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Background Systemic Lupus Erythematosus (SLE) patients show higher Red blood cells Distribution Width (RDW) regardless of anaemia status1. RDW has been found to positively correlate with serum IgM, CRP, ESR, and SLE Disease Activity Index 2000 (SLEDAI-2K), and glucocorticoid treatment decreased both SLEDAI-2K and RDW2. Objectives To determine whether RDW levels in SLE are associated with damage accrual. Methods This cross-sectional study was conducted in 276 SLE patients, 257 females and 19 males. Evaluations included interview, medical records review, physical examination and laboratory tests. Disease activity was measured with the SLEDAI. Damage accrual was ascertained with the SLICC/ACR damage index (SDI). Univariable and multivariable Poisson regression models were performed to determine if RDW levels were associated with damage accrual. These models were stratified by tertiles of RDW. The multivariable model was adjusted for variables known to be associated with this outcome [age at diagnosis, gender, socioeconomic status, ethnicity, tobacco use, disease duration, SLEDAI, anemia, antimalarials and immunosuppressive drugs use, average daily dose and time of exposure to prednisone (PDN)]. Results The patients mean (SD) age at diagnosis was 34.38 (13.33) years; nearly all patients were mestizo. Disease duration was 7.04 (6.16) years. The SLEDAI was 5.24 (4.67) and the SDI 0.92 (1.28). The average daily dose of PDN was 6.90 (6.07) mg/d and the time of exposure to PDN was 6.58 (9.59) years. RDW levels were 14.57 (1.52)%. Hemoglobin levels were 12.4 (1.7) g/dl. We divided the RDW levels into tertiles with cut points in 13.8 and 14.0; the highest tertiles were associated with disease damage; with a Rate Ratio (RR) 1.57 (1.07–2.28; p: 0.020 for the highest tertile, and 1.67 (1.15–2.42; p: 0.007) for the medium tertile. Conclusions Higher RDW levels are associated with damage accrual in SLE patients independent of other well-known risk factors for such occurrence. References Vaya A, Alis R, Hernandez J-L, et al. RDW in patients with systemic lupus erythematosus. Influence of anaemia and inflammatory markers. Clin Hemorheol Microcirc 2013; 54: 333–9. Hu Z-D, Chen Y, Zhang L, et al. Red blood cell distribution width is a potential index to assess the disease activity of systemic lupus erythematosus. Clin Chim Acta 2013; 425: 202–205. Disclosure of Interest None declared

Background Early diagnosis is an area of great unmet need in lupus. This need and other aspects of care have been reported from a provider9s perspective. Objectives The aims of this survey were to understand the experience of patients with diagnostic delays and to assess their access to care and the extent to which their care needs are met. Methods An online cross-sectional survey of English-speaking respondents aged ≥18 years with self-reported diagnosis of lupus was conducted across the US in partnership with the Lupus Foundation of America between February and March 2014. Demographic, clinical, and health-related quality of life information was collected, including a series of questions about patients9 experiences with diagnostic delays, access to care, and healthcare resource use (HCRU). Satisfaction with care was measured using the LupusPRO care satisfaction scale1, which has a score range of 0 to 100 (with 100 indicating the most satisfaction). Results Of the 827 lupus respondents, 97.5% were females and 85.3% white. Lupus respondents took on average 2.1 years (standard deviation [SD], 4.9 years) to seek medical help from the time they first noticed lupus symptoms (95% confidence interval [CI], 1.8 to 2.5 years) and waited an average of 3.5 years (SD, 5.4 years) from the time they first sought medical help for their lupus symptoms until formal diagnosis (95% CI, 3.1 to 3.8 years). A total of 62.8% lupus respondents reported being misdiagnosed before receiving a formal diagnosis of lupus; 75% of them reported being misdiagnosed by a primary healthcare provider. The median number of providers lupus respondents visited before receiving a formal lupus diagnosis was 3 (range, 0-10+). Overall, the rate of HCRU among lupus respondents was relatively high, with fatigue being the most frequently reported cause for seeking out-patient care. Although 90.2% of lupus respondents had healthcare coverage, 21.9% (17.8% of those with coverage and 59.3% of those without) reported that they were unable to get all the prescription medication they needed to manage their lupus and 22.5% (17.4% of those with coverage and 69.1% of those without) reported that they were unable to get all the healthcare they needed including specialist care and hospitalization to treat their lupus. On the LupusPRO “satisfaction with care” domain, lupus respondents reported not being fully satisfied (mean, 61.6; SD, 31.4; 95% CI, 59.5 to 63.8). Conclusions The results of this survey indicate a need to address the patients9 reported delays and inaccuracies in medical diagnosis, the quality of care, and the access to appropriate medical services for patients with lupus. Increased awareness of lupus symptoms in the general community and clinician education to improve understanding of both diagnostic criteria and medical treatment options are necessary to reduce the burden of illness in lupus References Jolly M, Pickard AS, Block JA, et al. Disease-specific patient reported outcome tools for systemic lupus erythematosus. Sem Arthritis Rheum 2012; 42: 56-65. Disclosure of Interest S. Al Sawah Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, R. P. Daly: None declared, S. Foster Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, A. Naegeli Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, K. Benjamin: None declared, H. Doll: None declared, G. Bond: None declared, O. Moshkovich: None declared, G. Alarcόn: None declared

Background Chronic inflammatory conditions are associated with a decrease of bone mineral density (BMD) and lean mass (in particular low appendicular lean mass) and an increase of fat mass (in particular areas considered more pro-atherogenic, like trunk fat mass or trunk-to-leg fat ratio). As prolactin (PRL) has a pro-inflammatory function in systemic lupus erythematosus (SLE) and it is associated with disease activity and damage, it would be expected that PRL could be associated with a decrease of BMD and lean mass and an increase of fat mass. Objectives To determine whether PRL levels are associated with a pro-inflammatory body mass distribution in female SLE patients. Methods This cross-sectional study was conducted in consecutive SLE female patients seen in our Rheumatology Department from 2012 to 2014. For the purpose of this study, baseline visits were included. Overweight patients (more than 115 kg), those with metallic implants or pregnant were excluded for this analysis. Disease activity was ascertained using the SLEDAI and disease damage with the SLICC/ACR damage index (SDI). PRL was measured in ng/ml. Body mass distribution was measured by DXA and it was divided into sub-total (whole body without the head) BMD, sub-total bone mineral content (BMC), lean mass index (appendicular lean mass/height2, LMI), sub-total, trunk and leg fat percentages and trunk-to-leg fat ratio. A pro-inflammatory body mass distribution is defined as a decrease of BMD, BMC and LMI and an increase of fat mass, in particular trunk fat mass and trunk-to-leg fat mass ratio. The association between PRL levels and body mass distribution components was evaluated by univariable and multivariable linear regression models, the last one adjusted for age, disease duration, SLEDAI, SDI, use of prednisone, antimalarials and immunosuppressive drugs. Results One hundred and fifty-five patients were evaluated; their mean (SD) age was 42.7 (13.4) years; nearly all patients were Mestizo. Patients included in this study had a lower body mass index than the rest of the cohort. Age, disease duration, SLEDAI and SDI were similar than the rest of the cohort. Disease duration was 7.3 (6.6) years. The SLEDAI was 5.5 (4.1) and the SDI 0.8 (1.3). PRL levels were 18.8 (14.3) ng/ml. BMD was 0.9 (0.1) g/cm2, BMC was 1.4 (0.3) kg, LMI 6.1 (1.1) kg/m2, percentage of subtotal fat 36.7 (6.7), trunk fat 34.3 (7.6), leg fat 37.9 (6.7), trunk-to-leg fat ratio 1.5 (0.6). Multivariable analysis is depicted in Table 01. Conclusions Higher PRL levels are associated with a pro-inflammatory body mass distribution in SLE patients. Disclosure of Interest None declared

Background Lupus affects patients9 health related quality of life (HRQoL). Objectives The aim of this study was to evaluate, in a sample of patients with lupus, HRQoL and how it varies according to patients9 perception of their health and their flare frequency. Methods An online cross-sectional survey of English-speaking respondents aged ≥18 years with self-reported diagnosis of lupus was conducted across the US in partnership with the Lupus Foundation of America between February and March 2014. Demographic, clinical, and HRQoL information was obtained. HRQoL was measured by the LupusPRO 1 , a validated lupus-specific QoL instrument consisting of 2 constructs (HRQoL and non-HRQoL) and 12 domains (HRQoL domains: lupus symptoms, cognition, lupus medications, procreation, physical health, pain-vitality, emotional health, and body image; non-HRQoL domains: desires-goals, social support, coping, and satisfaction with medical care). All constructs and domains scores range from 0 to 100 (with 100 