A. Consensi

Association between thyroid autoimmunity and fibromyalgic disease severity

Our objectives were to investigate thyroid abnormalities and autoimmunity in 120 patients affected by fibromyalgia (FM) and to study their relationships with clinical data and symptoms. Thyroid assessment by means of antithyroglobulin antibodies, antithyroid peroxidase antibodies, free triiodo–thyronine, free thyroxine, and thyroid stimulating hormone analyses was carried out. The clinical parameters “Fibromyalgia Impact Questionnaire”, pain, tender points, fatigue, and other symptoms, and the presence of depression or anxiety disorders were evaluated. The basal thyroid hormone levels of FM patients were in the normal range, while 41% of the patients had at least one thyroid antibody. Patients with thyroid autoimmunity showed a higher percentage of dry eyes, burning, or pain with urination, allodynia, blurred vision, and sore throat. Correlations found between thyroid autoimmunity and age or with the presence of depression or anxiety disorders were not significant. However, in the cohort of post-menopausal patients, the frequency of thyroid autoimmunity was higher with respect to pre-menopausal patients. In conclusion, autoimmune thyroiditis is present in an elevated percentage of FM patients, and it has been associated with the presence of typical symptoms of the disease.

Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated or Not with Low-dose Glucocorticoids: A Retrospective Study

Objective. To assess the prevalence of comorbidity in a cohort of patients with rheumatoid arthritis (RA), treated or not with low-dose glucocorticoids (GC) and who have been followed for at least 10 years. Methods. This was a retrospective study by review of medical records. Results. We identified 365 patients: 297 (81.3%) were GC users (4–6 mg methylprednisolone daily) and 68 (18.7%) were nonusers. We found that fragility fractures occurred in 18.2% of GC users and in 6.0% of GC nonusers (p < 0.02); arterial hypertension in 32.3% of GC users and in 10.4% of GC nonusers (p < 0.0005); acute myocardial infarction in 13.1% of GC users and in 1.5% of the nonusers (p < 0.01). Prevalence of diabetes mellitus, cataract, and infections was comparable. We divided GC users into groups of different duration of GC therapy: < 2, 2–5, and > 5 years; the mean duration of GC treatment was 1.3 ± 0.5, 3.6 ± 1.1, and 12.1 ± 5.1 years, respectively. GC treatment for > 5 years was associated with significantly higher prevalence of fragility fractures (26.6%; p < 0.001 vs the other groups), arterial hypertension (36.7%; p < 0.0002 vs nonusers and GC users < 2 years), myocardial infarction (16.1%; p < 0.01 vs nonusers), and infections (9.7%; p < 0.005 vs the other groups). GC treatment for 2–5 years was associated with a significantly higher prevalence of arterial hypertension (30.0%; p < 0.01) compared to nonusers. Conclusion. Patients with RA treated with low-dose GC compared to patients never treated with GC show a higher prevalence of fractures, arterial hypertension, myocardial infarction, and serious infections, especially after 5 years of GC treatment. The high prevalence of myocardial infarction and fractures in patients with RA suggests that a more accurate identification of risk factors and prevention measures should be adopted when longterm GC treatment is needed.

A multidisciplinary approach to study a couple of monozygotic twins discordant for the chronic fatigue syndrome: a focus on potential salivary biomarkers.

