eular 2017n-16-.pdf · 1 ativo asoreuma 16 2017 eular 2017 reunió, el pasado 14 de junio en...

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BOLETÍN INFORMATIVO ASOREUMA N.º 16/ Julio de 2017

EULAR 2017 reunió, el pasado 14 de junio en Madrid, a los especialistas más representativos en esta materia de Europa. Se presentaron los últimos avances en patologías como la espondiloartritis y la artritis.

Entre los datos expuestos, más relevantes, se destacó la no existencia de un riesgo mayor de cancer en pacientes con artritis reumatoide. Este avance se centra en aquellos pacientes a los que se les ha aplicado fármacos biológicos antirreumáticos modificadores de la enfermedad. La efectividad de un nuevo tratamiento para lograr disminuciones rápidas e importantes del riesgo de fractura vertebral, también fue un informe resaltado. Así mismo, los nuevos instrumentos que ayudan al

ASOREUMABoletín Informativo / Julio 2017

16Eular 2017

diagnóstico temprano de la esclerosis sistémica y la intervención temprana como clave, para reducir significativamente el riesgo de artritis reumatoide, fueron temas relevantes, desarrollados como objeto de estudio durante el encuentro científico.

Durante EULAR 2017 se abordó, la evaluación de la carga económica y social de la espondiloartritis en los últimos diez años. El primer estudio al respecto es el que se conoce como el Atlas de Espondiloartritis Axial en España 2017.

La espondilitis anquilosante es la más frecuente de todas las espondiloartritis. Se trata de una enfermedad inflamatoria crónica, que afecta fundamentalmente, las articulaciones de la columna vertebral. La padecen generalmente personas jóvenes y, especialmente, hombres entre los 15 y 25 años. En las mujeres suele ser más leve y por ello más difícil de diagnosticar. La espondilitis anquilosante puede ser una enfermedad debilitante que se manifiesta principalmente con lumbalgia crónica y rigidez; también puede acompañarse de artritis, inflamación ocular y/o del tubo digestivo.

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BOLETÍN INFORMATIVO ASOREUMA N.º 16 / Julio de 2017

Dra. Angela Catalina Mosquera, Dr. José Angel Salas, Dr. José Bernardo Martínez, Dr. William José Otero, Dr. Carlo Vinicio Caballero, Dr. Enrique Soriano (preseidente electo PANLAR) y Dr. Fernando Fernández

El mayor encuentro en Europa en el área de reumatología que atrae especialistas de todo el mundo.

Dr. Juan Camilo Rueda y Dr. Leonard Calabrese.

Ailsa Bosworth en la gran presentación Eular 2017.

Dr. Juan Camilo Rueda y Dra. Ana Maria Santos.

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Dr. Miguel Mesa, Dra. Gloría Vasquez.

Encuentro de Reumatólogos en Eular 2017 Dra. Ana María Santos.

Encuentro de Reumatólogos en Eular 2017

Dr. Fernando Fernández, Dr. Mauricio Abello, Dr. Diego Luis Saaibi, Dr. Alberto Torrenegra y Dr. José Ángel Salas.

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El EULAR fue un evento que se

desarrolló también a través de las redes

sociales estando presente en varias

plataformas digitales.

En este espacio, la repercusión ha sido notable, tal y como lo demuestran las 4,9 millones de impresiones registradas en Twitter con el hashtag #EULAR2017. De este modo, hasta 680 usuarios usaron esta etiqueta para interactuar con algún contenido relacionado con el congreso. En total se han publicado durante todos los días en los que se ha desarrollado la cita 1.989 twits. La jornada de mayor actividad en esta red social fue la del sábado por la mañana. Es decir, en ese espacio de tiempo se reunió la mayor concentración de contenido en Twitter sobre el congreso.

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Cuadro: Inmmune Checpoint inhibition

Eficacia de la terapia en axiales vs otras enfermedades en EULAR 2017

Maureen McAllister, who manages out Working Well with Arthritis Service in Scotland, presented at EULAR2017 in Madrid this week. @eular_org

Conferencias Eular 2017

Dra. Francy Cuervo Fellow y Dra. Eugenia Saldarriaga Anuncio del 70 aniversario en Eular 2017

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línea de tiempo @eular_org #rheumatology todavía? ¡Es en la avenida! #exciting

Annual European Congress of Rheumatology Eular 2017.

Las redes sociales han servido para amplificar el alcance de

este evento, no sólo

médicos, especialistas

sino a pacientes y el público en

general.

