Subclinical synovitis impact on the progression of lupus joint disease: A 10-year longitudinal multicenter study

OBJECTIVE

To determine the effect of subclinical synovitis on the progression of joint disease in a cohort of patients with systemic lupus erythematosus over a mean follow-up of 10 years.

METHODS

A longitudinal follow-up of 96 patients diagnosed with lupus was performed. All patients were considered clinically free of joint disease or with minimal joint impairment at baseline and were studied through ultrasound study of their dominant hand to assess the prevalence of subclinical synovitis. Now, over 10 years after we contacted them and reviewed their evolution to determine the impact of had or had not been diagnosed with subclinical synovitis in their current joint condition.

RESULTS

Thirty-one of the 91 reached patients developed clinical progression in their joint manifestations (at least one ordinal degree of worsening). Of these, 23 (74,9%) had demonstrated subclinical synovitis at baseline. In the group of patients who did not progress clinically, 46 (76,6%) did not have this finding at the start of follow-up (p < .01, OR 9,44 95%CI 3,46-25,74). The patients in whom clinical progression was demonstrated had worse combined ultrasound scores than the rest of the patients: 6,41 SD 1,45 vs. 1,15 SD 0,97 (p < .01).

CONCLUSIONS

The finding of subclinical synovitis in patients with systemic lupus erythematosus is associated with the development of joint disease progression both clinically and ultrasonographically.

Quality of life of patients with rheumatic diseases

OBJECTIVE

Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population.

METHODS

Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0-1 scale) and a visual analog scale (VAS, 0-100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed.

RESULTS

1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18-95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially "pain/discomfort", followed by "daily activities" and "mobility". This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the "peripheral and axial mechanical pathology" and the "soft tissue pathology" group.

CONCLUSIONS

Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

Serological short-chain fatty acid and trimethylamine N-oxide microbial metabolite imbalances in young adults with acute myocardial infarction

Acute myocardial infarction (AMI) is associated with systemic inflammatory processes and metabolic alterations. Microbial-derived metabolites, such as short-chain fatty acids and trimethylamine N-oxide (TMAO), have emerged in recent years as key players in the modulation of inflammation, with potential implications for cardiovascular diseases. We performed a prospective observational study that monitored the serological concentration of bacterial metabolites in 45 young patients (<55 years) without cardiovascular risk factors but with AMI, at hospital admission and at 3 months of follow-up, and compared them with a control group. TMAO and acetate levels were significantly higher in AMI, whereas butyrate and propionate were significantly lower. The acetate/propionate ratio showed the most discrimination between AMI and controls by receiver operating characteristic analysis (area under the curve 0.769, P < 0.0001). A multivariate logistic regression model revealed that this ratio was independently associated with AMI. Short-chain fatty acid concentrations, but not TMAO, exhibited significant correlations with inflammatory and coagulation parameters. Three months after the acute AMI event, all metabolite levels returned to those observed in healthy controls except butyrate. In conclusion, our study reveals disturbances of the serological concentration of microbiota-derived metabolites in AMI that are also related to inflammatory and coagulation parameters. These findings highlight an interesting field of study in the potential role of microbial metabolites from gut in cardiovascular disease.

AB0739 PSORIATIC ARTHRITIS RELATED-UVEITIS, OUR EXPERIENCE IN A THIRD-LEVEL SPANISH CENTRE

Background:

The occurrence of uveitis in patients with psoriatic arthritis (PsA) has been documented as the most frequent and important extra-articular manifestation, with an estimated frequency of 7 and 18%. Clinical onset may be acute or insidious, and it may be accompanied by other ocular manifestations. In contrast with spondyloarthropathy related-uveitis, PsA associated tends to be insidious, bilateral, chronic or posterior.

Objectives:

To describe clinic and immunological features of psoriatic arthritis patients in our centre, especially those with associated-uveitis and to define its frequency.

Methods:

A retrospective, descriptive and single-centre study (1985-2017) of 494 patients diagnosed with PsA according to the criteria of an expert rheumatologist was conducted. All patients were studied according to a standard protocol. The group was divided into 3 articular categories: pure axial, pure peripheric and mixed. Data regarding enthesitis and dactylitis, as well as HLA-Cw6 and HLA-B27 were extracted, from those available. Ophthalmologic and cutaneous involvement was registered. 216 patients were excluded because of data absence or alternative plausible diagnosis. Descriptive analyses were applied.

Results:

Eight patients had uveitis (2,9% in this series), only one case developed chronic pattern. Acute anterior uveitis was the form of presentation in 6 patients (75%). Unilateral involvement was registered in 3 (37,5%), in every case with right eye implication. One patient developed up to 13 episodes of acute anterior uveitis, every episode in the same eye. Median of age at first episode was 54 years, 3 (37,5%) patients were female. Regarding articular categories: 1(12,5%) pure axial, 3 (37,5%) pure peripheric and 4 (50%) mixed. Enthesitis was registered in 2 patients, none of our series developed dactylitis. 3 patients (37,5%) were HLA-B27 positive and 2 patients (25%), HLA-Cw6 positive. 6 cases had cutaneous psoriasis (75%). Adalimumab was prescribed to 5 PsA related-uveitis patients with optimal control of disease.

Larger PsA cohort without ocular involvement (270 patients), 118 (42,4%) cases were female and median of age was 44 years. Pure axial involvement was present in 20 (7,2%), pure peripheric, 134 (48,2%) and mixed, 122 (43,8%). 31 (11,15%) cases developed enthesis involvement and 18 (6,5%), dactylitis. HLA-B27 was tested positive in 45 patients (19,7%) and HLA-Cw6, in 56 (27,4%). Cutaneous psoriasis was present in 231 cases (83,1%).

Conclusion:

Frequency of psoriatic arthritis-uveitis is lower in our sample than referred in bibliography. Further investigations are needed to understand the underlying reasons, although it could be related to the use of biologic treatment and narrower inflammatory activity control in comparison to previous studies. No posterior pole involvement, bilaterality, chronicity nor insidious onset are common in our data; neither axial involvement seems to be predictor for the appearance of uveitis.

References:

[1]Rosenbaum JT. Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. Clin Rheumatol 2015;34:999-1002.

[2]Queiro R, et al. Clinical Features and Predictive Factors in Psoriatic Arthritis–Related Uveitis. Semin Arthritis Rheum 2002;31:264-270.

[3]Paiva ES, et al. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis. 2000;59(1):67–70.

Disclosure of Interests:

None declared