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Patients with rheumatic diseases (RD) have a higher risk of morbidity and mortality from vaccine-preventable infections attributed to disease activity, comorbidities, immunosuppressive therapy, and other factors. Vaccines are one of the safest and most effective public health interventions. The aim of this study was to investigate knowledge and attitudes about influenza vaccination as factors influencing vaccine uptake and hesitancy in a population with RD. A descriptive cross-sectional study was designed. A self-administered questionnaire surveyed age, RD diagnosis, ten questions about the uptake, safety and efficacy of influenza vaccine, knowledge of cost-free availability, and the relationship between influenza vaccination and RD. A total of 223 questionnaires were filled; 79.8% of patients were vaccinated for influenza at least once. Uptake by diagnosis was 80.3% in rheumatoid arthritis, 76.2% in osteoarthritis, 86.7% in lupus, 73.9% in other auto-immune diseases (AID), and 60% in other non-AID; 83.9% of patients considered influenza vaccine as safe and effective. From those who had never been vaccinated, 26.7% of patients did not consider influenza vaccine safe and effective vs. 13.5% among patients who had been vaccinated (P = .032). Only 7.6% considered that RD patients could not be vaccinated; 11.7% thought that influenza vaccine would worsen their RD symptoms. This study showed that concerns about safety, efficacy, side effects, fear of the vaccine, and knowledge of cost diminished vaccine uptake. These are factors related to confidence, complacency, and convenience as components of vaccine hesitancy that affect influenza vaccination in RD patients.

Objectives We aimed to determine the prevalence of anti-carbamylated protein (anti-CarP) antibodies in Mexican Hispanics with established rheumatoid arthritis (RA) and to assess their relationship with disease activity. Methods A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up. Results Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months. Conclusion Anti-CarP IgG antibodies are not associated to a higher disease activity in Hispanic patients with established RA. Our findings suggest that the clinical value of measuring anti-CarP antibodies in RA diminishes over time.

Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by multi-organ symptomatology. 16% of the patients with autoimmune thrombocytopenia have SLE and are associated with high mortality. Intravenous methylprednisolone or high-dose steroids are the first-line treatments in those patients who experienced life-threatening bleeding or have a severely low platelet count, whereas a second line includes splenectomy, as well as other immunosuppressive agents as monotherapy or combined therapy, including azathioprine, cyclophosphamide, cyclosporine, and mycophenolate mofetil. However, response rates of these therapies vary considerably. Rituximab (RTX) became a useful tool in the treatment of autoimmune diseases, due to the decrease of autoantibodies production. In addition, there is evidence that low doses of RTX (100 mg IV per week for 4 weeks) can have a similar effect compared to the standard dose. The objective of this study was to describe the response to low doses of RTX in patients with lupus-induced thrombocytopenia. We present a report of four female patients with newly diagnosed SLE, accompanied by purpuric syndrome and severe thrombocytopenia ( 30 × 109/L) as the clinical debut that was refractory to glucocorticoids (GC) therapy and treated with low doses of RTX. By week 5, complete response ( 100 × 109/L) was achieved in two patients, partial response ( 50 × 109/L) in 1 patient, and no response in one patient. There is little information on the treatment of SLE-associated autoimmune thrombocytopenia. The most extensive study found at the time of our search was the study of 10 Asian patients. They found that 80% of the patients responded by week four and maintained until week 24 of follow-up. At week 36, a follow-up for two patients showed relapse; this occurred on patients with the most disease duration ( 5 years) and was associated with a lower response rate. In contrast, our study with four patients found that half of them presented a complete response: one patient added concomitant therapy with azathioprine (AZA) and another patient without the concomitant therapy. A third patient with a partial improvement, this was seen by week five of treatment. Moreover, a fourth patient who did not have a response by week five of treatment presented a clinical response in subsequent appointments with a count of 100 at week 24. Those patients who required concomitant use of AZA were patients who had positive antiphospholipid serology. The use of low-dose RTX for the management of severe thrombocytopenia refractory to GC in patients with SLE has a good response. It could be a safe, economical, and effective therapy.

BackgroundCardiovascular (CV) disease is the major cause of death of RA patients. There is a direct association of systemic inflammation and an accelerated process of atherosclerosis, which is related to higher CV morbimortality (1). Additionally, RA patients with bilateral carotid plaque (CP) had a two-fold risk of developing a CV event compared to patients with unilateral CP (2).ObjectivesTo compare disease activity and other disease characteristics of RA patients with bilateral and unilateral CP.MethodsThis was a cross-sectional study nested of a RA patients’ cohort. We recruited RA patients who fulfilled the 2010 ACR/EULAR classification criteria. Patients with a previous CV event, another connective tissue disease, or pregnancy were excluded. Disease activity was assessed with DAS28-CRP. A carotid ultrasound was performed to all RA patients, and the presence of CP was considered as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing ≥ 0.5 mm. All RA patients with bilateral CP were included in this study and matched by age (± 5 years), gender, and traditional CV risk factors to RA patients with unilateral CP by a rheumatologist blinded to clinical information. Comparisons were done with Chi-square test for qualitative variables and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.ResultsMean age of RA patients with bilateral CP was 61.98 ± 6.82 years as compared to 59.70 ± 6.74 years in patients with unilateral CP (p = NS). Demographic characteristics are shown in Figure 1. When comparing disease characteristics, we found a difference in C-reactive protein (CRP) levels, higher in patients with bilateral CP (1.06 mg/dl vs 0.64 mg/dl, p = 0.012), in disease activity assessed with DAS28-CRP as a continuous variable, higher in patients with bilateral CP (3.83 vs 3.05, p = 0.023), and as moderate-high disease activity classification, more prevalent in patients with bilateral CP (70.0% vs 43.3%, p = 0.037) (Table 1). A binary logistic regression, including traditional CV risk factors and disease activity, showed that classification of disease activity in the moderate-high activity category is an independent risk factor for the presence of bilateral CP, OR 3.18, 95% CI 1.033-9.812, p = 0.044.Table 1.Comparison of disease characteristics.VariablesRA patients with bilateral CP (n=30)RA patients with unilateral CP (n=30)p-valueDisease duration, years, median (IQR)7.86 (2.97-19.18)9.02 (6.45-13.66)NSCRP, mg/dl, median (IQR)1.06 (0.67-1.93)0.64 (0.43-1.06)0.012DAS28-CRP, mean ± SD3.83 ± 1.273.05 ± 1.320.023Moderate-high activity, n (%)21 (70.0)13 (43.3)0.037Anti-CCP, median (IQR)15.30 (3.16-196.15)115.73 (1.60-196.05)NSFR IgG, median (IQR)5.84 (2.00-17.13)5.25 (2.00-20.41)NSFR IgM, median (IQR)156.86 (27.91-200.00)197.22 (65.71-200.00)NSFR IgA, median (IQR)85.87 (13.60-200.00)46.83 (5.33-129.93)NSMTX, n (%)22 (75.9)21 (70.0)NSGC, n (%)16 (55.2)11 (36.7)NSbDMARD, n (%)3 (10.3)6 (20.0)NSNS, no significant; RA, rheumatoid arthritis; CRP, C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide antibodies; RF, rheumatoid factor; MTX, methotrexate; GC, glucocorticoids; bDMARD, biologic disease modifying antirheumatic drugs.ConclusionWe found that RA patients with bilateral CP had higher levels of CRP levels, higher DAS28-CRP, and a higher prevalence of being classified in the moderate-high disease activity category, which was independently associated to the presence of bilateral CP. Emphasis should be placed on tight disease control to prevent the development of a major CV events in RA patients.References[1]Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol. 2015;11(7):390-400.[2]Evans MR, Escalante A, Battafarano DF, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum. 2011;63(5):1211-20.Disclosure of InterestsNone declared

BackgroundSystemic lupus erythematosus (SLE) patients have a worse cardiovascular prognosis than the general population. It is estimated that approximately 40% of SLE patients develop lupus nephritis (LN) throughout the evolution of the disease (1). Patients with LN had 8 times more risk of myocardial infarction and 4 times more risk of cardiovascular mortality than SLE patients without LN (2).ObjectivesTo compare the echocardiographic parameters between SLE patients with and without LN.MethodsThis was a cross-sectional study nested of a SLE cohort. We recruited patients with SLE diagnosis, according to the 2019 EULAR/ACR classification criteria, aged ≥ 18 years. Patients with a previous cardiovascular event, another connective tissue disease or pregnancy were excluded. A transthoracic echocardiogram was performed by two certified echocardiographers blinded to clinical information. Patients with LN were included and matched to patients without LN by age and gender. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables, and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.ResultsA total of 48 SLE patients, 24 with LN and 24 without LN were included. Mean age of patients with LN was 36.9 ± 10.4 years, compared to 36.5 ± 9.3 years in patients without LN, p = 0.873. There were no significant differences in demographic characteristics between groups (Figure 1). When evaluating echocardiographic parameters we found a significant difference in the left ventricular mass index, higher in LN patients (66.9 g/m2 vs 54.8 g/m2, p = 0.035) (Table 1).Table 1.Comparison of echocardiographic findings of SLE patients with and without LN.VariablesPatients with LN (n=24)Patients without LN (n=24)p-valueLV mass index, g/m2, mean ± SD66.9 ± 21.854.8 ± 16.10.035RWT, mean ± SD0.37 ± 0.080.34 ± 0.10NSLV geometry abnormality, n (%)7 (29.2)4 (16.7)NSLAESVI, ml/m2, mean ± SD29.72 ± 10.8026.04 ± 8.76NSLVEF, %, mean ± SD58.16 ± 7.4258.04 ± 7.04NSLVESV, ml, median (IQR)39.0 (26.0-54.5)32.5 (23.7-39.7)NSLVEDV, ml, mean ± SD92.10 ± 25.0981.57 ± 27.80NSSLE, systemic lupus erythematosus; LN, lupus nephritis; NS, not significant; LV, left ventricular; RWT, relative wall thickness; LAESVI, left atrial end-systolic volume index; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; LVEDV, left ventricular end-diastolic volume.ConclusionSLE patients with LN had higher left ventricular mass index than SLE patients without LN. An increased left ventricular mass could lead to the development of ventricular hypertrophy, which is associated to a higher risk of cardiovascular mortality. A transthoracic echocardiogram should be considered as part of the cardiovascular evaluation of SLE patients, especially those with LN.References[1]Hoover PJ, Costenbader KH. Insights into the epidemiology and management of lupus nephritis from the US rheumatologist’s perspective. Kidney Int 2016;90(3):487–92.[2]Hermansen ML, Lindhardsen J, Torp-Pedersen C, et al. The risk of cardiovascular morbidity and cardiovascular mortality in systemic lupus erythematosus and lupus nephritis: A Danish nationwide population-based cohort study. Rheumatol (United Kingdom) 2017;56(5):709–15.Disclosure of InterestsNone declared

BackgroundThe main cause of death in patients with rheumatoid arthritis (RA) is due to cardiovascular disease1. Cardiovascular mortality is strongly associated with the cumulative severity of the disease. Functional disability, as measured by the Health Assessment Questionnaire (HAQ), has been used to predict premature mortality in RA2. There are no studies relating its baseline score to the development of subclinical atherosclerosis by carotid ultrasound.ObjectivesTo determine whether baseline HAQ score is an independent factor for the development of subclinical atherosclerosis assessed by carotid ultrasound.MethodsProspective, observational study. Patients with a diagnosis of RA who met ACR/EULAR 2010 criteria and who were recruited at the Cardio-Rheumatic Clinic in 2014-2015 were included. Patients underwent a clinical history and physical examination and completed the HAQ. The presence of subclinical atherosclerosis was identified by carotid Doppler ultrasound at the end of follow-up. Subclinical atherosclerosis was defined by the presence of carotid plaque or carotid intima-media thickness (c-IMT) ≥0.8mm. Distribution was assessed with the Kolmogorov-Smirnov test. Correlation between cIMT value and baseline HAQ score was determined using Spearman’s correlation coefficient. Binary logistic regression was used to determine the independent factor for the development of subclinical atherosclerosis.ResultsA total of 48 patients were followed up. The median follow-up was 4.5 years (4.3-4.9). The baseline characteristics of the patients are shown in Table 1. A correlation was found between the GIMc value and the baseline HAQ score statistically significant (r=0.625, p=Table 1.Baseline characteristics.Basal (n=48)Age, years ± SD55.8 ± 9.7Female, n (%)44 (91.7)Disease duration, years (IQR)9.5 (4.3-16.5)DAS28-ESR ± SD4.4 ± 1.2DAS28-CPR ± SD3.3 ± 1.1CDAI ± SD13.0 ± 10.2HAQ, (IQR)0.87 (0.25-1.25)HT, n (%)19 (39.6)DM, n (%)2 (4.2)Active tabaquism, n (%)4 (8.3)Obesity, n (%)19 (39.6)BMI, kg/m2 ± SD29.1 ± 4.6Methotrexate, n (%)40 (83.3)Glucocorticoids, n (%)30 (62.5)DAS28, disease activity score using 28 joints; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; CDAI, clinical disease activity index; HAQ, Health Assessment Questionnaire; HT, hypertension; DM, diabetes mellitus; BMI, body mass index.ConclusionOur data show that at 4.5 years of follow-up, baseline HAQ score is a significant independent predictor of the presence of subclinical atherosclerosis by carotid ultrasound in patients with rheumatoid arthritis.References[1]Semb AG, Ikdahl E, Wibetoe G, Crowson C, Rollefstad S. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol. 2020;16(7):361-79.[2]Wolfe F, Michaud K, Gefeller O, Choi HK. Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum. 2003;48(6):1530-42.Disclosure of InterestsNone declared

BackgroundCurrent EULAR recommendations for cardiovascular risk (CVR) assessment in rheumatoid arthritis (RA) indicate that the CVR evaluation should be performed according to national guidelines; however, there was no algorithm designed for the Mexican population until 2019, when the World Health Organization (WHO) published the CVR charts for 21 world regions, including Mexico (1).ObjectivesTo determine the capacity of the WHO and other five algorithms for the detection of carotid plaque (CP) in RA patients.MethodsCross-sectional study. We included 164 patients with RA diagnosis according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. CVR was calculated with six algorithms: WHO, FRS-lipids, FRS-BMI, SCORE, ACC/AHA and QRISK3. Carotid ultrasound was performed in all patients to identify the presence of CP. A ROC-curve analysis was performed, and the cutoff points of each algorithm were determined using the Youden Index. Area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LR) were calculated. A p-value ResultsThe prevalence of CP was 35.9%. The WHO algorithm showed AUC: 0.729 (0.649-0.809), cutoff point: 5.25, sensitivity: 72.9%, and specificity: 64.8%. FRS-lipids showed AUC: 0.684 (0.601-0.767), cutoff point: 8.62, sensitivity: 67.8%, and specificity: 61.0%. FRS-BMI showed AUC: 0.700 (0.618-0.781), cutoff point: 11.55, sensitivity: 72.9%, and specificity: 61.0%. SCORE showed AUC: 0.687 (0.601-0.773), cutoff point: 1.5, sensitivity: 79.7%, and specificity: 45.7%. ACC/AHA showed AUC: 0.687 (0.604-0.770), cutoff point: 3.82, sensitivity: 62.7%, and specificity: 61.0%. QRISK3 showed AUC: 0.733 (0.654-0.811), cutoff point: 6.05, sensitivity: 71.2%, and specificity: 61.0%. All algorithms had a p-value Table 1.Capacity of cardiovascular risk algorithms to detect presence of carotid plaque in rheumatoid arthritis patientsAlgorithms (cut-off points)AUCCI 95%pSensibilitySpecificityLikelihood radioInferior limitSuperior limit+-WHO0.7290.6490.80972.9%64.8%2.070.42(5.25)FRS-lipids0.6840.6010.76767.8%61.0%1.740.53(8.62)FRS-BMI0.7000.6180.78172.9%61.0%1.870.44(11.55)SCORE0.6870.6010.77379.7%45.7%1.470.44(1.5)ACC/AHA0.6870.6040.77062.7%61.0%1.610.61(3.82)QRISK30.7330.6540.81171.2%61.0%1.820.47(6.05)AUC, area under the curve; WHO, World Health Organization; FRS, Framingham Risk Score; BMI, body mass index.ConclusionThe WHO calculator was one of the best algorithms for the detection of CP, with the best positive and negative likelihood ratios; however, like the other algorithms, a lower cut-off point than the one established by official guidelines was needed to identify high-risk patients with the presence of CP, who were initially classified as low-moderate risk by the CVR algorithm.References[1]Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45.Disclosure of InterestsNone declared.

