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Background:Sleep is essential to human health and it is increasingly regarded as an important lifestyle behavior. The reduction in sleep duration have been linked to an increased risk of cardiovascular disease (CVD) and death in general population (1). Patients with rheumatoid arthritis (RA) have a higher risk of CVD and as in other pain conditions, commonly report poor sleep quality as well as feeling unrested and fatigued after sleep (2). This can be attributed to a lack of awareness of sleep hygiene.Objectives:To determine the prevalence of self-reported estimated duration of total daily sleep, daytime naps and quality of sleep of patients with RA and without rheumatic diseases and its association with cardiovascular risk factors.Methods:Observational, cross-sectional study. RA patients aged 40 to 75 years that fulfilled 2010 ACR/EULAR criteria and controls (without RA) were included. Sleep duration and quality, daytime naps and awareness of sleep hygiene were assessed with self-administered questionnaire. Descriptive analysis was done with frequencies (%), mean (SD), median (q25-q75). Comparisons with Chi-square, Mann-Whitney U test and Wilcoxon. Binary regression analysis was used to test association between estimated sleep duration (Results:A total of 217 subjects were included. RA patients 93 (91.2%) vs 55 (47.8%) controls were female. Mean (SD) age was RA 56.68 (± 10.73) vs 57.27 (± 10.06) controls. Estimated sleep duration (Table 1.Cardiovascular risk factors and sleep characteristicsRA(n=102)Controls(n=115)pObesity, n (%)23 (25.3)31 (31.3)NSCurrent smoker, n (%)12 (11.8)21 (18.3)NSDiabetes Mellitus, n (%)15 (14.7)13 (11.3)NSDyslipidemia, n (%)32 (31.5)30 (26)NSHypertension, n (%)40 (39.2)33 (28.7)NSCardiovascular event, n (%)5 (4.9)3 (2.5)NSObstructive Apnea Sleep, n (%)3 (2.9)11 (9.6)0.047Estimated sleep time (21 (20.6)10 (8.7)0.012Participants taking naps, n (%)47 (46.1)50 (43.5)NSNumber of daytime naps at week, median (q25-q75)0 (0-7)1 (0-7)0.007Duration of daytime naps (min), median (q25-q75)0 (0-30)15 (0-40)NSGood Sleep quality, n (%)67 (65.7)69 (60)NSConclusion:Patients with RA had a higher frequency of less estimated sleep time, this is associated with hypertension, risk of deaths and major cardiovascular events. Additionally, to inflammation and coexistence of CVD risk in RA. There was an absence of awareness of most of the individuals of sleep hygiene. Therefore, in clinical practice, assessment and education of sleep patterns may be of value in identifying higher risk individuals. An integrated care approach may contribute to the awareness of healthcare professionals to develop appropriate interventions.References:[1]Wang, C., et al (2019). Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries.Eur Heart J, 40(20), 1620-1629.[2]Grabovac, I., et al (2018). Sleep Quality in Patients with Rheumatoid Arthritis and Associations with Pain, Disability, Disease Duration, and Activity.J Clin Med, 7(10).Disclosure of Interests:None declared

Background:Patients with Rheumatoid Arthritis (RA) have a higher prevalence of cardiovascular diseases (1) and a strong association with abnormalities in the left ventricle (LV) geometry. Both concentric and eccentric remodeling have been determined as an independent factor for sudden cardiac arrest in the general population with normal or slightly decreased ventricular function (2) but there is still controversy about the factors involved and the pathophysiology in patients with RA.Objectives:The aim of the study is to determine the characteristics of LV geometry and the impact of RA.Methods:A cross-sectional, observational, and comparative study of fifty-two RA patients that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Controls were included and matched by age, gender, and comorbidities. Subjects were evaluated using a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. Ventricular geometry was evaluated with indexed left ventricular mass and relative wall thickness. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A logistic binary regression was performed with the traditional cardiovascular risk factors (CVRFs), age and RA diagnosis. A p value Results:No significant differences were found in the traditional CVRFs (type 2 diabetes mellitus, dyslipidemia, active smoking, and hypertension) (Table 1). Most of the subjects reported normal geometry in both groups (55.8% for RA group vs 64.0% for controls). A higher prevalence of eccentric hypertrophy was found in the RA group, 13 (25%) subjects versus 3 (6%) in the control group, p = 0.009. The binary regression showed that the diagnosis of RA was the only independent risk factor for the presence of eccentric hypertrophy, OR 7.22 95% CI (1.68-31.02, p = 0.008).Table 1.Demographic characteristics and echocardiographic findings.RA(n=52)Control(n=50)pAge, years ± DE51.4 ±6.251.1 ± 5.5NSWomen, n (%)51 (98.1)49 (98.0)NSActive smoking, n (%)8 (15.4)8 (16.0)NSDyslipidemia, n (%)11 (21.2)13 (26.0)NSType 2 Diabetes Mellitus, n (%)5 (9.6)5 (10.0)NSHTN, n (%)8 (15.4)10 (20.0)NSBMI kg/m2, median (p25-p75)27.8 (24.5-31.4)28.3 (25.4-30.3)NSBSA, median (p25-p75)1.7 (1.6-1.8)1.8 (1.6-1.9)0.003Systolic blood pressure, mmHg (p25-p75)119.5 (110.0-127.5)120.0 (110.7-130.0)NSEchocardiography findingsLVPWTd, median (p25-p75)0.9 (0.8-1.0)0.9 (0.8-1.0)NSLVIDd, median (p25-p75)4.8 (4.3-5.2)4.6 (4.5-4.9)NSLV mass, median (p25-p75)131.2 (119.5-155.7)131.2 (113.2-154.3)NSLV mass index, median (p25-p75)78.6 (69.7-95.6)76.0 (66.7-84.6)NSRWT, mean ± SD0.4 ± 0.090.4 ± 0.07NSNS, no significant; BMI, body mass index; BSA, body surface area; LVPWTd, left ventricular posterior wall thickness at end-diastole; LVIDd, left ventricular internal dimension at end-diastole; RWT, relative wall thickness.Conclusion:There is a higher prevalence of eccentric remodeling in patients with RA independently of traditional CVRF. The diagnosis of RA is an independent risk factor for the presence of eccentric hypertrophy that is associated with higher mortality. Treatment of cardiovascular comorbidities should be intensified in those patients with abnormalities in LV geometry in order to prevent cardiovascular diseases such as heart failure.References:[1]You S, Cho CS, Lee I, et al. A systems approach to rheumatoid arthritis. PLoS One 2012;7(12):e51508. doi: 10.1371/journal.pone.0051508[2]Pascale V, Finelli R, Giannotti R, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Sci Rep 2018;8(1):5867. doi: 10.1038/s41598-018-24323-0Disclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) is a chronic and autoimmune disease characterized by systemic involvement. Patients with SLE have accelerated atherosclerosis, resulting in an up to nine-fold increased risk of cardiovascular disease, compared to the general population (1), being the leading cause of death for these patients. Speckle tracking echocardiography (STE) is an accurate technique to estimate myocardial function and deformation.Objectives:This study aims to determine the association between echocardiographic findings and the presence of antibodies in SLE patients.Methods:This was a cross-sectional and observational study. A total of forty-three patients ≥18 years with a diagnosis of SLE according to EULAR/ACR 2019 criteria were included for this study. Those with a history of cardiovascular disease (myocardial infarction, cerebrovascular accident, or peripheral arterial disease) and pregnancy were excluded. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Blood samples obtained from all patients were analyzed for the following: anti-nuclear antibodies (ANA), anti, SSA/Ro, SSB/La antibodies, anti-cardiolipin antibodies (IgA, IgM, IgG), and complement levels. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations between numerical variables were done using Spearman’s rho, considering two-tailed p-values Results:The 39 female patients (90.7%) and 4 male patients (9.3%) had a mean age of 35.5 ± 12.0 years and a median disease duration of 72 months (14-132). At the time of inclusion, 90.7% of the patients were being treated with glucocorticoids and antimalarials. Concerning traditional cardiovascular risk factors; 20.9% of the patients had hypertension, 7.0% had dyslipidemia, 2.3% had diabetes mellitus and 18.6% were active smokers. Correlations between echocardiographic findings and antibodies are shown in Table 1. We found a moderate positive correlation between global circumferential strain and IgA anticardiolipin antibody (r=0.507, p=0.002), a low positive correlation in left ventricular ejection fraction with anti-Ro (r=0.397, p=0.012) and anti-La (r=0.397, p=0.012) and a low positive correlation between TAPSE and C3 levels (r=0.396, p=0.013).Conclusion:There is an association between anticardiolipin antibody titers, anti-Ro, and anti-La with echocardiographic alterations. All SLE patients especially those who had positive antibodies should be screened for the presence of structural cardiac abnormalities. STE can be helpful as a noninvasive diagnostic tool, that could result in earlier treatment and prognosis.References:[1]Hesselvig JH, Ahlehoff O, Dreyer L, et al. Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. Lupus 2017;26(1):48-53. doi: 10.1177/0961203316651739Table 1.Spearman rho correlations between antibody titers and echocardiographic findings.VariablesGLS,mean ± SD-19.11 ± 3.33LVEF,mean ± SD57.43 ± 7.17TAPSE,mean ± SD22.23 ± 3.24ANA, median (p25-p75)640 (160-2550)NSNSNSIgA Anti-Cardiolipin, median (p25-p75)2 (2-3)0.507**NSNSIgM Anti-Cardiolipin, median (p25-p75)2 (2-4)NSNSNSIgG Anti-Cardiolipin, median (p25-p75)4 (3-6)NSNSNSAnti-Ro, median (p25-p75)17 (2-80)NS0.326*NSAnti-La, median (p25-p75)3 (2-5.5)NS0.397*NSC3, mean ± SD91.41 ± 37.38NSNS0.396***Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level. NS, not significant; GLS, global circumferential strain; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Disclosure of Interests:None declared

