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BackgroundANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology. In the most severe cases AAV can lead to end stage kidney disease or death. Since etiology and detailed pathogenesis of AAV is not known, the prediction of disease outcome at the time of diagnosis is challenging. Thus, there is an unmet need for tools to identify patients with the highest risk of organ dysfunction and death and apply effective personalized therapy.ObjectivesThe aim of this work was to search for tools allowing outcome prediction at the time of AAV diagnosis. Early identification of patients, who are likely to develop severe organ dysfunction and death is crucial for appropriate disease management. Induction therapy in AAV relays on immunosuppressive drugs characterized by a high risk of severe side effects. Thus, their administration in high doses should be limited only to individual patients with an especially high risk of poor outcome.MethodsWe applied here two methods of identification of AAV patients at risk to develop severe organ dysfunction and death. First method (latent class analysis [LCA] followed by logistic regression) was meant to subcategorize patients and identify a subgroup at subjects at risk to develop chronic renal replacement therapy (CRRT) and death [1]. Second, served to assess individual poor outcome risk and was based on two machine learning (ML) classifiers, which by analyzing clinical information allow assigning computed risk for CRRT and death in an individual patient allowing to identify subjects with high risk of chronic replacement therapy (CRRT) and death. We have evaluated a number of different approaches to build the ML models (including logistic regression, support vector machines, random forests), and obtained the best results for the gradient boosting algorithm implementation called LightGBM [2]. It works as a sequential ensemble of so-called weak learners (decision trees) finally combined in a one prediction model. Both analyses were based on retrospective data from Polish national AAV registry (POLVAS) [3] including presently 565 GPA and 135 MPA patients. The parameters used were: demographic data and laboratory parameters, specific organ involvement, ANCA specificity and time between selected stages of the disease.ResultsLCA used on our AAV cohort identified four subphenotypes – three already previously proposed - and revealing a fourth clinically relevant subphenotype. This new subphenotype includes only GPA patients, usually diagnosed at a younger age as compared to other groups, and characterized by multiorgan involvement, high relapse rate, relatively high risk of death, but no end-stage kidney disease. Logistic regression analysis revealed significant differences in the risk of CRRT and death between those subphenotypes – the worst prognosis was found for severe MPO AAV. On the other hand, using ML approach we obtained an individual prediction model with potentially relevant clinical performance (ROC AUC of 0.85 for CRRT and 0.82 for death).ConclusionWe consider results obtained encouraging. They may offer a new insight into AAV course based on data available at diagnosis, and create a solid foundation for potential clinical decision support system.References[1]Wójcik K et al. Subphenotypes of ANCA-associated vasculitis identified by latent class analysis. Clin Exp Rheumatol. 2021 Mar-Apr;39 Suppl 129(2):62-68.[2]Ke G, at al. Light GBM: A Highly Efficient Gradient Boosting Decision Tree. Advances in Neural Information Processing Systems 30 (NIPS 2017), pp. 3149-3157.[3]Wójcik K et al. Clinical characteristics of Polish patients with ANCA-associated vasculitides-retrospective analysis of POLVAS registry. Clin Rheumatol. 2019 Sep;38(9):2553-2563.AcknowledgementsThis work was supported by a grant from Polish National Science Center UMO-2018/31/B/NZ6/03898Disclosure of InterestsNone declared

Objectives The aim of the study was to assess the influence of different factors, including treatment, on the risk of ILD in the course of RA. Methods A total of 109 RA patients were included in the analysis. High-resolution computed tomography (HRCT) of chest was obtained in each patient. Patients were classified as having ILD (ILD group) or not (N-ILD group). The ILD was graded using the semi-quantitative Warrick scale of fibrosis. Warrick extent score (WES) and Warrick severity score (WSS) were calculated separately for each patient, then combined to obtain a global score (WGS). Results In univariate analysis the presence of ILD was associated positively with age (P = 5x10-6) and negatively with MTX treatment (P = 0.0013), mean MTX dose per year of treatment (P = 0.003) and number of DMARDs used (P = 0.046). On multivariate analysis only age and treatment with MTX were independently associated with the presence of ILD. WGS was significantly lower in patients treated with MTX in a dose of ≥15 mg/week (MTX≥15 group) as compared to patients treated with lower doses of MTX (0P = 0.04 and P = 0.037, respectively). The ILD prevalence was higher in N-MTX group than in 0P = 0.0036) and MTX≥15 group (0.0007). The difference in ILD prevalence between MTX≥15 and 0P = 0.044) and trended to have higher WSS and WGS. Consclusions We found a beneficial effect of MTX on RA-ILD. Importantly, this effect seems to be dose dependent.

INTRODUCTION ANCA-associated vasculitides (AAV) is a group of rare disorders where inflammation and damage of the small blood vessels lead to dysfunction of the supplied organs. In severe flares of the disease patients may require intensive care unit (ICU) admission and treatment. The study aims to characterize Polish patients with AAV who were admitted to the ICU and compare them to the others. MATERIAL AND METHODS An observational, retrospective study based on the POLVAS - registry of Polish adult patients with AAV was carried out. Patients admitted to the ICU (ICU group) were identified and compared with the patients who did not require ICU admission (non-ICU group). Characteristics and comparison between groups were made using standard statistic descriptive methods. RESULTS 30 patients admitted to the ICU were identified among 573 cases included in the registry. All patients in the ICU group with available data were ANCA positive. The clinical manifestations related to the ICU admission were respiratory, renal and central nervous system involvement. The treatment regimen for remission induction was similar in both groups. Almost half of the patients in the ICU-group (48.3%) required dialysis, whereas in the non-ICU group it was 21.8% (P = 0.01). Infections were also more frequent in the ICU group (72.4% vs. 36.9% P < 0.001). The mortality rate among patients who needed ICU treatment was significantly higher when compared to the rest of the patients (53.6% vs. 7.8%; P < 0.001). CONCLUSIONS In the Polish AAV cohort one in twenty patients required ICU admission. This group was characterized by multiple organ involvement and high mortality.

