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To evaluate the association between the adherence to Mediterranean diet (MD) and disease impact, activity, and comorbidities in patients with rheumatoid arthritis (RA).Consecutive patients with RA were enrolled in this cross-sectional study. For each patient, Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI), RA Impact of Disease (RAID), Health Assessment Questionnaire (HAQ), patient global assessment (PGA) and general health (GH) and a self-reported questionnaire called MD score were recorded.205 RA patients (median age 53 years, female 80.49 %) were enrolled. An association between MD score and HAQ (p-value = 0.033), PGA and GH (p-value 0.023 both) was observed. RAID total score had a statistically significant negative relationship with MD score (p-value = 0.016). A statistically significant negative association was found for pain (p-value = 0.025), functional disability (p-value0.001), sleep (p-value = 0.041), physical well-being (p-value = 0.027) and coping (p-value = 0.008). Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other. A negative trend, although not statistically significant was found for DAS28 and SDAI. The only comorbidity associated with MD score was arterial hypertension (OR = 0.94).In this Italian RA cohort, the adherence to MD was significantly associated with a better RAID, PGA and GH, but higher MD score was not significantly associated with lower disease activity. Our study suggests an overall potential beneficial effect of MD in RA patients.

OBJECTIVES: Italy was one of the first countries significantly affected by the coronavirus disease 2019 (COVID-19) epidemic. The Italian Society for Rheumatology promptly launched a retrospective and anonymised data collection to monitor COVID-19 in patients with rheumatic and musculoskeletal diseases (RMDs), the CONTROL-19 surveillance database, which is part of the COVID-19 Global Rheumatology Alliance. METHODS: CONTROL-19 includes patients with RMDs and proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) updated until May 3rd 2020. In this analysis, only molecular diagnoses were included. The data collection covered demographic data, medical history (general and RMD-related), treatments and COVID-19 related features, treatments, and outcome. In this paper, we report the first descriptive data from the CONTROL-19 registry. RESULTS: The population of the first 232 patients (36% males) consisted mainly of elderly patients (mean age 62.2 years), who used corticosteroids (51.7%), and suffered from multi-morbidity (median comorbidities 2). Rheumatoid arthritis was the most frequent disease (34.1%), followed by spondyloarthritis (26.3%), connective tissue disease (21.1%) and vasculitis (11.2%). Most cases had an active disease (69.4%). Clinical presentation of COVID-19 was typical, with systemic symptoms (fever and asthenia) and respiratory symptoms. The overall outcome was severe, with high frequencies of hospitalisation (69.8%), respiratory support oxygen (55.7%), non-invasive ventilation (20.9%) or mechanical ventilation (7.5%), and 19% of deaths. Male patients typically manifested a worse prognosis. Immunomodulatory treatments were not significantly associated with an increased risk of intensive care unit admission/mechanical ventilation/death. CONCLUSIONS: Although the report mainly includes the most severe cases, its temporal and spatial trend supports the validity of the national surveillance system. More complete data are being acquired in order to both test the hypothesis that RMD patients may have a different outcome from that of the general population and determine the safety of immunomodulatory treatments.

The ideal long-term maintenance therapy of Lupus Nephritis (LN) is still a matter of debate. The present study was aimed at comparing the efficacy/safety profile of cyclosporine (CsA), mycophenolate mofetil (MMF) and azathioprine (AZA) in long-term maintenance therapy of LN.We performed a retrospective study of patients with biopsy-proven active LN. After induction therapy, all patients received maintenance therapy with CsA, MMF or AZA based on medical decision. Primary endpoint was complete renal remission (CRR) after 8 years (defined as proteinuria 0.5 g/24 h, eGFR 60 ml/min/1.73 mq); secondary endpoints were: CRR after 1 year, renal and extrarenal flares, progression of chronic kidney disease (CKD stage 3 or above) and side-effects.Out of 106 patients, 34 received CsA, 36 MMF and 36 AZA. Clinical and histological characteristics at start of induction therapy were comparable among groups. At start of maintenance therapy, CsA patients had significantly higher proteinuria (P = 0.004) or nephrotic syndrome (P = 0.024) and significantly lower CRR (23.5% vs 55.5% on MMF and 41.7% on AZA, P = 0.024). At one year, CRR was similar in the three groups (79.4% on CsA, 63.8% on MMF, 58.3% on AZA, P = 0.2). At 8 years, the primary endpoint was achieved by 79.4% of CsA vs 83.3% of MMF and 77.8% of AZA patients (P = 0.83); 24 h proteinuria, serum creatinine, eGFR were similar. CKD stage 3 or above developed in 8.8% of CsA, in 8.3% of MMF and in 8.3% of AZA patients (P = 0.92). Flares-free survival curves and incidence of side-effects were not different.This is the first study comparing CsA, MMF and AZA on long-term LN maintenance therapy. All treatments had similar efficacy in achieving and maintaining CRR, despite more severe baseline clinical features in patients treated with CsA.

