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Background Non-infectious aortitis is often refractory to standard immunosuppressive therapy. In these cases, the use of inhibitors of TNF-α (iTNF-α) had been reported. Objectives Our aim was to assess the efficacy of iTNF-α in a series of patients with refractory non-infectious aortitis. Methods Retrospective multicenter study of patients diagnosed with aortitis refractory to traditional immunosuppressive agents and who received iTNFα. The diagnosis of aortitis was based on imaging techniques (MRI-angiography, computed tomography, PET scan, ultrasonography and/or arteriography). Results We studied 19 patients (15 women/4 men) with a mean age of 42±13 years. The iTNFα used were: infliximab (IFX) (n=14), adalimumab (ADA) (n=3) and etanercept (ETN) (n=2). The underlying conditions were: Takayasu arteritis (TA) (n=11), giant cell arteritis (GCA) (n=2), relapsing polychondritis (RP) (n=1), ulcerative colitis (n=1), Crohn9s disease (n=1), Behcet9s disease (n=1), sarcoidosis (n=1) and psoriatic arthritis (n=1). Seventeen patients were previously treated with traditional immunosuppressive agents [methotrexate (MTX) (n=15), azathioprine (AZA) (n=7), cyclophosphamide (CPM) (n=5), mycophenolate mofetil (MM) (n=3), chlorambucil (n=1), cyclosporine A (n=1), tacrolimus (n=1)]. Two patients needed a switching between biologic agents (a female with TA who switched from IFX to ETN; and a male with psoriatic arthritis who switched from ETN to ADA; in both cases switching was due to inefficacy of the first biologic drug). After a median follow-up of 16 [12–36] months, most patients experienced clinical improvement, showing a reduction of erythrocyte sedimentation rate from 37.5 [30–56] mm/1st hour at baseline, to 20.5 [10–24] mm/1st hour at the last visit. Besides, C-reactive protein decreased from 1.5 [0.1- 2.6] mg/dL to 0.3 [0.1–0.8] mg/dL. After 3 months of treatment, 55% of patients had experienced clinical improvement (p Conclusions iTNFα therapy appears effective and relatively safe in patients with non-infectious aortitis refractory to traditional immunosuppressive drugs. Acknowledgement This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared

We present a case of systemic lupus erythematosus complicated by pancytopenia and visceral leishmaniasis in Spain. The literature on opportunistic infection in lupus erythematosus is reviewed.Leishmaniasis is a group of infections caused by the protozoa Leishmania, which is endemic in the Mediterranean basin. These opportunistic infections are an emerging entity in immunosuppressed patients. The use of immunosuppressive treatment in systemic lupus erythematosus modifies natural defense patterns and increases the risk of visceral leishmaniasis in endemic areas.

Presentamos un caso de lupus eritematoso sistémico complicado con pancitopenia y leishmaniasis visceral ocurrido en España. A propósito del mismo, realizamos una revisión bibliográfica sobre infecciones oportunistas en el lupus eritematoso sistémico. La leishmaniasis es un grupo de enfermedades causadas por el protozoo Leishmania, endémica en la cuenca mediterránea y de carácter oportunista y emergente en pacientes inmunodeprimidos. El uso de inmunosupresores en el tratamiento del lupus eritematoso sistémico induce modificaciones en la defensa natural, aumentando el riesgo de aparición de leishmaniasis visceral en zonas endémicas.

Objectives Analyze the results of a pilot study to measure the functionality of a new online evaluation system of knowledge in Rheumatology MIR rotating units for this specialty. Methods It has been developed an online computer test platform for knowledge in Rheumatology with measurable results. 10 centers in the Valencian Community were asked to prepare questions of moderate and attainable complexity to MIR residents from other specialties. The evaluation procedure is carried out in two stages: a first test of 30 questions starts the rotation, which includes demographic data. At the end of the Rheumatology rotation, the MIR perform the second test similarly and lastly, they answer a satisfaction questionnaire about the rotation performed. Each question has 4 options, the valid answer is 1 point and an incorrect answer subtracts 0.25 points. Results It has been developed a set of 300 multiple choice questions, of which >10% include images. These questions cover topics from the entire spectrum of the specialty. To confirm the suitability of the questions at the expected level of MIR rotating one Delphi round was held between the participants, 59 were detected not suitable questions that were replaced by more affordable. The results obtained so far correspond to the last 10 months. In assessing 42 physicians participated in MIR formation of which 32 were women (76%). 2 in the province of Castellόn, 6 Valencia and 5 of Alicante results of 13 centers of Valencian Community were obtained. Most respondents were residents of 2nd year (64%) and from the Family and Community Medicine specialty (69%). Of a total of 30 questions in the questionnaire, in the first test (start of rotation) the mean of the correct questions was 18.90±3.81, with a mean failure of 10.50±3.37 and a mean of unanswered questions of 0.60±1.64. In the second test (final rotation), the mean of the correct questions was 21.30±3.59, with a mean failure of 8.43±3.62 and a mean of unanswered questions of 0.26±0.75. An average increase between the two assessments 4.38±2.67 relative to the total score was observed. This corresponds to an average increase of 0.89±1.46 standardized points (range 0-10) after performing the rotation in Rheumatology. The completion time was 22.2±8.57 minutes in the first test and 25.67±11.82 in the second. The satisfaction rates after rotation were >90% in all cases. Acceptance of the system was excellent by tutors and residents. Conclusions REUMEVAL is an online system that allows an objective assessment of the increase in knowledge of Rheumatology MIR performing rotary units of this specialty. In this pilot study we test the system acceptance by the MIR and their tutors, as well as a demonstrable increase in knowledge after rotation. Acknowledgements Acknowledgements: Study conducted with the support of the Valencian Society of Rheumatology and partial sponsorship of MSD Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2037

