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Background:Some autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are considered to be independent risk factors for vascular morbidity and mortality. These pathologies present accelerated atherosclerosis, partly because of a chronic sustained inflammation, greater prevalence of cardiovascular risk factors (CVRFs) and pharmacological therapy. However, regarding primary Sjögren’s syndrome (pSS), available data are heterogeneous and proceed from small case series. For this reason, the aim of this study was to provide further information on the identification of atherosclerosis in pSS and its possible association with clinical and analytical parameters of the disease.Objectives:To assess presence of subclinical atherosclerosis by means of carotid ultrasound in patients with pSS and to analyze clinical, analytical and CVRF along with their potential association with the presence of subclinical cardiovascular affectation.Methods:This is a cross-sectional study of 38 patients with pSS (all patients met ACR/EULAR1classification criteria for pSS) and 38 age and sex matched controls. Demographic variables and classical CVRFs were collected (Hypertension, Diabetes mellitus, dyslipemia, Body Mass Index and smoking habit) and the presence of subclinical atherosclerosis was assessed by carotid ultrasound with carotid intima-media thickness (CIMT) measurement and determination of the presence of atheromatous plaques2, both in pSS patients and controls. Disease features were also collected in pSS patients (disease duration, disease activity measured by ESSDAI, glandular vs extraglandular involvement, serological features and treatments received).Statistical analysis: To evaluate differences between patients and controls, T-test or Wilcoxon test with continuity correction, were used for quantitative features and Fisher test for categorical variables. In order to test the presence of pSS as an independent risk factor for subclinical atherosclerosis, from other features as classic CVRFs or analytical data, first we adjusted logistic binomial regression in a bivariate analysis, to select possible predictors to be included in a multivariate analysis. Statistical significance was pR-Statistics v- 3.6Table 1.Comparison of clinical data of two case groups and healthy control group M (p25, p75)GroupsCase group ACase group BHealthy control groupH valueP valueHistory of thrombus (case)4a8a-13.7090.001History of adverse pregnancy (case)3a19a-34.596ESR20.00(12.25,111.00)a35.00(14.25,95.00)a9.00(6.00,13.00)34.381CRP15.00(4.03,37.83)ab7.33(1.76,21.13)ab2.10(1.28,2.31)35.263PLT228.00(189.50,573.25)ab197.00(66.00,260.50)ab258.50(228.25,272.25)33.482Note:aComparison with healthy control groupP< 0.05;bComparison with case groupPTable 2.Comparison of lymphocyte subsets in peripheral blood of two case groups and healthy control group M (p25, p75)Results:All of the 76 patients included were women, with a mean age of 53.7 ± 11.7 years. For both groups, no differences between prevalence of classical CVRFs were found. Subclinical atherosclerosis presence was higher in patients with pSS than in controls [OR= 4.17, 95%CI (1.27- 16.54), pConclusion:This cohort showed a greater prevalence of subclinical atherosclerosis in patients with pSS, indicating this disease as an independent risk factor for presence of early vascular damage.References:[1]Vitali C et al. Classification Criteria for Sjögren Syndrome: a revised version of the European criteria proposed by the American-European Consensous Group. Ann Rheum Dis. 2002; 61: 554-8[2]Touboul PJ et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012; 34: 290-6Disclosure of Interests:Marta Novella-Navarro: None declared, José Luis Cabrera-Alarcón: None declared, José Luis Rosales Grant/research support from: I have received financial support from Novartis, UCB, Pfizer, Abvie to meeting and symposia, Jorge Juan González Martin Grant/research support from: I have received finacial grants from Novartis, Lilly, Pfizer, Abvie for meetings and symposia assistance, Paloma García de la Peña Grant/research support from: I have received finacial grants from Novartis, Lilly, Pfizer, Abvie for meetings and symposia assistance, Ofelia Carrion: None declared

Background Gout is the most prevalent arthritis globally, it is due to monosodium urate (MSU) crystals deposit on tissues, mainly in joints and periarticular structures. Although the main clinical pattern in gout is monoarticular, many patients suffer from oligo/polyarticular disease. Due to the information obtained through imaging tests such as ultrasonography (US), we know that the extent of MSU deposits are greater than we expected in many occasions, affecting clinically silent joints. Musculoskeletal US is a key tool due to its accessibility and safety, it determines accurately the current extent of deposits and joint involvement in gout, which may condition therapeutic changes. Objectives To evaluate the influence of articular US for clinical practice in Rheumatology when initiating treatment with febuxostat in patients with gout, determining the degree of crystalline deposit and articular ultrasonographic involvement. Methods Observational cross-sectional study of 129 patients diagnosed with gout (ACR criteria), treated with febuxostat (14 due to renal disease, adverse reaction/intolerance to allopurinol, and 115 due to non-response to allopurinol). One month after the onset of treatment, US examination was performed following the protocol proposed by Peiteado et al1, determining the number of joints with signs of gout (double contour, hyperechoic aggregates) and acute inflammatory activity (Doppler). Other variables were analysed: age, sex, hypertension, diabetes, dyslipidemia, chronic kidney disease, time of disease evolution and clinical pattern of joint involvement. Results 115 patients with febuxostat (112 men and 3 women), with a mean age of 57±13 years and mean of disease evolution 14±10 years. 59 patients had monoarticular clinical pattern, 46 oligoarticular and 10 polyarticular. US involvement: we observed acute inflammatory activity by Doppler in 47 patients (40.86%), microcrystalline aggregates in 90 patients (78.26%) and double contour sign in 53 patients (42.08%). The mean uricemia at the time of the joint ultrasound examination was 7.4±1.8 g/dl. Of the 94 patients with uric acid levels>6 mg/dl, 72 presented extensive US involvement (76.59%), whereas of the 21 patients with levels Conclusions US quantification of MSU deposits can significantly condition the intensity of uricemia-reducing treatment regardless of serum uric acid levels. In this study, patients with non-target uricemia did not present a greater joint affection evaluated by US, however, those with Reference [1] Peiteado D, et al. Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol2012;30:830–7. Disclosure of Interest None declared

