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Background: Increasing evidence suggests that TNF inhibitors (TNFi) are safe to use during pregnancy1. A drawback of TNFi use during pregnancy is active transport across the placenta, which is affected by the structure of the TNFi1. The European League Against Rheumatism (EULAR) defined points to consider (PtC) on the use of TNFi during pregnancy2: to prevent placental transfer, etanercept should be discontinued at gestational age (GA) 30-32 weeks, and both adalimumab and infliximab should be discontinued at GA 20 weeks. Certolizumab pegol can be conditionally continued throughout pregnancy. Objectives: The aim of this research is to validate the EULAR PtC by measuring the level of TNFi in cord blood. Methods: Patients were derived from the PreCARA study, an ongoing prospective cohort study on inflammatory rheumatic diseases and pregnancy in the Netherlands. Patients were treated according to a treat-to-target approach, which included the use of TNFi. TNFi were, if possible, discontinued at recommended stop time points. Maternal blood samples were collected in each trimester. Cord blood was analyzed for the presence of certolizumab pegol, etanercept, adalimumab and infliximab. Levels of TNFi in the cord blood were compared between patients that stopped at the advised GA and patients who did not. Results: Data from 111 patients with inflammatory rheumatic diseases were used for the current analysis. Most patients stopped treatment before the recommended GA (table 1). Certolizumab pegol (n = 68) was measured in a low number of cord blood samples (5.9%) and in low concentrations (median, (IQR): 0.25 µg/ml (0.15 – 1.3)). Etanercept was not detected in any cord blood samples (n = 28). Adalimumab (n = 24) and infliximab (n = 13) were measured more often in cord blood (in 50.0% and 61.5% of patients, respectively), this also was observed in patients that stopped before the recommended GA (in 47.7% for adalimumab and 60.0% for infliximab). However, the observed concentrations were low: the maximum observed concentrations in cord blood were 2.1 µg/ml (stopped at GA 19.4 weeks) for adalimumab and 4.5 µg/ml (stopped at GA 21.1 weeks) for infliximab. Conclusion: Stopping TNFi around the GA recommended by the EULAR PtC resulted in no measurable levels or low concentrations of TNF inhibitor in the cord blood in a majority of patients. References: [1]Smeele HTW, Dolhain RJEM. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum. 2019;49(3S):S32-S35. doi:10.1016/j.semarthrit.2019.09.010 [2]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795-810. doi:10.1136/annrheumdis-2015-208840 Disclosure of Interests: Erik Kemper: None declared, Nafise Ghalandari: None declared, Hubertina Johanna Maria Josephina Crijns: None declared, Hieronymus TW Smeele: None declared, Radboud Dolhain Speakers bureau: UCB, Roche, Abbvie, Genzyme, Novartis, Consultant of: Galapagos, Grant/research support from: UCB

ObjectivesPrevious research has demonstrated that patients with rheumatoid arthritis (RA) are less likely to breast feed their offspring. Treatment options for RA during lactation have expanded and the importance of counselling is recognised. The aim of the current research was to study breast feeding among women with RA who benefit from these developments.MethodsPatients were derived from the Preconceptional Counselling in Active Rheumatoid Arthritis (PreCARA) cohort. Patients were treated according to a modified treat-to-target approach aimed at remission and received pregnancy counselling, including counselling on breast feeding. Postpartum visits were scheduled at 4–6, 12 and 26 weeks post partum. Prevalence of breast feeding at each postpartum visit was compared with a historical reference cohort (Pregnancy-induced Amelioration of Rheumatoid Arthritis cohort) and the general population.ResultsData on 171 pregnancies were available for the current analysis. 120 (70.2%) patients with RA initiated breast feeding. 103/171 (60.2%), 68/171 (39.8%) and 45/171 (26.3%) patients with RA breast fed their offspring at 4–6, 12 and 26 weeks post partum, respectively. These percentages were higher at all postpartum visits compared with the historical reference cohort (pConclusionPatients with RA in the PreCARA cohort were more likely to breast feed their offspring compared with patients with RA in the historical reference cohort. The breastfeeding rates observed were similar to breastfeeding rates among women in the general population. The increase in breast feeding among patients with RA may be due to the extension of lactation-compatible medication and pregnancy counselling.

Clinical difficulty to discriminate between the Alzheimer disease (AD) and dementia with Lewy bodies (DLB) has led researchers to focus on highly sensitive functional imaging modalities. The aim of the present study was to assessSeventeen patients who were known cases of dementia underwentOut of 17 patients (13 males; 76.5%), 10 patients had AD (7 males; 70%) and 7 patients had DLB (6 males; 85%). The pooled HMR was 1.74±0.33 in the study population; with 1.95±0.22 in the AD group and 1.43±0.20 in the DLB group to demonstrate significantly different HMR scores between patients with AD and DLB (p value=0.001). The visual interpretation was positive in 10 patients (accuracy of 88.2%). The shortest distance on the ROC curve to the optimal value corresponding to HMR=1.57 identified 10 patients with a high HMR (positive cardiac uptake) and 7 patients with a low HMR (negative cardiac uptake), the accuracy calculated at 88.2%.