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Background: Systemic Sclerosis is a multisystem autoimmune disease characterized by fibrosis of the skin and internal organs and vascular damage. The diagnosis is usually made in the late stages, when irreversible damage has already occured. Recently, we have established new criteria to detect early cases of the disease. Performing capillaroscopy and its findings are crucial in the diagnosis of early systemic Sclerosis or “prescleroderma” and there may be changes seen in capillaries of patients without skin manifestations. Objectives: To analyze the nailfold capillaroscopy findings in patients with anti-centromere or anti-topoisomerase antibodies and evaluate their usefulness for the diagnosis of systemic sclerosis. Methods: Of a total of 255 capillaroscopy performed in our Rheumatology department, those patients with positive anti-centromere or anti-topoisomerase were selected. In all cases, capillaroscopy was performed in eight fingers, always by the same observer. The following findings were considered pathological or scleroderma pattern: Local or global capillary loss (> 20%), hemorrhages: two or more in at least two fingers and enlarged capillaries: two or more capillary with double or more caliber in at least two different fingers. Statistical analysis was performed with SPSS 19.0 program. Results: The study included 69 patients: 5 (7.2%) males and 64 (92.8%) women, 14 (20.3%) smokers, 47 (68.1%) non-smokers and 8 (11.6%) quitters. The characteristics of the patients included in the study were as follows: 20 patients (30%) were previously diagnosed of systemic sclerosis (19 limited and one diffuse), of which 4 patients had concomitant primary biliary cirrhosis Syndrome (Reynolds), 1 patient with primary biliary cirrhosis and positive anti-centomere without the presence of Raynaud, one patient diagnosed with Sjogren’s syndrome with positive anti-centromere without presence of Raynaud, 26 patients with suspected early systemic sclerosis and 21 patients with disease-specific autoantibodies in the absence of Raynaud. Nailfold capillaroscopy was normal in 32 patients (46.4%) and pathological (scleroderma pattern) in 37 patients (53.6%); we detected limited enlarged capillaries in 26.2%, generalized enlarged capillaries also in 26.2%, giant capillaries in 37.7%, local loss of capillaries in 27.9%, global loss of capillaries in 8.2%, hemorragies in small claims in 29.5% and abundant hemorrhagies in 9.8%. All patients previously diagnosed of systemic sclerosis had a pathological capillaroscopy except one. However, no changes were observed in capillaroscopy in patients who had only disease-specific autoantibodies in the absence of Raynaud’s phenomenon. While, the 26 patients who were referred for suspected systemic sclerosis (at least with the presence of Raynaud and autoantibodies) in 18 (69.9%) of these scleroderma pattern was observed with subsequent diagnosis of early systemic sclerosis or “prescleroderma”. Conclusion: Nailfod capillaroscopy is a useful and inexpensive tool for the diagnosis of systemic sclerosis. The scleroderma pattern is very specific of this disease and we can make an early diagnosis even in patients who only have autoantibodies and Raynaud’s phenomenon, without the presence of other severe manifestations. We have also observed that the absence of Raynaud’s phenomenon is associated with a normal result on capillaroscopy. Reference [1] Nailfold digital capillaroscopic findings in patients with diffuse and limited cutaneous systemic sclerosis. Saeedeh Shenavandeh, Mahyar Yousefipour Haghighi, Mohammad Ali Nazarinia. Reumatologia 2017; 55, 1: 15–23 Disclosure of Interests: None declared

Background Pathophysiology of primary Sjogren syndrome (SSp) is characterized by oligoclonal B-cell proliferation and ectopic lymphoid tissue formation. The association between ultrasound glandular parenchyma heterogeneity and hyperproduction of autoantibodies, which in turn represents characteristic B-cell hyperactivity of SSp, is described. Objectives To study the association between major salivary gland ultrasound (MSGUS) and their respective pathological grades with the analytical and serological data, and activity indexes obtained in patients with suspected SSp. Methods 72 patients were recruited consecutively with clinical and/or analytical suspicion of SSp from the Rheumatology