To our knowledge, no studies have investigated the relationship between a posteriori dietary patterns (DPs)&mdash, representing current dietary behavior&mdash, and disease activity in patients with rheumatoid arthritis (RA). We analyzed data from a recent Italian cross-sectional study including 365 RA patients (median age: 58.46 years, 78.63% females). Prevalent DPs were identified through principal component factor analysis on 33 nutrients. RA activity was measured according to the Disease Activity Score on 28 joints (DAS28) and the Simplified Disease Activity Index (SDAI). Single DPs were related to disease activity through linear and logistic regression models, adjusted for the remaining DPs and confounders. We identified five DPs (~80% variance explained). Among them, Vegetable unsaturated fatty acids (VUFA) and Animal unsaturated fatty acids (AUFA) DPs were inversely related to DAS28 in the overall analysis, and in the more severe or long-standing RA subgroups, the highest score reductions (VUFA: 0.81, AUFA: 0.71) were reached for the long-standing RA. The SDAI was inversely related with these DPs in subgroups only. This Italian study shows that scoring high on DPs based on unsaturated fats from either source provides independent beneficial effects of clinical relevance on RA disease activity, thus strengthening evidence on the topic.

Background Environmental exposure (e.g. tobacco smoking, pollution) has been accepted to contribute in autoimmune diseases. Air pollution has been described to be a risk factor for developing rheumatoid arthritis (RA). Currently, RA disease remission is considered an achievable target in a significant proportion of patients. Nevertheless, diseases flares, that significantly contributes to damage progression and disability, remain unpredictable. Thus, factors able to potentially interfere on disease activity should be considered and assessed. Objectives The aim of our study is to evaluate the influence of particulate matter (PM) on disease activity and general health (GH) in patients with RA. Methods Consecutive patients with RA (ACR/EULAR Criteria 2010) resident in Lombardy (Italy) were enrolled. In each patient Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI) and patients’ GH were assessed. Daily PM concentrations, estimated by Regional Environmental Protection Agency at municipality resolution, were used to assign short-term exposure from day of visit back to 14 days. Continuous variables are expressed as mean±SD. Categorical variables are presented as absolute numbers and frequencies. Multivariable linear regression models were performed to identify the day of PM10 and PM2.5 independently associated with DAS28, GH and SDAI indices, adjusting for the variables significant at the univariate analysis. GH was log transformed to achieve normality of residuals. β coefficients were reported for 10 μg/m3 increments of PM concentrations. All statistical analyses were performed using SAS 9.4. Results 258 patients (age at visit 57.4±13.5 years, disease duration 16.2±12.1, female 80.2%, rheumatoid factor and/or anti-citrullinated peptide antibodies positivity 60.5%, smokers 15.5%, radiographic damage 41.5%) were enrolled in the study. Multivariable linear regression models were adjusted for radiographic damage, disease duration and age. Increases of PM2.5 and PM10 exposure (9 day before the visit) were significantly associated with worsening of DAS28, SDAI and GH (table below). PM concentrations in days other than 9 days before were significantly associated with disease activity and GH. Conclusion In our cohort, PM10 and PM2.5 exposure seems to influence RA disease activity with a lag period that can last until 9 days before the visit. Nevertheless, the association between day-to-day PM changes and disease activity do not confirm causation. Further studied are required to evaluate the influence of air pollution on RA activity. Disclosure of Interests None declared

