Mirjana Zlatkovic-Svenda

United in Prevention–Electrocardiographic Screening for Chronic Obstructive Pulmonary Disease

CONFLICT OF INTEREST: NONE DECLARED Introduction P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, “Gothic” P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease. Aim We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema. Material and method 1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests. Conclusion Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema.

Could lung diffusion level for carbon monoxide be predicted in young elite athletes

Background: Lung diffusion capasity for carbon monoxide is determined with structural and functional characteristics of the lung performance. Elite athletes tend to have higher DLCO values. Aim: To evaluate the anthropometric and training factors influence on carbon monoxide lung diffusion capacity (DLCO) and on transfer coefficient (KCO) in elite athletes, by using the logistic regression model. Methods: From November 2012 to September 2015, 70 randomly selected male Caucasian elite athletes were analyzed. They came to be regularly screened for the respiratory diseases. DLCO and KCO were measured by the single breath method standardized technique; anthropometric values were measured as standing body height (cm) and body weight (kg). Results: The implemented logistic regression model has shown that only the combination of training frequency per week and the weekly amount of training expressed in hours had positive influence on DLCO. Predictors for KCO were not identified. This model was found to be excellent according to classification table, providing 80,0% of agreement for DLCO and 71,0% for KCO, at a cut off value of p=0.50. A set of goodness of fit tests was performed in order to further test the model, and all were nonsignificant, showing that it has correctly predicted the real data: Hosmer and Lemeshow test (p=0.866); Cox and Snell R2 (p=0.420) and Nagelkerke R2 (p=0.561). Conclusion: Training factors have shown to have positive influence on DLCO. Anthropometric features were not found to be significant predictors for DLCO. Further studies are encouraged.

Systemic Lupus Erythematosus Presenting as Acute Lupus Pneumonitis

Systemic lupus erythematosus (SLE) is an autoimmune chronic systemic disease involving skin, joints and/or internal organs, such as lungs, brain and heart. SLE affects predominantly women (female to male ratio 10:1).1 Pulmonary manifestations of SLE can include a wide spectrum of diseases. The most common is lupus pleuritis. Less common is parenchymal involvement, presenting either as acute lupus pneumonitis (ALP) or chronic interstitial lung disease. Possible pulmonary manifestations of SLE are pneumonia, pulmonary embolism, pneumothorax, acute reversible hypoxemia, shrinking lung syndrome and pulmonary haemorrhage.2 It is believed that pulmonary complications are the consequence of the immune complex mediated injury. A 66-year-old woman was presented to the Emergency Department, having severe breath shortness, high temperature and chest pain. She has been suffered from systemic lupus erythematosus for 20 years, and for the last six months was using 10 mg Prednisone and Methotrexate 5 mg once weekly. At the examination, she was found to have elevated body temperature 38.1 ◦C, tachycardia (120 beats/min) and elevated blood pressure (160/90 mm Hg). Her appearance was anorexic, diaphoretic, dyspnoeic, slightly disoriented. Her pupils were round equally with good light reaction, and her extraocular muscles were intact. She had neither neck adenopathy, nor jugular venous distention or meningismus. Precordial examination has shown no murmurs, rubs or gallops. Her breath sounds were decreased, with the right side percussion

AB1149 The ability of the health system to identify the burden of rheumatoid arthritis in serbia: a eular survey

