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Background:There are few data about variations in bone metabolism associated with weight loss in obese patients undergoing bariatric surgery.Objectives:To assess the influence on the bone metabolism of bariatric surgery in morbidly obese patients.Methods:Longitudinal pre-post study with analytical components. All morbidly obese patients undergoing bariatric surgery were, prior to this, referred to Rheumatology Department. In all cases, the baseline characteristics of the patients were collected and a complete bone metabolic analytical study and bone densitometry (BMD) were requested. This same study was repeated one year later, with a window period of ± 3 months. Statistical analysis was performed with the SPSS 20.0 software.Results:Of the 91 patients included in the study and who underwent baseline BMD and analytical tests prior to surgery, only follow-up data of 27 patients could be collected at the time of the present data analysis. Within this sample, the median age was 54 years (AIQ 11), with 6 men and 21 women (11 premenopausal, 10 postmenopausal). Prior to surgery, median body mass index (BMI) was 39.2 (AIQ4.43) and median vitamin D (25OHD) level was 22 (AIQ 16). High values of PTH were detected in two patients. Regarding baseline BMD, 78% had normal values and 22% had values in the range of osteopenia.After surgery, all patients presented a significant weight loss, being the median loss in BMI per year 9.8 Kg/m2(AIQ 3.8) as absolute value, and 25% (AIQ 8.12) as a percentage value. This weight loss was accompanied by a significant BMD worsening that was evident in all locations: lumbar spine (median -6.97%, AIQ 6.3), total hip (median -6.4%, AIQ 7.7) and femoral neck (median -3.57 %, AIQ 8); so that an additional 22% of patients changed to osteopenia values. All this despite a significant increase in 25OHD levels in all cases (35.7%; AIQ 52.3). No clinical or morphometric fractures were collected. Despite the parallel evolutionary course, the loss of BMI only showed a tendency to correlate with the decrease in bone mass in the femoral neck (p-value 0.089), but not in the other locations.Conclusion:In our sample of morbidly obese patients undergoing bariatric surgery, there is a significant and widespread loss of bone mineral density one year after the procedure, all this despite the supplementation and the increase in 25OHD levels. This loss only seems to be directly related to the decrease in weight at the femoral neck, just probably by a mechanism to reduce mechanical load.Disclosure of Interests:I Vázquez-Gómez: None declared, Ramón Trullenque Juan: None declared, Carlos Morillas Ariño: None declared, L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, Desamparados Ybañez: None declared, À Martínez-Ferrer: None declared, Inmaculada Torner Hernández: None declared, V Núñez-Monje: None declared, A Sendra-García: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

Background:Several studies have shown dissimilar results for the relationship between serum 25-hydroxyvitamin D concentration (25-OH-D) and disease activity in spondyloarthritis (SpA).Objectives:This study aims to assess whether vitamin D levels vary according to disease activity in patients with SpA before and after starting treatment with biologic disease-modifying anti-rheumatic drugs (bDMARDs).Methods:An observational retrospective study was performed in SpA patients followed in the Rheumatology department of a tertiary university hospital. Demographic and clinical data were collected from the Rheumatic Diseases Portuguese Register (Reuma.pt). Patients were assessed for 25-OH-D levels before and after 6 months of treatment with the first bDMARD. Correlation between 25-OH-D levels and disease activity measured by Ankylosing Spondylitis Disease Activity Score (ASDAS) at baseline and after 6 months were assessed using student’s t-test for two samples and one-way ANOVA and with post hoc tests for multiple comparisons.Results:A total of 189 patients were included. Ninety-seven patients were females (51.3%). The mean age at diagnosis was 34.8±11.2 years and the median disease duration at the start of the first bDMARD was 4.9 years (min: 0.1; max: 46.0). All patients fulfilled the ASAS criteria for SpA. Nonsteroidal anti-inflammatory drugs were used by 102 patients (54.0%) and conventional synthetic DMARDs by 69 patients (36.5%). At 6 months, 188 patients were treated with tumor necrosis factor inhibitors and one with interleukin-17 inhibitor. According to ASDAS criteria, at baseline 36.8% of patients had high disease activity and 59.5% had very high disease activity. After 6 months of treatment with bDMARD 14.7% of patients have inactive disease, 21.6% low disease activity, 36.3% high activity and 12.6% very high disease activity. The mean value of 25-OH-D at baseline was significantly lower in the group of patients with very high disease activity compared to the patients with high disease activity (21.9±11.1 ng/ml vs 26.1±11.6 ng/ml, p= 0.02). At 6 months of treatment the mean value of 25-OH-D in inactive, low, high and very high disease activity was 31.0±17.1ng/ml, 28.5±11.2ng/ml, 25.8±10.8ng/ml and 19.3 ±9.5ng/ml, respectively. There was a statistically significant difference between the groups, as determined by one-way ANOVA (p = 0.001). A post hoc Dunnett T3 test revealed that patients with very high disease activity have significantly lower mean 25-OH-D levels (19.29 ± 9.5) than patients with inactive disease (31.0 ± 17.1, p = 0.025) and low activity (28.5 ± 11.2, p = 0.009). Among the groups with high and very high disease activity, the significance is only marginal (p = 0.068).Conclusion:Vitamin D serum concentration varies according to disease activity in SpA. In fact, SpA patients with lower levels of 25-OH-D are associated with higher rates of disease activity, even in patients treated with biologics agents. It is important to be aware of vitamin D level as it can play a role in the management and treatment of the disease, mainly in the most severe patients.References:[1]Zhao SZ, Thong D, Duffield S, Goodson N. Vitamin D Deficiency in Axial Spondyloarthritis is Associated With Higher Disease Activity. Arch Rheumatol. 2017 Mar 24;32(3):209-215. doi: 10.5606/ArchRheumatol.2017.6212. PMID: 30375524; PMCID: PMC6190948.Disclosure of Interests:None declared.

Background:Vitamin D is thought to have an important role in immune regulation and is being subject of research in several autoimmune diseases. Some data suggest that vitamin D deficiency is common in Spondyloarthritis (SpA) and may be associated with disease activity and structural damage.Objectives:To evaluate if there is a relation between baseline vitamin D status and the response to biologic disease-modifying antirheumatic drugs (bDMARDs) in a SpA monocentric cohort.Methods:Retrospective study including all the SpA patients (ASAS classification criteria) followed at our Rheumatology Department, registered in the national database and treated with bDMARD between June 2008 and July 2020. Demographic, clinical and laboratorial data (including 25-hydroxyvitamin D [25-OHvitD]) at baseline and disease activity measures at 6 and 12 months of treatment with the first bDMARD were collected. Correlations between variables were evaluated by Spearman rank test, Mann-Whitney U test was used to the comparison analysis between groups and univariate logistic regression was used in the prediction analysis.Results:A total of 195 SpA patients were included: 103 (52.8%) females, 47 (24.1%) smokers and 91 (46.7%) HLA-B27 positive; 139 (71.3%) had Ankylosing Spondylitis, 18 (9.2%) had Inflammatory Bowel Disease Associated SpA and 38 (19.5%) had Undifferentiated SpA. At the time of the first bDMARD, the mean age was 43.5 years (±9.6) and the median disease duration was 12.4 years (0.7-52.7). The mean ASDAS-CPR (Ankylosing Spondylitis Disease Activity Score with C-reactive protein) was 3.9 (±0.8) and, in addition, 61 (31.3%) patients had 25-OHvitD levels below 30 ng/mL and 12 (6.2%) had 25-OHvitD levels below 20 ng/mL. Fifty-three patients (27.2%) were taking NSAIDs (nonsteroidal anti-inflammatory drugs), 77 (39.5%) were under csDMARDs (conventional synthetic disease-modifying antirheumatic drugs). Adalimumab (56%) and golimumab (33.3%) were the most frequently initiated bDMARDs in the first line.There were no statistically significant correlations between baseline 25-OHvitD levels and ASDAS-CRP at 6 (r=0.031; p=0.714) and 12 months (r=0.035; p=0.672) of bDMARD.In the subgroup analysis: there were no statistically significant differences in the response to bDMARD at 6 and 12 months evaluated by ASDAS response and ASAS 20, 40 and 70 responses according to the baseline 25-OHvitD levels (25-OHvitD In the line of these previous results, baseline 25-OHvitD levels did not predict the ASDAS response at 6 (OR 0.97 [0.95-1.00], 95% CI) or 12 (OR 0.98 [0.95-1.01], 95% CI) months of bDMARD.Conclusion:Despite some data that suggest that lower levels of 25-OHvitD may be associated with higher disease activity in SpA, our results failed to demonstrate that the baseline 25-OHvitD levels can be related or predict treatment response after 6 and/or 12 months of therapy with the first bDMARD in real-life SpA patients.Disclosure of Interests:None declared

Background:Vitamin D regulates the innate and adaptive immune system responses and low vitamin D levels have been associated with the increased risk of respiratory tract infections (1). Vitamin D deficiency has been recently reported to interfere with the prognosis of COVID-19 (2,3).Objectives:The aim of this study was to correlate the 25OH-vitamin D serum levels with lung involvement and disease severity, in a cohort of elderly patients hospitalized for SARS-CoV-2 infection.Methods:Sixty-five COVID-19 patients (mean age 76±13 years) and sixty-five sex- and age-matched control subjects (CNT) were included in the study. Respiratory parameters (PaO2, SO2, PaCO2, PaO2/FiO2), clinical and laboratory parameters (including 25OH-vitamin D, D-dimer, C-reactive protein) and type of radiological pulmonary involvement were collected at hospital admission. Statistical analysis was performed by non-parametric tests.Results:Vitamin D sufficiency (>30 ng/ml), insufficiency (between 20 and 30 ng/ml), deficiency (between 10 and 20 ng/ml) and severe deficiency (2 (p=0.05), PaO2 (p=0.03), PaO2/FiO2 (p=0.02). A statistically significant negative correlation was found between vitamin D serum levels and severity of radiologic pulmonary involvement: vitamin D was significantly lower in COVID-19 patients with either diffuse/severe interstitial lung involvement (p=0.05) or multiple lung consolidations (p=0.0001) than in those with mild radiological lung involvement. Significantly lower vitamin D serum levels were found in COVID-19 patients who died during hospitalization, compared to those who survived (median 3 vs 8 ng/ml, p=0.05). Finally, a statistically significant negative correlation was found between vitamin D serum levels and D-dimer (p=0.04), C-reactive protein (p=0.04) and disease duration (p=0.05).Conclusion:This study confirms that severe vitamin D deficiency is associated with more severe lung involvement, longer disease duration and risk of death in elderly COVID-19 patients.References:[1]Cutolo M, et al. RMD Open. 2020; 6(3):e001454.[2]Bilezikian JP, et al. Eur J Endocrinol. 2020; 183(5):R133-R147.[3]Weir EK, et al. Clin Med (Lond). 2020; 20:e107-e108.Disclosure of Interests:None declared

Background:Vitamin D is a fat-soluble vitamin, mainly involved in the regulation of calcium metabolism, and it has gained increasing interest in recent years because of its potential role in immunomodulatory activity. Recent data suggest that it is negatively associated with disease activity in rheumatoid arthritis (RA), however this is not yet fully understood.Objectives:This study’s aim was to investigate if there is any correlation between vitamin D serum levels at baseline, before taking the first biological disease-modifying antirheumatic drug (bDMARD), and at 6 months after, with disease activity in a cohort of RA patients.Methods:This is a cross-sectional study, including all the rheumatoid arthritis patients taking the first bDMARD with evaluation of the vitamin D status at baseline and 6 months after biologic therapy at our Rheumatology Department and registered in the national database (Reuma.pt).Demographic, clinical and laboratorial characteristics and disease activity measures were collected from the baseline visit and the visit after 6 months of treatment with the first biologic. For the statistical analysis, two groups were defined, based on the serum levels of 25(OH) vitamin D, considering the most common cut-off of 30 ng/mL. For comparison analyses between groups, chi-square test was used for categorical variables and Mann-Whitney U and T-tests were applied for continuous variables.Results:Seventy-seven patients were included, 58 (75.3%) were females; the mean age was 54.24 ±11.0 years and seropositivity was founded in 65 (84.4%) for anti-citrullinated protein antibodies and in 58 (75.3%) for rheumatoid factor. The first bDMARD most commonly prescribed were etanercept (28.6%) and rituximab (26%). Regarding the vitamin D status at baseline, the mean serum level for 25(OH)vitamin D was 28.35 ± 18.21 ng/mL, with the majority of patients having vitamin D insufficiency (25(OH)vitamin D < 30 ng/mL) (63.6%). After 6 months of treatment with the first bDMARD, disease activity measures showed that remission or low activity were achieved in 29.9% of the patients, using DAS28 criteria; in 42.9% and 46.8%, according CDAI and SDAI criteria, respectively. Vitamin D serum levels at 6 months were 26.81 ±11.72, with the majority of patients still with vitamin D insufficiency (62.3%).At baseline, patients with vitamin D insufficiency had greater patient VAS (79.00 ± 19,14 vs 71.71 ± 21.95), greater erythrocyte sedimentation rate (ESR) (40.67 ± 23.17 vs 32.46 ± 26.09) and greater Health Assessment Questionnaire (HAQ) score (1.75 ± 0.609 VS 1.61 ± 0.659) with neither of them having statistical significance. However, when comparing CRP levels at 6 months, it achieved statistical significance with the Mann-Whitney U-test (1.05 ± 1.79 VS 1.41 ± 5.22; p=0.026).The same tendency was confirmed when analyzing vitamin D levels at 6 months. Patients with vitamin D insufficiency presented greater patient VAS (55.33 ± 28.82 vs 42.86 ± 28.28), greater ESR (26.19 ± 21.57 vs 21.00 ± 20.38) and greater HAQ score (1.35 ± 0.662 VS 1.34 ± 0.705), although without statistical significance. However, it did achieve statistical significance when comparing baseline DAS28 and HAQ (5.60 ± 0.91 VS 5.38 ± 1.31; p=0.013 and 1.76 ± 0.53 VS 1.59 ± 0.75; p=0.007, respectively).Conclusion:Our data failed to demonstrate a statistically significant association between vitamin D serum levels at baseline and at 6 months with disease activity in our RA sample. However, it revealed a positive trend of vitamin D insufficiency related to higher activity disease. Interestingly, it showed that vitamin D insufficiency after 6 months of bDMARD treatment is related to higher DAS28 and HAQ at baseline. Nonetheless, we insist it is of paramount importance to conduct larger studies to confirm these findings.References:[1]Bellan M, Sainaghi PP, Pirisi M. Role of Vitamin D in Rheumatoid Arthritis. Adv Exp Med Biol. 2017;996:155-168.Disclosure of Interests:None declared

