Inflammatory Connective Tissue Diseases Research Articles

Pattern of Autoimmune Connective Tissue Diseases Among Patients Attending Al-Thawra Teaching General Hospital, Sana'a-Yemen

Background: Connective tissue is also called connectivum. Many autoimmune diseases affect the connective tissue and blood vessels, are often referred to as connective tissue disorders. Autoimmune diseases currently are estimated to affect 2-5% of the population in the developed countries. Aim: The aim of this study was to determine the pattern of autoimmune inflammatory connective tissue diseases among patients attending Al-Thawra teaching general hospital, Sana'a-Yemen. Method: This study is observational prospective study conducted at Al-Thawra hospital, Sana'a-Yemen, department of internal medicine, duration of the study was 12 months. Sample size was 137. Results: The results showed that systemic lupus erythematosus, antiphospholipid syndrome and rheumatoid arthritis have the highest prevalence. The main clinical presentations are arthritis, leg swelling and dyspnea. The main drugs used are corticosteroids, low molecular weight heparin, and rituximab. The proportion of females to males is 3.55 to 1. The age range 20 – 30 years is the highest representing 47% of the total patients. Patients from Sana'a, Taiz, and Ibb being the most common. Illiterates represent 63%, housewives represent 72% of the total patients. Conclusion: We conclude that autoimmune connective tissue diseases affect 8% of the total patients admitted to the internal medicine department. SLE is the most common autoimmune connective tissue disease encountered and represents 43% of total cases. Arthritis and leg swelling are the most common clinical presentations encountered; both represents 48% of the total presentations. Corticosteroids are the most common prescribed drugs, 45%. The aetiology of autoimmune connective tissue diseases is still not fully known. Immuno-modulators are needed to regulate the immune system. Physiotherapy is recommended beside medical therapy.

P030 Multiple autoantibody formation post COVID-19 infection

Abstract Background/Aims COVID-19 has been linked to the formation of a number of autoantibodies. This case is an important reminder to clinicians interpreting autoantibody results in conjunction with clinical manifestations. A previously fit 51 year old gentleman, with no prior history of autoimmune disease required admission with respiratory symptoms in April 2020 consistent with COVID-19 infection. His acute respiratory illness was complicated by empyema and left-sided pneumothorax requiring left pleural decortication and adhesiolysis under (VATS). Persistent respiratory symptoms and fatigue lead to investigations for long COVID. Positive antibodies detected were dsDNA 166IU/ml, Proteinase 3 antibodies 20IU/ml, Myeloperoxidase antibodies 32IU/ml, IgG anticardiolipin antibodies 90IU/ml and Glomerular basement membrane antibodies 351 IU/ml. Negative autoantibodies included ANA, RF, aCCP, b2GPI, smooth muscle, AMA and myositis related antibodies. Methods There were no clinical signs or symptoms of inflammatory arthropathy, vasculitis, thrombosis or connective tissue disease. Other investigations included a CT thorax showing no new lung lesions, unremarkable urine dipstick, normal urine ACR, normal US abdomen, CT sinuses and MRI brain. Results Trial course of prednisolone was given therapeutically due to long COVID symptoms. There was no significant impact on symptoms/ autoantibody titres thus steroids were discontinued. The patient was followed closely by the rheumatology team for two years. During that time, the autoantibody levels gradually decreased, and he did not develop clinical signs of autoimmune disease. His long COVID symptoms persisted, and he remains under the long COVID clinical team. Conclusion COVID-19 infection is known to cause an immune response. There have been published cases of positive ANA, U1-snRNP anti-SS-B/La, ANCA, anti-phospholipid and anti-SRP antibody formation following COVID-19 infection. The link between the pathophysiology of COVID-19, autoantibody formation and the role of autoimmunity is still unclear. This man's case was unusual in the number and variety of autoantibodies formed post COVID, this has not been reported in the literature to date. Some of the autoantibodies detected are highly specific for certain conditions, for example anti-GBM antibodies have a high specificity for Goodpasture’s syndrome, thus this case also illustrates the need to interpret positive autoantibodies in the context of clinical findings and history. Disclosure S. Islam: None. N. Erb: None.

