IntroductionThe aim of this study was to evaluate the proportion of patients with Systemic Lupus Erythematosus (SLE) who did not met the WHO recommendations for physical activity and to evaluate the amount of time spent in sedentary behavior.MethodsSLE patients were consecutively enrolled in a cross sectional study. The type and the time spent in physical activity and sedentary behavior were evaluated using the IPAQ short form questionnaire. The adequate physical activity was defined according to the 2010 WHO recommendations for health and the sedentary behavior according to the 2017 SBRN consensus. We also assessed quality of life using SF-36, mood disorders using BDI and HAM-H, fatigue using Facit-Fatigue and sleep disorders using PSQI scores.ResultsPhysical activity was not sufficient to meet WHO recommendations in 56 of 93 SLE patients (60%). SLE patients spent a median (95% range) of 180 (0–600) minutes everyday in sedentary activities. The length of daily sedentary time was more than 6 hours in 25% of SLE patients. In multivariable analysis, the factors associated to the probability of not meeting WHO criteria was only the time of exposure to antimalarials (OR 0.88, p 0.03) and the factors related to the probability of being in the upper tertile of sedentary time (more than 270 minutes) were age (OR 1.04, p 0.02), disease activity expressed by SELENA-SLEDAI score (OR 1.2, p 0.01) and Facit-fatigue score (OR 0.94, p 0.04).ConclusionA relevant proportion of SLE patients were inadequately physically active. It is essential to improve the awareness of the importance of increase physical activity and reduce sedentary time. A better control of disease activity and fatigue and a prolonged use of antimalarials could help to reach this notable goal.

fociti T e B, cellule della serie monocito-macrofagica, cellule epiteliali, cellule stromali, osteoclasti, sinoviociti. La produzione di APRIL è stata descritta da parte di macrofagi, cellule dendritiche, granulociti e linfociti T. Sono stati riportati diversi recettori per BAFF e APRIL: due recettori, il B cell maturation antigen (BCMA), e il trans-membrane activator and calcium modulator and cyclophilin ligand-interactor (TACI), legano BAFF ed APRIL; un terzo (BR3) è specifico per BAFF, mentre un recettore proteoglicanico è specifico per APRIL (2). BR3 è espresso su tutte le cellule B mature, BMCA è ristretto ai plasmablasti, TACI è specifico per determinate cellule B transizionali, e i proteoglicani INTRODUZIONEI l B-cell activating factor (BAFF o BLyS) e il proliferation-inducing ligand (APRIL) sono elementi della superfamiglia del TNF-alfa, implicati a vari livelli nella produzione, maturazione e funzione dei linfociti B (1). BAFF è prodotto dai granulociti, lin-

Wegener Granulomatosis (WG) is a multisystem autoimmune disorder characterized by necrotizing granulomatous vasculitis that most commonly involves the upper respiratory tract, lungs, and kidneys. The involvement of the central nervous system (CNS) is infrequent and can cause stroke, cranial nerve abnormalities, cerebrovascular events, seizures, and meningeal involvement. Meningeal involvement is rare and may occur due to local vasculitis, directly spread from adjacent disease in the skull base, paranasal or orbital region. We describe the case ofa 20-year-old Caucasian man who was diagnosed with sinonasal WG with frontal focal meningeal involvement. A literature review on diagnosis and treatment of meningeal involvement in course of WG was carried out. The importance of an early diagnosis and treatment of localized WG has been emphasized, in order to avoid the progression to a severe form of disease, especially in younger patients and in paucisymptomatic cases. Case reportA twenty-year-old Caucasian man with history of parietaria allergy presented with nasal congestion, occasional epistaxis and purulent rhinorrhea that had started 1 year previously. He had been seen at another hospital and had received a diagnosis of allergic rhinosinusitis. Large doses of intranasal steroids and multiple courses ofantibiotic therapy did not result in an improvement. An X-ray of the paranasal sinuses carried out six months previously was negative. His familial history was unremarkable; his parents were both living and well; the patient was the only child, he was a medical student at University in his own city, he was single and lived with his parents. He had no allergies to medications, and he denied use of alcohol, illicit drugs and smoking.On admission to our Department, headache, neck stiffness, dyspnoea, cough, fever, night sweats, fatigue, myalgia or arthralgia were absent. On examination, the patient was alert, oriented, and cooperative. There was nasal congestion and copious discharge. The lungs were clear on the auscultation, the cardiac and abdominal examinations were normal. Neurologic examination was negative for focal motor or sensory deficits as well as examination of cranial nerves II through XII. A complete blood count revealed a white-cell count of 8,430 per cubic millimeter, with 46% polymorphonuclear cells. The hematocrit was 41%, and the platelet count 296,000 per cubic millimeter. The blood urea nitrogen level was 27 mg per deciliter, and the creatinine level 0.70 mg per deciliter. Erythrocyte sedimentationrate (ESR)

