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Several studies have reported a higher prevalence of obesity in Psoriatic Arthritis (PsA)[1]. Obesity may lead to more weight on the joints, namely on the ankle/foot joints, altered mechanics, and repetitive micro-trauma. Foot involvement is common in PsA, including arthritis, dystrophic nails, toe dactylitis and Achilles enthesitis. Obesity has been found to be associated with higher disease activity and worse functionality scores in PsA patients. [1] The purpose of this study was to evaluate the role of obesity in foot involvement in PsA patients. A retrospective study including patients with PsA (all patients fulfill CASPAR criteria) followed from January to May 2022, from a Rheumatology Clinic. Patients were divided into two groups: with current or previous foot involvement (assessed clinically or by ultrasound) (group 1) and without current or previous foot involvement (group 2). Sociodemographic, clinical and laboratory data were collected. Obesity was defined as a body mass index greater than or equal to 30 Kg/m2 and multimorbidity was defined as 2 or more comorbidities. Descriptive analysis was performed using means and standard deviation (SD), medians and Interquartile. range (IQR) for continuous data, and frequencies and percentages for qualitative variables. Clinical, laboratory and radiological findings were compared between patients with and without foot. involvement using parametric and non-parametric tests, with a p-value ≤ 0.05. A total of 154 patients were enrolled (mean age of 57.08 (±11.54) years and 39.6% were women). Foot involvement was found in 110 patients (71.40%). Obesity was more prevalent among patients with foot involvement – group 1 (40.90% VS 13.64%; p=0.001). Enthesitis was found in 35.10 % of patients with Achilles enthesitis (28%) as the most frequent manifestation. PsA patients in group 1 who were obese had higher prevalence of Achilles enthesitis (p= 0.01). 18.18% of patients had current/previous toe dactylitis and dystrophic nails were found in 37.7% of patients (no differences were encountered between obese and non-obese patients). Multimorbidity were more frequent in PsA patients with foot involvement- group 1 (p=0.04). We found a higher frequency of extra-articular manifestations and higher HAQ disability index values in patients with foot involvement (p=0.03 and p<0.001, respectively). Although we did not find statistically significant differences in the HAQ disability index between obese and non-obese patients with foot involvement, there was a predominance of disability in obese patients. PsA patients in group 1 who are obese have higher C-reactive protein (p=0.01) and higher consumption of non-steroidal anti-inflammatory drugs (p=0.02). We did not find statistically significant differences in swollen and tender joint counts, in conventional and biological DMARDS between obese and non-obese patients in group 1. Obesity was more prevalent among PsA patients with foot involvement, suggesting its presence may enhance and contribute for foot complaints in these patients. Patients with foot involvement had higher HAQ disability index levels, reflecting the negative impact of foot involvement in daily functionality in these patients. Our study highlights the importance of obesity management in PsA patients with foot involvement. Further studies are needed to develop weight reduction strategies that can applied in clinical practice, in order to improve outcomes related to PsA. [1]Azevedo S, Santos-Faria D, Leite Silva J, Ramos Rodrigues J, Sousa Neves J, Peixoto D, Tavares-Costa J, Alcino S, Afonso C, Teixeira F. Obesity, metabolic syndrome and other comorbidities in rheumatoid arthritis and psoriatic arthritis: influence on disease activity and quality of life. Acta Reumatol Port. 2019 Oct-Dec;44(4):322-324. English. PMID: 32281967. NIL. None Declared.

