Search

To assess the golimumab retention rate during up to 8 years of follow up, and any associated factors.Retrospective analysis of the BIOBADASER (Spanish registry of biological drugs) database, assessing all adults who had ever started golimumab6 months before the analysis for an approved indication (rheumatoid arthritis [RA], axial spondyloarthritis [SpA] or psoriatic arthritis [PsA]).Among 885 patients (RA 267, axial SpA 370, PsA 248) receiving 944 cycles of golimumab, the retention rate of golimumab was 71.1% (95% confidence interval: 68.0-73.9) at year 1% and 37.7% (95% CI: 33.3-42.1) at year 7 and at year 8. Retention was higher when golimumab was used as the first biological drug (81.7% at year 1, 49.9% at year 7, p 0.001). In Cox regression analysis, factors associated with golimumab retention included use as first-line therapy (hazard ratio [HR] for discontinuation 1.52 for second- and 1.79 for third/later-line vs. first-line), use in axial SpA or PsA rather than RA (HR for axial SpA vs. RA 0.59, for PsA vs. Rheumatoid arthritis 0.67), and treatment with concomitant methotrexate (HR 0.67). Factors associated with golimumab discontinuation were corticosteroid use (HR 1.46) and disease activity above median (HR 1.29) at golimumab initiation.Based on this retrospective analysis of the BIOBADASER registry, nearly two-fifths (37.7%) of adult rheumatology patients initiating golimumab will remain on treatment for 8 years, with a higher probability of retention in axial SpA or PsA indications and when golimumab is used as first biologic.

Objetivo: describir la frecuencia de los microorganismos y la resistencia antibiótica de bacterias aisladas en hemocultivos de pacientes con Bacteremia, en un hospital universitario de Colombia. Métodos: Se desarrolló un estudio observacional, descriptivo y de corte transversal, en individuos mayores de 18 años, en donde se describió los hemocultivos positivos, aislados en todos los servicios del Hospital Universitario del Caribe. Resultados: De los 211 hemocultivos analizados, el 53,1% fueron hombres. Los microorganismos Gram positivos corresponden a 49,8%, con una alta frecuencia de S. aureus en un 16,1%. De los microorganismos Gram negativos fue aislado E.coli en un 18%. La resistencia a vancomicina se estableció en 4,4%. La K. pneumoniae presentó una resistencia a meropenem en un 15,3% de los casos. E.coli, P. aeruginosa y E.cloacae son sensibles a carbapénicos. Así en nuestro estudio las bacterias más frecuentemente aisladas en los hemocultivos fueron predominantemente Gram negativos, con resistencia a carbapénicos para algunas cepas de K. Pneumoniae.

Introducción: La práctica del autoexamen de mamas (AEM) puede estar influida por la autoeficacia percibida. Esta característica individual, definida como la confianza en las propias capacidades para alcanzar una meta, puede ayudar de forma positiva a que las mujeres desarrollen conductas promotoras de salud y realicen prácticas de cuidado rutinarias y regulares para la detección temprana del cáncer de mama. Objetivo: Determinar el nivel de autoeficacia percibida y su relación con la práctica adecuada del AEM en mujeres mayores de 20 años de Montería (Colombia). Materiales y métodos: Estudio analítico, con 867 mujeres mayores de 20 años, seleccionadas por muestreo aleatorio multietápico. Se utilizó una encuesta sociodemográfica para la recolección de información, la Escala de Autoeficacia General Percibida y un cuestionario para medir la práctica del AEM. Los datos se almacenaron en una hoja de cálculo de Microsoft Excel y fueron procesados en el programa SPSSS, versión 24. Resultados: Participaron 867 mujeres, con una edad promedio 36,2 años (DE = 13,0). El 72,6 % (629) se practica el AEM. Solo el 2 % (20) de las participantes lo hacen de forma adecuada. La práctica del AEM fue mayor en mujeres con un mayor nivel de autoeficacia (86,2 %). Conclusiones: En Montería, las mujeres de más de 20 años de edad practican de forma inadecuada el AEM, lo que contrasta con un alto nivel de autoeficacia. La autoeficacia es fundamental para mejorar las prácticas de cuidado de la salud y desarrollarlas de forma regular.

Objectives: To analyze the prevalence, incidence, survival and contribution on mortality of major central nervous system (CNS) involvement in systemic lupus erythematosus (SLE). Methods: Patients fulfilling the SLE 1997 ACR classification criteria from the multicentre, retrospective RELESSER-TRANS (Spanish Society of Rheumatology Lupus Register) were included. Prevalence, incidence and survival rates of major CNS neuropsychiatric (NP)-SLE as a group and the individual NP manifestations cere-brovascular disease (CVD), seizure, psychosis, organic brain syndrome and transverse myelitis were calculated. Furthermore, the contribution of these manifestations on mortality was analysed in Cox regression models adjusted for confounders. Results: A total of 3591 SLE patients were included. Of them, 412 (11.5%) developed a total of 522 major CNS NP-SLE manifestations. 61 patients (12%) with major CNS NP-SLE died. The annual mortality rate for patients with and without ever major CNS NP-SLE was 10.8% vs 3.8%, respectively. Individually, CVD (14%) and organic brain syndrome (15.5%) showed the highest mortality rates. The 10% mortality rate for patients with and without ever major CNS NP-SLE was reached after 12.3 vs 22.8 years, respectively. CVD (9.8 years) and organic brain syndrome (7.1 years) reached the 10% mortality rate earlier than other major CNS NP-SLE manifestations. Major CNS NP-SLE (HR 1.85, 1.29-2.67) and more specifically CVD (HR 2.17, 1.41-3.33) and organic brain syndrome (HR 2.11, 1.19-3.74) accounted as independent prognostic factors for poor survival. Conclusion: The presentation of major CNS NP-SLE during the disease course contributes to a higher mortality, which may differ depending on the individual NP manifestation. CVD and organic brain syndrome are associated with the highest mortality rates.

Objetivo: Validar un instrumento para evaluar el componente comunitario, de la estrategia de atención integrada a las enfermedades prevalentes de la infancia (AIEPI). Método: Estudio transversal descriptivo, el cual buscó hallar la validez de constructo de la encuesta SIAC utilizada para medir AIEPI comunitario, mediante un análisis factorial exploratorio, el cual redujo el número de ítems que explicaban los constructos; participaron 120 madres adolescentes de la ciudad de Cartagena, Colombia. La validación de constructo se realizó a través del Análisis Factorial Exploratorio, con el método de Factores Principales, se utilizó la prueba de esfericidad de Bartlett y la medida de la adecuación muestral de Kaiser-Meyer-Olkin (Coeficiente KMO) mediante el paquete estadístico SPSS versión 22.0. Resultados. De acuerdo a los valores obtenidos en los dominios 1 (saneamiento básico), 3 (lactancia materna y alimentación complementaria), 4 (inmunizaciones), 5 (signos de alarma), 11 (cuidado de la mujer gestante) y 13 (SIDA), se procedió a aplicar el método de factorización por ejes principales. En el dominio 7 (prevención de accidentes) se realizó el método de factorización por componentes principales. Conclusiones: La encuesta SIAC mantuvo en los 7 dominios buenos niveles de validez después del cambio, se hace necesario evaluar los puntos de corte que permitan un diagnóstico más sensible y específico del grado de apropiación y aplicación de las practicas clave de la estrategia AIEPI, por parte de los cuidadores de los niños y niñas menores de 5 años. Objective: Validate an instrument to evaluate the community component of the integrated care strategy for prevalent childhood diseases (IMCI).Method: descriptive cross-sectional study, which sought to find the construct validity of the SIAC survey specified to measure community IMCI, through an exploratory factor analysis, which reduces the number of items that explained the constructs; 120 teenage mothers from the city of Cartagena, Colombia participated. The construction validation was carried out through the Exploratory Factor Analysis, with the Main Factors method, the Bartlett sphericity test and the measurement of the sampling adequacy of Kaiser-Meyer-Olkin (KMO coefficient) were performed using the SPSS statistical package. version 22.0.Results: According to the values obtained in domains 1 (basic sanitation), 3 (breastfeeding and complementary feeding), 4 (immunizations), 5 (warning signs), 11 (care of pregnant women) and 13 (AIDS), the main axis factorization method was applied. In domain 7 (accident prevention) the principal component factorization method was performed.Conclusions: the SIAC survey maintained good levels of validity after the change in the 7 domains, it is necessary to evaluate the cut-off points that allow a more sensitive and specific diagnosis of the degree of appropriation and application of the key practices of the IMCI strategy, for part of the caregivers of children under 5 years Objetivo: validar um instrumento para avaliar o componente comunitário da estratégia de atendimento integrado para doenças prevalentes na infância (AIDPI). Método: estudo descritivo transversal, que buscou encontrar a validade de construto da pesquisa SIAC especificada para mensurar o IMCI da comunidade, por meio de uma análise fatorial exploratória, que reduz o número de itens que explicam os construtos; Participaram 120 mães adolescentes da cidade de Cartagena, Colômbia. A validação da construção foi realizada através da Análise Fatorial Exploratória, com o método dos Principais Fatores, o teste de esfericidade de Bartlett e a medição da adequação da amostra de Kaiser-Meyer-Olkin (coeficiente KMO), utilizando o pacote estatístico SPSS. versão 22.0. Resultados: De acordo com os valores obtidos nos domínios 1 (saneamento básico), 3 (aleitamento materno e alimentação complementar), 4 (imunizações), 5 (sinais de alerta), 11 (assistência a gestantes) e 13 (AIDS), o principal eixo método de fatoração foi aplicado. No domínio 7 (prevenção de acidentes), foi realizado o método de fatoração do componente principal. Conclusões: a pesquisa do SIAC manteve bons níveis de validade após a mudança nos 7 domínios, é necessário avaliar os pontos de corte que permitem um diagnóstico mais sensível e específico do grau de apropriação e aplicação das principais práticas da AIDPI. estratégia, para parte dos cuidadores de crianças menores de 5 anos

