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ObjectivesTo evaluate the differences between patients with rheumatoid arthritis (RA) with and without interstitial lung disease (ILD), to identify factors associated with the development of ILD and to evaluate subclinical ILD; prevalence and factors associated with its development.MethodsObservational and cross-sectional study of a cohort of patients with RA (ACR/EULAR 2010) and with ILD and a control group of patients without ILD. Both groups with HRCT performed in the last 18 months. The date of the last HRCT was considered as the study date. The % of patients who had subclinical ILD was retrospectively evaluated, defining this as pulmonary involvement due to a requested HRCT without any previous respiratory symptoms. Demographic variables, activity data (DAS28VSG, SDAI and CDAI on the study date), RF and ACPA levels, RA severity data and treatments they were receiving were collected. Descriptive analysis, χ2 or t-Student and multivariate logistic regression analysis was performed to find predictive variables of the development of ILD.Results66 patients with RA (41 with ILD and 25 without ILD) were included. The main differences between both groups are shown in Table 1. In the group of patients with ILD, the male sex predominated, they were older, with a longer duration of the disease and a longer diagnostic delay of RA. They made more use of biological therapies with better control of the disease by DAS28, SDAI and CDAI. Pulmonary function preserved by respiratory function tests. Of the total number of patients with ILD, 15 (36.6%) did not present any respiratory symptoms when the HRCT was requested. The reasons for their request were: finding abnormalities on chest X-ray (66.7%) and dry crackles on examination (33.3%). Subclinical ILDs were diagnosed with less evolution time of RA than clinical ones. In the rest of the variables there were no differences with the clinical ILD. The variables independently associated with the development of ILD, adjusted for age, tobacco use and ACPA at high titers, were male sex [OR = 4.2 (95% CI 1.05-19.7), p = 0.049] and time of evolution of RA [OR = 1.08 (95% CI 1.02-1.17), p = 0.014].ConclusionIn our cohort, the prevalence of subclinical ILD was high (36%). Clinical characteristics, disease activity and ILD data (PFT and HRCT patterns) were similar between clinical and subclinical ILD, but prospective studies are needed to assess whether the course and prognosis in both groups is also similar. Bearing in mind that ILD is an important cause of death in our patients, we must actively search for this condition in order to treat it early and improve its prognosis.Disclosure of InterestsNone declared

ObjectivesTo evaluate the association between different HLADRB1 alleles and the development of serious complications in patients with rheumatoid arthritis (RA).MethodsWe performed an observational, longitudinal and retrospective study of a cohort of 134 patients with established RA (ACR/EULAR 2010) from the registry of our department, older than 18 years and without other associated autoimmune pathologies except secondary Sjogren’s syndrome and who had the requested HLADRB1 genotype. Patients with ≥ 1 of the following HLA-DRB1 alleles were considered positive shared epitope carriers (SE+): *01:01, *01:02, *04:01, *04:04, *04:05, * 10:01, *03:01 or *07:01. The remaining patients without any of these alleles were considered shared epitope negative (SE-). Serious complications of RA were included: interstitial lung disease, cardiovascular events, cancer, admissions for serious infections, vasculitis, Felty’s syndrome, or death. Other severity data: erosions, rheumatoid nodules, multiple resistance to biologicals (3 or more biologicals), secondary Sjogren’s syndrome or osteoporosis. Descriptive and bivariate analysis was performed between the different alleles (χ2/ANOVA). Cox regression analysis was performed to estimate the influence of the different alleles on mortality.ResultsA total of 134 patients (91 SE+ and 43 SE-) were included. The main differences between the different alleles are shown in Table 1. The most frequent alleles were *0101 (n=18), *0301 (n=15) and *0701 (n=17). When the different alleles were compared, it was seen that the carriers of the alleles *04:05 presented positive ACPA more frequently (100%), rheumatoid nodules (50%) and showed higher mortality (50%) together with the carriers of *07:01 (41.2%), in a statistically significant way. There was no difference in the rest of the complications or severity data. The causes of death were varied in patients with both alleles (cardiovascular events, cancer, interstitial lung disease, and infections). There were no differences in age at death [mean 82.8 years (SD 3.8) vs 84.5 (6.6); p= 0.836, respectively]. Cox regression analysis adjusted for sex, age and ACPA showed that patients with alleles *04:05 (HR 9.1 (95% CI 1.1-72.3; p=0.036) and *07:01 (HR 10.9 (95% CI 1.5-81.2; p= 0.019) had a higher risk of mortality from any cause.Table 1.Characteristics of the patients with the different allelesVariablesSE- (n= 43)*01:01 (n= 18)*01:02 (n= 10)*04:01 (n= 12)*04:04 (n=10)*04:05 (n= 4)*10:01 (n= 5)*03:01 (n= 15)*07:01 (n= 17)pAge at diagnosis (years), mean (SD)54.1 (16.2)48.5 (14.8)55.5 (10.7)45.7 (12.9)50 (11.4)56.8 (20.9)55.1 (21.2)50.5 (11.3)59.7 (17.9)0.336Female sex, n (%)30 (69.7)12 (66.6)7 (70)10 (83.3)9 (90)03 (60)12 (80)12 (70.6)0.096Time since diagnosis (years), mean (SD)12.8 (7.8)15.3 (3.6)11.8 (7.6)14.1 (6)11.03 (7.9)9.3 (6.8)11.8 (7.4)16.4 (6.9)12.3 (7.3)0.420RF +, n (%)32 (74.4)17 (94.4)9 (90)12 (100)10 (100)4 (100)4 (80)12 (80)13 (76.5)0.216ACPA +, n (%)27 (62.7)16 (88.8)9 (90)11 (91.6)10 (100)4 (100)5 (100)9 (60)8 (47)0.004Erosions, n (%)12 (27.9)9 (50)3 (30)8 (66.7)5 (50)2 (50)2 (40)7 (46.7)7 (41.2)0.422Noduls, n (%)01 (5.5)01 (8.3)1 (10)2 (50)1 (20)01 (5.9)0.003Osteoporosis, n (%)14 (32.5)3 (16.7)4 (40)1 (8.3)3 (30)001 (6.6)4 (23.5)0.194Sjogren S., n (%)4 (9.3)001 (8.3)0002 (13.3)00.515ILD, n (%)5 (11.6)1 (5.5)1 (10)2 (16.7)2 (20)002 (13.3)2 (11.8)0.937CVD, n (%)11 (25.6)4 (22.2)1 (10)1 (8.3)1 (10)1 (25)1 (20)2 (13.3)4 (23.5)0.872Serious infections, n (%)11 (25.6)1 (5.5)1 (10)02 (20)2 (50)02 (13.3)2 (11.8)0.646Cancer, n (%)4 (9.3)3 (16.7)1 (10)1 (8.3)2 (20)1 (25)1 (20)2 (13.3)2 (11.8)0.972Multiresistants, n (%)2 (4.6)2 (11.1)01010200.465Deaths, n (%)12 (27.9)2 (11.1)0002 (50)01 (6.6)7 (41.2)0.005ConclusionOur results suggest that RA patients carrying the *0405 and *0701 alleles have an increased risk of mortality. Studies with larger numbers of patients are needed to confirm these results.Disclosure of InterestsNone declared

BackgroundEnthesitis represents one of the most important peripheral musculoskeletal manifestation in patients with axial Spondyloarthritis (axSpA). The prevalence and the burden of the disease associated with this symptom have been widely studied in axSpA and Psoriatic Arthritis (PsA). However, studies evaluating specifically the heel enthesitis and its impact over time are scarce.ObjectivesA) to evaluate the prevalence of patients with heel enthesitis during physical exploration in patients with radiographic axSpA (r-axSpA); b) to evaluate the association of heel enthesitis with higher Patient Reported Outcomes (PROs); c) to assess the impact of the heel enthesitis on the outcome measures after two years of follow-up in these patients.MethodsObservational and prospective study during 2 years of follow-up that included patients with r-axSpA from the REGISPONSER-AS study (Spanish Rheumatology Spondyloarthritis Registry). The patients were divided into two groups according to the presence on heel enthesitis on physical exploration during the study visit. The PROs evaluated were the Global VAS, BASDAI, ASDAS, BASFI and the mental and physical components from the SF12 questionnaire. Linear regression models were performed using the PROs as the dependent variable and the presence of heel enthesitis as the explanatory variable, adjusting for bDMARDs intake and age. The impact of the heel enthesitis on PROs over two years of follow-up was evaluated using mixed models for repeated measures adjusting for confounders. Finally, the achievement of ASDAS Low Disease Activity (ASDAS-LDA) and ASDAS Inactive Disease (ASDAS-ID) after 2 years of follow-up between the two groups were evaluated.Results749 patients were included (mean age 48.4 years; 75.3% men). 46 (6.1%) patients suffered from heel enthesitis on the study visit. Patients with heel enthesitis showed an increase (β coefficient, 95%CI) in Global VAS (1.32, 0.52-2.12), BASDAI (1.49, 0.81-2.18), ASDAS (0.45, 0.12-0.77) and BASFI (9.54, 1.78-17.30) compared with patients without heel enthesitis after adjusting for confounders. The impact of the presence of enthesitis on the PROs after two years of follow-up is shown in Table 1. Patients with heel enthesitis showed higher scores during the two years of follow-up in Global VAS, BASDAI, ASDAS and BASFI. In addition, the percentage of patients who achieved ASDAS-LDA after 2 years of follow up was lower in patients with heel enthesitis (15.9% vs. 31.5%, p=0.030) in comparison with patients without enthesitis. No differences were found regarding ASDAS-ID.Table 1.Impact of the presence of heel enthesitis on PROs over two years of follow-up: mixed models for repeated measures.Current heel enthesitis N = 46 Mean (SD)No current heel enthesitis N = 703 Mean (SD)p-valuep-value age and bDMARDs adjustedGlobal VAS5.1 (2.8)4.3 (2.6)0.0150.010BASDAI4.8 (2.7)3.9 (2.7)ASDAS2.9 (1.1)2.6 (1.0)0.0070.005BASFI43.8 (29.7)40.0 (27.4)0.2450.161PC-SF1233.3 (11.4)35.3 (10.7)0.1280.110MC-SF1247.4 (14.2)48.2 (12.2)0.5470.281ConclusionIn patients with r-axSpA, the presence of heel enthesitis on physical exploration was associated with poorer scores ​​on the outcome measures after two years of follow-up, in comparison with patients without heel enthesitis. The achievement of a low disease activity is less likely in patients with this manifestation.Disclosure of InterestsNone declared

