Background: Osteoarthritis (OA) is the most common musculoskeletal condition in the elderly population. However, to date, no disease modifying drug exists for this disease. In vivo studies have shown that glitazones may be used as anti-arthritic drugs. (Kobayashi, 2005; Boileau, 2007). Objectives: To determine the risk of total joint replacement (TJR) with the use of glitazones. Methods: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined as patients >18 years of age who had undergone TJR surgery between 2000 and 2012. Controls were matched by age, gender and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) associated with use of glitazones. We additionally evaluated risk of TJR in current glitazone users compared to DM patients using other antidiabetic drugs (ADs). In order to determine a dose effect relationship, we also stratified glitazone users by total number of prescriptions prior to surgery. Results: There is no difference in risk of TKR (OR=1.11 (95% CI=0.95-1.29)) or THR (OR=0.87 (95% CI=0.74-1.02)) between glitazone users and patients not using glitazones. Furthermore, there is no difference in risk of TKR (OR=1.03 (95% CI=0.88-1.22)) and THR (OR=0.90 (95% CI=0.75-1.08)) when glitazones users are compared to other AD users. Finally, we did not find a dose response effect with increasing number of prescriptions. Conclusions: This study did not find any evidence for an anti-arthritic effect of glitazones

Boonen, A.

Dagnelie, Pieter C

De Boer, A.

De Vries, F.

Emans, Pieter J

Lalmohamed, A.

Nielen, Johannes T H

Van Den Bemt, B.