Background:ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology and the broad clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Unfortunately the clinical classification, ANCA specificity or genetic characteristics alone is not able to categorize AAV patients in a satisfactory manner. As a consequence advanced statistical techniques were used to identify and stratify AAV subphenotypes [1, 2]. Here we have analyzed influence of the ANCA type on clinical manifestations and demographic characteristics in various types of AAV, based on data from the POLVAS registryObjectives:We decided to retrospectively analyze a large cohort of Polish AAV patients deriving from several referral centers – members of the Scientific Consortium of the Polish Vasculitis Registry (POLVAS) – and concentrate on demographic and clinical characteristics of anti-PR3 and anti-MPO positive patients regardless of their clinical diagnosis.Methods:We conducted a systematic multicenter retrospective study of adult patients diagnosed with AAV between Jan 1990 and Dec 2016. Patients were enrolled by 9 referral centers. We analyzed dichotomous variables: gender; ANCA status – anti-PR3+ or anti-MPO+, ANCA negative; organ involvement - skin, eye, ENT, respiratory, heart, GI, renal, urinary, CNS, peripheral nerves and polytomous variable (number of relapses), supported by quantitative covariates (e.g., age at diagnosis, CRP at diagnosis, maximal serum creatinine concentration ever)[3].Results:MPO-positive patients (both GPA and EGPA phenotype) were older at the time of diagnosis with a substantial percentage diagnosed > 65 years of age, and with high rate of renal involvement. Interestingly, while in the whole group of patients diagnosed with EGPA male to female ratio was 1:2, the MPO+ EGPA patients showed M:F ratio of 1:1.The analysis of ANCA negative AAV reveled significant differences in GPA, ANCA negative group is characterized with significantly lower frequency of renal involvement compared to rest GPA (11,5% vs 63,7%) pConclusion:ANCA specificity is indispensable as a separate variable in any clinically relevant analysis of AAV subcategories. MPO+ group is characterized by older age at time of diagnosis, male to female ration 1:1, kidney involvement, and shows more homogenous clinical phenotype than PR3+ AAV patients. In our group ANCA negative AAV never lead to ESRD (end stage renal disease) or even transient dialysis.References:[1]Mahr A, Specks U, Jayne D. Subclassifying ANCA-associated vasculitis: a unifying view of disease spectrum. Rheumatol Oxf Engl 2019;58:1707–9. https://doi.org/10.1093/rheumatology/kez148.[2]Wójcik K, Biedroń G, Wawrzycka-Adamczyk K, Bazan-Socha S, Ćmiel A, Zdrojewski Z et al. Subphenotypes of ANCA-associated vasculitis identified by latent class analysis. Clin Exp Rheumatol. 2020 Sep 1. Epub PMID: 32896241.[3]Wójcik K, Wawrzycka-Adamczyk K, Włudarczyk A, Sznajd J, Zdrojewski Z, Masiak A, et al. Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clinical Rheumatology. 1 wrzesień 2019;38(9):2553–63.Disclosure of Interests:None declared

Purpose The aim of this study is to present the treatment modalities and associated side effects in a Polish nation-wide ANCA-associated vasculitides (AAV) patients’ cohort. Materials and methods Retrospective analysis of patients diagnosed with AAV between 1990 and 2016, included in the POLVAS registry was performed. Standard descriptive statistic methods were used with an emphasis on the treatment modalities. Results There were 625 patients diagnosed with AAV included in this study: 417 cases of granulomatosis with polyangiitis (GPA; 66.7%), 106 cases of microscopic polyangiitis (MPA; 17.0%) and 102 cases of eosinophilic granulomatosis with polyangiitis (EGPA; 16.3%). The mean age at the date of diagnosis was 50.4 (±15.7) years and the median observational period amounted to 4.0 (2.0–8.0) years. Glucocorticosteroids (GCs) were the medicaments most frequently used for remission induction (593/622; 95.3%), followed by cyclophosphamide (487/622; 78.3%), rituximab (44/622; 7.1%), and methotrexate (39/622; 6.3%). GCs were also most frequently administered for maintenance therapy (499/592; 84.3%), followed by azathioprine (224/592; 37.8%), methotrexate (136/592; 23.0%) and mycophenolate mofetil (99/592; 16.7%). The median cumulative doses of cyclophosphamide and rituximab equalled 7.99 g (4.18–14.0) and 2000 mg (1500–2800), respectively. The most commonly observed adverse events included: infections - 214/551 cases (38.8%), which were associated with the time of observation (OR = 1.05; 95% CI 1.01–1.10), the use of GCs intravenous pulses (OR = 2.76; 95% CI 1.68–4.54) and need for haemodialysis (OR = 1.73; 95% CI 1.10–2.71). Conclusions Polish patients with AAV were predominantly treated according to appropriate guidelines. The most frequent adverse events were typical for usually administered immunosuppressive treatment.

Objective Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare small to medium-size vessel systemic diseases. As their clinical picture, organ involvement, and factors influencing outcome may differ between countries and geographical areas, we decided to describe a large cohort of Polish AAV patients coming from several referral centers-members of the Scientific Consortium of the Polish Vasculitis Registry (POLVAS). Methods We conducted a systematic multicenter retrospective study of adult patients diagnosed with AAV between Jan 1990 and Dec 2016 to analyze their clinical picture, organ involvement, and factors influencing outcome. Patients were enrolled to the study by nine centers (14 clinical wards) from seven Voivodeships populated by 22.3 mln inhabitants (58.2% of the Polish population). Results Participating centers included 625 AAV patients into the registry. Their distribution was as follows: 417 patients (66.7%) with GPA, 106 (17.0%) with MPA, and 102 (16.3%) with EGPA. Male-to-female ratios were almost 1:1 for GPA (210/207) and MPA (54/52), but EGPA was twice more frequent among women (34/68). Clinical manifestations and organ involvement were analyzed by clinical phenotype. Their clinical manifestations seem very similar to other European countries, but interestingly, men with GPA appeared to follow a more severe course than the women. Fifty five patients died. In GPA, two variables were significantly associated with death: permanent renal replacement therapy (PRRT) and respiratory involvement (univariate analysis). In multivariate analysis, PRRT (OR = 5.3; 95% confidence interval (CI) = 2.3–12.2), respiratory involvement (OR = 3.2; 95% CI = 1.06–9.7), and, in addition, age > 65 (OR = 2.6; 95% CI = 1.05–6.6) were independently associated with death. In MPA, also three variables were observed to be independent predictors of death: PRRT (OR = 5.7; 95% CI = 1.3–25.5), skin involvement (OR = 4.4; 95% CI = 1.02– 19.6), and age > 65 (OR = 6.3; 95% CI = 1.18–33.7). Conclusions In this first multicenter retrospective study of the Polish AAV patients, we have shown that their demographic characteristics, disease manifestations, and predictors of fatal outcome follow the same pattern as those from other European countries, with men possibly suffering from more severe course of the disease.

Background:Rituximab (RTX) is a B cell depleting monoclonal antibody with proven efficacy in the treatment of ANCA-associated vasculitis (AAV). The infectious complications occur in 15-25%.Objectives:We aimed to assess the frequency and risk factors of infections in patients with AAV receiving RTX among Polish patients.Methods:7 tertiary referral centers experienced in the treatment of vasculitis completed a questionnaire regarding AAV patients treated with RTX.Results:Among 49 patients included in the analysis (47 with GPA, 2 with MPA; 36/73% men; mean age at diagnosis 42,45±14,9 yrs., mean age on RTX initiation 46,14±14,72 yrs.,) at least one infection occurred in 20 patients (40.82%) after mean time of 16,65±16,01 weeks since the administration of RTX. Patients were followed for a mean time of 26,88±21,94 months. There were no differences in the incidence of infectious complications by gender, age, BMI, smoking status, severity of the disease, activity of the disease (BVAS), time from diagnosis to RTX initiation, carriage of staphylococcus aureus in the upper respiratory tract, total dose of CYC before RTX treatment. We didn’t observe severe hypogammaglobulinemia or neutropenia after RTX treatment. 40% of the observed infections occurred during the first month, 35% between second and sixth month of follow-up, while 25% were observed between 6 and 12 months after the RTX initiation. Of the 20 patients who developed infection, 12 (24.5%) had further infections. Antibiotic prophylaxis with trimethoprim–sulfamethoxazole was administered in 40 out of 49 (81.63%). Upper respiratory tract infection was the most common infectious complication (n=11), followed by lower respiratory tract (n=4), soft tissues (n=4) and urinary tract infections (n=4), lacrimal gland abscess (n=2) and abdomen (n=1). In cases with a positive microbial result Staphylococcus aureus (n=4), Klebsiella pneumoniae (n=2), Pseudomonas aeruginosa (n=1), Candida (n=1) and others (n=6) were identified. No fatalities were recorded and only 3 patients had severe infection with the necessity of prolonged treatment.Conclusion:Despite the high number of infections in our group treated with RTX, most of them were not severe. Upper respiratory tract was the most common site of infection.Disclosure of Interests:None declared

