M García Carrasco

Irritable bowel syndrome-type symptoms in female patients with mild systemic lupus erythematosus: frequency, related factors and quality of life.

Irritable bowel syndrome (IBS) impairs quality of life (HRQOL), as does systemic lupus erythematosus (SLE). Both are more common in women and are associated with fibromyalgia (FM). However, the relationship between IBS and SLE and its impact on HRQOL has not been explored. Therefore, we aimed to study the frequency and features likely to influence the presence of IBS‐type symptoms in SLE and their impact on HRQOL.

Bone mineral density in systemic lupus erythematosus women one year after rituximab therapy

The objective of this study was to assess the effects of rituximab on bone mineral density (BMD) in women with systemic lupus erythematosus (SLE) 1 year after treatment. Thirty active female SLE patients treated with rituximab were compared with 43 SLE women not treated with rituximab. BMD was measured using dual energy X-ray absorptiometry (DEXA) before initiating biologic therapy and after 1 year. The mean age was 38.5 ± 2.1 years; median disease duration was 7 years. In the rituximab group, after 1 year of follow-up, BMD at the femoral neck (FN) decreased from 0.980 ± 0.130 g/cm2 to 0.809 ± 0.139 g/cm2 (−17.4%; p = 0.001). Similarly, BMD at the lumbar spine (LS) decreased from 1.062 ± 0.137 g/cm2 to 0.893 ± 0.194 g/cm2 (−15.8%; p = 0.001). In control subjects, BMD at the FN decreased from 0.914 ± 0.193 g/cm2 to 0.890 ± 0.135 g/cm2 (−2.6%; p = 0.001), and BMD at the LS decreased from 0.926 ± 0.128 g/cm2 to 0.867 ± 0.139 g/cm2 (−6.2%; p = 0.09). After 1 year, SLE patients had lower BMD at both the FN and LS, but the loss was greater in postmenopausal patients who had received rituximab therapy.

AB0730 Comparison of a single-centre idiopathic inflammatory myopathy cohort from argentina with the euromyositis international registry

Background The idiopathic inflammatory myopathies (IIM) are rare systemic autoinmune diseases that affect the muscle and other organs. Ttraditionally, IIM encompasses polymyositis (PM) and dermatomyositis (DM), but progressively inclusion body myositis (IBM), Immune-mediated necrotising myopathy (IMNM), the antisynthetase syndrome (ASS) and connective tissue diseases-ovler myositis (CTD-OM) have been recognised within the IIM spectrum Objectives To compare the clinical characteristics and treatment in a IIM cohort from an Argentinian universitary hospital with the international IIM cohort EUROMYOSITIS Methods Descriptive, retrospective study. IIM patients defined by expert opinion followed in our centre between October 2007 and October 2017 were included. ASS was defined by the presence of arthritis, raynaud’s phenomenon, mechanic hands, elevated CK, muscle weakness, interstitial lung disease and/or presence of antisynthetase antibodies and, as in EUROMYOSITIS, patients with IIM with positive antisynthetase antibodies were reclassified as ASS. CTD-OM was defined as patients with IIM fulfilling classification criteria for other CTD. Demographic data, accumulated clinical features, time interval between disease onset and diagnosis, IIM subtype, treatment and presence of neoplasm were evaluated. Ethnicity was defined using the same classification as in EUROMYOSITIS Results 58 patients were included: DM 24, PM 4, ASS 10, CTD-OM 20. 89.6% Hispanic, mean age 48.4±15.2 years, median time interval between disease onset and diagnosis 5 months (IQR 2–11 months), been higher in AAS (8.5 months, IQR 1.5–18.2 months). 6,89% (4/58) patients presented associated neoplasm, 3 with DM and 1 with CTD-OM. Table 1 shows the demographic and clinical features of our IIM cohort and EUROMYOSITIS. Table 2 shows treatments received in our cohort and EUROMYOSITIS.Abstract AB0730 – Table 1 Demographic and clinical features Conclusions DM was the most frecuent IIM subtype in both cohorts. In our group, CTD-OM was second and ASS was third. Muscle weakness was found less frecuently in our DM and AAS than reported in EUROMYOSITIS. However, calcinosis was more frecuent. This could be explained by our mostly Hispanic population and/or by frecuent Systemic Sclerosis overlap in our patients. It’s important to remark that the ethnic variety defined as Hispanic in EUROMYOSITS has a complex composition in Latin America, due to interbreeding. No difference was found in therms of most frecuent treatments between both cohorts. However, use of IVIg was more frecuent in our patients. To our knowledge, this is the first comparative report of an argentinian single-centre IIM cohort and an international multi-centre cohort Disclosure of Interest None declaredAbstract AB0730 – Table 2 Treatment DM PM ASS CTD-OM HCJSM (n=24) EUROMYO (n=949) HCJSM (n=4) EUROMYO (n=813) HCJSM (n=10) EUROMYO (n=512) HCJSM (n=20) EUROMYO (n=358) Steroids 95 98 50 100 90 98 85 96 Hydroxichloroquine 50 37 25 11 40 16 40 29 Methotrexate 37.5 69 50 76 20 60 25 72 Leflunomide 0 0 0 3 20 3 5 4 Azathioprine 33.3 44 25 52 60 60 35 51 Mycophenolate 0 20 25 20 30 31 10 29 Cyclophosphamide 8.33 15 0 14 20 39 10 18 IVIg 29.16 11 0 13 20 7 5 7

