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

The presence and outcome of biliary sphincter disorders in liver-transplant recipients according to the Rome IV classification

Background

Biliary sphincter disorders after liver transplantation (LT) are poorly described. We aim to describe the presence and outcome of patients with papillary stenosis (PS) and functional biliary sphincter disorders (FBSDs) after LT according to the updated Rome IV criteria.

Methods

We reviewed all endoscopic retrograde cholangiopancreatographies (ERCPs) performed in LT recipients between January 2003 and December 2019. Information on clinical and endoscopic findings was obtained from electronic health records and endoscopy databases. Laboratory and clinical findings were collected at the time of ERCP and 1 month after ERCP.

Results

Among the 1,307 LT recipients, 336 underwent 849 ERCPs. Thirteen (1.0%) patients met the updated Rome IV criteria for PS [former sphincter of Oddi dysfunction (SOD) type I] and 14 patients (1.0%) met the Rome IV criteria for FBSD (former SOD type II). Biliary sphincterotomy was performed in 13 PS and 10 FBSD cases. One month after sphincterotomy, bilirubin, gamma-glutamyl transferase and alkaline phosphatase levels decreased in 85%, 61%, and 92% of those in the PS group (P = 0.019, 0.087, and 0.003, respectively) and in 50%, 70%, and 80% of those in the FBSD group (P = 0.721, 0.013, and 0.093, respectively). All the 14 patients initially suspected of having a FBSD turned out to have a different diagnosis during the follow-up.

Conclusions

PS after LT is uncommon and occurs in only 1% of LT recipients. Our data do not support the presence of an FBSD after LT. Sphincterotomy is a safe and effective procedure in LT recipients with PS.

AB0117 CARDIOVASCULAR MORBIMORTALITY IN RHEUMATOID ARTHRITIS: A 5 YEAR FOLLOW-UP STUDY

Background:

Rheumatoid arthritis (RA) is characterized by elevated cardiovascular morbimortality. RA patients have a higher risk to develop cardiovascular comorbidities when compared to the general population, being the main cause of mortality in these patients. Cardiovascular risk factors (CVRF) are well known, but their management is not optimal, increasing the risk of having a major heart disease (1).

Objectives:

To assess the prevalence of the main causes of morbimortality and development of CVRF in RA patients during a five-year follow-up period.

Methods:

A longitudinal and prospective study of a RA cohort from 2014-2019 was performed in a Cardio Rheumatology outpatient clinic at the University Hospital “Dr. Jose E. Gonzalez”, UANL. Patients aged 40-75 years with RA according to ACR/EULAR 2010 criteria were recruited. At both visits, demographic, clinical variables, and lipid profile were recorded. Outcomes included the development of cardiovascular comorbidity: hypertension, diabetes mellitus (DM), dyslipidemia, myocardial infarction, stroke. Survival probabilities and outcomes cumulative frequencies were calculated according to the Kaplan-Meier lifetime analysis method. Descriptive analysis: frequencies (%), mean (SD), or median (q25-q75). Comparisons with McNemar and Student’s t test.

Results:

A follow-up was done in a total of 92 patients. During the follow-up, 9 patients (9.8%) died, 3 died of cardiovascular death (one myocardial infarction and two strokes). The mean age of death was 67.2 ± 10.5 years. CVRF at baseline (T0) and after five years (T5) are shown in table 1. Of the remain 83 patients, 11 patients (13.3%) developed hypertension (p=0.001), 8 (9.6%) patients developed DM (p=0.031). The number of patients with dyslipidemia decreased significantly to 14 (16.9%) (p=0.031), 4 (4.8%) developed a stroke. A survival probability of 95.7% was found at the five-year follow-up from the time of entry into the cardio rheumatology clinic (Figure 1 next page) and a 30.1% probability of developing cardiovascular comorbidity.

Conclusion:

This long-term study provides updated information on RA morbimortality characteristics in our population. Patients with RA still develop significant cardiovascular comorbidities despite current treatment. In this cohort, hypertension and DM became more prevalent, and a 96% cardiovascular death-free survival was found. Is imperative to increase the effort in determining optimal markers and therapeutic measures to continue with the prevention of these comorbidities.

References:

[1]Semb AG, Ikdahl E, Wibetoe G, et al. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020;16(7):361-79. doi: 10.1038/s41584-020-0428-y.

Table 1.

Demographic and clinical characteristics at the time of inclusion and at 5 years.

T0(n=83)T5(n=83)pAge years, mean ± SD56.0 ± 8.9-Female, n (%)75 (90.4)-Disease duration years median (q25-q75)10.4 (4.4-15.7)-CVRF, n (%) Hypertension27 (32.5)38 (45.8)0.001 Dyslipidemia25 (30.1)16 (19.3)0.041 DM6 (7.2)14 (16.9)0.008 Active smoking8 (9.6)6 (7.2)NS Overweight/Obesity67 (81.7)63 (81.9)NS Stroke04 (4.8)-Clinical characteristics BMI kg/m2, mean ± SD28.1 ± 4.128.5± 4.3NS SBP mmHg, mean ± SD123.7 ± 18.4126.9± 16.8NS Total cholesterol mg/dl, mean ± SD180.8 ± 29.0173.9± 34.2NS Triglycerides mg/dl, mean ± SD136.1 ± 56.1146.1± 64.2NS HDL-C mg/dl, mean ± SD55.2 ± 16.355.1± 15.9NS Statins, n (%)9 (10.8)13(15.7)NS Methotrexate, n (%)71 (85.5)63 (75.9)0.039 Glucocorticoids, n (%)49 (59)40 (48.2)NS

NS, non-significant; CVRF, cardiovascular risk factors; DM, diabetes mellitus; BMI, body mass index; SBP, systolic blood pressure; HDL-C, high density lipoprotein cholesterol.

Disclosure of Interests:

None declared

POS1074 CARDIOVASCULAR RISK FACTORS IN A MEXICAN MESTIZO PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Psoriatic Arthritis (PsA) is a chronic inflammatory arthropathy that affects 14%-30% of patients with skin and/or nail psoriasis. Patients with psoriatic arthritis (PsA) have a higher prevalence of traditional cardiovascular (CV) risk factors and an increased risk of developing cardiovascular diseases (1), such as acute myocardial infarction, cerebrovascular accident, peripheral vascular disease and heart failure. Despite the evidence patients with PsA are inadequately screened and undertreated for CV risk factors (CVRF), highlighting a gap in preventive medicine to adjust cardiovascular therapies(2).

Objectives:

The aim of the study is to determine the main CVRF in Mexican Mestizo patients with a diagnosis of PsA and to compare it with healthy controls. Additionally, to assess the impact of the diagnosis of PsA on the presence on these cardiovascular comorbidities.

Methods:

A cross-sectional, observational, and comparative study of ninety-six patients with PsA between 40-75 years who fulfilled CASPAR criteria 2006. Patients were matched by age and gender with non-PsA subjects. A medical history and physical exam were performed, also a blood sample was collected during the first visit. Chi square and Student´s t test were used for comparations between groups. A binary logistic regression was performed including the traditional CVRF (type 2 diabetes mellitus, hypertension, obesity, and active smoking), age and the diagnosis of PsA. A p value <0.05 was considered statistically significant.

Results:

There were 58 (60.4%) women in each group with a mean of 53 years. Patients with PsA showed a higher prevalence of hypertension (HTN) compared to healthy controls (35.4% vs 19.8%, respectively, p = 0.015). Additionally, there was a significant difference in the diagnosis of dyslipidemia (42.7% vs 22.9%, p = 0.003).We found no statistically difference between the two groups in type 2 diabetes mellitus, active smoking and, obesity (Table 1. below).

Table 1.

Comparison of cardiovascular risk factors between Psoriatic Arthritis and controls.

PsA(n=96)Control(n=96)pAge, years ± SD53.19 ± 11.1353.34 ± 8.4NSWomen, n (%)58 (60.4)58 (60.4)NST2DM, n (%)21 (21.9)12 (12.5)NSHTN, n (%)34 (35.4)19 (19.8)0.015Active smoking, n (%)21 (21.9)20 (20.8)NSDyslipidemia, n (%)41 (42.7)22 (22.9)0.003Obesity, n (%)36 (37.5)25 (26.0)NS

NS, no significative; SD, standard deviation; HTN, hypertension; T2DM, type2 diabetes mellitus.

The binary logistic regression showed that the diagnosis of PsA (OR 2.235, 95% CI 1.141-4.375, p = 0.019) and active smoking (OR 2.429 95%, CI 1.137-5.186, p = 0.022) are independent risk factors for the presence of dyslipidemia.

Conclusion:

Patients with PsA have a higher prevalence of HTN and dyslipidemia. The diagnosis of PsA seems to be an independent factor for the presence of dyslipidemia. It is important for rheumatologists to identify those patients who could benefit from adjust antirheumatic and cardiovascular therapies due to their impact on morbidity and mortality.

References:

[1]Peluso R, Caso F, Tasso M, et al. Cardiovascular Risk Markers and Major Adverse Cardiovascular Events in Psoriatic Arthritis Patients. Rev Recent Clin Trials 2018;13(3):199-209. doi: 10.2174/1574887113666180314105511

[2]Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol 2017;76(3):393-403. doi: 10.1016/j.jaad.2016.07.065

Disclosure of Interests:

None declared.

