A. Secco

General characteristics of an early arthritis cohort in Argentina

OBJECTIVE The aim of the present study is to describe the general characteristics of a cohort of patients with early arthritis in Argentina. METHODS CONAART (Consorcio Argentino de Artritis Temprana--Argentine Consortium for Early Arthritis) is an initiative of seven rheumatology centres across Argentina. Patients were included if they had at least one or more swollen joints and <2 years of disease duration. Social, demographic, familiar, hereditary, clinical and laboratory data were recollected. At first visit and every year, X-rays of hands and feet were performed and working characteristics and pharmaco-economic data were re-collected. RESULTS A total of 413 patients were included. Of them, 327 (79.2%) were women with a median age of 49 years and a median disease duration of 6 months. Of the total, 183 (44.3%) had RA (ACR 1987) and 167 (40.4%) undifferentiated arthritis (UA). Other diagnoses included: 12 crystalics, 11 PsA, 6 uSpA, 6 other CTD, 1 AS and 27 other diagnosis. As 85% of our population had RA and UA, we only compared these two groups of patients. Patients with RA had significantly worse activity parameters of the disease (DAS of 28 joints), functional capacity (HAQ) and quality of life (Rheumatoid Arthritis Quality of Life) than patients with UA. The frequency of RF and anti-CCP, and symmetrical distribution were also significantly higher in patients with RA compared with UA patients. All patients with RA initiated early specific treatment, in a period no longer than 6 months from the beginning of the disease. CONCLUSION Early arthritis clinics are a useful tool to identify and treat patients with different forms of joint involvement.

Trasplante cardíaco en una paciente joven con diagnóstico de esclerosis sistémica difusa

Systemic sclerosis (SS) in a multifactorial and systemic, chronic, autoimmune disease that affects the connective tissue. We present this clinical case given the low prevalence of diffuse SS with early and progressive cardiac compromise in a young patient, and treatment with cardiac transplantation.

Utilidad de los anticuerpos y de la biopsia de glándula salival menor en el estudio del complejo sicca en la práctica diaria

OBJECTIVES To assess the association between histologic findings in the minor salivary gland biopsy (MSGB) and anti La (La/SS-B)y antiRo antibodies (Ro/SS-A), antinuclear antibodies (ANA) and Rheumatoid Factor (RF),and compare the value of the latter as diagnostic tests with MSGB, considered as the gold standard. MATERIAL AND METHOD Patients with suspected Primary Sjögren Syndrome (PSS) referred for MSGB were included. Antibody measurements were performed. Grade III and IV biopsy results were considered positive. RESULTS Two hundred and eighteen (218) patients were included, 95% females, with a median age of 54 years and 12 months median duration of sicca symptoms. 36 of the biopsies were positive. 33% of patients had positive anti Ro/SS-A anti La/SS-B antibodies, 62% had positive ANA, and 31% positive RF. A statistically significant association was found between MSGB and anti Ro/SS-A anti La/SS-B, ANA and RF. ANA were the most sensitive antibodies (84%. 95% CI: 75- 92), and the most specific were: Anti Ro/ SS-A and/or anti La/ SS-B (78%. 95% CI: 71-85) and RF (78%. 95% CI: 69-87). CONCLUSION On PSS clinical suspicion, anti Ro/ SS-A y anti La/ SS-B antibodies have a great value to achieve the diagnosis, with MSGB useful for diagnosis of seronegative patients. The results also suggest the importance of ANA and RF for PSS classification.

Factores asociados a remisión sostenida en pacientes con artritis reumatoide

OBJECTIVE To find out the factors that are associated with sustained remission measured by DAS28 and boolean ACR EULAR 2011 criteria at the time of diagnosis of rheumatoid arthritis. MATERIALS AND METHODS Medical records of patients with rheumatoid arthritis in sustained remission according to DAS28 were reviewed. They were compared with patients who did not achieved values of DAS28<2.6 in any visit during the first 3 years after diagnosis. We also evaluated if patients achieved the boolean ACR/EULAR criteria. Variables analyzed: sex, age, smoking, comorbidities, rheumatoid factor, anti-CCP, ESR, CRP, erosions, HAQ, DAS28, extra-articular manifestations, time to initiation of treatment, involvement of large joints, number of tender joints, number of swollen joints, pharmacological treatment. RESULTS Forty five patients that achieved sustained remission were compared with 44 controls. The variables present at diagnosis that significantly were associated with remission by DAS28 were: lower values of DAS28, HAQ, ESR, NTJ, NSJ, negative CRP, absence of erosions, male sex and absence of involvement of large joints. Only 24.71% achieved the boolean criteria. The variables associated with sustained remission by these criteria were: lower values of DAS28, HAQ, ESR, number of tender joints and number of swollen joints, negative CRP and absence of erosions. CONCLUSION The factors associated with sustained remission were the lower baseline disease activity, the low degree of functional disability and lower joint involvement. We consider it important to recognize these factors to optimize treatment.