Rapid diagnosis of systemic lupus erythematosus by Raman spectroscopy combined with spiking neural network

Multiple organs are affected by the autoimmune inflammatory connective tissue disease known as systemic lupus erythematosus (SLE). If not diagnosed and treated in a timely manner, it can lead to nephritis and damage to the blood system in severe cases, resulting in the patient's death. Therefore, correct and timely diagnosis and treatment are essential for patients. In this study, a framework based on neural network algorithm and Raman spectroscopy technique was established to diagnose SLE patients. Firstly, we pre-processed the obtained Raman data by three methods: baseline correction, smoothing processing and normalization methods, before using it as input for the model, and then ANN, ResNet and SNN classification models were established. The respective classification accuracies for SLE patients were 89.61%, 85.71%, and 95.65% for the three models, with corresponding AUC values of 0.8772, 0.8100, and 0.9555. The results of the experimental indicate that SNN possesses a good classification effect, and the number of model parameters is only 525,826, which is 414,221 less than that of ResNet model. Since the network only uses 0 and 1 to transmit information, and only has basic operations such as summation, compared with the second-generation artificial neural network, which simplifies the product operation of floating point numbers into multiple addition operations, the network has low energy consumption and is suitable for embedding portable Raman spectrometer for clinical diagnosis. This research highlights the significant potential for quick and precise SLE patient discrimination offered by Raman spectroscopy in conjunction with spiking neural networks.

Pseudo-chilblain lesions in children during the COVID-19 pandemic

Introduction and objective: During the COVID-19 pandemic, a range of uncommon cutaneous symptoms were observed, which were linked to the SARS-CoV-2 infection. These dermatological symptoms in the form of reddish or purple-coloured lesions on the fingers and toes, accompanied by blisters and ulcerations, were termed as “COVID fingers/toes” – a pseudo-chilblain cutaneous manifestation of COVID-19. The aetiopathogenesis of pseudo-chilblain lesions has not been conclusively determined. At first, SARS-CoV-2 infection was regarded as an evident cause of chilblains. Various studies conducted over a two-year period have not managed to plausibly confirm its direct implications. Materials and methods: The study was of a retrospective nature. The analysis involved clinical symptoms, results of selected laboratory tests, as well as capillaroscopy of the microcirculation in 15 children diagnosed with skin lesions of chilblain-like morphology. Results: All patients from the study population presented with lesions in distal body parts which were of erythematous or oedematous morphology, and resembled chilblains. None of the hospitalised patients suffered from fever or presented with other systemic symptoms. The reverse transcription polymerase chain reaction test for SARS-CoV-2 was negative in all the patients. SARS-CoV-2 antibodies were found in 5 out of 9 patients tested for their presence. Microcirculation abnormalities were diagnosed in 80% of the patients. In none of the children did capillaroscopy image correspond with microangiopathy characteristic of inflammatory connective tissue diseases. Frequent abnormalities found in more than two fingers/toes were: pericapillary oedema (57%), dilated capillaries (42.8%), venous stasis (35.7%), presence of branched and tortuous capillaries (28.5%). Conclusions: Pseudo-chilblain lesions observed during the SARS-CoV-2 pandemic are probably secondary to multifactorial epiphenomenon.

High Prevalence of IDH Mutation in Myeloid Neoplasm with Concomitant Autoimmune Rheumatic Disorders