BackgroundAromatase inhibitors (AI) are widely used in the treatment of estrogen receptor-positive breast cancer in postmenopausal women. The onset of musculoskeletal symptoms related to AI therapy limits the treatment compliance.ObjectivesTo evaluate the incidence and the clinical presentation of musculoskeletal syndromes and the prevalence of autoantibodies during AI therapy.MethodsWe enrolled 49 consecutive postmenopausal patients with non-metastatic breast cancer treated with third generation AI for at least three months (AI+ group) and 10 postmenopausal controls with breast cancer in adjuvant therapy but not treated with AI (AI- group). The two groups were evaluated with a rheumatological examination (tender and swollen joint count, tender points, CDAI), with PRO-CLARA, FACIT-fatigue and HAQ questionnaires and ANA, ENA screen and ACPA dosage. ANA were assayed in indirect immunofluorescence on Hep-2 cells using as a cut-off a dilution of 1:80; ENA screen and ACPA were assayed with ELISA commercial kits.ResultsThe mean ages were 62.6±9 years for AI+ group and 58±11.8 years for AI- group (p=0.2, U=140.5). In AI+ group, 27 (55%) patients exhibited at least one tender joint and 15 (30%) patients exhibited at least one swollen joint. In AI- group, two patients exhibited at least one tender joint and one patient exhibited at least one swollen joint. 22% of AI+ group patients and 20% of AI- group patients showed more than 11 tender points (TP). When patients with more than 11 TP positivity were excluded from the analysis, tender joint count was more higher in AI+ group (p=0.037). Differences between AI+ and AI- groups regarding PRO-CLARA, FACIT-fatigue, HAQ and CDAI were summarized in Tab. 1. In AI+ group, PRO-CLARA values correlates with FACIT-fatigue values (R=-0.59, p<0.0001), swollen joint count (R=0.48, p=0.001), tender joint count (R=0.72, p<0.0001), tender points count (R=0.76, p<0.0001), HAQ values (R=0.85, p<0.0001), CDAI values (R=0.89, p<0.0001) and does not correlate with the age of the patients. 67% of the AI+ group patients showed ANA positivity vs 20% AI- group patients (p 0.01, RR 3.3).Table 1AI+ groupAI- grouppPRO-CLARA2.65±2.151.56±2.39p 0.048FACIT-fatigue38±939±8p 0.58HAQ0.7500.3p 0.030CDAI7±62±3.5p 0.005ConclusionsIn this preliminary study, we demonstrated a higher prevalence of arthralgia/arthritis in AI+ group than in AI- group. No significant difference in tender points count was detected between the two groups. In AI+ group, higher values of PRO-CLARA, HAQ and CDAI than those of AI- group were showed. A higher rate of ANA positivity was demonstrated in AI+ group. These results support the hypothesis of a possible role of an immune system dysregulation in the development of musculoskeletal syndromes during AI therapy. The expertise of a rheumatologist could help patients with estrogen receptor-positive breast cancer treated with AI to improve their quality of life and to ensure a greater compliance to AI therapy.ReferencesLønning PE, et al. Endocr Relat Cancer. 2013 Jun 24;20(4):R183-201.Nirava...

Background Treatment adherence is particularly important in a serious, chronic disease like Rheumatoid Arthritis (RA). However several factors, such as the route of administration of the drug(s) and/or the clinical and logistical conditions of the patient, can have a negative impact on adherence. Abatacept (ABA) is a biologic drug indicated for the treatment of RA in combination with methotrexate that is commonly administered at hospital intravenously (iv), being the availability of its subcutaneous formulation only recent. The hospital iv administration is not only a setting which can potentially reduce adherence but it also implies additional costs for the patient and the caregiver(s) as well as for the health system. SuSTAin is a free, comprehensive, and integrated extra-hospital infusion Programme (Pr), available to Hospital Rheumatology Centres (HRC) and to patients who have been prescribed iv ABA, which was implemented in order to provide an infusion service outside the hospital with the aim of favouring treatment adherence and of reducing costs. Objectives To evaluate the benefits of the Pr in terms of patients' adherence to treatment and reduction of costs in the three years experience of the SuSTAin Pr. Methods To be eligible for the Pr, patients must have previously received at least 4 infusions of iv ABA at the HRC. The rheumatologist offers the Pr to the eligible patient who enters the Pr after providing his/her consent so that the subsequent infusions are administered outside the hospital as part of the Pr. A detailed record of the infusion timings, treatment adherence, infusion-related adverse events are collected by the nurses. In particular, any infusion-related adverse events are reported to the prescribing rheumatologist. Ongoing support is available through the SuSTAin telephone hotline. Results Between November 2010 and November 2013, the Pr has managed more than 100 patients, corresponding to >1350 infusions performed at the patients' homes or at dedicated infusion centres outside the HRC. Data collected showed an improvement in adherence to therapy up to 100% in patients enrolled in the Pr when compared to a value of 93% when infusions were performed at HRC. Moreover, patients reported a decrease in the time spent reaching the HRC and waiting for infusions corresponding to about 150 minutes/patient/infusion. When estimating cost savings related to these transfer's and waiting's times, this translated into an average reduction greater than €30 per transfer and exceeding €50 per working hour lost per patient/caregiver(s). Conclusions During three years of experience, the SuSTAin Pr provided an increase in treatment adherence to iv ABA treatment with respect to the HRC administration. In addition, an economic benefit for the patient and the caregiver(s) could be obtained. References The numbers quoted in the abstract were collected by Domedica, the provider of the Pr. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3661