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Background:SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is an acronym created with the aim of encompassing within the same entity the findings present in a heterogeneous group of patients with various osteoarticular and cutaneous disorders. For years it has been debated whether it is an entity itself or if, on the contrary, it is a specific phenotype of psoriatic arthritis.Objectives:Determine the relationship between SAPHO syndrome and psoriatic arthritis by comparing the classic criteria of SAPHO with CASPAR in patients previously diagnosed with SAPHO.Methods:A retrospective study where patients with a diagnosis of SAPHO in the same center (1984-2018) were reviewed. Of a total of 95 patients that met the criteria of Benhamou et al., 46 were excluded due to lack of information to complete the minimum necessary data, so 39 patients were finally included in the study. Demographic data were registered, age at diagnosis, CASPAR criteria (active psoriasis, history of own or familial psoriasis, nail psoriasis, negative RF, dactylitis and new formation/juxta-articular bone proliferation), classical criteria of SAPHO and HLAB27. For the statistical analysis, a Chi-square is applied to determine the differences between the groups with / without CASPAR criteria.Results:Of the sample of 39 subjects diagnosed with SAPHO, 15 patients (38%) met CASPAR criteria (4M/11W), with a median age at diagnosis of 42 years (range 21-50). Of them, 8 (60%) had active cutaneous psoriasis, 10 (73%) had a family or personal history of psoriasis, 6 (40%) had psoriatic nail dystrophy, 14 (93%) had negative FR, 3 (20%) had presented some episode of dactylitis and 10 (73%) had juxta-articular new bone formation. Of the 15 patients who met CASPAR criteria, 9 (67%) had synovitis, 2 (13%) acne, 4 (26%) pustulosis, 13 (87%) hyperostosis and 12 (80%) osteitis. HLAB27 was positive in 1 patient (2.5%) of the group that met CASPAR criteria. Of the patients who did not fulfill CASPAR criteria (9M/15W), the median age at diagnosis was 44.5 years (range 10-70). None of them had active cutaneous psoriasis, psoriatic nail distrophy or dactylitis, 1 (4%) had a family or personal history of psoriasis, all had RF- and 3 (12.5%) had juxta-articular bone new formation (Table 1). Synovitis was observed more frequently in patients who met CASPAR criteria than in those who did not (67% vs 25%, p 0.01). In contrast, osteitis was present more frequently in patients who did not meet CASPAR criteria (80% vs 96% p 0.05) and pustulosis, although it was not statistically significant (50% vs 26%, p 0.07). Among patients who did not meet CASPAR criteria only 1 met the 5 classic SAPHO criteria and another 3 met 4.Table 1.Conclusion:Approximately one third (38%) of patients diagnosed with SAPHO meet criteria for psoriatic arthritis, the most notable variables being active psoriasis or a history of psoriasis. Synovitis manifests more frequently in patients with CASPAR criteria and osteitis more present in patients who did not meet them.Acknowledgments:Rheumatology Service of the Germans Trias i Pujol HospitalDisclosure of Interests:None declared

Background:There are several studies assessing bone mass and osteoporosis (OP) development of patients with giant cell arteritis (GCA) during glucocorticoid treatment, however data at time of diagnosis is scarce.Objectives:To analyze bone metabolism, bone mineral density (BMD) and trabecular microarchitecture by measuring trabecular bone score (TBS) in patients with recent diagnosis of GCA.Methods:Retrospective observational study in which we included all patients with GCA and bone metabolism assessment at diagnosis. We recorded: risk factors for OP (previous fractures and anti-OP treatments), bone metabolism (calcium, phosphate, PTH, 25-vitaminD [25-OHD]) and the DXA results (Lunar, DPX) at the time of diagnosis and during the follow-up. The statistic analysis was made with SPSS.Results:36 patients (27 W: 9M) with a mean age of 76±9 years were included. The clinical characteristics of the GCA at diagnoses were: headache (81%), constitutional syndrome (58%), allodynia (42%), visual loss (42%, binocular in 2 patients), jaw claudication (39%), polymyalgic syndrome (28%), amaurosis fugax (25%) and lingular necrosis (n=1, 3%). Additional diagnosis tests included: temporal biopsy (86%, being pathologic in 55%), temporal ultrasound (97%, pathologic 34%), extra-cranial arteries ultrasound (81%, pathologic 7%) and PET/CT (19%, pathologic 86%). Up to 61% received three metilprednisolone bolus (mean dose 1700mg). 7 patients (19%) had previous OP and 3 had already suffered a fragility fracture (Colles, vertebral and femur). Only 4 patients were receiving anti-OP treatment (2 oral bisphosphonate, 2 zoledronate).At time of diagnosis of GCA, the mean of 25OHD was 17±13ng/mL (88%, Conclusion:Low bone mass and vitamin D insufficiency are frequent in patients with recent diagnoses of GCA and up to 38% have poor bone microarchitecture at baseline. Thus, it’s important to perform a bone mass assessment in all patients with recent diagnose of ACG and initiate therapeutic or preventive anti-OP treatment if required.Disclosure of Interests:None declared

Background:The incidence and factors related to an inadequate response to denosumab (Dmab) treatment remain unclear.Objectives:To describe clinical, analytical and densitometric characteristics of patients with inadequate response (IR) to Dmab in clinical practice. IR was defined as the presence of a new fracture [fxs-IR] or a significant decrease in BMD (≥5% lumbar or ≥4% femoral) [BMD-IR].Methods:retrospective study of patients with IR to Dmab treatment. Data of demographic variables, risk factors for osteoporosis, history of fractures, previous anti-osteoporotic treatment, densitometric and analytical parameters were collected before and after IR.Results:22 patients were included (19W:3M) with mean age of 75±10years. The causes of osteoporosis were: postmenopausal (50%), induced by glucocorticoids (22.7%), alcoholic (9.09%) and multifactorial (18.8%). Most patients were previously treated with bisphosphonates (59.09%, duration 5.2±2.6y) and had previous vertebral fractures (54.54% %, median 3).During Dmab treatment, 10 patients presented a BMD-IR (with a mean bone loss up to -3.5% at femur and -5.8% at lumbar spine) and 12 had fxs-IR (vertebral [n=8], humerus [n=1], pelvis [n=1], tibia [n=1]). No significant differences were observed in duration of Dmab between both IR groups (Fxs-IR: 3,2±1,9 vs BMD-IR: 2,4 ± 1,2y). In the BMD-IR, the BMD loss was higher at lumbar spine than at total hip (-6.6%±3.7 vs -1.9%±4.8). Only 1 patient of the fxs-IR had a secondary cause of IR (mieloma multiple).In the fxs-IR group, most patients started combined treatment with teriparatide (n=4), 1 changed to teriparatide and 7 remained with Dmab. In the BMD-IR group, most mantained Dmab treatment (n=8) and 2 switched to zoledronate.Conclusion:Most patients who developed IR to Dmab had been previously treated with bisphosphonates and had previous fragility fractures and appears within the first 3 years of treatment. BMD loss seems to be more marked at spine than total hip. Only one patient had a secundary cause of IR.Disclosure of Interests:None declared

