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Objective To evaluate the efficacy of 18 F-FDG PET-CT in the diagnosis of recurrence of colorectal cancer (CRC) in patients with elevated values of carcinoembryonic antigen (CEA) and/or signs of recurrence in the multidetector computerized tomography (MDCT), and to demonstrate that good results can be obtained applying the as low as reasonably achievable (ALARA) principles. Material and methods A retrospective study of 54 patients with suspected CRC, who underwent an 18 F-FDG PET-CT, administering a mean dose of 222 MBq (6 mCi) of 18 F-FDG, from 07/2007 to 01/2011 was carried out. Seven patients were excluded, thus studying 47 patients (27 males, 20 females, mean age 63 years). Recurrence was confirmed by histopathology study in 14 cases and by clinical evolution in 33. The patients were divided into 4 groups. A: patients with elevation of CEA and suspected recurrence in the MDCT. B: elevation of CEA, without suspicious lesions in the MDCT. C: normal levels of CEA and positive MDCT. D: normal levels of CEA and uncertain MDCT. Results We found sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of 91%, 69%, 89%, 75% and 85% respectively. For group A, we found 100% sensitivity, in group B, 75% sensitivity with 100% specificity, for C, sensitivity was 89% with 71% specificity. Finally, in group D, sensitivity was 100% and specificity 60%, respectively. Conclusion Applying a low dose, the 18 F-FDG PET-CT has high diagnostic performance in patients with suspicion of CRC, approaching in a higher grade the ALARA criteria.

A 50-year-old woman with a history of bilateral lobular carcinoma of the breast in 1995 and 2001 was treated with mastectomy, axillary lymphadenectomy, chemotherapy, and hormone therapy which achieved a complete response. In 2009, the patient developed a progressive elevation of tumor markers. A CT scan was performed showing no suspicious malignant lesions. She was referred for (18)F-FDG PET/CT and the images revealed highly increased tracer uptake in the uterus suggestive of malignancy. The patient underwent hysterectomy with bilateral double adnexectomy and a histopathological diagnosis of massive carcinomatous infiltration of breast lobular carcinoma was done.

Background Mortality in SLE has improved over the last decades. Outcome measures as damage become more important. Objectives To study damage manifestations and the timing of their appearance. Methods In the 1st transverse phase of RELESSER, accumulated information on 400 variables per patient at the time of the last evaluation was collected. We evaluated damage manifestations in each system and the temporal relationship of their appearance with the time of SLE diagnosis. Cumulative incidence function for damage was estimated.The impact on mortality was studied controlling for sex, race, age at diagnosis and delay of diagnosis of SLE by Cox regression. Results 2,662 SLE patients had the dates of presentation of each event of damage: 2,417 (91.0%) women, 2,402 (92.8%) Caucasian, mean age (±SD) 34.0 (±13.6) years at the time of diagnosis. The mean follow-up time was 115.6 (±50.8) months. 112 (4.2%) patients died. At the time of the study 917 (34.4%) patients had at least 1 damage manifestation, the mean number of systems per patient with at least 1 damage manifestation was 0.54 (±0.92) and the mean SDI score was 0.65 (±1.2). The systems more frequently damaged were musculoskeletal (MS) (11.9%), ophtalmic (7.8%) and cardiovascular (CV) (5.9%).In the 1st year after SLE diagnosis, the cumulative incidence (CI 95%) of damage in at least 1 system was 7.4% (6.4–8.4), at 5 years 18.9% (17.3–20.4) and after more than 10 years 29.2% (27.3–31.1).The systems damaged at earliest stages, 1 year after SLE diagnosis, were: MS 1.7% (1.2–2.2), neuropsychiatric 1.3% (0.8–1.7), renal 1.2% (0.8–1.6) and CV 0.9% (0.6–1.3). The rate of increase of damage is significantly higher (p Conclusions Damage occurs already in early stages