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Elderly-onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) are common rheumatic diseases in older adults. Oxylipins are bioactive lipids derived from omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) that serve as activators or suppressors of systemic inflammation. We hypothesized that arthritis symptoms in older adults were related to oxylipin-related perturbations. Arthritis in older adults (ARTIEL) is an observational prospective cohort with 64 patients older than 60 years of age with newly diagnosed arthritis. Patients’ blood samples at baseline and 3 months posttreatment were compared with 18 controls. A thorough clinical examination was conducted. Serum oxylipins were determined by mass spectrometry. Data processing and statistical analysis were performed in R. Forty-four patients were diagnosed with EORA and 20 with PMR. At diagnosis, EORA patients had a mean DAS28CRP (Disease Activity Score 28 using C-reactive protein) of 5.77 (SD 1.02). One hundred percent of PMR patients reported shoulder pain and 90% reported pelvic pain. Several n-6- and n-3-derived oxylipin species were significantly different between controls and arthritis patients. The ratio of n-3/n-6 PUFA was significantly downregulated in EORA but not in PMR patients as compared to controls. The top two candidates as biomarkers for differentiating PMR from EORA were 4-HDoHE, a hydroxydocosahexaenoic acid, and 8,15-dihydroxy-eicosatrienoic acid (8,15-diHETE). The levels of n-3-derived anti-inflammatory species increased in EORA after treatment. These results suggest that certain oxylipins may be key effectors in arthrtis in older adults and that the imbalance between n-6- and n-3-derived oxylipins might be related to pathobiology in this population.

To study retention of biologic disease-modifying anti-rheumatic drugs (bDMARDs) or apremilast and potential predictors of lack of response in patients with psoriatic arthritis (PsA). A single-center retrospective analysis of PsA patients who received ≥ 1 bDMARD or apremilast during 2000–2018. The main endpoint was lack of response (primary or secondary failure). Analyses included retention of DMARDs (Kaplan–Meier curves) and potential predictors of lack of response (bivariate and multivariate logistic regression models). A total of 159 patients with PsA received up to 8 DMARDs: etanercept (34%), adalimumab (30%), infliximab (9%), golimumab (9%), apremilast (7%), ustekinumab (5%), certolizumab (4%), and secukinumab (2%). Therapy was discontinued in 96 cases (60%), mainly owing to secondary failure (37%), followed by primary failure (25%) and adverse effects (24%). Retention was analyzed based on 313 units of analysis. Duration of follow-up was 846.1 treatment-years (maximum 14.8 years, median 2.75 years). A total of 172 DMARDs were discontinued. The probability of continuing the initial treatment was 37% at 5 years, 22% at 10 years, and 12% at 14 years. The longest medium retention time was observed for infliximab (6.2 years) and etanercept (4.5 years). Predictors of lack of response included male sex, number of swollen joints, and, especially, depression (OR = 35.2). The sensitivity and specificity of the model were 86.4% and 85.7%, respectively, with a coefficient of determination (R2) of 45.6 (ROC, 0.912). Rates of discontinuation due to primary and secondary failure are high in PsA. Retention is better for anti-TNF agents than for other agents.

Objectives To assess efficacy and safety of biologic therapy (BT) in neurobehçet’s disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug. Methods Open-label, national, multicentre study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analysed were glucocorticoid-sparing effect and improvement in laboratory parameters. Results We studied 41 patients [21 women; age 40.6 (10.8) years]. Neurological damage was parenchymal (n = 33, 80.5%) and non-parenchymal (n = 17, 41.5%). First BTs used were infliximab (n = 19), adalimumab (n = 14), golimumab (n = 3), tocilizumab (n = 3) and etanercept (n = 2). After 6 months of BT, neurological remission was complete (n = 23, 56.1%), partial (n = 15, 37.6%) and no response (n = 3, 7.3%). In addition, median (IQR) dose of oral prednisone decreased from 60 (30–60) mg/day at the initial visit to 5 (3.8–10) mg/day after 6 months (P Conclusions BT appears to be effective and relatively safe in refractory NBD.

Objective Septic arthritis is a medical emergency and crystal-induced arthritis is a risk factor for its development. If both occur simultaneously, crystal-induced arthritis may mask the diagnosis of infection and delay antibiotic therapy. Method Retrospective analysis of patients with coexistence of septic and crystal-induced arthritis. We included only patients with isolation of crystals in synovial fluid analysis and positive culture of synovial fluid and/or blood culture. Results A total of 25 patients (17 men and 8 women) with a mean age of 67 years. The most commonly affected joint was the knee. In synovial fluid cytological studies, the most frequently identified crystals were monosodium urate. Risk factors included diabetes and chronic renal failure. The most frequently isolated germs were methicillin-sensitive Staphylococcus aureus (48%), methicillin-resistant S. aureus (12%) and Mycobacterium tuberculosis (12%). In all, 36% of subjects required surgical drainage (excluding those caused by M. tuberculosis). Clinical outcome was favourable in 56%, although intercurrent complications were usual (40%). Mortality was 8%. Conclusions Coexistence of septic and crystal-induced arthritis represents a diagnostic challenge and requires a high index of suspicion. Gout was the most prevalent crystal-induced arthritis. S. aureus was the most commonly causative pathogen, with a high rate of methicillin-resistant S. aureus infection. If treated early, the outcome is usually favourable, making synovial fluid microbiological study imperative.

Resumen Objetivo La artritis septica es una urgencia medica y la artritis microcristalina es un factor de riesgo para su aparicion. Si ambas cursan de forma simultanea, la identificacion de microcristales puede enmascarar el diagnostico de la infeccion y causar un retraso en la instauracion del tratamiento antibiotico. Metodo Analisis retrospectivo de pacientes con coexistencia de artritis septica y microcristalina. Se incluye unicamente a los enfermos con aislamiento del germen en liquido articular y/o hemocultivo e identificacion de cristales en el liquido articular. Resultados Se identificaron un total de 25 pacientes (17 varones y 8 mujeres) con una media de edad de 67 anos. La articulacion que se afecto con mayor frecuencia fue la rodilla. Los cristales de urato monosodico fueron los que con mayor frecuencia se identificaron en el estudio citologico del liquido sinovial. Los factores de riesgo mas frecuentes fueron la diabetes mellitus y la insuficiencia renal cronica. El germen aislado con mayor frecuencia fue el Staphylococcus aureus sensible a meticilina (48%), seguido del Staphylococcus aureus resistente a meticilina (12%) y Mycobacterium tuberculosis (12%). El 36% de los pacientes precisaron desbridamiento quirurgico (excluyendo los causados por M. tuberculosis). La evolucion fue favorable en el 56% de los pacientes, aunque la presencia de complicaciones intercurrentes fue habitual (40%). La mortalidad fue del 8%. Conclusiones La coexistencia de artritis septica y microcristalina representa un reto diagnostico y requiere un alto indice de sospecha. La artropatia por cristales de urato monosodico es la mas prevalente y S. aureus el germen causal mas frecuente, con una tasa elevada de infeccion por S. aureus resistente a meticilina. Si se instaura de forma precoz el tratamiento adecuado, la evolucion suele ser favorable, por lo que el estudio microbiologico del liquido sinovial es imperativo. Objective Septic arthritis is a medical emergency and crystal-induced arthritis is a risk factor for its development. If both occur simultaneously, crystal-induced arthritis may mask the diagnosis of infection and delay antibiotic therapy. Method Retrospective analysis of patients with coexistence of septic and crystal-induced arthritis. We included only patients with isolation of crystals in synovial fluid analysis and positive culture of synovial fluid and/or blood culture. Results A total of 25 patients (17 men and 8 women) with a mean age of 67 years. The most commonly affected joint was the knee. In synovial fluid cytological studies, the most frequently identified crystals were monosodium urate. Risk factors included diabetes and chronic renal failure. The most frequently isolated germs were methicillin-sensitive S. aureus (48%), methicillin-resistant S. aureus (12%) and Mycobacterium tuberculosis (12%). In all, 36% of subjects required surgical drainage (excluding those caused by M. tuberculosis). Clinical outcome was favorable in 56%, although intercurrent complications were usual (40%). Mortality was 8%. Conclusions Coexistence of septic and crystal-induced arthritis represents a diagnostic challenge and requires a high index of suspicion. Gout was the most prevalent crystal-induced arthritis. S. aureus was the most commonly causative pathogen, with a high rate of methicillin-resistant S. aureus infection. If treated early, the outcome is usually favorable, making synovial fluid microbiological study imperative.

