I.J. Colunga-Pedraza

O volume plaquetário médio está reduzido em adultos com lúpus ativo

BACKGROUND Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. OBJECTIVE We investigated the association between MPV and disease activity in adult patients with SLE. METHODS In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. RESULTS MPV was significantly decreased with respect to those of inactive patients (7.16±1.39 vs. 8.16±1.50, p=0.005). At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r=0.407, p=0.001), which in turn is inversely associated with disease activity. CONCLUSIONS In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Mean platelet volume is decreased in adults with active lupus disease

BACKGROUND Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. OBJECTIVE We investigated the association between MPV and disease activity in adult patients with SLE. METHODS In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. RESULTS MPV was significantly decreased with respect to those of inactive patients (7.16±1.39 vs. 8.16±1.50, p=0.005). At a cutoff level of 8.32fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r=0.407, p=0.001), which in turn is inversely associated with disease activity. CONCLUSIONS In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in rheumatoid arthritis (RA) patients. Guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA) 2013 and the Adult Treatment Panel III (ATP-III) differ in their strategies to recommend initiation of statin therapy. The presence of carotid plaque (CP) by carotid ultrasound is an indication to begin statin therapy. We aimed to compare the recommendation to initiate statin therapy according to the ACC/AHA 2013 guidelines, ATP-III guidelines, and CP by carotid ultrasound. We then carried out an observational, cross-sectional study of 62 statin-naive Mexican mestizo RA patients, aged 40 to 75, who fulfilled the 1987 or 2010 ACR/European League Against Rheumatism (EULAR) classification criteria. CP was evaluated with B-mode ultrasound. Cohen’s kappa (k) was used to assess agreement between ACC/AHA 2013 guidelines, ATP-III guidelines, and the presence of CP, considering a p < 0.05 as statistically significant. Agreement was classified as slight (0.01–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), and an almost perfect agreement (0.81–1.00). Slight agreement (k = 0.096) was found when comparing statin recommendation between CP and ATP-III. Fair agreement (k = 0.242) was revealed between ACC/AHA 2013 and ATP-III. Comparison between ACC/AHA 2013 and CP showed moderate agreement (k = 0.438). ACC/AHA 2013 guidelines could be an adequate and cost-effective tool to evaluate the need of statin therapy in Mexican mestizo RA patients, with moderate agreement with the presence of CP by ultrasound.

AB0573 Neutrophil-Lymphocyte Ratio is not Superior to Lymphocyte Count Alone in Differentiating Disease Activity in SLE

Background Neutrophil-lymphocyte ratio (NLR) integrates the deleterious effects of neutrophilia and lymphopenia, and has been used as diagnostic and prognostic biomarker in various diseases (1). NLR was recently proposed as an inflammatory biomarker in systemic lupus erythematosus (SLE) (2). Objectives 1. To compare the neutrophil count (NEU), lymphocyte count (LYM) and NLR between lupus patients with active disease and those with inactive disease. 2. To determine the diagnostic accuracy of these markers for detecting disease activity. 3. To compare the diagnostic accuracy of these markers. Methods A retrospective comparative study. We compared two groups of lupus patients according to disease activity status (determined by Mex-SLEDAI). Subjects were age- and gender-matched. Normal distribution of the data was tested by the Shapiro-Wilk test. Comparisons between groups were performed by using Mann-Whitney U test. Associations between the variables were explored using Spearmans rho. A ROC curve was generated to determine the cutoff value in the NLR (and other markers) with the highest level of accuracy in identifying patients with active disease. Sensitivity and specificity were also calculated. Unless indicated otherwise, all results are expressed as median (25, 75%). A p-value below 0.05 was considered significant. Results We included a total of 72 patients in this study, of whom 36 were classified as having active disease (34 females, aged 18-64 years), and 36 patients as having inactive disease (35 females, aged 20-53 years). Age and gender distributions were similar in the two groups. NEU was not significantly different between groups. LYM was comparatively lower in the group with active disease (963 [601.25, 1447.5] vs. 1540 [1110, 2030]). NLR was significantly higher in patients with active disease (4.784 [2.768, 6.885] vs. 2.306 [1.709, 4.605]). There were no significant relationships between NLR and Mex-SLEDAI, erythrosedimentation rate, serum albumin, or hemoglobin. ROC curve analysis for NLR showed an area under the curve (AUC) of 0.724 (95% CI 0.605-0.824, p=0.0002) with an optimal cutoff value of 2.42. Sensitivity and specificity were 82% and 55%, respectively. The AUC for predicting disease activity was 0.705 (95% CI 0.585-0.808, p=0.0012) for LYM. At a cutoff level of 993 cells/microliter, sensitivity and specificity were 62% and 80%, respectively. The pairwise comparison among the ROC curves showed no statistical difference (Fig. 1). Conclusions NLR is not superior to LYM alone in differentiating disease activity in SLE. Therefore, NLR is probably not useful in clinical practice. References Eur J Gastroenterol Hepatol. 2015 Jan;27(1):108. Acta Med Indones. 2013 Jul;45(3):170-4. Acknowledgements We would like to extend our gratitude to Drs. Jesús Alberto Cárdenas-de-la-Garza and Raymundo Vera-Pineda for their help. Disclosure of Interest None declared

