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The case of a patient with cysts in the iliac bone is presented as an atypical cause of chronic low back pain that the rheumatologist may face, and a review of the literature on the types of bone cysts and their differential diagnoses will be made. Mention will also be made of your treatment options.

ANCA associated vasculitis (AAV) can cause various injuries along the gastrointestinal tract, but esophageal involvement is rare. Within the spectrum of lesions that may occur an esophageal hematoma is not a common mention in the literature. We present the case of a 67-year-old woman diagnosed with AAV and hematemesis. We consider the esophageal hematoma to be an atypical manifestation of a rare disease. The actual prevalence of this type of atypical manifestations is unknown, either due to its infrequent nature or the low reporting rate, so we believe that the publication of this type of manifestations is useful.

Autoimmune/inflammatory syndrome induced by adjuvant (ASIA) is a condition in which exposure to an adjuvant leads to an aberrant immune response resulting in signs and symptoms of autoimmune diseases. We present the case of a patient with arthritis and palpable purpura after hyaluronic acid lip injection.

Posterior reversible encephalopathy syndrome (PRES) is a poorly recognized and reversible condition in systemic lupus erythematosus (SLE) that could mimic neuropsychiatric lupus. The manifestations of PRES are headache, seizures, altered level of consciousness and blindness. In most cases, computed tomography of the brain shows hypodense lesions in the parieto-occipital lobe. Although this syndrome is rare, rapid and accurate recognition allows early treatment with favorable results. We present a case report of a patient with the onset of SLE following the episode of eclampsia, and who during the late puerperium presented sustained hypertension associated with seizures and deterioration of the level of consciousness in the context of PRES.

BackgroundInterstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) account for 60% of deaths related to scleroderma (SSc). The erythrocyte distribution width (RDW) has been used as a marker of poor prognosis in different pathologies. In SSc, RDW has been found to be elevated in PAH and has been proposed as a predictor of cardiorespiratory compromise.ObjectivesThe aim of this study is to evaluate the association between increased RDW and the presence of EPI in patients with SSc.MethodsThis is a multicenter, retrospective, cross-sectional study of patients diagnosed with SSc (ACR/EULAR 2013) from January 2011 to August 2021. Other concomitant autoimmune diseases, malignancy, active infections, iron-deficiency or pernicious anaemia and transfused patients were excluded. The diagnosis of PID was made by high-resolution computed tomography (HR-CT) and the extension evaluated by Goh criteria. A review of medical records was conducted, collecting clinical and demographic characteristics, interstitial pattern by HR-CT, assessed, acute phase reactants, capillaroscopy, functional respiratory tests (PFT) and echocardiographic resolution. Patients diagnosed with PAH by right heart catheterization were not excluded in this study but recorded.ResultsSeventy-five patients were included, with a mean age of 59.4 (SD 14.1 CI95% 56-6), from which 67 (89%) were women. A median of 8 years of disease evolution was observed RIC 8). Limited SS was observed in 50 (66%) and diffuse SS in 24 (32%). EPI was observed in 50 (66%) of which NSIP 25 (33%), NSIP-f 15 (20%) and UIP 10 (13%). The extension of the disease was limited in 25 (33%) and extensive in 19 (25%). Capillaroscopic findings were normal in 2 (3.4%), nonspecific in 1 (1.7%), early SD in 9 (15.3%), active SD in 22 (37.3%), and late SD in 25 (42.4%); in sixteen patients there was no capillaroscopy.We observed an increase in RDW in the EPI group with a statistically significant difference OR 6.06 CI95% 2-17 (p 0.001).The median RDW is higher in patients with ILD and PAH than in healthy people (pWe found a low negative correlation between RDW / FVC r (63) -.25 p 0.042 and RDW / FEV1 r (63) .30 p 0.015.ConclusionIn the present study we have been able to evidence that there is a statistically significant relationship between the percentage of RDW and the presence of PID. When analysing the association between patients without pulmonary compromise, ILD and PAH and the percentage of RDW, we were able to find a statistically significant difference between the three groups. It is necessary to continue with studies with a larger number of patients to grant robustness to the results.References[1]Muangchan, et al: 15% rule in SSc. The Journal of Rheumatology 2013; 40; 9; doi:10.3899/jrheum.121380.[2]Cottin and Brown. Interstitial lung disease associated with systemic sclerosis (Ssc-ILD) Respiratory Research (2019) 20:13[3]Thayer, T. E. et al. Unbiased Phenome-wide Association Studies of Red Cell Distribution Width Identifies Key Associations with Pulmonary Hypertension. Annals of the American Thoracic Society. doi:10.1513/annalsats.201809-594oc.[4]Zhao J,Mo H, Guo X,Wang Q, Xu D, Hou Y, Tian Z, Liu Y,Wang H, Lai J, Li M, ZengX (2018) Red blood cell distribution width as a related factor of pulmonary arterial hypertension in patients with systemic sclerosis. Clin Rheumatol 37:979–985.[5]Goh NSL, Desai SR, Veeraraghavan S, et al. Interstitial Lung Disease in Systemic Sclerosis: A Simple Staging System. American Journal of Respiratory and Critical Care Medicine. 2008. June;177(11):1248–54.[6]Hax V, Bredemeier M, Didonet Moro AL, et al. Clinical algorithms for the diagnosis and prognosis of interstitial lung disease in systemic sclerosis. Seminars in Arthritis and Rheumatism. 2017. October;47(2):228–34.[7]Peralta S. Guías Argentinas De Consenso En Diagnóstico Y Tratamiento De La Hipertensión Pulmonar. Sociedad Argentina de Cardiología. Área de Consensos y Normas. Vol 85 Suplemento 3. Octubre 2017.AcknowledgementsParticipating centersDisclosure of InterestsNone declared

