Search

Genetic and nongenetic factors are involved in the pathogenesis of immune-mediated inflammatory diseases (IMIDs). The best-known genetic factor for susceptibility to IMIDs is the human leukocyte antigen (HLA). The aim of the present study was to evaluate the association of HLA class II genes with the risk of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc) in the Paraguayan population. We included 254 patients with IMIDs (101 SLE, 103 RA, and 50 SSc) and 50 healthy controls. The haplotypes of five genes corresponding to HLA class II genes and their relationship to the IMIDs studied were determined. Note that 84.6% were women, with a mean age of 43.4 ± 14 years. Among the associated HLA alleles, we found the previously identified risk factors in other populations like HLA-DRB1*03:01 and HLA-DRB1*14:02 for RA, as well as new ones not previously identified, such as DPA1*02:01 for SLE and, DB1*02:01 for RA and SSc. In the genetic association analysis, already known associations have been replicated, and unpublished associations have been identified in Paraguayan patients with IMIDs. This is the first genetic association study in Paraguayan patients with IMIDs.

Aim To identify the association between vitamin D (VD) concentrations and the activity of systemic lupus erythematosus (SLE) and determine a supplementation dose that allows patients to maintain adequate levels of VD. Methods Longitudinal, observational study. Serum levels of 25-hydroxy-VD were measured in 100 Paraguayan SLE patients from the Hospital de Clinicas between 2016 and 2018. To analyze the response to different doses of VD supplementation, 50 patients received 1000 IU/day and the other 50 patients received 2000 IU. SLE disease activity measured by SELENA-SLEDAIwas scored before and after supplementation. Results The mean age was 27.5 ± 9.8 years, 88.9% of patients presented mild disease activity and 11.1% presented moderate to severe activity. The mean VD concentration was 30.8 ± 11.8 ng/mL. A total of 34% of patients presented VD insufficiency and 13% VD deficiency. There was an inverse relationship between VD concentrations and SLE disease activity (p = 0.03). Increasing levels of serum VD are associated with supplementation of 2000 IU/day (p = 0.0224). Conclusion SLE activity was associated with low levels of VD. In our cohort, SLE patients required a supplementation dose equal to or greater than 2000 IU/day to increase their serum VD.

Introduction Systemic exposure to bacterial components like lipopolysaccharide (LPS) is among the non-genetic factors that could be involved in the onset or progression of systemic lupus erythematosus (SLE). Lipopolysaccharide-binding protein (LBP) participates in the recognition of LPS and in the inflammatory response. Here, we investigated LBP in SLE patients and its relationship with disease activity and SLE phenotypes. Methods Eighty-one adult patients with SLE from IMID-PY biobank (Paraguay) were included in the study. The clinical and laboratory variables were used to determine SLE activity. LBP levels were determined by ELISA in SLE patients and age- and sex-matched population-based controls. Results Patients with SLE have lower levels of circulating LBP compared to healthy controls ( p = 0.0007). No significant correlation was found between serum LBP levels and disease activity. A significant difference was observed in LBP levels with regard to the presence of arthritis ( p = 0.026). No other relation was found with clinical parameters. Conclusions We found low levels of LBP in SLE patients compared to the control group. No correlation was detected between LBP levels and disease activity. It would be interesting for future studies to evaluate the impact of low levels of LBP on lupus immunopathogenesis.

Introduction: The enthesis is the target organ of inflammation in spondyloarthritis (SpA), being key in its physiopathology. Ultrasound is becoming the preferable technique to de- tect enthesitis. This study was done to describe the ultrasonographic characteristics of enthesis involvement in patients with spondyloarthritis Materials and methods: We evaluated 20 patients with diagnosis of SpA who presented to Hospital de Clinicas. We investigated clinical and demographic variables and later perfor- med ultrasound evaluation of 12 enthesis areas, calculating the GUESS (Glasgow Enthesitis Scoring System) and MASEI (Madrid Sonographic Enthesitis Index) scores with susequent correlation between ultrasonographic and clinical variables. Results: The BASDAI, ASDAS and BASFI scores were 4.05, 2.35, and 3.56 respectively. Out of the 240 evaluated enthesis, 35 (14.5%) had pain during clinical evaluation. Thickening of the tendon or ligament was found in 42.5% of all enthesis, 24.1% showed calcification, 10.8% showed erosions, and PD signal was seen in 1.25%. The average GUESS score was 8.45 and the average MASEI score was 15.2. No relation between sonographic scores and BASDAI, ASDAS or BASFI scores were found. There was no significant difference between GUESS and MASEI scores with different types of SpA, age, disease duration or type of treatment. Male gender and axial involvement was associated with higher GUESS and MASEI scores. Conclusion: We found poor correlation between the presence of enthesitis symptoms and the ultrasonographic findings. The MASEI and GUESS scores did not correlate with disease activity scores. The values of MASEI and GUESS scores were related to male gender and predominantly axial involment in patients with SpA. There was very low acute inflammatory findings with Power Doppler signal detection.

