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Objectives This study aims to determine whether the MetS predicts damage accrual in SLE patients. Methods This longitudinal study was conducted in a cohort of consecutive SLE patients seen since 2012 at one single Peruvian institution. Patients had a baseline visit and then follow-up visits every 6 months. Patients with ≥ 2 visits were included. Evaluations included interview, medical records review, physical examination, and laboratory tests. Damage accrual was ascertained with the SLICC/ACR damage index (SDI) and disease activity with the SLEDAI-2K. Univariable and multivariable Cox-regression survival models were carried out to determine the risk of developing new damage. The multivariable model was adjusted for age at diagnosis; disease duration; socioeconomic status; SLEDAI; baseline SDI; the Charlson Comorbidity Index; daily dose; and time of exposure of prednisone (PDN), antimalarials, and immunosuppressive drugs. Results Two hundred and forty-nine patients were evaluated; 232 of them were women (93.2%). Their mean (SD) age at diagnosis was 35.8 (13.1) years; nearly all patients were Mestizo. Disease duration was 7.4 (6.6) years. The SLEDAI-2K was 5.2 (4.3) and the SDI, 0.9 (1.3). One hundred and eight patients (43.4%) had MetS at baseline. During follow-up, 116 (46.6%) patients accrued at least one new point in the SDI damage index. In multivariable analyses, the presence of MetS was a predictor of the development of new damage (HR: 1.54 (1.05–2.26); p < 0.029). Conclusions The presence of MetS predicts the development of new damage in SLE patients, despite other well-known risk factors for such occurrence.

Objective The aim of this study was to determine whether remission and low disease activity state protect systemic lupus erythematosus patients from being hospitalized. Materials and methods Patients from the Almenara Lupus Cohort were included. Visits were performed every 6 months. Variables were measured at each visit. Hospitalizations were evaluated in the interval between two visits. Remission was defined as: a SLEDAI-2 K of 0, prednisone ≤5 mg/day and immunosuppressants on maintenance dose; low disease activity state as: a SLEDAI-2 K of ≤4, prednisone ≤7.5 mg/day and immunosuppressants on maintenance dose. Univariable and multivariable interval-censored survival regression models were used. In multivariable analysis, possible confounders were gender, age at diagnosis, socioeconomic status, educational level, disease duration, antimalarial use, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) and Charlson comorbidity index. Confounders were determined in the same visit as disease activity state. Results Of the 308 patients, 92.5% of them ( n = 285) were women, had a mean age at diagnosis of 34.8 (13.4) years and a disease duration of 7.7 (6.5) years. At baseline the mean SDI was 1.13 (1.34). A total of 163 of the patients were hospitalized. In the multivariable analysis remission (hazard ratio 0.445 (0.274–0.725), P = 0.001) and low disease activity state (relative risk 0.504 (0.336–0.757), P = 0.001) at baseline were found to decrease the risk of hospitalization in systemic lupus erythematosus patients. A total of 158 hospitalizations presented a discernible cause. Disease activity was the most common cause of hospitalization, with 84 admissions (53.16%), the majority, 38, was due to active kidney disease (45.23%). Conclusion Remission and low disease activity state decreased the risk of hospitalizations in these systemic lupus erythematosus patients. Disease activity, particularly renal, was the most frequent cause of hospitalization.

AIM: To validate the new classification criteria for antineutrophil cytoplasmic antibody-associated vasculitis in a real-life Peruvian cohort of antineutrophil cytoplasmic antibody-associated vasculitis patients. METHODS: We reviewed medical records from a Peruvian tertiary care center from January 1990 to December 2019. Antineutrophil cytoplasmic antibody-associated vasculitis was diagnosed based on the 1990 American College of Rheumatology (ACR) criteria, the 2012 Chapel Hill Consensus Conference definitions, the European Medicines Agency (EMEA) algorithm, and the clinical acumen of the treating rheumatologists. We classified all patients using the "former criteria" (the 1990 ACR criteria for granulomatosis with polyangiitis [GPA] and eosinophilic GPA [EGPA] and the 1994 Chapel Hill Consensus Conference definition for microscopic polyangiitis [MPA]), the EMEA algorithm, and the "new criteria" (the 2017 ACR/European League Against Rheumatism Provisional Criteria). The level of agreement (using Cohen κ) was calculated using the clinical diagnosis as the criterion standard. RESULTS: We identified 212 patients, 12 of whom were excluded. One hundred fifty-four (77%) had MPA, 41 (20.5%) GPA, and 5 (2.5%) EGPA. The new criteria performed well for MPA (κ = 0.713) and EGPA (κ = 0.659), whereas the EMEA algorithm performed well for GPA (κ = 0.938). In the overall population, the new criteria showed better agreement (κ = 0.653) than the EMEA algorithm (κ = 0.506) and the former criteria (κ = 0.305). CONCLUSIONS: The 2017 ACR/European League Against Rheumatism Provisional Criteria showed better agreement for the clinical diagnosis of all the patients overall and had the best performance for MPA and EGPA. The EMEA algorithm had the best performance for GPA

AIM The aim of this study was to identify the demographic and clinical features of patients with ANCA-associated vasculitides (AAVs) in a Peruvian tertiary referral hospital. METHODS Medical records of patients with AAV according to classification criteria or diagnosed by an experienced rheumatologist, and covering the period between January 1990 and December 2019, were reviewed. Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), and renal-limited vasculitis (RLV) were included. Demographic factors (age at diagnosis, sex), disease duration, clinical manifestations (per organ involvement), creatinine level at diagnosis (milligram per deciliter), ANCA status, diagnosis, 2009 Five Factor Score, disease categorization, and treatment were recorded. RESULTS Two hundred twelve patients were included. Their female-to-male ratio was 1.9:1 (139 [65.6%]/73 [34.4%]), and their mean (SD) age at diagnosis was 59.2 (12.5) years. One hundred fifty-eight patients (74.5%) had MPA, 42 (19.8%) GPA, 7 (3.3%) RLV, and 5 (2.4%) EGPA. Neurological, lung, and renal involvements were the most frequently affected systems. Myeloperoxidase preferentially occurred in MPA (82.5%), whereas proteinase 3 did occur in GPA (79.5%). Microscopic polyangiitis patients were older (61.1 [11.5] years). Female sex predominated in MPA and RLV (2.4:1 and 6:1, respectively), but the opposite was the case for EGPA (1:4). Ear-nose-throat and ocular involvement were more frequent in GPA (both p's < 0.001), and neurological and cardiovascular involvement were more frequent in EGPA (p < 0.001 and p = 0.002, respectively). CONCLUSIONS This is one of the largest series of AAV patients in Latin America. Overall, female sex predominated. Microscopic polyangiitis was the most frequent AAV, and myeloperoxidase-ANCA was the most frequent antibody in Peruvian AAV population.

