Advancing a Preventive Rheumatology Agenda: Poster Session Abstracts

Interested physicians and scientists from around the world came together for the third time in a meeting organized by the Rheumatologic Dermatologic Society, led by Dr. Victoria Werth. The first meeting of the ICCLE group was in Dusseldorf, Germany in 2004, and the second in Kyoto, Japan in 2008. This time at least twelve different countries and four continents were represented. One aim of the meeting was to present and discuss updated information and ongoing research related to cutaneous lupus erythematosus (CLE) in order to maximize the exchange of ideas within a cooperative international group. Skin involvement in individuals with lupus erythematosus is common and variable. The current classification system has been the basis for the understanding of skin lesions in lupus since the late 1970s. There is a need for more uniform definitions, enhanced diagnostic criteria and more specific classification of CLE and systemic lupus erythematosus associated skin lesions. This would help consistency in the field clinically and in studies. Presentations were made and posters viewed. These covered such diverse aspects as the role of antimicrobial peptides in CLE, clinical subtypes of lupus seen in Asia, the epidemiology and prevalence of CLE, medications and cancer in Sweden, the current categorizations of CLE and lupus non-specific skin lesions, and the derivation and validation of Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. The second aim of the meeting was to review the history related to the current definitions, diagnosis and classification of CLE and lupus non-specific skin lesions. An approach to building consensus on these topics was discussed and the Delphi method was presented and initiated. This method has been used previously by the Outcome Measures in Rheumatology (OMERACT) rheumatoid flare group. Attendees were divided into three working groups, each with a moderator and a recorder of minutes. The moderator’s job was to address specific concerns related to key questions about definitions and diagnosis on the first day and the classification of CLE on the second day, and to assure that every member of the group had a chance to verbalize his or her ideas, as well as to promote interactive discussion. After each session, collated minutes were presented by each moderator to all participants. Points of agreement and disagreement within and between groups were highlighted. Conclusions Presentations successfully promoted discussion and interchange of ideas, as well as the ambience for cooperation. The initiation of the Delphi process for consensus building highlighted the need for a change in the categorization of skin related problems in lupus erythematosus. The definitions, diagnosis, and classification of CLE need updating and reorganizing to make them more functional for diagnosis and research data collection. The ideas collected are in the process of being organized and highlighted to begin a Delphi voting process and to build a consensus. Poster 2: Fit & Strong! An evidence based community exercise program for older adults with osteoarthritis Authors Gail Huber, PhD, PT, MHPE,1 (presenting author) Associate Professor of Physical Therapy Susan L. Hughes, DSW 2 (PI) Amy Shah, MPH 2 Renae Smith-Ray, PhD2 1 Northwestern University, Dept. of Physical Therapy & Human Movement Sciences. 2 University of Illinois at Chicago, Institute for Health Research & Policy Abstract Introduction There are 26.9 million older adults with osteoarthritis. Older adults with lower extremity osteoarthritis (OA) are at risk for the development of disability. Increasing physicalIntroduction There are 26.9 million older adults with osteoarthritis. Older adults with lower extremity osteoarthritis (OA) are at risk for the development of disability. Increasing physical activity in this population is one strategy that may prevent the functional limitations typically seen in those with OA. Goals Fit & Strong! is a multi-component program of exercise and education, designed to increase aerobic fitness, muscle strength and self-efficacy for exercise and adherence. The program is low cost and easily replicated so it can be offered in the community. Methods Fit & Strong! is a 24 session program meeting for 90 minutes, 3x/wk, consisting of 1 hour of exercise and 30 min. of education and discussion. Exercises are designed to address aerobic fitness, strength, flexibility and balance. The education component covers exercise, OA, and strategies to promote lifelong adherence to physical activity and exercise. Outcomes include: timed sit to stand, 6 minute walk test, WOMAC, selfefficacy (SE) for arthritis self-management, exercise, and exercise adherence. Two randomized controlled trials provide evidence for the efficacy of Fit & Strong! A third trial evaluating dissemination of the program has also been completed. Support materials include: participant and instructor manuals as well as a website. Results Study 1 recruited 215 subjects, 115 were randomized to receive the program. Significant findings were seen at 2 months. These included exercise adherence (p=.000), SE for exercise (p=.001), WOMAC stiffness (p= .018) and 6MWD (p=.007). Results were maintained at 6 and 12 months, and additional improvements were seen for pain and SE for exercise adherence with maintenance of the improved 6MWD. Distance walked at baseline by the exercise group (mean) 350.6 m.; increased to 397.2 m. at 2 mos; and 396.9 m at 6 mos., which is a meaningful improvement. Study 2, 443 participants received the program from certified exercise instructors randomized to different reinforcement strategies. The intervention again resulted in improvements in stiffness; 6MWD; and exercise adherence. Effects were also seen for timed stands test; self-efficacy for symptom management and managing exercise barriers. Study 3, Fit & Strong! is offered in 7 states at 55 sites. There are 169 trained instructors. The total number of participants to date is 2,475. The program has been approved as an Evidence-Based Program by the Centers for Disease Control and Prevention; the Administration on Aging and the National Council on Aging. Discussion Osteoarthritis is one of the most prevalent diseases found in the older adult population. Community based strategies that have proven efficacy and effectiveness are one important avenue for maintenance of independent function in this population. Fit & Strong! has been found to be effective in reducing pain & stiffness, and improving physical function. Adoption of an active lifestyle has benefits to individuals as