Ischiofemoral impingement syndrome: A five-case series report

Gluteal pain is a frequent cause of medical attention in the daily clinical practice. It can be caused by multiple pathologies, being ischiofemoral impingement syndrome among those included in its differential diagnosis. Encompassed within the deep gluteal syndromes, this entity occurs as a consequence of the entrapment of the neuromuscular structures between the lesser femoral trochanter and the ischial tuberosity, causing pain in the root of the lower limb, with irradiation towards the thigh or the gluteal region and poor tolerance to deambulation and sedestation. The magnetic resonance imaging of the hip is fundamental for its diagnosis, and its management consists on medical treatment at onset. Despite not being a frequent diagnosis in the clinical practice in Rheumatology, keeping it in mind helps improving its prognosis by establishing an early and adequate treatment.

Analysis of factors involved in the development of humoral response to vaccination against SARS-CoV-2 in patients with rheumatic pathology under biological treatment

BACKGROUND AND OBJECTIVE

In the context of the SARS-CoV-2 pandemic, the development of new vaccines and their efficacy in patients with immune-mediated rheumatic diseases has been a target to investigate. The objective of this study is to evaluate the vaccine response rate in patients with immune-mediated rheumatic diseases under treatment with immunomodulators, including rituximab (RTX), as well as the influence of possible factors involved in the vaccination response in these patients.

MATERIAL AND METHODS

A single-centre, prospective cohort study was conducted in 130 patients with immune-mediated rheumatic disease on treatment with immunomodulators, including RTX, who received the full course of vaccination against SARS-CoV-2 with BioNTech/Pfizer, Moderna/Lonza, AstraZeneca, or Janssen between April and October 2021. Demographic factors such as age, sex, type of immune-mediated disease, immunomodulatory treatment and type of vaccine were analysed, as well as serological markers including anti-SARS-CoV-2 IgG antibody levels measured one and six months after vaccination, CD19+ lymphocyte levels and the presence or absence of hypogammaglobulinemia. A statistical analysis was performed to assess the influence of the different variables collected in the study on the antibody titres.

RESULTS

A sample of 130 patients was studied, 41 under treatment with RTX and 89 with other immunomodulators. A lower vaccination response rate was observed in patients with RTX (12/34, 36.7%) one month after the primary vaccination compared to 96.5% (82/85) of patients who did not receive this drug and did respond. In the analysis of secondary variables, hypogammaglobulinemia was significantly associated with lack of development of a vaccine response. The administration of the last RTX cycle in the 6 months prior to vaccination and low CD19+ levels (<20 mg/dL) also had a negative influence on the development of a vaccine response. In the group of patients who were not receiving RTX treatment, the vaccination response was like that observed in the general population. We did not observe statistically significant differences in the vaccine response based on immunomodulatory treatment other than RTX, concomitant corticosteroid treatment, type of immune-mediated pathology, age, or sex.

DISCUSSION AND CONCLUSIONS

In patients with rheumatic diseases receiving immunomodulatory treatment, the response to vaccination against SARS-CoV-2 is comparable to the general population, except in the case of patients receiving RTX, who have a lower response rate (around 36.7%) which is associated with factors such as hypogammaglobulinemia, pre-vaccination CD19+ lymphocyte levels, and a period between vaccination and the last dose of RTX of less than 6 months. It is important to take these factors into consideration to optimize vaccination in these patients.

[ANALYSIS OF FACTORS INVOLVED IN THE DEVELOPMENT OF HUMORAL RESPONSE TO VACCINATION AGAINST SARS-COV-2 IN PATIENTS WITH RHEUMATIC PATHOLOGY UNDER BIOLOGICAL TREATMENT.]

BACKGROUND AND OBJECTIVE

In the context of the SARS-CoV-2 pandemic, the development of new vaccines and their efficacy in patients with immune-mediated rheumatic diseases has been a target to investigate. The objective of this study is to evaluate the vaccine response rate in patients with immune-mediated rheumatic diseases under treatment with immunomodulators, including rituximab (RTX), as well as the influence of possible factors involved in the vaccination response in these patients.

MATERIAL AND METHODS

A single-centre, prospective cohort study was conducted in 130 patients with immune-mediated rheumatic disease on treatment with immunomodulators, including RTX, who received the full course of vaccination against SARS-CoV-2 with BioNTech/Pfizer, Moderna/Lonza, AstraZeneca, or Janssen between April and October 2021. Demographic factors such as age, sex, type of immune-mediated disease, immunomodulatory treatment and type of vaccine were analysed, as well as serological markers including anti-SARS-CoV-2 IgG antibody levels measured one and six months after vaccination, CD19+ lymphocyte levels and the presence or absence of hypogammaglobulinemia. A statistical analysis was performed to assess the influence of the different variables collected in the study on the antibody titres.

RESULTS

A sample of 130 patients was studied, 41 under treatment with RTX and 89 with other immunomodulators. A lower vaccination response rate was observed in patients with RTX (12/34, 36.7%) one month after the primary vaccination compared to 96.5% (82/85) of patients who did not receive this drug and did respond. In the analysis of secondary variables, hypogammaglobulinemia was significantly associated with lack of development of a vaccine response. The administration of the last RTX cycle in the 6 months prior to vaccination and low CD19+ levels (<20mg/dL) also had a negative influence on the development of a vaccine response. In the group of patients who were not receiving RTX treatment, the vaccination response was like that observed in the general population. We did not observe statistically significant differences in the vaccine response based on immunomodulatory treatment other than RTX, concomitant corticosteroid treatment, type of immune-mediated pathology, age, or sex.

DISCUSSION AND CONCLUSIONS

In patients with rheumatic diseases receiving immunomodulatory treatment, the response to vaccination against SARS-CoV-2 is comparable to the general population, except in the case of patients receiving RTX, who have a lower response rate (around 36.7%) which is associated with factors such as hypogammaglobulinemia, pre-vaccination CD19+ lymphocyte levels, and a period between vaccination and the last dose of RTX of less than 6 months. It is important to take these factors into consideration to optimize vaccination in these patients.

