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BackgroundA major systemic lupus erythematosus (SLE) susceptibility locus lies within a common inversion polymorphism region (encompassing 3.8 – 4.5 Mb) located at 8p23. Initially implicated genes includedFAM167A-BLKandXKR6, of whichBLKreceived major attention due to its known role in B-cell biology. Recently, additional SLE risk carried in non-inverted background was also reported.Objective and methodsIn this case –control study, we further investigated the ‘extended’ 8p23 locus (~ 4 Mb) where we observed multiple SLE signals and assessed these signals for their relation to the inversion affecting this region. The study involved a North American discovery data set (~1200 subjects) and a replication data set (> 10 000 subjects) comprising European-descent individuals.ResultsMeta-analysis of 8p23 SNPs, with p < 0.05 in both data sets, identified 51 genome-wide significant SNPs (p < 5.0 × 10−8). While most of these SNPs were related to previously implicated signals (XKR6-FAM167A-BLKsubregion), our results also revealed two ‘new’ SLE signals, includingSGK223-CLDN23-MFHAS1(6.06 × 10−9≤ meta p ≤ 4.88 × 10−8) andCTSB(meta p = 4.87 × 10−8) subregions that are located > 2 Mb upstream and ~ 0.3 Mb downstream from previously reported signals. Functional assessment of relevant SNPs indicated putativecis-effects on the expression of various genes at 8p23. Additional analyses in discovery sample, where the inversion genotypes were inferred, replicated the association of non-inverted status with SLE risk and suggested that a number of SLE risk alleles are predominantly carried in non-inverted background.ConclusionsOur results implicate multiple (known+novel) SLE signals/genes at the extended 8p23 locus, beyond previously reported signals/genes, and suggest that this broad locus contributes to SLE risk through the effects of multiple genes/pathways.

Background:To optimize the control of vaccine preventable diseases, high immunization coverage rates must be achieved. Influenza vaccination rates among patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are suboptimal. Understanding patient preferences for interventions that may increase vaccine uptake is the first step to inform the development of specific strategies to enhance vaccine coverage in RA/JIA.Objectives:To compare the perceptions of vaccinated and unvaccinated RA/JIA patients on a multi-modal intervention to enhance seasonal influenza vaccine coverage.Methods:During the 2018-2019 influenza season, a multi-modal intervention was implemented at a large Canadian academic center. This consisted of (i) a letter sent from the Division of Rheumatology to patients addressing common misconceptions about flu vaccines and encouraging patients to plan for immunization; (ii) a nurse providing inactivated influenza vaccine at the rheumatology clinics for the first 7 weeks after the vaccine was released, and (iii) clinics posters specifically designed for rheumatic patients and rheumatologists to prompt a discussion on influenza prevention. Patients that were vaccinated on site completed a survey evaluating the relevance of the individual components of the intervention. After the intervention, during a scheduled rheumatology visit, RA/JIA patients were asked to complete a similar survey. We compared the responses from RA/JIA patients that were vaccinated at our institution, to those of patients that reported not having received the influenza vaccine in 2018-2019.Results:During the intervention, 116 immunized RA/JIA patients completed the first survey. Forty RA/JIA patients not vaccinated during the 2018-2019 season completed the post-intervention survey. Both vaccinated and unvaccinated groups were mostly female (74.1% versus 87.2%), but vaccinated patients were older (50.8±19.4 versus: 40.5±14.9; 95% CI 3.7%,17%), and had shorter disease duration (10.1±9.3 versus 15.0±9.8; 95% CI -8.9%,-1.1%) than those not vaccinated. Unvaccinated patients were less likely than vaccinated patients to approve of the clinic’s provision of influenza vaccine (98.2% versus 75%; 95% CI 12.8%, 43.5%). When asked about elements of the intervention, unvaccinated patients were less likely than vaccinated patients to consider posters (65.2% versus 38.9%; 95% CI 7.9%, 42.9%), letters (69.4% versus 35.3%; 95% CI 16.2%, 51.2%), or phone calls (58.0% versus 41.7%; 95% CI 2.1%, 33.5%) as good reminders.Conclusion:Unvaccinated RA/JIA patients’ opinions about interventions to increase vaccine uptake differ from vaccinated patients. Alternative, novel strategies to target vaccine hesitant RA/JIA patients are needed to optimize vaccine coverage.Disclosure of Interests:None declared