The better understanding of the safety of biologic DMARDs (bDMARDs), as well as the emergence of new bDMARDs against different therapeutic targets and biosimilars have likely influenced the use patterns of these compounds over time. The aim of this study is to assess changes in demographic characteristics, disease activity and treatment patterns in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who started a first- or second-line biologic between 2007 and mid-2020. Patients diagnosed with RA, PsA or AS included in the BIOBADASER registry from January 2007 to July 2020 were included. According to the start date of a first- or second-line biologic therapy, patients were stratified into four time periods: 2007–2009; 2010–2013; 2014–2017; 2018–2020 and analyzed cross-sectionally in each period. Demographic and clinical variables, as well as the type of biologic used, were assessed. Generalized linear models were applied to study the evolution of the variables of interest over time periods, the diagnosis, and the interactions between them. A total of 4543 patients initiated a first biologic during the entire time frame of the study. Over the four time periods, disease evolution at the time of biologic initiation (p p p p p p p p p = 0.004), and incremental changes to the therapeutic target between the first and second biologic (p

Rheumatoid arthritis; Spondyloarthritis; Ankylosing spondylitis; Psoriatic arthritis Artritis reumatoide; Espondiloartritis; Espondilitis anquilosante; Artritis psoriásica Artritis reumatoide; Espondiloartritis; Espondiliti anquilosant; Artritis psoriàsica Biologic and targeted synthetic disease-modifying antirheumatic drugs (ts/bDMARDs) play a pivotal role in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Persistence of therapy provides an index of a drug’s overall effectiveness. The objective of the study was to identify factors associated with discontinuation of ts/bDMARDs in a real-world dataset. The study population comprised patients diagnosed with RA, PsA, and AS included in the BIOBADASER registry for whom follow-up data were available until November 2019. Patient features and treatment data were included in the analysis. The Kaplan–Meier method was used to study survival of the different drugs according to the reason for discontinuation. Factors associated with discontinuation were studied using Cox regression models and bivariate and multivariate analyses. P values of less than 0.05 were regarded as statistically significant. The study population comprised 4,752 patients who received a total of 8,377 drugs, of which 4,411 (52.65%) were discontinued. The Kaplan–Meier curves showed that survival for first-line treatment was greater in all 3 groups (p < 0.001). Patients with RA had a greater risk of discontinuation if they were younger (HR, 0.99; 95% CI 0.99–1.00), if they were receiving anti-TNFα agents (HR, 0.61; 95% CI 0.54–0.70), and if they had more comorbid conditions (HR, 1.09; 95% CI 1.00–1.17). Patients with PsA had a higher risk if they were women (HR, 1.36; 95% CI 1.15–1.62) and if they were receiving other ts/bDMARDs (HR, 1.29; 95% CI 1.05–1.59). In patients with AS, risk increased with age (HR, 1.01; 95% CI 1.00–1.02), as did the number of comorbid conditions (HR, 1.27; 95% CI 1.12–1.45). The factors that most affected discontinuation of ts/bDMARDs were line of treatment, age, type of drug, sex, comorbidity and the year of initiation of treatment. The association with these factors differed with each disease, except for first-line treatment, which was associated with a lower risk of discontinuation in all 3 diseases.

Background Oral and/or genital aphthous ulcers are the most common symptoms of Behçet´s disease (BD), and are often refractory to conventional treatment. The inhibitor of phosphodiesterase-4 apremilast (APR) has demonstrated efficacy in the treatment of this manifestations. The objective of the present study was to assess the efficacy of APR in the management of refractory oral and/or genital ulcers in patients with BD. Methods National multicenter open-label observational study on BD patients with recurrent oral and/or genital ulcers. In all cases orogenital ulcers were refractory to conventional therapy. APR was given and maintained at standard dose of 30 mg twice daily. The main outcome was the achievement of oral and/or genital ulcers remission. Efficacy of APR for other clinical manifestations was also evaluated. Results We included 51 patients (35 women/16 men; mean age 44.7 ± 13.2 years). Before APR, all patients had received several systemic conventional and/or biologic drugs. APR was initiated because of refractory oral (n = 19) or genital (n = 2) aphthous ulcers or both (n = 30). Other manifestations found at APR onset were arthralgia/arthritis (n = 16), folliculitis/pseudofolliculitis (n = 14), erythema nodosum (n = 3), furunculosis (n = 2), paradoxical psoriasis induced by TNFα-inhibitors (n = 2), ileitis (n = 2), deep venous thrombosis (n = 2), leg ulcers (n = 1), erythematosus and scaly skin lesions (n = 1), fever (n = 1), unilateral anterior uveitis (n = 1) and neurobehçet (n = 1). After a mean follow-up of 8.5 ± 6.9 months, most patients had experienced improvement of orogenital ulcers and prednisone dose had been successfully reduced or discontinued. APR also yielded improvement of some non-aphthous manifestations such as the cutaneous follicular and intestinal manifestations. However, the effect on musculoskeletal manifestations was variable. Conclusion APR yielded a rapid and maintained improvement of refractory mucocutaneous ulcers of BD, even in patients refractory to several systemic drugs including biologic therapy.

Background:Neuro-Behçet’s disease (NBD) is a severe complication of Behcet’s disease (BD). Despite well-established therapies with glucocorticoids and conventional immunosuppressants (cIS), a significant proportion of patients are refractory.Objectives:To assess efficacy and safety of biologic therapy (BT) in NBD refractory to glucocorticoids and at least one cIS.Methods:Open-label multicenter study of refractory NBD from 23 different referral Spanish Hospitals. Main outcome was neurological response. Secondarily, analytical efficacy was measured by Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and Hemoglobin (Hb) at baseline, 6 months, 1 year and 2 years.Results:We studied 42 patients (21 women/ 21 men; mean age 40.4±10.8 years). HLA B51 was positive in 15 out of 37 (40.5%) patients tested. Non-neurological manifestations were oral ulcers (n=41, 97.6%), genital ulcers (n=31, 73.8%), skin lesions (n=28, 66.7%), arthralgia (n=27, 64.3%), uveitis (n=21, 50.0%), arthritis (n=9, 21.4%), venous thrombosis (n=9, 21.4%) and arterial thrombosis (n=4, 9.5%). The underlying neurologic manifestation were parenchymal (n=34, 81.0 %) and non-parenchymal (n=17, 40.5%) involvement (Table 1). The first BT used was infliximab (n=20), adalimumab (n=13), golimumab (n=3), tocilizumab (n=3) and etanercept (n=2).After 58.2±51.4 months since initiation of BT, neurological response was complete (n=27; 64.3%), or partial (n=11, 26.1%) (Figure 1). Only 4 (9.5%) patients did not respond. After 6 months of BT, ESR improved from.31.5±25.6 to 15.3±11.9 mm/h (p=0.005), CRP from 1.4 [0.2-12.8] to 0.3[0.1-3] mg/dL (p= 0.002) and Hb from 13.1±1.6 to 13.8±1.3 g/dL (p=0.005).Figure 1.Neurological clinical response to biological therapy.Primary failure was observed in 16 (38.1%) patients due to inefficacy (n=11, 68.8%) or adverse effects (n=5, 31.3%). Similarly, causes of secondary failure (n=6, 14.3%) were inefficacy (n=5, 83.3%) and adverse effects (n=1, 16.7%). No serious adverse effects were observed.Conclusion:BT, especially monoclonal anti-TNF drugs, seems to be effective and safe in refractory NBD.Table 1.Neurologic manifestation of 42 patients with refractory neurobehçet's disease treated with biologic therapy.Parenchymal subtype, n (%)34 (81.0)-Hemiparesis8 (19.1)-Polineuropathy8 (19.1)-Encephalopathy6 (14.3)-Cognitive impairments4 (9.5)-Optic neuropathy4 (9.5)-Ophtalmoparesis4 (9.5)-Other cranial nerve involvement3 (7.1)-Hemihypoesthesia3 (7.1)-Cerebellar dysphasia1 (2.4)-Cerebellar involvement1 (2.4)-Non-steroidal psicosis1 (2.4)Non-parenchymal subtype, n (%)17 (40.5)-Aseptic meningitis12(28.6)-Thrombosis4 (9.5)-Intracranial hypertension1 (2.4)Disclosure of Interests:Alba Herrero-Morant: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Lilly, Janssen, and Celgene, Santos Castañeda: None declared, Iñigo González-Mazón: None declared, Olga Maiz: None declared, Ana Blanco Speakers bureau: AbbVie, Julio Sánchez: None declared, Norberto Ortego: None declared, Enrique Raya Speakers bureau: MSD, Grant/research support from: AbbVie, Alejandro Olive: None declared, Anahy Brandy-Garcia: None declared, Águeda Prior-Español: None declared, Clara Moriano: None declared, Elvira Diez Alvarez: None declared, Rafael Melero: None declared, Jenaro Graña: None declared, Álvaro Seijas-López: None declared, ANA URRUTICOECHEA-ARANA: None declared, Angel Ramos Calvo: None declared, Concepción Delgado Beltrán: None declared, Marta Loredo Martínez: None declared, Eva Salgado-Pérez: None declared, Francisca Sivera: None declared, Ignacio Torre-Salaberri: None declared, J. Narváez Speakers bureau: Bristol-Myers Squibb, José Luis Andréu Sánchez: None declared, Olga Martínez González: None declared, Ricardo Gómez de la Torre: None declared, Sabela Fernández: None declared, Susana Romero-Yuste: None declared, Gerard Espinosa: None declared, Miguel Á. González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Sanofi, Lilly and MSD, Grant/research support from: AbbVie, MSD, and Roche

