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Background: Personality traits are relevant for pain perception in persistent pain disorders, although they have not been studied in depth in sensitized and nonsensitized patients with knee osteoarthritis (OA). Objective: To explain and compare the personality profile of patients with OA, with and without central sensitization (CS), and fibromyalgia (FM). Setting: Participants were selected at the Rheumatology Department in two major hospitals in Spain. Participants: Case-control study where the sample consists of 15 patients with OA and CS (OA-CS), 31 OA without CS (OA-noCS), 47 FM, and 22 controls. We used a rigorous and systematic process that ensured the sample strictly fulfilled all the inclusion/exclusion criteria, so the sample is very well delimited. Primary outcome measures: Personality was assessed by the Temperament and Character Inventory of Cloninger. Results: The percentile in harm-avoidance dimension for the FM group is higher compared to OA groups and controls. The most frequent temperamental profiles in patients are cautious, methodical, and explosive. Patients with FM are more likely to report larger scores in harm-avoidance, with an increase in logistic regression adjusted odds ratio (ORadj) between 4.2% and 70.2%. Conclusions: Harm-avoidance seems to be the most important dimension in personality patients with chronic pain, as previously found. We found no differences between OA groups and between sensitized groups, but there are differences between FM and OA-noCS, so harm-avoidance might be the key to describe personality in patients with CS rather than the presence of prolonged pain, as found in the literature before.

Resumen Objetivo Determinar la prevalencia de fatiga en nuestra cohorte, asi como los factores a los que se asocia, su relacion con variables demograficas, niveles de vitamina D, tratamiento, sintomas y actividad del lupus eritematoso sistemico (LES). Metodos Se realizo un estudio transversal incluyendo de manera consecutiva 102 pacientes femeninas con LES (criterios del American College of Rheumatology de 1997) que acudieron a la consulta monografica de LES del Parc de Salut Mar, entre enero de 2012 y mayo de 2014. Se recogieron datos sociodemograficos, suplementacion de vitamina D, EVA de fatiga, tratamiento farmacologico, principales marcadores serologicos del LES y niveles plasmaticos de 25(OH)-vitD. La asociacion entre fatiga y las diferentes variables se evaluo mediante el coeficiente de correlacion Rho de Spearman para las continuas, la prueba U de Mann-Whitney para las categoricas y la de Kruskal-Wallis para las estaciones del ano. Resultados La variable fatiga fue evaluada por medio de una EVA con una media de 52,84 (rango 0-100), una mediana de 59 y una desviacion estandar de 29,86. Se hallo una relacion estadisticamente significativa entre fatiga y edad, MHAQ, SLICC, la estacion del ano del verano y fotosensibilidad. En cuanto a la relacion entre fatiga e insuficiencia de vitamina D (definida como niveles de 25(OH)-vitD ≤ 30), se dividio la muestra en pacientes que recibian suplementacion (n = 60) y pacientes que no la recibian (n = 40), hallandose una relacion significativa en este ultimo grupo. Conclusiones Se hallo una asociacion estadisticamente significativa entre la presencia de fatiga y la edad, el MHAQ, el SLICC, la fotosensibilidad, la fibromialgia y la estacion del verano, y con insuficiencia de vitamina D en el grupo de pacientes sin suplementacion (n = 40).

La infeccion por virus Chikungunya (CHIKV) presenta afectacion articular en la mitad de las ocasiones. Esta afectacion puede derivar en una artritis erosiva que, dada la elevada intervariabilidad en la presentacion tanto clinica como serologica y el probable papel del condicionamiento genetico en la gravedad y cronificacion del cuadro, supone un gran reto diagnostico y terapeutico. Existe una importante falta de evidencia cientifica que nos permita caracterizar la variabilidad del paciente y decidir el abordaje mas adecuado.

Chikungunya virus infection (CHIKV) is associated with joint involvement in half of the cases. This can lead to erosive arthritis which, given the high intervariability of clinical and serological presentations, and the probable role of genetic conditioning in the severity and chronification of the condition, represents a great diagnostic and therapeutic challenge. There is an important lack of scientific evidence that would enable us to characterize the variability of the patient and choose the most appropriate approach.