BACKGROUND: The association between myeloid neoplasm (MN) and autoimmune rheumatological diseases (AIRD) is increasingly recognized. Furthermore, prolonged cytotoxic disease modifying anti-rheumatological drugs (DMARD) for AIRD may potentially induce therapy-related MN (t-MN), a lethal haematological malignancy with dismal outcomes. However, the genetic association and mechanism underpinning immune dysfunction in patients with between MN and AIRD is not fully elucidated. METHODS: In this collaborative study across the two disciplines and continents (Australia and USA), we assessed the burden of well-defined AIRD in a large cohort of MN (n=1702) that included myelodysplastic syndrome (MDS; n=861), acute myeloid leukaemia (AML; n=640), myeloproliferative neoplasm (MPN; n=89) and MDS/MPN overlap (n=112). We characterized the cytogenetic and mutational landscape of MN with AIRD (MN-AIRD) and without AIRD. In order to assess the mechanistic link between AIRD and MN, we investigated the bone marrow microenvironment in MN-AIRD vs. well-curated age matched controls. RESULTS: 132 (7.75%) of MN (n=1702) had concomitant AIRD. Although association of AIRD was observed across all subtypes of MN, enrichment of AIRD was observed in patients with MDS, MDS/MPN and MPN compared to AML (9.5% vs. 9.8% vs 10.1% vs. 4.67%; P <0.001). Inflammatory arthritis (n=65; 49.24%) followed by inflammatory connective tissue diseases (CTD, n=23; 17.42%), polymyalgia rheumatica (PMR, n=18; 13.63%) and vasculitis (n=16; 12.12%) were the most prevalent AIRD in the MN cohort. Notably, 87.7% of inflammatory arthritis were rheumatoid arthritis (RA; n=57). Striking survival differences were observed between t-MN without AIRD and MN-AIRD (14.0 vs. 33.7 months; P <0.0001) and t-MDS no-AIRD and MDS-AIRD (16.1 vs. 33.4 months, P =0.001). Chromosomal abnormalities including complex karyotype, monosomal karyotype, del 5q, del 7q, marker chromosome and TP53 mutations were enriched in t-MN following independent primary cancer (t-MN without AIRD). However striking enrichment of IDH1 and IDH2 (henceforth referred as IDH) mutations in MN with AIRD compared to MN without AIRD (20% vs. 11%, P =0.02), particularly in MDS-AIRD compared to MDS without AIRD (21% vs. 7%; P =0.001). The enrichment of IDH mutations were particularly prevalent in in MN cases with RA compared to other AIRD (34% vs. 11%; P =0.005). While IDH mutations were observed in only 8% and 6% of PMR and inflammatory CTD patients, respectively. Surprisingly higher frequency of IDH mutations was observed in evaluable seronegative compared to seropositive RA patients (62% vs. 0%; P =0.006). We also observed that majority of IDH mutations in seronegative RA were IDH1 (6/8; 75%) while IDH2 mutations were common other AIRD (6/6; 100%) ( P =0.009). We also assessed the impact of DMARDs on genomics of myeloid neoplasm. The majority of MN-AIRD patients treated with methotrexate did not harbor poor risk cytogenetic and mutation features such as complex karyotype, monosomal karyotype, del 5q, del 7q and/or TP53 mutation. In contrast, the majority of patients who had cyclophosphamide harbored high risk cytogenetic and molecular features. To assess pathogenic mechanisms linking MN and AIRD, we evaluated bone marrow microenvironment in myeloid neoplasm patients with and without AIRD. Bone marrow mesenchymal stromal cells (MSC) isolated from MN-AIRD were highly senescent compared to age matched healthy controls, MN without AIRD, with defective proliferating and differentiation capacity of MN-AIRD and secretion of highly proinflammatory cytokines and chemokines. CONCLUSIONS: In summary, our key findings include: 7.8% of MN were associated with AIRD with stronger association of AIRD with MDS and MDS/MPN compared to AML and striking enrichment of IDH mutations in MN with inflammatory arthritis compared to MN with other AIRD (29% vs 11%; P =0.02), especially in seronegative RA compared to seropositive RA (62% vs. 0%; P =0.006). In contrast to cyclophosphamide and azathioprine, majority of cases treated with methotrexate did not harbor poor risk cytogenetic and/or TP53 mutation. As methotrexate is widely used as an anchor drug in many rheumatology treatment regimens, this is a highly significant finding of clinical relevance.

Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report.

Lipedema is a chronic inflammatory subcutaneous adipose-rich connective tissue disease affecting millions of women worldwide. Disproportionate fat accumulation on the extremities characterized by heaviness, tenderness, and swelling can affect function, mobility, and quality of life. Treatments include conservative measures and lipedema reduction surgery (LRS). Here, we report lipedema comorbidities and surgical techniques, outcomes measures, and complications after LRS. This is a single outpatient clinic retrospective chart review case series of comorbidities and complications in 189 women with lipedema. Bioelectrical impedance analyses, knee kinematics, gait, physical examinations, Patient-Reported Outcomes Measurement Information System, and RAND Short Form-36 questionnaires collected before and after LRS were analyzed for 66 of the 189 women. Hemoglobin levels were measured by transdermal hemoglobin monitor (Masimo noninvasive hemoglobin monitoring; Irvine, Calif.). Common comorbidities in 189 women were hypermobile joints (50.5%), spider/varicose veins (48.6/24.5%), arthritis (29.1%), and hypothyroidism (25.9%). The most common complication in 5.5% of these women after LRS was lightheadedness with a 2-g reduction or more in hemoglobin. After conservative measures and LRS in 66 women, significant improvements (P ≤ 0.0009) were found for: (1) knee flexion (10 degrees); (2) gait; (3) Patient-Reported Outcomes Measurement Information System T-score (16%); (4) mobility questions: gait velocity, rising from a chair, stair ascent; (5) RAND Short Form-36 scores: physical functioning, energy/fatigue, emotional well-being, social function, general health; (6) and Bioelectrical impedance analyses total and segmental body fat mass. LRS provided significant improvements to women with lipedema using direct physical measurements and validated outcome measures, comparable to those seen after total knee replacement.

