Systemic lupus erythematosus (SLE), pathology with net feminine predominance, is one of the most complex autoimmune diseases and has major impact on patients’ life. The aim is to identify patient and disease-related factors associated with self-perceived disease severity in female SLE patients. This cross-sectional study enrolled 73 women fulfilling the 2012 Systemic Lupus International Collaborating Clinic (SLICC) criteria. SLE disease activity was assessed by the Systemic Lupus Activity Measure (SLAM) score and overall damage by the SLICC/American College of Rheumatology (ACR) index. Patients’ general characteristics, associated conditions as well as SLE specific clinical involvements and therapeutic principles were also noted. Fatigue was assessed by FACIT-fatigue scale. Self-perceived disease severity was assessed using numerical rating scales (1–10 NRSs), to evaluate the disease severity at inclusion (1–10 NRS now) and worst severity anytime during disease history (1–10 NRS worst ever). In regard to worst ever lupus severity, 54.8% of patients responded with 9 or 10, while none with 1 or 2 even if only 22.9% of the patients responded with 7 or more for disease severity at inclusion (1–10 NRS now). Women with higher 1–10 NRS now answers had also higher 1–10 NRS worst ever, SLAM, SLICC, and FACIT-fatigue scores. They associated more frequently anxiety/depression diagnosis, antiphospholipid syndrome, joint involvement as well as treatments with corticosteroids. Self-reported disease severity worst ever, anxiety/depression diagnosis, fatigue, and the daily dose of corticosteroids were independently associated with patients’ perception on lupus severity at inclusion: OR (95% CI), 2.13 (1.15–3.94) p = 0.017, 6.67 (1.11–39.97) p = 0.038, 1.10 (1.02–1.19) p = 0.018, and 1.11 (1.02–1.21) p = 0.020, respectively. The vast majority of patients identified severe and very severe events during their disease history, results that raise awareness of burden concerning lupus occurrence in women’s life. Self-perceived lupus severity is multifactorial, influenced also by factors less considered in the SLE management like fatigue and the depression/anxiety disorders, but also by the previous patient’s experience.

Sir, Although systemic lupus erythematosus (SLE) and celiac disease (CD) might share common genetic features, their concomitance was only occasionally presented, mostly as case reports. The SLE risk of occurrence appears to be increased three-fold in CD when compared with the general population, but the absolute excess of risk proved to be actually low. In relation to CD serology in lupus, positive anti-deamidated gliadin peptides antibodies (DGPs) seem commonly encountered. Immunoglobulin (Ig)A and IgG DGPs were found in 23% to 29% lupus patients. Occurrence of both DGP and anti-tissue transglutaminase antibodies (tTGs) was found in 8% of SLE patients. Moreover, anti-endomysium antibodies (EMAs) IgA serotype seem associated with lupus disease. Our aim was to evaluate the gluten-induced immune and autoimmune phenomenon in SLE patients. Therefore, quantitative determination of serum IgA, tTG-IgA, DGP, and EMA was done in 126 SLE patients. None of the patients were previously diagnosed with CD and they all consumed a gluten-containing diet. At inclusion, 14 patients (11.1%) followed a treatment with azathioprine, 2 patients (1.6%) with mycophenolate mofetil, and 1 patient (0.8%) with methotrexate or cyclophosphamide. A total of 104 patients (82.5%) were under corticosteroids, with a median daily prednisone dose of 10mg and a similar proportion of patients, 82.5% presented hydroxychloroquine treatment. Variables were presented as median (med) and quartile (q) 1; 3 and the non-parametric Spearman’s rho coefficient (r) was used in all univariate correlations. Differences of sub-groups characteristics were assessed by a Mann Whitney test. Ethical approval was obtained from Colentina Hospital and Institute for Mother and Child Care, Bucharest, Romania, and written informed consent was obtained in all cases. All samples analyzed presented total serum IgA of more than 0.07 g/l. Serum levels of IgA, tTGIgA, and DGP found were: 2.73 (2.09; 3.63) g/l, 6.5 (5.0; 9.0) U, and 8.0 (5.0; 11.0) U respectively. Overall, four samples