BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease which affects 0.5% of adults, especially women. This disorder is associated with increased morbidity and mortality due to atherosclerotic cardiovascular diseases. In addition to classical cardiovascular risk factors, inflammation plays a key role in this fact. Intima-media thickness (IMT) measured by carotid ultrasound is currently used to detect the presence of atherosclerotic disease and its value could be a predictor of subclinical cardiovascular disease.ObjectivesTo study cardiovascular risk factors, disease activity and carotid IMT in a RA patients series.MethodsCross-sectional observational study of patients diagnosed with RA according to ACR/EULAR 2010 criteria. Patients with age under 75 years old and up of 5 years of disease evolution were included. Cardiovascular established disease patients were excluded. During a unique visit, patients underwent anamnesis, physical examination, laboratory test, electrocardiogram, chest X-ray and carotid ultrasound with Esaote-MyLabClassC equipment. Statistical analyses were performed using software R (version 3.3.2).ResultsA total of 31 patients (57.1±9.7 years, 83.6% female, with 19.2±11.2 years of average disease course) were included. In relation to the classic cardiovascular risk factors, 19.4% were active smokers, 41.9% hypertensives and 45.2% had hypolipidemic treatment (85.7% with a statin), three of the patients were diabetic (9.7%). All patients were treated with monotherapy or combination therapy and 41.9% were also given glucocorticoid at low doses during the last 6 months. The median DAS28-VSG was 2.49 (1°Q=1.6; 3°Q=3.9), with an average HAQ of 0.88±0.68. As for extra-articular manifestations, 45.2% had xerophthalmia, 29% xerostomia, and 19.4% had rheumatoid nodules. The median total cholesterol was 195 mg/dL (174–221), and LDL of 116 mg/dL (96.5–138). The mean of the right carotid IMT was 576.13±118.78 mm and the carotid left IMT was 616.32±134.31 mm, resulting in 12 determinations higher values than expected to their age and sex provided by the ultrasound developer (38.7%). Using the SCORE table (modified by EULAR), only 5 patients (16.1%) had moderate-to -high cardiovascular risk. Statistical analysis showed a significative association between an increased IMT with tobacco consumption (classic cardiovascular risk factor) (p=0.028) and the modified SCORE (p=0.04). Neither years of evolution of disease nor the analytical biomarkers showed a significant association.ConclusionsOur study shows that in patients with good disease control data, classic cardiovascular risk factors are related to increased carotid intima-media thickness. However, these factors may underestimate overall cardiovascular risk over other measures of subclinical cardiovascular disease, such as carotid IMT.Disclosure of InterestNone declared
BackgroundOxidative stress is increased in Systemic Lupus Erythematosus (SLE) patients, and contributes to the immune system imbalance, abnormal activation of apoptotic processes, autoantibodies production and the development of serious complications, such as cardiovascular comorbidities.ObjectivesTo evaluate the influence of oxidative stress as an additional factor to the classical cardiovascular risk ones, in SLE patients.MethodsCross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, coming from the Rheumatology Service of Arnau de Vilanova Hospital and La Fe Hospital. In all patients we analyzed the serum concentration of GS-Nem (GSH) and GSSG by UPLC-MS/MS (Acquity UPLC System). We have also taken healthy individuals as negative controls, who had the same blood-test. In patients was also made a complete blood-test, and clinical, treatment and biometric data were collected by personal interview. Biostatistical analysis was performed by the R software version 3.2.3., using a simple, binominal and logistic lineal regression.ResultsA total of 140 patients were evaluated; (95% women) with 33.39±13.63 year-old average at the diagnosis time with a 10.05± 11.42 year-evolution of SLE. We used GSH/GSSG ratio to assess the oxidative stress rate, being this value higher in patients than in healthy controls (P=0.005).We observed a statistically significant relationship between the presence of oxidative stress and accumulated damage assessed by SLICC-ACR (P<0.0001). No differences according to the disease activity, specific autoimmune profile or by organ or systems affected. However, we found a slight difference in the GSH/GSSG ratio among patients who have had a CVD (1±0.39) and those who have not suffered CVD (1.19±0.55). No differences in the levels of oxidative stress are observed according to treatment with folic acid or the administration of biological therapies.ConclusionsWe observed increased levels of oxidative stress in our SLE patients compared to healthy controls. Data suggest a rise of oxidative stress in patients with a greater cumulative damage, which is consistent with the presence of severe comorbidities in these patients. It seems to be a slight tendency to increased oxidative stress levels measured with GSH/GSSG ratio in patients with SLE and cardiovascular involvement, but more independent studies are needed to confirm it.Disclosure of InterestNone declared
