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Background Occult left ventricular (LV) systolic dysfunction (LVSD) is associated with worse cardiovascular outcomes in asymptomatic patients with arterial hypertension and/or diabetes mellitus. In these patients, LV systolic function may worsen or improve overtime. However, little is known about the changes in LV function during follow up of patients with rheumatoid arthritis (RA). Objectives This prospective study analyzed incidence and factors associated with changes in LV systolic function in patients with RA without known cardiovascular disease. Methods One-hundred-forty outpatients with RA without overt cardiac disease were recruited between March and December 2014. Patients underwent clinical and echocardiographic evaluation at baseline and after a median period [min-max] of 35 [23-47] months of follow up. Stress-corrected midwall fractional shortening (sc-MFS) was used as measure of LVSD and considered impaired if Results Impaired sc-MFS at follow up (sc-MFS-FU) was detected in 60/140 (43%) patients who were compared with 80 patients with normal sc-MFS-FU. Baseline sc-MFS did not differ significantly between the two groups, which appeared to diverge significantly soon after 1-year of follow up (figure). Baseline anti-citrullinated protein antibodies (ACPA) positivity, high disease activity (CDAI>10) and duration of RA were independently associated with impaired sc-MFS-FU at multiple logistic regression analysis. Among these parameters, ACPA had the highest sensitivity (80%) whereas high disease activity had the highest specificity (89%) for sc-MFS-FU. A predictive score including all three predictors (ACPA status, CDAI>10 and duration of RA) detected impaired sc-MFS-FU with a sensitivity of 78% and specificity of 82% (AUC 0.80 [IC 0.72-0.88], p Conclusion This study supports the hypothesis that changes overtime in LVSF in patients with RA are associated with ACPA, high disease activity and duration of disease. Disclosure of Interests: Alessandro Giollo: None declared, Giovanni Cioffi: None declared, Giovanni Orsolini Speakers bureau: Grunenthal, Luca Idolazzi: None declared, Antonio Carletto Speakers bureau: Roche, Novartis, MSD, Abbvie, Bristol, Jannsen, Celgene, Pfizer, Andrea Dalbeni: None declared, Federica Ognibeni: None declared, Elena Fracassi Speakers bureau: Novartis, Davide Gatti Speakers bureau: Abiogen, Amgen, Janssen-Cilag, Mundipharma, Pfeizer, Maurizio Rossini: None declared, Ombretta Viapiana Speakers bureau: Novartis, Abbvie, Eli-Lilly, Sanofi Genzyme

Background The positive effects of denosumab (DMAb) on bone mineral density (BMD) are quickly reversible after its discontinuation and concerns about the possible increase in vertebral fracture after stopping denosumab have been recently raised. Indeed, a rebound in bone turnover markers have been described after DMAb discontinuation. Dickkopf-1 (Dkk-1), and sclerostin, Wnt inhibitors, are considered master regulators of bone remodeling and directly influence the Receptor Activator of Nuclear factor Kappa B Ligand (RANKL) serum levels. Objectives We sought to determine whether the rebound of bone turnover following DMAb discontinuation is associated with dysregulation of the Wnt canonical pathway and/or with the increase in the receptor-activator of nuclear factor-kappa B ligand (RANKL) serum levels in long-term DMAb postmenopausal users. Methods The present study included patients (n = 15) with postmenopausal osteoporosis to whom DMAb was administered for 78 months and then discontinued. We collected BMD data at DMAb administration month 60 (M60), M84 (6 months after last DMAb administration, coinciding when the next DMAb dose would typically be due), and after discontinuation, 3 and 12 months of follow-up (FU-M3 and FU-M12, respectively). Serum C-terminal telopeptide of type 1 collagen (CTX-I), Dkk-1, and sclerostin were measured at M60, M84, FU-M3, and FU-M12. Serum N-terminal propeptide of type 1 procollagen (PINP) and RANKL were dosed at M60, M84, FU-M3, and FU-12. Results We found a significant decrease in the T- score at all sites at FU-M12, when compared to M84 (-0.51 ± 0.91 at the lumbar spine; -0.72 ± 0.33 at the total hip; and -0.42 ± 0.27 at the femoral neck, p Conclusion RANKL serum levels progressively increased after discontinuation of long-term DMAb while Dkk-1 and sclerostin serum levels decreased. The increase in RANKL serum levels supports the hypothesis of a sudden loss of inhibition of the resting osteoclast line after DMAb clearance, with a hyperactivation of these cells. Our results suggest that the decrease in serum Wnt inhibitors after DMAb suspension might represent a mere feedback response to the increased bone turnover. Disclosure of Interests Giovanni Adami: None declared, Angelo Fassio Speakers bureau: Abiogen Pharma, Camilla Benini: None declared, Elisabetta Vantaggiato: None declared, Kenneth Saag Grant/research support from: Amgen, Ironwood/AstraZeneca, Horizon, SOBI, Takeda, Consultant for: Abbvie, Amgen, Ironwood/AstraZeneca, Bayer, Gilead, Horizon, Kowa, Radius, Roche/Genentech, SOBI, Takeda, Teijin, Alessandro Giollo: None declared, Irma Lippolis: None declared, Luca Idolazzi: None declared, Giovanni Orsolini Speakers bureau: Grunenthal, Maurizio Rossini: None declared, Davide Gatti Speakers bureau: Abiogen, Amgen, Janssen-Cilag, Mundipharma, Pfeizer

