The case of comorbidity of sinus node dysfunction and new coronavirus infection with Sjogren’s disease and Thompson’s myotonia

Coronavirus infection, according to modern data, poses a threat not only to the respiratory system, in more than 15% of patients it can lead to cardiovascular complications, including in young and middle-aged people. COVID-19 is probably the trigger of a detailed clinical picture of chronic diseases occurring in a latent form. The article considers the case of sinus node dysfunction and polyneuropathy in a young patient after coronavirus infection against the background of concomitant diseases such as Sjogrens disease and Thompsons myotonia. To observe the dynamics of the three diseases, the timely organization of a multidisciplinary approach is important. It is necessary to consider all three diseases in the paradigm of the main and concomitant in order to timely and adequate therapy. Further study of the clinical features, therapeutic approaches and complications in patients with COVID-19 is required.

Ultrasound examination of the salivary glands in Sjogren’s disease

The article discusses the importance of ultrasound examination of the salivary glands in Sjogren’s disease for the diagnosis, as well as for assessing the activity of the disease. The characteristics of the main ultrasound changes in the salivary glands and the pathogenetic reasons of these changes are given. The results of studies of the dynamics of changes in ultrasound parameters both in patients not receiving treatment and in the presence of various methods of therapy are presented. The paper also provides basic data on the role of ultrasound in the differential diagnosis of diseases involving the salivary glands.

POS0422 PANNICULITIS AS A MANIFESTATION OF AN AUTOIMMUNE/AUTOINFLAMMATORY DISEASE

Background:ASIA syndrome or Schonfeld syndrome is an autoimmune/inflammatory condition induced by adjuvants in genetically susceptible individuals with the development of rheumatic diseases (RD), multiple sclerosis, sarcoidosis, and others.Objectives:to characterize the symptoms of panniculitis (Pn) associated with ASIA-syndromeMethods:Within 7 years, ASIA syndrome was diagnosed in 12 women, average age 37.2±7.4, with a referral diagnosis of “Erythema Nodosum” or “Panniculitis”. The duration of the disease was 16.7±3.9 months. In addition to general clinical study, the serum concentration of α-1 antitrypsin, amylase, lipase, ferritin, creatine phosphokinase (CPK), immunological parameters (ANP-Hep2, dsDNA, C3 and C4, CRP, ANCA, Scl-70, antibodies to cardiolipins G and M), computed tomography of the chest organs, pathomorphological and immunohistochemical examination of a biopsy specimen of skin with subcutaneous fat tissue (SFA) from the affected areas.Results:The development of ASIA syndrome was preceded by gluteoplasty using propantriol-1,2,3 (in 4 patients), liposuction (2), biorevitalization with hyaluronic acid (2) and endoprosthetics with breast implants (2), bone metal construction (1) and mesh hernioplasty (1). The clinical picture of Pn was characterized by generalized red-purple painful (VAS pain 55.8±17.3 mm) subcutaneous indurations on the upper limbs and trunk (in 100% of cases), face (16.6%) and lower limbs (33.3%), with ulceration and oily fluid leakage (58.6%). The saucer symptom was recorded in 83.3% of the observed patients. In 66.6% of cases, fever and articular syndrome were observed, in 41.6% – myasthenic syndrome and lymphadenopathy, in 8.3% – xerophthalmia, keratoconjunctivitis dry, xerostomia and recurrent parotitis. In blood tests, leukopenia (up to 2.0x109/l) was identified in 33.3% of patients, a significant increase in the level of creatinine phosphakinase – in 16,6%, a two or more times increase in ESR and CRP – in 100%. All patients demonstrated immunological changes. The morphological picture of the skin and SFA in 75% of cases resembled lobular Pn, in 8.3% – tumor lymphocytes with the immunophenotype of cytotoxic T-lymphocytes: CD3+, CD8+ were detected. The results obtained allowed confirming RD in 8 patients: systemic lupus erythematosus and idiopathic lobular panniculitis in 2 patients (respectively) and 1 in dermatomyositis, systemic scleroderma of Sjogren’s disease, mixed connective tissue disease. One case was diagnosed with sarcoidosis and T-cell lymphoma. In 2 patients after the liposuction procedure the course of Pn was reversible.Conclusion:Diagnosis of Pn associated with ASIA syndrome is a complex task that requires a multidisciplinary approach to verify the diagnosis and treatment tactics.Disclosure of Interests:None declared

Quality of life of patients with Sjogren’s disease with ongoing therapy with diseasemodifying antirheumatic drugs