AIM The aim of this study was to identify demographic and clinical risk factors for mortality in patients with antineutrophil cytoplasmic antibodies-associated vasculitides (AAVs) in a Peruvian tertiary referral hospital. METHODS Medical records of patients with AAV according to classification criteria or diagnosed by an experienced rheumatologist, covering the period between January 1990 and December 2018, were reviewed. Granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, and renal-limited vasculitis were included. Potential predictors of mortality were demographic factors, clinical manifestations, antineutrophil cytoplasmic antibodies status, diagnosis, disease categorization, the 2009 Five Factor Score (FFS), and treatment. Cox regression models were used to determine the risk factors for mortality. Univariable and multivariable analyses using a backward selection method were performed. RESULTS One hundred ninety-six patients were included; female-to-male ratio was 2:1. The median (interquartile range) age at diagnosis and follow-up were 60.0 (51.0-68.0) and 4.8 (1.3-11.6) years, respectively. One hundred forty-eight patients (75.5%) had microscopic polyangiitis, 37 (18.9%) granulomatosis with polyangiitis, 5 (2.6%) eosinophilic granulomatosis with polyangiitis, and 6 (3.0%) renal-limited vasculitis. Overall survival rates at 1, 5, and 10 years were 83.4%, 68.2%, and 51.7%, respectively. Ocular involvement was protective (hazards ratio [HR], 0.36; 95% confidence interval [CI], 0.17-0.74; p = 0.006), whereas renal (HR, 2.09; 95% CI, 1.33-3.28; p = 0.001) and lung involvement (HR, 2.07; 95% CI, 1.31-3.28; p = 0.002) and the 2009 FFSs were predictive of mortality (2009 FFS = 1: HR, 2.46; 95% CI, 1.50-4.04; p < 0.001; 2009 FFS = 2: HR, 3.07; 95% CI, 1.54-6.10; p = 0.001; 2009 FFS = 3: HR, 13.29; 95% CI, 3.69-47.88; p < 0.001). CONCLUSIONS Ocular involvement was protective, whereas 2009 FFS ≥ 1 and renal and lung involvement were predictive factors of mortality in Peruvian AAV patients.

IntroductionSerum uric acid levels have been reported as predictors of cardiovascular, pulmonary, neurological and renal morbidity in patients with SLE. However, their role in cumulative global damage in these patients has not yet been determined.ObjectiveTo determine whether serum uric acid levels are associated with new damage in patients with SLE.MethodsThis is a longitudinal study of patients with SLE from the Almenara Lupus Cohort, which began in 2012. At each visit, demographic and clinical characteristics were evaluated, such as activity (Systemic Lupus Erythematosus Disease Activity Index-2K or SLEDAI-2K) and cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index or SDI). Treatment (glucocorticoids, immunosuppressive drugs and antimalarials) was also recorded. Univariable and multivariable Cox regression models were used to determine the impact of serum uric acid levels on the risk of new damage.ResultsWe evaluated 237 patients, with a mean age (SD) at diagnosis of 35.9 (13.1) years; 220 patients (92.8%) were women, and the duration of the disease was 7.3 (6.6) years. The mean SLEDAI-2K and SDI scores were 5.1 (4.2) and 0.9 (1.3), respectively. Serum uric acid level was 4.5 (1.4) mg/dL. Follow-up time was 3.1 (1.3) years, and 112 (47.3%) patients accrued damage during follow-up. In univariable and multivariable analyses, serum uric acid levels were associated with new damage (HR=1.141 (95% CI 1.016 to 1.282), p=0.026; HR=1.189 (95% CI 1.025 to 1.378), p=0.022, respectively).ConclusionHigher serum uric acid levels are associated with global damage in patients with SLE.

The affiliations of Manuel F. Ugarte-Gil, one of the author of the above article has a discrepancy between the online version of the publisher's internet portal ( Springerlink.com ) and the online pdf version.

Background LDAS is an achievable goal in the treatment of SLE patients and it is associated with a lower probability of flares, damage and mortality; whether HRQoL is also influenced hy LDAS has only been evaluated cross-sectionally but not longitudinally. The aim of this study was to determine if achieving LDAS predicts a better HRQoL Methods SLE patients from a single center cohort with at least two visits were included. Visits were performed every six months. HRQoL was measured with the LupusQoL, disease activity with the SLEDAI-2K, damage with the SLICC/ACR damage index (SDI) and comorbidities with the Charlson Comorbidity Index (CCI). LDAS was defined as a SLEDAI-2K4, prednisone daily dose 7.5 mg/d and immunosuppressive drugs on maintenance dose; patient on remission were also included in this group. Generalized estimating equations were performed, using as outcome each one of the eight components of the LupusQoL in the subsequent visit, and the activity state in the previous visit; as possible confounders, we included disease duration, SDI, CCI, antimalarial use on each visit and age at diagnosis, gender, socioeconomic status and the same component of the LupusQoL at the baseline visit. Results Two hundred and forty-three patients were included, 225 (92.6%) were female, mean age at diagnosis was 35.44 (SD: 13.13) years. Patients had a mean of 3.94 (1.98) visits for a total of 958 visits. During the follow-up, 590 (61.6%) visits were categorized as LDAS. LDAS predicted a better HRQoL in the components of physical health [B: 4.17 (95% CI: 1.20; 7.14); p=0.006], pain [B: 6.47 (95% CI: 3.18; 9.76); p Conclusions Being on LDAS predicts a better HRQoL, especially in the components of physical health, pain, planning, burden to others, emotional health and fatigue. Funding Source(s): The Almenara Lupus Cohort is partially supported by three institutional grants from EsSalud (1483-GCGP-ESSALUD-2013, 1733-GCGP-ESSALUD-2014 and the 2015 Kaelin Prize 2015) and one from the Panamerican League of Associations for Rheumatology (PANLAR) (2015 PANLAR Prize).

Supplemental material, LUP876998 Supplemental Material for Remission and low disease activity state prevent hospitalizations in systemic lupus erythematosus patients by C Reátegui-Sokolova, Z Rodríguez-Bellido, R V Gamboa-Cárdenas, M Medina, F Zevallos, V R Pimentel-Quiroz, C Elera-Fitzcarrald, M Cucho-Venegas, C A Pastor-Asurza, R Perich-Campos, G S Alarcón and M F Ugarte-Gil in Lupus

Objective: To determine if low disease activity state (LDAS)/remission predicts a better health‐related quality of life (HRQoL). Methods: Patients with systemic lupus erythematosus from a single center and having completed at least 2 visits were included. Visits were performed every 6 months. HRQoL was measured with the LupusQoL questionnaire. The definition of remission included a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI‐2K) score of 0, prednisone daily dosage of ≤5 mg/day, and immunosuppressive drugs on maintenance dose. LDAS was defined as a SLEDAI‐2K score of ≤4, prednisone daily dosage of ≤7.5 mg/day, and immunosuppressive drugs as maintenance therapy. For these analyses, remission and LDAS were combined as one variable. Generalized estimating equations were calculated, using as the outcome 1 of each of the 8 components of the LupusQoL questionnaire in the subsequent visit and the activity state in the previous visit. Multivariable models were adjusted for possible confounders. Results: A total of 243 patients were included. During the follow‐up, 590 visits (61.6%) were categorized as LDAS/remission. LDAS/remission predicted a better HRQoL in the components of physical health (B = 4.17 [95% confidence interval (95% CI) 1.20, 7.14]; P = 0.006), pain (B = 6.47 [95% CI 3.18, 9.76]; P < 0.001), planning (B = 4.97 [95% CI 1.43, 8.52]; P = 0.006), burden to others (B = 4.12 [95% CI 0.24, 8.01]; P = 0.037], emotional health (B = 4.50 [95% CI 1.56, 7.44]; P = 0.003), and fatigue (B = 3.25 [95% CI 0.04, 6.47]; P = 0.048). Conclusion: Being in LDAS/remission predicts a better HRQoL, especially in the components of physical health, pain, planning, burden to others, emotional health, and fatigue.

