Dijana Perković

Relationship between vitamin D, IFN-γ, and E2 levels in systemic lupus erythematosus.

In this study, we investigated the relationship between vitamin D, interferon-gamma (IFN-γ), and estradiol (E2) in females of childbearing age with inactive systemic lupus erythematosus (SLE). The study included 22 SLE patients, and 21 age- and gender-matched healthy individuals. Serum concentrations of 25-hydroxyvitamin D3 (25(OH)D3), E2, and IFN-γ were measured by radioimmunoassay using the gamma-counter and ELISA. Patients and control subjects were divided into two groups based on their vitamin D levels (25(OH)D3 ≤ 20 ng/mL; 25(OH)D3 > 20 ng/mL). The median values of IFN-γ and E2 were higher in SLE patients compared to the controls, irrespective of vitamin D level (p = 0.001, p = 0.009, p = 0.003, and p = 0.003, respectively). In SLE patients, there was a negative correlation between IFN-γ and 25(OH)D3 (rs = −0.330; p = 0.03) and a positive correlation between IFN-γ and E2 (rs = 0.404; p = 0.007). This study demonstrates an interesting interplay between vitamin D, INF-γ, and E2 in SLE patients with inactive disease.

Churg-Strauss Syndrome Associated with Montelukast Therapy

Churg-Strauss syndrome is a rare form of eosinophilic vasculitis associated with asthma. Several cases of eosinophilic conditions including Churg-Strauss syndrome have recently been reported in asthmatic patients being treated with antileukotriene receptor antagonists. However, whether these drugs have a direct pathogenic role remains controversial. We describe two patients who developed Churg-Strauss syndrome after starting treatment with montelukast.

Fulminant diffuse systemic sclerosis following aortic valve replacement.

We present a case of fulminant diffuse systemic sclerosis (dSSc) developed after the aortic valve replacement followed by fatal congestive heart failure within the 6 months from the initial symptoms. A 61-year-old male developed rapidly progressive diffuse systemic sclerosis following aortic valve replacement due to stenosis of bicuspid aortic valve. He presented with diarrhoea, weight loss, mialgia and arthralgia after cardiac surgery. Heart failure, due to myocardial fibrosis, was noted as a cause of death. We hypothesize that artificial materials like the ones used in mechanical valves or silicon materials in breast implants may induce fulminant course of pre-existing systemic sclerosis or create a new onset in predisposed individual.

PS6:116 Diet habits in patients with systemic lupus erythematosus

Objective Many patients with systemic lupus erythematosus (SLE) are interested in diet advices. We wanted to investigate which diet habits are most common in our patients, and which of them are in correlation with laboratory parameters that are related to disease remission, such as normal values of serum complement and 24 hour proteinuria. Methods We included 76 patient with SLE in remission, in age between 21 and 75. They fulfilled 23-item questionnaire about weekly diet habits. Basic anthropometric data, disease duration, levels of C3 and C4 complement components and 24 hour proteinuria were recorded and analysed in correlation with diet habits. Results Majority of our patients had normal BMI (between 18.5 and 25 kg/m2), prefered to eat healthy food and did regular weekly workout. Milk, meat, fruits, vegetables, pasta, rice and bread were the most abundant food. Lower serum values of C3 were found in 34 (44.7%) cases, and lower values of C4 were found in 28 (36.8%) cases. Only 5 (6.6%) patients had significant 24 hour proteinuria higher than 3.5 g and another 7 (9.2%) had proteinuria higher than 1 g. Lower values of C3 were found in patients who often consumed meat (p=0.015) and fast food (p=0.060), and those patients who more often consumed fast food or fried food had lower levels of C4 (p=0.043 and p=0.051). Conclusions There is an evidence that food rich in proteins and calories can lower serum complement levels. As clinicians, we should always advice our SLE patients to eat a lot of fish, fruits and fresh vegetables, although there is no strong support for that. More studies with dietary interventions have to be done before final recommendations can be made.

Association between vitamin D, oestradiol and interferon-gamma in female patients with inactive systemic lupus erythematosus: A cross-sectional study:

Objectives To investigate possible associations between 25-hydroxyvitamin D3 (25(OH)D3), oestradiol (E2) and IFN-gamma (IFNγ) in female patients with inactive systemic lupus erythematosus (SLE). Methods Female patients with inactive SLE and age-matched healthy controls were recruited into this cross-sectional study. Serum concentrations of 25(OH)D3, E2 and IFNγ were measured by radioimmunoassay with gamma-counters and enzyme-linked immunosorbent assay. Results 36 patients and 37 controls were enrolled. In patients with SLE, the concentration of 25(OH)D3 was lower and E2 was higher compared with controls. In vitamin D deficient (i.e., 25(OH)D3≤20 ng/ml) patients, IFNγ was 150% higher compared with patients with 25(OH)D3>20 ng/ml and controls. The concentration of E2 was higher in all patients compared with controls independently of the vitamin D level. A difference was found between patients and controls in the correlation of 25(OH)D3 with E2 and a positive correlation was found between E2 and IFNγ in all participants. Conclusions Our results suggest that E2 may have a strong modulating effect on vitamin D function which is significant only at low concentration of E2.

