Search

Background: No fully validated index is available for assessing overall disease activity in systemic sclerosis (SSc). Objectives: To estimate the effect of disease activity as measured by different disease activity indices on the risk of subsequent organ damage. Methods: The European Systemic sclerosis study group activity index (EScSG AI), the European Scleroderma Trials and Research Group Activity Index (r-EUSTAR AI), 12 point activity index proposed by Minier (12point AI) were calculated for 91 patients; the CRISS (The Composite Response Index for Systemic Sclerosis) for patients included after 2016. Data were analysed by parametric and non-parametric tests and logistic regression. Results: EscSG AI, r-EUSTAR AI and 12point AI correlated with lung involvement. EScSG AI and r-EUSTAR AI correlated with diffuse skin involvement. EscSG AI correlated with digital ulcers and diffuse cutaneous involvement and r-EUSTAR AI with a renal crisis. Bivariate analysis showed an inverse correlation between the three disease activity scores and forced vital capacity (FVC) (p Conclusion: Our study could not establish a gold standard to assess disease activity in SSc; especially EscSG AI and r-EUSTAR AI could quantify and predict major organ involvement in daily practice. CRISS can be useful as an outcome measure for patients with short disease duration included in clinical studies.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which deposit within tissues and fix complement leading to systemic inflammation (1). Is a heterogeneous disease with a continuum of disease activity. Some patients can have predominant skin and joint involvement, whereas others can present with organ-threatening diseases such as nephritis, cardiac involvement or even neurologic manifestations. Relatives of patients with SLE appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable (2,3).

Autoimmune rheumatic disorders have a multifactorial determinism, caused by various environmental factors acting on the individual’s genetic susceptibility, destabilizing the systems which regulate the immune response. Epidemiological and genetic investigations are very important to demonstrate the contribution of genetic factors to the development of these autoimmune diseases. The contribution of genetic factors in causing autoimmune diseases has been demonstrated by familial aggregation. Moreover, it was also quantified by determining heritability, expressing the proportion of genetic factors in the etiology. It is now clear that common genes underlie multiple autoimmune disorders.

Introduction. Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) represent a group of conditions evolving with necrotizing inflammation in small and medium-sized blood vessels. AAV are composed of GPA (granulomatosis with polyangiitis, former Wegener’s granulomatosis), MPA (microscopic polyangiitis) and EGPA (eosinophilic granulomatosis with polyangiitis, former Churg-Strauss syndrome). AAV receive immunosuppressive therapy associated with a high risk of complications. Objective. The aim of this study was to characterize a single center cohort of AAV patients regarding clinical, biological and therapeutic features. Method. We realized a cross-sectional study by consequently enrolling all the patients registered with AAV diagnosis between 2009 and 2017 in Department of Rheumatology of “Sfânta Maria” Hospital. Demographic, diseaserelated and therapeutic-related parameters were collected. The data was extracted from the clinical files. Results. The study sample included 26 cases, 15 females and 11 males: 20 patients GPA, 4 MPA and 2 cases EGPA. Mean age at the time of diagnosis was around 48 but 12 patients presented delays between age at the onset and age at the time of diagnosis (the mean delay was 2 years). The most frequent clinical manifestation identified where pulmonary, musculoskeletal and renal. 15 patients had a diagnostic biopsy performed. ANCA detection revealed 16 cases of c-ANCA and 7 cases of p-ANCA and 11 patients presented other positive serology. A combination of glucocorticoids and cyclophosphamide was used in most of the cases for remission-induction treatment and the same scheme was used for relapse cases. For maintenance phase a combination of glucocorticoids and azathioprine was preferred. 13 patients (50%) developed treatment related complications. Conclusion. Most of the patients were diagnosed with GPA (20) and the least were diagnosed with EGPA (2). Biopsy was performed in 15 cases and it was mostly nasal. For remission-induction prevailed the combination of glucocorticoids and cyclophosphamide. Most treatment related complications were due to glucocorticoids administration. Osteoporosis was predominant.

Lupus nephritis is one of the most important organ involvement in patients diagnosed with Systemic Lupus Erythematosus (SLE). It requires aggressive and prolonged immunosuppression in order to induce and maintain remission. There is always a risk of adverse events. It is presented the case of a young woman diagnosed with SLE and active lupus nephritis with acute renal failure, who developed persistent hyponatremia after immunosuppression with Cyclophosphamide was started. The case emphases both the need for synthetic immunosuppression as well as the adverse events that may occur during treatment. Close monitoring of the clinical and biological parameters during immunosuppressive therapy is essential as even one minimally modified parameter may prove important in the evolution of the case. Measures to prevent one side effect do not prevent the developing of other.

We hypothesized that clinical outcomes might be influenced by personality type (A, B, C, D) in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). One hundred ninety-four patients (104 with RA, 90 with AS) participated in a questionnaire study. We evaluated health-related quality of life (HRQoL) using the Medical Outcome Study Short-Form 36 (SF-36), personality type A/B with the Jenkins Activity Survey, type C with the State-Trait Anger Expression Inventory Anger-in Scale, type D with the Type D Personality Scale, and disease activity with Disease Activity Score with 28 joints for RA and Bath Ankylosing Spondylitis Disease Activity Index for AS. We used Pearson's correlation coefficient, independent samples t tests, and multivariate analyses of variance. In the RA group, type D personality was significantly correlated with 7/12 SF-36 components. AS patients with type D personality had deficits in all SF-36 subscales. Type D was related with higher disease activity in RA and AS. Both RA and AS type C patients had more active disease forms and negatively affected HRQoL subscales. In the RA group, type A personality did not correlate with HRQoL, but it positively influenced pain visual analog scale scores. In AS patients, type A personality was linked with higher HRQoL and with less active disease. Type C and type D personality types were correlated with decreased HRQoL and higher disease activity in RA and AS patients. Type A personality was associated with less active disease and higher HRQoL in AS patients and with less pain in RA patients.

Background Currently there is no fully validated index for assessing overall disease activity in patients with systemic sclerosis (SSc). Objectives To estimate the effect of disease activity as measured by 4 disease activity indices on the risk of subsequent organ damage in a EUSTAR center cohort. Methods Longitudinal observational study; European Systemic sclerosis study group disease activity index (EScSG DAI), revised EUSTAR disease activity index (r-EUSTAR DAI), 12 point activity index proposed by Minier (12point DAI) were calculated for all patients; the CRISS (The Combined Response Index for Systemic Sclerosis) only for patients included after 2016. Student t-test/Mann-Whitney test, chi-square test were used to evaluate differences across subgroups; Pearson’s bivariate correlation/Spearman’s rank correlation coefficient to evaluate the association between variables. The predictive value of various variables for major organ involvement was assessed by Roc curves and univariate regression. Results 91 patients were selected,77 females (84,61%), 51,65(13,20) years old at diagnosis, 49,45% diffuse subset. Disease activity scores were all higher in male patients and in patients with diffuse cutaneous involvement, digital ulcers(DU), lung fibrosis, scleroderma renal crisis (SRC), arrythmias, muscle atrophy, gastric involvement, antitopoisomerase-1 positive, EscSG DAI correlated with forced vital capacity (FVC)(r=0.73,p R- EUSTAR DAI correlated with FVC(r=0.6,p 12 point DAI correlated with FVC(r=0.57,p EscSG predicted well lung fibrosis (AUC=0.79,p 12point DAI was a good predictor for lung fibrosis(AUC=0.74,p In the regression analysis, lung fibrosis(beta=0.5,95%CI=1,21-2,58,p The CRISS cohort included 35 patients, 32 females(91,42%), 48.48(14.24) years old, 62.85% diffuse subset, medium disease duration 11.88(7.9) months. 8 patients were excluded due to new onset or worsening of lung fibrosis or SRC. None of the patients had a CRISS score with a probability of improvement>0.6. Conclusion We could not conclude that there is a gold standard to measure disease activity; for daily practice especially EscSG and r-EUSTAR DAI quantify and predict major organ involvement. CRISS can be useful as an outcome measure for patients with short disease duration and closely monitored in clinical studies. References [1] K. Melsens, et al. Disease activity indices in systemic sclerosis: a systematic literature review Clin Exp Rheumatol2016; 34 (Suppl. 100):S186-S192. Disclosure of Interests Laura Groseanu: None declared, Sorana Petrescu: None declared, Andra Balanescu Speakers bureau: multiple, Daniela Opris-Belinski Grant/research support from: GLORIA, Speakers bureau: multiple, Violeta Bojinca Speakers bureau: multiple, Florian Berghea: None declared, Ioana Saulescu: None declared, Sanziana Daia-Iliescu: None declared, Diana Mazilu Speakers bureau: Pfizer, UCB, Andreea Borangiu: None declared, Cosmin Constantinescu: None declared, Maria Magdalena Negru: None declared, Mihai Abobului: None declared, Violeta Vlad: None declared, Ruxandra Ionescu: None declared