AB0993 Depressive Symptoms in Patients Consulting for The First Time A Rheumatology Service

Background Depression can easily go unnoticed in routine clinical care. The delay in the diagnosis may increase the risk of chronicity, the number of visits, health care costs and deteriorates the quality of life.1–3 Objectives Estimate the prevalence of depressive symptoms in patients consulting for the first time and determine if patients with depression had different reasons for consultation and highest score in the visual analog scale (VAS) of pain than patients without depression. Methods A observational, prospective study was performed. We included patients who consulted for the first time in Rheumatology Service, excluding these with psychiatric treatments and rheumatic diseases. The PHQ-9 (Patient Health Questionnaire) evaluated the presence of depressive symptoms in the last two weeks. According to the score, they were classified in 4 categories: (1) major depressive syndrome, (2) other depressive disorders, (3) positive depressive symptoms and (4) negative depressive symptoms. To perform the analysis the patients were divided into those with a depressive disorder (1 and 2) and those who did not have it (3 and 4). T-test or Mann Whitney test was used as sample size distribution for continuous variables. Chi square or Fisher exact test was used as expected frequency distribution table for categorical variables. Multivariate logistic regression analysis taking depression as the dependent variable was performed. Results 121 patients were included in the study. 86% were women, mean age of 49±15 years. The most frequent reasons for consultations were polyarthralgia (35.5%) and back pain (13%). According PHQ-9, 37% of patients were classified in major depressive syndrome and 19% in other depressive disorders. No statistically significant differences between patients with and without a depressive disorder in terms of different reasons were found. However, patients with depressive disorders were more VAS pain (7, IQR 5–8) than patients without depression (5, IQR 4–6) and more days with pain in the week (7, IQR 5–7 vs 5, IQR 3–7), both with p<0.01. Increased frequency of self-medication (61% vs 39%) and sleep disorders (63% vs 37%) among patients with depressive disorders was observed, although these differences were not statistically significant. In the multivariate analysis, the only variable that was found associated with depression was independently VAS pain (OR 1.33, CI 1.13–1.56). Conclusions High percentage of patients had a depressive disorder with higher frequency and pain perception. So rheumatologists should be aware of this problem in order to make a proper diagnosis, optimize the application of complementary studies, and perform a multidisciplinary approach to the patient. References Sylvia Arias, Victoria Fonsalía, Nicolás Asteggiante, Verόnica Bartesaghi. Enfermedades autoinmunitarias sistémicas y trastornos depresivos. Reumatología Clínica, Volume 7, Issue 6, Pages 389–391. Artiles-Péreza R, Lόpez-Chamόnb S. Síntomas somáticos de la depresiόn. SEMERGEN. 2009;35 supl 1:39–42. Lόpez Chamόn S. Manifestaciones clínicas de la depresiόn. Sintomatología: síntomas afectivos, de ansiedad, somáticos, cognitivos y conductuales. SEMERGEN. 2006; 32 Supl. 2:11–5. Disclosure of Interest None declared

