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Background:The prevalence of inflammatory bowel disease (IBD) in ankylosing spondylitis (AS) has been reported to range between 6%-15%. As occurs with axial spondyloarthrtitis (axSpA), patients with IBD have an increased risk of cardiovascular (CV) events because of a process of accelerated atherosclerosis1. However, it is unknown whether the presence of IBD confers an increased cardiovascular CV risk in patients with axSpA.Objectives:To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without IBD.Methods:Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant IBD. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.Results:A set of 886 axSpA patients were included. 829 (93.6%) of them had no concomitant IBD, which was present in 57 (6.4%) patients. Age, sex and AS/nr-axSpA ratio were comparable in both groups (Table 1. next page). Patients with IBD were characterised by a lower prevalence of HLA B27 (46% vs 72%, p=0.01) and a higher presence of concomitant psoriasis (21% vs 10%, p=0.01)Regarding peripheral disease (history of synovitis, enthesitis, dactylitis) and hip involvement, no differences were found between both groups. There were either no differences in the structural damage found in patients with and without IBD (Table 1. next page).With respect to the management of the disease, prednisone (21% vs 13%, p = 0.03), DMARDs (54% vs 35%, p = 0.01) and anti-TNFα therapy (54% vs 31%, p = 0.00) were more commonly used in the group with IBD, while treatment with NSAIDs was more frequent in patients without IBD (81% vs 70%, p = 0.04).Regarding CV risk features, smoking was more frequent in patients without IBD (34% vs 21%, p = 0.045) (Table 1. next page). No differences were observed neither in the lipid profile or blood pressure at the time of the study, nor in the prevalence of CV events (5% vs 4%, p=0.99) (Table 1) and the subclinical atherogenic burden assessed both by the presence of carotid plaques (31% vs 37%, p=0.45) and the cIMT (645 ± 147 mm vs 636 ± 112 mm, p = 0.64) (Table 1. next page).Conclusion:The presence of IBD does not confer additional CV risk to axSpA. In our series, patients with axSpA and IBD showed a lower frequency of HLA B27 and a higher prevalence of psoriasis.Table 1.axSpA without IBD (n=829)axSpA with IBD (n=57)pMen/Women, n272/55715/420.33Mean age (years) ±SD at the time of study49 ± 1349 ± 100.99AS/nr-AxSpa656/17345/120.97History of CV risk factors Current smoker285 (34)12 (21)0.045 Obesitty Dyslipemia280 (34)16 (28)0.42 Hypertension223 (27)16 (28)0.79 Diabetes Mellitus60 (7)4 (7)0.99 Chronic Kidney Disease20 (2)2 (4)0.65History of cardiovascular events, n (%)40 (5)2 (4)0.99Structural damage at the time of studyPresence of syndesmophytes, n (%)307 (37%)23 (49%)0.66mSASSS5 (1-15)6 (3-23)0.64Severe sacroiliitis (grade 3,4), n (%)436 (53)34 (60)0.42CV data at the time of studyCarotid plaques261 (31)21 (37)0.45IMT (mm)645 ± 147636 ± 1120.64IMT >= 0.9 mm46 (6)0 (0)0.066Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IBD = Inflammatory bowel disease. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.Disclosure of Interests:None declared

Background:Women with inflammatory arthropaties have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.Objectives:To evaluate pregnancy in women with inflammatory arthropaties in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment used (including BT).Methods:Retrospective and descriptive study of the evolution of pregnancy in patients withinflammatory diseases (Rheumatoid Arthritis (RA), Spondyloarthritis (SpA) and Juvenile Idiopathic Arthritis (JIA)) and follow-up in a multidisciplinary unit for more than 15 years (until December 2020). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, Caesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.Results:We registered 41 pregnancies (32 women): 20 RA (62.5%), 9 SpA (28.1%) and 3 JIA (9.4%). Maternal average age at diagnosis was 27.1±6.6 years and average age at childbirth/abortion was 34.9±5.1 years.It took an average time of 9.6±8.5 months to conceive. 9.8% received fertility treatment with in vitro fertilization techniques.AntiRo antibodies were registered in 7.3% of patients and 34.1% had at least 1 antiphospholipid antibody.At the time of gestational desire/gestation 17 women (12 RA, 4 SpA, 2 JIA) were receiving BT: 7 certolizumab (CZP), 7 adalimumab (ADA), 3 etanercept (ETN). 1 patient was being treated with baricitinib. Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as baricitinib. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 9 cases.9 abortions were registered prior to follow-up in the unit (0.28 abortions/mother) and 3 during follow-up (0.09 abortions/mother): 2 of them in women with CZP.C-section was performed in 26.8% of cases.Preterm birth (A total of 17 different fetal/maternal complications were registered during follow-up: 6 in the BT group (35.3%) compared to 11 (64.7%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Complications are listed in Table 1.Table 1.COMPLICATIONSWITH BT (n, %) n: 11WITHOUT BT (n, %) n: 30IUGR3 (27.3%)1 (3.3%)LOW BIRTH WEIGHT2 (18.2%)2 (6.6%)INFECTION1 (9.1%)4 (13.3%)CHOLESTASIS0 (0%)2 (6.6%)PREECLAMPSIA0 (0%)1 (3.3%)DIABETES MELLITUS0 (0%)1 (3.3%)HIGH BLOOD PRESSURE0 (0%)0 (0%)NEPHROPATY0 (0%)0 (0%)NEONATAL LUPUS0 (0%)0 (0%)HEART BLOCK (0%)0 (0%)MALFORMATION0 (0%)0 (0%)HELLP SYNDROME0/0%)0 (0%)TOTAL6 (54.6%)11 (36.4%)Regarding concomitant treatment, low dose prednisone was used in 48.8% of pregnancies, hydroxychloroquine in 51.2%, sulfasalazine in 9.8% and acetylsalicylic acid in 51.2%. We didn´t find differences in the use of these treatments between the two groups.Median DAS28 among RA patients and available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.Conclusion:In our series, as described in the literature, women with inflammatory arthropaties are older and are more likely to have preterm births compared to general population. Fewer abortions were registered during follow-up in the multidisciplinary unit. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR and low birth weight among women with BT but given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) associated lung disease is a relatively frequent extra articular disease manifestation, with a prevalence between 5% and 30%. The rather wide range of estimated prevalence is a result of differences in study designs and studied populations, as well as lacking diagnostic and classification criteria for lung disease in patients with RA.Objectives:To evaluate the prevalence of RA associated lung disease in patients with biological therapy (BT), as well as its severity, treatment changes and possible associated factors.Methods:Review of clinical records of 257 patients with RA treated with BT (TNFi, non-TNFi) between January 2015 to December 2020 in a single center. Patients with preexisting lung disease for other causes (asthma, smoking) have been excluded. RA diagnosis was performed according to ACR 2010 classification criteria. Epidemiological variables, clinical characteristics, type of pulmonary involvement, evolution, type of BT, changes in treatment and concomitant treatment were collected. For the analysis frequencies and percentages are used in qualitative variables, and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.Results:We registered 21 patients (85.7% women) mean aged 70.3±11.9 years. 52.4% were never smokers. RF was positive in 100% and 20 patients were anti-CCP positive. Erosive disease was present in 13 (61.9%) patients.At the time of lung disease diagnosis, 15 patients (66.7%) were receiving TNFi (Etanercept 7, Adalimumab 6, Infliximab 1, Golimumab 1), 2 were with non-TNFi (Rituximab) and 4 had never received BT previously. Symptoms (cough and/or dyspnea) were reported in 10 (47.6%) patients. The median time of treatment with BT until lung disease diagnosis was 33 [15.5-95.5] months. Conventional synthetic DMARDs (csDMARDs) were used in 85.7% of cases (methotrexate 72.2%, leflunomide 22.2%, other 5.6%). The inflammatory activity was mild (DAS28: 3.22±1.6). The median time until lung disease diagnosis was 104 [56.2-156] months.After the lung disease diagnosis, BT was only modified in 1 patient. In the 4 patients who had not previously received BT, non-TNFi was started (Rituximab 2, Abatacept 1, Tocilizumab 1). csDMARD was discontinued in 1 patient.Interstitial lung disease (ILD) was the most frequent pulmonary involvement (16 patients, 76.2%): 8 usual interstitial pneumonia (UIP), 6 non-specific interstitial pneumonia (NSIP), 1 organising pneumonia (OP) and 1 lymphocytic interstitial pneumonia (LIP). Other pulmonary manifestations observed in our patients were: nodular lung disease (2 patients) and small airways disease (bronchiectasis 2, obliterative bronchiolitis 1). Chest x-ray was normal in almost half of the patients (42.9%). Gold standard image diagnostic technique was high resolution CT.In respiratory function tests (PFTs) at diagnosis, only 4 patients (19%) had a FVC 10% and in 5 there was a worsening of the DLCO > 15%. In 3 (14.3%) patients PFTs were never performed and in 7 (43.7%) were not repeated after the diagnosis.We haven´t found association between different types of pulmonary involvement and the variables analysed.Conclusion:In our series, prevalence of RA associated lung disease is similar to that described in the literature. Lung involvement is asymptomatic and chest X-ray is normal in most RA patients. High resolution CT is the gold standard for diagnosis.ILD was the most frequent pulmonary involvement. Although in most patients the diagnosis of lung disease did not imply a BT change, it had an influence on the type of BT chosen for those who started treatment. Maintenance of csDMARD was not associated with a worsening of lung disease.Screening and treatment protocols for lung disease in patients with RA in clinical practice are needed.Disclosure of Interests:None declared

