BackgroundOverall, bacteria are the most common cause of infectious arthritis. Its incidence appears to be increasing in developed countries with an annual incidence of 2-6 cases/100,000 inhabitants. It is more prevalent in extreme ages, and in patients with comorbidities. The 40% of patients with septic arthritis have a prior arthropathy. The most common causative microorganism is Staphylococcus aureus, followed by Streptococcus group, of which the Streptococcus pyogenes is the most involved. In 75% of cases the infection is acquired through the blood and in 80% of cases affects a single joint. The knee is the most affected joint. The diagnosis is confirmed by isolating the organism in synovial fluid and due to its high morbidity and mortality treatment with intravenous antibiotics should be started promptly.ObjectivesTo describe the demographic, clinical and laboratory features of patients with septic arthritis, with microorganism identified in synovial fluid and/or blood cultures between January 1985 and December 2014 at the University Hospital of Donostia (Guipuzcoa, Spain).MethodsRetrospective research of clinical data of patients diagnosed with septic arthritis between January 1985 and December 2014. Patients without microorganism identified in synovial fluid and/or blood cultures were excluded. Variables included were: age, sex, potential risk factors for infection, previous joint aspiration, history of arthropathy, clinical features, identified microorganism, affected joint, laboratory and imaging tests and the presence of osteomyelitis.ResultsA total of 259 patients were enrolled with a diagnosis of septic arthritis and microorganism identified well in synovial fluid and/or blood. The 67.20% of the patients were male and the median age was 61 (IQR=31). Risk factors were identified in 72.7% of patients. The 39.92% of patients had previous arthropathy and 12.86% had history of previous arthrocentesis.The most common causative agent was Staphylococcus Aureus in 62.89% of cases, followed in frequency by Streptococcus group (21.88%) and Escherichia coli (5.47%). In 76.11% of cases the diagnosis was made by isolation of germ in synovial fluid and in 19.03% of cases with isolation in synovial fluid and blood cultures. The knee joint was affected in 51.02% of cases.Pain and swelling were present in most patients, 98.78% and 91.46% respectively. The 64.61% had fever. Osteomyelitis was present in 9.96% of patients. Conservative treatment was the most used (76.86%) and 23.14% required surgery at some point.ConclusionsThe most common causative agent was S. aureus.Almost half of the patients had previous arthropathyA small percentage of patients had osteomyelitis.Disclosure of InterestNone declared

BackgroundAccording to prospectus, cautious evaluation concerning potential risk of developing demyelinating diseases in patients treated with anti-TNF drugs should be considered before initiating therapy. There are several case reports of neurological complications in patients treated with anti-TNF drugs. The annual rate of this complications according with the Spanish Registry BIOBADASER in 2011, was 0.65/1000 patient-years (IC95 0.36-1.1) [1]. Until now, there is no cause-effect relationship known.ObjectivesTo describe the demographic characteristics, underlying disease and anti-TNF drug used in patients who developed neurological complications in the period 2000 – 2014 in the Rheumatology Department of the Donostia University Hospital, Spain.MethodsWe retrospectively identified patients who were administered anti-TNF drugs and subsequently developed neurological deficits. The analyzed variables were sex, age, underlying disease, anti-TNF drug, cumulative dose, complications, treatment and clinical outcome. The prevalence of these complications was measured.ResultsWe registered 388 patients treated with Infliximab (IFX), 39 with Adalimumab (ADA), 351 with Golimumab (GLM), 33 with Certolizumab (CZP) and 375 with Etanercept (ETN). A total of 7 cases (5 women and 2 men) were found with a median age of 48 years old, of whom 4 were diagnosed of rheumatoid arthritis (RA), 3 of spondyloarthritis (SA) and 1 of uveitis of unknown etiology. The anti-TNF drug found to be more associated with neurological complications was Infliximab (5 cases). The neurological complications included: posterior demyelinating optic neuritis (PDON), demyelinating motor polyneuropathy (DMPN) and “Stiff-man Syndrome” (SMS) with positive anti-glutamic acid decarboxylase (GAD) antibodies. The analized variables are shown in the table. The registered prevalence in our study was 0.6%.Table 1Case 1Case 2Case 3Case 4Case 5Case 6Case 7SexFFFMMFFAge (years)42783458483057Underlying diseaseRARARASASAUveitisRAAnti-TNF drugIFXIFXIFXIFXGLMADAIFXCumulative dose (mg)42003360630842050604017810Neurological complicationDMPNUnilateral PDONDMPN anti-GADSMS anti-GADBilateral PDONBilateral PDONUnilateral PDONDiscontinue anti-TNFYesYesYesYesYesYesYesAdditional treatmentIVIGGCIVIG + GCBotulinum toxinNoneNoneNoneOutcomeRecoveredRecoveredRecoveredPartially recoveredFollow upRecoveredRecoveredF: female; M: male; IVIg: intravenous immunoglobulin; GC: glucocorticoids.ConclusionsAll neurological complications developed after the use of monoclonal antibodies, being IFX responsible for 71% of cases. The cumulative drug dosage with IFX was very variable amongst patients, therefore complications do not seem to be directly related to the dose.ReferencesC. Rodríguez Lozano. Seguridad de las terapias biolόgicas: nuevos datos de BIOBADASER. Reumatol Clin. 2011;6(S3):S1–S6.Disclosure of InterestNone 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