To study the seroprevalence of hepatitis C virus in a cohort of six patients with a diagnosis of polyarteritis nodosa (PAN).There have been included six patients with a diagnosis of PAN, carrying out a serodiagnosis of hepatitis B virus (VHB) and C (VHC) this last one by means of the following methods: ELISA, RIBA-II and PCR.These cases (50%) showed exclusive positivity to VHC by means of the three ways of diagnosis, two cases showed positivity to VHB (33.3%), one case (16.6%) showed positivity to both virus (VHB and (VHC) and one case didn't show positivity virus.It is probable a ethipatogenic relation between hepatitis C virus and polyarteritis nodosa, our sample doesn't show any difference from that written in the literature. The positive rheumatoid factors can give false positive for VHC by means of the technique ELISA because of this it is necessary to confirm the positive by means of the techniques RIBA-II and PCR.

Recently, the syndrome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE), has been proposed. The RS3PE syndrome has an acute onset, does not produce bony erosions, with a predilection for elderly patients and an excellent prognosis. This condition distinguishing if from rheumatoid arthritis and polymyalgia rheumatica. The purpose is to call attention to a benign forms of arthritis in aging patients. We report two cases of RS3PE syndrome.

A 37 year old woman is presented with solitary splenic abscess, without involvement of other organs, in the context of septic abortion. Splenic abscess were effectively treated with 21 days of antibiotic administration, not was necessitated splenectomy and percutaneous drainage. Emphasis is laid on its rarity of solitary splenic abscess in the course of gynecologic infection, and complete response to antibiotic treatment.

Suprarenal insufficiency is the systemic disease more frequent associated to auricular cartilage calcification. Physiopathologic mechanism of this phenomenon remain without elucidate, several hypothesis have been postulated. We introduce one patient male attached of Addison's disease with external ear bilateral calcification. We review 20 case related in literature, postulating that low levels of cortisone, established in acute or chronic form, can cause a maintained or transitory hypercalcemia, calcium deposit in predisposed physically-chemically tissue: deficient peripheral vascularization and susceptibility to external aggression like traumatisms or cold.

The Neutrophilic dermatosis (ND) is considered as an independent entity with diverse clinical manifestations among which there are: gangrenous pyoderma, nodous erythema, Sweets Syndrome, vesiculopustula eruptions associated to ulcerous colitis and intestinal short circuit syndrome with or without short circuit. Histologically, they are characterized by infiltration of polymorphonuclear neutrophils, generally at the dermic level, but also at the epidermic. They are usually associated to systemic diseases, especially to chronic intestinal inflammatory disease. Our aim was to describe two forms of clinical presentation of neutrophilic dermatosis: gangrenous pyoderma and vesiculopustula eruption, associated to ulcerous colitis starting at advances ages.

We present the case of a patient under corticosteroid therapy (Deflazacort) developing a cutaneous Kaposi's Sarcoma. In a latter study performed due to the presence of digestive syndrome, a gastric Kaposi's sarcoma was detected. We review the cases published in the literature of patients with rheumatoid pathology under corticosteroid therapy.

Schönlein-Henoch purpura is a vasculitis due to hypersensitivity characteristic of the infancy that affects preferably small vessels. The etiology is unknown, although it has been related to allergic reactions to drugs, infections, vaccines and insecta bites. An adult with a Schönlein-Henoch purpura after receiving spiramicin is presented, beginning with epigastric pain and vomiting and the purpura appearing subsequently.

We present a case of mixed disease of the connective tissue in a 37-year-old woman previously healthy, whose first manifestations were ascites, facial edemas and tibiomalleolars, latter progressing with constitutional syndrome, myalgias, Raynaud's phenomenon and esophagic disorders. In the literature reviewed, we have not found any other case of this type of onset in mixed disease of the connective tissue.

We present a case of nodose polyarteritis (NPA) in a 65-years-old man with clinical manifestations at the level of the peripherical nervous system (PNS) as a subacute sensorimotor polyneuropathy. We believe that this is an interesting case due to the outlined symptomatology and the first clinical signs, not as common as the multiple mononeuropathy. The diagnosis was established through biopsy of muscle-nerve, without observing aneurysms at the Divas and with negative results for the Hepatitis B markers. Response to corticoid and immunosuppressive therapy was positive.

Two clinical cases of patients with rheumatoid arthritis (RA) and poor response to conventional treatment are described. Patients received immunosuppressor treatment with azathioprine (AZA) and developed hepatic hemangiomas without detectable hepatic pathology previous to the treatment with AZA. The hepatic iatrogenesis of AZA is discussed, as well as the etiopathogenic hypothesis regarding hepatic hemangioma.

We present a case of a 65-year-old woman, in whom diagnosis of primary systemic amyloidosis was established, being dyspnea the main cause of consultation. In addition, we emphasize the importance of the adequate valorization of such symptom in a patient with no precedents of cardiorespiratory pathology.

We report a case of rheumatic polymyalgia associated with temporal arteritis, in which clinical-biological symptoms and evolution with steroid or immunosuppressive therapy were analyzed. We confirm the lack of effectiveness of the treatment with AINES, the low response to steroids and the high response to immunosuppressive therapy.

Sweet's syndrome, or febrile neutrophilic dermatosis, is a disease first described by Sweet R.D. in 1964 as a dermatologic disease. Subsequently, it has been associated to several disease. One of those rarely describe is the association to chronic intestinal inflammatory disease. We reviewed the cases studied in our hospital since 1980 and found two cases associated to chronic intestinal inflammatory disease. We recommend the carrying out of gastrointestinal studies in patients afflicted by Sweet's syndrome to detect its association.