Background: Inhibitors of CTLA-4 and PD-1 have shown improvements in survival in multiple advanced cancers. Immune-mediated effects such as arthralgias and arthritis have been described, but their prevalence and characteristics have not been well defined. Objectives: The objective of the study is to describe the prevalence of immunomediated joint manifestations (IJM), its characteristics and evolution in patients who received immunotherapy (nivolumab (NV), pembrolizumab (PB)) from January 1, 2016 to December 31, 2018 in our center. Methods: Data collection was performed at through the RPT (Registre Pacients Tractats) database of the CatSalut, and the patients referred to the monographic medical office of inflammatory joint diseases of our center. In all cases, the variables: age, sex, neoplasia, drug, number of doses, were recorded. In patients with joint involvement: other autoimmune manifestations, joint affectation prior to treatment, delay rheumatology derivation, joint affectation type, swollen and tender joint counts, ESR, CRP, RF, ACPA, ANA, HLA B 27, Hb, leukocytes, neutrophils, lymphocytes, treatment and evolution, were recorded. The statistical analysis was carried out with the SPSS 15.0 computer package Results: 106 patients received treatment (TTO) with immunotherapy (71 NV, 35 BP) for neoplasia (81 lung, 10 renal, 8 melanoma, 2 oropharynx). The mean age was 67.93 ± 10.7 years (21.7% women, 78.3% men). There were 11 events cataloged as IJM. The overall prevalence was 10.3% (5.6% NV, 14.3% PB). Patients with IJM received a greater number of doses (17.67 ± 9.3 vs9.24 ± 10.1 p = 0.018). No patient with melanoma presented IJM. All IJM suspicions cases were assessed by a rheumatology. When studying their characteristics (Table 1), 3 patients were added from the database of the rheumatology service (14 cases). They received in a clinical trial BP29541 (rectal cancer), Atezolizumab (lung cancer) and Durvalumab (lung cancer). 42.9% of the patients presented inflammatory arthralgias (IAT) and 57.1% arthritis (AT). In reference to their previous history, 2 patients had a history of hyperuricemia and arthritis. One patient concomitantly presented lymphocytic colitis confirmed by biopsy. The delay time for assessment by rheumatology was 18.1 ± 22.1 days. Patients with AT were older (p = 0.014), had higher ESR (p = 0.047) than those with IAT. No differences were found in other variables (table1). With reference to the analytical study, 1 patient was RF +, 2 ANA + at mean titers (1/160-1/320), none ACPA or HLA B 27 +. After assessment by rheumatology, two patients with IAT were diagnosed with bone M1 and two AT were categorized as gouty arthritis. The rest of the IAT responded to NSAIDs, did not require corticosteroids and were resolved. 6 cases of AT received prednisone, 3 required treatment dose 1 mg/kg weight and subsequently MTX in 2 of them, with evolution to low disease activity at present. Only one patient met RA classification criteria. Conclusion: The prevalence of IJM was higher than 10%, depending on the number of doses. Patients with arthritis had higher age and higher ESR. No patient presented ACPA and HLA B 27 +, so to include them in the initial analytical could be not necessary. In these patients, it is important the assessment by a rheumatologist to make a correct differential diagnosis, as well as establish referral circuits to avoid delay of care Disclosure of Interests: Carolina Perez-Garcia: None declared, Fabiola Ojeda: None declared, Ana Pros Simon: None declared, Emma Beltran: None declared, Tarek Carlos Salman Monte: None declared, Edurne Arriola Aperribay: None declared, Jordi Monfort Speakers bureau: Bioiberica Procare Health