Background:The relationship between joint disease and gut inflammation has been established in axial spondyloarthritis (SpA) [1]. However, it is not yet well-established in psoriatic arthritis (PsA). Emerging evidence suggests a connection between dysbiosis, gut inflammation, and joint disease, mediated specifically by Th17 cells [2]. Therefore, PsA patients may experience clinical or even subclinical gut inflammation. Although subclinical gut inflammation in patients with PsA might be an important pathophysiological event playing a role in disease pathogenesis, it may not be present in patients with only psoriasis (PsO). Detecting subclinical gut inflammation is challenging, but some studies have demonstrated that faecal calprotectin (FC) is a highly sensitive marker for inflammation in the gastrointestinal tract [3].Objectives:To evaluate the presence of occult bowel inflammation in patients with PsA and PsO, as expressed by elevated levels of FC.Methods:A cross-sectional case-control study was conducted, including patients ≥ 18 years who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria or with a diagnosis of PsO according to a Dermatologist. The control group comprised individuals without rheumatologic diseases, PsO, or inflammatory bowel disease (IBD). Patients diagnosed with colorectal carcinoma, infectious gastroenteritis, intestinal diverticular disease, cystic fibrosis, coeliac disease, or those unable to discontinue non-steroidal anti-inflammatory drugs (NSAIDs) were excluded. All patients and controls completed a structured questionnaire regarding the presence of gastrointestinal symptoms - Red Flags Questionnaire for IBD - and underwent FC measurement with enzyme-linked immunosorbent assay (≥50 mg/g was considered positive). A general analysis was performed and a p-value ≤0.05 was statistically significant.Results:This study included 85 patients: 34 with PsA, 23 with PsO, and 28 controls. Demographic and clinical data are represented in Table 1. In the PsA group, 2.94% had weight loss and 2.94% had fever in the last 3 months; 5.88% had nocturnal diarrhea; 11.76% had rectal urgency and 11.76% had abdominal pain 30-45 minutes after meals. In the PsO group, 4.35% had abdominal pain 30-45 minutes after meals and 4.35% had a sibling with IBD. All controls were asymptomatic. Elevated FC was observed in 32.4% of PsA patients, 21.7% of PsO patients, and 10.7% of controls, however, no statistical significance was found between groups (p = 0.126).Conclusion:A higher prevalence of positive FC levels was observed in PsA and PsO patients, comparing with healthy controls, however without statistical significance. The small number of patients and the presence of patients under bDMARDs might have influence this results since anti-TNF and IL12/23 inhibitors can reduce bowel inflammation in IBD. Thus, the inclusion of more patients and invasive studies will contribute to assess the presence of subclinical bowel inflammation.REFERENCES:[1] Caballero S et al. Annu Rev Immunol. 2015; 33:227-56.[2] Talotta R e al. Pharmacol Res. 2019; 148: 104394.[3] Hansson C et al. J Immunol Res. 2014; 2014:696415.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Sacroiliitis is the hallmark of axial Spondyloarthritis (axSpA). ASAS-EULAR management recommendations for axSpA, consider glucocorticoid injections directed to the local site of musculoskeletal inflammation as a treatment option for pain relief, besides treatment with oral non-steroidal anti-inflammatory (NSAIDs) before starter biotechnological treatment. However, there are few studies to evaluate efficacy of this technique with a small number of patients and a short follow-up. Ultrasonography has been used as a valuable option to guide this technique.Objectives:To evaluate the efficacy and safety of ultrasound-guided injections of sacroiliac joints (SIJs) in patients with sacroiliitis using clinical and laboratory outcomes at baseline and at 4-6th weeks.Methods:This study involved patients with