Teresa Clavaguera

Estudio VARIAR: VAloración de la eficacia y seguridad a corto plazo en artritis reumatoide del uso de RItuximab comparado con Antagonistas del factor de necrosis tumoral alfa en segunda línea terapéutica en pacientes con artritis reumatoide Refractarios a un primer antagonista del factor de necrosis tumoral alfa

OBJECTIVE to compare the short-term efficacy and safety of rituximab (RTX) therapy versus anti-TNF in rheumatoid arthritis (RA) patients after discontinuation of a first anti-TNF agent. METHODS prospective observational multicenter study in the clinical practice setting, involving patients with severe RA refractory to a first anti-TNF agent, who received either RTX or a second anti-TNF (2TNF), comparing the efficacy endpoints, EULAR response (Good/Moderate) and safety at 6 months. RESULTS 103 patients enrolled, 82 completed 6-month follow-up, 73.7% women. Baseline data for RTX and 2TNF groups, respectively: TJC, 8.6 and 6.6; SJC, 8.8 and 7.5; DAS28 score, 5.45 (±1.28) and 5.18 (±1.21) (p=0.048), ESR, 41 and 38.7mmHg; and HAQ, 1.2 and 1.0. Improvement was observed in all parameters, with no significant differences (except for a more marked reduction in ESR with RTX). There were no serious adverse events. CONCLUSIONS RTX use as second-line therapy after anti-TNF failure led to improvements in the efficacy and functional variables at 6 months, with no serious adverse events. These results were comparable to those observed in patients who used a second anti-TNF agent in the same clinical scenario.

Retraso diagnóstico y terapéutico de la artritis reumatoide y su relación con dispositivos asistenciales en Catalunya. Estudio AUDIT

OBJECTIVE Diagnosis and therapy of patients with early onset rheumatoid arthritis (RA) is influenced by accessibility to specialized care devices. We attempted to analyze the impact of their availability. METHODS We analyzed time related to diagnosis delay measuring: 1) Time from first clinical symptoms to the first visit with the Rheumatologist; 2) Time from referral to the first visit of Rheumatology; 3) Time between first symptom until final diagnosis; 4) time between first symptom until the initiation of the first disease-modifying antirheumatic drug (DMARD). The presence of these 6 rheumatology devices was defined: 1) early arthritis monographic clinics, 2) RA monographic clinics, 3) Mechanisms for fast programming, 4) Algorithms for referral from primary care (PC), 5) rheumatology consultation services in PC and 6) consulting services in PC. RESULTS The mean time from onset of symptoms to diagnosis or the establishment of a DMARD in RA patients in Catalonia is very long (11 months). Patients seen in rheumatology devices such as RA monographic clinics, rheumatology consultation in PC and specially in early arthritis clinics are treated early with DMARDs. CONCLUSION the existence of monographic clinics or consulting in primary care centers is essential to improve early care of RA patients.

Artritis mutilante/resortiva. Estudio de 24 pacientes de una serie de 360 artritis psoriásicas

OBJECTIVE To describe a large series of patients with mutilans/resorptive arthritis (AM) of a representative population of patients with psoriatic arthritis (PsA) and analyze the associated variables. METHODS Multicenter cross-sectional study of consecutive patients affected by PsA in 8 centers. In patients with swelling or deformity of the hands or feet we performed an anteroposterior rx. The patient was affected by AM if erosive disorder affecting both articular surfaces completely was present. RESULTS Of the 360 patients studied, 24 had PsA and AM (6.7%). The duration of their disease was significantly higher, and they exhibited a worse functional capacity as well as more DIP joint affection (P<.05). 30% had radiological changes indistinguishable from nodular osteoarthritis. CONCLUSIONS AM in PA is associated with a worse functional capacity. Its possible association with nodular hand osteoarthritis deserves further study.