BackgroundSpondyloarthritis, (axial (axSpA), peripheral (pSpA)) and psoriatic arthritis (PsA)) share enthesitis as a hallmark clinical feature. Reliable clinical instruments have been developed to assess enthesitis: Spondyloarthritis Research Consortium of Canada Enthesitis (SPARCC), Leeds Enthesitis Index (LEI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and MEI (Mander Enthesitis Index). Since these four indexes include different enthesis locations, they may capture a different number of patients with enthesitis in the different SpA entities.Objectivesa) To describe the individual locations of enthesitis in axSpA, pSpA and PsA; b) to evaluate whether the prevalence of patients with at least one enthesitis across the three groups differs depending on the use of SPARCC, LEI, MASES and MEI indexes; c) to evaluate the level of agreement between these indexes for detecting patients with at least one enthesitis in axSpA, pSpA and PsA populations.MethodsPerSpA was a multinational observational, cross-sectional study with 24 participating countries worldwide. A total of 4185 patients with a diagnosis of axSpA (2719), pSpA (433) and PsA (1033) according to the Rheumatologist’s opinion were included in this analysis. Information on the location of enthesitis collected during the study visit was used according to the SPARCC, LEI, MASES and MEI indexes.The prevalence of patients with at least one enthesitis according to the different indexes were compared across the diseases (axSpA, PsA and pSpA), and pair-wise agreement between indexes were evaluated using the Cohen’s kappa in the global population and in the three groups.ResultsOut of 36 locations, the most prevalent enthesitis in the overall population were the lumbar spinous processes (6.5%), the thoracic spinous processes (4.9%) and the insertion of the Achilles tendon right (4.8%) and left (3.9%). A total of 10.7%, 8.3%, 13.5% and 17.2% of patients in the overall population showed at least one enthesitis according to the SPARCC, LEI, MASES and MEI indexes, respectively. Figure 1 shows that, among patients with axSpA, MEI and MASES indexes capture the majority of patients with at least one enthesitis (98.7% and 82.4%, respectively), while in pSpA and PsA, MEI and SPARCC are the indexes which capture the majority of patients with enthesitis (100% and 84.6% for MEI and SPARCC in pSpA, and 97.3% and 77% for MEI and SPARCC in PsA, respectively). In PsA, the LEI only captured 57.2% of the patients with at least one enthesitis. In the total population, MASES and MEI showed the strongest agreement for patients with at least one enthesitis (absolute agreement 96.3%; Cohen’s kappa: 0.86). Similarly, among axSpA patients, MASES and MEI showed an almost perfect agreement (97.3%; 0.90), while LEI and MEI showed a moderate agreement (90.4%; 0.54). In pSpA patients, SPARCC and MEI showed the strongest agreement (97.2%; 0.90), as well as among PsA patients (95.4%; 0.82). However, MASES and SPARCC showed a less agreement in PsA patients (94.2%; 0.67).Figure 1.Prevalence of enthesitis captured by different indexes.ConclusionThe most prevalent locations of enthesitis on the global SpA population are the lumbar spinous processes, the thoracic spinous processes and Achilles tendon. MEI and MASES are the two index that capture more patients with enthesitis in axSpA, while MEI and SPARCC are the two index that capture more patients in pSpA and PsA. The LEI index may underestimate the prevalence of enthesitis in these patients. MASES and MEI showed the largest level of agreement in the overall population and in axSpA, while MEI and SPARCC showed the largest level of agreement in pSpA and PsA. These results suggest that the prevalence of enthesitis across entities differs depending on the disease and on the use of the different index.References[1]Heuft-Dorenbosch L, et al. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003;62:127-132Disclosure of InterestsNone declared

BackgroundThe prevalence of late-onset psoriatic arthritis (PsA) is increasing in parallel with the progressive aging of the population. The elderly population presents a greater functional deterioration and a greater number of comorbidities than the young people. With this study we aim to find clinically relevant differences to predict the evolution and prognosis of the disease depending on the onset of the symptoms to carry out a more exhaustive follow-up.ObjectivesTo evaluate the association of the age at onset of PsA symptoms with the characteristics and burden of the disease.MethodsObservational study that includes a subgroup of 231 patients with Psoriatic Arthritis (PsA) from the REGISPONSER study (Registry of Spondyloarthritis of Spanish Rheumatology) and the RESPONDIA study (Ibero-American Registry of Spondyloarthropathies). Patients with less than 10 years of disease duration (since the first symptom) were selected so that the sample was homogeneous. Patients were divided into two groups according to the age of PsA onset (early-onset: ≤40 years old and late-onset: ≥60 years old). The characteristics and burden of the disease were compared using the Student’s t-test/Mann-Whitney U test for quantitative variables or using the chi-square/Fisher test for qualitative variables.Results411 patients were included [early-onset 179 (77.5%); late-onset 52 (22.5%)]. There was a higher percentage of men in the late-onset group compared to the early-onset group [94 (62.3%) vs. 38 (86.4%), p = 0.003]. The diagnostic delay was shorter in those whose onset of the disease was late [1.5 (2.7) vs 4 (7.7), p=0.036], as well as the duration of the disease [2.9 (2.4) vs 4.2 (2.7), p= 0.012]. A lower presence of sacroiliitis was found in patients with late-onset PsA [6 (12.2%) vs 58 (32.6%), p=0.005] as well as enthesitis [5 (9.8%) vs 44 (24.6%), p =0.023]. Regarding the comorbidities, there was a higher frequency of heart disease among patients with late-onset PsA [4 (7.8) vs 0 (0), p=0.000]. No statistically significant differences were found between kidney and lung disease. Regarding the outcome measures, the BASFI score was higher in the late-onset group [3.3 (2.5) vs. 2.2 (2.2), p=0.002]. The late-onset group had a lower FSF12 component [34.6 (8.7) vs. 38.7 (10.5), p = 0.001]. The radiographic indices measured by BASRI showed worse results in those patients with late-onset disease both in the spine [2.9 (3) vs 1.6 (2), p=0.020] and in the total BASRI [3.4 (3 .4) vs 1.9 (2.4), p=0.012].ConclusionOur study suggests that the age of onset of PsA was associated with the different characteristics of the disease. Patients with late-onset PsA were more frequently males, showed worse functionality and more structural damage in comparison with early-onset PsA. Sacroiliitis and enthesitis were found less frequently in the late-onset group. Quality of life, disease activity and treatments taken were not associated significantly with age of onset.Table 1.Description of different characteristics across two groups: early and late onsetEarly-onset N=179 n (%)=77.5Late-onset N=52 n (%)=22.5p-valueSex (male)94 (62.3)38 (86.4)0.003Age (SD)38.7 (9.3)71.3 (7.5)0.000Enthesitis44 (24.6)5 (9.8)0.023Dactilytis36 (20.1)9 (17.6)0.695Sacroiliitis58 (32.6)6 (12.2)0.005Diagnostic Delay, mean (SD)4 (7.7)1.5 (2.7)0.036Disease Duration, mean (SD)4.2 (2.7)2.9 (2.4)0.012Arthritis (lower limbs)118 (65.9)33 (64.7)0.872Arthritis (upper limbs)82 (45.8)31 (60.8)0.059BASDAI, mean (SD)3.9 (2.5)3.8 (2.4)0.932BASFI, mean (SD)2.2 (2.2)3.3 (2.5)0.002ASDAS, mean (SD)2.3 (1.1)2.3 (0.9)0.894FSF12, mean (SD)38.7 (10.5)34.6 (8.7)0.001MSF12, mean (SD)47.7 (10.6)49.3 (9.2)0.341BASRI spine1.6 (2)2.9 (3)0.020BASRI total1.9 (2.4)3.4 (3.4)0.012ESR mm/h, mean (SD)17.2 (14.2)23.9 (19.1)0.005csDMARDs (ever)111 (62.7)31 (63.3)0.943bDMARDs (ever)21 (11.9)3 (6)0.234Disclosure of InterestsNone declared

Background:Hyperkyphosis (HK) is a characteristic sign in patients with a large level of axial spondyloarthritis (axSpA) involvement. Kyphosis is defined as a sagittal deviation in the spinal alignment. Kyphosis can be graded in severity by the Cobb angle. The occiput-wall distance (OWD) is a surrogate measure of kyphosis. When this distance is greater than 0 cm, it is because the patient has an advanced affectation level that produces a reduction of physical function and other comorbidities. It is important that HK does not appear in the patient.Objectives:To analyze contributors and effects of HK in patients with axSpA.Methods:Nonparametric preprocessing for parametric causal inference was used for selection of two matched groups, formed by 42 axSpA patients each one, from the CASTRO cohort with similar covariate distributions (age and sex). Outcomes analyzed, besides OWD, included activity (BASDAI, ASDAS), physical function (BASFI) and mobility (BASMI). An inertial sensor-based system (ViMove) was used to analyze cervical and lumbar mobility and to calculate the UCOASMI index[1]. Structural damage was assesed according the mSASSS and its components (cervical and lumbar).Results:Mean (sd) values of the different variables for each group are shown in table 1. Significant differences according to an independent t-test (p), variation coefficient (V.C.), effect size (E.S.) and correlation with OWD (Pearson r), are also included in this table.OWD=0 (n=42)OWD>0 (n=42)PV.C.E.S.rAge (y)47.6 (8.9)48.7 (8.7)N.S.2%0.130.2Sex (female %)12%14%N.S.---B27 (positive %)87%86%N.S.---Disease duration (y)19.7 (11.4)24.9 (13.4)*26%0.42 0.30**Diagnostic delay (y)6.4 (9.6)6.6 (8.4)N.S.2%0.01-0.09BMI (kg/m2)25.8 (3.1)29.5 (4.6)***14%0.94¥ 0.39***ASDAS2.2 (1.0)2.7 (1.0)*21%0.430.08BASDAI3.6 (2.4)4.1 (2.5)N.S.6%0.17-0.02mSASSS10.6 (6.9)22.6 (19.2)***113%0.92¥ 0.75***Cervical mSASSS5.4 (4.4)11.2 (11.2)**106%0.74 0.69***Lumbar mSASSS5.1 (3.6)11.3 (10.0)***121%0.91¥ 0.67***BASFI2.6 (2.51)4.6 (2.8)***74%0.74 0.26*BASMI2.4 (1.1)4.2 (1.5)***77%1.40 0.77***UCOASMI3.7 (1.0)5.6 (1.4)***51%1.53 0.77***Cervical flexion (°)101 (20)74 (29)***-26%-1.07-0.71***Cervical rotation(°)133 (20)103 (37)***-23%-1.04-0.68***Cervical lat. flex.(°)67 (21)44 (24)***-33%-0.96¥-0.64***Sign.: *p0.8)There were not significant differences in age, sex as expected. HK group patients started earlier (5.2 years). The percentage of HLAB27+ is similar, so this antigen has not a relationship with HK. BMI is greater in HK group (14%); this can be a factor for HK appearance or a consequence of HK (less physical activity). Activity (according ASDAS) was slightly higher in HK. There were very significant differences in structural damage, and HK appears to be equally affected by damage at cervical and lumbar regions. BASFI also shown a significant reduction in HK. There was great reduction of mobility according to mobility indexes and cervical range of movement (23%-33%). In a multivariate regression analysis using all variables of the table and OWD as dependent variable, only mSASSS and BMI were included in the final model (adj. r2= 0.61). In a ROC analysis, mSASSS shown to and acceptable variable to distinguish between groups (AUC=0.70, cutoff=13). ASDAS obtained lower results (AUC=0.60, cutoff=2.38). Figure 1 shows cumulative probability plots of mSASSS and ASDAS versus OWD, showing cutoff values determined by ROC analysis.Conclusion:Structural damage, in cervical and lumbar spine, are the main contributor to HK appearance in axSpA patients. Inflammation it is not so determinant and acts only in the short term. HK produces a significant reduction of cervical mobility and physical function. New treatments that decrease radiographical progression, and overweight reduction are the most important factor to avoid HK.References:[1]Measuring Spinal Mobility Using an Inertial Measurement Unit System: A Validation Study in Axial Spondyloarthritis. Diagnostics 2020, 10(6), 426.Disclosure of Interests:None declared

