Teixeira F

Old and new challenges in Parkinson's disease therapeutics

&NA; Parkinsons disease (PD) is a neurodegenerative disorder characterized by the degeneration of dopaminergic neurons and/or loss od neuronal projections, in several dopaminergic networks. Current treatments for idiopathic PD rely mainly on the use of pharmacologic agents to improve motor symptomatology of PD patients. Nevertheless, so far PD remains an incurable disease. Therefore, it is of utmost importance to establish new therapeutic strategies for PD treatment. Over the last 20 years, several molecular, gene and cell/stem‐cell therapeutic approaches have been developed with the aim of counteracting or retarding PD progression. The scope of this review is to provide an overview of PD related therapies and major breakthroughs achieved within this field. In order to do so, this review will start by focusing on PD characterization and current treatment options covering thereafter molecular, gene and cell/stem cell‐based therapies that are currently being studied in animal models of PD or have recently been tested in clinical trials. Among stem cell‐based therapies, those using MSCs as possible disease modifying agents for PD therapy and, specifically, the MSCs secretome contribution to meet the clinical challenge of counteracting or retarding PD progression, will be more deeply explored. HighlightsOverview on the past and current therapeutic strategies for PD.New approaches in PD Regenerative Medicine.MSCs and their secretome in future PD regenerative medicine strategies.

Median nerve ultrasound findings in systemic sclerosis patients: How do they relate to clinical features of the disease?

rheumatic diseases 16 years after launching the first version of the same study.6 The increasing prevalence of rheumatic diseases in a context of an aging population can translate into an increase in the demand for health care and into the need for more human recourses to attend to this situation.7,8 The data obtained in EPISER, in combination with the results of this work, may be useful in decision making in the context of health systems. This report has certain limitations. Although the database utilized is based on the information provided by members of the SER, there can be some imprecisions, aside from the margin of error, which has been considered minimal. For the analysis of these results, we must take into account that it has been assumed that 95% of the rheumatologists in Spain are members of the SER and are included in the organization’s database. A deviation of 10% (that is, that there were another 95 rheumatologists not included in the database of members of the SER) would suppose that the number of rheumatologists per 100 000 population in all of Spain could reach 2.2. To achieve 2.5 rheumatologists per 100 000 population in all of Spain, there would have to be 221 rheumatologists not associated with the SER. In conclusion, although the interpretation of the number of specialists per 100 000 population may be controversial, the results of this report enable us to evaluate how rheumatology is facing the health care challenges that are being presented in recent years, and that will not be detained in the near future. The potential sociodemographic changes, which could affect the prevalence of rheumatic diseases, make further work necessary to enable us to analyze not only the present situation, but to also consider the future outlook of rheumatology in Spain.

Relationship between clinical evaluation and ultrasound assessment of rheumatoid arthritis patients using a 12 joint score

To identify if the use of a systematic ultrasound (US) evaluation has relevance in the determination of disease activity in rheumatoid arthritis patients on biological disease‐modifying anti‐rheumatic drug treatment.

Relevance of ultrasonography in assessing disease activity in patients with idiopathic inflammatory myopathies

Idiopathic inflammatory myopathies (IIM) comprise a group of rare and heterogeneous diseases difficult to diagnose and follow up. Precise measures for assessing disease activity are not available at the moment. Our objective was to evaluate the usefulness of ultrasonography (US) as a monitoring tool in IIM.

Tips on How to Collect and Administer the Mesenchymal Stem Cell Secretome for Central Nervous System Applications.

Human mesenchymal stem cells (hMSCs) have been proposed as possible therapeutic agents for central nervous system (CNS) disorders. Recently, it has been suggested that their effects are mostly mediated through their secretome, which contains a number of neuroregulatory molecules capable of increasing cell proliferation, differentiation, and survival in different physiological conditions. Here, we present an overview of the hMSC secretome as a possible candidate in the creation of new cell-free therapies, demonstrating the process of its collection and route of administration, focusing our attention on their effects in CNS regenerative medicine.