Background: According to international recommendations, psoriatic arthritis (PsA) should be managed by a treat-to-target approach, but the identification of the best tool for defining the target of remission/low disease activity (LDA) is still controversial. Objectives: To evaluate and compare the rates of remission/LDA by comparing Disease Activity in PSoriatic Arthritis (DAPSA) score with Very Low Disease Activity (VLDA)/Minimal Disease Activity (MDA) criteria in a real-life multicentre cohort of PsA patients. Methods: We performed a cross-sectional analysis including the first consecutive 500 PsA patients evaluated in 8 Italian rheumatology centres since September 2017. The rates of patients achieving DAPSA remission/LDA and VLDA/MDA were calculated and compared by a chi-square test. The agreement between the two criteria sets was established by Cohen’s kappa. The proportion of patients with residual disease activity despite remission/LDA and VLDA/MDA was computed for: peripheral arthritis (number of swollen [SJ] or tender joints [TJ] ≥1), Leeds Enthesitis Index (≥1), number of dactylitis (≥1), Body Surface Area (BSA, ≥3%), Patient Global Assessment (PGA, ≥20), Health Assessment Questionnaire (HAQ, ≥0.5), pain VAS (≥15), C-reactive protein (CRP, ≥1 mg/dL). Sub-analyses after stratification according to ongoing treatment (csDMARDs versus bDMARDs) were also performed. Results: The study population (53.2% men; mean [± standard deviation, SD] age 52.9±12 years; mean [±SD] disease duration 8.6±7.7 years) included 200 patients treated with csDMARDs (71% methotrexate) and 300 with bDMARDs (73% anti-TNF agents). The rates of DAPSA remission and VLDA were similar in the overall population (25.8 vs 22.2%, respectively; p=0.18) and in bDMARD subgroup (27.3 vs 26.7%, respectively; p=0.85), but greater for DAPSA remission in csDMARD patients (23.5 vs 15.5%, respectively; p=0.04). DAPSA LDA was significantly more frequent than MDA (40.6 vs 26.4%, respectively; p Conclusion: In our real-life cross-sectional analysis, the agreement between DAPSA and VLDA/MDA criteria was good only for the definition of remission, whereas DAPSA was significantly less stringent than MDA (especially in csDMARDs treated patients) in defining LDA, with a great proportion of patients showing residual arthritis and disability. Disclosure of Interests: Ennio Giulio Favalli: None declared, Luca Idolazzi: None declared, Serena Bugatti Speakers bureau: Bristol-Myers Squibb, Celgene, Lilly, Novartis, Sanofi, Janssen, Alberto Batticciotto: None declared, Luca Quartuccio: None declared, Matteo Filippini: None declared, Simone Parisi Speakers bureau: Chiesi, Jansenn, Pfizer, Celgene, Abbvie, Lilly., Martina Biggioggero: None declared, Angelo Fassio: None declared, G Zanframundo: None declared, Giuliana Guggino Grant/research support from: Laborest, Pfizer, Consultant for: Novartis, Abbvie, Speakers bureau: Sandoz, I Giovannini: None declared, Maria Chiara Ditto: None declared, Francesco Ciccia Grant/research support from: CELGENE, PFIZER, Consultant for: UCB, NOVARTIS, CELGENE, PFIZER, LILLY, Paid instructor for: UCB, NOVARTIS, CELGENE, PFIZER, LILLY, JANSSEN, Speakers bureau: UCB, NOVARTIS, CELGENE, PFIZER, LILLY, JANSSEN, MSD, ROCHE, AMGEN

Background Interstitial lung disease (ILD) is one of the leading cause of death in systemic sclerosis (SSc). Objectives The aim of this paper was to evaluate the relationship between faecal calprotectin (FC) and ILD. Methods 129 outpatients with SSc were enrolled. Data about disease characteristics, in particular lung involvement, were collected and FC was measured. Results Eighty-seven patients (67.4%) had a limited subset with a mean disease duration of 13.3 (7.1) years. Anti-Scl70 antibodies were found in 35 (27.1%) patients. GI tract involvement was severe/end stage in 3 cases (2.4%). ILD affected 35 patients (27.1%). Median levels of FC were 80 ug/g (157 ug/g). FC was found to be higher in patients with a moderate/severe/end stage score for gastrointestinal tract (p=0.046) and on steroids (p=0.015). In addition, it positively correlated with age (p Other than well-known risk factors such as higher mRSS or diffuse subset, patients with ILD had higher values of FC (p Conclusions in this paper we have found a possible link between gut inflammation and ILD. Many hypothesis may be done but it is intriguing that these data further support what previously found by other authors (Andreasson et al. 2016), that is a correlation between gut inflammation and dysbiosis and non-gastrointestinal disease manifestation. Our study may support the hypothesis of a role of gut dysbiosis in triggering a pathologic immune response leading to ILD. It may also be that increased FC simply reflects a more severe disease but this still doesn’t explain why only ILD was found to be linked with FC. Is it because lung is a filter of molecule (i.e. antigens, cytokines, metabolites, etc.) produced in the gut? Further studies with longitudinal evaluation are warranted. Disclosure of Interest None declared