BackgroundThe goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.ObjectivesTo describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).MethodsWe evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.ResultsOverall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).ConclusionA high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.References[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032Disclosure of InterestsRosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant

BackgroundInterstitial Lung Disease (ILD) is a frequent complication in patients with autoimmune diseases. Rheumatoid arthritis (RA) does not escape this statement. Different protocols have been proposed for the ultrasound evaluation of this affectation showing very good correlation with high-resolution computed tomography.ObjectivesTo determine the sensitivity and specificity of an ultrasound evaluation protocol as a screening method for interstitial lung disease in rheumatoid arthritis.MethodsConsecutive patients diagnosed with RA, with and without ILD, will be included. High-resolution chest CT (HRCT) will be performed in all patients. The lung evaluation protocol by ultrasonography (US); evaluates 50 intercostal spaces (ICS) and will be performed by a rheumatologist and imaging specialist trained in the procedure. The presence of B lines and pleural alterations in the EICs explored will be evaluated. A semiquantitative scale will be used to assess each EIC: 0 = normal, ( 50 B lines). CT scan was considered the “gold standard” for the diagnosis of ILD and they were evaluated by experienced pulmonologists who were blind to the patient.Results79 patients were included. Female sex 77% with a mean age of 55 (SD 11.4). The comorbidities observed were: hypertension 27%, dyslipidemia 15%, diabetes mellitus 10%, hypothyroidism 30%, smokers 14%, former smokers 18% and osteoporosis in 14% of patients. The patients had a median duration of the disease in years of 7.5 [IQR 9.2]. Erosive disease was seen in 20 (20%) and rheumatoid nodules in 9.1% of patients. 91% of the patients were under treatment with corticosteroids. Rheumatoid factor was observed in 87% of the patients and Anti-CCP in 71% of the patients, of which 70% had high titers. DILD was observed by HRCT in 21 (27%) patients. The tomographic patterns observed were UIP 7 (33%), probable UIP 2 (10%), cellular NSIP 6 (29%), fibrosing NSIP 3 (14%). An indeterminate pattern was observed in 3 patients. The extent of pulmonary involvement was extensive in 48% of patients and limited in 52%. A sensitivity of 63% (CI95% 44-78) and a specificity of 92% (CI95% 81-97) were observed for the ultrasound evaluation protocol with a PPV of 81% (CI95% 61-92) and NPV of 83 % (95% CI 71-90) and an LR+ 8.1 (95% CI 4.6-14.3) and LR- 0.4 (95% CI 0.3-0.48). AUC: 0.81 (pConclusionWe observed a moderate sensitivity and specificity of the method to assess interstitial lung involvement in RA with an acceptable AUC for a screening method. These findings are similar to what was found in other cohorts. We observe a high NPV. This means that in patients with a negative study result, the possibility of ILD would be removed. Studies in larger cohorts and comparison with other factors associated with ILD are necessary to improve our understanding of the method and give it the place it deserves.References[1]Spagnolo P. et al. The Lung in Rheumatoid Arthritis ARTHRITIS & RHEUMATOLOGY Vol. 70, No. 10, 2018, pp 1544–1554[2]Barskova T. et al. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis. Ann Rheum Dis 2013;72:390–395.[3]GUTIERREZ M, SALAFFI F, CAROTTI M et al.: Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders – preliminary results. Arthritis Res Ther 2011; 13: R134.[4]Cazenave T. et al. EVALUACIÓN DE PARÉNQUIMA PULMONAR Y LINEA PLEURAL POR ULTRASONOGRAFÍA: GRADO DE ACUERDO ENTRE OBSERVADORES ARGENTINOS. 53° Congreso de Reumatología.Salta. 2020.Disclosure of InterestsNone declared