BackgroundDue to the SARS-CoV-2 pandemic, an increase in stress, anxiety, and depression has been seen, as well as greater use of substances and a decrease in prenatal care in pregnant women. (1) Women of childbearing age with autoimmune rheumatic diseases (ARDs) experience greater psychological stress, which can negatively influence behavior. (2)ObjectivesThis study aims to compare changes in prenatal laboratory and ultrasound tests by trimester, as well as the detection of anxiety and depression in pregnant women with ARDs due to the SARS CoV-2 pandemic.MethodsThis study was carried out on pregnant patients with ARDs from the Pregnancy and Rheumatic Diseases clinic of the rheumatology department of the University Hospital “Dr. José Eleuterio González” during the period from February 2018 to August 2021.Two standardized evaluations of anxiety and depression were carried out using the Inventory of Trait and State Anxiety (IDARE) and the Edinburgh Postpartum Depression Scale (EPDS) respectively in the third trimester of pregnancy. Maternal report of alcohol consumption during any trimester of pregnancy, as well as adherence to routine laboratory studies such as structural ultrasound and gestational diabetes screening, was addressed.Positive COVID-19 nasopharynx PCR results were evaluated during pregnancy beginning in the pandemic period (March 2020). The pre-pandemic recruited group was compared with the pandemic group.The comparison of the groups was carried out using the Chi-Square and Fisher tests. A significant value of p < 0.05 was considered. Statistical analysis was performed using the IBM SPSS v.25 program.Results50 pregnant patients with ARDs were recruited, of which 24 were included in the pre-pandemic group and 26 in the pandemic group. Compared with the pre-pandemic group, pregnant women recruited during the pandemic had a statistically significant higher positivity for state anxiety (p=0.023), likewise trait anxiety, depression, and suicidal ideation were detected more frequently, but the difference was not statistically significant, a higher rate of adherence to laboratory and cabinet studies was found, being significant for laboratories performed in the 1st and 2nd trimesters (0.005 and 0.025 respectively). See Table 1.Table 1.Characteristics of pregnant women with autoimmune rheumatic diseases before and during the SARS-CoV-2 pandemic.MeasureBefore pandemicn=24During pandemic Covid Negativen=22During pandemic Covid Positiven=4P valueaEPDS Positive depression detection (≥10)16.7%36.4%50%.197suicidal ideation16.7%0%25%.099IDARE Positive state anxiety detection (>45)12.5%27.3%75%.023IDARE Positive trait anxiety detection (>45)8.3%13.6%50%.204Any alcohol consumption during pregnancy20.8%4.5%0%.176Structural Ultrasound – Mid-Pregnancy66.7%95.5%100%.025Gestational diabetes screening75%86.4%100%.376LaboratoriesFirst trimester20.8%50%0%0.005Second quarter45.8%77.3%100%0.025Third trimester58.3%81.8%75%0.216IDARE= State and Trait Anxiety Inventory, EPDS= Edinburgh Postpartum Depression Scale.A Chi-square test for categorical variables or Fisher’s exact test where the expected cell nConclusionA higher frequency of positivity for state anxiety was demonstrated in pregnant women with ARDs recruited during the pandemic, as well as higher trait anxiety, depression, and suicidal ideation, although this increase was not statistically significant. On the other hand, concern about the pandemic and health status could positively influence better adherence to screening and routine studies during pregnancy.References[1]Johnson D, Dave H, Cd LYC. Pandemic-Associated Complications in Pregnant Women with Rheumatic Diseases.:261.[2]Skinner-Taylor CM, Perez-Barbosa L, Corral-Trujillo ME, Perez-Onofre I, Barriga- Maldonado ES, Cardenas-de la Garza JA, et al. Anxiety and depression in reproductive age women with rheumatic diseases. Rheumatology International [Internet]. 2020;40(9):1433–8. Available from: https://doi.org/10.1007/s00296-020-04591-8Disclosure of InterestsNone declared

BackgroundObesity plays an important role in autoimmune and inflammatory diseases such as rheumatoid arthritis (RA). It has been demonstrated a paradoxical relationship between increased body mass index (BMI) and disease activity (1). Acute phase reactants (APR) play an essential role in determining the disease activity level (2).ObjectivesTo compare APR levels in obese and non-obese patients with RA, and to establish their relationship with the disease activity level.MethodsA total of 272 patients with a diagnosis of RA were included in a cross-sectional study. They were divided in two groups, 136 obese patients and 136 non-obese patients, matched by age, gender and comorbidities. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) level were measured, and the activity level was determined with Disease Activity Score 28-joint erythrocyte sedimentation rate (DAS28-ESR) and Disease Activity Score 28-joint C-reactive protein (DAS28-CRP).The distribution was evaluated with Kolmogorov-Smirnov. Comparisons with Chi- square test for qualitative variables, Student’s t-test, and Mann-Whitney U test for quantitative variables. Correlation between BMI and APR with Spearman-rho coefficient.ResultsThe Spearman-rho coefficient showed a significant correlation between CRP level and BMI (rho=0.187, p=0.002) (Figure 1). No difference was found between activity level when comparing both groups (Table 1).Table 1.Demographic Characteristics of the PatientsCharacteristicsObese RA Patients (n=136)Non-Obese RA Patients (n=136)P ValueAge, mean ± SD55.32±8.6755.38±8.64NSFemale, n (%)130 (95.5)130 (95.5)NSBMI, mean ± SD34.22±3.7424.70±2.89-T2DM, n (%)30 (22.0)23 (16.9)NSHypertension, n (%)62 (45.5)48 (35.2)NSDyslipidemia, n (%)39 (28.6)48 (35.2)NSMethotrexate, n (%)119 (87.5)114 (83.8)NSbDMARD, n (%)7 (5.1)11 (8.0)NSGlucocorticoid, n (%)89 (65.4)77 (56.6)NSCRP, median (p25-p75)1.00 (0.58-1.73)0.68 (0.38-1.25)NSESR, median (p25-p75)25.00 (16.00-36.00)24.50 (14.25-37.75)NSDAS28ESR, mean ± SD4.74±1.454.57±1.38NSDAS28CRP, mean ± SD3.62±1.463.37±1.39NSRA, rheumatoid arthritis; NS, not significant; BMI, body mass index; T2DM, type 2 diabetes mellitus; bDMARD, biological disease-modifying anti-rheumatic drugs; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; DAS28, Disease Activity Score 28-joint.Figure 1.Correlation between BMI and CRPBMI, body mass index; CRP, C-reactive proteinConclusionObese RA patients presented higher CRP levels compared to non-obese patients, suggesting that a higher BMI level may be related to a higher degree of inflammation and consequently worse systemic manifestations in patients.References[1]Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol. 2010;6(8):445–51.[2]van Riel PLCM, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(4):40–4.Disclosure of InterestsNone declared

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease with a high prevalence worldwide. Patients with SLE have a higher frequency of developing cardiovascular disease than the general population. There is little evidence on conduction abnormalities and arrhythmias in patients with SLE(1).ObjectivesThe aim of this study is to compare electrocardiogram alterations in patients with SLE and a control group.MethodsA cross-sectional, observational, comparative study was performed. A total of 70 patients with SLE, and 70 controls matched for age (± 5 years) and gender were recruited. An electrocardiogram was performed in all study subjects. Kolmogorov-Smirnov test was used for distribution analysis. Comparisons were performed by Chi-square test for qualitative variables and Student’s t-test or Mann Whitney U test for quantitative variables. A p value ResultsIn electrocardiogram findings, a significant difference was found in QRS segment duration (84.00 vs 89.50 ms, p=0.012), QT segment duration (397.01 vs 384.44 ms, p=0.016) and heart rate (68.60 vs 74.77, p=0.03) (Table 1).Table 1.ECG comparison between SLE and controls.CharacteristicsPacientes with SLE(n=70)Controls(n=70)PAge (years), median (p25-p75)35.0 (25.0-50.2)35.0 (22.7-50.2)NSFemale, n (%)63 (90)64 (91.4)NSQRS (ms), median(p25-p75)89.50 (84.75-95.50)84.00 (80.00-90.00)0.012QT (ms), mean ± SD384.44 ± 30.84397.01 ± 30.210.016HR (Bpm), mean ± SD74.77 ± 12.9368.60 ± 11.250.003ECG; electrocardiogram, SLE; systemic lupus erythematosus, NS; not significant, HR; heart rate, MS; milliseconds, BPM; beats per minute.ConclusionThe results suggest that patients with SLE have increased QRS segment, increased heart rate and decreased QT segment duration, which may be related to disturbances of the conduction system.References[1]Tselios K, Gladman DD, Harvey P, Su J, Urowitz MB. Severe brady-arrhythmias in systemic lupus erythematosus: prevalence, etiology and associated factors. Lupus. 2018;27(9):1415–23.Disclosure of InterestsNone declared

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune inflammatory disease. Patients with SLE have higher risk of developing a cardiovascular event than the general population (1), with multiple factors contributing to this increased risk, including systemic inflammation (2).ObjectivesTo compare the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and other disease characteristics of SLE patients with and without left ventricular (LV) geometry abnormalities.MethodsThis was a cross-sectional study nested of a SLE cohort. We recruited patients with SLE diagnosis, according to the 2019 EULAR/ACR classification criteria, aged ≥ 18 years. Patients with a previous cardiovascular event, another connective tissue disease or pregnancy were excluded. A transthoracic echocardiogram was performed by two certified echocardiographers blinded to clinical information. Disease activity was assessed with SLEDAI. SLE patients with LV geometry abnormalities were included in this study and matched by age and gender to SLE patients with normal LV geometry by a certified rheumatologist blinded to clinical information. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables, and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.ResultsA total of 44 SLE patients were included, 22 patients with LV geometry abnormalities and 22 patients with normal LV geometry. Mean age of SLE patients with LV geometry abnormalities was 35.1 ± 12.2 years, compared to 35.4 ± 9.4 years of SLE patients with normal LV geometry, p = 0.923. The rest of demographic characteristics are shown in Figure 1. When evaluating disease characteristics, the SLEDAI score was significantly higher in SLE patients with LV geometry abnormalities (26.45 vs 17.33, p = 0.016) (Table 1).Table 1.Comparison of disease characteristics of SLE patients with and without LV geometry abnormalities.VariablesPatients with LV geometry abnormalities (n=22)Patients with normal LV geometry (n=22)p-valueDisease duration, months, median (IQR)60.0 (12.7-150)72.0 (43.0-117.7)NSSLEDAI, median (IQR)10.5 (4.0-15.0)6.0 (2.0-9.0)0.016CRP, mg/dl, median (IQR)0.52 (0.33-1.29)0.60 (0.41-0.85)NSESR, mm/h, median (IQR)26.0 (13.2-34.2)29.0 (8.7-58.5)NSANA titers, median (IQR)640 (160-3200)480 (160-5120)NSAnti-dsDNA, median (IQR)0 (0-160)0 (0-200)NSC3, mean ± SD94.6 ± 31.4100.5 ± 46.1NSC4, median (IQR)13.6 (9.8-14.9)12.8 (6.4-19.8)NSAnti-Ro, median (IQR)4.5 (2.0-190.5)3.5 (2.0-82.2)NSAnti-La, median (IQR)2.0 (2.0-4.0)2.0 (2.0-3.0)NSHydroxychloroquine, n (%)20 (90.9)18 (81.8)NSGlucocorticoids, n (%)19 (86.4)17 (77.3)NSSLE, systemic lupus erythematosus; LV, left ventricular; NS, not significant; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ANA, antinuclear antibodies; anti-dsDNA, anti-double stranded DNA.ConclusionSLE patients with LV geometry abnormalities had higher SLEDAI score than patients with normal LV geometry. A transthoracic echocardiogram may be useful detect early cardiovascular abnormalities in SLE patients with high disease activity, and therefore should be considered as part of the cardiovascular evaluation of these patients.References[1]Chen J, Tang Y, Zhu M, et al. Heart involvement in systemic lupus erythematosus: a systemic review and meta-analysis. Clin Rheumatol 2016; 35:2437–48.[2]Kao AH, Sabatine JM, Manzi S. Update on vascular disease in systemic lupus erythematosus. Curr Opin Rheumatol 2003; 15:519–27.Disclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory disease in which cardiovascular disease is the leading cause of death (1). Exercise has been shown to have certain benefits in chronic diseases such as RA, decreasing symptoms and disease activity (2).ObjectivesTo correlate exercise and minutes of physical activity performed per week with the disease activity level in a Mexican RA population.MethodsThis was a cross-sectional study in which a total of 240 Mexican patients with a diagnosis of RA were included. They were divided into two groups (120 in each): those who self-reported performing at least 30 minutes of exercise 3 or more times per week and were matched with patients who did not perform it by age, gender, and comorbidities. The disease activity level was determined with Disease Activity Score 28-joint erythrocyte sedimentation rate (DAS28-ESR) and Disease Activity Score 28-joint C-reactive protein (DAS28-CRP).Distribution was evaluated with Kolmogorov-Smirnov. Comparisons with Chi-square test, Student’s t-test, and Mann-Whitney U test. Correlation between disease activity level and minutes of exercise per day with Spearman-rho coefficient.ResultsDAS28-ESR was significantly higher in patients who did not exercise [4.024 (3.08-5.31) vs 4.73 (3.6-54.82), p=0.006]. DAS28-CRP had similar trend [2.76 (1.89-4.14) vs 3.51 (2.28-4.63), p=0.004] (Table 1).Table 1.Demographic characteristics of the patients.CharacteristicsRA patients whoexercise (n=120)RA patients whodo not exercise (n=120)Value of pAge, mean ± SD54.4±8.154.5±8.2NSFemale gender, n (%)106 (88.3)106 (88.3)NSObesity, n (%)23 (19. 1)31 (25.8)NST2DM, n (%)15 (12.5)12 (10.0)NSHypertension, n (%)30 (25.0)24 (20.0)NSDyslipidemia, n (%)39 (32.5)34 (28.3)NSMethotrexate, n (%)93 (77.5)107 (89.1)0.015bDMARD, n (%)6 (5)5 (4.1)NSGlucocorticoid, n (%)61 (50.8)74 (61.6)NSMinutes of exercise perweek, median (p25- p75)180 (150-300)0-DAS28ESR, median (p25-p75)4.024 (3.08-5.31)4.73 (3.6-54.82)0.006DAS28CRP, median (p25-p75)2.76 (1.89-4.14)3.51 (2.28-4.63)0.004RA, rheumatoid arthritis; NS, not significant; T2DM, type 2 diabetes mellitus; bDMARD, biological disease-modifying anti-rheumatic drugs; DAS28, Disease Activity Score 28-joints; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.The Spearman-rho coefficient showed a significant correlation between the minutes of exercise performed per week and DAS28-ESR (rho=-0.193, p=0.003) and DAS28-CRP (rho=-0.207, p=0.001) (Figure 1). A multivariate analysis was performed in which minutes of exercise performed per week, treatment, and comorbidities were included, showing an independent association between minutes of exercise performed per week and the disease activity level assessed by DAS28-ESR (B=-0.001, 95% CI= -0.002- -0.0003, p=0.011) and DAS28-CRP (B=-0.001, 95% CI= -0.002- -0.0003, p=0.011).Figure 1.Correlation between exercise time and disease activity level in RA.RA, rheumatoid arthritis; DAS28, Disease Activity Score 28-joints; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.ConclusionMexican RA patients who exercise presented lower levels of disease activity. Emphasis should be placed on their practice to improve the patients’ symptomatology.References[1]Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Prim [Internet]. 2018;4:1–23. Available from: http://dx.doi.org/10.1038/nrdp.2018.1[2]Katz P, Andonian BJ, Huffman KM. Benefits and promotion of physical activity in rheumatoid arthritis. Curr Opin Rheumatol. 2020;32(3):307–14.Disclosure of InterestsNone declared