of the disease. It appears early in MS, neuropsychiatric and kidneys. The increase of damage is greater in the 1st year after SLE diagnosis. The accumulation of visceral damage increases the mortality rate. Disclosure of Interest J. Pego Grant/research support from: Spanish Society of Rheumatology, FIS/ISCIII (PI11/02857), BIOCAPS from the EU 7th Framework Programme/REGPOT-2012–2013.1 (316265),GSK, Roche, Novartis,UCB., A. Lois: None declared, C. Mourino: None declared, F. L-Longo: None declared, M. Galindo: None declared, J. Calvo: None declared, J. Una: None declared, V. Balboa: None declared, A. Olive: None declared, T. Otόn: None declared, J. Ibanez: None declared, L. Horcada: None declared, A. Sanchez: None declared, C. Montilla: None declared, R. Melero: None declared, V. MTaboada: None declared, E. Diez: None declared, M. Fernandez: None declared, E. Ruiz: None declared, J. HBeriain: None declared, M. Gantes: None declared, B. HCruz: None declared, A. Pecondon: None declared, N. Lozano: None declared, G. Bonilla: None declared, V. Torrente: None declared, L. Silva: None declared, A. FNebro: None declared, I. Rua: None declared

Background Chronic inflammatory arthropaties-CIA (RA-rheumatoid arthritis, PA-psoriatic arthritis, and AS-ankylosing spondylitis) cause functional disability and reduces health-related quality of life (HRQoL) of patients1 Objectives To evaluate HRQoL in patients with CIA and biologic therapy (BT), as a measure of patient reported outcome. Methods Descriptive cross-sectional study (August 2014) in a tertiary hospital. Inclusion criteria:a)adult patients with RA, PA, SA and other CIA (O) attended at the Rheumatology Service and b)≥2 months of treatment with BT (sc/iv adalimumab-ADA, sc/iv etanercept-ETA, iv infliximab, sc golimumab, sc certolizumab, sc/iv abatacept, sc/iv tocilizumab or iv rituximab). Sociodemographic and clinical variables were obtained by structured interview and review of medical record.Degree of disease activity measures: DAS28 index (≤3.2:low activity; >3.2-≤5.1:moderate; >5.1:high) for RA and PA peripheral; BASDAI ( Results A total of 382 patients were eligible for the study.314 patients agreed to answer the questionnaire (women:55.7%, average age (±SD): 55.2±13.9 years, average disease duration (±SD):13.05±8.1 years). Pathologies distribution: 44.3% RA, PA 26.1%, 21.3% AS, 8.3% O. BT: 51.9% ADA, 28.7% ETA and 19.4% others. 65.9% of patients had a first line of TB. 50% of patients had concomitant drug (corticosteroid/methotrexate/leflunomide). 71.7% of patients had low activity, with standard drug regimen (61.8%) and optimized regimen (37.6%). The EQ-index perceived was:0.73±0.22 and a global health EQ-VAS: 64.2±21.0 points. The worst rated questionnaire dimensions (severities 3–4-5) were P (33.7%), UA (29.9%) and M (26.7%). LRA showed significance differences (p Conclusions Generally, patients evaluated have a good control of disease activity and an acceptable HRQoL perceived. Chronic P and loss of autonomy to perform UA are the worst rated dimensions References Gerhold K, Richter A, Schneider M, Bergerhausen HJ, Demary W, Liebhaber A, et al. Heailth-related quality of life in patients with long-standing rheumatoid arthritis in the era of biologics: data from the German biologics register RABBIT. Rheumatology.2015; 54:1858–66. Rabin R, de Charro F. EQ-5D:a measure of health status from the EuroQol Group. Annals of Medicine. 2001; 33:337–43 Disclosure of Interest M. Άlvarez-Payero: None declared, F. Maceiras: None declared, R. Melero: None declared, C. Mourino: None declared, A. Martin: None declared, M. Rodriguez-Rodriguez: None declared, M. Ucha: None declared, N. Martinez: None declared, I. Hernandez: None declared, C. Barbazan: None declared, M. Rodriguez: None declared, V. Balboa: None declared, J. Una: None declared, G. Pineiro Grant/research support from: Pfizer, J. Pego Grant/research support from: Pfizer

