Abstract
OP01
The Heat Is On: Utility Of Infrared Thermography In Detecting Synovitis In Rheumatoid Arthritis
To find out the temperature difference over joints in RA patients in comparison with normal subjects. To correlate the thermography findings with the conventional DAS 28 score.
There is increased temperature detected by infrared thermography in RA patients when compared to healthy subjects. Increased temperature in RA patients detected by thermography correlates with DAS 28 ESR score. This could be used to detect tenosynovitis, subclinical synovitis and differentiating active from damaged joints.
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OP02
Quantifying the Economic Toll of Rheumatoid Arthritis: A Comprehensive Cost-of-Illness Analysis and Exploration of Catastrophic Healthcare Expenditure from Karnataka Chapter of Indian Rheumatology Association (KRA)
Vineeta Shobha1,
On univariate analysis, higher age, rural area of residence, lower SES, lower level of patient education, time taken for referral to rheumatologist (>1 year) and higher disease activity (DAS28, CDAI, HAQ) had significant association with CHE (all p < 0.01). In adjusted analysis, patients belonging to lower SES [AOR 2.41 (1.78, 3.26)], primary and middle level of patient education [AOR 1.56 (1.06, 2.29) & 2.01 (1.32, 3.07)] and higher CDAI (>22) (AOR 2.33 (1.24, 4.39) had higher odds of CHE (Table-1).
The overall annual hospitalization rate for this cohort was 7.7% (n = 165), median cost per hospitalization being ₹30000 (14000, 80000). Lifetime medical expenditure was ₹362800 (190000, 697000) per patient.
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OP03
The Impact of HLA Antigens on Susceptibility and Clinical Heterogeneity in Psoriatic Arthritis
On evaluating for genotype-phenotype association, an expected association of HLA-B*27 was found with the AS-like phenotype [p value = 0.002, Odds ratio (OR) 10.4]. HLA-B*27:05 subtype was most frequent. Although HLA-C*06 was significantly associated with PsA, it was protective for the axial pattern (p value = 0.014, OR 0.08). A positive trend of HLA-DR4 was seen in the RA-like cohort, however, this was not statistically significant (p value = 0.166, OR 3.5). HLA-A*01 had a significantly higher frequency among patients with pSpA-like phenotype (p value = 0.034, OR 5.37) as opposed to the RA-like phenotype where it appeared to be protective (p value = 0.018, OR = 0.21). Table 2 summarizes the genotype-phenotype association in our study population.
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This is an encore presentation that was published in the EULAR 2024 abstract book. The same abstract is being presented.
This study was funded by the Delhi Rheumatology Association
OP04
TLR2 (23bp) Promoter Polymorphism in Spondyloarthritis: Association with Disease Activity, and Levels of Cytokines (TNF-α & Il-17)
We investigated the role of TLR-2 (23 bp ins/del) polymorphisms, its association with disease activity and levels of cytokines in Spondyloarthritis patients.
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OP05
Evaluation of Chronic Lateral Hip Pain: Ultrasound-Based Study in 88 Patients
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OP06
A Comparative Study to Assess The Effect of Pregabalin and Duloxetine Medication in Patients Suffering from Primary Knee Osteoarthritis
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OP07
A Multicentric Descriptive Study of 360 Cases of Sarcoidosis in Karnataka, South India: A Rheumatologists’ Perspective
OP08
Gastrointestinal Involvement in Systemic Sclerosis – Review of 250 Patients’ Clinical, Radiological and Serological Profile in A Tertiary Care Centre, South India
In total, 177 out of 250 patients had reflux symptoms, 15 reported chronic diarrhoea, and 4 patients had chronic constipation. The imaging studies done for the patients and the findings are summarised in Table 1; the indications for endoscopy and the findings are summarised in Table 2. Chronic liver disease was diagnosed in 7 patients. 208 out of 250(83.2%) patients were treated with a combination of proton pump inhibitors (PPIs) and prokinetics and 42 patients with PPIs alone. H Pylori eradication and antifungal therapy were administered based on the endoscopy findings. 6 patients with chronic diarrhoea were empirically treated with Rifaximin for probable SIBO with symptomatic improvement.
