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BackgroundWomen with inflammatory arthropaties (IA) have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.ObjectivesTo evaluate pregnancy in women with IA in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment.MethodsRetrospective and descriptive study of the evolution of pregnancy in patients with IA [Rheumatoid Arthritis (RA), Spondyloarthritis (SpA), Psoriatic arthritis (PsA) and Juvenile Idiopathic Arthritis (JIA)] and follow-up in a multidisciplinary unit for more than 15 years (until December 2021). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, cesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.ResultsWe registered 49 pregnancies (39 women): 27 RA (55.1%), 9 SpA (18.4%), 9 PsA (18.4%) and 4 JIA (8.1%). Maternal average age at diagnosis was 26.8±6.7 years and average age at childbirth/abortion was 34.5±5.3 years.It took an average time of 9±7.7 months to conceive. 8.2% received fertility treatment with in vitro fertilization techniques.AntiRo antibodies were registered in 6.3% of patients and 28.6% had at least 1 antiphospholipid antibody.At the time of gestational desire/gestation 24 women (13 RA, 5 SpA, 3 PsA, 3 JIA) were receiving BT: 14 certolizumab (CZP), 5 adalimumab (ADA), 4 etanercept (ETN). 1 patient was being treated with baricitinib (BARI). Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as BARI. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 15 cases.9 abortions were registered prior to follow-up in the unit (0.23 abortions/mother) and 3 (2 RA, 1 PsA) during follow-up (0.07 abortions/mother): 2 (1 RA, 1 PsA) of them in women with CZP. RA patient had positive antiphospholipid antibodies and was a smoker and the other one had moderate disease activity by the time of the abortion. C-section was performed in 26.1% of cases. Preterm birth (A total of 19 different fetal/maternal complications were registered during follow-up: 8 in the BT group (42.1%) compared to 11 (57.9%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Table 1.Table 1.COMPLICATIONSWITH BT (n, %) n: 17WITHOUT BT (n, %) n: 32IUGR3 (17.6)1 (3.1)LBW2 (11.8)2 (6.2)INFECTION1 (5.9)4 (12.5)CHOLESTASIS0 (0)2 (6.2)PREECLAMPSIA0 (0)1 (3.1)DM2 (11.8)1 (3.1)HIGH BLOOD PRESSURE0 (0)0 (0)NEPHROPATY0 (0)0 (0)NEONATAL LUPUS0 (0)0 (0)HEART BLOCK0 (0)0 (0)MALFORMATION0 (0)0 (0)HELLP SYNDROME0 (0)0 (0)TOTAL811Regarding concomitant treatment, low dose prednisone was used in 32.7% of pregnancies, hydroxychloroquine in 44.9%, sulfasalazine in 8.2% and acetylsalicylic acid in 51%. We didn´t find differences in the use of these treatments between the two groups.Median DAS28 among RA patients with available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.ConclusionIn our series, as described in the literature, women with IA are older and more likely to have preterm births compared to general population. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR, low birth weight (LBW) and diabetes mellitus (DM) among women with BT but lower rate of infections. Given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.Disclosure of InterestsNone declared

BackgroundThe use of telehealth in the control of rheumatic diseases had been scarce, but COVID pandemic forced rheumatologists to try alternatives to classic face-to-face consultation. In times of lockdown phone calls and video calls were easy to perform, but later on an asynchronous model of teleconsultation would probably fit better. The purpose of this study is to prove that asynchronous whatsapp teleconsultation is an effective alternative to classic healthcare consultation models out of pandemic. So, we selected axial spondyloarthritis (SPA) patients with stable controlled disease under biological therapy and we offered teleconsultation with a whatsapp platform chatbot, that´s been created for this purpose as a way to send PROMS (BASDAI, VAS for patient global disease assesment, ASDAS, and 3 questions for extraarticular disease), and receive feedback and schedule for the following visitsObjectivesTo prove that teleconsultation through whatsapp platform was not inferior to face-to-face consultation in terms of mantaining axial SPA patients disease under control. And to prove that teleconsultation model was less time and resources consuming for the