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Background Dermatomyositis belongs to an infrequent group of diseases predominantly found in patients older than 40 years old and is characterized by dermal and muscular findings. This disease presents itself as proximal, ascending and symmetric weakness and typical dermatosis with findings such as elevated muscle enzymes, altered electromyography and typical changes in muscle biopsy; as of today, the etiology of the disease in unknown. The COVID-19 vaccine has been a fundamental tactic to achieve control of the coronavirus (SARS CoV2), and it’s clear that the benefits of getting the vaccine overweight the risks that might come along with it. Although rare, all adverse effects should be reported, this could help us to understand the elusive pathophysiology of inflammatory idiopathic myopathy. Case presentation In this text we will describe the case of a patient with dermatomyositis who was vaccinated against SARS CoV2 with BNT162b2 mRNA (Pfizer-BioNTech), showing a temporal relation between the vaccination and the beginning of her symptoms. We realized all the diagnostic approach to the suspected disease including electromyography, muscle biopsy and laboratory findings, corroborating the diagnosis. The patient received standard treatment for this disease (steroid therapy) and have a classic slow improvement. Conclusions Although it´s not possible to confirm a direct correlation between the vaccine and the onset of the disease, we considered that there are enough data to suspect that this could be a trigger event and therefore should always be considered a possible cause for a case of inflammatory idiopathic myopathy.

Resumen Introduccion La enfermedad renal terminal (ERT) por nefritis lupica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistemico (LES) fue una contraindicacion para el trasplante renal (TR). En la actualidad, la supervivencia del injerto a largo plazo sigue siendo motivo de controversia. El objetivo del estudio fue comparar la supervivencia del TR en los sujetos con LES con otras causas de ERT. Metodos Se incluyo a todos los pacientes con TR en sujetos con LES, de una cohorte retrospectiva en 2 centros de trasplante. Se realizo un grupo de comparacion con otras etiologias de ERT en una relacion 2:1 emparejados por edad, sexo y ano del trasplante. La supervivencia se evaluo por el metodo de Kaplan-Meier y por el modelo de riesgos proporcionales de Cox. Resultados Se incluyo a 25 sujetos con LES. La probabilidad de supervivencia en los sujetos con LES al ano, 5 y 10 anos fue del 92, el 66 y el 66%, respectivamente, la cual no difirio del grupo de comparacion (p = 0,39). En el analisis multivariante no existio una diferencia significativa en la supervivencia del injerto entre los 2 grupos (hazard ratio = 1.95, IC del 95%, 0,57-6,61; p = 0,28). La recurrencia de la NL fue del 8% y no se relaciono con la perdida del injerto. El rechazo agudo fue la unica variable asociada con la perdida del injerto en los sujetos con LES (HR 16,5, IC del 95%, 1,94-140,1, p = 0,01). Conclusiones El riesgo de perdida del injerto renal en los sujetos con LES fue similar al de los sujetos con otras causas de ERT.

Introduction End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%–30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD. Methods All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan–Meier test and the Cox proportional hazards model. Results Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P = .39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR = 1.95, 95% confidence interval [CI] 0.57–6.61, P = .28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR = 16.5, 95% CI 1.94–140.1, P = .01). Conclusions Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD.

Objective.Our aim is to describe the frequency of uveitis associated with rheumatic inflammatory autoimmune diseases (RIAD) in adult patients admitted to the Rheumatology Department at a tertiary-care hospital in Mexico City. We also describe the clinical features, seasonal distribution, treatment, and ocular complications associated with this disease.Methods.We reviewed 1332 charts of patients with RIAD and selected those that had a diagnosis of uveitis. We obtained the following data: age, sex, type of uveitis and relationship with diagnosis of RIAD, recurrences, seasonal distribution, treatment, and residual visual deficit.Results.We found 57 (4.27%) cases of uveitis in 1332 charts, including 38 men and 19 women (M:F ratio 2:1), aged 47 ± 16 years. Nongranulomatous acute anterior uveitis (NGAAU) comprised 90.52% of cases (52/57). In 64.91% of cases (37/57), uveitis preceded the diagnosis of RIAD by 12 ± 9 years, more frequently in winter (35.96%; p = NS). Uveitis was found in 40/93 patients with ankylosing spondylitis (AS), in 7/11 patients with relapsing polychondritis (RP), in 8/16 patients with Behçet’s disease, in 1/16 patients with polyarteritis nodosa, and in 1/590 patients with rheumatoid arthritis (RA). Ninety-six percent of the patients were treated with steroids. Upon a mean followup of 60 days (range 7–4745 days), reduction of visual acuity (≤ 20/200) was associated with recurrence of uveitis in 3/7 cases with AS, in 4/8 cases with Behçet’s disease, in 3/7 with RP, and in 1 case of uveitis and seronegative RA.Conclusion.NGAAU frequently precedes RIAD and is found predominately in men, with a tendency to occur in winter.

