Diego Jaimes

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.

Report from the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine organization 2012 workshop.

Abstract The first annual meeting of the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine (LASSERIM) was held in Bogotá, Colombia, in September 2012 and was attended by key opinion leaders, researchers, and rheumatologists. The meeting included presentations and discussions from renowned speakers during 2 days and a coaching leadership exercise led by an expert in the field followed by an open forum. Two groups defined a priori discussed the establishment of a professional network and organization to be involved in the identification, assessment, and effective resolution of health care issues in Latin America. A broad spectrum of topics were discussed but focused on the following: pharmacoeconomics in general rheumatology, spondyloarthritis and chronic back pain, therapeutic interventions in rheumatoid arthritis, ultrasonography in spondyloarthritis, impact of social media in medicine and global trends in leadership, quality of life, and innovation. A special workshop on coaching in health care and coaching as a tool to implement LASSERIM goals was part of the 2-day conference. LASSERIM will be working in the future on education, research, and innovation in the field of rheumatology and immunology. A special focus will be on spondyloarthritis, by promoting research, open discussions, and by conducting carefully planned research studies to impact on the quality of life of patients and doctors from Latin American countries.

Label-Free Quantification of Anti-TNF-α in Patients Treated with Adalimumab Using an Optical Biosensor

This study describes the development of an immunosensory label-free quantification methodology based on surface plasmon resonance (SPR) and its applicability in measuring/evaluating therapeutic drug monitoring (TDM) of anti-TNF-α monoclonal antibody (adalimumab) in rheumatoid arthritis (RA) patients. The experimental parameters evaluated in this study were immobilising ligands by pre-concentration assays, sensor surface regeneration, ascertaining the method’s sensitivity and correlating the results from quantifying plasma samples by ELISA immunoassay. The results showed that TNF-α quantification values (in RU) were significantly different when comparing patients (~50–250 RU) to controls (~10–20 RU). Likewise, there was 0.97 correlation for patients and 0.91 for healthy volunteers using SPR and ELISA comparison methodologies. SPR immunosensory detection provided a precise, sensitive strategy, along with real-time determination, for quantifying adalimumab, having great potential for clinical routine regarding TDM.

Improving skills in pediatric rheumatology in Colombia: a combined educational strategy supported by ILAR

Colombia is a densely populated country with a small number of pediatric rheumatology specialists, including 14 specialists for a population of 1,927,000 children in 2014. The objective of the study was to improve the skills required for early identification, timely referral, and management of musculoskeletal diseases, especially juvenile idiopathic arthritis (JIA), in a group of pediatricians and pediatric residents in a remote region of Colombia. Supported by grant programs developed by the International League of Associations for Rheumatology (ILAR), a combined educational strategy (blended learning) was implemented based on two classroom educational activities and four online modules. The students’ acquired knowledge and perception of the strategy were evaluated. Scores were reported as median values and interquartile ranges (IQR), and the differences between scores were estimated using the Wilcoxon test for equal medians. Forty-one students were enrolled, 37 completed the online modules, and 33 attended the final in-person session. The results of the written tests demonstrated an improved ability to solve clinical problems compared with the results of the tests before the course (the median initial vs. final test scores 3 (IQR = 1) vs. 5 (IQR = 0), p = 0.000). The students reported high levels of satisfaction related to compliance with the proposed objectives, the relevance of the contents and activities performed, and the impact on everyday practice. These types of strategies are useful as tools for continuing medical education. However, the results pertain only to short-term learning. It is necessary to evaluate their impact on “lifelong learning.”

El papel de los anticuerpos anti-cromatina, antiC1q y las fracciones del complemento unidas a células en el diagnóstico precoz de actividad lúpica

Resumen Actualmente se percibe una necesidad apremiante en la identificacion y validacion de biomarcadores que reflejen tempranamente el inicio de actividad lupica o que se conviertan en predictores de la misma. La actividad clinica del lupus eritematoso sistemico (LES) es ondulante a lo largo del tiempo y la actividad subyacente persistente lleva a dano tisular. Este dano es reflejo de cambios irreversibles en la funcion y estructura organica, por lo que la prevencion, mas que el tratamiento, deberia ser la meta de cualquier terapia en LES y asi lograr disminuir la morbimortalidad y los costos directos e indirectos causados por la enfermedad. Es necesario encontrar biomarcadores no invasivos de actividad lupica que no solo permitan tomar de forma oportuna decisiones terapeuticas, sino que tambien se correlacionen con los desenlaces clinicos y sean utiles en los ensayos clinicos, permitiendo acortar el tiempo del desarrollo de estos estudios. Este articulo pretende buscar la evidencia que se tiene con respecto a los nuevos biomarcadores existentes para actividad de la enfermedad en LES y su utilidad actual y futura, enfatizando en la necesidad de buscar nuevas moleculas que permitan un diagnostico mas precoz de la actividad de la enfermedad.

