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Galectins, a family of animal lectins, play central roles in immune system regulation, shaping both innate and adaptive responses in physiological and pathological processes. These include rheumatoid arthritis (RA), a chronic multifactorial autoimmune disease characterized by inflammatory responses that affects both articular and extra-articular tissues. Galectins have been reported to play central roles in RA and its experimental animal models. In this perspective article we present new data highlighting the regulated expression of galectin-1 (Gal-1) and galectin-3 (Gal-3) in sera from RA patients under disease-modifying anti-rheumatic drugs (DMARDs) and/or corticoid treatment in the context of a more comprehensive discussion that summarizes the roles of galectins in joint inflammation. We found that Gal-1 levels markedly increase in sera from RA patients and positively correlate with erythrocyte sedimentation rate (ERS) and disease activity score 28 (DAS-28) parameters. On the other hand, Gal-3 is downregulated in RA patients, but positively correlates with health assessment questionnaire parameter (HAQ). Finally, by generating receiver-operator characteristic (ROC) curves, we found that Gal-1 and Gal-3 serum levels constitute good parameters to discriminate patients with RA from healthy individuals. Our findings uncover a differential regulation of Gal-1 and Gal-3 which might contribute to the anti-inflammatory effects elicited by DMARDs and corticoid treatment in RA patients. Fil: Mendez Huergo, Santiago Patricio. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Hockl, Pablo Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Stupirski, Juan Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Maller, Sebastian Matias. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Morosi, Luciano Gastón. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Pinto, Nicolás Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Berón, Ana M.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina Fil: Musuruana, Jorge L.. Provincia de Santa Fe. Ministerio de Salud. Hospital J. B. Iturraspe; Argentina Fil: Nasswetter, Gustavo Guillermo. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina Fil: Cavallasca, Javier A.. Provincia de Santa Fe. Ministerio de Salud. Hospital J. B. Iturraspe; Argentina Fil: Rabinovich, Gabriel Adrián. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina

Objective.To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America.Methods.Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history.Results.Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (pBonferroni < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (pBonferroni = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment.Conclusion.Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.

Background Chikungunya fever is characterised by a high probability of persistent rheumatological manifestations, producing a negative impact in the work, social and economic fields. Objectives To determine the frequency and type of rheumatologic involvement in the subacute and chronic phase of Chikungunya fever. Methods Descriptive, cross-sectional study. We included patients>16 years old with Chikungunya infection (real time PCR, IgM or IgG for Chikungunya) who consulted consecutively for rheumatic symptoms/signs from March 2015 to March 2016. According to the time of evolution, the disease was divided in 2 Phases: acute (≤10 days of duration) and subacute/chronic (≥11 days). According to clinical presentation, patients were classified in two groups: 1) non-autoimmune rheumatologic compromise (NARC) and 2) autoimmune rheumatologic compromise (ARC). Current ACR/EULAR criteria for classification of autoimmune diseases were used. Results Two hundred and two patients were evaluated, 80 were excluded due to negative serology for Chikungunya. 122 were included: 107 (88%) female, mean age 52.52±13.19 years, and time of evolution of 116.66±91.61 days. Acute phase. 122 patients: fever 85 (69.67%), rash and pruritus 54 (44.26%), tenosynovitis 23 (18.8%), polyarthralgias 100 (82%) and arthritis 56 (45.90%). Chronic phase. 122 patients: 71 (58%) patients had a chronic persistent rheumatologic symptoms and 51 (42%) presented remission of symptoms but all of them presented subsequent recurrence in an 91±40 days. NARC in 33 patients (27%) and ARC in 89 (73%), with no significant differences in age and time of evolution was observed. NARC: 14 (42.4%) exacerbation of previous osteoarthritis pain, 9 (27.3%) developed fibromyalgia and 10 (30.3%) had localized soft tissue pain. ARC: 13 (14.6%) with a history of RA, SLE, psoriasis or DM reactivated the underlying disease and 76 (85.4%) developed ARC: Undifferentiated polyarthritis with negative antibodies 61 (80%), RA with positive antibodies 5 (6.5%), scleroderma 2 (2.6%), cutaneous vasculitis 2 (2.6%), polymyalgia rheumatica 1 (1.3%), Sjogren9s Syndrome 2 (2.6%), Dermatomyositis 1, Erythema nodosum 1 (1.3%) and vitiligo 1 (1.3%). Antibodies were requested according to clinical suspicion: FAN ≥320 in 5 patients, RF in 6, ACPA in 4 and anti RO in 1. Thyroid dysfunction was observed in 7 patients who had a previous normal thyroid profile. Conclusions The frequency of rheumatological manifestations post Chikungunya fever in our sample was high, and can trigger ARC. Patients presenting new immunological manifestations in an endemic area for Chikungunya fever should have a serologic test performed. This series of patients must be evaluated with long-term studies to define their evolution, under the possibility of developing definite autoimmune disease or remission. References Chikungunya Pathology and Cytokines. Chow et al. JID 2011. Disclosure of Interest None declared

