Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. Progress after treatment may include a transitory period of recurrence of the pain.

No abstract

Background:In our population the prevalence of hypovitaminosis D is high. A recent cross-sectional observational study conducted in Spain shows that 63% of postmenopausal women who receive osteoporosis (OP) therapy and 76% who do not receive treatment had 25 (OH) D levels below 30 ng / mL1.The latest studies show a relationship between hypovitaminosis D and the development of systemic inflammatory and tumor diseases, determined by the presence of receptors in various tissues, including breast.Objectives:To determine which levels of serum 25 (OH) D, and secondarily calcium, phosphorus, PTH and CTX, present 200 patients diagnosed with breast cancer and taking hormonal treatment, referred to a monographic OP consultation of a tertiary hospital for the assessment of their bone metabolism, and if these values differ from what is expected for the general population.Methods:Retrospective cross-sectional study of 200 women diagnosed with breast cancer receiving treatment with aromatase inhibitors (AI), performed in a tertiary hospital. Blood levels of vitamin D, calcium, phosphorus, PTH and CTX have been collected, as well as other variables and risk factors.Results:200 patients with a mean age of 64.8 years and an ED of 9.5 were collected. The median is 64.5 (Q1 58 and Q3 72).The vitamin D levels presented by the study patients were <10 ng/mL in 13 patients (6.67%), 11-20 ng/mL in 50 (25.64%), 21-30 ng/mL in 68 (34.87%), 31-70 ng/mL in 62 (31.79%), and> 70 ng/mL in 2 (1.03%). This implies that in 67.18% of the patients they had values below the optimal range.92.31% of patients (180) presented PTH values within the normal range and only 7.69% presented values above normal.The serum calcium and phosphorus levels of the patients selected for the study had ranges within normal (99.49%) except 1 case that presented high values (0.51%) for both.The values of CTX (carboxyterminal telopeptide used as a marker of bone resorption) were in the normal range in 81.96% of patients (159), low values in 0.52% (1) and values above the normal range by 17.53% (34).Conclusion:The prevalence of insufficient levels of vitamin D in our study (Breast cancer + AI) is not greater than that estimated for the general population according to various studies.Our study found that 67.18% of patients (2/3 of the selected population) had values below those considered optimal (<30 ng / mL) and 32% had values <20.Only 7.69% of the patients presented PTH values above the normal range.In 82% of patients, CTX used as a marker of bone resorption had normal values.References:[1]Quesada Gomez JM, Díaz Curiel M, Sosa Henríquez M, Malouf-Sierra J, Nogués-Solan X, Gómez-Alonso C, et al. Low calcium intake and insufficient serum vitamin D status in treated and non-treated postmenopausal osteoporotic women in Spain. J Steroid Biochem Mol Biol. 2013;136:175-7.[2]Jian Sun et al., Vitamin D receptor expression in peripheral blood mononuclear cells is inversely associated with disease activity and inflammation in lupus patients; Clinical Rheumatology (2019) 38:2509–2518Disclosure of Interests:None declared