Utrecht University Repository

Scientific Abstracts Saturday, 13 June 2015 779and treatment, we found no influence of the TB screening method on the risk ofLTBR. However, the TST2 and QTF groups had a significantly lower TB risk, withthe TST1 group as reference, when all cases of active TB were analyzed: HR[95% CI] were 0.19 [0.04-0.94], p=0.041 for TST2 and 0.09 [0.01-0.74], p=0.025for QTF, suggesting that the period of TNFi initiation, when the TB incidence ingeneral population was higher than in the later years, determined a higher risk foractive TB.Conclusions: In a country with a high TB burden, where all arthritis patientsstarted on TNFi were screened for latent TB, new TB infection exceeds LTBR.Baseline screening and prophylaxis was efficient in positive patients but it is notenough in preventing active TB on a long term and the screening protocol shouldbe revised.Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2015-eular.5726SAT0331 CLINICAL AND ULTRASOUND PARAMETERS INFLUENCE THEVARIABILITY OF PATIENTS’ AND PHYSICIANS’ GLOBALASSESSMENT IN PSORIATIC ARTHRITISA. Lackner, R. Husic, A. Ficjan, J. Gretler, W. Graninger, J. Hermann, C. Dejaco.Medical University Graz, Graz, AustriaBackground: Treatment decisions in Psoriatic Arthritis (PsA) depend upon theperception of disease activity by rheumatologists and patients. The factors ex-plaining the variability of disease activity assessments, however, are elusive so far.Objectives: The purpose of this study was the identification of clinical and/orultrasound parameters explaining the discrepancy between patients’ (PGA) andevaluator’s global assessment (EGA) of disease activity in PsA.Methods: We performed a prospective study on 83 consecutive PsA patientswith study visits at baseline and after 6 months. All patients underwent thefollowing clinical assessments: tender (TJ) and swollen joint (SJ) counts (68/66joint count), PASI, dactylitis score and the Leeds Enthesitis Score. We alsorecorded the PGA, patients’ pain assessment (pain VAS), the EGA (all measuredon a 100mm VAS) as well as the Dermatology Life Quality Index (DLQI) andthe HAQ. Ultrasound was performed by an independent investigator blinded toclinical results using an ESAOTE MyLab Twice ultrasound device (6–18 MHz and4-13 MHz probes). Structural (erosions, osteophytes) and inflammatory changes[gray scale (GS) and Power Dopper (PD)] were investigated at 68 joints and 14entheses. For statistical analysis, we used SPSS v22. Multivariate regressionmodels were performed to identify the possible association between clinical orultrasound parameters with EGA and PGA.Results: Mean age of patients was 51.8 (±11.7) years, 26.2% were female,43.4% were treated with methotrexate and 37.3% received anti-TNF agents.Disease activity was differently evaluated by patients and physicians in 65% ofcases: in 53% (n=44) of patients, PGA scores were higher than EGA and viceversa, 12% (n=10) of cases had higher EGA scores. EGA and painVAS correlatedstrongly in patients with high PD scores (r=0.756 (p<0.001) in cases with aPD score >10) whereas a weak association was observed in patients with lowlevels of ultrasound inflammation, (r=0.376, p<0.05). Besides, a good correlationbetween EGA and painVAS (r=0.823, p<0.001) was found in patients with a higherosion score (>10) whereas in patients with low levels of structural damage, thecorrelation was weak (r=0.384, p<0.05). The association between PGA and EGAwas not linked with the degree of ultrasound verified inflammation or damage.A multivariate regression model was conducted to identify clinical factorsexplaining the variability of PGA and EGA in PsA patients. Half of the variabilityof PGA results was explained by pain VAS (30.5%), swollen joints (15%) andtender joints (6.5%). Besides, pain VAS (B-coeff=0.534, P<0.001) and HAQ (B-coeff=6.266, P<0.05) were significant predictors of PGA. The variability of EGAresults was mainly explained by the SJ count (48.5%), SJ also predicted EGAlevels (B-coeff=3.098, P<0.001). In the ultrasound model half of the variability ofPGA was explained by pain VAS (42.9%) and GSS-joints (4.7%) while the EGAresults were clarified by GSS-joints (12.9%), HAQ-score (9.8%), pain VAS (9.1%)and PD-joints (6.6%).Conclusions: EGA and painVAS better correlate in PsA patients with highcompared to low levels of ultrasound verified inflammation or damage. PainVASand SJ are the most important clinical determinants of PGA and EGA, respectivelywhereas the most relevant ultrasound parameters were the GSS-joints and PD-joints score.Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2015-eular.5488SAT0332 DISEASE ACTIVITY TRAJECTORIES IN EARLY AXIALSPONDYLOARTHRITIS: RESULTS FROM THE DESIR COHORTA. Moltó 1,2, S. Tezenas du Montcel 3, D. Wendling 4, M. Dougados 2, A. Vanier 3,L. Gossec 1,5. 