axSpA with acute sacroiliitis, ≥18 and ≤ 65 years old, with body mass index (BMI) < 30kg/m2 attending the Rheumatology Outpatient Clinic, which had been poorly controlled (ASDAS>2.1) by conventional therapy (physiotherapy, NSAIDs at maximum tolerated dosing during ≥ 4 weeks). Sociodemographic, clinical (disease duration, BMI, BASDAI, BASFI, ASDAS) and laboratory (CRP) data was collected from the medical records at baseline and at 4-6th weeks.Statistical analyses were conducted using SPSS version 25. Continuous variables were described with mean/median ± standard deviation (SD).SIJs injection was performed, under ultrasound guidance, using standard procedures with 2mL of lidocaine 1% and 40mg of methylprednisolone, with a 22-gauge needle. The procedure was performed by the same operator. Written informed consents were obtained from all patients.Results:We performed eleven sacroiliac injection in eleven consecutive patients (one procedure per patient). Nine patients (81.8%) were female, mean age (±SD) of 40.6(±9.4) years, median disease duration(±SD) of 0.9(±6.2) years and median BMI(±SD) of 24.2(±3.3). Eight patients (72.7%) had Nr-axSpA. All patients were non-responders to NSAIDs.At 4-6th weeks there was a decreased in median (±SD) BASDAI (5.4±1.9 vs 4.1±1.9), BASFI (4.2±1.4 vs 3.5±2.3) and ASDAS (3.2±0.8 vs 2.2±0.6) indexes.Conclusion:As previous studies demonstrated, this technique seems to be safe and quite effective.Our goal is to increase the number of patients undergoing this technique and have a longer follow up to evaluate its efficacy. The study has several limitations: the mid- and long-term effects should be evaluated in the future based on the results of the short-term effects and the study was not conducted as a double-blinded, controlled study.References:[1]van der Heijde D, Burgos-Vargas R, Ramiro S.,et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2017; 76:978–991[2]Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 1992; 35:564–8.[3]Pekkafahli MZ, Kiralp MZ, Basekim CC et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003;22:553–9[4]Klauser A, De Zordo T, Feuchtner G et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008; 59:1618–1624.Disclosure of Interests:Ana Rita Cunha: None declared, Carolina Mazeda: None declared, Renata Aguiar: None declared, Anabela Barcelos Speakers bureau: Bene, Eli-Lilly, Pfizer, MSD, Novartis

BackgroundAxial spondyloarthritis (axSpA) had a predilection for the axial skeleton and belong to the group of Spondyloarthritis, a set of inflammatory rheumatic diseases with common clinical, radiologic, and serologic features in which extraarticular manifestations are frequent, including inflammatory bowel disease (IBD). The link between SpA and IBD has been recognized for decades, with 5-10% of axial SpA patients suffering from concurrent IBD.[2] But, emerging evidence suggests that subclinical gut inflammation in patients with SpA is an important pathophysiological event that plays a role in disease pathogenesis. However, it is difficult to detect subclinical gut inflammation since it is largely asymptomatic. Faecal calprotectin (FC) is a very sensitive marker for inflammation in the gastrointestinal tract. The role of FC in patients with SpA is not clearly defined, but some studies suggest that FC levels may predict the onset of IBD and may be related to disease activity.ObjectivesTo test the validity of FC as a marker of intestinal inflammation in patients with axSpA and to investigate factors associated with increased FC levels in patients with axSpA.MethodsPatients involved fulfilled ASAS classification criteria for axSpA and were divided into two groups - ankylosing spondylitis (AS) or non-radiographic axSpA (nr-axSpA); a control group without rheumatologic diseases or IBD was also included. All patients and controls answered a structured questionnaire about the presence of gastrointestinal symptoms - Red Flags Questionnaire for IBD and underwent FC measurement with enzyme-linked