POS0886 EFFICACY AND SAFETY OF RITUXIMAB IN AUTOIMMUNE DISEASE–ASSOCIATED INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Background

Interstitial lung disease (ILD) is a common condition in patients with connective tissue disease (CTD). It is associated with increased morbidity and mortality. Rituximab (RTX) has been approved for treatment of RA and some recent retrospective studies suggest that it could be an alternative treatment for patients with CTD-ILD, even in cases that prove refractory to conventional immunosuppressants.

Objectives

To analyze the efficacy and safety of RTX in connective tissue disease associated with interstitial lung disease (CTD-ILD).

Methods

We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving RTX between 2015 and 2020. Patients who had worsening of respiratory symptoms or decline in the pulmonary function tests (PFT) compared to the time of ILD diagnosis were treated with rituximab. The patients were assessed using high-resolution computed tomography and PFT baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC)>10% or diffusing capacity of the lungs for carbon monoxide (DLCO)>15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening of ILD.

Results

We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7-69.0) months (Table 1). At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in 7 (18.9%); 7 patients (18.9%) died. Mean PFT values decreased significantly at the start of RTX compared to the date of ILD diagnosis in FVC (72.2[21.3]vs 73.5 [16.9] mg/l;p=0.040) and DLCO-SB (55.9 [15.7] vs 58.3 [16.1] mg/l; p=0.041). No significant decline was observed in median FVC (72.2 vs 70.8; p=0.530) or DLCO (55.9 vs 52.2; p=0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR [95% CI], 0.904 [0.8-0.9]; p=0.015), time to initiation of RTX (1.01 [1.001-1.02]; p=0.029), and mycophenolate (0.202 [0.04-0.8]; p=0.034). The infection incidence rate was 0.21 patient-years.

Table 1.

Baseline demographic and clinical characteristics of 37 patients with CTD-ILD receiving rituximab.

VariableTotal n=37RAn=19SSn=14IMn=4p ValueFemale sex, n (%)27 (73.0)13 (68.4)11 (78.6)3 (75.0)0.806Age in years, mean (SD)62.8 (9.9)67.7 (9.7)57.9 (7.9)56.6 (5.5)0.001Smoking0.147Never smoked, n (%)20 (54.1)9 (47.4)7 (50.0)4 (100.0)Smoked at some time, n (%)17 (45.9)10 (52.6)7 (50.0)0 (0.0)Duration of CTD, months, median (IQR)107.8 (49.5-188.8)151.0 (8.,0-240.5)89.6 (51.3-184.4)35.1 (25.1-49.0)0.017Duration of ILD, months, median (IQR)65.4 (31.1-110.3)82.2 (37.4-120.1)64.5 (35.5-107.1)25.9 (25.0-36.0)0.136Time to initiation of RTX, median (IRQ)12.0 (6.5-48.2)25.1 (7.0-57.6)11.4 (3.9-43.6)7.4 (7.0-10.4)0.455Duration of treatment with RTX, median (IQR)38.2 (23.4-69.9)45.3 (22.2-79.9)52.5 (24.7-63.3)22.8 (17.7-36.2)0.291Combined with csDMARDs, n (%)15 (40.5)9 (47.4)5 (35.7)1 (25.0)0.637Methotrexate, n (%)5 (13.5)2 (10.5)3 (21.4)0 (0.0)0.468Leflunomide, n (%)2 (5.4)2 (10.5)0 (0.0)0 (0.0)0.367Sulfasalazine, n (%)1 (2.7)1 (5.3)0 (0.0)0 (0.0)0.615Hydroxychloroquine, n (%)7 (18.9)4 (21.1)2 (14.3)1 (25.0)0.840Combination with immunosuppressants, n (%)20 (54.1)7 (36.8)9 (64.3)4 (100.0)0.044Mycophenolate, n (%)19 (51.4)6 (31.6)9 (64.3)4 (100.0)0.021Azathioprine, n (%)1 (2.7)1 (5.3)0 (0.0)0 (0.0)0.615Corticosteroids, n (%)25 (67.6)14 (73.7)7 (50.0)4 (100.0)0.121Doses of corticosteroids, median (IQR)5.0 (0.0-10.0)5.0 (0.0-10.0)2.5 (0.0-7.5)10.0 (8.1-10.5)0.519

Conclusion

Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. No significant increase in infection rates was observed. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.

