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Background/Aims In axial spondyloarthritis, it has been shown that while some adverse lifestyle factors (smoking and high body mass index (BMI)) are less likely to respond to TNF inhibition (TNFi), those who drink alcohol are more likely to respond to treatment - a result currently unexplained, and unlikely to be causal. We aimed to investigate these associations in psoriatic arthritis (PsA) and to quantify the impact of lifestyle factors on TNFi treatment response. Methods Adults with PsA commencing TNFi were identified via the European Spondyloarthritis Research Collaboration Network (https://eurospa.eu). Participants were required to have data on lifestyle factors (smoking, alcohol consumption, and/or BMI) recorded within ±30 days of commencing TNFi. The relationship between lifestyle factors and treatment outcome (ACR-50 response criteria at 12 months) was assessed using logistic regression, adjusted for age, sex, country, year of TNFi initiation, disease duration and baseline disease activity (DAS28). The analysis was then repeated for other treatment response criteria: ACR-20, ACR-70, DAPSA28-remission, DAPSA68-remission and Minimal Disease Activity. Results From 12 PsA registries, 9409 participants were included, 21% of whom were current smokers, 54% drank alcohol, 38% were overweight and 29% were obese. Other baseline characteristics are shown in Table 1. Among smokers, 18% met ACR-50 response criteria at 12 months, versus 26% of non-smokers, an association that remained after adjusting for potential confounders (adjusted odds ratio: 0.59; 95%CI: 0.48-0.72). Participants who were overweight (adjusted odds ratio: 0.80; 0.64-0.99) or obese (0.57; 0.44-0.72) were also less likely to achieve treatment response, compared to patients of normal weight. Similar results were seen across other outcome measures. The proportion who achieved ACR-50 response did not differ between patients who did/did not consume alcohol (both 22%). Conclusion Smoking and high BMI were associated with substantial decreases in the likelihood of TNFi response. The addition of non-pharmacological therapy, including the modification of adverse lifestyle factors, may offer the potential to enhance treatment outcomes. For example, if 100 patients were able to give up smoking when commencing TNFi, an additional eight would achieve ACR-50 at 12 months. Previous findings regarding alcohol and treatment response in axSpA were not replicated in PsA. Disclosure G.T. Jones: None. O. Rotariu: None. B. Michelsen: None. B. Glintborg: None. B. Gudbjornsson: None. T.J. Love: None. D. Nordström: None. T. Sokka: None. J. Vencovský: None. P. Horák: None. Z. Rotar: None. M. Tomšič: None. M. van der Sande: None. M.J. Nissen: None. B. Möller: None. C. Codreanu: None. J.K. Wallman: None. K.M. Fagerli: None. S.H. Rasmussen: None. L.M. Ørnbjerg: None. M.J. Santos: None. P. Carvalho: None. M.L. Hetland: None. M. Østergaard: None. G.J. Macfarlane: None.

Objectives To investigate time trends in baseline characteristics and retention, remission and response rates in bio-naïve axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients initiating TNF inhibitor (TNFi) treatment. Methods Prospectively collected data on bio-naïve axSpA and PsA patients from routine care in 15 European countries were pooled. Three cohorts were defined according to year of TNFi initiation: A (1999–2008), B (2009–2014) and C (2015–2018). Retention, remission and response rates were assessed at 6, 12 and 24 months. Results In total, 27 149 axSpA and 17 446 PsA patients were included. Cohort A patients had longer disease duration compared with B and C. In axSpA, cohort A had the largest proportion of male and HLA-B27 positive patients. In PsA, baseline disease activity was highest in cohort A. Retention rates in axSpA/PsA were highest in cohort A and differed only slightly between B and C. For all cohorts, disease activity decreased markedly from 0 to 6 months. In axSpA, disease activity at 24 months was highest in cohort A, where also remission and response rates were lowest. In PsA, remission rates at 6 and 12 months tended to be lowest in cohort A. Response rates were at all time points comparable across cohorts, and less between-cohort disease activity differences were seen at 24 months. Conclusion Our findings indicate that over the past decades, clinicians have implemented more aggressive treatment strategies in spondyloarthritis. This was illustrated by shorter disease duration at treatment initiation, decreased retention rates and higher remission rates during recent years.

BACKGROUND AND AIMS The closure times [CTs; i.e. collagen/epinephrine (COL Epi) and collagen/adenosine 5-diphosphate (COL ADP)] are frequently used to evaluate primary haemostasis before kidney biopsy, although their usefulness to predict hemorrhagic events remains elusive [1]. CTs can be prolonged not only by antiplatelet agents but also by e.g. the presence of anaemia, thrombocytopaenia, uremic conditions in patients with advanced stages of chronic kidney disease (CKD) and even the circadian rhythm among others, which limits their dependability/usefulness [2–4]. We aimed to investigate the assumed association between prolonged CTs and the occurrence of hemorrhagic complications after kidney biopsy [5] in patients with CKD and to explore possible factors influencing their values. METHOD We retrospectively analysed following data collected during medically indicated ultrasound (US)-guided kidney biopsies in patients without antiplatelet/anticoagulant therapy or after its discontinuation for at least 1 week before the procedure: demographic and clinical data, kidney size and resistance index (RI) measured by ultrasound (US) on the biopsied kidney, serum creatinine (μmol/L), estimated glomerular filtration rate (eGFR; mL/min/1.73 m2; using CKD-EPI equation), basic haemostasis tests [prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT)] and CTs (COL Epi and COL ADP; seconds) to assess platelet function. We also collected data on haemoglobin concentration (g/L) and platelet counts (109/L) before and no longer than 24 h after the biopsy, the development of haematoma (HMT) up to 24 h after the procedure, macrohematuria, need for transfusion, percutaneous or surgical intervention. The analysis was performed with the statistical program R, using Student's t test, Mann–Whitney test and Fisher's exact test for categorical variables. P values RESULTS In 2016, our centre performed 144 biopsies of native kidneys, 141 kidney biopsies were included in the analysis. None of the patients had post-procedural macrohematuria or HMT requiring percutaneous or surgical intervention. None of the patients required a transfusion. Independently of CTs, haemoglobin decreased by ≥10 g/L in 25 (18%) patients. HMT was described in 39 (28%) patients. A total of 27 (20%) patients had to discontinue antiplatelet therapy (APT) prior to biopsy. There was no statistically significant difference in HMT occurrence in comparison to patients without APT (P = .346). Patients with APT had higher renal RI (0.77 versus 0.72, P = .049) and even after discontinuation of APT prolonged COL ADP (115 versus 97, P = .02), compared to patients without APT. Differences in PT/INR and aPTT values between groups were insignificant. Table 1 compares patients with prolonged and normal CTs. COL Epi was above the normal range in 20 (16%), COL ADP in 25 (20%) and either or both in 31 (25%) patients, respectively. Blood haemoglobin before biopsy trends to be slightly lower in patients with prolonged CTs (P = .066). CONCLUSION In our cohort of patients without or after timely discontinued APT, there were no serious adverse outcomes of kidney biopsy whether the CTs were prolonged or not. The persistently prolonged CT is nevertheless an important information that should not be omitted, especially in combination with other patient characteristics (e.g. anaemia, depth of the kidneys, blood pressure immediately before the procedure, etc.), that are influencing the individual biopsy provider's choice of needle gauge, the number of punctures that provide the additional safety of invasive procedure and its complications.