J.R. Azpiri-López

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

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

AB0204 Disease factors associated to abnormal intima-media thickness in mexican mestizo rheumatoid arthritis patients

Background Atherosclerotic cardiovascular disease (ASCVD) is the main mortality cause in patients with rheumatoid arthritis (RA) (1). It has been proven that the carotid intima-media thickness (CIMT) measured with carotid duplex ultrasonography (US) is an important ASCVD predictor with a measurement ≥0.9 mm (2–4). Objectives To characterize the disease factors related with abnormal carotid duplex US findings in Mexican mestizo patients with RA. Methods In a cross-sectional setting, we enrolled consecutive RA patients. Patients with overlap syndromes, personal history of ASCVD, dyslipidemia and previous use of any statin were excluded. A board-certified radiologist performed a bilateral carotid duplex US to all patients. Abnormal CIMT was defined as ≥0.9 mm (hypertrophy ≥0.9 – 1.2 mm and carotid plaque ≥1.2 mm). A clinical history and blood tests were performed at the time of the patients visit. Disease activity was measured with Disease Activity Score using 28 joints–C-reactive protein (DAS28-CRP). Results We enrolled 57 patients. Demographic characteristics are shown in table 1. A total of 30 (52.2%) patients had an abnormal CIMT. US findings are shown in table 2. A significant correlation between abnormal CIMT and RA disease duration (p=0.04), as well as between the former and anti-cyclic citrullinated peptide antibodies (ACPA) positivity (p=0.033) was found.Table 1. Demographic and disease characteristics Variable Results Female gender, n (%) 54 (94.7) Age (years), mean ± SD 56±9.9 Disease duration (years), mean ± SD 12.4±8.3 BMI (kg/m2), mean ± SD 28.22±4.9 Smoking status, n (%) 5 (8.77) DAS 28- CRP, mean ± SD 3.33±1.19 Disease Activity, n (%)  Remission 17 (29.8)  Low 11 (19.3)  Moderate 25 (43.8)  Severe 4 (7.1) Positive Anti-CCP, n (%) 44 (77.19) Positive RF, n (%) 51 (89.47) BMI: Body Mass Index. Conclusions There is a strong relationship between CIMT and the chronic inflammatory process of RA, as well as ACPA positivity. These results might be influenced by the high mean disease duration of our patients. Prospective studies that evaluate CIMT among disease duration intervals are necessary to support these findings. References Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. 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, Esquivel-Valerio JA, Garza-Elizondo MA, Gongora-Rivera F, Munoz-De Hoyos JL, Serna-Pena G. Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules. Reumatol Clin. 2013;9(3):136–41. Mateo I, Morillas P, Quiles J, Castillo J, Andrade H, Roldan J, et al. 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

SAT0106 Valvular Heart Disease in A Mexican Mestizo Cohort of Patients with Rheumatoid Arthritis: A Case-Control Study

Background Rheumatoid arthritis (RA) is associated with a higher rate of cardiovascular mortality. The prevalence of valvular heart disease (VHD) varies greatly in the published reports. Data in Mexican mestizo patients with RA is scarce. Objectives We aimed to evaluate the presence of VHD in a cohort of RA Mexican mestizo patients and compare it to matched controls. Methods An observational, comparative, case control study was designed. Patients with RA aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria were included. Exclusion criteria included prior atherosclerotic cardiovascular disease (myocardial infarction, stroke and peripheral arterial disease) and overlap syndromes. Patients were matched using age, sex and comorbidities. A standard transthoracic echocardiography was performed according to the American Society of Echocardiography guidelines. Valvular regurgitation was classified as mild, moderate or severe according to the European Association of Echocardiography and American Society of Echocardiography recommendations. Results A total of 56 patients and 28 controls were included in the final analysis. Characteristics of both groups are shown in Table 1. There was no statistical difference in sex, age, type 2 diabetes mellitus and body mass index between the two groups. VHD was reported in 45 (80.4%) RA-patients and 13 (46.4%) individuals in the control group (p<0.003). Statistical difference was found in mitral and tricuspid regurgitation (p<0.001 and p<0.003, respectively) in RA-patients when compared with the control group. In the RA group, 5 (8.9%) showed mild aortic regurgitation; 28 had mild and 1 had moderate (50% and 1.8%, respectively) mitral regurgitation; 8 (14.3%) showed mild pulmonary regurgitation; 39 had mild and 4 had moderate (69.6% and 7.1%, respectively) tricuspid regurgitation. In the control group, 1 (3.6%) showed mild aortic regurgitation; 3 (10.7%) had mild mitral regurgitation; 1 (3.6%) showed mild pulmonary regurgitation; 12 (42.9%) had mild tricuspid regurgitation. Conclusions In our cohort, 80.4% of the RA-patients had VHD, with the tricuspid valve being the most affected (76.8%). Prospective studies are needed to evaluate the role of VHD in RA-patients morbi-mortality. References Roldan, C. A., DeLong, C., Qualls, C. R., & Crawford, M. H. (2007). Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. The American journal of cardiology, 100(3), 496–502. Zoghbi, W. A., Enriquez-Sarano, M., Foster, E., Grayburn, P. A., Kraft, C. D., Levine, R. A., … & Stewart, W. J. (2003). American Society of Echocardiography: Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. European Heart Journal-Cardiovascular Imaging, 4(4), 237–261. Disclosure of Interest None declared