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To assess the Cardiovascular Risk (CV) in Rheumatoid Arthritis (RA) patients using carotid ultrasound additionally to the traditional CV risk factors.A cross-sectional case control study was performed including RA patients and matched controls. This study was performed from July-2019 to January-2020. Population over 75 years old, established CV disease and/or chronic kidney disease (from III Stage) were excluded. Statistical analysis included a multivariate variance analysis (Manova) and a negative binomial regression adjusted by confounding factors.Overall, a total of 200 cases and 111 controls were included in the study. Demographical and clinical variables were comparable between groups. A relationship between age, BMI and high blood pressure was detected in both groups. RA patients showed higher intima-media thickness and higher plaque account compared to controls and it was related to the disease duration and DAS28 score.RA leads to a higher intima-media thickness, and this is related to the disease duration and DAS28 score. These findings support that RA acts as an independent cardiovascular risk factor.

BACKGROUND AND OBJECTIVES: Systemic sclerosis (SSc) is an autoinmune disease that can affect several organs and its mortality is fundamentally related to its pulmonary involvement. There are some cytokines with high serum levels of patients with SSc. Our goal is to determine the role of CXCL4, CXCL8 and GDF15 in the physiopathology of SSc and whether they can be considered organic damage biomarkers. PATIENTS AND METHODS: Observational case-control study of SSc patients (ACR/EULAR 2013 criteria). Demographic, clinical, analytical, activity, severity, health perception, and disability variables were collected. Moreover, Videocapillaroscopy, Echocardiography and Respiratory Function Test were made. Serum levels of CXCL4, CXCL8 and GDF15 were measured both in SSc patients and in healthy controls. RESULTS: A total of 42 patients were included (95.4% women), with an average age of 59.2 years and a median of 4 years from diagnosis. We also included 42 healthy controls. We found significantly higher levels of GDF15 in SSc patients than in controls (p

Objectives DNA hydroxymethylation may be induced by oxidative stress in lupus patients, so we investigated the association between DNA hydroxymethylation and demethylation with the antioxidant response. Methods A case–control study was performed including lupus patients and matched healthy controls. Serum concentration of glutathione (GSH), glutathione disulphide (GSSG), superoxide dismutase (SOD) and total antioxidant capacity (TAC), 5-mC and 5-hmC were determined. Results One hundred and forty-two patients and 34 controls were included. 5-hmC levels were lower in SLE patients than in controls. GSH and GSSG values were lower in patients, while SOD levels were higher in patients. TAC did not show significant differences, but higher demethylation and lower hydroxydemethylation were associated to increased TAC values. Lower demethylation was associated with cytopenia and lower hydroxymethylation with longer course of the disease. Lower levels of GSH and GSSG and higher SOD values were associated with accumulated damage assessed by SLICC-ACR. Conclusions Lower hydroxymethylation in patients than in controls was observed. Moreover, higher demethylation and lower hydroxymethylation leads to high TAC levels. DNA hydroxymethylation seems to be related to longer course of the disease.

Introduction Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease that particularly affects young women during their second and third decades. Events attributed to SLE itself and others related to the disease may impact negatively on the quality of life, employment and disability. However, there are not many studies focused on the impact that the disease may have on patients regarding those aspects. In Spain, the evaluation of disability and the assignation of a pension is given by the National Social Security Institute of Spain, INSS (“Instituto Nacional de la Seguridad Social”). Objective To assess the relationship between cumulative damage regarding the affected organ and the percentage of disability recognised by the National Social Security Institute of Spain (INSS) in SLE patients. Methods Cross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, from the Rheumatology Service of two Spanish hospitals. We collected clinical and demographic data through personal interview and the SLICC/ACR questionnaire, and classified patients regarding a recognised disability or not. Results 142 patients were evaluated; 30% had some percentage of official disability. We found a positive correlation between percentage of recognised disability and the SLICC/ACR index score. Musculoskeletal system is the most affected system, without differences between both groups; but we found a higher proportion of damage in nervous system, renal and vasculitis in patients with a recognised disability. Conclusion There is a positive correlation between percentage of recognised disability in Spain and the cumulative damage in SLE.

Objective Polymyalgia rheumatica (PR) can be associated with large vessel vasculitis (LVV). We evaluate the diagnostic role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and its impact on the treatment of LVV associated with PR. Materials and methods Retrospective study of patients diagnosed with PR. Data was collected from health records. Blood analysis included acute-phase reactants (APR), C -reactive protein (CRP) and erythrocyte sedimentation rate. An 18F-FDG PET/CT scan was performed in those patients whose symptoms persisted, in those with elevated APR, those who required higher doses of steroids or those who had atypical features of PR (low-grade fever, weight loss, among others). Results Twenty-three were eligible; 48% (n = 11) of the patients were diagnosed with LVV associated with PR. The site was heterogeneous, but mostly involved the aorta. In 80% of the patients with LVV, a disease-modifying antirheumatic drug was added to their treatment. Elevated CRP values were associated with the likelihood of presenting LVV. Conclusions LVV is not uncommon, clinical features and elevated CRP levels should raise suspicion of LVV associated with PR. 18F-FDG PET/CT is useful in identifying LVV associated with PR.

Resumen Objetivo La polimialgia reumatica (PMR) puede asociarse a vasculitis de grandes vasos (VGV). Este trabajo pretende evaluar el papel de 18F-FDG PET/TC en el diagnostico de VGV asociado a PMR. Materiales y metodo Estudio retrospectivo de pacientes con PMR. Se recogieron datos clinicos, analiticos, reactantes de fase aguda (RFA) (PCR, VSG), y a quienes tenian clinica persistente, elevacion de RFA, precisaban dosis elevadas de corticoterapia o cuadros atipicos de PMR (febricula, perdida de peso, etc.) se realizo 18F-FDG PET/TC. Resultados Veintitres pacientes se incluyeron; el 48% (11) de los cuales tuvieron VGV asociada a PMR. La localizacion fue heterogenea pero en su mayoria involucro a la aorta. En cuanto al tratamiento, se anadieron farmacos modificadores de la enfermedad a mas del 80% de los pacientes con VGV. Los pacientes con VGV tenian niveles de PCR elevados comparado con aquellos con PMR aislada. Conclusiones La VGV en PMR no es infrecuente, tanto la clinica como los valores de PCR elevados deben hacer sospechar la posibilidad de VGV asociada. El estudio de imagen 18F-FDG PET/TC es una herramienta util identificando VGV asociada a PMR.

