Background25 (OH) D is a steroid prohormone that participates in calcium homeostasis and bone health.1 Nonclassical functions of this vitamin have been described in a variety of cells of the innate and adaptive immune system. Currently, the immunomodulatory role of 25 (OH) D in Systemic Lupus Erythematosus (SLE) continues in debate. In addition, a correlation between non-optimal levels of 25 (OH) D and disease activity has been observed.2 In the SLE, there is a high prevalence of non-optimal levels of vitamin D. A prevalence of 25 (OH) D insufficiency of 15% to 75% is reported.3 ObjectivesTo determine the relationship between vitamin D levels and disease activity in SLE.MethodsIt is a prospective, cross-sectional study, in all patients who attended the rheumatology clinic of the Hospital Docente Padre Billini in the period August – October 2017, where the levels of vitamin D and activity of the disease were measured with SELENA-SLEDAI (≤3 without activity, 3–12 moderate activity,≥12 high activity). Vitamin D deficiency is defined as serum levels of 25 (OH) D<10 ng/ml, insufficiency levels serum levels of 25 (OH) D of <30 ng/ml.3 Inclusion criteria: all patients with at least 18 years of age who met the SLE SLICC 2012 classification criteria were included with determination of vitamin D and calcium.Results45 patients who met criteria SLE SLICC 2012 were included. 97.7% (44) were women. The most frequent age range was 31–45 years. 24.4% (11) had decreased calcium values. The vitamin D values were insufficient in 77.7% (35) of the patients and deficient in 4.4% (2) According to SELENA-SLEDAI, 77.7% (35) had no activity of the disease, 20% (9) had moderate activity and 2.2% (1) had high activity. Of the patients who reported disease activity, only 13.3%6 had insufficient vitamin D. There is no significant difference between patients who have vitamin D values greater than or less than 20 ng/ml. In both groups, the majority had SELENA-SLEDAI in low activity.ConclusionsThe vitamin D levels were not associated with an increase in disease activity in our study patients. Although our country is an island, the use of sunscreen and avoid sunbathing is something common, it causes to find low levels of vitamin D, not only in patients with SLE, where avoiding sunbathing is a recommendation, but also in other pathologies that come to our service. We believe that vitamin D levels should be measured in the general population, to have a reference range and study their influence on health.References[1] Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev. 2016; 96:365–408[2] Mandal M, Tripathy R, Panda AK, et al. Vitamin D levels in Indian systemic lupus erythematosus patients: association with disease activity index and interferon alpha. Arthritis Res Ther. 2014;16: R49.[3] Hamza RT, Awwad KS, Ali MK, Hamed AI. Reduced serum concentrations of 25-hydroxy vitamin D in Egyptian patients with systemic lupus erythematosus: relation to dise...