Background Among the subtypes of idiopathic inflammatory myopathy (IIM), it has been recognised that primary polymyositis (PM) and primary dermatomyositis (DM) have a worse prognosis than overlap syndrome (OM). However, the benign course of OM has not been confirmed in other studies. The identification of specific characteristics that could allow a correct classification may be important for its prognosis. Objectives To analyse clinical characteristics and survival of patients diagnosed with OM, and to compare if there are differences with other IIM subgroups in a multicentric cohort. Methods Retrospective, multicentric longitudinal observational study of a cohort of patients followed between January 1980 and December 2014, with a diagnosis of MII. The patients were divided into 2 groups: OM and primary idiopathic inflammatory myositis (PIIM), which included PM and DM. Patients classified as OM had to meet IIM criteria and criteria for rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD) or primary Sjogren’s syndrome (SS). Results The present study included a total of 348 patients (98 OM, 250 PIIM). The connective tissue diseases associated with OM were: MCTD in 32 (32.7%), SSc in 29 (29.6%), SLE in 21 (21.4%), RA in 8 (8.2%) and SS in 8 (8.2%). Patients with OM showed remarkable differences compared to PIIM. In general, OM exhibited more extramuscular involvement and more complications, with more serious infections (41% vs. 24%, p Conclusions In the REMICAM registry of 348 inflammatory myopathies, 98 cases of myositis with overlap syndrome have been included, presenting with more extramuscular complications, more severe infections and higher mortality than other myopathies. It would be important to identify these patients at the onset of the disease, in order to closely monitor for development of possible complications. Disclosure of Interest None declared

Objectives Evaluate evolution of cardiovascular risk (CVR) in a cohort of systemic sclerosis (SSc) in one year of follow-up. Methods Prospective longitudinal study of a cohort of 45 patients with SSc during a period of one year. Sociodemographic and analytical variables were analysed at the time of inclusion in the study (baseline) and after 12 months of follow-up. The vascular protocol with carotid ultrasound was performed, including the determination of carotid intima-media thickness (IMT) and the evaluation of atheromatous plaques; in addition to the performance of the ankle-brachial index (ABI) and the determination of endothelial dysfunction (ED) through the measurement of flow-mediated vasodilation (FMVD), all at baseline and at one year. Results 45 patients were included, 94% of them female, with a mean age of 52.2±11.5 years and mean evolution time of 4.6±5.1 years. The distribution by subgroups was 44.4% limited SSc, 35.5% diffuse SSc, 4.4% pre-scleroderma, 4.4% sine scleroderma SSc, 6.6% MTCD, and 4.4% overlap syndrome. Classical CVR variables were collected as smoking habit, DM, HTN, obesity, DLP, hyperhomocysteinemia, and clinical variables of the SSc were added such as modified Rodnan Skin Score (mRSS), pulmonary arterial hypertension (PAH), interstitial lung disease (ILD), capillaroscopic pattern, SSc specific antibodies and previous treatments. A bivariate analysis was performed using binomial logistic regression, both at baseline and at one year. Pathological IMT (>0.9 mm) was significantly associated with hyperhomocysteinemia (p=0.024, OR=3.03, CI 1.33–9.58). The presence of atheromatous plaque was associated with corticosteroid treatment (p=0.048, OR=0.58, CI 0.28–0.97). Pathological ITB ( To evaluate the effect of time, a binomial model was adjusted by linear regression of mixed effects for the variables of CV affectation considered (see table 1). Time proved to be a risk factor to present pathological ITB values, since it was evidenced at baseline in 4.4% of the sample compared to 20% in the one-year study. Consequently, a multivariate analysis was performed showing pathological ABI was significantly associated to time (p Conclusions In our study, we observed the significant variation in ABI in one year, this may be due to the fact that this measurement has a high sensitivity for the detection of early peripheral arterial disease, in those patients who have not manifested signs and symptoms of arterial disease due to more evolved time of evolution. Acknowledgements Thank you Casandra Jimenez for her help with the vascular database compilation Disclosure of Interest None declared

Background Calcinosis is a cutaneous manifestation that produces disability and complications in patients with idiopathic inflammatory myopathies (IIM). Studies about associated factors are limited. Objectives To investigate cutaneous manifestations and factors associated with calcinosis in patients with IIM from the REMICAM registry. Methods A multicenter retrospective study (1980–2014) was performed. Patients were classified as primary dermatomyositis (DM), primary polymyositis (PM), cancer associated myositis (CAM), overlap myositis (OM), inclusion body myositis, immune-mediated necrotising myopathy (IMNM) and juvenile myositis (JuM). A description of the cutaneous manifestations in each subgroup of IIM was done. The associations between calcinosis and demographic data, clinical characteristics, antibodies and treatments were analysed independently for JuM and adult IIM. Results 479 patients were included, of whom 49 (10%) had calcinosis with the following distribution: 27 JuM (55%), 9 DM (18%), 9 OM (18%), 3 PM (6%) and 1 IMNM (2%). Non- characteristic cutaneous manifestations were more prevalent in DM, OM, CAM and IMNM. At multivariate analysis, disease duration (OR=2; p=0.016), immunoglobulin treatment (OR=5.68; p=0.036) and immunosuppressants (OR=8.94; p=0.01) were associated with calcinosis in JuM. In addition, dysphagia (OR=21.3; p=0.008), positivity for anti-PM-Scl (OR=34.1; p=0.01), baseline ESR (OR=1.05; p=0.04) and interstitial lung disease (OR=10.2; p=0.039) were associated with calcinosis in adult. Conclusions Our results suggest that factors associated with calcinosis might be different in adult and juvenile myositis, but in both cases, they are related to more severe disease. 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 Inflammatory myopathies (IIM) are a heterogeneous group of autoimmune rheumatic diseases characterized by muscle inflammation and progressive weakness. They include any kind of primary inflammatory muscle disease that is not otherwise better explained by metabolic, toxic, infectious, neurologic or inherited causes. The presence of autoantibodies (AA) in IIM is variable and they can recognize nuclear and cytoplasmic cellular components. Objectives To evaluate the AA profile in patients diagnosed with IIM. Methods We evaluated 479 patients that included 12 hospitals belonging to the IIM registry of the Rheumatology Society in Madrid (SORCOM-REMICAM) with diagnosis from January 1980 to December 2014. All patients were diagnosed of IIM according to Bohan and Peter criteria. The AAs evaluated were ANA (n=476), anti-Jo1 (n=457), anti-RNP (n=427), anti-MI2 (n=159) and ACA (n=293), according to the standard techniques in the respective laboratories. The presence of ANA was considered valid with at least two positive determinations. The AAs were compared according to the classification I) as dermatomyositis (primary and secondary dermatomiositis) (DM) and polymyositis (PM) including the rest of the patients. Also, IIM were classified (II) as primary polimiositis (PPM), primary dermatomyositis (PDM), overlap syndrome (OSd), juvenile myopathies (JM), cancer-associated myopathies (CAM), autoimmune necrotizing myopathy and inclusion body myositis (these were grouped as other myositis; OM). Results In the PM and DM groups 250 and 229 (52.2% and 47.8%) patients were included respectively. Positive ANA, anti-Jo1 and anti-RNP were higher in the PM than in the DM group (67, 22 and 19% vs. 56, 11 and 6%) (p=0.21, p=0.002, p=0.0001, respectively). The presence of anti-MI2 was higher in the DM group (p=0.024), according to the classification II, we found statistically significant differences in ANA, anti-Jo1, anti-RNP and anti-ACA. The OSd group had the highest proportion of ANA, anti-RNP and ACA positive AA and the JM group had the lowest frequency of Anti-Jo1 (see Table 1). Conclusions The AA associated with the IIM subtypes is consistent with published scientific evidence on other cohorts for ANA, anti-Jo1, anti-RNP and anti-MI2, in spite of the small sample size. The OSd group showed higher ANA and anti-RNP frequencies which might be explained by the coexistence of SLE and MCTD patients. It could be interesting to follow up those PPM patients with positive AA because they could be in the future diagnosed with a connective tissue disease. Carrying out longitudinal studies that include a greater proportion of patients may help to evaluate and predict the clinical course of IIM. References Bohan A, Peter JB. N Engl J Med 1975 Feb 13;292(7):344–7. Acknowledgements . Disclosure of Interest None declared

