La trombosis valvular protésica no obstructiva es una entidad de creciente diagnóstico en la actualidad. A continuación presentamos a una paciente de 74 años con antecedente de insuficiencia mitral severa funcional a quien se le realizó un reemplazo valvular mitral con una prótesis biológica. Durante el postoperatorio inmediato se realizó ecocardiograma transesofágico con evidencia de trombo en aurícula izquierda sobre la bioprotésis en ausencia de gradiente transvalvular aumentado. En dicho contexto se decidió tratamiento anticoagulante con heparina y, luego, antivitamínicos K, con buena evolución.

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Background Weekly low-dose MTX is now considered the anchor drug for the treatment of rheumatoid arthritis (RA) as improves both, short-term (disease activity) and long-term (radiographical progression, function and mortality rates) outcomes. Objectives To compare the probability of MTX utilization in patients with RA over three consecutive decades (80´s, 90´s y first decade of the 21st century) and to describe the variables associated with its use. Methods This was a retrospective analysis that included 1258 patients with RA (as per the 1987 ACR criteria) who were diagnosed between January 1980 and December 2009. The relationship between demographic (gender, age at first symptom and at diagnosis), clinical (date of diagnosis, diagnosis delay, presence of rheumatoid factor, sedimentation rate and joint erosions at diagnosis, extra-articular manifestations and follow-up time) and therapeutic (time to first time MTX) domains was examined. The cumulative rate of MTX utilization was estimated using the Kaplan-Meier method and the variables associated with its use analyzed with a Cox regression conditional model. Variables with a p value ≤ 0.05 were considered statistically significant. Results 1134 (91%) patients were ever treated with MTX and 680 (60%) reached doses ≥15 mg per week. Among those patients diagnosed during the 80´ (N= 211), 197 (93%) used MTX, during the 90´ (N= 426), 401 (94%) used MTX and during the first decade of this century (N= 610), 536 (88%) used MTX. The table below shows the cumulative rate of MTX utilization during the three decades (log rank test= 316.64; p <0.001). Conclusions In this study, the cumulative rate of MTX utilization has largely increased over the last three decades, placing in evidence an earlier indication of this drug when treating patients with RA. These findings are in accordance with local and international guidelines for the treatment of RA that denote the need of an early and effective treatment of patients with this disease, being this drug a standard and non-expensive therapeutic intervention. Disclosure of Interest None Declared

Background The early implementation of methotrexate and biologic drugs are known to improve prognosis in rheumatoid arthritis (RA) patients. Arthroplasty can be considered as an indirect indicator of lack of tight control. Objectives To compare the rate of arthroplasty (regardless of its cause) in patients with diagnosis of RA in three consecutive decades (80´s, 90´s and first decade of 21st century and to describe the variables associated with the occurrence of the event ¨arthroplasty¨. Methods This was a retrospective analysis that included 1258 patients with RA (as per the 1987 ACR criteria) who were diagnosed between January 1980 and December 2009. The relationship between demographic (gender, age at first symptom and at diagnosis), clinical (date of diagnosis, diagnosis delay, tobacco use, presence of rheumatoid factor, sedimentation rate and joint erosions at diagnosis, extra-articular manifestations, time to first arthroplasty, replaced joints, total number of arthroplasties and follow-up time) and therapeutic (number and delay in the use of DMARD`s, methotrexate and biologic agents since the diagnosis) domains was examined. The cumulative rate of arthroplasty was estimated using the Kaplan-Meier method and the variables associated with this event analyzed with a Cox regression conditional model. Variables with p value ≤ 0.05 were considered statistically significant. Results Patients were predominantly females (81.5%) and they had a a mean (SD) age at diagnosis of 45 (14.3) years. The median (IQR) follow-up time was 39 (88) months. We identified 111 (9%) patients who had at least one arthroplasty and a total of 146 arthroplasties (hip= 96, knee= 47, metacarpophalangeal= 2, shoulder= 1). Among patients diagnosed during the 80’s (N= 215), 45 (20.9%) had at least one arthroplasty, during the 90’s (N= 430), 46 (10.7%) had at least one arthroplasty and during the first decade of this century (N= 613), 20 (3.3%). The cumulative rate of arthroplasty at 5 years was 4%, 3% and 6% in the 3 decades, respectively, and at 10 years it was 13%, 14% y 13% (log rank test= 1.37; p= 0.50). In the multivariate analysis, the use of methotrexate (HR= 0.51, CI95% 0.43-0.59; p< 0.001) was protective for the event “arthroplasty”. Conclusions In this study, although the absolute risk of arthroplasty clearly decreases over the last three decades, the cumulative rate does not show the same trend. These disappointing data may not reflect yet the fully implementation of new treatment strategies in this patient population. The utilization of MTX, which is known to be a low cost and effective treatment intervention, was protective for the occurrence of the event arthroplasty. Disclosure of Interest None Declared

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