5% of all participants reported experiencing fatigue. Individuals with low levels of PA had an average MIF-20 score of 62.9±16.0. Correlation analysis showed that PA was significantly and negatively associated with fatigue (r = -0.224, p < 0.001). Additionally, PA was also negatively correlated with anxiety (r = -0.150, p < 0.05) and depression (r = -0.242, p < 0.001). On the other hand, PA was positively correlated with quality of life (QoL) (r = 0.171, p < 0.01). Furthermore, our analysis indicated that sleep disorders were positively associated with both anxiety (r = 0.349, p < 0.01) and depression (r = 0.354, p < 0.001). The levels of PA are significantly low, and there is a high prevalence of fatigue among individuals with IBD. PA in IBD showed a strong negative correlation with fatigue and a strong positive correlation with quality of life.

FRI478 Pharmacometrics-based Computer Model Utilizing Heart Rate To Monitor Thyroid Function In Children With Graves' Disease

Abstract Disclosure: B. Steffens: None. G. Koch: None. F. Claude: None. F. Bachmann: None. J. Schropp: None. M. Janner: None. D. l'Allemand: None. D. Konrad: None. M. Pfister: None. G. Szinnai: None. Graves’ disease (GD) with onset in childhood or adolescence is a pediatric rare disease (ORPHA:525731) with a ten times lower incidence than in adults. Leading clinical signs of hyperthyroidism are sinus tachycardia, weight loss, tremor, and goiter. First-line treatment are anti-thyroid drugs in order to normalize thyroid function. However, dose finding in pediatric GD is complex due to a broad spectrum of disease severity at diagnosis, and highly variable disease activity during follow-up, especially during puberty. As thyroid hormones have a strong positive chronotropic effect, heart rate (HR) turns out to be a useful clinical marker to monitor thyroid activity under treatment. Our overall aim was to provide a practical pharmacometrics-based (PMX-based) computer model characterizing both, individual FT4 dynamics and the relation between FT4 and tachycardia in children with various disease severity of GD during the first 120 days of treatment. Development of the PMX computer model was based on the non-linear mixed effects approach (i) linking FT4 kinetics with HR dynamics, (ii) accounting for inter-individual variability, and (iii) incorporating individual patient characteristics. Retrospectively collected clinical (resting heart rate during consultation) and laboratory data (FT4) from 41 children and adolescents with GD at four pediatric hospitals in Switzerland (75% female, median age 11.2 [IQR 8.5, 13.5] years) with 187 FT4 measurements and 132 HR measurements, and 124 paired measurements, were available and used for model development. Pediatric patients showed median FT4 of 59.6 [IQR 44.5, 73.0] pmol/l and median HR of 112 [IQR 100, 128] bpm at diagnosis. GD severity groups were defined based on FT4 measurement at diagnosis, resulting in equal numbers of mild (13), moderate (14) and severe (14) GD. We observed a significant difference in HR at diagnosis (p &amp;lt; 0.01) between the three GD severity groups based on FT4 at diagnosis. The final PMX computer model accounted for inter-individual variability and clinically relevant covariate effects such as age, gender, and GD severity, and was able to accurately predict FT4 and HR dynamics for each individual patient during the first 120 days of treatment. A PMX-based computer model that leverages individual HR dynamics can be applied to facilitate personalized pharmacotherapy in pediatric GD and mitigate the risk for under- or overdosing of anti-thyroid drugs in these patients. Prospective randomized validation trials are warranted to further validate and fine-tune such computer-supported personalized dosing in children with Graves’ disease. Presentation: Friday, June 16, 2023

Relationship between Clinical, Serological and Ultrasound Assessment of Rheumatoid Arthritis Activity

