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Introduction Although complementary and alternative medicine (CAM) use among patients with rheumatic diseases is extensive, discussions regarding these treatments occur rarely in the rheumatology setting, directly affecting the physician–patient relationship (PPR). Objectives The aim of this study was to evaluate the association between patient-physician relationship and complementary and alternative medicine use. As secondary objectives, to describe the patient’s perspective towards CAM use and estimate the prevalence of CAM treatments used in patients with rheumatoid arthritis. Methods and materials A descriptive cross-sectional survey was conducted, in which CAM use and physician–patient relationship were assessed by self-reported validated questionnaires (I-CAM-Q and PDRQ-9, respectively). Results The study included a total of 246 outpatients of a tertiary care hospital. There were no significant differences between CAM users vs. non-users, or informers vs. non-informers in terms of physician–patient relationship measured by PDQR. The prevalence of CAM use at 3 and 12 months were 37.4% and 41.5%, respectively. The most frequent used CAM treatments were: chiropractice, acupuncture, and herbal products. A large majority (78.5%) of the patients expressed agreement to the discussion of CAM use with the rheumatologist, but only 31.3% of total CAM users did so because of fear of retaliation (54.4%). Conclusion Despite the extensive practice of CAM among patients with rheumatoid arthritis, most patients did not discuss these treatments with their physicians. Associations were found between MCA use and a lower patient’s treatment satisfaction and between physician–patient communication about CAM practice and a higher patient’s treatment satisfaction.

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

Resumen La enfermedad de Behcet es una entidad clinica autoinflamatoria, de etiologia desconocida, generalmente con compromiso sistemico, con un patron de exacerbacion y remision frecuente que se asocia a retraso en el diagnostico. El diagnostico de esta enfermedad es complejo, por esta razon presentamos 4 casos de pacientes con enfermedad de Behcet, que durante el abordaje clinico fueron consideradas otras enfermedades de naturaleza autoinmune. La revision integrada de la historia clinica, la aparicion de ulceras orales y genitales, asi como el estudio de tipificacion del complejo mayor de histocompatibilidad (HLA) permitieron diagnosticar la enfermedad de Behcet.

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

Background Monocytes and toll-like receptors (TLR) have been found in the inflammatory infiltrate of muscle biopsies in patients with idiopathic inflammatory myopathies (IIM), suggesting an important role of these cells in the pathogenesis of myositis. The monocyte subsets, their TLR expression in peripheral blood and their relationship with the clinical characteristics of patients with IIM has not been addressed. Methods We recruited 45 patients with IIM diagnosis and 15 age and sex-adjusted healthy controls. We assessed the disease activity and damage, performed a nailfold capillaroscopy and registered the cardio-pulmonary parameters from the medical charts. Monocyte subsets, their expression of TLR2 and TLR4 and the serum Th1/Th2/Th17 cytokines levels were evaluated by flow cytometry. We expressed quantitative variables as medians and interquartile ranges (IQR) or minimum and maximum (min–max). Differences between groups were assessed with Mann–Whitney U and the Kruskal–Wallis tests. Correlation between quantitative variables was assessed with Spearman Rho. Results Twenty-nine patients were women (64.4%) and 32 (71.1%) had dermatomyositis. In comparison to healthy controls, patients with active IIM had a higher percentage of intermediate monocytes and lower amounts of classical monocytes. Patients with IIM had a higher expression of TLR4 in all their monocyte subsets, regardless of disease activity and prednisone treatment. Serum IL-6 correlated with the TLR2 expression in every monocyte subset and the expression of TLR2 in intermediate monocytes was higher among patients with dysphagia. Subjects with nailfold capillaroscopy abnormalities had a higher amount of TLR2+ classical and non-classical monocytes and those with interstitial lung disease (ILD) had a higher percentage of TLR4+ non-classical monocytes. The classical and intermediate monocytes from patients with anti Mi2 antibodies had a higher expression of TLR4. The percentage of intermediate monocytes and the expression of TLR4 in all monocyte subsets showed a good diagnostic capacity in patients with IIM. Conclusion Patients with IIM have a differential pool of monocyte subsets with an enhanced expression of TLR2 and TLR4, which correlates with disease activity and distinctive clinical features including dysphagia, ILD, vasculopathy, and pro-inflammatory cytokines. These immunological features might be useful as a potential diagnostic tool as well as novel disease activity biomarkers in IIM.

