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Systemic sclerosis is an autoimmune disease whose etiology remains unknown. Some patients prove refractory and require other therapies. Recently, the use of mesenchymal stem cells (MSC) for the treatment of disease refractory to conventional treatments has been considered. We present a case of refractory systemic sclerosis; Wharton's jelly mesenchymal stem cell was given in response. Decrease in perioral wrinkles, reduced telangiectasia and decrease in modified Rodnan skin score were observed two years later. A decrease in brain natriuretic peptide and improved pulmonary function were also found. And improvement of pulmonary fibrosis on high resolution tomography and capillaroscopy changes. In conclusion, MSC infusion seems to be effective and safe treatment of refractory scleroderma.

RESUMEN El síndrome de Sjögren primario (SSp) es una enfermedad autoinmune que afecta principalmente al tejido glandular. A pesar de ello, puede involucrar otros sistemas, siendo el compromiso neuropsiquiátrico una manifestación extraglandular común. Su presentación clínica varía ampliamente según el dominio que se encuentre afectado, y por tanto puede dividirse en tres grandes categorías: sistema nervioso central, sistema nervioso periférico y psiquiátrico. Algunas de estas complicaciones comparten mecanismos fisiopatológicos comunes, entre los principales la vasculitis/vasculopatía, la infiltración linfocítica y la presencia de anticuerpos antineuronales. La diversidad en la presentación clínica de esta entidad impide hacer una aproximación diagnóstica común, por lo cual la utilización de estudios específicos depende de un adecuado reconocimiento y de la localización por parte del clínico. El tratamiento debe dirigirse al mecanismo fisiopatológico implicado y, de acuerdo con el tipo de manifestación, puede incluso estar limitado al manejo sintomático. ABSTRACT Primary Sjögren's syndrome is an autoimmune disease that mainly involves glandular tissue. Despite this, it can potentially develop systemic involvement, within which neuropsychiatric manifestations are common. The clinical presentation may vary widely depending on the domain affected, and may thus be classified into three categories: central nervous system, peripheral nervous system, and psychiatric. Some of these complications share a common pathophysiology, amongst which are vasculitis/ vasculopathy, lymphocytic infiltration and positive antineuronal antibodies. The wide clinical presentation makes it difficult to establish a common diagnostic approach, making it essential for the clinician to recognise and localise the type of compromise, so that diagnostic tools can be more advantageously employed. Treatment must be directed towards the underlying pathophysiology, and depending on the type of compromise, it can even be limited solely to the management of symptoms.

Behcet's disease is a clinical autoinflammatory disorder of unknown etiology, usually with systemic manifestations, and a pattern of exacerbation-remission, often associated with delayed diagnosis. The diagnosis of this disease is complex. This article discusses four cases of patients with Behcet's disease, who during the clinical approach were considered to have other autoimmune diseases. A comprehensive review of the medical history, the development of oral and genital ulcers, in addition to the study of major histocompatibility complex typing (HLA), enabled the diagnosis of Behcet's disease.

Resumen La enfermedad de Behcet es una entidad clinica autoinflamatoria, de etiologia desconocida, generalmente con compromiso sistemico, con un patron de exacerbacion y remision frecuente que se asocia a retraso en el diagnostico. El diagnostico de esta enfermedad es complejo, por esta razon presentamos 4 casos de pacientes con enfermedad de Behcet, que durante el abordaje clinico fueron consideradas otras enfermedades de naturaleza autoinmune. La revision integrada de la historia clinica, la aparicion de ulceras orales y genitales, asi como el estudio de tipificacion del complejo mayor de histocompatibilidad (HLA) permitieron diagnosticar la enfermedad de Behcet.

The mesenchymal stromal cells (MSCs) are hematopoietic stem cells with high capacity of differentiation to other cellular lineages, depending on the microenvironment in which they live as well as on the interaction and signaling pathways they establish with the extracellular matrix. Several properties have been described in these cells: proangiogenic, antifibrotic and immunomodulatory. These properties are being studied as a therapeutic approach for autoimmune diseases such as cutaneous systemic sclerosis (SSc). SSc is a systemic chronic disease, with an approximate prevalence of 35.6 cases per 100,000 inhabitants in North America and of 0.02% in Colombia in 2018. There are two different clinical variants, diffuse and localized. In both variants an important skin involvement and a rapidly deterioration of organs is present, which can overshadow the clinical prognosis and increase the mortality. Options for the treatment of advanced diffuse SSc are scarce mainly targeting symptomatic control with little impact on the progression and mortality. Therefore, there is an increasing interest in new therapies like advanced cellular therapy with hematopoietic stem cells and stromal mesenchymal cells. This article reviews the information related to the use of stromal mesenchymal cells in patients with this disease. RESUMEN Las células mesenquimales estromales son células madre no hematopoyéticas pluripotenciales con alta capacidad de derivación a diferentes linajes celulares, dependiendo tanto del microambiente en el que se encuentren, como de la interacción y señalización que establezcan con la matriz extracelular del entorno, esto ha permitido describir un potencial proangiogénico, antifibrótico e inmunomodulador, que ha sido blanco de investigación en enfermedades autoinmunes como la esclerosis sistêmica cutánea. Considerando que la esclerosis sistêmica cutánea es una enfermedad inflamatoria crónica, con una prevalencia estimada de 35,6 casos por cada 100.000 habitantes en Norte América y de 0,02% en nuestro país para el 2018, se caracteriza por presentar dos variables clínicas principalmente; una variante limitada y una variante difusa, presentando en ambas un compromiso extenso de piel y órganos que puede ser rápidamente progresivo y deteriorar el pronóstico de los pacientes que la padecen aumentando su mortalidad. Debido a que las opciones terapéuticas en esta entidad son limitadas y buscan únicamente el control de síntomas, pero con poco impacto en progresión y mortalidad, terapias celulares avanzadas han surgido como nuevas opciones terapéuticas incluyendo el trasplante de células madre hematopoyéticas y las células mesenquimales estromales. A continuación, se revisará acerca de la utilidad y evidencia de células mesenquimales estromales en pacientes con esta enfermedad.

Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals’ variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations.

Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions.ObjectiveTo estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach.DesignThis is a secondary analysis of a previously published large-scale study on the prevalence of RMD.SettingStudies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis.ParticipantsA total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population.ResultsThe variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence.ConclusionsA syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.

In the current medical literature, there is increasing evidence for the involvement of the interleukin (IL)-17/23 axis and the potential role of Th17 cells in the pathogenesis of lupus nephritis. Knowledge about the interaction of these immunological pathways in the development of autoimmune diseases has led to the identification of new therapeutic strategies aimed at blocking them. For this reason, the main objective of this review focuses on knowing the recent evidence of the different anti-IL-17/23 treatment strategies in lupus nephritis and their future perspectives. A non-systematic narrative review of the literature was carried out following the objective of having the most representative information on the different anti-IL-17/23 drugs available together with the description of the pathophysiological mechanisms of this pathway involved in systemic lupus erythematosus and lupus nephritis. Despite the great existing theoretical foundation, today few clinical studies support the use of these therapies in both contexts. Nevertheless, the publication of research with a better methodology is expected to approve the indication of some of these drugs in lupus nephritis. However, the clinical response seen with ustekinumab and secukinumab in clinical studies and case reports published to date has been encouraging.

