Background: Decision making in the treatment of rheumatoid arthritis is a complex process. The opinion on the use of Artificial Intelligence (AI) in therapeutic decision-making is a controversial topic, while some see AI as an ally, others as a threat. Objectives: Compare the attitude of Spanish rheumatologists in different clinical situations with the answers provided by AI. Methods: An online Google form with 15 questions was sent through social networks to several groups of rheumatologists in the national territory. Descriptive statistical analysis was carried out, subsequently the survey was completed by ChatGPT 3.5 and ChatGPT 4. Results: 108 surveys were collected. In patients with recent-onset RA with poor prognostic factors, in addition to corticosteroids, half of those surveyed (50%) begin treatment with csDMARD + rapid escalation to bDMARD/sd if response is insufficient, while chatGPT 3.5 leans towards bDMARD/sd±MTX from baseline and chatGPT 4 due to combined therapy with ≥ 2 csDMARDs. The majority of rheumatologists (47.2%) and ChatGPT 3.5 and 4 agree that the patient's profile is the most important factor when choosing the drug. The most relevant factors when choosing each DMARD are: anti-TNF, rheumatologists (47.2%) due to its cost-effectiveness; AI for its effectiveness; anti-IL6, due to its effectiveness (rheumatologists (72.2%) and AI); abatacept, for its efficacy and safety in RA-ILD patients (rheumatologists (53.7%) and AI); rituximab, for its safety in patients refractory to other treatments (rheumatologists (76.9%) and ChatGPT 3.5), for its effectiveness in seropositive patients (ChatGPT 4); JAK inhibitor, due to the possibility of use in monotherapy (rheumatologists (40.7%) and ChatGPT 3.5) and efficacy (ChatGPT 4). The most important factor that makes rheumatologists (57.4%) and Chat GPT 4 change treatment is the measurement of activity, while ChatGPT 3.5 responded "existence of other potentially more effective or safe therapeutic alternatives." If there is a good therapeutic response, the majority of rheumatologists (50%) and ChatGPT 4 would first optimize the bDMARD/sd administration interval, while ChatGPT 3.5 would simultaneously optimize the csDMARD and bDMARD/sd. In case of using combined therapy of csDMARD and bDMARD/sdDMARD, both the majority of the rheumatologists surveyed (59.3%) and IA recommend maintaining csDMARD in addition to the bDMARD/sdDMARD. Regarding the use of corticosteroids, the vast majority of colleagues (79.6%) and ChatGPT4 prefer to try to stop them as soon as possible, while ChatGPT 3.5 would choose to maintain low doses, unless there are specific comorbidities. In the event of pregnancy, 59.3% of those surveyed replace the drug with a safer one, while IA opts to maintain the drug if it is anti-TNF. Incident diagnosis of cancer is a reason for discontinuation of all bDMARDs/sd for 47.2% of respondents, however the IA would prefer to maintain/switch to rituximab if the patient is receiving bDMARD/sd. Finally, biosimilar drugs are considered equally effective and safe as the originals by both rheumatologists (80.6%) and AI. Conclusion: A striking heterogeneity has been observed in the way of acting in complex clinical situations, both among rheumatologists and in comparison with ChatGPT. Among rheumatologists, there is consensus on the need to limit the use of corticosteroids, on the use of activity indices to evaluate therapeutic response and on the wide acceptance of biosimilar drugs, the latter is also supported by AI. ChatGPT 4 shows greater agreement with the rheumatologist's opinions than ChatGPT 3.5. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Background: Interstitial lung disease (ILD) is a well-known and severe systemic complication of numerous rheumatologic diseases. The management of these entities is still under study, being both mofetil mycophenolate (MMF) and rituximab (RTX) therapeutic alternatives used in routine clinical practice. Objectives: To compare the effectiveness of mycophenolate mofetil and rituximab in routine clinical practice as a treatment for interstitial lung disease associated with systemic autoimmune rheumatic disease (SARD) or with autoimmune features. Methods: A retrospective observational study of patients from the Rheumatology department of a tertiary hospital diagnosed with ILD, who received treatment with MMF or RTX from 2012 to 2022. Demographic, clinical, and ILD progression data (respiratory symptoms, pulmonary function tests (PFT), and