HIV subjects showed a higher prevalence and a different pattern of metabolic syndrome components. HAART, more than HIV infection per se, appeared to be responsible for the increased prevalence of metabolic syndrome and arterial function derangement.

HIV infected subjects present an unfavorable cardiovascular (CV) risk profile that is determined by the infection itself, highly active anti-retroviral therapy (HAART) and other factors, such as chronic kidney disease (CKD). Information is scant and contradictory on whether these factors are associated with arterial stiffness and blood pressure (BP) alteration. Our study aimed to evaluate those parameters in HIV-positive subjects both with and without HAART and with and without CKD, which was defined as the presence of microalbuminuria with a normal glomerular filtration rate. We enrolled 94 HIV-infected subjects without known CV risk factors and compared them with 37 control subjects. We recorded brachial and central BP (pulse wave analysis) and pulse wave velocity ( SphygmoCor). HIV-positive subjects of similar ages and with similar BP values showed central pulse pressure values that were significantly greater than those of controls; this was also the case for the Aix value. Central systolic and pulse pressure values and Aix were significantly greater in HIV-positive subjects with HAART and CKD than in the other HIV-positive subgroups and control subjects. PWV was also superimposable between groups when the data were analyzed relative to the presence of HAART and CKD. Our study shows that the unfavorable CV risk profile associated with HIV infection includes an increase in both central BP and Aix. The central BP increase seems to be favored by renal damage, which apparently has a role in the early stages of the disease.

The mean age at onset of systemic sclerosis (SSc) symptoms is in the early 40s, and women are now frequently delaying pregnancy. Moreover, attention has recently been drawn to so-called "early" SSc. The consequence is that pregnancy is no longer so rare in SSc women. Sexuality and SSc SSc has an important negative impact on sexuality due to fatigue, dyspareunia related to vaginal discomfort/tightness (1, 2), and the psychological implications of body appearance (3); these can be soothed using vaginal lubricants, keeping warm, and receiving psychological support. Sjogren's overlap and menopause may aggravate these problems. However, 60% of 101 SSc women interviewed in a study (4) were sexually active and only 17% of the others attributed their inactivity to the disease. Fertility and SSc Years ago some authors argued that SSc could interfere with conception and pregnancy (5). In 1992, Englert et al. (6) led a retrospective study on 204 women with SSc, 233 women with primary Raynaud's phenomenon, and 189 healthy women and reported that the women with SSc were more likely than the general population women to have a delay of more than 12 months in conception or of being infertile, but they were no different from the women with primary Raynaud's. In contrast, Steen and Medsger (7) in 1999 surveyed 214 women with SSc, 167 women with rheumatoid arthritis (RA), and 105 healthy controls about their obstetric history. As in earlier studies, they noticed a statistically significant higher rate of nulliparity among women with an autoimmune disease (21% SSc, 23% RA, 12% controls; p < 0.05), but this difference disappeared after adjusting for factors such as the number of

We describe the case of a patient hospitalized for the second time in a month due to delayed worsening of lung lesions in COVID-19 infection without bacterial superinfection. He was treated with hydroxychloroquine, IV dexamethasone and ruxolitinib with rapid improvement of respiratory failure; 1 month after the second discharge, maintaining low-dose oral prednisone, lung consolidations were significantly reduced on control CT.

