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To analyze the effects of a fast-velocity concentric resistance training (FVCRT) program on maximum strength of upper and lower limb, gait speed, walking endurance, fatigue, physical self-perception, and catastrophizing pain in people with multiple sclerosis (MS).Participants were randomized to either an experimental [EG] (n = 18) or a control [CG] (n = 12) group. The EG carried out 10-weeks of lower limb FVCRT. The CG did not perform any intervention. The maximum isometric voluntary contraction (MVIC) during knee extension, hand-grip strength, gait speed, walking endurance, fatigue, physical self-perception, and catastrophizing pain were measured.Inter-group differences after intervention were found on the right and left sides in MVIC (p = .032; ES = -0.7 and p = .009; ES = -0.9), and hand grip strength (p = .003; ES = -1.0 and p = .029; ES = -0.7). After FVCRT, there was in increase in MVIC (p .001; ES = -1.7 and p .001; ES = -1.3) and hand grip strength (p .001; ES = -1.3 and p .001; ES = -1.3) on both right and left sides, respectively. In addition, gait speed (p = .023; ES = 1.3), walking endurance (p .001; ES = -1.0), symptomatic fatigue (p = .004; ES = 0.6), and catastrophizing pain (p .001; ES = 1.0) improved in EG.Lower limb FVCRT improved the upper and lower limb strength, walking, symptomatic fatigue, and catastrophizing pain in MS participants.

Background: In a previous paper, we have demonstrated that: (1) local injection of corticosteroids for carpal tunnel syndrome (CTS) is as effective as decompressive surgery, at 1-year follow-up; and (2) surgery has an additional benefit in the 2-year follow-up. In this study, we assess the long-term outcomes of both therapies in an observational extension of the patients originally enrolled in our randomized clinical trial. Methods: Patients were included in an open, randomized clinical trial, comparing injections versus surgery in CTS. After the end of the clinical trial, patients received the treatment prescribed by their general practitioner or specialist. Therapeutic failure was defined as the need of any new therapeutic intervention on the involved wrist. Comparison between groups was made using Cox multiple regression analysis. Estimation of the accumulated incidence of new therapeutic failure was made considering the withdrawal as a competitive risk (Gooley’s test). Results: Of 163 randomized wrists at the beginning of the study, only 148 were available at the final follow-up. The mean follow-up was 6.3 and the median was 5.9 years. In the long-term follow-up, the accumulated incidence of therapeutic failure in the surgery group was 11.6% versus 41.8% in the injection group. The Cox multiple regression analysis showed a risk of failure associated with injection group of 4.5 (95% confidence interval [CI], 2.1-9.8; P < .0001). Conclusions: In long-term follow-up, surgery seems more effective than local corticosteroid injections in primary CTS. Nonetheless, about 58% of the patients in the injection group will not need further therapeutic interventions during the follow-up.

Resumen Objetivo Analizar la eficacia, adherencia, satisfaccion del paciente, seguridad, farmacodinamica y costo-efectividad del metotrexato (MTX) parenteral en pacientes con enfermedades reumaticas. Metodos Se llevo a cabo una revision sistematica basada en una estrategia de busqueda en Medline, Embase y Cochrane Library (inicio-06/2019). Se identificaron estudios que incluyeran pacientes adultos con enfermedades reumaticas en tratamiento con MTX parenteral y que analizaran datos de eficacia, adherencia, satisfaccion, seguridad, farmacocinetica o costo-efectividad. En cuanto a los disenos se permitieron revisiones sistematicas, ensayos clinicos o estudios observacionales, incluyendo transversales y estudios con muestras pequenas si eran estudios de farmacocinetica. Resultados De 4.160 articulos identificados, se incluyeron finalmente 80. El MTX parenteral parece util de manera general y en especial en aquellos pacientes con respuesta insuficiente a MTX oral. La via parenteral no parece aumentar la tasa ni la gravedad de los eventos adversos con respecto a la oral y podria reducir costes en aquellos pacientes con respuesta inadecuada a MTX oral. La adherencia y satisfaccion se ven favorecidas por programas de entrenamiento en la via parenteral. Los resultados en enfermedades reumaticas distintas a la artritis reumatoide (AR) son muy escasos y no permiten obtener datos concluyentes. Conclusiones El MTX por via parenteral podria ser una alternativa al uso de MTX oral, por su perfil de eficacia, seguridad, adherencia, satisfaccion y resultados farmaco-economicos, especialmente en pacientes con AR.

The university stage is a good time to promote healthy eating strategies. The sociological and cultural changes experienced by students lead them to skip meals, increase their intake of fast food and energy-dense foods, decreasing adherence to the Mediterranean diet (MD). Professionals related to food such as nutritionists and dietitians are also considered a population at risk of developing eating disorders due to the extensive knowledge they possess, which can be used for both good and bad practice. The objective was to analyze the impact of a 4-month educational program promoting the Mediterranean diet on risky eating behaviors, adherence to the Mediterranean diet, and body composition in nutrition and dietetics students, studying the differences according to the group investigated (control group and educated group). The context of the research was 196 students (49 males and 147 females) from two consecutive years. The control group did not receive any type of intervention, while with the control group (educated) an educational program was carried out. Results showed that women with greater control over energy intake, carbohydrates, and sugar had a lower percentage of fat mass, while in men, the relationship was established with weight. Regarding adherence to the Mediterranean diet, at post, it is adequate in both men (8.25 ± 2.87) and women (7.90 ± 2.89), with no significant differences between the intervention groups. This work was supported by a grant from the University Teaching Research Networks Program of the Institute of Education Sciences of the University of Alicante (2021-22). Ref: 5628.

