BackgroundPlasma d-dimer (DD) has proven to be a reliable marker of a systemic prothrombotic state and its measurement might be helpful in predicting cardiovascular events and even mortality across a broad variety of diseases. An association between high levels of DD and macrovascular disease, diffuse cutaneous involvement and active disease has been suggested in patients with SSc.ObjectivesTo determine the usefulness of DD measurement as a marker of macrovascular disease and mortality in patients with SSc. To explore its relation with other features and biomarkers of SSc.MethodsDescriptive ambispective observational study. We included, consecutively from 2010 to 2015, SSc patients controlled in a tertiary hospital. We gathered demographic, clinical, and analytical variables, including DD levels measured by turbidimetric immunoassay (ACL TOP 700 CTS, Werfen Spain). Other variables were collected retrospectively from the electronic medical record. We explored the extracranial branches of the carotid artery (ESAOTE MyLab XV70, 7–12 MHz linear probe, software RFQIMT) measuring intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques, as per the Mannheim consensus, was registered. The ankle-brachial index (ABI) was measured by a Vascular Surgeon. We considered an IMT>900 µ and/or presence of atheroma plaque and/or an ABI <0.9 as macrovascular damage. We prospectively collected mortality until dec-2017. Statistical analysis was performed using SPSS 17.0 software.Results115 patients where included consecutively, of which finally 100 were studied (91 women, 9 men), with a mean age of 60.2 years (SD 15). Mean SSc evolution time was 13.9 years (SD 11.2). LSSc was most frequently diagnosed (50%), followed by DSSc (18%), SSc without scleroderma (17%), overlap syndrome (9%) and pre-SSc (6%). 37% of patients were hypertensive, 45% dyslipidemic, and 7% were diabetic. Overall, 40% had macrovascular damage. The mean values of DD were 437.6 ng/mL (SD 683.5), 60% of the patients having levels of DD (>250 ng/mL). During follow up, there were 16 deaths, 50% due to vascular events. Baseline high levels of plasma DD were associated to macrovascular damage and ischaemic digital ulcers, together with advanced age, arthritis, inflammation biomarkers, HTA, sPAP, lower DLCO% and coexistence of an inflammatory disease (overlap, infection, neoplasia), and showed a tendency to an association with mortality. This association became statistically significant when considering DD plasma levels as a quantitative variable (p<0.001) and remained significant after adjustments (age, coexistence of an inflammatory disease) (p 0,003).ConclusionsDD plasma levels are associated with macrovascular involvement and can be helpful in predicting medium-term mortality in our SSc patients. Levels of plasma DD can be modified by systemic inflammation.Disclosure of InterestNone declared
BackgroundRheumatoid arthritis (RA) is an autoimmune inflammatory disease associated with accelerated atherosclerosis and increased cardiovascular (CV) disease. Elevated levels of the C-reactive protein (CRP) are related to an increase risk of coronary artery disease [1] and stroke [2]. Recently, PCR, GCKR, HNF1A, LEPR, ASCL1 and NLRP3 have been associated with CRP levels in non-rheumatic population [2].ObjectivesWe aimed to determine the potential role of these genes in the development of CV disease and subclinical atherosclerosis in patients with RA.MethodsGenotyping was performed in 2,384 Spanish RA patients by TaqMan assays. Subclinical atherosclerosis was determined by carotid ultrasonography (US) in 1,193 patients.ResultsNo statistically significant differences were found when PCR, GCKR, HNF1A, LEPR, ASCL1 and NLRP3 were assessed according to the presence/absence of CV disease. It was also the case when patients were stratified according the presence/absence of subclinical atherosclerosis.ConclusionsOur results do not confirm an association between these genes and the development of CV disease and subclinical atherosclerosis in patients with RA.ReferencesDanesh et al. N Engl J Med 2004, 350(14):1387–1397;Ridker et al. N Engl J Med 1997, 336(14):973–979;Dehghan A et al. Circulation, 123(7):731–738.AcknowledgementThis study was supported by European Union FEDER funds and “Fondo de Investigaciόn Sanitaria” (grants PI12/00060 and PI15/00525) from `Instituto de Salud Carlos III” (ISCIII, Health Ministry, Spain). It was also partially supported by RETICS Programs RD12/0009 (RIER) from “Instituto de Salud Carlos III” (ISCIII, Health Ministry, Spain), and in part by grants from the European IMI BTCure Program. RL-M and BU is supported by funds from the RETICS Program (RIER) (RD12/0009/0013). FG is a recipient of a Sara Borrell postdoctoral fellowship from the “Instituto Carlos III de Salud” at the Spanish Ministry of Health (Spain) (CD15/00095).Disclosure of InterestNone declared
Clinical evaluation consisted in the evaluation of the NAPSI and PASI scores. The MSUS evaluation consisted in the evaluation of 10 hand nails. In B-mode (BM) we evaluated the followings: thickness of the nail bed from the distal phalanx bone surface to the ventral plate (PB) according to Worstman X et al.; thickness of the nail from dorsal to ventral plate (IP); dorsal and ventral plate morphology, echogenicity and integrity. Additionally, we performed a color Doppler (CD) evaluation for the presence of CD signal at the nail bed and matrix level. A score for BM and different scores for CD were calculated for each nail and sums of all nails for BM and CD scores were calculated for each patient. Results: We evaluated 60 patients with PsA, 23 with Pso and 20 controls. 52.4% were female. The mean age (SD; range) was 50.2 (13.6; 23-83). The age was higher in patients (Pso and PsA) than in controls (p<0.001). Patients with PsA were more treated with DMARD (81.7%) while patients with Pso were more treated with topics (73.9%) than DMARDs (13%), (p<0.001). The majority of the patients (96%) had a PASI score less than 12. The NAPSI was higher in Pso patients than in PsA patients (p<0.001); for all controls the NAPSI was 0. US measurements of IP and PB were significantly higher in patients than in controls in the majority of the nail (p<0.045). Total US score for BM was significantly higher in patients than in controls (p<0.001). There were no significant differences for the majority of CD scores between patients and controls. Overall we found weak to moderate positive correlations between NAPSI and US scores for BM, both for matrix and bed. For most of the nails we found no correlation between NAPSI and CDUS scores; for the rest of the nails the correlation was weak, both positive and negative. References: [1] The MSUS measurements and scores showed to be higher in patients with PsA and Pso compared with controls, while CD scores showed no differences.
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