Background:SARS-CoV-2 infection can present with a broad clinical spectrum, from asymptomatic to lethal. Different risk factors have been recognized. Socio-economic status and educational level may affect access to the healthcare system and therefore COVID-19 infection outcome.Objectives:The aim of this study was to assess the association between socio-demographic status and educational level and SARS-CoV-2 outcomes, such as hospitalization, ICU admission, need for mechanical ventilation and death, in Argentinean patients with rheumatic diseases from the SAR-COVID Registry.Methods:We performed a cross-sectional study of consecutive adult patients with rheumatic diseases and SARS-CoV-2 infection included in the multicentric Argentinean SAR-COVID Registry. The following variables were included: gender, ethnicity, age, health insurance, educational level (under or over 12 years of education), socio-economic level according to Graffar Scale in high, medium-high, medium, medium-low, low; underlying rheumatic disease, its duration and treatment at the time of infection.SARS-CoV-2 infection outcomes were: hospitalization, admission to ICU, mechanical ventilation requirement and death.Statistical analysis was performed using Chi2, Fisher, T-test, ANOVA.Results:Five hundred and twenty-five patients were included, 422 (80.4%) were female, with a mean age of 51.3 years (SD 15.2). Most of them were caucasians (48%) or mestizos (43%) and 96.8% lived in an urban environment. Almost half of the patients (47%) were categorized as middle-class, 24% middle-high or high class, 21% middle-low or low. 48.4% of the patients were employed. Regarding educational level, 54% had more than 12 years of education.The most prevalent rheumatic disease was Rheumatoid Arthritis (40.4%), followed by Systemic Lupus Erythematosus (14.9%), Sjögren (5.5%) and Psoriatic Arthritis (5.5%). Treatments used at the time of SARS-CoV-2 infection were corticosteroids (19%), cs-DMARDs (49%), and b- and ts-DMARDs (16%).Overall hospitalization frequency was 35%, median hospital stay was 10 days (IQR 10 days), 11.6% were admitted to the ICU, 10% required mechanical ventilation and the global mortality was 8%.Notably, patients with less than 12 years of education required mechanical ventilation more frequently than the more educated ones (11.9% vs. 5.6%, p=0.026) and showed a higher mortality due to COVID-19 (9% vs. 2.8%, p=0.0004).Patients categorized as upper social classes (middle-high and high) were admitted to the hospital on a more frequent basis (74.4% of cases), when compared with middle class (64.4%) and middle-low and low class (58%) (p=0.77). Median duration of hospitalization for the aforementioned groups was 12.5 (IQR 17.3), 10 (IQR 9) and 10.5 (IQR 9.3) days respectively (p=0.60).Patients with health insurance were found to be hospitalized more frequently in comparison to those without insurance (42.4% vs. 33.7%, p=0.14), but showed similar admission rates to the ICU (11.8% vs. 12.8%; p=0.78), need for mechanical ventilation (10.7% vs. 8.7%; p=0.70) and mortality (7.1% vs. 6.5%; p=0.99).Caucasian patients had fewer hospital admissions when compared against other ethnicities (mestizos mostly) (26.1% vs. 43.4%; pConclusion:Patients with lower educational level needed twice the frequency of mechanical ventilation, and showed thrice the mortality than those with more than 12 years of education.Albeit patients in upper social stratus and those with health insurance were admitted to the hospital in a more frequent manner, no statistically significant differences were found regarding the need for ICU, mechanical ventilation or mortality.Caucasians were hospitalized less frequently than mestizos, but had no significant differences in the other measured outcomes.Disclosure of Interests:Laura Sorrentino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Federico Maldonado Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alejandro Brigante Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Hamaui Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Diana Dubinsky Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Roberto Baez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cecilia Pisoni Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla Gobbi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Leandro Carlevaris Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Tanten Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Karina Cogo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria DeLaVega Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rodolfo Perez Alamino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Alicia Lazaro Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mariana Pera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Susana Isabel Pineda Vidal Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Elena Calvo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Debora Guaglianone Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla G Alonso Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mara Guinsburg Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cinthya Retamozo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Aeschlimann Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Ayelen Isnardi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.

Introduction: SLS is a rare manifestation (0.6-13.5%) of SLE. It is suspected in patients with dyspnea and pleuritic pain, diaphragmatic elevation in thoracic images and a restrictive ventilatory defect. Objectives: Describe the clinical, radiological and functional features of a cohort of patients diagnosed with SLS; as well as its evolution in pulmonary function tests. Methods: A retrospective and descriptive review of the clinical histories of the patients diagnosed with SLS treated in the pulmonary and rheumatology division was conducted between 2009 and 2018. Demographic, clinical, functional, radiological, and treatment data were collected. Results: Out of a total of 225 patients diagnosed with SLE, 10 (4.44%) with SLS diagnosis were included. Mean age was 41.2 + - 16 years; 6 (60%) were women. The main symptom was dyspnea in 70 (70%). Two patients (20%) presented pleuritic pain. 9 (90%) presented decreased lung volumes and 5 (50%) laminar atelectasis. The mean FVC was 1.95l + -0.44 (50.5%); TLC 3.31l + - 0.47 (62.1%); DLCO 16.78 + -4.24 (68.2%); KCO (DL/VA) 5.62 + -1.28 (128%); maximal inspiratory pressure (MIP) 70.4 + -25.4 (72.6%); maximal expiratory pressure (MEP) 90.7 + -56.3 (84.6%). Corticosteroid treatment was used in 10 (100%) of the patients, associated with azathioprine in 3(30%). The mean FVC value after a median time of 27 months was 2.28 (58%); an improvement of 300 ml (7.7%) compared to the first FVC measurement was observed. Conclusions: The prevalence of SLS was 4.4%. The median time to diagnosis of SLS was 30 months. With the immunosuppressive treatment, a respiratory functional improvement was achieved.