Background Estimated prevalence of neuropsychiatric symptoms in SLE is among 17 to 71%1. Depressive symptoms are around 54%1,2. Fatigue is frequently referred, predicts high morbidity and may be influenced by lifestyle and individual psychological characteristics1. Objectives To evaluate the prevalence of depressive symptoms and its association with demographics and clinical variables in patients with SLE. To determine the predictive value of FACIT for fatigue in SLE vs controls. Methods Observational, retrospective case- control design. Patients ≥18 years old with SLE (ACR 97) were consecutively evaluated in our centre from January to July 2015. We analyzed age, disease duration, clinical manifestations, antibodies profile, SLEDAI (≥4 scored as active) and SLICC. We recorded familiar psychiatric diseases, educational and socioeconomic level (Graffar Scale), employment and marital status. Beck II and FACIT (IV version) questionnaires were used for evaluate depression and fatigue respectively. We tested two cut points for fatigue: Results 77 SLE and 100 controls, all female. SLE vs control group: Mean of age ys: 34 (19–49)vs 38 (19–60). Prevalence of depression: 52% (44/77) vs 29% (29/100) (p 0.05). Mean disease duration (months) 48 (24–114). Socio-demographic characteristics, SLICC/SLEDAI, clinical and serological manifestations were not correlated with major depression p>0.05. FACIT: Median value: 31 (range 22–40) SLE group. FACIT Conclusions Prevalence of depression was high in our cohort and similar to previously reported1. Our patients showed low levels of SLEDAI/SLICC. There was not relation between activity levels and baseline damage with the presence of depression4. FACIT IV scale was a good independent predictor of fatigue in SLE patients with or without depression vs controls. References L Palagini M et al Depression and systemic lupus erythematosus: a systematic review. Lupus 2013. Hugo FJ et al DSM-III-R classification of psychiatric symptoms in systemic lupus erythematosus. Psychosomatics 1996. Lai JS et al Validation of the Functional Assessment of Chronic Illness Therapy-Fatigue Scale in Patients with Moderately to Severely Active Systemic Lupus Erythematosus, Participating in a Clinical Trial Journal of Rheumatology 2011. Segui J et al Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: A longitudinal study of active and inactive stages of the disease. Lupus 2000. Disclosure of Interest None declared

