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Introduction There is currently no validated score capable of classifying cancer-associated pulmonary embolism (PE) in its full spectrum of severity. This study has validated the EPIPHANY Index, a new tool to predict serious complications in cancer patients with suspected or unsuspected PE. Method The PERSEO Study prospectively recruited individuals with PE and active cancer or receiving antineoplastic therapy from 22 Spanish hospitals. The estimation of the relative frequency θ of complications based on the EPIPHANY Index categories was made using the Bayesian alternative for the binomial test. Results A total of 900 patients, who were diagnosed with PE between October 2017 and January 2020, were enrolled. The rate of serious complications at 15 days was 11.8%, 95% highest density interval [HDI], 9.8–14.1%. Of the EPIPHANY low-risk patients, 2.4% (95% HDI, 0.8–4.6%) had serious complications, as did 5.5% (95% HDI, 2.9–8.7%) of the moderate-risk participants and 21.0% (95% HDI, 17.0–24.0%) of those with high-risk episodes. The EPIPHANY Index was associated with overall survival (OS) in patients with different risk levels: median OS was 16.5, 14.4, and 4.4 months for those at low, intermediate, and high risk, respectively. Both the EPIPHANY Index and the Hestia criteria exhibited greater negative predictive value and a lower negative likelihood ratio than the remaining models. The incidence of bleeding at 6 months was 6.2% (95% HDI, 2.9–9.5%) in low/moderate-risk vs 12.7% (95% HDI, 10.1–15.4%) in high-risk (p-value = 0.037) episodes. Of the outpatients, serious complications at 15 days were recorded in 2.1% (95% HDI, 0.7–4.0%) of the cases with EPIPHANY low/intermediate-risk vs 5.3% (95% HDI, 1.7–11.8%) in high-risk cases. Conclusion We have validated the EPIPHANY Index in patients with incidental or symptomatic cancer-related PE. This model can contribute to standardize decision-making in a scenario lacking quality evidence.

IntroductionThere is currently no validated score capable of classifying cancer-associated pulmonary embolism (PE) in its full spectrum of severity. This study has validated the EPIHANY Index, a new tool to predict serious complications in cancer patients with suspected or unsuspected PE.MethodThe PERSEO Study prospectively recruited individuals with PE and cancer from 22 Spanish hospitals. The estimation of the relative frequency θ of complications based on the EPIPHANY Index categories was made using the Bayesian alternative for the binomial test.ResultsNine hundred patients diagnosed with PE between 2017/2020 were recruited. The rate of serious complications at 15 days was 11.8%, 95% highest density interval [HDI], 9.8-14.1%. Of the EPIPHANY low-risk patients, 2.4% (95% HDI, 0.8-4.6%) had serious complications, as did 5.5% (95% HDI, 2.9-8.7%) of the moderate-risk participants and 21.0% (95% HDI, 17.0-24.0%) of those with high-risk episodes. The EPIPHANY Index correlated with overall survival. Both the EPIPHANY Index and the Hestia criteria exhibited greater negative predictive value and a lower negative likelihood ratio than the remaining models. The incidence of bleeding at 6 months was 6.2% (95% HDI, 2.9-9.5%) in low/moderate-risk vs 12.7% (95% HDI, 10.1-15.4%) in high-risk (p-value=0.037) episodes. Of the outpatients, complications at 15 days were recorded in 2.1% (95% HDI, 0.7-4.0%) of the cases with EPIPHANY low/intermediate-risk vs 5.3% (95% HDI, 1.7-11.8%) in high-risk cases.ConclusionWe have validated the EPIPHANY Index in patients with incidental or symptomatic cancer-related PE. This model can contribute to standardize decision-making in a scenario lacking quality evidence.SummaryWe have validated the EPIPHANY Index in patients with acute, incidental, or symptomatic cancer-related PE. This predictive model of complications can contribute to standardize decision-making in a scenario lacking quality evidence.

