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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 Los nodulos reumatoides benignos son nodulos subcutaneos, identicos en su morfologia e histologia a los que ocurren en el transcurso de la artritis reumatoide (AR), que aparecen en personas sin sintomas de artritis y con factor reumatoide (FR) negativo. Se presenta el caso de un varon de 46 anos de raza caucasiana que consulto por tumoracion en la pierna derecha. Destacaba negatividad de factor reumatoide, anticuerpos anti peptido citrulinado, anticuerpos antinucleares y anticuerpos anticitoplasma de neutrofilo, asi como normalidad de los reactantes de fase aguda. Una ecografia musculoesqueletica mostro una tumoracion solida de 3,5 × 1,5 cm, de margenes bien definidos, en musculo soleo, con una estructura heterogenea hipoecoica con vascularizacion intra y perilesional. La resonancia magnetica evidencio una tumoracion de caracter fibroso sin datos sugestivos de agresividad. Una biopsia guiada por ecografia mostro histologia caracteristica de nodulo reumatoide. Se discuten la clinica, el diagnostico, el diagnostico diferencial y el tratamiento de los nodulos reumatoides benignos.

Benign rheumatoid nodules are subcutaneous nodules, identical in morphology and histology to the nodules that develop over the course of rheumatoid arthritis (RA); they present in individuals with no symptoms of arthritis and with negative rheumatoid factor (RF). This article introduces the case of a 46-year-old caucasian male who consulted for a tumour in his right leg. He tested negative for rheumatoid factor, anticitrullinated protein antibodies, antinuclear antibodies, and antineutrophil cytoplasmic antibodies, as well as for acute phase reactants. A musculoskeletal ultrasound showed a solid tumour of 3.5 × 1.5 cm with well-defined margins in the soleus muscle, and with a heterogeneous hypoechoic structure with intra- and peri-lesional vascularisation. The MRI showed a fibrous tumour with no signs suggestive of aggressive growth. An ultrasound-guided biopsy showed the characteristic histology of a rheumatoid nodule. The clinical presentation, diagnosis, differential diagnosis, and treatment of benign rheumatoid nodules are discussed.

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.

In 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 The aim of this study is to describe the findings of a protocolised odontological evaluation of patients with primary Sjogren’s syndrome (pSS) treated in rheumatology units in the Community of Madrid. Methods Multicentric descriptive study in which pSS patients classified according to the American-European consensus of 2002 criteria were included. We collected the demographic, clinical and serological data of each patient. A complete oral examination was performed and salivary flow and the CAOD caries index were collected. The patients completed the visual analogue scale for xerostomia, the Oral Health Impact Profile-14 questionnaire and an oral health questionnaire. Results Sixty-one patients were recruited. Ninety-eight percent were women and the mean age of the patients was 57 years. Pathological oral signs (unstimulated salivary flow/salivary glands sialography/scintigraphy) were present in 52.5% of the patients, anti-Ro/anti-La were positive in 90.2%. Ninety-two percent of the patients reported xerostomia and 61% of the patients suffered from hyposialia. Thirty-five patients presented oral mucosa lesions. CAOD index was 16.97 ± 7.93 and visual analogue scale for xerostomia was 46.69 ± 14.43. The results of the OHIP-14 questionnaire were 23.13 ± 14.16. Patients with pathological oral signs obtained a significantly higher Oral Health Impact Profile-14 score (P = .03). We also found that patients with peripheral nervous system involvement obtained a significantly higher Oral Health Impact Profile-14 score (P = .001). Conclusions The presence of xerostomia in this cohort of pSS patients was high and hyposialia was present in 61% of the patients. Oral lesions appeared in more than half of the subjects. Oral health had a negative impact on the quality of life of patients with pSS, being higher in those with pathological objective oral signs and in those with peripheral nervous system involvement.

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.

Introduction The current paradigm of the management of rheumatoid arthritis (RA) recommends achieving a state of remission or low disease activity through the treat-to-target strategy. Our study assesses adherence to this strategy. Method Patients with RA (ACR-EULAR 2010 criteria) were included. From each centre, 19 patients were randomly selected. Clinical histories (CH) were assessed by independent auditors, checking compliance with predefined quality criteria. The study was approved by ethics committees. Results We included 856 patients (mean age 54 years; 71% women). The use of a combined index (CI) was recorded in 61% of cases. Visits were recorded every 4 weeks using a CI in 4% of CH while attempts were made to achieve remission. Monitoring of disease activity every 6–8 months after reaching the target was recorded in 73% of cases. Conclusions The implementation of the treat-to-target strategy is barely recorded in patients with RA in routine clinical practice.

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.

Introduction 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.

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.

The objective of the study was to assess the ESSDAI index characteristics in the SJOGRENSER cohort (Spanish Rheumatology Association’s registry of patients with Primary Sjogren Syndrome [PSS]). SJOGRENSER is a prospective multicentric study on a cohort of Spanish patients with PSS who meet the 2002 American–European consensus from rheumatology units. 298 variables were studied in patients for the inclusion of the study from an anonymous list from each department. The ESSDAI (EULAR Sjogren’s syndrome disease activity index) includes 12 domains and measures systematic activity in PSS patients. Each domain is divided into 3–4 levels, (0: no activity; 1: low activity; 2: moderate activity; 3: high activity) and is attributed a weight. Each domain score is obtained by multiplying the activity level by the weight assigned. According to ESSDAI: low activity

Objective To investigate the barriers and facilitators of adherence to methotrexate (MTX) in people with rheumatic diseases and to explore the experience of shared decision-making. Methods A qualitative study was carried out. People diagnosed with inflammatory arthritides or systemic autoimmune diseases and who were treated with MTX were invited to participate in focus groups. The discourse was coded and synthesised with a content analysis approach. Results The groups included 12 representative patients (rheumatoid arthritis, spondylarthritis, and systemic lupus erythematosus, taking either oral or subcutaneous MTX). Four main themes were identified: (1) drug-related aspects (package insert, adverse events, administration, and difficulties with treatment); (2) patient-physician relationship; (3) social environment (lack of visibility of rheumatic diseases and the support of patient associations); and (4) medication and medical care practicalities (information, reliable sources, and expanding knowledge in other health areas). Conclusions Aspects identified might help improve adherence, including quality information, especially on adverse events, the role of the setting, and shared decision-making.