Background: Although the pathophysiology of osteonecrosis (ON) is not completely well-understood, it is likely the result of multiple combined effects such as environment, metabolic or genetic factors. Clinical presentation of ON may be silent or may appear in a variable range of gradual-onset pain. The prevalence of ON in patients with SLE varies according to whether the lesions are symptomatic or asymptomatic. Corticosteroid therapy (CT) has been recognized as a main risk factor to develop ON. Nevertheless, it looks like ON is more frequent in patients with SLE than in any other disease requiring systemic CT, which suggests that the use of corticosteroids may not be the only risk factor in those patients. Objectives: To evaluate the prevalence of ON and to determine the association between ON and other variables such as sociodemographic factors, cardiovascular risk factors, SLE symptoms, autoimmunity, treatment received and disease activity in patients with SLE from Hospital del Mar. Methods: 177 medical records were reviewed. Inclusion criteria included patients with SLE that met at least 4 of 11 ACR-LUPUS criteria revised in 1982 and updated in 1997. We identified six ON cases. The ON variable was evaluated by nuclear magnetic resonance in symptomatic patients. Afterwards, we matched ON patients with controls according to age and gender in a 1:2 proportion. A bivariate descriptive analysis between cases and controls was made including demographic and clinical variables, cardiovascular risk factors and treatment received. The association between ON and the previously mentioned variables was evaluated by Fishers Exact test and Chi-square test. Results: The prevalence of ON was 3.4% (CI 95%: 0.01% - 0.07%), lower than that described in other series. We found statistical significance association between ON and arterial hypertension (patients with ON and hypertension: 62.5% vs patients with ON without hypertension: 10%; p-value 0.043), as well as between ON and CT evaluated by its presence in the last hospital follow-up (patients with ON under CT: 100% vs patients with ON without CT: 20%; p-value 0.025). The association between ON and the use of corticosteroid pulse therapy (CPT) was also statistical significance (patients with ON who received CPT: 80% vs patients with ON who did not receive CPT: 15.3%; p-value 0.022). Finally, we found a marginal association, although relevant, between ON and the SLICC damage index (p-value 0.057) (Table/Fig-1). Conclusion: We found a statistical significance association between ON and hypertension (classical known cardiovascular risk factor) as well as between ON and CT (in the last visit) and the use of CPT (risk factor known as an etiological agent in ON). We did not find a statistical significance association between ON and lupus disease activity (SLEDAI), but a trend to statistical significance was noticeable with respect to the accumulated irreversible damage on lupus disease (SLICC). In order to confirm the results obtained, it is necessary to carry out other studies, with a larger sample and a longer follow-up period. Disclosure of Interests None declared

Background: The prevalence of rheumatic diseases in the Spanish population is estimated at 22.6% according to the EPISER 2000 study. A new epidemiological study is currently underway, EPISER 2016 and its preliminary results point towards a higher prevalence. Within the national health system, primary care is the first level of access to the health system and is provided at primary care centers (CAP). The rheumatology at primary care centers at Spain has been a pioneer in the application from the team at Parc de Salut Mar (Hospital del Mar), with the physical presence of rheumatologists in the 14 centers belonging to the CAP network of the SAP Litoral. The high prevalence of the medical pathology of the musculoskeletal syste and the aging of the population, can condition an increase in visit requests in rheumatology, and with it, the increase in the waiting lists of patients. Objectives: The main objective of this study is to know the resolutive possibility of virtualization, measured in the number of visits resolved telematically, as well as its impact on the resolution capacity of the primary care physician and the reduction of the waiting list of first face-to-face visits. Methods: Prospective experimental study, started on December 1, 2017 and ended on May 31, 2018. Four primary care centers were selected according to population and waiting list: Sant Marti Nord, Sant Marti Sud, Ramon Turro and Villa Olimpica. The REVIR program proposes the creation of a circuit for the assessment of referrals to rheumatology from primary care physicians (MAP). Results: 726 first visit requests were received during the REVIR program. The most common categorized pathology was mechanical pathology, representing about 70% of the first visits requested. Metabolic bone disease ranked second with 16%, and inflammatory pathology ranked third (SLE, RA, SA, SPA, PsA). Chronic musculoskeletal pain ranked fourth (including fibromyalgia) and lastly soft tissue pathology. The number of first visit requests was multiplied by two in all the participating primary care centers of the project. Despite this increase, the telematic resolution of the visits created was stable, with a value greater than 40%. Conclusion: The implementation of a system of assessment of the first visits in rheumatology requested from Primary Care is effective in decreasing the waiting list to make face-to-face visits, as well as to detect early serious pathology that requires hospital control. It has been achieved, therefore, that the patient is treated at the level of attention that corresponds to him. Guaranteeing the adequate use of hospital resources and reducing the waiting list for a first in-person visit in rheumatology in primary care is one of the most important goals fulfilled, given that it is directly related to maintaining the accessibility and equity of the public health system. References: [1] Kataria, S., & Ravindran, V. (2018). Digital health: a new dimension in rheumatology patient care. Rheumatology International. https://doi.org/10.1007/s00296-018-4037- Disclosure of Interests: Fabiola Ojeda: None declared, Manel Ciria: None declared, Carolina Perez-Garcia: None declared, Eric Sitjas: None declared, Elena Martinez: None declared, Daniel Martinez-Laguna Speakers bureau: Eli Lilly, Amgen, Ferrer, Rubio and Novartis., Montserrat Pimienta: None declared, Jordi Monfort: None declared

