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  • 1
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1359.2-1359
    Abstract: Studies of human intestinal microbiota have focused mainly on bacteria and scarce information on how eukaryotic parasites fit in the gut context or its role in human health and disease. Objectives: This is an approach to explore if intestinal parasites represent a significant factor concerning the treatment-decisions or disease activity in inflammatory conditions such as SpA Methods: A Cross-sectional study including 65 patients with SpA according to ASAS classification criteria was performed. Clinical evaluation was made by rheumatologists and gastroenterologists. Stool samples were collected and microscopically analyzed by direct saline, Mini Parasep concentration and Kato Katz. Most prevalent protozoa in Colombia were also analyzed using PCR/qPCR. Lab tests included fecal calprotectin, CRP, ESR, and HLA-B*27. The association between intestinal parasite infection and clinical/treatment variables were evaluated using the Chi-square or Fisher’s exact test. (Ethical/Cod.2017-023) Results: SpA patients had a mean age of 43.9±11.5 years, 61.5% were male, 52.5% were positive for HLA-B*27 and 87.7% had axial involvement. In total, 67.7% of the patients were receiving biological treatment, 64.6% had ASDAS-CRP ≥2.1. In total, 75.4% of patients were positive for ≥2 gastrointestinal symptoms with a predominance of abdominal pain (66.2%), abdominal inflammation (63.1%), diarrhea (47.7%) and intolerance to some food (58.5%). Interestingly, 21.3% have high levels of calprotectin, 20% of patients with high calprotectin were receiving biological treatment against IL-17 (p=0.086) and 80% of these patients had BASDAI 〉 4 (p=0.017) and ASDAS-VSG 〉 2.1 (p=0.03). The parasites found in SpA patients were Endolimax nana (98%), Blastocystis ssp. (63.8%), Entamoeba coli (8.6%), Entamoeba histolytica (6.9%), Chilomastix mesnili (6.4%), E. dispar/moshkovskii (1.7%) and Giardia intestinalis (3.7%). Patients positive for E coli (80%) were treated with NSAIDs (p=0.003). 3/4 of patients positive for E histolytica presented HLAB*27:05:02 positive. Likewise, the only patient who was positive for G intestinalis expressed this allele. 5/7 of patients treated with Sulfasalazine presented Blastocystis ssp and 33.3% E coli . The presence of intestinal parasites in SpA patients was not associated with gastrointestinal symptoms, either disease-activity measures. Conclusion: The intestinal parasitism in the tropical countries as Colombia have shown an interesting pattern in SpA patients. The treatment may modulate the presence of some parasites; however, the presence of intestinal parasites in SpA does not seem to influence clinical disease activity Acknowledgments: The Government Institute of Science, Technology,and Innovation,Francisco Jose de Caldas—COLCIENCIAS(Grant No. 130877757442). Universidad El Bosque (PCI-2018-10091),Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem-Bogota,Colombia and Biomedicina de Chihuahua, México Disclosure of Interests: None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1481557-6
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  • 2
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1249.2-1249
    Abstract: Autoimmune diseases have a broad phenotypic spectrum, with great variability in clinical manifestations. Anti-DFS70/LEDGFp75 (ANAS/DFS70) antibodies have attracted interest as a positive result in patients without clinical evidence of autoimmune systemic rheumatic disease (SARD). It has been proven in non-rheumatic inflammatory diseases and in “apparently healthy” individuals. Objectives: To assess ANAS/DFS70 performance in a large population with autoimmune/autoinflammatory diseases compared with first degree relatives and healthy controls. Methods: A cross-sectional study was conducted. We analysed 531 individuals between 18-65 years old, 101 rheumatoid arthritis (RA) patients (ACR/EULAR 2010 classification criteria), 137 relatives from RA, 60 psoriasis (Ps) patients (Colombian classification consensus), 47 Undifferentiated connective tissue diseases(UCTD) patients and 186 healthy controls matched by age and sex. The healthy control group were individuals who lived and work similarly like those patients those criteria of exclusion criteria were to present autoimmune or auto-inflammatory disease, infectious, neoplasms, diabetes, antibiotic treatment, pregnancy or lactation, consanguinity with autoimmune entities. Ethical Committee approved. The determination of ANAS-HEp2 antibodies (ANA-Hep-2 AESKU.Dignostic®, Autoantiboy test SYSTEM IMCO DIAGNOSTICS REF 1103® and ANA-Hep-2 AESKU.Dignostic®) was carried out. The positive results (standard AC-2) are used as a confirmatory test the determination of ANAS / DFS70: AUTOANTIBOY TEST SYSTEM IMMCO DIAGNOSTICS (Knocked out, for the psip gene) REF 1108® and CytoBead ANA Generic Assays ref 8065 ® by indirect immunofluorescence-IFI technique. In addition, serum levels of C-reactive protein (PCR), erythrocyte sedimentation rate (ESR), IgG/IgA antibodies against citrullinated peptide (ACPA), and rheumatoid factor (RF). Absolute and relative frequencies were established. Results: 531 participants were included: RA 19%, 25,8% RA relatives, Ps 11,3%, UCTD 8,9%, and 35% healthy controls. RA mean age was 41,8±12,2 years, female 82,2%, with ANA test(+) result 42%. In Ps mean age 49,1±15,7 years, female 53,3%, ANA test(+) 41,7%. UCTD mean age 41,3±15,2 years, female 85,1%, and ANA test(+) 78,7%. Relatives of RA mean age 38,7±12,2 years, female 73%, ANA test(+) 26,3%. And healthy controls mean age 41,3±12,2 years, female 74,7%, and ANA test(+) 26,9%. ANA/DFS70 was positive in a 6,4% in UCTD, 3,2% in healthy controls, 1,7% in Ps, 1,5% in Relatives of RA, no RA had positive results. These 12 participants were negative for acute phase reactants (ESR[-] 83,3% and CRP[-] 66,6%), as well as they were all negative for RF and two were positive for APCA from UCTD. Conclusion: ANAS/DFS70 autoantibodies were present in very low frequency in patients with SARD. Thus, patients with a positive result tend to have a mild or non-progressing phenotype of autoimmune/inflammatory diseases, as UTCD. This is the first time ANA/DFS70 are tested in a large population cohort in Latin American countries which coincide with previous results in RA and RA relatives. Acknowledgments: Hospital Militar Central-Universidad El Bosque-Immco diagnosis-Dizar Ltda and Generic Assay-Medipan. Disclosure of Interests: Consuelo Romero-Sánchez: None declared, Omar-Javier Calixto Employee of: Worked in Janssen Cilag as medical manager from 2016 to 2018, V Romero-A: None declared, A Vargas: None declared, Luis Castro: None declared, Julio Amador: None declared, Pedro Lopez-Mojica: None declared, Daniela Marin: None declared, Diana Acero-M: None declared, M Acevedo: None declared, Diana Rincón-Riaño: None declared, Juan Manuel Bello-Gualtero: None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1481557-6
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  • 3
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1142.2-1143
    Abstract: Digital chromoendoscopy with magnification is a technique that identify microscopic inflammation, with a better characterize, highlighting specific gastrointestinal findings showing a good correlation with histopathological features. Spondyloarthritis (SpA) patients with the presence of non-specific gastrointestinal symptoms, subclinical intestinal inflammation is defined by endoscopic and histological techniques Objectives: To detect early structural inflammatory changes by chromoendoscopy and magnification colonoscopy in colonic/ileum digestive mucosa and establish its association with clinical variables in patients with SpA and gastrointestinal symptoms Methods: In total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=35) (19.4%) had an indication by a gastroenterologist to perform the chromoendoscopy, magnification colonoscopy and histological analysis. The association between clinical and colonoscopy variables were evaluated using the Chi square or Fisher’s exact test. (Ethical/Code. 2017-023) Results: The average age of the patients included for colonoscopy was 45.4±10.3 years, 57.1% were men and 42.9% presented the HLA-B*27 allele. Axial involvement (91.4%), inflammatory back pain (68.6%) and use of biological therapy (71.4%). High levels of calprotectin (25.7%), CRP 〉 3 (14.3%), positive ESR (22.9%) and positive ANCA (8.6%) was observed. Regarding outcome measures of function and activity, BASDAI 〉 4 (60%) and ASDAS-PCR 〉 2.1 (80.0%) was observed The loss of vascular pattern in the ileum was associated with high levels of calprotectin levels (p=0.002). At microscopic level, 80% of the patients who presented acute inflammation in the ileum had elevated calprotectin (p=0.013). Cryptitis (77.8%) in the ileum was associated with axial involvement (p=0.017). Ulcers and erosion in the ileum were associated with positive ESR (p=0.003). All patients who presented ulcerations and inflammation (64.3%) in ileum were HLA-B27 positive (p=0.029) and (p=0.052) respectively. The 50% of patients with atrophy of villi in ileum were receiving biological treatment (p=0.035) Conclusion: Digital chromoendoscopy and augmentation colonoscopy provided an improved and detailed contrast of the surface of the gastrointestinal mucosa. The tissue sampling showed the loss of vascular pattern as main finding in ileum with interesting associations with fecal calprotectin levels in patients with SpA. The interest of proposing the active search for symptoms, signs and biomarkers of gastrointestinal involvement in patients with SpA without IBD is to define subclinical gastrointestinal involvement and early remission through an endoscopic evaluation and objective histological and propose a specific clinical and therapeutic treatment. Acknowledgments: The Government Institute of Science, Technology, and Innovation, Francisco Jose de Caldas—COLCIENCIAS(Grant No. 130877757442). Universidad El Bosque (PCI-2018-10091), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem-Bogota, Colombia and Biomedicina de Chihuahua, México Disclosure of Interests: None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1481557-6
