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Objective To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies. Material and methods Design Observational, descriptive and cross-sectional study. Data collection from January to June 2017. Sample Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections. Results Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47 ± 9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist. Conclusions The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.

Resumen Objetivo Determinar el estado actual de la reumatologia en Cataluna, y actualizar la informacion respecto a los estudios previos. Material y metodos Diseno Estudio observacional, descriptivo y transversal. Recogida de datos de enero a junio de 2017. Muestra Reumatologos que ejercen actividad asistencial publica en Cataluna. Se envio un cuestionario en linea recabando informacion tanto de forma individual como colectiva de los servicios de reumatologia. Resultados Se obtuvo informacion de 34 hospitales y de 109 reumatologos: 39 varones y 70 mujeres; edad media: 47 ± 9 anos. El numero de reumatologos aumento un 8% en los ultimos 5 anos. La obtencion del titulo fue en 101 (92,7%) casos por via MIR. Noventa y seis (88,1%) facultativos tenian dedicacion completa. Un 50% de los reumatologos ejercian ademas en el sector privado. La actividad asistencial suponia un 76% de la jornada laboral. Se constato que 24 (70%) servicios de reumatologia dependian jerarquicamente de otra especialidad. En 6 hospitales de Cataluna no disponen de reumatologo. Conclusiones El numero de reumatologos aumento respecto hace 5 anos. La edad media de los reumatologos es avanzada y existe un claro predominio femenino en la especialidad. Un gran numero de unidades de reumatologia dependen de otros servicios. La actividad reumatologica se centra en Barcelona.

To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture.Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients.Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37).Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. Introduction There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. Methods We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. Results Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. Conclusion The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Vitamin D deficiency has been linked with schizophrenia. We aimed to determine whether patients with a first episode of psychosis (FEP) had lower vitamin D levels compared with controls considering their final diagnosis. We conducted a cross-sectional study determining 25-hydroxyvitamin D blood levels. 25-Hydroxyvitamin D levels were considered optimum at 20 ng/mL or greater. A group of 45 adult patients with FEP and a group of 22 healthy controls matched for age were recruited. The patient group was subdivided in two final diagnosis groups (schizophrenia versus other psychoses) after a 6-month follow-up. Average vitamin D values were deficient for FEP patients, especially those 22 with a final diagnosis of schizophrenia. These results relating vitamin D and schizophrenia generate interest to further examine this association.

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

Objectives To determine/measure the satisfaction degree of patients with rheumatologic (rheumatoid arthritis, spondyloarthropathies and other arthritis) and dermatological (psoriasis, psoriatic arthritis and suppurative hidrosadenitis) disease treated with a biological drug. Methods Descriptive prospective study conducted in a Regional Hospital with a reference area of 109,530 inhabitants. A survey was conducted to all patients, thepatientswhocollectedtheir medication at the Pharmacy Service (self-administration treatment) and the patients who came for consultation (treatment administered by the nursing staff). The satisfaction degree before and after the biological treatmentwas evaluated.From 0 to 10, where 0 was the maximum dissatisfaction and 10 the maximum satisfaction; and improvement of pain, where 0 implied no improvement and 10 maximum improvement. Clinical records were reviewed and a database was generated for exploitation with SPSS-vs 22. All patients received an information sheet from the study and signed an informed consent form. Results A total of 100 patients were analyzed: 45 men and 55 women. The mean age was 53 years (SD 14.9). 42% of patients were actively employed. Distribution of patients by pathologies: 46 (46%) rheumatoid arthritis, 25 (25%) psoriasis, 16 (16%) psoriatic arthritis, 8 (8%) spondyloarthropathies, 2 (2%) suppurative hydrosadenitis and 1 (1%) juvenile idiopathic arthritis. Distribution of biological drugs: 49 (49%) adalimumab, 20 (20%) ustekinumab, 18 (18%) etanercept, 6 (6%) golimumab, 3 (3%) tocilizumab, 2 (2%) secukinumab,1 (1%) certolizumab. The treatment was self-administered in 61 patients. Only 30 (30%) patients had undergone previous biological treatment. At present, 43 patients had some additional treatment, 38 with methotrexate and 5 with leflunomide. Conclusions The satisfaction degree of patients with their biological treatment is very high regardless of the route of administration. Most of them are in monotherapy or with low doses of FAME. 61% of patients self-administer the drug at home. 93% of patients consider that there has been a change in their quality of life and that they can lead a normal life. Disclosure of Interest None declared