Background:Vitamin D, a fat soluble vitamin that is mainly involved in the regulation of calcium/phosphate metabolism, has a increasingly understood role in immunomodulatory activity, both in innate and adaptive immune system. In rheumatoid arthritis (RA), vitamin D showed to suppress the proliferation of synoviocytes and to reduce the production of proinfammatory cytokines, in vitro. (1) Recently the hypothesis has been raised that vitamin D has a negative association with RA activity. (2)Objectives:This study aimed to evaluate the relationship between the 25-hydroxyvitamin D (25(OH) vitD) level, RA activity and response to a first biologic disease-modifying drug (bDMARD).Methods:This is a longitudinal, retrospective study including consecutive patients with the diagnosis of RA followed at our rheumatology department. Demographic, clinical, and laboratorial data were collected from our national database at baseline, 6 and 12 months after initiation of a first bDMARD. Statistical analysis was performed using SPSS 23.0. Correlations between variables were studied using Spearman correlation analysis and comparison between groups was performed using Wilcoxon and Kruskal-Wallis tests; pResults:Mean age of patients (n=236) was 51.5 ± 11.2 years old, 192 (81.4%) were females with a median disease duration of 10.1 [4.7, 16.7] years. Seropositivity for anti-citrullinated protein antibodies was present in 192 (81.4%) patients and for rheumatoid factor in 175 (74.2%). The majority exhibited a very high or high disease activity at baseline (median DAS28 5.75 [4.99 – 6.63]) and 90% (n=212) of them were concomitantly using corticosteroids and/or other disease-modifying anti-rheumatic drugs (117 with methotrexate (MTX), 62 with leflunomide and 32 with sulfasalazine). Regarding bDMARD, 56.8% (n=134) initiated an TNF alpha inhibitor.After 6 and 12 months from a bDMARD initiation there was a significant reduction of ESR, CRP levels, TJCs, SJCs and DAS28 (all p-values < 0.001), as expected. Median baseline serum 25(OH) vitD concentrations was 25.5 [16.5, 30.0] ng/ml; notably, 34.2% of our sample was affected by hypovitaminosis D at baseline (25(OH) vitD< 20 ng/mL).Among our study population 42.5% patients were responders to first bDMARD (23.8% good and 18.7% moderate responders) according to the EULAR response criteria. Disease remission (DAS28 The percentage of good responders was significantly lower in the subgroup of patients with hypovitaminosis D compared to subjects with normal 25(OH) vitamin D levels at baseline (p=0.002), as it was for the percentage of disease remission (p=0.015).The bivariate correlation analyses showed that 25(OH) vit D levels at baseline correlated with CRP levels and good response to RA treatment after 12 months (Spearman’s coefficient -0.201, p = 0.028; Spearman’s coefficient 0.255, p Conclusion:In patients with RA, basal 25(OH) vit D levels correlated with response to a bDMARD. These results suggest a role of basal vitamin D status in the prediction of disease evolution and support the hypothesis that vitamin D has an immunomodulatory potential.References:[1]Huhtakangas JA, Veijola J, Turunen S et al. 1,25(OH)2D3 and calcipotriol, its hypocalcemic analog, exert a long-lasting anti-infammatory and anti-proliferative effect in synoviocytes cultured from patients with rheumatoid arthritis and osteoarthritis. J Steroid Biochem Mol Biol 2017; 173: 13- 22.[2]Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clin Exp Rheumatol. 2016 Sep-Oct;34(5):827-833. Epub 2016 Apr 6. PMID: 27049238.Disclosure of Interests:None declared

Background:Several studies have suggested that multiple sclerosis (MS) patients have low bone mineral density (LBMD) compared to healthy adults of same age. This fact, combined with the functional impairment of the disease, increases the risk of fractures. However, information about the prevalence and the risk factors of LBMD in Spanish patients with MS is still quite limited1–3.Objectives:To evaluate the prevalence of LBMD and low vitamin D in patients with MS from a unique center from the east of Spain, describing the clinical features of these patients.Methods:Type of study: observational, cross-sectional, descriptive. Patients with MS from a local cohort have been consecutively recruited for this study since Apr-2020. A cross-sectional visit which included a clinical interview, analytic test (blood and urine) and a dual-energy X-ray absorptiometry (DXA) was performed. We defined LBMD as T score ≤-1SD in postmenopausal women and men over 50 years and a Z score ≤-2SD in premenopausal women and men under 50 years. Low levels of vitamin D were defined as < 20ng/mL. A descriptive and associative analysis of these data was carried out using the SPSS software.Results:From a cohort of 288 MS patients, due to the COVID-19 pandemia, we have only been able to assess 60 patients, and only 48 out of them have undergone all the tests required. These were 30 women and 18 men, with a mean age of 49 (SD 11,6) years. The main type of MS was relapsing-remiting (77,1%) and 25% of them were not taking any maintenance treatment. Some of the classical factors related to a LBMD are shown in table a1. A 43,8% of the patients had a LBMD and 40,5% had low levels of vitamin D. Despite these results, as far as 89% of patients had never received any specific treatment, not even calcium and/or vitamin D supplementation. Furthermore, 13 patients (27,1%) must have received specific treatment, according to latest guidelines4, and only 4 of them (8,5%) were being adequately treated.Table 1.Women/Men (n)30/18Mean age; SD (years)49; 11,6Non smokers/Smokers (%)58,4/41,7Alcohol abuse (%)8,3Personal history of fracture (%)10,4Personal history of nephrolithiasis (%)14,6Normal/Reduced mobility (%)77,1/22,9Sedentary lifestyle (%)66,7Conclusion:These preliminary results show that almost half of the MS patients have LBMD and a low vitamin D, most of them without taking any specific treatment. Taking this in mind, it is necessary to integrate the early diagnosis of LBMD in MS patients, working together with neurologists, to prevent the appearance of fractures and protect the quality of life of these patients. An analysis of our whole cohort of MS patients will help us in correctly assessing the magnitude of this problem.References:[1]López Méndez P, Sosa Henríquez M. Vitamin D and multiple sclerosis. Prevalence of hypovitaminosis D. Rev Osteoporos y Metab Miner. 2015;7(2):71-78.[2]Gupta S, Ahsan I, Mahfooz N, Abdelhamid N, Ramanathan M, Weinstock-Guttman B. Osteoporosis and multiple sclerosis: Risk factors, pathophysiology, and therapeutic interventions. CNS Drugs. 2014;28(8):731-742.[3]Moen S, E.Celius, L S, L N, E E, T H. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology. 2011;77(2):151-157.[4]Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017;76(5):802-810.Disclosure of Interests:None declared

Background:There is growing evidence that vitamin D [25(OH)D]) plays an important role in maintaining skeletal health and modulating the immune system. Epidemiological data indicate that vitamin D deficiency is common in immune-mediated rheumatic diseases, especially in rheumatoid arthritis, but there is little data regarding its association with disease activity and response to therapy in patients with psoriatic arthritis (PsA) under bDMARD therapy.Objectives:We aimed to assess whether 25(OH)D basal levels correlate with disease activity and clinical response to the first bDMARD, at 6 and 12 months of therapy, in a monocentric cohort of patients with PsA.Methods:This retrospective study was carried out on PsA patients from a Rheumatology department of a tertiary hospital, fulfilling CASPAR criteria and registered in our national database (Reuma.pt), who started the first bDMARD since 2008. Demographic, clinical and laboratory criteria were evaluated at 0, 6 and 12 months of biologic therapy. Disease activity was assessed using CDAI, SDAI, DAS28(4V), BASDAI, ASDAS, DAPSA and the response was measured using the EULAR, BASDAI50, ASDAS, ASAS, ACR and PsARC responses. Correlations were made between absolute serum levels of 25(OH)D and continuous variables, as well as associations between different vitamin D cutoffs and disease activity measures and response criteria. Multiple linear and logistic regression analyses were performed to determine whether vitamin D is a predictor of disease activity and therapeutic response.Results:We included 81 patients, 41 (50.6%) females; with a mean age of 48.0±11.7 years, a mean disease duration of 9.5±7.4 years and a mean body mass index of 28.4±5.2 kg/m2. Thirteen (16.0%) were smokers. The mean 25(OH)D basal level was 25.5±13.2 ng/ml, 21 (25.9%) had 25(OH)D basal levels ≥30 ng/mL and 31 (38.3%) ≤20 ng/mL. Sixty-two patients (76.5%) were under csDMARD therapy. Golimumab (29, 35,8%), etanercept (28, 34.6%) and adalimumab (10, 12.3%) were the most frequently prescribed bDMARDs. There were only very weak, albeit positive, correlations between 25(OH)D levels and measures of disease activity. The BASDAI50 response at 6 months was associated with higher basal 25(OH)D levels (29.5±14.5 vs 21.5±10.2 ng/mL, p = 0.013); the ASAS20 (33.9±15.9 vs 24.2±12.8 ng/mL; p = 0.023), ASAS40 (31.9±14.6 vs 25.0±13.8 ng/mL; p = 0.023) and ASAS70 (47.0±4.2 vs 26.6±14.2; p = 0.027) responses at 12 months were associated with higher basal levels of 25(OH)D; basal 25(OH)D levels were ≥ 30ng/mL in a significantly higher proportion of patients who achieved CDAI (38.9% vs 10.5%; p = 0.027) and SDAI (38.9% vs 7.7%; p = 0.008) remission and ASDAS disease inactive (29.4% vs 7.3%; p = 0.040) at 1 year. In the regression models, basal levels of 25(OH)D were found to be predictors of good EULAR responders (OR 1.315, 1.017-1.213 95% CI; p = 0.037) at 6 months. Basal levels of 25(OH)D were not significantly different in patients who discontinued bDMARD and no significant correlations or associations were identified regarding more specific PsA activity measures, such as DAPSA and PsARC, nor were they predictive of these responses.Conclusion:We can conclude that there is a global trend for an association between higher levels of vitamin D and lower measures of disease activity and better therapeutic responses to the first biologic. It was possible to find statistically significant associations with some disease activity measures and response criteria that, although primarily designed for other rheumatic diseases, are often used in PsA.Disclosure of Interests:None declared.

Background:Having complete information about osteoporosis is a prerequisite for preventive behavior, which determines the conscious adherence to the principles of a healthy lifestyle.Objectives:To assess the level of awareness of osteoporosis among women.Methods:A survey was conducted of 750 female respondents aged 15 to 55 years in the Chuvash Republic. The survey was conducted from January to December 2019. The questionnaire consisted of 30 questions. One point was awarded for each correct answer. The minimum score for passing the test was 75% correct answers. The questions addressed both general knowledge about osteoporosis and the relationship between disease onset and diet, physical activity, vitamin D, cigarette smoking, excessive alcohol consumption, and being overweight. The respondents were divided into two groups: group A (n = 375) - females from 15 to 35 years old and group B (n = 375) - females from 36 to 55 years old. Survey data was processed in Statistical Analysis Software 15.0. Statistical significance was calculated using Analysis of Variation.Results:We obtained the following results for the Main Aspects of the survey: 1. Osteoporosis is a rare condition that occurs primarily in women (Awareness level: Group A - 47%; Group B - 67,5%; Analysis of Variation > 0,05). 2. Postmenopausal women are more at risk of osteoporosis (Awareness level: Group A - 73,5%; Group B - 70,4%; Analysis of Variation > 0,05). 3. Prevention of osteoporosis is impossible (Awareness level: Group A - 78,8%; Group B - 89%; Analysis of Variation > 0,05). 4. Vitamin D is synthesized by direct exposure to UV radiation on the skin (Awareness level: Group A - 53,1 %; Group B - 69,1%; Analysis of Variation > 0,05). 5. Effective prevention of osteoporosis are: I. Balanced diet; II. Absence of bad habits; III. Occupation with health-improving physical culture. IV. Reduction of excess body weight (Awareness level: Group A - 69,2%; Group B - 47,1%; Analysis of Variation > 0,05). 6. Increased consumption of table salt, sugar and excessive consumption of protein foods, vegetarianism negatively affects the quality of bone tissue (Awareness level: Group A - 56,7%; Group B - 70,4%; Analysis of Variation > 0,05).Conclusion:The conducted survey shows that the level of awareness of osteoporosis and its prevention is low among women in different age groups. In some cases, it is even a cause for concern. We believe that respondents’ statements that osteoporosis cannot be effectively prevented are the most important findings of our study. Starting from adolescence, women should be well aware of the main risk factors for the development of osteoporosis, the mechanisms of its development and its consequences. This knowledge will help substantiate why it is necessary to lead a healthy lifestyle, which will help to prevent the development of this disease in the future. The concept of prevention of osteoporosis should include the following recommendations for the general population: to maintain a physically active lifestyle and to spend sufficient time under the influence of sunlight, avoid smoking and drinking large amounts of alcohol, ensure that dietary calcium intake is in line with the recommended level in the area, and maintain an appropriate body weight.Disclosure of Interests:None declared

Background:Vitamin D deficiency is highly prevalent in patients with systemic lupus erythematosus (SLE). Vitamin D acts through the vitamin D receptor (VDR) that is present in most cells, and it can regulate the transcription of over 200 genes. The expression of vitamin D receptors by a variety of cells belonging to the innate and adaptive immune systems has created interest with regards to the role of vitamin D in the pathogenesis of SLE. Several polymorphisms of the VDR gene have been described, namely Bsml, Apal, Taql and Fokl. A number of VDR gene polymorphism genotypes have been associated with increased risk of SLE mostly in Asians and Africans.1Objectives:The aim of this study was to establish whether an association was present between VDR gene polymorphisms and SLE susceptibility in a cohort of SLE patients living in Malta. A further aim was to assess the relationship between these VDR gene polymorphisms and SLE disease characteristics.Methods:59 SLE patients living in Malta and attending Rheumatology clinic at Mater Dei Hospital were recruited for the study after providing informed consent. The patients were over the age of 18 years and fulfilled the SLICC classification criteria for SLE. The patients were interviewed and blood samples were taken. RNA extraction was performed from whole blood. QuantiGene Plex technology was used to measure the expression of 12 interferon (IFN) signature genes in the extracted RNA.93 cord blood samples obtained from individuals living in Malta were used as a control. DNA extraction was carried out from the blood samples obtained from the patients and controls. The VDR gene was screened and the regions containing the VDR polymorphisms were amplified for each patient. The amplified regions were then digested with their respective restriction enzymes in order to view the patient’s genotype via restriction fragment length polymorphism. Statistical analysis, including odds ratio (OR), was carried out to gauge the significance in the association of these polymorphisms with SLE.Results:94.9% of SLE patients were female and they had a mean age of 44.5 years. All the patients were of Caucasian ethnicity. 13.6% had vitamin D deficiency (serum 25-hydroxyvitamin D The patients who were homozygous for the variant allele for BsmI had a significantly higher SLE disease activity index-2K (SLEDAI-2K) (mean 5.00) compared to those that were heterozygous (mean 2.66; p=0.010). No significant difference was noted in damage, IFN signature gene expression, organ manifestation and autoantibody profile between the different genotypes for the 4 VDR polymorphisms. SLE patients who were homozygous variant for the ApaI or TaqI polymorphisms had an increased prevalence of fibromyalgia (OR=7.50, CI 1.47-38.16, p=0.02 and OR=12.00, CI 1.80-80.05, p=0.02 respectively).Conclusion:The study showed that in the Maltese population the presence of the VDR gene polymorphism haplotype containing all wild-type alleles and the haplotype containing all wild-type alleles with the variant allele for FokI are associated with an increased risk of SLE. Moreover the homozygous variant genotype for BsmI was associated with a higher SLE disease activity. The homozygous variant genotype for ApaI and TaqI was associated with a higher risk of fibromyalgia in SLE patients.References:[1]Zhou TB, Jiang ZP, Lin ZJ, Su N. Association of vitamin D receptor gene polymorphism with the risk of systemic lupus erythematosus. J Recept Signal Transduct Res. 2015;35(1):8-14.Acknowledgements:The Faculty of Medicine and Surgery, University of Malta provided funding for this research.Disclosure of Interests:None declared

Background:Primary hyperparathyroidism (PHPT) is a common endocrine condition, commonly seen with increasing age. In vast majority, it is diagnosed incidentally and causes no particular symptoms. Symptoms are usually related to acute hypercalcaemia or the complications of chronically elevated serum calcium level. Vitamin D deficiency is common among general population and in patients with PHPT. Studies in secondary hyperparathyroidism (SHPT) have shown that parathyroid hormone (PTH) response is affected by age, with those over 80 showing greater rise in PTH levels. We wanted to see if age has a similar impact on PTH response to vitamin D in those with PHPT.Objectives:To evaluate the impact of age on PTH response to vitamin D insufficiency in those with PHPT.Methods:Patients with primary hyperparathyroidism (PHPT), attending general endocrine clinic of a district general hospital, were divided into two groups based on age; less than 70 (n=73) and 70 and above (n=61).Each group was subdivided into vitamin D insufficient (VDI) and vitamin D sufficient (VDS) subgroups. We compared calcium and parathyroid hormone levels and forearm BMD (presented as T score) in VDI and VDS subgroups in the two age groups, at the time of diagnosis. Data were analyzed using unpaired t-test and presented as mean ± SEM, using Graphpad Prism 9.0.1.Results:There was significant difference in Vitamin D levels in VDI and VDS subgroups, in both age groups (Conclusion:While in SHPT, those with increasing age show greater rise in PTH levels, our data show that in PHPT, younger patients show a greater PTH rise in response to vitamin D insufficiency. Further work is needed to elucidate the underlying mechanisms.References:[1]Wyskida et al., Parathyroid hormone response to different vitamin D levels in population-based old and very-old Polish cohorts, Experimental Gerontology, Volume 127, 2019, 110735, ISSN 0531-5565, https://doi.org/10.1016/j.exger.2019.110735.[2]Malik M Z, Latiwesh O B, Nouh F, et al. (August 15, 2020) Response of Parathyroid Hormone to Vitamin D Deficiency in Otherwise Healthy Individuals. Cureus 12(8): e9764. doi:10.7759/cureus.9764Disclosure of Interests:None declared.

