409 Taken together, these findings support the claim that subclinical atherosclerosis is common in patients with AS. They also highlight the role of both traditional cardiovascular risk factors and a proinflammatory state, in the context of a chronic disease, in the development of athero‐ sclerosis in these patients. With respect to this, Ozdowska et al1 described that AS patients with atherosclerotic plaques had higher levels of to‐ tal cholesterol, low ‐density lipoprotein (LDL) cholesterol, and triglycerides than those with‐ out plaques, with no differences in high ‐density lipoprotein (HDL) cholesterol levels. Moreover, the atherogenic index was higher in AS patients with plaques than in those without.1 Interestingly, the first recommendations pro‐ posed by the European League Against Rheuma‐ tism (EULAR) task force supported the use of the atherogenic index (total cholesterol/HDL cho‐ lesterol) rather than total cholesterol in the strati‐ fication of the cardiovascular risk of patients with rheumatoid arthritis (RA), another inflammato‐ ry joint disease associated with increased cardio‐ vascular mortality.5 Chronic inflammation leads to oxidative changes that alter HDL cholesterol structure and reduce apolipoprotein A ‐I in pa‐ tients with active RA.6 The levels of paraoxonase 1, an antioxidant enzyme associated with HDL cho‐ lesterol, are lower in patients with RA when com‐ pared with healthy controls. The presence of in‐ flammation leads to impairment of the normal anti ‐inflammatory, antioxidative, and cardiopro‐ tective function of HDL cholesterol that turns out to be proinflammatory.7 Moreover, lipids in pa‐ tients with inflammatory joint diseases have par‐ adoxical associations with the risk of cardiovascu‐ lar disease since lower levels of total cholesterol and LDL cholesterol are associated with increased risk of cardiovascular events in these patients.8 In the present issue of Polish Archives of Internal Medicine (Pol Arch Intern Med), Ozdowska et al1 re‐ port an increased prevalence of subclinical coro‐ nary atherosclerosis in patients with ankylosing spondylitis (AS). They found that the frequen‐ cy of coronary atherosclerotic plaques assessed by coronary computed tomography angiography was higher in young patients with AS and with‐ out diabetes than in matched controls.1 Although the number of individuals included in the study was relatively small,1 their results are in line with previous data from a study using carotid ultra‐ sound (another noninvasive way of assessing ath‐ erosclerotic disease), which showed an increased carotid ‐intima media wall thickness and a higher frequency of carotid plaques in patients with AS compared with controls.2,3 It is of great relevance since epidemiological studies have confirmed that AS is associated with augmented risk of cardio‐ vascular disease and mortality.4 Ozdowska et al1 revealed an association of cor‐ onary plaques with the presence of dyslipidemia and arterial hypertension in patients with AS. The duration of disease from onset of AS symp‐ toms and the erythrocyte sedimentation rate at disease diagnosis were the best predictors of carotid plaques detected by carotid ultrasound in a series of 64 patients who fulfilled the 1984 mod‐ ified New York diagnostic criteria for AS.2 Also, in a set of 149 consecutive patients without history of cardiovascular disease that fulfilled the Assess‐ ment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (115 of them also fulfilled definitions for AS ac‐ cording to the 1984 modified New York criteria), the subgroup of patients with carotid plaques had a longer disease duration than those with‐ out plaques when they were studied by carotid ultrasound.3 EDITORIAL

Background Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly whose diagnosis is usually based on clinical and ultrasound findings. Recently, 18F-FDG PET/CT has been proposed as a promising one-step tool for assessing extent and severity of PMR. However, the pattern of 18F-FDG uptake in PMR is not well established and there is a lack of imaging guidelines. Objectives Our aim was to describe the musculoskeletal pattern of 18F-FDG uptake in PMR patients and assess if there were any differences between classic and atypical PMR. Methods Retrospective study of 75 patients with PMR and their respective PET/CT scans from a referral centre. We considered two groups: a) Classic PMR: patients who fulfilled the 2012 EULAR/ACR criteria; and b) Atypical PMR: patients with symptoms resembling PMR but did not fulfil the 2012 EULAR/ACR criteria. Distributions of categorical variables were compared by Pearson Chi2 or Fisher exact test as appropriate. Results We evaluated 75 patients (27 men and 48 women) with a mean age ±SD of 68.2±10.7 years. A PET/CT was performed in all of them. Forty-two (56%) patients classic PMR and 33 (44%) atypical PMR. FDG-PET uptake was observed in the following musculoskeletal regions: in shoulders (n=45), sternoclavicular joints (n=33), hips (n=32), cervical interspinous bursae (n=8), lumbar interspinous bursae (n=29), pubic symphysis (n=4), subtrochanteric bursae (n=20), ischial tuberosities (n=19) and knees (n=33). The comparative study between both groups is shown in the TABLE, without observing any statistical significance. Conclusions In patients with PMR, 18F-FDG uptake seems to be more frequent in shoulders, sternoclavicular joints, hips and knees. In addition, 18FDG uptake can be also detected in lumbar interspinous bursae and less frequently in subtrochanteric bursae, ischial tuberosities, cervical interspinous bursae and pubic symphysis. No differences between classic and atypical PMR patients were seen. Disclosure of Interest None declared