Objective To determine the current state of rheumatology in Catalonia (Spain) and to update information regarding previous studies. Methods Study design: observational, descriptive and transversal. Sample: physicians practicing rheumatology in the public system of Catalonia. An epidemiological questionnaire was sent to all rheumatologists. The results were compared with previously published studies. Results Information was obtained on 130 rheumatologists (62 men/68 women, mean age 47 ± 9 years). Seventy-five (57.7%) physicians worked at a hospital, 5 (3.8%) in primary care and 50 (38.5%) in both. Seven (11.9%) hospitals had no rheumatologist. Eight hospitals were accredited by the National Commission to develop a training program in Rheumatology. The number of residents accredited by each hospital was variable. Conclusions The number of rheumatologists in the public health sector in Catalonia has increased 4.8% during the last seven years, unlike the 2005 study in which there was an increase of 40% over the previous eight years. There were 7 hospitals without a rheumatologist.

Objetivo Determinar el estado actual de la reumatologia en Cataluna, actualizando la informacion respecto los estudios previos. Metodos Se trata de un estudio observacional, descriptivo y transversal. La muestra incluye a todos los medicos que ejercen actividad asistencial reumatologica en Cataluna. Se elaboro un cuestionario especifico para el estudio y se remitio a todos los participantes. Los resultados se compararon con los resultados obtenidos en los estudios previos. Resultados Se obtuvo informacion acerca de 130 reumatologos (62 varones/68 mujeres; edad media: 47 + 9 anos). La asistencia en reumatologia se ejercia de la siguiente manera: 75 (57,7%) medicos trabajaban en el ambito hospitalario, 5 (3,8%) en la atencion primaria y 50 (38,5%) en ambos. En 7 (11,9%) hospitales no habia reumatologo. Ocho hospitales estaban acreditados por la Comision Nacional de la Especialidad de Reumatologia para la formacion de reumatologos mediante el programa MIR. Conclusiones El numero de reumatologos en el sector sanitario publico de Cataluna solo ha aumentado un 4,8% en los ultimos 7 anos, a diferencia del estudio realizado en 2005, en el que se incremento un 40% respecto a los 8 anos previos. Actualmente, aun hay un hospital universitario sin reumatologo

Resumen No existe un acuerdo para definir la osteoporosis en mujeres premenopausicas y el diagnostico debe realizarse cuidadosamente y sin basarse unicamente en parametros densitometricos. Hay que tener en cuenta la presencia de otros factores de riesgo como los antecedentes de fracturas por fragilidad, enfermedades o farmacos osteopenizantes. Mas del 50% de las mujeres con osteoporosis premenopausica van a presentar una causa secundaria, el resto seran diagnosticadas de osteoporosis idiopatica. Las consideraciones terapeuticas estan limitadas por los escasos estudios en este grupo de pacientes, sobre todo en lo que se refiere al riesgo de fracturas. Por otro lado, no disponemos del indice de FRAX, ya que no se puede aplicar a pacientes premenopausicas. Este articulo pretende realizar una revision sobre la actitud que se debe seguir segun el tipo de osteoporosis premenopausica basandonos en la evidencia cientifica actual.

a b s t r a c t Background: Granulomatosis with polyangiitis (GP) is a necrotizing vasculitis of unknown etiology that involves small and medium caliber vessels. It is associated with anti neutrophil cytoplasm antibodies (ANCA). It most often affects the respiratory tract and the kidneys and its most important pathologic feature is the presence of necrotizing granulomas. Objectives: To detail the features of 15 patients with GP diagnosed in a university referral center. Patients and methods: Retrospective study: between 1984 and 2009, 15 patients with GP were diagnosed in our center. Epidemiological, clinical, laboratory test as well as pathologic studies and treatment were retrospectively analyzed. Biopsy diagnosis of GP was considered as an inclusion criterion. Results: Fifteen patients were diagnosed: 12 men and 3 women. Mean age at diagnosis: 52.2 years (14-78). 12 patients had a history of smoking. A biopsy was diagnostic in all patients. ANCA were positive in 11 cases, 6 had a cytoplasmic c-ANCA pattern. All patients had pulmonary involvement and seven (40%) had renal involvement. All patients received intravenous glucocorticoids and cyclophosphamide as induction therapy. During the disease progression 5 patients died.