AB0842 CESAREAN SECTION IN MEXICAN WOMEN WITH AUTOIMMUNE RHEUMATIC DISEASES

Background:

Rheumatic diseases occur among women of childbearing age, adverse events during pregnancy in rheumatic diseases have been frequently reported. Mexico has one of the largest prevalence of cesarean section in women which negatively impacts the product.

Objectives:

The objective of this study is to describe the frequency of cesarean section in women with autoimmune rheumatic diseases compared to a control group.

Methods:

We conducted a cross-sectional and retrospective study in patients from the pregnancy and rheumatic diseases clinic, and the Obstetrics department form the University Hospital “Dr. José E. González” in Northeast Mexico. Women with autoimmune rheumatic diseases that gave birth between August 2017 to December 2020 were included. All the data, including the way of birth was retrieved from the clinical files.

Results:

One hundred and twelve patients were included (56 in the rheumatic disease group and 56 women without rheumatic diseases), two of them suffered miscarriage (one from the rheumatic disease group and 1 from the control group) giving a total of 110 products. The mean age was 29.6 years for the rheumatic patients and 24.6 for the control group. The most frequent rheumatic disease was RA in 22 patients (39.2%), followed by SLE in 13 patients (23.21%).

From the 56 pregnancies on the rheumatic disease group more than half ended by cesarean section (n=33, 58.92%) and there were 22 simple vaginal delivery. Table 1. On the control group there were 24 cesarean section procedures and 31 simple vaginal delivery. The indications for cesarean sections are presented in Figure 1. No statistically significant difference was found on cesarean section prevalence between both groups (p=0.389).

The most common indication for cesarean section in all patients was previous cesarean procedure. (n=12, 36.36%). There were more pathological fetal cardiotocographic changes (PFCC) as an indication for cesarean section on the rheumatic diseases group (n=11, p 0.002) compared with the control group (n=1).

Conclusion:

A higher prevalence of cesarean sections was found in women with rheumatic diseases versus women without rheumatic diseases, although this difference was not statistically significant. Studies with a higher sample size are necessary to elucidate the complications and differences between both groups.

References:

[1]Jara LJ, Cruz-Dominguez MDP, Saavedra MA. Impact of infections in autoimmune rheumatic diseases and pregnancy. Curr Opin Rheumatol. 2019;31(5):546-52.

[2]Saavedra MA, Sánchez A, Bustamante R, Miranda-Hernández D, Soliz-Antezana J, Cruz-Domínguez P, et al. [Maternal and fetal outcome in Mexican women with rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2015;53 Suppl 1:S24-9.

[3]Smeele HTW, Dolhain R. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum. 2019;49(3s):S32-s5.

[4]Sugawara E, Kato M, Fujieda Y, Oku K, Bohgaki T, Yasuda S, et al. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan. Lupus. 2019;28(12):1407-16.

[5]Vinet É, Bernatsky S. Outcomes in Children Born to Women with Rheumatic Diseases. Rheum Dis Clin North Am. 2017;43(2):263-73.

Table 1.

Demographic charecteristics

DISEASEN (%)AGE, YEARS MEANDURATION OF DISEASE, YEARS MEANCESAREAN SECTIONSIMPLE VAGINAL DELIVERYOTHERSRA22 (39.2%)29.956.7711101 MiscarriageAPS9 (16.98)28.222.7781DM3(5.35%)203.521IA3(5.35%)21.5321SS4 (7.14%)30.254.7531JIA2 (3.57%)361511SLE13 (23.21)31.835.3375TOTAL5629.641509433322

RA: Rheumatoid Arthritis, APS: Anti-phospholipid syndrome, DM: Dermatomyositis, IA: Idiopathic arthritis, SS: Sjogren syndrome, JIA: Juvenile idiopathic arthritis, SLE: Systemic Lupus Erythematosus

Disclosure of Interests:

None declared

POS1404 ECHOCARDIOGRAPHIC FINDINGS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS AND ITS RELATION TO ANTIBODIES TITERS

Background:

Systemic lupus erythematosus (SLE) is a chronic and autoimmune disease characterized by systemic involvement. Patients with SLE have accelerated atherosclerosis, resulting in an up to nine-fold increased risk of cardiovascular disease, compared to the general population (1), being the leading cause of death for these patients. Speckle tracking echocardiography (STE) is an accurate technique to estimate myocardial function and deformation.

Objectives:

This study aims to determine the association between echocardiographic findings and the presence of antibodies in SLE patients.

Methods:

This was a cross-sectional and observational study. A total of forty-three patients ≥18 years with a diagnosis of SLE according to EULAR/ACR 2019 criteria were included for this study. Those with a history of cardiovascular disease (myocardial infarction, cerebrovascular accident, or peripheral arterial disease) and pregnancy were excluded. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Blood samples obtained from all patients were analyzed for the following: anti-nuclear antibodies (ANA), anti, SSA/Ro, SSB/La antibodies, anti-cardiolipin antibodies (IgA, IgM, IgG), and complement levels. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations between numerical variables were done using Spearman’s rho, considering two-tailed p-values <0.05 as statistically significant.

Results:

The 39 female patients (90.7%) and 4 male patients (9.3%) had a mean age of 35.5 ± 12.0 years and a median disease duration of 72 months (14-132). At the time of inclusion, 90.7% of the patients were being treated with glucocorticoids and antimalarials. Concerning traditional cardiovascular risk factors; 20.9% of the patients had hypertension, 7.0% had dyslipidemia, 2.3% had diabetes mellitus and 18.6% were active smokers. Correlations between echocardiographic findings and antibodies are shown in Table 1. We found a moderate positive correlation between global circumferential strain and IgA anticardiolipin antibody (r=0.507, p=0.002), a low positive correlation in left ventricular ejection fraction with anti-Ro (r=0.397, p=0.012) and anti-La (r=0.397, p=0.012) and a low positive correlation between TAPSE and C3 levels (r=0.396, p=0.013).

Conclusion:

There is an association between anticardiolipin antibody titers, anti-Ro, and anti-La with echocardiographic alterations. All SLE patients especially those who had positive antibodies should be screened for the presence of structural cardiac abnormalities. STE can be helpful as a noninvasive diagnostic tool, that could result in earlier treatment and prognosis.

References:

[1]Hesselvig JH, Ahlehoff O, Dreyer L, et al. Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. Lupus 2017;26(1):48-53. doi: 10.1177/0961203316651739

Table 1.

Spearman rho correlations between antibody titers and echocardiographic findings.

VariablesGLS,mean ± SD-19.11 ± 3.33LVEF,mean ± SD57.43 ± 7.17TAPSE,mean ± SD22.23 ± 3.24ANA, median (p25-p75)640 (160-2550)NSNSNSIgA Anti-Cardiolipin, median (p25-p75)2 (2-3)0.507**NSNSIgM Anti-Cardiolipin, median (p25-p75)2 (2-4)NSNSNSIgG Anti-Cardiolipin, median (p25-p75)4 (3-6)NSNSNSAnti-Ro, median (p25-p75)17 (2-80)NS0.326*NSAnti-La, median (p25-p75)3 (2-5.5)NS0.397*NSC3, mean ± SD91.41 ± 37.38NSNS0.396*

**Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level. NS, not significant; GLS, global circumferential strain; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.

Disclosure of Interests:

None declared

POS0483 SUBCLINICAL ATHEROSCLEROSIS IN THE FIRST FIVE YEARS OF RHEUMATOID ARTHRITIS DIAGNOSIS

Background:

Patients with rheumatoid arthritis (RA) have a higher risk of developing a cardiovascular (CV) event than the general population, due to an accelerated process of atherosclerosis (1), which has been documented to begin in early stages of the disease and is directly associated with systemic inflammation (2).

Objectives:

The aim of this study was to compare the prevalence of subclinical atherosclerosis detected by carotid ultrasound (US) in patients with RA in the first five years of diagnosis and healthy controls.

Methods:

This was a cross-sectional, observational, and comparative study. A total of 53 patients aged 40-75 years old, with RA diagnosis, in the previous five years, according to the 2010 ACR/EULAR classification criteria, and 53 controls matched by age (±5 years), gender and comorbidities were included in this study. Subjects with a previous CV event, such as myocardial infarction, cerebrovascular event and peripheral arterial disease, another connective tissue disease and pregnant women were excluded from this study. A high-resolution B-mode carotid US was performed in all study subjects. Subclinical atherosclerosis was evaluated as the presence of carotid plaque (CP) or an increased carotid intima media thickness (cIMT). CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm of the surrounding lumen, and an increased cIMT was defined as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test and Fisher’s exact 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:

Comparisons of demographic characteristics showed no differences between the RA group and the control group (Table 1). When comparing carotid US findings there was a difference in the presence of CP, being more prevalent in RA patients (26.4% vs 11.3%, p=0.047), in the presence of an increased cIMT, being more prevalent in RA patients (34.0% vs 3.8%, p=<0.001), in the cIMT as a quantitative variable, being higher in RA patients (0.70mm vs 0.59mm, p=<0.001 in the right carotid artery, and 0.75mm vs 0.60mm, p=0.001 in the left carotid artery), and in the presence of subclinical atherosclerosis overall, being more prevalent in RA patients (52.8% vs 18.9%, p=<0.001) (Figure 1).

Table 1.

