Background:Inflammatory bowel disease (IBD) is an extra-articular manifestation that can appear in spondyloarthritis (SpA), as well as uveitis and psoriasis. Its prevalence is 5-10%, although subclinical intestinal inflammation has been found in up to 60%. Biological therapy (BT) can be the treatment for IBD or produce it paradoxically. Fecal calprotectin (FC) is an intestinal inflammation marker, useful for early diagnosis and monitoring disease activity.Objectives:To describe the frequency and characteristics of IBD in SpA with BT.Methods:Descriptive and retrospective study (January 2003-January 2019) of patients with SpA that develop IBD in a single center. Epidemiological variables, type of SpA, presence of IBD and its characteristics, levels of FC, presence of BT at IBD onset and treatment received were registered.For the analysis, frequencies and percentages were used in qualitative variables and mean±standard deviation (SD) in quantitative. Statistical analysis was performed with IBM SPSS v.23.Results:We studied 270 patients with SpA, 70.4% male with a mean age of 39.9±12 years. The subtypes of SpA were: ankylosing spondylitis (AS) (n=133; 49.3%), psoriatic arthritis (PsA) (n=116; 43%), undifferentiated SpA (n=16; 5.9%), SpA non-Rx axial (n=3; 1.1%) and reactive arthritis (n=2; 0.7%).IBD was observed in 25 patients (9.26%), 80% male. At the time of IBD onset, they had a mean age of 39.12±9.8 years, the mean ESR was 31.15±24mm1ªh, CRP 2.7±2mg/dL and BASDAI 4.6. 16 patients had AS, 6 PsA and 3 undifferentiated SpA. TABLE 1.Regarding Spa diagnosis, IBD appeared after in 15 patients with an average time of development of 8.39±8 years, before in 7 and was simultaneous in 3. The subtypes of IBD were: Crohn’s disease (CD) in 13 patients, ulcerative colitis (UC) in 9 and indeterminate colitis (IC) in 3. The FC was > 200μg/g in 17 patients (68%), normal (<50μg/g) in 1 and between 50-200μg/g in 7. The incidence rate adjusted for follow-up of the 25 cases was 7.7 cases/1000 patients-year.At the time of the IBD onset, 6 patients were with BT: Etanercept (ETN) (n=2), Infliximab (IFX) (n=1), Adalimumab (ADA) (n=1), Secukinumab (SCK) (n=1) and Ustekinumab (UST) (n=1). The BT had been initiated the previous 12 months in 5 of them. The incidence rate adjusted for follow-up of the 6 cases of IBD after BT was 1.83 cases/1000 patient-years. TABLE 2.The treatment of the 25 patients with IBD was mesalazine (n=15), oral corticoid (n=5), methotrexate (n=7) and BT in all cases. The BT was: ADA (n=11; 44%), IFX (n=6; 24%), UST (n=3; 12%), golimumab (n=3; 12%), SCK (n=1; 4%) and vedolizumab (n=1; 4%). The indication was intestinal in 4 patients, joint in 8 and both in 13.The clinical and analytical evolution in all patients was satisfactory, with a mean ESR of 11.6±9mm1ªh, CRP 0.6±0.3mg/dL and BASDAI 2 in the last control, after an average time of evolution of 12.5±9.3 years.Conclusion:In this series, IBD was observed in 9.26% of patients with SpA of which 64% were AS. The most frequent form was CD and it was diagnosed after SpA in 6...
