Search

Background Secondary prevention of osteoporotic fracture is more efficient with the Fracture Liaison Service (FLS) model. Objectives To describe the characteristics of male patients attended in a FLS Methods Prospective observational study. The program consists of: 1) recruitment from the emergency records, hip fracture admitted or referral to outpatient rheumatology; 3) baseline visit: questionnaire including demographCI variables, FRAX and previous treatments; 4) DXA; 5) patient education; 6) report of results to the patient and the PC doctor, with specifCI management recommendations; complex patients are referred to rheumatology; and 7) follow-up through telephone survey plus prescription check in electronCI records. The characteristCIs of male patients are described and compared with women. Results 2,135 patients have been included, 382 male (18%). The recruitment was in 300 cases (78%) from the emergency list, in 55 cases (14%) admission for hip fracture and in 25 cases (6%) from outpatient clinCI. The characteristCIs of the patients are shown in the table. The average age was similar in men and women. Hip fracture was more frequent in men (34% vs. 25%, OR 1.63 CI 95% 1.50-1.75) as opposed to forearm fracture (18% vs. 33%, OR 0.46 CI 95% 0.32-0.60). Male had previous DXA (6% vs 25%, OR 0.22 CI 95% 0.00-0.43) and previous treatment with bisphosphonate (4% vs 19%, OR 0.17 CI 95% 0, 0-0.44) less frequently. Of the variables included in the FRAX, in men was less frequent the previous fracture (13% vs 24%, OR 0.48 CI 95% 0.32-0.64), the hip fracture of the parents (9% vs. 13%; OR 0.66 CI 95% 0.47-0.85) and the use of corticoids (6% vs 10%, OR 0.61 CI 95% 0.39-0.84). However, active smoking was more frequent in men (21% vs 14%, OR 1.67 CI 95% 1.53-1.81) as well as consumption >2 daily units of alcohol (18% vs 5%; OR 3.96 CI 95% 3.78-4.13). The percentage of osteoporosis was lower in men compared to women (30% vs 46%, OR 0.49 CI 95% 0.30-0.68) as well as the percentage of patients with >1 fall in the last year (29% vs 45%, OR 0.51 CI 95% 0.30-0.71). In addition, after the visit to the FLS, a bisphosphonate was indicated less frequently to men than to women (68% vs. 77%, OR 0.64 CI 95% 0.51-0.76) and were referred less frequently to PC (64% vs. 76%; OR 0.55 95% CI 0.41-0.70). Finally, persistence at 12 months was lower in men than in women (53% vs. 68%, OR 0.53 CI 95% 0.30-0.76). Conclusion Compared with women, men seen in an FLS present hip fracture more frequently and a forearm fracture less frequently. Men also have a lower frequency of personal and family history of fracture and a greater frequency of smoking and alcohol intake. The percentage of patients who are candidates for treatment and persistence is lower than in women. These data should be taken into account in the identification and treatment of fragility fracture in men. Acknowledgement Fabiola Santana and Carmen Alonso Disclosure of Interests Antonio Naranjo Grant/research support from: Amgen, Consultant for: UCB, Speakers bureau: Amgen, UCB, Soledad Ojeda Grant/research support from: AMGEN, Speakers bureau: AMGEN, Aida Saavedra: None declared, Cristina Sepulveda: None declared, Francisco Rubino: None declared, Amparo Molina Speakers bureau: AMGEN, Olga Suarez: None declared, Casimira Dominguez: None declared, Jose A. Lorenzo: None declared, Nieves Martin: None declared, Carlos Rodriguez-Lozano: None declared

