FRI0339 Adherence To Vaccination and Osteoporosis Prevention in A French Systemic Lupus Erythematosus Cohort
Authors: M. Scherlinger, A. Hourdillé, C. Pichon, T. Schaeverbeke, J.-F. Viallard, J.-L. Pellegrin, E. Lazaro, C. Richez
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which improvements in treatments have led to new challenges in patient care. Longer survival and patients aging come with long-term complications that the rheumatologists should work to recognize and prevent effectively. In fact, osteoporosis and infections bear a great importance in disease-related morbidity, mortality and care-related costs of SLE patients. <h3>Objectives</h3> Evaluate adherence to influenza and pneumococcal vaccination as well as to osteoporosis prevention in regard of the 2003 french recommendations, in a SLE patient cohort. Describe the factors associated with osteoporosis as well as with adherence to adequate vaccinal prevention. <h3>Methods</h3> We included all SLE patients (fulfilling the American College of Rheumatology criteria), seen from May 2014 to November 2014, in Rheumatology or Internal medicine department from Bordeaux teaching hospital, France. Using 2 questionnaires and medical records, informations concerning patients, disease-related characteristics and adherence to preventions were collected. Statistical analyze was made with appropriate tests regarding the type of data and a p-value &lt;0,05 was considered of statistical significance. <h3>Results</h3> One hundred and nine patients were included. There was 100 women (92%), mean disease duration was 9,9 years. Renal and neurologic involvement were present in 20 and 9% of patients respectively. At the time of the study 76% were receiving hydroxychloroquine, 57% corticoids with 34% of them on a dose ≥7,5mg prednisone/day and 57% had received an immunosuppressant. Twenty-one (19%) patients had an indication for anti-osteoporotic treatment. These patients were older (mean 54 versus 42 years, p&lt;8.10<sup>–4</sup>), had a longer use of corticosteroid (103.7 versus 62,5 months, p&lt;0.01) and a greater use of immunosuppressant (81% versus 51%, p&lt;0.01). Lombar and femoral head T-score were negatively correlated with SLICC-ACR damage index after excluding fractures from the score (b = -0,35 and -0,27; p&lt;0,006 and p&lt;0,03 respectively). Only 12/21 (57%) patients received the indicated anti-osteoporotic treatment, mainly by lack of prescription by the attending physician. Only 11 patients (10%) received both influenza and pneumococcal vaccines, 35% received influenza vaccination at least once and 18% received pneumococcal vaccination. Reasons for non-vaccination were: lack of recommendation by general practitioner or rheumatologist (51%), fear of side effects (29%), contraindication with lupus (14%), inefficiency (2%). Predictive factors for an appropriate vaccination for both vaccines were: higher SLICC-ACR damage index (p&lt;0,03) and past or current treatment with rituximab (p&lt;0,02). Longer disease duration was associated with a better vaccination against influenza (p&lt;0,02), and contact with elderly for pneumococcal vaccine (p&lt;0,04). <h3>Conclusions</h3> Osteoporosis treatment and infection prevention with influenza and pneumococcal vaccination remains low among SLE patients. Rheumatologists need to better implement these aspects in the global care of their SLE patients. <h3>Disclosure of Interest</h3> None declared