Background Identify the preclinical phase of arthritis could be clinically relevant. In this scenario, musculoskeletal ultrasonography (US) may play an important role, since it may detect subclinical disease. Psoriatic Arthritis (PsA) is a perfect disease to identify risk factors, since the risk pool group [i.e. patients with only cutaneous Psoriasis (Pso)] is known. Objectives To evaluate in Pso patients, with and without clinical arthralgia (CA), defined by the presence of joint pain without other clinical evidence of musculoskeletal inflammation: I) the prevalence of subclinical US inflammation in joints, enthesis, tendons and bursae; II) the prevalence of US structural damage; III) the relationship between US lesions and clinical data. Methods Cross-sectional prevalence study of US abnormalities in Pso patients with or without CA and healthy controls (HCs). Inclusion and exclusion criteria (e.g. osteoarthritis and fibromyalgia) are pre-defined. Forty-four joints (MCP, PIP and DIP joints, wrists, knees, MTP joints) and 12 enthesis (achilles, quadriceps, proximal and distal patellar, plantar aponeurosis and common extensor tendon enthesis) were scanned in each patient. US scans were performed using a ESAOTE MyLabClassC equipped with a high frequency linear probe. Active synovitis was defined by the presence of a grade ≥2 for grey scale (GS) and ≥1 for PD, while active enthesitis if there was hypoecogenity in GS and an entheseal PD signal (≤2 mm from bone insertion). Results Sixty-four Pso patients and 21 HCs were included; globally 2816 joints and 768 entheses were scanned. Twenty-three out of 64 (35.9%) Pso patients displayed CA. Baseline characteristics are reported in table 1. Active synovitis was found, in at least one joint, in 20/64 (31.3%) Pso patients and 0/21 HCs (p=0.002), while active enthesitis in 14/64 (21.9%) Pso patients and 0/21 HCs (p=0.017). No significant differences were found for active synovitis or enthesitis between the two subgroups of Pso, with or without CA. In the Pso cohort, 5/23 (23.8%) patients with CA and 2/41 (5%) without CA displayed tenosynovitis or paratenonitis (p=0.042). Furthermore, active synovitis, as well as GS-synovitis ≥2, was associated with higher NAPSI (9.7±8.0 vs 4.6±7.1, p=0.04 for GS ≥2), whereas active enthesitis was associated with higher PASI (5.4±3.0 vs 3.7±2.9, p=0.02). No significant differences were found between Pso patients and HCs for the structural damage (i.e. osteoproliferation and erosions), both for joints and enthesis. Conclusions In Psoriasis subclinical US active synovitis and/or enthesitis are present in 20%–30% of patients. In Pso the comparison between groups, with or without CA, show no significant difference in active subclinical synovitis or enthesitis, but Pso patients with CA present more frequently US tenosynovitis or paratenonitis. In Pso subclinical US synovitis or enthesitis are significantly associated with higher NAPSI and PASI. The relevance of these results, to possibly identify a subgroup of Pso more prone to develop PsA, deserve further investigation and prospective evaluation. Disclosure of Interest None declared

Background The treat-to-target (T2T) strategy for the management of psoriatic arthritis (PsA) recently proposed by EULAR recommendations suggests to ideally achieve remission/Low Disease Activity (LDA) in all treated patients, but nowadays data on remission/LDA rate in a real-world setting are still lacking. Objectives To evaluate the disease activity state in a real-life cohort of PsA patients treated with synthetic and/or biologic disease modifying drugs (DMARDs). Methods We undertook a cross-sectional analysis of all PsA consecutive patients enrolled in a large Italian multicentric registry including 7 Italian tertiary rheumatology centres. Disease activity defined as number of swollen (SJ) and tender (TJ) joints, Leeds Enthesitis Index (LEI), number of dactylitis, Body Surface Area (BSA), patient global assessment (PGA), patient pain (PP), Health Assessment Questionnaire Disability Index (HAQ-DI), and C-reactive protein (CRP, mg/L) were computed and the rates of patients achieving Disease Activity in PSoriatic Arthritis (DAPSA) remission/LDA and Minimal Disease Activity (MDA) were calculated. Subanalysis after stratification according to ongoing treatment (sDMARDs or bDMARDs) were also performed. Results The study population included 362 PsA patients (56.6% men; mean [±standard deviation, SD] age 53.3±12.4 years; mean [±SD] disease duration 9.4±8.2 years), treated with sDMARDs (15.8%, mainly methotrexate [66.6%]) or bDMARDs (79.6%, mainly anti-TNF agents [72.9%], as monotherapy [78.1%] or in combination with sDMARDs [21.9%]). Oligoarthritis (32%), polyarthritis (42%), axial involvement (11.9%), enthesitis (10.5%), and dactilytis (3.6%) were the reported predominant subsets of PsA. In the overall population the mean values [±SD] of disease activity measures were: SJ count 1.4±2.6, TJ count 1.9±3, LEI 0.5±1.1, number of dactylitis 0.1±0.3, BSA 2.6±6.9, PGA 1.4±2.6, PP 3±2.6, HAQ-DI 0.4±0.5, CRP level 3.4±8, and DAPSA 9.3±9.2. The rates of DAPSA LDA and remission were 46.9% and 31.7%, respectively. We found 51.6% of patients achieving MDA, without significant difference according to ongoing treatment (53.4% and 51% in bDMARD versus sDMARD treated patients, respectively; p=0.87). Conclusions In our real-life cross-sectional analysis, an acceptable comprehensive disease control was reported only in half of patients, irrespectively of ongoing therapy. These findings suggest the need to further improve the real-world application of T2T strategy for the management of PsA. Disclosure of Interest None declared

