Slide Session : OS-RHEU-03 ; Rheumatology : Genetic Variability of The CD5 Lymphocytic Immunoreceptor and Clinical Expression of Systemic Autoimmune Diseases Related to B-Cell Hyperactivity

( Pilar Brito Zeron ),( Hoda Gheitasi ),( Marta Perez De Lis Novo ),( Noelia Armiger ),( Maria Jose Soto Cardenas ),( Myriam Gandia ),( Albert Bove ),( Xavier Bosch ),( Soledad Retamozo ),( Miriam Aka 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To investigate the mechanisms involved in lymphocyte activation mediated by the CD5 immunoreceptor in patients with systemic autoimmune diseases related to B-cell hyperactivity. Methods: A total of 508 patients were analyzed (273 primary Sjogren syndrome patients, 135 SLE patients, 47 SS associated HCV patients and 53 controls). CD5 genotyping receptor was analyzed by PCR-SBT technique with the detection of the SNP7 (rs2241002) andSNP26 (rs2229177). The homozygous haplotype CC/CC was classifi ed as inductor of autoimmunity, whereas the heterozygous haplotype CC/TT was a protective factor. Results: The haplotype CC/CC was found in 7.5% of controls vs 19% of patients with primary SS fulfi lling the 2002 criteria (p=0.047), 12% of SS-1993 criteria (p=0.39), 18% of SLE (p=0.10) and 21% of SS-HCV patients (p=0.049); the protective haplotype CC/TT was observed in 28% of controls vs 19% of patients with primary SS-2002 criteria (p=0.15), 13% of SS-1993 criteria (p=0.01), 15% of SLE (p=0.04) and 15% of SS-HCV patients (p=0.10). A specifi c analysis was carried out in patients with primary SS-2002 criteria comparing the clinical and immunological features of patients carrying protective haplotypes (n=33) and those carrying inductor haplotypes (n=33). A higher frequency of anti-La/SS-B antibodies (67% vs 39%, p=0.048) and a trend for an increased frequency of extraglandular involvement (52% vs 36%), neutropenia (33% vs 18%), ANA (91% vs 82%), FR (53% vs 48%) and low levels of C3 (12% vs 3%) was found in carriers of inductor haplotypes with respect to those carrying protective haplotypes. Conclusions: We found a higher frequency of the CC/CC haplotype (associated with increased autoimmunity) of the gene that encodes the immunoreceptor lymphocytic CD5 in SS patients, that was related to an increased extraglandular systemic activity, especially a higher frequency of anti-La/SS-B antibodies.

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.

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.