Relationship between trabecular bone score, bone mineral density and vertebral fractures in patients with axial spondyloarthritis

BACKGROUND

In patients with axial spondyloarthritis, vertebral fracture risk is elevated and not always correlated with bone mineral density (BMD). Trabecular bone score (TBS) may offer some advantages in the assessment of vertebral fracture risk in these patients. The primary objective of this study was to compare TBS and BMD between axial spondyloarthritis patients depending on their vertebral fracture status. Secondary objectives were to estimate the prevalence of morphometric vertebral fractures, and to explore factors associated with fracture, as well as the interference of syndesmophytes on BMD and TBS.

METHODS

A cross-sectional study was conducted. Data were collected on demographic and clinical characteristics, lab results, imaging findings and treatment. Statistical analysis was performed using SPSS v.13 statistical software.

RESULTS

Eighty-four patients (60 men and 24 women; mean age of 59 years) were included. Nearly half (47.6%) of them had lumbar syndesmophytes. The rate of morphometric fracture was 11.9%. TBS showed a higher area under the curve (0.89) than total hip, femoral neck and lumbar BMD (0.80, 0.78, and 0.70 respectively) for classifying patients regarding their fracture status. Nonetheless, the differences did not reach statistical significance. Syndesmophytes affected lumbar spine BMD (p < 0.001), but not hip BMD or TBS. Fractures were associated with TBS, total hip BMD, erythrocyte sedimentation rate and C-reactive protein levels.

CONCLUSIONS

We identified decreased TBS and total hip BMD, as well as increased erythrocyte sedimentation rate and C-reactive protein levels as factors associated with morphometric vertebral fractures. Unlike lumbar spine BMD, TBS is not affected by the presence of syndesmophytes.

POS1276 HUMORAL IMMUNE RESPONSE TO SARS-COV-2 VACCINE IN RITUXIMAB-TREATED PATIENTS

Background

Vaccination against SARS-CoV-2 has shown efficacy and safety in patients with chronic inflammatory rheumatic disease, similar to the general population. However, in patients treated with rituximab (RTX) it is known that usually have a lower vaccination response rate (1-2), and recent studies suggest that it also happens with the new SARS-CoV 2 vaccine (3), which entails an increased risk of hospitalization and mortality in this specific group of patients.

Objectives

To describe humoral immune response to SARS-CoV-2 vaccine in rituximab-treated patients after one and six months from the vaccination, and study if there is any other factor associated with a lower response rate.

Methods

Prospective analysis of a cohort of patients treated with RTX who received the SARS-CoV-2 vaccine between the months of April and October 2021. Demographic and medical data were collected through electronic medical records. Blood tests and serologies with levels of antibodies against SARS-CoV-2 were performed one and six months after having received the vaccine against SARS-CoV-2. The administration of a booster dose of the vaccine was recorded. A descriptive and statistical analysis of the data was carried out using the SPSS program.

Results

From a cohort of 41 patients, of whom 81,4% were women with a mean age of 56 (13,4 SD) years, vaccine response rate was only 36,7% after a 6-month follow-up. The 88,4% of them received a booster dose of the vaccine, but this failed to produce a vaccine response in any of the patients who had not developed it with the previous ones. One patient became infected after receiving one dose of the vaccine and failed to develop a serological response either.

Hypogammaglobulinemia was associated with a statistically significant lower probability of vaccine response (p=0,04). A trend of lower vaccination response rate was observed in patients who had received the last cycle of RTX in the 6 months prior to vaccination (p=0,058). In addition, the antibody levels developed one month after vaccination were statistically significantly correlated with the time between the last RTX cycle and vaccination (p=0,014) and also with CD19 B cells levels prior to vaccination (p<0,001); however, there was no correlation with the antibody levels detected at the 6-months serology. No statistically significant differences were found in relation to the number of previous cycles of RTX, concomitant treatment with synthetic disease-modifying drugs (DMARDs) or corticosteroids.

Conclusion

In our sample, after a 6-month follow-up only 36,9% achieved a vaccine response against SARS-CoV-2, which did not improve despite the administration of a booster dose. Hypogammaglobulinemia, the time between the last RTX cycle and vaccination (at least 6 months), and previous CD19 B cells levels significantly influenced in the development of a humoral response to the vaccine.

References

[1]Gelinck LB, Teng YK, Rimmelzwaan GF, et al. Poor serological responses upon influenza vaccination in patients with rheumatoid arthritis treated with rituximab. Ann Rheum Dis 2007; 66: 1402-3.

[2]Bingham CO, Looney RJ, Deodhar A, et al. Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial. Arthritis Rheum 2010; 62: 64-74.

[3]Mrak D, Tobudic S, Koblischke M, et al. SARS-CoV-2 vaccination in rituximab-treated patients: B cells promoted humoral immune responses in the presence of T-cell-mediated immunity. Ann Rheum Dis 2021; 80; 1345-1350

Disclosure of Interests

None declared

OP0139 IMPACT OF CHRONIC JOINT DISEASES ON THE SEXUAL SPHERE WITH REGARDS TO A HEALTHY POPULATION: A MULTICENTER STUDY

Background

Chronic joint diseases impair the quality of life. This occurs not only by the deformity generated, but also by the pain and disability produced by them (1, 2). There are a limited number of studies on joint diseases and sexuality (3, 4). Besides, many lack a control group and do not explore the different areas of sexuality(1-4).

Objectives

To describe the prevalence of sexual dysfunction (SD) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PA). To compare the results obtained between the two diseases and a healthy population. To analyse the factors associated with SD in the 3 populations.