Background:The term “glass ceiling” has been used since the late eighties, to designate an invisible barrier that prevents highly qualified women from reaching positions of responsibility in the organizations they work. (1) At first, this concept was used to analyze the career of women who, having a professional career and a high level of competition in their workplaces, encountered an interference when trying to advance in their careers. (2). The so-called “glass ceiling” refers to a last barrier based on prejudice towards women that prevents them from advancing to high-level positions.Currently, there is almost the same number of men and women affiliated to the Mexican College of Rheumatology (CMR). The position of president is the highest directorial position, we undertook the task of evaluating the percentage of women who have historically held that leadership position.Objectives:To assess the percentage of woman who have occupied the position of president of the Mexican College of Rheumatology.Methods:Observational, cross-sectional study. We evaluated the number of man and women who have historically held the position of president of the CMR.Results:Currently, the CMR has 630 active members, 308 women (48.9%) and 322 men (51.1%). Among rheumatologists younger than 40 years of age, women represent 58% (n=128). We found that historically the CMR has had 48 presidents, of which only 4 (8.3%) are women.Conclusion:There is a big gender gap between presidents of the CMR. It is important to talk about the gender perspective and recognize the causes that have originated this gap. Incorporating the gender perspective in senior management is a pending issue for our CMR.References:[1]Barberá E, Ramos A, Sarrió M, et al. Laberinto de cristal en el liderazgo de las mujeres. Psicothema 2011;23(2):173-179.[2]Bustos O. Mujeres rompiendo el techo de cristal: el caso de las universidades. OMNIA - Revista de la Coordinación de Estudios de Posgrado 2002(41);1-7.Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Pulse pressure (PP) is defined as the difference between systolic and diastolic blood pressure and represents arterial compliance and reflective properties of blood flow (1). It is well known that gender, age, and race / ethnicity are intrinsic factors of the patient that influence PP. Brachial PP has recently been associated with markers of subclinical cardiovascular disease after adjustment with traditional cardiovascular risk factors in the general population (2). However, this relationship has not been studied in patients with rheumatoid arthritis (RA) and its identification would allow earlier adjustments of cardiovascular therapies in this high-risk group.Objectives:The aim of the study is to analyze the difference in PP between patients with RA and healthy controls. Additionally, to analyze the difference between patients with carotid plaque (CP) and without CP.Methods:A cross-sectional, observational, and comparative study of ninety-two patients with RA aged 40-75 years and who fulfilled ACR/EULAR 2010 classification criteria. Also, we included ninety-two controls without RA, matched by gender, age and comorbidities. A carotid ultrasound was performed in patients with RA and it was divided into two subgroups, with the presence of CP and without CP. A blood pressure measurement was taken after 15 minutes of rest on the right arm of all patients. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A p value Results:We found no statistical difference between groups regarding age, gender and, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) (Table 1). There was a significant difference in PP between patients with RA and controls (50 mmHg vs 41 mmHg respectively, p = 0.032). Patients with RA had a significant difference in PP of patients with CP and without CP (50 mmHg vs 44 mmHg respectively, p = 0.008) (Figure 1). When performing a binary logistic regression, it was found that PP was the only independent factor for the presence of CP in patients with RA, OR 1.054 (95% CI 1.008-1.101, p = 0.020).Conclusion:Patients with RA had a higher PP than controls. Binary logistic regression showed PP as the only independent factor for the presence of subclinical atherosclerosis in patients with RA. PP is a parameter that all rheumatologists should consider when evaluating cardiovascular risk in patients with RA.References:[1]Winston GJ, Palmas W, Lima J, et al. Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Hypertens 2013;26(5):636-42. doi: 10.1093/ajh/hps092[2]Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. Stroke 1999;30(3):550-5. doi: 10.1161/01.str.30.3.550Table 1.Demographic characteristics.RA (n=92)Control (n=92)pWomen, n (%)85 (92.4)85 (92.4)NSAge, years ± SD58.0 (55.0-63.0)56.5 (54.0-61.0)NST2DM, n (%)17 (18.5)15 (16.3)NSHypertension, n (%)33 (35.9)33 (35.9)NSDyslipidemia, n (%)30 (32.6)29 (31.5)NSObesity, n (%)30 (32.6)31 (33.7)NSActive smoking, n (%)11 (12.0)20 (21.7)NSRA patients with CP (n=39)RA patients without CP (n=53)pWomen, n (%)36 (92.3)49 (92.5)NSAge, years ± SD60.13 ± 5.9858.08 ± 7.00NST2DM, n (%)9 (23.1)8 (15.1)NSHypertension, n (%)16 (41.0)17 (32.1) NSDyslipidemia, n (%)13 (33.3)17 (32.1)NSObesity, n (%)15 (38.5)15 (28.3)NSActive smoking, n (%)6 (15.4)5 (9.4)NSDisease duration, years (p25-p75)8.44 (3.00-15.50)12.86 (4.66-19.66)NSNS, no significant; T2DM, type 2 diabetes mellitus; CP, carotid plaque.Disclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) is a chronic, inflammatory, and autoimmune disease that damages vital organs such as the heart. Patients with SLE have a higher risk of developing a cardiovascular (CV) disease than the general population (1).Objectives:The aim of this study was to compare the echocardiographic findings in patients with SLE and controls.Methods:This was a cross-sectional, observational, and comparative study. A total of 38 patients with SLE according to the 2019 EULAR/ACR classification criteria, ≥18 years old and 38 matched controls by age (±5 years) and gender, were recruited for this study. Exclusion criteria were a poor echocardiographic window, patients with a previous CV event, such as myocardial infarction, cerebrovascular event or peripheral arterial disease, and pregnant women. A transthoracic echocardiogram, including speckle tracking technique, was performed, by two certified echocardiographers, in all study subjects. Distribution was evaluated with Kolmogorov-Smirnov test. Comparisons were done with χ2 and Fisher´s Exact test for qualitative variables, and Student’s t test and Mann-Whitney´s U test for quantitative variables. A p-value Results:When comparing demographic characteristics there were no significant differences in age, gender, and comorbidities between SLE patients and controls. In the echocardiographic findings a significant difference was found in the left ventricular ejection fraction (LVEF), lower in SLE patients compared to controls (57.02% vs 61.89%, p=0.001), in the global longitudinal strain (GLS), reduced in SLE patients (-19.55% vs -22.00%, p=0.001), in the tricuspid annular plane systolic excursion (TAPSE), lower in SLE patients (22.00mm vs 24.00mm, p=0.011), in the left atrial volume index, higher in SLE patients (28.44ml/m2 vs 22.29ml/m2, p=0.014) and in the presence of mitral regurgitation, more prevalent in SLE patients (31.6% vs 10.5%, p=0.024) (Table 1).Conclusion:Patients with SLE have a worse left ventricular function, evaluated by LVEF and GLS, a worse right ventricular systolic function, evaluated by TAPSE, an increased left atrial volume index and a higher prevalence of mitral regurgitation, which are associated with a higher risk of CV death. It is important to consider including a transthoracic echocardiogram as part of the CV evaluation in patients with SLE, which may result in an early detection of CV abnormalities and an opportune treatment.References:[1]Avina-Zubieta JA, To F, Vostretsova K, et al. Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Arthritis Care Res (Hoboken) 2017;69(6):849-56. doi: 10.1002/acr.23018Table 1.Demographic characteristics and echocardiographic findings.SLE patients(n=38)Controls(n=38)pAge years, median (p25-p75)37.5 (24.5-43.2)45.0 (24.0-50.0)NSWomen, n (%)34 (89.5)37 (97.4)NST2DM, n (%)1 (2.6)3 (7.9)NSHTN, n (%)9 (23.7)3 (7.9)NSDyslipidemia, n (%)3 (7.9)3 (7.9)NSObesity, n (%)1 (2.6)5 (13.2)NSActive smoking, n (%)7 (18.4)3 (7.9)NSEchocardiographic findingsLeft ventricle indexed mass g/m2, median (p25-p75)64.00 (50.66-87.09)60.30 (52.97-76.74)0.009RWT, median (p25-p75)0.37 (0.30-0.46)0.38 (0.33-0.45)NSLeft ventricular ejection fraction %, mean ± SD57.02 ± 7.3761.89 ± 5.230.001Global longitudinal strain %, median (p25-p75)-19.55 (-21.02 –-15.95)-22.00 (-21.00 –-20.00)0.001Left atrium indexed volume ml/m2, median (p25-p75)28.44 (20.34-33.56)22.29 (17.97-27.13)0.014TAPSE mm, median (p25-p75)22.00 (20.00-24.00)24.00 (21.00-25.00)0.011Valvular abnormalitiesAortic regurgitation, n (%)2 (5.3)1 (2.6)NSMitral regurgitation, n (%)12 (31.6)4 (10.5)0.024Tricuspid regurgitation, n (%)16 (42.1)17 (44.7)NSSLE, systemic lupus erythematosus; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; RWT, relative wall thickness; TAPSE, tricuspid annular plane systolic excursion.Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Psoriatic Arthritis (PsA) is a chronic inflammatory arthropathy that affects 14%-30% of patients with skin and/or nail psoriasis. Patients with psoriatic arthritis (PsA) have a higher prevalence of traditional cardiovascular (CV) risk factors and an increased risk of developing cardiovascular diseases (1), such as acute myocardial infarction, cerebrovascular accident, peripheral vascular disease and heart failure. Despite the evidence patients with PsA are inadequately screened and undertreated for CV risk factors (CVRF), highlighting a gap in preventive medicine to adjust cardiovascular therapies(2).Objectives:The aim of the study is to determine the main CVRF in Mexican Mestizo patients with a diagnosis of PsA and to compare it with healthy controls. Additionally, to assess the impact of the diagnosis of PsA on the presence on these cardiovascular comorbidities.Methods:A cross-sectional, observational, and comparative study of ninety-six patients with PsA between 40-75 years who fulfilled CASPAR criteria 2006. Patients were matched by age and gender with non-PsA subjects. A medical history and physical exam were performed, also a blood sample was collected during the first visit. Chi square and Student´s t test were used for comparations between groups. A binary logistic regression was performed including the traditional CVRF (type 2 diabetes mellitus, hypertension, obesity, and active smoking), age and the diagnosis of PsA. A p value Results:There were 58 (60.4%) women in each group with a mean of 53 years. Patients with PsA showed a higher prevalence of hypertension (HTN) compared to healthy controls (35.4% vs 19.8%, respectively, p = 0.015). Additionally, there was a significant difference in the diagnosis of dyslipidemia (42.7% vs 22.9%, p = 0.003).We found no statistically difference between the two groups in type 2 diabetes mellitus, active smoking and, obesity (Table 1. below).Table 1.Comparison of cardiovascular risk factors between Psoriatic Arthritis and controls.PsA(n=96)Control(n=96)pAge, years ± SD53.19 ± 11.1353.34 ± 8.4NSWomen, n (%)58 (60.4)58 (60.4)NST2DM, n (%)21 (21.9)12 (12.5)NSHTN, n (%)34 (35.4)19 (19.8)0.015Active smoking, n (%)21 (21.9)20 (20.8)NSDyslipidemia, n (%)41 (42.7)22 (22.9)0.003Obesity, n (%)36 (37.5)25 (26.0)NSNS, no significative; SD, standard deviation; HTN, hypertension; T2DM, type2 diabetes mellitus.The binary logistic regression showed that the diagnosis of PsA (OR 2.235, 95% CI 1.141-4.375, p = 0.019) and active smoking (OR 2.429 95%, CI 1.137-5.186, p = 0.022) are independent risk factors for the presence of dyslipidemia.Conclusion:Patients with PsA have a higher prevalence of HTN and dyslipidemia. The diagnosis of PsA seems to be an independent factor for the presence of dyslipidemia. It is important for rheumatologists to identify those patients who could benefit from adjust antirheumatic and cardiovascular therapies due to their impact on morbidity and mortality.References:[1]Peluso R, Caso F, Tasso M, et al. Cardiovascular Risk Markers and Major Adverse Cardiovascular Events in Psoriatic Arthritis Patients. Rev Recent Clin Trials 2018;13(3):199-209. doi: 10.2174/1574887113666180314105511[2]Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol 2017;76(3):393-403. doi: 10.1016/j.jaad.2016.07.065Disclosure of Interests:None declared.

Background:Rheumatoid arthritis (RA) is characterized by elevated cardiovascular morbimortality. RA patients have a higher risk to develop cardiovascular comorbidities when compared to the general population, being the main cause of mortality in these patients. Cardiovascular risk factors (CVRF) are well known, but their management is not optimal, increasing the risk of having a major heart disease (1).Objectives:To assess the prevalence of the main causes of morbimortality and development of CVRF in RA patients during a five-year follow-up period.Methods:A longitudinal and prospective study of a RA cohort from 2014-2019 was performed in a Cardio Rheumatology outpatient clinic at the University Hospital “Dr. Jose E. Gonzalez”, UANL. Patients aged 40-75 years with RA according to ACR/EULAR 2010 criteria were recruited. At both visits, demographic, clinical variables, and lipid profile were recorded. Outcomes included the development of cardiovascular comorbidity: hypertension, diabetes mellitus (DM), dyslipidemia, myocardial infarction, stroke. Survival probabilities and outcomes cumulative frequencies were calculated according to the Kaplan-Meier lifetime analysis method. Descriptive analysis: frequencies (%), mean (SD), or median (q25-q75). Comparisons with McNemar and Student’s t test.Results:A follow-up was done in a total of 92 patients. During the follow-up, 9 patients (9.8%) died, 3 died of cardiovascular death (one myocardial infarction and two strokes). The mean age of death was 67.2 ± 10.5 years. CVRF at baseline (T0) and after five years (T5) are shown in table 1. Of the remain 83 patients, 11 patients (13.3%) developed hypertension (p=0.001), 8 (9.6%) patients developed DM (p=0.031). The number of patients with dyslipidemia decreased significantly to 14 (16.9%) (p=0.031), 4 (4.8%) developed a stroke. A survival probability of 95.7% was found at the five-year follow-up from the time of entry into the cardio rheumatology clinic (Figure 1 next page) and a 30.1% probability of developing cardiovascular comorbidity.Conclusion:This long-term study provides updated information on RA morbimortality characteristics in our population. Patients with RA still develop significant cardiovascular comorbidities despite current treatment. In this cohort, hypertension and DM became more prevalent, and a 96% cardiovascular death-free survival was found. Is imperative to increase the effort in determining optimal markers and therapeutic measures to continue with the prevention of these comorbidities.References:[1]Semb AG, Ikdahl E, Wibetoe G, et al. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020;16(7):361-79. doi: 10.1038/s41584-020-0428-y.Table 1.Demographic and clinical characteristics at the time of inclusion and at 5 years.T0(n=83)T5(n=83)pAge years, mean ± SD56.0 ± 8.9-Female, n (%)75 (90.4)-Disease duration years median (q25-q75)10.4 (4.4-15.7)-CVRF, n (%) Hypertension27 (32.5)38 (45.8)0.001 Dyslipidemia25 (30.1)16 (19.3)0.041 DM6 (7.2)14 (16.9)0.008 Active smoking8 (9.6)6 (7.2)NS Overweight/Obesity67 (81.7)63 (81.9)NS Stroke04 (4.8)-Clinical characteristics BMI kg/m2, mean ± SD28.1 ± 4.128.5± 4.3NS SBP mmHg, mean ± SD123.7 ± 18.4126.9± 16.8NS Total cholesterol mg/dl, mean ± SD180.8 ± 29.0173.9± 34.2NS Triglycerides mg/dl, mean ± SD136.1 ± 56.1146.1± 64.2NS HDL-C mg/dl, mean ± SD55.2 ± 16.355.1± 15.9NS Statins, n (%)9 (10.8)13(15.7)NS Methotrexate, n (%)71 (85.5)63 (75.9)0.039 Glucocorticoids, n (%)49 (59)40 (48.2)NSNS, non-significant; CVRF, cardiovascular risk factors; DM, diabetes mellitus; BMI, body mass index; SBP, systolic blood pressure; HDL-C, high density lipoprotein cholesterol.Disclosure of Interests:None declared