Background:Anterior uveitis (AU) is one of the most frequent extra articular manifestations of axial spondyloarthritis (axSpA), present in around 25% of patients. As with axSpA, AU has also been associated with the development of accelerated atherosclerosis1. If the presence of AU confers an increased cardiovascular (CV) risk or specific disease-related features to patients with axSpA remains unclear.Objectives:To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without AU.Methods:Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant uveitis. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.Results:A set of 886 axSpA patients were included. 709 (80.0%) of them had no history of concomitant AU, which was present in the remaining 177 (20.0%). The group with AU was older (50 ± 11 vs 48 ± 13 years, p=0.05), had a higher proportion of patients with AS (90.1% vs 76.3%, p=0.00) (Table 1) and a longer disease duration 13(7-23) vs 7(2-16) years, p=0.00]. The prevalence of HLA-B27 was higher in AU patients (82% vs 67%).Remarkably, structural damage showed interesting differences between both groups (Table 1). AU patients had a higher prevalence of severe sacroiliits (69% vs 49%, p=0.00), which remained significant after adjustment for age, disease duration and AS/nr-axSpA ratio. Furthermore, a non-significant trend towards a higher prevalence of syndesmophytes (44% vs 36%, p=0.06) and hip involvement (20% vs 15%, p=0.09) was observed in the group of AU.Regarding CV risk features, no differences were observed in the prevalence of CV risk factors and events (Table 1). Patients with AU showed a higher cIMT in the crude analysis (665 ± 156 mm vs 640 ± 142 mm, p = 0.047), but no significant differences were observed after adjustment by age and sex (p=0.6). Prevalence of carotid plaques was comparable in both groups (32% Vs 32%, p=0.84).Table 1.axSpA without uveitis (n=709)axSpA with uveitis (n=177)pP (adjusted model)Men/Women, n477/232122/550.68Mean age (years) ±SD at the time of study48 ± 1350 ± 110.049AS/nr-AxSpa541/168160/170.000History of CV risk factors, n (%) Current smoker247 (35)50 (28)0.096 Obesitty Dyslipemia233 (33)63 (36)0.48 Hypertension188 (27)50 (28)0.63 Diabetes Mellitus50 (7)14 (8)0.69 Chronic Kidney Disease18 (3)4 (2)0.99History of cardiovascular events, n (%)29 (4)12 (7)0.13Structural damage at the time of studyPresence of syndesmophytes, n (%)253 (36)77 (44)0.063mSASSS5 (1-15)6 (0-16)0.31Severe sacroiliitis (grade 3,4), n (%)348 (49)122 (69)0.0000.000*Carotid US data at the time of studyCarotid plaques, n (%)225 (32)57 (32)0.84IMT (mm)640 ± 142665 ± 1560.0470.6**IMT >= 0.900 mm36 (5)10 (6)0.72*: adjusted by age, disease duration and AS/nr-axSpA ratio**: adjusted by age and sexAbbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.Conclusion:The presence of AU does not confer additional CV risk to axSpA patients, although it is associated with a more severe structural damage in our series.References:[1]Conkar S, Güven Yilmaz S, Koska İÖ, Berdeli A, Mir S. Evaluation of development of subclinical atherosclerosis in children with uveitis. Clin Rheumatol. 2018 May;37(5):1305-1308.Disclosure of Interests:None declared

Background:Patients with axial spondyloarthritis (axSpA) may present with concomitant psoriasis (Ps) in approximately 10% of cases. As with axSpA, Ps is also associated with an accelerated atherosclerosis process1. However, it is unknown whether the presence of Ps confers an increased cardiovascular (CV) risk in patients with axSpA.Objectives:To compare factors related to the disease, CV risk factors, atherosclerotic burden, and CV events in patients with axSpA with and without Ps.Methods:Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA. We compared axSpA patients with and without concomitant psoriasis, focusing mainly on CV risk characteristics. Background information on CV risk factors, CV events, and disease-related factors was reviewed, and data on maximum body index, blood pressure, lipid profile, and disease status at the time of the study were also obtained. Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.Results:A set of 882 axSpA patients were included. 786 (89.1%) of them had no concomitant Ps, which was present in 96 (10.9%) patients. Although the mean age was similar, male sex was more prevalent in axSpA patients with Ps (79.1% Vs 66.5%, p=0.01) (Table 1).Furthermore, it was found that axSpA with Ps had a more frequent history of synovitis (50% vs 33%, p = 0.001), dactylitis (13% vs 6%, p = 0.011) and concomitant inflammatory bowel disease (13% vs 6%, p = 0.01). AxSpA patients with Ps had a non-significant trend towards a higher prevalence of asymmetric sacroiliitis (23 vs 16%, p = 0.064) and had a lower frequency of positive HLA-B27 status (56% vs 72%, p = 0.003). Regarding the management of the disease, prednisone (23% vs 12%, p = 0.02), methotrexate (30% vs 15%, p = 0.000) and anti-TNFα therapy (50% vs 34%, p = 0.002) were more commonly used in the group with Ps.Regarding CV risk characteristics, no differences were observed either in the prevalence of traditional CV risk factors (Table 1), nor in the total serum level, HDL and LDL, blood pressure and body mass index at that time of the study. However, axSpA patients with Ps showed a higher prevalence of CV events (9% vs 4%, p = 0.05), including ischemic heart disease (6% vs 3%, p = 0.042) and ischemic stroke (4% vs 1%, p = 0.016) (Table 1). The subclinical atherogenic burden was also more severe in the group with Ps, with a higher prevalence of carotid plaques (39% vs 31%, p = 0.098), and higher values of cIMT (0.664 ± 0.170 mm vs 0.642 ± 0.142 mm, p = 0.16), although the differences did not reach statistical significance.Table 1.Main sociodemographic and cardiovascular differences among axSpA patients with and without psoriasis.axSpA without psoriasis (n=786)axSpA with psoriasis (n=96)pMen/Women, n523/26876/200.010Mean age (years) ±SD at the time of study49 ± 1349 ± 130.81AS/nr-AxSpa625/16677/190.79History of CV risk factors Current smokers267 (34)30 (31)0.60 Obesitty174 (22)26 (27)0.29 Dyslipidemia262 (33)35 (36)0.48 Hypertension211 (27)28 (29)0.57 Diabetes Mellitus56 (7)8 (8)0.65 Chronic Kidney Disease19 (2)3 (3)0.72History of cardiovascular events, n (%)33 (4)9 (9)0.023 Ischemic heart disease20 (3)6 (6)0.042 Congestive heart failure2 (0)1 (1)0.29 Ischemic stroke6 (1)4 (4)0.016 Peripheral artery disease6 (1)0 (0)0.99CV data at the time of studyCarotid plaques244 (31)38 (39)0.098IMT mm0.642 ± 0.1420.664 ± 0.1700.16IMT >= 900 mm40 (5)6 (6)0.66Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.Conclusion:The presence of Ps may confer additional CV risk to axSpA patients and is associated with particular disease related factors.References:[1]Fang N, Jiang M, Fan Y. Association Between Psoriasis and Subclinical Atherosclerosis: A Meta-Analysis. Medicine (Baltimore). 2016;95(20):e3576.Disclosure of Interests:None declared.