Resumen El lupus eritematoso sistemico (LES) es una enfermedad autoinmune cronica que puede comprometer cualquier organo o sistema, incluido el sistema nervioso central (SNC). Dentro del espectro de sus manifestaciones se incluye la enfermedad cerebrovascular, en la cual destacan su morbimortalidad y su discapacidad asociada. A pesar de ello, esta presentacion es muy rara como manifestacion inicial del LES, en particular el hematoma subdural. A continuacion, se presenta el caso de un paciente masculino de 57 anos que ingreso a un centro de atencion primaria con cefalea acompanada de signos de alarma, se documentaron colecciones subdurales escalonadas en la region frontal derecha, junto con una hemorragia intraparenquimatosa pontica del mismo lado, en el contexto de pancitopenia severa. En el trascurso de su evolucion y con los examenes complementarios en la busqueda de la etiologia de la pancitopenia, se concluyo, despues de excluir las causas mas comunes, un origen autoinmune en el contexto de un LES con presentacion clinica atipica.

Reactive arthritis is defined as arthritis that arises after infection, where pathogens cannot grow in the affected joints. Although the human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 are not among the most commonly implicated pathogens, there is growing evidence that they have major implications in the genesis of reactive arthritis. However, there are no described cases of coinfection of both entities that cause reactive arthritis at the same time, and the alterations involved in the immune system that could cause the change of certain clinical characteristics to more severe forms of the disease are unknown. The following describes the case of a male patient in his third decade of life who has an unusual and severe presentation of reactive arthritis associated with coinfection by COVID-19 and the human immunodeficiency virus.

Host immune response and virulence factors are key to disease susceptibility. However, there are no known association studies of human leukocyte antigen (HLA) class I and II alleles with chikungunya virus (CHIKV) infection in the Latin American population. Here we aimed to identify HLA alleles present in patients with CHIKV infection versus healthy controls as well as the allelic association with the clinical spectrum of the disease. We conducted a cross-sectional analysis of a community cohort and included patients aged 18 years and older with serologically confirmed CHIKV infection. HLA typing of HLA-A, HLA-B, and HLA-DRB1 alleles was performed. Two-by-two tables were used to establish associations between allele presence and clinical characteristics. Data from 65 patients with confirmed CHIKV infection were analyzed for HLA typing. CHIKV infection was significantly associated with the presence of HLA-A*68 (p = 0.005; odds ratio [OR]: 8.90; 95% confidence interval [CI]: 1.88-42.13), HLA-B*35 (p = 0.03; OR: 2.01; 95% CI: 1.06-3.86), HLA-DRB*01 (p

Reactive arthritis (ReA) is defined as arthritis that arises after infection, where pathogens cannot grow in the affected joints. Formerly, the clinical triad of postinfectious arthritis, urethritis, and conjunctivitis was called Reiter's syndrome; however, these clinical signs only represented a subset of patients with ReA. Due to the great diversity of its manifestations, its diagnosis is a challenge and can be overlooked in clinical practice. Additionally, it is associated with a variety of extra-articular manifestations that may be present either in the acute or chronic phase of the disease. Despite the cardinal clinical presentation characteristics of ReA, no case has been described in the literature that is diagnosed by the presence of classic extra-articular manifestations without objective joint involvement after COVID-19 infection. This report describes the case of a female patient in her third decade of life with an unusual presentation of ReA and focuses on her extra-articular manifestations.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system. Vasculitides are classified according to the predominant vessel involved such as large vessel, medium vessel, or small vessel vasculitis. Of these, Takayasu arteritis, Behcet's disease, relapsing polychondritis, and immunoglobulin G4 (IgG4)-related disease predominantly involve large vessels. The most common form of vasculitis seen in SLE is small vessel vasculitis. Aortitis in SLE is an extremely rare complication. This is a case report of a 21-year-old female patient with a history of SLE with overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis associated with antiphospholipid syndrome (APS), who presented with a one-week history of left-back burning lumbar pain, radiating to the flank, which increased with changes in position associated with intermittent claudication. In the angiography images and the positron emission tomography (PET) scan, a hypometabolic left para-aortic oval image was noted, corresponding to the presence of a contained hematoma in an abdominal aorta rupture. Later, she underwent vascular surgery and hemodynamics, performing thoracoabdominal aortic reconstruction together with aortorenal bypass and left nephrectomy. Pathology fundings of the left kidney correspond with class IV lupus nephritis, and the resection sample of the thoracoabdominal aneurysm showed a marked thinning and fragmentation of elastic fibers, areas of fibrosis of the wall with severe IgG4 negative lymphoplasmacytic infiltrate in the immunohistochemical study, establishing the diagnosis of aortitis.

Resumen Introduccion La validacion de cuestionarios es fundamental en el proceso de medicion de cualquier estudio de investigacion. El cuestionario Community Oriented Program for Control of Rheumatic Diseases (COPCORD) es util como tamizaje para la deteccion de enfermedades reumaticas. Objetivo Adecuar y validar la metodologia y el cuestionario COPCORD en poblacion colombiana. Materiales y metodos Se realizo un estudio de validacion de metodologia COPCORD que incluyo: 1) adecuacion transcultural del cuestionario COPCORD del espanol mexicano, y 2) validacion de los cuestionarios: COPCORD, cuestionario de nivel socioeconomico, uso de servicios de salud y un instrumento de calidad de vida (EQ-5D-3L), siguiendo las guias internacionales. Resultados Participaron 329 sujetos de 6 ciudades de Colombia, 10 en la primera fase del estudio y 309 en la segunda; un 67,3% fueron mujeres, con una edad promedio de 46,4 anos, con una escolaridad entre basica y media (77%). Los participantes residian en Bogota (29,4%), Barranquilla (22%), Cali (20,3%), Medellin (15,2%), Bucaramanga (6,4%) y Cucuta (6,4%). Reportaron dolor musculoesqueletico en los ultimos 7 dias el 43,6% y dolor historico el 68,9%. En 127 (41,1%) se establecio un diagnostico reumatologico: osteoartrosis (9,3%), sindrome de dolor regional (5,5%), lumbalgia (5,1%) y artritis reumatoide (0,9%). La validez interna fue de 0,70. Al comparar el cuestionario COPCORD con la revision por el reumatologo, tuvo una sensibilidad del 70,8%, una especificidad del 35%, una razon de verosimilitud positiva de 1,09 y un area bajo la curva de 0,53. Conclusiones El cuestionario COPCORD es valido como prueba de tamizaje de deteccion de malestares musculoesqueleticos y enfermedades reumaticas en poblacion colombiana.