Background Idiopathic inflammatory myopathies (IIM) comprise a heterogeneous group of autoimmune conditions. Joint involvement can be considered to be part of the IIM systemic manifestations, together with a possible gastrointestinal, cardiovascular and/ or pulmonary involvement. Although articular involvement in the IIM has been described as variable and non-specific with a chronic course it might be an early symptom of dermatomiositis in up to 30% of cases and in those patients with overlap syndromes. Objectives To evaluate and to identify joint manifestations in IIM patients. Methods We evaluated a cohort of 479 patients that included 12 hospitals in the Community of Madrid belonging to the IIM registry of the Society of Rheumatology of Madrid (SORCOM-REMICAM) with diagnosis from January 1980 to December 2014. All patients were diagnosed of IIM according to Bohan and Peter criteria (1). The presence of arthralgia and arthritis was considered. IIM were classified as dermatomyositis (primary and secondary dermatomiositis) (DM) and polymyositis (PM) including the rest of the patients (classification I). Also, IIM were classified (II) as primary polimiositis (PPM), primary dermatomyositis (PDM), overlap syndrome (OSd), juvenile myopathies (JM), cancer-associated myopathies (CAM), autoimmune necrotizing myopathy and inclusion body myositis (these were grouped as other myositis; OM). Results We found 70 (18%) patients with acute arthritis ( 6 weeks) and 245 (65%) patients without any joint manifestations. Using the Tanimoto et al. criteria (1), the presence of erosive arthritis was observed in 149/479 (38.3%) of the patients. When comparing the joint manifestations in the PM and DM groups (n=250, 52.2% vs. n=229, 47.8%) no statistically significant differences were observed. However, assessing joint manifestations according to classification II, we observed that the highest prevalence was found in the OSd group, followed by the PDM group (p=0.0001). The group with less joint manifestations was JM compared to OSd and PDM (Table 1. Conclusions The presence of joint manifestations associated with IIM in our cohort is higher compared to other studies described in the literature so far and emphasize the importance of an accurate joint examination in these patients. The OSd group showed more joint manifestations which might be explained by the coexistence of SLE and MCTD patients in this group. Currently, no association between the clinical subtypes of IIM, overall, these results are encouraging and suggest that joint assessment in follow up may be helpful in differentiating subtypes of IIM. References Bohan A, Peter JB. N Engl J Med 1975 Feb 13;292(7):344–7. Disclosure of Interest None declared

Contains fulltext : 88471.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To investigate the possible association of the BANK1 gene with genetic susceptibility to systemic sclerosis (SSc) and its subphenotypes. METHODS: A large multicentre case-control association study including 2380 patients with SSc and 3270 healthy controls from six independent case-control sets of Caucasian ancestry (American, Spanish, Dutch, German, Swedish and Italian) was conducted. Three putative functional BANK1 polymorphisms (rs17266594 T/C, rs10516487 G/A, rs3733197 G/A) were selected as genetic markers and genotyped by Taqman 5 allelic discrimination assay. RESULTS: A significant association of the rs10516487 G and rs17266594 T alleles with SSc susceptibility was observed (pooled OR=1.12, 95% CI 1.03 to 1.22; p=0.01 and pooled OR=1.14, 95% CI 1.05 to 1.25; p=0.003, respectively), whereas the rs3733197 genetic variant showed no statistically significant deviation. Stratification for cutaneous SSc phenotype showed that the BANK1 rs10516487 G, rs17266594 T and rs3733197 G alleles were strongly associated with susceptibility to diffuse SSc (dcSSc) (pooled OR=1.20, 95% CI 1.05 to 1.37, p=0.005; pooled OR=1.23, 95% CI 1.08 to 1.41, p=0.001; pooled OR=1.15, 95% CI 1.02 to 1.31, p=0.02, respectively). Similarly, stratification for specific SSc autoantibodies showed that the association of BANK1 rs10516487, rs17266594 and rs3733197 polymorphisms was restricted to the subgroup of patients carrying anti-topoisomerase I antibodies (pooled OR=1.20, 95% CI 1.02 to 1.41, p=0.03; pooled OR=1.24, 95% CI 1.05 to 1.46, p=0.01; pooled OR=1.26, 95% CI 1.07 to 1.47, p=0.004, respectively). CONCLUSION: The results suggest that the BANK1 gene confers susceptibility to SSc in general, and specifically to the dcSSc and anti-topoisomerase I antibody subsets. 01 april 2010

Resumen Aunque desconocemos la etiologia de la mayor parte de las vasculitis, los estudios epidemiologicos estan poniendo de manifiesto la existencia de diversos agentes infecciosos, farmacologicos y ambientales que pueden desempenar un papel desencadenante. Dichos agentes, bien a traves de la formacion de inmunocomplejos bien promoviendo la produccion de ANCA y con la participacion de mecanismos de inmunidad celular y de las moleculas de adhesion, ponen en marcha las vias que lesionaran el endotelio vascular.