Background Cystoid macular oedema (CME) represents the leading cause of blindness in uveitis of different immune-mediated inflammatory diseases (IMIDs). Objectives Our aim was to evaluate the efficacy of Tocilizumab (TCZ) in different IMIDs with refractory CME. Methods Multicentre study of 24 patients with CME due to uveitis of different IMIDs refractory to traditional treatment with systemic corticosteroids and at least one conventional immunosuppressive drug including in most cases biological therapy (n=21). CME was defined by (OCT >300 µm). We studied CME with TCZ in 4 different IMID; juvenile idiopathic arthritis (JiA), Behçet’s disease (BD), Birdshot retinochoroidopathy (BR) and idiopathic. The main outcome was the improvement of macular thickness. Other variables assessed were inflammation of the anterior chamber and vitreous and best corrected visual acuity (BCVA) Results We studied 16 ♀/8 ♂, mean age 35.2±19.3 years. The associated diseases were: JiA (n=9), BD,7 BR4 and idiopathic.4 The ocular patterns were: panuveitis,9 anterior uveitis,6 posterior uveitis5 and intermediate uveitis.4 Most patients had bilateral involvement.22 The biological therapy used before the administration of TCZ were infliximab,8 adalimumab,18 etanercept,2 golimumab,2 rituximab,2 abatacept,3 anakinra1 and daclizumab.1 TCZ administration schedule was 8 mg/kg/4 weeks iv.23 or every 2 weeks.1 TCZ was used in monotherapy12 or combined with conventional immunosuppressive drugs.12 OCT values improved considerably in 12 months: in JiA from 340.6±134.1 µm to 252.5±30 µm, in BD from 375.1±117 µm to 235±7.1 µm, in BR from 550.7±214.4 µm to 295.5±43.2 µm and in idiopathic from 515±219.6 µm to 208.3±46.7 µm (figure 1). Inflammation in anterior chamber and vitritis and BCVA also improved in the 4 subtypes. No minor side effects were observed, so no patient had to stop treatment. Conclusions TCZ seems a rapid effective treatment in severe and refractory uveitic CME, regardless of the underlying IMIDs. References [1] Calvo-Río V, de la Hera D. et al. Tocilizumab in uveitis refractory to other biologic drugs: a study of 3 cases and a literature review. Clin Exp Rheumatol2014;32(Suppl 84):S54–S57. [2] Calvo-Río V, Santos-Gomez M, et al. Anti-IL6-R Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to anti-TNF therapy. A multicenter study of 25 patients. Arthritis Rheumatol 2016;69:668–75. [3] Calvo-Río V, Blanco R, Santos-Gómez M, et al. Efficacy of Anti-IL6-Receptor Tocilizumab in Refractory Cystoid Macular Edema of Birdshot Retinochoroidopathy Report of Two Cases and Literature Review. Ocul Immunol Inflamm2017Oct;25(5):604–609. Disclosure of Interest None declared

Background Non ischaemic optic neuritis (NION) is a severe inflammation of the optic nerve that may lead to blindness. It can be primary or associated to immune-mediated inflammatory diseases (IMIDs). The treatment of the NION is based on systemic corticosteroids and conventional immunosuppressive drugs. Objectives To assess the efficacy of the biological treatment in refractory NION to conventional treatment. Methods Multicenter study of 8 patients diagnosed with NION refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were visual acuity (VA) and OCT of the optic nerve and the ganglionar cells. Comparisons were made between baseline and the 1st week, 1st and 6th month and 1st year. (STATISTICA, StatSoft Inc. Tulsa, Oklahoma, USA). Results We studied 8 patients (12 affected eyes) (4♀/4♂); mean age of 34.37±13.30 years. The underlying diseases were SLE (n=1), neuromyelitis optica (n=1), neuroretinitis (n=1), relapsing polychondritis (n=1), idiopathic (n=2) and Behçet’s disease (n=2). Before biological treatment and besides oral corticosteroids patients had received intravenous (IV) methylprednisolone boluses (n=6), cyclosporine A (CyA) (n=1), ciclophosphamide (n=2), micophenolate (n=2), hydroxycloroquine (n=1), methotrexate (MTX) (n=4) and azathioprine (AZA) (n=2). Biological treatment was based on rituximab (n=2) (2 IV. doses of 1 g/very 2 weeks and every 6 months), adalimumab (n=2) 40 mg/week, tocilizumab (n=2) 8 mg/kg/2–4 weeks and infliximab (n=2) 5 mg/kg at 0, 2 and 6 week and then every 8 weeks. The characteristics of the 8 patients are shown in the TABLE After biological treatment we observed an improvement in the ocular parameters: VA [0.60±0.33 to 0.76±0.41, p: 0.04], OCT of the optic nerve [130.63±60.54 to 102.60±8.17, p: 0.1] and OCT of the ganglionar cells [404.60±184.73 to 243±18.38, p: 0.17] at one year. After a mean follow-up of 27±14.47 months there were no severe adverse effects. Conclusions This study shows that treatment with biologic drugs, including ant-TNF drugs, in NION associated to IMIDs, refractory to conventional treatment, seems to be effective. These results must be confirmed in prospective and randomised trials. Disclosure of Interest None declared

