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BackgroundRaynaud’s phenomenon (RP) is frequently associated with the presence of scleroderma or other connective tissue diseases (CTD). Identify the presence of secondary RP is important to perform an adequate therapeutic management and to achieve the early control of these patients. Nailfold capillaroscopy is safe, economic, and relatively easy to perform and has proven to be useful in identifying patients with secondary RP.ObjectivesTo assess a long-term follow-up primary RP patient’s series.MethodsRetrospective observational study of a wide and unselected series of patients diagnosed as primary RP from a single university hospital from January 2012 to August 2017. Patients were classified as primary RP after the presence of CTD at the onset was excluded.ResultsWe studied 214 patients (85.98% were female), with a mean age of 47.6±16.7 years (range 15–88). After a mean follow-up period of 46.4±23.3 months, 8 patients were diagnosed of a CTD (2 Scleroderma/Systemic sclerosis, 3 Systemic Lupus Erythematosus, 1 Rheumatoid arthritis and 2 Sjogren’s syndrome). The remaining 206 patients continued classified as primary RP.The main capillaroscopic patterns observed were: Normal (n=157), unspecific (n=49), scleroderma pattern (n=2) and suggestive of other rheumatic diseases pattern (n=6).All patients who developed a CTD during the follow-up, showed changes in successive nailfold capillaroscopic examinations. 20 of 206 patients who remained primary RP showed minor changes at successive nailfold capillaroscopy. The main capillaroscopic changes detected on this group were: presence of capillary tortuosity (n=4), presence of a decreased capillary density2 and the presence of capillary bleeding (n=16).Antinuclear antibodies (ANA) were positive at the onset in 34 patients and after follow-up in 39 patients.ConclusionsAfter a mean follow-up period next to four years, most of our primary RP patients remained free of CTD. A minority of our patients showed changes at nailfold capillaroscopy exam or positivity of ANA.Disclosure of InterestNone declared

BackgroundThe mixed connective tissue disease (MCTD) is an autoimmune systemic disease characterised by clinical manifestations that are included in systemic lupus erythematous (SLE), scleroderma (SSc) or rheumatoid arthritis (RA). Moreover the MCTD exhibits anti-U1RNP high-titter antibodies. However, anti-U1RNP antibodies are not specific or exclusive from MCTD, because of can be detected in other systemic autoimmune diseases as SLE, SSc and RA.ObjectivesTo verify the differentiation of MCTD patients from other systemic autoimmune diseases using anti-U1RNP titters. The secondary objective is to characterise anti-U1RNP titter in other systemic autoimmune diseases with clinical manifestation.MethodsAn observational retrospective study of patients with inflammatory autoimmune disease evaluated in the Rheumatology Department from 2012 since 2016 was performed. In all cases a blood-test with anti-U1RNP, anti-Sm, anti-Ro, and anti-La analysis was conducted. Clinical data was registered according to the patients’ medical history, with special emphasis being placed on renal affection, vascular affection, pulmonary hypertension, arthrtitis-synovitis, tendonitis-tenosynovitis, dry eye syndrome and Raynaud’s phenomenon. Biostatistical analysis was performed using R.ResultsWe collected data from 355 patients with a mean age of 50.84 (15.49) years, 98.55% of them were female. 13.8% of patients showed anti-U1RNP high titters (up to 20 pg/mL), and a significant increase of anti-U1-RNP in MCTD patients in contrast to other connective pathologies (p<0.0001) was observed.Anti-Sm antibody also exhibit significantly higher values in MCTD patients than in RA (p=0.025) or scleroderma (p=0.003). No differences in anti-Ro and anti-La levels among all diagnosis were observed. Patients with the high anti-U1-RNP levels, regardless of the diagnosis, showed more Raynaud’s phenomenon and vascular affection, (p<0.001 y p=0.008). Related to Anti-Ro and anti-La, high titter of these antibodies in patients with Dry eye syndrome was observed (p<0.001).Specifically in SLE patients, those with the highest levels of anti-U1-RNP exhibit Raynaud’s phenomenon (p<0.001), highest levels of anti-La was shown in those patients with renal affection (p=0.02) and the highest levels of anti-Ro and anti-La was shown in those patients with Dry eye syndrome (p=0.002 and p=0.006).ConclusionsIn our patient series anti-U1RNP were significantly elevated in MCTD diagnosis, and in lesser extent anti-Sm antibodies. Anti-Ro and anti-La antibodies are increased in dry eye syndrome patients. In SLE patients, anti-La increased levels were associated to renal affection.Disclosure of InterestNone declared