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Background:Data about the obstetric outcomes of pregnant women with Systemic Sclerosis (SSc) mainly derive from retrospective studies. Moreover, little evidence is available to define if pregnancy impacts on SSc course and if children of SSc mothers have a normal post-natal development.Objectives:To assessed the obstetric, pediatric and rheumatologic outcomes of SSc pregnancies in a prospective controlled studyMethods:Prospective recruitment of three cohorts.1) 110 pregnant women with SSc.2) 218 control pregnancies without systemic autoimmune diseases3) 78 non-pregnant control SSc with a matching subject in cohort-1.SSc was characterized for disease activity, severity, cutaneous/organ involvement and therapy. Women and their offspring were followed until 21 months after enrollment (ie, 12 months after expected delivery).Results:Gestational and neonatal outcomesMiscarriages and fetal death occurred in 7% and 5% of SSc pregnancies. Compared to control pregnancies, SSc pregnancies had higher rates of gestational hypertension (12% Vs 4%, p=0.004), pre-eclampsia (9% Vs 1%, p=0.002), fetal growth-restriction (13% Vs 4%, p=0.004), prematurity (26% Vs 7%, p<0.001) and cesarean section (52% Vs 4%, p=0.002). Newborns from SSc mothers weighted less (2773 Vs 3243g, p<0.001), were more frequently small for gestational age (SGA, 18% Vs 12%, p=0.05) and required neonatal-intensive care unit (ICU) more frequently (12% Vs 1%, p<0.001). Rates of newborn malformation/death, and one year-pediatric outcomes were similar.Univariate and multivariate analyses were performed for relevant outcomes. For example, pre-eclampsia positively associated with baseline skin score and its evolution during pregnancy (p=0.015 and 0.013), immunosuppressive agents, bosentan and iloprost at baseline (p=0.001, 0.041 and 0.007), and twin pregnancy(p=0.006). Multivariate logistic regression for pre-eclampsia in SSc identified baseline arterial hypertension, immunosuppressive agents or of iloprost, twin pregnancy and assisted conception as risk factors (p=0.000, 0.002, 0.0025, 0.000 and 0.027), and baseline calcium channel blockers as protective factors (p=0.001).SSc course during pregnancyAs compared to matched non-pregnant SSc, SSc pregnant women had lower Medsger disease severity index (0.6 +/-0.9 Vs 1.0 +/-1.1, p=0.022), health assessment questionnaire (HAQ, 0.21 +/-0.38 Vs 0.40 +/-0.55, p=0.026), and lower rate of iv iloprost (21% Vs 42%, p=0.006). Pregnant and non-pregnant SSc women had a similar disease course during the 21 months of follow-up, despite a lower use of immunosuppressive agents (17% Vs 36%, p=0.014). Two scleroderma-renal-crises (SRC) occurred during pregnancy (one was a relapse of a previous SRC; the other occurred at week 33, and resolved after premature delivery of a SGA newborn and ACE-inhibitors, preventing differentiation from pre-eclampsia).Conclusion:SSc pregnancies have generally a favorable obstetric/pediatric outcome, albeit at a higher risk of gestational hypertension, pre-eclampsia, fetal growth restriction, prematurity, delivery of SGA newborn and requirement of neonatal-ICU. Pregnancy does not impact on SSc course, although SRC during late pregnancy and pre-eclampsia might be hardly discriminated.References:[1]Taraborelli M et al., Arthritis Rheum, 2012.Disclosure of Interests:None declared

We read with great interest the case report by Fierro et al. [...]

BackgroundRheumatoid arthritis (RA) is a systemic inflammatory disease characterized by an elevated cardiovascular morbidity and mortality, but detailed information on the risk score profile using different approaches, as well as on the major determinant(s) of the cardiovascular risk of these patients are scanty.ObjectivesThe present study reports data collected in a cohort of RA patients with CV risk score calculators Framingham and SCORE uncorrected or corrected according to EULAR recommendations. Cardiovascular events were recorded during the 3 year follow-up, to determine the burden of CV morbidity and the relative impact of traditional CV risk factors and disease activity/severity.MethodsWe enrolled 198 pts. We use Framingham and SCORE to predict CV risk. Cardiovascular events were recorded during the 3 year follow-up.ResultsWe enrolled 198 pts, 77% females, age 65.0±11.6 yrs (means ± SD), disease duration 13±9 yrs. 76% of pts were RF +, 68% ACPA+ and 46% with erosive disease. The mean DAS28 CRP was 2.67±1.17. 3% were smokers and 32% ex smokers. Mean BMI (24.6±44), plasma levels of cholesterol (total,HDL,LDL), triglycerides and glucose and prevalence of smokers were comparable with those detected in the local general population (GP), while the prevalence of hypertension (78 and 71% in RA M/F vs 49 and 43% in GP M/F) and diabetes (21.7 and 10.8% in RA M/F vs 4.8 and 2,58% in GP M/F) were significantly higher in both male and females. Risk scores with Framingham were lower than in GP and comparable using SCORE, but the application of 1.5x correction factor for RA, as recommended by EULAR, modified these figures. The number of hypertensive and diabetic pts increased significantly (P<0.0001/0.019) during the follow-up as well as the mean values of Framingham and SCORE (p<0.015/0.011). The MI and stroke prevalence were 5% and 2% respectively: the incidence rate/1000 person/year were 8.8 and 3.7 versus 2.7 and 2.6 in the general population. No relation was detectable between disease activity indices and CV events or risk scores. Half of our patients were treated with Prednisone ≤7.5 mg/day: lipid profile, glucose level and blood pressure were comparable in steroid-treated and steroid-free patients.ConclusionsThe present study provides evidence that 1) RA is associated with an increased CV morbidity even in the medium follow-up period, 2) risk score needs to be adjusted as by EULAR indications to obtain sensitive assessment of risk 3) that hypertension represents a major CV risk factor in this population and 4) that the achievement of low disease activity doesn't seem sufficient to reduce the CV risk.Disclosure of InterestNone declared