RESUMEN Introducción: El uso de medicina complementaria y alternativa (MCA) en pacientes con enfermedades reumáticas es prevalente pero la comunicación con el reumatólogo suele ser deficiente, lo cual afecta la relación médico-paciente (RMP). Objetivos: Evaluar la asociación entre el uso de MCA y la RMP en enfermos con artritis reumatoide. Como objetivos adicionales, describir la percepción del paciente sobre la comunicación con su reumatólogo respecto al uso de MCA y el patrón de uso de las diferentes modalidades terapéuticas. Materiales y métodos: Estudio descriptivo de corte transversal. El uso de MCA y la RMP se evaluaron mediante la autoaplicación de cuestionarios validados (I-CAM-Q y PDRQ-9 respectivamente). Resultados: Se incluyó a 246 pacientes ambulatorios de una institución de tercer nivel de atención. Se encontró asociación entre una mayor satisfacción con el tratamiento y el no usar MCA, y entre el hecho de informar al reumatólogo sobre el uso de MCA con un mayor grado de acuerdo con el médico sobre el origen de los síntomas y mayor satisfacción con el tratamiento. Las modalidades más frecuentemente utilizadas fueron: quiropraxia, acupuntura y productos herbales. El 78,5% afirmaron estar de acuerdo con comunicar el uso de este tipo de medicación al reumatólogo, sin embargo, solo el 31,3% lo notificó, por temor a represalias (54,4%). Conclusiones: Pese a la alta prevalencia de uso de MCA en nuestros pacientes, la mayoría no lo comunicó al reumatólogo. Se encontró asociación entre el uso de MCA y una menor satisfacción del paciente con el tratamiento y entre la comunicación médico-paciente sobre la práctica de MCA y una mejor satisfacción con el tratamiento. ABSTRACT Introduction: Although complementary and alternative medicine (CAM) use among patients with rheumatic diseases is extensive, discussions regarding these treatments occur rarely in the rheumatology setting, directly affecting the physician-patient relationship (PPR). Objectives: The aim of this study was to evaluate the association between patient-physician relationship and complementary and alternative medicine use. As secondary objectives, to describe the patient's perspective towards CAM use and estimate the prevalence of CAM treatments used in patients with rheumatoid arthritis. Methods and materials: A descriptive cross-sectional survey was conducted, in which CAM use and physician-patient relationship were assessed by self-reported validated questionnaires (I-CAM-Q and PDRQ-9, respectively). Results: The study included a total of 246 outpatients of a tertiary care hospital. There were no significant differences between CAM users vs. non-users, or informers vs. non-informers in terms of physician-patient relationship measured by PDQR. The most frequent used CAM treatments were: chiropractice, acupuncture, and herbal products. A large majority (78.5%) of the patients expressed agreement to the discussion of CAM use with the rheumatologist, but only 31.3% of total CAM users did so because of fear of retaliation (54.4%). Conclusion: Despite the extensive practice of CAM among patients with rheumatoid arthritis, most patients did not discuss these treatments with their physicians. Associations were found between MCA use and a lower patient's treatment satisfaction and between physician-patient communication about CAM practice and a higher patient's treatment satisfaction.