Methods

Cross-sectional observation study. Patients diagnosed of PA (CASPAR criteria) and RA (EULAR/ACR 2010 criteria), followed in outpatient Rheumatology offices of two different university hospitals of the same geographical area, were consecutively included. The following variables were collected: (age, gender, year of diagnoses, perceived health, marital status, level of education, employment situation and the annual level of income), as well as (history of depression and active treatment of mental health disease). The results were compared against healthy individuals, acting as a control group. Only adult patients, of any sexual orientation, were included. The CSFQ-14 questionnaire, which evaluates changes in sexual function due to the disease or its medication, was applied. This questionnaire studies 4 different domains in both genders (pleasure, desire, arousal, orgasm and pain during orgasm) and in addition, it evaluates orgasm completion in women and erection in men. A regression model was created to estimate the influence of the collected variables on the obtained results.

Results

188 patients were included (52.7% women and 47.3% men); 72 of them were diagnosed of PA and 27 of RA. Moreover, 30.43% of the patients with PA, 48.15% of the patients with RA and 5.88% of the control group had scores on the CSFQ-14 test in the SD range.

SD was found related to being diagnosed of PA and RA (p < 0.001), age (p < 0.001), employment status (p < 0.001) and the annual level of income (p = 0.002). On the CSFQ-14 test, men had a mean score 7.5 points higher than women, although this score decreased to 6.15 points in men with PA. Furthermore, patients with PA and RA had a mean score 8.2 points lower than the control goup. All of the domains of the CSFQ-14 questionnaire were negatively affected by having PA or RA (p < 0.001). The estimated odds ratio of having SD was 8.7 times higher in patients diagnosed of PA and 10 times higher in patients diagnosed of RA.

Conclusion

Patients with RA or PA have a deteriorated sexual life when compared to a healthy population. This detriment affects all of the domains of the sexual sphere (pleasure, desire, arousal and orgasm). As shown in previous studies, age, gender, perceived health, employment situation and economic status, are related to the risk of suffering from SD. Therefore, these factors must be considered when attending this area of our patient’s health. The CSFQ-14 questionnaire provides a complete approach to sexual health and can be a tool for the management of chronic joint diseases.

References

[1]Hill J, Bird H, Thorpe R. Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatol Oxf Engl. 2003 Feb;42(2):280–6.

[2]van Berlo WTM, van de Wiel HBM, Taal E, Rasker JJ, Weijmar Schultz WCM, van Rijswijk MH. Sexual functioning of people with rheumatoid arthritis: a multicenter study. Clin Rheumatol. 2007 Jan;26(1):30–8.

[3]Kurizky PS, Mota LMH da. Sexual dysfunction in patients with psoriasis and psoriatic arthritis--a systematic review. Rev Bras Reumatol. 2012 Dec;52(6):943–8.

[4]Zhao S, Li E, Wang J, Luo L, Luo J, Zhao Z. Rheumatoid Arthritis and Risk of Sexual Dysfunction: A Systematic Review and Metaanalysis. J Rheumatol. 2018 Oct;45(10):1375–82.

Disclosure of Interests

None declared

POS0168 BONE MINERAL DENSITY IN PATIENTS WITH MULTIPLE SCLEROSIS. A DESCRIPTIVE STUDY FROM A UNIQUE CENTER FROM THE EAST OF SPAIN

Background:

Several studies have suggested that multiple sclerosis (MS) patients have low bone mineral density (LBMD) compared to healthy adults of same age. This fact, combined with the functional impairment of the disease, increases the risk of fractures. However, information about the prevalence and the risk factors of LBMD in Spanish patients with MS is still quite limited1–3.

Objectives:

To evaluate the prevalence of LBMD and low vitamin D in patients with MS from a unique center from the east of Spain, describing the clinical features of these patients.

Methods:

Type of study: observational, cross-sectional, descriptive. Patients with MS from a local cohort have been consecutively recruited for this study since Apr-2020. A cross-sectional visit which included a clinical interview, analytic test (blood and urine) and a dual-energy X-ray absorptiometry (DXA) was performed. We defined LBMD as T score ≤-1SD in postmenopausal women and men over 50 years and a Z score ≤-2SD in premenopausal women and men under 50 years. Low levels of vitamin D were defined as < 20ng/mL. A descriptive and associative analysis of these data was carried out using the SPSS software.

Results:

From a cohort of 288 MS patients, due to the COVID-19 pandemia, we have only been able to assess 60 patients, and only 48 out of them have undergone all the tests required. These were 30 women and 18 men, with a mean age of 49 (SD 11,6) years. The main type of MS was relapsing-remiting (77,1%) and 25% of them were not taking any maintenance treatment. Some of the classical factors related to a LBMD are shown in table a1. A 43,8% of the patients had a LBMD and 40,5% had low levels of vitamin D. Despite these results, as far as 89% of patients had never received any specific treatment, not even calcium and/or vitamin D supplementation. Furthermore, 13 patients (27,1%) must have received specific treatment, according to latest guidelines4, and only 4 of them (8,5%) were being adequately treated.

Table 1.Women/Men (n)30/18Mean age; SD (years)49; 11,6Non smokers/Smokers (%)58,4/41,7Alcohol abuse (%)8,3Personal history of fracture (%)10,4Personal history of nephrolithiasis (%)14,6Normal/Reduced mobility (%)77,1/22,9Sedentary lifestyle (%)66,7

Conclusion:

These preliminary results show that almost half of the MS patients have LBMD and a low vitamin D, most of them without taking any specific treatment. Taking this in mind, it is necessary to integrate the early diagnosis of LBMD in MS patients, working together with neurologists, to prevent the appearance of fractures and protect the quality of life of these patients. An analysis of our whole cohort of MS patients will help us in correctly assessing the magnitude of this problem.

References:

[1]López Méndez P, Sosa Henríquez M. Vitamin D and multiple sclerosis. Prevalence of hypovitaminosis D. Rev Osteoporos y Metab Miner. 2015;7(2):71-78.