Background Osteoporosis is defined as a systemic skeletal disease characterized by low mineral density and microarchitectural changes in the bone which increase its fragility and fracture risk. Ankle fracture is one of the most common fractures; however the relation with osteoporosis is still being debated. The diagnosis and treatment of osteoporosis is not always adequate. Objectives To determine the relation of ankle fractures to osteoporosis Methods Retrospective study 2008–2014. Center: Tertiary academic hospital with a referral area of 850,000 inhabitants. The medical charts, bone mineral density (BMD), radiographs and electronic data bases of patients with ankle fracture were reviewed. Demographic data (age, gender), BMD, mechanism of injury (high or low energy trauma), fracture pattern (single malleolus, bimaleollar and trimalleolar fracture) and treatment of fracture and osteoporosis were collected. Patients were divided into younger age (≤60years) and older age (>60 years) groups. Results A total of 299 patients with ankle fractures were included. The mean age was 49.5 years (DS 26.5). There were 131 (43.8%) male and 168 (56.2%) female patients. Among these patients, 84 (28.1%) were in the older age group (74% female and 26% male) and 216 (72.2%) were in the younger age group (51% male and 49% female). Bimaleolar fracture was the most common pattern in both groups (62.7% and 50.5%). Proportion of low energy trauma and conservative treatment was higher in elderly group compared to younger group (63.9% vs 38%, p 0.002/20.5% vs 8.3%; p 0.003). Of note 34 (11.7%) of patients underwent a dual-energy X-ray absorptiometry (DXA): 17 (50%) in the elderly group and 17 (50%) in younger (82% were older than 50 years). In the older group only 1 (5.9%) patient had a normal BMD, 8 (47.1%) had osteopenia and 8 (47.1%) had osteoporosis. Compared with younger patients, osteoporosis was more frequent in older group (10.8% vs 1.4%; p Conclusions Ankle fracture was more common in females in the older group. DXA was performed in a very low percentage of cases. The features of ankle fractures and the higher ratio of new fractures in the older group suggest a possible link with osteoporosis. Patients with ankle fracture should be studied in order to diagnose osteoporosis. These patients may have a benefit of treatment. Disclosure of Interest None declared

Background Systemic vasculitis (SV) comprises a group of diseases characterized by inflammation of vessels in various organs. Histopathological confirmation is required for the diagnosis. The biopsy of an involved organ is invasive and carries the risk of complications. By contrast, gastrocnemius muscle biopsy is simple and minimally invasive technique that may be performed by a rheumatologist. Objectives To evaluate the diagnostic use of muscle biopsies for the diagnosis of SV. Methods Retrospective study 1984 - 2015. Center: tertiary academic hospital, referral area 850.000 inhabitants. We analyzed the database of all muscular biopsies performed at our hospital. We selected patients undergoing a muscular biopsy for possible diagnosis of SV and we analyzed the clinical, laboratory, neurophysiological and pathologic data. Biopsies were classified as positive (presence of necrotizing vasculitis or non necrotizing vasculitis seen by optical microscopy) or negative for vasculitis. Muscular biopsy was performed in all cases at the medial gastrocnemius muscle (“open” and unilateral) by a rheumatologist. The diagnosis of SV was based on clinical, serological and histological data. Results A total of 619 muscular biopsies were performed, 55 were indicated with suspicion of SV, 52.7% female, 47.3% male, median age 64.4 years (DS 15.22); 47 (85.4%) were positive (sensitivity of 85%) and 8 (14.6%) were negative. The positive biopsy group showed more electromiographic alterations (p=0.01) than negative group. Furthermore, the positive biopsy group showed more frequently systemic manifestations such as: weight loss, myalgia, paresthesias, purpura and testicular pain but these differences were not statistically significant. No complications were encountered in the procedure. Conclusions Our results suggest that muscle biopsy is a simple, clinically useful, safe and minimally invasive procedure for the diagnosis of SV with high sensitivity. No significant differences were observed in clinical or analytical features between patients with positive or negative biopsy, except in electromyography patients with positive biopsy had more a frequent pathological pattern. Disclosure of Interest None declared

Background Osteoporosis is a major health problem worldwide and leads to several million fractures every year. Diabetes mellitus (DM) and obesity are an increasing threat for global health. While the pathophysiology of diabetic bone disease is unknown, some recent studies have demonstrated an increased fracture risk related to type 2 DM. Type 1 DM has also been associated with a decreased bone mineral density (BMD). Objectives To investigate the relationship between DM and obesity, and their relation to osteoporosis and ankle fractures. Methods Retrospective study 2008–2014. Center: tertiary academic hospital with a referral area of 850,000 inhabitants. The medical charts, dual-energy X-ray absorptiometry (DXA), radiographs and electronic data bases were retrospectively reviewed of patients seen for ankle fractures. Patients were classified in 4 groups: obesity (IMC>30), non-obesity, diabetic and non-diabetic. We compared demographic data (age, gender), mechanism of injury (high or low energy trauma), pattern of fracture (single malleolus, bimaleollar and trimalleolar), treatment of the fracture, presence of new fracture (in other localizations) and osteoporosis treatment Results We compared a total of 65 diabetic patients (32.3% male and 67.7% female, mean age 61.8 years [DS 17.6]) with 234 non-diabetic patients (52.9% male, 47.1 female, mean age 31.5 [DS 41.7]) and 40 obese patients (37.5% male and 34.7% female, mean age 42 years [DS 21.2]) with 76 non obese patients (38.2% male, 61.8% female). The main characteristics of the study groups are presented in Table 1. There were no differences in fracture pattern, mechanism of injury, BMD and fracture treatment among all groups. Bimaleolar fracture was the most common pattern in all groups. Diabetic group had higher frequency of a low energy trauma, osteoporosis and new fracture. New fracture was reported in 12 patients, between 3 and 48 months (after the ankle fracture). There was 5 Colles9fracture, 3 hip, 2 in other localization. One patient had two fractures (Colles and vertebral) Obese group had higher frequency of osteopenia compared with non obese. Conclusions We did not found statistical differences between diabetic and obese compared with non diabetic or non obese patients. Ankle fracture in diabetic group could have features of osteoporotic injury including the high frequency of new fracture. Disclosure of Interest None declared