Objective: To determine the impact of homocysteine levels on damage accrual in systemic lupus erythematosus (SLE) patients. Methods: This longitudinal study was conducted in consecutive patients seen every 6 months at our Rheumatology Department since 2012. Patients with available homocysteine levels and who had at least one subsequent visit were included. Univariable and multivariable Cox regression models were done to determine if homocysteine levels were predictive of damage accrual as per the SLICC Damage Index (SDI). The multivariable model was adjusted for pertinent variables (age at diagnosis, gender, socioeconomic status, disease duration, disease activity (SLEDAI), Framingham score, antimalarial and immunosuppressive drug use, average daily dose, and exposure time to prednisone (PDN)). Results: One hundred forty-five patients were included; their mean (SD) age at diagnosis was 43.70 (12.09) years, 136 (93.8%) were female, and nearly all were Mestizo. At baseline, disease duration was 7.55 (6.73) years; patients were followed for 3.54 (1.27) years. The SLEDAI was 5.60 (4.34), and the SDI 0.97 (1.35). The average daily PDN dose was 7.30 (5.78) mg/day and the time of PDN exposure was 7.36 (6.73) years. Mean homocysteine levels were 10.07 (3.71) μmol/L. The highest tertile of homocysteine levels predicted new damage accrual in the univariable and multivariable models [HR 1.78 (95% CI, 1.042–3.039); p = 0.035 and HR 2.045 (95% CI, 1.077–3.883); p = 0.029, respectively]. Increased levels (> 15 μmol/L) were found in 12 (8.3%) patients; 75 (51.7%) patients increased ≥ 1 SDI point. Conclusion: In SLE patients, homocysteine levels predicted damage accrual independently of other well-known risk factors for such occurrence. © 2018, International League of Associations for Rheumatology (ILAR). Revisado por pares

Background Although the survival rate of patients with Systemic Lupus Erythematosus (SLE) has improved over the years, patients are frequently hospitalized or evaluated in the Emergency Room; these events account for most of the direct cost of these patients’ care. The objective of this study is to determine whether remission and low disease activity state (LDAS) are protective of hospitalization and Emergency Room visits in our SLE patients. Methods All hospitalizations and Emergency Room visits of Peruvian SLE patients members of the Almenara Lupus Cohort were identified during the two-years following their baseline visit. We used the baseline data (at admission to the cohort) in order to determine which factors were associated with hospitalizations and Emergency Room visits in these SLE patients. Remission was defined as a SLEDAI-2K=0, prednisone ≤5 mg/d and immunosuppressants on maintenance dose, LDAS was defined as not on remission an a SLEDAI-2K≤4, prednisone ≤7.5 mg/d and immunosuppressants on maintenance dose; antimalarials were allowed in both groups. Univariable and multivariable Poisson regression models were used to determine the impact of being on remission or LDAS on the risk of hospitalization and Emergency Room visits, adjusting for gender, age at diagnosis, socioeconomic status, disease duration, damage, comorbidities, time of exposure to prednisone and antimalarial use. Results Of the 314 cohort patients, 92.7% (n=291) were female, the median age of the patients was 40.7 (32.9–51.1) years, with a disease duration of 5.5 (2.6–10.3) years. Fifty-nine of the patients included were hospitalized, a total of 165 times (range 2.8 per patient). In the multivariable analysis we found that remission [RR 0.036 (0.005–0.259), p=0.001] and LDAS [RR 0.289 (0.182–0.457), Conclusions Remission and LDAS decrease the risk of hospitalizations and Emergency Room visits in SLE patients. Disease activity was the most frequent cause of hospitalization and within them renal disease. These findings have economic implications for the health care system. Acknowledgements To all the Almenara cohort patients for generously giving their time, and to coordinators and research assistants who make this study possible.

Background Serum uric acid levels have been reported as predictors of cardiovascular and renal morbidity(,1 and, of increasing the risk of renal damage in systemic lupus erythematosus (SLE) patients(.2 However, their role as predictors of global damage accrual in SLE patients has not been determined. Objectives To determine whether uric acid levels predict new damage in SLE patients. Methods This is a longitudinal study of SLE patients from a single centre cohort which started in 2012. Visits were performed every six months. Patients with at least two visits were included. Demographic and clinical characteristics as well as treatment were recorded at every visit. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI). Prednisone use was recorded as current daily dose and time of exposure. Immunosuppressive drugs and antimalarial use was recorded as current, past or never. All variables were ascertained at baseline, with the exception of new damage which was assessed at the subsequent visits. Univariable and multivariable Cox-regression models were performed to determine the impact of uric acid levels on the risk of new damage. Multivariable models were adjusted for age at diagnosis, disease duration, socioeconomic status, SLEDAI, SDI, comorbidities and use of prednisone, immunosuppressive drugs and antimalarials. Results Two hundred and thirty-seven patients were evaluated. The mean (SD) age at diagnosis was 35.9 (13.1) years, 220 patients (92.8%) were female, nearly all were Mestizo, disease duration was 7.3 (6.6) years. The mean SLEDAI and SDI were 5.1 (4.2) and 0.9 (1.3), respectively. The Charlson comorbidity index was 0.5 (0.9). Uric acid levels were 4.5 (1.4) mg/dl. The mean current prednisone dose 7.1 (6.4) mg/d. The duration of exposure to prednisone was 6.9 (6.2) years. Follow-up time was 3.1 (1.3) years. One hundred and twelve (47.3%) patients accrued damage during the follow-up. In univariable and multivariable analyses, uric acid levels predicted new damage [HR=1.14 (95% CI 1.01–1.28); p=0.026 and HR=1-.16 (95% CI 1.00–1.34); p=0.043, respectively]. Conclusions Higher uric acid levels predicted the development of new damage in our SLE patients. References [1] Zoccali C, et al. Uric acid, hypertension, and cardiovascular and renal complications. Current hypertension reports. 2013;15(6):531–7. [2] Reategui-Sokolova C, et al. Serum uric acid levels contribute to new renal damage in systemic lupus erythematosus patients. Clinical rheumatology2017;36(4):845–52. Disclosure of Interest None declared