immunosorbent assay (≥50 mg/g was considered positive). Patients treated with oral NSAIDs should undergo adequate washout (at least 3 weeks). In patients, BASDAI, BASFI, ASDAS-PCR and BASMI were recorded. A general analysis was performed; p-value ≤0.05 was statistically significant.ResultsWe included 64 patients (34 with AS and 30 with nr-axSpA) and 25 controls. Demographic, clinical data is represented in table 1. In AS group, 2.9% had nocturnal diarrhoea, first-degree relative with confirmed IBD and rectal urgency; in nr-axSpA, 6.7% had abdominal pain 30-45 minutes after meals and 3.3% chronic abdominal pain; all controls were asymptomatic. Elevated FC was observed in 32.4% of AS patients (129.2±404.0), 23.3% of nr-axSpA patients (70.9±114.4) and 4.2% of controls (21.9±18.4). FC was significantly higher in each axSpA subtype vs controls (p=0.03). There were no statistically significant differences in ASDAS, BASDAI, BASFI or BASMI scores between axSpA patients with normal vs high FC levels.Table 1.Characteristics of the population according to axSpA groups and controls.AS (n=34)axSpA (n=30)Controls (n=25)P*Age (years), mean±SD55.5±14.744.9±13.340.2±14.00.004Sex (F/M)15/1918/1213/110.205Age at disease onset (years), mean±SD11.8±7.75.4±3.3-<0.001Comorbidities, n (%) Arterial Hypertension13(38.2)10(33.3)1(4)0.166 Dyslipidemia8(23.5)7(23.3)2(8)0.985 Diabetes Mellitus3(8.8)2(6.7)00.748 Obesity1(2.9)1(3.3)0Smoking status, n (%)4(11.8)1(3.3)1(4)0.850Peripheral involvement, n (%)9(26.5)5(16.7)-0.344Dactylitis (ever), n (%)01(3.3)-0.283Enthesitis (ever), n (%)1(2.9)2(6.7)-0.482Uveitis (ever), n (%)9(26.5)4(13.3)-0.192Positivity HLA-B27, n (%)25(73.5)13(43.3)-0.014BASDAI, mean±SD3.4±2.53.8±2.4-0.589BASFI, mean±SD3.3±2.53.3±2.1-0.981ASDAS-PCR, mean±SD2.3±1.02.4±1.1-0.070BASMI, mean±SD4.2±1.83.1±1.7-0.226Therapeutic, n (%)- AINEs**16 (47.1)14 (46.7)0.124 cDMARDs2 (5.9)2 (6.7)0.897 bDMARDs9 (26.5)11 (36.7)0.408*Comparison between nr-axSpA and AS groups.** washout before collecting stool.ConclusionIn patients with axSpA, gut inflammation measured by FC was higher than among controls and it was also higher in patients with AS than in nr-axSpA. We also found that high FC values were not associated with more pronounced gastrointestinal symptoms. Thus, studies with a larger population and invasive studies are needed to assess the impact that this marker may have on the management of this pathology.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundGastrointestinal (GI) disease is a major cause of morbimortality in systemic sclerosis (SSc) and affects up to 90% of patients. GI manifestations are frequently unrecognized in early phases and there are few data suggesting the potential effect of immunosuppression (IS) in GI tract.ObjectivesThe aim of this study was to evaluate the role of IS in GI involvement and its impact on health-related quality of life (HRQoL) in SSc patients.MethodsA cross-sectional multicenter study was conducted, enrolling SSc patients that fulfilled the 2013ACR/EULAR criteria or presented the EUSTAR criteria for very early diagnosis of SSc (VEDOSS). Patients were requested to answer UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract, SHAQ and Short Form Health Survey (SF36) measures. Social-demographic and clinical data were collected. GI involvement was determined by the presence of one of the following: GI symptoms for at least 3 of the last 7 days, abnormalities in GI exams and/or use of GI pharmacological therapies. IS was defined as exposure to at least one of the following: mycophenolate mofetil (MMF), cyclophosphamide (CYC), methotrexate (MTX), azathioprine (AZA), leflunomide, glucocorticoids (>10mg/d prednisone-equivalent), rituximab, tocilizumab, and abatacept, for more than 6 months. General descriptive analysis and independent parametric or non-parametric tests were performed using SPSSv26.ResultsOne-hundred and one patients were included, 83 female (82.2%), with a mean age of 56.8±12.39 years-old and a mean