BackgroundRheumatoid cachexia is a clinical spectrum of rheumatoid arthritis in which individuals present increased inflammatory activity, more aggressive joint destruction, and worse cardiovascular prognosis (1). Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease in which there is a high cardiovascular mortality rate (2). Currently, the cachexia phenomenon in SLE patients has not been studied.ObjectivesTo correlate body weight with left ventricular (LV) indexed mass in SLE patients.MethodsThis was a cross-sectional study that included a total of 34 patients aged ≥18 years with a diagnosis of SLE according to EULAR/ACR 2019 criteria. Patients with a personal pathological history of cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease) and pregnancy were excluded. Three certified cardiologists performed a transthoracic echocardiogram in each patient, assessing relative wall thickness, and indexed LV mass.The distribution was assessed with Kolmogorov-Smirnov. Correlations between weight and echocardiographic parameters with Spearman-rho coefficient. A value of pResultsMost patients were female (94.1%), with a mean age of 33.29±9.91. Of the total patients 2 (5.88%) had Type 2 Diabetes Mellitus, 2 (5.88%) hypertension, 1 (2.94%) dyslipidemia, 3 (8.82%) obesity, and 6 (17.64%) smoking. Spearman-rho coefficient showed a significant negative correlation between LV indexed mass and body weight of SLE patients (rho=-0.411, p=0.016) (Figure 1).Figure 1.Spearman rho correlation between weight and LV indexed mass.ConclusionThere is a negative correlation between body weight and LV indexed mass in SLE patients, this suggests that a lower body weight may be related to higher LV mass, which may result in LV hypertrophy and increased cardiovascular morbidity and mortality.References[1]Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol [Internet]. 2010;6(8):445–51. Available from: http://dx.doi.org/10.1038/nrrheum.2010.105[2]Lee YH, Choi SJ, Ji JD, Song GG. Overall and cause-specific mortality in systemic lupus erythematosus: An updated meta-analysis. Lupus. 2016;25(7):727–34.Disclosure of InterestsNone declared

BackgroundPsoriatic arthritis (PsA) is associated with an increased prevalence of cardiovascular events due to accelerated atherosclerosis that seems to depend on traditional and non-traditional risk factors(1). There is a positive correlation between pulse pressure (PP) and the progression of atherosclerosis in general population (2). Currently, there are no studies linking PP as an independent risk factor of atherosclerosis in PsA patients.ObjectivesTo compare PP between PsA patients with and without carotid plaque (CP).MethodsThis was a cross-sectional study that included patients aged 40 to 75 years with PsA diagnosis according to the 2006 CASPAR criteria. A carotid ultrasound was performed in all patients, and they were divided into two groups, 27 patients with the presence of CP and 27 patients without CP matched by age, gender, and comorbidities. Blood pressure and PP was measured according to current guidelines. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi-square test for qualitative variables and Student´s t test for quantitative variables. A p value ResultsThere were no differences regarding demographic characteristics between groups. When comparing the arterial measures, a statistically significant difference was found in the PP, which was higher in patients with CP (48.66 ± 12.04 mmHg vs 41.51 ± 9.10 mmHg, p=0.017) (Table 1). A binary logistic regression was performed, and we found that PP was the only independent factor for the presence of CP in patients with PsA, OR 6.638 (95% CI 0.453- 12.823, p=0.036).Table 1.Demographic characteristics of the patients.CharacteristicsPsA patients with CP(n=27)PsA patients without CP(n=27)P ValueAge, mean ± SD51.55±8.2450.74±8.68NSFemale gender, n (%)16 (59.25)15 (55.55)NSObesity, n (%)16 (59.25)17 (62.96)NST2DM, n (%)20 (74.07)23 (85.18)NSHypertension, n (%)19 (70.37)22 (81.48)NSDyslipidemia, n (%)12 (44.44)17 (62.96)NSActive smoking, n (%)17 (62.96)16 (59.25)NSMethotrexate, n (%)9 (33.33)11 (40.74)NSGlucocorticoid, n (%)23 (85.18)22 (81.48)NSbDMARD, n (%)14 (51.85)18 (66.66)NSSAP, mean ± SD132.44±14.40123.44±13.800.023DAP, mean ± SD83.77±10.7181.92±10.95NSPP, mean ± SD48.66±12.0441.51±9.100.017PsA, psoriatic arthritis; NS, non-significant; T2DM, type 2 diabetes mellitus; bDMARD, biologic disease-modifying anti-rheumatic drugs; SAP, systolic arterial pressure; DAP, diastolic arterial pressure; PP, pulse pressure.ConclusionPsA patients with CP presented higher measures of PP compared with PsA patients without CP. This suggests that PP could be related with an increased risk of subclinical atherosclerosis in PsA patients. It is recommended to consider PP as an important parameter when evaluating cardiovascular risk in PsA patients.References[1]Ramonda R, Lo Nigro A, Modesti V, Nalotto L, Musacchio E, Iaccarino L, et al. Atherosclerosis in psoriatic arthritis. Autoimmun Rev [Internet]. 2011;10(12):773–8. Available from: http://dx.doi.org/10.1016/j.autrev.2011.05.022[2]Amar J, Chamontin B. Cardiovascular risk factors, atherosclerosis and pulse pressure. Adv Cardiol. 2007;44:212–22.Disclosure of InterestsNone declared

BackgroundThe oral health in patients with rheumatologic diseases is frequently affected because of chronic inflammation, slow rate of saliva production and poor self-care. These factors affect the life quality and psychosocial wellness, causing pain, difficulty biting and chewing, even malnutrition. The Geriatric/General Oral Health Assessment Index Spanish Version (GOHAI-SP) consists in 12 items and values self-perception in oral health and wellness (1), validated and applied to young adults (2).Objectivesto describe the oral health measured by the GOHAI-SP in patients with rheumatic diseases.Methodsa cross-sectional and observational study was conducted of January to May 2021 in rheumatology service of Hospital Universitario “Dr. José Eleuterio González” at Monterrey, Mexico. Patients with rheumatologic diseases was assessed with GOHAI-SP during their control consult, each item is valuated like a Likert ordinal scale from 1 to 5, the best and worst possible score is 60-12 respectively, patients whit score 50 as good oral health(3). This assessment is divided in self-perception of mechanical function, pain and discomfort in mouth, gums, teeth and psychosocial function (4).Results316 patients were included, 289 (91.5%) were women, the mean age was 46.23 years (SD: 15.49), the general mean score was 51.88 classified as good oral health. 24 (7.52%) patients was classified with moderate oral health and 63 (19.74%) as poor oral health. The most frequent diagnoses with poor oral health were rheumatoid arthritis 26 cases (8.22%), systemic lupus erythematosus 11 cases (3.48%) and psoriasic arthritis 4 cases(1.2%).ConclusionThe prevalence of poor or moderated self-perceived oral health in patients with rheumatologic diseases was 27.53%. The primary prevention and early detection plays a fundamental roll to avoid oral disease in this population.References[1]Aguirre-Bustamante, J., Barón-López, F., Carmona-González, FJ et al. Validación de una versión modificada del Índice de Evaluación de la Salud Oral Geriátrica Española (GOHAI-SP) para adultos y personas mayores. BMC Oral Health 20, 61 (2020). https://doi.org/10.1186/s12903-020-1047-3.[2]Atchison, K.A., Der-Martirosian, C. and Gift, H.C. (1998), Components of Self-reported Oral Health and General Health in Racial and Ethnic Groups. Journal of Public Health Dentistry, 58: 301-308. https://doi.org/10.1111/j.1752-7325.1998.tb03013.x[3]Hernández-Palacios RD, Ramírez-Amador V, Jarillo-Soto EC, Irigoyen-Camacho ME, Mendoza-Núñez VM. Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study. Cien Saude Colet. 2015 Apr;20(4):997-1004. doi: 10.1590/1413-81232015204.00702014. PMID: 25923612.[4]Sánchez-García S, Heredia-Ponce E, Juárez-Cedillo T, Gallegos-Carrillo K, Espinel-Bermúdez C, de la Fuente-Hernández J, García-Peña C. Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population. J Public Health Dent. 2010 Fall;70(4):300-7. doi: 10.1111/j.1752-7325.2010.00187.x. PMID: 20663049Table 1.Demographic characteristics and results GOHAI-SPGOHAI-SPCharacteristicsn=316Score, mean (SD)Age, mean (SD)46.23 (15.49)51.87 (8.35)Gender, n (%)Female289(91.5)51.92Classification GOHAI-SPGood229 (72.47)56.34Moderate24 (7.59)46.95Poor63 (19.93)37.5Rheumatologic diseases, n (%)Rheumatoid arthritis120(37.97)51.45Systemic lupus erythematosus53(16.77)51.81Osteoarthritis19 (6.02)53.57Other diagnoses124(39.24)52.26GOHAI-SP: Geriatric/General Oral Health Assessment Index Spanish Version; (SD) Standard deviation, n number; (%) Percentage.Disclosure of InterestsNone declared

BackgroundAutoimmune rheumatic diseases(ARDs) are more prevalent in women during childbearing age. These women have an increased risk of adverse pregnancy outcomes and maternal morbidity than general obstetric population(GOP)ObjectivesThe objective this study was to evaluate the obstetric outcomes in Mexican women with ARDsMethodsA retrospective and descriptive study was conducted in a pregnancy and rheumatic disease clinic of a university hospital in Northeast Mexico from Jan 2017 to Dec 2020. All data were collected from the medical records of childbearing age women with ARDs enrolled in our clinic at the time of their pregnancy and childbirth. Patients with non-inflammatory rheumatic diseases were excluded. The obstetric, maternal, and fetal outcomes were compared with the rate of adverse perinatal outcomes of the GOP (n=31,254) database from the same institution. Sociodemographic and clinical characteristics of the population are described. We used the Mann–Whitney U, Chi-square, or Kruskal–Wallis tests to analyze the differences between groups. A pResultsA total of 62 pregnancies in women with ARDs were included. RA (n=24, 38%) was the most frequent diagnosis followed by SLE (n=14, 22.5%) and APS (n=9, 14.5%). The median maternal age at conception was higher in pregnancies with ARDs than GOP(pTable 1.Pregnant outcome, maternal, fetal, and neonatal adverse eventsARD(n=62)GOP(n=31254)OR(CI 95%)pPregnancy outcomePregnancy lossa6(9.68)1560(4.99)1.94(0.84-4.49)0.122Live birthsa60(90.9)29694(95)0.96(0.67-1.35)0.8Gestational age, median (IQR)(weeks)b37.6(37-39)39(38-40.2)-0.001Birth weight, mean (CI)(Kg)c2831.6 (2677.4-2985.8)3022.2 (2986.8-3057.6)-0.007Maternal adverse eventsPreterm deliveriesa14(23.7)3821(12.2)1.85(1.03-3.3)0.038a3(5.1)1065(3.4)1.42(0.45-4.53)0.553Gestational diabetesa4(6.5)1406(4.5)1.43(0.52-3.95)0.485Preeclampsiaa5(8.1)2471(7.89)1.02(0.41-2.54)0.97Postpartum hemorrhagea0930(2.97)0.27(0.017-4.35)0.355Emergency cesarean sectiona8(12.9)1844(5.9)2.19(1.05-4.57)0.037Maternal deatha031(0.09)7.94(0.48-131.2)0.148Fetal adverse eventsMiscarriagesa3(4.8)663(2.12)2.28(0.71-7.29)0.164Stillbirthsa3(4.8)897(2.87)1.69(0.53-5.38)0.377Congenital anomaliesa4(6.5)1094(3.5)1.84(0.67-5.08)0.237Neonatal adverse eventsLow birthweight (a7(12.3)3782(12.1)0.933(0.43-2.04)0.862Very low birthweight (a3(5.3)813(2.6)1.86(0.58-5.93)0.294Low Apgar scores at 5 minutes (a4(7.02)1781(5.7)1.13(0.41-3.12)0.81Values in bold denote statistical significance (a n, %b IQR, interquartile range (25th–75th percentile)c CI, confidence interval (95%)The most common fetal adverse event was congenital anomalies in both groups with no significant difference(p=0.237). The most frequent neonatal adverse events were low birthweight(The prevalence of cesarean section was higher in the ARDs group(p=0.016). The distribution of indications for cesarean sections is shown in Figure 1.ConclusionPregnant women with ARDs had a higher median maternal age at conception, lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications in this populationReferences[1]Strouse J, et al. (2019) Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study. RMD open, https://doi.org/10.1136/rmdopen-2018-00087Disclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) patients have increased cardiovascular risk than the general population. Systemic inflammation causes a proatherogenic state in this group of patients (1). The carotid ultrasound is a useful diagnostic tool for the detection of subclinical atherosclerosis; however, it is not available for all patients. Pulse pressure, defined as the difference between systolic and diastolic blood pressure, has been associated with atherosclerosis in the general population (2). Information in RA patients is lacking.ObjectivesWe aimed to correlate pulse pressure and carotid intima media thickness (cIMT) in RA patients.MethodsThis was a cross-sectional study. We recruited a total of 92 patients with RA diagnosis, according to the 2010 EULAR/ACR classification criteria, aged 40-75 years. Patients with a previous cardiovascular event, another connective tissue disease or pregnancy were excluded. A B-mode carotid ultrasound was performed in all patients by a certified radiologist blinded to clinical information. cIMT was measured in the left and right carotid arteries. An average of both cIMT was obtained for each patient for this analysis. Correlation between pulse pressure and cIMT was determined with the Spearman’s correlation coefficient (rs). A p-value ResultsMean age of RA patients was 58.9 ± 6.6 years. Most of them were women (92.4%), with a median disease duration of 10.5 (4.2-17.5) years. Median cIMT was 0.08 (0.07-0.10) mm, and median pulse pressure was 50 (40-55) mmHg (Table 1). We found a significant positive correlation between pulse pressure and cIMT in RA patients (rs = 0.254, p = 0.015) (Figure 1).Table 1.Demographic and disease characteristics.CharacteristicsRA patients (n=92)Age, years, mean ± SD58.9 ± 6.6Women, n (%)85 (92.4)T2DM, n (%)17 (18.5)Hypertension, n (%)33 (35.9)Dyslipidemia, n (%)30 (32.6)Obesity, n (%)30 (32.6)Active smoking, n (%)11 (12.0)Disease duration, years, median (IQR)10.5 (4.2-17.5)CRP, mg/dL, median (IQR)0.70 (0.51-1.22)ESR, mm/h, median (IQR)21.0 (13.0-33.2)Pulse pressure, mmHg, median (IQR)50 (40-55)cIMT, mm, median (IQR)0.08 (0.07-0.10)RA, rheumatoid arthritis; T2DM, type 2 diabetes mellitus; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; cIMT, carotid intima media thickness.ConclusionHigher pulse pressure was associated with higher cIMT in RA patients. Pulse pressure may be useful for the detection of high-risk patients who would benefit from a carotid ultrasound evaluation, to identify patients with high cIMT.References[1]Dalbeni A, Giollo A, Bevilacqua M, et al. Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients. Hypertens Res 2020;43(9):922–8.[2]Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. Stroke 1999;30(3):550-5.Disclosure of InterestsNone declared