Genetic Disorders in Pediatric Rheumatology Clinic: When to Suspect, and Why?

Just under a decade ago, most children with genetic disorders received a phenotypic diagnosis, often by atlas matching. With advances in genomics (decoding of human genome, easy availability of genetic testing, and reduction in cost of tests), genotypic diagnosis is now a reality. Genetic diseases can lead to non-inflammatory arthritis that can mimic juvenile idiopathic arthritis (JIA). A small but growing number (as newer genes are discovered) of genetic diseases are being diagnosed in children with aseemingly inflammatory musculoskeletal diseases or connective tissue diseases. A high index of suspicion by the pediatrician is most important for early diagnosis of these genetic disorders. In a busy outpatientclinic, it is the atypical presentation of a disease in a child that suggests a possibility of underlying genetic autoinflammatory or autoimmune disease. Correct diagnosis helps the physician, child, parent, and community.

CT Patterns of Interstitial Lung Disease in Patients with Plaque Psoriasis: A Retrospective Case Series Study.

Background and Objectives: Recently published articles reported an association between psoriasis and interstitial lung diseases (ILDs). The aim of this study is to evaluate the differences in ILD computed tomography (CT) patterns between smoker and never smoker plaque psoriasis (PP) patients under topical treatment without psoriatic arthritis (PA), inflammatory bowel disease (IBD) or connective tissue diseases (CTDs). Matherials and Methods: Two radiologists evaluated chest CT examinations of 65 patients (33 smokers, 32 never smokers) with PP. Results: Usual interstitial pneumonia (UIP) pattern was diagnosed in 36 patients, nonspecific interstitial pneumonia pattern in 19, hypersensitivity pneumonitis in 7 and pleuropulmonary fibroelastosis (PPFE) in 3 patients. UIP pattern showed a statistically significant higher frequency in smoker patients (p = 0.0351). Respiratory symptoms were reported in 80% of patients. Conclusions: ILDs seems to represent a new comorbidity associated with psoriasis. Moreover, a statistically significant association between smokers and UIP pattern in PP patients is found. Respiratory symptoms should be evaluated in PP patients, in collaboration with a radiologist and a pneumologist. However, further studies are required to better understand the epidemiology of ILDs in PP patients.

Are Patients With Systemic Sclerosis Subject to an Increased Risk of Developing Superficial Erosion of Atherosclerotic Plaques?

Various inflammatory rheumatic diseases (RDs) are associated with an increased risk of developing cardiovascular (CV) disease. Increased cardiovascular morbidity and mortality has been reported in inflammatory arthritis (including rheumatoid arthritis, psoriatic arthritis, gout, and spondyloarthritis) and connective tissue disease (including vasculitis, systemic lupus erythematosus, and systemic sclerosis [SSc]).

Psychotherapy program as an additional treatment method for patients with rheumatoid arthritis, multidisciplinary approach

IntroductionChronic diseases, with the development of medicine, the extension of life expectancy and the reduction of dying from infectious diseases, have become a leading public health problem. Rheumatoid arthritis (RA) is a chronic, progressive, multifactorial, autoimmune, systemic inflammatory disease of connective tissue, and sufferers are at greater risk of developing psychological disorders, depression and anxiety being the most common. Optimal treatment of RA should include periodic screening of somatic and psychological comorbid disorders and diseases with a multidisciplinary approach to treatment.ObjectivesPresenting a psychotherapy program as an additional method of treating patients with rheumatoid arthritis.MethodsIn University Hospital Dubrava, a psychotherapy program was organized for patients with rheumatoid arthritis, which took place once a week for 12 weeks, and consisted of autogenic training, education about the disease and group psychotherapy. The program would begin with autogenic training held by a clinical psychologist, and the main goal was to achieve psychophysical relaxation. This was followed by an education on rheumatoid arthritis, in which a clinical rheumatologist was involved, and the goal was to provide basic information about the disease, thereby achieving better cooperation with health care personnel and a more active role in their own treatment. In the end, there would be a time-limited dynamic group psychotherapy conducted by a psychiatrist/psychotherapist with the basic therapeutic effects of group therapy.Results As a result of a 12-week psychotherapy program for somatic patients, which was held in a clinical hospital, patients’ anxiety and depression decreased, the experience of pain decreased, and there were positive changes in the perception of the quality of life.ConclusionsA multidisciplinary approach is recommended in treating patients with rheumatoid arthritis and psychotherapy progam can be used as an additonal way of treatment.Disclosure of InterestNone Declared

Interleukin-32 as a biomarker in rheumatic diseases: A narrative review.