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  • 4
    In: BMJ Open, BMJ, Vol. 12, No. 1 ( 2022-01), p. e048166-
    Abstract: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. Methods and analysis Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. Ethics and dissemination Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO registration number CRD42020177408.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 5
    In: BMJ Open, BMJ, Vol. 12, No. 1 ( 2022-01), p. e048165-
    Abstract: Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. Methods and analysis Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. Ethics and dissemination The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study’s findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. PROSPERO registration number CRD42020177408.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 6
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. Suppl 1 ( 2022-06), p. 418.2-419
    Abstract: Currently, mucosal immunity research has been investigated whether the serum levels of SIgA reflects the over-activation immune system in gut associated lymphoid tissues (GALT) and if the antigenic stimuli in the mucosa are responsible for inducing and maintaining the inflammatory response in Spondyloartrhitis (SpA). Based on our previous results, variances on levels of SIgA might influence in disease activity. SIgA Reverse transcytosis (retrotranscytosis) has been demonstrated as a GALT mechanism which enhance systemic inflammation in some autoimmune pathologies such as celiac disease. Objectives This study proposes the evaluation of receptors associated with retrotranscytosis CD71 and Dectin-1 (Dec-1) in gut tissues from SpA without IBD patients to explore a possible mechanism responsible of gastrointestinal inflammatory imbalance. Methods In total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=65, 36.1%) met the selection criteria and from them (n=41, 63.1%) by a gastroenterologist to perform digital chromoendoscopy with magnification for colon e ileum and histological analysis. Pregnant and lactating women, and cancer patients, patients with other autoinflammatory diseases, autoimmune diseases, immunodeficiency, chronic pancreatitis, or chronic liver disease, and those who had received antibiotic treatment in the last 3 months were excluded from the study. Furthermore, those patients with SpA and concomitant IBD were excluded. All included patients were between 18 and 65 years old. CD71 and Dec-1 apical expression were identified by indirect immunofluorescence. Fecal Calprotectin (FC), Serum SIgA in house and clinical indices BASDAI, BASFI, ASDAS-CRP, ASDAS-ESR were measured. The association were evaluated using the Chi-square or Fisher’s exact test and a multiple correspondence discriminant analysis (MCDA) was performed including those variables with significant associations from bivariate analysis and some that are considered clinically relevant to explain the impact of SIgA and CD71 in SpA. Results The average age of the patients included was 44,6±10.2 years, 56.1% were men, 39.0% were HLA-B*27:05 positive, 90.2% had axial involvement. Serum levels of SIgA were 62.3±24.1 gr/mL, CRP 1.7±2.4 and ESR 14.1±12.0 mm/h. Positive levels of FC ( 〉 120ng/mL) were observed in 31.7%. BASDAI 〉 4 was found in 58.5% of patients and ASDAS-CRP 〉 2.1 in 75.6%. Apical expression of CD71 and Dec-1 in the ileum was observed in 48.8% and 36% respectively, the expression of both receptors in colon tissues were irrelevant. CD71 expression was associated with high levels of serum SIgA (p=0.05). However, no associations were observed between retrotranscytosis receptors and any of the clinical and histological variables. The MCDA showed a Cronbach’s Alpha reliability coefficient of 0.763 and showed two dimensions: a main dimension (Dim 1) related to the presence of loss of the vascular pattern in the ileum (CC 0.325), FC + diarrhea (CC 0.695), FC + abdominal distension (CC 0.883) and FC + abdominal pain (CC 0.885) and a secondary dimension (Dim 2) that collected the variables serum SIgA (CC 0.513), ASDAS-CRP 〉 2.1 (CC 0.311), CD71 (CC 0.424), please see Figure 1. Figure 1. Multiple correspondence discriminant analysis for CD71, serum SIgA and activity index in SpA patient Conclusion The findings reflect a possible relationship among the apical expression of CD71in ileum with high levels of serum SIgA and activity, suggesting that retrotranscytosis mediated by this receptor might be a mechanism that mediate the intestine-joint axis in SpA. Acknowledgements The Ministry of Science, Technology, and Innovation - MinCiencias (Grants No. 68022 and 57442). Universidad El Bosque (PCI-2018-10300), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem, in Bogota, Colombia and Biomedicina de Chihuahua, México Disclosure of Interests None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1481557-6