Background:Vitamin D has proven skeletal effects and its administration is recommended in patients with osteoporosis by many national and international guidelines. Nevertheless, the compliance to treatment of patients with osteoporosis is scarce. Understanding the factors associated with low vitamin D intake and prescription might help design future intervention aimed to improve adherence.Objectives:This study aims to investigate the temporal trends and factors associated with vitamin D prescription and intake.Methods:Using a web-based fracture risk-assessment tool, we collected demographic, densitometric and clinical data of women at high risk for fractures. To determine the factors associated with low vitamin D intake we ran a multivariable logistic regression analysis. We described the public general interest in the term “vitamin D” using the Google Trends tool.Results:12,419 women were included in the study. 6,748 (54.4%) individuals had a prevalent fragility fracture and 8,950 (72.1%) individuals were on Figure 1.Google trends interest in the term “vitamin D” from January 2010 to October 2020Conclusion:Low vitamin D intake (Table 1.Binary logistic regression to predict the risk of low vitamin D intake (>800 IU day REFaOR (95% CI)p value400-800 IU dayAge1.001 (0.995-1.007)NST-score1.422 (1.342-1.508)No comorbiditiesREFRheumatoid arthritis0.732 (0.583-0.920)Psoriatic arthritis0.362 (0.218-0.607)Connective tissue disease0.630 (0.486-0.816)No cigarette smokingREFCigarette smoking1.040 (0.893-1.212)NSAlcohol REFAlcohol ≥3 unit day1.201 (0.660-2.187)NSNo glucocorticoidsREFGlucocorticoids 2.5-5 mg/day0.688 (0.550-0.860)Glucocorticoids ≥5 mg/day0.739 (0.554-0.986)No fallsREFFalls0.875 (0.754-1.015)NS250-400 IU dayAge0.994 (0.985-1.002)NST-score1.223 (1.117-1.339)No comorbiditiesREFRheumatoid arthritis0.670 (0.463-0.970)Psoriatic arthritis0.300 (0.119-0.752)Connective tissue disease0.651 (0.435-0.975)No cigarette smokingREFCigarette smoking1.371 (1.104-1.702)Alcohol REFAlcohol ≥3 unit day1.824 (0.865-3.887)NSNo glucocorticoidsREFGlucocorticoids 2.5-5 mg/day0.930 (0.666-1.297)NSGlucocorticoids ≥5 mg/day0.743 (0.464-1.189)NSNo fallsREFFalls0.934 (0.741-1.176)NSAge0.993 (0.988-0.998)T-score1.139 (1.079-1.202)No comorbiditiesREFRheumatoid arthritis0.645 (0.522-0.795)Psoriatic arthritis0.553 (0.376-0.812)Connective tissue disease0.697 (0.558-0.871)No cigarette smokingREFCigarette smoking1.339 (1.171-1.532)Alcohol REFAlcohol ≥3 unit day1.267 (0.749-2.145)NSNo glucocorticoidsREFGlucocorticoids 0.964 (0.796-1.168)NSGlucocorticoids ≥5 mg/day0.946 (0.736-1.215)NSNo fallsREFFalls0.615 (0.530-0.712)Disclosure of Interests:None declared.

Background:Spondyloarthritis is a group of chronic inflammatory diseases with involvement of the axial skeleton (mainly), and also of peripheral joints. Patients with spondyloarthritis have a significant prevalence of vitamin D levels below normal and that would correlate with the degree of activity of the disease.Objectives:To determine the association between vitamin D deficiency and the degree of activity of the disease (inflammatory activity) in a cohort of patients with spondyloarthritis.Methods:Case-control type analytical observational study. We propose a retrospective review of the database of patients with spondyloarthritis (according ASAS2010 criteria) who were treated in the outpatient clinics of the Rheumatology Service of the General University Hospital of Ciudad Real during June 2018 to June 2019. Patients with the data will be selected. necessary for the analysis of the variables under study. The numerical variables of normal distribution evaluated will be described using measures of frequency and measures of central tendency / dispersion as appropriate. To assess the association between vitamin D levels and activity index, the odds ratio (OR) is calculated, with a 95% confidence level and the T-student for related samples.Results:The final results of the study are presented. 115 patients were analyzed, of which 64 were men and 51 women, with an average age of 45.97 years (+/- 13.41 DE). 47% were ankylosing spondylitis, 21% psoriatic arthropathy, 16% undifferentiated spondyloarthritis, 7% spondyloarthropathy associated with inflammatory bowel disease and 9% were spondyloarthropathy associated with inflammatory bowel disease. The average of the activity was a BASDAI of 4.57 (+/- 2.35 SD) and measured by DAPSA was 12.61 (+/- 6.76 SD). 63 and 14 patients had activity measured by BASDAI and DAPSA, respectively. 49.56% patients presented an elevation of acute phase reactants. Vitamin D levels were 23.81 (+/- 10.5 SD). 77.4% presented figures of vitamin D deficiency or insufficiency. When performing the association analysis, the vitamin D deficit / insufficiency presented an OR 10 (95% CI: 3.66-27.29, p=Conclusion:Patients with spondyloarthritis, as in other autoimmune diseases, vitamin D deficiency is associated with increased inflammatory activity (BASDAI, DAPSA, RCP and ESR), measured in different time periods. Therefore, an optimization of vitamin D levels can imply an improvement in the patient’s clinical situation, measured by both BASDAI and DAPSA, as well as by RCP and ESR.In addition, it is necessary to monitor bone mineral density due to the risk of fracture in these patients for their multietiology (corticosteroid treatments, biological FAMEs, inflammatory activity).References:[1]Lange U, Teichmann J, Strunk J, Müller-Ladner U, Schmidt KL. Association of 1.25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis. Osteoporos Int. 2005;16:1999-2004.[2]Durmus B, Altay Z, Baysal O, Ersoy Y. Does vitamin D affect disease severity in patients with ankylosing spondylitis? Chin Med J. 2012;125:2511-2515.[3]Mermerci Baskan B, Pekin Dogan y, Sivas F, Bodur H, Ozoran K. The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis. Rheumatol Int. 2010;30:375-381.Disclosure of Interests:None declared

Background:Osteoporosis is a common rheumatologic disorder in postmenopausal women which could lead to morbidities later in life. However, this condition has not been properly studied in premonapausal women.During pregnancy, the fetus needs a total of 30 grams of calcium for its skeleton and during lactation, 200 mg of calcium is secreted in the breast milk per day which the mother acquires by doubling its intestinal absorption rate. If the calcium intake of the mother is not sufficient to satisfy the fetus’ needs, it will be provided by bone resorption, which will decrease the maternal calcium reserves [1].Pregnancy and Lactation Associated Osteoporosis (PLAO) is a rare condition associated with pregnancy that should be considered in premenopausal women. The most commonly affected sites are the vertebrae and, more rarely, the hips, pubic rami and ribs [2].An important complication of osteoporosis is fracture and a preemptive diagnosis and treatment thereof, can have drastic effects on the quality of life.Objectives:Our objective is to document the relevant risk factors, present signs and symptoms, course of illness, and response to treatment in three cases of PLAO. It is quite possible that osteoporosis in pregnancyand lactation is more frequent than recognized, simply because it is only recognized when an-unexpected fracture occurs[3]. Thus, in this article we are presenting three cases that showcase the need for more rigorous research on PLAO risk factors, the need for screening in high risk patients, and the advantages of early detection in patients’ outcome.Methods:The clinical cases of the patients whose PLAO diagnoses had been confirmed by both a radiologist and a rheumatologist in the past year was extracted. Information related to demographic indices, clinical manifestations, and the treatment methods was evaluated and compared.Results:In the past year, three patients with a chief complaint of low-back pain have visited our clinic. The first, a 22-year-old woman with a nursing history of 2 months, the next one, a 31-year-old woman with a nursing history of 3 months, and the last, a 22-year-old woman with a nursing history of 4 months. All three patients had low back pain and tenderness. Two out of three patients had deficient vitamin D levels and the other had a normal one. All three patients had low BMD in lumbar vertebra and MRI imagings indicative of osteoporotic fracture.Table 1.General and pregnancy-relatedcharacteristics of the case studiesVariablesCase 1Case 2Case 3Age223122Nursing duration2 months3months4monthsBMD(lumbar spine)-3.6-3.5-3.1Vitamin D level12.6(ng/ml)31.6(ng/ml)8(ng/ml)FractureT12,L1T4,5,6,7,10,L2L1,2,3,4,5Conclusion:Since the symptoms of PLAO are often confused with pain in other low-back pain conditions associated with pregnancy, PLAO is a mostly overlooked diagnosis[4]. It is only recognized when an unexpected fracture occurs [3]Therefore, high risk patients with less severe symptoms are usually not diagnosed and thusly, should undergo a proper screening test, so that they are recognized early and the morbid sequelae are averted.References:[1]Kovacs, C. S., and S. H. Ralston. “Presentation and Management of Osteoporosis Presenting in Association with Pregnancy or Lactation.”Osteoporosis International, vol. 26, no. 9, 2015, pp. 2223–2241., doi:10.1007/s00198-015-3149-3.[2]Gregorio, Silvana Di, et al. “Osteoporosis with Vertebral Fractures Associated with Pregnancy and Lactation.”Nutrition, vol. 16, no. 11-12, 2000, pp. 1052–1055., doi:10.1016/s0899-9007(00)00430-5.[3]Bartl, Reiner, and Christoph Bartl. “The Osteoporosis Manual.” 2019, doi:10.1007/978-3-030-00731-7.[4]Eroglu, Semra, et al. “Evaluation of Bone Mineral Density and Its Associated Factors in Postpartum Women.”Taiwanese Journal of Obstetrics and Gynecology, vol. 58, no. 6, 2019, pp. 801–804., doi:10.1016/j.tjog.2019.09.013.Disclosure of Interests:None declared

Background:Several studies have shown an inverse relationship between vitamin D levels (25OHD) and disease activity in patients with rheumatoid arthritis (RA). However, the existing data in patients with psoriatic arthritis (PsA) are poor, and they use the DAS28 index as a peripheral joint activity marker by extrapolation with RA.Objectives:To analyze the relationship between 25OHD levels, disease activity and functional capacity in patients with PsA.Methods:Transversal, observational, descriptive study. We included PsA patients with peripheral joint involvement. We collected demographic variables (gender, age), clinical variables [follow-up, received treatments, TJC (68), SJC (68), VAS] and analytical variables (25OHD, CRP, ESR). We usedDisease activity in psoriatic arthritis(DAPSA) score to measure disease activity, and theHealth assessment questionnaire(HAQ) to determine functional capacity. Levels of 25 OHD Results:125 patients were included, the majority women (60.8%), with an average age of 55.4 (SD 12.2) years. The average follow-up was 75.5 (SD 68.3) months. 97.6% of patients had received DMARDs and 40.8% biologics, and almost half of the patients (42.7%) took calcium and 25OHD supplements. The average value of 25OHD was 27.1 (SD 12.1) ng/ml, with 30% of patients having 25OHD deficit and 63.3% insufficiency. The majority of patients had an acceptable disease control, with a mean DAPSA of 10.5 (SD 7,9); and mean of CRP, ESR, TJC and SJC was 6.1 (SD 3.7) mg/l, 10.2 (SD 9.9) mm/h, 1.3 (SD 2.5) and 0.7 (SD 2.1), respectively. The average value of HAQ was 0.6 (SD 0.7). We observed an inverse correlation between 25OHD levels and joint counts, TJC (p=0.02) and SJC (p=0.03). On the other hand, patients with hypovitaminosis D presented a tendency to get higher scores in DAPSA index (P=0.07). We do not observe any relationship between 25OHD and HAQ.Conclusion:As can be seen in our sample, low values of 25OHD are related to increased disease activity in patients with PsA.Disclosure of Interests:L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

Background:Currently, most experts agree that levels of serum 25OH-Vitamin D (25OHD) lower than 20 ng/mL represent an acceptable threshold for deficiency (1). However, recommendations for vitamin D supplementation vary between scientific societies, and the best regimen to treat deficient patients is still not clear (1).Objectives:The aim of our study was to compare the pharmacokinetic profile of three different regimes of cholecalciferol supplementation in terms of 25OHD exposure and their safety profiles.Methods:We evaluated, in healthy subjects affected by vitamin D deficiency (defined as 25OHDResults:A total of 75 subjects were randomized to receive one supplementation regimen. The descriptive of the sample at baseline and relative 25OHD levels at the various observation points are reported in table 1. 25OHD increased significantly already at week 2 in all three groups (p=0.000). At week 2, 100% of the subject of the daily regimen group presented 25OHD levels >20ng/mL, 96% in the weekly and 88% in the biweekly ones.Table 1.mean values ± SD at the different observation points.ParameterDaily 10.000 Ui(N = 25)Weekly 50.000 Ui(n = 25)Biweekly 100.000 Ui(N = 25)p-valueM:F12:137:1812:13Age (years)30.2 ± 9.936.7 ± 8.735.4 ± 11.0*0.059Body Weight (kg)65.8 ± 13.267.8 ± 10.866.6 ± 13.7*NSHeight (m)1.7 ± 0.11.68 ± 0.11.7 ± 0.1*NSBMI22.55 ± 2.723.8 ± 2.222.8 ± 2.7*NSBaseline 25OHD (ng/mL)14.6 ± 3.912.8 ± 313.5 ± 4.1*NS25OHD week 232.3 ± 526.5 ± 3.425.6 ± 5a0.007b0.00025OHD week 455 ± 10.139.9 ± 4.236.9 ± 7.2a0.000b0.00025OHD week 879.1 ± 16.253.5 ± 7.246.4 ± 8.2a0.000b0.000c0.00125OHD week 12NA58.5 ± 7.850.6 ± 9.6b0.000c0.001*ANOVA test.aDaily 10.000 Ui vs weekly 50.000 Ui.bDaily 10.000 Ui vs Biweekly 100.000 Ui.cWeekly 50.000 Ui vs biweekly 100.000 Ui.In addition, the 25OH levels of the daily regimen group at week 8 were higher than both the ones of the weekly and the biweekly regimen groups both at week 8 and week 12 (pNo serious adverse event occurred.Conclusion:All the three different regimens proved to be effective in correcting vitamin D deficiency already after 1 months (2 weeks for the daily regimen). A more refracted approach seems to more effective than the bolus-based regimens. The safety profile was excellent in all groups.References:[1]R. Bouillon, Comparative analysis of nutritional guidelines for vitamin D, Nat. Rev. Endocrinol. 13 (2017) 466–479.https://doi.org/10.1038/nrendo.2017.31.Disclosure of Interests:Angelo Fassio Speakers bureau: Angelo Fassio reports personal fees from: Abiogen and Novartis, outside the submitted work., Giovanni Adami: None declared, Ombretta Viapiana: None declared, Giovanni Orsolini: None declared, Alessandro Giollo: None declared, Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work.