1GRC-UPMC 08 (EEMOIS), UPMC Université Paris 06; 2ParisDescartes University, Rheumatology Department, Cochin Hospital. INSERM(U1153): Clinical Epidemiology and Biostatistics, APHP-PRES SorbonneParis-Cité; 3Department of Biostatistics Public Health and Medical Informatics,UPMC Université Paris 06. AP-HP, Pitié Salpêtrière Hospital, Paris; 4Universitéde Franche-Comté; Rheumatology Department, CHRU de Besançon, Besançon;5Rheumatology Department, AP-HP, Pitié Salpêtrière Hospital, Paris, FranceBackground: Disease activity over time in axial spondyloarthritis (axSpA) canbe heterogeneous, and studies aiming to identify patterns of disease activity aresparse. In other disciplines, trajectory modelling have been applied to identifypatterns of behaviour (trajectories) but no studies have attempted to distinguishsubgroups with common disease activity over time in axSpA. ASDAS-CRP is avalidated tool to measure disease activity, and seems a logical criterion to definethe trajectories of disease activity in this setting.Objectives: To identify the disease activity trajectories in patients with earlyaxSpA over a 3-years follow-up period,the baseline predisposing factors todevelop such trajectories and the outcomes associated with each trajectory interms of sick leave and work disabilityMethods: Prospective, multi-centre study (DESIR cohort) of patients with earlyinflammatory back pain (<3 years duration) suggestive of axSpA. Only patientsfulfilling the ASAS criteria and for whom ≥3 ASDAS values were availableover the 3 years of follow-up were analysed. Statistical analysis: Trajectorieswere estimated by Group Based Trajectory Modelling; predisposing factors wereidentified by multinomial regression and days of sick leave/work disability werecompared in the trajectories by linear/logistic regression.Results: In total, 370 patients were included in the analysis. Five distinctivetrajectories of disease activity over 3 years were determined: traj 1 (n=134(35%) persistent moderate disease activity), traj 2 (n=66 (18%) persistent inactivedisease), traj 3 (n=29 (9%) very high disease activity at inclusion but reachinginactive disease after 12 months), traj 4 (n=126 (33%) persistent high diseaseactivity) and trajectory 5 (n=15 (6%) persistent very high disease activity): Figure.Traj 1 was set as the reference trajectory for the multinomial regression: awhitecollar job was found to be predictive of developing trajectory 2 (OR=2.2[1.1-5.0]).Male gender (OR=8.8 [2.2-34.5]), high degree of education (OR=4.7[1.1-22.0]) and past peripheral involvement (OR=7.0 [1.6-30.1]) were predictivefactors to develop traj 3. A high degree of education was found to be protective(OR=0.5 [0.2-0.9]) for developing traj 4.Traj 5 was significantly associated with sick leave over follow-up(p<0.001).Trajectories 4 (OR=6.2 [1.7-41.3]) and 5 (OR=22.7 [2.2-259.1]) weresignificantly associated with work disability.Conclusions: This study identified 5 trajectories of ASDAS-CRP. Gender, degreeof education and profession were the main baseline factors determining thetrajectories. Higher disease activity trajectories were significantly associatedwithmore days of sick leave and work disability over follow-up. Further analysisincluding treatments as time-changing covariables will allow us to continueexploring these trajectories.Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2015-eular.2057SAT0333 USE OF GLITAZONES AND THE RISK OF ELECTIVE HIP ORKNEE REPLACEMENT: A POPULATION BASEDCASE-CONTROL STUDYJ.T.H. Nielen 1,2, B. van den Bemt 3,4, A. Lalmohamed 2,5, A. de Boer 2,A. Boonen 6, P.C. Dagnelie 1, P. Emans 7, F. de Vries 2,8. 1Department ofEpidemiology, Maastricht University, Maastricht; 2Division ofPharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht;3Department of Pharmacy, Radboud University Medical Center; 4Department ofPharmacy, Sint Maartenskliniek, Nijmegen; 5Department of Clinical Pharmacy,University Medical Center Utrecht, Utrecht; 6Department of Rheumatology;7Department of Orthopaedics; 8Departement of Clinical Pharmacy andToxicology, Maastricht University Medical Center, Maastricht, NetherlandsBackground: Osteoarthritis (OA) is the most common musculoskeletal conditionin the elderly population. However, to date, no disease modifying drug existsfor this disease. In vivo studies have shown that glitazones may be used asanti-arthritic drugs. (Kobayashi, 2005; Boileau, 2007).Objectives: To determine the risk of total joint replacement (TJR) with the use ofglitazones.Methods: A population based case-control study was performed using theClinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined aspatients >18 years of age who had undergone TJR surgery between 2000 and2012. Controls were matched by age, gender and general practice. Conditional780 Saturday, 13 June 2015 Scientific Abstractslogistic regression was used to estimate the risk of total knee (TKR) and total hipreplacement (THR) associated with use of glitazones. We additionally evaluatedrisk of TJR in current glitazone users compared to DM patients using otherantidiabetic drugs (ADs). In order to determine a dose effect