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Introduction Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by recurrent thrombosis that can affect the arterial and venous circulation. Objectives To analyze the immunological and pharmacological differences, as well as the clinical outcomes of a cohort of patients with primary antiphospholipid syndrome and secondary antiphospholipid syndrome. Materials and methods A retrospective cohort study was conducted that included 352 records of patients diagnosed with APS and treated between 2014 and 2018. A description is presented of the sociodemographic, clinical, and immunological profile of the population. A bivariate analysis performed using the chi-squared test to determine differences between groups with primary APS and secondary APS, and finally a multivariate analysis to search for associations with thrombotic clinical outcomes in patients with APS. Results The mean age was 42.4 ± 14 years, and 84.6% were females. Two-thirds (67.6%) of the patients had a diagnosis of primary APS, and 32.4% of secondary APS, of which 84% were associated with systemic lupus erythematosus (SLE). Among the thrombotic events, the most frequent were deep vein thrombosis (17.3%) and stroke (9.9%). Obstetric events were frequent, with a prevalence of 39.4% for miscarriages. No differences were found in the sociodemographic or immunoserological profile when comparing the group of primary vs. secondary APS. Thrombotic events were more frequent in the primary APS group, although only pulmonary embolism reached statistical significance. There were no differences between the two groups as regards obstetric events, such as miscarriages. Women were found to be 5 times more likely to have a stroke and 3 times more to have deep vein thrombosis. The anti-B2GPI type IgM increased the probability of presenting miscarriages about 3 times in women with APS. Conclusion The study contains one of the largest Colombian cohorts with APS reported so far, and although it is both clinically and sociodemographically similar to other cohorts, there is a higher prevalence of primary APS. There was a lower frequency of thrombotic complications compared to other cohorts. Patients with primary APS had a tendency to develop thrombosis, as has already been reported in the literature.

Introduction: Over the past decades, incidence of SLE (Systemic Lupus Erythematosus) has increased due to early case detection and improved survival of patients. SLE presents at an earlier age and has a more severe presentation in African-American, Native American, Asian, and Hispanic populations. Worldwide, lupus nephritis (LN) is observed in 29–60% of SLE patients, it has a negative impact in renal survival and patient mortality. Several cohorts have established potential risk factors associated with lupus nephritis, such as male sex, serological markers, and some extra-renal manifestations. Objectives: To describe sociodemographic, clinical, immunological, and environmental risk factors in Colombian SLE patients and to compare the population with and without nephritis, in order to establish risk factors and possible associations. Materials and methods: A total of 1175 SLE patients participated in this study. During medical care, an interview and structured survey was conducted and later registered in a database. Sociodemographic, clinical, immunological, and environmental exposure variables were analyzed. Bivariate and multivariate analyses were performed using presence of LN as an outcome. Results: Prevalence of LN was 38.7%. Variables significantly associated with LN included being male (OR 1.98), a duration of SLE > 10 years (OR 1.48), positive anti-DNA (OR 1.34), positive anti-Sm (OR 1.45), and smoking (OR 1.66). Being non-smoker was a protective factor (OR 0.52). Conclusion: This study describes potentialfactors associated with lupus nephritis in a LatinAmerican population. Smoking status could be a target for intervention as it is a modifiable risk factor. The association between being male and LN is observed in Latin-American populations such as presented here. Further research in other large-scale population studies and more efforts are needed to gain better insights to explicate these relationships. Introducción: En las últimas décadas la incidencia del Lupus eritematoso sistémico (LES) se ha incrementado debido a la detección temprana y su mejoría en la supervivencia. La nefritis lúpica (NL) se observa en el 29% a 60% de los pacientes con LES, teniendo un impacto negativo en la supervivencia renal y la mortalidad. Varias cohortes han establecido factores de riesgo asociados con la NL, como el sexo masculino, marcadores serológicos y algunas manifestaciones extrarrenales.Objetivos: Describir los factores de riesgo sociodemográficos, clínicos, inmunológicos y ambientales en pacientes colombianos con LES y comparar la población con y sin NL para establecer posibles asociaciones. Materiales y métodos: Se incluyeron 1175 pacientes con LES, se analizaron variables sociodemográficas, clínicas, inmunológicas y ambientales, tomadas de bases de datos de registros cínicos. Los análisis bivariados y multivariados se realizaron utilizando la presencia de NL como desenlace. Resultados: La prevalencia de NL fue del 38,7%. Las variables significativamente asociadas con NL incluyeron sexo masculino (OR 1.98), una duración del LES > 10 anos ˜ (OR 1.48), anti-ADN positivo (OR 1.34), anti-Sm positivo (OR 1.45) y tabaquismo (OR 1.66), mientras que la ausencia de exposición al tabaco se comportó como factor protector (OR 0.52). Conclusión: Se describen los factores potenciales asociados con NL en una población latinoamericana. El tabaquismo se presenta como un factor de riesgo susceptible de intervención. El sexo masculino y su asociación con NL ya ha sido reportado en otras poblaciones latinoamericanas. Se requieren investigaciones a gran escala en otras poblaciones para explicar mejor estas asociaciones.

