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The introduction of graphene-related materials (GRMs) in carbon fibre-reinforced polymers (CFRP) has been proved to enhance their mechanical and electrical properties. However, methodologies to produce the 3-phase materials (multiscale composites) at an industrial scale and in an efficient manner are still lacking. In this paper, multiscale CFRP composites containing different GRMs have been manufactured following standard procedures currently used in the aerospace industry with the aim to evaluate its potential application. Graphite nanoplateletelets (GNPs), in situ exfoliated graphene oxide (GO) and reduced graphene oxide (rGO) have been dispersed into an epoxy resin to subsequently impregnate aeronautical grade carbon fibre tape. The resulting prepregs have been used for manufacturing laminates by hand lay-up and autoclave curing at 180 °C. A broad characterization campaign has been carried out to understand the behaviour of the different multiscale laminates manufactured. The degree of cure, glass transition temperature and degradation temperature have been evaluated by thermal evolution techniques. Similarly, their mechanical properties (tensile, flexural, in-plane shear, interlaminar shear and mode I interlaminar fracture toughness) have been analysed together with their electrical conductivity. The manufacturing process resulted appropriated for producing three-phase laminates and their quality was as good as in conventional CFRPs. The addition of GO and rGO resulted in an enhancement of the in-plane shear properties and delamination resistance while the addition of GNP improved the electrical conductivity.

Introduction: Our case is unique because the differential diagnosis was a challenge. At first, the patient presented with septic shock and multi-organ failure in the context of a suspected lymphoproliferative syndrome. Once the lymphoproliferative process had been ruled out, hemophagocytic syndrome due to COVID-19 infection was suspected, so he is probably one of the few patients with such an exhaustive study that could contribute to our understanding of COVID-19. We followed therapeutic guidelines that differ from the usual, using adrenalin and levosimendan. Corticosteroids helped to modulate the cytokine storm. Case report: A 16-year-old adolescent was admitted to the intensive care unit with fever, diarrhea, multiorgan failure and septic shock. He was IgG positive for COVID-19 and IgM negative. Thoraco-abdominal computed tomography demonstrated multiple para-aortic and peri-pancreatic lymphadenopathy and acute respiratory distress syndrome. The first suspected diagnosis was a lymphoproliferative syndrome and bacterial infection. The second possibility was a hemophagocytic syndrome in a patient recovering from COVID-19. He was treated with broad spectrum antibiotics because the differential diagnosis was difficult, and we removed them when the microbiological screening was negative. During the course of the disease he presented with severe biventricular dysfunction, probably due to the cytokine storm, so we used inotropic drugs (adrenaline, levosimendan). Infection with Salmonella species group B was diagnosed later, when the patient was in the Internal Medicine ward, although he was asymptomatic. Conclusion: The severity of COVID-19 infection ranges from mild to severe, causing serious disease in some people. Although the pathophysiology is not well known, it seems that in some cases an immune storm is triggered, and it is related to more serious and prolonged disease. In our case, heart failure was important, because it could have worsened the prognosis. Fortunately, the response to levosimendan and corticosteroids was adequate and he recovered favorably until discharge.

Objective To report on the long-term follow-up, clinically and serologically, of 98 patients with SLE treated with B cell depletion (BCD) over a 12 year period, focusing on the duration of the depletion. Methods A retrospective review of clinical and serological features of all SLE patients treated with BCD from January 2000 until December 2012 in the Centre for Rheumatology, University College London Hospital. Clinical activity was assessed by the classic BILAG score at baseline and 6 and 12 months after the treatment. Results The period of depletion is extremely variable between patients and within the same patient on different occasions. The patients were divided into two groups according to the duration of depletion and a defined threshold of 12 months was utilized. The group with longer duration of depletion was associated with a better outcome, with a decrease in BILAG score at 6 and 12 months. This group was also associated with lymphopenia present at any time during the course of the patient's disease. No other clinical or serological feature was associated with longer duration of BCD. Conclusion Cycles of BCD that induce longer duration of BCD are associated with better outcome. Lymphopenia may help to predict longer duration of the depletion and better outcome, although the mechanism is unclear.

Survival for patients with systemic lupus erythematosus has much improved in the last 50 years. Faster diagnosis, renal dialysis and transplant, and better general care (including lowering of blood pressure and treating osteoporosis) have had important roles in this. We have optimized the use of corticosteroids and conventional immunosuppressive drugs, reducing the side effects and improving efficacy. However, the progression to end-stage renal disease has not changed. The advent of targeted therapies using biologic agents has held great promise but because of the design of the trials, the results are disappointing and these drugs are not yet widely accepted. More and better designed trials are needed.