AB0478 Comparative study between patients with normal and overweight in a cohort of systemic lupus eritemathosus from argentina

Background Systemic lupus erythematous (SLE) have an increase cardiovascular risk, worsened by overweight and obesity. Increased BMI is associated with other severe complications and comorbidities as lupus nephritis, hypertension, insulin resistance and dyslipemia. Body weight is a modifiable risk factor. Objectives To determine the frequency of overweight and obesity in patients with SLE and their impact on this disease Methods Descriptive, cross-sectional study. We reviewed the medical records of outpatients with SLE (ACR 1997) who were seen since 2014 to 2016 in the Clinical Hospital of Buenos Aires, Argentina. We evaluated sex, age, disease duration, obstetric history, use and doses of oral corticosteroids, BMI, 25 OH vitamin D and educational level. Disease activity was scored by SLEDAI. Scores ≥4 were classified as active. The patients were classified into 2 groups, according to BMI: normal weight (NW) (19–25), overweight and obesity (≥25). Results One hundred and sixty two of 230 were evaluated. Sixty-eight patients were excluded due to lack of data. 157 (97%) were women. Mean age for both sexes was 40.6±14.3 years (p 0.70). Means of: SLEDAI 4.3±4.47 (54.9% had SLEDAI ≥4), IMC: 27.04±5.22 (56% had a BMI ≥25) and 25-hidroxivitamin D was 25.15±9.0. Relation between 2 groups, according to BMI: 84.5% whom were in NW group have received steroids at some point vs 95.6% in BMI≥25 group (p 0.02). Mean steroids doses: BMI ≥25: 9.53±10.98 vs 5.0±7.2 in NW group (p 0.04). Multivariate analysis showed that BMI ≥25 continued significantly associated with SLE duration, independently of the steroids use and other variables. 25 OH vitamin D tended to be lower in BMI ≥25 vs NW, but no significant differences (24.53±9.91 vs 25.50±9.85) (p=0.071)Table 1. In the multivariate analysis, Number of pregnancies was the only one variable remained significant (OR: 0.78, IC 95%: 0.63–0.98) (p=0.03) Variable IMC ? 25 (n: 71) IMC ≥25 (n: 91) P Duration (months) Median (rank) 60 (1–384) 84 (2–480) 0,02 Pregnancies mean (SD) 1,20±1,62 2,64±2,84 0,0 Menopause (%) 27 (38,5) 51 (58,6) 0,009 Abdominal perimeter mean (SD) 88±8,3 99±11,9 0,0 Depression (%) 9 (12,5) 24 (26,6) 0,02 Chronic renal failure (%) 2 (2,7) 9 (10) 0,03 SLEDAI ≥4 (%) 33 (45,8) 56 (62,2) 0,02 SLICC mean (SD) 0,30±0.55 1,3±1,3 0,0 SLICC ≥1 (%) 18 (25) 64 (71,1) 0,0 Arterial hypertension (%) 12 (16,6) 32 (35,5) 0,003 Grade and University Studies (%) 32 (45) 19 (20) 0,004 Conclusions Over a half of our cohort had BMI ≥25 and was characterized by older age, more frequent menopause, longer course of the disease, increased steroid use and lower educational level. Depression and hypertension were the statistically more frequent comorbidities found. Obesity was associated with more activity and accrual damage including chronic renal disease. Disclosure of Interest None declared