Background:Although many studies are calling into question the benefits commonly attributed to the vitamin D out of the bone sphere, in the recent years its determination and supplementation has been generalized in the population. Causes of this trend are not clear, but generalist media pressure or even specialized over patients and doctors, along with overrated normality levels could be contributing to this fact. Actual literature123indicates that 25-OH vitamin D levels of 30ng/ml or higher are not necessary, and most of the authors agree that 20ng/ml levels are enough for the general population, and only levels below 12.5ng/ml must be considered deficient and subsidiaries of supplementation.Objectives:Obtain the vitamin D levels distribution from a sample of individuals with no bone pathology, or supplementation prescription in Tenerife’s North Area.Methods:Retrospective descriptive study of the 25-OH vitamin D levels requests from the Tenerife’s North Area, made for any reason by the Primary Care Doctor or the rheumatologist, both in the Primary Care Centers and the Hospital Universitario de Canarias (HUC). 25-OH vitamin D values were gathered from 2662 blood samples from a total of 2635 patients, from September to November of 2018 (2241 from Primary Care and 421 from rheumatology). In order to determine the use of calcium and vitamin D supplements, and the presence of bone pathology, either renal or from a malabortive process, 400 individuals were randomized (250 from primary care and 150 from rheumatology. Demographic data (age and gender), calcium serum, phosphor and 25-OH vitamin D levels were gathered for the individual records. With regards to the treatment, data about vitamin D supplements, calcium with vitamin D, or the sum of both, that the patient may have in electronic prescriptions at that time; as well as osteoporosis treatment (biphosphonates, denosumab or teriparatide) were gathered.Results:Using the age, gender, male/female relation, the levels of vitamin D, calcium and phosphor, as comparison factors; the characteristics of the random population were statistically indistinguishable from the global population. Regarding the random sample characteristics, from the 150 rheumatology patients, 11 were men (7.3%) and 139 women (92.7%). While from the 250 primary care patients, 66 were men (26.4%) and 184 were women (73.6%). The average age of the primary care sample was 55.76±19.72 years and 65.16±13.84 years in the rheumatology sample.In the total random healthy population: without bone pathology, renal or malabortive and without calcium, vitamin D or antiresorptive drug (n=181) treatment, the levels of vitamin D were 31±14ng/ml with a normal distribution and without clear differences between the primary care and rheumatology patients. When the healthy population distribution was studied by vitamin D levels, the 55% presented values below 30ng/ml, 12% below 20ng/ml and 4% showed levels under 12.5ng/ml: levels agreed as deficient (see graph).Conclusion:The 55% of the patients studied in primary care and rheumatology, without renal, digestive or bone disease and without vitamin D supplement, presented vitamin levels below the actual limits of 30ng/ml. These limits, used by most of the laboratories, tend to overestimate the vitamin D deficiency.References:[1]Manson, JE. N Engl J Med 2018, DOI: 10.1056/NEJMoa1809944.[2]Spector, TD. BMJ 2016: 355: i6183[3]Wu, F. Osteoporosis International 2017; 28: 505-515.Disclosure of Interests:None declared

Background:Osteoporosis is a public health issue. Lack of therapeutic compliance is often a problem in the treatment of osteoroposis, with potentially dramatic consequences. No studies have evaluated the observance of zoledronic acid infusion after 3 years, the time of the therapeutic reassessment.Objectives:The main objective of assessing the level of compliance was to evaluate the level of zoledronic acid infusion adherence at 1, 2 and 3 year periods, in a cohort of osteoporotic patients on discharge from Begin hospital, following treatment for fracture caused by low-energy trauma. The first infusion was prescribed by rheumatologists, with the following infusions to be prescribed by general practitioners.Methods:We performed a retrospective observational study initially conducted by written and telephone questionnaires on a population of patients hospitalized in the rheumatology department of HIA Bégin for an osteoporotic fracture. Data was collected between July 2015 and December 2018. A first letter, containing a stamped addressed envelope to the Bégin hospital for ease of reply, was sent to the patients selected for the study. The protocol had to be modified following a very low response rate, unaided by bad quality addresses. We then tried to contact the patients by phone 3 times and, if unable to reach them, we called their general practitioners on 3 occasions.Results:94 patients were initially selected. Every year, we retained within the study patients who had followed their annual zoledronic acid infusion protocol. Taking into account all 94 patients, adherence level for the first infusion was 41.4%, down to 29.7% for the second infusion and down to 12.8% for the third infusion.For those who had the first infusion performed, adherence level for the second infusion was 71.8%, down to 30.8% for the third infusion.Conclusion:The observance and follow-up of zoledronic acid infusion in France by general practitioners is not adequate. Follow-up measures on an annual basis by the rheumatologist could significantly improve adherence.References:[1]Curtis JR et al. Adherence with intravenous zoledronate and intravenous ibandronate in the United States Medicare population. Arthritis care & research. 2012;64:1054-60.[2]Jaleel A et al. Improving drug adherence in osteoporosis: an update on more recent studies. Therapeutic advances in musculoskeletal disease. 2018;10:141-9.Acknowledgments:NoneDisclosure of Interests:None declared

Background:25OH Vitamin D (25-OH-D3) is a fat-soluble steroid-derived molecule involved in the calcium homeostasis. Low levels of 25-OH-D3 are commonly found in patients with systemic lupus erythematosus (SLE) and have been correlated to higher disease activity and severity. Several recent studies have demonstrated that high dose Vitamin D may influence several aspects of the innate and adaptive immune response and some authors hypothesized that high dose 25-OH-D3 may have a role in the treatment of SLE. Despite these observations, the immunomodulatory effect of high dose 25-OH-D3in vivostill needs to be demonstrated.Objectives:The aim of our study was to identify the effect of 25-OH-D3 on proteinuria, survival and renal biopsy in New Zealand Black/White F1 mice (NZ), that develop a disease very similar to human SLE nephritis.Methods:We administered to 20 NZ mice a diet enriched with high dose 25-OH-D3 10,000 UI/Kg starting from 8 weeks of age. Mice were divided in 7 experimental groups (5 mice each). The first group was sacrificed before the start of the treatment (8 week of age), three groups were treated (treated mice – TM) with 25-OH-D3 and sacrificed at 16, 26 and 36 weeks of age. The other three groups were enrolled as controls and sacrificed at 16, 26 and 36 weeks of age respectively (untreated mice – UM). The parameters collected included: total urinary protein and kidney histology for the evaluation of lupus nephritis (LN): glomerulonephritis, interstitial nephritis and vascular lesions according to a 5 points scale to obtain a total score (ranging from 0 to 12).Results:In UM, proteinuria tended to increase over 1 mg/day at 12 weeks of age (1.7±0.43mg/day) and further increased until to reach a plateau after 28 weeks of age (10±2.0 mg/day).In TM, a significant increase in proteinuria over 1 mg/day was observed at 24 weeks, when the mean proteinuria was 1.7±1.33 which was lower than controls at the same age although without statistical significance (2.9±2.6); thereafter proteinuria started to increase also in treated mice and at week 30 was higher in TM compared with UM (10,3±8.8 vs 4.3±3.5 p=0.05). Figure 1.Kidney histology showed, in mice sacrificed before the start of the treatment no signs of LN. In mice sacrificed at 16 weeks minimal interstitial nephritis (score 1) was identified in 2 mice only in UM. At 26 weeks of age, a higher total LN score was identified in TM compared with UM (3.4±3.8 vs 0.4 ±0.9) with higher score for all three parameters analyzed. At 36 weeks of age, the TM group maintained a higher total LN score compared to UM (6.5±1.7 vs 6.0±2.6) with higher score for glomerulonephritis and interstitial nephritis.In the TM group, three mice spontaneously died at 26, 30 and 32 weeks of age, while in the UM only one mouse died at 36 weeks of age.Conclusion:Our data suggest that, in this animal model of SLE, 25-OH-D3 administration seems to delay the onset of proteinuria, although has no effect on the overall disease control. In addition, it may have a negative effect on renal histology and survival with earlier development of LN.Figure:Disclosure of Interests:None declared

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 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 (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

Background:Osteoporosis (OP) is the most common cause of fragility fractures. It is characterized by a loss of bone mass that modifies the bone microstructure, increases fragility and predisposes to fractures. There are numerous risk factors for fragility fracture that must be evaluated for diagnosis and treatment. The treatment consists of non-pharmacological measures (balanced diet and exercise), adequate intake of calcium and vitamin D and specific pharmacological treatment (bisphosphonates, teriparatide, denosumab or selective estrogen receptor modulator) 1-3.Objectives:To perform a descriptive evaluation of the demographic and clinical characteristics of patients with osteoporosis treated with Denosumab, their degree of compliance with the therapy as well as the evaluation of the possible causes of treatment cessation.Methods:All patients diagnosed with OP from January 2015 to January 2020 have been reviewed in the Rheumatology Service of the University Hospital of Santiago de Compostela and patients treated with denosumab have been selected. Demographic, clinical and treatment data have been collected from data collected in their electronic medical recordResults:Of the 507 patients diagnosed with Osteoporosis from January 2015 to January 2020, a total of 133 patients (26.2%) have received treatment with Denosumab. The majority are women (92.5% n = 122) with a mean age of 76 years (age range: 49-105 years). Previously, 38% (n = 51) had vertebral fractures, with 8% (n = 11) standing out who had presented 3 or more vertebral fractures prior to Denosumab treatment.The mean time to start Denosumab therapy since the diagnosis of Osteoporosis (by Densitometry or established by fractures) has been 35 months (0 to 84 months from diagnosis)Through the electronic Medical Record the dispensations were accessed in the Denosumab pharmacy office and its administration in Primary Care was verified. Complete adherence to treatment (without skipping any dose) was observed in 73% of patients (n = 97). In 5.2% (n = 7) an omission was avoided. In 21.8% (n = 29) 2 or more dose omissions were corroborated 9 patients (6.8%) completed treatment with Denosumab in the follow-up period (55% due to the need for dental interventions, 33% for loss of follow-up and 12% for fear of secondary effects).In 66 patients (49.6%) risk factors were identified to present Osteoporosis; being corticosteroid therapy at doses greater than 5 mg / day of Prednisone or equivalent (26% n = 33) the most frequently identified risk factor.No vertebral fractures were registered at the end of treatment with Denosumab, with an average time since the end of treatment of 2.77 years (6 months - 8 years).Conclusion:The rate of patients diagnosed with Osteoporosis who receive Denosumab therapy at some time reaches 26%, being the most frequent drug used after bisphosphonates.Complete adherence to treatment has been observed in 73% of patients.We have not observed vertebral fractures after suspension of Denosumab in our series of patients, although the total exposure time (from the end of treatment to the end of follow-up) is short: 2.77 yearsReferences:[1]Passini M. Osteoporosis diagnosis and treatment. Rev Bras Ortop. 2010;45(3):220-229.[2]Lems WF, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017;76:802-810.[3]Naranjo A, et al. Recomendaciones de la Sociedad Española de Reumatología sobre osteoporosis. Reumatol Clin. 2019;15(4):188-210.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a chronic autoimmune condition affecting almost 1% of the general population (1). Pharmacological management has been the mainstay of treatment for RA and includes DMARDs and biologics. Despite these therapies, anywhere from 28-90% of patients with RA use complementary and alternative medicine (2). These non-pharmacological therapies range from dietary interventions to supplements to nonprescription therapies.Objectives:To determine the efficacy of non-pharmacological, orally-ingested interventions on clinically-relevant endpoints in patients with rheumatoid arthritis.Methods:We systematically reviewed EMBASE and MEDLINE electronical databases from inception until Feb 23, 2019 for relevant articles. Only randomized controlled trials (RCTs) which assessed oral, non-pharmacological interventions (e.g. diets, vitamins, oils, herbal remedies, fatty acids, supplements, etc.) in adult patients with RA, that presented clinically-relevant outcomes (defined as pain, fatigue, disability, joint counts, and/or disease indices) were included.Clinical outcome data was extracted by two independent authors as difference from baseline measurement. Therapies with at least 3 RCTs which presented data on the same clinical outcome were meta-analyzed using a pooled random effects model using RevMan 5.Results:A total of 4423 unique articles were independently assessed by two authors, of which 72 articles met our inclusion criteria. Thirteen different interventions were studied more than once, and six interventions had clinical outcomes reported in at least 3 trials. However, only vitamin D and fatty acids met criteria for meta-analysis.Pooled random effects models suggested vitamin D supplementation improved HAQ scores from baseline (mean difference = -0.10, 95% confidence interval (CI) = -0.17 to -0.02; p=0.01) but had no effect on DAS28 scores (Table 1).Table 1.Mean differences from baseline of various clinical outcomes in RA patients taking vitamin D or fatty acid supplementation compared to control group.Clinical OutcomeTotal PatientsMean Difference (95% CI)P-valueVitamin DHAQ573-0.10 (-0.17 to -0.02)0.01DAS28174-0.30 (-0.71 to 0.11)0.15Fatty AcidsTJC661-2.05 (-2.83 to -1.27)0.04SJC582-0.35 (-0.96 to 0.26)0.26RAI234-1.82 (-4.69 to 1.05)0.21Pain756-0.61 (-1.02 to -0.20)0.004Patient Global484-0.26 (-0.59 to 0.07)0.12Physician Global382-1.08 (-1.98 to -0.18)0.02HAQ277-0.13 (-0.18 to -0.09)DAS28543-0.19 (-0.36 to -0.01)0.03Fatty acid supplementation improved total joint counts, pain, physician global assessment scores, HAQ, and DAS28 from baseline (Table 1). There were significantly more patients who achieved ACR20 criteria (Relative Risk Ratio = 2.73, 95% CI 1.62-4.58; pFigure 1.Forest plot of studies in which RA patients taking fatty acids achieved ACR20 criteria.https://account-congress.eular.org/Modules/Abstract/Submission/summary.aspxConclusion:From our meta-analysis, vitamin D and fatty acids supplementation showed statistically significant improvement in some clinical outcomes in patients with RA; however, the degree of improvement is unlikely to be clinically significant.Overall, many trials were of low quality and had high risks of bias including inadequate reporting of data. Further clinical trials that are well-designed and fully powered are still needed to confirm the efficacy of many supplements and diets in RA.References:[1]Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007.Arthritis Rheum. 2010;62(6):1576–1582. doi:10.1002/art.27425[2]Efthimiou P, Kukar M, Mackenzie CR. Complementary and alternative medicine in rheumatoid arthritis: no longer the last resort!.HSS J.2010;6(1):108–111. doi:10.1007/s11420-009-9133-8Disclosure of Interests:Yideng Liu: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Matthew Turk: None declared

Background:Osteoporosis is a skeletal disease characterized by the loss of bone density resulting in an increased fracture risk. Female sex, advanced age, Caucasian ancestry, previous history of fractures, menopause and certain genetic factors predispose for osteoporosis. In addition, recent studies could prove that chronic inflammatory diseases such as Rheumatoid Arthritis (RA) and long-term treatment with higher doses of glucocorticoids (GCs) represent independent risk factors for the development of osteoporosis. On the other hand, the intake of vitamin D, a calcium-rich diet and physical exercise can be protective. Data describing the prevalence of osteoporosis in patients with other rheumatic diseases like psoriatic arthritis (PsA) are lacking.Objectives:We compared the prevalence of osteopenia and osteoporosis in patients with RA and PsA, respectively, based on data obtained from our ongoing prospective monocentric study Rh-GIOP investigating glucocorticoid (GC)-induced osteoporosis in patients with different rheumatic diseases (NCT02719314).Methods:Bone mineral density data measured by dual x-ray absorptiometry (DXA) in patients with PsA (n=92) were compared with data measured in 92 age- and gender-matched patients with RA. The results were analysed with respect to clinical and laboratory parameters such as data on GC treatment (frequency, duration defined as start of treatment until timepoint of measurement, actual and cumulative dose), csDMARD and bDMARD (including as well tsDMARDs) therapy, serological parameters (Vitamin D, alkaline phosphatase, calcium, inflammatory markers and rheumatoid factor) and functional status (e.g. Health Assessment Questionnaire (HAQ), sporting activities). Statistical analyses were performed descriptively using mean and standard deviation, t-tests for metric variables, and chi-square tests for nominal variables. For subgroup analyses with less than 30 patients per group, tests for non-normally distributed data were used due to the lower test power.Results:RA patients showed significantly lower means of bone density values (minimal T-score, p=0.03) than PsA patients leading to a higher frequency of osteopenic bone densities (pConclusion:The lower bone density in RA patients seems not to be fully explained by higher GCCD, disease duration or higher levels of inflammation. However, RA patients had a higher frequency of current GC intake. Additionally, differences in bone density between the two groups could be related to the higher number of bDMARD therapies in PsA patients, but further investigations like multivariate analyses with higher numbers of patients are necessary. Furthermore there is more need for research on possible molecular and genetic factors in PsA, which are protecting from low bone density.Disclosure of Interests:Desiree Freier: None declared, Edgar Wiebe: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Timo Gaber: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

