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Background: Gastric angiodysplasia and the typical “watermelon stomach” aspect is one of the most characteristic vascular manifestations in systemic sclerosis (SS). These angiodysplasias can affect the intestine ocasionally as well as the stomach. Objectives: Description of a series of 5 patients with systemic sclerosis and presence of intestinal angiodysplasia (IA). Methods: Retrospective unicentric observational study in a tertiary hospital. Demographic data, comorbidities, manifestations of the disease, serological profile, concomitant treatments and bleeding manifestations, as well as endoscopic findings and received treatment were collected. Descriptive statistics was used to present the data. Results: We reviewed the medical records of the 88 patients with a diagnosis of SS followed up in the Rheumatology Service. Five cases (5.6%) of IA were identified (4 women and one male), with a mean age of 73 years (SD 13.71). In one case, the diagnosis of SS and IA was simultaneous. In the remaining 4 cases, the mean time from the diagnosis of ES to the diagnosis of the IA was 7.75 years (SD 2.6). Regarding the clinical presentation, 4 of the cases presented as anemia with iron deficiency. In these cases IA were found in the endoscopic studies. In one case, IA were a finding in the context of the study of diarrhea. In 4 of the cases, the IA were in the small intestine, so the diagnosis was made using an endoscopic capsule. In one case they were found in the colon, so the diagnosis was by colonoscopy. Only one of the cases of angiodysplasias in the small intestine required specific treatment with argon laser by enteroscopy. One case required a transfusion of packed red blood cells. In the remaining cases, treatment with oral or intravenous iron therapy was enough. In all 5 cases, it was a limited form of the SS with the presence of anticentromere antibodies. All cases presented Raynaud’s phenomenon, 3 of them with digital ulcers. Three of the cases associated primary biliary cholangitis, 3 cases pulmonary hypertension, 3 cases peristaltic involvement, 1 case interstitial lung disease and 1 case restrictive cardiomyopathy. As comorbidities, we identified 1 case of essential mixed cryoglobulinemia associated with hepatitis C virus, 2 cases of valvular heart disease, 2 cases of atrial fibrillation. Conclusion: The extragastric localization of the angiodysplasias should be taken into account in the patient with SS and iron deficiency, especially in those with a limited form of the illness and positive anticentromere antibodies Disclosure of interests: Carolina Merino argumanez: None declared, Olga Rusinovich: None declared, Maria Espinosa: None declared, Consuelo Ramos Giraldez Speakers bureau: Sanofi, Carmen Barbadillo Mateos: None declared, Jose Luis andreu Sanchez: None declared, Hilda Godoy: None declared

Background: The time of rheumatoid arthritis (RA) evolution until treatment begins is key to controlling the disease. Many studies have shown that a prolonged duration of symptoms at the onset of treatment is associated with a more severe course of RA. The time from symptoms onset to first DMARD prescription is >12 weeks in Spain, because of diagnostic delay due to either patient-related factors (delay in consultation), Primary Care Physician (PCP) (delay in citation/referral) or rheumatologist (delay in citation). Objectives: To evaluate the usefulness of teleconsulting as a preferred referral tool from PCP to Rheumatology for early detection, diagnosis and treatment of inflammatory joint disease in adults, in the health area of a tertiary hospital. Methods: A preferential referral circuit was established between the PCP and the Rheumatology Service of a tertiary hospital, defining the referral criteria as “patient suspected of recent onset arthritis (ROA)”: arthritis or inflammatory arthralgia in >1 peripheral joint for >2 weeks with neither traumatic cause nor previous diagnosis of rheumatic disease. PCP performed first assessment, the request for initial tests (blood test including acute phase reactants, rheumatoid factor ± ANA, elemental urine and hands radiography) as well as the referral to Rheumatology with “ROA suspicion” motive. These consultation requests were cited from the Rheumatology Service within Before the protocol was established, its functioning was communicated as a face-to-face clinical session: by 2 rheumatologists in a Health Centre (HC) and by 1 PCP in the rest of the HC in the area. A poster was edited and published, exposing criteria and referral method for PCP‘s offices. Results: During the first 6 months 33 patients were correctly referred. 78.8% were women and the average age was 49 years old. 48.8% (16 patients) were diagnosed with some inflammatory arthropathy: 31.5% were RA (5 cases); other diagnoses were arthropathy due to microcrystals deposit (2), overlap SLE/RA (1), MCTD(1), psoriatic arthritis (1), spondyloarthritis associated with IBD (1) or inflammatory arthralgia associated with retroperitoneal fibrosis (1). 12% (4 patients) were diagnosed with hands incipient osteoarthritis and 33.8% (12 patients) with arthralgias without data on inflammatory pathology. One patient missed her follow-up. The median time from symptom onset to Rheumatology assessment was 90 days in all patients; in the inflammatory pathologies subgroup, 68.8% was assessed in Conclusion: In our experience, the establishment of a specific protocol in collaboration with Primary Care for the preferential referral of patients with suspected recent onset arthritis, obtained diagnoses not only for patients with rheumatoid arthritis, but also for other systemic autoimmune diseases in early stages, as well as early treatment initiation ( Disclosure of Interests: Consuelo Ramos Giraldez Speakers bureau: Sanofi, Maria Espinosa: None declared, Carolina Merino Argumanez: None declared, Patricia Fernandez Crespo: None declared, Olga Rusinovich: None declared, Fernando Leon Vazquez: None declared, Jose Luis Andreu Sanchez: None declared, Carmen Barbadillo Mateos: None declared