Background Glucocorticoids (GCs) are the cornerstone of polymyalgia rheumatica (PMR) therapy. Although guidelines for PMR generally recommend tapering GCs after 12–24 months, most patients are unable to discontinue GCs within the recommended time-frame. However, glucocorticoid-related adverse events can occur in up to 85% of treated cases. Patients treated with GCs should receive aminobisphosphonates (N-BPs) for the prevention of GCs-induced osteoporosis. Objectives In this retrospective observational study, we aimed to establish: 1) the proportion of patients with PMR who do not discontinue GCs, and 2) whether the use of N-BPs may be associated with a discontinuation of GCs. Methods Data were collected from electronic medical records of Rheumatology Unit at Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Italy. Patients were eligible for inclusion if they fulfilled the 2012 EULAR/ACR classification criteria for PMR. The following exclusion criteria were applied: a history of large vessel vasculitis and other diagnoses that could explain the symptoms. The main outcome was the long-term use of GCs, defined as a patient still receiving active treatment with GCs at the last evaluation available. Putative predictors included age, sex, dosage of prednisone, inflammatory markers (ESR and CRP), haemoglobin, peripheral joint involvement, use of DMARDs, number of relapses, osteoporosis and use of N-BPs. Univariable and multivariable Cox regression analyses were used to examine the association between several predictors and the outcome. Results 385/467 patients screened were eligible (median age 72 years [IQR 66–78], 64% females). Peripheral joint involvement was detected in 29%; 22% received DMARDs. The initial prednisone dose (median daily dose 20 mg13–25) was correlated with age, haemoglobin, CRP and ESR. More than 60% of patients were treated with N-BPs, of whom only 26% were diagnosed with osteoporosis. The median follow up time was 38 months [IQR 9–57]. Disease relapse occurred in 307/467 patients (80%). GCs were discontinued in 47% after a median time of 20 months [IQR 14–27], but were restarted in 39%. At the last evaluation, 276 patients (72%) were still receiving active treatment with GCs (median daily dose 5 mg [IQR 0–8]). Multiple Cox regression analysis showed that older age (HR 1.02, 95% CI 1.00–1.04, p=0.006) and higher CRP at baseline (HR 1.24, 95% CI 1.10–1.40, p=0.001) were associated with the long-term use of GCs, whereas significant predictors of a shorter treatment duration were the use of N-BPs (HR 0.66, 95% CI 0.50–0.88, p=0.004; figure 1) and a higher initial prednisone dose (HR 0.98, 95% CI 0.96–0.99, p=0.002). Adjusted HR 0.66 (95% CI: 0.50, 0.88), p=0.004. Conclusions Unlike current guidelines, in clinical practice a long-term treatment with GCs is often necessary in PMR. There is need to investigate novel treatments for PMR. This preliminary data suggests that aminobisphoshonates may have a role in the management of PMR. Disclosure of Interest None declared

Background Early cardiovascular (CV) involvement has been found in patients with psoriatic arthritis (PsA). These patients may have a high prevalence of subclinical left ventricular (LV) dysfunction, even without established CV disease and in the absence of traditional CV risk factors. However, currently, the factors associated with LV dysfunction in PsA are unknown. Patients with inflammatory disorders are exposed to the development of excessive left ventricular mass disproportionate to the need to compensate left ventricular load, a condition named ‘inappropriately high left ventricular mass’ (iLVM). Previously, we have shown that iLVM is associated with unfavourable prognosis in patients with rheumatoid arthritis independent of traditional CV risk factors. Objectives In this cross-sectional study, we assessed the prevalence and factors associated with iLVM in a cohort of patients with PsA and tested the hypothesis that PsA is per se related to iLVM. Methods We evaluated 101 non-institutionalised patients>18 years of age diagnosed with PsA according to CASPAR criteria and consecutively recruited between March 2014 and December 2016. All PsA patients were free of symptoms or signs of cardiovascular disease. Patients with PsA were compared with 101 controls matched for age, sex, BMI, prevalence of hypertension and diabetes. Left ventricular chamber dimensions and wall thicknesses were measured according to the American