Background:Apremilast (APR), a small molecule inhibitor of phosphodiestersa-4, has been shown to be effective in the treatment of oral and genital ulcers in Behçet’s disease (BD). BD is a systemic vasculitis with great heterogeneity of symptoms and manifestations. It can affect the blood vessels, mucosa, skin, joints, eyes, nervous system and digestive system. APR is indicated for treatment of oral ulcers in BD in some countries such as the USA and Japan.Objectives:To evaluate the efficacy and safety of APR treatment in BD patients.Methods:Single-center descriptive study of BD patients on APR treatment from February 2017 to December 2019. Demographic, clinical and analytical data were collected.Results:10 patients (9 women) were included, with a mean age at the beginning of APR treatment of 37±12 years and a mean disease evolution of 100±105 months. 8 of them showed HLAB51 positivity.Before treatment with APR, 4 patients were refractory to DMARDs (2 MTX, 2 AZA) and one patient to 2 anti-TNF (ADA, IFX). All patients were under treatment with colchicine and 5 with steroids before APR therapy. The concomitant treatment with APR were: corticosteroids (5), NSAIDs (2), colchicine (8), MTX (2), AZA (2).The main symptoms at the beginning of the APR treatment were: oral ulcers (100%), genital ulcers (60%) and arthritis/arthralgia (90%). We observed a clinical improvement after 3 months of treatment of 90% of oral ulcers, 100% of genitals and 55% of joint symptoms. The patients had a mean follow-up of 37±12 months and they maintain the therapy response during the APR treatment.Patients presented adverse events, some of them transitory: headache (5), diarrhea (5), nausea (3), dysthymia (1), tremors (2), herpes zoster (1) and autolytic ideation (1). The treatment was withdrawn in 4 patients with a mean duration of 11 ± 13 months. 2 of the 4 adverse events were by autolytic ideation and nausea, 1 for genesic desire and 1 for persistence of joint injury. The APR doses were reduced to 30 mg per day in 4 patients, resolving the adverse events and persisting with a good response. In addition, dose reduction of colchicine and prednisone was achieved in 4 patients.We observed other previous manifestations of BD such as uveitis (4), neurobehçet (3), cutaneous (folliculitis/pseudofoliculits) (4) and venous thrombosis (1). Cutaneous manifestations were resolved and the rest of previous manifestations remain without clinical changes during the follow-up.Conclusion:We observed an improvement in the most common manifestations of BD and a safety profile similar to those described in other studies. We observed a resolution of mucocutaneous manifestations, a variable response in joint manifestations and stability in neurological manifestations. Adverse effects referred included gastrointestinal and headache, most of which were transient and were resolved with adjustment of treatment.Disclosure of Interests:None declared

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease which affects 0.5% of adults, especially women. This disorder is associated with increased morbidity and mortality due to atherosclerotic cardiovascular diseases. In addition to classical cardiovascular risk factors, inflammation plays a key role in this fact. Intima-media thickness (IMT) measured by carotid ultrasound is currently used to detect the presence of atherosclerotic disease and its value could be a predictor of subclinical cardiovascular disease.ObjectivesTo study cardiovascular risk factors, disease activity and carotid IMT in a RA patients series.MethodsCross-sectional observational study of patients diagnosed with RA according to ACR/EULAR 2010 criteria. Patients with age under 75 years old and up of 5 years of disease evolution were included. Cardiovascular established disease patients were excluded. During a unique visit, patients underwent anamnesis, physical examination, laboratory test, electrocardiogram, chest X-ray and carotid ultrasound with Esaote-MyLabClassC equipment. Statistical analyses were performed using software R (version 3.3.2).ResultsA total of 31 patients (57.1±9.7 years, 83.6% female, with 19.2±11.2 years of average disease course) were included. In relation to the classic cardiovascular risk factors, 19.4% were active smokers, 41.9% hypertensives and 45.2% had hypolipidemic treatment (85.7% with a statin), three of the patients were diabetic (9.7%). All patients were treated with monotherapy or combination therapy and 41.9% were also given glucocorticoid at low doses during the last 6 months. The median DAS28-VSG was 2.49 (1°Q=1.6; 3°Q=3.9), with an average HAQ of 0.88±0.68. As for extra-articular manifestations, 45.2% had xerophthalmia, 29% xerostomia, and 19.4% had rheumatoid nodules. The median total cholesterol was 195 mg/dL (174–221), and LDL of 116 mg/dL (96.5–138). The mean of the right carotid IMT was 576.13±118.78 mm and the carotid left IMT was 616.32±134.31 mm, resulting in 12 determinations higher values than expected to their age and sex provided by the ultrasound developer (38.7%). Using the SCORE table (modified by EULAR), only 5 patients (16.1%) had moderate-to -high cardiovascular risk. Statistical analysis showed a significative association between an increased IMT with tobacco consumption (classic cardiovascular risk factor) (p=0.028) and the modified SCORE (p=0.04). Neither years of evolution of disease nor the analytical biomarkers showed a significant association.ConclusionsOur study shows that in patients with good disease control data, classic cardiovascular risk factors are related to increased carotid intima-media thickness. However, these factors may underestimate overall cardiovascular risk over other measures of subclinical cardiovascular disease, such as carotid IMT.Disclosure of InterestNone declared

