BackgroundThe COVID-19 pandemic has infected millions of people around the world and there has been a new surge of virulent strains in many parts of the world[2]. Patients with Systemic Lupus Erythematosus (SLE) were reported to be at higher risk of SARS-CoV-2 infection and worse outcomes from COVID-19, possibly due to their intrinsic immune dysfunction, demographics, disease activity, medications, associated organ damage, comorbidities and as such, have been among the first to receive the vaccines [3]. The most common reason for vaccine refusal in patients with SLE is fear of SLE disease flare. Additionally, SARS-CoV-2 mRNA vaccines could potentially induce interferon production, associated with increased SLE disease activity[1].Objectiveswe report a case of SLE presented with lupus flare after receiving the 1st dose of phizer vaccine.MethodsA 30-year-old female patient, kown case of SLE since 2011 well controlled on low dose steroids, hydroxychloroquine and azathioprine. Upon receiving her 1st shot of Pfizer-BioNTech COVID-19 Vaccine, she developed high grade fever associated with generalized tender papulovesicular skin eruption mainly on the back of the trunk and the outer surface of both thighs, then she developed generalized tonic-clonic convulsions and transferred for Intensive Care Unit (ICU), intubated, mechanically ventilated and received intravenous anti-epileptic medications. During her admission, Cerebrospinal fluid (CSF) examination and Magnetic Resonance Imaging (MRI) brain were done.she regained her consciousness, extubated after 48 hours.ResultsThe initial laboratory invwstigations revealed COVID19-PCR: negative,ESR: 35 mm/hr,CRP: 78,C3: 70 mg/dL (90 – 180) and C4: 8 mg/dL (10 – 40).CSF examination revealed proteins: 116.9 mg/dL (15 – 45),glucose: 46.3 mg/dL (50-60% of serum),LDH: 49.1 U/L (10% of serum) and no cells.Emergency MRI brain was performed revealed multiple bilateral symmetrical mainly cortical and subcortical abnormal signal with cortical swelling are seen mainly involving both occipito-temporo-parietal lobes with patchy enhancement of left cerebellar hemisphere, cerebellar vermis, both thalami, medulla and pons,Picture suggestive of Posterior Reversible Encephalopathy Syndrome (PRES).Accordingly the patient received received pulse steroid therapy for 3 days under cover of oral acyclovir.She also received levetiracetam and Oxcarbazepine.the condition markedly improved and discharged from the hospital for follow up after one month.Conclusion1)The mRNA COVID Vaccine may rarely cause CNS affection, or even SLE flare so, SLE patients must be well controlled before giving the Vaccine. 2) SLE patients must be monitored closely by clinical examination and laboratory investigations after taking mRNA COVID Vaccine.References[1]Barbhaiya M, Levine JM,Siege C,Bykerk VP,Jannat-Khah D and Mandl LA.1201 Flares after SARS-Cov-2 vaccination in patients with systemic lupus erythematosus. Lupus Science & Medicine 2021;8[2]Fernandez-Ruiz R,Paredes JL and Niewold TB. COVID-19 in patients with systemic lupus erythematosus: lessons learned from the infammatory disease.Transl Res.2021;232:13-36.[3]Tang W, Askanase AD, Khalili L, Merrill JT. SARS-CoV-2 vaccines in patients with SLE. Lupus Sci Med. 2021;8(1).Disclosure of InterestsNone declared

Background The relationship between autoimmune thyroid disease and systemic lupus erythematosus (SLE) has been revealed but the prevalence of thyroid disease in lupus patients is controversial. Objectives The aim of this study is to assess thyroid dysfunction and the presence of anti-thyroid antibodies in patients with SLE, and its association with disease characteristics and disease activity. Methods Sixty patients with SLE ≥18 years who satisfied the American College of Rheumatology (ACR) criteria and thirty age and sex matched normal volunteers were included, all underwent laboratory evaluation for serum free T3, free T4, TSH, Antithyroglobulin antibody (Ab TG) and Antithyroid peroxidase antibody (Ab TPO). Clinical and serological characteristics and disease activity of SLE were assessed; correlation with thyroid dysfunction was studied. Results 2 patients (3.33%) had