BackgroundCardiovascular disease is the major cause of death in rheumatoid arthritis (RA) patients. Cardiovascular risk algorithms are used to estimate the probability for the development of a cardiovascular event in 10 years, according to patients’ characteristics, however, no algorithm existed for the Hispanic population until the World Health Organization (WHO) published the cardiovascular disease risk charts for 21 regions (1).ObjectivesTo compare the capacity of the 2019 WHO algorithm and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) algorithm for detecting the presence of carotid plaque (CP) in RA patients.MethodsCross-sectional study. We recruited a total of 164 patients with RA diagnosis, according to the 2010 ACR/EULAR classification criteria, aged 40-75 years. Patients with a previous cardiovascular event were excluded. Cardiovascular risk was evaluated with the 2019 WHO algorithm for the Mexican population and the 2013 ACC/AHA cardiovascular algorithm. The results were multiplicated by 1.5, according to current guidelines. A carotid ultrasound was performed to all study subjects by a certified radiologist blinded to clinical information. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations were performed with the Spearman-rho coefficient (rho). A ROC-curve analysis was performed for both algorithms. The areas under the curve (AUC) of the algorithms were compared using the method of DeLong.ResultsThe presence of CP was detected in 59 (36.0%) patients. Demographic characteristics are shown in Table 1. There was a large positive correlation between the WHO and the ACC/AHA algorithms (rho=0.880, p=p=p=p=0.042) (Figure 1).Table 1.Demographic characteristics of RA patientsCharacteristicsRA patients(n=164)Age, years, mean ± SD55.82 ± 8.94Women, n (%)157 (95.73)T2DM, n (%)27 (16.46)Hypertension, n (%)53 (32.32)Dyslipidemia, n (%)58 (35.36)Obesity, n (%)56 (34.15)Active smoking, n (%)15 (9.15)WHO algorithm, median (IQR)4.5 (3.0-9.0)ACC/AHA algorithm, median (IQR)3.75 (1.80-9.26)Carotid plaque, n (%)59 (36.0)RA, rheumatoid arthritis; T2DM, type 2 diabetes mellitus; WHO, world health organization; ACC/AHA, American College of Cardiology/American Heart Association.ConclusionOur results showed that although both algorithms had significant discrimination for the presence of CP, the 2019 WHO algorithm had a better capacity for the detection of CP than the 2013 ACC/AHA algorithm, for this specific Hispanic RA population. This could be attributed to the fact that the WHO algorithm was designed for 21 different regions, including the Mexican population.References[1]Group WCRCW. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e45.Disclosure of InterestsNone declared.

BackgroundIn Mexico, over 60% of the population is uninsured and not able to afford private healthcare services. Women with autoimmune rheumatic diseases (ARDs) are a high-risk group during pregnancy. Morbidity associated with ARDs and pregnancy can include lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications, on the other hand these health interventions are not available to all women with ARDs because of the high prices that it represents.ObjectivesThe aim of this study was to estimate the cost of prenatal care in women with ARDs without health insurance in Northeast Mexico.MethodsTo assess the costs of prenatal care of women with ARDs in the Northeast of Mexico from the perspective of a women without any health insurance, we estimated only the direct costs of the mandatory medical follow-up. Direct costs are all healthcare costs that are directly related to the consultations with a multidisciplinary team, serological and immune laboratory test, and ultrasounds per trimester. All costs and medical fees were obtained from a university hospital in Monterrey, Mexico. To assess the impact of prenatal care in real life, we compared the health expenditure per trimester reported by the pregnancy and rheumatic diseases clinic from the same institution. The data is presented in USD. We were not able to assess indirect costs related to health coverage (like transportation) and specific medical treatment (antirheumatic drugs or other interventions).ResultsThe mean cost for medical consultations and ultrasounds per trimester was $184-277 USD. The average cost of immune test and general lab test ranges from $424-428 USD. The total cost per trimester was from $608 to 705 USD, and the direct cost per three trimesters was $1824-2115 USD.The average family income per month was $614.23 USD and the average health expenditure (per month) was 105.71 USD; which represents 16.21% of the family income. The average family health expenditure per trimester was $317.13 USD.ConclusionThe total cost for prenatal care per trimester was calculated in $608 to 705 USD. The cost of prenatal care per trimester is 193.69% higher than the average health expenditure per trimester for uninsured women with ARDs. More and new strategies are needed to solve and reduce inequalities in access to health.Table 1.Average cost of prenatal care per trimesterMedical consultations and ultrasoundsMedical ConsultationsCosts (USD)FrecuencyCOST PER TRIMESTER $184-277 USDRheumatologist$13MonthlyGenetics$49At least oneObtetrician$14MonthlyUS 1st Trimester$54Only one timeUS 2nd Trimester$49Only one timePsychologist$39If neededNutritionist$5If neededClinical testClinical testCosts (USD)FrecuencyCOST PER TRIMESTER $188 USDComplete Blood Count$9One per trimesterBlood Chemistry$38One per trimesterVitamin D (25-OH)$59One per trimesterThyroid profile test$16One per trimesterPT, TTP$36One per trimesterProtein C reactive$20One per trimesterErythrocyte sedimentation rate$5One per trimesterUrine general test$5One per trimesterImmune lab test (For patients with rheumatoid arthritis and spondylarthritis)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $240 USDRheumatoid factor$24One per trimesterAnti-CCP$33One per trimesterAnti SS-A/RO$19One per trimesterAnti-SS-B/LA$19One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterImmune lab test (For patients with lupus, antiphospholipid syndrome, Sjogren’s syndrome, vasculitis, and others) (Others: rheumatic skin and muscle diseases,)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $236 USDAnti-SS-A/RO$21One per trimesterAnti-SS-B/LA$21One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterAnti-DNA$24One per trimesterAntinuclear antibodies$25One per trimesterDisclosure of InterestsNone declared

BackgroundCachexia plays an important role in rheumatoid arthritis (RA), due to its chronic inflammatory process characterized by decreased muscular mass with preservation or increase of fat that occurs in 1-13% of the RA population. A decreased BMI has a paradoxical relationship with disease activity, with an increase in disease activity and mortality (1). Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of nuclear autoantibodies that can form immune complexes and cause inflammation of multiple organs. Cardiovascular events and mortality are nearly twice as high in patients with SLE as in the general population. (2)ObjectivesTo determine the relationship between BMI and disease activity in patients with SLE.MethodsA cross-sectional, observational study was conducted in which a group of 58 patients with SLE were included and their level of disease activity was determined using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and BMI. Distribution was assessed with the Kolmogorov-Smirnov test. Descriptive analysis using measures of central tendency. Correlation between BMI and SLEDAI with Pearson’s test. A p value ResultsThe mean age of SLE patients was 35.4 ± 12.11 years, rest of demographic characteristics in Table 1. Pearson’s test showed a correlation between BMI and disease activity (r=Table 1.Demographic characteristicsSLE n=58Female n (%)54 (93.0)Age, years, mean ± SD35.4 ± 12.1DM n (%)2 (3.4)AH n (%)12 (20.6)DLP n (%)4 (6.8)Obesity n (%)4 (6.8)SLEDAI mean ± SD8.06 ± 6.4ANA positivity n (%)47 (81.0)BMI mean ± SD25.0 ± 4.9DM; Diabetes Mellitus, AH; Arterial Hypertension, DLP; Dyslipidemia, SLEDAI; Systemic Lupus Erythematosus Disease Activity Index, ANA; Anti-Nuclear Antibodies, BMI; Body Mass Index.-0.304, p= 0.020) Image 1. Multivariate analysis found that a decrease in BMI is independently associated with an increase in disease activity assessed by SLEDAI(B= -0.411, 95% CI= -0.819- -0.003, p=0.049).Figure 1.Correlation between BMI and SLEDAI.ConclusionThe results show an inverse relationship between BMI and disease activity in patients with SLE. Further studies with a larger number of patients should be performed.References[1]Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol [Internet]. 2010;6(8):445–51. Available from: http://dx.doi.org/10.1038/nrrheum.2010.105[2]Ocampo-Piraquive V, Nieto-Aristizábal I, Cañas CA, Tobón GJ. Mortality in systemic lupus erythematosus: causes, predictors and interventions. Expert Rev Clin Immunol [Internet]. 2018;14(12):1043–53. Available from: https://doi.org/10.1080/1744666X.2018.1538789Disclosure of InterestsNone declared

BackgroundAn adequate nutritional status and a balanced diet are essential for a functional immune system, especially in chronic diseases that condition a catabolic state. The increase in adipose tissue and the proinflammatory environment that it generates influences rheumatic diseases.1. This translates to increased disease activity, morbidity and mortality.ObjectivesTo describe body composition and nutritional status alterations in patients with rheumatological diseases in a 3rd level center in northern Mexico.MethodsA prospective observational study was conducted in a third level center in northern Mexico. Anthropometric measurements were made by electrical bioimpedance analysis with the InnerScan TANITA BC-533 equipment (Yesod, S.A de C.V. Japan). Descriptive statistics were performed for categorical variables and measures of central tendency and dispersion were used for quantitative variables.ResultsA total of 1,666 evaluations of 1,218 individual patients were included: 1,098 (90.14%) women and 119 (9.77%) men. The mean age was 50 (±13). The most frequent diagnoses were rheumatoid arthritis 556 (45.64%), systemic lupus erythematosus 164 (13.46%), osteoarthritis 106 (8.7%) and fibromyalgia 48 (3.9%). The means of the anthropometric measurements were weight 69.78. kg (±15.53), height 1.57 m (±.07), percentage of total fat 35.17% (±9.3), percentage of body water 45.15% (±6.42), visceral fat 8.32(±.3.9), kg muscle 41.84 kg (6.4), bone mass 2.35 (±.0.75), metabolic age 50(±13), BMI 28.22(±.6.04), waist circumference 92.85(±.15.38), hip circumference 106.8, (±.12.94) waist-hip ratio 0.87 (±.0.08). A total of 431 (35.38%) patients were overweight, 407 (33.41%) had some degree of obesity, 338 (27.75%) had a normal BMI, and only 41 (3.36%) were underweight. 1,013 (83.16%) patients had low lean mass, 719 (59.03%) had low body water percentage, 680 (55.82%) had high levels of total fat, and 163 (13.38%) had visceral fat; 672 (55.17%) sarcopenic obesity and 320 (26.27%) a metabolic age greater than the chronological age.ConclusionThe nutritional status of rheumatology patients in northern Mexico is inadequate with a high prevalence of obesity, overweight, and low lean mass. Nutritional intervention is of paramount importance in the comprehensive management of patients with rheumatologic diseases.References[1]Scrivo, R., Vasile, M., Müller-Ladner, U., Neumann, E., & Valesini, G. (2013). Rheumatic diseases and obesity: adipocytokines as potential comorbidity biomarkers for cardiovascular diseases. Mediators of inflammation, 2013, 808125.Table 1.Means of electrical bioimpedance analysis.VariableMeanSDWeight, kg69.78(15)BMI, kg/m228.22(6.04)Total fat, %35.17(9.3)Total body water, %45.15(6.42)Visceral fat, kg8.32(3.9)Lean mass, kg41.84(6.4)Bone mass, kg2.35(0.75)Metabolic age, years50(13)Waist circumference92.85(15.38)Hip circumference106.8(12.94)W/H ratio0.87(0.08)BMI: Body mass index. W/H ratio: Waist/Hip ratioDisclosure of InterestsNone declared