To evaluate the aspects of the basal bone health status in prostate cancer patients. Furthermore, to evaluate in a real-world setting the effect of different schemes (intermittent or continuous) of androgen deprivation therapy (ADT) and the effect of denosumab in bone mass density (BMD).Observational, retrospective study of a cohort of prostate cancer patients in treatment with luteinizing hormone-releasing hormone (LH-RH) agonists, evaluated in the rheumatology department of a tertiary center. Demographics, FRAX score, LH-RH treatment scheme, osteoporosis treatment, laboratory data and BMD were collected. Mixed effect regression models to analyze the interaction between LH-RH treatment scheme, denosumab and BMD evolution were used.Eighty-three patients (mean age 71±8years) were included. At the basal evaluation, 16% of patients presented densitometric osteoporosis and 27% of patients presented high fracture risk. Eighty percent of patients had inadequate vitaminD levels. VitaminD30ng/mL was correlated with higher T-scores. There was no association between LH-RH treatment scheme and BMD evolution, however there was a positive association with denosumab.A high proportion of patients presented elevated fracture risk or inadequate vitaminD levels, not previously recognized. Bone health assessment and fracture risk evaluation are convenient in these patients. In a real-world setting, the effect of denosumab in BMD is detected, however the effect of intermittent LH-RH schema treatment is less evident.

Resumen Fundamento y objetivo Analizar la asociacion entre concentraciones de interferon-1α (INF1α), interleucina 10 (IL-10) y BLyS con la actividad clinica en el lupus eritematoso sistemico (LES). Pacientes y metodos Estudio observacional transversal de 142 pacientes con LES y 34 controles sanos mediante analitica de sangre y orina y revision de la historia clinica. La concentracion serica de citocinas se determino mediante metodos colorimetricos. El analisis bioestadistico se realizo con R (3.3.2). Resultados El 69% de pacientes mostraron al menos una citocina aumentada. Las tres citocinas estan mas elevadas en pacientes que en controles (p Conclusiones INF1α, IL-10 y BLyS estan mas elevados en pacientes con LES que en controles sanos. El aumento de IL-10, asociado o no a aumento de BLyS y/o INF1α, es la citocina que mejor se ajusta a la actividad clinica del LES medida con metodos clasicos.

to analyse the association between interferon-1α (INF1α), interleukin-10 (IL-10) and BLyS concentrations and clinical activity in systemic lupus erythematosus (SLE).A cross-sectional, observational study of 142 SLE patients and 34 healthy controls was performed, through a complete blood and urine test and review of their medical history. Serum concentration of INF1α, IL-10 and BLyS was determined by colorimetric methods. A biostatistical analysis was performed with R (3.3.2.).69% of our SLE patients showed at least one cytokine increased. INF1α, IL-10 and BLyS are higher in SLE patients than in healthy controls (P.001, P=.005 and P=.043, respectively), being INF1α the most frequent. Patients were categorised according to low or high concentrations of the three cytokines. We found a significant association between increased IL-10/INF1α concentrations and a higher clinical activity measured by SELENA-SLEDAI (P.0001) and, to a lesser extent, an association with increased INF1α/IL-10/BLyS concentrations. Elevated levels of IL-10/INF1α and INF1α/IL-10/BLyS related to increased C3-C4 consumption (P.001 and P=.001 respectively) and anti-dsDNA titres (P=.001 and P=.002 respectively). Elevated INF1α/BLyS related to higher anti-dsDNA titres (P=.004) and ENA positivity (P.001). Increased levels of INF1α/IL-10/BLyS related to positivity of ANAs (P.001) and APL (P=.004).INF1α, IL-10 and BLyS are higher in SLE patients than in healthy controls. Increased IL-10 levels, regardless of whether or not there were also increased levels of BLyS and/or INF1α, was the cytokine that best fit with clinical activity in SLE measured with classic methods.

Background/objective To assess the effectiveness and safety of Baricitinib and Tofacitinib in rheumatoid arthritis (RA) patients in “real world” conditions. Methods A single centre retrospective study was performed including RA patients who had initiated treatment with Baricitinib or Tofacitinib from September-2017 to January-2020. Demographic, clinical, laboratory, efficacy and safety variables were collected from baseline and at months 1, 3, 6, 12, 18 and 24. Effectiveness was evaluated by changes from the baseline in DAS28, SDAI, HAQ and acute phase reactants. Safety analysis included adverse events due to any cause, including infection or intolerance. Infection was considered severe if it implied hospitalization. Statistical analysis consisted in Bayesian mixed ordinal regression models including the monotonic effect of each visit and Kaplan–Meier survival curves. Results Overall, 98 patients were included. A significant reduction of disease activity scores was noted in both groups. No difference between either treatment was detected in terms of effectiveness even in first line, after bDMARD failure, in monotherapy nor combined therapy. A total of 54 adverse events were recorded of which 18 were considered relevant. The incidence of infection, including Herpes Zoster, was similar in both groups. No patients in either group suffered any tuberculosis, thromboembolic event, malignancy, death or cardiovascular adverse events. Survival analysis did not show any difference between groups. Conclusion Baricitinib and Tofacitinib are both comparable in terms of effectiveness and safety in real world conditions.

To investigate the role of plasma calprotectin in non-infectious uveitis.This is an observational both cross-sectional and prospective study. Patients with active non-infectious uveitis were recruited as well as nonuveitic controls. Plasma calprotectin was determined and an ophthalmological examination was performed for both patients and controls. Independent variables possibly influencing levels of plasma calprotectin were recorded and analyzed. Categorical variables were compared by chi-square test (applying correction by continuity if necessary). T-test (or Kruskal-Wallis when appropriate) was used to compare averages. Multiple linear regression analysis was used to assess relationship between plasma calprotectin levels and independent variables. Spearman coefficient was calculated in order to establish correlation between plasma calprotectin and anterior chamber cell grading. Changes in plasma calprotectin levels between the flare beginning and its resolution were determined with mixed model for repeated measures. R software (version 3.6.0) was used to perform the statistical analysis.We included 74 patients and 40 controls in the cross-sectional study. Plasma calprotectin levels were higher in uveitis patients compared to those of controls (Plasma calprotectin levels are elevated in uveitis patients and are influenced by age and anatomical location of uveitis. Further investigation is needed to assess the relationship between calprotectin and uveitis activity.