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Tu experiencia en Eular 2017

Me encantó Eular 2017! Las presentaciones impecables y muy buen nivel científico.Dra. Angela Catalina Mosquera

Asistir al EULAR representó para mí, la oportunidad estar al tanto de nuevos aspectos de las enfermedades reumatológicas, además de compartir nuevas formas de abordar un problema. Fue muy enriquecedor, además, conocer reumatólogos de distintos lugares, cada uno con una experiencia propia y un saber que transmiten en estos eventos. Dra. Adriana Vanegas

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Abstratcs Asoreuma en Eular 2017

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Abstratcs Asoreuma en EULAR 2017

AB1213-HPRA NATIONAL RHEUMATOID ARTHRITIS REGISTRY SUPPORTED BY A PUBLIC POLICY AS A STRATEGY FOR DISEASE CONTROL AND RISK MANAGEMENT IN COLOMBIA

O. Valencia 1, * , P. Sánchez 1 , L. Acuña 1 , L. Soler 1 , CE Toro 21 Cuenta de Alto Costo, 2 Asociación Colombiana de Reuma-tología, Bogotá, Colombia

Background: Rheumatoid arthritis (RA) is a chronic

disease that implies high direct and indirect costs for the health system (1,2). According to the needs of the health care system, the clinical interests and the national regulatory framework, it was developed a national registry information of RA patients (3).

Objectives: To show how a registry of information that would meet the RA situation was developed and to present the results obtained from the analysis of the Registry on this first year..

Methods: A national RA Registry was created after a comprehensive literature review to identify the relevant variables to determine monitoring indicators used by health insurers and health services providers in the attention of patients with RA. Variables were selected and defined by an agreement with clinical experts, thematic and methodological experts and were evaluated by the Ministry of Health in order to review and approve the structure to gather the information.

Results: A structure of 89 variables contained was defined. All entities must report annually to the Registry all the patients with a diagnosis of RA, their clinical and demographic characteristics, and the process of care and costs (3). On its first year the Registry provided a baseline of the disease situation of 68.357 patients with RA. Prevalence, incidence, state of disease and drugs including synthetic and biologic DMARDs were analyzed (Table 1). Most important results were: mean age 57 years; relation women: men 5.2:1; age at onset

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Conclusions: A national Registry supported by an official policy, with data from the real world provided for healthcare insurers gives an opportunity to obtain a global vision and to identify failures and strengths in the attention process of RA, and to develop indicators to obtain better outcomes. In the future, through continuous efforts towards improving the quality of care provided, these will allow to monitoring and decreasing the burden of RA in the country and may serve as a model to other countries.

Referencias: References: 1. Muñetón GA, Quintana G. La epidemiología de la artritis reumatoide. Rev Colomb Reumatol. 2015 Sep [cited 2016 Jul 25];22(3):145–7. Available from: http://www.

elsevier.es/es-revista-revista-colombiana-reumatologia-374-articulo-la-epidemiologia-artritis-reumatoide-S0121812315000845

2. Quintana G., Restrepo JP, Cáceres H, Rueda JD. Economic evaluation of the treatment of rheumatoid arthritis with anti-TNF biological therapy in Colombia. Acta Médica Colomb. 2011;36(1):24–9. Available from: http://www.scielo.org.co/pdf/amc/v36n1/v36n1a05.pdf

3. MSPS. Resolucion No. 1393. 2015. p. 14.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2017-eular.5017

MEDICAL OR RESEARCH PROFESSIONALS/CLINICIANSTOPIC AREA: CLINICAL TOPICS BY AREA OF RESEARCHTOPIC: 31. DIAGNOSTICS AND IMAGING PROCEDURES

G. Filippou* 1, C. A. Scirè 2, N. Damjanov3, A. Adinolfi1, G. Bruyn4, G. Carrara5, T. Cazenave6, M. A. D’Agostino7, A. Delle Sedie8, M. E. Diaz Cortes9, E. Filippucci10, F. Gandjbakhch11, M. Gutierrez12, D. MacCarter13, M. Micu14, I. Moller15, G.Mouterde16, M. A. Mortada17, E. Naredo18, V. Picerno1, C. Pineda12, F. Porta19, A. M. Reginato20, I. Satulu21, W. A. Schmidt22, T. Serban 23, L. Terslev24, V. Vlad25, F. Vreju26, P. Zufferey 27, S. Bellavia1, P. Bozios28, V. Di Sabatino1, C. Toscano1, A. Iagnocco29 on behalf of OMERACT US subtask force in CPPD 1University of Siena, Siena, 2University of Ferrara, Ferrara, Italy, 3University of Belgrade, Belgrade, Serbia, 4Department of Rheumatology, MC Groep, Lelystad, Netherlands, 5SIR Epidemiology Unit, Milan, Italy, 6Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 7Université Versailles Saint-Quentin en Yvelines, Paris, France, 8University of Pisa, Pisa, Italy, 9Fundacion Santa Fe de Bogotà, Bogotà, Colombia, 10Università Politecnica delle Marche, Jesi, Italy, 11Hôpital La Pitié Salpêtrière, Paris, France, 12Instituto Nacional de Rehabilitación, Mexico City, Mexico, 13North Valley Hospital, MT, United States, 14Rehabilitation Clinical Hospital, Cluj-Napoca, Romania, 15InstitutoPoal, Barcellona, Spain, 16Centre Hospitalier Universitaire de Montpellier , Montpellier, France, 17Zagazig University, Zagazig, Egypt, 18Hospital GU Gregorio Marañón, Madrid, Spain, 19Hospital of Pistoia, Pistoia, Italy, 20Brown University, RI, United States, 21Kalmar County Hospital, Kalmar , Sweden, 22Immanuel Krankenhaus Berlin, Berlin, Germany, 23Cantacuzino Hospital, Bucharest, Romania, 24Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, 25Sf. MariaHospital, Bucharest, 26University of Medicine and Pharmacy Craiova, Doja, Romania, 27Lausanne University Hospital, Lausanne, Switzerland, 28University of Ioannina,

of disease: 36 years, mean evolution time of disease: 7 years; population with DAS 28 measured 45.6%; mean DAS-28 2.8; percentage of the patient with DMARD therapy 78.9% and bDMARD 16.5%