BackgroundThe major SARD have an increased mortality compared to the general population. It is well known that the main causes of death in Systemic Lupus Erythematosus (SLE) are infections (INF), cardiovascular events (CV), neoplasia (NEO) and disease activity. However, the compared mortality of Mixed Connective Tissue Disease (MCTD), Systemic Sclerosis (SSc), Poly/Dermatomyositis (PM/DM), overlap syndromes (OS), Sjögren's syndrome (SS), Antiphospholipid syndrome (APS), systemic vasculitis (SV), and undifferentiated or incomplete Connective Tissue Disease (UCTD) is poorly described.ObjectivesTo analyze the causes of death and the autoantibodies (AAB) profile among the SARD.MethodsThis was a single center, prospective and observational study. Mortality by all causes and relationship with AAB profile were analyzed in patients diagnosed of SLE, MCTD, SSc, PM/DM, OS (simultaneous or sequential criteria of 2 or more SARD), SS, APS, SV and UCTD or incomplete SARD (at least one clinical criterion of the classification criteria and a related antibody of any of the SARD). Data were obtained from the “Systemic Autoimmune Rheumatic Diseases Registry” of a tertiary referral hospital from 1986 to 2016. Patients with rheumatoid arthritis were excluded. The SARD registry counts with the institutional review board approval.Results1750 patients were included, of whom 1453 (83%) were women. Five hundred fifty six SLE, 125 SSc, 111 PM/DM, 91 OS, 90 MCTD, 250 SS, 71 APS, 211 SV, 117 UCTD and 128 losses to follow-up, the global follow up rate was 92.7%. A global mortality of 350 (20%) cases was observed: 101 INF (28,8%), 89 CV (25,4%), 51 NEO (14,5%), 45 due to disease activity (12,8%), 41 other causes (11,7%) and 23 from unknown causes (6,5%). Table 1 shows detailed mortality causes compared by diseases. A higher mortality was associated (p<0,05) with older patients (71 years, 20–96), SV (OR 3,65), male patients (OR 1,95), SSC/PM/DM (OR 1,76), MCTD (OR 1,6) and OS (OR 1,43). AAB to pANCA (OR 4,43), anti-topoisomerase I (OR 3,64), myositis-specific AAB (OR 3.0), cANCA (OR 2,19) and anticardiolipin (OR 1,89) were associated with poorer survival. A higher survival rate was observed in patients with SLE (OR 1,7), SS (OR 1,69) and UCTD (OR 15,57) (p<0,05).CAUSESSLE, %SSC, %MCTD, %SV, %PM/DM, %OS, %SS, %APS, % CV 30,86 27,02 42,3 25,5518,1816,1217,6421,4INF27,1621,623,84 36,66 33,33 45,16 23,5221,4NEO14,8113,5115,388,8818,189,67 26,47 14,28ACTIVITY9,8718,9119,2311,1112,1219,3511,76 28,57 OTHER8,6413,5111,5315,559,093,228,820.00UNKNOWN8,645,407,692,229,096,4511,7614,28ConclusionsThe main causes of death among SARD patients are CV (MCTD, SLE, and SSC), severe infections (OS, SV, and PM/DM), disease activity (APS) and neoplasia (SS). A higher mortality is observed among ANCA positive SV, anti-topoisomerase I positive SSC, MCTD, OS, anticardiolipin and myositis-specific positive patients.Disclosure of InterestNone declared
BackgroundUveitis is the most frequent extra-articular manifestation (EAM) of spondyloarthritis (SpA). Its prevalence is approximately 30% and increases with the duration of the SpA. The characteristic pattern is anterior, acute, recurrent and unilateral uveitis. However, the frequency and characteristics of uveitis in SpA treated with biological therapy (BT) are unknown.ObjectivesThe main target is to describe the frequency and characteristics of uveitis in SpA with BT in a single centre.MethodsDescriptive and retrospective study (January 2003-December 2017) of SpA that develops uveitis in a reference hospital. The epidemiological variables, type of SpA, presence of uveitis and its characteristics, presence of BT at the time of onset and treatment received are collected. For the analysis, frequencies and percentages were used in qualitative variables, and mean and standard deviation (SD) for quantitative variables. Statistical analysis was performed with IBM SPSS v.23.ResultsWe studied 246 patients with SpA. The subtypes of SpA were: ankylosing spondylitis (AS) (n=125, 50.8%), psoriatic arthritis (PsA) (n=101, 41.1%), undifferentiated SpA (n=13, 5.3%), non-radiographic axial Spa (n=3, 1.2%), enteropathic arthropathy (n=3, 1.2%) and reactive arthritis (n=1, 0.4%).Uveitis was observed in 41 patients (16.7%) after an average time of development of 109.47 (73.9) months of the SpA. The incidence rate was 5.5 cases of uveitis/100 patients-year of follow-up. 70.7% were men and the mean age(SD) was 47.4 (12.06) years. 