duration of disease of 67.2±72.5 months. Sixty-four patients (63.4%) had limited SSc, 30 (29.7%) diffuse and 7 (6.9%) presented VEDOSS. Forty patients were under IS therapy, being the MTX the most frequent drug in 21.8%, followed by MMF in 11.9% and AZA in 5.9%. Seventy-two patients (71.3%) had GI involvement, where clinical manifestations were present in 72.2% patients, abnormalities in GI exams in 44.4% and GI pharmacotherapy was used in 41.7% patients. Patients with GI involvement were significantly more frequent under IS therapy (p=0.044), although no differences were found in severity of symptoms in UCLA domains between patients with and without IS. On the other hand, patients without GI involvement and under IS therapy presented significantly higher total UCLA score (mean 0.10±0.11 vs 0.11±0.18 for patients with and without IS therapy respectively, p=0.046). IS group was significantly more frequent under GI pharmacotherapy (p=0.006), being the proton pump inhibitors (PPI) the most significantly prescribed drug (55% vs 16.4% for patients with and without IS respectively, p<0.01). IS group had significantly higher SHAQ scores in total item (p=0.001) and overall disease severity VAS (p=0.009). Regarding HRQoL patients under IS present significantly lower SF36 scores for physical functioning (p=0.001), physical role functioning (p=0.002), physical component summary (p=0.001) and general health perception (p=0.036).ConclusionPatients with GI involvement were more frequent under IS, although no differences were found in severity of symptoms in UCLA domains when compared to those without IS. IS therapy was associated with worst HRQoL probably due to more severe multi-organ disease and were treated more often with PPI. Investigation is needed to evaluate the potential effects of IS in GI tract, as patients with absence of GI involvement presented higher UCLA scores when IS therapy was given, which may reflect the potential GI complaints as an adverse effect by therapy, rather than involvement by the SSc.References[1]Khanna D et al. Arthritis Rheum, 2009; 61: 1257-63[2]Thoua N, et al. Assessment of gastrointestinal symptoms in patients with systemic sclerosis in a UK tertiary referral centre, Rheumatology 2010;49:1770–1775[3]McFarlane I. et al, Gastrointestinal Manifestations of Systemic Sclerosis, McFarlane et al., Rheumatology (Sunnyvale) 2018Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundAnti-SSA autoantibodies can be differentiated according to their antigenic target proteins as anti-Ro60 (60 kDa) or anti-Ro52 (52 kDa). Anti-SSA(Ro60) are clearly associated with Connective Tissue Diseases (CTD), but the clinical significance of anti-SSA(Ro52) remains unclear.ObjectivesTo analyze the disease phenotype of patients with anti-Ro52 and/or anti-Ro60.MethodsMulticenter, cross-sectional study of anti-Ro52 and/or Ro60 positive patients followed at 10 Rheumatology centers from January 2018 until December 2021. Patients were categorised into 3 groups: group 1 (Ro52+/Ro60-); group 2 (Ro52-/Ro60+); group 3 (Ro52+/Ro60+). Antinuclear antibodies were evaluated by indirect immunofluorescence assay and further screened for anti-extractable nuclear antigen (ENA) antibodies. Demographics and clinical data were compared between the 3 groups, by patients’ medical chart review. Univariate analysis was performed using chi-square, Fisher’s exact or Kruskall-Wallis test. Subsequently, the Bonferroni test was used to identify intergroup differences (level of significance: p<0.0167). Univariate logistic regression was used to calculate the odds ratio with a 95% confidence interval (CI).ResultsWe included 776 patients [female: 83.1%; median age: 59 (46-71) years]. Groups 1, 2 and 3 comprised 31.1%, 32.6%, and 36.3% of the patients, respectively. Characteristics of the groups are presented in Table 1. Anti-Ro52 alone is more frequently associated with non-rheumatic diseases, older age, and men (p<0.05). Among patients with CTD, the diagnosis of systemic lupus