Introduction The validation of questionnaires is fundamental in the measurement process of any research study. The Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire is useful as a screening tool for the detection of rheumatic diseases. Objective To adapt and validate the methodology and the COPCORD questionnaire in the Colombian population. Materials and methods A validation study of the COPCORD methodology was carried out that included: (1) transcultural adaptation of the COPCORD questionnaire of Mexican Spanish, and (2) validation of the questionnaires: COPCORD, socioeconomic level questionnaire, use of health services and a quality of life questionnaire (EQ-5D-3L), following international guidelines. Results A total of 329 subjects of 6 cities in Colombia participated in the process, with 10 in the first phase and 309 in the second. Approximately two-thirds (67.3%) were women. The mean age was 46.4±18.4 years, with an educational level between basic and medium (77%). Participants resided in Bogota (29.4%), Barranquilla (22%), Cali (20.3%), Medellin (15.2%), Bucaramanga (6.4%), and Cucuta (6.4%). Musculoskeletal pain in the previous 7 days was reported by 43.6%, and historical pain was reported by 68.9%. A rheumatological diagnosis was established in 127 (41.1%) cases: osteoarthrosis (9.3%), regional pain syndromes (5.5%), low back pain (5.1%), and rheumatoid arthritis (0.9%). The internal validity was 0.70. When comparing the COPCORD questionnaire with the diagnosis made by the rheumatologist, it had a sensitivity of 70.8%, specificity 35%, positive likelihood ratio of 1.09 m and area under the curve of 0.53. Conclusions The COPCORD questionnaire is valid as a screening test to detect musculoskeletal complaints and rheumatic diseases in the Colombian population.

In 2014, the chikungunya virus reached Colombia for the first time, resulting in a nationwide epidemic. The objective of this study was to describe the demographics and clinical characteristics of suspected chikungunya cases. Chikungunya infection was confirmed by enzyme-linked immunosorbent assay and 548 patients where included in the study. Of these patients, 295 were positive for antibodies against chikungunya (53.8%), and 27.6% (151/295) were symptomatic for chikungunya infection, with a symptomatic:asymptomatic ratio of 1.04:1. Factors associated with infection included low income and low socio-economic strata (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0–3.2, p = 0.003 and OR: 2.1; CI: 1.3–3.4, p = 0.002, respectively). Confirmed symptomatic cases were associated with symmetric arthritis (OR: 11.7; CI: 6.0–23.0, p

Host immune response as well as virulence factors are key in disease susceptibility. There are no known association studies of HLA class I and II alleles with chikungunya (CHIKV) infection in Latin American population. We aim to identify Human Leukocyte Antigen (HLA) alleles present in patients with CHIKV infection when compared to healthy controls, as well as allele association with the clinical spectrum of the disease. A cross-sectional analysis nested in a community cohort was carried out. We included patients 18 years and older with serological confirmation of CHIKV infection. HLA typing of HLA-A, HLA-B and HLA-DRB1 alleles was performed. Two-by-two tables were used to establish associations between allele presence and clinical characteristics. Data from 65 patients with confirmed CHIKV infection were analyzed for HLA typing. CHIKV infection was associated with the presence of HLA-A*68, HLA-B*35, HLA-DRB*01, HLA-DRB1*04 and HLA-DRB1*13 alleles with statistical significance when compared to healthy subjects. A statistically significant relationship was found between the presence of rash in the face or the abdomen and the presence of HLA-DRB1*04. Our study demonstrated that in our cohort, HLA type I as well as type II alleles are associated with CHIKV infection, and specifically an HLA type II allele with dermatological symptoms. Further research is needed to set a path for future investigation on genes outside the HLA system to improve knowledge in the pathophysiology of CHIKV infection and its host-pathogen interaction.

Background: The aim of this study was to assess DKK-1 levels, in Gingival Crevicular Fluid (GCF) and serum, as a biomarker for bone loss and disease activity in periodontitis and early RA (eRA). Methods: In this cross-sectional study, we obtained serum and GCF from 10 interproximal sites (Distal Buccal I/S, Mesio Buccal I/S, Distal Palatal/Lingual, Mesio Palatal/Lingual) according to the highest degree of inflammation by a patient for 240 sites from eRA patients. Patients received a periodontal assessment, a radiographic evaluation, tomography of interproximal sites, and DKK1 levels were determined by ELISA. Comparisons were performed by the Mann-Whitney U test and analysis by Chi2 test, and a logistic regression model was applied. Results: The mean age was 46.33 ± 12.0 years, the Disease Activity Score (DAS-28-ESR) was 4.08 ± 1.4. Periodontitis was present in 65.2% of the patients, and 59.6% of these patients had bone loss in interproximal sites. Higher GCF-DKK1 levels were associated with serum-DKK1 (OR:2.41 IC95% 1.14-5.09, p=0.021) and were related with DAS28-ESR (p=0.001), Routine Assessment of Patient Index Data 3 (RAPID 3) (p=0.001), and tender joints (p=0.040). Foot bone erosion and juxta-articular osteopenia were associated with high levels of serum-DKK1 (p=0.009 and 0.001, respectively). Serum-DKK1 were associated with SDAI (OR: 2.38 IC95% 1.03-5.52, p=0.043), RAPID 3 (p=0.001), and rheumatoid factor (p=0.018). The GCF-DKK1 levels were associated with periodontal bone loss (p=0.011), periodontitis (p=0.070) and its severity (OR: 2.58 IC95% 2.28-7.28, p=0.001). Bone loss was more frequent in buccal sites (73.5%) and was associated with increased levels of DKK1 (p=0.033). Conclusion: In the early stages of the eRA disease, serum and GCF-DKK1 could be a biomarker for clinical disease activity and periodontal and articular bone erosion.

ObjectiveTo determine the association between endoplasmic reticulum aminopeptidase (ERAP)1 and ERAP2 single-nucleotide polymorphisms (SNPs) and human leukocyte antigens (HLA)-B27+ or HLA-B15+ patients with spondyloarthritis (SpA).Methods104 patients with SpA according to Assessment of Spondyloarthritis International Society criteria were included in the study. HLA typing was performed by PCR. The polymorphisms were determined by real-time PCR on genomic DNA using customised probes for SNPs rs27044, rs17482078, rs10050860 and rs30187 in ERAP1, and rs2910686, rs2248374 and rs2549782 in ERAP2.Results70 of the104 patients with SpA were HLA-B27+ and 34 were HLA-B15+. The distribution of ERAP1 and ERAP2 SNPs between the HLA-B15+ and HLA-B27+ patients with SpA did not reveal differences. Likewise, no differences in the frequencies of ERAP1 SNP haplotypes and alleles HLA-B15 or HLA-B27 were found. Interestingly, however, the frequencies of three particular haplotypes formed by ERAP2 SNPs rs2549782/rs2248374/rs2910686 varied between HLA-B15+ and HLA-B27+ patients: the ERAP2 SNPs haplotype TGT was more common in HLA-B15+ patients with SpA (OR 2.943, 95% CI 1.264 to 6.585; P=0.009), whereas the ERAP2 SNP haplotypes TGC and CAT were more associated with HLA-B27+ patients with SpA: (OR 4.483, 95% CI 1.524 to 13.187; p=0.003) and (OR 9.014, 95% CI 1.181 to 68.807; p=0.009), respectively.ConclusionAn association was found between HLA-B15+ patients with SpA and haplotype TGT of ERAP2 SNPs. On the other hand, HLA-B27+ patients with SpA were associated with ERAP2 haplotypes TGC and CAT. These associations could be related to the clinical presentation of the disease, specifically with a peripheral or axial predominance, respectively.