Background Cardiovascular disease (CVD) is the main cause of mortality and morbidity in patients with spondyloarthritis (SpA), partially explained by traditional CV risk factors (CVRF). Other non-conventional CVRF, probably related to chronic systemic inflammation, may be involved. In this sense, lipoprotein (a) [Lp (a)], an non-conventional risk factor with proatherogenic and thrombogenic properties, could be involved, since it seems to act as an acute-phase reactant, there are few data on this aspect in these patients. Objectives To evaluate the prevalence of hyperlipoproteinemia (a) in patients with SpA and analyse the possible related factors. Methods Analysis of the baseline visit of patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) of the CARMA project (CARdiovascular in Reumatology), a prospective cohort study of 10 years of follow-up, to evaluate the cardiovascular risk in chronic rheumatic inflammatory diseases, including rheumatoid arthritis, AS and PsA, followed in 67 Spanish rheumatology centres. A multivariate logistic regression model was performed, in which the dependent variable was hyperliproteinemia (a), defined as the plasma concentration of lipoprotein (a) [Lp (a)]≥50 mg/dl. Sociodemographic factors and those related to the disease itself have been included as independent variables. Results 1459 patients were analysed, 738 with AS and 721 with PsA. Plasma concentrarions of Lp(a) were available in 57.7% of the patients with AS and in 57.1% of the patients with PsA. A 19.2% (95% CI: 16.80–22.05) of the patients with SpA, 20.7% (95% CI: 16.91–24.82) of AS and 17.7% (95% CI: 14.15–21.75) of PsA, respectively, had hyperlipoproteinemia (a), without statistically significant differences with respect to the control group: 16.7% (95% CI: 13.23–20.86; p=0.326). After adjusted for age and sex, only patients with AS were more likely to have hyperlipoproteinemia (a) than the control grup (OR: 1.806, 95% CI: 1177–2.771, p=0.007). In the model adjusted for possible confounding factors, high values of apolipoprotein B in all patients, non-steroidal anti-inflammatories in AS, and sex (men) and kidney disease as comorbidity in PsA, were associated with a higher probability of presenting hyperlipoproteinemia (a). Conclusions Patients with AS have a higher percentage of hyperlipoproteinemia (a) compared to the control group. No specific factors of the disease have been identified that are associated with hyperlipoproteinemia (a) in each of the analysed groups. Disclosure of Interest None declared

Background: The updated EULAR cardiovascular risk management (CVRM) guideline recommends cardiovascular disease risk assessment at least once every five years in all patients with rheumatoid arthritis (RA).1 A literature search indicates that this guideline is marginally applied in clinical practice.2 An important factor explaining dissimilarities in the quality of CVRM could be the different strategies being used to implement this guideline in daily care. Objectives: This study describes the differences in cardiovascular risk identification and management for patients with RA between outpatient clinics of the members of the Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Methods: A questionnaire was sent to all members of ATACC-RA, which included 16 questions about ‘the organisation and responsibility of CVRM in their hospital’, ‘the screening of cardiovascular risk factors’, ‘communication about CVRM between medical professionals’ and ‘availability of data regarding CVRM’. Results: Six out of eight outpatient clinics reported that they work according the EULAR CVRM recommendations. Three strategies to organise CVRM in daily practice could be distinguished: 1) The treating rheumatologist performs CVRM during the outpatient visits; 2) Cardiologists, rheumatologists and/or a general practitioners co-operate in a cardio-rheuma-clinic/team with different tasks and responsibilities and 3) the general practitioner screens and treats cardiovascular risk factors. Six outpatient clinics reported that they have (digital) data about the current CVRM status of their RA patients and are willing to share them to compare the quality of the CVRM care between the different strategies. Conclusions: Each cardiovascular risk management strategy was based on agreements between medical professionals about who is responsible to perform CVRM. However, each strategy is also (partly) dependent of the national healthcare system and financial resources. Independent of how CVRM is organised, communication and feedback between medical professionals about the current CVRM status of each RA patient, are important factors to perform CVRM adequately. Further analyses on the effectiveness of the various systems are warranted. References 1. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the rheumatic diseases2016. doi:10.1136/annrheumdis-2016-209775 2. Weijers JM, Rongen-van Dartel SAA, Hoevenaars DMGMF, et al. Implementation of the EULAR cardiovascular risk management guideline in patients with rheumatoid arthritis: results of a successful collaboration between primary and secondary care. Annals of the rheumatic diseases2017. doi:10.1136/annrheumdis-2017-212392 Disclosure of Interest: None declared