Fundamento Multiples estudios sugieren que la medicion ultrasonica del hueso puede ser una alternativa rapida, barata y sin radiacion para determinar el riesgo de fracturas. En este trabajo hemos realizado medicion ultrasonica del hueso en 288 mujeres posmenopausicas, analizando la influencia de la historia ginecologica y de factores relacionados con el estilo de vida en los valores obtenidos. Pacientes y metodos Se incluyeron 119 mujeres postmenopausicas sanas y 169 con fracturas osteoporoticas previas. Se midio peso y talla y se realizo un cuestionario clinico para valoracion de los factores relacionados con la densidad mineral osea. Se obtuvieron las medidas de atenuacion ultrasonica de banda ancha (BUA) y velocidad del sonido (VS) con un analizador ultrasonico de contacto. Resultados En las mujeres sin fracturas los valores medios de BUA y VS (64,1 [14,9] y 1.601,1 [34,5], respectivamente) fueron significativamente superiores a los de BUA (48,8 [17,3]) y VS (1.573,6 [57,8]) en las mujeres con fracturas (p Conclusiones Los valores de BUA y VS son inferiores en las mujeres con fracturas osteoporoticas. El riesgo de fractura se puede predecir a traves de un modelo que incluya las variables BUA, edad, edad de la menopausia y talla.

Objectives. Our objective was to evaluate the efficacy and tolerability of bosentan in patients with systemic sclerosis (SSc) who develop ulcers and healed ulcers. We also wanted to analyse the effect of bosentan on other skin and general outcome measurements. Methods. In the present prospective, observational, non-controlled study, we followed all patients with SSc who started treatment with bosentan for ischaemic ulcers and healed ulcers from January 2003 to June 2006 in our centre. We recorded skin and general outcome measurements at baseline and at 6 months. Results. Fifteen patients were included. After a median follow-up of 24.7 months (range: 4-36), there was a significant decrease in the number of ulcers. A trend towards efficacy was seen in the number of healed ulcers and in the severity of ulcers. No significant effect was seen in other skin and general outcome measurements. Toxicity related to bosentan included mild transitory events and one toxic hepatitis. Conclusion. Bosentan may be a safe long-term alternative for treating the recurrence of skin ulcers and healed ulcers in SSc patients.

Background Some studies suggest that clinical subgroups of idiopathic inflammatory myopathies (IIM) and several myositis-specific antibodies (MSAs) could influence the prognosis of IIM with interstitial lung disease (ILD). Objectives To investigate the prognosis value of different clinical subgroups and of MSAs in a cohort of patients with IIM -associated ILD. Methods We analyzed patients with IIM-associated ILD included in the multicenter registry REMICAM (1980–2014). We compared prognosis between a) subgroups of IIM: dermatomyositis (DM) vs. polymiosytis (PM) (primary, juvenile, cancer-associated myositis or overlap myositis); and b) absence (−) or presence (+) of anti-Jo1 vs. anti-RO vs. anti-Jo1 and anti-RO. In this preliminary analysis, outcomes were mortality and change between final and initial visit in FVC and DLCO. Results 478 patients were included in the registry, of which 143 had ILD, 66% PM and 34% DM. The distribution by MSAs was: 56% anti-Jo1-/RO-, 20% anti-Jo1+, 9% anti-RO+ and 15% anti-Jo1+/RO+. There were 52 deaths; the main causes were 32.6% cardiovascular events and 22.4% infections without difference between subgroups of IIM. The probability of survival was 50% to 18.8 years and the mortality rate was 37.7/1000 patient-ys. We did not find differences when we compared survival between subgroups of IIM or we compared by MSAs. FVC seemed to improve more in DM than in PM patients (1.2±5.2vs. 0.5±4.7;p=0.059), but there were no significant changes in DLCO of DM patients or in FVC and DLCO according to MSAs. Conclusions We did not find prognostic differences in the causes of mortality, mortality rate between subgroups of IIM, or in mortality rate according to MSAs in patients with ILD. In DM patients there was a trend towards a greater improvement of FVC than in PM patients. Disclosure of Interest None declared

Background Several reports have shown the relationship between gout and increased cardiovascular risk (CVR). There is a lack of research in Spain about endothelial and cardiac dysfunction in gout Objectives Analyze CVR factors in gouty patients in our sample with vascular assessment, cardiological tests and laboratory parameters Methods Prospective cohort study with collection of clinical data, family history (FH) of gout and cardiovascular disease (CVD), and treatments received (calcium channel antagonists [CCA], ACE inhibitors [ACE-i], angiotensin receptor blokers [ARB], beta blockers [BB] or thiazides. A history of hypertension, diabetes (DM), dyslipidemia (DL), smoking, thrombotic events, ischemic heart disease (IHD) were also collected. Body mass index (BMI), serum uric acid (SUA), sedimentation rate (ESR), conventional/ultrasensitive RCP [cRCP, hsCRP], ferritin, total cholesterol (CHOL) and subtypes (HDLc, LDLc), triglycerides (TG), vitamin D and homocysteine were measured. Patients were referred to Vascular Surgery Department for ultrasound examination with search of carotid plaques and study of intima-media thickness (IMT), and also were to Cardiology Department for echocardiogram (ECHO-CG) and electrocardiogram (ECG) Results 150 patients, 97% men and 3% women. Average age at time of study and diagnosis: 56 (23–92) and 47 years (15–79), respectively. Age at symptoms onset: 45 years (15–77). 22.5% had tophi and 11.3% urate stones. FH: 42% had gout history and 41% CVD history. Classical CVR factors: hypertension 47.3%; DM-2 4.6%, glucose intolerance 0.6%; DL 56.7% (CHOL: 37, TG: 15, both: 33); smokers 20.6% and quitters 37.6%, 21 pack/year (1–90); 1 patient had suffered stroke; 4 thrombosis; 17 IHD (11 angina, 6 myocardial infarction). 75% overweight/obesity, BMI 28 (19–40). Analytical parameters: ESR 10 mm/h (1–68), hs-CRP 2.7 mg/dL (0.1–57.7), c-CRP 2.3 mg/L (0–14.8); SUA 6.9 mg/dL (2.4–11.8); ferritin 259 ng/ml (11–2000); COL-t: 187 mg/dL (102–321, 6 not collected [NC]), HDLc 47 mg/dL (15–88; 22 NC), LDLc 113 mg/dL (15–248) TG 145 mg/dL (53–603); vitamin D 24.7 ng/mL (5.6–23.6; 28.6% 15 mmol/L). ECHO-CG: 6 valvular disease, 13 left ventricular hypertrophy, 45 had >1 finding, 5 NC. ECG was normal in 79 patients; 9 right bundle branch block (BBB), 1 left BBB, 4 IHD signs, 2 repolarization abnormalities and 6 arrhythmia; 13 had ≥2 findings, 9 showed other findings, 54 NC. Vascular examination: carotid IMT greater than corresponding adjusted by age group in 75% and 79% of patients (right and left, respectively); both: 65%. Carotid plaques 23%. Treatments: ACA 2.6%, ACE-i 2%, ARB 4.6%, BB 2%, thiazides 3.3% Conclusions 75% of our patients have overweight/obesity. High percentage of subjects with hyperhomocysteinemia and/or vitamin D deficiency. Marked prevalence of increased IMT and carotid plaques, and outstanding number of cardiac abnormalities in ECHO-G/ECG. Further statistical studies will quantify the value of these early findings, that seem very relevant References Feig DI, et al. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811–21 Cukurova S, et al.Subclinical atherosclerosis in gouty arthritis patients: a comparative study. Rheumatol Int. 2012;32(6):1769–73 Disclosure of Interest None declared