Background:This tertiary hospital is the referall centre of 360.000 inhabitants, population with a Covid seroprevalence of 8,4% at final 2020.Since march, we have had a special concern for rheumatologic patients with systemic diseases and under inmunosupressive agents, including disease modifying antirheumatic drugs (DMARDs) and biological therapy (BT). This is why a special protocol for this population was set. It included performance of serology (CLIA test) for patients under BT and PCR and CLIA testing prior to new treatments. PCR testing was also generally performed: if symptomatology consistent with Covid; before hospitalisation; to tight contacts of infected people; and before procedures.Objectives:To evaluate the impact of COVID-19 in our SpA patients in terms of severity of viral infection and its effect on SpA.Methods:Data of 665 SpA patients and confirmed Covid infection seen in our center from March 15th to December 15th was crossed. 3 miscoded patients with rheumatoid arthritis and 2 with non definite CLIA positivity were excluded. Finally 49 patients’ clinical records were reviewed. Data regarding epidemiologic features, SpA characteristics, comorbidities, therapy received, clinical activity before and after Covid, and severity of the infection was collected. IBM SPSS v23 was used for statistical analysis.Results:Among 49 SpA patients, 59% were male, mean aged 56,63 years (range 23-79). 62,2% presented at least 1 comorbidity. 65% were psoriatic arthritis. They mostly had longstanding disease (median 10,5 years -range- 1-35). Previously 63% had received DMARDs, mainly methotrexate, and 32 % BT.When Covid was diagnosed 37,2% were under DMARDs and 53% under BT (69,2% TNF inhibitors, 26,9% anti-Il 17, 3,9% ustekinumab). At this point, disease activity was controlled in 82% of patients (39% in remission, and 43% in low disease activity state). Only 18% showed moderate activity.Within the 49 patients, 34 were diagnosed by PCR and 15 by CLIA tests. 9 required hospitalisation, of whom 4 developed more severe disease (3 received glucocorticoid pulses and 2 tocilizumab). A woman with PsA under secukinumab presented pneumonia and PE. None required mechanical ventilation. There were no exitus.Due to Covid infection 9 patients (50%) stopped DMARDs treatment, (5 of them hospitalised). 9 patients withdrew BT after Covid diagnosis; 60% of the BT-hospitalised, and 28.5% of the BT- non-hospitalised. 1 suffered a flow with severe disease activity after withdrawal of Il-17 inhibitor.Conclusion:Prevalence of SARS cov 2 infection in SpA patients was not greater than in general population. Most were asymptomatic or suffered mild disease. Only 9 were hospitalised. Factors related to hospitalisation seem similar to those of general population, even if statistical significance was not found due to the small sample. BT does not seem to relate to hospitalisation in SpA and we had no deaths to date in them.More studies should be made to throw out conclusions.Baseline characteristics of SpA patients with confirmed Covid19Hospitalised (N 9)Non-hospitalised (N 40)Total (N 49)Mean age (range) – yr 62,56 (43-74)55,3 (23-79)56,63 (23-79)Male sex - no. (%) 6 (66,6) 23 (57,5) 29 (59,1)Smoking habit (active, ex-smokers) - no. (%) 2 (22,2) 23 (57,5) 25 (51)Non comorbidities - no. (%) 2 (22,2) 17 (42,5) 19 (38,8)Hypertension - no. (%) 3 (33) 14 (35) 17 (35)Diabetes - no. (%) 1 (11) 6 (15) 7 (14,2)Dyslipidemia - no. (%) 4 (44) 9 (22,5) 13 (26,5)Obesity (BMI >30) - no. (%) 4 (44) 12 (30) 16 (32,7)Chronic obstructive pulmonary disease - no. (%) 2 (22,2) 4 (10) 6 (12,2)Asthma - no. (%) 0 (0) 4 (10) 4 (8,2)Cardiopathy - no. (%) 1 (11,1) 8 (20) 9 (18,4)Median disease time since diagnosis (range) – yr 14, 5 (7-20) 10 (1-35) 10,5 (1-35)SpA type Psoriatic arthritis - no. (%) 8 (88,8) 24 (60) 32 (65,3) Ankylosing spondylitis - no. (%) 1 (11,1) 15 (37,5) 16 (32,7) Non-Rx ankylosing spondylitis - no. (%) 0 (0) 1 (2,5) 1 (2)Current treatment when diagnosed (N 48) DMARDs - no. (%) 6 (66,6) 12 (30)18 (37,5) BT - no. (%) 5 (55,5)* 21 (52,5) **26 (54,1) * 5 anti-TNF (1 etanercept), 2 anti Il-17, 1 anti Il-12-23.** 12 anti-TNF (4 etanercept), 5 anti Il-17.Disclosure of Interests:None declared