Background Abdominal Obesity is highly prevalent in patients with RA and this condition is associated with adverse metabolic outcomes, but information about the impact of this condition in clinical activity disease is scarce, specially in our region Objectives To assess the association between central obesity with baseline clinical activity in a cohort of patients with established rheumatoid arthritis (RA). Methods Cross-sectional baseline analysis of a single centre RA cohort. This cohort began at 2011 and includes patients with a diagnosis of RA ACR EULAR 2010 criteria), followed by semestral visits. In this analysis, clinical disease activity was measured by SDAI, clinical remission and low disease activity (LDA) was defining according SDAI categories (a value Results Four hundred and twenty-five from 596 subjects of the cohort were include. The mean (SD) age was 58.5 (11.8) years. Disease duration was 15.2 (14.0) years; 90.4% were women and 75.8% were anti CCP positive. Two hundred and fifty-one patients (59.1%) have received glucocorticoids, 50.1% at least one DMARD and only 5.4% had received at least one biologic compound. The mean WC was 98.2 (11.3) cm and central obesity prevalence was 87.8% in men and 96.7% in woman. The baseline SDAI was 29.9 (24.1). Remission was met only by 1.7% patients and remission/LDA by 13.2% subjects. In the univariate analysis, a less WC was associated with remission(OR=0.9;CI:0.8–0.9;p=0.042); this association remained significant in the multivariable analysis (OR=0.9;CI:0.8–0.9;p=0.022). Conclusions A lower waist circumference is associated with clinical remission in patients with established RA. This condition should be taken in account in the baseline measure of activity disease. Disclosure of Interest None declared

Background The metabolic syndrome (MetS) is a complex of interrelated risk factors for the occurrence of cardiovascular disease and diabetes, and it is now both a public health and a clinical problem(. 1 The MetS has also been reported to be associated with new organ damage, vascular events and mortality in Systemic Lupus Erythematosus (SLE) patients. 2 Objectives To determine whether the MetS predicts damage accrual in SLE patients. Methods This prospective study was conducted in a cohort of consecutive SLE patients seen since 2012 at one single institution. Patients had a baseline visit and follow-up visits every 6 months. Patients with ≥2 visits were included. Evaluations included interview, medical records review, physical examination and laboratory tests. Damage accrual was ascertained with the SLICC/ACR damage index (SDI) and disease activity with the SLEDAI. The MetS was defined if the patient fulfilled 3 of 5 criteria according to Alberti et al. 1 Survival univariable and multivariable Cox-regression models were carried out to determine the risk of developing new damage. The multivariable model was adjusted for age at diagnosis, disease duration, socioeconomic status, SLEDAI, baseline SDI, the Charlson Comorbidity Index, baseline use of prednisone (PDN), antimalarials and immunosuppressive drugs. Results Two hundred and forty-nine patients were evaluated; 232 were females and 17 males. Their mean (SD) age at diagnosis was 35.8 (13.1) years; nearly all patients were mestizo. Disease duration was 7.4 (6.6) years. The SLEDAI was 5.2 (4.3) and the SDI 0.9 (1.3). The average daily dose of PDN was 7.3 (6.4) mg/d and the time of exposure to PDN was 6.9 (6.2) years. One hundred and eight patients (43.4%) had MetS at baseline. During follow-up, 116 (46.6%) patients accrued at least one new point in the SDI damage index. In multivariable analyses, the presence of MetS was a predictor of development of new damage; with a Hazard Ratio (HR) 1.54 (1.05–2.26); p: Conclusions The presence of MetS predicts the development of new damage in SLE patients, despite of other well-known risk factors for such occurrence. References [1] Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation [Internet]. 2009Oct 20 [cited 2018 Jan 27];120(16):1640–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19805654 [2] Mok CC, Tse SM, Chan KL, Ho LY. Effect of the metabolic syndrome on organ damage and mortality in patients with systemic lupus erythematosus: a longitudinal analysis. Clin Exp Rheumatol [Internet]. 2017Oct 18 [cited 2018 Jan 27]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/29148424 Disclosure of Interest None declared

Objective Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage. Methods We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results The IRF5–TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control–adjusted P [Pgcadj] = 2.61 × 10−29, OR 2.12 [95% CI 1.88–2.39]), followed by HLA class II on the DQA2–DQB1 loci (rs9275572: Pgcadj = 1.11 × 10−16, OR 1.62 [95% CI 1.46–1.80] and rs9271366: Pgcadj = 6.46 × 10−12, OR 2.06 [95% CI 1.71–2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj = 1.39 × 10−8) with an expression quantitative trait locus (eQTL) effect (Peqtl = 8.0 × 10−37 at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE. Conclusion Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases.

Objective To determine whether circulating CD4+CD28null and extra-thymic CD4+CD8+ double positive (DP) T cells are independently associated with damage accrual in systemic lupus erythematosus (SLE) patients. Methods This cross-sectional study was conducted between September 2013 and April 2014 in consecutive SLE patients from our Rheumatology Department. CD4+CD28null and CD4+CD8+ DP T-cell frequencies were analyzed by flow-cytometry. The association of damage (SLICC/ACR Damage Index, SDI) and CD4+CD28null and CD4+CD8+ DP T cells was examined by univariable and multivariable Poisson regression models, adjusting for possible confounders. All analyses were performed using SPSS 21.0. Results Patients’ ( n = 133) mean (SD) age at diagnosis was 35.5 (16.8) years, 124 (93.2%) were female; all were mestizo (mixed Caucasian and Amerindian ancestry). Disease duration was 7.4 (6.8) years. The SLE Disease Activity Index was 5.5 (4.2), and the SDI 0.9 (1.2). The percentages of CD4+CD28null and CD4+CD8+ DP T cells were 17.1 (14.4) and 0.4 (1.4), respectively. The percentage of CD4+CD28null and CD4+CD8+ DP T cells were positively associated with a higher SDI in both univariable (rate ratio (RR) 1.02, 95% confidence interval (CI): 1.01–1.03 and 1.17, 95% CI: 1.07–1.27, respectively; p Conclusions In SLE patients, CD4+CD28null and CD4+CD8+ DP T cells are independently associated with disease damage. Longitudinal studies are warranted to determine the predictive value of these associations.

To determine whether the CD4+CD28null T-cells subpopulation predicts the occurrence of damage in SLE.This longitudinal study was conducted in consecutive SLE patients seen every six months in our Rheumatology Department since 2012. Patients in whom CD4+CD28null T-cells had been measured and who had at least one subsequent visit were included in the study. Survival analyses (univariable and multivariable Cox-regression models) were performed to determine the risk of overall and domain damage (as per the SLICC Damage Index - SDI) as a function of the frequency of this T-cell subpopulation. The multivariable model was adjusted for pertinent confounders. All analyses were performed using SPSS 21.0.One hundred and nineteen patients were evaluated; their mean (SD) age was 43.5 (11.9) years, 113 (95.0%) were female. Disease duration was 7.8 (7.0) years, the SLEDAI 5.3 (4.1) and the SDI 1.0 (1.4). The percentage of CD4+CD28null T-cells was 17.4 (14.0). The mean follow-up was 2.1 (0.8) years, and the mean number of visits per patient 3.5 (1.1). Forty-six (38.7%) patients increase at least one SDI point. In the univariable and multivariable analyses, the percentage of CD4+CD28null predicted the occurrence of lung damage [HR: 1.042 (CI95%: 1.001-1.085); p=0.047 and HR: 1.099 (CI95%1.020-1.184); p=0.013, respectively] but neither the total SDI score nor all other SDI domain scores were predicted by the percentage of CD4+CD28null cells.In SLE patients, CD4+CD28null T-cells predict the occurrence of new lung damage, independently of other risk factors but not of overall damage or damage on other domains.