Background: Streptococcus pneumoniae (SPN) is an encapsulated gram-positive bacterium that can be found in the nasopharynx as part of the normal flora. However, is the most common cause of community-acquired pneumonia in adults and can also cause invasive diseases such as bacteremia, meningitis, and otitis media. Pneumococcal cellulitis and fasciitis are uncommon. Several factors are associated with a predisposition to infections in patients with Systemic Lupus Erythematosus (SLE). Objectives: To describe and analyze all documented cases of cellulitis or fasciitis caused by SPN in SLE patients. Methods: In the framework of the study of a 24-years-old woman that during the SLE onset presented left tight cellulitis and fasciitis caused by SPN, a systematic review was conducted (until September 2018). The search included terms to identify any SPN infection in SLE patients and all those articles that reported cellulitis or fasciitis were selected (Table 1). Results: A total of 313 articles were obtained. Eight of them (1-8) and 1 article identified in a manual search (9) described a total of 15 cases presenting SLE and cellulitis or necrotizing fasciitis caused by SPN; our case is the 16th described. Documented infections (n=16): – Cellulitis (n=8): neck, face or chest (n=5, 62.5%); extremities (foot or hand) (n=2, 25%); breast (n=1, 12.5%). – Fasciitis (n=8): neck, face ot chest (n=5, 62.5%); tights (n=3, 37.5%). Description of the documented cases: – Demographic characteristics (n=13): female sex (n=11, 85%); – Time of SLE evolution at the moment of the infection (n=9): ≤ 1 month (n=3, 33.3%); ≤ 3 years (n=3, 33.3%); ≤ 8 years (n=3, 33.3%). – Associated conditions (n=12): previous high doses of prednisone (n=5, 45%); recent respiratory sympthoms (n=4, 33.3%); renal insufficiency (n=2, 16.6%); previous SPN infections (n=1, 8.3%); recent surgery in the affected area (n=1, 8.3%). – Microbiological diagnosis (n=12): blood cultures (n=11, 91.6%); other cultures (n=5, 41.6%). – Treatment (n=12): beta–lactams (n=12, 100%); intensive care support (n=6, 50%); surgical debridment (n=5, 41%). – Outcome (n=15): death (n=3, 20%); reccurrent SPN infections (n=2, 13.3%). Conclusion: – Pneumococcal cellulitis and fasciitis in SLE were predominantly presented in young women and in a high rate of cases during the disease onset. – Almost half of the cases were previously treated with high doses of steroids. Nevertheless, no other potential predictors of pneumococcal cellulitis or fasciitis were identified; in addition, only one patient presented a previous surgery in the affected anatomical area, previous trauma were not described in any case, and a low number of cases reported associated respiratory symptoms. This supports the importance of the intrinsic immune dysregulation in SLE patients. – Pneumococcal cellulitis and fasciitis in SLE patients present poor prognosis, requiring intensive care support and surgical debridement in a high rate of cases, and presenting a fatal outcome in a fifth of them. References [1] DiNubile; 1991. [2] Hill; 1997. [3] Isik; 2007. [4] McDonald; 1993. [5] Page; 2003. [6] Patel; 1994. [7] Sabio; 2006. [8] Sanchez; 2016. [9] Kamran; 2008. Disclosure of Interests: Martin Greco: None declared, Inigo Rua-Figueroa: None declared, Antonio Naranjo Grant/research support from: Amgen, Consultant for: UCB, Speakers bureau: Amgen, UCB, Sabrina Ghiglione: None declared, Maria Celia Erausquin: None declared, Juan Carlos Quevedo-Abeledo: None declared, Carlos Rodriguez-Lozano: None declared, Cristina Almeida: None declared, Paola Leon: None declared, Estibaliz Loza Grant/research support from: Roche, MSD, Pfizer, Abbvie, BMS, UCB, Actelion, Celgene, Grunenthal and Sanofi

Background Rheumatoid arthritis (RA) is a risk factor for the development of fragility fractures, but there is little quality data on its prevalence. Conversely, osteoporosis is one of the most frequent comorbidities of RA. Objectives To determine the prevalence of vertebral fractures in postmenopausal women with RA and to analyse their characteristics and associated risk factors. Methods We included 346 postmenopausal women diagnosed with RA according to the ACR/EULAR 2010 criteria in 19 Spanish Rheumatology Departments, randomly selected from the registry of RA patients in each center, recruited during 2018. Lateral radiographs of the dorsal and lumbar spine were obtained from all patients, to evaluate morphometric vertebral fractures. Expert rheumatologists identified vertebral fractures and classified them into mild (grade 1: reduction of height of 20-25%), moderate (grade 2: reduction of 26-40%) and