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Background The lack of efficacy of biological therapies in rheumatic patients causes a change of treatment, usually to another biological therapy. A significant number of studies have been published in relation to the reasons that cause this inefficacy, (1,2,3); however, no studies have evaluated the involvement of the weight and lipid profile of patients in this process. Objectives To analyze the influence of weight and lipid profile in the relapse and change of biological therapy. Methods Retrospective-descriptive study. Rheumatic patients in treatment with biological therapies were recruited from January 2016 to December 2018. Sociodemographic data were collected (age and sex), along with anthropometric variables (weight, height, waist circumference and hip perimeter), toxic habits, comorbidities and variables related to the treatment. Associations between variables were analyzed using a Chi-square and T student. P-values Results Two hundred and nine patients were enrolled, of which 80 (38.3%) were male and 129 (61.7%) were female. The mean age (SD) was 48.9 12.8 years. One hundred and twenty patients (57.4%) suffered rheumatoid arthritis, 35 (16.7%) spondylitis, 29 (13.9%) psoriatic arthritis and 10 (4.8%) spondyloarthritis. One hundred and fifty-three (73.2%) had not switches of biological therapy, 51 (24.4%) switched of biological therapy once and 5 (2.4%) three or more times. Statistically significant differences were found in the obese males who switched of biological therapy in relation to obese males who not switched (35.6% vs. 11.1%). Accordingly, the percentage of patients with hyperlipemia that switched of biological therapy was significantly higher than those who did not (29.4% vs. 13.1%). The years of evolution and diagnosis we also involved, so that patients with more years of evolution and more years from the diagnosis had a higher percentage of switched (p = 0.006 IC 95% -17.22, - 0.96 and p = 0.042 -18, 32; -037 respectively). Conclusion Being obese male and with hyperlipidemia could be a risk factor that would condition the lack of response to a biological therapy and thus the need of switching to another. References [1] Glintborg B1, stergaard M, Krogh NS, Tarp U, Manilo N, Loft AG, Hansen A, Schlemmer A, Fana V, Lindegaard HM, Nordin H, Rasmussen C, Ejstrup L, Jensen DV, Petersen PM, Hetland ML. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013Jul;72(7):1149-55. doi: 10.1136/annrheumdis-2012-201933. Epub 2012 Aug 31. [2] Navarro-Compn V, Plasencia-Rodrguez C, de Miguel E, Diaz Del Campo P, Balsa A, Gratacs J. Switching biological disease-modifying antirheumatic drugs in patients with axial spondyloarthritis: results from a systematic literature review. RMD Open. 2017 Oct 10;3(2):e000524. doi: 10.1136/rmdopen-2017-000524. eCollection 2017. [3] Ganzetti G, Campanati A, Bettacchi A, Brandozzi G, Brisigotti V, Bugatti L, Cataldi I, Filosa G, Giacchetti A, Lemme G, Morresi L, Nicolini M, Postacchini V, Ricotti G, Rosa L, Simonacci M, Offidani A. Switching from a biological therapy to another biologic agent in psoriatic patients: the experience of PsOMarche group. G Ital Dermatol Venereol. 2018 Feb;153(1):5-10. doi: 10.23736/S0392-0488.16.05463-8. Epub 2016 Nov 15. Disclosure of Interests Rocio Segura: None declared, Maria del Carmen Abalos-Aguilera: None declared, Alejandra M. Patio-Trives: None declared, juan vacas: None declared, Joaquin Sosa: None declared, Celestino Gil: None declared, Maria del Rosario Navarro: None declared, Mara del Carmen Castro Villegas Paid instructor for: MSD, Abbvie, Pfizer, Janssen, Lilly, Roche, Rafaela Ortega Castro: None declared, Jerusalem Calvo Gutierrez: None declared, Desiree Ruiz: None declared, Montserrat Romero-Gmez: None declared, Ladehesa Pineda Lourdes: None declared, Alejandro Escudero Contreras: None declared, Eduardo Collantes-Estvez Consultant for: UCB Pharma, MSD, AbbVie, Novartis, Janssen, Font Ugalde Pilar: None declared, Luis Jurado: None declared

