The incidence of Type 1 (insulin-dependent) diabetes mellitus was prospectively evaluated in Catalonia, Spain in patients up to 30 years of age during the period 1987-1990. The population at risk (0-29 years) consisted of 2,690,394 inhabitants (total population of Catalonia 5,978,638). All the cases were independently identified from four sources: endocrinologists, sales of blood glucose monitors and insulin pen injectors, diabetes societies and diabetic summer camps. The degree of ascertainment was 90.1%. The overall observed incidence rate was 10.7 per 100,000 per year, being 11.5 per 100,000 per year in the 0-14 age group. The incidence in males (12.0 per 100,000 per year) was higher than in females (9.3 per 100,000 per year), with a male/female ratio of 1.36/l. The sex differences were only present in cases over 14 years of age. Age specific incidence rates per 100,000 per year were 4.4 (confidence interval 95%: 3.2-5.7) in the age group 0-4, 9.9 (8.5-11.4) in 5-9, 17.5 (15.7-19.4) in 10-14, 11.4 (9.9-13.0) in 15-19, 11.3 (9.7-13.0) in 20-24 and 8.5 (7.2-9.9) in 25-29. There was a seasonal onset pattern, with the highest incidence in winter (December-February). We conclude that the incidence of Type 1 diabetes observed in Catalonia during the period 1987-1990 is higher than that recently reported in other Mediterranean countries. This study offers the first standardized data on Type 1 diabetes incidence in Catalonia, including cases up to 30 years, and contributes to the knowledge of the epidemiology of diabetes in South Europe.

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Background: Antinuclear antibodies (ANA) are the serological hallmark of connective tissue diseases (CTD) and indirect immunofluorescence (IIF) on Hep-2 cells is still considered the gold standard for ANA screening. While this method is sensitive it lacks specificity. Moreover, low-titer ANA subspecificities may escape detection by IIF. Objectives: To investigate the usefulness of an ANA screening assay containing most of the diagnostically relevant antigens for CTD diagnostics. Methods: Sera from 265 consecutive patients presenting with symptoms characteristic of connective tissue diseases (but without a clear diagnosis yet) were analysed by IIF and the EliA ® CTD Screen (Thermo Fisher Scientific) containing the following antigens: dsDNA, U1-snRNP, Sm, Ro60, Ro52, La, Rib-P, topoisomerase I (Scl-70), centromere B, RNA polymerase III, fibrillarin, Jo-1, Mi-2, Pm/Scl. All positive sera were further analyzed by monospecific assays (Thermo Fisher Scientific). Results: Among the 265 patients, 90 were positive by IIF and 78 by CTD Screen; 61 sera were positive in both systems, 17 only in the CTD Screen and 29 only in IIF. In all double positive patients at least one diagnostically relevant antibody was detected, with anti-Ro and anti-dsDNA antibodies being most frequently detected. Importantly, antibodies were also detected in 15 of the 17 patients who were exclusively positive in the CTD Screen: 7 patients had anti-dsDNA, 4 anti-Ro, 1 anti-La, 2 anti-U1snRNP, and 1 patient had anti-Jo-1 antibodies. In contrast, among the 29 sera exclusively positive by IIF only two contained a diagnostically relevant antibody. Clinical evaluation revealed that 16 out of the 17 CTD Screen pos/IIF negative patients presented with at least 1 clinical sign commonly associated with systemic rheumatic disease (sicca syndrome, 12 patients; arthritis/arthralgias, 13 patients; microangiopathy, 2 patients; myositis, 2 patients; leukocytopenia, 2 patients; Raynaud's phenomenon, 5 patients; pericarditis, 1 patient; thromboembolic events, 2 patients). These patients may be at higher risk for developing a CTD, or, alternatively, may be at an early stage of a CTD in which a definite diagnosis is not yet to be made. The combination of distinct autoantibodies with clinical signs of systemic rheumatic disease, however, warrants a careful follow up in these patients. Conclusions: ANA screening assays containing multiple antigens such as the EliA ® CTD Screen seem to be helpful diagnostic tools that should be used in addition to IIF for detection of disease-associated autoantibodies enabling the physician to substantially improve diagnostics of connective tissue diseases.