indicating the most satisfaction). Health status and frequency and severity of flares were assessed as perceived by patients. Results Of the 827 patient respondents, 97.5% were females, 85.3% were white, 13.5% were Black, and 13.7% were Hispanic. A total of 66.3% perceived their health as either Fair or Poor, whereas 9.1% perceived it as either Very Good or Excellent. Recalling the past 4 weeks when completing the survey, 42.8% reported experiencing a lupus flare Most of the Time or All of the Time and 22.9% reported A Little of the Time or None of the Time. Overall, mean HRQoL (45.9; SD, 19.6) and non-HRQoL (54.0; SD, 17.1) scores implied a detrimental effect of lupus on QoL. The pain-vitality domain had the lowest mean score (32.0; SD, 24.1), indicating that pain and fatigue had the greatest relative impact on overall HRQoL, with patients affected, on average, Most of the Time. The highest single domain score was 63 (for coping), indicating that even in the least impacted domain patients were still being affected, on average, A Little of the Time or Some of the Time. Relating HRQoL to perceived health, HRQoL scores decreased linearly the poorer the patients9 perceived health – from (67.5; SD, 21.3) in the 9.1% of those perceiving their health as Excellent or Very Good to (29.8; SD, 15.3) in the 19.7% perceiving their health as Poor (p Conclusions HRQoL is significantly compromised in patients with lupus and is further impacted by how patients perceive their health and how often patients perceive they are experiencing flares. Better understanding of the main drivers of reduced HRQoL in this patient population will be important for future targeted interventions and treatment. References Jolly M, Pickard AS, Block JA, et al. Disease-specific patient reported outcome tools for systemic lupus erythematosus. Sem Arthritis Rheum 2012;42:56-65. Disclosure of Interest R. P. Daly: None declared, S. Al Sawah Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, S. Foster Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, A. Naegeli Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, K. Benjamin: None declared, H. Doll: None declared, G. Bond: None declared, O. Moshkovich: None declared, G. Alarcόn: None declared

Background CD4+CD28null T-cells are a subset of long-lived cytotoxic CD4+ T-cell with pro-inflammatory functions. This subset is supposed to be caused by chronic immune stimulation by either autoantigens or not. CD4+CD28null T-cells have been associated with cardiovascular morbidity and autoimmune diseases like rheumatoid arthritis, but in SLE patients the information is scarce. Objectives The aim of this study was to determine whether the CD4+CD28null T-cells are associated with disease damage in SLE patients after considering other possible factors. Methods This cross-sectional study was conducted in consecutive SLE patients seen in our Rheumatology Department from September 2013 to January 2014. An interview, medical records review, physical examination and laboratory tests were performed. SLE was defined using the ACR criteria. Disease activity was ascertained using the SLEDAI, disease damage with the SLICC/ACR damage index (SDI) and comorbidities with the Charlson Comorbidity Index (CCI). Use of prednisone was recorded as current dose and total time of exposure. Use of antimalarials and immunosuppressives was recorded as current, past or never. CD4+CD28null T-cells frequency was analyzed by flow-cytometry. The association of SDI and CD4+CD28null T-cells was examined by Spearman test. This was followed by multivariable analysis adjusted for age, gender, disease duration, CCI, SLEDAI, use of prednisone, antimalarials and immunosuppressive drugs. All analyses were performed using SPSS 21.0. Results Ninety four patients were evaluated; their median (IQR) age was 42.0 (36.6-50.2) years, 88 (93.6%) were female; almost all patients were mestizo (mixed Caucasian and Amerindian ancestry). Disease duration was 5.6 (2.5-11.4) years. The SLEDAI was 4.0 (2.0-8.0), the SDI 0.0 (0.0-1.0) and the CCI 1.0 (1.0-1.0). The current dose of prednisone was 5.0 (5.0-10.0) mg/d and the total time of exposure to prednisone was 5.0 (2.0-12.5) years; 68 (72.3%) and 14 (14.9%) were current and former users of antimalarials. Sixty five (69.1%) were current or former users of immunosuppressive drugs. Percentage of CD4+CD28null T-cells was 15.5 (8.7-27.1). In the univariable analysis, the percentage of CD4+CD28null T-cells was positively associated with a higher SDI (Rho=0.29, p Conclusions In SLE patients, CD4+CD28null T cells are independently associated with disease damage. Longitudinal studies are warranted to determine the predictive value of this association. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1912