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ObjectivesTo compare the incidence of psoriatic arthritis (PsA) in patients with psoriasis (PsO) according to different treatments for their skin: topics/no treatment, conventional disease-modifying antirheumatic drugs (DMARDs) (cDMARDs) or biological DMARDs (bDMARDs).MethodsPatients with PsO without PsA followed at a university hospital were included in this retrospective cohort study. Patients were classified according to their treatment in topics (topics, phototherapy or no treatment), cDMARDs (methotrexate and cyclosporine) and bDMARDs (tumour necrosis factor inhibitors (TNFi), interleukin 17 inhibitors (IL-17i) and IL-12-23i ((interleukin (IL) 12/IL-23 inhibitor))) groups. Incident cases of PsA were attributed to one treatment if developed during the administration of that treatment. A Cox proportional hazards model was used to evaluate the adjusted risk of PsA development by treatment group.Results1719 patients with PsO contributed a total of 14 721 patient/years (py). 1387 (81%) patients were in the topics, 229 (13%) in cDMARDs and 103 (6%) in the bDMARDs group. During follow-up, 239 patients (14%) developed PsA (231 under topics, six under cDMARDs and two under bDMARDs). Global incidence was 1.6 per 100 py. The risk of developing PsA in patients with PsO treated with bDMARDs was significantly lower (incidence rate ratio (IRR)=0.26; 95% CI 0.03 to 0.94; p=0.0111), compared with topics, but not compared with cDMARDs (IRR=0.35; 95% CI 0.035 to 1.96; p=0.1007). Adjusted Cox proportional hazards regression analysis showed that male sex, nail involvement and higher body max index were associated with increased risk of developing PsA, while biologics use was protective (HR: 0.19; 95% CI 0.05 to 0.81).ConclusionTreatment with biologics in patients with PsO reduced the risk of PsA development.

Background:For patients (pts) with PsA, several disease activity measures are available including very low/minimal disease activity (VLDA/MDA), cutoffs based on the Disease Activity in PsA (DAPSA) score, and on the Psoriatic Arthritis Disease Activity Score (PASDAS) score.Objectives:To assess the rates of pts achieving these remission or low disease activity (LDA) criteria at Wk 24 using data from the SELECT-PsA 1 and SELECT-PsA 2 phase 3 studies;1,2 Additionally, we assessed the distribution of individual MDA components among pts who did or did not achieve MDA criteria at Wk 24.Methods:In SELECT-PsA 1 and SELECT-PsA 2, pts with PsA and prior inadequate response (IR) or intolerance to ≥1 non-biologic DMARD (N=1705) or ≥1 biologic DMARD (N=642), respectively, were randomized to once daily upadacitinib (UPA) 15mg, UPA 30mg, adalimumab (ADA) 40mg every other week (SELECT-PsA 1 only), or placebo (PBO). Remission and LDA were assessed using VLDA/MDA, DAPSA scores of ≤4/≤14, and PASDAS scores of ≤1.9/≤3.2, at Wk 24 (Table 1). Non-responder imputation (NRI) was used for handling missing data; pts rescued at Wk 16 were considered non-responders. Pairwise comparisons between UPA doses and PBO or ADA were conducted using the Cochran-Mantel-Haenszel test.Results:Overall, 2345 pts were analyzed; mean age 51 years, 53% female. In both studies, higher rates of remission and LDA were observed with both UPA doses vs PBO at Wk 24 (nominal P-values Conclusion:Regardless of previous biologic DMARD failure, pts treated with UPA15 or UPA30 achieved a higher rate of remission or LDA measured by various disease activity measures vs PBO at Wk 24; higher rates of response were observed in most of the remission and LDA measures with UPA30 vs ADA in non-biologic DMARD-IR pts. Among pts who did or did not achieve MDA criteria at Wk 24, a greater proportion of UPA-treated pts achieved physician derived measures such as SJC ≤1, PASI ≤1 or BSA-Ps ≤3%, and LEI ≤1.References:[1]McInnes IB, et al. Ann Rheum Dis, 2020; 79:12.[2]Genovese MC, et al. Ann Rheum Dis, 2020; 79:139.Table 1.Proportion of Patients Achieving Remission and LDA Measures at Week 24Endpoint, n (%)SELECT-PsA 1SELECT-PsA 2PBON=423ADA 40mg EOWN=429UPA 15mg QDN=429UPA 30mg QDN=423PBON=212UPA 15mg QDN=211UPA 30mg QDN=218MDA52 (12.3)143 (33.3)157 (36.6) *, #192(45.4) *, †, #6 (2.8)53 (25.1) *, #63 (28.9) *, #≥6 VLDA components25 (5.9)90 (21.0)105 (24.5) *134 (31.7) *, †3 (1.4)26 (12.3) *44 (20.2) *VLDA11 (2.6)62 (14.5)55 (12.8) *72 (17.0) *3 (1.4)16 (7.6) *21(9.6) *DAPSA REM9 (2.1)43 (10.0)47 (11.0) *79 (18.7) *, †1 (0.5)15 (7.1) *28 (12.8) *DAPSA LDA70 (16.5)198 (46.2)204 (47.6) *235(55.6) *, †14 (6.6)73 (34.6) *91 (41.7) *PASDAS REM12 (2.8)51 (11.9)60 (14.0) *91 (21.5) *, †4 (1.9)20 (9.5) *31 (14.2) *PASDAS LDA63 (14.9)168 (39.2)195 (45.5) *211 (49.9) *, †9 (4.2)69 (32.7) *82 (37.6) **P ≤ 0.05 for UPA15 and UPA30 vs PBO; †P ≤ 0.05 for UPA30 vs ADA; #Statistically significant in the multiplicity-controlled analysis.MDA (5/7) and VLDA (7/7): TJC ≤ 1; SJC ≤ 1; PASI ≤ 1 or BSA-Psoriasis ≤ 3%; Patient’s Assessment of Pain NRS ≤ 1.5; PtGA-Disease Activity NRS ≤ 2.0; HAQ-DI score ≤ 0.5; and tender entheseal points ≤ 1.DAPSA REM ≤ 4; DAPSA LDA ≤ 14.PASDAS REM ≤ 1.9; PASDAS LDA ≤ 3.2.Figure 1Acknowledgements:AbbVie and the authors thank the patients, study sites, and investigators who participated in this clinical trial. AbbVie, Inc was the study sponsor, contributed to study design, data collection, analysis & interpretation, and to writing, reviewing, and approval of final version. No honoraria or payments were made for authorship. Medical writing support was provided by Ramona Vladea, PhD of AbbVie Inc.Disclosure of Interests:Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Arthur Kavanaugh Consultant of: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Grant/research support from: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Dafna D Gladman Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer Inc, and UCB, Oliver FitzGerald Speakers bureau: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Peter Nash Speakers bureau: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Consultant of: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Grant/research support from: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Dai Feng Shareholder of: AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: AbbVie, Employee of: AbbVie, Kevin Douglas Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Laure Gossec Consultant of: AbbVie,Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Samsung, Sanofi, UCB, Grant/research support from: Lilly, Pfizer, and Sandoz.