Objetivo. Evaluar los factores de riesgo asociados con el desarrollo de lupus eritematoso sistémico en población mexicana. Material y métodos. Estudio de casos y controles, efectuado en junio de 1996 en el Departamento de Reumatología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), del Instituto Mexicano del Seguro Social, de la Ciudad de México. Se estudiaron 130 pacientes (casos) que presentaban cuatro o más criterios de clasificación de lupus eritematoso sistémico (LES) y con una evolución de la enfermedad menor de cinco años. Los controles fueron pacientes hospitalizados por enfermedades agudas no autoinmunes. Fueron pareados 1:1 por edad y sexo; ambos grupos se evaluaron a través de una entrevista directa y la aplicación de un cuestionario estructurado. Se estudiaron los siguientes factores de riesgo: genéticos (historia familiar de LES o enfermedad de tejido conjuntivo), sociodemográficos (raza, lugar de residencia, educación, ingreso mensual); hormonales (anticonceptivos orales, terapia hormonal de remplazo y ginecobstétricos); ambientales (productos para el cabello, cohabitación con perros, infecciones, alergias). El análisis estadístico fue hecho con razón de momios (RM) IC 95% y regresión logística. Resultados. El análisis estadístico multivariado mostró asociación con el antecedente familiar de LES (RM 4.2, IC 95% 1.17-15.2) u otra ETC (RM 2.6, IC 95% 1.15-4.5), uso de anticonceptivos orales por más de un año (RM 2.1, IC 95% 1.13-4.3), faringoamigdalitis de repetición (RM 2.1, IC 95% 1.18 - 3.6) y fármacos (RM 5.0, IC 95% 1.62 - 21.6). No hubo relación con factores socieconómicos, el uso de productos para el cabello, con asma o con antecedentes alérgicos. Conclusiones. Factores genéticos como el antecedente heredo-familiar de LES o enfermedad de tejido conjuntivo en familiares de primer grado continúan siendo factores importantes en el desarrollo de LES. Otros factores de riesgo como el uso de fármacos, uso de anticonceptivos orales, faringitis de repetición, posiblemente interactúan en un huésped genéticamente susceptible para el desarrollo de la enfermedad.Objective. To assess risk factors associated with systemic lupus erythematosus (SLE) in the Mexican population. Material and Methods. A case-control study was conducted on June 1996, at the Reumathology Clinic of Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), Instituto Mexicano del Seguro Social, in Mexico City. Cases were one hundred thirty subjects with four or more SLE criteria and disease evolution of ± 5 years. Controls were hospitalized patients with acute diseases but without autoimmune diseases. Cases and controls were matched 1:1 by age and gender; both groups were evaluated by direct interview through a structured questionnaire. The following risk factors were assessed: genetic family history of SLE and connective tissue disease; socioedemographic (ethnicity, geographic distribution, education, monthly income); hormonal (use of oral contraceptives, replacement therapy and gynecoobstetric background); environmental (use of hair products, living with dogs, bacterial/viral infections, and allergies). Statistical analysis consisted of odd ratios (OR) with 95% confidence intervals (CI ) and multivariate analysis using logistic regression. Results. The multivariate model showed association with family history of SLE (OR 4.2, CI 95% 1.17-15.2), family history of connective tissue disorder (OR 2.6, CI 95% 1.15-4.5), use of oral contraceptives for more than one year (OR 2.1, CI 95% 1.13-4.3), repetitive pharyngitis (OR 2.1, CI 95% 1.18-3.6), and use of medications (OR 5.0 IC 95% 1.62 - 21.6). No association was found with socieconomic status, hair dye products, asthma, or allergies. Conclusions. Genetic factors, such as family history of SLE and connective tissue disease in first-degree relatives, persist as important factors in the development of SLE. Other factors, such as use of some drugs, oral contraceptives, and repetitive pharyngitis, may also favor the onset of disease in genetically susceptible hosts.

