Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes. 99mTc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P < 0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P < 0.005; OR = 3.4; 95% CI = 1.5-7.4). It is concluded that (a) abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.

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BackgroundA high prevalence of foot pain (70-90%) has been widely described in rheumatoid arthritis (RA) (1-4). Foot inflammation in RA usually starts in the metarsophalangeal (MTP) joints, extends to other joints with consequent pain, deformities and functional impairment (5, 6). The foot disorders and complaints it might have their origins in inflammatory disease activity or biomechanical abnormalities.ObjectivesThe objective of this cross-sectional prospective study was to establish what extend foot complaints in RA patients in remission or low disease activity may originate in subclinical inflammatory disease activity as opposed to podiatric biomechanical abnormalities.MethodsWe recruited 136 patients with foot complaints. Sixty-two were bDMARD-treated RA patients presenting DAS-determined remission or low disease activity while the remaining 74 were gender matched controls without rheumatic or muskoskeletal disorders. In an effort to identify the root cause of pain, we subjected both groups to a comprehensive podiatric and biomechanical assessment followed by an ultrasound (US) scan.ResultsMost RA patients and controls were female (77.4% and 83.8%, respectively). There was no statistical difference in the proportion of obese subjects in either group (p=0.792). Inappropriate shoes were used by 50.0% of RA patients and 33.8% of controls (p=0.080). Talalgia, particularly heel pain, was more frequent in the control group, with associated talalgia and metatarsalgia being more prevalent in the RA group (p<0.05). The RA patient group was also more likely to present greater foot deformity, more limited joint movement and foot pathologies than the controls. US inflammatory and structural changes were significantly more frequent in RA patients than in controls (p<0.05). US structural involvement was significantly associated with limited joint mobility and pathologic biomechanical tests only in RA patients (p<0.05).Figure 1.Transverse (A) and longitudinal (B) ultrasound image of tibialis posterior B-mode tenosynovitis and damage that shows hypoechoic sheath widening (s) and a peripherial tendon defect (d). mm, medial malleolus.ConclusionsRA foot pathologies often seem to be linked to disease activity and ultrasound can be useful to help the clinician differentiate disease-related foot pain from other possible biomechanical causes.ReferencesHooper L, et al. Arthritis Care Res.2012;64(8):1116-24.Rome K, et al. J Foot Ankle Res.2009;2:16.Rao S, Best Pract Res Clin Rheumatol 2012;26(3):345-68.Fuchs HA, et al. Arthritis Rheumatol.1989;32(5):531-7.van der Leeden M, et al. Rheumatology.2006;45(4):465-9.van der Leeden M, et al. Arthritis Res Ther.2010;12(1):R3.Disclosure of InterestNone declared

BackgroundPrimary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease with a substantial impact on patient's quality of life and associated comorbidities could worsen the prognosis and complicate the management of the disease.ObjectivesThe aim of our study was to describe comorbidities in a Spanish cohort os pSS patients.MethodsWe took advantage of a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American criteria. It is a randomised register of patients obtained from thirty three Reumathology clinics all over Spain. The presence of comorbidities was investigated in every patient. Previous informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75).ResultsA total of 437 patients were included, 95% of them women, with a median age of 58 years. Dyslipidemia was the most common comorbidity, appearing in 33% of the cases, with hypertension in second place with a prevalence of 25%. Osteoporosis was present in 18% of patients. Furthermore, 37 patients had at least an osteoporotic fracture. Seventy four patients had never smoked. Diabetes was present in 6% of cases. Less than 7% of the patients had some kind of cardiovascular event: 4 patients ischemic heart disease, 14 patients peripheral arterial disease and 15 patients strokes. Among patients with peripheral arterial disease, only one patient showed positive anti phospholipid antibodies. Thirteen patients (3%) had heart failure. Sixty four patients (14%) had fibromyalgia. Five patients (1%) had celiac disease and 2 (0.46%), multiple sclerosis. Seven lymphomas were observed, four of them MALT type and two Hogdkin's disease. Three patients developed multiple myeloma and two Waldenstrom's macroglobulinemia. Twenty one cases of other malignancy were registered.ConclusionsPrimary Sjögren's syndrome's patients frequently present associated comorbidities, been dyslipidemia, arterial hypertension and osteoporosis the most prevalent. Lymphoma prevalence rate for this series is 1,6 percent.Disclosure of InterestNone declared

Background Clinical manifestations, course and prognosis of idiopathic inflammatory myopathies (IIM) are extremely heterogeneous which, combined with its low prevalence, makes difficult the study of the disease in the absence of multicenter studies. Objectives To analyze the clinical characteristics and mortality in a cohort of patients diagnosed with IIM in rheumatology units from several hospitals in Madrid. Methods A multicenter retrospective longitudinal descriptive study of a cohort of patients diagnosed with IIM and in follow-up sometime between January 1980 and February 2013 in rheumatology from several hospitals in Madrid. All patients who met at least 2 criteria of Bohan and Peter1 for polymyositis (3 criteria if dermatomyositis) were included. We performed a descriptive study ot the initial cases recruited during the first months of the stuydy. All patients in current follow-up signed informed consent. Statistical analysis was performed using SPSS 11.5 for Windows, with a significance level of p<0.05. Results 127 cases were included in this study, with a 15% of patients lost to follow-up. There is a predominance of polymyositis over dermatomyositis (59.8% vs. 40.2% respectively). 74% of the cases were women, and patients had a medium age at diagnosis of 42.5±22.7 years, with a mean follow-up time of 76.8±70.8 months. Most of the cases were Caucasian (90.6% Caucasian, 7.9% Hispanic, 1.6% other). 97.6% met at least 3 criteria of Bohan and Peter. The most frequent form of classification were primary myopathies (47.6% primary myopathies, 26.2% myopathies associated with other connective tissue disease, 17.5% juvenile myopathies, 6.3% paraneoplastic myopathies, 1.6% inclusion body myopathies, and 0.8% necrotizing myopathies). Clinical manifestations associated with the disease included systemic manifestations (38.1%), joint manifestations (65.1%), skin manifestations (56.3%, the most frequent being Gottron sign) and interstitial lung disease (18.9%). EMG and muscle biopsy were performed in 96.1% and 66.9% and compatible with IIM in 92.6% and 77.6% of the cases respectively. 26 patients died (20.5%), mainly due to infections (26.9%), followed by cancer (19.2%), cardiovascular events (15.4%), interstitial lung disease (7.7%) and other causes. Conclusions In this retrospective, longitudinal study on idiopathic inflammatory myopathies followed-up in several hospitals inMadrid, 127 have been recruited for the moment. The most common subtype were primary myopathies (47.6%). 20.5% of patientsdied, mainly due to infections, followed by cancer, cardiovascular events, interstitial lung disease and other causes. More cases willbe included. References Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med 1975 Feb 13;292(7):344-7. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3732