Background Wegener's granulomatosis (WG) is a necrotizing vasculitis of unknown etiology that involves small and medium caliber vessels. It is associated with anti-neutrophil cytoplasm antibodies (ANCA). It most often affects the respiratory tract and the kidneys and its most important pathologic feature is the presence of necrotizing granulomas. Objectives To detail the features of 15 patients with WG diagnosed in a university referral center. Patients and methods Retrospective study: between 1984 and 2009, 15 patients with WG were diagnosed in our center. Epidemiological, clinical, laboratory tests as well as pathologic studies and treatment were retrospectively analyzed. Biopsy diagnosis of WG was considered as an inclusion criterion. Results Fifteen patients were diagnosed: 12 men and 3 women. Mean age at diagnosis: 52.2 years (14–78). Twelve patients had a history of smoking. A biopsy was diagnostic in all patients. ANCA were positive in 11 cases, 6 had a cytoplasmic c-ANCA pattern. All patients had pulmonary involvement and seven (40%) had renal involvement. All patients received intravenous glucocorticoids and cyclophosphamide as induction therapy. During the disease progression 5 patients died. Conclusion The clinical features of this series do not differ from those described by other authors. However, a history of smoking is more common than expected. Frequently used drugs were glucocorticoids and cyclophosphamide (oral and pulse therapy). The course was usually unfavorable, with outbreaks or complications due to immunosuppression, except for those with limited forms. Immunosuppressive therapy should be maintained indefinitely in most cases.

Resumen Los tratamientos biologicos pueden ser el heraldo de la curacion de la artritis reumatoide. Estos tratamientos dirigidos a dianas terapeuticas han cambiado el pronostico de la enfermedad. El tocilizumab es un anticuerpo monoclonal humanizado contra el receptor de la interleucina 6. El tocilizumab se ha aprobado en diferentes paises para el tratamiento de la artritis reumatoide moderada o grave. Se han publicado diferentes trabajos que han puesto de manifiesto la eficacia de tocilizumab en el tratamiento de la artritis reumatoide activa. Esta revision versa sobre la seguridad y la dosificacion del tocilizumab.

To determine the current state of Rheumatology in Catalonia (Spain) and to update information regarding previous studiesobservational, descriptive and transversal.Physicians practicing rheumatology in the public system of Catalonia. An epidemiological questionnaire was sent to all rheumatologists. The results were compared with previously published studies.Information was obtained on 130 rheumatologists (62 men/68 women, mean age 47±9 years). Seventy five (57.7%) physicians worked at a hospital, 5 (3.8%) in primary care and 50 (38.5%) in both. Seven (11.9%) hospitals had no rheumatologist. Eight hospitals were accredited by the National Commission to develop a training program in Rheumatology. The number of residents accredited by each hospital was variable.The number of rheumatologists in the public health sector in Catalonia has increased 4.8% during the last seven years, unlike the 2005 study in which there was an increase of 40% over the previous eight years. There were 7 hospitals without a rheumatologist.

The association between inflammatory bowel disease (IBD) and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome (SAPHO syndrome) was first reported in 1992. To date, only case reports and short series have been published.The purpose of this study was to report new cases and systematically review the literature on this association.All patients with concomitant diagnosis of SAPHO syndrome and IBD were identified from the databases of the rheumatology and gastroenterology departments of our institution. In addition, we systematically searched for published full articles in Medlars Online International Literature via PubMed. Relevant information of each positive match was collected and all authors were contacted for additional clinical data.Three patients sharing both SAPHO syndrome and IBD were identified among the 62 patients with SAPHO syndrome (4.8 % of the SAPHO cohort) and the 1,309 patients with IBD (0.2 % of the IBD cohort) from our hospital database. After a systematic review, a total of 39 reported patients with concomitant diagnosis of SAPHO syndrome and IBD were identified. There was a female predominance and most had Crohn's disease with colonic involvement.The association of SAPHO syndrome and IBD seems to be rare among IBD patients but not so among SAPHO patients. SAPHO could be underdiagnosed because of the similarity of its clinical manifestations and some more common extraintestinal manifestations or drug-related side effects in IBD.

There is no agreement in defining osteoporosis in premenopausal women and diagnosis must be done carefully and not based on densitometric parameters. One must take into account the presence of other risk factors and history of fragility fractures, diseases or drugs that cause bone loss. Over 50% of premenopausal women with osteoporosis will have a secondary cause, with the remainder diagnosed with idiopathic osteoporosis. Therapeutic considerations are limited by a few studies in this group of patients, especially in regard to the risk of fractures. On the other hand, the FRAX index cannot be applied to premenopausal women. This article will review the measures to apply depending on the type of premenopausal osteoporosis, based on current scientific evidence.

