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espanolEl registro de lupus de la Sociedad Espanola de Reumatologia (RELESSER) es un registro multicentrico de pacientes con lupus eritematoso sistemico seguidos en servicios de reumatologia espanoles, que contiene cuantiosa informacion sobre 4.024 pacientes. Hasta la fecha han sido publicados 14 analisis sobre la fase transversal del registro. Se describen los resultados mas relevantes, a criterio de los autores, concernientes a las caracteristicas clinicas acumuladas, nivel de actividad, tratamientos, refractariedad, dano y mortalidad. Se revisan asimismo los resultados de analisis especificos sobre el lupus incompleto, la nefritis lupica, las manifestaciones respiratorias, los eventos cardiovasculares, las infecciones graves, las neoplasias, la fibromialgia, el lupus en varones, el lupus en latinoamericanos y el lupus de inicio juvenil, comparando los diferentes subgrupos con el total de la cohorte. RELESSER se ha constituido como uno de los registros clinicos de lupus eritematoso sistemico mas importantes del mundo, resultando altamente productivo en terminos de generacion de conocimiento de la enfermedad en pacientes espanoles, util tambien para toda la comunidad cientifica. EnglishThe lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors’ perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.

The lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors' perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.

Introduction Lupus nephropathy (NL) is an important cause of morbidity and mortality in patients with SLE. The objective of the renal biopsy is to determine the type of glomerulonephritis that the patient presents to be treated. A proteomics study is proposed to determine biomarkers that help us to differentiate patients diagnosed with SLE with and without renal involvement. Objective To determine if there are a different patron of proteins between patients diagnosed with SLE with and without renal involvement. Methods We selected 12 patients diagnosed with SLE with renal involvement and 14 patients diagnosed with SLE without renal involvement. A 24 hour urine sample was obtained for analysis. Results A total of 292 proteins (identified with at least two peptides with a FDR Conclusion A different protein pattern is observed between the two groups of patients, so in a more detailed study we can indicate if some of these can serve as prognostic markers for this type of patients.

Background Low back pain of mechanical origin is a major cause of disability and surgical intervention. The lumbar computed tomography (CT)-guided steroid infiltration can accelerate the recovery process and sometimes avoid the surgery. Objectives Our aim was to review the indications, efficacy and complications of this technique in a wide series of unselected patients. In addition a comparative study of efficacy was performed according to the lumbar underlying pathology, type of steroid and approach of injection. Methods Study of lumbar CT-guided steroid injections performed in a University Hospital between January 2012 and June 2015. The minimum follow-up was 3 months. The procedure was performed in patients with low back pain refractory to standard medical therapy and Lumbar Spine Rehabilitation. Efficacy was assessed at 1 and 3 months according to a semiquantitative scale as the pain response as a) total response, b) partially c) no or d) worsening pain. A comparative study of the efficacy and safety was performed, regarding: a) underlying pathology, b) approach of injection and c) the different types of steroids used. Fisher9s test and χ 2 and the SAS System for Windows V program 9.2.were used for statistical analysis. Results During the study period 258 procedures were performed in 171 patients (132 men/126 women) with a mean age ± SD of 58.24±13.45 years (range, 18–88). The indications for the injection were: a) disc herniation (44.57%), b) lumbar stenosis (34.11%), c) postoperative fibrosis and spondylolisthesis (20.15%) and d) facet joint synovial cysts syndrome (1.17%). Approaches used were: a) posterior epidural (24.42%), b) lateral recess (58.91%), and c) foraminal (16.67%). The chosen steroid was triamcinolone (74.81%), dexamethasone (23.64%) and methylprednisolone (1.55%). In a significant proportion of the procedures improvement in the patient9s sintomatology was reported at the first month, regardless of the indication, route of corticosteroid injection and steroid used (TABLE). Regarding the overall outcome, at 3 months 72.48% of the patients experienced clinical improvement. And only 21.71% of patients required a subsequent surgery. The clinical efficacy showed no statistically significant differences according to the indication of the procedure or the route used for the injection. However, the improvement of pain was significantly greater in patients treated with triamcinolone than those treated with dexamethasone (p=0.01). Regarding safety there were 6 (2.3%) local complications (puncture of the thecal sac) and 3 (1.16%) systemic complications (allergic reaction). None of these complicationes were of clinical relevance and they were not associated with the corticosteroid used. Conclusions CT-guided corticosteroid injection is an effective and safe treatment in low back pain refractory to standard medical therapy in patients with spinal stenosis, disc herniation and postoperative fibrosis. Triamcinolone infiltration seems to be more effective than dexamethasone. Disclosure of Interest None declared