Background/Purpose Rhupus syndrome (RhS) is a rare combination of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). Different studies describe RhS cases that begin with erosive arthritis and the presence of rheumatoid factor (RF) and/or anti CCP and then the SLE symptoms. Despite the fact that RhS shows a low prevalence, it would be useful to know clinical characteristics of RhS patients since their therapy and outcome differ from those having RA or SLE alone. Methods Retrospective study with systematic revision of electronic clinical records of RhS patients was performed. Demographic, clinical and immunological data were collected. Results Eight RhS patients were included (all fulfilled SLICC 2012 criteria for SLE and ACR 2010 for RA). Mean age was 67.3 (45–84) years (7 were female). In 3 cases RA was the first diagnosis with a mean evolution of 4.5 years until SLE diagnosis. In contrast, in 5 cases SLE was the first diagnosis with a mean evolution of 7.2 years until RA diagnosis. Photosensitivity and arthritis were the predominant clinical manifestations. One patient presents pericarditis and other case showed rheumatoid nodules in elbows. Renal, pulmonary or neurological affection was no reported. 4 patients were under biological/JAK inhibitors therapies (2 abatacept, 1 rituximab and 1 baricitinib) with favorable response of treatment. Conclusions In contrast to other series, only the 37.5% of our RhS cases begins with polyarticular seropositive arthritis. The 62.5% started with SLE symptoms as haematological alterations, cutaneous and serological manifestation, and showed longer progression to have polyarticular affection. Thus, RhS diagnosis is earlier in patients that begin with RA symptoms. 4 RhS patients were refractory to DMARd treatments, where biological/JAK inhibitors therapies are needed.

Background/Purpose In Systemic Lupus Erythematosus (SLE) the presence of some autoantibodies is related to specific clinical manifestations. We aimed to define SLE patient groups according to an autoantibody profile and to analyze the correlation of these profiles to clinical manifestations. Methods A cross-sectional observational study of SLE (SLICC 2012 criteria) was conducted. A clinical and analytical evaluation was performed. Clinical manifestations were described according to RELESSER study. We selected 8 autoantibodies to classify SLE patients: anti-dsDNA, anti-Sm, anti-RNP, anticardiolipin IgG/IgM (aCL IgG/M), anti-s2microglobulin IgG/IgM (as2M IgG/M), lupus anticoagulant (LA), anti-Ro and anti-La. Immunological profiles were created according to previous study of Artim-Esen B et al. 2014. Results 142 SLE patients with a mean age at diagnosis of 33.29 (13.53) and a mean time of disease evolution of 15.82 (10.56) years were evaluated. Mean SLEDAI score was 5.91 (5.6) and mean SLICC value 1.1 (1.46). Autoantibody frequencies are: ANAs 87.3%, anti-dsDNA 36.62%, anti-Sm 9.2%, anti-RNP 3.5%, aCL IgG/M 20.15%, as2M IgG/M 21.88%, LA 26.27%, anti-Ro 45.07% and anti-La 16.2%. Profile n°2 included SLE patients with anti-Sm/RNP positivity. Profile n°3 included patients with anti-Ro/La positivity. Profile n°4 included patients with aCL IgG/M or aB2M IgG/M or LA positivity. Profile n°5 included patients who exclusively showed anti-DNA positivity. Profile n°1 included all patients excluded from the other profiles. Profile n°1 patients were diagnosed earlier and had a longer disease evolution, whereas Profile n°5 patients were diagnosed later and with shorter disease evolution. We observed a significant association among hematological affection and high levels of anti-Ro (P Conclusions An association between the presence of anti-Ro/La and hematological affection, as well as high incidence of Sjogren syndrome in these subgroup of patients was described.

Background/Purpose Poly-autoimmunity (PAI) is the presence of more than one Autoimmune Disease (AID) in one patient. The coexistence of Systemic Lupus Erythematosus (SLE) with other AIDs is a clinical challenge due to is one of the issues not yet elucidated in medical practice. We aimed to determine PAI frequency in the context of SLE patients reported in a tertiary hospital. Methods Cross-sectional observational study with systematic revision of electronic clinical records of SLE patients with other AIDs (from 2014 to 2018) was performed. Demographic, clinical and immunological data were collected. Results Of 261 SLE patients, 48 (18.39%) had PAI. Mean age was 51.19 (15.35) years (93.75% were female). 2 patients from the 48 (4.16%) had PAI with three AIDs. The 75% of cases developed SLE as the first AID. The mean age at diagnosis of the first AID was 35.52 (15.33) years and mean age at diagnosis of the second AID was 43.75 (16.31) years. A mean difference of 8.31 (9.24) years between the first and second AIDs debut was observed. The most frequent AIDs registered that go along with SLE are Antiphospholipid Syndrome (APS)(39.58%), Sjogren Syndrome (SS)(31.25%), and Rheumatoid Arthritis (RA) (16.67%). Moreover, in two cases a third AID was registered: SLE-SS-APS and SLE-APS-autoimmune-thyroiditis. In the SLE-APS group, SLE was the AID of debut in the 89.47% of cases, instead of SLE-RA group with a 62.5%. The SLE-APS group showed a 47.37% of cases with positive antiphospholipid antibodies and 64.71% positive lupus anticoagulant. In the SLE-RA group a 71.43% and 66.67% positive rheumatoid factor and antiCCP antibody was reported. Conclusions 18.39% of patients with PAI in our group of SLE patients was observed, mostly with the SLE as the first AID developed. The most frequent association of AIDs in SLE cases were with APS, SS and RA.

Background Neuropsychiatric manifestations in patients with systemic lupus erythematosus (SLE), termed neuropsychiatric SLE (NPSLE), involve a wide variety of neurological and psychiatric manifestations with a complex approach. The aim of this study was to determine the prevalence of mental disorders and neuropsychiatric involvement in a group of patients with SLE and to examine the relationship with other clinical manifestations. Methods A single center, retrospective, case control study was including patients 18 years and older diagnosed with SLE in a tertiary hospital. Clinical and demographical variables were collected. NPSLE was defined by classification criteria, and others minor nonspecific NPSLE manifestations (depression, anxiety, dizziness) were collected. Statistical analysis was carried out using R software. Results From a total of 66 patients 24.2% (16 patients) had at least one mental disorder or neuropsychiatric manifestation. The most frequently reported was depression (n=7, 43.8%), dizziness (n=5; 31,2%); headache (n=4; 25%); insomnia (n=2; 12.5%) and cognitive impairment (n=2; 12.5%). Brain MRI nonspecific findings were reported in 2 patients (12.5%). ANA was positive in all cases. The prevalence of anti-Rib-P was very low, only present in one patient (1.5%). 8 patients (12.1%) had secondary antiphospholipid syndrome (APS). Associations with APS, other manifestations or corticosteroid use were not statistically significant. Conclusions There is a low prevalence of severe neuropsychiatric syndromes in our cohort. Almost 1/4 of our cohort had at least one mental disorder or neuropsychiatric manifestation, the most frequently reported was depression.

