Session Information
Date: Monday, November 9, 2015
Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster Session II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Cystic fibrosis (CF) is a genetic disorder characterized by exocrine gland production of highly viscous mucus, leading to obstructive and inflammatory changes in the respiratory, digestive and reproductive systems. Musculoskeletal (MSK) burden in CF has historically been addressed in young adults when fewer therapies resulted in a greater infective and inflammatory pulmonary burden. Reported presentations included undifferentiated arthropathy, hypertrophic osteoarthropathy, fluoroquinolone induced arthropathy and osteoporosis. With an increasing lifespan and broader disease spectrum, the impact of CF on the MSK system warrants re-evaluation. Our objectives are to assess MSK burden, the prevalence of serologic and biochemical markers and the relationship of chronic infection to the MSK system in adult CF patients.
Methods:
We conducted a prospective cohort study of all adult patients in St. Michael’s Hospital CF clinic (n>400). To date, 163 subjects were recruited. Subjects completed MSK specific questionnaires; multidimensional health assessment questionnaire (MDHAQ), WOMAC, Osteoporosis and Fracture History. They were examined for tender and swollen joints. Serology (RF, ANA, anti-cyclic Citrullinated peptide (anti-CCP) antibodies, ESR, CRP and carboxy-terminal collagen crosslinks were obtained. MSK specific data was linked with the Toronto CF database, a comprehensive record of pulmonary and nutritional status, microbiology, and CF genotype.
Results:
Median age was 32 years; 86 males, 77 females. Median Routine Assessment of Patient Index data 3 (Rapid3) score was 1.33 (normal range: 0-10) and median WOMAC score was 1 (normal range: 0-96). Four subjects had at least 1 swollen joint and 24 had at least 1 tender joint. Seven subjects were RF positive (21-224), 14 were anti-CCP positive (5.1-229.5) and 20 were ANA positive (1.1-6.1). Two subjects had swollen joints and positive antibodies (RF and/or anti-CCP). There was no difference in median age (p=0.55), forced expiratory volume in 1 second (FEV1) % predicted (p=0.40), or proportion of females (p=0.13) between the MSK cohort and overall CF clinic patients. There was no significant association between lung function (FEV1), and antibody status. Stenotrophomonas maltophilia infections were associated with a significantly higher anti-CCP titre (p=0.03).
Conclusion:
In adult CF, MSK manifestations are mild. However, the prevalence of confirmed seropositive inflammatory arthritis is slightly higher than the general population (1.22%). The relationship between Stenotrophomonas maltophilia and anti-CCP titre warrants further investigation.
|
Baseline characteristics of the cohort (n-163) |
| Variable | Frequency/Median | Proportion/Range |
|
Gender Female Male |
77 86 |
47.2% 52.8% |
| Age at study visit | 31.6 | 18.4-69.1 |
| BMI | 22.8 | 15.9-39 |
|
Genotype Heterozygous dF508 Homozygous dF508 Missing Other |
72 59 8 24 |
44.2% 36.2% 4.9% 14.70% |
| FEV1 % predicted | 59.7 | 19.9-118.5 |
| CF related diabetes | 54 | 33.1% |
| Lung transplant | 9 | 5.5% |
|
Microbiology (n=144) Burkholderia cepacia complex Pseudomonas Staphylococcus aureus Stenotrophomonas maltophilia |
9 106 63 35 |
6.2% 73.6% 43.8% 24.3% |
|
Joints (n=97) Swollen Tender |
4 24 |
4.1% 24.7% |
| Rapid 3 score (n=160) | 1.33 | 0-6.86 |
| WOMAC score (n=161) | 1 | 0-68 |
|
Rheumatoid factor (n=150) <20 >20 |
143 7 |
95.3% 4.7% |
| Antinuclear antibodies (n=149) | 0.5 | 0.1-6.1 |
| Anti-cyclic Citrullinated peptide (n=150) | 0.4 | 0-229.5 |
| Carboxy-terminal collagen crosslinks (n=148) | 286.8 | 40-1153 |
| Vitamin D (n=150) | 64.5 | 8-155.8 |
| Fractures (n=158) | 66 | 41.8% |
To cite this abstract in AMA style:
Elarabi M, Griffin K, Mahendira L, Sykes J, Norris E, Stephenson A, Tullis E, Rubin L. Musculoskeletal and Serologic Findings in an Adult Cystic Fibrosis Clinic Population-a Systematic Review and Collation with Disease Status [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/musculoskeletal-and-serologic-findings-in-an-adult-cystic-fibrosis-clinic-population-a-systematic-review-and-collation-with-disease-status/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/musculoskeletal-and-serologic-findings-in-an-adult-cystic-fibrosis-clinic-population-a-systematic-review-and-collation-with-disease-status/