No abstract

BackgroundDifferent studies and meta-analysis have shown that subclinical atherosclerosis (AS) and vascular complications (VC) are higher in patients with Systemic Sclerosis (SSc) than in healthy population. However, the relationship between macrovascular damage and microvascular affection has not been adequately studied by specific techniques such as capillaroscopy.ObjectivesTo explore the possible relation between several macrovascular disease variables (carotid doppler ultrasound, ankle-brachial index [ABI]) and capillaroscopy findings in patients with SSc.MethodsTransverse descriptive study with analytical components. Study population: a cohort of 115 patients with SSc controlled in the Rheumatology Department of a tertiary hospital. Variables: 1) clinical variables; 2) capillaroscopy study: findings of scleroderma pattern (megacapillaries, haemorrhages and avascular areas) and classification of evolving patterns according to Cutolo et. Al.; 3) vascular study: ankle-brachial index (ABI) and carotid doppler ultrasound (ESAOTE MyLab XV70, 7–12 MHz linear transducer, software RFQIMT) measuring intima-media thickness (IMT) and presence of atheroma plaques (Mannheim Consensus). A vascular surgeon measured ABI and the capillaroscopy and carotid doppler ultrasound were done by a highly experienced rheumatologist, blind to the rest of findings, in a term of 3 months after the initial evaluation. Statistical analysis: IBM-SPSS Statistics v22.0 package.Results115 patients where included consecutively, of which 108 were studied; with a mean age of 60,16 years (SD ±15.16); 99 women (91.7%) and 9 men (8.3%). Mean SSc evolution was 11.45 years (SD ±8.84). LSSc was most frequently diagnosed (50%), followed by SSc without scleroderma (18.5%) and, decreasingly, DSSc (16.7%), overlap syndrome (9.3%) and pre-SSc (5.6%). The mean right side IMT was 0,579 mm (SD ± 0,126), and the left side 0,657 mm (SD ± 0,158); 33,3% had atheroma plaques. In total, 37% had a pathological carotid ultrasound, and 39,8% had macrovascular damage (atheroma plaque and/or IMT >0,9 mm and/or ABI<0,9). In the capillaroscopy study, megacapillaries, haemorrhages and avascular areas were found in a 82,4%, 74,1% and 56,5% of patients, respectively. When re-classifying the findings according to Cutolo et al, 31,5% of patients showed an early pattern, 37% an active pattern and a 22,2% a late SSc pattern.In the bivariate analysis, the existence of macrovascular affection showed an association with a capillary pattern with more avascular areas and fewer megacapillaries. Statistically, this association was significant between the presence of avascular areas and the macrovascular damage (χ2=4,412; p-value = 0,036) and the pathological carotid ultrasound (χ2=4,107; p-value = 0,043) variables. A tendency towards an association between these last two macrovascular variables and capillaroscopy patterns of major microvascular damage was seen.ConclusionsNailfold capillaroscopy might be a useful tool to predict the presence of AS and macro vascular damage in patients with...

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

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

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