Introduction: Biliary stricture is a well-known complication of chronic pancreatitis which may require surgical drainage in the form of bilioenteric anastomosis. We report a novel technique for surgical management of such strictures -intrapancreatic choledochoplasty during Frey's procedure (FP), where we lay open the intrapancreatic CBD and fix it to the pancreatic tissue/capsule in the head to keep it patent. Methods: The study was carried out at a tertiary care centre in India from January 2017 to December 2019. Patients of chronic pancreatitis with associated biliary strictures who were candidates for FP were evaluated for suitability for the procedure. Strictures confined to the intrapancreatic CBD requiring biliary drainage underwent choledochoplasty in addition to FP. Results: 10 patients underwent choledochoplasty (8:2males:female). The mean age was 39 years. Pain was reported for a median duration of 36 months (6 -96 months) and jaundice for a median of 12 months (1 -36 months). 80% patients had at least one episode of cholangitis. Exocrine and endocrine insufficiency was present in 60% and 80% patients respectively. Preoperative stent was placed in the CBD/MPD in 40% patients each. Mean duration of surgery was 300 minutes and mean blood loss was 300 ml. The mean post-operative hospital stay was 8.5 days with no grade III -V complications. On followup, LFT was normal in all patients. Conclusions: We describe our technique of intrapancreatic choledochoplasty during FP, which is an effective substitute to bilioenteric anastomosis in surgical management of chronic pancreatitis induced intrapancreatic CBD strictures.

Background:Spondyloarthropathies are a heterogeneous group of similar diseases, with interrelated clinical manifestations, such as Psoriasis Arthritis (APs) and Ankylosing Spondylitis (EA). There are different treatments for this group of pathologies.Objectives:It is very important to differentiate between those that present predominantly axial (spine and/or sacroiliac) or peripheral involvement, since the response to treatment is very different.In some clinical trials, secukinumab significantly improved versus placebo, the symptoms and signs, physical function and quality of life, however, at present, we do not have enough data from secukinumab in real clinical practice.This is the real reason of this study: the use of secukinumab in clinical practice.Methods:Multicentric longitudinal observational study of 5 Hospitals in Madrid.Patients are over 18 years old and meet the following inclusion criteria: New York criteria for AS, ASAS for EA, CASPAR for APs, and all of them are with secukinumab or have received it.We will evaluate the effectiveness rate as well as its confidence interval at 95%. In addition, the effectiveness of secukinumab will be compared in the different pathologies by using χ2.Results:72 patients were collected, 41 of them were women (57,75%).12 patients (16,90%) had not received FAME before secukinumab and 22 patients (33,99%) were naive to biological treatment.In 4 patients, the reason for starting secukinumab was the patient’s comorbidities, in 2 the adverse effects of previous treatment and in the rest, was the lack of efficacy of the previous treatment.The patients were divided into 4 categories according to the level of DAS-28 or BASDAI, at the beginning of the treatment and the last recorded value, in: Absence of activity, mild, moderate and severe activity. Of the patients with data, they managed to improve the DAS-28 score (change category) by 30,95%, while only 4,76% worsened their score. With respect to BASDAI, of the total number of patients, only 3,03% worsened, while his score improved 27,27%.According to baseline diagnosis, a greater improvement of the disease activity in peripheral APs(66,67%) and mixed APs(61,54%) is achieved.Conclusion:In real clinical practice, treatment with secukinumab was effective in patients with spondyloarthritis, achieving improvement in previous activity rates. In this study, the most significant improvement was obtained in peripheral and mixed APs.Disclosure of Interests:None declared

Background:Secukinumab inhibits the interaction between Interleukin 17A (IL-17A) and its receptor. Clinical trials have demonstrated good data in efficacy and safety in patients with spondyloarthritis (SpA) as first biological choice or inadecuate response to other biological in SpA. However there is few evidence in real clinical practice.Objectives:Evaluate the drug survival in a real clínical practice, as an indirect way to show the efficacy and security of Secukinumab at 24 monthsMethods:A multicentric observational, longitudinal, retrospective study of 24 months conducted in five Madrid hospitals (Spain). Patients older than 18 years treated with Secukinumab which fullfilled ASAS criteria for SpA and/or modified New York criteria for ankylosing spondylitis (AS) and/or CASPAR criteria for psoriatic arthritis (PsA) were included. For evaluation of the drug survival, dates from starting until closing date or definite withdrawal of the treatment were determined. Kaplan-Meier function was used to estimate the drug survival and Wilcoxon test for the comparison of the survival rate between the different diagnoses, because of the survival curves did not reach the medianResults:A total of 71 patients were included. The mean age was 50.26 ys (SD 11.01), 57.75% women. 35 patients fullfilled classification criteria for PsA ant 36 fullfilled classification criteria for axSpA. 22 patients were naïve for biologic therapies and 49 patients had an inadecuate response to TNFi. 13 patients discontinued Secukinumab before the closing date, the main reason for the interruption was secondary failure (n= 6), and primary failure (n=2). Secukinumab survival rate was 81.95% up to 24 months in this cohort. The median of survival was 2.36 years (IC: 1.79-2.84). There were no significant differences about the drug survival related to diagnosis (p=0.976). The safety data were similar to those described in clinical trials.Conclusion:Secukinumab is an effective and safe treatment for the management of espondiloarthritis regardless of the subtypes, with a high survival rate. In this study naive patients show similar data obtained in clinical trials. In this cohort of patients, those who initiated secukinumab after failure to TNFi, showed a greater secukinumab survival than the data provided in clinical trialsDisclosure of Interests:None declared