Background:ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus there is an unmet need for phenotype identification especially among patients with granulomatosis with polyangiitis GPA, patients with microscopic polyangiitis MPA group seems to be more uniform. Recently, based on previous clustering analysis and clinical, histopathological, serological and prognostic aspects three subcategories of AAV have been proposed and named as: non-severe AAV, severe PR3-AAV and severe MPO-AAV [1].Objectives:In line with these attempts to subcategorize AAV we decided to use latent class analysis (LCA) on a large multicenter cohort of polish AAV patients from POLVAS [2] registry to identify potential new subphenotypes or confirm already proposed ones.Methods:Latent Class Analysis (LCA) approach was used as a model based clustering method of objects described by dichotomous (e.g., gender; ANCA status – cANCA, pANCA; organ involvement - skin, eye, ENT, respiratory, heart, GI, renal, urinary, CNS, peripheral nerves) and polytomous (number of relapses) variables supported by quantitative covariates (e.g., age at diagnosis, CRP at diagnosis, maximal serum creatinine concentration ever).Results:Results of LCA on our AAV group returned four class model of AAV subphenotypes, confirming existence of the previously proposed by Mahr at al. [1] and revealed fourth – previously not described clinically relevant subphenotype. To this fourth class - belong patients only with GPA, diagnosed at young age, with multiorgan involvement, high relapse rate and relatively high risk of death.Table 1.AAV subcategorization – summary of clinical characteristics and ANCA specificityLCA Class 1LCA Class 2LCA Class 3LCA Class 4No of patients13019410297AAV typeMainly GPAMainly GPAmainly MPAOnly GPAAge at diagnosisMiddle ageMiddle ageOldYoungMale/female ratio1:22:11:11:1Main organ involvementENT, respiratory, eyeRenal, respiratory, ENTRenal, respiratory, skinMultiorgan involvementRelapse rateintermediateintermediatelowhighModified class description (based on ref. [1])Non severe AAVSevere PR3 AAVSevere MPO AAVSevere non-renalPR3 AAVConclusion:Based on multiple clinical and serological variables LCA methodology identified 4-class subphenotypes model of AAV. Fourth-class is a new clinically important subphenotype including exclusively PR3-positive young AAV patients with multiorgan involvement, high risk of relapse and distinct mortality.References:[1]Mahr A, Specks U, Jayne D. Subclassifying ANCA-associated vasculitis: a unifying view of disease spectrum. Rheumatol Oxf Engl 2019;58:1707–9.https://doi.org/10.1093/rheumatology/kez148.[2]Wójcik K, Wawrzycka-Adamczyk K, Włudarczyk A, Sznajd J, Zdrojewski Z, Masiak A, i in. Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clinical Rheumatology. 1 wrzesień 2019;38(9):2553–63.Disclosure of Interests:Krzysztof Wójcik: None declared, Adam Ćmiel: None declared, Anna Masiak: None declared, Zbigniew Zdrojewski: None declared, Radoslaw Jeleniewicz: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen, Iwona Brzosko: None declared, Marek Brzosko: None declared, Piotr Głuszko: None declared, Małgorzata Stasiek: None declared, Małgorzata Wisłowska: None declared, Joanna Kur-Zalewska: None declared, Marta Madej: None declared, Anna Hawrot-Kawecka: None declared, Hanna Storoniak: None declared, Barbara Bułło-Piontecka: None declared, Alicja Dębska-Ślizień: None declared, Eugeniusz Kucharz: None declared, Katarzyna Jakuszko: None declared, Jacek Musiał: None declared

Background:Orbital inflammatory masses have been described as the common manifestation of granulomatosis with polyangiitis (GPA) occuring in 7- 45% of patients.Objectives:Identification and characterization of patients with orbital pseudotumor among Polish patients based on the national vasculitis registry, POLVAS.Methods:Clinical presentation and management of all GPA patients fulfilling ACR criteria or Chapel Hill Consensus Conference definition included to the Polish registry POLVAS who developed orbital masses in the course of GPA were evaluated.Results:Ocular involvement was found in 114 (27%) of 417 GPA patients registered in POLVAS, 34 (8%) developed orbital masses. Mean patients’ age was 47.8 (range from 19-75) yrs., 23 (67%) were women. Forty four per cent of the patients developed tumor at the beginning of the disease, 56% during relapse. Patients’ characteristics on diagnosis of orbital mass: 24 cANCA, 2 pANCA, and 8 ANCA negative, 9% active smokers and 31% past smokers, 29% had localized disease, 21% early systemic and 50% systemic with organ involvement, 29% had other type of ophthalmological involvement before pseudotumor occurred, 88% had active paranasal sinus involvement, 41% lungs, 15% CNS, 15% skin and 6% heart manifestations. Thirty seven per cent of patients had positive nasal swabs cultures, 50% of which were positive for Staphylococcus aureus. In 65%, tumor occurred during steroid therapy (46% had prednisone more than 5mg/d) and 45% on immunosuppressive treatment (19% when treated with AZA, 16% MTX, 6,5% MMF and 3,5% CYC). Due to orbital mass 86.5% were treated with CYC and 13.5% with RTX. Twenty one per cent had complete remission of the pseudotumor, 76% partial remission and in 3% patients there was no response to the treatment; 43% developed visual impairment, 20% suffered from blindness.Conclusion:Orbital inflammatory mass was not common manifestation of GPA among our patients. The mass developed at the beginning or in the course of the disease, even during immunosuppressive treatment. Orbital masses have been resistant to therapeutic interventions and were accompanied by high risk of visual impairment.Disclosure of Interests:Anna Masiak: None declared, Marcin Ziętkiewicz: None declared, Krzysztof Wójcik: None declared, Katarzyna Wawrzycka-Adamczyk: None declared, Radoslaw Jeleniewicz: None declared, Marta Madej: None declared, Joanna Kur-Zalewska: None declared, Katarzyna Jakuszko: None declared, Małgorzata Wisłowska: None declared, Hanna Storoniak: None declared, Michał Komorniczak: None declared, Barbara Bułło-Piontecka: None declared, Iwona Brzosko: None declared, Małgorzata Stasiek: None declared, Eugeniusz Kucharz: None declared, Alicja Dębska-Ślizień: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen, Jacek Musiał: None declared, Zbigniew Zdrojewski: None declared

