Background The role of the nursing consultation in rheumatology is becoming more prevalent, especially in patient monitoring, reducing the burden of care of rheumatologists in many cases where in-person consultation with the rheumatologist is not required. Objectives To analyze the usefulness of telephone consultation to nursing staff to resolve doubts and/or health incidents to rheumatic patients and to assess the involvement of physicians on it. Methods We collected clinical data for the period between June 2012 and January 2013 of all telephone consultation received in the nursing department: clinical and laboratory data, number of calls, characteristics of the proposed consultation and its resolution, and involvement of the rheumatologist in consultations. Results We registered 122 telephone consultations, in which 77% of cases the nursing staff resolved the consultation (72% of them require the nurse consultant support by the rheumatologist) and in 88.5% of all consultations have required an additional call from the nursing. From the 23% of the queries unresolved by nurses (n=28), 19 cases required telephone consultation with the patient’s rheumatologist, and 7 cases were derived to an in-person appointment with the doctor (5 cases the rheumatologist, 1 to Emergency door and 1 to Primary Care). Patients who performed telephone consultations are mostly diagnosed as rheumatoid arthritis (40.2%), ankylosing spondylitis (13.1%) and systemic lupus erythematous (9.8%). 49.2% of the patients were treated with methotrexate, and 35.3% received biologic therapy. Consultations by patients are for different reasons, but the 22.9% of consultations were supply problems in medication, 19.7% were disease outbreaks and 9.8% to check analytical results. Conclusions Telephone consultation to nurse staff contributes greatly to answer questions from patients about disease outbreaks, as well as problems in treatment and/or analytical results, without the presence of the rheumatologist. It also prevents unnecessary movement of patients, reducing the number of telephone consultations and medical attendance, and helping manage health hospital resources effectively. Disclosure of Interest None Declared

BackgroundSystemic lupus erythematous (SLE) is an autoimmune disease characterised by deregulation of cytokine production. INF1A is a proinflamatory cytokine considered as a key molecule in the SLE etiopathogenesis, being responsible indirectly of IL10 upregulation. BLyS is involved in autoantibodies production and clinical activity in SLE, and its expression is regulated by other cytokines as IL10 and INF1A. IL2 is an anti-inflammatory cytokine in SLE, but its loss leads to the production of Th2 proinflammatory cytokines as IL4, IL5 and IL13.ObjectivesTo analyse the association among inflammatory cytokine levels and clinical activity, as well as to identify a cytokine profile related to disease activity in SLE.MethodsA cross-sectional, observational study of 142 patients diagnosed of SLESLICC 2012 criteria), and 35 healthy controls, was performed. A complete blood-test and an interview were carried out to collect their clinical data. We analysed inflammatory cytokines serum levels by colorimetric methods. Biostatistical analysis with R was performed.ResultsMean cytokine levels for the SLE patients and healthy controls are shown in the table 1.Abstract AB0058 – Table 1SLE patients (pg/mL)Mean (SD)Healthy controls (pg/mL)Mean (SD) IL24.34 (12.2)4,964,5IL458.65 (64.6)89,0570,18IL518 (5.71)7,338,59IL1012.29 (32.82)1,923,67IL1344.97 (273.78)42,8593,05IL213.18 (5.61)2,823,35INF1A15.69 (24.59)4,841,91BLyS2293.82 (6948.46)1181,15260,04The mean clinical activity measured by SLEDAI was 5.91±5.06, and we observed a statistically significant association between high levels of IL10 and high clinical activity (p=0.001).Statistical analysis indicates that complement consumption is associated with increased levels of IL10 (p=0.029), INF1A (p<0.001), IL4 (p=0.004), IL5 (p=0.009) and decreased levels of IL2 (p=0.045),; or anti-DNA positivity is associated with increased levels of INF1A (p=0.002) and decreased levels of IL2 (p=0.045), IL4 (p=0.034) and IL5 (p=0.007).Moreover, BLyS seems to have increased in patients with positive antiphospholipid antibodies and anti-DNA. IL10 is associated with ENAs positivity (p=0.022). In patients with other autoimmune disease associated with SLE, an increase of INF1A (p=0.008) and IL5 (p=0.044) is observed.SLE patients were categorised by normal, low or high level of the eight citokines. Despite the fact that no specific cytokine profile associated with clinical activity was observed, those patients with high SLEDAI score had increased levels of IL10 and INF1A and decreased levels of IL2 and IL21.ConclusionsOur SLE patients displayed mainly IL10, INF1A and BLyS increased, and IL2 decreased. Although IL10 seems to be the cytokine which best fits to clinical activity in SLE, altered levels of INF1A, IL2, IL4, and IL5 are associated with complement consumption or anti-DNA positivity.Disclosure of InterestNone declared

