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DIAGNOSTIC VALUE OF ANTI-CITRULLINATED PEPTIDE ANTIBODIES IN EARLY ARTHRITIS
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
compatible with sarcoidosis. Treatment was started with corticosteroid therapy with substantial improvement of joint complaints. Conclusion: Parte superior do formulário Sarcoidosis remains one of the most challenging diseases in medicine, because it can affect any organ and therefore can be manifested by a variety of symptoms and signs. DIAGNOSTIC VALUE OF ANTI-CITRULLINATED PEPTIDE ANTIBODIES IN EARLY ARTHRITIS Almudena Pérez Iglesias1, Manuel Rodríguez Gómez2, Javier Marnotes González1, Teresa Bujeiro3, Isabel Alonso3, Cristina Raposo3, Yago Mouriño López4, Ignacio Soto Iglesias4, Lara Rey González1, Elena Seco Hernández1, Paula Rodríguez Álvarez1, Verónica Pérez Carral1, Inés Fernández Regal1, Manuel de Toro Santos1. 1Department of Internal Medicine; 2Department of Rheumatology; 3Department of Clinical Analysis, Ourense University Hospital Complex; 4Servicio de Medicina Interna, Verín Hospital, Spain Objective/Background: To study the prognostic value of anti-citrullinated peptide antibodies (ACPA), rheumatoid factor (RF) and both, in early arthritis. Methods: A cross-sectional observational study in patients with inflammatory and non inflammatory joint disease in order to validate the ACPA assay in our area, and to confirm its sensibility and specificity. Subsequently, ACPA and RF were tested to recognize/achieve/determine its value as predictors of rheumatoid arthritis. For that purpose, we followed for one year, patients with one year or less arthritis development. Results: In the cross-sectional observational study 396 patients were included. ELISA was the assay used for detecting ACPA, and it was positive in 17% of the non rheumatoid arthritis inflammatory diseases patients, and 5.62% of the non inflammatory joint diseases patients. 175 patients with one year or less synovitis evolution (early arthritis) were assessed/evaluated with periodicity. In this group, the combination of ACPA and RF showed a specificity, positive predictive value (PPV), sensibility and negative predictive value (NPV) for the diagnostic of rheumatoid artritis of 89.7%, 85.4%, 39.4% and 49%, respectivily. The association of these two factors was statistically significant for predicting development to rheumatoid artritis. Conclusion: In patients with one year or less synovitis evolution, the combination of ACPA and RF shows a high specificity and positive predictive value for the development of Rheumatoid arthritis. Both factors can be used for early diagnostic and treatment of Rheumatoid arthritis. ANALYSIS OF MYOCARDIAL INFARCTIONS THROUGHOUT THE FIRST YEAR OF CODI INFART PROGRAMME AT THE ACCIDENT AND EMERGENCY DEPARMENT OF HOSPITAL DE TERRASSA Rosa María Pérez Ramos, Sonia Moreno Escribà, Maria Jose Peña Mateo, Josep Tost Valls. Hospital De Terrassa-Consorci Sanitari De Terrassa Background: The incidence of acute myocardial infarction (MI) is of 1/1251/500 inhabitants in Europe. MI is the first cause of mortality in Spain. In Catalonia, 40% of MIs are diagnosed on acute phase. Early revascularisation reduces necrotic area and primary angioplasty is the first-line treatment within the first 120 minutes. The Codi-Infart programme, first implemented in Catalonia in June 2009, consists of transferring ST-elevation myocardial infarctions in less than 120 minutes from first medical contact, MIs in which thrombolysis has failed or high risk MIs to a hospital where a primary angioplasty can be performed. MI at Hospital de Terrassa, are transferred to Hospital Mútua de Terrassa or Hospital Clínic i Provincial Methods: 192 MIs diagnosed at A&E department were studied within 2 years dividing them into two groups. Group 1: 97 MIs one year before the implementation of Codi-Infart and Group 2: 95 MIs on the first year of implementation of Codi-Infart. We compared time to primary angioplasty. Differences were statistically significant (p<0.05). Results: Mean time to coronary reperfusion after the implementation of Codi-Infart was reduced compared to the previous year. The analysis showed that mean time ±standard deviation was 3944±4898 minutes in Group 1 and 2000±2966 minutes in Group 2 (p=0.0007). This study also showed that the use of thrombolysis was lower after the implementation of Codi-Infart (p=0.034). Conclusion: Mean time to coronary reperfusion in MI was reduced after the implementation of Codi-Infart although mortality in the first six months after coronary reperfusion does not show statistically differences.
