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Behcet's disease is a clinical autoinflammatory disorder of unknown etiology, usually with systemic manifestations, and a pattern of exacerbation-remission, often associated with delayed diagnosis. The diagnosis of this disease is complex. This article discusses four cases of patients with Behcet's disease, who during the clinical approach were considered to have other autoimmune diseases. A comprehensive review of the medical history, the development of oral and genital ulcers, in addition to the study of major histocompatibility complex typing (HLA), enabled the diagnosis of Behcet's disease.

The mesenchymal stromal cells (MSCs) are hematopoietic stem cells with high capacity of differentiation to other cellular lineages, depending on the microenvironment in which they live as well as on the interaction and signaling pathways they establish with the extracellular matrix. Several properties have been described in these cells: proangiogenic, antifibrotic and immunomodulatory. These properties are being studied as a therapeutic approach for autoimmune diseases such as cutaneous systemic sclerosis (SSc). SSc is a systemic chronic disease, with an approximate prevalence of 35.6 cases per 100,000 inhabitants in North America and of 0.02% in Colombia in 2018. There are two different clinical variants, diffuse and localized. In both variants an important skin involvement and a rapidly deterioration of organs is present, which can overshadow the clinical prognosis and increase the mortality. Options for the treatment of advanced diffuse SSc are scarce mainly targeting symptomatic control with little impact on the progression and mortality. Therefore, there is an increasing interest in new therapies like advanced cellular therapy with hematopoietic stem cells and stromal mesenchymal cells. This article reviews the information related to the use of stromal mesenchymal cells in patients with this disease. RESUMEN Las células mesenquimales estromales son células madre no hematopoyéticas pluripotenciales con alta capacidad de derivación a diferentes linajes celulares, dependiendo tanto del microambiente en el que se encuentren, como de la interacción y señalización que establezcan con la matriz extracelular del entorno, esto ha permitido describir un potencial proangiogénico, antifibrótico e inmunomodulador, que ha sido blanco de investigación en enfermedades autoinmunes como la esclerosis sistêmica cutánea. Considerando que la esclerosis sistêmica cutánea es una enfermedad inflamatoria crónica, con una prevalencia estimada de 35,6 casos por cada 100.000 habitantes en Norte América y de 0,02% en nuestro país para el 2018, se caracteriza por presentar dos variables clínicas principalmente; una variante limitada y una variante difusa, presentando en ambas un compromiso extenso de piel y órganos que puede ser rápidamente progresivo y deteriorar el pronóstico de los pacientes que la padecen aumentando su mortalidad. Debido a que las opciones terapéuticas en esta entidad son limitadas y buscan únicamente el control de síntomas, pero con poco impacto en progresión y mortalidad, terapias celulares avanzadas han surgido como nuevas opciones terapéuticas incluyendo el trasplante de células madre hematopoyéticas y las células mesenquimales estromales. A continuación, se revisará acerca de la utilidad y evidencia de células mesenquimales estromales en pacientes con esta enfermedad.

Background: Whereas SLE is uncommon in men, the disease is usually more severe and requires more aggressive immunosuppression in male patients. There are multiple studies regarding sexual aspects in women with SLE, but information about sexual function in male patients is quite scant. Objectives: To determine the relationship between SLE and sexual function alterations in men, through the application of validated questionnaires. Methods: We performed a longitudinal study in a third-level referral center in Mexico City. We included men aged ≥16 years who fulfilled ACR criteria for SLE and who were sexually active. All subjects answered the International Index of Erectile Function-15 (IIEF-15), the SF-36 and the HAQ in two visits. Other clinical, serological and demographic variables were measured. Oxidized LDL was quantified by ELISA. Results: We included 108 male SLE patients. Mean age was 37.2±1.1 years and most patients (87%) were taking immunosuppressive therapy. Comorbidities were present in 58% of subjects, with dyslipidemia and hypertension being the most prevalent (34% and 28%, respectively). The prevalence of sexual dysfunction (SD) was 53%. In the basal visit, the only significant differences between the patients with SD and those without SD were a lower education degree (p=0.007) and persistent lymphopenia (p=0.01). There was a positive correlation between global IIEF-15 score and SF-36 score (r=0.46, p=0.001). The physical function domain had the highest correlation (r=0.50, p=0.001). Likewise, there was a weak negative correlation between IIEF-15 and HAQ score (r=-0.25, p=0.012). Also, the IIEF-15 had a weak correlation with the absolute lymphocyte count (r=0.27, p=0.005) and oxidized LDL (r=0.31, p=0.04). In the follow-up visit the only significant differences between the patients with SD when compared with subjects without SD was a low absolute lymphocyte count (1031±89 vs 1458±119, p=0.005); the correlations mentioned in the baseline visit remained significant. Regarding erectile function, 44% of the subjects had some degree of dysfunction. The rest of the variables are shown in Table 1. Conclusion: Sexual function is affected in men with lupus, regardless of comorbidities and treatment. Interestingly, lymphopenia is persistently associated with an impaired sexual function, which could be related to the role it plays in endothelial dysfunction and atherosclerosis. The patients’ disease perception, which is influenced by their academic level and physical role in their daily activities, seems to affect their sexual performance and quality of life. Disclosure of Interests: Jonathan Campos-Guzman: None declared, Ana Barrera-Vargas: None declared, Samuel Govea-Pelaez: None declared, Diana Gomez-Martin: None declared, Jorge Alcocer-Varela: None declared, Diana Padilla-Ortiz: None declared, Javier Merayo-Chalico Speakers bureau: Pfizer