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Ioannina, Greece, 29University of Turin, Turin, Italy

My abstract has been or will be presented at a scientific meeting during a 12 months period prior to EULAR 2017: No Is the first author applying for a travel bursary and/or an award for undergraduate medical students?: No

Background: The OMERACT US subtask force “US in CPPD” recently created the definitions for US identification of crystal deposits in joints and tested the reliability at the knee[1].

Objectives: To assess the inter/intra-observer reliability of US on detecting CPPD at triangular fibrocartilage complex (TFCC) of the wrists, fibrocartilage of the AC joint, hip labrum (HL), hyaline cartilage (HC) of the metacarpal (MC) and femoral head.

Methods: The OMERACT criteria for CPPD were used for the exercise[1] using a 2 steps approach. First, the panel of experts gave a dichotomous score (presence/absence of CPPD) of 120 images of the sites included, using a web platform. The images were evaluated twice to assess the inter/intra-observer reliability. Then, the experts met in Siena for a patient based exercise. Bilateral evaluation of TFCC, AC, HL /HC of the hip and HC of the II-III MCP of 8 patients was carried out twice in a day, using a dichotomous score for CPPD. 8 US machines (3 GE, 1 Samsung and 4 Esaote) equipped with high resolution linear probes were used.

Results: Reliability values of static exercise were high for all sites, demonstrating that definitions were clear. The results of the second step are presented in table 1. On live scanning, the TFCC resulted the most reliable site for CPPD assessment, followed by AC. Other sites demonstrated lower kappa values and thus are not reliable for CPPD assessment.Image/graph:

Conclusions: TFCC of the wrist is the most reliable site for CPPD. By adding these results to the previous [2], we confirm that the OMERACT definitions for CPPD can be applied reliably at the knee (meniscus and HC), TFCC and AC, usually the most involved sites in CPPD. The next step of the OMERACT subtask force will be to test these findings in a longitudinal observational study.

References: 1 Filippou G, Scirè CA, Damjanov N et al. Definition and reliability assessment of elementary US findings in CPPD.Results of an international multi-observer study by the OMERACT sub-task force “US in CPPD”. J Rheumatol, in press.


Scleroderma, myositis and related syndromes

SAT0354 NAILFOLD VIDEOCAPILLAROSCOPY AND RAYNAUD’S PHENOMENON IN A COHORT OF MESTIZO LATIN AMERICAN PATIENTS: A PRELIMINARY OBSERVATIONAL STUDY

CJ Velásquez-Franco1, A García Facio-Lince2, AL Zapata-Castellanos1, LM Rodríguez-Padilla2, MA Mesa-Navas1, on behalf of Clinical Immunology and Rheumatology Group. Universidad Pontificia Bolivariana

Author affiliationsAbstract

Background: The prevalence of Raynaud’s phenomenon (RP) has been reported between 3–22%. When associated with systemic autoimmune diseases (SAD), especially systemic sclerosis (SSc), it is the sentinel event of irreversible organic damage. Nailfold videocapillaroscopy (NVC) is a non-invasive and safe procedure that allows in vivo observation of the microcirculation. Between 15–20% of patients who have RP with videocapillaroscopic alterations and certain autoantibodies will develop a SAD over two years. In addition, 90% of individuals with SSc and 85% with mixed connective tissue disease (MCTD) had RP as the first symptom.

Objectives: To evaluate the role of NVC in the differential diagnosis of RP, as well as in the early detection of SAD, in a cohort of Colombian patients.

Methods: A prospective, longitudinal, analytical study was conducted in subjects with RP, over 18-year-old, not active smokers, without previous connective tissue disease, secondary causes or aggravating factors. Optilia NVC with OptiPix software was used (Optilia Instruments; Sollentuna, Sweden). Qualitative variables are described by means, as well as absolute and relative frequencies; quantitative variables, according to the distribution of data, were reported by means or median, with standard deviation (SD) and interquartile range (IQR), respectively. We are reporting the baseline

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characteristics of these individuals.

Results: Fifty-eight individuals were included; 91.4% were female. The mean age was 40.9 years (SD: 14.1). RP was biphasic in 63.6% of the patients, with a median of 30 episodes per month (IQR: 8–30). In 41 subjects (available data), antinuclear antibodies were positive; the most common patterns were: speckled (41.5%) and centromere (26.8%). The median of erythrosedimentation rate (ESR) was 9 (IQR 4–13). Ten individuals (19.2%) were diagnosed with SAD in the first NVC: Seven patients with limited SSc, two with MCTD, and one with diffuse SSc. The patterns observed in the individuals with SSc were: early (n=3), active (n=3), late (n=2), and minor and unspecific abnormalities in subjects with MCTD (one each). The most frequent NCV alterations in subjects with SAD were: megacapillaries (n=10), microhemorrhages (n=10), avascular zones (n=8), neovascularization (n=6), and capilar disorganization (n=6). In these subjects, the mean capillary diameter was 76.7±33.9 mm; the median of capillary number per mm was 7 (IQR: 6–8).