BackgroundThe Fracture Risk Assessment Tool (FRAX) estimates the 10-year probability of hip (FXC) and major osteoporotic (FXOM) fractures in patients aged 40 to 90 years using important clinical factors, such as bone mineral density (BMD), optional input variables. (1) There is convincing evidence that with or without the use of BMD it provides a well-validated instrument and may be useful in clinical practice for identifying patients at high risk of fracture and informing treatment decisions. (2)ObjectivesThis study aims to determine the concordance between the treatment decision, calculated using FRAX scores with and without BMD, and to identify the risk factors associated with the discordance in patients with autoimmune rheumatic diseases.MethodsA cross-sectional study was carried out in patients with autoimmune rheumatic diseases who had undergone osteoporosis detection (OP) using dual bone densitometry in the Rheumatology service of the University Hospital “Dr. José Eleuterio González” during the period August 2020 - August 2021. The FRAX questionnaire was applied to determine risk factors for OP and the results of the instrument with and without BMD were calculated, the patients were classified as low, intermediate, and high risk.A Student’s t-test, a Wilcoxon rank-sum test, and a Chi-square or Fisher’s exact test were used to compare variables between groups and calculate P-values.ResultsA total of 88 patients were included. Based on FRAX questionnaire responses, 82 (93.18%) patients had at least one risk factor for OP. The FRAX result with or without densitometry resulted in a treatment decision in 48 (54.5%) and 28 (31.8%) patients, respectively. The results were concordant in 65 (73.9%) of the cases. It was found that patients with osteopenia due to BMD had a greater agreement between both measurements (93.3%, p 0.003) than patients with normal BMD (62.5% p 0.001). Likewise, patients with secondary osteoporosis had lower concordance than patients without this diagnosis (25% and 72.5%, respectively, p 0.006).ConclusionThe results of FRAX with and without densitometry were mostly agreeable in predicting the need for treatment according to the 10-year probability of hip fracture, however, this concordance decreased in patients with a previous diagnosis of secondary osteoporosis, no significant difference was found between the risk factors for the concordant and discordant groups. More studies are required to determine the variables that cause a decrease in the concordance of the tests.Table 1.Factors that affect the results between the discordant groups.VariablesConcordant n=65No concordant n=23P valueSex (%)0.078Men8 (12.3%)0 (0%)Women57 (87.7%)23 (100%)Age (years)57.85 ± (11.66)59.2 ± (8.36)0.1312 (18.4%)4 (17.3%)50-5924 (36.9%)8 (34.6%)60-6917 (26.1%)9 (39.1%)70-7910 (15.3%)2 (8.7%)>802 (3%)0 (0%)Height (meters)1.52 ± (0.08)1.52 ± (1.06)0.042Weight (kilograms)68.5 (59.5-80.5)68 (64-74)BMI (kg/m 2)28.2 (24.9-33.1)30.9 (29.2-32.5)0.002Normal weight (%)16 (24.6%)3 (13%)0.136Overweight (%)22 (33.8%)5 (21.7%)0.150Obesity (%)27 (41.5%)15 (65.2%)0.051Normal BMD35 (53.84%)21 (93%)0.001Osteopenia28 (43.07%)2 (8.69%)0.003Osteoporosis2 (3.07%)0 (0%)0.395With BMDWithout BMDHip Fracture FRAX Score5.3 (3.62-9.77)1 (0.42-2.67)Major osteoporotic fracture6.2 (4.02-9.85)0.75 (0.3-1.77)Treatment suggested by FRAX48 (54.5%)28 (31.8%)BMI= Body mass index, BMD= Bone mineral density, FRAX= Fracture risk assessment toolReferences[1]Teeratakulpisarn N, Charoensri S, Theerakulpisut D, Pongchaiyakul C. FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais. Archives of Osteoporosis. 2021 Feb 26;16(1).[2]Horta-Baas G, Pérez Bolde-Hernández A, Pérez-Pérez A, Vergara-Sánchez I, Romero-Figueroa M del S. Concordancia del FRAX México con y sin el valor de la densidad mineral ósea en la evaluación del riesgo de fractura en la práctica clínica diaria. Medicina Clínica. 2017 May;148(9):387–93.Disclosure of InterestsNone declared

BackgroundSocial workers (SW) interventions are fundamental in health care; the main objective is to identify and mitigate social determinants of the patient’s health. The socioeconomic study (SES) is the core assessment of SW; it analyzes the demographic structure and population dynamics.ObjectivesDescribe the sociodemographic and social security characteristics in pregnant patients with autoimmune rheumatic diseases.MethodsA cross-sectional and retrospective study was conducted in a pregnancy and rheumatic diseases outpatient clinic from the university hospital in Monterrey, México. The data from the SES database was collected. The sociodemographic information, family’s monthly income and expenses, expenditures related to healthcare, type of social security, family nucleus (FN) and socioeconomic level (SL) were analized. The rheumatic diagnosis was retrieved from the medical records.The SL is classified in 7 levels (according to the score obtained in the SES); each level represents a percentage of the total cost of the healthcare received. Level 1 to 3 correspond to 0 - 28% percentage while levels 4 to 7 go from 53 to 100% of total payment that is due. To evaluate the health expenditure, the monthly limit expenditure per Mexican family is 98.39 dollars (the limit expenditure was taken from the Organization for Economic Co-operation and Development “OECD” 2019 report). For statistical analysis, the sociodemographic and clinical characteristics of the sample are presented as frequencies and percentages.ResultsFrom 2019 to 2021, 54 patients were interviewed. The mean age was 28.46 years(SD=6.69). The rheumatic diagnoses can be found in Table 1. The most common occupation was unemployment(n=34, 62.96%) and only completed basic levels of education(n=37,68.51%).Table 1.Sociodemographic characteristicsn=54Demographic DataAge, mean(SD)28.46(6.69)Occupation, n(%)Unemployed34(62.96)Employed17(31.48)Self-Employed3(5.55)Marital Status, n(%)Married/Cohabitating38(70.37)Single16(29.62)Level of Education, n(%)Basic education37(68.51)Higher education17(31.48)Family StructureFamily members, n(%)0-536(66.66)6-1118(33.32)Number of children, n(%)136(66.66)213(24.07)35(9.25)Family Nucleus, n(%)Nuclear27(50)Multi-nuclear26(48.14)Extended1(1.85)Rheumatic Disease, n (%)Rheumatoid arthritis29(53.7)Lupus9(16.66)Antiphospholipid syndrome8(14.81)Sjögren syndrome1(1.85)Health Expenditure, n(%)Active health insuranceNone39(72.22)Public health services (governmental and state workers)8(14.81)Private health insurance7(12.96)Average monthly family income (USD)$614.23Average monthly health expenditure (USD)$105.71Percentage of expenses in patient’s health16.21%SD:Standard deviationThe most frequent SL was level 3 (46.29%) and the predominant FN was the nuclear family (50%) (couple and their dependent children). Most of them were not under any health coverage(n=39, 72.22%). The average family income was $614.23 USD and the average health expenditure was 105.71 USD; which represents 16.21% of the family income (per month).ConclusionSW play a key role understanding basic needs and identifying health determinants that decreases the odds of access of healthcare. Women with autoimmune rheumatic diseases have an important burden of the main determinants of health like low income, unemployment, basic education, and poor health coverage.In addition, the average health expenditure is higher than the recommended by OECD. Different strategies are needed for childbearing age patients with rheumatic diseases to decrease the impact of health determinants.References[1]Sagrario, M. et al. (2006). El apoyo del trabajador social al paciente reumático. Epica, 28(6),6-8.[2]Silva, M. et al. (2015). Validez y Confiabilidad del Estudio Socioeconómico. Dgapa, UNAM. ISBN 978-607-02-7296-7[3]OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing. DOI: 10.1787/4dd50c09-enDisclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) patients have higher risk of developing cardiovascular (CV) events than the general population. Traditional CV risk algorithms have been shown to underestimate the real CV risk of RA patients (1). For this reason, current CV risk guidelines state that a carotid ultrasound could be considered as part of the CV evaluation of these patients.ObjectivesTo describe the carotid ultrasound changes in the follow-up of RA patients, and to compare demographic and disease characteristics in patients who had a reduction of carotid intima media thickness (cIMT) and those who did not.MethodsLongitudinal, observational, and prospective study. A total of 39 RA patients were included in this study. A first evaluation, including a carotid ultrasound, laboratory analyses, and clinical history, was performed at the time of inclusion. Posteriorly a follow-up carotid ultrasound was performed. Patients were divided into two groups, those with reduction of cIMT in both carotid arteries, and those who remained with the same measurements or had an increase of cIMT. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.ResultsMedian follow-up was 4.66 (4.33-5.00) years. When evaluating changes in the carotid ultrasound findings, 15 (38.5%) patients developed CP, 8 (20.5%) patients developed bilateral CP, and 10 (25.6%) patients had a reduction of cIMT at the follow-up (Figure 1). When comparing baseline characteristics, we found that patients with reduction of cIMT were younger (48.88 years vs 59.30 years, p = 0.004), with a lower prevalence of dyslipidemia (0% vs 34.5%, p = 0.040), had lower levels of erythrocyte sedimentation rate (ESR) (14.50 mm/h vs 28.0 mm/h, p = 0.024), and had higher prevalence of normal levels of ESR (p = 0.007) than patients who remained with the same measurements or had an increase of cIMT (Table 1). A multivariate analysis was performed, including variables with a p-value < 0.05, and we found that normal ESR was an independent factor associated with reduction of cIMT, with an OR 8.63 (1.27-58.33), p = 0.027.Table 1.Baseline characteristics of patients with and without reduction of cIMT.Baseline characteristicsPatients with cIMT reduction (n=10)Patients without cIMT reduction (n=29)p-valueDemographic characteristicsAge, years, mean ± SD48.88 ± 8.5959.30 ± 9.460.004T2DM, n (%)0 (0)3 (10.3)NSHypertension, n (%)1 (10)11 (37.9)NSDyslipidemia, n (%)0 (0)10 (34.5)0.040Active smoking, n (%)0 (0)2 (6.9)NSObesity, n (%)6 (60)8 (27.6)NSTreatmentStatins, n (%)2 (20)7 (24.1)NSMTX, n (%)9 (90)23 (79.3)NSGC, n (%)6 (60)16 (55.2)NSDisease characteristicsESR, mm/h, median (IQR)14.50 (9.00-21.25)28.0 (17.0-42.0)0.024ESR 7 (70)8 (27.6)0.027CRP, mg/dl, median (IQR)0.75 (0.45-1.26)0.91 (0.66-1.26)NSDAS28-ESR, mean ± SD4.30 ± 1.044.66 ± 1.09NSDAS28-CRP, mean ± SD3.23 ± 0.903.49 ± 1.06NScIMT, carotid intima media thickness; T2DM, type 2 diabetes mellitus; MTX, methotrexate; GC, glucocorticoids; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; DAS28, disease activity score 28 joints.ConclusionOur results show that patients without dyslipidemia and with lower ESR levels, a proinflammatory biomarker, had a reduction in cIMT, which decreases the risk of developing a major CV event. Emphasis should be placed on tight control of disease activity and traditional CV risk factors. A follow-up carotid ultrasound evaluation in RA patients may be necessary, to identify those who would benefit from an opportune treatment.References[1]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, et al. Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis. Clin Rheumatol 2016;35(11):2823-7.Disclosure of InterestsNone declared

Background:The reproductive capacity of women with rheumatic diseases (RD) could be affected by factors such as sexual dysfunction, reduced gonadal function, foetal losses, drugs, and personal choices [1]. Studies have suggested that women with RD may underestimate their reproductive capacity [2], which may be reflected in unplanned pregnancies and/or adverse outcomes. One study found that women with rheumatoid arthritis (RA) have longer time to pregnancy compared to those without RA, suggesting that a reduction in fertility may be involved [3]. Another study found that patients with RA have more subfertility related to medication [4]. Aspects of sexual and reproductive health are not routinely addressed, so they are areas of opportunity to improve quality in care and research.Objectives:Identify demographic and clinical factors associated with pregnancy decision in women with RD.Methods:A population study was carried out including women with RD who had their first obstetric event from September 2017 to November 2020. According to the onset of sexual life and the year of conception of the first pregnancy, two groups were formed, who conceived before and after 5 years elapsed. Demographic and clinical data were obtained from medical records. Categorical variables were assessed using χ2 test and Fisher’s exact test where appropriate. Student’s t-test was used to assess continuous variables. A p value of 0.05 or less was considered significative.Results:Data were collected from 28 women, the main diagnosis was rheumatoid arthritis (21, 75%), followed by systemic lupus erythematosus (7, 25%), 14 of them (50%) were pregnant in the first 5 years after starting sex life. There were no differences in age of onset of sex life (p = 0.362), or other clinical characteristic, but women with pregnancies in the first lustrum had lower percentages of marriage union (35% vs 42%), paid-work (21% vs 28%), and use of highly effective contraception (21% vs 28%).Conclusion:Conclusions: No factors were identified for pregnancies in the first lustrum, but there is a tendency to occur in single women, non-employees, and users of non-highly effective contraceptives methods. Further studies with a larger population are necessary to find modifiable factors and improve outcomes.Table 1.Clinical characteristics.Obstetric event before 5 yearsObstetric event after 5 yearsp-valueTotal1414Current average age24.85 +/- 4.329.92 +/- 5.70.404Age at the first obstetric event, years20.92 +/- 2.928.00 +/- 5.90.05Age at the onset of rheumatic disease, years20.71 +/- 5.523.42 +/- 4.00.135Average age of onset of sex life, n (%)18.64 +/- 2.918.07 +/- 2.50.362Alcoholism consumption, n (%)3 (21.42)4 (28.57)0.663Tobacco use, n (%)3 (21.42)3 (21.42)Diabetes mellitus, n (%)0 (0)1 (7.14)0.309Hypertension, n (%)1 (7.14)0 (0)0.309Depression, n (%)3 (21.42)1 (7.14)0.280Anxiety, n (%)2 (14.28)1 (7.14)0.541Pre-pregnancy medicationMethotrexate, n (%)3 (21.42)5 (35.71)0.403Leflunomide, n (%)1 (7.14)2 (14.28)0.541Sulfasalazine, n (%)3 (21.42)2 (14.28)0.622Hydroxichloroquine, n (%)6 (42.85)4 (28.57)0.430Azathioprine, n (%)1 (7.14)0 (0)0.309Cyclophosphamide, n (%)2 (14.28)0 (0)0.142Glucocorticoids, n (%)5 (35.71)5 (35.71)NA: Not applicable.Image 1.Demographic characteristics.References:[1]Østensen, M., 2017. Sexual and reproductive health in rheumatic disease. Nature Reviews Rheumatology, 13(8), pp.485-493.[2]Birru Talabi, M., Clowse, M., Blalock, S., Switzer, G., Yu, L., Chodoff, A. and Borrero, S., 2019. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatology, 3(1).[3]Jawaheer, D., Zhu, J., Nohr, E. and Olsen, J., 2011. Time to pregnancy among women with rheumatoid arthritis. Arthritis & Rheumatism, 63(6), pp.1517-1521.[4]Brouwer, J., Fleurbaaij, R., Hazes, J., Dolhain, R. and Laven, J., 2017. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care & Research, 69(8), pp.1142-1149.Disclosure of Interests:None declared

Background:Clinically relevant anti-carbamylated (anti-CarP) antibodies are detected in up to 45% of rheumatoid arthritis (RA) patients and are associated with severe radiological progression, higher disease activity, and significantly more disability when studied in early phases of arthritis.Objectives:We aimed to determine the prevalence of anti-CarP antibodies in Mexican Hispanics with established RA and to assess their relationship with disease activity.Methods:A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up.Results:Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months.Conclusion:Anti-CarP IgG antibodies are present in almost 50% of RA patients and, accounting for all isotypes, in 9% of RF and ACPA negative patients. Anti-CarP IgG antibody positivity was not associated to a higher disease activity measured by DAS28-ESR in Hispanic patients with established RA.References:Shi J, Knevel R, Suwannalai P, Van Der Linden MP, Janssen GMC, Van Veelen PA, et al. Autoantibodies recognizing carbamylated proteins are present in sera of patients with rheumatoid arthritis and predict joint damage. Proc Natl Acad Sci U S A. 2011;108:17372–17377.Table 1.Anti-CarP antibody status by isotype in a cohort of 278 patients with established RA.Mean (SD)Antibody positivity,n (%)95% CIRF IgAa266.9 (460.5)155 (58.9)53.0 to 64.9RF IgMa406.8 (611.9)188 (71.5)66.0 to 77.0RF IgGa36.1 (249.6)44 (16.7)12.2 to 21.3ACPA IgGa191.01 (411.1)144 (54.8)48.7 to 60.8Anti-CarP IgAb212.9 (464.2)74 (26.6)21.4 to 31.8Anti-CarP IgMb381.6 (762)89 (32)26.5 to 37.5Anti-CarP IgGb227.5 (402.5)133 (47.8)41.9 to 53.8aData were available for 263 patients. Units are RU/mL. bData were available for 278 patients. Units are AU/mL. RF, rheumatoid factor; ACPA, anticitrullinated protein antibodies; Anti-CarP, anti-carbamylated protein antibodies; IgG, immunoglobulin; SD, standard deviation; 95% CI, 95% confidence intervals.Figure 1.Disclosure of Interests:David Vega-Morales Grant/research support from: This research was funded as an Investigator Initiated Study by UCB (IIS-2015-104068). The sponsor did not have any role in the design or outcomes of this study., Mario Alberto Garza Elizondo: None declared, Leendert A Trouw: None declared, Karina Itzel González Márquez: None declared, Ernesto Torres-Lopez: None declared, Myriam Eguia Bernal: None declared, SALVADOR AZAHEL LOREDO ALANIS: None declared, Tayde Sarahi Gracia-Arechiga: None declared, Brenda Roxana Vázquez Fuentes: None declared, Diana Daniela Castañeda Martínez: None declared, Martha Mariana Castañeda-Martínez: None declared, Cesar Vidal Solis: None declared, Andres Mendiola-Jimenez: None declared, Mario Cesar Salinas-Carmona: None declared, Pablo Herrera-Sandate: None declared, Alberto Cárdenas: None declared, Gerardo Eugenio Rodriguez-Sanchez: None declared, Dionicio Ángel Galarza-Delgado: None declared