Background Systemic Lupus Erythematosus (SLE) patients show higher Red blood cells Distribution Width (RDW) regardless of anaemia status1. RDW has been found to positively correlate with serum IgM, CRP, ESR, and SLE Disease Activity Index 2000 (SLEDAI-2K), and glucocorticoid treatment decreased both SLEDAI-2K and RDW2. Objectives To determine whether RDW levels in SLE are associated with damage accrual. Methods This cross-sectional study was conducted in 276 SLE patients, 257 females and 19 males. Evaluations included interview, medical records review, physical examination and laboratory tests. Disease activity was measured with the SLEDAI. Damage accrual was ascertained with the SLICC/ACR damage index (SDI). Univariable and multivariable Poisson regression models were performed to determine if RDW levels were associated with damage accrual. These models were stratified by tertiles of RDW. The multivariable model was adjusted for variables known to be associated with this outcome [age at diagnosis, gender, socioeconomic status, ethnicity, tobacco use, disease duration, SLEDAI, anemia, antimalarials and immunosuppressive drugs use, average daily dose and time of exposure to prednisone (PDN)]. Results The patients mean (SD) age at diagnosis was 34.38 (13.33) years; nearly all patients were mestizo. Disease duration was 7.04 (6.16) years. The SLEDAI was 5.24 (4.67) and the SDI 0.92 (1.28). The average daily dose of PDN was 6.90 (6.07) mg/d and the time of exposure to PDN was 6.58 (9.59) years. RDW levels were 14.57 (1.52)%. Hemoglobin levels were 12.4 (1.7) g/dl. We divided the RDW levels into tertiles with cut points in 13.8 and 14.0; the highest tertiles were associated with disease damage; with a Rate Ratio (RR) 1.57 (1.07–2.28; p: 0.020 for the highest tertile, and 1.67 (1.15–2.42; p: 0.007) for the medium tertile. Conclusions Higher RDW levels are associated with damage accrual in SLE patients independent of other well-known risk factors for such occurrence. References Vaya A, Alis R, Hernandez J-L, et al. RDW in patients with systemic lupus erythematosus. Influence of anaemia and inflammatory markers. Clin Hemorheol Microcirc 2013; 54: 333–9. Hu Z-D, Chen Y, Zhang L, et al. Red blood cell distribution width is a potential index to assess the disease activity of systemic lupus erythematosus. Clin Chim Acta 2013; 425: 202–205. Disclosure of Interest None declared

Objective: to determine whether prolactin levels are independently associated with disease damage in systemic lupus erythematosus (SLE) patients. Methods: these cross-sectional analyses were conducted in SLE patient members of the Almenara Lupus Cohort who were seen between January 2012 and June 2013. Disease damage was ascertained with the System Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). Prolactin was measured in ng/ml. The association between prolactin levels and the SDI (total and its domains) was evaluated using Spearman's correlation. Subsequently, adjusted Poisson regression models were performed to evaluate these associations. Results: 160 patients were included. 147 (91.9%) were female; their median age at diagnosis was 33.4 (interquartile range (IQR): 26.0–44.3) years; their disease duration was 5.5 (IQR: 2.6–9.7) years. The median prolactin value was 16.8 (IQR: 11.8–24.5) ng/ml. After adjusting for confounders in the Poisson regression model the estimated rate ratios (RR) and 95% confidence interval (CI) for each 10 ng/ml increment of prolactin were 1.13 (95% CI 1.60–1.20, p

Objectives The objective of this study was to determine whether prolactin levels are associated with a pro-inflammatory body mass distribution in women with systemic lupus erythematosus (SLE). Methods This cross-sectional study was conducted in consecutive female SLE patients seen in our rheumatology department from January 2012 to July 2015. Prolactin was measured in ng/ml. Body mass distribution was measured by dual energy x-ray absorptiometry and it was divided into subtotal (whole body excluding the head), subtotal bone mineral content, lean mass index (appendicular lean mass/height2), subtotal trunk and leg fat percentages and trunk-to-leg fat ratio. The association between prolactin levels and body mass distribution components was evaluated by univariable and multivariable linear regression models adjusting for possible confounders. Results One hundred and eighty-five patients were evaluated; their mean (SD) age at diagnosis was 34.8 (13.8) years; nearly all patients were Mestizo. Patients included in this study were comparable to the rest of the cohort in terms of age, disease duration, SLEDAI, SDI and body mass index. Disease duration was 7.3 (6.6) years. The SLEDAI was 5.2 (4.3) and the SDI 0.9 (1.3). Prolactin levels were 18.9 (16.7) ng/ml. In univariable analyses, prolactin was negatively associated with bone mineral density, bone mineral content, leg fat percentage and lean mass index, and positively associated with trunk-to-leg fat ratio. In the multivariable analyses, prolactin was negatively associated with bone mineral content and positively associated with trunk-to-leg fat ratio. Conclusions Higher prolactin levels are associated with a pro-inflammatory body mass distribution in SLE patients.

This study aims to determine whether uric acid levels contribute to new renal damage in systemic lupus erythematosus (SLE) patients. This prospective study was conducted in consecutive patients seen since 2012. Patients had a baseline visit and follow-up visits every 6 months. Patients with ≥2 visits were included; those with end-stage renal disease (regardless of dialysis or transplantation) were excluded. Renal damage was ascertained using the SLICC/ACR damage index (SDI). Univariable and multivariable Cox-regression models were performed to determine the risk of new renal damage. Uric acid was included as a continuous and dichotomous (per receiving operating characteristic curve) variable. Multivariable models were adjusted for age at diagnosis, disease duration, socioeconomic status, SLEDAI, SDI, serum creatinine, baseline use of prednisone, antimalarials, and immunosuppressive drugs. One hundred and eighty-six patients were evaluated; their mean (SD) age at diagnosis was 36.8 (13.7) years; nearly all patients were mestizo. Disease duration was 7.7 (6.8) years. Follow-up time was 2.3 (1.1) years. The SLEDAI was 5.2 (4.3) and the SDI 0.8 (1.1). Uric acid levels were 4.5 (1.3) mg/dl. During follow-up, 16 (8.6%) patients developed at least one new point in the renal domain of the SDI. In multivariable analyses, uric acid levels (continuous and dichotomous) at baseline predicted the development of new renal damage (HR 3.21 (1.39–7.42), p 0.006; HR 18.28 (2.80–119.48), p 0.002; respectively). Higher uric acid levels contribute to the development of new renal damage in SLE patients independent of other well-known risk factors for such occurrence.