Introduction Nerve conduction studies (NCS) have been considered as the gold standard in carpal tunnel syndrome (CTS) diagnosis, despite correlation between clinical symptomatology and NCS severity has shown to be poor. In fact, clinical symptoms precede NCS changes in months or years. Few papers have been published about the clinical response to treatment of clinically typical CTS, but with normal NCS (NNCS). Objective To compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with NNCS and abnormal NCS (ANCS). Method We included patients older than 18, with typical CTS symptoms (ongoing daily nocturnal pain/paresthesias in hand, at least during 3 months). Follow-up was done at 3, 6 and 12 months. Primary outcome was the visual analog scale for pain (p-VAS), comparing NNCS CTS wrists with ANCS CTS wrists. Statistic signification was established by the Student's t test, Mann–Whitney's “U”, χ2 test and Yates’ correction. Results We included 44 wrists in the NNCS group, and 83 in the ANCS group. There was no statistical significance between data in both groups, except in the 12-month follow-up, where the NNCS group achieved better results than the ANCS group in the 20% response (p = 0.006). There was a trend toward a better 50% response in the 12-month follow-up. Conclusions Our data suggest that LCI are similarly effective in both CTS with NNCS and ANCS. Nonetheless, there is a mild better effect in NNCS than in ANCS at 12-month follow-up.

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.

Objective To describe the progress of the attractiveness of rheumatology at successive MIR calls, from 1983 to 2014. Methods Candidates in the Spanish training system for medical doctors choose their specialties sequentially, ordered by their ranking in the qualifying exam (MIR). The highest, median and lowest rank of candidates choosing rheumatology training positions in every MIR call from 1983 to 2014 was requested from the Department of Management of Specialized Medical Training (General Department of Professional Regulation; Spanish Ministry of Health). To compare, the same data was requested for other specialties. In order to define and analyze the attractiveness of each specialty we introduce an ‘index of attractiveness’, based on the normalized difference of the actual median rank reported for each year and the average median obtained in 1000 simulations in which candidates choose specialties at random. Results Regarding the median of the election of rheumatology, the range went from 244th in 1983 to 3394th in 2008, showing a progressive increase over the years in absolute figures. A mathematical simulation allowed quantifying the difference between the observed median and what would have happened if specialties had been chosen by pure chance. Results show a tendency to recover the attractiveness of rheumatology in recent years. Conclusions After a sharp decline in the attractiveness of rheumatology during the last years of the 20th century, there seems to be a recovery.

Objective To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. Methods Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. Results A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. Conclusions These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.

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.

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).

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

Background Primary Sjogren’s syndrome (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands. Among the extraglandular manifestations, digestive involvement (DI) is frequent, and may condition the quality of life of these patients. There are few studies that systematically analyze gastrointestinal involvement in pSS. Objectives To describe the prevalence of DI in patients with pSS included in SJOGRENSER Spanish registry and the phenotype of these patients, and to analyze their association with other clinical manifestations, serological markers, activity index and treatments used. Methods Transversal multicenter study that includes all patients of SJOGRENSER registry (patients who meet 2002 pSS classification criteria), a study conducted in 33 units of rheumatology in Spain between 2014-2016, which collected demographic and clinical and serological data (1). Patients were classified according to the presence of DI (that included esophagus, stomach, intestine, liver and pancreas). A descriptive analysis was done, with means and standard deviations, frequencies and proportions. Student t for quantitative variables and Chi2 for qualitative ones were performed to evaluate differences between groups. The association of DI with other variables was analyzed by bivariate and multivariate binomial logistic regression analysis. In the multivariate model all variables with p Results From 437 patients included (95% women, median age of 58 years), 59 (13.5%) had some DI (21 (36%) chronic atrophic gastritis, 12 (20%) esophageal dismotility, 3 (5%) lymphocytic colitis, 23 (39%) other). 54% of patients developed DI at the time of pSS diagnosis or later, and 45% before the diagnosis, with a mean age of 49 years at the onset of pSS symptoms. Patients with DI were older, both at diagnosis, onset of pSS symptoms and inclusion in the cohort, than those without it. There were no differences in the ESSDAI index between both groups. Comparison regarding clinical and serological characteristics is shown in Table 1. Patients with DI had more thyroid involvement and C3 hypocomplementemia. In addition, patients with DI had been treated more frequently with glucocorticoids and immunosuppressants. In the multivariate analysis, DI was significantly associated with older age at diagnosis (OR 1.03 (1.00-1.05); p=.005), more C3 hypocomplementemia (OR 2.40 (1.10-5.26) p=.027) and absence of anti-Ro antibodies (OR 0.33 (0.12-0.87) p=.025). Conclusion In patients with pSS from the SJOGRENSER cohort, the prevalence of digestive involvement is 13.5%. These patients are older at diagnosis, have more C3 hypocomplementemia and negative anti-Ro antibodies. These patients need more frequently glucocorticoids and immunosuppressants, suggesting a more severe disease phenotype. Reference [1] Fernandez Castro M, Reum Clin2016; 12:184-9 Disclosure of Interests Sheila Melchor: None declared, Carlos Sanchez-Piedra: None declared, Monica Fernandez Castro: None declared, Jose Luis Andreu: None declared, Victor Martinez Taboada: None declared, Alejandro Olive: 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, Patricia Carreira: None declared

