Álvaro Vivas, Colombia
Universidad Icesi Medical SchoolPresenter of 3 Presentations
REPRODUCIBILITY OF MINOR SALIVARY GLAND BIOPSY REPORTS IN SJÖGREN'S SYNDROME AND ITS CORRELATION WITH DISEASE BIOMARKERS
Abstract
Background and Aims
Diagnosis of Sjögren's syndrome (SS) can be challenging. Minor salivary gland biopsy (MSGB) is a useful ancillary study. However, different factors make their interpretation difficult. Also, the significance of distinct histopathological findings is unknown. Our objective was to determine the concordance between pathologists and rheumatologists in the interpretation of MSGBs results and the correlation (if any) between MSGB findings and paraclinical parameters.
Methods
This descriptive retrospective study reviewed medical charts from 998 individuals with sicca symptoms in whom a MSGBs was performed. Rheumatologists interpreted biopsy reports from pathologists in order to obtain the interobserver variability. We then performed logistic regression using immunological and histological parameters.
Results
We included 998 patients with sicca symptoms, the median age was 55 years (45-64 years). The majority were females (n=934, 93.6%). Chisholm and Mason's scoring system was the most used scale by pathologists (55.1%). There was a correlation between pathologists and rheumatologists for the diagnosis of SS regarding MSGB (Cohen’s kappa 0.91). In addition to focal lymphocytic infiltrates, we found a strong association between interstitial plasmocytes and SS (OR 24, 95% CI 9.09-64.94, p = 0). The logistic regression evaluating the probability of being diagnosed with SS by a rheumatologist, upon the presence of histological characteristics in the MSGB is shown in Table.
Conclusions
The MSGB is an essential tool for the diagnosis of SS. However, different factors may negatively affect its reproducibility. Histological findings, such as interstitial plasmocytes, may predict the risk of having SS.
ELECTROPHYSIOLOGICAL FEATURES OF PERIPHERAL NEUROPATHY IN SYSTEMIC LUPUS ERYTHEMATOSUS AND SJÖGREN´S SYNDROME AND ASSOCIATION WITH SERUM IMMUNE MARKERS
Abstract
Background and Aims
Peripheral neuropathy in patients with systemic lupus erythematosus (SLE) and Sjögren´s syndrome (SS) represents significant morbidity. Nerve conduction studies (NCS) are the primary diagnostic tool for the diagnosis. This study aims to describe the electrophysiological features of peripheral neuropathy in SLE and SS and evaluate their association with serum immune markers.
Methods
This is a retrospective study based on the medical charts, laboratory, and NCS results of SLE and SS patients treated between 2016-2019 in a high complexity center in Colombia.
Results
We included 55 patients; 51 (92.73%) were female with a median age of 53 (34-62) years. Thirty-one (56.36%) patients had SS, nineteen SLE (34.55%), and five SLE/SS overlap (9.09%). Alterations in NCS were present in 20 (36.36%) patients, characterized mainly as demyelinating (n=14, 70%). SS patients exhibited lower amplitudes and velocities for the ulnar motor nerve (p≤0.050). Whereas, higher latencies with lower velocities were observed for the sensory branch of the ulnar nerve in SLE patients (p≤0.050). Positivity for anti-Smith antibody was significantly associated with a higher left median motor latency (p=0.028), lower left median (p=0.024), and ulnar (p=0.046) motor amplitudes, and lower left median (p=0.049) and right ulnar (p=0.039) sensory amplitudes. Likewise, positivity for anti-cardiolipin IgG antibodies was associated with a higher right median motor latency (p=0.033), higher bilateral ulnar motor latencies (p≤0.05), and lower bilateral ulnar sensory amplitudes (p≤0.050).
Conclusions
Electrophysiological features significantly differ between SS and SLE patients, particularly for the ulnar nerves. Anti-Sm and Anti-cardiolipin IgG antibodies might be involved in the pathogenesis of autoimmune peripheral neuropathy.
THERAPEUTIC PLASMA EXCHANGE IN AUTOINMUNE NEUROLOGICAL DISEASES
Abstract
Background and Aims
Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (AND), which main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with AND at our institution.
Methods
This is an observational retrospective study, which took into account medical records of patients with diagnosis of AND who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure clinical response after therapy.
Results
187 patients were included with the following diagnoses: myasthenia gravis (MG), n=70 (37%); Guillain Barré syndrome (GBS), n=53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), n=35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), n=23 (12.2%); and autoimmune encephalitis (AE), n=6 (3.2%). The most used types of replacement solution were albumin (n=131, 70%) and succilynated gelatin (n=45, 24%). All patients received a median of five cycles. Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 (52.9%) patients showed improvement in the mRS scores and a statistical significance (p<0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP.
Conclusions
TPE has an adequate safety profile and improvement in functionality in treated patients reflects its effectiveness.