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Objective To develop and validate the prognostic prediction model DU-VASC to assist the clinicians in decision-making regarding the use of platelet inhibitors (PIs) for the management of digital ulcers in patients with systemic sclerosis. Secondly, to assess the incremental value of PIs as predictor. Methods We analysed patient data from the European Scleroderma Trials and Research group registry (one time point assessed). Three sets of derivation/validation cohorts were obtained from the original cohort. Using logistic regression, we developed a model for prediction of digital ulcers (DUs). C-Statistics and calibration plots were calculated to evaluate the prediction performance. Variable importance plots and the decrease in C-statistics were used to address the importance of the predictors. Results Of 3710 patients in the original cohort, 487 had DUs and 90 were exposed to PIs. For the DU-VASC model, which includes 27 predictors, we observed good calibration and discrimination in all cohorts (C-statistic = 81.1% [95% CI: 78.9%, 83.4%] for the derivation and 82.3% [95% CI: 779.3%, 85.3%] for the independent temporal validation cohort). Exposure to PIs was associated with absence of DUs and was the most important therapeutic predictor. Further important factors associated with absence of DUs were lower modified Rodnan skin score, anti-Scl-70 negativity and normal CRP. Conversely, the exposure to phosphodiesterase-5 inhibitor, prostacyclin analogues or endothelin receptor antagonists seemed to be associated with the occurrence of DUs. Nonetheless, previous DUs remains the most impactful predictor of DUs. Conclusion The DU-VASC model, with good calibration and discrimination ability, revealed that PI treatment was the most important therapy-related predictor associated with reduced DU occurrence.

Objective To assess the accuracy of ultrasound (US) versus fluorodeoxyglucose—positron emission tomography/computed tomography (FDG-PET/CT) to identify extracranial involvement in large vessel vasculitis (LVV). Methods A retrospective observational study of patients with suspected LVV. All patients underwent US exam within 24 h per protocol. FDG-PET/CT was performed according to clinician criteria. The gold standard for LVV diagnosis was clinical confirmation after 6 months. Results Of the 113 patients included (74.3% female, mean age 74 years), 37 (32.7%) were diagnosed with LVV after 6 months. The sensitivity and specificity of US were 86.5% and 96.1%, respectively. Only 12 (42.9%) of 28 patients undergoing a FDG-PET/CT per clinician criteria showed positive findings. The sensitivity and specificity of FDG-PET/CT for LVV were 61.1% and 90%, respectively. Taking FDG-PET/CT as the reference, US showed extracranial inflammation in 10/12 (83.3%) and detected 2 (12.5%) additional cases of extracranial involvement with negative FDG-PET/CT. Conversely, FDG-PET/CT was positive in two patients with negative US (one isolated aortitis and one aortoiliac involvement). Conclusions US and FDG-PET/CT are both valid tools to detect extracranial involvement. The presence of US extracranial artery inflammation is consistent with FDG-PET/CT examination, although a negative US scan does not rule out extracranial involvement.

Background and objectives Family planning in women with immune-mediated inflammatory diseases is a challenge for healthcare teams, highlighting the need for standardized available evidence to provide patients with objective and agreed information. This study reflects the work performed by a multidisciplinary team in reviewing available scientific evidence, and the strategy agreed for family planning, pregnancy, postpartum, and breastfeeding in patients with immune-mediated inflammatory diseases. Methods A literature search was conducted, information was structured across the different stages (preconception, pregnancy, postpartum and breastfeeding), and an on-site meeting was convened, in which patients and healthcare providers participated. Results Specific materials, which are included in this work, were developed to guide clinical decisions to be agreed upon by patients and healthcare providers. Conclusion These materials meet the need for validated and updated information on the approach and use of indicated drugs for professionals responsible for the management of immune-mediated inflammatory diseases.

Objective To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. Methods A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€, 2019) were obtained from national, local databases. Results During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3,642 for a preconception consultation in patients with PsA, RA and axSpA and €4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1,214 for a miscarriage in the first trimester, €4,419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3,188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5,507 were estimated associated with admissions to neonatology of premature infants of Conclusions This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.

espanolIntroduccion La capilaroscopia periungueal (CP) es util en la evaluacion del fenomeno de Raynaud tanto primario como secundario, y en el seguimiento de los pacientes con esclerosis sistemica. Nuestro estudio evalua el impacto de la CP en el diagnostico, en funcion del motivo de solicitud y el perfil de autoanticuerpos en la practica clinica diaria. Material y metodos Se incluyeron todos los pacientes con al menos una CP entre junio de 2012 y diciembre de 2017. Se revisaron las historias clinicas y se determino de forma dicotomica (si/no) si la CP contribuyo al diagnostico realizado en la consulta posterior a la realizacion de la CP. Se recogieron datos demograficos, clinicos y de laboratorio, motivo de solicitud de la CP y su relacion con los patrones CP. Resultados De 530 pacientes con una primera CP, 266 se realizaron como estudio de un fenomeno de Raynaud. De estos, en 20 pacientes (3,8%) se realizo un diagnostico de enfermedad del tejido conectivo en la consulta posterior a la CP; 15 fueron diagnosticados de esclerosis sistemica, 4 de conectivopatia indiferenciada y uno de enfermedad mixta. Salvo un paciente diagnosticado de conectivopatia indiferenciada, el resto tenia anticuerpos antinucleares positivos y 11 de ellos, ademas, anticuerpos especificos (9 anticentromero, uno anti-Scl70 y otro, anti-RNPC). La positividad de anticuerpos antinucleares se asocio con una mayor probabilidad de presentar una CP de esclerodermia, y ningun paciente diagnosticado de una enfermedad reumatica tras la CP tenia un patron normal. Conclusion La CP es una tecnica util, pero con impacto limitado en el diagnostico de enfermedades del tejido conectivo. La positividad de los anticuerpos se relaciona con una mayor probabilidad de presentar patrones patologicos en la CP. EnglishIntroduction Nailfold capillaroscopy (NC) is useful in the evaluation of Raynaud's phenomenon, associated with some connective tissue diseases and in the follow-up of patients with systemic sclerosis. Our study evaluates the impact of NC in the diagnosis, according to the reason for the request and profile of autoantibodies in daily clinical practice. Material and methods All patients that undergone at least one NC between June 2012 and December 2017 were included. Clinical records were reviewed and analysed in a dichotomous way (yes/no), to see whether the NC contributed to a change of diagnosis in subsequent consultations. In addition, demographic, clinical and laboratory data were collected, and the relationship with NC patterns evaluated. Results Of the 530 patients who had undergone at least one NC, 266 had Raynaud's phenomenon as primary indication for the technique. Of those, 20 patients (3.8%) had a diagnostic change in the post-NC consultation; 15 were diagnosed with systemic sclerosis, 4 with undifferentiated connective tissue disease and one with mixed connective tissue disease. All patients had, except for one patient diagnosed with undifferentiated connective tissue disease, positive antinuclear antibodies titres, 11 of them had disease specific antibodies (9 anti-centromere, one anti-Scl70 and other anti-RNPC). The positivity of antinuclear antibodies titres was associated with a higher probability of presenting a scleroderma pattern in the NC, and all patients with a specific rheumatological diagnosis had an abnormal NC. Conclusion NC is a useful technique, but with limited impact in the diagnosis of connective tissue diseases. Autoantibody positivity is associated with a greater likelihood of presenting pathological NC patterns.

Few studies have been published focusing on the differences between juvenile idiopathic inflammatory myopathy (JIIM) and adult IIM. This study aimed to describe the characteristics of JIIM main subgroups (juvenile dermatomyositis [JDM] and juvenile polymyositis [JPM]) and to compare their differences with adult IIM subgroups (adult DM and adult PM). Methods This study reviewed the medical records of patients from the REMICAM cohort, a multicentric longitudinal study carried out in patients with IIM, followed up between 1980 and 2014 in 12 hospitals in Madrid, Spain. Patients with definite or probable JPM, JDM, adult DM, and adult PM according to the modified Bohan and Peter criteria were selected. We compared the characteristics between JDM and JPM, and between JIIM and adult IIM. Results Eighty-six juvenile patients (75 JDMs and 11 JPMs) and 283 adult patients (133 DMs and 150 PMs) were included. Compared with patients with JDM, patients with JPM were older at diagnosis, had more fever and arthritis, and were less frequently treated with disease-modifying antirheumatic drugs (these differences were not statistically significant). Compared with patients with adult DM, those with JDM presented more frequently with calcinosis (33.8% vs 6.9%, p Conclusions Our findings confirm that JIIMs are a heterogeneous group of diseases with relevant differences compared with adult IIMs.

