BackgroundSpondyloarthropathies (SpAs) are a group of auto-inflammatory diseases, with overlapping symptoms, that include ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated spondyloarthritis (Und SpA), enteropathic arthritis, and reactive arthritis (1). Historically, SpAs have been viewed as diseases that predominantly affected men (2).ObjectivesTo analyze the influence of gender on disease patterns and therapeutic approach in a large cohort of Colombian patients with SpAs.MethodsA cross-sectional study was conducted in 621 patients with SpAs, in whom clinical and therapeutic characteristics were analyzed based on gender. Statistical association was examined by means of Chi-square tests, Mann-Whitney test, and logistic regression analyses.ResultsThe male-to-female ratio was 1,1:1 in this cohort. Younger age at diagnosis was found in males. AS was the most frequent disease (54,7%), followed by PsA (35,7%), and undifferentiated SpA (9,5%). The male gender was positively associated to the presence of AS (OR 2,29 95%IC 1,31–4,04), radiographic sacroilitis (OR 3,46 95%IC 1,82–6,56), HLAB27 positivity (OR 1,95 95%IC 1,31–2,91), low back pain (OR 1,85 95%IC 1,34–2,54) and axial involvement (OR 1,98 95%IC 1,42–2,77). According to the therapeutic profile, female gender was positively associated to the use of conventional DMARD therapy (i.e., methotrexate (p=0,03), leflunomide (p=0,0057), chloroquine (p=0,013)), while male patients were more associated to the use of biologic therapy.Table 1.General characteristics of patients with SpAs by genderAll (N=621)Male (N=328)Female (N=293)p-value Age (mean)49,448,650,20,15Age at diagnosis (mean)38,937,240,6 0,0042 Years of evolution (mean)9,810,69,1 0,02 N%N%N%Age at onset <45 years46975,525778,321272,30,008Diagnosis AS34054,720863,413245,1 PsA22235,79629,212643 <0.0001 Und SpA599,5247,33511,9Low back pain34255,120462,213847,1 0,0002 Arthritis41166,221565,519666,90,72Enthesitis21734,912538,19231,40,08Dactylitis11618,65416,46221,20,13Uveitis9214,85215,84013,60,44Psoriasis22536,29829,812743,3 0,0005 Sacroilitis (Rx)70/17140,946/8256,124/8926,9 0,0001 Sacroilitis (MRI)203/27972,7102/13675101/14370,60,41HLA-B27284/43864,8176/24671,5108/19256,2 0,0009 Axial39763,923471,316355,6 <0.0001 Peripheral48878,625477,423479,80,46Both26442,516048,810435,5 0,0008 ConclusionsIn this Colombian large sample with SpA, male patients have a younger onset of disease, higher proportion of axial involvement, HLAB27 positivity, evidence of radiographic sacroilitis and higher use of anti-TNF therapy.References Roussou E, Sultana S. Spondyloarthritis in women: differences in disease onset, clinical presentation, and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides. Clin Rheumatol. 2011;30(1):121–7.Ibn Yacoub Y, Amine B, Laatiris A, Hajjaj-Hassouni N. Gender and disease features in Moroccan patients with ankylosing spondylitis. Clin Rheumatol. 2012;31(2):293–7. Disclosure of InterestNone declared
BackgroundSpondyloarthropathies (SpAs) are a group of auto-inflammatory diseases, with overlapping symptoms, that include ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated spondyloarthritis (Und SpA), enteropathic arthritis, and reactive arthritis (1).ObjectivesTo characterize the disease in a large Colombian cohort with SpAs, assessing differences in its classification, clinical manifestations, laboratory results, radiographic changes, and treatment, according to the type of SpA.MethodsA cross-sectional study was conducted in 621 patients with SpAs, in whom sociodemographic, clinical and therapeutic characteristics were analyzed based on the type of diagnosis. Statistical