Conclusions: The frequency of systemic autoimmune disease was similar to the published reports in the literature. We highlight the following aspects: 1) The normal erythrosedimentation rate in subjects with a rheumatologic diagnosis, a particular finding when compared to previous data; 2) The important percentage of subjects with a specific diagnosis in the first nailfold capillaroscopy; one possible explanation could be a underdiagnosed disorder; this fact could be possibly demonstrated by the large capillary diameter found.

References: Ingegnoli F et al. Arthritis Rheum. 2008; 58 (7): 2174–82.Ingegnoli F et al. Rheumatology 2010; 49 (4): 797–805.

References:

Acknowledgements Clinica Universitaria Bolivariana. Universidad Pontificia Bolivariana.

Disclosure of Interest None declared

THU0005ERAP POLYMORPHISMS AND ITS ASSOCIATION WITHHLA-B15 AND HLA-B27 POSITIVE SPONDYLARTHRITISPATIENTS

J. Londono 1, A.M. Santos 2, J.C. Rueda2, P. Peña 2, I. Briceño

3, E.-L. Saldarriaga 2, J.-I. Angarita 2, E. Calvo 4, M. Avila 2,N. Martinez-Rodriguez 5, H. Cubides 2, V. Parra 2, J.F. Medina 6. 1Reumatología, Universidad de la Sabana-Hospital Militar Central, Bogotá; 2Reumatología; 3Facultad de Medicina, Grupo Genética Humana, Universidad de la Sabana, Chia; 4Departamento de Imágenes diagnósticas, Universidad Nacional, Bogotá, Colombia; 5Departamento de Investigación de Salúd Comunitaria, Hospital Infantil de México Federico Gomez, Ciudad de México, Mexico; 6Departamento de Medicina Interna, Escuela de Medicina, Universidad de Navarra, Pamplona, Spain.

Background: Since 1973, the association of HLA-B27 and spondyloarthritis (SpA) is well known, however in Colombian population it is present in only 40% of patients and HLA-B15 is present almost in 25%. A mechanism of polygenic mechanism has been proposed as an explanation for the development of SpA. Endoplasmic reticulum aminopeptidase (ERAP) genes 1 and 2 have been implicated. ERAP1 is strongly associated with HLA-B27 positive patients and ankylosing spondylitis, but not with ERAP2. Objectives: To determine the association between ERAP polymorphisms and HLA-B27 or HLA-B15 positive SpA patients.

Methods: 178 patients with SpA according to ASAS criteria were included in the study. HLA typing was performed by the PCR technique using the Biorad® HLA-SSP plates. The polymorphisms were determined

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by the RT-PCR technique using Roche® probes for ERAP1 rs27044, rs17482078, rs10050860, and rs30187. For ERAP2 the probes used were rs2910686, rs2248374 and rs2549782. The allele and genotype frequencies polymorphisms were obtained by direct counting. In each group the Hardy-Weinberg equilibrium was evaluated using the 2 test. Associations were assessed using odds ratio (OR). Stata v.12.0 program was used to analyse data. The construction and analysis of haplotypes was performed using Haploview v.4.2.

Results: In total 70 patients were HLA-B27 positive and 34 were HLA-B15 positive. 78 were women and 100 were men. Linkage disequilibrium map of the ERAP gene is depicted in figure 1. When analysed by ERAP2 haplotype it is observed that there is a statistically significant association with the combinations described in table 1. No associations were observed between ERAP1 haplotypes and HLA-B15 or B27.

Conclusions: In the group of patients analysed, a statistically significant association was found between patients with SpA HLA-B15 positive and the haplotype TGT of ERAP2. Also HLA-B27 positive SpA patients were associated with haplotype TGC and CAT of ERAP2 with statistical significance.

Disclosure of Interest: None declaredDOI: 10.1136/annrheumdis-2017-eular.5659

THU0052LEVELS OF INFLAMMATORY SEROLOGIC BIOMARKERS IN HLA-B27 AND HLA-B15 POSITIVE PATIENTS WITHSPONDYLOARTHRITIS

J. Londono 1, A.M. Santos 2, J.C. Rueda2, P. Peña 2, I. Briceño 3, E.-L. Saldarriaga 2, J.-I. Angarita 2, E. Calvo 4, M. Avila 2, N. Martinez-Rodriguez 5, H. Cubides 2, V. Parra 2, J.F. Medina 6. 1Reumatología, Universidad de la Sabana-Hospital Militar Central, Bogotá; 2Reumatología; 3Faculltad de Medicina,Grupo Genética Humana, Universidad de la Sabana, Chia; 4Departamento de Imágenes diagnósticas, Universidad Nacional, Bogotá, Colombia; 5Departamento de Investigación de Salúd Comunitaria, Hospital Infantil de México Federico Gomez, Ciudad de Mexico, Mexico; 6Unidad de Entrenamiento Clínico, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain.