Background Capillary bed of labial mucosa may be a potentially useful area for assessing abnormalities on the microcirculation. Videocapilaroscopy of the labial mucosa (LVC) in 12/13 scleroderma (SCL) patients showed capillaries disturbance such as great disorganization and anarchic orientation(1). Objectives To describe LVC features in SCL and compare them with healthy controls. (HC). To compare nailfold videocapillaroscopy (NVC) with LVC in HC and SCL patients. Methods ≥16 years old patients with SCL (ACR-EULAR 2013) were included consecutively since June to July 2016. Smoking patients were excluded. For the evaluation of the LVC we performed a general displaying and then we studied following areas: a-central (1 cm from the frenulum), b-lateral right and left (both 2 cm from the frenulum) and c-labial border. For evaluation of the NVC, 200x images were obtained from 2nd to 4th fingers both hands and was classified according Cutolo in early, active, late patterns(2). For assesment through LVC: photographs (200x) for each subject were taken. We define quantitative characteristics as means of: capillary diameter, length and density. The average of these parameters was obtained from the evaluation of capillaries included in 1 mm2 of at least 2 continuous images. In addition, the visibility of the subpapillary venous plexus, architecture, dilatation of capillaries, presence of megacapillaries and avascular areas were qualitatively evaluated (photo 1). Each image was reviewed by two experienced observers. We conducted the same process describe above for each healthy control subject. Results Twenty two patients were included (18 female, age 47±11 ys) with SCL (limited 17, diffuse 5); NVC pattern: early 8, active 11, late 3. Healthy subjects 12 (11 female, age: 34±10 years). Average capillary density: 17±4.13 (13–26) in SCL vs 21±3.65 (16–28) in HC (p 0.00). Average capillary diameter: 43±13.54 (17–83) SCL vs 19±1.67 μm (16–21) HC (p 0.02). Mean capillary length: 185±34 μm (125–248) SCL vs 237±42 μm (178–313) HC (p 0.00). In 22 SCL patients were observed dilated capillaries in 20 (90%), megacapillaries (≥70 μm) in 10 (45%) and 7 (32%) showed disturbed architecture with lost areas of the normal U-shape and changes in the parallelism of the main axis of the capillaries. About subpapillary venous plexus in SCL: 7 (32%) were prominent and only one had capillary hemorrhage. In contrast, none of the controls presented these alterations. (p 0.0). According to the 3 NVC patterns the following averages were observed in the LVC: Early Pattern (n: 8): diameter 36.93±10.84 μm; Long 191.21±47.58 μm; Density 18.12±5.33 μm. Active Pattern (n: 11): diameter 48.80±14.80 μm; Length 184.11±29.91 μm; Density 16.72±3.25 μm. Late Pattern (n: 3): diameter 36.27±10; Long 178.03±28.8 μm, density 19.33±4.16 μm. Conclusions We found that LVC in SCL patients show significant microvascular changes with respect to HC. In addition, all NVC patterns described in SCL showed similar alterations in LVC. Therefore, LVC could be a complementary or alternative method to NVC since it is easily accessible, has good visibility and is not influenced by local mechanical or chemical stimuli that can affect the nail bed. References W Grassi et al. Ann Rheum Dis 1993; 52 (8): 564–569. M. Cutolo et all. Rheumatology 2006; 45: 43–46. Disclosure of Interest None declared

Background Systemic Lupus Erythematosus (SLE) may associate with flares, an unfavorable course and the need of teratogenic treatment during pregnancy. Not every contraceptive method (CM) may be used in this patients. There are guidelines for their use according to existing morbidity and SLE activity 1 . Objectives Describe the use of CM in a cohort of outpatients with SLE Methods Descriptive, observational, cross-sectional study. Patients ≥16 years old with SLE (SLICC 2012) and ≥1 visit during the last year of our database were included. Those with menopause were excluded. We analyzed demographic data; disease duration; antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) (Sapporo 2006); socioeconomic status (Graffar scale); disease activity (SELENA-SLEDAI) and accrual damage (SLICC); use of teratogens: Methotrexate (MTX), Mycophenolate (MYC), Cyclophosphamide (CYC), biologic drugs (BD), self-reported sexual status (active/non active) and CM: intrauterine device (IUD), condom (Cdm) and hormonal contraceptive pill (CP). Results 132/219 were included. Female 91.6%, age: 30.1 (16–49) years, disease duration: 38.5 (1–324) months, SELENA-SLEDAI: 3.5 (0–29), SLICC: 0.5 (0–5). Sexual status and use of CM: were available for 120 patients. Sexually active (SA) 73%, female 77%. CM in SA patients: 74%: 5% CP, 77% Cdm and 18% IUD. CM in female patients stratified by Graffar (GF): GF I (n=1): none SA; GF II: (n=19): 84% SA, 75% of them used CM (75% Cdm, 25% IUD); GF III (n=33): 82% sexually active, 81% used CM (86% Cdm, 14% IUD), GF IV (n=41) 75% SA, 68% used CM (9% CP, 71% Cdm, 19% IUD), GF V (n=4) 100% SA, 50% used CM (50% CP, 50% Cdm); GF NA (n=11) 55% SA, 83% used CM (80% Cdm, 20% IUD). CM in female patients stratified by SLE activity: SLEDAI 12 (n=60): 60% SA, 67% used CM (100% Cdm). CM in female patients using teratogenic drugs: MTX (n=8): 100% SA, 75% of them used CM (17% CP, 66% Cdm, 17% IUD); MYC (n=20): 80% SA, 88% used CM (71% Cdm, 29% IUD); CYC (n=3): 33% SA, 100% used CM (100% Cdm); Belimumab (n=1): 100% SA, 100% surgical CM (tubectomy). aPL was evaluated in 96/132 patients. 17/96 had positive aPL and 5/17 fulfilled APS criteria. 2/17 patients had no CM data available, none with APS. 9/17 patients with aPL were female, 55% SA and all of them used Cdm. 3/5 patients with APS were female, all SA, 66% used Cdm. Conclusions Condom was the most reported CM. Use of CM was more frequent in the upper social stratus (GF I-III) respect to the lower (GF IV-V). The proportion of sexually active female patients was similar in those using teratogenic drugs compared with who had not used them. The self-reported sexual status was similar despite of SLEDAI stratification, being similar in patients with low or high disease activity. We deem necessary education, counseling and evaluation of use of the CM in every visit of patients with SLE. References Andreoli L, Bertsias GK, Agmon-Levin N, et al. Ann Rheum Dis, doi:10.1136/annrheumdis-2016–209770. Disclosure of Interest None declared