Objectives To assess the characteristics and risk of lymphoma in a large cohort of patients with SLE. Methods A case–cohort analysis was performed within a dynamic cohort of SLE patients from the Spanish Society of Rheumatology Lupus Registry (RELESSER). Clinical and analytical features were compared between the lymphoma SLE group and the control SLE group using an independent-sample Student’s t-test or Mann–Whitney test for continuous variables and the χ2 test for categorical variables with Fisher’s exact test if necessary. The multivariate analysis was based on a generalized linear model. Results Twenty-one patients with SLE and lymphoma and 3965 non-lymphoma controls with SLE were studied. Most lymphomas were of B cell origin (n = 15/21), with diffuse large B cell lymphoma being the most frequent histological type (8/21, 38.1%). As in the general population, the risk of lymphoma in SLE was higher in male than in female patients and increased with age. In the lymphoma SLE group, bivariate analysis showed a significantly higher percentage of pericarditis, organic brain syndrome, seizures, vasculitis, haemolytic anaemia, splenomegaly, venous thrombosis and mean modified (excluding lymphoma) SLICC/ACR damage index. In contrast, renal involvement, positive anti-dsDNA, and antimalarials ever were less frequent. Conclusions In this large multicentre Spanish cohort, we identified characteristics of SLE that are associated with a higher risk of lymphoma. Antimalarials were significantly negatively associated with risk of lymphoma in SLE patients. Nevertheless, further prospective studies are needed to clarify these findings.

Objetivos Describir la metodología del Registro de pacientes con miopatía inflamatoria idiopática (MII) de España (Myo-Spain), así como sus fortalezas y limitaciones. El objetivo principal del proyecto es analizar la evolución y el manejo clínico de una cohorte de pacientes con MII. Material y método Estudio observacional, longitudinal, ambispectivo y multicéntrico de una cohorte de pacientes con MII atendidos en servicios de reumatología de España. Se incluirán todos los pacientes con diagnóstico de MII en seguimiento habitual por los centros participantes, sin tener en cuenta la edad de inicio del proceso. Los casos incidentes serán todos los pacientes que al inicio del estudio en cada centro estén diagnosticados desde hace menos de 12 meses y casos prevalentes desde hace más de 12 meses. Se construirá un registro en el que se incluirán los datos de la visita basal, del año y dos años. Se recogerán variables sociodemográficas, clínicas, analíticas, complicaciones, comorbilidad, asociación con otras enfermedades reumáticas, ingresos hospitalarios, mortalidad y tratamientos. Además, se determinarán índices, escalas y cuestionarios de actividad, afectación muscular, daño, discapacidad y calidad de vida. El periodo de reclutamiento será de 23 meses. El propósito es conseguir una cohorte de 400 pacientes con MII. Conclusiones El estudio Myo-Spain constituye la oportunidad para desarrollar una cohorte de pacientes incidentes y prevalentes con MII en España. Myo-Spain permitirá evaluar en detalle, las características clínicas de la enfermedad en diferentes momentos. Se espera que la información exhaustiva recogida en las visitas suponga una amplia fuente de datos para futuros análisis. Objectives: To describe the methods of the Spanish Registry of patients with idiopathic inflammatory myopathy (IIM) (Myo-Spain), as well as its strengths and limitations. The main objective of the project is to analyse the evolution and clinical management of a cohort of patients with IIM. Methods: Observational, longitudinal, ambispective and multicentre study of a cohort of patients with IIM seen in rheumatology units in Spain. All patients with a diagnosis of IMM will be included in the regular follow-up of the participating centres, regardless of age on initiation of the process. Incident cases will be all patients who at the beginning of the study have been diagnosed for less than 12 months and prevalent cases for more than 12 months. The registry will include data from the visit at baseline, one year and two years. Socio-demographic, clinical, analytical variables, complications, comorbidities, association with other rheumatic diseases, hospital admissions, mortality and treatments will be collected. In addition, indices, scales and questionnaires of activity, muscle involvement, damage, disability, and quality of life will be determined. The recruitment period will be 23 months. The purpose is to obtain a cohort of 400 patients with IMM. Conclusions: Myo-Spain registry provides the opportunity to develop a cohort of incident and prevalent patients with IMM in Spain. Myo-Spain will be able to assess in detail the clinical characteristics of the disease at different times. The comprehensive information collected during the visits is expected to provide a broad source of data for future analysis. Sin financiación No data JCR 2021 0.311 SJR (2021) Q3, 44/61 Rheumatology No data IDR 2021 UEM

Background: The current subclassification of systemic sclerosis into cutaneous subtypes does not fully capture the heterogeneity of the disease. We aimed to compare the performances of stratification into LeRoy's cutaneous subtypes versus stratification by autoantibody status in systemic sclerosis. Methods: For this cohort study, we assessed people with systemic sclerosis in the multicentre international European Scleroderma Trials and Research (EUSTAR) database. Individuals positive for systemic-sclerosis autoantibodies of two specificities were excluded, and remaining individuals were classified by cutaneous subtype, according to their systemic sclerosis-specific autoantibodies, or both. We assessed the performance of each model to predict overall survival, progression-free survival, disease progression, and different organ involvement. The three models were compared by use of the area under the curve (AUC) of the receiver operating characteristic and the net reclassification improvement (NRI). Missing data were imputed. Findings: We assessed the database on July 26, 2019. Of 16 939 patients assessed for eligibility, 10 711 patients were included: 1647 (15·4%) of 10 709 were male, 9062 (84·6%) were female, mean age was 54·4 (SD 13·8) years, and mean disease duration was 7·9 (SD 8·2) years. Information regarding cutaneous subtype was available for 10 176 participants and antibody data were available for 9643 participants. In the prognostic analysis, there was no difference in AUC for overall survival (0·82, 95% CI 0·81–0·84 for cutaneous only vs 0·84, 0·82–0·85 for antibody only vs 0·84, 0·83–0·86 for combined) or for progression-free survival (0·70, 0·69–0·71 vs 0·71, 0·70–0·72 vs 0·71, 0·70–0·72). However, at 4 years the NRI showed substantial improvement for the antibody-only model compared with the cutaneous-only model in prediction of overall survival (0·57, 0·46–0·71 for antibody only vs 0·29, 0·19–0·39 for cutaneous only) and disease progression (0·36, 0·29–0·46 vs 0·21, 0·14–0·28). The antibody-only model did better than the cutaneous-only model in predicting renal crisis (AUC 0·72, 0·70–0·74 for antibody only vs 0·66, 0·64–0·69 for cutaneous only) and lung fibrosis leading to restrictive lung function (AUC 0·76, 0·75–0·77 vs 0·71, 0·70–0·72). The combined model improved the prediction of digital ulcers and elevated systolic pulmonary artery pressure, but did poorly for cardiac involvement. Interpretation: The autoantibody-only model outperforms cutaneous-only subsetting for risk stratifying people with systemic sclerosis in the EUSTAR cohort. Physicians should be aware of these findings at the time of decision making for patient management. Funding: World Scleroderma Foundation.

We read with great interest the paper published by Tomelleri et al 1 on ‘Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: a monocentric survey’. The authors aimed to evaluate the impact of COVID-19 and national lockdown among patients with large-vessel vasculitis (LVV) in a single centre by April 2020. First, we would like to congratulate them for the novelty of their work during the first wave of the pandemic in Italy. The implementation of ultrasound (US) fast-track pathways (FTPs) in rheumatology, aiming at an early diagnosis of giant cell arteritis (GCA), has led to a decrease in permanent vision loss.2 However, the COVID-19 pandemic lockdown has had a negative impact on patients with GCA, leading to difficulties in monitoring, reduced access to temporal artery biopsy3 and a decline in referral rates of patients accompanied by cases with delayed presentation and vision loss.4 Additionally, recent data suggest that COVID-19 seems to be more severe in patients with LVV with higher rates of hospitalisation and lethality,5 although these results should be further confirmed. The aim of our analysis was to assess the …

The aims of this study were to describe the long-term retention rate of golimumab (GLM) treatment in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA) in real life, and to analyze determinants of discontinuation. METHODS We conducted a single-center, medical records review of all patients with RA, PsA, and SpA on GLM treatment attending a large rheumatology department from 2010 to 2017. Times from start to end of GLM treatment were collected, as well as sociodemographic, clinical, and safety variables. Golimumab retention rate was estimated by the Kaplan-Meier method, and comparison across diseases was analyzed with the Mantel-Haenszel statistic (log-rank test). Cox proportional hazards regression models were used to identify factors associated with GLM discontinuation. RESULTS In the study period, a total of 212 patients (61 RA, 48 PsA, 103 SpA) were prescribed GLM. Retention rates were 72% in the first year, 61% in the second, 56% in the third, and 38% at 5 years. Differences were statistically significant across diseases (median times to GLM discontinuation were 50.2, 46.0, and 38.7 months for RA, SpA, and PsA, respectively) and according to the number of previous biologic therapies (55.2 months in biologic-naive patients vs 14.0 months in patients with ≥2 previous biologics; p < 0.001). The use of concomitant conventional synthetic disease-modifying antirheumatic drugs was associated with a lower probability of discontinuation (hazards ratio [HR], 0.57; 95% confidence interval [CI], 0.33-0.97). Female sex (HR, 1.84; 95% CI, 1.07-3.17) and having used 2 biologics before GLM (HR, 2.99; 95% CI, 1.76-5.06) were associated with increased discontinuation rates. Twenty-three patients (10.9%) had at least 1 serious adverse event. CONCLUSIONS In a real-life setting, GLM shows appropriate long-term safety-effectiveness ratio.