Background: Belimumab is a human IgG1l monoclonal antibody directed against BAFF, a B lymphocyte survival factor. It is indicated as adjuvant treatment in adult patients with active systemic lupus erythematosus (SLE), with positive autoantibodies and with a high degree of activity of the disease despite standard treatment. Objectives: This study aims to describe a sample of patients diagnosed with SLE who received treatment with belimumab in a tertiary hospital. Methods: Retrospective longitudinal unicentric observational study. Clinical records of all patients diagnosed with SLE who had received treatment with belimumab were reviewed. Demographic characteristics, clinical manifestations and reason for belimumab indicaton were collected. Results: The twelve patients included in the sample were women. Median age was 48.5 years (31-70). The most frequent reason for indication of belimumab was uncontrolled arthritis. The average time of treatment with belimumab in the total sample was 27.5 (+/- 26.24) months, with a median of 12 months (4-78). Mean treatment time (cases in which belimumab was discontinued excluded) was 31.25 (+/- 26.98) months with a median of 25 (5-78). The average dose reduction of prednisone after initiation of treatment with belimumab (in patients in which it was considered effective) was 5 mg per day (+/- 5). It should be noted that of the 14 cases, treatment was only discontinued in 4 patients, 2 of which were withdrawn due to ineffectiveness. There were 2 adverse events that required drug withdrawal: neutropenia and urothelial carcinoma. (Table). Conclusion: BLM is a well tolerated drug and effective in clinical practice. Adverse effects leading to drug withdrawal are infrequent. Disclosure of Interests: Carolina Merino Argumanez: None declared, Olga Rusinovich: None declared, Consuelo Ramos Giraldez Speakers bureau: Sanofi, Maria Espinosa: None declared, Hilda Godoy: None declared, Carmen Barbadillo Mateos: None declared, Jose Campos Esteban: None declared, Mercedes Jimenez Palop: None declared, Jesus Sanz: None declared, Luis Fernando Villa Alcazar: None declared, Carlos Isasi Zaragoza : None declared, Monica Fernandez Castro: None declared, Jose Luis Andreu Sanchez: None declared

Background Systemic sclerosis (SE) is a serious disease of the connective tissue characterized by dysfunction of the microcirculation. Angiogenesis is a complex process regulated by both angiogenic and angiostatic factors. Normally the functions of these factors are under an adequate balance, however, under certain conditions these factors can be induced initiating disorganized angiogenic phenomena. Objectives For the first time, the levels of intraplatelet growth and angiogenic factors (normalized by platelet number and volumen) are described in patients with systemic sclerosis. Methods We included 23 patients with systemic sclerosis (ACR/EULAR) and 16 controls. Patients underwent a platelet-apheresis to obtain platelet-rich plasma (PRP) and platelet-poor plasma (PPP). The samples were subjected to a freeze-thaw process to break the cell membranes and release the platelet content. Subsequently the various factors were measured (VEGF-α, PDGF ββ, HGF, FGF2, G-CSF, MCP-1, IL-1α, IL-1β, IL-8, IL-6, IL-13). Finally, the results were normalized according to the value of the plaquetocrit (number and volumen of platelets). We compared the levels in platelet-rich plasma and in platelet-poor plasma. A cut-off value p Results The mean age of the patients was 52 years ± 9.71, with a duration of the disease of 8 years, 74% were patients with limited SE, 70% of the patients had pulmonary involvement. Both patientes and controls, the TFG-β was 12 times more concentrated in PRP than in PPP (p Conclusion The levels of VEGF-α (intraplatelet) are lower in patients with SE vrs controls (p Reference [1] Choi JJ, et al. Elevated vascular endothelial growth factor in systemic sclerosis. J Rheumatol2003; 30: 1529-33. Acknowledgement Patients and bank blood secretary. Disclosure of Interests Bryan-Josue Flores Robles Grant/research support from: Transport and hotel, Maria-Alejandra Sanchez : None declared, Jose Luis Bueno cabrera : None declared, Lucia Nunez Martin-Buitrago : None declared, Cristina Gomez Casado: None declared, Juan Mulero Mendoza: None declared, Hilda Godoy: None declared, Valvanera Pinillos: None declared, Eztizen Labrador-Sanchez: None declared, Juan Antonio Lopez-Martin: None declared, Angel Elena-Ibanez: None declared, Leticia Merino-Melendez: None declared, Jose Luis Andreu Sanchez: None declared