espanolObjetivo El objetivo de este estudio es describir los hallazgos de una evaluacion odontologica protocolizada en pacientes con sindrome de Sjogren primario (SSp) atendidos en las consultas de reumatologia de la Comunidad de Madrid. Metodos Estudio descriptivo multicentrico en el que se incluyeron pacientes con SSp clasificados segun criterios del consenso Europeo-Americano de 2002. Se recogieron datos demograficos, clinicos y serologicos. Se realizo una exploracion oral, se recogio el flujo salival y el indice de caries CAOD. Los pacientes rellenaron la escala visual analogica para xerostomia, el cuestionario Oral Health Impact Profile-14 y un cuestionario de salud oral. Resultados Se reclutaron 61 pacientes. El 98% fueron mujeres y la edad media fue de 57 anos. El 52,5% presentaban signos orales patologicos (flujo salival no estimulado/sialografia/gammagrafia de glandulas salivales) y el 90,2% antiRo/antiLa+. El 92% de los pacientes referian xerostomia y un 61% hiposialia. Treinta y cinco pacientes presentaron lesiones de la mucosa oral. El indice CAOD fue de 16,97 ± 7,93 y la escala visual analogica para la xerostomia fue de 46,69 ± 14,43. Los resultados del Oral Health Impact Profile-14 fueron de 23,13 ± 14,16. Los pacientes con signos orales patologicos obtuvieron una puntuacion en el Oral Health Impact Profile-14 significativamente mayor (p = 0,03), al igual que los pacientes con afectacion del sistema nervioso periferico (p = 0,001). Conclusiones La prevalencia de xerostomia en esta cohorte de pacientes con SSp fue muy elevada y el 61% de los enfermos presentaron hiposialia. Mas de la mitad de los pacientes sufrieron lesiones orales. La salud oral presento un impacto negativo en la calidad de vida de los pacientes con SSp, siendo mayor en aquellos pacientes con signos orales objetivos patologicos y en los que presentaban afectacion del sistema nervioso periferico. EnglishObjective The aim of this study is to describe the findings of a protocolised odontological evaluation of patients with primary Sjogren's syndrome (pSS) treated in rheumatology units in the Community of Madrid. Methods Multicentric descriptive study in which pSS patients classified according to the American-European consensus of 2002 criteria were included. We collected the demographic, clinical and serological data of each patient. A complete oral examination was performed and salivary flow and the CAOD caries index were collected. The patients completed the visual analogue scale for xerostomia, the Oral Health Impact Profile-14 questionnaire and an oral health questionnaire. Results Sixty-one patients were recruited. Ninety-eight percent were women and the mean age of the patients was 57 years. Pathological oral signs (unstimulated salivary flow/salivary glands sialography/scintigraphy) were present in 52.5% of the patients, anti-Ro/anti-La were positive in 90.2%. Ninety-two percent of the patients reported xerostomia and 61% of the patients suffered from hyposialia. Thirty-five patients presented oral mucosa lesions. CAOD index was 16.97 ± 7.93 and visual analogue scale for xerostomia was 46.69 ± 14.43. The results of the OHIP-14 questionnaire were 23.13 ± 14.16. Patients with pathological oral signs obtained a significantly higher Oral Health Impact Profile-14 score (P = .03). We also found that patients with peripheral nervous system involvement obtained a significantly higher Oral Health Impact Profile-14 score (P = .001) Conclusions The presence of xerostomia in this cohort of pSS patients was high and hyposialia was present in 61% of the patients. Oral lesions appeared in more than half of the subjects. Oral health had a negative impact on the quality of life of patients with pSS, being higher in those with pathological objective oral signs and in those with peripheral nervous system involvement.

Teniendo en cuenta que la tuberculosis es una meta del tercer Objetivo de Desarrollo Sostenible, se propuso a través de un estudio transversal descriptivo, evaluar el estado del indicador de captación del programa de control de tuberculosis del departamento de Bolívar, se revisaron 334 fichas de notificación de 2016 a 2018, el porcentaje de captación fue menor al 80%, y solo se cumplió la meta de concentración de BK en el año 2017 con un promedio de 2,5%. Se concluye que no existe cumplimiento de la búsqueda de sintomáticos respiratorios, sin embargo, la concentración de baciloscopias reportó en el programa un mantenimiento adecuado.

Objetivo: Determinar el nivel de agotamiento profesional en personal sanitario, posterior al primer año de pandemia por Covid-19 Materiales y Métodos: Estudio observacional, descriptivo, transversal, con muestra de 355 trabajadores de IPS de la ciudad de Cartagena. Se empleó un cuestionario de dos secciones: Aspectos sociodemográficos y laborales (16 ítems) y Maslach Burnout Inventory que determina el síndrome de Burnout a través de las dimensiones de agotamiento emocional, despersonalización y baja realización personal (22 ítems). Se utilizó un análisis descriptivo mediante frecuencias absolutas y porcentajes. El principio ético estuvo regido por la resolución 8430 de 1993 y el Código de Helsinki. Resultados: Predominó el sexo femenino 78,6%, con formación de pregrado 69,9% y más de 10 años de experiencia laboral 25,6%, laboran en IPS de nivel terciario 41,4%, distribuidos en las áreas de urgencias 22,3%, consulta externa 18%, UCI 15,2%, hospitalización 11% y cirugía 5,9%; en contacto con pacientes positivos para SARS-CoV-2 74,6% y que han padecido COVID-19 11,8%. La dimensión de agotamiento obtuvo un puntaje leve 55,2%, igual la despersonalización con 51,5%, mientras que la realización personal fue severa 62,5%. El Burnout global fue severo 62,5%, moderado 35.5% y leve 5%. Conclusión: Fue posible determinar que durante la pandemia de COVID-19 el nivel de agotamiento laboral de un grupo de profesionales sanitario fue severo, afectando la salud de los profesionales y su desempeño frente a la atención prestada, lo que sugiere la realización de intervenciones para promover, restaurar y mantener la salud física y mental de los trabajadores de la salud en tiempos de pandemia.