AB1361 Diagnostic and therapeutic delay of rheumathoid artritis patients in catalonia (spain) and their relationship with specialized healthcare units. The audit study

Background The diagnosis and therapeutic approach to early onset rheumatoid arthritis (RA) patients may be influenced by their access to specialized healthcare units. Objectives To assess diagnostic and therapeutic delays in RA in Catalonia (Spain) and their relationship with patient’s access to specialized healthcare units. Methods We carried out a cross-sectional epidemiological survey in 19 Catalonian Rheumatology Centres. Ten consecutive patients newly diagnosed with RA (according to physician criteria) during 2009 and 2010 were recruited from each centre. Together with demographic and clinical variables, several parameters related to diagnostic delay were recorded: 1) Time from first symptom to first rheumatologist appointment, 2) Referral time from General Practitioner (GP) evaluation to first rheumatologist appointment, 3) Time from first symptom onset to final RA diagnosis, 4) Time from first symptom to first DMARD started. The presence/absence of specialized healthcare units was evaluated in all centres: 1) Early arthritis units (EAU), 2) RA Units (RAU), 3) Rapid/preferential programming for RA, 4) Referral algorithms from GPs 5) Primary care (PC) rheumatology units (RUPC) and 6) Primary care rheumatology advisory programme (RAPPC). Results 183 patients (51M/132F) were included. Mean age 52.7±14 years, mean disease duration 27.3±20 months. Mean delays from the first symptom were; to first rheumatology appointment 10.2±12.7 months, to final RA diagnosis 11.3±13.2 months, and first DMARD 11.1±12.8 months. 34.4% of patients had access to an EAU, 37.2% to an RA unit, 66.1% were evaluated through rapid appointment programming and 31.1% through GP referral algorithms. RUPC and RAPPC were available for 61.7% and 31.7% of patients, respectively. Time from first symptom to first DMARD was associated with EAU (8.4±10.5 vs 12.6±13.7 without EAU, p=0.015) and there was a trend to significance for PC rheumatology units (9.1±10.3 vs. 12.1±13.7, p=0.056), but there was no association with RA units, rapid appointment programming, PC rheumatology advisory or referral algorithms from GP. EAU were associated with a shorter delay from first symptom to first rheumatology appointment (7.5±10 vs. 11.6±13.7; p=0.016) and to the final RA diagnosis (8.8±11.4 vs 12.6±13.7; p=0.046). RUPC and RAPPC were associated with a shorter time between both first symptom and first GP evaluation and time to final RA diagnosis. Preferential appointment programming and referral algorithms from GP were not associated with significant differences in delays. Conclusions The mean delay from symptom onset to RA diagnosis or initiation of the first DMARD in Catalonia was 11 months. Patient’s access to specialized units, especially early arthritis units, can improve early diagnosis and treatment of RA. Disclosure of Interest None Declared

SAT0241 Is there any nailfold capillaroscopic pattern in patients with primary sjögren’s syndrome with or without raynaud’s phenomenon and/or positive anti-RO/anti-LA?

Background Nailfold capillaroscopy (NC) is a noninvasive technique that allows to scan the microcirculation. Tortuosities and isolated hemorrhages have been described in the NC of patients with primary Sjögren’s syndrome (PSS). In patients with Raynaud’s phenomenon (RP) associated with PSS decreased capillary density, greater presence of hemorrhage, enlarged loops and even megacapillaries have been reported. Objectives 1) To identify specific findings in patients with PSS defined according to the American-European criteria of 2002. 2) To assess capillaroscopic differences in patients with PSS with or without RP. 3) To analise if the positive of anti-Ro and/or anti-La confers a distinct profile in capillaroscopy pattern. 4) To describe whether patients with labial biopsy findings characteristic of PSS have differentiated features in microvascular examination. Methods The multicenter NC group of the Catalan Rheumatology Society (CapiCAT group), conducted 150 NC in patients with Sjögren’s syndrome, 136 of them were diagnosed of PSS. Mean age was 57.6 years (±12.7), 130 (96%) were women. The mean time since PSS diagnosis was 7.9 years (±6.7). Demographic variables, presence of RP, symptoms of PSS, ANA, reumathoid factor, anti-Ro, anti-La, anti-CCP, salivary scintigraphy, labial biopsy, treatment and outcome of NC according to CapiCAT group consensus (capillary density, capillary length, tortuosities, capillary diameter - including enlarges loops and megacapilaries -, branching, capillary organisation, pericapillary hemorrhages, capillary thrombosis, areas of capillary loss, subpapillary venous plexus and capillaroscopic pattern) were collected. Results RP was present in 32% of PSS, keratoconjunctivitis sicca in 91% (125/136) of patients (p<0.001), oral xerosis in 93% (127/136), skin or genital xerosis in 53% (72/136). Extraglandular involvement (arthritis, pneumonitis, blood disorders, peripheral neuropathy or CNS involvement) was associated in 47% (65/136). 75% of PSS were anti-Ro + (102/136) and 40% (54/136) anti-La +. In patients with positive anti-Ro and/or anti-La NC was normal in 53% of cases and nonspecific in 36% (p NS). Lip biopsy was characteristic of PSS in 45/50 lip biopsies. There were no difference in the findings of NC. NC in patients with PSS were normal in 51% of cases and nonspecific in 34%. Scleroderma pattern was reported in 14 patients. RP associated with PSS had nonspecific capillaroscopy in 40% of cases (p=0.1). The amount of pericapillary hemorrhages (p=0.06) and capillary thrombosis (p=0.2) were not increased in our patients, but more enlarged loops were detected in 48% (18/37) of cases. Conclusions 1) Patients with positive anti-Ro and/or anti-La have not a distinct profile in capillaroscopy pattern. 2) Patients with labial biopsy findings characteristic of PSS have not differential features in microvascular examination. 3) In our sample, patients with RP associated with PSS had more enlarged loops, but neither pericapillary hemorrhagesnor capillary thrombosis were observed, as reported in the literature. Disclosure of Interest None Declared