Background Osteoporosis (OP) in male under 70 years is less common than postmenopausal and senile OP, but causes important social and health costs associated with morbidity and mortality from fractures. It9s common in patients with inflammatory rheumatic diseases, enteric and endocrine diseases, also in COPD patients and in those undergoing chronic corticosteroid therapy. Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is done when one or more low energy mechanism fractures have already occurred (failure in early detection). Bone Metabolism Unit at Basurto University Hospital values from years ago male patients referred from different specialties with suspected OP. Objectives To describe main demographic and clinical characteristics of men aged 70 years or less, visited in our monographic OP consultation, with previous to 2013 protocols established with Primary Care (PC) and rheumatology (derivation according to risk factors). Methods Retrospective descriptive study based on a review of medical records and database of these patients. We analyze origin of derivation, risk factors, presence of fractures at moment of diagnosis, primary diagnoses and occurrence of refractures. The analysis was performed using statistical system SPSSv22. Results 127 patients, mean aged 58.17 years (18–70), up to 74% of the total derived from PC (47), and general rheumatology (47); 10 patients (7.9%) from traumatology; 8 from endocrinology (6.3%); 7 from gastroenterology (5.5%). 55.9% were smokers or former smokers, 22% kept drinking habit. 19.7% had received prednisone doses ≥7.5 mg for more than 3 months. 9 patients had family history of fracture (6.3%), and 46 themselves presented with one or more fractures (36.2%): 36 with one or more vertebral fractures, 4 hip fracture and 12 wrist fracture. 64 patients were diagnosed of OP with treatment indication by bone agent. 61% have secondary OP, the main cause (19%) enteric disorders (malabsorption syndromes and inflammatory bowel disease); 13% endocrine disorders and rheumatic inflammatory diseases by 13%. No primary cause was found in 39% of cases. The presence of fractures was associated with decreased DXA lumbar spine (p=0.027) and DXA hip (p=0.004). A very weak correlation between higher fracture FRAX and number of risk factors was detected, on the other hand a moderate correlation was observed with the number of fractures (Spearman Rho =0.472; p Of the 46 patients with previous fractures, only 12 (26%) had received prior treatment with bone agent. Only 5 patients suffered refracture after starting treatment and during follow-up (94.06 months) (25–129). Conclusions Almost 1/3 of men were referred for fractures caused by low energy impact, what means a late diagnose of male OP. It9s important to establish protocols with other medical specialties for men at risk to be identified and referred, in order to make an early diagnose. It highlights the lack of patients derived from pneumologists, although vertebral fractures in chronic respiratory patients worsen their functional status and mean a frequent cause of hospitalization in this group. Disclosure of Interest None declared

