Background:Some studies prove that a significant percentage of patients with rheumatoid arthritis (RA) in sustained clinical remission has radiological progression or joint damage, and the presence of residual activity objectified by imaging studies such as ultrasonography could be related to a relapse or flare of RA.(1,2)Objectives:To determine the presence of subclinical synovitis measured by ultrasonography in patients with RA on sustained clinical remission from the Rheumatology service at Hospital de Clínicas, San Lorenzo, Paraguay.Materials and Methods:Prospective, cross sectional, descriptive study, in RA patients meeting ACR/EULAR 2010 criteria, older than 18 years, on sustained clinical remission (≥6 months), measured by ESR-DAS28 (<2,6), doing follow-ups on our service. A healthy control group was included. All groups signed informed consent. Synovial hypertrophy (SH) and intraarticular vascularization grades on Power Doppler (PD) mode were determined according to EULAR recommendations and OMERACT 7 group definitions. Clinical data were obtained from the service’s registries.SPSS 23rd version was used for data analysis. Quantitative variables were presented as means and qualitative as frequencies. Chi square test was performed for comparisons between dichotomous variables and t Student for continuous. For comparisons between variables the Spearman’s rank correlation coefficient was performed, and p≤0.05 for statistical significance. Factors predicting subclinical synovitis were analyzed with Odds Ratio (OR) CI 95%.Results:From 147 patients, 31 (21%) met remission criteria; 87.1% women, mean age 51.9±14.8 years. Mean disease duration was 9,06±10,81 years. 64,5% were RF and ACPA positive and 25,9% had erosions.Ultrasonograms were made in 20 joints of both hands: radiocarpals (RC), metacarpophalangeals (MCP) and proximal interphalangeals (PIP). 12 patients (38.7%) presented subclinical synovitis (SH≥2+PD), more frequently on RC (29% right, 22.6% left), and MCP (9.7% on 2RMCP, 9.7% 4LMCP). These patients had greater CDAI (3.9±1.37 vs 2.89±1.15, p=0.03), HAQ (0.14±0.29 vs 0.00±0.00, p=0.04), CRP (9.90±7.46 vs 4.74±2.30, p=0.00) RF levels (502.67±275.66 vs 200.92±158.43, p=0,00), greater prednisone (16.5% vs 3.2%, p=0.04), and methotrexate use (20.16±5.54 vs 17.50±3.98, p=0.01). None of the healthy controls presented subclinical synovitis.In binary logistic regression CRP levels, RF titers and methotrexate doses were associated to subclinical synovitis. This association is not found in multivariate logistic regression. Negative association was found between subclinical synovitis and two csDMARDs use.Conclusion:This is the first study of its type in Paraguayan patients, which clearly evidenced that an important part of RA patients in clinical remission still presented subclinical synovitis (HS≥2 + PD). It was associated with CRP, RF and methotrexate dose.References:[1]Płaza M, Nowakowska-Płaza A, Pracoń G, Sudoł-Szopińska I. Role of ultrasonography in the diagnosis of rheumatic diseases in light of ACR/EULAR guidelines. J Ultrason. marzo de 2016;16(64):55-64.[2]Foltz V, Gandjbakhch F, Etchepare F, Rosenberg C, Tanguy ML, Rozenberg S, et al. Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis & Rheumatism. 2012;64(1):67-76.Disclosure of Interests:None declared
Background:Rheumatoid arthritis (RA) presents with an elevated incidence of congestive heart failure disease, which has a strong association with diastolic dysfunction, defined by left ventricular delayed relaxation pattern assessed by echocardiography.(1,2)Objectives:To describe the frequency of left ventricular delayed relaxation pattern in patients with RA, and the relationship with its clinical and serological characteristics, as well as with traditional and non-traditional cardiovascular risk factors.Methods:Descriptive, cross sectional, prospective study, in a Paraguayan cohort of patients with RA. This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the Consejo Nacional de Ciencias y Tecnología (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, t-PA, VCAM, PAI-1 and high sensitivity-CRP levels) and echocardiographic assessment with a Doppler 7 GE USA equipment at a private facility. All patients signed informed consent. SPSS Statistics v23 was used for data analysis. Quantitative variables were presented as means and qualitative variables as frequencies. Chi square test was performed for comparisons between dichotomous variables. A p value ≤ 0.05 was used for statistical significance.Results:100 patients were included, 87% women, with a mean age of 51.36 ± 11.03 years, mean disease duration of 130.9 ± 102.64 months. 84.4% had positive ACPA. 43.3% had bone erosions, with an average of DAS 28-ESR 3.42 ± 1.1. 60% of patients presented with echocardiographic left ventricular delayed relaxation pattern. Regarding traditional CV risk factors, the same ones presented more frequently HBP (40% vs 19.4%, p = 0.037), DM2 (11.7% vs 0%, p = 0.036), obesity (38.3% vs 16.7%, p = 0.025), altered glycemia (27.1% vs 6.5%, p = 0.02), altered HbA1C (50.8% vs 22.6%, p = 0.01), higher mean weight (75.9 ± 17.62 p = 0.02), higher Framingham index high (20% vs 3.2%, p = 0.03). Regarding to clinical parameters, a higher frequency of erosions was found (55.8% vs 22.2%, p = 0.004), without other significant differences for disease activity, seropositivity or disease duration. As for serum biomarkers, higher levels of fibrinogen (639.71 ± 189.84, p = 0.04), homocysteine (11.74 ± 7.81, p = 0.05) and VCAM (519, 16 ± 203.68, p = 0.02) were found.Conclusion:We found a high frequency of diastolic dysfunction in patients with RA. They presented a significant association with traditional CV risk factors, erosions, and fibrinogen, homocysteine, and VCAM biomarkers. Adequate control of cardiovascular risk factors and echocardiographic assessment of these patients is essential in order to avoid the progression of heart functional damage.References:[1]Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review. Arthritis Care & Research. 2013;65(4):534-43.[2]Liang KP, Myasoedova E, Crowson CS, Davis JM, Roger VL, Karon BL, et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Annals of the Rheumatic Diseases. 1 de septiembre de 2010;69(9):1665-70.Disclosure of Interests:None declared