AB0523 Cutaneous Manifestations in Primary Sjogren's Syndrome

Background Cutaneous manifestations are one of the most common extraglandular manifestations of Sjogrens syndrome (SS). Entities such as as Annular erythema, Sweet syndrome, erythema nodosum and vasculitis have been described. Vasculitis was reported in approximately 10% of SS patients, with histologically characterized by lymphocytic or leukocytoclastic vasculitis. Objectives Describe cutaneous manifestations in patients with primary SS, registered in the GESSAR (Argentine Study Group for the Sjogren Sydrome) database and determine their association with systemic and laboratory clinical manifestations. Methods Observational, analytical case-control study. Patients aged 18 years and older with a diagnosis of primary SS. Demographic, clinical and serological data about patients included in the GESSAR database was collected, from the moment of joining until June 2015. Cases (patients with cutaneous manifestations) and controls (patients without cutaneous manifestations) were included with a relationship 1:4. Cutaneous manifestations were described. In addition, patients with purple were compared to the rest of the patients included in the study. For the analysis of continuous variables t or Mann Whitney tests were used, according to distribution and sample size. Categorical variables were analyzed using chi-square or Fisher exact test, according to the expected frequency distribution table. Multivariate logistic regression analysis was performed. Results 335 patients were included, 67 with cutaneous manifestations, with an average age of 53 years (SD 15). 95% are female and the average diagnosis age is 47 years (SD 17). In the group of patients who had cutaneous manifestations, 60% had purple, 19% urticaria, 19% petechiae, 16% ulcers, 7% erythema multiforme, 4% erythema nodosum and 9% subcutaneous nodules. No statistically significant differences in age, sex and time of evolution of the disease between the two groups were found. In univariate analysis differences were found in: arthritis (47% vs 31%, p=0.01), neuropathy (21% vs 9%, p<0.01), decrease in C4 levels (34% vs 18%, p<0.01), decrease in C3 levels (25% vs 10%, p<0.01) and positive cryoglobulins (27% vs 9%, p<0.01). In the multivariate analysis no independent association of these variables was found. With respect to purple, significant differences were found with: arthritis (49% vs 31%, p=0.02), neuropathy (9% vs 25%, p<0.01), anemia of chronic disorders (34% vs 17%, p<0.01), decreased C3 (37% vs 10%, p<0.01) decrease in C4 level (49% vs 15%, p<0.01), anti LA (66% vs 47%, p<0.03) and positive cryoglobulins (37% vs 10%, p<0.01). In multivariate analysis, the decrease in C4 levels (OR 4.5; 95% CI 1.6–12.9, p<0.05) and positive cryoglobulins (OR 5.6; 95% CI 1.7–18.6, p<0.05) were independently associated with the presence purple. Conclusions No independent associations were found regarding demographic, clinical and serological characteristics between patients with and without cutaneous manifestations. Purple is the most common cutaneous manifestation. The group of patients with Purple is most often associated with decreased C4 levels and the presence of cryoglobulins. References Pilar Brito-Zer. Evoluciόn y pronόstico del paciente con Síndrome de Sjögren Primario. M Ramos-Casals, Primary Sjögrens syndrome: new clinical and therapeutic concepts. Manuel Ramos-Casals, Roser Solans, MD, Ph, Jose Rosas Primary Sjogren Syndrome. Disclosure of Interest None declared

AB0524 Immunosuppressive Treatment in Patients with Primary SjÖgren Syndrome (PSS)

Background There is not enough evidence either to support the use of immunosuppressive drugs in pSS or for which specific clinical features they would be indicated. Objectives To evaluate the most frequently immunosuppressive drugs prescribed in pSS and to describe the clinical features that determined the indication,in a multicentric cohort of Argentinean patients with pSS. To analyze the clinical characteristics of patients with immunosuppressive therapy in comparison to patients that had not received it. Methods We analyzed subjects with pSS included in the data-base of the Argentine study group for SS (GESSAR). We considered the use of methotrexate, azathioprine, cyclophosphamide, leflunomide, mycophenolate, rituximab, belimumab and/or prednisone (>20mg/day). Results From 431 patients, 72 (16.7%) had received immunosuppressive therapy. Female: 92%; mean age: 59 years; mean time of the disease: 5 years. Immunomodulatory treatment with hydroxychloroquine in 60%. The drugs most frequently used were:prednisone (40.3%), methotrexate (34.7%), azathioprine (23.6%), cyclophosphamide (9.7%), rituximab (5.6%), mycophenolate (4,2%), leflunomide (2.8%), more than one drug (6.9%). The clinical features that determined the indication of therapy were arthritis (50.8%), parotid swelling (28%), purpura (19.7%), peripheral neuropathy (18.3%), pulmonary involvement (13.9%), autoimmune hepatitis (8.33%) and glomerulonephritis (5.1%). When we compared the clinical characteristics of patients with immunosuppressive treatment against patients without treatment, we found differences in age [59.4 vs 53.8; (p<0.01)], disease duration [5 vs 3; (p<0.01)]; low C3 level [27 vs 12,3;(p<0.01)]; arthritis [50,8 vs 29,4;(p<0.01)]; purpura [19.7 vs 5.5;(p<0.01)], pulmonary disease [13.9 vs 6.3;(p:0.02)] and autoimmune hepatitis [62.5 vs 37.5;(p<0.01)]. Multivariate analysis (adjusted for age and years of disease), with immunosuppressive treatment (dependent variable), showed that arthritis (OR:2.8;95%CI:1.5-5; p<0.01), purpura (OR: 4.4; 95%CI: 1.9-10.3; p<0.01) and autoimmune hepatitis (OR: 8.7; 95%CI: 1.9-40.4; p<0.01)] were independently associated with this indication. Conclusions A low number of our patients received treatment with immunosuppressive drugs. The most frequently prescribed drugs were methotrexate and azathioprine. The main clinical features in the immunosuppressant treated group were arthritis, purpura and autoimmune hepatitis. Disclosure of Interest None declared