Background One of the missions of the Spanish Society of Rheumatology (SER) is to provide professionals involved with the necessary tools to ensure a better care for patients suffering from a rheumatic disease. Up to now, there is no benchmark that quantifies the complexity of medical acts in this specialty. Therefore, there is a need to adopt a physician activity scale that would allow assessment of their professional activity and skills regarding patient care. Objectives To compile a nomeclature of medical, diagnostic, and therapeutic procedures in the field of rheumatology; and to establish a hierarchical classification system according to a complexity index. Methods A list of care, diagnostic, and therapeutic acts was compiled based on the nomenclature created by Drs Fernandez and Olive. The hierarchical classification system was based on the construction of a complexity index which was calculated by two factors: time of completion and degree of complexity of each act. Time of completion was stated according to the document “Standards of Process Time and Patient Care Quality” by Dr Alonso. The degree of complexity of each rheumatologic act was agreed thanks to a panel of experts using a Delphi technique in two rounds. Subsequently, it was validated against a questionnaire which was sent to the 1144 partners of SER via its web. Results The total of included acts was 54. The results obtained with the Delphi method tended to show a consensus of opinion (media σ2 - σ1=0.75–1.43=-0.68, media IQR2 – IQR1=0.8–1.9=-1.1). Furthermore, a validation of these results was carried out through a massive survey among the partners of SER. The survey results showed a high degree of agreement (at least 70.0 per cent of the partners agreed or strongly agreed with the complexity of each act). The degree of complexity in successive visits was 100. In the query section for consultations, the highest scores were obtained by first visit to hospitalized patient (366) and home visit (369). Regarding diagnostic techniques, the highest scores were obtained with biopsies: bone (465), sural nerve (416), and synovial (380). Also worth mentionioning the scores obtained by ultrasound scan (204), capillarioscopy (113) and densitometry (112). Regarding therapeutic techniques, intra-articular injection under sedation in children obtained a score of 388; while intra-articular injection with ultrasound control obtained a score of 163. The clinical report of disability was agreed to have a score of 323, and the expert report obtained a score of 370. Conclusions This work has made it possible to create a nomenclature of 54 acts in Rheumatology where biopsies (bone, sural nerve, synovial), visits to hospitalized patients, home visits, infiltration under sedation in children, and expert reports are identified as the most complex acts. Musculoskeletal ultrasound is considered twice as complex as a successive visit, capillaroscopy, or bone densitometry. These results will make it possible to improve patient care and establish a solid and agreed foundation to negotiate the provision of public and private services. Disclosure of Interest None declared

Background Primary Sjogren9s syndrome (pSS) is a chronic systemic autoimmune disease often accompanied by analytical abnormalities. Altered levels in serum protein concentration, blood cell count and autoantibodies contribute to the broad spectrum of biological manifestations that characterize pSS. Objectives The objective of this study is to evaluate the presence of laboratory abnormalities in patients with pSS from the SjogrenSER registry. Methods We conducted a multicentre transversal study of a cohort of pSS patients fulfilling 2002 European/American criteria, from 33 Spanish rheumatology departments. Every patient was interviewed for data collection and signed an informed consent. Data were also collected by reviewing medical records. Local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians and rates. Chi-square was used to establish the statistical associations. A p Results Four hundred and thirty-seven patients were included. Ninety-five percent of them were women. The median age of the cohort was 58 years. AntiRo antibodies were present in 93.6% of patients and AntiLa antibodies in 67.3% of patients. All patients were ANA+. Rheumatoid factor (RF) was positive in 64.8% of patients. Low levels of C3 and C4 were observed in 14.87% and 14.19% of patients, respectively. Polyclonal hypergammaglobulinemia (HGG) was present in 53% of patients. Thirteen patients had cryoglobulins (2.97%). An increase in β2microglobulin was observed in 22.2% of patients. Fifty-six percent of the patients had hematological involvement: 29% of the patients had anemia, 38% had leukopenia (38% lymphopenia, 10.5% had neutropenia), and 9% had thrombocytopenia. The median ESR was 25 mm. Age at diagnosis and age at onset of symptoms were significantly lower in patients presenting RF+ vs RF- (48.71 vs 53.73, p Conclusions in SjogrenSER registry all patients were serologically positive. More than half of the patients presented abnormalities in serum proteins and 14% had hipocomplementemia. More than half of the patients had abnormalities, mostly leucopenia and lymphopenia. Patients with analytical alterations were younger at the time of diagnosis and had more often elevated ESR and higher ESSDAI score. Disclosure of Interest None declared