BackgroundCognitive dysfunction (CD) is a deficit of cognitive faculties including attention, memory, language, executive function and visuospatial processing. CD is the most frequent neuropsychiatric manifestation of SLE (55–80%) 1 and this is 3 times higher in patients with Systemic Lupus Erythematosus (SLE) than in healthy subjects.2 This is not routinely evaluated because it requires a lot of time. Brief and simple questionnaires are needed to identify CD.A study carried out by D'Amico et al. evaluated 21 SLE patients and all of them had CD.3 Pedraza et al. analyzed the MMSE score and Montreal Cognitive Assessment (MOCA) and concluded that MOCA performs much better than MMSE for cognitive impairment correct diagnosis.4ObjectivesTo determine the prevalence of CD in SLE patients and compare MMSE and MOCA diagnosis effectiveness.MethodsAll patients with at least 18 years old that met ACR/EULAR 2012 SLE classification criteria were included. Patients with associated comorbidity, not SLE related, that could alter cognitive functions, were excluded. 55 patients that fulfilled the inclusion criteria were admitted to Hospital Docente Padre Billini's rheumatology department from March to April 2016. After obtaining written consent, the psychology department applied both tests, MMSE and MOCA. A standardized form registered demographic variables. Data was analyzed using Microsoft Excel 2013.Results94.5% of the patients were women, 53% were between 31–45 years old, 52.7% were mulatto ethnic, 34.5% had at least a high school degree, 27.2% were diagnosed 1 year before enrollment, 60% had a low activity score using SLEDAI (<4), hypertension was the most common comorbidity with a 38.1%, 90.9% were taking corticoids, 80% were on antimalarial drugs (6 abandoned treatment, 2 by eye involvement, 1 allergic reaction, 2 were diagnosed with SLE the interview day), the most frequent neuropsychiatric symptom ever presented was convulsion (7.2%). Using MMSE 25.4% of the patients showed CD, however after adjusting the results according to the educational level, the percentage increased to 41.8%. MOCA classified that 67.2% of the patients had CD, of which 13 patients were MMSS positive, and finally, 22 classified after the score adjustment.ConclusionsMOCA is more effective than MMSE to detect CD. Nonetheless the MMSE should be considered as an option for patients with low levels of education.References Nasswetter, G. Tratado de reumatología. AKADIA. 2014. Page 323.Díaz-Cortés, D. Correa-González, N. Díaz, M. et al. Compromiso del sistema nervioso central en el lupus eritematoso sistémico. Rev colomb reumatol. 2015; 22 (1): 16–30.D'Amico et al. Estudio multicéntrico de deterioro cognitivo en lupus eritematoso sistémico: ECLES. Rev Arg Reumatol. 2015; 26 (2): 28–32.Pedraza L.O. Sánchez, E. Plata, S. Montalvo, C. et al. Puntuaciones del MOCA y el MMSE en pacientes con deterioro cognitivo leve y demencia en una clínica de memoria en Bogotá. Acta Neurol Colomb. (Bog) 2014. Acknowledgements.Disclosure of InterestNone declared

BackgroundAntimalarics are derivatives of quinine indicated in the treatment of autoimmune inflammatory diseases. The mechanism of antimalarial toxicity is unclear. It is hypothesized that toxicity is a result of drug binding to retinal pigmentary epithelium, damaging photoreceptors resulting in vision loss. Early retinal toxicity is asymptomatic with subtle alterations in foveal pigmentation generally not evident at routine ophthalmologic examination, progressively producing classic “bull's-eye” maculopathy, manifested as a decrease in central, color and night vision, and central scotoma. To prevent the sequelae of antimalarial use, sensitive tools are used to detect toxic maculopathy such as: campimetry, optical coherence tomography (OCT) and eye fundus.ObjectivesTo evaluate ocular toxicity in patients with systemic lupus erythematosus treated with antimalarics.MethodsMulticenter cross-sectional study, two rheumatology departments clinical records were analyzed from January 2016 to January 2017, with diagnosis of systemic lupus erythematosus according to ACR 1997 criteria, with ≥4 years using antimalarial drugs. 