Introduction Rheumatic diseases are the leading cause of permanent disability. The COPCORD model is an effective tool in the determination of the prevalence of diseases. The objective of this study is to estimate the prevalence of rheumatic disease in a Colombian population over 18 years of age. Methods A prevalence study was carried out using a probabilistic method of stratified random sampling in three stages: cartographic sectors in each city, selection of the blocks of each sector, and the households of each block. The COPCORD questionnaire adapted for Colombia was applied by standardized interviewers. Confirmation of the diagnosis was made by a rheumatologist with access to all the information. Results Out of a total of 6693 patients that completed the questionnaire, 64% were women. Pain not associated with trauma was reported by 48% of the participants. The most frequent locations were: knees 35%, hands 26%, lumbar spine 20%, and shoulders 16%. Non-specific skeletal muscle discomfort, osteoarthritis, regional appendicular syndrome, and non-inflammatory low back pain, were the most prevalent diseases. Rheumatoid arthritis and chronic inflammatory low back pain were the most common inflammatory conditions. The prevalence of Chikungunya fever was estimated at 6.68%. Conclusion The prevalence of rheumatoid arthritis in Colombia is higher than commonly reported, lower than for fibromyalgia and gout, and similar for osteoarthritis, systemic lupus erythematosus and spondyloarthritis. In Colombia these diseases are a public health problem without awareness of their impact on the general population.

Rheumatoid arthritis (RA) is an inflammatory disease characterized by joint destruction, deformity, lower functionality, and decrease in life expectancy. Wingless signaling pathway (Wnt) has been recently involved in bone homeostasis. Studies suggest that overexpression of the pathway inhibitors, like the Dickkopf 1 protein (DKK1), has been implicated in bone destruction. The objective of this study is to compare circulating levels of DKK1 in different groups of patients with disease activity (remission, low, moderate, high activity,) and functionality status. Three hundred seventy-nine patients with RA were evaluated between March 2015 and November 2016. Disease activity was evaluated by disease activity score 28 with C-reactive protein (DAS28CPR), simplified and clinical disease activity scores (SDAI, CDAI), routine assessment of patient index data 3 (RAPID3), functional status using Multidimensional Health Assessment Questionnaire (MD-HAQ), and the Steinbrocker functional classification. DKK1 levels were measured by ELISA. The mean age was 60.7 ± 13.9 years. Disease duration was 13.2 ± 10.9 years. Higher levels of DKK1 were not associated with disease activity by CDAI (p = 0.70), SDAI (p = 0.84), DAS28CRP (p = 0.80), or RAPID3 (p = 0.70). Interestingly higher levels of DKK1 were significantly associated to lower functional status evaluating by the Steinbrocker classification (p = 0,013), severe disability by MD-HAQ (p = 0,004), and variables associated with joint destruction like osteoporosis, higher titles of rheumatoid factor, smoking, and increased hospital admissions related to RA. Higher levels of DKK1 were found in patients with lower functional status. This association was not found in patients with greater disease activity by CDAI, SDAI, DAS28, and RAPID3. This could be explained by more structural damage; DKK1 could be used as a biomarker of joint destruction in RA.

Pachymeningitis is an uncommon disease with multiple etiologies with fibrosis of leptomeninges. One type of this disease is related to immunoglobulin G4 (IgG4). The most frequent manifestations include chronic cephalgia and focal neurological deficits. The case of a 31-year-old man with chronic cephalgia localized to the left hemicranium and left dysmetria is presented. Nuclear magnetic resonance imaging showed image hyperintensity and perilesional edema located at the infratentorial and left parietal occipital levels. The results of cerebral angiography and a cerebrospinal fluid examination were normal. A biopsy of the central nervous system (CNS) ruled out neoplastic lesions, granulomatous lesions, infection, and arteriovenous malformation and indicated thickened meningeal fragments. Elevated serum IgG4 levels were found. The antinuclear antibodies (ANAs), antibodies to extractable nuclear antigens (ENAs), anti-native DNA antibodies (anti-DNA), topoisomerase I antibodies (Scl-70), antibodies to cyclic citrullinated peptides (anti-CCP), and rheumatoid factor (RF) were negative. After an initial diagnosis of idiopathic hypertrophic cranial pachymeningitis, the patient received treatment with high doses of glucocorticosteroids for two years, without response, and developed Cushing's syndrome, cataracts, and osteoporosis. During the follow-up, dactylitis, distal upper limb sclerosis, and Raynaud's phenomenon occurred. A capillaroscopy indicated capillaries with dilated loops, microhemorrhaging, disorganization of the capillary architecture, and megacapillaries, which led to a diagnosis of limited systemic scleroderma. Although an association between scleroderma and pachymeningitis was originally proposed, review of the literature suggests that these are two different entities. Treatment with methotrexate, 25 mg weekly, allowed the withdrawal of glucocorticoids and resolution of neurological symptoms.

6 páginas There is a complex, dynamic, and bidirectional connection between autoimmunity and cancer. The underlying mechanisms of carcinogenesis and physiopathological aspects of autoimmune diseases are not fully understood. However, there is a common immunological base related to expression of autoantigens by tumour cells that cause an anti-cancer immune response, thereby, triggering the development of paraneoplastic rheumatic syndromes and autoimmune rheumatic diseases in a genetically predisposed population. The case is reported of a 57 year-old man presenting with pulmonary renal syndrome, and who was diagnosed lung cancer and systemic lupus erythematosus at the same time. Existe una relación compleja, dinámica y bidireccional entre la autoinmunidad y el cáncer. Si bien los mecanismos carcinogénicos y fisiopatológicos de las enfermedades autoinmunes no están claramente dilucidados, existe una base inmunológica común relacionada con la expresión de autoantígenos por parte de las células tumorales que desencadenan una respuesta antitumoral, facilitando el desarrollo de síndromes paraneoplásicos reumáticos y enfermedades autoinmunes reumáticas en población genéticamente susceptible. Se presenta un caso de un hombre que debutó con un síndrome pulmón riñón y se diagnosticó cáncer de pulmón y lupus eritematoso sistémico de forma simultánea.

Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective.To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses.Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries.Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality).LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.