Background Primary Sjogren’s syndrome (pSS) is a systemic autoimmune disease characterized by the involvement of the exocrine glands, mainly salivary and lacrimal glands. Approximately half of patients will experience extraglandular complications throughout their evolution. Objectives To characterize the involvement of the nervous system (NS) in patients with pSS. Methods Multicenter cross-sectional study of a cohort of patients with pSS, constructed by random selection of pSS patients fulfilling the 2002 American-European Consensus Criteria for pSS1 from 33 rheumatology units. Through review of clinical records and interview with patients, demographic, clinical, analytical, therapeutic data and disease activity indexes were collected. Univariate analysis was done by Chi square test, Mann-Whitney U test and Student’s t test. Multivariate analysis was done by linear logistic regression. A p Results 437 patients were included (95% women, median age of 58 years). 65 patients developed NS involvement: 26 patients central NS, 31 peripheral NS and 8 both. Multivariate analysis showed association between NS involvement and atherosclerotic stroke (OR 10.4, 95% CI 2.8-38.5), ear disease (OR 2.1, 95% CI 1.1-4.2) and myopathy (OR 6.5, 95% CI 1.3-31,6). Patients with NS involvement had higher probability of being treated with glucocorticoids (OR 3.3, 95%CI 1.5-7.2) and cyclophosphamide (OR 6.8, 95% CI 1.5-31). Conclusion 15% of patients with pSS develope NS involvement that is associated with atherosclerotic stroke, ear disease and myopathy. Reference [1] Vitali C. et al. Ann Rheum Dis 2002; 61:554 Disclosure of Interests Jose Luis Andreu: None declared, Carlos Sanchez-Piedra: None declared, Monica Fernandez Castro: None declared, Victor Martinez Taboada: None declared, Alejandro Olive: 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, Raul Menor-Almagro: None declared, Beatriz Rodriguez Lozano: None declared, Angel Garcia-Aparicio: None declared, Francisco J Lopez-Longo: None declared, Sara Manrique Arija Speakers bureau: ABBvie, MSD, Janssen, Lillly, Roche, Pfyzer, Novartis., Jesus ALberto Garcia Vadillo: None declared, Susana Gil: None declared, Ruth Lopez Gonzalez: None declared, J. Narvaez Consultant for: Bristol-Myers Squibb, Carles Galisteo: None declared, Jorge Juan Gonzalez Martin: None declared, M E Ruiz: None declared, Inigo Rua-Figueroa: None declared, Oscar Illera: None declared, Lurdes Romani: None declared, Sheila Melchor: None declared, Begona Moreira: None declared, Enrique Raya: None declared, Jose M Pego-Reigosa: None declared, Natalia Cid Boza: None declared, Enrique Judez: None declared, Clara Moriano: None declared, Vicente Torrente: None declared, Hector Corominas: None declared, Blanca Garcia-Magallon: None declared, Carlos Guillen-Astete: None declared, Ivan Castellvi Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Cristina Bohorquez: None declared, Javier Loricera: None declared, Joaquin Belzunegui: None declared

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

Objectives: To estimate the incidence of cancer in systemic lupus erythematosus (SLE) patients and to analyze factors associated with cancer differentiating between hormone-sensitive (HS) and non-HS cancers. Methods: Multicenter retrospective study of a cohort of patients included in Spanish Society of Rheumatology Lupus Registry (RELESSER). The first cancer after the diagnosis of SLE, sociodemographic, clinical, activity, cumulative damage, severity, comorbidity, treatments, and refractory disease data were collected. Cancers were classified into HS (prostate, breast, endometrial and ovarian) and non-HS (the rest). Standardized incidence ratio (SIR) was calculated and logistics regression models were constructed to identify factors associated with cancer. Results: We included 3539 patients (90.4% women) with SLE (ACR-97 criteria), of whom 154 had cancer (91% women), and 44 were HS (100% women). The SIR for cancer was 1.37 (95% CI: 1.15-1.59), reaching higher values in women under 65 years [2.38 (95% CI: 1.84-2.91)]. The SIR in women with cancer HS vs. non-HS was 1.02 (95% CI: 0.13-1.91) and 1.93 (95% CI: 0.98-2.89)], respectively. In HS vs. non-HS cancers, age at diagnosis of SLE [Odds ratio (OR) 1.04 (p = 0.002) vs. 1.04 (p = 0.019), respectively] and the evolution time [OR 1.01 (p Conclusion: The incidence of cancer in patients with SLE is increased compared to the Spanish population, specially in younger women. This increase might be due to non-HS cancers. SLE with more cumulative damage and more prescription of ACE inhibitors might associate with non-HS cancers. Disclosure of Interests: Tatiana Cobo-Ibanez: None declared, ANA URRUTICOECHEA-ARANA: None declared, Inigo Rua-Figueroa: None declared, Maria Auxiliadora Martin-Martinez: None declared, Juan Ovalles: None declared, Maria Galindo-Izquierdo: None declared, Jaime Calvo-Alen: None declared, Alejandro Olive: None declared, Antonio Fernandez-Nebro: None declared, Raul Menor-Almagro: None declared, Eva Tomero Muriel: None declared, Loreto Horcada: None declared, Esther Uriarte Isacelaya: None declared, Victor Martinez Taboada: None declared, Jose Luis Andreu: None declared, Alina Boteanu: None declared, J. Narvaez Consultant for: Bristol-Myers Squibb, Cristina Bohorquez: None declared, Carlos A. Montilla-Morales: None declared, Gregorio Santos Soler: None declared, Blanca Hernandez-Cruz: None declared, Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Eva Salgado Perez: None declared, Mercedes Freire Gonzalez: None declared, Jose A Hernandez Beriain: None declared, Elvira Diez Alvarez: None declared, Lorena Exposito: None declared, Olaia Fernandez- Berrizbeitia: None declared, Jose Luis Marenco Speakers bureau: abbie, pfizer, novartis, janmsen, Jose M Pego-Reigosa: None declared

