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Oral presentations that will be featured in PANLAR 2021 – Part 1

By : Richard Aguirre
Periodista científico de Global Rheumatology by PANLAR.



13 August, 2021

"In this first part we will address five of the research projects selected for the PANLAR Congress 2021 "

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  1. Inflammatory bowel disease

This research addresses the selection criteria for inflammatory bowel disease: application in patients with spondyloarthritis for patient referral between rheumatology and gastroenterology in a group of Colombian patients.

The objective was to apply clinical criteria for diagnostic testing (screening) of Inflammatory Bowel Disease (IBD), in patients with SpA, with gastrointestinal symptoms and their association with disease activity and function. 

A cross-sectional study of 82 patients with SpA was carried out, according to the ASAS classification criteria without diagnosis of IBD. It included clinical examination performed by a rheumatologist and patients with clinical gastrointestinal symptoms. It also included evaluation by a gastroenterologist and IBD screening criteria, which were analyzed through chromoendoscopy, magnifying colonoscopy, histology, PCR, VSG, ferritin, and transferrin. 

The results showed that of the 82 patients evaluated, 41 were referred to gastroenterology with indication for colonoscopy with chromoendoscopy and the IBD screening criteria were applied.

Likewise, it was found that 100% of the population presented gastrointestinal symptoms, the most frequent being diarrhea lasting more than 4 weeks in 61%; 68.3% had at least one of the three main criteria.

In addition, 70.8% of patients had at least one of the minor screening criteria associated with higher BASFI levels.

Among the findings, no patients with positive iron-deficiency anemia were found. However, altered ferritin associated with chronic inflammation of the colon was observed in 22% of patients. There were no cases of fever or family history of IBD.

In 17.1% of the cases a decrease in vitamin b12 levels was detected, associated to the presence of ulcers and acute inflammation of the ileum. Weight loss was also found in 31.7% of the cases and was associated with a history of smoking.

The research concludes that the application of IBD screening criteria in SpA without IBD reflects a high frequency of high intensity symptoms that affect the quality of life and disease activity. Engagement allows patients to benefit from comprehensive treatment of the disease in its early stages.  

  1. Metabolic syndrome in patients with psoriatic arthritis 

In order to study the prevalence of metabolic syndrome in patients with psoriatic arthritis and the correlation between obesity and PsAID-12 score, the researcher Rodrigo García Salinas, along with his team, carried out a cross-sectional multicenter study with a total of 160 patients that fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR), which were enrolled in six Brazilian rheumatology centers

The metabolic syndrome (MS) was defined based on the Adult Treatment Panel III criteria (ATP III) of the National Cholesterol Education Program (NCEP) and the obesity based on the Body Mass Index (BMI). The association of BMI with PsAID-12 was then evaluated through the Spearman correlation coefficient and the significance level adopted was of 5%.

On the method, the researcher highlights that of the 160 patients enrolled, 50% were women, with a mean age of 54 ± 11,2 years. Regarding psoriatic disease, 68% had only peripheral arthritis and 32% had pure or combined axial involvement. MS prevalence was 62.5% and obesity was present in 34.4% of patients. 

In this case there was a statistically significative positive association between BMI and PsAID-12 total score: the higher the degree of obesity defined by the BMI, the higher the PsAID-12 scores.

From the results, García Salinas says that from the research group experience, MS was present in more than 60% of patients and PsAID-12 score was correlated with obesity: obese patients had a significatively higher impact of psoriatic arthritis measured by PsAID-12 score.

  1. Covid-19 in spondyloarthritis patients in Argentina 

 

The aim of the research group, represented by Maria Victoria Martire, is to describe the incidence and severity of the disease caused by covid-19 in spondyloarthritis patients in Argentina.

To this end, they enrolled patients with axial spondyloarthritis (AxSpA) radiographic (EA) and non-radiographic (AxSpA-nr), peripheral spondyloartrhritis (according to ASAS criteria) and psoriatic arthritis (PsA) (according to CASPAR criteria). Patients were followed by telephone or in person on a monthly basis. Data were collected from April 1 to September 20, 2020, and then descriptive statistics were performed with mean and standard deviation (SD) and median and 25th-75th percentile according to distribution, and the cumulative incidence (CI) of the disease was calculated.