Disclosure of Interests

None declared

AB1090 IMPACT OF THE COVID19 PANDEMIC ON THE SOCIAL BEHAVIOR OF PATIENTS WITH RHEUMATIC DISEASES

Background

Depression in rheumatic diseases negatively influences the support network and the perception of company of these patients (1).

Objectives

To describe how the COVID-19 pandemic affects the social activitiesn patients with chronic rheumatic diseases such as Rheumatoid arthritis (RA), Systemic Lupus Erithematosus (SLE) and Spondyloarthritis (SpA).

Methods

Design: Observational, longitudinal study of a series of patients. Patients: RA (ACR/EULAR 2010 classification), SpA (ASAS/EULAR 2010 criteria), and SLE (ACR 1997 criteria) patients, age ≥ 18 years. Questionaries for the evaluation of participation in social activities is the Patient Reported Outcomes Measurement Information Systems (PROMIS) v2.0 Short-Form (8 items, PROMIS-APS) at baseline (OCT to DEC 2019) and after 18 months of pandemic (SEP to DEC 2021) were performed. Variables evaluated were: social activities in terms of various factors, such as satisfaction with social roles mobility, depression, companiony social isolation, emotional support, instrumental support, support via information and ability to participate in social activities. All the variables were evaluated using the PROMIS questionnaire with quantitative scores. We also recorded demographic, clinical, and comorbidity data. Statistical analysis: Multivariate Linear Regression (Dependent variable: PROMIS ability to participate in social activities 18 months COVID19) was performed.

Results

We recruited 91 patients, 31 (34.1%) RA, 30 (33%) SpA y 30 (33%) SLE. The 3 groups were well balanced in terms of clinical-epidemiological characteristics, except that patients with SLE were younger (mean 45 years) than patients with RA (53 years) and SpA (55 years) (p = 0.004) and because most of the patients with RA and SLE were women (97%) compared to those with SpA (60%) (p <0.001).

There was a worsening after 18 months of the COVID19 pandemic in the mean scores of the PROMIS for: satisfaction of the social role (26.9 ± 8.7 vs 25.3 ± 8.4; 0.046), depression (14.7 ± 7, 6 vs 16.1 ± 8.4; p = 0.044) and for the ability to participate in social activities (27.7 ± 7.2 vs 26.1 ± 6.8; p = 0.020). By diagnoses, the ability to participate in social activities was very similarbetween the different groups except for worse mobility in patients with RA and SpA compared to SLE, both at baseline and at 18 months of the pandemic. SLE patients worsened more after 18 months of the COVID19 pandemic in social role satisfaction, depression, instrumental support and ability to participate in social activities.

In the multivariate analysis, the ability to participate in social activities at 18 months of the COVID19 pandemic was inversely associated with the diagnosis of SLE compared to the rest (ß [95% CI], -2.60 [-4.62 - 0.58]; p = 0.012) and depression (ß [95% CI], -0.23 [-0.39, -0.08]; p = 0.004); and directly with social role satisfaction (ß [95% CI], 0.18 [0.10-0.35]; p = 0.031), mobility (ß [95% CI], 0.13 [0.07-0.20]; p = 0.001) and company (ß [95% CI], 0.32 [0.11-0.60]; p = 0.023).

Conclusion

At baseline evaluation, social activities were affected by the impact of rheumatic disease. After 18 months of the pandemic-COVID19, patients with RA and SPA remain stable but SLE patients significantly worsened their social role and depression.

References

[1]Cano-García L, Mena-Vázquez N, Manrique-Arija S, Redondo-Rodriguez R, Romero-Barco CM, Fernández-Nebro A. Ability to Participate in Social Activities of Rheumatoid Arthritis Patients Compared with Other Rheumatic Diseases: A Cross-Sectional Observational Study. Diagnostics (Basel). 2021;11(12).

Disclosure of Interests

None declared

AB0753 REAL LIFE DOSE REDUCTION OF BIOLOGICAL THERAPY IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. UTILITY OF THE REDOSER TOOL

Background

The long-term use of standard dosing of TNFi therapy is costly and not without side effects, including infections, tuberculosis and potential malignancies(1,2,). Hence, we undertook this study to determine whether dose reduction of TNFi therapy may be possible in a realworld setting and if REDOSER tool(3) is an appropriateness criteria for reducing the dose of BT.

Objectives

Describe the percentage of patients with inflammatory rheumatic diseases (IRD) who continue with dose reduction of biological therapy (BT). Evaluate relapse in clinical practice after 2 years of follow-up. Identify factors associated with relapse.