Assays that detect anti-citrullinated peptides antibodies (ACPA) are considered to be more specific than rheumatoid factor in the diagnosis of rheumatoid arthritis (RA). Several tests have been developed using different antigens: first, second and third-generation cyclic-ACPA (CCP1, CCP2, CCP3) and modified citrullinated vimentin (MCV).

To the Editor: We read with interest the article by Eriksson, et al 1 presenting a patient diagnosed with adult-onset Still’s disease (AOSD) and successfully treated with interleukin-1β (IL-1β) blockade, in whom the heterozygous germline p.R260W NLRP3 mutation was finally detected. AOSD is a systemic inflammatory disease characterized by fever, rash, articular involvement, lymphadenopathy, hepatosplenomegaly, and serositis2. Its cause remains unknown, but it is now considered an autoinflammatory disease on the basis of the absence of autoantibodies or autoantigen-specific T cells and the central role of IL-1β in its pathogenesis3,4. AOSD differential diagnosis should include the group of hereditary autoinflammatory diseases, especially the dominantly inherited cryopyrin-associated periodic syndromes (CAPS) and Blau syndrome (BS). The CAPS syndromes are caused by heterozygous gain-of-function mutations … Address correspondence to Dr. Garcia-Melchor. E-mail: emmitagm{at}gmail.com

Background Studies suggest a neuroprotective role for vitamin D. Its deficit has been linked with various psychiatric disorders such as schizophrenia (1). Increase in the prevalence of schizophrenia has been associated with high latitudes, winter/spring births, migration, urbanicity and cold climates (2,3). Vitamin D deficiency could be an important environmental risk factor, linking all of the previously exposed. Objectives We aimed to determine whether patients with a first psychotic episode had low levels of vitamin D compared to controls, considering their final diagnoses (schizophrenia vs other psychoses). Methods Cross-sectional study in an acute inpatient psychiatric unit. Vitamin D (25-hydroxyvitamin D) was determined by direct competitive chemiluminescence immunoassay. Vitamin D levels (ng/ml) were considered optimum >30, insufficient 20–30 and deficient Results We analyzed 27 patients with first-episode psychosis (13 with final diagnosis of schizophrenia and 14 of other psychoses) and 17 healthy controls, with no differences in mean age between the three groups (χ 2 (2)=5.20, p>0.05). Schizophrenic patients showed deficient average values (ng/ml) of vitamin D (mean 12.87, range 6-24.9). Vitamin D levels in the other psychoses patient group were higher but also deficient (mean 15.74, range 6-34.6). Controls presented higher levels of vitamin D, but still insufficient (mean 21.45, range 11.20-33.5). Vitamin D levels in the schizophrenia group were significantly lower compared to controls (CI 1.8 – 15.4; p Conclusions We observed deficient vitamin D levels in all the patients studied, being significantly lower for schizophrenic patients. Future studies are required to further examine this association in schizophrenia because vitamin D deficiency may be an easily modifiable risk factor by means of a cheap and save public health intervention. References Belvederi Murri, M., Respino, M., et al. 2013 Vitamin D and psychosis: mini meta-analysis. Schizophr Res 150, 235-239. McGrath, J. J., Eyles, D.W., et al. 2010 Neonatal vitamin D status and risk of schizophrenia: a populationbased case-control study. Arch Gen Psychiatry 67, 889-94. McGrath, J. J., Burne, T.H., et al. 2010 Developmental vitamin D deficiency and risk of schizophrenia: a 10-year update. Schizophr Bull 36, 1073-8. Holick, M.F. 2007 Vitamin D deficiency. N Engl J Med 357, 266-81. Disclosure of Interest None declared

