Ana María Santos

Associations of the Levels of C4d-bearing Reticulocytes and High-avidity Anti-dsDNA Antibodies with Disease Activity in Systemic Lupus Erythematosus

Objective. There are no laboratory tools that detect early flares in systemic lupus erythematosus (SLE). Our aim was to validate in our population the previous findings of the association of C4d-bearing reticulocytes (R-C4d) compared to anti-dsDNA antibodies, with disease activity assessed by the Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and the British Isles Lupus Assessment Group (BILAG) 2004 scales. Methods. All patients who met the 1987 American College of Rheumatology classification criteria and were seen consecutively in 2013 at a specialized SLE care clinic were included. Disease activity was established by the SELENA-SLEDAI and BILAG 2004. Anti-dsDNA and R-C4d were quantified in peripheral blood. Comparisons were made between values of active and inactive patients, and the correlations between the SELENA-SLEDAI and serum levels of anti-dsDNA and R-C4d were measured. Results. Sixty-two patients (83.9% women) were included. A total of 32.3% had active disease according to the SELENA-SLEDAI. There was a significant statistical difference (p = 0.0001) in the distribution of R-C4d between disease activity groups. The correlation coefficient between R-C4d and the SELENA-SLEDAI score was rs = 0.738 (p = 0.0001). R-C4d differed between patients with and without activity in the BILAG 2004 constitutional, mucocutaneous, gastrointestinal, renal, and hematological domains. Conclusion. R-C4d showed a higher correlation with SLE activity measured by the SELENA-SLEDAI and BILAG 2004 than anti-dsDNA did, suggesting a possible involvement in diagnosing disease activity. Prospective studies that confirm these findings and evaluate its involvement in followup are needed.

Risk factors and prevalence of osteoporosis in premenopausal women from poor economic backgrounds in Colombia

Introduction The prevalence of osteoporosis in premenopausal women along with associated risk factors has not been well elucidated. Recent studies have shown that poverty is a risk factor for osteoporosis. Objective To determine the prevalence of osteoporosis and its risk factors in a group of premenopausal women of poor economic background in Colombia. Materials and methods The study comprised 1483 women between 35 and 53 years of age with at least one risk factor for osteoporosis. Demographic characteristics, reproductive factors, comorbidities, and risk factors for osteoporosis were evaluated. Lumbar vertebrae (L2–L4) and the femur neck were assessed using dual-energy X-ray absorptiometry. Results Of the 1483 patients, 1443 (97.3%) had at least one risk factor for osteoporosis and 40 (2.7%) had no risk factors. Patients with one risk factor were referred to have a dual-energy X-ray absorptiometry scan, which 795 women completed. Osteopenia was found in 30.5% and osteoporosis in 4.8% of these women. The majority of these women were homemakers, and 18.5% of the patients with osteoporosis were also illiterate (P < 0.001). The risk factors identified in this population were: hypothyroidism (odds ratio [OR] = 5.19, 95% confience interval [CI]:1.6–16), age over 45 years old (OR = 1.13, 95% CI: 1.0–1.2), a history of malnutrition or low birth weight (OR = 2.35, 95% CI: 1.0–5.2), or early-onset menopause (OR = 3.4, 95% CI: 1.6–7.2). Conclusion Premenopausal Colombian women from impoverished areas showed increased rates of osteopenia and osteoporosis compared with the data described in the current literature. Hypothyroidism was an outstanding risk factor in Colombian premenopausal women with osteoporosis. This shows the influence of poverty and other risk factors on the onset of osteoporosis in women aged 35–53 years.

Chikungunya in Colombia: a description of an epidemic within the framework of a COPCORD study

During 2014 and 2015 the chikungunya virus reached Colombia unleashing an epidemic that spread throughout the whole territory. Concurrently, the Colombian Rheumatology Association was conducting a Community Oriented Program for Control of Rheumatic Diseases (COPCORD) to establish rheumatic disease prevalence in the country. Chikungunya infected patients were identified within the COPCORD population. The aim of this study was to describe the demographics, clinical characteristics and disability of patients with clinical suspicion of chikungunya infection. To confirm chikungunya infection, ELISA IgM and IgG serology was performed. From the 6528-surveyed people of the COPCORD study, 548 where included in the study because of clinical suspicion of chikungunya virus infection. Of those, 295 were positive for IgG or IgM chikungunya serology with 151 patients fulfilling WHO clinical criteria for chikungunya infection (true positives). Most patients were > 45 years (57.7%), and females (69.7%). Patients with low income and low socio-economic strata had increased risk of chikungunya infection (p = 0.00; OR: 2.36, CI: 1.47-3.77 and p = 0.00; OR: 2.81, CI: 1.90-4.17 respectively). True positive patients were associated with symmetric arthritis (p = 0.00; OR: 22.49, CI: 12.71-39.80) of ankles (p = 0.00; OR: 16.06, CI: 7.57-34.08), hands (p = 0.00; OR: 16.12, CI: 8.25-39.79), feet (p = 0.00; OR: 16.35, CI: 7.41-36.05) and elbows (p = 0.00; OR: 14.00, CI: 3.03-64.70). Most patients developed mild to moderate disability (95.2 to 100%). Our study showed that poverty and low socioeconomic status are associated with increased risk of chikungunya infection. Also, we found two distinctive phenotypes of chikungunya infection; those with positive chikungunya serology and typical clinical symptoms (true positives) and those with positive serology without clinical symptoms (false negatives). Finally, a distinctive clinical picture presented by chikungunya infected patients was found which should be considered as the hallmark for diagnostic clinical criteria.