BackgroundShoulder pain is a very common complaint with poor prognosis and high recurrence. To evaluate the shoulder pain, anamnesis and physical examination are used, but a diagnosis of certainty is difficult. Clinical history and specific exploration maneuvers tend to be poorly correlated with the underlying problem. There are few studies that assess the predictability of shoulder pathology using patient characteristics and exploration.ObjectivesTo assess if the combination of exploratory maneuvers and clinical data predicts the type of affection of the painful shoulder in a sensitive and specific way.MethodsWe conducted a prospective study with patients who attended to the Rheumatology Department of HUP La Fe by painful shoulder between February 2016 and January 2017, excluding those with known inflammatory diseases. A rheumatologist performed the anamnesis and the selected exploratory maneuvers: Jobe and Gerber test and palpation of the acromioclavicular joint. A second rheumatologist, blind to physical examination and medical history, performed the shoulder ultrasound scan. Biostatistic analysis was performed using software R version 3.3.2.Results119 patients (66.4% women) with a mean age of 60±12.56 years and shoulder pain were collected. Time of pain evolution was 20.43±24.09 months and the right shoulder was the most affected one (71.4%). The association between the maneuvers of Jobe and the involvement of the supraspinatus (SE), as well as the Gerber maneuver with the affectation of the subscapular were statistically significant. However the sensitivity and specificity of both maneuvers are very low, so that alone is not suitable to identify the affected tendon or the type of alteration. Thus, a predictor model (nomogram) of the most common shoulder pathologies (subacromiodeltoid bursitis, tendinosis or SE tears) was developed using epidemiological and clinical examination variables.ConclusionsBased on our results, the predictor model performed using epidemiological and clinical examination variables would be able to predict the most frequent pathologies of the shoulder. Imaging tests have a certain delay time, and by applying this predictor model, a diagnosis of presumption could be established in primary care, giving the opportunity to institute an early treatment. In addition, patients could be referred more efficiently to the appropriate specialty (rheumatology, traumatology or rehabilitation), avoiding delays.Disclosure of InterestNone declared

BackgroundOxidative stress is increased in Systemic Lupus Erythematosus (SLE) patients, and contributes to the immune system imbalance, abnormal activation of apoptotic processes, autoantibodies production and the development of serious complications, such as cardiovascular comorbidities.ObjectivesTo evaluate the influence of oxidative stress as an additional factor to the classical cardiovascular risk ones, in SLE patients.MethodsCross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, coming from the Rheumatology Service of Arnau de Vilanova Hospital and La Fe Hospital. In all patients we analyzed the serum concentration of GS-Nem (GSH) and GSSG by UPLC-MS/MS (Acquity UPLC System). We have also taken healthy individuals as negative controls, who had the same blood-test. In patients was also made a complete blood-test, and clinical, treatment and biometric data were collected by personal interview. Biostatistical analysis was performed by the R software version 3.2.3., using a simple, binominal and logistic lineal regression.ResultsA total of 140 patients were evaluated; (95% women) with 33.39±13.63 year-old average at the diagnosis time with a 10.05± 11.42 year-evolution of SLE. We used GSH/GSSG ratio to assess the oxidative stress rate, being this value higher in patients than in healthy controls (P=0.005).We observed a statistically significant relationship between the presence of oxidative stress and accumulated damage assessed by SLICC-ACR (P<0.0001). No differences according to the disease activity, specific autoimmune profile or by organ or systems affected. However, we found a slight difference in the GSH/GSSG ratio among patients who have had a CVD (1±0.39) and those who have not suffered CVD (1.19±0.55). No differences in the levels of oxidative stress are observed according to treatment with folic acid or the administration of biological therapies.ConclusionsWe observed increased levels of oxidative stress in our SLE patients compared to healthy controls. Data suggest a rise of oxidative stress in patients with a greater cumulative damage, which is consistent with the presence of severe comorbidities in these patients. It seems to be a slight tendency to increased oxidative stress levels measured with GSH/GSSG ratio in patients with SLE and cardiovascular involvement, but more independent studies are needed to confirm it.Disclosure of InterestNone declared

BackgroundSystemic Lupus Erythematosus (SLE) in a multisystemic autoimmune disease that specially affects young women during the second and third decade, and is able to injure different organs and or systems, being the most common one affected the musculoskeletal system.ObjectivesTo analyse the influence of the time of evolution and age of the patient in the current clinical manifestations and the debut of the disease in patients with SLE.MethodsCross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, coming from the Rheumatology Service of Arnau de Vilanova Hospital and La Fe Hospital. All patients had a complete blood-test with autoimmunity markers, and clinical, biometrics and treatment data were also collected from the personal interview and the medical history. Biostatistical analysis was performed using the R software version 3.2.3., using a simple, binomial and logistic lineal regression.ResultsA total of 140 patients were evaluated; of them, (95% were women) with 33.39±13.63 year-old average at the diagnosis time with a 10.05±11.42 year-evolution of SLE. We can find the clinical manifestations at the onset disease on the table.Onset manifestation(%)Onset manifestation(%)Musculoskeletal73.6Sjogren synd.2.9Skin39.3Raynaud's5Kidney5Other27.1Cytopenia7.9We observe statistically significant differences in the musculoskeletal system involvement (P=0.008), and in the presence of vasculitis (P=0.01) in patients with a shorter time of disease evolution. There is also a direct relationship between cardiovascular (P=0.002) and renal (P=0.03) affection in younger patients. Finally, cytopenias are correlated both in young patients (P=0.0009) as well as with a shorter time of evolution (P=0.02).ConclusionsWe observe a concordance between our SLE series and those already described at the literature, where renal involvement occurs at younger ages, and the musculoskeletal system involvement occurs early in disease or even as the onset symptom.Disclosure of InterestNone declared