severe (grade 3: reduction > 40%), according to the Genant grading scale. The spinal deformity index (SDI) was calculated by assigning numbers 1, 2 and 3 to each fractured vertebra and adding the total score of each patient. The study variables were: a) age, body mass index (BMI), b) factors related to RA: time of evolution, FR, ACPA, and c) fracture risk factors: prior fragility fracture, parental hip fracture, glucocorticoids, smoking, alcohol intake ≥3 units daily, secondary osteoporosis and time since menopause. Results The mean age was 66.8 (SD: 10.1) years and the median evolution of the disease, 8.00 [RIQ: 3.00-15.5] years. 77.2% (n: 267) and 75.7% (n: 252) had FR and ACPA +, respectively. The mean duration of the postmenopausal period was 15.0 (SD: 9.6) years. 23.4% (n: 79) of patients had at least one vertebral fracture; 10.7% (n: 36) had a single fracture and 12.7% (n: 43), multiple fractures. The most fractured vertebrae were D12, L1 and L2 (fractured in > 5% of patients). The median SDI was 3 [RIQ: 2-5]. The vertebrae with the highest mean IDE were D8, D10, D11 and L1 (all mean IDE ≥ 2).An association was found between the presence of vertebral fractures and age, height, postmenopausal period, time of disease progression, glucocorticoid treatment and parental hip. No linear association was found between SDI and age, time of evolution of the disease, BMI and time since menopause. Conclusion One out of every 4 postmenopausal women with RA has at least one vertebral fracture. Vertebrae of the dorso-lumbar hinge are the most frequently involved and the magnitude of the spinal deformity is relevant. Vertebral fractures are related to the time of evolution of RA and to the risk factors for fracture. Disclosure of Interests Carmen Gomez Vaquero: None declared, Dacia Cerda: None declared, Cristina Hidalgo: None declared, JA Martinez Lopez: None declared, Luis Marcelino Arboleya Rodriguez: None declared, Javier Aguilar del Rey: None declared, Silvia Martinez Pardo: None declared, Inmaculada Ros: None declared, Xavier Suris Speakers bureau: Lilly, Pfizer, MSD, Dolors Grados: None declared, Chesus Beltran: None declared, Evelyn Suero-Rosario: None declared, Inmaculada Gomez Gracia: None declared, Asuncion Salmoral: None declared, Irene Martin-Esteve: None declared, Helena Florez: None declared, Antonio Naranjo: None declared, Santos Castaneda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Soledad Ojeda Grant/research support from: AMGEN, Speakers bureau: AMGEN, S Garcia Carazo: None declared, Alberto Garcia-Vadillo: None declared, Laura Lopez Vives: None declared, A Martinez-Ferrer: None declared, Helena Borrell: None declared, Pilar Aguado: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Nuria Guanabens Consultant for: Advisory Boards from Amgen, Alexion and UCB, Speakers bureau: Fees and lectures from Eli Lilly

Smoking is associated with a higher prevalence of many diseases. When a health professional is well informed of the risks of smoking in rheumatic diseases, the advice given to the patient about quitting smoking could be more effective. It is known that smokers in the general population have an increased frequency of elevated rheumatoid factor (RF). Since 1987, we have known that cigarette smoking is a risk factor for rheumatoid arthritis (RA), especially in men with RF-positive who are heavy smokers. Later, it could be verified that cigarette smoking is implicated in the pathogenesis of RA particularly when associated with antibodies, cyclic citrullinated peptides (ACPA) and the shared epitope. Smoking increases the risk of both subsets of RA with a more pronounced influence on the risk of ACPA positive RA. The polyclonal immune response against modified antigens in patients with RA is not exclusively citrulline-specific, carbamylation of antigens like vimentin could be involved in the pathogenesis of the disease. Thus, smoking is a risk factor for breaking tolerance to multiple autoantigens in RA. In RA patients, cigarette smoking correlated with