RESUMEN Introducción: El síndrome antifosfolípido (SAF) es una enfermedad autoinmune sistémica, caracterizada por trombosis recurrente, que puede afectar la circulación arterial y venosa. Objetivo: Analizar las diferencias inmunológicas y farmacológicas, así como los desenlaces clínicos de una cohorte de pacientes con SAF primario y secundario. Materiales y métodos: Estudio de corte transversal que incluyó 352 pacientes con diagnóstico de SAF atendidos entre los arios 2014 y 2018. Se analizaron variables sociodemográficas, clínicas e inmunológicas y se realizó un análisis univariado y un análisis bivariado mediante la prueba chi-cuadrado para determinar diferencias entre los pacientes con SAF primario y SAF secundario. Finalmente, se hizo un análisis multivariado para buscar asociaciones con los desenlaces clínicos trombóticos en los pacientes con SAF. Resultados: La edad promedio de la población fue de 42,4 ± 14 años; el 84,6% correspondió a sexo femenino. El 67,6% de los pacientes tenía diagnóstico de SAF primario y un 32,4% de SAF secundario, siendo el lupus eritematoso sistémico (LES) la enfermedad asociada en un 84%. Dentro de los eventos trombóticos, el más frecuente fue la trombosis venosa profunda (17,3%), seguida por el ataque cerebrovascular (9,9%). En los eventos obstétricos existió una prevalencia del 39,4% para abortos. No se encontraron diferencias en el perfil sociodemográfico ni en el perfil inmunoserológico entre los pacientes con diagnóstico de SAF primario y aquellos con SAF secundario. Los eventos trombóticos tuvieron mayor frecuencia en el grupo de SAF primario, pero solo la tromboembolia pulmonar alcanzó significación estadística. Eventos obstétricos como los abortos no fueron diferentes entre ambos grupos. Dentro de los factores asociados a los eventos trombóticos, se encontró que el sexo femenino tiene una probabilidad 5 veces mayor de accidente cerebrovascular y 3 veces mayor de trombosis venosa profunda. Los anti- β2GPI tipo IgM aumentaron alrededor de 3 veces la probabilidad de presentar abortos en mujeres con SAF. Conclusión: Se presenta una de las cohortes colombianas más grandes de pacientes con SAF reportadas hasta el momento en la literatura. La población es comparable clínica y sociodemográficamente con lo encontrado en otros estudios, aunque la prevalencia de SAF primario fue mayor y las complicaciones trombóticas fueron menores. La tromboembolia pulmonar fue significativamente mayor en el grupo de SAF primario. ABSTRACT Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by recurrent thrombosis that can affect the arterial and venous circulation. Objective: To analyze the immunological and pharmacological differences, as well as the clinical outcomes of a cohort of patients with primary APS and secondary APS. Materials and methods: A retrospective cohort study was conducted that included 352 records of patients diagnosed with APS and treated between 2014 and 2018. A description is presented of the sociodemographic, clinical, and immunological profile of the population. A bivariate analysis performed using the chi-squared test to determine differences between groups with primary APS and secondary APS, and finally a multivariate analysis to search for associations with thrombotic clinical outcomes in patients with APS. Results: The mean age was 42.4 ± 14 years, and 84.6% were females. Two-thirds (67.6%) of the patients had a diagnosis of primary APS, and 32.4% of secondary APS, of which 84% were associated with systemic lupus erythematosus (SLE). Among the thrombotic events, the most frequent were deep vein thrombosis (17.3%) and stroke (9.9%). Obstetric events were frequent, with a prevalence of 39.4% for miscarriages. No differences were found in the sociodemographic or immunoserological profile when comparing the group of primary vs. secondary APS. Thrombotic events were more frequent in the primary APS group, although only pulmonary embolism reached statistical significance. There were no differences between the two groups as regards obstetric events, such as miscarriages. Women were found to be 5 times more likely to have a stroke and 3 times more to have deep vein thrombosis. The anti-β2GPI type IgM increased the probability of presenting miscarriages about 3 times in women with APS. Conclusion: The study contains one of the largest Colombian cohorts with APS reported so far, and although it is both clinically and sociodemographically similar to other cohorts, there is a higher prevalence of primary APS. There was a lower frequency of thrombotic complications compared to other cohorts. Patients with primary APS had a tendency to develop thrombosis, as has already been reported in the literature.

Background: Socioeconomic factors have been considered as possible confounding factors in the attribution of greater damage accrual in Afro-Caribbean and Hispanic patients with Systemic lupus erythematosus (SLE). Patients with SLE often experience long-term morbidity that can adversely affect their health-related quality of life (HRQoL)1 Objectives: To analyze the relation between socioeconomic status, damage accrual and HRQoL Methods: Analytic study in a cohort of SLE patients that were closely monitored in an autoimmunity program in Colombia. We stratified patients with damage (SDI ≥1) and no damage (SDI Results: We analyzed 400 Colombian patients. Baseline median age was 49 years (15 IQR) with median age at diagnosis and disease duration of 37 years (17 IQR) and 9 years (13 IQR) respectively. There were 94% female patients and 17.3% late onset SLE. Most frequent clinical manifestations were hematological (82.8%), mucocutaneous (75.3%) and nephritis (33.8%). Only 4.5% had neurological involvement. The mean SLEDAI were 1.18 and 0.65 at first and second measurement respectively, in the first measurement 97.1% of the patients had a SLEDAI ≤4. The mean SDI was 0.7275 at first measurement and 0.985 at the second measurement. When comparing the intervention in patients with SDI≥1 there was a significative improvement in the Quotidian Activities, Pain/Discomfort, Anxiety/Depression domains, independent of economic income. In patients with medium-high income there was also a significative improvement in the mobility and personal care domains. In the no-damage groups there was only a positive impact in the Anxiety/Depression domain in a statistically significant manner, and the medium-high income subgroup had improvement in the Pain/Discomfort domain. We didn’t find other statistically differences in the other domains. Low economic income seems to exert a negative influence in the different HRQoL domains with independence regarding treatment strategy, specially in patients with no damage accrual. In patients with higher income and damage accrual the opposite seems to appear, which could be related with a better ability or resources to cope with the consequences of the disease Conclusion: In Colombian patients with SLE, socioeconomic status (as a reflection of income) might be related with HRQoL. This relationship could be influenced by damage accrual Reference [1] Panopalis P, Petri M, Manzi S, Isenberg DA, Gordon C, Senecal JL, et al, and the Tri-Nation Study Group. The systemic lupus erythematosus Tri-Nation study: cumulative indirect costs. Arthritis Rheum2007;57:64–70 Disclosure of Interests: None declared

Background Systemic lupus erythematosus (SLE) is a chronic and multisystemic autoimmune disease. Higher prevalence of traditional and disease associated risk factors, such as corticosteroids and accelerated atherosclerosis due to chronic inflammation, result in an increased cardiovascular risk. Age and corticosteroid use have been described as cardiovascular risk factors but there is controversy surrounding antimalarials as a protective factor. Our objective is to analyze associated factors with the presentation of cardiovascular events such as high blood pressure (HBP), acute myocardial infarction (AMI), stroke and thromboembolic disease (TED) Methods A cross-sectional study was done with 1175 records of patients with SLE that fulfilled either ACR 1997 of SLICC 2012 classification criteria that had been in medical care between 2015 and 2017 in a rheumatology specialized institution in six cities of Colombia. We describe sociodemographic, clinical and immunoserological characteristics and a comparative analysis was done with chi2 and Mann Whitney’s U with a combined outcome of cardiovascular disease obtaining an OR of crude associations that were adjusted for several variables Results Women represented 91% of the cohort with a median age of 44 years (IQR 21) and 8 years of disease duration (IQR 11) with a mean age at diagnosis of 32 years, 5,4% were active smokers and 15% had smoked in the past. Cardiovascular events were found in 32% of the patients with HT as the most common. Other cardiovascular outcomes such as stroke, TED and AMI were infrequent with a prevalence of 3.3%, 2.9% and 2% respectively. In bivariate analysis, age >36 years and corticosteroid use were associated with a significantly higher risk, while the use of antimalarials for more than 6 years was found to protect for cardiovascular risk with no difference between chloroquine and hydroxychloroquine use (table 1) Conclusions Our cohort is comparable with other SLE cohorts regarding the frequency of cardiovascular events. Up to 32% of the described population presented a cardiovascular event and arterial hypertension was the most frequent. Continuous use of antimalarials for more than 6 years has a protective effect against cardiovascular events such as arterial hypertension, stroke, acute myocardial infarction and thromboembolic disease. The benefit seen only after 6 years of continuous use probably reflects the need of a long period of time before some of the potential benefits of these medications are seen Funding Source(s): None