Background:Psoriatic arthritis (PsA) patients have a higher risk of developing a cardiovascular (CV) event than the general population due to an increased prevalence of traditional CV risk factors and to disease characteristics such as disease duration and activity. The carotid ultrasound (US) is a non-invasive diagnostic tool that can detect the presence of subclinical atherosclerosis which is directly associated with the risk of developing a CV event.Objectives:The aim of this study is to compare the prevalence of subclinical atherosclerosis detected by carotid US in PsA patients and controls.Methods:This is a cross-sectional, observational, and comparative study. A total of seventy-five PsA patients aged 40-75 years old, who fulfilled the 2006 CASPAR criteria and seventy-five matched controls by age (±5 years), gender and comorbidities were recruited for this study. Patients with history of a previous CV event and pregnant women were excluded from this study. A high-resolution B mode carotid US was performed in all study subjects by a certified radiologist. Subclinical atherosclerosis was defined as the presence of a carotid plaque (CP) or an increased carotid intima media thickness (cIMT). The presence of CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm in the surrounding lumen. An increased cIMT was considered as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test for qualitative variables and Student´s t test and Mann-Whitney’s U test for quantitative variables. A p value Results:There were no differences when comparing the demographic characteristics between both groups (Table 1). When comparing the carotid US findings, a statistically significant difference was found in the prevalence of CP, which was higher in the PsA group (44.0% vs 26.7%, p=0.026), in the presence of unilateral CP (25.3% vs 10.7%, p=0.019) and in the presence of subclinical atherosclerosis (52.0% vs 34.7%, p=0.032) (Figure 1).Conclusion:The prevalence of subclinical atherosclerosis was higher in PsA patients than controls, and this could be attributed to an increase in the inflammatory burden of these patients. The carotid US should be considered as part of the CV evaluation in all PsA patients, identifying those who would benefit from an opportune treatment preventing the development of a CV event.References:[1]Yim KM, Armstrong AW. Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. Rheumatol Int. 2017;37(1):97–105.Table 1.Demographic and clinical characteristics of psoriatic arthritis patients and controls.PsA(n=75)Controls(n=75)pAge years, mean ± DE53.89 ± 10.5954.25 ± 7.08NSFemale gender, n (%)43 (57.3)43 (57.3)NST2DM, n (%)16 (21.3)15 (20.0)NSHTN, n (%)28 (37.3)21 (28.0)NSDyslipidemia, n (%)33 (44.0)28 (37.3)NSObesity, n (%)31 (41.3)32 (42.7)NSActive smoking, n (%)14 (18.7)18 (24.0)NSBMI kg/m2, median (p25-p75)29.32 (26.23-32.03)28.9 (25.4-33.5)NSDisease duration years, median (p25-p75)5.0 (3.0-10.0)--DAPSA, median (p25-p75)12.6 (5.3-22.9)--Glucocorticoids, n (%)10 (13.3)--MTX, n (%)51 (68.0)--bDMARD, n (%)28 (37.3)--PsA, psoriatic arthritis; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; DAPSA, disease activity for psoriatic arthritis; MTX, methotrexate; bDMARD, biological disease modifying antirheumatic drug.Disclosure of Interests:None declared

Background:A relationship between rheumatoid arthritis (RA) and the presence of abnormalities in left ventricular (LV) geometry such as eccentric remodeling has recently been determined, even in the absence of cardiovascular risk factors and before clinical manifestations (1). The 2016 European League Against Rheumatism (EULAR) recommendations that cardiovascular (CV) risk prediction models should be adapted by a 1.5 multiplication factor in RA patients. Risk prediction algorithms based on the CV risk factors (CVRF) have been an important tool for adopting preventive measures and intensifying therapies based on the estimated risk but their application in predicting cardiac structural abnormalities has never been studied.Objectives:The aim of the study is to determine the CV risk calculator that best predicts alterations in ventricular geometry in RA.Methods:A cross-sectional, observational study of 108 RA patients between 40-75 years (ACR / EULAR 2010 classification criteria). The QRISK3, OMNIBUS, Framingham Risk Score Lipids (FRSL), Framingham Risk Score BMI (FRS-BMI) and Reynolds Risk Score (RRS) calculators were compared. The diagnostic performance was determined by ROC curves, and the discriminative capacity by the Area Under the Curve (AUC) 95% CI. The echocardiogram was the diagnostic gold standard. A p value Results:The prevalence of abnormalities in ventricular geometry was 38.9%. QRISK3 reported AUC of 0.656, 95% CI (0.550-0.762, p=0.006), cut-off point ≥4.6, sensitivity of 73.8% and specificity of 54.5%, and likelihood ratio of +1.62. FRS-BMI showed AUC of 0.653, 95% CI (0.543-0.762, p=0.008), cut-off point ≥11.02, sensitivity and specificity of 61.9% and 57.6% respectively, and likelihood ratio of +1.46. OMNIBUS showed AUC of 0.635, CI 95% (0.525-0.746, p=0.018), cut-off point ≥3.8, sensitivity and specificity of 57.1% and 68.2%. While RRS had AUC 0.644, 95% CI (0.534-0.755, p=0.012), cut-off point of 2.25, sensitivity of 47.6% and specificity 78.8%, and likelihood ratio of +2.24 (Figure 1 and Table 1).Table 1.Discriminatory capacity of the different cardiovascular risk calculators.Calculators (cut-off point).AUCCI 95%pSensitivitySpecificityInferiorSuperiorQRISK (≥4.60)0.6460.5370.7540.01273.8%54.5%SCORE0.5910.4750.706NS--OMNIBUS (≥3.80)0.6210.5090.7340.03857.1%68.2%FRSL0.5940.4800.707NS--FRS-BMI (≥11.02)0.6420.5300.7540.01561.9%57.6%RRS (≥2.25)0.6270.5140.7410.02947.6%78.8%Conclusion:The QRISK3 calculator showed the highest discriminative ability and sensitivity to predict abnormalities in LV geometry. However, all calculators demonstrated the need for a lower cut-off point to predict alterations in ventricular geometry. Our findings require adequate reproducibility in other population groups to determine the applicability of CV risk algorithms as predictors of structural alteration of LV.References:[1]Pascale V, Finelli R, Giannotti R, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Sci Rep 2018;8(1):5867. doi: 10.1038/s41598-018-24323-0Disclosure of Interests:None declared

Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with cardiovascular abnormalities (1). The echocardiography is a non-invasive tool useful in the detection of cardiac abnormalities, which may be the only manifestation of cardiac involvement preceding a global dysfunction. However, echocardiographic differences between PsA patients, rheumatoid arthritis (RA) patients, and controls have not yet been well described.Objectives:To analyze the echocardiographic parameters in PsA patients and to compare them with RA patients and controls.Methods:This cross-sectional, observational and comparative study, included thirty-six patients (nineteen in each group), aged 40-75 years, with PsA and RA who fulfilled the CASPAR (Classification criteria for Psoriatic Arthritis) and ACR/EULAR 2010 classification criteria, respectively, matched by age, gender and comorbidities with nineteen healthy controls. Exclusion criteria were a poor echocardiographic window, patients with a previous atherosclerotic cardiovascular disease (ischemic heart disease, cerebrovascular accident or peripheral arterial disease), and pregnancy. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Comparisons were done with X2, Kruskall Wallis or ANOVA.Results:There were not differences in the demographic characteristics between groups (Table 1). When comparing echocardiographic findings a statistically significant difference was found in the prevalence of diastolic dysfunction, being more prevalent in PsA and RA patients compared with controls (52.6% vs 52.6% vs 5.3%, p=0.002), likewise the presence of mild mitral valve regurgitation was higher (84.2% vs 53.6% vs 10.5%, p=0.001) and mild pulmonary valve regurgitation (68.4% vs 10.5% vs 0%, p=0.001). Prevalence of abnormal left ventricular geometry was higher in PsA and RA patients than controls (68.4% vs 63.2% vs 21.1%, p=0.006).Table 1.Comparison of demographic characteristics and echocardiographic findings between patients with PsA, RA and controls.PsA(n=19)RA(n=19)Controls(n=19)pAge, years ± SD54.7 ± 7.755.4 ± 9.955.3 ± 5.9NSFemale, n (%)11 (57.9)11 (57.9)11 (57.9)NSDiabetes Mellitus4 (21.1)3 (15.8)2 (10.5)NSHypertension10 (52.6)8 (42.1)7 (36.8)NSDyslipidemia10 (52.6)4 (21.1)7 (36.8)NSActive smoking4 (21.1)2 (10.5)5 (26.3)NSDisease duration, years (p25-p75)6 (4-14)7 (5-18)-NSDAS28-CRP, mean ± SD2.2 ± 0.83.1 ± .8-0.003Echocardiographic findigsDiastolic dysfunction, n (%)10 (52.6)10 (52.6)1 (5.3)0.002LV mass index, g/m2 (p25-p75)78.9 (55.9-86.9)73.7 (61.0-85.7)69.5 (52.0-98.7)NSLVEF, ± mean SD62.3 ± 6.159.7 ± 8.662.9 ± 6.1NSTAPSE, cm ± SD21.8 ± 2.722.4 ± 2.723.7 ± 3.1NSMild aortic regurgitation, n (%)5 (26.3)4 (21.1)1 (5.3)NSMild mitral regurgitation, n (%)16 (84.2)10 (52.6)2 (10.5)Mild pulmonary regurgitation, n (%)13 (68.4)2 (10.5)0 (0)Mild tricuspid regurgitation, n (%)15 (83.3)13 (76.5)11 (57.9)NSLV geometry alterations, n (%)13 (68.4)12 (63.2)4 (21.1)0.006Concentric remodeling, n (%)12 (63.2)10 (52.6)4 (21.1)0.025NS, non-significant; DAS28-CRP, disease activity score using 28 joints and C reactive protein; LV, left ventricular; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Conclusion:This study shows the high prevalence of echocardiographic alterations in PsA patients compared to the general population, of the same magnitude as patients with RA. We emphasize the value of an echocardiogram for a complete cardiovascular evaluation and early detection of cardiac abnormalities in these patients.References:[1]Shang Q, Tam LS, Yip GW, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 2011;38(7):1363-70. doi: 10.3899/jrheum.101136Disclosure of Interests:None declared