were positive for tTG-IgA (cut-off: 20 U), 6 for DGP (cut-off: 20 U), and one for EMA (serum dilution titer 1:200, cut-off 1:5), corresponding to 3.2%, 4.8%, and 0.8% prevalence of gluten-induced antibodies in lupus, respectively. tTG-IgA levels were correlated with those of total IgA and DPG (r1⁄4 0.602; p< 0.001 and r1⁄4 0.603; p< 0.001). Among patients with positive tTG-IgA, one had antiphospholipid syndrome (APS), one Sjogren’s syndrome (S’sS), while none had autoimmune thyroiditis (AT). Moreover, in those with positive DGP, one patient had APS, one patient had S’sS, and none had AT. With regard to SLE’s clinical criteria, we found significantly higher tTG-IgA titers in patients presenting with hematological involvement at inclusion: 8.0 (6.0; 11.0) U versus 6.0 (5.0; 8.0) U, p1⁄4 0.004. No significant differences in relation to other active clinical involvements were found for tTG-IgA. No correlation of DGP with any lupus clinical features was identified. Moreover, tTG-IgA titers proved to be indirectly correlated with leucocytes (r1⁄4 0.196, p1⁄4 0.029) and lymphocytes (r1⁄4 0.235, p1⁄4 0.008), but not with hemoglobin levels or platelet counts (p> 0.05). As to parameters related to immune activity, we found that tTG-IgA levels were indirectly correlated to C4 complement (r1⁄4 0.238, p1⁄4 0.011). DGP titers again correlated to both C4 and C3 fractions (r1⁄4 0.319, p1⁄4 0.005 and r1⁄4 0.229, p1⁄4 0.044). tTG-IgA and EMA are considered highly CD-specific. Our finding of 3% positivity for tTG-IgA in SLE is higher than by chance alone as reported CD prevalence is around 1%. Our data are intriguing, although no control group was available for this study. Our results indicate gluten-induced immune phenomenon to occur in patients with SLE. However, low positive but unspecific titers of tTG-IgA have been detected in other pathologies including autoimmunity, while EMA is more specific for CD. In the present study EMA positivity was at 0.8%, similar to the general population. CD prevalence in SLE patients could not be defined in the present study due to no available endoscopic confirmation of gluteninduced small-intestinal mucosal injury. Correspondence to: A Popp, Institute for Mother and Child Care, Lacul Tei Street 120, 020395 Bucharest, Romania. Email: alina.popp@uta.fi Received 10 July 2016; accepted 21 February 2017

Background: Previous studies reported higher interleukin-6 (IL-6) levels in systemic lupus erythematosus (SLE) patients than in healthy controls. However, the clinical relevance of IL-6 in SLE has not been clearly established.Aim of the work: The present study aimed to evaluate the clinical significance of serum and urinary IL-6 and their usefulness as markers of disease activity in SLE.Patients and methods: 63 SLE patients were included. Disease activity was assessed according to the Systemic Lupus Activity Measure (SLAM) score. Serum and urinary IL-6 were assessed by ELISA.Results: The study included 63 Romanian patients, female to male ratio 9.5:1 with a mean age of 45.4 +/- 12.6 years and disease duration of 8 (3-12.3) years. The median SLAM score at inclusion was 5 (range 3-8). Urinary IL-6 significantly correlated with proteinuria (r = 0.25; p= 0.04) and negatively with the platelet count, C3 and C4 levels (r = -0.38; p= 0.002, r = -0.43; p = 0.001, and r = -0.46; p < 0.001 respectively). Moreover, in patients with active lupus nephritis (LN), urinary IL-6 correlated with the SLAM (r = 0.62; p = 0.01). Patients with low urinary IL-6 levels (<7.3 pg/ml) had a longer duration of treatment with corticosteroids or hydroxychloroquine (HCQ) (9.5 vs 4 years; p = 0.02 and 7 vs 4 years; p = 0.02). In a regression, only C3 was a significant determinant of urinary IL-6 level.Conclusions: Urinary but not serum IL-6 seems to be related to SLE activity in LN patients. Treatment with corticosteroids or HCQ therapy might reduce urinary IL-6 levels in SLE. (C) 2016 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background Erythrocyte sedimentation rate (ESR), C reactive protein (CRP), C3 complement (C3), and lymphocyte count are markers of disease activity in patients with systemic lupus erythematosus (SLE). Objectives Our aim was to identify a prediction tool for SLE disease activity with increased