Background:The use of biological therapies during pregnancy has been contraindicated since the beginning of the use of these drugs. In recent years several studies have demonstrated the minimal-to-no transfer of certolizumab pegol (CZP) to the placenta and breast milk, which has allowed its approval for use in pregnancy and breastfeeding if clinically necessary. However, there are no studies evaluating the use of CZP during this period in real life or the characteristics of this subgroup of patients.Objectives:To describe the profile of women of childbearing age diagnosed with chronic inflammatory rheumatic disease (CIRD): Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and axial Spondyloarthritis (axSpA), who initiate CZP by gestational desire using the GESTAMAD registry (multicenter study of women with chronic inflammatory rheumatic disease of childbearing age who are initiated on CPZ by gestational desire from the Madrid community).Methods:Prospective multicenter study that aims to know the characteristics of women of childbearing age diagnosed with CIRD and gestational desire to which CZP is initiated for this reason. The comorbidities of the patients such as hypertension, diabetes and cardiovascular disease were collected. Disease activity was measured by DAS28 using CRP in RA and PsA and BASDAI in axSpA. The present study presents preliminary data from the initial cohort and will be followed prospectively for 24 months to assess the efficacy and safety of the drug during pre-conception, pregnancy and lactation.Results:A total of 45 patients have been recruited in 6 Madrid hospitals from June to December 2019. Patients had a mean age of 35.9, (36.6 in RA, 35.2 in PA and 35.1 in SPA). Fifty-one percent had RA, 20.0 percent had PA and 28.8 percent had SPA. The mean disease duration for RA, PA and SPA was 9.5, 7.3 and 6.9 years, respectively. 48.9% of women were nulliparous. The abortion rate of patients diagnosed with spondyloarthropathy was upper of 25%. 33.3% of the patients had been treated with previous biologicals, with gestational desire/pregnancy being the reason for the change.75.5% of the patients had been treated with synthetic disease modifying antirheumatic drugs (DMARD) previously. With regard to disease activity, the mean DAS 28 at the start of treatment was 4.5 in RA and 3.8 in PA and BASDAI 7.0 in axSPA.In RA the highest values of CRP and ESR were found prior to initiation with CZP, but this difference was not statistically significant (p=0.644 and 0.605, respectively). 22.2% of patients had previous comorbidities.Conclusion:The mean age of patients with gestational desire in CIRD is high. Women diagnosed with PsA and axSpA have a high rate of previous abortions, upper than 25%. The duration of the disease is equally long at the time of manifesting gestational desire. The use of treatments such as CZP, compatible with pregnancy and lactation would allow a better control of inflammatory joint disease in this period of life, encouraging patients not to postpone their gestational desire.Disclosure of Interests:None declared

Background:Nailfold videocapillaroscopy is a non-invasive technique used to assess Raynaud syndrome. It is mainly used for the early diagnosis of connective tissue disorders (CTD) such as systemic sclerosis. There is some evidence that capillaroscopy findings may be altered by microcirculation abnormalities in patients with cardiovascular risk factors (CVRF).Objectives: to analyze the influence of cardiovascular risk factors on naildfold capillaroscopy in patients with Raynaud or suspect of CTD.Methods:An observational and descriptive study of consecutive patients that underwent a videocapillaroscopy examination for the study of Raynaud syndrome was conducted. A “Capiscope” model videocapilaroscope from Optilia was used, with a fixed magnification of 200x. Examination was made on 8 hand fingers, with 2 images per finger. The patients had to be at least 30 minutes in a fixed warm temperature room and without smoking 1 hour before the performance of the test. The following capillaroscopic parameters were considered: nailfold morphology, capillary loop enlargements, megacapillaries, microhaemorrhages, avascular areas and signs of neoangiogenesis. Demographic information (including age, gender and previous diagnosis) and cardiovascular risk factors (including arterial hypertension (HT), diabetes mellitus (DM), dyslipidemia (DL) and smoking habit), were collected. The influence of cardiovascular risk factors on naildfold capillaroscopy was analyzed, using univariate and multivariate logistic regression models, adjusted for possible confounders.Results:Out of the 136 included patients, 91% were women. Mean age was 54,6 ± 18,7 years. Raynaud syndrome was reported in 83% patients, with a mean duration of 6,1 ± 5,7 years and 12% of the patients had a previous diagnosis of CTD, including systemic lupus erythematosus (5%), systemic sclerosis (4%), undifferentiated connective tissue disorder (2%) and mixed connective tissue disease (1%). Regarding CVRF, HT was observed in 25%, DM in 7%, DL in 23% and past or current smoking habit in 32%. Capillaroscopic findings were: loop enlargements (81%), megacapillaries (30%), microhaemorrhages (46%), signs of neoangiogenesis (71%) and avascular areas (20%).Regarding the capillaroscopic pattern, 46% presented a normal or nonspecific pattern; 31% a microangiopathy pattern and 23% a scleroderma pattern (of which 58% had an early or active scleroderma pattern and 42% a late scleroderma pattern). A new diagnosis of CTD was made in 24 patients (18% of the cohort). In the group of patients without CTD, HT was associated with microhaemorrhages (p = 0.02) and avascular areas (p = 0.007), and there was a tendency to association between smoking habit and megacapillaries (p = 0.08). After adjusting for confounding factors for this group, an association between CTD and microhaemorrhages (OR = 1.9; p = 0.01) and avascular areas (OR = 2.12; p = 0.007) was found. The multivariate study showed no relationship between CVRF and capillaroscopy patterns.Conclusion:In our cohort we found an increased frequen...