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

Background: In the last years multiple genetic variants have been associated with autoimmune disease (AD) risk. However, much less is known on the association with important environmental factors like diet. Objectives: The objective of the present study is to characterize the dietary patterns of six prevalent ADs, including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE). Methods: A cross-sectional cohort of 11,621 individuals from Spain encompassing 1,949 RA, 2,186 psoriasis (PS), 1,437 PsA, 699 SLE, 1,415 ulcerative colitis (UC), 1,952 Crohn’s disease (CD) and 1,983 healthy controls, was recruited by the IMID-Consortium. The weekly consumption frequency of main food categories was recorded, together with drinking habits and smoking status. Multivariate linear models were used to test for association while adjusting for confounders. Results: Patients with AD targeting the digestive system showed the largest differences in comparison to controls. In the rheumatic ADs several food categories were also found to be consumed differently compared to controls. SLE had a high consumption of sweets and pastries, and RA ate more fruit and bread/wholegrain foods and less meat and cold cuts compared to controls. In PsA the dietary pattern differences with controls where milder, and non-overlapping with psoriasis. Disease activity was significantly associated with specific food categories in CD, UC and PS, mildly in RA and SLE, and PsA showed no association. High smoking cessation rates were observed in UC, CD and SLE, but not in Ps, RA and PsA. Tea/coffee and alcohol consumption was low in all ADs compared to controls. Conclusion: Our results show previously unreported associations with dietary habits in rheumatic ADs. Disclosure of Interests: Antonio Julia: None declared, Sergio Hilario Martinez: None declared, Jesus Tornero: None declared, Juan D. Canete: None declared, Antonio Fernandez-Nebro: None declared, Francisco Blanco: None declared, Jesus Rodriguez: None declared, Francisco J Lopez-Longo: None declared, Benjamin Fernandez-Gutierrez: None declared, Jordi Gratacos: None declared, Jose Javier Perez Venegas: None declared, Carolina Perez: None declared, Ruben Queiro Silva: None declared, Alejandro Olive: None declared, Mercedes Alperi-Lopez: None declared, Carlos A. Montilla-Morales: None declared, Jose Luis Andreu: None declared, Juan Carlos Torre-Alonso: None declared, M Angeles Aguirre-Zamorano: None declared, Hector Corominas: None declared, Paloma Vela Casasempere: None declared, Victor Martinez Taboada : None declared, Sara Manrique Arija Speakers bureau: ABBvie, MSD, Janssen, Lillly, Roche, Pfyzer, Novartis., Joan Miquel Nolla: None declared, Isidoro Gonzalez-Alvaro: None declared, Santiago Munoz-Fernandez: None declared, Jose Luis Marenco Speakers bureau: abbie, pfizer, novartis, janmsen, Carlos M. Gonzalez: None declared, Antonio Zea: None declared, Maria Lopez Lasanta: None declared, Daniel Roig: None declared, Jose M Pego-Reigosa: None declared, Mireia Lopez Corbeto: None declared, Pedro Zarco-Montejo: None declared, Mercedes Freire Gonzalez: None declared, Alba Erra: None declared, Elvira Diez Alvarez: None declared, Santos Castaneda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Esther Rodriguez Almaraz: None declared, Alicia Garcia: None declared, Patricia Carreira: None declared, GEORGINA SALVADOR ALARCON: None declared, Cesar Diaz Torne Consultant for: Grunenthal, Speakers bureau: Grunenthal, Ricardo Blanco: None declared, Alfredo Willisch Dominguez: None declared, Jose Antonio Mosquera Martinez: None declared, Simon Sanchez Fernandez: None declared, Julio Ramirez: None declared, Sara Marsal: None declared

Objectives. This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods. RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results. Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion. Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies., The RELESSER Registry was partially funded by GlaxoSmithKline (GSK), Roche, Union Chimique Belge (UCB), Lilly and Novartis. The sponsors had no role in the study design, data collection, analysis or interpretation, in writing the report, or in the decision to submit the article for publication. J.M.P.-R. is supported by grant 316265 (BIOCAPS) from the European Union 7th Framework Program (FP7/REGPOT-2012-2013.1). The study was supported by FIS Grant PI11/02857 (Instituto Carlos III, Fondos FEDER). Grant for medical researchers of the 'Fundacion Espanola de Reumatologia'.

Background The clinical coexistence of Systemic Lupus Erythematosus (SLE) and Sjogrens Syndrome (SS) was recognized in 1959. The prevalence of SS among patients with SLE varies considerably among the published studies (10%–30%). There is still controversy as to whether or not SLE patients with overlapping SS have a distinct and significantly milder lupus. To address the clinical and serologic features of SLE and differences from SLE that occurs in overlap with SS. Methods This is a multicenter, descriptive, cross-sectional study of 3575 patients from the Spanish Society for Rheumatology Lupus Registry (RELESSER). Unselected SLE patients from 45 Rheumatology Departments across Spain were evaluated for the presence of overlapping SS using the American-European consensus criteria. Cumulative clinical data were collected at the moment of the last assessment. Clinical and laboratory parameters in SLE patients with SS (SLEwSS) were compared with those in SLE patients without SS (SLEwoSS). Results SS was identified in 516 SLE patients (14.4%). Compared with the SLEwoSS group, patients with SLEwSS were significantly older, had a higher frequency of mucocutaneous manifestations, Raynauds phenomenon, peripheral neuropathy, anti-Ro/SSA, anti-La/SSB, neoplasia, and older age at death, but had a significantly lower frequency of renal involvement, thrombocytopenia, anti-dsDNA, anti-2-GPI IgM and complement consumption. Both groups displayed a clinically similar presentation of lymphadenopathy, systemic vasculitis, serositis, damage accrual, mortality, musculoskeletal and CNS manifestations. Conclusions SLEwSS appears to constitute a subgroup of SLE patients with distinct clinical and serologic features, in whom SS is expressed as an overlapping entity. A particular cluster of clinical variables, namely, mucocutaneous manifestations, Raynauds phenomenon, peripheral neuropathy, renal involvement and thrombocytopenia, was found to be important overall for discriminating SLE patients with or without SS. SLEwSS patients constitute a subgroup of patients with SLE characterized by milder lupus: older age at death, similar rates of mortality and SLICC-ACR damage index, less renal and immunological manifestations. Funding Source(s): None

