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The effect of systemic lupus erythematosus (SLE) in sexual function is one of the least studied areas. There are few previous studies that investigate sexual function in SLE, and current evidence indicates a negative impact. The main objective of this study is to evaluate sexual function in Mexican women with SLE and compare if sexual dysfunction occurs in a greater proportion than in healthy women. A case–control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis and a control group of healthy women (n = 156) matched by age. They were asked about their sexual life in the last month, and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann–Whitney U test. SLE women had less sexual activity than controls (63.7% vs 77.5%, p = 0.01). Out of the total, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual dysfunction (

Resumen Objetivo Valorar la relacion entre la productividad laboral y diversos factores propios de la artritis reumatoide (AR) como grado de actividad de la enfermedad, nivel de discapacidad, calidad de vida, carga laboral, farmacoterapia recibida y comorbilidades asociadas. Material y metodos Se realizo un estudio transversal, observacional y descriptivo. Se incluyeron pacientes de 18 a 75 anos con diagnostico de AR segun criterios ACR/EULAR 2010 que acudieron consecutivamente a la consulta de Reumatologia del Hospital Universitario en el periodo comprendido entre enero y marzo del ano 2017. Se aplicaron los cuestionarios WPAI-AR, HAQ-DI y RAQoL; el grado de actividad de la AR se calculo mediante DAS28-PCR. Se realizaron correlaciones entre las caracteristicas clinicas obtenidas y la capacidad laboral por WPAI-AR. Resultados Se incluyeron 204 pacientes con AR, de los cuales el 92,6% fueron mujeres; la edad media fue de 54,46 ± 9,3 anos. En el porcentaje de deficit en actividades basicas de la vida diaria (ABVD) se encontro diferencia estadisticamente significativa entre pacientes empleados y desempleados (p ≤ 0,002). Se encontro correlacion positiva entre actividad de la enfermedad por DAS28-PCR, nivel de calidad de vida por RAQoL y capacidad funcional por HAQ-DI con los porcentajes de ausentismo y presentismo laboral, perdida de la productividad laboral total y deficit en ABVD. Conclusion Existe correlacion entre el grado de actividad de la AR, calidad de vida y capacidad funcional con el rendimiento laboral de la poblacion estudiada. La asociacion mas fuerte encontrada fue con la capacidad funcional.

The objective was to compare the prevalence of subclinical atherosclerosis and cardiovascular risk (CVR) reclassification using six CVR algorithms and a carotid ultrasound in psoriatic arthritis (PsA) patients and controls. The method was cross-sectional study. A total of 81 patients aged 40-75 years, who fulfilled the 2006 CASPAR criteria and 81 controls matched by age, gender, and comorbidities were recruited. CVR was evaluated according to six CVR algorithms, including Framingham Risk Score (FRS)-lipids, FRS-body mass index (BMI), Atherosclerotic Cardiovascular Disease (ASCVD) Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, and Reynolds Risk Score (RRS). A carotid ultrasound was performed to identify the presence of carotid plaque (CP) defined as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing of the surrounding lumen ≥ 0.5mm. Patients with presence of CP, classified in the low-moderate risk by the CVR algorithms, were reclassified to a higher risk category. CP was more prevalent in PsA patients (44.4% vs 24.7%, p = 0.008), as was subclinical atherosclerosis (51.9% vs 33.3%, p = 0.017). When comparing the CVR reclassification to a higher risk category, a difference was found in the six CVR algorithms. The reclassification was more prevalent in PsA patients: 30.8% vs 12.3%, p = 0.004 with FRS-lipids; 28.4% vs 9.9%, p = 0.003 with FRS-BMI; 40.7% vs 19.8%, p = 0.003 with SCORE; 30.9% vs 16.0%, p = 0.026 with ASCVD algorithm; 37.0% vs 19.8%, p = 0.015 with RRS; and 33.3% vs 16.0%, p = 0.011 with QRISK3. The CVR algorithms underestimate the actual CVR of PsA patients. A carotid ultrasound should be considered as part of the CVR evaluation of PsA patients. KEY POINTS: • Subclinical atherosclerosis was more prevalent in psoriatic arthritis patients than controls. • Cardiovascular risk reclassification, through a carotid ultrasound, according to traditional cardiovascular risk algorithms was more common in psoriatic arthritis patients. • The cardiovascular risk algorithm that showed the lowest reclassification rate in psoriatic arthritis patients was the FRS-BMI. • All cardiovascular risk algorithms underestimate the actual risk of psoriatic arthritis patients, preventing the initiation of an adequate cardiovascular treatment.

Psoriatic arthritis (PsA) is a chronic, inflammatory and immune-mediated disease that affects up to 30% of psoriasis (PsO) patients.1 Nail involvement affects 80% of PsA patients and 30%–50% of PsO patients. Nail PsO has been associated with worse quality of life, higher score on the PsO Area Severity Index, early disease onset, arthritis, depression and anxiety.2 Patients with PsO and PsA have a higher risk of cardiovascular atherosclerotic morbidity and mortality than the general population. Nail PsO and cardiovascular disease have been seldom studied. Nail involvement in PsO patients has been associated to a higher prevalence of metabolic syndrome, higher risk of heart failure and higher cardiovascular risk overall.3 4 If PsA patients with nail PsO also have a higher cardiovascular risk is unknown. We aimed to determine if nail involvement in PsA patients is associated with a higher prevalence of subclinical atherosclerosis by carotid ultrasound. We performed a cross-sectional, observational and comparative study that included a total of 64 PsA patients consecutively recruited from …

El objetivo de este artículo es revisar la literatura médica y científica (incluida una revisión paraguas) relacionada con el uso de cubrebocas como medida de prevención en la transmisión de enfermedades respiratorias virales para tomar decisiones informadas durante una pandemia. Desde inicios del siglo XX se estableció que el cubrebocas es efectivo para reducir infecciones respiratorias. El uso entre la población general inició hasta la pandemia de 1918. Desde entonces, las investigaciones se han enfocado principalmente en determinar los mejores materiales para su elaboración, encontrando que la efectividad del cubrebocas aumenta con el número de las capas, siendo ideal tres, de punto cerrado y de diversos materiales. Los meta-análisis demostraron que el uso de cubrebocas disminuye el riesgo de contagio de enfermedades respiratorias virales, incluido COVID-19, comparado a no usarlo. Los cubrebocas evitan el paso de una gran proporción de partículas del virus SARS-CoV-2 protegiendo tanto al portador como al resto de la población al reducir la carga viral a la que se está expuesto, disminuyendo así el riesgo de desarrollar enfermedad grave de COVID-19. Cuando las personas están en espacios públicos es preferible elegir usar cualquier cubrebocas, a no usar ninguna protección naso bucal. Para decidir sobre el uso del cubrebocas es importante evaluar el riesgo-beneficio. Con este análisis concluimos que según la evidencia, los beneficios del uso del cubrebocas superan los riesgos, por lo que recomendamos que el uso de cubrebocas de forma generalizada.

Rheumatoid arthritis (RA) is a chronic, inflammatory disease closely linked with atherosclerosis. Recommended cardiovascular disease (CVD) integral evaluation includes screening for asymptomatic atherosclerosis plaques with carotid ultrasound (US). The aim of this study is to evaluate the carotid US characteristics, including carotid intima media thickness (cIMT) and carotid plaque (CP), and compare RA-patients and controls in a Mexican-mestizo population. Method Prospective cross-sectional, observational study comparing RA-patients and matched controls without RA. Medical history and physical exam was performed in all subjects by a rheumatologist and two clinical blinded radiologists did the carotid US. Increased cIMT was defined as ≥0.9 mm. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a cIMT ≥1.2 mm. Multivariable analysis was done comparing RA-patients and control subjects characteristics with carotid US. Result In the final analysis 209 patients were included, 103 patients with RA and 106 controls. Bilateral CP was found more than twice in RA than controls (15.5% vs 6.6%). Unilateral CP was more common in either side evaluated, being heterogeneous plaques the most common in RA-patients. The prevalence of increased cIMT was found higher in RA-patients either in both sides (right 37.9% vs 15.1%, P = 0.00; left 43.7% vs 19.8%, P = 0.00) were statistically significant. Conclusion It was confirmed that RA-patients have greater subclinical atherosclerosis represented in the carotid US measuring cIMT and CP as surrogates. RA-patients with subclinical atherosclerotic disease have more heterogeneous plaques characteristics.

Patients with rheumatoid arthritis (RA) have a high risk for comorbid conditions which increase mortality, hospital admissions, costs of care and inability. To evaluate the prevalence of comorbidities in Mexican mestizo patients with RA and determine the associated risk factors. Cross-sectional study in which RA patients admitted to our outpatient clinic were consecutively enrolled. We collected data regarding demographics, disease characteristics and comorbidities at the time of the patient's visit to the clinic. We analyzed 225 patients. Their mean age was 55.7 ± 8.3 years; disease duration, 9.5 (3.8-15.5) years; female gender, 93.8%; Disease Activity Score using 28 joints-C-reactive protein, 3 (2-4); methotrexate use, 84.9%; use of any other conventional disease modifying anti-rheumatic drug, 65.7%; use of biological agents, 8%. The most frequently associated diseases were: hypertension, 29.8%; dyslipidemia, 27.1%; osteoporosis, 19.1%; diabetes, 12.4%; hypothyroidism, 6.2%; solid malignancies 4.4%. Risk factors were also evaluated, the most prevalent was overweight in 101 (44.9%) of our patients. A total of 71 (31.6%) had obesity. We also detected high blood pressure in 12.4%, hyperglycemia in 27.1% and hyperlipidemia in 49.8%. Due to the high frequency of comorbidities among RA patients, it is important to follow existing recommendations for their timely detection and management. Cardiovascular diseases must be evaluated with priority. The initial evaluation should include a thorough examination to prevent the deleterious effect of comorbidities in RA.

Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.