Demographic and clinical characteristics

RAControlsp(n=53)(n=53)Age years, mean ± SD54.48 ± 9.0954.86 ± 6.83NSWomen, n (%)49 (92.5)49 (92.5)NST2DM, n (%)8 (15.1)7 (13.2)NSHTN, n (%)17 (32.1)17 (32.1)NSDyslipidemia, n (%)19 (35.8)19 (35.8)NSObesity, n (%)21 (39.6)20 (37.7)NSActive smoking, n (%)3 (5.7)4 (7.5)NSBMI kg/m2, median (p25-p75)28.78 (25.92-33.21)27.59 (24.55-33.34)NSDisease duration, mean ± SD2.48 ± 1.31--DAS28-CRP, median (p25-p75)3.21 (1.89-4.12)--MTX, n (%)39 (73.6)--Glucocorticoids, n (%)29 (54.7)--

Conclusion:

Patients with RA in the first five years of diagnosis have a higher prevalence of subclinical atherosclerosis than the general population. CV evaluation including a carotid US should be done at the time of diagnosis of RA patients, and subsequently it must be individualized according to the CV risk of each patient, with a maximum of five years to identify those patients who would benefit from an opportune treatment.

References:

[1]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436

[2]Ahmad S, Garg S, Dhar M, et al. Predictors of atherosclerosis in rheumatoid arthritis. Vasa 2012;41(5):353-9. doi: 10.1024/0301-1526/a000221

Disclosure of Interests:

None declared

POS1392 ECHOCARDIOGRAPHIC FINDINGS IN PSORIATIC ARTHRITIS, RHEUMATOID ARTHRITIS AND CONTROLS

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with cardiovascular abnormalities (1). The echocardiography is a non-invasive tool useful in the detection of cardiac abnormalities, which may be the only manifestation of cardiac involvement preceding a global dysfunction. However, echocardiographic differences between PsA patients, rheumatoid arthritis (RA) patients, and controls have not yet been well described.

Objectives:

To analyze the echocardiographic parameters in PsA patients and to compare them with RA patients and controls.

Methods:

This cross-sectional, observational and comparative study, included thirty-six patients (nineteen in each group), aged 40-75 years, with PsA and RA who fulfilled the CASPAR (Classification criteria for Psoriatic Arthritis) and ACR/EULAR 2010 classification criteria, respectively, matched by age, gender and comorbidities with nineteen healthy controls. Exclusion criteria were a poor echocardiographic window, patients with a previous atherosclerotic cardiovascular disease (ischemic heart disease, cerebrovascular accident or peripheral arterial disease), and pregnancy. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Comparisons were done with X2, Kruskall Wallis or ANOVA.

Results:

There were not differences in the demographic characteristics between groups (Table 1). When comparing echocardiographic findings a statistically significant difference was found in the prevalence of diastolic dysfunction, being more prevalent in PsA and RA patients compared with controls (52.6% vs 52.6% vs 5.3%, p=0.002), likewise the presence of mild mitral valve regurgitation was higher (84.2% vs 53.6% vs 10.5%, p=0.001) and mild pulmonary valve regurgitation (68.4% vs 10.5% vs 0%, p=0.001). Prevalence of abnormal left ventricular geometry was higher in PsA and RA patients than controls (68.4% vs 63.2% vs 21.1%, p=0.006).

Table 1.

Comparison of demographic characteristics and echocardiographic findings between patients with PsA, RA and controls.

PsA(n=19)RA(n=19)Controls(n=19)pAge, years ± SD54.7 ± 7.755.4 ± 9.955.3 ± 5.9NSFemale, n (%)11 (57.9)11 (57.9)11 (57.9)NSDiabetes Mellitus4 (21.1)3 (15.8)2 (10.5)NSHypertension10 (52.6)8 (42.1)7 (36.8)NSDyslipidemia10 (52.6)4 (21.1)7 (36.8)NSActive smoking4 (21.1)2 (10.5)5 (26.3)NSDisease duration, years (p25-p75)6 (4-14)7 (5-18)-NSDAS28-CRP, mean ± SD2.2 ± 0.83.1 ± .8-0.003Echocardiographic findigsDiastolic dysfunction, n (%)10 (52.6)10 (52.6)1 (5.3)0.002LV mass index, g/m2 (p25-p75)78.9 (55.9-86.9)73.7 (61.0-85.7)69.5 (52.0-98.7)NSLVEF, ± mean SD62.3 ± 6.159.7 ± 8.662.9 ± 6.1NSTAPSE, cm ± SD21.8 ± 2.722.4 ± 2.723.7 ± 3.1NSMild aortic regurgitation, n (%)5 (26.3)4 (21.1)1 (5.3)NSMild mitral regurgitation, n (%)16 (84.2)10 (52.6)2 (10.5)<0.001Mild pulmonary regurgitation, n (%)13 (68.4)2 (10.5)0 (0)<0.001Mild tricuspid regurgitation, n (%)15 (83.3)13 (76.5)11 (57.9)NSLV geometry alterations, n (%)13 (68.4)12 (63.2)4 (21.1)0.006Concentric remodeling, n (%)12 (63.2)10 (52.6)4 (21.1)0.025

NS, non-significant; DAS28-CRP, disease activity score using 28 joints and C reactive protein; LV, left ventricular; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.

Conclusion:

This study shows the high prevalence of echocardiographic alterations in PsA patients compared to the general population, of the same magnitude as patients with RA. We emphasize the value of an echocardiogram for a complete cardiovascular evaluation and early detection of cardiac abnormalities in these patients.

References:

[1]Shang Q, Tam LS, Yip GW, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 2011;38(7):1363-70. doi: 10.3899/jrheum.101136

Disclosure of Interests:

None declared

POS1402 HIGHER PREVALENCE OF SUBCLINICAL ATHEROSCLEROSIS IN PSORIATIC ARTHRITIS PATIENTS

Background:

Psoriatic arthritis (PsA) patients have a higher risk of developing a cardiovascular (CV) event than the general population due to an increased prevalence of traditional CV risk factors and to disease characteristics such as disease duration and activity. The carotid ultrasound (US) is a non-invasive diagnostic tool that can detect the presence of subclinical atherosclerosis which is directly associated with the risk of developing a CV event.

Objectives:

The aim of this study is to compare the prevalence of subclinical atherosclerosis detected by carotid US in PsA patients and controls.

Methods:

This is a cross-sectional, observational, and comparative study. A total of seventy-five PsA patients aged 40-75 years old, who fulfilled the 2006 CASPAR criteria and seventy-five matched controls by age (±5 years), gender and comorbidities were recruited for this study. Patients with history of a previous CV event and pregnant women were excluded from this study. A high-resolution B mode carotid US was performed in all study subjects by a certified radiologist. Subclinical atherosclerosis was defined as the presence of a carotid plaque (CP) or an increased carotid intima media thickness (cIMT). The presence of CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm in the surrounding lumen. An increased cIMT was considered as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 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 when comparing the demographic characteristics between both groups (Table 1). When comparing the carotid US findings, a statistically significant difference was found in the prevalence of CP, which was higher in the PsA group (44.0% vs 26.7%, p=0.026), in the presence of unilateral CP (25.3% vs 10.7%, p=0.019) and in the presence of subclinical atherosclerosis (52.0% vs 34.7%, p=0.032) (Figure 1).

Conclusion:

The prevalence of subclinical atherosclerosis was higher in PsA patients than controls, and this could be attributed to an increase in the inflammatory burden of these patients. The carotid US should be considered as part of the CV evaluation in all PsA patients, identifying those who would benefit from an opportune treatment preventing the development of a CV event.

References:

[1]Yim KM, Armstrong AW. Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. Rheumatol Int. 2017;37(1):97–105.

Table 1.

Demographic and clinical characteristics of psoriatic arthritis patients and controls.

PsA(n=75)Controls(n=75)pAge years, mean ± DE53.89 ± 10.5954.25 ± 7.08NSFemale gender, n (%)43 (57.3)43 (57.3)NST2DM, n (%)16 (21.3)15 (20.0)NSHTN, n (%)28 (37.3)21 (28.0)NSDyslipidemia, n (%)33 (44.0)28 (37.3)NSObesity, n (%)31 (41.3)32 (42.7)NSActive smoking, n (%)14 (18.7)18 (24.0)NSBMI kg/m2, median (p25-p75)29.32 (26.23-32.03)28.9 (25.4-33.5)NSDisease duration years, median (p25-p75)5.0 (3.0-10.0)--DAPSA, median (p25-p75)12.6 (5.3-22.9)--Glucocorticoids, n (%)10 (13.3)--MTX, n (%)51 (68.0)--bDMARD, n (%)28 (37.3)--

PsA, psoriatic arthritis; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; DAPSA, disease activity for psoriatic arthritis; MTX, methotrexate; bDMARD, biological disease modifying antirheumatic drug.

Disclosure of Interests:

None declared

AB0657 PERCEIVED STRESS AND FOOD INSECURITY IN PREGNANT AND POSTPARTUM WOMEN WITH RHEUMATIC DISEASES DURING THE COVID-19 PANDEMIC

Background:

The SARS-CoV-2 pandemic has directly impacted the psychological and physical health of individuals worldwide, as well as the global economy. Food insecurity rates have risen especially in vulnerable countries like Mexico. Furthermore, social isolation and economic uncertainty have multiplied depression and anxiety disorders. Pregnant and postpartum women are particularly vulnerable to food insecurity, increased stress, depression, and anxiety.