AB1300 Comorbidities in patients with rheumatic diseases in colombia

Background Patients with systemic autoimmune conditions often develop concomitant disease contributing to a higher mortality than in the general population. An early diagnosis and treatment is fundamental to improve the life expectancy of this population. Objectives The objective of this study was to describe the frequency of comorbidities in patients with rheumatic diseases. Methods Based on data from the population studied under the COPCORD strategy, in the prevalence of rheumatic disease in Colombia, the frequency of non-rheumatic diseases in patients with rheumatic diseases was described in 6 cities of Colombia (Bogotá, Medellín, Cali, Barranquilla, Bucaramanga and Cúcuta). Results From a total of 4020 individuals, 2274 rheumatic patients were identified. Sixty nine percent of the Colombian patients with rheumatic disease (n=1571) had some comorbidity. The most frequent was hypertension (HBP) in 20,95% (n=330), followed by migraine 19,11% (n=300) and venous insufficiency 17,69% (n=278). Seventeen percent had any mental disorders, of which, anxiety and depression were the most common (n=273). Other comorbidities like obesity (8,1%), diabetes (5,85%), heart disease (5,79%) and cerebrovascular disease (1,99%) were less common among rheumatic patients. The frequency of cancer was low 1.48% (n=23). Abstract AB1300 – Figure 1Abstract AB1300 – Figure 1 Most frequent comorbidities in rheumatic patients Conclusions Hypertension is the most common comorbidity in patients with rheumatic diseases in Colombia. Screening and diagnosis in early stages of HBP is important, since it is the main modifiable cardiovascular risk factor. The goals of pharmacological and non-pharmacological treatment are essential to reduce the risk of coronary heart disease, stroke and end-stage renal disease. Additionally, migraine is the second most frequent disease that affects the patient’s quality of life. And venous insufficiency should be taken into account by primary care physicians in order to assure a complete health care assessment. Disclosure of Interest None declared

Interobserver Agreement in Magnetic Resonance of the Sacroiliac Joints in Patients with Spondyloarthritis.

Background. Clinical, laboratory, and radiologic parameters are used for diagnosis and classification of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is being increasingly used to detect early sacroiliitis. We decided to evaluate the interobserver agreement in MRI findings of SI joints of SpA patients between a local radiologist, a rheumatologist, and an expert radiologist in musculoskeletal diseases. Methods. 66 MRI images of the SI joints of patients with established diagnosis of SpA were evaluated. Agreement was expressed in Cohens kappa. Results. Interobserver agreement between a local radiologist and an expert radiologist was fair (κ = 0.37). Only acute findings showed a moderate agreement (κ = 0.45), while chronic findings revealed 76.5% of disagreement (κ = 0.31). A fair agreement was observed in acute findings (κ = 0.38) as well as chronic findings (κ = 0.38) between a local radiologist and a rheumatologist. There was a substantial agreement between an expert radiologist and a rheumatologist (κ = 0.73). In acute findings, a 100% agreement was achieved. Also chronic and acute plus chronic findings showed high levels of agreement (κ = 0.73 and 0.62, resp.). Conclusions. Our study shows that rheumatologists may have similar MRI interpretations of SI joints in SpA patients as an expert radiologist.

AB0239 Dkk1 is not associated with inflammatory activity indexes in rheumatoid arthritis, but with functional disability related to the long evolution of the disease

Background Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease characterized by joint destruction, deformity, lower functional status and decrease in life expectancy. Wnt signaling pathway recently it has been implicated in bone homeostasis. Studies suggest that overexpression of inhibitors of the way, like the Dickkopf 1 protein (DKK1) has been implicated in bone destruction Objectives To compare circulating levels of DKK1 in patients with RA to their disease activity and functional status Methods 379 consecutive patients with early and established RA were evaluated at the Hospital Militar Central in Bogota-Colombia, between March 2015 and November 2016. A complete medical history related to RA was obtained. Disease activity was evaluated by DAS28-CRP, CDAI, SDAI and RAPID3. functional status was measurement using MDHAQ and the Steinbrocker functional classification. DKK1 levels measured by ELISA using an Abcam® kit Results The mean age was 60,7±13,1 years, disease duration 13,1±10,9 years, 80,4% were female. Higher levels of DKK1 were not associated with higher disease activity by CDAI (p=0,70), SDAI (p=0,84), DAS28 with CRP (p=0,80) or RAPID3 (p=0,70). Interestingly Higher levels of DKK1 were significantly associated to greater disability and lower functional status according to the Steinbrocker functional grading (p=0.013) and with severe disability by MDHAQ (p=0.004), Table 1. Other variables associated with joint destruction were osteoporosis, elevated rheumatoid factor, smoking, and hospitalization Conclusions Higher levels of DKK1 were found in patients with lower functional status. This association was not found in patients with greater disease activity according to CDAI, SDAI, DAS28 and RAPID3. This could be explaining by greater structural damage though more studies would be needed to explore this possibility References Huizinga TW, Pincus T. In the Clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1–1-ITC-15. Disclosure of Interest None declared

