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BackgroundPatients infected with the human immunodeficiency virus (HIV) have a high rate of low bone mineral density (BMD) and is thought to be multifactorial. Some instruments have been developed to estimate the risk of osteoporotic fracture in the general population such as the WHO Fracture Risk Assessment Tool (FRAX), which allows calculating the 10-year probability of fractures in men and women from clinical risk factors with or without the measurement of femoral neck BMD. The cut-off values for high risk of hip fracture >3% and for major osteoporotic fracture >20%. Although FRAX has been validated in multiple large cohorts, still there are no clear recommendations of its use in HIV-infected patients older than 50 years.ObjectivesTo evaluate the utility of FRAX tool in the prediction of risk of vertebral morphometric deformity (MVD) in HIV-infected patients over 50 years old seen in a Spanish tertiary care center.MethodsWe performed a cross-sectional study in HIV-infected patients with age 50 years treated in our centre during the period 2014–2016. Demographics and risk factors were collected through a specific survey. FRAX was calculated adding HIV as a cause of secondary osteoporosis in all patients with and without BMD measured by dual-energy X-ray absorptiometry scan (DXA). The MVD were assessed using the Genant's semiquantitative method. The sensitivity and specificity of the test were assessed and correlations made with the presence of MVD.ResultsA total of 121 patients were included, 34 women (28%), with a mean age of 54.1 years (range: 50–75). MVD was detected in 25 cases (21%). The patients presented with a mean BMI of 23.7 kg/m2, 33% were smokers, 7% had a consumption of ≥3 doses of alcohol per day, 9% had a family history of hip fracture but no patient presented with previous history of fracture, corticoid treatment or rheumatoid arthritis. The mean FRAX score for major osteoporotic fracture without BMD was of 2.29 (1.1–8.5), there were 2 patients above 7 and any above 10; the mean FRAX score for hip fracture without BMD was of 0.64 (0.1–3.9), 2 patients were above 3. With DXA, osteoporosis in femoral neck was detected in 8% and in the lumbar spine in 30%, while femoral neck osteopenia was detected in 64% and in the lumbar spine in 45%. Including DXA data, the mean FRAX score for major osteoporotic fracture was 2.52 (0.2–8.2), 2 patients were above 7, and for hip fracture the mean FRAX score was 0.67 (0.01–4.4), with 2 patients above 3. The values of FRAX with DXA or without DXA were very similar, with a variation of -0.4 for the mean value of major osteoporotic fracture and +0.03 for the mean value of hip fracture. In ROC curve, a value above 1 in FRAX for hip fracture with DXA, detected 9 MVD of 29 patients (sensitivity 38%, specificity 80%), a value above 2 detected 4 MVD of 10 patients (sensitivity 17%, specificity 93%) and a value of 3 detected 1 MVD of 2 patients (sensitivity 4%, specificity 99%).ConclusionsThe FRAX tool does not identify properly the HIV-infected patients older than 50 years ...

