Vicenç Torrente-Segarra

Prevalence and predictors of vitamin D deficiency in non-supplemented women with systemic lupus erythematosus in the Mediterranean region: a cohort study.

Objectives: Over the past few years researchers have suggested that vitamin D plays a diverse role in autoimmune diseases such as systemic lupus erythematosus (SLE). We sought to determine the prevalence and predictors of vitamin D deficiency in a cohort of non-supplemented female SLE patients from the Mediterranean region. Methods: We carried out a prospective cohort study on all SLE patients who had visited the Department of Rheumatology at the Parc de Salut MAR (Barcelona, Spain) between June 2007 and December 2008, excluding those who had been taking vitamin D supplements (total: 73 patients, all female). For each patient, demographic information was collected; scores were measured for disease severity [SLE Disease Activity Index (SLEDAI)] and structural damage [Systemic Lupus International Collaborating Clinic/American College of Rheumatology, (SLICC/ACR) Damage Index]; pharmacological treatment was recorded; analytical variables were analysed; and plasma levels of 25-hydroxy vitamin D [25(OH)D] were quantified. Results: Among the patients in our cohort, 68.5% [95% confidence interval (CI) 60.3–79.2] exhibited vitamin D deficiency [plasma level of 25(OH)D < 30 ng/mL]. The predictors for vitamin D deficiency were daily sunscreen use [odds ratio (OR) 1.67, p = 0.02] and high body mass index (BMI) (OR 1.32 when adjusted for seasons and patient age, p = 0.04). We did not find any correlation between vitamin D deficiency and SLEDAI score (p = 0.31), SLICC/ACR score (p = 0.82), or any other of the variables. Conclusions: Vitamin D insufficiency is highly prevalent among SLE patients, even in southern regions. Sunscreen use and obesity increase the risk. Clinicians should be aware of these factors and supplement SLE patients at risk of vitamin D deficiency accordingly.

Hand and wrist arthralgia in systemic lupus erythematosus is associated to ultrasonographic abnormalities

OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease which may has joint impairment. Often, SLE patients complain of hand and wrist arthralgia (HA). Usually, these patients do not show any swelling in the physical exam. Our aim was to demonstrate Power Doppler Ultrasound (PDUS) abnormalities in SLE patients with HA. METHODS We recruited 58 consecutive SLE patients and divided them into two groups: case group (n = 28) were patients with HA, and control group (n = 30) were patients without HA. We also collected socio-demographic and disease activity data, biological markers and SLEDAI index. We evaluated disability and quality of life by mHAQ and SF-12, respectively. We performed a bilateral hand and wrist PDUS on all patients. PDUS findings were based in OMERACT-7 group criteria. RESULTS We found PDUS abnormalities in most of SLE patients who suffered HA, when compared to SLE controls (P < 0.001). The main findings in Case Group were: tenosynovitis (39.2%), synovial effusion or hypertrophy (25%) and active synovitis (14.2%). SLEDAI score and dsDNA antibodies were related to the presence of PDUS abnormalities (P < 0.05 and P < 0.001, respectively). We also found worse physical SF-12 (P < 0.05) and mHAQ (NS) scores in case group. CONCLUSIONS SLE patients who present HA have more PDUS abnormalities. These findings are associated with a higher SLEDAI score and dsDNA antibodies. This articular affection may contribute to a worsened functional ability and a lower quality of life. PDUS seems to be a reliable tool in the assessment of SLE patients with HA.

Nailfold Capillary Patterns in a Patient With Multicentric Reticulohistiocytosis and Raynaud Phenomenon

A 72-year-old woman has been followed up in our rheumatology clinic since 2012. Her medical history included breast cancer 17 years before with mastectomy, lymphadenectomy, surgical intervention postradiotherapy, and treatment with tamoxifen for 7 years and uterus cancer with hysterectomy 5 years before. She reported mild joint pain in her hands, without arthritis, together with cutaneous papules on both hands and in the nasal septum as well as severe Raynaud phenomenon (RP). Laboratory studies showed cholesterol 6.20 mmol/L, low-density lipoprotein 4.16 mmol/L, C-reactive protein 4.5 mg/L, and β2-microglobulin 2.59 mcg/ml. Hematologic parameters and acute phase reactants were within reference ranges. The immunological study disclosed a speckled pattern of antinuclear antibody 1/320, whereas tests for SCL-70, DNA, and rheumatoid factor were all negative. Radiographic

Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review

Despite the improvement in the quality of life of patients with SLE due to scientific and technological advances, SLE remains a disease that over the years may produce irreversible damage to patients. Osteoporosis and secondary bone fractures are two of the major causes of irreparable injury in patients with SLE. Vitamin D insufficiency may play a vital role both in reduced bone mineral density (BMD) and in the appearance of fractures, although its mechanisms of action are still unclear. We performed a systematic review of the literature in order to determine the prevalence and predictors of reduced vitamin D plasma levels, bone loss and the presence of fractures in SLE patients. Our review encompassed all English-language publications using Medline and EMBase electronic databases from their inception (1966 and 1980, respectively) to December 2016. We included all intervention studies and observational studies in which vitamin D plasma levels, BMD and bone loss were measured and applied to patients with SLE. Previous studies suggested an increase in bone loss and fracture in patients with SLE compared with general population and although there is a high prevalence of vitamin D insufficiency in the general population, previous studies had demonstrated lower vitamin D levels in patients with SLE compared to age-matched controls. The etiology of reduced bone mass and reduced vitamin D plasma levels in SLE is multifactorial and includes a variety of intrinsic factors related to the disease itself and treatment side effects. SLE patients are at risk for developing these two comorbidities (reduced vitamin D plasma levels and low BMD) and it is therefore essential to study, monitor, prevent and treat bone metabolism disorders in SLE patients.

Incidence and clinical features of kawasaki disease in Catalonia (Spain)

between onset of the disease and diagnostic was 7.2±5.3 days. Ethnic distribution was: Caucasian 279 patients(69.9%), North African 26 (6.5%), Amerindian 21 (5.2%), Asian 14 (3.5%) and Sub-Saharan 4 (1%). Ethnicity was not available in 55 (13.8%) patients. Distribution of classical manifestations for KD was: fever in 100% of patients, changes in extremities 40.3% (desquamation in 31% of them), exanthema 84.2%, conjunctival injection 79.7%, changes in lips and oral cavity 55.6% and lymphadenopathy 28.8%. Other clinical findings reported were: sterile pyuria in 80(20%) patients, nausea and vomiting in 96(24%), abdominal pain in 85(21.3%), gallbladder distention in 14 (3.5%), transaminase elevation in 120(30%), jaundice in 21(5.1%), irritability in 118(29.5%), aseptic meningitis in 16(4%), sensorineural hearing loss in 2 patients, uveitis in 11(2.7%) and arthritis or arthralgia in 55(13.8%). Cardiologic findings were: perivascular brightness of the coronary wall in 42(10.5%) patients, pericarditis in 9(2.3%), myocarditis in 4(1%), mitral regurgitation in 28 (7%) and CA in 53 patients(13.3%), 26(49%) of them disappearing before the 2 nd month after the onset of KD. 4 patient had giant CA. Intravenous immunoglobulin (IVIG) was administered in 389(97.5%) patients with response to the 1 st dose in 332(83.2%). Day of IVIG administration was 7.5±3.1. Other treatment plans were: 2 nd (69% response) and 3 rd IVIG doses, oral or iv corticosteroids and abciximab (administered in 3 of the patients with giant CA). 97.7% of patients received anti-platelet dose aspirin in the convalescent phase. Conclusion

RENACER study: Assessment of 12-month efficacy and safety of 168 certolizumab PEGol rheumatoid arthritis-treated patients from a Spanish multicenter national database