Background:Systemic lupus erythematosus (SLE) clinical manifestations, and their severity, vary according to age, ethnicity and socioeconomic status. Both Hispanic and Afro-Americans have a higher incidence and more sever presentation when compared to Caucasian patients with SLEObjectives:To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018Methods:Retrospective follow-up study based in clinical records. Patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The main outcome was defined as time from diagnosis to sever renal involvement defined as creatinine clearance ≤50 ml/min, 24-hour proteinuria ≥3.5 grams o end stage renal disease.We analyzed clinical and immunological characteristics. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges (IQR) for quantitative variables. Age and sex adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models por interval-censored data. P values < 0.05 were considered statistically significantResults:548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 6 were interval censored as outcome occurred between study visits, and 475 were right-censored as involvement was not registered during follow-up. 529 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.5 (IQR = 20.6). 67% were mestizo, 13% Caucasian and 0.3% Afro-Colombian. Age and sex adjusted variables associated with time to severe lupus nephritis were high blood pressure HR = 3.5 (95%CI 2.2-5.6; p-value Conclusion:In our cohort the appearance of severe lupus nephritis occurs in less than 15% of patients at 10 years. Both high blood pressure and elevated anti-Ro titers were associated with a higher rate of onset in the presentation of severe lupus nephritis, as seen in some polymorphs of anti Ro.References:Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Lopez: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ana Sierra: None declared, Deicy Hernandez-Parra: None declared, Ricardo Pineda.Tamayo: None declared

Background Systemic Lupus Erythematosus (SLE) is a chronic multisystemic autoimmune pathology of unknown etiology with a variable course and a predilection for women of reproductive age. Chronic activity and flares of disease activity are correlated with greater damage accrual and mortality. Mortality and health-related quality of life (HR-QoL) are higher in SLE patients when compared to general population. Damage accrual, duration of the disease, disease activity and involvement of specific organ systems, might relate to worse HR-QoL in SLE. A worse perception of health is associated with a higher damage accrual over time. Methods A retrospective cohort of SLE patients (ACR 1997 or SLICC 2012 classification criteria), followed for at least 1 year, between 2015 and 2017 in a specialized center was analyzed. Activity evaluated by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), damage accrual by SLICC/ACR damage index (SDI) and HR-QoL by EQ-5D were measured. Bivariate analysis through chi squared and U Mann Whitney Multivariate analysis was performed by logistic regression to adjust for significant associations. Statistical analysis for related samples was evaluated with Mc. Nemar test. Results We analyzed 400 Colombian patients. Baseline median age was 49 years (15 IQR) with median age at diagnosis and disease duration of 37 years (17 IQR) and 9 years (13 IQR) respectively. There were 94% female patients and 17.3% late onset SLE. Most frequent clinical manifestations were hematological (82.8%), mucocutaneous (75.3%) and nephritis (33.8%). Only 4.5% had neurological involvement. The mean SLEDAI were 1.18 and 0.65 at first and second measurement respectively, in the first measurement 97.1% of the patients had a SLEDAI ≤4. The mean SDI was 0.7275 at first measurement and 0.985 at the second measurement. Although SDI was associated to various dimensions of HR-QoL measured by ED-5D, disease activity was not related (See table 1). Conclusions In SLE Colombian patients with a stablished disease and an altered HR-QoL, low disease activity is not related with HR-QoL when measured by EQ-5d. In the present study, it is highlighted that while disease activity decreases, damage increases. Damage accrual has a relation with HR-QoL in the short term. The impact and correlation must be better defined in a long-term follow-up. The associated effect on HRQOL emphasizes the need for strategies to reduce the risk of cumulative organ damage.

Background Age-related autoimmunity is a key differentiating factor with diverse presentations in different age groups possibly depending on immune regulatory mechanisms. Even patients with the same diagnostic category may have different presentations according to age and other factors. Inflammatory Idiopathic Myopathies (IIM) are not the exception with important clinical and prognostic differences between adults and children. Objectives To describe the clinical and therapeutical differences between adults and children (younger tahn 18 m years old) in a cohort with IIM Methods A cross-section retrospective research was done with data collected between 2014 and 2017 from a population diagnosed with IIM according to Peter and Bohan criteria and followed up for at least six months. Statistical association was evaluated by means of Chi-square and Fisher’s tests. Results Out a total of 149 patients, 112 were adults and 37 were children. There was significant difference between the clinical presentation of symmetrical muscle weakness 98% in adults vs 73% in children (p: 0,0001), Gottron’s papules 32% vs 89% (p: 0,0001), Heliotrope rash 31% vs 62% (p: 0,0016), Calcinosis cutis 1% vs 37% (p: 0,0001), Dermatological involvement 47% vs 94% (p: 0,0001), Myopathic changes in the electromyogram 41% vs 25% (p: 0,0001), and Myopathy proven biopsy 41% vs 25% (p: 0,0001). Theraepeutical options showed a significant difference in the use of steroid therapy 93% vs. 84% (p: 0,045), Methotrexate (58% vs 91% p: 0,0001), Azatioprine (62% vs 27% p: 0,0002) and Cloroquine (31% vs 73% p: 0,0001). Other therapies like Cyclophosphamide (19% vs 5% p: 0,04) and Inmunoglobulins (23% vs 5% p: 0,01) were significantly different between adults and children. EMG, electromyogram Conclusions Several differences in the clinical and therapeutical characeristics were found between adults and children with IIM. Adults had more frequently symmetrical weakness, myopathic changes in EMG and biopsy proven myopathy. In contrast children had higher skin involvement. Calcinosis constituded an important manifestation of IIM in children. These results suggest that paediatric IIM is a distinct sub-phenotype related to the early age at onset and possibly mediated by different immune interplay key factors. Reference [1] Tansley S, et al. Comparing and contrasting clinical and serological features of juvenile and adult-onset myositis: implications for pathogenesis and outcomes.1040–8711 Copyright!2015Wolters Kluwer Health, Inc Disclosure of Interest None declared

