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Background Concomitant presence of systemic lupus erythematous (SLE) and rheumatoid arthritis (RA) in the same patient is known as Rhupus. Poliautoimmunity is not an uncommon phenomenon reported, but only a small series of patients have been described so far with Rhupus. This study aimed to explore the utility of 2019 EULAR/ACR criteria in patients with Rhupus. Methods Cross-sectional study conducted in 11 Rheumatology Departments at Catalonia (Spain). We included prevalent cases classified as Rhupus (RA ACR/EULAR 2010 and SLE-ACR 1997). Data of patients with SLE were selected as control in a ratio 2:1, matched by sex. Results 120 patients were included, 40 Rhupus and 80 SLE alone as controls. 95% were female, with a mean age of 51 yrs and mean of 13 yrs. The 2019 SLE EULAR/ACR criteria were met in 92,5% of the Rhupus and in the 96,3% of the SLE cohort (p>0,05). Numerically, criteria score was higher in those patients with ‘pure’ SLE than Rhupus (21.3 ± 7.0 vs 18.8 ± 6.5, p=NS). Excluding articular domain, there were no significant differences among those who meet new criteria (65% Rhupus vs. 77% SLE (p>0.05)). Proteinuria was the only domain significantly more common in patients with SLE alone. No other differences were found in other clinical or serological characteristics. Conclusion More than 90% of patients classified as Rhupus criteria fulfilled new SLE criteria. This study shows that the new 2019 SLE EULAR/ACR criteria are not useful to differentiate SLE and Rhupus patients. Further investigations are needed to measure their utility in clinical practice for detecting overlap presentation of RA and SLE.

Background Community-acquired pneumonia (CAP), the most common pneumococcal infection, is a leading cause of morbidity and mortality among immunocompromised hosts. Although vaccination against Streptococcus Pneumoniae is recommended by international guidelines, most studies report a sub-optimal coverage. Objectives To describe the pneumococcal vaccination coverage, predictors for vaccination uptake and frequency of severe CAP and invasive pneumococcal disease during the study period. Methods We performed a cross-sectional study using electronic medical record data from October 2000 to October 2018, including patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS), treated with biologic (bDMARD) and conventional synthetic DMARD (csDMARD) with or without glucocorticoids (GC), followed-up at a referral centre. Since pneumococcal vaccination guidelines have changed during the study period, patients who received at least one dose of any of the available vaccines were defined as being “ever-vaccinated” whereas those who received a complete scheme defined as one dose of conjugated vaccine and one of polysaccharide vaccine 8 weeks apart were defined as having “optimal vaccination”. Predictors of vaccination were analyzed using logistic regression modelling using a set of covariates selected according to the literature. Model assessment was done using Akaike information criterion. To analyze the frequency of severe infections we defined two outcomes: Severe CAP: An episode requiring hospitalization or intravenous antibiotic treatment Invasive pneumococcal disease (IPD): an infection confirmed by the isolation of the micro–organism from a normally sterile site (i.e. blood). Results A total of 279 patients were included, their main clinical features are shown in Table 1. The vaccination coverage was 38.7% and 13.3% overall when analyzing as “ever-vaccinated” and having “optimal vaccination” respectively. A 66% of patients were vaccinated in primary care with a 7% of optimal vaccination whereas the remaining ones received vaccination in referral centres with an 85.3% of optimal vaccination. After adjustment in a multivariate model, age, presence of bronchiectasis, history of severe CAP, current use of csDMARD or GC were predictors of being ever-vaccinated against Streptococcus Pneumoniae. (Table 2) During the study period, 27 (10%) episodes of severe CAP and 4 of IPD were identified, 8 of the former with evidence of pneumococcal infection (either positive urine antigens or isolation in sputum). Conclusion Pneumococcal vaccination coverage remains lower than expected with most patients vaccinated in primary care and not receiving the current recommended scheme. Age, bronchiectasis, history of severe CAP and current use of csDMARD or GC were independent predictors of receiving vaccination. The frequency of severe CAP and IPD was 10% and 1,43% within this cohort. Disclosure of Interests Sebastian C Rodriguez-Garcia: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Victoria Hernandez: None declared, Roberto Gumucio: None declared, Anna Vilella: None declared, Carolina Garcia-Vidal Speakers bureau: Lilly, Pfizer, Juan D. Canete: None declared, Julio Ramirez: None declared, Raimon Sanmarti Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN, Jose A. Gomez-Puerta Consultant for: Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen, MSD, Pfizer, Roche

