Objective: Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis.Material and Methods: Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels. Results:The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=−0.318), digital contractures (p=0.036, r=−0.298), and muscle weakness (p=0.015, r=−0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=−0.29).Conclusion: Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.

Clinical response in patients with rheumatoid arthritis (RA) treated with biologic agents can be influenced by their pharmacokinetics and immunogenicity. The present study evaluated the concordance between serum drug and antidrug levels as well as the clinical response in RA patients treated with biological agents who experience their first disease exacerbation while being on a stable biologic treatment. 154 RA patients treated with rituximab (RTX), infliximab (IFX), adalimumab (ADL), or etanercept (ETN) were included. DAS28, SDAI, and EULAR response were assessed at baseline and reevaluated at precise time intervals. At the time of their first sign of inadequate response, patients were tested for both serum drug level and antidrug antibodies level. At the next reevaluation, patients retreated with RTX that had detectable drug level had a better EULAR response (P = 0.038) with lower DAS28 and SDAI scores (P = 0.01 and P = 0.03). The same tendency was observed in patients treated with IFX and ETN regarding EULAR response (P = 0.002 and P = 0.023), DAS28 score (P = 0.002 and P = 0.003), and SDAI score (P = 0.001 and P = 0.026). Detectable biologic drug levels correlated with a better clinical response in patients experiencing their first RA inadequate response while being on a stable biologic treatment with RTX, IFX, and ETN.

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BackgroundValidated disease activity scores and damage measurements were developed over time in order to allow a better way to evaluate patients and decide treatment plans.There are scores designed for a great variety of vasculitis like Birmingham Activity Score and others that are more specific like Behcet's Disease Current Activity Form2006.ObjectivesTo evaluate the ability of the activity scores (BVASv3and BDCAF)to predict damage,and the influence of immunosuppressive therapy on damage progression,as measured byVDI, in a group of patients with Behcet's Disease.MethodsA study was performed on a cohort of patients diagnosed with Behcet's Disease under surveillance in one tertiary Rheumatology Centre, from a non-endemic area.All documented cases of Behcet's Disease have been diagnosed according to The International Criteria for Behçet's Disease.The Birmingham Activity Score (BVAS)v3, Behcet's Disease Current Activity Form2006 (BDCAF)and Vasculitis Damage index (VDI) were calculated for all patients. Spearman's correlation coefficients were calculated between BVASv3 Score, BDCAF, VDI and immunosuppressive treatment.WindowsExcel/SPSS20.0 has been used to analyse the data.Results20 patients were included in the study, with ages at the time of the diagnosis between 13and 60years, 14 (70%) under the age of 40,with a male predominance 60% (12 patients). All patients presented active disease at the time of the diagnosis. In the clinical case series, Spearman's rank correlation coefficient between BVASv3 and BDCAFwas strong r=0,862with p<0,001.The outcome analysis after remission was calculated and rank correlation coefficient betweenVDI, and both BVASv3 and BDCAF was moderate (VDI-BVASv3 r=0,747, p<0,001, VDI- BDCAF r=0,795, p<0,001).As for immunosuppression induction decision and activity scores,the correlation coefficient was moderate (r=0,734 for BVASv3,r=0,647 for BDCAF)with p<0,001. There was a moderate correlation between immunosuppressive treatment and VDI (r=0,700, p<0,001). Since the cause of damage (vasculitis vs. treatment)is not taken into consideration when we calculate VDI, we tried to observe if there are any connections between this and immunosuppression duration. There was a mild correlation and no statistical impact between cyclophosphamide treatment duration and damage calculated as VDI (r=0,474, p=0,36).In contrast, when rank correlation coefficient between cortisone therapy and VDI was calculated, a moderate statistical impact was observed (r=0,609, p<0,001).ConclusionsBirmingham Vasculitis Activity score (BVAS) v3 and Behcet's Disease Current Activity Form2006 (BDCAF) are reliable tools for evaluating disease activity in patients with Behcet's Disease. They are able to anticipate the need for immunosuppressive therapy and the damage progression, as calculated with Vasculitis Damage Index (VDI).References Mukhtyar C, Lee R, et al. Modification and validation of the Birmingham vasculitis activity score, Ann Rheum Dis, 2009.Flossmann O, et al. Development of comprehensive disease assessment in systemic...

Background:Sexual health is an essential element of overall health and well-being. Rheumatic diseases may affect sexual functioning in many ways related to pain, fatigue, stiffness, functional impairment, depression, anxiety, negative body image, reduced libido, hormonal imbalance and drug treatment. However, these issues are rarely addressed in clinical practice.Objectives:The aim of this study was to evaluate sexual function in a cohort of men with rheumatic disease compared to healthy controls.Methods:This was an observational, single-center, cohort study conducted between august 2019 and march 2020 in the Rheumatology department of “Saint Mary” Clinical Hospital in Bucharest which included 120 men with ages between 18 and 60 years - 60 patients with rheumatic diseases and 60 healthy controls. The study tools were the Sexual Health Inventory for Men (SHIM) questionnaire and one questionnaire referring to personal data, history of the rheumatic disease, comorbidities, treatment and sexual impairment. Also, the disease activity was assessed using specific scores for each condition.Results:In this cohort of 60 patients, the mean age was 45.26 (7.8) years and the diagnoses wereankylosing spondylitis (AS) - 37%,psoriatic arthritis (PsA) - 18%, rheumatoid arthritis (RA) - 17%, systemic sclerosis (SS) - 15% and gout - 13%. More than half of the patients (62%) had active disease based on specific scores (ASDAS for AS, DAS28-CRP for RA, EScSG disease activity indices for SS, DAPSA for PsA). Regarding sexual life, this study showed a significant decrease in sexual life quality after rheumatic disease diagnosis(before diagnosis: 71,67% - satisfying and 16,67% - not satisfyingversus after diagnosis: 21,67% - satisfying and 68,33% - not satisfying). Most patients (90%) reported impairment of their sexual life after diagnosis. In terms of sexual dysfunction (SD), a significantly higher proportion of patients (40%) mentioned reduced libido compared to the control group (18,33%) (p=0.043). Also, 21,66% of the patients reported erectile dysfunction (ED) in comparison with only 8,33% in the control group (p=0.009). Most patients with AS, RA, PsA and gout had mild ED while most patients with SS presented with mild to moderate ED. Also, the SHIM score mean value was significantly lower in the study group (17,65)compared to the control group (20,15) (p=0.009). The importance of SD in this cohort is emphasized by the fact that only one patient conceived after rheumatic disease diagnosis. Concerning treatment, more than half of the patients (55%) reported no effect of the therapy on their sexual life while 38.33% mentioned that medication improved their sexual life and very few (7%) reported a worsening.Conclusion:This study revealed a higher prevalence of sexual dysfunction in male patients with rheumatic disease in comparison with healthy controls. Considering the importance of sexual and reproductive health, rheumatologists should approach this topic with their patients and offer them guidance.References:[1]AG Tristano, “The impact of rheumatic diseases on sexual function”, Rheumatol Int 2009 Jun;29(8):853-60Disclosure of Interests:None declared