Las enfermedades autoinmunes sistemicas son un gru-po heterogeneo de entidades con afectacion multior-ganica en las cuales es a menudo vital el tratamientoinmunodepresor para intentar frenar la respuesta inmune alterada. Los farmacos inmunodepresoresmas utilizados son los corticoesteroides, la azatioprina,la ciclofosfamida, el metotrexate y la ciclosporina,entre otros. Recientemente se han introducido nue-vas medicaciones para los casos refractarios al trata-miento como el micofenolato de mofetilo, las inmu-noglobulinas (Ig) endovenosas (ev) y nuevos agentesbiologicos como los anticuerpos monoclonales anti-factor de necrosis tumoral (FNT), anti-CD20 o an-ti-CD40. Las Ig ev son preparados de gammaglobulinas alta-mente purificadas extraidas de un deposito de plas-ma humano obtenido de entre 3.000 a 10.000 do-nantes sanos que ademas contiene escasa cantidadde IgA, IgM, CD4, CD8, moleculas de HLA y ciertas citocinas

OBJECTIVE The aim of this study was to determine whether the proportions of naive and memory CD4(+) T cell are independently associated with the metabolic syndrome (MetS) in patients with SLE. METHODS This cross-sectional study was conducted in SLE patients seen at our rheumatology department between September 2013 and April 2014. CD4(+) T cell subpopulations were examined by flow cytometry. The association of MetS and CD4(+) T cell subpopulations was examined by Mann-Whitney U-test and by multivariable analysis, adjusting for all possible confounding variables. RESULTS One hundred and seventeen patients were evaluated. Their mean age was 44.6 years (S.D. 12.6), 109 (93.2%) were female and all patients were Mestizo (mixed Caucasian and Amerindian ancestry). Fifty-two patients (44.4%) presented with MetS. Disease duration was 7.6 years (S.D. 6.8). The percentage of naive CD4(+) T cells was 25.0 (S.D. 12.7) and memory CD4(+) T cells was 66.7 (S.D. 13.2) and the memory:naive CD4(+) T cell ratio was 4.3 (S.D. 5.6). In multivariable analysis, the percentage of naive CD4(+) T cells was negatively associated with the presence of MetS [odds ratio (OR) 0.959 (95% CI 0.923, 0.997), P = 0.033], whereas the percentage of memory CD4(+)T cells and the memory:naive CD4(+) T cell ratio were positively associated with its presence [OR 1.040 (95% CI 1.003, 1.078), P = 0.031 and OR 1.238 (95% CI 1.041, 1.472), P = 0.016, respectively]. CONCLUSION In the SLE patients studied, a lower percentage of naive CD4(+) T cells, a higher percentage of memory CD4(+) T cells and the memory:naive CD4(+) T cell ratio were independently associated with the presence of MetS. This association could reflect the impact of immunosenescence among SLE patients with cardiovascular morbidity.

The aim of this study was to assess the cumulative incidence, risk and protective factors and impact on mortality of primary cardiac disease in SLE patients (disease duration ≤2 years) from a multi-ethnic, international, longitudinal inception cohort (34 centres, 9 Latin American countries).Risk and protective factors of primary cardiac disease (pericarditis, myocarditis, endocarditis, arrhythmias and/or valvular abnormalities) were evaluated.Of 1437 patients, 202 (14.1%) developed one or more manifestations: 164 pericarditis, 35 valvulopathy, 23 arrhythmias, 7 myocarditis and 1 endocarditis at follow-up; 77 of these patients also had an episode of primary cardiac disease at or before recruitment. In the multivariable parsimonious model, African/Latin American ethnicity [odds ratio (OR) 1.80, 95% CI 1.13, 2.86], primary cardiac disease at or before recruitment (OR 6.56, 95% CI 4.56, 9.43) and first SLICC/ACR Damage Index for SLE assessment (OR 1.31, 95% CI 1.14, 1.50) were risk factors for the subsequent occurrence of primary cardiac disease. CNS involvement (OR 0.44, 95% CI 0.25, 0.75) and antimalarial treatment (OR 0.62, 95% CI 0.44, 0.89) at or before recruitment were negatively associated with the occurrence of primary cardiac disease risk. Primary cardiac disease was not independently associated with mortality.Primary cardiac disease occurred in 14.1% of SLE patients of the Grupo Latino Americano de Estudio de Lupus cohort and pericarditis was its most frequent manifestation. African origin and lupus damage were found to be risk factors, while CNS involvement at or before recruitment and antimalarial treatment were protective. Primary cardiac disease had no impact on mortality.

PurposeTo determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors.MethodsSLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual.Results901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, pConclusionsThe number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.

Background Renal involvement is one of the most serious and frequent manifestations of systemic lupus erythematosus (SLE) and is associated with increased morbidity and mortality. Uric acid levels have been associated with the progression to subsequent end-stage renal disease in patients with chronic kidney disease (1). Uric acid has been reported to be associated with new onset lupus nephritis (2); however, the association between uric acid levels and renal damage has not been reported in SLE patients. Objectives To determine whether uric acid level predicts new renal damage in SLE patients after adjusting for known confounding factors. Methods This longitudinal study was conducted in consecutive SLE patients seen in our Rheumatology Department since 2012. Every patient had a baseline visit; follow-up visits were conducted every 6 months. For the purpose of this study, patients with at least two visits were included. Patients with end-stage renal disease (regardless of dialysis or transplantion) were excluded for this analysis. Renal damage was ascertained using the SLICC/ACR damage index (SDI). Uric acid was measured in mg/dl. Survival analyses using univariable and multivariable Cox-regression models were performed to determine the risk of new renal damage. The multivariable model was adjusted for age at diagnosis, gender, disease duration, socioeconomic status, SLEDAI, SDI, serum creatinine, use of prednisone, antimalarials and immunosuppressive drugs at baseline. Results One hundred and eighty-six patients were evaluated; their mean (SD) age at diagnosis was 36.8 (13.7) years; nearly all patients were Mestizo. Disease duration was 7.7 (6.8) years. Time of follow-up was 2.3 (1.1) years. At baseline, uric acid levels were 4.5 (1.3) mg/dl, the SLEDAI was 5.2 (4.3) and the SDI 0.8 (1.1). Sixteen (8.6%) patients had one point in renal domain at baseline and 2 (1.1%) had two. During the follow-up 16 (8.6%) patients developed at least one new point in the renal domain of the SDI. In univariable and multivariable analyses uric acid level at baseline predicted the development of new renal damage [HR: 2.24 (1.50–3.34), p Conclusions Higher uric acid levels predict the development of new renal damage in SLE patients even after adjusting for other well-known risk factors. References Uchida S, Chang WX, Ota T, Tamura Y, Shiraishi T, Kumagai T, et al. (2015) Targeting Uric Acid and the Inhibition of Progression to End-Stage Renal Disease – A Propensity Score Analysis. PLoS ONE 10(12): e0145506. Zaixing Yang, Yan Liang, Weihua Xi, Ye Zhu, Chang Li, Renqian Zhong (2011) Association of serum uric acid with lupus nephritis in systemic lupus erythematosus. Rheumatol Int (2011) 31:743–748 Disclosure of Interest None declared

To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were < 18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p < 0.05). On the other hand, myalgias, Sjögren’s syndrome and cranial nerve involvement were more frequently seen in adults (p < 0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.