Despite the improvement in the quality of life of patients with SLE due to scientific and technological advances, SLE remains a disease that over the years may produce irreversible damage to patients. Osteoporosis and secondary bone fractures are two of the major causes of irreparable injury in patients with SLE. Vitamin D insufficiency may play a vital role both in reduced bone mineral density (BMD) and in the appearance of fractures, although its mechanisms of action are still unclear. We performed a systematic review of the literature in order to determine the prevalence and predictors of reduced vitamin D plasma levels, bone loss and the presence of fractures in SLE patients. Our review encompassed all English-language publications using Medline and EMBase electronic databases from their inception (1966 and 1980, respectively) to December 2016. We included all intervention studies and observational studies in which vitamin D plasma levels, BMD and bone loss were measured and applied to patients with SLE. Previous studies suggested an increase in bone loss and fracture in patients with SLE compared with general population and although there is a high prevalence of vitamin D insufficiency in the general population, previous studies had demonstrated lower vitamin D levels in patients with SLE compared to age-matched controls. The etiology of reduced bone mass and reduced vitamin D plasma levels in SLE is multifactorial and includes a variety of intrinsic factors related to the disease itself and treatment side effects. SLE patients are at risk for developing these two comorbidities (reduced vitamin D plasma levels and low BMD) and it is therefore essential to study, monitor, prevent and treat bone metabolism disorders in SLE patients.

Objective To determine the prevalence of fatigue in our cohort as well as the factors to which it is associated, its relationship with demographic variables, vitamin D levels, treatment, systemic lupus erythematosus (SLE) symptoms and disease activity. Methods A cross-sectional study was carried out including 102 consecutive female patients with SLE (American College of Rheumatology 1997 criteria) who attended the Parc de Salut Mar between January 2012 and May 2014. Variables collected were: sociodemographic data, vitamin D supplementation, fatigue VAS, pharmacological treatment, main serological markers of SLE, and plasma levels of 25(OH)-vitD. The association between fatigue and the different variables was evaluated by the Spearman's Rho correlation coefficient for the continuous variables, the Mann–Whitney U test for the categorical and the Kruskal–Wallis test for the seasons of the year. Results The fatigue variable was evaluated through a fatigue VAS with a mean score of 52.84 (range 0–100), a median of 59 and a standard deviation of 29.86. A statistically significant relationship was found between fatigue and age, MHAQ, SLICC, summer and photosensitivity. As for the relationship between fatigue and vitamin D insufficiency (defined as 25-(OH)-vitD ≤ 30 levels), the sample was divided into patients receiving vitamin D supplements (n = 60) and patients without supplements (n = 40), finding a significant relationship in that last group. Conclusions A statistically significant association was found between the presence of fatigue and age, MHAQ, SLICC, photosensitivity, fibromyalgia and summer, and with vitamin D insufficiency in the group of patients without supplements (n = 40).