accuracy by combining the afore mentioned parameters, two by two, as ratios. Methods We prospectively enrolled 130 SLE patients admitted consecutively to our department. Clinical and biological parameters were assessed in each patient. Disease activity was quantified using Systemic Lupus Activity Measure (SLAM) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). For each patient we analyzed ESR/C3, CRP/C3, lymphocyte/ESR and lymphocyte/CRP ratios. Results The mean age of our study group was 46.58±12.69 years old and 90% were female. SLAM was correlated with ESR/C3 (r=0.549, p<0.01), CRP/C3 (r=0.343, p<0.01) and lymphocyte/ESR ratios (r=-0.240, p=0.01) better than with ESR (r=0.486, p<0.01), CRP (r=0.229, p=0.02), C3 (r=0.175, p=ns) and lymphocyte number (r=-0.235, p=0.01) alone. SLEDAI was correlated with ESR/C3 (r=0.745, p<0.01), CRP/C3 (r=0.342, p<0.01) and lymphocyte/ESR ratios (r=-0.312, p<0.01) better than with ESR (r=0.663, p<0.01), CRP (r=0.235, p=0.01) and lymphocyte number (r=-0.324, p<0.01) alone. In ROC curve analysis, ESR/C3 ratio predicted SLEDAI>10 with an AUC of 0.779, p<0.01 similar to ESR (AUC 0.782, p<0.01) and SLAM>10 with an AUC of 0.821, p<0.01 less than ESR (AUC 0.909, p<0.01). Lymphocyte/ESR ratio predicted SLEDAI>10 with an AUC of 0.754, p<0.01 and SLAM>10 with an AUC of 0.929, p<0.01. ESR/C3 ratio was the best predictor for severe disease quantified as SLAM>20 with an AUC 0.998 (p<0.01) compared to the lymphocyte/ESR ratio (AUC 0.983, p<0.01) and ESR (AUC 0.974, p<0.01). Lymphocyte/ESR ratio (AUC 0.890, p<0.01) and ESR (AUC 0.886, p<0.01) were better to predict severe disease using SLEDAI>20 compared to ESR/C3 ratio (AUC 0.850, p<0.01). Conclusions Lymphocyte/ESR and ESR/C3 ratios correlate with disease activity in SLE patients, possibly with higher accuracy compared to ESR, C3 and lymphocyte number alone. Acknowledgements This paper is supported by POSDRU/159/1.5/S/137390. Disclosure of Interest None declared

Background The assessment of disease activity in systemic lupus erythematosus (SLE) patients is appreciated by clinical and paraclinical data as well as by calculating the disease activity scores. All these methods are however laborious and time consuming. Objectives The aim of this study was to determine if the answers of the patients regarding the severity of their disease, as reflected by their general state, are related to disease activity, organ damage or fatigue degree. Methods Patients diagnosed with SLE according to the 2012 Systemic Lupus International Collaborating Clinic (SLICC) SLE9s criteria were consecutively included. Using a numerical rating scale (NRS) from 1 to 10 (1 - no disease; 10 – most severe disease), the patients answered at two questions: first, “How severe you think was your illness in the worst moment from the SLE diagnosis?” and second, “How severe you think is your illness in this moment?”. In order to reduce the subjectivity of the patient, we introduce also as variable the ratio of these two questions9 results. In all patients, the disease activity was assessed using the Systemic Lupus Activity Measure (SLAM) Score, the cumulative organ damage using the SLICC-ACR Damage Index, and the fatigue degree using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT fatigue) Scale. Results The lot consisted in 108 patients, 89.8% of feminine sex. The mean age at inclusion was 47.5±12.9 years, and the mean age at the SLE diagnosis 37.0±13.0 years. The results of the two questions regarding illness severity anytime and severity in present were 8.4±1.8 (3;10), respectively 4.6±2.5 (1;10). For the second question, a statistical significant difference was found between the patients with active disease and the patients with stable disease (cut-off for SLAM Score of 10 points): 6.6 (1;10) vs 4.3 (1;10), p-value 0.004 (Mann-Whitney test). In univariate analysis (Kendall test), the judge of illness severity in present was significant correlated with the results of SLAM Score, FACIT fatigue Scale (p-value <0.01), respectively with SLICC Damage Index (p-value <0.05). The judge of illness severity anytime was correlated only with the SLICC Damage Index result (p-value <0.05). Analyzing by ROC curve, the best predictor for a high SLAM Score (more or equal with 10 points) was the ratio between NRS illness severity in present reported and the NRS illness severity anytime [AUC (95%CI) 0.788 (0.658-0.918)], followed by the results of NRS illness severity in present, and by the FACIT fatigue Scale [AUC (95%CI) 0.755 (0.625-0.886), respectively 0.741 (0.617-0.865)]. Conclusions The simply patients9 self report of disease severity in the moment of presentation, on a NRS from one to ten, can give to the physician an additional information on SLE activity. Acknowledgements This paper is supported by the POSDRU/159/1.5/S/137390. Disclosure of Interest None declared

