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Background Lung diseases, such as airway disease and interstitial lung disease (ILD), are often complicated in patients with rheumatoid arthritis (RA). The presence of those pre-existing lung diseases is one of the poor prognostic factors and risk factors for infectious pneumonia in patients with RA. There have been several concerned issues regarding pulmonary complications in RA patients with pre-existing lung diseases during treatment with disease-modifying antirheumatic drugs (DMARDs) because of infectious pneumonia or acute exacerbation in ILD, occasionally resulting in fatal outcome. Objectives We identified risk factors for serious pulmonary complications in patients with pre-existing lung disease during treatment with DMARDs in RA. Methods This study enrolled consecutive 487 RA patients at our hospital from 2005 to 2016 retrospectively. 110 of those 487 patients had pre-existing lung disease at the first visit to our hospital. At first, we divided those 110 patients into two subsets, one with development of serious pulmonary complication and the other without that during observational periods. We defined hospitalisation due to lung disease as a serious pulmonary complication regardless of the causes. Demographic and clinical data at enrollment as well as treatment regimens were collected by review of medical charts. We conducted a univariate analysis to compare the differences of clinical characteristics between the subsets. In multivariate analysis, the Cox proportional hazard model was employed to identify factors independently associated with serious pulmonary complication. The explanatory variables were chosen based on candidates (p Results In 110 RA patients with pre-existing lung disease, the median age and disease duration at enrollment was 70 and 3 years, and 71% were female. Rheumatoid factor and anti-cyclic citrullinated protein antibody (anti-CCP) were detected in 97 (88%) and 95 (86%) patients. Methotrexate (MTX), sulfasalazine (SSZ), bDMARDs and corticosteroid were prescribed in 37 (34%), 48 (44%), 42 (38%) and 65 (59%) patients. During the median observation periods of 11 months, 17 (15%) patients had serious pulmonary complications due to pulmonary infection in 11, exacerbation of ILD in 5, and drug-induced pneumonia in 1. The univariate analysis identified candidate variables for serious pulmonary complications as follows: use of MTX and bDMARDs, and no use of SSZ. In multivariate analysis, use of bDMARDs (HR 2.9, 95% CI 0.99–9.0; p=0.05) was identified as the independent risk factor. In 42 patients during treatment with bDMARDs, the univariate analysis identified candidate variables as follows: elder age, male, higher levels of anti-CCP, use of MTX, and no use of SSZ. In multivariate analysis, the higher levels of anti-CCP (HR 1.002, 95% CI 1.0003–1.004; p=0.0007) and no use of SSZ (HR 441.8, 95% CI 1.1–4658460.2; p=0.04) were identified as the independent risk factors. Conclusions Serious pulmonary complications should be more careful for RA patients with pre-existing lung disease during treatment with bDMARDs, particularly those with higher levels of anti-CCP or no use of SSZ. Disclosure of Interest None declared

Background Cancer-associated myositis (CAM) is believed to be rarely complicated by interstitial lung disease (ILD), and, thus, detailed clinical characteristics of CAM in patients with polymyositis (PM)/dermatomyositis (DM)-associated ILD are not well known. Objectives To clarify the incidence, risk factors, and impact on survival of malignancy in patients with PM/DM-associated ILD, using a large cohort data. Methods We used 497 patients with PM/DM-associated ILD enrolled in a multicentre retrospective cohort of incident cases from 44 institutions across Japan (JAMI). CAM was defined as malignancy diagnosed within 3 years before or after PM/DM diagnosis. Demographic data and clinical characteristics were recorded at the time of diagnosis, and follow-up survival and malignancy data were collected prospectively. Results Thirty-two patients with CAM (6.4%) were identified. Patients in the CAM group were older (64.3 vs 55.1 years, p Conclusions In patients with PM/DM-associated ILD, older age at diagnosis and lack of arthritis are predictors for concomitant malignancy, which leads to a reduced survival. Disclosure of Interest Y. Kaneko Speakers bureau: Astellas, T. Nunokawa: None declared, Y. Taniguchi: None declared, Y. Yamaguchi: None declared, T. Gono: None declared, K. Masui: None declared, A. Kawakami: None declared, Y. Kawaguchi: None declared, S. Sato Grant/research support from: a patent on anti-MDA5 antibody-measuring kit, M. Kuwana Grant/research support from: Astellas, Speakers bureau: Astellas, Japan Blood Products Organisation, Medical and Biological Laboratories