radiological progression) were collected. Stability of PFT was defined as a variation <10% of FVC or <15% of DLCO. Attempts were made to define patient profiles that may benefit more from each treatment. Descriptive statistics were used to define patient clinical characteristics (average, standard deviation), and we also performed the χ2 test for statistical analysis of our dataset. Results: A total of 54 patients were included; 39 treated with MMF (72%) and 15 with RTX (28%); 36 women (67%) and 18 men (33%); the mean age was 64,27 years (SD 12.1). Systemic sclerosis was the most frequently associated SARD with ILD in 25 cases (46%), followed by rheumatoid arthritis in 10 cases (18.5%), and Sjögren's syndrome in 5 cases (9.25%); 7 cases were described as interstitial pneumonia with autoimmune features (IPAF) (13%). After one year of treatment, the sample treated with MMF showed stability of respiratory symptoms in 87% of the cases. PFRs were stable in 87.5% of the sample and 91% did not present radiological progression (in those cases for which control tests were available (24 and 23, respectively)). After undergoing one year of treatment, the totality of the sample treated with RTX showed stability of the respiratory symptoms. PFRs and radiological images were stable in 73% and 86% of the patients for whom spirometry and control CT scans were available (11 and 14, respectively). None of these differences reached statistically significant values. Among patients treated with MMF, 79.5% showed no deterioration in any of these three areas; for RTX-treated patients, this situation occurred in 73% of cases. In patients with systemic sclerosis treated with MMF, deterioration in any of these areas was observed in 10.5%; for those treated with RTX, deterioration in any of these aspects was observed in 33.3%; however, these differences did not reach statistically significant values. Conclusion: Both MMF and RTX manage to stabilize respiratory symptoms, PFT and radiological progression of ILD associated with SARD/IPAF in a significant percentage of the sample; 79.5% and 73% of cases, respectively. There is a greater tendency toward stability in cases treated with MMF, although statistically significant differences were not identified. No characteristics have been identified that condition a faster progression of ILD with statistical significance. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Background: Sjogren´s syndrome (SS) is a chronic, systemic autoimmune disorder with a great clinical heterogeneity being an orphan disease at present1. It is needed to find out new biomarkers to help us in the diagnosis, phenotype stratification and therapy of the disease. In a previous exploratory study we carried out in six serum and saliva samples from suspected SS patients we identified some proteins associated with SS2. Objectives: The aim of this study was to analyze sCD14 (soluble cluster of differentiation 14), CXCL10 (C-X-C Motif Chemokine Ligand 10), EGF (epidermal growth factor), PTX3 (pentraxine 3) and VEGFA (Vascular endothelial growth factor A) in serum samples and IL (interleukin)-6, IL-19 and ICAM1 (intercellular adhesion molecule-1) in saliva samples of suspected SS patients. Methods: We included a cohort of 227 consecutive patients attended the rheumatology department for suspected SS: 60 patients met classification criteria from 2016 and/or 2002 (SS group), 79 patients had a labial minor salivary gland biopsy (MGSB) compatible with SS (MGSB+ group) and 136 patients did not meet SS classification criteria nor had a compatible MGSB (control group). Serum samples were collected and centrifuged at 1800g, divided into aliquots and stored at -80ºC. Saliva samples were cold collected to prevent degradation of proteins, centrifuged at 1800g at 4ºC and stored at -80ºC. We evaluated serum and saliva levels of the proteins using three different assays: Human CD14 Sandwich ELISA Kit (Proteintech) and two bead-based fluorescent multiplex kits, the Procarta Plex-4 plex (CXCL10, EGF, PTX3, VEGFA) (Invitrogen) and Human Luminex Discovery Assay (R&D system) in the case of ICAM1, IL-6 and IL-19. Statistical analysis were performed using the Mann–Whitney U test for independent samples with the SPSS v.18 software. P values ≤0.05 were defined as significant and values of 0.1 0.05 were considered as borderline. Results: We found increased levels of ICAM1 in the saliva samples of SS group patients: Median (Me):13,60 µg/ml, interquartile range (IQR): 3,59-45,979; P=0,011, compared to the control group (Me: 6,14 µg/ml, IQR: 2,15-14,22) and moreover we found increased levels of serum CXCL10 (Me: 5,78 pg/ml; IQR: 3,09-8,77; P=0,083) in SS group compared to the control group (Me: 5,03 µg/ml, IQR: 3,13-8,46), although only in this case of ICAM1 statistical significance was reached. When we analyzed the differences between MGSB+ and control groups we found that patients from MGSB+ group showed significant increased levels of ICAM1(Me: 14,43 pg/ml; IQR: 5,55-48,08; P<0,001) and IL-6 (Me: 4,45 pg/ml; IQR: 1,59-12,01; P<0,032) in saliva as well as they had significant increased CXCL10 serum levels (Me: 6,30 pg/ml; IQR: 3,34-8,97; P<0,047) compared to control group (ICAM1: Me: 6,14 pg/ml; IQR: 2,15-14,22; IL-6: Me: 2,47 pg/ml; IQR: 1,19-5,31; CXCL10: Me 5,03 pg/ml; IQR: 3,13-8,46). Conclusion: SS and MGSB+ groups of patients showed significant higher levels of ICAM1 in saliva compared to the control group. The analysis of this protein in saliva could be useful for the early diagnosis of SS patients. REFERENCES: [1] Longhino S et al. Clin Exp Rheumatol 2023; 41: 2343-2356 [2] Santos-Bórnez, MJ. Ann Rheum Dis 2023, vol 82, suppl, 1: 1243,doi: 10.1136/annrheumdis-2023-eular.865 Acknowledgements: This study has been partially supported by the Sociedad de Reumatología de la Comunidad de Madrid (SORCOM). We would like to specially thank all the patients who have participated in this study. Disclosure of Interests: None declared.

Background Sjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min). The Saxon test [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compares the Saxon test with other diagnostic methods although it is developed in patients without SS [3]. Objectives To compare the Saxon test and UWSF in a cohort of patients with suspected SS. Methods In a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with Sjögren’s Syndrome of the EULAR (ESSPRI) was collected too. This is a patient-reported index designed to assess the severity of patients’ symptoms (dryness, pain, somatic and mental fatigue) in SS through an average of single 0–10 numerical scale for each domain. To measure the UWSF, patients were asked to swallow their saliva before the start of the test and then to spit into a container for 5 min. The Saxon test was performed by calculating the difference in the weight of two pieces of sterile gauze that the patient chews for two minutes. An UWSF >0.25 mL/min, a Saxon test >2.75 g/2min and an ESSPRI<5 were considered normal. Spearman’s rank correlation coefficient (r s ) was used to determine the correlation between both quantitative variables. The Chi-square test and the Gamma test were used in the comparisons between the groups (altered and normal) and the Mann-Whitney U in the comparisons of the quantitative variables based on the groups (altered and normal) previously defined. P values <0.05 were considered statistically significant. Results We enrolled 70 patients (63 women/7 men), with a mean age ± standard deviation of 54±13 years. The medians (Me) and interquartile ranges (IQR) obtained were 1.500 (0.6750 – 2.5000) mL/5min for the UWSF, 2.405 (1.6775-3.4925) g/2min for the Saxon test, 6.67 (3.67-7.67) for ESSPRI and 7.00 (4.00-8.00) for ESSPRI-dryness score. A direct and significant correlation between the Saxon test and the UWSF (r s =0.325; P =0.006) was observed. Twenty-four patients (34.3%) presented an altered UWSF and forty-two patients (60%) had an altered Saxon test. When we analysed the intensity of the association between the different groups (altered/normal) of both variables, we observed a direct and significant association (Gamma value=0.583, P =0.010) between both tools. We also detected differences in the Saxon test between patients with altered UWSF (Me: 1.89 gr/2min.; IQR: 1.47-2.68) and those with normal UWSF (Me: 2.78 gr/2 min.; IQR: 1.77-3, 75) ( P =0.029). Similarly, we observed significant differences in UWSF values between patients with altered Saxon test (Me: 1.30 mL/5min IQR: 0.50-2.13) and those with a normal Saxon test (Me: 2.00 mL/5min IQR: 1.5-2.88) ( P =0.008). Regarding the ESSPRI, 42 (62,7%) patients presented an altered ESSPRI and 49 (73,1%) had an altered ESSPRI-dryness score. The group patients with ESSPRI-dryness score≥5 obtained significantly worse scores on the Saxon test (Me: 2.10 g/2min IQR: 1.58-3.07) and on the ESSPRI (Me:7.33 IQR:5.83-8.00) than the normal ESSPRI-dryness score group: Me:3.02 g/2min, IQR:2.20-3.84, on Saxon test ( P =0.026); Me: 2.66 IQR:1, 00-4.08, on the ESSPRI ( P =0.000). Conclusion In patients with suspected SS, there is a direct and significant correlation between the Saxon test and the UWSF. Therefore, the Saxon test could be useful in the initial assessment of oral gland dysfunction, to save time and/or to select patients who require performing the UWSF. References [1]Martínez Ceballos MA et al. Rev. Colomb Reumatol.2020; 27 (S2):90-101. [2]Kohler PF & Winter ME. Arthr & Rheum. 1985;28(10):1128-32. [3]Minagi HO et al. J Oral Rehabil.2020;47:1550-6. Disclosure of Interests None declared