Abstract Background Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of synovial tissue that leads to damage of cartilage and bone, resulting in irreversible joint destruction. Aim of the Work Our study’s aim was to assess the relationship between systematic ultrasound (US) evaluation using 7-joint and 12-joint scores and both clinical and serological evaluations in the determination of disease activity in rheumatoid arthritis patients. Also, we assessed the difference between both scores to know which is more accurate in assessing disease activity. Patients and Methods It was a cross sectional study that was carried out on fifty-five Egyptian RA patients diagnosed according to the 2010 American College of Rheumatology (ACR)/EULAR criteria. Patients were recruited from the rheumatology outpatient clinic at Ain Shams university hospital. Results Regarding 7-joint score parameters, mean and standard deviation for GS synovitis was 5.72 ± 4.44, PD synovitis was 3.74 ± 5.24, GS tenosynovitis was 1.15 ± 1.68, PD tenosynovitis was 1.76 ± 3.44 and erosions 1.07 ± 1.37. Regarding the examined areas for 7-joint score, wrist dorsal synovitis was the most common synovitis (98%), 2nd metacarpo-phalangeal joint (56%) then 2nd metatarso-phalangeal joint (49%). Wrist dorsal tenosynovitis (36%) was the most frequent tenosynovitis. Radial (33%), dorsal erosions (18%) of 2nd metacarpo-phalangeal joint and radial erosions (13%) of 5th metatarso-phalangeal joint were the most common erosions found. Our study detected significant positive correlation (P value &amp;lt;0.05 and positive correlation coefficient) between majority of 7-joint and 12-joint score parameters (both GS and PD) and clinical disease activity variables, ESR, CRP and platelet count. Our study showed highly significant positive correlation (P value &amp;lt;0.01 and positive correlation coefficient) between all parameters of 7-joint and 12-joint scores. We found that 12 joint score is slightly better than 7 joint score in accuracy and sensitivity in assessing rheumatoid arthritis disease activity despite being more time-consuming. Conclusion The 7-joint and 12-joint ultrasound scores were simple and practical sum scoring systems for use in the detection of synovitis in patients with RA and in assessment of disease activity in synovium. The correlations between the clinical disease activity indices, ESR, CRP, platelet count and components of the 7-joint and 12-joint scores may indicate their value in assessment of disease activity and severity up to date. The composite score (Combined synovitis score) for 12-joint score was significantly differentiating between moderate-severe patient groups (classified according to DAS28) with P value 0.029, so 12-joint score was better in identifying minimal difference in disease activity despite being time-consuming.

Virgin Coconut Oil in Paste Form as Treatment for Dyspareunia and Vaginal Dryness in Patients With and Without Rheumatic Autoimmune Diseases: An Efficacy and Safety Assessment Pilot Study.

Introduction The use of virgin coconut oil (VCO) as an over-the-counter (OTC) treatment for vaginal dryness and dyspareunia (VDD) in the general population has increased worldwide despite the absence of evidence-based studies supporting its efficacy. The principal objective of our pilot study was to scientifically validate the significant benefits and safety of using intra- and peri-vaginal application of VCO in paste form (VCOPF)for the treatment of VDDin patients with and without rheumatic autoimmune diseases (RAD). Additionally, multiple psychosocial, sexuality, and disease activity variables were also assessed. Methods A survey study of patients with chronic VDD, with and without RAD, treated with a single proprietary brand of VCOPF via the 'CocoRelief' protocolcontinuously for at least six months in an outpatient rheumatology practice setting. We evaluated the comparison of group characteristics, treatment outcomes, and satisfaction questions by Fisher's exact test or chi-square test for independence for categorical variablesand two-sample t-tests for continuous variables. Results Of the 53 respondents, 31 (58%) had an RAD and 22 (42%) did not. Rheumatoid arthritis and primary Sjogren's syndrome comprised 75% of the RAD group. The non-RAD cohort had both a higher baseline mean of intercourse pain (on a scale of 0-5) before VCOPF use (4.4 (SD 1.1) vs 3.9 (SD 1.0)(p = 0.094)) and a higher mean intercourse pain after VCOPF (2.0 (SD 1.3) vs 1.3 (SD 1.1) (p = 0.039)). VDD decreased by 55% in the non-RAD and 66% in the RAD population. Although not statistically significant (p = 0.195), VCOPF was at worst comparable to estrogen-containing therapies (ECT). No adverse events (AE) were documented. Conclusion A high percentage of women with VDD, with and without RAD, needlessly continue to experience quality-of-life-altering physical and psychosocial morbidity due to the underutilization and lack of awareness of VCO-containing therapy. The small sample size, non-blinded, non-randomized, pilot platform, and the use of a non-validated assessment toolrepresentthe principal limiting factors. This study revealed that VCOPF, when used in paste form via the CocoReliefprotocol, provided statistically significant long-term VDD-related efficacy not inferior to ECT without AE in patients with and without RAD. VCOPF is, therefore, likely to be a useful, cost-effective alternative in a substantial percentage of patients with and without RAD, particularly in women hesitant to utilize ECT due to cost and/or fear of adverse effects.