Resumen Mujer de 58 anos sin antecedentes medicos de interes que consulta por diplopia binocular de una semana de evolucion, asociada a dolor costal, disnea, astenia intensa y perdida de peso de 2 meses de evolucion. En la analitica de urgencia presenta hipercalcemia, insuficiencia renal y bicitopenia, y en la radiografia de torax de urgencias se observan multiples imagenes osteoclasticas que orientan inicialmente a mieloma multiple con afectacion extraosea. Ademas del estudio correspondiente, ante la diplopia horizontal se realiza TC craneal sin contraste, donde se observa una lesion adyacente a la pared lateral de la orbita izquierda, de densidad de partes blandas, que incluye el musculo recto externo y ejerce efecto masa sobre el nervio optico desplazandolo medialmente. Ademas se observan multiples lesiones liticas de distribucion difusa en la calota, con patron permeativo «en sal y pimienta». Se procede a la biopsia del musculo recto lateral y osea de ala sacra, obteniendo como resultado metastasis de carcinoma compatible con origen mamario. Presentamos un caso atipico de diplopia horizontal en el contexto de una paciente con un cuadro constitucional severo sin diagnostico establecido, en el que la biopsia del recto lateral, junto con la biopsia de medula osea, son claves a la hora del diagnostico de confirmacion.

The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed. This was of soft tissue density, and included the external rectus muscle that exerts a mass effect on the optic nerve by displacing it medially. Many lytic bone diffuse lesions with salt and pepper pattern were found in the calotte. A rectus lateral muscle and bone biopsy of the sacral wing was performed, resulting in metastasis of carcinoma compatible with mammary origin. An atypical case is presented of horizontal diplopia in the context of a patient with a severe constitutional picture with no established diagnosis, in which the biopsy of the lateral rectum was key to the confirmation diagnosis.

Our aim was to assess the relationship between serum adalimumab levels, anti-drug antibodies (ADA) and disease activity in patients with axial spondylarthritis (SpA). We have carried out a single-centre cross-sectional study. adalimumab and ADA levels were analysed with ELISA and correlated with SpA activity using BASDAI and ASDAS scores. Adalimumab cut-off value was calculated to discriminate inactive disease/low disease activity (BASDAI 4; ASDAS 2.1) from moderate/high disease activity (BASDAI ≥ 4; ASDAS ≥ 2.1), using a receiver operating characteristic (ROC) curve. Up to January 2016, 51 consecutive patients were included. The median (range) age was 46.6 (18-68) and 47.1% were women. ADA prevalence was 27.5%, with none detected in the 21.6% receiving concomitant disease-modifying antirheumatic drugs (DMARDs) (p = 0.021). Adalimumab level was normal ( 3 mg/l) in 36 patients (70.6%), all without ADA. Fifteen patients (29.4%) had subtherapeutic adalimumab levels ( 3 mg/l), with ADA in 14 (93%). Median adalimumab (mg/l) was significantly higher in patients with inactive disease/low disease activity: BASDAI 4 vs ≥ 4: 9.5 vs 2.6 (p 0.01); ASDAS-CRP 2.1 vs ≥ 2.1: 9.3 vs 0.3 (p 0.001); ASDAS-ESR 2.1 vs ≥ 2.1: 9.9 vs 3.0 (p 0.001), and this finding was consistent with the result of the multivariate model. Patients with inactive disease/low disease activity presented significantly lower ADA levels. The adalimumab level cut-offs and area under the curve (AUC) obtained in the ROC curves were: ASDAS-CRP ( 2.1) 4.6 mg/l (AUC 81.2%; 95% CI 67.5-94.9; p 0.001); ASDAS-ESR ( 2.1) 7.7 mg/l (AUC 82.4%; 95% CI 69.3-95.5; p 0.001); BASDAI ( 4) 6.4 mg/l (AUC 73.5%; 95% CI 58.6-88.3; p 0.01). In conclusion, presence of ADA in axial SpA patients treated with adalimumab was associated with lower serum drug levels. ADA levels were lower and adalimumab levels were higher in patients with inactive disease/low disease activity based on BASDAI and ASDAS indices. Concomitant treatment with MTX reduces de likelihood of finding ADA. Serum adalimumab levels above 4.6 mg/l are recommended to avoid compromising efficacy.