Interleukin-32 (IL-32) is an important cytokine involved in the innate and adaptive immune responses. The role of IL-32 has been studied in the context of various diseases. A growing body of research has investigated the role of IL-32 in rheumatic diseases including inflammatory arthritides (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and connective tissue diseases (systemic lupus erythematosus, systemic sclerosis, granulomatosis and polyangiitis, and giant cell arteritis). IL-32 has been shown to play different roles according to the type of rheumatic diseases. Hence, the putative role of IL-32 as a biomarker is also different in each rheumatic disease: IL-32 could serve as a biomarker for disease activity in some diseases, whereas in other diseases it could be a biomarker for certain disease manifestations. In this narrative review, we summarize the associations between IL-32 and various rheumatic diseases and discuss the putative role of IL-32 as a biomarker in each disease.

Impact of vaccination on postacute sequelae of SARS CoV-2 infection in patients with rheumatic diseases

ObjectiveVaccination decreases the risk of severe COVID-19 but its impact on postacute sequelae of COVID-19 (PASC) is unclear among patients with systemic autoimmune rheumatic diseases (SARDs) who may have blunted...

Phenotypes of body composition in patients with systemic sclerosis

Background. Systemic sclerosis (SSc) is an autoimmune inflammatory disease of connective tissue with a polysyndromic clinical picture. One of the factors that significantly affect the quality of life of such patients is the involvement of the musculoskeletal system. A small number of studies were aimed at studying osteoporosis and body composition in patients with SSc, however, the clinical heterogeneity of the disease, a small number of patients included in the studies do not allow to draw unambiguous conclusions about the frequency of various phenotypes of body composition, their relationship and factors affecting their occurrence.Aim. To study the body composition and to establish the frequency of isolated and combined pathological phenotypes in women with SSс and to determine the factors associated with the muscle mass.Materials and methods. 85 postmenopausal women (46 with SSc, 39 without rheumatic pathology) were included. Questionnaires, anthropometric measurements, assessment of nutritional status by MNA, dual-energy X-ray absorptiometry of the whole body, lumbar spine, femoral neck and total hip were carried out. Correlation and univariate linear regression analyses were performed to identify factors related to appendicular muscle mass.Results. Normal body composition was found in 13.0% of patients with SSс and 25.6% — in the control, isolated and combined pathological phenotypes were detected in 34.8% and 52.2% women with SSс and in 61.5% and 12.8% in the group without rheumatic diseases, respectively. Combined pathological phenotypes, phenotypes with the presence of sarcopenia and/or osteoporosis were significantly more often in SSc patients (p< 0.001), but the frequency of obesity did not differ (69.6% and 64.1%, respectively). Negative correlations were revealed between the value of appendicular muscle mass and the presence of osteolysis of the nail phalanges (Rs=-0.23), the cumulative dose of glucocorticoids (GC) (Rs=-0.43) and direct — with the value of the femoral neck BMD (Rs=0.47), nutritional status by MNA (Rs=0.51), BMI (Rs=0.70), the circumference of the shoulder of the non-dominant arm (Rs=0.68), waist (Rs=0.66), hips (Rs=0.72) and lower leg of the non-dominant leg (Rs=0.81), p< 0.05. Univariate linear analysis confirmed the presence of positive associations between the appendicular muscle mass and proximal hip BMD, BMI, shoulder circumferences, waist, hips and lower leg (p< 0.001), and negative associations with the Rodnan skin score (p=0.012) and the cumulative dose of GC (p=0.001).Conclusion. 87% of patients with SSc had pathological phenotypes of body composition, among them combined phenotypes were significantly more common than in people without rheumatic diseases. BMD in the proximal hip, BMI, circumference of the shoulder, waist, hips and lower leg were positively, and the Rodnan skin score and cumulative dose of GC were negatively associated with the appendicular muscle mass.

Foot and Ankle Conventional Radiography in Juvenile Idiopathic Arthritis: Does It Still Matter?

