Medicina Interna.pósters

Utility of Epithelial Cell Biomarkers to Assess Severity and Discriminate Between Different Patterns of Interstitial Lung Disease in Patients with Rheumatoid Arthritis

2023-05-30T00:00:00Z

Utility of Epithelial Cell Biomarkers to Assess Severity and Discriminate Between Different Patterns of Interstitial Lung Disease in Patients with Rheumatoid Arthritis Paulín, F.; Antoniol, María Noelia; Stolar, M.; Barrios, P.; Fernándes, C.; Ferrero, F.; Fassola, F.; Alonso, D.; Litewka, D.; Presas, J.L.; Perandones, Carlos Edgardo; Buschiazzo, E. Background Several biomarkers have been studied in rheumatoid arthritis (RA) interstitial lung disease (ILD), but their clinical application has not been well established yet [1]. Given that usual interstitial pneumonia (UIP) is the most common pattern of ILD in patients with RA, the utilization of biomarkers that give information about the epithelial cell activation could be an interesting approach to assess the severity of lung disease in these patients [2]. Objectives To know the ability of CA19-9, CA125 and CEA to discriminate different patterns on HRCT and assess the severity of ILD in patients with RA. Methods We conducted a cross sectional study. Patients with a diagnosis of RA-ILD who were evaluated in three different rheumatic diseases clinics between December 2021 and January 2023 were consecutively included. The diagnosis of RA was defined according to ACR/EULAR 2010 classification criteria. The diagnosis of ILD was confirmed by an experienced radiologist. We performed HRCT, lung function tests, joint disease evaluation, and blood extraction to determine the values of CA 19-9, CA 125, CEA, rheumatoid factor (RF) and ACPAs. The pattern found on HRCT was classified in UIP pattern, probable UIP, indeterminate for UIP, and suggestive of another diagnosis, as proposed the inter society consensus of 2022 [4]. The score proposed by Goh was calculated to determine the extension of lung opacities (inflammatory, fibrotic, and total extension scores) [5]. The joint disease activity was assessed using the DAS28 score. The values of the biomarkers in serum were measured by electrochemiluminescence. T-test, Mann Whitney test, and Chi square were used for comparisons. The Spearman test was used for correlation analysis. Results We included 38 patients, 29 were women (76.3%). The mean (SD) age was of 62.1 (11.5) years. The median (IQR) of DAS28 was 3.3 (2.6-4). Regarding serologic tests, 35/36 (97.2%) and 36/37 (97.3) were positive for ACPAs and RF respectively. In relation to lung disease, the mean (SD) of FVC% was 83.8 (23.4) and the median (IQR) DLCO was 59 (52-81). Eighteen patients (47.3%) showed UIP or probable UIP pattern in the HRCT, while 20 (52.7%) had another pattern. The median (IQR) of Goh score for total lung disease extension was 20 (8-25). Patients with UIP pattern showed significantly higher values of CA19-9 [11.5 (7-35.7) vs 6.5 (2-12.5), p=0.017] and a trend to higher values of CA125 [22 (15-52) vs 14 (11.4-20.7), p=0.06] than those with other patterns. The values of CA19-9 showed a good correlation with total Goh score (r=0.52, p=0.02) and fibrosis Goh score (r=0.65, p=0.03) in patients with UIP pattern. Also, the values of CEA showed an acceptable correlation with total Goh score (r=0.46, p=0.05) and fibrosis Goh score (r=0.43, p=0.07) in patients with UIP pattern. Conclusion Patients with RA ILD and UIP pattern showed higher plasmatic values of biomarkers that reflect epithelial cell activation. Also, the values of some of these biomarkers showed good correlation with the extension of the disease on HRCT. Therefore, these biomarkers could be a useful tool to identify a more aggressive clinical behavior in patients with RA ILD.

The antiphospholipid antibodies registry of the Argentinean Society of Rheumatology (GESAF-SAR): baseline data of the first 162 patients

