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BackgroundThe PANLAR-EOA (early-onset-arthritis) project includes panamericanrheumatologists to determine regional characteristics of patients with early onset arthritis.ObjectivesTo describe the cohort of Paraguayan patients included in PANLAR-EOA project.MethodsLongitudinal, prospective, multicentricstudy. Patients were included according to the PANLAR-EOA project and registered in REPANARC(www.panlareoa.org) database. At baseline and annual visits, a large number of demographic, clinical and analytical variables were recorded. Quantitative variables were characterised by their means and standard deviations, while the qualitative variables were characterised according to the percentage of patients. The comparison of epidemiological and clinical variables was performed using the chi-squared test and the Wilcoxon test respectively for qualitative and quantitative variables, respectively.Results136 patients with early onset arthritis were included, out of which 88 completed the 12 months follow up and 58 the 24 months one. In these, 86%were female with a median age of 43.9±13.2 years. The most frequent race was mestiza in 80.1%. According to GRAFFAR index, middle class was the predominant social stratum (9.8±3.1). The average number of years of schooling was 12.8±3.8. Polyarticular onset was registeredin 61% patients. During follow-up, 43.1% had positive rheumatoid factor and 56.5% positive anti-CCP. The diagnostic delay was 3.9±3.0 months. Initially, 63.2% (86/136) were diagnosed with rheumatoid arthritis (RA) and 36.8% (50/136) with undifferentiated arthritis (UA). The most frequent treatment was methotrexate (85.3%, 90.9%, and 89.3% at baseline, 1 and 2 years of follow-up respectively). During follow-up, a significant diagnostic change was observed in patients with UA (p=0.004, OR=2.9 [95%CI, 1.4–6.5]). The variables associated with RA diagnosis werepresence of anti-CCP (p=0.000, OR=15.8 [95%CI,5.4–51.1]), rheumatoid factor (p=0.000, OR=9.2 [95%CI,3.4–27.0]), smoking (p=0.032, OR=8.8 [95%CI,1.1–404.7]), high body mass index (p=0.041, OR=1.94 [95%CI,−0.2–4.1]) and high activity measured by the DAS28 index (p=0.01). After one year of follow-up there was a significant decrease in disease activity according to DAS 28 (p=2.2e-09[95% CI, −1.5,–0.9]), SDAI(p=1.2e-11[95% CI, 18.2,–11.2]) and HAQ (p=7.2e-08[95% CI,−0.7,–0.4]). Similar results were found at the 2nd year of follow-up, DAS28 (p=8.8e-06[95% CI,−1.6,–0.7]), SDAI (p=2.1 e- 07 [95% CI,−20.0,−10.3]) and HAQ (p=3.4e-08[95% CI,−0.9,–0.5]).ConclusionsIn this cohort of early onset arthritis, diagnostic delay was lower than that observed in other series and the rate of change from diagnosis of UA to RA was statistically significant during the first year of follow-up. A good control of the inflammatory activity of the disease was observed, with a significant improvement of all the variables analysed during its evolution.Disclosure of InterestNone declared

BackgroundSystemic Lupus Erythematosus (SLE) is a systemic inflammatory disease associated with genetic, environmental, hormonal and immunological factors. Vitamin D levels are nowadays considered as one possible factor associated with disease activity. Therefore, previous studies have analyzed vitamin D to the severity of SLE.ObjectivesTo assess the Vitamin D status in paraguayan SLE patients and its association with disease activity.MethodsAn observational Trial has been performed on individuals diagnosed with SLE. Epidemiological, clinical and biochemical data have been recorded for each patient to study the association between vitamin D concentrations, the phospho-calcium metabolism parameters and disease activity. Quantitative determination of Vitamin D was perform using chemoluminescence ARCHITEC assay. Vitamin D status was interpreted as follows: deficiency ≤20 ng/ml and insufficiency 21–29 ng/ml. The statistical association tests were performed using linear (SLEDAI activity index) and logistic (Inactive/Mild vs Moderate/Severe) regressions. The epidemiological, clinical and biochemical variables were used as explanatory variables in these models.This study is a preliminary analysis of a trial supported by CONACYT (Paraguay) to investigate the role of vitamin D in patients diagnosed with SLE.ResultsWe included 77 SLE patients, of whom 94.8% (73/77) were female. The average age of patients at the time of the study was 30.7±10.3 years. All patients received calcium supplements associated with vitamin D. The average vitamin D concentration was 32.2±12.10 ng /ml. 29.9% (23/77) of patients had vitamin D insufficiency and 13.0% had vitamin D deficiency. 94.8% (73/77) of the population had normal serum calcium and the total population had a normal phosphoremia. As for the dosage of PTH, it was found that 27.3% (21/77) have high values of PTH. 20.8% (16/77) of the patients had positive anti-DNA. Low C3 complement was observed in 30/77 (39%) and low C4 in 50/77 (64.9%) patients.The mean value of SLEDAI at the time of the study was 2.32±2.83. When we study the distribution of vitamin D concentration according to the disease activity (SLEDAI) a clear pattern is observed linking lower vitamin D concentrations with higher disease activity (Figure 1). Patients with lower vitamin D concentrations are more likely to have higher disease activity (OR 0.93, 95% CI 0.88–0.99;P-Value=0.059. The means and standard deviations of vitamin D depending on the SLEDAI activity index are provided in Table 1.Table 1.Mean and standard deviation of each patient group according to the ranges of SLEDAI activity indexSLEDAIMeanStandard deviation 0–132.419.612–334.5913.374–532.2814.386–825.87.61>822.0318.13ConclusionsIn this preliminary study of Paraguayan SLE patients, Vitamin D deficiency was frequent despite treatment with supplements. In addition, a clear association between SLEDAI and Vitamin D values was observed. The final analysis in a larger patient cohort will have to confirm these findings and clarify relation with disease activity...

Patients with the diagnosis of systemic lupus erythematosus (SLE) have an elevated morbidity and mortality from cardiopulmonary complications that develop during the evolution of the disease. Considering the incidence of the mortality in this immunologic Cardiopulmonary morbidity and mortality in patients with systemic lupus erythematosus