Objectives:The aim of this study was to evaluate the residual value of Conventional Radiography in children with arthralgia clinically suspected of Juvenile Idiopathic Arthritis (JIA).Materials and Methods:Three hundred seventy-two patients aged 1–18 years suspected of JIA were retrospectively reviewed. All patients had foot and ankle plain films performed in standard two projections: ankle in antero-posterior and lateral, and foot in antero-posterior and oblique. The cohort was divided into two groups: patients with confirmed JIA and non-JIA control group of children with foot and ankle arthralgia without diagnosis of inflammatory connective tissue disease. Radiographic findings in both groups were compared.Results:In 40% of JIA and 70% of non-JIA patients radiographs were normal. All radiographic findings were significantly more common in JIA than in non-JIA group (p = 0.000). Soft tissue swelling was the most frequent abnormality found in JIA patients (31, 51%) and only in 2.41% of non-JIA patients (p = 0.000). Osteoporosis and joint space narrowing were also significantly more common in JIA group (p = 0.000). The majority of imaging findings in non-JIA group were non-inflammatory abnormalities.Conclusion:Conventional radiography is an important tool in differential diagnosis of arthralgia of unknown etiology, as soft tissue swelling, osteoporosis and joint space narrowing are significantly more common in JIA patients as compared with patients without the diagnosis of inflammatory connective tissue disease. However, in case of high clinical suspicion of JIA and normal radiography, we recommend subsequent ultrasound (US) and/or MRI to allow early treatment.

The Role of Leptin in Systemic Lupus Erythematosus: Is It Still a Mystery?

Systemic lupus erythematosus (SLE) is a chronic inflammatory connective tissue disease with varying clinical manifestations. Recent studies have proposed that leptin may be related to SLE development. This study aims to assess current information regarding the relationship between leptin and SLE. A systematic search was done using PubMed, Google Scholar, ScienceDirect, Epistemonikos, and Cochrane Library databases. Studies published in the English language in the last 10 years were selected based on predefined eligibility criteria. The quality of the studies was evaluated using the Newcastle-Ottawa Scale and the Assessment of Multiple Systematic Reviews 2 tool.A total of 12 studies were included in this systematic review. These included systematic reviews/meta-analyses, cross-sectional studies, and case-control studies. Based on the findings of this review, we conclude thatleptin is significantly elevated in SLE patients; however, it does not seem to correlate with disease activity. The exact mechanism of leptin in the pathogenesis of the disease remains unknown and further research is needed regarding this aspect.

P021 Development of a Rheumatology Hot Clinic in the Midst of a Pandemic

Background/AimsThe COVID-19 pandemic has had a significant impact on emergency and scheduled care, affecting both inpatient and outpatient services for all specialities, including Rheumatology. During the first pandemic peak, rheumatology outpatient clinics all became virtual (i.e. telephone or video), except for a single emergency clinic per week. However, this face-to-face clinic, quickly became oversaturated resulting in a waiting list extending above 4 weeks for our patients.MethodsIn the lead-up to the second COVID-19 peak during the winter, we developed a novel, urgent, hot Rheumatology Clinic within our Ambulatory Emergency Care (AEC) department. This whole-day weekly clinic was delivered by a Rheumatology registrar, with consultant support. Its purpose was to provide a service for patients who did not require hospitalisation but required urgent face-to-face Rheumatology speciality review that could not wait for an outpatient appointment. Referrals came from General Practice, Urgent Care (i.e. Emergency Care, Acute Medicine and AEC) and from the Rheumatology department. Pathologies reviewed included vasculitides, inflammatory arthritis and inflammatory connective tissue diseases. The clinic facilitated for patients with suspected new diagnoses or flares of established rheumatological diseases. Furthermore, patients could also undergo urgent joint and soft tissue procedures. All referrals were directed to the Rheumatology registrar to triage. Because of the success of the clinic, it continued beyond the second peak with data gathered from its inception.ResultsData was collected between November 2020 and June 2021, covering 23 hot clinics. A total of 118 patients were reviewed during this period. The highest number of referrals occurred during the second peak of the pandemic (38 patients over seven clinics compared to 48 patients over ten clinics post-peak). The majority of referrals were from Rheumatology directly (70%) compared with Urgent Care (14%) and General Practice (12%). Most (60%) were seen within 7-days of referral; a further 27% were seen within 7- 14 days. The main reasons for review delays beyond seven-days were lack of available clinic (46%) or lack of space (29%). The most common disease encountered was a chronic inflammatory arthropathy (48 patients).ConclusionThe service has generated positive feedback from all patients. Furthermore, this clinic has benefited both Rheumatology and AEC. Firstly, it ensured timely face-to-face reviews of patients requiring urgent Rheumatology assessments. Secondly, it eased pressure on the Rheumatology department, particularly the outpatient emergency clinic. Thirdly, it ensured that the Rheumatology registrar continued to have Rheumatology training opportunities, particularly when redeployed during the Winter wave on other days of the week. Fourthly, the AEC department have had easier access to Rheumatology reviews. Finally, it has empowered the registrar to manage their own workload and organise the clinic enhancing management and leadership experience. The success of the clinic has resulted in its ongoing continuation.Disclosure A. Khan: None. C. Murdoch: None. I. Wamuo: None.