patient and the system, and probably preferred by a group of patients.MethodsProspective study with retrospective control of patients diagnosed of Axial SPA, fullfilling ASAS criteria and with stable disease under biological therapy for the previous year, recruited from 01 jan to 30 nov 2021. We offered them two teleconsultation visits using their personal mobile device, once every four months and a face-to-face visit at the end of the study (one year since inclusion). If there is a deviation in the lab test or PROMs or if the patient asks for contact (via whatsapp) he is called up by the person in charge (nurse/doctor) that solves the question and arranges an aditional presential visit when needed. We consider disease controlled if BASDAI Results62 patients (52 men and 10 women) were recruited, mean aged 47,7 years (range 26-72), 36% were under 45 years at the time of inclusion. They were mostly Ankylosing Spondylitis (AS) (90%; only 6 non radiographic SPA), positive HLA B27 (90%) and with longstading disease (mean 24 years), and only 6 patients less than five years. 16% had peripheral involvement (arthritis/dactylitis), and 40% presented extraarticular manifestations, mainly uveitis (20%). 70% were under their first biological (TNF inhbitor, mostly adalimumab), 24% were refractory to the first, 3 patients to 2 previous biologicals and just 1 patient was refractoy to 5. 50% of patients were treated with tapered dose of TNF inhibitors.We have now a mean followup of 10 months, in which we have had 109 scheduled teleconsultations with aditional need of 36 phone calls and 10 aditional presential visits for the whole group. To date, 3 patients with reduced dose increased to standard dose of biological drug and none change of biological was required.ConclusionAsynchronous teleconsultation seems promising, specially for followup in patients with stable rheumatic disease, less interfering with daily activities, less time consuming for the patient and less resource consuming for healthcare systems, with no impairment of disease control and quailty of healthcare. This study will also show patient´s preference, and we´ll try to describe a profile of patient more prone to teleconsultation.References[1]Song Y, Bernard L, Jorgensen C, Dusfour G, Pers YM. The Challenges of Telemedicine in Rheumatology. Front Med (Lausanne). 2021 Oct 13;8:746219. doi: 10.3389/fmed.2021.746219.AcknowledgementsIn behalf of INNOBIDE working groupDisclosure of InterestsMaria Luz García-Vivar Grant/research support from: Novartis provided a grant for this study, Natalia Rivera: None declared, E. Galíndez-Agirregoikoa: None declared, EDUARDO CUENDE: None declared, ANA ROSA INTXAURBE PELLEJERO: None declared, Juan Maria Blanco Madrigal: None declared, L Vega: None declared, C García: None declared, MARIA ENJUANES: None declared, María Jesús Allande: None declared, OLAIA BEGOÑA FERNANDEZ BERRIZBEITIA: None declared, Rosa Exposito: None declared, MARIA ESTHER RUIZ LUCEA: None declared, Ignacio Torre-Salaberri: None declared

BackgroundInterstitial lung disease (ILD) in connective tissue diseases (CTD) is an important cause of morbidity and mortalitiy.ObjectivesTo evaluate ILD in CTD (systemic sclerosis, myositis, Sjögren syndrome, rheumatoid arthritis, mixed connective tissue disease), sarcoidosis and interstitial pneumonia with autoimmune features and its progression in 12 months evaluated through high resolution computed tomography (HRCT) and pulmonary function test (PFT).MethodsA retrospective single tertiary center cohort study in CTD-ILD outpatients seen between 2012 and 2021. Clinical, serological data, PFT and HRCT results were collected. ILD patterns were classified into: usual interstitial pneumonia (UIP), inconsistent UIP, nonspecific interstitial pneumonia (NSIP), fibrosing NSIP, organizing pneumonia, interstitial lymphoid pneumonia and associated to sarcoidosis. Progression of ILD was defined as:->10% decline in FVC in PFT.->15% decline in DLCO in PFT.