Background:SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is an acronym created with the aim of encompassing within the same entity the findings present in a heterogeneous group of patients with various osteoarticular and cutaneous disorders. For years it has been debated whether it is an entity itself or if, on the contrary, it is a specific phenotype of psoriatic arthritis.Objectives:Determine the relationship between SAPHO syndrome and psoriatic arthritis by comparing the classic criteria of SAPHO with CASPAR in patients previously diagnosed with SAPHO.Methods:A retrospective study where patients with a diagnosis of SAPHO in the same center (1984-2018) were reviewed. Of a total of 95 patients that met the criteria of Benhamou et al., 46 were excluded due to lack of information to complete the minimum necessary data, so 39 patients were finally included in the study. Demographic data were registered, age at diagnosis, CASPAR criteria (active psoriasis, history of own or familial psoriasis, nail psoriasis, negative RF, dactylitis and new formation/juxta-articular bone proliferation), classical criteria of SAPHO and HLAB27. For the statistical analysis, a Chi-square is applied to determine the differences between the groups with / without CASPAR criteria.Results:Of the sample of 39 subjects diagnosed with SAPHO, 15 patients (38%) met CASPAR criteria (4M/11W), with a median age at diagnosis of 42 years (range 21-50). Of them, 8 (60%) had active cutaneous psoriasis, 10 (73%) had a family or personal history of psoriasis, 6 (40%) had psoriatic nail dystrophy, 14 (93%) had negative FR, 3 (20%) had presented some episode of dactylitis and 10 (73%) had juxta-articular new bone formation. Of the 15 patients who met CASPAR criteria, 9 (67%) had synovitis, 2 (13%) acne, 4 (26%) pustulosis, 13 (87%) hyperostosis and 12 (80%) osteitis. HLAB27 was positive in 1 patient (2.5%) of the group that met CASPAR criteria. Of the patients who did not fulfill CASPAR criteria (9M/15W), the median age at diagnosis was 44.5 years (range 10-70). None of them had active cutaneous psoriasis, psoriatic nail distrophy or dactylitis, 1 (4%) had a family or personal history of psoriasis, all had RF- and 3 (12.5%) had juxta-articular bone new formation (Table 1). Synovitis was observed more frequently in patients who met CASPAR criteria than in those who did not (67% vs 25%, p 0.01). In contrast, osteitis was present more frequently in patients who did not meet CASPAR criteria (80% vs 96% p 0.05) and pustulosis, although it was not statistically significant (50% vs 26%, p 0.07). Among patients who did not meet CASPAR criteria only 1 met the 5 classic SAPHO criteria and another 3 met 4.Table 1.Conclusion:Approximately one third (38%) of patients diagnosed with SAPHO meet criteria for psoriatic arthritis, the most notable variables being active psoriasis or a history of psoriasis. Synovitis manifests more frequently in patients with CASPAR criteria and osteitis more present in patients who did not meet them.Acknowledgments:Rheumatology Service of the Germans Trias i Pujol HospitalDisclosure of Interests:None declared

To assess the effectiveness and survival of ustekinumab (UST) among patients with psoriatic arthritis (PsA) treated under routine clinical care.Multicenter study. Epidemiological and clinical data was collected through electronic medical records of all patients with PsA who started UST in 15 hospitals of Spain.Two hundred and one patients were included, 130 (64.7%) with 45 mg and 71 (35.3%) with 90 mg. One hundred and thirty one patients (65.2%) had previously received another biological therapy. The median baseline DAS 28 ESR was 3.99, and Psoriasis Area and Severity Index (PASI) was 3. Overall, there was a significant decrease in DAS66/68 CRP, swollen joint count (SJC), tender joint count (TJC), and PASI in the first month of treatment, with earlier improvement in skin (PASI) than joints outcomes. Survival was numerically lower in patients with UST 45 mg (58.1%) than 90 mg (76.1%), although significant differences were not found (p = 0.147). When comparing naïve and 1 TNF blocker versus 2 TNF blocker-experienced patients, a significantly earlier response was seen in the former group regarding SJC (p = 0.029) at 1 month. Fifty-one patients (25.3%) stopped UST due to joint inefficacy and 4 patients due to adverse events (1.9%). Drug survival was significantly better in patients with fewer lines of previous biological agents (p = 0.003 for 1 TNF blocker versus 2 TNF blocker users).UST was effective in PsA patients in a routine clinical care setting. Patients with UST 90 mg and fewer lines of previous biologics achieved better and faster responses. Key Points • Largest cohort of patients with PsA in treatment with UST with specific rheumatological indication. • First cohort of patients with PsA comparing effectiveness of UST according to 45/90 mg dose.

Background Elderly onset rheumatoid arthritis (EORA) has several peculiarities. Which activity index should we use in this age group is still an unresolved issue. The use of ESR in DAS28 is widespread, but it is well known that ESR could increase with age, overestimating activity. DAS28-PCR or SDAI, which uses PCR, or CDAI that does not use analytical data, could be more suitable alternatives. Objectives To describe disease activity scores evolution in EORA and to analyse the correlation and concordance between them. Methods Longitudinal observational study in naive treatment EORA patients (ACR/EULAR 2010 criteria). Study visits were carried out basally (pre-treatment) and at month 1, 3, 6 and 12. DAS28 VSG, DAS28 PCR, SDAI and CDAI were calculated at each visit, and ACR/EULAR remission index at 12 months. The same rheumatologist made all visits and explorations. Correlations were analysed using the Spearman or Pearson correlation index (p value ≤ 0.001). The concordance was evaluated with the kappa index. The statistical study was performed with Stata 15.1. Results 45 patients with EORA were enrolled. Table 1 and 2 summarize the clinical and analytical characteristics. All the scores had a very good linear correlation both at baseline and at follow-up (correlation score: 0.83-0.98). A moderate concordance was observed from the baseline visit between DAS28-VSG and DAS28-PCR (k=0.43-0.52, p Conclusion The correlation between the different scores was good. However, the concordance between all the scores decreases as time passes, according to a higher percentage of patients in remission or low activity. This low-moderate concordance is demonstrated even between DAS28-PCR and DAS28-VSG, and when these are compared with CDAI and SDAI. CDAI and SDAI are the only ones that maintain a good concordance between them, even when the number of patients in remission or low activity increases. ACR/EULAR only maintains an acceptable concordance with the most restrictive scores, SDAI and CDAI. By contrast, agreement is very low with DAS28, especially by DAS-PCR. Disclosure of Interests None declared

Background Myositis specific antibodies have gained special importance in last years. Its knowledge has allowed stratifying patients in different clinical phenotypes, predicting with greater accuracy prognosis and establishing a clinical attitude to follow. SAE1/2 antibody (anti-small ubiquitin-like modifier activating enzyme) was first described in 2007 in patients with amyopathic dermatomyositis with cutaneous and digestive involvement. Its prevalence ranges from 8% in European cohorts to 3% in asians. Objectives Describing myositis specific antibodies (MSA) in a cohort of inflammatory myopathies. To characterize the clinical phenotype of SAE1/2 antibody and to compare it with the rest of MSA. Methods Patients diagnosed of dermatomyositis in a tertiary hospital from 1978-2018, according to the criteria of Bohan and Peter (1975) and according to Dalakas classification criteria (2015). Clinical and analytical data, including the immunological profile were collected, as well as the treatments received and the evolution of the disease. Results Out of 46, 41 dermatomyositis had positive antinuclear antibodies (ANA). 55% percent had aNA titles≥640, being the fine speckled pattern the most frequent (43%) followed by coarse speckled and homogeneous (13.6% each). 72% had MSA, the most frequent being antiJo1 (27.3%) followed by MDA5 (18.2%) and SAE1/2 (15%). Up to 40% had two or more antibodies, being the association with antibodies Ro52 and Ro60, the most frequent. 5 patients presented positivity against SAE antibody. In comparison to the rest of MSA, 80% presented with cutaneous debut (p = 0.00), being the most frequent manifestations heliotrope erythema (p = 0.00), Gottron papules (p = 0.10) and skin rash (p = 0.00). 60% had pathological capillaroscopy compared to 15% (p = 0.00). Muscular balance was preserved in 60% of patients. Sixty percent had dysphagia vs 9% (p = 0.00). Two of them had lung involvement (alveolar hemorrhage and rapidly progressive pneumonitis). In comparison with SAE negative group, patients presented more pulmonary hypertension (44.5vs34 mmHg), without reaching significant differences. No significant differences were found between muscle enzyme levels’ neither acute phase reactants. As complications, one patient presented a myocarditis with quickly rapidly progressive pneumonitis that required high doses of corticotherapy and another one alveolar hemorrhage, which was treated the same way. All patients required corticotherapy at doses of mg/kg, requiring two of them to be treated with DMARDs (methotrexate and dolquine) and one of them with immunoglobulins due to cutaneous involvement. Mortality rate was 40% due to rapidly progressive lung affectation and cardiorespiratory arrest. Conclusion Higher prevalence of SAE1/2 antibody in our cohort may be explained due to the use of amplified myositis antibodies kit that specifically includes this antibody. These patients typically present with cutaneous involvement and dysphagia but also lung affectation as a complication. Studies with larger samples should be performed in order to know the prognosis of this antibody specificity. Disclosure of interests None declared

Background During the last 15 years, the comprehensive understanding of the safety, effectiveness, expanding access, and availability of new biologic disease-modifying antirheumatic drugs (bDMARDs) has likely contributed to the pattern of use of these compounds in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Objectives To assess changes in the baseline characteristics of patients who underwent biological therapy from 2007 to 2018 in a real world setting. Methods Data were obtained from BIOBADASER, the Spanish registry of biologics. Recorded data is obtained from routine clinical practice. Patients diagnosed with RA, PsA and AS and who started biological treatment from 2007 to 2018 were included. Sociodemographic and clinical variables, as well as first bDMARD used, were stratified by the starting year period (2007-2009; 2010-2012; 2013-2015; 2016-2018) and compared using Anova and Chi-square tests. Results 6943 patients (2827 RA patients, 1274 PsA and 1261 AS) were included in this analysis (Table 1). Patient age at the beginning of the first biologic was significantly higher during the period 2016-2018 than in 2007-2009 (48.3 vs 50.6). Disease duration until the use of biologics decreased from 8.6 to 8.1 years. In RA patients, disease activity, as assessed by DAS28 at the start of the biological treatment, was significantly higher in the 2007-2009 period than in the last period analyzed (5.1 vs 4.7). The use of TNF inhibitor as a first option also changed significantly (94.6% vs 58.5%). Regarding comorbidities, the number of rheumatic patients treated with biologics and a past history of cancer (1.8% vs 3.7%), ischemic heart disease (1.8% vs 3.1%), hypercholesterolemia (13.6% vs 26.1%), or hypertension (21.7% vs 23.7%) has increased significantly. Conclusion Our data show that during the last decade the pattern of use of biologics in patients with rheumatic diseases has changed. Nowadays these compounds are used in older patients, with shorter disease duration, with lower disease activity in RA, and with more comorbidities. Disclosure of Interests Carlos Sanchez-Piedra: None declared, Agueda Prior-Espanol: None declared, Mercedes Freire Gonzalez: None declared, Maria Colazo: None declared, Dolores Ruiz-Montesinos: None declared, Yanira Perez-Vera: None declared, Ana Ortiz: None declared, Sagrario Bustabad: None declared, Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Marta Rojas-Gimenez: None declared, Fernando Sanchez-Alonso: None declared, Federico Diaz-Gonzalez Grant/research support from: MSD, Abbvie, Roche, Novartis, Consultant for: Lilly, Novartis, Pfizer, Amgen, Biogen, Celgene, Speakers bureau: MSD, Lilly, Janssen, BMS, Roche, Juan Jesus Gomez-Reino: None declared

