A practical approach to the endoscopic management of biliary strictures after liver transplantation

Biliary tract complications are an important cause of morbidity and mortality after liver transplantation (LT) occurring in 5% to 25% of patients. The most common biliary complication in LT recipients are strictures representing approximately half of these biliary adverse events. Bile duct strictures can be divided into anastomotic biliary strictures (ABS) and non-anastomotic biliary strictures (NABS) depending on their location in the biliary tree, being ABS the most encountered type. Several risk factors identified in previous studies can predispose to the development of ABS and NABS, especially those related to surgical techniques and donor characteristics. Magnetic resonance cholangiopancreatography (MRCP) is the recommended noninvasive imaging test for detecting post-LT biliary strictures, given its high sensitivity and specificity. Once the diagnosis of a biliary stricture after LT has been made, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred initial therapy with good short and long-term results. Biliary sphincterotomy plus balloon dilation (BD) with placement of multiple plastic stents (MPS) has been the classic endoscopic approach for treating ABS, although fully-covered metallic stents (FCSEMS) have emerged as an alternative thanks to shorter total duration of stenting and fewer endoscopic procedures compared to MPS. In this review, we provide a practical update on the management of biliary strictures after LT, focusing our attention on the available evidence in the endoscopic therapy.

Securing the diagnosis of HRS-AKI: implications for current therapies

INTRODUCTION

Hepatorenal syndrome (HRS)-acute kidney injury (HRS-AKI) is a specific type of kidney injury seen in patients with cirrhosis and ascites and is associated with high mortality and morbidity. It is characterized by rapid deterioration of renal function due to reduced renal blood flow secondary to portal hypertensive splanchnic and systemic vasodilation. Early diagnosis and treatment of HRS-AKI are associated with greater likelihood of improvement in renal function, lower need for dialysis, and better post-transplant outcomes.

AREAS COVERED

This review discusses the diagnostic criteria for HRS-AKI, which has undergone several key changes over the last decade, with an aim to secure an early diagnosis and aid swift treatment initiation. Additionally, this review outlines the current treatment paradigms for HRS-AKI.

EXPERT OPINION

In the last 20 years, there have been several advances in understanding the pathophysiology and natural course of HRS-AKI. These have led to critical changes in its definition and diagnostic algorithm. However, prognosis of HRS-AKI remains dismal with no significant improvement in HRS-AKI reversal or HRS-related mortality over this time. We discuss several gaps in the current understanding and management of HRS-AKI that will benefit from further research.

Respiratory events with terlipressin and albumin in hepatorenal syndrome: A review and clinical guidance

Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a serious complication of severe liver disease with a clinically poor prognosis. Supportive care using vasoconstrictors and intravenous albumin are the current mainstays of therapy. Terlipressin is an efficacious vasoconstrictor that has been used for 2 decades as the first-line treatment for HRS-AKI in Europe and has demonstrated greater efficacy in improving renal function compared to placebo and other vasoconstrictors. One of the challenges associated with terlipressin use is monitoring and mitigating serious adverse events, specifically adverse respiratory events, which were noted in a subset of patients in the recently published CONFIRM trial, the largest randomized trial examining terlipressin use for HRS-AKI. In this article, we review terlipressin's pharmacology, hypothesize how its mechanism contributes to the risk of respiratory compromise and propose strategies that will decrease the frequency of these events by rationally selecting patients at lower risk for these events.

Motorized Spiral Enteroscopy Is Effective in Patients with Prior Abdominal Surgery

BACKGROUND

Motorized Spiral Enteroscopy (MSE) reduces procedure time and increases insertion depth into the small bowel; however, there is scarce evidence on factors affecting MSE efficacy.

AIMS

To evaluate diagnostic yield and adverse events of MSE including patients with prior major abdominal surgery.

METHODS

A prospective observational study was conducted on patients undergoing MSE from June 2019 to December 2021. Demographic characteristics, procedure time, depth of maximum insertion (DMI), technical success, diagnostic yield, and adverse events were collected.

RESULTS

Seventy-four anterograde (54.4%) and 62 retrograde (45.6%) enteroscopies were performed in 117 patients (64 males, median age 67 years). Fifty patients (42.7%) had prior major abdominal surgery. Technical success was 91.9% for anterograde and 90.3% for retrograde route. Diagnostic yield was 71.6% and 61.3%, respectively. The median DMI was 415 cm (264-585) for anterograde and 120 cm (37-225) for retrograde enteroscopy. In patients with prior major abdominal surgery, MSE showed significantly longer small bowel insertion time (38 vs 29 min, p = 0.004), with similar diagnostic yield (61 vs 71.4%, p = 0.201) and DMI (315 vs 204 cm, p = 0.226). The overall adverse event rate was 10.3% (SAE 1.5%), with no differences related to prior abdominal surgery (p = 0.598). Patients with prior surgeries directly involving the gastrointestinal tract showed lower DMI (189 vs 374 cm, p = 0.019) with equal exploration time (37.5 vs 38 min, p = 0.642) compared to those with other abdominal surgeries.

CONCLUSIONS

MSE is effective and safe in patients with major abdominal surgery, although longer procedure times were observed. A lower depth of insertion was detected in patients with gastrointestinal surgery.

AB0519 ELECTROCARDIOGRAPHIC ALTERATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND CONTROLS

Background

Systemic lupus erythematosus (SLE) is an autoimmune disease with a high prevalence worldwide. Patients with SLE have a higher frequency of developing cardiovascular disease than the general population. There is little evidence on conduction abnormalities and arrhythmias in patients with SLE(1).

Objectives

The aim of this study is to compare electrocardiogram alterations in patients with SLE and a control group.

Methods

A cross-sectional, observational, comparative study was performed. A total of 70 patients with SLE, and 70 controls matched for age (± 5 years) and gender were recruited. An electrocardiogram was performed in all study subjects. Kolmogorov-Smirnov test was used for distribution analysis. Comparisons were performed by Chi-square test for qualitative variables and Student’s t-test or Mann Whitney U test for quantitative variables. A p value <0.05 was considered statistically significant.

Results

In electrocardiogram findings, a significant difference was found in QRS segment duration (84.00 vs 89.50 ms, p=0.012), QT segment duration (397.01 vs 384.44 ms, p=0.016) and heart rate (68.60 vs 74.77, p=0.03) (Table 1).

Table 1.

ECG comparison between SLE and controls.

CharacteristicsPacientes with SLE(n=70)Controls(n=70)PAge (years), median (p25-p75)35.0 (25.0-50.2)35.0 (22.7-50.2)NSFemale, n (%)63 (90)64 (91.4)NSQRS (ms), median(p25-p75)89.50 (84.75-95.50)84.00 (80.00-90.00)0.012QT (ms), mean ± SD384.44 ± 30.84397.01 ± 30.210.016HR (Bpm), mean ± SD74.77 ± 12.9368.60 ± 11.250.003

ECG; electrocardiogram, SLE; systemic lupus erythematosus, NS; not significant, HR; heart rate, MS; milliseconds, BPM; beats per minute.

Conclusion

The results suggest that patients with SLE have increased QRS segment, increased heart rate and decreased QT segment duration, which may be related to disturbances of the conduction system.

References

[1]Tselios K, Gladman DD, Harvey P, Su J, Urowitz MB. Severe brady-arrhythmias in systemic lupus erythematosus: prevalence, etiology and associated factors. Lupus. 2018;27(9):1415–23.

Disclosure of Interests

None declared

POS1433 OBSTETRIC OUTCOMES OF MEXICAN WOMEN WITH AUTOIMMUNE RHEUMATIC DISEASES

Background

Autoimmune rheumatic diseases(ARDs) are more prevalent in women during childbearing age. These women have an increased risk of adverse pregnancy outcomes and maternal morbidity than general obstetric population(GOP)

Objectives

The objective this study was to evaluate the obstetric outcomes in Mexican women with ARDs

Methods

A retrospective and descriptive study was conducted in a pregnancy and rheumatic disease clinic of a university hospital in Northeast Mexico from Jan 2017 to Dec 2020. All data were collected from the medical records of childbearing age women with ARDs enrolled in our clinic at the time of their pregnancy and childbirth. Patients with non-inflammatory rheumatic diseases were excluded. The obstetric, maternal, and fetal outcomes were compared with the rate of adverse perinatal outcomes of the GOP (n=31,254) database from the same institution. Sociodemographic and clinical characteristics of the population are described. We used the Mann–Whitney U, Chi-square, or Kruskal–Wallis tests to analyze the differences between groups. A p<0.05 was considered statistically significant. The statistical analysis was performed with SPSS v.24 statistical software (IBM, NY).