The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were assessed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), therapy and laboratory variables were evaluated. After a follow-up of 22 7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26%), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. The variables signifycantly associated with infection in the univariate analyses were the presence of disease activity, SLEDAI score, renal activity, prednisone dose, and IV cyclophosphamide. The only variable associated with infection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening, and associated with disease activity independently of sociodemographic and therapeutic factors.

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index is a validated instrument specifically designed to ascertain damage in SLE; this instrument has been applied mainly to Caucasians and African-American SLE patients. The objective of this study was to assess damage using the SLICC/ACR Damage Index in Mexican SLE patients. The SLICC/ACR Damage Index was applied to 210 consecutive SLE patients with disease of variable duration. The SLICC/ACR Damage Index was assessed by review of hospital clinical records, interview and physical examination. One hundred and seventeen (55.5%) patients had some damage. The proportion of patients with damage increased significantly with disease duration (33% at 1–60 months, 66% at 61–120 months and 70% at ≥121 months, P < 0.001). The main organ systems involved were musculoskeletal (osteonecrosis), neuropsychiatric (neuropathy, seizures), gonadal (amenorrhea prior to age 40 years), ocular (cataracts), renal (glomerular filtration < 50%) and peripheral vascular (permanent damage by venous thrombosis). Damage was frequent, increased over time, particularly for ocular, renal, musculoskeletal and gonadal. Patients who experienced damage were older, had a longer disease duration, a greater number of ACR criteria at diagnosis, and were more likely to have renal involvement and antibodies to dsDNA. The damage occurred in many different domains and started to develop early after disease onset. Mexican patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations.

Blastocystis hominis is a common human parasite with infection rates up to 50% in developing countries, and giardiasis is the commonest intestinal one in Mexico. No doubt, various parasites as Giardia lamblia and Entamoeba histolytica can cause rheumatic diseases. This study coproparasitoscopic analysis evaluated the cysts by B. hominis, G. lamblia, E. hartmani, E. coli and E. histolytica in Mexican rheumatic disease patients. Also, ELISA was used to detect E. histolytica, Ascaris lumbricoides, Toxocara canis, and Trichinella spiralis in Mexican patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Thirty-six patients (24 with AS and 12 with RA) and 77 healthy control individuals were enrolled in this study. The frequencies of protozoan cysts were comparable in rheumatic disease patients (AS and RA) and healthy control donors (33 and 25 vs. 26%, respectively; p0.05). The frequency of antibodies to T. canis was significantly higher in AS patients than in healthy control donors (16 vs. 2.6%, respectively; p = 0.027), whereas no differences were observed for the prevalence of antibodies for the other parasites (E. histolytica, A. lumbricoides and T. spiralis) (p0.05). This information indicates the need to intensify educational efforts for the prevention of parasite infections associated with AS disease that cannot be controlled only by drugs.

The purpose of this guide is to provide for general practitioners or physicians of primary care a comprehensive, evidence based tool that permits them to take an adequate decision about the appropriate use of the non-opioid analgesics in the management of pain.

To assess the frequency and factors associated with metabolic syndrome in adult female patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).During January and June 2006, 192 consecutive adult female patients seen during their scheduled appointment at the out-patient rheumatology clinic and meeting the American College of Rheumatology classification criteria for RA and SLE were invited to participate in this study. Sociodemographic, menopausal status, personal history of coronary heart disease, and physical activity were evaluated. According to the National Cholesterol Education Program Adult Treatment III (NCEP/ATP III), metabolic syndrome was defined asor=3 of the following criteria: increased waist circumference (88 cm or 35 inches), hypertriglyceridemia (or=150 mg/dL), low (40 mg/dL) high-density lipoprotein, hypertension, and high fasting glucose (or=110 mg/dL).: One hundred-seven RA and 85 SLE patients with a mean age of 43 +/- 13 years were included in this study. The frequency of obesity and abnormal waist circumference were similar in RA and SLE patients. Two percent were underweight, 35% had a normal weight, 37% were overweight, and 25% were obese. The frequency of metabolic syndrome in RA and SLE patients was 17%. Metabolic syndrome was significantly associated with greater age, less education, lower income, and smoking. In RA patients, metabolic syndrome was significantly associated with a shorter treatment period with methotrexate, with pain, and with health assessment questionnaire scores. By multivariate logistic regression, the only statistically significant predictor of metabolic syndrome was smoking.The frequency of metabolic syndrome in RA and SLE patients was similar and associated with smoking. In RA patients, metabolic syndrome was related with pain and functional status, suggesting disease activity. A better control of disease activity may reduce the presence of metabolic syndrome and the risk of cardiovascular disease.