Introduction: Spondyloarthritis is an umbrella term for a group of chronic rheumatic diseases, genetically and clinically related, that lead to an important and often undervalued physical and psychological load. For this reason, the objective of this work is to identify patients with depression and low self-esteem in a group of spondyloarthritis patients with regular follow-up in the Department of Rheumatology at the Hospital de Clinicas, San Lorenzo, from January to December 2017. Methodology: Descriptive cross-sectional study. Patients who fulfilled ASAS criteria for spondyloarthritis were included. Data was collected from the entry questionnaire to the spondyloarthritis patients’ registry of the Department of Rheumatology of the Hospital de Clinicas during 2017. The questionnaire included the mayor depression inventory, Rosemberg self-esteem test, BASDAI, BASFI, HAQ questionnaire, Graffar scale of social stratification and demographic data, such as age at disease onset, age at diagnosis and disease duration. Results: We included 19 patients, 14 (73.7%) male and 5 (26.3%) female, with a mean age of 38.57 ± 13.97 and 38 ± 11.16 years, respectively. Most were single (10/19, 52.6%) and from Gran Asuncion (13/19, 68.4%). The mean age at symptom onset was 23.35±12.52 years in men and 22.6 8.93 years in women, with a mean disease duration of 200.28±167.28 months in men and 202.6±131.05 months in women. Only 3/19 (15.8%) of patients were found to be depressed and 12/19 (63.1%) had high self-esteem. Concerning disease in-dexes, 42.2% of patients presented with a BASDAI score >4, 7 (36.8%) had a BASFI = 0,5 and 73.7% had an HAQ

La vitamina D es una hormona cumple una funcion en la regulacion de numerosos genes que participan en la proliferacion y maduracion celular. El objetivo de este trabajo fue determinar la prevalencia de valores inadecuados de esta vitamina en jovenes sanos de Asuncion e identificar los posibles factores de riesgo asociados. Estudio observacional descriptivo basado en datos clinico-epidemiologicos y en la determinacion de la 25-hidroxivitamina D (25-OH vitamina D) por el metodo de quimioluminiscencia (CMIA). Se considero valor adecuado ≥30 ng/dl, inadecuado por debajo de este rango y deficiente ≤20 ng/dl. El analisis estadistico se realizo con el programa R–proyect. Para establecer factores de riesgo para tener deficiencia de vitamina D se utilizo regresion logistica bi y multivariante. Se incluyeron 817 jovenes universitarios de edad promedio 21 anos. La concentracion de vitamina D tuvo una media de 25 ± 8 ng/dl, oscilando entre 64,3 y 2,4 ng/dl. El 75,5% de los participantes tenian valores inadecuados de vitamina D. La deficiencia de vitamina D fue significativamente (p = 0,006) mas frecuente en mujeres, personas con sobrepeso (p = 0,03), con falta de exposicion al sol (p = 0,001) y con sedentarismo (p = 0,0001). Este estudio confirma la elevada prevalencia de valores inadecuados de vitamina D en nuestro pais y permite definir un perfil de muy alto riesgo para las jovenes sedentarias y con sobrepeso, lo que justifica una atencion especial de parte de los medicos y las instituciones responsables de la salud publica en nuestro pais.

El lupus eritematoso sistemico (LES) es una enfermedad autoinmune, de etiologia desconocida que presenta manifestaciones clinicas de gravedad y curso impredecible. Se ha observado en varias cohortes que esta enfermedad tiene un comportamiento mas agresivo en la poblacion no caucasica debido a diferencias socioeconomicas, demograficas y geneticas. El objetivo del estudio es describir las caracteristicas clinico-epidemiologicas de los pacientes con LES incluidos en la cohorte LUPUS-PY y la situacion actual de las muestras custodiadas en el BIOBANCO IMID-PY. Estudio basado en la revision de historias clinicas y en los cuestionarios clinico-epidemiologicos del dia de la inclusion al registro LUPUS-PY. Se calcularon las frecuencias para las variables categoricas y las medias con su desvio estandar para las continuas. Se incluyeron de forma consecutiva, 83 pacientes con diagnostico de LES (edad media: 34,4±10,0 anos), el 86,7% era del sexo femenino, el 55% provenia de Asuncion, el 49,1% tenia nivel educativo basico, el 45% percibia un ingreso mensual de un sueldo minimo (aproximadamente 350 dolares americanos) o menos. El 46,8% no realizaba ningun tipo de actividad fisica. La media del tiempo trascurrido desde el inicio de los sintomas y el diagnostico del LES fue de 9,3±13,7 anos y el tiempo de evolucion de la enfermedad hasta el ingreso al registro fue de 5,9±6,3. El 16% refirio antecedentes familiares de enfermedades autoinmunes. La primera manifestacion de la enfermedad mas descripta fue la articular (45%). Los pacientes con LES de nuestro centro tienen caracteristicas tanto clinicas como epidemiologicas similares a las reportadas por otras cohortes.

Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of “Lupus Investigators” in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.