outpatient consultations at the Principe de Asturias Hospital (2015-2018). Demographic, serological and validated activity indexes, ESSPRI and ESDAI, were collected. All of them underwent a MSGUS and their results were classified in three grades according to the Cornec et al system: normal (grade 0 and 1), mild (grade 2) and moderate-severe (grades 3 and 4). The final SSp diagnosis was made using both 2002 AECG and 2016 ACR/EULAR classification criteria. Data were analyzed using the software STATA. Association between MSGUS and qualitative variables was described according to the number of cases and the percentage by grades of MSGUS; the significance of the associations was tested with the Chi square test. As for the quantitative variables, the association was described with median and interval interquartile (IIQ) by grades of MSGUS and the significance of the association was verified with the non-parametric test of Kruskall-Wallis. Results From patients with pathological MSGUS: 51% had antiRo52, 51% antiRo60 and 36% anti-La positive; 62% hypergammaglobulinemia, 40% positive rheumatoid factor (RF), 6% and 13% C3 and C4 hypocomplementemia, respectively. Mean values were obtained: ESR 36, CRP 1.6, RF 12, ESSPRI 5.6 and ESSDAI 2. Statistically significant differences (p 0.150 in all associations explored). No differences have been found for RF, C3 and C4 hypocomplementemia, ESR, CRP and ESSDAI variables (table1). Conclusion In this series of patients, a statistically significant association was found between the positivity of anti-Ro antibodies, hypergammaglobulinemia and MSGUS, as well as its subdivision by pathological grades. No statistical significant association was found between MSGUS and positivity of antiRo60 and antiLa antibodies and ESSPRI, probably due to the small sample size. There were no differences for the rest of the variables analyzed (RF, complement, acute phase reactants and ESSDAI). References [1] Ultrasonography of salivary glands-a highly specific imaging procedure for diagnosis of Sjogren’s syndrome Dirk Wernicke J Rheumatol. 2008Feb;35(2):285-93. Epub 2008 Jan 15 [2] .The usefulness of ultrasound in the diagnostics of Sjogren’s syndrome. Fadhil Saied J Ultrason. 2013 Jun;13(53):202-11. Disclosure of Interests None declared

Background: Nailfold capillaroscopy (CP) is a simple, safe, low cost and non-invasive screenig test and together with the study of autoantibodies, is useful in the diagnosis of systemic sclerosis (SSc). It demonstrates certain specific patterns which are characterized by the presence of dilated capillaries, haemorrhages and avascular areas. Other systemic autoimmune diseases (SAD) do not have a specific pattern, but certain alterations in the morphology of the capillaries such as increased tortuosity have been described in SLE. In other diseases such as mixed connective tissue disease (MCTD), inflammatory myopathies and overlap syndromes, findings may be different to the pathological findings consistent with scleroderma pattern. Objectives: Description of nailfold capillaroscopic findings in different SAD. Methods: The study included 255 patients referred for CP that was performed in 8 fingers, and always by the same observer. The following findings were considered as “scleroderma pattern”: Local or global capillary loss (> 20%), haemorrhages: two or more in at least two fingers and enlarged capillaries: two or more capillary with double caliber or more in at least two different fingers. Abundant evidence of tortuosity (> 20%) as ringlets tangles and no evidence of disorders described above, was considered nonspecific, tortuous pattern or suspects SAD. Statistical analysis was performed with SPSS 19.0 program. Results: CP was performed in 255 patients, 31 males (12%) and 224 (88%) women. 23 patients (9%) had a diagnosis of SSc, 6 patients (2%) of SLE, other 6 (2%) of Sjogren’s syndrome, 7 (3%) of MCTD, 4 (1.5%) of inflammatory myopathy and 2 (0.8%) of overlap syndrome. 