Background Tocilizumab (TCZ) is a humanized anti-IL-6 receptor-blocking monoclonal antibody used for the treatment of rheumatoid arthritis (RA), idiopathic juvenile arthritis (IJA) and off-label in Adult Onset Still Disease (AOSD). The development of anti-TCZ antibodies could reduce treatment efficacy or induce treatment failure. Objectives To analyse TCZ serum levels and antidrug antibodies (ADA) in a cohort of RA, IJA and AOSD patients treated with TCZ, and to evaluate its relationship with Disease Activity Score using a 28-joint count (DAS28), C-reactive protein (CRP) levels and the presence of combined treatment with glucocorticoids or DMARDs. Methods Cross-section study including all patients undergoing chronic treatment with TCZ in a tertiary academic hospital. Referral area: 850,000 inhabitants. Twenty-two patients were included. TCZ serum and ADA levels were measured by ELISA (Theradiag) at baseline (before infusion), 15 days and 30 days after infusion. Results Twenty-two patients were studied: 18 RA, 3 IJA and 1 AOSD, 81.8% female; mean age and mean disease duration: 54.2 (±13) and 15.5 (±12) years respectively; 73% of the RA patients were positive for anti-CCP and 70% for rheumatoid factor, mean DAS28-CRP at day 0 and 30: 2.9 and 2.6 respectively. Fifteen patients were treated with TCZ for more than 1 year (range 12-58 months), 19 were treated with TCZ at 8 mg/kg, 2 at 6mg/kg, and one at 5mg/kg every 4 weeks due to low disease activity. Thirteen patients received TCZ in monotherapy, 9 received DMARDs combined treatment, 10 with glucocorticoids (mean dose 4mg/day, range 2-10mg). TCZ serum levels were at baseline: 1.2- 61.7 μg/ml, 15 days: Conclusions Levels of TZC were heterogeneous. Our patients showed no presence of ADA, this data suggest that TCZ has a low immunogenic potential. No correlation was found in disease activity and TCZ serum levels, but we found a relation with CRP levels. Patients with DAMRDs or without glucocorticoids showed higher levels of TCZ. We did not find correlation between combined treatment with DMARDs or glucocorticoids and levels of TCZ. Our study was limited due to a low sample size; we cannot exclude the correlation between TCZ and DAS28-CRP in a higher sample of patients. References Dougados M, Kissel K, Conaghan PG et al. Clinical, radiographic and immunogenic effects after 1 year of tocilizumab-based treatment strategies in rheumatoid arthritis: the ACT-RAY study. Ann Rheum Dis. 2014;73(5):803-9 Van Herwaarden N, Herfkens-Hol S, van der Maas A, et al. Dose reduction of tocilizumab in rheumatoid arthritis patients with low disease activity. Clin Exp Rheumatol. 2014;32(3):390-4 Disclosure of Interest None declared

Background Behcet9s disease is a recurrent systemic vasculitis which may have neurological manifestations: Neuro-Behcet (NB). The estimated frequency is 1-59%. It is more common in males. Central neurological system (CNS) involvement, presenting as pseudotumoral masses are very rare Objectives To describe the clinical characteristics, incidence, treatment, and outcome of patients diagnosed of pseudotumoral neuro-Behcet disease. We performed a systematic review of cases reported in the literature. Methods Desing: retrospective (1984-2014). Location: Two University hospitals. A hundred and fifty five patients records were reviewed with a diagnosis of Behcet9s disease from the Rheumatology service data base. Inclusion criteria: patients with pseudotumoral neuro-Behcet. A systematic search of all published cases with this diagnosis through PubMed was also performed. (1987-2014, keywords: pseudotumoral, neuro-Behcet) Results Three new cases of pseudotumoral Neuro-Behcet were identified. After a systematic review, other 27 cases were found with this diagnosis. The whole series were composed of 30 patients: a predominance of male (73.3%) was observed, with a mean age: 39.2±12.1 (range: 23-63 years). The mean duration of Behcet9s disease prior to the diagnosis of NB, was 9.3±7.8 years, in 50% of patients. The diagnosis was performed simultaneously or later in the remaining patients. The location of the lesion was: capsular thalamus region 15 (50%), peduncle and cerebellar 4 (13.3%), fronto parietal region 2 (6.7%), fronto temporal and temporo -occipital region in 1 (3.3%). Four (13.3%) patients presented more than one lesion. In 14 (46.7%) patients biopsy of the brain mass was performed in order to confirm the diagnostic. All reported patients were initially treated with high-dose of glucocorticosteroids (oral or intravenous), other immunosuppressive agents such as azathioprine, cyclophosphamide, methotrexate or chlorambucil were added. Three (10%) patients (2 of own serie and 1 described in literature) were treated with biological agents (anti TNF alpha, rituximab and tocilizumab). Only in one case plasmapheresis was performed because of refractory disease. Most patients showed progressive improvement, and three (10%) patients died. Conclusions The presence of pseudotumoral lesions is a very rare presentation of Neuro-Behcet. It is more common in males and occurs years after diagnosis; however it can also occurs simultaneously. A differential diagnosis with other CNS diseases and malignancy is mandatory. The response to glucocorticoides plus immunosuppressive drugs is good. Biological agents may be useful for refractory cases. Disclosure of Interest None declared

Background Rheumatoid vasculitis is an extra articular manifestation of rheumatoid arthritis (RA), that occurs during the course of long standing disease. It is associated with a poor prognosis Objectives To describe the clinical characteristics, incidence, treatment, and outcome of patients diagnosed with rheumatoid vasculitis (RV) at a Rheumatology service of a University hospital during the last 30 years Methods Retrospective study (1984-2014). Location: University hospital. Referral area: 850.000 inhabitants. Medical records of patients with diagnosis of RA were reviewed, from the Rheumatology service data base. Inclusion criteria: patients with RV with histopathological confirmation of vasculitis or high suspicion based on clinical or radiological (arteriography) findings (according to Scott and Bacon criteria) Results A total of 18 patients were included: 6 (33.3%) females and 12 (66.7%) males, mean age of 10.13±66.5 (49-83 years). The clinical characteristics of patients are listed in Table 1. The most common clinical presentation was skin involvement with palpable purpura and digital ulcers. Other common manifestations were multineuritis and systemic involvement. Heart, eyes, or pulmonary involvements secondary to RV were absent. Laboratory tests at diagnosis of RV, showed an increased of acute phase reactants and anemia. All patients had a positive rheumatoid factor, citrullinated antibodies were determined only in five (27.8%) cases, being positive in all of them.Histological confirmation was possible in 8 (44.4%) cases, in the other 10 (55.6%) cases the diagnosis was made with clinical or radiological findings. Most patients were treated with pulse steroids associated with other immunosuppressive drugs. Seven (38.9%) patients died. Three of them (16.7%) secondary to vasculitis, and 4 (22.2%) of other causes.The incidence of rheumatoid vasculitis has decreased considerably in the last decade. Just 4 cases were diagnosed during the last 10 years. Conclusions RV is a rare complication of RA. Cutaneous and neurological involvement is more common. It is more frequent in male smokers with seropositive and nodular RA. Histological diagnosis is difficult. Currently the incidence is decreasing, however mortality is still high. Disclosure of Interest None declared