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  • 7
    In: Gut, BMJ, Vol. 34, No. 6 ( 1993-06-01), p. 778-782
    Type of Medium: Online Resource
    ISSN: 0017-5749
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 1993
    detail.hit.zdb_id: 1492637-4
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  • 8
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. Suppl 1 ( 2022-06), p. 1833.2-1833
    Abstract: Antinuclear antibodies (ANA) have diagnostic significance in rheumatology. Anti-DFS70 (Dense Fine Speckle-70 kd) antibodies may be an exclusionary marker for systemic autoimmune rheumatic disease (SARD). Low frequency of this pattern has previously been described in healthy populations. Objectives To evaluate ANAS/DFS70 positivity and autoantibody profile in a large Colombian population with rheumatoid arthritis (RA), psoriasis (PsO), as well as, undifferentiated connective tissue diseases (UCTD), first degree relatives (FDR), and healthy controls (HC). Methods A cross-sectional study was conducted. We analyzed 531 individuals between 18-65 years, 101 RA patients (ACR/EULAR 2010 classification criteria), 137 relatives from RA, 60 PsO patients (Colombian classification consensus), 47 UCTD patients, and 186 HC matched by age and sex. The determination of ANAS-HEp2 antibodies, was carried out. The ANAS/DFS70 positive results used as a confirmatory test the determination by Knocked out, for the psip gen and CytoBead by indirect immunofluorescence-IFI technique. Absolute and relative frequencies were established and associations with chi square test. Results The distribution by diagnostic group was RA: 19%, PsO: 11,3%, UCTD: 8,9%, 25,8% RA relatives, and 35% healthy controls. RA was ANA test (+) in 42%, PsO 41,7%, UCTD 78,7%, FDR 26,3%, and HC 26,9%. The positive frequency of ANA/DFS70 in the total group was 2.3% and 1,4% in SARD (n=12; 2 FDR, 6 HC, 3 UCTD, and PsO 1), no RA patients were positive. These 12 participants were negative for rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), one patient with UCTD were positive for Anti SSB/La, Anti Sm, Anti RNP, and anti DNAds, another was positive for anti Sm IgG and IgM B2GP, and IgG ACA. Most participants had negative acute phase reactants (erythrosedimentation rate ESR[-] 83,3% and C-reactive protein CRP[-] 66,6%). ANAS/DFS70 was associated with positivity for ANAS independently of ANAS titers, (p 〈 0,001). None of the patients’ positives ANAS DFS70 in the UCTD group in 5 years developed definitive autoimmune disease. Conclusion Despite the low frequency in the group in general, it has been shown that anti-DFS70 is more prevalent in healthy individuals than in patients with SARD, which was found in this group of individuals. ANAS/DFS70 autoantibodies were present in very low frequency in Colombian patients with SARD. Thus, patients with a positive result tend to have a mild or non-progressing phenotype of autoimmune or autoinflammatory diseases. This analysis reinforce evidence of ANA/DFS70 positivity as well as autoantibody negativity described abroad as a negative predictive marker of SARD. Table 1. Clinical and demographical variables for ANAS/DFS70 patients n=12. AGE GENDER ANAS ESR CRP RF ACPA Ro La Sm RNP DNAds ACA IgG ACA IgM ACA IgA B2GP IgG B2GP IgM UCTD 30 F 1/160 - - - - - - + - - + - - + + UCTD 61 F 1/320 - - - - - + + + + - - - - - UCTD 42 F 1/160 - + - - - - - - + - - - - - PsO 43 F 1/320 - - - - - - - - - - - - - - FDR 31 M 1/80 - - - - - - - - - - - - - - FDR 32 F 1/160 + - - - - - - - - - - - - - HC 50 F 1/80 - - - - - - - - - - - - - - HC 26 F 1/80 + - - - - - - - - - - - - - HC 27 F 1/160 - - - - - - - - - - - - - - HC 54 F 1/320 - - - - - - - - - - - - - - HC 32 F 1/160 - - - - - - - - - - - - - - HC 53 F 1/320 - + - - - - - - - - - - - - Rheumatoid arthritis (RA), Psoriasis (PsO), as well as, Undifferentiated connective tissue diseases (UCTD), first degree relatives (FDR), healthy controls (HC), rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), erythrosedimentation rate (ESR), and C-reactive protein (CRP). Acknowledgements Hospital Militar Central / Universidad del Bosque Disclosure of Interests None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1481557-6
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