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: Several immune-inflammatory diseases are associated with an increased prevalence of cardiovascular diseases. Risk reduction through improved control of traditional cardiovascular risk (CVR) factors and the adoption of healthy lifestyle behaviors are critically important to reduce the CVR, although the general population must be aware of their CVR to make healthy sound decisions. Individuals who perceive an increased risk are more likely to adopt behaviors to reduce it, such as smoking cessation, exercise, weight loss, and medication compliance. Objectives: The aim of this study is to assess the awareness of the CVR in patients with/without rheumatic diseases (RD). Methods: Observational, cross-sectional study was design. Subjects with RD attending an outpatient clinic were consecutively recruited (RA, SLE, PsA OA, Sjogren syndrome, fibromyalgia, scleroderma, osteoporosis and osteopenia). A complete clinical history was made and a self-applied questionnaire (Precaution Adoption Process Model) was used to assess the awareness of the CVR in patients with RD. Comparisons were made to controls without RD. Frequencies (%), media and median values (q25-q75) were used for descriptive analysis and Chi Square test for comparisons. Results: 250 patients were included with 76 controls and 174 cases. Demographic characteristics shown in table 1. The majority of the patients located themselves in stage 1 of their CVR perception 31.6% in cases vs. 30.3% in controls (p>0.05), other results are shown in figure 2. In the case group, 69.5% have not made any changes to reduce their CVR and the same was seen in controls. Most of the individuals are unaware of their higher CVR even though they have traditional CVR factors. Only 30.5% of the group of RD have received information from a health care provider about their CVR. Conclusion: Even though patients with RD have and increased CVR, most of the individuals perceived it the same as the control group. The majority of the individuals (69.5%) haven’t made any changes to reduce their CVR and many of them didn’t have any source of information about their CVR, and according to EULAR recommendations the rheumatologist is the one responsible. Therefore, they should commit to give a better education to their patients. References [1] Lynch EB, et al. Cardiovascular disease risk factor knowledge in young adults and 10-year change in risk factors: The Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Epidemiol. 2006;164:1171Y1179. [2] Elmer PJ, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness and blood pressure control: 18 months results of a randomized trial. Ann Intern Med. 2006;144:485Y495. Disclosure of Interests: None declared

Background The influence of systemic lupus erythematosus (SLE) in sexual behavior has been one of the less studied areas, being a forgotten part of quality of life, and not routinely evaluated by a rheumatologist. The seeming lack of interest in sexual problems is explained by the underlying difficulty to talk about this topic, the uncertainty of the role and capability of the rheumatologist to treat any difficulties in this area. Objectives Determine the prevalence of sexual assessment in women with SLE by their rheumatologist in the daily practice, as well as their characteristics and the possible difficulties that doctors deal with during this process. Methods A cross-sectional study, where women between 18 and 60 years with SLE diagnosis (according to SLICC 2012 criteria) were evaluated consecutively at the rheumatology clinic at Hospital Universitario “Dr. Jose Eleuterio Gonzalez”. 102 women with SLE were asked two questions: “Question 1. In the last year, has your rheumatologist asked about your sexual life?”, and “Question 2. In case of having a trouble or disorder in your sexual life, would you ask your rheumatologist about it? (if not, why?)”. Demographic and disease associated variables were analyzed with Chi-square test and Mann-Whitney U test. Results Baseline characteristics according to answers to each question are shown in Table 1. Most of the patients (62.74%, n=64) denied being asked about their sexual life in the last year; in this group, the prevalence of menopause was significantly higher than in the group that had been asked about this (30% vs 11%, p=0.025). Whilst, 82% (n=89) of patients said they were willing to talk about this topic with their doctor. The patients that answered “no” to the second question had the following characteristics: older age (45.5±10.5 vs 35.0±11.2 years; p=0.002), were in their menopause (46% vs 19%; p=0.042), had fibromyalgia (39% vs 10%, p=0.015), and had children (92% vs 64%, p=0.024). When asking the reason why they wouldn’t ask, 70% (n=9) said they were ashamed to, 23% (n=3) ignored if this belonged to the rheumatologist and 7% (n=1) because of lack of time at consultation. *- p value was obtained by Chi-square test. SD – Standard deviation. Conclusion Rheumatologists rarely approach or evaluate the sexuality topic with their patients. However, in our population, patients are willing to talk about this with their doctor. Sexuality must be assessed in all patients; but special attention must be paid to women with SLE and menopause, children, fibromyalgia and/or age over 35, because they’re prone to not discuss this topic with their doctor. References [1] Perdriger A, Solano C, Gossec L. Why should rheumatologists evaluate the impact of rheumatoid arthritis on sexuality? Jt Bone Spine. 2010;77:493-495. doi:10.1016/j.jbspin.2010.07.005 [2] Tseng J-C, Lu L-Y, Hu J-C, et al. The Impact of Systemic Lupus Erythematosus on Women’s Sexual Functioning. J Sex Med. 2011. doi:10.1111/j.1743-6109.2011.02464.x Disclosure of Interests None declared

Background: Subjects with rheumatic diseases have an increased risk of cardiovascular morbimortality. Hypertension (HTN) is a key modifiable risk factor for cardiovascular events (1). A recently published and validated prediction model (Predicting Out-of-Office Blood Pressure, PROOF-BP) has been proposed as a tool to improve diagnosis of HTN, and detection of out-of-office HTN in subjects with a previous diagnosis, with a c-statistic (AUC) of 0.86 in non-rheumatic subjects (2). This model has not been explored in rheumatic patients. Objectives: To evaluate the diagnostic performance of the PROOF-BP algorithm for the prediction of HTN in subjects with/without rheumatic diseases. Methods: A cross-sectional, observational trial was designed. Subjects were recruited at a rheumatology outpatient clinic in northeastern Mexico. Subjects with/without rheumatologic conditions were recruited. Complete clinical history with somatometry of each subject was registered. BP was measured by a physician 3 times to each participant using current recommendations, with an OMRON HEM-7121 BP monitor. Calculations using the PROOF-BP online site were done, and risk categories were assigned to each subject using their predicted out-of-office BP: low ( 145/90 mmHg). Subjects in the medium and high risk strata were then asked to return for further evaluation and additional BP measurement, to define each diagnosis of HTN. We used frequencies (%) and median (q25-q75) for descriptive analysis. Diagnostic accuracy of each category was determined using 2 x 2 tables. Results: A total of 217 subjects were included. Baseline characteristics are shown in Table 1. The most frequent rheumatic disease was RA (n=78, 35.9%). Using PROOF-BP, 84 (38.7%) subjects were stratified as medium or high risk. Of these, only 36 (42.8%) returned for evaluation. A final diagnosis of HTN was attained in 14 (38.8%) of those who returned. Diagnostic performances of the low and high risk categories are shown in Table 2. In 21 (67.7%) cases of the medium risk category the diagnosis of HTN was finally discarded, and in the remaining 10 (32.2%) diagnosis of HTN was finally ascertained. The high risk category had a specificity of 95% and a PPV of 80% for the diagnosis of HTN. Conclusion: In a cohort of Mexican-mestizo subjects with rheumatic diseases, 38.7% were classified as medium or high-risk for HTN. Only 42.8% of patients that required further evaluation followed medical recommendations. More than 30% of patients in the medium-risk category had a final diagnosis of HTN. Using the PROOF-BP algorithm, none of the patients in the low-risk stratum had a final diagnosis of HTN (sensitivity= 100%); the high-risk category had a high specificity (95%) for the diagnosis of HTN. References [1] Lewington S, et al. Lancet. 2002;360:1903–1913. [2] Sheppard JP, et al. Hypertension. 2016;67:941–950. Disclosure of Interests: None declared

Background: Prevalence of depression is higher in subjects with rheumatic diseases (RD) when compared to other general medical conditions. It’s associated with chronic pain and long-term medical treatment. The Patient Health Questionnaire 9 (PHQ-9) is an extensively validated screening tool, with a negative predictive value of 99%; it has several advantages, like being self-applied and able to be used by any clinician. Currently there are no trials using this screening tool in Mexican rheumatic patients. Objectives: To determine the prevalence of depression in a group of rheumatic subjects and compare it to non-rheumatic controls. Methods: An observational, cross-sectional study was designed. Subjects with RD attending an outpatient clinic were consecutively recruited. A complete clinical history with information about exercise history, and the PHQ-9 screening tool were performed to every subject. Subjects without RD were recruited as controls. Descriptive analysis was done using frequencies (%) and median (q25-q75). Comparisons were done using Chi-square and Mann-U Whitney’s test, considering only p Results: A total of 269 subjects were included. Demographic characteristics are shown in Table 1. In the RD group, a higher percentage were female (p Conclusion: Patients with RD have a higher prevalence of depression than non-rheumatic controls (p References [1] O’Malley PG, Jackson JL, Kroenke K, Yoon IK, Hornstein E, Dennis GJ. The value of screening for psychiatric disorders in rheumatology referrals. Arch Intern Med 1998;158:2357-62. [2] Ohayon MM, Schatzberg AF. Using chronic pain to predict depressive morbidity in the general population. Arch of Gen Psychiatry 2003;60:39-47. [3] Anyfanti, P., et al. Depression, anxiety, and quality of life in a large cohort of patients with rheumatic diseases: common, yet undertreated. Clin Rheumatol DOI 10.1007/s10067-014-2677-0 Disclosure of Interests: None declared

Background Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease of the joints. Current classification criteria for RA diagnosis requires the presence of either rheumatoid factor (RF) or anti-citrullinated protein antibodies (ACPA). These have also been linked to chronic air pollutants exposure, such as tobacco smoke and biomass fuel smoke. Patients with COPD and biomass exposure have higher levels of ACPA (1). Nearly 50% of the world’s population still rely on biomass fuels for cooking, heating and industry, especially in low-income countries (2). Objectives To investigate the prevalence of biomass exposure in a cohort of Mexican-mestizo RA-subjects, and the effect of it in their RF and ACPA levels. Methods A cross-sectional, observational trial with RA-subjects that fulfilled the 2010 ACR/EULAR classification criteria, recruited at a rheumatology clinic in northeastern Mexico. Patient evaluation included a complete clinical history, somatometry, and blood samples to measure hs-CRP, RF isotypes (IgA, IgG, IgM) and ACPA. Biomass exposure was documented using the biomass exposure index (BEI), defined as: average hours exposed per day multiplied by years of exposure. Descriptive analysis was done using frequencies (%) and median values (q25-q75). Subjects were divided into 3 groups according to their BEI: non-exposed, BEI 30. Comparisons were done by Chi-square and Kruskal-Wallis test and correlation by Spearman’s rho test. Results A total of 285 subjects were included, 154 (54%) of them had history of exposure. Comparisons are shown in Table 1. A significant difference in age was found (p=0.006), this being caused by a difference between the BEI=0 and BEI >30 groups (p 30 (p 0.05). Conclusion In our cohort of Mexican-mestizo RA subjects, 54% had positive biomass exposure. Subjects with a BEI >30 were older and had a higher prevalence of dyslipidemia and hypertension. A significant correlation was found between higher BEI index and a higher value of ACPA antibodies. References [1] Sigari N, et al. (2015). Anti-cyclic citrullinated peptide (CCP) antibody in patients with wood-smoke-induced chronic obstructive pulmonary disease (COPD) without rheumatoid arthritis. Rheumatology International. [2] Yang, DH, et al. (2014). Circulating anti-cyclic citrullinated peptide antibody in patients with rheumatoid arthritis and chronic obstructive pulmonary disease. Rheumatology International. Disclosure of Interests None declared