Objective To investigate the human leukocyte antigen (HLA) association with anti-synthetase syndrome (ASSD). Methods We conducted the largest immunogenetic HLA-DRB1 and HLA-B study to date in a homogeneous cohort of 168 Caucasian patients with ASSD and 486 ethnically matched healthy controls by sequencing-based-typing. Results A statistically significant increase of HLA-DRB1*03:01 and HLA-B*08:01 alleles in patients with ASSD compared to healthy controls was disclosed (26.2% versus 12.2%, P = 1.56E–09, odds ratio–OR [95% confidence interval–CI] = 2.54 [1.84–3.50] and 21.4% versus 5.5%, P = 18.95E–18, OR [95% CI] = 4.73 [3.18–7.05]; respectively). Additionally, HLA-DRB1*07:01 allele was significantly decreased in patients with ASSD compared to controls (9.2% versus 17.5%, P = 0.0003, OR [95% CI] = 0.48 [0.31–0.72]). Moreover, a statistically significant increase of HLA-DRB1*03:01 allele in anti-Jo-1 positive compared to anti-Jo-1 negative patients with ASSD was observed (31.8% versus 15.5%, P = 0.001, OR [95% CI] = 2.54 [1.39–4.81]). Similar findings were observed when HLA carrier frequencies were assessed. The HLA-DRB1*03:01 association with anti-Jo-1 was unrelated to smoking history. No HLA differences in patients with ASSD stratified according to the presence/absence of the most representative non-anti-Jo-1 anti-synthetase autoantibodies (anti-PL-12 and anti-PL-7), arthritis, myositis or interstitial lung disease were observed. Conclusions Our results support the association of the HLA complex with the susceptibility to ASSD.

Objectives To describe the methods of the Spanish Registry of patients with idiopathic inflammatory myopathy (IIM) (Myo-Spain), as well as its strengths and limitations. The main objective of the project is to analyse the evolution and clinical management of a cohort of patients with IIM. Methods Observational, longitudinal, ambispective and multicentre study of a cohort of patients with IIM seen in rheumatology units in Spain. All patients with a diagnosis of IMM will be included in the regular follow-up of the participating centres, regardless of age on initiation of the process. Incident cases will be all patients who at the beginning of the study have been diagnosed for less than 12 months and prevalent cases for more than 12 months. The registry will include data from the visit at baseline, one year and two years. Socio-demographic, clinical, analytical variables, complications, comorbidities, association with other rheumatic diseases, hospital admissions, mortality and treatments will be collected. In addition, indices, scales and questionnaires of activity, muscle involvement, damage, disability, and quality of life will be determined. The recruitment period will be 23 months. The purpose is to obtain a cohort of 400 patients with IMM. Conclusions Myo-Spain registry provides the opportunity to develop a cohort of incident and prevalent patients with IMM in Spain. Myo-Spain will be able to assess in detail the clinical characteristics of the disease at different times. The comprehensive information collected during the visits is expected to provide a broad source of data for future analysis.

To assess whether adding the subclavian artery examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of giant cell arteritis (GCA) and its relationship with systemic inflammation.Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian, and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score, and the modified Halo Score. The gold standard for GCA diagnosis was clinical confirmation after 6-month follow-up.Sixty-four patients were evaluated in the FTP, 17 (26.5%) had GCA. Subclavian artery involvement was present only in patients with GCA (29.4% versus 0%, p0.001). Overall, the three scores showed excellent diagnostic accuracy for GCA (ROC AUC 0.906, 0.930, and 0.928, respectively) and moderate correlations with acute phase reactants (0.35-0.51, p0.01). Only the modified Halo Score correlated with markers of inflammation in patients with LV involvement.The inclusion of subclavian artery examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCA. Key Points • Adding the subclavian artery examination into the Southend Halo Score, as proposed in the modified Halo Score, does not improve the diagnostic accuracy of GCA. • However, the extent of vascular inflammation as quantified by the modified Halo Score correlates better with markers of systemic inflammation in the large vessel (LV) GCA subgroup of patients. • Although the diagnostic value of adding subclavian arteries to the current recommended US examination of GCA is limited, it may have a role in monitoring disease activity as it correlates with the general burden of inflammation in LV GCA. These findings need to be confirmed in additional populations and larger prospective studies.

Objective: To assess whether adding the subclavian arteries examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of giant cell arteritis (GCA) and its relationship with systemic inflammation.Methods: Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score and the modified Halo Score. The gold standard for GCA diagnosis was clinical confirmation after 6 months follow-up.Results: 64 patients were evaluated in the FTP, 17(26.5%) had GCA. Subclavian arteries involvement was present only in patients with GCA (29.4% versus 0%,pConclusions: The inclusion of subclavian arteries examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCA

We read with great interest the paper published by van der Geest et al 1 on ‘Novel ultrasonographic Halo Score for giant cell arteritis (GCA): assessment of diagnostic accuracy and association with ocular ischaemia’. The authors aimed to quantify the extent of vascular inflammation by ultrasound (US) in patients with GCA and developed two novel US scoring systems, the halo count and Halo Score, including the assessment of the three temporal artery (TA) segments and axillary arteries. First, we would like to congratulate them for the novelty of their work that opens up new perspectives in the use of US in the assessment of GCA. According to recent EULAR recommendations, US is recommended as the first imaging modality in patients with suspected predominantly cranial GCA.2 The halo sign is the most relevant US finding in GCA and is defined as a homogeneous, hypoechoic wall thickening, well delineated towards the luminal side, visible in two perpendicular planes, most commonly concentric in transverse scan.3 The halo count and Halo Score constitute the first quantitative tools to assess the extent of vascular inflammation by US in GCA.1 According to their findings, a high volume of vascular inflammation on US …

Objective To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. Methods We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. Results A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. Conclusion Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.

To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System.A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€, 2019) were obtained from national, local databases.During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3,642 for a preconception consultation in patients with PsA, RA and axSpA and €4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1,214 for a miscarriage in the first trimester, €4,419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3,188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5,507 were estimated associated with admissions to neonatology of premature infants of28, 28-32 and 33-37 weeks, respectively.This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.

Objective Salivary gland ultrasound (SGU) is a reliable technique for assessing the salivary glands in patients with primary Sjögren’s syndrome (pSS). The aim of this study was to elucidate the relationship between SGU findings and autoimmunity in patients with pSS. Methods Patients with pSS underwent an SGU assessment. The patients were classified into three groups according to their autoimmunity profile: the complete positive group (positive rheumatoid factor, antinuclear antibodies, and anti-Ro/anti-La antibodies), the partial seropositive group (positivity of at least one autoantibody but not all), and the seronegative group. Results In total, 93 patients were evaluated. Eighty-six (92.5%) were female, and their median age was 49.5 years. The median disease duration was 12.3 years. Pathological SGU findings were present in 32 (34.4%) patients [25 of 36 (78.1%) in the complete positive group and 7 of 44 (21.9%) in the partial positive group]. Patients with pathological SGU findings had a shorter disease duration and slightly higher European League Against Rheumatism Sjögren’s syndrome disease activity index. Conclusions The autoimmunity profile and pathological SGU findings are strongly associated with each other in patients with pSS. However, the disease duration does not seem to be related to pathological SGU findings.

Gastrointestinal (GI) involvement is almost universal in patients with systemic sclerosis (SSc) and is associated with significant disease-related morbidity and mortality.1 The entire GI tract can be involved and other disease features (eg, low mood, terminal organ failure and functional hand impairment) can result in significant nutritional impairment. Severe GI involvement has been reported to occur in ~10% of patients with SSc and often occurs early in the course of the disease.2 However, identification of patients at high risk of clinically significant weight loss is extremely challenging, including from the high prevalence of GI symptoms in patients with SSc. Therefore, there is a need to understand high-risk patients including potentially modifiable risk factors, with a view to early intervention strategies. Against this background, the aim of this study was to examine potential clinical risk factors of significant weight loss in patients with SSc. We performed an analysis of patients with SSc enrolled in the multinational, longitudinal European League Against Rheumatism (EULAR) Scleroderma Trials and Research (EUSTAR) database. In our study, we defined significant weight loss as 4.5 kg and/or least 5% of their body weight at 5 months onwards.3 Patients with a recorded second visit after 3 months and before 12 months were included in the analysis. We adopted a pragmatic approach (relevant to clinical practice) in …