Background Lack of compliance to prescribed treatment is an ongoing problem in healthcare, leading to therapeutic failure and increased costs. Treatment compliance is defined by two related concepts: adherence and persistence during time. WHO estimates show that one every two patients with a chronic disease is not adherent. Studies on compliance in patients with Systemic Lupus Erythematosus (SLE) are scares, especially in third world countries. Low treatment compliance can be presumed. Different tools had been developed to assess compliance, been the Compliance Questionnaire on Rheumatology (CQR) and the Morisky and Green questionnaire (MG) the most widely used. The aim of this study is to evaluate the correlation between both questionnaires in SLE patients and to evaluate the relation between this instruments and SLE disease activity. Methods Consecutive patients from our SLE unit were recruited in July and August 2018. The following variables were assessed: age, gender, ethnics, disease duration, occupation, monetary income, educational level, health insurance, place of residence, marital status, disease activity by SELENA-SLEDAI, accrual damage by SLICC-DI, current treatment and number of follow-up visits during the prior 12 months. Compliance was assessed by CQR19 (compliant if 80%) and by MG (compliant if=0). Continual variables are expressed as mean and DS or median and interquartile range according to distribution. Categorical variables are presented as n(%). Association was assessed by chi2 or logistic regression as appropriate. Statistical analysis was performed using SPSS v21. Results 70 consecutive patients were included. Baseline characteristics are shown in table 1. Sensitivity and specificity for MG to detect lack of compliance was 90% and 42% respectively. In our study, correlation between MG and CQR19 was found (RS=0.406, 0.01 bilateral; p=0.0005). However, none correlated with SELENA-SLEDAI, SLICC-DI. Both CQR19 and MG correlated with age (rs=0,272 :p=0023 and rs=0,471 :p=0,0000 respectively). Conclusions MG, counting only four questions, is simpler to perform than CQR19. In our study, we found good correlation between both questionnaires. Having found no correlation between compliance defined by either tool and SLE activity or accrual damage, we believe that the routine use of these tools has no influence in terms of therapeutic management in SLE patients. Funding Source(s): None

Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which inflammation is mediated by complement activation by immune complex deposit, leading to damage. Consumption of C3 and C4 complement fragments is accepted as a disease activity marker. The aim ofthis study is to describe clinical and serologic characteristics of SLE patients according to complement levels. Methods Our SLE electronic database was analyzed (Jan 2014–Aug 2016). We included patients 18 years, fulfilling ACR 1997/SLICC 2012 classification criteria, with at least one year follow-up and at least two complement levels determinations at different times during follow-up. Patients were classified in 4 groups, defined as following: Group 1 (normal C3 and C4 on all determinations), Group 2 (C3 and C4 below reference levels on all determinations), Group 3 (only C4 below reference levels on all determinations) and Group 4 (C3 and/or C4 on variable levels, with at least one determination below reference levels). Demographic data, disease activity by SELENA-SLEDAI, accrual damage by SLICC-DI, presence of anti DNAds and anti Sm antibodies and clinical manifestations were assessed. Statistical analysis was performed using Epi info v7. Correlation was assessed using chi2 or Fisher’s test appropriate. Results 149 patients were included. 95.3% female, mean age at diagnosis was 30.6 years (CI: 28,5 32,8), mean disease duration 9.7 years. Mean SLICC-DI by group: Group 1 1.0, Group 2 0.5, Group 3 1.3 and Group 4 0.6. All groups with hypocomplementaemia showed a higher SLEDAI respecting Group 1 (p=0.0013)(table 1) Presence of anti DNAds and anti Sm antibodies is shown in table 1. Respecting clinical manifestations, a significant difference was found in Lupus Nephritis (Group 1 36.8%, Group 2 44.1%, Group 3 78.6% and Group 4 36,4% (p=0.0002)) and hemolytic anemia (Group 3 28.6% and Group 1 17.6% (p: 0.0196))(table 1). Conclusions An association between C4 persistently below reference levels (Group 4) and anti DNAds antibodies and Lupus Nephritis was found. Group 3 patients may have a worse prognosis due to renal involvement. Complement levels during follow up could be used as a marker to assess nephritis risk in SLE patients. Funding Source(s): None