Background: There is a 50% increase in cardiovascular mortality in RA compared to controls. Chronic inflammation causes endothelial dysfunction and accelerated atherosclerosis. Key molecular pathways in this process are dependent on cytokines like TNF-α, IL-1, IL-6, among others, which are shared with RA. Increased disease activity could contribute to atherosclerosis. Carotid ultrasound (US) has recently been recommended as a screening tool for early detection of subclinical atherosclerosis. Objectives: To compare different cytokines between Mexican-mestizo RA-subjects with/without carotid plaque (CP). Methods: An observational cross-sectional trial was designed. Inclusion criteria: age between 40-75 years old, fulfillment of the 2010 ACR/EULAR classification criteria, and detection of a CP during a carotid US. Subjects with a prior diagnosis of cardiovascular disease or a poor US window were excluded. RA subjects were matched to controls (RA patients without CP) by age and cardiovascular (CV) comorbidities. Every subject had a carotid US performed; reviewed by two board-certified radiologists. Cytokines measured were IL-1, IL-6, TNF-α, VCAM-1, ICAM-1 and MMP-9, using an ELISA reader (Glomax E9032). Descriptive analysis was done with frequencies (%), median (q25-q75), and comparisons between groups with Chi square test and Mann U Whitney’s test. Results: 71 subjects were included, 95.8% were females, with a median age of 58 years (54-65). Levels of cytokines in Table 1. Comparisons between groups are in Table 2. Groups were well balanced, with no differences in CV comorbidities (p>0.05). No significant differences among cytokine levels regarding CP were found. Subjects in remission (n=12, 33%) had a lower prevalence of CP (p Conclusion: In our cohort subjects in remission had a lower prevalence of CP (OR= 0.3, 0.1-0.9). No difference was found between cytokines regarding CP. Subjects with active disease had a higher level of IL-1 than subjects in remission. To our best knowledge, this is the first study to evaluate levels of cytokines in Mexican RA-subjects. References [1] Lopez R, et al. Cardiovascular risk assessment in patients with rheumatoid arthritis. Autoimmun Rev2016. [2] Pasceri V, et al. A tale of two diseases: Atherosclerosis and rheumatoid arthritis Circulation1999. Disclosure of Interests: None declared

Background: It has been described an increased prevalence of cardiovascular diseases (CVD) in rheumatoid arthritis (RA) patients. When compared with the general population, CVD mortality is 50% higher in RA (1). It is reported a 35.3% prevalence of CVD in Latin-American population with RA (2). Cardio-rheuma (CR) clinics were designed to enhance detection, prevention and treatment of CVD in patients with rheumatic conditions. Our clinic located in the University Hospital in Monterrey Mexico, is the first and only established in Latin-America since 2014. Objectives: To describe the characteristics of patients with RA attending to a Latin-American CR clinic and compare the findings by carotid ultrasound (US) and echocardiography to controls. Methods: Cross-sectional, observational, comparative study. RA patients aged 40 to 75 years that fulfilled the 2010 EULAR criteria and matched controls were included. Patients with prior atherosclerotic CVD and overlap syndromes were excluded. Clinical history, blood samples, physical exam, carotid US and echocardiography were performed. Carotid plaque (CP) was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a carotid intima media thickness (cIMT) ≥1.2 mm, and increased cIMT was defined as ≥0.9 mm. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists. Differences were solved by consensus. Categorical variables are expressed as total number (%), and numerical variables as median (q25-q75). Chi square and Mann-Whitney U-test were used to compare groups and considered significant if p Results: A total of 336 RA patients and 144 controls were included (Table 1). Table 2 summarizes echocardiographic and carotid US findings; ejection fraction was higher in controls than RA patients, prevalence of bilateral CP and increased cIMT was significantly higher in RA patients. Conclusion: RA patients from this clinic had lower ejection fraction, more prevalence of cIMT and bilateral CP when compared to controls. It is important that rheumatologists perform a complete evaluation of their patients, in which cardiovascular assessment should be included. References: [1] Avina-Zubieta JA, et al. 2008. Arthritis & Rheumatism. [2] Sarmiento-Monroy JC, et al. 2012. Hindawi Publishing Corporation. Disclosure of Interests: None declared

Background: Rheumatoid arthritis (RA) is an inflammatory disease with an increased mortality compared to the general population. The measurement of carotid intima media thickness (CIMT) is used as an independent marker of subclinical atherosclerosis. Objectives: To determine the prevalence of carotid plaque (CP) in a cohort of Mexican RA subjects and diagnostic performance of cardiovascular risk (CVR) calculators for the prediction of augmented CIMT and CP. Methods: A cross-sectional study of subjects aged from 40-75 years that fulfilled the 2010 ACR/EULAR RA criteria. Exclusion criteria: previous CV disease and overlap syndromes. CVR was calculated by 6 scales: ACC/AHA 2013, Framingham-lipids (FRS-lipids), Framingham-Body Mass Index (FRS-BMI), Reynolds Risk Score (RRS), QRISK2 and SCORE. Carotid ultrasound (US) was performed by a board-certified radiologist and reviewed by other two. We defined an augmented CIMT as ≥0.9 mm and CP as CIMT ≥1.2 mm. We categorized subjects in 3 groups: 1) normal carotid US, 2) augmented CIMT, and 3) CP. We used Kruskal-Wallis test to compare the groups. Results: 130 patients were included, 124 (95.4%) were females with median age of 57 years old and disease duration of 9.7 years. Almost 50% of the subjects with CP were in the low-risk strata of every CVR calculator. The presence of CP was higher in subjects categorized as moderate/high risk using ACC/AHA 2013 CVR score (p=0.013), moderate/high risk strata of QRISK2 (p=0.004), and high-risk strata of ACC/AHA 2013 CVR score (p=0.02). Of these 3, the highest sensitivity was obtained by the moderate risk stratum of QRISK2 with 51%; the highest specificity was obtained by the high-risk stratum of the ACC/AHA 2013 CVR score with 84%. Conclusion: Increased CIMT or CP might be unidentified if the risk is exclusively determined by CVR calculators. Patients with a CIMT ≥0.9 mm had an average score that placed them in the low risk strata, leading to an underestimation of their real CVR. Calculators can be helpful to estimate the CVR, however, they don’t seem to be an adequate screening tool for an increased CIMT or CP. Meanwhile, to assess CVR precisely, a carotid US should be performed in all RA patients. References: [1] Peters M, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. ARD 2010. [2] Meune C, et al. Cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 2009. Disclosure of Interests: None declared

Background Multiple benefits from physical activity (PA) in rheumatoid arthritis (RA) patients have been described; exercise in RA is associated with a cardiovascular (CV) protective role, resulting in lower waist-hip ratio, vascular stiffness and hypertension (1). Other important advantage of PA in RA is the impact observed in disease activity; regular PA is associated with reduced DAS28 (2). There are no previous studies evaluating the effect of exercise on disease activity and carotid Ultrasound (US) findings in Mexican-mestizo RA patients. Objectives To compare clinical characteristics and carotid US findings of Mexican-mestizo RA patients who perform PA to sedentary RA patients. Methods Cross-sectional, observational, comparative study. We included RA patients aged 40 to 75 years that fulfilled the 2010 EULAR criteria. Patients with prior atherosclerotic CV diseases and overlap syndromes were excluded. Clinical history, blood samples, physical exam and carotid US were performed. Carotid plaque (CP) was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a carotid intima media thickness (cIMT) ≥1.2 mm, and increased cIMT was defined as ≥0.9 mm. Patients were classified in two groups: those who are sedentary and those who regularly perform PA (defined as ≥120 min/week). The Kolmogorov-Smirnov test was used to determine normal distribution. Categorical variables are expressed as total number (%), and numerical variables as median (q25-q75). Chi square and Mann-Whitney U-test were used to compare groups and considered significant if p Results A total of 334 RA patients were included. Clinical characteristics are shown in table 1. Patients who exercised had lower disease activity and BMI. Carotid US was performed in 127 patients (Table 2). There was a higher prevalence of CP, bilateral CP and increased cIMT in sedentary patients. Sedentary RA patients had an increased risk of CP (OR 3.1 [IC95% 1.0-9.7, p=0.04]). Conclusion Patients who perform PA had significantly lower disease activity and BMI. A higher prevalence of CP, increased cIMT and bilateral CP was found in sedentary patients. Sedentary RA patients had an increased risk of CP. These results are similar to previously described in other populations and may be indicators of the protective effect of PA in RA patients. Rheumatologists should encourage their patients to exercise regularly. References [1] Byram KW. et al. Exercise is associated with increased small HDL particle concentration and decreased vascular stiffness in RA. Journal of Clinical Rheumatology. 2018;00(00):1-5 [2] Sandberg ME. et al. Patients with regular physical activity before onset of RA present with milder disease. Ann Rheum Dis. 2014;73:1541-1544 Disclosure of Interests None declared