Society of Echocardiography guidelines and predicted LVM was calculated using a validated equation considering height, sex and left ventricular work. iLVM was defined as measured/predicted LVM ratio above the 95% percentile of a reference population of healthy controls.1 Results iLVM was detected in 58% of patients with PsA and 18% of controls (p Conclusions More than 50% of patients with PsA have a disproportionate increase in their LVM. An inappropriately high LVM in PsA is associated with LV systolic dysfunction and LV concentric geometry. Reference [1] Cioffi G, Viapiana O, Ognibeni F, Dalbeni A, Giollo A, Adami S, Gatti D, Russo G, Barbati G, Cherubini A, Di Lenarda A, Rossini M. Prevalence and factors related to inappropriately high left ventricular mass in patients with rheumatoid arthritis without overt cardiac disease. J Hypertens2015;33:2141–2149. Disclosure of Interest None declared

Background The ultrasonography (US) is a feasible technique when you refer to the peripheral small joints and also to the nail.1 DIP joints are not only affected by inflammatory disease and a more frequent condition is osteoarthritis (OA). The bone and synovial changes due to this condition are very similar to the ones of PSA especially regarding osteoproliferative lesions. Objectives The aim of our study was exploring through imaging the changes of nail and enthesis of extensor tendon of the finger in inflammatory and degenerative conditions in order to find structural differences of nail and DIP. Methods This is an observational study on PSO, PSA, RA or OA patients. A control group of 50 healthy volunteers was used for comparison. Diagnosis was based on clinical or scientific criteria, such as CASPAR or EULAR/ACR were applicable. The study sample included 203 individual. The ultrasonographers were blind to clinical data and diagnosis of the patient. The ultrasound examination was done with a GE Logiq S8. The structural alterations of the plate were evaluated using a semiquantitative score for the magnitude of the alteration. The score provides values from 0 (no alteration) to 3 (severly altered). A semiquantitative approach was also used for evaluation of the power Doppler signal. Results The study sample was composed by 51 patients affected by PsA, 31 affected by PSO group, 37 subjects with RA, 34 with OA and 50 HC. The analysis of nail bed PDUS revealed an unusual trend for patients affected by OA who showed a prevalence of lesions of every grade but a lower rate of normal cases. The evaluation of the PDUS of the enthesis revealed that patients affected by PsA have an increased rate of PDUS signal at the enthesis of the extensor tendon. Considering nail plate HC showed a strong difference (p value Conclusions The data support the concept that nail enthesis unit is in some way involved in different pathological conditions. No exclusive feature belongs only to one or another disease, but the data provided suggested that peculiar lesions might be found only in certain disease and in certain structures, like the entheses. The US of the nail should be considered as one of the possible and promising approach in the study of these structures. Reference [1] Arbault A, Devilliers H, Laroche D, et al. Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis. Jt Bone Spine Rev Rhum2016;83:539–44. doi:10.1016/j.jbspin.2015.11.004 Disclosure of Interest None declared

Background It has been demonstrated that IL-17A is able to induce GC insensitivity. Although several studies have reported the role of IL-17 in GC insensitivity the mechanism underlying remains still largely unclear. Objectives To understand the effects of interleukin-17 (IL-17) on the enzyme 11β-hydroxysteroid dehydrogenases (11β-HSDs) in the two main classes of monocytes, CD14 and CD16. Methods Peripheral Blood Mononuclear Cells (PBMCs) were isolated from 5 healthy donors and were sorted into CD14 and CD16 subpopulations using cell sorting. Effect of IL-17 on 11β-HSD1 enzyme activity was measured in terms of conversion of cortisone to cortisol in sorted and unsorted monocytes using Homogeneous Time-Resolved Fluorescence (HTRF). The direct involvement of 11β-HSD1 in the conversion of cortisone to cortisol was confirmed using carbenoxolone, an inhibitor of 11β-HSD1. Results Monocytes showed a concentration-dependent decrease in the 11β-HSD1 enzyme activity when incubated with increasing concentrations of IL-17. CD14 and CD16 cells stimulated similarly with IL-17 showed a significant difference in the enzyme activity between the untreated and stimulated cells in all treatment groups. However, a dose dependent decrease was observed only in case of CD14 cells. Both unsorted monocytes and monocyte sub-populations showed a significant decrease in the concentration of cortisol measured when co-incubated with carbenoxolone, indicative of the direct involvement of 11β-HSD1 enzyme in the conversion of cortisone to cortisol. Conclusions The results of this study showed that IL-17 induced GC insensitivity might be dependent on the reduced 11β-HSD1 enzyme activity in inflammatory conditions. We showed that the pro-inflammatory cytokine IL-17 causes a significant decrease in the 11β-HSD1 enzyme activity. Disclosure of Interest None declared