Abstract Objective: To assess effectiveness and safety of certolizumab PEGol (CZP) in rheumatoid arthritis (RA) patients after 12 months of treatment and to detect predictors of response. Methods: Observational longitudinal prospective study of RA patients from 35 sites in Spain. Variables (baseline, 3- and 12-month assessment): sociodemographics, previous Disease Modifying Anti-Rheumatic Drug (DMARD) and previous Biological Therapies (BT) use; TJC, SJC, ESR, CRP, DAS28, SDAI. Response variables: TJC, SJC, CRP, ESR, and steroids dose reductions, EULAR Moderate/Good Response, SDAI response and remission, DAS28 remission. Safety variables: discontinuation due to side-effects. Descriptive, comparative and Logistic regression analyses were performed. Results: We included 168 patients: 79.2% women, mean age 54.5 years (±13.2 SD), mean disease duration 7.5 years (±7.3 SD). Mean number of prior DMARD: 1.4 (±1.2 SD), mean number of prior BT was 0.8 (±1.1). Mean time on CZP was 9.8 months (±3.4 SD). A total of 71.4% were receiving CZP at 12-month assessment. Baseline predictors of response: lower prior number DMARD; low number prior BT; higher CRP, ESR, TJC, SJC, DAS28 and SDAI (p < 0.05) scores. A 25/46.4% Moderate/Good Response, a 20% SDAI remission, and a 44% DAS28 remission were observed. We observed 48 discontinuations (28.6%), 31 due to partial or complete ineffectiveness, and 17 due to side-effects. Conclusions: CZP showed benefit in severe RA patients, with significant reduction of all effectiveness parameters, despite the high prevalence of previous BT exposure in our series. We found CRP, ESR, prior DMARD/BT number, TJC, SJC, DAS28, and SDAI as baseline predictors of response. CZP was mostly well tolerated.

Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER)

OBJECTIVES To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS Mean age (years) ± S.D. at diagnosis was 14.2 ± 2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ± S.D. was 1.27 ± 1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

Musculoskeletal involvement and ultrasonography update in systemic lupus erythematosus: New insights and review

Ultrasonography has been rarely used to measure musculoskeletal and joint activity in systemic lupus erythematosus (SLE). The aim of this review is to discuss the utility and reliability of this non-invasive diagnostic tool for the assessment of joint disease in SLE patients. In the last decade, several reports have highlighted the role of ultrasonography for a better evaluation of SLE-related musculoskeletal symptoms. The symptoms have also been associated with worse outcomes in SLE; therefore, it is essential to seek useful and accessible techniques for better understanding of such patients who are insufficiently assessed by standard physical examination.

SAT0208 How good elderly rheumatoid arthritis patients respond at first year of treatment with certolizumab pegol

Background: In rheumatoid arthritis (RA), the efficacy and safety of Certolizumab pegol (CZP) is well stablished, as reported in randomized clinical trials (RCT)1 and some registries2. Only the 30% of RA patients are within the age range of 65 years or older. However, they are usually excluded from the RCT. Aging is associated with declining immune cell function and age-related comorbidities3,4. Objectives: The aim of this study was to determine the effectiveness and safety of CZP in elderly patients in a real world setting at 12 months follow-up. Methods: Observational longitudinal prospective study of RA patients from 40 sites in Spain. Variables (baseline, 3- and 12-month assessment): socio-demographics, smoking status, previous synthetic DMARD (sDMARD) and biological DMARD (bDMARD) use; TJC, SJC, ESR, CRP, DAS28. Response variables EULAR Moderate/Good Response and DAS28 remission and Safety were assessed. Low Disease Activity as DAS28 remission or mild DAS28. Descriptive, comparative and Logistic regression analyses were performed comparing <65 vs. >65 yr population. Kaplan-Meier survival curve was performed. Results: A total of 501 RA patients were included, 23% were aged ≥65 yr (mean age 70.8 (±4.5 SD)yr). Sociodemographics and baseline features are shown in table 1.Table 1 <65 >65 P Women 77.7% 80.7% NS Disease evolution (yr)- ≤2 yr 6.7 (±6.5 SD)-30.5% 10.4 (±9.1 SD)-18.3% <0.001-0.012 Smoking status:CurrentExsmoker never 19.9%13.6%66.5% 9.1%11.1%79.8% 0.024 Bio-naïve 56% 53.1%*previous Abatacept use was higher in >65 yr (p=0.017) NS Efficacy variables are shown in table 2. Variable <65 years ≥65 years p value DAS28 Remission (yes) 43% 31.3% 0.026 DAS28 Low Disease Activity 57.5% 47.3% NS DAS28 >1.2 score reduction 55.4% 60.7% NS EULAR Response 67.7% 75% NS CZP Retention rate 74.6% 67.5% NS Adverse Events 11.3% 19.3% 0.026 Commorbidities (yes) 34.8% 46.5% 0.024 The only associated factors to a better response in patients ≥65 yr were: higher DAS28 score, lower HAQ score and bio-naïve (p<0.05). Conclusions: The effectiveness of CZP among ≥65 yr only differed from their younger counterparts from DAS28 remission rate, with a lower percentage, and side-effects (higher percentage, with higher comorbidities percentage too). However, after one year of real-life data CZP seemed as both safety and effective enough as younger RA patients in real-life scenario. References [1]Keystone E, et al. Ann Rheum Dis2014Dec;73(12):2094–100. [2]Torrente-Segarra V, et al. Mod Rheumatol2015Nov 7:1–6. [3]van Onna M, et al. BMC Musculoskelet Disord2016;17:184. [4]Cross M, et al. Ann Rheum Dis2014;73:1316–22.1. Disclosure of Interest: None declared