Association of low socioeconomic status and physician assessment of disease severity with oral health-related quality of life in patients with systemic sclerosis: a pilot study from Croatia, a country in transition

Objective This study was performed to identify a possible association of the clinical parameters of systemic sclerosis (SSc) and the socioeconomic status (SES) with oral health-related quality of life (OHrQoL) as measured by the Oral Health Impact Profile 49 (OHIP 49), taking into account the effect of educational level (as a proxy of SES) on oral health. Methods Subjects were recruited from the Croatian SSc Center of Excellence cohort. Detailed dental and clinical examinations were performed according to standardized protocols. The associations of OHrQoL with disease characteristics and socioeconomic status were examined. Results Thirty-one consecutive patients with SSc were enrolled (29 women; mean age, 56.45 ± 13.60 years). OHIP 49 scores were significantly correlated with disease activity and severity. Furthermore, OHrQoL was positively correlated with skin involvement as evaluated by the modified Rodnan skin score. Impaired OHrQoL was positively correlated with the severity of general, skin, gastrointestinal, and joint/tendon involvement. The OHIP 49 score differed between patients who were positive and negative for anti-topoisomerase I antibody. Higher OHIP 49 scores were detected in patients with lower SES (primary school educational level). Conclusion Collaboration between rheumatologists and dental professionals is required to improve dental care and oral health outcomes of SSc.

AB0661 Oral health-related quality of life measured with ohip 49 highly correlates with disease activity and severity in systemic sclerosis patients

Background Systemic sclerosis (SSc) is associated with decreased saliva production and interincisal distance, more missing teeth, and periodontal disease. Orofacial manifestations of SSc contribute greatly to overall disease burden and still are regularly overlooked and under-treated. Previous studies did not confirm correlation between disease severity and oral health-related quality of life in SSc patients. Objectives The aim of this study was to determine possible correlation of the SSc clinical parameters with oral health-related quality of life measured with the Oral Health Impact Profile 49 (OHIP 49). Methods Subjects were recruited from the Center of excellency for systemic sclerosis in Croatia cohort. Detailed dental by the same dentist and clinical examinations were performed according to standardized protocols. Associations between oral health-related quality of life and disease charachteristics were examined. We evaluated the disease severity using clinical and laboratory parameters according to the Medsger Severity Scale. The level of SSc activity was evaluated according to Valentini activity score. Oral quality of life was measured using the OHIP 49, which consists of 49 questions on the frequency of adverse oral conditions such as toothache, mouth pain, difficulty chewing or pronouncing words and discomfort related to appearance (higher scores indicating worse oral health-related quality of life). The study was approved by the University Hospital Split Ethics Committee. Results Thirty-one SSc patients (29 women and 2 men, mean age 56.45±13.60 years, median disease duration 7 years with minimum–maximum range 1–28 years) were consecutively enrolled for this study between January 2014 and December 2015. All patients fulfilled the ACR criteria for the diagnosis of SSc. The distinction between limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) was made according to the Leroy et al. criteria (28 dcSSc, 3 lcSSc). OHIP 49 scores highly positively correlated with disease activity (p=0.005, r=0.4872, Spearmans rank coefficient) and severity (p=0.016, r=0.4303, Spearmans rank coefficient). Furthermore, oral health-related quality of life positively correlated with the skin involvement evaluated by modified Rodnan skin score (p=0.003, r=0. 5207, Spearmans rank coefficient). Impaired quality of oral health positively correlated with the severity of general involvement, skin, gastrointestinal and joint/tendon involvement (p=0.003, r=0.506 for general involvement, p=0.003, r=0.511; p<0.001, r=0.591 and p=0.02, r=0.391 for skin, gastrointestinal and joint/tendon involvement, respectively, Spearmans rank coefficient). OHIP 49 score was highly variable between anti-topoisomerase I antibodies positive or negative SSc patients (p<0.001, Fishers exact test). Conclusions Contrary to previous studies in our study disease severity and activity were related to OHIP 49 scores. Our data suggest that OHIP scores correlate with severity of general involvement, skin, gastrointestinal, and joint/tendon involvement in SSc patients. Disease subset and autoantibodies profil could play a role in the oral manifestation of SSc. Better collaboration between rheumatologists and the dental team is required to improve access to dental care and oral health outcomes for SSc patients. Disclosure of Interest None declared

AB0613 Clinical and Laboratory Differences between SSC Patients with and without Diastolic Dysfunction

