1018 Scientific Abstracts

and anti-SRP were tested by immunoblot (Orgentec® ). In addition, levels of mortality in these patients.2 However, there is no consensus on a cutoff point
creatin-quinase (CK) were measured by turbidimetry (Roche® ) that confirms mRSS as an independent marker of activity and severity disease;
Results: Eight patients were positive for anti-SRP Ab, (6 Caucasians and 2 furthermore, the subjectivity in the evaluation and disease staging and therapeutic
north-african women; mean age 63 years). Three of them (37.5%) had PM (1 response-related variability impair its accuracy and reprodutibility.3
associated to systemic sclerosis). At initial evaluation muscle weakness was Objectives: To evaluate the correlation between skin thickening and disorders
severe in 2 patients (defined as <3 of manual muscle strength testing) associated mood, quality of life and disability aspects in a group with diffuse and limited SSc
to dysphagia and respiratory muscle involvement. The season of onset of patients.
muscle weakness was: 2 in the spring and 1 in winter. All 3 patients were Methods: Cross-sectional study with 59 SSc patients, followed-up at the Walter
treated with glucocorticoids; 2 required immunosupressive agents (methotrexate, Cantidio University Hospital. The skin thickening was analyzed by mRSS; the
azathioprine, rituximab or intravenous immunoglobulin). The histologic study of disorders mood and quality of life by SRQ-20 and SF-36 questionnaires; and
biceps brachii muscle was performed during the initial diagnostic evaluation disability by HAQ. Mann-Whitney test was carried out to compare the scales of
and before treatment. It showed histological changes consistent with necrotising the diffuse and limited groups, and the Spearman test to correlate mRSS with the
myopathy with scarce inflammatory cells. other scales. The significance level was stipulated in 5%.
All the other patients (62.5%) had no features of myositis after a follow-up of 6 Results: In that sample, 47 patients had the diffuse form (79%). The mean and
months to 3½ years. Furthermore most of them (4/5) had a normal EMG and their standard deviation of mRSS was 20 (±8.7); of positives responses SRQ-20 8,9
levels of CK were normal. Their diagnoses were: rheumatoid arthritis, Sjögren’s (±4.9); of functional capacity, physical aspect and health general status, respec-
syndrome, autoimmune hepatitis, primary biliary cirrhosis (pure and associated tively, were 42.5 (±21.5), 26.5 (±35.9) and 38.3 (±20.1); of HAQ was 1.10 (±0.7).
to systemic sclerosis). The mRSS correlated negatively with SRQ-20 (-0.2) and positively with HAQ
There were no deaths or history of malignancy among the 8 anti-SRP patients. (-0.2). When compared the diffuse and limited forms, the worse mRSS was the
Conclusions: Although anti-SRP remains as specific Ab for PM, it is occasionally first one (21.9±8.5), P=0.00; in this group, mRSS correlated stronger negatively
detected in patients with other rheumatic diseases and autoimmune hepatitis in with SRQ-20 (-0.32; P=0.027) and positively with HAQ (-0.31; P=0.033).
the absence of myositis. Conclusions: It was confirmed that exist SSs related-disorders mood tendency,
Disclosure of Interest: None declared quality of life decrease and disability. The diffuse form showed the highest degree
DOI: 10.1136/annrheumdis-2014-eular.3621 of skin thickening and that seemed to determine worsening of emotional and
functional aspects.
References:
AB0643 THE Ψ-REUMA PROJECT: ROLE OF EARLY AND RECENT LIFE [1] Sampaio-Barros PD, Bortoluzzo AB, Marangoni RGJ, Rheumatol.
EVENTS ON SYSTEMIC SCLEROSIS (SSC) CLINICAL [2] Merkel PA, Silliman NP, Clements PJ, Arthritis Rheum
PRESENTATION AND COURSE [3] Hasegawa M, Asano Y, Endo H, Rheumatology (Oxford)
Disclosure of Interest: None declared
F. Rotella 1 , F. Pietrini 2 , L. Lelli 1 , S. Guiducci 3 , S. Bellando-Randone 3 ,
DOI: 10.1136/annrheumdis-2014-eular.5829
J. Blagojevic 3 , G. Lepri 3 , C. Bruni 3 , M. Matucci-Cerinic 3 , C. Faravelli 2 .
1
Psychiatric Unit Careggi Teaching Hospital; 2 Department of Health Sciences;
3
Department of Clinical and Experimental Medicine, Section of Rheumatology,
AB0645 PUFFY FINGERS USUALLY POINT AT MICROVASCULAR
University of Florence, Florence, Italy
DAMAGE
Background: Stressful Life Events (SLEs) may play a role in the etiopathogenesis
S. Recuero 1 , F.I. Romero-Bueno 1 , C. Franco 1 , S. Pérez-Esteban 1 ,
of autoimmune diseases, especially during childhood (early SLEs) and in the
S. Bermúdez 1 , M.J. Martínez-Becerra 2 , G. Herrero-Beaumont 1 ,
year prior to the onset of the disease (recent SLEs). Such a deleterious effect
O. Sanchez-Pernaute 1 . 1 Section For Autoimmune Diseases, Rheumatology
of stressful events seems to be mediated by the inadequate responsiveness to
Division; 2 Section For Autoimmune Diseases, Immunology Department, Jimenez
stressors and to chronic inflammation due to a dysregulation of the Hypothalamic-
Diaz Foundation University Hospital, Madrid, Spain
Pituitary-Adrenal axis (HPA axis). Few studies have addressed the relationship
between SLEs and SSc and none of them evaluated the effect of both early and Background: Nailfold capillaroscopy (NC) can predict progression to systemic
recent life events. sclerosis (SSc) in patients diagnosed with primary Raynaud’s phenomenon (RP).