Objectives:

The aim of this study is to determine the perception of food insecurity (FI) and perceived stress in pregnant and postpartum women with rheumatic disease during the SARS-CoV-2 pandemic.

Methods:

An observational, cross-sectional and descriptive study was conducted. Patients from to the pregnancy and rheumatic diseases clinic of the University Hospital “Dr. José E. González” in Northeast Mexico evaluated between August to October 2020 were included. The Spanish validated versions of the Household Food Security Access Scale (HFIAS) and the Perceived Stress Scale (PSS-10) were applied by telephonic interview. The WHO recommendations were employed to determine the appropriate intake for each food group in a week. The Kolmogorov-Smirnov test was used to determine normality of the data. The Spearman correlation coefficient and the Kruskal-Wallis test were used for statistical analysis.

Results:

A total of 29 women were included. Six (20.6%) women were found to have moderate or severe degrees of food insecurity. In addition, 12 (40.30%) perceived moderate and severe levels of stress in the PSS-10. No relationship was found between food insecurity and perceived stress (p= 0.059). The food groups that exceeded the recommended weekly frequency were oils and sugars exceeded 3.9 and 2.9 frequencies, respectively.

Conclusion:

We found that 20.6% women suffered household food insecurity and 40.3% suffered moderate and severe levels of stress. No relationship was found between food insecurity with the HIFAS scale and perceived stress measures with the PSS-10. We found that oils and sugars exceeded more by the double of the recommended frequency per week.

References:

[1]Pérez-Escamilla R, Cunningham K, Moran VH. COVID-19 and maternal and child food and nutrition insecurity: a complex syndemic. Matern Child Nutr. 2020;16(3):e13036. doi:10.1111/mcn.13036

[2]Adams EL, Caccavale LJ, Smith D, Bean MK. Food Insecurity, the Home Food Environment, and Parent Feeding Practices in the Era of COVID-19. Obesity (Silver Spring). 2020;28(11):2056-2063. doi:10.1002/oby.22996

Table 1.

Socio-demographic characteristics and scale results.

Age, years, mean (SD)27.5 (7.03)Diagnosis, n (%)RA16 (55.1)SLE7 (24.4)Others6 (20.6)Results per scalesHFIAS, n (%)No risk13 (44.8)Mild10 (34.4)Moderated3 (10.3)Severe3 (10.3)EPP-10, n (%)Mild17 (58.6)Moderated9 (31.0)Severe3 (10.3)

SD: standard deviation, RA: Rheumatoid arthritis, SLE: Systemic lupus erythematosus, HFIAS: Household food security access component scale, EPP-10: Perceived stress scale 10 items.

Disclosure of Interests:

None declared.

AB0867-HPR VIOLENCE IN PREGNANT AND POSTPARTUM MEXICAN WOMEN WITH AUTOIMMUNE RHEUMATIC DISEASES

Background:

Gender violence is a prevalent issue worldwide. In Mexico, four out of ten women suffer any kind of violence. The factors that make women even more vulnerable to domestic violence are pregnancy, socioeconomic status, educational level, and the presence of chronic health problems. Violence represents a major risk factor for depression, anxiety, poor adherence to medical treatment, and obstetric adverse events.

Objectives:

The aim of this study is to determine the frequency of domestic violence in pregnant and postpartum women with autoimmune rheumatic diseases (ARD) and to compare with childbearing age women with ARD.

Methods:

Pregnant and postpartum women (PPW) with rheumatic disease evaluated at the Pregnancy and Rheumatic Diseases Clinic from the University Hospital “Dr. José E. González” in Monterrey, México from August to October 2020 were invited to participate. To compare, we enrolled childbearing age women with ARD without previous pregnancies. The Spanish validated version of the Hurt, Insulted, Threatened with Harm, Screamed scale (HITS) was applied via telephonic interview. The HITS scale evaluates in 4 questions the presence and frequency of violence by their intimate partners in the last 12 months. A score ≥ 10 points is considered as positive for violence.

Results:

A total of 48 women were included, 24 patients each group. The pregnant-postpartum group was divided in 6 (25) pregnant and 18 (75) postpartum women. Most of them were housewives (54.1%) with >10 years of education and with not formalized marital status 41% (common-law marriage). In the childbearing age group, most of them were employees (70.8), with >10 years of education with a current marital status of single (66.6%). The HITS scale was positive in the pregnant-postpartum group in 4 women (16.6%). Two of them had been victims of sexual assault and 2 reported physical/verbal violence. While in childbearing age group only 1 (4.16) reported physical/verbal violence.

Conclusion:

The 16% of the pregnant-postpartum group in our sample were suffering from domestic violence by their intimate partners, in contrast to the childbearing age group with only 1 patient reported violence. We found that postpartum and pregnancy women had more prevalence of violence. Screening for domestic violence followed by counseling and early referral are necessary to mitigate the physical and psychological consequences of domestic violence.

References:

Moreira DN, Pinto da Costa M. The impact of the Covid-19 pandemic in the precipitation of intimate partner violence. Int J Law Psychiatry. 2020;71:101606. doi:10.1016/j.ijlp.2020.101606.

Jackson CL, Ciciolla L, Crnic KA, Luecken LJ, Gonzales NA, Coonrod DV. Intimate partner violence before and during pregnancy: related demographic and psychosocial factors and postpartum depressive symptoms among Mexican American women. J Interpers Violence. 2015;30(4):659-679. doi:10.1177/0886260514535262.

Table 1.

Sociodemographic characteristics and scale results

Postpartum and pregnancy womenn= 24Childbearing age womenn= 24Age, years, mean27.527.08Occupation, n (%)Housewive13 (54.1)5 (20.8)Employee7 (29.1)17 (70.8)Student4 (16.6)2 (8.3)Education years, n (%)Less than 10 years11 (45.8)7 (29.1)More than 10 years13 (54.1)17 (70.8)Marital status, n (%)Common-law marriage10 (41.6)-Married8 (33.3)8 (33.3)Single6 (24.9)16 (66.6)Status, n (%)Postpartum18 (75)-Pregnancy6 (25)-Results of the HITS scaleTotal, mean5.374.37Score per ranges, n (%)0 – 9 points20 (83.3)23 (95.8)10 – 20 points4 (16.6)1 (4.1)

Disclosure of Interests:

None declared

POS0491 LEFT VENTRICULAR GEOMETRIC ABNORMALITIES ASSOCIATED WITH HIGHER TITERS OF RHEUMATOID FACTOR AND ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODIES IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Rheumatoid arthritis (RA) patients have a higher risk of developing left ventricular (LV) geometric abnormalities which can result in the development of heart failure and cardiac death (1). High titers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with a worse cardiovascular (CV) prognosis in RA patients (2).

Objectives:

The aim of this study was to assess the association between RF and anti-CCP antibody titers, and the LV geometric abnormalities detected by a transthoracic echocardiogram.

Methods:

This was a cross-sectional, observational, and comparative study. Patients aged 40-75 years who fulfilled the 2010 ACR/EULAR classification criteria for RA underwent a transthoracic echocardiogram. Patients with RA and an alteration of LV geometry were matched to RA patients with normal LV geometry, by age, gender, comorbidities, and disease characteristics to eliminate confounders. LV geometry was evaluated with LV mass index and relative wall thickness. A blood sample was taken to measure RF and anti-CCP antibody titers. 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:

A total of 82 RA patients were included in this study, 41 patients with altered LV geometry and 41 patients with normal LV geometry. Of the 41 patients with LV geometric abnormalities, 37 (90.2%) presented LV concentric remodeling and 4 (9.8%) presented LV concentric hypertrophy. We found no significant differences in the demographic and clinical characteristics between both groups (Table 1). Patients with altered LV geometry showed higher titers of IgA-RF (102.11 U/ml vs 21.70 U/ml, p=0.011) and anti-CCP antibodies (193.04 U/ml vs 18.29 U/ml, p=0.005) (Figure 1).

Table 1.

Demographic and disease characteristics.

RA patients with altered LV geometry(n=41)RA patients with normal LV geometry(n=41)pAge years, mean ± SD53.12 ± 7.6252.34 ± 7.74NSWomen, n (%)39 (95.1)39 (95.1)NST2DM, n (%)7 (17.1)4 (9.8)NSHTN, n (%)13 (31.7)10 (24.4)NSDyslipidemia, n (%)9 (22.0)11 (26.8)NSActive smoking, n (%)4 (9.8)3 (7.3)NSObesity, n (%)11 (26.8)14 (34.1)NSBMI kg/m2, median (p25-p75)27.95 (25.33-31.45)28.42 (25.84-32.00)NSDisease duration years, median (p25-p75)10.37 (2.72-17.80)6.40 (3.43-13.29)NSCDAI, median (p25-p75)14.00 (2.00-22.00)10.00 (3.00-16.50)NSDAS28-CRP, mean ± SD3.52 ± 1.423.09 ± 1.11NSTreatmentMTX, n (%)33 (80.5)34 (82.9)NSGlucocorticoids, n (%)25 (61.0)23 (56.1)NSAntihypertensive, n (%)13 (31.7)8 (19.5)NSStatins, n (%)6 (14.6)4 (9.8)NS

RA, rheumatoid arthritis; LV, left ventricular; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; CDAI, clinical disease activity index; DAS28, disease activity score using 28 joints; CPR, C-reactive protein; MTX, methotrexate.