Background:Axial spondyloarthritis (SpA) is an umbrella term encompassing a number of inflammatory conditions involving the axial skeleton. A substantial delay between disease onset, diagnosis and treatment often occurs, related in part to under-recognition of SpA symptoms. Although several studies have investigated since the publication of the ASAS classification criteria in 2009, the prevalence and incidence of axial SpA in the general population and in patients with SpA-related conditions, the actual prevalence of SpA in many countries (including Argentina) is unknown.Objectives:To estimate the prevalence of axial SpA and the amount of undiagnosed axial SpA in people under 45 years of age that contacted the health care system for chronic low back pain.Methods:The setting was a university hospital-based health management organization with a population distribution similary to that of Buenos Aires. All electronic medical records of patients < 45 years of age at the time of onset of symptoms (as per the ASAS 2009 criteria) and chronic low back pain for 3 or more months) seen at the university hospital-based health management organization between 2009 and 2019, were reviewed. If the patient fulfilled the ASAS criteria, was classified as having axial SpA [ankylosing spondylitis (AS) or non-radiographic axial SpA (nr-axSpA)]. Among this group, if the diagnosis was already established in the medical records by the treating physicians, these patients were also classified as diagnosed with axial SpA; if not, they were classified as undiagnosed with axial SpA. We are reporting the results of descriptive analysis.Results:A total of 796 patients were included (Table 1), 426 were women (53.52%, 95% CI 50.1-57) with a median age of 34 years (IQR 29-40) at initiation of low back pain with a median follow up of 77.7 months (IQR 35.7-136.4). The prevalence of axial SpA among patients with chronic low back pain was 5.78% (n= 46, 95% CI 4.2-7.4). 22 patients had AS (2.76%, 95% CI 1.6-3.9) with a median lag time between the onset of low back pain and diagnosis of 58.7 months (IQR 33.5 - 92). All AS cases were already diagnosed. 24 patients had nr-axSpA (3.02%, 95% CI 1.8 - 4.2). Of those, 14 were diagnosed by treating physicians with a lag time median of 23.2 months (IQR 13.1 - 36.5) between the onset of low back pain and diagnosis. Ten patients fulfilled the ASAS criteria (41.7%, CI 95% 22 - 61.4) but were not diagnosed by the treating physicians (22%, 95% CI 9.82-33.66) among the patients with axial SpA.Table 1.Demographic, clinical features and therapeutic characteristics of patients with chroniclow back pain stratified by diagnosisAxial spondyloarthritisN=46Ankylosing spondylitisN=22Diagnosednr-axSpAN=14Undiagnosednr-axSpAN=10OtherdiagnosisN=749Female, n (%, CI)18(39.13%, 25.04-53.23)4(18.18%, 2.06-34.29)10(71.42%,47.76-95.09)4(40%, 9.63-70.36)407(54.34,50.77-57.9)Age at chronic LBP initiation, years, median (IQR)36(29.25-40)32(32-40)38(22-36.75)39(35.25-41.5)34(29-40)Follow up, median months (IQR)88(33.43-148.66)33.67(23.38-90.34)16.73(7.64-24.02)64.77(11.21-164.7)77.69(35.83-135.32)Inflammatory chronic LBP by any criteria n (%)44 (95.7)21 (95.5)13 (92.8)10 (100)56 (7.5, 5.6-9.4)Seen by a Rheumatologist, n (%)42 (91.3)22 (100)14 (100)6 (60)36 (5.1)Lag time between first LBP to SpA diagnosis, months, median (IQR)34.6 (22.6-63.2)58.7 (33.5 – 92)23.1 (13.1-36.5)--bDMARDs treatment n, (%, CI)15(33; 19.5–48)10(45; 24.4–67.8)5(36; 13–64.9)--Lag time between NSAIDs failure and first bDMARDs, months, median (IQR)2.66(2.05-4.63)2.76(2.07-11.3).2.66(2.04-3.25)--CI: 95% confidential interval, IQR: interquartile range, bDMARDs: biologic disease modifying anti-rheumaticdrugs, LBP: low back painConclusion:In our cohort, 5.78% of the patients < 45 years with chronic low back pain had axial SpA (AS: 2.76%; and nr-axSpA: 3.02%). Approximately, one in every five patients had undiagnosed axial SpA. Original manuscript made in collaboration with Novartis Argentina S.ADisclosure of Interests:Mayra Alejandra Tobar Jaramillo: None declared, Nicolas Marin Zucaro: None declared, Javier Rosa: None declared, Josefina Marin: None declared, Maria Laura Acosta Felquer: None declared, LEANDRO FERREYRA: None declared, JOHN FREDY JARAMILLO GALLEGO: None declared, Josefina Marcos Employee of: Novartis, Vanesa Duarte Employee of: Novartis, Enrique Soriano Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz.