Objectives: The aims of the present study were to explore the multiple effects of The occurrence of puffy fingers (PuFi) in patients with RP and positive antinuclear
stress on SSc onset and course, and to evaluate the impact of pain perception antibodies (ANA) has been associated to NC SSc-like lesions. The coexistence
and health-related quality of life on patients with SSc. of these three factors has been recently proposed as criterium for very early SSc
Methods: 110 consecutive SSc patients were enrolled. The assessment included diagnosis.
a face-to-face interview and the administration of self-reported questionnaires Objectives: In this study we have explored the NC features in patients with PuFi
evaluating pain perception and quality of life (Short Form (36) Health Sur- in a 1-year NC registry from our unit.
vey (SF-36), Brief Pain Inventory (BPI), Childhood Experience of Care and Methods: Data were retrospectively collected from clinical records and from
Abuse Questionnaire and Florence Psychiatric Interview). Clinical status was systematized NC evaluation sheets, which include a semiquantitative scoring,
assessed by modified Rodnan Skin Score and Raynaud Condition Score, nailfold classification into established patterns of lesions, and description of coincidental
videocapillaroscopy and instrumental examination of internal organs. macroscopic alterations. Data are shown as incidence rates. Statistical analysis
Results: Compared to a group of matched controls (n=110), a higher proportion was done with Chi-Square, Fisher’s test and multivariate analysis.
of patients reported at least one Stressful Life Events (56.3% vs 34.5%, p<0.01). Results: 136 cases were included in the analysis. NC was considered pathologic
All early life events were more frequently reported by SSc patients, even though in 73 cases (54% of the cohort, rising to 60% in RP+ patients, p 0.036). PuFi
a significantly difference was obtained only for “loss of mother” and for “sexual were present in 20% of all patients. A higher incidence of pathologic NC studies
abuse” (13.6% vs 5.4%, p<0.05 and 16.4% vs 8.2%, p<0.05, respectively). was observed in the PuFi+ group (78%, p 0.002). NC lesions in this subgroup
Patients displayed a worse quality of life and a higher pain perception (all the of patients were classified as SSc-like (13 p), non-SSc CTD-like (7 p), and
subscales of SF-36 and of BPI were significantly different between the two groups, non-immmune vasculopathy (2 p). There was coexistence with RP in 20 PuFi+
p<0.01). SSc patients, with a significant clinical worsening (33.6%), reported cases, but it did not increase either the risk of having a pathologic NC study (81%
more frequently the occurrence of severe recent life events compared to patients in double positive patients vs 83% in PuFi+ without RP) or the appearance of a
without a significant clinical worsening (54.0% vs 26.0% p<0.05). SSc-like NC pattern in the subgroup. The occurrence of PuFi showed a strong
Conclusions: Early SLEs can be considered potential risk factors for the onset association with + ANA (77% vs 54% in PuFi- patients, p 0.029). Moreover,
of SSc. The occurrence of recent SLEs may have a role in the course of the the presence of both traits strongly predicted NC alterations, which appeared in
disease, being linked to a significant clinical worsening. 0.9% of double negative cases, 73% of ANA+ patients alone, and 90% of double
Disclosure of Interest: None declared positive cases.
DOI: 10.1136/annrheumdis-2014-eular.4998 Patients with PuFi were diagnosed with primary RP (3 p), SSc (11 p), mixed
connective tissue disease (CTD) (1 p), dermato/polymiositis (4 p), and non-
classifiable CTD (6 p), while no PuFi+ cases were found in primary Sjögren’s
AB0644 SCLERODERMA CUTANEOUS FORM AND ITS INFLUENCE IN syndrome, lupus, rheumatoid arthritis, vasculitis, or antiphospholipid syndrome.
DISORDER MOOD, QUALITY OF LIFE AND DISABILITY No specific microscopic features were associated to PuFi.
ASPECTS Conclusions: In summary, in this cohort we have observed a high incidence of
NC alterations in association with PuFi. Our findings support the relevance of PuFi
G.A.M.B. Bezerra 1 , M.R. Costa 1 , N.B.C. Lima 1 , F.M.L. Pinheiro Júnior 2 ,
as a CTD-associated trait, as recently underscored by the new EUSTAR proposed
S.M.A. Fontenele 3 . 1 Clinic, Christus Universitary Center; 2 Medicine, Christus
criteria for SSc classification. In addition, the appearance of ANA together with
Universitary; 3 Rheumatology, Christus Universitary Center, Fortaleza, Brazil
PuFi in our patients strongly predicted NC lesions, even in the absence of RP.
Background: The modified Rodnan skin score (mRSS) analyzes the extent Also of interest, PuFi were not exclusive of a SSc-like pattern of NC lesions. We
and severity of skin thickening of Systemic Sclerosis (SSc) by palpation in suggest that NC should be performed in any patients presenting with a CTD-like
17 anatomical sites. It is graded by a scale 0-3, where 0 = normal skin, 1 scenario and swollen hands or PuFi, even in the absence of RP, because findings
= mild skin thickening, 2 = moderate 3 = skin thickening and skin thickening are likely to help characterize their syndrome.
with intense inability to pucker the skin.1 Studies have shown that diffuse Disclosure of Interest: None declared
SSc have higher mRSS and this may compromise the rates of morbidity and DOI: 10.1136/annrheumdis-2014-eular.3024