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The aim of this article is to evaluate the use of musculoskeletal ultrasound in the daily clinical practice of a rheumatology unit. We conducted a descriptive retrospective analysis of the ultrasound examinations performed during 2011 and a comparison of these examinations with those performed between 1998 and 2003 and between 2007 and 2008. A total of 712 ultrasound examinations performed in 2011 were reviewed. Out of the total, examinations of individual areas of the body represented 11.6% versus 45.9% of the exami-nations made between 2007 and 2008 and 100% of those performed before 2003. The re-maining 88.4% of ultrasound examinations performed in 2011 were intended to investigate inflammation in 25.8%, differential diagnosis of arthralgia in 17.1%, enthesis in 12.6% and temporal arteries in 17.3%, and to conduct ultrasound-guided procedures in 10.6% and study microcrystalline pathologies in 4.7%. In our unit, ultrasonography is evolving from being a mere investigation of individual areas of the body to becoming a clinical information tool, which contributes to the diagnosis and monitoring of the disease activity in the patient as a whole.

BackgroundPrimary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease with a substantial impact on patient's quality of life and associated comorbidities could worsen the prognosis and complicate the management of the disease.ObjectivesThe aim of our study was to describe comorbidities in a Spanish cohort os pSS patients.MethodsWe took advantage of a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American criteria. It is a randomised register of patients obtained from thirty three Reumathology clinics all over Spain. The presence of comorbidities was investigated in every patient. Previous informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75).ResultsA total of 437 patients were included, 95% of them women, with a median age of 58 years. Dyslipidemia was the most common comorbidity, appearing in 33% of the cases, with hypertension in second place with a prevalence of 25%. Osteoporosis was present in 18% of patients. Furthermore, 37 patients had at least an osteoporotic fracture. Seventy four patients had never smoked. Diabetes was present in 6% of cases. Less than 7% of the patients had some kind of cardiovascular event: 4 patients ischemic heart disease, 14 patients peripheral arterial disease and 15 patients strokes. Among patients with peripheral arterial disease, only one patient showed positive anti phospholipid antibodies. Thirteen patients (3%) had heart failure. Sixty four patients (14%) had fibromyalgia. Five patients (1%) had celiac disease and 2 (0.46%), multiple sclerosis. Seven lymphomas were observed, four of them MALT type and two Hogdkin's disease. Three patients developed multiple myeloma and two Waldenstrom's macroglobulinemia. Twenty one cases of other malignancy were registered.ConclusionsPrimary Sjögren's syndrome's patients frequently present associated comorbidities, been dyslipidemia, arterial hypertension and osteoporosis the most prevalent. Lymphoma prevalence rate for this series is 1,6 percent.Disclosure of InterestNone declared

BackgroundPrimary Sjögren syndrome (pSS) is a systemic autoimmune disease affecting primarily the exocrine glandular system that requires a multidisciplinary approach.ObjectivesThe aim of our study was to describe the clinical and epidemiological features of a pSS's cohort of patients visited in Spanish Reumathology DepartmentsMethodsThis is a multicenter descriptive transversal study of pSS patients fulfilling European/American consensus criteria from thirty three Rheumatology departments. Patients were included by randomisati from an anonymized list provided by every department. Data were collected by reviewing clinical records and an interviewing the patients. Informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75).ResultsFour hundred and thirtyseven patients were included. Ninety five percent of them were women, with a median age of 58. Eighteen percent of the patients had a familiar history of autoimmune disease, most commonly rheumatoid arthritis. Median age at the time of the first symptoms was 46 years and at pSS's diagnosis was 50 years. Ocular symptoms (94%) were the most frequent complaint, followed by mouth dryness (94%), and ocular foreign body sensation (92%). Schirmer's test was performed in 402 patients and was positive in 85% of the cases. Basal salivary flow test was performed in 133 patients, and 89% were positive. Rose Bengal staining test was performed in 144 patients and was positive in 81 percent of them. Salivary gland scintigraphy was performed in more than fifty percent of patients and 87% showed abnormal results. Salivary gland biopsy was obtained in 193 patients, fulfilling histological criteria in 69% of them. Anti-Ro/SS-A, in 93% of the cases, and anti-La/SS-B, in 67%, were found positive during follow up. Only 27% of the patients fulfilled the new 2012 SICCA-ACR classification criteria.ConclusionsThe clinical and demographical profile of pSS patients from Spanish rheumatology departments is similar to that previously described in other series. Diagnostic delay is substantial. A majority of patients showed ocular and oral symptoms. Schirmer test was the preferred diagnostic test used for dry eye evaluation. Only a small group of patients fulfilled the new 2012 ACR classification criteria.Disclosure of InterestNone declared

