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Background:Primary fibromyalgia syndrome is a prevalent rheumatic condition characterized by widespread pain and whose etiopathogenesis is not well understood. Fibromyalgia can also be secondary to other rheumatic diseases like Sjogren’s syndrome; however, its relation to this disease is unknown. It has been suggested that the immune system is involved in their pathogenesis. The role of activation stages and cytokines profiles of CD4+T lymphocytes in fibromyalgia or fibromyalgia secondary to Sjogren´s syndrome are completely unclear and could play a key role in the pathophysiology of these diseases.Objectives:The objective of this study is to investigate the counts and distribution of the CD4+T lymphocyte activation subsets and their pattern of cytokine production in women with primary fibromyalgia, fibromyalgia secondary to Sjogren´s, Sjogren´s syndrome and healthy controls (HC). The counts and distribution of naïve (TN), central memory (TCM), effector memory (TEM) and effector (TE) CD4+T lymphocyte subsets were analyzed in these diseases. Furthermore, we investigated their pattern of IL-4, IL-10, IL-17A, IFNγ, and TNFα production.Methods:Counts and distribution of CD4+T subsets (TN, TCM, TEM, TE)and their cytokine producing capacity were measured using multiparametric flow cytometry in peripheral blood mononuclear cells (PBMC) from 20 primary fibromyalgia, 15 fibromyalgia associated to Sjögren and 15 primary Sjögren patients and 15 female controls. Fibromyalgia and/or Sjögren’s syndrome were diagnosed based on ACR criteria. CD4+T cell activation stages were analyzed by the expression of the CD3, CD4, CD45RA, CD27 and CCR7 antigens. Cytokine CD4+T producing cells subsets were assayed stimulating PBMC during 6 hours, fixed, permeabilized and simultaneously stained with IL-4, IL-10, IL-17A, IFNγ, and TNFα intracellular cytokines.Results:Fibromyalgia patients showed a significant increase in the CD4+T, TNand TCMcells counts with compared to fibromyalgia secondary to Sjogren, Sjogren´s syndrome and HC. The counts of IL-17A, IL-4 and IFNγ producing CD4+T cells were increased in fibromyalgia patients with respect to HC. However, only IL17A and IFNγ, but not IL-4 producing CD4+T lymphocytes were increased with respect fibromyalgia secondary to Sjogren. These alterations were due to an increment of TEMIL-17A, TCMand TEMIL-4 and TNTCMand TEMIFNγ producing CD4+T cell subsets in fibromyalgia patients. Furthermore, IFNγ producing CD4+T cells were decreased in fibromyalgia secondary to Sjogren´s with respect to fibromyalgia patients and HC. Counts of TNTNFα producing CD4+ T cells were increased in fibromyalgia with respect fibromyalgia secondary to Sjogren. IL-10 producing CD4+T cells were normal in fibromyalgia but decreased in fibromyalgia secondary to Sjogren.Conclusion:Fibromyalgia patients show an abnormal circulating activation stages of CD4+T cells, as well as, express unusual elevated counts of CD4+T cells producing IL-17A, IL-4 and IFNγ. These alterations could differentiate two different pathologic and inflammatory behaviors of the T cell compartment between fibromyalgia and fibromyalgia secondary to Sjogren patients.References:[1]T helper 1 response is correlated with widespread pain, fatigue, sleeping disorders and the quality of life in patients with fibromyalgia.. Guggino G et al, Clin Exp Rheumatol. 2019.[2]A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sjögren’s Syndrome. Bucourt E et al, Pain Med. 2019Disclosure of Interests:None declared

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 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

Objectives: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. Methods: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. Results: Mean age (years) ± S.D. at diagnosis was 14.2 ± 2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ± S.D. was 1.27 ± 1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). Conclusions: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

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

Resumen Los tratamientos biologicos constituyen un importante avance en el pronostico clinico de las enfermedades reumatologicas y autoinmunes sistemicas. Los farmacos anti-TNF son los primeros que se desarrollaron para la artritis reumatoide (AR). Se han aprobado otras indicaciones para otras formas de enfermedad distintas a la AR. El conocimiento de la implicacion patogenica de las distintas citoquinas ha llevado al desarrollo de farmacos dirigidos especificamente frente a esas moleculas (IL-6, IL-12/23, blys, IL-17…). En esta actualizacion se revisaran los farmacos de produccion biotecnologica (biologicos), sus principales indicaciones, criterios de respuesta, uso fuera de guia clinica, sus contraindicaciones, dosis, via de administracion farmacocinetica y efectos adversos, asi como las peculiaridades en el manejo clinico. Las inmunoglobulinas, aunque no se obtengan por tecnicas de biologia molecular, en ocasiones son utiles como complemento terapeutico de algunas formas de enfermedad. Comentaremos la irrupcion de los biosimilares en el mercado farmacologico que probablemente mejoren la eficiencia en el manejo de estas enfermedades.