Objective To validate the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) in patients from a capillaroscopy clinic. Methods All patients attended in a capillaroscopy clinic were included. Sociodemographic and SSc-related variables were collected. Using as gold standard for SSc the clinical judgement, the performance (sensitivity, specificity, predictive values, and likelihood ratios) of the 2013 ACR/EULAR criteria were analyzed. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were calculated for the global score and individual items, and the best cutoffs were obtained. Results We included 327 patients (84% women, mean age at capillaroscopy 48 years). Main reasons for capillaroscopy referral were Raynaud's phenomenon (39%) and SSc evaluation (27%). The most frequent final clinical diagnosis were SSc (32.4%) and primary Raynaud's phenomenon (25.7%). The 2013 ACR/EULAR SSc classification criteria were met by 116 patients (35.5%). Sensitivity and specificity of the new criteria were 98.1% and 94.6%, respectively, and positive and negative predictive values were 89.7% and 99.1%. The individual variables with the best sensitivity were Raynaud's phenomenon (99.1%) and abnormal nailfold capillaries (81.1%). All the individual variables, except Raynaud's phenomenon, puffy fingers and sclerodactily showed high specificity values, over 90%. The best cutoffs of the total score were ≥8, ≥9, and ≥10, and the AUC=0.993. Conclusions We validated the new ACR/EULAR classification criteria for SSc in unselected patients from a capillaroscopy clinic. Global score and individual items included in the new criteria show high diagnostic accuracy and discriminatory capacity.

Objective To describe the objectives and methods of the Spanish Society of Rheumatology primary Sjogren syndrome (pSS) registry (SJOGREN-SER). Methods This is a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American consensus criteria collected from Rheumatology clinics all over Spain. Patients were included by randomisation from an anonymised list provided by every department. Data were collected by reviewing clinical records and an interviewing the patients. Two hundred and ninety eight variables were investigated: epidemiological, clinical, serological characteristics, treatments and complications. Informed consent was obtained and local ethics committees approved the study. Variables were analyzed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25–p75). Results A total of 3 rheumatology departments participated in the registry. A total of 437 patients were included. And 95% of them were women, with a median age of 58. Median age at pSS's diagnosis was 50 years. Dryness symptoms (95%) were the most frequent complaint and anti-Ro/SS-A were present in 94% of the cases. Only 27% of the patients fulfilled the new 2012 SICCA-ACR classification criteria. Conclusions SJOGREN-SER has been designed in order to characterize a representative pSS Spanish cohort, in clinical daily practice, to analyze the magnitude and distribution of its manifestations, activity, accumulated damage and therapeutic management of the disease. This will allow broadening the knowledge of this disease and plan strategies of action in pSS.

Objectives:Primary Sjögren´s Syndrome (pSS) is characterized by hyperactivity of the B cell, with the consequent production of autoantibodies. The presence of anti-Ro and anti-La has been associated with extraglandular manifestations and lymphoma development. The aim of this study is to evaluate the frequency of different serological profiles in patients of SJOGRENSER registry and to assess whether the combination of antibodies and serological markers are associated with the development of systemic disease and the systemic illness and/or the development of systemic disease and complications.Methods:SJOGRENSER is a transversal multicenter study with pSS patients (patients who meet 2002 pSS classification criteria); it is collected demographic, clinical, serological data and the activity index: ESSDAI and ESSPRI. It was established three serological profiles: 1. ANA/Ro+ with La/RF-; 2. ANA/Ro/La+ with RF-; 3. ANA/Ro/La/RF+. A descriptive analysis was done, with means and standard deviations, frequencies and proportions. Student t for quantitative variables and Chi2 for qualitative ones were performed to evaluate differences between groups, it was considered a p Results:Four hundred and thirty-seven patients were included, the most frequent serological patterns observed were: ANA/Ro/La/RF+ 221 patients (50.5%), ANA/Ro/La+ 61 patients (13.9%) and ANA/Ro+ 60 patients(13.7%). There were only two patients with ANA/La +. The ESSDAI score was significantly associated with the profile ANA/Ro/La/RF+ (6 vs 4, p=0.007) and the group with the ANA/Ro/La+ profile reached an ESSDAITable 1.Serological markers associated with the development of systemic diseaseInvolvementProfile 1ANA +Anti-Ro +Anti-La -RF –n=60N° (%)Profile 2ANA +Anti-Ro +Anti-La +RF –n= 61N° (%)Profile3ANA +Anti-Ro +Anti-La +RF +n= 221N°(%)pESSDAI index4460.007ESSDAI44 (73.3)48 (78.7)139 (63.2)0.043ESSPRI index6.15.35.00.007Constitutional syndrome5 (8.3)9 (14.8)51 (23.1)0.023Lymphadenopathy8 (13.3)9 (14.8)37 (16.7)0.790Glandular14 (23.3)16 (26.2)87 (39.4)0.024Articular49 (81.7)40 (65.6)187 (84.6)0.004Lung3 (5.0)4 (6.6)29 (13.2)0.100Kidney0 (0)5 (8.2)31 (14.1)0.006Peripheral nervous system5 (8.3)6 (9.8)18 (8.2)0.918Central nervous system4 (6.7)7 (11.5)13 (5.9)0.320Hematological24 (40.0)26 (42.6)147 (66.5)Biologic5 (8.3)4 (6.6)26 (11.8)0.428Lymphoma1 (1.7)2 (3.3)3 (1.4)0.598In contrast to the ESSPRI index was lower significantly associated with the profile ANA/Ro/La/RF+ and higher in the ANA/Ro+ (5 vs 6.1, p=0.007). The presence of antiLa and/or RF to the profile ANA/Ro+ rises the percentage of patients with constitutional syndrome, glandular, kidney and hematological affectation with statistically significant differences. The percentage of patients with articular involvement it was similar in the profiles ANA/Ro+ and ANA/Ro/La/RF +.The multinomial analysis showed that the profile ANA/Ro/La/RF+ was associated with higher ESSDAI values (OR=1.09 (1.01-1.17)). The hematological involvement was associated with the profiles ANA/Ro/La/FR+ (OR= 2.76 (1.46-5.22)). Higher scoring of ESSPRI was associated with the profile ANA/Ro+ (OR=0.79 (0.69-0.91)).Conclusion:The most frequent serological profile was ANA/Ro/La/RF+ and it was associated with higher ESSDAI score. The presence of antiLa and/or RF with an ANA/Ro+ increased the presence of systemic involvement. The ANA/Ro+ profile was associated with a higher level of ESSPRI.Disclosure of Interests:None declared