Objectives Assess TBS to categorize skeletal status in adult subject which history of Poliomyelitis sequels in limbs. Methods We scan total body, lumbar spine (L1-L4) and both hips (Total femur and Femoral Neck ROI9s) in 58 patients with history of poliomyelitis infection and limb paralysis (men: 14 -57.5 years; women: 48 -57±8.5 years). A DXA device GE-iDXA model was used. The difference between affected extremity and the opposite in BMD T-score and trabecular microarchitecture assessed by TBS (TBS® Insight; Medimaps) were used. The results were stratified as normal, low bone density or osteoporosis taking the lower T-score of the scanned regions of interest. TBS results were categorized as normal (TBS N) ≥1.350; partially deteriorated-(TBS-PD) between: 1.250 -1.349, and significantly deteriorated (TBS-SD): Results Three patients had hip fracture history. The left limb was the extremity most affected in this group (32 vs 20). Five patients had both extremities affected, with more severe affectation on the right side (4/5). Only 7 patients had normal BMD of the hip, which contrasts with the 43.1% of patients with normal lumbar BMD. The TBS was normal in 16 patients (27.6%). Stratification was more similar in patients who had a low bone density (48.3% in the hip and 50% in lumbar spine) and TBS-PD (50%). In patients categorized as osteoporotic the lowest T-score of BMD was found in proximal femur (39.7%) of the most affected limb, the T-score BMD of the lumbar spine in 6.9% of the patients, while the TBS-SD was found at 22.4%. The DXA spine images showed a spondyloarthritis and scoliosis signs in 25 patients. 16.7% of patients had a osteoporotic T-score in affected femur and had normal BMD at the lumbar spine and opposite femur, but interestingly had a deteriorated TBS (TBS-PPD and TB SSD). Conclusions A degradation TBS allow identify a greater number of patients who had polio with low bone status than assess BMD of lumbar spine and femur. Postural instability could increase irregular mechanical charges to lumbar spine and femur unaffected that may decrease the sensitivity of DXA when only the BMD is used to classify patients. Disclosure of Interest None declared

Background Denosumab is a human monoclonal antibody (IgG2) that targets and binds with high affinity and specificity to RANKL. It is indicated for the treatment of osteoporosis in postmenopausal women and in men with high risk of fractures. Objectives To describe the clinical characteristics, indications, side effects and densitometric parameters in patients treated with denosumab. Methods Retrospective study (2012-2014). We reviewed the medical records of patients treated with denosumab. We collected the epidemiological and clinical features and side effects. Results Sixty-eight patients received denosumab, all of them women with an average age of 74.8 years (60-91 years). All of them had osteoporosis: postmenopausal in 48 patients (70.5%) and secondary in 20 patients (29.5%): 9 early menopause, 6 primary hyperparathyroidism, 2 glucocorticoid treatment and 2 epilepsy. Fifty-two patients (76.4%) had received other treatments previously (70.5% oral or intravenous bisphosphonates, 16.2% teriparatide or PTH1-84, 19.1% strontium ranelate, 5.9% SERMS). Sixteen patients (23.5%) had no prior treatment performed mostly by gastric intolerance. Forty patients (58.8%) had fractures before treatment: vertebral (29.4%), wrist (17.6%), femur (8.8%) and other (19.1%): pubic rami, sacrum and humerus. The average of bone mineral density before treatment was: T score -3.2 in the lumbar spine (L2-L4) and -2.6 in the femur, and after treatment (36 patients) was: T score -2.6 in the lumbar spine and -2.1 in the femur. Before injecting each dose of denosumab, all patients underwent an analytic with calcium and phosphorus metabolism in which we checked that calcium levels were correct. All patients received calcium supplements and vitamin D. We observed that in the analysis prior to the second dose of denosumab, 14 patients had elevated PTH values (average of 88pg/ml), vitamin D average of 26.8ng/ml, with previous normal values (10-65pg/ml). Out of all patients, 4 had received a single injection, 30 two, 12 three, 12 four, 7 five and 3 six injections of denosumab. Twelve patients suffered side effects (17.6%): urine infections and otitis (3 patients), symptomatic hypocalcemia (3 patients), arthralgia (2 patients), toothache (1 patient), tooth loss (1 patient), leukopenia (1 patient) and abnormal liver tests (1 patient). Two patients (3%) had fractures after treatment: a patient with polio presented a vertebral fracture during a treatment break and a patient who had previously undergone 10 years of oral bisphosphonate presented bilateral femoral shaft fractures. Conclusions The treatment was well tolerated and only a small percentage of patients was suspended by mild side effects. Densitometric values showed an improvement in both spine and femoral neck. Two fractures were observed during follow-up of patients, one in a patient with spinal polio and bilateral femoral shaft fractures four months after administration of denosumab in a patient previously treated over 10 years with bisphosphonate. Disclosure of Interest None declared