Background Cardiovascular complications are a common cause of morbidity in inflammatory arthritis and connective tissue diseases like several studies have shown. Objectives Detection of cardiovascular risk factors and endothelial dysfunction in patients diagnosed with Systemic Sclerosis (SSc) and Mixed Connective Tissue Disease (MCTD). Creation of a longitudinal cohort of patients. Methods Studies have been collected from April 2012 to December 2015. The data collection protocol included BMI, dyslipidemias, DM, HTN, previous or active smoking, thrombotic episodes, strokes and ischemic cardiopathy. ESR, CPR, cholesterol level, LDL, HDL, triglycerides, 25OH-D and homocysteine levels were requested to all patients. Vascular surgery9s ultrasound protocol was: 1. Carotid study, intima-media thickness (IMT) and presence of plaques; 2. Ankel branquialindex (ABI), being pathological when ABI ≤0.9; 3. Endothelial dysfunction was assessed measuring abnormal brachial artery flow-mediated dilatation (FMD) after a four minutes transient ischemia period, being patologic if FMV Results A total of 61 patients (95.1% women) were included: 28 SSc limited, 21 SSc diffuse, 2 SSc Sine Scleroderma, 4 MCTD, 3 overlap SSc-polymyositis and 3 Prescleroderma. The mean age at the time of the study and diagnosis were 49 (19–76) and 46 years (17–75). The average time of the disease was 5 years (0–37). 7 patients had HTN, 2 had DM, 18 hyperlipidemia (10 HCL, 2 HTG, 6 mixed hyperlipidemia), 9 active smokers, 18 ex-smokers, 2 patients with stroke, 2 have had thrombotic episodes and 1 had ischemic heart disease. The mean BMI was 24 (18–50) and 37.3% had a BMI>25. The mean value of the different analytic parameters was: ESR: 15 mm/h (1–55), PCR: 2.7 mg/L (0,1–22), COL: 198 mg/dL (143–298), 25OH D Vitamin:23,6 ng/mL (12–118), homocystein 10.8 micromol/l (5,9–19,5) and 21.4% had pathological levels ≥15 micromol/l. The mean modified Rodnan skin score was 9 (0–42), 20% of patients had ILD and 3 patients had PAH. 64% patients were treated with steroids, 65% DMARDs and 13.1% biologic therapies. The echographic findings were the following: 1. The mean right and left common carotid IMT were 0.6 (0.47–1.2) and 0.7 mm (0.44–1.3) respectively. 66% and 61.2% of the cases had an increase of right and the left IMT respectively and 43% of both when it was compared with age group of reference population. 2. 26% had unilateral plaques and 7% bilateral plaques. 3. Three patients had a pathologic ABI. 4. The average FMV was 4%, 80% cases had endothelial dysfunction, being severe in 51% of these. Conclusions 1. Nearly 40% of patients have overweight (BMI>25). 2. A high percentage of patients (16%) have hyperhomocyisteinemia. 3. The percentage of subjects with increased IMT is high, around 65%. The presence of plaques is less frequent (30%). 4. Endothelial dysfunction was found in 80% of the cases, and it was severe in almost 50%. References Man A et al. The risk of cardiovascular disease in systemic sclerosis. Ann Rheum Dis. 2013 Jul;72(7):1188- 93. Tyndall AJ et al. Causes and risk factors for death in systemic sclerosis: a study from the EUSTAR database. Ann Rheum Dis. 2010 Oct;69(10):1809–15. Disclosure of Interest None declared