Background: The usefulness of capillaroscopy in the follow-up of scleroderma (SSc) patients and the possible prognostic role for the appearance of visceral involvement is suggested by many authors but still under debate. Objectives: The aim of this study was to assess the role of monitoring capillaroscopic abnormalities (qualitative and semiquantitative) in relation with parameters of interstitial lung involvement and pulmonary arterial hypertension(PAH). Methods: Longitudinal prospective study, 118 SSc patients, follow-up 2000-2017 based on MEDS evaluation sheets. Student t-test/Mann-Whitney test, chi-square test were used to evaluate differences across subgroups. Pearson’s bivariate correlation/Spearman’s rank correlation coefficient were used to evaluate the association between variables. Nailfold videocapillaroscopy (NVC) was performed by a trained physician: qualitative (scleroderma pattern) and semiquantitative scoring (microangiopathy evolution score-MES) were evaluated. Results: 118 patients were included, 103 females (87,29%), 50,58(12,71) years old at diagnosis, 53.39% diffuse subset, mean disease duration 2,81(4.3) years, mean follow-up duration 4.42(3.16)years. At baseline 43.22% of the patients had lung fibrosis,18.64% had PAH, 9,32% had both. At first capillaroscopic evaluation: 12.7% had early, 46.61% active and 37.29% late pattern, medium MES was 4,76(1.43). Baseline active and late capillaroscopic pattern were correlated with lung fibrosis (χ2=9.62, p=0.047) and PAH (χ2=15,36, p=0.004). A strong correlation was identified between initial MES and FVC (r=-.47, p=0.002), FEV(r=-.45, p=0.003), DLCO (r=-.51, p At the 2nd evaluation 5.93% of the patients had early, 0.85% active and 54,24% late scleroderma pattern, mean MES was 5.88(1.74). 19.49% had one step progression of capillaroscopic pattern, 1.69% had 2 steps progression. Lung involvement worsening was defined as decrease of FVC >15%, DLCO>10%, new diagnosis of alveolitis on high resolution computerized tomography or new diagnosis of PAH. Active and late capillaroscopic pattern were correlated with diagnosis of lung fibrosis (χ2=14, p=0.007) and pulmonary hypertension at follow-up examinations (χ2=14,2, p=0.007). Progression of capillaroscopic pattern at follow-up evaluations was not correlated with significant worsening of lung volumes, DLCO, sPAP. Instead, progression of MES (>1) was asociated with worsening of FVC (r=0.32,p Conclusion: Active and late capillaroscopic pattern are associated with increased frequency of interstitial lung disease and pulmonary hypertension in SSc patients. Semiquantitative scoring (microangiopathy evolution score), rather then qualitative capillaroscopic assessment can have a predictive role for new involvement or worsening of previous lung involvement (especially interstitial lung disease) in scleroderma patients, confirming the putative role of capillaroscopy as biomarker in SSc. References [1] Sulli a How to Score the Qualitative Capillaroscopic Patterns in Systemic Sclerosis annals of the Rheumatic Diseases 2013;72:A11 Disclosure of interests: Laura Groseanu: None declared, Patricia Paraschiva: None declared, andra Balanescu Speakers bureau: multiple, Violeta Bojinca Speakers bureau: multiple, Daniela Opris-Belinski Grant/research support from: GLORIA, Speakers bureau: multiple, Florian Berghea: None declared, Diana Mazilu Speakers bureau: Pfizer, UCB, Sanziana Daia-Iliescu: None declared, Ioana Saulescu: None declared, andreea Borangiu: None declared, CLAUDIA COBILINSCHI: None declared, Maria Magdalena Negru: None declared, cosmin-laurentiu constantinescu: None declared, Violeta Vlad: None declared, Mihai abobului: None declared, Ruxandra Ionescu: None declared

Background:The term elderly onset of rheumatoid arthritis (EORA) refers to patients with rheumatoid arthritis (RA) onset after the age of 60. Data published in the literature suggest a special clinical pattern and different prognostic factors in this class of patients.Objectives:To analyze prospectively a cohort of patients diagnosed with EORA, their disease particularities, comorbidities and treatment.Methods:This cohort included consecutive EORA patients, diagnosed and treated in “Sfanta Maria” Clinical Hospital, Bucharest, Romania. The study was conducted for 2 years. Demographic, clinical and laboratory data was obtained. Disease activity was assessed using Disease Activity Score of 28 joints with erythrocyte sedimentation rate (DAS28-ESR). The patients were monitored using disease activity, treatment schedule modifications and possible adverse reactions.Results:The cohort included 110 patients (88 females, 22 males). Their mean age at the beginning of disease manifestations was 70.14 years and the mean age at the diagnosis was 70.85 years. There was no statistical difference regarding the patient’s residential area (urban/rural) and the period between the appearance of clinical signs and the moment of diagnosis confirmation. A great proportion of patients (77 patients, 70%) had seropositive RA, ACPA being found in 84% of the patients with seropositive RA. The mean DAS28-ESR at the diagnosis was 4.44(±1.54). A proportion of 40% of the patients had moderate disease activity, 35 patients (32.73%) - high disease activity, 11 patients (10%) - low disease activity and unexpectedly there were 19 patients (17.27%) in remission at the moment of RA diagnosis. Joint distribution was analyzed: 61.82% patients had large joint involvement, 91.82% - small joint involvement and 53.64 % had mixed joint pattern involvement. A negative significant correlation was found between the small joint involvement pattern and the body mass index (BMI) (p=0.028, R=-0.21). The mean BMI at the diagnosis was 25.81±5.358. Ninety five patients (86,36%) had at least one cardiovascular comorbidity. Hypertension was found in 70% of the patients. Only 4.55% of the patients had rheumatoid nodules and a similar proportion (4.55) had Sjogren syndrome associated. Pulmonary fibrosis was found in only 2 patients. At the moment of diagnosis 50% of patients had anemia, 36.36% had osteoporosis, 25.46% of the patients - hepatic disease, 11.82% - chronic kidney failure and 6.36% were found with a neoplasia. The main conventional synthetic disease modifying drug (csDMARD) that was recommended was methotrexate (81.8%). The second most used csDMARD was hydroxichroloquine (42 patients, 38,18%). The proportion of patients with monotherapy (50%) was similar to that with csDMARD combination (49.09%). During the follow up period only 8 patients (7.27%) had biologic therapy (4 patients - an anti TNF drug). Non steroid anti-inflammatory drugs were used in 46.63%. Cortisone therapy was used for more than 3 months in 80% of the patients. In patients with biologic therapy chronic glucocorticoids were stopped. At least one infection was documented in 20.91% of patients: 2 patients out of 6 patients (33.33%) with biologic DMARD, 14.81% of the patients with csDMARD combination and 21.81% of the patients with csDMARD monotherapy. csDMARD therapy was well tolerated with only 23.63% adverse reactions.Conclusion:Compared to the data published in the literature, in our cohort the rate female:male was higher (4:1). A distinct feature was the high proportion of patients with seropositive RA. The joint pattern seems to be influenced by BMI: small joint pattern is less found in patients with higher BMI. As expected, the patients with EORA had multiple cardiovascular comorbidities. Arterial hypertension was the most frequent. Caution is needed in choosing treatment regarding comorbidities and the risk of infection in these patients.References:[1]Villa-Blanco JI, Calvo-Alén J. Elderly onset rheumatoid arthritis: differential diagnosis and choice of first-line and subsequent therapy. Drugs Aging. 2009;26(9):739-50.Disclosure of Interests:None declared

Background:The spondyloarthritis (SpA) family includes a heterogeneous spectre of inflammatory diseases with several common features, such as the axial and peripheral joint involvement, but also trigger factors, as for instance, mechanical stress, infectious diseases or gut dysbiosis.[1,2]Entheseal inflammation is the common background in the pathogenesis of SpA, leading to osteitis, periostitis and osteoproliferation. Despite being a central feature in SpA, enthesitis remains underdiagnosed in everyday practice.[3,4]Objectives:The primary objective is to assess the frequency of ultrasound versus clinically detected enthesitis in a sample of Romanian patients with highly active SpA. A secondary objective is to determine the existence of an enthesitis pattern according to the dominant side in this sample of patients.Methods:Out of 140 SpA patients, 106 were diagnosed with axial/peripheral SpA and 34 with psoriatic arthritis (PsA), and were clinically (medical history, clinical examination) evaluated, scanned using MSUS during the same visit, then asked which was their dominant side, in order to avoid any biases. The evaluation targeted 16 entheseal sites (Achilles tendon, plantar fascia, quadriceps tendon, proximal and distal patellar tendon, triceps tendon, extensor and flexor tendons of the hand, all evaluated on both sides), reaching a total of 2240 entheses. The medical history form included questions related to present or past spontaneous pain in any of the 16 evaluated sites as well as the clinical examination that evaluated the entheseal pain upon pressure (digital pressure on the enthesis overlying skin).The MSUS evaluations were conducted using Esaote My Lab machines with 6-12/8-18 MHz linear probes. The same clinician/ultrasonographer performed all evaluations, in order to avoid interobserver variability.Results:In the studied sample of patients, 68.6% were men, had a mean age of 43,46 (+/- 11,77), 51.4% were diagnosed with peripheral SpA, with a mean disease duration of 61,60 (+/- 71,03) months, and entheseal abnormalities were found in up to 62.7% of the asymptomatic entheses, lacking both spontaneous and elicited pressure pain.The best performance of clinical and ultrasound examination was observed in the evaluation of the flexor tendons of the hand, with strong agreement between the two methods (kappa = 0,718, p = 0.001). Conversely, the lowest performance of clinical and ultrasound examination was noticed in Achilles (kappa = 0,292, p = 0.001) and distal patellar tendons (kappa = 0,202, p = 0.001), with low agreement indices.Both GS and PD abnormalities were more frequently detected on the right side, in a sample of 98.57% right handed patients. The differences were higher regarding the insertions of the triceps tendon (2.2%) and the plantar fascia (2.1%), in favour of the dominant side.Conclusion:Entheseal reported pain (spontaneous and elicited by pressure) correlates poorly with MSUS detected enthesitis. This study highlights the high rates of imaging detected, but clinically overlooked entheseal abnormalities in SpA patients.Enthesitis was more frequently detected on the dominant side, emphasizing the role of mechanical stress in the pathogenesis of this feature. This outcome also requires the selection of the most reliable entheseal sites for SpA, being a future direction of research for this ongoing study.References:[1]Barnett R, Ingram T, Sengupta R. Axial spondyloarthritis 10 years on: still looking for the lost tribe. Rheumatology (Oxford). 2020; 59(4): iv25-iv37[2]Kehl AS, Corr M, Weisman MH, et al. Enthesitis - New Insights Into Pathogenesis, Diagnostic Modalities, and Treatment. Arthritis Rheumatol. 2016; 68(2): 312–322[3]Ruta S, Gutierrez M, Pena C, et al. Prevalence of subclinical enthesopathy in patients with spondyloarthropathy: an ultrasound study. J Clin Rheumatol. 2011; 17: 18–22[4]Yi E, Ahuja A, Rajput T, et al. Clinical, economic, and humanistic burden associated with delayed diagnosis of axial spondyloarthritis: a systematic review. Rheumatol Ther. 2020; 7: 65–87Disclosure of Interests:None declared.

