Katarina Borić

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 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

FRI0481 Increased Caspase-3 Activity in the Stomach Tissue Correlates with Disease Activity and Severity in Systemic Sclerosis Patients – A Pilot Study

Background Systemic sclerosis (SSc) is an autoimmune disease characterized by chronic inflammation, vascular injury and excessive fibrosis. Apoptosis is a key mechanism involved in all the stages of the disease: vascular damage, immune dysfunction, and fibrosis. Caspases are a family of endoproteases that provide critical links in cell regulatory networks controlling inflammation and cell death. Dysregulation of caspases underlies human diseases including cancer and inflammatory disorders, and major efforts to design better therapies for these diseases seek to understand how these enzymes work and how they can be controlled. Objectives This pilot study aimed to explore the expression of caspase-3 in stomach tissue in SSc patients and possible correlation with disease activity and severity. Methods A total of thirteen stomach tissue biopsies (11 SSc and 2 controls) were collected. The same investigator, blind to clinical features, performed upper gastrointestinal endoscopy. The sections of stomach tissue were separately incubated for 45 min with rabbit anti-human/mouse active caspase-3 primary antibody. The intensity of apoptosis according to the caspase 3 activity was semiquantitatively selected into four categories: mild, moderate and abundant. We evaluated the disease activity and severity using clinical and laboratory parameters according to a modified Medsger severity scale and activity score. The disease activity was assessed according to Valentinis Scleroderma Disease Activity Index. In all the patients skin involvement was assessed by the modified Rodnan skin score (mRSS). The study was approved by the University Hospital Split Ethics Committee. Results Eleven SSc female patients [mean age 54.3 (13.6) years, median disease duration 13 years with minimum–maximum range 1–35 years] were enrolled in this study after they gave written informed consent. All patients fulfilled the ACR criteria for the diagnosis of SSc. Five SSc patients had moderate/abundant and six had mild apoptosis on the basis of the caspase 3 activity. In SSc patients, the number of apoptotic cells is high, and their distribution is observed in several layers of the stomach wall, including blood vessels (Figure 1). The skin involvement and disease duration were highly different between SSc patients regarding to the apoptosis level (P<0.05, P<0.05, Mann–Whitney test). No significant difference was found for autoantibody profile between SSc patients regarding apoptosis levels of stomach tissue. Disease activity and severity were higher in SSc patients with moderate/abundant apoptosis of the stomach tissue (P<0.05, P<0.05, Mann-Whitney test). Figure 1. Normal mucosa of the stomach: columnar surface epithelium (e), connective tissue lamina propria (lp), glands (g) (A); brown-staining nuclei and nuclear fragments of caspase-3 positive apoptotic cells in the lamina propria. Immunohistochemical staining to caspase-3 (B); part of lymphocyte accumulation and blood vessel (bv), both contacting numerous apoptotic cells (arrows) (C). Conclusions In SSc patients we have showed increased caspase-3 activity (cell death) in the stomach tissue. Increased cell death in the stomach tissue correlates with disease duration, activity, severity and skin involvement. 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