BackgroundSystemic Sclerosis (SSc) has been widely studied from a purely global standpoint, but only a few trials have analysed patients with interstitial lung disease (SSc-ILD) as well.Objectives1. Describe the clinical features of a cohort of patients with SSc and SSc-ILD. 2. Determine whether there are disparities among different types of SSc-ILD and their progression in patients with either limited (lcSSc) or diffuse involvement (dcSSc). 3. Ascertain whether there are disparities among different types of SSc-ILD and their progression according to the SSc-specific autoantibody (AAb).MethodsRetrospective study of a cohort of patients with ILD-SSc controlled during an SSc consultation. The following variables were collected: sex, age, SSc and ILD progress in years, type of SSc and ILD, smoking, digital ulcers (DU), pulmonary hypertension, digestive disorders, cancer, SSc treatment, corticosteroid doses and lastly, lung function tests upon diagnosis, at treatment onset, and 24 months later. Additionally, a record was kept on the types of AAb present in every SSc. Qualitative and quantitative variables were compared in relation to the clinical and immunological sub-classification. Chi-square and Student's T Tests were performed. A p-value≤0.05 was considered significant.Resultsout of 266 patients with SSc, data from 47 patients with ILD-SSc were gathered; 89.4% were female, with an age range of 66.09±15.1 years old, and 9.85±10.2 and 4.38±9.24 years of progression of their SSc and ILD respectively. 33 out of 47 sustained lcSSc, and both Scl-70/ATA (29.8%) and ACA (26.1%) were the most frequently found AAb. Non-specific interstitial pneumonia (NSIP) was the most common ILD radiological pattern (76.6%). Most patients with SSc underwent treatment (51.1%), 24% with mycophenolate mofetil (MMF); 36.2% of the patients had been concomitantly administrated corticosteroids with a mean prednisone dose of 15.73±10.3 mg/d.Upon comparing patients with lcSSc and dcSSc, prevalence of DU was higher in those with dcSSc (p<0.01), MMF was less frequently used (p<0.02), rituximab was more usually employed (p<0.03), and they presented worse values of FEV1/FVC ratio after 24 months of treatment (p<0.03). No differences were observed as to either type of ILD or progression. However, when variables were analysed regarding AAb in SSc, patients with ACA presented both fewer DU (p<0.02) and NSIP pattern (p<0.02), and more frequent compromise of the small airway (p<0.01), they were younger and thus, they had had shorter progression of the disease. ILD diagnosis was made significantly earlier in those patients with RNA polymerase, and later in those with anti-U1RNP. No AAb was observed associated with neoplasia. Considering the types of ILD, patients with NSIP pattern were younger (p0.054) and presented worse spirometric values.ConclusionsIn terms of ILD-SSc patient stratification, sub-classification by AAb appears to be more specific than the clinical sub-classification. ACA is related to less frequency of NSIP pattern. Unlike what has been de...

BackgroundCardiac conductance disturbances are known to be one of the many extra-articular manifestations of Ankylosing Spondilitis but not as well related to axial spondyloarthropathies.ObjectivesDescription of conduction disturbances found in a group of patients with Axial Spondyloarthropathy (AxSpa) that met ASAS criteria.MethodsClinical and demographic variables of 78 patients with AxSpa were registered. It included cardiovascular risk factors as well as cardiacvascular adverse events. All of them had a routine electrocardiogram done which were analized by a cardiologist.Results48 of the 78 patients were men, with a mean age of 61 with standard deviation (SD) of 14. The mean time of evolution of the disease was 23 years (SD ±16). HLA-B27 was prevalent in 54 (69.2%). The sacroileitis was found in radiologic examination of 72 (92.2%), and 6 (7.7%) of them presented edema in magnetic resonance imaging. Other clinical traits were: 43 (55.1%) peripheric arthritis 43, 8 (10.3%) dactilitis, 33 (42.3%) enthesitis, 16 uveitis (20.5%), 2 (2.6%) inflammatory bowel disease and psoriasis 34 (43.3%). The following cardiovascular risk factors were registered: 25 (32%) smokers, 42 (53%) hypertension, 32 (41%) dislipemia, 9 (12%) diabetes, 9 (12%) hyperuricemia and 20 (20%) obesity. 14 patients had structural cardiopathy (11 ischemic cardiopathy and 3 aortic valvulopathy). The electrocardiographic register showed conductance disorders in 20 patients (25.6%). The details of these findings are specified in table 1.First grade auriculoventricular block5Second and third grade auriculoventricular block2Left anterior fascicular block1Right bundle branch block2Unspecific intraventricular conduction disorder4Bachmann interatrial conduction disorder1ConclusionsA quarter of our series of presented conduction disturbances in electrocardiography. The relation with disease evolution, as in Ankylosing Spondilitis remains yet to be analized.Disclosure of InterestNone declared