Background Biphophosnates are the most widely used treatment for osteoporosis. The optimal treatment duration, however, remains unclear. The occurrence of adverse effects, such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF), has raised the issue of bisphosphonate discontinuation (”drug holiday”) after a certain treatment period. Objectives To assess the incidence of fractures in patients during the drug holidays period with bisphosphonates, as well as to determine the risk factors are associated to it. Methods Analytical, observational, longitudinal, and ambispective study of a cohort of patients with postmenopausal osteoporosis or men over 50 years of age treated with oral bisphosphonates (at least for 5 years) or intravenous (at least for 3 years) and who had been at least for one year in a drug holidays period, from 01/01/2012 to 12/31/17. Patients treated with corticosteroids and/or with diseases with effects on bone metabolism were excluded. Statystical analysis included a descriptive study of the variables to assess the association between the incidence of fractures and various risk factors, as well as univariate and multivariate Cox regression analysis. Results 128 patients with osteoporosis were studied, of wich 19 (14.7%) suffered an osteoporotic fracture during the follow-up. Bivariate analysis showed in the group of patients with fractures a higher proportion of smoking patients (p = 0.004), osteopening treatment (p = 0.005) and a femoral neck t score lower at the beginning of the drug holidays period -2.07 (0.68) vs - 1.58 (0.63), p = 0.008. In addition, there was a higher proportion of patients with fracture with moderate risk before the start of the drug holidays period (p = 0.007). The fracture survival curves were lower in patients older than 75 years (p = 0.04). When applying the same treatment, for each year increase, the risk of fracture was increased by 6% (p = 0.04), while, for the same age, this risk was increased 4.33 times in patients who were treated with Risedronate versus those with Alendronate (p = 0.05). The multiple regression analysis showed that vertebral fracture was independently associated with Tabaco (HR 4,28 p=0,047). Conclusion Based on our results, it would be useful to follow closely those patients during drugs holidays period who are smokers, older than 75 years, with osteopening treatment, who present a low femoral neck tscore and/or have been previously treated with Risedronate. References [1] Silverman SL, et al. Osteoporos Int. 2016;27 (3):849-852. [2] Bindon B, et al. Endocr Pract. 2018;24(2):163-169. [3] Mignot MA, et al. Osteoporos Int. 2017;28(12):3431-3438. Disclosure of Interests Laura Bautista: None declared, Angel Delgado Zamorano: None declared, Asuncion Salmoral: None declared, Inmaculada Gomez Gracia: None declared, Ladehesa Pineda Lourdes: None declared, Perez Sanchez Laura: None declared, Gomez Garcia Ignacio: None declared, Font Ugalde Pilar: None declared, Maria del Carmen Castro Villegas Paid instructor for: MSD, Abbvie, Pfizer, Janssen, Lilly, Roche, Alejandro Escudero Contreras: None declared, Eduardo Collantes Estevez: None declared

Objectives To describe the clinical-demographic characteristics and behaviour over time (12, 24 and 60 months) of a cohort of Undifferentiated Arthritis (UA), as well as to analyze which factors are associated with the evolution towards Rheumatoid Arthritis (RA), use of Biological Therapy (BT) and the development of Cardiovascular Disease (CVD). Methods Ambispective cohort study of patients with UA evaluated longitudinally from January 2009 to 2019. We analyzed baseline clinical and laboratory variables and a Multivariate Logistic Regression was performed to determine the factors associated with RA development after 5 years of follow-up. To analyze what factors were associated with the use of BT and the presence of CVD chi-square or Fisher’s test were used for binary variables, and U-Mann Whitney for continuous variables. Results 180 patients were included, 55% were women, with an average age of 49.3 (SD 16.1) years. The average duration of symptoms before the first visit was 6.9 (SD 9.9) months. 47.2% were FR+, 41% ACPA+, 20.6% HLA-DRB1 shared epitope. At the end of follow-up: 33.3% evolved to RA, 17.2% remained as palindromic rheumatism, 25% were diagnosed other chronic rheumatic diseases, 21.1% remitted spontaneously and 3.3% remained as UA. Of the 60 AR, 37 were diagnosed in the first year, 13 at second and 10 at 5 years of follow-up. During follow-up, 13 patients with RA started BT, and 12 patients presented CVD (7 of them died). Table 1 identifies the factors associated with the development of RA. The MLR identified ACPA +, OR (95% CI) = 10.69 (4.43 - 25.78), and the HLA-DRB1 shared epitope OR (95% CI) = 9.18 (2.96 - 28.48) p Conclusion 1) Useful clinical and laboratory characteristics have been identified to predict which patients are at risk of developing persistent arthritis. 2) HLADRB1 shared Epitope and ACPA are predictive factors of evolution to RA. 3) Possibly the continued use of glucocorticoids, even at low doses, may be related to the development of long-term CVD Disclosure of Interests Jerusalem Calvo Gutierrez: None declared, Rafaela Ortega Castro: None declared, Clementina Lopez-Medina: None declared, Ladehesa Pineda Lourdes: None declared, Maria del Carmen Castro Villegas Paid instructor for: MSD, Abbvie, Pfizer, Janssen, Lilly, Roche, Alejandro Escudero Contreras: None declared, Eduardo Collantes Estevez: None declared