Results

A total of 62 pregnancies in women with ARDs were included. RA (n=24, 38%) was the most frequent diagnosis followed by SLE (n=14, 22.5%) and APS (n=9, 14.5%). The median maternal age at conception was higher in pregnancies with ARDs than GOP(p<0.001). Table 1 shows the pregnancy and product outcomes between groups. Maternal age ≥ 35 years was also more frequent in the ARDs group(p<0.001). The birth weight was lower in ARDs group than GOP(p=0.007). The odds of preterm delivery were increased in ARDs group(p=0.038)

Table 1.

Pregnant outcome, maternal, fetal, and neonatal adverse events

ARD(n=62)GOP(n=31254)OR(CI 95%)pPregnancy outcomePregnancy lossa6(9.68)1560(4.99)1.94(0.84-4.49)0.122Live birthsa60(90.9)29694(95)0.96(0.67-1.35)0.8Gestational age, median (IQR)(weeks)b37.6(37-39)39(38-40.2)-0.001Birth weight, mean (CI)(Kg)c2831.6 (2677.4-2985.8)3022.2 (2986.8-3057.6)-0.007Maternal adverse eventsPreterm deliveries<37 weeksa14(23.7)3821(12.2)1.85(1.03-3.3)0.038<34 weeksa3(5.1)1065(3.4)1.42(0.45-4.53)0.553Gestational diabetesa4(6.5)1406(4.5)1.43(0.52-3.95)0.485Preeclampsiaa5(8.1)2471(7.89)1.02(0.41-2.54)0.97Postpartum hemorrhagea0930(2.97)0.27(0.017-4.35)0.355Emergency cesarean sectiona8(12.9)1844(5.9)2.19(1.05-4.57)0.037Maternal deatha031(0.09)7.94(0.48-131.2)0.148Fetal adverse eventsMiscarriagesa3(4.8)663(2.12)2.28(0.71-7.29)0.164Stillbirthsa3(4.8)897(2.87)1.69(0.53-5.38)0.377Congenital anomaliesa4(6.5)1094(3.5)1.84(0.67-5.08)0.237Neonatal adverse eventsLow birthweight (<10th percentile)a7(12.3)3782(12.1)0.933(0.43-2.04)0.862Very low birthweight (<3rd percentile)a3(5.3)813(2.6)1.86(0.58-5.93)0.294Low Apgar scores at 5 minutes (<7)a4(7.02)1781(5.7)1.13(0.41-3.12)0.81

Values in bold denote statistical significance (<0.05)

a n, %

b IQR, interquartile range (25th–75th percentile)

c CI, confidence interval (95%)

The most common fetal adverse event was congenital anomalies in both groups with no significant difference(p=0.237). The most frequent neonatal adverse events were low birthweight(<10th percentile) and a low Apgar score at 5 minutes(<7pts) in both groups

The prevalence of cesarean section was higher in the ARDs group(p=0.016). The distribution of indications for cesarean sections is shown in Figure 1.

Conclusion

Pregnant women with ARDs had a higher median maternal age at conception, lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications in this population

References

[1]Strouse J, et al. (2019) Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study. RMD open, https://doi.org/10.1136/rmdopen-2018-00087

Disclosure of Interests

None declared

AB1170 IMPACT IN PRENATAL EVALUATION OF PREGNANT WOMEN WITH RHEUMATIC DISEASES BY THE SARS-COV2 PANDEMIC

Background

Due to the SARS-CoV-2 pandemic, an increase in stress, anxiety, and depression has been seen, as well as greater use of substances and a decrease in prenatal care in pregnant women. (1) Women of childbearing age with autoimmune rheumatic diseases (ARDs) experience greater psychological stress, which can negatively influence behavior. (2)

Objectives

This study aims to compare changes in prenatal laboratory and ultrasound tests by trimester, as well as the detection of anxiety and depression in pregnant women with ARDs due to the SARS CoV-2 pandemic.

Methods

This study was carried out on pregnant patients with ARDs from the Pregnancy and Rheumatic Diseases clinic of the rheumatology department of the University Hospital “Dr. José Eleuterio González” during the period from February 2018 to August 2021.

Two standardized evaluations of anxiety and depression were carried out using the Inventory of Trait and State Anxiety (IDARE) and the Edinburgh Postpartum Depression Scale (EPDS) respectively in the third trimester of pregnancy. Maternal report of alcohol consumption during any trimester of pregnancy, as well as adherence to routine laboratory studies such as structural ultrasound and gestational diabetes screening, was addressed.

Positive COVID-19 nasopharynx PCR results were evaluated during pregnancy beginning in the pandemic period (March 2020). The pre-pandemic recruited group was compared with the pandemic group.

The comparison of the groups was carried out using the Chi-Square and Fisher tests. A significant value of p < 0.05 was considered. Statistical analysis was performed using the IBM SPSS v.25 program.

Results

50 pregnant patients with ARDs were recruited, of which 24 were included in the pre-pandemic group and 26 in the pandemic group. Compared with the pre-pandemic group, pregnant women recruited during the pandemic had a statistically significant higher positivity for state anxiety (p=0.023), likewise trait anxiety, depression, and suicidal ideation were detected more frequently, but the difference was not statistically significant, a higher rate of adherence to laboratory and cabinet studies was found, being significant for laboratories performed in the 1st and 2nd trimesters (0.005 and 0.025 respectively). See Table 1.

Table 1.

Characteristics of pregnant women with autoimmune rheumatic diseases before and during the SARS-CoV-2 pandemic.

MeasureBefore pandemicn=24During pandemic Covid Negativen=22During pandemic Covid Positiven=4P valueaEPDS Positive depression detection (≥10)16.7%36.4%50%.197suicidal ideation16.7%0%25%.099IDARE Positive state anxiety detection (>45)12.5%27.3%75%.023IDARE Positive trait anxiety detection (>45)8.3%13.6%50%.204Any alcohol consumption during pregnancy20.8%4.5%0%.176Structural Ultrasound – Mid-Pregnancy66.7%95.5%100%.025Gestational diabetes screening75%86.4%100%.376LaboratoriesFirst trimester20.8%50%0%0.005Second quarter45.8%77.3%100%0.025Third trimester58.3%81.8%75%0.216

IDARE= State and Trait Anxiety Inventory, EPDS= Edinburgh Postpartum Depression Scale.

A Chi-square test for categorical variables or Fisher’s exact test where the expected cell n

Conclusion

A higher frequency of positivity for state anxiety was demonstrated in pregnant women with ARDs recruited during the pandemic, as well as higher trait anxiety, depression, and suicidal ideation, although this increase was not statistically significant. On the other hand, concern about the pandemic and health status could positively influence better adherence to screening and routine studies during pregnancy.

References

[1]Johnson D, Dave H, Cd LYC. Pandemic-Associated Complications in Pregnant Women with Rheumatic Diseases.:261.

[2]Skinner-Taylor CM, Perez-Barbosa L, Corral-Trujillo ME, Perez-Onofre I, Barriga- Maldonado ES, Cardenas-de la Garza JA, et al. Anxiety and depression in reproductive age women with rheumatic diseases. Rheumatology International [Internet]. 2020;40(9):1433–8. Available from: https://doi.org/10.1007/s00296-020-04591-8

Disclosure of Interests

None declared

AB0520 ASSOCIATION BETWEEN LEFT VENTRICULAR MASS INDEX AND BODY WEIGHT IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Rheumatoid cachexia is a clinical spectrum of rheumatoid arthritis in which individuals present increased inflammatory activity, more aggressive joint destruction, and worse cardiovascular prognosis (1). Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease in which there is a high cardiovascular mortality rate (2). Currently, the cachexia phenomenon in SLE patients has not been studied.

Objectives

To correlate body weight with left ventricular (LV) indexed mass in SLE patients.

Methods

This was a cross-sectional study that included a total of 34 patients aged ≥18 years with a diagnosis of SLE according to EULAR/ACR 2019 criteria. Patients with a personal pathological history of cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease) and pregnancy were excluded. Three certified cardiologists performed a transthoracic echocardiogram in each patient, assessing relative wall thickness, and indexed LV mass.

The distribution was assessed with Kolmogorov-Smirnov. Correlations between weight and echocardiographic parameters with Spearman-rho coefficient. A value of p<0.05 was considered statistically significant.

Results

Most patients were female (94.1%), with a mean age of 33.29±9.91. Of the total patients 2 (5.88%) had Type 2 Diabetes Mellitus, 2 (5.88%) hypertension, 1 (2.94%) dyslipidemia, 3 (8.82%) obesity, and 6 (17.64%) smoking. Spearman-rho coefficient showed a significant negative correlation between LV indexed mass and body weight of SLE patients (rho=-0.411, p=0.016) (Figure 1).

Figure 1.

Spearman rho correlation between weight and LV indexed mass.