Conclusion:

RA patients with altered LV geometry had higher titers of IgA-RF and anti-CCP antibodies. This suggests an association between antibody titers and CV prognosis in RA patients. Rheumatologists should take these data into account when evaluating CV risk in RA patients, assessing the possibility of performing an echocardiogram for early detection of CV abnormalities and an opportune treatment in this group of patients.

References:

[1]Myasoedova E, Davis JM, 3rd, Crowson CS, et al. Brief report: rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a population-based cross-sectional study. Arthritis Rheum 2013;65(7):1713-8. doi: 10.1002/art.37949

[2]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436

Acknowledgements:

We have no acknowledgements to declare.

Disclosure of Interests:

None declared

Hyperkalemia influences the outcome of patients with cirrhosis with acute decompensation (AD) and acute-on-chronic liver failure (ACLF)

INTRODUCTION

The presence of hyperkalemia in different clinical scenarios has been described as a risk factor for mortality. Information about this electrolyte disorder in patients with cirrhosis is limited and there are no data in patients with acute-on-chronic liver failure (ACLF).

AIM

The aim of this study was to investigate whether hyperkalemia is a risk factor for mortality in patients with cirrhosis and acute decompensation (AD) with and without ACLF.

METHODS

We performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,314 consecutive patients admitted to 29 European centers with AD both with and without associated ACLF (294 and 1020 respectively). Hyperkalemia was defined as serum potassium ≥ 5.0 mEq/L. All patients had at least one valid measure of serum potassium from admission and/or through the whole hospitalization.

RESULTS

1314 patients were admitted with AD and 294 of them had ACLF at admission. Prevalence of hyperkalemia was significantly higher in ACLF versus AD (22.4% and 8.6% respectively, p<0.001). Hyperkalemia was associated with an increased 90, 180 and 360-day mortality risk in ACLF compared to AD (HR 10 vs 2.3 at 90-day p<0.001, 8.9 vs 3.1 at 180-day, p<0.001 and 5.8 vs 3.8 at 360-day, p<0.001). In a multivariate analysis, the presence of hyperkalemia during admission was independently associated with 90-day mortality [HR 2.4 (1.7 - 3.4)]. Variability of potassium between two valid measures ≥ 0.9 mg/dl was always also associated with a higher mortality rate. Addition of hyperkalemia to MELD score (MELD-K model) improved the accuracy to predict 90-day mortality risk.

CONCLUSIONS

Hyperkalemia is an independent risk factor of mortality in patients with AD and ACLF. Addition of hyperkalemia to the MELD score improves diagnostic accuracy to predict 90-day mortality in patients with AD and ACLF.

AB0113 ANTI-CARBAMYLATED PROTEIN ANTIBODIES POSITIVITY AND DISEASE ACTIVITY IN HISPANIC PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS: AN OBSERVATIONAL STUDY

Background:

Clinically relevant anti-carbamylated (anti-CarP) antibodies are detected in up to 45% of rheumatoid arthritis (RA) patients and are associated with severe radiological progression, higher disease activity, and significantly more disability when studied in early phases of arthritis.

Objectives:

We aimed to determine the prevalence of anti-CarP antibodies in Mexican Hispanics with established RA and to assess their relationship with disease activity.

Methods:

A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up.

Results:

Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months.

Conclusion:

Anti-CarP IgG antibodies are present in almost 50% of RA patients and, accounting for all isotypes, in 9% of RF and ACPA negative patients. Anti-CarP IgG antibody positivity was not associated to a higher disease activity measured by DAS28-ESR in Hispanic patients with established RA.

References:

Shi J, Knevel R, Suwannalai P, Van Der Linden MP, Janssen GMC, Van Veelen PA, et al. Autoantibodies recognizing carbamylated proteins are present in sera of patients with rheumatoid arthritis and predict joint damage. Proc Natl Acad Sci U S A. 2011;108:17372–17377.

Table 1.

Anti-CarP antibody status by isotype in a cohort of 278 patients with established RA.

Mean (SD)Antibody positivity,n (%)95% CIRF IgAa266.9 (460.5)155 (58.9)53.0 to 64.9RF IgMa406.8 (611.9)188 (71.5)66.0 to 77.0RF IgGa36.1 (249.6)44 (16.7)12.2 to 21.3ACPA IgGa191.01 (411.1)144 (54.8)48.7 to 60.8Anti-CarP IgAb212.9 (464.2)74 (26.6)21.4 to 31.8Anti-CarP IgMb381.6 (762)89 (32)26.5 to 37.5Anti-CarP IgGb227.5 (402.5)133 (47.8)41.9 to 53.8

aData were available for 263 patients. Units are RU/mL. bData were available for 278 patients. Units are AU/mL. RF, rheumatoid factor; ACPA, anticitrullinated protein antibodies; Anti-CarP, anti-carbamylated protein antibodies; IgG, immunoglobulin; SD, standard deviation; 95% CI, 95% confidence intervals.

Figure 1.

Disclosure of Interests:

David Vega-Morales Grant/research support from: This research was funded as an Investigator Initiated Study by UCB (IIS-2015-104068). The sponsor did not have any role in the design or outcomes of this study., Mario Alberto Garza Elizondo: None declared, Leendert A Trouw: None declared, Karina Itzel González Márquez: None declared, Ernesto Torres-Lopez: None declared, Myriam Eguia Bernal: None declared, SALVADOR AZAHEL LOREDO ALANIS: None declared, Tayde Sarahi Gracia-Arechiga: None declared, Brenda Roxana Vázquez Fuentes: None declared, Diana Daniela Castañeda Martínez: None declared, Martha Mariana Castañeda-Martínez: None declared, Cesar Vidal Solis: None declared, Andres Mendiola-Jimenez: None declared, Mario Cesar Salinas-Carmona: None declared, Pablo Herrera-Sandate: None declared, Alberto Cárdenas: None declared, Gerardo Eugenio Rodriguez-Sanchez: None declared, Dionicio Ángel Galarza-Delgado: None declared

POS0552 DIASTOLIC DYSFUNCTION ASSOCIATED WITH INCREASED ACTIVITY IN RHEUMATOID ARTHRITIS

Background:

Cardiovascular disease (CVD) is the main cause of mortality in patients with rheumatoid arthritis (RA) reflected by a higher prevalence of cardiovascular risk factors (CVRFs), a chronic systemic inflammatory state and heart failure compared to the general population (1). Left ventricular diastolic dysfunction (LVDD) is attributable to structural abnormalities such as hypertrophy or interstitial fibrosis and impaired myocyte relaxation resulting from ischemia and is frequently asymptomatic (2). The presence of LVDD it could be considered as the first step to development of heart failure.

Objectives:

The aim of the study is to identify the association of disease activity and the presence of LVDD in patients with RA.

Methods:

A cross-sectional, observational, and comparative study of RA subjects that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Subjects were evaluated by a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. A total of fifty-one RA patients diagnosed with LVDD were included according to the 2016 American Society of Echocardiography (ASE). Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student´s t test and Mann-Whitney U test were used for comparations between groups. A p value <0.05 was considered statistically significant.

Results:

We found no statistical difference between groups regarding age, gender, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) and body mass index. Patients with LVDD demonstrated a higher disease activity evaluated by disease activity score using 28 joints-C reactive protein (DAS28-PCR) (4.88 vs 3.56, p= 0.004) (Table 1). It was observed that patients with LVDD have a higher prevalence of being in the high disease activity category (41.2% vs. 13.7%, p= 0.002) (Figure 1). When performing a binary logistic regression, it was found that a high disease activity was the only independent predictor for the presence of LVDD, with an OR 4.70, (95% CI 1.63-13.50, p= 0.004).

Table 1.

Demographic and disease characteristics

RA patients with LVDD(n=51)RA patients without LVDD(n=51)pWomen, n (%)50 (98)47 (92.2)NSAge, years ± SD56.12 ± 8.7653.91 ± 5.61NSHTN, n (%)17 (33.3)13 (25.5)NST2DM, n (%)6 (11.8)10 (19.6)NSDyslipidemia, n (%)17 (33.3)11 (21.6)NSActive smoking, n (%)5 (9.8)5 (9.8)NSBMI kg/m2 ± SD28.20 ± 4.8929.40 ± 5.13NSDisease duration, years (p25-p75)10.70 (5.16-17.87)5.66 (2.67-15.64)0.033DAS28-CRP, median (p25-p75)4.88 (3.53-5.45)3.56 (3.00-4.69)0.004

NS, no significative; HTN, hypertension; T2DM, type 2 diabetes mellitus; BMI, body mass index; DAS28, disease activity score using 28 joints; CPR, C reactive protein

Conclusion:

Patients with RA and LVDD have a higher disease activity, so emphasis should be placed on strict antirheumatic treatment and cardiovascular therapies to avoid the risk of developing CVD and the progression to heart failure. Logistic regression demonstrates that inadequate disease control is an independent factor from traditional CVRFs for the presence of LVDD.