Background: A main challenge in spondyloartritis

(SpA) management was theavailability of reliable biomarkers related with disease activity, or predicting joint damage and the response to treatment. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are currently used as biomarkers for disease activity, they lack sensitivity, specificity and reproducibility. With the understanding of SpA pathogenesis, additional biomarkers like metalloproteinase 3 (MMP-3), interleukin (IL)-1a, IL-6, lipopolysaccharide-binding protein (LBP), tumour necrosis factor a (TNFa), macrophage colony stimulating factor (M-CSF), interferon gamma (INF-g), IL-17 and IL-23, had been proposed.

Objectives: We aimed to evaluate the associations of MMP-3, IL-1a, IL-6, M-CSF, LPB, IL-17 and IL-23 levels in SpA patients positive for HLA-B27 or HLA-B15

Methods: 178 patients (100 men and 78 women) with SpA according to ASAS criteria were included in the study. HLA typing was performed by PCR using the Biorad® HLA-SSP ABDR plates. The levels of TNFa, IL-1a, IL-6, INF-g and IL-17 were measured by a cytometric bead-array (CBA Flex Set) using a FACS Canto II Flow CytometerÔ. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of IL-23, M-CSFand MMP-3. CRP and LBP levels were measured by chemiluminescence. Statistical analysis was made with SPSS v19. For comparison of quantitative variables with a normal distribution we used the Student’s t-test. Categorical variables were presented in frequency charts and percentages, and the Chi-squared test and Fisher’s exact test were used when necessary, for comparing groups. Two-tailed P-value <0.05 was considered statistically significant.

Results: Of the 178 patients, 70 were positive for HLA-B27, 34 for HLA-B15 and 74 had other HLA-B. According to ASAS classification criteria, 152 patients had axial SpA (axSpA) manifestations, 161 had peripheral SpA (pSpA) manifestations, and 148 patients had mixed axial and peripheral manifestations. Figure 1 shows the mean levels of inflammatory serologic biomarkers in these subgroups of patients.

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Conclusions: High levels of IL-17 and IL-23 were associated with the presence of HLA-B27, which mainly correlates with an axial presentation of the disease as compared to HLA-B15 patients. Accordingly, the genotype (presence of HLA-B27or HLA-B15) and phenotype (axial or peripheral involvement) may help physicians when considering a targeted therapy of SpA patients with IL-17 inhibition in a context of personalized medicine.


FRI0694PREVALENCE OF RHEUMATIC DISEASE IN AN ADULTPOPULATION FROM COLOMBIA. A COPCORD METHODOLOGY STUDY

A.M. Santos 1, J.C. Rueda1, J.-I. Angarita 1, R. Giraldo 1, E. Forero 2, I. Pelaez-Ballestas 3, J.G. Ballesteros Muñoz4, E.-L. Saldarriaga 1, J. Ramirez 5, C. Toro 5, J. Londono 6. 1Reumatología, Universidad de la Sabana, Chia; 2Medicina Interna, Reumatología, Universidad del Norte, Barranquilla, Colombia; 3Departamento de Reumatología, Hospital General de México, Ciudad de México, Mexico; 4Departamento de Medicina Interna, Hospital San José;5Asociación Colombiana de Reumatología; 6Reumatología, Universidad de la Sabana-Hospital Militar Central, Bogotá, Colombia.

Background: Rheumatic diseases are the leading cause of permanent disability. In our country are the fourth cause of consultation in health institutions. The COPCORD model constitutes an effective tool in the determination of the prevalence of diseases. Globally, this model has been carried out in Asia, Europe and in some countries of Latin America. In Colombia the epidemiology of rheumatic diseases

is not known globally; this would be the first national study that uses the data collection questionnaire using the COPCORD instrument.

Objectives: To estimate the prevalence of rheumatic disease and related factors in a Colombian population over 18 years of age in six Colombian cities.

Methods: A Cross-sectional analytical study was designed in people older than 18 years. A probabilistic stratified sampling method using three stages. The first stage of sampling was the selection of cartographic sectors in each city. The second stage of sampling was the blocks of each sector. The third stage of sampling was the homes of each block. All household members were surveyed. The sample size was calculated to be 6,528 people (2336 from Bogotá, 1220 from Medellín and Cali each, 746 from Barranquilla, 503 from Bucaramanga and Cúcuta each). The COPCORD questionnaire adapted for Colombia, was applied in the first stage by standardized interviewers. Positive cases were reviewed at home by a first year rheumatology fellow. To assess whether it is a rheumatic disease; the positive cases for a probable rheumatic disease were reviewed by a second year rheumatology fellow and reviewed again with laboratory and image studies by a certified rheumatologist to establish the definitive diagnosis.

