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BackgroundCurrently, mucosal immunity research has been investigated whether the serum levels of SIgA reflects the over-activation immune system in gut associated lymphoid tissues (GALT) and if the antigenic stimuli in the mucosa are responsible for inducing and maintaining the inflammatory response in Spondyloartrhitis (SpA). Based on our previous results, variances on levels of SIgA might influence in disease activity. SIgA Reverse transcytosis (retrotranscytosis) has been demonstrated as a GALT mechanism which enhance systemic inflammation in some autoimmune pathologies such as celiac disease.ObjectivesThis study proposes the evaluation of receptors associated with retrotranscytosis CD71 and Dectin-1 (Dec-1) in gut tissues from SpA without IBD patients to explore a possible mechanism responsible of gastrointestinal inflammatory imbalance.MethodsIn total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=65, 36.1%) met the selection criteria and from them (n=41, 63.1%) by a gastroenterologist to perform digital chromoendoscopy with magnification for colon e ileum and histological analysis. Pregnant and lactating women, and cancer patients, patients with other autoinflammatory diseases, autoimmune diseases, immunodeficiency, chronic pancreatitis, or chronic liver disease, and those who had received antibiotic treatment in the last 3 months were excluded from the study. Furthermore, those patients with SpA and concomitant IBD were excluded. All included patients were between 18 and 65 years old. CD71 and Dec-1 apical expression were identified by indirect immunofluorescence. Fecal Calprotectin (FC), Serum SIgA in house and clinical indices BASDAI, BASFI, ASDAS-CRP, ASDAS-ESR were measured. The association were evaluated using the Chi-square or Fisher’s exact test and a multiple correspondence discriminant analysis (MCDA) was performed including those variables with significant associations from bivariate analysis and some that are considered clinically relevant to explain the impact of SIgA and CD71 in SpA.ResultsThe average age of the patients included was 44,6±10.2 years, 56.1% were men, 39.0% were HLA-B*27:05 positive, 90.2% had axial involvement. Serum levels of SIgA were 62.3±24.1 gr/mL, CRP 1.7±2.4 and ESR 14.1±12.0 mm/h. Positive levels of FC (>120ng/mL) were observed in 31.7%. BASDAI >4 was found in 58.5% of patients and ASDAS-CRP >2.1 in 75.6%. Apical expression of CD71 and Dec-1 in the ileum was observed in 48.8% and 36% respectively, the expression of both receptors in colon tissues were irrelevant. CD71 expression was associated with high levels of serum SIgA (p=0.05). However, no associations were observed between retrotranscytosis receptors and any of the clinical and histological variables. The MCDA showed a Cronbach’s Alpha reliability coefficient of 0.763 and showed two dimensions: a main dimension (Dim 1) related to the presence of loss of the vascular pattern in the ileum (CC 0.325), FC + diarrhea (CC 0.695), FC + abdominal distension (CC 0.883) and FC + abdominal pain (CC 0.885) and a secondary dimension (Dim 2) that collected the variables serum SIgA (CC 0.513), ASDAS-CRP >2.1 (CC 0.311), CD71 (CC 0.424), please see Figure 1.Figure 1.Multiple correspondence discriminant analysis for CD71, serum SIgA and activity index in SpA patientConclusionThe findings reflect a possible relationship among the apical expression of CD71in ileum with high levels of serum SIgA and activity, suggesting that retrotranscytosis mediated by this receptor might be a mechanism that mediate the intestine-joint axis in SpA.AcknowledgementsThe Ministry of Science, Technology, and Innovation - MinCiencias (Grants No. 68022 and 57442). Universidad El Bosque (PCI-2018-10300), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem, in Bogota, Colombia and Biomedicina de Chihuahua, MéxicoDisclosure of InterestsNone declared

Background:Digital chromoendoscopy with magnification is a technique that identify microscopic inflammation, with a better characterize, highlighting specific gastrointestinal findings showing a good correlation with histopathological features. Spondyloarthritis (SpA) patients with the presence of non-specific gastrointestinal symptoms, subclinical intestinal inflammation is defined by endoscopic and histological techniquesObjectives:To detect early structural inflammatory changes by chromoendoscopy and magnification colonoscopy in colonic/ileum digestive mucosa and establish its association with clinical variables in patients with SpA and gastrointestinal symptomsMethods:In total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=35) (19.4%) had an indication by a gastroenterologist to perform the chromoendoscopy, magnification colonoscopy and histological analysis. The association between clinical and colonoscopy variables were evaluated using the Chi square or Fisher’s exact test. (Ethical/Code. 