Conclusion

There is a negative correlation between body weight and LV indexed mass in SLE patients, this suggests that a lower body weight may be related to higher LV mass, which may result in LV hypertrophy and increased cardiovascular morbidity and mortality.

References

[1]Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol [Internet]. 2010;6(8):445–51. Available from: http://dx.doi.org/10.1038/nrrheum.2010.105

[2]Lee YH, Choi SJ, Ji JD, Song GG. Overall and cause-specific mortality in systemic lupus erythematosus: An updated meta-analysis. Lupus. 2016;25(7):727–34.

Disclosure of Interests

None declared

AB0220 FACTORS ASSOCIATED WITH CAROTID INTIMA MEDIA THICKNESS REDUCTION IN RHEUMATOID ARTHRITIS PATIENTS: A FOLLOW-UP STUDY

Background

Rheumatoid arthritis (RA) patients have higher risk of developing cardiovascular (CV) events than the general population. Traditional CV risk algorithms have been shown to underestimate the real CV risk of RA patients (1). For this reason, current CV risk guidelines state that a carotid ultrasound could be considered as part of the CV evaluation of these patients.

Objectives

To describe the carotid ultrasound changes in the follow-up of RA patients, and to compare demographic and disease characteristics in patients who had a reduction of carotid intima media thickness (cIMT) and those who did not.

Methods

Longitudinal, observational, and prospective study. A total of 39 RA patients were included in this study. A first evaluation, including a carotid ultrasound, laboratory analyses, and clinical history, was performed at the time of inclusion. Posteriorly a follow-up carotid ultrasound was performed. Patients were divided into two groups, those with reduction of cIMT in both carotid arteries, and those who remained with the same measurements or had an increase of cIMT. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.

Results

Median follow-up was 4.66 (4.33-5.00) years. When evaluating changes in the carotid ultrasound findings, 15 (38.5%) patients developed CP, 8 (20.5%) patients developed bilateral CP, and 10 (25.6%) patients had a reduction of cIMT at the follow-up (Figure 1). When comparing baseline characteristics, we found that patients with reduction of cIMT were younger (48.88 years vs 59.30 years, p = 0.004), with a lower prevalence of dyslipidemia (0% vs 34.5%, p = 0.040), had lower levels of erythrocyte sedimentation rate (ESR) (14.50 mm/h vs 28.0 mm/h, p = 0.024), and had higher prevalence of normal levels of ESR (<20 mm/h) (80.0% vs 27.6%, p = 0.007) than patients who remained with the same measurements or had an increase of cIMT (Table 1). A multivariate analysis was performed, including variables with a p-value < 0.05, and we found that normal ESR was an independent factor associated with reduction of cIMT, with an OR 8.63 (1.27-58.33), p = 0.027.

Table 1.

Baseline characteristics of patients with and without reduction of cIMT.

Baseline characteristicsPatients with cIMT reduction (n=10)Patients without cIMT reduction (n=29)p-valueDemographic characteristicsAge, years, mean ± SD48.88 ± 8.5959.30 ± 9.460.004T2DM, n (%)0 (0)3 (10.3)NSHypertension, n (%)1 (10)11 (37.9)NSDyslipidemia, n (%)0 (0)10 (34.5)0.040Active smoking, n (%)0 (0)2 (6.9)NSObesity, n (%)6 (60)8 (27.6)NSTreatmentStatins, n (%)2 (20)7 (24.1)NSMTX, n (%)9 (90)23 (79.3)NSGC, n (%)6 (60)16 (55.2)NSDisease characteristicsESR, mm/h, median (IQR)14.50 (9.00-21.25)28.0 (17.0-42.0)0.024ESR <20 mm/h, n (%)7 (70)8 (27.6)0.027CRP, mg/dl, median (IQR)0.75 (0.45-1.26)0.91 (0.66-1.26)NSDAS28-ESR, mean ± SD4.30 ± 1.044.66 ± 1.09NSDAS28-CRP, mean ± SD3.23 ± 0.903.49 ± 1.06NS

cIMT, carotid intima media thickness; T2DM, type 2 diabetes mellitus; MTX, methotrexate; GC, glucocorticoids; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; DAS28, disease activity score 28 joints.

Conclusion

Our results show that patients without dyslipidemia and with lower ESR levels, a proinflammatory biomarker, had a reduction in cIMT, which decreases the risk of developing a major CV event. Emphasis should be placed on tight control of disease activity and traditional CV risk factors. A follow-up carotid ultrasound evaluation in RA patients may be necessary, to identify those who would benefit from an opportune treatment.

References

[1]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, et al. Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis. Clin Rheumatol 2016;35(11):2823-7.

Disclosure of Interests

None declared

AB0218 ASSOCIATION OF PULSE PRESSURE AND CAROTID INTIMA MEDIA THICKNESS IN RHEUMATOID ARTHRITIS PATIENTS

Background

Rheumatoid arthritis (RA) patients have increased cardiovascular risk than the general population. Systemic inflammation causes a proatherogenic state in this group of patients (1). The carotid ultrasound is a useful diagnostic tool for the detection of subclinical atherosclerosis; however, it is not available for all patients. Pulse pressure, defined as the difference between systolic and diastolic blood pressure, has been associated with atherosclerosis in the general population (2). Information in RA patients is lacking.

Objectives

We aimed to correlate pulse pressure and carotid intima media thickness (cIMT) in RA patients.

Methods

This was a cross-sectional study. We recruited a total of 92 patients with RA diagnosis, according to the 2010 EULAR/ACR classification criteria, aged 40-75 years. Patients with a previous cardiovascular event, another connective tissue disease or pregnancy were excluded. A B-mode carotid ultrasound was performed in all patients by a certified radiologist blinded to clinical information. cIMT was measured in the left and right carotid arteries. An average of both cIMT was obtained for each patient for this analysis. Correlation between pulse pressure and cIMT was determined with the Spearman’s correlation coefficient (rs). A p-value <0.05 was considered statistically significant.

Results

Mean age of RA patients was 58.9 ± 6.6 years. Most of them were women (92.4%), with a median disease duration of 10.5 (4.2-17.5) years. Median cIMT was 0.08 (0.07-0.10) mm, and median pulse pressure was 50 (40-55) mmHg (Table 1). We found a significant positive correlation between pulse pressure and cIMT in RA patients (rs = 0.254, p = 0.015) (Figure 1).

Table 1.

Demographic and disease characteristics.

CharacteristicsRA patients (n=92)Age, years, mean ± SD58.9 ± 6.6Women, n (%)85 (92.4)T2DM, n (%)17 (18.5)Hypertension, n (%)33 (35.9)Dyslipidemia, n (%)30 (32.6)Obesity, n (%)30 (32.6)Active smoking, n (%)11 (12.0)Disease duration, years, median (IQR)10.5 (4.2-17.5)CRP, mg/dL, median (IQR)0.70 (0.51-1.22)ESR, mm/h, median (IQR)21.0 (13.0-33.2)Pulse pressure, mmHg, median (IQR)50 (40-55)cIMT, mm, median (IQR)0.08 (0.07-0.10)

RA, rheumatoid arthritis; T2DM, type 2 diabetes mellitus; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; cIMT, carotid intima media thickness.

Conclusion

Higher pulse pressure was associated with higher cIMT in RA patients. Pulse pressure may be useful for the detection of high-risk patients who would benefit from a carotid ultrasound evaluation, to identify patients with high cIMT.

References

[1]Dalbeni A, Giollo A, Bevilacqua M, et al. Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients. Hypertens Res 2020;43(9):922–8.

[2]Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. Stroke 1999;30(3):550-5.

Disclosure of Interests

None declared

AB1551-HPR BODY COMPOSITION AND NUTRITIONAL STATUS IN PATIENTS WITH RHEUMATIC DISEASES

Background

An adequate nutritional status and a balanced diet are essential for a functional immune system, especially in chronic diseases that condition a catabolic state. The increase in adipose tissue and the proinflammatory environment that it generates influences rheumatic diseases.1. This translates to increased disease activity, morbidity and mortality.

Objectives

To describe body composition and nutritional status alterations in patients with rheumatological diseases in a 3rd level center in northern Mexico.

Methods

A prospective observational study was conducted in a third level center in northern Mexico. Anthropometric measurements were made by electrical bioimpedance analysis with the InnerScan TANITA BC-533 equipment (Yesod, S.A de C.V. Japan). Descriptive statistics were performed for categorical variables and measures of central tendency and dispersion were used for quantitative variables.

