BackgroundIn patients with Elderly-onset Rheumatoid Arthritis (EORA) has been described a clinical debut mimicking polymyalgia rheumatica with rhizomelic pseudopolyarthritis, in contrast with the classical profile of patients with Rheumatoid Arthritis similar to younger patients. We compare in our study these two profiles of the disease.ObjectivesTo describe and compare the differences according to clinical debut, serological positivity and its implications in terms of treatment and prognostic factors in patients with Elderly-onset Rheumatoid Arthritis (EORA).MethodsPatients with a diagnosis of RA over 65 years of age according to ACR/EULAR 2010 criteria were included. A database was created including the age of onset, the presence of polymyalgia-like symptoms (rhizomelic pseudopolyarthritis), the positivity of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), elevation of acute phase reactants (APR), the presence of erosions and the treatment required. Finally, data was analyzed according to clinical debut, serological positivity and prognostic factors.Results83 patients diagnosed of EORA were included, with an average age of 73.8 years. 71.25% had positive RF (58.75% high titers) and 62.5% had positive ACPA (52.3% high titers). 24/83 patients (29%) debuted with a polymyalgia-like symptoms. 47.5% had persistent APR elevation during follow-up. Regarding treatment, 15% were treated only with corticosteroids, 81.5% required treatment with DMARDs and 15% were receiving biological treatment. 42/83 patients (50%) had erosions on plain X-rays. Of those patients with a polymyalgia-like profile, 52.2% (43/83) had positive RF but most of them had low titers (61%). On the other hand, patients without polymyalgia-like symptoms had positive RF in 78% of the cases and most of them at high titers (66%, p = 0.01). In the first group there was less positivity for ACPAs (26%, p = 0.00004) and half of them had low titers. Erosions were observed in only 30% of the patients with polymyalgia-like symptoms, while those without this profile had more erosions (58%, p = 0.02) and higher APR (50%, p = 0.026). Regarding treatment, in the group with polymyalgia-like symptoms only 34% were treated with corticosteroids, 65% required DMARDs and no patients had received biological treatment, whereas in the non-polymyalgic group, 88% required DMARDs and 21% required biologics (p = 0.01 for both results). Analyzing patients with positive RF and ACPAs at high titers, 93% received treatment with DMARDs and 24% required biological treatment. 65% had persistent elevation of APR and 48% presented erosions on plain X- rays. Only 2 patients with positive RF and ACPAs at high titers debuted with a polymyalgia-like symptoms.ConclusionPatients with EORA with polymyalgia-like symptoms tend to have less erosions and a higher prevalence of negative RF and ACPA or at low titers. These patients usually require less DMARDs and biological treatments to control the disease unlike patients with non-polymyalgia symptoms. On the other hand, pat...
Objectives We evaluated the prevalence of 25-hydroxyvitamin D (25-(OH)D) deficiency in our setting according to season, sex, and age. We also studied the association with parathyroid hormone (PTH) levels. Methods The study population comprised all patients with requests for assessment of 25-(OH)D between January 1 and December 31, 2018, as registered in the database of the laboratory information system. Major exclusion criteria were pediatric samples (<18 years) and factors affecting 25-(OH)D and/or PTH levels (i.e., kidney injury, liver disease, PTH disorders). Results Among 33,601 patients (24,028 women, 9,573 men), the prevalence of 25-(OH)D deficiency was 48%. Prevalence was greater in males than in females (53% vs. 46%). By age group, deficiency was more prevalent in quartile 1 (Q1, 74–87 years) and less prevalent in quartile 2 (Q2, 60–73 years). By season, deficiency was greater in spring (nonsignificant differences with respect to winter) and lower in summer. The association between 25-(OH)D and PTH was assessed in 9,368 persons. Linear regression analysis showed a weak association (coefficient – 0.303). Multiple logistic regression analysis revealed a significant association between 25-(OH)D deficiency and increased PTH (Odds ratio (OR), 1.63). Other risk factors for increased PTH include female sex (OR, 1.27), season (winter, OR 1.63, spring OR 1.16), and age (quartile 1, OR, 3). Conclusions The prevalence of 25-(OH)D deficiency differed according to sex, age, and season of the year. Furthermore, elevation of PTH is mainly influenced by low 25-(OH)D, female sex, season, and age.
