Background/objectives Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. Methods Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. Results The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p<0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p<0.0001), pulmonary hypertension (3.71 [1.84-7.25], p<0.0002), valvulopathy (6.33 [3.41-11.62], p<0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p<0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p=0.0015). Female sex (0.46 [0.25-0.88], p=0.0147) and antimalarials (0.28 [0.17-0.45], p<0.000) proved to be protective factors. Conclusions Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.
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...
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:Large vessel vasculitis (LVV) is a severe entity with nonspecific clinical symptoms, which contributes to a delay in diagnosis and sometimes to serious complications. LVV can be primary or secondary, with giant cell arteritis (GCA) being the most common association.Objectives:To describe the characteristics and differences between patients with primary LVV and LVV associated with GCA in a single center.Methods:Retrospective study of patients with LVV in a University Hospital (January 2013-December 2018). Patients diagnosed with aortitis using an imaging test (PET-CT/angioCT/CT/MRI) were included. GCA was diagnosed by biopsy and/or ultrasound of the temporal artery. The primary LVV was considered by exclusion of inflammatory or infectious causes. Epidemiological, clinical and analytical variables, affected vascular territories and the treatment received in both groups were reviewed.Frequencies and percentages were used in qualitative variables, mean±SD in quantitative and for the comparison between groups Chi2 test or Fisher test was used in categorical variables and Student T test or U of Mann-Whitney in quantitative. The statistical analysis was performed with IBM SPSS v.23.Results:We included 28 patients diagnosed with LVV (9 between 2013-2015 and 19 between 2016-2018). 75% were female with an average age±SD of 71.18±10.8 years. They were divided into two groups: primary LVV (n=15) and LVV associated with GCA (n=13). The diagnosis of GCA was made by ultrasound (n=6), biopsy (n=5) and both tests (n=2). In 7 patients (54%) aortitis and GCA diagnosis was simultaneous. In LVV with GCA, headache was observed in 84.6% of patients and constitutional syndrome in 53.8%.Primary LVV was characterized by lower age at onset, inflammatory low back pain, fever, atypical polymyalgia rheumatica and lower CRP levels; only the first two variables reached statistical significance, probably due to sample size. TABLE 1 The mean number of affected vascular territories was 3 and thoracic aorta was the most affected territory in both groups.The steroid treatment was similar in both groups, whereas methotrexate (MTX) was used more frequently in the LVV associated with GCA. In the first 4 months, 1 patient with primary LVV required Tocilizumab (TCZ).The final clinical evolution was similar and favorable in both groups. At the last visit, after a mean follow-up of 11.94±8.5 months in the primary LVV and 29.63±14.8 months in the LVV secondary to GCA, 93% of patients were asymptomatic with a mean ESR of 24,07±20 and CRP 0.56±0.91. Treatment used in primary LVV were: glucocorticoids (CS) (n=4), mean dose 8.75±7.4mg; MTX (n=11), mean dose 18.18±5.6mg/week and TCZ (n=2). In LVV associated with GCA, 2 patients were without treatment; CS (n=9), mean dose 4.75±4mg; MTX (n=8), mean dose 13.44±6mg/week and TCZ (n = 2).15 imaging tests were performed 6-10 months after diagnosis. Later, after an average time of 28.77±10.7 months 9 more control PET-CT were requested. TABLE 2.Conclusion:In this study, younger age at onset and inflammatory low...
BackgroundInflammatory myopathies are a group of rare systemic diseases characterised by muscle weakness and inflammation. Clinical manifestations, course and prognosis of these patologies are very heterogeneous.ObjectivesThe aim is to describe the main characteristics of patients diagnosed with inflammatory myositis fulfilling Bohan and Peter criteria.MethodsDescriptive analysis of a cohort of 34 patients from the same hospital with follow-up between January 2010 and December 2017. We recorded demographic characteristics, clinical manifestations, treatment, comorbidity and mortality.Results34 patients (73% female) were recruited with an average age at diagnosis of 56.3 years27–83 among adults and 10 years4–15 among children. Most of them were Caucasian (94%). 18% were smokers and 15% previous smokers.The most frequent type was dermatomyositis (DM) (40%) followed by antisynthetase syndrome (ASS) (15%), necrotizing myopathy (12%), inclusion body myopathy (12%), overlap myositis (9%) and polymyositis (9%). 2 patients (out of 4) with necrotizing myopathy were treated with statins.Clinical manifestation included muscle weakness (84%) and skin manifestations (48%) mainly among DM patients. 8 patients (24%) showed interstitial lung disease (4 non-specific interstitial pneumonia, 3 usual interstitial pneumonia and 1 cryptogenic organising pneumonia), especially among patients with overlap syndrome (n=3), DM (n=2) and ASS (n=2). Pulmonary hypertension occurred in 7 patients (21%), 30% among patients with overlap myositis associated to systemic sclerosis. The rest of extramuscular manifestations are expressed in the table 1.Muscle biopsy was performed in 57% of patients (77% compatible with myopathy). MRI was carried out in 45% (100% with active myositis). EMG was performed in 94% of patients with myopathic findings in 67% of them. 20 patients (60%) presented positive antinuclear antibodies, being the most frequent antiPML-SCL (18%), antiJo1 (18%), antiRo (12%) and anti-MDA5 (9%).All patients were treated with corticosteroids. Only 2 responded to corticosteroids in monotherapy. More than 90% needed additional immunosuppressive treatment and 65% received 2 or more immunosuppressants. The most commonly used drugs were methotrexate (72%), rituximab (28%), azathioprine (25%), immunoglobulins (21%) and cyclophosphamide (21%). Only in 12% treatment could be stopped because of sustained remission.3 cases of cancer (9%) were reported: myelodysplastic syndrome, lung neoplasm (in the case of paraneoplasic myositis) and lymphoma.During the follow-up period 4 deaths were registered (12%) due to infections and cancer.38% of patients required a multidisciplinary approach.ConclusionsInflammatory myopathies have frequent multiorganic involvement and represent a heterogeneous group of systemic diseases as shown in our registry and in the literature. Most patients need chronically combined immunosuppressive treatment and few achieve sustained remission. In consequence the collaboration of several specialties is necessary for the diagnosis a...