[2]Gupta S, Ahsan I, Mahfooz N, Abdelhamid N, Ramanathan M, Weinstock-Guttman B. Osteoporosis and multiple sclerosis: Risk factors, pathophysiology, and therapeutic interventions. CNS Drugs. 2014;28(8):731-742.

[3]Moen S, E.Celius, L S, L N, E E, T H. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology. 2011;77(2):151-157.

[4]Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017;76(5):802-810.

Disclosure of Interests:

None declared

AB0806 THE JOURNEY OF AXIAL SPONDYLOARTHRITIS IN SPAIN: FROM THE GENERAL PRACTITIONER TO THE RHEUMATOLOGIST

Background:

The delay in the diagnosis of axial spondyloarthropathies (AxSp), with the morbidity and economic burden that this entails, is well known1,2. According to the 2017 Atlas of axial spondyloarthritis in Spain3, the mean diagnostic delay was 8,5 years, with an average total cost per patient of 659,8€ including medical consultations and complementary tests until diagnosis. However, nowadays there are still many patients who are incorrectly referred from the general practitioner (GP) despite showing typical features of AxSp.

Objectives:

To describe the AxSp journey until diagnosis and treatment. To analyze additional costs of either a wrong or a delayed referral of the patients with AxSp to rheumatologists.

Methods:

Type of study: observational, retrospective, descriptive. We included all the patients who were referred to our Department of Rheumatology from Jan-2019 to Dec-2020 and whose final diagnosis was AxSp. All the data since the first contact to the GP until the final diagnosis and initiation of treatment in Rheumatology were collected, including consultations to our emergency department (EmD) and other specialists. The number of consultations, complementary tests (analytical and imaging), as well as the direct costs of all of them were also collected4. A descriptive and associative analysis of these data was carried out using the SPSS software. We used median and interquartile range (IQR) for descriptive analysis and a significant p value < 0,05.

Results:

From Jan-2019 to Dec-2020, 15 patients with AxSp and a median age of 43 (Interquartile range (IQR) 34-51) years were diagnosed, 10 women and 5 men. The main reason for referral was inflammatory low back pain (66.7%). The 60% of the patients were referred from the GP, followed by the EmD (20%). Despite typical symptoms, 4 patients (26,7%) were initially referred to Traumatology, and 3 out of them returned to the GP without the right diagnosis.

The median delay for referral from the GP to the rheumatologist was 47 (IQR 20-173) days. A wrong referral of the patient was associated with a delayed diagnosis (p 0, 018) and higher direct costs of management (p 0, 018). The average cost (including medical consultation and complementary tests) of the patient referred directly to Rheumatology was 267,71 (IQR 193,7-462,3) €, while the average cost of patients referred to other specialists was 578,83 (IQR 368,32-898,7) €. The extra cost of a wrong referral of a patient with AxSp was 311€ on average per patient in our sample (Table 1).

Table 1.Women/men10/5Median age (years; IQR)43; 34-51Median diagnostic delay (days; IQR)45; 20-173Median cost of patient referred initially to Rheumatology (€; IQR)267,71; 193,7-462,3Median cost of patient referred initially to another specialist (€; IQR)578,83; 368,32-898,7Extra cost of wrong referral per patient(€)311

Conclusion:

AxSp is still a disease with a not negligible diagnostic delay, but it seems to be lower than previously reported. A wrong referral of the patient to other specialists, mainly Traumatology, is associated with this delay and can double the cost of managing these patients. This demonstrates the still unmet need of improving the management and referral of the patients with AxSp from the GP to the rheumatologist, ensuring an early diagnosis and treatment at the lowest cost for the system. Our study has limitations due to its small sample size, but preliminary results indicate that a larger-scale study would be necessary to correctly assess the magnitude of this problem.

References:

[1]Fernández Carballido C. Diagnosing early spondyloarthritis in Spain: the ESPeranza program. Reumatol Clin. 2010;6(SUPPL. 1):6-10

[2]Muñoz-Fernández S et al. A model for the development and implementation of a national plan for the optimal management of early spondyloarthritis: The Esperanza Program. Ann Rheum Dis. 2011;70(5):827-830

[3]Garrido Cumbrera M et al. Atlas de Espondilartritis Axial En España 2017. Vol 45.; 2017.

[4]Generalitat Valenciana. LEY 20/2017, de 28 de diciembre, de la Generalitat, de tasas. [2017/12159]:96-222.

Acknowledgements:

We would like to thank Novartis for its support.

Disclosure of Interests:

None declared

Long-term Follow-up and Optimization of Infliximab in Refractory Uveitis Due to Behçet Disease: National Study of 103 White Patients

OBJECTIVE

In a large series of White patients with refractory uveitis due to Behçet disease (BD) being treated with infliximab (IFX), we assessed (1) long-term efficacy and safety of IFX, and (2) IFX optimization when ocular remission was achieved.

METHODS

Our multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressant agents treated 103 patients/185 affected eyes with IFX as first biologic therapy in the following intervals: 3-5 mg/kg intravenous at 0, 2, 6, and then every 4-8 weeks. The main outcome variables were analyzed at baseline, first week, first month, sixth month, first year, and second year of IFX therapy. After remission, based on a shared decision between patient and clinician, IFX optimization was performed. Efficacy, safety, and cost of IFX therapy were evaluated.

RESULTS

In the whole series (n = 103), main outcome variables showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Serious adverse events were observed in 9 patients: infusion reactions (n = 4), tuberculosis (n = 1), Mycobacterium avium pneumonia (n = 1), severe oral ulcers (n = 1), palmoplantar psoriasis (n = 1), and colon carcinoma (n = 1). In the optimization subanalysis, the comparative study between optimized and nonoptimized groups showed (1) no differences in clinical characteristics at baseline, (2) similar maintained improvement in most ocular outcomes, (3) lower severe adverse events, and (4) lower mean IFX costs in the optimized group (€4826.52 vs €9854.13 per patient/yr).

CONCLUSION

IFX seems to be effective and relatively safe in White patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective.