Background Vascultides are a heterogeneous group of rare diseases with unknown etiology and the clinical spectrum ranging from life–threatening systemic disease to minor isolated skin changes. Present nomenclature and definitions of systemic vasculitides have been proposed in 2012 at the International Chapel Hill Consensus Conference. 1 Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) belong to the small to medium-size vessel systemic diseases comprising granulomatosis with polyangitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Objectives We decided to retrospectively analyse a large cohort of Polish AAV patients coming from referral centres – members of the Scientific Consortium of the Polish Vasculitis Registry (POLVAS). 2,3 Methods We conducted a systematic multicenter retrospective study of adult patients diagnosed with AAV between Jan 1990 and Dec 2016 Patients were enrolled to the study by 9 referral centres (14 clinical wards: – rheumatology – 10, nephrology – 2, metabolic diseases – 1, clinical immunology −1) from 7 Voivodships populated by 22,3 mln inhabitants (58,2% of the Polish population). Patient data have been collected according to the uniform protocol in the POLVAS registry. Results Distribution of AAV in the Polish population resembles that of north European cohorts. 4 In POLVAS registry 417 (66.7%) patients were diagnosed with GPA, 106 (17.0%) with MPA and 102 (16,3%) with EGPA. Male-to-female ratios were almost 1:1 for GPA (210/207) and MPA (54/52), but EGPA wasd twice more frequent among women (34/68). Clinical manifestations and organ involvement were analysed both by clinical phenotype (GPA, MPA, EGPA) and ANCA specificity (anti-PR3+, and anti-MPO+)Analysis by ANCA specificity showed no apparent difference as compared to phenotype analysis. Clinical manifestations of different AAV in the polish population seems very similar to other European countries. Conclusions This is the first multicenter retrospective study of the Polish patients sufferng from with AAV. Demographic characteristics and disease manifestations of AAV patients in POLVAS registry follow the same pattern as those from other European countries. 4 References [1] Jennette JC, et al. Arthritis Rheum2013Jan;65(1):1–11. [2] Padjas A, et al. Pol Arch Med Wewn2014;124(3):143–4. [3] Musiax J, Wojcik K. Pol Arch Intern Med2017Jan 31;127(1):71–72. [4] Bajema, et al. Kidney Int Rep2017;1018–1031. Disclosure of Interest None declared

Background Early change in body composition is one of the risk factors of CVD in rheumatoid arthritis (RA). These changes have been atributed to inflammation and decreased physical activity. Glucocorticosteroids (GCS) reduces inflammation but may influence body composition. There is limited information about the effects of low-dose GCS on body composition in early RA. Objectives The aim of the study was to assess the presence of altered body composition in patients with early rheumatoid arthritis (eRA) and to determine whether low-dose prednisone affects body composition. Methods 65 consecutive eRA patients (49 women) aged 61±14 years were assessed at the time of diagnosis and after 12 months of treatment. All the patients had been treated with methotrexate (target dose 25–30mg/week) and tapered doses of prednisone (mean dose 4.8±3.4 mg/day). Disease activity score (DAS28), Health Assesment Questionnaire (HAQ), body mass index (BMI), waist/hip ratio, comorbidities, physical activity and smoking were recorded. Total and regional lean mass and fat mass were measured with dual energy X-ray absorptiometry (DXA). DXA measures were repeated after 12 months in 34 patients (24 women) and compared with baseline data. Results At baseline fat free mass index (FFMI; kg/m2) was below the 10th percentile of a reference population in 32% of the women and 25% of the men. Reduced FFMI correlated with baseline ESR. Fat mass index (FMI) was above 90th percentile in 28% of the women and 42% of the men. Fat mass index (FMI;kg/m2) correlated with HAQ, age and femoral BMD in women. After 12 months FFMI and FMI did not change significantly. There was no correlation between prednisone doses and the duration of prednisone treatment and changes in regional lean mass and fat mass. The decrase of FFMI (in 16 patients) was associated with higher mean ESR and lower vitamin D3 serum concentration. Conclusions Low FFMI was common in patients with eRA. The treatment with low-dose glucocorticosteroids did not influence altered body composition during the first year of eRA therapy. References Book C, Karlsson MK, Nilsson JA et al. Changes in body composition after 2 years with rheumatoid arthritis. Scandinavian Journal of Rheumatology 2011(40:2); 95–100. Schtz Y, Kyle UUG, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y. International Journal of Obesity 2002(26);953–960. Engvall IL, Brisman K, Hafstrom I et al. Treatment with low-dose prednisolone is associated with altered body composition but no difference in bone mineral density in rheumatoid atrhritis patients: a controlled cross-sectional study. Scandinavian Journal of Rheumatology 2010(40:3)161–168. Disclosure of Interest None declared

W artykule przedstawiono sytuacje szczególne w leczeniu tocznia rumieniowatego układowego, w tym okres ciąży, oraz istotne klinicznie choroby współistniejące, tj. wtórny zespół antyfosfolipidowy i tętnicze nadciśnienie płucne.

Plamica Schönleina-Henocha to zapalenie małych naczyń, które występuje głównie u dzieci i zwykle wiąże się u nich z dobrym rokowaniem. Znacznie rzadziej choroba występuje u dorosłych, u których często ma cięższy przebieg. W pracy przedstawiono przypadek 65-letniej pacjentki z plamicą Schönleina-Henocha o burzliwym przebiegu, z zajęciem przewodu pokarmowego oraz nerek, a także typowymi objawami skórnymi i stawowymi. U chorej stosowano leczenie glikokortykosteroidami, cyklofosfamidem, leczenie nerkozastępcze; konieczna okazała się również interwencja chirurgiczna. Pomimo zastosowanego złożonego leczenia stan chorej się pogarszał. Choroba zakończyła się zgonem pacjentki. Przedstawiony przypadek zwraca uwagę na możliwość wystąpienia i ciężkiego przebiegu zapalenia naczyń tego typu u pacjentów dorosłych.

Introduction: The aim of the study was to investigate the presence of subclinical atherosclerosis and predictors of change in carotid intima-media measures in early rheumatoid arthritis patients (eRA) as compared to chronic RA patients and patients without arthritis. Material and methods: Fifty-five consecutive eRA patients were assessed at the time of diagnosis and after 1 year of therapy. Fifty-five sex- and age-matched chronic RA patients and 29 patients without inflammatory disease were used as controls. Carotid artery intima-media thickness (CIMT) and carotid plaques were measured at baseline and after follow-up. In eRA patients ultrasound assessment of hand joints was performed before and after treatment. Carotid artery intima-media thickness was assessed again after 2 years in 44 eRA patients. Results: Carotid artery intima-media thickness progression after 1 year of therapy was higher in eRA patients compared to both control groups (p = 0.017) and correlated with symptoms duration (p = 0.017) and DMARD monotherapy (p = 0.015). Ultrasound progression of hand joint erosions was associated with longer symptoms duration (p = 0.006). After 2 years of observation CIMT progression was similar in all examined groups. Conclusions: We observed rapid CIMT progression during the first year of RA therapy. Longer symptoms duration and less aggressive therapy were associated with CIMT increase.