Background Mediterranean diet (MD) is considered a well-balance and potentially anti-inflammatory diet characterized by high consumption of olive oil, unrefined cereals, fresh or dried fruit and vegetables, fish, dairy, meat and with a moderate amount of red wine. Currently, there is conflicting data for the benefits of MD in RA, and no enough evidence to support a role of MD in the prevention and treatment of rheumatoid arthritis (RA) [1]. Objectives The aim of our study was to evaluate the association between MD adherence and disease activity, general health (GH) and comorbidities in patients with RA. Methods Consecutive patients with RA (ACR/EULAR Criteria 2010) were enrolled in this cross-sectional study. For each patient, Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI), patient GH and a self-reported questionnaire called MD score [2] were recorded. The association between MD score and the above mentioned variables was assessed through univariate regression models (MD score as response variable and the variables of interest as independent variables). Results from each model were reported in terms of: 1) test of association (Likelihood Ratio test, with a Chi-square distribution); 2) for categorical independent variables, estimated differences of mean MD score between groups, with respective 95% CI; 3) for numerical independent variables, estimate of correlation coefficient and regression slope coefficient, with respective 95% CI. All analyses were performed using the R software. Results 205 patients (197 Italian) were enrolled: median age at visit 53 (q1-q3: 44-59) years, age at onset 38 (q1-q3: 28-47), disease duration 12 (q1-q3: 7-19), female 80.49%, rheumatoid factor and/or anti–citrullinated protein antibody positivity 58.54%, radiographic damage 41.79%. Comorbidities were also assessed: gastrointestinal 19% (gastro-esophageal reflux disease; inflammatory bowel disease; gastritis; esophagitis), chronic renal failure 1%, arterial hypertension 21.95%, diabetes mellitus 3.9%, coronary artery disease 1.95%. A significant positive correlation was found between MD score and GH, as shown in the table below: this suggests a low/moderate tendency of having better GH with higher MD score. Although not statistically significant, a negative correlation was found with DAS28 and SDAI, suggesting an association between higher MD score with lower disease activity. Among comorbidities, a significant difference of mean MD score values between subjects with and without arterial hypertension was also found (mean difference -2.0 CI: -3.7, -0.2; p=0.029). Conclusion In this Italian RA cohort, the adherence to MD was significantly associated with a better GH, but higher MD score was not significantly associated with lower disease activity. Arterial hypertension was the only comorbidity associated with lower MD score, probably due to the fact that the prevalence of the other comorbidities was low. Our study suggests an overall beneficial effect of MD in RA patients. Further studies are needed to better understand the impact of lifestyle modification (e.g. diet) in achieving RA disease control. References [1] Forsyth C, et al. Rheum Intern 2018 [2] Demosthenes B, et al. Nutr metab cardiovasc dis 2006 Disclosure of Interests None declared

Background:Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially anti-inflammatory diet that encompasses all food groups. Presently, there are conflicting data about the benefits of MD in rheumatoid arthritis (RA). Not enough evidence support a role of MD in the prevention and treatment of RA, and a modest impact of MD on laboratory parameters has been described. Greater effect on subjective aspects of the disease such as joint pain, morning stiffness, and fatigue was reported.Objectives:To investigate whether the adherence to MD affects RA perception as measured by Rheumatoid Arthritis Impact of Disease (RAID) score.Methods:Consecutive patients Results:205 RA patients were enrolled: median age at visit 53 (q1-q3: 44-59) years, female 80.5 %. The median MD and RAID score were 35 (q1-q3: 32-39) and 2.42 (q1-q3: 0.63-4.51) respectively.RAID total score had a statistically significant negative relationship with MD score (regression coefficient -0.08; p-value=0.016). Concerning the single RAID items, a statistically significant negative association was found for pain (regression coefficient -0.08; p-value=0.025), functional disability (regression coefficient -0.13; p-valueMultiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other.Conclusion:To our knowledge, this is the first study addressing the relationship between the adherence to MD and the perception of RA impact. A better MD adherence was associated with lower self-reported composite total RAID score as well as lower pain, functional disability, sleep, physical well-being and coping. The effect of MD adherence on overall RAID is relevant but, at the same time, a prominent effect of one single item on the others could not be documented. This study confirmed the importance of non-pharmacological interventions, such as diet, in RA management.References:[1] Gossec L, et al. Ann Rheum Dis 2011;70(6):935-42.[2] Panagiotakos DB, et al. Nutr Metab Cardiovasc Dis 2006;16(8):559-68.Disclosure of Interests:Francesca Ingegnoli: None declared, Isabella Scotti: None declared, Tommaso Schioppo: None declared, Tania Ubiali: None declared, Giuseppe Marano: None declared, Patrizia Boracchi: None declared, Orazio De Lucia: None declared, Antonella Murgo: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

