ResumenObjetivosEvaluar la prevalencia, severidad y factores de riesgo asociados a la retinopatía diabética (RD) en Cantabria.DiseñoEstudio transversal de base poblacional.EmplazamientoCentro de salud de Cantabria.ParticipantesMuestra aleatoria de 442 pacientes con diabetes mellitus tipo 2.Mediciones principalesRetinografía no midriática, clasificándolas según la International Clinical Diabetic Retinopathy Disease Severity Scale. Los factores de riesgo estudiados: edad, sexo, edad diagnóstico, años de evolución de la diabetes, grado de control glucémico (HbA1c), tratamiento de la diabetes, control de la tensión arterial, control lipídico, obesidad, tabaquismo, hematocrito bajo, embarazo, déficit de vitamina D, nefropatía y eventos cardiovasculares.ResultadosPrevalencia de RD del 8,56% (IC: 5,81-11,32). RD no proliferativa leve: 5,07% (IC: 2,89-7,25); RD no proliferativa moderada: 1,38% (IC: 0,17-2,60); RD no proliferativa severa: 0,27% (IC: 0,006-1,28); RD proliferativa: 1,84% (IC: 0,46-3,22); edema macular diabético: 2,30% (IC: 0,77-3,83). Edad media: 70 años, edad de diagnóstico 58,97 años; índice de masa corporal 29,86; hipertensos 78,40%; dislipidemia 67,30% y HbA1c mediana 6,76%. El déficit de 25 (OH) D fue del 77%. En el análisis multivariante los factores independientes fueron tratamiento de la diabetes mellitus tipo 2, índice de masa corporal, años de evolución y control de la diabetes.ConclusionesLa prevalencia de RD ha disminuido hasta el 8,56%; esta disminución se asocia a la mejora en el control de los factores de riesgo modificables. Los factores de riesgo asociados de forma independiente fueron: tratamiento, índice de masa corporal, años de evolución y control de la diabetes. Las variables control hipertensión arterial, eventos cardiovasculares y nefropatía también mostraron capacidad predictiva para la RD.

Objectives To assess the efficacy and safety of anti-TNFα drugs in refractory uveitis to conventional synthetic immunosuppressive drugs (CSISDs). Methods Study of refractory uveitis from a single Universitary hospital who had failed to at least one CSISD. The degree of ocular inflammation was established according to SUN-2005. Macular thickness was evaluated by OCT. We compared data between baseline 1st month, and 1st, 2nd, 3rd and 4th year (Wilcoxon test). Results We studied 40 adult patients/62 affected eyes (16 men/24 women); mean age, 39.3±11.5 years. The underlying pathologies were Spondyloarthritis-HLA-B27+ (n=7), Behçet disease (n=6), sarcoidosis (n=6), VKH (n=2), Birdshot (n=1), serpinginous (n=1), sympathic opthalmopathy (n=1), Juvenile Idiopathic Arthritis (n=1) and idiopathic uveitis (n=15). Besides oral corticosteroids and before anti-TNFα, patients had received methylprednisolone i.v. (n=9), methotrexate (n=16), cyclosporine A (n=13) and azathioprine (n=10). The first anti-TNFα was: adalimumab (n=18; 45%) (40 mg/sc/2 weeks) and infliximab (n=22; 55%) (5 mg/kg/i.v./every 4-8 weeks. Anti-TNFα drugs were used as monotherapy (n=8), or combined with methotrexate (n=18), azathioprine (n=10), Cyclosporine A (n=3) and salazopyrine (n=1). Adalimumab was switched to golimumab (50 mg/sc/week) (n=2) and to tocilizumab (n=2). Infliximab was switched to adalimumab (n=8) and to golimumab (n=2). Visual acuity (VA), Tyndall, vitritis and OCT experienced significant improvement at the 1st month, and 1st, 2nd and 3rd year. The mean OCT in cases of cystoid macular edema (OCT>300 μ) (n=11 eyes) improved from 382.2±98.4 (baseline) to 195.5±38.9 microns (1st year). After a mean follow-up of 40.7±25 months anti-TNFα drugs was well tolerated in most cases. The most important side effects were pulmonary TBC (n=1), herpes zoster (n=2), urinary tract infection (n=3) and elevation of liver enzymes during treatment (n=2). Conclusions Anti-TNFα therapy seems effective and relatively safe in refractory uveitis. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3369

Objectives Syphilitic Uveitis (SU) may be the first manifestation of syphilis. SU may be indistinguishable morphologically from other etiologies causing uveitis. Our aim was to study and describe the SU as first manifestation of syphilis. Methods We describe 11 patients with SU diagnosed at our Hospital from 2006 to 2013. Diagnosis was based on active uveitis and specific microbiological test. To evaluate neurological involvement, a lumbar puncture was performed in 9 patients. Results Eleven patients (3 women/8 men) with a mean age of 45.8±13.8 years (range 26 -70) were diagnosed as having SU. First syphilitic manifestation was uveitis (n=9) and mucocutaneous lesions (n=2). The pattern of uveitis were: posterior (n=6), panuveitis (n=3), and anterior (n=2). Ocular involvement was unilateral (n=8) and bilateral (n=3). The median diagnostic delay was 0,75 months (IQR 0-2) (range 0-12). Positive serology of HIV (n=3) and neurosyphilis (n=2) were observed. Treatment was based on penicillin G (4 million-units/4h/i.v.) for 14 days (n=8) and for 21 days (n=2), and doxicillin 100 mg/12h for 28 days, because of allergic condition (n=1). We had a relapse in one case treated initially with benzathine penicillin/1.2 MU/i.m x 3 day, and then with penicillin G 4MU/4h ev x 21 days. The median of visual acuity improved from 0,1 (IQR 0,05-0,3; range 0-0.8) to 0.6 (IQR 0,05-0,9; range 0,05-1) after treatment. The main ocular complications of SU were complete unilateral ocular blindness (n=3), retina detachment (n=2), cataract (n=1), and increased ocular tension (n=1). Conclusions It is recommended to include SU in the differential diagnosis of uveitis. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias”PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3879