Objective: To estimate the prevalence of polymyositis and dermatomyositis using population-based administrative data, the sensitivity of case ascertainment approaches and patient demographics and these parameters. Methods: Cases were ascertained from Quebec physician billing and hospitalisation databases (approximately 7.5 million beneficiaries). Three different case definition algorithms were compared, and statistical methods were also used that account for imperfect case ascertainment, to generate estimates of disease prevalence and case ascertainment sensitivity. A hierarchical Bayesian latent class regression model was developed to assess patient characteristics with respect to these parameter estimates. Results: Using methods that account for the imperfect nature of both billing and hospitalisation databases, the 2003 prevalence of polymyositis and dermatomyositis was estimated to be 21.5/100 000 (95% credible interval (CrI) 19.4 to 23.9). Prevalence was higher for women and for older individuals, with a tendency for higher prevalence in urban areas. Prevalence estimates were lowest in young rural men (2.7/100 000, 95% CrI 1.6 to 4.1) and highest in older urban women (70/100 000, 95% CrI 61.3 to 79.3). Sensitivity of case ascertainment tended to be lower for older versus younger individuals, particularly for rheumatology billing data. Billing data appeared more sensitive in ascertaining cases in urban (vs rural) regions, whereas hospitalisation data seemed most useful in rural areas. Conclusions: Marked variations were found in the prevalence of polymyositis and dermatomyositis according to age, sex and region. These methods allow adjustment for the imperfect nature of multiple data sources and estimation of the sensitivity of different case ascertainment approaches.

Objectives The authors aim to calculate the number of live births, before and after systemic lupus erythematosus (SLE) diagnosis, in women diagnosed during their reproductive years and to compare this with general population rates. Methods The authors identified women with SLE using Quebec administrative databases (1 January 1994 to 31 December 2003). The authors determined the number of live births, and calculated the standardised incidence ratio (SIR) of observed to expected live births. Results 1334 women with SLE were identified. Overall, the number of live births over the interval (559) was below that which would be expected (708) (SIR 0.79; 95% CI 0.73 to 0.86). Compared with the general population, live births were substantially lower after SLE diagnosis (SIR 0.62; 95% CI 0.55 to 0.70) than before diagnosis (SIR 1.01; 95% CI 0.90 to 1.13). Conclusion After diagnosis, women with SLE have substantially fewer live births than the general population.

Background Many countries face a critical shortage of rheumatologists. Based on an accepted benchmark of 1 specialist per 50,000 people as the number needed for effective patient care, 1 recent figures show shortages in some EU Member states, 2 parts of the US 3 and in Canada. 4 Objectives This qualitative environmental scan was designed to identify how Canadian rheumatologists are trained, perceived positive aspects of a career in this subspecialty, how programs inform/attract learners and what can be done collectively to attract more trainees. Methods Individual-level data from faculty/administrators and learners across Canada via an online survey (n=30) and interviews (n=20); program-level data from accreditation reports for the Royal College of Physicians & Surgeons of Canada. Data subjected to Thematic Framework Analysis to identify themes and issues from all sites. Results 57% of the respondents were female, 80% Canadian-trained and 93% work in teaching hospitals. Half the interviewees are female; most were faculty/administrators (63%) who had on average 14.8 years experience. Learners included undergraduate medical students rotating through a Rheumatology program and postgraduate trainees (PGY4-6). The need for rheumatologists is widely recognized ( “La rhumatologie est la specialite d9avenir au Canada” [L]*). Respondents advocate targeting both undergraduates ( “People who influenced me were [role models] I had as a medical student” [F]) and junior Internal Medicine residents. Methods included increasing rheumatology presence in undergraduate programs (lectures, clinical skills sessions, hands-on training, faculty available to shadow or join in research) and postgraduate training (weekend info & training sessions, mandatory rotation in Internal Medicine, internships, career counseling). Messages to brand rheumatology as an attractive specialty included the intellectual challenge ( “This field fascinates me” [L]; “novel immunotherapies make it very exciting” [F]), stimulating workday ( “nice mix of procedural and cerebral work” [L]), positive relationships with colleagues and patients ( “According to a recent survey we are the happiest specialists” [F]), alleviating suffering ( “We know how to treat arthritis now” [L]), good quality of life ( “excellent work-life balance” [F]) and excellent job prospects ( “the health care system needs you” [F]. Key to Quotes *[L] = learner; [F] = faculty. Conclusions We found consensus on the need to inform potential trainees about rheumatology earlier in their education. The next step will be to develop innovative tools and methods collectively for use in multiple sites. This study will guide a program of research to collaboratively develop, test and evaluate tools across Canada designed to increase the number of future rheumatologists. References Karolinska Institutet/i3 Innovus. (2009) (http://www.comparatorreports.se/RA%20Barrier%20Report_FINAL_050110.pdf). Ibid. Deal et al. (2007). Arthritis & Rheumatism 56(3):722-729. 2012 CMA Masterfile (www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Statistics/02SpecAge.pdf). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5515