298 patients were identified, 93 of them fulfilled inclusion criteria, and were evaluated by two retinologists performing OCT on each patient. Accumulated antimalarial doses were calculated and all variables were analyzed with SPSS software V.22.Results97.8% were females, the mean age was 37.4±13 years, 78.5% of the patients used 4mg/kg of chloroquine (CQ) versus 21.5% took 6mg/kg of hydroxychloroquine (HCQ), the mean use duration was 5.1±2 years, 19.4% of patients had retinal pigment epithelium (RPE) changes suggesting maculopathy, of which, 15% used CQ versus 4.35% with HCQ, 54.50% using CQ had a cumulative dose of 365 grams, 10.75% with HCQ had cumulative doses of 292 grams, and the mean for the cumulative dose of both antimalarials was 485 grams.ConclusionsPrevious studies have shown that the antimalarial toxicity rate are between 7.5%>13.1%, in our population we observed that our patients had a higher toxicity rate associated with the use of CQ compared to HCQ, and no association was found relevant with other variables. We understand that both, patients and physicians who manage this drug, should be educated about the need to maintain an adequate ophthalmologic control, due to the progression of retinopathy from 1 to 3 years after discontinuation of treatment. It is necessary to carry out prospective studies with a greater number of patients.References Block, J.A. (1998) Hydroxychloroquine and retinal safety. The Lancet 351(9105), 771–771.Battagliotti, C., Gentiletti, A., Pons-Estel, B. Lupus Eritematoso Sistémico, Aspectos Clínicos y Terapéuticos. 1°. Ediciόn, 42, 515–531.Rosenbaum, J.T., Mount, G.R., et al. (2016). Avoiding Antimalarial Toxicity.Arthritis & Rheumatology.Marmor MF, Melles RB. Hydroxychloroquine and the retina. JAMA 2015;313:847–8. Disclosure of InterestNone declared

BackgroundSjogren’s syndrome (SS) is an autoimmune chronic where there is a B-cell activation and lymphocytic Infiltration of exocrine glands, this can be primary or secondary and characterised by xerostomia, xerophtalmia and extraglandular manifestations1. Thyroid involvement is frequent in patients with SS sharing histological and antigenic characteristics2. 10–24% of patients with SS have thyroid involvement, the most common are Hashimoto’s thyroiditis or Grave’s disease are the most frequent autoimmune syndromes. Some reports indicated that Hashimoto’s Thyroiditis and Grave’s disease has an incidence of 4.2% and 3.4% in the patients with SS respectively. A study showed that in patients with SS 45% had changes in the values of thyroid hormones and 24% autoimmune thyroiditis.3-5 ObjectivesDetermine the changes in the thyroid hormones in patients with Sjogren’s syndrome.MethodsA cross-sectional study. The information was collected from the digital records of Hospital Docente Padre Billini Rheumatology department during the period October 2017-January 2018. Inclusion criteria: age ≥to 18 years old, patients with Sjogren’s syndrome according to ACR/EULAR 2016 criteria. Excluded patients who did not thyroid test during the study and patients who have a thyroid disorder under treatment. The data was analysed using SPSS V23 Windows 10.Results79 cases were reviewed, of which 51 met the inclusion criteria. 98% were women, average age of 45 years, 9.8% had hypothyroidism and 3.9% hyperthyroidism by laboratory tests. 82.3% were euthyroid. 82.3% had anti Ro and anti La, 96% Schirmer test +and 37.2% positive biopsy report for SS.ConclusionsIn our study, we found that 9.8% of patients with Sjogren’s syndrome could be associated with subclinical hypothyroidism and 3.9% with hyperthyroidism what can mask the clinical manifestations at the time of diagnosis. The screening in high-risk patients such as patients with autoimmune disorders remains important.References[1] Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: a consensus and data-driven methodology involving three international Patient cohorts. Arthritis Rheumatol2017; 69:35–45.[2] José Rosa Gómez, José Miguel Senabre Gallego, et al. Management of extra glandular manifestations of Sjogren’s syndrome. Clinical Rheumatology. 2010; 6 (s2): 6–11[3] Barragán-Garfias JA, et al. Enfermedades tiroideas autoinmunes y del tejido conectivo. Rev. Med Inst Mex Seguro Soc. 2013; 51(2):e1–5[4] Tsuboi H, Asashima H, Takai C, et al. Primary and secondary surveys on Epidemiology of Sjögren’s syndrome in Japan. Mod Rheumatol2014; 24:464–70[5] Sumie Moriyama, Reo Yoshikawa, et al. Clinical, Endocrinological and Immunological Characteristics of Japanese Patients with Autoimmune Polyglandular Syndrome Type 3a. J Endocrinol Metab. 2016; 6(2):46–51Disclosure of InterestNone declared