Methods

Retrospective observational study. Patients with axial spondyloarthritis (axial SpA), psoriatic arthritis (PSA) and rheumatoid arthritis (RA) in BT dose reduction. Inclusion criteria: Axial SpA according to ASAS criteria, APS according to CASPAR criteria and RA according to ACR2010 criteria, who have started reducing the dose of BT treatment between 2009-2019 at the Hospital Regional Universitario de Málaga, Spain. Protocol: patients with TB are followed prospectively in a monographic consultation with a pre-established protocol. The day of dose reduction = baseline visit (v0). Variables:Maintained dose reduction: % of patients who maintained dose reduction from the start of optimization to the index date (data collection). Relapse at 12 and 24 months: % of patients who, after starting dose reduction, returned to the previous or usual dose. Other variables: Demographic, time to diagnosis and evolution of the disease, clinical-analytical: disease activity (DAS28, DAPSA and BASDAI) and physical function (HAQ, BASFI). Previous treatments. Appropriateness criteria for reducing the dose of BT according to REDOSER (1): 1.appropriate, 2. inappropiate, 3. uncertain. Statistical analysis: Descriptive, bivariate, multivariate logistic regression (VD: relapse).

Results

One hundred twenty-nine patients with axial SpA, PSA and RA in BT dose reduction were included. The mean time from the start of BT to dose reduction was 38.1 months (16.6-73.1). The mean time in dose optimization was 19.5(±15.7) months. At the end of follow-up, 70.2% of the patients (87pts) achieved a sustained dose reduction. At 12 months and 24 months, 12.4% and 11.6% of patients relapsed, respectively. At the end of follow-up, there were no differences between baseline inflammatory activity and after 24 months in dose reduction measured by the different indexes: DAS28 (1.9[0.7] Vs 2.1[1, 7], p=0.323; DAPSA (5.4[4.9] Vs 4.8[4. 7], p=0.718, and BASDAI (1.5[1.1] Vs 1.4[1.3], p=0.867). Retrospectively, we evaluated the appropriateness of optimization according to the REDOSER tool (1) at the end of follow-up and it was observed that 85% of patients who maintained the dose reduction had an appropriate REDOSER and 14.5% uncertain and none inappropriate p<0.001.

Conclusion

Dose reduction of BT in IRD is possible in most patients, maintaining low disease activity or remission at 24 months, compared to baseline.

Relapse was associated with a longer evolution time of the IRD, a longer diagnostic delay, a higher inflammatory activity measured by the respective indices and a uncertain or inappropriate result of the REDOSER tool. This tool can be very useful used prior to the assessment of TB dose reduction

References

[1]Galloway JB, et al. Ann Rheum Dis 2011;70:1810_4.

[2]Dixon WG, et al. Ann RheumDis 2010;69:522_8.

[3]González-Álvaro I, Blasco AJ, Lázaro et al. Heliyon. 2017 Nov 14;3(11):e00452.

Disclosure of Interests

Sara Manrique Arija Speakers bureau: Abbvie, Gedeon, Jansen, Lilly, Menarini, MSD, Novartis, Pfizer, Roche, Sanofi, UCB.

Consultant of: Abbvie, Jansen, Lilly, Novartis, Sanofi.

Alba María Cabezas-Lucena: None declared, FJavier Godoy-Navarrete: None declared, Maria Morales-Águila: None declared, Rocio Redondo: None declared, Natalia Mena-Vázquez: None declared

AB0859-HPR NETWORK OF SUPPORT AND DEPRESSION IN RHEUMATIC DISEASES

Objectives:

To describe the impact that depression has on the personal support network of patients with rheumatic diseases.

Methods:

Design. Cross-sectional observational study of a series of patients with spondyloarthritis (SpA), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) selected by consecutive sampling of the Rheumatology consultations. Selection criteria: age ≥18 years with AD (ASAS criteria), RA (EULAR / ACR 2010 criteria) and SLE (ACR-EULAR criteria) capable of understanding and willing to take the questionnaires. Protocol: The reference rheumatologist offered to participate in the study to all the patients who attended the consultation between October and December 2019 and met the selection criteria. After their approval and signing the informed consent, they went to the nursing consultation to carry out a battery of questionnaires from the PROMIS platform and collect clinical data. The infirmary was in charge of explaining the questionnaires to the patients. Variables: the main endpoint variable was depression evaluated by PROMIS and the secondary endpoint variables were questionnaires that evaluate the support network in various settings: company, emotional support, instrumental support, support through information. Likewise, data on their disease, comorbidities were collected using Charlson and socio-occupational profile. Statistical analysis: Descriptive analysis, R-Pearson correlation and multivariate linear regression analysis (VD: PROMIS depression).