BackgroundRisk perception (RP) describes patient´s judgment of the likelihood of experiencing something unpleasant, and has been associated to the adoption of health behaviors. Current rheumatoid arthritis (RA) guidelines recommend early and intensive treatment, although patients also commonly use Complementary and Alternative Medicine (CAM). We aimed to investigate if significant RP was associated to CAM use in Hispanic RA outpatients and to describe additional associated factors.MethodsBetween March and August 2019, 266 consecutive outpatients were invited to a face-to-face interview to collect socio-demographic and RA-related information, to assess comorbidity and the following patient-reported-outcomes: pain, overall-disease and treatment adherence with visual analogue scales, disease activity with RAPID-3, RP with a validated questionnaire, and CAM use with a translated and cross-culturally adapted for Argentina version of the International CAM questionnaire. Medical records were reviewed to corroborate the data provided by the patients. CAM use definition was restricted to "in the last 3 months". Significant RP was defined based on published cut-off. Multiple logistic regression analysis was used to investigate factors associated to CAM use. The study received IRB approval.ResultsThere were 246 patients included, primarily middle-aged women, with substantial disease duration, moderate disease activity and 70 patients (28.5%) had significant RP. Two hundreds patients (81.3%) were CAM users. Significant RP (OR: 2.388, 95%CI: 1.044-5.464, p = 0.039) and access to Federal health care system (OR: 2.916, 95%CI: 1.081-7.866, p = 0.035) were associated to CAM use.ConclusionsPatient´s perception of RA-related negative consequences was associated to recent CAM use in Hispanic RA outpatients.

6 páginas There is a complex, dynamic, and bidirectional connection between autoimmunity and cancer. The underlying mechanisms of carcinogenesis and physiopathological aspects of autoimmune diseases are not fully understood. However, there is a common immunological base related to expression of autoantigens by tumour cells that cause an anti-cancer immune response, thereby, triggering the development of paraneoplastic rheumatic syndromes and autoimmune rheumatic diseases in a genetically predisposed population. The case is reported of a 57 year-old man presenting with pulmonary renal syndrome, and who was diagnosed lung cancer and systemic lupus erythematosus at the same time. Existe una relación compleja, dinámica y bidireccional entre la autoinmunidad y el cáncer. Si bien los mecanismos carcinogénicos y fisiopatológicos de las enfermedades autoinmunes no están claramente dilucidados, existe una base inmunológica común relacionada con la expresión de autoantígenos por parte de las células tumorales que desencadenan una respuesta antitumoral, facilitando el desarrollo de síndromes paraneoplásicos reumáticos y enfermedades autoinmunes reumáticas en población genéticamente susceptible. Se presenta un caso de un hombre que debutó con un síndrome pulmón riñón y se diagnosticó cáncer de pulmón y lupus eritematoso sistémico de forma simultánea.

Background During the 2014-2015 a Chikungunya virus (CHIKV) epidemic reached Colombia. Concurrently, the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was being developed in Colombia to establish rheumatic diseases prevalence. Since CHIKV generates rheumatic manifestations, the presence of CHIKV infection was included. Objectives Based on the population entered in this program this study was developed with the aim to describe the disability of CHIKV infection through four questionnaires (HAQ-DI, EQ-5D, EQ-5D VAS and VAS for pain). Methods World Health Organization (WHO) criteria for CHIKV diagnosis and ELISA IgG and IgM serology were performed to identify CHIKV infection. Four groups of patients were defined: true positives (WHO + and + serology), true negatives (WHO - and - serology), false positives (WHO + and - serology), false negatives (WHO - and + serology). Three scores of disability and one of pain were applied to evaluate disability. A descriptive analysis was made using the media and standard deviation for continuous variables and percentage for the categorical variables, the Odds ratio was calculated with a confidence interval of 95% and a p Results From 548 patients with clinical suspicion of CHIKV infection, 295 were positive for CHIKV IgG and/or CHIKV IgM. Functionality evaluated by HAQ-DI showed a media of 0.17 (SD±0.45), with highest score after 7 weeks since the beginning of symptoms and the lowest in patients with CHIKV IgM positive. In the EQ-5D (Figure 1), between 72% and 92% of patients didn’t report problems on the mobility, self-care, usual activities, anxiety and depression dimensions. In contrast pain and discomfort dimensions were affected from moderate to extreme (44.7% and 8.6%). There weren’t significant differences between true positives, true false, false negative within all the variables, except on the anxiety and depression dimensions where the false positives had a higher significant score in comparison to the other groups (n: 10, 38.5%; p=0.00; OR:4.17, IC:1.8-9.57). In the EQ-5D-VAS, media for VAS was 75.56 (SD±21.18) where the highest scores of VAS were found on the false negatives. In pain VAS, false positives as well as the duration greater than 7 weeks where associated with several pain (n: 10, 2.9%; OR: 0.2; IC 1.25–6.33 y n: 27, 21.3%; p=0.018; OR 2.02, IC: 1.12-3.66 respectively). Conclusion In general, the disability of CHIKV infected patients was mild to moderate, finding the most affected dimensions to be pain, discomfort, anxiety and depression. The false positives and the population with anxiety and depression are related with higher score of disability. Disclosure of Interests None declared