Background Vitamin D deficiency is common in rheumatoid arthritis (RA) and may be related to disease activity. Objectives 1. To study the relationship between vitamin D deficiency and disease activity at RA onset. 2. To investigate possible influence of vitamin D supplementation on disease activity in early RA patients. Methods We studied 81 consecutive patients with new RA onset (71,6% women, mean age 60±14 years) admitted to the Department of Internal Medicine and Rheumatology, Military Institute of Medicine in Warsaw. Demographic, clinical, laboratory, and treatment variables were collected. The patients were treated with methotrexate, low dose of glucocorticoids and supplemented with vitamin D. Disease activity was assessed every month during the first year of therapy using DAS28-ESR, DAS28-CRP, CDAI, SDAI indices. Serum 25-hydroxy- vitamin D (25(OH)D3) was measured at baseline, after 6 and 12 months. Ultrasound assessment of hand joints was performed by the same assesssor at baseline and after 12 months. We defined vitamin D serum concentration Results At baseline mean 25(OH)D3 serum concentration was 14,6±7,7ng/mL. Sufficient vitamin D serum concentration was found in 22% patients, 49% of patients had vitamin D insufficiency and 29% were vitamin D deficient. The patients with vitamin D deficiency at baseline had significantly higher number of tender and swollen joints, higher physician global assessment and higher number of joint effusion detected by ultrasound examination than other patients. There were no significant differences in ESR and CRP values according to vitamin D concentration. After 12 months (the data available for 65 patients) 20,3% of the patients had still insufficient vitamin D concentration and 4,7% were vitamin D deficient. Taking into account the mean vitamin D concentration during observation period only 52,4% of patients were vitamin D sufficient. New erosions in ultrasound examination were found in 14 (21,5%) patients. We have found no significant difference between vitamin D sufficient and insufficient patients according to the average indices of disease activity, disease activity improvement, time to achieve remission, duration of the remission and disease progression during the first year of therapy. Conclusions Higher disease activity at RA onset is associated with lower serum vitamin D concentration. Vitamin D supplementation does not improve disease outcome during the first year of therapy. References M. Salesi, Z. Farajzadegan. Efficacy of vitamin D in patients with active rheumatoid arthritis receiving methotrexate therapy. Rheumatol Int 2012; 32: 2129–2133 K. Gopinath, D. Donda. Supplementation of 1,25 dihydroxy vitamin D3 in patients with treatment naive early rheumatoid arthritis: a randomized controlled trial. International Journal of Rheumatic Diseases 2011;4: 332–339 Disclosure of Interest None declared

We present the case of a 37-year-old woman with severe, drug-resistant rheumatoid arthritis. The patient has been previously treated with several disease-modifying anti-rheumatic drugs as well as infliximab alone and in combination therapy. Despite the treatment, a high disease activity persisted. For this reason, the patient was qualified to etanercept therapy. During the therapy, a gradual joint condition improvement was demonstrated, including arthritis remission. From the fourth month of etanercept administration, neurological disorders such as sight and speech disorders, amentia and muscle weakening were reported. The symptoms aggrevated with therapy continuation. The patient reported her complaints to her leading rheumatologist after 8 months of their duration. Optic fundus and visual area examination, as well as in the neurological examination no significant abnormalities were found. Magnetic resonance imaging of the head demonstrated single, small hyperintensive lesions in the T2w images located in the white matter of the frontal and parietal lobes of the left cerebral hemisphere, which could be identical with demyelization. Based on the clinical and laboratory findings, drug-induced neurological disorders associated with etanercept administration were suspected. After discontinuation of etanercept therapy, the complaints gradually subsided. The amentia episodes, concentration disorders and speech disorders were less frequent. There was no relapse of muscle weakening. Within 6 months of the drug discontinuation, neurological symptoms resolved completely.

Background Delay of disease modifying anti-rheumatic drugs (DMARDs) therapy is an important factor for poor outcome in rheumatoid arthritis (RA). Objectives To study the lag time between the onset of arthritis symptoms and the beginning of DMARD9s therapy, and to determine factors associated with therapy delay. Methods We studied 70 consecutive patients with new RA onset (70% female, median age 60±14 years) admitted to the Department of Internal Medicine and Rheumatology, Military Institute of Medicine in Warsaw. Demographic, clinical, laboratory, and treatment variables were collected. Disease activity was assessed every month during the first year of therapy using DAS28, CDAI, SDAI indices. Health assessment questionnaire (HAQ) and Beck depression inventory were assessed at baseline, after 6 and 12 months. Factors associated with delay of DMARD9s therapy were analyzed. Results The median time from the onset of symptoms to DMARD administration was 3 months (0.5-36 months).The median time before the patient was assessed in primary care was 3 weeks (7 days-35 months),the median time to referral from primary to secondary care was 1 month (0 days-30 months)and the median delay from that referral to the assessment by rheumatologist was 10 days (0 days-3 months). 33 (47.14%) patients were diagnosed within 3 months, 15 (21.4%) within 6 months, 22 (31.4%) waited for diagnosis >6 months. These 22 patients were significantly older than others. ESR, global visual analogue scale (VAS) by patient and physician, CDAI, SDAI, DAS28, HAQ at baseline correlated inversely with the treatment delay. The treatment delay was significantly longer in patients living alone. This delay was determined by the period from symptoms onset to primary care visit and the time from secondary care referral to rheumatologist9s consultation (p=0.006). The treatment delay was associated with shorter period of remission (DAS28≤2.6) during the first year of therapy. We have found no significant association between age, sex, socioeconomic status, years of education, depression symptoms, comorbidities and presence of rheumatoid factor or anticitrulinated antibodies and delay of the treatment. Conclusions The patients living alone and with low disease activity at baseline are less likely to receive immediate DMARD9s treatment. Delay of the treatment is associated with shorter time of remission during the first year of therapy. Awareness of factors associated with a delay in access to rheumatology care and DMARD therapy may help to reduce barriers that prevent early access and improve outcome in RA patients. References V.P.K. Nell, K.P. Machold, G. Eberl, T.A. Stamm, M. Uffmann, J.S. Smolen. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 2004;43:906–914 D.E. Feldman, S. Bernatsky, J. Haggerty, K. Leffondre, P. Tousignant, Y. Roy, Y. Xiao, M. Zummer, M. Abrahamowicz. Delay in Consultation With Specialists for Persons With Suspected New-Onset Rheumatoid Arthritis: A Population-Based Study. Arthritis & Rheumatism 2007;57:1419–1425 Disclosure of Interest None declared