Acute Exacerbation of Rheumatoid Arthritis Misdiagnosed as COVID-19: A Case Report

BackgroundRheumatoid arthritis (RA) is a systemic inflammatory connective tissue disease that affects 1–2% of the population worldwide. Pulmonary manifestations including interstitial lung disease (ILD), airway disease, pleural and vascular disease can be seen in up to 30–40% of patients with RA, which are recognized as the second most frequent cause of death in RA patients. The simultaneous occurrence of COVID-19 in RA patients with or without ILD, and the similarities and differences between RA-related ILD and COVID-19 lung findings have been reported in the literature. However, there was no reported case on differentiation of clinical findings of a patient with RA exacerbation causing a new diagnosis of ILD during the pandemic conditions.Case PresentationHere, we presented a patient with RA who was misdiagnosed as COVID-19 twice due to non-specific respiratory symptoms and ground-glass opacities observed in high-resolution CT. The misdiagnosis led to a delayed diagnosis of ILD and prolonged pulmonary symptoms.DiscussionClinicians must critically review patients throughout the diagnostic workup by thinking other diseases besides COVID-19, particularly in the absence of a confirmatory result. The link between ILD or ILD exacerbation and COVID-19 remains to be determined. While research continues in the field, it is important to consider the importance of COVID-19 in cases of ILD exacerbation, and vice versa.ConclusionDistinguishing lung imaging findings of COVID-19 from ILD is a major concern. Even though the primary manifestation of COVID-19 consists of respiratory symptoms, clinicians should be vigilant for other common conditions having the same symptoms. Clinicians should carefully distinguish a differential diagnosis between COVID-19 and a flare of rheumatic disease.

Vitamin D status of patients with systemic inflammatory connective tissue diseases: a cross-sectional study

Background. In addition to regulating mineral metabolism and bone metabolism, vitamin D is important for supporting structure and other types of connective tissue. Studies have shown the role of vitamin D deficiency in the pathogenesis of systemic inflammatory diseases of the connective tissue, autoimmune diseases. The results of studying this problem in countries with different geographic locations are also of interest.Aim. Comparative assessment of vitamin D status of patients with systemic inflammatory diseases of the connective tissue and patients without rheumatic diseases.Materials and methods. This cross-sectional observational study analyzed the vitamin D supply of the following groups: patients with systemic inflammatory diseases of the connective tissue who do not take vitamin D preparations, patients with systemic inflammatory diseases of the connective tissue who take vitamin D preparations, and «conditionally healthy» individuals, without complaints, examined in the same period comparable in gender and age with the patients of the main group. The vitamin D supply of the studied patients was determined by the level of the content of the vitamin D metabolite calcidiol in the blood serum 25 (OH) D. Study period: January 2019 to December 2020.Results. The data of 625 patients who applied to the Osteoporosis Prevention and Treatment Center for the specified period were analyzed. Among the patients of the main group who did not take vitamin D preparations, a deficiency was revealed in 54.7% of the examined, the optimal provision in 11.2%. The median serum 25 (OH) D concentration was in the range of 19.0 ng / ml deficiency. The study participants belonging to the comparison group had a deficit in 44.1% of cases and an optimal provision in 21.5%. The study group of the main group receiving vitamin D preparations had the maximum number of individuals with the optimal status – 37.0%, while a significant part of the examined had a deficit of varying severity – 29.1%. In addition, this group was characterized by the highest median serum metabolite 25 (OH) D – 26.0 ng / ml.Conclusion. A comparative analysis of the D-vitamin status of patients with systemic inflammatory diseases of the connective tissue and «conditionally healthy» individuals without complaints was carried out, which made it possible to establish differences in the provision depending on the existing disease, as well as depending on the therapy with vitamin D preparations. a lower supply of vitamin D than control group «healthy» individuals. In the case of receiving vitamin subsidies, the provision with it in the group of patients was statistically significantly higher, both in comparison with patients who did not take the vitamin, and in comparison, with individuals from the comparison group.