Background The idiopathic inflammatory myopathies (IIM) are rare systemic autoinmune diseases that affect the muscle and other organs. Ttraditionally, IIM encompasses polymyositis (PM) and dermatomyositis (DM), but progressively inclusion body myositis (IBM), Immune-mediated necrotising myopathy (IMNM), the antisynthetase syndrome (ASS) and connective tissue diseases-ovler myositis (CTD-OM) have been recognised within the IIM spectrum Objectives To compare the clinical characteristics and treatment in a IIM cohort from an Argentinian universitary hospital with the international IIM cohort EUROMYOSITIS Methods Descriptive, retrospective study. IIM patients defined by expert opinion followed in our centre between October 2007 and October 2017 were included. ASS was defined by the presence of arthritis, raynaud’s phenomenon, mechanic hands, elevated CK, muscle weakness, interstitial lung disease and/or presence of antisynthetase antibodies and, as in EUROMYOSITIS, patients with IIM with positive antisynthetase antibodies were reclassified as ASS. CTD-OM was defined as patients with IIM fulfilling classification criteria for other CTD. Demographic data, accumulated clinical features, time interval between disease onset and diagnosis, IIM subtype, treatment and presence of neoplasm were evaluated. Ethnicity was defined using the same classification as in EUROMYOSITIS Results 58 patients were included: DM 24, PM 4, ASS 10, CTD-OM 20. 89.6% Hispanic, mean age 48.4±15.2 years, median time interval between disease onset and diagnosis 5 months (IQR 2–11 months), been higher in AAS (8.5 months, IQR 1.5–18.2 months). 6,89% (4/58) patients presented associated neoplasm, 3 with DM and 1 with CTD-OM. Table 1 shows the demographic and clinical features of our IIM cohort and EUROMYOSITIS. Table 2 shows treatments received in our cohort and EUROMYOSITIS. Conclusions DM was the most frecuent IIM subtype in both cohorts. In our group, CTD-OM was second and ASS was third. Muscle weakness was found less frecuently in our DM and AAS than reported in EUROMYOSITIS. However, calcinosis was more frecuent. This could be explained by our mostly Hispanic population and/or by frecuent Systemic Sclerosis overlap in our patients. It’s important to remark that the ethnic variety defined as Hispanic in EUROMYOSITS has a complex composition in Latin America, due to interbreeding. No difference was found in therms of most frecuent treatments between both cohorts. However, use of IVIg was more frecuent in our patients. To our knowledge, this is the first comparative report of an argentinian single-centre IIM cohort and an international multi-centre cohort Disclosure of Interest None declared

Background Chikungunya fever is characterised by a high probability of persistent rheumatological manifestations, producing a negative impact in the work, social and economic fields. Objectives To determine the frequency and type of rheumatologic involvement in the subacute and chronic phase of Chikungunya fever. Methods Descriptive, cross-sectional study. We included patients>16 years old with Chikungunya infection (real time PCR, IgM or IgG for Chikungunya) who consulted consecutively for rheumatic symptoms/signs from March 2015 to March 2016. According to the time of evolution, the disease was divided in 2 Phases: acute (≤10 days of duration) and subacute/chronic (≥11 days). According to clinical presentation, patients were classified in two groups: 1) non-autoimmune rheumatologic compromise (NARC) and 2) autoimmune rheumatologic compromise (ARC). Current ACR/EULAR criteria for classification of autoimmune diseases were used. Results Two hundred and two patients were evaluated, 80 were excluded due to negative serology for Chikungunya. 122 were included: 107 (88%) female, mean age 52.52±13.19 years, and time of evolution of 116.66±91.61 days. Acute phase. 122 patients: fever 85 (69.67%), rash and pruritus 54 (44.26%), tenosynovitis 23 (18.8%), polyarthralgias 100 (82%) and arthritis 56 (45.90%). Chronic phase. 122 patients: 71 (58%) patients had a chronic persistent rheumatologic symptoms and 51 (42%) presented remission of symptoms but all of them presented subsequent recurrence in an 91±40 days. NARC in 33 patients (27%) and ARC in 89 (73%), with no significant differences in age and time of evolution was observed. NARC: 14 (42.4%) exacerbation of previous osteoarthritis pain, 9 (27.3%) developed fibromyalgia and 10 (30.3%) had localized soft tissue pain. ARC: 13 (14.6%) with a history of RA, SLE, psoriasis or DM reactivated the underlying disease and 76 (85.4%) developed ARC: Undifferentiated polyarthritis with negative antibodies 61 (80%), RA with positive antibodies 5 (6.5%), scleroderma 2 (2.6%), cutaneous vasculitis 2 (2.6%), polymyalgia rheumatica 1 (1.3%), Sjogren9s Syndrome 2 (2.6%), Dermatomyositis 1, Erythema nodosum 1 (1.3%) and vitiligo 1 (1.3%). Antibodies were requested according to clinical suspicion: FAN ≥320 in 5 patients, RF in 6, ACPA in 4 and anti RO in 1. Thyroid dysfunction was observed in 7 patients who had a previous normal thyroid profile. Conclusions The frequency of rheumatological manifestations post Chikungunya fever in our sample was high, and can trigger ARC. Patients presenting new immunological manifestations in an endemic area for Chikungunya fever should have a serologic test performed. This series of patients must be evaluated with long-term studies to define their evolution, under the possibility of developing definite autoimmune disease or remission. References Chikungunya Pathology and Cytokines. Chow et al. JID 2011. Disclosure of Interest None declared