Background: Osteoarthritis (OA) is the most prevalent rheumatic disease in Colombia, as reported by the COPCORD 2015 study. The prevalence is 10.81% (IC 95, 9.68-12.06) (1). Objectives: To estimate the disease burden of OA for 2015 Methods: A descriptive study was developed. The reference data of the population was taken by DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization). It was necessary to develop an algorithm to determine the distribution in percentages of severity levels, according to the GBD definitions. A Markov model was elaborated to calculate the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and Disability-Adjusted Life Year (DALY). Results: Figure 1 shows the distribution of cases by age of OA, with the highest frequency of cases over 50 years in both sexes. Figure 2 describes the distribution of the severity levels of the disease, with most cases being moderately severe. The YLLs were 781 and the YLDs were 245,626. Finally, the DALYs calculated were 246,408 for a rate of 752.69 per 100,000. When compared with that reported data by the GBD 2016, the burden of disease for OA was 204 (IC95% 143-278). The results of the present study show that the burden of the disease is higher, and the conditional factor is the YLDs. Conclusion: Osteoarthritis is a frequent and disabling rheumatic disease that confers a large burden of rheumatic disease affecting people over 50 years of age. The treatment of OA should be focused on reducing disability and holistic intervention strategies to promote good quality of life. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Ignacio Angarita: None declared, Ana Maria Santos: None declared, Eugenia-Lucia Saldarriaga: None declared, Juan Camilo Rueda: None declared, Jesus G Ballesteros: None declared, Rodrigo Giraldo: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background: The prevalence of rheumatoid arthritis (RA) in Colombia according to the COPCORD study was 1.49%. The disease burden data available in our country are based on the results of the Global Burden Disease study (GBD) of 2016. However, the GBD study takes reference data from non-Colombian residents that was extrapolated to our population, given the absence of demographic data at that moment. Objectives: To estimate the disease burden of RA for 2015 Methods: A descriptive study was developed. The reference data of the population was taken by DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization). The GBD disability definitions were adapted from individual questions of functionality and quality of life questionnaires of the COPCORD study in Colombia (1). A Markov model was developed to calculate the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and Disability-Adjusted Life Year (DALY). Results: The distribution of cases by age and severity levels of RA are shown in figure 1 and 2 respectively. Since direct death due to RA were not registered according to the search of the ICD-10 codes in DANE, the YLL was 0. The YLDs in total were 118,358. The DALYs were 118,358 for a rate of 361.54 per 100,000, which is higher than the GBD 2016 results (60 per 100.000). Conclusion: The burden disease of rheumatoid arthritis is higher than that referred by GBD. Holistic approaches are required to reduce these parameters of impact on the public health of Colombians. Our data on DALYs usefulness lies in the urgent need for an early diagnosis, to reduce disability and thereby improve the quality of life of patients. Even though, RA was not the registered primary cause of death, it is necessary to explore mortality-associated conditions due to this rheumatic disease. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Ana Maria Santos: None declared, Ignacio Angarita: None declared, Juan Camilo Rueda: None declared, Rodrigo Giraldo: None declared, Jesus G Ballesteros: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background: Low back pain (LBP) is the second most frequent rheumatic disease in Colombia. According to the COPCORD study, LBP prevalence was 7.24% (CI 95% 6.28-8.34%) (1). Objectives: To estimate the disease burden of LBP for 2015. Methods: A descriptive study was conducted. A Markov model was developed based on cases with LBP, distribution of disability and mortality according to DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization) reference data. The results are shown in terms of the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and finally as Disability-Adjusted Life Year (DALY). Results: The distribution of cases by age of LBP are shown in figure 1. An algorithm was designed to determine the distribution in percentages of severity levels, according to the GBD definitions (figure 2). According to ICD-10 codes, 9 deaths were reported, so the YLL were 124. The YLDs were 264,658. Finally, the DALYs were 264,782 for a rate of 808.82 per 100,000, which is higher than the GBD 2016 results (647 per 100,000). Conclusion: The main cause of burden disease of rheumatic disease in Colombia is due to LBP. The burden is because of the YLD, related to the frequency of cases in people younger than 50 years of age. It is necessary for an early detection and development of intervention strategies. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Juan Camilo Rueda: None declared, Ana Maria Santos: None declared, Eugenia-Lucia Saldarriaga: None declared, Ignacio Angarita: None declared, Rodrigo Giraldo: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Jesus G Ballesteros: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background Whereas SLE is uncommon in men, the disease is usually more severe and requires more aggressive immunosuppression in male patients. There are multiple studies regarding sexual aspects in women with SLE, but information about sexual function in male patients is quite scant. Methods We performed a longitudinal study in a third-level referral center in Mexico City (January–November 2018). We included men aged 16 years who fulfilled ACR criteria for SLE and who were sexually active in the previous six months. All subjects answered the International Index of Erectile Function-15 (IIEF-15), the SF-36 (which determines generic health-related quality of life) and the HAQ in two visits. Other clinical, serological and demographic variables were measured. Oxidized LDL was quantified by ELISA. Results We included 108 male SLE patients. Mean age was 37.2±1.1 years and most patients (87.9%) were taking immunosuppressive therapy. Comorbidities were present in 58.3% of subjects, with dyslipidemia and hypertension being the most prevalent (34.2% and 28.7%, respectively). The prevalence of sexual dysfunction (SD) was 53.7%. In the basal visit, the only significant differences between the patients with SD and those without SD were a lower education degree (p=0.007) and persistent lymphopenia (p=0.01). There was a positive correlation between global IIEF-15 score (gsIIEF-15) and global SF-36 score (r=0.459, p=0.0001). The physical function domain had the highest correlation (r=0.509, p=0.0001). Likewise, there was a weak negative correlation between gsIIEF-15 and HAQ score (r=−0.252, p=0.012). Also, the gsIIEF-15 had a weak correlation with the absolute lymphocyte count (r=0.273, p=0.005) and oxidized LDL (r=0.310, p=0.04). In the follow-up visit the only significant differences between the patients with SD when compared with subjects without SD was a low absolute lymphocyte count (1031±89 vs 1458±119, p=0.005); the correlations mentioned in the baseline visit remained significant. Regarding erectile function, 44% of the subjects had some degree of dysfunction. The rest of the variables are shown in table 1. Conclusions Sexual function is affected in men with lupus (mostly young and with adequate functional capacity), regardless of comorbidities and treatment. Interestingly, lymphopenia is persistently associated with an impaired sexual function, which could be related to the role it plays in endothelial dysfunction and atherosclerosis. The patients disease perception, which is influenced by their academic level and physical role in their daily activities, seems to affect their sexual performance and quality of life. These findings reinforce the need of a multidisciplinary approach for male SLE patients with sexual dysfunction. Funding Source(s): None

Background Although systemic lupus erythematosus (SLE) has a higher prevalence in women, the disease usually has a more aggressive course in men. Information regarding erectile function in men with SLE is quite scant. Objectives The aim of this study was to describe the prevalence of erectile dysfunction (ED), as well as associated demographic and clinical features, in men with SLE, by means of a systematic, standardized evaluation. Methods We performed a transversal study in eight tertiary care centers in Latin America. We included male patients ≥16 years who fulfilled ≥4 ACR criteria for SLE, and who had regular sexual activity in the previous 6 months. Patients with other rheumatic diseases (except for APS), chronic viral infections and late-onset SLE were excluded. All patients answered the IIEF-5 Questionnaire, which has been validated in Spanish. Other relevant demographic, clinical and serological characteristics were documented. We included two control groups: the first one was made up by healthy men and the second by men with autoimmune diseases different from SLE (non-SLE group). Results We included 279 subjects (174 SLE, 55 non-SLE and 50 healthy controls). The prevalence of ED in SLE group 68% ( vs 22% in healthy group, p=0.001). The mean age of patients with ED in the SLE group was 36.1±1.03, while in patients without ED it was 32.5±1.27 (p=0.022). Whereas there was no difference regarding ED prevalence between SLE patients and the non-SLE group (68 vs 60%, p=0.25), patients with other autoimmune diseases were 10 years older (46.3±1.60 years, p=0.001). Among SLE patients with and without ED, the presence of persistent lymphopenia (≤1000cells/mcl at three consecutive times, p=0.006), the prednisone dose (9.3±1.2 vs 5.3±1.2mg, p=0.026), as well as the SLICC damage score (1.2±0.1 vs 0.8±0.1 points, p=0.026), were significantly different. Comorbidities and other demographic, serological and treatment variables were not different between those groups. Multivariate analysis showed the following independent risk factors for ED in SLE patients: persistent lymphopenia (OR 2.79 CI95% [2.79–5.70], p=0.001) and corticosteroid use (any dose) in the previous year (OR 2.15 CI95% [1.37–3.37], p=0.001). Only 7% of patients had been questioned about their sexual function in the previous three visits to the rheumatologist; also, 81% of subjects considered it would be appropriate to be asked about their sexual function. Conclusions Regardless of comorbidities, treatment (excluding steroids) and type of disease activity, SLE patients have a high prevalence of ED, especially considering most patients are young and sexually active. Rheumatologists should be aware of the relevance of this problem in male SLE patients and should ask about this issues in regular visits. Disclosure of Interest None declared