Background. People with multiple sclerosis (MS) suffer from symptoms related to neural control, such as reduced central activation, lower muscle activity, and accentuated spasticity. A forced 9-week home confinement related to COVID-19 in Spain may have worsened these symptoms. However, no study has demonstrated the impact of home confinement on neuromuscular mechanisms in the MS population. This study was aimed at analyzing the effects of a 9-week home confinement on central activation, muscle activity, contractile function, and spasticity in MS patients. Methods. Eighteen participants were enrolled in the study. Left and right knee extensor maximum voluntary isometric contraction (MVIC), maximal neural drive via peak surface electromyography (EMG) of the vastus lateralis, central activation ratio (CAR), and muscle contractile function via electrical stimulation of the knee extensor muscles, as well as spasticity using the pendulum test, were measured immediately before and after home confinement. Results. Seventeen participants completed the study. CAR significantly decreased after lockdown ( ES = 1.271 , p < 0.001 ). Regarding spasticity, there was a trend to decrease in the number of oscillations ( ES = 0.511 , p = 0.059 ) and a significant decrease in the duration of oscillations ( ES = 0.568 , p = 0.038 ). Furthermore, in the left leg, there was a significant decrease in the first swing excursion ( ES = 0.612 , p = 0.027 ) and in the relaxation index ( ES = 0.992 , p = 0.001 ). Muscle contractile properties, MVIC, and EMG variables were not modified after confinement. Conclusions. The results suggest that a home confinement period of 9 weeks may lead to an increase in lower limb spasticity and a greater deficit in voluntary activation of the knee extensors.

espanolEn el ano 2015 la Sociedad Espanola de Reumatologia (SER) publico su posicionamiento sobre farmacos biosimilares. En esta actualizacion, la SER, sigue manifestando su compromiso inequivoco con la sostenibilidad del sistema sanitario de nuestro pais y se alinea con las medidas que, sin reducir la calidad asistencial, esten encaminadas a asegurar su sostenibilidad. Desde la publicacion del anterior posicionamiento la Comision Europea ha autorizado la comercializacion de nuevos farmacos biosimilares, lo que abre una excelente oportunidad de avanzar en la eficiencia de la atencion sanitaria. En este nuevo escenario de incremento de la oferta terapeutica de biologicos, la SER considera imprescindible preservar la libertad de prescripcion de los medicos que realizan la indicacion de farmacos basandose exclusivamente en las caracteristicas y circunstancias individuales de cada paciente, sin olvidar los aspectos economicos que se derivan de dicha actuacion. EnglishIn 2015 the Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia [SER]) published its position paper on biosimilar drugs. In this update, the SER, continues to manifest its unequivocal commitment to the sustainability of the health system of our country and is aligned with the measures that, without reducing quality of care, are aimed at ensuring its continuity. Since the publication of the previous position paper, the European Commission has authorized new biosimilar drugs, which provides an excellent opportunity to advance the efficiency of health care. In this new scenario of increased therapeutic offer of biologics, the SER considers it crucial to preserve the freedom of prescription of physicians who prescribe drugs based exclusively on the characteristics and individual circumstances of each patient, without forgetting the economic aspects there of.

Objective To evaluate the efficacy and safety of belimumab in patients with Primary Sjogren's syndrome (pSS). Methods The search included manuscripts assessing the efficacy or safety of belimumab in patients with pSS (American-European Consensus Criteria 2002) published between 2004 and 2017 in MEDLINE, EMBASE or Cochrane databases. Two reviewers independently selected the articles, extracted data and evaluated the quality of the evidence following Scottish Intercollegiate Guidelines Network (SIGN) recommendation grades. Results Out of 135 citations, only 3 articles were included. All of them publishing results from the same study at different time points including 28 patients. At week 28 improvement was reported for visual analogue scale (VAS) dryness score and glandular manifestations in 37% and 77% of patients, respectively, which persisted at week 52 (W52). Belimumab was well tolerated and safely administered. Conclusion Published evidence to determine the efficacy of belimumab in pSS is limited. Belimumab seems to be effective to reduce systemic activity, parotid enlargement, lymphadenopathies, articular manifestation and B cell biomarkers.

La esclerosis múltiple (EM) es una enfermedad neurológica progresiva, que conduce a un declive de la función física, siendo la espasticidad uno de los síntomas más recurrentes en esta población. En los últimos años, el entrenamiento vibratorio de cuerpo completo (WBVT) ha mostrado beneficios en la capacidad funcional, la función neuromuscular o la calidad de vida en personas con EM. Sin embargo, los efectos agudos de una sesión de WBVT sobre variables como la espasticidad son todavía desconocidos. Por ello, los objetivos principales de este estudio fueron analizar los efectos agudos del WBVT sobre la espasticidad de la rodilla, así como conocer las diferencias en esta variable entre la pierna más y menos afectada tras la sesión en personas con EM.13 sujetos formaron parte de este estudio. La sesión de WBVT consistió en 12 series de 1 minuto de vibración con 1 minuto de descanso entre series en posición de sentadilla estática. La frecuencia y la amplitud fue fijada en 35 Hz y 4 mm respectivamente. Para medir la espasticidad de la articulación de la rodilla, el Test del Péndulo fue utilizado antes y después de la sesión. No se encontraron diferencias pre-post en ninguna de las variables. Sin embargo, el tiempo de oscilación mejoró significativamente en el post-sesión en la pierna menos afectada en comparación con la más afectada. Basándonos en nuestros resultados, se evidencia que la respuesta ante una sesión de WBVT es diferente dependiendo tanto del grado de discapacidad como de la pierna analizada de un mismo paciente. Estos resultados muestran que la individualización del WBVT es una cuestión de vital importancia en población con EM., Multiple sclerosis (MS) is a progressive neurological disease, which leads to a decline in physical function, being spasticity one of the most recurrent symptoms in this population. In recent years, whole body vibration training (WBVT) has shown benefits in functional capacity, neuromuscular function or quality of life in people with MS. However, the acute effects of a WBVT session on variables such as spasticity are still unknown. Therefore, the main objectives of this study were to analyzethe acute effects of WBVT on knee spasticity, as well as to know the differences in this variable between the most and least affected leg after the session in people with MS. 13 subjects were part of this study. The WBVT session consisted of 12 series of 1-minute vibration with 1 minute rest between series in a static squat position. The frequency and amplitude were set at 35 Hz and 4 mm respectively. To measure the spasticity of the knee joint, the Pendulum Test was used before and after the session. No pre-post differences were found in any of the variables. However, the time of oscillation was significantly improved in the post-session in the less affected leg compared to the more affected one. Based on our results, it is evident that the response to a WBVT session is different both depending on the degree of disability and between the legs of the same patient. These results show that the individualization of WBVT is a matter of vital importance in the population with MS.