RESUMEN Introducción: La entesis es el órgano diana de la inflamación en las espondiloartritis (EspA) siendo clave en su fisiopatogenia. La ecografía está emergiendo como la técnica de preferencia para la detección de entesitis. Se realizó este estudio a fin de describir las ca- racterísticas ecográficas del compromiso de las entesis en pacientes con espondiloartritis. Materiales y métodos: Se evaluaron 20 pacientes con diagnóstico de EspA que acudieron al Hospital de Clínicas. Se investigaron variables clínicas y demográficas y posteriormente exploración ecográfica en 12 sitios de entesis hallándose los índices GUESS (Glasgow Enthesitis Scoring System) y MASEI (Madrid Sonographic Enthesitis Index) y posterior cor- relación de las variables ecográficas con las clínicas. Resultados: Los promedios de los índices BASDAI, ASDAS y BASFI fueron 4,05, 2,35, 3,56 respectivamente. De las 240 entesis evaluadas 35 (14,5%) presentaban dolor a la evaluación clínica. Se halló engrosamiento de tendón o ligamento en 42,5% de las entesis, calcificaciones en 24,1%, erosiones en 10,8%, y señal PD en 1,25%. El índice GUESS medio fue de 8,45 y el MASEI medio 15,2. No se encontró relación entre índices ecográficos e índices de BASDAI, ASDAS o BASFI. No se halló diferencia significativa entre los Índices GUESS y MASEI con los diferentes tipos de EspA, edad, tiempo de evolución ni tipo de tratamiento. El sexo masculino y el compromiso axial se asociaron a mayor índice GUESS y MASEI. Conclusión: Se encontró una pobre correlación entre la presencia de síntomas de entesitis y los hallazgos ecográficos. Los índices ecográficos MASEI y GUESS, no se correlacio- naron con los índices de actividad de la enfermedad. Los valores de los índices MASEI y GUESS se relacionaron con el sexo masculino y el compromiso predominantemente axial en pacientes con EspA. Se halló una muy baja afectación inflamatoria aguda mediante detección de señal power doppler. ABSTRACT Introduction: The enthesis is the target organ of inflammation in spondyloarthritis (SpA), being key in its physiopathology. Ultrasound is becoming the preferable technique to de- tect enthesitis. This study was done to describe the ultrasonographic characteristics of enthesis involvement in patients with spondyloarthritis Materials and methods: We evaluated 20 patients with diagnosis of SpA who presented to Hospital de Clinicas. We investigated clinical and demographic variables and later perfor- med ultrasound evaluation of 12 enthesis areas, calculating the GUESS (Glasgow Enthesitis Scoring System) and MASEI (Madrid Sonographic Enthesitis Index) scores with susequent correlation between ultrasonographic and clinical variables. Results: The BASDAI, ASDAS and BASFI scores were 4.05, 2.35, and 3.56 respectively. Out of the 240 evaluated enthesis, 35 (14.5%) had pain during clinical evaluation. Thickening of the tendon or ligament was found in 42.5% of all enthesis, 24.1% showed calcification, 10.8% showed erosions, and PD signal was seen in 1.25%. The average GUESS score was 8.45 and the average MASEI score was 15.2. No relation between sonographic scores and BASDAI, ASDAS or BASFI scores were found. There was no significant difference between GUESS and MASEI scores with different types of SpA, age, disease duration or type of treatment. Male gender and axial involvement was associated with higher GUESS and MASEI scores. Conclusion: We found poor correlation between the presence of enthesitis symptoms and the ultrasonographic findings. The MASEI and GUESS scores did not correlate with disease activity scores. The values of MASEI and GUESS scores were related to male gender and predominantly axial involment in patients with SpA. There was very low acute inflammatory findings with Power Doppler signal detection.

Health education is fundamental in the management of RA patients. This study explored patient needs for educational material appropriate for RA patients in our region through a website. This study includes seven focus groups and semi-structured interviews across 4 countries (Argentina, Chile, Colombia, and Mexico) with 71 RA patients. Transcripts were analyzed by anthropologists using qualitative analysis (QA), resulting in themes and subthemes to be developed. Five themes and over 50 subthemes of interest were identified by patients. Grouped into categories as follows: (1) knowing the disease, (2) living with arthritis, (3) treatment and therapies for RA, (4) psychosocial support, and (5) information for families. A response was written by the team in plain Spanish on patient subthemes of interest including additional areas that the team considered relevant. Three videos for YouTube were produced: on patient-doctor relationships, patients at work, and home and at the clinic. Illustrations in a comic book format on RA diagnosis were created. The educational site on RA of PANLAR can be found at htpp://artritisreumatoide.cl. This project accomplished a comprehensive list of RA patient interests, revealing the complex relationship between the information on the disease, the experience of a chronic disease, and the way in which patients approach, conceive, and manage their disease. We expect to gather information on how the website will be used in the future for patients and their families and maintain and improve the website as well as adapt its content to different socioeconomic realities.

Background:Rheumatoid arthritis (RA) presents with an elevated incidence of congestive heart failure disease, which has a strong association with diastolic dysfunction, defined by left ventricular delayed relaxation pattern assessed by echocardiography.(1,2)Objectives:To describe the frequency of left ventricular delayed relaxation pattern in patients with RA, and the relationship with its clinical and serological characteristics, as well as with traditional and non-traditional cardiovascular risk factors.Methods:Descriptive, cross sectional, prospective study, in a Paraguayan cohort of patients with RA. This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the Consejo Nacional de Ciencias y Tecnología (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, t-PA, VCAM, PAI-1 and high sensitivity-CRP levels) and echocardiographic assessment with a Doppler 7 GE USA equipment at a private facility. All patients signed informed consent. SPSS Statistics v23 was used for data analysis. Quantitative variables were presented as means and qualitative variables as frequencies. Chi square test was performed for comparisons between dichotomous variables. A p value ≤ 0.05 was used for statistical significance.Results:100 patients were included, 87% women, with a mean age of 51.36 ± 11.03 years, mean disease duration of 130.9 ± 102.64 months. 84.4% had positive ACPA. 43.3% had bone erosions, with an average of DAS 28-ESR 3.42 ± 1.1. 60% of patients presented with echocardiographic left ventricular delayed relaxation pattern. Regarding traditional CV risk factors, the same ones presented more frequently HBP (40% vs 19.4%, p = 0.037), DM2 (11.7% vs 0%, p = 0.036), obesity (38.3% vs 16.7%, p = 0.025), altered glycemia (27.1% vs 6.5%, p = 0.02), altered HbA1C (50.8% vs 22.6%, p = 0.01), higher mean weight (75.9 ± 17.62 p = 0.02), higher Framingham index high (20% vs 3.2%, p = 0.03). Regarding to clinical parameters, a higher frequency of erosions was found (55.8% vs 22.2%, p = 0.004), without other significant differences for disease activity, seropositivity or disease duration. As for serum biomarkers, higher levels of fibrinogen (639.71 ± 189.84, p = 0.04), homocysteine (11.74 ± 7.81, p = 0.05) and VCAM (519, 16 ± 203.68, p = 0.02) were found.Conclusion:We found a high frequency of diastolic dysfunction in patients with RA. They presented a significant association with traditional CV risk factors, erosions, and fibrinogen, homocysteine, and VCAM biomarkers. Adequate control of cardiovascular risk factors and echocardiographic assessment of these patients is essential in order to avoid the progression of heart functional damage.References:[1]Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review. Arthritis Care & Research. 2013;65(4):534-43.[2]Liang KP, Myasoedova E, Crowson CS, Davis JM, Roger VL, Karon BL, et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Annals of the Rheumatic Diseases. 1 de septiembre de 2010;69(9):1665-70.Disclosure of Interests:None declared

