Warwickshire NHS Trust, Coventry, 2Department of Rheumatology,. University ... Royal Infirmary, Aberdeen, 7Department of Rheumatology, St Helens. Hospital ...
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116. ASSOCIATION BETWEEN LEVELS OF SERUM HEPATOCYTE GROWTH FACTOR AND JOINT REPLACEMENT OF THE HIP OR KNEE IN RHEUMATOID ARTHRITIS Cara A. Jenvey1, Samantha L. Hider1,2, John R. Glossop1, Jonathan Packham1, Peter Dawes1, Nicola Nixon1 and Derek Mattey1 1 Haywood Rheumatology Centre, Haywood Hospital, Stoke-onTrent, 2Research Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK Background: RA is a chronic inflammatory disease of the synovial joints leading to progressive joint destruction, functional impairment and, in severe cases, the need for joint replacement. There is a need to identify which of these patients are more likely to need a joint replacement in order to plan both clinically and economically for patient care. Previous research has identified several biomarkers that may be associated with inflammation and disease activity in RA. Hepatocyte growth factor (HGF) is a pleiotropic cytokine that regulates cell growth, cell motility and tissue regeneration. Expression of HGF has been reported in the synovium of patients with RA and may be associated with disease activity. The objective of our study was to investigate the association between levels of HGF and total joint replacement of the hip and knee in patients with RA. Methods: Data were collected from 412 RA patients with established disease who were followed prospectively. The mean (S.D.) age of the cohort was 61 (10.8) years with a disease duration of 11(4.8) years and 279 (67.7%) of the cohort were female. Clinical indices of disease severity were recorded including whether each patient had undergone hip or knee replacement. Of the 412 patients enrolled, 209 have reached 5 year follow-up (50.7%). Serum levels of HGF at recruitment were quantified using a fluorescent bead-based assay system (Luminex) and at the 5-year follow-up using enzyme-linked immunosorbent assays (ELISA). Associations between joint replacement and HGF levels were analysed using the Mann–Whitney U test for non-parametric data. Results: High levels of HGF were associated with joint replacement of the hip or knee at baseline and at 5-year follow-up. At baseline, significantly higher levels of serum HGF were found in patients who had previously had a hip or knee replacement (n ¼ 63) compared with patients who had not received a joint replacement: median (IQR) HGF level (1502 (665) vs 1388 (554) pg/ml, P ¼ 0.048). This association was significantly greater for knee replacement alone: median (IQR) HGF level (1610 (683) vs 1382 (548) pg/ml, P ¼ 0.016). At 5-year follow-up, serum HGF levels were significantly higher in patients who had received a new hip or knee replacement since baseline (n ¼ 33) compared with those who had not had these joints replaced: median (IQR) HGF level (1296 (1894) vs 1115 (862) pg/ml, P ¼ 0.040). Conclusion: Joint replacement of the hip or knee in patients with RA is associated with high circulating levels of HGF and may reflect a role for HGF in joint damage. Disclosure statement: The authors have declared no conflicts of interest.