References:

[1]Dal Piaz EC, Cioffi G, Ognibeni F, et al. Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic patients with rheumatoid arthritis without overt cardiac disease. Monaldi Arch Chest Dis 2019;89(3) doi: 10.4081/monaldi.2019.1053

[2]Abdul Muizz AM, Mohd Shahrir MS, Sazliyana S, et al. A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity. Int J Rheum Dis 2011;14(1):18-30. doi: 10.1111/j.1756-185X.2010.01593.x

Disclosure of Interests:

None declared

POS0463 BEST CARDIOVASCULAR RISK CALCULATOR TO PREDICT ABNORMALITIES IN LEFT VENTRICULAR GEOMETRY IN RHEUMATOID ARTHRITIS

Background:

A relationship between rheumatoid arthritis (RA) and the presence of abnormalities in left ventricular (LV) geometry such as eccentric remodeling has recently been determined, even in the absence of cardiovascular risk factors and before clinical manifestations (1). The 2016 European League Against Rheumatism (EULAR) recommendations that cardiovascular (CV) risk prediction models should be adapted by a 1.5 multiplication factor in RA patients. Risk prediction algorithms based on the CV risk factors (CVRF) have been an important tool for adopting preventive measures and intensifying therapies based on the estimated risk but their application in predicting cardiac structural abnormalities has never been studied.

Objectives:

The aim of the study is to determine the CV risk calculator that best predicts alterations in ventricular geometry in RA.

Methods:

A cross-sectional, observational study of 108 RA patients between 40-75 years (ACR / EULAR 2010 classification criteria). The QRISK3, OMNIBUS, Framingham Risk Score Lipids (FRSL), Framingham Risk Score BMI (FRS-BMI) and Reynolds Risk Score (RRS) calculators were compared. The diagnostic performance was determined by ROC curves, and the discriminative capacity by the Area Under the Curve (AUC) 95% CI. The echocardiogram was the diagnostic gold standard. A p value <0.05 was considered statistically significant.

Results:

The prevalence of abnormalities in ventricular geometry was 38.9%. QRISK3 reported AUC of 0.656, 95% CI (0.550-0.762, p=0.006), cut-off point ≥4.6, sensitivity of 73.8% and specificity of 54.5%, and likelihood ratio of +1.62. FRS-BMI showed AUC of 0.653, 95% CI (0.543-0.762, p=0.008), cut-off point ≥11.02, sensitivity and specificity of 61.9% and 57.6% respectively, and likelihood ratio of +1.46. OMNIBUS showed AUC of 0.635, CI 95% (0.525-0.746, p=0.018), cut-off point ≥3.8, sensitivity and specificity of 57.1% and 68.2%. While RRS had AUC 0.644, 95% CI (0.534-0.755, p=0.012), cut-off point of 2.25, sensitivity of 47.6% and specificity 78.8%, and likelihood ratio of +2.24 (Figure 1 and Table 1).

Table 1.

Discriminatory capacity of the different cardiovascular risk calculators.

Calculators (cut-off point).AUCCI 95%pSensitivitySpecificityInferiorSuperiorQRISK (≥4.60)0.6460.5370.7540.01273.8%54.5%SCORE0.5910.4750.706NS--OMNIBUS (≥3.80)0.6210.5090.7340.03857.1%68.2%FRSL0.5940.4800.707NS--FRS-BMI (≥11.02)0.6420.5300.7540.01561.9%57.6%RRS (≥2.25)0.6270.5140.7410.02947.6%78.8%

Conclusion:

The QRISK3 calculator showed the highest discriminative ability and sensitivity to predict abnormalities in LV geometry. However, all calculators demonstrated the need for a lower cut-off point to predict alterations in ventricular geometry. Our findings require adequate reproducibility in other population groups to determine the applicability of CV risk algorithms as predictors of structural alteration of LV.

References:

[1]Pascale V, Finelli R, Giannotti R, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Sci Rep 2018;8(1):5867. doi: 10.1038/s41598-018-24323-0

Disclosure of Interests:

None declared

POS0482 WOOD SMOKE EXPOSURE IS ASSOCIATED WITH HIGHER ANTI-CCP ANTIBODY TITERS IN HISPANIC PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Wood smoke exposure is a risk factor for the development of chronic obstructive pulmonary disease (COPD), lung cancer and cardiovascular disease and it has also been linked to higher anti-CCP antibodies in patients with rheumatoid arthritis (RA) and COPD (1).

Objectives:

The objective of the present study is to report the correlation between anti-CCP, IgG, IgM and IgA rheumatoid factor (RF) to wood smoke exposure in patients with RA. Additionally, evaluate the impact of disease activity, biomass exposure, and disease duration on anti-CCP antibody levels.

Methods:

A cross-sectional, observational study was designed based on a cohort of Hispanic RA patients. All fulfilled the 2010 ACR/EULAR classification criteria for RA. Biomass smoke exposure was expressed using the biomass exposure index (BEI) calculated from the mean of exposed hours per day multiplied by the number of years exposed. Subjects were divided into two groups: those exposed to wood smoke with BEI ≥1 and subjects not exposed to wood smoke. They were matched by age, gender, and comorbidities. Anti-CCP antibodies and RF were measured by ELISA with cutoff points of <5 U/mL and <20 U/mL respectively.

Results:

A total of 318 subjects were included, 159 (50%) of them had a history of exposure to wood smoke. Anti-CCP antibody positivity was present in 102 (64.2%) with a median titer of 97.1 U/mL (1.7-198) in the RA exposed group, and in 89 (56%) with a median titer of 8.5 U/mL (1.1-145) in the RA non-exposed group. A significant difference was found in anti-CCP antibody titers between groups (p=0.003). (Table 1). Spearman’s rho showed a small but statistically significant correlation between BEI and anti-CCP antibody titers (rho= 0.170, p=0.002). Biomass exposure was independently related to higher anti-CCP antibody titers (B=35.4, p<0.001).

Conclusion:

RA patients who were exposed to wood smoke had higher titers of anti-CCP antibodies than non-exposed RA patients. Furthermore, biomass exposure was shown to be independently related to higher titers of anti-CCP antibodies.

References:

[1]Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102(9):843-51.

Table 1.

Comparison of demographic, seropositivity and clinical characteristic between patients with RA exposed and matched non-exposed RA patients.

CharacteristicsRA exposed(n=159)RA not exposed(n=159)pAge years, ± SD56.7 ± 8.755.4 ± 8.1NSFemale, n (%)148 (93.1)148 (93.1)NSBEI years, median (p25-p75)35 (15-90)0Disease duration years, median (p25-p75)9 (3.5-15.1)6.8 (2.8-14.6)NSDAS 28-CRP, median (p25-p75)3.37 (2.11-4.4)3.17 (2.09-4.2)NSDyslipidemia, n (%)50 (31.4)43 (27)NSHypertension, n (%)55 (34.6)48 (30.2)NSDiabetes Mellitus, n (%)24 (15.1)23 (14.5)NSActive smoking, n (%)8 (5)8 (5)NSSeropositivityAnti-CCP antibody positivity, n (%)102 (64.2)89 (56)0.137Anti-CCP antibody titers, median (p25-p75)97.1 (1.7-198)8.5 (1.1-145)0.003IgG RF positivity, n (%)31 (19.5)24 (15.1)0.299IgG RF titers, median (p25-p75)5 (2-13)4.9 (2-13)0.529IgM RF positivity, n (%)136 (85.5)126 (79.2)0.141IgM RF titers, median (p25-p75)198 (41-200)177 (28-200)0.067IgA RF positivity, n (%)98 (61.6)92 (57.9)0.493IgA RF titers, median (p25-p75)52.9 (9.3-193)33(5-159)0.060

NS, non-significant; RA, rheumatoid arthritis; BMI, body mass index; BEI, biomass exposure index; DAS28-CRP, disease activity score using 28 joints-C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide; RF, rheumatoid factor

Disclosure of Interests:

None declared

POS1220 PREGNANT AND POSTPARTUM WOMEN WITH AUTOIMMUNE RHEUMATIC DISEASES AND COVID-19: A CASE SERIES

Background:

Pregnant women represent a high-risk population during the COVID-19 pandemic. The main cause of maternal deaths in Mexico during 2020 was COVID-19 with 191 (21.2%) deaths registered until December 2020. The age group most affected was 30 to 34 years. Women during their third trimester and during puerperium were the most affected. Information regarding pregnant and postpartum women with autoimmune rheumatic diseases remains scarce.

Objectives:

The aim of this study was to describe a COVID-19 case series from a clinic of pregnancy and rheumatic diseases.

Methods:

We conducted a descriptive, retrospective study in patients from the clinic of pregnancy and rheumatic diseases of the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. Pregnant patients with RD and documented COVID-19 between March and November 2020 were included. Demographic and clinical features were obtained. Results are shown in descriptive statistics.

Results:

From the 18 women with autoimmune rheumatic disease in follow-up during this period, 2 (11.1%) pregnant women, 2 (11.1%) postpartum women, and 1(5.5%) post-miscarriage woman developed COVID-19. The mean age was 28 ± 6.3 years, 3 (60%) had systemic lupus erythematosus, 1 (20%) had rheumatoid arthritis, and 1 (20%) had the antiphospholipid syndrome. Clinical features and treatments are shown in Graphic 1 and Table 1. The most frequent symptoms were fever (80%), cough (60%) and anosmia (60%). Four (80%) had mild symptoms, and 1 (20%) had severe symptoms requiring intensive care unit admission and mechanical ventilation. Three (60%) referred history of contact with a person who had COVID-19. All the patients were using hydroxychloroquine and prednisone. No patient in our study died.

Conclusion:

From our population, a total of 27.8% presented COVID-19. Most of our patients had a mild course of SARS-CoV-2 infection consistent with data from the general population. Additionally, none of our patients had risk factors such as hypertension, diabetes, chronic kidney disease or lung disease. Nonetheless, pregnant women remain a vulnerable population. Prevention measures must continue worldwide to avoid additional COVID-19 morbidity and mortality.

