Objective. To determine the prevalence and impact of autoimmune thyroid disease (AITD) in patients with rheumatoid arthritis (RA). Methods. Eight-hundred patients were included. The association between AITD and RA was analyzed was analyzed by bivariate and multivariate analysis. In addition, a literature review was done focusing on geographical variations. Results. In our cohort the prevalence of AITD was 9.8% while the presence of antibodies was 37.8% for antithyroperoxidase enzyme (TPOAb) and 20.8% for antithyroglobulin protein (TgAb). The presence of type 2 diabetes, thrombosis, abnormal body mass index, and a high educational level was positively associated with AITD. The literature review disclosed a geographical variation of AITD in RA ranging from 0.5% to 27%. Autoantibody prevalence ranges from 6% to 31% for TgAb, 5% to 37% for TPOAb, and from 11.4% to 32% for the presence of either of the two. Conclusion. AITD is not uncommon in RA and should be systematically assessed since it is a risk factor for developing diabetes and cardiovascular disease. These results may help to further study the common mechanisms of autoimmune diseases, to improve patients' outcome, and to define public health policies. An international consensus to accurately diagnose AITD is warranted.

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Background: Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective: To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods: HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results: A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion: The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients.

Background There is a clear causal relationship between tobacco smoking and rheumatoid arthritis (RA), supported by observational studies and systematic reviews (1); however, the effect of smoking on disease activity and the development of joint surface erosions has not been clearly established. Current data are conflicting, with some studies reporting an increased activity and progression (2,3) of erosions and others showing an opposite relationship (4). Objectives To summarize through a systematic review and meta-analysis of available data in the literature about cigarette smoking and RA, regarding its effect on disease activity and radiographic progression. Methods The systematic search was done following PRISMA guidelines in the Medline, EMBASE databases up to August 2012 and databases alerts until November 2012. Additional studies were identified from the EULAR and ACR congresses from 2000 to 2012 and article references. Search terms included “smoking”, “tobacco”, “smoke”, “cigarette” and “rheumatoid arthritis”. Any type of study done with RA cases, defined by accepted classification criteria and having information about the relationship between cigarette smoking and DAS28 or erosion score was considered for inclusion. A common effect size was calculated based on a random effects model. Results Out of a total of 2215 articles retrieved, 43 articles met inclusion. Of these, 27 were included in the meta-analysis. Twelve contained information about DAS28 and 17 about radiographic progression. There was a negative association between smoking and EULAR response (OR: 0.72; 95% CI:0.57-0.91; p-value:0.005) and DAS28 remission (OR:0.78; 95%CI:0.63-0.96; p-value:0.023). DAS28 was significantly higher in current smokers (MD:0.29; 95% CI:0.12-0.44;p-value:<0.001) as well as erosive score (SMD:0.38;95% CI:0.04-0.72; p-value:0.028). Data was ambiguous for erosion progression during follow-up (OR: 0.93; 95% CI: 0.72-1,2; p-value:0.59). A sensitivity analysis confirmed that the results were not sensitive to restrictions on the data included. Publication bias was trivial. Conclusions Cigarette smoking is associated with a diminished response to treatment (by the EULAR criteria) and an increased erosion score. However, an increased rate of radiographic progression was not demonstrated in smokers. Prospective studies are warranted for this topic. References Sugiyama D, et al. Ann Rheum Dis 2010;69:70-81. Saag KG, et al. Ann Rheum Dis 1997;56:463-9. Papadopoulos NG, et al. Clin Exp Rheumatol 2005;23:861-6. Salliot C, et al. Arthritis Rheumatism 2009;60:364. Disclosure of Interest None Declared