Background The correct indication of the suspension of treatment with FAMES and biological therapy in pediatric patients, in the presence of a mild infectious disease or vaccination is a common problem in children’s rheumatology. In patients with juvenile idiopathic arthritis (JIA), joint or extra-articular clinical reactivation during these “pauses” is not uncommon, however, there are not enough studies in the pediatric population to show the influence of treatments on the immune system., and therefore, that justify this clinical practice. Objectives To analyze the levels of T, B and NK lymphocyte subpopulations in patients diagnosed with JIA treated with FAMES and biological therapy. Methods A descriptive and cross-sectional study in which 39 patients from the Pediatric Rheumatology Unit of the Reina Sofia University Hospital were recruited, diagnosed with JIA according to the ILAR 2001 criteria. The patients were divided into four groups: 8 controls in clinical remission without treatment, 17 in treatment with DMARD in monotherapy, 7 in biological treatment in monotherapy and 7 in treatment with DMARD-biological. Patients with systemic JIA were excluded because they had a pathogenic mechanism different from the rest of the JIA categories. By flow cytometry, the levels of CD3, CD4, CD8 and CD19 cells were measured for acquired immunity and from NK for innate, the CD4/CD8 index was also calculated. Results The mean age of the 39 patients was 10 ± 5.7 years, 29 were girls (74.3%), 4 patients had arthritis related to enthesitis, 16 patients had oligoarticular involvement ANA +, 6 subjects polyarticular involvement FR- and 13 they were psoriatic arthritis. Although no statistically significant differences were found when contracting cellular levels among the 4 groups evaluated, it was observed that the group treated with DMARD monotherapy had the highest percentage of children with alterations in cellular levels CD3, CD4, CD8 and CD19 (41.17% of the patients of the group); the group treated in monotherapy with biological treatment (28%) presented alteration in the levels of CD8 and CD19 and the group treated in combination of DMARD and biological (14.28%) in CD19. On the other hand, the NK cells and the CD4/CD8 index were not altered in any of the groups. Only 6 cases of serious infections were registered in patients in combination therapy (DMARD-biologic) who had received corticosteroids by clinical activity. There were no statistical differences between patients who had received corticosteroids and those who did not. Conclusion Patients in treatment with DMARD monotherapy had a tendency to decrease cellular levels. On the other hand, alterations in innate immunity or CD4/CD8 index were not observed. Disclosure of Interests None declared

Background: Studies suggest that radiographic damage is associated with cardiovascular (CV) risk in axial spondyloarthritis (axSpA). However, the relationship among disease characteristics directly related to structural damage and CV risk has not yet been fully clarified. Objectives: To analyze the association of structural damage with the presence of atherosclerotic plaques via carotid ultrasound (US) and the increased CV risk in a registry of patients with SpA. Methods: Eighty-five patients with SpA (ASAS criteria) from the SpA registry from Cordoba (CoSpaR) were selected for a cross-sectional study and underwent a complete clinical history, physical examination and biochemical analysis. Variables about demographics, clinical parameters and CV risk factors were collected. CV risk was evaluated by estimating SCORE index and assessing presence of atherosclerotic plaques through carotid US performed by a qualified radiologist. Independent-samples t test was used to evaluate the association between radiological characteristics and presence of atherosclerosis. Multiple lineal regression (MLR) was performed to assess the variables potentially associated with increased SCORE. All comparisons were bilateral. Results: Baseline characteristics are shown in the table. Values are mean±SD for quantitative and N (%) for qualitative variables. Regarding characteristics related with radiographic damage and CV risk, they exhibited a mSASSS of 14.84±18.4 (7.27±9.64 in cervical spine and 7.72±10.14 