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

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

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

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

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

Objective.The aim of this study was to describe the prevalence of erectile dysfunction (ED), as well as associated demographic and clinical features, in men with systemic lupus erythematosus (SLE), by means of a systematic, standardized evaluation.Methods.We performed a transversal study in 8 tertiary care centers in Latin America. We included male patients ≥ 16 years who fulfilled ≥ 4 American College of Rheumatology criteria for SLE and had regular sexual activity, and evaluated them with the International Index of Erectile Function-5 questionnaire. Relevant demographic, clinical, and serological characteristics were recorded. We included 2 control groups: the first was made up of healthy men and the second of men with autoimmune diseases other than SLE (non-SLE group).Results.We included 590 subjects (174 SLE, 55 non-SLE, and 361 healthy controls). The prevalence of ED in the SLE group was 69%. Mean age in that group was 36.3 ± 1.03 years. Among SLE patients with and without ED, these factors were significantly different: the presence of persistent lymphopenia (p = 0.006), prednisone dose (9.3 ± 1.2 vs 5.3 ± 1.3 mg, p = 0.026), and the Systemic Lupus International Collaborating Clinics damage score (1.25 ± 0.14 vs 0.8 ± 0.16 points, p = 0.042). Independent risk factors for ED in patients with SLE were persistent lymphopenia (OR 2.79, 95% CI 1.37–5.70, p = 0.001) and corticosteroid use in the previous year (OR 2.15, 95% CI 1.37–3.37, p = 0.001).Conclusion.Regardless of comorbidities, treatment (excluding steroids), and type of disease activity, patients with SLE have a high prevalence of ED, especially considering that most patients are young. Recent corticosteroid use and persistent lymphopenia, which could be related to endothelial dysfunction, are risk factors for this complication in men with SLE.

IntroductionPatients with obstructive sleep apnoea hypopnoea syndrome (OSA) might have varying degrees of laryngopharyngeal mechanical hyposensitivity that might impair the brain’s capacity to prevent airway collapse during sleep. However, this knowledge about sensory compromises in OSA comes from studies performed using methods with little evidence of their validity. Hence, the purpose of this study is to assess the reliability and accuracy of the measurement of laryngopharyngeal mechanosensitivity in patients with OSA using a recently developed laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER).Methods and analysisThe study will be prospective and double blinded, with a randomised crossover assignment of raters performing the sensory tests. Subjects will be recruited from patients with suspected OSA referred for baseline polysomnography to a university hospital sleep laboratory. Intra-rater and inter-rater reliability will be evaluated using the Bland–Altman’s limits of agreement plot, the intraclass correlation coefficient, and the Pearson or Spearman correlation coefficient, depending on the distribution of the variables. Diagnostic accuracy will be evaluated plotting ROC curves using standard baseline polysomnography as a reference. The sensory threshold values ​​for patients with mild, moderate and severe OSA will be determined and compared using ANOVA or the Kruskal–Wallis test, depending on the distribution of the variables. The LPEER could be a new tool for evaluating and monitoring laryngopharyngeal sensory impairment in patients with OSA. If it is shown to be valid, it could help to increase our understanding of the pathophysiological mechanisms of this condition and potentially help in finding new therapeutic interventions for OSA.Ethics and disseminationThe protocol has been approved by the Institutional Review Board of Fundacion Neumologica Colombiana. The results will be disseminated through conference presentations and peer-reviewed publication.Trial registrationThis trial was registered at Clinical Trials Accuracy of the sensory test using the lLaryngopharyngeal endoscopic esthesiometer in obstructive sleep apnea. Protocol ID: 201611-22405. ClinicalTrials.gov ID:NCT03109171.

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