We had the challenged to treat a 40-year-old female with Systemic Scleroderma who was showing unspecific symptoms. During her time at the hospital she rapidly develops renal dysfunction, associated with hypertension. She required renal replacement therapy initiation and we observed a decline in hemoglobin and platelets numbers. We confirm a microangiopathic hemolytic anemia and rule out other immune diseases or thrombotic thrombocytopenic purpura. Systemic Sclerosis is a chronic immune disorder of unknown origin that it is not completely understood. It is believed that environmental factors may contribute and also altered genes may be implicated in the immune system's function. Microangiopathic hemolytic anemia occurs in 43% of patients who develop scleroderma renal crisis and an activation of the complement system through the classical pathway may be involved. Given that context we decided to treat the patients with C5 blocker Eculizumab and obtain an extraordinary positive response.

BackgroundRheumatoid arthritis (RA) and DMARDs are associated with a dysfunction of the cellular and humoral immune system that increases their susceptibility to infection, with vaccinations being one of the main infection prevention measures in these patients.ObjectivesTo describe the efficacy and safety of the SARS-CoV-2 vaccine in a series of patients with RA.MethodsRetrospective observational study of RA patients, fulfilling the ACR/EULAR 2010 classification criteria, vaccinated against the SARS-CoV-2 virus from December 2020 to October 2021, who had post-vaccination serology and subsequent follow-up for a minimum of 6 months in a university hospital. The efficacy and effectiveness of the vaccine was evaluated by analyzing the serological response (anti-SARS-CoV-2 IgG antibodies) and the incidence of post-vaccination SARS-CoV-2 infection. Vaccine safety was investigated recording adverse events and RA flares. Logistic and linear multivariate regression analyzes adjusted for age, sex, and time elapsed from vaccination to serological determination were used to identify factors associated with vaccine response. Statistical analysis was carried out with Stata® and significance was set at p<0.05.ResultsWe included 118 patients with RA (87.2% women, mean age 65.4±11.6 years, mean evolution 12.0±9.6 years) vaccinated against SARS-CoV-2 (95.76% received the complete vaccination schedule). Patient characteristics regarding socio-demographic, clinical and laboratory RA related variables, as well as prior Covid infection are shown in Table 1.Table 1.POPULATION CHARACTERISTICSSEROLOGICAL RESPONSE TO VACCINEGRADE OF SEROLOGICAL RESPONSEYESNOppAge (years)65.47±11.6965.25±11.6767.14±12.100.2330.498Sex (male/female)15 (12.71)/ 103 (87.29)12 (11.54)/ 92 (88.46)3 (21.43)/ 11 (78.57)0.3850.019Smoking (pack-year index)8.79±18.556.87±15.2323.01±31.83<0.0010.387Comorbility68 (57.63)58 (55.77)10 (71.43)0.3890.498RA duration12.08±9.6311.57±8.5915.93±15.280.9940.815Rheumatoid factor +79 (66.95)72 (69.23)7 (50.00)0.1510.102Anticitrullinated protein antibodies +63 (53.39)52 (82.54)52 (94.55)0.0510.328Erosive RA32 (27.11)26 (25.00)6 (42.86)0.1580.423Extraarticular manifestations26 (22.03)20 (19.23)6 (42.86)0.0450.129ESR19.88±18.6420.00±19.0419.00±15.940.8550.020CRP0.51±0.780.47±0.640.82±1.440.2390.006HAQ0.575 (0.66)0.59±0.670.43±0.590.8100.561DAS282.39±1.072.37±1.122.53±0.600.1100.603Prior COVID-1921 (17.8)22 (20.19)0 (0)0.072<0.001Figure 1.57.6% of the patients had associated comorbidity, especially dyslipidemia 41.5%, arterial hypertension 31.4% and diabetes mellitus 10.2%. Almost all patients received csDMARDs, especially MTX (83.9%), and 46.6% had biologic therapy or JAK inhibitors, with a predominance of TNF antagonists (20,3%) and RTX (16,1%). Types of vaccines and schedule are shown in Figure 1A. Most patients (88.1%) developed humoral immunogenicity. Univariate analysis of factors associates with humoral response and grade of response to the vaccine are shown in Table 1. Multivariate analysis found that smoking (OR 0.96, 95%CI: 0.94-0.99, p=0.034) was the only variable significantly associated with humoral response to the vaccine. The degree of serological response was significantly related to younger age (coefficient -16.11, 95%CI: -31.84 to -0.39, p=0.045) and previous COVID-19 infection (coefficient 4.496, IC 95%: 3.604-5.388, p<0.001), which had occurred in 17.8% (5% severe) and was associated with male gender (p=0.016). After vaccination, 18.6% presented SARS-CoV-2 infection, although mild. Vaccine adverse events (19.5%) were mostly mild (Figure 1B) and associated with age (OR 0.95, 95%CI: 0.91–0.99, p=0.042). RA flares were anecdotal (1.7%), being inversely related to age (OR 0.95, 95%CI: 0.91-0.99, p=0.042).ConclusionOur results, with a limited sample, suggest that the SARS-CoV-2 vaccine induces adequate humoral immunogenicity, with an acceptable safety profile in RA patients, reducing the severity of SARS-CoV-2 infection.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundBiphosphonates are considered the first line treatment for osteoporosis. One of the side effects of the continuous treatment is the development of atypical fractures. These are generally subtrochanteric, although they can appear anywhere in the femoral diaphysis, with a low prevalence (1.1% of all the femur fractures). Their incidence grows with the time to exposure to bisphosphonates. Radiologically they show a traverse trace or slightly oblique, non comminuted with formation of a medial spicule and the majority of the cases show thickness of the lateral cortical. They appear after a minimum traumatism or spontaneously.ObjectivesTo determine the prevalence or atypical fractures according to the American Society of Mineral and Bone Research (ASMBR) criteria between 2011 and 2014 in the Universitary Hosptial of Donostia (Guipúzcoa, Spain).MethodsRetrospective research of clinical data of patients operated of hip fracture and/or femur fractures between November 2011 and December 2014 Variables included were: age, sex, race, clinical features, treatment received, and presence or absence of diseases and pharmacological treatments that participate in the bone remodeling.Results921 patients operated of hip fracture and 76 of diaphyseal fracture. 6 patients met the clinical and radiologic criteria of the ASMBR for an atypical fracture, 100% of these had recieved a long term treatment with biphosphonates and ment the 6,57% of the diaphyseal fractures, the 0,12% of the hip fractures and the 0,6% of the total of the fractures studied. Two of the patients also received treatment with other antirresortive and osteoformating treatments. The median age was 75 years (IQR=20). The most used biphosphonate was Alendronate, beeing in the 66,6% of the patients the first treatment. The median time of expotion to biphosphonates was 8,5 years (IQR=3). In the 83,3% of the patients the fracture was situated in the medial third of the femoral diaphisis.Table 1IDSexAgeTreatment for osteoporosisLocation of fractureMedical treatmentComorbidities (diseases/drugs)1Female421. Alendronate2. Teriparatide3. Ibandronate4. Denosumab + strontium ranelare1. 10 years2. 2 years3. 2 years4. 1 yearDiaphyseal femur (1/3 medium)Strontrium ranelateNo/No2Female631. Alendronate1. 10 yearsDiaphyseal femur (1/3 medium)TeriparatideHypothyroidism/No3Female731. Alendronate2. Denosumab1. 6 years2. 6 monthsSubtrochantericTeriparatideDiabetes mellitus4Female771. Alendronate1. 8 yearsDiaphyseal femur (1/3 medium)NoHipothyroidism/No5Female831. Risedronate2. Alendronate1. 6 years2. 3 yearsDiaphyseal femur (1/3 medium)NoNo/No6Female881. Risedronate2. Alendronate1. 5 years2. 2 yearsDiaphyseal femur (1/3 medium)NoHypothyroidism/NoConclusionsIn our study the prevalence of atypical fractures with biphosphonates was low, a 0,6% of all of the fractures studied.Disclosure of InterestNone declared

