Background The diagnostic and therapeutic management of patients with joint pathology in the emergency department often includes the need for joint punctures. On the other hand, anticoagulant therapy often generates resistance to perform these procedures because of the risk of bleeding. This resistance is a major obstacle when assessing or treating joint complains considering that it is estimated that about 12 per 1000 people in Spain are receiving oral anticoagulants. This resistance, however, does not seem to be supported by the few studies conducted with warfarin, however it conditions a delayed diagnosis with a potential risk of irreparable joint damage or serious complications. No studies have been conducted to measure this risk in patients using acenocoumarol. Objectives The purpose of this study is to determine the rate of bleeding complications in patients anticoagulated with acenocoumarol according to the international normalized ratio (INR) index of coagulation. Methods A retrospective study was performed with 901 records of patients who underwent a puncture joint from 2009 to 2013. Records were grouped on the basis of having INR index higher or lower than 2.0 (268 and 633 records, respectively). The rate of bleeding complications was performed using chi-square test. Results A 0.37% rate of early bleeding complications (<24 hours) in the group of patients with INR <2 and a rate of 0.99% in the group of patients with INR > or =2 was observed (p=0.47). Only one case of tardive bleeding complication was detected (between 24 hours and 30 days) in the group of patients with INR > or =2. A need for medical reassessment due to pain was observed in 5.22% of patients with INR <2 and 3.44% of patients with INR > or =2 (p>0.05). Conclusions This is, to our knowledge, the first study aimed at determining the presence of complications related to joint puncture in anticoagulated patients with acenocoumarol according to the INR index. Based on our results we consider that the use of acenocoumarol at therapeutic doses not mean an increased risk of bleeding when performing arthrocentesis or joint infiltration and therefore delay these procedures until reversion of the INR is an unnecessary behavior. The few available studies, conducted with warfarin agree that there are no statistically significant differences in the rate of bleeding complications according to the INR at the time of the procedure. The results of our study are consistent with those obtained by Ahmed et al. (Am J Med 2012; 125[3]:265-9) in terms of early and late bleeding complications in warfarin users, however, in our study consultation motivated by pain was much higher in both groups. This increase could be explained by the fact that a significant proportion of patients whose records were included came from an area where access to emergency reassessments are relatively easy. Thumboo et al. (Arthritis Rheum 1998; 41[4]:736-9) and Salvati et al. (Reumatismo. 2003; 55[3]:159-63) published similar prospectives studies with smaller sample sizes, ho...

BackgroundBehçet’s disease (BD) is a chronic and recurrent inflammatory disease of unknown etiology, classified into polygenic autoinflammatory diseases or variable vessel vasculitis. It has a wide spectrum of symptoms with a very variable range of severity, from mucocutaneous involvement to neurological manifestations, systemic vascular or severe ocular manifestations. About 5.4%–7.6% of Behçet’s cases have a paediatric debut.ObjectivesTo evaluate and compare the clinical and laboratory manifestations of a series of 52 patients, adults and children, diagnosed with BD according to the classification criteria of the International Study Group of BD (ISGBD-1990).MethodsRetrospective cross-sectional observational study, which included 43 adult patients and 9 paediatric patients diagnosed with EB in the Rheumatology Department of a Madrid tertiary hospital. The clinical-analytical characteristics of both groups were evaluated, as well as the correlation of HLA-B51 with the described symptomatology.ResultsThe mean age at diagnosis of BD was 36.9±11.8 years in adults and 11.4±5.1 years in children. 27.3% of adults and 11.1% of children with BD were male, with oral ulcers close to 90% in both groups. Contrary to what was reported in other series, genital ulcers were more frequent in children (77.8% versus 65.9% of adults), as was the presence of uveitis (44.4% in children compared to 22.7% in adults) and neurological manifestations (22.2% in children versus 6.8% in adults). Joint involvement was also more frequent in children (88.9% versus 52.3% in adults), as well as fever (44% in children versus 14% in adults); being these two manifestations the only parameters that were associated in a statistically significant way with their presentation in the paediatric age in BD. In contrast, skin involvement and vascular manifestations were more frequent in adults. The positivity of HLA-B51 did not correlate statistically with any clinical manifestation, but those who had it had a mean age at diagnosis of 26.5 years compared to a mean of 39 years in those who did not present this genetic marker.ConclusionsBehçet’s disease presents with a wide spectrum of clinical manifestations, potentially serious, ranging from skin lesions to neurological or vascular manifestations. In our series, patients diagnosed at paediatric age most frequently had systemic manifestations (fever), arthritis or severe clinical manifestations such as neurological involvement or uveitis. Limitations: a small number of paediatric cases included in our study.Disclosure of InterestNone declared