Background Idiopathic inflammatory Myopathies are a group of diseases characterised by weakness due to muscle inflammation, with or without dermatological involvement, that classically includes pathognomonic findings like Gottron sign. There have been different criteria used to classify these diseases, being Peter and Bohan the most used in time, but recently the ARC/EULAR group proposed a new wat to approach the classification. Objectives To compare ACR/EULAR 2017 versus Peter and Bohan criteria for Idiopathic Inflammatory Myopathy in a Colombian cohort Methods A cross-section retrospective research was done with data collected between 2014 and 2017 from a population diagnosed with Idiopathic Myopathy according to Peter and Bohan criteria and followed up for at least six months. The new ACR/EULAR criteria were applied to each individual using the online tool (hhtp://www.imm.ki.se/biosatistics/calculators/iim). Both sets of criteria were compared using Cohen’s kappa coefficient and concordance was evaluated. Results Data of 149 patients were obtained. Anti-Jo1 results were not available for 75% of the patients. Biopsy was available in 44,3% of patients. Biopsy results were compatible with inflammatory myopathy in 66,7% and non-compatible in 33,3%. According to Peter and Bohan criteria the diagnosis of idiopathic inflammatory myopathy was definite in 63,1% of the patients, and probable in 27,5%. Using ACR/EULAR 2017 criteria instead the diagnosis was definite in 63,1%, probable 10,1% and non-possible in 20,8%. According to the new criteria, 31 patients had polymyositis, 47 dematomyositis, 4 amyopathic dermatomyositis, 35 juvenile myositis and 1 inclusion body myositis. The concordance analysis between the two sets of criteria showed agreement of 54% (kappa 0,22 p Conclusions Data of 149 patients were obtained. Anti-Jo1 results were not available for 75% of the patients. Biopsy was available in 44,3% of patients. Biopsy results were compatible with inflammatory myopathy in 66,7% and non-compatible in 33,3%. According to Peter and Bohan criteria the diagnosis of idiopathic inflammatory myopathy was definite in 63,1% of the patients, and probable in 27,5%. Using ACR/EULAR 2017 criteria instead the diagnosis was definite in 63,1%, probable 10,1% and non-possible in 20,8%. According to the new criteria, 31 patients had polymyositis, 47 dematomyositis, 4 amyopathic dermatomyositis, 35 juvenile myositis and 1 inclusion body myositis. The concordance analysis between the two sets of criteria showed agreement of 54% (kappa 0,22 p Reference [1] I. Lundberg, et al. 2017European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis2017;0:1–10. doi:10.1136/annrheumdis-2017-211468 Disclosure of Interest None declared

Background The clinical characteristics of paediatric patients with idiopathic inflammatory myopathies difere from adutls in several aspects. Its clinical presentation can include amyopathic onset and the skin involvement has diferent charecteristics Objectives To describe a Colombian cohort with Juvenile Myositis (JM) recruited in a rheumatology facility. Methods A cross-section retrospective research with data collected between 2014 and 2017 from a population diagnosed before 16 years of age with Idiopathic Myopathy according to Peter and Bohan criteria and followed up for at least six months. Kaplan-Meier curves were performed to analize time to achieve remission. Results Out of 37 patients, one was excluded for having a dystrophy myopathy gene, 73% fulfilled definitive and 16% probable Bohan and Peter criteria; most patients were female 75,8%,28 with mean age of onset 7,2 years, and clinical remission was achieved on average at 4 years of disease. There was high prevalence of Gottron’s sign and papules (89%), Heliotrope rash (62%) and Calcinosis (37%). Other involvements are described in Table 1. Antinuclear antibodies were positive in 52%. Electromyography (EMG) was positive for myopathy in 39% of the patients. Biopsy was compatible with myopathy in 10% and was negative in 32% of the patients. The most common treatment was metrothexate (91%) followed by antimalarials (72%) and corticoids (56,7%). Medication used in severe forms included Cyclophosphamide (5%), Rituximab (16%) and IV Immunoglobulin (5%). Kaplan-Meier curves showed an earlier time to remmision in patients with Gottron sign compared to patients without them (HR:8,25 HR CI95%IL:1,076–63,3;p=0042 and in childrens younger than 15 years compared to older patients (HR: 2,529 HR95%IL: 1,084–5,901, p: 0,039). Conclusions Our results agreed with those obtained in other multi-centred studies including latin america that evaluated clinical and therapeutic characteristics in children with myopathy, Gottron’s sign and papules being the most common findings and with high rates of calcinosis and joint involvement. There was a significant difference between remission lapse in patients younger than 15 years compared to older ones. Reference [1] , D. Guseinova, et al. Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis. Clinical and Experimental Rheumatology2011; 29: 117–124 Disclosure of Interest None declared

Background The multidisciplinary adherence team (MAT) is a interprofessional health care group conformed by a general practitioner, a pharmaceutical chemist and a psychologist, which evaluate the patient to provide a simultaneous multidisciplinary approach focused on promoting strategies to improve adherence to treatment in patients with high disease activity of autoimmune or autoinflammatory pathologies Objectives To determine the impact of the MAT group intervention on the disease activity and therapeutic adherence of Colombian patients with rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA). Methods A quasi-experimental analytical study was performed where 4.921 RA and 756 SpA patients were analysed, of which 395 and 90 respectively presented high persistent disease activity (from moderate to severe persistent), despite of conventional strategies implemented; therefore they underwent intervention by the MAT group between January and December of 2016. Clinical disease activity according to each disease (DAS28 and BASDAI measurements respectively) and adherence level (categories through the Morisky-Green test: no adherence, partial adherence, total adherence) were measured before and after the MAT intervention. The impact on disease activity and adherence level was determined through the McNemar test for independent samples Results A significant increase in the proportion of patients in total adherence level was found for both diseases when comparing the initial and final measurements after the intervention by the MAT (table 1). Furthermore, statistical significant differences in the disease activity level were found, identifying a reduction in the proportion of patients with moderate to severe disease activity (Graph 1, A and B) after the MAT intervention Figure 1 A) Disease Activity in patients whit RA (DAS28); B) Disease Activity in patients whit SpA (BASDAI) Conclusions The intervention by the MAT interprofessional group is an efficient strategy impacting the disease activity and therapeutic adherence of RA and SpA patients, improving their clinical outcomes and the natural history of the disease. These findings are relevant and may highlight the potential benefits for the implementation of this approach in patients with devastating autoimmune diseases. Disclosure of Interest None declared

Background Adherence in the treatment of rheumatoid arthritis (RA) ranges 20% to 70% in worldwide population.1 In Colombia there are no studies comparing adherence and persistence to conventional and biological treatment. Objectives To determine adherence and persistence and associated factors to the treatment of conventional disease-modifying anti-rheumatic drugs (cDMARD) and biological DMARD (bDMARD) in patients with RA under real world data. Methods We conducted an observational, analytical retrospective cohort study from January 2015 to December 2016. The study population was 552 RA patients older than 18 years who received any cDMARD treatment in monotherapy or combined with two or more cDMARD and bDMARD (Rituximab and Tofacitinib were excluded). Clinical information was obtained from electronic clinical records and Morisky-Green test was performed during the follow-up. Univariate analysis (proportions and medians), bivariate analysis [relative risk (RR)] and multivariate analysis (logistic regression and Kaplan-Meier survival curve) were developed. Results Eighty nine percent were women, the median age was 59 years, 50% have ≥12 years of duration of disease. Adherence for cDMARD was 61% and for bDMARD 56%. There was an association between adherence and high degree education level (adjusted RR=2.1; CI: 1.09–4.14) and non-adherence with clinical factors such as high disease activity (adjusted RR=0.41; CI: 0.22–0.75); in the cDMARD group the greatest persistence was leflunomide (mean: 631 days) followed by methotrexate (mean: 526 days) and in the bDMARD group was etanercept (mean 1577 days) and tocilizumab (mean 1064 days). Patients with social support had greater persistence in the treatment with cDMARD (adjusted HR=2.1; CI: 1.11–4.28). Conclusions In real world data, education level and disease activity significantly impact adherence level in RA patients. Social support positively impacts the persistence of the treatment of RA patients, which suggest the implementation of care programs taking this aspect into consideration in order to improve outcomes. Reference [1] De Klerk E, van der Heijde D, Landewe R, van der Tempel H, Urquhart J, van der Linden S. Patient compliance in rheumatoid arthritis, polymyalgia rheumatica, and gout. J Rheumatol2003;(1):44–54. Disclosure of Interest None declared