Background Chronic inflammatory conditions are associated with a decrease of bone mineral density (BMD) and lean mass (in particular low appendicular lean mass) and an increase of fat mass (in particular areas considered more pro-atherogenic, like trunk fat mass or trunk-to-leg fat ratio). As prolactin (PRL) has a pro-inflammatory function in systemic lupus erythematosus (SLE) and it is associated with disease activity and damage, it would be expected that PRL could be associated with a decrease of BMD and lean mass and an increase of fat mass. Objectives To determine whether PRL levels are associated with a pro-inflammatory body mass distribution in female SLE patients. Methods This cross-sectional study was conducted in consecutive SLE female patients seen in our Rheumatology Department from 2012 to 2014. For the purpose of this study, baseline visits were included. Overweight patients (more than 115 kg), those with metallic implants or pregnant were excluded for this analysis. Disease activity was ascertained using the SLEDAI and disease damage with the SLICC/ACR damage index (SDI). PRL was measured in ng/ml. Body mass distribution was measured by DXA and it was divided into sub-total (whole body without the head) BMD, sub-total bone mineral content (BMC), lean mass index (appendicular lean mass/height2, LMI), sub-total, trunk and leg fat percentages and trunk-to-leg fat ratio. A pro-inflammatory body mass distribution is defined as a decrease of BMD, BMC and LMI and an increase of fat mass, in particular trunk fat mass and trunk-to-leg fat mass ratio. The association between PRL levels and body mass distribution components was evaluated by univariable and multivariable linear regression models, the last one adjusted for age, disease duration, SLEDAI, SDI, use of prednisone, antimalarials and immunosuppressive drugs. Results One hundred and fifty-five patients were evaluated; their mean (SD) age was 42.7 (13.4) years; nearly all patients were Mestizo. Patients included in this study had a lower body mass index than the rest of the cohort. Age, disease duration, SLEDAI and SDI were similar than the rest of the cohort. Disease duration was 7.3 (6.6) years. The SLEDAI was 5.5 (4.1) and the SDI 0.8 (1.3). PRL levels were 18.8 (14.3) ng/ml. BMD was 0.9 (0.1) g/cm2, BMC was 1.4 (0.3) kg, LMI 6.1 (1.1) kg/m2, percentage of subtotal fat 36.7 (6.7), trunk fat 34.3 (7.6), leg fat 37.9 (6.7), trunk-to-leg fat ratio 1.5 (0.6). Multivariable analysis is depicted in Table 01. Conclusions Higher PRL levels are associated with a pro-inflammatory body mass distribution in SLE patients. Disclosure of Interest None declared

Background New Classifications of HLADRB1 alleles expanding the concept of the Shared Epitope (SE) hypothesis have allowed to profile predisposing or protective determinants of aggressive disease course in Caucasian patients with Rheumatoid Arthritis (RA). In mestizo Latin American (LA) subjects there is scarce information available. Objectives To determine if SE subtypes according to Gao classification are associated with risk of more severe joint damage in a RA LA cohort Methods A cross sectional study was conducted in RA outpatients between September to December 2013. HLA–DRB1 typification was performed by a polymerase chain reaction–based method, using a panel of sequence-specific oligonucleotides. DRB1 subtyping was described according to the classification of HLA DRB1 alleles by Gao et al: E 1 , E 3 (QRRAA), E 2 /E x (KRAA), E x (ERAA) or Ex (DERAA). Then four categories were pre determined: I = none present (0/0); II = E 1 ,E 3 (+/0 or +/+), III = E 1 , E 3 , E x (+/+), and IV= E x (+/0 or +/+). A single blind investigator (RG) determined Joint Damage according to erosion, narrowing and total Sharp Van Der Heijde (Sharp VDH) score. Other severity risk factors were measured. A univariable Student9s t test to compare all categories was done. Then a regression multivariable linear analysis was performed to determine the association of these DRB1 categories with joint damage adjusted to other risk factors. All analyses were performed using SPSS 21.0. Results One hundred and seventy nine patients were included, 90.5% (162) were women, media of age was 58.9 (12.87) years, Disease duration 15.84 (11.76) years and 31 patients (17.3%) had tobacco habits in the past. The total, erosion and narrowing space Sharp VDH score were 110.33 (86.36), 41.85 (48.45) and 68.48 (41.26) respectively, DAS28 was 4.69 (1.26), MDHAQ was 0.88 (0.60) and Charlson index 0.65 (1.27). On univariate analysis Category II was associated to Sharp VDH score (Table 1) After the multivariable analyses (adjusted for age, disease duration, gender, tobacco, Rheumatoid Factor, DAS28 and Charlson comorbidity index) category II persisted associated with erosions (B: 29.32; IC 95%: 1.19-57.44, p=0.041), and total (B: 50.52; IC 95%: 2.59-98.45, p=0.039) Sharp VDH index but not with narrowing score (B: 21.20; IC 95%: -1.02-43.42, p=0.061) Conclusions Presence of HDRB1 E 1 and/or E 3 alleles are independently associated with structural severity on our RA Peruvian patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5660

Background CD4+CD28null T-cells are a subset of long-lived cytotoxic CD4+ T-cell with pro-inflammatory functions. This subset is supposed to be caused by chronic immune stimulation by either autoantigens or not. CD4+CD28null T-cells have been associated with cardiovascular morbidity and autoimmune diseases like rheumatoid arthritis, but in SLE patients the information is scarce. Objectives The aim of this study was to determine whether the CD4+CD28null T-cells are associated with disease damage in SLE patients after considering other possible factors. Methods This cross-sectional study was conducted in consecutive SLE patients seen in our Rheumatology Department from September 2013 to January 2014. An interview, medical records review, physical examination and laboratory tests were performed. SLE was defined using the ACR criteria. Disease activity was ascertained using the SLEDAI, disease damage with the SLICC/ACR damage index (SDI) and comorbidities with the Charlson Comorbidity Index (CCI). Use of prednisone was recorded as current dose and total time of exposure. Use of antimalarials and immunosuppressives was recorded as current, past or never. CD4+CD28null T-cells frequency was analyzed by flow-cytometry. The association of SDI and CD4+CD28null T-cells was examined by Spearman test. This was followed by multivariable analysis adjusted for age, gender, disease duration, CCI, SLEDAI, use of prednisone, antimalarials and immunosuppressive drugs. All analyses were performed using SPSS 21.0. Results Ninety four patients were evaluated; their median (IQR) age was 42.0 (36.6-50.2) years, 88 (93.6%) were female; almost all patients were mestizo (mixed Caucasian and Amerindian ancestry). Disease duration was 5.6 (2.5-11.4) years. The SLEDAI was 4.0 (2.0-8.0), the SDI 0.0 (0.0-1.0) and the CCI 1.0 (1.0-1.0). The current dose of prednisone was 5.0 (5.0-10.0) mg/d and the total time of exposure to prednisone was 5.0 (2.0-12.5) years; 68 (72.3%) and 14 (14.9%) were current and former users of antimalarials. Sixty five (69.1%) were current or former users of immunosuppressive drugs. Percentage of CD4+CD28null T-cells was 15.5 (8.7-27.1). In the univariable analysis, the percentage of CD4+CD28null T-cells was positively associated with a higher SDI (Rho=0.29, p Conclusions In SLE patients, CD4+CD28null T cells are independently associated with disease damage. Longitudinal studies are warranted to determine the predictive value of this association. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1912