2020-04-01T00:00:00Z

The antiphospholipid antibodies registry of the Argentinean Society of Rheumatology (GESAF-SAR): baseline data of the first 162 patients Nieto, Romina; Serrano, Rosa; Savio, Verónica; Lema, Luis Roberto; Maldini, Carla; Perés, Silvia; Izaguirre, Pia; Bellomio, Verónica; Leguizamón, Maria Lilia; Sacnun, Mónica; Estevez, Adrián; Avalo, Alejandra; Etcheverri, Maira; Antoniol, María Noelia; Perandones, Carlos Edgardo; Goizueta, Cecilia; Lobo, Victoria; Gobbi, Carla; Artesana, Pablo Objective: Antiphospholipid antibodies registry of the Argentinean Society of Rheumatology (GESAF-SAR) was created to study long-term disease characteristics and outcomes in persistently antiphospholipid antibody (aPL)-positive patients. The objective was to report baseline demographic, clinical, laboratory and treatment characteristics of aPL-positive patients enrolled in the registry. Materials and Methods: GESAF-SAR is a multicenter, multidisciplinary and longitudinal study. Thirty centers from Argentina participated. Data collection was performed by review of medical records and interview with individuals/patients, after signing an informed consent. A web-based data capture system (ARTHROS) was used. Inclusion criteria: aPL with at least one positive determination of Lupus Anticoagulant (LAC) and/or positive Anticardiolipin Antibodies (aCL) and Anti-βeta 2 Glycoprotein I (aβ2GLPI) IgG and IgM greater 40 or positive aCL and/or aβ2GLPI with levels 20-40 GPL or MPL (at least two determinations) separated by 12 weeks. Patients were followed every 12±3 months. Descriptive cross-sectional analysis of data collected from May to October 2019 was performed. Results: Overall 162 patients were enrolled, 139 (86%) were women with a mean age at entry of 40.3 years (SD 12.9); 76 (47%) patients were Mestizo, 72 (44%) Caucasians and 14 (9%) others. The socioeconomic level was Medium-Low in 47 patients (29%), Medium in 58 (36%) and Medium-High in 25 (15%). Seventy-four patients (46%) met classification criteria for Primary APS, 37 (23%) were APS associated with autoimmune disease and 2 (1%) were catastrophic APS (CAPS). Of the 111 APS patients, 50 (45%) presented thrombotic manifestations, 44 (40%) obstetric and 16 (15%) both. Forty-nine patients (30%) did not meet classification criteria of APS. A total of 40 (24.7%) venous events, 34 (21%) arterial, 70 (43.2%) obstetric morbidity and 55 (34%) non-criteria manifestations were recorded. Seventy-seven women presented at least one pregnancy with a total 265 gestations, resulting in 104 (39%) live births. Of all gestations, 80 (30%) were miscarriages <10 weeks, 53 (20%) premature births, 42 (16%) placental insufficiency, 24 (9%) preeclampsia and only 2 (1%) eclampsia. Based on aPL profile, 88 (54%) were positive for LAC, 110 (68%) aCL and 74 (46%) for aβ2GLPI. Regarding treatments, 117 (72%) patients received Aspirin, 71 (43.8%) oral anticoagulation, 53 (32.7%) prophylactic heparin, 46 (28.4%) therapeutic heparin, 92 (56.8%) hydroxychloroquine. Conclusions: In our multi-center Argentinean aPL-positive cohort, at baseline: a) 30% of patients did not meet classification criteria of APS, b) 46% met classification criteria for Primary APS, c) one-fourth were APS associated with autoimmune disease, d) 45% presented thrombotic manifestations, e) the most frequent obstetric morbidity were miscarriages <10 weeks. Future longitudinal analysis of GESAF-SAR Registry will help clarify the risk profiles of aPL in Argentina.

Association between neurological syndromes and Arbovirus in Buenos Aires - Relationship between Guillain Barre Syndrome, Encephalitis and Myelitis with Zika, Dengue and Chikungunya (P4.6-024)

2019-05-08T00:00:00Z

Association between neurological syndromes and Arbovirus in Buenos Aires - Relationship between Guillain Barre Syndrome, Encephalitis and Myelitis with Zika, Dengue and Chikungunya (P4.6-024) Kohler, Alejandro Alfredo; Farez, Mauricio Franco; Heck, Evelyn Sabrina; Barroso, Fabio Adrián; Bruno, Verónica Objective: Analyze the association between Guillain Barre Syndrome (GBS), Infectious Encephalitis (IE) and Transverse Myelitis (TM) with secondary infections to arboviruses in hospitalized patients of Buenos Aires city. Background: Arbovirus infections are currently considered a pandemic in Argentina. There was a significant increase in the incidence of these infections during the 2014–2016 period, compared to previous years. Viruses such as Zika (ZIKV), Dengue (DENV) and Chikungunya (CHIKV) have been associated with different neurological syndromes, mainly with GBS and to a lesser extent with IE and TM. Design/Methods: We conducted a prospective cohort study, including all adult patients diagnosed with GBS, IE and TM, attended at our institution from 1/1/17 to 12/31/17. Samples of serum and / or cerebrospinal fluid were obtained. ELISA test was performed to detect antibodies against ZIKV, DENV and CHIKV. Clinical-epidemiological variables and complementary methods of both groups were recorded. We compared the GBS incidence results obtained in 2017 with respect to those presented in the last 10 years of our institution. Results: We included 39 patients with diagnosis of GBS (n=17), IE (n=18) and TM (n=4). 2 cases of GBS presented positive serology for ZIKV and 2 cases of IE presented positivity for DENV. During the period from 2015–2017, there was an increase in the incidence of GBS cases compared to previous years. Conclusions: In the present cohort, the incidence of cases of GBS, IE and MTA associated with arbovirus infections was relatively low. However, the cases associated with arbovirus infections showed differential clinical characteristics. We believe that epidemiological surveillance of neurological syndromes associated with arbovirus infections is essential to understand the magnitude of the problem at a national and regional level.