Background:Osteoporosis is one of the most important adverse effects of glucocorticoids in patients with systemic lupus erythematosus (SLE). Because osteoporosis is accelerated by chronic kidney disease (CKD), more attention should be paid to the treatment for osteoporosis in SLE patients with CKD. Many treatment options for osteoporosis have emerged recently, but treatment status in patients with SLE is not elucidated.Objectives:The purpose of this study is to elucidate the treatment status for osteoporosis in patients with SLE among the CKD stages.Methods:Using data from lupus registry of nationwide institutions (LUNA), a cross-sectional analysis was performed. We firstly described treatment status for osteoporosis in all enrolled patients. Secondary, treatment status for osteoporosis was compared among CKD stages. Finally, bone damage in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was compared among CKD stages.Results:The median age (interquartile range [IQR]) of enrolled 917 patients was 44 (34- 57) years and 809 patients (88%) were female. CKD stages were follows: CKD stage 1, 234 (26%); CKD stage 2, 465 (51%); CKD stage 3, 189 (21%); CKD stage 4, 9 (1%); CKD stage 5, 16 (2%). Median (IQR) age, female sex, and median (IQR) previous maximum dose of prednisolone in patients with and without CKD (≥CKD stage 3) were 56 (46.5-66) and 41 (32-50), 191 (89%) and 615 (88%), and 40 (30-60) and 40 (30-55) mg/day, respectively. Bisphosphonate was administered in 388 (42%) patients, vitamin D supplements in 448 (49%), Ca supplements in 36 (4%), denosumab in 20 (2%) and teriparatide in 14 (2%), respectively. Of enrolled patients, any treatment for osteoporosis was not administered in 226 (25%) patients. In spite of more frequent bone damage in patients with CKD compared to those without CKD (15% vs 10%, p=0.036), treatment status did not differ between patients with and without CKD (bisphosphonate: 41% vs 46%, p=0.29; vitamin D supplements: 50% vs 44%, p=0.14).Conclusion:About a quarter of patients with SLE did not take any treatment for osteoporosis. Treatment for osteoporosis might be strengthened to prevent bone damage in SLE patients with CKD.Disclosure of Interests:KEN-EI SADA Speakers bureau: I received speaker’s fee from GSK and Astra Zeneca K.K., Keigo Hayashi: None declared, Yosuke ASANO: None declared, Yu Katayama: None declared, Sumie Hiramatsu Asano: None declared, Keiji Ohashi: None declared, Michiko Morishita: None declared, Haruki Watanabe: None declared, Mariko Narazaki: None declared, Yoshinori Matsumoto: None declared, Nobuyuki Yajima: None declared, Ryusuke Yoshimi: None declared, Yasuhiro Shimojima: None declared, Shigeru Ono: None declared, Hiroshi Kajiyama: None declared, Kunihiro Ichinose: None declared, Shuzo Sato: None declared, Michio Fujiwara: None declared, Jun Wada: None declared

Background:Vitamin D is known for its immunomodulatory and epigenome interacting effects. Vitamin D deficiency is frequently observed in rheumatoid arthritis (RA) patients compared to healthy controls, is also named as a potential risk factor in RA ethiopatogenesis and may alter DNA methylation of certain genes [1,2]. Still, causality of vitamin D deficiency in RA patients needs to be elucidated.Objectives:The aim of the study was to evaluate relationship between DNA methylation status of vitamin D related genes (VDR,CYP24A1,CYP2R1), miRNA-155 expression, vitamin D level and its association with RA.Methods:CpG islands in promoter region of theVDR,CYP24A1,CYP2R1genes were chosen for DNA methylation analysis by means of pyrosequencing. DNA from blood mononuclear cells of 31 RA patients and 31 age and sex matched healthy controls was assessed for methylation pattern after informed consent was obtained in Vilnius university Hospital Santaros klinikos Centre of Rheumatology. For miRNA analysis quantitative reverse transcription PCR was used. Chemiluminescent microplate immunoassay was used to asses 25(OH)D serum levels.Results:25(OH)D concentrations varied from deficiency (CYP24A1methylation level was significantly higher in comparison toVDR(pCYP2R1(pCYP24A1hypermethylation was also observed in older subjects (p=0.012). The study demonstrated a significant positive correlation between vitamin D concentration andVDR,CYP2R1genes methylation intensity (r2=0.31, p=0.014; r2=0.25, p=0.042, respectively). However, gene methylation frequency and methylation intensity showed no significant difference between RA patients and healthy controls (VDR– 2.4vs2.6 %,CYP24A1– 16.6vs15.3 %,CYP2R1– 2.6vs2.6 %) (p>0.05). To note, miRNA-155 expression negatively correlated withCYP24A1methylation intensity (r2=-0.43, p=0.009).Conclusion:Our study identified significant associations between theVDRandCYP2R1promoter methylation and vitamin D concentration. However, no significant differences in DNA methylation pattern between RA patients and healthy controls were detected. MiR-155 expression was associated withCYP24A1methylation level, confirming its possible involvement in vitamin D metabolism. The data of our study suggests that epigenetic phenomena are significantly involved in vitamin D metabolism and may have an indirect effect on RA ethiopatogenesis.References:[1]Jeffery LE, et al. Nat Rev Rheumatol. 2016,12.4:201.[2]Fetahu IS et al. Front Physiol. 2014,5:164.Acknowledgments:This project has received funding from the Research Council of Lithuania (LMTLT), agreement No. S-MIP-17-12.Disclosure of Interests:None declared

Background:Systemic sclerosis (SSc) is characterized by early vascular involvement and by varying degrees of fibrosis in skin, lungs, and other tissues. Vascular manifestations include Raynaud’s phenomenon, digital ulcers, and pulmonary hypertension (PAH). The prevalence of PAH is 7.85–13% in SSc and it is the second most common cause of mortality in SSc. Circulating CD34+ cell number is associated to cardiovascular health status in several chronic conditions, including inflammatory disease. CD34+ cell number was found inconstantly reduced in SSc. Endocan is a proteoglycan expressed by endothelial cells likely interacting with white blood cells, recently suggested as a marker of vascular stress.Objectives:to evaluate CD34+ cell number and endocan as a markers od cardiovascular involvement in SSc.Methods:Standard transthoracic echocardiography, Rodnan skin score were performed. Vitamin D levels, CD34+ cell number, markers of inflammation, red blood cells distribution width (RDW) and Endocan plasma levels were also determined.Results:37 female SSc patients (11 diffuse/26 limited) and 35 matched healthy controls (HC) were enrolled. CD34+ cell count was lower as compared to controls (2.3±0.73 vs 2.9±0.6; pConclusion:In our study population, we found a significant correlation between CD34+ cell number and Endocan plasma levels and PAPs; Endocan and CD34+ progenitor cells might be suggested as potential marker of pulmonary arterial hypertension in SSc patients.References:[1]Lo Gullo et al. Atherosclerosis 2018Disclosure of Interests:Alberto Lo Gullo Speakers bureau: bayer, Davide Sinicropi: None declared, Mara Cinquegrani: None declared, Francesca Savarino: None declared, Clemente Giuffrida: None declared, Giovanni Squadrito: None declared, Giuseppe Mandraffino: None declared

Background:Chronic kidney disease-mineral and bone disorder (CKD-MBD) is complex and management can be difficult. We aimed to compare management of our CKD patients to 2018 KDIGO guidelines. The guidelines suggest checking calcium and phosphate (Ca/PO4) within 12 mths in CKD 3a and 3b, within 6 mths for CKD 4, and within 3 mths for CKD 5. Parathyroid hormone (PTH) should be checked at baseline in CKD 3a-b, within 12 mths in CKD 4 and within 6mths in CKD 5. Alkaline phosphatase (ALP) should be measured within 12 mths in CKD 4 and 5. 25-(OH)D levels ‘might’ be measured at baseline in CKD 3a to 5D. BMD scanning is suggested if the result will impact treatment decisions. Lateral abdominal X ray is recommended as an alternative to CT for detection of vascular calcification. Calcitriol and vitamin D analogues are no longer routinely advised in CKD 3a-5; 25-(OH)D insufficiency should be corrected as in the normal population.Objectives:To compare management of our CKD patients to 2018 KDIGO guidelinesMethods:We randomly selected 70 patients in whom data was available from renal clinics between May and September 2019.Results:Mean age was 67.3 yrs. 41 male, 29 female. 33 patients had CKD 3a-b; 31 had CKD 4; 6 had CKD 5. Mean duration of CKD was 10.6 yrs. 10 patients were taking activated vitamin D analogues; 13 were taking 25-(OH)D analogues. 25-(OH)D levels ranged from 24-158 nmol/L (mean 65nmol/L). PTH levels ranged from 2- 69pmol/L (mean 23pmol/L). 3 patients were taking bisphosphonates. 44 had previous lumbar spinal imaging; vertebral fractures were evident in 4 (9%). 12 patients had had DXA scans; lowest T score was -2.5. Table 1 - tests within suggested time frames:CKD 3a-3bCKD 4CKD 5Ca/ PO433 (100%)29 (93%)6 (100%)ALP33 (100%)31 (100%)6 (100%)PTH14 (42%) (ever)8 (26%)3 (50%)25-(OH)D8 (24%) (ever)8 (26%) (ever)1 (14%)(ever)Conclusion:Optimum PTH levels in CKD patients are not known, and therapeutic options in CKD-MBD often limited. Nevertheless, our results suggest that bone biochemistry could be checked more consistently in CKD patients. Although detection of vascular calcification may not alter renal management, abdominal imaging provides an opportunity to screen for vertebral fracture, present in a significant number of our patients. The KDIGO guidelines offer a framework to work with our renal colleagues, as many patients will be jointly managed.References:[1]Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney[2]Disease–Mineral and Bone Disorder: Synopsis of the Kidney Disease:[3]Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Int Med 2018Disclosure of Interests:NATALIA CERNOVSCHI: None declared, SHABEENA ZEB: None declared, TRACEY SALTER: None declared, MARK LLOYD Speakers bureau: £700 into department fund

Background:The association between hyperuricemia and psoriatic arthritis (PsA) is actually generally accepted. Previous studies have demonstrated that uric acid suppress 25(OH)D metabolism [1]. More evidence is required to demonstrate the immune modulatory effects in psoriasis, psoriatic arthritis and other autoimmune diseases. In particular, the potential association between 25-hydroxyvitamin D serum levels and PsA still remains unknown.Objectives:To assess a clinical association between uric acid/25(OH)D serum levels ratio related to PASI, BASDAI and DAPSA, if any, in patients with psoriatic arthritis.Methods:We retrospectively observed 61 patients with psoriatic arthritis referred to our outpatients clinic, independently from already being on therapy or naïve. All selected patients underwent only conventional non-biological therapy at baseline and none received vitamin D supplementation and either allopurinol or febuxostat previously. Blood samples were drawn from all participants for assessment of 25-hydroxyvitamin D and uric acid serum levels. Disease activity of psoriasis and psoriatic arthritis were assessed by the Psoriasis Area and Severity Index (PASI), the Disease Activity Index for Psoriatic Arthritis (DAPSA) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). We assessed the covariates of interest by the Wilcoxon non parametric test, through the SPSS 24 Software.Results:We observed 61 patients, mainly females (83.6%). At the univariate analysis, the uric acid/25(OH)D serum levels ratio revealed significantly associated with DAPSA and BASDAI indexes (pConclusion:Data in the literature about these associations in the context of psoriatic arthritis are really poor. As a consequence, our findings, though preliminary, suggest us to hypothesize a potential role of uric acid/25(OH)D serum levels ratio as potential inflammation marker in order to better assess the disease activity. However, future larger studies are needed to investigate more in depth this association.[1]Charoenngam N, Ponvilawan B, Ungprasert P. Vitamin D insufficiency and deficiency are associated with a higher level of serum uric acid: A systematic review and meta-analysis. Mod Rheumatol. 2019 Mar 4:1-6.Disclosure of Interests:None declared

Background:Psoriatic arthritis (PsA) is associated with insufficent levels of vitamin D (25OHD) and an increased cardiovascular risk. Several studies, have shown an inverse relationship between 25OHD levels and cardiovascular damage.Objectives:To study the relationship between 25OHD and vascular damage, as well as its possible influence on its progression, in patients with PsA.Methods:Pre-post longitudinal study with analytical components. PsA patients with peripheral joint involvement were included. Demographic (sex, age), clinical [follow-up time, DAPSA, current treatment, body mass index (BMI), classic vascular risk factors, vascular events] and analytical variables [atherogenic index, glomerular filtration (GF-MDRD), glycosylated hemoglobin (HbA1c), CRP, ESR, 25OHD] were collected. We considered deficient level of 25OHD Results:78 patients were included. Eighteen patients were excluded due to high vascular risk [previous event, diabetes type II or type I with target organ injury and/or GF-MDRD< 60 ml/min]. 57.5% were women with a mean age of 54.2 (SD 10.9) years. The mean follow-up time was 96.8 (SD 163.6) months and mean DAPSA was 10.2 (SD 8.3). 96.2% of patients had received DMARDs and 42.3% biologicals, and 42.3% took calcium and 25OHD supplements. Mean BMI was 27.5 (SD 4.7) kg/m2. 42.3% had tobacco exposure, 29.5% were hypertensive and 32% dyslipidemic. Mean SCORE was 1.6 (SD 1.8) and mean 25OHD was 27.6 (DSD 11.6) ng/ml. 28.2% patients had 25OHD deficit and 60.3 % insufficiency. At the beginning, 32.1 % of patients had atheromatous plaques with a number of plaques around 1.7 (SD 1.2), and 6.7% and 19.7% had a pathological IMT or PWV, respectively. Baseline, we had not observed any association between 25OHD and the presence of atheroma plaques, IMT or PWV. Three years later, we detected progression of vascular damage in 31.2% patients. In these patients, the existence of hypovitaminosis D was associate with the appearance of atheroma plaques (p=0.043). This association desappeared in the multivariate analysis, in which only the CRP influenced the appearance of atherome plaques (OR: 1.4, IC 95% 1.04-1.98, p=0.025).Conclusion:Low 25OHD levels are not related to vascular damage or influence a posible progression of it in our serie. As might be expected, the progression of vascular damage depends on the inflammatory load in these patients.Disclosure of Interests:L Montolio-Chiva: None declared, M Robustillo-Villarino: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

Background:Spondyloarthritis is the term for a group of inflammatory chronic diseases primarily affecting the axial skeleton, as well as the peripheral joints. Regarding bone metabolism in these patients, several studies have reported higher levels of inflammatory activity (BASDAI, BASMI, ESR and CRP) in patients with osteoporosis compared to those without this disease, although no correlations were found.Objectives:To describe clinical, serological and biological characteristics, as well as bone and mineral metabolism, according to analytical and densitometric criteria in a patient cohort with spondyloarthritis.Methods:Observational, descriptive and cross-sectional study. A retrospective review was conducted of a database of patients with spondyloarthritis treated during outpatient visits at the Rheumatology Department of Hospital General Universitario de Ciudad Real between June 2018 and June 2019. Variables are described using measures of frequency and of central tendency and dispersion.Results:Cohort of 115 patients (64 men and 51 women). Average age 45.97 years (+/- 13.41 SD). Ankylosing spondylitis in 54 patients, psoriatic arthropathy in 24, spondyloarthropathy associated with inflammatory bowel disease in 8, undifferentiated spondyloarthritis in 18 and other types of spondyloarthritis in 11. Regarding treatment, 40.88% of patients received disease-modifying drugs (methotrexate, sulfasalazine, etc.) and 43.4% received biologic drugs (86% anti-TNF alpha, 12% anti-IL-17 and 2% anti-IL-12/23). Moreover, 53.04% had received corticosteroids during some phase of their disease. Vitamin D levels were 23.81 (+/- 10.5 SD) and 77.4% of patients had a vitamin D deficiency/insufficiency. Of the total cohort, 34.78% presented osteopenia and 3.58% osteoporosis (T-Score and Z-Score).Conclusion:In this study, patients with spondyloarthritis show high percentages of osteopenia and osteoporosis, undiagnosed until this time, along with vitamin D deficiency. This data suggests higher prevalences of these metabolic bone diseases. Osteoporosis prevention is essential due to the risk of developing early fractures resulting from increased bone fragility.References:[1]Pray C, Feroz NI, Nigil Haroon N. Bone Mineral Density and Fracture Risk in Ankylosing Spondylitis: A Meta-Analysis. Calcif Tissue Int. 2017 Aug;101(2):182-192.[2]Zhang M et al. The association between ankylosing spondylitis and the risk of any, hip, or vertebral fracture: A meta-analysis. Medicine (Baltimore). 2017 Dec; 96(50): e8458.[3]Erten S, Kucuksahin O, Sahin A, Altunoglu A, Akyol M, Koca C. Decreased plasma vitamin D levels in patients with undifferentiated spondyloarthritis and ankylosing spondylitis. Intern Med. 2013;52(3):339-44[4]Mermerci B, Pekin Dogan Y, Sivas F, Bodur H, Ozoran K. The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis. Rheumatol Int 2010;30:375-381.[5]Arends S, Spoorenberg A, Bruyn W, Houtman PM, Leijsma MK, Kallenberg CGM, Brouwer E, van der Veerce. The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis. Osteoporos Int 2011;22:1431-1439.[6]Lange U, Teichmann J, Strunk J, Iler-Ladner U, Schmidt KL. Association of 1.25 vitamin D2 deficiency, disease activity and low bone mass in ankylosing spondylitis.Disclosure of Interests:None declared