POST-MALARIA NEUROLOGICAL SYNDROME Andreia Pestana, Ana Alho, Mónica Grafino, Luís Lourenço, Catarina Policiano, José Júnior, Glória Silva. Department of Medicine, Hospital Pulido Valente, Lisbon, Portugal Infection with Plasmodium falciparum (PF) is known to cause several neurological complications usually with bad prognosis. Rarely these complications occur weeks after complete recovery from an infection by the parasite and it is described as Post-Malaria Neurological Syndrome (PMNS). It is characterized by various clinical symptoms, and its pathogenesis remains elusive, probably immunologically mediated. We describe a case of a 48-year-old female patient, born and resident in Angola, admitted to an area hospital on February 2011 for non-complicated Malaria by PF and discharged home after treatment with quinine. Two days after she started with symptoms of dizziness, vertigo, vomiting, slowed speech and gait abnormality, which persisted after symptomatic therapy. For clinical investigation and treatment she was admitted to our hospital in Portugal. On physical examination she had dysarthria, bilateral dysmetria, dysdiadochokinesia, positive Romberg`s test and ataxic gait. The otolaryngologist excluded peripheral origin of the vertigo and further investigations revealed: blood smear negative for PF; MRI with moderate cerebral and cerebellar atrophy and multifocal white matter abnormalities. During the first 20 days of hospitalization the patient remained symptomatic and after exclusion of any other infectious cause (negative microbiological study, negative cultures of the cerebrospinal fluid, blood and urine), we assumed the diagnosis of PMNS. She was treated with high-dose Methylprednisolone, with complete resolution of neurological deficits. In conclusion PMNS is still a discussed entity that occurs after an episode of successfully treated PF malaria. It is self-limited and requires no specific treatment, despite steroids may play a role in severe cases. Key words: Post-Malaria Neurologic Syndrome; Malaria; Plasmodium falciparum; Ataxic gait GOUT IN YAKUTIA Milana Petrova. North-Eastern Federal University Background: The official data of gout in Republic of Sakha (Yakutia) are absent. This is a preliminary report on incidence of gout requiring hospitalization 2007-2010. Methods: A research project has been initiated to determine the incidence and characteristics of gout in Yakutia from 2007-2012. Patients hospitalized in the department of rheumatology of Yakut City Hospital are being studied by means of a questionnaire developed by the Institute of Rheumatology (Moscow), which includes questions on anamnesis, form of gout, and specifics of treatment. Data also being collected include: laboratory measures (glucose, HDL-C, LDL-C, TC, TG, creatinine, urea, uric acid, TP, bilirubin, ALT, AST, GGTP, alkaline phosphatase, creatine kinase); urinalysis, on admission plus daily analysis of urine (creatinine, protein, uric acid); radiographic assessment of feet and wrists; ultrasound of kidneys. Results: 2007 – 13 patients were registered, including 8 with secondary gout. The tophaseus form was observed in 5 patients. 2008 – 12 patients; 5 with secondary gout. The tophaseus form was observed in 2 patients. 2009 – 8 patients; 6 with secondary gout. 2010 – 6 patients; 2 with secondary gout. The tophaseus form was observed in 1 patient. Conclusion: The research proceeds. Results will be used for characterization of incidence and diagnostic features of gout in the Republic of Sakha (Yakutia) with the goal of standardizing guidelines for diagnosis and treatment of gout, assuring optimal care for these patients. PREDICTING THE SEVERITY OF ACUTE PANCREATITIS Vasiliki Petsimeri, Ourania Papadopoulou, Konstantinos Goulas, Konstantinos Stathogiannis. General Hospital of Karpenisi. Karpenisi, Greece Background: Seventeen (17) patients with acute pancreatitis were studied and evaluated based on their outcome. Methods: The following classification systems were applied to the 17 patients: APACHE II (cut off point 7), Ranson (cut off point 2, 3-5, 6), MGAPS (cut off point 3), SOFA (cut off point 8) en BISAP (cut off point 2).