Background:Patients with rheumatoid arthritis (RA) have a higher risk of developing a cardiovascular (CV) event than the general population, due to an accelerated process of atherosclerosis (1), which has been documented to begin in early stages of the disease and is directly associated with systemic inflammation (2).Objectives:The aim of this study was to compare the prevalence of subclinical atherosclerosis detected by carotid ultrasound (US) in patients with RA in the first five years of diagnosis and healthy controls.Methods:This was a cross-sectional, observational, and comparative study. A total of 53 patients aged 40-75 years old, with RA diagnosis, in the previous five years, according to the 2010 ACR/EULAR classification criteria, and 53 controls matched by age (±5 years), gender and comorbidities were included in this study. Subjects with a previous CV event, such as myocardial infarction, cerebrovascular event and peripheral arterial disease, another connective tissue disease and pregnant women were excluded from this study. A high-resolution B-mode carotid US was performed in all study subjects. Subclinical atherosclerosis was evaluated as the presence of carotid plaque (CP) or an increased carotid intima media thickness (cIMT). CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm of the surrounding lumen, and an increased cIMT was defined as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test and Fisher’s exact test for qualitative variables, and Student’s t test and Mann-Whitney’s U test for quantitative variables. A p-value Results:Comparisons of demographic characteristics showed no differences between the RA group and the control group (Table 1). When comparing carotid US findings there was a difference in the presence of CP, being more prevalent in RA patients (26.4% vs 11.3%, p=0.047), in the presence of an increased cIMT, being more prevalent in RA patients (34.0% vs 3.8%, p=p=p=0.001 in the left carotid artery), and in the presence of subclinical atherosclerosis overall, being more prevalent in RA patients (52.8% vs 18.9%, p=Table 1.Demographic and clinical characteristicsRAControlsp(n=53)(n=53)Age years, mean ± SD54.48 ± 9.0954.86 ± 6.83NSWomen, n (%)49 (92.5)49 (92.5)NST2DM, n (%)8 (15.1)7 (13.2)NSHTN, n (%)17 (32.1)17 (32.1)NSDyslipidemia, n (%)19 (35.8)19 (35.8)NSObesity, n (%)21 (39.6)20 (37.7)NSActive smoking, n (%)3 (5.7)4 (7.5)NSBMI kg/m2, median (p25-p75)28.78 (25.92-33.21)27.59 (24.55-33.34)NSDisease duration, mean ± SD2.48 ± 1.31--DAS28-CRP, median (p25-p75)3.21 (1.89-4.12)--MTX, n (%)39 (73.6)--Glucocorticoids, n (%)29 (54.7)--Conclusion:Patients with RA in the first five years of diagnosis have a higher prevalence of subclinical atherosclerosis than the general population. CV evaluation including a carotid US should be done at the time of diagnosis of RA patients, and subsequently it must be individualized according to the CV risk of each patient, with a maximum of five years to identify those patients who would benefit from an opportune treatment.References:[1]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436[2]Ahmad S, Garg S, Dhar M, et al. Predictors of atherosclerosis in rheumatoid arthritis. Vasa 2012;41(5):353-9. doi: 10.1024/0301-1526/a000221Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) patients have a higher risk of developing left ventricular (LV) geometric abnormalities which can result in the development of heart failure and cardiac death (1). High titers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with a worse cardiovascular (CV) prognosis in RA patients (2).Objectives:The aim of this study was to assess the association between RF and anti-CCP antibody titers, and the LV geometric abnormalities detected by a transthoracic echocardiogram.Methods:This was a cross-sectional, observational, and comparative study. Patients aged 40-75 years who fulfilled the 2010 ACR/EULAR classification criteria for RA underwent a transthoracic echocardiogram. Patients with RA and an alteration of LV geometry were matched to RA patients with normal LV geometry, by age, gender, comorbidities, and disease characteristics to eliminate confounders. LV geometry was evaluated with LV mass index and relative wall thickness. A blood sample was taken to measure RF and anti-CCP antibody titers. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi square test for qualitative variables and Student’s t test and Mann-Whitney’s U test for quantitative variables. A p-value Results:A total of 82 RA patients were included in this study, 41 patients with altered LV geometry and 41 patients with normal LV geometry. Of the 41 patients with LV geometric abnormalities, 37 (90.2%) presented LV concentric remodeling and 4 (9.8%) presented LV concentric hypertrophy. We found no significant differences in the demographic and clinical characteristics between both groups (Table 1). Patients with altered LV geometry showed higher titers of IgA-RF (102.11 U/ml vs 21.70 U/ml, p=0.011) and anti-CCP antibodies (193.04 U/ml vs 18.29 U/ml, p=0.005) (Figure 1).Table 1.Demographic and disease characteristics.RA patients with altered LV geometry(n=41)RA patients with normal LV geometry(n=41)pAge years, mean ± SD53.12 ± 7.6252.34 ± 7.74NSWomen, n (%)39 (95.1)39 (95.1)NST2DM, n (%)7 (17.1)4 (9.8)NSHTN, n (%)13 (31.7)10 (24.4)NSDyslipidemia, n (%)9 (22.0)11 (26.8)NSActive smoking, n (%)4 (9.8)3 (7.3)NSObesity, n (%)11 (26.8)14 (34.1)NSBMI kg/m2, median (p25-p75)27.95 (25.33-31.45)28.42 (25.84-32.00)NSDisease duration years, median (p25-p75)10.37 (2.72-17.80)6.40 (3.43-13.29)NSCDAI, median (p25-p75)14.00 (2.00-22.00)10.00 (3.00-16.50)NSDAS28-CRP, mean ± SD3.52 ± 1.423.09 ± 1.11NSTreatmentMTX, n (%)33 (80.5)34 (82.9)NSGlucocorticoids, n (%)25 (61.0)23 (56.1)NSAntihypertensive, n (%)13 (31.7)8 (19.5)NSStatins, n (%)6 (14.6)4 (9.8)NSRA, rheumatoid arthritis; LV, left ventricular; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; CDAI, clinical disease activity index; DAS28, disease activity score using 28 joints; CPR, C-reactive protein; MTX, methotrexate.Conclusion:RA patients with altered LV geometry had higher titers of IgA-RF and anti-CCP antibodies. This suggests an association between antibody titers and CV prognosis in RA patients. Rheumatologists should take these data into account when evaluating CV risk in RA patients, assessing the possibility of performing an echocardiogram for early detection of CV abnormalities and an opportune treatment in this group of patients.References:[1]Myasoedova E, Davis JM, 3rd, Crowson CS, et al. Brief report: rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a population-based cross-sectional study. Arthritis Rheum 2013;65(7):1713-8. doi: 10.1002/art.37949[2]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Wood smoke exposure is a risk factor for the development of chronic obstructive pulmonary disease (COPD), lung cancer and cardiovascular disease and it has also been linked to higher anti-CCP antibodies in patients with rheumatoid arthritis (RA) and COPD (1).Objectives:The objective of the present study is to report the correlation between anti-CCP, IgG, IgM and IgA rheumatoid factor (RF) to wood smoke exposure in patients with RA. Additionally, evaluate the impact of disease activity, biomass exposure, and disease duration on anti-CCP antibody levels.Methods:A cross-sectional, observational study was designed based on a cohort of Hispanic RA patients. All fulfilled the 2010 ACR/EULAR classification criteria for RA. Biomass smoke exposure was expressed using the biomass exposure index (BEI) calculated from the mean of exposed hours per day multiplied by the number of years exposed. Subjects were divided into two groups: those exposed to wood smoke with BEI ≥1 and subjects not exposed to wood smoke. They were matched by age, gender, and comorbidities. Anti-CCP antibodies and RF were measured by ELISA with cutoff points of Results:A total of 318 subjects were included, 159 (50%) of them had a history of exposure to wood smoke. Anti-CCP antibody positivity was present in 102 (64.2%) with a median titer of 97.1 U/mL (1.7-198) in the RA exposed group, and in 89 (56%) with a median titer of 8.5 U/mL (1.1-145) in the RA non-exposed group. A significant difference was found in anti-CCP antibody titers between groups (p=0.003). (Table 1). Spearman’s rho showed a small but statistically significant correlation between BEI and anti-CCP antibody titers (rho= 0.170, p=0.002). Biomass exposure was independently related to higher anti-CCP antibody titers (B=35.4, pConclusion:RA patients who were exposed to wood smoke had higher titers of anti-CCP antibodies than non-exposed RA patients. Furthermore, biomass exposure was shown to be independently related to higher titers of anti-CCP antibodies.References:[1]Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102(9):843-51.Table 1.Comparison of demographic, seropositivity and clinical characteristic between patients with RA exposed and matched non-exposed RA patients.CharacteristicsRA exposed(n=159)RA not exposed(n=159)pAge years, ± SD56.7 ± 8.755.4 ± 8.1NSFemale, n (%)148 (93.1)148 (93.1)NSBEI years, median (p25-p75)35 (15-90)0Disease duration years, median (p25-p75)9 (3.5-15.1)6.8 (2.8-14.6)NSDAS 28-CRP, median (p25-p75)3.37 (2.11-4.4)3.17 (2.09-4.2)NSDyslipidemia, n (%)50 (31.4)43 (27)NSHypertension, n (%)55 (34.6)48 (30.2)NSDiabetes Mellitus, n (%)24 (15.1)23 (14.5)NSActive smoking, n (%)8 (5)8 (5)NSSeropositivityAnti-CCP antibody positivity, n (%)102 (64.2)89 (56)0.137Anti-CCP antibody titers, median (p25-p75)97.1 (1.7-198)8.5 (1.1-145)0.003IgG RF positivity, n (%)31 (19.5)24 (15.1)0.299IgG RF titers, median (p25-p75)5 (2-13)4.9 (2-13)0.529IgM RF positivity, n (%)136 (85.5)126 (79.2)0.141IgM RF titers, median (p25-p75)198 (41-200)177 (28-200)0.067IgA RF positivity, n (%)98 (61.6)92 (57.9)0.493IgA RF titers, median (p25-p75)52.9 (9.3-193)33(5-159)0.060NS, non-significant; RA, rheumatoid arthritis; BMI, body mass index; BEI, biomass exposure index; DAS28-CRP, disease activity score using 28 joints-C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide; RF, rheumatoid factorDisclosure of Interests:None declared

Background:In the last decades there has been a great progress towards gender equality in medicine, and this can be reflected in the proportion of women in Rheumatology, which has been on the rise recently. However, there continues to be a need for women to be able to succeed on equal opportunities with men (1).Objectives:The aim of this study was to recognize the professional limitations and barriers that Mexican female rheumatologists must face.Methods:Female rheumatologists were invited to participate. An online survey was applied anonymously, consisting of questions regarding demographic characteristics, professional, academic and research activities, as well as perceptions of gender discrimination and limitations of their profession.Results:A total of 127 female rheumatologists voluntarily answered the electronic survey. Most of them were aged between 30 and 35 years (40.9%) and had 1-5 years of professional practice (40.2%) (Table 1); 52% have children and 42.4% of them consider that motherhood has had a negative impact on their professional life; 75.6% of female rheumatologists do not work on research activities and only 20.5% have participated in international congresses in the last 5 years; 80.5% report not participating in medical colleges (as leaders or board members). The three main reasons female rheumatologists refer as limitations on their profession are: having other priorities (34.6%), lack of time (32.3%) and lack of support from their peers/bosses (23.6%). Almost half women (45.7%) consider not being discriminated because of their gender in their profession, while the rest of them consider that they are or may be.Table 1.Demographic characteristics.Age, n (%)Younger than 35 years52 (40.9%)From 35 to 40 years29 (22.8%)From 40 to 45 years16 (12.6%)From 45 to 50 years12 (9.4%)Older than 50 years18 (14.2%)Marital status, n (%)Married66 (52%)Single38 (29.9%)Free union13 (10.2%)Divorced8 (6.3%)Widowed2 (1.6%)Years of professional practice, n (%)From 1 to 5 years51 (40.2%)From 5 to 10 years31 (24.4%)From 10 to 15 years16 (12.6%)From 15 to 20 years10 (7.9%)More than 20 years19 (15%)Conclusion:We found that most female rheumatologists are young and with a few years of professional practice, which coincides with the recent increase in the proportion of women in Rheumatology; and perhaps this is the reason why there is low participation in research activities and medical colleges. It is relevant that almost half of them perceive their gender as a reason of discrimination in their professional life. We consider that initiating the conversation of gender equality in Rheumatology, in national and international forums, and to actively search for a strategy to support and encourage our colleagues, are priorities at this moment.References:[1]Andreoli L, Ovseiko PV, Hassan N, et al. Gender equity in clinical practice, research and training: Where do we stand in rheumatology? Joint Bone Spine 2019;86(6):669-72. doi: 10.1016/j.jbspin.2019.05.005.[2]Colunga-Pedraza IJ, Arvizu-Rivera RI, Serna-Pena G, et al. Women’s journey in Mexican rheumatology. Comment on ‘Gender gap in rheumatology: speaker representation at annual conferences’ by Monga et al. Ann Rheum Dis 2020 doi: 10.1136/annrheumdis-2020-218541.Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Cardiovascular disease (CVD) is the main cause of mortality in patients with rheumatoid arthritis (RA) reflected by a higher prevalence of cardiovascular risk factors (CVRFs), a chronic systemic inflammatory state and heart failure compared to the general population (1). Left ventricular diastolic dysfunction (LVDD) is attributable to structural abnormalities such as hypertrophy or interstitial fibrosis and impaired myocyte relaxation resulting from ischemia and is frequently asymptomatic (2). The presence of LVDD it could be considered as the first step to development of heart failure.Objectives:The aim of the study is to identify the association of disease activity and the presence of LVDD in patients with RA.Methods:A cross-sectional, observational, and comparative study of RA subjects that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Subjects were evaluated by a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. A total of fifty-one RA patients diagnosed with LVDD were included according to the 2016 American Society of Echocardiography (ASE). Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student´s t test and Mann-Whitney U test were used for comparations between groups. A p value Results:We found no statistical difference between groups regarding age, gender, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) and body mass index. Patients with LVDD demonstrated a higher disease activity evaluated by disease activity score using 28 joints-C reactive protein (DAS28-PCR) (4.88 vs 3.56, p= 0.004) (Table 1). It was observed that patients with LVDD have a higher prevalence of being in the high disease activity category (41.2% vs. 13.7%, p= 0.002) (Figure 1). When performing a binary logistic regression, it was found that a high disease activity was the only independent predictor for the presence of LVDD, with an OR 4.70, (95% CI 1.63-13.50, p= 0.004).Table 1.Demographic and disease characteristicsRA patients with LVDD(n=51)RA patients without LVDD(n=51)pWomen, n (%)50 (98)47 (92.2)NSAge, years ± SD56.12 ± 8.7653.91 ± 5.61NSHTN, n (%)17 (33.3)13 (25.5)NST2DM, n (%)6 (11.8)10 (19.6)NSDyslipidemia, n (%)17 (33.3)11 (21.6)NSActive smoking, n (%)5 (9.8)5 (9.8)NSBMI kg/m2 ± SD28.20 ± 4.8929.40 ± 5.13NSDisease duration, years (p25-p75)10.70 (5.16-17.87)5.66 (2.67-15.64)0.033DAS28-CRP, median (p25-p75)4.88 (3.53-5.45)3.56 (3.00-4.69)0.004NS, no significative; HTN, hypertension; T2DM, type 2 diabetes mellitus; BMI, body mass index; DAS28, disease activity score using 28 joints; CPR, C reactive proteinConclusion:Patients with RA and LVDD have a higher disease activity, so emphasis should be placed on strict antirheumatic treatment and cardiovascular therapies to avoid the risk of developing CVD and the progression to heart failure. Logistic regression demonstrates that inadequate disease control is an independent factor from traditional CVRFs for the presence of LVDD.References:[1]Dal Piaz EC, Cioffi G, Ognibeni F, et al. Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic patients with rheumatoid arthritis without overt cardiac disease. Monaldi Arch Chest Dis 2019;89(3) doi: 10.4081/monaldi.2019.1053[2]Abdul Muizz AM, Mohd Shahrir MS, Sazliyana S, et al. A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity. Int J Rheum Dis 2011;14(1):18-30. doi: 10.1111/j.1756-185X.2010.01593.xDisclosure of Interests:None declared

