P Munguía-Realpozo

Immunopathogenesis of vitiligo

Vitiligo is a common depigmenting disorder which may have devastating psychological and social consequences and is characterized by the presence of circumscribed white macules in the skin due to the destruction of melanocytes in the epidermis. Various hypotheses have been proposed to explain the pathomechanisms involved in this disease, and studies have shown the participation of autoimmune processes in the pathogenesis of vitiligo. Cellular and humoral immunities have been implicated in the development of vitiligo and their role continues to be investigated. Peripheral blood and skin biopsies of patients with vitiligo show that T-cells, mononuclear cells, various pro-inflammatory cytokines, and auto-antibodies can damage melanocytes. Further research is required to determine whether autoimmunity is the main mechanism of vitiligo or only a consequence.

Vitamin D and Sjögren syndrome

The immunomodulatory effects of vitamin D have been extensively studied in the context of autoimmunity. Multiple studies have demonstrated a high prevalence of vitamin D deficiency in autoimmune diseases. Recently, a possible protective role of vitamin D in autoimmunity has been described; however, this function remains controversial. Few studies have investigated the role of vitamin D in patients with Sjögren syndrome (SS). In this review, we compiled the main features of SS pathogenesis, the vitamin D immunomodulatory effects and the possible interaction between both. Data suggests that vitamin D may play a role in the SS pathogenesis. In addition, vitamin D low levels have been found in SS patients, which are associated with extra-glandular manifestations, such as lymphoma or neuropathy, suggesting a possible benefit effect of vitamin D in SS.

Carotid atherosclerosis is not associated with lower bone mineral density and vertebral fractures in patients with systemic lupus erythematosus

Background Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE). Methods We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound. Results Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p = 0.001), have a higher body mass index (p = 0.008), and exhibit dyslipidemia at study entry (p = 0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p = 0.91 and p = 0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08 ± 0.12 vs. 0.06 ± 0.03 mm, p = 0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p = 0.2). Conclusions In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.

Lack of association between serum 25-hydroxyvitamin D levels and cervical human papillomavirus infection in systemic lupus erythematosus.

Our objective was to evaluate whether vitamin D deficiency is associated with cervical human papilloma virus (HPV) infection in women with SLE. This is a cross-sectional study of 67 women with SLE. A structured questionnaire was administered to ascertain the possible risk factors associated with cervical HPV infection. A gynaecological evaluation and cervical cytology screening were made. HPV detection and genotyping was made by PCR and linear array assay. Serum 25 hydroxyvitamin D levels were quantified by chemiluminescence immunoassay. Mean age and disease duration were 44.8 ± 10.6 and 42.5 ± 11.8 years, respectively. Demographic characteristics were similar in patients with and without deficiency (<20 ng/ml and ≥20 ng/ml). There were 28.4% of women with cervical HPV infection and 68.4% had high-risk HPV infections. Patients with 25 hydroxyvitamin D levels <20 ng/ml had a higher prevalence of cervical HPV infection than those with levels ≥20 ng/ml (30.7% vs. 25.8%; p = 0.72). We found no significant difference when high-risk HPV infection was evaluated (36.8% vs. 31.5%; p = 0.73). In conclusion, women with SLE have a high prevalence of vitamin D deficiency and cervical HPV infection. However, we found no association between vitamin D deficiency and cervical HPV.

Factors of the epidemiological triad that influence the persistence of human papilloma virus infection in women with systemic lupus erythematosus

We studied the epidemiologic triad-related factors influencing human papilloma virus (HPV) persistence in Mexican women with systemic lupus erythematosus (SLE). Patients aged ≥18 years with SLE (American College of Rheumatology criteria), with and without HPV persistence, were selected. Groups were analyzed by (1) host: clinical disease characteristics; (2) agent: (I) infectious (prevalence, incidence, HPV genotype and co-infections (≥2 HPV genotypes or mycoplasmas)), (II) chemical (contraceptives and immunosuppressive drugs) and (III) physical (vitamin D deficiency) and (3) environment. A total of 121 SLE patients were selected over a two-year period. (1) Host: mean age 45.8 years and disease duration 12.7 years. (2) Agent: (I) infectious. HPV infection prevalence in the second sample was 26.4%, high-risk HPV genotypes 21.5% and co-infections 7.4%. HPV infection incidence was 13.2%, persistence 13.2% and clearance 15.7%. (II) Chemical: use of oral hormonal contraceptives 5% and immunosuppressive treatment 97.5%. (III) Physical: Vitamin D levels were similar in both groups. (3) Environment: (I) natural. A total of 60.6% of patients were residents of Puebla City. (II) Social: The mean education level was 10.9. Poverty levels were: III degree 52.4%, IV degree 28% and II degree 17%. (III) Cultural behavioral: Onset of sexual life was 20.5 years, 10% had ≥3 sexual partners and 51.2% were postmenopausal. In conclusion, no factor of the epidemiologic triad was associated with HPV infection prevalence.