Background Aortitis is a several and potentially lethal clinical condition. It is usually oligosymptomatic or may present with non-specific symptoms that complicate and delay the diagnosis. On the other hand, treatment of aortitis is not established. Objectives The objetive of this study is to describe clinical manifestations, laboratory studies and treatment of patients with aortitis in a single center. Methods We have reviewed the medical records of patients who had positive Positron Emission Tomography (PET) for aortitis fron January 2013 to December 2015 in the Rheumatology Department of a University Hospital. We included 13 cases and we recorded epidemiological, clinical data, laboratory results, treatment and evolution. Quantitative variable results were expressed as mean±standard deviation (SD) or median (interquatile range-IQR). Qualitative variable results were expressed as percentage. The analysis was performed with the SAS System for Windows V 9.2. Results In the last 3 years 13 cases of aortitis were diagnosed (3 in 2013, 3 in 2014 and 7 in 2015). The male to female ratio was 3/10. Mean age±SD was 72.23±12.36 years [range, 51–83]. The underlying conditions were: giant cell arteritis (GCA) (n=7), polymyalgia rheumatica (PmR) (n=2), idiopathic (n=2), relapsing polychondritis (n=1) and Sjogren syndrome (n=1). The median interval between the diagnosis of the underline disease and the aortitis was 7 months [1–20]. The most common manifestations were constitutional syndrome (n=5), inflammatory back pain (n=4), pain irradiated to lower limbs (n=4), atypical polymyalgia (n=1) and fever (n=1). All patients exhibited increased acute phase reactants except for the two patients with idiopathic aortitis. Erythrocyte sedimentation rate (ESR) mean was 62±33.84 mm/1st hour and C Reactive Protein (CRP) median level mas 3.3 [2.91–5.13] mg/dl. Five patients presented anaemia. At the time of diagnosis, 9 patients were receiving prednisone (mean dose, 18.89±19.3 mg/day), 4 were with methotrexate (MTX) (mean dose, 15±5.77 mg/week) and the remaining 3 were not receiving any drug. Treatment of aortitis was based on the onset or increase in prednisone dose (mean dose, 34.17±9.73 mg/day) in all cases except for one patient who needed surgery for aortic aneurysm. MTX was initiated in 5 patients and its dose was increased in 4 more (mean maximum dose, 14.72±6.43 mg/week). Three patients were treated with methilprednisolone i.v. (0.5 g/day, 3 consecutive days). Tocilizumab (TCZ) was added to therapy in 2 cases due to refractory disease. In the first visit, two to four months later, the ESR mean was 25.92±24.88mm/1st hour and CRP median was 0.32 [0.16–1.11] mg/dl. In successive clinical controls, after a mean follow-up of 10±4.32 months, clinical and laboratory improvement was maintained. Four patients had a new PET-TAC control 6–16 months later, 3 of them presented complete remission and another one partial remission. Conclusions According to our data, clinical and laboratory data are often nonspecific in aortitis. The increase in the diagnosis cases in the last years is probably related to a higher index of suspicion. The presence of GCA or PmR refractory to standard treatment or unexplained raised ESR or CRP, may be red flags for suspecting an aortitis. Treatment with moderate doses of corticosteroids and MTX was effective in most of our patients. In 2 refractory cases, TCZ was useful. Disclosure of Interest None declared

Background Early diagnosis and treatment of aortitis are important to prevent possible serious complications such us aneurysm, aneurismal ruptured or aortic dissection. Aortitis may present with non-specific symptoms. Positron emission tomography (PET) is useful in diagnosing aortitis. However, PET is an expensive technique. Objectives Our aim was to evaluate those PET performed by suspected aortitis in order to find some predictive factors for positive PET for aortitis. Methods Study of PET performed by suspected aortitis in a University Hospital (from January 2013 to December 2015). The main epidemiological, clinical and laboratory data of these patients were extracted from clinical records according to a specifically designed protocol, reviewed for confirmation of the diagnosis, and stored in a computerized file. To minimize entry error all data were double checked. A comparative study was made between positive and negative PET to identify red flags of an underlaying aortitis. Quantitative variable results were expressed as mean±standard deviation (SD) or median [IQR] and were analyzed by Mann-Whitney U test. Qualitative variable results were expressed as percentages and frequency and were analyzed by Fisher9s exact test. Statistic analysis was performed with the SAS System for Windows V 9.2. Results In last 3 year period 33 PET were requested to confirm aortitis (5 of them in 2013, 7 in 2014 and 21 in 2015). We had 3 positive results of 5 (60%) in 2013, 3 of 7 (42.85%) in 2014 and 7 of 21 (33.33%) in 2015. The mean age of the 33 (22 female/11 male) patients was 70.30±14.16 years (range, 31–89). The underlying diseases associated to these patients were: giant cell arteritis (GCA) (n=12), polymyalgia rheumatic (PmR) (n=8), connective tissue diseases (Sjogren syndrome, dermatomyositis, undifferentiated connective pathology) (n=5), seronegative polyarthritis (n=3), relapsing polychondritis (n=2), idiophatic (n=2), hiper-IgG syndrome (n=1). Comparative study between positive and negative PET is summarized in TABLE. Inflammatory back pain and irradiated lower limb pain conditions were more common among patients with positive PET. They were the unique variables with statistically significant difference. The rest of both epidemiologic, clinical, laboratory or the possible influence of treatment with steroids and/or immunosuppressants at the time of conducting PET did not differ between groups. Conclusions In this estudy we observed an increasing in demand for PET for suspected aortitis every year and more cases were diagnosed in recent years. However, positive test percentage progressively decreased. The presence of inflammatory back pain and pain radiating to the lower extremities may have clinical relevance to suspect aortitis and a positive PET result. Prospective studies are needed with larger numbers of patients to establish a predictive model for aortitis. Disclosure of Interest None declared