Background Increasing interest has focussed upon assays which are not currently included in the Antiphospholipid syndrome (APS) classification criteria to detect antibodies directed against other phospholipids (PL), PL binding proteins and/or coagulation factors. Objectives We carried out a systematic review to establish the prevalence of each non-criteria assay in APS and control populations. Methods We searched PubMed and EMBASE using the keywords APS, antiphospholipid antibodies (aPL), non criteria, new assays, aCL, LA, anti-Domain I (aDI), anti-β2GPI, antiphosphatidylserine (aPS), antiphosphatidylethanolamine (aPE), antiphosphatidic acid (aPA), antiprothrombin (aPT), antiphosphatidylserine-prothtombin (aPS-PT), anti-cardiolipin/vimentin (CL/Vm) and Annexin A5 resistance (AnxA5R). Each publication was systematically examined. Results We selected 14 (4 retrospective, 2 case-control and 8 cross-sectional) studies from which we were able to extract original data on prevalence of non-criteria aPL in 1307 patients with APS and 1612 disease controls and 625 healthy controls. ![Table 1][1] Table 1 Conclusions The highest prevalence of non-criteria aPL in the largest number of patients with APS was found in studies of IgA anti β2GPI (56.33% in 229 APS patients), AnxA5R (53.37% in 163 APS patients) and IgG aDI (44% in 548 APS patients). All non-criteria aPL studied were found to be significantly raised in APS compared with controls. Most studies however, were confounded by: small sample size, retrospective collection; and different determination of positivity. Therefore, further prospective studies are urgently required to confirm these findings. References 1. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost JTH. 2006 Feb;4(2):295–306. 2. Garcia D, Akl EA, Carr R, Kearon C. Antiphospholipid antibodies and the risk of recurrence after a first episode of venous thromboembolism: a systematic review. Blood. 2013 Aug 1;122(5):817–24. 3. Tincani A, Andreoli L, Casu C, Cattaneo R, Meroni P. Antiphospholipid antibody profile: implications for the evaluation and management of patients. Lupus. 2010 Apr;19(4):432–5. 4. Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum. 1999 Jul;42(7):1309–11. 5. Lee RM, Branch DW, Silver RM. Immunoglobulin A anti-beta2-glycoprotein antibodies in women who experience unexplained recurrent spontaneous abortion and unexplained fetal death. Am J Obstet Gynecol. 2001 Sep;185(3):748–53. 6. Lakos G, Kiss E, Regeczy N, Tarjan P, Soltesz P, Zeher M, et al. Isotype distribution and clinical relevance of anti-beta2-glycoprotein I (beta2-GPI) antibodies: importance of IgA isotype. Clin Exp Immunol. 1999 Sep;117(3):574–9. 7. De Laat B, Pengo V, Pabinger I, Musial J, Voskuyl AE, Bultink IEM, et al. The association between circulating antibodies against domain I of beta2-glycoprotein I and thrombosis: an international multicenter study. J Thromb Haemost JTH. 2009 Nov;7(11):1767–73. Disclosure of Interest V. Rodriguez-Garcia Grant/research support: FER grant from The Spanish Society of Rheumatology, Y. Ioannou: None declared, A. Fernandez-Nebro: None declared, D. A. Isenberg: None declared, I. Giles: None declared DOI 10.1136/annrheumdis-2014-eular.2749 [1]: pending:yes

Background We were alerted to the possibility of very long term B cell depletion (BCD) in Systemic Lupus Erythematosu (SLE) by a patient treated with rituximab in 2001 whose CD19 counts remain 9 /L 12 years later. The duration of B cell depletion is variable between SLE patients. Objectives Because most relapses occur after the return of B cells, our purpose was to analyse clinical and serological features and outcome in patients considering the duration of B cell depletion. Methods We analysed our lupus cohort retrospectively to identify those BCD treated patients. We collected data noting the time to return of the B cells, clinical and serological features and classic British Isles Lupus Assessment Group (BILAG) scores and baseline, 6 months and 12 months after the treatment. Logistic regression analysis was made using SPSS Statistics Data Editor software. Results A total of 190 courses of BCD in 101 patients in whom we had full serological and clinical data prior to December 2012 were considered. Among the 101 patients, 94 were female and ethnicities included 40 Caucasian, 28 Afro-Caribbean, 23 Asian, 7 Oriental and 3 others. 57 patients had more than 1 treatment. One patient and one of the infusions of another patient were excluded because of incomplete BCD after the treatment. 32.1% repopulated between 6 to 9 months and 28.6% repopulated after 12 months (figure 1). Two groups were analysed based on the time to repopulation at a defined threshold of 12 months. We included infusions for which the patients had not repopulated but were depleted for at least 12 months. We excluded the infusions for which a follow up was less than 12 months and for which the patients remained depleted. 144 treatments were analysed. 41.7% (group 1) repopulated in less than 12 months and 58.3% (group 2) were depleted for at least 12 months. An association with longer time to repopulate and lymphopenia (p=0.008) at any point in the course of the patient9s disease was noted. Inverse association with alopecia (p=0.033) and oral ulcers (p=0.039) was also noted. No association was found between serological features such as the presence of anti-dsDNA or anti-Sm antibodies or low complement. The cohort9s mean classic BILAG numerical score at baseline was 13.44 (SD=7.55). Group 2 was associated with a higher BILAG score at baseline (p=0.026). At 6 months group 2 patients had lower numerical BILAG score (p=0.002); at 12 months the same tendency was observed but with no statistical significance. Likewise, there was an association between group 2 patients and no BILAG As nor Bs at 6 months (p=0.012). Also a decrease of the BILAG score at 6 months (p=0.012) and 12 months (p=0.012) in these patients was noted. Conclusions Despite higher disease activity at baseline, as measured by classic BILAG, patients who were B cell depleted for longer showed some differences in clinical features and most importantly, had a better outcome at 6 and 12 months. References Harvey PR, Gordon C. B-cell targeted therapies in systemic lupus erythematosus:successes and challenges. BioDrugs Clin Immunother Biopharm Gene Ther.2013 Apr;27(2):85–95. Furtado J, Isenberg DA. B cell elimination in systemic lupus erythematosus. Clin Immunol Orlando Fla. 2013 Feb;146(2):90–103. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5894