Carli, Linda

Elefante, Elena

Ferro, Francesco

Mosca, Marta

Parma, Alice

Signorini, Viola

Stagnaro, Chiara

Tani, Chiara

Undetermined

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270 The discordance between patient and physician perception of the disease: the paradigm of SLE

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nr-AxSpA was made based upon the presence inflammatorylow-back pain, human leukocyte antigen B27 positivity, andpresence of sacroiliitis only in MRI. SLE was diagnosed withbutterfly-shaped rash on her cheeks, inflammatory arthritis,photosensitivity, erythema involving dorsal inter-joint area ofhand fingers, alopecia together with antinuclear antibody(ANA) and anti-dsDNA positivity, low serum complement lev-els, leucopenia and thrombocytopenia. Additional presence ofsicca symptoms, low Schirmer I test, anti SSA/Ro and anti-SSB/La positivity, supported by positive labial salivary glandbiopsy led to the diagnosis of SjS.Results Furthermore, this patient also had miscarriage at 16thweek and cerebral vascular disease at 33 years. Besides, IgGand IgM anticardiolipin antibodies were found to be positivetwice. Therefore, she was also diagnosed as secondary APS. Shefulfilled the relevant criteria for AxSpA, SLE, SjS and APS.Conclusions To our knowledge, this is the first case reportshowing the association of these four diseases, with differentgenetic, etiopathogenetic and clinical systemic inflammatorydiseases.Funding Source(s): No270 THE DISCORDANCE BETWEEN PATIENT AND PHYSICIANPERCEPTION OF THE DISEASE: THE PARADIGM OF SLE1Elena Elefante*, 2Chiara Tani, 3Francesco Ferro, 2Chiara Stagnaro, 3Alice Parma,2Linda Carli, 2Viola Signorini, 4Marta Mosca. 1University of Siena, Siena, Italy;2Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa,Pisa, Italy; 3University of Pisa; 4Director Rheumatology Unit, Associate Professor inRheumatology, University of Pisa10.1136/lupus-2019-lsm.270Background Background: a discordance exists between patientand physician perspective in the evaluation of SLE and it maynegatively impact on patient care. Our purpose was to com-pare patient and physician evaluation of the disease in amonocentric cohort of SLE patients, analyzing factors thatinfluence patient perception.Methods Methods: this is a cross-sectional study that enrollsadult patients with a diagnosis of SLE (ACR 1997 criteria).For each patient, demographics, comorbidities, treatment his-tory, clinical and laboratory data were collected. Disease activ-ity was evaluated with the SELENA-SLEDAI score and organdamage with the SLICC/DI. At enrollment each patient com-pleted the following PROs: SF-36, FACIT-F, LIT, SLAQ andBILD. The Spearman test has been used for linear correlationbetween continuous data.Results Results: we included 223 adult SLE patients (97,24%Caucasian, 91,93% female, mean age 44,9413,17 years,median disease duration 13 years). Median SLEDAI at enroll-ment was 2 (IQR 0–4); 18,22% of patients had SLEDAI >4;49,33% had SLICC/DI>0. 11,8% of the cohort had a con-comitant fibromyalgia. At enrollment, the most frequent activedisease manifestations were articular (36/223) and hematologi-cal (33/223), while only 15 patients had active renalinvolvement.The median score of the SLAQ questionnaire was 11 (IQR6–16). No correlation was found between patients self-evalua-tion of the disease and the physicians assessment: SLAQ andSLEDAI scores were not significantly correlated.Among active disease manifestations, only arthritis(p=0,03) and skin involvement (p=0,04) resulted signifi-cantly associated with higher SLAQ scores. Moreover, theSLAQ score resulted significantly influenced by fibromyalgia(p<0,001): patients with fibromyalgia seems to overestimateSLE disease activity. Finally, while SLEDAI didnt show anycorrelation with PROs on HRQoL, higher SLAQ scores werestrongly associated with a worst patient perception of QoL,fatigue and SLE impact, as expressed by SF-36, FACIT-F andLIT (table 1).Conclusions Conclusion: differently from the physicians assess-ment, SLE patients evaluation of their disease is influenced bymilder manifestations but with a heavy impact on daily func-tioning, like arthritis and fibromyalgia. Patients self-evaluationhas a strong impact on their perception of health status anddisease burden. The integration of patient-driven data to thetraditional clinical evaluation may improve the management ofSLE patients.Abstract 270 Table 1 Correlation between SLAQ and PROsAbstractsLupus Science & Medicine 2019;6(Suppl 1):A1–A227 A197 on June 7, 2020 by guest. Protected by