Background: Rheumatoid arthritis (RA) patients have a higher insulin resistance (IR) and some studies report that it is present at diagnosis. Systemic inflammation has been pointed out as the reason. However, data on polymyalgia rheumatica (PMR) are controversial. Objectives: To analyse IR in a group of untreated patients with a recent diagnosis of RA and PMR, and to establish predictive factors related with IR. Methods: Longitudinal observational study of patients older than 60 years, newly diagnosed with elderly-onset AR (ACR/EULAR 2010) and PMR (ACR/EULAR 2012). Comparison with healthy control group of the same age. Inclusion: consecutive and voluntary. Exclusion: patients with insulin-dependent diabetes. Follow-up time: 12 months. The clinical-epidemiological, anthropometric and analytical characteristics were collected. IR was calculated by HOMA-IR [(homeostatic model assessment of insulin resistance) = glucose (mg/dL) * insulin (mUI/L)/405] baseline and at 12 months. HOMA-IR>2.75 was considered IR (according to Spanish data). The statistical study was performed with Stata 15.1. Results: We recruited 42 patients with RA, 18 with PMR and 18 healthy controls. None of them had received treatment with corticosteroids or with DMARD at the baseline visit. Baseline characteristics are summarized in the table. At baseline visit, 66.7% of patients with elderly-onset RA had IR, compared with 33.3% of controls (p=0.024) and 27.8% of PMR (p=0.006). Therefore, the prevalence of IR in patients with RA doubled that of controls and patients with PMR before starting treatment. After 12 months of evolution and treatment, patients with RA and IR decreased from 66.7% to 51.2%, not being statistically significant (p=0.179). On the other hand, the percentage of patients with PMR and IR remained the same (27.8%). The differences in IR between RA and PMR at 12 months remained statistically significant (p=0.048). Given the results we decided to analyze the predictive factors related with IR only in the 42 patients with RA. In the univariate logistic regression analysis, the predictors of presenting IR were the BMI, the abdominal perimeter and the scapular girdle involvement. Specifically for BMI, for each of 2 kg/m2 the probability of having IR was 1.24 times higher (OR=1.24, IC95%: 1.12-1.37). Patients with scapular girdle involvement had a 6-fold increased risk of developing IR (OR = 6.0, 95% CI: 1.3-26.6). And for every 5 centimetres of abdominal perimeter the risk increased almost 4 times more (OR=3.9, 95% CI: 2.9-5.1). In the multivariate analysis, the only independent factor to increase the IR was the abdominal perimeter (aOR = 1.23, IC95%: 1.07-1.41). Conclusion: Patients with elderly-onset RA have a higher IR than the general population. High IR in RA is present at diagnosis. IR in AR is not exclusively mediated by systemic inflammation, since patients with PMR do not have this increase. The predictors of presenting IR in late onset AR were BMI, scapular girdle involvement and abdominal perimeter. Only the abdominal perimeter was shown as an independent factor. Disclosure of Interests: None declared

Background: Adult-onset Still’s disease (AOSD) is an uncommon disease with an unpredictable clinical course and variable prognosis. Sometimes, it requires biologic treatment in early phases. A prognosis score has been described, which has never been applied in a Spanish case series. Objectives: To apply the prognosis score described by Pouchot et al (Systemic Score System (SSS)) on a 64 cases series diagnosed with AOSD in Spanish population and to determine if SSS high values registered at the onset of the pathology are related to AOSD clinical patterns (monocyclic, polycyclic and chronic course), requirement of biologic treatment along the disease’s course and development of AOSD clinical complications. To establish the relationship between its value and the AOSD-related mortality. Methods: Retrospective study realized in two University Hospitals. Clinical, laboratory, AOSD-related complications data, administered biologic treatments and number of deaths (AOSD related or not) were recorded. Each patient was characterized for the presence of AOSD-related complications such as macrophage activation syndrome (MAS), myocarditis, lung involvement (pulmonary hypertension, interstitial infiltrate), renal involvement (tubulointerstitial nephritis, acute renal failure), secondary amyloidosis and AOSD-related death. SSS was applied at the onset of the disease development, assigning a point to each of the next 12 variables: fever, exanthema, pleuritis, pneumonitis, pericarditis, alteration of liver tests or hepatomegaly, splenomegaly, lymphadenopathy, odynophagia, leukocytosis >15,000/mm3, myalgia and abdominal pain. A ≥7 score has been validated on other populations as the one which identifies the patients with high risk of complications. The relationship between SSS value and the next parameters was determined: clinical course, complications, biologic treatments administered and AOSD-related mortality. Results: Data from 64 patients was analyzed (40,6% men, mean age 37 years). SSS values of Conclusion: The prognosis score described by Pouchot et al could be useful to identify those patients with high risk of developing clinical complications and those who will need biologic treatment along the course of their disease. It is necessary a higher number of patients to determine if the score could be useful to estimate the death risk related to AOSD complications. References: [1] Ruscitti, et al. Adult-onset Still’s disease: evaluation of prognostic tools and validation of the systemic score by analysis of 100 cases from three centers. BMC Medicine (2016)14:194 Disclosure of Interests: Ivette Casafont-Sole: None declared, Susana Holgado: None declared, J. Narvaez Consultant for: Bristol-Myers Squibb, Maribel Mora: None declared, Josep Roca: None declared, Anahy Brandy-Garcia: None declared, Lourdes Mateo: None declared, Melania Martinez-Morillo: None declared, Laia Gifre: None declared, Maria Aparicio Espinar: None declared, Agueda Prior-Espanol: None declared, Anne Riveros: None declared, Clara Sanguesa: None declared, Jordi Camins-Fabregas: None declared, Annika Nack: None declared, Joan Miquel Nolla: None declared, Alejandro Olive: None declared

Background Polyarthritis at the elderly people usually has a similar onset with an acute inflammatory character and scapular girdle involvement. Differentiating elderly onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) can be a diagnostic challenge. Objectives To analyse the clinical and analytical differences between EORA and PMR. Methods Longitudinal observational study of patients older than 60 years newly diagnosed with EORA (ACR/EULAR 2010) and PMR (ACR/EULAR 2012). Inclusion: consecutive and voluntary. Follow-up time: 12 months. A single rheumatologist made all follow-up visits. The clinical-epidemiological and analytical characteristics were collected. The statistical study was performed with Stata 15.1. Results 45 EORA were recruited (53% women; mean age 74.8 ± 7.5) and 20 PRM (85% women; mean age 76.6±5.0). 75% of EORA had scapular girdle involvement, but only 44% of the pelvic girdle. All had peripheral arthritis, and the small joints of the hands were involved in 93.3%, with edema in 46.7%. Forty percent of EORA patients were seropositive (RF> 20 IU/mL and/or ACPA> 20 U/mL): 33% RF positive (132.8 ± 126 IU/mL), 28.9% for ACPA (2 cases [15.4%] from 100 to 250 U/mL and 11 cases [84.6%] above 250 U/mL) and in 10 patients [22.2%] double positive). All patients with PMR patients had shoulder girdle involvement and 90% of the pelvic girdle. None of them had peripheral arthritis. RF was positive in one patient (73 IU/mL) and ACPA in 2 patients (titers between 20-40 U/mL). No patient was double positive. Table 1 and 2. After 12 months of follow-up, there was no difference between the dose of glucocorticoids received in patients with EORA and PMR (p = 0.684). There were also no differences in glucocorticoids adverse effects according to the diagnosis (p = 0.734). Regarding the use of immunosuppressors, this was higher in patients with EORA (91% EORA and 20% PMR), according to the usual clinical practice guidelines. The percentage of remission in PMR at 12 months was 95%. However, using DAS 28-VSG, only 40.9% of patients with EORA were in remission at 12 months (p=0.003). Conclusion The female predominance was higher in PMR than in EORA. The scapular girdle involvement, but especially the pelvic girdle, was more frequent in PMR. In contrast, involvement of peripheral joints and edema were more frequent in EORA. RF and ACPA were more frequent in EORA. There were no other analytical differences that would help their differential diagnosis. The mean and accumulated doses of glucocorticoids during the first 12 months were similar, as well as the percentage of side effects. Immunosuppressors are more frequently used in EORA than in PMR. Remission is achieved more commonly in PMR than in EORA. References [1] Olivieri I, Pipitone N, D’ Angelo S, Padula A, Salvarani C. Late-onset rheumatoid arthritis and late-onset spondyloarthritis. Clin Exp Rheumatol 2009;27(4 Suppl 55):S139-145. [2] Pease CT, Haugeberg G, Montague B, Hensor EMA, Bhakta BB, Thomson W, et al. Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study. Rheumatology 2009;48(2):123-7. Disclosure of Interests None declared