Background:Immune Mediated Inflammatory Diseases (IMIDs) are complex diseases that are believed to have a strong interaction between the genome and the environment as part of their aetiology. In studies using the candidate gene strategy, genetic variation in a gene where functionality has been associated with the pathophysiology of the disease under study is being analyzed. In the last decade, polymorphisms of the vitamin D receptor (VDR) and VDBP genes have been more emphatically studied in IMIDs in different populations, but the results reported have not yet been conclusive.Objectives:To identify an association between vitamin D receptor (VDR) and vitamin D-binding protein (VDBP) gene polymorphisms, and IMIDs in Paraguayan patients.Methods:Association study of VDR (SNPs rs731236, rs7975232, rs2228570) and VDBP (rs4588) gene polymorphisms with susceptibility to IMIDs in Paraguayan population. A total of 399 patients with IMIDs (i.e. Systemic Lupus Erythematosus (SLE), Scleroderma (ES), Rheumatoid Arthritis (RA), and Cutaneous Psoriasis (CPS) and 100 hypernormal controls (HC) from the same population were included in this study. Genotyping was performed using Taqman real-time PCR-based technology (Life Technologies, USA). Statistical analysis was performed using Rv3.0.1 statistical language software (www.R-project.org). A p value ≤ 0.05 was used for statistical significance.Results:A total of 399 individuals, 100 controls and 299 patients (99 RA, 100 SLE, 50 ES, and 50 PSO) were included. Seventy-six percent were female and 24% were male. The mean age was 43.7±14 years. Four SNPs were genotyped: rs731236, rs7975232, rs2228570, rs4588. The HWE test was not statistically significant for any of the 4 SNPs considered (P>0.05), confirming the quality of genotyping and the absence of technical bias. (Table 1).Table 1.Genotyping of SNPs of the VDR and VDBP gene in Paraguayan population with IMIDs.SNPIMIDMinor AlleleMajor AlleleMAFControlMAFCaseORIC.LIC.Hp allelicP.Geneticrs731236SLEGA0.50.40.640.420.970.0350.08rs731236RAGA0.50.410.690.461.050.0710.12rs731236SSGA0.50.420.710.421.180.180.37rs731236CPSGA0.50.380.60.361.010.0490.042rs2228570SLEAG0.360.381.140.741.740.60.45rs2228570RAAG0.360.310.830.531.280.40.56rs2228570SSAG0.360.361.020.61.7310.057rs2228570CPSAG0.360.391.160.681.960.610.83rs7975232SLECA0.360.320.820.531.260.40.072rs7975232RACA0.360.290.720.461.120.140.064rs7975232SSCA0.360.220.490.270.880.0120.0064rs7975232CPSCA0.360.411.210.722.030.450.016rs4588SLETG0.230.271.240.7720.420.48rs4588RATG0.230.220.930.561.530.810.84rs4588SSTG0.230.210.890.471.650.770.76rs4588CPSTG0.230.291.370.762.430.260.53Conclusion:There is evidence of nominal association between VDR SNPs: rs731236 (in SLE and CPS), and rs7975232 (in SS and CPS) and the presence of IMIDs disease in Paraguayan patients.Disclosure of Interests:None declared
Fecha de envío 19/05/21 Fecha de aprobación 30/05/21 Palabras claves Síndrome de sjogren Características clínicas ResumenEl síndrome de Sjögren es una enfermedad autoinmune sistémica caracterizada por la sequedad de mucosas y compromiso sistémico. El objetivo del presente estudio fue describir las características clínico epidemiológicas de los pacientes con Síndrome de Sjögren primario incluidos en la cohorte Psecopy que reúnan los criterios ACR/EULAR 2016 y que hayan acudido al Departamento de Reumatología del Hospital de Clínicas de San Lorenzo. Resultados: Se incluyeron 33 pacientes con Síndrome de Sjögren primario. De los cuales 31 (93,93%) pertenecían al género femenino y 2 (6,01%) al género masculino. Con una edad promedio al momento del diagnóstico de Sjögren primario de 46,12 años. Y un tiempo de duración de la enfermedad con una media de 2,10 años. Las comorbilidades más frecuentemente asociadas fueron la hipertensión arterial (21,21%) seguido del hipotiroidismo (18,18%). A estos pacientes se les realizó la biopsia salival por no cumplir criterios, en el 12,12 % de los pacientes según criterios de Chisholm y Mason, donde se encontró un focus score predominante de 3. En relación al ESSDAI se encontró un compromiso articular en 51,51 %, glandular en el 54,54 %, articular en 51,51%, pulmonar, linfadenopatía y dominio biológico en un 12,12%, hematológico y dominio constitucional en un 9,09%, cutáneo y renal en un 6,06%, sistema nervioso central y periférico en un 3,03%. Se destaca también la baja actividad de la enfermedad en un 63,63%, moderada actividad en un 21,21% y alta actividad en un 15,15% según la escala de ESSDAI. No se encontraron neoplasias. Epidemiological and clinical profile of patients withSjögren's Syndrome of the Rheumatology Department of the Hospital de Clínicas. Psecopy Project. Preliminary data.
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