Resumen Las miopatias inflamatorias son enfermedades con componente autoinmune que cursa con debilidad muscular, elevacion de las enzimas musculares y patron miopatico en el electromiograma. Pueden presentarse de forma aislada o asociada a otras enfermedades autoinmunes como sindromes de superposicion o relacionadas con neoplasias. Por su histologia se clasifican en 4 formas que son: dermatomiositis, polimiositis, miositis por cuerpos de inclusion y miopatia necrotizante inmunomediada. La primera y la ultima presentan un componente de inmunidad humoral (celulas-B y complemento), mientras que la polimiositis y la miositis por cuerpos de inclusion estarian mediadas por celulas-T. En las formas con componente humoral es importante descartar su asociacion con procesos neoplasicos. El tratamiento de estos pacientes se basa en la utilizacion de esteroides e inmunosupresores. Se utilizan inmunoglobulinas intravenosas en formas graves. La utilizacion de farmacos biologicos como rituximab parece ser prometedora en las formas mediadas por inmunidad humoral.

Altered renal function in patients diagnosed with systemic autoimmune disease is particularly important, since renal involvement with worse prognosis in these cases. The regular analytical monitoring of these patients who are subject to detect changes in creatinine levels or alterations in urinalysis that will make a diagnosis and treatment. It is also important to recognize the role of immunosuppressive drugs and concomitant pathology in the study of renal function. To emphasize the usefulness of urine sediment study and urine of 24 h to detect possible renal and glomerular damage, and the need for renal biopsy to obtain an accurate histologic diagnosis.

Resumen Las vasculitis son un grupo heterogeneo de enfermedades caracterizadas por la inflamacion de la pared vascular. La expresion clinica de cada entidad dependera del dano vascular, tipo de vaso afectado, localizacion del mismo y grado de severidad. La vasculitis por hipersensibilidad es generalmente autolimitada, con afectacion usual de la piel en exclusiva, y relacionada con la toma previa de algunos farmacos o infecciones. La clinica habitual es la purpura palpable y sintomas generales inespecificos. La purpura de Schonlein-Henoch es una vasculitis de pequeno vaso, mas frecuente en la infancia. El hallazgo histologico mas caracteristico es una vasculitis leucocitoclastica acompanada de depositos de inmunocomplejos de IgA en los organos afectados. Se trata de una clinica consistente en purpura localizada sobre todo en los miembros inferiores, gluteos, clinica abdominal, artralgias- artritis y ocasionalmente afectacion renal. El tratamiento sera sintomatico, salvo en casos graves en los que se utilizan corticoides e inmunosupresores. La vasculitis crioglobulinemica es de pequeno y mediano vaso, originada por el deposito de crioglobulinas. Se clasifica segun el tipo de las mismas, y cada una presenta una asociacion a distintas enfermedades: el tipo I esta asociado a enfermedades linfoproliferativas, el tipo II a infecciones, sobre todo al virus de la hepatitis C y el tipo III a enfermedades autoinmunes. El tratamiento es sintomatico y de la enfermedad de base. Existen estudios que demuestran muy buenos resultados en el caso de vasculitis asociada a virus de hepatitis C, con la triple terapia de interferon, mas antiviral y rituximab.

We aimed to describe juvenile-onset systemic lupus erythematosus (jSLE) features and to establish its differences compared to adult-onset SLE (aSLE) from a large national database.Data from patients (≥4 ACR criteria) included in Spanish Society of Rheumatology Lupus Registry (RELESSER) were analysed. Sociodemographic, clinical, serological, activity, treatment, cumulative damage, comorbidities and severity data were collected. Patients with disease onset18 years were described and compared to those with disease onset ≥18 years.We reviewed 3,428 aSLE patients (89.6% women) and 484 jSLE patients (89.8% girls), 93% Caucasian (both groups). Mean age at diagnosis was 38.1±14 and 16.6±6.3 years (p0.001) and mean age at the end of follow-up was 48.8±14.3 and 31.5±30 years (p0.001), respectively. jSLE showed significantly more clinical (including lymphadenopathy, fever, malar rash, mucosal ulcers, pericarditis, pleuritis, Raynaud's phenomenon, lupus nephritis, recurrent nephritis, histologic nephritis changes, thrombocytopenia, haemolytic anaemia, thrombotic thrombocytopenic purpura, seizures, lupus headache and organic brain syndrome) and immunological (a-dsDNA and a-Sm antibodies, hypocomplementaemia) involvement than did aSLE, except for secondary Sjögren's syndrome, a-Ro antibodies, fibromyalgia and osteoporosis. jSLE also showed more SLE family history, longer diagnosis delay, higher SLEDAI and Katz scores, but lower Charlson scores than aSLE. Several specific domains were more frequently involved in SLICC/ACR DI in jSLE. jSLE patients more frequently underwent all SLE-related treatment and procedures, as well as dialysis and kidney transplantations.jSLE shares many clinical and serological features with aSLE. However, jSLE patients typically manifested more activity, severity, cumulative damage in certain areas, than their aSLE counterparts.