Results:

151 patients participated: 50 with RA (90% women, mean age 55.12 ± 13.64 years), 51 with AD (51% women, 52.59 ± 12.15 years) and 50 patients with SLE (96 % women, mean age 47.14 ± 11.3 years). The baseline characteristics and comorbidities of the included. The mean (SD) of PROMIS depression in all patients was 16.4 (8.3) and a total of 65 patients (43%) had depression according to the Charlson index. Patients with Charlson depression had a higher mean (SD) of PROMIS depression than those without Charlson depression (24.5 [6.2] vs 10.3 [2.5], p <0.001). An inverse correlation was observed between PROMIS depression with the rest of PROMIS questionnaires: company (r = -0.369, p = <0.001), emotional support (r = -0.533, p = <0.001), information support (r = -0.577, p = <0.001) and instrumental support (r = -0.362, p = <0.001). Likewise, it was observed that patients without depression by Charlson compared with patients with depression had higher mean values (SD) in all questionnaires of the support network compared to those without depression by Charlson: company (17, 8 (2.9) vs 14.7 (4.7), p <0.001), emotional support (37.2 (5.2) vs 29.0 (9.5), p <0.001) and instrumental support (35.7 (7.2) vs 29.4 (8.8), p <0.001).Finally, in the multivariate analysis, the variables that were independently associated with depression by PROMIS were information support (B = -0.390; p <0.001) and emotional support (B = -0.239; p = 0.027). (R2 = 0.340).

Conclusion:

Depression in rheumatic diseases negatively influences the support network and the perception of company of these patients. Treating depression is important for social functioning and social relationships in these patients and for any group of chronic patients.

Disclosure of Interests:

None declared

POS0211 PREDICTORS OF PROGRESSION AND MORTALITY IN PATIENTS WITH PREVALENT RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Objectives:

To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) and identify risk factors associated with disease progression and mortality in patients with rheumatoid arthritis associated with interstitial lung disease (RA-ILD).

Methods:

We performed a multicenter, prospective, observational study of patients with RA-ILD receiving DMARDs between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 60 months. The main outcome measure at 60 months was worsening of FVC >10% or DLCO >15% and radiological progression or death. We recorded demographic and clinical characteristics, lung function, and the incidence of adverse events. A Cox regression analysis was performed to identify factors associated with worsening of ILD.

Results:

After 60 months, lung disease had stabilized in 66 patients (56.9%), improved in 9 (7.8%), and worsened in 23 (19.8%). Eighteen patients (15.5%) died, with a mean survival of 71.8 (1.9) months. Baseline characteristics of 116 with RA-ILD treated with DMARDs is in table 1.The Cox multivariate analysis revealed the independent predictors of worsening of RA-ILD to be usual interstitial pneumonia (HR, 2.6 [95%CI, 1.0-6.7]), forced vital capacity (%) (HR, 3.8 [95%CI, 1.5-6.7]), anticitrullinated protein antibody titers (HR, 2.8 [95%CI, 1.1-6.8]), smoking (HR, 2.5 [95%CI, 1.1-6.2]), and treatment with abatacept, tocilizumab, or rituximab (HR, 0.4 [95%CI, 0.2-0.8]). During follow-up, 79 patients (68%) experienced an adverse event, mostly infection (61%).

Conclusion:

Lung function is stable in most patients with RA-ILD receiving treatment with DMARDs, although one third of patients die. Identifying factors of worsening in RA-ILD is important for clinical management.

Table 1.