Background: Normal sexual function consists in the transition, during sexual activity, through the phases of excitement to relaxation without problems, and with a feeling of pleasure, satisfaction and fulfillment (1). The effect of systemic lupus erythematosus (SLE) in sexual function has been one of the least studied areas, but it is thought that some disease-related characteristics could have a negative effect. There are few previous studies that investigate sexual function in SLE, general results indicate a negative impact (2). Objectives: The main aim of this study is to determine if there is an altered sexual function in Mexican women with SLE and compare if it occurs in a greater proportion than in healthy women. Methods: A case-control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis (according to SLICC 2012 criteria) and a control group of healthy women (n=156) matched by age. Patients were excluded if they couldn’t answer the questionnaires reliably and pregnant women. They were asked about the presence of active sexual life in the last month and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann U Whitney test. Results: Baseline demographic characteristics between groups are shown in table 1. Women with SLE had less sexual activity, during the last month, than controls (63.7% vs 77.5%, p = 0.01). Out of the total women included, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual disfunction ( *-Mann U Whitney or Chi-Square test according to type of variable. SD – Standard Deviation. *-Mann U Whitney or Chi-square test according to type of variable. Conclusion: Women with SLE, in this study, have less sexual activity than healthy women, but no greater sexual disfunction. However, they have a worse performance in the desire and excitation areas. This alteration did not show a relation with demographic nor disease-related variables. The abnormality found could be explained by a psychosocial factor not evaluated in this study. References: [1] Tristano AG. The impact of rheumatic diseases on sexual function. Rheumatol Int. 2009. doi:10.1007/s00296-009-0850-6 [2] Daleboudt GMN, et al. The impact of illness perceptions on sexual functioning in patients with systemic lupus erythematosus. J Psychosom Res. 2013. Disclosure of Interests: None declared

Background Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that mainly affects the synovial joints. Subjects with RA have an increased cardiovascular (CV) morbimortality (1). This increase in cardiovascular diseases (CVD) is not explained by traditional risk factors (2). Screening for CVD in RA patients is an essential part of CV risk management. Echocardiography is a simple, non-invasive approach that provides reliable markers for cardiac evaluation (3). Objectives To determine the prevalence of echocardiographic abnormalities in RA patients and compare them to matched controls. Methods Observational, cross-sectional study. RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR classification criteria and matched controls were included. Patients with a poor ultrasound window, history of previous atherosclerotic CVD (ischemic heart disease, cerebrovascular accident or peripheral arterial disease) and pregnancy were excluded. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists. Differences were solved by consensus. Descriptive analysis was done with frequencies (%) and median (q25-q75), and comparisons with Chi-square and Mann U-Whitney’s test. Results A total of 133 subjects were included. Baseline characteristics are shown in Table 1. Groups were well balanced, with no differences among them. Echocardiographic comparisons are shown in Table 2. Prevalence of abnormal left ventricle (LV) geometry was higher in RA patients (p= .038), as were mitral and tricuspid valvular dysfunction (p LV= Left ventricle. Conclusion Patients with rheumatoid arthritis have higher prevalence of mitral and tricuspid valves dysfunction in our population, and greater left ventricular geometry alterations, compared to controls. As the left ventricular ejection fraction is a strong prognosticator for CV disease, echocardiography might be a simple non-invasive tool for cardiac risk screening in RA. References [1] Avina-Zubieta JA, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum2008; 59(12):1690-1697. [2] Curtis JR, et al. Is Rheumatoid Arthritis a Cardiovascular Risk-Equivalent to Diabetes Mellitus?Arthritis Care Res. 2018Nov; 70(11):1694-1699. [3] Fine NM, et al. Evaluation of myocardial function in patients with rheumatoid arthritis using strain imaging by speckle-tracking echocardiography. Ann Rheum Dis. 2014; 73(10):1833-1839. 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 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: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: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

Background:A relationship between rheumatoid arthritis (RA) and the presence of abnormalities in left ventricular (LV) geometry such as eccentric remodeling has recently been determined, even in the absence of cardiovascular risk factors and before clinical manifestations (1). The 2016 European League Against Rheumatism (EULAR) recommendations that cardiovascular (CV) risk prediction models should be adapted by a 1.5 multiplication factor in RA patients. Risk prediction algorithms based on the CV risk factors (CVRF) have been an important tool for adopting preventive measures and intensifying therapies based on the estimated risk but their application in predicting cardiac structural abnormalities has never been studied.Objectives:The aim of the study is to determine the CV risk calculator that best predicts alterations in ventricular geometry in RA.Methods:A cross-sectional, observational study of 108 RA patients between 40-75 years (ACR / EULAR 2010 classification criteria). The QRISK3, OMNIBUS, Framingham Risk Score Lipids (FRSL), Framingham Risk Score BMI (FRS-BMI) and Reynolds Risk Score (RRS) calculators were compared. The diagnostic performance was determined by ROC curves, and the discriminative capacity by the Area Under the Curve (AUC) 95% CI. The echocardiogram was the diagnostic gold standard. A p value Results:The prevalence of abnormalities in ventricular geometry was 38.9%. QRISK3 reported AUC of 0.656, 95% CI (0.550-0.762, p=0.006), cut-off point ≥4.6, sensitivity of 73.8% and specificity of 54.5%, and likelihood ratio of +1.62. FRS-BMI showed AUC of 0.653, 95% CI (0.543-0.762, p=0.008), cut-off point ≥11.02, sensitivity and specificity of 61.9% and 57.6% respectively, and likelihood ratio of +1.46. OMNIBUS showed AUC of 0.635, CI 95% (0.525-0.746, p=0.018), cut-off point ≥3.8, sensitivity and specificity of 57.1% and 68.2%. While RRS had AUC 0.644, 95% CI (0.534-0.755, p=0.012), cut-off point of 2.25, sensitivity of 47.6% and specificity 78.8%, and likelihood ratio of +2.24 (Figure 1 and Table 1).Table 1.Discriminatory capacity of the different cardiovascular risk calculators.Calculators (cut-off point).AUCCI 95%pSensitivitySpecificityInferiorSuperiorQRISK (≥4.60)0.6460.5370.7540.01273.8%54.5%SCORE0.5910.4750.706NS--OMNIBUS (≥3.80)0.6210.5090.7340.03857.1%68.2%FRSL0.5940.4800.707NS--FRS-BMI (≥11.02)0.6420.5300.7540.01561.9%57.6%RRS (≥2.25)0.6270.5140.7410.02947.6%78.8%Conclusion:The QRISK3 calculator showed the highest discriminative ability and sensitivity to predict abnormalities in LV geometry. However, all calculators demonstrated the need for a lower cut-off point to predict alterations in ventricular geometry. Our findings require adequate reproducibility in other population groups to determine the applicability of CV risk algorithms as predictors of structural alteration of LV.References:[1]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:Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with cardiovascular abnormalities (1). The echocardiography is a non-invasive tool useful in the detection of cardiac abnormalities, which may be the only manifestation of cardiac involvement preceding a global dysfunction. However, echocardiographic differences between PsA patients, rheumatoid arthritis (RA) patients, and controls have not yet been well described.Objectives:To analyze the echocardiographic parameters in PsA patients and to compare them with RA patients and controls.Methods:This cross-sectional, observational and comparative study, included thirty-six patients (nineteen in each group), aged 40-75 years, with PsA and RA who fulfilled the CASPAR (Classification criteria for Psoriatic Arthritis) and ACR/EULAR 2010 classification criteria, respectively, matched by age, gender and comorbidities with nineteen healthy controls. Exclusion criteria were a poor echocardiographic window, patients with a previous atherosclerotic cardiovascular disease (ischemic heart disease, cerebrovascular accident or peripheral arterial disease), and pregnancy. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Comparisons were done with X2, Kruskall Wallis or ANOVA.Results:There were not differences in the demographic characteristics between groups (Table 1). When comparing echocardiographic findings a statistically significant difference was found in the prevalence of diastolic dysfunction, being more prevalent in PsA and RA patients compared with controls (52.6% vs 52.6% vs 5.3%, p=0.002), likewise the presence of mild mitral valve regurgitation was higher (84.2% vs 53.6% vs 10.5%, p=0.001) and mild pulmonary valve regurgitation (68.4% vs 10.5% vs 0%, p=0.001). Prevalence of abnormal left ventricular geometry was higher in PsA and RA patients than controls (68.4% vs 63.2% vs 21.1%, p=0.006).Table 1.Comparison of demographic characteristics and echocardiographic findings between patients with PsA, RA and controls.PsA(n=19)RA(n=19)Controls(n=19)pAge, years ± SD54.7 ± 7.755.4 ± 9.955.3 ± 5.9NSFemale, n (%)11 (57.9)11 (57.9)11 (57.9)NSDiabetes Mellitus4 (21.1)3 (15.8)2 (10.5)NSHypertension10 (52.6)8 (42.1)7 (36.8)NSDyslipidemia10 (52.6)4 (21.1)7 (36.8)NSActive smoking4 (21.1)2 (10.5)5 (26.3)NSDisease duration, years (p25-p75)6 (4-14)7 (5-18)-NSDAS28-CRP, mean ± SD2.2 ± 0.83.1 ± .8-0.003Echocardiographic findigsDiastolic dysfunction, n (%)10 (52.6)10 (52.6)1 (5.3)0.002LV mass index, g/m2 (p25-p75)78.9 (55.9-86.9)73.7 (61.0-85.7)69.5 (52.0-98.7)NSLVEF, ± mean SD62.3 ± 6.159.7 ± 8.662.9 ± 6.1NSTAPSE, cm ± SD21.8 ± 2.722.4 ± 2.723.7 ± 3.1NSMild aortic regurgitation, n (%)5 (26.3)4 (21.1)1 (5.3)NSMild mitral regurgitation, n (%)16 (84.2)10 (52.6)2 (10.5)Mild pulmonary regurgitation, n (%)13 (68.4)2 (10.5)0 (0)Mild tricuspid regurgitation, n (%)15 (83.3)13 (76.5)11 (57.9)NSLV geometry alterations, n (%)13 (68.4)12 (63.2)4 (21.1)0.006Concentric remodeling, n (%)12 (63.2)10 (52.6)4 (21.1)0.025NS, non-significant; DAS28-CRP, disease activity score using 28 joints and C reactive protein; LV, left ventricular; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Conclusion:This study shows the high prevalence of echocardiographic alterations in PsA patients compared to the general population, of the same magnitude as patients with RA. We emphasize the value of an echocardiogram for a complete cardiovascular evaluation and early detection of cardiac abnormalities in these patients.References:[1]Shang Q, Tam LS, Yip GW, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 2011;38(7):1363-70. doi: 10.3899/jrheum.101136Disclosure of Interests:None declared