BackgroundSpondylodiscitis is an infectious disease of the vertebral body and intervertebral space, the early diagnosis and treatment are essential to give the patient the best chance of a good outcome, but these are often delayed because it tends to present nonspecific manifestations.ObjectivesTo analyse cases of Spondylodiscitis and identify poor prognosis variables.MethodsA retrospective observational study, included all adult patients with confirmed infectious spondylodiscitis between January 2010 and December 2017. Demographic features, concurrent disease, clinical history, laboratory findings, microbiological diagnosis, radiological data and clinical outcome were compiled from the clinical history management software. Statistical analysis was performed with the software R (version 3.3.2).ResultsWe included 87 patients with a mean age of 62.05 (16.94) years old. Males predominated (69%). Almost 31% patients presented of a level of immunosuppression (immunosuppression treatment, cirrhosis, HIV infection, solid organ transplantation). The average time with axial pain was 74 (87.65) days. Mean length of hospital stay was 34.24 (34.3) days and readmission rate was 34.9%. Most of patients showed high CRP levels at their admission, with an average value of 88.92 (84.58) mg/L, it was not correlated with worse prognosis. Underlying endocarditis proportion was 11.5%. Blood cultures were positive in 29 patients (33,3%), it was correlated with hospital stay (p=0,03). 51 patients had puntion-aspiration and intervertebral biopsy with microbiologic findings diagnosis in 30 patients (58.8%): 42.5% patients had an identifiable gram +bacteria (37,8% Streptococcus genere), 13.7% a Gram- bacteria, Mycobacterium tuberculosis in 8% and fungi infection (all Candida spp.) in 3.4%. 38% of patients showed vertebral destruction on MRI; 17.4% cord compression and developed neurological complications (8 of them paraparesis). 18.4% of patients required further surgical procedures. Furthermore, vertebral destruction was statistically correlated with epidural abscess (p=0,006). Almost 6% of patients died in the following year after diagnostic.ConclusionsDelay in diagnosis is an important issue in Spondylodiscitis patients. Higher complications rates are mainly in relation to greater vertebral destruction. Underlying infectious endocarditis was described in a small proportion of patients in contrast to other studies. Presence of epidural abscess was also correlated with vertebral destruction, for this reason, patients with this finding should be more carefully follow-up.Disclosure of InterestNone declared

BackgroundShoulder pain is a very common complaint with poor prognosis and high recurrence. To evaluate the shoulder pain, anamnesis and physical examination are used, but a diagnosis of certainty is difficult. Clinical history and specific exploration maneuvers tend to be poorly correlated with the underlying problem. There are few studies that assess the predictability of shoulder pathology using patient characteristics and exploration.ObjectivesTo assess if the combination of exploratory maneuvers and clinical data predicts the type of affection of the painful shoulder in a sensitive and specific way.MethodsWe conducted a prospective study with patients who attended to the Rheumatology Department of HUP La Fe by painful shoulder between February 2016 and January 2017, excluding those with known inflammatory diseases. A rheumatologist performed the anamnesis and the selected exploratory maneuvers: Jobe and Gerber test and palpation of the acromioclavicular joint. A second rheumatologist, blind to physical examination and medical history, performed the shoulder ultrasound scan. Biostatistic analysis was performed using software R version 3.3.2.Results119 patients (66.4% women) with a mean age of 60±12.56 years and shoulder pain were collected. Time of pain evolution was 20.43±24.09 months and the right shoulder was the most affected one (71.4%). The association between the maneuvers of Jobe and the involvement of the supraspinatus (SE), as well as the Gerber maneuver with the affectation of the subscapular were statistically significant. However the sensitivity and specificity of both maneuvers are very low, so that alone is not suitable to identify the affected tendon or the type of alteration. Thus, a predictor model (nomogram) of the most common shoulder pathologies (subacromiodeltoid bursitis, tendinosis or SE tears) was developed using epidemiological and clinical examination variables.ConclusionsBased on our results, the predictor model performed using epidemiological and clinical examination variables would be able to predict the most frequent pathologies of the shoulder. Imaging tests have a certain delay time, and by applying this predictor model, a diagnosis of presumption could be established in primary care, giving the opportunity to institute an early treatment. In addition, patients could be referred more efficiently to the appropriate specialty (rheumatology, traumatology or rehabilitation), avoiding delays.Disclosure of InterestNone declared