Background:The prevalence of inflammatory bowel disease (IBD) in ankylosing spondylitis (AS) has been reported to range between 6%-15%. As occurs with axial spondyloarthrtitis (axSpA), patients with IBD have an increased risk of cardiovascular (CV) events because of a process of accelerated atherosclerosis1. However, it is unknown whether the presence of IBD confers an increased cardiovascular CV risk in patients with axSpA.Objectives:To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without IBD.Methods:Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant IBD. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.Results:A set of 886 axSpA patients were included. 829 (93.6%) of them had no concomitant IBD, which was present in 57 (6.4%) patients. Age, sex and AS/nr-axSpA ratio were comparable in both groups (Table 1. next page). Patients with IBD were characterised by a lower prevalence of HLA B27 (46% vs 72%, p=0.01) and a higher presence of concomitant psoriasis (21% vs 10%, p=0.01)Regarding peripheral disease (history of synovitis, enthesitis, dactylitis) and hip involvement, no differences were found between both groups. There were either no differences in the structural damage found in patients with and without IBD (Table 1. next page).With respect to the management of the disease, prednisone (21% vs 13%, p = 0.03), DMARDs (54% vs 35%, p = 0.01) and anti-TNFα therapy (54% vs 31%, p = 0.00) were more commonly used in the group with IBD, while treatment with NSAIDs was more frequent in patients without IBD (81% vs 70%, p = 0.04).Regarding CV risk features, smoking was more frequent in patients without IBD (34% vs 21%, p = 0.045) (Table 1. next page). No differences were observed neither in the lipid profile or blood pressure at the time of the study, nor in the prevalence of CV events (5% vs 4%, p=0.99) (Table 1) and the subclinical atherogenic burden assessed both by the presence of carotid plaques (31% vs 37%, p=0.45) and the cIMT (645 ± 147 mm vs 636 ± 112 mm, p = 0.64) (Table 1. next page).Conclusion:The presence of IBD does not confer additional CV risk to axSpA. In our series, patients with axSpA and IBD showed a lower frequency of HLA B27 and a higher prevalence of psoriasis.Table 1.axSpA without IBD (n=829)axSpA with IBD (n=57)pMen/Women, n272/55715/420.33Mean age (years) ±SD at the time of study49 ± 1349 ± 100.99AS/nr-AxSpa656/17345/120.97History of CV risk factors Current smoker285 (34)12 (21)0.045 Obesitty Dyslipemia280 (34)16 (28)0.42 Hypertension223 (27)16 (28)0.79 Diabetes Mellitus60 (7)4 (7)0.99 Chronic Kidney Disease20 (2)2 (4)0.65History of cardiovascular events, n (%)40 (5)2 (4)0.99Structural damage at the time of studyPresence of syndesmophytes, n (%)307 (37%)23 (49%)0.66mSASSS5 (1-15)6 (3-23)0.64Severe sacroiliitis (grade 3,4), n (%)436 (53)34 (60)0.42CV data at the time of studyCarotid plaques261 (31)21 (37)0.45IMT (mm)645 ± 147636 ± 1120.64IMT >= 0.9 mm46 (6)0 (0)0.066Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IBD = Inflammatory bowel disease. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.Disclosure of Interests:None declared

Background:The spinal range of motion (ROM) and the mechanical muscle properties (MMPs) at rest are defined as relevant clinical factors in inflammatory (i.e. axial Spondyloarthritis -axSpA) and mechanical spinal pain (i.e. Mechanical Neck pain -NP- or Mechanical Low Back pain -LBP-). Nevertheless, there is not enough evidence regarding if ROM and MMPs are different in both types of spinal pain.Objectives:To identify differences between axSpA patients and NP or LBP subjects, in cervical and lumbar ROMs and MMPs at rest.Methods:Subjects with axSpA and with NP or LBP composed the Inflammatory pain Group (IG) and the Mechanical pain Group (MG), respectively. For the analysis of the spinal mobility, two Inertial Measurement Units (IMU) were used. For both spinal regions (cervical and lumbar - Figure 1A,B) 3 repetitions of flexion-extension, lateral-flexion, and rotation were executed separately[1]. A record of the MMPs using a hand myotonometer was made in both lumbar (muscular belly of the erector spinal – Figure 1D) and cervical (the semispinalis capitis muscles at C4 - Figure 1C) spine in prone position with both arms along the body. The MMPs recorded in this study included: frequency (tone), stiffness, decrement (elasticity), relaxation and creep (viscosity). The order of assessments (right/left) was randomized. Since no side-to-side differences in either group were observed, the mean of both sides was considered. Student-t tests were used to compare the groups, and Cohen-d effect size index was estimated as a measure of the size of difference. PResults:61 subjects in IG (42% women, age 41±12 years, BMI 25±3) and 66 in MG (51% women, age 38±13 years, BMI 25±3) participated in this study. No significant differences were identified in sociodemographic data between both groups. Table 1 shows ROM and MMPs between groups. All lumbar ROMs were significantly lower in the IG, with the different between means achieving the minimum clinical important difference (>8°) for flexion-extension and lateroflexion. On the contrary, the cervical ROMs were not different between groups, and showed the highest variability, probably related to compensatory mechanisms due to lumbar ROMs restrictions. The IG showed greater Lumbar stiffness than the MG with large effect size (d=0.94). No other difference in MMPs was identified in this region (p>0.05). Regarding the cervical region, all MMPs showed differences between groups. Thus, tone, stiffness and elasticity were higher in the IG, while relaxation and viscosity were lower. In all cases, except for decrement, the effect size was from moderate to large (0.6Table 1.IG (n=61)MG (n=66)p-valueCohen-dLumbar flexion- extension (°)62.7 ± 20.270.8 ± 17.90.019 *0.42Lumbar rotation (°)25.6 ± 8.330.1 ± 10.10.007 *0.48Lumbar lateral-flexion (°)46.6 ± 12.354.8 ± 10.80.70Cervical flexion- extension (°)96.5 ± 21.696.2 ± 18.80.9410.01Cervical rotation (°)130.9 ± 27.3131.9 ± 25.60.8170.01Cervical lateral-flexion (°)66.4 ± 21.571.6 ± 15.60.1220.27Lumbar tone (Hz)15.32 ± 3.4014.52 ± 1.930.1290.29Lumbar stiffness (N/m)330.85 ± 56.93272.48 ± 65.590.001 *0.94Lumbar decrement1.33 ± 0.411.29 ± 0.320.4800.10)Lumbar relaxation (ms)19.11 ± 7.5820.23 ± 4.290.3120.18Lumbar creep1.16 ± 0.431.21 ± 0.220.5190.14Cervical tone (Hz)17.27 ± 1.9316.17 ± 1.840.001 *0.58Cervical stiffness (N/m)313.93 ± 54.17282.61 ± 50.070.001 *0.59Cervical decrement1.34 ± 0.231.42 ± 0.180.020 *0.39Cervical relaxation (ms)16.66 ± 2.5218.49 ± 2.740.69Cervical creep1.02 ± 0.141.13 ± 0.140.80Conclusion:AxSpA patients present lower lumbar ROMs than NP and LBP subjects. Further, posterior cervical MMPs of axSpA are more rigid and less viscoelastic than those of NP and LBP subjects. ROMs and MMPs show a different behavior pattern in cervical and lumbar regions when spinal pain from different origin is assessed.References:[1]Measuring Spinal Mobility Using an Inertial Measurement Unit System: A Validation Study in Axial Spondyloarthritis. Diagnostics 10(6):426Disclosure of Interests:None declared

Background:Esperanza was a multicenter national health program developed to facilitate an early diagnosis of patients with Spondyloarthritis (SpA) in Spain.Objectives:To compare the clinical evolution of patients with axial SpA (axSpA) and peripheral SpA (pSpA) included in this program.Methods:Patients from the Esperanza cohort fulfilling ASAS criteria for axSpA or pSpA and completed the 6-year follow-up were included. Patients were classified according to the predominant symptom. In case of having axSpA and pSpA, they were classified as axSpA. Clinical features, disease activity and treatment aspects at baseline and 6-year visit were evaluated.Results:From 775 patients recruited at baseline, 6-year follow-up data from 178 (83.5%) fulfilling ASAS criteria at the final visit were available: 133 (74.7%) for axSpA and 45 for pSpA (25.3%). 118 (66.3%) were males (50.6% with axSpA and 62.2%, pSpA, p=0.4). Patients with axSpA had more frequently positive HLA-B27 (90.5%) vs. (9.5%), pConclusion:The early diagnosis of recent-onset SpA achieves a significant improvement in clinical features, disease activity and quality of life in patients with axSpA and pSpA after 6 years of follow-up. Although previous publications revealed a low radiographic progression in this cohort1, the worsening of BASMI must aware clinicians of possible evolutive structural damage.Reference:[1]Fernández-Carballido et al. RMD Open. 2020 Sep;6(2):e001345Acknowledgements:The Spanish Foundation of Rheumatology received funding from Pfizer (formerly Wyeth) to develop the Esperanza Program. Later, the Program has been supported by restricted grants from the Instituto de Salud Carlos III and Fondos FEDER (FIS PI13/02034 and PI17/01840) and AbbVie.Disclosure of Interests:Carolina Tornero: None declared, Victoria Navarro-Compán: None declared, Beatriz Joven-Ibáñez: None declared, RAQUEL ALMODOVAR: None declared, Xavier Juanola-Roura: None declared, Cristina Fernández-Carballido: None declared, Juan Carlos Quevedo-Abeledo: None declared, Jose Rosas: None declared, Azucena Hernández: None declared, Carlos A. Montilla-Morales: None declared, Jose Ramón Maneiro: None declared, A. Juan-Mas: None declared, Jose Antonio Pinto Tasende: None declared, Mireia Moreno: None declared, Jesus Sanz: None declared, Teresa Ruiz Jimeno: None declared, Manuel Moreno: None declared, María Lourdes Ladehesa Pineda: None declared, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi., Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: Abbvie, Novartis, Pfizer.