Background Concomitant malignancy is one of the prognostic factors in patients with myositis,1 but clinical parameters for mortality still remain unknown in patients with cancer-associated myositis (CAM). Objectives Initial predictors for mortality were examined using a multicenter cohort of CAM patients. Methods This retrospective study enrolled 67 consecutive patients diagnosed as having CAM in 3 referral hospitals between 1995 and 2017. Clinical data at diagnosis of myositis as well as treatment regimens and outcomes of myositis and malignancy were collected by review of medical charts. Myositis-specific autoantibodies (MSAs) were comprehensively detected using RNA immunoprecipitation (IP), enzyme-linked immunosorbent assay, and IP-immunoblotting. We initially conducted a univariate analysis to select variables that were different between survivors and dead cases. In multivariate analysis, the Cox proportional hazard model with backward selection method (p>0.20) was employed to identify factors independently associated with mortality. Explanatory variables were chosen based on the following three models. The Model 1 included age at diagnosis of myositis, gender and candidate variables (p Results The median age at diagnosis of myositis was 63 years, and 62% were female. MSAs were detected in 47 patients: anti-TIF1-γ in 27, anti-ARS in 6, anti-MDA5 in 5, anti-Mi-2 in 3, anti-NXP2 in 3, anti-SAE in 2, and anti-SRP in 1. During the median observation period of 2 years, 19 (28%) of 67 CAM patients were dead due to tumour in 16, ILD in 1, and an unknown cause in 2. The univariate analysis identified significant poor prognostic factors (p Conclusions Male and progression of malignancy at diagnosis of myositis were identified as predictors of survivals in CAM patients. Reference [1] Callen JP. Dermatomyositis. Lancet2000;355:53–7. Disclosure of Interest H. Kadota: None declared, T. Gono: None declared, Y. Yamaguchi: None declared, E. Watanabe: None declared, Y. Okazaki: None declared, Y. Nakajima: None declared, S. Kobayashi: None declared, Y. Shirai: None declared, M. Takeno: None declared, C. Terai: None declared, M. Kuwana Grant/research support from: Astellas, Speakers bureau: Astellas and Japan Blood Products Organisation

Background Raised levels of serum rheumatoid factors (RFs) of different immunoglobulin classes had been reported in a high proportion of patients with rheumatoid vasculitis. RF used to be studied and was shown elevated in some forms of vasculitides. Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are often positive for RF. However, the clinical significance of RF has been seldom examined in AAV. Objectives The aim of this study was to investigate association between the presence of RF and clinical features and outcomes in AAV. Methods Eighty-one patients were diagnosed with AAV from 2006 to 2015 in our hospital. Among 81 patients, forty-seven patients (17 males, median age 67 years) who were not complicated with rheumatoid arthritis and in whom RF was measured before the treatment, were studied, retrospectively. Patients were classified using the European Medicines Agency vasculitis classification algorithm. AAV included eosinophilic granulomatosis with polyangitis (n=10), granulomatosis with polyangitis (n=14), microscopic polyangitis (n=16) and unclassifiable vasculitis (UV) (n=7). Patients with UV with MPO-ANCA or PR3-ANCA were included in this study. IgM-RF was measured using a latex agglutination assay. Disease activity was assessed with Birmingham vasculitis activity score (BVAS). IgM-RF, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum ferritin, IgG, IgM, IgA, MPO-ANCA and PR3-ANCA were obtained from hospital records. Clinical manifestations between RF-positive subset (n=29) and RF-negative subset (n=18) were analyzed using Fisher9s exact and Wilcoxon rank sum tests. Correlation coefficients were established with Spearman9s correlation coefficient. Data were shown as medians (interquartile range). Results BVAS was higher (14 (12–22) vs 12 (6–16), P=0.026) in the RF-positive subset than the RF-negative subset. CRP and ESR were higher (P=0.020 and 0.007, respectively) in the RF-positive patients. IgM-RF titers significantly correlated with BVAS (r=0.50, P=0.0004). In addition, CRP, ESR, IgM and IgG also had a significant correlation with IgM-RF titers. The frequency of initiation of dialysis therapy (14% vs 6%), usage of mechanical ventilation (14% vs 0%) and mortality (10% vs 0%) were higher in the RF-positive subset than in the RF-negative subset although no significant differences were shown. Conclusions In AAV, IgM-RF titers are significantly correlated with disease activity and inflammatory markers. Presence of RF could be a poor prognostic factor in patients with AAV. References Watts R, Lane S, Hanslik T, et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007;66:222–227. Westedt ML, Herbrink P, Molenaar JL, et al., Rheumatoid factors in rheumatoid arthritis and vasculitis. Rheumatol Int 1985;5:209–14. Kronbichler A, Kerschbaum J, Grundlinger G, et al. Evaluation and validation of biomarkers in granulomatosis with polyangiitis and microscopic polyangiitis. Nephrol Dial Transplant 2016;31(6):930–6. Disclosure of Interest None declared