BackgroundChronic Fatigue Syndrome (CFS) is a severe, systemic illness characterized by persistent, debilitating and medically unexplained fatigue. The etiology and pathophysiology of CFS remains obscure, and diagnosis is formulated through the patient’s history and exclusion of other medical causes. Thereby, the availability of biomarkers for CFS could be useful for clinical research. In the present study, we used a proteomic approach to evaluate the global changes in the salivary profile in a couple of monozygotic twins who were discordant for CFS. The aim was to evaluate differences of salivary protein expression in the CFS patient in respect to his healthy twin.MethodsSaliva samples were submitted to two-dimensional electrophoresis (2DE). The gels were stained with Sypro, and a comparison between CFS subject and the healthy one was performed by the software Progenesis Same Spot including the Analysis of variance (ANOVA test). The proteins spot found with a ≥2-fold spot quantity change and p<0.05 were identified by Nano-liquid chromatography electrospray ionization tandem mass spectrometry. To validate the expression changes found with 2DE of 5 proteins (14-3-3 protein zeta/delta, cyclophilin A, Cystatin-C, Protein S100-A7, and zinc-alpha-2-glycoprotein), we used the western blot analysis. Moreover, proteins differentially expressed were functionally analyzed using the Ingenuity Pathways Analysis software with the aim to determine the predominant canonical pathways and the interaction network involved.ResultsThe analysis of the protein profiles allowed us to find 13 proteins with a different expression in CFS in respect to control. Nine spots were up-regulated in CFS and 4 down-regulated. These proteins belong to different functional classes, such as inflammatory response, immune system and metabolism. In particular, as shown by the pathway analysis, the network built with our proteins highlights the involvement of inflammatory response in CFS pathogenesis.ConclusionsThis study shows the presence of differentially expressed proteins in the saliva of the couple of monozygotic twins discordant for CFS, probably related to the disease. Consequently, we believe the proteomic approach could be useful both to define a panel of potential diagnostic biomarkers and to shed new light on the comprehension of the pathogenetic pathways of CFS.

Oral sildenafil in skin ulcers secondary to systemic sclerosis

Digital ulcers (DUs) are a major clinical problem in scleroderma patients, associated with reduced quality of life, pain, and disability, and resulting in loss of productivity and mutilation that c...

THU0309 Proteomic Differential Expressed Protein in Fibromyalgic Saliva: Comparison with Other Pain Model as Rheumathoid Arthritis and Migraine

Background Fibromyalgia Syndrome (FM) is a chronic non inflammatory musculoskeletal disorder characterized by widespread pain and by the presence of at least 11 out of 18 specific tender points on physical examination and associated with a plethora of dysfunctional disorders. Currently no validated laboratory biomarkers are available for FM and the diagnosis of the disease remains exclusively clinical. Objectives With the present study, we used two-dimensional electrophoresis (2DE) in combination with mass spectrometry (MS) to evaluate the global changes in salivary profile of FM patients. The aim was the search for any eventual diagnostic or prognostic salivary biomarkers which could be useful for the management of FM patients and compare the profile of FM with two different model of chronic pain: migraine patient such as non-inflammatory chronic pain and rheumathoid arthritis (RA) patients as inflammatory chronic pain. Methods Samples were pooled according to their diagnosis, and submitted to 2DE. The gels were stained with Sypro and images analyzed performing a comparison between FM and control classes (healthy, rheumatoid arthritis, migraine). Proteins spots of interest were identified by NanoLC-ESI-MS/MS analysis. Results The analysis of the protein profiles allowed us to find 26 spots with a different expression in FM respect to RA (p-value<0.05), 28 spots from the comparison of FM with migraine, and 32 in FM respect to healthy subjects. In particular, we found 7 spots differentially expressed exclusively in FM. Six spots were identified as serotransferrin and the other as alpha-enolase. Both serotransferrin and alpha-enolase increased in FM respect to all the control classes. Furthermore, the proteins differentially expressed in FM respect to the control classes, were functionally analyzed by using the Ingenuity Pathways Analysis software with the aim to determine the predominant canonical pathways and the interaction network involved. Serotransferrin is an iron binding transport protein, responsible for the transport of iron from sites of absorption to those of storage and utilization, and alpha-enolase is a multifunctional enzyme that, as well as its role in glycolysis, plays a part in various processes such as growth control, hypoxia tolerance and allergic responses. Moreover, serum transferrin plays an important role in inflammation, while alpha enolase stimulates immunoglobulin production. Therefore our results seem to support the inflammatory and a dis-regulation of immunity system hypothesis for FM. In fact, also the network built with our proteins highlights the involvement of inflammatory response in FM and the immune cell trafficking. In addition, proteomic profile of FM patients is more similar to that of RA patients, rather than migraine and healthy subjects. Conclusions In conclusion, this study shows the presence of differentially expressed proteins in the saliva of FM patients, probably related to the disease. Consequently, the proteomic approach could be useful both to define a panel of potential diagnostic biomarkers and to shed new light on the comprehension of the pathogenetic pathways of FM. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3714