MUC5B rs35705950 (G/T) is strongly associated with idiopathic pulmonary fibrosis (IPF) and also contributes to the risk of interstitial lung disease (ILD) in rheumatoid arthritis (RA-ILD) and chronic hypersensitivity pneumonitis (CHP). Due to this, we evaluated the implication of MUC5B rs35705950 in antisynthetase syndrome (ASSD), a pathology characterised by a high ILD incidence. 160 patients with ASSD (142 with ILD associated with ASSD [ASSD-ILD+]), 232 with ILD unrelated to ASSD (comprising 161 IPF, 27 RA-ILD and 44 CHP) and 534 healthy controls were genotyped. MUC5B rs35705950 frequency did not significantly differ between ASSD-ILD+ patients and healthy controls nor when ASSD patients were stratified according to the presence/absence of anti Jo-1 antibodies or ILD. No significant differences in MUC5B rs35705950 were also observed in ASSD-ILD+ patients with a usual interstitial pneumonia (UIP) pattern when compared to those with a non-UIP pattern. However, a statistically significant decrease of MUC5B rs35705950 GT, TT and T frequencies in ASSD-ILD+ patients compared to patients with ILD unrelated to ASSD was observed. In summary, our study does not support a role of MUC5B rs35705950 in ASSD. It also indicates that there are genetic differences between ILD associated with and that unrelated to ASSD, This study was partially supported by grants from the Foundation for Research in Rheumatology (FOREUM). RL-M is a recipient of a Miguel Servet type I programme fellowship from the ‘Instituto de Salud Carlos III’ (ISCIII), cofunded by the European Social Fund (ESF, ‘Investing in your future’) (grant CP16/00033). SR-M is supported by funds of the RETICS Program (RD16/0012/0009), co-funded by the European Regional Development Fund (ERDF). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). VM is supported by funds of a Miguel Servet type I programme (grant CP16/00033) (ISCIII, co-funded by ESF). LL-G is supported by funds of PI18/00042 (ISCIII, co-funded by ERDF). OG is Staff Personnel of Xunta de Galicia (Servizo Galego de Saude, SERGAS) through a research-staff stabilization contract (ISCIII/SERGAS). OG,is member of RETICS Programme, RD16/0012/0014 (RIER: Red de Investigación en Inflamación y Enfermedades Reumáticas) via Instituto de Salud Carlos III (ISCIII) and FEDER. The work of OG (PI17/00409), was funded by Instituto de Salud Carlos III and FEDER. OG is a beneficiary of a project funded by Research Executive Agency of the European Union in the framework of MSCA-RISE Action of the H2020 Programme (Project number 734899). OG is beneficiary of a grant funded by Xunta de Galicia, Consellería de Educación, Universidade e Formación Profesional and Consellería de Economía, Emprego e Industria (GAIN), GPC IN607B2019/10

Mixed connective tissue disease (MCTD) is a systemic autoimmune rheumatic disease (SARD) characterised by the combination of clinical manifestations of systemic lupus erythematosus (SLE), cutaneous systemic sclerosis (SSc) and polymyositis-dermatomyositis, in the presence of elevated titers of anti-U1-RNP antibodies. Main symptoms of the disease are polyarthritis, hand oedema, Raynaud's phenomenon, sclerodactyly, myositis and oesophageal hypomobility. Although widely discussed, most authors today accept MCTD as an independent entity. Others, however, suggest that these patients may belong to subgroups or early stages of certain definite connective diseases, such as SLE or SSc, or are, in fact, SARD overlap syndromes.

Mixed connective tissue disease (MCTD) is a systemic autoimmune rheumatic disease (SARD) characterised by the combination of clinical manifestations of systemic lupus erythematosus (SLE), cutaneous systemic sclerosis (SSc) and polymyositis-dermatomyositis, in the presence of elevated titers of anti-U1-RNP antibodies. Main symptoms of the disease are polyarthritis, hand oedema, Raynaud's phenomenon, sclerodactyly, myositis and oesophageal hypomobility. Although widely discussed, most authors today accept MCTD as an independent entity. Others, however, suggest that these patients may belong to subgroups or early stages of certain definite connective diseases, such as SLE or SSc, or are, in fact, SARD overlap syndromes.

Objective Arthritis, myositis and interstitial lung disease (ILD) constitute the classic clinical triad of anti-synthetase syndrome (ASSD). These patients experience other accompanying features, such as Raynaud's phenomenon, fever or mechanic's hands. Most ASSD patients develop the complete triad during the follow-up. In the present study we aimed to determine whether the subsequent appearance of accompanying features may suggest the development of triad findings lacking at the onset in anti-Jo1 positive ASSD patients. Methods Anti-Jo1 positive patients presenting with incomplete ASSD (no >2 classic triad features) were assessed. Clinical characteristics and clusters of disease manifestations were retrospectively collected and analyzed in a large international multicenter cohort of ASSD patients. Results 165 patients (123 women) with incomplete ASSD were identified. Ninety-five patients (57.5%) developed new classic triad manifestations after 15months median (IQR 9–51) and 40 (24%) developed new accompanying features after 19months median (IQR 6–56) from disease onset. During the follow-up, the ex-novo occurrence of triad features was observed in 32 out of 40 patients (80%) with new accompanying findings and in 63 out of 125 patients (50.5%) without new accompanying findings (p=0.002). In patients with at least one new accompanying feature the odds ratio for the occurrence of new triad manifestations was 3.94 with respect to patients not developing ex-novo accompanying findings (95% CI 1.68–9.21, p=0.002). Conclusion Anti-Jo1 ASSD patients with incomplete forms at disease onset are at high risk for the subsequent occurrence of lacking classic triad findings. Although all ASSD patients should be carefully assessed for the occurrence of new triad features, a closer follow-up should be considered in the subgroup of patients developing ex novo accompanying findings. These patients, indeed, have near four-fold increased risk for new classic triad manifestation occurrence with respect to patients not presenting ex novo accompanying findings.

Background: In inflammatory diseases, such as rheumatoid arthritis, early treatment has demonstrated to improve disease control and decrease mortality. It is not known if an early treatment could have similar effects on inflammatory myositis (IM) patients. Objectives: To analyze if the delay between initial symptoms and diagnosis or therapy initiation influences disease control or mortality in IM patients. Methods: All patients from REMICAM were included (1). The influence of time elapsed between initial symptoms and diagnosis or start of therapy, and the year of diagnosis (before or after 2000), on mortality and disease control (defined as the possibility of glucocorticoid (GC) withdrawal due to IM improvement), was studied by means of survival analysis and regression proportional hazard bi and multivariate Cox models. All factors with p Results: From 479 patients (74% females, 52% polimiositis, 44±22 years at diagnosis, 10±8 years follow up), 208 (43%) were diagnosed before 2000, and 473 (99%) received any treatment: 473 (99%) oral GC, 50/344 (15%) GC pulses, 78 (16%) HCL, 355 (74%) immunosuppressants (IS) (MTX 228, LF 10, AZA 190, CYP 44, MP 38, CyS 32), 55 (12%) biologics (RTX 45, abatacept 2, aTNF 16) and 79 (17%) IVIG. Disease control was more frequent in younger patients, diagnosed after year 2000, and was independently associated with less ILD presence, lower n° of therapies and a shorter time between the initial symptoms and the start of IS therapy (Table 1). Risk factors for mortality were age, male sex and cancer, but not the delay in diagnosis or in the start of therapy (Table 2) Conclusion: In the REMICAM cohort, disease control is more frequent in younger patients, diagnosed after 2000, with early initiation of IS therapy. Mortality was not associated with the delay in diagnosis or therapy in our study. Our data support the hypothesis that, in IM, as in other inflammatory diseases, an early treatment is essential to decrease inflammation and achieve disease control. Reference: [1] Nuno L, Rheumatol Clin 2017; 13:331-337 Disclosure of Interests: Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, AbbVie, and Janssen, Laura Nuno: None declared, Francisco J Lopez-Longo: None declared, Julia Martinez-Barrio: None declared, Carmen Larena: None declared, Valentina Maldonado : None declared, Carmen Barbadillo: None declared, Paloma Garcia de la Pena: None declared, Irene Llorente : None declared, Eva Tomero Muriel: None declared, Ana Perez Gomez: None declared, Henry Moruno : None declared, Tatiana Cobo-Ibanez: None declared, RAQUEL ALMODOVAR: None declared, LETICIA LOJO : None declared, Maria Jesus Garcia de Yebenes: None declared, Patricia Carreira: None declared