Background/objectives: Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. Methods: Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. Results: The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p < 0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p < 0.0001), pulmonary hypertension (3.71 [1.84-7.25], p < 0.0002), valvulopathy (6.33 [3.41-11.62], p < 0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p < 0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p = 0.0015). Female sex (0.46 [0.25-0.88], p = 0.0147) and antimalarials (0.28 [0.17-0.45], p < 0.000) proved to be protective factors. Conclusions: Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect. (c) 2021 Published by Elsevier Inc.

Introducción: El Indoor Cycling (IC) ha generado un gran desarrollo en los centros de fitness, debido a lo atrayente, dinámico y beneficioso en la calidad de vida de las personas, contribuyendo a disminuir porcentajes elevados de grasa, reclutamiento de importantes grupos musculares, un bajo impacto osteoarticular y un elevado gasto calórico; en tal sentido, se hace necesario llevar a cabo un programa sistemático de Indoor Cycling, que incida satisfactoriamente en la composición corporal de las personas. Objetivo general: Determinar la incidencia de un programa sistemático de Indoor Cycling en la composición corporal de usuarios del gimnasio Smart Fit, de Tunja, Boyacá. Metodología: La presente investigación está dentro del enfoque cuantitativo, con un diseño metodológico cuasi-experimental. Se aplicó un programa sistemático, cuyo objetivo se centra en el diseño de sesiones de Indoor Cycling de 8 semanas, con una frecuencia de 3 sesiones por semana y participaron 30 afiliados al gimnasio Smart Fit, en Tunja, 10 mujeres y 5 hombres del grupo control y la misma cantidad de sujetos del grupo experimental, con una edad promedio de 33,24 ± 38,47 años, se valoraron a los sujetos objeto de estudio (pre y post) a la aplicación del programa, esto por medio de una báscula de bioimpedancia que permitió registrar la información en una tabla de datos, el % graso, % músculo, % agua, peso e IMC. Resultados: El análisis de los resultados entre los dos grupos con lo que concierne al pre-test y el pos-test, el P-valor de cada una de las variables a contrastar es ˃α 0,05, lo que determina que no alcanza a existir significancia. Conclusión: Según los resultados, el programa de Indoor Cycling no incidió estadísticamente en el análisis del grupo experimental con el grupo control. Introduction: Indoor Cycling (IC) has generated a great development in fitness centres due to the attraction, dynamics and benefits it can have, contributing to reduce high percentages of fat, recruitment of important muscular groups, a low osteoarticular impact and a high caloric expenditure. In this sense, it is necessary to carry out a systematic Indoor Cycling programme that satisfactorily affects the body composition of people. Objective: To determine the incidence of a systematic Indoor Cycling programme on the body composition of users of the Smart Fit gymnasium in Tunja-Boyacá. Methodology: This research is within the quantitative approach, with a quasi-experimental design. A systematic 8 week Indoor Cycling programme was developed, with a frequency of 3 sessions per week and 30 members of the Smart Fit gymnasium, in Tunja participated, they were divided into an experimental group and a control group, with an average age of 33.24 ± 38.47, evaluations were made (pre and post) this by means of a bioimpedance scale that allowed the recording of fat, % muscle, % water, weight and I in a data table. M.C.Results: The analysis of the results between the two groups with regard to the pre-test and post-test, the P-value of each of the variables to be contrasted is ˃α 0.05 which determines that there is no significance. Conclusion: According to the results, the Indoor Cycling programme did not statistically affect the analysis of the experimental group with the control group Incluye referencias bibliográficas

El objetivo de este trabajo de investigación es realizar un análisis descriptivo del tratado de libre comercio (TLC) con Estados Unidos, el cual entró en vigor en el 2012, a partir del comportamiento de los flujos comerciales según su posición arancelaria, sector económico y departamento de origen y destino, entre el 2012 y el 2019. Adicionalmente, se describe el comportamiento comercial entre los principales departamentos identificados y Estados Unidos durante los mismos años. Desde la entrada en vigencia del TLC con Estados Unidos —2012-2019— no se evidencia un cambio representativo de los principales productos comercializados entre los dos países. Las exportaciones han disminuido, posiblemente por la reducción del precio del petróleo en los últimos años, el cual se destaca como el rubro exportador principal, aunque con menor participación que en el 2012, mientras que los sectores manufacturero y agrícola reflejan un aumento en sus exportaciones. En cuanto a las importaciones, estas se caracterizaron por ser manufacturas. Los departamentos más representativos, según el valor de las exportaciones e importaciones con Estados Unidos, son Antioquia, Atlántico, Bogotá, Bolívar, Cundinamarca y Valle del Cauca.

Objectives To determine the frequency of retinochoroidal lesions by ocular toxoplasmosis and their relationships with risk factors, in residents of two districts with high exposure to Toxoplasma, in Armenia-Quindío, Colombia. Methods Cross-sectional analyses of fundoscopy screening, serological tests, and questionnaires were performed to determine risk factors associated with ocular toxoplasmosis retinochoroidal lesions. Differences in proportions were analyzed using the chi-squared test. Results Of 161 individuals examined, 17 (10.5%) exhibited retinochoroidal scars suggestive of old inactive Toxoplasma gondii infection. All 17 individuals were seropositive for T. gondii antibodies. Consumption of bottled water was protective against T. gondii infection among individuals in this study. There were no specific epidemiological risk factors associated with ocular toxoplasmosis retinochoroidal lesions. Conclusion Ocular toxoplasmosis is an important cause of visual impairment in Armenia-Quindío, Colombia. The consumption of boiled or bottled water is a major preventive public health measure to reduce infection by T. gondii and the subsequent onset of OT., Ocular toxoplasmosis, Toxoplasma gondii, Screening, Risk factors, Retinochoroiditis, Colombia

Introduction: Academic stress is a physiological, emotional, cognitive and behavioral response of students to some stressors such as the global COVID-19 pandemic. Objective: To determine the level of stress perceived by nursing students at a Colombian Caribbean university during the mandatory COVID-19 lockdown. Materials and Methods: An analytical study was conducted with 398 nursing students at a Colombian Caribbean university, who completed two instruments, a sociodemographic questionnaire and the Perceived Stress Scale (PSS-10). Results: Average stress rate was 18.83 5.19, indicating a mild level of stress but being lower in older students (30-34 and >=35 years) (P= 0.00). Women had a slightly lower rate of perceived stress compared to men (P=0.04). Students living in rural areas showed to have higher stress levels. Discussion: This study revealed the impact of three months of restrictions during the COVID-19 lockdown in a population of young university students who have interrupted their in-person educational training to online training, causing academic stress in the study population. Conclusion: Younger men showed higher levels of stress compared to women, decreasing as their age increases. Living in rural areas may become a stressor for students. How to cite this article: Muvdi Muvdi Yolanda, Malvaceda Frias Eynick, Barreto Vasquez Marisol, Madero Zambrano Kendy, Mendoza Sanchez Xilene, Bohorquez Moreno Cristina. Estres percibido en estudiantes de enfermeria durante el confinamiento obligatorio por Covid-19. Revista Cuidarte. 2021;12(2):e1330. http://dx.doi.org/10.15649/cuidarte.1330

Rheumatoid arthritis; Spondyloarthritis; Ankylosing spondylitis; Psoriatic arthritis Artritis reumatoide; Espondiloartritis; Espondilitis anquilosante; Artritis psoriásica Artritis reumatoide; Espondiloartritis; Espondiliti anquilosant; Artritis psoriàsica Biologic and targeted synthetic disease-modifying antirheumatic drugs (ts/bDMARDs) play a pivotal role in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Persistence of therapy provides an index of a drug’s overall effectiveness. The objective of the study was to identify factors associated with discontinuation of ts/bDMARDs in a real-world dataset. The study population comprised patients diagnosed with RA, PsA, and AS included in the BIOBADASER registry for whom follow-up data were available until November 2019. Patient features and treatment data were included in the analysis. The Kaplan–Meier method was used to study survival of the different drugs according to the reason for discontinuation. Factors associated with discontinuation were studied using Cox regression models and bivariate and multivariate analyses. P values of less than 0.05 were regarded as statistically significant. The study population comprised 4,752 patients who received a total of 8,377 drugs, of which 4,411 (52.65%) were discontinued. The Kaplan–Meier curves showed that survival for first-line treatment was greater in all 3 groups (p < 0.001). Patients with RA had a greater risk of discontinuation if they were younger (HR, 0.99; 95% CI 0.99–1.00), if they were receiving anti-TNFα agents (HR, 0.61; 95% CI 0.54–0.70), and if they had more comorbid conditions (HR, 1.09; 95% CI 1.00–1.17). Patients with PsA had a higher risk if they were women (HR, 1.36; 95% CI 1.15–1.62) and if they were receiving other ts/bDMARDs (HR, 1.29; 95% CI 1.05–1.59). In patients with AS, risk increased with age (HR, 1.01; 95% CI 1.00–1.02), as did the number of comorbid conditions (HR, 1.27; 95% CI 1.12–1.45). The factors that most affected discontinuation of ts/bDMARDs were line of treatment, age, type of drug, sex, comorbidity and the year of initiation of treatment. The association with these factors differed with each disease, except for first-line treatment, which was associated with a lower risk of discontinuation in all 3 diseases.