Background Classically the prognosis of idiopathic inflammatory myopathies (IIM) has improved in recent decades, but can still be poor in certain subgroups or in the presence of some clinical factors. Objectives To analyze survival, causes of death and poor prognosis factors in a cohort of patients diagnosed with IIM. Methods A multicenter retrospective study from REMICAM 1 myositis study group was performed. All patients were diagnosed with IIM according to Bohan and Peter 2 criteria and were classified into 5 different clinical subgroups: primary dermatomyositis (DM), primary polymyositis (PM), juvenile dermatomyositis (JuvM), cancer associated myositis (CAM) and overlap myositis (OM). Results 478 IIM cases were included. 74% of the cases were women, with an age at diagnosis of 43.7±22.6 ys. and a mean follow-up of 9.7±8.3 ys. During the follow-up period there were a total of 114 deaths (24%), the main causes were infections (24%), cancer (24%), and cardiovascular events (22%). Factors associated with poor prognosis were CAM (HR 15.4) and OM subgroups (HR 4.55), older age at diagnosis (HR 1.05), shorter time of disease (HR 1.30), serious infections (HR 4.57), cancer (HR 3.07), systemic symptoms (HR 1.64), heart (HR 2.52) and haematological manifestations (HR 1.53), ESR/CRP elevation at baseline (HR 3.05) and chronic renal failure (HR 2.41). The clinical characteristics that showed a protective effect were arthralgia (HR 0.68), typical skin lesions (HR 0.62), drug use (HR 0.53) and female sex (HR 0.5). In multivariate analysis the independent variables associated with mortality were CAM (HR 8.83) and OM (HR 5.17) subgroups, severe infections (HR 3.42), older age at diagnosis (HR 1.03), shorter course of the disease (HR 1.34), thrombocytopenia (HR 2.93) and elevated ESR/CRP (HR 2.47). Conclusions In our REMICAM registry on inflammatory myopathies 24% of patients died, mainly due to infections, cancer and cardiovascular events. The independent predictors of mortality were belonging to the subgroups of paraneoplastic myopathies or overlap syndrome, the presence of severe infections, thrombocytopenia, elevated ESR/CRP at baseline, shorter course of the disease and older age at onset. References REMICAM: Registry on inflammatory myopathies in Madrid Bohan A, Peter JB. N Engl J Med 1975 Feb 13;292(7):344–7. Disclosure of Interest L. Nuno Grant/research support from: SORCOM-MSD grant for myositis study, M. J. Garcia: None declared, B. Joven: None declared, V. Maldonado: None declared, I. Llorente: None declared, C. Barbadillo: None declared, P. Garcia de la Pena: None declared, L. Ruiz: None declared, H. Moruno: None declared, T. Cobo: None declared, R. Almodovar: None declared, L. Lojo: None declared, F. J. Lόpez Longo: None declared

Background Clinical manifestations, evolution and prognosis of idiopathic inflammatory myopathies (IIM) are very heterogeneous which, together with its low prevalence, limits the study of the disease. Objectives To analyze the clinical characteristics of patients diagnosed of IIM in a multicenter study. Methods A multicenter retrospective descriptive study from REMICAM 1 myositis study group was performed. All patients were diagnosed with IIM according to Bohan and Peter 2 criteria, were followed up sometime between January 1980 and December 2014 and were classified into 7 different clinical subgroups: primary dermatomyositis (DM), primary polymyositis (PM), juvenile dermatomyositis (JuvM), cancer associated myositis (CAM), overlap myositis (OM), inclusion body myositis (IBM) and necrotizing myositis (NM). Results 478 IIM cases were included. 74% of the cases was women, with an age at diagnosis of 43.7±22.6 years, and an average follow-up time of 9.7±8.3 years. The main IIM subgroups were primary myopathies (PM 28%, DM 22%, OM 19.9%, JuvM 19.2%, CAM 8.4%, NM 1.3%, BMI 1.3%). The connective tissue diseases more frequently associated in OM subgroup were MCTD (30%), systemic sclerosis (27%) and SLE (18,9%). The main extramuscular manifestations were cutaneous lesions (65%), arthritis (43%), general symptoms (39%) gastrointestinal complications (33%), and interstitial lung disease (ILD) (30%). Patients with OM had a higher prevalence of ILD (46.8% vs. 25.8%;p Conclusions In this multicenter REMICAM registry 478 IIM cases have been included. The most common subtypes were primary myopathies, and the most frequent extramuscular manifestation were typical cutaneous lesions. Overlap myositis patients presented with more extramuscular manifestations than the other subgroups. References REMICAM: Registry on inflammatory myopathies from Madrid Bohan A, Peter JB. N Engl J Med 1975 Feb 13;292(7):344–7. Disclosure of Interest None declared

Background Clinical manifestations and prognosis of idiopathic inflammatory myopathies (IIM) are extremely heterogeneous which, combined with its low prevalence, makes difficult the study of the disease in the absence of multicenter studies. Objectives To analyze the clinical characteristics and mortality in a cohort of patients diagnosed with IIM in rheumatology units from several hospitals in Madrid. Methods A multicenter retrospective longitudinal descriptive study from REMICAM myositis study group was performed. All patients diagnosed with IIM according to Bohan and Peter1 criteria for myositis and in follow-up sometime between January 1980 and December 2014 in rheumatology units were included. Patients were classified into clinical subgroups: primary dermatomyositis (DM), primary polymyositis (PM), juvenile dermatomyositis (JDM), paraneoplasic myositis, overlap myositis (OM), inclusion body myositis (IBM) and necrotizing myositis (NM). Main causes of death and influence of age and sex were studied. Results 485 cases were included in this study, with a medium age at diagnosis of 43,3±23,2 years and mean follow-up time of 11,3±19 years. Most cases were Caucasian (93%), and women (74,4%). The most frequent form of classification were primary myopathies (28,8% PM; 21% DM; 20,6% OM; 19,4% JDM; 8,3% paraneoplasic myositis; 1% IBM and 0.8% NM) and the most frequent myositis specific antibodies detected were anti-Jo-1 (16,3% anti-Jo-1; 4,1% anti-Mi-2; 2,7% anti-PM-Scl; 0,6% anti-SRP; 0,2% anti-Ku). 25,4% of patients died, with a higher mortality rate in men (32,5% vs. 22,9; p=0,04) and older age at onset (54,1±24,8 years vs. 37,2±26,4 years, p Conclusions In our cohort of IIM 25,4% of patients died, with a worse prognosis in men and older age at onset, mainly due to cancer and cardiovascular events. Cardiovascular events are the most important cause of death in PM and MCTD, and infections in DM. References Bohan A, Peter JB. N Engl J Med 1975 Feb 13;292(7):344-7. Disclosure of Interest None declared