Background:Comorbidities have been reported to be more prevalent in patients with Spondyloarthritis (SpA) compared to the general population. Previous studies have suggested that patients with peripheral phenotypes exhibit a higher prevalence of traditional cardiovascular risk (CV) factors compared to those with a predominantly axial phenotype. However, the role of psoriasis in such differences has not been deeply studied.Objectives:To compare the prevalence of comorbidities (CV, malignancies and osteoporosis (vertebral or peripheral fracture, or low bone mineral density)) between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities in the whole spectrum of SpA (including psoriatic arthritis).Methods:Patients from the cross-sectional ASAS-COMOSPA study were classified as having either axial (presence of sacroiliitis on x-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of arthritis, enthesitis or dactylitis). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial and peripheral with psoriasis/without psoriasis phenotypes) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and country as fixed and random effects, respectively. Multivariate analysis using were used to evaluate whether psoriasis and the phenotype are independently associated with each comorbidity.Results:A total of 3291 patients were included in this analysis (mean age 43.6 years, 65% males). The peripheral phenotype with psoriasis showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while axial phenotype without psoriasis exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%) (Table 1). Among patients with psoriasis, the axial phenotype showed a significantly [OR, 95%CI] lower prevalence of hypertension [OR 0.5, 0.4-0.8] and lower Framingham score [OR 0.97, 0.95-0.99] compared to peripheral patients even after adjusting for disease duration and country. Among patients with axial phenotype, patients with psoriasis showed higher prevalence of hypertension [OR 1.8, 1.4-2.2], dyslipidaemia [OR 2.0, 1.7-2.5], diabetes [OR 2.1, 1.4-3.0] and Framingham score [OR 1.0, 1.0-1.1] than non-psoriatic patients. Multivariate analysis confirmed that hypertension, dyslipidaemia and the Framingham score are independently associated with both the psoriasis and the peripheral phenotype.Prostatic cancer and colon cancer were independently associated with the presence of psoriasis but not with the phenotype. No differences were found across groups concerning osteoporosis.Conclusion:Both a peripheral phenotype and the presence of psoriasis were independently associated with an increased CV risk. Psoriasis seems to be associated with a higher prevalence of some malignant diseases, while osteoporosis do not seem to be associated with either phenotype or the presence of cutaneous involvement.Table 1.Description of comorbidities across the four groups.Psoriatic axialN = 460n (%)Non-psoriatic axialN = 2541n (%)Psoriatic peripheralN = 147n (%)Non-psoriatic peripheralN = 136n (%)p-value*BMI, mean (SD)27.4 (5.5)25.5 (5.5)27.3 (5.7)26.6 (5.3)Hypertension135 (29.5)487 (19.2)66 (44.9)25 (18.4)Dyslipidemia113 (24.8)359 (14.2)50 (34)23 (17)Diabetes37 (8.1)104 (4.1)13 (8.8)7 (5.2)Ischemic heart disease16 (3.5)51 (2)5 (3.4)2 (1.5)0.162Stroke11 (2.4)22 (0.9)3 (2)2 (1.5)0.028Framingham score, mean (SD)9.6 (8.7)6.6 (7.5)11.8 (8.8)5.8 (6)Prostatic cancer5 (1.8)5 (0.3)0 (0)0 (0)0.006Breast cancer (1.7)3 (0.4)1 (1.4)0 (0)0.181Colon cancer4 (0.9)4 (0.2)1 (0.7)1 (0.7)0.046Basal cell carcinoma6 (1.3)9 (0.4)1 (0.7)4 (3)Lymphoma0 (0)4 (0.2)3 (2)0 (0)*ANOVA or chi-square for continuous and qualitative variables, respectively.Acknowledgements:This study was conducted under the umbrella of the International Society for Spondyloarthritis Assessment (ASAS).Disclosure of Interests:None declared

Background:Patients diagnosed with Rheumatoid Arthritis (RA) have an increased risk of comorbidities and secondary mortality, in a large extent due to cardiovascular events.Objectives:To identify the frequency of comorbidity, mortality and variables related to its increase in a cohort of patients with rheumatoid arthritis established (RAE).Methods:Controlled cross-sectional observational study of a cohort of 188 patients with RAE a 10 year follow-up (5 years if not complete this period).Results:62.8% were women, mean age of patients at the time of inclusion was high 73.3 (+/-13.8) years and mean duration of disease was 12,8 (+/-6,99) years. Regarding CV risk factors, 26.6% smoked, 60.6% hypertension and 52.1 % diabetic. Regarding comorbidities, the most frequent were serious infections (45.2%), CVD (35.1%), Osteoporosis (31.9%), Depression (31.9%) and Kidney disease (26.6%). During follow-up, an improvement was observed inflammatory parameters and activity levels (p Conclusion:-The incidence of comorbidities in our cohort is similar to that described in the literature.-Relationship between mortality and CVD and severe infection is demonstrated.-The mortality rate observed is higher than that described in the literature, which be influenced by the advanced age of the patients in the cohort and high time evolution of RA.References:[1]Lee YK, Ahn GY, Lee J, Shin JM, Lee TH, Park DJ, Song YJ, Kim MK, Bae SC. Excess mortality persists in patients with rheumatoid arthritis. Int J Rheum Dis. 2021 Jan 19. doi: 10.1111/1756-185X.14058. Epub ahead of print. PMID: 33463890.[2]Mikuls, T. R. (2003). Co-morbidity in rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 17(5), 729-752.[3]Naz, S. M., & Symmons, D. P. M. (2007). Mortality in established rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 21(5), 871-883.Table 1.Student’s t test for paired data.VariablesBasal10 yearPDAS285,25 (15,08)2,89 (1,06)0,036VAS38,61 (36,45)26,93 (24,97)HAQ1,04 (0,79)0,88 (0,87)NSTJC4,96 (5,38)1,40 (2,57)SJC3,55 (3,69)0,72 (2,11)ESR (mm/h)31,47 (21,19)25,86 (18,47)CRP (mg/L)15,24 (16,13)9,41 (21,02)0,001Hemoglobin (mg/dL)13,44 (7,92)13,52 (7,64)NSGlucose (mg/dL)102,26(35,97)103,83 (37, 98)NSCholesterol (mg/dL)203,56 (46,11)195,65 (38,12)0,042LDL (mg/dL)123,91 (40,69)119,58 (33,89)NSHDL (mg/dL)56,73 (19,07)54,84 (20,38)NSTriglycerides (mg/dL)110,85 (60,77)113,44 (55,61)NSTable 2.Logistic regression model. Hosmer-Lemeshow Chi square 9.035 Gl 7 p 0.25. Likelihood ratio test Chi square 64.658 Gl 5 p VariableUnivariate analysisOR (IC 95%)pMultiivariate analysisFINAL MODELOOR (IC 95%)PDyslipidemia1,02 (0,47-2,23)0,965HT4,73 (1,79-12,48)0,002DM1,42 (0,59-3,44)0,438CV disease11,25 (4,45-28,44)< 0,00112,33 (3.89-39,04)< 0,001Hyperuricemia3,27 (1,39-7,65)0,006Thyroid disease0,56 (0,15-2,11)0,393Interstitial lung disease2,48 (0,77-7,99)0,1277,37 (1,48-36,84)0,015Osteoporosis2,38 (1,07-5,29)0,033Renal disease8,25 (3,41-19,97)< 0,0014,14 (1,34-12,80)0,014Depressión0,32 (0,12-0,84)0,0210,20 (0,06-0,74)0,015Solyd CA1,12 (0,44-2,87)0,809Hematologic CA0,999Amyloidosis2,65 (0,16-43,52)0,496Severe infecction6,22 (2,53-15,29)< 0,0015,59 (1,66-18,79)0,005COVID-19 infection1,31 (0,12-14,91)0,828Disclosure of Interests:None declared