Background:Vitamin D deficiency is more prevalent in patients with systemic lupus eythematosus (SLE) as a result of sun avoidance.1The potential negative impact of vitamin D deficiency on SLE disease activity has been shown in a number of studies.2The expression of the interferon signature genes in SLE correlates positively with disease activity, and these genes are thought to mediate the clinical manifestations of the disease.3Objectives:The aim of this study was to establish whether a relationship exists between serum 25-hydroxyvitamin D level and the interferon signature gene expression in whole blood of SLE patients.Methods:Informed consent was obtained from 92 SLE patients who were over the age of 18 and who fulfilled the SLICC classification criteria for SLE. The patients were interviewed and blood samples were taken. SLE disease activity was measured by SLE disease activity index-2K (SLEDAI-2K). RNA extraction was performed from whole blood. QuantiGene Plex technology was used to measure the expression of 12 interferon signature genes in the extracted RNA. The study was approved by the University Research Ethics Committee.Results:92.4% of the cohort studied were female. 58.7% were receiving vitamin D3 supplementation at a mean dose of 1031IU daily. 27.2% had vitamin D insufficiency (25-hydroxyvitamin D 21-29ng/ml) and 15.2% were vitamin D deficient (25-hydroxyvitamin D Conclusion:This study did not show a significant relationship between serum vitamin D level and disease activity. In keeping with this, there was no significant negative correlation between serum 25-hydroxyvitamin D and interferon signature gene expression. Further prospective studies and randomised controlled trials are required to study this relationship in greater depth.References:[1]Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS. Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev. 2006; 5: 114-7.[2]Sahebari M, Nabavi N, Salehi M. Correlation between serum 25(OH)D values and lupus disease activity: an original article and a systematic review with meta-analysis focusing on serum VitD confounders.Lupus2014; 23: 1164-77.[3]Arasappan D, Tong W, Mummaneni P, Fang H, Amur S. Meta-analysis of microarray data using a pathway-based approach identifies a 37-gene expression signature for systemic lupus erythematosus in human peripheral blood mononuclear cells. BMC Med. 2011; 9: 65.Disclosure of Interests: :None declared

Background:Osteoporosis is commonly seen in patients with Systemic Lupus Erythematosus (SLE), even in pre-menopausal patients. The etiology is multifactorial and chronic glucocorticoid therapy seems to play a central role.Objectives:To investigate the ten-year risk of fracture assessed by Fracture Risk Assessment Tool (FRAX), with and without dual-energy X-ray absorptiometry (DXA) and to determine possible demographic or clinical factors associated with an increased risk of fracture in a SLE population.Methods:Retrospective study including all the over 40 years-old patients with the diagnosis of SLE (2012 SLICC classification criteria) followed at our Rheumatology Department registered in our national database. Demographic, clinical and laboratorial data were collected at the last follow-up visit. Data from the last DXA (until 3 years prior to the last visit) were collected. Indication for pharmacological treatment by FRAX was assessed according to the national recommendations: estimated fracture risk, without DXA, ≥11% for major osteoporotic fracture or ≥3% for hip fracture and/or estimated fracture risk, with DXA, ≥9% for major osteoporotic fracture or ≥2.5% for hip fracture.Results:We included 104 patients, 101 (97.1%) females, aged 54.5±9.9 years, with a median disease duration of 19.3 years [4.3-51.6]. Twelve patients (11.5%) were current smokers, 31 (29.8%) had elevated anti-dsDNA antibodies (≥100 IU/mL) and 27 (26.0%) had complement consumption (C3cTen patients (9.6%) had previous fragility fractures, 54 patients (51.9%) had DXA in the last 3 years and 81 (77.9%) were taking calcium and/or vitamin D supplements.Sixteen (15.4%) had indication for treatment by FRAX without DXA and 8 of these (50%) were under treatment. Moreover, thirteen (12.5%) had indication for treatment by FRAX with DXA and 8 of these (61.5%) were under treatment.Five patients (4.8%) were reclassified in FRAX with DXA: 3 patients (2.9%) had no indication for treatment by FRAX without DXA but conquered it by FRAX with DXA and 2 patients (1.9%) had indication for treatment by FRAX without DXA but lost it by FRAX with DXA. We found a good level of agreement in the indication for treatment between FRAX with and without DXA (kappa=0.741; pThere was no significant difference in the risk of fracture estimated by FRAX with or without DXA, both for major osteoporotic fracture and for hip fracture. Correlations between fracture risk and some clinical variables can be seen in table 1.Table 1.Correlations between the risk of fracture estimated by FRAX and disease related features.Age at SLE diagnosisDisease DurationESRSLEDAIEstimated fracture risk by FRAX:without DXAmajor osteoporotic fracturer=0.483pn.s.r=0.249p=0.012r=-0.586p=0.028hip fracturer=0.481pn.s.r=-0.552p=0.041n.s.with DXAmajor osteoporotic fracturer=0.386p=0.005r=0.299p=0.033n.s.n.s.hip fracturer=0.338p=0.015n.s.n.s.n.s.Conclusion:A higher number of patients had indication for pharmacological treatment by FRAX with DXA in comparison with FRAX without DXA. However, we found no statistically significant difference in the estimated fracture risk with and without DXA. This, together with the good level of agreement between FRAX with and without DXA, suggests that the fracture risk estimation, even without DXA, may be an appropriate approach. The low number of patients with indication for pharmacological treatment by FRAX, with and without DXA, may be explained by their low mean age and the high number of them under vitamin D/calcium supplementation.Disclosure of Interests:Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

Background:Osteoporosis is one of the major comorbidities in patients with rheumatoid arthritis (RA). There are a lot of evidence that denosumab increase bone mineral density (BMD) in patients with osteoporosis. However, there are few reports investigated the influence of denosumab in patients with RA.Objectives:We evaluated the BMD change in patients with RA treated denosumab and assessed the effect of various factors, such as disease activity, biological disease-modifying anti-rheumatic drugs (bDMARDs) use, concomitant medications of osteoporosis and pretreatment of osteoporosis.Methods:This study included 140 consecutive RA patients (135 female, mean age was 70.6 ± 8.6 years) who fullfilled the criteria of osteoporosis and treated with denosumab. BMD at the lumbar spine, proximal femoral and femoral neck were evaluated by dual energy X-ray absorptiometry at baseline and one year after treatment. We evaluated the influence of disease activity, bDMARDs use, the concomitant type of vitamin D and pretreatment of osteoporosis for BMD change.Results:BMD change at the lumbar spine, proximal femoral and femoral neck were 5.9% (pConclusion:Denosumab improved BMD in patients with RA independently regardless of disease activity, bDMARDs, the concomitant type of vitamin D and pretreatment of osteoporosis.References:[1]Y Nakamura et al, Arch Osteoporos: 2017; 12:80.[2]K Kaneko et al, Journal of Experimental Orthopaedics: 2019; 6:41.[3]T Suzuki et al, Therapeutics and Clinical Risk Management: 2018; 14:453–459.Acknowledgments:We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka, Masato Uematsu and all participants in this study.Disclosure of Interests:Shohei Anno: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly involving the axial skeleton and sacroiliac joints. Although the exact aetiology remains largely unknown, there is thought to be an immune-driven element. Vitamin D deficiency has been associated with a number of autoimmune diseases and is thought to play an important role in modulating the immune system. Low vitamin D levels may contribute to the development and progression of axSpA1.Objectives:To study the possible associations between low vitamin D and disease activity in axSpA.Methods:A systematic literature search using Medline, Embase and Cochrane was performed using MESH search terms “ankylosing spondylitis”, “axial spondyloarthropathy” and “vitamin D”. Articles examining disease activity measured by BASDAI, ASDAS-CRP, ESR and CRP identified through title/abstract screening, were included in the study, with relevant information extracted.Results:Out of 495 articles identified from the initial search, 19 observational studies which were mostly (89%) cross-sectional studies were identified. There was considerable heterogeneity between studies, including in the definition of vitamin D deficiency, latitude where study took place and seasonal variation. Vitamin D levels were often lower in patients with axSpA compared to controls. Seventeen studies found no association with vitamin D deficiency and disease activity. The exceptions included one study which measured serum vitamin D receptor levels as opposed to serum 25 (OH) D or 1,25 (OH)2 D concentrations, and another study whose recruitment occurred over four years and therefore seasonal variation may conflict results. Patients taking NSAIDs or anti-TNF had no difference in vitamin D levels.Conclusion:Vitamin D deficiency is more prevalent in axSpA but does not seem to associate with increased disease activity. Longitudinal studies are required to better define these links.References:[1]Sizheng Z, et al. Systematic review of association between vitamin D levels and susceptibility and disease activity of ankylosing spondylitis. Rheumatology 2014; 53:1595-1603.Disclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) patients shown an increased risk of low bone mass as a result of multifactorial events: physical inactivity, persistent inflammation, low vitamin D levels (photosensitivity) and glucocorticoid treatment. Trabecular Bone Score (TBS), is an index extracted from the dual-energy X-ray absorptiometry (DXA) that provides an indirect measurement of bone axial microarchitecture and allows to get information about bone quality in several rheumatic diseases (1-4).Objectives:The aims of this study were to examine the prevalence and risk factors for low bone mineral density (BMD) (osteoporosis or osteopenia) in female patients affected by SLE and to compare with matched healthy subjects (CNT).Methods:70 female patients (mean age 41±20 years) affected by SLE and 65 age- matched CNT (mean age 46±7 years) were enrolled. Bone Mineral Density (BMD, g/cm2) of the lumbar spine (L1-L4) was analyzed using a DXA scan (GE, Lunar Prodigy). Lumbar spine TBS was derived for each spine DXA examination using the TBS index (TBS iNsight Medimaps).Results:The mean BMD±SD was 0.47±0.57 g/cm2 at the lumbar spine and 0.78 ± 0.22 g/cm2 at the hip in SLE patients. The prevalence of osteopenia was 40.0% and was 19.4% of osteoporosis in SLE patients. Most of SLE patients (75%) presented a bone loss that was significantly higher when compared with control group (pConclusion:The study shows that the further TBS analysis, independently from the concomitant BMD value, is significatively lower then expected in SLE patients. The detection of the TBS, together with the BMD, may offer a more reliable indication of the real whole bone condition in chronic and systemic inflammatory rheumatic diseases, such as SLE.References:[1]Cutolo M et al. Ann Rheum Dis. 2009;68 446-7; 2 Dey M et al. Lupus. 018;271547-1551; 3 Ruaro B, Casabella A, et al. Rheumatology (Oxford). 2018;57:1548-1554. 4 Ruaro B, Casabella A, et al. Clin Rheumatol. 2018 Nov;37(11):3057-3062.Disclosure of Interests:Andrea Casabella: None declared, Sabrina Paolino: None declared, Elisa Alessandri: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Barbara Ruaro: None declared, Carmen Pizzorni: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha

Background:Fibromyalgia syndrome (FMS) is a chronic pain syndrome which presented by easy fatigability, widespread body pain, anxiety and tenderness points on specific anatomic regions. Fibromyalgia may be risk factor for vitamin D deficiency because of pain, poor mobility, or depression, potentially leading to less time of sun exposure or high rates of adiposity leading to decreased synthesis of vitamin D & there are conflicting results on the role of vitamin D in improving chronic nonspecific musculoskeletal pains1, 2.Objectives:Assessment of the effectiveness of vitamin D supplements as adjuvant therapy in functional status, quality of life and psychological status in fibromyalgia patients with vitamin D insufficiency.Methods:One hundred adult patients of primary FMS (according to the 2010 ACR criteria for FMS) associated with vitamin D insufficiency (21-29 ng/mL) were selected to participate in this study. Patients with secondary FMS were excluded; also we excluded patients with any psychiatric disorders and patients who had other chronic diseases interfering with calcium, phosphorus, and vitamin D metabolism. After written consent; the patients were randomly divided into 2 equal groups; group I received duloxetine (60 mg once daily for 6 months) plus 50,000 unit oral cholecalciferol weekly for 8 weeks then monthly for 16 weeks. Group II received duloxetine (60 mg once daily for 6 months) plus placebo. The patients were assessed at baseline and after 6 months of treatment by measuring serum levels of 25(OH)D, Fibromyalgia Impact Questionnaire (FIQ), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) & Hospital Anxiety and Depression Scale (HADS).Results:Eighty six patients completed this study. There was no significant difference between all groups in demographic data, educational status and all baseline variants except serum levels of 25(OH) D. After 6 months; there was significant improvement (PTable 1.Pre- and post-treatment assessment measures of the patient groupsassessment measuresBaselineBaselineAfter 6 monthsAfter 6 monthsGroup IGroup IIGroup IGroup II25(OH)D25.3 ± 4.9 ng/ml26.8+5.3 ng/ml36.8+3.9 ng/ml25.6 ± 3.4 ng/mlFIQ47.5±5.446.7±6.727.5±6.138.5±7.3SF-36 (Total score)47.6±10.447.0±9.961.0±5.854.8±5.3HAD anxiety8.2±0.68.4±0.37.1±0.77.5±1.4HADS depression8.6±0.38.6±0.97.3±0.87.7±1.4Conclusion:Vitamin D supplement is effective as an adjuvant therapy in improving functional status, quality of life and psychological status in fibromyalgia patients with vitamin D insufficiency.References:[1]Abd Elghany S E et al, Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. Journal of Back and Musculoskeletal Rehabilitation -1 (2018) 1–8[2]Maria Helde-Frankling, Linda Björkhem-Bergman. Vitamin D in Pain Management. Int. J. Mol. Sci. 2017, 18, 2170Disclosure of Interests: :None declared

Background:There seems to be a relationship between 25-hydroxyvitamin D [25(OH)D] level and rheumatoid arthritis (RA)(1). It has been proposed that susceptibility for RA exists in selected patients with low 25(OH) with conflicting results (2,3) Regarding disease activity, most of the evidence suggests an inverse relationship of disease activity with 25(OH)D levels(4). To our knowledge, there is only a small study that suggests low 25(oh) D levels as a predictor of disease activity (5) in our regionObjectives:We aimed to evaluate the possible association of low 25(OH) D levels and disease activity in a large cohort of patients with Rheumatoid Arthritis in ColombiaMethods:We evaluated the clinical records of 3576 patients with RA that fulfilled the 2010 EULAR Classification Criteria for Rheumatoid Arthritis and that were managed in our autoimmunity center between 2014 and 2017. Registries that contained both the measurement of 25(OH)D levels and DAS28 VSG with no more than 6 months apart and that also had at least a mean 12-month follow-up were included. We classified 25(OH) D insufficiency as levels ≤ 20ng/ml. We evaluated differences in achieving disease control depending on the 25(OH) D levels with McNemar’s test. Disease control was defined as DAS28VSG≤3.2Results:A total of 880 patients were included, 90% were female and their mean age was 63 years and 24.3% had 25(OH) D insufficiency. The vast majority were seropositive and only 13% were on biologics (Table 1). A 25% of patients who 25(OH)D insufficiency had DAS28 3.2 and a year of follow-up decreased to 24% with medical intervention (p=0,1), while patients without 25(OH)D insufficiency at the beginning of follow-up, 27% had DAS28 3.2 and after one year follow-up decreased to 17% (p=0.001)Table 1Mean (SD)Age (years)63.3 (10.6)Disease Duration14.7 (10.8)Age at diagnosis48.6(13.5)N%Sex (Feminine)79390.1Rheumatoid Factor (Positive)N=81769985.6ACPA (Positive)N=36632.377.6Actual Steroid use61169.4Actual Biologic Therapy12313.9DMARD Methotrexate57064.8 Leflunomide68277.5 Sulfasalazine21824.8 Azathioprine50.6 Antimalarials14716.7Conclusion:In Colombian patients with rheumatoid arthritis low 25(OH) D status has an inverse correlation with disease control. Even in an equatorial country, up to 24% of RA patients had low vitamin levels. A strategy of active detection of 25(OH) D insufficiency could have an impact on disease activity and health statusReferences:[1]Ishikawa LLW, Colavite PM, Fraga-Silva TF de C, Mimura LAN, França TGD, Zorzella-Pezavento SFG, et al. Vitamin D Deficiency and Rheumatoid Arthritis. Vol. 52, Clinical Reviews in Allergy and Immunology. Humana Press Inc.; 2017. p. 373–88.[2]Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, et al. Vitamin D and rheumatoid arthritis: An ongoing mystery. Vol. 29, Current Opinion in Rheumatology. Lippincott Williams and Wilkins; 2017. p. 378–88.[3]Bae SC, Lee YH. Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis: a Mendelian randomization. Clin Rheumatol. 2018 Sep 1;37(9):2415–21.[4]Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis. Clin Exp Rheumatol. 2016;34(5):827–33.[5]Quintana-Duque MA, Caminos JE, Varela-Nariño A, Calvo-Paramo E, Yunis JJ, Iglesias-Gamarra A. The role of 25-hydroxyvitamin D as a predictor of clinical and radiological outcomes in early onset rheumatoid arthritis. J Clin Rheumatol. 2017;23(1):33–9.Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Carolina Perez-Rios: None declared, Yecenia Durango-Durango: None declared, Ricardo Pineda.Tamayo: None declared