Background Estimated prevalence of neuropsychiatric symptoms in SLE is among 17 to 71%1. Depressive symptoms are around 54%1,2. Fatigue is frequently referred, predicts high morbidity and may be influenced by lifestyle and individual psychological characteristics1. Objectives To evaluate the prevalence of depressive symptoms and its association with demographics and clinical variables in patients with SLE. To determine the predictive value of FACIT for fatigue in SLE vs controls. Methods Observational, retrospective case- control design. Patients ≥18 years old with SLE (ACR 97) were consecutively evaluated in our centre from January to July 2015. We analyzed age, disease duration, clinical manifestations, antibodies profile, SLEDAI (≥4 scored as active) and SLICC. We recorded familiar psychiatric diseases, educational and socioeconomic level (Graffar Scale), employment and marital status. Beck II and FACIT (IV version) questionnaires were used for evaluate depression and fatigue respectively. We tested two cut points for fatigue: Results 77 SLE and 100 controls, all female. SLE vs control group: Mean of age ys: 34 (19–49)vs 38 (19–60). Prevalence of depression: 52% (44/77) vs 29% (29/100) (p 0.05). Mean disease duration (months) 48 (24–114). Socio-demographic characteristics, SLICC/SLEDAI, clinical and serological manifestations were not correlated with major depression p>0.05. FACIT: Median value: 31 (range 22–40) SLE group. FACIT Conclusions Prevalence of depression was high in our cohort and similar to previously reported1. Our patients showed low levels of SLEDAI/SLICC. There was not relation between activity levels and baseline damage with the presence of depression4. FACIT IV scale was a good independent predictor of fatigue in SLE patients with or without depression vs controls. References L Palagini M et al Depression and systemic lupus erythematosus: a systematic review. Lupus 2013. Hugo FJ et al DSM-III-R classification of psychiatric symptoms in systemic lupus erythematosus. Psychosomatics 1996. Lai JS et al Validation of the Functional Assessment of Chronic Illness Therapy-Fatigue Scale in Patients with Moderately to Severely Active Systemic Lupus Erythematosus, Participating in a Clinical Trial Journal of Rheumatology 2011. Segui J et al Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: A longitudinal study of active and inactive stages of the disease. Lupus 2000. Disclosure of Interest None declared

Background Capillary bed of labial mucosa may be a potentially useful area for assessing abnormalities on the microcirculation. Videocapilaroscopy of the labial mucosa (LVC) in 12/13 scleroderma (SCL) patients showed capillaries disturbance such as great disorganization and anarchic orientation(1). Objectives To describe LVC features in SCL and compare them with healthy controls. (HC). To compare nailfold videocapillaroscopy (NVC) with LVC in HC and SCL patients. Methods ≥16 years old patients with SCL (ACR-EULAR 2013) were included consecutively since June to July 2016. Smoking patients were excluded. For the evaluation of the LVC we performed a general displaying and then we studied following areas: a-central (1 cm from the frenulum), b-lateral right and left (both 2 cm from the frenulum) and c-labial border. For evaluation of the NVC, 200x images were obtained from 2nd to 4th fingers both hands and was classified according Cutolo in early, active, late patterns(2). For assesment through LVC: photographs (200x) for each subject were taken. We define quantitative characteristics as means of: capillary diameter, length and density. The average of these parameters was obtained from the evaluation of capillaries included in 1 mm2 of at least 2 continuous images. In addition, the visibility of the subpapillary venous plexus, architecture, dilatation of capillaries, presence of megacapillaries and avascular areas were qualitatively evaluated (photo 1). Each image was reviewed by two experienced observers. We conducted the same process describe above for each healthy control subject. Results Twenty two patients were included (18 female, age 47±11 ys) with SCL (limited 17, diffuse 5); NVC pattern: early 8, active 11, late 3. Healthy subjects 12 (11 female, age: 34±10 years). Average capillary density: 17±4.13 (13–26) in SCL vs 21±3.65 (16–28) in HC (p 0.00). Average capillary diameter: 43±13.54 (17–83) SCL vs 19±1.67 μm (16–21) HC (p 0.02). Mean capillary length: 185±34 μm (125–248) SCL vs 237±42 μm (178–313) HC (p 0.00). In 22 SCL patients were observed dilated capillaries in 20 (90%), megacapillaries (≥70 μm) in 10 (45%) and 7 (32%) showed disturbed architecture with lost areas of the normal U-shape and changes in the parallelism of the main axis of the capillaries. About subpapillary venous plexus in SCL: 7 (32%) were prominent and only one had capillary hemorrhage. In contrast, none of the controls presented these alterations. (p 0.0). According to the 3 NVC patterns the following averages were observed in the LVC: Early Pattern (n: 8): diameter 36.93±10.84 μm; Long 191.21±47.58 μm; Density 18.12±5.33 μm. Active Pattern (n: 11): diameter 48.80±14.80 μm; Length 184.11±29.91 μm; Density 16.72±3.25 μm. Late Pattern (n: 3): diameter 36.27±10; Long 178.03±28.8 μm, density 19.33±4.16 μm. Conclusions We found that LVC in SCL patients show significant microvascular changes with respect to HC. In addition, all NVC patterns described in SCL showed similar alterations in LVC. Therefore, LVC could be a complementary or alternative method to NVC since it is easily accessible, has good visibility and is not influenced by local mechanical or chemical stimuli that can affect the nail bed. References W Grassi et al. Ann Rheum Dis 1993; 52 (8): 564–569. M. Cutolo et all. Rheumatology 2006; 45: 43–46. Disclosure of Interest None declared