Relación entre productividad laboral y características clínicas de la artritis reumatoide

OBJECTIVE This study assesses the relationship between the ability to perform productive activities and the clinical characteristics of RA, such as disease activity, quality of life, functional capacity, workload, pharmacotherapy, and comorbidities. MATERIALS AND METHODS A cross-sectional, observational and descriptive study was conducted. Patients aged 18-75years with a diagnosis of RA according to ACR/EULAR 2010 criteria who attended regularly to the Rheumatology service in the period between January and March 2017 were included. The questionnaires, WPAI-AR, HAQ-DI and RAQoL, were applied. RA disease activity was measured by DAS28-PCR. Correlations were made between the clinical data obtained and work productivity and activity impairment measured by WPAI-AR. RESULTS Two hundred four patients with a diagnosis of RA were included, of whom 92.6% were women. Mean age was 54.46±9.3years. Regarding the percentage of impairment of daily life activities, we found a significant difference between employed and unemployed patients (P≤.002). A positive correlation was found between RA activity measured by DAS28-PCR, quality of life, and functional ability with the percentages of absenteeism, presenteeism, overall productivity loss, and impairment of daily life activities. CONCLUSION A correlation between RA disease activity, functional capacity, quality of life, and working impairment was found. The strongest association was established with the degree of functional capacity.

SAT0142 Pulmonary hypertension among hispanic patients with rheumatoid arthritis: a case-control study

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, multifactorial disease that mainly affects synovial joints. Pulmonary artery hypertension (PAH) can appear as a complication of connective tissue diseases. It is possible that pulmonary artery systolic pressure (PASP) in RA may be elevated due to interstitial lung disease, pulmonary vasculitis, pulmonary veno-occlusive disease, or cardiac disease (1). Although right heart catheterization is the gold standard, Doppler echocardiography has proved to be a reliable non-invasive method for detecting PAH (2). Objectives: To determine the prevalence of PAH in RA patients and compare it to matched controls. Methods: A case-control study with RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and matching controls were included. Exclusion criteria: poor acoustic window, absence of tricuspid regurgitation (TR), prior atherosclerotic cardiovascular (CV) disease and overlap syndromes. Patients were matched using age, sex and comorbidities. Transthoracic echocardiogram was performed by a board-certified cardiologist. PASP was calculated using the Bernoulli equation: TR velocity2 × 4 + right atrial pressure according to ASE’s guidelines. We used Denton’s definition of PAH on Doppler echocardiography as an estimated PASP≥30 mmHg (3). Results: A total of 76 RA patients and 52 matched controls were included. Demographic and clinical characteristics of both groups are shown on table 1. As shown on table 2, the mean PASP was higher RA patients (27.14±6.34 mmHg) than controls (24.68±5.44 mmHg) (P=0.024). PASP≥30 mmHg prevalence was significantly higher in RA patients (34.2% vs 11.5%; P=0.004).Table 1 Demographic characteristics RA Control P (n = 76) (n = 52) Women, n (%) 74 (97.4) 46 (88.5) 0.041 Age, mean±SD 55.71±8.84 53.86±6.14 0.195 BMI, mean±SD 29.11±5.42 28.31±4.37 0.343 Hypertension, n (%) 26 (34.2) 12 (23.1) 0.176 Type 2 Diabetes mellitus, n (%) 8 (10.5) 7 (13.5) 0.612 Active smoking, n (%) 6 (7.9) 6 (11.5) 0.487Table 2 Echocardiographic findings RA Control P (n = 76) (n = 52) TR Vmax (m/s), mean±SD 2.27±0.32 2.18±0.33 0.157 PASP (mmHg), mean±SD 27.14±6.34 24.68±5.44 0.024 PASP≥30 mmHg, n (%) 26 (34.2%) 6 (11.5%) 0.004 TR Vmax – Tricuspid regurgitation maximum velocity Conclusions: Elevated PASP, suggesting PAH, was more prevalent on RA patients than controls. A higher number of CV events that cannot be explained by traditional risk factors have been reported in RA patients; and it is possible that the elevation in the PASP could contribute to the problem. Prospective studies are needed to evaluate the role of elevated PASP in morbidity and mortality of RA patients. References [1]Panagiotidou E, et al. Rheumatoid arthritis associated pulmonary hypertension. Respir Med Case Reports2017;20:164–7. [2]Udayakumar N, et al. Pulmonary hypertension in rheumatoid arthritis-Relation with the duration of the disease. Int J Cardiol2008;127(3):410–2. [3]Denton CP, et al. Comparison of Doppler Echocardiography and Right Heart Catheterization To Assess Pulmonary Hypertension in Systemic Sclerosis. Br J Rheumatol1997;36:239–43. Disclosure of Interest: None declared