Background:Since the 2015 GRAPPA treatment recommendations were published, therapeutic options and management strategies for psoriatic arthritis (PsA) have advanced considerably.Objectives:The goal of the GRAPPA recommendations update is to develop high quality, evidence-based recommendations for the treatment of PsA, including related conditions and comorbidities.Methods:GRAPPA rheumatologists, dermatologists and patient research partners (PRPs) updated overarching principles for the management of adults with PsA by consensus. Principles considering use of biosimilars and tapering/discontinuing of therapy were added to this update. Systematic literature searches based on data publicly available from three databases (MEDLINE, EMBASE, and Cochrane CENTRAL) were conducted from the end of the previous recommendations’ searches through August 2020. Additional abstract searches were performed for conference presentations in 2017-2020. Searches covered PsA treatments (peripheral arthritis, axial arthritis, enthesitis, dactylitis, skin, and nail disease). Additional searches were performed for related conditions (uveitis and IBD) and comorbidities evaluating their impact on safety and treatment outcomes. Individual groups assessed the risk of bias and applied the GRADE system to generate strong or conditional recommendations for therapies within the domain groups and for the management of comorbidities and related conditions. These recommendations were then incorporated into an overall treatment schema.Results:Updated, evidence-based treatment recommendations are shown (Table 1). Since 2015, many new medications have been incorporated. Additional results for older medications, such as methotrexate, have been published across PsA domains. Based on the evidence, the treatment recommendations developed by individual groups were incorporated into the overall schema including principles for management of arthritis, spondylitis, enthesitis, dactylitis, skin, and nail disease in PsA, and associated conditions (Figure 1). Choice of therapy for an individual should ideally address all of the domains that impact on that patient, supporting shared decision making with the patient involved. Additional consideration in the recommendations was given to key associated conditions and comorbidities as these often impact on therapy choice.Conclusion:These GRAPPA treatment recommendations provide up to date, evidence-based guidance to providers who manage and treat adult patients with PsA. These recommendations are based on domain-based strategy for PsA and supplemented by overarching principles developed by consensus of GRAPPA members.IndicationStrongForConditional ForConditionalAgainstStrongAgainstInsufficient evidencePeripheral Arthritis DMARD NaïvecsDMARDs, TNFi, PDE4i, IL-12/23i, IL-17i, IL-23i, JAKiNSAIDs, oral CS, IA CS,IL-6i,Peripheral Arthritis DMARD IRTNFi, IL-12/23i, IL-17i, IL-23i, JAKiPDE4i, other csDMARD, NSAIDs, oral CS, IA CS,IL-6i,Peripheral ArthritisbDMARD IRTNFi, IL-17i, IL-23i, JAKi,NSAIDs, oral CS, IA CS, IL-12/23i, PDE4i, CTLA-4-IgIL-6i,Axial arthritis, Biologic NaïveNSAIDs, Physiotherapy, simple analgesia, TNFi, IL-17i, JAKiCS SIJ injections, bisphosphonatescsDMARDs, IL-6i,IL-12/23i, IL-23iAxial PsA, Biologic IRNSAIDs, Physiotherapy, simple analgesia, TNFi, IL-17i, JAKi csDMARDs, IL-6i,IL-12/23i, IL-23iEnthesitisTNFi, IL-12/23i, IL-17i, PDE4i, IL-23i, JAKiNSAIDs, physiotherapy, CS injections, MTXIL-6i,Other csDMARDsDactylitisTNFi IL-12/23i, IL-17i, IL-23i, JAKi, PDE4iNSAIDs, CS injections, MTXOther csDMARDsPsoriasisTopicals, phototherapy, csDMARDs, TNFi, IL-12/23i, IL-17i, IL-23i, PDE4i, JAKi AcitretinNail psoriasisTNFi, IL12/23i, IL17i, IL23i, PDE4iTopical CS, tacrolimus and calcipotriol combination or individual therapies, Pulsed dye laser, csDMARDs, acitretin, JAKiTopical Cyclosporine / Tazarotene, Fumarate, Fumaric Acid Esters, UVA and UVB Phototherapy, AlitretinoinIBDTNFi (not ETN), IL-12/23i, JAKiIL-17iUveitisTNFi (not ETN)Disclosure of Interests:Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb,GSK, Genzyme, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb,GSK, Genzyme, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, Janssen, Novartis Pharma, Pfizer, Roche, and UCB, Nadia Corp: None declared, Heidi Bertheussen Consultant of: Pfizer, Kristina Callis-Duffin Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Lilly, Janssen, Novartis, Pfizer, Sienna Biopharmaceuticals, Stiefel Laboratories, UCB, Ortho Dermatologics, Inc, Regeneron Pharmaceuticals, Inc., Anaptys Bio, Boehringer Ingelheim., Cristiano Barbosa Campanholo Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Jeffrey Chau: None declared, Lihi Eder Consultant of: Abbvie, UCB, Janssen, Eli Lily, Pfizer, Novartis, Grant/research support from: Abbvie, UCB, Janssen, Eli Lily, Pfizer, Novartis, Daniel Fernandez Consultant of: Abbvie, UCB, Roche, Janssen, Pfizer, Amgen and Brystol, Grant/research support from: Abbvie, UCB, Roche, Janssen, Pfizer, Amgen and Brystol, Oliver FitzGerald Speakers bureau: AbbVie, Janssen and Pfizer Inc, Consultant of: BMS, Celgene, Eli Lilly, Janssen and Pfizer Inc, Grant/research support from: AbbVie, BMS, Eli Lilly, Novartis and Pfizer Inc, Amit Garg Consultant of: Abbvie, Amgen, Asana Biosciences, Bristol Myers Squibb, Boehringer Ingelheim, Incyte, InflaRx, Janssen, Pfizer, UCB, Viela Biosciences, Grant/research support from: Abbvie, Dafna D Gladman Consultant of: Abbvie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Jansen, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Amgen, Eli Lilly, Jansen, Novartis, Pfizer and UCB, Niti Goel: None declared, Suzanne Grieb: None declared, Philip Helliwell Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: Eli Lilly, M Elaine Husni Consultant of: Abbvie, Amgen, Janssen, Novartis, Lilly, UCB, Regeneron, and Pfizer, Deepak Jadon Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Arnon Katz: None declared, Dhruvkumar Laheru: None declared, John Latella: None declared, Ying Ying Leung Speakers bureau: Novartis, AbbVie, Eli Lilly, Janssen, Consultant of: Pfizer and Boehringer Ingelheim, Grant/research support from: Pfizer and conference support from AbbVie, Christine Lindsay Shareholder of: Amgen, Employee of: Aurinia pharmaceuticals, Ennio Lubrano Speakers bureau: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Consultant of: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Luis Mazzuoccolo Speakers bureau: Abbvie, Amgen, Novartis, Elli Lilly, Jansen, Consultant of: Abbvie, Amgen, Novartis, Elli Lilly, Jansen, Roland McDonald: None declared, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Janssen, Novartis, Pfizer, SUN and UCB, Denis O’Sullivan: None declared, Alexis Ogdie Consultant of: AbbVie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, and Pfizer, Grant/research support from: Novartis and Pfizer and Amgen, Wendy Olsder: None declared, Lori Schick: None declared, Ingrid Steinkoenig: None declared, Maarten de Wit Consultant of: AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Danielle van der Windt: None declared, Arthur Kavanaugh Speakers bureau: AbbVie, Amgen, BMS, Eli Lilly, Gilead Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Gilead Janssen, Novartis, Pfizer, UCB