Objetivo. Investigar la asociación del antecedente de parasitosis intestinal extrema (PIE) durante la infancia enpacientes ahora adultos con enfermedades reumáticas/ autoinmunes (ERAI). Métodos. Se estudiaron 54 pacientes consecutivos con ERAI, (27 con espondilitis anquilosante 9 con artritis reumatoide, 19 con lupus eritematoso sistémico) y 54 controles sanos; 27 hombres y 27 mujeres. Todos los sujetos tenían padres que informaran de eventos PIE durante la infancia, previos al inicio de la ERAI. Resultados. Ocho de los 54 controles presentaron PIE (15%). En el grupo de las enfermedades reumáticas, 10 de los 27 con espondilitis anquilosante (37%, p 0.017) y 6 de los 9 con artritis reumatoide (67%, p 0.002) presentaron PIE. No se reportaron casos de PIE en el grupo de lupus eritematoso sistémico. Conclusión. Las PIE durante la infancia se asocian con el desarrollo posterior de la espondilitis anquilosante y la artritis reumatoide, durante la adolescencia o en el adulto joven, no así los pacientes de lupus eritematoso sistémico.

Antecedentes. La insalubridad en el medio ambiente se ha asociada con alta frecuencia a infecciones, y estas a su vez se han relacionado con la Espondilitis Anquilosante (EA) y Artritis Reumatoide (AR). Objetivo. Investigar las condiciones de insalubridad del hogar y el desarrollo de infecciones en la infancia de pacientes con EA y AR. Métodos. Se investigaron la carencia de agua potable, ausencia de drenaje, fecalismo al aire libre y hacinamiento (= 3 individuos durmiendo en una habitación) durante la infancia de 55 pacientes con EA, 16 con AR y 71 sujetos controles sanos ahora adultos. Resultados. Los pacientes con EA de inicio juvenil (EAJ) carecieron de drenaje (OR 3.65; CI 95%, 1.11-12.13) y tuvieron hacinamiento (OR 4.35; CI 95%, 1.32-14.32) durante la infancia con más frecuencia que los controles. En los pacientes con EA iniciada en la edad adulta (EAA), el hacinamiento en la infancia fue más frecuente que los controles (OR 2.72 (1.06-7.13). La frecuencia de insalubridad en la infancia de pacientes con AR fue similar a la de los controles. La frecuencia de infecciones en la infancia de pacientes con EA y la AR fue similar a la de los controles. Conclusión. Se observa una asociación entre la presencia de EAJ y la carencia de drenaje y presencia de hacinamiento durante la infancia; y entre la presencia de EAA y hacinamiento en la infancia. Mientras que en el paciente con AR no se encontró asociación alguna con la presencia de insalubridad en la infancia.

Systemic lupus erythematosus (SLE) is a clinical syndrome of varying severity. Although the survival and prognosis of SLE have steadily improved, there is a group of patients who present an acute fatal outcome despite aggressive therapy. We designed this study to evaluate the factors associated with mortality in patients with acute severe SLE. During 2004—06, 41 Mexican SLE patients that could not be managed in the out-patient clinic and with acute severe major organ system involvement [nephritis, severe thrombocytopenia (platelet count below 20 000 per μL) acute neuropsychiatric pulmonary, gastrointestinal or cardiac disease and generalized vasculitis] were studied. During the first admission, disease activity (SLE Disease Activity Index (SLEDAI), SLE Activity Measured), damage [SLE International Collaborating Clinics (SLICC)], and therapy were assessed. Survival using Kaplan—Meier curves, odd ratios with 95% confidence interval and logistic regression analysis were used to determine risk factors for mortality. Ninety percent were female with a mean age of 29 ± 19 years and mean disease duration of 21 ± 9 months. The principal causes of first admission were renal (27%), SNC (22%) and cardiopulmonary (15%). After a mean follow-up of 9.7 ± 6 months, 16 (39%) patients died. Deceased patients had significantly higher SLEDAI ( P = 0.004), and SLICC ( P = 0.03) scores. The manifestations associated with mortality were renal disease activity (odds ratio, OR 4.6, confidence interval, CI 95% 1.0—20.6), infections (OR 3.2 CI 95% 2.0—5.3) and thrombocytopenia (OR 4.0, CI 95% 1.0—15.9). The survival at 9.7 months was 72, 62 and 50% in patients with an SLEDAI score of 3—10, 11—20 and ≥21, respectively. The SLEDAI score, the presence of damage and infection were associated with death in patients with acute severe SLE. Lupus (2007) 16, 997—1000.

