The aim of this study was to analyse the prevalence of the most relevant clinical features of the diagnosis of systemic lupus erythematosus (SLE) in a sample of male patients with lupus as well as the incidence of the main causes of morbidity in a 5-year period after the diagnosis. A further aim of this study was to investigate the impact of gender on expression and morbidity of SLE. Data were collected from the medical records of 59 male and 535 female patients with SLE who were diagnosed at the hospitals in the region of Thessaloniki. Several differences in the expression and morbidity of the disease were found in relation to the gender of the patient. Male patients had a higher prevalence of thromboses, nephropathy, strokes, gastrointestinal tract symptoms and antiphospholipid syndrome when compared with female patients, but tended to present less often with arthralgia, hair loss, Raynaud's phenomenon and photosensitivity as the initial clinical manifestations. During the 5-year follow-up, positive associations have been found between male gender and the incidence of tendonitis, myositis, nephropathy and infections, particularly of the respiratory tract. In conclusion, this study has provided information regarding the features of clinical expression and morbidity in male patients, and has shown that gender is a possible factor that can influence the clinical expression of SLE.

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OBJECTIVES:To explore the impact of Dupuytren's Disease (DD) on patients' quality of life (QoL) and identify implications for clinical practice. A search of the literature failed to identify a patient-reported outcome measure for assessing the impact of DD. The study was designed to be the first stage in the development of such a measure. METHODS: The needs-based model of QoL was adopted and unstructured qualitative interviews were conducted with DD patients attending out-patients clinics. Data were transcribed and then underwent interpretative phenomenological analysis (IPA) to identify the key impact areas and common themes in individuals' personal experiences. RESULTS: Thirty-four DD patients (73.5% male; aged 41-80; mean (SD): 64.2 (12.5) years) were interviewed. The sample had a wide range of duration of DD (0.5-40; mean (SD) 12.6 (9.9) years). A total of 953 statements relating to the impact of DD were identified from the interview transcripts. These statements fell into 3 major categories of impact; emotional impairment (4 themes including having no confidence in hand and being embarrassed), activity limitations (10 themes including dressing, gripping and personal care) and QoL (11 themes including avoiding physical contact, self-consciousness and socialisation). CONCLUSIONS: Dupuytren's disease impacts on patients in three main areas; emotional reactions, activity limitations and QoL. In any trial designed to determine the benefits of new interventions for the disease it is important to ensure that each of these areas is assessed. It is intended to develop valid and reliable DDspecific scales to cover each of these outcomes.

SummaryWe report a case of a female with hemihypertrophy, who developed five recurrences of pheochromocytomas until the age of 35. Timely follow-up of the patient's blood pressure assisted in early diagnosis and treatment of recurrent tumors.Learning points Recurrent benign pheochromocytomas should raise suspicion of a genetic syndrome.A pheochromocytoma at a young age has a high propensity to recur and strict follow-up is mandatory.

Background Rheumatoid Arthritis (RA) patients, are at high risk of developing Cardio-Vascular Disease (CVD). Objectives The aim of our study, was to investigate any possible relation, between disease activity and the appearance of CVD event, in a cohort of Greek patients with early RA. Methods From 2002 to December 2012, 227 patients with early RA and without a prior history of a CVD, were diagnosed and subsequently followed-up as outpatients at the Rheumatology Unit of our hospital. Demographic, clinical, laboratory and therapeutic parameters were evaluated during every follow-up. At the end of the study all the above parameters, were re-evaluated, considering the appearance of the first CVD event. As end point, we considered the time of the appearance of the first CVD event, the death of a patient, or the last follow-up visit during 2012. Cox regression survival analysis was applied. Results 72.2% out of 227 patients were females, 51.1% were aCCP positive and 44.9% RF positive. Current smokers were 29.1%. Twenty patients (8.81%) suffered from a CVD event. Five of them suffered from a myocardial infarction, 11 suffered from a coronary artery disease and 2 suffered from an ischemic cerebral vascular disease. Univariate survival analysis revealed that high age at disease's onset (p<0.0001), aCCP positivity (p=0.001), RF positivity (p=0.001), high CRP on study entry (p=0.01), high DAS-28 on study entry (p=0.003), DAS-28 change (between study entry and time of sensoring) below or above median (p<0.0001), the presence of extra-articular manifestations (p=0.022) and Arterial Hypertension (p0.001), were statistically significant associated with short CVD event-free time. Multivariate survival analysis revealed that only age at disease's onset and demonstrating a DAS-28 change above the median value were statistically significant determinants of time-to-CVD event. In particular, each 1-year increment of age at disease's onset caused an 8% (95% Cis: 2.8-13.9%) increase of the risk to develop an early CVD event. Similarly, a patient belonging to the upper half of DAS-28 change among study participants was nine-times more likely to have a longer time to event than if he had belonged to the lower half. That means patients with well controlled disease were significantly less likely to appear a CVD event, even after controlling for age, presence of hypertension, aCCP-or RF-positivity, extra-articular disease, baseline CRP and DAS-28. All other variables (including DAS-28 on study entry, even marginally so) lost their statistical significance in the multivariate analysis. Conclusions In patients with early RA and without a prior history of CVD, high age at disease's onset and high disease activity seems to be associated with the presence of the first CVD event. A well controlled disease is less likely to arrive at a CVD event. References John H, Kitas G, Toms T, Goodson N Cardiovascular co-morbidity in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2009:23;71-82 Disclosure of Interest None declared ...