Background Isolated non-infectious aortitis is a potentially serious condition whose diagnosis is often delayed due to the non-specific nature of its symptoms. Most of the patients initially present with polymyalgic syndrome associated with atypical symptoms. Nowadays 18 F-FDG PET/CT scan is the best tool for early detection of aortitis. However, it is a complex and expensive technique. Thus, we should make an effort to select those patients who will benefit the most from this procedure. Unfortunately, we have no data about which factors may improve the probability of a positive diagnosis of aortitis using this imaging technique. Objectives Our aim was to evaluate, in patients with polymyalgia rheumatica (PMR), the predictive factors for a positive 18F-FDG PET/CT scan, in order to make an early diagnosis of aortitis and optimise the use of this technique. Methods Retrospective study on 97 patients with PMR who had undergone an 18F-FDG PET/CT scan between January 2010 and August 2017 with a high clinical suspicion of aortitis. Only patients with polymyalgic syndrome without any other underlying disease were included. We considered two groups: a) Classic PMR: patients who fulfilled the 2012 EULAR/ACR criteria; and b) Atypical PMR: patients with symptoms resembling PMR but did not fulfil the 2012 EULAR/ACR criteria. Distribution of categorical variables was compared by the Pearson Chi-squared test or Fisher exact test. Quantitative variables were analysed using the Student t test or Mann Whitney U test as appropriate. An adjusted logistic regression model was built to assess the best set of predictive factors for a positive PET scan in both groups of patients. Results 18F-FDG PET/CT scans were performed in 97 patients due to clinical suspicion of aortitis, being positive in 60 (61.9%). Patients (60 women/37 men) had a mean age of 68.4±10.7 years. Fifty-one (52.6%) had classic PMR and 46 (47.4%) atypical PMR. In patients with classic PMR, the best set of predictors for a positive PET/CT scan were lower limb pain (OR=8.4, 95% CI 2.0–35.1; p=0.004) and low back pain (OR=7.6, 95% CI 1.3–45.5, p=0.027), once adjusted for age, sex and current tobacco use. In atypical PMR patients, only the pelvic girdle affection (OR: 5.0, 95% CI 1.3–19.5; p=0.002) was significantly associated with a positive PET/CT scan, in the logistic adjusted model. Conclusions We have found that, in patients with classic PMR, the presence of diffuse lower limb pain and inflammatory low back may have clinical relevance when requesting a PET/CT scan due to aortitis suspicion. On the other hand, in patients with atypical PMR, only the presence of pain in the pelvic girdle seems to be a predictive factor for a positive result in PET/CT scan. Disclosure of Interest None declared

Background Giant cell arteritis (GCA) is a large vessel vasculitis that has a special predilection for extracranial branches of the external carotid artery. Among its most fearsome complications is visual affectation. Tocilizumab (TCZ) is a monoclonal antibody directed against the interleukin 6 receptor that has shown utility in the treatment of GCA. Objectives Our aim was to assess the evolution of visual clinic in patients with GCA treated TCZ. Methods Retrospective multicentre study of 20 GCA patients with visual involvement treated with TCZ. The efficacy of this drug on visual symptoms was evaluated. Results We evaluated 20 patients (14 women and 6 men) with a mean age ±SD of 73.7±10.1 years with GCA and visual symptoms. In total there were 23 affected eyes. The symptoms reported were: unilateral blindness (n=6), unilateral blurred vision (n=6), unilateral amaurosis fugax (n=3), unilateral hemianopsia (n=2), bilateral blindness (n=1), bilateral blurred vision (n=1), bilateral hemianopsia (n=1). Before starting treatment with TCZ all patients had received high doses of prednisone, with a mean ±SD of 54.2±13.8 mg/day (range of doses: 40–80 mg/day). In addition, 9 of them also received intravenous corticosteroid boluses. In addition, 13 patients received traditional immunosuppressants: methotrexate (MTX) (n=12), cyclophosphamide (n=2), leflunomide (n=1) and azathioprine (n=1). Regardless of corticosteroids, TCZ was administered as monotherapy in 14 patients, while in 6 it was administered in combination with MTX. The TABLE shows the evolution of the visual affectation of these patients. Throughout a median follow-up [RIC] of 94–18 months, none of the 7 patients who had a blindness regained vision. The 2 patients who presented unilateral hemianopsia recovered vision. The patient with bilateral hemianopsia and the patient with bilateral blurred vision experienced a partial improvement. The rest of the patients achieved a complete recovery. Conclusions Although TCZ seems to be also useful in the treatment of visual manifestations of ACG, once blindness is established, it does not seem to be effective. Disclosure of Interest None declared