RHEUMATOID ARTHRITIS: COMORBIDITIES 117. AORTIC ANEURYSM: AN ESTABLISHED ENTITY IN RHEUMATOID ARTHRITIS? Reena R. Panchal1, Shirish Dubey2, Alison Kite3 and Asif Mahmood3 1 Department of Elderly Care, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, 2Department of Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, 3Department of Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK Background: There are scattered cases of RA with the systemic feature of an aortic anuerysm and/or aortitis. Some studies have found aortitis in patients with rheumatoid arthritis at autopsy and in isolation. There are also reports of aortic insufficiency and RA. Although there is a recognized association between large vessel vasculitis (Giant Cell Arteritis and Takayasu’s arteritis) and aortic aneurysms, there are no studies yet assessing this association in RA. We had an index case of a RA patient with an aneurysm with aortitis, which led us to investigate further a link between the two. Methods: Patients with a diagnosis of RA were sought from an Aortic Aneurysm Database of over one thousand, held at University Hospital Coventry and Warwickshire (UHCW). The database includes people
who have incidentally been found to have an abdominal aortic aneurysm, or were part of AAA screening (males >50). We investigated the associations with rheumatological conditions to see if RA was represented more in this population. The identified cases form a case series with certain characteristics analysed—patient demographics, RA diagnosis, disease activity, RA therapy, aneurysm type, size and management. Results: The prevalence of aortic aneurysms in RA was 0.8%. 18 patients had a definite diagnosis of RA. 8 had active disease, 17 patients were treated with DMARDs. 16 patients had an abdominal aortic aneurysm, the remaining 2 patients were on the surveillance programme due to family risk of aneurysm, but had not yet developed one. All aneurysms were detected some years after RA diagnosis; majority being incidental or due to further investigations of peripheral vascular disease, 2 were symptomatic initial presentations. Sizes ranged from 3.1 cm to 6 cm. 2 had EVAR or Open AAA repair, the remainder are under surveillance. Other rheumatological conditions included PMR, psoriasis and giant cell arteritis. Conclusion: RA seemed to be more significant in the aneurysm population compared with other rheumatological disease. The population tended to be male, over 65 years old, with at least a 5 year diagnosis of RA. Disease activity was variable, and all but one were managed with DMARDS. All aneurysms were abdominal. Aortic aneurysms should be considered to be a significant entity of RA. RA is a predisposition to developing an aneurysm, hence there should be high suspicion of this vascular pathology in routine rheumatology clinics. Disclosure statement: The authors have declared no conflicts of interest.
118. RA-RELATED INTERSTITIAL LUNG DISEASE: ASSOCIATION BETWEEN IMMUNOSUPPRESSIVE THERAPY AND RELATIVE RISK OF DEATH Geetha Janakiraman1, Clive Kelly1, Mohamed Nisar2, Subha Arthanari2, Felix Woodhead3, Alec Price-Forbes4, David Middleton5, Owen Dempsey6, Julie Dawson7, Nav Sathi7, Yasmeen Ahmad8, Gouri Koduri9 and Adam Young9 1 Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, 2Department of Rheumatology, Burton Hospital, Burton, 3 Department of Chest medicine, Coventry and Warwick Hospital, Coventry, 4Department of Rheumatology, Coventry and Warwick Hospital, Coventry, 5Department of Rheumatology, Aberdeen Royal Infirmary, Aberdeen, 6Department of Chest Medicine, Aberdeen Royal Infirmary, Aberdeen, 7Department of Rheumatology, St Helens Hospital, St Helens, 8Department of Rheumatology, North Wales Hospital, Betsy Coed, 9Department of Rheumatology, St Albans Hospital, St Albans, UK Background: RA is associated with clinically relevant interstitial lung disease (ILD) in around 5% of patients. A variety of immunosuppressive agents have been advocated in patients with RA-ILD, with very little evaluation of their comparative effectiveness. We have examined the influence of a range of immunosuppressives (ISP) on mortality in a large multi-centre group of patients retrospectively to determine any effect of these agents on relative risk of death. Methods: For the purposes of this study, we collected data from seven centres across the UK on patients with both RA and ILD (proven on HRCT) identified over a 12 year period from 2000 to 2012 using a standard proforma. We analysed the age, duration of both RA and ILD, outcome and, where appropriate, cause of death. Equivalent data were obtained from a control group of RA patients from one centre without lung disease, matched for age, sex and disease duration. We recorded the number of patients receiving ISP. We compared all cause and respiratory mortality between RA controls, all patients with RAILD, and those receiving immunosuppressives. We calculated the influence of each agent on the relative risk of dying from any cause, and from lung disease, compared with RA controls. Results: A total of 188 patients were identified from across the UK with proven RA-ILD which carried increased relative risks (RR) of death from any cause [1.55 (1.1–2.0)] and from lung disease [1.90 (0.9–3.9)]. Among these, 83 received ISP therapy compared with 27 controls in the RA group. The effects of ISP on RR are shown in Table 1. Conclusion: Patients with RA-ILD have increased mortality compared with controls. They are more likely to receive immunosuppressive therapy. It is impossible to confidently attribute excess mortality to the use of specific drugs, as thresholds for their use differ. However, this large retrospective multi-centre study suggests a possible survival advantage in treating these patients with MMF or tacrolimus, as opposed to traditional therapy with AZA, especially in terms of their respiratory mortality. This theory could be tested in a large prospective study.
