OP0132 PREVALENCE AND COMORBIDITIES OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE IN SPAIN: A RETROSPECTIVE ANALYSIS OF ELECTRONIC HEALTH RECORDS USING NATURAL LANGUAGE PROCESSING
Jose Andrés Román IvorraIsabel de la MorenaN. Costas TorrijoB. SafontJulia Fernández-MelonBrenda NunezL. Silva FernándezL. Cebrián MéndezL. LojoB. López-MuñizE. TralleroMaría López‐LasantaRaul María Veiga CabelloMaria Del Pilar Ahijado GuzmanD. BenaventD. VilanovaR. Castellanos MoreiraS. Lujan Valdés
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Background Interstitial lung disease (ILD) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA) and leads to a significantly increased risk for morbidity and mortality compared with RA alone [1]. The analysis of Electronic Health Records (ERHs) using machine learning (ML) and Natural Language Processing (NLP) holds great promise to better characterize the disease in real-world settings. Objectives This study aims to a) estimate the prevalence of RA in Spain, b) determine the frequency of RA-ILD among RA patients, and c) describe the demographic and clinical characteristics in RA/RA-ILD patients. Methods Observational, retrospective, and multicenter study based on the secondary use of unstructured clinical data in EHRs from 6 Spanish hospitals between January 1, 2014 and December 31, 2019. The free-text information from patients’ records was captured with SAVANA’s EHRead , a validated NLP technology which extracts clinical information from EHRs and standardizes it into a SNOMED-CT-based clinical terminology [2]. The study population comprised all adult patients ≥18 years with RA in the selected period and sites. Descriptive statistics were presented in summary tables. Prevalence was calculated dividing the total number of patients with RA over the total number of attended patients. This analysis was performed by age and sex. Results Among all attended patients in the participating hospitals within the study period, 11,163 patients with RA were identified; of these, 8.6% (n = 959) had RA-associated ILD (RA-ILD). The age-adjusted prevalence of RA is shown in Figure 1. The estimated prevalence (95% CI) in the overall population was 0.49 (0.37-0.60), being 0.26 (0.19-0.32) in males and 0.71 (0.54-0.87) in females. Most patients in the RA (73.9%; n = 8,250) and RA-ILD populations (63.3%, n = 607) were female (Table 1). The median age (Q1, Q3) was 60.8 (49, 74) and 67 (56, 77) years in the RA and RA-ILD groups, respectively. Regarding disease course, the time from RA to ILD diagnosis was 27.6 (3.7, 73.2) months. Most comorbidities presented higher rates in the RA-ILD population, as shown in Table 1. Among patients with available ILD subtype information (n = 618), the most common was usual interstitial pneumonia (29.8%; n = 184). Table 1. Demographics and comorbidities in the RA and RA-ILD patient populations RA* N=11,163 RA-ILD N=959 Gender, n (%) Female 8,250 (73.9) 607 (63.3) Male 2,913 (26.1) 352 (36.7) Age at first mention of disease (years) 1 Median (Q1, Q3) 61 (49, 74) 67 (56, 77) Comorbidities, n (%) Dyslipidaemia 4369 (39.1) 316 (33) Hypertension 3851 (34.5) 320 (33.4) Diabetes mellitus 2970 (26.6) 248 (25.9) Infections 2129 (19.1) 328 (34.2) Bone fracture 1875 (16.8) 210 (21.9) Osteoporosis 1275 (11.4) 150 (15.6) Malignancies 1004 (9) 169 (17.6) Kidney failure 1006 (9) 156 (16.3) Heart failure 993 (8.9) 184 (19.2) Depression 825 (7.4) 99 (10.3) Psoriasis 773 (6.9) 39 (4.1) Obesity 732 (6.6) 90 (9.4) Asthma 740 (6.6) 82 (8.6) Atrial Fibrillation 729 (6.5) 102 (10.6) *RA includes patients in the RA-ILD population. 1 Patients’ age when either RA or ILD was first detected in the EHRs. RA = rheumatoid arthritis; ILD = interstitial lung disease Conclusion This pioneering study is the first to characterize RA-ILD using NLP methodology in a multicenter setting. By analyzing readily available real-world data in patients EHRs, we were able to estimate the prevalence of RA in the Spanish population and describe the demographic and clinical characteristics of patients with RA/RA-ILD. References [1]Bongartz T, Nannini C, Medina-Velasquez YF et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis and rheumatism 2010; 62: 1583-1591. [2]Canales L, Menke S, Marchesseau S et al. Assessing the Performance of Clinical Natural Language Processing Systems: Development of an Evaluation Methodology. JMIR Med Inform 2021; 9: e20492. Acknowledgements RA-W-ILD Study Group Disclosure of Interests Jose Andrés Román Ivorra Speakers bureau: AbbVie, Bristol Myers Squibb, FER, Galápagos, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, FER, Galápagos, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Grant/research support from: AbbVie, Bristol Myers Squibb, FER, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Isabel de la Morena Speakers bureau: Pfizer, Novartis, Janssen, AbbVie, MSD, UCB, Sanofi, Roche, Nordic, Lilly, NEREA COSTAS TORRIJO Speakers bureau: UCB, Novartis, Pfizer, Belen Safont Speakers bureau: AstraZeneca, Roche, Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, J. Fernández-Melón Speakers bureau: Bristol Myers Squibb, UCB, Galapagos, Belen Nuñez Speakers bureau: Boehringer Ingelheim, Roche, Bristol Myers Squibb, Grant/research support from: Boehringer Ingelheim, Roche, Lucía Silva Fernández Speakers bureau: Bristol Myers Squibb, Consultant of: Novartis, MSD, Laura Cebrián Méndez Speakers bureau: Pfizer, Lilly, Gebro, Novartis, Consultant of: Pfizer, Leticia Lojo Consultant of: UCB, Belén López-Muñiz Speakers bureau: Boehringer Ingelheim, Roche, AstraZeneca, Novartis, Mundipharma, Gebro, GlaxoSmithKline, Ernesto Trallero Speakers bureau: Amgen, MSD, Maria Lopez Lasanta: None declared, Raul Maria Veiga Cabello: None declared, Maria Del Pilar Ahijado Guzman: None declared, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Employee of: Savana, David Vilanova Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Celgene, Raul Castellanos Moreira Speakers bureau: Lilly, Pfizer, Roche, Sanofi, UCB, Bristol Myers Squibb, Consultant of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sara Lujan Valdés Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers SquibbKeywords:
Health records
Background: Rheumatoid arthritis is a systemic autoimmune disease characterized by chronic joint inflammation and subsequent destruction.It also associates with excessive cardiovascular morbidity and mortality similar to metabolic syndrome which reflects a clustering of classical cardiovascular risk factors.This study is designed to investigate the Prevalence of Metabolic syndrome in rheumatoid arthritis patients and possible association to disease related risk factors.Material and Methods: The subjects were 203 patients with rheumatoid arthritis diagnosed according to the American College of Rheumatology criteria while metabolic syndrome was defined according to National Cholesterol Education Program criteria.Results: The overall prevalence of metabolic syndrome in rheumatoid arthritis patients was 51.2 %; being higher in women than men.Women with metabolic syndrome had a higher prevalence of Cardiovascular disease than those without metabolic syndrome (p = 0.004).Significant differences were observed in traditional cardiovascular disease risk factors which are common in rheumatoid arthritis with metabolic syndrome (p < 0.001).Conclusion: The prevalence of metabolic syndrome is high in patients with rheumatoid arthritis.The correlation of rheumatoid arthritis disease with metabolic syndrome suggests that the increased prevalence of Cardiovascular disease in patients with rheumatoid arthritis may be attributed to the inflammatory burden of the disease in addition to traditional Cardiovascular disease risks of metabolic syndrome.
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The results of treatment of 73 transcervical and 49 extracapsular fractures of the femoral neck in patients with rheumatoid arthritis were compared with the results in 152 normal patients. In undisplaced transcervical fractures that were internally fixed and followed up for more than six months, there was no significant difference in results between the rheumatoid patients (5 acceptable results in 8 patients) and the control patients (8 acceptable results in 9 patients). In displaced fractures, when internally fixed, the rheumatoid group (8 acceptable results in 27 patients) did significantly less well than the control group (17 acceptable results in 30 patients). In hips affected by the disease, the results were worse (1 acceptable result in 9 patients). Hemiarthroplasty gave acceptable results in two-thirds of the rheumatoid patients with transcervical fractures, whether used as primary treatment of displaced fractures or as revision of failed pinnings. This was not affected significantly by the presence of disease in the joint. In extracapsular fractures, the presence of rheumatoid arthritis, whether or not it affected the hip, did not appear to affect the outcome. The presence of osteoporosis was associated with poor results.
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In this prospective study, 50 patients with a confirmed diagnosis of rheumatoid arthritis had total hip replacement. Preoperatively and at regular intervals postoperatively, all patients had evaluation of pain, ambulation, and range of motion according to the scale of d'Aubigne and Postel. Follow-up ranged from three to seven years, with the average being longer than four years. All patients demonstrated significant improvement in these parameters. Specific problems of the rheumatoid patient are discussed in detail.
Hip pain
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the investigator, could constitute a risk when taking investigational product or could interfere with the interpretation of data
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It is important that to give to consideration the optimal timing and order when performing multiple joint arthroplasties of lower extremities in patients with rheumatoid arthritis. We report our experience with 30 patients treated over a 15 year period.Their age at the time of first operation ranged from 32-72 years (average 55.3 years). The duration of their rheumatoid disease ranged from 9-49 years (average 22 years). We have followed the patients for 1-12 years (average 5.3 years).In patients with multiple joint destructive in the lower extremities, the first therapy to be performed should be correction of painful toe deformities. Secondary the most painful joint was operated on.Patients requiring multiple joint arthroplasties during one admission, or patients with cervical or lumbar spondilotic disturbance, and with joint destruction of upper extremities valued their total functional requirements and, decided their goal of therapy and in which order this should be achieved. When this was done, therapy. Produced good results.
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The therapeutic results of anti-rheumatic agents in the treatment of rheumatoid arthritis were as follows:These agents had good effects in acute signs and symptomes, but when the agents were discontinued, signs and symptomes reappeared, the ill-effects in the cases of cortisone and ACTH were absent, and in T. T. G and Salcylamid were slight. In Irgapyrin, edema was observed, but agranulocytosis was absent.
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