Background Antimalarials represent the cornerstone of SLE treatment, since its uses control clinical manifestations in many patients, prevents disease flare and permits steroid reduction. The aim of this study is to describe the safety profile and the reasons for discontinuation of antimalarials in patients with SLE and determine which factors act as a predictor of drop-out. Methods A single centre, retrospective, case control study was performed including patients with SLE according to SLICC 2012 criteria. Clinical and demographical variables were collected. Disease activity was measured with clinical, analytical and disease scores. Results 66 patients were included, 56 patients (84.8%) were females, the median age was 49.3 years (23.4, 76.2). 95.50% of patients were Caucasian. 11 patients (16.7%) had high blood pressure and 6 (9.1%) diabetes mellitus. The disease duration of SLE had a median of 198 months (5.1, 144.9), and median SLEDAI was 3.4 (2–23). 45 patients (68.2%) were taking steroids and its median dosage was 3,6 (1.2, 2.5) mg. 58 patients received antimalarial treatment during their follow-up with a median exposure time of 354 (6, 867) months. 91.2% took hydroxychloroquine (HCQ), 6.9% chloroquine (CQ), and only one patient mepacrine (1.7%). At least one side effect was reported in 22 patients (33.3%) leading to permanent withdrawal in 13 (19.7%): 7 cases of ocular toxicity, 4 intolerance (6,1%), and 2 cases of inefficacy (3%). 45 patients (68.2%) continued antimalarials after introduction. Retinal alterations were not associated with age, disease length and duration of the antimalarial therapy. Conclusions We observed a similar frequency of antimalarial suspension as reported in other studies. The main adverse events during the therapy were ocular toxicity, but in a percentage of patients remains the main cause of treatment withdrawal.

Background/Purpose Patient-Reported Outcomes (PROs) allow us to know how the disease could affect patients, and maybe could not be detected by clinical measures. Among these, PROs of health-related quality of life (PRO-QL) represents patient evaluation of its health status. In systemic lupus erythematosus (SLE) patients, the heterogeneous inflammatory symptoms can affect the health-related quality of life in different ways. We aimed to measure the PRO-QL in SLE patients and correlate them with the clinical activity of the disease. Methods A cross-sectional observational study with SLE patients diagnosed according to SLICC 2012 criteria was performed. SLEDAI score was carried out, and patients full-filled questionnaires of fatigue (FACIT-FATIGUE), quality of life (EQ-5D-5L), disability (HAQ) and a Global Health Status Scale (GHS) (0–100). Biostatistical analysis was performed using the multivariate analysis of variance by Pillai test. Results 54 SLE patients (91.84% female) with a mean age at diagnosis of 27.55±13.21 years and a mean time of disease evolution of 20.45±9.7 years were included. Mean SLEDAI score was 6.63±6.89, with a 37.04% of patients with SLEDAI>6. The 64.66% of patients were under glucocorticoid treatment, 38.77% under immunosuppressants (methotrexate, azatioprine or mycophenolate) and 51.02% under antimalarials. Patients showed a mean score of 34.02±12.38 in FACIT-FATIGUE, 0.72±0.26 in EQ-5D-5L, 0.62±0.71 in HAQ and 64.02±25.93 in GHS. Statistical analysis showed correlation among high SLEDAI scores and low scores of EQ-5D-5L, FACIT-FATIGUE and GHS, and an increment in HAQ, considering as correcting factors the age, years of disease evolution, glucocorticoid treatment, antimalarials and immunosuppressants (P=0.0107). Conclusions We observed a correlation between PROs-QL full-filled by SLE patients with the clinical activity of the disease, independently of glucocorticoid treatment, antimalarials and immunosuppressants, the age and the disease evolution.

[EN] An autoantigen piezoelectric sensor to quantify specific circulating autoantibodies in human serum is developed. The sensor consisted on a quartz crystal microbalance with dissipation monitoring (QCM-D) where TRIM21 and TROVE2 autoantigens were covalently immobilized, allowing the selective determination of autoantibodies for diagnosis and prognosis of Systemic Lupus Erythematosus (SLE). The sensitivity of the biosensor, measured as IC50 value, was 1.51 U/mL and 0.32 U/mL, for anti-TRIM21 and anti-TROVE2 circulating autoantibodies, respectively. The sensor is also able to establish a structural interaction fingerprint pattern or profile of circulating autoantibodies, what allows scoring accurately SLE patients. Furthermore, a statistical association of global disease activity with TRIM21-TROVE2 interaction was found (n=130 lupic patient samples, p-value=0.0413). The performances of the biosensor were compared with standard ELISA and multiplex DVD-array high-throughput screening assays, corroborating the viability of piezoelectric biosensor as a cost-effective in vitro assay for the early detection, monitoring or treatment of rare diseases., We acknowledge financial support from the Generalitat Valenciana (GVA-PROMETEOII/2014/040) as well as the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund under award numbers CTQ2013-45875-R and CTQ2013-42914-R.

Background Spinal Cord Injury (SCI) produces a wide variety of changes in systemic physiology that can lead to several complications, such as Osteopenia or even Osteoporosis. It has been reported in several studies, an incidence of fracture between 30-40% in this population. Objectives To evaluate the evolution of bone turnover biomarkers before and after treatment (according to 2015 NOF guidelines) and to describe the incidence of fracture after a SCI. Methods A prospective study was conducted, including 48 SCI patients followed during an observation period of 24 months, with visits every six months. Thirty two patients concluded the study. In each visit patients were enquired about fractures. A blood test was also performed. In addition a dual-energy x-ray absorptiometry (DEXA) and simple x-ray of hip and spine was requested annually. Patients were also educated in lifestyle measures, such as an adequate calcium and vitamin D dietary intake. Oral supplementation was initiated in cases of low intake or deficit, respectively. In patients with bone mineral density (BMD) measured by DEXA in range of Osteoporosis, pharmacological therapy was initiated (bisphosphonate or Denosumab). Statistics had been performed with mixed linear regression models. Results Our sample was 56.25% men with an average age of 56.08 ± 13.82 years old. In 32 patients (68.09%) low Vitamin D levels were detected. At baseline in 12 cases (25%) DEXA showed a BMD in osteoporosis range; in 12 (25%) osteopenia, plus 6 fractures (2.6 fractures per 100 years/patient). Afterwards, until the end of the study only a fracture of the tibia was observed (however, it was after a high impact accident), so the fracture rate was 1.2 fractures per 100 year/patient. The evolution of the variables can be seen on the next table. On multivariate analysis an inverse relationship between vitamin D and CTX levels was detected (p≤ 0.05). DEXA hip measures tend to become stabilized after Bisphosphonate treatment. Conclusion On our cohort, bone resorption biomarkers decrease after Vitamin D restoring. Antiresorptive therapy in high risk patients stopped bone loss, especially in hip. After two years follow up, with the treatment algorithm applied, fracture incidence was lower than other series published. Reference [1] *J Musculoskelet Neuronal Interact 2011: 11(3):257-265 Disclosure of Interests None declared