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed. (C) 2019 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.

Resistance training (RT) variables can affect sleep quality, strength recovery and performance. The aim of this study was to examine the acute effect of RT leading to failure vs. non-failure on sleep quality (SQ), heart rate variability (HRV) overnight and one-repetition maximum (1-RM) performance 24 hours after training. Fifteen resistance-trained male athletes (age: 23.4 ± 2.4 years; height 178.0 ± 7.6 cm; weight: 78.2 ± 10.6 kg) performed two training sessions in a randomized order, leading to failure (4x10) or non-failure (5x8(10) repetitions), with 90 seconds for resting between sets at 75% 1-RM in bench press (BP) and half squat (HS). The day after, the participants completed the predicted 1-RM test for both exercises. In addition, the subjective and actigraphic SQ and HRV during sleep were measured after each training session. The day after the training protocol leading to failure, the 1-RM of BP (MD = 7.24 kg; -7.2%; p < 0.001) and HS (MD = 20.20 kg; -11.1%; p < 0.001) decreased. However, this parameter did not decrease after a non-failure RT session. No differences were observed between failure and non-failure training sessions on SQ and HRV; therefore, both types of training sessions similarly affected the SQ and the autonomic modulation during the night after the training session. This study provides an insight into the influence of different training strategies on SQ, strength performance and recovery after moderate- to high-demand training. This information could be useful especially for professional coaches, weightlifters and bodybuilders, due to the potential influence on the programming processes.

Introduction: Mucopolysaccharidosis type I (MPS-I: Hurler/Scheie´s disease) is a rare disease with a wide spectrum of severity. This results in underdiagnosis and delayed diagnosis. Prognosis greatly depends upon early diagnosis. The availability of reliable diagnostic tests and the existence of enzyme replacement therapy and/or hematopoietic stem cell transplantation, make an early diagnosis of these patients extremely important. Carpal tunnel syndrome (CTS) is among one of the most common findings in MPS I, whilst CTS is very uncommon in infancy and young adulthood. Objective: To ascertain the prevalence of MPS-I among children and young adults (≤ 30 years) diagnosed with CTS in our population. To get an early diagnosis of MPS-I patients. Material and Methods: This is a cross-sectional prospective study of a cohort of patients with an electromyogram-confirmed diagnosis of CTS. Our total population is over 600,000 people of an urban area of Madrid. We searched for children and young adults with suggestive symptoms of CTS. χ2 for categorical variables and Student “t” analysis or Anova test for quantitative variables were used. Results: 12 patients were included, 10 females, range 8-28 years, mean 23, median 23.5. Two patients had a low α-L-Iduronidase activity. Nonetheless, the results of confirmatory test of enzymatic activity of α-L-Iduronidase in lymphocytes were negative in both cases. Conclusions: We did not find any MPS-I in our series of CTS in children and young adults. Larger series will be needed to ascertain if this approach is valid for early diagnosis of MPS-I in the paediatric population.

Background: Multiple sclerosis (MS) is a neurological disease that affects balance. Among the non-pharmacological strategies to improve this variable, physical exercise is one of the most widely used. However, the benefits of some types of training, such as resistance training, on static balance in this population are still unclear. This study aims to analyze the effects of a resistance training (RT) intervention on balance in people with MS. Methods: Thirty people with MS were randomized to either an experimental (n = 18) or a control (n = 12) group. The RT group performed 10 weeks of lower limb resistance training with a concentric phase at maximum velocity. Static balance was measured before and after intervention. Results: No significant group × time interaction effects were found (ANOVA test) in any of the variables at the end of the intervention. No intragroup differences were found before or after the intervention in the balance variables. Conclusions: Resistance training with a concentric phase at maximum velocity showed no impact on balance in our sample. Future studies should examine programs of longer duration or combined with other types of training, such as balance training, with the aim of obtaining improvements in this variable in people with MS.

This study was conducted at the Institute of Arid Regions of Gabes in Tunisia. Three plots were left as controls and received no input, three plots were amended with cattle manure with a dose equivalent to 37.5 t/ha, and nine plots were amended with phosphogypsum in three doses (12.5 t/ha, 25 t/ha, and 50 t/ha), with three repetitions for each dose. A pot test to determine the germination index and radioactivity analysis was carried out in the laboratory. The results showed that organic manure amendments and phosphogypsum improved the germination rate of the different crops (jute mallow, turnip, and oat) compared with the control. At the same time, the 50 t/ha dose had the highest germination rate. An increase in yield of all crops during the whole duration of the experiment was observed for the soil amended by phosphogypsum. The best yield was recorded when the highest dose of phosphogypsum was applied. The cadmium level in plants of the two applied amendments was variable but still below the toxicity threshold (7 ppm). The values recorded following the analysis of the phosphogypsum radioactivity showed that the mean value of Ra-226 equals 214.45 Bq/kg, which is below the limit announced by the EPA (Environmental Protection Agency). The radioactivity results from the control soil samples showed the presence of natural radioactivity. Samples of phosphogypsum-amended soil and plants grown in these soils have radioactivity values that are still lower than those announced by the EPA. The novelty aspect of this study is the application of phosphogypsum in different crops during two consecutive years in degraded-soil areas of Tunisia, in addition to the study of different aspects of phosphogypsum reuse in agriculture as a promising strategy for a sustainable environment.