The anti-thrombotic effects of vitamin D and their possible relationship with antiphospholipid syndrome

The importance of the immunomodulatory effects of vitamin D has recently been associated with autoimmune and chronic inflammatory diseases. Vitamin D deficiency has been linked to the development of autoimmune conditions. Antiphospholipid syndrome is an autoimmune disease characterized by thrombotic events and obstetric complications in patients with antiphospholipid antibodies. Current data show that patients with antiphospholipid syndrome have a high prevalence of vitamin D deficiency even without classic risk factors. Several studies have suggested vitamin D may have anti-thrombotic functions. In antiphospholipid syndrome, low vitamin D serum levels have been associated with thrombotic manifestations, suggesting a possible protective role of vitamin D in antiphospholipid syndrome. This literature review presents current evidence on the haemostatic functions of vitamin D and their possible relationship with the clinical manifestations of antiphospholipid syndrome.

SAT0022 Lack of Association between Serum 25-Hydroxyvitamin D Concentrations and Cervical Human Papillomavirus Infection in Systemic Lupus Erythematosus

Background Growing evidence demonstrates the role of vitamin D deficiency in infections. Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that has been linked to vitamin D insufficiency. Objectives We aimed to evaluate whether vitamin D deficiency is associated with cervical human papilloma virus (HPV) infection in women with SLE. Methods We conducted a cross-sectional, prospective, observational study in women with SLE (1997 ACR classification criteria). A structured questionnaire was administered to the study subjects to ascertain the possible behavioural and biologic risk factors associated with cervical HPV infection. The Systemic Lupus Erythematosus Disease Activity Index, validated for the Mexican population (mexSLEDAI) was used to assess disease activity. A gynaecological evaluation and cervical cytology screen were performed. HPV detection and genotyping were made by PCR and linear array assay. Plasma 25(OH) levels were quantified by enzyme immunoassay. Results A total of 67 SLE women were analysed. Mean age was 44.8±10.6 years and disease duration 42.5±11.8 years. Median serum vitamin D level was 18.9 ng/mL (p25: 15.2; p75: 23.1). The demographics were similar in patients with and without vitamin D insufficiency (<20 ng//mL and ≥20 mg/mL). Nineteen (28.4%) women had cervical HPV infection, of whom 13 (68.4%) had HR HPV infections, and 7 (36.8%) had 2 o more HPV infections. The most prevalent HR HVP types were 59 (42.1%) and 18 (15.7). SLE patients with vitamin D levels <20 ng/mL had a higher prevalence of cervical HPV infection compared to those with vitamin D levels ≥20 ng/mL (30.7% vs. 25.8%; p=0.72). We found no significant difference in vitamin D insufficiency according to HR-HPV infection prevalence (36.8% vs. 31.5%; p=0.73). Conclusions Women with SLE have a high prevalence of vitamin D deficiency and cervical HPV infection. However, we found no relationship between vitamin D deficiency and cervical HPV. Further multicentre studies with a larger sample size are required to validate our data. References Van Belle TL, Gysemans C, Mathieu C. Vitamin D in autoimmune, infectious and allergic diseases: a vital player? Best Pract Res Clin Metab 2011;25:617-632. Field CJ, Johnson IR, Schley PD. Nutrients and their role in host resistence to infection. J Leukocyte Biol 2002;71:16-32. Amital H, Szekanecz Z, Szucs G, Danko K, Nagy E, Csepany T, et al. Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis 2010;69:1155-1157. Acknowledgements We would like to thank David Buss for his valuable guidance and advice during this project. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2290

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