RA patients treated with TCZ show lower plasma concentrations of Lp(a) compared with patients without BT.

BackgroundOsteoporosis (OP) in male under 70 years is less common than postmenopausal and senile OP, but causes important social and health costs associated with morbidity and mortality from fractures. It's common in patients with inflammatory rheumatic diseases, enteric and endocrine diseases, also in COPD patients and in those undergoing chronic corticosteroid therapy.Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is done when one or more low energy mechanism fractures have already occurred (failure in early detection).Bone Metabolism Unit at Basurto University Hospital values from years ago male patients referred from different specialties with suspected OP.ObjectivesTo describe main demographic and clinical characteristics of men aged 70 years or less, visited in our monographic OP consultation, with previous to 2013 protocols established with Primary Care (PC) and rheumatology (derivation according to risk factors).MethodsRetrospective descriptive study based on a review of medical records and database of these patients. We analyze origin of derivation, risk factors, presence of fractures at moment of diagnosis, primary diagnoses and occurrence of refractures.The analysis was performed using statistical system SPSSv22.Results127 patients, mean aged 58.17 years (18–70), up to 74% of the total derived from PC (47), and general rheumatology (47); 10 patients (7.9%) from traumatology; 8 from endocrinology (6.3%); 7 from gastroenterology (5.5%).55.9% were smokers or former smokers, 22% kept drinking habit. 19.7% had received prednisone doses ≥7.5 mg for more than 3 months.9 patients had family history of fracture (6.3%), and 46 themselves presented with one or more fractures (36.2%): 36 with one or more vertebral fractures, 4 hip fracture and 12 wrist fracture. 64 patients were diagnosed of OP with treatment indication by bone agent.61% have secondary OP, the main cause (19%) enteric disorders (malabsorption syndromes and inflammatory bowel disease); 13% endocrine disorders and rheumatic inflammatory diseases by 13%. No primary cause was found in 39% of cases.The presence of fractures was associated with decreased DXA lumbar spine (p=0.027) and DXA hip (p=0.004). A very weak correlation between higher fracture FRAX and number of risk factors was detected, on the other hand a moderate correlation was observed with the number of fractures (Spearman Rho =0.472; p<0.001). So does to the hip FRAX (Spearman Rho =0.417; p<0.001).Of the 46 patients with previous fractures, only 12 (26%) had received prior treatment with bone agent. Only 5 patients suffered refracture after starting treatment and during follow-up (94.06 months) (25–129).ConclusionsAlmost 1/3 of men were referred for fractures caused by low energy impact, what means a late diagnose of male OP.It's important to establish protocols with other medical specialties for men at risk to be identified and referred, in order to make an early diagnose.It highlights the lack of patients derived from pneumologists, although vertebral fractures...

BackgroundAt the end of 2011 we established a protocol in dose reduction of biological therapy in patients with imflammatory diseases. Those who achieved remission by clinical and laboratory tests and showed no radiographic progression or Doppler activity by ultrasound examination, received reduction of dosing. Patients with etanercept (ETN) reduced dose to 25 mg, and patients with adalimumab (ADA) increased injection interval to 3 weeks. Tocilizumab (TCZ) was tapered from 8 to 6 mg/kg. We have achieved optimization rates of 20% in 2012, close to 40% at the end of 2013.ObjectivesThe aim of this study is to take account of activity flares in optimized patients and their characteristics, in order to describe predictive factors of flare if possible.MethodsRetrospective analysis data from clinical records and database of 105 patients treated with ETN, ADA and TCZ, optimized from January 2012 to June 2013 considering lab tests (ESR, RCP), disease activity (DAS 28, BASDAI),functional capacity indexes (HAQ, BASFI), and GPE (general patient evaluation), at optimization, 6 and 12 months visits. We used SPSS 21.0 for statistical analysis.ResultsTable 1ParameterBasal6 months12 monthsESR12,5 (2–64)16,3 (1–52)17,20 (1–78)RCP0,23 (0,02–1,3)0,43 (0,1–1,4)0,30 (0,1–2,06)DAS282,04 (0,11–4,03)2,51 (1,13–4,88)2,38 (0,56–4,17)HAQ0,5 (0–2)0,5 (0–2)0,5 (0–2)BASDAI1,45 (0–4,2)2,37 (0–4,3)2,480 (0,5–6,4)BASFI1,85 (0–9)2,9 (0–9,5)2,67 (0–9,6)EGP21,03 (0–100)27,07 (0–100)21,83 (0–80)105 patients (53 female and 52 male), 31% rheumatoid arthritis (RA), 27,5% ankylosing spondylitis (AS), 37,7% psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with longstanding disease, (150 months (18-638)). All of them were considered to keep remission by second visit, but at 12 months 32% were diagnosed of flare (24,5% under ADA and 39,2% under ETN; none with TCZ). Patients who flared were RA (30%), AS (29%), PA (37%) and one JIA. Half of the patients with RA, 27,6% of AS and 21,6% of PA. Clinical response was good to increasing of DMARD dosing in 25% and to increasing of biological dosing in 68,7%, but 3 patients (9,3%) required switching to another biological drug.We applied an univariate regression logistic model using parameters at visit 2, and we found modestly risk of flare related with ESR, DAS 28, number of swelling and tender joints. An increase of one tender joint at visit 2 means OR 3,56 (95% CI: 1,28-9,91), increase of one swelling joint means OR 11,26 (95% CI: 2,23-43,23). Increase of DAS 28 over 0,6 means OR 8 (95% CI: 1,85-34,6), and an increase over 1,2 means OR 60 (95% CI: 6,41-561,96).Conclusions1/3 of patients suffered flares of disease activity, mostly happened in RA patients, most of them in the ETN group (not statistically significant). Patients who flared had increased DAS 28 at visit 2, but were considered at clinical remission then. Response to increasing in treatment dosing is usually good. We consider optimization as cost-effective practice among biological treated population. We need wider popula...