Objectives To assess efficacy and safety of biologic therapy (BT) in neurobehçet’s disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug. Methods Open-label, national, multicentre study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analysed were glucocorticoid-sparing effect and improvement in laboratory parameters. Results We studied 41 patients [21 women; age 40.6 (10.8) years]. Neurological damage was parenchymal (n = 33, 80.5%) and non-parenchymal (n = 17, 41.5%). First BTs used were infliximab (n = 19), adalimumab (n = 14), golimumab (n = 3), tocilizumab (n = 3) and etanercept (n = 2). After 6 months of BT, neurological remission was complete (n = 23, 56.1%), partial (n = 15, 37.6%) and no response (n = 3, 7.3%). In addition, median (IQR) dose of oral prednisone decreased from 60 (30–60) mg/day at the initial visit to 5 (3.8–10) mg/day after 6 months (P Conclusions BT appears to be effective and relatively safe in refractory NBD.

espanolIntroduccion Una mision de la Sociedad Espanola de Reumatologia es aportar las herramientas necesarias para alcanzar la excelencia asistencial. En la actualidad no existe una referencia que cuantifique la complejidad de los actos medicos de esta especialidad. Material y metodo Se elaboro una relacion de los actos propios del reumatologo y se establecio un sistema de clasificacion jerarquica a partir de la construccion de un indice de complejidad, calculado mediante el tiempo de realizacion y el grado de dificultad de cada acto. Resultados Los resultados del metodo Delphi tendieron a una opinion grupal consensuada (media σ2 - σ1 = 0,75-1,43 = -0,68, media IQR2 - IQR1 = 0,8-1,9 = -1,1). El rango de valores del indice de complejidad oscilo de 48 a 465 puntos. Entre las consultas, las que alcanzaron mayor gradacion fueron la primera visita al paciente hospitalizado (366) y la visita a domicilio (369). Entre las tecnicas diagnosticas, destacaron las biopsias. Las que puntuaron mas alto fueron: biopsia osea (465), de nervio sural (416) y sinovial (380). La ecografia tuvo una puntuacion de 204, la capilaroscopia de 113 y la densitometria de 112. Entre las tecnicas terapeuticas, la maxima dificultad (388), la alcanzo la infiltracion/artrocentesis/ inyeccion articular infantil. La puntuacion de la inyeccion articular con control ecografico fue de 163. El informe clinico de minusvalia, 323 y el informe pericial, 370. Conclusiones Este trabajo ha permitido elaborar un nomenclator de 54 actos en reumatologia donde se identifican como actos mas complejos la realizacion de biopsias (osea, nervio sural, sinovial), la visita a paciente hospitalizado, la visita a domicilio, la infiltracion infantil bajo sedacion y la elaboracion de un informe pericial. La ecografia osteomuscular es considerada el doble de compleja de una visita sucesiva, la capilaroscopia o la densitometria osea. EnglishIntroduction One of the missions of the Spanish Society of Rheumatology is to provide the necessary tools for excellence in health care. Currently, there is no reference point to quantify medical actions in this specialty, and this is imperative. Material and method A list of actions was drawn up and a hierarchical classification system was established by developing a complexity index, calculated based on the completion time and difficulty level of each action. Results The results of the Delphi method tended to the consensus opinion within a group (mean σ2 - σ1 = 0.75-1.43 = -0.68, mean IQR2 - IQR1 = 0.8-1.9 = -1.1). The values of the complexity index ranged between 48 and 465 points. Among consultation actions, those reaching the highest scores were the first inpatient visit (366) and visits to the patient's home (369). Among diagnostic techniques, biopsies were prominent, those with the highest score were: bone biopsy (465), sural nerve biopsy (416) and synovial biopsy (380). Ultrasound scan scored 204, capillaroscopy 113 and densitometry 112. Among therapeutic techniques, infiltration/ arthrocentesis/articular injection in children reached the highest difficulty (388). The score for ultrasound-guided articular injection was 163. The score for clinical report on disability was 323 and expert report 370. Conclusions A nomenclature of 54 actions in Rheumatology was compiled. Biopsies (bone, sural nerve, synovial), inpatient visits, visits to the patient's home, infiltrations in children, and the preparation of the expert report were identified as the most complex actions. Musculoskeletal ultrasound is twice as complex as subsequent visits, capillaroscopy or bone densitometry.

Resumen Objetivo Elaborar recomendaciones SER sobre el uso de agentes biologicos en el sindrome de Sjogren primario (SSp). Metodos Se identificaron preguntas clinicas de investigacion relevantes sobre el uso de agentes biologicos en el SSp. Las preguntas clinicas se reformularon en 4 preguntas PICO. Se diseno una estrategia de busqueda y se realizo una revision de la evidencia cientifica de estudios publicados hasta mayo de 2017. Se reviso sistematicamente la evidencia cientifica disponible. Se evaluo el nivel global de la evidencia cientifica utilizando los niveles de evidencia del SIGN. Tras ello, se formularon recomendaciones especificas. Resultados Se recomienda rituximab como el farmaco biologico de eleccion para las manifestaciones extraglandulares refractarias al tratamiento convencional. Se desaconseja el uso de agentes anti-TNF. La evidencia cientifica es escasa con belimumab y abatacept, por lo que deberian considerarse solamente en los casos resistentes a rituximab. Conclusiones El rituximab es el farmaco biologico de eleccion en las manifestaciones graves extraglandulares del SSp. Belimumab o abatacept podrian ser de utilidad en casos seleccionados.

