Evaluate the relationship between structural damage assessed by radiography or ultrasonography in the hands of patients with psoriatic arthritis (PsA) with loss of strength together with functional ...disability.
A cross-sectional study was conducted in patients with PsA involving the hands. Erosions and loss of radiographic joint space were measured in the dominant hand using a modified Sharp van der Heijde method and an ultrasound assessment. Hand strength was assessed with a dynamometer and disability was assessed using the Health Assessment Questionnaire (HAQ). The statistical analysis was performed using multiple linear regression models.
76 patients were included with a mean age of 57 ± 9.9 years, with 56.6% women. A statistically significant relationship was found between presence of erosions and reduction in lateral (p = 0.027) and tip (p = 0.030) pinch strength in the hand. This was also the case for loss of joint space and reduction in lateral (p = 0.012) and tip (p = 0.006) pinch strength. There was an association between total ultrasound (US) alterations and reduction in lateral pinch strength (p = 0.03). An association was also observed between erosions, loss of joint space and total US alterations and disability measured by the HAQ (p < 0.001; <0.001; 0.012, respectively). HAQ scores were associated with a decrease in mean lateral (p < 0.001) and tip (p < 0.001) pinch strength.
In patients with PsA involving the hands, structural alterations of the dominant hand assessed by conventional x-ray and ultrasound are associated with loss of strength measured objectively with dynamometry and greater disability also studied subjectively using the HAQ.
•Higher scores for erosions and joint space narrowing in the radiography are related to the total HAQ score in a very similar way to loss of strength•In PsA patients, erosions and loss of joint space in the structures involved in the hand pinch action are associated with loss of strength, measured by dynamometry and greater disability measured by the Health Assessment Questionnaire.•The close relationship between Health Assessment Questionnaire score and mean strength measured by dynamometry reveals that measuring strength is a good instrument for studying disability, even in patients with intellectual or language difficulties, and either of the two methods can be applied interchangeably.
To evaluate the aspects of the basal bone health status in prostate cancer patients. Furthermore, to evaluate in a real-world setting the effect of different schemes (intermittent or continuous) of ...androgen deprivation therapy (ADT) and the effect of denosumab in bone mass density (BMD).
Observational, retrospective study of a cohort of prostate cancer patients in treatment with luteinizing hormone-releasing hormone (LH-RH) agonists, evaluated in the rheumatology department of a tertiary center. Demographics, FRAX score, LH-RH treatment scheme, osteoporosis treatment, laboratory data and BMD were collected. Mixed effect regression models to analyze the interaction between LH-RH treatment scheme, denosumab and BMD evolution were used.
Eighty-three patients (mean age 71±8years) were included. At the basal evaluation, 16% of patients presented densitometric osteoporosis and 27% of patients presented high fracture risk. Eighty percent of patients had inadequate vitaminD levels. VitaminD >30ng/mL was correlated with higher T-scores. There was no association between LH-RH treatment scheme and BMD evolution, however there was a positive association with denosumab.
A high proportion of patients presented elevated fracture risk or inadequate vitaminD levels, not previously recognized. Bone health assessment and fracture risk evaluation are convenient in these patients. In a real-world setting, the effect of denosumab in BMD is detected, however the effect of intermittent LH-RH schema treatment is less evident.
The aim of this study was to analyze which are the main factors that could influence the result of a CT guided biopsy in vertebral osteomyelitis (VO) patients.
A single center retrospective ...observational study was performed including adult patients who had been diagnosed with VO and undergone CT guided needle biopsy from January 2010 to January 2020. Demographical features, concurrent diseases, laboratory findings, microbiological diagnosis, radiological data, medical complications, antibiotic exposure were compiled. Multivariate analysis was performed with a logistic regression comparing the patients depending on the culture result.
Seventy-seven patients were included in the study. Baseline characteristics were comparable between groups. Sample culture was positive in 43 cases (56%). Microorganism isolated were gram+(72%), gram-(14%), mycobacteria (7%) and fungi (7%). Delay in the procedure, antibiotic exposure and blood culture positivity were also similar among both groups. The biopsy results were not influenced by the CRP value, the presence of fever nor antibiotic exposure. The longer duration of back pain was associated to a lower probability of a positive culture.
In conclusion, our study displays an acceptable reliability of CT guided needle biopsy in VO patients, even in cases under antibiotic treatment. The presence of fever or CRP values did not predict a positive culture. Delay in diagnosis could impact negatively on culture yield.
Polymyalgia rheumatica (PR) can be associated with large vessel vasculitis (LVV). We evaluate the diagnostic role of
F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) ...and its impact on the treatment of LVV associated with PR.
Retrospective study of patients diagnosed with PR. Data was collected from health records. Blood analysis included acute-phase reactants (APR), C-reactive protein (CRP) and erythrocyte sedimentation rate. An
F-FDG PET/CT scan was performed in those patients whose symptoms persisted, in those with elevated APR, those who required higher doses of steroids or those who had atypical features of PR (low-grade fever, weight loss, among others).
Twenty-three were eligible; 48% (n = 11) of the patients were diagnosed with LVV associated with PR. The site was heterogeneous, but mostly involved the aorta. In 80% of the patients with LVV, a disease-modifying antirheumatic drug was added to their treatment. Elevated CRP values were associated with the likelihood of presenting LVV.
LVV is not uncommon, clinical features and elevated CRP levels should raise suspicion of LVV associated with PR.
F-FDG PET/CT is useful in identifying LVV associated with PR.
ObjectiveSeveral drugs have been implicated in the development of de novo systemic lupus erythematosus (SLE), unmasking of quiescent SLE or causing an exacerbation of previously diagnosed SLE. Our ...aim is to describe the causative drugs, clinical and serological features of patients diagnosed of Drug-Induced lupus (DIL) in our Rheumatology Department.MethodsA total of 445 patients diagnosed with SLE treated in our Rheumatology Department from 2012 to 2023 were retrospectively screened for the fulfilment of DIL criteria through the search of medical electronic records. Demographic, clinical and laboratory data were summarised using descriptive statistics.ResultsWe identified 18 patients diagnosed with DIL, representing a prevalence of 4% among all SLE patients in our Department. There was a female preponderance and a young age at disease onset. Patients’ clinical and serological characteristics are shown in table 1. Only three drugs (infliximab, adalimumab and sulfasalazine) were identified as causative agents of DIL, anti-TNF being the most common. Most patients were treated for a condition different from a rheumatic disease, mainly inflammatory bowel disease (IBD). Median time to symptom onset after drug initiation ranged from 3 to 194 weeks (median 50.4). Peripheral arthritis and skin rash were the most frequent symptoms, with 4 patients (22%) presenting both at onset. Serologically, only 2 patients were ANA negative, but tested positive for anti-dsDNA. After drug withdrawal, ANA titre showed a slow decreasing trend over time, as well as anti-dsDNA antibodies. However, only 2 patients lost ANA-positivity through follow-up. Remarkably, more than half of the patients tested positive for antiphospholipid antibodies.ConclusionDIL showed a prevalence of 4% in our Rheumatology Department. Anti-TNF agents were the most common drugs causing DIL. ANA tend to decrease over time, but only become undetectable in a few patients. Antiphospholipid antibodies are common in our DIL patients. Age at onset is earlier than previously reported, probably because causative drugs are being used in younger populations.Abstract P28 Table 1Patients’ clinical and serological characteristics Age at onset (median years; IQR) 37.6 ± 19.6 Gender (n,%) Female 14 (78%) Male 4 (22%) Baseline diagnosis Inflammatory Bowel Disease 8 (44%) Inflammatory arthritis 4 (22%) Hidrosadenitis 3 (17%) Psoriasis 2 (11%) Nonspecific Orbital Inflammation 1 (6%) Drug Infliximab 12 (66%) Adalimumab 5 (28%) Sulfasalazine 1 (6%) Time to onset after drug initiation (median weeks, range) 50.4 (3 – 194) Symptoms at onset Peripheral arthritis 9 (50%) Skin rash 4 (22%) Peripheral arthritis AND skin rash 4 (22%) Inflammatory arthralgia 1 (6%) Autoantibodies profile ANA positivity 16 (89%) Median ANA titre 1/320 Low C3 and/or C4 5 (28%) Anti-Ro 1 (6%) Antihistone positivity 0 Anti-La 0 Anti-Sm 0 Antiphospholipid antibodies (AAF) 10 (55.5%) 1 AAF 5 (28%) 2 AAF 4 (22%) 3 AAF 1 (6%)
ObjectiveThe objective is to analyze the association between therapeutic adherence and disease activity in SLE patients.MethodsAn observational, prospective study in SLE patients (SLICC/ACR ...criteria), treated whit subcutaneous Belimumab (200 mg/week) was made. Disease activity was measured by SLEDAI in three consecutive visits, and it was considered clinical worsening an increase of SLEDAI-score of ≥4 point. Persistence and adherence of Belimumab data during the follow-up were collected and were calculated based on the number of drug dispensing. Poor therapeutic adherence was established under the 95%.ResultsThirty-one prescriptions of Belimumab were registered (83.9% women) with a mean age of 48.1 (14.9) years. Time since the diagnosis was 12.5 (6.29) years and treatment period were 2.2 (1.4) years. Fifteen patients were considered as non-adherent (48.4%).Persistence and disease activity data in each group were showed in the table 1.Abstract P149 Table 1Poor adherence was secondary to clinical improvement (66.67%), recurrent infections (13.33%), surgery (6.67%), pregnancy (6.67%) and inability to drug collect due to COVID-19 pandemic (6.67%). Non-adherent group showed worse SLEDAI-score than adherent group in V0, despite of a similar SLEDAI-score at V2 in both groups was observed. There was an association between poor therapeutic adherence and high delta_SLEDAI (p=0.046).ConclusionsWe observed an association between poor therapeutic adherence and delta_SLEDAI. The high SLEDAI-score at the beginning of the study in non-adherent group would be due to clinical manifestations, despite of the similar serological activity in both groups.
ObjectiveWe aimed to analyze the association between inflammatory cytokine levels (IFN-a2, IFN-b, IFN-g, IL10 and BLyS) and disease activity for a 12 months of follow-up in SLE patients.MethodsA ...longitudinal, observational prospective study with evaluations at baseline and follow-up visits every 3 months in SLE patients (SLICC 2012 criteria) and 65 healthy controls was performed. In SLE patients complete laboratory test, clinical evaluation and SLEDAI score was carried out. We analyzed inflammatory cytokines serum levels by colorimetric methods in all cases.Results45 SLE patients (86.7% female) participated in the study, with a mean age at diagnosis of 32.8 (16.2) years and a mean time of disease evolution of 17.9 (11.4) years. The 28.9% of patients showed SLEDAI>6 at the basal visit. The 66.7% were under glucocorticoid treatment, 44.4% under immunosupressants (methotrexate, azatioprine, belimumab or mycophenolate) and 66.7% under antimalarials. SLEDAI and inflammatory cytokine levels during follow-up is shown in table 1.Abstract P9 Table 1 CONTROLS N=65 Mean (SD) SLE V0 N=45 Mean (SD) SLE V3 N=45 Mean (SD) SLE V6 N=45 Mean (SD) SLE V9 N=45 Mean (SD) SLE V12 N=45 Mean (SD) SLEDAI score --- 6.09 (5.38) 3.53 (3.41) 5.09 (4.06) 3.71 (2.87) 3.64 (2.61) IFN-alpha2 (pg/mL) 85.53 (104.72) 202.59 (608.11) 115.24 (219.33) 170.6 (634.44) 103.21 (194.39) 157.22 (523.12) IFN-beta (pg/mL) 38.49 (35.43) 74.61 (91.24) 72.65 (114.59) 76.2 (101.37) 77.23 (114.21) 74.55 (97.51) IFN-gamma (pg/mL) 150.95 (133.14) 257.18 (413.65) 293.62 (395.65) 334.26 (485.59) 289.19 (354.71) 370.53 (794.94) IL-10 (pg/mL) 5.66 (5.45) 14.35 (21.07) 15.48 (16.92) 11.79 (15.23) 11.02 (11.14) 11.86 (11.76) BLyS (pg/mL) 2576.86 (882.64) 3073.4 (2198.6) 6232.42 (4838.81) 4111.58 (3593.74) 4812.91 (3786.77) 5432.31 (4747.82) Statistical analysis showed significant association between SLEDAI score and IL-10 (P=0.014) and IFNa2 (0.009), as well as a tendency with IFN-beta (P=0.057), independently of the time of follow-up. Regarding to clinical activity biomarkers, we observed an association between high levels of antidsDNA and elevated IFN-beta (P=0.005) and IFN-gamma (P=0.038), and low levels of C3 and an increment in IL-10 (P=0.006).Patients under antimalarials treatment during follow-up exhibit low levels of IL-10 (P=0.012) and those under belimumab treatment showed high levels of BLyS (P<0.001). No influence of age at diagnosis, time of evolution, vitamin D levels, corticoids and tobacco use in cytokine levels was observed.SLE patients were categorized by normal or high level of the five cytokines, based on the cytokine level above 2 SD of the mean in healthy controls. Despite the fact that no specific cytokine profile associated with clinical activity was observed, those patients with high SLEDAI score had increased levels of IL10.ConclusionWe observed an association between IL-10, IFN-alpha2, IFN-beta and IFN-gamma levels with clinical activity, independently of the time of follow-up. IL-10 levels may be influenced by antimalarial treatment and BLyS levels by belimumab treatment.
PDF