Objetivo: Evaluar el riesgo de desarrollar Diabetes Mellitus Tipo 2 (DM2) y sus factores asociados en estudiantes de una institución universitaria de Barranquilla-Colombia. Material y Método: Se realizó un estudio correlacional de corte transversal, en el cual se aplicó el cuestionario Finnish Diabetes Risk Score (FINDRISC) a 362 sujetos para calcular el riesgo de DM2. Se determinó glicemia en ayunas a aquellos que obtuvieron puntuación 712 (riesgo moderado a muy alto de desarrollar DM2) en el cuestionario. Resultados: El 12,4% de los participantes mostraron una puntuación 712. Se encontró asociación estadísticamente signi8cativa entre esta puntuación y factores modi8cables como sedentarismo y sobrepeso/obesidad. Se detectó glicemia en ayunas alterada (100 - 125 mg/dL) en el 26,67% de los sujetos testeados. Conclusiones: Este estudio presenta evidencias sobre el riesgo de DM2 y exposición a factores asociados en un colectivo de adultos mayoritariamente jóvenes. Los resultados sugieren adoptar medidas de prevención de DM2 en el grupo de estudio basadas en cambios de estilos de vida. Objective: To assess the risk of developing Diabetes Mellitus Type 2 (DM2) and its associated factors among students from a university in Barranquilla, Colombia. Materials and Methods: A cross-sectional, correlational study was conducted, in which the Finnish Diabetes Risk Score (FINDRISC) questionnaire was applied to 362 subjects in order to calculate the risk of DM2. Fasting glycemia was determined for those participants who obtained a 712 score (moderate to very high risk of developing DM2) in the questionnaire. Results: 12.4% of participants showed a 712 score. A statistically signi8cant association was found between this score and modi8able factors such as sedentary lifestyle and overweight/obesity. Altered fasting glycemia (100 - 125 mg/dL) was detected in 26.67% of the participants. Conclusions: 9is study provides evidence about the risk of DM2 and exposure to associated factors in a group of mostly young adults. 9e results suggest adopting measures to prevent DM2 in the study group based on lifestyle changes.

Background:Factors associated with the development of chronic heart failure (CHF) in systemic lupus erythematosus (SLE) have received little attention. On the other hand, recent data from the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection during the COVID19 pandemic have cast some doubts on its cardiological safety.Objectives:To identify factors associated to CHF in SLE.Methods:Retrospective cross-sectional study, including all patients with SLE (≥4 ACR-1997 criteria) recruited in RELESSER registry. The objectives and methodology of the registry have been described previously (1). CHF was defined according to the Charlson index item. Patients with CHF before diagnosis of SLE were excluded. Cumulative damage was measured with the SLICC/ACR index, excluding cardiovascular (CV) items (mSDI). Multivariate analysis exploring factors associated with CHF was carried out.Results:117 patients (3% of the entire cohort) with SLE and CHF and 3,506 controls with SLE without CHF were included. 90% were women. Disease duration: mean (SD), 120.2 (87.7) months. CHF appeared after a median (P25-P75) of 9.40 (4.2-18.3) years from SLE diagnosis. Patients with CHF were older (59.8 ± 18.2 vs. 46.2 ± 4.3). In the bivariate analysis, the association of CHF with greater severity [Katz severity index: median (IQR): 4 (3-5) vs. 2 (1-3)], damage [mSDI: 3 (2-4) vs 0 (0-1)], comorbidity [modified Charlson- excluding CV items: 4 (3-6) vs 1(1-3)] and both CV (37.5% vs 6.7%) and overall mortality (43.2% vs 4.7%) (pTable 1.Congestive heart failure associated factors (multivariable analysis)Odds Ratio95% CIP-valueSex (female)0.460.25 - 0.880.0147Ischaemic cardiopathy7.964.01 - 15.48Cardiac arrhythmia7.384.00 - 13.42Pulmonary hypertension3.711.84 - 7.250.0002Cardiac valvulopathy6.333.41 - 11.62Hospitalization (due to SLE)3.741.81 - 8.650.0008Calcium or vitamin D5.292.07 - 16.860.0015Antimalarials0.280.17 - 0.45mSDI *1.291.16 - 1.44*mSDI = modified SLICC/ACR damage index (without cardiovascular items)Conclusion:- CHF is a rather late complication of SLE.- Patients with SLE and CHF have more severe SLE, with greater refractoriness to SLE treatments and higher overall mortality.- Treatment with antimalarials, as routinely used in SLE patients, is not only safe to heart, but even appears to have a cardioprotective effect.References:[1]Rúa-Figueroa I, López-Longo FJ, Calvo-Alén J, et al. National registry of patients with systemic lupus erythematosus of the Spanish Society of Rheumatology: objectives and methodology. Reumatol Clin. 2014;10(1):17-24.Acknowledgements:Research Unit of Spanish Society of RheumatologyDisclosure of Interests:None declared

Objectives: To assess whether age, at the beginning of biologic treatment, is associated with the time a first adverse event (AE) appears in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA). Methods: All patients in the BIOBADASER registry diagnosed with RA, AS, and PsA, and classified as young (< 25 years old), adult (25-64 years old), elderly (65-75 years old) or very elderly (> 75 years old) at start of biological treatment were included. Factors associated with the appearance of a first AE using adjusted incidence rate ratios (IRR) (Poisson regression) were analyzed. Survival to first AE was studied by Kaplan-Meier analysis and hazard ratios (HR) by Cox regression. Results: 2483 patients were included: 1126 RA, 680 PsA, and 677 AS. Age group stratification was as follows: 63 young, 2127 adults, 237 elderly, and 56 very elderly. Regression model revealed an increased probability of suffering a first AE at age 65 years or older [IRR elderly: 1.42 (CI95% 1.13-1.77)]. Other characteristics associated with AE were female gender, the use of DMARDs, including methotrexate, the presence of comorbidities, and the time of disease duration. Factors that had the greatest impact on survival over a first AE were age > 75 years [HR 1.50 (1.01-2.24)] and female gender [HR 1.42 (1.22-1.64)]. Conclusion: Age at the start of treatment and female gender are key factors associated with the appearance of a first AE with biologics. Other factors related to patient status and treatment were also associated with a first AE in rheumatic patients treated with biologics., BIOBADASER is supported by the Spanish Agency for Medicine and Health Products (AEMPS), Biogen, Bristol-Myers Squibb (BMS), Celltrion Healthcare, Lilly, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, and Samsung Bioepis.