Background This study shows that treatment with biologic drugs, including ant-TNF drugs, in NION associated to IMIDs, refractory to conventional treatment, seems to be effective. These results must be confirmed in prospective and randomised trials. Objectives Our aim was to compare anti-TNFα vs Rituximab (RTX) in refractory PUK. Methods Multicenter study of 24 patients with PUK. All of them presented inadequate response to corticosteroids and at least 1 systemic traditional immunosuppressive drug. Anti-TNFα were used in 17 patients: Adalimumab (n=9) 40 mg/sc every 1–2 weeks, infliximab (IFX) (n=7) 3–5 mg/kg iv/4–6 weeks, etanercept (n=1) 50 mg/week. RTX was used in 7 patients 1–2 g i.v. every 6 or 12 months. The main outcomes were Best Corrected Visual Acuity (BCVA), signs of inflammation (scleritis and episcleritis), progression to corneal thinning, central keratolysis and ocular perforation.Abstract FRI0095 – Table 1 Comparisons were made between baseline and 1 st month, 6th month and 1 st year (STATISTICA, StatSoft Inc. Tulsa, Oklahoma, USA). Quantitative variables were expressed as mean ±SD or median [IQR], accordingly to its distribution. They were compared with the Student t or the Mann-Whitney U test respectively. Dichotomous variables were expressed as percentages and compared by the chi-square test. Results We studied 24 patients/32 affected eyes. The underlying diseases in the anti-TNFα group were Rheumatoid Arthritis (RA) (n=14), Psoriatic Arthritis (n=2) and Behçet Disease (n=1); and in the RTX group: RA (n=5), granulomatous polyangiitis (n=1) and microscopic polyangiitis (n=1). At baseline there were no significant differences between both groups in general features or in ocular involvement (table 1). Before biologic therapy they had received the following systemic drugs (anti-TNFα vs RTX) i.v. methylprednisolone (2 vs 4), doxycycline (7 vs 1), ascorbic acid (2 vs 0), MTX (11 vs 4), AZA (1 vs 2) and others (7 vs 3). In addition,10 patients, in both groups, had required surgery: amniotic membrane (n=5), penetrating keratoplasty (n=2), conjunctival resection (n=2), tissue adhesives (n=2), conjunctival flap (n=1) and lamellar keratoplasty (n=1). Once the treatment was initiated the ocular outcome was similar (table 1). After a mean follow-up of 22.53±22.60 (anti-TNFα) and 22.28±8.28 months with RTX the following severe side effects were observed: supraventricular tachycardia (n=1) with RTX and pulmonary tuberculosis (n=1) with IFX. Conclusions In this study, anti-TNFα therapy and RTX were equally effective for the treatment of peripheral ulcerative keratitis associated to rheumatic diseases refractory to conventional treatment. Disclosure of Interest None declared

Background Polymyalgia rheumatica (PMR) is an inflammatory disease characterised by pain and stiffness of the neck, shoulder and pelvic girdles. It can also be accompanied by other non-specific symptoms such as inflammatory low back pain, diffuse lower limb pain and constitutional syndrome. The role of 18F-FDG PET/CT is increasing in the diagnosis of PMR but it remains unknown if there is a correlation between clinical symptoms and 18F-FDG uptake. Objectives Our aim was to asses if the localization of pain of patients with PMR correlates with 18F-FDG uptake in the corresponding region of interest. Methods Retrospective study of 75 patients with PMR and their respective PET/CT scans from a referral centre. PMR diagnosis was based on 2012 EULAR/ACR criteria. Results We evaluated 75 patients (27 men and 48 women) with a mean age ±SD of 68.2±10.7 years. A PET/CT was performed in all of them. Pattern of F-FDG uptake in patients with different clinical manifestations were summarised in the TABLE. Twenty-two out of thirty-three patients (66.7%) with 18F-FDG uptake in sternoclavicular joints had shoulder girdle pain. In all patients with morning stiffness (n=11) an increase of 18F-FDG uptake in shoulders was observed. Twenty-three patients of thirty-two patients (71.8%) with18F-FDG uptake in hips had pelvic girdle pain. The remaining localizations of 18F-FDG uptake in PET/CT scans did not show significant correlations with clinical symptoms. Conclusions In patients with PMR, the presence of shoulder girdle pain seems to correlate with F-18FDG uptake in sternoclavicular joints, morning stiffness with 18F-FDG uptake in shoulders and pelvic girdle pain with 18FDG uptake in hips. No other significant correlations were found between any other symptom and 18F-FDG uptake. Disclosure of Interest None declared