relationship, we alsostratified glitazone users by total number of prescriptions prior to surgery.Results: There is no difference in risk of TKR (OR=1.11 (95% CI=0.95-1.29)) orTHR (OR=0.87 (95% CI=0.74-1.02)) between glitazone users and patients notusing glitazones. Furthermore, there is no difference in risk of TKR (OR=1.03(95% CI=0.88-1.22)) and THR (OR=0.90 (95% CI=0.75-1.08)) when glitazonesusers are compared to other AD users. Finally, we did not find a dose responseeffect with increasing number of prescriptions.Conclusions: This study did not find any evidence for an anti-arthritic effect ofglitazones.References:[1] Boileau et al. Arthritis and Rheumatism, 2007; Kobayashi et al. Arthritis &Rheumatism, 2005.Disclosure of Interest: J. Nielen: None declared, B. van den Bemt Grant/researchsupport from: Pfizer, Roche, Speakers bureau: Pfizer, Roche, Abbvie and MSD,A. Lalmohamed Grant/research support from: Netherlands Organisation forScientific Research (NWO), A. de Boer: None declared, A. Boonen Grant/researchsupport from: Amgen Abbvie, Pfizer and Merck, Speakers bureau: Pfizer, UCBand Sandoz, P. Dagnelie: None declared, P. Emans Grant/research supportfrom: Stryker, Active implants, Carbylan Biosurgery, DSM Biomedical, Regentis,Speakers bureau: Biomet and Push braces, F. de Vries: None declaredDOI: 10.1136/annrheumdis-2015-eular.3886SAT0334 PATIENT-PHYSICIAN DISCORDANCE IN GLOBALASSESSMENT IN RHEUMATOID ARTHRITIS: A SYSTEMATICREVIEW OF THE LITERATUREC. Desthieux, B. Fautrel, L. Gossec. Rheumatology, Pitié-Salpêtrière Hospital,Paris 6, Pierre et Marie Curie University, GRC 08, IPLESP, Paris, FranceBackground: The integration of the patient in therapeutic decisions (shareddecision-making) is an important aspect of management of chronic inflammatorydiseases. However, the patient’s opinion does not always reflect the physician’sopinion. Patient-physician discordance in the global assessment of disease canlead to patient dissatisfaction regarding treatment decisions and negatively affectmedical care with potentially poor adherence, and costs for society. Publisheddata on patient-physician discordance appears heterogeneous.Objectives: The aim of our study was to assess in the published literaturethe discordance between patients and physicians in the global assessment ofrheumatoid arthritis (RA).Methods: A systematic review of articles published from January 2000 toJanuary 2015 was performed using PUBMED. Keywords used were [rheumatoidarthritis and (discordance or discrepancy) and global assessment]. The outcomescollected were i) definitions used for discordance, ii) percentage of discordanceand iii) drivers of global assessment.Results: In all, 15 articles were identified, 7 were selected. The 7 articles reportedon 8532 patients. The weighted mean age was 55.5±13.8 years, 80.5% werewomen, weighted mean RA duration was 10.8±9.6 years. Five articles (71%) hada cut-off. The cut-off defined as the absolute difference between patient globalassessment and physician global assessment was very heterogeneous varyingbetween 0.5 to 3cm on 0-10 visual analog scale. The mean percentage of patientswith discordance was 40.3% but varied between 36% and 76%; there was morediscordance with a lower cut-off to define discordance. However, a cut-off of 2cmversus 2.5cm or 3cm didn’t change the percentage of discordance (around 36%).The drivers of patient global assessment were pain and functional incapacity.Whereas, drivers of physician global assessment were acute phase reactants(ESR, CRP), tender and swollen joints count.Conclusions: Discordance has a heterogeneous definition in literature. Aroundone third of patients with RA have a significant discordance with the physician inglobal asseessment of disease.This work suggests that patient global assessement is based more heavily onpatients’ subjective perception of pain and functional incapacity. In contrast,physicians are more focused on “RA-specific outcomes” and such as swollen andtender joints count and acute phase reactants. Taking into account the patientperspective is important but aspects such as widespread pain syndrome, personalfactors and culture may play a role in discordance.Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2015-eular.1851SAT0335 BREASTFEEDING IS ASSOCIATED WITH A DECREASED RISKOF ACPA-POSITIVE RHEUMATOID ARTHRITIS: RESULTSFROM THE SWEDISH EIRA STUDYC. Orellana 1, L. Klareskog 2, L. Alfredsson 1, C. Bengtsson 1,3. 