association was examined by means of Chi-square tests, Fisher's exact test, Mann-Whitney test, and logistic regression analyses. In all cases, a p value <0.05 was considered significant.ResultsOut of the 621 patients included, AS was observed in 54,7%, PsA in 35,7%, and Und SpA in 9,5%. AS was positively associated to male gender (OR 2.05 95%IC 1.5–2.8), younger age at onset, axial involvement (OR 23.2 95%IC 15.2–35.5), uveitis (OR 3.8 95%IC 2.25–6.57), radiographic sacroilitis (OR 6.95 95%IC 3.02–16.02), and HLA-B27 positivity (OR 2.3 95%IC 1.5- 3.5). PsA was associated to female gender, older age at onset, arthritis, and peripheral involvement. According to the therapeutic approach, more use of conventional DMARD therapy was found in PsA and Und SpA, while more use of biology therapy in AS.Table 1.General characteristics of patients with SpAsAllASPsAUnd SpAp-value N=621N=340N=222N=59 N%N%N%N% Mean (SD) Age, year49.3 (12.4)45.2 (12.5)56.7 (11.8)45.9 (12.9) <0.0001 Age at diagnostic, year40.1 (12.9)33.5 (12.6)46.8 (13.5)39.9 (12.5) <0.0001 Male32852.820861.19643.22440.6 <0.0001 Age at onset, <45 years46975.529185.514063.13864.4 <0.0001 Low back pain34255.126678.24721.22949.2 <0.0001 Arthritis41166.215244.7213964678 <0.0001 Enthesitis21734.913640.3716.74474.60.38Dactylitis11618.74914.44520.32237.3 0.0002 Psoriasis22536.230.8822199.611.7 <0.0001 Uveitis9214.87522.173.21016.9 <0.0001 Family history10817.45516.24721.2610.20.09Sacroilitis (Rx)70/17140.962/11653.57/3718.91/185.6 <0.0001 Sacroilitis (MRI)203/27972.8182/21285.921/3953.90/280.0 <0.0001 HLA-B27284/43864.8229/32171.317/6127.938/5667.9 <0.0001 Axial39763.932896.53716.83254.2 <0.0001 Peripheral48878.621362.621898.25796.6 <0.0001 Both26442.520159.13314.93050.9 <0.0001 SD, standard deviation; Rx, radiography; MRI, Magnetic resonance.ConclusionsTo our knowledge, this is the larger existing cohort with SpAs in Colombia. Understanding the natural history of disease is important to do an early diagnosis and treatment that could prevent irreversible disability.References Ehrenfeld M. Spondyloarthropathies. Best Pract Res Clin Rheumatol. 2012;26(1):135–45. AcknowledgementsNone.Disclosure of InterestNone declared
BackgroundScreening latent tuberculosis (TB) and other opportunistic infections in patients with spondyloarthropathies (SpA) with biologic or immunosuppression therapy is important in highly endemic population (1).ObjectivesTo assess the prevalence of latent and active TB, hepatitis B, hepatitis C, HIV and Syphilis in a colombian cohort with SpA, as well as evaluate differences between treatments.MethodsA cross-sectional study was conducted in 621 patients with SpAs, in whom TB, hepatitis B, hepatitis C, HIV and syphilis screening was analyzed based on type of diagnosis. Differences among immunomodulatory therapies were assessed. Statistical association was examined by means of Chi-square tests, Mann-Whitney test, and logistic regression analyses.ResultsThe prevalence of latent and active TB in this cohort were 63,1%, and 2,9%, respectively. Significant differences were found in proportions of latent and active TB among types of SpAs, indicating a positive association with AS. A high proportion of TST conversion during immunotherapy was found. According to the immunomodulatory therapy, no differences were found among latent TB patients, active TB disease and no infection with the use of conventional DMARD therapy, but a positive association between latent TB and the use of biologic therapy was recognized. Low prevalences of opportunistic infections (i.e., Hepatitis B and C, syphilis and HIV) were found in this cohort, dispite the