Background The Health Improvement and Prevention Program (HIPP) in systemic lupus erythematosus (SLE) is the first intervention aimed at improving health status and coping skills of persons with lupus while reducing cardiovascular (CVD) and osteoporotic risk. Objectives To determine whether HIPP will improve health status, endothelial function and CVD risk at one year. Methods An unblinded RCT of the HIPP intervention compared to usual care assessed physical (PCS) and mental (MCS) component summary scores of SF-36, CVD risk derived from the Framingham risk score (FRS) and flow mediated dilatation (FMD) of the brachial artery. Patients with SLE and no CVD were recruited from three academic centres. After providing consent, SF-36, disease activity (SLEDAI-2K) and damage (SDI), CVD risk factors and FMD were collected. Those randomized to HIPP NOW were administered a personalized risk modification program by a nurse (disease education, CVD risk reduction {including smoking cessation}, exercise, psychological intervention). Repeated clinical assessments and FMD were performed at one and two years. A cross-over of the LATER group occurred at one year and all patients were reassessed at 2 years. We report here on the results from both groups one year after the HIPP intervention. Paired t-tests at the Bonferroni-corrected 2-tailed alpha=0.0125 were used to assess the statistical significance of the mean changes, estimated from data pooled across the two trial arms, in the four primary outcomes PCS, MCS, FMD and FRS comparing the one year post HIPP versus baseline data. Results We randomized 288 patients; one withdrew at baseline leaving 287 for analysis. Mean age was 44 yrs, 70% were Caucasian, 53% married, 91% high school graduates, mean disease duration was 11.3 yrs, mean SLEDAI 4.04 and mean SDI 1.17. Mean FMD increased significantly during the intervention period from 0.33 to 0.344, with mean increase of 0.014 (95% CI: 0.004 to 0.024), p=0.005). Mental health also improved significantly, as mean MCS scores increased from 45.15 to 46.78 with a mean increase of 1.63 (95% CI: 0.62 to 2.65, p=0.002) In contrast, there was no evidence of a systematic change in the PCS with scores of 40.71 pre and 40.61 post HIPP (p=0.80). We observed a significant increase in the FRS, even after eliminating the effect of age. More analyses will be done to determine if the increase in FRS was slower in those who received HIPP immediately compared to those who received it one year later. Conclusions The HIPP behavioral intervention improved significantly the endothelial dysfunction and mental health of persons with SLE but not the physical health. Cardiovascular risk measured by FRS worsened over that period despite HIPP. We need to evaluate next whether HIPP sufficiently improves endothelial dysfunction to mitigate the effects of the progression in cardiovascular risk. Disclosure of Interest P. Fortin Consultant for: Roche, GSK, Speakers Bureau: GSK, Actelion, E. Aghdassi: None Declared, A. Cymet: None Declared, S. Morrison: None Declared, J. Su: None Declared, W. Wynant: None Declared, J. Pope: None Declared, S. Hewitt: None Declared, C. Pineau: None Declared, C. Neville: None Declared, P. Harvey: None Declared, J.-C. Tardif: None Declared, M. Abrahamowicz: None Declared, D. DaCosta: None Declared