Results

A total of 1,666 evaluations of 1,218 individual patients were included: 1,098 (90.14%) women and 119 (9.77%) men. The mean age was 50 (±13). The most frequent diagnoses were rheumatoid arthritis 556 (45.64%), systemic lupus erythematosus 164 (13.46%), osteoarthritis 106 (8.7%) and fibromyalgia 48 (3.9%). The means of the anthropometric measurements were weight 69.78. kg (±15.53), height 1.57 m (±.07), percentage of total fat 35.17% (±9.3), percentage of body water 45.15% (±6.42), visceral fat 8.32(±.3.9), kg muscle 41.84 kg (6.4), bone mass 2.35 (±.0.75), metabolic age 50(±13), BMI 28.22(±.6.04), waist circumference 92.85(±.15.38), hip circumference 106.8, (±.12.94) waist-hip ratio 0.87 (±.0.08). A total of 431 (35.38%) patients were overweight, 407 (33.41%) had some degree of obesity, 338 (27.75%) had a normal BMI, and only 41 (3.36%) were underweight. 1,013 (83.16%) patients had low lean mass, 719 (59.03%) had low body water percentage, 680 (55.82%) had high levels of total fat, and 163 (13.38%) had visceral fat; 672 (55.17%) sarcopenic obesity and 320 (26.27%) a metabolic age greater than the chronological age.

Conclusion

The nutritional status of rheumatology patients in northern Mexico is inadequate with a high prevalence of obesity, overweight, and low lean mass. Nutritional intervention is of paramount importance in the comprehensive management of patients with rheumatologic diseases.

References

[1]Scrivo, R., Vasile, M., Müller-Ladner, U., Neumann, E., & Valesini, G. (2013). Rheumatic diseases and obesity: adipocytokines as potential comorbidity biomarkers for cardiovascular diseases. Mediators of inflammation, 2013, 808125.

Table 1.

Means of electrical bioimpedance analysis.

VariableMeanSDWeight, kg69.78(15)BMI, kg/m228.22(6.04)Total fat, %35.17(9.3)Total body water, %45.15(6.42)Visceral fat, kg8.32(3.9)Lean mass, kg41.84(6.4)Bone mass, kg2.35(0.75)Metabolic age, years50(13)Waist circumference92.85(15.38)Hip circumference106.8(12.94)W/H ratio0.87(0.08)

BMI: Body mass index. W/H ratio: Waist/Hip ratio

Disclosure of Interests

None declared

AB0199 RELATIONSHIP BETWEEN EXERCISE AND DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory disease in which cardiovascular disease is the leading cause of death (1). Exercise has been shown to have certain benefits in chronic diseases such as RA, decreasing symptoms and disease activity (2).

Objectives

To correlate exercise and minutes of physical activity performed per week with the disease activity level in a Mexican RA population.

Methods

This was a cross-sectional study in which a total of 240 Mexican patients with a diagnosis of RA were included. They were divided into two groups (120 in each): those who self-reported performing at least 30 minutes of exercise 3 or more times per week and were matched with patients who did not perform it by age, gender, and comorbidities. The disease activity level was determined with Disease Activity Score 28-joint erythrocyte sedimentation rate (DAS28-ESR) and Disease Activity Score 28-joint C-reactive protein (DAS28-CRP).

Distribution was evaluated with Kolmogorov-Smirnov. Comparisons with Chi-square test, Student’s t-test, and Mann-Whitney U test. Correlation between disease activity level and minutes of exercise per day with Spearman-rho coefficient.

Results

DAS28-ESR was significantly higher in patients who did not exercise [4.024 (3.08-5.31) vs 4.73 (3.6-54.82), p=0.006]. DAS28-CRP had similar trend [2.76 (1.89-4.14) vs 3.51 (2.28-4.63), p=0.004] (Table 1).

Table 1.

Demographic characteristics of the patients.

CharacteristicsRA patients whoexercise (n=120)RA patients whodo not exercise (n=120)Value of pAge, mean ± SD54.4±8.154.5±8.2NSFemale gender, n (%)106 (88.3)106 (88.3)NSObesity, n (%)23 (19. 1)31 (25.8)NST2DM, n (%)15 (12.5)12 (10.0)NSHypertension, n (%)30 (25.0)24 (20.0)NSDyslipidemia, n (%)39 (32.5)34 (28.3)NSMethotrexate, n (%)93 (77.5)107 (89.1)0.015bDMARD, n (%)6 (5)5 (4.1)NSGlucocorticoid, n (%)61 (50.8)74 (61.6)NSMinutes of exercise perweek, median (p25- p75)180 (150-300)0-DAS28ESR, median (p25-p75)4.024 (3.08-5.31)4.73 (3.6-54.82)0.006DAS28CRP, median (p25-p75)2.76 (1.89-4.14)3.51 (2.28-4.63)0.004

RA, rheumatoid arthritis; NS, not significant; T2DM, type 2 diabetes mellitus; bDMARD, biological disease-modifying anti-rheumatic drugs; DAS28, Disease Activity Score 28-joints; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.

The Spearman-rho coefficient showed a significant correlation between the minutes of exercise performed per week and DAS28-ESR (rho=-0.193, p=0.003) and DAS28-CRP (rho=-0.207, p=0.001) (Figure 1). A multivariate analysis was performed in which minutes of exercise performed per week, treatment, and comorbidities were included, showing an independent association between minutes of exercise performed per week and the disease activity level assessed by DAS28-ESR (B=-0.001, 95% CI= -0.002- -0.0003, p=0.011) and DAS28-CRP (B=-0.001, 95% CI= -0.002- -0.0003, p=0.011).

Figure 1.

Correlation between exercise time and disease activity level in RA.

RA, rheumatoid arthritis; DAS28, Disease Activity Score 28-joints; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.

Conclusion

Mexican RA patients who exercise presented lower levels of disease activity. Emphasis should be placed on their practice to improve the patients’ symptomatology.

References

[1]Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Prim [Internet]. 2018;4:1–23. Available from: http://dx.doi.org/10.1038/nrdp.2018.1

[2]Katz P, Andonian BJ, Huffman KM. Benefits and promotion of physical activity in rheumatoid arthritis. Curr Opin Rheumatol. 2020;32(3):307–14.

Disclosure of Interests

None declared

AB0198 BASELINE FUNCTIONAL CAPACITY IN RHEUMATOID ARTHRITIS PREDICTS SUBCLINICAL ATHEROSCLEROSIS ON FOLLOW-UP

Background

The main cause of death in patients with rheumatoid arthritis (RA) is due to cardiovascular disease1. Cardiovascular mortality is strongly associated with the cumulative severity of the disease. Functional disability, as measured by the Health Assessment Questionnaire (HAQ), has been used to predict premature mortality in RA2. There are no studies relating its baseline score to the development of subclinical atherosclerosis by carotid ultrasound.

Objectives

To determine whether baseline HAQ score is an independent factor for the development of subclinical atherosclerosis assessed by carotid ultrasound.

Methods

Prospective, observational study. Patients with a diagnosis of RA who met ACR/EULAR 2010 criteria and who were recruited at the Cardio-Rheumatic Clinic in 2014-2015 were included. Patients underwent a clinical history and physical examination and completed the HAQ. The presence of subclinical atherosclerosis was identified by carotid Doppler ultrasound at the end of follow-up. Subclinical atherosclerosis was defined by the presence of carotid plaque or carotid intima-media thickness (c-IMT) ≥0.8mm. Distribution was assessed with the Kolmogorov-Smirnov test. Correlation between cIMT value and baseline HAQ score was determined using Spearman’s correlation coefficient. Binary logistic regression was used to determine the independent factor for the development of subclinical atherosclerosis.

Results

A total of 48 patients were followed up. The median follow-up was 4.5 years (4.3-4.9). The baseline characteristics of the patients are shown in Table 1. A correlation was found between the GIMc value and the baseline HAQ score statistically significant (r=0.625, p=<0.001). In multivariate analysis that included scales to assess disease activity (DAS28-CPR, DAS28-ESR, CDAI, HAQ) and disease duration, and HAQ score was found to be an independent factor with MR 5.94 95% CI (1.65-21.41) (p=<0.001). DAS28-CRP with MR 1.52 95% CI (0.39-5.87), DAS28-ESR MR 0.27 95% CI (0.05-1.41), CDAI with MR 0.66 95% CI (0.82-1.12), disease duration 0.32 95% CI (0.07-1.49), but these were not statistically significant.

Table 1.

Baseline characteristics.

Basal (n=48)Age, years ± SD55.8 ± 9.7Female, n (%)44 (91.7)Disease duration, years (IQR)9.5 (4.3-16.5)DAS28-ESR ± SD4.4 ± 1.2DAS28-CPR ± SD3.3 ± 1.1CDAI ± SD13.0 ± 10.2HAQ, (IQR)0.87 (0.25-1.25)HT, n (%)19 (39.6)DM, n (%)2 (4.2)Active tabaquism, n (%)4 (8.3)Obesity, n (%)19 (39.6)BMI, kg/m2 ± SD29.1 ± 4.6Methotrexate, n (%)40 (83.3)Glucocorticoids, n (%)30 (62.5)

DAS28, disease activity score using 28 joints; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; CDAI, clinical disease activity index; HAQ, Health Assessment Questionnaire; HT, hypertension; DM, diabetes mellitus; BMI, body mass index.