Background The chronic inflammatory process in patients with rheumatoid arthritis (RA) acts as an independent cardiovascular (CV) risk factor. Hence they have an higher risk of developing cardiovascular disease compared to healthy people of the same age and sex. This increased risk is being evaluated in other chronic inflammatory rheumatic diseases. Besides the control of rheumatic disease, it is necessary to evaluate other factors of CV risk as lipid profile, blood pressure (BP) and blood glucose. Objectives The aim of this study was to determine CV risk factors in a series of patients with chronic inflammatory rheumatic diseases follow up in Rheumatology Service. Methods We conducted a prospective observational study during 6 months (April to October 2013) in a population of patients older than forty years with chronic inflammatory rheumatic diseases. We collected the medical history of hypertension, diabetes, dyslipidemia, ischemic heart disease (IHD) and smoking habit. BP, blood glucose and lipid profile (total cholesterol, low-density lipoprotein –LDL-, high-density lipoprotein –HDL- and triglycerides) were measured. CV risk has been analyzed by the REGICOR and modified SCORE function by RA EULAR consensus. Results A total of 125 patients were enrolled, 82 women (66%) and 43 men (34%) with a mean age of 61 years (40-89 years). We included 79 patients with RA (63%), 23 with psoriatic arthritis (18%), 15 with ankylosing spondylitis (12%), 5 with palindromic rheumatism (4%) and 3 with arthritis associated with inflammatory bowel disease (3%). At the time of registration, 37 patients were active smokers (30%). In all patients were determined: BP, with a mean of 138 mmHg (90 - 190mmHg) systolic BP, serum lipid profile determination, obtaining mean values of total cholesterol 1.97g/L, HDL 0.64 g/L, LDL 1.09 g/L and triglyceride 1.17 g/L. At baseline, 42 patients had diagnosed and had treated with hypertension (34%), 14 patients with diabetes mellitus (11%) and 29 patients with dyslipidemia (23%). Six patients had a history of IHD. In outpatient it found systolic BP greater than 140 mmHg in 60 patients, 32 of whom were undiagnosed hypertension. High cholesterol levels (greater than 2g/L) were found in 59 patients, 47 of which were previously undiagnosed dyslipidemia. No patient was diagnosed of diabetes mellitas. The mean SCORE and REGICOR was 3.61 (0-19) and 3.99 (1-12) respectively, both values are considered low cardiovascular risk. In 11 patients (9%) CV risk was high (above 10), 2 patients were active smokers, 3 patients were not known hypertension and 5 patients were detected an unknown dyslipidemia. Conclusions Unknown hypertension was detected in 26% of patients and dyslipidemia in 38%. High CV risk was found in 9% of patients with chronic inflammatory rheumatic disease, and in some cases modifiable CV risk factors undiagnosed. Patients with chronic inflammatory rheumatic diseases necessitates careful monitoring of all factors of CV risk. Outpatient Rheumatology is a good place screening of these risk factors and may be useful for the prevention of future CV events. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4090

Background Adult Onset Still’s disease (AOSD) is a rare systemic disease of unknown etiology,characterized by fever peaks with a evanescent rash, arthritis and/or arthralgia that is associated with odynophagia, lymphadenopathy and hepatosplenomegaly. Laboratory test usually present with leukocytosis, neutrophilia, anemia and an increased in acute phase reactants. There is no pathognomonic laboratory test. Diagnosis is difficult and exclusion of other diseases is requered. Objectives To describe the clinical characteristics, treatment and outcome of a series of patients diagnosed with adult Still’s disease. Methods Retrospective (1978-2011). UniversityHospital with a referal area of 800,000 inhabitants.We reviewed the medical records of patients from the database service of Rheumatology. Inclusion criteria: Yamaguchi criteria. Results Thirty one patients were diagnosed: 9 men (30%) and 21 women (70%). The mean age at diagnosis was 39.9 years (16-68). All had fever associated with rash, except for 3 patients who were enrolled without a rash. The odynophagia was presented in all cases except 1. Polyarticular pattern predominated (22 patients, 73.3%) compared to oligoarticular (3 patients, 9.7%); in 5 patients was not found arthritis, however, arthralgia were seen in 96.7% of cases. Twelve patients had lymphadenopathies and eleven, splenomegaly. Seven patients had both clinical signs. Serositis was uncommon, affecting only 3 patients. Laboratory findings were as followed: leukocytosis with neutrophilia (22 patients, 73.3%), anemia with hemoglobin ≤12 g/dl (15 patients, 50%), with mean hemoglobin of 11.5g/dl, transaminitis (9 patients, 1%), high ferritin with an average of 6614 ng/ml in 19 patients (63.3%). The ESR was determined in 29 patients and was founded elevated in 24 (80%), with a mean of 77.4±39.8 mm in the first hour. C Reactive Protein was determinedin 26 cases, being elevated in 21 patients (70%).Joint radiographswere performed according to articular involvement and remained normal in 23 patients (76.7%). The treatment was: aspirin and/or NSAIDs (90%), corticosteroids (76%), other disease-modifying drugs, 15 patients (76.7%); biological drugs, 6 patients (20%). Mean follow-up: 88 months. The form of evolution of the disease was polycyclic in 15 patients (50%) and monocyclic on the other half of patients. Remission during follow-up was presented in 27 patients (93.1%). Conclusions The clinical and laboratory characteristicsof this series, did not differ from those reported by other authors. All in all Adult Onset Still’s disease responded to treatment. Biological drugs was required in one third of patients. Disclosure of Interest None Declared