Background:Sexual health is an essential element of overall health and well-being. Rheumatic diseases may affect sexual functioning in many ways related to pain, fatigue, stiffness, functional impairment, depression, anxiety, negative body image, reduced libido, hormonal imbalance and drug treatment. However, these issues are rarely addressed in clinical practice.Objectives:The aim of this study was to evaluate sexual function in a cohort of men with rheumatic disease compared to healthy controls.Methods:This was an observational, single-center, cohort study conducted between august 2019 and march 2020 in the Rheumatology department of “Saint Mary” Clinical Hospital in Bucharest which included 120 men with ages between 18 and 60 years - 60 patients with rheumatic diseases and 60 healthy controls. The study tools were the Sexual Health Inventory for Men (SHIM) questionnaire and one questionnaire referring to personal data, history of the rheumatic disease, comorbidities, treatment and sexual impairment. Also, the disease activity was assessed using specific scores for each condition.Results:In this cohort of 60 patients, the mean age was 45.26 (7.8) years and the diagnoses wereankylosing spondylitis (AS) - 37%,psoriatic arthritis (PsA) - 18%, rheumatoid arthritis (RA) - 17%, systemic sclerosis (SS) - 15% and gout - 13%. More than half of the patients (62%) had active disease based on specific scores (ASDAS for AS, DAS28-CRP for RA, EScSG disease activity indices for SS, DAPSA for PsA). Regarding sexual life, this study showed a significant decrease in sexual life quality after rheumatic disease diagnosis(before diagnosis: 71,67% - satisfying and 16,67% - not satisfyingversus after diagnosis: 21,67% - satisfying and 68,33% - not satisfying). Most patients (90%) reported impairment of their sexual life after diagnosis. In terms of sexual dysfunction (SD), a significantly higher proportion of patients (40%) mentioned reduced libido compared to the control group (18,33%) (p=0.043). Also, 21,66% of the patients reported erectile dysfunction (ED) in comparison with only 8,33% in the control group (p=0.009). Most patients with AS, RA, PsA and gout had mild ED while most patients with SS presented with mild to moderate ED. Also, the SHIM score mean value was significantly lower in the study group (17,65)compared to the control group (20,15) (p=0.009). The importance of SD in this cohort is emphasized by the fact that only one patient conceived after rheumatic disease diagnosis. Concerning treatment, more than half of the patients (55%) reported no effect of the therapy on their sexual life while 38.33% mentioned that medication improved their sexual life and very few (7%) reported a worsening.Conclusion:This study revealed a higher prevalence of sexual dysfunction in male patients with rheumatic disease in comparison with healthy controls. Considering the importance of sexual and reproductive health, rheumatologists should approach this topic with their patients and offer them guidance.References:[1]AG Tristano, “The impact of rheumatic diseases on sexual function”, Rheumatol Int 2009 Jun;29(8):853-60Disclosure of Interests:None declared

Background:Two pivotal studies, RAPIDS-1 and RAPIDS-2 revealed that bosentan reduces the development of new digital ulcers (DUs) in patients with systemic sclerosis (SSc). However data regarding the long-term use of this dual endothelin antagonist receptor in the treatment of DUs is scarce.Objectives:The aim of the present study was to evaluate long term efficacy and safety profile of bosentan in patients with DUs related to SSc.Methods:A prospective observational case-control study, conducted between 2014 and 2020 enrolled 65 SSc patients with ≥1 active DUs at baseline, who received bosentan therapy. Demographic and clinical features, including DUs incidence and patients subjective perception of DU pain and/or Raynaud’s Phenomenon, were collected. Nailfold videocapillaroscopy was performed in all patients.Results:The study included 51 females and 14 males, with a mean age of 52.6 years, 30 with diffuse subset, most of them with late scleroderma pattern (46/65). Number of DUs at baseline was 4.55 (±2.8), median duration of treatment was 25.95 (±19.4) months. Microangiopathy evolution score (MES) was 5.1 (2.19), visual analog scale (VAS) for DU was 77.9, VAS for Raynaud was 73.4.Patients receiving bosentan had clinically significant reduction in the mean number of DU (pThere was a clear trend towards an improvement in MES score, between baseline and the next follow-up assessments (p=0.003). The difference was statistically significant when compared to control group, but only for the first 18 months of treatment (p14 patients (28.75%) discontinued bosentan therapy for administrative reasons. The median time among patients who interrupted the treatment was 6.9 months. An accelerated development of new DU was described 6 months after (p=0.02). Following recommencement of bosentan, the mean number of DU has rapidly decreased (p=0.008). There was no significant difference between patients who temporarily discontinued bosentan for 6 or 12 months.Bosentan was stopped due to lack of efficacy in 2 cases and due to side effects in 7 cases: 4 elevated liver enzymes, 1 severe trombocytopenia, 1 dyspneea agravation and low blood pressure.Conclusion:The present data suggest that treatment with endothelin receptor antagonist bosentan was associated with a significant reduction in the mean number of DU in patients with SSc. The beneficial effect of bosentan persisted throughout the study but was most evident in the first 6 months of treatment. Statistical analysis showed a significant improvement of the microangiopathy evolution score from baseline to end of therapy. 14 patients had a high relapse rate due to potential rebound effect, 6 months after bosentan withdrawal.The drug was reintroduced succesfully for 10 (70%) patients with a significant decrease in the number of DU.References:[1]UK Scleroderma Study Group: digital vasculopathy in systemic sclerosis, Rheumatology, Volume 54, Issue 11, November 2015, Pages 2015[2]Groseanu L, Berghea F, Bojinca V, et al AB0779 Long term follow-up of a systemic sclerosis group treated with bosentan, Annals of the Rheumatic Diseases 2018;77:1523-1524.Disclosure of Interests:None declared

Background:Systemic sclerosis is associated with increased risk of cardiovascular disease (CVD) (1) and studies using MRI suggest that microvascular disease has an important role (2). Capillaroscopy is a non invasive and safe technique that assesses peripheral microvascular damage (3).Objectives:The objective of this study was to evaluate the predictive value of the capillaroscopy in relation to major adverse cardiovascular events (MACE).Methods:Retrospective study with three timepoints (at baseline, at 5 and 10 years) including patients with scleroderma from EUSTAR center 096. Data were collected from the registry and observation papers. We performed capillaroscopy to all patients at the time of inclusion in the EUSTAR registry (2004) and at baseline (2009). Also, CV risk scores were calculated at baseline and were reassessed at 5 and at 10 years using the SCORE calculator. Risk score was considered low if was between 0 and 2, moderate 3-9 and high >10. The relation between capillaroscopy and MACE was tested in using bivariate regression.Results:Of 22 patients, mean (standard deviation (SD)) age was 43.1 (11.5), all patients were females, mean (SD) disease duration was 5.4 (4.5). During the 10 years of follow up, 5 (22.7) patients had been lost of follow up and 8 (36.4) patients had died. Only 9 (40.9) patients completed the 10 year follow up.At the time of inclusion in the EUSTAR, one patient showed early scleroderma pattern at capilaroscopy, 15 had active pattern and 6 patients had late pattern. Capillaroscopic scoring showed 2 (9.1) patients with disarranged (50%) aspect, 4 (18.2) patients with local paucity, 10 (45.5) patients with enlarged loop bordering local paucity and 1 patient (4.5) with complete paucity.Capilaroscopy at baseline showed active pattern in 4 patients and late pattern in 18 patients. Thus, 13 (59.1) of patients had a progression of the disease at capilaroscopy before follow up.At baseline, 14 (63.6) patients had traditional CV risk factors. Cardiovascular risk scores found 21 (95.5) patients with a low risk score and 1 (4.5) patient with a moderate risk score. At 5 years 11 (0.5) patients had a low risk score and 1 (4.5) patient had moderate risk score and at 10 years, 5 (22.7) and 2 (9) patients had low and moderate risk scores, respectively. We found 6.2 MACE/100 patient-year and 5.5 deaths/100 patient-year.Capillaroscopy (p=0.684), disease progression on capillaroscopy (p=0.781), capillaroscopic scoring (p=0.92) and CV risk score (p=0.98) were not predictive factors of MACE.Conclusion:Patients with systemic sclerosis are at high risk of MACE and traditional CV risk scores underestimate this risk. Changes/progression on capilaroscopy is not predictive for MACE. However, this hypothesis needs to be tested on a bigger cohort.References:[1]Xintao Cen, SIning Feng, Shanshan Wei, Lu Wan, Ledong Sun, Systemic sclerosis and risk of cardiovascular disease: A PRISMA – compliant systemic review and meta-analysis of cohort studies, Medicine (Baltimore), 2020, 99(47)[2]N Galea, E Rosato, A Gigante, C Borrazzo, A Fiorelli et al, Early myocardial damage and microvascular dysfunction in asymptomativ patients with systemic sclerosis: A cardiovascular magnetic resonance study with cold pressor test, PLoS One 2020, 15 (12)[3]F Ingegnoli, R Gualtierotti, A systematic overview on the use and relevance of capillaroscopy in systemic sclerosis, Expert Rev CLin Ummunol, 2013, 9(11):1091-7Disclosure of Interests:None declared

Background:Certainly, the year 2020 changed the healthcare system due to SARS-CoV2 pandemic that affected globally, more than 100 million people, causing more than 2 million of deaths worldwide. The evidence of how this infection impact patients with rheumatic and musculoskeletal diseases treated with disease modifying anti-rheumatic drugs is still an unmet need.Objectives:The main focus of this study is to evaluate the influence of DMARDs therapy on the evolution of COVID-19 disease in patients with RMDs. The second objective is to study and find correlations between the severity of infection in patients with rheumatic diseases.Methods:A retrospective observational study was conducted between June 2020 and January 2021, enrolling 81 patients with rheumatic diseases that went through SARS-CoV2 infection. The data was collected using patients’ clinical documents and through telemedicine, in accordance with EULAR COVID-19 Rheumatological Database.Results:Among the 81 patients, 53 (65,43%) were females and 28 (34,56%) were males. The mean age was 47,9 years old (49,49 years old for females and 45,25 years old for males). The majority lives in urban areas – 62 patients (76,54%).The temporal trends of COVID-19 observed in this cohort was in consonance with the evolution of the pandemic in Romania: one third of cases were recorded between June and October 2020 and two-thirds between November 2020 and January 2021, when the number of COVID-19 cases tripled in the general population.Surprisingly, more than 27% of patients in this study were asymptomatic at the time of COVID-19 diagnosis. They were tested according to the protocol before admission to the hospital. 9,8% of patients also asymptomatic, were tested positive as a screening before leaving the country. The majority (45,6%) were symptomatic or contact with someone infected with SARS-CoV2-and tested positive with RT-PCR.We divided the cohort in 3 groups: patients with mild infection that required no hospitalization (22 patients counting for 27,16%), moderate infection – hospitalization but not in the Intensive Care Unit (52 patients – 64,19%) and severe infection – admission to the ICU/deaths (7 patients in the ICU, 4 deaths – 4,9%).Mild and moderate COVID 19 disease was identified in patients with axial spondyloarthtis (56,7%), with remission or with low disease activity, with a few or no comorbidities, with a mean age of 47,56 years old and also in patients in treatment with MTX (14,86%) or TNF alfa inhibitors (35,13%). 51% of patients stopped the therapy during COVID19 diseases.Factors correlated with severe infection and death were age (the mean age was 62,14), high and moderate disease activity RA, overlap syndromes (RA with SLE or Sjogren Syndrome) and important cardiovascular comorbidities. Two of the deceased patients were in treatment with MTX and RTX (the last infusion was more than 6 months).Conclusion:The data in our study suggests that the use of cs DMARDs (MTX) and TNF alfa inhibitors is associated with better outcomes for patients with RMDs and COVID-19. These results are in accordance with the data found in literature [1,2,3]. The limitation of this study is the little number of patients and the fact that the real number of COVID-19 cases might be higher in reality due to asymptomatic or pauci-symptomatic patients.References:[1]Filière des Maladies Autoimmunes et Autoinflammatoires Rares (FAI2R); Hôpital Huriez, CHU Lille, Univ. Lille, Lille, France, Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients, Annals of the Rheumatic Diseases Published Online First: 02 December 2020[2]Sanchez-Piedra C et al., On behalf of the BIOBADASER study group, et al, Clinical features and outcomes of COVID-19 in patients with rheumatic diseases treated with biological and synthetic targeted therapies,Annals of the Rheumatic Diseases 2020;79:988-990.[3]Hyrich, K.L et al. Rheumatic disease and COVID-19: epidemiology and outcomes. Nat Rev Rheumatol 17, 71–72 (2021)Disclosure of Interests:None declared