Background Uveitis is a severe manifestation of Juvenil Idiopathic Arthritis (JIA). Anti-TNFa are recommended in refractory cases, mainly infliximab (IFX) or adalimumab (ADA) (Levy-Clarke et al. Ophthalmology 2014; 121: 785–796). However, sometimes they are ineffective, contraindicated or not tolerated. The next therapeutic step is not defined. Objectives To compare the efficacy of Golimumab (GLM) and Tocilizumab (TCZ) in related AIJ uveitis refractory to conventional immunosuppressive drugs and anti-TNFα. Methods Multicenter study of 33 patients with uveitis associated-JIA. They were refractory to conventional treatment with high dose of corticosteroids and at least a) one conventional immunosuppressive drug and b) one anti-TNFa. For this reason it was decided to iniciate TCZ or GLM. TCZ was used in 25 patients: 8 mg/kg/4 w iv (n=21), 8 mg/kg/2 w (n=2); 8 mg/kg/8 w (n=1) and 2.9 mg/kg sc/w (n=1). GLM was used in 8 patients (50 mg/sc/month). We assessed visual acuity (VA), degree of intraocular inflammation, vitreous inflammation and macular thickening (with OCT). Quantitative variables were expressed with mean±SD or median [IQR], according to its distribution. They were compared with the Student t or the Mann-Whitney U test, respectively. Dichotomous variables were expressed as percentages and compared by the chi-square test. Results We studied 33 patients/61 affected eyes. There were no significant differences between TCZ and GLM at baseline in sex (♂/♀;4/21 vs 3/5; p=0.19), mean age (18.5±8.3 vs 19.9±8.7; p=0.55), positive ANA (95% vs 100%; p=0.7), uveitis duration before TCZ or GLM onset (116.4±93.6 vs 142.3±74.7 p=0.46), number of previous biological treatments (1.9±1.1 vs 2±1.4; p=0.84), VA (0.57±0.35 vs 0.5±0.37; p=0.42), combined immunosuppressive therapy (88% vs 75%; p=0.37), presence of cells in the anterior chamber (median, 1 [0–1] vs 1 [0.25–1.5]; p=0.6), vitritis (0 [0–0] vs 0 [0–1]; p=0.7), macular thickening (358.7±92.2 vs 313.6±77.1; p=0.32). There were no significant difference in the efficacy between TCZ and GLM (TABLE). After a mean follow-up of 20.48±11.7 months with TCZ and 24.25±17 months with GLM the following side effects were observed: TCZ: viral conjunctivitis plus bullous impetigo (n=1), severe thrombocytopenia and pneumonia. This last patient showed hemolytic anemia, thrombocytopenia and splenomegaly, for this reason treatment with TCZ was discontinued. With GLM cutaneous reaction was observed in 2 patients. Conclusions TCZ and GLM seem to be equally effective and safe for refractory uveitis associated-JIA. The superiority of one or the other should be established with prospective randomized studies “Head to Head” Disclosure of Interest None declared

Background Anti-TNFα drugs and several conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (MTX) have been involved in the development of Interstitial Lung Disease (ILD). Objectives Our aim was to assess the efficacy and safety of Rituximab (RTX) in RA patients with ILD. Methods Multicenter study of RA patients with ILD treated with RTX. ILD was diagnosed by high-resolution computed tomography (HRCT). RTX was used at standard dose (1 gx2 and premedication with iv Methylprednisolone for a six month interval. We assess the the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) FVC improvement ≥10%; and improvement ≥10% in DLCO; c) radiological changes in HRCT scan, and d) changes in the joint assessment measured by DAS28 score. Results We studied 18 patients (13 women /5 men) with ILD associated to RA. The mean age±SD was 62.8±11.0 years. The median [IQR] to progression of RA was 5.25 [2–12.8] years. They had received the following DMARDs previously; MTX (n=11), Leflunomide (LFN) (n=9) mycophenolate (MMF) (n=1) sulfasalazine (SSZ) (n=5), hydroxichloroquine (HCQ) (n=4), azathioprine (AZA) (n=1), gold salts (n=1), D-penicillamine (n=1), cyclophosphamide (n=1). 7 patients had previously received biological drugs. RA was seropositive in 16 cases (89%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 4 patients. In 2 patients ILD was drug-related: MTX (n=2). RTX was prescribed as monotherapy (n=7) and combined with DMARDs (11. The DMARDs prescribed were: LFD (4), SSZ (2), MTX (3), HCQ (1), AZA (1) MMF (1). A significant improvement of the dyspnea was observed. FVC and HRCT showed an improvement in the period between 6 and 12 months. DLCO remained stable in the majority of the patients (%). DAS28 also improved. After a follow-up of 12 months, the only serious adverse effect was a severe Infection respiratory. Conclusions RTX seems to be an effective and relatively safe treatment in RA patients with ILD. However, these data should be verified in prospective and randomized studies. Disclosure of Interest None declared