Background Systemic lupus erythematous (SLE) have an increase cardiovascular risk, worsened by overweight and obesity. Increased BMI is associated with other severe complications and comorbidities as lupus nephritis, hypertension, insulin resistance and dyslipemia. Body weight is a modifiable risk factor. Objectives To determine the frequency of overweight and obesity in patients with SLE and their impact on this disease Methods Descriptive, cross-sectional study. We reviewed the medical records of outpatients with SLE (ACR 1997) who were seen since 2014 to 2016 in the Clinical Hospital of Buenos Aires, Argentina. We evaluated sex, age, disease duration, obstetric history, use and doses of oral corticosteroids, BMI, 25 OH vitamin D and educational level. Disease activity was scored by SLEDAI. Scores ≥4 were classified as active. The patients were classified into 2 groups, according to BMI: normal weight (NW) (19–25), overweight and obesity (≥25). Results One hundred and sixty two of 230 were evaluated. Sixty-eight patients were excluded due to lack of data. 157 (97%) were women. Mean age for both sexes was 40.6±14.3 years (p 0.70). Means of: SLEDAI 4.3±4.47 (54.9% had SLEDAI ≥4), IMC: 27.04±5.22 (56% had a BMI ≥25) and 25-hidroxivitamin D was 25.15±9.0. Relation between 2 groups, according to BMI: 84.5% whom were in NW group have received steroids at some point vs 95.6% in BMI≥25 group (p 0.02). Mean steroids doses: BMI ≥25: 9.53±10.98 vs 5.0±7.2 in NW group (p 0.04). Multivariate analysis showed that BMI ≥25 continued significantly associated with SLE duration, independently of the steroids use and other variables. 25 OH vitamin D tended to be lower in BMI ≥25 vs NW, but no significant differences (24.53±9.91 vs 25.50±9.85) (p=0.071) Conclusions Over a half of our cohort had BMI ≥25 and was characterized by older age, more frequent menopause, longer course of the disease, increased steroid use and lower educational level. Depression and hypertension were the statistically more frequent comorbidities found. Obesity was associated with more activity and accrual damage including chronic renal disease. Disclosure of Interest None declared

Background Systemic sclerosis (SS) is an autoimmune disease with generalized vascular dysfunction and a myriad of clinical and laboratory manifestations. Spreading of thickening of the skin, serological characteristics and the pattern of compromise of the internal organs help to classify them as diffuse scleroderma, localized sclerosis and systemic sinus scleroderma. Reports of Latin American cohorts published to date are scarce. Objectives To describe the clinical and serological data for a single center cohort and to compare those with national and international cohorts. Methods Descriptive, observational, cross-sectional study. We analyzed our SS database. Patients were evaluated since 01/15 to 05/2016 and fulfilled SS classification criteria (ACR 1980/ACR-EULAR 2013).Patients were classified according to Le Roy criteria in Limited Systemic Sclerosis (lSS), Diffuse Systemic Sclerosis (dSS), Systemic Sclerosis sine scleroderma (SsnS) and pre-systemic sclerosis (pSS). Organic compromise was defined as follows: Gastrointestinal (GI): esophagic dismotility by manometry or esophagitis by endoscopy; Lung: Pulmonary hypertension (PH): PSAP>25 mmHg by right heart catheterization; Intersticial Lung Disease (ILD): compatible HRCT or Results 123 patients were included.74% with lSS,24% dSS and 2% SsnS; age at diagnosis (years): 49.7 (18–79 DS: 12.27) and 48.7 (27–79 DS: 13.01) in lSS and dSS respectively. Raynaud9s phenomenon previous to diagnosis (years) 7,7 (0–54 DS: 12.81) in lSS and 4.03 (0–22 DS: 5.5) in dSS. 49.5% lSS were ACA positive vs 17% in dSS as well also 41,4% had Scl-70 positive (p Conclusions Our data showed similar results to the local and european cohorts. We found fewer calcinosis and digital tip ulcers in both lSS and dSS than international cohorts. A lower prevalence of PH was reported in lSS respect to other series, and it might be atributed to the method wich it was measured. (right heart catheterism). Disclosure of Interest None declared