BackgroundPregnancy in rheumatic diseases is a process that requires careful handling, beginning with proper planning. Infertility and chronic use of teratogenic drugs are some common situations in these patients, giving them a high-risk obstetrics.ObjectivesTo established a protocol for planning and monitoring pregnancies in patients with rheumatic diseasesMethodsRetrospective review of a follow-up protocol for patients with rheumatic diseases and pregnancy wishes. This protocol includes: preconception consultation to asses fertility of the couple, as well as pregnancy couselling and establishment of a appropriate pharmacological treatment; after pregnancy period start, monthly consultations by a multidisciplinary team; and finally, a postpartum consultation after deliveryResultsA total of 51 patient with different rheumatic diseases were included: Sistemic Lupus Erythematosus (8 patients), Sjogren'S Syndrom (10 patients), Rheumatoid arthritis (13 patients), Psoriatic arthritis (5 patients), Behcet's disease (3 patients), Spondiloarthritis (2 patients), Familial Mediterranean Fever (2 patients), Conective mixed Tissues Disease (1 patient), Primary Antiphospholipi Syndrom (2 patient) an Hyper IgD Syndrome (1 patient). The results were: Infertility was detected in 8 couples and assisted reproductive techniques was requieres in 7 (6 IVF and 1 insemination). Safe Pharmacological treatments were used: sulfasalazine (4), hydroxychloroquine (13), azathioprine (2). Biological DMARDs in 3 patients (1 infliximab and Certlizumab in 2). Other treatments were: steroids (12) and intravenosus immunoglobulins for fetal heart block (2). All patients with thrombophilia have been treated with LMWH alone or plus aspirin. The course of pregnancy was:delivery at term (28), delivery pre-term (3)**, miscariages (3)*, pregnancy on course (7), neonatal death (1) and 8 patients are plannig the pregnancy. The abortions have occurred in 2 patients with lupus erythematosus and in 1 patient with rheumatoid arthritis. Postpartum care of newborns with mothers with positivity anti-Ro has objectified a neonatal transfer of Acs in 100% of cases;only 8 of them developed neonatal SLE.ConclusionsA satisfactory evolution of pregnancy was observed in 87% of our patients, a fact that supports our impression that this process should be approached in a multidisciplinary team. Infertility is a situation that should be considered and treated at an early stage in this patients, preferably before preconceptional period.Disclosure of InterestNone declared

Background The identification of individuals with primary Raynaud’s likely to develop scleroderma or other connective tissue diseases is of great importance in order to have an early control and therapeutic management of the disease, with great influence on the patient’s prognosis. The most appropriate methodology for this would be the capillaroscopy, as it is an affordable, non-invasive and easy to use method. Objectives Evaluate the correlation between clinical diagnosis and capillaroscopic pattern in patients with Raynaud’s phenomenon both primary and secondary. Methods We performed a descriptive observational study comprising 116 capillaroscopies performed in the H.U.P. La Fe in 2012. All were conducted on patients with Raynaud’s phenomenon both primary and secondary. Rheumatologists ignored the clinical diagnosis for each case and based on observed characteristics a capillaroscopic pattern was assigned to each patient. We performed a biostatistical analysis using multinomial logistic regression model in order to estimate the likelihood of each diagnosis based on a given capillaroscopic pattern. Results The results obtained in the capillaroscopies are: heterogeneous capillary disposition (30%); visible venous plexus (44%) maintained capillary density (78%), decreased (15%), greatly decreased (7%); elongated capillary morphology (24%), lack of dilatation (22%), isolated dilatation (40%), diffuse dilatation (38%); existence of megacapillaries (28%); existence of bleeding (56%), presence of avascular areas (8%), absence of windings (10%), presence of grade I tortuosities (29%), grade II (38%), grade III (22%); angiogenesis (47%). According to these results the patients were classified according to the capillaroscopic pattern and clinical diagnosis. See Table 1. Conclusions Our results showed that a high percentage of cases with a regular capillaroscopic pattern had a high probability of presenting/displaying Primary Raynaud’s diagnosis. Thus, capillaroscopy could be useful in primary Raynaud’s discrimination based on the pattern found. Disclosure of Interest None Declared

Background In March 2012, a new project was started in the HUP La Fe, following the pilot project performed in San Carlos Clinical Hospital in Madrid, where patients off work for musculoskeletal causes were referred to us from Primary Care. Objectives The aim of the study is to analyze the variation in days off work in those individuals included in this program with respect to the normal average of days off. Methods Cohort, observational, cross-sectional study from April to December 2012, which included patients from the HUP La Fe area, for the first time referred to the Rheumatology Early Intervention consultation because of temporary disability due to musculoskeletal origin. These patients are referred to medical appointment with a maximum waiting time of one week and were provided of medical treatment, ultrasound articular injections and directed exercises if needed. The patient is reviewed continuously until discharge. We excluded patients whose disabilities were traumatic or surgical, or their situation can cause a permanent disability. Results We included a total of 116 patients with a mean age of 49 years and 58% were women. The most frequently reported diseases were: back pain (34%), neck pain (12%), shoulder pain syndrome (9%) and other tendinopathies (10%). The 44.8% of cases had a history of sick leave. 100% of the patients received medical treatment, 31% underwent articular ultrasound, 25% of them with infiltration and 61% were trained to perform physical therapy exercises at home. The pathology that had a higher average number of days from the first visit to the medical discharge were lumbociatalgia (34 days), neck pain (21 days), painful shoulder syndrome (17 days) and low back pain (14 days). Comparing these data with the population controlled pilot study there is a decrease of the days off, being in the control group lumbociatalgia (57.6 days), neck (37.4 days), back pain (34.5 days) and tendinitis (36.7 days). Conclusions Preliminary results obtained in our study show that early intervention by rheumatologists in patients with temporary incapacity pathology with musculoskeletal origin decreases the number of days off work, compared to patients treated regularly, and can incorporate to work early and consequently, save all costs resulting from such temporary disability. Disclosure of Interest None Declared