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
compatible with sarcoidosis. Treatment was started with corticosteroid therapy with substantial improvement of joint complaints. Conclusion: Parte superior do formulário Sarcoidosis remains one of the most challenging diseases in medicine, because it can affect any organ and therefore can be manifested by a variety of symptoms and signs. DIAGNOSTIC VALUE OF ANTI-CITRULLINATED PEPTIDE ANTIBODIES IN EARLY ARTHRITIS Almudena Pérez Iglesias1, Manuel Rodríguez Gómez2, Javier Marnotes González1, Teresa Bujeiro3, Isabel Alonso3, Cristina Raposo3, Yago Mouriño López4, Ignacio Soto Iglesias4, Lara Rey González1, Elena Seco Hernández1, Paula Rodríguez Álvarez1, Verónica Pérez Carral1, Inés Fernández Regal1, Manuel de Toro Santos1. 1Department of Internal Medicine; 2Department of Rheumatology; 3Department of Clinical Analysis, Ourense University Hospital Complex; 4Servicio de Medicina Interna, Verín Hospital, Spain Objective/Background: To study the prognostic value of anti-citrullinated peptide antibodies (ACPA), rheumatoid factor (RF) and both, in early arthritis. Methods: A cross-sectional observational study in patients with inflammatory and non inflammatory joint disease in order to validate the ACPA assay in our area, and to confirm its sensibility and specificity. Subsequently, ACPA and RF were tested to recognize/achieve/determine its value as predictors of rheumatoid arthritis. For that purpose, we followed for one year, patients with one year or less arthritis development. Results: In the cross-sectional observational study 396 patients were included. ELISA was the assay used for detecting ACPA, and it was positive in 17% of the non rheumatoid arthritis inflammatory diseases patients, and 5.62% of the non inflammatory joint diseases patients. 175 patients with one year or less synovitis evolution (early arthritis) were assessed/evaluated with periodicity. In this group, the combination of ACPA and RF showed a specificity, positive predictive value (PPV), sensibility and negative predictive value (NPV) for the diagnostic of rheumatoid artritis of 89.7%, 85.4%, 39.4% and 49%, respectivily. The association of these two factors was statistically significant for predicting development to rheumatoid artritis. Conclusion: In patients with one year or less synovitis evolution, the combination of ACPA and RF shows a high specificity and positive predictive value for the development of Rheumatoid arthritis. Both factors can be used for early diagnostic and treatment of Rheumatoid arthritis. ANALYSIS OF MYOCARDIAL INFARCTIONS THROUGHOUT THE FIRST YEAR OF CODI INFART PROGRAMME AT THE ACCIDENT AND EMERGENCY DEPARMENT OF HOSPITAL DE TERRASSA Rosa María Pérez Ramos, Sonia Moreno Escribà, Maria Jose Peña Mateo, Josep Tost Valls. Hospital De Terrassa-Consorci Sanitari De Terrassa Background: The incidence of acute myocardial infarction (MI) is of 1/1251/500 inhabitants in Europe. MI is the first cause of mortality in Spain. In Catalonia, 40% of MIs are diagnosed on acute phase. Early revascularisation reduces necrotic area and primary angioplasty is the first-line treatment within the first 120 minutes. The Codi-Infart programme, first implemented in Catalonia in June 2009, consists of transferring ST-elevation myocardial infarctions in less than 120 minutes from first medical contact, MIs in which thrombolysis has failed or high risk MIs to a hospital where a primary angioplasty can be performed. MI at Hospital de Terrassa, are transferred to Hospital Mútua de Terrassa or Hospital Clínic i Provincial Methods: 192 MIs diagnosed at A&E department were studied within 2 years dividing them into two groups. Group 1: 97 MIs one year before the implementation of Codi-Infart and Group 2: 95 MIs on the first year of implementation of Codi-Infart. We compared time to primary angioplasty. Differences were statistically significant (p<0.05). Results: Mean time to coronary reperfusion after the implementation of Codi-Infart was reduced compared to the previous year. The analysis showed that mean time ±standard deviation was 3944±4898 minutes in Group 1 and 2000±2966 minutes in Group 2 (p=0.0007). This study also showed that the use of thrombolysis was lower after the implementation of Codi-Infart (p=0.034). Conclusion: Mean time to coronary reperfusion in MI was reduced after the implementation of Codi-Infart although mortality in the first six months after coronary reperfusion does not show statistically differences.