Background Systemic Lupus Erythematosus (SLE) may associate with flares, an unfavorable course and the need of teratogenic treatment during pregnancy. Not every contraceptive method (CM) may be used in this patients. There are guidelines for their use according to existing morbidity and SLE activity 1 . Objectives Describe the use of CM in a cohort of outpatients with SLE Methods Descriptive, observational, cross-sectional study. Patients ≥16 years old with SLE (SLICC 2012) and ≥1 visit during the last year of our database were included. Those with menopause were excluded. We analyzed demographic data; disease duration; antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) (Sapporo 2006); socioeconomic status (Graffar scale); disease activity (SELENA-SLEDAI) and accrual damage (SLICC); use of teratogens: Methotrexate (MTX), Mycophenolate (MYC), Cyclophosphamide (CYC), biologic drugs (BD), self-reported sexual status (active/non active) and CM: intrauterine device (IUD), condom (Cdm) and hormonal contraceptive pill (CP). Results 132/219 were included. Female 91.6%, age: 30.1 (16–49) years, disease duration: 38.5 (1–324) months, SELENA-SLEDAI: 3.5 (0–29), SLICC: 0.5 (0–5). Sexual status and use of CM: were available for 120 patients. Sexually active (SA) 73%, female 77%. CM in SA patients: 74%: 5% CP, 77% Cdm and 18% IUD. CM in female patients stratified by Graffar (GF): GF I (n=1): none SA; GF II: (n=19): 84% SA, 75% of them used CM (75% Cdm, 25% IUD); GF III (n=33): 82% sexually active, 81% used CM (86% Cdm, 14% IUD), GF IV (n=41) 75% SA, 68% used CM (9% CP, 71% Cdm, 19% IUD), GF V (n=4) 100% SA, 50% used CM (50% CP, 50% Cdm); GF NA (n=11) 55% SA, 83% used CM (80% Cdm, 20% IUD). CM in female patients stratified by SLE activity: SLEDAI 12 (n=60): 60% SA, 67% used CM (100% Cdm). CM in female patients using teratogenic drugs: MTX (n=8): 100% SA, 75% of them used CM (17% CP, 66% Cdm, 17% IUD); MYC (n=20): 80% SA, 88% used CM (71% Cdm, 29% IUD); CYC (n=3): 33% SA, 100% used CM (100% Cdm); Belimumab (n=1): 100% SA, 100% surgical CM (tubectomy). aPL was evaluated in 96/132 patients. 17/96 had positive aPL and 5/17 fulfilled APS criteria. 2/17 patients had no CM data available, none with APS. 9/17 patients with aPL were female, 55% SA and all of them used Cdm. 3/5 patients with APS were female, all SA, 66% used Cdm. Conclusions Condom was the most reported CM. Use of CM was more frequent in the upper social stratus (GF I-III) respect to the lower (GF IV-V). The proportion of sexually active female patients was similar in those using teratogenic drugs compared with who had not used them. The self-reported sexual status was similar despite of SLEDAI stratification, being similar in patients with low or high disease activity. We deem necessary education, counseling and evaluation of use of the CM in every visit of patients with SLE. References Andreoli L, Bertsias GK, Agmon-Levin N, et al. Ann Rheum Dis, doi:10.1136/annrheumdis-2016–209770. Disclosure of Interest None declared