Background Denosumab (Dmab), an anti-receptor activator of nuclear factor kappa-B ligand (RANKL) monoclonal antibody, has been shown to increase bone mineral density (BMD) at lumbar spine and proximal femur up to 21.6% and 9.1% respectively at 10 years of treatment. Additionally, Dmab has shown a marked decrease of vertebral, nonvertebral and femoral fractures during treatment. Nowadays, the existence of inadequate response to Dmab treatment remains unknown. Objectives: to describe the clinical, analytical and densitometric characteristics of patients with an inadequate response (IR) to Dmab treatment. IR was defined as the presence of a new fragility fracture during Dmab treatment or a significant decrease in BMD (≥5% at lumbar spine or ≥4% at proximal femur) within at least 12 months of therapy. Methods: retrospective study including patients with osteoporosis with an IR to Dmab. Therapeutic compliance was checked by clinical anamnesis and the electronic prescription. Risk factors for osteoporosis, history of fragility fractures, previous anti-osteoporotic treatment, densitometric and analytical data were collected before and at the moment when IR was diagnosed. Results Fourteen patients were included (12 women and 2 men) with mean age of 75 ± 9 years. The causes of osteoporosis were: postmenopausal (n=8, 57.14%), induced by glucocorticoids (n=3, 21.43%), alcoholic (n = 1, 7.14%) and multifactorial (n=2; 14.28%). Nine patients (64.28%) had been previously treated with oral or intravenous bisphosphonates for a mean of 5.8 ± 2.76 years. Nine patients (64.28%) had previous vertebral fractures (median 2, range 1-8), 2 of them had also presented a femoral fracture. During Dmab treatment, 7 patients (50%) presented a decrease in BMD (mean loss: proximal femur -3.5%, p=0.09; lumbar spine - 5.8%, p=0.046;) and 7 had incidental fractures: 5 vertebral (median 1, range 1-4), 1 humerus and 1 femur. The duration of treatment with Dmab was 3.82 ± 1.85 years in patients who sustained fragility fractures and 2.39 ± 1.4 years in patients with a BMD decrease. A multiple myeloma was diagnosed in a patient with vertebral fractures during Dmab treatment. After The identification of Dmab RI most patients mantained same treatment. Of the patients with incidental fragility fractures, 2 started combined treatment with teriparatide and Dmab, 1 changed to teriparatide and 2 maintained the same treatment. Of the 7 patients with BMD only 1 changed to zoledronic acid. Conclusion Most patients with IR to Dmab treatment had previous fragility fractures and had been previously treated with bisphosphonates for a mean duration of 5 years. The patients with a significant decrease in BMD had lesser duration of Dmab treatment than those who sustained fractures during Dmab treatment. Only one patient had a clinical cause for the IR development. Disclosure of Interests None declared

Background: Oral and/or genital aphthous ulcers are the most common symptoms of Behcet’s disease (BD), and are often refractory to conventional treatment. The inhibitor of phosphodiesterase-4 Apremilast (APR) has demonstrated efficacy in the treatment of this manifestations. Objectives: To assess the efficacy and safety of APR in BD patients with oral and/or genital ulcers refractory to conventional treatment. Methods: National multicenter open-label study on 49 BD patients treated with APR at maintained standard dose of 30 mg twice daily, with the initial 5-day titration schedule in 38 cases. The main outcome was achievement of oral and/or genital ulcers remission. Results: We included 49 patients (35 women/14 men), mean age of 44.5±13.4 years. Before APR, all patients had received several systemic conventional and/or biological drugs: oral corticosteroids (n=45), colchicine (n=48), NSAIDs (n=21), methotrexate (n=27), azathioprine (n=23), cyclosporine (n=9), dapsone (n=6), adalimumab (n=12), infliximab (n=8), tocilizumab (n=3), etanercept (n=3), sulfasalazine (n=2), cyclophosphamide (n=2) and/or others (pentoxifylline, thalidomide, mycophenolate mofetil, hydroxychloroquine, golimumab, 1 each). The main clinical symptoms for starting APR were oral (n=18) and genital (n=2) aphthous ulcers or both (n=29). After a mean follow-up of 8.3±6.8 months, most of the patients experienced main clinical improvement and prednisone dose was reduced or discontinued (TABLE). In this period of time, 31 patients developed any side-effect, most of them transitory: nausea (n=12), diarrhea (n=11), dyspepsia (n=9), abdominal pain (n=7), headache (n=5), loss of appetite (n=4), weight loss (n=3), halitosis (n=1), dry mouth (n=1), palpitations (n=1) and/or depression (n=1). Six patients had to reduce the dose to 30 mg/day. APR was discontinued in 11 patients due to: not obtaining the expected improvement (n=5), intense gastrointestinal adverse effects (n=3), desire of pregnancy (n=1), persistent erythema nodosum (n=1) and development of neurological involvement (n=1). Conclusion: Our data show a rapid and maintained improvement with APR in patients with mucocutaneous ulcers of BD refractory to several systemic drugs, including biologic therapy. References: [1] Davatchi F, et al. The International Criteria for Behcet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatology Venereol. 2014;28(3):338–47. [2] Gulen Hatemi, et al. Apremilast for Behcet’s Syndrome — A Phase 2, Placebo-Controlled Study. N Engl J Med 2015; 372:1510-1518. Disclosure of Interests: Belen Atienza-Mateo: None declared, Jose Luis Martin-Varillas: None declared, J. Loricera: None declared, Vanesa Calvo-Rio: None declared, Jenaro Grana: None declared, Gerard Espinosa: None declared, Clara Moriano: None declared, Trinidad Perez-Sandoval: None declared, Manuel Martin-Martinez: None declared, Elvira Diez Alvarez: None declared, Maria Dolores Garcia-Armario: None declared, Esperanza Martinez: None declared, Ivan Castellvi Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Patricia Moya: None declared, Francisca Sivera: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb, Isabel de la Morena Speakers bureau: Abbvie, Celgene, Pfzier, UCB, Ghebro, Roche, Sanofi, Janssen., Francisco Ortiz-Sanjuan: None declared, Jose Andres Roman-Ivorra: None declared, Ana Perez Gomez: None declared, Sergi Heredia: None declared, Alejandro Olive: None declared, Agueda Prior-Espanol: None declared, Carolina Diez: None declared, Juanjo J Alegre-Sancho: None declared, D Ybanez-Garcia: None declared, Angels Martinez-Ferrer: None declared, J. Narvaez Consultant for: Bristol-Myers Squibb, Ignasi Figueras: None declared, Ana Isabel Turrion : None declared, Susana Romero-Yuste: None declared, Pilar Trenor: None declared, Soledad Ojeda Grant/research support from: AMGEN, Speakers bureau: AMGEN, Santos Castaneda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Monica Calderon-Goercke: None declared, D. Prieto-Pena: None declared, Inigo Gonzalez-Mazon: None declared, Lara Sanchez Bilbao: None declared, Miguel A. Gonzalez-Gay: None declared, Ricardo Blanco: None declared

Background Clinical manifestations of systemic lupus erythematosus (SLE) and infections sometimes are difficult to distinguish. In clinical practice low complement and anti(ds)DNA levels are used to assess lupus activity but its determination usually requires some days. Leukocyte count, CRP and ESR cannot discriminate SLE from infectious processes. Calprotectin could be a good biomarker to assess lupus activity since it is more specific than CRP and ESR and faster to analyse than anti(ds)DNA. Objectives Our aim is to determine serum calprotectin levels in patients with SLE, and its correlation with analytical and clinical manifestations, especially with disease activity. Methods A total of 148 patients were included. All patients included fulfilled the SLE criteria (SLICC 2012). A quantitative ELISA analysis was performed to assess levels of serum calprotectin (CALPRO AS, Norway). Other biomarkers of lupus disease activity were also assessed (levels of anti(ds)DNA, hypocomplementemia, ESR and CRP). Clinical variables and activity/damage index (SLEDAI/SLICC) were also evaluated. The study was approved by the Clinical Research Ethics Committee of the hospital and all patients signed an informed consent. The results were compared with a healthy control group of similar age and sex (n=20). Results 134 patients (92%) were women with a mean age of 46±12 years and an average SLE evolution of 12±7 years. Mean SLEDAI was 2±2 (105 inactive [ 13]). Mean SLICC was 0.31±0.70. No significant differences were observed in serum calprotectin levels between patients with SLE and healthy controls (2.93±2.35 vs 2.17±1.49 µg/mL, p=0.160). Calprotectin was positively correlated with CRP (r=0.447, p= 100UI/mL) had higher calprotectin compared to patients with lower anti(ds)DNA (3.20±2.63 vs 2.42±1.57 µg/mL; p=0.027), however this pattern was not observed with hypocomplementemia. Contrary to what we expected, we did not observe significant differences on calprotectin levels depending on SLEDAI index classification (cutoff at 4 and 12). Moreover, no differences were observed on calprotectin levels between those patients with/without clinical manifestations such as serositis, arthritis or glomeruloneprhitis. Patients with antiphospholipid antibodies had higher calprotectin levels (3.75±2.04 vs 2.77±2.38 µg/mL;p=0.045). Conclusion Serum calprotectin levels were positively correlated with CRP levels and leukocyte count. Patients with higher anti(ds)DNA levels had higher calprotectin levels, however we did not observe significant differences depending on SLEDAI index or the presence of arthritis, serositis neither glomerulonephritis. Even that calprotectin determination is faster than anti(ds)DNA levels and could be helpful in assessing inflammatory activity. There is an interesting relation between antiphospholipid antibodies and calprotectin. This study should be continued in a larger sample of active SLE patients to assess its utility in clinical practice as a discriminating biomarker for flares and even infection Disclosure of Interests None declared

