Background Interleukin 6 (IL6) has been associated with modified Rodnan Skin Score (mRSS), interstitial lung disease (ILD), anti-Scl70 and anti-RNA polymerase III antibodies, as well as with ischemic digital ulcers (IDU) and pulmonary hypertension (PH) in patients with Systemic Sclerosis (SSc). Objectives To evaluate the usefulness of determining plasma IL6 in patients with SS, as a marker of vascular disease. To investigate its association with other clinical manifestations and biological markers of SS. Methods Patients with Limited SSc (LSSc), Diffuse SSc (DSSc), overlap syndrome and early SSc (ESSc) were consecutively included in this descriptive and cross-sectional study. Serum IL6, biomarkers of disease activity and vascular risk, and autoantibodies were determined. Clinical history was reviewed. Clinical assessment was simultaneously performed, collecting: mRSS, finger flexion and extension, oral aperture measurement, capillaroscopic findings, sHAQ, and Cochin Hand Function Score. Afterward, a vascular surgeon, blinded to clinical findings, underwent ultrasonographic measurement of common carotid intima-media thickness (IMT) and recorded the presence of atheromatous plaques. SPSS Statistics 17.0 was used for data analysis. Spearman coefficient was used to assess the correlation between quantitative variables, and the non-parametric Mann-Whitney and Kruskal-Wallis test were used to compare quantitative and categorical variables. Qualitative variables were compared by means of the X2 statistic. Results A total of 47 patients were evaluated (29 LSSc, 8 DSSc, 2 ESSc, 8 overlap syndromes): 28% with history of IDU, 9% with PH, 40% with ILD, 12% with heart disease and 30% with gastrointestinal disease (GId). Most of them were female (90%), mean age: 56 years (SD=15), mean disease duration: 11 years (SD=9). The mean mRSS was 8 (SD=8). The mean IMT was 0.6 mm (SD=0.15), 11% of patients having carotid atheromatous plaques. Mean plasma concentrations of IL6 were 4 pg/mL (SD=4). IL6 concentrations showed a positive correlation with pulmonary artery systolic pressure (r=0.583), and were associated with the presence of avascular areas in capillaroscopy (p=0.001). No association was found with previous IDU or the presence of carotid atheromatous plaques, neither with the IMT. Regarding the rest of the variables, IL6 plasma levels showed a positive correlation with CRP (r=0.425), high-sensitivity CRP (r=0.455), fibrinogen (r=0.450), sHAQ (r = 0.449), and disease duration (r=0.434). A negative correlation was found with albumin (r=-0.629). IL6 plasma levels were also associated with GId (p=0.035), joint contractures (p=0.04) and anti Scl70 antibodies (p=0.002). However, IL6 plasma concentrations were lower in patients with anticentromere antibodies (p=0.01). Conclusions IL6 in SSc patients is a surrogate marker of inflammation and fibrosis, but can also be a marker of microvascular disease. These results should be taken into consideration when planning future clinical trials with IL6 as a therapeutic target for the trea...

Background Viral infections can cause inflammatory joint manifestations. Wide series regarding B19 Parvovirus have been published, but the arthritis secondary to Epstein - Barr virus (A-EBV), however, is infrequent and usually presents with multiple joint involvement during a systemic infection. Objectives To describe the epidemiological characteristics, clinical presentation and evolution of a series of patients with A-EBV. Methods Descriptive study of A-EBV cases diagnosed in our hospital in a 6-month period. In all cases, serological demonstration of EBV-IgM allowed us to confirm a recent viral infection. Clinical notes were reviewed to collect data in the virus presentation. Results Case 1: 27-year old woman with a 3-week history of progressive and asymmetrical oligoarthritis involving small joints and high levels of acute phase reactants. Treated with NSAIDs and corticosteroids. Clinical resolution within 3 months, with EBV-IgM clearance. Case 2: 54-year old woman with a 3-week history of