Background:The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results have often been observed.Objectives:The aim of the study was to assess differences in disease manifestations in a cohort of SSc patients according to gender.Methods:We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096.We looked at sex influence on disease characteristics at baseline and then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival.Results:173 patients with SSc were available for the baseline analyses. Males were older (52,96 vs 45,88, p=0.009), were more likely to smoke (73% vs 7%, pIn the longitudinal analysis after a mean follow-up of 3,5(±0,65) years, male sex was associated with a higher risk of scleroderma renal crisis (OR:9.45 (1.49 to 59.69); p=0.004), digital contractures (OR:8,2 (3,1 to 21,9); pConclusion:Although more common in women, SSc appears as strikingly more severe in men. Our results demonstrate a higher risk of severe organ involvement and poor prognosis in men. These results raise the point of including sex in the management and the decision-making process.Disclosure of Interests:None declared

Background/Objective. Disease activity in spondyloarthritis (SpA) is evaluated through conventional scores such as BASDAI or ASDAS. The aim of this study was to determine disease activity in SpA patients under biological therapy with further assessment on the quality of each activity indicator and their clinical value together with their impact on NSAID intake. Materials and methods. Over nine months (January–August 2015) we enrolled 100 patients with SpA on antiTNF therapy (33% IFX; 35% ADL; 32% ETA). We collected demographic, clinical (BASDAI, ASDAS, PtGA) and laboratory data (ESR, CRP). Frequency of NSAID ingestion expressed as days per week was included in a questionnaire. Considering their biologic treatment, patients were divided into disease activity groups and sample characteristics were correlated and compared. Statistical analysis was performed with SPSS 20.0, using specific tests such as Pearson, Spearman or ANOVA. Results. Patients with active disease, stated by both activity scores had an increased NSAID intake. Out of 86% of patients with a BASDAI under 4, only 82.6% had an ASDAS-CRP lower than 1.3. BASDAI correlated to both ASDAS scores (r = 0.65 and 0.71, P

Background:The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results.Objectives:To evaluated sex influence on disease characteristics at baseline and then to estimate the effects of sex on disease progression and survival.Methods:We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096. 173 patients were analysed (26 males).The severity of organ system involvement was defined as described previously (1).Results:Males were significantly older at symptom onset (p=0.007) and at first center visit (p=0.009). There were no differences regarding disease duration at first visit or the interval between the onset of Raynaud syndrome and other non-Raynaud manifestations (p=0.06). Male patients were significantly more likely to have ever smoked (pIn multivariate analysis, male sex was independently associated with a higher risk of diffuse cutaneous subtype (OR: 1.56, (1.35 to 1.84); pConclusion:In essence, the disease prophyle in females is that of younger age of onset, longer disease duration at first center visit, less severe peripheral vascular involvement, the most frequent cause of death being PAH. In contrast, males are older at onset, present earlier in their disease, have dcSSc, more severe peripheral vascular disease, higher mRSS, more frequent and severe ILD, more frequent heart involvement, higher risk of PAH and SRC, the most common cause of death being ILD. These results raise the point of including sex in the management and the decision-making process.References:[1]Peoples C, Medsger TA Jr, Lucas M et al Gender differences in systemic sclerosis: relationship to clinical features, serologic status and outcomes.J Scleroderma Relat Disord. 2016;1(2):177–240Disclosure of Interests:Laura Groseanu Speakers bureau: novartis, eli-lilly, ucb, pfizer,sandoz, Andra Balanescu Consultant of: pfizer, Speakers bureau: Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, UCB, Violeta Bojinca Speakers bureau: Eli-Lilly, Novartis, Pfizer, Daniela Opris-Belinski Speakers bureau: Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Ioana Saulescu Speakers bureau: Eli-Lilly, Pfizer, Diana Mazilu: None declared, Sanziana Daia-Iliescu Speakers bureau: sandoz, Andreea Borangiu: None declared, Florian Berghea Paid instructor for: abbvie, Speakers bureau: gideon richter, egis, novartis,ucb, cosmin-laurentiu constantinescu: None declared, CLAUDIA COBILINSCHI Speakers bureau: novartis, Maria Magdalena Negru: None declared, mihai abobului Speakers bureau: gideon richter, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz

Background In patients with primary Sjogren Syndrome (pSS), haematological involvement – autoimmune cytopenia, might be present at the time of the diagnosis or can develop in time after the characteristic glandular involvement. (1,2) Objectives The objective of the study is to evaluate the correlation between glandular involvement (ocular) and presence of cytopenia in patients diagnosed with pSS. Methods A retrospective analysis was performed on a cohort of patients diagnosed with primary Sjogren Syndrome under surveillance in one Rheumatology Centre between 2009 and 2016. The documented cases have been diagnosed according to the 2002 American-European Consensus group classification criteria, the 2012 ACR criteria or 2016 ACR/EULAR Classification Criteria for pSS. The EULAR Sjogren’s Syndrome Disease Activity Index (ESSDAI) was calculated for all patients. Ocular assessment and follow-up were performed in collaboration with the same ophthalmologist. The data was analysed using Windows Excel/SPSS20.0. Results 30 female patients diagnosed with pSS were included in the study. The mean age at the time of diagnosis was 52.1 years±SD 9.1. The ESSDAI was calculated for all patients at baseline: 5 (17%) patients presented high disease activity (ESSDAI >14), 14 (46%) patients moderate disease activity (5≤ESSDAI≤13) and 11 (37%) patients low disease activity (ESSDAI In the clinical case series, Spearman’s rank correlation coefficient between haematological (autoimmune cytopenia), and biological markers (hypocomplementemia) and ocular involvement were calculated. A strong negative correlation was found between autoimmune cytopenia and glandular manifestations (ocular involvement-xerophthalmia) (r=-0,60; p Conclusions Patients diagnosed with primary Sjogren Syndrome that presented at disease’s onset cytopenia and hypocomplementemia had a less severe ocular involvement. References [1] Seror R, Theander E, Brun JG, et al, Validation of EULAR primary Sjogren’s syndrome disease activity (ESSDAI) and patient indexes (ESSPRI)Annals of the Rheumatic Diseases 2015;74:859–866. [2] Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, International Sjogren’s Syndrome Criteria Working Group, Ann Rheum Dis. 2017Jan;76(1):9–16. [3] Koh JH, Lee J, Chung SH, Kwok SK, Park SH, Relation of Autoimmune Cytopenia to Glandular and Systemic Manifestations in Primary Sjogren Syndrome: Analysis of 113 Korean Patients, J Rheumatol. 2015Oct;42(10):1817–24. Disclosure of Interest None declared

Background Prospective studies with Bosentan have shown short term efficacy, while it is not clear whether long-term treatment may be effective or whether ulcers may recur once treatment is discontinued. Objectives Our objective was to evaluate the long term efficacy and tolerability of bosentan in patients with systemic sclerosis (SSc) who develop digital ulcers (DU). Methods In the present prospective, observational, non-controlled study, we followed 26 SSc patients treated with Bosentan from Sept 2014 to Dec 2017 Number of DU, semiquantitative capillaroscopic scoring, VAS (visual analoque scale) for Raynaud, VAS for DU and HAQ were evaluated every 6 month. Results are presented as mean(sd). The difference between efficacy measures at follow-up visits was tested with the Wilcoxon’s signed-rank test. Results The group included 26 patients, 16 females, 11 diffuse subsets, age was 48.08 (9.8) years, disease duration was 84.35 (76.04) months, number of DU was 4.27 (3.71), most of them had a late scleroderma pattern pattern (16/26). Microangiopathy evolution score was 5.19 (2.04), VAS for DU was 75.52 (16.17), VAS for Raynaud was 67,43 (14.16), HAQ was 1.62 (0.55). 5 patients received Bosentan less then 6 month, so they were excluded from the statistical analysis. 6 month evaluation revelead significant decrease in the number of DU (p Regarding Bosentan safety: 6 patients died during the follow up (3 cases of severe pulmonary arterial hypertension, 1 scleroderma renal crisis, 1 heart failure, 1 post vascular surgery). Bosentan was stopped due to lack of efficacy in 2 case and due to side effects in 3 cases: 2 elevated liver enzymes, 1 severe trombocytopenia and 1 dyspneea agravation. 12 patients had a follow up after a 6 months Bosentan stop. We did not notice any significant increase in the number of DU, the VAS for DU or Raynaud, the capillaroscopic semiquantitative scoring or the HAQ. Conclusions We noted a significant decrease in the number of DU, patients perception of Raynaud and of DU after 6 months of treatment and the effect was maintained in the 3 years follow-up, even 6 months after Bosentan was stopped. In this long-term follow-up no new unidentified adverse reactions were found, except for the unexpected severe thrombocytopenia. The present study is limited due to the small sample size, to the observational nature and should be viewed as descriptive. Questions rise about drug costs (6 months or long term treatment), but it also has to be emphasised that most of these lesions were chronic and nonresponsive to previous treatments. References [1] Matucci-Cerinic M, et al.Bosentan treatment of digital ulcers related to systemic sclerosis: results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2011;70(1):32–8 2] P. Garcia de la Pena-Lefebvre, et al. Long-term experience of bosentan for treating ulcers and healed ulcers in systemic sclerosis patients. Rheumatology (Oxford). 2008;47(4):464–6. Disclosure of Interest None declared