References:

[1]Gob.mx. 2021. INFORME SEMANAL DE NOTIFICACIÓN INMEDIATA DE MUERTE MATERNA. [online] Available at: <https://www.gob.mx/cms/uploads/attachment/file/601780/MM_2020_SE51.pdf> [Accessed 10 January 2021].

[2]Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020;323(16):1612–1614. doi:10.1001/jama.2020.4326

Graphic 1.

Diagnosis, severity disease and clinical symptoms of pregnant rheumatic disease patients with COVID-19

Table 1.

Features, preventive measures, and treatments of pregnant rheumatic disease patients with COVID-19

N=5Age, years, mean (SD)28 (6.36)Obesity, n (%)2 (40)Current occupation, n (%) Employee3 (60) Student1 (20) Housewife1 (20)  Positive PCR test, n (%)5 (100)Prevention measures, n (%) Social Distancing2 (40) Quarantine3 (60) Contact with a person who had COVID-193 (60)Treatments used before disease, n (%) Prednisone5 (100) Hydroxychloroquine5 (100) Sulfasalazine2 (40) Azathioprine1 (20) Methotrexate*1 (20)Rheumatic treatment during disease, n (%) Continued3 (60) Suspended2 (40)

PCR: polymerase chain reaction, *Methotrexate was used during conception and suspended immediately after the pregnancy detection.

Disclosure of Interests:

None declared

AB0329 HIGHER PREVALENCE OF ECHOCARDIOGRAPHIC ABNORMALITIES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is a chronic, inflammatory, and autoimmune disease that damages vital organs such as the heart. Patients with SLE have a higher risk of developing a cardiovascular (CV) disease than the general population (1).

Objectives:

The aim of this study was to compare the echocardiographic findings in patients with SLE and controls.

Methods:

This was a cross-sectional, observational, and comparative study. A total of 38 patients with SLE according to the 2019 EULAR/ACR classification criteria, ≥18 years old and 38 matched controls by age (±5 years) and gender, were recruited for this study. Exclusion criteria were a poor echocardiographic window, patients with a previous CV event, such as myocardial infarction, cerebrovascular event or peripheral arterial disease, and pregnant women. A transthoracic echocardiogram, including speckle tracking technique, was performed, by two certified echocardiographers, in all study subjects. Distribution was evaluated with Kolmogorov-Smirnov test. Comparisons were done with χ2 and Fisher´s Exact 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:

When comparing demographic characteristics there were no significant differences in age, gender, and comorbidities between SLE patients and controls. In the echocardiographic findings a significant difference was found in the left ventricular ejection fraction (LVEF), lower in SLE patients compared to controls (57.02% vs 61.89%, p=0.001), in the global longitudinal strain (GLS), reduced in SLE patients (-19.55% vs -22.00%, p=0.001), in the tricuspid annular plane systolic excursion (TAPSE), lower in SLE patients (22.00mm vs 24.00mm, p=0.011), in the left atrial volume index, higher in SLE patients (28.44ml/m2 vs 22.29ml/m2, p=0.014) and in the presence of mitral regurgitation, more prevalent in SLE patients (31.6% vs 10.5%, p=0.024) (Table 1).

Conclusion:

Patients with SLE have a worse left ventricular function, evaluated by LVEF and GLS, a worse right ventricular systolic function, evaluated by TAPSE, an increased left atrial volume index and a higher prevalence of mitral regurgitation, which are associated with a higher risk of CV death. It is important to consider including a transthoracic echocardiogram as part of the CV evaluation in patients with SLE, which may result in an early detection of CV abnormalities and an opportune treatment.

References:

[1]Avina-Zubieta JA, To F, Vostretsova K, et al. Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Arthritis Care Res (Hoboken) 2017;69(6):849-56. doi: 10.1002/acr.23018

Table 1.

Demographic characteristics and echocardiographic findings.

SLE patients(n=38)Controls(n=38)pAge years, median (p25-p75)37.5 (24.5-43.2)45.0 (24.0-50.0)NSWomen, n (%)34 (89.5)37 (97.4)NST2DM, n (%)1 (2.6)3 (7.9)NSHTN, n (%)9 (23.7)3 (7.9)NSDyslipidemia, n (%)3 (7.9)3 (7.9)NSObesity, n (%)1 (2.6)5 (13.2)NSActive smoking, n (%)7 (18.4)3 (7.9)NSEchocardiographic findingsLeft ventricle indexed mass g/m2, median (p25-p75)64.00 (50.66-87.09)60.30 (52.97-76.74)0.009RWT, median (p25-p75)0.37 (0.30-0.46)0.38 (0.33-0.45)NSLeft ventricular ejection fraction %, mean ± SD57.02 ± 7.3761.89 ± 5.230.001Global longitudinal strain %, median (p25-p75)-19.55 (-21.02 –-15.95)-22.00 (-21.00 –-20.00)0.001Left atrium indexed volume ml/m2, median (p25-p75)28.44 (20.34-33.56)22.29 (17.97-27.13)0.014TAPSE mm, median (p25-p75)22.00 (20.00-24.00)24.00 (21.00-25.00)0.011Valvular abnormalitiesAortic regurgitation, n (%)2 (5.3)1 (2.6)NSMitral regurgitation, n (%)12 (31.6)4 (10.5)0.024Tricuspid regurgitation, n (%)16 (42.1)17 (44.7)NS

SLE, systemic lupus erythematosus; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; RWT, relative wall thickness; TAPSE, tricuspid annular plane systolic excursion.

Acknowledgements:

We have no acknowledgements to declare.

Disclosure of Interests:

None declared

POS0562 PULSE PRESSURE AS AN INDICATOR OF SUBCLINICAL ATHEROSCLEROSIS IN RHEUMATOID ARTHRITIS

Background:

Pulse pressure (PP) is defined as the difference between systolic and diastolic blood pressure and represents arterial compliance and reflective properties of blood flow (1). It is well known that gender, age, and race / ethnicity are intrinsic factors of the patient that influence PP. Brachial PP has recently been associated with markers of subclinical cardiovascular disease after adjustment with traditional cardiovascular risk factors in the general population (2). However, this relationship has not been studied in patients with rheumatoid arthritis (RA) and its identification would allow earlier adjustments of cardiovascular therapies in this high-risk group.

Objectives:

The aim of the study is to analyze the difference in PP between patients with RA and healthy controls. Additionally, to analyze the difference between patients with carotid plaque (CP) and without CP.

Methods:

A cross-sectional, observational, and comparative study of ninety-two patients with RA aged 40-75 years and who fulfilled ACR/EULAR 2010 classification criteria. Also, we included ninety-two controls without RA, matched by gender, age and comorbidities. A carotid ultrasound was performed in patients with RA and it was divided into two subgroups, with the presence of CP and without CP. A blood pressure measurement was taken after 15 minutes of rest on the right arm of all patients. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A p value <0.05 was considered statistically significant.

Results:

We found no statistical difference between groups regarding age, gender and, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) (Table 1). There was a significant difference in PP between patients with RA and controls (50 mmHg vs 41 mmHg respectively, p = 0.032). Patients with RA had a significant difference in PP of patients with CP and without CP (50 mmHg vs 44 mmHg respectively, p = 0.008) (Figure 1). When performing a binary logistic regression, it was found that PP was the only independent factor for the presence of CP in patients with RA, OR 1.054 (95% CI 1.008-1.101, p = 0.020).

Conclusion:

Patients with RA had a higher PP than controls. Binary logistic regression showed PP as the only independent factor for the presence of subclinical atherosclerosis in patients with RA. PP is a parameter that all rheumatologists should consider when evaluating cardiovascular risk in patients with RA.

References:

[1]Winston GJ, Palmas W, Lima J, et al. Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Hypertens 2013;26(5):636-42. doi: 10.1093/ajh/hps092

[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. doi: 10.1161/01.str.30.3.550

Table 1.

Demographic characteristics.

RA (n=92)Control (n=92)pWomen, n (%)85 (92.4)85 (92.4)NSAge, years ± SD58.0 (55.0-63.0)56.5 (54.0-61.0)NST2DM, n (%)17 (18.5)15 (16.3)NSHypertension, n (%)33 (35.9)33 (35.9)NSDyslipidemia, n (%)30 (32.6)29 (31.5)NSObesity, n (%)30 (32.6)31 (33.7)NSActive smoking, n (%)11 (12.0)20 (21.7)NSRA patients with CP (n=39)RA patients without CP (n=53)pWomen, n (%)36 (92.3)49 (92.5)NSAge, years ± SD60.13 ± 5.9858.08 ± 7.00NST2DM, n (%)9 (23.1)8 (15.1)NSHypertension, n (%)16 (41.0)17 (32.1) NSDyslipidemia, n (%)13 (33.3)17 (32.1)NSObesity, n (%)15 (38.5)15 (28.3)NSActive smoking, n (%)6 (15.4)5 (9.4)NSDisease duration, years (p25-p75)8.44 (3.00-15.50)12.86 (4.66-19.66)NS

NS, no significant; T2DM, type 2 diabetes mellitus; CP, carotid plaque.