Background:Patients with rheumatoid arthritis (RA) have a higher risk of developing a cardiovascular (CV) event than the general population, due to an accelerated process of atherosclerosis (1), which has been documented to begin in early stages of the disease and is directly associated with systemic inflammation (2).Objectives:The aim of this study was to compare the prevalence of subclinical atherosclerosis detected by carotid ultrasound (US) in patients with RA in the first five years of diagnosis and healthy controls.Methods:This was a cross-sectional, observational, and comparative study. A total of 53 patients aged 40-75 years old, with RA diagnosis, in the previous five years, according to the 2010 ACR/EULAR classification criteria, and 53 controls matched by age (±5 years), gender and comorbidities were included in this study. Subjects with a previous CV event, such as myocardial infarction, cerebrovascular event and peripheral arterial disease, another connective tissue disease and pregnant women were excluded from this study. A high-resolution B-mode carotid US was performed in all study subjects. Subclinical atherosclerosis was evaluated as the presence of carotid plaque (CP) or an increased carotid intima media thickness (cIMT). CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm of the surrounding lumen, and an increased cIMT was defined as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test 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:Comparisons of demographic characteristics showed no differences between the RA group and the control group (Table 1). When comparing carotid US findings there was a difference in the presence of CP, being more prevalent in RA patients (26.4% vs 11.3%, p=0.047), in the presence of an increased cIMT, being more prevalent in RA patients (34.0% vs 3.8%, p=p=p=0.001 in the left carotid artery), and in the presence of subclinical atherosclerosis overall, being more prevalent in RA patients (52.8% vs 18.9%, p=Table 1.Demographic and clinical characteristicsRAControlsp(n=53)(n=53)Age years, mean ± SD54.48 ± 9.0954.86 ± 6.83NSWomen, n (%)49 (92.5)49 (92.5)NST2DM, n (%)8 (15.1)7 (13.2)NSHTN, n (%)17 (32.1)17 (32.1)NSDyslipidemia, n (%)19 (35.8)19 (35.8)NSObesity, n (%)21 (39.6)20 (37.7)NSActive smoking, n (%)3 (5.7)4 (7.5)NSBMI kg/m2, median (p25-p75)28.78 (25.92-33.21)27.59 (24.55-33.34)NSDisease duration, mean ± SD2.48 ± 1.31--DAS28-CRP, median (p25-p75)3.21 (1.89-4.12)--MTX, n (%)39 (73.6)--Glucocorticoids, n (%)29 (54.7)--Conclusion:Patients with RA in the first five years of diagnosis have a higher prevalence of subclinical atherosclerosis than the general population. CV evaluation including a carotid US should be done at the time of diagnosis of RA patients, and subsequently it must be individualized according to the CV risk of each patient, with a maximum of five years to identify those patients who would benefit from an opportune treatment.References:[1]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436[2]Ahmad S, Garg S, Dhar M, et al. Predictors of atherosclerosis in rheumatoid arthritis. Vasa 2012;41(5):353-9. doi: 10.1024/0301-1526/a000221Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) patients have a higher risk of developing left ventricular (LV) geometric abnormalities which can result in the development of heart failure and cardiac death (1). High titers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with a worse cardiovascular (CV) prognosis in RA patients (2).Objectives:The aim of this study was to assess the association between RF and anti-CCP antibody titers, and the LV geometric abnormalities detected by a transthoracic echocardiogram.Methods:This was a cross-sectional, observational, and comparative study. Patients aged 40-75 years who fulfilled the 2010 ACR/EULAR classification criteria for RA underwent a transthoracic echocardiogram. Patients with RA and an alteration of LV geometry were matched to RA patients with normal LV geometry, by age, gender, comorbidities, and disease characteristics to eliminate confounders. LV geometry was evaluated with LV mass index and relative wall thickness. A blood sample was taken to measure RF and anti-CCP antibody titers. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi square test for qualitative variables and Student’s t test and Mann-Whitney’s U test for quantitative variables. A p-value Results:A total of 82 RA patients were included in this study, 41 patients with altered LV geometry and 41 patients with normal LV geometry. Of the 41 patients with LV geometric abnormalities, 37 (90.2%) presented LV concentric remodeling and 4 (9.8%) presented LV concentric hypertrophy. We found no significant differences in the demographic and clinical characteristics between both groups (Table 1). Patients with altered LV geometry showed higher titers of IgA-RF (102.11 U/ml vs 21.70 U/ml, p=0.011) and anti-CCP antibodies (193.04 U/ml vs 18.29 U/ml, p=0.005) (Figure 1).Table 1.Demographic and disease characteristics.RA patients with altered LV geometry(n=41)RA patients with normal LV geometry(n=41)pAge years, mean ± SD53.12 ± 7.6252.34 ± 7.74NSWomen, n (%)39 (95.1)39 (95.1)NST2DM, n (%)7 (17.1)4 (9.8)NSHTN, n (%)13 (31.7)10 (24.4)NSDyslipidemia, n (%)9 (22.0)11 (26.8)NSActive smoking, n (%)4 (9.8)3 (7.3)NSObesity, n (%)11 (26.8)14 (34.1)NSBMI kg/m2, median (p25-p75)27.95 (25.33-31.45)28.42 (25.84-32.00)NSDisease duration years, median (p25-p75)10.37 (2.72-17.80)6.40 (3.43-13.29)NSCDAI, median (p25-p75)14.00 (2.00-22.00)10.00 (3.00-16.50)NSDAS28-CRP, mean ± SD3.52 ± 1.423.09 ± 1.11NSTreatmentMTX, n (%)33 (80.5)34 (82.9)NSGlucocorticoids, n (%)25 (61.0)23 (56.1)NSAntihypertensive, n (%)13 (31.7)8 (19.5)NSStatins, n (%)6 (14.6)4 (9.8)NSRA, rheumatoid arthritis; LV, left ventricular; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; CDAI, clinical disease activity index; DAS28, disease activity score using 28 joints; CPR, C-reactive protein; MTX, methotrexate.Conclusion:RA patients with altered LV geometry had higher titers of IgA-RF and anti-CCP antibodies. This suggests an association between antibody titers and CV prognosis in RA patients. Rheumatologists should take these data into account when evaluating CV risk in RA patients, assessing the possibility of performing an echocardiogram for early detection of CV abnormalities and an opportune treatment in this group of patients.References:[1]Myasoedova E, Davis JM, 3rd, Crowson CS, et al. Brief report: rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a population-based cross-sectional study. Arthritis Rheum 2013;65(7):1713-8. doi: 10.1002/art.37949[2]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Wood smoke exposure is a risk factor for the development of chronic obstructive pulmonary disease (COPD), lung cancer and cardiovascular disease and it has also been linked to higher anti-CCP antibodies in patients with rheumatoid arthritis (RA) and COPD (1).Objectives:The objective of the present study is to report the correlation between anti-CCP, IgG, IgM and IgA rheumatoid factor (RF) to wood smoke exposure in patients with RA. Additionally, evaluate the impact of disease activity, biomass exposure, and disease duration on anti-CCP antibody levels.Methods:A cross-sectional, observational study was designed based on a cohort of Hispanic RA patients. All fulfilled the 2010 ACR/EULAR classification criteria for RA. Biomass smoke exposure was expressed using the biomass exposure index (BEI) calculated from the mean of exposed hours per day multiplied by the number of years exposed. Subjects were divided into two groups: those exposed to wood smoke with BEI ≥1 and subjects not exposed to wood smoke. They were matched by age, gender, and comorbidities. Anti-CCP antibodies and RF were measured by ELISA with cutoff points of Results:A total of 318 subjects were included, 159 (50%) of them had a history of exposure to wood smoke. Anti-CCP antibody positivity was present in 102 (64.2%) with a median titer of 97.1 U/mL (1.7-198) in the RA exposed group, and in 89 (56%) with a median titer of 8.5 U/mL (1.1-145) in the RA non-exposed group. A significant difference was found in anti-CCP antibody titers between groups (p=0.003). (Table 1). Spearman’s rho showed a small but statistically significant correlation between BEI and anti-CCP antibody titers (rho= 0.170, p=0.002). Biomass exposure was independently related to higher anti-CCP antibody titers (B=35.4, pConclusion:RA patients who were exposed to wood smoke had higher titers of anti-CCP antibodies than non-exposed RA patients. Furthermore, biomass exposure was shown to be independently related to higher titers of anti-CCP antibodies.References:[1]Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102(9):843-51.Table 1.Comparison of demographic, seropositivity and clinical characteristic between patients with RA exposed and matched non-exposed RA patients.CharacteristicsRA exposed(n=159)RA not exposed(n=159)pAge years, ± SD56.7 ± 8.755.4 ± 8.1NSFemale, n (%)148 (93.1)148 (93.1)NSBEI years, median (p25-p75)35 (15-90)0Disease duration years, median (p25-p75)9 (3.5-15.1)6.8 (2.8-14.6)NSDAS 28-CRP, median (p25-p75)3.37 (2.11-4.4)3.17 (2.09-4.2)NSDyslipidemia, n (%)50 (31.4)43 (27)NSHypertension, n (%)55 (34.6)48 (30.2)NSDiabetes Mellitus, n (%)24 (15.1)23 (14.5)NSActive smoking, n (%)8 (5)8 (5)NSSeropositivityAnti-CCP antibody positivity, n (%)102 (64.2)89 (56)0.137Anti-CCP antibody titers, median (p25-p75)97.1 (1.7-198)8.5 (1.1-145)0.003IgG RF positivity, n (%)31 (19.5)24 (15.1)0.299IgG RF titers, median (p25-p75)5 (2-13)4.9 (2-13)0.529IgM RF positivity, n (%)136 (85.5)126 (79.2)0.141IgM RF titers, median (p25-p75)198 (41-200)177 (28-200)0.067IgA RF positivity, n (%)98 (61.6)92 (57.9)0.493IgA RF titers, median (p25-p75)52.9 (9.3-193)33(5-159)0.060NS, non-significant; RA, rheumatoid arthritis; BMI, body mass index; BEI, biomass exposure index; DAS28-CRP, disease activity score using 28 joints-C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide; RF, rheumatoid factorDisclosure of Interests:None declared