Conclusion

Our data show that at 4.5 years of follow-up, baseline HAQ score is a significant independent predictor of the presence of subclinical atherosclerosis by carotid ultrasound in patients with rheumatoid arthritis.

References

[1]Semb AG, Ikdahl E, Wibetoe G, Crowson C, Rollefstad S. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol. 2020;16(7):361-79.

[2]Wolfe F, Michaud K, Gefeller O, Choi HK. Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum. 2003;48(6):1530-42.

Disclosure of Interests

None declared

AB0943 ASSOCIATION BETWEEN PULSE PRESSURE AND ATHEROSCLEROSIS IN PSORIATIC ARTHRITIS PATIENTS

Background

Psoriatic arthritis (PsA) is associated with an increased prevalence of cardiovascular events due to accelerated atherosclerosis that seems to depend on traditional and non-traditional risk factors(1). There is a positive correlation between pulse pressure (PP) and the progression of atherosclerosis in general population (2). Currently, there are no studies linking PP as an independent risk factor of atherosclerosis in PsA patients.

Objectives

To compare PP between PsA patients with and without carotid plaque (CP).

Methods

This was a cross-sectional study that included patients aged 40 to 75 years with PsA diagnosis according to the 2006 CASPAR criteria. A carotid ultrasound was performed in all patients, and they were divided into two groups, 27 patients with the presence of CP and 27 patients without CP matched by age, gender, and comorbidities. Blood pressure and PP was measured according to current guidelines. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi-square test for qualitative variables and Student´s t test for quantitative variables. A p value <0.05 was considered statistically significant.

Results

There were no differences regarding demographic characteristics between groups. When comparing the arterial measures, a statistically significant difference was found in the PP, which was higher in patients with CP (48.66 ± 12.04 mmHg vs 41.51 ± 9.10 mmHg, p=0.017) (Table 1). A binary logistic regression was performed, and we found that PP was the only independent factor for the presence of CP in patients with PsA, OR 6.638 (95% CI 0.453- 12.823, p=0.036).

Table 1.

Demographic characteristics of the patients.

CharacteristicsPsA patients with CP(n=27)PsA patients without CP(n=27)P ValueAge, mean ± SD51.55±8.2450.74±8.68NSFemale gender, n (%)16 (59.25)15 (55.55)NSObesity, n (%)16 (59.25)17 (62.96)NST2DM, n (%)20 (74.07)23 (85.18)NSHypertension, n (%)19 (70.37)22 (81.48)NSDyslipidemia, n (%)12 (44.44)17 (62.96)NSActive smoking, n (%)17 (62.96)16 (59.25)NSMethotrexate, n (%)9 (33.33)11 (40.74)NSGlucocorticoid, n (%)23 (85.18)22 (81.48)NSbDMARD, n (%)14 (51.85)18 (66.66)NSSAP, mean ± SD132.44±14.40123.44±13.800.023DAP, mean ± SD83.77±10.7181.92±10.95NSPP, mean ± SD48.66±12.0441.51±9.100.017

PsA, psoriatic arthritis; NS, non-significant; T2DM, type 2 diabetes mellitus; bDMARD, biologic disease-modifying anti-rheumatic drugs; SAP, systolic arterial pressure; DAP, diastolic arterial pressure; PP, pulse pressure.

Conclusion

PsA patients with CP presented higher measures of PP compared with PsA patients without CP. This suggests that PP could be related with an increased risk of subclinical atherosclerosis in PsA patients. It is recommended to consider PP as an important parameter when evaluating cardiovascular risk in PsA patients.

References

[1]Ramonda R, Lo Nigro A, Modesti V, Nalotto L, Musacchio E, Iaccarino L, et al. Atherosclerosis in psoriatic arthritis. Autoimmun Rev [Internet]. 2011;10(12):773–8. Available from: http://dx.doi.org/10.1016/j.autrev.2011.05.022

[2]Amar J, Chamontin B. Cardiovascular risk factors, atherosclerosis and pulse pressure. Adv Cardiol. 2007;44:212–22.

Disclosure of Interests

None declared

AB0543 HIGHER LEFT VENTRICULAR MASS INDEX IN PATIENTS WITH LUPUS NEPHRITIS

Background

Systemic lupus erythematosus (SLE) patients have a worse cardiovascular prognosis than the general population. It is estimated that approximately 40% of SLE patients develop lupus nephritis (LN) throughout the evolution of the disease (1). Patients with LN had 8 times more risk of myocardial infarction and 4 times more risk of cardiovascular mortality than SLE patients without LN (2).

Objectives

To compare the echocardiographic parameters between SLE patients with and without LN.

Methods

This was a cross-sectional study nested of a SLE cohort. We recruited patients with SLE diagnosis, according to the 2019 EULAR/ACR classification criteria, aged ≥ 18 years. Patients with a previous cardiovascular event, another connective tissue disease or pregnancy were excluded. A transthoracic echocardiogram was performed by two certified echocardiographers blinded to clinical information. Patients with LN were included and matched to patients without LN by age and gender. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables, and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.

Results

A total of 48 SLE patients, 24 with LN and 24 without LN were included. Mean age of patients with LN was 36.9 ± 10.4 years, compared to 36.5 ± 9.3 years in patients without LN, p = 0.873. There were no significant differences in demographic characteristics between groups (Figure 1). When evaluating echocardiographic parameters we found a significant difference in the left ventricular mass index, higher in LN patients (66.9 g/m2 vs 54.8 g/m2, p = 0.035) (Table 1).

Table 1.

Comparison of echocardiographic findings of SLE patients with and without LN.

VariablesPatients with LN (n=24)Patients without LN (n=24)p-valueLV mass index, g/m2, mean ± SD66.9 ± 21.854.8 ± 16.10.035RWT, mean ± SD0.37 ± 0.080.34 ± 0.10NSLV geometry abnormality, n (%)7 (29.2)4 (16.7)NSLAESVI, ml/m2, mean ± SD29.72 ± 10.8026.04 ± 8.76NSLVEF, %, mean ± SD58.16 ± 7.4258.04 ± 7.04NSLVESV, ml, median (IQR)39.0 (26.0-54.5)32.5 (23.7-39.7)NSLVEDV, ml, mean ± SD92.10 ± 25.0981.57 ± 27.80NS

SLE, systemic lupus erythematosus; LN, lupus nephritis; NS, not significant; LV, left ventricular; RWT, relative wall thickness; LAESVI, left atrial end-systolic volume index; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; LVEDV, left ventricular end-diastolic volume.

Conclusion

SLE patients with LN had higher left ventricular mass index than SLE patients without LN. An increased left ventricular mass could lead to the development of ventricular hypertrophy, which is associated to a higher risk of cardiovascular mortality. A transthoracic echocardiogram should be considered as part of the cardiovascular evaluation of SLE patients, especially those with LN.

References

[1]Hoover PJ, Costenbader KH. Insights into the epidemiology and management of lupus nephritis from the US rheumatologist’s perspective. Kidney Int 2016;90(3):487–92.

[2]Hermansen ML, Lindhardsen J, Torp-Pedersen C, et al. The risk of cardiovascular morbidity and cardiovascular mortality in systemic lupus erythematosus and lupus nephritis: A Danish nationwide population-based cohort study. Rheumatol (United Kingdom) 2017;56(5):709–15.

Disclosure of Interests

None declared

AB0296 RELATIONSHIP BETWEEN OBESITY AND ACUTE PHASE REACTANTS IN RHEUMATOID ARTHRITIS

Background

Obesity plays an important role in autoimmune and inflammatory diseases such as rheumatoid arthritis (RA). It has been demonstrated a paradoxical relationship between increased body mass index (BMI) and disease activity (1). Acute phase reactants (APR) play an essential role in determining the disease activity level (2).

Objectives

To compare APR levels in obese and non-obese patients with RA, and to establish their relationship with the disease activity level.

Methods

A total of 272 patients with a diagnosis of RA were included in a cross-sectional study. They were divided in two groups, 136 obese patients and 136 non-obese patients, matched by age, gender and comorbidities. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) level were measured, and the activity level was determined with Disease Activity Score 28-joint erythrocyte sedimentation rate (DAS28-ESR) and Disease Activity Score 28-joint C-reactive protein (DAS28-CRP).

The distribution was evaluated with Kolmogorov-Smirnov. Comparisons with Chi- square test for qualitative variables, Student’s t-test, and Mann-Whitney U test for quantitative variables. Correlation between BMI and APR with Spearman-rho coefficient.