Background:In recent years, it is becoming increasingly clear that osteoprosis (OP) holds the important place among complications of ankylosing spondylitis (AS). The frequency of emergence of OP, according to the data of last investigations, ranges from 18.7 to 62%, osteopenic syndrome – from 50 to 92%. It is known that decrease of bone mineral density (BMD) in patients with AS is caused not only by the action of traditional risk factors (age, sex, genetic predisposition, low body mass, and others) but also by the action of factors associated with the disease itself such as: duration of AS, activity of the inflammatory process, administration of glucocorticoids (GC), deficiency of Vitamin D, low physical activity of patients and so on. However, until now there are no clear data about the role of each of them in the formation of disorders of bone metabolism in men with AS. In the Ukrainian population of patients with AS such investigations have not been conducted.Objectives:To investigate the role of age, duration of disease andcumulative glucocorticoid dosein the formation of disorders of bone mineral density (BMD) in men with AS.Methods:The investigation of 108 men with AS at the age of 40.74 ± 0.87 years and 25 normal control subjects of the same age and sex has been carried out. The diagnosis of AS was established on the basis of modified New York criteria. BMD of the lumbar spine and femoral neck was determined by dual-energy X-ray absorptiometry on the apparatus ‘Hologic Discovery Wi’ (S / N 87227). The diagnosis of osteoporosis in men over 50 years was considered in case of decrease of BMD by T-score ≤ – 2.5 SD, osteopenia corresponded to T-score from –1 to –2.5 SD, for men under the age of 50, the Z-score was used, and its decrease ≤ – 2.0 SD and more indicated the significant loss of bone mass.Results:A decrease of BMD at the level of the lumbar spine and femur neck was found in 61 (56.5%) patients, of these 29 (27.7%) had osteoporosis, 31 (29.5%) had osteopenia. In the control group, decrease of BMD was detected in 6 (24%) patients, of these osteoporosis was diagnosed in 1 (4%), and osteopenia was diagnosed in 5 (20%) patients. In the age group of below 35 years, 18 (64.3%) patients had a decrease in BMD, 35 (56.5%) patients – in the 36-55 age group, and 8 (53.3%) patients – over the age of 45. The index of BMD also did not differ significantly between the groups. As for the duration of the disease, the largest proportion of 33 (75%) patients with decreased BMD was found in the group of patients with duration of the disease from 5 to 10 years. In the group of patients with duration of the disease up to 5 years, patients with decrease in the Z-score were 11 (55%), and in the group with duration of the disease more than 10 years - 17 (41.6%) patients. Decrease of BMD was associated withcumulative glucocorticoid dose. In particular, in the group of patients with acumulativedose of glucocorticoids less than 12.6 g Z-score at the level of the lumbar spine was -0.98 ± 0.17 SD, in the group with acumulativedose of GC 12.6-21.6 g Z-score was equal to –0.43 ± 0.40 SD, and in the group withcumulativeglucocorticoid dose – above 21.6 g the Z-score was –1.69 ± 0.30 SD. As the glucocorticoid dose increased, the proportion of patients with decreased BMD increased. In the group of patients with the highest dose of GC there were 67.7% such patients, while in the group with the lowest dose – only 30 (57.6%). Significant correlation (r = -0.24) was established between Z-score of the lumbar spine and the total dose of GC.Conclusion:In 61 (56.5%) patients with AS decreased BMD at the level of the lumbar spine and neck of the femur is revealed. Decrease of BMD in patients with AS does not depend on the age and duration of the disease, but is associated with thecumulativedose of GC.Disclosure of Interests:Sergii Shevchuk Grant/research support from: Celltrion, Inc, Oksana Pavliuk: None declared

Background:Low bone mineral density (BMD) is common in ankylosing spondylitis (AS). The fracture risk (FR) is increased and its reduction with pharmacologic therapy is not clearly defined in this population. However, early screening and bisphosphonates as first-line treatment are recommended.Objectives:To investigate the influence of dual-energy X-ray absorptiometry (DXA) in the ten-year risk of fracture assessed by FR Assessment Tool (FRAX) and to determine possible demographic or clinical factors associated with an increased FR in a spondyloarthritis (SpA) population.Methods:Retrospective study including all the over 40 years-old SpA patients (ASAS classification criteria) followed at our Rheumatology Department and registered in the national database. Demographic, clinical and laboratorial data were collected at the time of the last follow-up visit. Data from the last DXA (until 3 years prior to the last visit) were collected. Indication for pharmacological treatment by FRAX was assessed according to the national recommendations.Results:A total of 231 SpA patients were included: 126 males (54.5%), 53 (22.9%) smokers; 171 (74%) had AS, 23 (10%) had Inflammatory Bowel Disease Associated SpA and 37 (16%) had Undifferentiated SpA. At the last follow-up visit, the mean age was 52.9 years (±9.6) and the median disease duration was 21.9 years [1.0-55.5]. The mean ASDAS-CRP was 2.5 (±0.9) and the majority of patients had moderate (25.5%) or high (48.5%) disease activity (according to ASDAS). One hundred and thirty patients (56.3%) were taking NSAIDs, 45 (19.5%) were taking glucocorticoids, 85 (36.8%) were under csDMARDs and 170 (73.6%) under bDMARDs [157 (68%) under TNFi, 11 (4.8%) under secukinumab and 2 (0.9%) under ustekinumab].Eleven patients (4.8%) had previous fragility fractures, 118 (51.1%) had DXA in the last 3 years and 167 (72.3%) were taking calcium and/or vitamin D supplements.Sixteen patients (6.9%) had indication for treatment by FRAX without DXA and 9 of these (56.3%) were already under treatment. Similarly, 16 (6.9%) had indication for treatment by FRAX with DXA and 13 of these (81.3%) were already under treatment. Ten patients (4.3%) were reclassified in FRAX with DXA: 7 (3%) had no indication for treatment by FRAX without DXA but obtained it by FRAX with DXA and 3 (1.3%) had indication for treatment by FRAX without DXA but they lost it by FRAX with DXA. We found a moderate level of agreement in the indication for treatment between FRAX with and without DXA (kappa=0.595; pWe found significant correlations between FR and some disease-related variables (table 1).Table 1.Correlations between the risk of fracture estimated by FRAX and disease-related variables.Disease durationBASDAIASDAS-CRPBASMIBASFIEstimated fracture risk by FRAX:without DXAmajor osteoporotic fracturer=0.352pr=0.204p=0.002r=0.214p=0.001r=0.301pr=0.317phip fracturer=0.389pr=0.142p=0.034r=0.170p=0.011r=0.305pr=0.275pwith DXAmajor osteoporotic fracturer=0.227p=0.014r=0.314p=0.001r=0.356pr=0.293p=0.002r=0.379phip fracturen.s.r=0.197p=0.036r=0.269p=0.004r=0.271p=0.004r=0.258p=0.006Conclusion:Our results showed that a similar number of patients had indication for pharmacological treatment by FRAX both with and without DXA. Although the inclusion of DXA resulted in a higher estimated FR by FRAX, the observed moderate level of agreement between FRAX with and without DXA suggests that the FR estimation by FRAX, even without DXA, may be a reasonable approach in SpA patients. In line with literature, we found significant associations between the estimated risk fracture by FRAX and some disease activity and function measures.Disclosure of Interests:Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

Background:Vitamin D deficiency is a highly prevalent entity worldwide, with relevance in specific diseases and stages of life1. Few guidelines assess the indications and optimal dosing in the general population, and although there is no international consensus, 800IU/day is associated with benefits in bone metabolism. Calcifediol, a vitamin D analog, is presented as a therapeutic alternative.Objectives:To assess the efficacy of calcifediol in the treatment of vitamin D deficiency, compared with therapeutic guidelines recommendations for cholecalciferol in postmenopausal women.Methods:Phase III-IV, double blind, randomised, controlled, multicentre superiority clinical trial. Postmenopausal women with baseline levels of 25(OH)D < 20 ng/mL were randomised to three arms: 266 mcg of calcifediol/month for 4 or 12 months (standard and test regime), or to cholecalciferol 25000 IU/month for 12 months (as per therapeutic guidelines).Results from an interim analysis - performed upon completion of month 4 visit by 100% of evaluable patients - are presented and reported without unblinding the study treatments. Both calcifediol groups are summarised for analysis.The trial has been approved by the corresponding ethics committees and national competent authorities.Results:298 women were included in the ITT analysis. The average age was 63.4 ± 8.2 years, mean BMI was 29.3 ± 6 Kg/m2, 10.7% had osteoporosis and received treatment. All demographic characteristics and risk factors for osteoporosis were balanced amongst groups.When analysing per treatment group,13.5% and 35% of women in the calcifediol group reached values of 25(OH)D > 30ng/mL at 1 and 4 months when compared to 0% and 8.2% respectively in the cholecalciferol group (pFigure 1.Regarding baseline levels, 25% of the population had levels Table 1.Basal 25(OH)D levels< 10ng/mLNS10 to Calcifediol (n= 54)Cholecalciferol(n= 20)Calcifediol(n= 146)Cholecalciferol(n= 78)Month 1>30 ng/mL2 (3.7%)0 (0%)25 (17.1%)0 (0%)>20 ng/mL12 (22.2%)2 (10%)106 (72.6%)31 (39.7%)Month 4>30 ng/mL8 (14.8%)1 (5%)62 (42.5%)7 (9%)>20 ng/mL27 (50%)8 (40%)135 (92.5%)63 (80.8%)NSp>0.05; **p≤0.01Conclusion:Calcifediol shows a greater efficacy than cholecalciferol regime (as recommended in therapeutic guidelines), for the treatment of vitamin D deficiency in postmenopausal women and in a timely manner, which could impact osteoporosis treatment. Cholecalciferol fails to achieve recommended levels in a significant proportion of this population. Baseline vitamin D levels are to be considered for the supplementation of vitamin D.References:[1]Amrein, K., Scherkl, M., Hoffmann, M.et al.Vitamin D deficiency 2.0: an update on the current status worldwide.Eur J Clin Nutr(2020).Acknowledgments:Osteoferol Study Group principal investigators and their teams: F Cereto, ML Brandi, E Jodar, JM Quesada-Gómez, JM Olmos-Martínez, MA Colmenero-Camacho, R Alhambra, C Gómez-Alonso, B GalarragaDisclosure of Interests:Javier del Pino Grant/research support from: Roche, Bristol, Consultant of: Gedeon, José Luis Pérez-Castrillón Grant/research support from: Farmalider, Pfizer, Consultant of: Farmalider, Faes Farma, Gedeon-Richter, Speakers bureau: Amgen, Lilly, MSD, Faes Farma, Antonio Dueñas-Laita Grant/research support from: Faes Farma, Farmalider, Consultant of: Faes Farma, Speakers bureau: Farmalider, Gonzalo Hernandez Employee of: Faes Farma S.A., Paula Arranz-Gutiérrez Employee of: Faes Farma, Sandra Pamela Chinchilla Employee of: Faes Farma S.A.

Background:Vitamin D plays an important role in the pathogenesis of autoimmune diseases, so that it has been shown that an adequate level is associated with a lower risk of developing this group of entities as well as a lower severity of them. Specifically, in spondyloarthritis (SpA) the deficiency has been associated with greater aggressiveness and greater radiological progression.Objectives:Assess levels of vitamin D in patients diagnosed with SpA in the León University Assistance Complex and study its possible relationship with different clinical-epidemiological variables.Methods:Prospective observational study between January 1, 2019 and December 31, 2019 with consecutive sampling of patients diagnosed with SpA (New York criteria, ASAS) in our hospital between 1973 and 2018. It was taken as a cut-off point for vitamin normality D those values ≥ 30 ng / ml. The disease activity was assessed based on BASDAI and CRP level (taking as a cut-off point 5 mg/l, reference value of our hospital and ruling out elevation due to intercurrent processes) in the last consultation. Positive values above 130 mlg/dL were considered for the orosomucoid and for calprotectin as undetermined values between 50-100 mg/kg feces and suspected IBD greater than 100 mg/kg feces. An attempt was made to link the value of vitamin D with disease activity, tobacco, the development of uveitis and the presence of subclinical intestinal inflammation.Results:132 patients were included, of which 60.6% were men with a mean age of 49.35 ± 12.95 years. 84.8% were B27 positive. 88.6% met New York criteria. 35.6% suffered uveitis at some time during their evolution. As for tobacco, 68.2% were non-smokers, 12.9% were former smokers and 18.9% were active smokers. 6.8% of the sample presented positivity for the orosomucoid and 37.8% alterations in calprotectin (of which 24.2% were undetermined and 13.6% suspected of inflammatory bowel disease). Only 25% of patients had elevated CRP levels and 11.4% of patients had BASDAI> 4. 50.8% of our sample had optimal levels of Vitamin D while 49.2% were at low values.A statistically significant association was observed between hypovitaminosis D and elevated CRP levels (p 0.038). In our sample we found no statistical association with uveitis or with markers of subclinical inflammatory activity.Conclusion:-Almost half of the patients in our sample have hypovitaminosis D which is probably attributable to the meteorological characteristics of León region.-Low levels of vitamin D are statistically significantly related to higher levels of CRP and, therefore, with greater disease activity.-No significant relationship was found with uveitis or with a higher risk of subclinical intestinal inflammation in our simple.References:[1]Castro Domínguez F, Salman Monte TC, Blanch Rubió J. Vitamin D in rheumatic diseases.Rev Osteoporos Metab Miner. 2017; 9 (1) supplement: 31-39.Disclosure of Interests:None declared

Background:The high incidence of ankylosing spondylite (AS) in people of working age, as well as the negative impact of the disease on the quality of life of patients, determine the need for adjuvants to reduce the severity of pain and thereby achieve the physical, psychological and emotional well-being of patients.Objectives:To study the effect of vitamin D (colecalciferol) on the quality of life and the severity of pain in patients with ankylosing spondylite.Methods:The study included 69 patients with AS, who studied the quality of life indicators according to the Medical Outcomes Study Short Form (SF-36); pain syndrome and stiffness in the spine were assessed by a visual analogue scale by patients, and by a physician - by counting the number of painful joints (NPJ), the disease activity index (BASDAI) and the Functional Index (BASFI). All patients were receiving a basic therapy in a stable dose for at least 10 months. They were divided into 2 groups, comparable in age, disease activity; Group 1 (n = 33) additionally received colecalciferol 1500 МЕ during 6 months of observation.Results:At the end of the observation period when evaluating data on SF-36: in the 1st group, the physical health component has improved - the increase in physical functioning (PF) and bodily pain (BP) by 51.4% and 37.8% from the baseline; vital activity, psychological health, and social functioning due to emotional state have also increased by 37.6%, 33.4% and 42.5%, respectively. In the 2nd group above mentioned parameters have not changed. In the 1st group the indexes of BASDAI and BASFI have decreased by 16% and 22% (p = 0.0079, p = 0.0022, respectively), and their dynamics in the 2nd group were less significant (p = 0.013, p = 0.017, respectively) Also, in patients of the 1st group have decreased the severity of morning stiffness and the pain in the spine a highly reliable (p < 0.001), and in the 2nd group they were less significant (p = 0.043, p = 0.016, respectively). Positive dynamics of NPJ in the 1st group was more significant (p = 0.003) than it was in the 2nd group (p = 0.033).Conclusion:In the group of patients treated with colecalciferol was noted improvement in indicators of quality of life (the parameters of the physical component of health, vitality and social functioning) and also more significant decrease of the intensity of pain and of morning stiffness duration, of NPJ, than in not received to colecalciferol patients. Inclusion of vitamin D in the comprehensive AS therapy promotes not only reduction the severity of the chronic pain manifestations, but also improves the quality of life of patients with this pathology.Disclosure of Interests:None declared

