Margarita Duarte

Pan-American League of Associations for Rheumatology (PANLAR) recommendations and guidelines for musculoskeletal ultrasound training in the Americas for rheumatologists.

Objective:To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas. Methods:A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level. Results:General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions. Conclusion:A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.

PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee.

ObjectiveThe objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America. MethodsRecommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique. ResultsBoth “strong” and “conditional” recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement. ConclusionsThese recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)–Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an ‘overarching’ treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.

Therapeutic Guidelines for Latin American Lupus Patients: Methodology

Modem medicine is in a continuous state of flux given the relentless development of new evidence: thus, it is quite difficult for clinicians to abreast of all advances as they happen

Educational website incorporating rheumatoid arthritis patient needs for Latin American and Caribbean countries

Health education is fundamental in the management of RA patients. This study explored patient needs for educational material appropriate for RA patients in our region through a website. This study includes seven focus groups and semi-structured interviews across 4 countries (Argentina, Chile, Colombia, and Mexico) with 71 RA patients. Transcripts were analyzed by anthropologists using qualitative analysis (QA), resulting in themes and subthemes to be developed. Five themes and over 50 subthemes of interest were identified by patients. Grouped into categories as follows: (1) knowing the disease, (2) living with arthritis, (3) treatment and therapies for RA, (4) psychosocial support, and (5) information for families. A response was written by the team in plain Spanish on patient subthemes of interest including additional areas that the team considered relevant. Three videos for YouTube were produced: on patient-doctor relationships, patients at work, and home and at the clinic. Illustrations in a comic book format on RA diagnosis were created. The educational site on RA of PANLAR can be found at htpp://artritisreumatoide.cl. This project accomplished a comprehensive list of RA patient interests, revealing the complex relationship between the information on the disease, the experience of a chronic disease, and the way in which patients approach, conceive, and manage their disease. We expect to gather information on how the website will be used in the future for patients and their families and maintain and improve the website as well as adapt its content to different socioeconomic realities.

AB0599 Relation between the deficit/deficiency of vitamin d and the depression/anxiety in patients with lupus in the department of rheumatology of the hospital of clinics

Background It has been postulated that low concentrations of 25-hidroxivitamin D serum [25 (OH) D] is associated with a greater prevalence of depression. People with deficient levels of vitamin D are more likely to experience mood disorders such as depression and anxiety. The vitamin D plays a role in the release of neurotransmitters such as serotonin and dopamine which is why is interesting the study of this in patients with systemic lupus erythematosus, who are discouraged from sun exposure. Objectives Determine the association between the deficit/insufficiency of vitamin D and the anxiety/depression in patients with SLE of the Department of Rheumatology of the Hospital de Clínicas Methods Observational study of longitudinal court based in a questionnaire according to the scale HADS (Hospital anxiety and Depression Scale) and the dosages of vitamin D performed on patients who entered the LUPUS PY cohort with prior informed consent. The dosage of vitamin D realised by chemiluminescence. Data and samples were taken in week 0 and week 24 and the prevalence of depression and anxiety and its association with vitamin D deficiency and insufficiency were identified. Patients with vitamin D deficiency or insufficiency were supplemented with vitamin D. For the descriptive analysis of the quantitative variables, average and SD were used, for the qualitative frequencies and percentages. For the analysis of association the test × 2 was used. The value of the p considered statistically significant was less than 0,05. Results In relation to the characteristics of the studied cohort, we can see that 90.5% were female, with an average age of 33±10.2 years. At week 0 the average value of vitamin D concentration was 31.8±10.2 ng/ml. It is found that 4,48% of patients had depression and 33,69% of patients have anxiety. In the week 24 the value of the average of vitamin D was of 31,1±13,6 ng/ml. It was observed in this week that 6% of patients presented depression and 12% of patients anxiety. In the analysis of association there was no association between vitamin D deficits and the presence of depression or anxiety of these patients both at the week 0 as a week 24 post vitamin D supplementation such, and as seen in table 1.Abstract AB0599 – Table 1 Deficit and insufficiency of vitamin D associated with the depression and anxiety in patients with SLE. Conclusions A significant percentage of patients with deficient or insufficient vitamin D were found, as well as a considerable percentage had depression or anxiety, although no association was found between the state of this vitamin and the alterations of the studied mood. More studies are required that include more patients in order to obtain more conclusive results. Reference [1] Okereke, Olivia I., Ankura Singh. “The Role of Vitamin D in the Prevention of Late-Life Depression.”Journal of affective disorders198 (2016): 1–14. PMC. Web. 30 Jan. 2018. Disclosure of Interest None declared