To evaluate the efficacy of (18)F-FDG PET-CT in the diagnosis of recurrence of colorectal cancer (CRC) in patients with elevated values of carcinoembryonic antigen (CEA) and/or signs of recurrence in the multidetector CT (MDCT), and to demonstrate that good results can be obtained applying the ALARA principles.A retrospective study of 54 patients with suspected CRC, who underwent an (18)F-FDG PET-CT, administering a mean dose of 222 MBq (6 mCi) of (18)F-FDG, from 07/2007 to 01/2011 was carried out. Seven patients were excluded, thus studying 47 (27 males, 20 females, mean age 63 years). Recurrence was confirmed by histopathology study in 14 cases and by clinical evolution in 33. The patients were divided into 4 groups. A: patients with elevation of CEA and suspected recurrence in the MDCT. B: elevation of CEA, without suspicious lesions in the MDCT. C: normal levels of CEA and positive MDCT. D: normal levels of CEA and uncertain MDCT.We found sensitivity, specificity, PPV, NPV and overall accuracy of 91%, 69%, 89%, 75% and 85% respectively. For group A, we found 100% sensitivity, in group B, 75% sensitivity with 100% specificity%, for C, sensitivity was 89% with 71% specificity. Finally, in group D, sensitivity was 100% and specificity 60%, respectively.Applying a low dose, the (18)F-FDG PET-CT has high diagnostic performance in patients with suspicion of CRC, approaching in a higher grade the ALARA criteria.

Background Daily clinical practice not always corresponds with the standard use of biologic therapies (BT) in rheumatic patients.st Objectives To determine the real vs. theoretical annual cost of BT per patient with chronic arthritis at a University tertiary Hospital. Methods Descriptive, observational, retrospective and cross-sectional study. Information over a 5-year period (2009-2014) is collected. Inclusion criteria: a) adult patients with RA (ACR), AE (New York modified/ASAS) or PsA (CASPAR) attended at the Rheumatology Service of the University Hospital of Vigo and b) >6 months of treatment with BT. Variables: a)demographics, b)clinical, c)pharmacotherapeutic history and d)per each BT: number of dispensations, adverse events, therapeutic failures, transitory or definitive discontinuation, survival of each BT line, real and theoretical (price to retailer) annual cost/patient of each BT line. Variables are described per disease and BT. Results 484 patients were studied (total: 755 BT lines). Mean age (years): 53.8±14.8; females: 263 (54.3%). The diseases treated were RA 226 (46.8%), AE 107 (22.2%), PsA 117 (24.2%) and other spondyloartrhopaties 33 (6.8%). Mean disease duration (years): 13.1±8.2. Mean global BT duration (months) from the beginning of the evaluation (January 2009) was: 40.9±58.9. The table shows the different BT lines used and their mean duration (months) from that date. There were 359 (47.4%) definitive withdrawals of BT, being secondary failure 156 (43.4%) and adverse events 82 (22.8%) the most frequent reasons. There were 94 (12.4%) temporal discontinuations of doses of BT. The most frequent reasons of temporal discontinuations were surgery 13 (13.8%) and non-infectious adverse events 12 (12.8%). There was modification of BT doses by optimization in 236 (31.2%) BT lines. The number (%) of patients optimized per disease was: RA 77 (34.1%), AE 35 (32.7%) and PsA 44 (37.6%). The mean duration (months) of optimization was: RA 42.0±12.7; AE 22.9±20.0 and PsA 21.9±18.2. There was modification of BT doses by intensification regimes in 24 (3.2%) of the BT lines. The number (%) of optimizations and intensifications of each BT and the mean duration (months) of optimization of the 3 more used BT are shown in the table. The mean theoretical global BT cost per year of treatment was 12,569€ ±1,707. The mean real global cost per year was 11,167€ ±3,266. The mean real and theoretical annual cost and its ratio, for the 3 more used BT are shown in the table. The mean theoretical annual cost per the 3 main diseases was: RA 12,538€ ±1,509; EA 12,703€ ±1,536 y APs 12,647€ ±1,165. The mean