Background Anoressia nervosa (AN) is associated with an increased risk of low bone mineral density (BMD) and fractures as a consequence of an inadequate bone mass peak in adolescence and bone loss in young adulthood. Moreover, recently we have showed that vitamin D (25-OH-D) deficiency is widespread in untreated patients with AN, and there is a strong positive relationship between vitamin D status and BMD in AN. However, if vitamin D status could affect the efficacy of weight restoration in improving bone health in patients with AN is currently unknown. Objectives Our aim was to investigate the potential role of vitamin D status in determining the efficacy on bone mineral density (BMD) of weight restoration in AN. Methods Bone mineral density assessed by dual-energy x-ray absorptiometry (DXA), vitamin D, N-propeptide of type I collagen (P1NP), C-terminal telopeptide of type I collagen (CTX), intact parathyroid hormone (PTH) were evaluated before and after a 20-weeks intensive weight restoration therapy in patients with anorexia nervosa and secondary amenorrhoea for at least 6-months. The subjects were not receiving medications known to affect bone metabolism. Results Ninety-one female patients aged 13–45 years old were evaluated, baseline weight 39.4±5.6 kg and BMI 15.1±1.6 kg/m 2 . Weight and BMI were significantly increased in all patients after treatment. The mean BMD values were significantly increased only at the spine (1.0±3.6%, p=0.009). A positive trend was demonstrated between post-treatment 25-OH-D and BMD changes at the spine (p=0.032). However, only the patients with post-treatment 25-OH-D ≥30 ng/ml showed significantly higher increases in BMD at the spine (2.5% vs 0.5% respectively for 25-OH-D ≥30 ng/ml and 25-OH-D Conclusions In anorexia nervosa, a hypovitaminosis D status counteracts the efficacy of the weight restoration treatment because of an increase in bone resorption mediated by a secondary hyperparathyroidism. Our study strongly support the use of vitamin D supplements for bone health in anorexia nervosa. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is a systemic inflammatory disease with articular and extra-articular features, the disease activity ranges from mild mono-oligoarthritis to destructive polyarthritis. Hence, establishing the prognosis of a patient with PsA is important to better define the treatment strategy. Furthermore, minimal disease activity (MDA) is a validated composite outcome measure since it correlates well with long-term outcomes (e.g. development of joint damage) 1 . Objectives The aim of this study was to identify the baseline clinical variables associated with MDA at 12th month of follow up in two cohorts of early PsA. Methods Consecutive PsA patients, attending the outpatient Early Arthritis Clinic in Udine or Verona in the last two years, were assessed. All the included patients had: I) CASPAR score ≥2 2 II) new diagnosis of PsA III) a complete clinical data and follow-up of at least 12 months. The GRAPPA recommendations on the management of PsA were followed. Statistical analysis included T- test, ANOVA and Pearson9s test in order to find possible predictors of MDA. Results Eighty-one early PsA patients were included in the study. 47/81 (58.2%) reached MDA at 12th month of follow-up; 68/81 (83.9%) were in c-DMARDs while 11/81 (13.6%) were in b-DMARDs. Two variables at baseline were selected comparing the groups based on achievement of MDA. These were: 1) LEI, which was significantly lower at baseline in patients reaching MDA (0.43 Vs 0.86, p=0.001); and 2) a lower baseline CRP (1.2 mg/dl vs 2.8 mg/dl, p=0.008). Of note, neither the baseline disease activity evaluated with DAPSA nor the time to referral were selected by statistical analysis. Conclusions Baseline lower LEI score and lower CRP were identified as clinical predictors of MDA after 12 months of treatment in PsA. Therefore, patients with a more active enthesitis or higher inflammation may have a less responsive disease. This may be relevant to select proper treatments at baseline, and indirectly confirms that enthesitis is a key therapeutic target in PsA. References Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010; 69: 48–53. Coates LC, Conaghan PG, Emery P et al. Sensitivity and specificity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. Arthritis Rheum 2012; 64: 3150–3155. Disclosure of Interest None declared