Background:Golimumab is a human monoclonal antibody directed against TNFα in its soluble and transmembrane forms. It can be used subcutaneously or intravenously and has shown efficacy for use in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).Objectives:The aim of this study was to evaluate the efficacy, safety, and cumulative survival of golimumab in patients with RA, PsA and AS from different rheumatology centers in Argentina.Methods:We performed a longitudinal study of consecutive adults with RA (ACR/EULAR 2010 criteria), PsA (CASPAR criteria) and AS (ASAS 2009 criteria), who have started treatment with subcutaneous or intravenous golimumab according to medical indication in each center. Data was obtained by review of medical records. Sociodemographic and clinical data, musculoskeletal manifestations, comorbidities, previous treatments were recorded. In reference to golimumab treatment, start date, route of administration and concomitant treatments were identified. Disease activity was assessed using DAS28 for RA patients, DAPSA and MDA for PsA and BASDAI for AS. The presence of adverse events (AE) was recorded. If golimumab was stopped, date and cause was documented. Patients were followed up until golimumab discontinuation, loss of follow-up, or study completion (November 30, 2020). Statistical analysis: Chi2 test or Fischer exact test and T test or Mann Whitney and ANOVA or Kruskal Wallis, as appropriate. The incidence of EA was assessed in events every 100 patient/year. Kaplan-Meier curves and log Rank analysis. Cox proportional regression.Results:One hundred eighty two patients were included, 116 with a diagnosis of RA, 30 with PsA and 36 with AS. Most of them (70.9%) were female with a median (m) age of 55 years (IQR 43.8-64) and m disease duration of 7 years (IQR 4-12.7) at treatment initiation. Al least one prior biological DMARD or a small molecule was received by 63 patients (34.6%). The most frequent indication cause was conventional DMARD failure. In 94.8% of the patients Golimumab was administered subcutaneously, and in 80.8% in association with conventional DMARDs, the most frequently used was methotrexate. Total follow-up was 318.1 patients/year.Golimumab treatment showed clinical improvement in all three groups of patients. In RA patients DAS28 significantly decreased during the first 12 months of follow-up, m 5.9 (IQR 4.9-6.6) at baseline, 3.8 (IQR 2.6-4.6) at 6 months and 2.8 (IQR 2.1-3.6) at 12 months, p The incidence of adverse events was 6.6 per 100 patients/year, being infections the most frequents ones. During follow-up, 50 patients (27.5%) discontinued golimumab, the most frequent cause was treatment failure (68%), followed by lack of health insurance (16%) and adverse events (10%). Golimumab persistence was 79% and 57.6% at 12 and 24 months, respectively. Treatment survival was 50.2 months (95% CI 44.4-55.9). Patients who had received prior treatment with biological DMARDs or small molecules showed lower survival (Figure 1). In the multivariate analysis, adjusting for age, sex and disease duration, those patients showed twice the risk of suspending treatment (HR 2.01, 95% CI 1.1-3.7).Figure 1.Golimumab survival according to prior b-DMARD o small molecule treatment.Conclusion:Golimumab treatment in real life patients in Argentina has shown good efficacy and safety. Drug survival was over 4 years and almost 80% were still using golimumab after one year. Prior treatment with other b-DMARDs o small molecules was associated with lower treatment survival.Disclosure of Interests:Carolina Ayelen Isnardi Speakers bureau: Bristol Myers Squibb, Janssen, Grant/research support from: Pfizer, Emma Estela Civit De Garignani Speakers bureau: Abbvie, Novartis, Agustín García Ciccarelli Speakers bureau: Janssen, Novartis, Consultant of: Novartis, Grant/research support from: Janssen, Novartis, Jimena Sanchez Alcover: None declared, Rodrigo Garcia Salinas Speakers bureau: Abbvie, AMGEN, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen Cilag, Montpellier-UCB, Novartis, Roche – Genentech, Sanofi, Merck Serono., Sebastian Magri Speakers bureau: Abbvie, AMGEN, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen Cilag, Montpellier-UCB, Novartis, Roche – Genentech, Sanofi, Merck Serono., Eduardo Albiero Consultant of: Janssen, Carla Gobbi Speakers bureau: Pfizer, Consultant of: Pfizer, Janssen, Edson Velozo Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: Abbvie, Janssen, Novartis, Grant/research support from: Janssen, Novartis, Pfizer, Enrique Soriano Speakers bureau: AbbVie, Novartis, Bristol MS, Novartis, Eli Lilly, Genzyme, Pfizer, Amgen, and Roche, Consultant of: Novartis, AbbVie, Pfizer, Eli Lilly, Sanofi, Sandoz, Amgen., Grant/research support from: Roche, Novartis, AbbVie, Glaxo Smith Kline, BMS, Martín Brom: None declared, Johana Zacariaz Grant/research support from: Bristol Myers Squibb, Ingrid Strusberg Speakers bureau: Gema Biotech SAU, BMS, Abbvie, Consultant of: Gema Biotech SAU, Abbvie, Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Marcos BARAVALLE Speakers bureau: Montepellier, Consultant of: Abbvie, Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Sol Castaños Speakers bureau: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Liliana Morales Speakers bureau: Lilly, Consultant of: Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Sergio Paira: None declared, Romina Calvo: None declared, Alberto Ortiz: None declared, Rodolfo Perez Alamino Speakers bureau: Pfizer, Abbvie, Amgen, Bristol-Myers-Squibb, Lilly, Janssen, Novartis, Hernan Maldonado Ficco Speakers bureau: Pfizer, Abbvie, Jansen, Novartis, Bago, Bristol, Eli Lilly., Consultant of: Pfizer, Abbvie, Novartis, Jansen, Bago, Eli Lilly., Gustavo Citera Speakers bureau: Abbvie, BMS, Lilly, Jansen, Gema, Pfizer, Roche, Grant/research support from: Pfizer

Background:As psoriasis (Pso) commonly precedes psoriatic arthritis (PsA), an important unanswered question is whether treatment of Pso might influence the development of PsA in patients with psoriasisObjectives:The objective of this study was to analyze the incidence of PsA in a large cohort of patients with PsO according to different treatments, with the hypothesis that treatment with biologics might prevent the development of PsA.Methods:Patients with PsO without PsA followed at a University Hospital were included in this retrospective cohort study. Data was obtained from the Hospital Electronic Medical Record (EMR). Patients were classified according to their treatment in topics group (topic and phototherapy), conventional DMARDs (cDMARDs) group (Methotrexate (MTX) and cyclosporine (Cyc)), and biologic DMARDs group (bDMARDs) (TNFi, IL17i, and IL12-23i). Patients contributed time since beginning of the corresponding treatment until diagnosis of PsA, lost of follow up, end of treatment or end of study. Incident cases of PsA were attributed to one treatment if developed during the administration of that treatment and up to 6 months after its discontinuation if no other treatment was started. Incident cases that developed more than one year after discontinuation of treatment were disregarded (3 cases). Incidence rate was calculated for the whole population and for each one of the treatment groups and compared with chi2test, and rate ratios were calculated as well. A multivariable logistic model for the development of PsA was analyzed by treatment groups, adjusting by other variables.Topics, n= 599cDMARDs, n=106bDMARDs, n=92Total group, n=797Mean age at PsO diagnosis (SD)43.6 (20.6)46.2 (20.7)35.1 (18.9)42.9 (20.6)Female, n (%)314 (52)53 (50)36 (39)403 (50.5)Plaque PsO, n/N (%)514/578 (89)93/103 (90)85/90 (94)692/771 (90)BMI, n; Mean (SD)498; 27.6 (5.4)80; 28.5 (5.6)91; 30 (7)659; 28 (5.7)N Developed PsA (%)68 (8.5)3 (0.38)1 (0.13)72 (9)Follow up (patient/years)915331654810017Incidence rate/1000 Patient/ years (95% CI)7.4 (5.8-9.4)9.5 (1.9-27.5)1.81 (0.04-10)7.2 (5.6-9)Median years between PsO and PsA (IQR)10 (2-21)Patient 1: 23Patient 2: 11.7Patient 3: 24.7Patient (1): 9.610.5 (2-20.8)Results:797 patients, contributed a total of 10017 patient/years. Patient’s characteristics are shown in table 1. 599 (75%) patients were treated only with topics or phototherapy, 106 (13%) with cDMARDs (81% MTX and 19% Cyc) and 92 (11.5%) with biologics (TNFi: 64: etanercept: 44, adalimumab:23, infliximab:6; IL17i: 43: 14 Ixekizumab, 29 Secukinumab; IL12-23i: (Ustekinumab) 16; some patients received more than one biologic). During follow-up 72 patients developed PsA (68 under topics; 3 under cDMARDs (2 MTX and 1 Cyc) and 1 under biologics (1 Secukinumab): Global incidence rate: 7.2 per 1000 patient/years (table 1). Although numerically the incidence of PsA in PsO patients treated with biologics was lower, the difference was not statistically significant. In Cox regression analysis, after adjusting by sex, age, and BMI, treatment with biologics was significantly associated with a reduced risk of developing PsA: Hazard ratio (95% CI): 0.1 (0.013 – 0.7); p= 0.021.Conclusion:Treatment with biologics in patients with PsO seemed to reduce the risk of PsA and preventing its development in this retrospective single center cohort.Acknowledgments:This study was awarded with the PANLAR stimulus award 2019Disclosure of Interests:Luciano Lo Giudice: None declared, Maria Laura Acosta Felquer: None declared, Maria Laura Galimberti: None declared, Luis Mazzuoccolo: None declared, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche

Background:An international task force has agreed that remission and low disease activity (LDA) are treatment targets for patients (pts) with PsA, and recommends the Disease Activity Index in Psoriatic Arthritis (DAPSA) and minimal disease activity (MDA) to assess disease activity states.1Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA.Objectives:In this post hoc analysis, we compared DAPSA LDA with MDA, and DAPSA remission with very low disease activity (VLDA) and DAS28-3(CRP) remission, in pts with PsA receiving tofacitinib.Methods:Data were pooled from 2 Phase 3 studies (OPAL Broaden [12 months;NCT01877668]; OPAL Beyond [6 months;NCT01882439]) for pts receiving tofacitinib 5 or 10 mg twice daily (BID) or placebo (PBO). DAPSA was determined by summing: swollen joint count (SJC66); tender/painful joint count (TJC68); Patient’s Global Assessment of Arthritis (PtGA; visual analogue scale [VAS]); pain (VAS); and CRP. Pts were classified as achieving MDA or VLDA when meeting ≥5 (MDA) or 7 (VLDA) of the following criteria: TJC68 ≤1; SJC66 ≤1; Psoriasis Activity and Severity Index ≤1 or body surface area ≤3%; pain (VAS) ≤15; PtGA (VAS) ≤20; HAQ-DI ≤0.5; tender entheseal points (using Leeds Enthesitis Index [LEI]) ≤1. A logistic regression model was used to assess demographic and baseline characteristics as predictors of a trend in DAPSA scores at Month (M)3. DAPSA LDA (≤14), MDA, DAPSA remission (DAPSA ≤4), VLDA and DAS28-3(CRP) remission (DAS28-3[CRP]Results:This analysis included 709 pts: tofacitinib 5 mg BID, n=237; tofacitinib 10 mg BID, n=236; PBO, n=236. At M3, older patients treated with tofacitinib, and tofacitinib- or PBO-treated pts with higher baseline SJC66, TJC68, PtGA VAS, HAQ-DI, LEI and Pain VAS, were significantly (pConclusion:Remission and LDA rates generally increased over time in pts with PsA receiving tofacitinib. DAPSA LDA showed moderate agreement with MDA, and DAPSA remission showed at least moderate agreement with VLDA, confirming that DAPSA and MDA are useful measurement tools to assess disease activity in pts with PsA treated with tofacitinib.References:[1]Smolen et al. Ann Rheum Dis 2018;77:3-17.Acknowledgments:Study sponsored by Pfizer Inc. Medical writing support was provided by Sarah Piggott of CMC Connect, McCann Health Medical Communications, and funded by Pfizer Inc.Disclosure of Interests:Emilce Schneeberger: None declared, Gustavo Citera Grant/research support from: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Consultant of: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche, Claudia Helling Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Annette E Szumski Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Rajiv Mundayat Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Daniela Graham Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Dario Ponce de Leon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

Background:SARS CoV-2 infection has recently burst onto the global scene, and the knowledge of the course of this infection in patients with rheumatic diseases receiving immunomodulatory treatment is still insufficient. The Argentine Society of Rheumatology (SAR) designed a national registry called SAR-COVID in order to get to assess our reality.Objectives:To identify the particular characteristics of patients with rheumatic diseases and COVID-19 in Argentina (SAR-COVID Registry), and to compare them with the data reported at the Latin American and Global level (Global International Alliance Rheum-COVID Registry).Methods:A national, multicenter, prospective and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or serology, were included between August 13, 2020 and January 17, 2021. Demographic data, underlying rheumatic disease (activity of the disease, current treatment), comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as received treatments (pharmacological, oxygen therapy / ventilatory support) and outcomes (hospitalization, mortality) were recorded. The characteristics of the included patients were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher’s test, according to the type of variable.Results:Four hundred sixty-five patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women (79.6%, 73% and 71% respectively), with a mean age of 50.2 (SD 15.3), 53.5 (DE 15.6) and 55.8 (15.5), years respectively. The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (43.9%, 35%, and 39%) and systemic lupus erythematosus (16.1%, 22%, and 14%) (Table 1).In Argentina, fewer patients received specific pharmacological treatment for COVID-19 (40.9%, 68% and 43% respectively, p Hospitalization was lower in Argentina than in the rest of Latin America (37.4% vs 61% p 0.0002) and of the world (37.4% vs 45% p 0.0123), and mortality was numerically lower in Argentina, but without statistically significant differences between the three groups (6.9%, 12% and 11%; p 0.6311). Most of the patients, (86.9%) did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, p Conclusion:The patients with rheumatic diseases and SARS-CoV-2 infection reported in this argentinian registry received less specific pharmacological treatment for COVID-19, presented fewer complications and required less ventilatory support, than those reported in the Latinoamerican and Global registry. However, no statistically significant differences were observed in terms of mortality.Graph 1.Main outcomes and evolution of patients with rheumatic disease and COVID-19.References:[1]Stokes, Erin K, Zambrano, Laura D, Anderson, Kayla N, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep; 69(24): 759-765, 2020 Jun 19.[2]Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm síndromes and immunosuppression. Lancet 2020;395:1033–4.[3]Gianfrancesco M, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866.[4]Manuel F. Ugarte-Gil, et al. Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America. Global Rheumatology. Septiembre 2020.Disclosure of Interests:Alvaro Andres Reyes Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Gelsomina Alle Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Tanten Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Marina Scolnik Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Enrique Soriano Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Berbotto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Maria Haye Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, María Julieta Gamba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Nieto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Mercedes García Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Veronica Savio Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana Gonzalez Lucero Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Paula Alba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Lorena Takashima Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, FABIAN RISUEÑO Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana CASALLA Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Natalia Cucchiaro Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Ana Bertoli Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Sabrina POrta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carla Maldini Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Gallo Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Cecilia Goizueta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Eugenia Picco Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Quintana Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Karen Roberts Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carolina Ayelen Isnardi Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Pons-Estel Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”