well as society. Conclusion Fit & Strong! is an effective community based option for older adults with OA to manage their disease and develop the skills needed to remain active. It is important to include lifestyle strategies in preventing OA disability. Funding Centers for Disease Control (1R18 DP001140-01) National Arthritis Foundation NIAMS National Institute on Aging Roybal Center (P50 AG15890) National Institute on Aging (R01 AG23424) Retirement Research Foundation Poster 3: Seafood consumption and persistent organic pollutants as triggers of autoimmunity among Gullah African Americans Presenting Author Diane L. Kamen, MD, MSCR Associate Professor of Medicine, Medical University of South Carolina, Department of Medicine Abstract Introduction / Background Local seafood is a dietary staple among the African American Gullah population of South Carolina. High levels of persistent organic pollutants (POPs) have been found in local bottlenose dolphins, sentinel species for human health and consumers of many of the same fish as the Gullah. Links have been established between these bioaccumulating, ubiquitous compounds and deleterious health effects in humans. The objective was to determine whether levels of POPs, specifically perfluorinated compounds (PFCs), correlate with fish intake and markers of immune dysfunction in the Gullah, who have low non-African genetic admixture, environmental homogeneity, and a high prevalence of autoimmune diseases, particularly lupus.Introduction / Background Local seafood is a dietary staple among the African American Gullah population of South Carolina. High levels of persistent organic pollutants (POPs) have been found in local bottlenose dolphins, sentinel species for human health and consumers of many of the same fish as the Gullah. Links have been established between these bioaccumulating, ubiquitous compounds and deleterious health effects in humans. The objective was to determine whether levels of POPs, specifically perfluorinated compounds (PFCs), correlate with fish intake and markers of immune dysfunction in the Gullah, who have low non-African genetic admixture, environmental homogeneity, and a high prevalence of autoimmune diseases, particularly lupus. Goals / Hypotheses The overall hypothesis of the Persistent Organic Pollutants in Autoimmunity (POPAI) study is that POPs play a pathogenic role as environmental triggers of autoimmunity in genetically at-risk individuals. Methods At the onset of the Persistent Organic Pollutants in AutoImmunity (POPAI) study, one-onone interviews were conducted with Gullah community members to validate a comprehensive environmental exposure questionnaire. The validated questionnaire, including a seafood intake survey, was then administered prospectively to patients with lupus, first-degree relatives of lupus patients, and unrelated nonlupus controls participating in the SLE in Gullah Health (SLEIGH) study. PFC levels (PFOS, PFOA and PFNA), antinuclear antibody titers and other autoantibodies were measured in the serum of participants drawn at the time of their study visit. Results Initial surveys returned by 103 of the SLE in Gullah Health participants confirmed that local seafood consumption is common, with 57% reporting they consumed locally caught seafood at least once a month, 25% catch fish from shores/piers/bridges, and 91% consumed species known or suspected to contain high levels of POPs in the Charleston Harbor area. Interviews with Gullah community members found that the majority who fish either do not understand or mistrust the posted Fish Advisories warning of potentially hazardous contamination. Preliminary results from 53 Gullah controls show that all have measurable serum levels of PFCs (specifically PFOS, PFOA and PFNA) from baseline and follow-up visits 7.3 ± 1.4 years apart. Annual servings of seafood directly correlated with baseline serum PFOS (p=0.02) and PFNA levels (p=0.03) and the strongest correlation was with reported intake of seafood known to have the highest concentrations of PFCs. Local serum levels of PFCs among the Gullah at baseline (2003-2004) are significantly higher compared to NHANES non-Hispanic black serum levels from 2003-2004 (p<0.01 for PFOS, PFOA and p=0.01 for PFNA). ANA positive controls (48% of controls at baseline) had higher median levels compared to ANA negative controls for PFOS (62.3 vs 46.4 ng/ml, p=0.05), PFOA (6.1 vs 5.4, p=NS) and PFNA (2.8 vs 1.6, p=0.03). Conclusions Genetically at-risk, autoantibody-positive but clinically asymptomatic populations can give us valuable insights into environmental triggers of progression to autoimmune disease. These ongoing studies address concerns of the Sea Island Gullah community regarding the potential immune health effects of the bioaccumulating pollutants found in local dietary staples such as fish. Poster 4: Serum Urate Association with Hypertension in Young Adults: Analysis from the Coronary Artery Risk Development in Young Adults Cohort Presenting Author Kenneth G. Saag, MD, MSc Professor of Medicine and Epidemiology, University of Alabama at Birmingham Abstract Objective To determine if serum urate concentration is associated with development of hypertension in young adults.Objective To determine if serum urate concentration is associated with development of hypertension in young adults. Methods Retrospective cohort analysis from 4752 participants with available serum urate and without hypertension at baseline from the Coronary Artery Risk Development in Young Adults (CARDIA) study; a mixed race (African-American and White) cohort established in 1985 with 20 years of follow-up data for this analysis. Associations between baseline serum urate concentration and incident hypertension (de!ned as a blood pressure greater or equal to 140/90 or being on antihypertensive drugs) were investigated in sexstrati!ed bivariate and multivariable Cox-proportional analyses. Results Mean age (SD) at baseline was 24.8 (3.6) years for men and 24.9 (3.7) years for women. Compared with the referent category, we found a greater hazard of developing hypertension starting at 345 mmol/l (5.8 mg/dl) of serum urate for men and 214 mmol/l (3.6 mg/dl) for women. There was a 25% increase in the hazard of developing hypertension in men (HR1.25 (95% CI 1.15 to 1.36)) per each mg/dl increase in serum urate but no signi!cant increase in women (HR 1.06 (95%CI 0.97 to 1.16)). Conclusions We found a signi!cant independent association between higher serum urate concentrations and the subsequent hazard of incident hypertension, even at concentrations below the conventional hyperuricaemia threshold of 404 mmol/l (6.8