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BackgroundCardiovascular disease (CVD) is a major cause of morbidity and mortality in rheumatoid arthritis (RA) patients. It has been postulated that chronic inflammatory activity is important for the development of CVD in RA even after adjustment for traditional cardiovascular risk factors.(1) One of the changes occurring in the context of inflammation is citrullination. Development of anti-citrullinated protein antibodies (ACPA) is implicated in higher frequency of extra-articular manifestations including cardiovascular complications.(2)ObjectivesTo assess the relation of ACPA to subclinical cardiac affection in RA patients.MethodsThirty RA patients fulfilling the 2010 ACR-EULAR classification criteria for RA with no clinically evident CVD were subjected to full history taking and clinical examination. Disease activity was assessed by 28-joint disease activity score based on C-reactive protein (DAS28-CRP) (4 variables). The levels of ACPA, CRP, total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol were measured. The patients were subjected to M-mode and colour Doppler echocardiographic examination.Patients were subdivided into two subgroups according to ACPA positivity (ACPA positive patients represented “group A” and ACPA negative patients represented “group B”).ResultsThe frequency of subclinical cardiac affection by echocardiographic examination was significantly higher among group A patients (4 patients had valvular lesion and 9 patients had diastolic dysfunction) than in group B patients (3 patients had diastolic dysfunction), (p=0.011). ACPA level showed significant positive correlation with isovolumic relaxation time (IVRT) in group A patients (prolongation of IVRT is a sign of diastolic dysfunction), (p=<0.001).Comparison between the two studied groups according to subclinical cardiac affectionGroup A (n=18)Group B (n=12)Test of sig. p No.%No.% Subclinical cardiac affectionPresent1372.2325.0FEχ2=6.4510.011*Absent527.8975.0FE: Fisher Exact for Chi square test, χ2: Chi square test. *Statistically significant at p≤0.05.ConclusionsThe presence of ACPA is related to development of subclinical cardiac involvement in RA patients and all RA patients with high level of ACPA should be routinely evaluated with echocardiography to assess their cardiovascular status.References Arnab B, Biswadip G, Arindam P, Shyamash M, Anirban G, Rajan P. Anti-CCP antibody in patients with established rheumatoid arthritis: Does it predict adverse cardiovascular profile? J Cardiovasc Dis 2013; 4(2):102–6.Crowson C, Liao K, Davis J, Solomon D, Matteson E, Knutson K, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J 2013; 166(4):622–28. Disclosure of InterestNone declared

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Objectives We aimed to compare the effects of different aerobic exercise training (ET) programs on respiratory performance, exercise capacity, and quality of life in fibrosing interstitial lung diseases (f-ILD). Methods A case-control study where 31 patients with f-ILD diagnosis based on chest high-resolution computed tomography were recruited from Main Alexandria University hospital-Egypt. Ten patients were randomly assigned for only lower limbs (LL) endurance training program, and 10 patients for upper limbs, lower limbs, and breathing exercises (ULB) program for consecutive 18 sessions (3 sessions/week for 6 consecutive weeks). Eleven patients who refused to participate in the ET program were considered as control. All patients were subjected for St George’s respiratory questionnaire (SGRQ), 6-minute walk test (6-MWT), forced spirometry and cardiopulmonary exercise testing (CPET) before and after ET programs. Results Fibrosing non-specific interstitial pneumonia (NSIP) and collagenic associated-ILD were the commonest pathologies among the ET groups (30% each) with mean age of 44.4±12.25 and 41.90±7.58 years for LL and ULB groups respectively and moderate-to-severe lung restriction. 6-MWT and SGRQ significantly improved after both ET programs (p<0.001). Peak oxygen consumption (VO2) improved significantly after both LL training (median of 22 (interquartile range (IQR) = 17.0–24.0) vs. 17.5 (IQR = 13.0–23.0) ml/kg/min, p = 0.032) and ULB training (median of 13.5 (IQR = 11.0–21.0) vs. 10.5 (IQR = 5.0–16.0) ml/kg/min, p = 0.018). Further, maximal work load and minute ventilation (VE) significantly improved after both types of ET training (p<0.05); however, neither ventilation equivalent (VE/VCO2) nor FVC% improved after ET (p = 0.052 and 0.259 respectively). There were no statistically significant important differences between LL and ULB training programs regarding 6-MWT, SGRQ or CPET parameters (p>0.05). Conclusions ET was associated with improvements in exercise capacity and quality of life in f-ILD patients irrespective of the type of ET program provided.

To report normative data for diaphragmatic compound muscle action potentials (DCMAPs) recorded from over the sternum and lateral chest wall (LCW) and highlight factors that may contribute to variations in DCMAP parameters at the two sites. The phrenic nerve of seventy-three healthy subjects was bilaterally stimulated at the posterior border of the sternocleidomastoid muscle. DCMAPs from over the sternum and LCW were recorded (inspiration/expiration). Normative values of sternal and LCW DCMAPs were presented. The mean values of latency of LCW DCMAPs, duration of sternal DCMAPs and area from both recording sites are close to values reported by other studies. The mean values of latency of sternal DCMAPs are higher than that reported by other studies. Significant differences were found between sternal and LCW potentials in the mean latency, amplitude, and area (p < 0.001). The duration did not differ between the two sites. Differences were found between inspiration and expiration, right and left sides, and men and women. Regression analysis showed a relation between latency of sternal and LCW potentials and age. Latency (LCW potentials) and amplitude and area (sternal/LCW potentials) were related to gender. Amplitude (LCW potentials/inspiration) and area (sternal potentials/inspiration) were related to chest circumference (p = 0.023 and 0.013 respectively). Area (sternal potentials/expiration) was related to the BMI (p = 0.019). Our normative values for sternal and LCW DCMAPs are provided. Notable differences in the DCMAPs parameters were detected between the two recording sites, inspiration and expiration, right and left, and men and women. The technique of phrenic nerve should be standardized.

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Objectives:To report normative data for diaphragmatic compound muscle action potentials (DCMAPs) recorded from over the sternum and lateral chest wall (LCW).Method:The phrenic nerve of seventy-three healthy subjects was bilaterally stimulated at the posterior border of the sternocleidomastoid muscle. DCMAPs from over the sternum and LCW were recorded (inspiration/expiration). Results: Normative values of sternal and LCW DCMAPs were presented. Significant differences were found between sternal and LCW potentials in the mean latency, amplitude, and area (p<0.001). The duration did not differ between the two sites. Differences were found between inspiration and expiration, right and left sides, and men and women. Regression analysis showed a relation between latency of sternal and LCW potentials and age. Latency (LCW potentials) and amplitude and area (sternal/LCW potentials) were related to gender. Amplitude (LCW potentials/inspiration) and area (sternal potentials/inspiration) were related to chest circumference (p=0.023 and 0.013 respectively). Area (sternal potentials/expiration) was related to the BMI (p=0.019). Conclusions: Our normative values for sternal and LCW DCMAPs are provided. Notable differences in the DCMAPs parameters were detected between the two recording sites, inspiration and expiration, right and left, and men and women. Significance:The technique of phrenic nerve should be standardized.