Background There is limited data available (case series, small clinical trials and expert opinion) regarding the need to initiate immunosuppressive therapy in patients with primary Sjogren syndrome (pSS). Objectives The aim of this study is to determine the factors that correlate with physician’s decision to start immunosuppressive therapy in pSS patients. Methods Subjects with pSS diagnosed according to the classification criteria in use at the time of their first presentation, were included in a monocentric cohort. A retrospective analysis was performed. The EULAR Sjogren’s Syndrome Disease Activity Index (ESSDAI) at onset and Sjogren Syndrome Damage Index(SSDI) at the last evaluation were calculated. Treatment was given according to the physician’s decision. Laboratory tests and Ultrasonography(US) of major salivary glands were performed in all cases. The data was analysed using Windows Excel/SPSS20.0. Results Corticotherapy was prescribed in 26/30 cases (86.6%), mean duration 50.65 months. Immunomodulatory treatment with hydroxychloroquine was given in 26/30 cases (86.6%). Immunosuppressive treatment was required in 10/30 patients (33.3%)- azathioprine 7 (23.3%) cases, methotrexate 3 (10%)cases. The mean ESSDAI score was 6.83±SD 1.8. In 19 (63.3%)cases disease activity was moderate or high (ESSDAI >5). The mean damage score value (SSDI) was 3.1±SD1.2. There was a moderate correlation between the activity score ESSDAI and the damage score SDDI (r=0.41, p Conclusions An important number of patients received corticotherapy, immunomodulatory agents and immunosuppressive therapy. The decision to initiate and maintain immunosuppressive therapy correlated with hypergammaglobulinemia and specific Sjogren’s US changes. The damage score(SSDI) does not correlate with immunosuppressive therapy duration. References [1] Rischmueller M, Tieu J, Lester S. Primary Sjogren’s syndrome. Best Pract Res Clin Rheumatol2016Feb 30. [2] Seror R, Bootsma H, Saraux A, et al. Defining disease activity states and clinically meaningful improvement in primary Sjogren’s syndrome with EULAR primary Sjogren’s syndrome disease activity (ESSDAI) and patient-reported indexes (ESSPRI). Ann Rheum Dis2016. Disclosure of Interest None declared

Background While macrovascular disease and higher cardiovascular (CV) risk are well documented in other systemic rheumatic diseases, the risk for major cardiovascular events for patients with systemic sclerosis (SSc) is yet to be established. Objectives The aim of the study was to determine the ability of different cardiovascular risk indices to predict major cardiovascular events (MACE) in systemic sclerosis. Methods The study included 144 patients followed in EUSTAR centre 096, but only patients with a follow-up for more then 10 years were selected for statistical analyses. Cardiovascular risk was estimated using QRiskII, systemic coronary risk evaluation (SCORE) and ACC/AHA risk indices. MACE were defined as: myocardial infarctions, strokes, peripheral vascular disease and cardiovascular related death. Data were compared by non-parametric tests. Results 32 patients, 31 females, 12 diffuse SSc subsets were included. The control group included 30 age and sex matched patients without autoimmune diseases. Mean age of the group was 52 years±SD 9.7, mean disease duration was 8 years±SD 9. The prevalence of traditional risk factors was: 13% smokers, significant family history 38%, obesity 16%, dyslipidemia 32%, older age 13%, hypertension 16%. There were no significant differences from the control group. Major cardiovascular events were: 13% myocardial infarction, 9% peripheral vascular disease, 9% CV related deaths. Concerning CV risk indices of the 32 SSc patients, 4 (13%) were classified as having high CV risk according to QRiskII/SCORE/ ACC risk.. In SSc patients, we could not identify any correlation between the above mentioned risk indices and MACE, including death of cardiovascular causes, except for a slight correlation between the SCORE and cardiovascular related death (p=0.04). Conclusions In our study, the main prediction indices were not correlated with the 10 year risk for CV events in SSc patients suggesting that we need better risk prediction tools. Both traditional risk factors and endothelial dysfunction have been proposed to participate at the onset and progression of vascular disease in SSc. Special attention should be paid to correct the traditional risk factors in combination with specific treatment for SSc. References [1] Psarras A, Soulaidopoulos S, Garyfallos A, Kitas G, Dimitroulas T A critical view on cardiovascular risk in systemic sclerosis. Rheumatol Int2017;37(1):85–95. [2] Groseanu L, Bojinca V, Gudu T, Saulescu I, Predeteanu D, Balanescu A, et al. Low vitamin D status in systemic sclerosis and the impact on disease phenotype Eur J Rheumatol2016;3(2):50–55. Disclosure of Interest None declared

Background Systemic lupus erythematosus (SLE) patients may have nutritional changes triggered by disease itself or by treatment with possible implication for patients prognosis. Objectives The main focus of the study was to evaluate nutritional status and its impact in a SLE cohort with disease duration of at least 1 year. Methods 105 SLE patients admitted in Sf. Maria Clinical Hospital in 2017 were enrolled. Inclusion criteria were represented by disease evolution of at least 1 year. All patients agreed to participate in this observational study. Data about demographic, clinical or serological characteristics, but also activity (SLEDAI), damage accrual (SLICC damage index SDI) and treatment or complications (osteoporosis, cataract, glaucoma, etc) were collected. Nutritional status was evaluated by calculating Body Mass Index (BMI) for each patient. A descriptive and analytical statistics was performed with SPSS. Results 99 females and 6 males were enrolled. Mean age at SLE diagnosis was 34.39, SD 11.34. BMI was calculated as ratio of body weight to squared height (kg/m2). According to BMI, 5% of patients were underweight (BMI 30). Increased BMI was correlated with longer disease duration (p 0.0001, r 0.30) and older age (p 0.0001, r 0.35), but these correlation loose the strength for patients older than 40 years (p 0.04, r 0.15), suggesting a more pronounced weight gain at the beginning of the disease. Quality of sleep was significant altered in patients with abnormal BMI (p0.005, r 0.35). As expected, overweight and obese patients had a sedentary life style (p Conclusions SLE patients have an increased risk for higher BMI, especially patients younger than 40 years, in the first years after diagnosis. Optimising weight in our SLE patients should be in our focus in order to limit number of complications, damage accrual and lifestyle patterns that negatively impact their life. References [1] Zhu LW, Zhang T, Pan HF. BMI, disease activity and health-related quality of life in systemic lupus erythematosus. Clin Rheumatol2010;29:1413. [2] Rizk A, Gheita TA, et al. The impact of obesity in SLE on disease parameters, quality of life, functional capacity and the risk of atherosclerosis. Int J Rheum Dis2012;15:261–267. Disclosure of Interest None declared

Aims: Doppler ultrasonography assessment is mandatory nowadays for the complete description of rheumatic disease activity. Initially it was performed in semi quantitative way but recently the (fully) quantitative assessment is gaining more interest. In quantitative assessment, the ratio between total colorized and total pixels (CTR) is computed for the whole image or just for the region of interest (ROI). The frame with the highest amount of Doppler signal (also called worst case scenario image – WCSI) is usually the only one analyzed. The technique requires a very precise identification of WCSI from a certain number of consecutive frames, captured from the same position of the US probe, (and in most cases this is done manually). Our study examined the ability of both experienced and in-training sonographers to identify WCSI using a computerized analytical system as the gold standard.Materials and methods: The study analyzed 480 frame selections done in two distinct exercises. The WCSI and other 3 images with a 5%, 10% and respectively 20% lower level of CTR compared with WCSI were packed in one selection. All frames emerging from the same video clip were randomly presented to six experienced and six in training sonographers; the request was to select the frame with the highest CTR (WCSI) from each package (twenty packages in total). A similar exercise was performed with CTRs decreasing in steps of 2%.Results: In the first exercise the WCSI was correctly identified in 79.1% cases and in 67% of cases in the 2nd exercise. The interobserver agreement between experienced and in-trainer evaluators for the 1st exercise was 0.78 and 0.4 in the 2nd exercise.Conclusion: Using computerized analysis as the gold standard, we demonstrated a large heterogeneity across sonographers regarding their ability to identify the best Doppler image even from a small group of frames.

Background Antiphospholipid syndrome (APS) is an autoimmune disease with wide clinical features and cumulative damage. The nervous system involvement is very broad and severe. Objectives The aim of this study is to analyze the impact of neurologic manifestations on Damage Index in Patients with APS (DIAPS). Methods All consecutive patients known with APS were included in our monocentric cohort. Data on medical history, clinical manifestations, aPL profile and medication were collected. DIAPS score was used to measure damage in each patient. Results Seventy six patients with APS were included: 11 patients with primary APS and 65 patients with secondary APS, with mean disease duration of 9.59±7.39years. Overall,35 patients (46.1%) had neurologic manifestations. Their mean disease duration was 9.2±5.76 years. Seven patients had primary APS and 28 patients had secondary APS. Six patients were on chronic oral anticoagulant therapy and low dose aspirin, 12 patients on oral anticoagulant alone and 15 patients on low dose aspirin. Transient ischemic attack was the first manifestation of APS in 4 patients (11.42%) at mean age of 29.5±10.96 years. Their mean DIAPS value was 7.75±4.19. Ischemic stroke was the first APS manifestation in 12 patients (34.28%) at mean age of 40.08±16.31years, with DIAPS mean value of 7.41±3.67. All of these patients have neurological sequelaes. The DIAPS value was higher in patients with neurologic manifestations (3±2.9 vs 5.71±3.62, p=0.001) and DIAPS value correlated significantly to neurologic manifestations (R=0.416, p Conclusions Neurologic manifestations in APS patients have a great impact on cumulative damage especially in patients presenting with ischemic stroke or transient ischemic attack as the first manifestation of APS. References M-C Amigo et al. Development and initial validation of a damage index (DIAPS) in patients with thrombotic antiphospholipid syndrome (APS). Lupus (2015) 24, 927–934. L.A. Martinez-Martinez et al. Damage Index in Patients with Thrombotic Antiphospholipid Syndrome: Retrospective Cohort Study. Ann Rheum Dis 2016;75:1065. Disclosure of Interest None declared