Results: 3,146 men and 3,547 women were included. Pain in the last 7 days not associated with trauma was reported in 3,213 (48%) participants. The most frequent sites were knees (right 31%, left 29%), hands (right 25%, left 24%), lumbar spine (18%) and shoulders (right 16%, left 14%). Table 1 depicts the prevalence of rheumatic diseases in Colombia

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Conclusions: Our study shows a similar prevalence to those worldwide in scleroderma,dermatomyositis, systemic lupus erythematosus, and spondyloarthritis. A lower prevalence was observed in Sjögren Syndrome, fibromyalgia, gout and osteoarthritis. A slightly higher prevalence of rheumatoid arthritis was observed in our population. The high prevalence of rheumatoid arthritis and soft tissue rheumatism should increase awareness in our governmental health entities given their long term disability risk.


SAT0573SOCIODEMOGRAPHIC, CLINICAL CHARACTERISTICS AND JOINT INVOLVEMENT OF A CHIKUNGUNYA EPIDEMIC IN COLOMBIA

J.C. Rueda1, J.-I. Angarita 1, A.M. Santos 1, E.-L. Saldarriaga 1, I. Pelaez-Ballestas 2, E. Couto-Luvie 1, J. Londono 3. 1Reumatología, Universidadde la Sabana, Chia, Colombia; 2Reumatología, Hospital General de México,México, Mexico; 3Reumatología, Universidad de la Sabana-Hospital MilitarCentral, Bogotá, Colombia.

Background: During 2014 and 2015 a chikungunya epidemic took place in Colombia concurrently with a COPCORD study across the country.

Objectives: To describe the clinical characteristics of CHIKV infection in 6 different cities in Colombia and determine the most frequently associated clinical picture with CHIKV.

Methods: World Health Organization criteria was used to identify CHIKV patients. A complete characterization and confirmation was established with CHIKV immunoglobulin G and IgM serology. Four possible scenarios were stablished: patients who met or not the criteria for probable case, and patients who met or not the criteria for confirmed case. P values were calculated between patients who met or not met the criteria. Sensibility and specificity was calculated for the WHO criteria.

Results: A total of 604 patients with MSK symptoms were evaluated in 6 different cities. The sociodemographic, clinical characteristics and joint involvement of the studied population is depicted in tables 1 and 2. Sensibility and specificity of the WHO criteria were 56.2% and 91.1% respectively (PPV: 83.3%,

NPV: 74.4%).

Conclusions: Our study shows a clear clinical picture of systemic symptoms, high titters of CHIKV immunoglobulins, and a defined joint involvement, which will help clinicians to identify and differentiate CHIKV infection from other viralinfections and MSK diseases. Also, the sensibility of the WHO criteria applied to our cohort of patients demonstrates the need to improve clinical criteria without the use of laboratory tests.


SAT0574PERFORMANCE OF IMMUNOGLOBULIN M AND G (IGM AND IGG) ANTIBODIES AGAINST CHIKUNGUNYA VIRUS (CHIKV) BY ENZYME-LINKED IMMUNOSORBENT (ELISA) TECHNIQUEJ.C. Rueda1, J.-I. Angarita 1, A.M. Santos 1, E.-L. Saldarriaga 1, I. Pelaez-Ballestas 2, P. López-Morales 1, J. Londono 3. 1Reumatología, Universidad de la Sabana, Chia, Colombia; 2Reumatología, Hospital General de México, México, Mexico; 3Reumatología, Universidad de la Sabana-Hospital Militar Central, Bogotá, Colombia.

Background: CHIKV is suspected based on epidemiological and clinical criteria, however confirmation of the disease is only achieved by laboratory tests. Laboratory diagnosis is made by two approaches: the detection of viral RNA and

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identification of the specific immune response by serological methods. Serological tests are the most frequently used laboratory methods for the diagnosis of CHIKV. IgM is the first detected antibodies during 4 to 6 days after onset of symptoms followed by IgG. In Colombia, CHIKV’s probable cases are not mandatory to be confirmed, so there is no standardization for laboratory confirmation tests.

Objectives: To evaluate the performance of IgM and IgG antibodies against CHIKV in a cohort of patients with CHIKV.

Methods: IgM and IgG antibodies against CHIKV were measured by ELISA (AbcamÒ ab177835 and ab177835 anti-chikungunya virus IgM and IgG human ELISA kit, Cambridge, UK) technique in 604 patients with CHIKV suspicion. A typical case of CHIKV with high sensitivity and specificity obtained from a previous study was used as gold standard for diagnosis of CHIKV. Since CHIKV epidemic of 2014–2015 was the first to be reported in our country (Colombia), no second measurements of IgG were needed to confirmed infection.

Results: Cut off point for IgG was 14,3 SU and for IgM was 11,2 SU. Mean values for IgG was 36,7 SU (±22,7) in patients with CHIKV and 8,6 SU (SD± 6,3) for IgM. Statistical significance was obtained for both IgG and IgM (p<0,0001) when comparing patients with and without CHIKV. Receiver operating characteristic (ROC) curves showed and area under the curve (AUC) of 0,81 for IgG and 0,65 for IgM (figure 1).

Conclusions: Our study revealed a good performance of IgG and regular performance of IgM for the diagnosis of CHIKV in a cohort of CHIKV patients from Colombia’s epidemic. Cut off points for both IgG and IgM were measured for future reference.