Background: Dermatomyositis (DM) is an idiopathic inflammatory myopathy. The recent years has increased its knowledge thanks to best characterization of myositis-specific antibodies that correlate with different clinical phenotypes.with different clinical phenotypes. Objectives: To describe the clinical and analytical features of a series of dermatomyositis: clinical debut, clinical manifestations as well as the treatments received and the evolution of the disease. Methods: Patients diagnosed of dermatomyositis in a tertiary hospital between the years 1978-2018 according to the criteria of Bohan and Peter (1975) and according to Dalakas’ classification criteria (2015). Clinical, analytical and immunological profile data were collected, as well as treatments received and the evolution of the disease. Results: A total of 59 inflammatory myopathies diagnosed between the years 1985 and 2018 were included. 46 were dermatomyositis (78%), 9 polymyositis (15%) and 4 necrotizing myositis (7%). 69% were women and 22% were smokers. Clinic started at 54 ± 17 years. The initial manifestation was pulmonary in 26.7% followed by cutaneous manifestations (24.4%) and the muscular (22.2%), while a 17.8% started skin and muscular manifestations at the same time. 45.5% behaved like a myopathic DM while a 28% as amyopathic DM and antisynthetase syndrome respectively. 38% presented interstitial involvement being the most common non-specific interstitial pneumonitis (76%)followed by usual interstitial pneumonitis (17%). In these patients, DLCO was decreased (mean of 58.9% and 13.2) as well as the FVC (average of 58%, 2.5L). 73.3% presented cutaneous involvement being the most common manifestations the Gottron papules (37.8%) and the heliotrope rash (35.6%), and up to 27% had cuticular affectacion. 64% had muscle involvement, afecting proximal and symmetrical. Neck flexors were affected in a 38% of patients while 20% had dysphagia.Only 3 patients presented dysphonia (7%) and 2 myocarditis Analytical data Conclusion: 80% received corticotherapy at a dose of mg/kg/day and 20% required high doses of metilprednisolone due to muscular involvement or pulmonary. 18% immunoglobulins and 11% cyclophosphamide. As maintenance 80% received disease modifiying antirheumatic drug in addition to corticosteroid therapy in descending doses (azathioprine 22%, dolquine 15%, tacrolimus 13.3%, rituximab 11%) due to muscle (29.9%), cutaneous (24.4%) and pulmonary involvement (22.2%). As complications, 2 cases of the syndrome were registered hemophagocytic Virtually all patients they presented pulmonary hypertension (mean 34 ± 12 mmHg). 5 patients (11.1%) were diagnosed with neoplasia, two of them after the diagnosis of DM. The mortality was 24%. 3 patients died due to a rapidly progressive pneumonitis, another 2 due to alveolar hemorrhage and three of them due to complication of the neoplastic disease. Dermatomyositis occurs in a variable way, with predominance of pulmonary, skin and muscle manifestations. They require corticotherapy and immunosuppressive treatment for maintenance, even so, mortality is high. Disclosure of interests: None declared

Background Extra-articular manifestations (EAM) in rheumatoid arthritis (RA) are more prevalent in patients with seropositive, nodular and long term disease. Around 40% of patients with RA can develop EAM, although the incidence has decreased with the “treat to target” strategy. Objectives To describe EAM in a cohort of patients with rheumatoid arthritis. Methods Retrospective descriptive study of patients diagnosed with RA between 2000 and 2018 who are currently under active biological treatment. Cardiovascular risk factors, baseline characteristics of RA and EAM during their evolution are collected. Statistical analysis is performed with SPSS 24. Results We recruited 108 patients, 81.5% female, with mean age at onset of RA of 50 ±15 years (range 17-82). RF was positive in 84.3% and ACPA in 81.3%. Erosions were observed on hands or feet at diagnosis in 35.2%. Mean follow up period: 12±8 years. The most common initial treatment was methotrexate (82.4%) and 44.4% received other DMARDs: leflunomide (32.3%), hydroxychloroquine (16.2%) and others (9.1%). DAS28VSG at diagnosis was 4.15±1.18 (1.89-6.02) and at the introduction of the first biological drug it was 5.02 ±1.16 (mean years since diagnosis 6±5). The first biological drug was etarnecept (40.7%), followed by adalimumab (17.6%), abatacept (15.7%), rituximab (7.4%), tocilizumab (7.4%) and infliximab (4.6%). 57.4% discontinued the first biologic: secondary failure (58.1%) or adverse effects (20.6%). 65.7% (71 patients) developed some EAM during disease evolution and 14.8% appeared during the first year. During this first year, secondary Sjogren (37.5%) was the most frequent, followed by rheumatoid nodules (18.7%), EPID (18.7%) and osteoporosis (18.7%). Two or more EAMs were present in 33.3% of patients. Fifty-four patients (56.3%) did not present any EAM at the beginning of the biological treatment and 29.6% (21 patients) developed EAM afterwards, with an average of 1±3 years. Pulmonary involvement was the first EAM to appear after the onset of biological treatment, followed by anemia (both in the first year). Summarizing the data of all patients over time, the most frequent EAMs were: osteoporosis (28.7%, mean appearance: 5 years from diagnosis); secondary Sjogren syndrome (27.8%, mean 6 years); normochromic normochromic anemia (21.3%, mean 8 years) and pulmonary involvement (17.6%, mean 4 years), presented as EPID (63.3%), NINE (25%), NIU (8.3%) and pulmonary nodules (8.3%). Other EAM observed were: cutaneous involvement in the form of rheumatoid nodules (15.7%, mean 5 years); ophthalmological involvement (6.5%, mean 18 years) (PUK 2.8%, uveitis 1.9%, scleritis 0.9%, episcleritis 0.9%); amyloidosis (3.7%, mean 16 years) and vasculitis (2.4%, mean 14 years). Conclusion EAM have a high prevalence in RA patients receiving biologic treatment (76.6%). A third part of patients had 2 or more EAMs. 14.8% develop the first EAM during the first year of evolution of RA and 30% in the first 5 years. The most frequent are osteoporosis and Sjogren’s syndrome, according to what is described in the literature. Pulmonary involvement is the most rapid during the evolution of RA with an average of 4 years. References [1] Marcucci E, Bartoloni E, Alunno A, Leone MC, Cafaro G, Luccioli F, et al.Extra-articular rheumatoid arthritis. Reumatismo. 2018Dec20;70(4):212-224 Disclosure of Interests None declared

Background: Ustekinumab (UST) is an anti- interleukin (IL) 12/23 monoclonal antibody that has been shown to be effective and safe in psoriatic arthritis (PsA) in two phases III clinical trials. However, we have very few UST data in a real- life setting. Objectives: To assess the effectiveness, safety and survival of UST among patients with PsA treated under routine clinical care. Methods: Retrospective and multicentric study. Epidemiological and clinical data were collected through the electronic medical record of all patients with PsA who started UST due to rheumatological indication in 14 hospitals of Catalonia and the Balearic Islands (Spain). Results: 152 patients were included, 116 (76.3%) with 45mg and 36 (23.8%) with 90mg. 55.9% were women, mean age 54.79 (12.5) years, and mean disease duration 209 months. 132 patients (87%) had oligo (30.3%) or polyarticular involvement (56.6%). 26.8% had enthesitis and 36.2% dactylitis. 48p(35.6%) had erosions. 94p (61.8%) had previously received another biological therapy, and 39 of them (38.8%) had received 2 or more. 54.6% of the patients were taking DMARDs and 39.5% glucocorticoids. The baseline DAS 28 was 3.97 (1.45), C reactive protein (CRP) was 2 mg/dl (2), SJC was 4.0 (5.4), and PASI was 6.5 (8.4). There were no significant differences in clinical and epidemiological data between patients at 45 or 90 mg except in obese patients (58.4% in 90mg vs 40% in 45mg, p = 0.038). Overall, there was a significant decrease in DAS28, SJC, TJC and PASI in the first month of treatment, with more pronounced improvement in skin (PASI and BSA) than in joints outcomes, where the curves reached a plateau at 6 months. There were no significant differences between joint and/or skin outcomes between 45 and 90 mg doses. Patients naive to biological therapy had an earlier skin improvement than patients with previous biological failure. Likewise, the improvement in joint outcomes was also faster in naive vs biological experienced patients (DAS28 and SJC 4m, p = 0.01 and 0.01, respectively). After an average of 19m of follow-up, 94 out of 152p (61.8%) continued with UST, 54.4% started at 45mg and 72.2% at 90mg (p = 0.04). 42p (28.2%) stopped UST due to joint inefficacy, 8p (5.4%) for skin inefficacy and 4 (2.7%) for adverse effect. Although survival was better in patients with fewer previous biological agents, no significant differences were achieved (p = 0.233 for naive and p = 0.072 for patients with 1 biological failure). Conclusion: This analysis demonstrates that UST, administered to PsA patients in a routine clinical care setting, is safe and effective in improving skin and joint outcomes. 61.2% of the patients continued with the treatment after an average of 19m of follow-up. Joint and skin outcomes reached significant differences from the first month. The efficacy seems faster in those patients with fewer lines of previous biological therapies. One third of the patients interrupted the therapy due to joint inefficacy. Acknowledgement: JANSSEN Disclosure of interests: Ana Belen azuaga-Pinango: None declared, Beatriz Frade-Sosa: None declared, ana Laiz Consultant for: Lilly, Novartis, abbVvie, MSD, UCB and Janssen, Speakers bureau: Lilly, Novartis, abvvie, MSD, UCB and Janssen, Paula Estrada: None declared, Luciano Polino: None declared, Emma Beltran: None declared, Agueda Prior-Espanol: None declared, Lourdes Mateo Soria: None declared, Carme Moragues Pastor : None declared, agusti Sellas-Fernandez: None declared, aNA URRUTICOECHEA-ARANA: None declared, Mireia Moreno : None declared, Javier Garcia Miguel: None declared, Jose L Tandaipan: None declared, Manel Pujol: None declared, Vicenc Torrente Segarra : None declared, inmaculada Ros Vilamajo : None declared, Sergi Ordonez : None declared, Delia Reina-Sanz: None declared, andrea Cuervo: None declared, Juan D. Canete: None declared, Julio Ramirez: None declared