Introducción: la Jatropha gossypifolia es una planta tradicionalmente utilizada como agente antidiabético e hipolipemiante. Por tanto, es importante evaluar la actividad antioxidante e inhibidora de la enzima HMG CoA reductasa, para validar su uso tradicional. Objetivo: determinar la actividad inhibidora in vitro de la enzima reductasa HMG- CoA y la actividad antioxidante del extracto metanólico de Jatropha gossypifolia. Metodología: se evaluó la inhibición de la 3-hidroxi-3-metilglutaril-coenzima A reductasa (HMG-CoA) usando el kit de ensayo HMG-CoA reductasa (HMGR) de sigma Aldrich, la actividad antioxidante se realizó mediante la inhibición de hemólisis de los glóbulos rojos expuestos a H2O2. Los resultados se analizaron mediante análisis de varianza, aceptando significancia estadística con p

This study aimed at determining socio-demographic and clinical factors of primary Sjögren syndrome (pSS) associated with osteoporosis (OP) and fragility fracture. SJOGRENSER is a cross-sectional study of patients with pSS, classified according to American European consensus criteria developed in 33 Spanish rheumatology departments. Epidemiological, clinical, serological and treatment data were collected and a descriptive analysis was conducted. Bivariate and multivariate analyses were performed using a binomial logistic regression to study the factors associated with OP and fragility fracture in pSS. 437 patients were included (95% women, with a median age of 58.6 years). 300 women were menopausal (76.4%). Prevalence of OP was 18.5% [in men (N = 21) this measured 19%]. A total of 37 fragility fractures were recorded. In the multivariate analysis, there was an association between OP and age: in the 51-64 age range (menopausal women), the OR measured 9.993 (95% CI 2301-43,399, p = 0.002); In the age 64 years group, OR was 20.610 (4.679-90.774, p 0.001); between OP and disease duration, OR was 1.046 (1.008-1085, p = 0.017); past treatment with corticosteroids, OR 2.548 (1.271-5.105, p = 0.008). Similarly, an association was found between fragility fractures and age: in the 51-64 age group, OR measured 5.068 (1.117-22,995, p = 0.035), age 64 years, OR was 7.674 (1.675-35,151, p 0.009); disease duration, OR 1.049 (CI 1.003-1097, p 0.036) and the ESSDAI index, OR 1.080 (1.029-1134, p = 0.002). Patients with pSS can develop osteoporosis and fragility fractures over the course of the disease. Age, corticosteroids treatment and disease duration were associated with the development of OP. Disease duration and ESSDAI were associated with the development of fractures in patients with pSS.

Objetivo: determinar la calidad de vida y la sobrecarga percibida por el cuidador familiar del paciente con insuficiencia renal crónica en Cartagena. Materiales y métodos: estudio descriptivo participaron 135 cuidadores familiares de pacientes con IRC que están en proceso de hemodiálisis y diálisis peritoneal en Cartagena, para evaluar la calidad de vida se aplicó la escala: medición de la calidad de vida de un miembro familiar que brinda cuidados a una persona, instrumento propuesto por Ferrel y cols (1997) y la escala de sobrecarga del cuidador de Zarit. Se analizaron los datos en el paquete estadístico SPSS versión 22®. Los cuales se expresaron en promedios, frecuencias absolutas y relativas. Resultados: la mayoría de los participantes fueron mujeres, que dedican de 7 a 12 horas al cuidado del paciente y llevan más de 37 meses como cuidador. En los cuidadores los bienestares físico, social y espiritual presentaron baja alteración, con medias de 8,4, 14,8 y 16,1 respectivamente, la media del bienestar psicológico estuvo en 28,1, con una desviación estándar de 6,1 indicando una percepción negativa, lo que sugiere una alta afectación. En lo que concierne a la sobrecarga, el 39,3% de los cuidadores manifestó tener una sobre carga ligera y el 25,2% sobrecarga intensa. Conclusión: se identificaron cuidadores con alta afectación del bienestar psicológico y baja afectación de los bienestares físico, social y espiritual, elementos indispensables para el desarrollo del individuo. Percibieron presencia de ligera sobrecarga ante la experiencia de cuidar.

El presente informe de investigacion da a conocer la pertinencia de las asignaturas virtuales y sus procesos de transformacion en los programas presenciales de la Universidad Manuela Beltran (UMB), desde el punto de vista de las percepciones de los estudiantes. La informacion se recolecta por medio de una encuesta en linea que permite diferenciar algunas variables inmersas en el proceso ensenanza-aprendizaje, valoradas bajo una escala de Likert. Estas variables miden el grado de satisfaccion que manifiestan los estudiantes frente a la interaccion en el aula virtual, teniendo en cuenta elementos del modelo pedagogico de la Universidad, tales como: materiales, recursos, contenidos, el rol del docente, estrategias pedagogicas y didacticas empleadas en los cursos. Su analisis se hace bajo un diseno cuantitativo centrado en identificar la correlacion y la correspondencia entre las variables involucradas y de esta manera determinar su incidencia en la satisfaccion de los estudiantes. Se inicia con un analisis descriptivo que arroja resultados que refuerzan lo encontrado en el diseno estadistico a partir de los cuales se proponen estrategias para cualificar el modelo b-learning propuesto, comenzar su rediseno, busqueda de recursos y materiales, fortalecimiento de las estrategias pedagogicas, la cualificacion y formacion de los docentes. PALABRAS CLAVE . E-learning; modalidad presencial; satisfaccion del estudiante. Doi:10.21703/rexe.Especial3_2018911018

Objetivo: determinar la práctica adecuada del autoexamen de mama en estudiantes de enfermería de Cartagena. Materiales y métodos: estudio descriptivo, que incluyó 388 estudiantes de los tres programas de Enfermería de la ciudad, seleccionados mediante un muestreo estratificado con afijación proporcional, según semestre y universidad. Fueron medidas variables sociodemográficas y la práctica del autoexamen según lo establecido en la norma técnica nacional colombiana. Resultados: El promedio de edad de las participantes fue de 22,8 años (DE=3, 7). El 75,8% (294) práctica el autoexamen de mama, de éstas el 85% (250) lo realiza con una frecuencia mensual, 17,7% (52) realiza la práctica entre el cuarto y décimo día desde el primer día de la menstruación, el 83% (244) se palpa. Solo 2% (6) de ellas, reúne todas las características de una práctica adecuada del autoexamen de mama. Conclusiones: Pese a su formación las estudiantes de enfermería de Cartagena, tienen una práctica inadecuada del autoexamen de mama, lo que puede generar mayores riesgos para la salud y reduce la posibilidad de la detección precoz de una patología mamaria.

Background:Primary fibromyalgia syndrome is a prevalent rheumatic condition characterized by widespread pain and whose etiopathogenesis is not well understood. Fibromyalgia can also be secondary to other rheumatic diseases like Sjogren’s syndrome; however, its relation to this disease is unknown. It has been suggested that the immune system is involved in their pathogenesis. The role of activation stages and cytokines profiles of CD4+T lymphocytes in fibromyalgia or fibromyalgia secondary to Sjogren´s syndrome are completely unclear and could play a key role in the pathophysiology of these diseases.Objectives:The objective of this study is to investigate the counts and distribution of the CD4+T lymphocyte activation subsets and their pattern of cytokine production in women with primary fibromyalgia, fibromyalgia secondary to Sjogren´s, Sjogren´s syndrome and healthy controls (HC). The counts and distribution of naïve (TN), central memory (TCM), effector memory (TEM) and effector (TE) CD4+T lymphocyte subsets were analyzed in these diseases. Furthermore, we investigated their pattern of IL-4, IL-10, IL-17A, IFNγ, and TNFα production.Methods:Counts and distribution of CD4+T subsets (TN, TCM, TEM, TE)and their cytokine producing capacity were measured using multiparametric flow cytometry in peripheral blood mononuclear cells (PBMC) from 20 primary fibromyalgia, 15 fibromyalgia associated to Sjögren and 15 primary Sjögren patients and 15 female controls. Fibromyalgia and/or Sjögren’s syndrome were diagnosed based on ACR criteria. CD4+T cell activation stages were analyzed by the expression of the CD3, CD4, CD45RA, CD27 and CCR7 antigens. Cytokine CD4+T producing cells subsets were assayed stimulating PBMC during 6 hours, fixed, permeabilized and simultaneously stained with IL-4, IL-10, IL-17A, IFNγ, and TNFα intracellular cytokines.Results:Fibromyalgia patients showed a significant increase in the CD4+T, TNand TCMcells counts with compared to fibromyalgia secondary to Sjogren, Sjogren´s syndrome and HC. The counts of IL-17A, IL-4 and IFNγ producing CD4+T cells were increased in fibromyalgia patients with respect to HC. However, only IL17A and IFNγ, but not IL-4 producing CD4+T lymphocytes were increased with respect fibromyalgia secondary to Sjogren. These alterations were due to an increment of TEMIL-17A, TCMand TEMIL-4 and TNTCMand TEMIFNγ producing CD4+T cell subsets in fibromyalgia patients. Furthermore, IFNγ producing CD4+T cells were decreased in fibromyalgia secondary to Sjogren´s with respect to fibromyalgia patients and HC. Counts of TNTNFα producing CD4+ T cells were increased in fibromyalgia with respect fibromyalgia secondary to Sjogren. IL-10 producing CD4+T cells were normal in fibromyalgia but decreased in fibromyalgia secondary to Sjogren.Conclusion:Fibromyalgia patients show an abnormal circulating activation stages of CD4+T cells, as well as, express unusual elevated counts of CD4+T cells producing IL-17A, IL-4 and IFNγ. These alterations could differentiate two different pathologic and inflammatory behaviors of the T cell compartment between fibromyalgia and fibromyalgia secondary to Sjogren patients.References:[1]T helper 1 response is correlated with widespread pain, fatigue, sleeping disorders and the quality of life in patients with fibromyalgia.. Guggino G et al, Clin Exp Rheumatol. 2019.[2]A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sjögren’s Syndrome. Bucourt E et al, Pain Med. 2019Disclosure of Interests:None declared