Background Lofgren9s syndrome is a common form of sarcoidosis in the Mediterranean region. Characterized by bilateral hilar lymphadenopathy, erythema nodosum and arthritis,usually symmetrical and predominate in lower extremities. Objectives To describe the clinical characteristics, treatment and outcome of a series of patients diagnosed with Lofgren syndrome. Methods Retrospective design (1984–2013) multicenter (2 university hospitals) with a total catchment area of 1,015,000 inhabitants. Lofgren syndrome was defined as the association of erythema nodosum and/or ankle arthritis and bilateral hilar lymphadenopathy in chest radiography. Exclusion criteria:presence of some other granulomatous disease. Results 80 patients were diagnosed: 29 men and 51 women (mean age: 42.3). The mean follow-up was 54 months. 48 (60%) had the classic triad of the disease; 18 (22.5%) hilar adenopathy and arthritis,13 (16.7%) hilar adenopathy and erythema nodosum. In one case the diagnosis was casual. Ocular manifestations occurred in 11 patients with the most common xerophthalmia. 28 patients had fever, 18 fatigue and 4 significant weight loss. All had abnormalities in the study of the chest and were classified in the stage I-II. Pulmonary function tests were perfomed in 55 patients,was pathological in 6. In laboratory tests it was seen: normocytic normochromic anemia in 26 patients (32.5%), lymphopenia in 6 (7.5%), bicytopenia in 4 (5%), hypercalcemia in 4 and hypercalciuria in 1.T he ESR was determined in 78 patients with a mean of 52.4±37.2 mm/hour. The tuberculin test was positive in 6 cases. In these patients, active tuberculosis disease is excluded. 39 biopsies were performed: 23 transbronchial, 11 skin, 3 lymph node, 2 muscular and 1 of lower lid. Were available for pathologic confirmation of sarcoidosis in 28 cases (35%). It was nonspecific in 11 patients. NSAID treatment was performed in 54 patients and glucocorticoids in 33. The remission in the first 2 years after diagnosis was observed in 87.5% of cases. 14 patients relapsed: 7 performed glucocorticoids, 3 NSAIDs and 4 had not received treatment. Table 1 shows the main characteristics of the patients compared to the most important series in the literature. Conclusions Lofgren9s syndrome is a common clinical form of sarcoidosis in the Mediterranean area. Should be suspected in the presence of erythema nodosum or periarticular swelling ankles. The clinical and radiological pattern can obviate biopsy. The prognosis is good and recurrence scarce. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2955

Background Secondary amyloidosis (AAa) is a disorder caused by deposition of insoluble amyloid A fibrils in different tissues and organs. It is a rare and serious complication of rheumatic diseases including spondyloarthropathies. Objectives The aim of this study was to determine the clinical features, laboratory data, treatment and clinical outcome of patients with spondyloarthropathies who developed AAa. Methods Design retrospective (1984-2013). Hospital: academic tertiary hospital. Referral area: 850.000 inhabitants. We reviewed the medical records of 1125 patients with spondyloarthropathies: 509 (45%) psoriatic arthritis (PsA), 263 (23%) ankylosing spondylitis (AS), 128 (11.3%) spondylitis associated with inflammatory bowel diseases (IBD), 190 (16.8%) undifferentiated spondyloarthropathy and 35 (3.1%) reactive arthritis diagnosed at our centre. We selected patients who had a histological diagnosis of AAa. Results Twelve (1.06%) patients with AAa were recruited: 10 (83%) males and 2 (16.6%) females. Five (41,6%) AS, 3 (25%) PsA, 3 (25%) spondylitis associated with IBD and 1 (8%) reactive arthritis. Mean age at AAa diagnosis: 55.75 years (interval 71-33 years). Amyloid deposits were observed on rectal biopsy (5 cases), kidney biopsy (3 cases) and subcutaneous fat biopsy (2 cases). In two cases the diagnosis was made incidentally (bladder and gallbladder). The mean age at spondyloarthropathy diagnosis was 32 years and the mean disease duration was 23.2 years. The mean values of erythrocyte sedimentation rate and C-reactive protein, at diagnosis of AAa, were 58.71mm and 35.47 mg/L respectively. AAa was suspected in 8 patients because of nephrotic-range proteinuria (2 patients), acute renal failure (5 patients) and diarrhea (1 patient). HLA B27 was positive in 6 patients, negative in 2. Five patients were treated with infliximab, 4 of whom because amyloidosis. Four patients underwent hemodialysis for end-stage renal disease, one of them died because complications directly related to renal failure. Four patients died of sepsis. Conclusions The frequency of clinical apparent AAa in our patients was 1.06% (12 patients). There was a marked male predominance. Clinical AAa was diagnosed at a relatively late stage in spondyloarthropathies. The predominant clinical picture was nephrotic syndrome. Prognosis was ominous. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3143

Background Undifferentiated arthritis (UA) is defined as an inflammatory arthritis in which no definitive diagnosis can be made. The prognosis of patients with UA may vary from spontaneous remission, to severe defined inflammatory joint disease. Patients UA poses a challenging problem to the rheumatologist. It is important to identify patients who will develop a persistent and/or erosive disease because early treatment might offer an effective means to slow disease progression. Objectives To describe the outcome of patients with UA after 30 months of follow up. Methods Design retrospective (2006 - 2011) in an academic tertiary hospital with a reference area of 850,000 inhabitants. We reviewed the medical records of patients with “undifferentiated arthritis” from the database of rheumatology Department. We reviewed the pattern of involvement at the onset of the disease and final diagnosis in December 2013. Results A hundred and fifty four patients were included. The involvement, at the beginning of the disease was: 36 (23.3%) monoarticular, 71 (46.1%) oligoarticular and 47 (30.5%) polyarticular. During follow-up, it was observed that 30 (19.5%) patients went into remission spontaneously, 57 (64.9%) evolved to a defined inflammatory joint disease and 67 (43.5%) continued under the diagnosis of undifferentiated arthritis. Among those patients were a definite inflammatory joint disease was established: 38 (66.6%) continued follow up controls, 16 (28%) discontinued the follow-up and 3 (5.3%) were discharged. A progression to extended polyarthitis was observed in 3 patients with an oligoarticular pattern. Four patients with monoarthitis developed oligoarthritis. The knee was the most commonly involved joint (58.3%). Conclusions The most common pattern of joint involvement in UA is oligoarticular. Furthermore half of patients with UA went into remission. Patients with a monoarticular pattern had a greater chance of spontaneous remission compared with patients with oligo and polyarticular involvement. The frequency of follow up was also significantly higher in patients with definite inflammatory joint disease compared with patients with persistent UA (66.6% versus 47.7%). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2933