Objectives. This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods. RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results. Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion. Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies., The RELESSER Registry was partially funded by GlaxoSmithKline (GSK), Roche, Union Chimique Belge (UCB), Lilly and Novartis. The sponsors had no role in the study design, data collection, analysis or interpretation, in writing the report, or in the decision to submit the article for publication. J.M.P.-R. is supported by grant 316265 (BIOCAPS) from the European Union 7th Framework Program (FP7/REGPOT-2012-2013.1). The study was supported by FIS Grant PI11/02857 (Instituto Carlos III, Fondos FEDER). Grant for medical researchers of the 'Fundacion Espanola de Reumatologia'.

Objective To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD). Methods This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect. Results We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P Conclusion ABA may be an effective and safe treatment for patients with RA-ILD.

Background Rheumatoid arthritis (RA) may associate with Interstitial Lung Disease (ILD). Disease-modifying anti-rheumatic drug (DMARD) or TNF alfa inhibitors (iTNF), had been involved in the ILD development as well as exacerbation of an existing one. Nowadays there is no consensus related to treatment. Objectives The aimed of this study is to evaluate efficacy and safety of Abatacept (ABA) treatment in patients with AR and ILD. Methods Multicentre study in patients with RA and ILD associated were treated with ABA. ILD was diagnosed by High Resolution Computed Tomography (HRCT). ABA was used at dose of 10 mg/kg/4 weeks iv or 125 mg/week sc. Its efficacy was evaluated according to the following measures: a) Dyspnea classified by the Modified Medical Research Council (MMRC); Significant variability of 1 point and asymptomatic MMRC=0; b) Pulmonary function test (PFT); Significant oscillations >10% in Forced Vital Capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) >10%; c) Imaging technique (HRCT); d) Joint assessment (DAS28). Quantitative variables were expressed as mean ± SD or as median (interquartile range) and compared with (Wilcoxon test) (Test Fisher) between the baseline and 3, 6 and 12 months. Results 34 individuals were included (19 women /15 men), patients with ILD associated to RA, with a mean age of 61,4 ± 9,8 years. The median duration of RA before ADA was initiated was 4,8 [0,86–13,12] (0–25) years, and had previously received an average 1,29±0,90 DMARDs. RA was seropositive in 24 cases (71%). ILD was associated with a DMARD: MTX (n=3), Etanercept (n=3), Adalimumab (n=3) y Certolizumab (n=1). ABA was used in monotherapy in 14 patients and combined with other immunosuppressors in 20 patients: Leflunomide (LFD) (n=7), LFD and cyclosporine (n=1), Sulfasalazine (n=1), MTX (n=2), MTX with LFD (n=1), hydroxychloroquine (n=5), Hydroxychloroquine with LFD (n=2), Azathioprine (n=1). A significant improvement of dyspnea was observed; patients who didn9t have dyspnea, kept asymptomatic. FVC and HRCT showed a significant improvement during 6 to 12 months period. DLCO remained stable in the majority of the patients. RA (DAS28) activity also improved. After follow up of 12,82±7,48 months, the most significant adverse effects were: pulmonary Infection (n=2), urinary infections (n=1), infusion reactions (n=1). ABA was discontinued due to: Serious infections (n=2); join inefficacy (n=2), pulmonary inefficacy (n=1), infusion reaction (n=1). Conclusions ABA seems to be an effective and relatively safe treatment in patients with RA and associated ILD. This data should be verified again in prospective and randomized studies. Disclosure of Interest None declared