SAT0575ASSOCIATION OF HUMAN LEUKOCYTE A, B AND DRANTIGENS IN PATIENTS WITH CHIKUNGUNYA VIRUSINFECTION.J.C. Rueda1, J.-I. Angarita 1, A.M. Santos 1, E.-L. Saldarriaga 1, I. Pelaez-Ballestas 2, B. Zaldivar-Castaño 1, J. Londono 3. 1Reumatología, Universidad de la Sabana, Chia, Colombia; 2Reumatología, Hospital General de México, México, Mexico; 3Reumatología, Universidad de la Sabana-HospitalMilitar Central, Bogotá, Colombia.

Background: Host factors like innate and adaptive immune response play an important part in disease susceptibility. Also, the role of host genetics factors in the pathogenesis of viral diseases have been reported. Human leukocyte antigen (HLA) is responsible for initiating innate and adaptive immune responses. Studies have demonstrated HLA class II alleles association to susceptibility or resistance to chikungunya virus infection (CHIKV), however there is no evidence of association studies of HLA class I and II in the Latin-American CHIKV epidemic.

Objectives: To evaluate the association of human leukocyte A, B and DR antigens in a group of Colombian patients with CHIKV.

Methods: Characterization of HLA allele A, B, and DR of 62 patients with confirmed CHIKV was compared with 100 unrelated healthy subjects as a control group. The comparison between the different allele frequencies in the patient group and the control population was performed using chi2, with Bonferronicorrection. A p value <0.05 was considered to be significant. The magnitude of associations was assessed using odds ratio (OR) and confidence intervals (CI) of 95%. To establish the homogeneity of the studied groups, the Hardy-Weinberg disequilibrium was used.

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Results: Of the 62 patients studied 46 were female (74,2%). The mean age was 45,0 (SD±16,8) years. Most of the patients were from Barranquilla (64,5%; n: 40). Mean CHIKV immunoglobulin G (IgG) was 38,6 SU (SD±21,7), while IgM was 13,3 SU (SD±7,6). Also C reactive protein levels were high (mean: 14,7 mg/L; SD±8,4). Association alleles of HLA-A, and DR are depicted in table 1. No association was found with HLA-B alleles.

Conclusions: Our study demonstrated the alleles A*28 and A*29 to be associated with resistance to CHIKV, and alleles A*68, DRB1*01, DRB1*04 and DRB1*13 to be associated with susceptibility to CHIKV. No association was found in any HLA-B alleles.


SAT0576IMPROVED CLINICAL SCENARIO FOR CHIKUNGUNYADIAGNOSIS.

J.C. Rueda1, J.-I. Angarita 1, A.M. Santos 1, E.-L. Saldarriaga 1, I. Pelaez-Ballestas 2, M.J. Soares-Santeugini 1, J. Londono 3. 1Reumatología, Universidad de la Sabana, Chia, Colombia; 2Reumatología, Hospital General de México, México, Mexico; 3Reumatología, Universidad de la Sabana-Hospital Militar Central, Bogotá, Colombia

Background: The World Health Organization (WHO) criteria for chikungunya virus infection (CHIKV) have a specificity of 91,1% with a low sensibility of 56,2%, which decreases the ability to detect patients with the infection. Because of this issue a group of rheumatology, epidemiology and bacteriology experts in diagnosing and treating CHIKV patients performed an agreement consensus on the clinical characteristics of CHIKV infection and proposed a set of clinical criteria. In order to test the performance of the new criteria and improve sensibility and specificity a clinical scenario was developed with

the agreements from the expert panel and the clinical characteristics with higher odds ratios.

Objectives: To improve sensibility and specificity of a set of clinical criteria for thediagnosis CHIKV.

Methods: Odds ratios of the clinical features of patients with CHIKV infection were analysed. A clinical scenario was developed and sensitivity and specificity was calculated.

Results: 37 clinical characteristics were evaluated in a cohort of 604 patients with suspicion of CHIKV. From those, 29 exhibited statistical significance and only 10 had high odds ratios (table 1). A clinical scenario with the following joint involvement (symmetrical arthritis of shoulders or wrists or hands or knees or ankles or feet) or systemic symptoms (fever or rash or myalgia or fatigue) poised a sensitivity of 74,2% (PPV: 83,5%) and a specificity of 88,4% (NPV: 81,2%). The following clinical characteristics extracted from the agreements of the consensus group were added to the clinical picture: origin from an epidemic area and abrupt onset of symptoms.

Conclusions: Our study demonstrated that the proposed clinical scenario for suspicion of CHIKV improves diagnostic sensibility with a slight decrease in specificity, increasing the chance of diagnosis without the need for laboratory tests. We propose that a patient from an epidemic area (fulfilling epidemiological criteria according to the WHO) with an abrupt onset of a clinical picture of symmetrical arthritis of any of the following joints: hands, wrists, shoulders, knees or feet, or the presence of any of the following systemic symptoms: fever, rash, fatigue or myalgia, is more likely to have CHIKV infection.


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Conclusions: Higher levels of DKK1 were found in patients with lower functional status. This association was not found in patients with greater disease activity according to CDAI, SDAI, DAS28 and RAPID3. This could be explaining by greater structural damage though more studies would be needed to explore this possibility.