BackgroundTreatment and management of Rheumatoid Arthritis (RA) results in a high cost to the Health system such as the Spanish Health System. During the realization of clinical trials (CT) the sponsor is the one that pays for the direct healthcare costs of the patients, which leads to savings to the National Health System (NHS).ObjectivesTo estimate the economic impact of conducting clinical trials (CT) for the NHS in terms of avoided costs.MethodsA retrospective observational study was conducted using information from the clinical trials performed at the Clinical Research Rheumatology Department in the HUP la Fe from 2011 to 2015. Also a Cost-analysis was performed according Health System perspective. We calculated the length of stay in the CT in weeks for each patient included with RA diagnosis. Afterwards, we also calculated the total number of weeks of treatment for the total number of patients. In order to evaluate the economic impact in terms of avoided costs, economic evaluation included direct healthcare costs (rheumatologist visits, nurse care, laboratory tests and pharmacological treatment), and it was compared to the cost of the best alternative treatment in the market.ResultsA total of 35 CT were analyzed in this period, 14 of them focused on RA. Two observational studies and one CT (premature closure by the sponsor) were discarded. Therefore, 11 were considered in this study and a total of 76 patients with RA were analysed which add together 2609 weeks of treatment. This is approximately equivalent to treating 50 RA patients with biological therapy during one year. Evaluating the health savings that biological treatment would have cost during the 2609 weeks, we obtain a total amount of 699.176,88 €. This represents an annual saving of 139.835€ over the 5 years analyzed.ConclusionsOur Clinical Research Unit managed to save a total amount of 13.935,30 € per patient in CT per year. Clinical Research Units should be considered as an efficient tool to the NHS.Disclosure of InterestNone declared

BackgroundIn the management of rheumatologic patients treated with intravenous therapies, its regular monitoring is recommended in order to ensure its safety. The Nursing Consultation for monitoring rheumatologic patients treated with Intravenous Therapies (NCIT) represents a major support to patient caring for it provides patient monitoring before treatment administration and prior to rheumatologist consultation.ObjectivesTo analyze number and types of incidents detected in the NCIT.MethodsA cross-sectional longitudinal, observational study of data from patients followed-up in the NCIT (which was initiated in 2012) was performed. We have collected data of gender, diagnosis, drug administered, incidents detected previously to the drug administration, and if the incident was detected by telephone (one day before drug administration) or by personal interview. Biostatistical analysis with R (3.3.2.) was performed.ResultsWe analyzed 7809 drug infusions corresponding to 545 patients (73% women). 48.25% of patients were diagnosed with osteoporosis (OP), 30.1% rheumatoid arthritis (RA), 5.7% ankylosing spondylitis (AS), 4.2% systemic lupus erythematous (SLE), 2.9% psoriatic arthritis (PsoA) and 8.3% had other diagnosis. The intravenous therapies were antiosteoporotic drug (7.8%) and biological and immunosuppressive treatment, being the most common drugs tocilizumab (38.89%), infliximab (31.9%) and abatacept (18.05%). In the 7809 treatment infusions, 477 incidents (4.1%) were registered, 33 of them related to the antiosteoporotic therapies and the other 444 incidents (93%) occurred in the biological therapies. The 63.7% of the incidents were detected by telephone one day before drug infusion. Statistical analysis showed that SLE patients exhibit higher tendency to incidents (4.8% of incidents in the 392 treatments for SLE patients; P=0.026) than other autoimmune diseases. On the other hand, RA and AS patients have incidents detected mainly by telephone ((P=0.047 y P=0.029 respectively). We also observed a high number of incidents in the intravenous administration of TCZ (P=0.009).ConclusionsThe NCIT has performed the follow-up of more than 5oo patients with only 6% of incidents, contributing to an improvement in the patients' health and in its caring. Moreover, the fact of identifying the incidents helps to reduce the number of personal consultations, avoids drug preparation in those cases where this infusion is suspended, and in summary it improves management of hospital resources.Disclosure of InterestNone declared