AB1317 Identification of cardiometabolic abnormalities in the first visit to a preventive cardio-rheuma clinic

Background Rheumatoid arthritis (RA) is a chronic, systemic and autoimmune disease with articular and extra-articular manifestations. RA is associated with increased prevalence of comorbidities and higher cardiovascular risk when compared to general population. Atherosclerotic cardiovascular (CV) events are the leading cause of death in RA. In a recent meta-analysis, hypertension, type 2 diabetes mellitus (T2DM) and hypercholesterolemia were shown to increase the risk of CV disease in this population.1 A study reported a prevalence of hypertension 29.8%; dyslipidemia 27.1% and T2DM 12.4% in Mexican-mestizo RA patients.2 The cardio-rheuma clinics were designed to provide healthcare for CV diseases in patients with rheumatic conditions. Specific guidelines recommendations have been published to enhance detection and management of specific comorbidities associated to RA.3 Objectives To identify the prevalence of unknown cardiometabolic risk factors in a Mexican-mestizo cohort with RA. Methods Cross-sectional, observational study. Patients who fulfilled the 1987 ACR and/or the 2010 ACR/EULAR classification criteria were consecutively recruited. Patients were divided in two groups, with and without history of cardiovascular comorbidities. Clinical history and physical exam were performed by a general physician in a cardio-rheuma clinic. Fasting blood glucose and lipid profile were performed on all subjects. Categorical variables are expressed as percentages and numerical variables as means±standard deviations. Results A total of 296 patients were included. Demographical characteristics are shown in Figure 1. Hypertension was the most frequent comorbidity (27.7%), followed by dyslipidemia (26.7%) and T2DM (13.5%). Many of the patients without history of cardiometabolic risk factor had important findings on baseline visit: 18.7% had altered blood pressure without history of hypertension, 76.5% had an abnormal lipid profile without history of dyslipidemia, and 21.5% had an altered fasting glucose without history of T2DM.Abstract AB1317 – Figure 1 *Altered lipid profile was defined as TC ≥200 mg/dL, HDL-C <50 mg/dL, TG ≥150 mg/dL, LDL-C ≥100 mg/dL. SD=Standard deviation; T2DM=Type 2 diabetes mellitus; bDMARDs=biological agents; DAS 28-CRP=Disease Activity Score 28 joints C-reactive protein. Conclusions In our cohort of Mexican-mestizo RA patients there is a high prevalence of cardiometabolic risk factors. An important amount of these were discovered in patients without previous diagnosis at their first visit to a cardio-rheuma clinic. References [1] Dougados, et al. (2014). Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Annals of the rheumatic diseases, 73(1), 62–68. [2] Galarza-Delgado, et al. (2017). Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatology international, 37(9), 1507–1511. [3] Perk, J., et al. (2012). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis, 223(1), 1–68. Acknowledgements None Disclosure of Interest None declared