Background: The prevalence of rheumatoid arthritis (RA) in Colombia according to the COPCORD study was 1.49%. The disease burden data available in our country are based on the results of the Global Burden Disease study (GBD) of 2016. However, the GBD study takes reference data from non-Colombian residents that was extrapolated to our population, given the absence of demographic data at that moment. Objectives: To estimate the disease burden of RA for 2015 Methods: A descriptive study was developed. The reference data of the population was taken by DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization). The GBD disability definitions were adapted from individual questions of functionality and quality of life questionnaires of the COPCORD study in Colombia (1). A Markov model was developed to calculate the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and Disability-Adjusted Life Year (DALY). Results: The distribution of cases by age and severity levels of RA are shown in figure 1 and 2 respectively. Since direct death due to RA were not registered according to the search of the ICD-10 codes in DANE, the YLL was 0. The YLDs in total were 118,358. The DALYs were 118,358 for a rate of 361.54 per 100,000, which is higher than the GBD 2016 results (60 per 100.000). Conclusion: The burden disease of rheumatoid arthritis is higher than that referred by GBD. Holistic approaches are required to reduce these parameters of impact on the public health of Colombians. Our data on DALYs usefulness lies in the urgent need for an early diagnosis, to reduce disability and thereby improve the quality of life of patients. Even though, RA was not the registered primary cause of death, it is necessary to explore mortality-associated conditions due to this rheumatic disease. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Ana Maria Santos: None declared, Ignacio Angarita: None declared, Juan Camilo Rueda: None declared, Rodrigo Giraldo: None declared, Jesus G Ballesteros: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background: Low back pain (LBP) is the second most frequent rheumatic disease in Colombia. According to the COPCORD study, LBP prevalence was 7.24% (CI 95% 6.28-8.34%) (1). Objectives: To estimate the disease burden of LBP for 2015. Methods: A descriptive study was conducted. A Markov model was developed based on cases with LBP, distribution of disability and mortality according to DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization) reference data. The results are shown in terms of the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and finally as Disability-Adjusted Life Year (DALY). Results: The distribution of cases by age of LBP are shown in figure 1. An algorithm was designed to determine the distribution in percentages of severity levels, according to the GBD definitions (figure 2). According to ICD-10 codes, 9 deaths were reported, so the YLL were 124. The YLDs were 264,658. Finally, the DALYs were 264,782 for a rate of 808.82 per 100,000, which is higher than the GBD 2016 results (647 per 100,000). Conclusion: The main cause of burden disease of rheumatic disease in Colombia is due to LBP. The burden is because of the YLD, related to the frequency of cases in people younger than 50 years of age. It is necessary for an early detection and development of intervention strategies. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Juan Camilo Rueda: None declared, Ana Maria Santos: None declared, Eugenia-Lucia Saldarriaga: None declared, Ignacio Angarita: None declared, Rodrigo Giraldo: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Jesus G Ballesteros: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background During the 2014-2015 a Chikungunya virus (CHIKV) epidemic reached Colombia. Concurrently, the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was being developed in Colombia to establish rheumatic diseases prevalence. Since CHIKV generates rheumatic manifestations, the presence of CHIKV infection was included. Objectives Based on the population entered in this program this study was developed with the aim to describe the disability of CHIKV infection through four questionnaires (HAQ-DI, EQ-5D, EQ-5D VAS and VAS for pain). Methods World Health Organization (WHO) criteria for CHIKV diagnosis and ELISA IgG and IgM serology were performed to identify CHIKV infection. Four groups of patients were defined: true positives (WHO + and + serology), true negatives (WHO - and - serology), false positives (WHO + and - serology), false negatives (WHO - and + serology). Three scores of disability and one of pain were applied to evaluate disability. A descriptive analysis was made using the media and standard deviation for continuous variables and percentage for the categorical variables, the Odds ratio was calculated with a confidence interval of 95% and a p Results From 548 patients with clinical suspicion of CHIKV infection, 295 were positive for CHIKV IgG and/or CHIKV IgM. Functionality evaluated by HAQ-DI showed a media of 0.17 (SD±0.45), with highest score after 7 weeks since the beginning of symptoms and the lowest in patients with CHIKV IgM positive. In the EQ-5D (Figure 1), between 72% and 92% of patients didn’t report problems on the mobility, self-care, usual activities, anxiety and depression dimensions. In contrast pain and discomfort dimensions were affected from moderate to extreme (44.7% and 8.6%). There weren’t significant differences between true positives, true false, false negative within all the variables, except on the anxiety and depression dimensions where the false positives had a higher significant score in comparison to the other groups (n: 10, 38.5%; p=0.00; OR:4.17, IC:1.8-9.57). In the EQ-5D-VAS, media for VAS was 75.56 (SD±21.18) where the highest scores of VAS were found on the false negatives. In pain VAS, false positives as well as the duration greater than 7 weeks where associated with several pain (n: 10, 2.9%; OR: 0.2; IC 1.25–6.33 y n: 27, 21.3%; p=0.018; OR 2.02, IC: 1.12-3.66 respectively). Conclusion In general, the disability of CHIKV infected patients was mild to moderate, finding the most affected dimensions to be pain, discomfort, anxiety and depression. The false positives and the population with anxiety and depression are related with higher score of disability. Disclosure of Interests None declared

Background: Osteoarthritis (OA) is the most prevalent rheumatic disease in Colombia, as reported by the COPCORD 2015 study. The prevalence is 10.81% (IC 95, 9.68-12.06) (1). Objectives: To estimate the disease burden of OA for 2015 Methods: A descriptive study was developed. The reference data of the population was taken by DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization). It was necessary to develop an algorithm to determine the distribution in percentages of severity levels, according to the GBD definitions. A Markov model was elaborated to calculate the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and Disability-Adjusted Life Year (DALY). Results: Figure 1 shows the distribution of cases by age of OA, with the highest frequency of cases over 50 years in both sexes. Figure 2 describes the distribution of the severity levels of the disease, with most cases being moderately severe. The YLLs were 781 and the YLDs were 245,626. Finally, the DALYs calculated were 246,408 for a rate of 752.69 per 100,000. When compared with that reported data by the GBD 2016, the burden of disease for OA was 204 (IC95% 143-278). The results of the present study show that the burden of the disease is higher, and the conditional factor is the YLDs. Conclusion: Osteoarthritis is a frequent and disabling rheumatic disease that confers a large burden of rheumatic disease affecting people over 50 years of age. The treatment of OA should be focused on reducing disability and holistic intervention strategies to promote good quality of life. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Ignacio Angarita: None declared, Ana Maria Santos: None declared, Eugenia-Lucia Saldarriaga: None declared, Juan Camilo Rueda: None declared, Jesus G Ballesteros: None declared, Rodrigo Giraldo: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

