Objective. Adult-onset Still's disease (AOSD) is frequently refractory to standard therapy. Tocilizumab (TCZ) has demonstrated efficacy in single cases and in small series of patients with AOSD. The aim of this multicenter study was to assess the efficacy of TCZ in patients with AOSD refractory to conventional treatment.Methods. This was a retrospective open-label study of TCZ treatment in 34 patients with AOSD who had experienced an inadequate response to corticosteroids and at least 1 standard synthetic immunosuppressive drug and also, in many cases, biologic agents.Results. The mean ؎ SD age of the patients (8 men and 26

Background Adult-onset Still’s disease (AOSD) is often refractory to standard immunosuppressive therapy. Tocilizumab (TCZ) has shown efficacy in isolated cases or in small series. Objectives We assess the efficacy of TCZ in AOSD. Methods Multicenter study of 27 patients with AOSD of 18 hospitals diagnosed according to Yamagouchi’s criteria (J Rheumatol 1992;19:424). TCZ was used due to lack of good response to standard therapy or to other biologic agents. Results The 27 patients (20 women/ 7 men), had a mean age of 37.2±15.9 (range 16-71) and an average duration of AOSD of 5.9±4.6 years (range 0.1-17) to onset of TCZ. Prior to the onset of TCZ and besides corticosteroids, patients had recived the following drugs: Metotrexate (26 patients), Anakinra (12), Etanercept (6), Adalimumab (5) and Infliximab (3). TCZ standard dose was 8 mg/k/iv/4 weeks. At TCZ onset, the most frequent clinical manifestations were joint (27 cases), cutaneous (14) and fever (18), along with analytical abnomalities, increase of ESR or CRP (20 cases), anemia (11) or leukocytosis (15). Clinical and analytical improvement was observed soon, 1st month after the onset of TCZ therapy (TABLE). After a mean follow-up of 20.8±12 months, cutaneous manifestations disappeared in 13 of 14 patients (92,9%), fever in 17 of 18 (94.4%) and joint manifestation in 22 of 27 (81,5%). Improvement of analytical abnormalities was observed in most cases with normalization of the blood cell count in 9 of 15 (60%) patients, anemia in 11 of 11 (100%), ESR in 15 of 19 (78.9 % ), CRP in 17 of 20 (85%), hepatic enzymes (AST/ALT) in 3 of 4 (50 %) and ferritin seric levels in 11 of 13 (84,6%). The median [IQR] dose of steroids was reduced from 15 [8.8-25] to 5 [1.3-7.5]. Conclusions In refractory AOSD, TCZ yields early and maintained clinical-analytical response, even in refractory cases to other biological agents. Although TCZ showed global efficacy, joint are more refractory than other systemic manifestations. Disclosure of Interest None Declared

BackgroundAt the end of 2011 we established a protocol in dose reduction of biological therapy in patients with imflammatory diseases. Those who achieved remission by clinical and laboratory tests and showed no radiographic progression or Doppler activity by ultrasound examination, received reduction of dosing. Patients with etanercept (ETN) reduced dose to 25 mg, and patients with adalimumab (ADA) increased injection interval to 3 weeks. Tocilizumab (TCZ) was tapered from 8 to 6 mg/kg. We have achieved optimization rates of 20% in 2012, close to 40% at the end of 2013.ObjectivesThe aim of this study is to take account of activity flares in optimized patients and their characteristics, in order to describe predictive factors of flare if possible.MethodsRetrospective analysis data from clinical records and database of 105 patients treated with ETN, ADA and TCZ, optimized from January 2012 to June 2013 considering lab tests (ESR, RCP), disease activity (DAS 28, BASDAI),functional capacity indexes (HAQ, BASFI), and GPE (general patient evaluation), at optimization, 6 and 12 months visits. We used SPSS 21.0 for statistical analysis.ResultsTable 1ParameterBasal6 months12 monthsESR12,5 (2–64)16,3 (1–52)17,20 (1–78)RCP0,23 (0,02–1,3)0,43 (0,1–1,4)0,30 (0,1–2,06)DAS282,04 (0,11–4,03)2,51 (1,13–4,88)2,38 (0,56–4,17)HAQ0,5 (0–2)0,5 (0–2)0,5 (0–2)BASDAI1,45 (0–4,2)2,37 (0–4,3)2,480 (0,5–6,4)BASFI1,85 (0–9)2,9 (0–9,5)2,67 (0–9,6)EGP21,03 (0–100)27,07 (0–100)21,83 (0–80)105 patients (53 female and 52 male), 31% rheumatoid arthritis (RA), 27,5% ankylosing spondylitis (AS), 37,7% psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with longstanding disease, (150 months (18-638)). All of them were considered