AB1292 Metabolic syndrome and its components among hispanic ra patients: a case control study

Background Metabolic syndrome (MetS) comprises a group of risk factors for type 2 diabetes and cardiovascular diseases. MetS is responsible for a three-fold increase in the risk of atherosclerotic cardiovascular diseases (ASCVD) and increased mortality compared to general population.1 The frequency of MetS in RA patients is 14% to 56%. However, although many studies have reported a higher prevalence of MetS among RA patients, a number of studies have reported a higher prevalence of MetS in healthy controls.2 Despite the importance of detection of MetS and its role in RA patients, information is scarce. Objectives To compare the prevalence of MetS among Mexican-mestizo RA-patients and matched controls. Methods Design: observational, cross-sectional, case-control study. Patients of 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were consecutively enrolled. Patients with any other rheumatic disease were excluded. Our study used ATP III Criteria (Abdominal obesity: Men>102 cm Women>88 cm; Triglyceride level ≥150 mg/dL; HDL:<40 mg/dL for men<50 mg/dL for women; Blood pressure ≥130/≥85 mmHg; Fasting glucose ≥100 mg/dL) to classify patients with MetS. Results There were no differences in any independent variable of these patients. However there was a higher prevalence of high blood pressure in controls than RA patients (See Table 1).Abstract AB1292 – Figure 1 Metabolic Syndrome among RA patients. A. Demographic Characteristics. B. Metabolic Syndrome by ATP III Criteria Conclusions There is no difference in the diagnosis of MetS in RA patients than control population. However, the role of the diagnosis of MetS in patients with RA represents an important task in the management of the disease in order to reduce its high cardiovascular risk. References [1] Hallajzadeh, J., Safiri, S., Mansournia, M. A., Khoramdad, M., Izadi, N., Almasi-Hashiani, A., Karamzad, N. (2017). Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis. PloS one, 12(3), e0170361. [2] Zafar Z, H.Mahmud T, Rasheed A, AhmedWagan A. Frequency of metabolic syndrome in Pakistani cohort of patients with rheumatoid arthritis. J Pak Med Assoc. 2016; 66(6):671–6. Acknowledgements None Disclosure of Interest None declared

THU0140 Speckle tracking echocardiography evaluation of coronary territories in mexican mestizo patients with rheumatoid arthritis

Background The main cause of death in patients with rheumatoid arthritis (RA) is atherosclerotic cardiovascular disease. Speckle Tracking Echocardiography (STE) is an imaging technique that analyses the local and global myocardial function by assessing the myocardial deformation (strain). This technique is useful in addressing early alterations in ischemic pathologies (1,3). Objectives The aim of this study was to analyze if longitudinal strain abnormalities correspond with vascular territories, and compare the results between RA-patients and matched controls. Methods An observational cross-section case-control study was designed. Patients that fulfilled the 1987 ACR and/or 2010 ACR/EULAR classification criteria for RA, were 40–75 years old, with no overlap syndromes and no history of atherosclerotic cardiovascular disease were included. The control group was integrated by age- and sex-matched subjects, with no rheumatologic or cardiovascular diseases. A standard transthoracic echocardiogram was performed by a board-certified echocardiographer. Affection of coronary territories was compared between groups using longitudinal strain by speckle tracking according to the European Society of Cardiology and the American Society of Echocardiography recommendations. Results A total of 53 RA-patients and 24 control subjects were included. Demographic characteristics for each group are shown in table 1. There was no statistical difference in global longitudinal strain between RA-patients and controls (-20.86±2.82 vs -21.19±2.46, p=0.62). Comparison of longitudinal strain values of the three vascular territories evaluated between RA-patients and controls did not reach statistical difference (Table 2).Table 1. Demographic characteristics RA group (n=53) Control group (n=24) p Age, mean ± SD 55.54±9.11 52.81±6.61 0.172 Women, n (%) 51 (96.2) 26 (96.3) 0.988 Body Mass Index, mean ± SD 27.53±5.85 28.05±4.66 0.956 Hypertension, n (%) 18 (33.96) 5 (18.5) 0.149 Type 2 Diabetes mellitus, n (%) 7 (13.2) 4 (14.8) 0.844 Conclusions Contrary to previous published evidence (1, 2), there was no statistical difference in global longitudinal strain between RA patients and controls. Coronary territories are not affected in RA patients in comparison with controls. Further studies with a larger cohort are necessary to determine the usefulness of strain in the evaluation of subclinical cardiovascular disease. References Fine et al. Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography, Ann Rheum Dis. 2014 Oct;73(10):1833–9. Sitia S, Tomasoni L, Cicala S, et al. Detection of preclinical impairment of myocardial function in rheumatoid arthritis patients with short disease duration by speckle tracking echocardiography. Int J Cardiol 2012;160:8–14. Batir et al, Herz. 2015 Jun;40(4):669–74. Preclinical impairment of myocardial function in rheumatoid arthritis patients. Detection of myocardial strain by speckle tracking echocardiography. Disclosure of Interest None declared