Background Interstitial Lung Disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA). AntiTNFα drugs and conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (MTX) have been involved in the development of ILD. IL6 has been implicated in the pathogenesis of ILD (Kobayashi J et al). However, a fatal case of exacerbation of ILD has been described with tocilizumab (TCZ) (Kawashiri SY el at). Objectives Our aim was to assess the efficacy and safety of TCZ in ILD associated with AR. Methods Multicenter study of RA patients with ILD treated with TCZ. ILD was diagnosed by high-resolution computed tomography (HRCT). TCZ was used at standard dose (8 mg/k/iv/4 weeks). We have analyzed the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) Forced Vital Capacity (FVC) improvement ≥10%; and improvement ≥10% in DLCO; c) HRCT, and d) joint assessment (DAS28 score). Results We studied 12 patients (9 women/3 men) with ILD related to RA. The mean age±SD was 57.1±16.1 years. The mean evolution of RA was 9±5.8 years. The patients had previously received the following DMARDs; MTX (n=12), leflunomide (LFN) (8) sulfasalazine (SSZ) (3) hydroxichloroquine (HCQ) (1) azathioprine (AZA) (2), gold salts (2). In addition, 11 patients had previously received biological drugs: adalimumab (4) anakinra: (1), etarnecept (4), rituximab (4), infliximab (1), certolizumab (1), abatacept (1). RA was seropositive in 11 cases (92%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 4 patients. In 2 patients ILD was drug-related: MTX (n=2). TCZ was prescribed in monotherapy (n=8) or combined with other DMARDs (4). These DMARDs were: LFN (2), MTX (1), AZA (1). In many patients the dyspnea and DLCO remain stable (Table). After a follow-up of 12 months, 2 patients withdrew TCZ, 1 patient for ILD worsening and 1 patient for joint inefficacy. Conclusions In our knowledge, this is the largest series that assess the EPID associated with RA treated with TCZ. We observed that in many cases pulmonary involvement remains stable. References Kobayashi J et al. Chest 1995; 108: 311. Kawashiri SY el at. Rheumatol Int 2012; 32: 4023–6. Disclosure of Interest None declared

Objectives To evaluate the efficacy of adalimumab (ADA) in short and long term follow-up in refractory uveitis of Behçet9s disease (BD) Methods Multicenter study. Ocular inflammation was evaluated according to “SUN working Group” (Am J Ophthalmol 2005;140:509–516), and the macular thickening with OCT. A comparison was carried out between baseline, and follow-up visits. Results are expressed as mean±SD or median [IQR]. Continuous variables were compared with Wilcoxon test. Results We studied 74 patients/132 affected eyes (39M/35W); mean age 38.7±11.3. The ocular pattern was panuveitis (n=45), posterior uveitis (n=14), anterior uveitis (n=14) and intermediate uveitis (n=1). Before ADA, systemic treatment with corticosteroids, iv metilprednisolone (n=23), Cyclosporin A (58), azathioprine (33), metotrexate (31) and other drugs (28) was used. The dose of ADA was 40 mg/2 weeks/ sc in monotherapy (n=22) or combined (n=52). Most patients showed a rapid and progressive improvement (TABLE). The 24 patients (37 affected eyes) with CME showed a significant improvement. ADA was optimized in 23 (31.1%) that were in remission for 15.3±9 months. Interval of administration was increased to 3 (n=6), 4 (13), 5 (1), 6 (1) and 8 weeks. After a mean follow-up of 13.0±9.7 months after optimization, 21 patients were stable and 2 had a severe flare. In 4 patients ADA was stopped after 35.2±9.3 months in remission. The main adverse effects observed were lymphoma (n=1), pneumonia (1), and 2° bacteriemia by E. Coli (1) Conclusions ADA was effective in short and long-term follow-up in refractory uveitis associated to BD. Optimization or even suspension of ADA is possible. Disclosure of Interest None declared

ObjectivesTo assess the efficacy of tocilizumab (TCZ) at short and long term follow-up for severe juvenile idiopathic arthritis-associated uveitis.MethodsMulticentre study of 25 patients who had inadequate response to traditional treatment with corticosteroids and at least one conventional immunosuppressive drug including biological therapy. The outcome variables were the degree of inflammation, visual acuity and macular thickness. The results are expressed as mean±SD for normally distributed variables, or median [IQR] when are not. Comparison of continuous variables was performed using the Wilcoxon test.ResultsWe studied 25 patients (21 women/4 men); mean age 18.6±8.3. Uveitis was bilateral in 22. JIA subsets were oligoarthritis (n=17), polyarthritis (5), psoriatic (2) and enthesitis-related arthritis (1). Ocular sequelae at TCZ onset were cataracts (13), glaucoma (7), synechiae (10), band keratopathy (12), maculopathy (9), and amblyopia (5). Pattern of uveitis was: anterior (17), panuveitis (4), intermediate (2) and posterior (2). Before TCZ, they had received corticosteroids, conventional immunosuppressive drugs and biologics, including adalimumab (24), etanercept (8), infliximab (7), abatacept (6), rituximab (2), anakinra (1), and golimumab (1). TCZ dosage regimen was 8 mg/kg IV/4 weeks (21), every 2 weeks (2), every 8 weeks (1), or 2.9 mg/kg sc every week (1). All outcome variables showed a rapid and maintained improvement (Table 1) after a follow up of one year (n=21), 2 years (n=11), and 3 years (n=5). A reduction in the daily median dose of prednisone from 10 mg [0–15 mg] to 0 [0–0 mg] in 3 years, (p<0.05) was observed. After a median follow-up of 20.5±11.7 months in 4 patients, the interval between TCZ doses was increased to 5 weeks (n=2), 6 weeks (1) and 7 weeks (1) because of remission. TCZ had to be withdrawn due to articular inefficiency (1) or articular and ocular inefficiency (1). The main adverse effects were severe autoimmune thrombocytopenia, autoimmune anemia and thrombocytopenia, pneumonia, viral conjunctivitis and bullous impetigo in 1 patient each.ConclusionsTCZ is useful at short and long term follow-up for severe Juvenile Idiopathic Arthritis-associated uveitis. It is possible to optimize the TCZ dose.Disclosure of InterestNone declared

