BackgroundCHIKV is suspected based on epidemiological and clinical criteria, however confirmation of the disease is only achieved by laboratory tests. Laboratory diagnosis is made by two approaches: the detection of viral RNA and identification of the specific immune response by serological methods. Serological tests are the most frequently used laboratory methods for the diagnosis of CHIKV. IgM is the first detected antibodies during 4 to 6 days after onset of symptoms followed by IgG. In Colombia, CHIKV's probable cases are not mandatory to be confirmed, so there is no standardization for laboratory confirmation testsObjectivesTo evaluate the performance of IgM and IgG antibodies against CHIKV in a cohort of patients with CHIKVMethodsIgM and IgG antibodies against CHIKV were measured by ELISA (AbcamÒ ab177835 and ab177835 anti-chikungunya virus IgM and IgG human ELISA kit, Cambridge, UK) technique in 604 patients with CHIKV suspicion. A typical case of CHIKV with high sensitivity and specificity obtained from a previous study was used as gold standard for diagnosis of CHIKV. Since CHIKV epidemic of 2014–2015 was the first to be reported in our country (Colombia), no second measurements of IgG were needed to confirmed infection.ResultsCut off point for IgG was 14,3 SU and for IgM was 11,2 SU. Mean values for IgG was 36,7 SU (±22,7) in patients with CHIKV and 8,6 SU (SD± 6,3) for IgM. Statistical significance was obtained for both IgG and IgM (p<0,0001) when comparing patients with and without CHIKV. Receiver operating characteristic (ROC) curves showed and area under the curve (AUC) of 0,81 for IgG and 0,65 for IgM (figure 1).ConclusionsOur study revealed a good performance of IgG and regular performance of IgM for the diagnosis of CHIKV in a cohort of CHIKV patients from Colombia's epidemic. Cut off points for both IgG and IgM were measured for future reference.Disclosure of InterestNone declared
BackgroundRheumatoid arthritis (RA) is a systemic chronic inflammatory disease characterized by joint destruction, deformity, lower functional status and decrease in life expectancy. Wnt signaling pathway recently it has been implicated in bone homeostasis. Studies suggest that overexpression of inhibitors of the way, like the Dickkopf 1 protein (DKK1) has been implicated in bone destructionObjectivesTo compare circulating levels of DKK1 in patients with RA to their disease activity and functional statusMethods379 consecutive patients with early and established RA were evaluated at the Hospital Militar Central in Bogota-Colombia, between March 2015 and November 2016. A complete medical history related to RA was obtained. Disease activity was evaluated by DAS28-CRP, CDAI, SDAI and RAPID3. functional status was measurement using MDHAQ and the Steinbrocker functional classification. DKK1 levels measured by ELISA using an Abcam® kitResultsThe mean age was 60,7±13,1 years, disease duration 13,1±10,9 years, 80,4% were female. Higher levels of DKK1 were not associated with higher disease activity by CDAI (p=0,70), SDAI (p=0,84), DAS28 with CRP (p=0,80) or RAPID3 (p=0,70). Interestingly Higher levels of DKK1 were significantly associated to greater disability and lower functional status according to the Steinbrocker functional grading (p=0.013) and with severe disability by MDHAQ (p=0.004), Table 1.Other variables associated with joint destruction were osteoporosis, elevated rheumatoid factor, smoking, and hospitalizationConclusionsHigher levels of DKK1 were found in patients with lower functional status. This association was not found in patients with greater disease activity according to CDAI, SDAI, DAS28 and RAPID3. This could be explaining by greater structural damage though more studies would be needed to explore this possibilityReferences Huizinga TW, Pincus T. In the Clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1–1-ITC-15. Disclosure of InterestNone declared