Background The antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are known to be associated with increased risk of cardiovascular disease (CVD). However, there are few data regarding the osteoprotegerin (OPG), one of the validated markers of the CVD risk, in patients with APS or SLE. Objectives The aim of this study was to evaluate the correlations between the OPG and antiphospholipid antibodies (APLA). Methods Patients with APS (primary and secondary to SLE) were successively included. The diagnosis was sustained according to the 2006 Sydney APS9s criteria, respectively to the 2012 SLICC SLE9s criteria. Laboratory workup included the “diagnostic” APLA [IgG and IgM anticardiolipin (aCL), IgG and IgM anti-β2 glycoprotein I (aβ2GPI)] and also the “non-diagnostic” APLA [IgG and IgM antiphosphatidylserine (aPS), IgG and IgM anti phosphatidylethanolamine (aPE), respectively IgG and IgM antiprothrombin (aPT)]. We assessed the SCORE and Framingham risk as the widely used score of CVD risk in general population. We divided the study group in two subgroups: A - patients with low OPG (≤1.5 pg/ml), and B - patients with high OPG (>1.5 pg/ml). Results For the 40 patients included, the mean age at inclusion (SD) was 43.7±10.7 years. OPG values were higher in patients with history of stroke vs patients without stroke (3.44±2.24 vs 2.15±1.5, p=0.02). We did not found differences of OPG values in patients with or without history of stable angina, myocardial infarction or peripheral artery disease. Values of SCORE risk (1.19±1.81 vs 0.43±0.75, p=0.03) and Framingham risk (6.56±6.41 vs 3.9±2.73, p=0.02) were significantly higher in group B comparing with group A. Moreover, in patients associating SLE, the SLEDAI score was higher in group B vs group A (4.47±3.51 vs 4.00±6.21, p=0.04). Also, for the SLE patients, we found a higher prevalence for the anti-DNA and anti-Sm in patients with high OPG (2/5 vs 13/0; p=0.042, respectively 0/7 vs 6/7; p=0.032). OPG values were positively correlates only with the values of IgM aPT (0.35, p=0.02). When we performed the ROC curve analysis, we found that the titers of IgM aPT, IgG aβ2GPI, and IgG aPE were the best predictors of an OPG values>1.5 [AUC (CI) 0.604 (0.418-0.791), 0.578 (0.392-0.795), respectively 0.536 (0.342-0.730)]. For the patients with APS secondary to SLE, IgM aPT and IgG aPE [AUC (CI) 0.632 (0.348-0.915), respectively 0.549 (0.289-0.810)] were the best predictors of high OPG levels. Conclusions OPG levels might be related with CVD risk in patients with APS. The OPG levels were correlated with “non-diagnostic” APLA, raising the hypothesis of “non-diagnostic” APLA involvement in the pathogenesis of CVD risk in patients with APS. Moreover, the anti-DNA and anti-Sm might be to be related with the OPG levels in patients with APS secondary to SLE. This is an interesting finding especially as we do not have yet a clear explanation for the increased CVD risk in SLE. Acknowledgements This paper is supported by the POSDRU/159/1.5/S/137390. Disclosure of Interest None declared