Background Still’s disease is a rare systemic entity of unknown etiology,characterized by fever peaks with evanescent rash, arthritis and/or joint pain that is associated with odynophagia, lymphadenopathy and hepatosplenomegaly. Diagnosis is difficult and exclusion. Treatment has varied over time. Systemic glucocorticoidsare the first choice, although biological drugs are an alternative for refractory cases. Objectives Describe the clinical characteristics and evolution of a series of patients diagnosed with Still’s disease who have followed biological treatment. Methods Retrospective (1978-2011). UniversityHospital with a referal area of 800,000 inhabitants. We reviewed the medical records of patients from the database section of Rheumatology.Inclusion criteria: patients with Still’ disease following Yamaguchi critera who were treated with biological drugs. Results Seven patientswere selected: 5 women (71.5%) and 2 men (28.5%).The mean age at diagnosis was 30.2 (16-58).All hadsore throat,fever and allbut onerash.All hadpolyarthralgia. Six patients (85.7%) polyarthritis and one oligoarthritis.Four patients (57.1%) had splenomegaly, lymphadenopathy 2 of them (28.5%). Two patients did not have any of these clinical signs.Serositiswas foundonlyin one patient. Inlaboratory data yielded: leukocytosis with neutrophilia in 2 patients (28.5%), anemia (hb ≤12 g/dL in 3 patients (42.9%). Ferritinwas elevatedin two patients. The ESR was elevated in 4 cases (57.4%), with a mean of 45±39.53 mm in the first hour. The CRP was elevated in six patients (85.5%) with an average of 27.5 mg/L. Mean follow-up: 70 months. The form of evolution of the disease was polycyclic in 4 patients and monocyclic in three. Biological treatment was: anakinra in 5 patients (71.5%), etanercept, 2 patients (28.5%), tocilizumab, two patients (28.5%).In addition, one patient was refractory to all biologicals(infliximab, rituximab, anakinra,tocilizumab, abatacept). Three patients (60%) treated with anakinra achieved complete remission. The other two patients without remission, were treated with tocilizumab with a good response in one case. The remaining patientwas treated well with infliximab, rituximab, anakinra and tocilizumab. All treatments weerretired because of serious side effects or ineffectiveness. This patient is currently treated with abatacept with good response although is not achieving complete remission. The 2 patients treated with etanercept achieved complete remission. Conclusions Biological therapy as treatment for refractory Still’s disease was effective in most cases. Anakinra was the drug most widely used and more than half of patients who were treated with it, achieved complete remission. Disclosure of Interest None Declared