BackgroundWorld Health Organization suggested case definitions to suspect and diagnose chikungunya virus infection which are: possible case, probable case and confirmed case. Although useful, when applied in practice, its lack definition for specific joint involvement and absence of other systemic symptoms apart from fever, leads to a broad clinical spectrum which increases the need for laboratory tests.ObjectivesTo establish agreement on clinical criteria of CHIKV infection based on clinical expertise of specialists from affected areas of Colombia and to develop a set of clinical criteria.MethodsA group of specialists in rheumatology, epidemiology and bacteriology from different parts of Colombia with experience in diagnosis and treatment of CHIKV patients from the epidemic of 2014–2015 met to reach agreements on clinical characteristics of CHIKV infection. A series of questions were formulated and agreement in percentage was calculated on the following answers: totally agree, agree, not in agree or disagree, disagree and totally disagree. Agreement was set when the sum to the answers totally agree and agree or disagree and totally disagree of was ≥50%. When agreement was not reached, the moderator performed a discussion with the opinions of the confronting members of the group and after that reformulated the question. This procedure was made until agreement was reached. With the results a set of clinical criteria was proposed.ResultsThe agreement percentage to the formulated questions are depicted in table 1. Disagreement was achieved with mucosal imvolvement (100%), G/I involvement (88%), and arthralgia and arthritis in shoulders (63% and 100%) and in elbows (100%).Table 1.Agreement Percentage to Formulated Questions on CHIKV Clinical CharacteristicsDo you consider as clinical criteria:Totally AgreeAgreeNot in Agree or DisagreeDisagreeTotally DisagreeType of Agreement (Total) Symmetrical joint involvement1000000Agree (100)Abrupt onset of symptoms1000000Agree (100)Fever38501200Agree (78)Rash13750120Agree (88)Myalgia2575000Agree (100)Fatigue63251200Agree (88)Arthralgia in wrists502513012Agree (75)Arthritis in wrists75130120Agree (88)Arthralgia in hands8812000Agree (100)Arthritis in hands8812000Agree (100)Arthralgia in knees136301212Agree (76)Arthritis in knees136312012Agree (76)Arthralgia in ankles1000000Agree (100)Arthritis in ankles1000000Agree (100)Arthralgia in feet50380120Agree (88)Arthritis in feet75130120Agree (88)ConclusionsAgreement was achieved in abrupt onset of symptoms, and the presence of fever, rash, myalgia, fatigue, and symmetrical arthritis or arthralgia of wrists, hands, knees, ankles and feet. A set of clinical criteria was proposed (figure 1).Disclosure of InterestNone declared
BackgroundDuring 2014 and 2015 a chikungunya epidemic took place in Colombia concurrently with a COPCORD study across the country.ObjectivesTo describe the clinical characteristics of CHIKV infection in 6 different cities in Colombia and determine the most frequently associated clinical picture with CHIKV.MethodsWorld Health Organization criteria was used to identify CHIKV patients. A complete characterization and confirmation was established with CHIKV immunoglobulin G and IgM serology. Four possible scenarios were stablished: patients who met or not the criteria for probable case, and patients who met or not the criteria for confirmed case. P values were calculated between patients who met or not met the criteria. Sensibility and specificity was calculated for the WHO criteria.ResultsA total of 604 patients with MSK symptoms were evaluated in 6 different cities. The sociodemographic, clinical characteristics and joint involvement of the studied population is depicted in tables 1 and 2. Sensibility and specificity of the WHO criteria were 56.2% and 91.1% respectively (PPV: 83.3%, NPV: 74.4%).Table 1.Sociodemographic and Clinical Characteristics of Patients with Positive COPCORDWHO Probable Case CriteriaWHO Confirmed Case Criteria Met CriteriaDid Not Met CriteriaMet CriteriaDid Not Met Criteria (n: 180)(n: 424)(n: 150)(n: 454) Age (mean; SD) in years46,1±16,249,5±17,844,9±16,349,7±17,6*Gender Female (%)133 (73,9)285 (67,2)113 (75,3)305 (67,2)CHIKV IgG in SU (mean; SD)36,5±22,9*16,2±18,342,9±19,4*15,4±18,0CHIKV