Background Clinical manifestations, course and prognosis of idiopathic inflammatory myopathies (IIM) are extremely heterogeneous which, combined with its low prevalence, makes difficult the study of the disease in the absence of multicenter studies. Objectives To analyze the clinical characteristics and mortality in a cohort of patients diagnosed with IIM in rheumatology units from several hospitals in Madrid. Methods A multicenter retrospective longitudinal descriptive study of a cohort of patients diagnosed with IIM and in follow-up sometime between January 1980 and February 2013 in rheumatology from several hospitals in Madrid. All patients who met at least 2 criteria of Bohan and Peter 1 for polymyositis (3 criteria if dermatomyositis) were included. We performed a descriptive study ot the initial cases recruited during the first months of the stuydy. All patients in current follow-up signed informed consent. Statistical analysis was performed using SPSS 11.5 for Windows, with a significance level of p Results 127 cases were included in this study, with a 15% of patients lost to follow-up. There is a predominance of polymyositis over dermatomyositis (59.8% vs. 40.2% respectively). 74% of the cases were women, and patients had a medium age at diagnosis of 42.5±22.7 years, with a mean follow-up time of 76.8±70.8 months. Most of the cases were Caucasian (90.6% Caucasian, 7.9% Hispanic, 1.6% other). 97.6% met at least 3 criteria of Bohan and Peter. The most frequent form of classification were primary myopathies (47.6% primary myopathies, 26.2% myopathies associated with other connective tissue disease, 17.5% juvenile myopathies, 6.3% paraneoplastic myopathies, 1.6% inclusion body myopathies, and 0.8% necrotizing myopathies). Clinical manifestations associated with the disease included systemic manifestations (38.1%), joint manifestations (65.1%), skin manifestations (56.3%, the most frequent being Gottron sign) and interstitial lung disease (18.9%). EMG and muscle biopsy were performed in 96.1% and 66.9% and compatible with IIM in 92.6% and 77.6% of the cases respectively. 26 patients died (20.5%), mainly due to infections (26.9%), followed by cancer (19.2%), cardiovascular events (15.4%), interstitial lung disease (7.7%) and other causes. Conclusions In this retrospective, longitudinal study on idiopathic inflammatory myopathies followed-up in several hospitals inMadrid, 127 have been recruited for the moment. The most common subtype were primary myopathies (47.6%). 20.5% of patientsdied, mainly due to infections, followed by cancer, cardiovascular events, interstitial lung disease and other causes. More cases willbe included. References Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med 1975 Feb 13;292(7):344-7. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3732

Multiple studies suggest that ultrasound measurement of the bone can be a rapid, cheap, and radiation-free alternative to determine the fracture risk. In this paper the ultrasound measurement of the bone was performed among 288 postmenopausal women, and the influence of gynecologic history and factors related to lifestyle on the obtained values was examined.One hundred nineteen healthy postmenopausal women and 169 women with previous osteoporotic fractures were included in the study. Both weight and height were determined and a clinical questionnaire was administered to assess factors related to bone mineral density. The values of broadband ultrasound attenuation (BUA) and speed of sound (SOS) were obtained with a contact ultrasound analyzer.Among women without fractures the mean BUA and SOS values (64.1 [14.9] and 1,601.1 [34.5], respectively) were significantly higher than mean BUA (48.8 [17.3]) and SOS (1,573 [57.8]) values among women with fractures (p0.001). Using the logistic regression analysis for predicting fracture risk, the model that suited best was that including BUA (OR = 0.668 [0.544-0.818]), age (OR = 1.102 [1.055-1.151]), age at postmenopause (OR = 0.794 [0.731-0.862]) and height (OR = 0.932 [0.883-0.983]). The area under the curve for this model was 0.871.BUA and SOS values are lower among women with osteoporotic fractures. The fracture risk can be predicted by means of a model including the variables BUA, age, postmenopausal age, and height.

Background Cochin Hand Function Score(CHFS) is a questionnaire proposed and validated by Poole JL et al(Arthritis Rheum 2004; 51:805-9), to measure the disability due to hand involvement in Systemic Sclerosis(SSc) patients. It includes 18 items, refering to personal hygiene, dressing, cooking, occupation and other tasks. Objectives To assess the CHFS applicability in spanish SSc patients, as well as its correlation with some clinical features, measurements and specific disease questionnaires. Methods Multicentric, descriptive and cross-sectional study with analytic components. SSc patients from two hospitals were assessed regarding hand disability by means of the CHFS. This questionnaire had previously been translated and adaptated to Spanish. Clinical assessment was simultaneously performed, and the next data were collected: age, time since SSc diagnosis, modified Rodnan skin score(mRSS), mRSS of fingers and hands, finger flexion and extension, digital ischemic ulcers(DIU), digital necrosis, amputations, calcinosis, tendon contractures and joint swelling of the hands. Global disability was assessed by the sHAQ and VAS of Raynaud(VAS-FRy) and DIU(VAS-DIU). In each hospital, patients were always evaluated by the same expert rheumatologist. SPSS Statistics 17.0 was used for data analysis, and percentages, means(SD) and medians(range) were assessed for describing variables. Pearson’s test was used to assess the correlation between CHFS and quantitative variables, and Spearman’s coefficient for the correlation between CHFS and qualitative variables, interpreted as excellent(>0.8), good(0.6-0.8), moderate(0.4-0.6), and poor( Results A total of 56 patients were evaluated (51 female, 5 male; 40 lSSc, 16 dSSc; age and disease duration: 52±15, 11±9 years; 23% with DIU; 21% with joint swelling of the hands; 18% with finger contractures; 16% with hand calcinosis; 9% with digital necrosis; 2% with previous finger amputation). Mean total CHFS was 16.1 (dSSc:25.2, lSSc:12.2). Correlation between disease duration and total CHFS was good (r: 0.70), as well as it was with scores of its different domains, with the exception of “other tasks” (r: 0.48). Correlation between CHFS and total mRSS, mRSS of fingers, digital flexion, necrosis, calcinosis and joint contractures was only moderate, but it was good with hands’ mRSS, SHAQ, and both VAS (r: 0.678, 0.677, 0.619 and 0.7, respectively). When correlations were assessed separately for each type of SSc, it happened to be a very good correlation between CHFS and mRSS of the hands, SHAQ and both VAS (r: 0.82, 0.87, 0.89 and 0.93, respectively) in dSSc patientes. However, correlations between CHFS and mRSS were moderate or even poor in lSSc (though it was kept good for the SHAQ, r: 0.72). Conclusions The Spanish version of the CHFS is useful in spanish SSc patients, and mainly assesses hand disability related to the degree of skin involvement, specially in dSSc patients. A complete method of validation is needed to confirm these previous results. Disclosure of Interest None Declared