The objective of this study is to correlate the patient-driven tool Routine Assessment of Patient Index Data 3 (RAPID-3) with other common tools used in daily practice to measure disease activity in rheumatoid arthritis (RA).One hundred nineteen RA patients according to 1987 American College of Rheumatology criteria who consecutively attended a RA outpatient clinic between August and December 2015 were evaluated. Data was stored in an electronic form that included demographic information, comorbidities, concomitant medication, and laboratory results. The disease activity was determined by tender and swollen joint count, pain and disease activity visual analog scales (VAS), disease activity score 28 (DAS28), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and multidimensional health assessment questionnaire (MDHAQ). Correlations between RAPID-3 and other disease activity tools were assessed. Mean age was 61 ± 13.8 years with a median disease duration of 14 years (IQR 5–21), 77% were females. Median scores were MDHAQ 0.5 (IQR 0.1–1.2), DAS 28 3.8 (IQR 2.7–5.1), and RAPID-3 12.3 (IQR 6–19). A strong correlation was obtained between RAPID-3 and DAS 28 (r 0.719, p

Objective.There are no laboratory tools that detect early flares in systemic lupus erythematosus (SLE). Our aim was to validate in our population the previous findings of the association of C4d-bearing reticulocytes (R-C4d) compared to anti-dsDNA antibodies, with disease activity assessed by the Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and the British Isles Lupus Assessment Group (BILAG) 2004 scales.Methods.All patients who met the 1987 American College of Rheumatology classification criteria and were seen consecutively in 2013 at a specialized SLE care clinic were included. Disease activity was established by the SELENA-SLEDAI and BILAG 2004. Anti-dsDNA and R-C4d were quantified in peripheral blood. Comparisons were made between values of active and inactive patients, and the correlations between the SELENA-SLEDAI and serum levels of anti-dsDNA and R-C4d were measured.Results.Sixty-two patients (83.9% women) were included. A total of 32.3% had active disease according to the SELENA-SLEDAI. There was a significant statistical difference (p = 0.0001) in the distribution of R-C4d between disease activity groups. The correlation coefficient between R-C4d and the SELENA-SLEDAI score was rs = 0.738 (p = 0.0001). R-C4d differed between patients with and without activity in the BILAG 2004 constitutional, mucocutaneous, gastrointestinal, renal, and hematological domains.Conclusion.R-C4d showed a higher correlation with SLE activity measured by the SELENA-SLEDAI and BILAG 2004 than anti-dsDNA did, suggesting a possible involvement in diagnosing disease activity. Prospective studies that confirm these findings and evaluate its involvement in followup are needed.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by inflammation of multiple joints, leading to destruction of cartilage and juxta articular bone. It eventually leads to deformity, disability, and impaired quality of life. Methotrexate (MTX) has a reported response rate of 33–65%, and this variability may be explained by genetic variations (polymorphisms) in the metabolic pathway of this drug. To evaluate possible relationships between polymorphisms in the metabolic pathway and response to MTX in patients with RA. Methodology A systematic search and review of the literature was conducted. A total of 29 studies that evaluated polymorphisms in the metabolic pathway of MTX were included, due to their full text and methodological quality. Results Of the 29 studies, five were systematic reviews and/or meta-analyses, three of which clinical trials none was triple blind and only one was double-blind, six were cohort, seven were case–control, and eight cross sectional. The polymorphism identified were: methylene tetrahydrofolate reductase, dihydrofolate reductase, thymidylate synthase, 5-amino-imidazole-4-carboxamide ribonucleotide formyl transferase (AICAR formyltransferase), 5-aminoimidazole-4-carboxamide polymorphisms formyltransferase/IMP cyclohydrolase ribonucleotide (ATIC) identified conveyors attached to ATP cassette (ABC ATP-binding cassette), folylpoly-glutamate, glutamyl hydrolase, reduced folate carrier (RFC-SLC10A1). The dihydrofolate reductase and methylene tetrahydrofolate reductase polymorphism were shown to be associated with increased MTX toxicity. RFC and C677T polymorphisms are associated with better efficacy of MTX. Conclusions The polymorphisms of methylene tetrahydrofolate reductase, C677T and RFC1-G80A generate increased efficacy and toxicity in patients treated with MTX. However, for the other polymorphisms, although studies show statistically significant associations, they are not conclusive and some are contradictory. This justifies conducting multicenter studies to assess the presence and association with the effectiveness or toxicity in patients with RA treated with MTX.

RESUMEN Introducción: Las enfermedades reumáticas son causa frecuente de discapacidad, deterioran la calidad de vida y causan alto gasto en salud. El modelo COPCORD se ha implementado universalmente para estimar su prevalencia. El objetivo es estimar la prevalencia de las enfermedades reumáticas en la población colombiana mayor de 18 arios. Métodos: Se realizó un estudio de prevalencia utilizando un método probabilístico de muestreo aleatorio estratificado en 3 etapas: selección de los sectores cartográficos en cada ciudad, selección de los bloques de cada sector y del hogar de cada bloque. El cuestionario COPCORD, adaptado para Colombia, fue aplicado por entrevistadores estandarizados. La confirmación del diagnóstico fue hecha por un reumatólogo con acceso a toda la información. Resultados: De un total de 6.693 personas encuestadas el 64% fueron mujeres. El dolor no asociado con trauma fue reportado por el 48% de los participantes. Los sitios más frecuentes fueron rodillas (35%), manos (26%), columna lumbar (20%) y hombros (16%). El malestar musculoesquelético no específico, la osteoartritis, el síndrome de dolor regional apendicular y la lumbalgia no inflamatoria fueron las enfermedades más prevalentes. La artritis reumatoide y la lumbalgia crónica inflamatoria fueron las condiciones inflamatorias más comunes. La fiebre chikungunya afectó al 6,68% de la población. Conclusión: La prevalencia de la artritis reumatoide en Colombia es mayor a lo comúnmente reportado, menor para fibromialgia y gota, y similar para osteoartritis, lupus eritematoso sistémico y espondiloartritis. En Colombia, estas enfermedades representan un problema de salud pública sin que exista conciencia de su impacto en la población general. ABSTRACT Introduction: Rheumatic diseases are the leading cause of permanent disability. The COP-CORD model is an effective tool in the determination of the prevalence of diseases. The objective of this study is to estimate the prevalence of rheumatic disease in a Colombian population over 18 years of age. Methods: A prevalence study was carried out using a probabilistic method of stratified random sampling in three stages: cartographic sectors in each city, selection of the blocks of each sector, and the households of each block. The COPCORD questionnaire adapted for Colombia was applied by standardised interviewers. Confirmation of the diagnosis was made by a rheumatologist with access to all the information. Results: Out of a total of 6,693 patients that completed the questionnaire, 64% were women. Pain not associated with trauma was reported by 48% of the participants. The most frequent locations were: knees 35%, hands 26%, lumbar spine 20%, and shoulders 16%. Nonspecific skeletal muscle discomfort, osteoarthritis, regional appendicular syndrome, and non-inflammatory low back pain, were the most prevalent diseases. Rheumatoid arthritis and chronic inflammatory low back pain were the most common inflammatory conditions. The prevalence of Chikungunya fever was estimated at 6.68%. Conclusion: The prevalence of rheumatoid arthritis in Colombia is higher than commonly reported, lower than for fibromyalgia and gout, and similar for osteoarthritis, systemic lupus erythematosus and spondylarthritis. In Colombia these diseases are a public health problem without awareness of their impact on the general population.