AB0611 Leflunomide in rheumatoid arthritis: Efficacy and safety analysis. Loading dose assessment

Background Leflunomide (LFN) is used as a DMARD in the treatment of rheumatoid arthritis (RA). The consensus of using loading dose (LD) has not yet been established and it has only been analysed in scarce studies. Objectives To assess efficacy and safety of patients who were treated with LFN because of RA. We also analyse the effect of the LD and if treatment with prior DMARD changed the clinical response. Methods We conducted an observational post-authorization, prospective, multicentre study under condition of daily clinical practice in patients with active RA receiving LFN. Our patients were recruited from June 2009 to September 2010 from 5 outpatients’ rheumatology services in Girona (Spain). Inclusion criteria were: age >18 years, diagnosis of RA based on ACR 1987 criteria, active RA (DAS 28 ≥3.2) and indication of treatment according to the consensus of Spanish Society. Exclusion criteria: specific contraindications of LFN, failure to a correct follow-up, pre-treatment with LFN or biological therapy. Study variables were: 1) dependent variables: efficacy (DAS 28 and EULAR response criteria), safety (variable drop-outs and side effects), 2) independent variables: age, sex, RF, ACPA, LD, disease associated variables, previous therapies and laboratory data. Assessment was performed at 4, 8, 12 and 24 weeks. Data evaluation and statistical analysis (SPSS-18.0 software package): 1) Univariate analysis: frequencies and main statistical. 2) Bivariate descriptive analysis using χ2 test, Fisher’s exact test and t-Student with a significance level of 5%. Results 76 patients were included. 64 (84.2%) were women. The mean age was: 54 yrs. (range 29-80). 37 (48.9%) received LD (100mg/day for 3 days). 30 (39.5%) hadn’t received any DMARD prior to LFN but 38 (50%) had been previously treated with MTX. Population characteristics (median [range]) were: mean duration of disease 24 months (4-420m.), 24 (31.6%) had erosions, 40 (52.6%) RF+, 39 (51,%) ACPA +, TJC 7 (1-25), SJC 5 (0-19), patient VAS 60 (10-100), ESR 25.5 mm/1st h (1-66), CRP 6.40 (0-50)mg/L, DAS 28 5.21 (3,22-6,79) and HAQ 1,125 (0 to 2.750). Remission rate at 24 week (DAS 28 <1.6): 22.8%, LDAs 28 (DAS <3.2): 7.01%. According to the EULAR response criteria, our results were: 16 patients (28%) none, 25 (43.9%) moderate and 16 (28%) good response. Our dropout rate was 18.4% (4.1% to 4.1% lack of efficacy and side effects,respectively). In bivariate analysis, we didn’t find any significant difference in efficacy nor safety between patients receiving or not LD. Furthermore, we didn’t also observe a faster effect in LD group. Finally, there were no differences between patients who LFN was the first DMARD used and those who received a prior therapy with MTX. Conclusions Our results do not greatly differ from those reported in the literature. Loading dose has no advantages in RA patients treated with LFN. These results had not been influenced by a prior therapy with MTX. Although, studies with a greater sample size were needed, probably, the use of the LD should be definitely excluded from the guidelines and consensus of RA therapy. Disclosure of Interest None Declared