Background:Vitamin D (VitD) was first used to treat rickets in children in depressed urban areas of England, due to malnutrition and lower sun exposure. During the last decade its use has become widespread in western societies because it has been associated with lower risk of suffering from multiple diseases and there is also a lack of consensus in establishing adequate levels for the general population. Regarding the beneficial effects of VitD, well-designed current observational studies are calling them into question and many authors believe that levels of 30 ng/mL, adopted as optimal, are overestimated1-2. All this has led many individuals who come to our consultations to use supplements without scientific evidence of their benefits.Objectives:The main objective was to determine the distribution of VitD levels in the healthy canarian population, an area with high solar radiation and stratified according to demographic factors (age, sex and place of residence). As a secondary objective, the study was established to determine prevalence of hyperparathyroidism hypercalcemic in the canarian population.Methods:Cross-sectional population study to determine VitD levels in healthy subjects. The EPIRCAN study screen was used, a population study carried out between 2004 and 2005 to determine the prevalence of rheumatic diseases in the Canary Islands. In 949 serums, the levels of VitD, phosphorus and calcium were determined, as well as Parathyroid hormone (PTH), only in which calcium levels were >10,4 mg/dl. Data were analysed according to demographic characteristics, comorbidities and medication. For the statistical analysis the SPSS was used.Results:The sociodemographic characteristics (age, sex and rural/urban population) of the 949 samples were representative of the Canarian population in the period studied according to data of the ISTAC (Canary Institute of Statistics) with a level of accuracy of 0.7 ng/ml for the vitD and a confidence level of 95%. Healthy (n=876, 92.3%) and sick subjects (n= 73, 7.7%) (renal failure, dialysis, Crohn’s, ulcerative colitis, osteoporosis, calcium supplements, vitD, bisphosphonates or calcitonin). The median and Interquartile range of vitD levels in the entire population studied was 26.3 (20.9-32.9) ng/ml. The VitD levels distribution of healthy population was: 66% were below 30 ng/ml,23% were below 20 mg/ml and 4% were below 12,5 ng/ml. According to the age groups, sex and location: women versus men have 2.8 ng/ml less VitD (CI95%: 1.487;4.177). As the age increases the VitD values decrease; those aged 20-45 with respect to ≥65 years have 5.5 ng/ml more (CI95%: 3.574;7.592), those 45-65 years old have 2.397 ng/ml more (CI95% 0.255;4.539) with respect to ≥65 years, being statistically significant. There were no significant differences between the rural and urban population. The prevalence of hyperparathyroidism hypercalcemic was 0.2%.Conclusion:In the healthy population, baseline levels of VitD are higher in men than in women and tend to decrease with age. Due to the distribution of VitD levels in a healthy population, in an area of high sun exposure, seems to be more reasonable to establish the optimal VitD levels in the general population at 20 ng/ml instead of the established 30 mg/ml.References:[1] F. Wu et al. Cut-points for associations between vitamin D status and multiple musculoskeletal outcomes in middle-aged women. (2017). Osteoporosis International; Volume 28, Issue 2, pp 505–515.[2] E. Manson, J. (2016). Vitamin D Deficiency — Is There Really a Pandemic? The New England Journal of Medicine, pp.75;19.Disclosure of Interests:None declared

Background:The etiology of bone loss in Rheumatoid Arthritis (RA) is multifactorial and systemic inflammation plays a relevant role. Recently, a relationship between autoimmunity and bone mineral density (BMD) has been described in patients with RA.Objectives:To study BMD and biochemical parameters of bone metabolism in a cohort of patients with early rheumatoid arthritis, and assess the relationship between them and autoimmunity and other markers of inflammation.Methods:A prospective longitudinal study was performed. 128 patients from an early Rheumatoid Arthritis Unit (ERAU) were included. All of them fullfilled ACR 2010 classification criteria for RA. Demographic, clinical, biochemical, immunological, radiological and densitometric data, and also inflammatory activity index DAS 28, HAQ functional index, were collected. Any value >20 IU/mL for RF and >30 IU/mL for ACPA was defined as positive.Results:Between January 2009 and June 2017, 801 patients were evaluated in our ERAU. After two years of follow-up, the most frequent definitive diagnoses were: Early RA 221 (27.6%), Undifferentiated Arthritis 97 (12.1%), Psoriatic Arthritis 62 (7.7%), Spondyloarthritis 54 (6.7%) and autoimmune Diseases 28 (3.4%).From the 128 patients with early rheumatoid arthritis evaluated, 104 (81.9%) were ACPA positive and 98 (77.2%) FR positive. The mean BMD in the total column was 0.96 ±0.14 g/cm2 and in the femoral neck was 0.76 ±0.12 g/cm2. No correlation of BMD with autoimmunity markers was found in either of the two locations studied, while a negative relationship between BMD and the PCR inflammation marker (BMD femoral neck: rho-0.203, p = 0.027 and BMD lumbar spine rho =-0.27, p 0.003) was found. The BMD did not correlate with DAS28 nor the HAQ index.The mean baseline serum calcidiol value was 20.7±8 ng/ml, and a negative correlation of basal serum calcidiol with the functional HAQ index was observed (rho=-0.23, p= 0.008). No correlation between other autoimmunity (FR and ACPA) and inflammation (VSG, PCR and DAS 28) markers and vitamin D was found.Conclusion:The BMD in patients with early rheumatoid arthritis of our cohort correlates with the PCR inflammation marker. Unlike other studies shows, in our cohort, serological autoimmunity factors do not have shown to have an independent effect on BMD.References:[1]Llorente I, Merino M, Ortiz AM, et al. Anti-citrullinated protein antibodies are associated with decreased bone mineral density: baseline data from a register of early arthritis patients. Rheumatol Int (2017) 37:799–806Disclosure of Interests:Sara Garcia Carazo: None declared, Diana Peiteado: None declared, Alejandro Villalva: None declared, Laura Nuño: None declared, Mariana Diaz: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Pilar Aguado: None declared

Background:Low vitamin D levels are common in Rheumatoid Arthritis (RA)1, and possibly associated with disease course,2but data on vitamin D levels during long-term disease course has not been reported previously.Objectives:To describe vitamin D trajectories from time of diagnosis through 10 years follow-up in early diagnosed RA patients.Methods:The CIMESTRA trial included 160 newly diagnosed RA-patients, treated aiming at remission with methotrexate and intraarticular steroid, further randomized to ciclosporine or placebo. Vitamin D supplementation was recommended according to national guidelines. Vitamin Dtotalwas measured at diagnosis, and year 1, 5 and 10 using LC-MS/MS. 1,25(OH)2D was measured at diagnosis and year 1 using RIA. Linear mixed effects models were used to study vitamin D levels serially. We had fixed effects for time, and patients modelled as a random effect. We tested the hypothesis that percentage of patients achieving Dtotal≥ 50 nmol/l during follow-up was 90%. Analyses of associations between Dtotaland DAS28-CRP during the disease-course were adjusted for age, sex, symptom-duration prior to diagnosis and season of diagnosis.Results:Median Dtotalat baseline was 53 nmol/l (IQR 36-567.8). Dtotalincreased significantly during follow-up, independently of level at diagnosis (ptotal≥50nmol/l during follow-up was 80-87%, but not as high as 90% at year 1 and 5, ptotaltrajectories only in crude (β-coefficient (β) -0.0034, 95%CI (-0.007; -0.0002) p=0.039) and partially adjusted analyses (β -0.003, 95%CI (-0.007; -0.002) p=0.04). Estimate was left insignificant in fully adjusted analyses (β -0.003, 95%CI (-0.0006; 0.0001) p=0.06). 1,25(OH)2D levels did not change significantly during follow-up (p=1.00).Conclusion:Dtotalincreased significantly during follow-up, but fewer than 90% achieved the recommended 50 nmol/l at year 1 and 5. Disease activity during follow-up was associated with Dtotaltrajectories only in partially adjusted analyses, while adjustment for possible confounders left estimates insignificant. Results suggest vitamin D supplementation to be recommended in all RA patients.References:Reference List[1]Herly M, Stengaard-Pedersen K, Vestergaard P, et al. The D-vitamin metabolite 1,25(OH)2 D in serum is associated with disease activity and Anti-Citrullinated Protein Antibodies in active and treatment naive, early Rheumatoid Arthritis Patients.Scand J Immunol2018;88(3):e12704. doi: 10.1111/sji.12704[2]Mouterde G, Gamon E, Rincheval N, et al. Association between Vitamin D deficiency and disease activity, disability and radiographic progression in early rheumatoid arthritis. The ESPOIR cohort.J Rheumatol2019 doi: 10.3899/jrheum.190795Disclosure of Interests:Mette Herly Grant/research support from: Pfizer Denmark - “Unrestricted Grant” for PhD projectDanish Rheumatism Association, Research Grant, Speakers bureau: Speaker for Danish Rheumatism Association, Kristian Stengaard-Pedersen: None declared, Peter Vestergaard: None declared, Robin Christensen: None declared, Sören Möller: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Peter Junker: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Kim Hørslev-Petersen Grant/research support from: Pfizer (Travel expences), Torkell Ellingsen: None declared

Background:Various cutaneous manifestations are described in patients with Sjogren’s syndrome (SS). However, the predictors for its occurrence are not fully investigated. Recently, data regarding the role of hematological parameters ratios in patients with rheumatic diseases were reported. However, routine hematological parameters and the derived ratios were not studied in SS patients.Objectives:The aim of this study was to evaluate the predictors for cutaneous manifestations in a large cohort of patients with SS followed in a tertiary center.Methods:We included 114 patients with SS (mean age: 53.1±12.1; 94.7% female). We divided the patients in group A – patients with cutaneous manifestations and group B – without cutaneous manifestations. The complete laboratory workup [including the calculation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) to platelet ratio, platelet distribution width (PDW) to platelet ratio], clinical manifestations and treatment were reviewed and the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was calculated for each patients.Results:Cutaneous manifestations were diagnosed in 11 patients (9.6%). The age of the patients, the levels of anti-SSA, complement, inflammatory markers (ESR, CRP), immunoglobulins and vitamin D levels, the ultrasonographic score of salivary glands and the ESSDAI value were similar in both groups. The patients with cutaneous manifestations were more frequently treated with hydroxychloroquine (9/11 vs 49/103, p=0.03) but the mean doses were similar in both groups. The values of anti-SSB were marginally higher in patients with cutaneous manifestations (102.3±83.1 vs 53.6±79.9, p=0.07). The lymphocyte, neutrophil count, MPV and PDW were similar in both groups, while platelet count was lower in patients with cutaneous manifestations (224090.9±59528.9 vs 264339.8±60669.0, p=0.03). The MPV/Plt ratio tended to be higher in patients with cutaneous manifestations (0.051±0.017 vs. 0.043±0.013, p=0.07), but the values of PDW/Plt ratio (0.064±0.022 vs 0.051±0.018, p=0.03) and of NLR (3.82±2.30 vs 2.35±0.92, p=0.001) were found to be significantly higher in these patients. In multivariate analysis, only the NLR remains independently associated with cutaneous manifestations (p=0.001). Using the ROC curve analysis, a cutoff of 2.70 for NLR had a 63% sensitivity and 69% specificity for cutaneous manifestations.Conclusion:The hematological parameters related to platelets appear to be modified in patients with SS and cutaneous manifestations. However, only neutrophil to lymphocite ratio is independently associated with cutaneous involvement in these patients.Disclosure of Interests:Ancuta MIHAI: None declared, DENISE MARDALE: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Ciprian Jurcut: None declared

Vitamin D has an important immunoregulatory function,1 ,2 and there is suggestive evidence for its role in the aetiology of autoimmune diseases, including rheumatoid arthritis (RA).3 Vitamin D levels are reduced in individuals with severe RA,4 ,5 but it is difficult to determine whether this reduction is cause or effect. The onset of arthritis during winter is associated with greater radiographic progression at 6 months, which would be compatible with a causative role.6 Single nucleotide polymorphisms (SNPs) in four vitamin D metabolism genes (GC, DHCR7/NADSYN1, CYP2R1 and CYP24A1) are associated at genome-wide significance with circulating vitamin D levels.7 ,8 Since vitamin D level is associated with RA severity, an association between those SNPs and RA severity would establish causality. Testing the association of genetic variants in genes that control circulating vitamin D levels provides, therefore, an instrument to obtain an unbiased test of the hypothesis that vitamin D levels are aetiologically linked to RA outcome by controlling unmeasured confounding (Mendelian randomisation9). Hence, we tested SNPs previously associated with vitamin D metabolism,7 ,8 and SNPs in these …

Vitamin D deficiency is widespread and has been associated with many chronic diseases, including autoimmune disorders. A study was undertaken to explore the impact of low vitamin D levels on autoantibody production in healthy individuals, as well as B cell hyperactivity and interferon α (IFNα) activity in patients with systemic lupus erythematosus (SLE).Serum samples from 32 European American female patients with SLE and 32 matched controls were tested for 25-hydroxyvitamin D (25(OH)D) levels, lupus-associated autoantibodies and serum IFNα activity. Isolated peripheral blood mononuclear cells were tested for intracellular phospho-ERK 1/2 as a measure of B cell activation status.Vitamin D deficiency (25(OH)D20 ng/ml) was significantly more frequent among patients with SLE (n=32, 69%) and antinuclear antibody (ANA)-positive controls (n=14, 71%) compared with ANA-negative controls (n=18, 22%) (OR 7.7, 95% CI 2.0 to 29.4, p=0.003 and OR 8.8, 95% CI 1.8 to 43.6, p=0.011, respectively). Patients with high B cell activation had lower mean (SD) 25(OH)D levels than patients with low B cell activation (17.2 (5.1) vs 24.2 (3.9) ng/ml; p=0.009). Patients with vitamin D deficiency also had higher mean (SD) serum IFNα activity than patients without vitamin D deficiency (3.5 (6.6) vs 0.3 (0.3); p=0.02).The observation that ANA-positive healthy controls are significantly more likely to be deficient in vitamin D than ANA-negative healthy controls, together with the finding that vitamin D deficiency is associated with certain immune abnormalities in SLE, suggests that vitamin D plays an important role in autoantibody production and SLE pathogenesis.

Background: Identified aetiological factors for chronic widespread pain (CWP) are largely related to emotional and behavioural factors, but current management leads to modest improvement in symptoms. Vitamin D deficiency has been suggested as a new modifiable risk factor for CWP. Objective: To examine the association between vitamin D status (measured by 25-hydroxyvitamin D (25(OH)D)) and CWP in a nationwide population sample of white British adults, accounting for potential mediating and confounding lifestyle factors. Methods: 9377 participants born 1 week in March 1958, in England, Scotland or Wales and completing a biomedical assessment at age 45; 6824 eligible participants had data on 25(OH)D and completed pain manikins. Results: Prevalence of CWP varied by 25(OH)D concentration in women but not in men, with the lowest prevalence observed for women with 75–99 nmol/l (14.4% for

Objectives:Vitamin D has immune-modulating effects and may protect against the development of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Methods:We identified incident cases of SLE and RA among 186 389 women followed from 1980 to 2002 in the Nurses’ Health Study and Nurses’ Health Study II cohorts. We excluded subjects where SLE or RA was not confirmed by medical record review, and those who failed to return questionnaires. Semi-quantitative food frequency questionnaires assessed vitamin D intake from food and supplements. We used cumulative-updated total energy-adjusted dietary exposures for each 2-year cycle. Relationships between vitamin D intake and incident SLE and RA were examined in age-adjusted and Cox proportional hazards models, adjusted for confounders. Results were pooled using meta-analysis random effects models.Results:We confirmed 190 incident cases of SLE and 722 of RA with dietary information. Increasing levels of vitamin D intake had no relationship to the relative risk of developing either SLE or RA.Conclusions:Vitamin D intake was not associated with risk of SLE or RA in these large prospective cohorts of women.