FRI0387 Factors associated with osteoporosis and fracture in patients with sjÖgren primary syndrome

Background Primary Sjögren’s syndrome (SSp) is a systemic autoimmune disease characterised by exocrine gland affectation and multisystem involvement. In addition to the systemic inflammatory affectation, patients with pSS have additional risk factors to develop osteoporosis (OP) and its major complication, osteoporotic fracture. Objectives The aim of the study is to determine the sociodemographic and clinical factors of pSS associated with the presence of OP and osteoporotic fracture in patients with pSS from the SJOGRENSER registry. Methods SJOGRENSER is a descriptive, cross-sectional and multicenter study of patients with pSS classified according to European-American consensus criteria. Patients attended in consultations of 33 Spanish rheumatology services were randomly included. Both the medical history and the medical interview were used to obtain the data. Epidemiological, clinical, serological and complications were collected. The continuous and categorical variables were analysed by means, medians and frequencies, with their respective deviations and interquartile ranges (p25-p75). Bivariate and multivariate analyses were carried out using a binomial logistic regression to study the factors associated with osteoporosis and osteoporotic fracture in pSS. Results In the SJOGRENSER registry, 437 patients were included (95% women, with a median age of 58.63 (50.02–67.98) years). The prevalence of OP in the cohort was 18.54% (81 patientes). The prevalence of OP in men (n=21) was 19%, 2 men in the age group of 51–64 years and 2 in the group of >64 years. Three hundred of the women in the registry were menopausal (76.4%); a total of 67/300 women with menopausia had OP (15%). A total of 37 osteoporotic fractures (8.5%) were recorded in the cohort. Factors associated with OP in women with SSp in the bivariate analysis were: age (60.5% in the group of >64 years, 28% in the group of 51–64 years and 2.6% in the group ≤50 years, p<0.001), the time course of the disease (11.35 (SD 7.95) vs 7.8 (SD 6.14), p<0.001), the age of menopause (47(SD 7.29) vs 48.11 (SD 5.67), p=0.020), the ESSDAI (6 (DS 7) vs 4 (DS 5), p=0.020), and presence of anti-La (77.6% vs 64.7, p=0.030). In the multivariate analysis, there was an association between OP and age in the 51–64 age group, OR 9.993 (95% CI, 2.301–43.399, p=0.002), age >64 years, OR 20.610 (CI 95% 4.679–90.774, p<0.001) and time course of the disease, OR 1.046 (95% CI 1.008–1.085, p=0.017). Similarly, an association was found between the fracture and age in the 51–64 age group, OR 5.068 (95% CI, 1.117–22.995, p=0.035), age >64 years, OR 7.674 (95% CI 1.675–35.151, p<0.009), the time course of the disease, OR 1.049 (95% CI 1.003–1–097, p<0.036) and the ESSDAI score, OR 1.080 (95% CI, 1.029–1–134, p=0.002). Conclusions Patients with pSS have a considerable prevalence of osteoporosis and osteoporotic fracture. Age and time of evolution were factors associated with the development of OP, and similarly, age, time of evolution of the disease and ESSDAI were factors associated with the development of fracture in patients with pSS. Disclosure of Interest None declared