Background and Aims Systemic Lupus Erythematosus (SLE) and its treatment predispose to infections such as human papillomavirus (HPV) that is a risk factor for the development of lower genital tract (LGT) and anal cancers. To assess LGT- anal lesions, frequency of HPV lesions and premalignant and malignant lesions. Methods Descriptive, cross-sectional design. Women with SLE (ACR 1997) of Argentina were consecutively sent to examination of the LGT and high-resolution anoscopy (2010–2015). Biopsies were performed according to gynaecological criteria and patient consent (Bethesda). Koilocytic cells were associated with HPV. Three Socioeconomic status (SES) groups were established (Graffar). EditorResults 73 SLE patients and 104 healthy control were included. Table 1: Demographics characteristics. SLE patients 25/73 (34.3%) had HPV versus 6/104 (5.8%) in the control group (p=0.00). In the SLE-HPV were found statistically significant differences in: low SES, sexual partners≥5, antiDNA+ and low complement and a trend to low educational level (p=0,07). At check data the average dose of steroids was 10.8 Mg/d (SLE-HPV) vs 2.9 Mg/d in without HPV (p=0.00) while 61% (HPV group) vs 29% (without HPV) were receiving immunosupressors (IS) (Table 2) Non-differences were found related to duration of SLE, smoking, beginning of sexual intercourse, condom use and anal or oral intercourse. Conclusions The frequency of HPV was high in women with SLE. We remark oligo/asymptomatic HPV and its association with low SES, serological activity and treatment. As we detected a high frequency of sole anal lesions we highlight the anoscopy regardless of symptoms.

Objective To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry. Methods Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software. Results A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA–DQB1– DQA2 (P = 7.6 × 10−10), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10−6), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10−7). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10−6). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti–cyclic citrullinated peptide antibodies. Conclusion Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13.

Henoch-Schonlein Purpura (HSP) is a systemic vasculitis mediated by IgA and characterized by the clinical triad of non-thrombocytopenic palpable purpura, abdominal pain, and arthritis. In addition, there may be varying degrees of renal involvement. It is the most frequent vasculitis in children and the incidence in adults varies from 3.4 to 14.3 cases per million, depending upon the experimental series analyzed.1 We report the onset, course and response to treatment of five adult patients who required hospitalization at our institution between 2002 and 2006 (all fulfilled the 1990 American College of Rheumatology (ACR) criteria).2 Case 1 A 24-year-old white male with frequent episodes of pharyngitis was admitted for an eight day course of palpable purpuric lesions on his lower limbs, arthritis in both ankles, and diffuse abdominal pain. A complete blood count with differential analysis, liver function test, coagulation test, chemistry panel, and ERS were normal. A urinary sediment showed dysmorphic hematuria with 30 to 40 red blood cells/high power field and proteinuria of 2.29 g / 24 hr. A skin biopsy of the lower limbs showed leukocytoclastic vasculitis. IgA and C3 deposits were observed upon immunofluorescent assay. The renal biopsy indicated mesangial nephropathy due to IgA deposition (Figure 1). Figure 1 Renal biopsy with mesangial IgA deposition (inmunofluorescence, 200X) The patient began treatment with IV methylprednisolone, 1 g/day for 3 days, and continued with oral prednisone, 40 mg/day. During treatment, the patient presented an increase in proteinuria (3.12 g/day), the persistence of dysmorphic hematuria, and developed hypertension. He was therefore treated with IV cyclophosphamide, 1g/m²/month for six months, and enalapril, 10 mg/day. Both blood and urine laboratory parameters stabilized after the first pulse of cyclophosphamide.

