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BackgroundFatigue is a common symptom in chronic inflammatory diseases. The mechanism by which fatigue occurs is multidimensional. Previous studies suggested that several factors, including physiology, psychology and behavior, may contribute to its pathogenesis.Fatigue is considered one of the most common symptoms in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) with an incidence of 50–70%.Fatigue is a major factor contributing to unsatisfactory treatment outcome and poor quality of life, or even disability. Therefore, from a clinical point of view, how to improve the symptom of fatigue remains a challenge. Identifying factors related to fatigue could be a key to the management of this complex symptom.ObjectivesTo compare fatigue and its associated factors in patients with PsA and AS from two university hospitals.MethodsA cross-sectional analysis was performed in 105 patients (May – December 2022)Fatigue was assessed using 3 instruments: the fatigue subscale of the Short-form 36 survey (fatigue-SF36), the Visual Analogue scale of fatigue (VASf) and the Functional Assessment of chronic illness Therapy Fatigue Scale (FACIT-F). T-test was used to compare mean fatigue between PsA and AS patients.To determine in each patient group the relationship between fatigue (assessed by FACIT-F) and the other variables (DAPSA or ASDAS, CPR, ESR, hemoglobin, HAQ, Hospital Anxiety and depression Scale [HAD] and Brief Pain Inventory [BPI]) a Spearman correlation was performed. A value of p < 0.05 was accepted as statistically significant.ResultsA total of 105 patients were included, 55 (52.4%) PsA patients and 50 (47.6%) AS patients.We found that mean fatigue (using 3 instruments) had not significant differences in patients with PsA and AS (Table 1).In patients with PsA and AS, fatigue correlated to HAD, HAQ and pain, but not with CRP, ESR and hemoglobin (Table 2).In AS patients, high disease activity (assess by ASDAS) correlated with high levels of fatigue (lower levels on FACIT-F). However, in patients with PsA, fatigue and disease activity (DAPSA) were not related.ConclusionIn PsA and AS patients, fatigue seems to be related to subjective but not with objective (analytical) variables. In patients with AS, fatigue was related to disease activity, but in patients with PsA we found no correlation.References[1]Li, Aissaoui N et al. Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int. 2012 Jul;32:2117-24.[2]Conaghan PG et al Relationship of pain and fatigue with health-related quality of life and work in patients with psoriatic arthritis on TNFi: results of a multi-national real-world study RMD Open 2020;6:e001240.Table 1.Mean of fatigue in PsA and AS patientsPsA Mean (SD)AS Mean (SD)p-valueFACIT-F38.1 (10.3)37.7 (11.4)0.88VAS-F3.8 (2.5)4.29 (2.8)0.396SF36-Fatigue53.4 (22)56.7 (21.8)0.45Table 2.Fatigue correlations in PsA and AS patientsPsAp-valueASp-valueDisease activity-0.190.164-0.63<0.001PCR0.010.9470.010.30VSG0.050.6800.040.325Hemoglobin-0.130.337-0.150.46HAQ-0.50<0.001-0.67<0.001HAD depression-0.75<0.001-0.61<0.001HAD anxiety-0.70<0.001-0.47<0.001Pain (BPI)-0.64<0.001-0.71<0.001Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundGiven that teratogenic medications prescribed to women with immune-mediated inflammatory disease (IMID) may cause significant fetal harm, the use of effective contraception is crucial in reproductive-age women receiving potentially teratogenic medications.ObjectivesTo determine: Relationship between potentially teratogenic drugs and the efficacy of contraception methods. The prevalence of contraceptive methods in women of reproductive age with IMID.MethodsCross- sectional study (May 2021 - May 2022). All women of reproductive age with an IMID (rheumatology, dermatology and gastroenterology external consultation) were invited to participate. Patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, Crohn’s disease and ulcerative colitis were included. Patients with hysterectomy, primary or secondary amenorrhea were excluded. A self-administered questionnaire including questions on the use of contraceptive methods was administered.Medications prescribed for IMID were identified and assigned a pregnancy risk category (according FDA): Class A - B (safe to use during pregnancy), C (have not been adequately studied to assign a pregnancy classification) and D-X (potentially teratogenic, their use is relatively/ absolutely contraindicated during pregnancy). For women who were prescribed multiple drugs, we assigned their FDA risk category based on their drug with the highest potential teratogenicity.Contraceptive methods were also classified according to their relative effectiveness (based on World Health Organization (WHO)) (Table 1). When women had more than one contraceptive method we classified according to their most effective method.Our analysis categorizes drugs as either A/B/C or D/X, (“low risk” vs “high risk”). To determine the relationship between the potential teratogenic drug and the effectiveness of contraceptive method we used Chi-square tests.ResultsA total of 59 women participated (Table 2), mean age 41.2 (SD ± 6.8) years. Contraceptive use was referred by 41 (69.5%) of the patients (Table 1): 56.1% (23 patients) used a method classified as moderately effective, 31.7% (13) as highly effective and 9.8% (4) as ineffective.Of women with teratogenic drugs: 37.5% (15 patients) did not use a contraception method or it was considered as ineffective.The relationship between potentially teratogenic drugs and effectiveness of contraceptive methods has a P value of 0.668 (Table 3).ConclusionThe prevalence of contraception methods in reproductive-age women with IMID is about 70%.In women who used a contraceptive method, contraception considered to be ineffective was the least frequent.We found no relationship between the risk of teratogenicity in drugs prescribed for IMID and the effectiveness of contraceptive method.References[1]Hunt N. Family Planning and Rheumatoid Arthritis. Curr Rheumatol Rep. 2019;21:16[2]Leverenz DL. Contraception methods used by women with rheumatoid arthritis and psoriatic arthritis. Clin Rheumatol. 2019;38:1207-12Table 1.Frequency of contraceptive use (N 41)MethodFrequency (%)OMS classificationCondoms15 (36.6)ModerateOral contraceptive7 (17.1)ModerateSurgical sterilization6 (14.6)HighIntrauterine device4 (9.8)HighCoitus interruptus3 (7.3)IneffectiveVasectomy2 (4.9)HighVaginal rings2 (4.9)ModerateEmergency contraception1 (2.4)IneffectiveSubdermic implants1 (2.4)ModerateTable 2.Diagnosis frequencyDiagnosisFrequency (%)Rheumatoid arthritis20 (34.9)Crohn ´s disease12 (20.3)Psoriasis11 (18.6)Ankylosing spondylitis8 (13.6)Psoriatic arthritis7 (11.9)Ulcerative colitis1 (1.7)Table 3.Relationship between potentially teratogenic drugs and effectiveness of contraceptive methodsHigh effectiveness of contraceptionModerate effectiveness of contraceptionIneffective or not use of contraceptionHigh risk of teratogenicity (N 40)10 (25%)15 (37.5%)15 (37.5%)Low risk of teratogenicity (N 19)3 (15.8%)9 (47.4%)7 (36.8%)Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background Pulmonary arterial hypertension (PAH) is one of the most relevant causes of death in systemic sclerosis. The aims of this study were to analyse the recently published DETECT algorithm comparing it with European Society of Cardiology/European Respiratory Society (ESC/ERS) 2009 guidelines: as screening of PAH; (2) identifying median pulmonary arterial pressure (mPAP) ≥21 mmHg; and (3) determining any group of pulmonary hypertension (PH). Methods Eighty-three patients fulfilling LeRoy’s systemic sclerosis diagnostic criteria with at least right heart catheterization were studied retrospectively. Clinical data, serological biomarkers, echocardiographic and hemodynamic features were collected. SPSS 20.0 was used for statistical analysis. Results According to right heart catheterization findings, 35 patients with PAH and 28 with no PH met the standards for DETECT algorithm analysis: 27.0% of patients presented with functional class III/IV. Applying DETECT, the sensitivity was 100%, specificity 42.9%, the positive predictive value 68.6% and the negative predictive value 100%, whereas employing the ESC/ERS guidelines these were 91.4%, 85.7%, 88.9% and 89.3%, respectively. There were no missed diagnoses of PAH using DETECT compared with three patients missed (8.5%) using ESC/ERS guidelines. The DETECT algorithm also showed greater sensitivity and negative predictive value to identify patients with mPAP ≥21 mmHg or with any type of PH. Conclusions The DETECT algorithm is confirmed as an excellent screening method due to its high sensitivity and negative predictive value, minimizing missed diagnosis of PAH. DETECT would be accurate either for early diagnosis of borderline mPAP or any group of PH.