Background and aims: Brain white matter hyperintensities (WMHs) have been associated with an increased risk of ischemic stroke and considered as markers of brain ischemia. Progression of WMHs in asymptomatic patients with non-hemodynamically significant carotid plaque could represent a putative marker of plaque vulnerability. We prospectively evaluate progression and determinants of WMHs in this population. Methods: This prospective study included 51 asymptomatic patients with carotid stenosis

Alteration of circulating T-cell subpopulations may reflect the local immune process in plaques [(1)][1], providing insights on atherosclerosis pathogenesis. Only limited knowledge concerning the relationship between circulating lymphocytes and features of atherosclerotic lesions is available [(2

Background and Aim Patients with Systemic Lupus Erythematosus (SLE) present increased cardiovascular mortality compared to the general population. Few studies have assessed the long-term development and progression of carotid atherosclerotic plaque in SLE patients. Our aim was to investigate the association of clinical and laboratory markers of disease activity and classical cardiovascular risk factors (CVRF) with carotid atherosclerosis development in SLE patients in a prospective 5-year study. Methods and results Clinical history and information on principal CVRFs were collected at baseline and after 5 years in 40 SLE patients (36 women, mean age 42 ± 9 years; 14.4 ± 7 years of mean disease duration) and 50 age-matched controls. Carotid Doppler ultrasonography was employed to quantify the atherosclerotic burden at baseline and at follow up. Clinimetrics were applied to assess SLE activity over time (SLEDAI). The association between basal circulating T cell subsets (including CD4+CCR5+; CD4+CXCR3+; CD4+HLADR+; CD4+CD45RA+RO−, CD4+CD45RO+RA− and their subsets) and atherosclerosis development was evaluated. During the 5-year follow up, 32% of SLE patients, developed carotid atherosclerosis compared to 4% of controls. Furthermore, considering SLEDAI changes over time, patients within the highest tertile were those with increased incidence of carotid atherosclerosis independently of CVRF. In addition, increased levels of CD4+CCR5+ T cells were independently associated with the development of carotid atherosclerosis in SLE patients. Conclusion Serial clinical evaluations over time, rather than a single point estimation of disease activity or CVRF burden, are required to define the risk of carotid atherosclerosis development in SLE patients. Specific T cell subsets are associated with long-term atherosclerotic progression and may further be of help in predicting vascular disease progression.

Aim: White matter hyperintensities (WMH) can be incidentally found in patients with carotid atherosclerosis on brain magnetic resonance imaging (MRI). They are believed to reflect cerebral ischemic burden. We investigated the relationship between carotid atherosclerosis and presence and extension of WMH in asymptomatic patients with carotid plaques of intermediate severity. Methods: We screened 235 consecutive patients with carotid stenosis

Monocytes are known to play a key role in the initiation and progression of atherosclerosis and contribute to plaque destabilization through the generation of signals that promote inflammation and neoangiogenesis. In humans, studies investigating the features of circulating monocytes in advanced atherosclerotic lesions are lacking.Patients (mean age 69 years, 56% males) with intermediate asymptomatic carotid stenosis (40-70% in diameter) were evaluated for maximal stenosis in common carotid artery, carotid bulb and internal carotid artery, overall disease burden as estimated with total plaque area (TPA), greyscale and neovascularization in 244 advanced carotid plaques. Absolute counts of circulating CD14+ monocytes, of classical (CD14No correlation was found between monocytes and overall atherosclerotic burden, nor with high sensitivity C-reactive protein (hsCRP) or interleukin-6 (IL-6). In contrast, plaque signs of neovascularization were associated with significantly lower counts of circulating CD14+ monocytes (297 versus 350 cells/mmNeovascularized atherosclerotic lesions selectively associate with lower blood levels of CD14+ and CD14

Background and aims Monocytes are known to play a key role in the initiation and progression of atherosclerosis and contribute to plaque destabilization through the generation of signals that promote inflammation and neoangiogenesis. In humans, studies investigating the features of circulating monocytes in advanced atherosclerotic lesions are lacking. Methods Patients (mean age 69 years, 56% males) with intermediate asymptomatic carotid stenosis (40–70% in diameter) were evaluated for maximal stenosis in common carotid artery, carotid bulb and internal carotid artery, overall disease burden as estimated with total plaque area (TPA), greyscale and neovascularization in 244 advanced carotid plaques. Absolute counts of circulating CD14+ monocytes, of classical (CD14 high CD16−), intermediate (CD14 high CD16+) and non-classical (CD14 low CD16+) monocytes and HLA-DR+ median fluorescence intensity for each subset were evaluated with flow cytometry. Results No correlation was found between monocytes and overall atherosclerotic burden, nor with high sensitivity C-reactive protein (hsCRP) or interleukin-6 (IL-6). In contrast, plaque signs of neovascularization were associated with significantly lower counts of circulating CD14+ monocytes (297 versus 350 cells/mm 3 , p = 0.039) and of classical monocytes (255 versus 310 cells/mm 3 , p = 0.029). Conclusions Neovascularized atherosclerotic lesions selectively associate with lower blood levels of CD14+ and CD14 high CD16− monocytes independently of systemic inflammatory activity, as indicated by normal hsCRP levels. Whether the reduction of circulating CD14+ and CD14 high CD16− monocytes is due to a potential redistribution of these cell types into active lesions remains to be explored.