Background: Juvenile idiopathic inflammatory myopathies (JIIM) are a heterogeneous group of autoimmune diseases affecting children, characterized by symmetric muscular weakness, cutaneous rash and systemic organ involvement. Given its low incidence, there are few studies describing the characteristics of this disease and its subtypes in Spanish patients1. Objectives: To describe the demographic, clinical and analytical characteristics of patients with JIIM from the registry of inflammatory myopathies in Madrid community (REMICAM), and to compare those measures between polymyositis (PM) and juvenile dermatomyositis (JDM) subgroups. Methods: A multicentre retrospective study from the REMICAM registry was performed. Patients were selected if they were 18 years or younger at onset of JIIM and met definite or probable criteria for IIM by the modified Bohan and Peter criteria. We included patients with JDM or PM subgroups, overlap myositis patients were excluded. Results: 86 patients were included, 12 classified as PM and 74 as JDM. 70% were women and 96% were Caucasian. Mean age at diagnosis was 11.8 years in PM group vs 7.2 years in JDM group. 44% presented arthritis and 93% presented muscular weakness. Gottron sign was present in 76% of the patients, and calcinosis was present in 31.4%. Cardiac and pulmonary manifestations were rare ( Conclusion: JDM was the most frequent form of MIIJ in our study (86%). The most frequent manifestations were the muscular and dermatological ones, but an important group also presented arthritis and fever. There was no statistical difference between both groups, regardless, myalgias and dysphagia were more common in JDM group, and they had higher CPK and aldolase values. PM patients were older, had more fever and arthritis, also, cytopenia and ANA positivity were more common. Reference: [1] Shah M, Mamyrova G, Targoff IN, Huber AM, Malley JD, Rice MM, et al. The Clinical Phenotypes of the Juvenile Idiopathic Inflammatory Myopathies. Medicine (Baltimore). 2013 Jan;92(1):25–41. Disclosure of Interests: Jesus Loarce-Martos: None declared, Carmen Larena: None declared, M. Angeles Blazquez: None declared, Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, AbbVie, and Janssen, Patricia Carreira: None declared, Francisco J Lopez-Longo: None declared, Julia Martinez-Barrio: None declared, J.C. Lopez Robledillo: None declared, RAQUEL ALMODOVAR: None declared, Maria Jesus Garcia de Yebenes: None declared, Laura Nuno: None declared

Background Inflammatory myositis (IM) are heterogeneous autoimmune diseases, characterized by muscular inflammation, which can associate systemic manifestations. In other inflammatory diseases, as rheumatoid arthritis, inflammation is a cardiovascular risk factor (CVRF), with clear influence on cardiovascular events and mortality (CVE, CVM). Objectives To analyze the influence of IM severity in the development of CVE and CVM in the REMICAM registry. Methods All patients from REMICAM were included(1). REMICAM is a retrospective multicentric registry of IM patients (n=479), performed in Madrid between 2012 and 2014, containing demographic, clinical and outcome data (1). The presence of extra muscular features (cardiac, pulmonary, cutaneous and systemic involvement), number of therapies, immunosuppressants (IS) need, and glucocorticoids (GC) withdrawal due to IM remission defined IM severity. Bi and multivariate logistic regression analysis were used to determine the association between these factors and CVE. Survival analysis and regression proportional hazard bi and multivariate Cox models were used to determine the effect of these factors on CVM. All factors with p Results From 479 patients (74% females, 52% polymyositis, 44±22 years at diagnosis, 10±8 years follow up), 104/467 (22%) presented CVE and 24/409 (6%) died due to CVE. CVE were associated to age, male sex, CVRF number, diagnosis before year 2000, presence of arrhythmia or Raynaud (Table 1). Arrhythmia was the only independent risk factor for CVM. GC withdrawal due to IM remission, and a smaller number of therapies, were protective factors for CVM (Table 2). Conclusion In the REMICAM registry, extra muscular manifestations such as arrhythmia, were associated to CVE and CVM, as independent risk factors. A smaller number of treatment or GC withdrawal due to remission were protective factors for CVM. Our results support the hypothesis that more severe IM, with extra muscular involvement and persistent inflammation, could favor atherosclerosis and CVE development. Reference [1] Nuno L, Rheumatol Clin2017; 13:331-337 Disclosure of Interests Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, AbbVie, and Janssen, Laura Nuno: None declared, Francisco J Lopez-Longo: None declared, Julia Martinez-Barrio: None declared, Carmen Larena: None declared, Valentina Maldonado : None declared, Carmen Barbadillo: None declared, Paloma Garcia de la Pena: None declared, Irene Llorente : None declared, Eva Tomero Muriel: None declared, Ana Perez Gomez: None declared, Henry Moruno : None declared, Tatiana Cobo-Ibanez: None declared, RAQUEL ALMODOVAR: None declared, LETICIA LOJO : None declared, Maria Jesus Garcia de Yebenes: None declared, Patricia Carreira: None declared

Background Although glucocorticoids (GC) remain the cornerstone in the treatment of inflammatory myositis (IM), the management of these processes is not yet standardized. Experts recommend early use of immunosuppressants (IS), in order to prevent GC side effects. It is not known what is the actual management in clinical practice. Objectives To describe the management of IM in REMICAM registry, and to identify differences according to disease subtype (polymyositis (PM), or dermatomyositis (DM)), and to the year of diagnosis (before or after 2000). Methods All patients from REMICAM were included (1). A descriptive analysis of the different therapies (GC, IS, biologics, IV immunoglobulins (IVIG), and hydroxychloroquine HCL) was performed, attending to possible differences between IM subtype and the year of diagnosis. T student and Chi square tests were used for quantitative and qualitative variables, respectively. Results From 479 patients (74% females, 52% PM, 44±22 y at diagnosis, 10±8 y follow up), 473 (99%) received oral GC, 50/344 (15%) pulses GC, 78 (16%) HCL, 355 (74%) IS (methotrexate MTX 228, leflunomide 10, azathioprine AZA190, cyclophosphamide 44, mycophenolate MP 38, cyclosporine 32), 55 (12%) biologics (rituximab 45, abatacept 2, aTNF 16) and 79 (17%) IVIG. Differences according to IM subtype (1), and to the year of diagnosis (2), are shown in Tables. Conclusion The therapeutic management of IM has changed over the last few years, with a clear increase and earlier use of IS in patients diagnosed after 2000. In spite of a more aggressive approach in recent years, severe infections are less frequent, perhaps as a consequence of lower GC doses. The management of PM and DM is similar. Reference [1] Nuno L, Rheumatol Clin2017; 13:331-337 Disclosure of Interests Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, AbbVie, and Janssen, Laura Nuno: None declared, Francisco J Lopez-Longo: None declared, Julia Martinez-Barrio: None declared, Carmen Larena: None declared, Valentina Maldonado : None declared, Carmen Barbadillo: None declared, Paloma Garcia de la Pena: None declared, Irene Llorente : None declared, Eva Tomero Muriel: None declared, Ana Perez Gomez: None declared, Henry Moruno : None declared, Tatiana Cobo-Ibanez: None declared, RAQUEL ALMODOVAR: None declared, LETICIA LOJO : None declared, Maria Jesus Garcia de Yebenes: None declared, Patricia Carreira: None declared

Background As we know, the use of disease modifying antirheumatic drugs (DMARDs) improves the overall prognosis of rheumatoid arthritis (RA) specially when treatment is started early in the course of the disease. The most widely used DMARD is methotrexate (MTX) mainly because of its favorable efficacy-toxicity ratio. However, there is a lot of variability using MTX when it comes to dosage and route of administration; and little research on the overall response of patients to the different strategies used. Objectives To compare the clinical response of oral (PO) versus subcutaneous (SC) MTX in recently diagnosed RA patients with no previous use of DMARDs. We evaluated the data collected at baseline, the 3, 6 and 12 month after the beginning of MTX treatment. Methods This descriptive, observational, longitudinal retrospective study was achieved using a cohort of patients with recently diagnosed RA in which treatment with MTX was started between August 1st 2015 to September 1st 2018. We collected demographic and clinical data, disease activity markers, MTX and corticoid dosage, routes of administration and treatment changes. Results In total, 52 patients were included of which 39 (75%) were women, with an average age of 57.56 years. There was a mean of 26 weeks between the first symptoms and the beginning of MTX. In the PO MTX group, 8 (32%) patients required a change to SC MTX; in 87.5% of cases due to treatment inefficacy and 7 (87.5%) of these patients kept the SC route until the end of the study. Out of the patients that began with SC MTX, the one that changed route to PO maintained a good response. All the patients with biologic DMARDs kept the SC MTX as adjuvant therapy. On the other hand, the 3 (12%) patients of the PO that used a biologic DMARD had suspended MTX several months before. Both groups had a good response to MTX. There was a significant reduction in corticoid requirements during the first year of treatment(P At the end of the study, 21 (41%) patients received SC MTX and the number goes up to 25 (49%) if we include those who also had biologic DMARDs. Of those who suspended MTX, 85% were due to adverse effects, similar in both groups. Conclusion Our study suggests that patients that start with PO MTX require route administration changes more frequently than the SC group during the first year of follow-up. SC MTX was the route used by almost half the patients by the end of the study. We can also see that the inflammatory response to MTX was acceptable regardless of administration route and that corticoids could be reduced significantly in both groups. References [1] Braun, J. et al. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: Results of a six-month, multicenter, randomized, double-blind, controlled, phase IV trial. Arthritis Rheum 2008; 58: 73-81. [2] Tornero Molina, J et al. Recommendations for the use of methotrexate in rheumatoid arthritis: Up and down scaling of the dose and administration routes. Reumatol Clin 2015;11:3-8. Disclosure of Interests None declared