Background:There are several studies assessing bone mass and osteoporosis (OP) development of patients with giant cell arteritis (GCA) during glucocorticoid treatment, however data at time of diagnosis is scarce.Objectives:To analyze bone metabolism, bone mineral density (BMD) and trabecular microarchitecture by measuring trabecular bone score (TBS) in patients with recent diagnosis of GCA.Methods:Retrospective observational study in which we included all patients with GCA and bone metabolism assessment at diagnosis. We recorded: risk factors for OP (previous fractures and anti-OP treatments), bone metabolism (calcium, phosphate, PTH, 25-vitaminD [25-OHD]) and the DXA results (Lunar, DPX) at the time of diagnosis and during the follow-up. The statistic analysis was made with SPSS.Results:36 patients (27 W: 9M) with a mean age of 76±9 years were included. The clinical characteristics of the GCA at diagnoses were: headache (81%), constitutional syndrome (58%), allodynia (42%), visual loss (42%, binocular in 2 patients), jaw claudication (39%), polymyalgic syndrome (28%), amaurosis fugax (25%) and lingular necrosis (n=1, 3%). Additional diagnosis tests included: temporal biopsy (86%, being pathologic in 55%), temporal ultrasound (97%, pathologic 34%), extra-cranial arteries ultrasound (81%, pathologic 7%) and PET/CT (19%, pathologic 86%). Up to 61% received three metilprednisolone bolus (mean dose 1700mg). 7 patients (19%) had previous OP and 3 had already suffered a fragility fracture (Colles, vertebral and femur). Only 4 patients were receiving anti-OP treatment (2 oral bisphosphonate, 2 zoledronate).At time of diagnosis of GCA, the mean of 25OHD was 17±13ng/mL (88%, Conclusion:Low bone mass and vitamin D insufficiency are frequent in patients with recent diagnoses of GCA and up to 38% have poor bone microarchitecture at baseline. Thus, it’s important to perform a bone mass assessment in all patients with recent diagnose of ACG and initiate therapeutic or preventive anti-OP treatment if required.Disclosure of Interests:None declared

Background:The incidence and factors related to an inadequate response to denosumab (Dmab) treatment remain unclear.Objectives:To describe clinical, analytical and densitometric characteristics of patients with inadequate response (IR) to Dmab in clinical practice. IR was defined as the presence of a new fracture [fxs-IR] or a significant decrease in BMD (≥5% lumbar or ≥4% femoral) [BMD-IR].Methods:retrospective study of patients with IR to Dmab treatment. Data of demographic variables, risk factors for osteoporosis, history of fractures, previous anti-osteoporotic treatment, densitometric and analytical parameters were collected before and after IR.Results:22 patients were included (19W:3M) with mean age of 75±10years. The causes of osteoporosis were: postmenopausal (50%), induced by glucocorticoids (22.7%), alcoholic (9.09%) and multifactorial (18.8%). Most patients were previously treated with bisphosphonates (59.09%, duration 5.2±2.6y) and had previous vertebral fractures (54.54% %, median 3).During Dmab treatment, 10 patients presented a BMD-IR (with a mean bone loss up to -3.5% at femur and -5.8% at lumbar spine) and 12 had fxs-IR (vertebral [n=8], humerus [n=1], pelvis [n=1], tibia [n=1]). No significant differences were observed in duration of Dmab between both IR groups (Fxs-IR: 3,2±1,9 vs BMD-IR: 2,4 ± 1,2y). In the BMD-IR, the BMD loss was higher at lumbar spine than at total hip (-6.6%±3.7 vs -1.9%±4.8). Only 1 patient of the fxs-IR had a secondary cause of IR (mieloma multiple).In the fxs-IR group, most patients started combined treatment with teriparatide (n=4), 1 changed to teriparatide and 7 remained with Dmab. In the BMD-IR group, most mantained Dmab treatment (n=8) and 2 switched to zoledronate.Conclusion:Most patients who developed IR to Dmab had been previously treated with bisphosphonates and had previous fragility fractures and appears within the first 3 years of treatment. BMD loss seems to be more marked at spine than total hip. Only one patient had a secundary cause of IR.Disclosure of Interests:None declared

Background:Tocilizumab (TCZ) is the only biological agent approved in Giant Cell Arteritis (GCA). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is scarce.Objectives:Our aim was to assess efficacy and safety of TCZ therapy optimization in an unselected wide series of GCA in clinical practice.Methods:Multicenter study, 134 patients with GCA who received TCZ due to inefficacy/adverse events of previous therapy. Once complete remission was reached and based on a shared decision between patient and physician TCZ was optimized in some cases. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively.Results:134 GCA patients treated with TCZ (101w/33m); mean age 73.0±8.8 years. TCZ was administered IV to 106 (79.1%) patients and SC to 28 (20.9%). TCZ was optimized in 43 (32.1%) patients. No demographic, clinical manifestations or laboratory data differences had been found at TCZ onset (TABLE). After a follow up of 12 [6-15.5] months, and a complete remission for 6 [3-12] months; the first TCZ optimization was performed. Median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. TCZ IV was optimized from 8 to 4 mg/kg/4weeks in 12 of 106 (11.3%) and from 162 mg/SC/week to 162 mg/SC/2weeks in 9 of 28 (32.1%) cases. Five (11.6%) of the 43 optimized cases relapsed. In 4 cases, the relapses were treated increasing TCZ up to the pre-optimization dose, in 1 case the route of administration was change (4 mg/kg/4week to 162 mg/SC/week). In 8 of 43 optimized patients (18.6%), it was possible to withdraw TCZ after complete remission for 30 [16.25-45.75] months. Regarding adverse events and severe infections were similar in both groups. The mean TCZ treatment costs were lower in the optimized group.Conclusion:Once remission is reached in GCA patients under TCZ treatment, optimization of TCZ may be performed. Based on our experience it could be performed by reducing the dose with IV TCZ or by prolonging dosing interval with SC TCZ.References:[1]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.TABLE.OPTIMIZED-TCZ GROUP (n=43)NON-OPTIMIZED TCZ GROUP (n=91)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURESAge, years, mean± SD68.9±8.771.4±8.50.125Sex, female/male n(%)32/1068/240.779Time from GCA diagnosis to TCZ onset (months), median [IQR]19.5[7.75-45]10.5[4 – 25]0.047SYSTEMIC MANIFESTATIONSFever, n(%)1(2.4)8(8.7)0.176Constitutional syndrome, n(%)11(26.2)19(20.7)0.476PMR, n(%)18(42.9)56(60.9)0.052ISCHEMIC MANIFESTATIONSVisual involvement, n(%)5(11.9)23(25)0.084Headache, n(%)26(61.9)42(45.7)0.081Jaw claudication, n(%)1(2.4)11(12)0.072CORTICOSTEROIDS AT TCZ ONSETPrednisone dose, mg/d mean (SD)15.1±11.125±17.40.001FOLLOW-UP ON TCZ THERAPY (MONTHS), MEDIAN [IQR]24[18-27]6 [3-18]0.000Relapses, n(%)5(11.6)5(5.5)0.207End follow-up remission, n(%)40(93)84(92)0.99Severe side efects, n(%)14(32.6)22(24.2)0.307Seriuos infections, n(%)6(14)10(11)0.878Cost, (mean) euros per yearIVSC7 538.47 329.011 726.411 726.4--Disclosure of Interests:Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

Background Cardiac block in neonatal lupus is associated with placental transfer of anti-Ro antibodies. The effect of these antibodies on cardiac conduction disorders in adult patients is controversial. The association between anti-Ro antibodies and heart rhythm disorders have been described in isolated cases. However, there are just a few studies that analyse the relationship between autoimmune diseases and electrocardiographic disturbances. Objectives To determine if there are differences in cardiac conduction of SLE patients in presence of anti-Ro antibodies. Methods All patients included fulfilled the SLE criteria, SLICC 2012 and they were followed up in a single centre. The inclusion was consecutive and voluntary. Patients who took drugs that altered the conduction (except antimalarial drugs), and those who had heart or thyroid disease were discarded. All patients were assessed blindly by a cardiologist who performed an interrogation and physical examination, an electrocardiogram, an echocardiogram and a 24 hour Holter study. Besides, a rheumatologist performed a clinical and analytical assessment including a qualitative analysis by immunoblotting of anti-Ro Ab and a quantification by chemiluminescence of the anti-Ro52 and Ro60 Ab. The presence of other SLE specific Ab (ANA, DNA, antiphospholipids), was also analysed. Clinical, analytical and, activity and damage indexes, were collected (SLEDAI and SLICC). The data were compared by Student’s t test, Fisher’s test and Chi square using 21 SPSS version. The level of significance was established at 5%. Results 145 patients were included: 91.7% women, average age 45±12, average disease duration 11 years. The patients were undergoing the following treatments: antimalarial 91%, mycophenolate 20%, azathioprine 12%, biological treatment 5% and glucocorticoids 70%. The clinical characteristics are summarised in table 1. There were no significant differences between the group of positive and negative anti-Ro Ab in terms of gender, age, clinical characteristics or cardiovascular risk factors. None of the patients was affected by an atrio-ventricular block and the rest of the electrocardiographic alterations had no clinical significance and did not predominate in the positive Ro Ab group. Additionally, no differences in heart rate, ventricular extrasystoles or PR, QT or QRS intervals were detected between both groups. The echocardiogram’s findings were not relevant and there were no differences between groups. Since the majority of patients with SLE are double positive, differences between the two subspecificities of Ro (52 and 60) could not be analysed. On the other hand, no differences were found in cardiac conduction regarding the treatments received, the activity or damage indexes, or the analytical or clinical characteristics of the patients. Conclusions The study results show that there are no differences in cardiac conduction according to the presence of anti-Ro antibodies in SLE patients. Thus, the cardiac screening in SLE patients with anti-Ro positive antibodies seems not helpful in clinical practice. Disclosure of Interest None declared