Background The effectiveness of the switch when the first anti-TNF failure in patients with rheumatoid arthritis has been demonstrated in multiple studies. But what is more effective, if you make the switch to another anti-TNF or another molecule, is not clearly defined. Objectives A retrospective study was performed in clinical practice to determine if there is a response to DAS 28 at 6 months of change and whether there is a difference in response if the switch is performed on another anti-TNF or another biological. Methods From a total of 254 that met ACR 2010 criteria for RA, which have been biologically treated at Rheumatology of the Parc Salut Mar from 2000 to 2016, 61 (24%) were the first switch and the DAS 28 response at 3 and 6 months of follow-up. The following variables were analyzed: age, sex, years of evolution RA, erosions, FR, ACPA, type of biological treatment, DAS 28 at the start of the switch, 3 months and 6 months,% of patients presenting DAS 28 Results Of the total of 61 first treatment changes, 27 (44.3%) were to another anti-TNF alpha, 23 (37.7) to tocilizumab (TCZ), 7 to abatacept (11.5%) and 4 to RTX (6,6). The demographic and response data DAS 28 are shown in Table 1. There are no differences in the years of evolution,% of women, FR or ACPA positive, erosions and disease activity, as measured by DAS 28, before the switch, between The two groups (anti-TNF vs non-anti-TNF). Patients in the anti-TNF group were slightly younger than non-anti-TNF.When the DAS 28 response is evaluated at 3 and 6 months, modifying the treatment is effective (DAS 28 beginning 4,40 vs DAS 28 6 months 2.8 p When comparing the patients with anti TNF alpha vs TCZ, 62.5% of the patients with TCZ are in remission compared to 38, 5% (p=0.047). Conclusions In this retrospective study in daily clinical practice, it is evident that the change in treatment after failure of the first biological one, without differences if the change is to an anti TNF or another treatment. The percentage of patients who are remission at 6 months is higher if the change is at TCZ. Given the small number of patients, larger studies would be needed to confirm the results. References Johnston SS et col. Comparison of Biologic Disease-Modifying Antirheumatic Drug Therapy Persistence Between Biologics Among Rheumatoid Arthritis Patients Switching from Another Biologic. Rheumatol Ther. Disclosure of Interest None declared

Background In patients with SLE, subjective parameters are very important as they have a great impact on the quality of life. Among them, fatigue is the most prevalent symptom in SLE, as it occurs in more than 90% of patients (1). Likewise, approximately 50% of patients consider fatigue the most disabling symptom of the disease (2). Despite its high prevalence and impact on quality of life, fatigue has not been extensively studied in patients with SLE. Objectives To determine the prevalence of fatigue in our cohort as well as the factors with which it is associated, its relationship with demographic variables, vitamin D levels, treatments, SLE symptoms and disease activity. Methods A cross-sectional study was carried out including female patients with SLE (ACR 1997 criteria) who regularly attended the Parc de Salut Mar-IMAS in Barcelona between January 2012 and May 2014. We collected sociodemographic data, vitamin D supplementation, the VAS fatigue, pharmacological treatment, main serological markers of SLE, and plasma levels of 25-hydroxy vitamin D. The association between fatigue and the different variables was evaluated by the Spearman9s rho correlation coefficient for the continuous and the Mann-Whitney U test for the categorical variables. Results One hundred and two consecutive female patients were included. The fatigue variable was evaluated through a fatigue VAS with a mean score of 52.84 (range 0–100), a median of 59.00 and a standard deviation of 29.86. A statistically significant relationship was found between fatigue and age, MHAQ, SLICC and photosensitivity in the entirety of the 102 patients. As for the relationship between fatigue and vitamin D insufficiency (25-OH vit. D≤30 levels), the sample was divided into patients receiving vitamin D supplementation (N=60) and without supplementation (N=40), finding a significant relationship between fatigue and vitamin D insufficiency in the group without supplementation. Conclusions Fatigue is highly prevalent among female patients with SLE. A statistically significant association was found between the presence of fatigue, on the one hand, and age, MHAQ, SLICC, photosensitivity, and vitamin D insufficiency in the group of patients without supplementation on the other. It is necessary to carry out further studies with a larger sample and with validated fatigue measurement scales to confirm our findings. References Zonana-Nacach, A., Roseman, J. M., McGwin, G., Friedman, A. W., Baethge, B. A., Reveille, J. D., et al., and the LUMINA Study Group. Systemic lupus erythematosus in three ethnic groups. VI. Factors associated with fatigue within 5 years of criteria diagnosis. Lupus 2000; 9: 101–9. Krupp, L. B., LaRocca, N. G., Muir-Nash, J., Steinberg, A. D. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch. Neurol. 1989; 46: 1121–3. Disclosure of Interest None declared