Objectives To know the characteristics of patients with rheumatoid arthritis (RA), in treatment with baricitinib (BARI), who have failed to conventional synthetic DMARD (DMARDcs) and/or biological DMARDs (DMARD). Methods Prospective observational study, in real life, of patients with RA, under treatment with BARI. General data of the patients, (age, gender, comorbidity), RA and treatment were collected (time of evolution, presence of RF and ACPA, efficacy indexes at the beginning of BARI and the last visit: DAS28-VSG and CDAI, previous or concomitant treatment with DMARDcs and/or DMARDb, end of treatment and cause, time in BARI, serious adverse effects during treatment with BARI. Results Of 529 patients in follow-up, who have received at least one dose of DMARDb, 224 (42%) are diagnosed with RA, and 58 (26%) of them receive some drug inhibitor of the JAK pathway; 40/224 (18%) of them BARI. The patients treated with BARI, 77% were women, mean age of 58.95 ± 10.8 years and mean evolution of RA of 9.6 ± 8.8 years. The mean BMI is 28.8 ± 1.8. The FR and ACPA are positive at 86% and 89%, respectively. 94% of patients continued concomitant treatment with some DMARDcs. BARI is the first drug after failure of DMARDcs (F1) in 24/40 (60%) patients, and in 16/40 (40%), after failure to some DMARDb: second drug after failure to DMARDb (F2) in 2 (6%), third (F3) in 5 (13%) patients, fourth (F4) in 6 patients (17%) and fifth (F5) in 3 (9%) patients. The mean global time in BARI is 9.6 ± 3.2 months, being for F1, F2, F3, F4, F5, of 7, 5.2, 7.7, 6.9 and 11.1 months, respectively. BARI patients, such as F1 versus F2-F5, presented significantly higher BMI (30.83 ± 2.6 vs. 26.95 ± 4.4, p Regarding safety, 1 patient presented herpes zoster. The results of clinical efficacy with DAS28-VSG and baseline CDAI and in the last evaluation are shown in the table. Conclusion 1. Baricitinib is effective and safe in real clinical practice. 2. It is competent of achieving clinical remission or low activity, in a high percentage of patients, even in those who have failed several biological drugs or several therapeutic targets previously. Acknowledgement The study was supported with a research grant from the Association for Research in Rheumatology of Marina Baixa (AIRE-MB) Disclosure of Interests Jose Rosas Consultant for: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Speakers bureau: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Jose Miguel Senabre-Gallego: None declared, Gregorio Santos Soler: None declared, Jose Antonio Bernal-Vidal: None declared, Esteban Salas-Heredia: None declared, Ana Pons: None declared, Catalina Cano: None declared, Estibaliz Ivars: None declared, Jose Alberto Garcia-Gomez: None declared, Xavier Barber: None declared