Validez de la gammagrafía ósea de sacroilíacas para el diagnóstico de sacroiliítis en una cohorte colombiana de pacientes con espondiloartritis (SpA)

Resumen Introduccion La identificacion radiologica de sacroiliitis es de vital importancia para el diagnostico de las SpA, el uso de la resonancia magnetica nuclear (RNM) ha ayudado en la deteccion temprana de este hallazgo, mejorando el tratamiento y pronostico de los pacientes, con el inconveniente de ser un estudio costoso y de limitado acceso, lo que restringe su uso en la practica clinica, situacion que facilita la solicitud de estudios mas economicos y de facil acceso, como la radiografia de pelvis y la gammagrafia osea (GO). Objetivos Establecer la utilidad de la GO para el diagnostico de sacroiliitis, en pacientes con SpA. Materiales y metodos Se determino sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la GO para el diagnostico de sacroiliitis, usando como patron de oro diagnostico la RNM, en una cohorte colombiana de pacientes con diagnostico de SpA. Resultados Se analizaron 55 pacientes, 43.6% mujeres y 53.3% hombres, promedio de duracion de la enfermedad 9.1±8.4 anos, edad promedio de 31±10.5 anos al inicio de los sintomas. Predominaron los pacientes con espondiloartritis no diferenciada (uSpA) (60.5%), y compromiso mixto (axial y periferico) (58,2%). El comportamiento de la GO fue sensibilidad 15% (IC 95% 0.04–0,25), especificidad 81% (IC 95% 0.72–0,9), valor predictivo positivo 32% (IC 95% 0.11–0.52), valor predictivo negativo 62% (IC 95% 0.52–0.72). Conclusiones Se evidencia una sensibilidad variable de la GO con baja especificidad, valor predictivo positivo y valor predictivo negativo, para la deteccion de sacroiliitis, lo que permite establecer que no es util como ayuda diagnostica en espondiloartritis (SpA).

FRI0462 Inter-observer variation among conventional radiologist, expert radiologist and rheumatologist, in magnetic resonance imaging (MRI) of the sacroiliac (SI) joints in a group of colombian patients with spondyloarthritis (SPA)

Background The MRI of SI joints, included in the ASAS criteria, is being increasingly used to detect early sacroiliitis and as a tool to measure response to treatment in clinical studies. However, evaluation of the MRI of SI joints has been considered difficult to a non-experienced observer, in which case, Sacroiliitis could be mis diagnosed or delay diagnosis and cost increase. Objectives To evaluate the concordance rate of detecting abnormalities of sacroiliac joints on MRI, between a musculoskeletal expert observer and conventional radiologist, in a group of patients with SpA Methods 66 patients with diagnosis of SpA according to the ESSG (European Study Group spondyloarthritis), who were attended to a SpA clinic from January to November of 2012 and their MRI films of SI joints and its originals reports by conventional radiologist were selected. Those images were read independently in a second time by a musculoskeletal expert observer. The agreement between two readers was analyzed through the kappa statistic. Results The agreement between the two readers (musculoskeletal expert radiologist and conventional radiologist) was poor (K 0.37), on the normal case (K 0.39), and on chronic findings (K0.31), while there was moderate agreement on the presence of acute changes (K 0.45). The agreement between a rheumatologist expert in SpA and a musculoskeletal expert radiologist observer also was analyzed, the agreement was acceptable to be useful in ascertaining acute inflammatory and chronic structural changes due to sacroiliitis (sacroilitis by X-ray K 0,5; acute changes K 0,52, chronic changes K 0,61). Conclusions Sacroiliitis can be difficult to detect in early stages of SpA. The agreement for changes due to sacroiliitis by MRI between expert and non- expert radiologist in this study was poor, while between two experts readers (Radiologist and Rheumatologist) was better. Although MRI is highly sensitive in detecting early changes according to other studies, these findings may be no detected by non-expert observers, that’s why training of rheumatologists and radiologists in the evaluation of sacroiliac joints on MRI is necessary, to optimize the accuracy of the diagnostic test, avoid mis diagnostic and cost increase. Disclosure of Interest None Declared