We described that having vitamin D deficiency and suffering from an AD are independent risk factors for women primary infertility. Supplementation of vitamin D might be useful for pregnancy outcome.

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Evidence supports that hereditary angioedema (HAE) may be considered as a paroxysmal permeability disorder with defective but self-limiting endothelial barrier dysfunction. A potential subclinical abnormal vascular permeability at retinal capillaries could induce damage resulting in retinopathy. We aimed at exploring for the first time the presence of microangiopathy at retinal level from a highly selective cohort of patients with HAE due to C1 esterase inhibitor protein (C1INH) deficiency (type I). We conducted a pilot, prospective, case-control study including 20 type I HAE patients and 20 age−/sex-matched healthy controls (HC). All participants underwent standard ophthalmological examination including visual fields. Superficial and deep capillary plexi in the retina were analyzed by using new optical coherence tomography angiography (OCT-A). A total of 40 eyes from 20 HAE patients and 20 eyes from HC were evaluated. Perimetric indices of visual field were slightly worse in HAE than in controls. OCT-angiograms documented in HAE patients a lower retinal capillary density in both superficial and deep scans and a higher retinal thickness compared to healthy eyes. Our findings firstly documented subclinical abnormalities in retinal microvascular network in type I HAE patients that might be associated with early subtle functional changes. This preliminary evidence supports the hypothesis of a recurrent endothelial barrier failure at retinal level in HAE patients potentially resulting in chronic damage.

BackgroundEnteropathic spondyloarthritis (eSpA) is a chronic autoimmune disease associated with inflammatory bowel disease (IBD) that is poorly diagnosed and managed.ObjectivesTo assess the diagnostic and therapeutic effect of a combined gastro-rheumatological approach in eSpA patients.MethodsIBD-patients with joint pain referred to a dedicated rheumatologist by gastroenterologist were enrolled. Clinical and biochemical variables, SpA and intestinal disease activity measures, and treatment (biologic; bDMARDs and conventional synthetic; csDMARDs) were recorded at baseline, 3, 6, 12 and 24 months. The association between treatment on demographic and clinical characteristics was evaluated by logistic regression.ResultsFrom a total of 229 IBD patients, 147 (64.2%) were diagnosed with eSpA; 96 (65.3%) showing peripheral involvement and 51 (34.7%) with axial involvement. The majority (67.3%) of eSpA patients were female (n=99), median age and disease duration of 46 and 14.6 years. bDMARD treatment increased over the follow-up period (baseline-24 months: 32.6%>60%; AOR:3.45, 95% CI: 1.93–6.2, p<0.001), however, their use was less frequent in elderly patients (AOR: 0.73, 95% CI: 0.56–0.96, p=0.023), in ulcerative colitis patients (AOR:0.43, 95% CI:0.2–0.94, p=0.034) and in patients with peripheral involvement (AOR:0.53, 95% CI:0.3–1.04, p=0.067). csDMARD use was increased in patients with peripheral involvement (AOR: 4.65, 95% CI:2.09–10.33, p<0.001) and in patient with ulcerative colitis (AOR:2.30, 95% CI:1.13–4.67, p=0.021) (figure 1). CRP, ESR, ASDAS-ESR levels and BASFI were significantly decreased over the follow-up period whereas pMayo score, BASDAI and HAQ-S were unchanged (figure 2).ConclusionsA multidisciplinary approach can improve in the therapeutic management and outcome (e.g. disease activity measures) of eSpA patients. bDMARD use paralleled an improvement in disease measures and confirmed a good safety profile.Disclosure of InterestNone declared

Baseline microbiome and metabolome are associated with response to ITIS diet in an exploratory trial in patients with rheumatoid arthritisDear Editor, Changes in diet might modify the faecal microbiome and metabolomic profile, affecting pain in rheumatoid arthritis (RA). We examined the effect of an anti-inflammatory "ITIS" diet 1 on clinical outcomes, gut microbiome, and metabolome in RA patients, and found that baseline faecal microbiome and metabolome composition were associated with the pain response.A prospective, open-label pilot trial was conducted to evaluate a 2-week isocaloric ITIS diet (Figure 1A) in patients with active RA. The study was approved by the Institutional Board Review. Change in pain (assessed on a visual analogue scale from 0 to 10) was the primary outcome. Patients were classified as responders (N = 7) or non-responders (N = 13), based on the achievement of a 50% improvement in pain. Amplicon sequencing was used for microbiome profiling and untargeted metabolomics for metabolite analysis. Additional methods are included in the supporting information.Twenty patients finalized the trial. Demographics and disease characteristics are summarized in Figure 1B. A diet score (212 = gold-standard) was designed to characterize patients' baseline diet (Figure 1C and Tables S1 and 2). Patients with higher baseline disease activity had lower anti-inflammatory food scores, specifically fruit, probiotics, and anti-inflammatory spices (Figure 1D).Dietary intervention was well tolerated, and overall adherence based on the self-reported diaries was approximately 70%, except for plant protein and probiotics, with final average scores less than 60% of the gold standard (Figure 1C,E and Table S3). We also assessed adherence using a reference data-driven metabolomics approach. In large, the foods recommended increased while forbidden foods decreased post-intervention (https://assets.researchsquare.com/files/rs-654519/v1/ bc74ec0e-1d08-4c67-ad53-98a73e03e3ff.pdf?c=1631886103 and Figure 1F).