an increased risk of joint erosions, extra-articular manifestations and cardiovascular disease, in addition to the established effects of longstanding disease activity on the risk of myocardial infarction and stroke. Systemic lupus erythematosus (SLE) is also associated with smoking. A strong and specific connection of current smoking and >10 pack-years of smoking with dsDNA+ SLE has been observed. In patients with SLE, smoking exposure has deleterious effects on lupus morbidity and is related to cumulative chronic damage. In mucocutaneous SLE, smoking have a negative impact on the efficacy of belimumab and a 2-fold decrease in the proportion of patients achieving cutaneous improvement with antimalarials. Published data indicate that smoking has a dose-dependent impact on structural damage progression in Ankylosing Spondylitis. In a large UK cohort, smoking was positively associated with the risk of psoriatic arthritis in the general population, but negatively associated among patients with psoriasis. In addition, smokers with psoriatic arthritis had a poorer response to TNFi”s compared to non-smokers. Regarding osteoporosis, smoking has been identified as a predictor of ten-year fracture risk in men and women, largely independent of the densitometric results. This finding has eventually lead to incorporation of this risk factor into FRAX®. The impact of smoking on bone status is mainly associated with the number of smoking years. In a few reports, it has been observed an association between smoking and carpal tunnel syndrome and inflammatory bowel disease. Finally, current smoking in patients with fibromyalgia is associated with greater pain, possibly as a function of depression. Disclosure of Interests: Antonio Naranjo Grant/research support from: Amgen, Consultant for: UCB, Speakers bureau: Amgen, UCB

Background The enigma of fragility fracture with normal bone mass; Experience of a Liaison Service Fracture Unit Objectives To describe the characteristics of patients with fragility fracture and normal DXA treated in an FLS unit. Methods Prospective 6-year observational study of a FLS fracture unit. Demographic variables, FRAX items, DXA and TBS were collected. The characteristics of patients with normal and abnormal DXA are described. The statistical analysis was performed by means of a descriptive, comparing the normal DXA/osteopenia/osteoporosis groups by means of contingency tables, Fisher’s exact test, Student’s t test or ANOVA, as appropriate, as well as regression analysis. Results 1,631 patients were included, 205 with normal DXA (12.5%), 747 with osteopenia (45.8%) and 680 with osteoporosis (41.6%). Patients with normal DXA were characterized by a higher percentage of males, a younger age and a higher BMI. Hip fracture was less frequent in patients with normal DXA, while the frequency of other fractures was higher. The frequency of previous fracture, history of hip fracture of the parents and secondary osteoporosis was lower in patients with normal DXA. The TBS and FRAX values were higher in the cases of normal DXA compared to osteopenia and osteoporosis. In the multiple regression analysis, excluding TBS, remained significant associated with abnormal DXA age (OR 1.04; 1.03-1.06), sex (OR 2.48; 1.71-3.58), BMI (OR 0.91; 0.89-0.94),) and parent hip fracture (OR 1.99; 1.11-3.58). Including TBS Conclusion Patients with fragility fracture and normal DXA are younger, with more frequent males and with BMI and higher TBS values. Acknowledgement Fabiola Santana y Carmen Alonso Disclosure of Interests Antonio Naranjo Grant/research support from: Amgen, Consultant for: UCB, Speakers bureau: Amgen, UCB, Soledad Ojeda Grant/research support from: AMGEN, Speakers bureau: AMGEN, Aida Saavedra: None declared, Cristina Sepulveda: None declared, Amparo Molina Speakers bureau: AMGEN, Tatiana Marrero: None declared, Maria Pino Afonso: None declared, Margarita Ramirez: None declared, Nieves Martin: None declared, Alicia Olivares: None declared, Carlos Rodriguez-Lozano: None declared