The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.

Although cardiac tamponade or severe pericardial effusion is an infrequent complication in SSc patients, it can be the first manifestation of disease associated with the diffuse cutaneous subset. No specific treatment for this complication is known.

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The term "mucocele " refers to a benign cystic neoformation of the minor salivary glands lining the oral mucosa. It is most commonly in the lower lip but can appear in other places. The most of the cases, the diagnosis may be suspected by the practitioner, although it should be to confirmed with histopathology. The aim of this case is to describe the clinical characteristics and to establish the treatment of this lesion. Case report: A 66-years-old woman was referred to go to the Oral Surgery Servica of Virgen de la Paloma Hospital with a tissue growth into the right lower lip. The intraoral examination revealed a lesion of 1 cm in diameter, oval, soft consistency and pink-blue coloration. It refers not pain, but discomfort when eating and speaking. After signing the informed consent proceeded to perilesional infiltrative anesthesia and surgical excision of the lesion and adjacent glands by conventional scalpel. Histopathological analysis reported the presence of lip Mucocele. After 1 year follow-up of the patient there was no recurrence. Conclusion: It is characteristic of mucocele , the presence of a rounded growth with a rose-bluish color. Treatment consists of surgical removal of the lesion and patient counseling to eliminate habits that favor the appearance of new lesions-Oral Presentation 60 TITLE: Breathing problems during sleep. Report of clinical case