Background:Infections are one of the main complications among patients with rheumatoid arthritis (RA) with immunosuppressive treatment. The differences between treatments and the influence of other factors is unclear.Objectives:To evaluate the frequency and factors associated with serious infections in patients with RA treated with biological therapy (BT) and JAKi and the differences between treatments.Methods:Descriptive and retrospective study (January 2015-December 2020) of patients with RA treated with BT (TNFi, non-TNFi) and JAKi (tofacitinib, bariticinib, upadacitinib) in a single center. Severe infection was considered a life-threatening infection or one that required hospitalization and intravenous treatment. Epidemiological variables, clinical characteristics, Charlson comorbidity index, type of BT or JAKi and concomitant treatment were collected.For the analysis frequencies and percentages are used in qualitative variables and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.Results:We registered 257 patients (84.4% women) mean aged 56.1±13.4 years. RF was positive in 86.8%, anti-CCP in 75.9% and 16.5 % presented extra-articular manifestations (nodulosis 9.7%, intersticial lung disease 4.3%, other 1.5%). At the start of the study, 157 (61.1%) patients were with TNFi, 80 (31.1%) with non-TNFi and 20 (7.8%) with JAKi. Conventional synthetic DMARDs (csDMARDs) were used in 86% of cases (methotrexate 71.1%, leflunomide 21.2%, other 7.7%).During the study, 162 (63%) patients continued with the same treatment and in 95 (37%) it was changed at least once. 3 patients discontinued the treatment. At the end of the study, 126 (49%) patients were with TNFi, 81 (31.5%) with non-TNFi and 47 (18.3%) with JAKi.Severe infection was developed in 28 (10.9%) patients (13 respiratory, 5 urinary, 5 cellulitis, 4 sepsis, 1 osteomyelitis) among them 2 patients had severe infection and herpes zoster at the same time and 3 developed a second infection. 14 (50%) patients were with TNFi, 8 (28.6%) with non-TNFi and 6 (21.4%) with JAKi. Table 1The inflammatory activity of RA was mild at the time of infection (DAS28: 2.6±1.1). The median time until infection was: TNFi 45.25 [4.9-202.3] months, non- TNFi 19.14 [4.9-72.5] months and JAKi 17.63 [1.1-29.2] months.The Charlson index, concomitant use of glucocorticoids (GCC) at lower doses than 10mg/d, chronic obstructive pulmonary disease (COPD), diabetes (DM), moderate-severe renal insufficiency, congestive heart failure (CHF) and peripheral vascular disease were statistically significantly associated with infection. Table 1.TABLE 1.CHARACTERISTICS OF PATIENTS WITH INFECTION VS. WITHOUT INFECTIONINFECTIONYES n:28NO n:229pFEMALE, n (%)22 (78.6)195 (85.2)0.406AGE years, (mean±SD)57.7 ± 13.955.9 ± 13.40.507AGE ≥ 65 n (%)10 (35.7)68 (29.7)0.513RF +, n (%)25 (89.3)198 (86.5)0.677ANTI-CCP +, n (%)21 (75)174 (75.1)1.00ILD, n (%)1 (3.5)10 (4.3)0.809ALCOHOL, n (%)3 (10.7)17 (7.4)0.465SMOKER, n (%)10 (35.7)60 (26.2)0.244COPD, n (%)7 (25)24 (10.5)0.026*DM, n (%)7 (25)19 (8.3)0.013*CHF, n (%)4 (14.3)1 (0.4)0.001*RENAL INSUFFICIENCY, n (%)3 (10.7)2 (0.9)0.010*PERIPHERAL VASCULAR DISEASE, n (%)9 (32.1)22 (9.6)0.002*CHARLSON INDEX (mean±SD)1.64 ± 2.10.63 ± 1.20.001*TNFi, n (%) NON-TNFi n (%) JAKi, n (%)14 (50)112 (48.9)8 (28.6)73 (31.9)6 (21.4)41 (17.9)csDMARDs, n (%)22 (78.6)159 (69.4)0.317GCC dose <10mg/d, n (%)17 (60.8)111 (48.5)0.007*Conclusion:In our study, 10.9% of patients with RA treated with BT or JAKi developed severe infection during 5 years of follow-up. Concomitant GCC therapy and comorbidity increased the risk of presenting this complication.Disclosure of Interests:None declared
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