Objectives: To determine the incidence and risk factors implicated in the development of first cardiovascular (CV) event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) attending Spanish rheumatology clinics after 5 years of follow-up Methods: Analysis of data of patients included in an observational prospective study [CARdiovascular in rheuMAtology (CARMA) project] after 5 years of follow-up. The study includes a cohort of 2234 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA), and another cohort of matched individuals (n=677) without CIRD from 67 hospitals in Spain. Cumulative incidence per 1000 patients of CVE was estimated in both cohorts at 5 years from the start. Weibull proportional hazard model was used to calculate the Hazard Ratio (HR) and 95% confidence intervals (CI) of the risk factors involved in the development of CV events. Losses to follow-up and their causes were also analyzed. Results: The total number patient who completed the follow-up visit at 5 years was 2.382 (81.9%). Fifteen patients died due to CVE and sixty due to non-CVE. The patients with CIRD showed higher cardiovascular cumulative incidence (40.5; 95% CI: 36.2-44.8) than controls (28.3; 95% CI: 21.8-34.8). The higher risk of developing a first CVE during the 5 years of follow-up was seen in patients with AS (HR: 4.60; 95% CI: 1.32-15.99; p=0.02), those with older age (HR:1.09; 95% CI: 1.05-1.13; p<0.001), higher systolic blood pressure (HR: 2.64; 95% CI: 1.32-5.25; p=0.006), and those with longer duration of the rheumatic disease (HR: 1.07; 95% CI: 1.03-1.12; p=0.002). In contrast, woman gender was a protective factor (HR: 0.45; 95% CI: 0.21-0.99; p=0.047). Conclusion: Patients with AS prospectively followed-up at rheumatology outpatient clinics showed higher risk of developing a first CVE than those without CIRD. Besides traditional CV disease risk factors, a longer time course of the disease is a risk factor for the development of CV disease in patients with CIRD. Acknowledgments: This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results and preparation of the manuscript has been done independently of Abbvie. Disclosure of Interests: Maria Auxiliadora Martin-Martinez: None declared, Santos Castañeda: None declared, Fernando Sánchez-Alonso: None declared, Carmen García Gomez: None declared, Carlos Gonzalez Juanatey: None declared, Maria Angeles Belmonte: None declared, Jesús Tornero: None declared, José Santos Rey: None declared, CARMEN OLGA SANCHEZ GONZALEZ: None declared, Estefanía Quesada-Masachs: None declared, MARIA DELPUERTO MORENO GIL: None declared, Tatiana Cobo-Ibáñez: None declared, Jose Antonio Pinto Tasende: None declared, Jesús Babío: None declared, Gemma Bonilla: None declared, Antonio Juan Mas: None declared, Javier Manero: None declared, Montserrat Romera: None declared, Javier Bachiller-Corral: None declared, Eugenio Chamizo Carmona: None declared, Javier Calvo: None declared, Raimon Sanmarti: None declared, Maria Celia Erausquin: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Carmen Barbadillo: None declared, Sergio Ros Exposito: None declared, Javier del Pino Grant/research support from: Roche, Bristol, Consultant of: Gedeon, MARIA JOSE GONZALEZ: None declared, José Manuel Pina Salvador: None declared, Javier Llorca: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