Background The clinical coexistence of Systemic Lupus Erythematosus (SLE) and Sjogrens Syndrome (SS) was recognized in 1959. The prevalence of SS among patients with SLE varies considerably among the published studies (10%–30%). There is still controversy as to whether or not SLE patients with overlapping SS have a distinct and significantly milder lupus. To address the clinical and serologic features of SLE and differences from SLE that occurs in overlap with SS. Methods This is a multicenter, descriptive, cross-sectional study of 3575 patients from the Spanish Society for Rheumatology Lupus Registry (RELESSER). Unselected SLE patients from 45 Rheumatology Departments across Spain were evaluated for the presence of overlapping SS using the American-European consensus criteria. Cumulative clinical data were collected at the moment of the last assessment. Clinical and laboratory parameters in SLE patients with SS (SLEwSS) were compared with those in SLE patients without SS (SLEwoSS). Results SS was identified in 516 SLE patients (14.4%). Compared with the SLEwoSS group, patients with SLEwSS were significantly older, had a higher frequency of mucocutaneous manifestations, Raynauds phenomenon, peripheral neuropathy, anti-Ro/SSA, anti-La/SSB, neoplasia, and older age at death, but had a significantly lower frequency of renal involvement, thrombocytopenia, anti-dsDNA, anti-2-GPI IgM and complement consumption. Both groups displayed a clinically similar presentation of lymphadenopathy, systemic vasculitis, serositis, damage accrual, mortality, musculoskeletal and CNS manifestations. Conclusions SLEwSS appears to constitute a subgroup of SLE patients with distinct clinical and serologic features, in whom SS is expressed as an overlapping entity. A particular cluster of clinical variables, namely, mucocutaneous manifestations, Raynauds phenomenon, peripheral neuropathy, renal involvement and thrombocytopenia, was found to be important overall for discriminating SLE patients with or without SS. SLEwSS patients constitute a subgroup of patients with SLE characterized by milder lupus: older age at death, similar rates of mortality and SLICC-ACR damage index, less renal and immunological manifestations. Funding Source(s): None

Introduction Nailfold capillaroscopy (NC) is useful in the evaluation of Raynaud's phenomenon, associated with some connective tissue diseases and in the follow-up of patients with systemic sclerosis. Our study evaluates the impact of NC in the diagnosis, according to the reason for the request and profile of autoantibodies in daily clinical practice. Material and methods All patients that undergone at least one NC between June 2012 and December 2017 were included. Clinical records were reviewed and analysed in a dichotomous way (yes/no), to see whether the NC contributed to a change of diagnosis in subsequent consultations. In addition, demographic, clinical and laboratory data were collected, and the relationship with NC patterns evaluated. Results Of the 530 patients who had undergone at least one NC, 266 had Raynaud's phenomenon as primary indication for the technique. Of those, 20 patients (3.8%) had a diagnostic change in the post-NC consultation; 15 were diagnosed with systemic sclerosis, 4 with undifferentiated connective tissue disease and one with mixed connective tissue disease. All patients had, except for one patient diagnosed with undifferentiated connective tissue disease, positive antinuclear antibodies titres, 11 of them had disease specific antibodies (9 anti-centromere, one anti-Scl70 and other anti-RNPC). The positivity of antinuclear antibodies titres was associated with a higher probability of presenting a scleroderma pattern in the NC, and all patients with a specific rheumatological diagnosis had an abnormal NC. Conclusion NC is a useful technique, but with limited impact in the diagnosis of connective tissue diseases. Autoantibody positivity is associated with a greater likelihood of presenting pathological NC patterns.

Background:An ACR/EULAR task force released new criteria in 2013 to classify patients with systemic sclerosis (SSc).Objectives:This study evaluates the diagnostic performance of these criteria in a multidisciplinary care setting.Methods:Patients with an active follow-up in a Systemic Autoimmune Diseases Unit with a clinical diagnosis of SSc were matched by age and gender with consecutive patients referred to a capillaroscopy clinic. The classification criteria were tested on discrimination and diagnostic accuracy between both groups of patients defined as cases-SSc and controls. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) was calculated for the global score to define the best cut off to classify the patients as having SSc.Results:A total of 130 patients with SSc and 130 matched-controls were included in this analysis, 90% women, with a mean age of 61.5. Main diagnosis for the control groups were primary Raynaud´s phenomenon (34.6%), undiferentiated connective tissue disease (13.1%), and mixed connective tissue disease (9.2%). The 92% and 8% of patients in the SSc-cases and control groups met the 2013 ACR/ EULAR SSc classification criteria respectively. Sensitivity and specificity of the criteria were 81.5% and 93.7%, respectively. The best cut offs for the total score were 8 and 9, and the AUC (95%CI) was 0.962 (0.939-0.985). The individual items with a better discriminatory capacity were abnormal capillaroscopy, telangiectasia and anticentromere antibody positivity.Table 1.Demographic data and ACR/ EULAR SSc classificacion criteria of SSC patients and controls.Cases-SSc, n= 130Controls, n= 130pAge, mean (SD)62.4 (16.0)61.3 (14.8)0.58Female, %90.590.80.92Disease duration from onset of symptoms, mean (SD)7.5 (6.4)7.8 (6.7)0.73% Patients with individual ACR/EULAR 2013 Criteria ItemsSkin thickening15.80.7Sclerodactily45.56.1Puffy fingers27.71.5Digital tip ulcers30.25.3Fingertip pitting scars18.84.60.001Telangiectasia51.56.1Abnormal nailfold capillaries79.40.8Pulmonary Arterial Hypertension16.33.80.001Pulmonary fibrosis18.86.20.002Raynaud´s phenomenon90.766.9Anticentromere antibody60.718.9Scl7012.00Total Score12.5 (4.8)3.4 (2.9)Figure 1.ROC curve for global score of the ACR/EULAR2013 SSc classification criteria.Conclusion:The ACR/EULAR 2013 criteria showed good diagnostic properties in this cohort reflecting daily practice. Individual items showing the highest discriminatory capacity were abnormal capillaroscopy, telangiectasia and anticentromere antibody positivity.References:[1]van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Annals of the Rheumatic Diseases 2013;72:1747-1755.Disclosure of Interests:None declared

Background:EULAR recommendations propose temporal and axillary arteries ultrasound (US) as first-line investigation when predominantly cranial giant cell arteritis (GCA) is suspected. Recently, two novel US scoring systems, the halo count and the Southend Halo Score, have been developed to quantify the extent of inflammation by US in GCA.Objectives:To assess whether adding the subclavian arteries examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of GCA and its relationship with systemic inflammation.Methods:Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score and the modified Halo Score (Image 1). The gold standard for GCA diagnosis was clinical confirmation after 6 months follow-up.Results:64 patients were evaluated in the FTP, 17(26.5%) had GCA. Subclavian arteries involvement was present only in patients with GCA (29.4% versus 0%,pFigure 1.Proposed scores to quantify the extent of vascular inflammation by ultrasound in giant cell arteritis. A. Halo count, B. Halo Score, C: Modified Halo ScoreTable 1.Clinical, laboratory and ultrasound findings of patients included in the fast track pathway with or without GCA clinical confirmation.Totaln=64Patients with GCAn=17Patients without GCAn=47pAge, median (IQR)78 (69.3-83)78 (72.5-83)78 (66-83)0.5Female, n (%)42 (65.6%)10 (58.8%)32 (68.1%)0.491Temporal artery biopsy positive n=13, no. of patients5 (38.5%)5 (50%)0 (0%)0.23118F-FDG-PET/CT positive n=14, no. of patients7 (50%)5 (62.5%)2 (33.3%)0.592Fulfilling 1990 GCA criteria, no. of patients16 (25%)8 (47.1%)8 (17%)0.022PMR diagnosis before US examination, no. of patients21 (32.8%)4 (23,5%)17 (36,2%)0.386Headache, no. of patients31 (48.4%)12 (70.6%)19 (40.4%)0.033Jaw claudication, no. of patients12 (18.8%)9 (52.9%)3 (6.4%)Ocular ischaemia, no. of patients4 (6.3%)2 (11.8%)2 (4.3%)0.285Abnormal TA clinical examination, no. of patients5 (7.8%)3 (17.6%)2 (4.3%)0.112CRP (mg/dL), median (IQR)1.7(0-6.5)7 (2.1-14)1.1 (0-5.1)0.001ESR (mm/h), mean (SD)52.8 (34.6)68.3 (33.3)46.8 (33.3)0.044Haemoglobin (g/dL), mean (SD)12.5 (1.7)11.8 (1.6)12.7 (1.7)0.059Platelets 109/L, mean (SD)276.1 (105.8)323.4 (116.3)258.7 (97.3)0.52Positive US findings, no. of patients17 (26.6%)15 (88.2%)2 (4.3%)Temporal artery positive US findings, no. of patients13 (20.3%)12 (70.6%)1 (2.1%)Axillary positive US findings, no. of patients9 (14.1%)8 (47.1%)1 (2.1%)Subclavian positive US findings, no. of patients5 (7.8%)5 (29.4%)0 (0%)Temporal artery + axillary or subclavian positive US findings, no. of patients5 (7.9%)5 (29.4%)0 (0%)0.003Halo Count, median (IQR)0 (0-0.75)2 (1-4.5)0 (0-0)Halo Score, median (IQR)0 (0-4.5)18 (7-22.5))0 (0-0)Modified Halo Score, median (IQR)0 (0-2.75)8 (3-13.5)0 (0-0)Conclusion:The inclusion of subclavian arteries examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCADisclosure of Interests:None declared