84 Table 1

BackgroundLupus Nephropathy (LN) is an important cause of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). The goal of LN treatment is to suppress inflammation and preserve renal structure and function to prevent progression to kidney failure, in addition to minimizing side effects. Currently therapy for severe LN is based on high doses of glococorticoids and differents immunosuppressive drugs.ObjectiveTo determine the response time and immunosuppressive drugs used in a series of patients with LN.MethodsRetrospective analysis of Lupus patients in a single center with renal disease. The variables recorded were: the number of immunosuppressive drugs used from the diagnosis of LN until remission and the response evaluated regarding 24 hour proteinuria (achieve remission, improvement greater than or equal to 50% respect to baseline and/or no improvement).ResultsIn a series of 80 patients with SLE, 17 were diagnosed with NL, and of these, 14 proliferative diffuse glomerulonephritis (GN lV). The sample consists of 2 men and 12 women between 30 and 65 years of age, with a follow-up time of 6 to 55 months and 9 Caucasian and 5 Latin Americans. All patients were treated with hydroxychloroquine (HCQ), antihypertensive and corticosteroids. The immunosuppressant treatment used was: mycophenolate mofetil, azatioprine, cyclophosphamide, tacrolimus and rituximab. Considering that the time of follow-up of patients varies, each temporary space was analyzed according to the number of patients. Figure 1 shows that at 6 months, 38% of patients had an improvement >50% and 7.7% of patients achieved remission. After one year of treatment, 42% of patients presented improvement >50% and 17% achieved remission but in 23% of patients two changes of immunosuppressive treatment was needed. At 24 months, 50% of patients improved >50% and 25% achieved remission; in 13% of patients it was necessary to make another treatment change. Finally, after 24 months, it was observed that 50% of patients achieved remission, 33% of patients presented an improvement >50% and only 17% presented renal failure, and it was necessary to make another treatment change. Globally, in 36% of patients 1 or more changes of immunosuppressive treatment were necessary to achieve improvement >50% or remission.Abstract 263 Figure 1Response time of the LN with immunosuppressive treatment regarding to 24h proteinuria. Blue: normal value of proteinuria 24 h, Red: improvement 50% compared to baseline, Green: no improvement or remissionConclusionsPatients who do not experience an improvement >50% in a period of 6 months are more likely to improve if a change in immunosuppressive treatment is made. It is necessary to extend the series to reach conclusions with statistical value.Funding Source(s):No funding

Background:Infections are one of the main complications among patients with rheumatoid arthritis (RA) with immunosuppressive treatment. The differences between treatments and the influence of other factors is unclear.Objectives:To evaluate the frequency and factors associated with serious infections in patients with RA treated with biological therapy (BT) and JAKi and the differences between treatments.Methods:Descriptive and retrospective study (January 2015-December 2020) of patients with RA treated with BT (TNFi, non-TNFi) and JAKi (tofacitinib, bariticinib, upadacitinib) in a single center. Severe infection was considered a life-threatening infection or one that required hospitalization and intravenous treatment. Epidemiological variables, clinical characteristics, Charlson comorbidity index, type of BT or JAKi and concomitant treatment were collected.For the analysis frequencies and percentages are used in qualitative variables and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.Results:We registered 257 patients (84.4% women) mean aged 56.1±13.4 years. RF was positive in 86.8%, anti-CCP in 75.9% and 16.5 % presented extra-articular manifestations (nodulosis 9.7%, intersticial lung disease 4.3%, other 1.5%). At the start of the study, 157 (61.1%) patients were with TNFi, 80 (31.1%) with non-TNFi and 20 (7.8%) with JAKi. Conventional synthetic DMARDs (csDMARDs) were used in 86% of cases (methotrexate 71.1%, leflunomide 21.2%, other 7.7%).During the study, 162 (63%) patients continued with the same treatment and in 95 (37%) it was changed at least once. 3 patients discontinued the treatment. At the end of the study, 126 (49%) patients were with TNFi, 81 (31.5%) with non-TNFi and 47 (18.3%) with JAKi.Severe infection was developed in 28 (10.9%) patients (13 respiratory, 5 urinary, 5 cellulitis, 4 sepsis, 1 osteomyelitis) among them 2 patients had severe infection and herpes zoster at the same time and 3 developed a second infection. 14 (50%) patients were with TNFi, 8 (28.6%) with non-TNFi and 6 (21.4%) with JAKi. Table 1The inflammatory activity of RA was mild at the time of infection (DAS28: 2.6±1.1). The median time until infection was: TNFi 45.25 [4.9-202.3] months, non- TNFi 19.14 [4.9-72.5] months and JAKi 17.63 [1.1-29.2] months.The Charlson index, concomitant use of glucocorticoids (GCC) at lower doses than 10mg/d, chronic obstructive pulmonary disease (COPD), diabetes (DM), moderate-severe renal insufficiency, congestive heart failure (CHF) and peripheral vascular disease were statistically significantly associated with infection. Table 1.TABLE 1.CHARACTERISTICS OF PATIENTS WITH INFECTION VS. WITHOUT INFECTIONINFECTIONYES n:28NO n:229pFEMALE, n (%)22 (78.6)195 (85.2)0.406AGE years, (mean±SD)57.7 ± 13.955.9 ± 13.40.507AGE ≥ 65 n (%)10 (35.7)68 (29.7)0.513RF +, n (%)25 (89.3)198 (86.5)0.677ANTI-CCP +, n (%)21 (75)174 (75.1)1.00ILD, n (%)1 (3.5)10 (4.3)0.809ALCOHOL, n (%)3 (10.7)17 (7.4)0.465SMOKER, n (%)10 (35.7)60 (26.2)0.244COPD, n (%)7 (25)24 (10.5)0.026*DM, n (%)7 (25)19 (8.3)0.013*CHF, n (%)4 (14.3)1 (0.4)0.001*RENAL INSUFFICIENCY, n (%)3 (10.7)2 (0.9)0.010*PERIPHERAL VASCULAR DISEASE, n (%)9 (32.1)22 (9.6)0.002*CHARLSON INDEX (mean±SD)1.64 ± 2.10.63 ± 1.20.001*TNFi, n (%) NON-TNFi n (%) JAKi, n (%)14 (50)112 (48.9)8 (28.6)73 (31.9)6 (21.4)41 (17.9)csDMARDs, n (%)22 (78.6)159 (69.4)0.317GCC dose <10mg/d, n (%)17 (60.8)111 (48.5)0.007*Conclusion:In our study, 10.9% of patients with RA treated with BT or JAKi developed severe infection during 5 years of follow-up. Concomitant GCC therapy and comorbidity increased the risk of presenting this complication.Disclosure of Interests:None declared

