Background In January 2011, at our centre, we started a Rheumatology nurse-led telephone clinic, in order to monitor drugs toxicity and evolution of disease in patients with good disease control and on stable treatment. Objectives To describe the nurse-led telephone clinic activity in a Rheumatology Service, and its influence on the decrease of welfare load and safety of drugs management. Methods Descriptive retrospective study, collecting the nurse-led telephonic clinic between January 27th and December 30th 2011. This clinic was performed 3 days a week by one nurse with a computer with access to the clinical history and laboratory results, and an external telephone. The protocolized data collected included: duration of the call, necessity of doctor involvement and doctor visit, drug monitoring and diagnosis. Results A total of 978 telephone consultations were carried out for 414 patients. The diagnosis distribution was Rheumatoid Arthritis 45.2% (187), Osteoporosis 18.6% (77), Psoriatic Arthritis 13.1% (54), Ankylosing Spondylitis 9.7% (40), other Spondyloarthropaties 7.7% (32), Paget Disease 1.4% (6), SLE 1.2% (5), Polymyalgia Rheumatica 1.2% (5), and others 1.9% (8). The distribution of monitored drugs was Methotrexate 61% (597), Zoledronic Acid 14.7% (144), Leflunomide 10% (97), Sulfasalazine 5.9% (58), and others 15% (147). The duration of calls was fewer than 10 minutes in 91.5% (895) of the cases. Only in 8.7% (85) was consultation with a doctor necessary, with a doctor’s visit required in 30% (25) of them. In regards to inflammatory systemic diseases, this strategy allows saving 834 visits with a doctor. Conclusions Creating a nurse-led telephone clinic in Rheumatology allows the avoidance of unnecessary hospital visits, benefiting both patients and doctors. Disclosure of Interest None Declared

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Background Hepatitis B virus (HBV) vaccination is recommended in patients with inflammatory arthropaties on biologic treatment. Usually these patients cannot complete the vaccination schedule before starting biologic therapy. Lower immune response to HBV vaccination was observed in rheumatoid arthritis patients treated with non-biologic DMARDs compared with general populationin a study published in 2002. The effect of anti-TNF therapy (antiTNF) on humoral response to influenza vaccination in patients with inflammatory arthropaties has been assessed afterwards. In a study published in 2010 a lower response was observed in patients with spondyloarthropaties (SpA) compared to a healthy sample. Up to the present moment the inmunne response to HBV vaccination in patients with SpA treated with antiTNF has not yet been assessed. Objectives Main objective: to evaluate the effect of antiTNF therapy on immune response to HBV vaccination in SpA patients. Secondary objetives: to identify potential effect modifiers on immune response to HBV vaccination; comparison with a group of hemodialyzed patients (HD). Methods Study type: This is an observational cohort study both prospective and retrospective. Patients and procedures: SpA group: Patients with SpA treated with antiTNF. They recieved 3 doses of HBV vaccination. HD group: Patients on HD who had recieved HBV vaccination following HD schedule. Stadistic analysis Proportions for categorical variables and average ± SD (or median if appropiate) for continuous variables were calculated. Categorical variables were compared by chi-square test (applying continuity correction if necessary). T-test (or Kruskal-Wallis if appropiate) was used to compare averages. Results 30 patients in the SpA group and 19 patients in the HD group were included. 17 patients (89.5%) in the HD group showed immune response to HBV vaccination whereas only 14 patients (46.7%) in the SpA group did. Immune response to vaccination was independent of any of the variables analyzed in the SpA group. When immune response was compared between the two different doses of vaccination (including all patients both from the SpA and the HD groups), a significant statistical difference was observed (p=0.034). The proportion of 'responders' was higher if the dose recieved was 40 mcg/mL. Conclusions In our study, immune response to HBV vaccination in patients with SpA treated with antiTNF was lower than in hemodialyzed patients and general population. The proportion of response was larger in patients who recieved the higher dose of vaccination.This study is limited by the small sample size. It wood be useful to continue our investigation in order to ameliorate the vaccination standards of our patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3302

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BackgroundTumour necrosis factor (TNF) plays a major role in defense against leishmaniasis. Despite wide use of TNFα inhibitor (anti-TNF) for several diseases, leishmaniasis has been a rare infectious complication so far in these patients. Recently, an increased incidence has been noted.ObjectivesTo describe a recent multicenter case series of leishmaniasis in patients with chronic inflammatory diseases treated with anti-TNF.MethodsWe reviewed the clinical history of a multicentric series of patients with chronic inflammatory diseases treated with anti-TNF, who were diagnosed with leishmaniasis between January 2013 and December 2017. Patients came from Rheumatology, Digestive and Dermatology departments of several hospitals in Valencia2 and Cataluña1 region. Demographic (age, sex) and clinical (inflammatory disease, comorbidities, current treatment, year of infection and leishmaniasis form) variables were collected. Anti-TNF withdraw, subsequent reintroduction and recurrence rate were recorded in two hospitals. Biologic drug dispensation trends from 2013 to 2016 and epidemiological data published by the Regional Ministry of Health of Valencia for the area where cases were most incident were analysed.Results25 cases of leishmaniasis in patients treated with immunomodulators were identified:7 on DMARD, 1 on tocilizumab and 17 on anti-TNF (7 infliximab, 4 adalimumab, 3 golimumab, 2 certolizumab, 1 etanercept). Regarding patients on anti-TNF, 2 cases were collected in 2014, 4 in 2015, 4 in 2016 and 7 in 2017. Three patients developed the visceral form, 13 the cutaneous form and 1 presented visceral and cutaneous involvement. Seven patients were males and 10 females, with an average age of 50 (SD14) years. One patient presented rheumatoid arthritis, 4 psoriatic arthritis, 1 undifferentiated spondyloarthropathy, 2 ankylosing spondylitis, 1 uveitis, 6 Crohn’s disease and 2 ulcerative colitis. Six patients presented other chronic disease (1 latent tuberculosis, 1 pyoderma gangrenosum, 1 psoriasis and 3 diabetes mellitus). In two hospitals (15 patients), anti-TNF treatment was withdrawn in 10 cases, and it was reintroduced after treating the infection in 5 cases. No infection recurrences have been indentified. Focusing on the area with the highest incidence of cases, despite the increase in anti-TNF use over the last years, its consumption was not parallel to the rise of leishmaniasis cases reported.Conclusionsthe disproportionate increase of leishmaniasis cases in patients with anti-TNF suggests the necessity to investigate and control other possible factors involved.Disclosure of InterestNone declared