Background Antiphospholipid syndrome (APS) is an autoimmune disease defined as the presence of antiphospholipid antibodies (aPL), at least a clinical thrombotic event and is associated with an important risk of organ damage. The new index proposed, Damage Index in patients with Thrombotic Antiphospholipid Syndrome (DIAPS) may be an useful tool to estimate cumulative damage in patients with primary and secondary APS. It includes 38 clinical items expanded to show the complexity of clinical manifestations in APS patients. Objectives The aim of this study is to analyze the serological pattern as potential predictive factor for an increased DIAPS. Methods All consecutive patients known with APS according to the Sapporo and/or Sydney classification criteria were included in our monocentric cohort. Data on medical history, clinical manifestations, aPL profile and medication were collected. DIAPS score was used to measure damage in each patient. The relationship between aPL profile and DIAPS score was analysed. Results Seventy six patients with APS were included: 11 patients with primary APS, 65 patients with secondary APS. Their mean disease duration was 9.59±7.39years. The most frequent clinical manifestation from DIAPS was the peripheral vascular (deep vein thrombosis, intermittent claudication, tissue loss, vascular venous insufficiency) found in 61.8% of patients, followed by the neuropsychiatric manifestations (46.1%). The mean DIAPS score in our cohort was 4.25±3.51, not significantly different between patients with primary vs secondary APS (4.72 vs 4.16, p=0.629). Lupus anticoagulant (LA) was found in 25 patiens (32.9%), anti cardiolipin antibodies (aCL) in 49 patients (64.5%) and antibodies to β2-glycoprotein I (β2GPI) in 23 patients (30.3%). There were 36 patients known with a single positive aPL (47.4%), 27 patients (35.5%)with 2 positive aPL and only 2 patients with triple positivity. There were no significant differences regarding antibody profile between patients with primary and secondary APS. Higher values of DIAPS were seen in patients with β2GPI (p=0.042) and with positivity for 2 aPL (p=0.003). DIAPS value correlated to the presence of β 2GPI (p=0.042, R=0.233) and to positivity for two aPL (p=0.003, R=0.341). Conclusions Our study suggests that double positivity for aPL, especially the presence of β2GPI confers an increased value of DIAPS in patients with primary and secondary APS. References M-C Amigo et al. Development and initial validation of a damage index (DIAPS) in patients with thrombotic antiphospholipid syndrome (APS). Lupus (2015) 24, 927–934. LM Amezcua-Guerra. Improving definitions for an index of cumulative organ damage in patients with the antiphospholipid syndrome (DIAPS). Lupus (2016) 25, 671–672. Disclosure of Interest None declared

Background Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. Objectives The purpose of this study was to assess health-related quality of life and disease perception in a group of SSc patients. Methods We performed a case-control study on 50 SSc patients from EUSTAR cohort 096. Socio-demographic data, disease characteristics and self-assessment questionnaires: Health assesment questionnaire (HAQ), EuroQol-5D (EQ5D) and the Brief Illness Perception Questionnaire were collected. Results The group included 41 females,31 limited SSc subsets. Medium HAQ value was 0.9 (0.6). Patients with higher Rodnan score (p=0.002), synovitis (p=0.02), late capillaroscopic pattern (p=0.02), muscle weakness (p=0.001), gastrointestinal involvement (p=0.01) and those on immunosuppressants (p=0.02) have a poor life quality. According to EQ-5D, the quality of life was related to specific organ involvement. 48% of the patients had some mobility problems, 6% were confined to bed; mobility was influenced by lung involvement (p=0.008), digital ulcers (p=0.03) and Medsger score (p=0.01). 48% of the patients had some self-care problems and 8% were not able to wash/dry themselves; self-care was influenced by the Rodnan score (p=0.02), diffuse subset (p=0.02), muscle weakness (p=0.03) and gastrointestinal involvement (p=0.021). 64% of the patients had some problems in performing usual activities and 16% were not able to perform them; the performance was influenced by disease subset (p=0.01), Medsger score (p=0.02), cardiac involvement (p=0.02) and the use of immunosuppressants (p=0.01). 52% of the patients had some and 38% had extreme pain/disconfort; 66% of the patients were moderately and 20% were extremly anxious/depressed. Both were related to digital ulcers (p=0.01, respectively p=0.045) The illness had a great impact on patients life 7.3 (2.5)/10. The main determinant was pulmonary fibrosis (p=0.04). The patients consider that their disease will continue for quite a long time 8.7 (2.6)/10. Most of the patiens do not feel to have a good control on their disease 6.3 (3.3)/10 and unfortunately they do not think that the treatment is very helpful 7.9 (2.7)/10. The intensity of the symptoms is quite severe 7.5 (2.7)/10,related to digital ulcers (p=0.04) and gastrointestinal involvement (p=0.02). Patients are very concerned about their disease 9.1 (2.3)/10, most of them being emotionally affected 7.6 (2.6). Conclusions This study confirms the presence and magnitude of impaired life quality in patients with SSc with impact on mobility, self-care, usual activities. The major determinants were the extend of skin involvement, musculoarticular, gastrointestinal involvement and digital ulcers. Often patients are anxious/depressed, had a high pain intensity and the perception of this illness is pessimistic. References Hudson M, Canadian Scleroderma Research Group Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum. 2009;61(8):1112–2. Frantz C et al. Impaired quality of life in systemic sclerosis and patient perception of the disease: A large international survey. Semin Arthritis Rheum. 2016;46(1):115–23. Disclosure of Interest None declared

Background Proper diagnosis of scleroderma is often long and difficult, since it is such a rare disease, and one which few doctors or patients are familiar with. Objectives To establish the interval between the symptoms9 onset of systemic sclerosis (SSc) and what type of investigations are performed until the patients reach the final diagnosis of a rheumatologist Methods This is a cross-sectional study that included randomly selected patients with a a diagnosis of SSc which were evaluated based on a questionnaire about symptoms at onset, specific consults and investigations. Descriptive statistics were used. Results The study group included 47 patients, of which only 5 were males and 17 from rural areas.The medium age was 53 (14.4) years. First symptom of onset was Raynaud phenomena 91.3% of the cases, followed by skin changes (56.5%), puffy fingers (52,2%), gastrointestinal and musculoarticular symptoms (23.9% each). The medium duration between the first symptom and a medical consult was 6 (63.5) months. The first medical consult was done by a internal medicine specialist -38.3%, by a rheumatologist-29.8%, a gastroenterologist-12.8%, a dermatologist-8.5%, a nephrologist and a pneumologist-4.2% and neurologist 2.1% The first suspected diagnosis was SSc in 14 cases, Raynaud syndrome in 8, connective tissue disease in 5, rheumatoid arthritis in 4, cancer, autoimmune hepatitis, idiopathic pulmonary fibrosis each in 2 cases and none in 10 cases. The medium number of consults until final diagnosis was 3.4 (1.7). The medium duration from the first symptom until the correct diagnosis was 39.2 (74) months. The first investigations recommended were blood tests in almost all of the patients (95.7%), but only a third of them included specific scleroderma autoantibodies. Capillaroscopy was performed as an initial diagnostic test in only 6 patients (12.8%). The mean interval from disease onset until the patient was referred to the first capillaroscopy was 13.5 (28.8) months, to specific autoantibodies was 40.17 (61.3) month, to echocardiography was 36.38 (54) months, to lung function tests and lung CT – 41.76 (65.8) months. There were no significant statistical differences between patients coming from rural environment and those coming from urban environment. The only significant statistical difference between diffuse and limited subset was the time the patient was referred to echocardiography (19.8 (47.6) months for the diffuse subset, 66.8 (94.6) months for the limited subset, p=0.04). The only statistical difference between males and females was related to the interval that capillaroscopy was performed (14 (20.5)months in females, 4.8 (5) months in males, p=0.02). Conclusions Scleroderma is a less well-known disease. This lack of awareness contributes to delayed diagnosis and delayed onset of therapy. Often such diagnostic uncertainty and frustration takes a huge toll on the psychological well-being of these patients, who describe their journey to diagnosis as being one of the most difficult part of their illness. One of our missions as rheumatologist is to increase recognition of this disorder. References https://www.sclero.org/scleroderma/diagnosis/difficult. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is associated with important comorbidities: cardiovascular, gastro-intestinal, infectious, malignant, and psychiatric [1, 2]. However, they are less studied in PsA compared to other chronic inflammatory arthritis. Objectives The objective of this study was to calculate the prevalence of comorbidities and risk factors in a cohort of PsA patients. Methods This was an observational cross-sectional study, including consecutive, unselected adult patients, with a diagnosis of PsA according to their rheumatologist. Data collected: demographical, clinical (affected joints, current psoriasis, axial involvement, enthesitis, dactylitis), biological (acute phase reactants), and treatment related (nonsteroidal anti-inflammatory drugs, synthetic remissive drugs and biologics). Data on comorbidities and risk factors were collected according to the European League Against Rheumatism (EULAR) recommendations on reporting comorbidities in chronic inflammatory rheumatic diseases in daily practice [3]. Results In all, 129 PsA patients were included: 77 (59.7%) women, mean age ± standard deviation 53.5±11.8 years, disease duration 7±7.4 years; 53 (41.1%) had axial involvement, 33 (25.6%) dactylitis, 18 (14%) enthesitis, and 24 (18.6%) current moderate/severe psoriasis. Most of them had low or moderate disease activity and almost a quarter of them (32; 24.8%) were taking a biologic. The most prevalent comorbidities were: dyslipidaemia 103 patients (79.8%), hypertension 67 (51.9%), obesity 44 (34.1%), diabetes 21 (16.3%) and ischemic heart disease 15 (11.6%). Almost a third of patients (42, 32.6%) suffered a cardiovascular event after their PsA diagnosis, of which heart attack 2 patients, stroke 4, cardiac failure 4 and peripheral arterial disease one patient. Cardiovascular events correlated with smoking (r=0.893, p Regarding infectious comorbidities: 11 patients (8.5%) had a history of tuberculosis after being diagnosed with PsA, 7 (5.4%) chronic viral hepatitis, of which 4 with B virus and 3 with C virus, and 5 patients (3.9%) developed severe infections. Five patients (3.9%) were diagnosed with neoplasia, but no correlation was identified with any of the clinical, biological or treatment related included variables. Only 11 patients (8.5%) were diagnosed with depression, but the prevalence is probably underestimated, since not all patients were screened to this end. Conclusions PsA is associated with a high prevalence of comorbidities, especially cardiovascular diseases. This should be taken into consideration in the therapeutic and the global management of PsA patients. References Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep 2010;12(4):281–7. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: apopulation-based cohort study. Ann Rheum Dis 2015;74(2):326–32. Baillet A, Gossec L, Carmona L, et al. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Ann Rheum Dis 2016;75(6):965–73. Disclosure of Interest None declared