Objectives To know risk of admission due to infection in patients treated with biological drugs (DMARDb). Methods Case-control study, in patients admitted for infection, treated with DMARDb, from 2000-2018. As a control group, patients included, in treatment with conventional synthetic DMARDs (DMARDcs). General data (age, gender), disease (diagnosis, time evolution, DMARDb, time in DMARDb, DMARDcs); and infection (time in DMARDb to infection, location of infection, more than one admission). Results Of 364 patients, 48 (13%) admitted for infection: 32 (9%) treated with DMARDb, 16 (4%) with DMARDcs alone. When comparing patients admitted vs who do not, RA predominates and no differences in the treatment with DMARDb and/or DMARDcs, corticosteroids, type of DMARD or the infection. Of 275 patients with DMARDb, 41 admissions for infection in 32 patients (11.6%); more than once. 20 (62.5%), were women, with mean age 69.2±2.12 years, mean time evolution 24.5±22.6 years. Diagnosis was RA: 22 (69%) patients, ankylosing spondylitis: 7 (22%), psoriatic arthritis: 3 (9%). Concomitant with DMARDcs in 81% and 26% corticosteroid (mean dose: 4.6±2.6 mg). The diagnosis of 41 admitted was: Pneumonia: 9 (41%), non-pneumonic respiratory infection: 5 (24%), septic arthritis: 8 (24%), urinary infection-pyelonephritis urinary o sepsis: 8 (22%), influenza A: 3 (7%), abscess, gastroenteritis and leishmaniasis in 2 (5%) each, osteomyelitis and varicella in 1 (2%) each. The DMARDb at admission were: anti-TNF: 34 (83%) patients (adalimumab: 19/46%, etanercept: 7/17%, infliximab: 4/10%, golimumab and certolizumab: 2/5% each), tocilizumab: 4 (10%), abatacept: 2 (5%). When comparing patients admitted for infection, patients with DMARDb has higher number of admissions (41 (67%) vs 20 (33%), p Conclusion 1. The prevalence of admission due to infection in DMARDb is 9% and 4% in DMARDs in monotherapy. 2. Admission predominates in RA, with a long evolution, with biological therapy. 2. The most frequent infections were respiratory origin, followed by sepsis or bacteremia and septic arthritis. Acknowledgement The study was supported with a research grant from the Association for Research in Rheumatology of Marina Baixa (AIRE-MB). Disclosure of Interests Jose Rosas Consultant for: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Speakers bureau: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Ana Pons: None declared, Jose Alberto Garcia-Gomez: None declared, Jose Miguel Senabre-Gallego: None declared, Gregorio Santos Soler: None declared, Esteban Salas-Heredia: None declared, Jose Antonio Bernal-Vidal: None declared, Catalina Cano: None declared, Estibaliz Ivars: None declared, Xavier Barber: None declared

Objectives To know the impact of obesity on the risk of fracture. Methods Observational study, during 2010-2018, of patients referred for bone densitometry (BMD), to the Bone Densitometry Unit of Rheumatology. BMD performed by Rheumatology nursing, collect several data (age, gender); osteoporosis (OP) risk factors: age of menopause, smoking and current alcohol intake, hip fracture parents, body mass index (BMI), diseases-drugs that reduce bone mass, fractures, treatment; BMD in lumbar spine (LS), femoral neck (FN); FRAX with BMD. BMI result was as WHO recommendations in kg/m2: Normal: 18.5-24.99; Obesity: ≥30; type I: 30-34.99, type II: 35.39.99, type III: ≥40. Results A first BMD in 6.943 postmenopausal women was done. 2.196 (32%) had normal BMI, low weight (BMI Obesity (BMI ≥30 kg/m2) vs normal BMI, are older (65±13 vs 61±13, p=0.005), lower current smokers (12% vs 27%) P Conclusion In postmenopausal women referred for BMD, obese women vs normal BMI are 1. Older. 2. Overall, with higher percentage of fractures. 3. But, women with BMI≥ 40 kg/m2 do not have a higher overall percentage of fracture, except in DR. Acknowledgement The study was supported with a research grant from the Association for Research in Rheumatology of Marina Baixa (AIRE-MB) Disclosure of Interests Jose Rosas Consultant for: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Speakers bureau: Abbvie, Amgen, Bristol, Janssen, Lilly, Merck Sharp & Dohme, Pfizer, UCB Pharma, Catalina Cano: None declared, Ana Pons: None declared, Estibaliz Ivars: None declared, Jose Miguel Senabre-Gallego: None declared, Gregorio Santos Soler: None declared, Esteban Salas-Heredia: None declared, Jose Antonio Bernal-Vidal: None declared, Jose Alberto Garcia-Gomez: None declared, Xavier Barber: None declared