Background: The absence of therapy adherence is a public health problem and leads to negative consequences in inflammatory chronic diseases. The measurement of therapy adherence has demonstrated effectiveness on the improvement of compliance, but it is difficult to estimate because it is based on indirect measurements. With high probability there will be discrepancies between different measurements. Objectives: To estimate the discrepancies between therapy adherence controlled by prescription of medication, Morisky-Green test and self-perception adherence patients under biological subcutaneous treatment or under JAKinhibs oral treatment. Methods: Observational study including inflammatory chronic disease patients under biological subcutaneous treatment or under JAKinhibs oral treatment, selected consecutively. We performed a preliminary stage where patients were contacted by telephone and after that the questionnarie was sent to the email address they provided. The questionnaire included Morisky-Green test and a self-perception adherence scale (0-10). Data about dispensation of medication was collected from the pharmacy service. We defined as “adherent patient” a dispensation rate over 80%. Results: 54 patients were contacted, and 37 of them full-filled the questionnaire. 28 full-filled the online questionnaire but the other 9 preferred the paper format. The patients from the online format questionnaire had a mean age of 50.86 years (range 22-74), and patients of paper format questionnaire had a mean age of 61.38 years (38-71). We observed a high proportion of patients with university studies among those who preferred the online format. 21 of the patients surveyed had rheumatoid arthritis, 7 psoriatic arthritis, 7 ankylosing spondylitis and 1 juvenile idiopathic arthritis. 21 were under subcutaneous biological therapies and 16 under oral JAKinhibitor therapies. From the 37 patients, 64.8% took 2 or more pills daily. among the 37 surveyed patients a discrepancy between therapy adherence controlled by dispensation of medication and adherence by Morisky-Green was observed (94.6% vs 72.97%, P among the analyzed factors which may affect the therapy adherence, the oral route of administration showed more adherence rate controlled by dispensation of medication (P=0.019) and with Morisky-Green adherence rate (P=0.016). No other association with other factors as age, gender or time of disease evolution was observed. Conclusion: Younger patients and those with university studies preferred to full-fill the online questionnaire. A discrepancy between therapy adherence controlled by dispensation of medication and adherence by Morisky-Green was observed. Moreover oral route of treatment showed more therapy adherence than subcutaneous route of treatment. Even if the patients are no self-considered as 100% adherents (Morisky-Green), a tendency of collect the medication on a regular basis was observed. This seems to indicate that instead of the controlled dispensation of medication by Pharmacy, patients with lower therapy adherence will collect all the medication. Disclosure of Interests: None declared

Background: There is none defined competences framework for Rheumatology Nursing at the moment in Spain. This fact leads to an heterogeneous roles and interventions in each Rheumatology department which has not ever been described nor quantified. Objectives: To describe and quantify the rheumatology Nursing interventions in the Valencian Region (Spain). Methods: A descriptive study was performed by the completion of an online questionnaire with a list of clinical and research intervention. The questionnaire was sent to the Head of Rheumatology Department of 33 public hospitals from the Valencian Region. Results: 32 hospitals of the Valencian Region fulfilled the questionnaire: 15 from Valencia, 13 from Alicante and 4 from Castellon. 50% of the hospitals had a Rheumatology nurse. In those hospitals, 50% had only 1 Rheumatology nurse working at the moment. The maximum Rheumatology nurses working in the same hospitals were 4; 2 hospitals used to have a Rheumatology nurse but do not have it anymore at this moment. 11 hospitals have an auxiliary nurse (3 of them without nurses and 8 with nurses). The year of incorporation of the Rheumatology nurse in the Department was quite heterogeneous, being the earlier in 1992 and the last incorporation in 2017. The nurses worked mainly in a Rheumatology department full time (68.75%). The 81% of the hospitals had an specific nursing agenda but only 7 hospitals had a monographic nurse-led clinic (osteoporosis nurse-led clinic -25%-, intravenous treatments nurse-led clinic -12.5%- or cardiovascular risk nurse-led clinic -6.25%) Nurses clinical interventions are very heterogeneous covering the patient clinical management and practice nurses intervention activities. Nurses organized patient education workshops in 25% hospitals. In 11 hospitals, nurse undertook teaching activities. 56% participating in scientific workshops/congress, 44% teaching undergraduated nurses/registered nurses and 37.5% teaching other healthcare professionals. In 11 hospitals, nurses undertook research activities. In 2 hospitals an specific research nurse was available. 56% of nurses participated in clinical trials, 50% participated in research projects and 50% participated in scientific congress. 25% of nurses lead research projects. In 12 hospitals, nurses belong to a scientific society; in 11 hospitals, nurses participated in regional, national and/or international nurses working groups. Conclusion: In at least 50% of the hospitals from the Valencian Region, nurse activity was registered. There are heterogeneous clinical activities performed by nurses. This fact raised the issue of the importance of having unified criteria for nurse’s intervention and competences framework comparable in each and every hospital. Teaching and research were also a common interventions mentioned. These activities are necessary for a constant recycling and updating of the nurses and will help to gain the necessary visibility for the rheumatology nurses. Disclosure of Interests: None declared

Background: Systemic lupus erythematosus (SLE) is an autoimmune systemic disease characterized by autoantibody production. The presence of some of them is related to specific clinical manifestations. Previous studies have classified SLE patients according to an autoantibody profile, associating them to specific clinical groups. Objectives: To define SLE patient groups according to an autoantibody profile and to analyze the correlation of these profiles to clinical manifestations, clinical activity and accumulated damage. Methods: A cross-sectional observational study of SLE patients diagnosed according to SLICC 2012 criteria was conducted. A clinical and analytical evaluation was performed in all cases. Clinical manifestations were described according to RELESSER study. We selected 8 autoantibodies to classify SLE patients in different subgroups according to autoimmune similar profiles: anti-dsDNA, anti-Sm, anti-RNP, anticardiolipin IgG o IgM (aCL IgG/M), anti-B2microglobulin IgG o IgM (aB2M IgG/M), lupus anticoagulant (LA), anti-Ro and anti-La. Biostatistical analysis was performed using software R and immunological profiles were created according to previous study of Artim-Esen B et al. 2014. Results: 142 SLE patients were evaluated (94.4% female) with a mean age at diagnosis of 33.29 (13.53) and a mean time of disease evolution of 15.82 (10.56) years. Mean SLEDAI score was 5.91 (5.6) and mean SLICC value 1.1 (1.46). Frequency of the selected autoantibodies was: ANAs 87.3% (n=124), anti-dsDNA 36.62% (n=52), anti-Sm 9.2% (n=13), anti-RNP 3.5% (n=5), aCL IgG/M 20.15% (n=27), aB2M IgG/M 21.88% (n=28), LA ANTI--LA? 26.27% (n=31), anti-Ro 45.07% (n=64) and anti-La 16.2% (n=23). Profile n°2 included SLE patients with anti-Sm/RNP positivity. Profile n°3 included patients with anti-Ro/La positivity and not included in profile n°2. Profile n°4 included patients with aCL IgG/M or aB2M IgG/M or LA positivity and not included in previous profiles. Profile n°5 included patients who exclusively showed anti-DNA positivity. Profile n°1 included all patients excluded from the other profiles. Depending on the results obtained, we analyzed autoantibody levels in order to assess its association with the presence of the described clinical affections. A significant association among hematological affection and high levels of anti-Ro (P Conclusion: Profile n°1 patients (absence of autoantibodies) were diagnosed earlier and had a longer disease evolution, whereas Profile n°5 patients (only anti-DNA positivity) were diagnosed at a mean age of 36 years and had a shorter disease evolution. We observed an association between the presence of anti-Ro/La and hematological affection, as well as high incidence of Sjogren syndrome in these subgroup of patients. Disclosure of Interests: None declared