in lumbar spine). Average BMI 26.88±4.13, 33 (38.8%) were smokers, 16 (18.8%) had diagnosis of arterial hypertension, 1 (1.2%) of diabetes mellitus, 13 (15.3%) of hyperlipidemia, and 8 (9.4%) took lipid lowering drugs. Examination with carotid US found that 14 (16.5%) patients had previously unknown atherosclerotic plaques. After classification according to SCORE index, 60 (76.9%) had low CV risk, 10 (12.8%) moderate, and both high and very high CV risk categories had 4 (5.1%) patients each. In patients with atherosclerotic plaques, age, disease duration and variables related to radiographic damage (mSASSS [total, cervical and lumbar], and bone bridges) were significantly higher (p Conclusion: Presence of atherosclerosis is associated with age, disease duration and radiographic damage in SpA. Age and structural damage especially in the cervical spine predicted a greater CV risk. Thus, it is important to identify these patients in order to maintain tight control and avoid development of CV disease. Acknowledgement: Funded by: JA PI-0139-2017 Disclosure of interests: Ladehesa Pineda Lourdes: None declared, Gomez Garcia Ignacio: None declared, Maria del Carmen Castro Villegas Paid instructor for: MSD, abbvie, Pfizer, Janssen, Lilly, Roche, Pedro Segui azpilcueta: None declared, Maria del Carmen abalos-Aguilera: None declared, Bautista aguilar Laura: None declared, inmaculada Concepcion aranda-Valera: None declared, Rocio Segura: None declared, Rafaela Ortega Castro: None declared, Clementina Lopez-Medina: None declared, Perez Sanchez Laura: None declared, Puche Larrubia Maria Angeles: None declared, Chary Lopez-Pedrera: None declared, Font Ugalde Pilar: None declared, Garrido Castro Juan Luis: None declared, alejandro Escudero Contreras: None declared, Eduardo Collantes Estevez: None declared, Jimenez Gomez Yolanda: None declared

Background Osteoporosis is the most frequent comorbidity in axial spondyloartritis (axSpA). The change in spinal mobility (traditional measures) in patients with axSpA has been associated with low bone mineral density (BMD) although the data are variable (DIM, lateral flexion, BASMI). Objectives The aim of our study is to understand the relationship between spinal mobility, BMD and fragility fractures. Methods Analytical, observational, longitudinal, and retrospective study of a cohort of patients with axSpA (ASAS criteria). Perimenopausal or menopausal women, diseases and/or osteopening treatments, biological drugs, immunosuppressive drugs (at least one year before), and treatment with drugs that interfere in the bone metabolism were excluded; bisphosphonates, ranelate of strontium, selective modulators of the estrogen receptor, calcitonin, hormone therapy, denosumab and teriparatide, among others. Results 74 patients were studied, 67 were clasified as axSpA and 7 as peripheral SpA. Bivariate analysis showed that the group of patients with osteoporosis (14,86%) had a worse DIM (p = 0.001), tragus-to-wall distance (p = 0.001) and lateral flexion (p = 0.045) than patients who did not have osteoporosis. The multiple regression analysis indicated that lumbar spine t/zscore was independently associated with BASMI index (B 0,682, p=0,013), femoral neck t/zscore was independently associated with BASFI index (B 1,575, p=0,007) and with lower levels of 25 OH vitamin D (B 0,895, p=0,028). Conclusion UCOASMI is a validated metrological index with three-dimensional measurements of human spinal mobility that shows higher levels of objectivity and precision than traditional measures. Subsequent studies will compare mobility parameters (UCOASMI) and BMD of patients with axSpA. Clarifyng the relationship between spinal mobility, BMD and fragility fractures would help us to better understand the course of the disease in axSpA. References [1] Molto A, et al. Ann Rheum Dis. 2016Jun;75(6):1016-23. [2] Weijden MA,et al. Clin Rheumatol. 2011;30(4):497–503. [3] Venceviciene, et al. Medicine,2015; 51(5): 272-279 Disclosure of Interests Laura Bautista: None declared, Asuncion Salmoral: None declared, Inmaculada Gomez Gracia: None declared, Ladehesa Pineda Lourdes: None declared, Perez Sanchez Laura: None declared, Gomez Garcia Ignacio: None declared, Inmaculada Concepcion Aranda-Valera: None declared, Maria del Carmen Abalos-Aguilera: None declared, Garrido Castro Juan Luis: None declared, Font Ugalde Pilar: None declared, Maria del Carmen Castro Villegas Paid instructor for: MSD, Abbvie, Pfizer, Janssen, Lilly, Roche, Alejandro Escudero Contreras: None declared, Eduardo Collantes Estevez: None declared