Patients with long-term, treated, rheumatoid arthritis (RA) show abnormalities in their circulating CD4+ T-lymphocytes, but whether this occurs in recently diagnosed na&iuml, ve patients to disease-modifying drugs (DMARDs) is under discussion. These patients show heterogeneous clinical response to methotrexate (MTX) treatment. We have examined the count of circulating CD4+ T-lymphocytes, and their na&iuml, ve (TN), central memory (TCM), effector memory (TEM) and effector (TE) subsets, CD28 expression and V&beta, TCR repertoire distribution by polychromatic flow cytometry in a population of 68 DMARD-na&iuml, ve recently diagnosed RA patients, before and after 3 and 6 months of MTX treatment. At pre-treatment baseline, patients showed an expansion of the counts of CD4+ TN, TEM, TE and TCM lymphocyte subsets, and of total CD4+CD28&minus, cells and of the TE subset with a different pattern of numbers in MTX responder and non-responders. The expansion of CD4+TEM lymphocytes showed a predictive value of MTX non-response. MTX treatment was associated to different modifications in the counts of the CD4+ subsets and of the V&beta, TCR repertoire family distribution and in the level of CD28 expression in responders and non-responders. In conclusion, the disturbance of CD4+ lymphocytes is already found in DMARD-na&iuml, ve RA patients with different patterns of alterations in MTX responders and non-responders.

Background The advent of biologic therapy (BT) in ankylosing spondylitis (AS) has substantially benefited patients with inadequate response to conventional therapy. However, it is known patients with inadequeate response to a 1st BT have worse response to 2nd and further lines. Objectives To analyze the effectiveness of BT in biologic-naive and biologic-experienced real-world AS patients, measuring response through change in activity indexes (ASDAS-CRP and BASDAI) and percentage of low activity and inactive disease at 12 months. Methods Data were obtained from BIOBADASER III, an ongoing observational longitudinal multicenter cohort of patients with rheumatic diseases treated with BT or targeted synthetic DMARDs. Patients were divided into 2 groups, according to their state before entering the study: BT-naive (BTn) receiving their 1st BT, and BT-experienced (BTe) receiving their 2nd or further BT; regardless of the specific drug they received. Disease activity indexes (DAI) were collected at baseline and after 12 months of BT; mean and SD was calculated for each group and interpreted according to ASDAS disease activity states and, since not established, analogous categories previously used for BASDAI ( Results 846 patients, (29.3% women, mean age 47.6 years) were included, 422 BTn and 424 BTe. Mean DAI results (table 1): at baseline, AS had high disease activity by BASDAI (>4) and ASDAS (>2.1 to 1.3 to Conclusion The mean disease activity on patients starting biologic therapy is high. A clinically important improvement is met after 12 months of therapy, irrespectively of the index used or the prior use of biologics. The delta in DAI is bigger in the biologic-naive group who receive the 1st BT. The biologic-naive group also reaches a higher percentage of low disease activity and inactive disease. Further analysis is needed to see if these tendencies remain after separating the groups per type of biologic drug. References [1] Ramiro S, et al. Ann Rheum Dis2014;73:1455-61. [2] Kviatkovsky MJ, et al. J Rheumatol2016;43:1680-6. Acknowledgement We thank the BIOBADASER group Disclosure of Interests None declared

Background: Systemic Sclerosis is a multisystem autoimmune disease characterized by fibrosis of the skin and internal organs and vascular damage. The diagnosis is usually made in the late stages, when irreversible damage has already occured. Recently, we have established new criteria to detect early cases of the disease. Performing capillaroscopy and its findings are crucial in the diagnosis of early systemic Sclerosis or “prescleroderma” and there may be changes seen in capillaries of patients without skin manifestations. Objectives: To analyze the nailfold capillaroscopy findings in patients with anti-centromere or anti-topoisomerase antibodies and evaluate their usefulness for the diagnosis of systemic sclerosis. Methods: Of a total of 255 capillaroscopy performed in our Rheumatology department, those patients with positive anti-centromere or anti-topoisomerase were selected. In all cases, capillaroscopy was performed in eight fingers, always by the same observer. The following findings were considered pathological or scleroderma pattern: Local or global capillary loss (> 20%), hemorrhages: two or more in at least two fingers and enlarged capillaries: two or more capillary with double or more caliber in at least two different fingers. Statistical analysis was performed with SPSS 19.0 program. Results: The study included 69 patients: 5 (7.2%) males and 64 (92.8%) women, 14 (20.3%) smokers, 47 (68.1%) non-smokers and 8 (11.6%) quitters. The characteristics of the patients included in the study were as follows: 20 patients (30%) were previously diagnosed of systemic sclerosis (19 limited and one diffuse), of which 4 patients had concomitant primary biliary cirrhosis Syndrome (Reynolds), 1 patient with primary biliary cirrhosis and positive anti-centomere without the presence of Raynaud, one patient diagnosed with Sjogren’s syndrome with positive anti-centromere without presence of Raynaud, 26 patients with suspected early systemic sclerosis and 21 patients with disease-specific autoantibodies in the absence of Raynaud. Nailfold capillaroscopy was normal in 32 patients (46.4%) and pathological (scleroderma pattern) in 37 patients (53.6%); we detected limited enlarged capillaries in 26.2%, generalized enlarged capillaries also in 26.2%, giant capillaries in 37.7%, local loss of capillaries in 27.9%, global loss of capillaries in 8.2%, hemorragies in small claims in 29.5% and abundant hemorrhagies in 9.8%. All patients previously diagnosed of systemic sclerosis had a pathological capillaroscopy except one. However, no changes were observed in capillaroscopy in patients who had only disease-specific autoantibodies in the absence of Raynaud’s phenomenon. While, the 26 patients who were referred for suspected systemic sclerosis (at least with the presence of Raynaud and autoantibodies) in 18 (69.9%) of these scleroderma pattern was observed with subsequent diagnosis of early systemic sclerosis or “prescleroderma”. Conclusion: Nailfod capillaroscopy is a useful and inexpensive tool for the diagnosis of systemic sclerosis. The scleroderma pattern is very specific of this disease and we can make an early diagnosis even in patients who only have autoantibodies and Raynaud’s phenomenon, without the presence of other severe manifestations. We have also observed that the absence of Raynaud’s phenomenon is associated with a normal result on capillaroscopy. Reference [1] Nailfold digital capillaroscopic findings in patients with diffuse and limited cutaneous systemic sclerosis. Saeedeh Shenavandeh, Mahyar Yousefipour Haghighi, Mohammad Ali Nazarinia. Reumatologia 2017; 55, 1: 15–23 Disclosure of Interests: None declared