Background:Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% to 51%1,2. Factors associated with it include the use of electronic medical records, administrative tasks and prolonged working hours. This has several repercussions such as higher prevalence of depression/anxiety and less productivity.Objectives:To determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it.Methods:Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory (MBI) with cut off values of ≥27 for emotional exhaustion (EE), ≥10 for depersonalization (DP), and ≤33 for personal accomplishment (PA). Other variables were studied such as demographics, working conditions, satisfaction, comorbidities, depression using PHQ-9 and happiness using the Subjective Happiness Scale. Data was analyzed using the statistical program SPSS v.22.Results:297 rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%) and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week. 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work. 36% received an annual income less than 25K.56.6% had burnout in at least 1 dimension. According to the dimensions, 35.7% had burnout in EE, 25.6% in PA and 26.6% in DP. 32.3% had burnout in only 1 dimension, 17.2% in two and 7.1% in all three dimensions. Only 20.2% thought they had burnout, 9.1% were currently with professional help and 15.8% had sought help in the past. 72.1% said they were willing to participate in a program to reduce burnout.The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015), mentioned more frequently that they would like to decrease the number of working hours (56.5% vs 36.4%, p = 0.002) and had lower practice satisfaction (5.2 vs 6.2, p Conclusion:Burnout affects near half of rheumatologists in Latin America and was associated to younger age, long working hours, low satisfaction, less happiness, higher PHQ-9, suicidal thoughts, anxiety, income, presence of comorbidities and low self-esteem. Most of the rheumatologists were willing to participate in programs to reduce burnout which represents an opportunity for interventions to reduce this syndrome.References:[1]Martin K. Medscape Rheumatologist Lifestyle, Happiness & Burnout Report 2020. 2020; Available at: https://www.medscape.com/slideshow/2020-lifestyle-rheumatologist-6012480#4. Accessed July 10, 2020.[2]Tiwari V, Kavanaugh A, Martin G, Bergman M. High impact of burnout on rheumatology practitioners. Journal of rheumatology 2020:jrheum.191110.Disclosure of Interests:None declared

Background:Polypharmacy (PP) is an important risk factor for drug toxicity, delirium, falls, hospitalizations and death. Patients with rheumatoid arthritis (RA) often have comorbid conditions and have PP. Treat to target strategy (T2T) implies a drug escalation and rheumatologists may not apply it in patients with PP.Objectives:Our objective was to analyze if PP affects T2T in a real-world scenario.Methods:Observational, retrospective cohort study. Patients with a new RA diagnosis (ACR/EULAR 2010 criteria) after 2010, over 18 years old, belonging to a Health Management Organization (HMO) from a university tertiary hospital, with a minimum follow-up period of 2 years, were included. PP was defined as consumption greater than or equal to 5 medications at the time of RA diagnosis, regardless of the medication used for RA, administered for a minimum period of 6 months. T2T strategy was defined as accomplished if an escalation in treatment was done when the patient had moderate or high disease activity at medical visit (by DAS28 and/or CDAI), without a significant improvement with respect to the previous visit. Prevalence of PP at RA diagnosis was calculated and RA patients were divided in those with PP at RA diagnosis time and those without. The first 2 years of disease were analyzed and compare between both groups: clinical and demographic characteristics, percentage of visits where T2T was applied, treatments received during that period. A multivariate logistic regression analysis was performed in order to identify factors associated with no T2T compliance.Results:147 patients with RA were included, 86% women, with an average age at diagnosis of 60 years (SD: 15.8). The prevalence of PP at RA diagnosis was 12% (17 patients). Table 1 shows the comparison between patients with and without PP. Patients with PP showed a greater frequency of erosions at baseline and after 2 years of disease, a greater use of corticosteroids at 2 years, higher percentage of hospitalizations and a higher mortality. In the multivariate logistic regression analysis, no compliance of the T2T strategy was only associated with the consumption of corticosteroids at 2 years (OR: 0.36, CI95%: 0.15-0.85; p=0.019) and no association was found with PP at the beginning of the disease.Table 1.Demographic and clinical characteristics in patients with and without polypharmacy.)Patients without Polypharmacy(n= 127)Patients with Polypharmacy(n= 17)PMale sex, n (%)18 (13.8)3 (17.6)0.6Mean age at diagnosis (SD)58.5 (15.6)70.6 (12.2)0.9Positive rheumatoid factor, n (%)87 (66.9)12 (70.5)0.7Positive anti CCP, n (%)109 (85.8)13 (81.2)0.6Erosions at baseline, n (%)25 (19.2)7 (41.1)0.03Active smoker, n (%)28 (21.5)3 (17.6)0.2Past smoker, n (%)23 (17.6)7 (35.2)Charlson score, median (IQR)3 (1-4)4 (4-5)Polypharmacy at 2 years, n (%)17 (13.0)46.8 (88.2)Rheumatological consultations in 2 years, mean (DE), (IC 95%)8.6 (3.3)(8.0-9.2)8.8 (3.1)(7.2-10.5)0.6Corticosteroid therapy at 2 years, n (%)29 (22.3)8 (47.0)0.02cDMARDs therapy at 2 years, n (%)114 (87.6)13 (76.4)0.2Biologic therapy at 2 years, n (%)13 (10)4 (23.5)0.1Erosions at 2 years, n (%)29 (22.3)9 (52.9)0.007No T2T compliance, n (%)65 (50)5 (29.4)0.1Hospitalizations, n (%)12 (9.2)7 (41.1)Mortality, n (%)2 (1.5)2 (11.7)0.01Conclusion:The prevalence of PP in our patients with a new RA diagnosis was 12% and was associated with more baseline erosions, a higher consumption of steroids, and a higher frequency of hospitalizations and mortality during the first 2 years of the disease. No relationship between PP and adherence to the T2T strategy was demonstrated. In the multivariate logistic regression analysis, no compliance with the T2T strategy was only associated to the consumption of corticosteroids at 2 years, may be reflecting a poorer disease control.Disclosure of Interests:JOHN FREDY JARAMILLO GALLEGO: None declared, Javier Rosa: None declared, Marina Scolnik: None declared, Mayra Alejandra Tobar Jaramillo: None declared, LEANDRO FERREYRA: None declared, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche

Background:The demand for rheumatology care has been steadily increasing over the last few years. However, supply seems to be insufficient, according to previous research1. This situation may be at least partly explained by less physicians beginning a rheumatology residency program2.Objectives:We aim to identify baseline data, room for change, and to strengthen functional processes associated with the rheumatology workforce in order to improve care offered to patients living with rheumatic diseases.Methods:Descriptive cross-sectional study. We obtained data on each country through local PANLAR rheumatologists. They completed an online survey using the RedCap® platform, used for capture and storage of data. The sample was described according to the type of variable.Results:19 Latin American countries were included in this study, globally 1 rheumatologist was available per 106,838 inhabitants. The highest rates were found in Uruguay (1 per 23.695 inhabitants) and Argentina (1 per 40.384 inhabitants). The lowest rates were found in Nicaragua (1 per 640.648 inhabitants) and Guatemala (1 per 559.902 inhabitants). The ratio between women and men rheumatologists was 0,99 women per each man. The lowest proportions were found in Peru (0,26:1), and the highest in the Dominican Republic (2.5:1). The average age for rheumatologists was 51,6 (SD12,75). Lowest average ages were found in Paraguay (43,1 SD10,77) and the highest age averages were found in Peru (56,23 SD12.93). The average monthly compensation was USD $2.382,6 (SD$1.462,5). Venezuela had the lowest salary ($197), the highest salary was found in Costa Rica ($4.500). The proportion of rheumatologists trained abroad was 26,7%, ranging between 0% in Uruguay and 90% in Bolivia.The countries with more rheumatology training programs were Brazil n = 50 and Mexico n = 20, while Ecuador, Honduras and Nicaragua don’t have any. The countries with the greatest amount of active residents were Brazil (n = 252) and Argentina (n = 100). The educational level required to enter the program was postgraduate studies in internal medicine in 42.11% of the programs. Currently, 108 residency programs in Latin America are active. Duration of residency programs is variable: 2 years (79.63% of cases), 3 years (16.67%), 4 years (1.85%), 5 years (0.96%) or 6 years (0.96%). The median monthly compensation for residents was $ 528 USD (IQR $ 774), the country with the highest payment was Costa Rica ($ 2637). Contrarily, in Cuba, Chile and Colombia there is no payment to residents. Finally, in 8 countries (42.11%) residents must not pay for their postgraduate studies, the average annual tuition expense in the rest of countries is $ 1248 (SD $ 2749).Conclusion:The rate of rheumatologists per inhabitant is low. The demographic characteristics and the current status of the rheumatology workforce, as well as rheumatology training in Latin-America varies widely among countries. For instance, relevant differences can be found regarding payment to rheumatologists and residents, and tuition fees. The collected information will be useful when planning regional-based strategies, as well as for future research projects in each country and within PANLAR.References:[1]Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030. Arthritis Care Res.2018;70(4):617-26[2]Zborovski S, Rohekar G, Rohekar S. Strategies to improve recruitment into rheumatology: results of the Workforce in Rheumatology Issues Study. J Rheumatol. 2010;37:1749-55Disclosure of Interests:Daniel G. Fernández-Ávila: None declared, Daniela Patino-Hernandez: None declared, Sergio Kowalski: None declared, Alfredo Vargas-Caselles: None declared, Ana María Sapag Durán: None declared, Antonio Cachafeiro Vilar: None declared, Belia Meléndez: None declared, Carlos Santiago Pastelín: None declared, Cesar Graf: None declared, Chayanne Rossetto: None declared, Daniel Palleiro: None declared, Daniela Trincado: None declared, Diana Fernández-Ávila: None declared, Dina Arrieta: None declared, Gil Reyes: None declared, Jossiell Then: None declared, Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Mario Cardiel: None declared, Nelly Colman: None declared, Nilmo Chávez: None declared, Paula Burgos: None declared, Ruben Montufar: None declared, Sayonara Sandino: None declared, Yurilis Fuentes-Silva: None declared, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche

Background:Psoriatic arthritis (PsA) is a chronic systemic disease with manifestations affecting musculoskeletal and extra-articular domains. Treatment and assessment of response are therefore major challenges in routine clinical practice. Minimal disease activity (MDA) is a multidimensional endpoint that can define a treatment target1. In SPIRIT-H2H2, a head-to-head clinical trial comparing the efficacy and safety of ixekizumab (IXE) versus) to adalimumab (ADA), the percentage of patients simultaneously achieving American College of Rheumatology 50 (ACR50) and Psoriasis Area and Severity Index 100 (PASI100), was the primary endpoint in order to reflect improvement in two domains of PsA.Objectives:To evaluate how individual components of the simultaneous achievement of ACR50 and PASI100 compare with those of MDA at week 24.Methods:Patients with active PsA (defined as those with a tender joint count [TJC] ≥ 3/68, a swollen joint count [SJC] ≥ 3/66 and a body surface area [BSA] of active plaque psoriasis ≥ 3%) were randomised 1:1 to approved dosing (according to baseline psoriasis involvement) of IXE or ADA in SPIRIT-H2H, an open label, assessor-blinded study.The proportion of patients meeting each criterion of the composite endpoints was calculated for the intent-to-treat ([ITT], N=566) population and the population of MDA responders at Week 24 (N=235). Missing individual responses were imputed with non-responder status. Spidergrams were generated using SAS 9.4.Results:For both the overall ITT population and the MDA responders population, the use of PASI≤1 or BSA≤3% in the skin-related component of the MDA contributed to the higher response rate relative to the PASI100 response. Thus, the PASI100 response is a more stringent endpoint. Proportions of responders are similar across MDA and ACR50+PASI100 individual components for HAQ and SJC. The high baseline TJC levels (mean TJC: IXE=19.1, ADA=21.3) as opposed to lower levels observed for baseline SJC (mean SJC: IXE=10.1, ADA=10.7) made MDA-TJC criterion (≤1) more difficult to achieve than the equivalent criterion of the ACR50+PASI100 endpoint.Conclusion:Despite the differences in criteria definitions, there are consistent response patterns in the individual components of the simultaneous ACR50+PASI100 and MDA endpoints in particular for the peripheral arthritis domain.References:[1]Smolen, Josef S et al. “Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.”Annals of the rheumatic diseasesvol. 77,1 (2018): 3-17.[2]Mease PJ The SPIRIT H2H study group, et al. “A head-to-head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naïve patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial.”Annals of the Rheumatic Diseases2020;79:123-131.Disclosure of Interests:Laura C Coates: None declared, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Celine El Baou Consultant of: Eli Lilly and Company, Jane Zochling Employee of: Jannssen Cilag, Speakers bureau: Janssen Cilag, AbbVie, Novartis, UCB, BMS, Eli Lilly, Antonio Marchesoni Speakers bureau: Abbvie, Pfizer, UCB, Novartis, Celgene, Eli Lilly, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche, Valderilio F Azevedo Grant/research support from: Abbvie, Janssen, Bristol-Myers Squibb, Boehringer-Ingelheim, Lilly and Novartis, Consultant of: Lilly, Novartis, Janssen, Boehringer-Ingelheim, Amgen, Pfizer and Abbvie, Speakers bureau: Sandoz, Celltrion, Lilly, Novartis, Janssen, Boehringer-Ingelheim, Amgen, Pfizer and Abbvie, Klaus Machold Grant/research support from: AbbVie, MSD, UCB, Consultant of: Arsanis, Astro, Baxter, BMS, Celgene, Eli-Lilly, MSD, Pfizer, Roche, Novartis, Sandoz, Speakers bureau: MSD, Pfizer, BMS, Janssen-Cilag, Sandoz, Novartis, Eli-Lilly, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company

We want to thank Dr Morton Scheinberg for his interest1 in our recent lupus guidelines communication.2 In his letter, he points out several concerns regarding belimumab which we had recommended at the same therapeutic level as other immunosuppressants for joint and skin manifestations. Few clarifications are needed. The development of our guidelines followed a rigorous methodology in which the evidence on effect estimates should come, when available, from randomised controlled trials (RCTs). We did not identify any clinical trial comparing belimumab against other immunosuppressants. Therefore, in considering this comparison, the development group had to rely on indirect evidence (the difference in belimumab effect against placebo and other immunosuppressants against placebo) or high risk of bias evidence (from observational studies). In this context, the panel agreed that the certainty that belimumab was better (or worse) than other immunosuppressants was low/very low and therefore decided not to recommend one over the others...