We read with great interest the letter written by Monga et al addressing the narrowing of the gender gap in the annual meetings of the American College of Rheumatology, in which they reported an increase in female speakers from 42.8% in 2017 to 47.0% in 2018.1 However, women under-representation goes beyond annual meetings as Adami et al found that of 366 guidelines and recommendations in Rheumatology published from 2004 to 2019, only 32% of first authors were women, a proportion which has been increasing in the last 15 years.2 Their findings propelled us to evaluate women’s participation as first authors of oral presentations in the …

Background:Adherence to medications among patients with rheumatic diseases is often suboptimal.1Adherence to treatment has been described to be affected by several factors.2The rheumatologist plays a crucial role in influencing adherence behavior by addressing perceptions about medication, providing information, and establishing trust in the treatment plan.3There is no record of attitudes and thoughts of Mexico’s rheumatologists about adherence to medication.Objectives:To know the rheumatologist’s attitudes regarding treatment adherence in follow up consultation.Methods:Descriptive, cross sectional study. Rheumatologists from across the country were invited to respond an electronic survey created with Google Forms, link was sent by Whatsapp ® message, responses were anonymous. The survey was constructed taking into account the main barriers of adherence related to the doctor. Seven questions were created, from one to six were multiple selections and the seven were open question1.Where do you practice medicine? 2.Do you ask all your patients about adherence medication? 3.If your answer was positive, do you ask individually for each drug? 4.How long do you spend on explaining: side effects, benefits, and mechanisms of action of drugs? 5 Do you discuss available treatment options with your patients to decide one? 6.What’s the definition of adherence? 7.Which activities can the doctor do to improve adherence to their patients?Results:Data were collected from 158 rheumatologists who completed the survey. Regarding the question where they practice medicine, 19.5% answered they work in public medical institutions, 31.8% do private practice and 48.7% work in both of them, 88.3% answered correctly adherence definition, 93% of rheumatologists ask for adherence to medication in the follow up consultation and only 86.1% do it individually for each medication, 97.4% discuss therapeutic options with their patients. The time used to explain treatment is presented in Figure 1. The interventions considered by rheumatologists to increase adherence are reported in Table 1.Table 1Interventions considered by rheumatologists to increase adherencePatient education(in follow up consultation, conferences, pamphlets)Develop rapportwith patient. (“be accessible”, “answer questions” “make the patient part of“ don’t be paternalistic or authoritarian”)Adherence measure(Use the available method, questionnaires, self-report, drug levels, electronic pillbox, pill count, etc. “Don’t matter which one, measure it!“)Interventions for no adherence reasons(phone calls, text messages, telephone alarms) fixed schedules for each medication, cognitive-behavioral therapy, access to medications)Family support networkPresented in order to frequencies and grouped by topicConclusion:Rheumatologists ask for adherence medication but more than half use a limited amount of time to explain about medication, nevertheless, they think that patient education is the best intervention to increase adherence.References:[1]Pasma, Annelieke et.al Facilitators and Barriers to Adherence in the Initiation Phase of Disease modifying Antirheumatic Drug (DMARD) Use in Patients with Arthritis Who Recently Started Their First DMARD Treatment, The Journal of Rheumatology (2013) DOI:10.3899/jrheum.140693.[2]M.F. M. Improving treatment adherence in patients with rheumatoid arthritis: What are the options? Int J Clin Rheumtol. 2015;10(5):345–56.[3]Voshaar et al. Barriers and facilitators to disease modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskeletal Disorders (2016) 17:442 DOI 10.1186/s12891-016-1289-zDisclosure of Interests:None declared

Background:Cardiovascular disease (CVD) is the primary cause of mortality in women in developed countries. CVD risk rises with age, yet for women there is a rapid increase that occurs after the onset of menopause (1). There has been found that there is four to five times atherosclerosis compared to premenopausal women. Adding to traditional CVD risk, rheumatoid arthritis (RA) patients have an increased CVD morbimortality because of the inflammatory disorder (2). To detect the burden of CVD, carotid ultrasound has been promoted to identify preclinical atherosclerosis.Objectives:To determine the prevalence of carotid atherosclerosis andcarotidintima-media thickness (cIMT) in postmenopausal patients with RA and compare them to matched controls.Methods:Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled 2010 ACR/EULAR criteria with post-menopause and matched controls (without RA) were included. Patients with history of previous atherosclerotic CVD, women who undergone menopause due to hysterectomy or cessation of periods other than by a natural cause, women on hormone replacement therapy and having irregular menses were excluded. Clinical history and carotid ultrasound were performed. Increased cIMT defined as ≥0.9 mm was measured using the two inner layers of the common carotid artery and carotid plaque as a focal narrowing ≥0.5 mm of the surrounding lumen. Descriptive analysis was done with frequencies (%), median (q25-q75). Comparisons with Chi-square and Mann Whitney-U test. Binary regression analysis was used to test association an increased cIMT with cardiovascular risk factors and RA diagnosis.Results:A total of 139 women with established post-menopause were included. Baseline characteristics (Table 1). Right carotid atherosclerosis prevalence was found more than twice (19% vs 8%, p=0.01) and an increased cIMT was higher in postmenopausal RA patients (right 25% vs 10%, p=Table 1.Baseline characteristicsRA(N=70)Control(N= 69)pAge, median (q25-q75)55.04 ± 5.38156 6 ±.481NSDisease duration, year, median (q25-q75)10.32 (4.5-15.3)Body mass index, median (q25-q75)28.19 (25.36-31.84)28.55 (26.57-31.18)NSDiabetes Mellitus, n (%)8 (11.6)14 (20)NSHypertension, n (%)19 (27.5)26 (37.1)NSDyslipidemia, n (%)23 (32.9)21 (30.4)NSActive smoking, n (%)14 (20.3)5 (7.1)NSTable 2.Carotid ultrasound findingsRA(N= 70)Controls(N=69)pAny plaque, n (%)24 (34.3)17 (24.6)NSRight CP, n (%)19 (27.9)8 (11.6)0.01Left CP, n (%)17 (25)13 (18.8)NSAny cIMT ≥0.9 mm, n (%)38 (54.3)19 (27.5)0.001Right carotid cIMT ≥0.9 mm, n (%)25 (35.7)10 (14.7Left carotid cIMT ≥0.9 mm, n (%)31 (44.3)15 (21.7)CP characteristics:Homogeneous n (%)2 (2.8)3 (4.3)NSHeterogeneous, n (%)20 (28.6)16 (23.2)NSCP: carotid plaqueConclusion:Despite the increase in cardiovascular risk in postmenopausal women compared to the general population, women with RA have a higher risk compared to healthy women. Carrying out cardiovascular prevention and management in patients with RA is essential, especially in those who are in a stage of post-menopause.References:[1]Karvinen, S. et al (2019). Menopausal Status and Physical Activity Are Independently Associated with Cardiovascular Risk Factors of Healthy Women, Endocrinol, 10, 589.[2]Schott, L., et al (2009). Do carotid artery diameters manifest early evidence of atherosclerosis in women with rheumatoid arthritis? JWomensHealth, 18, 21-29.Disclosure of Interests:None declared