BackgroundSpondylodiscitis is an infectious disease of the intervertebral space, often caused by hematological spreading from a distance septic focus, especially Endocarditis. Because of its low incidence combined with an ambiguous symptoms, delay diagnosis and treatment of this condition, raising probability of an undesirable outcome.ObjectivesTo identify poor prognosis variables in patients with SpondylodiscitisMethodsObservational retrospective study with non-quirurgic spondylodiscitis patients from 2010 to 2016 was performed. Demographic information, clinical history, laboratory test and radiological data were compiled from the clinical history management software. Statistical analysis was performed with the software R (version 3.3.2).ResultsWe included 55 patients, with a mean age of 63.47 (16.11) years old. Males predominated (69%). The average time with axial pain was 64.44 (80.63) days. Mean length of hospital stay was 64.44 (80.63) days and readmission rate was 32.7%. 20% of patients required further surgical procedures. Most of patients showed high CRP levels at their admission, with an average value of 112.97 (83.64) mg/L. Underlying endocarditis proportion was 16.4% and in this patients hospital stay was significative higher; nevertheless, it was not correlated with worse prognosis. 50% of patients showed vertebral destruction on MRI; 14.8% cord compression and 20.4% of patients developed neurological complications (7 of them paraparesis). Furthermore, vertebral destruction was statistically correlated with epidural abscess (P=0.026). Isolation and microbiological identification in blood cultures was possible in 83.6% of patients. Most frequent bacteria was Gram positive (50.09%), then Gram negative (18.2%), mycobacteria (10,9%) and fungi (3.6%).ConclusionsDelay in diagnosis is an important issue in Spondylodiscitis patients. Higher complications rates are mainly in relation to greater vertebral destruction. Underlying infectious endocarditis was described in a small proportion of patients in contrast to other studies. Presence of epidural abscess was also correlated with vertebral destruction, for this reason, patients with this finding should be more carefully follow-up.Disclosure of InterestNone declared

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease which affects 0.5% of adults, especially women. This disorder is associated with increased morbidity and mortality due to atherosclerotic cardiovascular diseases. In addition to classical cardiovascular risk factors, inflammation plays a key role in this fact. Intima-media thickness (IMT) measured by carotid ultrasound is currently used to detect the presence of atherosclerotic disease and its value could be a predictor of subclinical cardiovascular disease.ObjectivesTo study cardiovascular risk factors, disease activity and carotid IMT in a RA patients series.MethodsCross-sectional observational study of patients diagnosed with RA according to ACR/EULAR 2010 criteria. Patients with age under 75 years old and up of 5 years of disease evolution were included. Cardiovascular established disease patients were excluded. During a unique visit, patients underwent anamnesis, physical examination, laboratory test, electrocardiogram, chest X-ray and carotid ultrasound with Esaote-MyLabClassC equipment. Statistical analyses were performed using software R (version 3.3.2).ResultsA total of 31 patients (57.1±9.7 years, 83.6% female, with 19.2±11.2 years of average disease course) were included. In relation to the classic cardiovascular risk factors, 19.4% were active smokers, 41.9% hypertensives and 45.2% had hypolipidemic treatment (85.7% with a statin), three of the patients were diabetic (9.7%). All patients were treated with monotherapy or combination therapy and 41.9% were also given glucocorticoid at low doses during the last 6 months. The median DAS28-VSG was 2.49 (1°Q=1.6; 3°Q=3.9), with an average HAQ of 0.88±0.68. As for extra-articular manifestations, 45.2% had xerophthalmia, 29% xerostomia, and 19.4% had rheumatoid nodules. The median total cholesterol was 195 mg/dL (174–221), and LDL of 116 mg/dL (96.5–138). The mean of the right carotid IMT was 576.13±118.78 mm and the carotid left IMT was 616.32±134.31 mm, resulting in 12 determinations higher values than expected to their age and sex provided by the ultrasound developer (38.7%). Using the SCORE table (modified by EULAR), only 5 patients (16.1%) had moderate-to -high cardiovascular risk. Statistical analysis showed a significative association between an increased IMT with tobacco consumption (classic cardiovascular risk factor) (p=0.028) and the modified SCORE (p=0.04). Neither years of evolution of disease nor the analytical biomarkers showed a significant association.ConclusionsOur study shows that in patients with good disease control data, classic cardiovascular risk factors are related to increased carotid intima-media thickness. However, these factors may underestimate overall cardiovascular risk over other measures of subclinical cardiovascular disease, such as carotid IMT.Disclosure of InterestNone declared

