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

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

Background:Apremilast (APR), a small molecule inhibitor of phosphodiestersa-4, has been shown to be effective in the treatment of oral and genital ulcers in Behçet’s disease (BD). BD is a systemic vasculitis with great heterogeneity of symptoms and manifestations. It can affect the blood vessels, mucosa, skin, joints, eyes, nervous system and digestive system. APR is indicated for treatment of oral ulcers in BD in some countries such as the USA and Japan.Objectives:To evaluate the efficacy and safety of APR treatment in BD patients.Methods:Single-center descriptive study of BD patients on APR treatment from February 2017 to December 2019. Demographic, clinical and analytical data were collected.Results:10 patients (9 women) were included, with a mean age at the beginning of APR treatment of 37±12 years and a mean disease evolution of 100±105 months. 8 of them showed HLAB51 positivity.Before treatment with APR, 4 patients were refractory to DMARDs (2 MTX, 2 AZA) and one patient to 2 anti-TNF (ADA, IFX). All patients were under treatment with colchicine and 5 with steroids before APR therapy. The concomitant treatment with APR were: corticosteroids (5), NSAIDs (2), colchicine (8), MTX (2), AZA (2).The main symptoms at the beginning of the APR treatment were: oral ulcers (100%), genital ulcers (60%) and arthritis/arthralgia (90%). We observed a clinical improvement after 3 months of treatment of 90% of oral ulcers, 100% of genitals and 55% of joint symptoms. The patients had a mean follow-up of 37±12 months and they maintain the therapy response during the APR treatment.Patients presented adverse events, some of them transitory: headache (5), diarrhea (5), nausea (3), dysthymia (1), tremors (2), herpes zoster (1) and autolytic ideation (1). The treatment was withdrawn in 4 patients with a mean duration of 11 ± 13 months. 2 of the 4 adverse events were by autolytic ideation and nausea, 1 for genesic desire and 1 for persistence of joint injury. The APR doses were reduced to 30 mg per day in 4 patients, resolving the adverse events and persisting with a good response. In addition, dose reduction of colchicine and prednisone was achieved in 4 patients.We observed other previous manifestations of BD such as uveitis (4), neurobehçet (3), cutaneous (folliculitis/pseudofoliculits) (4) and venous thrombosis (1). Cutaneous manifestations were resolved and the rest of previous manifestations remain without clinical changes during the follow-up.Conclusion:We observed an improvement in the most common manifestations of BD and a safety profile similar to those described in other studies. We observed a resolution of mucocutaneous manifestations, a variable response in joint manifestations and stability in neurological manifestations. Adverse effects referred included gastrointestinal and headache, most of which were transient and were resolved with adjustment of treatment.Disclosure of Interests:None declared

Background:Rhupus syndrome (RhS) is a rare combination of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Different studies describe RhS cases that begin with erosive arthritis and the presence of rheumatoid factor (RF) and/or anti CCP and then the SLE symptoms.Objectives:Despite the fact that RhS shows a low prevalence, it would be useful to know clinical characteristics of RhS patients since their therapy and outcome differ from those having RA or SLE alone.Methods:Retrospective study with systematic revision of electronic clinical records of RhS patients was performed. Demographic, clinical and immunological data were collected.Results:Eight RhS patients were included (all fulfilled SLICC 2012 criteria for SLE and ACR 2010 for RA). Mean age was 67.3 (45-84) years (7 were female).In 3 cases RA was the first diagnosis with a mean evolution of 4.5 years until SLE diagnosis. In contrast, in 5 cases SLE was the first diagnosis with a mean evolution of 7.2 years until RA diagnosis. Photosensitivity and arthritis were the predominant clinical manifestations. One patient presents pericarditis and other case showed rheumatoid nodules in elbows. Renal, pulmonary or neurological affection was no reported.4 patients were under biological/JAK inhibitors therapies (2 abatacept, 1 rituximab and 1 baricitinib) with favorable response of treatment.Conclusion:In contrast to other series, only the 37.5% of our RhS cases begins with polyarticular seropositive arthritis. The 62.5% started with SLE symptoms as haematological alterations, cutaneous and serological manifestation, and showed longer progression to have polyarticular affection. Thus, RhS diagnosis is earlier in patients that begin with RA symptoms. 4 RhS patients were refractory to DMARd treatments, where biological/JAK inhibitors therapies are needed.Disclosure of Interests:None declared

Background:Systemic Sclerosis (SSc) is an autoinmune disease that can affect several organs and its mortality is fundamentally related to its pulmonary involvement.It is mandatory to seek for biomarkers that help us with early diagnosis and that are also useful for predicting organic involvement, so that we can adjust the diagnostic and therapeutic approach.Objectives:Our aim was to check if the presence of CXCL4, CXCL8 and GDF-15 is greater in the disease than in healthy population, and also their involvement in organic damage.Methods:Observational and cross-sectional study, with a prospectively performed protocol, of patients diagnosed of SSc according to ACR/EULAR 2013 criteria. Demographic, clinical, analytical, activity (EUSTAR index), severity (Medsger scale and modified Rodnan index), health perception (SF36) and disability (HAQ and Cochin test) variables were collected. Moreover, Videocapillaroscopy (VCL) and Respiratory Function Test were made, as well High Resolution Lung Tomography and Echocardiography in order to describe pulmonary features. Serum levels of CXCL4, CXCL8 and GDF-15 were measured in SSc patients and in healthy controls.Results:A total of 42 patients (95.4% women) were included, with an average age of 59.2 years. The median of years since diagnosis was 4, by 6 since the first non-Raynaud symptom. 20 patients were diagnosed with limited SSc, 20 patients diffusely and 2 patients with SSc without scleroderma. 42 healthy controls were also included.We found significantly higher levels of GDF-15 in patients with SSc (P<0.001), without significant differences in CXCL4 and CXCL8 levels between patients with SSc and healthy controls.The presence of GDF-15 was associated with diffuse SSc (P=0.009), pulmonary arterial hypertension (P=0.038), interstitial lung disease (P=0.004), decreased forced vital capacity (FVC), (P=0.002), high serum titles of antiScl70 (P=0.006), increased disease activity measured by EUSTAR index (P=0.001), as with capillary dilations in Capillaroscopy (P=0.015).Moreover, we found an association between CXCL4 levels and the consumption of complement C3 fraction (P=0.008) and skin involvement (higher Rodnan modified score), (P = 0.001); not finding association with lung involvement or other features (spirometric or analytical changes, capillaroscopy or functional tests).Attending to CXCL8, it was associated to consumption of the C4 fraction of complement (P=0.013) and the presence of tortuosities in capillaroscopy (P=0.02) with no other significant findings.Conclusion:The presence of GDF-15 is associated with diffuse SSc, lung impairment, disease activity and changes in capillaroscopy. In addition, CXCL4 was only associated with skin involvement, while CXCL8 was not related to any organic damage in our patients.Disclosure of Interests:None declared