Background At the end of 2011 we established a protocol in dose reduction of biological therapy in patients with imflammatory diseases. Those who achieved remission by clinical and laboratory tests and showed no radiographic progression or Doppler activity by ultrasound examination, received reduction of dosing. Patients with etanercept (ETN) reduced dose to 25 mg, and patients with adalimumab (ADA) increased injection interval to 3 weeks. Tocilizumab (TCZ) was tapered from 8 to 6 mg/kg. We have achieved optimization rates of 20% in 2012, close to 40% at the end of 2013. Objectives The aim of this study is to take account of activity flares in optimized patients and their characteristics, in order to describe predictive factors of flare if possible. Methods Retrospective analysis data from clinical records and database of 105 patients treated with ETN, ADA and TCZ, optimized from January 2012 to June 2013 considering lab tests (ESR, RCP), disease activity (DAS 28, BASDAI),functional capacity indexes (HAQ, BASFI), and GPE (general patient evaluation), at optimization, 6 and 12 months visits. We used SPSS 21.0 for statistical analysis. Results 105 patients (53 female and 52 male), 31% rheumatoid arthritis (RA), 27,5% ankylosing spondylitis (AS), 37,7% psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with longstanding disease, (150 months (18-638)). All of them were considered to keep remission by second visit, but at 12 months 32% were diagnosed of flare (24,5% under ADA and 39,2% under ETN; none with TCZ). Patients who flared were RA (30%), AS (29%), PA (37%) and one JIA. Half of the patients with RA, 27,6% of AS and 21,6% of PA. Clinical response was good to increasing of DMARD dosing in 25% and to increasing of biological dosing in 68,7%, but 3 patients (9,3%) required switching to another biological drug. We applied an univariate regression logistic model using parameters at visit 2, and we found modestly risk of flare related with ESR, DAS 28, number of swelling and tender joints. An increase of one tender joint at visit 2 means OR 3,56 (95% CI: 1,28-9,91), increase of one swelling joint means OR 11,26 (95% CI: 2,23-43,23). Increase of DAS 28 over 0,6 means OR 8 (95% CI: 1,85-34,6), and an increase over 1,2 means OR 60 (95% CI: 6,41-561,96). Conclusions 1/3 of patients suffered flares of disease activity, mostly happened in RA patients, most of them in the ETN group (not statistically significant). Patients who flared had increased DAS 28 at visit 2, but were considered at clinical remission then. Response to increasing in treatment dosing is usually good. We consider optimization as cost-effective practice among biological treated population. We need wider population to establish other statistically significant conclusions. Disclosure of Interest None declared

Background Biological therapy has changed the management of patients with inflammatory disease, but with a great increase of pharmaceutical costs and emergence of potential adverse effects. At the end of 2011 we established an internal protocol in management and dose optimization of the patients with biological treatment. Those patients with inflammatory disease who achieve remission by clinical and laboratory parameters and show no ecographic activity (arthritis, enthesitis), receive a reduction of dose. Patients with etanercept 50 mg sc. weekly reduce dose to 25 mg, and patients with adalimumab at a dose of 40 mg/2 weeks increase injection interval to 3 weeks. Thus we have achieved optimization of 20% in 2012, which is close to 40% at the end of 2013. Objectives To show that there is not a significant clinical or analytical worsening in our optimized patients, considering basal data at the time of optimization and six months later. Methods Retrospective analysis of data from clinical records and our database of 105 patients treated with etanercept and adalimumab, optimized from 2011, considering lab tests results (ESR, RCP), disease activity (DAS 28, BASDAI), functional capacity indexes (HAQ, BASFI), and GP E (global patient evaluation of the disease). We used SPSS 21.0 for statistical analysis. Results 105 patients (53 female and 52 male), 31% with rheumatoid arthritis (RA), 27,5% with ankylosing spondylitis (AS), 37,7% wiyh psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with a longstanding disease, with a mean of 152,47 months of evolution (18-638). Table 1 shows both, the basal findings and the results from six months later. Furthermore, 32,4% of patients had a DAS 28 increase over 0,6, but in only 14,7% DAS 28 increase resulted over 1,2. BASDAI an BASFI increases >2 from basal occurred in 4,4% of patients. EGP increases >20 from baseline occurred in 15% of patients. Conclusions Our patients optimized with etanercept and adalimumab maintain remission criteria based on clinical and laboratory parameters at six months. So, optimization seems to be safe and cost effective in an important amount of patients with longstanding disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5931