Background The prevalence of chronic kidney disease (CKD) in general population is about 10%. Objectives The aim of this study was to determine the prevalence of CKD in patients with rheumatoid arthritis (RA) and factors associated with its occurrence. Methods 155 unselected patients (138 women and 17 men) with RA fulfilling 1987 ACR criteria were enrolled in the study. A detailed medical history, including course and treatment of RA was taken. The physical examination and laboratory analysis were performed in each subject. An ultrasonography of the abdomen was performed in 123 patients. The diagnosis of CKD was established according to Kidney Diseases Outcome Quality Initiative (KDOQI) and based on either presence of kidney damage or decreased glomerular filtration rate (GFR) 2 for at least 3 months. Kidney damage was defined as structural or functional abnormalities of the kidney with or without decreased GFR, manifest by pathologic abnormalities or markers of kidney damage, including abnormalities in composition of the blood or urine or abnormalities in imaging studies. Stages of CKD was assigned based on the level of kidney function (estimated GFR), according to the KDOQI CKD classification. The level of GFR was estimated by Modification of Diet in Renal Disease Study equation (MDRD). Results The mean age was 60.5 (±12.1) years. The mean RA duration was 10.4 (±9.5) years. The mean serum creatinine concentration was 0.74 (±0.24) mg/dl. The mean GFR was 90.4 (±20.9) ml/min/1.73m 2 . CKD was diagnosed in 56 patients (36%), of whom 48 had kidney damage with or without decreased GFR and 8 had decreased GFR 2 without kidney damage. Among patients with kidney damage 7 had abnormal blood tests, 17 had abnormal urine tests and 37 had abnormalities in ultrasonography of the abdomen. Among CKD patients, 21 (37.5%) had first, 18 (32.1%) had second, 16 (28.6%) had third and 1 (1.8%) had fourth stage of the disease. Significantly higher prevalence of CKD was observed in RA patients with presence of extra-articular manifestations (76% vs 52%, p- 0.004), elevated ESR (67% vs 51%, p- 0.05), higher radiological stage of the disease (p- 0.04) and co-existing hypertension (69% vs 51%, p- 0.04). There were also significant differences in mean age (64 vs 59 years, p- 0.009), mean RA duration (13.2 vs 8.5 years, p-0.008) and mean hemoglobin level (11.9 vs 12.5 g/dl, p- 0.03) between patients with and without CKD. No statistically significant difference was found between these two groups for gender, smoking status, RA activity indices (tender and swollen joints count, DAS28, HAQ) and serological markers (RF, ACPA, ANA). Additionally, we analyzed association between level of kidney function and demographic factors, smoking status, RA activity indices and treatment, laboratory and serological tests results. We found a significantly lower value of estimated GFR in patients with older age (p- 0.0000001), longer RA duration (p- 0.05), presence of extra-articular manifestations (p- 0.02), co-existing hypertension (p- 0.0000001), lower methotrexate dose (p- 0.003) and in methotrexate naive patients (p- 0.003). Conclusions Our study showed a great percentage of CKD in patients with RA. The obtained results suggested that older age, long-standing, severe disease with extra-articular manifestations, inappropriate RA treatment and co-existing hypertension increased risk of CKD in patients with RA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4686

Background Belimumab is a monoclonal antibody, inhibitor of soluble B-cell activating factor, that is used in the adjuvant treatment of adult patients with active seropositive systemic lupus erythematosus (SLE) [1]. Belimumab was approved in Poland in 2011. Objectives To analyze the influence of belimumab therapy on the severity of SLE (expressed as SLEDAI score) and glucocorticoid (GC) use in Polish patients qualified to Early Access Program (EAP). Methods Recruitment to EAP was started in April 2012 in 8 Polish tertiary rheumatology centers. A total of 23 subjects were enrolled. The data of 22 patients (mean age 38.5±8.7 years, 18 women) with at least 3-month follow-up were analyzed. Median time elapsed between the diagnosis of SLE and the enrollment was 7 years (range: 1-39 years). Median SLEDAI score at baseline equaled 13.5 points (range: 6-32 points), and median baseline prednisone equivalent amounted to 11 mg (range: 5-35 mg). Results Median SLEDAI score at 3 months (7 points, range: 3-14 points) was significantly lower than the respective baseline value (p Conclusions The obtained results point to the efficacy of belimumab in the management of SLE. Our findings are similar to those documented in the BLISS trial [2]. References Ginzler EM, Wallace DJ, Merrill JT, et al. Disease control and safety of belimumab plus standard therapy over 7 years in patients with systemic lupus erythematosus. J Rheumatol. 2013 [Epub ahead of print]. van Vollenhoven RF, Petri MA, Cervera R, et al. Belimumab in the treatment of systemic lupus erythematosus: high disease activity predictors of response. Ann Rheum Dis. 2012 Aug;71(8):1343-9. Acknowledgements GlaxoSmithKline provided support for data analysis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2880

Background EULAR Task Force strongly discourage the use of bDMARDSs before trying a csDMARDs, particularly MTX. Maximisation of treatment effects includes reaching an optimal MTX dose within a few weeks and maintaining the maximal dose (25–30 mg weekly) for at least 8 weeks, before adding biologicals. Additionally Task Force recommends that all bDMARDs should be used preferentially in combination with MTX or other csDMARDs. But today there is lack of data confirming the efficacy of biologicals in patients in whom treatment with recommended high doses of MTX has failed. Objectives The study aimed to assess the efficacy of some biologicals in patients in whom a treatment with recommended high doses of MTX failed. Methods 122 pts (97 F, 25 M, aged 57±22 years, disease duration 10.1±5.2) with RA diagnosed acc to ACR 1987 criteria and high activity (DAS 28ESR >5.1) after 6 months of MTX treatment (at least 3 months with a dose 25-30 mg/week according to toleration) were included into an open study. In 74 pts etanercept 50 mg/each week, 19 adalimumab 40 mg/each second week, 4 infliximab 3 mg/kg.b.w. each 2nd month, 26 rituksymab 2x1.0 each 6th month were added. Following the EULAR treatment recommendations the number of RA remissions according to DAS28ESR ( Results After 3 months 12 (9.8%), after 6 and 9 months 50 (41%), after 15 months 57 (46.7%) pts were in remission. There were no statistical differences between different biologicals. Important AE leading to treatment discontinuation was observed in 5 (4.1%) pts, skin reactions dominated. In a double blinded trials, MTX was used as background therapy in doses Conclusions The efficacy of biologicals started after the failure of optimal doses of MTX is very high, allowing a remission to be reached in nearly half of patients treated. It seems to that doses of MTH higher than 20 mg/w not increase efficacy, but this have to be confirmed by the further investigation. References Smolen J., Landewe R., Breedveld F. Et al.: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis published online October 25, 2013 doi: 10.1136/annrheumdis-2013-204573, Burmester G, Kivitz A, Kupper H, et al. Efficacy, pharmacokinetics, and safety of different doses of methotrexate in combination with adalimumab: results from the CONCERTO trial. Ann Rheum Dis 2013;72(Suppl 3):72. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3899