SAT0510 Painful Shoulder: Relevance of Clinical and Sonographic Data on Corticosteroid Injection Outcome

Background Painful shoulder (PS) is a common condition and a frequent cause of referral to a Rheumatology department, particularly in refractory patients. Objectives To study the association between clinical and sonographic data and corticosteroid injection (CI) outcome in PS patients. Methods Adult patients with PS, consecutively observed in a Rheumatology outpatient clinic were included. Demographic and clinical data (age, gender, time of symptoms, pain in contralateral shoulder, past CI of any shoulder, active abduction limitation and dominant side) were registered. The portuguese version of QuickDASH questionnaire (QD) and pain Visual Analogic Scale (VAS) were answered by the patient. If the patient fulfilled clinical criteria for CI (inflammatory or mixed pattern of pain, refractory to at least a 2 week NSAID treatment on full dose, or contra-indication to NSAID, and absence of contraindication to CI), a shoulder ultrasound (US) was performed before CI, and the sonographic findings were registered (presence of subacromial bursitis (SAB), long bicipital head tenosynovitis (LBHT), tendon calcification or supraspinatus (SS) tear). After 9 ± 2 weeks, patients were reassessed, repeating the QD and VAS questionnaires. Absolute and relative variation of QD score (aΔQD and rΔQD, respectively) and absolute and relative variation of pain VAS (aΔVAS and rΔVAS, respectively) were calculated. Patients with generalized pain syndromes, with suspected or confirmed chronic rheumatic inflammatory disease or secondary cause of the shoulder pain, with sonographic complete supraspinatus tear or glenoumeral effusion and those refusing CI treatment or proposed for calcification lavage, or those in whom reassessment was out of the defined interval were excluded. Statistical analysis was performed using SPSS 21.0 software. Results Sixty-eight patients were included, of whom 36 were excluded because of presenting at least one of the exclusion criteria. Thirty-two patients, 23 women, with a mean age of 58.9 ± 10.2 years, concluded the study. The mean time of symptoms was 8 ± 7.4 months; 11 (34.4%) patients had also pain in the contralateral shoulder, 8 (25%) had active abduction limitation, 5 (15.6%) had history of shoulder CI, and 24 (75%) had pain on the dominant side. Regarding US findings, 18 (56.3%) had SAB, 12 (37.5%) had LBHT, 16 (50%) had intratendinosis or transtendinosis SS tear and 11 (34.4%) had any tendon calcification. Age or time of symptoms did not correlate with any of the improvement scores. Higher baseline QD score correlated with higher aΔQD (r=0.55, p<0.01) and rΔQD (r=0.37, p<0.05); higher baseline VAS score correlated with higher aΔVAS (r=0.38, p<0.05). SS tear was present in older patients (p<0.05), but it was not associated to improvement scores. Active abduction limitation was associated with greater aΔQD or rΔQD (p<0.01), and aΔVAS or rΔVAS (p<0.05). Patients with sonographic inflammatory signs (SAB or LBHT) had greater aΔVAS and rΔVAS scores (p<0.05); there was also a trend towards greater improvement on QD scores, although not statistically significant. Conclusions Patients with more severe symptoms or active abduction limitation have greater benefit from CI; having any of the inflammatory US findings described is also associated with greater pain relief after CI. Disclosure of Interest None declared

AB0953 Contribution of Ultrasonography To Assess Disease Activity in Patients with Inflammatory Myopathies

