BackgroundAutoimmune/inflammatory syndrome induced by adjuvants (ASIA) has been associated with previous exposure to various agents such as silicone implants, which elicit chronic stimulation of the immune system against the prosthetic material and clinical manifestation of autoimmune disease. This is particularly the case in genetically susceptible hosts.ObjectivesThe aim is to describe de prevalence, family background and main autoimmune rheumatic disease (ARD) associated to silicone breast implant (SBI).MethodsWe study a cohort of 150 patients with diagnosis of ASIA associated injection of mineral oil and silicone breast implant (SBI) in a tertiary Hospital, from 2011 to 2016. All patients were evaluated for the fulfilment of ASIA criteria. We only included patients with ASIA criteria associated with SBI plus criteria for an autoimmune rheumatic disease according to The American College of Rheumatology or EULAR. We excluded patient with ASIA and without ARD.ResultsThere were 17 women patients with mean age 42.4±15.3 years, mean disease duration of disease 8±3. The clinical manifestation post SBI appeared 8±2 years later.The ARD were systemic sclerosis (SSc) 5, systemic lupus erythematosus (SLE) 3, rheumatoid arthritis (AR) 3, overlap syndrome 2 (SSc plus SS and SLE plus SSc, Sjogren syndrome 1, Takayasu arteritis 1, Still disease 1, antiphospholipid syndrome 1, and 3 patients also had secondary fibromyalgia. Five Patients had more than 2 autoantibodies, 4 patients had relatives with an ARD. All patients are being treated according to the ARD (steroids plus immunosuppressive 8 patients, immunosuppressive 7, and only steroids 2), in 4 patients the prosthesis were withdrawn with improvement of clinical manifestations.ConclusionsWe found a prevalence of ASIA associated to SBI of 11%. The main ARD were SSc, SLE and RA. In these cases of ASIA associated with SBI some had genetic predisposition to ARD. The use of SBI is not recommended in women who have a family history of ARD.References Colaris MJ et al. Two hundred cases of ASIA syndrome following silicone implants: a comparative study of 30 years and rewiew of current literature. Immunol Res 2016 Jul 13.Jara LJ, et al. Severe manifestation of autoimmune syndrome induced by adjuvants (Shoenfeld's syndrome) Immunol Res Jul 13.Watad et a. Autoimmune/Inflammatory induced by adjuvants (Shoenfeld's syndrome) UN update. Lupus 2017 Jan 1. Disclosure of InterestNone declared

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Background Primary central nervous system vasculitis (PCNSV) is an uncommon condition in which vascular inflammatory lesions are limited to the brain and spinal cord. Diagnostic criteria include a newly acquired neurological deficit that is unexplained by other processes and angiographic or central nervous system (CNS) biopsy features of vasculitis. In contrast secondary central nervous system vasculitis (SCNSV) is vascular inflammation in which CNS involvement is due to diverse causes. Objectives To investigate the clinical, laboratory, neuroimaging characteristics and treatment in Primary Central Nervous System Vasculitis (PCNSV) versus Secondary Central Nervous System Vasculitis (SCNSV). Methods We studied twenty female patients with central nervous system vasculitis (CNS) during a period of 3 years in a tertiary level center. The clinical manifestations, laboratory, neuroimaging diagnosis and treatment were analyzed. Patients were divided in PCNSV and SCNSV. Biopsy CNS was performed in 3 patients. Results We studied 10 PCNSV and 10 SCNSV patients: systemic lupus erythematous 5, systemic sclerosis (SSc) 4, Sjogren syndrome (SS) 1. Mean age in the PCNSV was 26±5 years and SCNSV 47±7years. Clinical manifestation in PCNSV versus SCNSV were: headache 90% vs 60% (NS), fatigue 80% versus 40% (<0.01), paresthesias 90% versus 80% (NS), motor deficit 20%vs 80% (0.01) and ischemic event 40% vs 40% (NS) respectively. The Antinuclear antibodies (ANA’s) were positive 100% in SCNCV vs 20% (<0.001), anti-DNA was present in 100% (<0.01) in SLE patients with SCNSV, hypocomplementemia was 80% in patients with SCNSV and 22% PCNSV (<0.01). Anti Scl-70 were present in 2 patients with SSc, and anti Ro in patients with SS Cerebral spinal fluid (CSF) was negative for infection, neoplastic process and the proteins were elevated in all cases. MRI showed periventricular and subcortical hyperintense lesions in both groups; however, theses lesions were more frequent in SCNSV. Initial treatment was methylprednisolone pulse followed by monthly cyclophosphamide. Maintenance treatment was prednisone (0.5mg/kg/day) alone in 100% of PCNSV cases and in 60% of SCNSV cases, and prednisone plus azathioprine in 40% of SCNSV cases. Recurrence was present in 20% in PCNSV (20%) and in SCNSV (30%).CNS biopsies showed vasculitis. Conclusions PCNSV had lower frequency of motor deficit, as well as lower ANA’s, and hypocomplementemia in comparison with SCNSV; an increase of CSF proteins was observed in all patients. MRI showed more periventricular and subcortical hyperintense lesions in SCNSV than PCNCV. All patients responded successfully to treatment with steroids plus cyclophosphamide. Early recognition and treatment may reduce poor outcomes. References Salvarini C, Brown RD Jr, Hunder GG. Adult primary central nervous system vasculitis: an update. curr Opin Rheumatol 2012;24:46-52 Salvarini C, Brown RD Jr, Calamia KT, Christianson TJ, Weigand SD, Miller DV, Giannini C, Meschia JF, Huston J3rd, Hunder GG Primary central nervous system vasculitis: an...

BackgroundSystemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology affecting different organs and systems, and requiring the use of immunosuppressors (IS), which increases the risk of infections such as tuberculosis (TB) and its deliberate search is mandatory. Patients with SLE are prone to infections as a consequence of either intrinsic immunologic defects or the IS mainly steroids. The prevalence of TB is higher in SLE patients compared with the general population and has been reported in endemic areas up to 5%.ObjectivesTo determine the prevalence of pulmonary TB - extrapulmonary and associated factor in SLE patients.Methodswe performed a retrospective study in a cohort of 328 SLE patients between 2010–2015 in tertiary level hospital. We included SLE patients with TB diagnosis which was made by PCR, culture, histopathology (HP), acid fast bacillus (AFB) and therapeutic trial (TT). We investigated associated factors for TB: IS drugs 6 months prior diagnosis of Tb (steroids, cyclophosphamide pulse (CY), azathioprine, mycophenolate mophetil (MM) and rituximab), comorbidities (diabetes mellitus, chronic renal disease, arterial hypertension). We also investigated previous exposure and vaccination for TB, type of TB: pulmonary and extra pulmonary. Time evolution, organ involved and SLEDAI at time of diagnosis of Tb were analyzed. Descriptive statistics were performed descriptive statistical.ResultsWe found 13 SLE patients with TB (mean age 43.5± 9.06 years, mean disease evolution of SLE: 6.6±3.2 years). SLE organ involvement: Renal: 7, hematological: 4 Neuropsychiatric: 2; joint -mucocutaneous 6. Active SLE: 9 (SLEDAI 11.5±4.9), inactive SLE: 4. Use of IS: MM 6, Azathioprine: 7, Cy: 5, steroid: 13 (prednisone: median 2.5, range 2.5 to 50 mg/day and methylprednisolone pulse 3g bimonthly in 2 patients), Rituximab: 3. Prevalence of TB was 13 of 328 (4%) patients, extrapulmonary:10 (77%) renal: 4, meningeal: 3, cerebral tuberculoma: 1 peritoneal: 1 disseminated: 1, and pulmonary TB: 3 (23%). Manifestation associated with TB: Fever 12 (92%) appetite loss: 3 (23%), weight loss 5 (38%), asthenia 8 (61%) headache: 3 (23%), hematuria: 2 (15%). TB diagnosis: AFB: 9 (69%), HP: 1 (7.5%), culture and PCR: 2 (15%), TT: one patients with miliary TB who died.ConclusionsThe prevalence of TB in SLE patients was about 4% and its main form was extrapulmonary. The presence of tuberculosis in patients LES constitute a chalence and should be identified in promptly in order to initiate an adequate treatment. TB diagnosis in patients with active SLE is difficult because both diseases share clinical and laboratory manifestations.ReferencesLu MC, Lai CL, Tsai CC et al. Increased risk of pulmonary and extra-pulmonary tuberculosis in patients with rheumatic diseases. Int J Tuberc Lung Dis. 2015;19:1500–6. doi: 10.5588/ijtld.15.0087.Disclosure of InterestNone declared

BackgroundSystemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by clinically heterogeneous manifestations. Infections can be the initial trigger to the development of autoimmunity. Initial presentation of SLE can mimic infections, and in turn infections can mimic disease flares in established SLE. Infections are an important cause of morbidity and mortality in SLE. Bacterial infections are most frequent, followed by viral and fungal infections. The impaired cellular and humoral immune functions seen in patients with SLE are predisposing conditions. Disease activity and high doses of methylprednisolone or cyclophosphamide are well-recognized risk factors for infection.ObjectivesTo determine the prevalence and mortality from infection in SLE patients as well as to identify etiology, associated factors to severity and site of infection.MethodsWe performed a retrospective study from 2010 to 2014 in a referral hospital. We analyzed risk factors (RF) on admission, involved organ, infectious type and etiology. Statistical analysis: We did descriptive statistical, Chi2, multivariate analysis.ResultsThere were 328 patients, 87% women and 13% men, mean age 32.4±9.9 years. Infections as cause of hospitalizations were 42.2%, prevalence of infections was 49%, and mortality from severe infections was 45%. The RF for severe infections were: renal involvement Odds Ratio (OR) 3.057, P<0.019; hematologic OR 1.9, p<0.001; increased dsAnti-DNA RM 5.1 p<0001, hypocomplementaemia: OR 2.673, P<0.02, leukolymphopenia OR 2.5, p<0001. Type of infecctions: bacterial 87%, viral: 3.4%, fungal: 8%, mycobacterial: 1.5%. Site of infection: lower respiratory tract 38%, urinary tract: 49% soft tissues: 6.1%, central nervous system: 1.2%, Others: 4.2%. Most frequent etiology agent were: bacterial: S. aureus, E. coli, A. baumanii, E. faecalis. Virales: H. zoster, mycotic: candida albicans and M. tuberculosis.ConclusionsInfections are an important cause of morbidity, mortality and hospitalization in SLE patients. The lower respiratory tract infections of bacterial origen were most frequent. The renal and hematological involvement, increased dsAnti-DNA, hypocomplementaemia, and leukolymphopenia were the most important factors for severe infections. Infections in active SLE patients constitute a true challenge for the clinicianReferencesLee YH, Choi SJ, Ji JD, Song GG. Overall and cause-specific mortality in systemic lupus erythematosus: an updated meta-analysis. Lupus. 2016 Jan 24.Tektonidou MG, Wang Z, Dasgupta A, Ward MM. Burden of Serious Infections in Adults With Systemic Lupus Erythematosus: A National Population-Based Study, 1996–2011. Arthritis Care Res (Hoboken). 2015;67:1078–85.Disclosure of InterestNone declared