POST-MALARIA NEUROLOGICAL SYNDROME Andreia Pestana, Ana Alho, Mónica Grafino, Luís Lourenço, Catarina Policiano, José Júnior, Glória Silva. Department of Medicine, Hospital Pulido Valente, Lisbon, Portugal Infection with Plasmodium falciparum (PF) is known to cause several neurological complications usually with bad prognosis. Rarely these complications occur weeks after complete recovery from an infection by the parasite and it is described as Post-Malaria Neurological Syndrome (PMNS). It is characterized by various clinical symptoms, and its pathogenesis remains elusive, probably immunologically mediated. We describe a case of a 48-year-old female patient, born and resident in Angola, admitted to an area hospital on February 2011 for non-complicated Malaria by PF and discharged home after treatment with quinine. Two days after she started with symptoms of dizziness, vertigo, vomiting, slowed speech and gait abnormality, which persisted after symptomatic therapy. For clinical investigation and treatment she was admitted to our hospital in Portugal. On physical examination she had dysarthria, bilateral dysmetria, dysdiadochokinesia, positive Romberg`s test and ataxic gait. The otolaryngologist excluded peripheral origin of the vertigo and further investigations revealed: blood smear negative for PF; MRI with moderate cerebral and cerebellar atrophy and multifocal white matter abnormalities. During the first 20 days of hospitalization the patient remained symptomatic and after exclusion of any other infectious cause (negative microbiological study, negative cultures of the cerebrospinal fluid, blood and urine), we assumed the diagnosis of PMNS. She was treated with high-dose Methylprednisolone, with complete resolution of neurological deficits. In conclusion PMNS is still a discussed entity that occurs after an episode of successfully treated PF malaria. It is self-limited and requires no specific treatment, despite steroids may play a role in severe cases. Key words: Post-Malaria Neurologic Syndrome; Malaria; Plasmodium falciparum; Ataxic gait GOUT IN YAKUTIA Milana Petrova. North-Eastern Federal University Background: The official data of gout in Republic of Sakha (Yakutia) are absent. This is a preliminary report on incidence of gout requiring hospitalization 2007-2010. Methods: A research project has been initiated to determine the incidence and characteristics of gout in Yakutia from 2007-2012. Patients hospitalized in the department of rheumatology of Yakut City Hospital are being studied by means of a questionnaire developed by the Institute of Rheumatology (Moscow), which includes questions on anamnesis, form of gout, and specifics of treatment. Data also being collected include: laboratory measures (glucose, HDL-C, LDL-C, TC, TG, creatinine, urea, uric acid, TP, bilirubin, ALT, AST, GGTP, alkaline phosphatase, creatine kinase); urinalysis, on admission plus daily analysis of urine (creatinine, protein, uric acid); radiographic assessment of feet and wrists; ultrasound of kidneys. Results: 2007 – 13 patients were registered, including 8 with secondary gout. The tophaseus form was observed in 5 patients. 2008 – 12 patients; 5 with secondary gout. The tophaseus form was observed in 2 patients. 2009 – 8 patients; 6 with secondary gout. 2010 – 6 patients; 2 with secondary gout. The tophaseus form was observed in 1 patient. Conclusion: The research proceeds. Results will be used for characterization of incidence and diagnostic features of gout in the Republic of Sakha (Yakutia) with the goal of standardizing guidelines for diagnosis and treatment of gout, assuring optimal care for these patients. PREDICTING THE SEVERITY OF ACUTE PANCREATITIS Vasiliki Petsimeri, Ourania Papadopoulou, Konstantinos Goulas, Konstantinos Stathogiannis. General Hospital of Karpenisi. Karpenisi, Greece Background: Seventeen (17) patients with acute pancreatitis were studied and evaluated based on their outcome. Methods: The following classification systems were applied to the 17 patients: APACHE II (cut off point 7), Ranson (cut off point 2, 3-5, 6), MGAPS (cut off point 3), SOFA (cut off point 8) en BISAP (cut off point 2).