Anti-IL-6 Receptor Tocilizumab in Refractory Graves' Orbitopathy: National Multicenter Observational Study of 48 Patients

Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD). Our aim was to assess the efficacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to the European Group on Graves' Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men) patients (95 eyes); mean age ± standard deviation 51 ± 11.8 years. Before TCZ and besides oral glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43) or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of the variables improved; BCVA (0.78 ± 0.25 vs. 0.9 ± 0.16; p = 0.0001), CAS (4.64 ± 1.5 vs. 1.05 ± 1.27; p = 0.0001) and intraocular pressure (IOP) (19.05 ± 4.1 vs. 16.73 ± 3.4 mmHg; p = 0.007). After a mean follow-up of 16.1 ± 2.1 months, low disease activity (CAS ≤ 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or inefficacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.

AB0807 VITAMIN D ROLE IN VASCULAR DAMAGE PROGRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Psoriatic arthritis (PsA) is associated with insufficent levels of vitamin D (25OHD) and an increased cardiovascular risk. Several studies, have shown an inverse relationship between 25OHD levels and cardiovascular damage.

Objectives:

To study the relationship between 25OHD and vascular damage, as well as its possible influence on its progression, in patients with PsA.

Methods:

Pre-post longitudinal study with analytical components. PsA patients with peripheral joint involvement were included. Demographic (sex, age), clinical [follow-up time, DAPSA, current treatment, body mass index (BMI), classic vascular risk factors, vascular events] and analytical variables [atherogenic index, glomerular filtration (GF-MDRD), glycosylated hemoglobin (HbA1c), CRP, ESR, 25OHD] were collected. We considered deficient level of 25OHD <20 ng/ml and insufficient <30 ng/ml. Basal vascular risk was estimated through SCORE tool. Extracranial carotid artery was explored with an Esaote MyLab70XVG ultrasound with linear probe (7-12mHz) and an automated program that measures intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques was evaluated following Mannheim consensus. Pulse wave velocity (PWV) was measured through Mobil o graph® dispositive. IMT≥900 µ and PWV≥ 10m/s were considered as pathological values. We repeat vascular study 3 years later. Vascular damage progression was defined as the appearance of atheroma plaques during the follow-up and/or an increase in their number. Statistical analysis was performed using SPSS 22.0 program.

Results:

78 patients were included. Eighteen patients were excluded due to high vascular risk [previous event, diabetes type II or type I with target organ injury and/or GF-MDRD< 60 ml/min]. 57.5% were women with a mean age of 54.2 (SD 10.9) years. The mean follow-up time was 96.8 (SD 163.6) months and mean DAPSA was 10.2 (SD 8.3). 96.2% of patients had received DMARDs and 42.3% biologicals, and 42.3% took calcium and 25OHD supplements. Mean BMI was 27.5 (SD 4.7) kg/m2. 42.3% had tobacco exposure, 29.5% were hypertensive and 32% dyslipidemic. Mean SCORE was 1.6 (SD 1.8) and mean 25OHD was 27.6 (DSD 11.6) ng/ml. 28.2% patients had 25OHD deficit and 60.3 % insufficiency. At the beginning, 32.1 % of patients had atheromatous plaques with a number of plaques around 1.7 (SD 1.2), and 6.7% and 19.7% had a pathological IMT or PWV, respectively. Baseline, we had not observed any association between 25OHD and the presence of atheroma plaques, IMT or PWV. Three years later, we detected progression of vascular damage in 31.2% patients. In these patients, the existence of hypovitaminosis D was associate with the appearance of atheroma plaques (p=0.043). This association desappeared in the multivariate analysis, in which only the CRP influenced the appearance of atherome plaques (OR: 1.4, IC 95% 1.04-1.98, p=0.025).

Conclusion:

Low 25OHD levels are not related to vascular damage or influence a posible progression of it in our serie. As might be expected, the progression of vascular damage depends on the inflammatory load in these patients.

Disclosure of Interests:

L Montolio-Chiva: None declared, M Robustillo-Villarino: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

AB0620 EFFECTIVENESS OF RITUXIMAB IN PATIENTS WITH EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. A MULTICENTER ANALYSIS

Background:

Rituximab (RTX) is effective in improving skin affection in patients with diffuse cutaneous systemic sclerosis (DcSSc). However, there are few data on early use of this drug.

Objectives:

To evaluate RTX effectiveness for skin disease in patients with DcSSc of less than 3 years of evolution.

Methods:

Multicenter, observational and retrospective study. Patients with DcSSc starting RTX within 3 years since first non-Raynaud symptom were recruited. Demographic variables, time of disease duration at the beginning of RTX, immune pattern and time on RTX treatment were collected. Effectiveness was defined as modified Rodnan skin score (mRSS) improvement. Evaluations were done by the same experienced rheumatologist. Patients subjective perception of skin hardening and/or tightness was evaluated. mRSS changes from baseline to 6 and 12 months after RTX beginning and, later on, to the last available observation were analysed using Wilcoxon test. Statistical analysis was performed with SPSS 20.0.

Results:

11 patients (8 women) were recruited from 2 university hospitals. Median age was 48 years (IQR 22). Median time since diagnosis to RTX beginning was 12 months (IQR 8). 5, 3 and 2 patients presented ATA +, RNPIII + and Ro-52 +, respectively. Median duration of RTX treatment was 12 months (IQR 68). Median baseline mRSS was 15.5 (IQR 18). Median mRSS after 6 and 12 months of RTX treatment and at last available mRSS evaluation was 15 (IQR 13), 14.5 (IQR 13) and 11 (IQR 16), respectively. mRSS showed statistically significant improvement at 6 (29%, IQR 37) and 12 months of RTX treatment (35%, IQR 34) and, thereafter, at last available observation (39%, IQR 51), compared to basal mRSS. Most patients reported subjective improvement at 6 (9 of 10 patients) and 12 months (6 of 7), and at last available evaluation (6 of 8); all other patients reported stability.