Background Generally, early mobilization in patients with subacromial shoulder tendinitis has shown a benefit in terms of recovery of function. By their nature, subacromial acute calcifying tendinitis might be an exception, however there are no studies that have compared the mobilization with rest or sling use in such patients. Objectives To compare benefits of early movement and rest with sling in patients diagnosed by acute subacromial calcifying tendinitis. Methods We reviewed the clinical chart of patients with acute subacromial calcifying tendinitis of three different centers that carry on a similar management of this patology. This protocol includes radiological, ultrasound diagnosis and eventually the realization of infiltration of glucocorticoid assisted real-time ultrasound. Patients were classified in cases (patients without symptomatic improvement) and controls (patients with satisfactory symptoms control defined by its reincorporation to normal activity). We used as cutoff time: 30 days after diagnosis ±10 days. We evaluated the exposure to immobilization with a sling at least 12 hours per day. No patient had been infiltrated with glucocorticoids. All patients were diagnosed with ultrasound or radiology of shoulder and all were treated with NSAIDs and/or opioids. Results One hundred twenty subacromial acute calcifying tendinitis diagnosis were established between 2011 and 2013, of which 77 were included for presenting baseline data and control at one month. Their corresponding medical records were reviewed and grouped according to clinical outcome once made the corresponding review. Thirty patients (38.9%) were considered as cases (no improvement) and 47 (61.1%) were considered controls (return to normal activity). The gender ratio and mean age of the two groups was similar. The proportion of patients receiving NSAIDs, NSAIDs and opioids or opioids alone was similar in the two groups. Twenty-four cases had used the sling according to indication (51.06%) while 23 had not used or had used less than half the time indicated (48.94%). Furthermore, 24 controls had used the sling (80.0%) while 6 (20.0%), no (p value =0.0154 bilateral, Fisher). Conclusions Immobilization with sling appears to be associated with better clinical response in the acute management of subacromial calcifying tendinitis. Although early mobilization in other forms of tendinitis of the shoulder is fairly widespread, inflammatory pathophysiology of calcifying tendinitis, secondary to a mechanical phenomenon of subacromial entrapment, could justify that early mobilization play a deleterious role in the rehabilitation of these patients and it would therefore be inadvisable. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5911

BackgroundSharp described Mixed Connective Tissue Disease (MCTD) in 19721. MCTD is characterised by the presence of Raynaud phenomenon, puffy hands, synovitis, acrosclerosis, myositis and positive anti-ribonucleoprotein (RNP) antibodies. Classification criteria for MCTD except for Kasukawa's criteria demand the presence of high titres of anti-RNP antibodies (measured by hemagglutination). As a result, the cut-point between low and high anti-RNP titres must be well defined. In best of our knowledge, this cut-point have not been established for modern laboratory techniques.ObjectivesDeterminate a cut-point between low/high anti-RNP titles measured by ELISA, for the diagnosis of Mixed Connective Tissue disease. Describe the clinical and immunological characteristics of patients with positive titres of anti-RNP antibodies.MethodsIt was a Retrospective cohort study of patients with positive anti-RNP antibodies (>10) measured by ELISA. We had identified all patients with positive antiRNP antibodies titres in the last five years, using our laboratory base date. Clinical histories were reviewed, we recollected clinical and paraclinical data. We performed descriptive analysis and ROC curves for diagnostic tests with STATA software.ResultsWe detected 75 patients with positive antiRNP antibodies, we obtained 65 clinical records. 89,23% (58) of patients were women and 10,77% (7) men. The mean age at diagnosis was 45,01 years (SD 16,71 ± years), The median of tracing was seven yeas (P25 de four years/P75 de 14 years). The mean initial antiRNP titre was 239,33 the median was 144 (P25 58/P75 400). The initial diagnosis were Mixed Connective Tissue Disease 6,25% (4), Undifferentiated Connective Tissue Disease 31,25% (20), systemic erythematosus lupus 45,31% (29) and Others 14,06% (9). MCTD diagnosis was made in 29,69% (19) of patients at the end of follow-up. Patients with MCTD as final diagnosis presented in their first visit Raynaud phenomenon 73,68% (14), puffy hands 31,58% (5), acrosclerosis 10,56% (2), myositis 21,05% (4), Arthralgias 68,42% (13), arthritis 57,89% (11), Pulmonary arterial hypertension 5,26% and Interstitial lung disease 10,53% (2). The initial RNP titre was evaluated using the number of times over the laboratory cut point. The area under the ROC curve for the initial RNP was 0,70. Looking for the highest specificity with and adequate sensitivity, we selected the cut-point with highest LR +. The selected cut-point was ≥24,4 times the laboratory cut-point, with s specificity of 77,78 and a sensitivity of 57,89.ConclusionsThe cut-point for low/high RNP titres measured by ELISA in our cohort of patients with MCTD as a final diagnosis was ≥24,4 times the laboratory cut-point.References Sharp GC, Irvin WS, Tan EM, Gould RG, Holman HR. Mixed connective tissue disease–an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med. 1972 Feb;52(2):148–59.Amigues JM1, Cantagrel A, Abbal M, Mazieres B. Comparative study of 4 diagnosis criteria sets...