Objective The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis. Methods In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016. Results A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group). Conclusions The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.

Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy and thus is frequently encountered by general practitioners (GPs). The aim of this study is to investigate the referral pattern of GPs with regard to electrodiagnostic (EDX) testing for suspected CTS prior to hand surgery consultation, as well as to investigate the results of EDX testing for suspected CTS when requested by GPs prior to evaluation by a hand surgeon.We retrospectively reviewed patients referred to our hand surgery clinic over a consecutive 2-year period for suspected CTS.A total of 403 patients were referred to our hand surgery clinic from January 1, 2016, to December 31, 2017. Of the 403, 295 (73.2%) were referred by GPs. GPs obtained prereferral EDX testing in 198 (67.1%) of these patients. EDX testing confirmed their diagnosis in 177 patients (89.4%). There were 21 patients (10.6%) identified with normal EDX testing and a more likely diagnosis reached based on clinical examination.GPs make up the majority of our referrals for CTS, and they obtain EDX testing prior to consultation in two-thirds of referrals. GPs appear to accurately utilize EDX testing to confirm their diagnosis prior to referral and have a low rate of normal testing where symptoms are more readily explained by an alternative diagnosis.

Background Belimumab is a human monoclonal antibody that inhibits B-cell activating factor shown to be efficacious in systemic lupus erythematosus. In other B cell mediated autoinmune disease such as primary Sjogren’s syndrome(pSS) the efficacy is unclear. Objectives To evaluate the efficacy of belimumab in patients with pSS. Methods A systematic literature review was perfomed (EMBASE, MEDLINE and Cochrane) as part of the Spanish Rheumatology Society’s Recommendations for the Use of Biological Therapies in Primary Sjogren’s Syndrome. Inclusion criteria was defined as: Population: patients with pSS according to American-European Consensus Criteria 2002 Intervention: belimumab; Control: synthetic or biologic DMARDs, corticosteroids, ursodesoxicolic acid or placebo; Outcome: efficacy in dryness, glandular and extraglandular manifestations. Studies with Results 3 articles were included out of 135. All of them published results from the same study1 at different timepoints. The study design was experimental but with a small sample size and no control group or randomization. The article of Mariette et al 20151 evaluated the efficacy and safety of belimumab in 30 patients with systemic activity or early disease until week 28(W28). There was a significant decrease in mean ESSDAI (8.8 to 6.3 p=0.02), ESSPRI (6.4 to 5.6 p=0.02) and VAS for dryness (7.8 to 6.2 p=0.02). Physician’s VAS for disease systemic activity also decreased in 43% as well as parotid inflammation in 76.9% of patients. Also, B cell biomarkers decreased: IgG (21.2 to 18.2 g/L, p=0.02), IgA (3.7 to 3.3 g/L, p=0.04), IgM (1.6 to 1.3 g/L, p The study of De Vita et al 20152 compared results at week 52 (W52) and W28 in 19 patients, of whom 15 had previously responded to treatment. Of these 15 patients 13 maintained response and 3 out of the 4 patients that did not respond achieved primary outcome. The improvement at W52 continued for ESSDAI, glandular inflammation, lympadenopathy and joints. B cell biomarkers remained stable. Overall items conributing to ESSDAI descreased but only physician’s VAS for disease systemic activity was statistically significant (3.2 W28 vs 2.5 W52; p=0.04). The study of Quartuccio et al.3 compared clinical and lab variables of W52 with 12 months of follow up after interrupting belimumab. A significant decrease in ESSDAI in 9 out of 13 patients (3.5±3.7 vs 7.0±5.7; p Conclusions Published evidence to determine the efficacy of belimumab in primary Sjogren is limited and poor. Belimumab seems to be effective to reduce systemic activity, parotid enlargement, dryness, lymphadenopathies, articular manifestation, fatigue and B cell biomarkers. References [1] ARD 2015;74:526–531. [2] Rheumatology2015;54(12):2249–56. [3] Clin Exp Rheumatol2016;34(2):311–4. Acknowledgements This Project has been financed by the SER. Disclosure of Interest None declared