Background Aromatase Inhibitors (AI) are an important component in adjuvant therapy in postmenopausal women with positive estrogenic receptors in breast cancer. They inhibit the enzyme Cytochrome P450 CYP19, which causes a loss of BMD and consequently an increase in the risk of fracture. In patients with early breast cancer (EBC) in treatment with AI, it is estimated that the risk of fracture is 11% at five years. FRAX is used to calculate the probability of fracture at 10 years. Within its limitations, it should be highlighted that among its risk factors it does not include medications such as AI and that the treatment threshold adapted to patients of the Spanish population is not currently valid. Objectives To determine if the therapeutic intervention thresholds according to the FRAX proposed by the NOF (National Osteoporosis Foundation) as well as of the NOGG (National Osteoporosis Guidelines Group) identify appropriately whether patients with early breast cancer have a high risk of fracture at the start of AI treatment. Methods Retrospective and descriptive study of 73 patients with EBC in treatment with AI sent to the medical oncology department of a tertiary hospital (Basurto University Hospital) for monographic consultation of osteoporosis for its diagnosis, control and monitoring in the period from 01/01/2006 to 31/12/2010. A questionnaire was conducted of the risk factors, BMD DXA and FRAX. The FRAX results are described in the basal visit and the incidence of fractures in this population in December 2012 (monitoring period of 2 to 7 years). The patients with densitometric osteopenia and high risk of fracture according to the FRAX and the patients with both densitometric and established osteoporosis received treatment with bone agents by the Osteoporosis Unit. Results The mean age of our series is 63 years (40-83). The median time from the start of the AI and the realization of the basal BMD is 4 months. The initial densitometry identified 36 patients (49%) with osteoporosis, 35 patients (48%) osteopenia and 2 patients (3%) normal. According to the FRAX applying the treatment thresholds of the NOF (FMO >= 20% and FC >=3%): 19 patients (25%) have high risk of fracture: 16 patients (21%) of FMO and 18 patients (23.6%) of FC. Applying the treatment thresholds of the NOGG in which the values vary according to age: 3 patients (4%) have high risk of fracture, 1 patient (1%) of FMO and 3 patients (4%) of FC. Of the 73 patients, 15 (20%) present fracture, all vertebral, with 5 (33%) of high risk by FRAX according to NOF and only 1 (6%) according to NOGG. Conclusions In our series, the treatment thresholds for the FRAX of the NOF are more sensitive by identifying a greater number of patients with high risk of fracture (25%) than the NOGG (6%). Of the patients with fractures of the study (20%), only 33% of them were identified previously as high risk according to the NOF and 6% according to the NOGG. Both thresholds clearly underestimate the risk of fracture. It is necessary to validate the FRAX in prospe...

No abstract