Resumen Objetivo El paradigma actual en el tratamiento de la artritis reumatoide (AR) contempla el diagnostico temprano y el uso precoz de farmacos modificadores de enfermedad (FAME) para alcanzar la remision o baja actividad inflamatoria, lo cual, se conoce como «treat to target» (T2T). El objetivo del trabajo es desarrollar un indicador compuesto (IC) para evaluar la calidad asistencial en el manejo de los pacientes con AR atendiendo a la estrategia T2T y a otras recomendaciones generales para la atencion de estos pacientes. Material y metodo La construccion del IC siguio las fases: 1) seleccion de los criterios de calidad mediante un juicio de expertos ; 2) priorizacion de los criterios, a partir de un Delphi con 20 expertos; 3) diseno de los indicadores de calidad, y 4) calculo del IC ponderado. La fuente de informacion para el calculo del IC son las historias clinicas de los pacientes con AR. Resultados De los 37 criterios seleccionados, 12 necesitaron una segunda ronda Delphi. Se priorizaron 31 criterios, los cuales presentaron una mediana en relevancia y factibilidad, en las rondas Delphi, mayor o igual a 7,5, con un rango intercuartilico inferior a 3,5, y un grado de acuerdo (puntuacion mayor o igual a 8) igual o superior al 80%. Conclusiones El IC construido, consensuado y ponderado, permite evaluar la calidad asistencial de los pacientes con AR, en las Unidades de Reumatologia de hospitales espanoles, ofreciendo una medida resumen valida y facilmente interpretable.

Objective The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables. Methods Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care). Results Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the “Timed Up and Go” Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects. Conclusion The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise. Impact The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.

22 páginas.- 6 figuras.- 6 tablas.- 41 referencias.- (This article belongs to the Special Issue Future of Irrigation in Agriculture), The tomato cultivated surface is one of the most important surfaces in the world. This crop needs a sufficient and continuous supply of water during vegetative growth. Therefore, production may be at risk in warm and water-scarce areas. Therefore, the implementation of irrigation alternatives such as regulated deficit irrigation (RDI) is of great importance to reduce the use of water and improve the production of the quality of tomatoes. The objective of this work was to evaluate the deficit irrigation scheduling using plant water status as a tool in deficit irrigation. Experimental design was a randomized design with four replications per treatment. Two irrigation treatments were applied: Control (125% of crop evapotranspiration (ETc)) and Regulated Deficit Irrigation (RDI). This latter treatment considered different threshold values of midday leaf water depending on crop phenological stage. No differences were observed in yield, with RDI treatment being more efficient in the use of irrigation water than the control. Besides, RDI tomatoes presented, in general, greater weight, size, Total soluble solids (TSS), sugars, antioxidant activity, lycopene, β-Carotene, and redder color with more intense tomatoes flavor. Finally, it might be said that RDI strategy helped to reduce 53% of irrigation water and to improve the nutritional, functional, and sensory quality of tomatoes.

The main objective of this research was to carry out an experimental study, triple-blind, on the possible immunophysiological effects of a nutritional supplement (synbiotic, Gasteel Plus®, Heel España S.A.U.), containing a mixture of probiotic strains, such as Bifidobacterium lactis CBP-001010, Lactobacillus rhamnosus CNCM I-4036, and Bifidobacterium longum ES1, as well as the prebiotic fructooligosaccharides, on both professional athletes and sedentary people. The effects on some inflammatory/immune (IL-1β, IL-10, and immunoglobulin A) and stress (epinephrine, norepinephrine, dopamine, serotonin, corticotropin-releasing hormone (CRH), Adrenocorticotropic hormone (ACTH), and cortisol) biomarkers were evaluated, determined by flow cytometer and ELISA. The effects on metabolic profile and physical activity, as well as on various parameters that could affect physical and mental health, were also evaluated via the use of accelerometry and validated questionnaires. The participants were professional soccer players in the Second Division B of the Spanish League and sedentary students of the same sex and age range. Both study groups were randomly divided into two groups: a control group—administered with placebo, and an experimental group—administered with the synbiotic. Each participant was evaluated at baseline, as well as after the intervention, which lasted one month. Only in the athlete group did the synbiotic intervention clearly improve objective physical activity and sleep quality, as well as perceived general health, stress, and anxiety levels. Furthermore, the synbiotic induced an immunophysiological bioregulatory effect, depending on the basal situation of each experimental group, particularly in the systemic levels of IL-1β (increased significantly only in the sedentary group), CRH (decreased significantly only in the sedentary group), and dopamine (increased significantly only in the athlete group). There were no significant differences between groups in the levels of immunoglobulin A or in the metabolic profile as a result of the intervention. It is concluded that synbiotic nutritional supplements can improve anxiety, stress, and sleep quality, particularly in sportspeople, which appears to be linked to an improved immuno-neuroendocrine response in which IL-1β, CRH, and dopamine are clearly involved.

Highlights • Endurance foot races increase the levels of markers for heart damage, which persist at high levels for a 24-h minimum period. • Gender, body mass index, and intensity of the race exert a moderating effect on the acute increase of troponin T and troponin I. • It is recommended that individuals should be adequately prepared for foot-race competition, particularly races that combine long duration and moderate intensity (i.e., marathons). Men and less experienced or young participants with high fat percentages or high body mass indexes should be especially adequately prepared., Background To finish an endurance race, athletes perform a vigorous effort that induces the release of cardiac damage markers. There are several factors that can affect the total number of these markers, so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers. Methods A systematic search of PubMed, Web of Science, and the Cochrane Library databases was performed. This analysis included studies where the acute effects of running races on cardiac damage markers (troponin I and troponin T) were analyzed, assessing the levels of these markers before and after the races. Results The effects of running races on troponin I (mean difference = 0.0381 ng/mL) and troponin T (mean difference = 0.0256 ng/mL) levels were significant. The ages (R2 = 14.4%, p = 0.033) and body mass indexes (R2 = 14.5%, p = 0.045) of the athletes had a significant interaction with troponin I. In addition, gender, mean speed, time to finish the race, and type of race can affect the level of cardiac damage markers. Conclusion Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the races. In addition, young male athletes with high body mass indexes who perform races combining long duration and moderate intensity (i.e., marathons) release the highest levels of cardiac damage markers. Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races., Graphical Abstract Image, graphical abstract