Background The Mouth Handicap in Systemic Sclerosis Scale (MHISS) is a 12-item questionnaire proposed and validated by Mouthon L et al (Ann Rheum Dis 2007; 66: 1654-1655) which assesses mouth disability in Systemic Sclerosis (SSs). Items are organized in 3 subscales measuring oral aperture, xerostomia and stetic damage. Objectives To evaluate the applicability of MHISS in Spanish SSc patients, as well as its correlation with various clinic variables and specific measures of the disease. Methods Multicentric, descriptive and cross-sectional study with analytic components. SSc patients from two hospitals were assessed regarding mouth disability by means of the MHISS. This questionnaire had previously been translated and adaptated into Spanish. Clinical assessment was simultaneously performed, and the next variables were collected: age, time since SSc diagnosis, modified Rodnan skin score(mRSS), oral aperture measurement, oesophageal symptoms, sicca syndrome(SS), and smoking habit. All patients were evaluated, in each of the hospitals, by the same expert rheumatologist. SPSS Statistics 17.0 was used for data analysis, and percentages, means(SD) and medians(range) were assessed for describing variables. Pearson’s test was used to assess the correlation between MHISS and quantitative variables, and Spearman’s coefficient for the correlation between MHISS and qualitative variables, interpreted as excellent(>0.8), good(0.6-0.8), moderate(0.4-0.6), and poor( Results A total of 56 patients were evaluated(51 female, 5 male; 40 lSSc, 16 dSSc; age and disease duration: 52±15, 11±9 years; 30% smokers; 45% with oesophageal symptoms; 54% with SS). Mean total MHISS was 16±12, being higher in dcSSc patients (20±15) than in lcSSc(15±10). Oesophageal symptoms, mRSS and mouth opening limitation were also higher in dSSc than in lSSc patients. No differences were found regarding the existence of SS. When analyzing all of the patients, we detected an acceptable negative correlation between mRSS and oral aperture(r: -0.57), as well as between oral aperture and MHISS(r: -0.57). There was a good correlation between the presence of SS and questionnaire items 7 and 8, related to xerostomia (r: 0.69). This correlation was even better when considering dSSc patients separately(r: 0.83). In dSSc patients, correlations between mRSS and oral aperture, and between oral aperture and MHISS were also better(r:-0.6 and -0.66, respectively). Moreover, disease duration showed a good correlation with oral aperture(r: -0.75) and MHISS(r: 0.66). On the other hand, correlations between mRSS and oral aperture(r: -0.5), as well as between oral aperture and MHISS(r: -0.47) were found to be moderate in lSSc patients. Even though there were no differences regarding the existence of SS, correlation between this variable and MHISS items related to xerostomia was lower(r: 0.64) in lSSc patients. Conclusions The Spanish adaptation of MHISS is useful in spanish SSc patients, mainly measuring mouth disability related to the degree of skin involvement and xerostomia, and specially in dSSc patients. Disclosure of Interest None Declared

Background Raynaud Phenomenon (RP) is present in more than 90% of the patients with Systemic sclerosis (SSc) and it may progress to scars, ulcers, necrosis resulting in an incapacitating problem for many of them. Objectives To evaluate the efficacy of the most common drugs used in clinical practice in SSc patients with RP (SSc-RP). Methods A systematic literature search was performed in Medline, EMBASE and Cochrane Central Register of Controlled Trials (from the beginning to October 2011) and a manual search. We selected meta-analysis, systemic literature reviews, randomized clinical trials (RCT) and high quality cohorts studies (English, Spanish) which included SSc-RP (limited cutaneous and diffuse) patients, aged 18 years or above, with RP and/or digital ulcers on: calcium channel blockers, ACEI,ARB, endothelin receptor antagonist, phosphodiesterase inhibitors, prostanoids, antioxydants, NAC, SRA, cyclofenil, atorvastatin, stanazolol, hyperbaric oxygen, ulcers topical treatment, electrical neurostimulator, sympatectomy or nitroglycerine. Efficacy was evaluated as: number of RP episodes, RP severity, time without flares, ulcers improvement and healing, change of ulcers size, number of new ulcers, etc. Studies including patients with primary RF and basic science were excluded. Title and abstract selection and subsequent detailed review of selected articles were independently performed by two reviewers, BN and CP. Evidence tables were generated. The included studies quality was graded using the 2001 Oxford Levels of Evidence Scale, and results expressed as level of evidence (LE), recommendation grade (RG). Results A total of 1,541 studies were identified, of which 29 fulfilled inclusion criteria. Quality was good in 19/29 (65.5%) studies. We found a great variability in the outcomes evaluated in the included studies. The efficacy in terms of level of evidence and grade of recommendation in SSc-RP patients are as follows: alpha adrenergic blockers: prazosin (LE 1a, GR A), OPC-2826 (LE 1c, GR B); ACEI: quinapril (LE 1a, GR A), enalapril (LE 1c, GR B); prostanoids: Iloprost iv (LE 1a, GR A), beroprost (LE 1a, GR A), cisoprost (LE 1b, GR B), misoprostol (LE 1c, GR B); endothelin receptor antagonist: bosentan (LE 1a, GR A); phosphodiesterase inhibitors: tadalafil (LE 1a, GR A), sildenafil (LE 1c, GR B); topic treatments: MQQx-503 (LE 1a, GR A), DMSO (LE 1b, GR B); other drugs: cyclofenil (LE 1b, GR B), atorvastatin (LE 1b, GR B), antioxydants (LE 1c, GR B), stanozolol (LE 1c, GR B). Conclusions The evidence on the efficacy of the different pharmacological treatments for SSc-RP patients is heterogeneous. The best evidence regarding to the efficacy in SSc-RP patients was found in the following drugs: calcium channel blockers, ACEI, prostanoids, tadalafil and bosentan. There is a lack of high quality prospective studies. Disclosure of Interest None Declared

Objective—To determine the responsibility of hepatitis B virus (HBV) and hepatitis C virus (HCV) and therapeutic implications in a patient who developed systemic vasculitis. Case report—The case of a 38 year old woman who had a past history of addiction to intravenous drugs and developed systemic vasculitis after infection by HBV and HCV is described. The clinical and laboratory findings substantiated not only the diagnosis of polyarteritis nodosa (PAN) but also that of mixed cryoglobulinaemia with a monoclonal IgMŒ component. Conclusion—Because cryoglobulins are rarely found in HBV related PAN but often associated with HCV infection, and in light of the histological findings, cryoglobulinaemia was interpreted as being secondary to HCV infection.This example of a highly complex situation emphasises the need to gather all relevant clinical, biological, histological, and complementary data so that the best treatment for overlapping of distinct vasculitides can be selected. (Ann Rheum Dis 2001;60:1068‐1069)