Background Primary Sjogren’s syndrome (pSS) is a systemic autoimmune disease characterized by the involvement of the exocrine glands, mainly salivary and lacrimal glands. Approximately half of patients will experience extraglandular complications throughout their evolution. Objectives To characterize the involvement of the nervous system (NS) in patients with pSS. Methods Multicenter cross-sectional study of a cohort of patients with pSS, constructed by random selection of pSS patients fulfilling the 2002 American-European Consensus Criteria for pSS1 from 33 rheumatology units. Through review of clinical records and interview with patients, demographic, clinical, analytical, therapeutic data and disease activity indexes were collected. Univariate analysis was done by Chi square test, Mann-Whitney U test and Student’s t test. Multivariate analysis was done by linear logistic regression. A p Results 437 patients were included (95% women, median age of 58 years). 65 patients developed NS involvement: 26 patients central NS, 31 peripheral NS and 8 both. Multivariate analysis showed association between NS involvement and atherosclerotic stroke (OR 10.4, 95% CI 2.8-38.5), ear disease (OR 2.1, 95% CI 1.1-4.2) and myopathy (OR 6.5, 95% CI 1.3-31,6). Patients with NS involvement had higher probability of being treated with glucocorticoids (OR 3.3, 95%CI 1.5-7.2) and cyclophosphamide (OR 6.8, 95% CI 1.5-31). Conclusion 15% of patients with pSS develope NS involvement that is associated with atherosclerotic stroke, ear disease and myopathy. Reference [1] Vitali C. et al. Ann Rheum Dis 2002; 61:554 Disclosure of Interests Jose Luis Andreu: None declared, Carlos Sanchez-Piedra: None declared, Monica Fernandez Castro: None declared, Victor Martinez Taboada: None declared, Alejandro Olive: None declared, Jose Rosas Consultant for: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Speakers bureau: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Raul Menor-Almagro: None declared, Beatriz Rodriguez Lozano: None declared, Angel Garcia-Aparicio: None declared, Francisco J Lopez-Longo: None declared, Sara Manrique Arija Speakers bureau: ABBvie, MSD, Janssen, Lillly, Roche, Pfyzer, Novartis., Jesus ALberto Garcia Vadillo: None declared, Susana Gil: None declared, Ruth Lopez Gonzalez: None declared, J. Narvaez Consultant for: Bristol-Myers Squibb, Carles Galisteo: None declared, Jorge Juan Gonzalez Martin: None declared, M E Ruiz: None declared, Inigo Rua-Figueroa: None declared, Oscar Illera: None declared, Lurdes Romani: None declared, Sheila Melchor: None declared, Begona Moreira: None declared, Enrique Raya: None declared, Jose M Pego-Reigosa: None declared, Natalia Cid Boza: None declared, Enrique Judez: None declared, Clara Moriano: None declared, Vicente Torrente: None declared, Hector Corominas: None declared, Blanca Garcia-Magallon: None declared, Carlos Guillen-Astete: None declared, Ivan Castellvi Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Cristina Bohorquez: None declared, Javier Loricera: None declared, Joaquin Belzunegui: None declared

Background Pathophysiology of primary Sjogren syndrome (SSp) is characterized by oligoclonal B-cell proliferation and ectopic lymphoid tissue formation. The association between ultrasound glandular parenchyma heterogeneity and hyperproduction of autoantibodies, which in turn represents characteristic B-cell hyperactivity of SSp, is described. Objectives To study the association between major salivary gland ultrasound (MSGUS) and their respective pathological grades with the analytical and serological data, and activity indexes obtained in patients with suspected SSp. Methods 72 patients were recruited consecutively with clinical and/or analytical suspicion of SSp from the Rheumatology outpatient consultations at the Principe de Asturias Hospital (2015-2018). Demographic, serological and validated activity indexes, ESSPRI and ESDAI, were collected. All of them underwent a MSGUS and their results were classified in three grades according to the Cornec et al system: normal (grade 0 and 1), mild (grade 2) and moderate-severe (grades 3 and 4). The final SSp diagnosis was made using both 2002 AECG and 2016 ACR/EULAR classification criteria. Data were analyzed using the software STATA. Association between MSGUS and qualitative variables was described according to the number of cases and the percentage by grades of MSGUS; the significance of the associations was tested with the Chi square test. As for the quantitative variables, the association was described with median and interval interquartile (IIQ) by grades of MSGUS and the significance of the association was verified with the non-parametric test of Kruskall-Wallis. Results From patients with pathological MSGUS: 51% had antiRo52, 51% antiRo60 and 36% anti-La positive; 62% hypergammaglobulinemia, 40% positive rheumatoid factor (RF), 6% and 13% C3 and C4 hypocomplementemia, respectively. Mean values were obtained: ESR 36, CRP 1.6, RF 12, ESSPRI 5.6 and ESSDAI 2. Statistically significant differences (p 0.150 in all associations explored). No differences have been found for RF, C3 and C4 hypocomplementemia, ESR, CRP and ESSDAI variables (table1). Conclusion In this series of patients, a statistically significant association was found between the positivity of anti-Ro antibodies, hypergammaglobulinemia and MSGUS, as well as its subdivision by pathological grades. No statistical significant association was found between MSGUS and positivity of antiRo60 and antiLa antibodies and ESSPRI, probably due to the small sample size. There were no differences for the rest of the variables analyzed (RF, complement, acute phase reactants and ESSDAI). References [1] Ultrasonography of salivary glands-a highly specific imaging procedure for diagnosis of Sjogren’s syndrome Dirk Wernicke J Rheumatol. 2008Feb;35(2):285-93. Epub 2008 Jan 15 [2] .The usefulness of ultrasound in the diagnostics of Sjogren’s syndrome. Fadhil Saied J Ultrason. 2013 Jun;13(53):202-11. Disclosure of Interests None declared

Objectives: To estimate the incidence of cancer in systemic lupus erythematosus (SLE) patients and to analyze factors associated with cancer differentiating between hormone-sensitive (HS) and non-HS cancers. Methods: Multicenter retrospective study of a cohort of patients included in Spanish Society of Rheumatology Lupus Registry (RELESSER). The first cancer after the diagnosis of SLE, sociodemographic, clinical, activity, cumulative damage, severity, comorbidity, treatments, and refractory disease data were collected. Cancers were classified into HS (prostate, breast, endometrial and ovarian) and non-HS (the rest). Standardized incidence ratio (SIR) was calculated and logistics regression models were constructed to identify factors associated with cancer. Results: We included 3539 patients (90.4% women) with SLE (ACR-97 criteria), of whom 154 had cancer (91% women), and 44 were HS (100% women). The SIR for cancer was 1.37 (95% CI: 1.15-1.59), reaching higher values in women under 65 years [2.38 (95% CI: 1.84-2.91)]. The SIR in women with cancer HS vs. non-HS was 1.02 (95% CI: 0.13-1.91) and 1.93 (95% CI: 0.98-2.89)], respectively. In HS vs. non-HS cancers, age at diagnosis of SLE [Odds ratio (OR) 1.04 (p = 0.002) vs. 1.04 (p = 0.019), respectively] and the evolution time [OR 1.01 (p Conclusion: The incidence of cancer in patients with SLE is increased compared to the Spanish population, specially in younger women. This increase might be due to non-HS cancers. SLE with more cumulative damage and more prescription of ACE inhibitors might associate with non-HS cancers. Disclosure of Interests: Tatiana Cobo-Ibanez: None declared, ANA URRUTICOECHEA-ARANA: None declared, Inigo Rua-Figueroa: None declared, Maria Auxiliadora Martin-Martinez: None declared, Juan Ovalles: None declared, Maria Galindo-Izquierdo: None declared, Jaime Calvo-Alen: None declared, Alejandro Olive: None declared, Antonio Fernandez-Nebro: None declared, Raul Menor-Almagro: None declared, Eva Tomero Muriel: None declared, Loreto Horcada: None declared, Esther Uriarte Isacelaya: None declared, Victor Martinez Taboada: None declared, Jose Luis Andreu: None declared, Alina Boteanu: None declared, J. Narvaez Consultant for: Bristol-Myers Squibb, Cristina Bohorquez: None declared, Carlos A. Montilla-Morales: None declared, Gregorio Santos Soler: None declared, Blanca Hernandez-Cruz: None declared, Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Eva Salgado Perez: None declared, Mercedes Freire Gonzalez: None declared, Jose A Hernandez Beriain: None declared, Elvira Diez Alvarez: None declared, Lorena Exposito: None declared, Olaia Fernandez- Berrizbeitia: None declared, Jose Luis Marenco Speakers bureau: abbie, pfizer, novartis, janmsen, Jose M Pego-Reigosa: None declared

Objectives. This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods. RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results. Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion. Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies., The RELESSER Registry was partially funded by GlaxoSmithKline (GSK), Roche, Union Chimique Belge (UCB), Lilly and Novartis. The sponsors had no role in the study design, data collection, analysis or interpretation, in writing the report, or in the decision to submit the article for publication. J.M.P.-R. is supported by grant 316265 (BIOCAPS) from the European Union 7th Framework Program (FP7/REGPOT-2012-2013.1). The study was supported by FIS Grant PI11/02857 (Instituto Carlos III, Fondos FEDER). Grant for medical researchers of the 'Fundacion Espanola de Reumatologia'.