Baseline characteristics of 116 with RA-ILD treated with DMARDs

VariableTotal=116Epidemiological characteristicsFemale sex, n (%)63 (54.3)Age, years, mean (SD)68.3 (9.9)Clinical and analytical characteristicsCurrent smokerNonsmoker, n (%)57 (49.1)Smoker, n (%)23 (19.8)Exsmoker, n (%)36 (31.0)Time since diagnosis of RA, months, median (p25-p75)148.5 (71.5-217.8)Diagnostic delay, months, median (p25-p75)8.5 (4.9-16.8)Time since diagnosis of ILD, months, median (p25-p75)27.5 (9.8-60.0)Positive rheumatoid factor (>10), n (%)111 (95.7)Positive ACPA titer (>20), n (%)100 (86.2)Erosive disease, n (%)76 (65.5)Treatment Synthetic DMARD100 (86.2) Methotrexate, n (%)51 (44.0) Leflunomide, n (%)30 (25.9) Sulfasalazine, n (%)9 (7.8) Hydroxychloroquine, n (%)21 (18.1)Biologic DMARD50 (43.1) Infliximab, n (%)1 (0.9) Etanercept, n (%)6 (5.2) Adalimumab, n (%)3 (2.6) Golimumab, n (%)3 (2.6) Certolizumab, n (%)3 (2.6) Tocilizumab, n (%)6 (5.2) Abatacept, n (%)15 (12.9) Rituximab, n (%)13 (11.2) Immunosuppressants11 (9.5) Mycophenolate, n (%)7 (6.0) Azathioprine, n (%)4 (3.4) Antifibrotic agents, nintedanib, n (%)1 (0.9) Baseline corticosteroids, n (%)69 (60.0) Dose of baseline corticosteroids, median (p25-p75)5.0 (0.0-7.5)

Abbreviations. RA: rheumatoid arthritis; ILD: interstitial lung disease; ACPA: anticyclic citrullinated protein antibody; DMARD: disease-modifying antirheumatic drug; SD: standard deviation.

Acknowledgements:

Grant for Medical Researchers of the “Fundación Española de Reumatología” 2019. declare.

Disclosure of Interests:

None declared

AB0284 RHEUMATOID ARTHRITIS REFRACTORY TO BIOLOGICAL TREATMENT

Background:

In Rheumatoid arthritis (RA), between 20% and 40% of patients do not achieve a 20% improvement in American College of Rheumatology (ACR) criteria, another similar percentage loses response over time or experience adverse events that forces them to the suspension of treatment. Those patients who have failed one or more therapeutic strategies, are more refractory patients and the response to successive targets is usually lower than naive patients, with 50% ACR20 response percentages.

Objectives:

To describe the clinical-analytical characteristics and response to the last treatment, in rheumatoid arthritis (RA) refractory to biological disease modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs). To identify possible factors related to refractoriness to bDMARDs and tsDMARDs.

Methods:

Retrospective multicentre, controlled study of patients with RA refractory to bDMARDs and tsDMARDs. Control group was formed by patients with non-refractory RA; matched by gender, age and diseaseduration. Refractoriness was defined as failure to more than 2 different targets of bDMARDs or tsDMARDs. Demographic, clinical-analytical data and rates of disease activity and physical function were collected. A descriptive analysis, a bivariate analysis and a binary logistic regression were performed to see the variables associated with refractoriness.

Results:

A total of 94 patients were selected from HRUM and HCUVV: 47 with refractory RA and 47 with non-refractory RA. The clinical-epidemiological characteristics of both groups are classified in Table 1. The majority were women with a mean age of 57 years. There was a greater proportion of patients with multimorbidity and cardiovascular risk factors among the refractory to FAMEb. All patients affected a significant improvement with the new treatment in activity and physical function at 6 months compared to baseline. Refractoriness is associated with a higher body mass index [OR(IC95%), 7.73 (1.56-8.42); p=0.012], and depression [OR(IC95%), 1.11 (1.24-1.83); p=0.035].

Table 1.

Clinical-epidemiological characteristics of patients.

VariableRefractory RA (N=47)Non-refractory RA(N=47)p-valueSex (female), n (%)38 (80,9)38 (80,9)1,000Age, means (SD)57,1 (10,8)57,4 (10,8)0,896Caucasian race, n (%)45 (95,7)44 (93,6)0,646Body mass index, means (SD)30,4 (6,8)26,5 (3,8)0,002Non-smoker, n (%)26 (55,3)28 (59,6)Former smoker>6 months, n (%)16 (34,0)7 (14,9)Smoker, n (%)5 (10,6)12 (25,5)Rheumatoid Factor, n (%)40 (85,1)42 (89,4)0,536Anti-cyclic citrullinated peptide, n (%)37 (78,7)38 (80,9)0,797Erosions, n (%)33 (70,2)28 (59,6)0,280Hypertension, n (%)24 (51,1)20 (42,6)0,408Obesity, n (%)19 (40,4)9 (19,1)0,024Diabetes Mellitus, n (%)10 (21,3)6 (12,8)0,272Dyslipidemia, n (%)20 (42,6)15 (31,9)0,286Neoplasia, n (%)2 (4,3)0 (0,0)0,153Fibromyalgia, n (%)4 (8,5)1 (2,1)0,168Depression, n (%)18 (38,3)4 /8,5)0,001Multicomorbidity, n (%)17 (36,2)6 (12,8)0,008Comorbidities number, median (IQR)2,0 (1,0-3,0)1,0 (0,0-2,0)0,002

Conclusion:

Patients with refractory RA have an adequate response to subsequent treatment lines. These patients have a remarkable percentage of associated comorbidities.

