Slide Session : OS-RHEU-07 ; Rheumatology : Predicting Death in Patients with Primary Sjogren Syndrome: Prognostic Factors and Standardized Mortality Ratio in Comparison to the General Population (RESSPGEAS- SEMI)

( Pilar BRITO ZERÓN ),( Marta PEREZ DE LIS NOVO ),( Belchin KOSTOV ),( Roser SOLANS ),( Guadalupe FRAILE ),( Carlos SUÁREZ CUERVO ),( Arnau CASANOVAS ),( Francisco Javier RASCÓN ),( Rami QANNETA ),( R 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To analyze prognostic factors and standardized mortality ratio (SMR) with respect to the general population in a cohort of Spanish patients with primary Sjogren`s syndrome (SS). Methods: In October 2013, the RESSP-GEAS-SEMI database included 1045 consecutive patients who met the 2002 SS-criteria. Hazard ratios (HR) and confi dence intervals (95% CI) obtained in the adjusted regression model were calculated. The SMR was estimated using the life tables of the general population of Spain in 2012. Results: The cohort included 982 (94%) women with a mean age at diagnosis of 54 years and a mean disease evolution of 118 months; 115 (11%) patients died due to systemic disease (n=18), infection (n=21), cardiovascular disease (n=35), hematologic malignancy (n=10) and other causes (n=31). The SMR for the total cohort of patients (adjusted for age and sex with the general Spanish population) was 4.66. Survival rates at 5, 10, 20 and 30 years were 96.0%, 90.5%, 80.9% and 60.4%, respectively. The Cox-regression analysis identifi ed the following baseline variables at diagnosis associated with death: male gender (HR 2.98, p<0.001), altered parotid scintigraphy (HR 2.81, p=0.043), lymphopenia (HR 1.63, p=0.034), anti-La antibodies (HR 1.51, p=0.034), low C3 (HR 1.93, p=0.034), low C4 (HR 2.06, p=0.016), monoclonal gammopathy (HR 1.81, p=0.047) and cryoglobulins (HR 2.58, p<0.001). The main baseline factors associated with mortality caused by systemic disease were systemic-activity at diagnosis, cytopenias, monoclonal gammopathy, cryoglobulins, and hypocomplementemia. Conclusions: Primary SS should not be considered a mild disease, since mortality is almost 5 times greater with respect to general population, with an overall survival at 20 years of 81%. Patients with a lower survival are those who present with active disease at diagnosis and associated immunological markers of B-cell hyperactivity.

Poster Session:PS 0206 ; Family Medicine : Comprehensive Initial Training for Medical Doctors Starting in 1980 in Musashino Red Cross Hospital

( Marta Perez De Lis Novo ),( Roberto Perez Lyarez ),( Pilar Brito Zeron ),( Antoni Siso Almirall ),( Belchin Kostov ),( Mireia Marti Villalta ),( Albert Bove ),( Hoda Gheitasi ),( Soledad Retamozo ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Medical education for medical school graduates in Japan greatly changed after World War II. From 1948, the General Headquarters (GHQ), the Supreme Commander for the Allied Powers imposed internship medical school graduates as early clinical training, internal medicine for 5 months, surgery for a month, obstetrics and gynecology for a month, public health for a month, for initial year. This system was unpaid before the nation examination, and abolished in 1968 by the campus dispute spread throughout Japan. Subsequently became mainstream medical center by the universities and colleges, but did not develop the training of general practitioners and family doctors in Japan because of aiming for the priority of specialization by university faculty of medicine. Musashino Red Cross Hospital (MRCH) started comprehensive initial training for medical doctors since 1980. One of the reason is that The Japan Red Cross Society as the most important philosophy advocates disaster medicine and its realization in general medical education is very important. Methods: MRCH employed the intern doctors by general invitation examination, and educated them for two years. In principle mandatory training period within 2 years in internal medicine, surgery, pediatrics, obstetrics and gynecology training, psychiatry, and regional medical training. Results: From 1980 to now MRCH did general medical education to more than 200 doctors. These doctors are working around the world. In Japan, from 2004 Initial general medical training was compulsory to all new medical doctors for two years. Conclusions: Comprehensive initial training for medical doctors is very important in general medicine for all the generations and the disaster medicine. In Japan from the year 2020 general medicine training under the new medical program scheduled.