Background:There are few published data regarding physician’ and patient’ perception of the disease control for ankylosing spondylitis (AS) and psoriatic arthritis (PsA).Objectives:To evaluate the relationship between physician’ and patient’ disease control perception compared to clinical outcomes for controlled disease (BASDAIMethods:MIDAS is an observational, non-interventional, cross-sectional, multicenter study. Patients ≥18 years with ≥6 months AS or PsA diagnosis according to ASAS and modified New York criteria or CASPAR criteria, respectively, undergoing treatment ≥3 months before inclusion. The endpoint of this analysis was the relationship between disease control perception by physicians and patients and disease control (BASDAIResults:313 AS patients included: 75.7% male, 78.5% HLA-B*27+, a mean (SD) age of 50.4 (12.0) years, a mean (SD) disease duration of 15.5 (11.6) years and a mean (SD) CRP of 5.1 (8.2) mg/l. 313 PsA patients included: 54.3% male, 17.95% HLA-B*27+, a mean (SD) age of 54.1 (12.2) years, a mean (SD) disease duration of 10.5 (9.0) years and a mean (SD) CRP of 4.91 (7.3) mg/l. AS group: in 95.5% of AS patients with BASDAI14 matched the physician’s perception. PPV was 73.1%, NPV was 89.6% and precision was 76.4%. Patients perceived their own disease as controlled in 93.5% of the cases with DAPSA scores ≤14 and as not controlled in 32.3% of the cases with DAPSA>14. PPV was 66.8%, NPV was 77.4% and precision was 68.4%. The same trend was observed when assessing disease control through the MDA criteria (Table 1).Table 1.Physician’s and patient’s perception of the disease control related to disease control variables in AS and PsAControlled disease by physician’s perception?Controlled disease by patient’s perception?Valid NYesN (%)NoN (%)Valid NYesN (%)NoN (%)ASDisease control(BASDAI)Controlled(BASDAI202 (100%)193 (95.5%)9 (4.5%)202 (100%)192 (95.0%)10 (5.0%)Not controlled(BASDAI≥4)111 (100%)64 (57.7%)47 (42.3%)111 (100%)78 (70.3%)33 (29.7%)Disease activity(ASDAS-CRP)Inactive(ASDAS-CRP92 (100%)90 (97.8%)2 (2.2%)92 (100%)91 (98.9%)1 (1.1%)Active(ASDAS-CRP≥1.3)221 (100%)167 (75.6%)54 (24.4%)221 (100%)179 (81.0%)42 (19.0%)PsADisease control(DAPSA)Controlled(DAPSA≤14)186 (100%)179 (96.2%)7 (3.8%)185 (100%)173 (93.5%)12 (6.5%)Not controlled(DAPSA>14)126 (100%)66 (52.4%)60 (47.6%)127 (100%)86 (67.7%)41 (32.3%)Active disease (MDA)Inactive(MDA criteria ≥5)161 (100%)154 (95.7%)7 (4.3%)160 (100%)152 (95.0%)8 (5.0%)Active(MDA criteria151 (100%)91 (60.3%)60 (39.7%)152 (100%)107 (70.4%)45 (29.6%)AS, ankylosing spondylitis; ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score- C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; DAPSA, Disease Activity in Psoriatic Arthritis; MDA, Minimal Disease Activity; PsA, psoriatic arthritis.Conclusion:A higher agreement between physician’s and patient’ perception with the current clinical evaluation was observed when patients were controlled. MiDAS study showed that in real clinical practice in Spain, physicians perceived more disease control than the patientsAcknowledgements:We thank to MIDAS group investigators and patients included in the study.Disclosure of Interests:José Luis Pablos Speakers bureau: Janssen, Pfizer, Lilly, Novartis, Roche, Celgene, Bristol, Abbvie, Sanofi, Consultant of: Janssen, Pfizer, Lilly, Novartis, Roche, Celgene, Bristol, Abbvie, Sanofi, Gilead, Galápagos, Xavier Juanola Speakers bureau: Novartis, Abbvie, Pfizer, Lilly, Consultant of: Novartis, Lilly, Abbvie, Ceferino Barbazán Speakers bureau: Sanofi, Pfizer, Novartis, Amgen, Abbvie, Roche, Galápagos, Lilly, BMS, Biogen, UCB, Consultant of: Sanofi, Pfizer, Novartis, Amgen, Abbvie, Roche, Galápagos, Lilly, BMS, Biogen, UCB, María L. García Vivar Speakers bureau: Lilly, Novartis, Pfizer, Amgen, Bristol, Abbvie, Sanofi, Janssen and UCB, Consultant of: Lilly, Novartis, Pfizer, Amgen, Bristol, Abbvie, Sanofi, Janssen and UCB, Ana Cruz Valenciano Speakers bureau: Novartis, Consultant of: Novartis, Carlos Rodriguez-Lozano: None declared, Maria Estadella Employee of: I’m employed at Syneos Health providing services for Novartis., Ana Venegas Employee of: employee at Novartis, Cristina Sanabra Employee of: Novartis employee, Carlos Sastré Employee of: Novartis employee.

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:Systemic inflammatory diseases are common in women at the reproductive age. These women may have fertility problems and complications during pregnancy.Objectives:To describe the experience in a multidisciplinary unit (composed of Rheumatologists and Obstetricians) and asses the complications and treatments used in patients with inflammatory diseases in a tertiary hospital compared to those registered in healthy women from the same center (preterm births 6.59%, Caesarean section (C-section) 14.4%, maternal average age 33.33 years).Methods:Retrospective and descriptive study of the evolution of pregnancy in patients with inflammatory diseases and follow-up in a multidisciplinary unit for more than 15 years (until December 2019). Demographics, maternal disease, time until conception, births, abortions, C-sections, treatments and complications were collected. Data was analyzed using IBM SPSS v23.Results:We registered 29 pregnancies (25 patients): 20 Rheumatoid Arthritis (RA), 5 Psoriatic Arthritis (PsA), and 4 Spondylarthritis (SpA). Maternal average age at diagnosis was 27.6±6.36 years and average age at childbirth/abortion 35±5.6 years.It took an average time of 8 months to conceive. 11.5% received fertility treatment using in vitro fertilization techniques.5 abortions were registered prior to follow-up in this unit (0.2 abortions/mother). During follow-up 1 abortion (0.04 abortions/mother) was recorded in a RA patient. C-section was performed in 11 cases (39.2%): 6 RA (31.6%), 3 SpA (75%) and 2 PsA (40%).17.2% of pregnancies were preterm (Intrauterine growth restriction (IUGR) was observed in a woman (3.4%) with RA and preeclampsia was observed in 2 cases (6.9%) (RA 1, SpA 1).Disease activity (DAS28 and BASDAI) is shown in Table 1.Table 1.DAS28 (median)PreviousFirstTrimesterSecondTrimesterThirdTrimesterPosteriorRheumatoid Arthritis2.692.593.093.333.11Psoriatic Arthritis2.582.53.323.082.89RA with biological agents (n: 6)2.372.942.712.42.52BASDAI (median)Spondylarthritis2.82.41.7511.9Treatments used prior to and during pregnancy are listed in Table 2.Table 2.TREATMENT BEFORE PREGNANCYn (%)TREATMENT DURINGPREGNANCYn (%)Hydroxychloroquine13 (44.8%)Prednisone17 (58.6%)Prednisone12 (41.4%)Acetylsalicylic acid16 (55.2%)Methotrexate9 (31%)Hydroxychloroquine15 (51.7%)TNF inhibitors7 (24.1%)Sulfasalazine2 (6.9%)Sulfasalazine2 (6.9%)TNF inhibitors2 (6.9%)8 patients had received biological treatment prior to pregnancy (2 SpA, 6 RA)(3 Etanercept, 3 Adalimumab, 2 Certolizumab). 2 of them (RA) continued treatment during pregnancy. 1 of them discontinued it at week 17 on her own (Adalimumab) while the other continued with Certolizumab throughout pregnancy and presented IUGR. No other complications, such as infections or malformation, were observed in newborns. DAS28 data of these women can be found in Table 1.Conclusion:In our series, as described in the literature, women with inflammatory arthropaties are older, need longer time to achieve pregnancy and have increased use of fertility techniques and increased likelihood of preterm and instrumental delivery compared to general population. Given the low number of patients receiving biological treatment no conclusions about complications and evolution of the disease can be drawn, so further investigation are needed in this group of patients.Monitoring inflammatory arthropathies in a multidisciplinary unit increases the chances of successful pregnancies.Disclosure of Interests:None declared