Results

The Spearman-rho coefficient showed a significant correlation between CRP level and BMI (rho=0.187, p=0.002) (Figure 1). No difference was found between activity level when comparing both groups (Table 1).

Table 1.

Demographic Characteristics of the Patients

CharacteristicsObese RA Patients (n=136)Non-Obese RA Patients (n=136)P ValueAge, mean ± SD55.32±8.6755.38±8.64NSFemale, n (%)130 (95.5)130 (95.5)NSBMI, mean ± SD34.22±3.7424.70±2.89-T2DM, n (%)30 (22.0)23 (16.9)NSHypertension, n (%)62 (45.5)48 (35.2)NSDyslipidemia, n (%)39 (28.6)48 (35.2)NSMethotrexate, n (%)119 (87.5)114 (83.8)NSbDMARD, n (%)7 (5.1)11 (8.0)NSGlucocorticoid, n (%)89 (65.4)77 (56.6)NSCRP, median (p25-p75)1.00 (0.58-1.73)0.68 (0.38-1.25)NSESR, median (p25-p75)25.00 (16.00-36.00)24.50 (14.25-37.75)NSDAS28ESR, mean ± SD4.74±1.454.57±1.38NSDAS28CRP, mean ± SD3.62±1.463.37±1.39NS

RA, rheumatoid arthritis; NS, not significant; BMI, body mass index; T2DM, type 2 diabetes mellitus; bDMARD, biological disease-modifying anti-rheumatic drugs; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; DAS28, Disease Activity Score 28-joint.

Figure 1.

Correlation between BMI and CRP

BMI, body mass index; CRP, C-reactive protein

Conclusion

Obese RA patients presented higher CRP levels compared to non-obese patients, suggesting that a higher BMI level may be related to a higher degree of inflammation and consequently worse systemic manifestations in patients.

References

[1]Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol. 2010;6(8):445–51.

[2]van Riel PLCM, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(4):40–4.

Disclosure of Interests

None declared

AB1532-HPR GERIATRIC/GENERAL ORAL HEALTH ASSESSMENT INDEX AS EARLY DETECTION TEST OF ORAL DISEASES IN RHEUMATOLOGY

Background

The oral health in patients with rheumatologic diseases is frequently affected because of chronic inflammation, slow rate of saliva production and poor self-care. These factors affect the life quality and psychosocial wellness, causing pain, difficulty biting and chewing, even malnutrition. The Geriatric/General Oral Health Assessment Index Spanish Version (GOHAI-SP) consists in 12 items and values self-perception in oral health and wellness (1), validated and applied to young adults (2).

Objectives

to describe the oral health measured by the GOHAI-SP in patients with rheumatic diseases.

Methods

a cross-sectional and observational study was conducted of January to May 2021 in rheumatology service of Hospital Universitario “Dr. José Eleuterio González” at Monterrey, Mexico. Patients with rheumatologic diseases was assessed with GOHAI-SP during their control consult, each item is valuated like a Likert ordinal scale from 1 to 5, the best and worst possible score is 60-12 respectively, patients whit score <45 is classified as poor oral health and >50 as good oral health(3). This assessment is divided in self-perception of mechanical function, pain and discomfort in mouth, gums, teeth and psychosocial function (4).

Results

316 patients were included, 289 (91.5%) were women, the mean age was 46.23 years (SD: 15.49), the general mean score was 51.88 classified as good oral health. 24 (7.52%) patients was classified with moderate oral health and 63 (19.74%) as poor oral health. The most frequent diagnoses with poor oral health were rheumatoid arthritis 26 cases (8.22%), systemic lupus erythematosus 11 cases (3.48%) and psoriasic arthritis 4 cases(1.2%).

Conclusion

The prevalence of poor or moderated self-perceived oral health in patients with rheumatologic diseases was 27.53%. The primary prevention and early detection plays a fundamental roll to avoid oral disease in this population.

References

[1]Aguirre-Bustamante, J., Barón-López, F., Carmona-González, FJ et al. Validación de una versión modificada del Índice de Evaluación de la Salud Oral Geriátrica Española (GOHAI-SP) para adultos y personas mayores. BMC Oral Health 20, 61 (2020). https://doi.org/10.1186/s12903-020-1047-3.

[2]Atchison, K.A., Der-Martirosian, C. and Gift, H.C. (1998), Components of Self-reported Oral Health and General Health in Racial and Ethnic Groups. Journal of Public Health Dentistry, 58: 301-308. https://doi.org/10.1111/j.1752-7325.1998.tb03013.x

[3]Hernández-Palacios RD, Ramírez-Amador V, Jarillo-Soto EC, Irigoyen-Camacho ME, Mendoza-Núñez VM. Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study. Cien Saude Colet. 2015 Apr;20(4):997-1004. doi: 10.1590/1413-81232015204.00702014. PMID: 25923612.

[4]Sánchez-García S, Heredia-Ponce E, Juárez-Cedillo T, Gallegos-Carrillo K, Espinel-Bermúdez C, de la Fuente-Hernández J, García-Peña C. Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population. J Public Health Dent. 2010 Fall;70(4):300-7. doi: 10.1111/j.1752-7325.2010.00187.x. PMID: 20663049

Table 1.

Demographic characteristics and results GOHAI-SP

GOHAI-SPCharacteristicsn=316Score, mean (SD)Age, mean (SD)46.23 (15.49)51.87 (8.35)Gender, n (%)Female289(91.5)51.92Classification GOHAI-SPGood229 (72.47)56.34Moderate24 (7.59)46.95Poor63 (19.93)37.5Rheumatologic diseases, n (%)Rheumatoid arthritis120(37.97)51.45Systemic lupus erythematosus53(16.77)51.81Osteoarthritis19 (6.02)53.57Other diagnoses124(39.24)52.26

GOHAI-SP: Geriatric/General Oral Health Assessment Index Spanish Version; (SD) Standard deviation, n number; (%) Percentage.

Disclosure of Interests

None declared

AB0518 OBESITY PARADOX IN SLE PATIENTS LOWER BMI TRADUCES TO HIGHER DISEASE ACTIVITY

Background

Cachexia plays an important role in rheumatoid arthritis (RA), due to its chronic inflammatory process characterized by decreased muscular mass with preservation or increase of fat that occurs in 1-13% of the RA population. A decreased BMI has a paradoxical relationship with disease activity, with an increase in disease activity and mortality (1). Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of nuclear autoantibodies that can form immune complexes and cause inflammation of multiple organs. Cardiovascular events and mortality are nearly twice as high in patients with SLE as in the general population. (2)

Objectives

To determine the relationship between BMI and disease activity in patients with SLE.

Methods

A cross-sectional, observational study was conducted in which a group of 58 patients with SLE were included and their level of disease activity was determined using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and BMI. Distribution was assessed with the Kolmogorov-Smirnov test. Descriptive analysis using measures of central tendency. Correlation between BMI and SLEDAI with Pearson’s test. A p value <0.05 was considered statistically significant.

Results

The mean age of SLE patients was 35.4 ± 12.11 years, rest of demographic characteristics in Table 1. Pearson’s test showed a correlation between BMI and disease activity (r=

Table 1.

Demographic characteristics

SLE n=58Female n (%)54 (93.0)Age, years, mean ± SD35.4 ± 12.1DM n (%)2 (3.4)AH n (%)12 (20.6)DLP n (%)4 (6.8)Obesity n (%)4 (6.8)SLEDAI mean ± SD8.06 ± 6.4ANA positivity n (%)47 (81.0)BMI mean ± SD25.0 ± 4.9

DM; Diabetes Mellitus, AH; Arterial Hypertension, DLP; Dyslipidemia, SLEDAI; Systemic Lupus Erythematosus Disease Activity Index, ANA; Anti-Nuclear Antibodies, BMI; Body Mass Index.

-0.304, p= 0.020) Image 1. Multivariate analysis found that a decrease in BMI is independently associated with an increase in disease activity assessed by SLEDAI

(B= -0.411, 95% CI= -0.819- -0.003, p=0.049).

Figure 1.

Correlation between BMI and SLEDAI.

Conclusion

The results show an inverse relationship between BMI and disease activity in patients with SLE. Further studies with a larger number of patients should be performed.