For this research, 320 patients were enrolled of which 55% were men, with a mean age of 50, 21.6% had a diagnosis of EA, 6.9% AxSpA-nr, 6.9% SpA and 64.7% PsA.

14 patients were reported with a diagnosis of covid-19 (4.4%), of which 10 diagnosed by positive PCR and 4 by symptoms associated with close contact with a positive case.

In this case, 13 of the patients, equivalent to 93% of the cases, were in the province of Buenos Aires and Ciudad Autonoma de Buenos Aires (CABA), while only one came from Santiago del Estero. 

From the 14 patients with covid-19, 50% were men; 4 had a diagnosis of EA, 1 of AxSpA-nr and 9 (64.3%) of PsA.

The researchers found a 4.4% incidence of covid-19 in the population with EA, with mild symptoms and no deaths were reported. 

  1. Predictors of disease in RA patients 

Rocío Gamboa-Cárdenas and her research group, with the aim of identifying the predictors of active disease in RA patients, carried out a study during four years in a real-world cohort of patients.

In addition, they underscore that clinical remission is the current focus in the treatment of Rheumatoid Arthritis (RA); however, in the clinical practice this may be difficult to achieve, especially in Latin America. 

For this purpose, a real-world setting longitudinal RA cohort study was conducted between January 2016 and 2020, which was defined using the ACR/EULAR 2010 criteria and overlap syndromes (except Sjogren's) were excluded.

For this case, the predictors examined at baseline and at each subsequent visit wee sex, age at diagnosis, disease duration, socioeconomic status according to the Graffar method, tobacco use, anti-CCP antibody, rheumatoid factor, active disease (simple disease activity index – SDAI), disability (MDHAQ), health related quality of life [SF-36, reported as physical component summary (PCS) and mental component summary (MCS)], measurements, glucocorticosteroids (GC, use and dosage), b FAME/synthetic molecules and all the immunosuppressive agents, including cDMARDs.

A single variable model and a multivariable widespread equation model were run to determine predictors of clinically persistent active disease at each visit. All potential predictors were assessed at the same visit and disease activity (SDAI> 3.3) was defined at the subsequent visit.

550 RA patients were enrolled in the study (2009 patients/follow-up year); at baseline 91.8% were women and the mean age was 44.4 years. The SDAI was 28.8, only 94.4 patients were in remission and the rest were in persistent disease activity.  

From the conclusions, they highlight that active disease, disability and low quality of life of patients are predictors of clinically persistent active disease in AR patients.

  1. Power Doppler Ultrasound detected tenosynovitis

With the aim of estimating the frequency of Rheumatoid Arthritis (RA) in a cohort of patients that consulted for polyarthralgia, including hand arthralgia, and identifying differential characteristics between seropositive and seronegative AR patients, Rodrigo García Salinas, and his research group, conducted a cohort study that included patients older than 18 years old who were admitted for polyarthralgia in the “Reumacheck” program (2017-2020).   

In this program, at the first visit laboratory studies were conducted (including acute phase reactants, RF and anti-CCP), x rays, hands power Doppler ultrasound (22 joints: carpal, MCP and PIP (bilateral) and 20 tendons: 6 carpal extensors compartments and flexor tendons from 2° to 5° fingers bilaterally) and interview (sociodemographic, clinical and clinimetrics).

Each evaluator, in this case laboratory, imaging and clinical, did not know the data of the other studies conducted. At subsequent visits, in which only patients who completed at lest two visits were included, the results were evaluated, and the definitive diagnosis of RA was established according to the ACR/EULAR 2010 classification criteria. 

For this purpose, RA was considered seronegative when patients tested negative for both FR and anti-CCP and through statistical analysis descriptive statistics, Chi2 test, Fisher’s exact test, Student T-test and Mann Whitney were performed. 

A total of 746 patients with polyarthralgia were included in the study, of whom 128 ended up with a final diagnosis of RA. Of these, 87 (67.9%) were seropositive, while 41 (32%) were seropositive.

Among the conclusions it was found that the frequency of RA in the cohort of patients with polyarthralgia was 17.1% and the only differential characteristic of the patients with seronegative RA was the higher proportion of tenosynovitis detected by ultrasound with positive power Doppler signal compared to patients with seropositive RA.

 

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