Background Inflammatory myopathies (IM) comprise a group of rare and heterogeneous diseases, challenging to diagnose, treat and follow-up. Monitoring patients with IM is difficult as there is a lack of precise measures for assessing disease activity. Ultrasonography (US) is a non-invasive, relatively inexpensive technique that is increasingly being used to evaluate muscular system. Objectives To assess the utility of US evaluation in the monitoring of patients with IM. Methods Patients diagnosed of IM from 2005 to 2015 followed up at a Rheumatology Department were included. Fourteen patients (11 female) with a mean age of 50.1±21.4 years and mean disease duration of 4.8±3.2 years were evaluated. The different diagnosis were as follows: 6 dermatomyositis (DM), 3 polymyositis (PM), 2 myositis associated with Systemic Lupus Erythematosus, 1 inclusion body myositis (IBM), 1 recurrent focal myositis (RFM) and 1 undifferentiated IM. Physical examination, including muscle strength tests, laboratorial tests (comprising levels of serum muscle enzymes) and a selective muscle US assessment were performed to each patient. For US evaluation a General Electric LOGIQ S8 equipment with a 6–15 MHz linear transducer was used. Muscles were subjectively evaluated for echogenicity (determined by gray-scale) and muscle morphology. Power Doppler (PD) was used to assess vascularity. Results Nine of the 14 patients evaluated were on clinical remission, with absence of symptoms or signs of disease, preserved muscle strength, normal muscle enzyme levels and conserved muscle pattern on US assessment. One female with DM presented with an acute exacerbation of disease, with proximal muscular weakness of the upper limb and US findings of increased muscle echogenicity of biceps revealing a muscle oedema pattern. The patient with IBM also experienced a flare which was associated with proximal muscle weakness and asthenia; US assessment showed focal oedema through right biceps muscle but also proximal lower limb muscle atrophy characterized by increased echogenicity with diminished volume of the quadriceps compartment and change of normal architecture of tibialis anterior muscle of both legs. These findings are consistent with a long term disease with acute flare. Another patient with longstanding PM in remission revealed no signs or symptoms of active disease, normal muscle strength but low creatine phosphokinase levels and symmetrical proximal muscle atrophy pattern in US evaluation. On the other hand, the patient with shorter duration of disease, recently diagnosed as myositis (undifferentiated IM), revealed proximal weakness and elevated serum muscle enzymes; in this case, US assessment showed diffuse increased echogenicity of proximal muscle compartment and increased PD signal. Finally, the patient with RFM presented with left arm swelling and weakness and US evaluation showed enlargement and diffuse increased echogenicity within the left carpal extensor compartment. Conclusions US findings in patients with IM seem to correlate well with disease activity suggested by clinical and laboratory data. As a result, US imaging may be a useful tool to assess disease activity and damage in these patients as well as to monitor disease progression. References Adler RS and Garofalo G. Ultrasound in the evaluation of the inflammatory myopathies. Curr Rheumatol reports. 2009. 11:302–308. Disclosure of Interest None declared

AB0230 Symptoms of Depression, Anxiety and Poor Sleep Quality in Patients Followed in a Rheumatology Day-Care Unit: Associated Sociodemographic and Disease-Related Factors

Background The presence of depression, anxiety and sleep disorders are common among patients with inflammatory rheumatic diseases. Frequently are underdiagnosed in clinical practice and can negatively influence the perception of pain by the patient, the disease activity and the individuals quality of life. Objectives To determine the levels of depression, anxiety and sleep quality in patients with inflammatory rheumatic diseases followed in a rheumatology day-care unit, with current or past history of biological treatment, and to identify associated demographic and disease-related factors. Methods The Beck depression and anxiety inventory (BDI and BAI) and Pittsburgh sleep quality index (PSQI) were applied as instruments for measuring the severity of depression, anxiety and sleep quality, respectively. Disease activity was ascertained using validated clinical index: ASDAS-PCR for spondylarthritis with predominant axial involvement and DAS28-ESR for spondylarthritis with predominant peripheral involvement or rheumatoid arthritis. Health Assessment Questionnaire (HAQ) was used to assess impairment in daily activities due to illness and Short Form-36 (SF-36) to assess health related quality of life. A p value of <0.05 was considered as significant. Results A total of 84 patients were consecutively included, of which 50 (59.5%) were female, with a mean age of 46.25±13.25 years (19 to 85) and a mean disease duration of 14.62±8.07 years (1 to 38). Thirty six (42.9%) patients had rheumatoid arthritis and 48 (57.1%) had spondylarthritis. Symptoms of anxiety and depression were found in 46 (54.8%) and 30 (35.7%) patients, with moderate or severe score in 23 (27.3%) and 14 (16.7%) patients respectively. Thirteen (15.5%) patients were taking antidepressant treatment. Poor sleep quality was found in 53 (63.1%) patients but only 14 (16.7%) took sleeping pills. Strong correlation (p<0.01) was found between high scores of anxiety, depression and sleep index. These scores correlated too with high HAQ and pain on a VAS, low SF36 and both on their mental and emotional components (p<0.01). High ASDAS-PCR scores were positively correlated with anxiety, depression and sleep index (p<0.01). Similarly high DAS-28 positively correlated with depression (p<0.01) and poor sleep quality (p<0.05), but not with anxiety. The female gender and other than single civil status were associated with higher anxiety and history of hypertension with more depressive symptoms (p<0.05). Active employees and current corticosteroid treatment were associated both with higher anxiety and depression scores (p<0.05). Older age and longer disease duration associated with poorer sleep quality (p<0.05). The scores were not statistically different between bDMARDS or cDMARDS, the kind of disease, habits or other associated diseases. Conclusions Anxiety, depression and sleep disorders were very prevalent in this patient group. Higher disease activity, worse quality of life and higher pain were noted in the presence of these disturbances. The female gender, civil status, employment, corticoid therapy and history of hypertension were also associated. Recognize and treat both conditions is important to best manage these patients. Disclosure of Interest None declared