Background Spondyloarthropathies (SpA) include a heterogeneous group of rheumatic diseases that mainly affect the axial skeleton and entheses. Despite the anti-TNF therapy has been demonstrated effective in SpA patients, about 30% of them develop primary or secondary inefficacy. In rheumatoid arthritis (RA) has been shown that the development of antibodies (Ab) against the first anti-TNF determines the clinical response to a second anti-TNF. Objectives To assess if the effectiveness of second anti-TNF therapy is associated with the development of Ab against the first anti-TNF in SpA patients switching to a second anti-TNF. Methods We studied 33 SpA patients treated with a second anti-TNF after having an inadequate response to the first anti-TNF therapy. The diagnoses were: 23 (69.7%) Ankylosing Spondylitis (AS), 6 (18.2%) undifferentiated SpA, 2 (6.1%) psoriatic SpA, 1 (3%) SpA associated with inflammatory bowel disease and 1 (3%) reactive SpA. Clinical activity was measured by ASDAS-CRP at baseline to the 1st and 2nd anti-TNF treatment and after 6 months of the switching. Clinical improvement was assessed by the Delta-ASDAS (clinically important improvement ≥1.1). Drug through levels and anti-drug Ab were measured by ELISA at the end of the fist anti-TNF treatment. Statistical analysis was performed using SPSS 11.0. Results Our cohort included 33 patients, 18 (54.5%) male, mean age of 50.09±10 years and 21 (63.6%) HLA B27 positive. All of them were initially treated with an anti-TNF: 14 (42.4%) with infliximab (Ifx), 3 (9.1%) with adalimumab (Ada), 16 (48.5%) with etanercept (Eta). Nine out of 33 (27.3%) developed anti-drug Ab [8 anti-Ifx Ab (ATI) and 1 anti-Ada Ab (AAA)]. All patients switched to a 2nd anti-TNF, due to inefficacy: 7 (21.2%) to Ifx, 16 (48.5%) to Ada, 5 (15.2%) to Eta, 5 (15.2%) to golimumab. Clinical activity (ASDAS-CRP) was not different at baseline between first and second anti-TNF therapy (3.45±0.99 vs 3.22±0.96, p=0.24). No differences were observed between patients who developed or not anti-drug Ab at baseline to the first (3.34±0.87 with Ab vs 3.50±1.04 without Ab, p=0.93) and second (2.99±0.95 with Ab vs 3.31±0.96 without Ab, p=0.37) anti-TNF treatment. After 6 months of switching to a second anti-TNF, patients who had developed anti-drug Ab had lower clinical activity (ASDAS-CRP) than patients without anti-drug Ab (1.76±0.98 with Ab vs 2.79±1.10 without Ab, p=0.021). Moreover clinical improvement was higher in patients with anti-drug Ab (1.23±1.22 with Ab vs 0.52±1.08 without Ab, p=0.063). Most patients who had clinically important improvement had anti-drug Ab before switching [60% (6/10) vs 40% (4/10), p=0.010]. Conclusions Same as in RA, in SpA, the failure to a first anti-TNF therapy associated with the development of anti-drug Ab predicts a better clinical response to a second anti-TNF. The study of the immunogenicity in the biological treatment failure helps predict the response to a second biological treatment in SpA. Disclosure of Interest None Declared