Background Percutaneous coronary interventions (PCI) in patients with ischemic systolic left ventricular dysfunction (SLVD) are routinely performed although their impact on prognosis remains unclear. Methods We retrospectively evaluated 385 consecutive patients (76 % male, 66 ± 9 years) with SLVD (left ventricular ejection fraction [LVEF] ≤40 %) due to chronic coronary artery disease, who underwent PCI between 1999 and 2009, and explored clinical factors associated with higher risk of death or of a composite of death and hospitalization for acute decompensated heart failure (ADHF). Results The median follow-up was 28 months (inter-quartile range 14–46 months). Death and the composite outcome of death and hospitalization for ADHF occurred in 80 (21 %) and 109 (28 %) patients respectively (8.4 and 11.5 per 100 patient-years of follow-up). Insulin-dependent diabetes mellitus (IDDM), multivessel disease, LVEF

BACKGROUND AND AIM: Patients with systemic lupus erythematosus (SLE) have a higher prevalence of subclinical atherosclerosis and higher risk of cardiovascular (CV) events compared to the general population. The relative contribution of CV-, immune- and disease-related risk factors to accelerated atherogenesis in SLE is unclear. METHODS AND RESULTS: Fifty SLE patients with long-lasting disease (mean age 44 ± 10 years, 86% female) and 50 sex- and age-matched control subjects were studied. Common carotid artery intima-media thickness (CCA-IMT) was used as a surrogate marker of atherosclerosis. We evaluated traditional and immune- and disease-related factors, assessed multiple T-cell subsets by 10-parameter-eight-colour polychromatic flow cytometry and addressed the effect of pharmacological therapies on CCA-IMT. In SLE patients, among several cardiometabolic risk factors, only high-density lipoprotein levels (HDL) and their adenosine triphosphate-binding cassette transporter 1 (ABCA-1)-dependent cholesterol efflux capacity were markedly reduced (p

Background A relationship between systemic inflammation and increased cardiovascular risk is often postulated. Simple and affordable clinical predictors of increased cardiovascular risk in patients with autoimmune disease, however, are not yet available in the clinical practice. Objectives To address the role of clinical, serological markers of disease activity, and of classical cardiovascular risk factors (CVRF) in predicting the carotid intima-media thickness (c-IMT) progression at 5 years (Δc-IMT) in patients with the prototypic autoimmune disease systemic lupus erythematosus (SLE). Methods Clinical and biochemical data including SLEDAI were collected at baseline and at five years of follow up from 50 patients with SLE and 50 age- and gender-matched healthy controls. C-IMT was also measured at baseline and at 5 years to evaluate progression. Results A higher SLEDAI score at baseline correlated with a faster Δc-IMT (0.007 (0.006) mm/year vs 0.003 (0.001) mm/year when compared to controls, P=0.026), irrespectively of the presence of CVRF and of the serological profile. Patients with higher SLEDAI score at baseline also experienced disease flares more frequently (p=0.037) than those with milder disease at baseline. Patients with a higher disease activity during follow up had also a faster Δc-IMT when compared to those with a persistently low disease activity (0.008 (0.004) mm/year vs -0.006 (0.004) mm/year, P=0.021). Elevated LDL-C levels were the only CVRF associated with disease flare-up; this might a consequence of the aggressive immunosuppressant therapy in those patients. Conclusions Patient with SLE show an increased cardiovascular risk as estimated by the c-IMT. Disease activity and in particular disease flares accelerate the progression of the vascular damage. Disclosure of Interest None declared

In the recently published post-hoc analysis from the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, low high-density lipoprotein cholesterol (HDL-C) levels remained a powerful and independent predictor of cardiovascular (CV) risk in 2,193 patients with