87.8% of the cases were HLAB27 positive and had a family history of SpA 41.5%.Uveitis was observed in 33 patients (80.5%) with AS, in 6 (14.6%) with PsA, in 1 (2.4%) with non-Rx axial SpA and in 1 (2.4%) with undifferentiated SpA. (table 1)The uveitis pattern was anterior (100%), acute (92.7%), unilateral (87.8%) and in 12.2% bilateral (80% in PsA). At the time of onset of uveitis, the mean ESR was 30.11 mm1ªh, CRP 3.56 mg/dL, DAS28 3.66 and BASDAI 3.21.Regarding the diagnosis of SpA, uveitis was after (85.4%), before (12.2%) and simultaneous (2.4%).At the time of the onset of uveitis, 14 patients (34.1%) were with BT (35.7% etanercept, 28.6% infliximab, 21.4% adalimumab, 7.1% golimumab and 7.1% certolizumab). BT was modified in 3 of the cases.The treatment of uveitis was topical (78%), corticoids in oral regimen (57.5%), conventional DMARDs (12.5%), with methotrexate predominating in 60% of cases and BT (15%). The most used biologics were adalimumab (50%), infliximab (33.3%) and sekukinumab (16.7%).Abstract THU0259 – Table 1Characteristics of the UVEITIS in SpA subtypesConclusionsIn our series, uveitis was observed in 16.7% of patients with SpA of which 80.5% were AS and 14.6% PsA. The most frequent uveitis was anterior, unilateral, acute and recurrent. In PsA, the association with HLA B27 was less frequent and was more bilateral. In most cases, the diagnosis was later than the SpA.Disclosure of InterestNone declared
Background:Women with inflammatory arthropaties have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.Objectives:To evaluate pregnancy in women with inflammatory arthropaties in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment used (including BT).Methods:Retrospective and descriptive study of the evolution of pregnancy in patients withinflammatory diseases (Rheumatoid Arthritis (RA), Spondyloarthritis (SpA) and Juvenile Idiopathic Arthritis (JIA)) and follow-up in a multidisciplinary unit for more than 15 years (until December 2020). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, Caesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.Results:We registered 41 pregnancies (32 women): 20 RA (62.5%), 9 SpA (28.1%) and 3 JIA (9.4%). Maternal average age at diagnosis was 27.1±6.6 years and average age at childbirth/abortion was 34.9±5.1 years.It took an average time of 9.6±8.5 months to conceive. 9.8% received fertility treatment with in vitro fertilization techniques.AntiRo antibodies were registered in 7.3% of patients and 34.1% had at least 1 antiphospholipid antibody.At the time of gestational desire/gestation 17 women (12 RA, 4 SpA, 2 JIA) were receiving BT: 7 certolizumab (CZP), 7 adalimumab (ADA), 3 etanercept (ETN). 1 patient was being treated with baricitinib. Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as baricitinib. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 9 cases.9 abortions were registered prior to follow-up in the unit (0.28 abortions/mother) and 3 during follow-up (0.09 abortions/mother): 2 of them in women with CZP.C-section was performed in 26.8% of cases.Preterm birth (<37 weeks) happened in 9.7% (n: 4) of the pregnancies: 1 case in a woman with CZP.A total of 17 different fetal/maternal complications were registered during follow-up: 6 in the BT group (35.3%) compared to 11 (64.7%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Complications are listed in Table 1.Table 1.COMPLICATIONSWITH BT (n, %) n: 11WITHOUT BT (n, %) n: 30IUGR3 (27.3%)1 (3.3%)LOW BIRTH WEIGHT2 (18.2%)2 (6.6%)INFECTION1 (9.1%)4 (13.3%)CHOLESTASIS0 (0%)2 (6.6%)PREECLAMPSIA0 (0%)1 (3.3%)DIABETES MELLITUS0 (0%)1 (3.3%)HIGH BLOOD PRESSURE0 (0%)0 (0%)NEPHROPATY0 (0%)0 (0%)NEONATAL