Objectives to estimate the rheumatoid arthritis (RA) prevalence in two urban regions of Serbia, covering the northern and the southern part, under the European League Against Rheumatism (EULAR) prevalence survey; to assess the ability of the health system to recognize and treat patients with RA. Methods The survey was conducted in four Serbian towns: Belgrade in the north and three towns in the south: Cacak (Moravicki region), Uzice (Zlatiborski region) and Krusevac (Rasinski region), covering 36.5% of the total Serbian population with more than 99% Caucasians, mostly orthodox Serbs (83%), <4% Hungarians, Roms and Bosnians and a minority of other nationalities. The first-detection phase of the study comprised previously translated and validated telephone Questionnaire usage with 33 items covering signs, symptoms, self-reported diagnosis and classification criteria for RA (ACR 1987) (1). Diagnoses were confirmed by rheumatologists in a second-confirmation phase. Prevalence results were standardized for age and sex with regard to Serbian population (national census 2002). Confirmed RA cases were asked two more questions: “How long had you had symptoms before you were given the diagnosis of RA” and “How had you been treated for that period of time”. Results 6213 people were contacted and 63.6% answered the survey; joint pain was reported by 1,799 persons, and joint pain accompanied with joint swelling by 606 persons. A total of 23 RA cases were identified; 2 newly diagnosed. The standardized RA prevalence estimates were 0.30% (95% confidence interval [95% CI] 0.09;0.51) for the north, e.g. 0.09 (95% CI 0.08;0.26) for men and 0.49% (95% CI 0.19;0.79) for women. RA prevalence estimates were 0.42% (0.12;0.72) for the south; 0.28 (0.00;0.56) for men and 0.55% (0.09;1.00) for women, with the female to male ratio 5,5:1 in the north and 2:1 in the south. Time period from the first symptoms occurence to the RA diagnosis was 17.7 (13.2) months for the northern part and 25.0 (16.9) for the southern; 20.6 (14.9) for Serbia; in that period patients were mostly treated with NSAIDS (82%) and physical therapy (30%); short-lasting corticosteroids were given to 13%, peroral corticosteroids to 4% and no patients were treated with DMARDS. Conclusions RA prevalence in the southern and northern part of Serbia is in line (0.42% [95% CI 0.12;0.72]) vs 0.30% [95% CI 0.09;0.51]), being more frequently presented in females as compared to males (five times more in the north and two times more in the south). Delay in diagnosis as compared to the first symptoms occurence was 21 months and during that time no patients were treated with DMARDS. References Zlatkovic-Svenda MI, Stojanovic RM, Milenkovic MP, Vlajinac HD, Le Bihan E, Guillemin F. Adaptation and validation of a telephone questionnaire – Serbian version for case detection of rheumatoid arthritis and spondyloarthropathy (multicentric Eular study). Clin Exp Rheumatol. 2007;25 (1): 75–84. Disclosure of Interest None declared

Dry Olive Leaf Extract in Combination with Methotrexate Reduces Cell Damage in Early Rheumatoid Arthritis Patients—A Pilot Study

The effects of co‐administration of dry olive leaf extract (DOLE) with standard methotrexate (MTX) therapy on the parameters of cell damage and inflammation in patients with early and long‐term rheumatoid arthritis (RA) were evaluated at baseline, 3 and 6 weeks. Patients were assigned to groups: the early phase RA group on MTX monotherapy (E MTX), and the two RA groups that received co‐treatment with DOLE and MTX: early (E MTX + DOLE) and long‐term phase patients (L‐t MTX+ DOLE). Baseline values indicated increased parameters of cell damage and disruption of redox balance in all groups. After three weeks the E MTX + DOLE group maintained high catalase activity, exhibited decrease of lipid peroxidation and protein damage indicators—thiols and nitrites, while levels of DNA damage and pro‐inflammatory interleukin‐6 were significantly reduced. In E MTX group catalase activity remained unaltered while significant lipid peroxidation and DNA damage reductions were seen only after six weeks. L‐t MTX + DOLE group showed only modest alterations of cell damage parameters during six weeks. Combined administration of DOLE with MTX contributes to faster reduction of cell damage, restores oxidative balance and improves interleukin‐6 suppression during high disease activity in early phase RA, but not in long term patients. Copyright