Background Dipeptidyl peptidase 4 (DPP-4) is an enzyme which plays a fundamental role on glucose homeostasis through degradation of the incretine hormones glucagon like peptide 1 and gastric inhibitory polypeptide. Objectives To analyze if DPP-4 levels differ between Rheumatoid arthritis (RA) patients and healthy controls, as well as to investigate if they correlate with the insulin resistance (IR) that RA patients express. Methods 406 subjects, 178 patients with RA and 228 controls adjusted by age and sex, were selected. We determined in both groups glucose, insulin and C peptide levels, Homeostatic Model Assessment (HOMA2) index for insulin and C peptide, and blood levels of the soluble form of DPP-4. We studied with multivariant analysis adjusted for the intake of steroids and other classic factors associated with IR, the differences between patients and controls as well as the correlation of DPP-4 with the activity of the disease and with IR in both groups. Results Patients had higher levels of insulin (16±26 vs 10±7 microU/mL, p=0,001) and C peptide (1,15±1,02 vs 0,50±0,26 nmol/L, p<0,001) compared to controls. Equivalently, insulin resistance index HOMA-IR (1,81±1,82 vs 1,35±0,93, p=0,002) and HOMA2-IR-peptide C (2,59±2,45 vs 1,10±0,55 nmol/L, p<0,001) were higher in patients with RA. DPP-4 levels were lower in patients with RA than controls (beta coef. -162 [-259–65] ng/ml, p=0.001), after adjustment for age, sex, body mass index and classic factors for IR. Patients with high or moderate activity (633±270 vs 844±757 ng/ml, p=0.06) and low activity (761±340 vs 844±756 ng/ml, p=0.40) had a lower expression of DPP-4 levels compared to those patients in remission, although this difference did not reach statistical significance. Conclusions Patients with RA express lower levels of DPP-4. This decrease could be explained by the activity of the disease and could play a role in the development of insulin resistance that RA patients express. Disclosure of Interest None declared

Background Although Cystatin C relation with atherosclerosis has been studied before in RA patients, cathepsin S association with subclinical atherosclerosis has not been previously considered in RA patients. This could help to better stratify or predict the development of cardiovascular diseases in RA. Objectives To assess if serum cathepsin S and cystatin C, two novel markers of cardiovascular disease risk (CVDR), are associated with subclinical carotid atherosclerosis in RA patients. Methods Serum cystatin C and cathepsin S levels, carotid intima-media thickness (cIMT) and carotid plaques were assessed in a cross-sectional study involving 178 RA patients. All of them were 18 years or older and fulfilled the 2010 ACR/EULAR classification criteria. Results Patients with a mean ± SD age of 55 ± 11 years were included. Regarding cardiovascular risk factors, 35% of the patients had hypertension, 32% dyslipidemia and 15% diabetes. Disease duration was 7 (IQR 4–15) years. Patients had moderate-active disease as shown by DAS28 (3.74 ± 1.91). One third (35%) of them were taking prednisone, 86% were under disease-modifying antirheumatic drugs and 22% were taking anti-TNF-alpha or other biologic therapies. The mean cIMT was 0.670 ± 0.143 mm, and 66 patients (37%) had carotid plaques in the carotid ultrasound assessment. Both cystatin C and cathepsin S were significantly associated with hypertension, diabetes and dyslipidemia. However, neither positive rheumatoid factor nor prednisone use were associated with cystatin C or cathepsin S. A trend for lower levels of cystatin C was observed in patients undergoing anti-TNF-alpha therapy (log beta coef. -0.20 (-0.44–0.04), p=0.09). An association between disease activity scores with higher levels of cystatin C but not with cathepsin S was found. Cystatin C levels were also associated with cIMT in the subgroup of patients included in the higher quartile of cIMT (OR 1.31, 95%CI [1.00–1.72], p=0.04) after adjusting for traditional cardiovascular risk factors, age and sex. An association between serum cystatin C levels and carotid plaques was also found in the univariate analysis (OR 1.37, 95%CI [1.06–1.76], p=0.02). However, this significant association was lost after adjusting for traditional cardiovascular risk factors and age. Cathepsin S was not associated with cIMT or carotid plaques. Conclusions High cystatin C serum levels identify a subgroup of RA patients with high risk of subclinical atherosclerotic disease. Disclosure of Interest None declared

These two analysesprovide analogous evidence for the association of ERAP2 withAS in HLA-B27-negative cases because of the genetic interactionbetween HLA-B27 and the AS-associated ERAP1 variants in AScases. ERAP1 and ERAP2 are located on chromosome 5q15 inthe opposite orientation. The locus is challenging to analysebecause of the strong linkage disequilibrium (LD) across thelocus and the epistasis between ERAP1 and HLA-B alleles asso-ciated with AS. We therefore sought to investigate the associationof ERAP2 with AS in HLA-B27-positive patients.