Background:Gender violence is a prevalent issue worldwide. In Mexico, four out of ten women suffer any kind of violence. The factors that make women even more vulnerable to domestic violence are pregnancy, socioeconomic status, educational level, and the presence of chronic health problems. Violence represents a major risk factor for depression, anxiety, poor adherence to medical treatment, and obstetric adverse events.Objectives:The aim of this study is to determine the frequency of domestic violence in pregnant and postpartum women with autoimmune rheumatic diseases (ARD) and to compare with childbearing age women with ARD.Methods:Pregnant and postpartum women (PPW) with rheumatic disease evaluated at the Pregnancy and Rheumatic Diseases Clinic from the University Hospital “Dr. José E. González” in Monterrey, México from August to October 2020 were invited to participate. To compare, we enrolled childbearing age women with ARD without previous pregnancies. The Spanish validated version of the Hurt, Insulted, Threatened with Harm, Screamed scale (HITS) was applied via telephonic interview. The HITS scale evaluates in 4 questions the presence and frequency of violence by their intimate partners in the last 12 months. A score ≥ 10 points is considered as positive for violence.Results:A total of 48 women were included, 24 patients each group. The pregnant-postpartum group was divided in 6 (25) pregnant and 18 (75) postpartum women. Most of them were housewives (54.1%) with >10 years of education and with not formalized marital status 41% (common-law marriage). In the childbearing age group, most of them were employees (70.8), with >10 years of education with a current marital status of single (66.6%). The HITS scale was positive in the pregnant-postpartum group in 4 women (16.6%). Two of them had been victims of sexual assault and 2 reported physical/verbal violence. While in childbearing age group only 1 (4.16) reported physical/verbal violence.Conclusion:The 16% of the pregnant-postpartum group in our sample were suffering from domestic violence by their intimate partners, in contrast to the childbearing age group with only 1 patient reported violence. We found that postpartum and pregnancy women had more prevalence of violence. Screening for domestic violence followed by counseling and early referral are necessary to mitigate the physical and psychological consequences of domestic violence.References:Moreira DN, Pinto da Costa M. The impact of the Covid-19 pandemic in the precipitation of intimate partner violence. Int J Law Psychiatry. 2020;71:101606. doi:10.1016/j.ijlp.2020.101606.Jackson CL, Ciciolla L, Crnic KA, Luecken LJ, Gonzales NA, Coonrod DV. Intimate partner violence before and during pregnancy: related demographic and psychosocial factors and postpartum depressive symptoms among Mexican American women. J Interpers Violence. 2015;30(4):659-679. doi:10.1177/0886260514535262.Table 1.Sociodemographic characteristics and scale resultsPostpartum and pregnancy womenn= 24Childbearing age womenn= 24Age, years, mean27.527.08Occupation, n (%)Housewive13 (54.1)5 (20.8)Employee7 (29.1)17 (70.8)Student4 (16.6)2 (8.3)Education years, n (%)Less than 10 years11 (45.8)7 (29.1)More than 10 years13 (54.1)17 (70.8)Marital status, n (%)Common-law marriage10 (41.6)-Married8 (33.3)8 (33.3)Single6 (24.9)16 (66.6)Status, n (%)Postpartum18 (75)-Pregnancy6 (25)-Results of the HITS scaleTotal, mean5.374.37Score per ranges, n (%)0 – 9 points20 (83.3)23 (95.8)10 – 20 points4 (16.6)1 (4.1)Disclosure of Interests:None declared

Background:Rheumatic diseases (RD) are more frequent among women of childbearing age. Adverse events during pregnancy in RDs have been frequently reported, leading some women to avoid pregnancy. “CEER” is an outpatient clinic in Monterrey, Nuevo Leon, Mexico, that was created for pregnant women with RD.Objectives:The objective is to describe pregnancy outcomes in patients with RD surveilled at a rheumatology outpatient clinic.Methods:A single-center retrospective study of women with RD at CEER between 2017 and 2020 was conducted. Clinical features and maternal, fetal and neonatal outcomes were retrospectively collected. The rate of adverse perinatal outcomes (APO) was compared with the tertiary referral center´s general obstetric population (GOP). All data was retrieved from clinical files.Results:Overall, 62 pregnancies in women with RD were recorded. The median maternal age at conception was significantly higher in pregnancies with RD than GOP (29 [24-35] years old vs 23 [19-28] years old, pCesarean sections were recorded in 41 pregnancies in RD group, more frequent than in GOP (66.1% vs 50.8%, p=0.016). Figure 1 shows the distribution of indications for cesarean sections, the two leading indications were previous cesarean section (43.9%) and Nonreassuring fetal heart rate pattern (19.5%) Pregnancies with RD appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (12.9% vs 15.9%, p=0.02 and 23.7% vs 12.2%, p=0.006, respectively).Conclusion:Pregnancies with RD were at increased risk for APO. Women of this population should be made aware of these risks and be closely monitored by a multidisciplinary team as a high-risk pregnancy.References:[1]Aljary H, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Pregnancy outcomes in women with rheumatoid arthritis: a retrospective population-based cohort study. J Matern Fetal Neonatal Med. 2020;33(4):618-24.[2]Alvarez-Nemegyei J, Cervantes-Díaz MT, Avila-Zapata F, Marín-Ordóñez J. [Pregnancy outcomes before and after the onset of rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2011;49(6):599-604.[3]Davutoğlu EA, Ozel A, Yilmaz N, Madazli R. Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet. 2017;296(6):1079-84.[4]Harris N, Eudy A, Clowse M. Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019;71(3):390-7.[5]Ideguchi H, Ohno S, Uehara T, Ishigatsubo Y. Pregnancy outcomes in Japanese patients with SLE: retrospective review of 55 pregnancies at a university hospital. Clin Rev Allergy Immunol. 2013;44(1):57-64.Table 1.Pregnant outcome, maternal, fetal and neonatal adverse eventsRD (n=62)GOP (n=31254)OR (CI 95%)pPregnancy outcomePregnancy lossa6 (9.68)1560 (4.99)1.94 (0.84-4.49)0.122Live birthsa60 (90.9)29694 (95)0.96 (0.67-1.35)0.8Gestational age,median (IQR) (weeks)b37.6 (37-39)39 (38-40.2)-Birth weight,mean (CI) (Kg)c2831.6(2677.4-2985.8)3022.2(2986.8-3057.6)-0.007Maternal adverse eventsPreterm deliveries(a14 (23.7)3821 (12.2)1.85 (1.03-3.3)0.038a3 (5.1)1065 (3.4)1.42 (0.45-4.53)0.553Gestational diabetesa4 (6.5)1406 (4.5)1.43 (0.52-3.95)0.485Preeclampsiaa5 (8.1)2471 (7.89)1.02 (0.41-2.54)0.97Postpartum hemorrhagea0930 (2.97)0.27 (0.017-4.35)0.355Emergency cesarean sectiona8 (12.9)1844 (5.9)2.19 (1.05-4.57)0.037Fetal adverse eventsMiscarriagesa3 (4.8)663 (2.12)2.28 (0.71-7.29)0.164Stillbirthsa3 (4.8)897 (2.87)1.69 (0.53-5.38)0.377Congenital abnormalitiesa4 (6.5)1094 (3.5)1.84 (0.67-5.08)0.237an,%bIQR, interquartile range (25th–75th percentile)cCI, confidence interval (95%)Disclosure of Interests:None declared

Background:In Mexico, the SARS-CoV-2 pandemic has totaled almost two million cases and exceeded 150,000 deaths (29/01/2021). Currently, COVID-19 has become the leading cause of death in pregnant women in Mexico. COVID-19 has additionally impacted the psychological health of individuals including women with rheumatic diseases.Objectives:The aim of this study is to compare the Fear of COVID-19 Scale (FCV-19S) in postpartum women with and without autoimmune rheumatic diseases.Methods:A cross-sectional, descriptive, and comparative study was conducted. The Spanish FCV-19S version was applied by telephone or e-mail. The instrument consists of seven items, each with a five-point Likert scale of options. The participant must choose the options that best represent their perception about the statements presented. The maximum possible total is 35 points. Sociodemographic information was collected from the clinical charts. The Kolmogorov-Smirnov test was used to determine normality of the data. Statistical analysis was done using the Mann-Whitney U test.Results:Forty-four postpartum women were included (22 from the Pregnancy and Rheumatic Diseases Clinic and 22 from the Obstetrics Department, both groups from the University Hospital “Dr. José E. González in Monterrey, México). The mean level of fear found in women with rheumatic disease was 16 (6.6) points versus 14 (4.6) points in the non-rheumatic patients group. No significant difference was found between groups (p=0.65). Regarding the rheumatic diseases group, women in the category of other diagnoses (that included Sjögren’s Syndrome, antiphospholipid syndrome, and dermatomyositis) had a greater mean FCV-19S score (20.2), than patients with systemic lupus erythematosus (17.3) and rheumatoid arthritis (15.4).Conclusion:Women with postpartum rheumatic disease had a higher FCV-19S score than postpartum women without rheumatic diseases, although this difference was not statistically significant.References:[1]Lumbreras-Marquez MI, Campos-Zamora M, Seifert SM, et al. Excess Maternal Deaths Associated With Coronavirus Disease 2019 (COVID-19) in Mexico. Obstet Gynecol. 2020;136(6):1114-1116. doi:10.1097/AOG.0000000000004140[2]Yan H, Ding Y, Guo W. Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Psychol. 2020;11:617001. Published 2020 Nov 25. doi:10.3389/fpsyg.2020.617001Table 1.Sociodemographic dataWomen with rheumatic diseasesN= 22Women without rheumatic diseases N= 22p=Age, years, mean, (SD)28 (6.8)23 (5.0)0.65Occupation, n (%)Housewive14 (63.6)18 (81.8)Employee5 (22.7)3 (13.6)Other3 (13.6)1 (4.5)Education level, n (%)0.28Middle school10 (45.45)16 (72.72)High School8 (36.36)5 (22.72)College4 (18.18)1 (4.54)Rheumatic diagnosis, n(%)Rheumatoid arthritis9 (40.9)Systemic lupus erythematosus8 (36.6)Others (SS, APS, DM)5 (22.7)SS: Sjögren’s syndrome, APS: antiphospholipid syndrome, DM: dermatomyositisDisclosure of Interests:None declared.

Background:Primary Sjögren’s syndrome (pSS) and systemic lupus erythematosus (SLE) share several clinical manifestations including neurological involvement. Cognitive dysfunction is a common neuropsychiatric manifestation in both, but evaluation and diagnosis is often challenging and delayed. The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized cognitive screening tool that does not need specialized personnel to apply and is less time consuming than other tests.Objectives:Assess cognitive function of SLE and pSS patients with a computer-based tool (ANAM) in a single rheumatology clinic, compare its performance, and record their clinical and demographic characteristicsMethods:We recruited patients from the rheumatology clinic of the UANL University Hospital who met the pSS 2002 AECG or ACR-EULAR 2016 classification criteria and SLE patients fulfilling SLICC 2012 criteria. We defined mild cognitive impairment as 1 to 1.9 SD below controls, and moderate-severe cognitive impairment as 2 SD or more below the comparison group (subjects matched by age, sex, ethnicity and educational level by the ANAM program) as previously employed in SLE.Percentages were used for categorical variables and means (±SD) for numerical ones. To observe differences between groups, chi square and Student´s t were used,pResults:A significant difference was observed in the total ANAM score between SLE and pSS patients (Table 1). In SLE, the most affected domains were simple reaction time, code substitution and delayed memory; in pSS patients, the most affected domains were inhibition and spatial work memory (Table 2).Table 1.Differences in ANAM performance between pSS and SLE.VariablepSSmean, (SD)SLEmean, (SD)pFemale, %92.293.50.77Age (years)56.25 (10.45)31.99 (13.17)0.001Disease duration (years)6.38 (6.15)5.61 (6.1)0.492ANAM total score-1.43 (0.85)-1.87 (0.96)0.008Simple reaction time25.554.50.001Simple reaction time score148.39 (32.44)144.13 (52.37)0.571Code substitution (Learning)13.79.10.411Code substitution (Learning) score33.39 (8.42)38.61 (14.23)0.001Procedural reaction time-Attention15.727.30.125Procedural reaction time-Attention score70.29 (12.11)73.17 (17.68)0.277Mathematical processing11.8130.838Mathematical processing score17.92 (11.07)15.57 (6.63)0.177Matching to sample-spatial work memory21.67.80.025Matching to sample-spatial work memory score20.08 (7.66)22.26 (8.72)0.139Code substitution-delayed memory15.77.80.161Code substitution-delayed memory score26 (11.57)33.69 (18.99)0.005Simple reaction time21.632.90.165Simple reaction time score148.88 (24.82)166.29 (38.87)0.004Go/No-Go, Inhibition21.65.20.005Go/No-Go, Inhibition score3.41 (1.573.27 (1.68)0.635Conclusion:Cognitive impairment was common in both diseases but the cognitive domains affected were different. Rheumatologists should be aware of these differences when evaluating cognitive dysfunction in SLE and pSS patients.References:[1]Kurtuluş F, Çay H, Parlak E, Yaman A. Montreal cognitive assessment in primary sjogren’s syndrome. A brief screening tool. Neurosciences. 2019;24(3):199-206.[2]Tayer-Shifman O, Green R, Beaton D, Ruttan L, Wither J, Tartaglia M et al. Validity evidence supports the use of automated neuropsychological assessment metrics as a screening tool for cognitive impairment in lupus. Arthritis Care & Research. 2019;.Disclosure of Interests:None declared