progressive and symmetrical small joint polyarthritis. Treated with NSAIDs and corticosteroids. Persistence of symptoms, without EBV-IgM clearance, in spite of DMARD introduction. Case3: 32-year old woman with a 2-month history of progressive and symmetrical small joint polyarthritis, in association with a flu-like syndrome. Needed DMARDs because of the persistence of symptoms. EBV-IgM clearance within 5 months. Case 4: 37-year old woman with a 5-day evolution inflammatory polyarthralgia, associated with erythema, hypertransaminasemia and elevated acute phase reactants. Clinical resolution within 2 weeks. Awaiting check on EBV-IgM clearance. Conclusions A-EBV seems to affect young women preferably, with a seasonal predominance. It is not infrequent to find chronicity, which is associated with delay in specialist attendance. Given the possible relationship between Epstein-Barr virus and Rheumatoid Arthritis, we should not delay a DMARD treatment in those patients who develop chronic disease. Disclosure of Interest None Declared

Background Analysis of arterial stiffness is a good marker of early arterial disease, which also has a prognostic value. It can be determined in a simple, non-invasive and reproducible way through the pulse wave velocity (PWV), a measure that has been proved to be useful in the stratification of cardiovascular risk (CVR). Objectives To determine arterial stiffness by studying PWV in patients with rheumatoid arthritis (RA), and estimate its utility in CVR stratification in these patients. Methods 134 patients with RA were assessed over a period of one year, excluding those with high CVR (previous cardiovascular events, renal failure and/or diabetes mellitus). Gender, age, duration of RA, extra-articular disease, smoking habit, blood pressure (BP), RF and/or anti-CCP antibodies +, and atherogenic index were collected. These data were used to calculate the SCORE and mSCORE. An ultrasound (US) examination was performed with an Esaote MyLab 70 US system equipped with a linear probe (7- 12MHz) and an automated measurement of intima-media thickness (IMT) by radiofrequency (QIMT). IMT was measured in bilateral common carotid, and the presence of atherosclerotic plaques was recorded in the extracranial carotid arteries according to Mannheim Consensus. PWV measurement was performed using a Mobil O Graph device. Patients were classified as high CVR if the PWV≥10m/s (Mancia G, et al. J Hypertens 2013;31:1281-1357). Statistical analysis was performed using the SPSS 17.0 program. Results 75.4% of patients were female, the mean age was 60.36 years and 29.1% were smokers. The mean duration of RA was 17.18 years, 20.9% with extra-articular features. The percentage of patients classified as low CVR (mSCORE =0), medium (1≤mSCORE<5) high and very high (mSCORE≥5) was 23.9%, 65.8% and 10.3%, respectively. Plaques were found in 43.6% of the patients, the mean IMT being 0.74 mm. 16.2% of the patients had an IMT >0.9 mm. Patients with IMT>0.9mm and/or presence of plaque accounted for 46.2%. The average PWV was 8.84 m/s and 26.8% of the patients showed a PWV≥10m/s. 52 patients (46%) with mSCORE<5 had atheromatous plaques and/or IMT>0.9mm, and 25 (23.8%) had a PWV≥10m/s. PWV showed a correlation with mSCORE (r0.721, p 0.000) and pathological findings in carotid US (r 0.568, p 0.000). A composite gold standard for high CVR (mSCORE≥5 or mSCORE<5 with IMT>0.9 mm and/or plaque or PWV≥10m/s) was considered (Corrales A, et al. Ann Rheum Dis 2013, 72:1764-70) for the estimation of the sensitivity of the following models: Model Sensitivity Gold Standard n 63/113 mSCORE ≥5 19% (12/63) PWV ≥10m/s 52,4% (33/63) US abnormalities (IMT >0.9mm or atherosclerotic plaque) 77,8% (49/63) mSCORE ≥5 or mSCORE <5 and PWV≥10m/s 58,7% (52/63) mSCORE ≥5 or mSCORE <5 and US abnormalities 82,5% (37/63) Conclusions The sensitivity of the PWV is higher than that of the mSCORE, but lower than carotid US in estimating the CVR in patients with RA. However, it is a more fast, simple, objective and reproducible test and, therefore, can be a u...