Our aim was to assess the relationship between serum adalimumab levels, anti-drug antibodies (ADA) and disease activity in patients with axial spondylarthritis (SpA). We have carried out a single-centre cross-sectional study. adalimumab and ADA levels were analysed with ELISA and correlated with SpA activity using BASDAI and ASDAS scores. Adalimumab cut-off value was calculated to discriminate inactive disease/low disease activity (BASDAI < 4; ASDAS < 2.1) from moderate/high disease activity (BASDAI = 4; ASDAS = 2.1), using a receiver operating characteristic (ROC) curve. Up to January 2016, 51 consecutive patients were included. The median (range) age was 46.6 (18-68) and 47.1% were women. ADA prevalence was 27.5%, with none detected in the 21.6% receiving concomitant disease-modifying antirheumatic drugs (DMARDs) (p = 0.021). Adalimumab level was normal (> 3 mg/l) in 36 patients (70.6%), all without ADA. Fifteen patients (29.4%) had subtherapeutic adalimumab levels (< 3 mg/l), with ADA in 14 (93%). Median adalimumab (mg/l) was significantly higher in patients with inactive disease/low disease activity: BASDAI < 4 vs = 4: 9.5 vs 2.6 (p < 0.01); ASDAS-CRP < 2.1 vs = 2.1: 9.3 vs 0.3 (p < 0.001); ASDAS-ESR < 2.1 vs = 2.1: 9.9 vs 3.0 (p < 0.001), and this finding was consistent with the result of the multivariate model. Patients with inactive disease/low disease activity presented significantly lower ADA levels. The adalimumab level cut-offs and area under the curve (AUC) obtained in the ROC curves were: ASDAS-CRP (< 2.1) 4.6 mg/l (AUC 81.2%; 95% CI 67.5-94.9; p < 0.001); ASDAS-ESR (< 2.1) 7.7 mg/l (AUC 82.4%; 95% CI 69.3-95.5; p < 0.001); BASDAI (< 4) 6.4 mg/l (AUC 73.5%; 95% CI 58.6-88.3; p < 0.01). In conclusion, presence of ADA in axial SpA patients treated with adalimumab was associated with lower serum drug levels. ADA levels were lower and adalimumab levels were higher in patients with inactive disease/low disease activity based on BASDAI and ASDAS indices. Concomitant treatment with MTX reduces de likelihood of finding ADA. Serum adalimumab levels above 4.6 mg/l are recommended to avoid compromising efficacy.

Background The EPIPHANY decision tree is the first algorithm developed to predict serious complications in patients with cancer and pulmonary embolism (PE) (PMID: 28267709). Methods The objective is to evaluate the discriminatory ability of EPIPHANY in a prospective multicenter cohort. Patients with PE diagnosed by objective methods were recruited from October 2017 to April 2019. The association between the increase in prognostic category and in complications at 15 days was assessed using the linear by linear association test. Results The sample contains 463 patients with PE (39.7% suspected and 60.3% unsuspected). 68.3% (n = 316) showed clinical or haemodynamic instability, while 31.7% (n = 147) were normotensive PE with apparent clinical stability. The breakdown of initial risk criteria is: sudden or progressive dyspnea (58.7%), tachycardia >110 lpm (17.3%), hypotension 30 rpm (3.2%), thrombopenia Conclusions EPIPHANY is the only model available for the classification of patients with cancer and PE, based on their short-term risk of complications, with potential implications for decision making. Legal entity responsible for the study Asociacion de Investigacion de la Enfermedad Tromboembolica Venosa de la Region de Murcia. Funding Leo Academy. Disclosure M. Sanchez Canovas: Research grant / Funding (institution): Leo Pharma. All other authors have declared no conflicts of interest.

Análisis energético a lo largo de un año de uso de un edificio de oficinas ubicado en Vitoria, teniendo en cuenta para ello la envolvente térmica del edificio, así como las instalaciones térmicas y eléctricas de este, tales como: la instalación de iluminación, de climatización, de ventilación y la instalación de producción de Agua Caliente Sanitaria, utilizando la herramienta informática de simulación energética Calener GT. Se trata de proporcionar una visión global del comportamiento energético del edificio junto con el de sus instalaciones térmicas y eléctricas.

