No abstract

BackgroundAccelerated atherosclerosis is known in gout. Hyperuricemia is considered an independent risk factor for cardiovascular (CV) disease. Evidence supporting both proatherogenic and prothrombotic states in HU is also publishedUltrasound (US) measurement of the carotid intima-media thickness (cIMT) is a recognized measure of premature subclinical atherosclerosis with a predictive value respect to vascular events.ObjectivesTo determine the prevalence of increased cIMT, as sign of subclinical atherosclerosis, by an automated US method, and the associated risk factors in patients with gout and asymptomatic hyperuricemia (aHU)Methods138 patients with gout, 105 with aHU and 99 age and sex matched healthy controls were enrrolled. For all patients were recorded: clinical history, disease duration, smoking, ischemic heart disease, comorbidities (diabetes mellitus, high blood pressure, dyslipidemia, renal insufficiency, obesity), and current therapy. ESR and serum CRP, total and HDL cholesterol, triglycerides, glucose, creatinine and uric acid were recorded. Patients with history of CV and cerebrovascular events or autoimmune diseases were excluded.US examinations of both common carotids were performed by an experienced sonographer trained in cIMT examination, with a Esaote My Lab 70XVG, equipped with a linear probe (4–13 MHz) and an automatic IMT measure software. The definitions of Mannheim cIMT Consensus were adoptedResultsA total of 684 common carotids were assessed. The prevalence of increased cIMT was 47.1%, 47.6% and 1% in patients with gout, aHU, and control group, respectively. The final adjusted logistic regression for patients with gout showed that time of disease progression (OR =0.79, 95% CI 0.66–0.95) and previous smoking (OR =0.32, 95% CI, 0.10–0.97) were associated with cIMT increase (p<0.05) whereas the uric acid levels (OR =1.66, 95% CI 1.07–2.56) was associated with an increased cIMT in aHU. No significant correlation was found with the other variables. No differences in US findings were found between gout and aHU (p=0.936). There was a significant difference in cIMT in gout versus control (p=0.0001) and aHU versus control (p=0.0001).ConclusionsOur results demonstrate that patients with gout and aHU without clinically evident cardiovascular disease have a high prevalence of subclinical atherosclerosis. Disease duration and levels of uric acid are independent factors related with increased cIMT in gout and aHU respectively. These results support the importance of screening for CV risk and to include carotid ultrasound in CV prevention strategies in these patients.Disclosure of InterestNone declared

From the study of our cases we think that the process does not seem to be a coincidence of both diseases but rather of the action of the X factor or factors of RA upon the domain of AS which would result in a variant of associate AS. This would be the true 'rheumatoid spondyloarthritis'. Its rate of frequency, since the predominance of AS marked by HL-A 27 is 6% in our country, would be somewhat higher than that reported by Fallet, if our hypothesis proves to be correct. Evidently it would not reach the ratio of 1/1600 which is the ratio to be expected if every factor of RA, by incidence of the HL-A 27, would cause this mixed picture.

Fabricado en China

BackgroundUltrasound (US) is an important tool to support the clinician in the diagnosis and treatment monitoring of rheumatoid arthritis (RA). The EULAR recommended it for the follow up of RA patients. In spite of the evidence supporting the value of US, the real impact in treatment decisions is not clearly defined.ObjectivesTo investigate the impact of US findings in the treatment decisions of rheumatologists in patients with RA in a real-life setting. Additionally, to verify the US findings that play a role in change of treatment, types of changes and their distribution.MethodsRA patients were included. As a first step, the rheumatologist performed a clinical examination (including DAS28) and recorded the treatment approach suggested according his clinical evaluation (i.e. starting, changing or stopping pharmacological medication as well as local injection). In the same day, after the clinical assessment, the patients were sent for an US examination using the 7-joint score, which was performed by an independent rheumatologist sonographer who reported the US findings to the same rheumatologist that previously evaluated clinically the patient. This last decided, according to the US findings to maintain or change the previous suggested therapy. Additionally, the clinical rheumatologist reported the reasons which induced to change or not the treatment after the US examinationResultsA total of 128 RA patients were included [female 117 (91.4%), male 11 (8.59%)], with mean ± SD disease duration of 9.88±8.22 years. Ninety-four patients (73.4%) had active disease according the DAS 28, whereas 34 (26.5%) were considered in remission.US findings influenced a change in the treatment in 56 cases (43.7%) (47 with clinical active disease and 9 in remission). Among the main reasons that induced a change in the treatment based on the US examinations were: grade of synovitis (25%), higher number of synovitis than clinical examination (16.6%) and presence of power Doppler (PD) (16.7%). The most frequent treatment changes were increasing dose or start a new combination of DMARDs [39 patients (69.5%)]. The multiple logistic regression analysis showed that synovitis of 2nd metacarpophalangeal joint (MCPj) was the US finding with more influence in the decision to change treatment (p=0.016).With respect to distribution, 122 patients (95.3%) had al least one joint with US synovitis and 76 patients (59.3%) had at least one joint with PD. The wrist, 2nd MCPj and 2nd metatarsophalangeal joint (MTPj) were the most affected in terms of synovitis whereas the 5th MTPj showed more erosions (37.7%) and the extensor fingers tendons showed more tenosynovitis (23.02%).ConclusionsUS demonstrated to play an important role in the treatment decision of RA patients. The impact was more frequent in patients with active disease but also affected the decision in patients considered in clinical remission.Disclosure of InterestNone declared