Background:Immune Mediated Inflammatory Diseases (IMIDs) are complex diseases that are believed to have a strong interaction between the genome and the environment as part of their aetiology. In studies using the candidate gene strategy, genetic variation in a gene where functionality has been associated with the pathophysiology of the disease under study is being analyzed. In the last decade, polymorphisms of the vitamin D receptor (VDR) and VDBP genes have been more emphatically studied in IMIDs in different populations, but the results reported have not yet been conclusive.Objectives:To identify an association between vitamin D receptor (VDR) and vitamin D-binding protein (VDBP) gene polymorphisms, and IMIDs in Paraguayan patients.Methods:Association study of VDR (SNPs rs731236, rs7975232, rs2228570) and VDBP (rs4588) gene polymorphisms with susceptibility to IMIDs in Paraguayan population. A total of 399 patients with IMIDs (i.e. Systemic Lupus Erythematosus (SLE), Scleroderma (ES), Rheumatoid Arthritis (RA), and Cutaneous Psoriasis (CPS) and 100 hypernormal controls (HC) from the same population were included in this study. Genotyping was performed using Taqman real-time PCR-based technology (Life Technologies, USA). Statistical analysis was performed using Rv3.0.1 statistical language software (www.R-project.org). A p value ≤ 0.05 was used for statistical significance.Results:A total of 399 individuals, 100 controls and 299 patients (99 RA, 100 SLE, 50 ES, and 50 PSO) were included. Seventy-six percent were female and 24% were male. The mean age was 43.7±14 years. Four SNPs were genotyped: rs731236, rs7975232, rs2228570, rs4588. The HWE test was not statistically significant for any of the 4 SNPs considered (P>0.05), confirming the quality of genotyping and the absence of technical bias. (Table 1).Table 1.Genotyping of SNPs of the VDR and VDBP gene in Paraguayan population with IMIDs.SNPIMIDMinor AlleleMajor AlleleMAFControlMAFCaseORIC.LIC.Hp allelicP.Geneticrs731236SLEGA0.50.40.640.420.970.0350.08rs731236RAGA0.50.410.690.461.050.0710.12rs731236SSGA0.50.420.710.421.180.180.37rs731236CPSGA0.50.380.60.361.010.0490.042rs2228570SLEAG0.360.381.140.741.740.60.45rs2228570RAAG0.360.310.830.531.280.40.56rs2228570SSAG0.360.361.020.61.7310.057rs2228570CPSAG0.360.391.160.681.960.610.83rs7975232SLECA0.360.320.820.531.260.40.072rs7975232RACA0.360.290.720.461.120.140.064rs7975232SSCA0.360.220.490.270.880.0120.0064rs7975232CPSCA0.360.411.210.722.030.450.016rs4588SLETG0.230.271.240.7720.420.48rs4588RATG0.230.220.930.561.530.810.84rs4588SSTG0.230.210.890.471.650.770.76rs4588CPSTG0.230.291.370.762.430.260.53Conclusion:There is evidence of nominal association between VDR SNPs: rs731236 (in SLE and CPS), and rs7975232 (in SS and CPS) and the presence of IMIDs disease in Paraguayan patients.Disclosure of Interests:None declared

El Lupus eritematoso sistemico (LES) es una enfermedad autoinmune compleja que se caracteriza por su capacidad de afectar a diversos organos, lo que determina las diferentes manifestaciones clinicas objetivadas durante la evolucion de la enfermedad. De forma asociada se ha descrito que estas manifestaciones presentan una variacion geografica o etnica, siendo por lo general menos grave en pacientes con ascendencia europea que en aquellos que presentan ascendencia africana, asiatica o hispana. Alteraciones, tanto del sistema inmune adaptativo (celulas T y B) como del innato (Toll like receptorx-TLR), contribuyen al desarrollo del LES. Las celulas B tienen su papel en la produccion de los autoanticuerpos (i.e. anticuerpos anti-ADN y anticuerpos anti-nucleosoma) y de determiandas citocinas. Las pruebas de laboratorio son de gran valor cuando se evalua a un paciente con sospecha de enfermedad autoinmune. Los resultados pueden confirmar el diagnostico, estimar la severidad de la enfermedad, evaluar el pronostico y son de suma utilidad para el seguimiento de la actividad del LES.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. BACKGROUND: Latin America is a heterogeneous region made up of different populations, cultures, latitudes, altitudes, and immigrants from different areas and ethnic groups. OBJECTIVE: The purpose of this study is to describe the clinical and demographic profile of patients with osteoarthritis (OA) evaluated by a selected group of rheumatologists in 13 Latin American countries. METHODS: A descriptive, observational, cross-sectional study was conducted in 13 Latin American countries of patients with symptomatic OA. Data were collected over a 3-month period using an ad hoc questionnaire to evaluate the clinical and demographic features of OA seen by rheumatologists. RESULTS: Among the 3040 patients, their average age was 62.5 years, and female-to-male ratio was 4.8:1. Patients with body mass index of greater than 30 kg/m or obesity was found in 38.2%. Approximately 88% had primary OA. Joints with OA were as follows: knee 31.2%, hand 9.5%, hand and knee 22.9%, proximal and distal interphalangeal joints (erosive OA) 6.5%, axial 6.6%, and hip 1.3%. Approximately 88.5% had radiographic severity of grade 2 or 3 on Kellgren-Lawrence scale (0-4). Nonsteroidal anti-inflammatory drugs were the predominant OA treatment included in combinations with glucosamine sulfate/chondroitin and viscosupplementation. Associated comorbidities included hypertension (39%), obesity (36.3%), diabetes mellitus (12%), and without comorbidity (12.7%). CONCLUSIONS: This is 1 of the largest population studies that evaluated the characteristics of OA in 3040 patients evaluated by rheumatologists in 13 Latin American countries. This study provides important data for each Latin American country to develop new health care planning in management of OA. Revisión por pares

