Comparison of the plasma cortisol response at + 30 minutes with both short ACTH tests and the peak in the insulin tolerance test did not reveal differences. Each test, for each time point and for each biochemical method, requires its own minimum threshold of normality to assess the hypothalamo-pituitary-adrenal axis.

The elimination rate of ACTH in healthy volunteers was significantly lower in LDT than in HDT, but cortisol production rate appears to be identical in both tests, so that a maximum adrenal stimulation seems to exist. The use of LDT may be more adequate, although data from patients need studying.

The objective of this study was to determine ability to detect neonatal acidemia and interobserver agreement with the FIGO 3-tier and 5-tier fetal heart rate (FHR) classification systems. This was a case-control study. This study was set at the University Medical Center. A total of 202 FHR tracings of 102 women who delivered an acidemic fetus (umbilical arterial cord gas pH ≤ 7.10 and BE< - 8) and 100 who delivered a nonacidemic fetus (umbilical arterial cord gas pH > 7.10) were assessed. A subanalysis was performed for those fetuses who suffered severe metabolic acidemia (pH ≤ 7.0 and BE < - 12). Two reviewers blind to clinical and outcome data classified tracings according to the new 3-tier system proposed by the FIGO and the 5-tier system proposed by Parer and Ikeda. Sensitivity and specificity for detecting neonatal acidemia and interobserver agreement in classifying FHR tracings into categories of both systems were studied. The 3-tier system showed a greater sensitivity and lower specificity to detect neonatal acidemia (43.6% sensitivity, 82.5% specificity) and severe metabolic acidemia (71.4% sensitivity, 74.0% specificity) compared with the 5-tier system (36.3% sensitivity, 88% specificity and 61.9% sensitivity, 80.1% specificity, respectively). Both systems were compared by area under the receiver-operating characteristic curve, with comparable predictive ability for detecting neonatal acidemia (FIGO-area under the curve [AUC]: 0.63 [95% confidence interval [CI]: 0.57-0.68] and Parer-AUC: 0.62 [95% CI: 0.56-0.67]). Interobserver agreement was moderate for both systems, but performance at each specific category showed a better agreement for the 5-tier system identifying a pathological tracing (orange or red, κ: 0.625 vs. pathological category, κ: 0.538). Both systems presented a comparable ability to predict neonatal acidemia, although the 5-tier system showed a better interobserver agreement identifying pathological tracings.

Background Charcot arthropathy is a destructive arthropathy with severe bone resorption that occurs in patients with sensory neuropathy of any etiology. This arthropathy can be a diagnostic challenge, because it has little clinical expression and requires to be suspected by specialists not used to assess patients with joint pathology. Objectives To analyze the clinical features of patients with Charcot arthropathy diagnosed in our department in the last years. Methods We systematically reviewed cases with Charcot arthropathy diagnosed in our department in the last 12 years (2002-2013). Demographics, underlying disease, time since onset of the arthropathy, clinical characteristics and referral department were collected. Results 21 cases of Charcot arthropathy (57% male), age 55.8 years (29-78) were confirmed. The underlying disease was 15 diabetes, 2 syringomyelia, 2 leprosy 1 Charcot-Marie-Tooth, and 1 idiopathic sensory autonomic polyneuropathy. Patients with diabetes had a disease of 13.5 years of evolution (range 1-25). Of these patients 73% had peripheral vascular disease and 93% almost had one cardiovascular risk factor. The patients came mainly from Endocrinology (34%). Other referral departments were: Emergency (16%), Vascular Surgery (14%), Podiatry (14%), Internal Medicine (9%), Neurology (5%) and Orthopaedics (5%). We observed a delayed diagnosis of the arthropathy, with a mean of 360 days (4-1500). The most common form of clinical presentation was: swelling (57%), mild pain (52%), deformity (38%), fracture (1 patient). In 1 patient the diagnosis was casual (radiological finding). Most patients (57%) had a trigger: local infection (58%), surgery (25%) or injury (17%). The most common site in patients with diabetes was the tarsus (87%). Conclusions Charcot arthropathy is mostly seen in patients with long-standing diabetes with peripheral vascular disease associated with other cardiovascular risk factors. Patients come mostly from Endocrinology, and although half of the patients had a trigger there is a clear diagnostic delay. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4001