Background:Psoriatic Arthritis (PsA) displays increased traditional cardiovascular (CV) risk factors, such as insulin resistance (IR), metabolic syndrome or obesity. Thus, it is an urgent need to treat and manage these cardiometabolic comorbidities associated. Some evidence points out that methotrexate could improve CV risk due to its anti-inflammatory properties, however the effect of PDE4 inhibitor treatment on CV risk have not been elucidated yet.Objectives:1) To evaluate the effect of conventional therapy and PDE4 inhibitor in PsA patients with high prevalence of cardiometabolic comorbidities. 2) To identify a molecular patient profile susceptible of being benefit from each therapy regarding disease activity and CV risk.Methods:Thirty biological-naïve patients with PsA were treated with the PDE4 inhibitor (Apremilast), Methotrexate or combined therapy (Apremilast and Methotrexate) following the clinical routine practice for 6 months. A cohort of 30 age and sex-matched healthy donors (HDs) was included. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of patients and HDs. Different parameters related to the cardiometabolic risk were analyzed, including: atherogenic index, ratio apolipoprotein B (apo B)/apolipoprotein A (apo A), insulin resistance (IR), metabolic syndrome, obesity, arterial hypertension, and the SCORE. Clinical and analytical parameters were collected: lipid profile (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, apo A and apo B), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAPSA, C-reactive protein and erythrocyte sedimentation rate. A panel of 92 proteins involved in cardiovascular disease (cardiovascular panel II, Olink) and an adipocytokine profile was measured in plasma and PBMCs. Hard cluster analysis was carried out in order to identify two distinctive molecular phenotypes depending on the treatment response related to the reduction of CV risk.Results:Among the 92 CV-related proteins, the higher levels of two molecules, CD163 and FABP4 observed in PsA patients compared to HDs, were strongly associated with elevated rates of CV risk factors such as apolipoprotein B/A and atherogenic risks, metabolic syndrome, obesity, IR, arterial hypertension and smoking. Thus, we could identify two clinical profiles of patients according to the plasma levels of these molecules: cluster 1 defined by 20 patients with low levels of CD163 and FABP4 and low prevalence of CV comorbidities and cluster 2 defined by 10 patients with high levels of CD163 and FABP4 and high prevalence of CVD comorbidities. Regarding cluster 2, those patients that were treated with Apremilast or combined therapy had a significant reduction of CD163 and FABP4 associated with a drop in total cholesterol, apo B, IR state and body mass index. In addition, both PDE4 inhibitor and combined treatment reduced activity disease. However, Methotrexate in monotherapy did not show a beneficial effect in PsA patients displaying higher levels of CD163, FABP4, total cholesterol and no changes in disease activity after treatment. In regard to cluster 1, the three therapy strategies reduced disease activity after 6 months. Even with low rates of comorbidities, those patients treated with Apremilast had reduced levels of total cholesterol and apolipoprotein B and body mass index after 6 months of therapy. However, no changes were observed in the treatment with Methotrexate or Methotrexate combined with Apremilast.Conclusion:1- CD163 and FABP4 could be considered as potential biomarkers of treatment efficacy regarding cardiometabolic comorbidities. 2- Apremilast might target metabolic alterations in PsA modulating lipid profile, insulin resistance and body mass index, decreasing the levels of surrogate CV-related molecules. 3- Apremilast treatment should be considered in PsA patients with higher rates of cardiometabolic comorbidities.Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.Disclosure of Interests:None declared.

Background:The harmful effect of smoking on axial spondyloarthritis (axSpA) in relation to radiographic progression is well known, but there are controversies around the role of cigarettes in other manifestations of SpA, such as peripheral involvement. Besides, it has been observed an inverse association between alcohol consumption and disease activity and functional impairment1, although it is still unclear its association with peripheral manifestations of SpA.Objectives:To evaluate the association between smoking/alcohol intake and the prevalence of peripheral articular manifestations (arthritis, enthesitis or dactylitis).To assess the association between smoking/alcohol intake and the location of such manifestations.Methods:Patients from the cross-sectional ASAS-PerSpA study with available data for both the smoking status and alcohol intake were included. Mixed logistic regressions using the peripheral manifestation (or location) as dependent variable, the smoking status or alcohol intake as fixed effect and the country as random effect were used. The interaction between smoking and alcohol was tested.Results:A total of 4451 patients with either axSpA, peripheral SpA or Psoriatic Arthritis were included. 59.5% had smoked at any moment and 42.7% had been alcohol drinkers. Patients who had ever suffered arthritis showed lower frequency of smoking habit (OR 0.72, 95%CI 0.63-0.82) and lower alcohol intake (OR 0.82, 95%CI 0.71-0.94) (Table 1). Among patients with arthritis, smoking was associated with predominantly upper limbs vs. lower limbs involvement (OR 0.78, 95%CI 0.65-0.94), while alcohol was associated with predominant mono/oligoarticular vs. polyarticular involvement (OR 1.13, 95%CI 0.94-1.36).Patients who had ever suffered enthesitis also showed lower frequency of smoking habit and alcohol intake (OR 0.75, 95%CI 0.63-0.89 and OR 0.69, 95%CI 0.57-0.83, respectively). No association was found with regard to the prevalence of dactylitis.At the moment of the study visit, 20.4% patients were current smokers and 32.2% consumed alcohol. Current alcohol intake was associated with lower prevalence of current arthritis (26.9% vs. 33.6% (OR 0.76, 95%CI 0.64-0.91) and current enthesitis (21.1% vs. 34.6% (OR 0.78, 95%CI 0.62-0.96), while current smoking did not show significant differences.No interaction was found in the association between alcohol and tobacco with regard to the prevalence of peripheral symptoms in the past. However, when assessing current arthritis, current smoking and no drinking was associated with arthritis in the lower limbs.Conclusion:These results suggest that, taking into account the country, smoking and alcohol are associated with lower prevalence of peripheral manifestations (arthritis and enthesitis), with no interaction effect between both habits. Smoking seems to be associated with predominantly upper limbs arthritis while alcohol intake seems to be associated with a predominantly oligo/mono articular involvement. Future studies are required including the influence of psoriasis and psoriatic arthritis in the relationship between alcohol and smoking and its association with peripheral manifestations.References:[1]Zhao S, Thong D, Duffield SJ, et al. Alcohol and disease activity in axial spondyloarthritis: a cross-sectional study. Rheumatol Int 2018. 38(3):375-381.Table 1.Association between peripheral musculoskeletal manifestations and smoking and alcohol.Peripheral joint disease with objective signs in the pastPeripheral enthesitis with objective signs in the pastDactylitis in the pastYes 2292No 2169OR (95%CI)*Yes 765No 3696OR (95%CI)*Yes 685No 3776OR (95%CI)*Smoker ever887 (38.7%)1013 (46.7%)OR 0.72312 (40.8%)1588 (43.0%)OR 0.75277 (40.4%)1623 (43.0%)OR 0.89(0.63-0.82)(0.63-0.89)(0.75-1.06)Alcohol ever929 (40.4%)882 (40.7%)OR 0.82276 (36.1%)1535 (41.5%)OR 0.69299 (43.6%)1512 (40.0%)OR 1.01(0.71-0.94)(0.57-0.83)(0.84–1.22)*Mixed logistic regression using the country as a random effect.Disclosure of Interests:None declared.

Background:Anterior uveitis (AU) is one of the most frequent extra articular manifestations of axial spondyloarthritis (axSpA), present in around 25% of patients. As with axSpA, AU has also been associated with the development of accelerated atherosclerosis1. If the presence of AU confers an increased cardiovascular (CV) risk or specific disease-related features to patients with axSpA remains unclear.Objectives:To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without AU.Methods:Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant uveitis. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.Results:A set of 886 axSpA patients were included. 709 (80.0%) of them had no history of concomitant AU, which was present in the remaining 177 (20.0%). The group with AU was older (50 ± 11 vs 48 ± 13 years, p=0.05), had a higher proportion of patients with AS (90.1% vs 76.3%, p=0.00) (Table 1) and a longer disease duration 13(7-23) vs 7(2-16) years, p=0.00]. The prevalence of HLA-B27 was higher in AU patients (82% vs 67%).Remarkably, structural damage showed interesting differences between both groups (Table 1). AU patients had a higher prevalence of severe sacroiliits (69% vs 49%, p=0.00), which remained significant after adjustment for age, disease duration and AS/nr-axSpA ratio. Furthermore, a non-significant trend towards a higher prevalence of syndesmophytes (44% vs 36%, p=0.06) and hip involvement (20% vs 15%, p=0.09) was observed in the group of AU.Regarding CV risk features, no differences were observed in the prevalence of CV risk factors and events (Table 1). Patients with AU showed a higher cIMT in the crude analysis (665 ± 156 mm vs 640 ± 142 mm, p = 0.047), but no significant differences were observed after adjustment by age and sex (p=0.6). Prevalence of carotid plaques was comparable in both groups (32% Vs 32%, p=0.84).Table 1.axSpA without uveitis (n=709)axSpA with uveitis (n=177)pP (adjusted model)Men/Women, n477/232122/550.68Mean age (years) ±SD at the time of study48 ± 1350 ± 110.049AS/nr-AxSpa541/168160/170.000History of CV risk factors, n (%) Current smoker247 (35)50 (28)0.096 Obesitty Dyslipemia233 (33)63 (36)0.48 Hypertension188 (27)50 (28)0.63 Diabetes Mellitus50 (7)14 (8)0.69 Chronic Kidney Disease18 (3)4 (2)0.99History of cardiovascular events, n (%)29 (4)12 (7)0.13Structural damage at the time of studyPresence of syndesmophytes, n (%)253 (36)77 (44)0.063mSASSS5 (1-15)6 (0-16)0.31Severe sacroiliitis (grade 3,4), n (%)348 (49)122 (69)0.0000.000*Carotid US data at the time of studyCarotid plaques, n (%)225 (32)57 (32)0.84IMT (mm)640 ± 142665 ± 1560.0470.6**IMT >= 0.900 mm36 (5)10 (6)0.72*: adjusted by age, disease duration and AS/nr-axSpA ratio**: adjusted by age and sexAbbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.Conclusion:The presence of AU does not confer additional CV risk to axSpA patients, although it is associated with a more severe structural damage in our series.References:[1]Conkar S, Güven Yilmaz S, Koska İÖ, Berdeli A, Mir S. Evaluation of development of subclinical atherosclerosis in children with uveitis. Clin Rheumatol. 2018 May;37(5):1305-1308.Disclosure of Interests:None declared