BackgroundHyperuricemia and gout has been described as metabolic complications in patients with more extensive Paget’s disease, with a very variable prevalence. However, there is no data about fluctuations of uric acid levels asociated with its treatment and its correlation with alkaline phosphatase variations during gout attacks.ObjectivesTo analyze the frequency of hyperuricemia and gout in patients with a diagnosis of Paget’s disease of bone (PD) and to establish the correlation between the activity of Paget’s disease and its treatment in the fluctuations of uric acid levels.MethodsPatients with Paget’s disease and with scintigraphic uptake suggestive of activity were included. A database was created including demographic information, the presence of symptoms associated with PD, its type (monostotic or polyostotic), alkaline phosphatase (AP) and uric acid (UA) levels at diagnosis and the treatment received. AP and UA levels after treatment were also collected as well as the presence of possible hyperuricemic risk factors (HRF), history of gout and levels of AP and UA during gout attacks, if any. Finally data was analyzed using SPSS v21.ResultsA total of 95 patients were included with a mean age of 70.59 years (range 45-89), with 56% of them being women. The mean values of AP and UA at diagnosis were 178.05± 82.81 mg/dL and 5.84±1.74 mg/dL respectively. 58.9% of the patients had monostotic involvement (56/95) and only 53.12% had associated symptoms (51/95), whereas in the rest of the patients PD was an incidental finding. 70.83% did not present HRF and 56 patients (58.9%) had received treatment for their PD (41% of them with zoledronic acid). Pearson correlation between PA and UA levels was found moderatly positive (0.710 with p<0.0005) and 50.52% of the patients (48/95) had UA levels above 6mg/dL at the time of diagnosis, with a mean of 7.10 mg/dl ±1.74. In 93.5% of the cases there was a decrease in UA levels after the treatment for PD, with a mean decrease of 0.78±1.3 mg/dL over the baseline value at one year of follow-up. Only 11.57% of the patients in our cohort presented gout symptoms during their follow-up, with an increase in AP levels at the time of the attack in 63.63% of the cases.ConclusionIn our cohort, there was a moderate positive correlation between the elevation of AP and UA in patients with active Paget’s disease. Treatment for PD produced a decrease in UA levels from baseline in most patients. Similarly, during gout attacks, an increase in AP levels could be.Reference[1] Lluberas-Acosta G, Hansell JR, Schumacher HR Jr. Paget’s disease of bone in patients with gout. Arch Intern Med1986Dec; 146 (12):2389-92.Disclosure of InterestsNone declared
ObjectivesTo analyse the relationship between 25-hydroxyvitamin-D3 and parathyroid hormone levels and to determine its variation between the different seasons of the year.MethodsAn observational descriptive study was carried out, collecting and analysing 25-hydroxyvitamin-D3 (25OH-D3) and parathyroid hormone (PTH) serum levels of patients from .January to December of 2017 The frequencies distribution analysis of both variables was compared and Pearson’s correlation coefficient (PCC) was used to analyse linear relationship between them. The results were classified by date in four seasons: winter, spring, summer, and autumn, assessing the mean seasonal oscillations of each variable and calculating correlation in each case. Different levels of 25OH-D3 were evaluated in order to identify differences in the grade of correlation.ResultsSerum samples from 6265 patients were recollected. 59% of the patients had 25OH-D3 levels lower than 25 ng/ml. Pearson’s correlation coefficient between both variables was −0.159 (p<0.01). The mean values of 25OH-D3 were calculated for each seasonal period, establishing a mean level of 23 ng/ml for winter, 25 ng/ml for spring, 31 ng/ml for summer and 29 ng/ml for autumn. Regarding PTH levels, the mean values for each season were 108 pg/ml, 101 pg/ml, 86 pg/ml and 84 pg/ml from winter to autumn respectively. PTH/Vitamin D correlation was also assessed for each period: Pearson’s correlation coefficient during winter was −0.08(p<0.01), for spring −0.249(p<0.01), for summer −0,21(p<0.01) and for autumn −0,19(p<0.01). At last, correlation calculated with deficiency levels of 25OH-D3 (<30 ng/ml) was −0.18(p<0.01), and with levels inferior than 10 ng/ml was −0.12(p<0.01).Abstract AB1007 – Figure 1ConclusionsLinear correlation between levels of 25OH-D3 and PTH could not be established in our study, not even using levels classified as vitamin D deficiency. 25OH-D3 levels tended to increase from winter to summer whereas PTH levels decreased inversely during these seasons, without any linear correlation.Disclosure of InterestNone declared
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