to keep remission by second visit, but at 12 months 32% were diagnosed of flare (24,5% under ADA and 39,2% under ETN; none with TCZ). Patients who flared were RA (30%), AS (29%), PA (37%) and one JIA. Half of the patients with RA, 27,6% of AS and 21,6% of PA. Clinical response was good to increasing of DMARD dosing in 25% and to increasing of biological dosing in 68,7%, but 3 patients (9,3%) required switching to another biological drug.We applied an univariate regression logistic model using parameters at visit 2, and we found modestly risk of flare related with ESR, DAS 28, number of swelling and tender joints. An increase of one tender joint at visit 2 means OR 3,56 (95% CI: 1,28-9,91), increase of one swelling joint means OR 11,26 (95% CI: 2,23-43,23). Increase of DAS 28 over 0,6 means OR 8 (95% CI: 1,85-34,6), and an increase over 1,2 means OR 60 (95% CI: 6,41-561,96).Conclusions1/3 of patients suffered flares of disease activity, mostly happened in RA patients, most of them in the ETN group (not statistically significant). Patients who flared had increased DAS 28 at visit 2, but were considered at clinical remission then. Response to increasing in treatment dosing is usually good. We consider optimization as cost-effective practice among biological treated population. We need wider popula...

BackgroundOsteoporosis (OP) in male under 70 years is less common than postmenopausal and senile OP, but causes important social and health costs associated with morbidity and mortality from fractures. It's common in patients with inflammatory rheumatic diseases, enteric and endocrine diseases, also in COPD patients and in those undergoing chronic corticosteroid therapy.Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is done when one or more low energy mechanism fractures have already occurred (failure in early detection).Bone Metabolism Unit at Basurto University Hospital values from years ago male patients referred from different specialties with suspected OP.ObjectivesTo describe main demographic and clinical characteristics of men aged 70 years or less, visited in our monographic OP consultation, with previous to 2013 protocols established with Primary Care (PC) and rheumatology (derivation according to risk factors).MethodsRetrospective descriptive study based on a review of medical records and database of these patients. We analyze origin of derivation, risk factors, presence of fractures at moment of diagnosis, primary diagnoses and occurrence of refractures.The analysis was performed using statistical system SPSSv22.Results127 patients, mean aged 58.17 years (18–70), up to 74% of the total derived from PC (47), and general rheumatology (47); 10 patients (7.9%) from traumatology; 8 from endocrinology (6.3%); 7 from gastroenterology (5.5%).55.9% were smokers or former smokers, 22% kept drinking habit. 19.7% had received prednisone doses ≥7.5 mg for more than 3 months.9 patients had family history of fracture (6.3%), and 46 themselves presented with one or more fractures (36.2%): 36 with one or more vertebral fractures, 4 hip fracture and 12 wrist fracture. 64 patients were diagnosed of OP with treatment indication by bone agent.61% have secondary OP, the main cause (19%) enteric disorders (malabsorption syndromes and inflammatory bowel disease); 13% endocrine disorders and rheumatic inflammatory diseases by 13%. No primary cause was found in 39% of cases.The presence of fractures was associated with decreased DXA lumbar spine (p=0.027) and DXA hip (p=0.004). A very weak correlation between higher fracture FRAX and number of risk factors was detected, on the other hand a moderate correlation was observed with the number of fractures (Spearman Rho =0.472; p<0.001). So does to the hip FRAX (Spearman Rho =0.417; p<0.001).Of the 46 patients with previous fractures, only 12 (26%) had received prior treatment with bone agent. Only 5 patients suffered refracture after starting treatment and during follow-up (94.06 months) (25–129).ConclusionsAlmost 1/3 of men were referred for fractures caused by low energy impact, what means a late diagnose of male OP.It's important to establish protocols with other medical specialties for men at risk to be identified and referred, in order to make an early diagnose.It highlights the lack of patients derived from pneumologists, although vertebral fractures...