Background: Vertebral Osteomyelitis (VO) is an infectious disease that could involve intervertebral space (discitis). Its incidence is raising for several reasons, such as the increasing number of patients on immunosuppressive therapy. The treatment includes long term antibiotic, that should be initiated after biopsy (if possible) and sometimes, further surgery is needed1. Objectives: To analyze the influence on prognosis of detection of OV in immunosuppressed (IS) patients. Methods: Single center retrospective observational study including IS adult patients diagnosed of VO based on the combination of clinical presentation with either a definitive bacteriologic diagnosis or pathological and/or imaging studies from January 2010 to January 2019. Demographic features, concurrent diseases, clinical history (length of pain and fever prior to admission), laboratory findings, microbiological diagnosis and radiological data were compiled. We considered as IS patients those who had rheumatic or inflammatory bowel disease undertaking immunomodulatory drugs, solid organ transplantation receptors, patients with an active malignancy or Human Immunodeficiency Virus (HIV) infected. Clinical and radiological history of lumbar stenosis or disc herniation was considered as prior spine pathology. Surgical infections were excluded. We considered deaths attributive to PVO those which were directly caused by the infectious picture and/or its complications during the next year after diagnosis. Results: Eighteen of 122 patients with VO (21.96%) were IS. Basal demographic and clinical features are exposed in table 1. Detailed data about the cause of the IS is provided separately in table 2. Duration of pain prior to diagnosis had a median of 30 days (15.5, 55). C reactive protein showed a median value of 65.2mg/L (19.32, 153.9) and Erythrocyte Sedimentation Rate mean value was 80.57mm/H (31.75). MRI was the imaging technique most often used for diagnosis (83.33%), followed by CT-scan(16.67%). The region most frequently affected was lumbosacral spine (44.44), then dorsal (33.33%) and finally cervical (22.22%). Some abscess (epidural or paravertebral) was detected in 16 patients (88.89%) close to non-IS patients (90.38%). Worst data concerning vertebral destruction was observed (66.67% in IS group against 49.04 in non-IS, p=0.3) and cord compression (61.11% versus 26.92% respectively, p=0.05). Fifteen patients underwent CT guided biopsy (83.33%) with prior antibiotic exposure in 11 of them. Median exposure was 4.5 days (3, 8.75). Delay from admission to procedure had a median value of 6 days (3.5, 9). Culture was positive in 53.33% of cases. In 10 patients, the picture was attributed to Gram+ (55.56%), in other 2 cases Gram- (11.11) and 1 case of tuberculosis (5.56). In 5 cases (27.78%) final pathogen was unknown. Four patients (22.22%) required further surgery and 2 patients (11.11) died, similar than non-IS group, 11.54%. Conclusion: In general terms, data about imaging is worse in IS patients and higher proportion of cervical spine involvement was also noted. Although, early intervention (diagnosis, punction guided biopsy and treatment) seems to be protective against a bad outcome, since IS patients showed similar prognosis (further surgical procedures and death) than non IS patients. To sum up, new onset back pain in a IS patient, should be thoroughly studied so as to consider a VO as soon as possible. Disclosure of Interests: None declared

Background: Pulmonary involvement is the main cause of death in Systemic Sclerosis patients (SS). However, there is little information whether its presence is capable of affecting the functional capacity of patients and if this influences the quality of life perceived by them. Objectives: To determine whether the presence of pulmonary involvement in patients with SS (Interstitial Lung Disease and or Pulmonary Arterial Hypertension) is related to greater functional disability. Methods: Observational and cross-sectional study, with a prospectively performed protocol, of patients diagnosed of SS according to ACR/EULAR 2013 criteria. Demographic, clinical, analytical, activity (EUSTAR index), severity (Medsger scale and modified Rodnan index), health perception (SF36) and disability (HAQ and Cochin test) variables were collected. Moreover, Videocapillaroscopy (VCL) and Respiratory Function Test were made. All the patients had pulmonary TCMD and echocardiography in order to describe pulmonary features. Results: 42 patients were included (95.4% women), with an average age of 59.2 (S.D 12.9) years. The median of years from diagnosis was 4, and 6 from the first not Raynaud symptom. Out of them, 20 were SS limited, 20 patients SS diffuse; and 2 patients SS sine scleroderma. Pulmonary hypertension (HTP) was found in 11.9% of patients, as well as EPID in 33.3% (UIP 16.7%, NSIP 14.3%, bronchiolitis 2.3%). Analyzing the subgroup of patients with EPID, we can highlight higher score of HAQ, Cochin and activity index EUSTAR, with less influence in Rodnan index and without differences in SF36. Regarding the subset of patients with PAH, we found higher score on HAQ, EUSTAR activity index, index Rodnan, Medsger gravity scale and the SF36, than in non-PAH patients, with no differences in Cochin test. Conclusion: We can highlight the presence of greater functional limitation that is especially reflected in rates of disability (HAQ and Cochin), as well as a increased activity of disease and a lower self-perception of health in patients with Systemic Sclerosis pulmonary involvement. Disclosure of Interests: None declared