Background In some rheumatic diseases low dosis of glucocorticoids (2-5 mg) are used for long periods of time. It is not clear if there is an inhibition of the adrenal axis when one of these patients experiences a stressful situation, such as an illness. This is particularly important in elderly patients, who are most vulnerable to hospitalization. Objectives Determine whether there is inhibition of adrenal axis in elderly patients under treatment with low dosis of corticosteroids. Methods Design: prospective. Type of center: University hospital with a referral area of 850,000 inhabitants. Nineteen patients with inflammatory rheumatic diseases (Elderly Onset Rheumatoid Arthritis and Polymyalgia Rheumatica) were studied: 7 women and 12 men, with a mean age of 77±6.84 years. We underwent stimulation test with synthetic ACTH 1 μg before the onset of oral glucocorticoid treatment and 6 months later. Methylprednisolone was the glucocorticoid used in all patients. The starting mean dose used is these patients was 9.26±2.68 mg, the dose accumulated in 6 months 972.6±248 mg, and the mean daily dose of 5.22±1.0 mg/day. Statistical methods: student t test, ANOVA and ROC curve. Results A good response was observed in all patients before before the onset of oral glucocorticoids (cortisol at 30 minutes ≥18 mg/dl). After 6 months of treatment the basal cortisol decreased from 18.5±5.9 to 11.95±5.9 (p=0.002) and the stimulated one from 28.96±5.8 to 17.95±5.98 (p Patients with an inadequate response had received a higher starting dose of glucocorticoids (8±2.8 versus 10.4±2.0, p=0.048) and also a higher mean daily dose (4.6±1.05 versus 5.7±0.7, p=0.018). Moreover, the accumulated dose and the mean daily dose were inversely correlated with the cortisol response. The ROC curve analysis at 6 months of treatment showed that the best cut off for predicting a poor response was a mean daily dose of 5.16 mg/day, with 70% sensitivity and 88.89% specificity (AUC =0.789, p=0.0065) and that a 100% of patients with insufficient response received a mean daily dose higher than 4.5mg/day. Conclusions A large percentage of elderly patients treated with low dosis of glucocorticoids showed adrenal axis inhibition after a few months of treatment. Thus, supplementation with higher dosis of glucocorticoids should be recommended to these patients in stressful situations. Acknowledgements To all the Biochemistry and Reumathology nurses. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4520

Background Autoantibodies against SS-A/Ro include two specificities (anti-Ro52 and anti-Ro60). These are directed against different antigens. Sera with reactivity against Ro52 are usually precipitin negative and cannot be detected by SS-A/Ro native based ELISAs. This fact has generated a bias to the detection of Ro60 when classifying SS-A/Ro positive patients. Currently the idea that anti-Ro52 and anti-Ro60 should be considered as independent markers in connective tissue diseases (CTD) is gaining ground. Objectives To correlate the detection of antibodies against Ro52 and/or Ro60 and the development of an organ specific clinical pattern in patients with CTD Methods Design retrospective (1999-2012). Type of center: University academic center with a referral area of 800.000 inhabitants (HUGTiP). Sera from patients with CTD from HUGTiP where tested for SS-A/Ro specificities by ELISA (Orgentec) and inmunoblot (Innolia). Medical records of all the patients with positivity for one of the specificities in at least one occasion were analyzed. In addition demographic, immunological and clinical data of the patients with systemic lupus erythematosus (SLE), Sjogren syndrome (SS), systemic sclerosis (SSc) or poly-dermatomyositis (PM-DM) were recorded. Results Data from 347 patients (299 women and 48 men) with positive serum were collected. Mean follow up 7.1 year (0-12.8 years). Of those, 151 presented reactivity only against Ro52 (Ro52+), 34 against Ro60 (Ro60+) and 162 against bothspecificities (Ro52+Ro60+). The associated diagnoses were: SLE (n=99), SS (n=57), PM-DM (n=15), SSc (n=20), undifferentiated connective tissue diseases (n=12), inflammatory arthropathy (n=20; rheumatoid arthritis=9) and liver diseases (n=34; VHC=21 and autoimmune liver diseases=13). Finally, 30 patients wereunclassified. Ro 52+ patients included SLE (16%, n=24), SS (11%, n=17), SSc (12%, n=18) and PM-DM (10%, n=15). While Ro52+Ro60+ included mainly SLE (37%, n=60) and SS (27%, n=43) but also SSc (2%, n=3) and PM-DM (0.5%, n=1). Finally Ro60+ included only SLE (44%, n=15) and SS (6%, n=2). Interestingly enough: 18% (n=26) of the Ro52+patients and 8% (n=13) of the Ro52+Ro60+ patients presented lung involvement, while none was detected in the Ro60+ group. Ro52+ patients showed more involvement of the lung than Ro60+ patients (p=0.003). Furthermore Ro52+ and Ro60+ groups also showed differences in the frequency of presence of sicca syndrome (p=0.024) and Raynaud phenomenon (p=0.016). No differences were founded in the frequency of involvement of heart, renal, cutaneous, and hematological systems or in cancer. Conclusions Antibodies against Ro60 are associated to SLE and SS while Ro52 are present in a heterogeneous group of diseases. Our data suggest that Ro52 is a marker of systemic involvement. Ro52 patients have more involvement of the lung, sicca syndrome and Raynaud phenomena. Disclosure of Interest None Declared

Background Still’s disease is a rare systemic entity of unknown etiology,characterized by fever peaks with evanescent rash, arthritis and/or joint pain that is associated with odynophagia, lymphadenopathy and hepatosplenomegaly. Diagnosis is difficult and exclusion. Treatment has varied over time. Systemic glucocorticoidsare the first choice, although biological drugs are an alternative for refractory cases. Objectives Describe the clinical characteristics and evolution of a series of patients diagnosed with Still’s disease who have followed biological treatment. Methods Retrospective (1978-2011). UniversityHospital with a referal area of 800,000 inhabitants. We reviewed the medical records of patients from the database section of Rheumatology.Inclusion criteria: patients with Still’ disease following Yamaguchi critera who were treated with biological drugs. Results Seven patientswere selected: 5 women (71.5%) and 2 men (28.5%).The mean age at diagnosis was 30.2 (16-58).All hadsore throat,fever and allbut onerash.All hadpolyarthralgia. Six patients (85.7%) polyarthritis and one oligoarthritis.Four patients (57.1%) had splenomegaly, lymphadenopathy 2 of them (28.5%). Two patients did not have any of these clinical signs.Serositiswas foundonlyin one patient. Inlaboratory data yielded: leukocytosis with neutrophilia in 2 patients (28.5%), anemia (hb ≤12 g/dL in 3 patients (42.9%). Ferritinwas elevatedin two patients. The ESR was elevated in 4 cases (57.4%), with a mean of 45±39.53 mm in the first hour. The CRP was elevated in six patients (85.5%) with an average of 27.5 mg/L. Mean follow-up: 70 months. The form of evolution of the disease was polycyclic in 4 patients and monocyclic in three. Biological treatment was: anakinra in 5 patients (71.5%), etanercept, 2 patients (28.5%), tocilizumab, two patients (28.5%).In addition, one patient was refractory to all biologicals(infliximab, rituximab, anakinra,tocilizumab, abatacept). Three patients (60%) treated with anakinra achieved complete remission. The other two patients without remission, were treated with tocilizumab with a good response in one case. The remaining patientwas treated well with infliximab, rituximab, anakinra and tocilizumab. All treatments weerretired because of serious side effects or ineffectiveness. This patient is currently treated with abatacept with good response although is not achieving complete remission. The 2 patients treated with etanercept achieved complete remission. Conclusions Biological therapy as treatment for refractory Still’s disease was effective in most cases. Anakinra was the drug most widely used and more than half of patients who were treated with it, achieved complete remission. Disclosure of Interest None Declared