Background:Infections are one of the main complications among patients with rheumatoid arthritis (RA) with immunosuppressive treatment. The differences between treatments and the influence of other factors is unclear.Objectives:To evaluate the frequency and factors associated with serious infections in patients with RA treated with biological therapy (BT) and JAKi and the differences between treatments.Methods:Descriptive and retrospective study (January 2015-December 2019) of patients with RA treated with BT (TNFi, non-TNFi) and JAKi (tofacitinib, bariticinib) in a single center. Severe infection was considered a life-threatening infection or one that required hospitalization and intravenous treatment. Epidemiological variables, clinical characteristics, Charlson comorbidity index, type of BT or JAKi and concomitant treatment were collected.For the analysis frequencies and percentages are used in qualitative variables, and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.Results:We registered 246 patients (85% women) mean aged 55.8±13.5 years. RF was positive in 87%, anti-CCP in 75.6% and 15.4 % presented extra-articular manifestations (nodulosis 8.9%, intersticial lung disease 5.3%, other 1.2%). At the start of the study 149 patients (60.6%) were with TNFi, 79 (32.1%) non-TNFi and 18 (7.3%) with JAKi and non-biologic DMARD (nbDMARDs) were used in 84.1% of cases (methotrexate 71.2%, leflunomide 21.4%, other 7.4%).During the study 176 patients (71.5%) continued with the same treatment and in 70 (28.5%) it was changed at least once. 5 patients discontinued the treatment. At the end of the study, 124 patients (50.4%) were with TNFi, 83 (33.7%) non-TNFi and 34 (13.8%) with JAKi.Severe infection was developed in 17 (6.9%) patients (respiratory 7, se sis 4, urinary 3, cellulitis 2, osteomyelitis 1) among them 2 patients had severe infection and herpes zoster and 3 developed a second infection. 9 patients were with TNFi (52.9%), 6 non- TNFi BT (35.3%) and 2 JAKi (11.8%). Table 1TABLE 1.CHARACTERISTICS OF PATIENTS WITH INFECTION VS. WITHOUT INFECTIONINFECTIONYESn:17NOn:229pFEMALE,n (%)13 (76.5)196 (85.6)0.297AGE years,(mean±SD)60.8 ± 1355.4 ± 13.50.112AGE ≥ 65n (%)9 (52.9)63 (27.5)0.070RF +,n (%)17 (100)197 (86)0.139ANTI-CCP +,n (%)14 (82.4)172 (75.1)0.770ILD,n (%)1 (25)12 (35.3)0.708ALCOHOL, n (%)1 (5.9)19 (8.3)1.00SMOKER, n (%)5 (29.4)60 (26.2)0.772COPD, n (%)5 (29.4)24 (10.5)0.036*DM, n (%)7 (41.2)19 (8.3)0.001*SEVERE LIVER DISEASE, n (%)2 (11.8)1 (0.4)0.013*RENAL INSUFFICIENCY,n (%)2 (11.8)3 (1.3)0.040*PERIPHERAL VASCULAR DISEASE, n (%)7 (41.2)25 (10.9)0.003*CHARLSON INDEX(mean±SD)2.35 ± 2.10.66 ± 1.20.014*TNFi, n (%)9 (52.9)115 (50.2)NON-TNFi n (%)6 (35.3)77 (33.6)JAKi, n (%)2 (11.8)32 (14)nbDMARDs,n (%)12 (70.6)156 (68.1)0.833GCC, n (%)13 (76.5)115 (50.2)0.037*The inflammatory activity of RA was mild at the time of infection (DAS28: 2.7±1.2). The median time until infection was: TNFi 28.05 months, non- TNFi BT 25.03 and Jakinibs 16.97.The Charlson index, concomitant treatment with glucocorticoids (GCC) (not treatment with nbDMARDs), chronic obstructive pulmonary disease (COPD), diabetes (DM), severe liver disease and moderate-severe renal insufficiency were statistically significantly associated with infection. Table 1Conclusion:In our study, 6.9% of patients with RA treated with BT or JAKi developed severe infection during 4 years of follow-up. Concomitant GCC therapy and comorbidity increased the risk of presenting this complication.Disclosure of Interests:None declared

Background:Blocking of the Tumor Necrosis Factor (TNF) activity is a successful therapeutic approach for 2 out of 3 Rheumatoid Arthritis patients. Identifying the patients that will not respond to this therapeutic approach is a major translational goal in RA. Association of seropositivity to rheumatoid factor (RF) or anti-cyclic-citrullinated antibodies (anti-CCP) with anti-TNF response has proven inconclusive, suggesting that other yet unexplored biomarkers could be more informative for this goal.Objectives:We tested the association of two recently introduced biomarkers in RA: anti-carbamylated protein antibodies (anti-CarP) and anti-peptidylarginine deiminase type 4 (anti-PAD4).Methods:A prospective cohort of n=80 RA patients starting anti-TNF therapy was recruited and levels for all four autoantibodies -RF, anti-CCP, anti-CarP and anti-PAD4- were measured at baseline. The change in DAS28 score between baseline and week 12 of therapy was used as the clinical endpoint.Results:Single marker-analysis showed no significant association with drug response. However, when testing for interactions between autoantibodies, we found highly significant associations with drug response. Anti-CCP and RF showed a positive interaction with the response to anti-TNF therapy (P=0.00068), and anti-PAD4 and antiCarP titers showed a negative interaction with the clinical response at week 12 (P=0.0062). Using an independent retrospective sample (n=199 patients), we validated the interaction between anti-CCP and RF with the clinical response to anti-TNF agents. (P=0.044).Conclusion:The results of this study show that interactions between antibodies are important in the response to anti-TNF therapy and suggest potential pathogenic relationships.Acknowledgments :We would like to thank the clinical researchers and patients participating in the IMID Consortium for their collaborationDisclosure of Interests:Antonio Julià: None declared, Maria Lopez Lasanta: None declared, Francisco Blanco: None declared, Antonio Gómez: None declared, Isabel Haro: None declared, Antonio Juan Mas: None declared, Alba Erra: None declared, Mª Luz García Vivar: None declared, Jordi Monfort: None declared, Simon Sánchez Fernandez: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Mercedes Alperi-López: None declared, Raúl Castellanos: None declared, Antonio Fernandez-Nebro: None declared, Cesar Diaz Torne: None declared, Núria Palau: None declared, Raquel M Lastra: None declared, Jordi Lladós: None declared, Raimon Sanmarti: None declared, Sara Marsal: None declared

Background Lupus nephropathy (NL) is an important cause of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). The objective of the renal biopsy is to determine the type of glomerulonephritis that the patient presents to direct treatment. Considering that it is a specialised technique and not risk free, a proteomics study is proposed to determine biomarkers that help us to differentiate patients diagnosed with SLE with and without renal involvement. Objectives To determine if there is a different pattern of proteins between patients diagnosed with SLE with and without renal involvement. Methods We selected 12 patients diagnosed with SLE with renal involvement and 14 patients diagnosed with SLE without renal involvement. There were no differences between groups according to race, gener and age. The patients were classified as high, low or negative level of proteinuria in the urine. A 24 hour urine sample was obtained for analysis. Results We have done a Principal Component Analysis (PCA) where we can see differences between samples from patients who have high level of proteinuria in 24 hours and patients who have not renal involvement. Patients with positive proteinuria but not high level are a little confuse figure 1. A total of 292 proteins (identified with at least two peptides with a FDR Consistent with the nature of the sample, the Gene Ontology (GO analysis) of the whole list of identified proteins revealed the presence of extracellular (277 proteins, p=2.25E-171) and secretion-related proteins (49 proteins, p=1.1E-09), among others. Proteins related to defensive processes were prominent among them. Interestingly, the subset of proteins whose abundance increases upon renal damage is comprised of typical highly-abundant serum proteins. These proteins render a large number of peptides, suggesting they are very abundant. This protein pattern may reflect the higher albuminuria characteristic of patients with affected renal function. On the other hand, a number of proteins became significantly less abundant upon renal damage. The presence of highly abundant serum proteins in the urine of patients with compromised renal function may explain this phenomenon, since this will provoke a dramatic reduction in the relative abundance of the proteins already present in their urine. Conclusions A different protein pattern is observed between the two groups of patients, so in a more detailed study we can indicate if some of these can serve as prognostic markers for this type of patients. Disclosure of Interest None declared

Introduction Lupus nephropathy (NL) is an important cause of morbidity and mortality in patients with SLE. The objective of the renal biopsy is to determine the type of glomerulonephritis that the patient presents to be treated. A proteomics study is proposed to determine biomarkers that help us to differentiate patients diagnosed with SLE with and without renal involvement. Objective To determine if there are a different patron of proteins between patients diagnosed with SLE with and without renal involvement. Methods We selected 12 patients diagnosed with SLE with renal involvement and 14 patients diagnosed with SLE without renal involvement. A 24 hour urine sample was obtained for analysis. Results A total of 292 proteins (identified with at least two peptides with a FDR Conclusion A different protein pattern is observed between the two groups of patients, so in a more detailed study we can indicate if some of these can serve as prognostic markers for this type of patients.