frequent use of biologic therapy.Table 1.Infectious profile in colombian patients with SpAsAllASPsAUnd SpAp-value N=621N=340N=222N=59 N%N%N%N% Latent TB251/39863,1156/24463,976/12660,319/2867,90,009Positive TST before immunotherapy175/3984498/24440,264/12650,813/2846,40,64TST conversion during immunotherapy76/39819,159/24424,213/12610,34/2814,3<.0001Active TB182,9123,541,823,40,03Latent TB conversion to active TB71,161,810,40–0,04Active TB during immunotherapy111,8102,910,40–0,008Hepatitis B11/4002,84/2411,76/1284,71/313,20,32Hepatitis C2/4000,52/2410,80/128–0/31–0,61VDRL test2/2850,71/1670,61/941,10/24–0,38HIV3/3300,92/19710/111–1/224,50,14Ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated spondyloarthritis (Und SpA), tuberculin skin test (TST).ConclusionsIn a TB-endemic population, higher prevalences of latent and active TB were found in patients with SpAs, when compared to the general population. Complete infectious screening is mandatory in patients under consideration of biologic agents, and close follow-up must be done to recognize TST conversion.References Pérez-Díaz CE, Uribe-Pardo E, Calixto OJ, Faccini-Martínez ΆA, Rodriguez-Morales AJ. Infections with biological therapy: strategies for risk minimization in tropical and developing countries. J Infect Dev Ctries. 2016;10(12). Disclosure of InterestNone declared
BackgroundLupus nephritis (LN) is one of the major indicators of poor prognosis in patients with systemic lupus erythematosus (SLE). Multiple studies with Latin-American SLE population have shown a higher prevalence of LN, higher severity, and less favorable outcomes (1).ObjectivesTo determine the incidence of lupus nephritis and end-stage renal failure, as well as evaluate progression of renal function and proteinuria during an 18-month follow up in colombian patients with SLE.MethodsA retrospective cohort study was conducted in 1448 patients with SLE, 41 of which were diagnosed with LN between August/2014 and July/2015. Follow up was made for 18 months, analyzing glomerular filtration rate (GFR) and proteinuria, induction and manteinance therapy, renal relapses, hospitalizations and mortality. Univariate analysis was done to describe sociodemographic and clinical variables. Longitudinal data analysis was performed using linear mixed models with random intercepts. In all cases, a p value <0.05 was considered statistically significant.ResultsClinical characteristics of patients with LN are shown in table 1. Eighty-five percent of LNs where biopsy-proven. Incidence of LN was 2,83 cases/100 SLE patients/year. The incidence of end-stage renal failure was 7,31 cases/100 LN patients. During the 18-month follow up, 34% of patients had hospitalizations related to SLE activity or complications, 7,3% renal relapse, 2,4% rebiopsy, and no mortality cases. Induction therapy was done with cyclophosphamide in 58,5% and with mycophenolate mofetil in 41,4%, with 30% of the patients requiring re-induction therapy, Ten percent of patients required use of rituximab due to refractory response to multiple treatments. In longitudinal linear analyses, age at diagnosis and anti dsDNA was positively associated to GFR variations (Figure 1,A), while anti Sm, hematologic involvement and biopsy classification were associated to proteinuria variations during time of follow-up (Figure 1,B).Table 1.Clinical characteristics of patients with lupus nephritisCharacteristic (N=41)Mean (SD) Age37,2 (11,2)Age at diagnosis32,2 (11,1)Years of evolution4,6 (4,4)N (%)Female38 (92,7)Malar rash11 (28,2)Discoid lupus2 (4,9)Photosensitivity18 (46,1)Oral ulcers14 (34,1)Serositis16 (44,4)Arthritis31 (75,6)Neurological involvement5 (12,2)Hematological involvement32 (78)ANAs (+)39/39 (100)Anti dsDNA (+)29/41 (70,7)Anti Sm (+)17/35 (48,6)Anti Ro (+)19/36 (52,7)Anti La (+)10/34 (29,4)Anti RNP (+)18/36 (50)ConclusionsIn a real life scenario, anual incidence of lupus nephritis was 2,83 cases/100 SLE patients. A high proportion of patients with refractory response to multiple immunomodulatory treatments for LN were identified.References Pons-Estel GJ, Catoggio LJ, Cardiel MH, Bonfa E, Caeiro F, Sato E, et al. Lupus in Latin-American patients: lessons from the GLADEL cohort. Lupus. 2015;24(6):536–45. Disclosure of InterestNone declared
BackgroundThe idiopathic inflammatory myopathies (IIM) are a group of immune-mediated systemic conditions characterized by chronic muscle inflammation, resulting in muscle weakness (1).ObjectivesTo characterize the disease in a Colombian cohort with idiopathic inflammatory myopathy, assessing differences in its classification, cutaneous and systemic manifestations, laboratory results, and therapeutic approach, according to the type of myopathy.MethodsA cross-sectional study was conducted in 112 patients, in whom sociodemographic, clinical and therapeutic characteristics were analyzed based on the type of myopathy. Statistical association was examined by means of Chi-square tests, Mann-Whitney test, and logistic regression analyses.ResultsFrom the 112 patients recruited, 59 had polymyositis (PM) and 53 had dermatomyositis (DM). The patients were classified with Peter & Bohan criteria as: “definite” diagnosis 67 (60%), “probable” 35 (31%) and “possible” 9 (10%). A high proportion of males were found in this cohort. Our most notable findings are listed in Table 1, noticing for this population a high rate of polyautoimmunity associated to PM (OR 3.81 95%IC 1,003–14,53) and an association between ANAs antibodies positivity and DM (OR 7.03 95%IC 2,16–22,9). Patients with PM presented higher values of CK, LD and transaminases. Also, according to the therapeutic approach, PM was positively associated with the use of azathioprine and immunoglobulins (OR 2,59 95%IC 1,18–5,69 and OR 3,21 95%IC 1,19–8,19, respectively), while chloroquine and hydroxychloroquine were mainly used in DM patients.Table 1.Sociodemographic and clinical characteristics of Colombian patients with idiopathic inflammatory myopathyPolymyositisDermatomyositisp-value N=59N=53 N%N% Female4169,535660,69Age (mean)54,349,40,09Clinical characteristics Symmetrical muscle weakness591005196,20,13 Gottron's papules0–4992,4 <0.0001 Heliotrope rash0–3566 <0.0001 Shawl sign/ V sign0–2954,7 <0.0001 Polyautoimmunity1118,635,6 0,03 Muscle enzymes in serum CK (median)38251012 0,006 LD (median)554433 0,003 ALT (median)8746,3 0,01 AST (median)7238 0,005 Aldolase813,559,40,43Autoantibodies ANA (+)2745,73871,7 0,0006 Anti-Jo1 (+)23,423,80,74EMG Myophatic changes4169,52750,90,34Biopsy-proven myopathy Positive3050,81630,20,7SES, socioeconomic status; CK, creatine phosphokinase; LD, lactate dehydrogenase; AST, aspartate transaminase; ALT, alanine transaminase; EMG, electromyogram.ConclusionsIn this Colombian sample, a high proportion of patients were classified as definite diagnosis, high frequency of male-gender compromise, low association with cancer, and low prevalence of articular, pulmonary and cardiac involvements were found.References Rosa J, Garrot LF, Navarta DA, Saucedo C, Scolnik M, Bedran Z, et al. Incidence and prevalence of polymyositis and dermatomyositis in a health management organization in Buenos Aires. J Clin Rheumatol. 2013;19(6):303–7. Disclosure of InterestNone declared
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