To investigate the prevalence, associated factors, and effects of primary overt renal disease on morbidity in patients with primary Sjögren's syndrome (pSS).All patients in the Sjögrenser (registry of adult pSS patients of the Spanish Society of Rheumatology) cohort were retrospectively investigated for the presence of clinically significant renal involvement directly related to pSS activity.Of the 437 patients investigated, 39 (9%) presented overt renal involvement during follow-up. Severe renal disease necessitating kidney biopsy was relatively rare (2%). Renal involvement may complicate pSS at any time during the disease course and is associated with severe disease (indicated by higher scores of involvement, activity, and damage), systemic multiorgan involvement, and a higher frequency of lymphoma. Multivariate analysis showed that older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.07), higher European League Against Rheumatism Sjögren's Syndrome Disease Activity Index scores (OR 1.1, CI 1.03-1.18), serum anti-La/SSB positivity (OR 6.65, CI 1.41-31.372), and non-vasculitic cutaneous involvement (OR 5.47, 1.03-29.02) were independently associated with this complication. Chronic renal failure developed in 23 of 39 patients (59%); only 1 of them progressed to end-stage renal disease necessitating renal replacement therapy. Patients with overt renal disease showed higher Sjögren's syndrome disease damage index scores, higher rates of hospitalisation due to disease activity and higher rates of clinically relevant comorbidities.Overt renal involvement in pSS is not uncommon. Although it usually shows a favourable prognosis, is associated with significant morbidity.

Objectives: This study aims to analyse the validity (agreement between two methods) of the movement propulsive velocity (MPV) as an indicator of relative load in leg press (LP) and bench press (BP) exercises in persons with multiple sclerosis (MS). Methods: 18 persons with MS (sex = 55% male, age (mean SD) = 44.88 10.62 years, body mass = 67.19 10.63 kg, height = 1.66 0.07 m, Expanded Disability Status Scale (EDSS) = 3.12 1.73) performed an incremental loading test in BP and LP exercises in two separate sessions. Individual determination of the one-repetition maximum (1RM) and full load-velocity profile were obtained for each participant. Results: a significant linear relationship was observed between the %1RM load and the MPV in LP (%1RM = &minus, 133.58 &times, MPV + 117.44, r2 = 0.84, standard error of the estimate (SEE) = 9.38%1RM) and BP (%1RM = &minus, 95.66 &times, MPV + 115.26, r2 = 0.86, SEE = 9.82%1RM). In addition, no significant differences were found between the %1RM achieved directly and the %1RM obtained by the equation calculated from the linear regression (LP, p = 0,996, BP, p = 0,749). Conclusions: these results indicate that movement velocity can estimate the relative load in bench press and leg press exercises in persons MS.

Objectives To investigate the prevalence, associated factors, and effects of primary renal disease on morbidity in patients with primary Sjögren’s syndrome (pSS).Methods All patients in the SJÖGRENSER (registry of adult SSp patients of the Spanish Society of Rheumatology) cohort were retrospectively investigated for the presence of clinically significant renal involvement directly related to pSS activity.Results Of the 437 patients investigated, 39 (9%) presented overt renal involvement during follow-up. Severe renal disease necessitating kidney biopsy was relatively rare (23%). Renal involvement may complicate pSS at any time during the disease course and is associated with severe disease (indicated by higher scores of involvement, activity, and damage), systemic multiorgan involvement, and a higher frequency of lymphoma. Multivariate analysis showed that older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.07), higher European League Against Rheumatism Sjogren’s Syndrome Disease Activity Index scores (OR 1.1, CI 1.03–1.18), serum anti-La/SSB positivity (OR 6.65, CI 1.41–31.372), and non-vasculitic cutaneous involvement (OR 5.47, 1.03–29.02) were independently associated with this complication. Chronic renal failure developed in 23 of 39 patients (59%); only 1 of them progressed to end-stage renal disease necessitating renal replacement therapy. Patients with renal disease showed higher Sjögren’s syndrome disease damage index scores, higher rates of hospitalization due to disease activity and higher rates of clinically relevant comorbidities.Conclusion Renal involvement is an uncommon complication in pSS that was observed in 9% of patients. Although categorized as a non-negligible comorbidity, this condition shows a favorable prognosis.

Resumen Objetivo Establecer recomendaciones, basadas en la evidencia, sobre el uso de la ecografia (US) y la resonancia magnetica en pacientes con espondiloartritis, incluyendo la artritis psoriasica, y en la artritis idiopatica juvenil. Metodos Las recomendaciones se consensuaron mediante metodologia basada en grupos nominales. Un grupo de expertos (15 reumatologos y 3 radiologos) definio el alcance, los usuarios, los apartados, las posibles recomendaciones y las revisiones sistematicas a realizar (se utilizaron y actualizaron las revisiones de documentos de consenso de EULAR), y se asignaron tareas. Los expertos delimitaron los apartados y redactaron las recomendaciones. El nivel de evidencia y el grado de recomendacion se establecieron utilizando el sistema del Centre for Evidence Based Medicine de Oxford, y el grado de acuerdo mediante Delphi a 2 rondas. Las recomendaciones se votaron segun una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiendose el acuerdo como una puntuacion ≥ 7 por al menos el 70% de los participantes. El documento fue revisado por los expertos y el proyecto estuvo coordinado por un metodologo experto. Resultados Se emitieron 12 recomendaciones sobre la validez de la US y la resonancia magnetica para la deteccion de actividad y dano estructural, capacidad diagnostica, predictora (de progresion de dano estructural, brote de la enfermedad, respuesta al tratamiento, etc.), utilidad en la evaluacion y monitorizacion del tratamiento, y uso de la US como guia (para infiltraciones, biopsias, etc.) en pacientes con espondiloartritis y artritis idiopatica juvenil. Conclusiones Se presentan unas recomendaciones utiles para el manejo de la US y la resonancia magnetica por los clinicos en pacientes con espondiloartritis y artritis idiopatica juvenil.