Purpose of the study. Assessing the association between the life quality of patients with Sjogren’s Disease and ongoing therapy with various disease-modifying antirheumatic drugs.Material and methods. The study was conducted on the basis of the regional rheumatology center of the consultative diagnostic clinic of the Sverdlovsk Regional Clinical Hospital No. 1. This work is based on the results of a simultaneous study of 74 patients with primary Sjogren’s Disease (SD), distributed in three comparison groups receiving various disease-modifying antirheumatic drugs chlorambucil, methotrexate and hydroxychloroquine. The diagnosis of SD was carried out according to European-American criteria AECGC (2002) [18]. In order to analyze the quality of life of patients with SD, the 36-Item Short Form Health Survey (SF‑36) was used. Statistical data processing was carried out using Statistica 7.0 program.Results. Assessment of the quality of life of patients with SD, which is an integrative criterion of human health and well-being, revealed the absence of statistically significant differences (p > 0.05) on eight scales and two health components of the SF‑36 questionnaire in the analyzed groups that differ in the treatment of disease-modifying antirheumatic drugs chlorambucil, methotrexate and hydroxychloroquine.Conclusions. The obtained data indicate an equivalent quality of life in SD patients treated with different disease-modifying antirheumatic drugs methotrexate, chlorambucil and hydroxychloroquine, and therefore hydroxychloroquine can be considered as an alternative basic therapy in patients with SD with certain limitations and contraindications methotrexate and chlorambucil.

AB0250 OSTEOPOROSIS, VERTEBRAL FRACTURES AND NON-ALCOHOLIC FATTY LIVER DISEASE IN RHEUMATOID ARTHRITIS: ARE THEY ASSOCIATED?

Background:Non-alcoholic fatty liver disease (NAFLD) is a frequent finding in rheumatoid arthritis (RA). It has been advanced that NAFLD and vertebral fractures (VF) are associated in healthy men recently(1).Objectives:The aim of this study was to evaluate NAFLD association with BMD and VF in RA population.Methods:Cross-sectional study was made at our rheumatology department, patients with RA have been assessed for NAFLD with ultrasonography and osteoporosis (hip and lumber BMD) with DXA device. Patients with secondary liver disease (viral, alcoholic) were excluded. Data about osteoporosis risk factors, clinical features and laboratory tests (liver enzymes, lipid profile, hemoglobin, ferritin, etc) were collected. Anterior vertebral fractures (VF) were assessed by lateral spine radiographs. Comparison of patients with and without NAFLD was done by SPSS.20. Multiple regressions were made to explain osteoporosis and VF with models including NAFLD and other risk factors. Significance was defined by p under 0.05.Results:We have included 172 RA patients, mean age was 55.4±11.9 years. Ninety per cent were females. Their average BMI was 26.8±5.47. Hypertension was diagnosed in 23.8% and 16.3% had diabetes. Forty per cent (40.1) had osteoporosis, 27.3% (47) had NAFLD. RA patients with NAFLD were older (p=0.04), obese (p=0.003), frequently associated to diabetes (p=0.02), Sjogren’s disease (p=0.001), higher total cholesterol (p=0.02) and gamma-glutamyl transferase (GGT) (p=0.002). Comparison tests did not reveal any associations with fractures, BMD or osteoporosis. In multiple regression models, patients with NAFLD and altered liver enzymes were associated to VF (p=0.04, OR=4.7[1.05-21.69] but not to BMD when adjusted on age (p=0.02), BMI (p=0.02), diabetes, menopause and Sjogren’s disease.Conclusion:NAFLD was frequent among our RA patients and was associated to VF prevalence in this study but not to BMD.References:[1]Mantovani A, Dauriz M, Gatti D, Viapiana O, Zoppini G, Lippi G, et al. Systematic review with meta-analysis: non-alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density. Aliment Pharmacol Ther. 2019 Feb;49(4):375–88.Disclosure of Interests:None declared

Efficacy of rituximab for glandular Sjö gren's disease according to international clinical trials

Sjögren's disease (SD) is a chronic autoimmune disease characterized by lymphoplasmacytic infiltration of the exocrine glands, leading to the development of their destruction and progressive functional failure. The prevalence of SD is about 5%, which makes it one of the most common autoimmune diseases. SD often has a chronic, slowly progressing course.The paper discusses the results of international clinical trials of the efficiency of anti-B-cell therapy with rituximab (RTM) for glandular SD. It considers the impact of this therapy on various immunological, histological indicators, subjective and objective parameters of glandular function, and disease activity. Possible reasons for the discrepancy between the results of open-label clinical trials and randomized clinical trials, as well as predictors for the efficiency of RTM therapy are discussed.It has been found that RTM used to treat SD effectively reduces B-cell activity, improves the morphological pattern in the salivary glands and some extraglandular manifestations of the disease, and diminishes dryness and weakness. Anti-B-cell drugs have a great potential to treat SD.