Background Osteogenesis Imperfecta (OI) is a rare generalized connective tissue disease. Its main features are skeletal fragility and substantial growth deficiency [1]. Currently, bisphosphonates showed to increase bone mineral density (BMD). A positive effect on prevention of fractures both in adults and in children is reported by some studies, but generally data are still inconsistent [2]. Neridronate is an amino-bisphosphonate licensed in Italy for the treatment of OI. Objectives to assess the long-term efficacy and safety of the treatment in patients with OI. Methods the patients were divided by age into two groups and observed for 3 years: 55 patients younger than 20 years old and 114 patients older than 20 years old. Neridronate was administered by i.v. infusion at the dosage of 2 mg/kg, up to a maximum of 100 mg at three months intervals. DXA of the lumbar spine, hip and ultradistal radius were evaluated every 6 months. Blood calcium, phosphate, bone turnover markers and fasting urinary calcium/creatinine ratio, were obtained at baseline and every 3 months. Results the mean lumbar spine and total hip BMD and BMC significantly increased from baseline up to month 36 in both patients groups. The mean ultradistal radius BMD significantly increased from baseline to any time point in patients younger than 20 years, while, in patients older than 20 years, BMD significantly increased from baseline only at month 18, 30 and 36 respectively. The mean ultradistal radius BMC significantly increased from baseline to any time point in patients younger than 20 years, while there were no substantial or statistically significant changes from baseline to any time point in patients aged older than 20 years. The mean number of fractures observed in the 3 years of treatment was significantly lower than that observed in the 3 years before the start of treatment in both groups (table 1). Most of AEs were symptoms of an acute phase reaction, which was reported in 47.3% of patients younger than 20 years and in 22.8% of those older than 20 years. Serious adverse events (SAEs) were reported in 19 patients (34.5%) younger than 20 years and in 26 patients (22.8%) aged older than 20 years. None of the reported SAEs in both groups was considered as treatment-related. Conclusions long-term treatment with i.v.neridronate has positive effects on BMD, BMC, bone turnover markers and fracture risk with a good safety profile in both groups. References Hoyer-Kuhn H, Netzer C, Semler O. Osteogenesis imperfecta: pathophysiology and treatment. Wien Med Wochenschr 1946 2015;165:278–84. doi:10.1007/s10354–015–0361-x. Hald JD, Evangelou E, Langdahl BL, et al. Bisphosphonates for the Prevention of Fractures in Osteogenesis Imperfecta: Meta-Analysis of Placebo-Controlled Trials. J Bone Miner Res 2015;30:929–33. doi:10.1002/jbmr.2410. Disclosure of Interest None declared

Background psoriatic arthritis (PsA) is a chronic inflammatory disease characterized also by increased levels of cells producing IL-17 [1], and these levels have been shown to correlate with measures of disease activity and structural damage and bone loss [2]. Secukinumab is a new monoclonal antibody licensed woth the treatment of PsA which selectively binds to and neutralizes interleukin-17 (IL-17). Currently, data about the effects on the activity of either bone-reabsorbing cells and bone-forming cells secondary to the inhibition of the IL-17 pathway are completely absent. Objectives the aim of our study was to explore the short-term effects of secukinumab on bone turnover markers (BTM) and Dkk-1 and sclerostin. Methods we enrolled 28 patients with PsA, classified with the CASPAR criteria and 43 healthy controls (HC). For the PsA group DAS28 was recorded and serum samples were stored at baseline and then at the first, the third and the sixth month of therapy. Intact N-propeptide of type I collagen (PINP) and C-terminal telopeptide of type I collagen (CTX-I). Dickkopf-related-protein 1 (Dkk-1) and sclerostin were dosed too. For the HC group, a single blood sample was taken. Results Neither P1NP nor CTX showed any statistically significant variation. Baseline Dkk-1 for the PsA group was lower than HC. Both Dkk-1 and sclerostin demonstrated a significant increase at the sixth month. When the PsA groups was compared to HC, the difference between the levels of Dkk-1 lost significance at month six. Conclusions our study demonstrated that the treatment with secukinumab has little influence on the levels of BTM within the first six months of treatment but a definite influence on some fine regulators of the bone cells activity such as the WNT inhibitors and it is able, in some way, to normalize the Dkk-1 levels in PsA patients. The clinical implications of this trend are currently unclear thought it might suggest an drug-induced inhibition of the over-proliferation of bone typical of the joint lesions of PsA. Further studies with greater numbers of patients are warranted to determine whether these preliminary results have clinical relevance. References Jandus C, Bioley G, Rivals J-P, et al. Increased numbers of circulating polyfunctional Th17 memory cells in patients with seronegative spondylarthritides. Arthritis Rheum 2008;58:2307–17. doi:10.1002/art.23655. Uluckan O, Jimenez M, Karbach S, et al. Chronic skin inflammation leads to bone loss by IL-17-mediated inhibition of Wnt signaling in osteoblasts. Sci Transl Med 2016;8:330ra37. doi:10.1126/scitranslmed.aad8996. Disclosure of Interest None declared