AB0732 Reliability and Validity of the Duruöz Hand Index in an Argentinian Population with Scleroderma

Background The Duruöz Hand Index (DIH) is a reliable tool for the evaluation of hands function in patients with scleroderma. Objectives The aim of our study was to adapt and to validate the DHI questionnaire in an Argentinian population with scleroderma. Methods For validation, 3 rheumatologists adapted and translated to Spanish the original version in French and the final version was re-translated to French by a bilingual person. To evaluate the construct validity, we used the patient global visual analogue scale (VAS), VAS for questions for the same activity, the health assessment questionnaire (HAQ) and the Rodnan. A subsample attended a second visit to evaluate reproducibility, with no modifications in the treatment in relation to the previous visit. Continuos variables were expressed as mean and standard desviation (SD) or medians with their interquartile range (IQR). Spearmans correlation coefficient was used to quantify the degree of correlation between the different VAS, HAQ and Rodnan with the total score. The intraclass correlation coefficient (ICC) was used to assess reproducibility and Cronbachs alpha to evaluate internal consistency. Results 45 patients diagnosed with scleroderma were included in the study. 84,44% were women, mean age of 51±13,72 years (SD), 48,89% were Mestizos, while 46,67% were Caucasians with a disease duration of 24 months (IQR: 18-60). 64, 44% patients had diagnostic of limited scleroderma; 77, 78% were right handed and 53, 33% had extra cutaneous manifestations. Raynaud was present in 93, 33%, pitting scars in 33, 33% and digital ulcers in 26, 67%. The median score of the total questionnaire was 4, 5 (IQR: 0-26), of the global VAS 49 (IQR: 10-50), of HAQ 0,3 (IQR: 0-1) and of Rodnan 5 (IQR:2-11). The correlation between the total score of DHI and the patient global VAS was 0, 58, with the HAQ was 0, 63 and with Rodnan 0, 08. The correlation coefficient between the VAS and each group of questions for the same activity in the DHI questionnaire, indicated good correlation for the questions that refer to activities of kitchen(0,60;0,71;0,67;0,67;0,59;0,62;0,55), as well as for dressing(0,69;0,65;057), for hygiene (0,61;0,56), and for the office questions (o,56;0,73). There was excellent level of correlation with those related to fine motor activities with a maximun r value of 0, 78. The reproducibility was 0, 88 (CI 95% 0,76-0,99) and the internal consistency according to Cronbachs alpha was 0,98. Conclusions The results from this study show the DHI to be a reliable and valid test for this Argentinian population with scleroderma. References Duruoz MT, Poiraudeau S, Fermanian J, Menkes C, Amor B, Dougados M, et al. Development and validation of a rheumatoid Duruozs Hand Index that assesses functional handicap. J Rheumatol 1996; 23:1167–72. Acknowledgements Janet L. Poole. Disclosure of Interest None declared

AB0610 Value of Ultrasonography Parotid Glands in Patients with Suspected Primary Sjögren's Syndrome