Background Latin American (LA) population with autoimmune/autoinflammatory (AID/AI) diseases is considered as a minority, with special characteristics of ancestry, socioeconomic status (SES) and cultural among others, with particular manifestations and prognosis outcomes Objectives To describe the largest cohort of patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA) and systemic lupus erythematosus (SLE), in Colombia, evaluated through the social health care security system (SHCSS) and under a risk management model highlighting shared characteristics, as well as differences Methods A national register-based retrospective cohort study of the SHCSS since 2015 assessing three AID/AI diseases (RA, SLE, SpA) treated in a centre of excellence in rheumatology, under a risk management program in six cities of Colombia. Data about covered population was obtained from the integral information system of SHCSS (SISPRO). Clinical records of patients with AID/AI ICD-10 codes were selected. Adult patients fulfilling international validated diagnoses criteria for the three AID/AI were included. A survey data collection instrument was implemented. Analyses (SAS software V9.4) with standard statistical methods (Polytomous logistic regression, Chi-squared test Fisher’s exact test, and Kruskal-Walis test) were done. Odds ratio (OR) and 95% percent CIs were computed (p Results Of 1 62 487 population covered from national security system (SISPRO data) having AID/AI diseases, 71 515 were evaluated in the 6 cities and 12 323 records were selected of patients by population census attended in the institution. A total of 5372 records meet international validated criteria and were included (RA=3576, SLE=1175, SpA=621). RA patients were older, had lower educational level and SES, longer duration of the disease and late age at onset. Cardiovascular compromise was high in RA and SLE. Polyautoimmunity was predominant in SLE. A total of 89% of patients were under steroids treatment (SLE and RA) and 35% in SpA. Biologics were indicated in 59% (SpA), 23% (RA) and 7,1% (SLE). EuroQol five dimensions scores were significantly better in the SLE group (time of admission). Additional clinical characteristics are described in Table 1 Conclusions This is the largest cohort evaluated through the SHCSS and under a risk management model in Colombia (LA). This population share special characteristics, highlighting differences between these three AID/AI diseases that are frequently evaluated in the same scenario in real life conditions by the rheumatologist. It is worth noting the specific poor prognosis factors of RA and the high percentage of patients under biological treatment in SpA group, which implies a high cost for the health system Reference [1] O. Valencia, P. Sanchez, L. Acuna, et al. Ann Rheum Dis2017;76 supplement:1536 Disclosure of Interest None declared

Background: Autoimmune diseases are chronic inflammatory pathologies of complex etiology and variable clinical expression that usually affect young individuals, generating chronical pain and altering their functionality. Therefore, one of the mainstays of the treatment is to improve the quality of life (QoL) of these patients Objectives: To determine the impact of a tight control multidisciplinary rheumatologyprogram in the QoL of patients with rheumatoid arthritis (RA), Systemic lupus erythematosus (SLE) and seronegative spondyloarthropathies (SpA). Methods: A analytical quasi-experimental study was conducted were 3812 patients with RA, 590 patients with SLE and 605 patients with SpA were included and followed between February 2015 and December 2016. Two separated measurements of QoL were developed through the EuroQol Five Dimensions Questionnaire (EQ-5D) by time trade-off (TTO) valuation technique and the visual analogue scale valuation technique (EQ-VAS). Sociodemographic characteristics were analyzed with univariate statistic. The impact on QoL was determined by McNemar test and repeated measures analysis of variance (rANOVA) Results: The most affected dimensions of the EQ-5D were pain/discomfort and anxiety/depression, while the least affected was self-care. When comparing each dimension before and after the entry to the tight control program, a significant increase in the proportion of patients that perceive level 1 for each aspect evaluated was found. In addition, significant improvement was found in the global EQ-VAS (table 1) Conclusions: The tight control multidisciplinary rheumatology program is an efficient strategy to improve the QoL and the health perception of patients with chronic autoimmune diseases which impacts on the functionality, performance of everyday activities and productivity Reference 1. Wang L, Wang FS, Gershwin ME. Human autoimmune diseases: A comprehensive update. Journal of Internal Medicine2015;278(2015):369–395. doi:10.1111/joim.12395 Disclosure of Interest: None declared

Background Systemic lupus erythematosus (SLE) is an autoimmune disease characterised by multiple organ involvement, lupus nephritis (LN)1 being one of the most serious manifestations Objectives To establish associated factors with lupus nephritis development in patients with SLE Methods Cross-sectional study taken from a cohort of 1175 patient with SLE who met criteria for classification for ACR 1997 or ,SLICC 2012 between 2007 and 2015. Bivariate analysis of multiple characteristics was performed between patients with presence and absence of LN at through chi squared and U Mann Whitney. Multivariate analysis was performed by logistic regression to adjust for significant associations Results The cohort of patients with SLE 90% was female gender, had an average of 44 years with a duration of the disease of 10.6 years. Joint and haematological involvement was present in more than 80% of patients. The presence of antibodies against DNA and low complement was found in 53% and 60% respectively. The exposure to dyes was 44% and tobacco 21%. It was found 455 patients with SLE and LN with an average age of 41 years and a time of evolution of SLE of 11 years. The male gender proportion was higher in those who presented LN with 11.6% compared to 7.1% who did not have LN. The immunological profile of patients with NL was characterised by a higher proportion of positivity for Anti-DNA, anti-SM and low complement. Male gender has a greater association with LN (OR 1.98 CI 95% 1,20–3,27). Having a disease duration greater than 10 years increases the association with LN (OR 1.48 95% CI 1–2,16) as well as the presence of anti-DNA (OR 1.34 CI95% 1,03–1,75) and antiSM (OR 1.45 95% CI 1.04–2.02). Never smoker was a protective factor for LN (OR 0.52 CI95% 0.34–0.81). Conclusions This study shows a greater association of LN in men. Although there are disparities in the findings worldwide, we believe that other factors typical of this current population such as ancestry and racial mixing may be influencing this finding. No smoking seems to be a protective factor. Awareness of the disclosed risk factor should encourage preventive strategies for LN in SLE patients such as suppression of cigarette smoking. References [1] Pons-estel GJ, Catoggio LJ, Cardiel MH, Bonfa E, Caeiro F, Sato E, et al. Lupus in Latin-American patients: lessons from the GLADEL cohort. 2015;536–45 [2] V. A. Seligman, R. F. Lum JLO. Demographic Differences in the Development of Lupus Nephritis: A Retrospective Analysis. Am J Med. 2002;9343(2):726–9. Disclosure of Interest None declared