18 patients (7%) had positive aNA and Raynaud without another data suggestive of SAD, 76 patinents with primary Raynaud (30%) and 66 patients (26%) with a miscellany of other diseases such as antiphospholipid syndrome, vasculitis, fibromyalgia and psoriatic arthritis. Also, 29 patients (12.4%) were sent for performing CP for suspected systemic sclerosis and 16 patients (6.3%) presented with only positive anti-centromere. CP was normal in 191 patients, while in 45 patients scleroderma pattern was observed and in 19 patients nonspecific pattern suggestive of SAD was seen. Capillaroscopic findings: in each of the 23 patients diagnosed with SSc, 21 patients had scleroderma pattern. Of the 6 patients with SLE, CP was normal in 4 patients, while one patient had abundant tortuosity. Likewise, the 6 patients with Sjogren’s syndrome, only one patient had a nonspecific pattern suggestive of SAD. Of the 7 patients with MCTD, four had normal CP, two had a scleroderma pattern and one had tortuous pattern. The 2 patients with overlap (myopathy-scleroderma and Lupus-scleroderma) both had a pathological CP with scleroderma pattern. Conclusion: Our study demonstrates that the evidence of scleroderma pattern is very specific of SSc. However, in certain diseases such as MCTD, overlap syndromes and inflammatory myopathies, we can also see this pattern. In other SAD, CP is usually normal or may show some nonspecific changes. References: The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Practice & Research Clinical Rheumatology Vol. 21, No. 6, pp. 1093–1108, 2007 Disclosure of interests: None declared

Background Minor salivary gland biopsy (MSGB) is the most used diagnostic tool for primary Sjogren Syndrome (SS). The potential relevance of an alternative non-invasive, fast, low cost and choice by the patient technique, like mayor salivary gland ultrasonography (MSGUS), has to be investigated. Objectives To evaluate the utility of MSGUS as a diagnostic tool for primary SS and to study the concordance with MSBG. Methods 36 patients were consecutively recruited with clinical and/or analytical suspicion of SS, from outpatient Rheumatology consultations from 2015–2017. All patients received a MSGB and a MSGUS. Two echographers performed two images readings with an interval of at least one week. They worked blinded for clinical and histological results. Demographics, clinical, serological, ESSPRI and ESDAI were recorded. The histological results were classified according to Chisholm and Mason score and the US results according to the system by Cornec et al. The final SS diagnosis was made using the 2002 classification criteria. Subsequently the data was analysed using the statistical software STATA/MP. Adjusted concordance intra and interobserver (kappa coefficient) was calculated for the diagnoses performed by US (normal/pathological). The validity of US and biopsy to diagnose SS according to the 2002 criteria was evaluated by calculating the percent agreement between the tests, along with the specificity, sensitivity, PPV, NPV and area below the curve (AUC). Further, the percent association of the diagnoses between serology and US were determined, and the statistical significance of it was evaluated with chi-square test. Results 94% were female, with an average age of 58 years. 69% were non-smokers. 89% showed pathological Shirmer test, 78% extraglandular features, 19% hypocomplemetemia and 44% hypergammaglobulinemia. As for the serological data, 81% had positive ANAS, 44% antiRo52, 39% antiRo60% and 28% antiLa. 39% of the patients were RF positive. 69% fulfilled the 2002 classification criteria with an average ESSPRI of 5.3 and ESSDAI of 1.5. Using these criteria as a gold-standard, the total percentage agreement was 83.3% for US and 80.6% for biopsy (S 92, Sp 64.3%). A good concordance was found between both observers (kappa=0.8) along with intraobserver (kappa=0.64 and 0.78 for first and second observer respectively). The percentage of patients with positive antibodies (48% antiRo52, 41% antiRo60, 30% antiLa) had pathological US. Significant statistical differences were not found in patients with normal US (p>0.44 in all associations explored). Conclusions MSGUS is a non-invasive imaging method useful for the diagnosis of primary SS in common clinical practice with a diagnostic value similar to the MSGB. MSGUS has good correlation intra and interobserver. There was no statistical significant association found between the positive autoimmune antibodies and US. References [1] Is salivary gland ultrasonography a useful tool in Sjogren’s syndrome? A systematic review. Sandrine Jousse-Joulin Rheumatology (Oxford)2016May;55(5):789–800. [2] Mossel E, et al. Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjogren’s syndrome. Ann Rheum Dis2017. Disclosure of Interest None declared