Poster Session:PS 0207 ; Family Medicine : The Cardiovascular Paradox of Sle in Family Medicine: A Case-Control Study of the Prevalence and Management of Cardiovascular Disease in Patients with Sle Followed in a Primary Care Center

( Marta Perez De Lis Novo ),( Roberto Perez Lvarez ),( Pilar Brito Zeron ),( Antoni Siso Almirall ),( Belchin Kostov ),( Mireia Marti Villalta ),( Albert Bove ),( Hoda Gheitasi ),( Soledad Retamozo ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To analyze the prevalence of SLE in the field of primary care and to evaluate the management of cardiovascular risk factors (CVRF) in comparison with a non-autoimmune control population. Methods: Analysis of the diagnostic accuracy of SLE by primary care physicians using medical record audit (EMR) in 3 health centers including a population of 44,184 inhabitants. The prevalence of CVRF and clinical cardiovascular disease (CVD) in the SLE population was evaluated and compared with a control population of patients without autoimmune disease matched for gender. Results: 145 patients were identifi ed as SLE. After a case-by-case audit, 112 (77%) patients were confirmed as having SLE, representing a prevalence of 0.25%: 92% were women, with a median follow-up of 11.3 years: death was recorded in 8.9%. The comparison of the main characteristics between SLE and the control group showed that SLE patients had a lower mean age (53.2 vs 60.5, p=0.001), a lower frequency of dyslipidemia (26% vs 47%, p=0.001), a lower mean total cholesterol (199.5 vs 211.3 mg/dL, p=0.023) and a lower mean systolic blood pressure (119 vs. 124.2 mmHg, p=0.043). In contrast, patients with SLE had a higher frequency of renal disease (32.1% vs 12.1, p<0.001), cerebrovascular disease (8.0% vs 1.6%, p=0.027) and non-fatal cardiovascular events (17.0% vs 4.8%, p=0.003). Conclusions: The level of diagnostic accuracy of SLE in our primary care area was high. We found a ‘cardiovascular paradox “: despite having a signifi cantly better degree of control of the main CVRF, and even being a younger population, a higher prevalence of CVD was observed in SLE patients, suggesting that this autoimmune disease is, per se, a cardiovascular risk factor.

Slide Session : OS-RHEU-08 ; Rheumatology : Minimally-Invasive Biopsy of Minor Salivary Glands in Internal Medicine: Searching for Systemic Infi ltrative Diseases

( Pilar Brito Zeron ),( Marta Perez De Lis Novo ),( Soledad Retamozo ),( Lluisa Alos ),( Albert Bove ),( Hoda Gheitasi ),( Belchin Kostov ),( Antoni Siso Almirall ),( Roberto Perez Alvarez ),( Manuel 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To analyze the safety and utility of minor lip biopsy by using the minimally invasive technique, performed in the Department of internal medicine, in patients presenting with immunonegative sicca syndrome. Methods: Prospective analysis of 122 patients (100 women, mean age 60 years) with sicca syndrome and negative anti-Ro/La antibodies in which minimally invasive biopsy of minor salivary glands was performed. Results: The most common histopathological feature consisted of lymphoplasmacytic infi ltration in 57 (47%) patients, followed by fi brosis in 46 (38%) and acinar atrophy in 32 (26%); the type of lymphoplasmacytic infi ltrate was detailed in 53 patients (21 lymphocytic, 20 plasmacytic, and 12 lymphoplasmacytic). According to the lymphocytic classifi cation of Chisholm and Mason, 53 (44%) were classifi ed as normal, 42 (35%) grade I, 11 (9%) grade II, 8 (7%) grade III and 7 (6 %) grade IV. Histopathologic diagnosis were: normal in 46 patients, non-specifi c sialadenitis in 42, primary Sjogren`s syndrome in 26 (15 as the fi nal diagnosis, 11 and probable), and other diagnoses in 6 (fat infi ltration in 5, systemic amyloidosis in 1); no cases of infi ltration by granulomas or IgG4+ were found. The presence of fi brosis was detected more frequently in women (43% vs 14%, p=0.014); the existence of fi brosis (67.70 vs 55.76 years) and acinar atrophy (69.50 vs 56.71 years) correlated with increasing age. No correlation between the degree of infi ltration and diagnostic or immunological features was found. Only 8% patients reported transient adverse events. Conclusions: In 21% of patients with an immunonegative sicca syndrome, a diagnosis of primary SS was confi rmed by minimally invasive biopsy, whereas 35% of patients disclosed a non-specifi c chronic sialadenitis, which could refl ect a “mild” SS that have no place in the current classifi cation criteria of this disease.