Cardiovascular Diseases and Periodontitis.

Periodontitis is a chronic inflammatory disease of the tooth-supporting connective tissue and alveolar bone that is initiated by a bacterial biofilm in periodontal pockets. It affects about half of adults in the Western world, and is associated with a range of systemic comorbidities, e.g., cardiovascular disease (CVD), diabetes and rheumatoid arthritis, and these diseases share overlapping systemic and target tissue inflammatory mechanisms. Indeed, mounting evidence has indicated that their association is causal and built on the presence of systemic low-grade inflammation (LGI). Prior research linking periodontitis to CVD has mainly been derived from experimental studies, observational data, and small interventional trials with surrogate markers of CVD, e.g., endothelial dysfunction. However, recent data from randomised studies have demonstrated that intensive treatment of periodontitis can reduce blood pressure in patients with hypertension in conjunction with reduction of systemic inflammatory markers. Furthermore, targeted anti-inflammatory therapy has been shown to reduce recurrent events in patients with established CVD and LGI. Along this line, the concept of residual inflammatory risk has emerged as an independent new risk factor for atherothrombotic CVD. The present review summarizes translational evidence indicating that periodontitis is a risk factor for CVD dependent on LGI, and we conclude that treatment of periodontitis is likely to contribute importantly to reduction of residual inflammatory risk.

Mortality related to COVID-19 in patients with rheumatic and musculoskeletal diseases, first wave of the outbreak: a single-center study.

Objectives:The aim of this study was to assess the cause-specific mortality rate related to COVID-19 (CMR) in patients with rheumatic and musculoskeletal diseases (RMDs) and COVID-19 and to analyze the role of the different RMDs in their mortality risk.Methods:An observational longitudinal study was conducted during the first pandemic wave in our center. Patients with the diagnosis of RMDs and COVID-19 were included. Main outcome is the death related to COVID-19. Independent variable – type of RMDs: autoimmune rheumatic diseases (ARD), such as chronic inflammatory arthritis (CIA) and connective tissue diseases (CTD) and non-autoimmune Rheumatic Diseases (non-ARD). Survival techniques were used to estimate the CMR per 1000 patients-month with a 95% confidence interval (CI), and Cox multivariate regression analysis was run to examine the effect of ARD compared to non-ARD on mortality risk adjusted by confounders. Results were expressed by Hazard Ratio (HR) and CI.Results:Overall, 405 patients were included (642.5 patients-month). During the study period, 44 (10.86%) deaths were recorded. CMR was 68.48 (50.96–92.01). After adjusting for confounders, HR of mortality in ARD compared to non-ARD did not achieve statistical significance [HR: 1.15 (0.64–2.07)], neither CTD versus CIA nor CTD versus non-ARD. Age and certain comorbidities which are being diagnosed in March compared to April or May [HR: 2.43 (1.1–5.55)] increased the mortality risk. Glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) dropped from the final model.Conclusion:In patients with RMDs and COVID-19, CMR was 6.8% patients-month. This study shows that mortality risk is higher in males, older patients, and similar between CTD, CIA, and non-ARD. COVID-19 management improved after the first month of pandemic.Plain Language Summaries Mortality related to the outbreak of COVID-19 in patients with rheumatic and musculoskeletal diseases Why was this study done? - To report the COVID-19-specific mortality rate in patients with a variety of RMDs during the first pandemic peak in a tertiary hospital in Madrid and to analyze the role of specific types of ARD and other possible factors in the risk of death related to COVID-19. What did the researchers do? - We performed a retrospective observational study during the first wave of the COVID-19 pandemic in Madrid, Spain. What did the researchers find? - In this study, neither the different diagnoses of RMDs, including CIA, CTD, or non-ARD disease or its treatment were not implicated as a potential risk of death related to COVID-19- In consonance with other studies, RMDs patients and COVID-19, older age, male sex, and certain comorbidities implied more mortality risk- Our data reflect COVID-19 severity in a particular context, time, and population. In times of the absence of COVID-19 vaccine, healthcare, social, and political measures taken to contain the coronavirus outbreak have worked properly. What do the findings mean? - The presence of comorbidities in RMDs patients represents a greater risk than the different types of RMDs themselves, in the development of COVID-19 fatal outcome. It is important to integrate the control of comorbidities in the daily management.