Background:In the last decades there has been a great progress towards gender equality in medicine, and this can be reflected in the proportion of women in Rheumatology, which has been on the rise recently. However, there continues to be a need for women to be able to succeed on equal opportunities with men (1).Objectives:The aim of this study was to recognize the professional limitations and barriers that Mexican female rheumatologists must face.Methods:Female rheumatologists were invited to participate. An online survey was applied anonymously, consisting of questions regarding demographic characteristics, professional, academic and research activities, as well as perceptions of gender discrimination and limitations of their profession.Results:A total of 127 female rheumatologists voluntarily answered the electronic survey. Most of them were aged between 30 and 35 years (40.9%) and had 1-5 years of professional practice (40.2%) (Table 1); 52% have children and 42.4% of them consider that motherhood has had a negative impact on their professional life; 75.6% of female rheumatologists do not work on research activities and only 20.5% have participated in international congresses in the last 5 years; 80.5% report not participating in medical colleges (as leaders or board members). The three main reasons female rheumatologists refer as limitations on their profession are: having other priorities (34.6%), lack of time (32.3%) and lack of support from their peers/bosses (23.6%). Almost half women (45.7%) consider not being discriminated because of their gender in their profession, while the rest of them consider that they are or may be.Table 1.Demographic characteristics.Age, n (%)Younger than 35 years52 (40.9%)From 35 to 40 years29 (22.8%)From 40 to 45 years16 (12.6%)From 45 to 50 years12 (9.4%)Older than 50 years18 (14.2%)Marital status, n (%)Married66 (52%)Single38 (29.9%)Free union13 (10.2%)Divorced8 (6.3%)Widowed2 (1.6%)Years of professional practice, n (%)From 1 to 5 years51 (40.2%)From 5 to 10 years31 (24.4%)From 10 to 15 years16 (12.6%)From 15 to 20 years10 (7.9%)More than 20 years19 (15%)Conclusion:We found that most female rheumatologists are young and with a few years of professional practice, which coincides with the recent increase in the proportion of women in Rheumatology; and perhaps this is the reason why there is low participation in research activities and medical colleges. It is relevant that almost half of them perceive their gender as a reason of discrimination in their professional life. We consider that initiating the conversation of gender equality in Rheumatology, in national and international forums, and to actively search for a strategy to support and encourage our colleagues, are priorities at this moment.References:[1]Andreoli L, Ovseiko PV, Hassan N, et al. Gender equity in clinical practice, research and training: Where do we stand in rheumatology? Joint Bone Spine 2019;86(6):669-72. doi: 10.1016/j.jbspin.2019.05.005.[2]Colunga-Pedraza IJ, Arvizu-Rivera RI, Serna-Pena G, et al. Women’s journey in Mexican rheumatology. Comment on ‘Gender gap in rheumatology: speaker representation at annual conferences’ by Monga et al. Ann Rheum Dis 2020 doi: 10.1136/annrheumdis-2020-218541.Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Cardiovascular disease (CVD) is the main cause of mortality in patients with rheumatoid arthritis (RA) reflected by a higher prevalence of cardiovascular risk factors (CVRFs), a chronic systemic inflammatory state and heart failure compared to the general population (1). Left ventricular diastolic dysfunction (LVDD) is attributable to structural abnormalities such as hypertrophy or interstitial fibrosis and impaired myocyte relaxation resulting from ischemia and is frequently asymptomatic (2). The presence of LVDD it could be considered as the first step to development of heart failure.Objectives:The aim of the study is to identify the association of disease activity and the presence of LVDD in patients with RA.Methods:A cross-sectional, observational, and comparative study of RA subjects that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Subjects were evaluated by a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. A total of fifty-one RA patients diagnosed with LVDD were included according to the 2016 American Society of Echocardiography (ASE). 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, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) and body mass index. Patients with LVDD demonstrated a higher disease activity evaluated by disease activity score using 28 joints-C reactive protein (DAS28-PCR) (4.88 vs 3.56, p= 0.004) (Table 1). It was observed that patients with LVDD have a higher prevalence of being in the high disease activity category (41.2% vs. 13.7%, p= 0.002) (Figure 1). When performing a binary logistic regression, it was found that a high disease activity was the only independent predictor for the presence of LVDD, with an OR 4.70, (95% CI 1.63-13.50, p= 0.004).Table 1.Demographic and disease characteristicsRA patients with LVDD(n=51)RA patients without LVDD(n=51)pWomen, n (%)50 (98)47 (92.2)NSAge, years ± SD56.12 ± 8.7653.91 ± 5.61NSHTN, n (%)17 (33.3)13 (25.5)NST2DM, n (%)6 (11.8)10 (19.6)NSDyslipidemia, n (%)17 (33.3)11 (21.6)NSActive smoking, n (%)5 (9.8)5 (9.8)NSBMI kg/m2 ± SD28.20 ± 4.8929.40 ± 5.13NSDisease duration, years (p25-p75)10.70 (5.16-17.87)5.66 (2.67-15.64)0.033DAS28-CRP, median (p25-p75)4.88 (3.53-5.45)3.56 (3.00-4.69)0.004NS, no significative; HTN, hypertension; T2DM, type 2 diabetes mellitus; BMI, body mass index; DAS28, disease activity score using 28 joints; CPR, C reactive proteinConclusion:Patients with RA and LVDD have a higher disease activity, so emphasis should be placed on strict antirheumatic treatment and cardiovascular therapies to avoid the risk of developing CVD and the progression to heart failure. Logistic regression demonstrates that inadequate disease control is an independent factor from traditional CVRFs for the presence of LVDD.References:[1]Dal Piaz EC, Cioffi G, Ognibeni F, et al. Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic patients with rheumatoid arthritis without overt cardiac disease. Monaldi Arch Chest Dis 2019;89(3) doi: 10.4081/monaldi.2019.1053[2]Abdul Muizz AM, Mohd Shahrir MS, Sazliyana S, et al. A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity. Int J Rheum Dis 2011;14(1):18-30. doi: 10.1111/j.1756-185X.2010.01593.xDisclosure of Interests:None declared

ResumoAntecedentesExistem poucos biomarcadores disponíveis para avaliar a atividade da doença no lúpus eritematoso sistêmico (LES). O volume plaquetário médio (VPM) foi recentemente estudado como um biomarcador inflamatório. Atualmente não está claro se o VPM também pode desempenhar um papel como um biomarcador da atividade da doença em pacientes adultos com LES.ObjetivoInvestigou‐se a associação entre o VPM e a atividade da doença em pacientes adultos com LES.MétodosNeste estudo retrospectivo, compararam‐se dois grupos de pacientes adultos divididos de acordo com a atividade da doença (36 por grupo). Os indivíduos foram pareados por idade e gênero.ResultadosO VPM esteve significativamente diminuído nos pacientes com doença ativa em comparação com os níveis em pacientes com doença inativa (7,16±1,39 versus 8,16±1,50, p=0,005). Em um nível de corte de 8,32 fL, o VPM tem uma sensibilidade de 86% e uma especificidade de 41% para a detecção da atividade da doença. Encontrou‐se uma correlação positiva modesta entre o VPM e a albumina (r=0,407, p=0,001), que por sua vez está inversamente associada à atividade da doença.ConclusõesEm resumo, o VPM está diminuído em pacientes adultos com lúpus ativo e positivamente correlacionado com a albumina, outro biomarcador da atividade da doença. São necessários estudos prospectivos para avaliar o valor prognóstico desse biomarcador.AbstractBackgroundOnly a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE.ObjectiveWe investigated the association between MPV and disease activity in adult patients with SLE.MethodsIn this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age‐ and gender‐matched.ResultsMPV was significantly decreased with respect to those of inactive patients (7.16±1.39 vs. 8.16±1.50, p=0.005). At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r=0.407, p=0.001), which in turn is inversely associated with disease activity.ConclusionsIn summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in rheumatoid arthritis (RA) patients. Guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA) 2013 and the Adult Treatment Panel III (ATP-III) differ in their strategies to recommend initiation of statin therapy. The presence of carotid plaque (CP) by carotid ultrasound is an indication to begin statin therapy. We aimed to compare the recommendation to initiate statin therapy according to the ACC/AHA 2013 guidelines, ATP-III guidelines, and CP by carotid ultrasound. We then carried out an observational, cross-sectional study of 62 statin-naive Mexican mestizo RA patients, aged 40 to 75, who fulfilled the 1987 or 2010 ACR/European League Against Rheumatism (EULAR) classification criteria. CP was evaluated with B-mode ultrasound. Cohen's kappa (k) was used to assess agreement between ACC/AHA 2013 guidelines, ATP-III guidelines, and the presence of CP, considering a p

We read with great interest the letter written by Monga et al addressing the narrowing of the gender gap in the annual meetings of the American College of Rheumatology, in which they reported an increase in female speakers from 42.8% in 2017 to 47.0% in 2018.1 However, women under-representation goes beyond annual meetings as Adami et al found that of 366 guidelines and recommendations in Rheumatology published from 2004 to 2019, only 32% of first authors were women, a proportion which has been increasing in the last 15 years.2 Their findings propelled us to evaluate women’s participation as first authors of oral presentations in the …