Background Osteoporosis (OP) in male under 70 years is less common than postmenopausal and senile OP, but causes important social and health costs associated with morbidity and mortality from fractures. It9s common in patients with inflammatory rheumatic diseases, enteric and endocrine diseases, also in COPD patients and in those undergoing chronic corticosteroid therapy. Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is done when one or more low energy mechanism fractures have already occurred (failure in early detection). Bone Metabolism Unit at Basurto University Hospital values from years ago male patients referred from different specialties with suspected OP. Objectives To describe main demographic and clinical characteristics of men aged 70 years or less, visited in our monographic OP consultation, with previous to 2013 protocols established with Primary Care (PC) and rheumatology (derivation according to risk factors). Methods Retrospective descriptive study based on a review of medical records and database of these patients. We analyze origin of derivation, risk factors, presence of fractures at moment of diagnosis, primary diagnoses and occurrence of refractures. The analysis was performed using statistical system SPSSv22. Results 127 patients, mean aged 58.17 years (18–70), up to 74% of the total derived from PC (47), and general rheumatology (47); 10 patients (7.9%) from traumatology; 8 from endocrinology (6.3%); 7 from gastroenterology (5.5%). 55.9% were smokers or former smokers, 22% kept drinking habit. 19.7% had received prednisone doses ≥7.5 mg for more than 3 months. 9 patients had family history of fracture (6.3%), and 46 themselves presented with one or more fractures (36.2%): 36 with one or more vertebral fractures, 4 hip fracture and 12 wrist fracture. 64 patients were diagnosed of OP with treatment indication by bone agent. 61% have secondary OP, the main cause (19%) enteric disorders (malabsorption syndromes and inflammatory bowel disease); 13% endocrine disorders and rheumatic inflammatory diseases by 13%. No primary cause was found in 39% of cases. The presence of fractures was associated with decreased DXA lumbar spine (p=0.027) and DXA hip (p=0.004). A very weak correlation between higher fracture FRAX and number of risk factors was detected, on the other hand a moderate correlation was observed with the number of fractures (Spearman Rho =0.472; p Of the 46 patients with previous fractures, only 12 (26%) had received prior treatment with bone agent. Only 5 patients suffered refracture after starting treatment and during follow-up (94.06 months) (25–129). Conclusions Almost 1/3 of men were referred for fractures caused by low energy impact, what means a late diagnose of male OP. It9s important to establish protocols with other medical specialties for men at risk to be identified and referred, in order to make an early diagnose. It highlights the lack of patients derived from pneumologists, although vertebral fractures in chronic respiratory patients worsen their functional status and mean a frequent cause of hospitalization in this group. Disclosure of Interest None declared

Background Aortitis is a several and potentially lethal clinical condition. It is usually oligosymptomatic or may present with non-specific symptoms that complicate and delay the diagnosis. On the other hand, treatment of aortitis is not established. Objectives The objetive of this study is to describe clinical manifestations, laboratory studies and treatment of patients with aortitis in a single center. Methods We have reviewed the medical records of patients who had positive Positron Emission Tomography (PET) for aortitis fron January 2013 to December 2015 in the Rheumatology Department of a University Hospital. We included 13 cases and we recorded epidemiological, clinical data, laboratory results, treatment and evolution. Quantitative variable results were expressed as mean±standard deviation (SD) or median (interquatile range-IQR). Qualitative variable results were expressed as percentage. The analysis was performed with the SAS System for Windows V 9.2. Results In the last 3 years 13 cases of aortitis were diagnosed (3 in 2013, 3 in 2014 and 7 in 2015). The male to female ratio was 3/10. Mean age±SD was 72.23±12.36 years [range, 51–83]. The underlying conditions were: giant cell arteritis (GCA) (n=7), polymyalgia rheumatica (PmR) (n=2), idiopathic (n=2), relapsing polychondritis (n=1) and Sjogren syndrome (n=1). The median interval between the diagnosis of the underline disease and the aortitis was 7 months [1–20]. The most common manifestations were constitutional syndrome (n=5), inflammatory back pain (n=4), pain irradiated to lower limbs (n=4), atypical polymyalgia (n=1) and fever (n=1). All patients exhibited increased acute phase reactants except for the two patients with idiopathic aortitis. Erythrocyte sedimentation rate (ESR) mean was 62±33.84 mm/1st hour and C Reactive Protein (CRP) median level mas 3.3 [2.91–5.13] mg/dl. Five patients presented anaemia. At the time of diagnosis, 9 patients were receiving prednisone (mean dose, 18.89±19.3 mg/day), 4 were with methotrexate (MTX) (mean dose, 15±5.77 mg/week) and the remaining 3 were not receiving any drug. Treatment of aortitis was based on the onset or increase in prednisone dose (mean dose, 34.17±9.73 mg/day) in all cases except for one patient who needed surgery for aortic aneurysm. MTX was initiated in 5 patients and its dose was increased in 4 more (mean maximum dose, 14.72±6.43 mg/week). Three patients were treated with methilprednisolone i.v. (0.5 g/day, 3 consecutive days). Tocilizumab (TCZ) was added to therapy in 2 cases due to refractory disease. In the first visit, two to four months later, the ESR mean was 25.92±24.88mm/1st hour and CRP median was 0.32 [0.16–1.11] mg/dl. In successive clinical controls, after a mean follow-up of 10±4.32 months, clinical and laboratory improvement was maintained. Four patients had a new PET-TAC control 6–16 months later, 3 of them presented complete remission and another one partial remission. Conclusions According to our data, clinical and laboratory data are often nonspecific in aortitis. The increase in the diagnosis cases in the last years is probably related to a higher index of suspicion. The presence of GCA or PmR refractory to standard treatment or unexplained raised ESR or CRP, may be red flags for suspecting an aortitis. Treatment with moderate doses of corticosteroids and MTX was effective in most of our patients. In 2 refractory cases, TCZ was useful. Disclosure of Interest None declared