BackgroundB lymphocyte stimulator factor (BLyS) is produced by wide range of cells of the immune system, and has proven to be a key factor in the selection and survival of B cells. BLyS is an important factor in the pathology of Systemic Lupus Erythematosus; elevated serum levels (≥20ng/mL) of soluble BlyS are at increased risk of flare.ObjectivesAnalyze the association among BLyS levels and clinical manifestations, as well as with SLE clinical activity.MethodsA cross-sectional and observational study was performed in patients diagnosed of SLE according to SLICC 2012 criteria and healthy controls. The study included a complete blood-test and clinical data collected by personal interview. Disease activity assessment was made by SLEDAI index and for the evaluation of chronic damage we used the validated SLICC damage index. Serum concentration of BLyS was analyzed by colorimetric methods. Lupus patients were dichotomized as high and low BLyS levels based on BLyS levels above 2 SD of the mean in healthy controls. Biostatistical analysis with R (3.3.2.) was performed.ResultsTwo hundred forty-two SLE patients were evaluated; 94.4% of them were female. Mean values were as follow: age at diagnosis 33.29±13.53 years, disease duration 15.82±10.56 years, SLEDAI 5.91±5.06, SLICC score 1.06±1.42, BLyS levels 1.811±1.757 ng/mL. The 22.5% of patients displayed increased BLyS levels. The 29.6% of total patients exhibit SLEDAI values up to 6, and only the 7% of them showed SLEDAI values up to 6 and high BLyS levels simultaneously. Higher BLyS levels were significantly correlated to the ANAs positivity (p=0.0006) and lymphopenia (p=0.01) but showed no correlation with hypocomplementemia neither anti-dsDNA. The statistical analysis did not yield differences in the clinical activity or accumulated damage between patients with lower and higher BLyS levels.ConclusionsIn our series we observed a 22.5% of patients with high levels of BLyS, and the 7% of cases had BLyS high levels and SLEDAI>6. BLyS upregulation is related to ANAs positivity and lymphopenia. We have found no statistical evidences on the relationship of BLyS levels and clinical activity in our series of patients.Disclosure of InterestNone declared

BackgroundSystemic lupus erythematous (SLE) is an autoimmune disease characterized by immune system disruption, including T and B cell activation and upregulation of autoantibody and immunocomplexes production that could damage different organs. Sometimes, patients with positives autoantibodies and serological manifestations show low disease activity or clinical remission. There is not enough information about persistent positive autoantibodies in absence of clinical activity neither the role of proinflamatory cytokines in this context.ObjectivesTo assess the clinical and molecular differences in SLE patients with positives autoantibodies and with low clinical activity or in clinical remission compared to the group with clinical activity.MethodsA cross-sectional, observational study of patients diagnosed of SLE according to SLICC 2012 criteria was performed. In these patients a complete blood-test was made, and clinical data by personal interview was collected. We analyzed the serum concentration of IL10, BLyS and INF1A by colorimetric methods. Biostatistical analysis was performed with R 3.3.2.ResultsWe selected 130 SLE patients with serological manifestations (defined by RELESSER study) out of 142 SLE patients. 91 cases showed low activity or remission (SLEDAI<6) and 39 presented moderate or high activity (SLEDAI>6). SLE patients with positives autoantibodies without clinical activity showed significantly lower anti-dsDNA levels (P=0.006), lower complement consumption (P=0.003) and lower accumulated damage evaluated by SLICC score (P=0.041). No differences on time of evolution in both groups were observed. In addition, SLE patients with positives autoantibodies without clinical activity exhibit significantly lower levels of IL10 (P<0.001) and INF1A (P=0.019). No differences on BLyS levels in both groups were observed. Finally, SLE patients with positives autoantibodies with clinical activity present more mucocutaneous lesions (P=0.014), musculoskeletal manifestations (P=0.004), neuropsychiatric manifestations (P=0.002), renal manifestations (P<0.001) and lymphopenia (P=0.008) than patients with positives autoantibodies and without clinical activity.ConclusionsIn our series of SLE patients with both serological manifestations and low clinical activity have lower levels of IL10 and INF1A, compared to patients with high clinical activity. This result would suggest that differences in the cytokine levels are not related to autoantibodies presence but there are other mechanisms involved in cytokine production that would also be involved in maintenance of clinical remission.Disclosure of InterestNone declared