2017-023)Results:The average age of the patients included for colonoscopy was 45.4±10.3 years, 57.1% were men and 42.9% presented the HLA-B*27 allele. Axial involvement (91.4%), inflammatory back pain (68.6%) and use of biological therapy (71.4%). High levels of calprotectin (25.7%), CRP>3 (14.3%), positive ESR (22.9%) and positive ANCA (8.6%) was observed. Regarding outcome measures of function and activity, BASDAI >4 (60%) and ASDAS-PCR >2.1 (80.0%) was observedThe loss of vascular pattern in the ileum was associated with high levels of calprotectin levels (p=0.002). At microscopic level, 80% of the patients who presented acute inflammation in the ileum had elevated calprotectin (p=0.013). Cryptitis (77.8%) in the ileum was associated with axial involvement (p=0.017). Ulcers and erosion in the ileum were associated with positive ESR (p=0.003). All patients who presented ulcerations and inflammation (64.3%) in ileum were HLA-B27 positive (p=0.029) and (p=0.052) respectively. The 50% of patients with atrophy of villi in ileum were receiving biological treatment (p=0.035)Conclusion:Digital chromoendoscopy and augmentation colonoscopy provided an improved and detailed contrast of the surface of the gastrointestinal mucosa. The tissue sampling showed the loss of vascular pattern as main finding in ileum with interesting associations with fecal calprotectin levels in patients with SpA. The interest of proposing the active search for symptoms, signs and biomarkers of gastrointestinal involvement in patients with SpA without IBD is to define subclinical gastrointestinal involvement and early remission through an endoscopic evaluation and objective histological and propose a specific clinical and therapeutic treatment.Acknowledgments:The Government Institute of Science, Technology, and Innovation, Francisco Jose de Caldas—COLCIENCIAS(Grant No. 130877757442). Universidad El Bosque (PCI-2018-10091), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem-Bogota, Colombia and Biomedicina de Chihuahua, MéxicoDisclosure of Interests:None declared

Background An association between Rheumatoid arthritis(RA) and Periodontal Disease(PD) has been reported. However, predicting factors of PD progression in patients with eRA are lacking Objectives To establish the predictive factors for progression of PD in patients with eRA including clinical and serological active scores of RA and status of PD Methods This cohort study evaluated the progression of PD at 280 inter-proximal dental sites in 28 patients within 2 years of diagnosis with eRA and they were evaluated to establish their progression through one year of follow-up. Adult patients were classified according to the 2010 ACR and the EULAR criteria. Periodontal diagnosis was established based on the AAP and the CDC and Prevention criteria. Serum markers of RA (rheumatoid factor, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and anticitrullinated protein antibodies (APCAs) were evaluated, disease activity was assessed by disease activity score (DAS28-ESR) AND the simplified disease activity index (SDAI). Plaque index, gingival index, pocket depth, and clinical attachment loss (CAL) were evaluated at baseline and at one year follow-up. Data were analysed to establish predictive generalised linear mixed models (GLMM) for clinical attachment loss progression at each site with ≥2 or≥3 mm CAL Results The patients included had an average age of 47.5±12.69 and 75% were women. The comorbidity given by the habit of smoking actively occurred only in 1% of patients. The 35.71% had levels of ESR >20 mm3/h and 39% APCA positive while in 60.71% had CRP ≥3 mg/L and 67.86% of patients had a positive FR. Regarding the indices of activity of the disease, DAS28-PCR>2.6 was found in 67.86% of the patients and SDAI scale >3.3 in 75%. 71.43% of the patients were being treated with DMARD and corticoid therapy. 71.43% of patients had a diagnosis of periodontitis. CAL≥2 mm and ≥3 mm was observed at 15% and 7.5% of dental sites, respectively. Factors associated with CAL in dental sites were: age, ESR, RF, DAS28, treatment with DMARD-Corticoids, periodontal pocket, CAL and percentage of CAL>5 mm, plaque index, gingival index and haemorrhage. Variables RA associated with activity such as CRP, DAS28, and SDAI showed a similar behaviour and they were more frequently associated in periodontal progressive sites. The principal predictive periodontal factors were the percentage of sites with CAL>5 mm and high gingival inflammation at baseline. Patients receiving combined treatment with disease-modifying antirheumatic drugs (DMARD) and corticosteroids exhibited less CAL. The predictive values of the GLMM for CAL of ≥3 and≥2 mm were 98% and 82%, respectively Conclusions Systemic factors as disease activity score and serum biomarkers such as baseline periodontal status are associated with periodontal disease progression in early RA patients. It is known that the very