Pioderma gangrenoso refractario: utilidad de la terapia combinada. Enfoque en beneficio de la terapia hiperbárica en su tratamiento

Pyoderma gangrenosum is a type of neutrophilic dermatosis that has an idiopathic component, or can be associated with other underlying systemic pathologies. It is the result of an exaggerated response against specific and non specific stimuli. The first line of therapy are glucocorticoids (GC); however, in some patients, control of the pathology is not achieve with this treatment (local or systemic), and it is needed a step-up therapy going through several immuno-modulating treatments, biologic agents Anti – TNFa, and in refractory cases, the use of non conventional therapies such as Hyperbaric Oxygen Therapy

AB0385 Anti-chromatin antibodies: a useful marker for early activity.

Background The anti-chromatin antibody is frequently is elevated in patients with active SLE and its titer correlates with activity. Objectives The objective of this study is to determine the diagnostic value of anti-chromatin antibodies in the assessment of clinically active SLE. Methods A cross-sectional study with 74 patients (110 samples) diagnosed with SLE. Disease activity was evaluated by Safety of Estrogens in SLE National Assessment— SLE Activity Index (SELENA-SLEDAI) and the British Isles Lupus Activity Group 2004 (BILAG 2004) index. Serological titers of anti-dsDNA high avidity, anti-chromatin and anti-C1q antibodies were measured by enzyme-linked immunosorbent assay (ELISA) using commercially available kits INOVA Diagnostics, Inc. Complement levels by nephelometric test Values in this study were expressed as mean ± standard deviation (SD). The chi-squared test was used for the categorical variables as needed. The Wilcoxon Rank-Sum Testwas used for comparison of SLEDAI score indices. Correlation among the levels of complements, anti-dsDNA, anti-chromatin, anti-C1q antibodies and disease activity scores was made by the nonparametric Spearman’s rank correlation test (correlation coefficient ρ [rho]). Values of p< 0.05 were considered to be of statistical significance. STATA SE-11,1 (STATA Corp®) was used. Results The mean SLEDAI score was 3,36 ± 3,19 (0-14). 49,9% (n=54) of patients had a SLEDAI score of ≥ 4. Activity by BILAG A/B: Renal 9% (n=10), mucocutaneous 8,18 (n=9), musculoskeletal 6,5% (n=7), neuropsychiatric 1,8% (n=2), hematological 1,8% (n=2), cardiorespiratory and constitucional 0,9% (n=1). 60% of patients had activity by SLEDAI or BILAG. Biomarkers: Anti-chromatin antibodies 64,08 ± 74,3 (1-251), anti-dsDNA 54,99 ± 77,63 (12-543), anti-C1q antibodies 14,66 ± 23,09 (2-153), C3 97,81± 30,5 (26-152) and C4 16,53 ± 8,99 (2-42). The prevalence of positive anti-chromatin, anti-dsDNA and anti-C1q antibodies in the recruited patients was 51%, 45%, and 16% respectively. Anti-chromatin antibodies and anti dsDNA antibodies were found to be positive in 70% and 72% active-SLE patients by SLEDAI ≥ 4 (p<0,0001). Anti-chromatinantibodies were found to be positive in 15,4% SLE patients lacking anti-dsDNA antibody, 53% without activity for SLEDAI o BILAG at the moment of the study. The Wilcoxon Rank-Sum Testshowed an excellent correlation between anti-chromatin antibodies and SLEDAI score ≥ 4 (p< 0,0001). Spearman’s rank correlation test (ρ) among the levels of anti-chromatina and anti-dsDNA with disease activity scores was 0,38 (p<0,001) and 0,41 (p<0,001) respectively. Conclusions Anti-chromatincould precede the development of lupus flares and thus has a value in predicting lupus flares and preempting treatment. References Translational Research 2012;159:326–342. Arthritis Research & Therapy 2009, 11:R154. Ann Rheum Dis 2007;66:693–696. Disclosure of Interest None Declared

Viability and functional capacity after thawing of hematopoietic progenitor cells cryopreserved at a cord blood stem cell bank in Colombia

To evaluate the viability and functional capacity of hematopoietic progenitor cells from cord blood samples cryopreserved at the Banco de Células Stem de Colombia.