To assess risk factors associated with systemic lupus erythematosus (SLE) in the Mexican population.A case-control study was conducted on June 1996, at the Reumathology Clinic of Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), Instituto Mexicano del Seguro Social, in Mexico City. Cases were one hundred thirty subjects with four or more SLE criteria and disease evolution of +/- 5 years. Controls were hospitalized patients with acute diseases but without autoimmune diseases. Cases and controls were matched 1:1 by age and gender; both groups were evaluated by direct interview through a structured questionnaire. The following risk factors were assessed: genetic family history of SLE and connective tissue disease; socioedemographic (ethnicity, geographic distribution, education, monthly income); hormonal (use of oral contraceptives, replacement therapy and gynecoobstetric background); environmental (use of hair products, living with dogs, bacterial/viral infections, and allergies). Statistical analysis consisted of odd ratios (OR) with 95% confidence intervals (CI) and multivariate analysis using logistic regression.The multivariate model showed association with family history of SLE (OR 4.2, CI 95% 1.17-15.2), family history of connective tissue disorder (OR 2.6, CI 95% 1.15-4.5), use of oral contraceptives for more than one year (OR 2.1, CI 95% 1.13-4.3), repetitive pharyngitis (OR 2.1, CI 95% 1.18-3.6), and use of medications (OR 5.0 IC 95% 1.62-21.6). No association was found with socieconomic status, hair dye products, asthma, or allergies.Genetic factors, such as family history of SLE and connective tissue disease in first-degree relatives, persist as important factors in the development of SLE. Other factors, such as use of some drugs, oral contraceptives, and repetitive pharyngitis, may also favor the onset of disease in genetically susceptible hosts. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objetivo. Evaluar los factores de riesgo asociados con el desarrollo de lupus eritematoso sistémico en población mexicana. Material y métodos. Estudio de casos y controles, efectuado en junio de 1996 en el Departamento de Reumatología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), del Instituto Mexicano del Seguro Social, de la Ciudad de México. Se estudiaron 130 pacientes (casos) que presentaban cuatro o más criterios de clasificación de lupus eritematoso sistémico (LES) y con una evolución de la enfermedad menor de cinco años. Los controles fueron pacientes hospitalizados por enfermedades agudas no autoinmunes. Fueron pareados 1:1 por edad y sexo; ambos grupos se evaluaron a través de una entrevista directa y la aplicación de un cuestionario estructurado. Se estudiaron los siguientes factores de riesgo: genéticos (historia familiar de LES o enfermedad de tejido conjuntivo), sociodemográficos (raza, lugar de residencia, educación, ingreso mensual); hormonales (anticonceptivos orales, terapia hormonal de remplazo y ginecobstétricos); ambientales (productos para el cabello, cohabitación con perros, infecciones, alergias). El análisis estadístico fue hecho con razón de momios (RM) IC 95% y regresión logística. Resultados. El análisis estadístico multivariado mostró asociación con el antecedente familiar de LES (RM 4.2, IC 95% 1.17-15.2) u otra ETC (RM 2.6, IC 95% 1.15-4.5), uso de anticonceptivos orales por más de un año (RM 2.1, IC 95% 1.13-4.3), faringoamigdalitis de repetición (RM 2.1, IC 95% 1.18 - 3.6) y fármacos (RM 5.0, IC 95% 1.62 - 21.6). No hubo relación con factores socieconómicos, el uso de productos para el cabello, con asma o con antecedentes alérgicos. Conclusiones. Factores genéticos como el antecedente heredo-familiar de LES o enfermedad de tejido conjuntivo en familiares de primer grado continúan siendo factores importantes en el desarrollo de LES. Otros factores de riesgo como el uso de fármacos, uso de anticonceptivos orales, faringitis de repetición, posiblemente interactúan en un huésped genéticamente susceptible para el desarrollo de la enfermedad.