real annual cost per disease was: RA 11,400€ ±2,988; AE 10,993€ ±3,024 and PsA 10,870€ ±2,797. The annual real/theoretical cost ratios per disease were: 91.4, 87.6 and 86.5%, respectively. Conclusions In daily practice there are different reasons that make that BT use differs from the standard recommendations. This makes that the real cost usually is less than the theoretical one. The detailed analysis of our data will give us relevant information about the factors that determine these variations and their involvement on the pharmaceutical cost. Disclosure of Interest J. M. Pego-Reigosa Grant/research support from: Pfizer, M. Ucha: None declared, F. Maceiras: None declared, R. Melero: None declared, M. Άlvarez: None declared, C. Mourino: None declared, A. Martin: None declared, M. Rodriguez: None declared, M. Rodriguez: None declared, V. Balboa: None declared, J. Una: None declared, I. Hernandez: None declared, C. Barbazan: None declared, G. Pineiro Grant/research support from: Pfizer, N. Martinez: None declared

Background Damage in SLE is associated with mortality. Not every damage manifestation is associated in the same way. Some studies were made assessing this relation but in small and heterogeneous samples making difficult to obtain meaningful conclusions. Objectives To evaluate patterns of damage accrual and mortality in a large sample of SLE patients. Methods SLE patients from RELESSER were studied. After K-means cluster analysis, different clusters of patients with similar characteristics in terms of damage accrual were identified. Kaplan-Meier log-rank test and Cox regression were used to analyse mortality in each group. Results 3,656 SLE patients from 45 Rheumatology Units across Spain were studied. 90.3% were women. 93.1% Caucasian, 5.2% Latinamerican and 1.6% other races. Mean age (±SD) at SLE diagnosis was 35.1±14.6 years. Mean follow-up time was 120.1±87.6 months. Mean SLICC/ACR damage index (SDI) score was 1.1±1.6. Average number of organ systems affected in terms of damage was 0.6±1.0. 207 (5.6%) patients died. The SDI organ systems most frequently damaged were: musculoskeletal (MS) (13.7%), ocular (8.5%), cardiovascular (CV) (7.9%) and renal (6.1%). The least frequently present were:gastrointestinal (1.9%), diabetes mellitus (2.4%) and premature gonadal failure (2.5%). Three clusters (C) were formed. C1 had mild or no damage. Patients in C2 had MS damage but no CV. In C3 all had CV damage. Among the 3 clusters, there were significant differences in prevalence of damage in each organ system assessed by the SDI, in average SDI score, in number of SDI systems damaged and mortality rate (p C3 patients were older at SLE diagnosis and had higher %of males (p Comparing survival curves of the 3 clusters, the log-rank test showed significant differences (p Cox regression analysis showed that, compared with C1, the mortality hazard ratio of C2 and C3 was 1.9 and 3.5 higher respectively (p Conclusions SLE patients can be divided into different homogeneous groups (clusters) based on damage accrual. These clusters have different mortality rates. Disclosure of Interest J. Pego Grant/research support from: Spanish Society of Rheumatology, FIS/ISCIII (PI11/02857), BIOCAPS from the EU 7th Framework Programme/REGPOT-2012-2013.1 (316265), GSK, Roche, Novartis,UCB., A. Lois: None declared, F. Lόpez: None declared, M. Galindo: None declared, J. Calvo: None declared, J. Una: None declared, V. Balboa: None declared, A. Olive: None declared, C. Mourino: None declared, T. Otόn: None declared, J. Ibanez: None declared, L. Horcada: None declared, A. Sanchez: None declared, R. Blanco: None declared, C. Montilla: None declared, R. Melero: None declared, E. Diez: None declared, M. Fernandez: None declared, E. Ruiz: None declared, J. Hernandez: None declared, M. Gantes: None declared, B. Hernandez: None declared, A. Pecondόn: None declared, N. Lozano: None declared, G. Bonilla: None declared, V. Torrente: None declared, I. Rua: None declared