Utility of trichoscopy in comparison to the standard methods for assessing the disease activity, severity, and therapeutic response in alopecia areata

Objectives: Alopecia areata (AA) is a common autoimmune hair disorder with variable disease activity and severity. Conventionally, hair pull test (HPT) and off late trichoscopy are used to diagnose and monitor disease course in AA. The aim of the study was to evaluate the use of trichoscope in monitoring the disease activity, severity, and therapeutic response in AA. Material and Methods: This was a hospital-based and longitudinal study. Consecutive patients with AA between March 2018 and February 2019 were included in the study. Baseline clinical examination, HPT, and trichoscopy of patients was done at baseline and adequate treatment initiated. Monthly follow-up for next 3 months was done to study response to treatment. Results: Black dots (BDs) (100%) were commonest trichoscopic feature followed by yellow dots (YDs) (93.5%). BDs, broken hairs (BHs), and short vellus hairs (SVH) had significant correlation with disease activity while all trichoscopic markers significantly correlated with disease severity. With each follow-up, mean values for YDs, BDs, and BHs were declining, while SVH was increasing steadily. The abatement of trichoscopic activity markers preceded the disappearance of a positive HPT. Conclusion: The abatement of trichoscopic markers of disease activity in AA preceded a negative HPT, highlighting the role of trichoscopy as a useful tool in monitoring therapeutic response.

Screening of silent myocardial ischaemia using a stress test in rheumatoid arthritis patients: Association with traditional risk factors and disease activity.

We aimed to screen the presence of silent myocardial ischaemia, in established rheumatoid arthritis (RA) patients, using a stress test then to evaluate its association with the disease activity and the cardiovascular (CV) risk factors and Heartscore. It is a transversal study in a rheumatologic centre in Tunisia. One hundred three RA patients, asymptomatic for CV diseases, were submitted to a stress test. Demographic data, CV risk factors and disease characteristics were assessed and risk factors of silent myocardial ischaemia in RA patients were identified. There were 103 patients (sex-ratio=0.3) with a mean age of 53±10years. The evaluation of the disease activity showed that the mean Disease Activity Score in 28 joints C-reactive protein, Clinical Disease Activity Index and Simplified Disease Activity Index were 3.9±1.38, 17.17±11.4 and 33.39±26, respectively. The ischaemic ratio (CT/HDL) revealed that 42% of patients had a moderate to high myocardial ischaemic risk. HeartSCORE was high in 35% of cases. A silent myocardial ischaemia in the stress test was found in 11 patients (10.6%) and was associated with male sex (p=0.03), advanced age (p=0.04), erosive character (p=0.05), the advanced age of the RA diagnosis (p=0.01) and the ischaemic ratio (p=0.05). No relationship was found with the majority of traditional CV risk factors nor with disease activity variables. Our results corroborated the hypothesis that the stress test could reveal subclinical CV dysfunction and supported the utility of the Heartscore as a screening tool.

Risk Factors of Quality-Of-Life and Sexual Function Impairment in Chronic Spontaneous Urticaria Patients: Cross-Sectional Study

Background: Chronic spontaneous urticaria (CSU) has been associated with poor quality of life and mood disturbances. However, factors associated with these dimensions have not been properly assessed. Moreover, there is a lack of studies regarding sexual dysfunction (SxD) and CSU. Therefore, the aims of this study were to assess quality of life associated factors and to evaluate the prevalence and potential impact of SxD in patients with CSU. Method: Cross-sectional study of patients suffering from CSU. Sociodemographic and disease activity variables, quality of life, sleep, SxD, anxiety, and depression were collected using validated questionnaires. Results: Seventy-five patients were included, with a female-to-male ratio of 2.40. Female sex, worse disease control, and sexual dysfunction were associated with poor quality-of-life indexes (p < 0.001). SxD was detected in 52% of female and 63% of male patients. SxD was associated with poor disease control (p < 0.001). Female SxD, but not male, was associated with poorer quality of life (p = 0.02) and an increased risk for anxiety 85% and depression 90% (p < 0.05). Conclusions: Female patients and those with an inadequate control of CSU are in higher risk of having poorer quality of life. SxD seems to be frequent in patients with CSU. Moreover, female SxD seems to have a more profound impact on quality of life and mood disturbances when compared to males. Assessment of SxD in Urticaria Clinic might be of benefit to identify patients at a higher risk of poor quality of life.

68Ga-FAPI PET/CT for Rheumatoid Arthritis: A Prospective Study.