Conclusion:

In our experience, patients with DcSSc seem to benefit of early RTX treatment. Improvement may be seen as early as 6 months and seems to reach a plateau at 12 months.

Disclosure of Interests:

I Vázquez-Gómez: None declared, J. Narváez: None declared, J Lluch Pons: None declared, Marta Aguilar-Zamora: None declared, L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, Desamparados Ybañez: None declared, À Martínez-Ferrer: None declared, A Sendra-García: None declared, Inmaculada Torner Hernández: None declared, V Núñez-Monje: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

AB0711 USEFULNESS OF THE TRABECULAR BONE SCORE AS A PREDICTOR OF VERTEBRAL FRACTURE IN PATIENTS WITH AXIAL SPONDYLOARTHROPATHY

Background:

In axial spondyloarthritis (axSpA) the risk of vertebral fracture is increased, not always corresponding with the values of bone mineral density (BMD). One possible explanation is that syndesmophytes interfere with these values. We consider whether the evaluation of trabecular microarchitecture by an accessible methodlike the Trabecular Bone Score (TBS), that does not involve additional irradiation neither seem to be influenced by the presence of syndesmophytes, may be an advantage to estimate the risk of fracture.

Objectives:

To estimate the prevalence of vertebral fractures in patients with axSpA. To assess the diagnostic accuracy of TBS and BMD for vertebral fracture, and if it is influenced by the presence of syndesmophytes. To analyze the correlation between the absolute values of BMD and TBS in the lumbar spine.

Methods:

Cross-sectional study. Patients were consecutive recruited. We collected demographic (sex, age), clinical (syndesmophytes, vertebral fracture, BASDAI, BASFI, time of evolution of axSpA, treatment) and analytical variables [vitamin D (1,25-OHD), CRP and ESR]. The BMD was determined using the Lunar Prodigy ProTM densitometer from GE Healthcare, to which the TBS iNsight® software version 2.2 was added to perform the TBS analysis. The presence of fracture was evaluated by radiology. The statistical analysis was performed with the SPSS 22.0 and OpenEpi softwares.

Results:

84 patients were included, 60 men and 24 women, with a mean age of 59 years (± SD 13). 51.2% had lumbar syndesmophytes. The prevalence of fractures was 13.7%, 95 CI (7.8-22.9). 51.2% were treated with NSAIDs, and 48.8% with biological drugs. The evolution of axSpA was > 10 years in 65.5%. The mean scores of BASDAI and BASFI were 3.7 and 4.3 respectively (± SD 2.2 and 2.3). The mean CRP value was 8.5 mg / L (± SD 8.4), ESR 12.2 mm / h (± SD 11.4) and 1.25-OHD 27.9 ng / dL (± SD 13.6).

According to the lumbar and femoral T Score, 9.5% and 15.5% of the patients were in the range of osteoporosis respectively.19% patients had a low TBS value (≤1.23).

Regarding the influence of syndesmophytes on TBS and BMD values, we found significant differences in lumbar spine BMD (p = 0.01) but not in total hip and femoral neck BMD (p = 0.2 and 0.3 respectively) nor in the TBS (p = 0.1).

Regarding the correlation of TBS and BMD values of the spine, no correlation was observed in patients with syndesmophytes, while a moderate correlation (r = 0.4, p = 0.02) was observed in patients without syndesmophytes.

In the univariate analysis, the factors related to the presence of vertebral fracture were age, female sex, absolute BMD values in the lumbar spine and total hip, and TBS values. No relationship was found with the rest of the variables. In the multivariate analysis, only the TBS showed a significant association with the presence of fractures (p =0.02).

Regarding the predictive capacity of fractures, TBS showed a higher sensitivity than that of BMD (55.6% versus 18.2% and 30% of BMD in the spine and hip respectively), being the specificity comparable (85.3% versus 91.3% and 85.1% of BMD in column and hip respectively).

Conclusion:

the prevalence of fractures was 13.7% among the patients studied, 95 CI (7.8-22.9). The presence of syndesmophytes influenced the values of lumbar BMD but not the hip BMD or those of the TBS. We found a correlation between the values of BMD of the spine and TBS only in patients who did not have syndesmophytes. Only TBS values were significantly related to the presence of fractures in the multivariate analysis. TBS showed greater sensitivity with similar specificity than BMD for the detection of vertebral fractures.

Disclosure of Interests:

Ana V Orenes Vera: None declared, L Montolio-Chiva: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, À Martínez-Ferrer: None declared, Desamparados Ybañez: None declared, Luis García-Ferrer: None declared, María Vega-Martínez: None declared, Magdalena Graells-Ferrer: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, Inmaculada Torner Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

AB0806 DOES VITAMIN D INFLUENCE THE ACTIVITY OF THE DISEASE IN PATIENTS WITH PSORIATIC ARTHRITIS?

Background:

Several studies have shown an inverse relationship between vitamin D levels (25OHD) and disease activity in patients with rheumatoid arthritis (RA). However, the existing data in patients with psoriatic arthritis (PsA) are poor, and they use the DAS28 index as a peripheral joint activity marker by extrapolation with RA.

Objectives:

To analyze the relationship between 25OHD levels, disease activity and functional capacity in patients with PsA.

Methods:

Transversal, observational, descriptive study. We included PsA patients with peripheral joint involvement. We collected demographic variables (gender, age), clinical variables [follow-up, received treatments, TJC (68), SJC (68), VAS] and analytical variables (25OHD, CRP, ESR). We usedDisease activity in psoriatic arthritis(DAPSA) score to measure disease activity, and theHealth assessment questionnaire(HAQ) to determine functional capacity. Levels of 25 OHD <20 ng/ml and between 20-30 ng/ml were considered deficient and insufficient, respectively. Statistical analysis was made with SPSS 22.0. The descriptive analysis results were expressed as percentage and mean ± SD. We used Pearson’s correlation to assess the association between quantitative variables and T test to compare means between dichotomous variables.