Background Primary Sjogren’s syndrome (pSS) is characterised by lymphocytic infiltration of exocrine glands and other organs, resulting in dry eye, dry mouth and extraglandular systemic involvement such as pain, mialgia or polyarthralgia, among others. Objectives The aim of the present study is to explore the association of severe or very severe dry eye with extraocular involvement in patients with pSS. Methods SJOGRE-SER registry is a multicenter cross-sectional study of pSS patients fulfilling European/American consensus criteria 2002 from 33 Spanish rheumatology departments. Data were collected by reviewing clinical records and interviewing patients. For the construction of our main variable, “severe/very sever dry eye” (S/VSDE), we used those variables present in our cohort that represented a degree 3–4 of severity (S/VSDE) according to the dry eye TFOS DEWS I classification 2007 (Tear Film and Ocular Surface Society Dry Eye Work-Shop): Schirmer score (≤5 mm/5 min) and/or corneal ulcers and/or use of autologous sera and/or contact lenses and/or Stenon conduit bypass and/or palpebral cleft reduction. First, bivariate logistic regression models were used to identify the effect of each independent variable on S/VSDE. Secondly, multivariate analysis using regression model was used to establish the independent effect of patient characteristics associated with the dependent variable. Results Four hundred and thirty-seven patients were included in SJOGREN-SER registry (female gender 95%; median age 58 (50.02–67.98) years). Mean time of evolution of the disease in the cohort was 8.3 years. ESSDAI mean score was 2 (0–4, P25-P75) in the full registry. Ninety-four per cent of the patients in SJOGREN-SER cohort complained of daily, persistent, troublesome dry eyes, 92% had sensation of sand in the eyes and 16% developed corneal ulcer. In the full cohort Schirmer’s test was performed in 402 patients and was pathological (≤5 mm/5 min) in 371 patients (92%). The use of autologous sera was 14%, contact lenses 2%, Stenon conduit bypass 0.23% and palpebral cleft reduction 0.23%. Three hundred and seventy-eight patients (86.5%) presented S/VSDE; 95% were women, and the median age was years. Mean time of evolution of the disease was 8.51 and ESSDAI mean score was 5. Inflammatory articular involvement was significantly more frequent in patients with S/VSDE (82.5%) than in those without S/VSDE (69.5%) (p=0,028). Inflammatory joint affectation was associated with S/VSDE in the multivariate analysis, OR 2.079 (95% CI, 1.096–3.941). These results were adjusted by sex, age, time of evolution of the disease and ESSDAI score. Conclusions Severe or very severe ocular involvement is associated with the presence of inflammatory joint involvement in patients with pSS. These results suggest that a directed anamnesis including systemic comorbidities, such as the presence of inflammatory joint affectation and dry mouth, in patients with severe dry eye, would be useful to suspect an pSS. Reference [1] Report of the International Dry Eye Workshop (DEWS). Ocul Surf2007;5:65. Disclosure of Interest None declared

Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease associated with systemic inflammatory processes. Chronic inflammation alters the of the number and type of non-cellular elements, including lipoproteins and glycoproteins. Objectives Here we investigate the plasmatic lipoprotein and glycoprotein profiles associated with SLE. Methods Plasma samples were obtained from 50 healthy control individuals and 50 SLE patients. All patients fulfilled the ACR criteria for classification of SLE. 1H-NMR was used to determine the lipoprotein and glycoprotein profiles from cases and controls. For the lipoprotein profiles, VLDL, LDL, IDL and HDL concentration, lipid composition and particle properties were quantified. The glycoprotein profile was decomposed in four reproducible peak regions LMW, Glyc-B, Glyc-A, Glyc-Lipid and baseline, and quantified for concentration, position and aggregation state. Association analysis to disease was performed using logistic regression fitting for age, gender and body mass index. Classifiers were built using recursive-partition algorithm and classification accuracy was evaluated using receiver operating curves. Results We found a significant perturbation of the lipoprotein profile in SLE patients compared to controls. A statistically significant (P Conclusions SLE is characterized by perturbations of the plasmatic lipoprotein and glycoprotein profiles. The increase of triglyceride VLDL in patients compared to controls, could explain the increased risk for cardiovascular disease observed in SLE. Our results also show that SLE patients have a significantly different glycoprotein profile compared to controls. In both cases, plasmatic 1H-NMR profiling could be a valuable source of informative biomarkers for SLE. Disclosure of Interest None declared

Background Primary Sjogren’s syndrome (SSp) is a systemic autoimmune disease characterised by exocrine gland affectation and multisystem involvement. In addition to the systemic inflammatory affectation, patients with pSS have additional risk factors to develop osteoporosis (OP) and its major complication, osteoporotic fracture. Objectives The aim of the study is to determine the sociodemographic and clinical factors of pSS associated with the presence of OP and osteoporotic fracture in patients with pSS from the SJOGRENSER registry. Methods SJOGRENSER is a descriptive, cross-sectional and multicenter study of patients with pSS classified according to European-American consensus criteria. Patients attended in consultations of 33 Spanish rheumatology services were randomly included. Both the medical history and the medical interview were used to obtain the data. Epidemiological, clinical, serological and complications were collected. The continuous and categorical variables were analysed by means, medians and frequencies, with their respective deviations and interquartile ranges (p25-p75). Bivariate and multivariate analyses were carried out using a binomial logistic regression to study the factors associated with osteoporosis and osteoporotic fracture in pSS. Results In the SJOGRENSER registry, 437 patients were included (95% women, with a median age of 58.63 (50.02–67.98) years). The prevalence of OP in the cohort was 18.54% (81 patientes). The prevalence of OP in men (n=21) was 19%, 2 men in the age group of 51–64 years and 2 in the group of >64 years. Three hundred of the women in the registry were menopausal (76.4%); a total of 67/300 women with menopausia had OP (15%). A total of 37 osteoporotic fractures (8.5%) were recorded in the cohort. Factors associated with OP in women with SSp in the bivariate analysis were: age (60.5% in the group of >64 years, 28% in the group of 51–64 years and 2.6% in the group ≤50 years, p 64 years, OR 20.610 (CI 95% 4.679–90.774, p 64 years, OR 7.674 (95% CI 1.675–35.151, p Conclusions Patients with pSS have a considerable prevalence of osteoporosis and osteoporotic fracture. Age and time of evolution were factors associated with the development of OP, and similarly, age, time of evolution of the disease and ESSDAI were factors associated with the development of fracture in patients with pSS. Disclosure of Interest None declared