Background Interstitial lung disease (ILD) in rheumatoid arthritis (RA) is frequent. Joint disease precedes the interstitial lung involvement by several years in most cases, although ILD may be the first RA manifestation. Objectives The aim of this study was to evaluate the prevalence and clinical presentation of ILD in patients with early RA, and to identify factors associated with its occurrence. Methods 48 patients (34 women and 14 men) with early RA, fulfilling 2010 ACR-EULAR classification criteria were enrolled to the study. The mean age was 59.6 years (±15.7). The mean disease duration was 4.7 months. Detailed medical and smoking history was taken. A physical examination, laboratory analysis, PFT and HRCT of the lung were performed in all patients. Pulmonary manifestations were defined as the presence of respiratory symptoms and abnormalities revealed on physical examination of the lung. The diagnosis of ILD was based on high resolution computed tomography (HRCT) of the lung and defined as the presence of diffuse or patchy reticular or reticulo-nodular lesions, honeycombing and/or ground-glass opacities, localized mainly in the peripheral or subpleural parts of the lower lobes. Non-specific interstitial lung lesions were defined as the presence of parenchymal or subpleural bands, or pleural thickening. Results Based on the definitions above, ILD was diagnosed in 11 patients (23%) and non-specific interstitial lung lesions in 20 patients (41.6%). Among patients with ILD, 6 had reticular lesions, 3 had ground-glass opacities and remaining 2 had ground-glass opacities associated with reticular lesions. Respiratory symptoms were reported in 25 patients (52%) and included: cough (11), dyspnea (4), decreased physical endurance (3), fatigue (9) and fever (14). The physical examination revealed abnormalities in 3 patients (6.3%) and included: bilateral basal crackles (1) and wheezes and/or rhonchi (2). Pulmonary manifestations occurred in 27 patients (56.3%). 6 of them (22%) had ILD and 11 (40.7%) non-specific interstitial lung lesions. Among patients with ILD, 6 (54.5%) had the following pulmonary manifestations: cough (3), fatigue (2), fever (3) and bilateral basal crackles (1). 11 patients with non-specific interstitial lung lesions (55%) reported the following respiratory symptoms: cough (6), dyspnea (11), decreased physical endurance (3), fatigue (8) and fever (7). PFT showed restrictive process in 1 patient (2.1%) with non-specific interstitial lung lesions on HRCT of the lung. The obstructive lung disease occurred in 1 patient (1.8%) with normal chest HRCT. There were significant differences in time from the first RA symptoms to the first rheumatological assessment (9 vs 3.6 months, p- 0.008), time from the first symptoms to RA diagnosis (9.1 vs 4.6 months, p- 0.02) and time from the first symptoms to treatment (8.9 vs 4.3, p- 0.02) between patients with and without ILD. There were no significant differences between these two groups in terms of age, gender, RA activity (ESR, CRP, SJC, TJC, DAS28, SDAI, CDAI), presence and level of RF and anti-citrulinated peptide, presence of pulmonary manifestations and results of PFT. Conclusions Our study disclosed a great percentage of interstitial lung lesions in patients with early RA. Delay in RA diagnosis and treatment appears to be associated with increased risk of ILD in patients with RA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4221

Background Atherosclerosis is accelerated in rheumatoid arthritis (RA). Cardiovascular disease has become a major cause of morbidity and mortality in RA. Carotid intima media thickness (CIMT) is considered as a noninvasive surrogate marker of early atherosclerosis. Studies in RA showed an accelerated progression of IMT and plaques in carotid arteries [1]. Recently, we presented the results of a retrospective study showing correlation between continuous treatment with disease modifying anti-rheumatic drugs (DMARDs) and slower progression of IMT in rheumatoid arthritis (RA) [2]. We launched a prospective study to confirm this findings. Here we present preliminary results of this study. Objectives To assess the influence of disease modifying anti-rheumatic drugs (DMARDs) on IMT in RA. Methods 40 RA patients and 20 age- and sex-matched healthy controls were included in the study. The mean follow-up period was 36 months in RA patients and 35 months in controls. IMT of the common carotid artery (CIMT) was determined by B-mode ultrasound imaging twice- during the inclusion visit and after follow-up period. Laboratory tests were performed in all patients and controls. DAS28 was calculated in all RA patients. Results All RA patients were treated continuously with DMARDs: 18 patients with methotrexate in monotherapy, 7 patients with methotrexate plus anti-TNFα, 6 patients with metohotrexate plus rituximab, 6 patients with methotrexate plus leflunomide, 1 patient with anti-TNFα in monotherapy and 2 patients with leflunomide in monotherapy. Mean DAS28 in RA patients at the last visit was 3.57 (13 patients had complete remission, 15 patients had low activity disease- LAD, 8 patients had medium activity disease- MAD and 4 patients had high activity disease- HAD). No significant differences in classical atherosclerosis risk factors between study and control groups were found. Mean increase of CIMT in RA patients was similar to control group (27.7µm per year vs 30.7µm per year, p=0.89). We did not find significant differences in CIMT increase between patients with remission/LAD and patients with MAD/HAD. Conclusions Preliminary results of our prospective study confirm that continuous treatment with DMARDs slow the progression of CIMT. Interestingly, we did not find significant differences in CIMT increase between patients with remission/LAD and patients with MAD/HAD. It may suggest that the beneficial effect of DMARDs on the progression of atherosclerosis is present despite inadequate RA control. However, this hypothesis has to be confirmed in larger groups of patients. References Tyrrell PN, Beyene J, Feldman BM et al. Rheumatic Disease and Carotid Intima-Media Thickness. A Systematic Review and Meta-Analysis. Arterioscler Thromb Vasc Biol 2010; 30(5): 1014-26. Kisiel B, Kruszewski R, Juszkiewicz A et al. Strong impact of anti-rheumatic drugs on intima media thickness in high-risk patients. Ann Rheum Dis 2012;71(Suppl3):658 Acknowledgements This work was supported by Polish Ministry of Science and Higher Education grant number N N402 077234 Disclosure of Interest None Declared