References: [1] Huizinga TW, Pincus T. In the Clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1–1-ITC-15.

Disclosure of Interest: None declaredDOI:10.1136/annrheumdis-2017-eular.1518

AB0913AGREEMENT STUDY AND EXPERT CONSENSUS FOR THE CLINICAL PICTURE OF CHIKV INFECTION

J.C. Rueda1, J.-I. Angarita 1, C. Pinzon 2, A.M. Santos 1, E.-L. Saldarriaga 1, J.M. Rueda3, D.L. Saaibi 4, E. Forero 5, I. Pelaez-Ballestas 6, P.X. Pavía 7, J. Londono 8. 1Reumatología; 2Departamento de Investigación Clínica, Facultad de Medicina, Universidad de la Sabana, Chia; 3Unidad de Reumatología, Centro Médico Imbanaco, Cali; 4Reumatología Ubit, Centro Médico Carlos Ardila Lulle, Bucaramanga; 5Medicina Interna, Reumatología, Universidad del Norte, Barranquilla, Colombia; 6Reumatología, Hospital General de México, México, Mexico; 7Unidad de Investigación Científica, Hospital Militar Central; 8Reumatología, Universidad de la Sabana-Hospital Militar Central, Bogotá, Colombia.

Background: World Health Organization

DOI: 10.1136/annrheumdis-2017-eular.1883

AB0239DKK1 IS NOT ASSOCIATED WITH INFLAMMATORY ACTIVITY INDEXES IN RHEUMATOID ARTHRITIS, BUT WITH FUNCTIONAL DISABILITY RELATED TO THE LONG EVOLUTION OF THE DISEASE

R. Giraldo-Bustos 1, E.L. Saldarriaga 1, A.M. Santos 1, J.I. Angarita 1, J.G. Ballesteros 1, J.C. Rueda-Sanchez 1, A. Vasquez 1, L. Valero 1, S. Arias 2, J. Londono 1 on behalf of Grupo de Espondiloartropatías Universidad de La Sabana – Hospital Militar Central. 1Department of Rheumatology; 2Universidad de la Sabana – Hospital Militar Central., Bogotá, Colombia.

Background: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease characterized by joint destruction, deformity, lower functional status and decrease in life expectancy. Wnt signaling pathway recently it has been implicated in bone homeostasis. Studies suggest that overexpression of inhibitors of the way, like the Dickkopf 1 protein (DKK1) has been implicated in bone destruction.

Objectives: To compare circulating levels of DKK1 in patients with RA to their disease activity and functional status.

Methods: 379 consecutive patients with early and established RA were evaluated at the Hospital Militar Central in Bogota-Colombia, between March 2015 and November 2016. A complete medical history related to RA was obtained. Disease activity was evaluated by DAS28-CRP, CDAI, SDAI and RAPID3. functional status was measurement using MDHAQ and the Steinbrocker functional classification. DKK1 levels measured by ELISA using an Abcam® kit.

Results: The mean age was 60,7±13,1 years, disease duration 13,1±10,9 years, 80,4% were female. Higher levels of DKK1 were not associated with higherdisease activity by CDAI (p=0,70), SDAI (p=0,84), DAS28 with CRP (p=0,80) or RAPID3 (p=0,70). Interestingly Higher levels of DKK1 were significantly associated to greater disability and lower functional status according to the Steinbrocker functional grading (p=0.013) and with severe disability by MDHAQ (p=0.004), Table 1. Other variables associated with joint destruction were osteoporosis, elevated rheumatoid factor, smoking, and hospitalization.

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suggested case definitions to suspect and diagnose chikungunya virus infection which are: possible case, probable case and confirmed case. Although useful, when applied in practice, its lack definition for specific joint involvement and absence of other systemic symptoms apart from fever, leads to a broad clinical spectrum which increases the need for laboratory tests.

Objectives: To establish agreement on clinical criteria of CHIKV infection based on clinical expertise of specialists from affected areas of Colombia and to develop a set of clinical criteria.

Methods: A group of specialists in rheumatology, epidemiology and bacteriology from different parts of Colombia with experience in diagnosis and treatment of CHIKV patients from the epidemic of 2014–2015 met to reach agreements on clinical characteristics of CHIKV infection. A series of questions were formulated and agreement in percentage was calculated on the following answers: totally agree, agree, not in agree or disagree, disagree and totally disagree. Agreement was set when the sum to the answers totally agree and agree or disagree and totally disagree of was ≥50%.

When agreement was not reached, the moderator performed a discussion with the opinions of the confronting members of the group and after that reformulated the question. This procedure was made. until agreement was reached. With the results a set of clinical criteria was proposed.

Results: The agreement percentage to the formulated questions are depicted in table 1. Disagreement was achieved with mucosal imvolvement (100%), G/I involvement (88%), and arthralgia and arthritis in shoulders (63% and 100%) and in elbows (100%).

Conclusions: Agreement was achieved in abrupt onset of symptoms, and the presence of fever, rash, myalgia, fatigue, and symmetrical arthritis or arthralgia of wrists, hands, knees, ankles and feet. A set of clinical criteria was proposed (figure 1).


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