Background Primary Sjogren’s syndrome (pSS) is a systemyc autoimmune disease that produces a limpho-plasmocitary infiltrate of the exocrine glands. Considering the primary role attributed to B-lymphocytes in pSS pathophysiology, it has been suggested that Rituximab (RTX) may have certain role in controlling the disease. Objectives To evaluate RTX efficacy in the treatment of xerostomia, xerophthalmia and systemic manifestations (including fatigue) in patients with pSS. Methods In the framework of the preparation of a recommendations document of the Spanish Society of Rheumatology on the use of biologics in pSS, a systematic search of the literature was carried out (until May 2017). Were included adults older than 18 years who met the 2002 American European Consensus Criteria, treated with RTX, with desired comparison to groups treated with other drugs or with placebo and a follow-up time of 6 months. The quality of the studies was assessed through the levels of evidence (LOE) of SIGN scale. Results The search resulted in a total of 749 articles and only 9 of them were selected (figure 1). The best available evidence for each variable studied is summarised in chart 1 (”+” significant improvement; ”-” no significant improvement). The most relevant results obtained in the studies with LOE 1+, showed significant differences comparing RTX with lacebo (p Conclusions The studies of high methodological quality that evaluate the efficacy of RTX in pSS do not find significant improvement in the primary outcome variables, such as ESSDAI, glandular involvement and other objective parameters of dryness. However, open and retrospective studies find significant improvement in activity parameters, systemic manifestations, glandular involvement and improvement of certain objective tests of dryness. Disclosure of Interest None declared

Background Ultrasonography (US) is the rheumatologists’ best tool that must be taught and learnt correctly. The ultrasound school of the Spanish Society of Rheumatology has trained many rheumatologists for more than twenty years. Approximately 75% of the rheumatology departments in Spain use US. However, we lack current views of features related with competency, teaching rheumatology residents, US usage and implementation. Methods A cross sectional survey was performed using an online standardised questionnaire sent to all members of the SSR in January 2017. The questionnaire was developed by the four authors, corrected for size, style, syntaxes and was piloted on four different aged rheumatologists. Six aspects were studied; general data, US training, rheumatology residents training in US and main uses and applications of US. The questionnaire used either closed or Likert scale answers and took about 20 min to answer. Herein we describe the main results on usage and applications of US. Results 113 responses: 60% women, 45±12 years old, 73% working in public university hospital with one or more US machines. US is usually used at the time of clinical consultation or at appointment for US. 43% have a specific agenda for US diagnosis and monitoring inflammatory arthritis patients. The 3 principals for using US are: as a problem solving tool in the clinical context; as a diagnostic tool in inflammatory arthritis and; as a tool to guide injections. The table shows the percentage of the responses always and almost always for 10 clinical contexts. As diagnostic tool in rheumatoid arthritis (RA), 66% use US to confirm arthritis when clinical exam is unclear and 33% in patients with inflammatory arthralgia plus high ESR, CRP, RF or anti-CCP. 36% monitor disease activity using a reduced joint assessment; one target joint plus 2,3 MCP and 2,3, 5 MTP joints and 32% use a validated joint count. 66% use US to assess remission in RA all patients (22%), only in those treated with biologic drugs (28%) and in RA patients with poor prognostic factors (18%). Most use US to confirm clinical enthesitis when a spondyloarthropathy (SpA) is suspected and half consider that a positive entheseal Dopppler signal supports more aggressive management. 76% perform real-time guided injections for the following disorders/sites: Baker’s cyst, subacromial-subdeltoid bursa, tibionavicular joint, anterior coxofemoral joint, retrocalanceal bursa and extensor wrist tenosinovitis. Conclusions Rheumatologist- ultrasonographers in Spain use ultrasonography in a wide spectrum of diseases and clinical contexts mainly to facilitate diagnosis and improve treatment of rheumatic patients. Disclosure of Interest None declared

Objectives To investigate the primary respiratory manifestations (PRM) in SLE. Methods All patients in the RELESSER cohort were retrospectively investigated for the presence of PRM Results At least one PRM was present in 11.3% (365/3215) of cases. The most common was pleurisy, occurring in 21.1% of patients, followed by ALP in 3.6%, PE in 2.9%, PPH 4%, DILD in 2%, DAH in 0.8%, and SLS in 0.8%. The variables associated with the presence of PPM are shown in the following table 1: Conclusions PPM independently contributed to a decreased survival in SLE Disclosure of Interest None declared

Background Primary Sjogren syndrome (pSS) is a systemic autoimmune disease whose main characteristic is the involvement of the exocrine glandular system. Thus, its most common clinical manifestation is eye and mouth dryness. No therapy has been demonstrated to significantly modify disease course and, currently, evidence-based therapy for pSS is mainly limited to symptomatic drugs for drynes. Objectives To describe the dryness treatment in a cohort of primary Sjogren Syndrome patients. Methods SJOGRENSER registry is a multicentre descriptive cross-sectional study of pSS patients, fulfilling European/American criteria, from 33 Spanish rheumatology departments. Data were collected by reviewing clinical records and interviewing the patients. Informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistics using means, medians and ranges. Chi square test was used to compare categorical variables. A p Results Four hundred and thirty seven patients were included (female 95%; median age 58 years). Ninety four per cent of the patients complained of daily, persistent, troublesome dry eyes for more than 3 months, 92% had sensation of sand in the eyes, 16% developed corneal ulcer. Ninety four per cent of the patients complained of dry mouth for more than 3 months and 27% had dental loss. The most frequent ocular dryness treatments were tear substitutes (96%), followed by lubricating ophthalmological ointments (46%), autologous sera solutions (14%), topical corticosteroids (13%), topical cyclosporine (6%). Comparing patients with and without ocular dryness, only pilocarpine and lubricating eye ointment were used significantly with more frequency in symptomatic patients (p Conclusions Despite the high number of symptomatic patients, the use of dryness treatments is limited in pSS patients. Chewing gums or candies without sugar, xylitol and fluoride remain underutilised in this cohort. Despite the dryness VAS score, patients do not seem to use all the symptomatic therapeutic options available. Disclosure of Interest None declared