low daily dose prednisolone in combination DMARD therapy substantially decreased radiographic progression and it could influence periodontal disease progression too in patients with RA in early stages of the disease Reference [1] Bello-Gualtero JM,et al.J Periodontol.2016;87:346 Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease characterised by joint destruction, deformity, lower functional status and decrease in life expectancy. The Porphyromonas gingivalis (P. gingivalis) has been reported to be significantly associated with RA. The adipokines are suggested to be a common link between periodontitis and RA Objectives To determine the association between serum adipokines levels and presence of P gingivalis in patients with early rheumatoid arthritis (eRA) compared to healthy individuals Methods A cross sectional study was conducted. Patients with the diagnosis of (eRA) according to the ACR/EULAR 2010 criteria were studied in Bogota-Colombia. A complete medical history related to RA was obtained. Adiponectin levels measured by Luminex technology (MILLIPLEXMAP ), IL6 by chemiluminescence (Immulite 1000, Siemens) and leptin quantification by ELISA (Diasource, ), high-sensitivity CRP (hs-CRP) (Immulite 1000, Siemmens) and ESR (Test 1 THL Ali FAX), and the detection of periodontopathic bacteria was carried out by qPCR from subgingival plaque samples. Cancer, autoimmune disease, infection, antibiotic use, diabetes, orthodontics treatment were exclusion criteria. An association analysis was made to evaluate the relationship between adipokines levels and periodontal, rheumatologic conditions using X2 test, Mann Whitney test and logistic regression model was performed to confirm this associations. All the results were performed with a level of significance of 95% Results A total of 51 patients with eRA and 51 healthy individuals were matched by age and gender. The mean age in RA patients was 48,54±10,93 years, 80,39% were female, between RA patients, 17.64% were in high activity and 27.45% in remission by DAS 28-ESR. 45.1% had APCA>20 UE. 37.25% were overweight and 13.72% were obese. 82.35% of patients had treatment, of which 80.39% received treatment with conventional disease modifying therapy, being methotrexate the most frequent one in 86.8%. In turn, 64.7% and 51% had high leptin and adiponectin levels respectively. An association of high adiponectin levels was found with Body Mass Index-BMI 47755 pg/ml were found associated with the absence of P gingivalis (OR=0.078 95% CI 0.01–0.62) adjusted an ever smoking history of cigarette smoking, Body Mass Index>30 and high level of leptin and IL6. Conclusions The adiponectin plays an anti-inflammatory role in the pathophysiology of several chronic inflammatory diseases and it has been reported to inhibit LPS-induced NFκB nuclear translocation and to affect other LPS-triggered pathways. To promote the weight control in eRA could be to prevent the oral infection Reference [1] Le Sage F, et al. Mol Cell Endocrinol2017;446:102–110. Disclosure of Interest None declared

Background Association studies in rheumatoid arthritis (RA) have been focused in the pre-clinical phases of the disease in first-degree relatives (FDR). Data has shown that obesity, ACPA and the periodontal condition may modulate the severity and the clinical presentation of RA Objectives To investigate the levels of adipokines in FDR and establish their association with the state of rheumatic and periodontal condition Methods 124 FDR individuals and 124 healthy controls matched by age and gender were included. Rheumatologic (clinical and serological markers) and periodontal assessment was performed. It was quantified the adiponectin, leptin, IL6 levels. HLA-DRB1 was determined. Serum markers of RA (rheumatoid factor, erythrocyte sedimentation rate, C reactive protein (CRP), and APCA. P gingivalis and IgG1/IgG2 P gingivalis were measured. Radiographs of hands and feet were evaluated the Sharp-van der Heijde score. An association analysis was made to evaluate the relationship between adipokines and periodontal, rheumatologic conditions using X2 test, and logistic regression model was performed to confirm this associations Results In FDR group, 71.77% were women with a mean age of 39.24±12.22 years. 37.09% had overweight and 4.83% had obesity. Among the controls, 70.97% were women, with an average age of 39.31±12.30 years. 