Resumen El lupus eritematoso sistemico es el paradigma del sindrome o “enfermedad” autoinmune sistemica, cuya etiologia esta lejos de ser aclarada, aunque el conocimiento de su patogenia avanza inexorablemente, como el de los secretos mas ocultos del funcionamiento del sistema inmune. Es mucho mas frecuente en mujeres (10:1), y suele presentarse entre la adolescencia tardia y los 50 anos. Tambien es mas frecuente y grave en algunos grupos etnicos, en especial afroamericanos e hispanos. El caracter cronico, con episodios de activacion o brotes, la presencia de numerosos autoanticuerpos en suero, la gran variabilidad clinica y la respuesta al tratamiento inmunosupresor son muestra de su naturaleza autoinmune. Indudablemente, fruto de nuestro desconocimiento, la aproximacion diagnostica y terapeutica actual puede considerarse rudimentaria, y susceptible de sufrir sustanciales cambios en un futuro proximo. Con todas estas sombras planeando sobre el conocimiento, esta actualizacion pretende mostrar los conceptos clasicos, junto a los mas recientes, dejando algunos caminos abiertos por los que ya se ha empezado a avanzar.

Objective: This study aimed to investigate the effectiveness and safety of single and repeated courses of rituximab in patients with refractory lupus. Methods: LESIMAB is a multicenter, retrospective, longitudinal study of lupus patients who have not responded to standard therapy and have been treated with rituximab. Response rates at six months and at follow-up were defined as efficacy outcomes. Complete response was defined as a SELENA-SLEDAI score ≤ two and a SELENA-SLEDAI Flare Index of zero. Partial response was defined as a reduction in the SELENA-SLEDAI score of ≥four points with no new or worsening of symptoms. Adverse events were collected. Results: Seventy-three (62.9%) of 116 patients achieved a response at six months (complete in 22 and partial in 51). Ninety-seven (77.6%) of 128 patients achieved a response after a mean follow-up of 20.0 ± 15.2 months (complete in 50 and partial in 47). High baseline SLEDAI score, previous treatment with ≥100 mg/day prednisone, and no history of severe hematologic flare were associated with response after the first treatment course. The median time to response was 6.5 months (95% CI, 5.0–8.0). Thirty-seven patients (38.1%) relapsed after the first infusion. The flare was severe in seven cases and mild to moderate in 29 cases. Serious infection rate was 12.6/100 patient-years. A schedule of four weekly doses was associated with more serious infections. Six patients died: two of infection and four of lupus complications. Conclusion: Rituximab can be an effective treatment option for patients who have refractory lupus with severe or life-threatening disease with an acceptable tolerance profile.

Rheumatoid arthritis (RA) is characterized by high cardiovascular (CV) mortality, which has been related to systemic inflammation. Our aim was to analyze coronary calcification by computed tomography and subclinical myocardial dysfunction evaluated by brain natriuretic peptide (BNP) levels and an electrocardiogram in RA patients and its relationship with disease characteristics. Seventy-three RA patients and same number of controls formed by osteoarthritis patients were studied, all without a background of cardiovascular clinical events. RA patients had a higher calcium score than the control group (19.2% vs. 11%; p=0.17)), this being associated with disease duration. BNP levels (90.0 vs. 45.4; p=0.003), corrected QT length, large QT frequency and silent myocardial infarct were higher in the RA group. In conclusion, RA patients showed more coronary calcification frequency than in general population and more biochemical and electrocardiogram myocardial subclinical dysfunction signs.

espanolEl dolor abdominal en el lupus eritematoso sistemico (LES) es un sintoma frecuente. El 40% de los pacientes lo presentara durante el transcurso de la enfermedad, aunque tambien puede ser una manifestacion inicial de una enfermedad no diagnosticada. El origen del dolor es diverso, ya que puede ser similar al de la poblacion general o producto de la actividad del propio LES o de una enfermedad concomitante. Como parte del abordaje inicial, se debe descartar la necesidad de cirugia urgente; en caso contrario, se ha de realizar un estudio completo, incluyendo anamnesis con examen fisico, pruebas de laboratorio, reactantes de fase y parametros de actividad del LES y estudio de imagen segun sospecha. Se debe mantener un alto indice de sospecha para infeccion y neoplasia, e instaurar un tratamiento inmunosupresor una vez descartadas estas posibilidades. EnglishAbdominal pain in systemic lupus erythematosus (SLE) is a common symptom. Forty percent of patients will present with abdominal pain during the course of the disease, although it may also be an initial manifestation of undiagnosed disease. The origin of the pain is diverse, as it can be similar to that of the general population or be the result of activity specific to SLE or a concomitant disease. As part of the initial approach, the need for urgent surgery should be ruled out; otherwise, a complete work-up should be undertaken, including clinical history taking with physical examination, laboratory tests, phase reactants and SLE activity parameters, and imaging on suspicion. A high index of suspicion should be kept for infection and neoplasia, and immunosuppressive treatment instituted once these possibilities have been discounted.