Background:Metabolic syndrome (MS) is associated with increased abdominal adipose tissue and production of inflammatory cytokines. Patients with MS are at increased risk for developing cardiovascular disease and diabetes mellitus, which are among the leading causes of death in chronic rheumatic diseases.Objectives:To characterize patients with rheumatic disease and MS and its association with inflammatory markers.Methods:Descriptive, cross sectional, prospective study, in 3 Paraguayan cohorts of patients with rheumatoid arthritis (RA), systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the Consejo Nacional de Ciencias y Tecnología (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, t-PA, VCAM, PAI-1 and high sensitivity-CRP levels). MS patients were categorized according to 2007 ALAD criteria. All patients signed informed consent. SPSS Statistics v23 was used for data analysis. Quantitative variables were presented as means and qualitative variables as frequencies. Chi square test was performed for comparisons between dichotomous variables. A p value ≤ 0.05 was used for statistical significance.Results:We included a total of 253 patients, 100 with RA, 100 with SLE and 52 with SSc. Metabolic syndrome was found in 23,58% (50/212). There was no significant difference in MS prevalence between diseases, but there was a higher frequency of increased abdominal circumference in RA and low HDL in SLE. Frequencies for different features of MS in RA, SLE and SSc are detailed in table 1.Table 1.Frequencies of MS component in SLE, SSc and RA.SLESScRAphsCRP23,52% (16/68)26,31% (10/38)42,85% (36/84)0,027E-Selectin5,88% (4/68)21,05% (8/38)5,95% (5/84)0,014t-PA0% (0/68)2,63% (1/38)5,95% (5/84)0,111VCAM20,58% (14/68)8,1% (3/37)0% (0/83)0,000TNF-α7,35% (5/68)18,42% (7/38)13,09% (11/84)0,229Endotelin20,58% (14/68)31,57% (12/38)19,75% (16/81)0,192PAI-111,36% (5/44)0% (0/38)0% (0/83)0,002Table 2.Frequency of high serum inflammatory biomarkers in SLE, RA and SSc.SLESScRApAbdominal circumference criteria43,4% (43/99)46,66% (21/46)64% (64/100)0,009Hypertension criteria67% (67/100)67,3% (35/52)55% (55/100)0,152HDL criteria55,22% (37/67)52,63% (20/38)16,12% (15/93)0,000TAG criteria22,38% (15/67)28,94% (11/38)22,58% (21/93)0,703Glycemia criteria7,69% (4/52)13,15% (5/38)25,67% (19/74)0,114Metabolic Syndrome24,35% (19/78)25% (9/36)22,44% (22/98)0,934Regarding inflammatory biomarkers, there was a significant difference between biomarkers elevated in each disease: hsCRP was found more frequently in RA, E-Selectin in SSc and VCAM and PAI-1 were more prevalent in SLE.Conclusion:We found a similar frequency of metabolic syndrome in our cohorts of RA, SSc and SLE Paraguayan patients but they had a different clinical and serological profile, suggesting that the pathways leading to metabolic syndrome are dissimilar in each disease. We need more studies to confirm this hypothesis.Disclosure of Interests:None declared

Background:The mechanism of increased cardiovascular risk in RA is not well understood and is independent of traditional CV risk factors. Intima-media thickness of the common carotid wall measured by ultrasonogram is a safe and useful biomarker of early stage atherosclerosis that correlates with coronary involvement; and it correlates with severity and duration of disease. Several studies have shown a relationship between inflammation markers, endothelial dysfunction markers, and carotid involvement. (1)Objectives:To determine the presence of inflammation biomarkers and its relationship with subclinical atherosclerosis measured by carotid ultrasound, and with the clinical characteristics in patients with established Rheumatoid Arthritis (RA)Methods:Descriptive, cross sectional, prospective study, in a Paraguayan cohort of patients with RA meeting ACR/EULAR2010 criteria. This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the National Sciences and Technology Council (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, homocysteine, apolipoprotein, fibrinogen, and high sensitivity-CRP levels) and carotid ultrasound evaluation by a trained specialist, to evaluate subclinical atherosclerosis. Subclinical atherosclerosis was defined as carotid intima-media thickness (CIMT) >0,9mm and/or presence of carotid plaques. All patients signed informed consent. SPSS 23rd version was used for data analysis. Quantitative variables were presented as means and qualitative as frequencies. Chi square test was performed for comparisons between dichotomous variables and t Student for continuous, and p ≤ 0.05 for statistical significance.Results:100 patients were included, 87% were women, mean disease duration 130.9±102.64 months, 77% were RF positive, and 84.4% were ACPA positive, 43.4% had bone erosions, mean ESR-DAS28 was 3,42±1,1; 30% had remission criteria. 39% had extra-articular manifestations.Elevated serum biomarkers were found: fibrinogen >400 mg/dL 88.2%, high sensitivity-CRP (hs-CRP) >5mg/dL 42.9%, endothelin >2 ng/mL 20%, alpha-TNF >15,6 pg/mL 13.1%, E-selectin >79,2 ng/mL 6%. 25.3% had CIMT >0,9 mm and mean CIMT was 0.68±0.25mm. 27.14% had carotid plaques. Patients with CIMT>1mm had higher frequency of family history of arterial hypertension (p=0.006), greater mean disease duration (p=0.0007), hip circumference (p=0.014), blood pressure (SBP p=0.038, DBP p=0.027), HAQ levels (p=0,019) and hs-CRP levels (p=0.013), also lower mean height (p=0,04); while carotid plaques were related to higher homocysteine (p=0.026) and hs-CRP levels (p=0.024).Conclusion:A considerable percentage of patients had subclinical atherosclerosis. Patients with CIMT>0,9mm had a longer disease duration, higher HAQ levels, hip circumference, as well as higher BP. High levels of hs-CRP were more frequently related to the presence of subclinical atherosclerosisReferences:[1]Aday, A. targeting residual inflammatory risk: a shifting paradigm for atherosclerotic disease. Frontiers in cardiovascular medicine. 2019. 6:16.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6403155/pdf/fcvm-06-00016.pdfDisclosure of Interests:None declared