subclinical hyperthyroidism, 24 patients (40%) were euthyroid, 12 patients (21.67%) had subclinical hypothyroidism and 22 patients (35%) had overt hypothyroidism. All subjects of the control group were euthyroid. Patients with thyroid dysfunction had more arthralgias, arthritis, changes of voice, bowel habits and weight, irregular menstruation, sleep disturbance, nervousness and tremors than the euthyroid lupus patients (p<0.05). The lupus patients with subclinical and overt hypothyroidism had statistically significant higher (Ab TG) than the euthyroid patients and patients with subclinical hyperthyroidism and control group (p<0.05) but no statistically significant difference between all groups as regard (Ab TPO). SLE patients with subclinical and overt hypothyroidism had statistically significant higher ESR and SLAM score than the euthyroid patients and patients with subclinical hyperthyroidism (p<0.05). There was a positive correlation between (Ab TG) levels and body mass index BMI, ESR and disease activity measures by SLAM score (p<0.05). Conclusions The thyroid dysfunction is more frequent in SLE patients than control group. Subclinical and overt hypothyroidism are more likely to occur in SLE patients. There are a positive correlation between (Ab TG) levels and disease activity and negative correlation with free T3 & free T4. References Zakeri Z. & Sandooghi M. Thyroid Disorder in Systemic Lupus Erythematosus Patients in Southeast Iran. Shiraz E Medical Journal.2010; 11: 34-8. Scofield RH. Autoimmune thyroid disease in systemic lupus erythematosus and Sjögren's syndrome. Clin Exp Rheumatol 1996; 14: 321-30. Boey ML., Fong PH., Lee JSC., Ng WY. & Thai AC. Autoimmune thyroid disease in SLE in Singapore. Lupus 1993; 2: 51-4. Magaro M., Zoli A., Altomonte L., Mirone L., La Sala L., Barini A. & Scuderi F. The association of silent thyroiditis with active systemic lupus erythematosus. Clin Exp Rheumatol.1992;10:67. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1623

Background: The relationship between autoimmune thyroid disease and systemic lupus erythematosus (SLE) has been revealed but the prevalence of thyroid disease in lupus patients is controversial. The aim of this study is to assess thyroid dysfunction and the presence of anti-thyroid antibodies in patients with SLE, and its association with disease characteristics and disease activity. Methods: Sixty patients with SLE ≥ 18 years who satisfied the American College of Rheumatology (ACR) criteria and thirty age and sex matched normal volunteer were included, all underwent laboratory evaluation for serum free T3, free T4, TSH, Antithyroglobulin antibody (Ab TG) and Antithyroid peroxidase antibody (Ab TPO). Clinical and serological characteristics and disease activity of SLE were assessed; correlation with thyroid dysfunction was studied. Results: 2(3.33%) patients had subclinical hyperthyroidism, 24 (40%) were euthyroid, 12 (21.67%) had subclinical hypothyroidism and 22 (35%) had overt hypothyroidism. All the control group was euthyroid. The patients with thyroid dysfunction had more arthralgias, arthritis, changes of voice, bowel habits and weight, irregular menstruation, sleep disturbance, nervousness and tremors than the euthyroid lupus patients (p<0.05). The lupus patients with subclinical and overt hypothyroidism had statistically significant higher Ab TG than the euthyroid patients and patients with subclinical hyperthyroidism and control group (p<0.05) but no statistically significant difference between all groups as regard Ab TPO. SLE patients with subclinical & overt hypothyroidism had statistically significant higher ESR and SLAM score than the euthyroid patients and patients with subclinical hyperthyroidism (p<0.05). There was a positive correlation between Ab TG levels and body mass index BMI, ESR and disease activity measures by SLAM score (p<0.05). Conclusion: The thyroid dysfunction is more frequent in SLE patients than control group. Subclinical and overt hypothyroidism are more likely to occur in SLE patients. There are a positive correlation between Ab TG level and disease activity and negative correlation with free T3 & free T4.