SAT0595 Spondyloarthritis Prevalence in Europe, A EULAR-Endorsed Survey

Background The spondyloarthritis (SpA) prevalence has shown a trend to increase in the last two decades, in line with better recognition of the disease as well as the use of new classification criteria (1). The need to estimate and compare the SpA prevalence accross Europe was recognized. Objectives to estimate the SpA prevalence in several European countries: France, Turkey, Lithuania and Serbia using identical methodology and sampling; to standardize the results with reference to the European Standard Population by using direct method. Methods A two-step approach was taken. First, a unique detection Questionnaire, covering self-reported diagnosis, SpA classification criteria (ESSG 1991), personal and family history for SpA (2), previously translated and validated for each of the participating countries, was administered to a population sample. A two-stage sampling was carried out on seven areas covering 20 counties in France, seven geographical regions covering 25 administrative provinces in Turkey, two largest cities- Vilnius and Kaunas in Lithuania and two geographical regions covering four counties in Serbia. Second, diagnoses were confirmed by rheumatologists. Results were standardized by age and sex using the European Standard Population, defined as EU-27+EFTA, 2010 estimates. Results Detection Questionnaire was administered by telephone on 15219 persons in France (3), 6558 in Lithuania (4) and 6213 in Serbia (1), with 64.7%, 64.7% and 63.3% response rate, respectively. In Turkey, Questionnaire was administered face-to face on 4012 persons. Diagnoses were confirmed for 29 cases in France (37.9% male), 18 in Turkey (16.7% male), 27 in Lithuania (55.6% male) and 16 in Serbia (37.5% male). Estimates of the SpA prevalence standardized for age and sex are given in Table 1.Table 1. Age- and sex- standardized SpA prevalence, % (95% CI) for France, Lithuania, Turkey and Serbia, ≥18 years Men Women Total France 0.29 (0.12–0.47) 0.31 (0.16–0.45) 0.30 (0.19–0.41) Lithuania 1.38 (0.68–2.09) 0.39 (0.16–0.63) 0.89 (0.78–1.00) Turkey 0.17 (0.00–0.36) 0.57 (0.28–0.87) 0.37 (0.18–0.56) Serbia 0.38 (0.06–0.71) 0.32 (0.10–0.54) 0.35 (0.17–0.54) Conclusions Age- and sex-standardized SpA prevalence estimates in France, Turkey and Serbia were in line, but were as twice as high in Lithuania, confirming a north-south decreasing gradient using homogenous sampling and case ascertainment method. Standardized SpA prevalence estimates in men and women were similar in France and Serbia, but not in Turkey and Lithuania. This study adds to previous observation on similarity of RA and SpA prevalence estimates. References Zlatković-Švenda M, Stojanović R, Šipetić-Grujičić S, et al. Prevalence of spondyloarthritis in Serbia: a EULAR endorsed study. Ann Rheum Dis. 2015; 74(10):1940–2. Guillemin F, Saraux A, Fardellone P, et al. Detection of cases of inflammatory rheumatic disorders: performance of a telephone questionnaire designed for use by patient interviewers. Ann Rheum Dis 2003;62:957–63. Saraux A, Guillemin F, Guggenbuhl P, et al. Prevalence of spondyloarthropathies in France: 2001. Ann Rheum Dis 2005;64:1431–5 Adomaviciute D, Pileckyte M, Baranauskaite A et al. Prevalence survey of rheumatoid arthritis and spondyloarthropathy in Lithuania. Scand J Rheumatol 2008;37:113–9. Acknowledgement Study supported by a EULAR grant Disclosure of Interest None declared

THU0358 The Ability of the Health System to Identify the Burden of Spondyloarthritis in Two Regions of Serbia: A Eular Survey