Background Pulmonary affection is a serious complication in Rheumatoid Arthritis (RA) with an important impact on mortality and morbidity. Objectives To describe the clinical and radiographic characteristics of patients with RA in our centre, and specifically from those with interstitial lung disease (ILD). Methods Retrospective analysis of patients with RA and pulmonary affection from a University Hospital with a referral area of 85.000 inhabitants. Clinical, laboratory, imaging and pulmonary function test (PFT) data was recorded. Results Data from 85 patients, 37 (43.5%) male and 48 (56.5%) female, were recorded. The mean time from RA diagnosis to pulmonary disease was 9.2 years, with mainly erosive (58.8%) and seropostive (84.7% were positive rheumatoid factor (RF) and 84.2% anti-citrullinated protein antibodies (ACPA)) disease. The 56.5% of the patients were smokers or ex-smokers. PFT results were documented in 75.3% of the patients: diffusing capacity for carbon monoxide (DCLO) baseline values were over 60% in a 38.8% of cases and forced vital capacity (FVC) baseline values were over 50% in a 69.4% of patients. The most frequent High Resolution CT scan pattern was the presence of bronchiectasis (64.7%), followed by ILD (31.8%) and, specifically, the Usual Interstitial Pneumonia pattern (UIP, 66.6%); lung infections (25.8%), rheumatoid lung nodules (22.4%), pleural effusion (15.3%), lung tumours (9.4%) and bronchiolitis (5.8%). The presence of extra articular manifestations as rheumatoid nodules (27%), epieschleritis (2.3%) and vasculitis (9.4%) was registered. The coexistence of Chronic Obstructive Pulmonary Disease (COPD) was recorded too (24.7%). Related to treatment, 84.7% of patients had received Methotrexate and in a 40% of cases, at least one biological disease-modifying antirheumatic drug had been administrated. Though the causes were not registered, a 25.9% of deaths were documented. In parallel we did a subanalysis of ILD related to RA cases, summarised in table 1 (n=27): Conclusions Bronchiectasis is the most common pulmonary manifestation of RA patients in our area. The most frequent clinical profile is a non-smoker woman with seropositive disease. ILD affects approximately one third of RA patients in our area and is an underdiagnosed entity. We consider that it is necessary to establish a screening program to diagnose and treat it early. Disclosure of Interest None declared

Background Septic arthritis (SA) is a rheumatologic emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality. Accurate diagnosis can be particularly challenging in patients with underlying inflammatory joint disease. Crystal-induced arthritis (CA) is a risk factor for its appearance. When both conditions appear simultaneously, CA may mask diagnosis of infection and delay the antibiotic treatment. Objectives To describe the characteristics of patients with concurrent septic and CA. Methods Retrospective analysis of patients with coexistence of septic and CA attended between 1985 and 2015 in a university hospital with a reference area of 850,000 inhabitants. We collect demographic, clinical, laboratory and imaging data as well as patient medical treatment, complications and evolution records. All patients had positive bacterial culture (blood and/or joint fluid) and crystals in synovial fluid. Results A total of 123 patients with SA were identified. 20.3% (n=25) of them had concomitant CA, with mean age of 67 years (SD 14), 17 (68%) males and 8 (32%) females. Risk factors were: diabetes (24%), diuretic drugs (24%), chronic renal failure (16%) -2 of them undergoing hemodialysis and 4 kidney transplant patients with immunosuppressive treatment. In only 2 cases there was a previous arthrocentesis. The mean diagnostic delay was 14 days (SD 13) (data available in 14 cases). The most commonly affected joint was the knee (48%), followed by the foot (20%) and the hip (12%). In 2 cases several joints were involved at the same time. In synovial fluid cytological studies, the most frequently identified crystals were: urate (60%), calcium pyrophosphate (20%) and hydroxyapatite (8%). In 32% of cases gram staining was positive, but 88% of patients had a positive joint fluid culture, with the most frequently isolated germs being methicillin-sensitive S. aureus (48%), methicillin-resistant S. aureus (MRSA) (12%) and M. tuberculosis (12%). 32% of patients presented positive blood cultures (12% with negative synovial fluid culture), although 48% of patients had fever at the time of diagnosis. It should be noted that 48% had radiological baseline damage. Surgical debridement was performed in 32% of patients. Evolution was successful in 56% of patients; although intercurrent complications were usual (40%). Mortality was 8% -one case due to acute pulmonary edema and the other because of septic shock. Conclusions Coexistence of infectious and CA represents a diagnostic challenge and requires a high suspicion index. It usually appears in elderly patients with comorbidities. Gout was the most prevalent CA. S. aureus was the most commonly causative pathogen, with a high rate of MRSA infection. If it9s treated early the evolution is usually favorable, which makes synovial fluid microbiological study imperative. Disclosure of Interest None declared

Background Systemic vasculitis (SV) comprises a group of diseases characterized by inflammation of vessels in various organs. Histopathological confirmation is required for the diagnosis. The biopsy of an involved organ is invasive and carries the risk of complications. By contrast, gastrocnemius muscle biopsy is simple and minimally invasive technique that may be performed by a rheumatologist. Objectives To evaluate the diagnostic use of muscle biopsies for the diagnosis of SV. Methods Retrospective study 1984 - 2015. Center: tertiary academic hospital, referral area 850.000 inhabitants. We analyzed the database of all muscular biopsies performed at our hospital. We selected patients undergoing a muscular biopsy for possible diagnosis of SV and we analyzed the clinical, laboratory, neurophysiological and pathologic data. Biopsies were classified as positive (presence of necrotizing vasculitis or non necrotizing vasculitis seen by optical microscopy) or negative for vasculitis. Muscular biopsy was performed in all cases at the medial gastrocnemius muscle (“open” and unilateral) by a rheumatologist. The diagnosis of SV was based on clinical, serological and histological data. Results A total of 619 muscular biopsies were performed, 55 were indicated with suspicion of SV, 52.7% female, 47.3% male, median age 64.4 years (DS 15.22); 47 (85.4%) were positive (sensitivity of 85%) and 8 (14.6%) were negative. The positive biopsy group showed more electromiographic alterations (p=0.01) than negative group. Furthermore, the positive biopsy group showed more frequently systemic manifestations such as: weight loss, myalgia, paresthesias, purpura and testicular pain but these differences were not statistically significant. No complications were encountered in the procedure. Conclusions Our results suggest that muscle biopsy is a simple, clinically useful, safe and minimally invasive procedure for the diagnosis of SV with high sensitivity. No significant differences were observed in clinical or analytical features between patients with positive or negative biopsy, except in electromyography patients with positive biopsy had more a frequent pathological pattern. Disclosure of Interest None declared

Background Tocilizumab (TCZ) is a humanized anti-IL-6 receptor-blocking monoclonal antibody used for the treatment of rheumatoid arthritis (RA), idiopathic juvenile arthritis (IJA) and off-label in Adult Onset Still Disease (AOSD). The development of anti-TCZ antibodies could reduce treatment efficacy or induce treatment failure. Objectives To analyse TCZ serum levels and antidrug antibodies (ADA) in a cohort of RA, IJA and AOSD patients treated with TCZ, and to evaluate its relationship with Disease Activity Score using a 28-joint count (DAS28), C-reactive protein (CRP) levels and the presence of combined treatment with glucocorticoids or DMARDs. Methods Cross-section study including all patients undergoing chronic treatment with TCZ in a tertiary academic hospital. Referral area: 850,000 inhabitants. Twenty-two patients were included. TCZ serum and ADA levels were measured by ELISA (Theradiag) at baseline (before infusion), 15 days and 30 days after infusion. Results Twenty-two patients were studied: 18 RA, 3 IJA and 1 AOSD, 81.8% female; mean age and mean disease duration: 54.2 (±13) and 15.5 (±12) years respectively; 73% of the RA patients were positive for anti-CCP and 70% for rheumatoid factor, mean DAS28-CRP at day 0 and 30: 2.9 and 2.6 respectively. Fifteen patients were treated with TCZ for more than 1 year (range 12-58 months), 19 were treated with TCZ at 8 mg/kg, 2 at 6mg/kg, and one at 5mg/kg every 4 weeks due to low disease activity. Thirteen patients received TCZ in monotherapy, 9 received DMARDs combined treatment, 10 with glucocorticoids (mean dose 4mg/day, range 2-10mg). TCZ serum levels were at baseline: 1.2- 61.7 μg/ml, 15 days: Conclusions Levels of TZC were heterogeneous. Our patients showed no presence of ADA, this data suggest that TCZ has a low immunogenic potential. No correlation was found in disease activity and TCZ serum levels, but we found a relation with CRP levels. Patients with DAMRDs or without glucocorticoids showed higher levels of TCZ. We did not find correlation between combined treatment with DMARDs or glucocorticoids and levels of TCZ. Our study was limited due to a low sample size; we cannot exclude the correlation between TCZ and DAS28-CRP in a higher sample of patients. References Dougados M, Kissel K, Conaghan PG et al. Clinical, radiographic and immunogenic effects after 1 year of tocilizumab-based treatment strategies in rheumatoid arthritis: the ACT-RAY study. Ann Rheum Dis. 2014;73(5):803-9 Van Herwaarden N, Herfkens-Hol S, van der Maas A, et al. Dose reduction of tocilizumab in rheumatoid arthritis patients with low disease activity. Clin Exp Rheumatol. 2014;32(3):390-4 Disclosure of Interest None declared