Background Assays that detect anti-citrullinated peptides antibodies (ACPA) are considered to be more specific than rheumatoid factor in the diagnosis of rheumatoid arthritis (RA). Several tests have been developed using different antigens: first, second and third-generation cyclic-ACPA (CCP1, CCP2, CCP3) and modified citrullinated vimentin (MCV). Objectives To investigate anti-CCP3 in a group of patients positive citrullinated vimentin antibodies (MCVA). Methods The retrospective study was done at the university hospital with a reference population of 800,000. Atotal of 259 patients positive for IgG MCV antibodies (by ELISA) attending the outpatient rheumatology clinic were tested for anti-CCP3 (by ELISA). From the total, 182 (70.3%) of them had a rheumatic disease: RA in 121 (66.5%) and other: elderly-onset arthritis, non-filiated arthritis, connective, vasculitis, Still’s disease, espondiloarthritis, microcrystalline arthritis, polymyalgia rheumatica and sarcoidosis, in 61 (33.5%). There are 77 (29.7%) patients with other conditions (non rheumatic disease) positive for MCVA were also tested for anti-CCP3. Results From the 121 RA patients, 106 (87.6%) were positive for anti-CCP3. In contrast, only 15 (24.6%) of the 61 patients without RA and only 4 (5.2%) of the 77 MCVA positive patients with no rheumatic disease associated were CCP3 positive. Interestingly, within the group no RA, of the 13 patients with anti-CCP3 values >60 U/ml, 6 (46.2%) were patients with palindromic rheumatism and two of them had developed RA. Specificity of anti-CCP3 for RA as compared to other rheumatic disease was 76.7%, that raised to 86.9% when comparing RA versus to non-RA (with or without another rheumatic disease). Positive and negative predictive values of anti-CCP3 for RA were 85.5% and 88.8%, respectively whereas positive predictive values for anti-MCV was 39.1%. Conclusions Anti-CCP3 antibodies show a higher specificity for RA when compared to MCVA with a better positive predictive values, a crucial feature for a test in use for clinical practice. Disclosure of Interest None Declared

Objectives To describe the clinical characteristics, treatment and outcome of patients diagnosed with pyogenic septic arthritis. Methods Design: retrospective (1984-2012). Location: University hospital. Referial area: 800,000 inhabitants. The medical records of patients with pyogenic arthritis were reviewed. Inclusion criteria: isolation of bacteria in joint fluid or blood. Patients with soft tissue infection, prosthetic, fungal and mycobacterial septic arthritis were excluded. Results One hundred one patients were selected: 66 males and 35 females. Mean age: 54.5 ± 21.2 years. The following risk factors were identified: alcoholism (24), cirrhosis (12), diabetes mellitus (18), chronic renal failure (17), neutropenia (6), immunosuppression (10), HIV (10), AIDS (5), parenteral drug addiction (12), cancer (6), RA (4) and microcrystalline arthritis (17). Seventeen patients had undergone joint manipulation prior to the onset of the infection: 9 arthrocentesis with corticosteroids injection, 6 arthrocentesis and 2 arthroscopies. The pattern of join involvement was monoarticular in 72 patients (71.3%): knee 38 (36.8%), and shoulder and ankle 8 (8%) respectively. Polyarticular involvement was found in 29 patients (28.7%). Fifty nine patients 58.4% had fever. Cellulitis was observed in 17 cases (17%). The mean time between onset of symptoms and diagnosis was 7.9 ± 8.2 days. Mean hospital stay was 30.4 ± 28 days. Blood cultures were positive in 40 cases (39.7%) and in 85% of them the same microorganism was isolated in joint fluid. Septic arthritis was caused by gram positive in 79%, gram negative 19% and 2% were polymicrobial. The most common were: S. aureus methicillin sensitive (45), S. aureus methicillin resistant (MRSA in 5 cases since 2008), S. agalactiae (6), S. pyogenes (3), S. pneumoniae (9), E.Coli (9), P.aeuriginosa (3), Enterobacter cloacae (2) and Salmonella (2). Acute phase reactants were increased: ESR: 89.5 ± 29.6 mm/1sth and C-reactive protein 162 ± 122 mg/dl. The mean leukocyte count of joint fluid was 65,602 ± 62477/mm 3 . Synovial glucose was decreased in 50% of patients. Mean duration of intravenous antibiotic therapy: 3 weeks. Thirty-four patients (33.6%) required surgical treatment. Three patients required a second arthrotomy. Complications were: septic shock (20), pneumonia (6), reflex sympathetic dystrophy (2), osteonecrosis (2), endocarditis (3), respiratory distress (1). Most of the cases evolved favorably. Fifteen cases resulted in death (15%): 8 cases had monoarticular involvement and 7, polyarticular involvement. The causative organisms were: S. Aureus (10 cases), MRSA (3 cases), Pneumococcal (1 case) and polymicrobial (1 case of S.aureus more E.Coli). Conclusions S. aureus is the most common pathogen isolated. Furthermore MARSA is an emerging microorganism. Hematogenous spread and polyarticular involvement are poor prognostic factors. Prolonged antibiotic therapy and surgical debridement are essential for proper healing. Disclosure of Interest None Declared