Background Primary Sjögrens syndrome (pSS) is an autoimmune disease, which affects the exocrine glands. The most serious complication is development lymphomas, having a close relationship with the presence of hypocomplementemia, cryoglobulins, parotid swelling and a Minor Salivary Gland Biopsy (MSGB) with III or IV score (Chisholm and Mason Classification). Therefore the evaluation of the salivary glands have both diagnostic and prognostic value in pSS. The MSGB is a minimally invasive procedure, though not without complications. The parotid ultrasonography (US) is a noninvasive, economic, imaging tool, that has been demonstrated to be useful in the diagnosis of patients with suspected pSS. Recent studies that evaluated its utility to replace the Sialography on American-European Criteria or as an additional item in the 2012 American College of Rheumatology Classification Criteria. Objectives Assess the diagnostic value of ultrasonography (US) in those patients underwent minor salivary gland biopsy (MSGB) by suspected Primary Sjögren Syndrome (pSS). Methods All patients underwent bilateral parotid glands US and MSGB. The same expert blinded examiner performed the US. All patients were scanned using an MyLab 25 US scanner (Esaote Italy) with a 10-18 MHz linear-array transducer. The following parameters were assessed: homogeneity, hypoechoic areas, hyperechoic foci, Power Doppler (PD) and margins graded from 0 to 2 (0: well-defined, 1: ill-defined, 2: blurred) and gland size was measured. The gold standard was the MSGB. According to the quantity and type of US variables, we determined the following cut-off values (at least unilateral parotid finding) A: presence of heterogeneity on unilateral or bilateral parotid glands B: presence of any variable (not more than one and excluding heterogeneity) on unilateral or bilateral parotid glands. C: presence of three or more variables (any variable) on unilateral or bilateral parotid glands. Results We included a total of fifty-one biopsies (36 negative and 15 positive). 96.1% were female. According to A cut-off values had 47% sensitivity (S) (CI 33-60), 69% specificity (Sp) (CI 57-82), 39% positive predictive value (PPV) (26-52), 77% Negative Predictive Value (NPV) (CI 64-88) and Positive Likelihood Ratio (LR+) 1.5 (CI 0.7-3.2). B findings showed 33% S (CI 20-46), 86% Sp (CI 77-96), 50% PPV (CI 36-64), 76% NPV (CI 64-87%) amd LR+ 2.4 (CI 0.8-7.1). We observed C findings with a 33% of Sensitivity (CI 20-46), 75% Specificity (CI 63-87), 36% PPV (CI 23-49), 73% NVP (CI 61-85) and LR+ 1.6 (CI 0.7-3.7). Conclusions We considered that B findings are the best cut-off values because it demonstrated greater specificity. Nevertheless, in our study the US of parotid gland not prove to be an appropriate diagnostic tool to replace the MSGB. References Takagi Y, Sumi M. Ultrasonography as an additional item in the American College of Rheumatology classification of Sjögrens syndrome. Rheumatology doi: 10.1093: June 6, 2014. Carotti M, Ciapetti A. Ultrasonography of the salivary glands: the role of grey-scale and colour/power Doppler. Clin Exp Rheumatol 2014; 32 (Suppl. 80): S61-S70. Theander E, Mandl T. Primary Sjögrens Syndrome: Diagnosticand Prognostic Value of Salivary Gland Ultrasonography Using a Simplified Scoring System. Arthritis Care & Research Vol. 66, No. 7, July 2014, pp 1102–1107. Disclosure of Interest None declared

FRI0429 Hypocomplementaemia in A Cohort of Patients with Primary Sjogren's Syndrome (Gessar Registry)

Background the clinical significance of hypocomplementaemia in primary Söjgren Syndrome (SSp) is being studied due to recent studies that associated low complement levels with lymphoma development and mortality. Objectives 1-To determine whether patients with SSp and hypocomplementaemia (C3 and/or C4) at diagnosis have an increased frequency of clinical manifestations (at least one of the following: parotid swelling, arthritis, Raynaud, purple, lung parenchymal involvement, renal impairment, neuropathy and lymphoma) compared with patients with normal complement. 2 - Assess differences between groups having each particular clinical manifestations, laboratory abnormalities and treatment with corticosteroids and immunosuppressants. Methods We evaluated patients diagnosed SSp (all fulfilled the 2002 European American Criteria), using the GESSAR database of those patients with complement determinations at diagnosis. T test or Mann Whitney were used for the analysis of continuous variables and the categorical variables were analyzed by chi-square or Fisher exact test, as appropriate. Multivariate logistic regression analysis was performed. Results 183 patients were taken randomly from 234 patients with complement determinations, 137 with normal complement and 46 with hypocomplementaemia (low C3 and C4 values in 22 patients, low C3 values in 4 and low C4 values in 20). 97.25% were females with a median age of 53.5 (IQR 43-63) and a median follow-up time for 3 years (IQR 1-5). The group with hypocomplementaemia showed a significant higher prevalence of clinical manifestations compared with patients with normal complement (71.74% versus 48.18%, p<0.01). When adjusting for FAN, anti Ro, anti- La and RF this association remained without seeing a confounding effect, or having observed a statistically significant association (OR: 2.73, 95% CI: 1.32-5.63, P<0.01). These manifestations were significantly associated with hypocomplementaemia: arthritis (44.19 vs 20.15%, p<0.01), purple (24.32 vs 5.3%, p<0.01), lung involvement (p<0.01 vs 21.74 6.57), neuropathy (22.22 vs. 9.09%, p: 0.03) and lymphoma (11.76 vs 0%, p=0.02). Conclusions A higher frequency of extraglandular manifestations were found in patients with hypocomplementaemia, with a significant difference between patients with normal complement values. We emphasize that these findings should be considered while revealing the diagnosis of the disease and perform a close clinical follow-up due to the risk of having severe complications. References M. Ramos-Casals et al. Hypocomplementaemia as an immunological marker of morbidity and mortality in patients with primary Sjögrens syndrome. Rheumatology 2005. Brito-Zerόn P et al. Predicting adverse outcomes in primary Sjögrens syndrome: identification of prognostic factors. Rheumatology 2007 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4511