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OP09
Insights into Clinical Features, Laboratory Parameters, and Outcomes in Systemic Sclerosis - A Single-Center Experience of Over Three Decades (COSSIL Cohort)
1. Bernatsky S, Joseph L, Pineau CA, Belisle P, Hudson M, Clarke AE. Scleroderma prevalence: demographic variations in a population-based sample. Arthritis Rheum. 2009 Mar 15;61(3):400–4.
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OP10
Monogenic Autoinflammatory Disorders in a North Indian Tertiary Rheumatology Care Centre
Predominant manifestations included fever (n = 18) mucocutaneous symptoms (n = 14), musculoskeletal symptoms (n = 13), cytopenia (n = 5) vasculitis (n = 6) and hearing loss (n = 3) alongside diverse systemic manifestations. A history of infections was present in 6 patients. Family history of consanguinity was present in 1 patient while similar diseases or unexplained early deaths in relatives was there in 8 patients.
Diagnoses spanned various conditions like hyper IgD syndrome, Muckle Wells syndrome, neonatal onset multisystem inflammatory disease (NOMID), histiocytosis-lymphadenopathy plus syndrome (H syndrome) and deficiency of adenosine deaminase 2 (DADA2) among others, highlighting the spectrum of disorders encountered (Table 1).
Regarding treatment response, 23 patients had good or partial response to therapy while 6 patients were lost to follow up. Majority of patients (n = 26) had received some form of immunosuppression. One patient with STING associated vasculopathy of infancy (SAVI) who had excellent initial treatment response to tofacitinib had weaning of the effect later, while another patient with DADA2 and severe cytopenia succumbed to her illness.
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OP11
Scleroderma Renal Crisis: Three Decades of Clinical Insights, Laboratory Profiles, and Patient Outcomes from A Single Center
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OP12
Long-Term Outcome of Pediatric Chronic Anterior Uveitis from A Single Centre in North India
Isolated CAU: Median diagnosis age:66mo(IQR 77.5). 77.8% female. Initial visit:67% both eye involved. Of 15 eyes:53% Grade(Gr)1 VA,47% Gr2.Final visit:82% Gr1, 18% Gr 2/3. Complications: Initial visit-PS and cataract(47% each), glaucoma(13%), BSK(7%). Final FU-PS and BSK 24%. Cataract 18%.T/t:Mtx and ADA for all; 2(22%) Golimumab; 1(11%) Infliximab, MMF, TOFA each. 1 given 3 Anti-TNF over 123mo; 1 given ADA for 8y then Golimumab.59.3% on Anti TNF achieved 6/6-6/9 versus 6.7% without. No difference in VA between isolated CAU or JIA associated CAU (p = 0.406).
JIA with Uveitis:Median age at uveitis diagnosis 56mo(IQR 26.5),median 24mo b/w arthritis and uveitis.Female 82%,85% ANA+ve. Pre-uveitis:16 Mtx, 5 Etanercept. Initial visit:67% both eyes involved. T/t:All received topical/systemic steroids+Mtx; ADA 18(55%), MMF 6(18%). Isolated uveitis flare 23(70%), arthritis-associated 5(15%). At last FU:Mtx 31(94%), ADA 13(39%) Tofacitinib 4(12%), MMF and Actemra 2(6%) each; 1(3%) Golimumab. Initial: 67% both eyes and Last FU: 88% had both eyes involved. First visit VA:40 eyes(73%) Gr 1, 15(27%)Gd 2/3. Last visit: 50 (86%)Gr1,8(14%)Gr2/3. Initial: PS 16%, BSK15%, cataract 9%, no glaucoma. Last: PS10%, BSK 7%, cataract 12%, new glaucoma 2%. Factors impacting VA were male sex (p = 0.02), complicated uveitis at presentation (p = 0.046).
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OP13
Impact of Disease Activity on Annual Healthcare Expenditure in Relation To DMARD Prescriptions in Rheumatoid Arthritis (RA): An Analysis from Karnataka Chapter of Indian Rheumatology Association (KRA)
Vineeta Shobha1,
Methotrexate, tofacitinib, GC and biologicals were prescribed either alone or as co-prescription in 1715(80%), 576(27%), 795(37.1%) and 132 (6%) patients respectively. Annual direct expenditures (both medical and nonmedical) were significantly higher in highest disease severity and higher disability compared to lowest disease severity and lower disability categories (p <0.001, Table-1). Regression analysis showed that higher disease severity and disability had significant association with higher direct annual expenditure; HAQ (β = 1.13, 95% C.I. 1.04-1.22), CDAI (β = 1.01, 95% C.I. 1.005-1.02), and DAS (β = 1.03, 95% C.I. 1.01-1.06).