Background Zoledronic acid is an intravenous bisphosphonate used in osteoporosis and Paget’s disease of bone. It is usually well tolerated, although it may cause some side effects. Objectives To describe the clinical characteristics, indications, side effects and densitometric parameters in patients treated with zoledronic acid. Methods Retrospective study (2006-2012) at two hospitals with a referral area of 900.000 people. We reviewed the medical records of patients treated with zoledronic acid. We collected the epidemiological and clinical features and side effects. We conducted a telephone interview to complete the missed data. Results Two hundred and four patients received zoledronic acid: 146 women (71.6%) and 58 men (28.4%), with mean age of 70.5 years (range: 38-89 years). The medical indication for the administration was: 149 osteoporosis, 46 Paget’s disease of bone and 8 other bone diseases (5 SAPHO syndrome, 2 Brittle bone’s disease and 1 progressive multifocal osteitis). The causes of osteoporosis were: postmenopausal 93 (62.4%), secondary 42 (28.2%) - most of them due to glucocorticoid treatment -, and male osteoporosis 14 (9.4%). Seventy-three percent of the patients with osteoporosis had received other treatments previously (73.6% oral bisphosphonates, 27.3% teriparatide or PTH 1-84, 22.7% intravenous ibandronate, 18.1% strontium ranelate, 10% calcitonin, 9% raloxifene and 7.3% pamidronate). Ninety-seven patients (65.1%) had fractures before treatment: vertebral (82%), rib (12.3%), wrist (9.2%), femur (8.2%), other (12.3%) - isquiopubian branches, foot, elbow, humerus, phalanges. Only 14 patients (9.4%) had fractures after treatment. The average of bone mineral density before treatment was: T score -3.1 in the lumbar spine (L2-L4) and -2.4 in the femur. Of all patients, 110 (73.8%) had received a single infusion, 46 (30.9%) 2 infusions, 38 (25.5%) 3 infusions and 10 (6.7%) 4 infusions of zoledronic acid. Thirty-nine patients had side effects (19.1%): 26 men and 13 women, with a mean age of 66.4 years. Twenty-three of these patients were treated because of having osteoporosis, 15 Paget’s disease of bone and one osteogenesis imperfecta. The most described side effects were: flu-like syndrome (69%), arthralgia (7.7%), uveitis (5.1%) and arthritis, kidney failure, hypertensive crisis, rash, epistaxis, fatigue and ventricular arrhythmia (2.6 % each). We used chi-square test with Yates correction to compare the incidence of side effects in patients with osteoporosis to patients with Paget’s disease of bone. We obtained a value of 5.56 with statistical significance (p = 0.01) for Paget’s disease of bone. Conclusions The most common indication for administration of intravenous zoledronic acid is postmenopausal osteoporosis. A high percentage of patients had previously received different treatments and had fractures before treatment. Nearly 20% of patients have side effects and the most common is a flu-like syndrome. Patients treated for Paget’s disease of bone have a higher incidence of side effects than those treated for osteoporosis (p = 0.01). Disclosure of Interest None Declared

Objectives To describe the clinical, microbiological characteristics and evolution of pyogenic arthritis according to treatment. Methods Design retrospective (1984-2012). Hospital: academic terciary hospital. Referral area 800.000. We reviewed the medical records of patients with pyogenic arthritis from the database of the Rheumatology Department. The inclusion criterion was the isolation of bacteria in the culture of joint fluid or blood cultures. Soft tissue infection, prosthetic infection, spondylodiscitis, fungal and mycobacterial arthritis were excluded. Results We selected a total of 101 cases. Thirty four cases (33.6%) underwent surgical debridement and the remaining 67 (66.4%) were treated medically (Table 1). All patients received specific intravenous antibiotic, with an average duration of three weeks. Surgical treatment (bursectomy in 2 cases, arthrotomy in 31 cases and amputation in 1 case) was required in 34 cases (intervention before 7 days in 18 (53%) patients, arthrotomy within 48 hours in 9 patients). A second arthrotomy was required in 3 patients (9%). Moreover, articular lavages were performed daily in 35 cases (51%) of the 67 patients without arthrotomy. There were 14 deaths among the patients who were not debrided and one death in the group of patients that were surgically debrided. Of the patients who died, 5 had monoarticular involvement (knee) and 7 cases had polyarticular involvement. The causative organisms in these patients were S. Aureus (7 cases), MRSA (3 cases), Pneumococcal (1 case), E. coli (1 case), polymicrobial (1 case of S. aureus and E. coli). Conclusions The mortality of the patients with septic arthritis that were debrided was much lower than those not debrided. The history of arthroscopy or arthrocentesis before septic arthritis was more common among patients that were debrided. Patients with greater diagnostic delay needed debridement more frequently. Disclosure of Interest None Declared

Background Heart block in the young is uncommon and sometimes the etiology is not found. Several inflammatory rheumatic diseases can cause conduction disturbances. Some of them are well described, such as in patients with ankylosing spondylitis, but others are controversial. Ro autoantibodies have been traditionally associated with the development of neonatal lupus and congenital heart block. Recent research has demonstrated their physiopathological implication. Some investigators have tried to demonstrate the relationship between these autoantibodies and electrocardiographic abnormalities in adult patients with controversial results. Objectives To determine whether atrioventricular block (AVB) of unknown cause in young patients may be associated with an inflammatory rheumatism. Methods Retrospective observational study (1973-2011) at a university hospital with a referral area of 800000 inhabitants. The medical records of patients with pacemakers were reviewed from cardiology’s database: a total of 3359 patients. Patients under fifties with a heart block of unknown cause were selected: 24 patients. One was dead at the time of the study, and 3 refused to participate. The 20 remaining patients underwent an immunological study with antinuclear antibodies (AAN in HEp2 substrate) and extractable nuclear antigens (ENA) by immunoassay and immunoblot. A clinical interview was performed by a rheumatologist looking for signs and symptoms of inflammatory rheumatism. Results Twenty patients were included: 7 men (35%) and 13 women (65%). Mean age when they were reviewed was: 51 years ± 12 years (range: 28-70). Mean age at the time of pacemaker implantation was 37.5 ± 10 years (range: 17-49). The implantation causes were: complete AVB 14 patients (70%), advanced AVB 3 (15%), Wenckebach type 1 AVB (5%) and unknown AVB in 2 cases. Two patients had family history of autoimmune diseases: 1 rheumatoid arthritis and 1 autoimmune thyroiditis. A positive Ro52 patient without connective tissue disease and a Ro 60 positive patient diagnosed with systemic lupus erythematous were found; no other autoantibody was present. Another patient was diagnosed of ankylosing spondylitis (HLA B27 positive). The diagnosis of systemic lupus erythematous and ankylosing spondylitis were previous to the heart block. No signs or symptoms of inflammatory rheumatism were found in the other patients. The Schirmer test was abnormal in 5 (20%) patients. The 2 patients with systemic lupus erythematous and ankylosing spondylitis had sicca syndrome secondary to their underlying diseases. Conclusions Fifteen percent of patients had features of inflammatory rheumatic diseases: in 2 cases heart block occurred in a patient diagnosed with systemic lupus erythematous and another with ankylosing spondylitis. A third case with positive Ro52 antibodies was detected in a woman without connective tissue disease. Family history of autoimmune diseases was found in 2 patients. Anti Ro antibodies might be related to heart block in the young. It is recommended to purpose a clinical evaluation of the patients by a rheumatologist and an immunological study in order to clarify the origin of the heart block and to unmask other underlying pathologies. References Disclosure of Interest: None Declared