Background The Quality of life (QoL) in patients with SLE is deeply affected by multiple factors including psychological and physical factors, the functional status and the general perception over health. Objectives Evaluation of Quality of life and the perceptions over the disease in patients with SLE.functional status and the general perception over health. Methods This is a 10 month prospective, cross-sectional study performed on 52 patients hospitalized diagnosed with SLE according to SLICC 2012 criteria. There were evaluated demographic data, organs manifestations, disease activity scores (SLEDAI, SLICC) and treatment. To evaluate the QoL several questionnaires were performed: Health Assessment Questionnaire (HAQ), EuroQol five dimensions questionnaire (EQ5d), Illness Perception Questionnaire and SF-36. Results All patients were women with the mean age 49 years with a mean durations of illness 136 month (14). The mean SLEDAI – 5,52 (5,37) and SLICC – 2,25 (1,71). The mean HAQ value was 0,83 (0,81). The HAQ score doesn9t correlate with SLICC (p=0,461) and with SLEDAI (p=0,172), but it was correlated with the neuropsychiatric manifestations. So the psychiatric affectation influences performing the usually daily activities (p=0,005). When assessing Illness Perception Questionnaire, patients considered their life seriously affected by pain, mean value 6,3 (2,6), 72% consider the illness will be present for the rest of their lives, 90% appreciate that treatment is improving the QoL mean 9,3 (1,3), 68% consider to have many severe symptoms, more than 80% patients consider themselves preoccupied for their illness, more than 70% are emotionally affected by their illness and 48% consider stress being the main determinant factor of their illness. Questionnaire EQ-5d: 10% must stay in bed due to the disease, 8,33% can not wash or dress themselves, 12,5% are unable to perform usual daily activities, 62% experience pain or a moderate uncomfortable state and 65% are worried and or depressed. Cardio-vascular manifestations are correlated with diminished mobility (p=0,002) leading to deficiency in self care (p=0,002)also correlated with renal (p=0,034) and psychiatric (p=0,022) manifestations. Psychiatric manifestations also affect usual daily activities (p=0,05). Age is correlated with pain and uncomfortable state (p=0,004) but the responses to this item of EQ5D are not correlated with organ affectation, biological modification or disease activity scores. The presence of cutaneous manifestations is correlated with anxiety and depression (p=0,02). Based on SF36 when calculating the mean value on each category was observed all the 8 categories affected - smallest values at physical role (37,32) and general health (34,21), less influenced part being the social function (51,32).None of this items of SF 36 is correlated with SLICC or SLEDAI. Conclusions SLEDAI as well as SLICC or specific organ involvement give no indications over the patients QoL, which must be assessed by performing HAQ and SF 36. References Lupus. 2016 Mar 16. pii: 0961203316638934. [Epub ahead of print]Gender differences in systemic lupus erythematosus concerning anxiety, depression and quality of life.Macedo EA1, Appenzeller S2, Costallat LT2. Disclosure of Interest None declared

Background Corticosteroids are still one of the main treatment in Systemic Lupus Erythematosus (SLE). Beside the effect on controlling disease activity, they are also implicated in damage accrual. Both patients and physicians are some time afraid to adopt a steroid free regimen when possible. Objectives To evaluate the knowledge and perception of patients with SLE upon glucocorticoids. Methods 84 patients with SLE were evaluated and data about demographic, clinical, serological characteristics or treatment were collected. Presence of steroids related side effects like hypertension, osteoporosis, cataracts or diabetes mellitus were also assessed. All patients completed a questionnaire in order to evaluate patient9s knowledge about steroids. They were asked if they had a discussion with the doctors about corticotherapy and side effects related to them, if they consider that this treatment could be stopped with specialist approval. Statistics was performed with SPSS program. Results All patients had treatment with corticosteroids during disease evolution. 57.14% of them experienced at least one steroids related side effect. This patients were significant older: mean age at evaluation 49.50 versus 36.47 (p When patients were asked if they will stop steroids according to medical advice, almost 1/3 of patients - 28.57% - responded “no- to afraid to do that”. Patients willingness to adhere to a steroid free regimen in the future according to a physician recommendation was significant more frequent in younger patients (p 0.031, r -0.235), in those with steroids initiated in less than 1 year (p 0.016, r -0.297) and in those with less damage accrual (p 0.017, r-0.267). Flare at the moment of evaluation significantly reduced this possibility, at least from the patient perspective (p0.041, r 0.224). The likelihood of a future steroid free regimen was increased by a previous discussion patient-doctor about steroids (p0.002). Conclusions This study clearly shows that an open discussion with our SLE patients about corticosteroids is mandatory from the beginning. Patients should be informed about possibility of a steroid free regimen when disease status permits. This will increase patient willingness to get free of steroids when possible, helping physician to limit the continuum damage accrual of SLE patients. References Duru N, van der Goes MC, Jacobs JWG et al, “ EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases”, Ann Rheum Dis 2013; 72: 1905–1913. Disclosure of Interest None declared

Background Behcet9s Disease is a rare type of vasculitis that involves both arterial and venous blood vessels of all sizes. The type of organ involvement and overall disease activity evaluated in the clinical practice determine the course of treatment and the decision to initiate immunosuppression. Activity scores such as Birmingham Vasculitis Activity score (BVASv3), Behcet9s Disease Current Activity Form2006 (BDCAF), or damage indices like Vasculitis Damage Index (VDI) have been developed in this respect. Objectives To evaluate the ability of classical immunosuppressant therapy to prevent damage progression. To find the correlation between disease activity scores: BVASv3, BDCAF, long term treatment, immunosuppressant use and damage after remission, as calculated by VDI. Methods A study on a cohort of patients diagnosed with Behcet9s Disease from an Internal Medicine and Rheumatology Clinic was performed. Activity and damage scores,BVASv3,BDCAF and VDI after obtained remission, were calculated. The documented cases were diagnosed according to the International Criteria for Behcet9s Disease (ICBD).Windows Excel/SPSS20.0 (Spearman9s correlation)were used to analyse the data. Results The study included 16 patients treated with long term cortisone and immunosuppressive therapy. The mean age at the time of the diagnosis was 32.3years with a male predominance 62% (10 patients). Severe systemic involvement was present in 10 cases (Ophthalmological involvement-6cases, recurrent venous thrombosis-6cases, pulmonary vasculitis-1 case, severe cardiac involvement-1case, central nervous system involvement-3cases) and all patients received classical immunosuppression (cyclophosphamide, azathioprine).The mean scores for BVASv3 and BDCAF at the time of the diagnosis were 9 and 4.12.A strong correlation was identified between BVASv3 and BDCAF (r=0.830, p Conclusions Damage progression is influenced by disease activity, as calculated by activity scores (BVASv3 and BDCAF). Classical immunosuppression is used for severe organ involvement and for limiting new organ lesions once started. There was a stronger correlation between long-term cortisone use and VDI than between immunosuppression duration and damage. The damage index increased by irreversible organ damage due to disease activity and long term cortisone use, but not due to the immunosuppressive therapy. References DavatchiF,et al How to deal with Behcet9s disease in daily practice. Int J Rheum Dis. 2010 May. Raashid Ahmed Luqmani Disease assessment in systemic vasculitis. Nephrol Dial Transplant 2015. Acknowledgements The first two authors,Sinziana Daia-Iliescu and Casandra Buzatu contributed equally to this study. Disclosure of Interest None declared

To identify the particularities of the clinical phenotype of endothelial dysfunction in a lot of Romanian patients from a reference center and compare it to data reported by international registries.51 patients were included in a cross-sectional study. The patients were evaluated for the pattern of disease, main visceral involvement, serum markers of disease.41.2% patients had history of digital ulcers, 27.45% had pulmonary arterial hypertension; cardiovascular involvement also included: diastolic dysfunction in 31.1% of the patients, global systolic dysfunction in 9.8%, rhythm and conduction disturbances in 19.6%, peripheral vascular disease in 19.6%. Scleroderma renal crisis was identified in 2 patients.Vascular complications are a major cause of morbidity and mortality in systemic sclerosis. Earlier therapeutic intervention demands improved screening and diagnosis in all cases.

to identify the particularities of the clinical phenotype of endothelial dysfunction in a lot of Romanian patients from a reference center and compare it to data reported by international registries.51 patients were included in a cross sectional study. The patients were evaluated for the pattern of disease, main visceral involvement, serum markers of disease.41.2% patients had history of digital ulcers, 27.45% had pulmonary arterial hypertension; cardiovascular involvement also included: diastolic dysfunction in 31.1% of the patients, global systolic dysfunction in 9.8%, rhythm and conduction disturbances in 19.6%, peripheral vascular disease in 19.6%. Scleroderma renal crisis was identified in 2 patients.Vascular complications are a major cause of morbidity and mortality in systemic sclerosis. Earlier therapeutic intervention demands improved screening and diagnosis in all cases.

Clinical response in patients with rheumatoid arthritis (RA) treated with biologic agents can be influenced by their pharmacokinetics and immunogenicity. The present study evaluated the concordance between serum drug and antidrug levels as well as the clinical response in RA patients treated with biological agents who experience their first disease exacerbation while being on a stable biologic treatment. 154 RA patients treated with rituximab (RTX), infliximab (IFX), adalimumab (ADL), or etanercept (ETN) were included. DAS28, SDAI, and EULAR response were assessed at baseline and reevaluated at precise time intervals. At the time of their first sign of inadequate response, patients were tested for both serum drug level and antidrug antibodies level. At the next reevaluation, patients retreated with RTX that had detectable drug level had a better EULAR response (P=0.038) with lower DAS28 and SDAI scores (P=0.01andP=0.03). The same tendency was observed in patients treated with IFX and ETN regarding EULAR response (P=0.002andP=0.023), DAS28 score (P=0.002andP=0.003), and SDAI score (P=0.001andP=0.026). Detectable biologic drug levels correlated with a better clinical response in patients experiencing their first RA inadequate response while being on a stable biologic treatment with RTX, IFX, and ETN.

Objective Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis. Material and methods Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels. Results The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=-0.318), digital contractures (p=0.036, r=-0.298), and muscle weakness (p=0.015, r=-0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=-0.29). Conclusion Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.