IgM in SU (mean; SD)9,0±6,9*6,6±5,19,8±7,2*6,5±4,9Fever (%)180 (100)*0 (0,0)150 (100)*30 (6,6)Rash (%)126 (70,0)*28 (6,6)109 (72,7)*45 (9,9)*p<0,005.Table 2.Clinical Characteristics of Joint InvolvementWHO Probable Case CriteriaWHO Confirmed Case Criteria Met CriteriaDid Not Met CriteriaMet CriteriaDid Not Met Criteria (n: 180)(n: 424)(n: 150)(n: 454) Symmetry (%) Arthralgia177 (98,3)*215 (50,7)147 (98,0)*245 (54,0) Arthritis85 (47,2)*14 (3,3)80 (53,3)*19 (4,2)Arthralgia (%) Elbows58 (32,2)*60 (14,2)48 (32,0)*70 (15,4) Wrists78 (43,3)*67 (15,8)65 (43,3)*80 (17,6) Hands120 (66,7)*126 (29,7)103 (68,7)*143 (31,5) Knees128 (71,1)*200 (47,2)107 (71,3)*221 (48,7) Ankles103 (57,2)*95 (22,5)92 (61,3)*106 (23,4) Feet71 (39,4)*94 (22,2)65 (43,3)*100 (22,0)Arthritis (%) Wrists17 (9,4)*4 (0,9)16 (10,7)*5 (1,1) Hands44 (24,4)*6 (1,4)42 (28,0)*8 (1,8) Knees21 (11,7)*4 (0,9)20 (13,3)*5 (1,1) Ankles43 (23,9)*8 (1,9)42 (28,0)*9 (2,0) Feet40 (22,2)*7 (1,7)39 (26,0)*8 (1,8)Myalgia (%)130 (72,2)*35 (8,3)106 (70,7)*59 (13,0)Fatigue (%)165 (91,7)*41 (9,7)137 (91,3)*69 (15,2)*p<0,005.ConclusionsOur study shows a clear clinical picture of systemic symptoms, high titters of CHIKV immunoglobulins, and a defined joint involvement, which will help clinicians to identify and differentiate CHIKV infection from other viral infections and MSK diseases. Also, the sensibility of the WHO criteria applied to our cohort of patients demonstrates the need to improve clinical criteria without the use of laboratory tests.Disclosure of Interes...
BackgroundA main challenge in spondyloartritis (SpA) management was the availability of reliable biomarkers related with disease activity, or predicting joint damage and the response to treatment. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are currently used as biomarkers for disease activity, they lack sensitivity, specificity and reproducibility. With the understanding of SpA pathogenesis, additional biomarkers like metalloproteinase 3 (MMP-3), interleukin (IL)-1a, IL-6, lipopolysaccharide-binding protein (LBP), tumour necrosis factor a (TNFa), macrophage colony stimulating factor (M-CSF), interferon gamma (INF-g), IL-17 and IL-23, had been proposedObjectivesWe aimed to evaluate the associations of MMP-3, IL-1a, IL-6, M-CSF, LPB, IL-17 and IL-23 levels in SpA patients positive for HLA-B27 or HLA-B15Methods178 patients (100 men and 78 women) with SpA according to ASAS criteria were included in the study. HLA typing was performed by PCR using the Biorad® HLA-SSP ABDR plates. The levels of TNFa, IL-1a, IL-6, INF-g and IL-17 were measured by a cytometric bead-array (CBA Flex Set) using a FACS Canto II Flow CytometerÔ. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of IL-23, M-CSFand MMP-3. CRP and LBP levels were measured by chemiluminescence. Statistical analysis was made with SPSS v19. For comparison of quantitative variables with a normal distribution we used the Student's t-test. Categorical variables were presented in frequency charts and percentages, and the Chi-squared test and Fisher's exact test were used when necessary, for comparing groups. Two-tailed P-value <0.05 was considered statistically significantResultsOf the 178 patients, 70 were positive for HLA-B27, 34 for HLA-B15 and 74 had other HLA-B. According to ASAS classification criteria, 152 patients had axial SpA (axSpA) manifestations, 161 had peripheral SpA (pSpA) manifestations, and 148 patients had mixed axial and peripheral manifestations. Figure 1 shows the mean levels of inflammatory serologic biomarkers in these subgroups of patientsConclusionsHigh levels of IL-17 and IL-23 were associated with the presence of HLA-B27, which mainly correlates with an axial presentation of the disease as compared to HLA-B15 patients. Accordingly, the genotype (presence of HLA-B27 or HLA-B15) and phenotype (axial or peripheral involvement) may help physicians when considering a targeted therapy of SpA patients with IL-17 inhibition in a context of personalized medicineDisclosure of InterestNone declared
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