Background: Oncohematological diseases have an increased incidence in Rheumatoid Arthritis (RA) patients. However, their trend in RA in Spain is unknown Objectives: To analyze the incidence and trend of hospital admissions for lymphomas and leukemias in RA patients in Spain from 1999–2015 Methods: We performed an observational retrospective population study analyzing the spanish administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of RA patients from 1999–2015. We selected MBDSs for lymphomas and leukemias. Cases were identified by the presence in primary/secondary diagnosis of ICD9 codes. The population at risk was estimated with a prevalence of RA of 0,5% (0,8% women and 0,2% men). Crude and adjusted rates were calculated, and the trend was analyzed using the Generalized Linear Model with the year as the analysis variable. SPSS version 20 (Chicago, IL) was used Results: 338.343 RA hospital admissions were detected, being 3561(1,1%) lymphomas (61,5% women, 38,5% men) and 1664(0,5%) leukemias (52,3% women, 47,7% men). Mean age 68,94(SD 11,38) in lymphomas and 71,46(SD 11,24) in leukemias. Age-adjusted rate during the period for lymphoma was 152,19/105 inhab/year (92,05 women and 240,14 men). Lymphoma age-adjusted rate increased from 52,46/105 inha/year in 1999 to 187,57 in 2015, both women (from 42,74 to 142,95) and men (from 280,77 to 326,63). An annual increase in lymphoma rate of 6,9% is estimated (RRI 1,069; CI 95% 1,054–1,085). Age-adjusted rate during the period for leukemia was 90,87/105 inhab/year (37,09 women and 144,65 men). Leukemia age-adjusted rate increased from 18,86/105 inhab/year in 1999 to 94,05 in 2015, both women (13,80 in 1999 to 65,93 in 2015) and men (38,70 in 1999 to 204,84 in 2015). An annual increase in leukemia rate of 8,2% is estimated (RRI 1,083; CI 95% 1,069–1,097). Conclusions: In Spain from 1999–2015 lymphoma and leukemia hospital admissions in RA patients increased, with an estimation of 6,9% and 8,2% annual increase respectively. Disclosure of Interest: None declared

Background Treatment and evolution of Rheumatoid Arthritis (RA) have had an important change in the last years. However the trend of amyloidosis, habitually related to long-standing and active RA, in Spain is unknown. Objectives To analyse the incidence and trend of hospital admissions for amyloidosis in RA patients in Spain from 1999 to 2015. Methods We performed an observational retrospective population study analysing the spanish administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of RA patients from 1999 to 2015. We selected the MBDSs for amyloidosis. Cases were identified by the presence in primary and secondary diagnosis of its ICD9 code. The population at risk was estimated with an estimated prevalence of RA of 0,5% (0,8% women and 0,2% men). Crude and adjusted rates were calculated, and the trend was analysed using the Generalised Linear Model (GLM) with the year as the analysis variable. SPSS version 20 (SPSS Inc, Chicago, IL) was used. Results 338.343 RA hospital admissions were detected, being 3085 (0,9%) due to amyloidosis with 2298 (74,5%) women and 787 (25,5%) men. Mean age 65,42 (SD 13,08). There were 366 (11,9%) deaths. Age-adjusted rate during the period was 122,87/105 inhab. per year (98,96 women and 146,79 men). Amyloidosis age-adjusted rate decreased from 138,88/105 inhab. per year in 1999 to 71,47 in 2015, both women (128,18 in 1999 to 61,35 in 2015) and men (162,36 in 1999 to 107,95 in 2015). An annual decrease in the amyloidosis rate of 4,6% is estimated (RRI 0,953; CI 95% 0,939–0,968). Conclusions In Spain from 1999 to 2015 amyloidosis hospital admissions in patients with RA decreased, with an estimation of 4,6% annual reduction. This finding concurs with a greater knowledge of RA and its treatment advances with ”treat-to-target” strategies. Disclosure of Interest None declared

Background There have been important changes in the management of rheumatoid arthritis (RA) in the last 20 years, due to the incorporation of new drugs. An increase in the incidence of tuberculosis infection (TB) has been observed because of reactivation of latent TB with the use of new treatments. Adequate prevention measures have been implemented. Objectives To analyse the incidence and trend of hospital admissions for TB in patients with RA in Spain during the period between 1999 and 2015. Methods This is a retrospective population based study. We analysed a national administrative database that includes a Minimum Basic Data Set (MBDS) of hospital admissions of patients with RA. Period: 1999 to 2015. The TB cases were identified by the presence in primary and secondary diagnosis of ICD 9 codes. The population at risk was estimated through the population census of the National Institute of Statistics, with an estimated prevalence of RA of 0.5%. The crude and adjusted rates of TB were calculated. The trend was analysed using Generalised Linear Models (GLM) using the year variable as the analysis variable. Results Among all the admissions of patients