Background The COVID-19 pandemic caused a global confinement of more than 2 months in Spain. As a result, the general population has significantly decreased their physical activity levels. The consequences of this abrupt, sedentary lifestyle in Spanish people with Multiple Sclerosis (pwMS) were unknown. Our aim was to examine the impact of COVID-19 home confinement on neuromuscular performance, functional capacity, physical self-perception, and anxiety in pwMS. Methods Eighteen pwMS (8:10 men/women, age: 43.41±10.88 years, Expanded Disability Status Scale: 2.85±1.34) participated in the study. Rate of force development (RFD) and maximal voluntary isometric contraction during knee extension in both legs, Timed-Up and Go test (TUG), sit-to-stand test, 6 min walk test, 10 m walk test, Physical-Self Perception Questionnaire (PSPQ) and State-Train Anxiety Inventory (STAI) were performed just before and after home confinement. Results A non-significant moderate effect (p = 0.07; ES = -0.48) was observed in the time in the sit-to-stand test compared to pre-home confinement. There was a significant increase in the time in TUG (p = 0.02; ES = -0.67). The PSQP score decreased (p = 0.01; ES = 0.79) and STAI-state increased (p = 0.01; ES = -0.65) following home confinement. Conclusion Home confinement had an impact on functional capacity, physical self-perception and state anxiety. However, neuromuscular performance was not altered after home confinement.

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades. Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed. Sin financiación No data JCR 2020 0.271 SJR (2020) Q4, 50/58 Rheumatology No data IDR 2020 UEM

OBJECTIVES: To explore the remission concept in rheumatoid arthritis (RA) and the implications of the existing definitions when applied to clinical practice among rheumatologists with different profiles. METHODS: A qualitative study through focus groups was conducted. Three focus groups were organised from February to March 2016. Each group was composed of rheumatologists with extensive clinical experience with different profiles; experts in basic research (RBR), experts in imaging techniques research (RIR), and experts in clinical research (RCR). The data was collected with audio recording. Verbatim transcriptions of the audio files were made, and a subsequent reflexive thematic analysis assisted by ATLAS.ti (GmbH, Berlin, v. 7) software was performed. RESULTS: From the reflexive thematic analysis, three main themes were generated: (1) remission limitations, (2) instruments or measures to assess remission, and (3) a new definition of remission. Rheumatologists mentioned frequently that the following variables should be considered when developing a new remission definition: inflammatory activity, calprotectin, psychological variables, sex, disease stage, and sociocultural factors. Contrary to what could be expected, all groups acknowledged that their research field could contribute with domains for a gold standard remission instrument, but not in a hierarchical arrangement of importance. The dissonance existing in the entire remission evaluation process was outlined: remission in clinical practice versus remission in clinical trials, remission following the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean versus Musculoskeletal Ultrasound (US) remission, and remission from the rheumatologist's point of view versus the patient's point of view. CONCLUSIONS: Currently, rheumatologists would not accept a domain as more important than others in remission. Our suggestion is, not to generate a universal definition of remission - one that could cover all aspects - but rather to develop definitions of remission for the different settings that could be pondered by the patient's perspective.

The aim of this study was to investigate the acute effects of vibration training (WBVT) under hypoxic and normoxic conditions on the voluntary rate of force development (RFD), balance and muscle oxygen saturation (SMO2) in persons with Multiple Sclerosis (MS). 10 participants completed the study (30% males, 44.4±7.7 years, 164.3±8.9 cm, 65.2±11.1 kg, 2.5±1.3 Expanded Disability Status Scale, 24.1±4.0 kg.m−2 BMI). Maximal force, RFD during isometric knee extension, static balance with eyes open and closed and sit-to-stand test were evaluated before and immediately after one session of WBVT (12 60-s bout of vibration; frequency 35 Hz; amplitude 4 mm; 1-min rest intervals) under both normoxic and hypoxic conditions. In addition, SMO2 of the gastrocnemius lateralis was assessed during each condition. No changes were found in force, static balance and sit-to-stand test. Time-to-peak RFD increased in the left leg (p=0.02) and tended to increase in the right leg (p=0.06) after the hypoxic session. SMO2 resulted in significant increases from the initial to final intervals of the WBVT under both hypoxic and normoxic conditions (p

This study aimed at determining socio-demographic and clinical factors of primary Sjögren syndrome (pSS) associated with osteoporosis (OP) and fragility fracture. SJOGRENSER is a cross-sectional study of patients with pSS, classified according to American European consensus criteria developed in 33 Spanish rheumatology departments. Epidemiological, clinical, serological and treatment data were collected and a descriptive analysis was conducted. Bivariate and multivariate analyses were performed using a binomial logistic regression to study the factors associated with OP and fragility fracture in pSS. 437 patients were included (95% women, with a median age of 58.6 years). 300 women were menopausal (76.4%). Prevalence of OP was 18.5% [in men (N = 21) this measured 19%]. A total of 37 fragility fractures were recorded. In the multivariate analysis, there was an association between OP and age: in the 51-64 age range (menopausal women), the OR measured 9.993 (95% CI 2301-43,399, p = 0.002); In the age 64 years group, OR was 20.610 (4.679-90.774, p 0.001); between OP and disease duration, OR was 1.046 (1.008-1085, p = 0.017); past treatment with corticosteroids, OR 2.548 (1.271-5.105, p = 0.008). Similarly, an association was found between fragility fractures and age: in the 51-64 age group, OR measured 5.068 (1.117-22,995, p = 0.035), age 64 years, OR was 7.674 (1.675-35,151, p 0.009); disease duration, OR 1.049 (CI 1.003-1097, p 0.036) and the ESSDAI index, OR 1.080 (1.029-1134, p = 0.002). Patients with pSS can develop osteoporosis and fragility fractures over the course of the disease. Age, corticosteroids treatment and disease duration were associated with the development of OP. Disease duration and ESSDAI were associated with the development of fractures in patients with pSS.