Background:Patients with inflammatory arthralgia (IA) are considered to be at increased risk for progression to RA. Ultrasound (US) has shown high sensitivity to detect synovitis compared with physical examination. Thus, US is recommended to identify subclinical synovitis in patients without clinical signs of inflammation.Objectives:To determine the frequency and pattern of US detected active inflammation in patients with IA and investigate factors contributing to predict this outcome.Methods:An US clinic is scheduled in an academic center running twice every week. A retrospective analysis of our US unit cohort during a period of 12 months was undertaken. Patients with IA and no previous diagnosis of inflammatory arthropathies were included for analysis. Inclusion criteria of IA definition included: severe symptoms presenting in the morning, duration of morning stiffness ≥60 min, symptoms predominantly located in MCP joints and absence of clinically detected synovitis by the referral rheumatologist. The following routinely collected variables were included in the analysis: demographics, clinical features and laboratory tests. Patients underwent bilateral US examination of hands and/or feet according to the European League Against Rheumatism (EULAR) guidelines. The presence of synovitis and tenosynovitis was assessed on a semi quantitative scale (0–3) for Grey Scale(GS)/Power Doppler(PD). Active inflammation was defined as PD synovitis and/or tenosynovitis >1 at any location. First, differences between groups were tested using chi-squared/Fisher and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate the association between possible predictive factors of US active inflammation.Results:A total of 110 patients were included in the analysis. Mean age was 53.6±15.6 years, 80 (72.7%) were females, and mean symptoms duration was 11.7±9.9 months (Table1). A total of 76 (69.1%) patients presented with a polyarticular arthralgia pattern. US active inflammation were present in 38 (34.5%) patients (28.2% showed PD synovitis and 19.1% PD tenosynovitis). Hands were most commonly involved with PD synovitis at wrists in 18.2% and at MCP in 14.5% of patients. For PD tenosynovitis, the flexor MCP 2-5 (4.5%) and 6th extensor tenosynovitis (5.5 %) were the most frequent affected locations. Only 9 (8.2%) patients had erosions in hands and/or feet at baseline examination. In the univariate analysis, the higher ESR values, the shorter time from symptoms onset and the presence of ACPA were significantly associated with the presence of US active inflammation (pConclusion:US features of active inflammation are found in 1 over 3 patients with IA being PD synovitis the most common finding, specially at the wrists and MCP joints. Higher ESR and ACPA values are significantly associated with the presence of US active inflammation. Thus, we strongly recommend the use of PD US to detect subclinical inflammation in at-risk patients with IA with no sign of inflammation on clinical examination, especially those with high ESR and ACPA values.Table 1.Baseline characteristics of patients with IATotaln= 110US inflammatoryfindingsn= 38 (34.5%)Non-US inflammatoryfindingsn=72 (65.5%)pAge53.6 ± 15.657.2±16.251.6±13.40.071SexFemale80 (72.7%)26 (68.4%)54 (75%)0.461Smokingn= 87Non smoker45 (51.7%)12 (44.4%)33 (55%)0.412Smoker34 (39.1%)11 (40.7%)23 (38.3%)Former smoker8 (9.2%)4 (14.8%)4 (6.7%)ExtensionMonoarticular12 (10.9%)6 (15.8%)6 (8.3%)0.176Oligoarticular 22 (20%)10 (26.3%)12 (16.7%)Polyarticular76 (69.1%)22 (57.9%) 54 (75%)Time (months)from symptoms onset11.7 ± 9.99.1±8.113±10.50.035ESR (mm/h) n=4524.7 ± 18.233.1±21.820.3 ±14.4RF (IU/mL) n=5339.1 ± 230.528.5±5645.1±286.10.647ACPA (IU/mL) n=5698.1 ± 331.2209.4±488.426±125.20.01Disclosure of Interests:None declared

OBJECTIVE To compare structural damage assessed by conventional radiography and tendon damage assessed by musculoskeletal US (MSUS) at wrist and ankle in RA patients. METHODS We evaluated 72 consecutive patients [56 (77.8%) females] with RA. The MSUS evaluation consisted in a B-mode examination of bilateral extensor carpi ulnaris and tibialis posterior tendons. Tendon damage was defined and scored according to OMERACT. A total score for the tendon damage score (TDS) was calculated by summing the grades for each tendon. For the radiographic evaluations we used the van der Heijde score; a total radiographic score (RTS) was calculated by summing a bone erosion score (ERS) and a joint space narrowing score (JSNS). RESULTS We evaluated 288 tendons. The mean (s.d.) of TDS was 2.3 (1.8). Fifty-four (75%) patients presented tendon damage of at least one tendon. From all evaluated tendons, 134 (46.5%) had no tendon damage, 146 (50.7%) had grade 1 and 8 (2.8%) had grade 2 tendon damage. The mean (s.d.) for RTS was 91.4 (97), for ERS was 47.3 (61.9) and for JSNS was 44.1 (37.2). We found a significant correlation between disease duration and both TDS and RTS (r = 0.413 and r = 0.560, respectively; P < 0.0001). We found a good significant correlation between TDS and all variables of radiographic structural damage (RTS, r = 0.65; ERS, r = 0.637; JSNS, r = 0.618; P < 0.001). CONCLUSION The MSUS assessment of only four tendons can be an additional feasible method to assess structural damage in RA patients.

Background:Sjogren’s syndrome (SS) is characterized by lymphocytic infiltration of the exocrine glands and marked B-lymphocytic cell hyperreactivity involving a variety of serum autoantibodies.1Salivary Gland Ultrasound (SGU) is a simple, fast, and well- tolerated examination, wich provides information about glandular structure and has proven to be very useful in the Sjögren Syndrome diagnosis2. A prognostic value has also been proposed due to its posible relationship with lymphomas and extra-glandular manifestations.Objectives:The objective of our study is to evaluate ultrasound results in patients who went through an SGU in clinical practice, its usefulness in the diagnosis of Sjögren’s syndrome and the presence of complications (lymphomas, extra-glandular manifestations or factors related to increased lymphoma risk).Methods:We conducted a retrospective cross-sectional study with review of clinical records that included all those patients coded as SGU in the Ultrasound unit of Rheumatology Department from 2016 to December 2019. Information collected included final diagnosis, laboratory results, clinical manifestations and ultrasound results. We performed an analysis on the frequency of pathological SGU and on the relationship between this lesions in patients with final SS diagnosis and the presence of lymphoma, extra-glandular manifestations and the laboratory values related with increased lymphoma risk (low complement levels, cryoglobulinemia, positive autoimmunity).Results:SGU was performed in 171 patients in four years, 162 women (94.7%). The previous diagnoses, reason for the request and final diagnosis are shown in Table 1. The vast majority of the SGU were normal, only 28 (16,3%) were pathological, 13 with a grade II and 8 with a grade III. In the other 7 patients grading was not available. Of the 28 patients with pathological SGU, none had lymphoma, only 3 had recurrent parotitis and 15 had had extra-glandular manifestations, mainly arthralgia / arthritis (12). Only 1 patient, with rheumatoid arthritis, had had a lymphoma and the SGU was normal. Antibody positivity was frequent in pathological SGU, 16/23 antinuclear antibodies, 13/22 anti-Ro and 9/23 rheumatoid factor. Of the 86 patients without previous diagnosis, 18 were diagnosed with Sjogren syndrome, 9 with pathological SGU and the rest were normal. No patient diagnosed with a dry non-autoimmune syndrome presented pathological SGU.Table 1.Previous diagnoses, reason for request and final diagnoses.Previous diagnoses (n: 171)Reason for request (n: 171)Final diagnosis (n: 78)Without prior diagnosis (n: 86)Dry non- autoinmune syndrome (n: 127)Dry non-autoimmune syndrome (n: 60)Primary Sjögren’s syndrome (n: 11)Primary Sjögren’s syndrome (n: 12)Primary Sjögren’s syndrome (n: 18)Systemic Lupus Erythematosus (n: 9)Lymphoma (n: 0)Secondary Sjögren’s syndrome (n: 0)Rheumatoid arthritis (n: 24)Control (n: 13)Other diagnoses (n: 7)Other diagnoses (n: 18)Other reasons (n: 11)Conclusion:The impact of the SGU is low and its use cannot, for now, displace other methods (e.g. salivary gland biopsy) in the diagnosis of SS. Also our low number of patients with pathological SGU together with the low prevalence of the complications studied (e.g. lymphomas = 1) prevents the expected comparisons.References:[1]Ramos-Casals M, Solans R, Rosas J, et al. Primary Sjogren syndrome in Spain: clinical and immunologic expression in 1010 patients. Medicine (Baltimore) 2008; 87: 210–219.[2]Damjanov N, Milic V, Nieto-Gonzalez JC, et al. Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjogren Syndrome. J Rheumatology 2016; 43: 1858–1863.Disclosure of Interests:Fernando Montero: None declared, Karen Carpio: None declared, Iustina Janta: None declared, Juan Molina Collada: None declared, Belén Serrano Benavente: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Alfonso Ariza: None declared, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi

Background:Recommendations to collect the most relevant information on disease course, treatment and outcomes in giant cell arteritis (GCA) has been proposed by EULAR to facilitate clinical research and to improve clinical care.Objectives:To assess the quality of data collection in routine clinical practice according to EULAR recommendations and to describe baseline and follow-up characteristics of a retrospective cohort of patients with GCA.Methods:We reviewed medical records of patients diagnosed with GCA in a tertiary academic center between 2004-2018. We included patients with available data at diagnosis and one year of follow-up. Data extraction included: demographics, diagnosis, GCA-related signs and symptoms, laboratory, imaging modalities, comorbidities and treatment. Data in the chart was then compared with the core set of parameters proposed for GCA registries and databases by EULAR. Major relapse, according to the EULAR 2018 definition, was independently assessed by two rheumatologists.Results:58 patients were identified, 39 met predefined inclusion criteria with 151 visits during first-year follow-up. Headache (100%; 80.4%), ocular symptoms (89.7%; 81.2%), constitutional symptoms (89.7%; 80.4%), polymyalgia rheumatica (89.7%; 82%) and jaw claudication (87%; 81.2%) were the most frequently collected items at baseline and follow-up. Weight and height (2.6%; 2.6%), peripheral pulses (8%; 4.5%), smoking status (41%; 21%), and blood pressure (61.5%; 4.5%) were the less frequently collected. Most patients lacked differential pressure measurement. Myocardial infarction, malignancy, serious infections, arterial hypertension, diabetes and osteoporosis were collected in every patient (39, 100%). Only 2 mayor relapses were identified (5%). Two (2) patients died during the one-year follow-up period. Table 1 provides information on GCA-related signs and symptoms, laboratory and therapeutic data.Table 1.GCA-related signs and symptoms, laboratory and therapeutic data.ItemPerformed BaselineBaselinen=39Performed Follow-upFollow-upn=112Ocular symptoms35/39 (89.7%)15/35 (42.9%)91/112 (81.2%)29/91 (31.9%)Permanent ocular symptoms34/39 (87%)9/34 (26.5%)92/112 (82%)28/92 (30.4%)Headache39 (100%)30/39 (77%)90/112 (80.4%)13/90 (14.4%)Scalp tenderness31/39 (79.5%)9/31 (29.8%)88/112 (78.6%)4/88 (4.5%)Jaw claudication34/39 (87%)19/34 (55.85)91/112 (81.2%)6/91 (6.6%)Cranial artery abnormality27/39 (69.2%)17/27 (63%)69/112 (61.6%)3/69 (4.3%)Constitutional symptoms35/39 (89.7%)19/35 (54.3%)90/112 (80.4%)11/90 (12.2%)PMR35/39 (89.7%)18/35 (51.4%)92/112 (82%)9/92 (9.8%)ESR mean (SD)33/39 (84.6%)58.7 (32.1)83/112 (74%)14.6 (18.8)CRP mean (SD)31/39 (79.5%)8.4 (7.9)70/112 (62.5%)1.3 (3.3)Haemoglobin mean (SD)38/39 (97.4%)12.0 (1.7)90/112 (80.4%)12.9 (1.5)Peripheral pulses9/39 (8%)3/9 (33.3%)5/112 (4.5%)2/5 (40%)Large vessel involvement8/39 (20.5%)5/8 (62.5%)7/112 (6.25%)3/7 (42.8%)Glucocorticoids median (IQR)39 (100%)102.5 (50-250)112 (100%)10.0 (5-15)Synthetic DMARD39 (100%)8/39 (20.5%)111/112 (99%)17/39 (43.6%)Biological DMARD39 (100%)0/39 (0%)111/112 (99%)3/39 (7.7%)Antiplatelet agents39 (100%)6/39 (15.4%)110/112 (98%)25/110 (22.7%)PMR: polymyalgia rheumatica, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, SD: standard deviation, IQR: interquartile range, DMARD: disease modifying antirheumatic drugsConclusion:Although data collection in routine care is usually comprehensive enough according to EULAR proposed data set, key components in physical exam mostly those aiming to detect large vessel involvement, should be addressed more carefully.References:[1]Ehlers L, et al. Ann Rheum Dis. 2019;78(9):1160–6.[2]Hellmich B, et al. Ann Rheum Dis. 2019;1–12.Disclosure of Interests:Julia Martínez-Barrio Consultant of: UCB Pharma, Belén Serrano Benavente: None declared, Tamara Del Río Blasco: None declared, Alfonso Ariza: None declared, Juan Ovalles: None declared, Juan Molina Collada: None declared, Teresa González: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose Maria Alvaro Gracia: None declared

Background:Tofacitinib is an oral JAK 1 and 3 inhibitor for the treatment of moderate to severe active rheumatoid arthritis (RA) or psoriatic arthritis (PsA) in adults with inadequate response or intolerant to one or more conventional disease-modifying antirheumatic drugs (cDMARDs). Since its approval by the European Medicines Agency (EMA), there is limited data about its use in daily practice in Europe.Objectives:To describe rates and reasons for discontinuation of Tofacitinib in patients with RA and other inflammatory conditionsMethods:We identified patients with a prescription for tofacitinib at our academic center from January 2017 to January 2020. Patients were treated according to their rheumatologist evaluation following standards of care. The following variables were retrospectively collected from the electronic medical chart: age, gender, diagnosis, date of treatment initiation, date and reasons for treatment discontinuation, the use of concomitant or previous cDMARDs and of biologics. A comparison between patients continuing and stopping tofacitinib was performed through chi2or t-test for qualitative and quantitative variables, respectively. Survival analysis was done by Kaplan-Meier methodResults:Ninety patients receiving tofacitinib were identified, 81 with RA, 6 with PsA, 1 with Dermatomyositis, 1 with Sjögren´s and 1 with juvenile idiopathic arthritis. Table 1 shows the baseline characteristics. 84% percent patients were women and the mean (SD) age was 58.5 (14.2) years. 51% patients started tofacitinib in monotherapy. When used, methotrexate was the most frequent cDMARD (61.3%); 10% patients used tofacitinib as first line after cDMARD and the majority used it after 1 or 2 previous biologics (46.7%).Table 2.Clinical coutcome of patients who developed HZ at initiation of baricitinibAll patients(n=90, 100%)Continue Tofacitinib(n=58; 64%)Not continue Tofacitinib(n=32; 35.5%)p-valueFemale (%)76 (84.4)48 (82.7)28 (87.5)0.55Age (year) – mean (SD)58.5 (14.2)58 (12.9)59.5 (16.5)0.63Diagnosis0.66Rheumatoid arthritis81 (90)52 (89.6)29 (90.6)Psoriatic arthritis6 (6.7)4 (6.8)2 (6.2)Other3 (3.3)2 (3.4)1 (3.1)Treatment duration (months) – mean (SD)10.6 (6.9)11.9 (7.3)8.2 (5.5)0.02Prednisone (mg) – mean (SD)1.75 (3.2)1.20 (2.5)2.73 (4.1)0.03Monotherapy (%)46 (51.1)28 (48.2)18 (56.2)0.244Concomitant csDMARDs (%)44 (48.8)30 (51.7)14 (43.7)0.62Methotrexate (%)27 (30)17 (29.3)10 (31.2)Leflunomide (%)10 (11.1)8 (13.7)2 (6.2)Other (%)7 (7.7)5 (8.6)2 (6.2)Prior biologic treatment0.13None (%)9 (10)6 (10.3)3 (9.3)1-2 (%)42 (46.6)28 (48.2)14 (43.7)≥3 (%)39 (43.3)24 (41.3)15 (46.8)Survival rates when used as first or second line were 85% at 6 months and 70% at 12 months; when used as third line or further, 76% and 70%, respectively (graphic 1).Factors associated to tofacitinib discontinuation were treatment duration and baseline prednisone dose. In contrast concomitant csDMARD and number of previous biologics were not. Reasons for tofacitinib discontinuation were: lack/loss of efficacy 46.9%, adverse events 50% (including intolerance -22%- herpes zoster -16%-, other infections 12%) and others.Conclusion:Tofacitinib in our experience is mostly used in RA patients after biologic failure. Overall survival rate at 12 months was good regardless line of therapy. Adverse event rates were similar to other biologic treatments. Herpes zoster was the most common infectious AE.Graphic 1:References:[1]Wollenhaupt J, Lee EB, Curtis JR, et al. Safety and efficacy of tofacitinib for up to 9.5 years in the treatment of rheumatoid arthritis: final results of a global, open-label, long-term extension study. Arthritis Res Ther. 2019;21(1):89.Disclosure of Interests:Christian Y Soleto: None declared, Belén Serrano Benavente: None declared, Luis A Torrens Cid: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Juan Molina Collada: None declared, Javier Rivera: None declared, Teresa González: None declared, Indalecio Monteagudo: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB