In our study, one-third of Brazilian patients with PsO, followed in dermatology settings, were diagnosed with PsA by a rheumatologist. Almost half of subjects with PsA had no previous diagnosis. A collaboration between dermatologists and rheumatologists is greatly needed to establish earlier PsA diagnoses and adequate multidisciplinary management.

SUMMARY INTRODUCTION Systemic sclerosis (SSC) is an autoimmune disorder that affects several organs of unknown etiology, characterized by vascular damage and fibrosis of the skin and organs. Among the organs involved are the esophagus and the lung. OBJECTIVES To relate the profile of changes in esophageal electromanometry (EM), the profile of skin involvement, interstitial pneumopathy (ILD), and esophageal symptoms in SSC patients. METHODS This is an observational, cross-sectional study carried out at the SSC outpatient clinic of the Hospital de Clínicas of the Federal University of Uberlândia. After approval by the Ethics Committee and signed the terms of consent, 50 patients were initially enrolled, from 04/12/2014 to 06/25/2015. They were submitted to the usual investigations according to the clinical picture. The statistical analysis was descriptive in percentage, means, and standard deviation. The Chi-square test was used to evaluate the relationship between EM, high-resolution tomography, and esophageal symptoms. RESULTS 91.9% of the patients had some manometric alterations. 37.8% had involvement of the esophageal body and lower esophageal sphincter. 37.8% had ILD. 24.3% presented the diffuse form of SSC. No association was found between manometric changes and clinical manifestations (cutaneous, pulmonary, and gastrointestinal symptoms). CONCLUSION The present study confirms that esophageal motility alterations detected by EM are frequent in SSC patients, but may not be related to cutaneous extension involvement, the presence of ILD, or the gastrointestinal complaints of patients.

Background Psoriatic Arthritis (PsA) may affect up to 40% of patients with psoriasis (PsO). Usually PsO precedes PsA for many years, though PsA is frequently not identified in dermatology clinics. Diagnosis of PsA is based on clinical recognition of arthritis, enthesitis and spondylitis. Objectives To determine the prevalence of PsA in a large cohort of Brazilian patients with PsO attending different dermatology reference centers. Methods A multicenter study was conducted in four universitary dermatology clinics, from January to March 2011. In each center, consecutive patients with a confirmed diagnosis of PsO were evaluated by a rheumatologist. Following detailed musculoskeletal anamnesis and physical examination, subjects were classified as having: isolated PsO, osteoarthritis (OA) and/or chronic myofascial pain (CMP) syndrome, PsA (CASPAR criteria1). Laboratory and x-Ray tests were performed, as needed, according to the rheumatologist clinical judgment. Results A total of 524 PsO patients were evaluated. Mean age was 48.5 ± 14.5yrs, 50% were females and PsO mean duration was 15.4±11.7yrs. The vast majority (79%) had plaque psoriasis and 57.8% required systemic treatment. Isolated PsO was the diagnosis in 45% of patients, whereas 22% manifested OA and/or CMP. A definitive diagnosis of PsA was documented in 175 patients (33%), of which 49% were newly identified by the rheumatologist. Lab and/or x-Ray tests were necessary for the diagnosis of PsA in 42/175 individuals. In 38/175 subjects, PsA was associated with OA and/or CMP. Most PsA patients (72%) had peripheral, 11% axial and 17% both peripheral and axial involvement. Dactilitis occurred in 20% and clinical enthesitis in 30%. Remarkably, PsA patients were older (51 vs 47yrs, p 0.015), had more nail involvement (59 vs 47%, p 0.008), were less likely to be on any systemic treatment (42 vs 56%, p 0.01) and were more frequently using biologic drugs (21 vs 5%, p>0.001) compared with those without PsA. Conclusions We have demonstrated a similar worldwide prevalence of 1/3 of PsA among Brazilian patients with PsO. The identification of new PsA diagnosis by a rheumatologist in half of patients, previously unrecognized at the dermatology setting, points out to the need for shared care between dermatologists and rheumatologists in order to establish earlier PsA diagnosis and adequate multidisciplinary management. References Taylor W, Gladman D, Helliwell P et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54:2665–73 Disclosure of Interest None Declared

Background This case report, unlike the current literature related to vitamin D intoxication, aims to highlight the risk of self-medication, and how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional indication or supervision. This practice can pose a serious health risk to the population. Case presentation Our patient, a brazilian retired 64-year-old female, presented to the emergency service with post-prandial food vomiting of undigested content and stabbing abdominal pain with worsening during palpation. Concomitantly, onset of sporadic frontal headache, fatigue, hyporexia, weight loss of 18 kg in the same period, severe pruritus, musculoskeletal pain in the limbs and nocturia. The physical examination showed hypertension (160/80 mmHg) and itchy macules in the lower limb. Initially, the main diagnostic hypotheses were multiple myeloma, hyperparathyroidism and pancreatitis secondary to hypercalcemia, osteolytic neoplasms and other neoplasms that present with hypercalcemia. However, blood count, parathyroid hormone, chest X-ray, immunoglobulins, myelogram and bone marrow biopsy were not compatible with these diagnoses. Meanwhile, 25 OH vitamin D dosage and diluted vitamin D test confirmed the diagnosis of hypervitaminosis D. Hypercalcemic crisis was managed with vigorous hydration (50 ml/kg in 2 h), furosemide, bisphosphonates and blood pressure control with amlodipine and atenolol. Subsequently, the patient was discharged from the outpatient clinic with complete remission of symptoms, weight gain, serum calcium values of 10.76 mg/dL and ionizable calcium values of 6.52 mg/dL. Conclusion Our report summarizes the possible consequences of using a vitamin compound without supervision of a competent professional, as these substances are mistakenly considered non-toxic. To add, little information is available about the supplements’ metabolism and their biological effects. Therefore, It is difficult to diagnose intoxication. This case report shows that even the self-administration of a product designed to bring health benefits can become a risky behavior. These vitamin and mineral supplements are supposed to bring patient empowerment and reduce government spending in health-care, but indeed represent a significant public health concern due to possible overdose and drug interactions.

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Objectives The prevalence and characteristics of systemic sclerosis-associated interstitial lung disease (SSc-ILD) vary between geographical regions worldwide. The objectives of this study were to explore the differences in terms of prevalence, phenotype, treatment, and prognosis in patients with SSc-ILD from predetermined geographical regions in the EUSTAR database. Methods Patients were clustered into seven geographical regions. Clinical characteristics and survival of patients with SSc-ILD were compared among these pre-determined regions. Results For baseline analyses, 9260 SSc patients were included, with 6732 for survival analyses. The prevalence of SSc-ILD in the overall population was 50.2%, ranging from 44.0% in “Western Europe & Nordic countries” to 67.5% in “Eastern European, Russia & Baltic countries”. In all regions, anti-topoisomerase antibodies were associated with SSc-ILD. Management also significantly differed; mycophenolate mofetil was prescribed at baseline in 31.6% of patients with SSc-ILD in “America (North & South)” and 31.7% in “Middle East” but only 4.3% in “Asia & Oceania” (P < 0.0001). Patients from “America (North & South)” and “Middle East” had the highest survival rate at the end of follow-up (85.8% and 85.2%, respectively). Conclusion Our study highlights key differences among regions in terms of clinical presentation and prognosis of SSc-ILD. This work also demonstrates that the management of SSc-ILD is highly variable among the different regions considered, suggesting that efforts are still needed for the standardisation of medical practice in the treatment of this disease.

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BACKGROUNDThe Brazilian Registry on Primary Sjögren's Syndrome (RE-BRASS) is a prospective national cohort and research biobank. To date, 16 centers from all Brazilian regions are collaborating, with the potential to include more centers over time. The RE-BRASS started in 2021 and has the support of the Brazilian Society of Rheumatology. The main objective of RE-BRASS is to generate a set of Brazilian epidemiological data on patients with pSS fulfilling the 2002 AECG and/or 2016 ACR-EULAR classification criteria and to promote high-quality clinical research. METHODSResearch Electronic Data Capture (REDCap) will be used to insert the clinical data. In addition to demographic and laboratory data, clinical data that are being collected from enrolled patients such as disease activity (EULAR Sjögren's syndrome disease activity index -ESSDAI), disease damage (Sjögren's syndrome disease damage index -SSDDI), comorbidities, cardiovascular risk (Framingham), labial biopsy and salivary gland ultrasound of minor salivary gland, pharmacological and nonpharmacological treatment. Patients are also been interviewed by patient-reported outcomes such as EULAR Sjögren's syndrome patient-reported index (ESSPRI), profile of fatigue and discomfort (PROFAD), hospital anxiety and depression scale (HADS), Epworth sleepiness scale (ESE), international physical activity questionnaire-short form (IPAQ-SF) and EuroQol-5 Domain (EQ-5D). RESULTSCurrently 1,010 patients are included. Mean age is 55.6 ± 13.6 years and 96.5% are women. Most of the patients are white (52%), employed (38.1%) and married (56.2%). Ninety-three percent of patients present xerostomia, 93.7% xerophthalmia, 78.9% anti-Ro and 41.8% anti-La. From the 70.5% of the patients who performed labial biopsy gland, 86.3% were positive. Ninety-four percent and 90% have met the 2002 AECG and 2016 ACR-EULAR classification criteria, respectively.