Background: Anti-carbamylated protein antibodies (Anti-CarP) represent a novel autoantibody family present in sera of patients with rheumatoid arthritis (RA) with high specificity. Objectives: To analyse the prevalence of Anti-CarP in an established RA cohort and evaluate their association with the presence of other autoantibodies and disease activity and severity. Methods: Cross-sectional study. Presence of Anti-CarP was analyzed in a cohort of patients with established RA (n: 158) by a home-made ELISA test using fetal calf serum. We investigated the demographic, radiological and current and at disease onset clinical features. Rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) status were also assessed. Results: Anti-CarP were positive in 46.2% of the patients in our cohort and in 15.1%, 19.2% and 9.1% of the patients negative for ACPA, RF and both respectively. Demographic and clinical features are shown in table 1. The mean titer of ACPA (1361±1054 U/mL vs. 918 ± 1092 U/mL) and RF (258 ± 255 AU vs. 174 ± 205 AU) were significantly higher in Anti-CarP positive patients. No difference in symptoms at RA onset was observed. Current (24.7% vs. 11.8%) and previous (54.8% vs. 37.6%) smoking consumption were significantly associated with Anti-CarP antibodies. Anti-CarP positive patients presented a higher CRP values (1. 0±1.6 mg/dL vs. 0.5 ±0.8 mg/dL), swollen joint count (1.3±2.2 vs 0.7 ±1.8) and patient global health assessment VAS (34.8 ±21.5 mm vs. 26.4 ±17.1 mm); although no between-group differences in disease activity (DAS28, CDAI, SDAI and RAPID3) or demographic features were observed. Anti-CarP positive patients presented significant higher scores in Larsen index (23.6 ± 15.7 vs. 15.7 ± 12.6) and disability (HAQ-DI >1) (23.3% vs. 8.3%). Conclusion: Anti-CarP were present in approximately half of the RA cohort and were also detected in seronegative (RF and/or ACPA) patients. In our cohort, patients with Anti-CarP antibodies presented higher tobacco consumption and poorer disease outcomes. Disclosure of Interests: Raul Castellanos-Moreira Speakers bureau: For Lilly and Merk Sharp and Dohme, Sebastian C Rodriguez-Garcia: None declared, Virginia Ruiz: None declared, Oscar Camacho: None declared, Julio Ramirez: None declared, Andrea Cuervo: None declared, Cristina Garcia-Moreno: None declared, Rosa Morla: None declared, Jose Gomez Puerta Speakers bureau: BMS, Pfizer, Amgen, Juan D. Canete: None declared, Isabel Haro: None declared, Raimon Sanmarti Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN

Background Interstitial lung disease (ILD) is an extra-articular manifestation of Rheumatoid Arthritis (RA), has been related with a poor prognosis. However, there is a lack of clinical data regarding its evolution with different treatment approaches. Objectives Our aim was to assess clinical features and evolution of ILD in a cohort of RA patients from a tertiary hospital Methods Single-centre retrospective observational study including all patients diagnosed with ILD with a previous or posterior diagnosis of RA evaluated from January 2007 to December 2016 in the Rheumatology Department of a university hospital. Variables analysed: age, sex, smoking status, duration of RA, presence and titers of ACPA (antiCCP2) and rheumatoid factor (RF), presence of erosions, use of glucocorticoids (GC), synthetic and biological DMARDs before and after ILD diagnosis and presence of other extra-articular manifestations. We also analysed: duration of ILD, HRCT (High Resolution Computed Tomography) patterns and pulmonary function tests (PFT) at baseline and during follow-up to assess the evolution of the disease. The PFT results were evaluated according to the American Thoracic Society/European Respiratory Society definitions (1). Results Twenty-one patients (18 women) were included, mean age 68. 4±11.9, mean RA duration 12.3±8.2 years. 9.5% were current smokers and 33.3% former smokers. 61.9% were ACPA + (52.4% with high basal titers, median ACPA titers: 698) and 81% RF+ (47.6% with high basal titers). 71.4% had erosions and 5 patients (23.8%) had extra-articular manifestations, mainly rheumatoid nodules. RA diagnosis was made after that of ILD in 4 patients; mean elapsed time 1.56±1.26 years. In the other 17 patients, the mean duration of RA until ILD diagnosis was 11.2±7.2 years. Currently 17 subjects (85%) receive GC; 4 (19%) in monotherapy and 11 (57.9%) synthetic DMARDs (5 methotrexate, 3 leflunomide (LEF), 1 hydroxychloroquine (HCQ) and 2 with double therapy (HCQ/AZA and HCQ/LEF)). Four patients are currently treated with biological therapy (2 abatacept (ABA), 1 rituximab and 1 etanercept (ETN)), all of them in monotherapy. Five patients received TNFi prior to ILD diagnosis (3 ETN, 1 infliximab and 1 adalimumab). Biological therapy was withdrawn in 3 cases and switched to ABA in the two remaining ones. The median duration of EPID was 2.5 (range 0.7–11.9) years. HRCT patterns were: non-specific interstitial pneumonia (NSIP) 52.9%, usual interstitial pneumonia (UIP) 17.6%, cryptogenic organized pneumonia (COP)11. 8%, and other patterns 17.7%. 14 patients had baseline and follow-up PFT: 9 (64.3%) remained stable; 3 (21.4%) improved and 2 (14.3%) worsened (1 had received previous ETN). There was a trend for worsening of PFT in patients with UIP pattern. No patient died from ILD during this period Conclusions In our RA-ILD cohort, NSIP was the most common HRCT pattern and PFT remained stable in most patients during follow-up. Five patients (23.8%) had received TNFi prior to ILD diagnosis and only one of them showed worsening of PFT during ETN treatment, with clinical improvement after withdrawal. References Pellegrino R et al. Eur Respir J. 2005;26:94868. Disclosure of Interest None declared