BackgroundHypo or amyopathic dermatomyositis (DM) represent about 20% of the classic DM. Melanoma differentiation-associated gene 5 antibody or anti-MDA5 antibody, formerly known as anti-CADM140 antibody, has been reported in the last decade. This antibody is detected in more than 50% of patients with hypo or amyopathic DM and it has specific features such as the presence of ulcerative vascular lesions and rapid progression of the interstitial lung disease.ObjectivesTo report anti-MDA5 positive DM cases diagnosed at a university county hospital, between 2012 and 2016.MethodsDesign: Retrospective descriptive study. Location: University county hospital. Reference area: ?350.000 inhabitants. Clinical manifestations, analytical results, diagnostic approach, treatment administered and follow-up have been exposed.ResultsWe report four anti-MDA5 positive DM with a mean age at diagnosis of 54 years (35–77). Caucasian origin in 2 men and Maghreb origin in 2 women. They had no relevant medical history neither neoproliferative process was detected.Table 1ABCD SexFemaleMaleFemaleMaleAge at disease onset43773562FeverYesNoNoNoHeliotrope rashYesNoYesNoGottron papulesYesNoNoNoSkin ulcerationNoNoNoYesJoint disease (J)NoNo RA like Palindromic like Raynaud's diseaseNoNoNoNoMuscular disease (M)NoNo Yes NoPulmonary disease (P) Bronchiolitis Interstitial lung disease No Interstitial lung disease Cardiac disease (Card)No Arrhythmias Sinus tachycardia NoAldolase (N<7)NormalNA 11 14,6 ESR/CRP mg/dL 30/4,5 41/13,7 102/8,1 50/1,8 Ferritin (30–400 ng/ml) 1253 NA225 2437 ElectromyographyNANANormalNAMuscle biopsyNANA Miopathy NASkin biopsy DM NANonspecific DM TreatmentCC + CPM + TACR + IVIGCCCC + MTX + HCQCC + CPM + TACROutcome (months)DeathDeathClinical response (18 m)Alive (16 m)RA = Rheumatoid Arthritis; NA = Not Avalaible; ANA = Antinuclear Antibodies; DM = Dermatomyositis; CC = Corticosteroids; CPM = Cyclophosphamide; TACR = Tacrolimus; IVIG = Intravenous Immunoglobulins; MTX = Methotrexate; HCQ = Hydroxychloroquine.ANA were negative and CK values were normal in all the cases. Nailfold capillaroscopy was characteristic of DM pattern. Case B did not present cutaneous manifestations and he was diagnosed as anti-MDA5 DM after his death.DiscussionB and C cases showed abnormal heart rhythm that could be related to myocardial involvement, as suggested in a recent publication of anti-MDA5 DM (1). In case C, sinus tachycardia was resolved with the clinical response to treatment.In the literature reviewed, anti-MDA5 positive DM has been reported as a dermato-pulmonary syndrome, but probably the clinical profile of these patients remains to be defined. In our cases, one of them did not present skin lesions and another case did not develop pulmonary involvement 18 months after the diagnosis.ConclusionsKeep in mind anti-MDA5 antibody in patients with cutaneous manifestations of DM with vasculopathy lesions, minimal or absent muscular disease, heart rhythm abnormalities not explained by other causes and/or rapidly progressive pulmonary involvement.Anti-MDA5 positive DM may have a poor response to treatment and fatal outcome. It remains to be seen if early diagnosis could improve the life expectancy of these patients.References J Eur Acad Dermatol Venereol 2014; 28: 1097–102. Disclosure of InterestNone declared