Background Ankylosing spondylitis (AS) is a systemic inflammatory disorder that causes axial and peripheral arthritis with extraarticular features1. Increased mortality is largely attributable to cardiovascular disease (CVD) that has been found as 20%>40% 2 due to many risk factors driven by systemic inflammatory mediators3. Objectives Is to assess presence of atherosclerosis in Egyptian patients with AS and its relation to disease duration and disease activity. Methods This study included 60 subjects divided into 2 groups; Group I: 30 patients with AS diagnosed according to the modified New York criteria1984 aged ≥18 years. Group II: 30 age and sex matched healthy controls. Patients with heart failure, diabetes mellitus, obesity BMI >30, were excluded. All the subjects were subjected to detailed medical history, clinical examination. Assessment of AS disease activity was done using: BASDAI, BASMI and BASFI. Laboratory investigations included CBC, ESR, CRP titre, lipid profile (Total cholesterol, TG, LDL, HDL), liver and kidney function tests, vWF Ag level in serum by ELISA. ECG, common carotid arterial duplex and dobutamine echocardiography were done for patients only. All the results were subjected to statistical analysis. Results 11 patients (37%) had active AS; 3 of them (27%) were on Anti-TNF blockers treatment and 8 (73%) were not. 19 patients (63%) had inactive disease; 6 of them (32%) were on Anti-TNF blockers treatment and 13 (68%) were not. By carotid duplex, 3 patients (10%) had increased intimal medial thickness (IMT) while 27 patients (90%) were normal. Dobutamine echo showed hypertensive response in 8 cases (26.7%); 6 (75%) of them had active disease while 2 (25%) had inactive disease and it was normal in 22 cases (73.3%). There was significant increase in the level of vWF in actively diseased patients than inactive patients than control group (p<0.05). IMT was significantly increased in AS patients than the control group (p<0.05). AS patients receiving Anti-TNF blocker had a significantly higher LDL (p<0.05). In the inactive group, vWF and IMT were significantly increased in patients receiving biological treatment (p<0.05). Hypertensive response shows significant increase in active than inactive AS patients (p<0.05). There was positive correlation between vWF level and BASDI, BASMI, BASFI scores, fatigue, peripheral arthritis, enthesitis, morning stiffness and IMT and hypertensive response showed positive correlation with BASDI, BASFI scores and morning stiffness. Conclusions vWF, as a marker of atherosclerosis in AS patients, was positively correlated with disease activity scores and IMT. AS patients receiving Anti-TNF blocker had a significantly higher LDL. In the inactive group, vWF and IMT were significantly increased in patients receiving biological treatment. References Yuan SM (2009): Cardiovascular involvement in ankylosing spondylitis. Vascular; 17: 342-54. Lautermann D and Braun J (2002): Ankylosing spondylitis – cardiac manifestations. Clin Exp Rheumatol; 20 suppl: s11-s15. Divecha...

Background A large spectrum of cardiac involvement in rheumatoid arthritis (RA) was already described. The most common cardiac involvement in RA is pericarditis [1]. RA-associated valvular heart disease is common [2]). Also RA patients had higher incidence of heart failure compared to general population due to left ventricular diastolic dysfunction [3], which remains clinically asymptomatic for a long time [4]. Objectives This study was designed to assess cardiac abnormalities in a population of Egyptian patients with rheumatoid arthritis, their association with cardiovascular risk factors and disease characteristics Methods Our study included 50 RA patients and 10 healthy individuals as controls. For all included subjects, detailed medical history was taken, general and local examination were performed as well as laboratory investigations including (complete blood count, ESR, BUN, serum creatinine, AST, ALT, HDL, LDL, cholesterol, triglycerides, hs-CRP, vWF, RF), ECG and echocardiography. RA disease activity was assessed using DAS28 (ESR). Results On Echocardiography, 2 (4%) patients had minimal pericardial effusion, 18 (36%) patient had diastolic dysfunction and 40 (80%) patients had valvular disease: 18 (36%) patients had MR, 6 (12%) patients had AR, 12 (24%) patients had TR and 4 (8%) patients had PR. Patients with valvular lesions were older than other patients (P<0.001). RA patients had significantly higher vWF, hs-CRP, ESR (p<0.001) and diastolic dysfunction prevalence (p=0.023) when compared to controls. Diastolic dysfunction was more in older patients and patients with longer disease duration, higher disease activity, higher hs-CRP (p<0.001), DM, hypertension, longer NSAIDS use and in presence MR, AR and pericardial effusion. vWF was not different (p=0.11) between those with diastolic dysfunction and those without diastolic dysfunction. hs-CRP ≥6.25 ug/ml had high sensitivity (82.4%) and low specificity (51.6%) in diagnosis of diastolic dysfunction in RA patients. Conclusions Patients with RA have significantly higher inflammatory markers (ESR, h-CRP and vWF) as compared to controls. Valvular lesions and diastolic dysfunction are common in RA patients. The prevalence of diastolic dysfunction in RA patients increases with older age, presence of DM, hypertension, longer disease duration, more disease activity, longer use of NSAIDS and high titre of hs-CRP. References Voskuyl AE (2006): The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology Oxford; 45 Suppl 4:iv 4-7. Roldan CA, DeLong C, Qualls CR and Crawford MH (2007): Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. Am J Cardiol; 100: (3), 496-502. Udayakumar N, Venkatesan S and Rajendiran C (2007): Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease. Singapore Med J; 48 (6):537. Philbin EF, Rocco TA, Lindenmuth NW, Ulrich K and Jenkins PL (2000): Systolic versus diastolic heart failure in community practi...