The most frequently requested professional service was the dispensing service, mainly for treating throat symptoms. Community pharmacists play a major role in managing patients with an oropharyngeal condition. They can keep them out of general practice or act as referral agents when a more severe disease is identified.

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

A493literature review was performed to identify relevant randomized controlled trials (RCTs). Data were extracted on study design and patient characteristics. Endpoints concerning efficacy were evaluated using network meta-analyses. Clinical response was defined as a decrease in Mayo score of ≥ 30% and ≥ 3 points, accompanied by a decrease in rectal bleeding score of ≥ 1 point or rectal bleeding score of 0 or 1. Clinical remission was defined as a total Mayo score of 2 points or lower, with no individual subscore exceeding 1 point. Mucosal healing was defined as absolute subscore for endoscopy of 0 or 1. Bayesian network meta-analyses (NMA) were conducted to evaluate each efficacy endpoint for TNF-naïve patients at the end of induction. All analyses were conducted using the OpenBUGS software package. Results: Six RCTs were identified from the literature. Similar clinical response was observed between the IFX and GOL treatment regimens (IFX 5mg:

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

BackgroundB lymphocyte stimulator factor (BLyS) is produced by wide range of cells of the immune system, and has proven to be a key factor in the selection and survival of B cells. BLyS is an important factor in the pathology of Systemic Lupus Erythematosus; elevated serum levels (≥20ng/mL) of soluble BlyS are at increased risk of flare.ObjectivesAnalyze the association among BLyS levels and clinical manifestations, as well as with SLE clinical activity.MethodsA cross-sectional and observational study was performed in patients diagnosed of SLE according to SLICC 2012 criteria and healthy controls. The study included a complete blood-test and clinical data collected by personal interview. Disease activity assessment was made by SLEDAI index and for the evaluation of chronic damage we used the validated SLICC damage index. Serum concentration of BLyS was analyzed by colorimetric methods. Lupus patients were dichotomized as high and low BLyS levels based on BLyS levels above 2 SD of the mean in healthy controls. Biostatistical analysis with R (3.3.2.) was performed.ResultsTwo hundred forty-two SLE patients were evaluated; 94.4% of them were female. Mean values were as follow: age at diagnosis 33.29±13.53 years, disease duration 15.82±10.56 years, SLEDAI 5.91±5.06, SLICC score 1.06±1.42, BLyS levels 1.811±1.757 ng/mL. The 22.5% of patients displayed increased BLyS levels. The 29.6% of total patients exhibit SLEDAI values up to 6, and only the 7% of them showed SLEDAI values up to 6 and high BLyS levels simultaneously. Higher BLyS levels were significantly correlated to the ANAs positivity (p=0.0006) and lymphopenia (p=0.01) but showed no correlation with hypocomplementemia neither anti-dsDNA. The statistical analysis did not yield differences in the clinical activity or accumulated damage between patients with lower and higher BLyS levels.ConclusionsIn our series we observed a 22.5% of patients with high levels of BLyS, and the 7% of cases had BLyS high levels and SLEDAI>6. BLyS upregulation is related to ANAs positivity and lymphopenia. We have found no statistical evidences on the relationship of BLyS levels and clinical activity in our series of patients.Disclosure of InterestNone declared