Background The prevalence of chronic kidney disease (CKD) in general population is about 10% and is higher among individuals with diabetes, hypertension and autoimmune diseases. Adverse outcomes of CKD can be prevented or delayed through early detection and treatment. Objectives The aim of this study was to determine the prevalence of CKD in patients with rheumatoid arthritis (RA) and factors associated with its occurrence. Methods We evaluated unselected patients with RA. A detailed medical history, including course and treatment of RA was taken. The physical examination, laboratory analysis and ultrasonography of the abdomen were performed in each subject. According to Kidney Diseases Outcome Quality Initiative (KDOQI), the diagnosis of CKD was established based on either presence of kidney damage or decreased glomerular filtration rate (GFR) 2 for at least 3 months. Kidney damage was defined as structural or functional abnormalities of the kidney with or without decreased GFR, manifest by pathologic abnormalities or markers of kidney damage, including abnormalities in composition of the blood or urine or in imaging studies. Stages of CKD was assigned based on the level of kidney function (estimated GFR), according to the KDOQI CKD classification. The level of GFR was estimated by Modification of Diet in Renal Disease Study equation (MDRD). Results 111 patients (94 women and 17 men) with RA were included in the study. The mean age was 60.7 years. The mean RA duration was 9.7 years. The mean serum creatinine concentration was 0.7 mg/dl. The mean GFR was 93 ml/min/1.73m 2 . Based on the definition above, CKD was diagnosed in 35 patients (31.5 %), of whom 27 had kidney damage with or without decreased GFR and 8 had decreased GFR 2 without kidney damage. Among patients with kidney damage, 5 had abnormal blood tests, 3 had abnormal urine tests and 26 had abnormalities in imaging studies. Among CKD patients, 12 (34.3%) had first, 10 (28.6%) had second and 13 (37.1%) had third stage of the disease. Significantly higher prevalence of CKD was observed in RA patients with presence of extra-articular manifestations (60% vs 32.9%, p- 0.007) and co-existing hypertension (74.3% vs 49.3%, p- 0.01). There was also significant difference in mean RA duration (13.4 vs 8.2 years, p-0.005) between patients with and without CKD. No statistically significant difference was found between these two groups for demographic factors (age, gender), smoking status, RA activity indices (morning stiffness, tender and swollen joint count, DAS28, VAS- pain, VAS- activity, HAQ, Steinbrocker radiological stage and functional class), laboratory tests results (ESR, CRP, Hgb) and serological markers (RF, ACPA, ANA, ENA). Conclusions The prevalence of CKD in patients with RA is 31.5%. RA patients with long-lasting disease, extra-articular manifestations and co-existing hypertension are at increased risk for CKD. Disclosure of Interest None Declared

Objectives The aim of the study was to determine risk factors of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). Methods 111 unselected patients (94 women and 17 men) with RA, as defined by the 1987 ARA criteria, were included in the study. The diagnosis of ILD was based on high resolution computed tomography (HRCT) of the chest. The following risk factors of RA related ILD (RA-ILD) were evaluated: –demographic: age and gender, –smoking status: current, former and cigarette pack-year, –RA related: disease duration, Steinbrocker radiological stage, presence of atlanto-axial subluxation; presence of extra-articular manifestations (vasculitis, Sjogren syndrome, amyloidosis and subcutaneous rheumatoid nodules); activity indices assessed by both patient and rheumatologist (morning stiffness, tender and swollen joint counts, DAS28, VAS-pain, VAS-activity, HAQ, Steinbrocker functional class); laboratory test results (ESR, CRP, Hgb, PLT), serological markers (RF, ACPA, ANA, ENA) –treatment related: methotrexate (MTX) use, duration of MTX use, MTX dose (current, cumulative and yearly; yearly MTX dose was defined as cumulative MTX dose/year of RA duration), prednisone use, cumulative dose of prednisone, other synthetic and biological DMARDs use. Results The mean age was 60.7 years. Median duration of RA was 7 years. Abnormalities consistent with ILD were found in 53 patients (47,8%). Univariate analysis revealed significantly increased risk ofRA-ILD in patients with older age (per 5 years: OR 1,41; 95% CI 1,16-1,73; p- 0,001), presence of atlanto-axial subluxation (OR 4,39; 95% CI 1,33-14,46; p- 0,02), higher Steinbrocker functional class (OR 2,96; 95% CI 1,39-6,32; p- 0,01) and higher serum RF level (per 100 IU/ml: OR 1,22; 95% CI 1,05-1,41; p- 0,01). Cyclosporine A use (OR 0,31; 95% CI 0,12-0,79; p- 0,01), infliximab use (OR 0,12; 95% CI 0,01-0,99; p- 0,05) and treatment with higher current (per 5mg/week: OR 0,7; 95% CI 0,57-0,88; p- 0,002), cumulative (per 1000 mg: OR 0,74; 95% CI 0,58-0,95; p- 0,02) and yearly MTX dose (per 100 mg/1 year of RA: OR 0,74; 95% CI 0,62-0,88; p- 0,001) were associated with a significantly lower ILD risk. Multivariate analysis showed following risk factors ofRA-ILD: age, serum RF level and yearly MTX dose. The risk of RA-ILD significantly increased with older age (per 5 years: OR 1,35; 95% CI 1,001-1,68; p- 0,007) and higher serum RF level (per 100 IU/ml: OR 1,16; 95% CI 1,001-1,36; p- 0,05), while higher yearly MTX dose significantly decreased the risk of RA-ILD (per 100 mg/1 year of RA: OR 0,74; 95% CI 0,61-0,9; p- 0,003). Conclusions The independent risk factors of ILD in patients with RA were older age, higher serum RF level and treatment with lower MTX dose. Disclosure of Interest None Declared

Background The 2009 RAISE Patient Needs Survey done in Canada, France, Germany and United Kingdom revealed important information about concerns patients have regarding their subcutaneous anti-TNF treatment. Authors concluded that these concerns were surprising and it is important to recognize that they exist among patients in aim to address them through both clinical practice and future innovation of anti-TNF delivery devices. Objectives The study aimed to find out how much rheumatologists know about everyday life of rheumatoid arthritis (RA) patients treated with biological therapies. The parameters studied were the convenience or inconvenience of taking biological drugs, the form and frequency of drug taking preferred by patients. Rheumatologists’ and patients’ opinions were then compared. Methods The questionnaire study was performed with a standardised interview method by trained interviewers. Patients were asked about the problems and complaints which they associated with taking biological drugs (especially pain perceived and associated with drug administration), whether they injected the drug themselves or were helped by a relative or a health professional, what form of drug and the frequency of its consecutive administrations they preferred. Other questions asked whether patients were satisfied with the efficacy and safety of the therapies available now, their needs which biological therapies failed to meet, and a model of an ideal drug in RA biological therapy. Doctors were asked the some questions Results The survey was completed by 30 rheumatologists who employ biological therapies and 120 patients treated with biological drugs, either subcutaneously (52%) or intravenously (48%). Physicians thought that patients found administering subcutaneous injections easy or very easy, problems with opening a package were rare (in 14%), more common with the use of an applicator (in 43%), and 83% of patients preferred this mode of applying, thus rarely chose intravenous application (3%). Physicians believed 85% of patients administered injections themselves, and they preferred taking medication once a month. Patients reported few substantial problems with package opening (17% did) or operating the applicator (16% did). But they declared being afraid of needles (24%), felt more adverse effects after subcutaneous application (24% vs 10%) – most often pain (17%) or allergic reaction in the injection site (8%). Consequently, in every fourth patient, the injection was administered by another person (usually a nurse). 38% of patients preferred medication being administered subcutaneously, intravenously – 39%, others hardly cared. Drug administration frequency preferred by patients was once a month or more rarely. Conclusions Servey reveald that physicians’ and patients’ opinions are very different. The authors conclude that patients should decide about how medication is administered. References McInnes I., Burmester G., Jonas M. et al.: Rheumatoid arthritis: insights, strategies and expectations—patient perceptions of anti-TNF subcutaneous delivery devices in rheumatoid arthritis [AB0302-HP]. Ann Rheum Dis 2010;69 (Suppl3):680 Disclosure of Interest M. Tlustochowicz Grant/research support from: Questionnaire sponsored by MSD Poland, J. Kur-Zalewska: None Declared, W. Tlustochowicz: None Declared