The multiple autoimmune syndromes (MAS) consist on the presence of three or more well-defined autoimmune diseases (ADs) in a single patient. The aim of this study was to analyze the clinical and genetic characteristics of a large series of patients with MAS. A cluster analysis and familial aggregation analysis of ADs was performed in 84 patients. A genome-wide microsatellite screen was performed in MAS families, and associated loci were investigated through the pedigree disequilibrium test. Systemic lupus erythematosus (SLE), autoimmune thyroid disease (AITD), and Sjögren's syndrome together were the most frequent ADs encountered. Three main clusters were established. Aggregation for type 1 diabetes, AITD, SLE, and all ADs as a trait was found. Eight loci associated with MAS were observed harboring autoimmunity genes. The MAS represent the best example of polyautoimmunity as well as the effect of a single genotype on diverse phenotypes. Its study provides important clues to elucidate the common mechanisms of ADs (i.e., autoimmune tautology).

Resumen Los gastos en salud y el uso de medicamentos han aumentado de forma importante en los ultimos anos, lo que alerta a gobiernos y entes sanitarios y puede relacionarse con algunos fenomenos: prescripcion medica poco estandarizada, ganancias exageradas de la industria farmaceutica, avances en biotecnologia y desperdicio de recursos, falta de comunicacion entre gestores publicos y medicos clinicos y ausencia de regulacion en precios de farmacos. La importancia de la farmacoeconomia se fundamenta en varios aspectos: optimizacion de prescripcion medica, papel crucial en la comercializacion y la distribucion de medicamentos, capacidad de mostrar un amplio panorama del impacto social y economico de las enfermedades, como de abrir perspectivas de investigacion en varios campos del conocimiento. Dentro de los tipos de estudios farmacoeconomicos se encuentran los que expresan la unidad de ingreso (costos) en terminos monetarios y los resultados en unidades monetarias, naturales o de utilidad: reduccion de costos (costo minimizacion), costo beneficio, costo utilidad y costo efectividad, como tambien los que estudian el panorama global de las enfermedades (analisis costo de la enfermedad). Los costos en salud se distribuyen de la siguiente manera: costos directos (medicos y no medicos), indirectos (impacto en la sociedad como unidad productiva) e intangibles (relacionados con calidad de vida de pacientes y familiares). La farmacoeconomia permite una mejor practica clinica, sistemas de salud mas eficientes y un consumo de recursos mas racional. El uso de estos estudios es necesario para estructurar programas de salud y tomar decisiones. Asi mismo es recomendada la inclusion de conceptos de economia de la salud en programas de medicina y ciencias de la salud.

Objectives: Rheumatoid arthritis (RA) is associated with an increased prevalence of cardiovascular disease (CVD). Since atherosclerosis development is a gradual process of damage inside the artery wall, and the phenotype –genotype correlation of complex diseases may vary depending on ethnicity, we sought to investigate the influence of clinical features, routine inflammatory markers, and the genetic component of RA on different stages of atherosclerosis in northwestern Colombian patients with RA. Methods: A group of 140 patients with RA were enrolled in this study. All patients underwent a noninvasive evaluation of endothelial function by flow-mediated vasodilation (FMV) and an assessment of carotid intima-media thickness (IMT) by high-resolution B-mode ultrasonography. The patients were classified into 3 categories: endothelial dysfunction (FMV 5%), increased IMT (0.91-1.29 mm), and plaque (IMT 1.30 mm). The risk of being in each category was assessed by investigating traditional and nontraditional cardiovascular risk factors. For each stage of atherosclerosis development, we searched for nontraditional risk factors that were significantly associated with the stage after adjusting for traditional risk factors and current age. Results: Rheumatoid factor seropositivity was significantly associated with endothelial dysfunction (adjusted odds ratio, AOR 3.0). A duration of RA 10 years (AOR 29.0) and being a carrier of an HLA-DRB1 shared epitope allele (AOR 4.8) were associated with atherosclerotic plaque. No association of extra-articular manifestations, anticyclic citrullinated peptide (anti-CCP3) antibodies, and tumor necrosis factor 308 polymorphism with CVD was found. Conclusions: Our results reveal the presence of RA-related risk factors for CVD which act independently of traditional risk factors. These factors can be used by clinicians to predict CVD in RA patients, and this data should assist in the development of public health policies in our population for the improvement of patient outcomes.

The present study aimed to assess the tolerance and efficacy of rituximab (RTX), a chimeric IgG1 monoclonal antibody directed against the CD20 receptor present in B lymphocytes, in patients with autoimmune rheumatic diseases (AIRD). For this purpose, patients treated with RTX and their respective clinical charts were comprehensively examined. Indications for treatment were a refractory character of the disease, inefficacy or intolerance of other immunosuppressors. Activity indexes (SLEDAI, DAS28, and specific clinical manifestations) were used to evaluate efficacy. Serious side effects were also recorded. Seventy-four patients were included. Forty-three patients had systemic lupus erythematosus (SLE), 21 had rheumatoid arthritis (RA), 8 had Sjogren’s syndrome (SS), and 2 had Takayasu’s arteritis (TA). RTX was well-tolerated in 66 (89%) patients. In 8 patients (SLE = 3, SS = 3, RA = 2), serious side effects lead to discontinuation. The mean follow-up period was 12 ± 7.8 (2–35) months. The efficacy of RTX was registered in 58/66 (87%) patients, of whom 36 (83%) had SLE, 18/21 (85%) had RA, 3/8 (37%) had SS, and 1 had TA. The mean time of efficacy was 6.3 ± 5.1 weeks. A significant steroid-sparing effect was noticed in half of the patients. These results add further evidence for the use of RTX in AIRD. Based on its risk–benefit ratio, RTX might be used as the first-choice treatment for patients with severe AIRD.

Los antagonistas del factor de necrosis tumoral alfa (infliximab, adalimumab y etanercept) son agentes biológicos utilizados en el tratamiento de enfermedades inflamatorias crónicas y autoinmunes. Sin embargo, su uso está asociado con el incremento de la tasa de tuberculosis, micosis endémicas e infecciones bacterianas intracelulares. Dado que la tuberculosis es moderada/altamente endémica en Colombia, el riesgo de esta infección en los pacientes tratados con estos agentes biológicos puede incrementarse y hacer dicha tasa mayor que la informada previamente (tanto en Colombia como en el mundo). Se presentan cuatro pacientes que desarrollaron tuberculosis durante el tratamiento con antagonistas del factor de necrosis tumoral alfa. La presentación de la tuberculosis ocurrió en promedio 15 meses después del inicio del agente biológico y fue independiente de la prueba de tuberculina. Se hace una revisión del tema y se plantea la necesidad de implementar guías y estrategias gubernamentales orientadas a la detección y profilaxis de tuberculosis en este grupo de pacientes.