with AR (338.343), 1209 (0.35%) were due to TB, 665 (55%) in women and 544 (44,9%) in men. The mean age was 63.25 (SD 13.7). The mean of the Charlson index was 1.84 (SD 1.45), in women 1.63 (SD 1.3) and in men 2.09 (SD 1.59) (p<0.001). There were a total of 94 (7.8%) deaths during admission (6.9% in women, 8.8% in men, p=0.231). The TB age-adjusted rate during the study period was 42.78/100.000 inhabitants RA-year (28.2 in women and 100.74 in men). The TB age-adjusted rate in both sexes remains without significant changes between 1999 and 2015 (IRR 0.225; CI95% 0.985–1.025). During the period 1999–2011 an increase of the incidence is observed, while in the period 2011–2015 it is observed a decrease of the same (fig 1). Conclusions Conclusion: In Spain, in patients with RA, the income rate in relation to tuberculosis increased from 1999 to 2010 and subsequently decreased in the period from 2011 to 2015. Disclosure of Interest None declared

Background Several changes have appeard in the last years in the management of Rheumatoid Arhritis (RA), and also a greater awareness about cardiovascular risk has emerged. However, the trend of CVDs in RA in Spain is unknown. Objectives To analyze the incidence and trend of hospital admissions for CVDs in patients with RA in Spain during the period between 1999 and 2015. Methods We performed an observational retrospective population study analyzing the spanish administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of patients with RA 1999-2015. We selected the MBDSs for CVDs, myocardial infarction (MI), ischemic heart disease (IHD), congestiveheart failure (CHF), cerebrovascular disease (CeVD) and aortic aneurysm (AA). Cases were identified by the presence in primary and secondary diagnosis of ICD9 codes. The population at risk was estimated through the population censuswith an estimated prevalence of RA of 0,5% (0,8% women, 0,2% men). Crude and adjusted rates were calculated, and the trend was analyzed using the Generalized Linear Model (GLM) with the year as the analysis variable. SPSS statistical package version 20 (SPSS Inc, Chicago, IL) was used. Results 338.343 RA hospital admissions were detected in the period, being 207.597 (61,3%) due to CVDs. table1 summarizes the data of the six subgroups of CVDs. Conclusions CVDs were the first cause of hospital admissions in Spain in RA patients during the period 1999-2015. Moreover, in that period there was an increasing incidence of hospital admissions due to CVDs in all the studied subgroups, being strikingly higher inmen after age-adjusted rates. An annual rate increase is estimated in all the different studied subgroups oscilating between 5 and 9% annual increasing. Disclosure of Interest: None declared

Background Felty’s syndrome (FS) is an unfrequent entity realted to Rheumatoid Arthritis (RA) but it’s unknown the trend of FS in Spain. Objectives To analyse the incidence and trend of hospital admissions for FS in RA patients in Spain from 1999 to 2015. Methods We performed an observational retrospective population study analysing the spanish administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of RA patients from 1999 to 2015. We selected the MBDSs for FS. Cases were identified by the presence in primary and secondary diagnosis of its ICD9 code. The population at risk was estimated with an estimated prevalence of RA of 0,5% (0,8% women and 0,2% men). Crude and adjusted rates were calculated, and the trend was analysed using the Generalised Linear Model (GLM) with the year as the analysis variable. SPSS version 20 (SPSS Inc, Chicago, IL) was used. Results 338.343 RA hospital admissions were detected, being 802 (0,2%) due to FS, 455 (56,7%) women and 347 (43,3%) men. Mean age was 67,94(SD 13,76). There were 61 (7,6%) deaths. Age-adjusted rate during the period was 42,19/105 inhab. per year (19,76 women and 64,61 men). FS age-adjusted rate decreased from 25,90/105 inhab. per year in 1999 to 17,20 in 2015, both women (12,85 in 1999 to 11,75 in 2015) and men (80,15 in 1999 to 38,75 in 2015). An annual decrease in the FS rate of 0,5% is estimated (RRI 0,995; CI 95% 0,976–1,014). Conclusions In Spain FS hospital admissions in patients with RA decreased between 1999–2015 with an estimation of 0,5% annual reduction not statistically significative. Disclosure of Interest None declared