PurposeTo determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors.MethodsSLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual.Results901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, pConclusionsThe number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation leading to both cartilage destruction and bone erosions. Early identification of patients with RA, and in particular those with erosive course of the disease would allow a timely therapeutic strategy for cartilage and bone protection. Objectives To investigate the degree of agreement between local expert rheumatologists and central trained readers in the detection of erosions (presence/absence) on plain radiographs of hands and feet. Methods Patients with early RA ( Results From 1069 patients in the GLADAR cohort, there were 516 RA patients with hands and feet radiographs available for standardized radiographic scoring system. According to local and central reading 137 patients (26.6%) and 276 patients (53.5%) displayed erosions, respectively. Agreement between local and central reading was poor (kappa =0.171). From a total of 525 patients with hands radiographs available for standardized scoring, according to local reading 153 (29.1%) fulfilled the radiographic changes criteria RA 1987, whereas central reading showed that 227 (43.2%) presented hand erosions. Again, agreement was poor (kappa =0.120). Conclusions In patients with early RA trained readers and local rheumatologists agreed poorly on the recognition of erosions. This is relevant as therapeutic decisions may change in the presence of erosions and indicate the necessity of more/better training for radiologists/rheumatologists in evaluating articular damage in RA in LA. References Early Rheumatoid Arthritis in Latin America: Low Socioeconomic Status Related to High Disease Activity at Baseline. Arthritis Care & Research 2012; 64: 1135-1143 Treatment of Early Rheumatoid Arthritis in a Multinational Inception Cohort of Latin American Patients. The GLADAR Experience. J Clin Rheumatol 2012; 18: 327-335 Acknowledgements To Dr. Daniel E. Furst, Geffen School of Medicine, University of California Los Angeles Disclosure of Interest L. Massardo Grant/research support from: Abbott, B. PonsEstel Grant/research support from: Abbott, C. Pineda Grant/research support from: Abbott, E. Soriano Grant/research support from: Abbott, M. Cardiel Grant/research support from: Abbott, C. Galarza Grant/research support from: Abbott, R. Levy Grant/research support from: Abbott, M. Sacnum Grant/research support from: Abbott, C. V. Caballero Grant/research support from: Abbott, E. Acevedo Grant/research support from: Abbott, W. Bianchi Grant/research support from: Abbott, H. Gonzalez Grant/research support from: Abbott, R. Montufar Grant/research support from: Abbott, R. Pinto Grant/research support from: Abbott, L. A. Ramirez Grant/research support from: Abbott, C. Zerbini Grant/research support from: Abbott

Background Rheumatoid arthritis (RA) is known to have a variable course resulting in a wide range of outcomes, varying from a mild disease causing hardly any impairment to severe disease leading to extensive disability and radiological damage 1,2 . Objectives The aim of the present study was to identify predictive factors for unfavorable outcomes in early rheumatoid arthritis patients. Methods The 1-year outcome of RA patients from a prospective inception cohort (CONAART-Argentine Consortium for Early Arthritis) was assessed. We defined the following 3 criteria for unfavorable outcomes: a clinical course with persistent moderate-high disease activity during the last 6 months (DAS28 average ≥ 3.2, or an increase > 1.2 compared to baseline, or at least one DAS28 >5.1), a disability worsening and a radiological damage increasing (HAQ deterioration within 1 year of ≥ 0.5 points and Simple Erosion Narrowing Score (SENS)- deterioration within 1 year of ≥ 1 points, respectively). Two groups of patients (unfavorable outcome or not unfavorable outcome), were identified for each of the 3 outcome dimensions. Significance of the difference between groups was tested using a Student’s t -test, a Mann–Whitney U test, or a chi-square test where appropriate. All baseline parameters (demographic and socioeconomic parameters; comorbidities; disease characteristics; laboratory measures and radiographic measures) for both patient groups were analyzed. To calculate which baseline parameters predict outcome several logistic regression models were constructed. Results A total of 237 patients were included; 200 (84.4%) were women; 73% rheumatoid factor positive and 71% APCA positive. The mean age was 49 years (SD 12) and the median symptoms duration was 7 months (RIQ 3-12). After one year of follow-up, 141 (59.5%) patients had persistent moderate-high disease activity, 19 (8%) HAQ deterioration and 57 (24.1%) SENS worsening. The prognostic factors for persistent moderate-high disease activity were: medical history of anxiety or depression (OR 3.7; p 0.016), female gender (OR 3.1; p 0.003), and DAS28 (OR 1.3 p 0.005). Among all the factors we found that patients with monoarthritis at baseline had more probability of HAQ deterioration (OR 8.2; p 0.03) and greater values of DAS28 reduced it (OR 0.6 p 0.007). There were not baseline variables associated with radiographic progression. Conclusions Our study showed that in short-term follow up of early RA patients, different outcomes could be predicted using widely available baseline parameters. References Arthritis Rheum. 2002;47:383-90. Arthritis Res Ther. 2008;10:R106. Disclosure of Interest L. Casalla Grant/research support from: Pfizer Argentina, R. Chaparro del Moral : None Declared, O. Rillo : None Declared, M. Benegas: None Declared, F. Dal Pra: None Declared, H. Maldonado Ficco: None Declared, G. Citera: None Declared, A. Catalan Pellet: None Declared, A. Berman: None Declared, M. Haye Salina: None Declared, A. Alvarez: None Declared, F. Caeiro: None Declared, J. Marcos: None Declared, J. C. Marcos: None Declared, L. Catoggio: None Declared, E. Soriano: None Declared, F. Ceccato: None Declared, S. Paira: None Declared, M. O. Leal: None Declared, A. Quinteros: None Declared, G. Salvatierra: None Declared, M. Crespo: None Declared