Background: Systemic lupus erythematosus (SLE) is an autoimmune chronic disease produced by aberrant immunological response that consequently, causes a widespread organic damage. Treatment leads to regulating this disrupted immunological response. As a result, in 2011 Belimumab was approved for adults patients diagnosed with SLE, what is a monoclonal human antibody whose target is a B-lymphocyte stimulator (BLyS), a protein involved in the disease pathogeny. Objectives: To evaluate the glucocorticoesteroid dose variation in adult patients with systemic lupus erythematosus during Belimumab IV treatment. Methods: Retrospective, observational study that includes patients diagnosed with SLE according to SLICC 2012 criteria, who are treated with Belimumab IV. Treatment has been administrated as an initial dose: 10 mg/kg every 14 days and then, a maintenance dose: 10 mg/kg every 28 days. Data form serological profile, clinical manifestations at diagnoses and at the onset of treatment, existence of comorbidities or other diseases, concomitant therapy directed to the main disease or to the complications that came from the disease, non administration causes and definitive treatment discontinuation were collected from July 2012 until December 2018. Results: A total of 19 patients (94.74% women) with 28 years old (Q1 14, Q3 31.82) as a median age at diagnosis and 11 (Q1 6.5, Q3 20) years since disease diagnosis were included. Follow up mean was 29 (Q1 7.5, Q3 37) months. Regards to concomitant therapies, 5 patients (26.31%) were treated with Azatioprine and 3 patients with Methotrexate (15.79%). At the onset of biological therapy, 17 patients were treated with glucocorticoids, at a dose of 10 mg (Q1 9.38, Q3 10.63). At the end of follow up, 18 patients (94.73%) were treated with corticoid and the mean dose was 8.75 mg (Q1 8.75, Q3 8.75). We observed a mean corticoid dose reduction of 4.02 mg (Q1 2.5, Q3 5). Dose was not modified in 4 patients after the beginning of Belimumab IV. As exceptions, in 1 patient we added corticoids to treatment (dose of 5 mg/day) and in another one we doubled corticoid dose, until a maximum dose of 20 mg/day. Belimumab treatment was definitive discontinued in 5 patients because of peripheral venous insufficiency, pregnancy, itchy skin lesions, uncertain drug allergy and primary pulmonary hypertension. Conclusion: As we observed, an important percentage of patients (in our sample close to 90%) take usually corticoids, with the clinical consequences and development of comorbidities in a long time and adverse events related to this therapy. Diary dose is reduced in 57.9% of our patients, even in those patients who have discontinued Belimumab treatment, in which we observed a dose reduction too. Disclosure of Interests: None declared

Background Vertebral Osteomyelitis (VO) is an infectious disease that could involve intervertebral space (discitis), which it is avascular in adults. VO and discitis may occur together or independently. Both are frequently the result of a spreading of a distant focus, such as infectious endocarditis or soft tissue infection. Due to the lack of direct blood supply, reliability of blood cultures is low, so biopsy is highly encouraged by current guidelines. Treatment includes long term antibiotic (ATB), that should be initiated after biopsy (if possible) and sometimes, further surgery is needed. Objectives To analyze which factors influence the result of a CT-guided biopsy in patients with VO. Methods Retrospective observational study including adult patients diagnosed of VO based on the combination of clinical presentation with either a definitive bacteriologic diagnosis or pathological and/or imaging studies, who underwent CT-guided biopsy from January 2010 to January 2019. Demographic features, concurrent diseases, clinical history (length of pain and fever prior to admission), laboratory findings, microbiological diagnosis and radiological data were compiled. Days until biopsy from admission, prior antibiotic exposure was also collected. We considered as immunosuppressed patients those who had rheumatic or inflammatory bowel disease undertaking immunomodulatory drugs, solid organ transplantation receptors, and patients with an active malignancy or Human Immunodeficiency Virus (HIV) infected. Clinical and radiological history of lumbar stenosis or disc herniation was considered as prior spine pathology. Spinal infections after surgery, Fungal and tuberculous disease were excluded. We considered deaths attributive to PVO those which were directly caused by the infectious picture and/or its complications during the next year after diagnosis. Results Seventy-two of 109 patients with VO underwent biopsy (66.06%). Thirty-nine brought a positive culture (54.2%). Basal demographic and clinical features are exposed in table 1. Positive cultures included 33 cases (84.61%) of Gram+ infection (23 Staphylococcus and 6 Streptococcus) and 6 (15.39%) by Gram- bacilli (3 cases of Pseudomona aeruginosa, 2 Escherichia coli and 1 Brevundimona spp). Conclusion In our population, it has been observed that not a single variable collected showed influence on culture result, although a negative tendency is observed in cases of prior antibiotic exposure, with no signification. Since CT guided biopsy is a safe technique, offering an acceptable reliability, our results support its use even in those cases that empirical antibiotic had been already initiated. Disclosure of Interests None declared

Background: Patient-Reported Outcomes (PROs) allow us to know the way the disease could affect patients, and maybe could not be detected in clinical measures. Among these, PROs of health-related quality of life (PRO-QL) represents patient evaluation of its health status and treatment, which affects the functional, psychological, social and emotional capabilities. In fact, patients with the same health status could show different PROs-QL. In the case of systemic lupus erythematoSus (SLE), patients experience many inflammatory symptoms and all of them can affect the health-related quality of life in different ways. Objectives: We aimed to measure the PRO-QL in SLE patients and correlate them with the clinical activity of the disease. Methods: A cross-sectional observational study with SLE patients diagnosed according to SLICC 2012 criteria was performed. In all cases SLEDAI score was carried out, and patients full-filled questionnaires of fatigue (FACIT-FATIGUE), quality of life (EQ-5D-5L), disability (HAQ) and a Global Health Status Scale (GHS) (0-100). Biostatistical analysis with software R was performed, using the multivariate analysis of variance by Pillai test. Results: 54 SLE patients (91.84% female) participated in the study, with a mean age at diagnosis of 27.55±13.21 years and a mean time of disease evolution of 20.45±9.7 years. Mean SLEDAI score was 6.63±6.89, with a 37.04% of patients with SLEDAI>6. The 64.66% of patients were under glucocorticoid treatment, 38.77% under immunosupressants (methotrexate, azatioprine o mycophenolate) and 51.02% under antimalarials. Patients showed a mean score of 34.02±12.38 in FACIT-FATIGUE, 0.72±0.26 in EQ-5D-5L, 0.62±0.71 in HAQ and 64.02±25.93 in GHS. Statistical analysis showed correlation between SLEDAI score and the four questionnaires of PROs-QL (P Conclusion: We observed a correlation between PROs-QL full-filled by SLE patients with the clinical activity of the disease, independently of glucocorticoid treatment, antimalarials and inmunosupressants, the age and the disease evolution. Disclosure of Interests: None declared