Objective: The aim of this study was to assess whether infliximab and adalimumab drug serum levels and the detection of anti-drug antibodies can be of use in better observing disease activity in patients with spondyloarthritis, besides classical tools such as BASDAI, ASDAS and inflammatory markers. We proposed to evaluate the influence of ADA in non-responders and in drug-related adverse events. Methods: Over one year, we enrolled 115 patients with SpA, treated with infliximab or adalimumab. Patients who delayed prescribed drug administration were excluded from the study cohort. The population comprised 69 patients - 33 on IFX and 35 on ADA. NSAIDs administration was recommended “on demand”. Demographic, clinical (BASDAI, ASDAS) and laboratory (ESR, CRP) data was collected together with drug serum level and anti-drug antibodies using ELISA. The statistical analysis was performed using the SPSS software, version 20.0 with the aid of Student t-test, Spearman and Pearson tests. Results: Detectable IFX serum levels were identified in 60% of patients while 40% had undetectable drug titers. The IFX-negative had significantly higher disease activity scores: BASDAI (P=0.023), ASDAS-ESR (P

Background Digital ulcers are frequent in patients with systemic sclerosis and have a high morbidity. No previous studies have evaluated the efficacy of immunosuppression on digital ulcers risk. Current treatment guidelines do not include the use of immunosuppressants as routine treatment for digital ulcers. Objectives To asses the efficacy of imunosuppresive therapy on the digital ulcer prevention in patients with systemic sclerosis Methods Prospective study on EUSTAR cohort 096 during september 2005-september 2015. Patients with systemic sclerosis (SSc) without previous digital ulcers at their first presentation in the clinic were selected. Immunosupression was started based on current recommandations according to specific organ involvement. Patients were evaluated every 6 month according to MEDS evaluation sheets and a special evaluation form for digital ulcer (number, type of ulcer, date of onset). Results 116 systemic sclerosis (SSc) patients were evaluated, but only those without previous ulcers at their first presentation in the clinic were selected – 60 patients; 12 of them were lost to follow-up. There were 40 females, 8 males, 23 diffuse and 25 limited SSc. 26 out of the 48 patients received immunosupressants. The mean (±SD) interval of follow up was 72.67 (±60.75) months. No significant statistical difference was identified between patients with immunosuppression and those without regarding the age, the disease duration, the visceral involvement and the follow-up period. 69.23% received Methotrexate, 3,84% received Mycophenolate and 26.92% received monthly pulses of Cyclophosphamide. The use of immunosupresants was related to diffuse subset (R=0.631,p=0.001), antiSCL70 positivity (R=0.624, p=0.001) and lung involvement (R=0.331, p=0.034). There was no difference of the immunosuppressants efficacy regarding the new digital ulcers onset. The incidence of digital ulcers was 15.38% in patients receiving immunosuppression and 68.18% in patients without immunosuppression (p=0.001). The mean (±SD) number of ulcers in the follow-up period was 0.85 (±1.4) in immunosuppresed patients and 6.18 (±4.79) in the other group, p=0.001. The onset of new digital ulcers was also correlated with advanced age (R=0.392, p=0.032) and longer follow-up interval (R=0.036, p=0.049). The mean (±SD) interval from first visit of the patient until the appearence of the first digital ulcer was 7.3 (±5.43) month in patients with immunosuppression and 30 (±11.78) months in patients without immunosuppression. Conclusions Immunosupression might decrease the risk and the number of digital ulcers of patients with SSc, but they do not seem to extend the interval until their first appearance. More prospective, multicentric studies on larger cohorts with longer follow-up interval are needed in order to aasses the efficacy of immunosuppression on digital ulcers onset, number, rate and time to healing. Disclosure of Interest None declared

Background Osteoarthritis (OA) is a prevalent condition for which treatments are based on analgesia and physical therapies. Despite that, most of the patients continue to have pain and limited function influencing there day by day life. Objectives Our objective was to evaluate pain perception in a cohort of participants, diagnosed with osteoarthritis. Methods 75 patients with osteoarthritis were enrolled in this study, conducted in Sf. Maria Hospital between 1 June and 30 December 2015. All patients signed an informed consent approved by local ethic committee. Data about demographics, joint involvement and treatment were collected. All patients completed a HAQ evaluation and a Visual Analogue Scale (VAS) for pain (0–10). We developed a questionnaire in order to capture patient perception about osteoarthritis symptoms and how this disease impact there life. They were asked about how pain interfere with usual activity (work, preparing meal, house kipping), with social activity (family interaction, friends) or how they perceived pain or efficacy of the treatment in the last month. They were also asked about there expectations related to this disease. Statistical analysis was made with SPSS. Results Mean age at evaluation was 63 with a female predominance (83%). 89.3% were taking NSAIDs and 73.3% acetaminophen. Functional status evaluated by HAQ showed that 24% patients had a score of 0, with 57% having a score of 1 and 19% a score of 2. VAS for pain was at least 5 for more than 80% of patients, despite treatment. Higher VAS was significant more frequent in female patients (p 0.001), in patients with family history of osteoarthritis (p 0.023) and in the one with sedentary life style (p 0.035). Most of the patients considered that pain interfere with daily activity, the impact being evaluated as moderate for 46.67% of patients and severe for 32%. Pain also had a negative impact on their social life, the percentage for moderate disturbance being of 38.67% and 18.67% for severe one. Only 11% of patients consider that the pain control is well managed. Despite these results, 40% of the patients do not expect that there quality of life will improve in the future. Conclusions Residual pain after treatment is present in most of the patients with osteoarthritis and these interfere significantly with daily living and quality of life. These patients enter in a vicious cycle related to worsening pain – low physical activity. Although this findings, there is a resumption of these patients in front of the disease. References Neogi T, The epidemiology and impact of pain in osteoarthritis, Osteoarthritis and cartilage, 2013, 21: 1145–1153. Disclosure of Interest None declared

Background Systemic Lupus Erhytematosus (SLE) is a multiorgan disease in which pattern of evolution is linked to activity and damage. When the disease starts at an early age, all the outcomes might be influenced by this. Objectives The main focus of this study is to describe the differences between juvenile and adult onset SLE in a Romanian cohort. Methods 101 SLE patients were evaluated between March 2015 and December 2015. Patients were diagnosed with SLE according to ACR classification criteria and splited in 2 groups, taking into account age at disease onset: before and after 18. All patients agree to participate in this study. Data about demographic, clinical or serological characteristics, activity (SLEDAI) or damage (SLICC damage index SDI), treatment were collected. Statistical analisys was performed with SPSS 20.0. Results Our cohort was made from 18 patients with juvenile onset SLE and 83 with adult onset SLE. Mean age at diagnosis was 14.05 versus 37.89. The juvenile onset SLE group had significant more autoimmune disease as family background, mainly SLE and rheumatoid arthritis (33.3% versus 12.04%, p 0.025), significant more severe organ involvement during the disease evolution: SLE related neurologic involvement 33.3% versus 12% (p 0.025) and renal involvement 50% versus 16.8% (p 0.023), more frequent anti dsDNA Ab positives 88.8% versus 60.24% (p 0.021). This more severe pattern of evolution is also reflected by immunosuppressant therapy, Cyclophosphamide being used in juvenile subgroup in 66% cases versus 35.3% in adults (p 0.014). Interesting, there were no differences between cumulative damage between groups, as measured by SDI (p 0.24), with the mention that in juvenile onset patients, SDI>1 was more frequent SLE related. This is in line with the fact that side effects of the corthicotherapie were identified more in adult onset SLE 61.44% versus 33.3% in juvenile onset (p 0.029). Conclusions Our data clearly show that juvenile onset SLE has more genetic background and it is more prone to a severe disease, renal and neurologic involvement being more frequent than in adult onset form. Severity seems to be related both to the activity, but also to fast damage accrual over time. Controlling the disease activity must be our goal, since cumulative irreversible damage is mainly SLE related for our patients. References Watson, L., Leone, V., Pilkington, C., et all, on behalf of the UK Juvenile-Onset Systemic Lupus Erythematosus Study Group, “Disease activity, severity, and damage in the UK juvenile-onset systemic lupus erythematosus cohort”. Arthritis & Rheumatism, 2012, 64: 2356–2365. doi: 10.1002/art.34410. Disclosure of Interest None declared

Background There is an increased appreciation of the burden of cognitive impairment in people with autoimmune diseases (1). Recent studies have demonstrated that patients with systemic sclerosis (SSc) have a specific pattern of cognitive impairment: the dysexecutive syndrome (2). Objectives We evaluated the prevalence of cognitive impairment in SSc and assessed the association with the disease features and impact on daily living Methods Consecutive SSc from EUSTAR center 096 were examined. Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction and scores ≤26 were considered abnormal (3). SSc patients were assessed according tu MEDS evaluation sheets to determine organ involvement, autoantibody profile, disease activity (Valentine Activity Index) and disease severity (Medsger Severity Index). sHAQ (Scleroderma Health Assessment Questionnaire) has also been completed. Data were compared by difference tests according to the types of variables: t-test, Mann-Whitney or chi-square. To evaluate correlations between variables Pearson or Spearman correlations were used. Results A total of 70 SSc patients [36 (51.42%) limited SSc (lSSc) and 34 (48.57%) with diffuse SSc (dSSc), 60 female; mean age 54.5 (±11.62) years; mean disease duration 66 (±429.6) months] were included in the study. 47.14% of the patients had active disease, the mean Rodnan score was 7 (±4.17), the mean Medsger score was 5.5 (±2.89), 24.28% of the patients had lung involvement and 20% had pulmonary arterial hypertension. The mean HAQ was 1 (±0.59). Cognitive impairment was identified in 65.71% SSc patients; the mean MOCA score was 26 (±2.83). Cognitive impairment of SSc patients was related to older age (r=-0.378, p=0.001), rural provenience (r=-0.351,p=0.003), severity of the disease evaluated by the Medsger score (r=–0.262,p=0.029) and poor quality of life evaluated by sHAQ (r=-0.323,p=0.003).Correlations were also identified with musculoarticular involvement (r=-0.330,p=0.006), advanced capillaroscopy patttern (r=-0.331, p=0.006). The diiffuse SSc patients were more likely to have cognitive dysfunction (likehood ratio 0.012) as were those with SCL70 positive (0.0.18). No relationship was identified between cognitive impairment and lung, heart or renal involvement, the presence of digital ulcers, the use of corticosteoids or immunosuppression. Conclusions An increased prevalence of cognitive impairment was observed in SSc and associated with age, rural provenience, more severe disease, muscle involvement and poor quality of life. Further studies are needed to be compared with healthy controls and to assess the role of microvascular damage or that of other confounders. References T.N.Amaral et al. Prevalence and significance of cognitive impairment in systemic sclerosis Ann Rheum Dis 2015;74:605 Ylmaz N. et al Dysexecutive syndrome: a specific pattern of cognitive impairment in systemic sclerosis Cogn Behav Neurol. 2012 Jun;25(2):57–62. www.mocatest.org/normative-data/ Disclosure of Interest None declared