Background:The presence or absence of marrow bone edema (MBE) in the sacroiliac joints (SIJ) is very important in the diagnosis of axial Spondyloarthritis (axSpA). The quantification of this lesion and its extension may be important to analyze responsiveness of the treatment. Several scoring systems have been proposed for MRI images of SIJ, some of them being observer dependent (Berlin, SPARCC). Others, works in a semi-automatically way, such as the s-SCAISS[1], which makes it possible to quantify the size of the lesion, based on the indication of the expert. Recently, methods like the KITs4R[2], based on a deep patch-based classification network. allow a fully automated detection and quantification of the MBE lesions.Objectives:To analyze responsiveness of several scores (observer independent, semiautomatic and full automatic) for quantify MBE in SIJ of axSpA patients.Methods:Two rheumatologists independently quantified SIJ images from axSpA patients by visual inspection methods (Berlin and SPARCC indexes) and a semiautomatic system (s-SCAISS) on a single semi-coronal MRI slide (STIR). Full semi-coronal MRI images (15 to 18 slices) were used for an automatic detection algorithm (KITs4R), where total MBE was calculated as sum of areas of MBE in each slice. Patients were assessed before TNF-α therapy (PRE) and 3 months later (POST). Spearman correlations was used to analyze relationship between variables, Wilcoxon signed-rank test for significant differences and Cohen’s d for calculating the effect size of improvement. Figure 1 shows processing of the MRI images: A) Area of MBE selected by the SCAISS, when the rheumatologist “click” on each MBE; B) Lesions detected automatically by KITs4R; C) Automated deep segmentation of bones and subchondral regions (with split into quadrants with central axes of joints also shown. D) Superposed A, B and C images.Results:12 axSpA patients were recruited from the CASTRO cohort (42% female, age 46±11 years, disease duration 16±13 years, BMI 28±5). Results PRE and POST are shown in Table 1: mean values (sd), statistical significance (NS, not significant; *, p0.8;p0.7;pPREPOSTSignESBASDAI6.12 (2.45)4.96 (2.74)N.S.0.44-SmallASDAS3.61 (1.04)2.58 (1.25)*0.89-LargeCRP11.26 (8.93)4.81 (4.08)**0.84-LargeBERLIN2.58 (1.98)1.17 (1.85)**0.74-MediumSPARCC3.92 (3.42)1.58 (2.43)**0.69-MediumSCAISS295 (332)95 (163)**0.68-MediumKITs4R1671 (1596)258 (421)**1.04-LargeNS, not significant; *, pConclusion:All MRI scores have good level of agreement between them and good responsiveness. Berlin and SPARCC are observer dependent, and do not quantify the extension of the MBE area. s-SCAIS helps to this quantification. KITs4R is not observer dependent but clinimetric validation, analizing agreement level with human expert, is necessary. New advanced tools are improving quantitative and objective measurement of BME which is important to analyze responsiveness.References:[1]Development and validation of SCAISS, a tool for semi-automated quantification of sacroilitis by magnetic resonance in spondyloarthritis. Rheumatol Int. 2018 Oct;38(10):1919-1926.[2]The semi-automated algorithm for the detection of bone marrow oedema lesions in patients with axial spondyloarthritis. Rheumatol Int. 2020 Apr;40(4):625-633.Disclosure of Interests:None declared.

Background:Patients with axial spondyloarthritis (axSpA) may present with concomitant psoriasis (Ps) in approximately 10% of cases. As with axSpA, Ps is also associated with an accelerated atherosclerosis process1. However, it is unknown whether the presence of Ps confers an increased cardiovascular (CV) risk in patients with axSpA.Objectives:To compare factors related to the disease, CV risk factors, atherosclerotic burden, and CV events in patients with axSpA with and without Ps.Methods:Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA. We compared axSpA patients with and without concomitant psoriasis, focusing mainly on CV risk characteristics. Background information on CV risk factors, CV events, and disease-related factors was reviewed, and data on maximum body index, blood pressure, lipid profile, and disease status at the time of the study were also obtained. Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.Results:A set of 882 axSpA patients were included. 786 (89.1%) of them had no concomitant Ps, which was present in 96 (10.9%) patients. Although the mean age was similar, male sex was more prevalent in axSpA patients with Ps (79.1% Vs 66.5%, p=0.01) (Table 1).Furthermore, it was found that axSpA with Ps had a more frequent history of synovitis (50% vs 33%, p = 0.001), dactylitis (13% vs 6%, p = 0.011) and concomitant inflammatory bowel disease (13% vs 6%, p = 0.01). AxSpA patients with Ps had a non-significant trend towards a higher prevalence of asymmetric sacroiliitis (23 vs 16%, p = 0.064) and had a lower frequency of positive HLA-B27 status (56% vs 72%, p = 0.003). Regarding the management of the disease, prednisone (23% vs 12%, p = 0.02), methotrexate (30% vs 15%, p = 0.000) and anti-TNFα therapy (50% vs 34%, p = 0.002) were more commonly used in the group with Ps.Regarding CV risk characteristics, no differences were observed either in the prevalence of traditional CV risk factors (Table 1), nor in the total serum level, HDL and LDL, blood pressure and body mass index at that time of the study. However, axSpA patients with Ps showed a higher prevalence of CV events (9% vs 4%, p = 0.05), including ischemic heart disease (6% vs 3%, p = 0.042) and ischemic stroke (4% vs 1%, p = 0.016) (Table 1). The subclinical atherogenic burden was also more severe in the group with Ps, with a higher prevalence of carotid plaques (39% vs 31%, p = 0.098), and higher values of cIMT (0.664 ± 0.170 mm vs 0.642 ± 0.142 mm, p = 0.16), although the differences did not reach statistical significance.Table 1.Main sociodemographic and cardiovascular differences among axSpA patients with and without psoriasis.axSpA without psoriasis (n=786)axSpA with psoriasis (n=96)pMen/Women, n523/26876/200.010Mean age (years) ±SD at the time of study49 ± 1349 ± 130.81AS/nr-AxSpa625/16677/190.79History of CV risk factors Current smokers267 (34)30 (31)0.60 Obesitty174 (22)26 (27)0.29 Dyslipidemia262 (33)35 (36)0.48 Hypertension211 (27)28 (29)0.57 Diabetes Mellitus56 (7)8 (8)0.65 Chronic Kidney Disease19 (2)3 (3)0.72History of cardiovascular events, n (%)33 (4)9 (9)0.023 Ischemic heart disease20 (3)6 (6)0.042 Congestive heart failure2 (0)1 (1)0.29 Ischemic stroke6 (1)4 (4)0.016 Peripheral artery disease6 (1)0 (0)0.99CV data at the time of studyCarotid plaques244 (31)38 (39)0.098IMT mm0.642 ± 0.1420.664 ± 0.1700.16IMT >= 900 mm40 (5)6 (6)0.66Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.Conclusion:The presence of Ps may confer additional CV risk to axSpA patients and is associated with particular disease related factors.References:[1]Fang N, Jiang M, Fan Y. Association Between Psoriasis and Subclinical Atherosclerosis: A Meta-Analysis. Medicine (Baltimore). 2016;95(20):e3576.Disclosure of Interests:None declared.

Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with an increased prevalence of cardiovascular (CV) events. Traditional CV risk factors do not account for the increased CV disease mortality in PsA. Inflammation seems to have a key role in the development of this comorbidity, however the specific molecular mechanisms involved are not defined yet.Objectives:To evaluate clinical CV risk factors and surrogate markers and their relationship with inflammation, disease activity and metabolic comorbidities in PsA patientsMethods:This is a cross-sectional study including 100 PsA patients without CV disease recruited in the routine clinical practice at the Rheumatology Department, Reina Sofia Hospital of Cordoba and 100 age-matched healthy donors (HDs). Different parameters related to the cardiometabolic risk were analyzed. Clinical and analytical parameters were collected: lipid profile (cholesterol, HDL, LDL, TG, ApoA and ApoB), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAPSA, VAS, CRP and ESR. To measure the persistence of inflammation, CRP levels were recorded retrospectively once, twice, or three times during the 5 years prior to study and at the moment of the study. Increased levels of CRP in at least 50% of the determinations was considered as persistent inflammation. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of patients and HDs. A panel of 92 proteins involved in CV disease and an adipocytokine profile was measured in plasma and PBMCs. In addition, activation of 18 intracellular pathways involved in cell activation was also measured in PBMCs. In vitro experiments in adipocytes treated with serum from PsA patients were also carried out.Results:Traditional CV risk factors including atherogenic risk, insulin resistance (IR), metabolic syndrome, smoking, obesity, arterial hypertension, apolipoprotein B/A risk, type 2 diabetes mellitus and the levels of SCORE were significantly increased in PsA patients. The presence of IR was associated with disease activity markers (DAPSA, ESR and CRP). In fact, the HOMA-IR index was related to the CRP persistence. PsA patients with obesity had significantly increased the number of tender and swollen joints, the levels of DAPSA and CRP. Twenty-eight proteins involved in CV disease and six adipocytokines were significantly elevated in the plasma of PsA patients. Several of these cardiovascular molecules were associated with higher levels of DAPSA (CTSD, GAL3, CD163, FABP4, IL6 and IL1RT2), acute phase reactants (GAL3, TNFα, Adiponectin, TNFR1 and IL6), affected body surface area (IL2RA, GAL3, CCL15, TRAP, CSTB, CD163, OPG and CNTN1) and onychopaty (TRAP, VWF, MCP-1, GAL3, LTBR, TFPI, CHI3L1, CTSZ and JAM-A). In addition, the mRNA expression of most of those 28 CV molecules were significantly increased in PBMCs from PsA patients. At intracellular level, the activation of 11 kinases (ERK1/2, AKT, S6 Ribosomal, mTOR, HSP27, Bad, p70 S6 kinase, PRAS40, p53 and caspase-3) involved in insulin signaling, inflammation, cell survival and apoptosis were altered in PBMCs. Finally, serum from PsA patients was able to modify the expression of these molecules in adipocytes.Conclusion:1) Disease activity and inflammatory burden are closely associated with the presence of metabolic alterations, specifically obesity and IR in patients with PsA. 2) The development of IR is extremely related to the persistence of CRP levels in the previous 5 years. 3) Inflammation is closely associated to the adipose tissue dysfunction in PsA and 4) FABP4, CD163 and GAL3 are surrogate CV markers commonly associated with clinical features of PsA, suggesting the role of these molecules linking CVD and PsA pathogenesis.Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.Disclosure of Interests:None declared.