FRI0493 Clinical Features of The Vogt-Koyanagi-Harada Syndrome

Background Vogt-Koyanagi-Haradas disease (VKHD) is a bilateral, diffuse and chronic granulomatous panuveitis characterized by serous retinal detachment. This disease is often associated with neurological, auditory and dermatological disorders. The incidence of appearance is low, affecting mainly young women between 30 years approximately. Objectives The objective of the present study was to describe and to analyze the characteristics of patients with VKHD, followed in a third level hospital. Methods Retrospective and descriptive study of patients with EVKH. A large number of clinical, epidemiological variables and treatment were recorded. Statistical analysis was performed with SPSS19.0 program. The qualitative variables were expressed as frequencies and percentages, quantitative variables in mean. Results In the last 5 years, 3727 clinical records were reviewed and 8 patients were included. Of these, 5 (62.5%) were women with a mean age at diagnosis of 43 years old. All patients referred decreased visual acuity, 100% with bilateral panuveitis and 75% were associated with serous retinal detachment. Dermatological disorders was found in 25% (i.e. vitiligo, poliosis and alopecia), neurosensorial hearing loss in 25% and 12.5% of patients presented asthenia and fever. Neurological symptoms (ie epilepsy, meningismus, confusion, impaired balance) were found in 37.5%. About treatment, all patients received high doses of systemic glucocorticoids and 25% also received non-steroidal anti-inflammatory drugs (NSAIDs). 37.5% of patients received cyclophosphamide, 62.5% azathioprine and 12.5% methotrexate. Visual acuity improved in 75% of cases. Ocular complications were seen in 50% of patients, 12.5% with cataracts, 25% synechiae and glaucoma and band keratopathy in 12.5%. No patients required vitrectomy, nor developed ocular hypertension. Currently only 1 patient has active disease. Conclusions In our series of VKHD patients, we found that all required immunosuppressive therapy due to the severity of the disease and with this aggressive treatment, the prognosis of this disease was favorable. Acknowledgement Dra Gabriela Avila. Disclosure of Interest None declared

AB0473 Quality of Life in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis Measured by The SF36

Background Systemic Lupus Erythematosus (SLE) and rheumatoid arthritis (RA) are autoimmune diseases that mainly affect people in the reproductive stage of their life; it is interesting to investigate the impact of both diseases have in patients quality of life. Objectives The main objective of this study was to evaluate the quality of life of patients diagnosed with SLE and RA using the SF36 questionnaire and the factors that influence it Methods Analytical, observational cross-sectional study of a cohort of SLE and RA patients. A large number of clinical and epidemiological variables were recorded (i.e. years of evolution, the age at diagnosis, disease activity, gender, marital status, etc). Quality of life was determined by SF36 questionnaire. Statistical analysis was performed with SPSS19.0 program. Qualitative variables were expressed as percentages and frequencies while quantitative were informed as mean and standard deviation. Association was analyzed with X2 test and Student T test. Pearsons test was used for correlation analysis. Results 112 patients were studied, 50.9% (57/112) patients had SLE and 49.1% (55/112) RA. 69.6% (78/112) of patients came from the capital city and metropolitan area. 87.5% (90/112) were female, 57.14% (64/112) were living in couple and 49.1% (55/100) had basic education. 43.8% (49/97) perceive less or equal to the minimum wage monthly income. 42% (47/98) were living with 3 or fewer inhabitants in the house and 58.9% (66/108) had ≥40 years old at disease onset. The mean value of physical (PCS) component of SF36 questionnaire in SLE and RA was 45.13±12.5 and 47.7±12.5 respectively and the difference between them was significantly (p=0.01). On the other hand, the mean value of mental (MCS) component was 47.7±12.5 and 46.4±12 respectively but no significant difference was found (p=0.58). In relation to the 8 SF36 components we found significant difference between them, principally in the components that measures body pain (p=0.0001) and health perception (p=0.047). In SLE patients, a significant negative correlation it was found between PCS and HAQ (p=0.00018) and SLEDAI (p=0.0020). No significantly correlation with MCS was found. Regarding the SLICC Score, a statistically negative correlation was found with MCS (p=0.036). In RA patients, a significant negative correlation was found between PCS and HAQ (p=0.0001), no association with the DAS28 was found. But, a negative correlation between the MCS and DAS28 (p=0.03) was found. No significant correlation was observed with HAQ. Conclusions In this cohort revealed that physical and mental component of SF36 are influenced by the disease activity and functional impairment. Acknowledgement Sr Horacio Medina Disclosure of Interest None declared