References

[1]Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol [Internet]. 2010;6(8):445–51. Available from: http://dx.doi.org/10.1038/nrrheum.2010.105

[2]Ocampo-Piraquive V, Nieto-Aristizábal I, Cañas CA, Tobón GJ. Mortality in systemic lupus erythematosus: causes, predictors and interventions. Expert Rev Clin Immunol [Internet]. 2018;14(12):1043–53. Available from: https://doi.org/10.1080/1744666X.2018.1538789

Disclosure of Interests

None declared

AB1034 FRACTURE RISK BY FRAX WITH AND WITHOUT BONE MINERAL DENSITY, COMPARISON OF FACTORS AFFECTING CONCORDANCE

Background

The Fracture Risk Assessment Tool (FRAX) estimates the 10-year probability of hip (FXC) and major osteoporotic (FXOM) fractures in patients aged 40 to 90 years using important clinical factors, such as bone mineral density (BMD), optional input variables. (1) There is convincing evidence that with or without the use of BMD it provides a well-validated instrument and may be useful in clinical practice for identifying patients at high risk of fracture and informing treatment decisions. (2)

Objectives

This study aims to determine the concordance between the treatment decision, calculated using FRAX scores with and without BMD, and to identify the risk factors associated with the discordance in patients with autoimmune rheumatic diseases.

Methods

A cross-sectional study was carried out in patients with autoimmune rheumatic diseases who had undergone osteoporosis detection (OP) using dual bone densitometry in the Rheumatology service of the University Hospital “Dr. José Eleuterio González” during the period August 2020 - August 2021. The FRAX questionnaire was applied to determine risk factors for OP and the results of the instrument with and without BMD were calculated, the patients were classified as low, intermediate, and high risk.

A Student’s t-test, a Wilcoxon rank-sum test, and a Chi-square or Fisher’s exact test were used to compare variables between groups and calculate P-values.

Results

A total of 88 patients were included. Based on FRAX questionnaire responses, 82 (93.18%) patients had at least one risk factor for OP. The FRAX result with or without densitometry resulted in a treatment decision in 48 (54.5%) and 28 (31.8%) patients, respectively. The results were concordant in 65 (73.9%) of the cases. It was found that patients with osteopenia due to BMD had a greater agreement between both measurements (93.3%, p 0.003) than patients with normal BMD (62.5% p 0.001). Likewise, patients with secondary osteoporosis had lower concordance than patients without this diagnosis (25% and 72.5%, respectively, p 0.006).

Conclusion

The results of FRAX with and without densitometry were mostly agreeable in predicting the need for treatment according to the 10-year probability of hip fracture, however, this concordance decreased in patients with a previous diagnosis of secondary osteoporosis, no significant difference was found between the risk factors for the concordant and discordant groups. More studies are required to determine the variables that cause a decrease in the concordance of the tests.

Table 1.

Factors that affect the results between the discordant groups.

VariablesConcordant n=65No concordant n=23P valueSex (%)0.078Men8 (12.3%)0 (0%)Women57 (87.7%)23 (100%)Age (years)57.85 ± (11.66)59.2 ± (8.36)0.13<5012 (18.4%)4 (17.3%)50-5924 (36.9%)8 (34.6%)60-6917 (26.1%)9 (39.1%)70-7910 (15.3%)2 (8.7%)>802 (3%)0 (0%)Height (meters)1.52 ± (0.08)1.52 ± (1.06)0.042Weight (kilograms)68.5 (59.5-80.5)68 (64-74)BMI (kg/m 2)28.2 (24.9-33.1)30.9 (29.2-32.5)0.002Normal weight (%)16 (24.6%)3 (13%)0.136Overweight (%)22 (33.8%)5 (21.7%)0.150Obesity (%)27 (41.5%)15 (65.2%)0.051Normal BMD35 (53.84%)21 (93%)0.001Osteopenia28 (43.07%)2 (8.69%)0.003Osteoporosis2 (3.07%)0 (0%)0.395With BMDWithout BMDHip Fracture FRAX Score5.3 (3.62-9.77)1 (0.42-2.67)Major osteoporotic fracture6.2 (4.02-9.85)0.75 (0.3-1.77)Treatment suggested by FRAX48 (54.5%)28 (31.8%)

BMI= Body mass index, BMD= Bone mineral density, FRAX= Fracture risk assessment tool

References

[1]Teeratakulpisarn N, Charoensri S, Theerakulpisut D, Pongchaiyakul C. FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais. Archives of Osteoporosis. 2021 Feb 26;16(1).

[2]Horta-Baas G, Pérez Bolde-Hernández A, Pérez-Pérez A, Vergara-Sánchez I, Romero-Figueroa M del S. Concordancia del FRAX México con y sin el valor de la densidad mineral ósea en la evaluación del riesgo de fractura en la práctica clínica diaria. Medicina Clínica. 2017 May;148(9):387–93.

Disclosure of Interests

None declared

POS0575 CAPACITY OF SIX DIFFERENT CARDIOVASCULAR RISK ALGORITHMS FOR THE DETECTION OF CAROTID PLAQUE IN RHEUMATOID ARTHRITIS

Background

Current EULAR recommendations for cardiovascular risk (CVR) assessment in rheumatoid arthritis (RA) indicate that the CVR evaluation should be performed according to national guidelines; however, there was no algorithm designed for the Mexican population until 2019, when the World Health Organization (WHO) published the CVR charts for 21 world regions, including Mexico (1).

Objectives

To determine the capacity of the WHO and other five algorithms for the detection of carotid plaque (CP) in RA patients.

Methods

Cross-sectional study. We included 164 patients with RA diagnosis according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. CVR was calculated with six algorithms: WHO, FRS-lipids, FRS-BMI, SCORE, ACC/AHA and QRISK3. Carotid ultrasound was performed in all patients to identify the presence of CP. A ROC-curve analysis was performed, and the cutoff points of each algorithm were determined using the Youden Index. Area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LR) were calculated. A p-value <0.05 was considered statistically significant.

Results

The prevalence of CP was 35.9%. The WHO algorithm showed AUC: 0.729 (0.649-0.809), cutoff point: 5.25, sensitivity: 72.9%, and specificity: 64.8%. FRS-lipids showed AUC: 0.684 (0.601-0.767), cutoff point: 8.62, sensitivity: 67.8%, and specificity: 61.0%. FRS-BMI showed AUC: 0.700 (0.618-0.781), cutoff point: 11.55, sensitivity: 72.9%, and specificity: 61.0%. SCORE showed AUC: 0.687 (0.601-0.773), cutoff point: 1.5, sensitivity: 79.7%, and specificity: 45.7%. ACC/AHA showed AUC: 0.687 (0.604-0.770), cutoff point: 3.82, sensitivity: 62.7%, and specificity: 61.0%. QRISK3 showed AUC: 0.733 (0.654-0.811), cutoff point: 6.05, sensitivity: 71.2%, and specificity: 61.0%. All algorithms had a p-value <0.001 (Figure 1 and Table 1).

Table 1.

Capacity of cardiovascular risk algorithms to detect presence of carotid plaque in rheumatoid arthritis patients

Algorithms (cut-off points)AUCCI 95%pSensibilitySpecificityLikelihood radioInferior limitSuperior limit+-WHO0.7290.6490.809<0.00172.9%64.8%2.070.42(5.25)FRS-lipids0.6840.6010.767<0.00167.8%61.0%1.740.53(8.62)FRS-BMI0.7000.6180.781<0.00172.9%61.0%1.870.44(11.55)SCORE0.6870.6010.773<0.00179.7%45.7%1.470.44(1.5)ACC/AHA0.6870.6040.770<0.00162.7%61.0%1.610.61(3.82)QRISK30.7330.6540.811<0.00171.2%61.0%1.820.47(6.05)

AUC, area under the curve; WHO, World Health Organization; FRS, Framingham Risk Score; BMI, body mass index.

Conclusion

The WHO calculator was one of the best algorithms for the detection of CP, with the best positive and negative likelihood ratios; however, like the other algorithms, a lower cut-off point than the one established by official guidelines was needed to identify high-risk patients with the presence of CP, who were initially classified as low-moderate risk by the CVR algorithm.

References

[1]Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45.

Disclosure of Interests

None declared.

POS0577 COMPARISON OF THE WHO AND ACC/AHA CARDIOVASCULAR ALGORITHMS TO DETECT CAROTID PLAQUE IN RHEUMATOID ARTHRITIS

Background

Cardiovascular disease is the major cause of death in rheumatoid arthritis (RA) patients. Cardiovascular risk algorithms are used to estimate the probability for the development of a cardiovascular event in 10 years, according to patients’ characteristics, however, no algorithm existed for the Hispanic population until the World Health Organization (WHO) published the cardiovascular disease risk charts for 21 regions (1).

Objectives

To compare the capacity of the 2019 WHO algorithm and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) algorithm for detecting the presence of carotid plaque (CP) in RA patients.

Methods

Cross-sectional study. We recruited a total of 164 patients with RA diagnosis, according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. Patients with a previous cardiovascular event were excluded. Cardiovascular risk was evaluated with the 2019 WHO algorithm for the Mexican population and the 2013 ACC/AHA cardiovascular algorithm. The results were multiplicated by 1.5, according to current guidelines. A carotid ultrasound was performed to all study subjects by a certified radiologist blinded to clinical information. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations were performed with the Spearman-rho coefficient (rho). A ROC-curve analysis was performed for both algorithms. The areas under the curve (AUC) of the algorithms were compared using the method of DeLong.