FRI0276 Prevalence of depression by beck ii and importance of fatigue by facit iv questionnaires in systemic lupus erythematosus patients vs controls in a single center of argentina

Background Estimated prevalence of neuropsychiatric symptoms in SLE is among 17 to 71%1. Depressive symptoms are around 54%1,2. Fatigue is frequently referred, predicts high morbidity and may be influenced by lifestyle and individual psychological characteristics1. Objectives To evaluate the prevalence of depressive symptoms and its association with demographics and clinical variables in patients with SLE. To determine the predictive value of FACIT for fatigue in SLE vs controls. Methods Observational, retrospective case- control design. Patients ≥18 years old with SLE (ACR 97) were consecutively evaluated in our centre from January to July 2015. We analyzed age, disease duration, clinical manifestations, antibodies profile, SLEDAI (≥4 scored as active) and SLICC. We recorded familiar psychiatric diseases, educational and socioeconomic level (Graffar Scale), employment and marital status. Beck II and FACIT (IV version) questionnaires were used for evaluate depression and fatigue respectively. We tested two cut points for fatigue:<22 and<40 to determine sensitivity/specificity for this tool in SLE patients vs controls3. Continues data were compared using t Student and Mann Whitney. Categorical data: chi-square or Fishers exact test by SPSS version 20.0. To predic fatigue we calculated the area under the curve by Receiver Operating Characteristic (ROC). Statistical significant= p<0.05. Results 77 SLE and 100 controls, all female. SLE vs control group: Mean of age ys: 34 (19–49)vs 38 (19–60). Prevalence of depression: 52% (44/77) vs 29% (29/100) (p<0.05). Prevalence of fatigue (FACIT<40): 42% (33/77) and 36% (36/100) (p>0.05). Mean disease duration (months) 48 (24–114). Socio-demographic characteristics, SLICC/SLEDAI, clinical and serological manifestations were not correlated with major depression p>0.05. FACIT: Median value: 31 (range 22–40) SLE group. FACIT<22 total SLE: 12/77 (15%) and FACIT<40: 33/77 (42%). Cut points FACIT SLE vs controls: <22: 15% (12/77) vs 1% (1/100) (p<0.05), 30% sensitivity/100% specificity, 100% PPV and 57% NPV. AUC FACIT <22: 0.65 (0.65–0.77). FACIT<40 in SLE vs controls: 42% (33/77) vs 26% (26/100) (p<0.05), 69% sensitivity and 84% specificity, 82% PPV and 70% NPV. AUC FACIT<40: 0.75 (0.64–0.87). Conclusions Prevalence of depression was high in our cohort and similar to previously reported1. Our patients showed low levels of SLEDAI/SLICC. There was not relation between activity levels and baseline damage with the presence of depression4. FACIT IV scale was a good independent predictor of fatigue in SLE patients with or without depression vs controls. References L Palagini M et al Depression and systemic lupus erythematosus: a systematic review. Lupus 2013. Hugo FJ et al DSM-III-R classification of psychiatric symptoms in systemic lupus erythematosus. Psychosomatics 1996. Lai JS et al Validation of the Functional Assessment of Chronic Illness Therapy-Fatigue Scale in Patients with Moderately to Severely Active Systemic Lupus Erythematosus, Participating in a Clinical Trial Journal of Rheumatology 2011. Segui J et al Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: A longitudinal study of active and inactive stages of the disease. Lupus 2000. Disclosure of Interest None declared

FRI0635 Description of videocapillaroscopy of the labial mucosa in comparison with nailfold videocapillaroscopy in scleroderma