Background:Adherence to medications among patients with rheumatic diseases is often suboptimal.1Adherence to treatment has been described to be affected by several factors.2The rheumatologist plays a crucial role in influencing adherence behavior by addressing perceptions about medication, providing information, and establishing trust in the treatment plan.3There is no record of attitudes and thoughts of Mexico’s rheumatologists about adherence to medication.Objectives:To know the rheumatologist’s attitudes regarding treatment adherence in follow up consultation.Methods:Descriptive, cross sectional study. Rheumatologists from across the country were invited to respond an electronic survey created with Google Forms, link was sent by Whatsapp ® message, responses were anonymous. The survey was constructed taking into account the main barriers of adherence related to the doctor. Seven questions were created, from one to six were multiple selections and the seven were open question1.Where do you practice medicine? 2.Do you ask all your patients about adherence medication? 3.If your answer was positive, do you ask individually for each drug? 4.How long do you spend on explaining: side effects, benefits, and mechanisms of action of drugs? 5 Do you discuss available treatment options with your patients to decide one? 6.What’s the definition of adherence? 7.Which activities can the doctor do to improve adherence to their patients?Results:Data were collected from 158 rheumatologists who completed the survey. Regarding the question where they practice medicine, 19.5% answered they work in public medical institutions, 31.8% do private practice and 48.7% work in both of them, 88.3% answered correctly adherence definition, 93% of rheumatologists ask for adherence to medication in the follow up consultation and only 86.1% do it individually for each medication, 97.4% discuss therapeutic options with their patients. The time used to explain treatment is presented in Figure 1. The interventions considered by rheumatologists to increase adherence are reported in Table 1.Table 1Interventions considered by rheumatologists to increase adherencePatient education(in follow up consultation, conferences, pamphlets)Develop rapportwith patient. (“be accessible”, “answer questions” “make the patient part of“ don’t be paternalistic or authoritarian”)Adherence measure(Use the available method, questionnaires, self-report, drug levels, electronic pillbox, pill count, etc. “Don’t matter which one, measure it!“)Interventions for no adherence reasons(phone calls, text messages, telephone alarms) fixed schedules for each medication, cognitive-behavioral therapy, access to medications)Family support networkPresented in order to frequencies and grouped by topicConclusion:Rheumatologists ask for adherence medication but more than half use a limited amount of time to explain about medication, nevertheless, they think that patient education is the best intervention to increase adherence.References:[1]Pasma, Annelieke et.al Facilitators and Barriers to Adherence in the Initiation Phase of Disease modifying Antirheumatic Drug (DMARD) Use in Patients with Arthritis Who Recently Started Their First DMARD Treatment, The Journal of Rheumatology (2013) DOI:10.3899/jrheum.140693.[2]M.F. M. Improving treatment adherence in patients with rheumatoid arthritis: What are the options? Int J Clin Rheumtol. 2015;10(5):345–56.[3]Voshaar et al. Barriers and facilitators to disease modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskeletal Disorders (2016) 17:442 DOI 10.1186/s12891-016-1289-zDisclosure of Interests:None declared

Background:Cardiovascular disease (CVD) is the primary cause of mortality in women in developed countries. CVD risk rises with age, yet for women there is a rapid increase that occurs after the onset of menopause (1). There has been found that there is four to five times atherosclerosis compared to premenopausal women. Adding to traditional CVD risk, rheumatoid arthritis (RA) patients have an increased CVD morbimortality because of the inflammatory disorder (2). To detect the burden of CVD, carotid ultrasound has been promoted to identify preclinical atherosclerosis.Objectives:To determine the prevalence of carotid atherosclerosis andcarotidintima-media thickness (cIMT) in postmenopausal patients with RA and compare them to matched controls.Methods:Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled 2010 ACR/EULAR criteria with post-menopause and matched controls (without RA) were included. Patients with history of previous atherosclerotic CVD, women who undergone menopause due to hysterectomy or cessation of periods other than by a natural cause, women on hormone replacement therapy and having irregular menses were excluded. Clinical history and carotid ultrasound were performed. Increased cIMT defined as ≥0.9 mm was measured using the two inner layers of the common carotid artery and carotid plaque as a focal narrowing ≥0.5 mm of the surrounding lumen. Descriptive analysis was done with frequencies (%), median (q25-q75). Comparisons with Chi-square and Mann Whitney-U test. Binary regression analysis was used to test association an increased cIMT with cardiovascular risk factors and RA diagnosis.Results:A total of 139 women with established post-menopause were included. Baseline characteristics (Table 1). Right carotid atherosclerosis prevalence was found more than twice (19% vs 8%, p=0.01) and an increased cIMT was higher in postmenopausal RA patients (right 25% vs 10%, p=Table 1.Baseline characteristicsRA(N=70)Control(N= 69)pAge, median (q25-q75)55.04 ± 5.38156 6 ±.481NSDisease duration, year, median (q25-q75)10.32 (4.5-15.3)Body mass index, median (q25-q75)28.19 (25.36-31.84)28.55 (26.57-31.18)NSDiabetes Mellitus, n (%)8 (11.6)14 (20)NSHypertension, n (%)19 (27.5)26 (37.1)NSDyslipidemia, n (%)23 (32.9)21 (30.4)NSActive smoking, n (%)14 (20.3)5 (7.1)NSTable 2.Carotid ultrasound findingsRA(N= 70)Controls(N=69)pAny plaque, n (%)24 (34.3)17 (24.6)NSRight CP, n (%)19 (27.9)8 (11.6)0.01Left CP, n (%)17 (25)13 (18.8)NSAny cIMT ≥0.9 mm, n (%)38 (54.3)19 (27.5)0.001Right carotid cIMT ≥0.9 mm, n (%)25 (35.7)10 (14.7Left carotid cIMT ≥0.9 mm, n (%)31 (44.3)15 (21.7)CP characteristics:Homogeneous n (%)2 (2.8)3 (4.3)NSHeterogeneous, n (%)20 (28.6)16 (23.2)NSCP: carotid plaqueConclusion:Despite the increase in cardiovascular risk in postmenopausal women compared to the general population, women with RA have a higher risk compared to healthy women. Carrying out cardiovascular prevention and management in patients with RA is essential, especially in those who are in a stage of post-menopause.References:[1]Karvinen, S. et al (2019). Menopausal Status and Physical Activity Are Independently Associated with Cardiovascular Risk Factors of Healthy Women, Endocrinol, 10, 589.[2]Schott, L., et al (2009). Do carotid artery diameters manifest early evidence of atherosclerosis in women with rheumatoid arthritis? JWomensHealth, 18, 21-29.Disclosure of Interests:None declared

Background:Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD). Risk stratification algorithms for general population, such as cardiovascular risk calculators, have been developed to improve primary prevention and early detection of CVD; however, it underestimates cardiovascular risk in PsA patients1. Carotid ultrasound, which measures both carotid intima-media thickness (cIMT) and carotid plaque (CP), is useful in the detection of subclinical carotid atherosclerosis improving risk stratification.Objectives:This study aimed to evaluate the use of carotid ultrasound in the reclassification of cardiovascular risk in PsA patients and compare it with controls.Methods:This cross-sectional study included 70 PsA patients that fulfilled the CASPAR criteria and 70 controls subjects matched by age and comorbidities. Patients with a history of previous atherosclerotic CVD and pregnancy were excluded. Clinical examination, blood tests and Framingham Risk Score Lipids and BMI based (FRS-Lipids/FRS-BMI) and ACC/AHA 2013 calculators were performed. Carotid B-mode ultrasonography was used for measurements of cIMT and CP presence.Increased cIMT was defined as ≥0.9 mm. CP was definedas afocal narrowing ≥0.5 mm of the surroundinglumen or acIMT ≥1.2 mm.Descriptive analysis was done with measures of central tendency and dispersion and comparisons with Chi-square, Student´s t and Mann-Whitney U tests.Results:A total of 138 subjects were included. Clinical and demographic characteristics are shown in Table 1. Differences were found in the cardiovascular risk classification between the calculators and the carotid ultrasound. However, these were not significant when compared to controls, with the exception of the FRS-Lipids which had a significant difference when recategorized as high risk by the increase in the cIMT (p = 0.016). A 70.8% and a 56% of patients with PsA who had CP were not classified as high risk according to FRS-Lipids (p = 0.010) and ACC / AHA 2013 (p Table 1.Clinical and demographic characteristics.PsA(n=69)Controls(n=69)PAge, (mean±SD)53.58±10.94653.86±7.313NSWomen, n (%)38(55.1)59(85.5)Type 2 Diabetes Mellitus, n (%)14(20.3)9(13)NSHypertension, n (%)27(39.1)19(27.5)NSDyslipidemia, n (%)29(42)24(34.8)NSObese, n (%)26(37.7)28(40.6)NSActive smoker, n (%)15(21.7)12(17.4)NSDisease duration, median (q25-q75)5(2.5-8)--DAS28-ESR, (mean±SD)3.74±1.477--DAPSA, median (q25-q75)35(27.5-58.5)--Conclusion:None of the traditional calculators used in the general population correctly estimates cardiovascular risk in patients with PsA. Among the calculators we performed, FRS-Lipids was the worst, underestimating PsA individuals with CP up to 70.8%. Therefore, it is advisable to perform a carotid ultrasound without relying on the results obtained by any of these calculators in order to achieve an adequate classification and accomplish a correct management of the disease.References:[1]Sobchak, C.et al.(2019), Value of Carotid Ultrasound in Cardiovascular Risk Stratification in Patients with Psoriatic Disease. Arthritis Rheumatology, 71: 1651-1659. doi:10.1002/art.40925Table 2.Ultrasound Characteristics in PsA patientsCPWithout CPPFRS-Lipids, n (%)0.010Low and Moderate risk17(70.8)39(95.1)High risk7(29.2)2(4.9)FRS-BMI, n (%)NSLow and Moderate risk15(62.5)32(80)High risk9(37.5)8(20)ACC/AHA 2013, n (%)Low, Borderline and Moderate risk14(56)35(97.2)High risk11(44)1(2.8)Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) and psoriasic arthritis (PsA) are autoimmune diseases, in both diseases it has been described that the main cause of morbidity and mortality is cardiovascular (CV) disease. Dyslipidemia is the most recognized CV risk factor. An association is recognized between the concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total triglycerides (TG), atherogenic index (AI) and the risk of myocardial infarction (MI), stroke and fatal cardiovascular disease (CVD). The relationship between serum lipid levels and CVD risk is potentially paradoxical in RA but this relationship has not been clarified in PsA.Objectives:To compare lipid profile between groups with RA, PsA and controls.Methods:A cross-sectional observational study was designed, which included 95 patients between 45-75 years who fulfilled the CASPAR classification criteria for PsA. 95 patients between 45-75 years who fulfilled the ACR / EULAR 2010 classification criteria for RA and 95 age-matched controls. Concentrations of CT, HDL-C, LDL-C, TG and atherogenic index were compared between the groups. Clinical measures were compared using one-way ANOVA or Kruskall-Wallis tests. Post-hoc analysis was performed with Bonferroni’s correction. Ap≤ 0.05 was considered statistically significant. The data was analyzed using the SPSS version 25 software package.Results:In our study, no significant difference in LDL-C was found between RA and PsA, however post-hoc analysis was performed where we found higher LDL-C levels among RA patients compared with controls (p0.025). RA patients had higher HDL-C than PsA patients (p0.006) but PsA had a higher HDL-C than controls (p0.007). TC/HDL-C was higher in PsA than RA and controls (p0.050). PsA patients were the group with the lowest HDL-C levels (p0.007). In contrast RA were the groups with the highest HDL-C levels (p0.007). (Table 1).Table 1.Clinical parameters.PARAMETERRAPsAControlspTC*176.6 ± 37.2176.3 ± 35.9186.34 ± 33.1720.089TG**132.7 (102.0-187.3)131.0 (97.2-189.2)118.35(88.2-162.25)0.245HDL-C**50.7 (42.1-62.6)46.7 (37.4-53.9)51.7 (41.3-60)0.007LDL-C*94.36 ± 21.7097.71 ± 30.12105.32 ±31.350.025TC/HDL-C**3.41 (2.81-4.08)3.74 (3.17-4.47)3.49 (2.99-4.52)0.050*Data are reported in mean ± SD**Data is reported in median (IQR)Conclusion:Patients with inflammatory joint diseases have more adverse lipid profiles than controls.References:[1]Pietrzak, A., Chabros, P., Grywalska, E., Kiciński, P., Pietrzak-Franciszkiewicz, K., Krasowska, D., & Kandzierski, G. (2019). Serum lipid metabolism in psoriasis and psoriatic arthritis–an update. Archives of medical science: AMS, 15(2), 369.Disclosure of Interests:None declared