Background Raynaud’s phenomenon (RP) is frequently associated with the presence of scleroderma or other connective tissue diseases (CTD). Identify the presence of secondary RP is important to perform an adequate therapeutic management and to achieve the early control of these patients. Nailfold capillaroscopy is safe, economic, easy to perform and has proven to be useful in identifying patients with secondary RP. Objectives To assess a long-term follow-up primary RP patient’s cohort. Methods Retrospective observational study of a wide and unselected series of patients diagnosed as primary RP from a single university hospital from January 2012 to December 2018. Patients were classified as primary RP after the presence of CTD at the onset was excluded. Results We studied 248 patients (210 women/38 men), with a mean age of 46.3±15.2 years (range 15-88). After a mean follow-up period of 57.2±21.6 months, 9 (3.6%) patients were diagnosed of a CTD. The remaining 239 (96.4%) patients continued classified as primary RP. The main pathologies observed after follow-up were: Scleroderma/Systemic sclerosis (n=3), Systemic Lupus Erythematosus (n=3), Rheumatoid arthritis (n=1), Sjogren’s syndrome (n=2). The main capillaroscopic patterns observed were: Normal (n=175), Unspecific (n=64), Scleroderma pattern (n=3) and suggestive of other rheumatic diseases pattern (n=6). All the patients who developed a CTD during follow-up showed changes at successive nailfold capillaroscopic examinations. 28 of 239 patients who remained primary RP showed minor changes at successive nailfold capillaroscopy. The main capillaroscopic changes detected on this group were: Presence of capillary tortuosity (n=6), presence of a decreased capillary density (2) and the presence of capillary bleeding (n=20). Antinuclear antibodies (ANA) were positive at he onset in 46 patients (16.9%) and after follow-up in 44 (17.7%) patients. Conclusion After a mean follow-up period next to 5 years, most of our primary RP patients remained free of CTD. A minority of our patients showed changes at nailfold capillaroscopy exam or positivity of ANA. Disclosure of Interests None declared

Background: Polyautoimmunity (PAI) is the presence of more than one Autoimmune Disease (AID) in one patient. PAI have been reported in different AIDs as systemic lupus erythematosus (SLE) (33-45%), rheumatoid arthritis (RA) (13-23%), systemic sclerosis (SSc) (10-43%) or Sjogren Syndrome (SS) (32-52%). On the other hand, Multiple Autoimmune Syndrome (MAS) where three or more AIDs coexisting in one patient has been reported. Objectives: To determine PAI frequency in the context of AIDs reported in a tertiary hospital. Methods: Cross-sectional observational study with systematic revision of patients’ electronic clinical records with AIDs (from 2014 to 2018). We selected those patients who had two or more diagnosis of AIDs. Demographic, clinical and immunological data were collected. Results: Of 1854 patients with AIDs, 96 (5.17%) had PAI. Mean age was 56±15 years and 93.75% were female. 7 patients from the 96 (0.4%) also had MAS. The mean age at diagnosis of the first AID was 39.03±15.93 years and mean age at diagnosis of the second AID was 48.16±15.04 years. A mean difference of 9.17±10.18 years between first and second AIDs debut was observed. The most frequent AIDs registered are shown in table 1. Antiphospholipid syndrome (APS), Sjogren syndrome (SS), Systemic lupus erythematosus (SLE), Systemic sclerosis (SSc), Rheumatoid arthritis (RA), Psoriasic arthritis (PsA), Inflammatory bowel disease (IBD), Autoimmune hypothyroidism (AHyp), Celiac disease (CD), Diabetes mellitus type 1 (DM-1), Autoimmune hepatitis (AHep). The most frequent PAI cases registered were RA-SS (N=23), SLE-APS (N=17), SLE-SS (N=11), AR-IBD (N=7), RA-SLE (N=5), RA-CD (N=5), SS-SSc (N=4) and PsA-IBD (N=4). In the total group of 1854 patients with AIDs, SLE with PAI was present in 41 (2.21%) patients, SS with PAI in 42 (2.26%), RA with PAI in 46 (2.48%) and APS with PAI in 23 (1.2%). Moreover, SS was present in the 4.21% of SLE patients and in the 2.48% of RA patients. In contrast, APS was present in the 6.51% of SLE patients, being de of 7.64 (17.62) years the difference between the onset of the first AID and the second AID. In the MAS group an AHyp-SLE-APS in 2 patients was observed, as well as 1 patient with SLE-SS-Aps, 1 with SS-RA-APS, 1 with RA-vasculitis-AHyp and 1 with SS-Ahyp-Ahep. Conclusion: A 5.17% frequency of patients with PAI in our group of AID patients was observed, mostly women. APS, SS and SLE respectively were the diseases that most PAI showed. The most frequent association of AID diseases in PAI cases were RA-SS, APS-SLE and SS-SLE. We found a rather lower frequency compared with those published in the literature, possibly due to the putative bias of retrospective studies and the geographical differences of PAI patients. Disclosure of Interests: None declared

[EN] The mechanism of self-recognition of the autoantigen TROVE2, a common biomarker in autoimmune diseases, has been studied with a quartz crystal microbalance with dissipation monitoring (QCM-D) and dual polarization interferometry (DPI). The complementarity and remarkable analytical features of both techniques has allowed new insights into the onset of systemic lupus erythematosus (SLE) to be achieved at the molecular level. The in vitro study for SLE patients and healthy subjects suggests that anti-TROVE2 autoantibodies may undergo an antibody bipolar bridging. An epitope-paratope-specific binding initially occurs to activate a hidden Fc receptor in the TROVE2 tertiary structure. This bipolar mechanism may contribute to the pathogenic accumulation of anti-TROVE2 autoantibody immune complex in autoimmune disease. Furthermore, the specific calcium-dependent protein-protein bridges point out at how the TRIM21/TROVE2 association might occur, suggesting that the TROVE2 protein could stimulate the intracellular immune signaling via the TRIM21 PRY-SPRY domain. These findings may help to better understand the origins of the specificity and affinity of TROVE2 interactions, which might play a key role in the SLE pathogenesis. This manuscript gives one of the first practical applications of two novel functions (-df/dD and Delta h/molec) for the analysis of the data provided by QCM-D and DPI. In addition, it is the first time that QCM-D has been used for mapping hidden Fc receptors as well as linear epitopes in a protein tertiary structure., We would like to thank Sylvia Daunert for her invaluable help with the discussion of the paper. Furthermore, we acknowledge financial support from the Generalitat Valenciana (GVA-PROMETEOII/2014/040) as well as the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund under award numbers CTQ2013-45875-R and CTQ2013-42914-R

Polymyalgia rheumatica (PR) can be associated with large vessel vasculitis (LVV). We evaluate the diagnostic role ofRetrospective study of patients diagnosed with PR. Data was collected from health records. Blood analysis included acute-phase reactants (APR), C-reactive protein (CRP) and erythrocyte sedimentation rate. AnTwenty-three were eligible; 48% (n = 11) of the patients were diagnosed with LVV associated with PR. The site was heterogeneous, but mostly involved the aorta. In 80% of the patients with LVV, a disease-modifying antirheumatic drug was added to their treatment. Elevated CRP values were associated with the likelihood of presenting LVV.LVV is not uncommon, clinical features and elevated CRP levels should raise suspicion of LVV associated with PR.