Background: Knee Osteoarthritis (KOA) is a common condition associated with pain and morbidity. The impact of this pathology makes it necessary to develop new procedures for joint regeneration. Regenerative treatments such as platelet-rich plasma (PRP) are being proposed as a safe alternative, capable of regenerating damaged tissues and improving the quality of life, reducing the need to surgical procedures (1-4). Objectives: To compare the effectiveness of PRP treatment vs Hialuronic Acid (HA) and Non-Arthroscopic Joint Lavage (NAJL) in patients with KOA. Methods: It was performed a prospective, 3-months observational study of 51 patients with KOA, from the OA clinic of the Reina Sofia Hospital of Cordoba. Patients were treated according to clinical practice in 1 of the 3 treatment arms (PRP, HA, NAJL). Pain and disability were evaluated using Visual Analogue Scale (VAS) of joint pain, WOMAC and OARSI. We compared the baseline data using simple ANOVA and chi-squared tests and the intra- and inter-group differences before and after treatment (0, 1 and 3 months) using the mixed ANOVA test. All comparisons were bilateral considering p≤0.05 as a significant result. Results: 51 patients were enrolled, of which 52.9% were female. The average age (±SD) was 58.47 ± 7.48 years. The average Body Mass Index (BMI) was 30.64 ± 4.25 Kg/m2. Characteristics at baseline were comparable among the 3 treatment groups (Table 1). An overall improvement was observed during the follow-up in the PRP group in terms of pain and disability with respect to the baseline, with a VAS MD of -3.00 [95% CI, -4.79 to -1.21] in the first month and -3.08 [CI 95%, -4.79 to -1.38] at 3 months (p Conclusion: Based on our results, the intra-articular infiltration with PRP could therefore constitute a safe and effective treatment option in KOA patients, with short-medium term results superior in terms of pain and disability to conventional treatment with HA and NALJ. Reference [1] Huang Y, et al. Orthopade. 2019 Jan 8. 2)Burke, et al. Clin trans Med (2016) 5-27. 3)Wroblewski AP, et al. Oper Tech Orthop 2010; 20: 98-105. 4) De La Mata J, et al. Reumatol Clinica. 2013; 9(3):166-71. Disclosure of Interests: Rafaela Ortega Castro: None declared, Rocio Segura: None declared, Jerusalem Calvo Gutierrez: None declared, Rocio Espino-Garcia: None declared, Maria del Carmen Castro Villegas Paid instructor for: MSD, Abbvie, Pfizer, Janssen, Lilly, Roche, Alejandro Escudero Contreras: None declared, Miguel A. Caracuel-Ruiz: None declared, Ladehesa Pineda Lourdes: None declared, Desiree Ruiz-Vilchez: None declared, Montserrat Romero-Gomez: None declared, Pilar Carreto-Font: None declared, Eduardo Collantes Estevez: None declared, Font Ugalde Pilar: None declared

Funder: Europeo de Desarrollo Regional de la Unión Europea, Funder: Rheumatic Diseases Network, OBJECTIVE: To analyze the relationship between complement component 3 (C3) and the prevalence of cardiometabolic risk factors and disease activity in the rheumatic diseases having the highest rates of cardiovascular morbidity and mortality: rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS: This is a cross-sectional study including 200 RA, 80 PsA, 150 axSpA patients and 100 healthy donors. The prevalence of cardiometabolic risk factors [obesity, insulin resistance, type 2 diabetes mellitus, hyperlipidemia, apolipoprotein B/apolipoprotein A (apoB/apoA) and atherogenic risks and hypertension] was analyzed. Serum complement C3 levels, inflammatory markers and disease activity were evaluated. Cluster analysis was performed to identify different phenotypes. Receiver operating characteristic (ROC) curve analysis to assess the accuracy of complement C3 as biomarker of insulin resistance and disease activity was carried out. RESULTS: Levels of complement C3, significantly elevated in RA, axSpA and PsA patients, were associated with the prevalence of cardiometabolic risk factors. Hard clustering analysis identified two distinctive phenotypes of patients depending on the complement C3 levels and insulin sensitivity state. Patients from cluster 1, characterized by high levels of complement C3 displayed increased prevalence of cardiometabolic risk factors and high disease activity. ROC curve analysis showed that non-obesity related complement C3 levels allowed to identify insulin resistant patients. CONCLUSIONS: Complement C3 is associated with the concomitant increased prevalence of cardiometabolic risk factors in rheumatoid arthritis and spondyloarthritis. Thus, complement C3 should be considered a useful marker of insulin resistance and disease activity in these rheumatic disorders.