Nursing clinics in rheumatology (NCRs) are organisational care models that provide care centred within the scope of a nurse's abilities. To analyse the impact of NCR in the rheumatology services, national multicenter observational prospective cohort studied 1-year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; and (3) its own appointment schedule. Variables included were (baseline, 6 and 12 months): (a) test to evaluate clinical activity of the disease, research and training, infrastructure of unit and resources of NCR and (b) tests to evaluate socio-demographics, work productivity (WPAI), use of services and treatments and quality of life. A total of 393 rheumatoid arthritis and ankylosing spondylitis patients were included: 181 NCR and 212 not NCR, corresponding to 39 units, 21 with NCR and 18 without NCR (age 53 + 11.8 vs 56 + 13.5 years). Statistically significant differences were found in patients attended in sites without NCR, at some of the visits (baseline, 6 or 12 months), for the following parameters: higher CRP level (5.9 mg/l ± 8.3 vs 4.8 mg/l ± 7.8; p < 0.005), global disease evaluation by the patient (3.6 ± 2.3 vs 3.1 ± 2.4), physician (2.9 ± 2.1 vs 2.3 ± 2.1; p < 0.05), use of primary care consultations (2.7 ± 5.4 vs 1.4 ± 2.3; p < 0.001) and worse work productivity. The presence of NCR in the rheumatology services contributes to improve some clinical outcomes, a lower frequency of primary care consultations and better work productivity of patients with rheumatic diseases.

Background The occurrence of fibromyalgia (FM) with other rheumatologic diseases has been estimated with the following frequencies; Psoriatic arthritis 24%, rheumatoid arthritis 25%, systemic lupus erythematosus 30% and Chron’s disease 49%. The diagnosis of FM is essentially made on clinical data, with the presence of trigger points, sleep disorders, some dysautonomic findings and the lack of evidence of inflammatory or degenerative disease. The clinical syndrome of FM and the spondyloarthritis (SpA) share some signs and symptoms such as fatigue, lower back pain, unspecific urinary disorders and sleep disturbances. Objectives The purpose of this study was to determine the frequency of FM in patients with spondyloarthritis and to describe the clinical findings that are shared in both diseases. Methods Forty patients from the outpatient clinic in the Rheumatology service with spondyloarthritis according to ESSG classification criteria were included. We reviewed medical files; the clinical evaluation was done by two independent rheumatologists, clinical assessments included BASDAI and BASFI for SpA group and FIQ for FM patients. Current drug treatment, ESR, CRP, RF, HLA-B27 antigen were done. X ray of sacroiliac joints and lumbosacral were made in all patients. Statistical analysis on the program SPSS v 17, using arithmetic mean, standard deviation and correlation with Pearson’s test. Results Out of 40 patients, 90% (36/40) were women and 10% (4/40) men. The mean age was 48±9.7, all the patients had some kind of SpA and fifty-seven percent (23/40) had FM. Eighty percent (32/40) of the patients with diagnosis of undifferentiated SpA, ankylosing spondylitis in 7.5% (3/40) and psoriatic arthritis in 7.5% (3/40). ESR was abnormal in 47.5% (19/40), CRP abnormal in 15% (6/40). The clinical scales BASDAI and BASFI were abnormal in 75% and 37% respectively; the functional index questionnaire for FM was abnormal in 42%. The most frequent painful enthesis were as follow: first costochondral joint 72%, seventh costochondral joint 60%, medial condyle of femur 70% and plantar fascia 70%. The positive trigger points were: inter-transverse lower neck space C4-C5 and C5-C6 62%, second chondrocostal joint 67%; Knee medial fat pad proximal to the joint line 72% and gluteal at upper outer quadrant 72%. No statistical correlation between BASDAI and FIQ r =0.101. Conclusions In our work the frequency of FM in patients that are classified as SpA was fifty percent. We hypothesized that in some patients with SpA, the initial clinical picture could have been signs and symptoms of FM, because they share signs and symptoms. We suggest investigating specific clinical data, such achillea and plantar enthesitis, in patients that are classified as primary FM. References Azevedo V, Paiva E, Hiurko LR, Amorim R. Occurrence of fibromyalgia in patients with ankylosing spondylitis. Bras J Rheumatol 2010; 50 (6): 646-54 Disclosure of Interest None Declared

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Background Sarcopenia refers to age-related loss of muscle mass and function. However, autoimmune sarcopenia refers to excessive weight loss usually with disproportionate muscle wasting due to cytokine excess. Previous studies have found a frequency of autoimmune sarcopenia of about 15 to 20%. The progressive loss of muscle mass lead to decrease in physical activity and a rise in cardiovascular and metabolic disorders. There is currently no widely accepted definition of sarcopenia in autoimmune diseases. Objectives The purpose of this study was to determine the frequency of muscle wasting in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Methods In a cross-sectional study, we screened the patients from outpatient clinic in the rheumatology service and were excluded patients with chronic disorders of heart, kidney and liver, also the patients that were on HMG-CoA reductase inhibitors treatment; we performed medical history and physical examination, specialist in clinical nutrition made the anthropometric measures, blood samples were taken for clinical laboratory analysis. Activity scales for each disease were made, DAS-28 in RA and MEX-SLEDAI in SLE patients. We determined the whole body lean mass using Dual-emission X-ray Absorptiometry (DEXA). Statistical analysis was performed using arithmetic mean, standard deviation, Student T test; chi-square and Fisher exact test when appropriate and Spearman rank correlation test all using SPSS program (v 12.0). Results Forty-six patients with autoimmune disease (AID), twenty six patients with RA and 20 with SLE according to the 1987 ACR criteria and 25 healthy subjects were analyzed; mean age of AID was 40±13.4 vs. 39±18 years in control group. Ninety-four percent were women. 90% of the AID group was taking hydroxychloroquine and 80% was on mild doses of corticosteroids. The anthropometric measures revealed obesity in 28% of the patients vs 16% in control group. The frequency of sarcopenia in AID group was 26% (12 pts) vs 20% (5 pts) in control group, p=0.000; There was no difference in the cases of sarcopenic-obesity. The risk of sarcopenia in sedentary patients was OR 1.93 (IC 95% 0.385 to 9.7). There was no correlation between activity scales of AID and sarcopenia rho =0.121 for SLE and rho=0.170 in RA patients. The use of hydroxychloroquine is not protection for muscle wasting OR 1.4 (IC 95% 0.147 to 14.59). Finally the risk of sarcopenia in patients with AID was OR 1.4 (IC 95% 0.434 to 4.596). Conclusions Our work demonstrated that patients with AID have a slightly risk of sarcopenia when are compared to control group. This finding may affect the quality of life and promote the increasing of morbidity in such patients. References Santos MJ, Vinagre F, Canas Da silva J, Gil V, Fonseca JE. Body composition phenotypes in systemic lupus erythematosus and rheumatoid arthritis: a comparative of caucasian female patients. Clin Exp Rheum; 2011 29: 470-476 Disclosure of Interest None Declared