La paquidermoperiostosis u osteoartropatía hipertrófica primaria es una rara enfermedad caracterizada por compromiso cutáneo y osteoarticular. Comunicamos dos casos que presentaban hipocratismo digital, uñas en vidrio de reloj, agrandamiento óseo, tumefacción articular y diferentes grados de afectación cutánea, sin otros hallazgos clínicos relevantes. Ambos desconocían antecedentes familiares similares. El estudio radiográfico de las zonas comprometidas mostró periostosis. Con resultados de laboratorio y radiografía de tórax normales, y ausencia de evidencia clínica de otra enfermedad subyacente, se realizó diagnóstico de osteoartropatía hipertrófica primaria.Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteo-arthicular involvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings, arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of having relatives with the same alterations. Radiological studies of the affected areas showed periostosis. Because of normal laboratory results and chest radiography plus the absence of other underlying causes, diagnosis of primary hypertrophic osteoarthropathy was made.

To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry.Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software.A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA-DQB1- DQA2 (P = 7.6 × 10(-10) ), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10(-6) ), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10(-7) ). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10(-6) ). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti-cyclic citrullinated peptide antibodies.Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13.

In systemic lupus erythematosus (SLE), the respiratory system is frequently compromised. One of its uncommon manifestations is the shrinking lungs syndrome (SLS), characterised by dyspnoea, diaphragmatic elevation and a restrictive pattern in the spirometry. We report two cases affected with this rare entity. They presented with different degrees of respiratory involvement and responses to the therapy. At the same time, clinical, physiopathological, prognostic and therapeutic aspects of this syndrome are reviewed.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteoarthicular involvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings, arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of having relatives with the same alterations. Radiological studies of the affected areas showed periostosis. Because of normal laboratory results and chest radiography plus the absence of other underlying causes, diagnosis of primary hypertrophic osteoarthropathy was made.

Background The SF36 is a generic 36 items questionnaire which measures eight dimensions of health status, and permit to make direct comparisons with other disease states or with population norms. SF36 reflects a combination of physical and mental function, and well-being, the extent of social and role disability, and patients personal evaluation of health status. It has been used in several countries and its contents and construct validity, test retest reliability and responsiveness have also been reported. Objectives to evaluate the health related quality of life (HRQoL) of patients affected by rheumatoid arthritis (RA) through SF36, and to correlate the results with ACR core set activity index and with mHAQ disability index. Methods The study included 121 consecutive patients affected by RA attending the “Hospital de Clinicas”, mean age 50(18-84) years, mean disease duration 91(3-480) months, erythrocyte sedimentation rate (ESR)34.71(8-105) mm/h, and mean mHAQ 0.68(0-3). The HRQoL was evaluated through SF36(100-0) eight domains, physical function (PF), physical role (PR), bodily pain (BP), general health (GH), vitality (V), social function (SF), emotional role (ER), and mental health (MH). Disease activity was assessed using ACR core set, swollen joint count (SJcount 0-28), tender joint count (TJ count 0-28), pain by visual analogue scale (VAS 0-100), patient global assessment by VAS, physician global assessment by VAS, acute phase reactant erythrocyte sedimentation rate (Westergren, mm/h), and disability by mHAQ(0-3). Results The mHAQ showed good correlation with PF, BP(r > 0.61), SF(r > 0.55), and correlated with PR, V(r > 0.47). VAS pain correlated well with BP and V(r > 0.60), and correlated with PF, PR, and GH(r >o.41), patients global assessment correlated with BP, GH, V(r > 0.48). All correlations had p Conclusion SF36 showed to be a practical tool for use in RA patients and may facilitate to achieve burden of impact of disease and to compare with that of other chronic diseases. In this cohort mHAQ was significantly associated with physical and social function as well as bodily pain and vitality. VAS patients global assessment was associated with general health, vitality and bodily pain. No correlation were found with physical and mental role suggesting that different information is involved. Differences with others RA cohorts may be due to demographic characteristics and medical conditions in our group.