Background:Previous studies showed that 93% of rheumatologists consider fibromyalgia (FM) as a clinical entity. However, accompanying symptoms such as fatigue, widespread pain, sleep disturbance and headache are underrecognized among physicians. According to a previous study, most recognized symptoms by general practitioners are fatigue and widespread pain (72.6%), while about thirty percent of physicians recognize sleep disturbance and depression as symptoms.Objectives:To investigate physicians’ point of view of FM accompanying symptoms in northeastern Mexico.Methods:We designed an electronic survey about physicians’ perceived importance of depression, fatigue, widespread pain, sleep disturbances, headache and irritable bowel disease symptoms (pain and cramping) in patients with FM. Questions were answered using a 5-point Likert scale: 1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree. General practitioners, rheumatologists, neurologists, psychiatrists were included.Results:A total of 236 physicians were included: general practitioners, 149 (59.3%); rheumatologists, 21 (8.9%); neurologists 18 (7.6%); psychiatrists 8 (3.4%), and family physicians, 49 (20.8%). FM was considered a clinical diagnosis by 208 (88.1%) and most physicians think FM is both a physical and psychological condition, 190 (80.5%). Full results on physicians’ perceptions is shown in Table 1. Fatigue was the symptom which most physicians agreed or strongly agreed was important in FM, 219 (92.7%). Disagreement (any degree) was greater regarding abdominal pain/cramping being an important symptom in FM, 52 (22%). Complete results can be seen in Image 1.Table 1.Perceptions’ of physicians about FM.VariableFM is a clinic diagnostic, n (%)208 (88.1)Unsure FM is a clinical diagnostic, n (%)12 (5)FM is a physical illness, n (%)33 (14)FM is a psychological illness, n (%)11 (4.7)FM is both physical and psychological, n (%)190 (80.5)FM has a negative impact on quality of life, n (%)227 (96.2)FM has a negative impact on life expectancy, n (%)135 (57.2)Conclusion:FM was considered a clinical diagnostic and an illness both physical and psychological by most physicians. Headache and abdominal pain/cramping are symptoms less likely to be perceived as important in patients with FM.References:[1]Perrot S, Choy E, Petersel D, et al. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia. BMC Health Serv Res. 2012 Oct 10;12:356.[2]Kianmehr N, Haghighi A, Bidari A. Are general practitioners well informed about fibromyalgia? Int J Rheum Dis. 2017 Dec;20(12):1917-1921Figure 1.Image 1. Perception of accompanying symptoms of fibromyalgia (FM)Disclosure of Interests:None declared

Background:Patients with Rheumatoid Arthritis (RA) have higher incidence of cardiovascular diseases (CVD) compared to general population. There is controversy about the impact of RA disease activity on left ventricular systolic function (LVSF)1. LVSF may be assessed by conventional methods like left ventricular ejection fraction (LVEF) and myocardial shortening or by novel techniques evaluating myocardial strain such as speckle tracking echocardiography (STE).Objectives:To assess the impact of RA disease activity on LVSF using ejection fraction and myocardial strain by STE.Methods:Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled the 2010 ACR/EULAR classification criteria and matched controls were included. Patients with a poor US window, history of previous CVD (ischemic heart disease, cerebrovascular accident or peripheral arterial disease) and pregnancy were excluded. Individuals were evaluated using two-dimensional speckle tracking echocardiography performed and reviewed by 2 certified echocardiographers. LVEF and myocardial strains (circumferential, longitudinal and radial) were measured; differences were solved by consensus. Descriptive analysis was done with measures of central tendency and dispersion. Student-t and Mann-Whitney U tests were used for comparisons.Results:A total of 140 subjects were included. Demographic and clinical characteristics are shown in Table 1. RA patients were divided in 2 groups, according to disease activity by DAS 28-CRP (remission or low activity and moderate or high activity). Echocardiographic comparisons between RA and controls and between the 2 groups in which RA patients were divided by disease activity are shown in Table 2. The LVEF was lower in RA subjects compared with controls (p=0.022), however LVEF was normal (> 52% in men and >54% in women) in both groups. There was a significant difference in the circumferential strain (CS) between RA patients based on the disease activity by DAS 28-CRP (p=0.006).Table 1.Demographic and clinical characteristics.RA(n= 70)Control(n= 70)PFemale, n (%)67 (95.7)69 (98.6)NSAge, mean ± SD52,4±6,752,0±6,1NSType 2 Diabetes Mellitus, n (%)9 (12.9)7 (10)NSHypertension, n (%)14 (20)16 (22.9)NSDyslipidemia, n (%)16 (22.9)17 (24.3)NSActive smoking, n (%)11 (10.9)8 (16.3)NSDisease duration, years,median (q25 –q75)8.0(3.0-15.0)--DAS-28-PCR, median (q25 –q75)3.2(2.1-3.9)--Table 2.Echocardiographic findingsLVEFPCSPRA, mean ± SD63.0±4.30.022-16.4±4.5NSControls, mean ± SD64.7±3.8-16.2±4.1LVEFPCSPRemission or low disease activity, median (q25 –q75)64.0(60.0-66.0)NS-15.1(-17.2- -12.2)0.006Moderate and high diseases activity, median (q25 –q75)63.0(60.0-66.0)-18.1(-22.0- -13.9)LVEF= Left ventricular ejection fractionCS= Circumferential strainConclusion:The decrease in the circumferential strain depends on the disease activity. Myocardial strain by speckle tracking echocardiography may detect early myocardial dysfunction in RA. It is important for the rheumatologist to establish an appropriate treatment in order to achieve the disease remission or a low disease activity, as there is an impact of the disease activity on the myocardial function.References:[1]Hanvivadhanakul, P., Buakhamsri, A. Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease.Adv Rheumatol59, 56 (2019).https://doi.org/10.1186/s42358-019-0100-xDisclosure of Interests:None declared

Background:Rheumatoid Arthritis (RA) has been associated with depression by up to 46% (1)Within the universe of manifestations of depression is learned helplessness (LH)LH is defined as an inadequate perception of the disease, generating feelings of defenselessness, loss of self-esteem, pessimism, and negativity. This leads to passivity, surrendering to fate, and thoughts that nothing within their power can change their situation, this condition produces a rapid deterioration which prevents responding adaptively to a traumatic situation, increasing the frequency of anxiety and depression. (2)Objectives:To assess the relationship between depression, LH, disability and disease activity among patients with RAMethods:Descriptive observational study included RA patients diagnosed according to ACR / EULAR 2010 randomly recruited between June and September 2019 at University Hospital “Dr. José Eleuterio González” in Monterrey, México.Beck Depression Inventory (BDI) and Rheumatology Attitude Index (RAI) were applied for measure depression and LH, to measure disability Health Assessment Questionnaire (HAQ-DI) was applied. CDAI and DAS28-PCR scales were used for measure disease activity.Descriptive analysis was carried out with measures of central tendency and dispersion. Spearman correlation were used for comparisons, according to the distribution of the variables. A p Results:A total of 177 patients were included, demographic and clinic features are presented in table 1. Prevalence of LH was 94.5% (167/177); 60% (100/167) mild levels (9-15) and 33% (67/167) high levels (>15). A significant correlation was found between higher levels of dysfunctionality and BDI and higher levels of LH (rho = 0.338; p = 0.001). There was a positive association when measuring CDAI (rho = 0.235; p = 0.002) BDI (rho=0.278 P=Table 1.Demographic and clinical characteristics of the patients. HAQ-DI Health Assessment Questionnaire RAI Rheumatology attitude index, DAS28-PCR Disease Activity Score CDAI Clinical disease activity index BDI Beck Depression InventoryDemographicsn = 177Gender Female n, %165 (93.3%). Male n, %12 (6.8%)Age (mean), SD.52.16 (12.8)Years of study (average), SD.8.3 (3.6)Years with RA (mean), SD.8.2 (8.0)RAI (mean), SD13.83 (3.9)HAQ-DI (mean), SD0.67 (0.77)CDAI (mean), SD12.0 (11.4)DAS28-PCR (mean), SD2.4 (0.6)BDI (mean), DE9.30 (9.7)LH, n (%)168/177 (94.5%)High levels 108/177 (61%)Low levels 60/177 (33%)Conclusion:In this study the prevalence of LH was high >90%, mainly in mild levels. Dysfunctionality seems to be the factor most associated with the presence of depression and LH.Rheumatologist should consider the high levels of LH, to assess patients in order to obtain a better outcome.Table 2.Correlation between learned helplessness and clinical variables LH Learned Helplessness HAQ-DI Health Assessment Questionnaire RAI Rheumatology Attitude Index DAS28-PCR Disease Activity Score CDAI Clinical Disease Activity Index BDI Beck Depression InventoryrhopLH –HAQ-DI0.338LH-CDAI0.2350.002LH-DAS28PCR0.1660.027LH-BDI0.278[1]Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol. 2011;6(6):617-23.[2]Moyano S, Scolnik M, Vergara F, Garcia MV, Sabelli MR, Rosa JE, et al. Evaluation of Learned Helplessness, Perceived Self-efficacy, and Functional Capacity in Patients With Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol. 2019;25(2):65-8.Disclosure of Interests:None declared