Objectives:To estimate the incidence of cancer in systemic lupus erythematosus (SLE) patients and to analyze factors associated with cancer differentiating between hormone-sensitive (HS) and non-HS cancers.Methods:Multicenter retrospective study of a cohort of patients included in Spanish Society of Rheumatology Lupus Registry (RELESSER). The first cancer after the diagnosis of SLE, sociodemographic, clinical, activity, cumulative damage, severity, comorbidity, treatments, and refractory disease data were collected. Cancers were classified into HS (prostate, breast, endometrial and ovarian) and non-HS (the rest). Standardized incidence ratio (SIR) was calculated and logistics regression models were constructed to identify factors associated with cancer.Results:We included 3539 patients (90.4% women) with SLE (ACR-97 criteria), of whom 154 had cancer (91% women), and 44 were HS (100% women). The SIR for cancer was 1.37 (95% CI: 1.15-1.59), reaching higher values in women under 65 years [2.38 (95% CI: 1.84-2.91)]. The SIR in women with cancer HS vs. non-HS was 1.02 (95% CI: 0.13-1.91) and 1.93 (95% CI: 0.98-2.89)], respectively. In HS vs. non-HS cancers, age at diagnosis of SLE [Odds ratio (OR) 1.04 (p = 0.002) vs. 1.04 (p = 0.019), respectively] and the evolution time [OR 1.01 (p <0.001) vs. OR 1.00 (p = 0.029), respectively] were factors associated with cancer. SLICC/ACR damage index [OR 1.27 (p = 0.022)] and Angiotensin-Converting Enzyme (ACE) inhibitors prescription [OR 2.87 (p = 0.048)] were associated with non-HS cancers.Conclusion:The incidence of cancer in patients with SLE is increased compared to the Spanish population, specially in younger women. This increase might be due to non-HS cancers. SLE with more cumulative damage and more prescription of ACE inhibitors might associate with non-HS cancers.Disclosure of Interests:Tatiana Cobo-Ibáñez: None declared, ANA URRUTICOECHEA-ARANA: None declared, Iñigo Rua-Figueroa: None declared, Maria Auxiliadora Martin-Martinez: None declared, Juan Ovalles: None declared, María Galindo-Izquierdo: None declared, Jaime Calvo-Alen: None declared, Alejandro Olive: None declared, Antonio Fernandez-Nebro: None declared, Raúl Menor-Almagro: None declared, Eva Tomero Muriel: None declared, Loreto Horcada: None declared, Esther Uriarte Isacelaya: None declared, Victor Martinez Taboada: None declared, José Luis Andreu: None declared, Alina Boteanu: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Cristina Bohorquez: None declared, Carlos A. Montilla-Morales: None declared, Gregorio Santos Soler: None declared, Blanca Hernández-Cruz: None declared, Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Eva Salgado Perez: None declared, Mercedes Freire González: None declared, José A Hernandez Beriain: None declared, Elvira Diez Alvarez: None declared, Loren...

Background Biological therapy has changed the management of patients with inflammatory disease, but with a great increase of pharmaceutical costs and emergence of potential adverse effects. At the end of 2011 we established an internal protocol in management and dose optimization of the patients with biological treatment. Those patients with inflammatory disease who achieve remission by clinical and laboratory parameters and show no ecographic activity (arthritis, enthesitis), receive a reduction of dose. Patients with etanercept 50 mg sc. weekly reduce dose to 25 mg, and patients with adalimumab at a dose of 40 mg/2 weeks increase injection interval to 3 weeks. Thus we have achieved optimization of 20% in 2012, which is close to 40% at the end of 2013. Objectives To show that there is not a significant clinical or analytical worsening in our optimized patients, considering basal data at the time of optimization and six months later. Methods Retrospective analysis of data from clinical records and our database of 105 patients treated with etanercept and adalimumab, optimized from 2011, considering lab tests results (ESR, RCP), disease activity (DAS 28, BASDAI), functional capacity indexes (HAQ, BASFI), and GP E (global patient evaluation of the disease). We used SPSS 21.0 for statistical analysis. Results 105 patients (53 female and 52 male), 31% with rheumatoid arthritis (RA), 27,5% with ankylosing spondylitis (AS), 37,7% wiyh psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with a longstanding disease, with a mean of 152,47 months of evolution (18-638). Table 1 shows both, the basal findings and the results from six months later. Parameter Basal 6 Months later ESR 12,5 (1–64) 16,3 (1–52) RCP 0,23 (0,02–1,3) 0,43 (0,1–1,4) DAS28 2,04 (0,11–4,03) 2,51 (1,13–4,88) HAQ 0,5 (0–2) 0,5 (0–2) BASDAI 1,45 (0–9,2) 2,38 (0–7) BASFI 1,85 (0–9) 2,9 (0–9,5) EGP 21,03 (0–100) 27,07 (0–100) Furthermore, 32,4% of patients had a DAS 28 increase over 0,6, but in only 14,7% DAS 28 increase resulted over 1,2. BASDAI an BASFI increases >2 from basal occurred in 4,4% of patients. EGP increases >20 from baseline occurred in 15% of patients. Conclusions Our patients optimized with etanercept and adalimumab maintain remission criteria based on clinical and laboratory parameters at six months. So, optimization seems to be safe and cost effective in an important amount of patients with longstanding disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5931