Background Left ventricular diastolic dysfunction (LVDD) is the most common cardiac abnormality in systemic sclerosis (SSc). It is known that aging is a primary determinant of LVDD in SSc patients and many of the clinical factors associated with LVDD were no longer associated after simply adjusting for age. Objectives The aim of this study was to determine clinical and laboratory parameters of SSc patients with and without LVDD matched for age. Methods We studied 13 SSc patients with preserved left ventricular ejection fraction (LVEF) and LVDD, and 13 SSc patients without LVDD matched for age, sex, body mass index and smoking status. LVDD was defined and classified according to the American Society of Echocardiography recommendations. Serum IL-6 and NT-proBNP levels were measured and subjects were evaluated by conventional and pulsed-wave tissue Doppler echocardiography and by the six minute walk test (6MWT). Results There was no difference between SSc patients with and without LVDD according to heart rate, systolic and diastolic blood pressure, left ventricular mass index, prevalence of pulmonary artery hypertension, and antibody status. SSc patients with LVDD had longer duration of SSc than SSc patients without LVDD (16.0 vs 6.65 yrs; P=0.004), and had higher EUSTAR score (5.77 vs 3.12; P=0.001). The serum level of IL-6 (6.39 vs 2.94 pg/ml; P=0.021) and NT-proBNP (24.78 vs 10.12 pmol/L; P=0.003) were significantly increased in SSc patients with LVDD. The 6MWT distance was shorter in SSc patients with LVDD as compared to those without LVDD (326.46 vs 398.69 m; P=0.034). Also, desaturation during the 6MWT was more significant in SSc patients with LVDD (-3.38% vs -1.92%; P=0.022). Conclusions SSc patients with LVDD had longer disease duration and higher disease activity (EUSTAR) scores. SSc patients with LVDD showed significantly increased serum IL-6 and NT-proBNP levels in comparison with those without LVDD. LVDD is associated with decreased exercise capacity in SSc patients. References Hinchcliff M, Desai CS, Varga J, Shah SJ. Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol. 2012;30:30-7. Scala E, Pallotta S, Frezzolini A et al. Cytokine and chemokine levels in systemic sclerosis: relationship with cutaneous and internal organ involvement. Clin Exp Immunol 2004;138:540-6. Nagueh SF, Appleton CP, Gillebert TC et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-33. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5652

AB0369 Diastolic dysfunction in patients with rheumatoid arthritis: relation with disease activity, anti-cyclic citrullinated peptide antibodies and central obesity

Background Previous echocardiographic studies have reported higher prevalence of diastolic dysfunction in patients with rheumatoid arthritis (RA) (1-4). A few of them have found a correlation between disease duration and diastolic dysfunction (5,6). There are less data regarding the influence of disease activity, specific serologic markers and body proportions on diastolic dysfunction in RA (3,4). Objectives The aim of the study was to assess: (a) the possible impact of specific serologic markers on diastolic dysfunction; (b) the possible effects of disease activity scores on diastolic dysfunction; (c) the possible effects of the body proportions on diastolic dysfunction. Methods The study included 80 RA patients (70 females, 10 males) with no clinically evident CV disease or obesity and 80 matched healthy controls. Upon clinical and laboratory evaluation, all subjects underwent complete echocardiographic examination. Results Isovolumetric relaxation time (IVRT) prolongation as the first sign of diastolic dysfunction was present in 36.25% of RA patients and in 15% of controls (P=0.002). IVRT was found to correlate with anti-CCP antibodies (r=0.382; p=0.001), DAS28-CRP (r=0.204; p=0.039) and waist-to-hip ratio (r=0.266; P=0.018). The ratio of early and late transmitral wave (E/A ratio) was found to correlate with body mass index (BMI) (r=-0.376; P=0.001) and age (r=-0.524; P<0.001).In multivariate linear regression analysis anti-CCP titer demonstrated significant correlation with IVRT while E/A ratio independently correlated with age and DAS28-CRP. Conclusions Anti-CCP antibodies, DAS28-CRP and central obesity are predictors of cardiac involvement in the RA. References Montecucco C, Gobbi G, Perlini S, et al. Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 1999; 17:407-12. Levendoglu F, Temizhan A, Ugurlu H, Ozdemir A, Yazici M. Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatol Int 2004;24:141-6. Wislowska M, Jaszczyk B, Kochmański M, Sypuła S, Sztechman M. Diastolic heart function in RA patients. Rheumatol Int 2008; 28:513-9. Yazici D, Tokay S, Aydin S, i sur. Echocardiographic evaluation of cardiac diastolic function in patients with rheumatoid arthritis: 5 years of follow-up. Clin Rheumatol 2008; 27:647-50. Arslan S, Bozkurt E, Sari R, Erol M. Diastolic function abnormalities in active rheumatoid arthritis evaluation by conventional Doppler and tissue Doppler: relation with duration of disease. Clin Rheumatol 2006; 25:294–9. Birdane A, Korkmaz C, Ata N, et al. Tissue Doppler imaging in the evaluation of the left and right ventricular diastolic functions in rheumatoid arthritis. Echocardiography 2007; 24:485–93. Disclosure of Interest None Declared