erythematosus is 3 and 2 times more prevalent in groups 2 and 3, respectively, than in group 1 [OR 2.8 (95% CI 1.60, 4.97),p=<0.001; OR 2.2 (95% CI 1.28, 3.86), p=0.007]. In group 2, the diagnosis of undifferentiated connective tissue disease is more frequent than in the other groups. The presence of isolated Ro52+ is more frequently associated with inflammatory myositis than in group 2 [OR 0.09 (95% CI 0.01, 0.33), p=<0.001] or group 3 [OR 0.08 (95% CI 0.01, 0.29), p=<0.001]. Group 1 was also more frequently associated with arthritis (p=0.006), interstitial lung disease (p=0.002), and myositis (p=0.009).Table 1.Characteristics of the study population according to the groups of anti-SSA(Ro) positivity.Group 1 (n=241)Group 2 (n=253)Group 3 (n=282)pAge, median (IQR)64 (52-76)56 (44-67)57 (44-69)<0.001Female, n (%)185 (76.8)214 (84.6)246 (87.2)0.005Other anti-ENA, n (%) Anti-La24 (10)50 (19.8)114 (40.4)<0.001 Anti-RNP11 (4.6)23 (9.1)17 (6.0)0.115 Anti-Scl703 (1.2)4 (1.6)6 (2.1)0.146 Anti-Jo17 (3)1 (0.4)3 (1.1)0.070 Anti-Sm1 (0.4)7 (2.8)6 (2.13)0.098Anti-dsDNA11 (4.6)39 (15.4)37 (13.1)<0.001Anti-centromere12 (5)3 (1.2)6 (2.1)0.026Lupus anticoagulant10 (4.2)32 (12.7)23 (8.2)0.008Anti-cardiolipin8 (3.3)10 (3.9)23 (8.2)0.024Anti-β2 glycoprotein 16 (2.5)10 (3.9)10 (3.6)0.736Rheumatoid Factor46 (19.1)44 (17.4)81 (28.7)0.001Anti-CCP11 (4.6)15 (5.9)19 (6.7)0.327Non-rheumatologic disease, n (%)77 (32)35 (13.8)30 (10.6)<0.001 Infections11 (14.3)2 (5.7)1 (3.3)0.192 Neoplasms22 (28.6)3 (8.6)6 (20.0)0.057 Interstitial lung disease5 (6.5)4 (11.4)00.168 Other diseases46 (59.7)25 (71.4)22 (73.3)-Immune-mediated rheumatologic disease, n (%)164 (68.1)218 (86.2)252 (89.4)<0.001 Sjögren syndrome92 (56.1)88 (40.3)150 (59.5)<0.001 Systemic lupus erythematosus20 (12.2)61 (28)59 (23.4)0.001 Systemic sclerosis11 (6.7)7 (3.2)8 (3.2)0.150 Inflammatory myositis15 (9.2)2 (0.9)2 (0.8)<0.001 Rheumatoid arthritis18 (11)17 (7.8)16 (6.4)0.234 Undifferentiated connective tissue disease11 (6.7)35 (16.1)21 (8.3)0.004 Mixed connective tissue disease6 (3.7)6 (2.8)4 (1.6)0.406 Other diseases9 (5.5)8 (3.7)10 (4.0)-ConclusionAnti-Ro52+ alone is frequently found in patients with non-rheumatic diseases. In addition, anti-Ro52+ is also prevalent in patients with CTD and associated with clinical phenotypes that are different from anti-Ro60+.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

PurposeSystemic Lupus Erythematosus (SLE) is a chronic and multisystem autoimmune disorder characterized by a heterogeneity of clinical presentations. Clinical expression is the consequence the production of autoantibodies and immune complex vasculitis with endothelial cell damage leading to blood vessel destruction and serious internal organ dysfunction. Nailfold video-capillaroscopy (NVC) is a non-invasive and inexpensive tool that allows assess the microvascular involvement. In SLE only normal patterns and a variety of ‘non-specific’ capillary abnormalities have been observed. The aim of this study was to evaluate the capillaroscopic changes SLE patients and correlation with organ involvement, laboratory findings and disease activity.MethodsA retrospective study was performed including SLE patients followed in outpatient rheumatology clinic; healthy controls with primary Raynaud’s phenomenon (RP) were also enrolled in the study. Socio-demographic and clinical data were collected. Descriptive analysis was performed; p-value≤0.05 was statistically significant.Results50 SLE patients (47 female; 3 men) and 50 healthy controls (42 female; 8 men) are included, averaging 47.1±13.6 and 50.3±18.8 years old, respectively (p=0.33). Mean disease duration in SLE patients was 10.6±7.7 years and the most frequent involvements were hematological (64%), cutaneous (64%) and musculoskeletal (56%). Only 18% of patients had RP. All patients with SLE had positive ANAs (36% anti-dsDNA, 32% anti-Ro60, 26% anti-Ro52, 10% anti-SSB, 4% anti-RNP and 4% anti-Smith) and 20% had positive antiphospholipid antibodies. 