Results

The presence of CP was detected in 59 (36.0%) patients. Demographic characteristics are shown in Table 1. There was a large positive correlation between the WHO and the ACC/AHA algorithms (rho=0.880, p=<0.001). Both algorithms showed significant discrimination for the presence of CP in RA patients, the WHO algorithm had an AUC 0.729 (95% CI 0.649-0.809, p=<0.001) and the ACC/AHA algorithm had an AUC 0.687 (95% CI 0.604-0.770, p=<0.001). However, there was a difference when comparing both AUC, which was higher with the WHO algorithm (p=0.042) (Figure 1).

Table 1.

Demographic characteristics of RA patients

CharacteristicsRA patients(n=164)Age, years, mean ± SD55.82 ± 8.94Women, n (%)157 (95.73)T2DM, n (%)27 (16.46)Hypertension, n (%)53 (32.32)Dyslipidemia, n (%)58 (35.36)Obesity, n (%)56 (34.15)Active smoking, n (%)15 (9.15)WHO algorithm, median (IQR)4.5 (3.0-9.0)ACC/AHA algorithm, median (IQR)3.75 (1.80-9.26)Carotid plaque, n (%)59 (36.0)

RA, rheumatoid arthritis; T2DM, type 2 diabetes mellitus; WHO, world health organization; ACC/AHA, American College of Cardiology/American Heart Association.

Conclusion

Our results showed that although both algorithms had significant discrimination for the presence of CP, the 2019 WHO algorithm had a better capacity for the detection of CP than the 2013 ACC/AHA algorithm, for this specific Hispanic RA population. This could be attributed to the fact that the WHO algorithm was designed for 21 different regions, including the Mexican population.

References

[1]Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45.

Disclosure of Interests

None declared.

AB0944 HIGHER PREVALENCE OF PULSE PRESSURE IN PSORIATIC ARTHRITIS PATIENTS

Background

There is an increased risk of cardiovascular diseases in patients with psoriatic arthritis (PsA) compared with the general population due to higher prevalence of cardiovascular risk (CVR) factors (1). Pulse pressure (PP) is an independent risk factor for cardiovascular morbidity and mortality (2). Currently, there are no studies about PP in PsA patients.

Objectives

To compare PP between PsA patients and healthy controls.

Methods

This was a cross-sectional, observational, and comparative study. A total of 74 PsA patients aged 40-75 years old, who fulfilled the 2006 CASPAR criteria were recruited and matched to 74 controls by age (±5 years), gender and comorbidities. Patients with history of a previous cardiovascular event or pregnancy were excluded from this study. Blood pressure and PP was measured according to current guidelines.

Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi-square test for qualitative variables and Student´s t test and Mann-Whitney’s U test for quantitative variables. A p value <0.05 was considered statistically significant.

Results

There were no differences regarding demographic characteristics between groups. When comparing the arterial measures, a statistically significant difference was found in the PP, which was higher in the PsA group [45.00 mmHg (40.00-56.50) vs 42.50 mmHg (38.00-50.00), p=0.024], and in the systolic arterial pressure, higher in PsA patients (131.06 ± 18.27 mmHg vs 123.02 ± 14.27 mmHg, p=0.003) (Table 1).

Table 1.

Demographic characteristics of the patients.

CharacteristicsPsA patients(n=74)Controls(n=74)P ValueAge, mean ± SD55.08±7.6154.94±7.45NSFemale gender, n (%)41 (55.40)41 (55.40)NSObesity, n (%)47 (63.51)48 (64.86)NST2DM, n (%)58 (78.37)56 (75.67)NSHypertension, n (%)48 (64.86)44 (59.45)NSDyslipidemia, n (%)44 (59.45)46 (62.16)NSActive smoking, n (%)49 (66.21)53 (71.62)NSSAP, mean ± SD131.06±18.27123.02±14.270.003DAP, mean ± SD81.06±11.1279.13±9.69NSPP, median (p25-p75)45.00 (40.00-56.50)42.50 (38.00-50.00)0.024

PsA, psoriatic arthritis; NS, non-significant; T2DM, type 2 diabetes mellitus; SAP, systolic arterial pressure; DAP, diastolic arterial pressure; PP, pulse pressure.

Conclusion

PsA patients presented higher measures of PP compared to healthy controls. This suggests that PsA patients could have a higher risk of cardiovascular disease. It is recommended to consider PP as an important parameter when evaluating CVR in PsA patients. Further studies are necessary to validate these results.

References

[1]Jamnitski A, Symmons D, Peters MJL, Sattar N, Mcilnnes I, Nurmohamed MT. Cardiovascular comorbidities in patients with psoriatic arthritis: A systematic review. Ann Rheum Dis. 2013;72(2):211–6.

[2]Asmar R, Safar ME, Queneau P. Pulse pressure: An important tool in cardiovascular pharmacology and therapeutics. Drugs. 2003;63(10):927–32.

Disclosure of Interests

None declared

AB0544 LEFT VENTRICULAR GEOMETRY ABNORMALITIES ASSOCIATED WITH DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease. Patients with SLE have higher risk of developing a cardiovascular event than the general population (1), with multiple factors contributing to this increased risk, including systemic inflammation (2).

Objectives

To compare the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and other disease characteristics of SLE patients with and without left ventricular (LV) geometry abnormalities.

Methods

This was a cross-sectional study nested of a SLE cohort. We recruited patients with SLE diagnosis, according to the 2019 EULAR/ACR classification criteria, aged ≥ 18 years. Patients with a previous cardiovascular event, another connective tissue disease or pregnancy were excluded. A transthoracic echocardiogram was performed by two certified echocardiographers blinded to clinical information. Disease activity was assessed with SLEDAI. SLE patients with LV geometry abnormalities were included in this study and matched by age and gender to SLE patients with normal LV geometry by a certified rheumatologist blinded to clinical information. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables, and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.

Results

A total of 44 SLE patients were included, 22 patients with LV geometry abnormalities and 22 patients with normal LV geometry. Mean age of SLE patients with LV geometry abnormalities was 35.1 ± 12.2 years, compared to 35.4 ± 9.4 years of SLE patients with normal LV geometry, p = 0.923. The rest of demographic characteristics are shown in Figure 1. When evaluating disease characteristics, the SLEDAI score was significantly higher in SLE patients with LV geometry abnormalities (26.45 vs 17.33, p = 0.016) (Table 1).

Table 1.

Comparison of disease characteristics of SLE patients with and without LV geometry abnormalities.

VariablesPatients with LV geometry abnormalities (n=22)Patients with normal LV geometry (n=22)p-valueDisease duration, months, median (IQR)60.0 (12.7-150)72.0 (43.0-117.7)NSSLEDAI, median (IQR)10.5 (4.0-15.0)6.0 (2.0-9.0)0.016CRP, mg/dl, median (IQR)0.52 (0.33-1.29)0.60 (0.41-0.85)NSESR, mm/h, median (IQR)26.0 (13.2-34.2)29.0 (8.7-58.5)NSANA titers, median (IQR)640 (160-3200)480 (160-5120)NSAnti-dsDNA, median (IQR)0 (0-160)0 (0-200)NSC3, mean ± SD94.6 ± 31.4100.5 ± 46.1NSC4, median (IQR)13.6 (9.8-14.9)12.8 (6.4-19.8)NSAnti-Ro, median (IQR)4.5 (2.0-190.5)3.5 (2.0-82.2)NSAnti-La, median (IQR)2.0 (2.0-4.0)2.0 (2.0-3.0)NSHydroxychloroquine, n (%)20 (90.9)18 (81.8)NSGlucocorticoids, n (%)19 (86.4)17 (77.3)NS

SLE, systemic lupus erythematosus; LV, left ventricular; NS, not significant; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ANA, antinuclear antibodies; anti-dsDNA, anti-double stranded DNA.

Conclusion

SLE patients with LV geometry abnormalities had higher SLEDAI score than patients with normal LV geometry. A transthoracic echocardiogram may be useful detect early cardiovascular abnormalities in SLE patients with high disease activity, and therefore should be considered as part of the cardiovascular evaluation of these patients.

References

[1]Chen J, Tang Y, Zhu M, et al. Heart involvement in systemic lupus erythematosus: a systemic review and meta-analysis. Clin Rheumatol 2016; 35:2437–48.

[2]Kao AH, Sabatine JM, Manzi S. Update on vascular disease in systemic lupus erythematosus. Curr Opin Rheumatol 2003; 15:519–27.

Disclosure of Interests

None declared