LUPUS0 (0%)0 (0%)HEART BLOCK (0%)0 (0%)MALFORMATION0 (0%)0 (0%)HELLP SYNDROME0/0%)0 (0%)TOTAL6 (54.6%)11 (36.4%)Regarding concomitant treatment, low dose prednisone was used in 48.8% of pregnancies, hydroxychloroquine in 51.2%, sulfasalazine in 9.8% and acetylsalicylic acid in 51.2%. We didn´t find differences in the use of these treatments between the two groups.Median DAS28 among RA patients and available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.Conclusion:In our series, as described in the literature, women with inflammatory arthropaties are older and are more likely to have preterm births compared to general population. Fewer abortions were registered during follow-up in the multidisciplinary unit. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR and low birth weight among women with BT but given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.Disclosure of Interests:None declared
Background:In our population the prevalence of hypovitaminosis D is high. A recent cross-sectional observational study conducted in Spain shows that 63% of postmenopausal women who receive osteoporosis (OP) therapy and 76% who do not receive treatment had 25 (OH) D levels below 30 ng / mL1.The latest studies show a relationship between hypovitaminosis D and the development of systemic inflammatory and tumor diseases, determined by the presence of receptors in various tissues, including breast.Objectives:To determine which levels of serum 25 (OH) D, and secondarily calcium, phosphorus, PTH and CTX, present 200 patients diagnosed with breast cancer and taking hormonal treatment, referred to a monographic OP consultation of a tertiary hospital for the assessment of their bone metabolism, and if these values differ from what is expected for the general population.Methods:Retrospective cross-sectional study of 200 women diagnosed with breast cancer receiving treatment with aromatase inhibitors (AI), performed in a tertiary hospital. Blood levels of vitamin D, calcium, phosphorus, PTH and CTX have been collected, as well as other variables and risk factors.Results:200 patients with a mean age of 64.8 years and an ED of 9.5 were collected. The median is 64.5 (Q1 58 and Q3 72).The vitamin D levels presented by the study patients were <10 ng/mL in 13 patients (6.67%), 11-20 ng/mL in 50 (25.64%), 21-30 ng/mL in 68 (34.87%), 31-70 ng/mL in 62 (31.79%), and> 70 ng/mL in 2 (1.03%). This implies that in 67.18% of the patients they had values below the optimal range.92.31% of patients (180) presented PTH values within the normal range and only 7.69% presented values above normal.The serum calcium and phosphorus levels of the patients selected for the study had ranges within normal (99.49%) except 1 case that presented high values (0.51%) for both.The values of CTX (carboxyterminal telopeptide used as a marker of bone resorption) were in the normal range in 81.96% of patients (159), low values in 0.52% (1) and values above the normal range by 17.53% (34).Conclusion:The prevalence of insufficient levels of vitamin D in our study (Breast cancer + AI) is not greater than that estimated for the general population according to various studies.Our study found that 67.18% of patients (2/3 of the selected population) had values below those considered optimal (<30 ng / mL) and 32% had values <20.Only 7.69% of the patients presented PTH values above the normal range.In 82% of patients, CTX used as a marker of bone resorption had normal values.References:[1]Quesada Gomez JM, Díaz Curiel M, Sosa Henríquez M, Malouf-Sierra J, Nogués-Solan X, Gómez-Alonso C, et al. Low calcium intake and insufficient serum vitamin D status in treated and non-treated postmenopausal osteoporotic women in Spain. J Steroid Biochem Mol Biol. 2013;136:175-7.[2]Jian Sun et al., Vitamin D receptor expression in peripheral blood mononuclear cells is inversely associated with disease activity and inflammation in lupus patients; Clinical Rheumatology (2019) 38:2509–2518Disclosure of Interests:None declared
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