76% of patients were in remission and the rest had minimal activity according to SLEDAI-2K. In the capillaroscopy findings, SLE patients showed a normal pattern and morphological alterations including tortuous capillaries (30%) and presence of hemorrhages (10%). All controls had normal pattern with tortuous capillaries (5%) and with hemorrhages (2%). In SLE patients, we found statistically significant differences regarding morphology changes in NVC and hematological and nervous system involvement (p=0.04 and p=0.01, respectively) as well as the SLEDAI score (p=0.04).When comparing the SLE patients and healthy controls, significant differences were found in the changes in capillary morphology, Raynaud’s phenomenon, and the presence of positive antinuclear antibodies in two groups (p<0.05).ConclusionsAs in previous studies, our study showed that nonspecific changes (abnormal morphology, tortuous capillaries and haemorrhages) in NVC are frequent in SLE patients. Some changes seem to be associated with disease activity, but studies with larger sample sizes are warranted and may be beneficial to assess its evolution over time to understand its impact on the clinical outcome.

PurposeMicrovascular changes play central roles in the pathophysiology of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). Nailfold video-capillaroscopy (NVC) is a non-invasive and inexpensive tool that allows assess the microvascular involvement. In the last two decades, capillaroscopic patterns specific to SSc have been defined but in SLE only normal patterns and a variety of ‘non-specific’ capillary abnormalities have been observed. The aim of this study was to evaluate the association between capillaroscopic changes, organ involvement and laboratory findings SLE and SSc patients.MethodsA retrospective study was performed including SLE and SSc patients followed in outpatient rheumatology clinic. Socio-demographic and clinical data were collected. Descriptive analysis was performed; p-value≤0.05 was statistically significant.Results31 SLE (29 female; 2 men) and 24 SSc (19 female; 5 men) patients are included, averaging 46.96±13.80 and 58.42±11.38 years old with a mean disease duration was 10.93±7.65 and 3.58±2.63 years, respectively. In SLE patients, the most frequent involvements were hematological and cutaneous (70.1%). Only 19.4% of patients had Raynaud’s phenomenon. All patients had positive ANAs (22.7% anti-dsDNA, 22.6% anti-Ro60, 12.9% anti-Ro52, 6.5% anti-SSB and 3.2% anti-Scl70) and 10% had positive antiphospholipid antibodies. In the capillaroscopy findings, all patients showed a normal pattern and alterations were observed in the morphology of the capillaries in 35.5% with tortuous capillaries and 6.5% with the presence of hemorrhages. We found statistically significant differences regarding morphology changes in NVC and hematological involvement as well as the SLEDAI score (p=0.044). In the case of SSc, 29.2% had the limited involvement and all patients had Raynaud’s phenomenon (45.8% had a history of digital ulcers). Also, all patients had positive ANAs (58.3% anti-centromere, 25% anti-Scl70, 12.5% anti-RNA polymerase III and 8.3% anti-SSA) In capillaroscopy findings, all patients had a scleroderma pattern (50% early, 33.3% active and 16.7% late). History of digital ulceration, pulmonary involvement and positivity for anti-Scl70 were found to be statistically correlated with SSc pattern.When comparing SSc and SLE groups, significant differences were found between the pattern of NVC and Raynaud’s phenomenon, as well as the presence of anti-Scl70.ConclusionsMicrovascular changes are a prominent feature in both diseases and their assessment will be important in both diagnosis and follow-up. Findings in patients with SSc have already been demonstrated in previous studies but studies with larger sample sizes are warranted in patients with SLE with standardized capillaroscopic to clarify the role of NVC changes and the link between these and clinical or laboratory features.