The patients on treatment with methotrexate with lower disease activity and disability had lowest annual cost compared to other medications. (p <0.001) Patients on treatment with tofacitinib and biologicals had significantly higher annual expenditure to achieve a lower disability and disease activity (p < 0.01).
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OP14
Rheumatoid Arthritis through Care - givers’ Eyes: A Single Center Cross-sectional Study on Knowledge and Disease Impact
To identify disease related knowledge-gaps among caregivers of RA patients. To identify the degree of impact of RA on the caregiver.
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OP15
Mindin (Spondin-2) Differentially Regulates Fibroblast Subpopulations During Fibrogenesis
To understand contribution of distinct fibroblasts subpopulations during fibrogenesis To elucidate the distinct responses of fibroblasts sub-populations to Mindin To understand the molecular mechanism of fibroblast activation in the subpopulations in response to Mindin
OP16
Tadalafil Loaded SNEDDS Promote Chondroprotective Effect by Mitigating Mitochondrial Reactive Oxygen Species in Osteoarthritis Derived Senescent Chondrocytes
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OP17
Gene Expression Profiling of Kawasaki Disease in North Indian Children: A Real-Time PCR Based Study- The First of Its Kind from The Indian Subcontinent
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OP18
An Il-6 Mediated Amplifier Loop Exists in Aortic Adventitial Fibroblasts and is Responsive to A Combination of Il-6 and Il-17 Inhibition
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OP19
Novel Composite Score Comprising Multiple Urinary Biomarkers Accurately Predicts Active Nephritis in Systemic Lupus Erythematosus: Derivation and Validation
ACT, HAP, IL-6, MCP-1, OPG, RBP and sCD25 were higher in the active nephritis group (Fig 1). We further split the cohort randomly into a training cohort of 81 patients (70%) and a test cohort of 35 patients (30%). On multivariable logistic regression serum complement C4, urinary MCP-1, alpha-1-antichymotrypsin and haptoglobin were significant predictors of active nephritis (Table 1). Using this logistic regression model, we developed a novel composite score for predicting lupus nephritis. On receiver operator characteristic curve analysis, the overall accuracy was 96.37%, and a cutoff of 0.6113 with sensitivity of 87.5% and specificity 97.5% was selected. In the test cohort, our score cut-off resulted in a sensitivity, specificity, positive predictive value and negative predictive value of 82.3%, 100%, 100% and 85.7% respectively suggesting excellent internal validity.
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OP20
Harnessing Indian Sle Inception Cohort (Inspire) Data for An Earlier Diagnosis of Systemic Lupus Erythematosus (Sle): A Predictive Modelling Approach
Data was split into testing (70%) and validation group (30%). In the test group, patients were classified based on their SLEDAI-2K values; scores < 5 were categorised as controls, while those with scores of 6 or higher were classified as SLE diagnosis. This classification established the target variable for our predictive model. To identify variables significantly associated with the SLEDAI category > 6, a logistic regression(LR) model adjusted for age and gender was performed. A neural network model was then employed to calculate the variable importance scores. These scores, combined with expert opinion, allowed us to assign a weighted score to each variable as follows: alopecia-1, albuminuria-4, elevated creatinine-2.5, microscopic hematuria-2, leukopenia-1.5, malar rash-3, oral ulcer-1, pedal edema-2, pleural effusion-1.5, polyarthritis-2, seizures-2, SCLE-2, and thrombocytopenia-2. For each individual, we calculated a composite risk score by summing the weighted scores of the significant variables identified. Model was validated in the validation data set and reported with sensitivity, specificity and predictive values.
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OP21
Sequential Pneumococcal Vaccination in SLE: Immunogenicity, Side Effects and Comparison with PPSV23 Vaccination
Baseline parameters were comparable among the two groups (Table 1). Patients with SLE had poorer response to PPSV23 than healthy controls(26/35 versus 15/15, p = 0.03). Vaccine response was similar for sequential vaccine(82.35%, 95%CI 68-94%) and PPSV23 alone (74.28%, 95%CI 60-89%) [Table 2]. Fold-change in all 5 serotypes was similar between sequential and PPSV23 arms.