Results:

125 patients were included, the majority women (60.8%), with an average age of 55.4 (SD 12.2) years. The average follow-up was 75.5 (SD 68.3) months. 97.6% of patients had received DMARDs and 40.8% biologics, and almost half of the patients (42.7%) took calcium and 25OHD supplements. The average value of 25OHD was 27.1 (SD 12.1) ng/ml, with 30% of patients having 25OHD deficit and 63.3% insufficiency. The majority of patients had an acceptable disease control, with a mean DAPSA of 10.5 (SD 7,9); and mean of CRP, ESR, TJC and SJC was 6.1 (SD 3.7) mg/l, 10.2 (SD 9.9) mm/h, 1.3 (SD 2.5) and 0.7 (SD 2.1), respectively. The average value of HAQ was 0.6 (SD 0.7). We observed an inverse correlation between 25OHD levels and joint counts, TJC (p=0.02) and SJC (p=0.03). On the other hand, patients with hypovitaminosis D presented a tendency to get higher scores in DAPSA index (P=0.07). We do not observe any relationship between 25OHD and HAQ.

Conclusion:

As can be seen in our sample, low values of 25OHD are related to increased disease activity in patients with PsA.

Disclosure of Interests:

L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

FRI0446 VIRAL ARTHRITIS: DESCRIPTIVE ANALYSIS OF A SERIES OF 131 PATIENTS

Background:

Arthritis of viral aetiology is considered the most frequent cause of acute arthritis. The most common etiologic agent is parvovirus B19 (B19). Besides, other viruses can lead to inflammatory joint disease, such as Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Human immunodeficiency virus (HIV), Rubella, Mumps, Hepatitis B and C virus (HBV and HCV) and Chikungunya (in transcontinental travellers or immigrants).

Objectives:

To describe the epidemiological characteristics, clinical and analytical course, evolution and treatment of a series of patients with a confirmed diagnosis of viral arthritis.

Methods:

A descriptive study was performed, considering a series of cases of viral arthritis collected between 2000 and 2019. Epidemiological (sex, age, the season of the year, year of diagnosis, children of pediatric age), clinics (joint pattern, prodromes, accompanying clinic) and analytical (CRP, ESR, ANA, RF) variables were collected. Statistical analysis was performed with the SPSS 22.0 program.

Results:

The data of 131 patients (109 women, 22 men), with a mean age of 39.7 years (SD 11.9) were collected. 93.9% of the cases were produced by B19, 3.8% by EBV, and only 3 by other viruses (1 by CMV, 1 by HBV, 1 by Mumps). The highest incidence years were 2005(55 cases), 2000(10 cases) and 2016(8 cases). Almost half of the cases (46.6%) occurred in spring, while 32.8% in summer, 15.3% in winter and 5.3% in autumn. Contrary to the expectations, only 20% of the patients had children in pediatric age.

The most frequent clinical picture was acute polyarthritis (53.4%), followed by inflammatory polyarthralgias (19.1%). Moreover, acute oligoarthritis was present in 10.7% of cases, and acute monoarthritis in 3.1% of cases. More than half of the patients (54.2%) had prodromes, most frequently respiratory symptoms, and the joint clinic was accompanied by a skin rash in 35.1% and fever in 29% of cases. Analytically, 33.6% presented high CRP, 39.7% high ESR, 19.8% transient anemia, 9.9% positive ANA (4.6% transiently), 9.1% anti dc-DNA (7.6% transiently), and 10.7% positive RF (3.1% transiently). In 79.4% of cases, the clinic picture was limited, with a mean duration of 36 days (SD 47.7), but 12.3% had recurrences. The 69.5% of the patients needed treatment with acetaminophen and/or NSAIDs (6.7% did not need treatment), but corticotherapy was needed in 21.4% of cases. 4.6% of the cases evolved to chronicity, which made DMARD necessary in 3 patients (two of them with a final diagnosis of rheumatoid arthritis, being treated with Methotrexate and Leflunomide, and the third one had a diagnosis of undifferentiated connective disease, treated with Hydroxychloroquine).

Conclusion:

B19 remains the most common cause of viral arthritis in our population. It appears with a sporadic, occasionally epidemic, pattern of presentation, predominantly in warm seasons. A clinical presentation as an oligoarthritis or an acute monoarthritis or even the positivity of autoimmunity markers, should not make us rule out this possible aetiology. One out of 20 cases can evolve to chronicity and even make necessary the addition of DMARD.

Disclosure of Interests:

Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, L Montolio-Chiva: None declared, Eduardo Flores: None declared, Desamparados Ybañez: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, À Martínez-Ferrer: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, Inmaculada Torner Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, Nagore Fernandez-Llanio: None declared

FRI0377 BARIATRIC SURGERY: EFFECTS ON BONE METABOLISM

Background:

There are few data about variations in bone metabolism associated with weight loss in obese patients undergoing bariatric surgery.

Objectives:

To assess the influence on the bone metabolism of bariatric surgery in morbidly obese patients.

Methods:

Longitudinal pre-post study with analytical components. All morbidly obese patients undergoing bariatric surgery were, prior to this, referred to Rheumatology Department. In all cases, the baseline characteristics of the patients were collected and a complete bone metabolic analytical study and bone densitometry (BMD) were requested. This same study was repeated one year later, with a window period of ± 3 months. Statistical analysis was performed with the SPSS 20.0 software.

Results:

Of the 91 patients included in the study and who underwent baseline BMD and analytical tests prior to surgery, only follow-up data of 27 patients could be collected at the time of the present data analysis. Within this sample, the median age was 54 years (AIQ 11), with 6 men and 21 women (11 premenopausal, 10 postmenopausal). Prior to surgery, median body mass index (BMI) was 39.2 (AIQ4.43) and median vitamin D (25OHD) level was 22 (AIQ 16). High values of PTH were detected in two patients. Regarding baseline BMD, 78% had normal values and 22% had values in the range of osteopenia.