BackgroundAortitis is a several and potentially lethal clinical condition. It is usually oligosymptomatic or may present with non-specific symptoms that complicate and delay the diagnosis. On the other hand, treatment of aortitis is not established.ObjectivesThe objetive of this study is to describe clinical manifestations, laboratory studies and treatment of patients with aortitis in a single center.MethodsWe have reviewed the medical records of patients who had positive Positron Emission Tomography (PET) for aortitis fron January 2013 to December 2015 in the Rheumatology Department of a University Hospital. We included 13 cases and we recorded epidemiological, clinical data, laboratory results, treatment and evolution.Quantitative variable results were expressed as mean±standard deviation (SD) or median (interquatile range-IQR). Qualitative variable results were expressed as percentage. The analysis was performed with the SAS System for Windows V 9.2.ResultsIn the last 3 years 13 cases of aortitis were diagnosed (3 in 2013, 3 in 2014 and 7 in 2015). The male to female ratio was 3/10. Mean age±SD was 72.23±12.36 years [range, 51–83]. The underlying conditions were: giant cell arteritis (GCA) (n=7), polymyalgia rheumatica (PmR) (n=2), idiopathic (n=2), relapsing polychondritis (n=1) and Sjögren syndrome (n=1). The median interval between the diagnosis of the underline disease and the aortitis was 7 months [1–20].The most common manifestations were constitutional syndrome (n=5), inflammatory back pain (n=4), pain irradiated to lower limbs (n=4), atypical polymyalgia (n=1) and fever (n=1).All patients exhibited increased acute phase reactants except for the two patients with idiopathic aortitis. Erythrocyte sedimentation rate (ESR) mean was 62±33.84 mm/1st hour and C Reactive Protein (CRP) median level mas 3.3 [2.91–5.13] mg/dl. Five patients presented anaemia.At the time of diagnosis, 9 patients were receiving prednisone (mean dose, 18.89±19.3 mg/day), 4 were with methotrexate (MTX) (mean dose, 15±5.77 mg/week) and the remaining 3 were not receiving any drug.Treatment of aortitis was based on the onset or increase in prednisone dose (mean dose, 34.17±9.73 mg/day) in all cases except for one patient who needed surgery for aortic aneurysm. MTX was initiated in 5 patients and its dose was increased in 4 more (mean maximum dose, 14.72±6.43 mg/week). Three patients were treated with methilprednisolone i.v. (0.5 g/day, 3 consecutive days). Tocilizumab (TCZ) was added to therapy in 2 cases due to refractory disease.In the first visit, two to four months later, the ESR mean was 25.92±24.88mm/1st hour and CRP median was 0.32 [0.16–1.11] mg/dl. In successive clinical controls, after a mean follow-up of 10±4.32 months, clinical and laboratory improvement was maintained.Four patients had a new PET-TAC control 6–16 months later, 3 of them presented complete remission and another one partial remission.ConclusionsAccording to our data, clinical and laboratory data are often nonspecific in aortitis. The increase in the diagnosis c...