Since cardiovascular disease (CVD) is the most common cause of mortality in patients with rheumatoid arthritis (RA), we aimed to determine factors associated with such a complication in a large series of Colombian patients. This was a cross-sectional analytical study in which 800 consecutive Colombian patients with RA were assessed for variables associated with CVD. Furthermore, a systematic literature review was performed to address the state of the art about non-traditional risk factors for CVD in RA. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed in data extraction, analysis, and reporting of articles selected. Hypercholesterolemia, type 2 diabetes mellitus, abnormal body mass index, abdominal obesity, and current smoking were all traditional risk factors significantly associated with CVD in Colombians. As non-traditional risk factors, familial autoimmunity, more than 10 years of duration of the disease, patients working on household duties, use of systemic steroids, and low education level were associated with CVD in the studied population. Out of a total of 9,812 articles identified in PubMed and Scopus databases, 140 fulfilled the eligibility criteria and were included. Through this systematic review, several factors and outcomes related to CVD were confirmed and identified. These were categorized into genetics, RA-related, and others. Traditional risk factors do not completely explain the high rates of CVD in patients with RA; thus, novel risk factors related to autoimmunity are now recognized predicting the presence of CVD as strong as traditional risk factors. Our results may assist health professionals and policymakers in making decisions about CVD in patients with RA. © 2013 Springer Science+Business Media New York.

The coexistence of autoimmune diseases (i.e., polyautoimmunity) in Sjögren's syndrome (SS) was investigated in a cross-sectional study involving 410 patients. Logistic regression analysis and the Rogers and Tanimoto index were used to evaluate risk factors and clustering, respectively. There were 134 (32.6%) patients with polyautoimmunity. The most frequent and closer coexistent diseases were autoimmune thyroid disease (21.5%), rheumatoid arthritis (8.3%), systemic lupus erythematosus (7.6%), and inflammatory bowel disease (0.7%) which together constituted a cluster group. There were 35 (8.5%) patients with multiple autoimmune syndrome. Besides disease duration, a history of habitual smoking and spontaneous abortion were found to be risk factors for the developing of polyautoimmunity. This study discloses a high prevalence of polyautoimmunity in SS, its associated risk factors and the grouping pattern of such a condition. These results may serve to define plausible approaches to study the common mechanisms of autoimmune diseases. © 2012 Elsevier Ltd.

The objective of this study was to examine the clinical and genetic variables associated with extra-articular rheumatoid arthritis (ExRA). This was a cross-sectional study in which 538 Northwestern Colombian patients with rheumatoid arthritis (RA) were included. Information about demographics and clinical characteristics including disease activity, inflammatory markers, co-morbidities, cardiovascular (CV) risk factors, history of familial autoimmunity and therapy was recorded. The presence of HLA 'shared epitope' (SE) alleles and TNF gene polymorphism was assessed. A multivariate statistical analysis was performed. ExRA was found in 32% of the patients, of which nodulosis, Sjögren's syndrome, and lung involvement were registered in 21%, 9%, and 4% of patients, respectively. Patients with ExRA were older than patients without it and they presented longer disease duration as well. Thus, an association between disease duration and ExRA manifestations was also observed. Patients with ExRA presented significant higher titers of anti-CCP antibodies as compared to patients without ExRA. Hypertension and thrombosis were significantly associated with ExRA. Never having smoked constituted a protective factor against ExRA onset. Associations between ExRA and the presence of traditional CV risk factors were also found. Our results show that duration of RA, CV disease and high titers of anti-CCP antibodies are associated with ExRA in Colombian patients with RA, and highlight the importance of preventing smoking in those who are prone to develop autoimmune diseases including RA. © Clinical Rheumatology 2009.

Considering the significant morbidity and mortality of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc) and the lack of precise information on disease in Latin America, we investigated the clinical and laboratory characteristics associated with PAH in Colombian patients with SSc and review the literature.This multicenter study included patients followed at 5 rheumatology units that were systematically assessed using a pretested questionnaire on clinical and immunological variables, focusing on PAH. Conditional logistic regression was employed to assess association between PAH and specific clinical characteristics. A systematic review of the literature was performed through electronic databases.Of a total of 349 patients with SSc, 61 (17%) met the criteria for PAH. Pulmonary fibrosis [adjusted odds ratio (AOR) 7.37, 95% CI 3.67-14.81, p0.0001], microstomia (AOR 3.3, 95% CI 1.70-6.28, p0.0001), gastroesophageal reflux (AOR 2.41, 95% CI 1.31-4.43, p = 0.005), dysphagia (AOR 2.7, 95% CI 1.49-4.77, p = 0.001), hyperpigmentation (AOR 2.15, 95% CI 1.11-4.16, p = 0.02), and hypopigmentation (AOR 2.4, 95% CI 1.26-4.64, p = 0.008) were the most prevalent clinical characteristics associated with PAH, while anemia (AOR 5.4, 95% CI 1.98-14.93, p = 0.001) was observed as the unique laboratory risk factor. Association between subtypes of SSc and PAH was not observed. Significant differences in both clinical and laboratory data were observed among different series.PAH may be a frequent complication of SSc in the Colombian population regardless of disease subtype. The identified clinical and laboratory risk factors might assist earlier diagnosis and guide decisions on therapeutic interventions on this critical complication of SSc. The reasons underlying the reported divergences among patients from different ethnicities are not fully understood, but it is most likely that both genetic and environmental factors are responsible for them.

Objective: To estimate the common effect size of HLA-DRB1 and -DQB1 alleles on systemic lupus erythematosus (SLE) susceptibility across Latin America populations through a meta-analysis. Methods: Case-control studies on HLA class II association with SLE in Latin America were searched up to August 2007. The effect summary odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by means of the random effect model. Results: Eleven studies were selected, which included 747 cases and 1180 controls. Associations with SLE susceptibility were found for HLA-DR2 (OR: 1.75; 95% CI: 1.40-2.19) and -DR3 (OR: 2.02; 95% CI: 1.44-2.83) groups. HLA-DRB1*0301 allele disclosed the strongest association (OR: 2.14; 95% CI: 1.28-3.56). HLA-DR3-DQ2 haplotype was a risk factor (OR: 2.92; 95% CI: 1.66-5.14). A protective effect was found for the HLA-DR5 group (OR: 0.43; 95% CI: 0.27-0.67), mainly due to a negative association between HLA-DRB1*1101 allele and disease (OR: 0.21; 95% CI: 0.06-0.72). Functional analysis of susceptibility and protective alleles revealed physicochemical differences of critical amino acids shaping the peptide-binding groove at DR? chain allowing us to infer an approach to understand the role of HLA in SLE. No significant association was established for HLA-DQB1 alleles. Conclusions: HLA-DRB1 gene is a mayor factor for development of SLE in Latin Americans. © 2007 Elsevier B.V. All rights reserved.