AB1104 Influence of Sociodemographic and Clinical Factors in Health Related Quality of Life in Patients Followed in a Rheumatology Day-Care Unit

Background The health-related quality of life (HRQL) is an important indicator of the burden of inflammatory rheumatic diseases (IRD). Their outcomes may also be affected by coexisting chronic conditions that can cause functional impairment and activity limitation with significant reductions in HRQL. Objectives To determine the health status and quality of life in patients with IRD followed in a rheumatology day-care unit and to identify associated demographic and disease-related parameters influencing it. Methods The Health Assessment Questionnaire (HAQ) to assess impairment in daily activities due to illness and Short Form-36 (SF-36) to assess HRQL were applied to patients on day-care routine visits. Disease activity clinical measures (DAS28-ESR, ASDAS-PCR, mean pain on VAS) were collected according to the disease and the predominant involvement. A p value of <0.05 was considered as significant. Results A total of 84 patients were consecutively included, predominantly female (59.5%), with a mean age of 46.25±13.25 years (range 19-85) and a mean disease duration of 14.62±8.07 years (1-38). Thirty six (42.9%) patients had rheumatoid arthritis and 48 (57.1%) had spondylarthritis. Seventy seven (91.7%) patients with current bDMARDS, 51 (60.7%) also with cDMARDS and 19 (22.6%) with low doses corticosteroid treatment. Twenty four (28.6%) had associated hypertension, 4 (4.8%) diabetes and 10 (11.9%) dyslipidemia. The mean DAS28-ERS was 2.59±1.06 (0.53 to 6.94), median ASDAS-PCR 1.40±1.15 (0.20 to 5.50), mean pain on a VAS 3.77±2.58 (0 to 10), mean HAQ 0.76±0.71 (0 to 2.88) and mean SF-36 418.71±162.31 (103.50 to 707). Strong correlation (p<0.01) was found between high scores of HAQ and low SF-36. These scores correlated also with older age, high pain on a VAS and high disease activity measured by ASDAS-PCR and DAS28-ESR. Longer disease duration correlated as well with lower level of SF-36 (p<0.05), but not with HAQ. Rheumatoid arthritis showed significant higher levels of HAQ than spondylarthritis. The female gender, current corticosteroid treatment and history of hypertension were associated both with higher HAQ and lower SF-36 (p<0.05). The scores were not statistically different between bDMARDS or cDMARDS, smoking and alcohol consumption, civil or employment status, level of education or other associated diseases. Conclusions Our findings suggest that not only the activity or duration of the disease, but also the gender, concomitant comorbidities and therapies can influence the HRQL and daily activities. The disease activity could be a determinant of disability but is important to incorporate coexisting conditions and demographic data in the evaluation of HRQL. Disclosure of Interest None declared