We describe two patients with pancreatitis. One patient had acute pancreatitis of biliary origin and presented with small joint polyarthritis and panniculitis lesions. The other patient was originally hospitalised for dyspnoea with bilateral pleural effusion, and subsequently developed migratory polyarthritis. During his hospital stay he developed panniculitis lesions and a monoclonal IgG disorder of unknown significance. Very few patients with pancreatitis develop polyarthritis and panniculitis. The appearance of pseudocysts in the pleural and mediastinal cavity in the course of pancreatitis is an infrequent complication.

Background As vaginal flucytosine is not commercially available, it is necessary to prepare this formulation in the Pharmacy Department. Purpose To describe the preparation of flucytosine 15.5% (FLUCY15.5), and flucytosine 17% + amphotericin 3% (FLUAM) creams for vaginal use and their efficacy in the treatment of Candida glabrata and Candida tropicalis. Materials and methods FLUCY15.5 was prepared as follows: Twenty-eight 500 mg capsules of flucytosine (Ancotil) were opened into a mortar and the contents crushed. The powder was mixed with glycerine to form a paste. Cold Cream was added up to 90 g. It was blended until smooth. The procedure for preparing FLUAM was: Thirty-one 500 mg capsules of flucytosine were opened into a mortar and the contents crushed. Then 2.7 g of amphotericin B powder were added and mixed with glycerine to create a paste. Acuagel was added to a total weight of 90 g. It was blended until smooth. An expiry date of 14 days was given, although according to the Spanish Pharmacopoeia the stability of these formulations is 3 months. Vaginal applicators were used to apply the cream intravaginally. Results A 36-year-old woman with vulvovaginitis (positive culture for C. glabrata resistant to itraconazole and sensitive to amphotericin B, flucytosine, fluconazole and voriconazole in January 2009), was treated with oral and intravenous fluconazole, vaginal ketoconazole, intravenous voriconazole and vaginal boric acid. However, in February 2009 the culture was still positive. The physician prescribed 5 g/day vaginal FLUCY 15.5 for 14 days. For preparation details see materials and methods. After this treatment, the culture became negative (April 2009). Unfortunately, in March 2010, the patient again developed pain and vaginal itching. Culture of vaginal discharge was positive for C. tropicalis. The physician prescribed 5 g/day vaginal FLUAM and oral fluconazole 50 mg/day for 14 days. It was prepared as indicated above. After this treatment, the culture was negative (April 2010). Conclusions Local treatment with flucytosine and amphotericin B was effective against vaginal infections caused by non-albicans Candida species.

Background:In last years, the direct health-care costs derived from admissions and readmissions to Rheumatology departments of patients with Rheumatoid Arthritis (RA) have diminished. Presumably, the higher survival rate and the amount of comorbidities of these patients have derived in an increased of admissions and direct costs to other medical and surgical departments.Objectives:To describe the admission and readmission causes of all patients with RA admitted during 2015 and 2016 and to identify factors associated to readmission. Finally to estimate the costs derived from these events in the same period.Methods:All electronic medical reports were revised; demographic, medical and therapeutic data, as well as diagnosis at discharge were collected. A descriptive analysis followed by a logistic regression analysis were done to identify readmission-associated variables. Financial analysis was done by calculating the price of the stay according to established in 2015-scale.Results:240 admissions of 158 patients were found. Mean age 63,8 years, 69% women and mean evolution of RA of 13,1 years. At admission, 53% were on oral steroids and 45% with synthetic DMARD. Admissions were mainly distributed in Internal Medicine department (26%). Infections were the most frequent admission cause (33%), followed by cardiovascular events (20%) and oncological processes (13%). Forty-nine patients (31%) were readmitted, 47% due to infections. Age (OR/year 1.02 CI 95% 1.00–1.04), diabetes (OR 2.1 CI 95% 1.1–4.4) and chronic kidney disease (OR 3.3 CI 95% 1.0–10.2) were the associated risk factors. There were a total of 2172 days of stay with an estimated cost of 530420 euros and 783 days of stay due to readmissions with a total cost of 203218 euros. Departments which generated more costs either for admissions or readmissions were Oncology (65064 euros/19585 euros respectively) and Intensive Care (68011 euros/42651 respectively). Costs for admission and readmission in Rheumatology department were 5230 and 3175 euros respectively.Conclusions:Admission and readmission of patients with RA are mostly due to infections and cardiovascular causes. Estimated direct costs are higher for patients admitted to Intensive Care Unit or OncologyDisclosure of Interest:None declared

BackgroundAccording to clinical guidelines, treatment with a DMARD should be initiated as soon as possible, and any patient who does not improve with at least one relevant synthetic DMARD is a candidate for a biological one. However, up to one third of the patients treated with a biological DMARD do not accomplish the therapeutic objective.ObjectivesTo identify and assess the attributes of the biological DMARDs which determine the most suitable treatment of patients with RA.MethodsWe performed a systematic search with the following MeSH terms: rheumatoid arthritis, biologic, DMARD, characteristic, efficacy, safety, side effects, pharmacology, route–administration, adherence y cost. More than 500 publications were reviewed, from which we selected 77 attributes: 7 about general aspects, 5 about pharmacological aspects, 18 about efficacy, 31 about safety, 6 administration aspects and 10 related with cost. Between May and September 2015, 12 meetings were held, followed by a Delphi process of 2 rounds in which the degree of importance was awarded to each attribute on a Likert scale from 1 (minimum) to 9 (maximum). The consistency and concordance of the agreement were determined and they were circulated, obtaining the percentage supported for each one of them.Results83 Spanish rheumatologists participated, reaching a high degree of agreement with the attributes, 75 with a high importance (97.4%) and none of low importance. Fifteen attributes were ratified by all the participants:Product with approved indication in RA as first-line biological.Product recommended in the guidelines as first-line biological.Product that shows efficacy following the failure of another biological.Treatment accompanied by a reduction in articular damage progression.Treatment that reduces comorbidities associated with RA.Treatment characterised by a sustained long-term response.Safe product (globally).Proven long-term safety.Treatment with a low incidence of serious infections.Product that does not increase the incidence of solid malignancies.Product that does not increase the incidence of haematological neoplasms.Safe product in patients with cardiovascular pathology.Safe product in patients with interstitial pulmonary disease.Product that has demonstrated a reduction in mortality.Product that presents a scant incidence of serious adverse events.ConclusionsThere was a high degree of agreement with the selected attributes, none of which were regarded as being of low importance; 15 of them received the full support of the work group. These attributes would help to define the ideal profile of the biological DMARD following the failure of a synthetic or previous biological DMARD.AcknowledgementFinancing: Bristol-Myers SquibbDisclosure of InterestNone declared