1Institute ofEnvironmental Medicine, Karolinska Institutet; 2Rheumatology Unit, Departmentof Medicine, Karolinska University Hospital; 3Center for Occupational andEnvironmental Medicine, Stockholm County Council, Stockholm, SwedenBackground: Breastfeeding has been associated with both a decreased [1,2]and an increased [3] risk of developing RA. To our knowledge no previousstudy has investigated the impact of breastfeeding on the two subgroups of RA,characterized by presence/absence of antibodies to citrullinated peptides (ACPA).Objectives: To study the association between breastfeeding and the risk ofACPA-positive and ACPA-negative RA among women aged 18-70.Methods: Data from the population-based EIRA (Epidemiological Investigation ofRA) case-control study was analyzed. In total, 938 incident cases and 1917 con-trols participated between 2006-2011. An extensive questionnaire was answeredby the participants, including questions regarding duration of breastfeeding foreach delivered child and potential confounders (education, smoking, BMI, oralcontraceptive use, postmenopausal hormone therapy, reproductive factors). Totalhistory of breastfeeding was categorized into 0-3, 4-7, 8-12, 13-19 and ≥20months, using the lowest category as the reference group. We calculated oddsratios (ORs) with 95% confidence intervals (CI) by means of unconditional logisticregression, adjusting for age, residential area and number of children.Results: A longer duration of breastfeeding was associated with a decreased riskof ACPA-positive RA (OR 4-7 months=1.0, 95% CI 0.7-1.4; OR 8-12 months=0.8,95% CI 0.6-1.2; OR 13-19 months=0.6, 95% CI 0.4-0.9; OR ≥20 months=0.7,95% CI 0.4-1.0) compared to parous women who breastfed less than 3 months.No association between breastfeeding and ACPA-negative RA was found.Conclusions: Our results indicate that a longer duration of breastfeeding reducesthe risk of ACPA-positive RA among parous women, but has no association withthe risk of ACPA-negative RA. Further research is needed to explore the biologicalmechanisms behind our findings but our study contributes to the knowledge ofenvironmental risk factors such as breastfeeding and its different impact on thesubgroups of RA.References:[1] Pikwer M, et al. Breast feeding, but not use of oral contraceptives, is associatedwith a reduced risk of rheumatoid arthritis. Ann Rheum Dis. 2009;68(4):526-30.[2] Karlson EW, et al. Do breast-feeding and other reproductive factors influencefuture risk of rheumatoid arthritis? Results from the Nurses’ Health Study.Arthritis Rheum. 2004;50(11):3458-67.[3] Berglin E, et al. Influence of female hormonal factors, in relation to autoantibod-ies and genetic markers, on the development of rheumatoid arthritis in northernSweden: a case-control study. Scand J Rheumatol. 2010 Nov;39(6):454-60.Acknowledgements: We want to thank Marie-Louise Serra and Lena Nise forexcellent assistance in collection of data. We also thank all the cases andcontrols who participated in the study as well as clinicians and nurses part of theEpidemiological Investigation of Rheumatoid Arthritis study group.Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2015-eular.5686SAT0336 DEVELOPMENT OF AN ALGORITHM TO IDENTIFY SERIOUSOPIOID TOXICITY IN CHILDRENC.P. Chung, S.T. Callahan, W.O. Cooper, K.T. Murray, K. Hall, J.A. Dudley,C.M. Stein, W.A. Ray. Vanderbilt University, Nashville, United StatesBackground: The use of opioids is increasing in children; therefore, opioid toxicitycould be a public health problem in this vulnerable population. However, we arenot aware of a published algorithm to identify cases of opioid toxicity in childrenusing administrative databases.Objectives: We sought to develop an algorithm to identify cases of opioid toxicityin children using administrative databases.Methods: After review of literature and de-identified computer profiles, a broadset of ICD-9 CM codes consistent with serious opioid toxicity was selected.Based on these codes, we identified 195 potential cases of opioid toxicity inchildren enrolled in Tennessee Medicaid. Medical records were independentlyreviewed by two physicians; episodes considered equivocal were reviewed by anadjudication committee. Cases were adjudicated as definite/probable, possible,or were excluded.Results: Of the 195 potential cases, 168 (86.2%) had complete records for reviewand 85 were confirmed cases. The overall positive predictive value (PPV) for allcodes was 50.6%. The PPV for codes indicating: unintentional opioid overdose(25/31) was 80.7%; intentional opioid overdose (15/30) was 50.0%, adverseevents (33/58) was 56.9%, the presence of signs or symptoms compatible withopioid toxicity (12/47) was 25.5%, and no cases were confirmed in records fromthe two deaths. Of the confirmed cases, 65.8% were related to therapeutic opioiduse.Conclusions: The collective and individual PPV for many ICD-9 CM codesconsistent with opioid toxicity is low. For studies utilizing administrative claims,medical record review is to be important to accurately identify episodes of opioidtoxicity and optimize case ascertainment.Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2015-eular.1028

Use of glitazones and the risk of elective HIP or knee replacement: A population based case-control study

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Use of glitazones and the risk of elective HIP or knee replacement: A population based case-control study

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