copyright.http://lupus.bmj.com/Lupus Sci Med: first published as 10.1136/lupus-2019-lsm.270 on 1 April 2019. Downloaded from Funding Source(s): Founding: INTEGRATE project (EuropeanCommission, 3rd Health Program, Proposal ID 769736)271 FREQUENCY OF NEONATAL LUPUS IN REFERENCECENTERS IN THE MANAGEMENT OF PREGNANCY ANDAUTOIMMUNE DISEASES1Carla Maldini*, 1Cintia Otaduy, 2Florencia Beatriz Mollerach, 2Marina Scolnik, 3BelenMaria Virasoro, 3Cecilia Pisoni, 4Mercedes Croce, 4Maria Hu, 5Fabiola Natalia CamargoSerrudo, 6Diana Dubinsky, 7María de la Paz Leon, 7Veronica Bellomio, 8DanielaFlores Rengifo, 8Eduardo Kerzberg, 9Fernanda Guzzanti, 9Emma E Civit, 10Ana Bertoli,10Maria Jose Lopez Perez, 11Maximiliano Machado Escobar, 12Veronica Savio,12Alejandra Babini, 13Cecilia Alvarez, 13Verónica Saurit, 14Rosa Serrano Morales,15Cruz Lascano, 16María Constanza Danielsen, 17Mayra Etcheverry, 17Adrian Estevez,18Marina Werner, 18Laura Onetti, 1Paula Alba, 19Carla Gobbi. 1Cátedra de SemiologíaUHMI 3 Hospital Córdoba FCM Universidad Nacional de Córdoba, Córdoba, Argentina;2Hospital Italiano de Buenos Aires, Argentina; 3Centro de Educación Médica eInvestigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina; 4HospitalPenna, Buenos Aires, Argentina; 5Rheumatology Division, Sanatorio Guemes; 6SanatorioGuemes; 7Hospital Padilla, Tucumán, Argentina; 8Hospital J. M. Ramos Mejía, Buenos Aires,Argentina; 9Hospital El Carmen, Mendoza, Argentina; 10Clínica Universitaria Reina Fabiola,Universidad Católica de Córdoba, Córdoba. Argentina; 11Instituto de Maternidad yGinecologia Nuestra Sra de las Mercedes, Tucuman, Argentina; 12Hospital Italiano,Córdoba, Argentina; 13Servicio de Reumatología, Hospital Privado Universitario de Córdoba,Córdoba, Argentina; 14Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR)/Maternidad Oroño, Rosario, Argentina; 15Hospital San Roque, San Salvador deJujuy, Argentina; 16Clínica del Pilar, Santiago del Estero, Argentina; 17Hospital de AltaComplejidad El Cruce, Buenos Aires, Argentina; 18Hospital Nacional de Clínicas, Córdoba,Argentina; 19Universidad Nacional de Córdoba10.1136/lupus-2019-lsm.271Background Neonatal lupus (NL) is a disease in children ofmothers who have specific anti-Ro/La IgG autoantibodies bypassive transplacental transfer. LN is characterized by skin andcardiac involvement, as well as cytopenias, hepatic or neuro-logical manifestations. NL can be diagnosed intra-uterus or inneonatal period, being self-limiting in several months or beirreversible. Congenital heart block (CHB) in a structurallynormal heart, is perhaps the most serious manifestation withan estimated mortality rate of around 19%. Objetives: to esti-mate the frequency of NL in children of mothers with anti-Ro/La in reference centers in the management of pregnancyand autoimmune diseases in Argentina, and to describe mater-nal and children features.Methods A descriptive multicenter study was conducted inreference centers in the management of autoimmune diseasesand pregnancy in Argentina. Inclusion criteria were the pres-ence of positive maternal serology anti-Ro/La and at least onepregnancy. Demographic and maternal-fetal clinical data wereobtained from the clinical histories and each center completeda data collection form created for this study. We defined aNL case (born or not) who presented, pre and/or postpartum,characteristic skin lesions, cytopenias, cardiac involvement(CHB, endocardial fibroelastosis and dilated cardiomyopathy),hepatic or neurological manifestations. Ethnicity was classifiedusing GLADEL groups. NL frequency was calculated dividingthe number NL cases by the number of mothers with positiveanti-Ro/La serology.Results 18 reference centers in the management of autoim-mune diseases and pregnancy participated in this study in 7different geographic areas of Argentina (6 of Buenos Aires, 6of Cordoba, 1 of Jujuy, 1 of Mendoza, 1 of Santa Fe, 1 ofSantiago del Estero and 2 of Tucuman). 193 mothers withpositive anti-Ro/La serology were included with 364 pregnan-cies. 19 cases NL cases were reported (10 diagnosed duringAbstract 271 Table 1 Maternal and fetal characteristics of the 19 NL casesAbstractsA198 Lupus Science & Medicine 2019;6(Suppl 1):A1–A227 on June 7, 2020 by guest. Protected by copyright.http://lupus.bmj.com/Lupus Sci Med: first published as 10.1136/lupus-2019-lsm.270 on 1 April 2019. Downloaded from 

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270 The discordance between patient and physician perception of the disease: the paradigm of SLE

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