AB0205 Carotid intima-media thickness linked to the presence of cardiovascular risk factors in mexican mestizo patients with rheumatoid arthritis

Background Rheumatoid Arthritis (RA) is associated to subclinical atherosclerosis. Traditional risk factors for cardiovascular outcomes do not explain completely the higher risk, which could be caused by chronic systemic inflammation. Objectives The aim of this study is to relate abnormal carotid intima-media thickness (CIMT) to the presence of cardiovascular risk factors. Methods Observational cross-section design. We included patients who fulfilled the 1987 ACR and/or 2010 ACR/EULAR classification criteria for RA, 40 to 75 years old, with no personal history of atherosclerotic CV disease. A board-certified radiologist performed carotid duplex ultrasounds. Patients were distributed in two groups according to the absence (Group 1) or presence (Group 2) of traditional risk factors for cardiovascular disease (smoking status, dyslipidemia, high blood pressure and diabetes). Results A total of 82 patients were included. Demographic characteristics for each group are shown in Table 1. Ultrasound findings are shown in Table 2. CIMT alterations were more common in Group 2 (66.7%) than in Group 1 (38.7%), with statistical significance (p=0.013). Presence of carotid plaque was more common in Group 2 (27.5%) than in Group 1 (16.1%), shown clinical relevance, although did not shown statistical significance (p=0.18).Table 1. Demographic characteristics Variable Total Group 1 (n=31) Group 2 (n=51) p (CVRF−) (CVRF+) Patients, n (%) 82 (100) 31 (37.80) 51 (62.20) – Female gender, n (%) 77 (93.9) 29 (93.5) 48 (94.1) 0.0917 Age (years), mean ± SD 57±9.96 51.90±8.43 59.82±9.69 0.001 Disease duration (years), mean ± SD 12.45±8.39 11.74±8.76 12.89±8.32 0.554 BMI (kg/m2), mean ± SD 28.22±4.9 29.05±5.09 27.72±4.92 0.248 Smoking status, n (%) 8 (9.75) – 8 (15.68) – Diabetes, n (%) 13 (15.85) – 13 (25.49) – HBP, n (%) 28 (34.14) – 28 (54.90) – Dyslipidemia, n (%) 8 (9.75) – 8 (15.68) – CVRF: Cardiovascular Risk Factors, HBP: High Blood Pressure. Conclusions In this cohort of Mexican patients with RA, we demonstrate relation between the presence of alterations in CIMT (carotid hypertrophy and carotid plaque) and risk factors for cardiovascular disease, which can be enhanced by intrinsic risk of RA. These findings reaffirm the importance of global health assessment in patients with RA to reduce morbidity. References Avina-Zubieta JA. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71(9):1524–9. Galarza-Delgado DA, Serna-Pena G. Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules. Reumatol Clin. 2013;9(3):136–41. Mateo I, What measure of carotid wall thickening is the best atherosclerotic loading score in the hypertensive patient: maximum or mean value?]. Rev Esp Cardiol. 2011;64(5):417–20. Disclosure of Interest None declared