Background Recently, a Spanish group[i] has proposed an algorithm that improves mSCORE estimation of cardiovascular risk (CVR) in patients with rheumatoid arthritis (RA), by adding the findings on carotid ultrasound (US). Objectives To estimate CV risk in our RA patients by combining mSCORE and the findings on carotid US (intima-media thickness [IMT] and/or atherosclerotic plaques). Methods A set of 188 patients with RA were assessed over a period of one year. Gender, age, duration of RA, extra-articular disease, smoking habit, blood pressure (BP), RF and/or anti-CCP antibodies +, and atherogenic index (AI) were collected. These data were used to calculate the SCORE and mSCORE. An ultrasound (US) examination was performed with an Esaote MyLab 70 US system equipped with a linear probe (7-12MHz) and an automated measurement of IMT by radiofrequency (QIMT). IMT was measured in bilateral common carotid, and the presence of atherosclerotic plaques was recorded in the extracranial carotid arteries according to Mannheim Consensus. Descriptive statistics were performed with the package SPSS 17.0. Results 188 patients were evaluated, of whom 39 were excluded for high CVR (previous cardiovascular events, renal failure and/or diabetes mellitus). 75.8% were women, the mean age was 60.05 years, and 30.9% were smokers. The mean duration of RA was 17.37 years. Anti-CCP antibodies or FR positivity were found in 66.7% and 73%, respectively. The mean BP was 130.5/80.57mmHg, and the mean AI was 3.84. The average SCORE was 1.84 and mSCORE was 2.40. The percentage of patients classified as low CVR (mSCORE=0), moderate (1≤mSCORE<5), high and very high (mSCORE≥5) was 25.6% (n=32), 64% (n=80), and 10.4% (n=13), respectively. The mean IMT was 0.73mm, and 15.2% of the patients had an IMT>0.9mm. Plaques were found in 43.2% of patients. Patients with IMT>0.9mm and/or presence of plaque accounted for 45.5%. Following the recommendations1, 40 patients classified as moderate risk (52.6%) were reclassified as high risk by the presence of one or both carotid abnormalities. Only one patient with low risk had a pathological US examination. Our patients, compared with a population of northern Spain1, had less plaques and/or IMT>0.9mm, despite being an older population with a higher percentage of males and smokers, having a longer history of illness, a higher presence of extra-articular involvement, a worse AI, and a higher average mSCORE. Conclusions Our results confirm that the CVR in RA patients is underestimated by the mSCORE and therefore, a carotid US examination is needed for the re-stratification of this risk. Compared with a population of northern Spain1, our patients have a lower vascular damage even though its clinical profile is theoretically less favorable from a CVR point of view. We could appeal to genetic or environmental factors such as diet to explain these differences. References Corrales A, et al. Ann Rheum Dis 2013 Mar 16[Epub ahead of print] Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eu...

Background Cochin Hand Function Score(CHFS) is a questionnaire proposed and validated by Poole JL et al(Arthritis Rheum 2004; 51:805-9), to measure the disability due to hand involvement in Systemic Sclerosis(SSc) patients. It includes 18 items, refering to personal hygiene, dressing, cooking, occupation and other tasks. Objectives To assess the CHFS applicability in spanish SSc patients, as well as its correlation with some clinical features, measurements and specific disease questionnaires. Methods Multicentric, descriptive and cross-sectional study with analytic components. SSc patients from two hospitals were assessed regarding hand disability by means of the CHFS. This questionnaire had previously been translated and adaptated to Spanish. Clinical assessment was simultaneously performed, and the next data were collected: age, time since SSc diagnosis, modified Rodnan skin score(mRSS), mRSS of fingers and hands, finger flexion and extension, digital ischemic ulcers(DIU), digital necrosis, amputations, calcinosis, tendon contractures and joint swelling of the hands. Global disability was assessed by the sHAQ and VAS of Raynaud(VAS-FRy) and DIU(VAS-DIU). In each hospital, patients were always evaluated by the same expert rheumatologist. SPSS Statistics 17.0 was used for data analysis, and percentages, means(SD) and medians(range) were assessed for describing variables. Pearson’s test was used to assess the correlation between CHFS and quantitative variables, and Spearman’s coefficient for the correlation between CHFS and qualitative variables, interpreted as excellent(>0.8), good(0.6-0.8), moderate(0.4-0.6), and poor(<0.4). Results A total of 56 patients were evaluated (51 female, 5 male; 40 lSSc, 16 dSSc; age and disease duration: 52±15, 11±9 years; 23% with DIU; 21% with joint swelling of the hands; 18% with finger contractures; 16% with hand calcinosis; 9% with digital necrosis; 2% with previous finger amputation). Mean total CHFS was 16.1 (dSSc:25.2, lSSc:12.2). Correlation between disease duration and total CHFS was good (r: 0.70), as well as it was with scores of its different domains, with the exception of “other tasks” (r: 0.48). Correlation between CHFS and total mRSS, mRSS of fingers, digital flexion, necrosis, calcinosis and joint contractures was only moderate, but it was good with hands’ mRSS, SHAQ, and both VAS (r: 0.678, 0.677, 0.619 and 0.7, respectively). When correlations were assessed separately for each type of SSc, it happened to be a very good correlation between CHFS and mRSS of the hands, SHAQ and both VAS (r: 0.82, 0.87, 0.89 and 0.93, respectively) in dSSc patientes. However, correlations between CHFS and mRSS were moderate or even poor in lSSc (though it was kept good for the SHAQ, r: 0.72). Conclusions The Spanish version of the CHFS is useful in spanish SSc patients, and mainly assesses hand disability related to the degree of skin involvement, specially in dSSc patients. A complete method of validation is needed to confirm these previous results. Disclosure of Interest None Dec...