Background Systemic lupus erythematous (SLE) have an increase cardiovascular risk, worsened by overweight and obesity. Increased BMI is associated with other severe complications and comorbidities as lupus nephritis, hypertension, insulin resistance and dyslipemia. Body weight is a modifiable risk factor. Objectives To determine the frequency of overweight and obesity in patients with SLE and their impact on this disease Methods Descriptive, cross-sectional study. We reviewed the medical records of outpatients with SLE (ACR 1997) who were seen since 2014 to 2016 in the Clinical Hospital of Buenos Aires, Argentina. We evaluated sex, age, disease duration, obstetric history, use and doses of oral corticosteroids, BMI, 25 OH vitamin D and educational level. Disease activity was scored by SLEDAI. Scores ≥4 were classified as active. The patients were classified into 2 groups, according to BMI: normal weight (NW) (19–25), overweight and obesity (≥25). Results One hundred and sixty two of 230 were evaluated. Sixty-eight patients were excluded due to lack of data. 157 (97%) were women. Mean age for both sexes was 40.6±14.3 years (p 0.70). Means of: SLEDAI 4.3±4.47 (54.9% had SLEDAI ≥4), IMC: 27.04±5.22 (56% had a BMI ≥25) and 25-hidroxivitamin D was 25.15±9.0. Relation between 2 groups, according to BMI: 84.5% whom were in NW group have received steroids at some point vs 95.6% in BMI≥25 group (p 0.02). Mean steroids doses: BMI ≥25: 9.53±10.98 vs 5.0±7.2 in NW group (p 0.04). Multivariate analysis showed that BMI ≥25 continued significantly associated with SLE duration, independently of the steroids use and other variables. 25 OH vitamin D tended to be lower in BMI ≥25 vs NW, but no significant differences (24.53±9.91 vs 25.50±9.85) (p=0.071) Conclusions Over a half of our cohort had BMI ≥25 and was characterized by older age, more frequent menopause, longer course of the disease, increased steroid use and lower educational level. Depression and hypertension were the statistically more frequent comorbidities found. Obesity was associated with more activity and accrual damage including chronic renal disease. Disclosure of Interest None declared

Background and Aims Systemic Lupus Erythematosus (SLE) and its treatment predispose to infections such as human papillomavirus (HPV) that is a risk factor for the development of lower genital tract (LGT) and anal cancers. To assess LGT- anal lesions, frequency of HPV lesions and premalignant and malignant lesions. Methods Descriptive, cross-sectional design. Women with SLE (ACR 1997) of Argentina were consecutively sent to examination of the LGT and high-resolution anoscopy (2010–2015). Biopsies were performed according to gynaecological criteria and patient consent (Bethesda). Koilocytic cells were associated with HPV. Three Socioeconomic status (SES) groups were established (Graffar). EditorResults 73 SLE patients and 104 healthy control were included. Table 1: Demographics characteristics. SLE patients 25/73 (34.3%) had HPV versus 6/104 (5.8%) in the control group (p=0.00). In the SLE-HPV were found statistically significant differences in: low SES, sexual partners≥5, antiDNA+ and low complement and a trend to low educational level (p=0,07). At check data the average dose of steroids was 10.8 Mg/d (SLE-HPV) vs 2.9 Mg/d in without HPV (p=0.00) while 61% (HPV group) vs 29% (without HPV) were receiving immunosupressors (IS) (Table 2) Non-differences were found related to duration of SLE, smoking, beginning of sexual intercourse, condom use and anal or oral intercourse. Conclusions The frequency of HPV was high in women with SLE. We remark oligo/asymptomatic HPV and its association with low SES, serological activity and treatment. As we detected a high frequency of sole anal lesions we highlight the anoscopy regardless of symptoms.

In systemic lupus erythematosus (SLE), the respiratory system is frequently compromised. One of its uncommon manifestations is the shrinking lungs syndrome (SLS), characterised by dyspnoea, diaphragmatic elevation and a restrictive pattern in the spirometry. We report two cases affected with this rare entity. They presented with different degrees of respiratory involvement and responses to the therapy. At the same time, clinical, physiopathological, prognostic and therapeutic aspects of this syndrome are reviewed.

Two general schemes for the synthesis of isotope labelled monomethyl catecholamine metabolites are described. Catechol was converted to 2-methoxy-d3-phenol (2) with deuteromethyl iodide and reacted with sodium glyoxylate to form 4-hydroxy-3-methoxy-d3-mandelic acid (3). Hydrogenolysis of the methyl ester-diacetate of 3 with excess sodium borohydride in water yielded 4-hydroxy-3-methoxy-d3-phenylacetic acid (4). Reduction of 3 with diborane produced 4-hydroxy-3-methoxy-d3-phenylethylene glycol (5). An alternative route was to alkylate 3,4-dihydroxybenzaldehyde (6) and produce 3 or its 3-hydroxy-4-methoxy isomer via the nitrile mandelic acid synthesis. Suitability of these isotopic and isomeric variants as internal standards for quantitation by gas chromatography-mass spectrometry is discussed.