Background High prolactin (PRL) levels have been reported in systemic lupus erythematosus (SLE) patients to be associated with disease activity; they have also been described in patients with chronic diseases like chronic renal failure and chronic liver disease. To our knowledge, an association between disease damage and PRL levels in SLE patients has not been previously evaluated. Objectives To determine whether PRL levels are independently associated with disease damage in SLE patients. Methods This cross-sectional study was conducted in consecutive SLE patients seen in our Rheumatology Department from January to December 2012. An interview, chart review, physical examination and laboratory tests were performed. SLE was defined using the revised and updated ACR criteria; disease activity was ascertained using the SLEDAI and disease damage with the SLICC/ACR damage index (SDI). Use of steroids was recorded as current dose of prednisone and time of exposure. Chronic liver disease was defined as the presence of cirrhosis or chronic hepatitis. The association between PRL levels and SDI was evaluated using Spearman’s correlation. Subsequently, a linear regression model was performed to evaluate the association between PRL levels and SDI, adjusting for age, gender, disease duration, disease activity, thyroid-stimulating hormone (TSH), use of steroids, chronic liver disease and serum creatinine level. Results 130 patients were evaluated, 119 (91.5%) were female; their average (SD) age was 42.6 (13.2) years. Disease duration was 7.3 (6.1) years; almost all patients were mestizo. The mean SLEDAI was 5.9 (4.6), the SDI was 0.9 (1.3), 57 (43.8%) patients had at least one point in the SDI. Mean current prednisone dose was 7.8 (4.6) mg/d, and time of exposure to steroids was 7.1 (6.0) years. Mean creatinine level was 1.3 (1.8) mg/dl, 3 (2.3%) patients had chronic liver disease. TSH was 5.2 (10.5) mIU/l, 37 (28.5%) had TSH above upper normal limit. Mean PRL level was 20.0 (14.4) ng/ml, 38 (29.2%) had a PRL level above upper normal limit. In univariate analysis, PRL level was associated with a higher SDI (Rho: 0.29, p: 0.001). In the adjusted model, PRL level remained associated with SDI (β: 0.37, p Conclusions In our SLE patients, we found a positive association between the prolactin level and SDI, independently of age, gender, disease duration, disease activity, TSH, use of steroids, chronic liver disease and creatinine level. Longitudinal studies are needed to sort out the role of this variable in disease damage in lupus. Disclosure of Interest : None Declared

Background There is a connection between periodontal disease (PD) and a higher incidence and severity of rheumatoid arthritis (RA) but to our knowledge there is no reported study evaluating the impact of PD in joint damage (JD). In our country, the prevalence of PD is 95%. Objectives To demonstrate that a more severe PD is independently associated with higher Sharp/van der Heijde radiologic scores(Sharp VDH) in RA patients. Methods A cross sectional study. All subjects met the ACR criteria for RA, had no other autoimmune disease and were older than 18 years at the diagnosis. We excluded patients with less than 4 teeth, serious or local ongoing infections, oral cancer or precancerous lesion, hospitalized, pregnant, or gingival hyperplasia induced by drugs. We applied a personal interview, physical examination, laboratory analysis and review of medical charts to assess factors associated with JD. Diagnosis and severity of PD were defined according to the American Academy of Periodontology criteria. Severity was categorized on the basis of the amount of clinical periodontal attachment loss (as mild, moderate or severe). All dental assessments and radiographs were interpreted by three odolontologist blinded to JD. A blinded investigator to clinical RA and PD status determined JD score according to Sharp VDH method. Statistical analysis: An univariated linear regression model to determine association between PD and JD was applied. Then, a multiple linear regression model adjusted for age, tobacco, gender, rheumatoid factor (RF), disease duration (DD), diagnosis delay, socioeconomic status (Graffar scale), disease activity (DAS 28CRP), functional status (MDHAQ) and comorbidities (Charlson index) was performed in order to determine persistence of the association. SPSSv16.0 statistical package was used. Results 157 patients were evaluated, 88.5% were women, average (SD) age was 59.00 (12.73) years, DD: 17.60 (11.28) years, socioeconomic status were more frequent medium / medium low (34.4% and 30.6%), 89.2% were RF (+), the mean CRP: 12.78 (17.18) mg/L and the DAS28CRP: 3.94 (1.14). Erosion, joint narrowing space and total Sharp VDH score were 40.21 (48.28), 66.02 (43.85) and106.23 (89.12) respectively. 139 patients (88.5%) had PD, mostly moderate (54.1%). In multivariate analysis PD was independently associated with a higher score for erosion (B: 0.27, P = 0.002), joint space narrowing (B: 0.25, P = 0.003) and total SharpVDH scores (B: 0.27, P = 0.001). Conclusions A more severe PD is associated with joint damage independently of other known associated factors. A more strict periodontal evaluation and follow-up could be useful for better outcomes with less disease progression in RA patients. Disclosure of Interest None Declared

Background Chronic inflammatory diseases such as Rheumatoid Arthritis (RA) and periodontal disease (PD) havebeen associated with accelerated cardiovascular disease and Metabolic Syndrome (MS) is also strongly associatedwith this condition. No previous study, to our knowledge, has investigated if more severe PD influences the emergence of MS in RA. Objectives To demonstrate that a more severe PD is independently associated with MS in RA population. Methods A cross sectional study. All subjects met the ACR criteria, had no other autoimmune disease. We excluded patients with less than 4 teeth, serious or local ongoing infections, oral cancer or precancerous lesion, hospitalized, pregnant, local antibiotics (previous 3 months) or drugs associated with gingival hyperplasia. A personal interview, physical examination, auxiliary tests and medical chart review were performed. Diagnosis and severity of PD were defined according to the American Academy of Periodontology criteria. Severity was categorized on the basis of the amount of clinical attachment loss as mild, moderate or severe. Alldental assessments were interpreted by three odolontologist blind to clinical patient condition. MS was defined according to International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.2009. Statistical analysis: First an univariated x 2 analysis was performed to evaluatethe association between MS and PD severity, then a logistic binary regression model adjusted to age, tobacco, gender, rheumatoid factor (RF), disease duration (DD), socioeconomic level (Graffar scale), disease activity (DAS28CRP), functional status (MDHAQ), body fat distribution by DXA(trunk-to-leg fat ratio), percentage of body fat by DXA, body mass index(BMI) and current dose of glucocorticoids was done to assess the persistence of the association. Statistical package SPSSv16.0 was used. Results 165 patients were evaluated, all mestizos, 90.3% were women, average (SD) age was 58.96 (12.51) years, DD: 15.47(11.43) years, socioeconomic status was more frequently medium, (middle Class: 36.2%), 89.7% were RF(+), and the DAS28CRP was 4.06 (1.19); 17% were current or past smokers. Mean BMI was 27.91(4.89)kg/m 2 . Current dose of prednisone: 4.92 (3.43) mg/d;124 patients (75.2%) had PD, mostly moderate (43.6%). A MS was identified in 37.6% patients. In the adjusted model a higher PD severity was independently associated with MS (OR: 2.92; p=0.006). Conclusions In our RA patients, more severe PD correlates with MS independently of other known associated factors. Prospective studies to explore cardiovascular risk in RA patients with PD are necessary to establish the impact of this condition. Disclosure of Interest None Declared