Background Glasgow Prognostic Score (GPS) is a simple, systemic inflammation-based prognostic score used mostly in oncology and intensive-care. Objectives We aimed to investigate the utility of GPS in assessing disease activity in patients with systemic lupus erythematosus (SLE). Methods Patients admitted consecutively to our department were prospectively enrolled in the study. Clinical and biological parameters were assessed in each participant. Disease activity was quantified using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Systemic Lupus Activity Measure (SLAM) and European Consensus Lupus Activity Measurement (ECLAM). GPS was calculated using 1 point for C reactive protein>10mg/L and 1 point for hypoalbuminemia. Results Our study group included 130 patients with a mean age of 46.58±12.69 years old and 90% female predominance, out of which 17 (13.07%) had a GPS≥1. Median ECLAM score was 2[0-7.5], median SLAM score was 4[0-24] and median SLEDAI score 6[0-48]. Patients with a GPS≥1 had a higher ECLAM score compared to those with a GPS=0 (3[0-10.5] vs. 2[0-7], p=0.007), a higher SLAM score (7[0-22] vs. 4[1-14], p=0.003), a higher SLEDAI score (8[0-48] vs. 4.5[0-30], p=0.006) and a higher erythrocyte sedimentation rate (ESR) (24[10-90] vs. 13.5[2-61], p=0.03). ROC curve analysis identified ECLAM and SLAM scores as predictors of a GPS≥1 with an AUC of 0.825 (95%CI 0.0.686-0.964, p=0.01) and 0.740 (95%CI 0.483-0.998, p=0.07) respectively. Elevated ESR was also associated with a GPS≥1 with an AUC of 0.819 (95%CI 0.693-0.945, p=0.01). Conclusions GPS was correlated with disease activity in patients with SLE. A simple systemic inflammation score, it could be used as an auxiliary tool for their assessment. Acknowledgements This paper is supported by POSDRU/159/1.5/S/137390. Disclosure of Interest None declared

Background Large studies validated the ankle-brachial index (ABI) as an important clinical marker of peripheral atherosclerosis in general population. However there are few studies regarding ABI in patients with antiphospholipid syndrome (APLS), a clinical condition associated with an increased cardiovascular risk. Objectives The aim of this study was to evaluate the predictors of an abnormal ABI in patients with APLS. Methods In 106 patients with APLS (primary and secondary) we performed the evaluation of the ABI according to standard recommendations. Traditional cardiovascular risk factors, along with a large spectrum of antiphospholipid antibodies (including the antiphosphatidylserine, antiphosphatidylethanolamine and antiprothrombine antibodies) and lupus anticoagulant were assessed. We calculated the pulse pressure as the difference between systolic and diastolic blood pressure – as a marker of arterial stiffness. We divided the study group in two subgroups: A- patients with an abnormal ABI (defined by a value below 0.9); and B - patients with normal ABI. Results In our study, 30 pts (28.3%) were found to have a low ABI. Mean age (51.1±13.2 in subgroup A vs 42.1±11.0 yo in subgroup B, p=0.001), mean age at diagnostic (42.9±13.4 vs 36.1±10.6 yo, p=0.007), prevalence of arterial hypertension (63.3 vs 32.8%, p=0.008), diabetes (23.3 vs 6.5%, p=0.02), pulse pressure (53.8±12.3 vs 48.6±9.8 mmHg, p=0.02), fasting glucose (95.2±17.5 vs 84.6±15.9 mg/dl, p=0.004) and values of HDL-cholesterol in men (43.1±7.9 vs 58.4±10.1, p=0.01) were associated with an abnormal ABI. Anti-beta 2-glycoprotein I IgG antibodies [median values (interval): 4.00 (1.00-79.00) vs 3.00 (0.00-29.00), p=0.02] and anti-prothrombin IgM antibodies [4.50 (0.00-82.00) vs 3.00 (0.00-14.00), p=0.05] were found to have higher values in patients with abnormal ABI. The anti-beta 2-glycoprotein IgG antibodies has had the higher AUC (area under the curve) for the prediction of low ABI (AUC=0.660). In multivariate analysis, only the titer of anti-beta 2-glycoprotein I IgG were significantly associated with an abnormal ABI (p=0.04). Conclusions In our study group of APLS patients we found a high prevalence of an abnormal ABI. As expected, the traditional cardiovascular risk factors are associated with more important vascular changes in these patients. However, only the titer of anti-beta 2-glycoprotein I IgG was independently associated with a low ABI in patients with APLS reflecting the role of disease itself in the pathogenesis of atherosclerosis. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4529

Cadmium sulfide uniform fine particles have been synthesized in soft conditions, at room temperature, using cadmium complex compounds and thioacetamide. The microstructure and morphology of cadmium sulfide were characterized by X - ray Diffraction, Transmission Electron Microscopy, High Resolution Transmission Electron Microscopy, and Selected Area Electron Diffraction. The optical properties of the samples were examined by UV - Visible spectroscopy.