-Progression of fibrosis in HRCT.IBM SPSS v23 was used for statistical analysis.Results51 patients were collected. Baseline characteristics are shown in Table 1. Figure 1 shows ILD progression in 1 year.Table 1.Baseline characteristics.Sociodemographic characteristicsClinical features/affection– n (%)Total51Raynaud23 (45,1%)Female-n (%)42 (82,4%)Skin23 (45,1%)Age- years (mean) IQR)56 (27-82)Ocular13 (25,5%)Arthritis16 (31,4%)Myositis7 (13,7%)Renal1 (2%)Esophagus7 (13,7%)Hemathological3 (5,9%)PHT7 (13,7%)Smoking status- n (%)Symptoms at ILD diagnosis- N (41) %Current9 (17,6%)Cough31,4%Former13 (25,5%)Toracic pain11,8%Never29 (56,9%)Dyspnea47,1%Comorbidities- n (%)Pattern HRCT- n (%)Diabetes mellitus5 (9,8%)UIP11 (21,6%)Ischaemic cardiopathy3 (5,9%)Fib-NSIP5 (9,8%)Hypertension15 (29,4%)UIPincons13 (25,5%)POCD3 (5,9%)NSIP15 (29,4%)OP2 (3,9%)LIP2 (3,9%)Sarcoidosis3 (5,9%)Type of disease associated to ILD - n (%)Immunosupression- n (%)Systemic Sclerosis14(27,5%)Methotrexate20(39,2%)Sjögren’s Syndrome7 (13,7%)Mycophenolate mofetil16 (31,4%)Sarcoidosis3 (5,9%)Hydroxychloroquine19(37,3%Myositis8 (15,7%)Cyclophosphamide4 (7,8%)SLE1 (2%)Etanercept6 (11,8%)MCTD3 (5,9%)TNF inhibitors4 (7,8%)RA12(23,5%)Tocilizumab2 (3,9%)IPAF4 (7,8%)Azathioprine10 (19,6%)Leflunomide3 (5,9%)MP pulses15 (29,4%)Rituximab12 (23,5%)Abatacept5 (9,8%)Tacrolimus5 (9,8%)Antibodies- n (%)Anti-myositis6 (11,8%)Anti-sclerosis15(29,4%)Anti- Ro25 (49%)Anti- RNP3 (5,9%)ANA35(68,6%)RF21(41,2%)Anti- Synt6 (11,8%)Note. POCD = Pulmonary Obstructive Chronic Disease SLE = Systemic Lupus Erythematosus MCTD = Mixed Connective Tissue Disease RA = Rheumatoid Arthritis IPAF = Insterstitial Pneumonia with Autoimmune Features Anti RNP = Anti RiboNucleoProtein ANA = Antinuclear Antibodies RF = Rheumatoid Factor Anti Synt =Anti-synthetasePHT= Pulmonary Hypertension UIP = Usual Interstitial Pneumonia Incons-UIP = Inconsistent Usual Interstitial PneumoniaNSIP = Nonspecific Interstitial PneumoniaFib-NSIP = Fibrosing Nonspecific Interstitial PneumoniaOP = Organizing PneumoniaLIP = Lymphoid Interstitial PneumoniaTNF inhibitor = Tumor Necrosis Factor inhibitorMP = MetyhprednisoloneFigure 1.During follow up, 1 patient with sarcoidosis died of COVID19 bilateral pneumonia.ConclusionIn our series most patients were middle aged women. Anti-Ro antibodies and smoking status (former or current) were common among patients. Common clinical features were Raynaud (45%), skin affection (45%) and arthritis (40%). 47% of the patients expressed dyspnea at ILD diagnosis. 29,4% were treated with MP pulses, 23,5% with rituximab, 31,4% with mycofenolate mophetil. Fibrosing pattern in HRCT (UIP and fib-NSIP) was the most prevalent. 20% of the patients had progressive fibrosis under PFT criteria and 18% under HCRT.More studies of ILD-CTD are necessary to identify factors for progression and response to treatment and throw out more conclusions of prediction and prognosis of disease.Disclosure of InterestsNone declared

Background: Polymorphisms of the vitamin D receptor (VDR) gene have been implicated in the genetic regulation of bone mineral density (BMD). However, the clinical impact of these variants remains unclear. Objective: To evaluate the relation between VDR polymorphisms, BMD, and fractures. Design: Prospective multicenter large-scale association study. Setting: The Genetic Markers for Osteoporosis consortium, involving 9 European research teams. Participants: 26242 participants (18405 women). Measurements: Cdx2 promoter, FokI, BsmI, ApaI, and TaqI polymorphisms; BMD at the femoral neck and the lumbar spine by dual x-ray absorptiometry; and fractures. Results: Comparisons of BMD at the lumbar spine and femoral neck showed nonsignificant differences less than 0.011 g/cm(2) for any genotype with or without adjustments. A total of 6067 participants reported a history of fracture, and 2088 had vertebral fractures. For all VDR alleles, odds ratios for fractures were very close to 1.00 (range, 0.98 to 1.02) and collectively the 95% CIs ranged from 0.94 (lowest) to 1.07 (highest). For vertebral fractures, we observed a 9% (95% CI, 0% to 18%; P = 0.039) risk reduction for the Cdx2 A-allele (13% risk reduction in a dominant model). Limitations: The authors analyzed only selected VDR polymorphisms. Heterogeneity was detected in some analyses and may reflect some differences in collection of fracture data across cohorts. Not all fractures were related to osteoporosis. Conclusions: The FokI, BsmI, ApaI, and TaqI VDR polymorphisms are not associated with BMD or with fractures, but the Cdx2 polymorphism may be associated with risk for vertebral fractures.