Background:Cognition is the ability to learn, process and remember information to be used later.(1) Cognitive impairment reflects a decrease in one or more cognitive domains: memory, language, reasoning, among others.(2) It has been reported in rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, fibromyalgia, and it is frequently found in young patients during the first years of their illness correlating the disease progression.(3) This condition can lead to anxiety and depression, compromising the quality of life. Given the lack of consensus regarding the best test to diagnose cognitive impairment, multiple tools have been used to address this problem.Objectives:To describe the systematical assessment in a Cognitive Evaluation and Rehabilitation Clinic in rheumatic patients from a University Hospital in Mexico.Methods:Observational and descriptive study. A multidisciplinary team met for 6 months to establish the structure a Cognitive Evaluation and Rehabilitation Clinic in a University Hospital in Mexico (Figure 1). As a pilot group we included outpatients from a Rheumatology clinic, referred by their physician (Table 1). The following psychological tests were used: Montreal Cognitive Assessment (MoCA) and Neurobehavioral Cognitive Status Examination (NCSE). After results (Table 2), the team decided to extend the evaluation with Automated Neuropsychological Assessment Metrics (ANAM), Wechsler Adult Intelligence Scale (WAIS-IV) and International Neuropsychiatric Interview (MINI) (Figure 2). Statistical analysis was performed with SPSS v.24, descriptive statistic were used with measures of central frequency trend.Table 1.Demographic characteristicsN=21Age, mean (SD)43.62 (14.68)Female, n (%)14 (66.66)Years of education, mean (SD)15.24 (2.70)Psychiatric disorderDepression, n (%)4 (19.04)Rheumatic diagnosisSystemic lupus erythematosus, n (%)13 (61.90)Rheumatoid arthritis, n (%)3 (14.30)Others, n (%)5 (23.80)Table 2.Comparison of MoCA and NCSE results.MoCAN=21NCSE N=21Total score, mean (SD)24.24 (3.49)38.52 (1.69)Level of cognitive impairmentNormal, n (%)7 (33.3)17 (81)Mild, n (%)13 (61.9)1 (4.8)Moderate, n (%)1(4.8)3 (14.2)Severe, n (%)0 (0)0 (0)MoCA, Montreal Cognitive Assessment; NCSE, Neurobehavioral Cognitive Status Examination.Figure 1.Pilot program of the Neurocognitive AssessmentFigure 2.Final Program of the Neurocognitive AssessmentResults:We evaluated 21 patients (66% females) with an average age of 43.62 years (SD 14.6) (Table 1). The total number of patients with cognitive impairment was 15 (71%), 14 (66%) diagnosed with MoCA, 6 (28%) with NCSE and a coincidence of both tests in 4 (19%) patients (Table 2).Conclusion:A high percentage of patients with cognitive impairment was found, also a discrepancy between the MoCA and NCSE results. We realized those tests were not enough to get a detail cognitive functioning, for this reason it was decided to make a more extensive evaluation adding ANAM, WAIS-IV and MINI. Neuropsychological evaluation should be performed as part of a multidisciplinary management for the patient and the rheumatologist should be aware of this manifestation and the importance of cognitive testing.References:[1]Gutierrez Rodriguez J, Guzman Gutierrez G. Definition and prevalence of mild cognitive impairment. Rev Esp Geriatr Gerontol. 2017;52 Suppl 1:3-6.[2]Quijano JP-CyTdS. Evaluación Neuropsicológica y Funcional de la Demencia. Barcelona1996.[3]Wijbrandts CA, Tak PP. Prediction of Response to Targeted Treatment in Rheumatoid Arthritis. Mayo Clin Proc. 2017;92(7):1129-43.Disclosure of Interests:None declared

Background:Osteoporosis (OP) is characterized by compromised bone strength and deterioration of quality, often leading to fragility fractures (1). Dual-energy x-ray absorptiometry (DXA) is the recommended test for OP screening among patients with rheumatoid arthritis (RA) and other RD (2). However, there are limitations to perform DXA on every patient, and the clinicians use screening tools to identify those patients with higher risk. The opportune identification of the patients at increased risk and early treatment can prevent the loss of bone mineral density (BMD) and reduce the risk of fractures(3).Objectives:To evaluate the FRAX risk and its correlation with the spine and femoral neck T-score in patients with RD.Methods:An observational retrospective study was done in the rheumatology clinic of the university hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between March and November 2019. Patients who had reported DXA from the spine and hip in the medical record were included. The risk factors included in FRAX tool was collected; FRAX tool was used online athttps://www.sheffield.ac.uk/FRAX/(algorithm for Mexicans) and classified as low (Results:141 patients were included, Patients with OP was older (mean 62.6 years), weight and height were higher in those with normal BMD. There was no difference between the use of glucocorticoids or other risk factors (Table 1). According to FRAX risk for OP, 122 (86.5%) had low risk, 14 (9.9%) had intermediate risk and only 5 (3.5%) had high risk. According to FRAX risk for hip, 81 (57.4%) had low risk, 38 (27.0%) had intermediate risk and only 22 (15.6%) had high risk (Table 2). There was a low negative correlation between spine T-score and FRAX risk for OP (r= -0.396, P=Table 1.FRAX score risk factorsNormal BMDN= 27Low BMDN= 66OsteoporosisN= 48PAge, years, mean (SD)46.8 (10.6)56.5 (11.7)62.6 (9.1)Female, n (%)24 (88.8%)61 (92.4)43 (89.5)0.814Weight, kg, mean (SD)76.6 (14.6)66.4 (12.1)64.8 (10.6)0.001*Height, cm, mean (SD)156.7 (7.5)152.3 (6.8)153.3 (7.1)0.034*Previous Fracture, n (%)----Parent Fractured Hip, n (%)----Current Smoking, n (%)-2 (3.0%)4 (8.3%)0.060Glucocorticoids, n (%),15 (55.5%)30 (45.4%)19 (39.6%)0.411Rheumatoid arthritis, n (%)18 (66.6%)40 (60.6%)21 (43.7%)0.040*Secondary osteoporosis, n (%)----Alcohol use, n (%)1 (3.7%)2 (3.0%)1 (2.0%)0.631Osteoporosis treatment, n (%)-16 (24.2%)42 (87.5%)Table 2.BMD and FRAX riskNormal BMDN= 27Low BMDN= 66OsteoporosisN= 48PFRAX risk for OP, n (%)Low risk, (n=122)27 (100%)63 (95.4%)32 (66.6%)Intermediate risk, (n=14)-3 (4.5%)11 (22.9%)0.001*High risk, (n=5)--5 (10.4%)0.007*FRAX risk for hip, n(%)Low risk, (n=81)26 (96.3%)45 (68.1%)10 (20.8%)Intermediate risk, (n=38)1 (3.7%)18 (25.7%)20 (41.6%)0.001*High risk, (n=22)-4 (6.0%)18 (37.5%)Conclusion:Most of the patients were classified as low risk for OP and hip, including a high amount of those with OP showing a low and moderate correlation with DXA respectively.References:[1]Ann Intern Med. 2017;166(11):818-839[2]Osteoporos Int. 2014; 25(10): 2359-81[3]Arthritis Rheumatol. 2019;71(Suppl 10):3924-3925Disclosure of Interests:None declared

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

Background:The importance of safe and effective contraception for women with rheumatic diseases has been increasing.1Several studies have demostrated that carefully planned pregnancies are related with better outcomes making the use of contraceptive methods (CM) more significant.Objectives:To describe the use of methods of contraception among Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE).Methods:A Cross-sectional study where women aged 18-45 followed in our CEER outpatient clinic, at Monterrey, Mexico, were questioned about the use of CM. Sociodemographic data was collected from the medical record.CM were classified as Ineffective (10-25% pregnant each year), effective (6-9% pregnant each year) and highly effective (The statistical analysis was performed using SPSS 24.0. Ap<0.05was taken to indicate statistical significance.Results:A total of 91 patients were included, 35 (38.5%) SLE patients with a median age of 30 years (22-39) and 56 (61.5%) RA patients with a median age of 34.5 years (27.25-40). From the total population, 58 (63.7%) reported the use of teratogenic drugs, with a higher use in RA patients (p Table 1.Table 1.Socio-demographic characteristics.RA(n=56)SLE(n=35)pAge,years, median (IQR)34.5 (27.25-40)30(22-39)Disease duration,years, median (IQR)3.5 (1.25-7.75)4 (1-7)Onset of Sexual activity,n (%)46 (82.1)24 (68.6).135Onset of Sexual activity age, median (IQR)18 (17-20)14 (17-20)Sexually Active,n (%)*34 (60.7)18 (51.4).384Use of teratogenic drugs,n (%)44 (78.6%)14 (40%)RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus. *Sexual activity in the last month.Among the patients that had started sexual activity (SLE=24, RA=46), the most common CM was tubal ligation 26 (28.6%)Graphic 1. In this group, 49 (70%) patients received contraceptive counseling, however, 21 (42%) patients were using innefective CM.Table 2.According to effectiveness, highly efective were the most frequent method used in patients that had started sexual activity (n=39, 55.7%)Graphic 2.Conclusion:Despite highly effective CM were more frequent in patients that had started sexual activity, 42% of patients that received contraceptive counseling reported the use of inneffective methods. It is neccesary to promote the counseling and use of contraception and provide a multidisciplinary support among rheumatoid patients.Table 2.Methods according to effectiveness in patients that received contraception counseling.GRADE OF EFFECTIVENESSn (%)PatientsThat receive Contraceptive counselingInneffectiveEffectiveHigly effectiveRA= 4630 (65.21)12 (40)1(3.3)17 (56.6)SLE= 2419 (79.16)9 (47.3)1 (5.2)9 (47.36)Total = 70 *49 (70)21 (42)2 (4.08)26 (53.06)RA= Rheumatoid Arthritis; SLE= Systemic Lupus Erythematosus. * Total of patients that have started sexual activity.References:[1]Sammaritano, L. R. (2014). Contraception in Rheumatic Disease Patients. InContraception and Pregnancy in Patients with Rheumatic Disease(pp. 201-227). Springer, New York, NY.Figure 1.Graphic 1. This graphic shows the frequence in percentage % of contraceptive methods used by Rheumatoid Arthritis (RA) n=56 and Systemic Lupus Erythematosus (SLE) n=35 patients, which are categorized by the grade of effectiveness. Only were included patients that had started sexual activity.Figure 2.Graphic 2. This graphic shows the percentage of use according to the effectiveness of contracetive methods. RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus. Only were included patients that had started sexual activity.Disclosure of Interests:None declared

Background: RA patients have high latent tuberculosis(LTBI)prevalence(20-37%)1. In Mexico,ranges from 21.7% to 31.3% using tuberculin skin test (TST)2. The methods to detect LTBI are TST and IGRAs. QuantiFERON Gold-Plus (QTF-Plus)uses an antigen tube (TB1) that stimulates CD4+T cells and an additional tube (TB2) that also stimulates CD8+T cells3. Objectives: Determine the LTBI prevalence,variables that predict QTF-Plus and TST results and the concordance between TST and QTF-Plus in RA patients. Methods: A cross-sectional study in RA patients from the rheumatology department of the University Hospital “Jose E. Gonzalez” in Mexico between October 2017 and June 2018. RA patients with ACR/EULAR 2010 classification criteria without a history of tuberculosis (TB) were included.QFT-Plus was performed according to manufacturer instructions.TST was applied with the Mantoux technique; a ≥5mm cutoff was used.The square chi and Fisher test were used for proportions, Mann-Whitney to compare means,trend analysis using linear trend test and a binary logistic regression model for variables related to positivity to both tests. Results: We included 111 patients (table 1), the mean age was 51.9 years, 92.3% were women,disease duration 8.7±8.8 years. QTF-Plus was positive in 46 (44.6%) patients. TST was positive in 31(27.9%) patients.Agreement between tests was 73.7% (kappa=0.45, p Conclusion: The LTBI prevalence in RA patients in our study is similar to countries with a high TB burden.We recommend considering RA patients as a high-risk population for LTBI.An intermediate agreement between TST and QTF-Plus was found.The use of antimalarials and ≥2DMARDs influence the TST reactivity,none of the variables altered the QTF-Plus results.Based on the results, we recommend the QuantiFERON Gold Plus over TST for the LTBI screening in RA patients. References: [1] Sester M,et al.Am J Respir Crit Care Med.2014;190(10):1168–76. [2] Perez-Barbosa L,et al.Rheumatol Int.2015;35(9):1555–9. [3] Takasaki J,et al.J Infect Chemother.2018;24(3):188–92. Disclosure of Interests: None declared

Background Comorbidities are an important issue to consider in patients with rheumatic diseases (RD), as well as the clinical assessment of the autoimmune disease. Looking for concomitant diseases is a necessary step for a global approach of the rheumatic patient, knowingly that some diseases are more frequent in patients with RD than in the general population and could influence the course of RD and achievement of treatment goals1. Despite this, there is a need of new evidence about primary Sjogren’s Syndrome (pSS) comorbidities and their association with clinical outcomes. Objectives To determine the prevalence of comorbidities in patients with pSS in mexican population. Methods This was a national, multicenter, cross-sectional, and observational study. We included 393 patients with pSS, diagnosed according to the American-European Consensus Group (AECG) criteria 2002 or ACR/EULAR 2012 criteria. Comorbidities, serological profile of autoantibodies, Schirmer’s test, sialometry and histopathological assessment from minor salivary gland biopsies reported in the medical records were evaluated by a rheumatologist. The comparisons between the study groups were carried out using the two-tailed Student’s t test, χ2 test, and unidirectional. A value of p Results At least one comorbidity were reported in 310 (78.9%) patients, 2 to 4 comorbidities were reported in 183 (46.6%), and only 18 (4.6%) had a least 5 comorbidities. Thyroid disease was the most frequent comorbidity, observed in 91 (23.2%) subjects, being hypothyroidism the main cause. Smoking (21.9%) and hypertension (19.6%) were in second and third place. Psychiatric disease was present in 62 (15.8%) patients being depression and anxiety disorders the most frequent, appearing in 49 (79%) and 12 (19.35%) patients respectively. Regarding malignancy, we documented 10 (2.5%) patients with lymphoma, and 4 (1%) patients with breast cancer. The rest of comorbidities are shown at Figure 1 and Table 1. There was no significant difference for each variable measured between the groups except for the mean age (p= 0.001). Conclusion The systematic evaluation of comorbidities in patients with pSS is essential for an integral management. Physicians should be aware that these conditions might directly impact quality of life, prognosis, treatment response and healthcare costs. We encourage further research for the identification of new approaches in benefit of the patients. References [1] Yurkovich, et al. (2014). Overall and Cause-Specific Mortality in Patients With Systemic Lupus Erythematosus: A Meta-Analysis of Observational Studies. Arthritis Care & Research, 66(4), 608–616. https://doi.org/10.1002/acr.22173. Disclosure of Interests None declared