Background Early diagnosis and treatment of aortitis are important to prevent possible serious complications such us aneurysm, aneurismal ruptured or aortic dissection. Aortitis may present with non-specific symptoms. Positron emission tomography (PET) is useful in diagnosing aortitis. However, PET is an expensive technique. Objectives Our aim was to evaluate those PET performed by suspected aortitis in order to find some predictive factors for positive PET for aortitis. Methods Study of PET performed by suspected aortitis in a University Hospital (from January 2013 to December 2015). The main epidemiological, clinical and laboratory data of these patients were extracted from clinical records according to a specifically designed protocol, reviewed for confirmation of the diagnosis, and stored in a computerized file. To minimize entry error all data were double checked. A comparative study was made between positive and negative PET to identify red flags of an underlaying aortitis. Quantitative variable results were expressed as mean±standard deviation (SD) or median [IQR] and were analyzed by Mann-Whitney U test. Qualitative variable results were expressed as percentages and frequency and were analyzed by Fisher9s exact test. Statistic analysis was performed with the SAS System for Windows V 9.2. Results In last 3 year period 33 PET were requested to confirm aortitis (5 of them in 2013, 7 in 2014 and 21 in 2015). We had 3 positive results of 5 (60%) in 2013, 3 of 7 (42.85%) in 2014 and 7 of 21 (33.33%) in 2015. The mean age of the 33 (22 female/11 male) patients was 70.30±14.16 years (range, 31–89). The underlying diseases associated to these patients were: giant cell arteritis (GCA) (n=12), polymyalgia rheumatic (PmR) (n=8), connective tissue diseases (Sjogren syndrome, dermatomyositis, undifferentiated connective pathology) (n=5), seronegative polyarthritis (n=3), relapsing polychondritis (n=2), idiophatic (n=2), hiper-IgG syndrome (n=1). Comparative study between positive and negative PET is summarized in TABLE. Inflammatory back pain and irradiated lower limb pain conditions were more common among patients with positive PET. They were the unique variables with statistically significant difference. The rest of both epidemiologic, clinical, laboratory or the possible influence of treatment with steroids and/or immunosuppressants at the time of conducting PET did not differ between groups. Conclusions In this estudy we observed an increasing in demand for PET for suspected aortitis every year and more cases were diagnosed in recent years. However, positive test percentage progressively decreased. The presence of inflammatory back pain and pain radiating to the lower extremities may have clinical relevance to suspect aortitis and a positive PET result. Prospective studies are needed with larger numbers of patients to establish a predictive model for aortitis. Disclosure of Interest None declared

Background Nowadays there is a great variability in evaluation and management of patients with autoimmune and inflammatory diseases during fertility, pregnancy, post-partum and breastfeeding, in part due to lack of knowledge. Objectives To develop recommendations on the evaluation and management of patients with autoimmune and inflammatory diseases during fertility, pregnancy, post-partum and breastfeeding based on the best evidence and experience. Methods Recommendations were generated following nominal group methodology and Delphi technique. A panel of experts was established (12 rheumatologists). A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in the 1st panel meeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinements. A national survey analyzing different aspects of this topic was undertaken separately. Then, a Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. Results A total of 14 recommendations (see figure) were generated on the pre-conception period (oral and hormonal anticonception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High risk situations were included as lupus or antiphospholipid syndrome. A consensus >90% was reached in all but one recommendation. Conclusions These recommendations are intended to provide rheumatologists, patients, families and other stakeholders a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during fertility, pregnancy, post-partum and breastfeeding. Disclosure of Interest None declared

Background There is growing evidence in rheumatoid arthritis (RA) that ultrasound assessments (UA) have a better predictive value for X-ray progression than clinical assessments Objectives To analyze the association between UA with a reduced 12-joint ultrasound (US) power Doppler (PD) examination and X-ray progression at 12 months Methods Patients were included with available X-ray examination in a multicenter, observational, prospective cohort of RA patients with moderate disease activity (3.2≤DAS28≤5.1), conducted under conditions of routine daily practice (ECO-DAIStudy) 12-joint PDUS assessments were performed at baseline, 6 and 12 months. Synovitis grey scale (SGS) and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain SGS and PD scores. X-ray examinations were performed at baseline and at 12 months. An independent, blinded observer read paired films in chronological order and scored them according to Sharp-van der Heijde method. X-ray progression was defined as an increase >1 point and non-progression as ≤0. In order to increase contrast, patients with doubtful X-ray progression (>0 - ≤1) were excluded from association analyses of X-ray progression and US findings. Several cutoffs for SGS and PD were tested, and sensitivity (Se) and specificity (Sp) were computed when a significant association was found Results The sample consisted of 129 patients, including 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) yrs, median time from diagnosis of 5.0 (3.0-11.5) yrs, and rheumatoid factor positivity in 82 patients (63.6%). At baseline, 6 and 12 months, the median (IQR) values of SGS counts were 5.0 (4.0-8.0), 5.0 (2.0-7.0) and 4.0 (2.0-6.0); SGS scores were 8.0 (5.0-11.0), 5.0 (3.0-8.0) and 5.0 (2.0-7.8); PD counts were 4.0 (2.0-6.0), 2.0 (1.0-4.0) and 2.0 (1.0-3.0); and PD scores were 6.0 (2.0-9.0), 3.0 (1.0-6.0) and 2.0 (1.0-5.0), respectively 3.5±3.9 (Friedman test; p Conclusions Power Doppler joint counts or cumulative scores greater than 0.5 or 1.5 in a 12-joint PDUS assessment are significantly associated with X-ray progression. Cutoff of 1.5 performed slightly better for PD-scores than for PD-counts. Grey scale synovitis counts or scores were not significantly associated with X-ray progression Acknowledgements The authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract. The financial support for these services was provided by AbbVie. Disclosure of Interest E. de Miguel Grant/research support from: AbbVie, E. de Vicente Grant/research support from: AbbVie, F. Diaz Alcazar Grant/research support from: AbbVie, J. de la Iglesia Grant/research support from: AbbVie, M. Garcia Vivar Grant/research support from: AbbVie, J. Ivorra Grant/research support from: AbbVie, J. Rivas Employee of: AbbVie

Background At the end of 2011 we established a protocol in dose reduction of biological therapy in patients with imflammatory diseases. Those who achieved remission by clinical and laboratory tests and showed no radiographic progression or Doppler activity by ultrasound examination, received reduction of dosing. Patients with etanercept (ETN) reduced dose to 25 mg, and patients with adalimumab (ADA) increased injection interval to 3 weeks. Tocilizumab (TCZ) was tapered from 8 to 6 mg/kg. We have achieved optimization rates of 20% in 2012, close to 40% at the end of 2013. Objectives The aim of this study is to take account of activity flares in optimized patients and their characteristics, in order to describe predictive factors of flare if possible. Methods Retrospective analysis data from clinical records and database of 105 patients treated with ETN, ADA and TCZ, optimized from January 2012 to June 2013 considering lab tests (ESR, RCP), disease activity (DAS 28, BASDAI),functional capacity indexes (HAQ, BASFI), and GPE (general patient evaluation), at optimization, 6 and 12 months visits. We used SPSS 21.0 for statistical analysis. Results 105 patients (53 female and 52 male), 31% rheumatoid arthritis (RA), 27,5% ankylosing spondylitis (AS), 37,7% psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with longstanding disease, (150 months (18-638)). All of them were considered to keep remission by second visit, but at 12 months 32% were diagnosed of flare (24,5% under ADA and 39,2% under ETN; none with TCZ). Patients who flared were RA (30%), AS (29%), PA (37%) and one JIA. Half of the patients with RA, 27,6% of AS and 21,6% of PA. Clinical response was good to increasing of DMARD dosing in 25% and to increasing of biological dosing in 68,7%, but 3 patients (9,3%) required switching to another biological drug. We applied an univariate regression logistic model using parameters at visit 2, and we found modestly risk of flare related with ESR, DAS 28, number of swelling and tender joints. An increase of one tender joint at visit 2 means OR 3,56 (95% CI: 1,28-9,91), increase of one swelling joint means OR 11,26 (95% CI: 2,23-43,23). Increase of DAS 28 over 0,6 means OR 8 (95% CI: 1,85-34,6), and an increase over 1,2 means OR 60 (95% CI: 6,41-561,96). Conclusions 1/3 of patients suffered flares of disease activity, mostly happened in RA patients, most of them in the ETN group (not statistically significant). Patients who flared had increased DAS 28 at visit 2, but were considered at clinical remission then. Response to increasing in treatment dosing is usually good. We consider optimization as cost-effective practice among biological treated population. We need wider population to establish other statistically significant conclusions. Disclosure of Interest None declared