All serotypes showed a good correlation between fold change in ELISA and OPA, suggesting functional antibodies. Increasing age was the only predictor of decreased response(0.96 fold per 1-year age).
In sequential arm, 1 patient each had injection-site pain, migraine, fever, fatigue after conjugate vaccine and 1 had fever after receiving PPSV23. 1 patient who refused PPSV23 at 3 months and had NPSLE in past developed GBS(Miller-Fisher variant) 4 months after initial dose. In PPSV23 arm, 1 each had injection-site pain, Herpes zoster reactivation, headache & fever.
In PPSV23 arm 3 minor flares occurred while in sequential arm 1 major and 1 minor flare occurred over 6 months.
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OP22
Data-driven Bayesian Network Analysis for Predicting Difficult-to-Treat (DTT) Lupus Nephritis
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OP23
Effect of Glucocorticoid Withdrawal in Clinically Quiescent Systemic Lupus Erythematosus
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OP24
High Burden of Catastrophic Health Expenditure for Systemic Lupus Erythematosus Treatment in India: Insights from the Multicentric Study by the SLE SIG of Indian Rheumatology Association
Vineeta Shobha1 and Kriti Kishor2,
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OP25
A Multicenter Prospective Longitudinal Observational Study to Determine Safety of Extended Treatment with Rituximab in Maintaining Remission in Patients with Anca Associated Vasculitis (AAV) - An Interim Analysis
During a median follow-up of 6 (IQR 3-9) months (Figure 1), 1 patient given LD rituximab had major flare with renal involvement (BVAS=11) at 6 months. One patient on ULD rituximab developed exacerbation of colitis and succumbed, while 1 patient in LD group developed sepsis at 15 months follow up and died. The B-cell-depletion percentage and hypogammaglobulinemia were similar in both groups at T2.
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OP26
Treatment Outcomes and Disease Relapse in IgG4-Related Disease: A Tertiary Care Experience
All patients received initial steroid therapy with prednisolone at a dose of 0.5-1 mg/kg/day, followed by a tapering regimen. All patient received additional steroid sparing agent most commonly Methotrexate (29 patients, 48%) and Mycophenolate Mofetil (17 patients, 28%) and Rituximab (9 patients, 15%).
At 6 months, 13 (28%) of patients achieved CR, which increased to 18 (47%) at 1 year. PR was observed in 29 (62%) at 6 months, decreasing to 12 (32%) at 1 year as more patients transitioned to CR. Despite initial improvements, 25/38 (66%) of patients experienced disease relapse during a median follow-up of 13 months (IQR 6-36). One patient succumbed to urosepsis secondary to ureteral involvement (Table 2).
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OP27
In Vitro Evaluation of Therapeutic Potential of Genistein in Takayasu Arteritis: Perspectives From Network Pharmacology and Molecular Docking Studies
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OP28
Serum P-Glycoprotein and Monomeric C-Reactive Protein are Novel Biomarkers of Takayasu Arteritis and Serum P-Glycoprotein is Associated with Inactive Disease
To compare levels of serum p-gp, mCRP and CRP between patients with TAK and healthy control. To compare levels of serum p-gp, mCRP and CRP between active and inactive TAK patients. To assess the correlation between levels of serum p-gp and p-gp expression on T helper lymphocyte populations in peripheral blood. Serial assessment of serum p-gp, mCRP and CRP in patients with TAK before and after immunosuppressive treatment.
1. Misra DP, Singh K, Rathore U, et al. Management of Takayasu arteritis. Best Pract Res Clin Rheumatol 2023;37(1):101826.
2. Misra DP, Jain N, Ora M, Singh K, Agarwal V, Sharma A. Outcome Measures and Biomarkers for Disease Assessment in Takayasu Arteritis. Diagnostics (Basel) 2022;12(10):2565.