Disclosure of Interests:

None declared

FRI0496 FRECUENCY OF POLYAUTOIMMUNITY IN RHEUMATOID ARTHRITIS AND SYSTEMIC LUPUS ERITHEMATOSUS

Background:

Objectives:

To study the frequency of polyautoinmunity and multiple autoinmune syndrome (MAS) in patients with rheumatoid arthritis (RA) and systemic lupus erithematosus (SLE).

Methods:

Study design: We performed a cross-sectional study in patients with RA and SLE, and compared them with healthy subjects. Cases: RA patients classified by ACR/EULAR 2010 criteria and SLE patients classified by ACR/EULAR 2019 criteria. SLE and RA patients were compiled consecutively from a rheumatology clinic of the Regional University hospital of Malaga. Controls: subjects without rheumatologic autoimmune disease (AD) from the same population area. Protocol: All subjects filled out a predesigned questionnaire for the collection of polyautoimmunity data on the cut-off date. Main variables: polyautoimmunity was defined as co-occurrence of SLE or RA and other AD. Secondary variables: Rheumatologic, cutaneous, endocrine, digestive and neurological AD. MAS was defined as presence of three or more AD. Family history of SLE, RA and other autoimmune diseases were also collected. Statistic analysis: descriptive analysis, bivariate analysis and multivariable analysis were done. (Dependent variable: Polyautoimmunity).

Results:

We recruited 109 patients with RA, 105 with SLE and 88 controls. Fifteen patients with RA (13.8%), 43 with SLE (41%) and 2 controls (2.2%) reported polyautoimmunity. Table 1 describes the epidemiological characteristics, comorbidities and polyautoimmunity in study population. The most frequent AD associated with RA was Sjögren’s syndrome (SS) (53.3%) and SS (55.8%) followed by the antiphospholipid syndrome (30.2%) were associated with SLE. Hashimoto’s thyroiditis and psoriasis were the next most frequent AD. According to family history, 5 patients with RA (33.3%) and 12 with SLE (27.9%) had a family history of first degree of other AD. Obesity was associated with polyautoimmunity in RA (OR = 3,362, p = 0.034). In SLE, joint damage (OR = 2.282, p = 0.038) and anti-RNP antibodies (OR = 5.095, p = 0.028) were factors associated with polyautoimmunity and taking hydroxychloroquine was a protective factor (OR = 0.190, p = 0.004).

Conclusion:

Polyautoimmunity in RA and especially in SLE is frequent. It was associated with obesity in RA and in SLE with joint damage and anti-RNP antibodies. The hydroxychloroquine appeared as a protective factor.

VariablesRA(N=109)SLE(N=105)Controls(N=88)P valueEpidemiological characteristicsSex: female, n (%)85 (78.0)99 (94.3)68 (77.3)0.001Age, mean (SD), years56.5 (10.8)50.8 (13.2)57.1 (10.6)0.133Caucasic race, n (%)107 (98.2)105 (100)88 (100)0.168ComorbiditiesSmoking0.001 No smoking, n (%)55 (50.5)78 (74.3)56 (63.6) Smoking history, n (%)54 (49.5)27 (25.7)32 (36.4)Obesity, n (%)38 (34.9)21 (20.0)22 (25.0)0.044Dyslipidemia, n (%)24 (22.0)22 (21.2)17 (19.3)0.896Hypertension, n (%)27 (24.8)28 (26.7)23 (26.1)0.746Diabetes mellitus, n (%)7 (6.4)1 (1.0)1 (1.1)0.031Polyautoimmunity, n (%)15 (13.8)43 (41)2 (2.2)<0.001MAS, n (%)1 (0.9)9 (8,6)0 (0.0)<0.001FH polyautoimmunity, n (%)19 (17.6)26 (24.8)15 (17.0)0.060

RA: rheumatoid arthritis; SLE: systemic lupus erithematosus; SD: standard desviation; MAS: multiple autoinmune syndrome; FH:Family history