La nefritis por derivación es una glomerulonefritis mediada por inmunocomplejos,que saturan el sistema reticuloendotelial y se depositan en los capilares glomerulares,con lo que activan la cascada del complemento y la reacción inflamatoria crónica que lleva a una lesión renal. El diagnóstico clínico de las infecciones no es fácil; se da por gérmenes de baja virulencia que producen una infección crónica. Sin embargo, los cultivos pueden ser negativos. En este artículo se presenta un caso de nefritis por derivación tras dos años de colocación de una válvula ventriculoatrial, confirmada con biopsia renal, con posterior resolución tras su retiro. Los cultivos del paciente, así como los de la válvula, fueron negativos.

BackgroundUveitis is the most common ocular inflammatory disease. According to the classification, non-infectious uveitis 70% of the total, presenting a chronic course and with it, an increased risk of complications. The phased therapeutic approach in ophthalmology is well established and is based on the efficacy of synthetic and biological immunosuppressive therapy.1 However, we do not have evidence-based protocols that allow us to know how long to maintain them, or when to interrupt them.ObjectivesThe main objective is to evaluate the free time without ocular inflammatory activity after the withdrawal of the synthetic and/or biological immunosuppressive treatment in patients with non-infectious uveitis.As secondary objectives are collected the epidemiological and clinical characteristics, the distribution of the different immunosuppressive drugs employed and analysed the cases of recurrence after the interruption of treatment, and the need of reintroduction.MethodsA retrospective cohort multicenter study was conducted in patients with a diagnosis of non-infectious uveitis followed in a multidisciplinary unit, that after two or more years of ocular and extraocular inactivity, the inmunossuppresive treatment was suspended. It was defined inactive uveitis as cell Tyndall 0 in anterior and vitreous chamber, as well as the absence of other signs of active inflammation (retinal infiltrates, choroid and vasculitis and/or papillitis with angiographic leakage).Demographic characteristics, anatomical location and laterality of the uveitis, visual acuity at the beginning and end of the study and the drugs used were recorded.ResultsWe analysed 48 patients with an average age at the onset of immunosuppressive treatment of 39.3 years (±16 years). 85.4% of the uveitis were bilateral. The main diagnoses are described in table 1. In 56.3% of cases a single immunosuppressant was used. Cyclosporine was the most employed (72.9%) and methotrexate was the most used in monotherapy (83.3%). 83% of patients received corticosteroids and 12% treatment with Infliximab. The mean duration of immunosuppressive treatment was 6.9 years (±5, 7años). The percentage of total and ocular recurrence was 37.5% and 31.25% respectively. The mean duration of follow-up after treatment suspension was 4.3 years (±4.5 years), being more than 1 year in 77.1% of patients. We found that 75% of patients remained free of recurrence at least 27 months. The administration of two or more immunosuppresive drugs proved to be a risk factor for recurrence (p=0,048) and reintroduction of treatment after it (p=0,008), which was performed in 39% of the ocular recurrences. Visual acuity did not suffer variation in 78.6% of recurrences and 80.3% of those that did not recur.Abstract SAT0595 – Table 1- Main diagnosesConclusionsIn our cohort, patients with no ocular inflammatory activity for at least two years could benefit from the suspension of immunosuppressive treatment without a visual risk. The use of one or more immunosuppressive drugs has been identified as a risk facto...