Background:Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD). Risk stratification algorithms for general population, such as cardiovascular risk calculators, have been developed to improve primary prevention and early detection of CVD; however, it underestimates cardiovascular risk in PsA patients1. Carotid ultrasound, which measures both carotid intima-media thickness (cIMT) and carotid plaque (CP), is useful in the detection of subclinical carotid atherosclerosis improving risk stratification.Objectives:This study aimed to evaluate the use of carotid ultrasound in the reclassification of cardiovascular risk in PsA patients and compare it with controls.Methods:This cross-sectional study included 70 PsA patients that fulfilled the CASPAR criteria and 70 controls subjects matched by age and comorbidities. Patients with a history of previous atherosclerotic CVD and pregnancy were excluded. Clinical examination, blood tests and Framingham Risk Score Lipids and BMI based (FRS-Lipids/FRS-BMI) and ACC/AHA 2013 calculators were performed. Carotid B-mode ultrasonography was used for measurements of cIMT and CP presence.Increased cIMT was defined as ≥0.9 mm. CP was definedas afocal narrowing ≥0.5 mm of the surroundinglumen or acIMT ≥1.2 mm.Descriptive analysis was done with measures of central tendency and dispersion and comparisons with Chi-square, Student´s t and Mann-Whitney U tests.Results:A total of 138 subjects were included. Clinical and demographic characteristics are shown in Table 1. Differences were found in the cardiovascular risk classification between the calculators and the carotid ultrasound. However, these were not significant when compared to controls, with the exception of the FRS-Lipids which had a significant difference when recategorized as high risk by the increase in the cIMT (p = 0.016). A 70.8% and a 56% of patients with PsA who had CP were not classified as high risk according to FRS-Lipids (p = 0.010) and ACC / AHA 2013 (p Table 1.Clinical and demographic characteristics.PsA(n=69)Controls(n=69)PAge, (mean±SD)53.58±10.94653.86±7.313NSWomen, n (%)38(55.1)59(85.5)Type 2 Diabetes Mellitus, n (%)14(20.3)9(13)NSHypertension, n (%)27(39.1)19(27.5)NSDyslipidemia, n (%)29(42)24(34.8)NSObese, n (%)26(37.7)28(40.6)NSActive smoker, n (%)15(21.7)12(17.4)NSDisease duration, median (q25-q75)5(2.5-8)--DAS28-ESR, (mean±SD)3.74±1.477--DAPSA, median (q25-q75)35(27.5-58.5)--Conclusion:None of the traditional calculators used in the general population correctly estimates cardiovascular risk in patients with PsA. Among the calculators we performed, FRS-Lipids was the worst, underestimating PsA individuals with CP up to 70.8%. Therefore, it is advisable to perform a carotid ultrasound without relying on the results obtained by any of these calculators in order to achieve an adequate classification and accomplish a correct management of the disease.References:[1]Sobchak, C.et al.(2019), Value of Carotid Ultrasound in Cardiovascular Risk Stratification in Patients with Psoriatic Disease. Arthritis Rheumatology, 71: 1651-1659. doi:10.1002/art.40925Table 2.Ultrasound Characteristics in PsA patientsCPWithout CPPFRS-Lipids, n (%)0.010Low and Moderate risk17(70.8)39(95.1)High risk7(29.2)2(4.9)FRS-BMI, n (%)NSLow and Moderate risk15(62.5)32(80)High risk9(37.5)8(20)ACC/AHA 2013, n (%)Low, Borderline and Moderate risk14(56)35(97.2)High risk11(44)1(2.8)Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) and psoriasic arthritis (PsA) are autoimmune diseases, in both diseases it has been described that the main cause of morbidity and mortality is cardiovascular (CV) disease. Dyslipidemia is the most recognized CV risk factor. An association is recognized between the concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total triglycerides (TG), atherogenic index (AI) and the risk of myocardial infarction (MI), stroke and fatal cardiovascular disease (CVD). The relationship between serum lipid levels and CVD risk is potentially paradoxical in RA but this relationship has not been clarified in PsA.Objectives:To compare lipid profile between groups with RA, PsA and controls.Methods:A cross-sectional observational study was designed, which included 95 patients between 45-75 years who fulfilled the CASPAR classification criteria for PsA. 95 patients between 45-75 years who fulfilled the ACR / EULAR 2010 classification criteria for RA and 95 age-matched controls. Concentrations of CT, HDL-C, LDL-C, TG and atherogenic index were compared between the groups. Clinical measures were compared using one-way ANOVA or Kruskall-Wallis tests. Post-hoc analysis was performed with Bonferroni’s correction. Ap≤ 0.05 was considered statistically significant. The data was analyzed using the SPSS version 25 software package.Results:In our study, no significant difference in LDL-C was found between RA and PsA, however post-hoc analysis was performed where we found higher LDL-C levels among RA patients compared with controls (p0.025). RA patients had higher HDL-C than PsA patients (p0.006) but PsA had a higher HDL-C than controls (p0.007). TC/HDL-C was higher in PsA than RA and controls (p0.050). PsA patients were the group with the lowest HDL-C levels (p0.007). In contrast RA were the groups with the highest HDL-C levels (p0.007). (Table 1).Table 1.Clinical parameters.PARAMETERRAPsAControlspTC*176.6 ± 37.2176.3 ± 35.9186.34 ± 33.1720.089TG**132.7 (102.0-187.3)131.0 (97.2-189.2)118.35(88.2-162.25)0.245HDL-C**50.7 (42.1-62.6)46.7 (37.4-53.9)51.7 (41.3-60)0.007LDL-C*94.36 ± 21.7097.71 ± 30.12105.32 ±31.350.025TC/HDL-C**3.41 (2.81-4.08)3.74 (3.17-4.47)3.49 (2.99-4.52)0.050*Data are reported in mean ± SD**Data is reported in median (IQR)Conclusion:Patients with inflammatory joint diseases have more adverse lipid profiles than controls.References:[1]Pietrzak, A., Chabros, P., Grywalska, E., Kiciński, P., Pietrzak-Franciszkiewicz, K., Krasowska, D., & Kandzierski, G. (2019). Serum lipid metabolism in psoriasis and psoriatic arthritis–an update. Archives of medical science: AMS, 15(2), 369.Disclosure of Interests:None declared

Background:Previous studies showed that 93% of rheumatologists consider fibromyalgia (FM) as a clinical entity. However, accompanying symptoms such as fatigue, widespread pain, sleep disturbance and headache are underrecognized among physicians. According to a previous study, most recognized symptoms by general practitioners are fatigue and widespread pain (72.6%), while about thirty percent of physicians recognize sleep disturbance and depression as symptoms.Objectives:To investigate physicians’ point of view of FM accompanying symptoms in northeastern Mexico.Methods:We designed an electronic survey about physicians’ perceived importance of depression, fatigue, widespread pain, sleep disturbances, headache and irritable bowel disease symptoms (pain and cramping) in patients with FM. Questions were answered using a 5-point Likert scale: 1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree. General practitioners, rheumatologists, neurologists, psychiatrists were included.Results:A total of 236 physicians were included: general practitioners, 149 (59.3%); rheumatologists, 21 (8.9%); neurologists 18 (7.6%); psychiatrists 8 (3.4%), and family physicians, 49 (20.8%). FM was considered a clinical diagnosis by 208 (88.1%) and most physicians think FM is both a physical and psychological condition, 190 (80.5%). Full results on physicians’ perceptions is shown in Table 1. Fatigue was the symptom which most physicians agreed or strongly agreed was important in FM, 219 (92.7%). Disagreement (any degree) was greater regarding abdominal pain/cramping being an important symptom in FM, 52 (22%). Complete results can be seen in Image 1.Table 1.Perceptions’ of physicians about FM.VariableFM is a clinic diagnostic, n (%)208 (88.1)Unsure FM is a clinical diagnostic, n (%)12 (5)FM is a physical illness, n (%)33 (14)FM is a psychological illness, n (%)11 (4.7)FM is both physical and psychological, n (%)190 (80.5)FM has a negative impact on quality of life, n (%)227 (96.2)FM has a negative impact on life expectancy, n (%)135 (57.2)Conclusion:FM was considered a clinical diagnostic and an illness both physical and psychological by most physicians. Headache and abdominal pain/cramping are symptoms less likely to be perceived as important in patients with FM.References:[1]Perrot S, Choy E, Petersel D, et al. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia. BMC Health Serv Res. 2012 Oct 10;12:356.[2]Kianmehr N, Haghighi A, Bidari A. Are general practitioners well informed about fibromyalgia? Int J Rheum Dis. 2017 Dec;20(12):1917-1921Figure 1.Image 1. Perception of accompanying symptoms of fibromyalgia (FM)Disclosure of Interests:None declared

Background:Patients with Rheumatoid Arthritis (RA) have higher incidence of cardiovascular diseases (CVD) compared to general population. There is controversy about the impact of RA disease activity on left ventricular systolic function (LVSF)1. LVSF may be assessed by conventional methods like left ventricular ejection fraction (LVEF) and myocardial shortening or by novel techniques evaluating myocardial strain such as speckle tracking echocardiography (STE).Objectives:To assess the impact of RA disease activity on LVSF using ejection fraction and myocardial strain by STE.Methods:Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled the 2010 ACR/EULAR classification criteria and matched controls were included. Patients with a poor US window, history of previous CVD (ischemic heart disease, cerebrovascular accident or peripheral arterial disease) and pregnancy were excluded. Individuals were evaluated using two-dimensional speckle tracking echocardiography performed and reviewed by 2 certified echocardiographers. LVEF and myocardial strains (circumferential, longitudinal and radial) were measured; differences were solved by consensus. Descriptive analysis was done with measures of central tendency and dispersion. Student-t and Mann-Whitney U tests were used for comparisons.Results:A total of 140 subjects were included. Demographic and clinical characteristics are shown in Table 1. RA patients were divided in 2 groups, according to disease activity by DAS 28-CRP (remission or low activity and moderate or high activity). Echocardiographic comparisons between RA and controls and between the 2 groups in which RA patients were divided by disease activity are shown in Table 2. The LVEF was lower in RA subjects compared with controls (p=0.022), however LVEF was normal (> 52% in men and >54% in women) in both groups. There was a significant difference in the circumferential strain (CS) between RA patients based on the disease activity by DAS 28-CRP (p=0.006).Table 1.Demographic and clinical characteristics.RA(n= 70)Control(n= 70)PFemale, n (%)67 (95.7)69 (98.6)NSAge, mean ± SD52,4±6,752,0±6,1NSType 2 Diabetes Mellitus, n (%)9 (12.9)7 (10)NSHypertension, n (%)14 (20)16 (22.9)NSDyslipidemia, n (%)16 (22.9)17 (24.3)NSActive smoking, n (%)11 (10.9)8 (16.3)NSDisease duration, years,median (q25 –q75)8.0(3.0-15.0)--DAS-28-PCR, median (q25 –q75)3.2(2.1-3.9)--Table 2.Echocardiographic findingsLVEFPCSPRA, mean ± SD63.0±4.30.022-16.4±4.5NSControls, mean ± SD64.7±3.8-16.2±4.1LVEFPCSPRemission or low disease activity, median (q25 –q75)64.0(60.0-66.0)NS-15.1(-17.2- -12.2)0.006Moderate and high diseases activity, median (q25 –q75)63.0(60.0-66.0)-18.1(-22.0- -13.9)LVEF= Left ventricular ejection fractionCS= Circumferential strainConclusion:The decrease in the circumferential strain depends on the disease activity. Myocardial strain by speckle tracking echocardiography may detect early myocardial dysfunction in RA. It is important for the rheumatologist to establish an appropriate treatment in order to achieve the disease remission or a low disease activity, as there is an impact of the disease activity on the myocardial function.References:[1]Hanvivadhanakul, P., Buakhamsri, A. Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease.Adv Rheumatol59, 56 (2019).https://doi.org/10.1186/s42358-019-0100-xDisclosure of Interests:None declared

Background:Rheumatoid Arthritis (RA) has been associated with depression by up to 46% (1)Within the universe of manifestations of depression is learned helplessness (LH)LH is defined as an inadequate perception of the disease, generating feelings of defenselessness, loss of self-esteem, pessimism, and negativity. This leads to passivity, surrendering to fate, and thoughts that nothing within their power can change their situation, this condition produces a rapid deterioration which prevents responding adaptively to a traumatic situation, increasing the frequency of anxiety and depression. (2)Objectives:To assess the relationship between depression, LH, disability and disease activity among patients with RAMethods:Descriptive observational study included RA patients diagnosed according to ACR / EULAR 2010 randomly recruited between June and September 2019 at University Hospital “Dr. José Eleuterio González” in Monterrey, México.Beck Depression Inventory (BDI) and Rheumatology Attitude Index (RAI) were applied for measure depression and LH, to measure disability Health Assessment Questionnaire (HAQ-DI) was applied. CDAI and DAS28-PCR scales were used for measure disease activity.Descriptive analysis was carried out with measures of central tendency and dispersion. Spearman correlation were used for comparisons, according to the distribution of the variables. A p Results:A total of 177 patients were included, demographic and clinic features are presented in table 1. Prevalence of LH was 94.5% (167/177); 60% (100/167) mild levels (9-15) and 33% (67/167) high levels (>15). A significant correlation was found between higher levels of dysfunctionality and BDI and higher levels of LH (rho = 0.338; p = 0.001). There was a positive association when measuring CDAI (rho = 0.235; p = 0.002) BDI (rho=0.278 P=Table 1.Demographic and clinical characteristics of the patients. HAQ-DI Health Assessment Questionnaire RAI Rheumatology attitude index, DAS28-PCR Disease Activity Score CDAI Clinical disease activity index BDI Beck Depression InventoryDemographicsn = 177Gender Female n, %165 (93.3%). Male n, %12 (6.8%)Age (mean), SD.52.16 (12.8)Years of study (average), SD.8.3 (3.6)Years with RA (mean), SD.8.2 (8.0)RAI (mean), SD13.83 (3.9)HAQ-DI (mean), SD0.67 (0.77)CDAI (mean), SD12.0 (11.4)DAS28-PCR (mean), SD2.4 (0.6)BDI (mean), DE9.30 (9.7)LH, n (%)168/177 (94.5%)High levels 108/177 (61%)Low levels 60/177 (33%)Conclusion:In this study the prevalence of LH was high >90%, mainly in mild levels. Dysfunctionality seems to be the factor most associated with the presence of depression and LH.Rheumatologist should consider the high levels of LH, to assess patients in order to obtain a better outcome.Table 2.Correlation between learned helplessness and clinical variables LH Learned Helplessness HAQ-DI Health Assessment Questionnaire RAI Rheumatology Attitude Index DAS28-PCR Disease Activity Score CDAI Clinical Disease Activity Index BDI Beck Depression InventoryrhopLH –HAQ-DI0.338LH-CDAI0.2350.002LH-DAS28PCR0.1660.027LH-BDI0.278[1]Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol. 2011;6(6):617-23.[2]Moyano S, Scolnik M, Vergara F, Garcia MV, Sabelli MR, Rosa JE, et al. Evaluation of Learned Helplessness, Perceived Self-efficacy, and Functional Capacity in Patients With Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol. 2019;25(2):65-8.Disclosure of Interests:None declared