Background Associations between muscle pathology and clinical features in inflammatory myositis(IM) are not well defined Objectives to describe the pathological findings in REMICAM1 muscle biopsies, and analyse their associations with clinical features Methods All patients with available biopsy were included. According to the score proposed by ENMC workshop2, from muscle biopsy reports was extracted: inflammatory cells and location (endomysial, perimysial, perivascular), rimmed vacuola, fibre atrophy, necrosis, regeneration, and HLA expression. Descriptive analysis and association studies between histology and clinical features were performed (t and chi square tests, univariate logistic regression with OR) Results From 479 patients, 244 (51%) had available biopsy. Most frequent findings were: inflammatory infiltrates(75%): endomysial(44%), perimysial(49%) perivascular(26%); fibre atrophy(54%), perifascicular(27%); necrosis(55%) and regeneration(47%). HLA expression was +in 60/75 cases(80%). Endomysial infiltrate was associated with PM (OR 0.4;p<0.0001), cardiac involvement (OR 2.2;p=0.014), less arthritis (OR 0,5;p=0.01) and older age (51 vs 42 y;p<0.01); perimysial infiltrate and perifascicular atrophy with DM (OR 3.8;p<0.0001) and younger age (40 vs 48 y;p<0.05); necrosis with cardiac involvement (OR 2.1;p=0.035), neoplasia (OR 2.5;p=0.02) and no connective tissue disease (OR 0.4;p=0.01); and HLA with PM (OR 0.1;p=0.003) Conclusions most frequent histologic findings in IM muscle are inflammatory infiltrates, necrosis, HLA expression and perifascicular atrophy. Endomysial infiltration and HLA are characteristic of PM, and perimysial infiltration/perifascicular atrophy of DM. Endomysial infiltrates are associated with cardiac involvement. Necrosis is more frequent in neoplasia and less in connective tissue diseases, and is associated with cardiac involvement and older age. Our data suggest that muscle biopsy might help to identify those IM patients at higher risk of severe complications, as neoplasia or cardiac involvement References [1] Nuño L. Rheumatol Clin2017. [2] De Bleecker JL. Neuromuscular Disorders2015. Disclosure of Interest None declared

Background A collaborative EULAR/ACR Project has developed new criteria for inflammatory myopathies(IM) and their subgoups1 Objectives To analyse agreement between the 2017 IM classification criteria and the Bohan and Peter(BP) criteria in REMICAM cohort2 Methods All patients were included. New criteria were applied to obtain classification as: possible(Pos), probable(Pro) and definitive(Def) IM, and subclassification in 6 subgroups: polymyositis(PM), dermatomyositis(DM), juvenile DM(JDM), amiopathic DM(ADM), inclusion body myositis(IBM) and juvenile myositis(JM). The 7 subgroups in REMICAM were harmonised to fit the 6 subgroups of the 2017 criteria. Agreement between 2017 and BP criteria was analysed in classification/subclassification, calculating the weighted kappa value (k). Subanalysis including only patients with available data on the muscle strength items required for the 2017 criteria, and in those having also muscle biopsy data, were conducted. Results From 479 REMICAM patients, 477 (99.6%), fulfilled BP criteria (5.9%Pos, 26.8%Pro, 67.4%Def) and 431 (89.9%) 2017 criteria (2.5%Pos, 21.8%Pro, 65.7Def). Global agreement between both criteria was 89.5%. Agreement between subtypes (Pos, Pro, Def) was low (k=0.15). When 399 patients with muscle strength data, and 243 with muscle biopsy data were analysed, results were similar (k=0.17). Disagreement was mainly seen in Pos/Pro subtypes with BP criteria, since 60% classified as Def when the 2017 criteria were applied. Agreement in the different subgroups of IM (PM, DM, JDM, ADM, IBM, JM) between both criteria was very high (k=0.94). Conclusions The new 2017 EULAR/ACR criteria for IM classification show good agreement with BP criteria in the REMICAM cohort. New criteria classify 60% of Pos/Pro patients by BP criteria, as Def, and show very high agreement between IM subgroups. Validation studies are needed, but our results in this large cohort suggest the 2017 criteria might be useful for clinical trials and research in IM. References [1] Lundberg IE. Ann Rheum Dis2017;76:1955–64. [2] Nuño L. Rheumatol Clin2017;13:331–7. Disclosure of Interest None declared