Disclosure of Interests:

None declared

Influence of tree canopy on N₂ fixation by pasture legumes and soil rhizobial abundance in Mediterranean oak woodlands

Symbiotic N2 fixation is of primordial significance in sustainable agro-forestry management as it allows reducing the use of mineral N in the production of mixed stands and by protecting the soils from degradation. Thereby, on a 2-year basis, N2 fixation was evaluated in four oak woodlands under Mediterranean conditions using a split-plot design and three replicates. (15)N technique was used for determination of N2 fixation rate. Variations in environmental conditions (temperature, rainfall, radiation) by the cork tree canopy as well as the age of stands and pasture management can cause great differences in vegetation growth, legume N2 fixation, and soil rhizobial abundance. In the present study, non-legumes dominated the swards, in particular beneath the tree canopy, and legumes represented only 42% of total herbage. A 2-fold biomass reduction was observed in the oldest sown pasture in relation to the medium-age sward (6 t DW ha(-1)yr(-1)). Overall, competition of pasture growth for light was negligible, but soil rhizobial abundance and symbiotic N2 fixation capacity were highly favored by this environmental factor in the spring and outside the influence of tree canopy. Nitrogen derived from the atmosphere was moderate to high (54-72%) in unsown and sown swards. Inputs of fixed N2 increased from winter to spring due to more favorable climatic conditions (temperature and light intensity) for both rhizobia and vegetation growths. Assuming a constant fixation rate at each seasonal period, N2 fixation capacity increased from about 0.10 kg N ha(-1) per day in the autumn-winter period to 0.15 kg N ha(-1) per day in spring. Belowground plant material contributed to 11% of accumulated N in pasture legumes and was not affected by canopy. Size of soil fixing bacteria contributed little to explain pasture legumes N.

Quality evaluation of microscopy and scanned histological images for diagnostic purposes

In this work we present a study for assessing and comparing the fidelity of biopsy and cytology images captured with two different devices, that is optical microscopes and scanners, at 40× magnification in bright field. The devices use different ways to magnify images. Microscopes use a set of lenses while scanners capture light through arrays of micro-photoreceptors. The objective is to carry out a quantitative evaluation to discern which of the two devices provides better image quality in terms of contrast, colour and stain. Since there is no unanimous consensus on quality metrics, we will make use of both an objective metric based on perceptual features, together with a subjective psychophysical test as the International Telecommunications Union (ITU) recommends in ITU-R BT.500 for such type of tests. Both techniques indicate a slight preference for the scanner over the microscope in terms of better image quality, considering defocus as the main problem followed by colour distortions. However, the image quality of both devices is suitable for clinical, educational and research purposes.

Effects of feed intake on composition of sheep rumen contents and their microbial population size

The present study was conducted to determine the effect of feed intake on the composition of the rumen contents of sheep and on their bacterial densities. Whole rumen contents were sampled after a period of continuous inter-rumen infusion of 15NH3 from four rumen-cannulated wethers successively fed on a hay-concentrate diet (2:1, w/w on a DM basis) at two rates of feed intake: 40 and 80 g DM/kg body weight0.75. Total weight and chemical composition of rumen contents, as well as the distribution by size and chemical composition of particles, were determined. The populations of bacteria associated with the liquid (liquid-associated bacteria, LAB) and solid (solid-associated bacteria, SAB) fractions of rumen digesta and the distribution of SAB according to feed particle size were also examined. The greater feed intake caused an increase in the mass of the rumen contents, while its chemical composition did not change, except for a higher content of organic matter (P=0.023). The distribution of feed particles by size was similar at both levels of intake. The concentrations of neutral- and acid-detergent fibre in feed particles decreased and those of total, dietary, and microbial N increased, both with a quadratic response (P=0.001), as particle size decreased. The proportion of LAB in the microbial biomass of rumen digesta reached only 8.0 %. This proportion and the density of LAB were unaffected by the level of feed intake, whereas an apparent reduction (10.4 %) occurred with the SAB biomass in whole rumen contents. A systematic, but not significant, reduction (mean value 11.9 %) in the level of microbial colonisation in the different particle fractions with the increase of feed intake was also observed.

[Dysphagia as a symptom of diffuse idiopathic skeletal hyperostosis (Forestier-Rotes disease). A case report and literature review]

Swallowing disorders can be caused by cervical spine diseases, such as diffuse skeletal hyperostosis (DISH). This entity is diagnosed as a cause of dysphagia only after excluding all other possible causes. We report a case in which dysphagia was the initial symptom of DISH. The most important clinical and diagnostic aspects of the disease are discussed.