27.41% had overweight and 4.83% had obesity. Leptin levels were found in 37.66% vs 18.42% in controls(p=0.002). In FDR, 60.48% had periodontal disease of which 62.66% moderate, P gingivalis in 62.10%. In controls, 55.64% had periodontal disease, of which 63.76% moderate with 42.74% P gingivalis positive (p=0.002). In the FDR, radiography of hands and feet showed in 25.28% of them had some alteration, 68.18% had ≥1 erosion, 45.45% had ≥1 joint space narrowing and in 6.89% juxtaarticular osteopenia. An association of leptin levels with the low economic level was found p=0.006 and high levels of leptin in individuals with BMI ≥30 p=0.031. IL6 was found to be associated with severity of periodontal disease, with higher levels being found frequently in mild periodontal disease p=0.039.The condition of FDR was significantly associated with high leptin levels adjusted for presence of swollen joints, presence of P gingivalis and low levels of IL6 OR=2,57, 95% CI: 1.14 to 5.95. In this group, the individual with leptin at moderate levels adjusted with BMI >25, has a lower probability of presenting CRP >3 mg/L OR=0.43 95% CI: 0.20 to 0.90. Conclusions High levels of leptin, the presence of P gingivalis and swollen joints may be relevant conditions associated with the development of RA in FDR.Leptin levels and overweight can modulate the production of acute phase proteins in this group of individuals contributing to the mechanism of systemic inflammation. The clinical implications of our findings propose regulated exercise programs, oral hygiene, and weight control in FDR Reference [1] Unriza-Puin S, et al. Clin Rheumatol2017;28(36):799–806. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints but also has extra-articular manifestations such as Periodontal Disease (PD). The Dickkopf-1 (DKK-1) may have an active role in the regulation of bone biology and patients with RA that carry genetic variants of DKK-1 have greater bone damage Objectives To investigate the polymorphisms of DKK-1 in patients with early RA (eRA) and its association with some rheumatic, radiological and periodontal variables. Methods A cross-sectional study in 63 patients with eRA according to the ACR/EULAR 2010 criteria and PD based on the AAP/CDC and Prevention criteria. Serum markers rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and anticitrullinated peptide antibodies (APCAs) were evaluated. Patients selected were over 18 and less than 65 years old and were on treatment with conventional disease modifying antirheumatic drugs. Rheumatic activity was assessed by scales disease activity score 28 and simplified disease activity index. Radiographs of hands and feet were evaluated using the Sharp-van der Heijde (SvH) and Simple Erosion Narrowing Scores (SENS). DKK-1 polymorphisms as rs1896368, rs1896367 and rs1528873 were determined using the High resolution Melting technique (Bio-Rad). A bivariate analysis was performed to determine the variables associated between polymorphism to the presence of radiological and activity scores, diagnosis and severity of PD. A regression model was performed to confirm these associations. Results The mean age was 48.57±11.35 years, and 76.7% were female. 11.7% had a body mass index >30 kg/m2. 35% had an ESR >20 mm/h, and 56,7% had elevated CRP. RF >20 was observed in 61,7% of patients as were ACPAs>20 in 43,3% of them. 30%, 42% and 1.6% of patients were homozygous for polymorphism rs1896367, rs1896368 and rs1528873 respectively. Individuals heterozygous for polymorphism rs1896367 had more frequent erosions (p=0.026) and joint space narrowing (JSN) (p=0.005) in the feet, and consequently higher SHS scores (p=0.016). These patients also had higher SENS scores (p=0.001) and more frequent erosions (p=0.02). In contrast, patients homozygous for polymorphism rs 1896368 had less frequent JSN in hands and feet as assessed by SHS, as well as less presence of erosions based on the SENS scale. These findings were validated in the regression model (OR: 0.04, 95% CI:0.00–0.93;p Conclusions DKK-1 polymorphisms can be associated with the presence of bone damage in patients with eRA and it could affect periodontal outcomes. While polymorphism rs1696367 seems to be associated with greater radiological compromise, polymorphism rs1696368 confers protection against bone damage in Colombian eRA patients. Reference [1] De Rooy D, et al. Ann Rheum Dis. 2013;72:769–75. Disclosure of Interest None declared

Background Periodontal disease (PD) and rheumatoid arthritis (RA) are two common chronic inflammatory diseases globally destructive. Recently, there has been increasing evidence that periodontal disease and rheumatoid arthritis share many biological and pathological features like the significant increase in acute phase reactants. It is important to demonstrate that periodontal inflammation can affect clinical index and variability of the patients with RA. Objectives To evaluate the association between clinical indices of PD and markers of activity in Colombian RA patients and individuals with first-degree relatives of patients with RA. Methods The rheumatologic condition and periodontal status of 73 individuals with rheumatoid early arthritis and 164 individuals first degree relative with RA patient were evaluated. Porphyromona gingivalis (Pg), IgG1, and IgG2 to Pg were determined. The C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor-RF, anti-citrullinated protein antibodies, RA 33 antibodies and scales of RA activity