Background Capillary bed of labial mucosa may be a potentially useful area for assessing abnormalities on the microcirculation. Videocapilaroscopy of the labial mucosa (LVC) in 12/13 scleroderma (SCL) patients showed capillaries disturbance such as great disorganization and anarchic orientation(1). Objectives To describe LVC features in SCL and compare them with healthy controls. (HC). To compare nailfold videocapillaroscopy (NVC) with LVC in HC and SCL patients. Methods ≥16 years old patients with SCL (ACR-EULAR 2013) were included consecutively since June to July 2016. Smoking patients were excluded. For the evaluation of the LVC we performed a general displaying and then we studied following areas: a-central (1 cm from the frenulum), b-lateral right and left (both 2 cm from the frenulum) and c-labial border. For evaluation of the NVC, 200x images were obtained from 2nd to 4th fingers both hands and was classified according Cutolo in early, active, late patterns(2). For assesment through LVC: photographs (200x) for each subject were taken. We define quantitative characteristics as means of: capillary diameter, length and density. The average of these parameters was obtained from the evaluation of capillaries included in 1 mm2 of at least 2 continuous images. In addition, the visibility of the subpapillary venous plexus, architecture, dilatation of capillaries, presence of megacapillaries and avascular areas were qualitatively evaluated (photo 1). Each image was reviewed by two experienced observers. We conducted the same process describe above for each healthy control subject. Results Twenty two patients were included (18 female, age 47±11 ys) with SCL (limited 17, diffuse 5); NVC pattern: early 8, active 11, late 3. Healthy subjects 12 (11 female, age: 34±10 years). Average capillary density: 17±4.13 (13–26) in SCL vs 21±3.65 (16–28) in HC (p 0.00). Average capillary diameter: 43±13.54 (17–83) SCL vs 19±1.67 μm (16–21) HC (p 0.02). Mean capillary length: 185±34 μm (125–248) SCL vs 237±42 μm (178–313) HC (p 0.00). In 22 SCL patients were observed dilated capillaries in 20 (90%), megacapillaries (≥70 μm) in 10 (45%) and 7 (32%) showed disturbed architecture with lost areas of the normal U-shape and changes in the parallelism of the main axis of the capillaries. About subpapillary venous plexus in SCL: 7 (32%) were prominent and only one had capillary hemorrhage. In contrast, none of the controls presented these alterations. (p 0.0). According to the 3 NVC patterns the following averages were observed in the LVC: Early Pattern (n: 8): diameter 36.93±10.84 μm; Long 191.21±47.58 μm; Density 18.12±5.33 μm. Active Pattern (n: 11): diameter 48.80±14.80 μm; Length 184.11±29.91 μm; Density 16.72±3.25 μm. Late Pattern (n: 3): diameter 36.27±10; Long 178.03±28.8 μm, density 19.33±4.16 μm. Conclusions We found that LVC in SCL patients show significant microvascular changes with respect to HC. In addition, all NVC patterns described in SCL showed similar alterations in LVC. Therefore, LVC could be a complementary or alternative method to NVC since it is easily accessible, has good visibility and is not influenced by local mechanical or chemical stimuli that can affect the nail bed. References W Grassi et al. Ann Rheum Dis 1993; 52 (8): 564–569. M. Cutolo et all. Rheumatology 2006; 45: 43–46. Disclosure of Interest None declared

AB0518 Clinical Relevance of the Activity of P-Glycoprotein on Peripheral Blood Mononuclear Cells and Polymorphonuclear Neutrophils to Methotrexate in Patients with Systemic Lupus Erythematosus