Background In rheumatoid arthritis (RA), fibroblast-like synoviocyte cells, which are involved in inflammation of the articular cartilage and bone, overexpress fibroblast activation protein (FAP). This is a feature that could be leveraged to improve imaging assessment of disease. Purpose To determine the performance of gallium 68 (68Ga)-labeled FAP inhibitor (FAPI) in assessing joint disease activity of RA and to compare with fluorine 18 (18F) fluorodeoxyglucose (FDG) imaging. Materials and Methods Twenty participants with RA (15 women; mean age, 55 years ± 10 [SD]) were prospectively enrolled from September 2020 to December 2021 and underwent clinical and laboratory assessment of disease activity and dual-tracer PET/CT (68Ga-FAPI and 18F-FDG) imaging. Imaging-derived variables of PET joint count (the number of joints positive for RA at PET) and PET articular index (a sum of the points of the joints using a three-point scale) were correlated to clinical and laboratory variables of disease activity. Results The combined output of both PET/CT techniques helped detect 244 affected joints, all of which showed positive results at 68Ga-FAPI PET/CT. However, fifteen of 244 (6.1%) FAPI-avid joints in six of 20 (30%) participants were not detected at 18F-FDG PET/CT. The maximum standardized uptake value of the most affected joint in each participant was higher in 68Ga-FAPI than in 18F-FDG PET/CT (9.54 ± 4.92 vs 5.85 ± 2.81, respectively; P = .001). The maximum standardized uptake values of the joints at both 68Ga-FAPI and 18F-FDG PET/CT were positively correlated with laboratory evaluation of C-reactive protein levels (r = 0.49 [P = .03] and 0.54 [P = .01], respectively). The PET joint count and PET articular index scores at 68Ga-FAPI PET/CT were also positively correlated with most clinical disease activity variables and radiographic progression of joint damage (P < .05). Conclusion In participants with rheumatoid arthritis who underwent gallium 68 fibroblast activation protein inhibitor PET/CT, the extent of joint involvement correlated with clinical and laboratory variables of disease activity and showed a greater amount and degree of affected joints than at fluorine 18 fluorodeoxyglucose PET/CT. Clinical trial registration no. NCT04514614 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Williams and Ahlman in this issue.

Beneficial effects of Helicobacter pylori eradication in systemic sclerosis patients.

Previous studies have shown that Helicobacter pylori (HP) infection is associated with increased activity and severity of systemic sclerosis (SSc), hence we aimed to evaluate the effect of HP eradication on various symptoms and inflammatory indices. The SSc patients without dyspeptic symptoms were prospectively enrolled in this 18-month cross-sectional study. Patients were divided into two groups based on determination of HP infection. The infected group was treated in accordance with the current HP eradication protocol. Assessment of disease activity, severity and organ involvement was performed every 6months. A total of 42 consecutive SSc patients without dyspepsia and variable disease activity and severity were recruited. Levels of modified Rodnan skin score, erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) significantly decreased following HP eradication (p < 0.001, p < 0.001 and p = 0.001, respectively), and in the HP-negative patient group ESR and CRP values increased (p = 0.03, p = 0.002). Eradication of HP in the group of infected patients induced progressive and significant improvement of disease activity and severity over time compared to baseline (p < 0.01, p < 0.001, respectively), whereas in the HP-negative patient group these scores remained unchanged. In our study, HP eradication was associated with an improvement of clinical symptoms and disease activity. These findings suggest that HP detection and subsequent eradication could be beneficial in the management of SSc patients. Although, HP eradication seems to be advantageous in infected SSc patients, larger controlled studies are needed for apotential recommendation.

Metabolic syndrome in a cohort of rheumatoid arthritis patients

Objectives. We aimed to assess the presence of MetS and traditional CV risk factors in a group of RA patients, compared to controls and their possible inter-relation with disease activity variables. Methods. We performed an observational study on 38 consecutive patients diagnosed with RA in Rheumatology Department of the Emergency County Hospital Craiova, based on ACR/EULAR criteria, in a one-year interval between 2019-2020, and a control group including 30 subjects. Patients’ data were obtained from each subject according to the study protocol and included demographic, clinical, laboratory parameters. The presence of MetS was assessed according to the National Cholesterol Education Program Adult Treatment Panel (NCPATP) III. Results. Regarding the components of metabolic syndrome, as defined by NCPATP III, the differences established for the RA vs control groups were: increased waist circumference in 21 (52.25%) vs 13 (43.33%) subjects (p=0.002); high triglycerides (or under treatment) in 10 (26.31%) vs 6 (20%) subjects, p=0.004; low HDL cholesterol in 15 (39.47%) vs 7 (23.33%) subjects, p=0.002; high blood pressure (or under treatment) in 25 (65.79%) vs 12 (40%) subjects, p&lt;0.0001; high blood glucose (or under treatment) in 7 (18.42%) vs 8 (26.66%) subjects, p= 0.08. Our data revealed a positive correlation between disease activity index and smoking (r=0.432, p=0.02), as well as between DAS 28-CRP and LDL cholesterol (r=0.454, p=0.004), or triglycerides (r=0.337, p=0.03). We also observed a strong, positive correlation between the presence of MetS and disease activity score (r=0.645, p&lt;0.0001). Conclusions. Metabolic syndrome is associated with a high cardiovascular risk, the main cause of mortality in RA patients. Due to the chronic inflammatory state and the intervention of both traditional and non-traditional cardiovascular risk factors, each patient should undergo periodic evaluations, in order to apply an adequate and early therapeutic intervention and reduce further cardiovascular morbidity and mortality rates.