During 2014 and 2015 the chikungunya virus reached Colombia unleashing an epidemic that spread throughout the whole territory. Concurrently, the Colombian Rheumatology Association was conducting a Community Oriented Program for Control of Rheumatic Diseases (COPCORD) to establish rheumatic disease prevalence in the country. Chikungunya infected patients were identified within the COPCORD population. The aim of this study was to describe the demographics, clinical characteristics and disability of patients with clinical suspicion of chikungunya infection. To confirm chikungunya infection, ELISA IgM and IgG serology was performed. From the 6528-surveyed people of the COPCORD study, 548 where included in the study because of clinical suspicion of chikungunya virus infection. Of those, 295 were positive for IgG or IgM chikungunya serology with 151 patients fulfilling WHO clinical criteria for chikungunya infection (true positives). Most patients were > 45 years (57.7%), and females (69.7%). Patients with low income and low socio-economic strata had increased risk of chikungunya infection (p = 0.00; OR: 2.36, CI: 1.47-3.77 and p = 0.00; OR: 2.81, CI: 1.90-4.17 respectively). True positive patients were associated with symmetric arthritis (p = 0.00; OR: 22.49, CI: 12.71-39.80) of ankles (p = 0.00; OR: 16.06, CI: 7.57-34.08), hands (p = 0.00; OR: 16.12, CI: 8.25-39.79), feet (p = 0.00; OR: 16.35, CI: 7.41-36.05) and elbows (p = 0.00; OR: 14.00, CI: 3.03-64.70). Most patients developed mild to moderate disability (95.2 to 100%). Our study showed that poverty and low socioeconomic status are associated with increased risk of chikungunya infection. Also, we found two distinctive phenotypes of chikungunya infection; those with positive chikungunya serology and typical clinical symptoms (true positives) and those with positive serology without clinical symptoms (false negatives). Finally, a distinctive clinical picture presented by chikungunya infected patients was found which should be considered as the hallmark for diagnostic clinical criteria.

Background/Objective Although mortality rates related with chikungunya (CHIK) outbreaks in Latin America's (LA's) dengue-endemic rural and new urban regions are low, dealing with symptoms and sequelae can both produce a significant burden of disease and diminish quality of life-from many months to years-after the acute phase of the infection, with a significant impact on public and individual health. The aim of this work was to establish Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association (ACCAR) consensus-conference endorsements and recommendations on the diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Aedes aegypti and Aedes albopictus in LA. Methods Based on the Consensus Development Conference format, a panel of ACCAR rheumatologist voting members (n = 10) took part in this Pan-American League of Associations for Rheumatology initiative. Experts voted from a previous content analysis of the medical literature on CHIK, 4 subsequent topic conferences, and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. Results The experts' panel reached 4 overarching principles: (1) CHIK virus (CHIKV) is a re-emergent virus transmitted by 2 species of mosquitoes: A. aegypti and A. albopictus; (2) CHIKV caused massive outbreaks in LA; (3) chronic CHIKV infection produces an inflammatory joint disease that, in some cases, can last for several months to years, and (4) currently, there are no vaccines or antivirals licensed for CHIKV infections. Recommendations Pan-American League of Associations for Rheumatology-ACCAR achieved 13 endorsements and recommendations on CHIK categorized in 3 groups: (1) epidemiology and clinical manifestations, (2) diagnosis, and (3) treatment, representing the consensus agreement from the panel's members.

Background Methotrexate (MTX) as monotherapy or in combination, is the most commonly Disease-Modifying-AntiRheumatic-Drug (DMARDs) used in rheumatoid arthritis (RA). About 40% of patients do not respond to treatment or have adverse effects. The genetic variability could be responsible for this phenomenon. Different studies suggest associations between polymorphisms in the enzymes involved in the metabolic pathway of MTX with alterations in the efficacy and toxicity. Objectives Determine the polymorphisms of the enzymes involved in MTX metabolism in a group of Colombian patients. Methods 400 patients with RA over 18 years old, diagnosed according to the ACR/EULAR classification criteria, who consecutively attended an outpatient RA clinic between March 2015 and December 2016 were included. MTX efficacy was defined by DAS28 score ≥3.2, liver toxicity by elevation of transaminases above three times the normal value, Haematological toxicity by: leukocytes 1.5. The single nucleotide polymorphisms (SNPs) studied were MTHFR C677T, MTHFR A1298C, ATIC C347G, RFC1 G80A, FPGS-AG and DHFR-CT and were identified by the technique of polymerase chain reaction in real time (RT-PCR). Results The mean age of patients was 60.7±13.9 years, the duration of the disease was 13.2±10.9 years and 76% were women. A significant increase in the frequency of MTHFR C677T and A1298C SNPs (p=0.05 and p=0.048) were found in the responding patients compared to non-responders. The DHFR-CT and the ATIC C347G SNPs were significantly increased in patients with any toxicity to MTX (p=0.0095 and p=0.005 respectively). We did not find a significant difference between the polymorphisms studied with any specific toxicity. Conclusions The Colombian population has similar statistical data compared to the global studies regarding the association of SPNs with the efficacy and toxicity of methotrexate, however the polymorphisms associated with inefficiency in the literature are not replicated in our data. These SNPs could be established as biomarkers to the methotrexate response in terms of efficacy and toxicity in our Colombian population with RA. Reference [1] Fan H, Li Y, Zhang L, Li W. Lack of association between MTHFR A1298C polymorphism and outcome of methotrexate treatment in rheumatoid arthritis patients: Evidence from a systematic review and meta-analysis. Int J Rheum Dis2017;20(5):526–40. Disclosure of Interest None declared

Background Although mortality rates related with Chikungunya (CHIK) outbreaks into Latin America’s endemic-dengue rural and new urban regions are low, dealing with symptoms and sequelae can produce both a significant burden of disease and diminish quality of life — from many months to years — after the acute phase of infection, with a significant impact on public and individual health. Objectives The aim of this work was to establish a PANLAR-ACCAR consensus on diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Ae. Aegypti and Ae. Albopictus in Latin America (LA). Methods Based on the Consensus Development Conference format, a panel of ACCAR rheumatologists (n=10) took part in this PANLAR initiative. Experts voted recommendations from a previous content analysis of the medical literature on CHIK, four subsequent topic’s Conferences and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. Results The panel reach four overarching principles: 1) CHIK virus (CHIKV) is a re-emergent virus transmitted by two species of mosquitoes: Ae. Aegypti and Ae. Albopictus; 2) CHIKV caused massive outbreaks in LA; 3) Chronic CHIKV infection produces an inflammatory joint disease that in some cases can last several months to years, and 4) Currently, there are no vaccines or antivirals available for CHIKV infections. Conclusions PANLAR-ACCAR achieve 13 recommendations on CHIK categorised in three groups: 1) epidemiology and clinical manifestations; 2) diagnosis, and 3) treatment, representing the consensus agreement from the panel’s members. References [1] Pineda C, Munoz-Louis R, Caballero-Uribe CV, Viasus D. Chikungunya in the region of the Americas. A challenge for rheumatologists and health care systems. Clin Rheumatol2016;35(10):2381–5. [2] Fernandez-Salas I, Danis-Lozano R, Casas-Martinez M, Ulloa A, Bond JG, Marina CF, et al. Historical inability to control Aedes aegypti as a main contributor of fast dispersal of chikungunya outbreaks in Latin America. Antiviral Res2015;124:30–42. [3] Khoury VJ, Camilo PR. Chikungunya virus (CHIKV): what can be expected after the acute phase?Reumatol Clin2016;12(1):1–3. [4] JC Rueda, J-I Angarita, AM Santos, E-L Saldarriaga, I Pelaez-Ballestas, MJ Soares-Santeugini, J Londono. SAT0576 [5] Improved clinical scenario for chikungunya diagnosis Annals of the Rheumatic Diseases2017Jun;76(Suppl 2):994. Disclosure of Interest None declared

Background Knowledge of the prevalence of rheumatic diseases allows us to design public health strategies for their comprehensive care and reduction of the costs derived from the potential complications of these diseases. Objectives To describe and compare the prevalence of rheumatic disease between six cities from Colombia. Methods The study was developed according the COPCORD epidemiological strategy designed for the identification, prevention and control of rheumatic diseases in developing countries. A cross-sectional analytical study including individuals older than 18 years was designed with a calculated sample size of 6528 people (2336 from Bogota, 1220 from Medellin and Cali each, 746 from Barranquilla, from Bucaramanga and Cucuta each one). Prevalence of each rheumatic disease was compared between the evaluated cities from Colombia. Results A total of 6693 individuals from six cities of Colombia were evaluated. The average age was 46,40±18,35 and 4283 (64%) individuals were women. The cities with the highest frequency of positive COPCORD population were Bogota 36,6% (n=1813), Cali 19,1% (n=945) and Medellin 15,9% (n=789). Abstract AB1298 – Figure 1 The majority of musculoskeletal pain manifested by the population correspond to non-specific muscular discomfort (MMNE). Osteoarthritis (OA) is the most prevalent rheumatic disease (10,81%, 95% CI, 9,68–12,06%). Mechanical low back pain was the most frequent disease in Barranquilla, with a prevalence of 11,91%, mainly in men 15,9% (95% CI, 11,24–21,92%). Regarding to rheumatoid arthritis (RA) it was more prevalent in women, between 40 and 59 years. It was found to be more prevalent in Bogota (2,8%, 95% CI, 1,8%–4,1%), Cali (4,2%, 95% CI, 2,4–7,3%) and Barranquilla (1,5%, 95% CI, 0,65–3,23%). Table 1. COPCORD*: Community Oriented Program for Control of Rheumatic Diseases Conclusions Prevalence of rheumatic diseases is higher in the cities of Bogota, Cali and Medellin. In Bogota, Cali and Barranquilla, RA was more prevalent. Low back pain was found to be more prevalent in Barranquilla. The hypothesis is that ethnic diversity of Colombia could explain the difference in prevalence of the rheumatic disease among separate regions. Disclosure of Interest None declared

Background Within public health strategies, the quality of life is a fundamental factor of intervention. The EQ-5D-3L is one of the most used instruments worldwide. Objectives To describe the change in quality of life and functional limitation of patients with rheumatic diseases compared to a healthy population and patients with other systemic diseases. Methods The EQ-5D-3L survey was used in 6693 people from 6 cities in Colombia. An analytical study was developed. Results In general, the healthy population (n=1104) reported not to have problems according to the EQ-5D-3L (median: 98,34). Of the non-rheumatic patients (n=642), 20% showed a moderate compromise because of pain and discomfort, as well as anxiety and depression. Twenty percent of patients with cardiovascular disease (n=53) reported moderate limitation for mobility. Patients with cardiovascular diseases reported moderate difficulties in carrying out daily activities. * The values of each of the dimensions of the instrument are expressed in% ** HBP: high blood pressure, CVD: cardiovascular disease, TB: tuberculosis *** Mental disorders: anxiety, nervousness or depression. Patients with rheumatic diseases (n=2274) manifested different degrees of limitation in mobility and daily activities. Patients with rheumatic diseases and comorbidities had greater compromise in quality of life predominately by pain and physical discomfort (more than 50% of the patients) figure 1. Conclusions In comparison with general population, rheumatic patients had a lower quality of life, and it is even worse in patients with rheumatic diseases and comorbidities. Comprehensive care of rheumatic patients should include strategies to improve standards of quality of life such as mobility, to perform daily activities and management of problems such as pain and discomfort. There are specific factors of intervention to reduce long-term disability of patients with rheumatic diseases. Disclosure of Interest None declared

Background Patients with systemic autoimmune conditions often develop concomitant disease contributing to a higher mortality than in the general population. An early diagnosis and treatment is fundamental to improve the life expectancy of this population. Objectives The objective of this study was to describe the frequency of comorbidities in patients with rheumatic diseases. Methods Based on data from the population studied under the COPCORD strategy, in the prevalence of rheumatic disease in Colombia, the frequency of non-rheumatic diseases in patients with rheumatic diseases was described in 6 cities of Colombia (Bogota, Medellin, Cali, Barranquilla, Bucaramanga and Cucuta). Results From a total of 4020 individuals, 2274 rheumatic patients were identified. Sixty nine percent of the Colombian patients with rheumatic disease (n=1571) had some comorbidity. The most frequent was hypertension (HBP) in 20,95% (n=330), followed by migraine 19,11% (n=300) and venous insufficiency 17,69% (n=278). Seventeen percent had any mental disorders, of which, anxiety and depression were the most common (n=273). Other comorbidities like obesity (8,1%), diabetes (5,85%), heart disease (5,79%) and cerebrovascular disease (1,99%) were less common among rheumatic patients. The frequency of cancer was low 1.48% (n=23). Abstract AB1300 – Figure 1 Conclusions Hypertension is the most common comorbidity in patients with rheumatic diseases in Colombia. Screening and diagnosis in early stages of HBP is important, since it is the main modifiable cardiovascular risk factor. The goals of pharmacological and non-pharmacological treatment are essential to reduce the risk of coronary heart disease, stroke and end-stage renal disease. Additionally, migraine is the second most frequent disease that affects the patient’s quality of life. And venous insufficiency should be taken into account by primary care physicians in order to assure a complete health care assessment. Disclosure of Interest None declared