Background Previous studies have reported that methotrexate is effluxed from cells by several transmembrane proteins, including P glycoprotein (P-gp). Moreover, various studies have examined the relationship between disease activity and P-gp expression levels/function in systemic lupus erythematosus (SLE) patients. Nonetheless, the role of P-gp activity in SLE patients receiving methotrexate has not previously been evaluated. Objectives To investigate the relationship between P-gp activity on peripheral blood leukocytes from SLE patients with lupus arthritis and clinical response to methotrexate. Methods Mononuclear cells (MNC) and polymorphonuclear neutrophils (PMN) were isolated from SLE patients (≥4 of the ACR classification criteria) with joint manifestations who had received methotrexate and corticosteroids (≥15 mg). Methotrexate responders and non-responders were compared according to the Clinical Disease Activity Index (CDAI) score. A flow cytometric daunorrubicin- efflux assay was made in peripheral blood leukocytes to determine the P-gp activity. Results Thirty-two patients were included: 34.4% had responded to methotrexate and 65.6% had not. The mean relative fluorescence unit (RFU) of both MNC and PMN were significantly lower in patients with a good response compared with those without good response (7.0±4.3 vs. 9.6±3.8; p=0.4 and 4.2±3.5 vs. 7.6±4.0; p=0.004. The prevalence of low fluorescence levels (<5 RFU), which signifies higher P-gp activity of both MNC and PMNC was higher in methotrexate responders compared to non-responders, 27.3% vs. 4.8% (p=0.10) and 81.8% vs. 23.8% (p=0.003), respectively. Conclusions In patients with SLE, P-gp activity with clinical response to oral methotrexate treatment led to down P-gp activity. Further studies are required to determine the mechanisms behind this finding and whether P-gp activity mediates alterations in the efficacy of methotrexate. References Carneiro JR, Sato EI. Double blind, randomized, placebo controlled clinical trial of methotrexate in systemic lupus erythematosus. J Rheumatol. 1999; 26: 1275–9. Tsujimura S, Saito K, Nakayamada S, et al. Clinical relevance of the expression of P-glycoprotein on peripheral blood lymphocytes to steroid resistance in patients with systemic lupus erythematosus. Arthritis Rheumatol. 2005; 52: 1676–1683. Lu MC, Lai NS, Li KJ, et al. Increased multidrug resistance-associated protein activity in mononuclear cells of patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2008; 26: 638-645. Acknowledgements We would like to thank David Buss for his valuable guidance and advice during this project. Disclosure of Interest None declared

AB0411 The impact of irritable bowel syndrome on health related quality of life in systemic lupus erythematosus

Background Health-related quality of life (HRQOL) is impaired in patients with systemic lupus erythematosus (SLE). Irritable bowel syndrome (IBS) is highly prevalent and also reduces HRQOL. However, the relationship between IBS in SLE and its impact on HRLQOL has not been explored. Objectives To evaluate the prevalence and risk factors for IBS in patients with SLE and its impact on HRQOL. Methods Patients with confirmed SLE according to American College of Rheumatology (ACR) criteria were included in this cross-sectional study. Sociodemographic and clinical variables were recorded. HRQOL was assessed using the Short Form 36 (SF-36) instrument; fibromyalgia (FM) and depression symptoms were also evaluated. The diagnosis of IBS was based on the Rome III criteria. Results 105 women with SLE were included. The mean age and disease duration were 43.6±11.3 and 10.4±7.3 years, respectively. FM was present in 23.8% of patients. Fifty-one (48.6%) patients were diagnosed with IBS. The prevalence of IBS-C, IBS-D and IBS-M subtypes was 23.5%, 37.3% and 39.2%, respectively. IBS-C patients had higher depression scores than those of the other subtypes. Compared with non-IBS patients, those with IBS were more likely to have FM (33.0% vs. 14.8%; p= 0.02) and had higher SLE activity scores (2.5±8.6 vs. 1.7±2.0; p=0.03). Logistic multivariate analysis showed that IBS was significantly associated with depression and FM in SLE patients (OR= 1.07 95% CI: 1.02-1.13 and OR= 2.85 95% CI: 1.1-7.4, respectively). SF-36 scores were significantly lower in IBS patients compared with non-IBS patients (49.6 ± 18.5 vs. 62.6 ± 18.1; p = 0.025). There was a trend to a lower SF-36 lower global score in patients with IBS+FM compared to those without FM (p = 0.76). Conclusions IBS is highly prevalent among women with SLE. Risk factors for this association were depression and fibromyalgia. SLE patients with IBS have worse HRQOL, independently of the presence of FM. We suggest that treating IBS may improve HRQOL in patients with SLE. References Morgan DR, Squella FE, Pena E, Mearni F, Rey E, Enriquez-Blanco HE, et al. Multinational validation of the Spanish ROME III adult diagnostic questionnaire: comparable sensitivity and specificity to English instrument. Gastroenterology 2012;138:S386. Lopez-Colombo A, Morgan D, Bravo-González D, Montiel-Jarquín A, Méndez-Martínez S, Schmulson M. The epidemiology of functional gastrointestinal disorders in Mexico: A population-based study. Gastroenterol Res Pract 2012;2012:606174 Acknowledgements We would like to thank to David Buss for the valuable guidance and advice in this project. Disclosure of Interest None Declared