Objectives To determine spondyloarthritis (SpA) prevalence in two different regions of Serbia, as part of the European League Against Rheumatism (EULAR) prevalence survey; to assess the ability of the health system to identify and treat patients with SpA. Methods Survey comprised a two-stage approach with a sample of urban population in 2 areas: Belgrade, located in the north and Cacak, Uzice and Krusevac in the south, covering 36.5% of the total Serbian population. In a detection phase, every 100-th telephone number was contacted to answer a previously validated screening telephone questionnaire. Confirmation of cases was by contact with the patients rheumatologist or rheumatological examination. Prevalence results were standardized for age and sex according to Serbian population (national census 2002). Confirmed SpA cases were asked two more questions: “How long had you had symptoms before you were given the diagnosis of SpA” and “How had you been treated for that period of time”. Results 6213 people were contacted; 63.6% answered the survey; 66 were examined. A total of 16 SpA cases were identified (5 newly diagnosed). The standardized SpA prevalence for the north was 0.28% (95% confidence interval [95% CI] 0.08;0.48); 0.31 (95% CI 0.00;0.65) for men and 0.25% (95% CI 0.01;0.49) for women; for the south 0.42% (0.02;0.82); 0.41 (0.02;0.81) for men and 0.43% (0.04;0.82) for women. Mean (SD) time (months) to SpA diagnosis was 23.6 (24.9) for the north and 13.6 (11.3) for the south; 19.2 (20.2) for Serbia. Before they were given the SpA diagnosis, all patients were treated with NSAIDS, but mostly “on demand” (56.2%), some of them with physical therapy (43.7%) and benzodiazepins (18.7%). Conclusions SpA prevalence in Serbia does not differ much between southern and northern part of the country as well as between women and men. Diagnostic delay for SpA is 19 months and most of the patients were inadequately treated for that period of time. One third of the revealed SpA cases were not diagnosed previously. Disclosure of Interest None declared

Prevalence of spondyloarthritis in Serbia: a EULAR endorsed study

In order to determine the burden of inflammatory rheumatic diseases across Europe, the European League Against Rheumatism (EULAR) unique-methodology prevalence survey of rheumatoid arthritis (RA) and spondyloarthritis (SpA) was carried out in several European countries, including Serbia. Aiming to enable comparable results, it comprised a common two-stage approach: a detection phase (validated screening telephone questionnaire, primarily tested in France1 ,2) and a confirmation phase (according to a certified rheumatologist or, for previously non-diagnosed cases, a rheumatology examination). The Serbian SpA prevalence survey was conducted by 30 trained interviewers on urban population in four Serbian towns: Belgrade (north), and Cacak, Krusevac and Užice (south), by telephone (every 100th telephone number) from April to October 2008. The sample covered 36.5% of the total Serbian population with more than 99% Caucasians, mostly orthodox Serbs (83%), <4% Hungarians, Gypsies and Bosnians and a minority of other nationalities. Respondents were asked whether they have (or …

Quality of treatment in gouty patients considering EULAR recommendations

INTRODUCTION There are 12 recommendations for gout treatment, based on evidence and opinion of experts. OBJECTIVE To assess the quality of therapy in patients with gout analyzing adherence to four selected recommendations. METHODS Retrospective cross sectional study of 111 patients with gouty flare was conducted. Adherence to selected recommendation was defined as odds ratio between the number of patients whose therapy adhered to treatment recommendation and the number of patients eligible for the relevant recommendation. These recommendations refer to indications for allopurinol treatment (R1), prophylaxis of induced gouty flares in the first month of allopurinol treatment (R2), treatment goals (R3), and treatment monitoring regime (R4). RESULTS Out of 111 patients with gout, 25 with tophi, 87 with frequent gouty flares and 46 with CUA or X-ray erosions were indicated for allopurinol treatment. The adherence to R1 was 76% for tophi patients, 54% for patients with frequent gouty flares, and 63% for patients with CUA. None of the patients starting allopurinol was either recruited for gouty prophylaxis or monitored properly; adherence to R2 as well as to R4 was 0%. Target serum uric acid (SUc) rating below 360 micromol/L was achieved in 13/50 patients treated with allopurinol, while the adherence to R3 was 26%. Therapeutic monitoring in accordance with P4 was not done in any of the patients on allopurinol. There were no differences in mean levels of the SUc between allopurinol users and non-users: 471.3 +/- 164.4 vs. 460.0 +/- 103.5 micromol/L (p = 0.067). Therefore, almost every second patient with gouty flares was on allopurinol therapy (50/111). CONCLUSION The degree of deviation in relation to the key principles of correct treatment in patients with gout ranged from a relatively high (24%) to that of absolute digression (100%).