The relationship between RA and asthma has been yielding conflicting results, with most recent studies showing a possible positive association. The study aims at the outcomes of adult patients hospitalized for asthma exacerbation in those with and without RA. We used data from the National Inpatient Sample (NIS) for the period of 2012-2014. ICD 9 code was used to identify the diagnosis. Our primary outcome was in-hospital mortality. Our secondary outcome was total asthma exacerbation hospitalizations, length of stay, and total hospital charges. Compared to those without RA, RA was associated with increased hospitalizations for asthma exacerbation (unadjusted OR 1.29, p < 0.001; adjusted OR 1.06, p = 0.002), more respiratory and systemic comorbidities, increased in-hospital mortality (unadjusted OR 1.89, p = 0.001; adjusted OR 1.60, p = 0.020), length of stay (4.5 vs 3.8; unadjusted p < 0.001, adjusted p < 0.001), and total hospital charges (30,149 vs 26,247; unadjusted p < 0.001, adjusted p = 0.048). Our study was the first to demonstrate that RA is associated with increased in-hospital mortality, length of stay, and cost using a national inpatient database. We hypothesize that in asthmatic patients with concurrent RA, their asthma may represent a distinctive subgroup that is more severe and carries a poorer prognosis, which deserves more attention and future investigation.

Background Tumor necrosis factor alpha (TNFa) is a proinflammatory cytokine than its synthesis increases in patients with Rheumatoid Arthritis, promoting other proinflammatories cytokines and is associated with tenderness and swelling of joints. Etanercept is a DNA recombinant fusion protein, acting as a TNFa inhibitor. Objectives To evaluate the efficacy and safety of Infinitam® (biosimilar etanercept) compared with Enbrel®(reference etanercept) after 12 and 24 weeks of treatment. Methods This is a three treatment group randomized study: first and second group were in a PK sub population. First group received methotrexate plus biosimilar Etanercept 25 mg twice weekly (n=12) during 24 weeks. Second group initially received methotrexate plus reference Etanercept25 mg twice weekly (n=12) followed by 12 weeks with methotrexate plus biosimilar Etanercept 25 mg twice weekly. Third group received methotrexate plus biosimilar Etanercept 25 mg twice weekly (n=30) during 24 weeks. Primary end point was to evaluate the average on patients who achieved on the Disease Activity Score 28 joint assessment (DAS28) at weeks 12 and 24. Results A total of 58 patients were randomized to groups 1, 2 and 3 (12; 12 and 34 respectively). Patients mean age was 47 years old, 91.2% female, and average of methotrexate dose was 12.3 mg/week. The average of DAS28 score at baseline was 6.4, 6.2, 5.9; as week 12: 3.1, 3.8, 3.7 and at 24 week 2.4, 2.7, 2.8 respectively A, B, and C group. None significant difference was observed in the pharmacokinetic groups (p=0.355). Serious adverse events ocurred in one patient of group 3 Conclusions Clinical response, procedures and observations at the end of treatment was as expected in all group of patients. Study drug safety was similar for both drugs. All patients improved DAS28 evaluations. References Klareskog L, Van der Heijde D, de Pager JP, et al. Therapeutic effect of the combination of Etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomized controlled trial. Lancet 2004;363:675-81. Kavanaughm A, Klareskog L, Van Der E. D, et al. Improvement in clinical response between 12 and 24 weeks in patients with rheumatoid arthritis on Etanercept therapy with or without methotrexate. Ann Rheum Dis 2008;67:1444-1447. Weinblatt ME, Kremer JM, Bankhurst AD, et al. A comparison of Etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients rheumatoid arthritis receiving methotrexate. N Engl J Med 1999;340:253-9. G Wells, JC Becker, J Teng, M Dougados, et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis. 2009; 68(6): 954-960 Disclosure of Interest None Declared

We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3-47·7] and 44% (95% CI 36·4-51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3-49·0) and 36% (95% CI 27·9-44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

Aim:We investigated the association between systemic sclerosis (SSc) and perioperative cardiovascular risk for inpatient non-cardiac surgical procedures. Methods:We used data from the National Inpatient Sample (NIS) for the year 2014 to identify patients undergoing inpatient non-cardiac surgery. SSc and major adverse cardiovascular events (MACE) were defined by International Classification of Diseases 9th Revision diagnosis codes. Univariate and multivariate analyses were performed. We adjusted for demographic information, socioeconomic status, cardiac comorbidities, cardiovascular risk factors and procedural category. Two models were used with different categorization strategies for surgical procedures.Results: A total of 8 156 379 hospitalizations for non-cardiac surgeries were included, 4385 of which had a diagnosis of SSc. Patients with SSc were older, more likely to be female and Caucasian and with higher cardiac and systemic comorbidity burden. In univariate analysis, SSc was associated with higher risk of perioperative MACE (odds ratio [OR] = 2.9; P < 0.001) and all-cause death (P = 3.07; P < 0.001). Multivariate analysis yielded conflicting results regarding the association betweenSSc and perioperative MACE (Model 1: OR = 1.42; P = 0.146; Model 2: OR = 1.59; P = 0.048). Subsequent analysis showed that only perioperative myocardial infarction (Model 1 OR = 1.85; P = 0.048; Model 2 OR = 1.94; P = 0.031) was independently associated with SSc.

Macrophage activation syndrome (MAS) is a rare manifestation of systemic lupus erythematosus (SLE) with potentially life-threatening consequences. To the best of our knowledge, this is the first case reported in literature for a constellation of MAS, glomerulonephritis, pericarditis, and retinal vasculitis as initial presentation of SLE. Despite extensive multisystem involvement of his disease, the patient responded well to initial steroid treatment, with mycophenolate mofetil successfully added as a steroid-sparing agent. Our case highlights the importance of multispecialty collaboration in the diagnosis and management of SLE with multisystem involvement.