Background Immune-mediated inflammatory disease (IMID) is a concept used to describe a group of conditions that share common inflammatory pathways leading to systemic inflammation. The best-known genetic factor for IMID susceptibility is the human leukocyte antigen (HLA) haplotypes. Nowadays, there is a lack of information about HLA profile in Paraguayan patients with IMIDs. Objectives To identify HLA alleles associated with susceptibility to develop an IMID in Paraguayan patients controlled in a reference centre. Methods Paraguayan IMID patients were recruited from the Rheumatology Department of Hospital de Clinicas, Paraguay. IMID HLA II frequencies where compared with a control group of 50 unrelated individuals without disease and from the same geographic origin. Genotyping for HLA was performed using Luminex PCR technology. The association analysis with the IMIDs risk was performed using the chi-square allelic test. Results 249 IMID patients (95 lupus,104 rheumatoid arthritis and 50 systemic sclerosis) where included. Of these 84,4% were women with an average age of 43,4 (±14). Comparing the haplotypes profiles for the 5 HLA class II genes between the patients and the healthy controls, in the risk association analysis, the association of the known risk allele was corroborated HLADRB1*03:01 (p=2e-06, OR:14,97). A significant association was identified between the allele HLADRB1* 08:02 (p=0.0271, OR:0,13) and HLADRB1* 08:07 (p=0.0133, OR: 0.08). In the gene HLADQA1, 1 allele associated with the IMIDs were found, the HLADQA1*04:01 (p=1.4e-05, OR: 0.06). In the HLADPB1 gene 3 alleles associated with the IMIDs were identified: HLADPB1*02:01 (p=4.2e-05, OR: 82.91), HLADPB1*03:01 (p=2e-06, OR: 14.97), HLADPB1*04:01 (p=1.5e-05 OR: 34.55). Different associations between IMIDs and alleles was identify (table 1). Conclusions In the genetic association analysis, already known associations have been replicated and new ones previously unpublished have been identified in Paraguayan IMIDs patients. This is the first genetic association study in IMID patients Paraguayan origin. Disclosure of Interest None declared

Background It has been postulated that low concentrations of 25-hidroxivitamin D serum [25 (OH) D] is associated with a greater prevalence of depression. People with deficient levels of vitamin D are more likely to experience mood disorders such as depression and anxiety. The vitamin D plays a role in the release of neurotransmitters such as serotonin and dopamine which is why is interesting the study of this in patients with systemic lupus erythematosus, who are discouraged from sun exposure. Objectives Determine the association between the deficit/insufficiency of vitamin D and the anxiety/depression in patients with SLE of the Department of Rheumatology of the Hospital de Clinicas Methods Observational study of longitudinal court based in a questionnaire according to the scale HADS (Hospital anxiety and Depression Scale) and the dosages of vitamin D performed on patients who entered the LUPUS PY cohort with prior informed consent. The dosage of vitamin D realised by chemiluminescence. Data and samples were taken in week 0 and week 24 and the prevalence of depression and anxiety and its association with vitamin D deficiency and insufficiency were identified. Patients with vitamin D deficiency or insufficiency were supplemented with vitamin D. For the descriptive analysis of the quantitative variables, average and SD were used, for the qualitative frequencies and percentages. For the analysis of association the test × 2 was used. The value of the p considered statistically significant was less than 0,05. Results In relation to the characteristics of the studied cohort, we can see that 90.5% were female, with an average age of 33±10.2 years. At week 0 the average value of vitamin D concentration was 31.8±10.2 ng/ml. It is found that 4,48% of patients had depression and 33,69% of patients have anxiety. In the week 24 the value of the average of vitamin D was of 31,1±13,6 ng/ml. It was observed in this week that 6% of patients presented depression and 12% of patients anxiety. In the analysis of association there was no association between vitamin D deficits and the presence of depression or anxiety of these patients both at the week 0 as a week 24 post vitamin D supplementation such, and as seen in table 1. Conclusions A significant percentage of patients with deficient or insufficient vitamin D were found, as well as a considerable percentage had depression or anxiety, although no association was found between the state of this vitamin and the alterations of the studied mood. More studies are required that include more patients in order to obtain more conclusive results. Reference [1] Okereke, Olivia I., Ankura Singh. “The Role of Vitamin D in the Prevention of Late-Life Depression.”Journal of affective disorders198 (2016): 1–14. PMC. Web. 30 Jan. 2018. Disclosure of Interest None declared