Dietary intake of a physically active elderly Spanish male group of high socioeconomic status

The energy and nutrient intake of a group of 29 non-institutionalised elderly males was evaluated. Subjects were between 65 and 79 years of age and practised sport (usually tennis) daily. Their high income classified them as belonging to a high socioeconomic group. The subjects consumed more fruits, fish and non-alcoholic beverages than results reported for the sedentary elderly. Although the nutritional situation of the subjects is better than that of other elderly Spanish groups, more than 50% of the population showed intakes of vitamin D, zinc and magnesium lower than 80% of the recommended intakes (RI). Even though the intake of many of these nutrients will be higher than the observed, given the degree of underreporting noticed, a risk of falling into situations of deficit of these micronutrients must be considered. These require adjustment if a more optimum health and functional status is to be achieved.

Influence of the intake of fortified breakfast cereals on dietary habits and nutritional status of Spanish schoolchildren

A study was performed on the breakfast habits of 200 schoolchildren between 9 and 13 years of age. The subjects were classified into two groups: group C, children who consumed fortified breakfast cereals (65 boys and 35 girls), and group NC, children who did not (64 boys and 36 girls). The different dietary habits and the nutritional status of the two groups were analyzed. Haematological, biochemical, anthropometric, and dietary data were collected, the latter involving a 5-day food record. The children of the C group were found not only to have a more complete and nutritive breakfast, but also showed better dietary patterns for the rest of the day. Their lipid intake (% kJ) was lower and the carbohydrate intake (g/d and % kJ) higher than in the NC children. The intakes of thiamine, pyridoxine, folates, and beta-carotenes were also higher in group C. Better dietary habits were reflected in higher blood levels of some important compounds. Group C children had higher retinol, serum folate, and riboflavin levels than NC children. The percentage of children with hypercholesterolaemia (serum cholesterol > 4.5 mmol/l) was higher amongst those of the NC group: 37% as compared with 18% of the C children.

Relationship between diet composition and body mass index in a group of Spanish adolescents

The dietary patterns of sixty-four adolescents (thirty-seven young men and twenty-seven young women) between 15 and 17 years of age were examined by analysis of food, energy and nutrient intakes, over a period of 5 d, including a Sunday. Adolescents were identified for inclusion in two study groups: (1) overweight and obese subjects (O) with a BMI (kg/m2) > or = 75th percentile, and (2) subjects of normal weight (NW) with BMI < 75th percentile. The study was designed to investigate the differences between the energy and nutrient intakes of NW and O adolescents. No differences were found in energy intake between NW and O adolescents. However, O subjects derived a greater proportion of their energy from proteins (19.8% v 16.4% for NW subjects) and fats (45.4% v. 38.7% for NW subjects), and less from carbohydrates (34.6% v. 44.6% for NW subjects). Also, O subjects consumed significantly larger amounts of cholesterol. In order to prevent obesity and avoid the disorders associated with this condition, it appears necessary not only to regulate energy intake, but also to control the composition of the diet. Given that it is during infancy that feeding habits are developed, it is important to ensure that correct habits are acquired. Special attention should be given to improving the dietary habits of overweight and obese children and adolescents.

[The role of folates in the diverse biochemical processes that control mental function]

A variety of studies indicate that folate deficiency is associated with the appearance of problems of a neuromuscular or neurological nature such as depression, muscular and mental fatigue, states of confusion and non-senile dementia, and that these processes improve fully or partly when the deficiency is corrected. Because of the role of folates in the reactions in synthesis of neuro-transmitter and elements of neuron structure, it is not surprising that a deficiency is associated with depression and other mental problems. Folates are involved in the synthesis of S-adenosylmethionine (SAM) which is the main contributor of methyl groups in the nervous system and whose action as an antidepressive agent is confirmed. They are also involved in the synthesis of glutamate which is an excitant neurotransmitter, and in the formation of puric and pyrimidic bases. An alternative mechanism for explaining the etiopathogenesis of folate deficiency in depression and other mental disorders involves the regeneration of tetrahydrobiopterin (THB) which is an essential cofactor in hydroxylation process in the brains of mammals. Folate deficiency is a common nutritional problem in many groups of the Spanish population and, given the role of this vitamin in the operation of the nervous system, we might consider the possibility that, in some case, folate deficiency may cause or aggravate some alterations to mental function.