This article estimates the frequency of cardiovascular (CV) events that occurred after diagnosis in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigates the main risk factors for atherosclerosis. RELESSER is a nationwide multicenter, hospital-based registry of SLE patients. This is a cross-sectional study. Demographic and clinical variables, the presence of traditional risk factors, and CV events were collected. A CV event was defined as a myocardial infarction, angina, stroke, and/or peripheral artery disease. Multiple logistic regression analysis was performed to investigate the possible risk factors for atherosclerosis. From 2011 to 2012, 3658 SLE patients were enrolled. Of these, 374 (10.9%) patients suffered at least a CV event. In 269 (7.4%) patients, the CV events occurred after SLE diagnosis (86.2% women, median [interquartile range] age 54.9 years [43.2–66.1], and SLE duration of 212.0 months [120.8–289.0]). Strokes (5.7%) were the most frequent CV event, followed by ischemic heart disease (3.8%) and peripheral artery disease (2.2%). Multivariate analysis identified age (odds ratio [95% confidence interval], 1.03 [1.02–1.04]), hypertension (1.71 [1.20–2.44]), smoking (1.48 [1.06–2.07]), diabetes (2.2 [1.32–3.74]), dyslipidemia (2.18 [1.54–3.09]), neurolupus (2.42 [1.56–3.75]), valvulopathy (2.44 [1.34–4.26]), serositis (1.54 [1.09–2.18]), antiphospholipid antibodies (1.57 [1.13–2.17]), low complement (1.81 [1.12–2.93]), and azathioprine (1.47 [1.04–2.07]) as risk factors for CV events. We have confirmed that SLE patients suffer a high prevalence of premature CV disease. Both traditional and nontraditional risk factors contribute to this higher prevalence. Although it needs to be verified with future studies, our study also shows—for the first time—an association between diabetes and CV events in SLE patients.

This article estimates the frequency of cardiovascular (CV) events that occurred after diagnosis in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigates the main risk factors for atherosclerosis. RELESSER is a nationwide multicenter, hospital-based registry of SLE patients. This is a cross-sectional study. Demographic and clinical variables, the presence of traditional risk factors, and CV events were collected. A CV event was defined as a myocardial infarction, angina, stroke, and/or peripheral artery disease. Multiple logistic regression analysis was performed to investigate the possible risk factors for atherosclerosis. From 2011 to 2012, 3658 SLE patients were enrolled. Of these, 374 (10.9%) patients suffered at least a CV event. In 269 (7.4%) patients, the CV events occurred after SLE diagnosis (86.2% women, median [interquartile range] age 54.9 years [43.2-66.1], and SLE duration of 212.0 months [120.8-289.0]). Strokes (5.7%) were the most frequent CV event, followed by ischemic heart disease (3.8%) and peripheral artery disease (2.2%). Multivariate analysis identified age (odds ratio [95% confidence interval], 1.03 [1.02-1.04]), hypertension (1.71 [1.20-2.44]), smoking (1.48 [1.06-2.07]), diabetes (2.2 [1.32-3.74]), dyslipidemia (2.18 [1.54-3.09]), neurolupus (2.42 [1.56-3.75]), valvulopathy (2.44 [1.34-4.26]), serositis (1.54 [1.09-2.18]), antiphospholipid antibodies (1.57 [1.13-2.17]), low complement (1.81 [1.12-2.93]), and azathioprine (1.47 [1.04-2.07]) as risk factors for CV events. We have confirmed that SLE patients suffer a high prevalence of premature CV disease. Both traditional and nontraditional risk factors contribute to this higher prevalence. Although it needs to be verified with future studies, our study also shows-for the first time-an association between diabetes and CV events in SLE patients.

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 20 juillet 2015