Mechanisms of chronic pain in inflammatory rheumatism: the role of descending modulation.

Persistent pain despite satisfactory disease treatment is frequent in rheumatoid arthritis (RA) and spondyloarthritis (Spa) and may result from specific changes in central pain processing. We assessed these mechanisms further by systematically comparing thermal pain thresholds and conditioned pain modulation (CPM) between patients with active RA or Spa and healthy controls. We included 50 patients with RA and 50 patients with Spa and 100 age-matched and sex-matched controls. Heat and cold pain thresholds (HPT-CPT) were measured on the dominant forearm, and CPM was assessed by applying conditioning stimuli (immersion in a cold-water bath) to one foot and the nondominant hand in 2 successive randomized sequences. Descending pain modulation was assessed as the difference in HPTs (in °C) before and after conditioning. Larger HPT differences (ie, a larger CPM effect) reflected more efficient descending inhibition. Potential associations between changes in CPM and clinical data, including disease activity, pain intensity, and psychological and functional variables, were systematically assessed. Heat pain threshold and cold pain threshold were similar in patients and controls. The mean CPM effect was significantly weaker in patients than that in controls for conditioning applied to either the foot (0.25°C ±2.57 vs 2.79°C ±2.31; P < 0.001) or the nondominant hand (0.57°C ±2.74 vs 2.68°C ±2.12; P < 0.001). The smaller CPM effect in patients was correlated with average pain intensity, but not with disease activity or other clinical characteristics, suggesting a significant pathophysiological role for changes in endogenous pain modulation in the mechanisms of chronic pain associated with inflammatory rheumatism.

The Sensitivity to Change of the ASAS Health Index in an Observational Real-Life Cohort Study.

The Assessment of Spondyloarthritis international Society Health Index (ASAS HI) measures global functioning and health in patients with axial spondyloarthritis (axSpA) covering domains of physical, emotional, and social functioning. The main aim of this study was to investigate the sensitivity to change of ASAS HI in comparison with established variables of disease activity, function, and mental health. Patients with axSpA from the disease register RABBIT-SpA with follow-up time of at least 12 months and available ASAS HI questionnaires were included. Patients received questionnaires addressing disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), mental health (5-item World Health Organization Well-Being Index [WHO-5]), and global functioning (ASAS HI). Standardized response means (SRMs) were calculated to compare the sensitivity to change of different variables. Six hundred and sixty-seven patients were included, 552 treated with biologic disease-modifying antirheumatic drugs (bDMARDs) and 115 with conventional synthetic DMARDs and/or nonsteroidal antiinflammatory drugs (control group). Between baseline and month 12, the mean ASAS HI declined from 6.9 to 5.1 in the bDMARD group and from 5.9 to 5.6 in the conventionally treated group. In the bDMARD group, the SRM of ASAS HI was 0.52, compared to 0.59 for BASFI, 0.65 for WHO-5, 0.73 for BASDAI, and 0.90 for ASDAS. The following ASAS HI domains were most frequently affected: pain (78% agreed), maintaining body position (75%), and energy/drive (73%). In the patients receiving bDMARDs, there was an improvement in all items. In the control group, the largest improvement was seen in pain. As expected, ASDAS and BASDAI as disease activity scores showed high sensitivity to change, whereas changes in physical function (BASFI), mental health (WHO-5), and the broader concept of functioning and health (ASAS HI) were moderate.

Serum Neurofilament Light Chain as a Biomarker in Multiple Sclerosis

Background: Currently MS disease activity, neurodegeneration and treatment response are assessed mainly through clinical evaluation and magnetic resonance imaging. These measures lack sensitivity and accuracy, so new biomarkers are necessary. Several markers have been studied and to date among the most promising is the neurofilament light chain (NfL).Many studies have shown elevated CSF Nf levels in a wide variety of neurological disorders in which axonal degeneration occurs including MS.The release of NfL into the peripheral blood represents a significant opportunity for monitoring disease activity and progression without the need for the more invasive CSF sampling.this study is conducted to assess the relationship between serum neurofilament (NfL & NfH chain) levels and the disease type, duration, disease activity, severity, and other variables among Iraqi multiple sclerosis patients.