The Q&U Bolometric Interferometer for Cosmology (QL’BIC) is the first bolometric interferometer designed to measure the primordial B -mode polarization of the Cosmic Microwave Background (CMB). Bolometric interferometry is a novel technique that combines the sensitivity of bolometric detectors with the control of systematic effects that is typical of interferometry, both key features in the quest for the faint signal of the primordial B -modes. A unique feature is the so-called “spectral imaging”, i.e., the ability to recover the sky signal in several sub-bands within the physical band during data analysis. This feature provides an in-band spectral resolution of ∆ v / v ~ 0.04 that is unattainable by a traditional imager. This is a key tool for controlling the Galactic foregrounds contamination. In this paper, we describe the principles of bolometric interferometry, the current status of the QU BIC experiment and future prospects.

The Q&U Bolometric Interferometer for Cosmology (QL’BIC) is the first bolometric interferometer designed to measure the primordial B-mode polarization of the Cosmic Microwave Background (CMB). Bolometric interferometry is a novel technique that combines the sensitivity of bolometric detectors with the control of systematic effects that is typical of interferometry, both key features in the quest for the faint signal of the primordial B-modes. A unique feature is the so-called “spectral imaging”, i.e., the ability to recover the sky signal in several sub-bands within the physical band during data analysis. This feature provides an in-band spectral resolution of ∆v/v ~ 0.04 that is unattainable by a traditional imager. This is a key tool for controlling the Galactic foregrounds contamination. In this paper, we describe the principles of bolometric interferometry, the current status of the QU BIC experiment and future prospects.

The Q&U Bolometric Interferometer for Cosmology (QUBIC) is the first bolometric interferometer designed to measure the primordial B-mode polarization of the Cosmic Microwave Background (CMB). Bolometric interferometry is a novel technique that combines the sensitivity of bolometric detectors with the control of systematic effects that is typical of interferometry, both key features in the quest for the faint signal of the primordial B-modes. A unique feature is the so-called \"spectral imaging\", i.e., the ability to recover the sky signal in several sub-bands within the physical band during data analysis. This feature provides an in-band spectral resolution of \\Delta{\\nu}/{\\nu} \\sim 0.04 that is unattainable by a traditional imager. This is a key tool for controlling the Galactic foregrounds contamination. In this paper, we describe the principles of bolometric interferometry, the current status of the QUBIC experiment and future prospects.

The Q&U Bolometric Interferometer for Cosmology (QUBIC) is a novel kind of polarimeter optimized for the measurement of the B-mode polarization of the Cosmic Microwave Back-ground (CMB), which is one of the major challenges of observational cosmology. The signal is expected to be of the order of a few tens of nK, prone to instrumental systematic effects and polluted by various astrophysical foregrounds which can only be controlled through multichroic observations. QUBIC is designed to address these observational issues with a novel approach that combines the advantages of interferometry in terms of control of instrumental systematics with those of bolometric detectors in terms of wide-band, background-limited sensitivity.

We calculate the mutual information function for each of the 24 chromosomes in the human genome. The same correlation pattern is observed regardless the individual functional features of each chromosome. Moreover, correlations of different scale length are detected depicting a multifractal scenario. This fact suggest a unique mechanism of structural evolution. We propose that such a mechanism could be an expansion-modification dynamical system.