BackgroundThe autoinflammatory diseases (AD) are uncommon, most of them are presented as episodes of recurrent fever and may be accompanied by other inflammatory symptoms. This group of diseases includes polygenic entities (without a single known genetic mutation) such as Behçet's disease (BD), systemic-onset juvenile idiopathic arthritis (soJIA), Chronic recurrent multifocal osteomyelitis (CRMO) and PFAPA syndrome. On the other hand, we found the entities that present with specific monogenic mutations, such as Familial Mediterranean Fever (FMF), TNF receptor-associated periodic syndrome (TRAPS), hyper-IgD syndrome and periodic fever (HIDS), cryopyrinopathies (FCAS, MWS, CINCA), Blau's syndrome and PAPA. A group of patients who can not be classified into a specific diagnosis are clustered as recurrent fever without known genetic anomaly (RFW).ObjectivesTo describe and compare the clinical features of monogenic and polygenic AD and RFW seen in a paediatric and transitional rheumatology unit of a Spanish tertiary care hospital.MethodsWe performed a retrospective study including 39 patients with AD followed-up in our center.ResultsThe distribution of diagnoses was: soJIA 19 patients (48.72%), BD 5 (12.82%), PFAPA 6 (15.38%), CRMO 3 (7.69%), RFW 4 (10.26%), HIDS 1 (2.56%) and CINCA 1 (2.56%). Patients came from different regions of Spain, being 22 of them boys (56.41%) and 17 girls (43.59%). The genetic study was performed in 12 patients, being positive in 7 (17.95%). Mean age at onset of symptoms was 5±5.65 years in monogenic diseases, 7.96±4.84 years in polygenic disorders and 9.5±5.91 years RFW. Delay in diagnosis in monogenic diseases was higher than in polygenic diseases (67±69.29 months vs. 24.03±30.33 months, respectively). The clinical manifestations more frequently found were fever, followed by joint involvement, being more common in monogenic diseases than in polygenic disorders (table). Haemoglobin levels were lower in monogenic than in polygenic diseases 9.95 g/dL ± 0.63 vs. 11.69 g/dL ± 2, ESR and CRP was higher in monogenic diseases 106 mm/h ± 68.5 and 80.5 mg/L ± 84.14 vs. 56.1 mm/h ± 33.78 and 57.95 mg/L ± 57.95, unlike ferritin that was more elevated in polygenic disease 896 μg/dL ± 1788.34 than in monogenic diseases 183 μg/dL ± 195.7. During his follow up 84.62% of patients received corticosteroids, 51.8% methotrexate and 46.15% biological therapy.MonogenicPolygenicRecurrent fever Fever100%81.25%100%Joint involvement100%62.5%75%Rash100%59.38%0%Lymphoadenopathy50%46.88%25%Splenomegaly100%12.5%0%Abdominal involvement30%21.88%25%ConclusionssoJIAs was the most frequent AD in our center. All the patients had a similar gender distribution. Delay in diagnosis was greater in monogenic diseases compared with polygenic disorders. Fever and joint involvement were the more common clinical manifestations, especially in monogenic diseases. Ferritin levels were higher in polygenic diseases, whereas CRP and ESR which were higher in monogenic diseases. During the follow-up most patients required treatment with corti...

Background Recently, trasndermal diclofenac patch has been introduced into the medical practice with relative success in the management of sport injuries. Our experience of its use in the greater trochanteric pain syndrome is positive however there is no study comparing its therapeutic benefits with steroids and anesthetics injection. Objectives Purpose of present study is to assess the results of management of greater trochanteric pain syndrome with transdermal diclofenac patch compared with steroids and anesthetics injection. Methods We conducted a prospective observational study based on usual clinical practice at our hospital urgency and emergency department. Patients with greater trochanteric pain syndrome were indentified. Only were included patients treated with steroid injections (most of them also with mepivacaine 2%) or a 140 mg transdermal diclofenac patch. Patients were contacted once clinical assessment concluded to concert an interview seven days after. Clinical and epidemiological data were collected. Therapeutic success was determined by the subjective opinion of self being of each patient (dichotomous variable) and measure using a analogical visual scale (continuous variable). This protocol was aproved by the local ethics committee. Results Thirteen patients treated with transdermal diclofenac bid for at least three days (Group I) and 37 patients treated with a local injection of 40mg of triamcinolone and 1 or 2 cc of mepivacaine 2% (Group II) were included. Specific orocedure technic was not available in the records of 33 patients who underwent locally injected. Average age was 66 SD 6 in group I and 69 SD 8 years old in group II (p>0.05). Female proportion was 76.9% in group I and 78.3% in group II (p>0.05). Terapeutical success was achive according to patient opinion in 4 patients in group I and 11 in group II (30.7% and 29.7% respectively, p>0.05). symptoms reduction measured by in analogic visual scale was 35.6 SD 18.8% in group I and La 40.5 SD 21.1% in group II (p=0.056). Considering only male patients such reduction was 78.4 SD 22.1% and 44.4 SD 27.4%, respectively (p<0.01) Conclusions Our results point that transdermal diclofenac and local injections of steroids are equivalent therapies in the management of greater trochanteric pain síndrome. Although our results are preliminary, they open an interesting use of diclofenac patches, for instance, in patients in whom there are contraindications for infiltrations. The fact that men benefit more than women by this therapy could be explained by the characteristics of the male pelvis in terms of fat distribution and the penetration capacity of the patch. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4983

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