Background The association of the SAPHO syndrome and inflammatory bowel disease (IBD) was first reported in 1992. To date, only case reports and short series have been published. Objectives To report three new cases and systematically review the literature on this association. Methods All patients with concomitant diagnosis of SAPHO syndrome and IBD were identified from the databases of the Rheumatology and Gastroenterology departments of our institution, which has a reference area of 800000 inhabitants. In addition, we systematically searched for published full articles in Medlars Online International Literature (MEDLINE) via PubMed. Relevant information of each positive match was collected and all authors were contacted for additional clinical data. Results Three patients sharing both SAPHO syndrome and IBD were identified among the 62 patients with SAPHO syndrome (4.8% of the SAPHO cohort) and among 1,309 patients with IBD (0.2% of the IBD cohort) from our hospital database. After a systematic review, others 36 cases with concomitant diagnosis of IBD and SAPHO syndrome or its variant chronic recurrent multifocal osteomyelitis (CRMO) were identified. There was a female predominance (64%) and an early age of onset of both diseases (24 years for SAPHO syndrome and 18 years for IBD). SAPHO diagnosis preceded IBD diagnosis in 55% of cases, being simultaneous or subsequent in the rest. A high proportion of patients presented Crohn’s disease (69%) with colonic involvement. The most frequent osteoarticular locations were peripheral joints (61%); anterior chest wall (56%), sacroiliac joint (20%), y spine (18%). Approximately 41% of cases developed typical SAPHO skin manifestations, being palmoplantar pustolosis the most common. The most common treatment for IBD of the subgroup of cases published after year 2000 were corticosteroids (68%), aminosalicylates (52%), immunossupresors (37%), anti-TNF (16%); and for SAPHO syndrome NAIDs (63%), corticosteroids (37%); aminosalicylates (31%), immunossupresors (21%), pamidronate (16%) y anti-TNF (16%). Conclusions SAPHO syndrome seems to precede IBD. It is more frequent in females and at early ages. Crohn’s disease is more associated to SAPHO than ulcerative colitis. Interestingly enough colic involvement is more frequent. Both diseases respond well to the same treatments but NAIDs should be avoided because their potential risk of triggering a flare of IBD. Disclosure of Interest None Declared

Background Adult Onset Still’s disease (AOSD) is a rare systemic disease of unknown etiology,characterized by fever peaks with a evanescent rash, arthritis and/or arthralgia that is associated with odynophagia, lymphadenopathy and hepatosplenomegaly. Laboratory test usually present with leukocytosis, neutrophilia, anemia and an increased in acute phase reactants. There is no pathognomonic laboratory test. Diagnosis is difficult and exclusion of other diseases is requered. Objectives To describe the clinical characteristics, treatment and outcome of a series of patients diagnosed with adult Still’s disease. Methods Retrospective (1978-2011). UniversityHospital with a referal area of 800,000 inhabitants.We reviewed the medical records of patients from the database service of Rheumatology. Inclusion criteria: Yamaguchi criteria. Results Thirty one patients were diagnosed: 9 men (30%) and 21 women (70%). The mean age at diagnosis was 39.9 years (16-68). All had fever associated with rash, except for 3 patients who were enrolled without a rash. The odynophagia was presented in all cases except 1. Polyarticular pattern predominated (22 patients, 73.3%) compared to oligoarticular (3 patients, 9.7%); in 5 patients was not found arthritis, however, arthralgia were seen in 96.7% of cases. Twelve patients had lymphadenopathies and eleven, splenomegaly. Seven patients had both clinical signs. Serositis was uncommon, affecting only 3 patients. Laboratory findings were as followed: leukocytosis with neutrophilia (22 patients, 73.3%), anemia with hemoglobin ≤12 g/dl (15 patients, 50%), with mean hemoglobin of 11.5g/dl, transaminitis (9 patients, 1%), high ferritin with an average of 6614 ng/ml in 19 patients (63.3%). The ESR was determined in 29 patients and was founded elevated in 24 (80%), with a mean of 77.4±39.8 mm in the first hour. C Reactive Protein was determinedin 26 cases, being elevated in 21 patients (70%).Joint radiographswere performed according to articular involvement and remained normal in 23 patients (76.7%). The treatment was: aspirin and/or NSAIDs (90%), corticosteroids (76%), other disease-modifying drugs, 15 patients (76.7%); biological drugs, 6 patients (20%). Mean follow-up: 88 months. The form of evolution of the disease was polycyclic in 15 patients (50%) and monocyclic on the other half of patients. Remission during follow-up was presented in 27 patients (93.1%). Conclusions The clinical and laboratory characteristicsof this series, did not differ from those reported by other authors. All in all Adult Onset Still’s disease responded to treatment. Biological drugs was required in one third of patients. Disclosure of Interest None Declared

Background IFN-γ release assays are useful methods for diagnosing LTBI (latent tuberculosis infection). It allow us to detect: a) false negative TST in anergic subjects, b) false positives in BCG-vaccinated patients and c) NTM (non-tuberculous mycobacterias) previously sensitized individuals. All in all, these tests contribute to detect additional cases of LTBI. Objectives To establish the usefulness of blood interferon-γ (IFN-γ) release assays in patients with inflammatory rheumatic diseases scheduled for anti-TNF-α treatment and at the follow up. Methods Prospective study including rheumatic patients starting an anti-TNF-α agent. All patients underwent TST (two step), a chest radiograph, QuantiFERON GOLD in tube (QFN-G-IT), and T-SPOT.TB. Both tests were repeated after a year of anti-TNF treatment in 21 patients. As control group, 35 adult individuals were included. Concordance were analyzed by Cohen’s kappa test. Results We included 53 patients (18 male/35 female) candidates for anti-TNF-α (18 rheumatoid arthritis, 13 ankylosing spondylitis, 9 psoriatic arthritis and 13 miscellanea). Mean age was 49±13 years and mean disease evolution was 8.8±8 years. Twenty-four out of 53 patients (45.3%) were receiving systemic steroids, mean daily dose 9.1±11.9 mg/day. BCG vaccination status was documented in 3 patients, 2 referred history suggestive of TB disease and other 3 patients had contact with a confirmed TB case in the past. The results of our study are summarized in Table 1. The differences in the results between the IFN-γ tests were not significant ( p= 0.675). Interestingly enough, neither T-SPOT.TB nor QFN-G-IT were significant in comparison to TST results ( p= 0.344 and p= 0.727, respectively). Overall agreement between TST and T-SPOT.TB and QFN-G-IT was 77.35% (k=0.33; and k=0.40, respectively), and between both in vitro tests was 83.01% (k=0.57) was observed. Three patients with positive TST and negative T-SPOT.TB and QFN-G-IT, was positive on ELISPOT after stimulation with NTM sensitins. Positive TST, T-SPOT.TB and QFN-G-IT results were not affected by the immunosuppressive therapies. We found 4 conversions (1 patient convert T-SPOT and QFN, and 3 patients convert only T-POT) out of 21 cases evaluated after a year under anti-TNF-α agents. We also observed 2 reversions, one in a patient who had undergone prophylactic treatment for tuberculosis. Conclusions In those patients with a high risk of developing active TB, the combined use of TST and IFN-γ may be recommended to increase the overall number of LTBI diagnosis. Reversion is described in subjects who have made prophylaxis. More studies are needed to recommend prophylaxis in conversions. Disclosure of Interest None Declared