Introduction: The aim of this study is to assess the relationship among inflammatory charge, cardiovascular risk and bone metabolism in patients with rheumatoid arthritis initiating biological therapy treatment. Patients and methods: This is a prospective cohort study conducted in patients diagnosed with active rheumatoid arthritis (RA) assessed in the Rheumatology Unit and initiating biological therapy. Patients will be selected consecutively, with preliminary data on 14 patients. We present preliminary data from 14 patients. Results: Reduced Dickkopf-1 (DKK1) concentrations after commencing biological therapy were detected (baseline: 53.12±60.43 pg/ml vs 6 months 13.5±23.2 pg/ml, p=0.307) but without statistical significance. Changes were found in markers for bone remodeling with increased osteocalcin levels and CTX which were not statistically significant either. Conclusions: We observed a nonsignificant decrease in DKK1 serum in patients with active RA treated with biologic therapy. Expanding the scope of study subjects and pending biochemical determinations will allow us, in the near future, to establish more precisely this link and the relationship of DKK1, bone remodeling, biological therapy and cardiovascular disease in RA patients.
Background The antimalarial drugs are considered safe and well tolerated, with minimal risk of side effects. Hydroxychloroquine is considered safer but less effective than chloroquine, although the choice remains a matter of debate and is generally dependent on the experience. Both can cause ocular toxicity corneal and retinal deposition. The latter produces irreversible alterations of the vision and the patient may not perceive his presence at an early stage so regular eye tests are recommended Objectives To study the incidence of retinal toxicity in patients treated with antimalarials in a Rheumatology consultation. Methods We conducted a retrospective study of 39 patients treated with antimalarials in rheumatology consultation who were referred to ophthalmology to study retinal toxicity during 2011. Data collection included demographic data of patients, type of antimalarial prescribed, daily and cumulative doses, base rheumatic disease, corticosteroid use, associated morbidity and ophthalmological examination. Results Five out of 39 patients had alterations in the SD-OCT, and two out of these five were also observed in the funduscopy. Among the patients with retinopathy, three had been treated with chloroquine (CQ) and two with hydroxychloroquine (HCQ). The average duration of treatment in these patients was 2.37±1.37 years and the mean cumulative dose of CQ was 559 g and 172.5 g for HCQ. There is no statistically significant association between retinal toxicity and sex, age, rheumatic disease, duration or dose of treatment with p value greater than 0.05. Conclusions The incidence of retinal toxicity in our patients treated with antimalarial drugs was 12.8%. Chloroquine was the antimalarial that caused most of cases of retinopathy and the most sensitive test to detect it was the SD-OCT. References Peponis V, Kyttaris VC, Chalkiadakis SE, Bonovas S, Sitaras NM. Ocular side effects of antirheumatic medications: what a rheumatologist should know. Lupus. 2010;19(6): 675-682 Wolfe F, Marmor MF. Rates and predictors of hydroxochloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2010;62(6): 775-84 Levy GD, Munz SJ, Pachal J, Cohen HB, Pince KJ, Peterson T. Incidence of hydroxychloroquine retinopathy in 1207 patients in a large multicenter outpatient practice. Arthritis Rheum 1997; 40: 1482-6. Kobak S, Deveci H. Retinopathy due to antimalarial drugs in patients with connective tissue diseases: are they so innocent? A single center retrospective study. Int J Rheum Dis. 2010 Aug;13(3):e11-5. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011 Feb;118(2):415-22 Disclosure of Interest None Declared
BackgroundIt is known that some rheumatologic disorders may affect the cardiovascular system. In the last years, psoriatic arthritis (PsA) has been pointed out as one of those.ObjectivesThe aim of this study was to analyze if there was any subclinical dysfunction sign in patients with PsA of whom no cardiovascular disease had been diagnosed.MethodsForty three patients with PsA were studied. A comprehensive echocardiogram was performed. Variables recorded for each patient were: left ventricular (LV) dimensions, LV and right ventricular (RV) systolic function, valve morphology and function, LV diastolic function assessment, and longitudinal strain (LS) assessment with speckle tracking imaging. Information on age, sex, cardiovascular risk factors (hypertension, diabetes, dyslipemia, renal disease and smoking), and evolution time of PsA was also recorded. An electrocardiogram was also carried out for each patient.ResultsThere were 23 men and 20 women. The mean age was 52±12 years old. The PsA mean evolution time was 6.8±5.3 years. Most of patients had at least one cardiovascular risk factor. All patients were in synusal rhythm. The LV end-diastolic diameter and ejection fraction, left atrium, and RV function were within normal limits. Men had overall a thicker interventricular septum (12±1.7 mm) when compared to women (9.7±1.6mm). 86% patients had a normal mitral valve function, as so 91% with aortic valve. None of them had findings suggesting pulmonary hypertension, or pericardial effusion. The diastolic function assessment in the general population revealed normal average of septal and lateral A' and S waves peak velocities, and E/E' ratio. Men had lower septal E' and S waves values and higher septal A' wave velocity. Nearly 50% of patients had a low septal E' or lateral E' wave peak velocity. 13 patients (30%) had impaired both septal E' and lateral E' waves, who were older and mainly men. The strain analysis showed an average of global LS - 17.9%±3%, two-chambers general LS -17.2%±5%, three-chambers general LS -19%±5.2%, and four-chambers general LS -17.3%±3.5%; without any significant difference between sex. 26 patients (60.5%) had global LS above normal limits; these were younger and with less PsA evolution time. Longitudinal strain values tended to be less negative at the basal level.ConclusionsHalf of the patients with PsA were found to have some feature of diastolic dysfunction and more than the half of them had a slightly impaired global longitudinal strain value. Further studies could be of value to determine whether these findings would have a specific impact on the follow-up in this kind of patients.Disclosure of InterestNone declared
Introduction: Previous studies have linked the Wnt pathway in the alteration of bone metabolism and cardiovascular pathology. Also, the control of inflammation with biological therapy has a positive effect on bone mineral density (BMD) and cardiovascular risk. The aim of the study was to evaluate the effect of biological therapy in patients with rheumatoid arthritis, naïve to these therapy, on the inflammatory load and its relation with cardiovascular risk and bone metabolism. Patients and methods: Prospective cohort study performed in patients diagnosed with active rheumatoid arthritis (RA) initiating biological therapy. Patients were selected consecutively not selected. The serum concentrations of Dickkopf-1 protein (DKK1) and sclerostin were collected, both by means of the ELISA method (Biomedica Medizinprodukte GmbH and Co. KG, Vienna, Austria); demographic and clinical variables, markers of bone remodeling, hip and lumbar spine BMDs were measured by dual energy X-ray absorptiometry (DXA), measurement of intima-media thickness (IMT), evaluation cardiovascular risk by Systematic Coronary Risk Evaluation (SCORE). Results: 46.7% of patients presented EULAR response to treatment at 12 months. Only in this subgroup of patients, we found in the subgroup of patients an increase in the concentrations of DKK1 following the initiation of biological therapy (baseline 20.55±8.13 pg/ml vs 12 months 31.20±4.88 pg/ml, p=0.03). Regarding markers of bone remodeling, an increase in osteocalcin levels (baseline: 11.25±3.28 ng/ml vs 12 months 15.78±4.11 ng/ml, p=0.01). There was no change in IMT or SCORE at 12 months of treatment. Conclusions: In patients with RA treated with biological therapy who presented EULAR response we observed a significant increase in serum concentrations of DKK1 at 12 months of treatment not associated with changes in bone metabolism and cardiovascular risk.
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