Background Assays that detect anti-citrullinated peptides antibodies (ACPA) are considered to be more specific than rheumatoid factor in the diagnosis of rheumatoid arthritis (RA). Several tests have been developed using different antigens: first, second and third-generation cyclic-ACPA (CCP1, CCP2, CCP3) and modified citrullinated vimentin (MCV). Objectives To investigate anti-CCP3 in a group of patients positive citrullinated vimentin antibodies (MCVA). Methods The retrospective study was done at the university hospital with a reference population of 800,000. Atotal of 259 patients positive for IgG MCV antibodies (by ELISA) attending the outpatient rheumatology clinic were tested for anti-CCP3 (by ELISA). From the total, 182 (70.3%) of them had a rheumatic disease: RA in 121 (66.5%) and other: elderly-onset arthritis, non-filiated arthritis, connective, vasculitis, Still’s disease, espondiloarthritis, microcrystalline arthritis, polymyalgia rheumatica and sarcoidosis, in 61 (33.5%). There are 77 (29.7%) patients with other conditions (non rheumatic disease) positive for MCVA were also tested for anti-CCP3. Results From the 121 RA patients, 106 (87.6%) were positive for anti-CCP3. In contrast, only 15 (24.6%) of the 61 patients without RA and only 4 (5.2%) of the 77 MCVA positive patients with no rheumatic disease associated were CCP3 positive. Interestingly, within the group no RA, of the 13 patients with anti-CCP3 values >60 U/ml, 6 (46.2%) were patients with palindromic rheumatism and two of them had developed RA. Specificity of anti-CCP3 for RA as compared to other rheumatic disease was 76.7%, that raised to 86.9% when comparing RA versus to non-RA (with or without another rheumatic disease). Positive and negative predictive values of anti-CCP3 for RA were 85.5% and 88.8%, respectively whereas positive predictive values for anti-MCV was 39.1%. Conclusions Anti-CCP3 antibodies show a higher specificity for RA when compared to MCVA with a better positive predictive values, a crucial feature for a test in use for clinical practice. Disclosure of Interest None Declared

Background Zoledronic acid is an intravenous bisphosphonate used in osteoporosis and Paget’s disease of bone. It is usually well tolerated, although it may cause some side effects. Objectives To describe the clinical characteristics, indications, side effects and densitometric parameters in patients treated with zoledronic acid. Methods Retrospective study (2006-2012) at two hospitals with a referral area of 900.000 people. We reviewed the medical records of patients treated with zoledronic acid. We collected the epidemiological and clinical features and side effects. We conducted a telephone interview to complete the missed data. Results Two hundred and four patients received zoledronic acid: 146 women (71.6%) and 58 men (28.4%), with mean age of 70.5 years (range: 38-89 years). The medical indication for the administration was: 149 osteoporosis, 46 Paget’s disease of bone and 8 other bone diseases (5 SAPHO syndrome, 2 Brittle bone’s disease and 1 progressive multifocal osteitis). The causes of osteoporosis were: postmenopausal 93 (62.4%), secondary 42 (28.2%) - most of them due to glucocorticoid treatment -, and male osteoporosis 14 (9.4%). Seventy-three percent of the patients with osteoporosis had received other treatments previously (73.6% oral bisphosphonates, 27.3% teriparatide or PTH 1-84, 22.7% intravenous ibandronate, 18.1% strontium ranelate, 10% calcitonin, 9% raloxifene and 7.3% pamidronate). Ninety-seven patients (65.1%) had fractures before treatment: vertebral (82%), rib (12.3%), wrist (9.2%), femur (8.2%), other (12.3%) - isquiopubian branches, foot, elbow, humerus, phalanges. Only 14 patients (9.4%) had fractures after treatment. The average of bone mineral density before treatment was: T score -3.1 in the lumbar spine (L2-L4) and -2.4 in the femur. Of all patients, 110 (73.8%) had received a single infusion, 46 (30.9%) 2 infusions, 38 (25.5%) 3 infusions and 10 (6.7%) 4 infusions of zoledronic acid. Thirty-nine patients had side effects (19.1%): 26 men and 13 women, with a mean age of 66.4 years. Twenty-three of these patients were treated because of having osteoporosis, 15 Paget’s disease of bone and one osteogenesis imperfecta. The most described side effects were: flu-like syndrome (69%), arthralgia (7.7%), uveitis (5.1%) and arthritis, kidney failure, hypertensive crisis, rash, epistaxis, fatigue and ventricular arrhythmia (2.6 % each). We used chi-square test with Yates correction to compare the incidence of side effects in patients with osteoporosis to patients with Paget’s disease of bone. We obtained a value of 5.56 with statistical significance (p = 0.01) for Paget’s disease of bone. Conclusions The most common indication for administration of intravenous zoledronic acid is postmenopausal osteoporosis. A high percentage of patients had previously received different treatments and had fractures before treatment. Nearly 20% of patients have side effects and the most common is a flu-like syndrome. Patients treated for Paget’s disease of bone have a higher incidence of side effects than those treated for osteoporosis (p = 0.01). Disclosure of Interest None Declared