Background The recent characterization of the canonical WNT pathway in the regulation of bone modeling and remodeling provided important insights for our understanding of the pathophysiology of bone involvement in chronic arthritis [1]. Dkk-1 and sclerostin are the main regulators of WNT/b-catenin signaling, regulating both bone formation and resorption [2]. In a previous our study we showed that in patients with Rheumatoid Arthritis (RA) Dkk-1 is significantly increased and associated with the presence of typical erosions and lower BMD [3]. Objectives we decided to perform this study in order to compare the serum levels of WNT-pathway regulators alongside bone turnover markers (BTM) and Parathyroid Hormone (PTH) between a group of female patients with PsA and healthy controls (HC) or patients with Rheumatoid Arthritis (RA). Methods this is a cross-sectional study including 18 patients with PsA classified with the CASPAR criteria, 35 HC, and 28 patients with RA classified with the ACR/EULAR 2010 criteria. Intact N-propeptide of type I collagen (PINP), C-terminal telopeptide of type I collagen (CTX-I), Dickkopf-related-protein 1 (Dkk-1), sclerostin, PTH and 25OH-Vitamin D serum levels were dosed. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Results the PsA group showed significantly lower Dkk-1 levels when compared to the HC and RA groups. Dkk-1 in the RA group was also significantly higher than in the HC group. A similar trend was documented also for PTH, however a statistically significant difference was observed only when we comparing the PsA vs RA group (table 1, figure 1). No other statistically significant differences in the other markers were found. Conclusions this study demonstrated for the first time that Dkk-1 levels in PsA are lower than HC, in contrast with RA where they are higher. These results might contribute to explain the different bone involvement of the two different diseases. References Xie W, Zhou L, Li S, et al. Wnt/β-catenin signaling plays a key role in the development of spondyloarthritis. Ann N Y Acad Sci 2016;1364:25–31. doi:10.1111/nyas.12968. 2 Spencer GJ, Utting JC, Etheridge SL, et al. Wnt signalling in osteoblasts regulates expression of the receptor activator of NFkappaB ligand and inhibits osteoclastogenesis in vitro. J Cell Sci 2006;119:1283–96. doi:10.1242/jcs.02883. 3 Rossini M, Viapiana O, Adami S, et al. In patients with rheumatoid arthritis, Dickkopf-1 serum levels are correlated with parathyroid hormone, bone erosions and bone mineral density. Clin Exp Rheumatol 2015;33:77–83. Disclosure of Interest None declared

Background Since 2013, in Veneto9s Region, data registration is mandatory for all patients affected by Rheumatoid arthritis (RA), Psoriatic Arthritis (PA), Ankylosing Spondylitis (AS) in treatment with biologic agents. The biologic DMARDs currently marketed in Italy are: anti-TNF (originator and biosimilar infliximab, etanercept, adalimumab, certolizumab and golimumab), anti-IL6 (tocilizumab), anti-CD20 (rituximab), CTLA-4 like (abatacept) and anti IL-12/23 (ustekinumab). Objectives The aim of this study was first to describe the characteristics of patients with RA, PA, AS under biologics and then, to extract and analyze real-life data regarding rheumatic treatments in Verona9s cohort. Methods The study has been carried out on behalf of Regione del Veneto, Giunta regionale- Ricerca Sanitaria Finalizzata-Venezia-Italy. Data used for analysis were retrieved from Veneto9s Region Biologics Register (VRBR). VRBR provides that core variables such as onset and type of disease, anthropometric characteristics (age, sex, body weight, height) are registered at the beginning. Furthermore, prior and concomitant rheumatic treatment (conventional and biologic DMARDs, corticosteroids, NSAIDs), disease activity indicators (DAS 28-PCR, ASDAS-PCR, pain-NRS), prognostic factors (positivity for rheumatoid factor and/ or anti-citrulline antibodies in AR, presence of radiological erosions) were assembled at baseline, every 6 months and at the time of biologic9s switch or swap. Results A total of 983 patients under biologics were examined; 543 (55,2%) with AR, 272 (27,7%) with AP and 168 (17,1%). Between these, 262 (27,2%) patients were naive to biologics, 128 with AR, 84 with AP, 50 with SA. Mean duration of disease was of 15,3, 10,7 and 12,6 years respectively for RA, PA and AS. Radiological erosions were present in 73% of RA-patients and the percentage was higher in those with positivity for rheumatoid factor and/ or anti-citrulline antibodies (84,4% versus 56,2%). More than half of the patients in this cohort were treated at least with one biologic agent; anti-TNFs were the main biologic used (RA:54,8%, PA:92,7%, AS: 100%) followed by Abatacept (25,4%), tocilizumab (12,3%) and rituximab (5,9%) in patients with RA. Methotrexate (MTX) was the prevalent associated c-DMARDs (41,8% in RA and 34,2% in PA) with mean dose of 11,9 mg/week in RA and 12,1 mg/week in PA. The optimal dose of methotrexate was not achieved prevalently because of drug intolerance. Conclusions Profile of both conventional and biological DMARDs looks very different according to the type of rheumatic disease. The first data show an underuse of MTX in patients with RA and PA under biologics with a low mean dosage due to intolerance. Next step is to evaluate long-term outcomes in clinical practice. Disclosure of Interest None declared