Objective: To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors. Methods: All bacteremic episodes from the Spanish RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted. Results: The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p < 0.001), cancer (OR 5.32, 95% CI 2.23-12.70; p < 0.001), immunosuppressors (OR 6.35, 95% CI 3.42-11.77; p < 0.001), and damage (OR 1.65, 95% CI 1.31-2.09; p < 0.001). Conclusion: Bacteremia occurred mostly in patients with active SLE and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities, and disease-related damage were associated with bacteremia. This work was supported by the Spanish Foundation of Rheumatology. JMPR is supported by grant 316265 (BIOCAPS) from the European Union 7th Framework Programme (FP7/ REGPOT-2012-2013.1) and FIS/ISCIII-Fondo Europeo de Desarrollo regional (FEDER) (Grant number PI11/02857).

18 páginas.- 9 figuras.- 3 tablas.- 46 referencias, Deficit irrigation scheduling is becoming increasingly important under commercial conditions. Water status measurement is a useful tool in these conditions. However, the information about water stress levels for olive trees is scarce. The aim of this experiment was to evaluate the effect on yield of a moderate controlled water stress level at the end of the irrigation season. The experiment was conducted in the experimental farm of La Hampa (Coria del Río, Seville, Spain) during three years. A completely randomized block design was performed using three different irrigation treatments. Deficit irrigation was applied several (4 or 2) weeks before harvest. Irrigation was controlled using the midday stem water potential, with a threshold value of −2 MPa and compared with a full irrigated treatment. This water stress did not reduced gas exchange during the deficit period. The effect on yield was not significant in any of the three seasons. In the high-fruit load season, fruit volume was slightly affected (around 10%), but this was not significant at harvest. Results suggest an early affection of fruit growth with water stress, but with a slow rate of decrease. Moderate water stress could be useful for the management of deficit irrigation in table olive trees., This research was supported by the Agencia Española de Investigación (AEI) and the Fondo Europeo de Desarrollo (FEDER) projects AGL2013-45922-C2-1-R and AGL2016-75794-C4-4-R.

Background Primary Sjogren’s syndrome (pSS) is characterized by lymphocytic infiltration of the exocrine glands. These patients have a higher risk than the general population of developing non-Hodgkin lymphoma (NHL). This risk also increases with the time of evolution of the disease. pSS is also associated with the development of non-hematological cancer such as thyroid, digestive or gynecological among others. Objectives The aim of the study is to explore the association between the development of neoplasia and demographic, clinical or therapeutic factors in pSS. Methods The SJOGRENSER registry is a multicenter, cross-sectional study of patients with pSS who meet the American-European consensus criteria of 2002, of 33 Spanish rheumatology units. The demographic, clinical, analytical, therapeutic and neoplastic data were collected through review of the clinical records and interviews with the patients. Previously, all the patients signed informed consent and the approval of the local ethic committees was obtained. Descriptive statistics was used for the analysis of the data. The chi-squared test was used to establish the statistical associations and it was considered a p Results Four hundred and thirty-seven patients were included in SJOGREN-SER Registry (female gender 95.19%; median age 58.3 years). We found 30 patients (6.86%) with neoplasia (3 of them with more than one neoplasia): 7 with lymphomas (23.3%) (4 MALT lymphomas, 2 Hodgkin’s lymphomas, 1 immunocytoma), 9 with gynecological neoplasia (30%), 2 with digestive malignancies, 2 with hematological, 2 with endocrine, 6 with malignancies in other locations, 3 with multiple mieloma and 2 patients with Waldenstrom macroglobulinemia. The results of the bivariate analysis are shown in the table. The factors significantly associated with the development of neoplasia were older age, glandular inflammatory involvement, lung involvement and use of rituximab. The age at diagnosis of the disease tended to be higher in the group with neoplasia (50.1 (± 12.9) vs 54.7 (± 11.7), p = 0.059). In the multivariate analysis, positive associations were found for the development of neoplasia in older patients (OR 1.045; CI95% 1.010-1.081), patients with glandular inflammation (OR 3.104; CI95% 1.396-6.906), and use of rituximab (OR 3.745; CI95% 1.386-10.118). Conclusion Thirty (6.86%) patients with pSS from the SJOGRENSER registry developed some neoplasia; the most frequent was gynecological, followed by lymphoproliferative processes. Older age, glandular inflammatory involvement and use of rituximab (presumably indication bias) were associated with the presence of neoplasia. References [1] Brito –Zeron, et al. Characterization and risk estimate of cancer in patients with primary Sjogren syndrome. Journal of hematology & oncology 2017;10:90. [2] Liang Y, et al. Primary Sjogren syndrome and malignance risk: a systematic review and meta-analysis. Ann Rheum Dis 2014;73:1151 Disclosure of Interests Monica Fernandez Castro: None declared, Carlos Sanchez-Piedra: None declared, Jose Luis Andreu: None declared, 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, Victor Martinez Taboada: None declared, Alejandro Olive: None declared

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