Background: Lupus erythematosus (LE) is a heterogeneous disease with broad clinical spectrum from cutaneous to visceral and systemic inflammation. IL-17 isoforms (IL-17A and IL-17F) are proinflammatory cytokines with unclear implications in lupus erythematosus pathogenesis. In this study we focused upon IL-17 in normal and modified lupus skin with a correlative study between local and serological expression.Material and methods: 89 subjects were recruited and divided in 5 groups-10 patients with psoriasis (disease control group), 13 healthy controls, 26 with discoid chronic lupus (DLE), 23 with systemic lupus erythematosus (SLE) and 17 with subacute lupus erythematosus (SCLE). Blood samples and skin punched-biopsy specimens were performed. Serum IL-17A, IL-17F, and IL-23 concentrations were determined by ELISA. Skin IL-17A and CD4 expression were evaluated by immunohistochemistry.Results: Immunohistochemical expression of IL-17A was higher in DLE, SCLE and SLE patients than in negative control subjects (all p<0.05). Serum IL-17A concentrations were higher in DLE and SLE patients than in negative controls (p<0.05). Serum IL-17A levels were similar in SCLE and negative controls (p>0.05). Serum IL-17F concentrations were higher in DLE, SCLE and SLE patients than in healthy controls (all p<0.05). In DLE, SCLE, SLE patients and healthy controls we observed comparable levels of IL-23 (p>0.05). Serum anti Ro antibodies correlate with IL-17A+ lymphocytes from SCLE lesion and SLE normal skin (all p<0.05).Conclusion: IL-17 isoforms (IL-17A and IL-17F) are implicated in SLE but also in DLE and SCLE immunopathogenesis. (C) 2010 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved.

The zinc sulfide was prepared using as precursors zinc complexes and thioacetamide, at room temperature. The size and morphology, crystal structure, and optical properties of the zinc sulfide were analyzed by X-ray Diffraction, Selected Area Electron Diffraction, Transmission Electron Microscopy, Fourier Transform Infrared Spectrometry, and UV - Visible Spectrophotometry. The results show that the zinc sulphide powders are constituted by crystalline aggregates, which are made by uniform nanoparticles. The X-ray Diffraction and Selected Area Electron Diffraction patterns confirm the presence of cubic structure (blende type). The IR spectra prove that the zinc sulfide has good transmittance within the wavelength number range from 400 to 4000 cm(-1). The UV-Vis spectra show that the obtained zinc sulfide has strong absorption within the wavelength range from 250 to 300 nm.

We report the fabrication of solar cells based on nanocrystalline TiO2 sensitized with anthocyanins extracted from various plants, such as red cabbage and red onion, in an attempt to recycle residues from the food industry. We vary the solvent and the conditions in which the dye is extracted and analyze their effect on the solar cell performance. We find that all the extracts present light harvesting properties and perform charge transfer sensitization of the TiO2 semiconducting layer. The current-voltage curves have the expected shape for a photovoltaic device and the values of the fill-factors are relatively good, some in excess of 0.57. The efficiency, measured under standard AM 1.5 conditions, is 0.17 or lower, which is typical for most natural extracts tested so far.