Tumor necrosis factor alpha antagonists (TNFA) are biological agents to treat chronic inflammatory and autoimmune diseases. However, their use is associated with an increased rate of tuberculosis, endemic mycoses, and intracellular bacterial infections. Since tuberculosis is moderately to highly endemic in Colombia, the risk of these infections in patients treated with TNFAs may be higher than previously reported in Colombia. Recently, four patients have developed tuberculosis during TNFA therapy. Tuberculosis appeared between 3 to 24 months after initiation of TFNA therapy and was independent of previous tuberculin skin test status. A review of the relevant literature and recommendations are presented as guides for surveillance and prophylaxis on a country-wide basis.

The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5+/-6 days. The mean total cost was 1,277 US dollars, and the mean cost per day of hospitalization was 235 US dollars. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs (p0.01). In conclusion, the direct costs for inpatients with rheumatoid arthritis were considerable, and arose mainly from organic complications. Prevention and treatment of cardiovascular disease are indispensable not only to reduce the economic burden of rheumatoid arthitis, but also to diminish the risk of mortality. These data assist in the estimation of health care resources and in the selection of public health policies for the improvement of patient outcomes.

A functional single nucleotide polymorphism (SNP) C1858T in the protein tyrosine phosphatase nonreceptor 22 (PTPN22) gene encoding an intracellular phosphatase with negative regulatory effects on T-cell activation is associated with some autoimmune diseases in Caucasians. Taking into account firstly, that SNP frequencies may vary across populations and, secondly, that replication studies are important to confirm previous associations, we examined the influence of PTPN22 polymorphism in 621 Colombian patients with four autoimmune diseases. Accordingly, 298 patients with rheumatoid arthritis (RA), 143 with systemic lupus erythematosus (SLE), 70 with primary Sjogren's syndrome (pSS) and 110 with Type 1 diabetes (T1D) were studied. The control group consisted of 308 matched healthy individuals. Genotyping of PTPN22 was performed by the real-time polymerase chain reaction technology, using the TaqMan 5?-allele discrimination assay. The 1858 T allele was found to be a risk factor for pSS (odds ratio (OR)=2.42), SLE (OR=2.56), and T1D (OR =1.83). A lower but nonsignificant trend was observed for RA (OR=1.26). These results confirm the influence of PTPN22 in autoimmunity and indicate that autoimmune phenotypes could represent pleiotropic outcomes of nonspecific disease genes that underlie similar immunogenetic mechanisms. © 2005 Nature Publishing Group. All rights reserved.

Background: Data on the effect of gender in rheumatoid arthritis (RA) in non-Caucasian populations is scarce. Latin America and the Caribbean (LAC) is a large population with unique characteristics, including high admixture. Objective: Our aim was to examine the effect of gender in patients with RA in LAC. Methods: This was a 2-phase study. First we conducted a cross-sectional and analytical study in which 1128 consecutive Colombian patients with RA were assessed. Second, a systematic review of the literature was done to evaluate the effect of gender in LAC patients with RA. Results: Our results show a high prevalence of RA in LAC women with a ratio of 5.2 women per man. Colombian women with RA are more at risk of having an early age at onset and developing polyautoimmunity and abdominal obesity, and they perform more household duties than their male counterparts. However, male gender was associated with the presence of extra-articular manifestations. Of a total of 641 potentially relevant articles, 38 were considered for final analysis, in which several factors and outcomes related to gender were identified. Conclusions: RA in LAC women is not only more common but presents with some clinical characteristics that differ from RA presentation in men. Some of those characteristics could explain the high rates of disability and worse prognosis observed in women with RA in LAC. © 2012 Elsevier HS Journals, Inc.

Introduccion. Las enfermedades que afectan al sistema nervioso y al sistema musculoesqueletico tienen particular potencial de producir diferentes limitaciones, deficit y afectar la concepcion individual de la calidad de vida. Objetivo. Determinar el impacto generado en la calidad de vida por enfermedades cronicas autoinmunes, tipo esclerosis multiple (EM), artritis reumatoide (AR), lupus eritematoso sistemico (LES), sindrome de Sjogren (SS), espondilitis anquilosante (EA) y enfermedades cronicas musculotendinosas, tipo osteoartritis (OA) y fibromialgia (FM), por medio del cuestionario de salud Short Form item 36 (SF-36). Pacientes y metodos. Estudio descriptivo y transversal en el que se incluyeron, entre enero de 2004 y junio de 2006, 509 individuos, de los cuales 56 presentaban EM, 36 SS, 24 EA, 200 AR, 65 LES, 54 OA y 74 FM. Se practico una entrevista dirigida en la que se evaluo cada esfera del cuestionario de salud SF-36. El analisis estadistico se realizo por medio del modelo lineal general, con diferencia de medias segun cada diagnostico. Resultados. En los pacientes con EM, comparados con aquellos con AR, se observaron diferencias significativas en las dimensiones de funcion fisica y funcion social. En aquellos con FM se registro la menor puntuacion, excepto en la funcion fisica, donde la EM tuvo la media menor. La puntuacion media sobre concepcion general del estado de salud en cada entidad analizada no mostro diferencias. Conclusiones. La EM deteriora de manera progresiva y diversa diferentes funciones neurologicas, que repercuten en el sistema musculoesqueletico; esto determina una disminucion en la calidad de vida, principalmente en las funciones fisica y social. La discapacidad generada no se define unicamente por deficit, sino tambien por los grados de limitacion funcional en el contexto personal de salud. Esto convierte la calidad de vida en un fenomeno global biopsicosocial.

El objetivo del presente estudio fue analizar las causas y los costos directos de hospitalización de pacientes con artritis reumatoidea, establecer la morbilidad asociada y evaluar su impacto sobre los costos de la hospitalización. Para tal fin, se revisaron las historias clínicas y los registros del Departamento de Estadística y Contabilidad de todos los pacientes con artritis reumatoidea admitidos a la Clínica Universitaria Bolivariana en Medellín, en el periodo comprendido entre enero de 1999 y junio de 2003. Se hospitalizaron 41 pacientes en 62 oportunidades (0,34 hospitalizaciones por paciente por año). La principal causa de hospitalización fue la actividad de la enfermedad (60%), seguida de cirugía (18%) e infección (10%). En 30 casos hospitalizados (48,4%) se observó, al menos, una morbilidad asociada; la más frecuente fue la enfermedad cardiovascular (32%). El promedio de estancia fue de 5±6 días. El promedio de los costos totales fue de US$1.277, y el costo promedio del día de hospitalización fue de US$235. Los medicamentos representaron el 54% de los costos totales, mientras que los de asistencia médica representaron apenas el 3%. La enfermedad cardiovascular fue el determinante más importante de altos costos de hospitalización (p