were measured. The rheumatologic Scores and periodontal condition were evaluated by two experienced and calibrated periodontists and rheumatologist. The chi-square test was used to evaluate association between periodontal variables and RA activity indices. The study was approved by the Ethics Committee of the Universidad El Bosque and the Hospital Militar Central, Bogota, Colombia. Results RA group showed 67.1% of periodontitis, of which 43.8% were classified as moderate and 15.1% as severe, positive RF in 49 patients (67.2%) and ACPAs (52%), RA patients had association between dental Plaque >30% with activity clinical index DAS28ESR (p=0.05), SDAI (p=0.008), Bleeding of probing with DAS28ESR (p=0.05), ESR (p=0.03) and CRP (p=0.03) and association between clinical attachment level with ACPAs (p=0.05), Furthermore first-degree relatives of patients with RA showed periodontal disease in a 70.1% classified as moderate 43.9% and 12.8% as severe, positive RF 18 (18%), and ACPAs (7.1%), was finding association between gingival index with activity clinical index DAS28ESR (p=0.05), CRP (p=0.03), ESR (p=0.005) and RAPID3 (p=0.05), association periodontal pocket deep with HAQ-DI score (p=0.05) and bleeding of probing with SDAI (p=0.05). Conclusions RA and PD share pathophysiological mechanisms that explain how greater commitment periodontal dental plaque index and periodontal pocket deep are directly related to indices of clinical activity of the joint disease. This would explain the persistence of elevated acute phase reactants with minimal or absent joint clinical manifestations. References Bello-Gualtero JM, et al. Periodontal Disease in Individuals With a Genetic Risk of Developing Arthritis or With Early Rheumatoid Arthritis: A Cross-Sectional Study.J Periodontol. 2015;26:1–18 Disclosure of Interest None declared

Background Periodontitis and rheumatoid arthritis (RA) are two chronic destructive inflammatory diseases with significant worldwide prevalence. Periodontal disease and RA are characterized by the destruction of articular and periodontal tissue, and they share several biological and pathological features. Objectives Evaluate the effects of conventional drug treatment and anti-TNF therapy in patients with RA on periodontal condition and subgingival microbiota, establishing the association of markers of periodontal infection with indexes of rheumatic activity. Methods A cross-sectional study was conducted in two groups of RA patients with more than two years of diagnosis. The first group used conventional therapy, and the second group used anti-TNF treatment. An association analysis was performed to observe the relationship between clinical and microbiological markers of periodontal infection, and RA activity. A comparative analysis was performed to assess clinical and microbiological periodontal markers and RA activity. The data were released to STATA v11. Frequencies of nominal variables and means and standard deviations for continuous variables were calculated for sociodemographic, periodontal and rheumatological data. Associations between periodontal status and rheumatological variables by Chi square/Fisher9s exact test and Mann-Whitney U tests. The results were considered statistically significant at p≤0.05. The ethics committee of institution approved the study. Results An overall high frequency of periodontal disease 91%, in most cases from moderate to severe, was observed in all subjects. The frequency of periodontal disease was 93.22% in the anti-TNF-alpha group and 88.7% in the conventional treatment group. The percentage of sites with clinical attachment loss ≥4 mm was significantly associated with the group receiving methotrexate and leflunomide p=0.05. Steroid therapy was associated with the presence of teeth p=0.027. Significant associations were observed with the use of more than one DMARD and the presence of P. gingivalis p=0.004. T. denticola was found in the anti-TNF-α therapy group compared to the conventional therapy group p=0.001. Conclusions Different pharmacological treatments for RA affect the clinical condition and sub-gingival microbiota. Patients treated with more than one DMARD promote the increase subgingival microbiota. Therefore, a more strict periodontal monitoring is necessary in these RA patients References Lafaurie Gi, Contreras a, barόn a, et al. demographic, clinical, and microbial aspects of chronic and aggressive periodontitis in Colombia: a multicenter study. J Periodontol. 2007; 78: 629–639. Bingham Co, Moni M. periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Curr Opin Rheumatol. 2013 25:345–53. Disclosure of Interest None declared

We describe the case of a 44-yr-old woman, suffering from rheumatoid arthritis for 15 yr, who developed porphyria cutanea tarda while being treated with methotrexate. The cutaneous lesions healed and the metabolic anomalies improved after a few months, despite continuing the treatment.