Disclosure of Interests:

None declared

POS0553 IMPACT OF RHEUMATOID ARTHRITIS ON LEFT VENTRICULAR REMODELING

Background:

Patients with Rheumatoid Arthritis (RA) have a higher prevalence of cardiovascular diseases (1) and a strong association with abnormalities in the left ventricle (LV) geometry. Both concentric and eccentric remodeling have been determined as an independent factor for sudden cardiac arrest in the general population with normal or slightly decreased ventricular function (2) but there is still controversy about the factors involved and the pathophysiology in patients with RA.

Objectives:

The aim of the study is to determine the characteristics of LV geometry and the impact of RA.

Methods:

A cross-sectional, observational, and comparative study of fifty-two RA patients that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Controls were included and matched by age, gender, and comorbidities. Subjects were evaluated using a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. Ventricular geometry was evaluated with indexed left ventricular mass and relative wall thickness. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A logistic binary regression was performed with the traditional cardiovascular risk factors (CVRFs), age and RA diagnosis. A p value <0.05 was considered statistically significant.

Results:

No significant differences were found in the traditional CVRFs (type 2 diabetes mellitus, dyslipidemia, active smoking, and hypertension) (Table 1). Most of the subjects reported normal geometry in both groups (55.8% for RA group vs 64.0% for controls). A higher prevalence of eccentric hypertrophy was found in the RA group, 13 (25%) subjects versus 3 (6%) in the control group, p = 0.009. The binary regression showed that the diagnosis of RA was the only independent risk factor for the presence of eccentric hypertrophy, OR 7.22 95% CI (1.68-31.02, p = 0.008).

Table 1.

Demographic characteristics and echocardiographic findings.

RA(n=52)Control(n=50)pAge, years ± DE51.4 ±6.251.1 ± 5.5NSWomen, n (%)51 (98.1)49 (98.0)NSActive smoking, n (%)8 (15.4)8 (16.0)NSDyslipidemia, n (%)11 (21.2)13 (26.0)NSType 2 Diabetes Mellitus, n (%)5 (9.6)5 (10.0)NSHTN, n (%)8 (15.4)10 (20.0)NSBMI kg/m2, median (p25-p75)27.8 (24.5-31.4)28.3 (25.4-30.3)NSBSA, median (p25-p75)1.7 (1.6-1.8)1.8 (1.6-1.9)0.003Systolic blood pressure, mmHg (p25-p75)119.5 (110.0-127.5)120.0 (110.7-130.0)NSEchocardiography findingsLVPWTd, median (p25-p75)0.9 (0.8-1.0)0.9 (0.8-1.0)NSLVIDd, median (p25-p75)4.8 (4.3-5.2)4.6 (4.5-4.9)NSLV mass, median (p25-p75)131.2 (119.5-155.7)131.2 (113.2-154.3)NSLV mass index, median (p25-p75)78.6 (69.7-95.6)76.0 (66.7-84.6)NSRWT, mean ± SD0.4 ± 0.090.4 ± 0.07NS

NS, no significant; BMI, body mass index; BSA, body surface area; LVPWTd, left ventricular posterior wall thickness at end-diastole; LVIDd, left ventricular internal dimension at end-diastole; RWT, relative wall thickness.

Conclusion:

There is a higher prevalence of eccentric remodeling in patients with RA independently of traditional CVRF. The diagnosis of RA is an independent risk factor for the presence of eccentric hypertrophy that is associated with higher mortality. Treatment of cardiovascular comorbidities should be intensified in those patients with abnormalities in LV geometry in order to prevent cardiovascular diseases such as heart failure.

References:

[1]You S, Cho CS, Lee I, et al. A systems approach to rheumatoid arthritis. PLoS One 2012;7(12):e51508. doi: 10.1371/journal.pone.0051508

[2]Pascale V, Finelli R, Giannotti R, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Sci Rep 2018;8(1):5867. doi: 10.1038/s41598-018-24323-0

Disclosure of Interests:

None declared

AB0658 FEAR OF COVID-19 IN POSTPARTUM WOMEN WITH RHEUMATIC DISEASE

Background:

In Mexico, the SARS-CoV-2 pandemic has totaled almost two million cases and exceeded 150,000 deaths (29/01/2021). Currently, COVID-19 has become the leading cause of death in pregnant women in Mexico. COVID-19 has additionally impacted the psychological health of individuals including women with rheumatic diseases.

Objectives:

The aim of this study is to compare the Fear of COVID-19 Scale (FCV-19S) in postpartum women with and without autoimmune rheumatic diseases.

Methods:

A cross-sectional, descriptive, and comparative study was conducted. The Spanish FCV-19S version was applied by telephone or e-mail. The instrument consists of seven items, each with a five-point Likert scale of options. The participant must choose the options that best represent their perception about the statements presented. The maximum possible total is 35 points. Sociodemographic information was collected from the clinical charts. The Kolmogorov-Smirnov test was used to determine normality of the data. Statistical analysis was done using the Mann-Whitney U test.

Results:

Forty-four postpartum women were included (22 from the Pregnancy and Rheumatic Diseases Clinic and 22 from the Obstetrics Department, both groups from the University Hospital “Dr. José E. González in Monterrey, México). The mean level of fear found in women with rheumatic disease was 16 (6.6) points versus 14 (4.6) points in the non-rheumatic patients group. No significant difference was found between groups (p=0.65). Regarding the rheumatic diseases group, women in the category of other diagnoses (that included Sjögren’s Syndrome, antiphospholipid syndrome, and dermatomyositis) had a greater mean FCV-19S score (20.2), than patients with systemic lupus erythematosus (17.3) and rheumatoid arthritis (15.4).

Conclusion:

Women with postpartum rheumatic disease had a higher FCV-19S score than postpartum women without rheumatic diseases, although this difference was not statistically significant.

References:

[1]Lumbreras-Marquez MI, Campos-Zamora M, Seifert SM, et al. Excess Maternal Deaths Associated With Coronavirus Disease 2019 (COVID-19) in Mexico. Obstet Gynecol. 2020;136(6):1114-1116. doi:10.1097/AOG.0000000000004140

[2]Yan H, Ding Y, Guo W. Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Psychol. 2020;11:617001. Published 2020 Nov 25. doi:10.3389/fpsyg.2020.617001

Table 1.

Sociodemographic data

Women with rheumatic diseasesN= 22Women without rheumatic diseases N= 22p=Age, years, mean, (SD)28 (6.8)23 (5.0)0.65Occupation, n (%)Housewive14 (63.6)18 (81.8)Employee5 (22.7)3 (13.6)Other3 (13.6)1 (4.5)Education level, n (%)0.28Middle school10 (45.45)16 (72.72)High School8 (36.36)5 (22.72)College4 (18.18)1 (4.54)Rheumatic diagnosis, n(%)Rheumatoid arthritis9 (40.9)Systemic lupus erythematosus8 (36.6)Others (SS, APS, DM)5 (22.7)

SS: Sjögren’s syndrome, APS: antiphospholipid syndrome, DM: dermatomyositis

Disclosure of Interests:

None declared.

Self-Tuning Extended Kalman Filter Parameters to Identify Ankle's Third-Order Mechanics

The estimation of human ankle's mechanical impedance is an important tool for modeling human balance. This work presents the implementation of a parameter-estimation approach based on a state-augmented extended Kalman filter (AEKF) to infer the ankle's mechanical impedance during quiet standing. However, the AEKF filter is sensitive to the initialization of the noise covariance matrices. In order to avoid a time-consuming trial-and-error method and to obtain a better estimation performance, a genetic algorithm (GA) is proposed to best tune the measurement noise (Rk) and process noise covariances (Q) of the extended Kalman filter (EKF). Results using simulated data show the efficacy of the proposed algorithm for parameter-estimation of a third-order biomechanical model. Experimental validation of these results is also presented. They suggest that age is an influencing factor in the human balance.

Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study

BACKGROUND

Colon capsule endoscopy (CCE) and CT colonography (CTC) are minimally invasive techniques for colorectal cancer (CRC) screening. Our objective is to compare CCE and CTC for the identification of patients with colorectal neoplasia among participants in a CRC screening programme with positive faecal immunochemical test (FIT). Primary outcome was to compare the performance of CCE and CTC in detecting patients with neoplastic lesions.

METHODS

The VICOCA study is a prospective, single-centre, randomised trial conducted from March 2014 to May 2016; 662 individuals were invited and 349 were randomised to CCE or CTC before colonoscopy. Endoscopists were blinded to the results of CCE and CTC.

RESULTS

Three hundred forty-nine individuals were included: 173 in the CCE group and 176 in the CTC group. Two hundred ninety individuals agreed to participate: 147 in the CCE group and 143 in the CTC group. In the intention-to-screen analysis, sensitivity, specificity and positive and negative predictive values for the identification of individuals with colorectal neoplasia were 98.1%, 76.6%, 93.7% and 92.0% in the CCE group and 64.9%, 95.7%, 96.8% and 57.7% in the CTC group. In terms of detecting significant neoplastic lesions, the sensitivity of CCE and CTC was 96.1% and 79.3%, respectively. Detection rate for advanced colorectal neoplasm was higher in the CCE group than in the CTC group (100% and 93.1%, respectively; RR = 1.07; p = 0.08). Both CCE and CTC identified all patients with cancer. CCE detected more patients with any lesion than CTC (98.6% and 81.0%, respectively; RR = 1.22; p = 0.002).

CONCLUSION

Although both techniques seem to be similar in detecting patients with advanced colorectal neoplasms, CCE is more sensitive for the detection of any neoplastic lesion.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02081742 . Registered: September 16, 2013.