The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, χ2, and ANOVA. Ninety percent of JOAS and 51 % of AOAS patients were B27+ (p = 0.005). The disease duration was 19.3 ±8.8 years in JOAS and 14.8 ± 12.8 years in AOAS (p = NS). Age at the time of the study was 30.7 ±9.9 years in JOAS vs 40.3 ± 12.7 in AOAS (p = 0.003), and vs 40.2 ± 17 years in controls (p = NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p = 0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p = NS) and controls (0%, p = 0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p = 0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p = 0.001).The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.

To describe the influence of serum rheumatoid factor (RF) on the clinical and radiological picture of definite ankylosing spondylitis (AS).In a retrospective chart review of 281 AS patients typed for RF, the clinical picture of RF positive patients (Group 1) was compared with RF negative patients (Group 2); mode of onset, disease duration, and treatment were recorded. All patients were examined to determine their clinical status; the blood cell count. HLA-B27, serum IgG, IgM, IgA, and erythrocyte sedimentation rate (ESR) were determined, and radiological studies of the entire spine, pelvis and affected peripheral joints were carried out. In patients from Group 1 the HLA-DR was also determined.Fifteen of 281 patients (8 men, 7 women) with AS were RF+ (1:64 to 1:1024) (5.3%) and 11 were HLA-B27+. Seven patients in Group 1 had spine involvement and chronic arthritis of the knees. Four out of these 7 were tested for DR, and none was positive; in 6, AS and rheumatoid arthritis (RA) coexisted, 2 were DR1 and 2 were DR4 (test not carried out in 2). In two others we found spinal involvement only, and one of them had both DR1 and DR4. The onset of AS was similar in both groups. Group 1 was characterized by a chronic disease of moderate intensity with chronic arthritis of the metacarpophalangeal and proximal interphalangeal joints (p = 0.0008 and p = 0.04, respectively), no valvulopathy (p = 0.04) and fewer uveitis sequelae (p = 0.007) than Group 2. The ESR (p = 0.01), IgG (p = 0.008) and IgM (p = 0.0001) were higher in Group 1 than in Group 2.The presence of RF in AS is associated with a chronic disease of moderate intensity with chronic peripheral arthritis and fewer extra-articular manifestations. The presence of RF, not always associated with HLA-DR, seems to affect the course of AS and does not necessarily indicate an association with RA.

Background In addition to muscular weakness, patients with Idiopathic inflammatory myopathy (IIM) may presentasymtomatic myocardial damage and endothelial dysfunction. Malondialdehyde (MDA) is a product of lipid peroxidation that may cause endothelial activation and dysfunction, also it has been related to disease activity in patients with SLEand RA. Myocardial global strain is a useful method for the detection of impaired myocardial contractility in diseases thatcause microvascular damage such as diabetes mellitus, ischemic heart disease, SLE, RA and Antiphospholipidsyndrome. Neither, MDA and myocardial strain have been studied in patients with IIM. Objectives To evaluate the presence of endothelial dysfunction and asymtomatic myocardiopathy in patients with IIM. Methods Patients with diagnosis of IIM (Bohan and Peter), >16 yr old, without symptoms of heart failure were recluted and matched with healthy controls. We excluded patients with diagnosis of ischemic heart disease, valvulopathy, arrythmia, anemia, pregnancy, nefrotic or overlap syndrome. Medical charts were reviewed for demographic data, disease status and treatment. Measurement of serum levels of malondyaldehyde (MDA), brain natriuretic peptide (BNP), standard transthoracic ecochardiography with tisular doppler mode and strain imaging were performed to patients and controls. Descriptive statistics, Student’s t, χ 2 , Mann Whitney’s U and Spearman’s rho tests were used. Results Eighteen patients, 15 (83%) dermatomyositis, 3 (17%) polimyositis and 18 controls were compared. Mean age 43 (±13.93) and 42 (±13.18).Body mass index was similar between groups (24.48 vs 24.23, p=0.981).The serum levels of BNP were normal.The control group had higher MDA serum levels than the IIM group (13.93±6.10 vs 8.53±3.27, p Conclusions Adult patients with IIM have asymptomatic diastolic dysfunction and decreased global longitudinal strainvalues that may be caused by microvascular lession and/or myocardial inflammatory infiltrate. Echocardiographic evaluation should be used in the routine care of this patients. Longitudinal studies are necessary to stablish the prognosis and the need of treatment against myocardial remodeling in this group of patients. References Buss SJ, Wolf D, Korosoglou G, et al. Myocardial left ventricular dysfunction in patients with systemic lupuserythematosus: new insights from tissue Doppler and strain imaging. J Rheumatol. 2010 Jan;37(1):79-86. Disclosure of Interest None Declared