After surgery, all patients presented a significant weight loss, being the median loss in BMI per year 9.8 Kg/m2(AIQ 3.8) as absolute value, and 25% (AIQ 8.12) as a percentage value. This weight loss was accompanied by a significant BMD worsening that was evident in all locations: lumbar spine (median -6.97%, AIQ 6.3), total hip (median -6.4%, AIQ 7.7) and femoral neck (median -3.57 %, AIQ 8); so that an additional 22% of patients changed to osteopenia values. All this despite a significant increase in 25OHD levels in all cases (35.7%; AIQ 52.3). No clinical or morphometric fractures were collected. Despite the parallel evolutionary course, the loss of BMI only showed a tendency to correlate with the decrease in bone mass in the femoral neck (p-value 0.089), but not in the other locations.

Conclusion:

In our sample of morbidly obese patients undergoing bariatric surgery, there is a significant and widespread loss of bone mineral density one year after the procedure, all this despite the supplementation and the increase in 25OHD levels. This loss only seems to be directly related to the decrease in weight at the femoral neck, just probably by a mechanism to reduce mechanical load.

Disclosure of Interests:

I Vázquez-Gómez: None declared, Ramón Trullenque Juan: None declared, Carlos Morillas Ariño: None declared, L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, Desamparados Ybañez: None declared, À Martínez-Ferrer: None declared, Inmaculada Torner Hernández: None declared, V Núñez-Monje: None declared, A Sendra-García: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

AB0595 EFFECTIVENESS OF TOPICAL SODIUM TIOSULFATE FOR THE TREATMENT OF CALCINOSIS-ASSOCIATED CUTANEOUS ULCERS IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Treatment of calcinosis associated with systemic sclerosis (SSc) mainly involves the use of systemic therapies, which often have limited efficacy. However, little attention has been paid to local treatment, which is especially useful when associated with skin ulcers.

Objectives:

To show our experience with topical sodium thiosulfate (TST) for the treatment of calcinosis-associated cutaneous ulcers in patients with SSc.

Methods:

Descriptive analysis of a case series of patients with SSc and calcinosis-associated skin ulcers treated with TST.Wound management procedure: wounds and perilesional skin cleaning and disinfection is performed and, if needed, additional debridement. TST is compounded at 25% as w/o emulsion, for extensive calcinosis, or as beeler-base or cold-cream ointment, for limited calcinosis. Wounds are then covered with a polymeric foam dressing. This cure in moist healing environment shows some advantages over the dry cure (exudate control without damaging the periulceral skin, protection against contamination, and reduction of the needed cures, healing time and pain).

Results:

Nine patients (7 women) with calcinosis-associated skin ulcers and SSc were included: 2 patients with diffuse SSc (DcSSc), 6 with limited SSc (LcSSc) and 1 with overlap syndrome. Median age was 60 years (IQR 20). 6 patients had localized wounds and 3 had extensive involvement and/or tumoral calcinosis which had been refractory to systemic treatment with diltiazem, colchicine, zoledronate, rituximab, and/or acenocoumarol and had suffered recurrent superinfections. Follow-up results of more than 3 months are available for 8 patients, who have been on TST a median time of 9 months (IQR 8.25). They have shown clinical improvement (disappearing of many calcinosis foci and partial or complete healing of the ulcers together with an improvement in pain, function, quality of life and satisfaction of the patients). Radiological improvement was also observed in 1 case. No TST related adverse effect has been detected, except for slight maceration of the wound edges due to the ointment preparation, which was resolved by protecting these with zinc oxide cream

Conclusion:

In our experience, treatment with TST for calcinosis-associated skin ulcers in patients with SSc is an effective, safe and easily implementable therapeutic alternative in clinical practice.

Disclosure of Interests:

Inmaculada Torner Hernández: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, Eduardo Flores Fernandez: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behçet's Disease: National Multicenter Study of 177 Cases

OBJECTIVE

To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD).

METHODS

We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups.

RESULTS

The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042).

CONCLUSION

Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up.

Anti-interleukin 6 receptor tocilizumab in refractory uveitis associated with Behçet's disease: multicentre retrospective study

Objective

To assess the efficacy of tocilizumab (TCZ) in refractory uveitis of Behçet's disease (BD).

Methods

Multicentre study of patients with BD-associated uveitis. Patients were refractory to conventional and biologic immunosuppressive drugs. The main outcome measures were intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects.

Results

We studied 11 patients (7 men) (20 affected eyes); median age 35 years. Uveitis was bilateral in nine patients. The patterns of ocular involvement were panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1). Cystoid macular oedema was present in seven patients. The clinical course was recurrent (n = 7) or chronic (n = 4). Before TCZ, patients had received systemic corticosteroids, conventional immunosuppressants and the following biologic agents: adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1). TCZ was used as monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1). At TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2). TCZ yielded rapid and maintained improvement in all ocular parameters of the patients, with complete remission in eight of them. However, this was not the case for the extraocular manifestations, since TCZ was only effective in three of them. After a mean (s.d.) follow-up of 9.5 (8.05) months, TCZ was withdrawn in two cases, due to a severe infusion reaction and arthritis impairment, respectively.

Conclusion

TCZ could be a therapeutic option in patients with BD and refractory uveitis.

[Joint Infections Due to Streptococcus agalactiae in Non Immunocompromised Adults: Presentation of Two Cases]

Streptococcus agalactiae (S agalactiae) is a germ habitually associated with infections in neonates and women during the pregnancy and the immediate puerperiumum. S. agalactiae has also been related with bacteriemias, endocarditis and bone, joint, skin and soft tissues infections in adults with concomitant diseases and even in immunocompetent patients. In the last years more than 70 cases of septic arthritis in adults due to this germ have been communicated. We present two cases of axial and peripheral joint infection due to S. agalactiae, comparing finds, treatment and evolution with the cases published until April, 2008.