POS1426 PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES ARE OVERREPRESENTED IN LOW- FREQUENCY VIRAL SYMPTOM CLUSTERS
Authors: K. Tascilar, D. Simon, G. Krönke, A. Kleyer, A. Ramming, R. Atreya, M. Tenbusch, K. Überla, C. Berking, M. Sticherling, M. F. Neurath, G. Schett
Journal: Annals of the Rheumatic Diseases (2021)

Background: Viral respiratory infections are common in the general population and result in a spectrum of outcomes ranging from effective viral clearance with no symptoms, to a maladaptive immune response that can result in severe symptomatic disease and death. Although patients with immune-mediated inflammatory diseases (IMID) are considered susceptible to poor outcomes from infectious syndromes, it is not known whether IMID patients are overall more prone to manifest common viral infection symptoms. Objectives: To explore frequency patterns of common viral infection symptoms in IMID patients. Methods: We previously recruited patients with IMIDs and individuals with no IMIDs for a seroprevalence study between February 1 st and April 30 th 2020 (1). Participants were questioned for the presence of eleven common viral disease symptoms. We clustered these data using an unsupervised binary data clustering algorithm (2) into 6 symptom clusters based on symptom frequency. Three major clusters (broadly symptomatic, intermediately symptomatic and oligo-/asymptomatic) and 2 sub-clusters (higher and lower frequency) for each major cluster. In addition, qualitative symptom clustering was done. We estimated standardized residuals to quantify the over/underrepresentation of IMID diagnosis frequencies in each subject cluster. We used Poisson regression to compare symptom counts by diagnosis. Results: We analyzed 1909 participants (757 with IMIDs; 1152 non-IMID controls; Table 1). Within each major subject cluster (Figure 1A), IMID patients showed the highest positive deviation from the expected frequencies in lower frequency sub-clusters while non IMID controls showed the highest positive deviations in the higher frequency sub-clusters (Figure 1B). Inflammatory bowel disease and psoriasis were remarkably overrepresented in the lower frequency sub-cluster of the broadly-symptomatic cluster while RA was overrepresented in the lower frequency sub-clusters of intermediate and oligo-/asymptomatic clusters. X axis of Figure 1A presents qualitative symptom clusters. Regression analysis shows that RA patients among other IMIDs reported overall less symptoms (RR= 0.69, 95%CI, 0.58 - 0.80) compared to non-IMID controls. Figure 1. A) distribution of common viral respiratory disease symptoms across patient and symptom clusters. B) Standardized residuals indicating deviation from expected frequencies of IMID diagnoses across patient clusters. sob: shortness of breath, mskpain: musculoskeletal pain Conclusion: This analysis shows that symptoms of common respiratory viral infections are less frequent in RA patients and to a lesser extent in other IMID patient. As major clusters in this analysis can also be considered to represent exposure categories, these data suggest that IMIDs or their treatments may mitigate common respiratory viral infection symptoms. References: [1]Simon D. et al. Nat Commun (2020) 11, 3774 [2]Bhatia P. et al. J. Stat. Softw (2017) 76(9) Table 1. Participant characteristics and distribution of IMID diagnoses across subject clusters. Clusters Broad Symptomatic Intermediate Symptomatic Oligo-Asymptomatic Overall Higher Lower Higher Lower Higher Lower N 1909 101 85 412 259 283 769 Age, years, mean (SD ) 45.4 (15.2) 42.4 (13.3) 47.3 (15.2) 42.4 (12.9) 50.4(15.5) 41.8 (14.9) 46.8(15.9) Male 1080 (56.6) 42 (41.6) 38 (44.7) 196 (47.6) 137 (52.9) 178 (62.9) 489 (63.6) Diagnosis, n(% ) No-IMID 1152 (60.3) 72 (71.3) 44 (51.8) 280 (68.0) 112 (43.2) 207 (73.1) 437 (56.8) RA 226 (11.8) 7 (6.9) 5 (5.9) 29 (7.0) 56 (21.6) 17 (6.0) 112 (14.6) IBD 178 (9.3) 5 (5.0) 15 (17.6) 46 (11.2) 29 (11.2) 19 (6.7) 64 (8.3) SpA 142 (7.4) 7 (6.9) 5 (5.9) 23 (5.6) 25 (9.7) 14 (4.9) 68 (8.8) Psoriasis 89 (4.7) 4 (4.0) 9 (10.6) 14 (3.4) 8 (3.1) 13 (4.6) 41 (5.3) Other 122 (6.4) 6 (5.9) 7 (8.2) 20 (4.9) 29 (11.2) 13 (4.6) 47 (6.1) Symptom count/patient, mean (SD ) 1.2 (1.7) 6.0 (1.3) 3.9 (1.1) 2.2 (1.0) 1.5 (0.6) 0.5 (0.5) 0.0 (0.0) IBD, inflammatory bowel disease. Acknowledgements: This study was supported by the Deutsche Forschungsgemeinschaft (DFG- FOR2886 PANDORA and the CRC1181), the Bundesministerium für Bildung und Forschung (BMBF; project MASCARA), the H2020 GA 810316 - 4D-Nanoscope ERC Synergy Project, the IMI funded project RTCure, the Emerging Fields Initiative MIRACLE of the Friedrich-Alexander-Universität Erlangen-Nürnberg as well as the Schreiber Stiftung gemeinnützige Gesellschaft mbH. Disclosure of Interests: None declared