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OP29
“Beyond the Flares: Colchicines’ Promise in Palindromic Rheumatism” - Impact of Colchicine Withdrawal on Disease Control in Palindromic Rheumatism
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OP30
Clinical and Imaging Outcome of Takayasu Arteritis Patients with Persistent Systemic Inflammation
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OP31
Cancer Risk and Screening Effectiveness in Idiopathic Inflammatory Myopathy: Validating IMACS Guidelines in A Retrospective Indian Cohort
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OP32
Predictors and Patterns of Mortality in Indian Systemic Sclerosis: Insights from the Indian Progressive Systemic Sclerosis Registry
To describe the frequency, chronology and causes of mortality in the IPSSR cohort. To assess baseline predictors of mortality.
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OP33
Machine Learning-Based Prediction of Susceptibility to Infection During Treatment with Different Immunosuppressants for Connective Tissue Disease-Interstitial Lung Disease
The temporal dimensions of each patients’ HRCT were normalized through standard sampling methods and then by image segmentation. A multi-head deep learning model was created to learn the combined features for both the CT images and clinical information(age, sex, disease duration, comorbidities, autoantibody profile, baseline FEV1 and FVC, haemoglobin, alanine transaminase and creatinine, presence of pulmonary hypertension, morphological classification of the ILD, and vaccination status). The CT images were passed through a convolutional neural network(CNN) while the clinical information is input as a vector through a neural network(NN). The feature embeddings of the CNN and the NN were combined to optimize the model to predict the chances of having an infection in the patient within a given timeframe.
GradCam visualizations were used to validate whether the deep learning model was assessing clinically relevant areas. The dataset was divided into ten groups, and, by rotation, nine groups were used to train and the remaining group was used to validate the model. The next part included making predictions of the susceptibility to infections by permuting different immunosuppressants within the first 365 days.
The CNN model had an median accuracy of 97.77%(IQR: 91.8-98.5) across ten iterations. Figure-1 shows the probabilities of infections in four representative patients within the first year of immunosuppression if treated with specific drugs.
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OP34
Study of Type -1 Interferon Gene Signature Markers in Muscle Biopsy Samples of Patients with IIM
Evaluate the expression of Type 1 IFN genes (MxA, ISG15, and RIG-I) in muscle biopsy - IIM. Comparison of IFN expression -DM versus non-DM IIMs.
Cross-sectional observational study, including patients meeting 2017 EULAR/ACR classification criteria/ Bohan-Peter classification criteria - IIM. Immunohistochemistry on muscle biopsy samples - Type 1 IFN genes: MxA, ISG15, and RIG-I.
There was a differential expression of all 3 Type 1 IFN markers in DM over Non-DM IIMs.
In DM group, 11 patients - MSA negative, most of these patients showed a significant expression of IFN markers.
These IFN markers were expressed mainly in the sarcoplasm.MxA expression was predominantly perifascicular; ISG 15 and RIG-I - focal or scattered.
MHC-1 expression seen in all DM and 84% of Non -DM.
PFA was seen in 22-18 in DM and 4 - Asys.
Among 7 DM who were negative for PFA, 4 had expression of at least one type1 IFN marker. Among 4 Asys who had PFA positivity,only one had type 1 IFN expression.
These findings albeit lesser in number is pathologically important in establishing the role of type 1 IFN marker’s superiority over PFA as a specific marker in DM.
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OP35
Derivation of A New Index to Reduce The Occurrence of Multiple Positivity in Line Immunoassay for Myositis Specific Autoantibodies in Inflammatory Myopathies
We used receiver operator characteristic (ROC) curves to determine optimal cutoffs for PCBI for each subtype of IIM (Table 1).
Multiple MSA positivity was seen in 19 patients (15.4%), who were diagnosed with IPAF (9), DM (4), JDM and ASS (2 each), IMNM (1) and 1 patient who did not meet diagnostic criteria for IIM. Using the revised PCBI cutoffs, 8 remained positive for multiple antibodies. These patients had IPAF (4), DM (2), IMNM (1) and one without IIM.
On correspondence analysis, both Euroline cutoffs and PCBI showed association between antibody positivity and clinical diagnosis (Chisq p values <0.001). However, using the PCBI gave a better fit to the data and explained 73.4% of the variability in the data compared to 60.3% with Euroline cutoffs.
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OP36
Comparing the Efficacy of Conventional Immunosuppression and Rituximab in Anti-SRP Myositis: Insights from A Tertiary Care Centre
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