BackgroundRaynaud's phenomenon (RP) is characterized by transient episodes of vasoconstriction of the arteries and arterioles of the extremities in response to cold or emotional stimuli. Depending on the severity of the vascular insult, it can cause superficial ulceration or deep-tissue necrosis. Pharmacological treatments aim to enhance blood flow but their efficacy is not uniform.ObjectivesTo evaluate the efficacy of botulinum toxin-A in the treatment of severe RP.MethodsWe present a series of 7 patients with RP with bad response to conventional pharmacological therapy that have been treated with local botulinum neurotoxin-A. Exclusion criteria included botulinum toxin allergy, active infection at the site of injection, previous digital sympathectomy and pregnancy.4 to 8 units of botulinum toxin-A were administered per point of injection depending on the degree of severity. Points of injection were located on the lateral and medial aspect of the base of the fingers, except the thumb. Prior to infiltration, obstructive pathology was ruled out by Doppler ultrasound; also, a nailfold capillaroscopy test was performed before and after the infiltration. Variables such as the number of episodes per day, pain during the episodes, recuperation time, finger color and presence of digital ulceration or necrosis have been studied baseline, 30 minutes, one week and one month after the infiltration.Follow up of 6 patients was performed with a 9 weeks median, being 18 weeks the maximum time registered. Patient 1 died due to a peritonitis 3 days after the study started.Results30 minutes after infiltration, three patients felt no improvement, two assessed slight improvement and two very important improvement. At the patients' one-week and thirty-days follow-up visits two patients did not perceive any change and four experienced great amelioration. Patients that did not register any change where those with fewer subjective clinical complaints and normal Doppler ultrasound and capillaroscopy tests.The variable with the most remarkable response was pain, with important pain decrease in all of the cases. Three patients presented digit ulcers at baseline visit; ulceration healing was noted in all of them, two of them one week after the injection and the other one, one month after.Three patients reported mild “weakness” after being injected and one reported slight thenar-eminence pain that lasted a few days. None of the patients suffered any systemic complications related to the toxin.ConclusionsBotulinum toxin-A is a safe and effective therapeutic option for patients with severe RP that have failed to conventional treatment.Disclosure of InterestNone declared

No abstract

BackgroundBiologic drugs are a mainstay in the treatment of juvenile idiopathic arthritis (JIA). The early use of these drugs allows controlling disease activity avoiding its consequences and improving the quality of life of patients. We know the main characteristics of our cohort of JIA patients treated with biologics.ObjectivesTo describe the main characteristics of patients and biological treatments received during the last 5 years (2010–2015) in a pediatric unit of a children's hospital.MethodsRetrospective descriptive analytical study of patients diagnosed with JIA (as proposed by ILAR nomenclature) receiving biological treatment from 1 January 2010 to 30 June 2015. Data from medical records collected from patients who biological treatment received. Statistical analysis performed on SPSS.19.0 program.ResultsTotal 105 patients treated with biological drugs in the last 5 years, 2/3 female (67 girls, 64%), 1/3 male (38 boys, 36%), mean age at diagnosis 5.3 years (DE ±3.95años). The distribution of JIA: Oligoarticular arthritis 40% (42 patients). Polyarticular RF negative arthritis 22.9% (24 patients). Enthesitis-Related arthritis 15.2% (16 patients). Systemic 14.3% (15 patients). Polyarticular RF positive arthritis 3.8% (4 patients). Psoriatic arthritis 3.8% (4 patients).Patients with positive antinuclear antibodies (ANA) 24.8% (26 of 105 patients).Of the patients 32.2% (34 patients), i.e. 1/3 had uveitis, of these 41% (14 patients) had positive ANA.Initial treatment with methotrexate 78.1% (82 patients), methotrexate maintained 56.2 (59 patients), with adalimumab 37.1% (39 patients), etanercept 16.2% (17 patients), tocilizumab 2.9% (3 patients).Total received 123 biological treatments: adalimumab 49 (39.8%), etanercept 47 (39.2%), tocilizumab 16 (13%), anakinra 8 (3.5%) and canakinumab 3 (2.4%). Overall median time of monitoring 33.3 months (SD ±22.4 months). Continue with the drug 54 (43.9%), decrement regimen 50 (40.7%), replaced by inefficiency 15 (12.2%) (adalimumab 3, etanercept 4, anakinra 3, tocilizumab 5), suspended for toxicity 4 (3.3%) (anakinra 3, adalimumab 1). No deaths recorded.ConclusionsThe clinical features in this cohort of JIA patients treated with biologics are similar to those described in other “general series” that do not distinguish the type of treatment.The biological treatments used most often are etanercept and adalimumab, both with similar percentages (mainly in non-systemic JIA). The most commonly used drugs in systemic JIA are anakinra, tocilizumab and canakinumab.The biological treatments appear to be safe based on what has been described: few drugs had to be replaced by toxicity, and was not recorded death by the treatment or the disease itself.Disclosure of InterestNone declared

No abstract

No abstract