To assess flares in outpatients with systemic lupus erythematosus (SLE) using SLAM (systemic lupus activity measure) and to determine laboratory abnormalities as predictors of disease activity.Fifty-three Mexican patients were assessed using SLAM scale. They were evaluated monthly for a total of at least 572 months. The SLAM scale was applied at each visit. Samples were drawn for complete blood cell count, erythrocyte sedimentation rate, urinalysis, 24-h protein and creatinine clearance, anti-DNA, C3 and C4. An SLE flare was defined as the occurrence of new clinical manifestations or worsening compared to the previous month that usually required restarting or increasing prednisone or immunosuppressive drugs.Thirty-three patients had flares, mainly in minor organs. The incidence of flares was 0.69/patient/year of followup. Active nephritis and extrarenal manifestations correlated with high levels of dsDNA and low complement levels. We found an odds ratio (OR) = 3 (CI = 1.7-5.7) for flare in asymptomatic patients with high dsDNA and OR = 2 (CI = 1.3-4.5) for low C3 levels.Flares are frequent in patients with SLE and they occur independent of disease duration and the time the disease has been under control. Flares are apparently predictable and are related to serologic abnormalities.

Our goal in the present work was to determine whether male patients with untreated hypogonadism have an increased risk of developing rheumatic/autoimmune disease (RAD), and, if so, whether there is a relation to the type of hypogonadism. We carried out neuroendocrine, genetic, and rheumatologic investigations in 13 such patients and 10 healthy male 46,XY normogonadic control subjects. Age and body mass index were similar in the two groups. Nine of the 13 patients had hypergonadotropic hypogonadism (five of whom had Klinefelter's syndrome [karyotype 47,XXY]) and 4 of the 13 had hypogonadotropic hypogonadism (46,XY). Of these last four, two had Kallmann's syndrome and two had idiopathic cryptorchidism. Eight (61%) of the 13 patients studied had RADs unrelated to the etiology of their hypogonadism. Of these, four had ankylosing spondylitis and histocompatibility B27 antigen, two had systemic lupus erythematosus (in one case associated with antiphospholipids), one had juvenile rheumatoid arthritis, and one had juvenile dermatomyositis. In comparison with the low frequencies of RADs in the general population (about 0.83%, including systemic lupus erythematosus, 0.03%; dermatomyositis, 0.04%; juvenile rheumatoid arthritis, 0.03%; ankylosing spondylitis, 0.01%; rheumatoid arthritis, 0.62%; and other RAD, 0.1%), there were surprisingly high frequencies of such disorders in this small group of patients with untreated hypogonadism (P < 0.001) and very low serum testosterone levels (P = 0.0005). The presence of RADs in these patients was independent of the etiology of their hypogonadism and was associated with marked gonadal failure with very low testosterone levels.

Blastocystis hominis is a common human parasite with infection rates up to 50% in developing countries, and giardiasis is the commonest intestinal one in Mexico. No doubt, various parasites as Giardia lamblia and Entamoeba histolytica can cause rheumatic diseases. This study coproparasitoscopic analysis evaluated the cysts by B. hominis, G. lamblia, E. hartmani, E. coli and E. histolytica in Mexican rheumatic disease patients. Also, ELISA was used to detect E. histolytica, Ascaris lumbricoides, Toxocara canis, and Trichinella spiralis in Mexican patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Thirty-six patients (24 with AS and 12 with RA) and 77 healthy control individuals were enrolled in this study. The frequencies of protozoan cysts were comparable in rheumatic disease patients (AS and RA) and healthy control donors (33 and 25 vs. 26%, respectively; p > 0.05). The frequency of antibodies to T. canis was significantly higher in AS patients than in healthy control donors (16 vs. 2.6%, respectively; p = 0.027), whereas no differences were observed for the prevalence of antibodies for the other parasites (E. histolytica, A. lumbricoides and T. spiralis) (p > 0.05). This information indicates the need to intensify educational efforts for the prevention of parasite infections associated with AS disease that cannot be controlled only by drugs.