Background Rheumatoid Arthritis is a chronic rheumatic disease characterised by polyarticular inflammation. The rheumatoid factor is one of the most known prognostic markers, not only its presence, but also the levels. It also presents different isotypes (IgG, IgM, IgA), which can affect the course of the disease. Objectives To analyse the presence of different rheumatoid factor (RF) isotypes in Paraguayan patients with rheumatoid arthritis (RA) and to study their association with clinical and analytical characteristics. Methods Descriptive, cross-sectional study. A large number of clinical and serological variables were recorded. The anti-CCP 3.1 and Rheumatoid factor (RF) isotypes IgA, IgG, and IgM were measured in serum samples by ELISA (enzyme-linked immunosorbent assay) (NV Results 103 patients with RA were included, 86.4% were female, with a median age of onset of 44.7±13.6 years, and the mean disease duration was 7.13±7.03 years. The olygoarticular onset was the most frequent (46.6%). 13.7% were smokers. Extra-articular manifestations were present in 13.5%. The most frequent treatment was methotrexate (84.3%). Erosions were observed in 43.2% of patients. 28% were in remission of the disease measured by the DAS28 index. The average of HAQ was 0.47%±0.58. 91.3% had anti-CCP positive, the mean anti-CCP levels were 290.5±152.8 U/mL. RF isotypes was observed in 75.7%, 53.4% and 38.8% for IgM, IgA and IgG respectively. Mean levels were as follow, IgA 85.62±56.6 U/mL, IgM 96.7±30.9 U/mL, IgG 70.98±72.42 U/mL. 32% of the patients had 2 isotypes of RF, while 25.2% had the 3 isotypes. The 57.3% had ≥2 isotypes of RF. We did not find significant differences when comparing gender, age, disease duration, form of onset, extra-articular manifestations, smoking status, erosions, disease activity, HAQ, treatment, between the different RF isotypes, and levels, except in the presence of anti-CCP with the RF-IgM isotype (p Conclusions This is the first study of RF isotypes in Paraguayan patients with RA. The most frequent isotype of RF was IgM. More than 50% of patients had 2 or more RF isotypes. The majority of patients with positive RF had high levels of different isotypes, being the highest IgM. Disclosure of Interest None declared

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings. Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina Fil: Bonfa, Eloisa. Universidade de Sao Paulo; Brasil Fil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; Argentina Fil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; México Fil: Izcovich, Ariel. Hospital Alemán; Argentina Fil: Popoff, Federico. Hospital Aleman; Argentina Fil: Criniti, Juan M.. Hospital Alemán; Argentina Fil: Vásquez, Gloria. Universidad de Antioquia; Colombia Fil: Massardo, Loreto. Universidad San Sebastián; Chile Fil: Duarte, Margarita. Hospital de Clínicas; Paraguay Fil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; México Fil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina Fil: Amigo, Mary Carmen. Centro Médico Abc; México Fil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; Argentina Fil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; Brasil Fil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; Brasil Fil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; Perú Fil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; Venezuela Fil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; Ecuador Fil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; Colombia Fil: Molina, José Fernando. Centro Integral de Reumatología; Colombia Fil: Neira, Oscar. Universidad de Chile; Chile Fil: Silva, Clóvis A.. Universidade de Sao Paulo; Brasil Fil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; Uruguay Fil: Gómez Puerta, José A.. Hospital Clinic Barcelona; España Fil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; Argentina Fil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; Argentina Fil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; Brasil Fil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; Argentina Fil: Drenkard, Cristina. University of Emory; Estados Unidos Fil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; Argentina Fil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; Perú Fil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; Argentina Fil: Cavalcanti, André. Universidade Federal de Pernambuco; Brasil Fil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; Uruguay Fil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; Argentina Fil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; Venezuela Fil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; Brasil Fil: Eraso Garnica, Ruth M.. Universidad de Antioquia; Colombia Fil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; Colombia Fil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; México Fil: Robaina Sevrini, Ricardo. Universidad de la República; Uruguay Fil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina Fil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; Argentina Fil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; México Fil: Rosario, Violeta. Hospital Docente Padre Billini; República Dominicana Fil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; Argentina Fil: Appenzeller, Simone. Universidade Estadual de Campinas; Brasil Fil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; Brasil Fil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: González Naranjo, Luis A.. Universidad de Antioquia; Colombia Fil: González Bello, Yelitza C.. Ceibac; México Fil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; Argentina Fil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; Perú Fil: Cairoli, Ernesto. Universidad de la República; Uruguay Fil: Conti, Silvana M.. Hospital Provincial de Rosario; Argentina Fil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; México Fil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; México Fil: Borba, Eduardo F.. Universidade de Sao Paulo; Brasil Fil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; Argentina Fil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina Fil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; Argentina Fil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; Argentina Fil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; Argentina Fil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; Argentina Fil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; Argentina Fil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; Brasil Fil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; Brasil Fil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; Brasil Fil: Da Silva, Nilzio A.. Universidade Federal de Goiás; Brasil Fil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; Brasil Fil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; Brasil Fil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; Brasil Fil: Llanos, Carolina. Universidad Católica de Chile; Chile Fil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El Salvador Fil: Garcia De La Torre, Ignacio. Hospital General de Occidente; México Fil: Pineda, Carlos. Instituto Nacional de Rehabilitación; México Fil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; México Fil: Danza, Alvaro. Hospital Pasteur Montevideo; Uruguay Fil: Guibert Toledano, Marlene. Medical-surgical Research Center; Cuba Fil: Reyes, Gil Llerena. Medical-surgical Research Center; Cuba Fil: Acosta Colman, Maria Isabel. Hospital de Clínicas; Paraguay Fil: Aquino, Alicia M.. Hospital de Clínicas; Paraguay Fil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República Dominicana Fil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; México Fil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; Argentina Fil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; Chile Fil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; Argentina Fil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unidos

Modern medicine is in a continuous state of flux given the relentless development of new evidence; thus, it is quite difficult for clinicians to remain abreast of all advances as they happen. Trustworthy clinical practica guidelines (CPGs) rigorously developed following a transparent methodology (http://www.gradeworkinggroup.org/) and including the best available evidence represent one of the best solutions to overcome these problems...