Background:It has been shown that the cardiovascular risk (CV) in spondyloarthritis (SpA) patients is higher than that of the general population. Furthermore, an association has recently been described between structural damage at the axial level and an increase in estimated CV risk 1.Objectives:To evaluate the association between the estimated cardiovascular risk (CV) and the presence of subclinical atherosclerosis with the MASEI index (Madrid Sonographic Enthesis Index) in patients with axial spondyloarthritis (Ax-SpA) as an expression of peripheral enthesitis.Methods:Cross-sectional study performed in 103 patients with ax-SpA from the Córdoba AxSpA Task force, Registry and Outcomes (CASTRO), in which patients undergoing treatment with biological therapy and with a previous history of CV event were excluded. Clinical data, disease activity data and factors related to CV risk were collected, as well as the presence of persistently elevated CRP levels in the five years prior to the study visit. The SCORE index was calculated, as well as the thickness of the carotid intima media (CIMT) and the MASEI index, both measured by ultrasound. The association between MASEI-SCORE and MASEI-atheroma plaques was evaluated using generalized linear models (GLM), adjusted for time of evolution of the disease, disease activity and smoking.Results:Of the patients included, 35 were men (34.0%), with a mean age of 45.2 (±12.1) years and time of evolution of the disease of 18.5 (±13.0) years. The mean MASEI score was 13.6 (±9.1), and the mean SCORE score was 8.1 (±8.9). The GLM regressions showed that the MASEI was independently associated with the SCORE (coefficient β 0.22; 95% CI 0.02-0.43) adjusted for the duration of the disease, smoking, and the presence of persistent CRP (Table 1A). The MASEI index was also significantly associated with the CIMT, although these differences disappeared when the model was adjusted for other factors (Table 1B).Table 1.A. Association between MASEI and SCORE adjusting for disease duration, smoking status and CRP.Crude modelAdjusted for disease durationAdjusted for disease duration and smokingAdjusted for disease duration, smoking and CRPβ coefficient (95%CI)p-valueβ coefficient (95%CI)p-valueβ coefficient (95%CI)p-valueβ coefficient (95%CI)p-valueMASEI0.37 (0.20-0.55)0.25 (0.08-0.42)0.0060.25 (0.09-0.42)0.0040.22 (0.02-0.43)0.039Conclusion:In patients with ax-SpA, peripheral enthetic damage measured by the MASEI index is associated with an increase in estimated CV risk independently of the time of evolution, smoking and levels of CRP.References:[1]Ladehesa-Pineda ML, Arias-de la Rosa I, López-Medina C, et al. Assesment of the relationship between estimated cardiovascular risk and structural damage in patients with axial spondyloarthritis. Ther Adv Musculoskelet Dis 2020;12:1-15Table 1.B. Association between MASEI and intima media thickness (IMT) adjusting for disease duration, smoking status and CRP.Crude modelAdjusted for disease durationAdjusted for disease duration and smokingAdjusted for disease duration, smoking and CRPβ coefficient (95%CI)p-valueβ coefficient (95%CI)p-valueβ coefficient (95%CI)p-valueβ coefficient (95%CI)p-valueMASEI0.01 (0.00-0.01)0.0410.003 (-0.01-0.004)0.1780.002 (-0.001-0.004)0.1490.002 (-0.001-0.005)0.226Disclosure of Interests:None declared.

Background:Spinal mobility is an important assessment outcome in axial spondyloarthritis (axSpA). Until now, conventional metrology (Schober test, lateral flexion, BASMI, …) has been used to assess spinal mobility, however, new technologies have been developed that provide better accuracy, reliability and responsiveness. Motion capture has been validated and Inertial Measurement Unit (IMU) sensors, appears to be a promising alternative. To use this IMU sensors in axSpA patients, wireless systems must be developed and validated allowing to doctors and patients to use them in hospitals and at home.Objectives:To develop an easy to use mobile app and IMU sensors system for analyse mobility for axSpA patients.Methods:A mobile app has been developed (iUCOTrack) that communicates with two IMU sensors (Shimmer 3©, Fig-a). These sensors are attached in different locations: at forehead and T12 for cervical mobility (Fig-c) and T12 and Sacrum for thoracolumbar mobility (Fig-b). The app provides mobility results for the different tests (Fig-d) and store results in the cloud. Validation tests of these sensors, using Matlab©, were done previously [1]. Our study test the validity of this app against a motion capture system, the UCOTrack®, and its metrology index, the UCOASMI [2], and conventional metrology as reference standards. Patiens with axSpA were recruited consecutively from the COSPAR cohort. Conventional metrology, PRO questionnaires and mobility (Cervical and thoracolumbar - flexion, lateral bending, rotation) using the iUCOTrack app and the UCOTrack were registered. Intraclasss Correlation Coefficients (ICC 3,1) between systems and correlations (spearman) with other axSpA outcome measures were performed for testing validity.Results:15 axSpA patients (47% female, age 52±12 years, disease duration 21±16 years) were included. Table shows ROM (SD) in degrees obtained for cervical and thoracolumbar spine measured by motion capture (UCOTrack) and the app (iUCOTrack). In the last column appears the UCOASMI (SD) calculated using angles obtained by each system. All ICC were good (ICC>0.8), and correlations were significant (p0.8) specially the UCOASMI. Cervical rotation using a goniometer was 106.2±36°, with a significant correlation with both systems (p0.8). Schober correlation with lumbar flexion was poor (NS;r>0.5) but a good correlation appeared with lateral flexion (p0.9). Mean BASMI was 4.0± 1.8 with an excellent correlation with UCOASMI measured by Mocap (pCervicalThoracolumbarFlexRotLatFlexRotLatUCOASMIUCOTrack79.5(24.7)109.8(29.6)62.5(25.1)100.7(21.6)61.8(25.3)54.7(22.9)6.07(1.66)iUCOTrack83.0(33.6)112.6(44.3)73.9(29.7)114.4(28.1)51.4(16.1)59.4(15.4)6.15(1.65)ICC0.8640.9030.8120.9360.7980.9010.970Corr0.89*0.96**0.82*0.97**0.88*0.97***0.97**Conclusion:New metrology tools are needed to improve features of convencional metrology. Motion Capture has proved to be valid but has feasibility problems. IMU sensor based systems provide similar results to motion capture but it can be faster and cheaper. A system based on mobile app connected to wireless IMU sensors could be a solution to improve metrology in axSpA. Further studies and developments are needed to introduce these technologies in research and clinical daily practice.References:[1] Use of inertial sensors for the assessment of spinal mobility in axial spondyloarthritis patients. Rehabilitacion. 2018 Apr;52(2):100-106.[2] High Reproducibility of an Automated Measurement of Mobility for Patients with Axial Spondyloarthritis. J Rheumatol. 2018 Oct;45(10):1383-1388.Acknowledgments:Funded by Junta de Andalucia (PIN-0079-2016) and ISCIII (DTS18/00046).Disclosure of Interests:Juan L. Garrido-Castro: None declared, Francisco Torres Vidal: None declared, MLourdes Ladehesa Pineda: None declared, María del Carmen Castro Villegas: None declared, Inmaculada Concepcion Aranda-Valera: None declared, Rafaela Ortega Castro: None declared, Cristina Gonzalez-Navas: None declared, Eduardo Collantes Estevez Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene

Background:Uveitis is one of the most usual extraaxial manifestations of spondyloarthrities (SpA) but the impact of the date of the onset is no well-known.Objectives:a) To assess the prevalence of acute anterior uveitis (AAU) in the Spanish population with SpA; b) To describe the time of appearance of the AAU regarding to the onset of rheumatic symptoms and SpA diagnosis; c) To evaluate the impact of the moment of appearance of the AAU on the treatment and disease activity.Methods:A cross-sectional study with data extracted from REGISPONSER registry. First, the prevalence of AAU was determined. Patients were classified as AAU before/ concomitant/ after the onset of rheumatic symptoms and as AAU before/ concomitant/ after the SpA diagnosis regarding the date of appearance of each symptom and SpA diagnosis. Treatment and disease activity were compared between ‘AAU before or concomitant with rheumatic symptoms’ vs. ‘AAU after rheumatic symptoms’ groups, as well as ‘AAU before or concomitant with SpA diagnosis’ vs. ’AAU after the SpA diagnosis’ groups using Chi-square and T-Student tests.Results:Among the 2346 patients included in REGISPONSER, 379 (16.2%) had at least one episode of AAU. Information concerning the date of occurrence of rheumatic symptoms and SpA diagnosis was available in 280 and 284 patients, respectively. A total of 28 (9.7%), 31 (10.8%) and 229 (79.5%) patients suffered the first episode of AAU before, concomitantly and after the rheumatic symptoms, respectively; while 108 (38.0%), 38 (13.4%) and 138 (48.6%) suffered the episode of AAU before, concomitantly and after the SpA diagnosis, respectively. The comparison of patients with ‘AAU before or concomitant with rheumatic symptoms’ vs ‘AAU after rheumatic symptoms’ (Table 1), showed in the second group a younger age of symptoms onset, a greater diagnosis delay, higher disease activity (CRP and BASDAI), greater structural damage (BASRI). No significant differences were found in the use of biological (27.9% vs. 23.2%) or synthetic DMARDs (14.8% vs. 20.3%). The comparison of ‘AAU before or concomitant with the SpA diagnosis’ vs. ‘AAU after the SpA diagnosis’ groups (Table 1) showed similar results to the previous ones with no significant differences were obtained in the use of biological (28.8% vs 20.4%) or synthetic (17.2% vs 20.4%) DMARDs.Conclusion:These results suggest that patients who presented the first episode of AAU prior to the onset of rheumatic symptoms showed a later start of the disease with a shorter diagnosis delay, lower disease activity and less structural damage.AAU regarding the rheumatic symptoms onset (n=280)AAU regarding the SpA diagnosis (n=284)Before or concomitantN = 61 (%)AfterN = 229 (%)pBefore or concomitantN = 146 (%)AfterN = 138 (%)pGender (male)32/61 (52,5%)160/229 (69,9%)NS88/146 (60,3%)100/138 (72,5%)NSAge of symptoms onset (years), mean (SD)31,02 (9,12)24,49 (9,89)27,01 (9,77)24,66 (9,65)0,042Diagnosis delay (years), mean (SD)3,00 (4,98)9,68 (10,73)10,90 (11,76)5,59 (7,32)Clinical classificationAxial40/61 (65,%)144/228 (62,9%)NS96 (66,2%)85 (61,6%)NSPeripheral4/61 (6,6%)9/228 (4,0%)NS7 (4,8%)4 (2,9%)NSMixed17/61 (27,9%)75/228 (32,9%)NS42 (29%)47 (34,1%)NSHLAB27+50/57 (87,7%)195/213 (91,5%)NS119/135 (88,1%)121/130 (93,1%)NSESR (mm/h), mean (SD)16,47 (12,88)18,04 (16,34)NS17,44 (15,57)18,41 (16,27)NSCRP (mg/l), mean (SD)5,57 (9,63)8,96 (11.62)0,0446,82 (9,88)9,86 (12,65)0,031BASDAI, mean (SD)3,57 (2,25)4,31 (2,33)0,0273,92 (2,30)4,42 (2,37)0,073Spinal BASRI, mean (SD)3,00 (2,63)6,06 (3,58)4,99 (3,31)5,60 (5,45)NSDisclosure of Interests:Gómez García Ignacio: None declared, Clementina López-Medina: None declared, MLourdes Ladehesa Pineda: None declared, María del Carmen Castro Villegas: None declared, Pérez Sánchez Laura: None declared, María Ángeles Puche Larrubia: None declared, José Miguel Sequí-Sabater: None declared, Font Ugalde Pilar: None declared, Rafaela Ortega Castro: None declared, Alejandro Escudero Contreras Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene., Eduardo Collantes Estevez Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene

Background:The presence of inflammatory signals in sacroiliac joints (SIJ), using MRI, is used for early diagnosis of axial spondyloarthritis (axSpA)[1]. Some studies also demonstrate that this inflammation can be suppressed quite dramatically by TNF-α blockers. Different scoring methods to quantify inflammatory changes in SIJ using MRI have been defined and validated: SPARCC, Leeds, Berlin, and ASSpiMRI-a. However, its use is complex and subjective. Recently Zarco et al[2] developed a method to measure bone marrow edema (BME) in MRI images from SIJ. This method, in a semiautomatic procedure, allows to measure the area affected by inflammation and the signal intensity to produce an index: the SCAISS. A simplified version, the s-SCAISS, using only a semi-coronal slide, has been proposed with good validity and reliability results.Objectives:To assess responsiveness of inflammation in SIJ of axSpA patients, treated with TNF-α inhibitors, using a novel score method: the s-SCAISS.Methods:Two rheumatologists independently quantified SIJ images from axSpA patients by three methods (s-SCAISS, SPARCC and Berlin) on a single semi-coronal MRI slide (STIR). Patients were assessed before TNF-α therapy (PRE) and 3 months later (POST). Spearman correlations was used to analyze relationship between variables, Wilcoxon signed-rank test for significant differences and Cohen’s d for calculating the effect size of improvement. Figure shows MRI images of a patient before and after treatment.Results:9 axSpA patients were recruited from the COSPAR cohort (44% female, age 47±13 years, disease duration 18±14 years, BMI 29±4). Results PRE and POST are shown in Table: mean values (sd), statistical significance (NS, not significant; *, pPREPOSTSignE.S.Area71.33 (66.71)20.89 (39.02)**0.86-Larges-SCAISS118.67 (114.6)27.78 (51.09)**0.98-LargeBERLIN2.33 (1.66)0.67 (1.12)**1.14-LargeSPARCC3.11 (2.26)0.78 (1.39)**1.18-LargeCRP13.1 (9.4)4.1 (3.2)**0.90-LargeBASDAI6.5 (1.7)4.4 (2.7)*0.84-LargeBASFI6.3 (2.6)4.1 (3.4)*0.69-MediumASDAS3.6 (1.0)2.3 (1.2)**1.15-LargeBASDAS3.7 (1.1)2.6 (1.3)*0.96-LargeBASMI3.6 (1.5)3.3 (1.3)NSConclusion:Different methods exist for quantifying inflammation in MRI images of SIJ in axSpA patients. According to our preliminary results, all of them had significant improvements in axSpA patients treated with anti tnf-α. The s-SCAISS index show good responsiveness, with similar features to validated indexes, but with an accuracy assessment of the BME area.References:[1]Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Annals of the Rheumatic Diseases 2016;75:1958-1963.[2]Development and validation of SCAISS, a tool for semi-automated quantification of sacroilitis by magnetic resonance in spondyloarthritis. Rheumatol Int. 2018 Oct;38(10):1919-1926.Disclosure of Interests:Cristina Garrido-González: None declared, María del Carmen Castro Villegas: None declared, MLourdes Ladehesa Pineda: None declared, Juan L. Garrido-Castro: None declared, Rafaela Ortega Castro: None declared, Cristina Gonzalez-Navas: None declared, Pedro Zarco-Montejo Speakers bureau: Abbvie, MSD, Novartis, Pfizer., RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer., Angel Bueno: None declared, Luis Miguel Molinero: None declared, Eduardo Collantes Estevez Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene

Background The objectives of Rheumatoid Arthritis (RA) treatment comprise achieving persistent Clinical Remission (CR) or sustained low clinical activity. Nowadays management follows a “treat to target” strategy based on adjustment of treatment in accordance with protocolos. In patients with persistent disease activity after treatment with at least two of the classic disease-modifying antirheumatic drugs the use of biological therapy is recommended. Once sustained CR is achieved, the most efficient strategy is optimisation, by tapering the dose of the biological therapy or by increasing administration intervals. Searching for the lowest effective dose for each patient could minimise the risk of adverse effects and improve the cost-effectiveness of RA treatment. Objectives To proof that the performance of an optimisation strategy in patients with RA and sustained CR under biological treatment maintains the proportion of patients with DAS28 ≤2,6 after 4 years, to assess the maintenance of the effectivenes of the optimisation at 4 years in terms of clinical manifestations, and to analyse the time until relapse. Methods An open observational prospective study that included 70 patients with RA (CREATE registry) in CR at least for 6 months, under treatment with tapered dose of biological therapy (TNFi, abatacept or tocilizumab). Treatment effectiveness was assessed with the main variable DAS28 ≤2,6. Statistical analysis included a descriptive study of variables and a confidence interval of 95% (95% CI) was estimated. For bivariate analysis, we used Student t-test for independent samples, repeated measures analysis of variance and mixed analysis of variance, and as a post-hoc contrast, Sidak adjustment. The log-rank test was used to compare the time until relapse according to the biological therapy. Results The mean age of the patients was 56,9 (13,7) years, 78,6% were women, 68,8% were rheumatoid factor (RF) positive and 66,7% ACPA positive; the mean DAS28 at the beginning of the optimisation was 2,24 (0,73). After 4 years, 27,7% (95%CI:16,82%–38,58%) of patients maintained CR with the optimised dose, with a DAS28 2,15 (0,81). Through the first year, the percentage of relapses was 15,71%, in the second year, 7,35% and 4,61% relapsed during the third year. The median time of optimisation until relapse was 13,833,18 months (95% CI:7,6–20,06). No significative differences were found at comparing the survival curves of the optimised patients until relapse for 4 years according to the biological therapy (TNFi vs no TNFi) (log-rank test:0,865, p:0,352) (graphic). Conclusions After 4 years, all of the patients maintained DAS28 levels of low disease activity, including those who had suffered a previous relapse and had turned back to the previous dose of biologic treatment. In view of this outcomes, optimisation strategy in clinical practice is posible and effective in patients with persistently controlled RA. Disclosure of Interest None declared

Background Inside the therapeutic algorithm of knee osteoarthritis (OA) it is included the Non-Arthroscopic Joint Lavage (NAJL) since around 1934 Burman reported that arthroscopies improved the symptoms. Current medical treatment strategies are aimed at pain reduction and symptom control rather than disease modification (1). The large variety of potentially interventions available has raised the need to assess their effectiveness. Objectives To compare the short-term effectiveness among five treatment strategies in patients with symptomatic knee OA. Methods An open, controlled, randomized prospective study involving 150 patients of whom 76.7% were females. The average age was 65.37±8.35. Patients had knee OA according to American College of Rheumatology criteria, with Kellgren-Lawrence radiographic grades II-III. They were randomly assigned to five groups of treatment, 1)NAJL (n=30), 2)NAJL+hyaluronic acid (HA) (n=32), 3)NAJL+ corticosteroid (CS) (n=32), 4)HA (n=31), and 5)CS (n=25). Evaluations took place at baseline, one and three months. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lequesne scores were recorded. Statistical analysis included mixed analysis of variance, with post-hoc comparisons with Sidak9s adjustment, and multiple linear regression (MLR) to identify those possible factors associated to WOMAC total at 3 months. Results Regarding WOMAC pain, significative differences were found in NAJL, at one month and at 3 months; and in NAJL+CS at one month. For WOMAC stiffness, there were significative differences in NAJL at one month and at 3 months; in NAJL+HA after one month and 3 months versus one month; and in NAJL+CS, at one month. For WOMAC function, significative differences were found in NAJL at one month and at three months; in NAJL+CS at one month; and in HA at 3 months. Regarding WOMAC total, significative differences were found in NAJL at one month (p Conclusions One month after treatment, best outcomes were obtained with HA due to the results found in Lequesne scale when comparing HA versus NAJL+HA, and NAJL+CS. Three months after the treatment, the most effective modality treatment was NAJL; since we did find significant differences regarding articular stiffness, physical function and Lequesne scale. The treatment with NAJL+HA appears to be less effective than the other modalities. References Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research Vol. 64, No.4, April 2012,pp 465–474. Disclosure of Interest None declared

Background Left ventricular ejectionfraction (LVEF) has beendirectlyassociatedwith BMD in patientswithheartfailure. Nevertheless, no study has linked yet the left ventricular ejection fraction to bone mineral density and fragility fractures in cardiac transplantation. Objectives The main aim of this study was to evaluate the possible relationship between LVEF and BMD in heart transplantation and the association of LVEF with 25 OH vitamin D, paratohormone (PTH) and markers of bone remodeling in patients with heart transplantation (osteocalcin, telopeptide C terminal (CTX). Methods Seventy nine patients (66 male) were included in this cross-sectional study with a mean age of 55,75±14,81 years, body mass index (BMI) values of 26,95±5,35 kg/m2 and an average post-transplantation period of 8,46±8,71 years. Transthoracic doppler echocardiography measuring LVEF (%) was calculated for each of patients, as well as bone mass study that included: bone mineral density scans of lumbar spine and hip, spine radiography, biomarkers of bone metabolism (calcium, phosphorus, osteocalcin,CTX,Parathyroid hormone and vitamin D). The association of LVEF with BMD and biomarkers of bone remodeling was determined by performing multiple linear regression analysis adjusted for variables directly related to BMD (age, sex, BMI, post-transplantation period and pharmacological treatment (daily corticoids dose, immunosuppressive treatment). Results A total of 79 patients were included in this present study. BMD in osteoporotic range was found in 31.2% of patients (17.7% in spine,16.52% in femoral neck and 13% in hip). Vitamin D deficiency (≤20ng/d) was detected in 68.4% of patients. Vertebral fracture was found in 30.4% and a 2.6% hip fracture. Bivariate analysis showed that the group of patients with FEVI ≤65% had a higher proportion of femoral neck osteoporosis (p=0.04), higher proportion of osteoporosis in total hip (p=0.03) and higher percentage of vertebral fractures (p=0.04) compared with group with LVEF>65%. The multiple linear regression analysis indicated that LVEF was independently associated with osteoporosis in spine (B = -5.225, p=0.011), femoral neck osteoporosis (B = -5.411, p=0.015) and vertebral fractures (B = -5.433, p=0.002). In addition, LVEF was associated with osteocalcin levels (B = -0.105, p=0.002). Conclusions These results suggest that post-transplantation LVEF may have an influence on bone remodeling. However, further studies are neededin order to consider LVEF as a risk factor for osteoporosis and fractures due to fragility after heart transplantation. Disclosure of Interest None declared