Background:Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with psoriasis. It occurs in approximately 8% –30% of patients diagnosed with psoriasis. In addition to joint and skin manifestations, patients with PsA have an increased prevalence of traditional cardiovascular (CV) risk factors that has been associated with a higher severity of PsA and increased cardiovascular disease (CVD). However, this increased risk has been attributed not only to increased traditional risk factors but also to chronic systemic inflammation.Objectives:To compare the most relevant CV comorbidities in patients with PsA and controls.Methods:A cross-sectional observational study was designed, 94 patients between 45-75 years who fulfilled the CASPAR classification criteria for PsA and 94 age-matched controls were included. The clinical characteristics compared between groups were: age, BMI, waist/hip index, gender, diabetes mellitus, hypertension, dyslipidemia, overweight, obesity, smoking history and prior cardiovascular event. Student-t test, Mann-Whitney U, Chi2test and Fisher’s exact test were used to compare data and odds ratio were calculated.p≤ 0.05 was considered statistically significant. Logistic regression analysis was used to test association between significant clinical risk factors for PsA. The data were analyzed using the SPSS version 25 software.Results:94 PsA patients and 94 controls were included. The majority of the patients were women (57.4% in the PsA group and 80.9% in the control group) (p0.001). Body mass index and waist/hip index were higher in PsA group (p0.002) (pPsA patients had more hypertension than controls (p0.022), more overweight (p0.005), and a higher smoking history (pTable 1.Clinical comorbidities and risk factors for PsA.VariablePsAControlpOR (95% CI)Age*53.23 ± 11.3153 ± 100.790BMI*29.37 ± 5.3227.21 ± 4.170.002Waist/Hip Index**0.94 (0.88-1.03)0.90 (0.85-0.92)Gender0.001Female54 (57.4%)76 (80.9%)Male40 (42.6%)18 (19.1%)Diabetes18 (19.1%)14 (14.9%)0.4381.35 (0.62-2.91)Hypertension33 (35.1%)19 (20.2%)0.0222.13 (1.10-4.12)Dyslipidemia36 (38.3%)24 (25.5%)0.061.81 (0.97-3.37)Overweight77 (81.9%)60 (63.8%)0.0052.56 (1.31-5.03)Obesity36 (37.6%)26 (27.7%)0.1461.57 (0.85-2.92)Smoking history36 (38.3%)78 (83%)0.127 (0.06-0.25)History of CVD68 (72.3%)8 (53.3%)0.1372.28 (0.75-6.94)*Data are reported in mean ± SD**Data is reported in median (IQR)We performed a multivariate analysis that showed that being overweight and presenting a waist / hip index above 0.90 cm confers an increased risk of developing PsA (Table 2).Table 2.Multivariate analysis of significant clinical risk factors for PsA.VariablepOR (95% CI)Hypertension0.2391.69 (0.70-4.05)Overweight0.0272.57 (1.11-5.92)Waist/hip index >0.900.0072.80 (1.32-5.95)Conclusion:Several traditional cardiovascular risk factors were found with a higher prevalence in the group with psoriasis. It is critical that physicians known the common comorbidities associated with PsA so that they can provide optimal management and treatment and improve mortality and quality of life.References:[1]Husni, M. E. (2015). Comorbidities in psoriatic arthritis. Rheumatic Disease Clinics, 41(4), 677-698.Disclosure of Interests:None declared

Background:Rheumatic diseases such as Psoriatic Arthritis (PsA) and Rheumatoid Arthritis (RA) are associated with increased morbidity and mortality, mainly due to cardiovascular causes. Cardiovascular outcomes in patients with PsA and RA cannot be completely explained by traditional cardiovascular risk factors, suggesting that the systemic inflammation that characterizes these diseases may have an important role on accelerated atherosclerosis.1Objectives:To compare carotid intima-media thickness (cIMT) and asymptomatic carotid plaque (CP) prevalence, between patients with PsA, RA and controls.Methods:Cross-sectional observational study. Seventy patients, aged 35-75 years, with PsA and RA who fulfilled the CASPAR and ACR/EULAR 2010 classification criteria, respectively, who were active on a cardio-rheuma preventive clinic were recruited, matched with 70 healthy controls. All groups underwent a noninvasive examination using B-mode ultrasonography of the right and left common carotid artery. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or cIMT ≥1.2 mm; hyperplasia of the carotid intima was defined as cIMT ≥ 0.9 mm to 1.1 mm. Descriptive data were analyzed by continuous and categorical variables. Continuous variables with normal distribution are shown as mean ± standard deviation (SD), and non-normal distribution as median and quartiles (25q-75q). ANOVA, Kruskal Wallis,X2and Mann-Whitney U were used to compared data. Apvalue ≤0.05 was considered statistically significant. Statistical analysis was done using SPSS version 24 (IBM Corp., Armonk, NY, USA).Results:Clinical and demographic characteristics are shown in Table 1. The global prevalence of carotid atherosclerosis was 25.7% and 38.6% in RA and PsA respectively, and 27.1% in controls (p=0.170). Intimal hyperplasia was found in 20%, 12.9% and 0% in RA, PsA and controls (p=0.001), respectively (Table 2).Table 1.Clinical and demographic characteristicsRAn=70PsAn=70Controlsn=70PvalueGender Male9 (12.9%)31 (44.4%)11 (15.7%) Female61 (87.1%)39 (55.7%)59 (84.3%)Age, years54.51±9.65753.1±10.8753.54±7.48NSBody Mass Index, BMI, kg/m228.99 (25.95-32.34)29.04 (26.23-31.92)27.44 (24.98-30.95)NSComorbidities Diabetes Mellitus11 (15.7%)14 (20%)8 (11.4%)NS Hypertension24 (34.3%)27 (38.6%)15 (21.4%)NS Dyslipidemia19 (27.1%)30 (42.9%)18 (25.7%)NS Active smoker7 (10%)16 (22.9%)15 (21.4%)NSDisease duration Duration, years8.45 (3.34-15.88)5 (2.75-8)-0.005Statins9 (12.9%)12 (17.1%)10 (14.3%)NSTable 2.Ultrasonographic characteristicsRAn=70PsAn=70Controlsn=70PvalueRight CIMT, mm0.8 (0.6-1.1)0.6 (0.5-0.9)0.6 (0.5-0.8)Left CIMT, mm0.8 (0.6-0.9)0.6 (0.5-0.7)0.6 (0.5-1.2)0.002Any Hyperplasia14 (20%)9 (12.9%)00.001Right intimal hyperplasia7 (10%)5 (7.1%)00.021Left intimal hyperplasia13 (18.6%)2 (2.9%)0Any plaque18 (25.7%)27 (38.6%)19 (27.1%)NSConclusion:This study shows the high prevalence of asymptomatic atherosclerosis in RA and PsA compared to general population. Even though it was shown a higher prevalence of CP in PsA, subclinical atherosclerosis in RA patients may have an increased clinical significance. The presence of carotid plaque between groups was not statistically significant. We observed increased prevalence of carotid intimal hyperplasia in RA and PsA compared with age-matched controls. We emphasize the value of ultrasonography in the detection of early atherosclerosis lesions.References:[1]Wah-Suarez, M. I., et.al. (2019). Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study.International Journal of Rheumatic Diseases,22(1), 25–31.Disclosure of Interests:None declared

Background:Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD). The carotid ultrasound, which measures both carotid intima-media thickness (cIMT) and carotid plaque (CP), is a non-invasive tool useful in the detection of subclinical atherosclerosis1. However, carotid ultrasound differences between PsA patients and general population have not yet been well described.Objectives:This study aimed to compare the carotid ultrasound characteristics in PsA patients with controls.Methods:This cross-sectional study included 70 PsA patients that fulfilled the CASPAR (Classification Criteria for Psoriatic Arthritis) criteria and 70 controls subjects matched by age and comorbidities. Patients with a history of previous atherosclerotic CVD (ischemic heart disease, cerebrovascular accident or peripheral arterial disease) and pregnancy were excluded. A clinical history and blood tests were performed. Carotid B-mode ultrasonography was used for measurements of cIMT and the presence of plaques.Increased cIMT was defined as ≥0.9 mm to 1.1 mm. CP was definedas afocal narrowing ≥0.5 mm of the surroundinglumen or acIMT ≥1.2 mm.Descriptive analysis was done with frequencies (%), mean (±SD) and median (q25-q75), and comparisons with Chi square, Student´s t and Mann-Whitney U tests.Results:A total of 138 subjects were included. Clinical and demographic characteristics are shown in Table 1. Increased cIMT and right carotid plaque were significantly more prevalent in PsA patients compared to controls(p=0.017 and p=0.049, respectively). No significant differences were found in the prevalence of carotid plaque and in the intima-media thickness between the PsA patients and the control group.Table 1.Clinical and demographic characteristics.VariablePsA(n=69)Controls(n=69)PAge(mean±SD)53.58±10.94653.86±7.313NSWomen, n (%)38(55.1)59(85.5)Obese, n (%)26(37.7)28(40.6)NSType 2 Diabetes, n (%)14(20.3)9(13)NSHypertension, n (%)27(39.1)19(27.5)NSDyslipidemia, n (%)29(42)24(34.8)NSActive smoker, n(%)15(21.7)12(17.4)NSDisease duration, median (q25-q75)5(2.5-8)--Methotrexate, n (%)46(66.7)--Biologics, n (%)23(33.3)--DAS28-ESR, (mean±SD)3.74±1.477--DAS28-CRP, (mean±SD)2.43±1.088--DAPSA, median (q25-q75)35(27.5-58.5)--Conclusion:Patients with psoriatic arthritis have a higher cardiovascular risk, as proven by the increased cIMT found on carotid ultrasound results. Therefore, it is advisable to perform a carotid ultrasound in patients with PsA to achieve an optimal management of the disease. The rheumatologist must be aware of the importance of performing a complete cardiovascular evaluation to provide a correct treatment in order to lower possible cardiac events.References:[1]Lucke, M., Messner, W., Kim, E.S.H.et al.The impact of identifying carotid plaque on addressing cardiovascular risk in psoriatic arthritis. Arthritis Research & Therapy 18, 178 (2016).https://doi.org/10.1186/s13075-016-1074-2Table 2.Carotid ultrasound findings.VariablePsA(n=69)Controls(n=69)PAny carotid plaque, n (%)27(39.1)17(24.6)NSRight carotid plaque, n (%)18(26.1)8(11.6)0.049Left carotid plaque, n (%)19(27.5)15(21.7)NSIncreased cIMT, n (%)9(13)1(1.4)0.017Right cIMT, median (q25-q75)0.58(0.46-0.76)0.6(0.51-0.69)NSLeft cIMT, median (q25-q75)0.58(0.5-0.73)0.61(0.54-0.78)NSDisclosure of Interests:None declared

Background:Fibromyalgia (FM) is a disease characterized by widespread pain which affects 2-8% of the population. Previous studies have shown lack of awareness of classification criteria and accompanying symptoms of FM, as well as heterogeneity in the management of these patients among both rheumatologist and non-rheumatologist physicians.Objectives:The objective of this study was to explore the trends in diagnosis and management of fibromyalgia among general practitioners, family physicians, psychiatrists, neurologists and rheumatologists in northeastern MexicoMethods:We designed an online survey to yield data on perception of FM, knowledge of existing classification criteria including the ACR 1990, ACR 2010, ACR 2010 modified and AATP classification criteria, as well as pharmacologic and nonpharmacologic therapy for the treatment of FM. Participants should have finished their residence at least in 2019. General practitioners, family physicians, psychiatrists, neurologists and rheumatologists were included.Results:A total of 236 participants were included, most of the participants were general practitioners, 149 (59.3%). Other specialties included were rheumatologists 21 (8.9%), neurologists 18 (7.6%), psychiatrists 8 (3.4%), and family physicians 49 (20.8%). FM was considered a clinical entity by 208 (88.1%) participants. Participants’ characteristics are shown in Table 1. Twenty-eight (11.9%) participants didn’t know any classification criteria for FM, and 38 (16.1%) participants answered that they didn’t use any classification criteria to make a formal diagnosis of FM. The 1990 ACR classification criteria was used the most, 62 (26.3%); closely followed by the 2010 modified ACR classification criteria, 61 (25.8%). A total of 101 (42.8%) participants made a formal diagnosis of FM in the previous year and 179 (75.8%) referred the patient to another specialist. Most patients were referred to a rheumatologist, 126 (53.4%). One-hundred and fifty-eight (66.9%) participants believe rheumatologist should be the main care providers for patients with FM.Table 1.Participants’ characteristics.VariableAge, median (25p-75p)33 (27-38)Women, n (%)203 (86)Rheumatologists, n (%)21 (8.9)General practitioners, n (%)140 (59.3)Public practice, n (%)113 (47.9)Public and private practice, n (%)51 (21.6)< 5 years of practice, n (%)100 (42.4)> 15 years of practice, n (%)30 (12.7)Conclusion:A total of 88.1% of physicians know at least one classification criteria for the diagnosis of FM. In Mexico, rheumatologists are considered the main care providers for patients with FM. Regarding therapies with level 1A evidence for efficacy in the treatment of FM, only cognitive behavioral therapy and patient education were used by more than 50% of physicians. Serotonin-norepinephrine reuptake inhibitor and tricyclic antidepressants (both of which have level 1A evidence) were only used by 20.8 and 29.2%, respectively.References:[1]Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55.Table 2.Pharmacologic and non-pharmacologic treatment of fibromyalgia among physicians.Variablen (%)Exercise (any kind), n (%)91 (38.6)Aerobic exercise (aerobic), n (%)86 (36.4)Cognitive behavioral therapy, n (%)127 (53.8)Patient education, n (%)142 (60.2)Gabapentinoids, n (%)107 (45.3)Tricyclic antidepressants, n (%)69 (29.2)Selective serotonin reuptake inhibitors, n (%)121 (51.3)Serotonin-norepinephrine reuptake inhibitor, n (%)49 (20.8)Muscle relaxers, n (%)85 (36)NSAID, n (%)137 (58.1)Opioids, n (%)27 (11.4)Mindfulness, n (%)42 (17.8)Disclosure of Interests:None declared

Posterior reversible encephalopathy syndrome (PRES) is a well-known but rare complication in patients (1%) with systemic lupus erythematosus (SLE). However, current epidemiological data are quite scant. The aim of the present study was to describe potentially unrecognised risk factors.We performed a multicentre, retrospective case-control study in Mexico between 1999 and 2014. We included a total of 168 patients who accounted for 77 episodes of PRES, as follows: SLE/PRES, 43 patients with 48 episodes; SLE without PRES, 96 patients; and PRES without SLE, 29 patients. SLE diagnosis was considered when patients fulfilled ≥4 American College of Rheumatology criteria. PRES was defined by reversible neurological manifestations and MRI changes.Patients with SLE/PRES were younger, presented with seizures as the most common manifestation (81%) and 18% had the typical occipital MRI finding. Hypertension (OR=16.3, 95% CI 4.03 to 65.8), renal dysfunction (OR=6.65, 95% CI 1.24 to 35.6), lymphopenia (OR=5.76, 95% CI 1.36 to 24.4), Systemic Lupus Erythematosus Activity Index ≥ 6 points (OR=1.11, 95% CI 1.01 to 1.22) and younger age (OR=0.86, 95% CI 0.81 to 0.91, p0.001) were independent risk factors for development of PRES in SLE. Furthermore, dyslipidemia also characterised the association between PRES and SLE (OR=10.6, 95% CI 1.17 to 96.4).This is the largest reported series of patients with SLE and PRES. We were able to corroborate the known risk factors for of PRES, and found two previously undescribed factors (lymphopenia and dyslipidemia), which suggests that endothelial dysfunction is a key element in PRES pathogenesis in lupus patients.

Background Tuberculosis (TB) represents a major global health problem. TB has a higher incidence among patients with autoimmune rheumatic diseases than in the general population. The incidence and severity of TB in patients with systemic lupus erythematosus (SLE) varies greatly among different series (2.5–13.8%). Objectives To investigate the frequency and characteristics of TB in Mexican mestizo patients with SLE. Methods We reviewed the charts of 123 patients with SLE in our lupus clinic. Patients who developed TB after the diagnosis of SLE were identified. Data of all SLE patients followed up in our clinic were retrospectively analyzed. Clinical and demographic characteristics and treatment before diagnosis of TB were recorded. Results A total of 123 SLE patients were analyzed, 89.43% (n=110) woman. Seven cases (5.69%) of TB infection developed after the diagnosis of SLE. Pulmonary TB was reported in 3 patients (2.44%). Extra-pulmonary TB infecction was reported in 3 (2.44%) patients (one case of tuberculous pleurisy, one case of meningeal TB, and 1 case of cutaneous TB). Also, we found 1 SLE patient (0.81%) with latent TB infection. All patients had good response to treatment. No one received biologic therapy at the time of the diagnosis of TB infection. We did not found any case of disseminated infection or mortality related to TB infection. Conclusions These results suggest that in a country with high TB burden, TB screening and treatment of latent TB would be useful since the diagnosis of SLE is made. References Erdozain, J. G., Ruiz-Irastorza, G., Egurbide, M. V., Martinez-Berriotxoa, A., & Aguirre, C. (2006). High risk of tuberculosis in systemic lupus erythematosus? Lupus, 15(4), 232–235. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is associated with a higher rate of cardiovascular mortality. The prevalence of valvular heart disease (VHD) varies greatly in the published reports. Data in Mexican mestizo patients with RA is scarce. Objectives We aimed to evaluate the presence of VHD in a cohort of RA Mexican mestizo patients and compare it to matched controls. Methods An observational, comparative, case control study was designed. Patients with RA aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria were included. Exclusion criteria included prior atherosclerotic cardiovascular disease (myocardial infarction, stroke and peripheral arterial disease) and overlap syndromes. Patients were matched using age, sex and comorbidities. A standard transthoracic echocardiography was performed according to the American Society of Echocardiography guidelines. Valvular regurgitation was classified as mild, moderate or severe according to the European Association of Echocardiography and American Society of Echocardiography recommendations. Results A total of 56 patients and 28 controls were included in the final analysis. Characteristics of both groups are shown in Table 1. There was no statistical difference in sex, age, type 2 diabetes mellitus and body mass index between the two groups. VHD was reported in 45 (80.4%) RA-patients and 13 (46.4%) individuals in the control group (p In the RA group, 5 (8.9%) showed mild aortic regurgitation; 28 had mild and 1 had moderate (50% and 1.8%, respectively) mitral regurgitation; 8 (14.3%) showed mild pulmonary regurgitation; 39 had mild and 4 had moderate (69.6% and 7.1%, respectively) tricuspid regurgitation. In the control group, 1 (3.6%) showed mild aortic regurgitation; 3 (10.7%) had mild mitral regurgitation; 1 (3.6%) showed mild pulmonary regurgitation; 12 (42.9%) had mild tricuspid regurgitation. Conclusions In our cohort, 80.4% of the RA-patients had VHD, with the tricuspid valve being the most affected (76.8%). Prospective studies are needed to evaluate the role of VHD in RA-patients morbi-mortality. References Roldan, C. A., DeLong, C., Qualls, C. R., & Crawford, M. H. (2007). Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. The American journal of cardiology, 100(3), 496–502. Zoghbi, W. A., Enriquez-Sarano, M., Foster, E., Grayburn, P. A., Kraft, C. D., Levine, R. A., … & Stewart, W. J. (2003). American Society of Echocardiography: Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. European Heart Journal-Cardiovascular Imaging, 4(4), 237–261. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is associated with accelerated atherosclerosis and increased cardiovascular risk (CVR). There is no specific CVR score in RA population. Scores developed for general population inaccurately estimate this risk. Carotid intima-media thickness (CIMT) measurement by ultrasound (US) is a non-invasive method that identifies subclinical atherosclerosis and strongly predicts future cardiovascular disease. Objectives Correlate carotid intima-media thickness and the result of 4 different risk scores (Framingham lipids, Framigham BMI, QRisk II, and Omnibus 2013 ACC/AHA cardiovascular risk score) in a cohort of patients with RA. Methods Observational, cross-sectional study based on a cohort of 87 Mexican Mestizo patients with RA who fulfilled the 1987/ 2010 ACR classification criteria who attended our referral center. Clinical assessment of cardiovascular comorbidities, disease activity, anthropometry, lipid profiles, and carotid Doppler US for measurement of intima-media thickness and plaque were performed. Simple bivariate correlations for cardiovascular risk by the 4 models were analyzed against CIMT by Spearman9s correlation coefficient. To determine difference between each of the correlations, bivariate correlations comparison was performed by Steiger9s Z-test. Results 87 patients were included in the analysis. Demographic characteristics and correlations are shown on Table 1. Plaque was recorded in 38 patients (43.67%). CIMT median was 0.08cm (IQR 0.07-0.09). A positive correlation was found between all CVR scores evaluated and CIMT (p Conclusions All 4 scales positively correlated with CIMT. QRisk II incorporates RA into its CVR calculation and showed a trend toward a better performance than the other 3 scales, although this difference was not statistically significant. A specific CVR score designed for RA patients could improve the prediction of subclinical atherosclerosis and cardiovascular disease in this population. References Arts EE, Popa C, Den Broeder AA, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 2014; 0:1-7. Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007;115:459-67. Disclosure of Interest None declared

Background Cardiovascular (CV) morbidity and mortality in patients with rheumatoid arthritis (RA) is higher than general population. It is the leading cause of death in this group. The traditional cardiovascular risk (CVR) factors do not fulfilled explain this increased risk. The Framingham risk score (FRS) is the main tool to stratify CVR in general population; its usefulness in RA patients remains controversial as it is believed may underestimate the CVR. Objectives The aim of this study is to stratify CVR by FRS in a Mexican Mestizo RA cohort. Methods A descriptive, cross sectional study was designed. This study included diagnosed RA patients (ACR criteria 1987/2010) who attended our referral center, in a period of three months (July to September 2014). Information from clinical records was collected. Patients whose clinical records did not include age, gender, diagnosis, weight, height, blood pressure, smoking and use of antihypertensive medications were excluded. Results 204 patients with RA were included. The mean age was 54.19 years and 90.19% (n=184) were women. It was found an increased CV risk of 10% at 10 years in 45 patients (22%). The mean for this group of patients was 7.22% at 10 years. Conclusions FRS could underestimate CVR in our population. Optimum control of CV risk factors entails a risk of 3.6%. Standard risk prediction models used in the general population do not adequately identify many RA patients with elevated CV risk. More studies are needed to evaluate the ability of FRS to predict CV risk in RA Mexican population. References Sandoo A, et al. The relationship between cardiovascular disease risk prediction scores and vascular function and morphology in rheumatoid arthritis.Clin Exp Rheumatol. 2014 Nov-Dec;32(6):914-21. Arts EE, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis. 2014 Jan 3. Disclosure of Interest None declared

Background Premature atherosclerosis had been observed in Systemic Lupus Erythematosus (SLE) patients, [1] but the reason for this accelerated process is still debatable [2] although traditional risk factors are more prevalent in those patients than general population, they do not seem to fully explain that enhanced risk [3]. In SLE mexicans we do not have enough information. Objectives To recognize premature atherosclerosis in Mexican SLE patients, through carotid ultrasound. Methods We did an observational, descriptive, cross-sectional study in mexican population, between 2 groups (69 SLE patients and 69 age-sex-diabetes-hypertension- matched subjects), realized biochemical and anthropometric measurements, and carotid ultrasound. Results We found a statistically significant higher prevalence of thickness in both internal carotid arteries, but we did not found association between carotid plaque and hypertension, diabetes or any cardiovascular risk factor. Conclusions Hence a multi-targeted approach to treatment which addresses both lupus-specific factors as well as the associated traditional cardiovascular risks is important to further reduce the burden of cardiovascular disease among our Mexican SLE patients. References Thomas GN, Tam LS, Tomlinson B, Li EK.Accelerated atherosclerosis in patients with systemic lupus erythematosus: a review of the causes and possible prevention. Hong Kong Med J. 2002 Feb;8(1):26-32. Bruce IN. “Not only ... but also”: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford).2005 Dec;44(12):1492-502. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R,et al.Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum.2001 Oct;44(10):2331-7. Disclosure of Interest None Declared