Los pacientes con diagnóstico de lupus eritematoso sistémico (LES) presentan una elevada morbi-mortalidad asociada a las manifestaciones cardiopulmonares que se desarrollan durante la evolución de la enfermedad. En este sentido, se han descrito dos picos de incidencia de mortalidad de esta enfermedad inmunológica. El primer pico está relacionado a la actividad de la enfermedad y se observa durante los tres primeros años posteriores al diagnóstico. El segundo pico está relacionado principalmente a las complicaciones cardiopulmonares y se presenta entre los 4 y 20 años posteriores al diagnóstico. Si bien la mortalidad temprana ha disminuido gracias a un mayor conocimiento de la fisiopatología de la enfermedad y al uso de terapias inmunosupresoras, la mortalidad tardía presenta un aumento progresivo de su frecuencia a pesar del avance en el manejo terapéutico. El estudio de estas complicaciones se ha convertido en un tema de gran interés debido a su efecto negativo en el pronóstico de los pacientes que las presentan. Algunos estudios epidemiológicos sugieren que los pacientes con LES tienen un mayor riesgo cardiovascular al ser comparados con la población sana. En este sentido, se ha descrito que estos presentan un mayor riesgo de desarrollar eventos cardiovasculares (infarto agudo del miocardio, accidente cerebro vascular y enfermedad arterial periférica) en comparación con la población general. De forma asociada, se ha objetivado que la presencia de manifestaciones pleuro-pulmonares (pleuritis lúpica, neumonitis, hemorragia pulmonar, embolismo pulmonar e hipertensión pulmonar) aumenta la morbimortalidad de los pacientes con LES. El conocimiento adecuado de las complicaciones cardiopulmonares en los pacientes con diagnóstico de lupus eritematoso sistémico permitirá realizar un manejo individualizado y por lo tanto más eficaz, permitiendo disminuir la morbilidad asociada a las citadas complicaciones. El objetivo de este manuscrito es realizar una revisión de la literatura sobre las principales manifestaciones cardiopulmonares, además de analizar la morbilidad y mortalidad asociada a ellas dentro del contexto clínico de los pacientes con LES.

RESUMEN Los pacientes con lupus eritematoso sistémico (LES) presentan un elevado riesgo cardiovascular, cuya etiología aún no se conoce con exactitud. Se ha postulado que podrían estar implicados tanto los factores de riesgo cardiovascular tradicionales como determinados factores relacionados a la propia enfermedad. En el presente estudio, se ha analizado a un grupo de pacientes con LES y se ha determinado la presencia de eventos cardiovasculares (EC), así como también a los factores de riesgo cardiovascular (FRCV) tradicionales y los relacionados a la enfermedad. Además, se ha estudiado la asociación de estos últimos con el desarrollo de un EC (i.e. infarto de miocardio agudo, hipertensión arterial, accidente cerebrovascular). En el total de 83 pacientes analizados, el EC más frecuente fue la hipertensión arterial (HTA) en un 41%. En relación a los FRCV tradicionales, el sedentarismo fue el hallado con más frecuencia, seguido por la obesidad. Al analizar cada EC y su asociación con los FRCV, se observó una asociación significativa entre la HTA y la dislipidemia (p = 0,001). En relación a los accidentes cerebrovasculares, se observó una asociación con la edad avanzada (p = 0,037) y la presencia de síndrome antifosfolípido (p = 0,001). La elevada frecuencia de EC en los pacientes con diagnóstico de LES pone de manifiesto la necesidad de una evaluación inicial detallada para estratificar tanto FRCV tradicionales como los no tradicionales de los pacientes con LES para permitir una mejor supervisión y así mejorar el pronóstico cardiovascular de estos pacientes. ABSTRACT Patients with systemic lupus erythematosus (SLE) have a high cardiovascular risk, whose etiology is not yet known accurately. It has been postulated that both traditional cardiovascular risk factors and certain factors related to the disease itself could be involved. In this study, we analyzed a group of patients with SLE and determined the presence of cardiovascular events (CE), and cardiovascular risk factors (CVRF), both traditional ones and those inherent to the disease. Besides, the association of the risk factors with the development of a CE (i.e. acute myocardial infarction, arterial hypertension (AHT), cerebrovascular accident) was studied. In a total of 83 patients, the most frequent CE was AHT in 41% of the patients. In relation to traditional CVRF, sedentary lifestyle was the most frequent (72%) followed by obesity. When we analyzed each CE and their association with the CVRF, we found a significant association between AHT and dyslipidemia (p = 0.001). In relation to cerebrovascular accidents, we observed an association with advanced age (p = 0.037) and presence of antiphospholipid syndrome (p = 0.001). The high frequency of CE in patients with diagnosis of SLE showed the need of a detailed initial assessment to stratify both traditional and non-traditional CVRF of a patient with SLE to allow a better monitoring and thus improve cardiovascular prognosis of these patients.