BackgroundThe Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) has been recently developed and validated, providing improved accuracy and sensitivity for changes in SLE disease activity in comparison to SLE Disease Activity Index 2000 (SLEDAI-2K) [1]. New recommendations to standardize the Physician Global Assessment (PGA) scoring may improve its reliability [2].ObjectivesTo assess the intra- and interrater reliability of SLE-DAS, SLEDAI-2K and PGA for measuring SLE disease activity.MethodsA set of 24 clinical vignettes were abstracted, each from a real clinical visit of patients followed at an academic lupus clinic. These vignettes were selected to include a wide spectrum of SLE manifestations, organ-system involvements, and global severity of disease activity. Abstracted data were presented in a standardized format, including demographic, past medical history, current clinical picture and treatment, laboratory, and other workup assessments. A group of 19 raters were recruited as a random multicenter sample of Rheumatologists. All raters completed a preliminary training session on scoring rules for SLE-DAS, SLEDAI-2K and PGA. Each rater scored each clinical vignette with SLE-DAS, SLEDAI-2K, and PGA through an online survey. The scoring was repeated in a second round 7-14 days after the first one. The clinical vignettes were randomly ordered for each round. Inter and intra-rater reliability of each instrument was estimated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (95%CI), based on single-measurement, absolute agreement, with a two-way random effect or two-way mixed-effects model, respectively.ResultsThe 19 raters included 8 rheumatologists and 11 rheumatology trainees from 11 hospitals, with a mean of 12.1±7.1 and 3.6±0.5 years of rheumatology practice, respectively, and 78.9% of the participants assess ≤5 SLE patients per week in their regular clinical practice. The 24 clinical vignettes included 83.3% female patients, with a mean of 36.5±17.9 years of age. Active SLE organ involvement included: skin rashes (20.8%); arthritis (12.5%); nephritis (12.5%); thrombocytopenia (12.5%); cardiac/pulmonary involvement (12.5%); mucocutaneous vasculitis (8.3%); serositis (8.3%); neuropsychiatric lupus (8.3%). Systemic vasculitis, myositis, alopecia, hemolytic anemia, and leukopenia were each present in 4.2% of the vignettes. Hypocomplementemia and/or high anti-dsDNA were present in 75.0%. Twenty-one percent of the cases were in remission.All raters completed the survey, totaling 912 case assessments. Scores attributed by the raters ranged from 0.37 to 49.53 in SLE-DAS, 0 to 24 in SLEDAI-2K, and 0.0 to 3.0 in PGA. The interrater reliability was good for SLE-DAS and SLEDAI-2K, and moderate for PGA. The intra-rater reliability was excellent for SLE-DAS, and good for SLEDAI-2K and PGA (Table 1).Table 1:Interrater and intra-rater reliability of SLE-DAS, SLEDAI-2K and PGA.ICC (95%CI)Interrater reliabilityIntra-rater reliabilitySLE-DAS0.877 (0.807-0.934)0.908 (0.891-0.923)SLEDAI-2K0.812 (0.717-0.896)0.892 (0.871-0.909)PGA0.704 (0.578-0.828)0.900 (0.881-0.916)CI: confidence interval; ICC: intraclass correlation coefficient.ConclusionSLE-DAS presents high intra- and interrater reliability for measuring SLE disease activity. The high reliability of SLE-DAS is an important quality both in clinical practice and research, allowing consistent scoring among different clinicians including those who are not SLE experts.References[1] Jesus D, Matos A, Henriques C, et al. Derivation and validation of the SLE Disease Activity Score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis 2019;78:365-71.[2] Piga M, Chessa E, Morand EF, et al. Physician Global Assessment International Standardisation Consensus in Systemic Lupus Erythematosus: the PISCOS study. Lancet Rheumatol 2022;4:e441-e449.AcknowledgementsBeatriz Mendes and Carolina Mazeda contributed equally and share first authorship.Disclosure of InterestsNone Declared.