BackgroundSystemic Lupus Erythematosus (SLE) in a multisystemic autoimmune disease that specially affects young women during the second and third decade, and is able to injure different organs and or systems, being the most common one affected the musculoskeletal system.ObjectivesTo analyse the influence of the time of evolution and age of the patient in the current clinical manifestations and the debut of the disease in patients with SLE.MethodsCross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, coming from the Rheumatology Service of Arnau de Vilanova Hospital and La Fe Hospital. All patients had a complete blood-test with autoimmunity markers, and clinical, biometrics and treatment data were also collected from the personal interview and the medical history. Biostatistical analysis was performed using the R software version 3.2.3., using a simple, binomial and logistic lineal regression.ResultsA total of 140 patients were evaluated; of them, (95% were women) with 33.39±13.63 year-old average at the diagnosis time with a 10.05±11.42 year-evolution of SLE. We can find the clinical manifestations at the onset disease on the table.Onset manifestation(%)Onset manifestation(%)Musculoskeletal73.6Sjogren synd.2.9Skin39.3Raynaud's5Kidney5Other27.1Cytopenia7.9We observe statistically significant differences in the musculoskeletal system involvement (P=0.008), and in the presence of vasculitis (P=0.01) in patients with a shorter time of disease evolution. There is also a direct relationship between cardiovascular (P=0.002) and renal (P=0.03) affection in younger patients. Finally, cytopenias are correlated both in young patients (P=0.0009) as well as with a shorter time of evolution (P=0.02).ConclusionsWe observe a concordance between our SLE series and those already described at the literature, where renal involvement occurs at younger ages, and the musculoskeletal system involvement occurs early in disease or even as the onset symptom.Disclosure of InterestNone declared
BackgroundGuidelines for monitoring patients with biological therapy require frequent consultations (every 2-4 months) in order to ensure the patient safety. These recommendations involve high use of consultations and interference with the daily and professional life of patients and their family. In this context, nursing telephone consultations can be an efficient alternative for monitoring subcutaneous therapies.ObjectivesTo analyze the usefulness of telephone nursing consultations in monitoring patients with subcutaneous therapy.MethodsWe have collected data from all telephone nursing consultations in order to monitor patients with subcutaneous biological therapy from September 2012 to December 2014: clinical data, number of calls, characteristics of the consultation and its resolution, and involvement of rheumatologists in queries.ResultsThere were a total of 555 telephone consultations, of which the nurse resolved directly 84.9% of cases. The nurse resolved directly with physician support in 9.7% of cases, a telephone appointment with the rheumatologist was necessary in 1.3% of calls and an in-person appointment with the rheumatologist was necessary in 1.9% of calls. The 2.2% of patients were not located by telephone. Incidents were detected in the 34% of telephone nursing consultation, being the most frequent alterations in analytical parameters or infections. The 30.7% of incidents were referred to other medical specialty, mainly Primary Care. In 69.3% the nurse resolved directly the incidents.ConclusionsThe telephone nursing consultation helps the monitoring of patients with subcutaneous therapy, managing directly the telephone nursing consultation and identifying the incidents. In this way, the nurse avoids unnecessary travels, reduces the number of medical consultations and improves management of hospital resources.Disclosure of InterestNone declared
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