Background: In Sjogren’s Syndrome (SS), ocular damage is mediated by inflammation induced by antibodies, enzymes, and other effectors that could be used as clinical indicators of the ocular surface damage. There is evidence suggesting that increased activity of matrix metalloproteinases (MMPs) is corelated with an increased ocular damage because of its potential inflamatory activity and could be used as a potential therapeutic target for dry eye1,2. Very few studies have addressed the rol betwen the ocular MMPS and the clinical parameters of SS. Objectives: To determine the level of correlation between the serological profile of autoantibodies with ophthalmological parameters at the cornea level. Methods: Cross-sectional, observational, and descriptive study. Sixty patients with a diagnosis of primary Sjogren’s syndrome (pSS) classified according to the ACR/EULAR 2016 criteria were included. The following measurements were made: Schirmer test, lacrimal osmolarity, ocular staining score (OSS), and ocular surface disease index (OSDI) and metalloproteinase-9 (MMP-9) in tear and antibodies were measured in peripheral blood serum: RF isotypes (IgA, IgG, IgM), anti-SSA/Ro and anti-SSB/La in. Results: Fifty-eight women participated (96.7%) with an average age of 53 years (± 13.01) (Table 1). We found a positive correlation between OSS and RF-IgM (rho=0.385 P=0.002), RF-IgA (rho=0.256 P=0.049), and anti-Ro/SSA (rho=0.302 P Conclusion: A significant correlation was observed between serology, ocular surface damage (OSS), and ocular surface inflammation (MMP-9). The positivity of RF isotypes IgM and IgA could alert the clinician about the ocular damage to initiate a study directed to this organ. Nevertheless this present study shows preeliminary outcomes, we need to enroll more patients to obtain better outcomes. References: [1] Aluri, H. S., et al. (2015). Role of Matrix Metalloproteinases 2 and 9 in Lacrimal Gland Disease in Animal Models of Sjogren’s Syndrome. Investigative ophthalmology & visual science, 56(9), 5218-28. [2] Messmer, E. M., et al. (2016). Matrix Metalloproteinase 9 Testing in Dry Eye Disease Using a Commercially Available Point-of-Care Immunoassay. Ophthalmology, 123(11), 2300–2308. https://doi.org/10.1016/j.ophtha.2016.07.028. Disclosure of Interests: None declared

Background: Primary Sjogren’s syndrome (pSS) has several classification criteria, whose diagnostic performances vary depending on the studied population1. Concordance and differences among these criterias should be evaluated for independent populations to determine the diagnostic performance. Objectives: To compare the performance among 3 classification criteria for pSS and determine the level of concordance among them. Methods: Descriptive, retrospective, and cross-sectional study including 172 patients from the Rheumatology Service of the Hospital Universitario ”Dr. Jose Eleuterio Gonzalez”, who were studied for dry syndrome. The clinical criterion of the attending physician was considered as the gold standard for diagnosis. Different parameters were collected: presence of xerostomia, xerophthalmia, Schirmer’s test, sialometry, ocular staining, ANA, anti-Ro/SSA and anti-La/SSB antibodies, RF isotypes (IgA, IgM, IgG), and focal lymphocytic infiltrate in minor salivary gland biopsy. The criteria proposed by the American European Consensus Group (AECG), ACR and, ACR/EULAR were used to evaluate the classification. Compliance was determined for each set of criteria. Results: Sociodemographic characteristics and clinical manifestations are shown in Table 1. For the AECG, ACR, and ACR/EULAR criteria, the sensitivity was 89.1%, 98.9% and 88% and the specificity was 93.8%, 71.3%, and 96.3%, respectively (Table 2). The ACR/EULAR criteria have an adequate level of agreement (k=0.663, P AECG: American European Consensus Group criteria; Conclusion: In our population, the ACR criteria showed the highest sensitivity, while the ACR/EULAR criteria showed the highest specificity, showing a moderate level of agreement. Despite the validation of these criteria, its application in real life tests its performance according to the population studied. References: [1] Tsuboi, H., et al. (2017). Comparison of performance of the 2016 ACR-EULAR classification criteria for primary Sjogren’s syndrome with other sets of criteria in Japanese patients. Annals of the Rheumatic Diseases, 76(12), 1980?1985. https://doi.org/10.1136/annrheumdis-2016-210758. Disclosure of Interests: None declared

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

Background:Systemic Lupus Erythematosus (SLE) is a heterogeneous chronic multisystemic disease that has an increased risk of requiring inpatient management with higher morbidity and mortality rates.The most frequent causes of mortality are a high disease activity, infections, and cardiovascular diseases.Objectives:To determine the predictors of mortality in patients diagnosed with SLE.Methods:A longitudinal, descriptive, observational study was performed from March 2017-March 2020 at the University Hospital of the Autonomous University of Nuevo León, México, including patients with a diagnosis of SLE according to the ACR-EULAR 2012/2019 criteria.Descriptive statistics were used for demographic variables. Associations between mortality and clinical variables were determined using binary logistic regression analysis; a p Results:One-hundred and eighty-six patients with SLE diagnosis who fulfilled ACR-EULAR 2012/2019 criteria were included, 161 (86.6%) were women; the mean age was 35.8 (SD 15.41) years. The main chief complaints were dyspnea 31 (16.7%), fever in 28 (15.1%), renal involvement in 21 (11.29%), and arthritis in 19 (10.22%) patients.Of the 186 patients, 34 (18.3%) had a readmission, 13 (7%) required intensive care unit management, 68 (36.6%) had some type of infection and 22 (11.8%) died. Factors associated with mortality are shown in table 1.Patients receiving steroids and immunosuppression previous to hospitalization were 73 (39.2%) and 92 (49.5%) respectively.Conclusion:Infections remain the leading cause of death in SLE patients. Factors that predispose to infections are a chronic use of steroids and immunosuppression as well as high activity of disease.References:[1]Wu X-Y, Yang M, Xie Y-S, Xiao W-G, Lin J, Zhou B, et al. Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort. Clin Rheumatol. enero de 2019;38(1):107-15.Table 1.Association between clinical and therapeutic factors with mortality in SLE patients.Factors associated with mortalityUnivariadoMultivariadoβ (95 % IC)β (95 % IC)□Age0.93 (0.96-1.02)0.98 (0.96-1.02)Use of mechanical ventilation3.83 (1.07-13.4)*3.07 (0.59-16.04)Previous use of steroids3.92 (1.51-10.15)*2.04 (0.58-7.35)Previous use of immunosupression4.04 (1.42-11.45)*2.85 (0.71-11.48)Infection3.57 (1.41-9.01)*3.25 (1.19-8.86)*p Disclosure of Interests:None declared

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

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

Background:Dermatological manifestations are not rare in patients with rheumatic diseases (RD). Multidisciplinary management and direct interaction between these disciplines are essential. According to Dermatology-Rheumatology clinics, most diagnoses evaluated are systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), with dermatitis being the most common manifestation. It is important to be aware that skin problems in RD patients are not always related to the underlying condition(1). Nowadays, there is significant evidence to support the manifold advantages of the joint dermatology-rheumatology clinics, including improved quality of care for patients and multidisciplinary training for new physicians(2). This ongoing trend is intended to highlight the important interaction between specialties that treat overlapping conditions, and it has been incorporated in academic health centers to give a comprehensive approach to patients.Objectives:Our purpose was to describe the collaboration between the Rheumatology and Dermatology services during the evaluation of RD patients.Methods:An observational, retrospective study was performed in the Rheumatology Service of the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between March 2019 and February 2020. All the patients with a Rheumatology or Dermatology consultation requested were included (hospitalized and outpatients). Demographic (age, gender, baseline diagnosis), the reason for consultation, specialty requested, type of treatment, final diagnoses, and agreement in final diagnosis were registered. Results are shown in descriptive statistics.Results:One hundred and seventy-four patients were included, 142 (81.6%) patients from the outpatient clinic and 32 (18.4%) patients hospitalized. The mean age was 45.1 (SD±15.8) years, 135 (77.6%) were females, 54 (31%) patients were under initial diagnosis evaluation, 30 (17.2%) had RA, 25 (14.4%) patients had SLE, 15 (8.6%) patients had psoriatic arthritis, 12 (6.9%) patients had systemic sclerosis, 6 (3.4%) patients had dermatomyositis. The main reasons for consultation in hospitalized patients were acute lupus (15.6%), subacute lupus (12.5%), purpura (12.5%), cutaneous vasculitis (9.4%), urticarial dermatitis (9.4%), dermatomyositis (6.3%) and others (34.3%). The consultation requested was: 156 (89.7%) to Dermatology and 18 (10.3%) to Rheumatology. The type of treatment prescribed was topic/local in 37 (21.3%) patients, systemic in 25 (14.4%) and both in 92 (52.9%) patients. The final diagnoses were related to the underlying disease in 102 (77%) patients and unrelated in 40 (23%) patients. The agreement between initial clinical suspicion and final diagnoses reached 75.9% between Rheumatology and Dermatology services. Figure 1.Conclusion:The collaboration between Rheumatology and Dermatology services are very important. Most of the patients were under initial evaluation. All the rheumatologists and dermatologists should be aware of the interdependence from both specialties to give the best quality of care to the patients.References:[1]Samycia M, McCourt C, Shojania K, Au S. Experiences From a Combined Dermatology and Rheumatology Clinic: A Retrospective Review. J Cutan Med Surg. 2016;20(5):486-489. doi:10.1177/1203475416649138.[2]Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists?. Dermatol Ther. 2020;33(3):e13283. doi:10.1111/dth.13283Figure 1.Disclosure of Interests:None declared

Background:Clinically Suspect Arthralgia (CSA) was defined by European League Against Rheumatism to identify a combination of clinical features that best characterise patients with arthralgia who are at risk of progression to rheumatoid arthritis (RA) (1). A specificity >90% is obtained with the presence of ≥4 parameters. Another clinical feature useful to identify patients at risk is the squeeze test (ST). Recently, we have identified the necessary strength to screen the patient with arthralgia through ST, with a median squeeze force of 3 kg and 2.78 kg to evoke pain in the right and left hand of the RA patient, respectively (2). Primary care physicians (PCP), the first contact of patients at risk, could benefit from these screening tools, prompting early referral, diagnosis, and treatment of these individuals.Objectives:To identify the clinical utility of CSA and ST in the referral of patients with hand arthralgia from PCP to rheumatologists.Methods:We conducted a cohort study from October 2018 to December 2020 in 110 patients who attended a Family Medicine clinic at University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. We recruited patients with hand arthralgia with no history of previous trauma or autoimmune rheumatic diseases. A questionnaire assessing CSA criteria was employed, and an ST maneuver was performed through an automated compressor with quantitative measures of applied force. Patients were grouped based on referral to Rheumatology consultation and variables categorized according to clinically relevant thresholds. Chi square test was performed in categorical variables, t-student test was performed in normal, continuous variables and Spearman’s rho correlation was utilized between CSA number of criteria and quantitative ST force using SPSS v25.Results:Out of 110 patients, 49 (44.5%) were referred to a rheumatologist. A non-significant association was found across assessed variables in referred and non-referred patients as seen in Table 1. Spearman’s rho found a moderate correlation between the number of CSA criteria and quantitative force in right (r=-.445) and left (r=-.382) hand as seen in Figure 1. Evaluation of CSA cutoffs other than ≥4 did not yield a significant association in referral of patients to the rheumatologist (data not shown).Conclusion:The clinical utility of CSA criteria and ST in referral of patients with hand arthralgia from PCP to rheumatologists is currently limited. More research is needed to elucidate the clinical utility of these screening tools.References:[1]van Steenbergen HW, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis. 2017;76(3):491-496.[2]Vega-Morales D, et al. Automated squeeze test (Gaenslen’s manoeuvre) to identify patients with arthralgia suspicious for progression to RA: improving time delay to rheumatology consultation. Ann Rheum Dis. 2017;76(10):e40.Table 1.Demographic characteristics and clinical performance of CSA and ST in referral of patients with hand arthralgia from PCP to rheumatologists.Referred patients,n = 49Non-referred patients, n = 61pFemale, n (%)40 (81.6)50 (82.0)0.964Age in years, mean ± SD46.76 ± 14.4352.05 ± 15.000.064Patients with ≥4 CSA criteria, n (%)23 (46.9)19 (31.1)0.090Right hand positive ST patients, n (%)21 (42.9)22 (36.1)0.468Left hand positive ST patients, n (%)26 (53.1)28 (45.9)0.455Force in right hand ST, mean kg ± SD4.19 ± 2.923.86 ± 3.070.571Force in left hand ST, mean kg ± SD4.25 ± 3.043.54 ± 2.740.198CSA, Clinically Suspect Arthralgia; ST, Squeeze Test; SD, Standard Deviation.Disclosure of Interests:None declared

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

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

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

Background:Pregnancy in women with autoimmune rheumatic diseases (ARD) is associated with an increase in the risk of adverse perinatal outcomes and birth defects. Many factors have been attributed to these including medication employed and maternal autoantibodies. The national prevalence of congenital anomalies in newborns in Mexico is estimated to be 73.9 per 10,000 births but the rate of these in Mexican women with ARD is unknown.Objectives:This study aims to describe the frequency of adverse perinatal outcomes and congenital defects in Mexican women with ARD.Methods:We performed a descriptive and prospective study that included all pregnant patients with ARDs from the clinic of pregnancy and rheumatic diseases in the University Hospital “Dr. José Eleuterio González” who gave birth between February 2019 to November 2020. Demographic information, pregnancy outcome, and congenital defects were prospectively evaluated. Congenital defects were clinically confirmed by a clinical geneticist.Results:A total of 40 women were taken in the final analyses. The ARD diagnosis is shown in graphic 1. Rheumatoid arthritis was the most frequent diagnosis that had an adverse perinatal outcome with 4 (40%) and congenital defects in 2 (40%). No complications or birth defects were reported in 25 (62.5%). The adverse perinatal outcome was reported in 10 (25%) women and congenital defects in 5 (12.5%). The most frequent adverse perinatal outcomes were preterm birth 6 (15%) and the second most frequent miscarriage 3 (7.5%) (Table 1 below).Conclusion:We found a high frequency (12.5%) of adverse perinatal outcomes and congenital defects in Mexican women with ARD. Multidisciplinary groups and clinics are needed to adequately serve this complex population and reduce morbidity and mortality. A multidisciplinary approach before, during, and after pregnancy in patients with ARD may improve morbidity and mortality.References:[1]Vinet, E., Bernatsky, S. (2017). Outcomes in Children Born to Women with Rheumatic Diseases. Rheum Dis Clin N Am. http://dx.doi.org/10.1016/j.rdc.2016.12.006.[2]Krishnan AN, Sable CA, Donofrio MT.(2008). Spectrum of fetal echocardiographic findings in fetuses of women with clinical or serologic evidence of systemic lupus erythematosus. J Matern Fetal Neonatal Med. 21(11):776–82.[3]NAVARRETE HERNANDEZ, Eduardo et al. Prevalencia de malformaciones congénitas registradas en el certificado de nacimiento y de muerte fetal: México, 2009-2010. Bol. Med. Hosp. Infant. Mex. [online]. 2013, vol.70, n.6, pp.499-505.Graphic 1.Percentage of adverse perinatal outcomes and congenital defects due to rheumatic disease.Table 1.Frequency and percentages of adverse perinatal outcomes and congenital defects.Adverse perinatal outcome (n=10) 25%Congenital defects (n=5) 12.5%Preterm birth6 (15%)-Miscarriage3 (7.5%)-Stillbirth1 (2.5%)-Congenital heart disease*-1 (2.5%)Congenital cardiac block with pacemaker placement-1 (2.5%)Krabbe´s disease-1 (2.5%)Preauricular appendix-1 (2.5%)Diabetic fetopathy-1 (2.5%)*Tetralogy of FallotDisclosure of Interests:None declared

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

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