Background Clinical remission is the treatment target for patients with rheumatoid arthritis (RA). However, different definitions have been proposed. Still, damage and/or subclinical inflammation (eg, positive Doppler signal) may persist despite apparent clinical remission Objectives To examine the validity of different definitions of remission and Doppler ultrasound using X-Ray progression as the gold standard Methods Data were obtained from an observational, prospective, multicenter study in RA patients with moderate disease activity (3.2≤DAS28(CRP)≤5.1) who started anti-TNF therapy, conducted under conditions of daily practice. At recruitment and at months 6 and 12, patients were scheduled for a clinical examination, laboratory data collection and reduced 12-joints Power Doppler (PD) ultrasound examination of the wrist, 2nd and 3rd MCP, elbow, knee, and ankle bilateral joints. Synovitis grey scale and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain grey scale synovitis and PD scores. DAS28 (ESR/CRP), SDAI, CDAI, and ACR/EULAR remission criteria were collected. At baseline and month 12, radiographs of hands and feet were obtained and assessed by an independent observer in pairwise, chronological order and scored according to Sharp-van der Heijde method. X-Ray progression was defined as an increase >1 point and non-progression as ≤0. Patients with doubtful X-ray progression (progression =1), were excluded from independent tests of X-ray progression and US findings Results The sample consisted of 129 patients, 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) years, median time from diagnosis of 5.0 (3.0-11.5) years, and positive rheumatoid factor in 82 patients (63.6%). At 12 months, Sharp-van der Heijde9s score median increase was 3.0 (0.0-6.5) points, with 36 patients not progressing and 79 with progression (14 patients with doubtful X-ray progression). Remission rates at 6 and 12 months according to different clinical criteria were: CDAI, 10.5% and 15.9%, SDAI, 12.3% and 15.7%; ACR/EULAR, 12.6% and 14.2%, DAS28ESR, 21.1% and 33.9%; DAS28CRP, 45.9% and 56.7%, respectively. Disease activity at any study time by any composite index (DAS28ESR, DAS28CRP, SDAI, CDAI and ACR/EULAR) was not significantly associated with X-Ray progression. PD score ≥1 at baseline and persistence of PD score ≥1 at 6 months were associated with X-Ray progression: OR=5.067 (IC95%: 1.162 – 21.576; p=0.017), and OR=7.474 (IC95%: 2.644 – 21.123; p Conclusions A short 12 joints PD US score shows better predictive validity for structural damage progression in RA than composite indices of disease activity. PD signal, but not clinical disease activity, can predict X-ray progression at 6 and 12 months. Probably in the near future Ultrasound may need to be considered as a component of RA remission criteria. Acknowledgements The authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract and poster. The financial support for these services was provided by AbbVie. Disclosure of Interest E. de Miguel Grant/research support from: AbbVie, E. de Vicente Grant/research support from: AbbVie, F. Diaz Alcazar Grant/research support from: AbbVie, J. de la Iglesia Grant/research support from: AbbVie, M. L. Garcia Vivar Grant/research support from: AbbVie, J. Uson Jaeger Grant/research support from: AbbVie, J. Ivorra Grant/research support from: AbbVie, J. Rivas Employee of: AbbVie

Background Biological therapy has changed the management of patients with inflammatory disease, but with a great increase of pharmaceutical costs and emergence of potential adverse effects. At the end of 2011 we established an internal protocol in management and dose optimization of the patients with biological treatment. Those patients with inflammatory disease who achieve remission by clinical and laboratory parameters and show no ecographic activity (arthritis, enthesitis), receive a reduction of dose. Patients with etanercept 50 mg sc. weekly reduce dose to 25 mg, and patients with adalimumab at a dose of 40 mg/2 weeks increase injection interval to 3 weeks. Thus we have achieved optimization of 20% in 2012, which is close to 40% at the end of 2013. Objectives To show that there is not a significant clinical or analytical worsening in our optimized patients, considering basal data at the time of optimization and six months later. Methods Retrospective analysis of data from clinical records and our database of 105 patients treated with etanercept and adalimumab, optimized from 2011, considering lab tests results (ESR, RCP), disease activity (DAS 28, BASDAI), functional capacity indexes (HAQ, BASFI), and GP E (global patient evaluation of the disease). We used SPSS 21.0 for statistical analysis. Results 105 patients (53 female and 52 male), 31% with rheumatoid arthritis (RA), 27,5% with ankylosing spondylitis (AS), 37,7% wiyh psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with a longstanding disease, with a mean of 152,47 months of evolution (18-638). Table 1 shows both, the basal findings and the results from six months later. Furthermore, 32,4% of patients had a DAS 28 increase over 0,6, but in only 14,7% DAS 28 increase resulted over 1,2. BASDAI an BASFI increases >2 from basal occurred in 4,4% of patients. EGP increases >20 from baseline occurred in 15% of patients. Conclusions Our patients optimized with etanercept and adalimumab maintain remission criteria based on clinical and laboratory parameters at six months. So, optimization seems to be safe and cost effective in an important amount of patients with longstanding disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5931

Background Aromatase Inhibitors (AI) are an important component in adjuvant therapy in postmenopausal women with positive estrogenic receptors in breast cancer. They inhibit the enzyme Cytochrome P450 CYP19, which causes a loss of BMD and consequently an increase in the risk of fracture. In patients with early breast cancer (EBC) in treatment with AI, it is estimated that the risk of fracture is 11% at five years. FRAX is used to calculate the probability of fracture at 10 years. Within its limitations, it should be highlighted that among its risk factors it does not include medications such as AI and that the treatment threshold adapted to patients of the Spanish population is not currently valid. Objectives To determine if the therapeutic intervention thresholds according to the FRAX proposed by the NOF (National Osteoporosis Foundation) as well as of the NOGG (National Osteoporosis Guidelines Group) identify appropriately whether patients with early breast cancer have a high risk of fracture at the start of AI treatment. Methods Retrospective and descriptive study of 73 patients with EBC in treatment with AI sent to the medical oncology department of a tertiary hospital (Basurto University Hospital) for monographic consultation of osteoporosis for its diagnosis, control and monitoring in the period from 01/01/2006 to 31/12/2010. A questionnaire was conducted of the risk factors, BMD DXA and FRAX. The FRAX results are described in the basal visit and the incidence of fractures in this population in December 2012 (monitoring period of 2 to 7 years). The patients with densitometric osteopenia and high risk of fracture according to the FRAX and the patients with both densitometric and established osteoporosis received treatment with bone agents by the Osteoporosis Unit. Results The mean age of our series is 63 years (40-83). The median time from the start of the AI and the realization of the basal BMD is 4 months. The initial densitometry identified 36 patients (49%) with osteoporosis, 35 patients (48%) osteopenia and 2 patients (3%) normal. According to the FRAX applying the treatment thresholds of the NOF (FMO >= 20% and FC >=3%): 19 patients (25%) have high risk of fracture: 16 patients (21%) of FMO and 18 patients (23.6%) of FC. Applying the treatment thresholds of the NOGG in which the values vary according to age: 3 patients (4%) have high risk of fracture, 1 patient (1%) of FMO and 3 patients (4%) of FC. Of the 73 patients, 15 (20%) present fracture, all vertebral, with 5 (33%) of high risk by FRAX according to NOF and only 1 (6%) according to NOGG. Conclusions In our series, the treatment thresholds for the FRAX of the NOF are more sensitive by identifying a greater number of patients with high risk of fracture (25%) than the NOGG (6%). Of the patients with fractures of the study (20%), only 33% of them were identified previously as high risk according to the NOF and 6% according to the NOGG. Both thresholds clearly underestimate the risk of fracture. It is necessary to validate the FRAX in prospective studies that include AI as a risk factor and apply new validated cut-off points in our population. Disclosure of Interest None Declared