Background: Nailfold capillaroscopy (CP) is a simple, safe, low cost and non-invasive screenig test and together with the study of autoantibodies, is useful in the diagnosis of systemic sclerosis (SSc). It demonstrates certain specific patterns which are characterized by the presence of dilated capillaries, haemorrhages and avascular areas. Other systemic autoimmune diseases (SAD) do not have a specific pattern, but certain alterations in the morphology of the capillaries such as increased tortuosity have been described in SLE. In other diseases such as mixed connective tissue disease (MCTD), inflammatory myopathies and overlap syndromes, findings may be different to the pathological findings consistent with scleroderma pattern. Objectives: Description of nailfold capillaroscopic findings in different SAD. Methods: The study included 255 patients referred for CP that was performed in 8 fingers, and always by the same observer. The following findings were considered as “scleroderma pattern”: Local or global capillary loss (> 20%), haemorrhages: two or more in at least two fingers and enlarged capillaries: two or more capillary with double caliber or more in at least two different fingers. Abundant evidence of tortuosity (> 20%) as ringlets tangles and no evidence of disorders described above, was considered nonspecific, tortuous pattern or suspects SAD. Statistical analysis was performed with SPSS 19.0 program. Results: CP was performed in 255 patients, 31 males (12%) and 224 (88%) women. 23 patients (9%) had a diagnosis of SSc, 6 patients (2%) of SLE, other 6 (2%) of Sjogren’s syndrome, 7 (3%) of MCTD, 4 (1.5%) of inflammatory myopathy and 2 (0.8%) of overlap syndrome. 18 patients (7%) had positive aNA and Raynaud without another data suggestive of SAD, 76 patinents with primary Raynaud (30%) and 66 patients (26%) with a miscellany of other diseases such as antiphospholipid syndrome, vasculitis, fibromyalgia and psoriatic arthritis. Also, 29 patients (12.4%) were sent for performing CP for suspected systemic sclerosis and 16 patients (6.3%) presented with only positive anti-centromere. CP was normal in 191 patients, while in 45 patients scleroderma pattern was observed and in 19 patients nonspecific pattern suggestive of SAD was seen. Capillaroscopic findings: in each of the 23 patients diagnosed with SSc, 21 patients had scleroderma pattern. Of the 6 patients with SLE, CP was normal in 4 patients, while one patient had abundant tortuosity. Likewise, the 6 patients with Sjogren’s syndrome, only one patient had a nonspecific pattern suggestive of SAD. Of the 7 patients with MCTD, four had normal CP, two had a scleroderma pattern and one had tortuous pattern. The 2 patients with overlap (myopathy-scleroderma and Lupus-scleroderma) both had a pathological CP with scleroderma pattern. Conclusion: Our study demonstrates that the evidence of scleroderma pattern is very specific of SSc. However, in certain diseases such as MCTD, overlap syndromes and inflammatory myopathies, we can also see this pattern. In other SAD, CP is usually normal or may show some nonspecific changes. References: The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Practice & Research Clinical Rheumatology Vol. 21, No. 6, pp. 1093–1108, 2007 Disclosure of interests: None declared

Background Minor salivary gland biopsy (MSGB) is the gold-standard technique for primary Sjogren Syndrome (SSp) but nowadays the use of mayor salivary gland ultrasonography (MSGUS) is increasing because it is a fast and non-invasive technique and with no adverse events for the patient. Objectives To assess the utility of MSGUS as a diagnostic tool for SSp and to study the concordance with MSGB. Methods 72 patients were recruited consecutively with clinical and/or analytical suspicion of SSp, from the Rheumatology outpatient consultations at the Principe de Asturias Hospital (2015-2018). Demographics, clinical and serological data and validated activity indexes, ESSPRI and ESSDAI, were recorded. All patients underwent a MSGB and blindly, both for clinical and histological results, a MSGUS. The histological results were classified according to Chisholm and Mason scores (pathological grades 3/4), and the US results according to the system by Cornec et al. (pathological grade ≥2). The final SSp diagnosis was made using both the 2002 and the 2016 ACR/EULAR classification criteria. The data was analyzed using the software STATA. The validity of the US and the MSGB to diagnose SSp according to the 2002 and 2016 ACR/EULAR classification criteria was evaluated by calculating the percentage of agreement between the tests, along with the specificity (Sp), sensitivity (S), positive and negative predictive values (PPV and NPV) and area under the curve (AUC). Results Descriptive analysis of the main variables is shown in Table 1. Using the MSGB as a gold-standard, the total% of agreement was 78% with a good AUC (0.75) (IC95%0.65-0.84). Using the 2002 classification criteria as a gold-standard, the total% of agreement was 82% for US and 79% for MSGB with an AUC of 0.78 (IC95%0.67-0.88) and 0.80 (IC95%0.70-0.89) respectively. In this case, US had a S of 93% (IC95%0.82-0.99) and a Sp of 62% (IC95%0.41-0.80) whereas MSGB had a S of 78% (IC95%0.64-0.89) and a Sp of 81% (IC95%0.61-0.93). Similar results were obtained using ACR/EULAR criteria: US% of agreement 83%, AUC 0.78 (IC95%0.67-0.90), S 90% (IC95%0.79-0.97) and Sp 67% (IC95%0.43-0.85); while MSGB% agreement 81%, AUC 0.83 (IC95%0.75-0.92), S 76% (IC95%0.63-0.87) and Sp 90% (IC95%0.70-0.99). In addition, 9 patients who fullfilled the 2002 classification criteria with a negative histological result had a pathological US. Conclusion MSGUS has a similar diagnostic value compared to MSGB in patients with SSp, which could be part of the classification criteria used to date. In this series of patients and compared to MSGB, it has a higher sensitivity and a lower specificity, so it could be used as an initial diagnostic method in patients with high suspicion of disease, leaving the MSGB for those cases in which US and other clinical and serological data are inconclusive. With this approach, the disadvantages derived from an invasive technique such as MSGB would be avoided. References [1] Zhou M. Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjogren’s syndrome: a systematic review and meta-analysis. Sci Rep. 2018 Nov 20;8(1):17128. [2] Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjogren’s syndrome Esther MosselMossel E, et al. Ann Rheum Dis 2017. Disclosure of Interests None declared

Objective: to determinate the use of antenatal care in pregnant women of the delegation Iztapalapa in the Federal District of Mexico. Materials and methods: sudy descriptive, retrospective (December 2014 to April of 2015), in the delegation of Iztapalapa of the District Federal of Mexico, it shows was constituted by 135 women. To collect the information is used a survey to data socio-demographic and characterization family based in the ENSANUT. Also used the instrument of assessment of family functionality (APGAR family) and satisfaction with the services. Data were coded in an array of data in the Microsoft Excel program and its analysis was performed by descriptive statistics using the statistical software SPSS version 23. Results: were included in the study, 135 women pregnant women, with an average age of 26,7 years, prenatal median was 5, the main reason to attend is the detecting early alterations, also they are satisfied with the care provided by health personnel and they have adequate family support. Conclusions: the use of the control prenatal is greater among primiparous women, that living nuclear families and that perceived their families as functional.