Background The need of orthopaedic surgery (OS) is a marker of disease severity in RA. During the last 20 years, the treatment in RA has changed, incorporating strategies based on ”treat-to-target” and biological therapies. But, have these new strategies modified the incidence of OS in RA? Objectives To analyse the incidence and trend of hospital admissions for OS in patients with RA, in Spain, during the period between 1999 and 2015. Methods This is a national retrospective population based study. We analysed a national administrative database that includes a Minimum Basic Data Set (MBDS) of all hospital admissions of patients with RA. Period: 1999 to 2015. The OS were identified by the presence of ICD9 codes for arthrodesis, Total Hip Arthroplasty -THA-, Total Knee Arthroplasty -TKA-, Total Superior Limb Arthroplasty -TSLA. The population at risk was estimated through the population census of the National Institute of Statistics. The adjusted rates of hip fracture were calculated, by sex and age. The trend was analysed by Generalised Linear Models (GLM). Results Of a total of 338.343 hospital admissions, 21.088 (6,62%) were for OS. The main clinical-demographic characteristics are shown in the next table 1. The mean age of OS increased 6 years during the study period (p<0,001). The OS age-adjusted rate during the study period was 752,9/105 inhab-year. The global fracture age-adjusted remained stable during de study period (IRR 1,002; IC95% 0,9–1,01). In RA patients>60 the rate increase while in RA <60 years the rate decrease (figure 1). Conclusions In Spain, during the period from 1999 to 2015, the global incidence rate of orthopaedic surgery in patients with RA has remained stable. In RA patients>60 years the rate increase while in RA <60 years the rate decrease. The mean age of OS increased 6 years. Disclosure of Interest None declared

Background During the last 20 years there have been significant changes in the treatment of patients with rheumatoid arthritis (RA) and in the prevention and treatment of osteoporosis. The potential impact of these strategies on important outcomes as the incidence of hip fracture in RA is unknown. Objectives To analyse the incidence and trend of hospital admissions for hip fracture in patients with RA, in Spain, during the period between 1999 and 2015. Methods This is a retrospective population based study. We analysed a national administrative database that includes a Minimum Basic Data Set (MBDS) of hospital admissions of patients with RA. Period: 1999 to 2015. The hip fracture cases were identified by the presence in primary and secondary diagnosis of ICD 9 codes. The population at risk was estimated through the population census of the National Institute of Statistics, with an estimated prevalence of RA of 0.5%. The crude and adjusted rates of hip fracture were calculated. The trend was analysed using Generalised Linear Models (GLM) using the year variable as the analysis variable. Results Of a total of 338.343 admissions of patients with RA, 6.656 (2%) was due to hip fracture, 5.608 (84.2%) in women and 1.048 (15.7%) in men. The mean age was 77.54 (SD 9.6). Mean age increased linearly during the study period (from 75,3 years in 1999 to 79,9 in 2015). There was a total of 326 (4.9%) deaths during admission. The fracture age-adjusted rate during the study period was 243,66/100.000 RA-patients*year (245,24 in women and 198,05 in men). The fracture age-adjusted rate increased from 150.11/100.000*year in 1999, to 303.12 in 2015 (in both sex). In women from 134.71 in 1999 to 304.83 in 2015) and in men from 99.63 in 1999 to 268.5 in 2015). An annual increase in the fracture rate of 3.1% is estimated. Conclusions In Spain, during the period from 1999 to 2015, although the mean age has increased, the incidence of hip fracture has not been reduced. We estimate an annual increase of 3.1%. Disclosure of Interest None declared

Background Regardless of disease activity, functional status gets worse in patients with rheumatoid arthritis (RA) with comorbidities. However, the impact of comorbidities on physical function in ankylosing spondylitis (AS) and psoriatic arthritis (PsA) is less known. Objectives To assess the impact of comorbidities on physical function (PF) in patients with AS and PsA. Methods Analysis of the baseline visit from the ongoing multicentric, observational, prospective, CARMA study. Data from patients with AS and PsA were analysed. Two different adjusted multivariate models were performed, where PF was the dependent variable (BASFI in AS and HAQ in PsA) and the following independent variables: comorbidities, a proxy for the Charlson index (ChI) (minimum 0; maximum 11), sociodemographic, disease activity (ESR, CRP and BASDAI in AS; while SJC, TJC, CRP, ESR, DAS, dactylitis count and PASI in PsA) and duration, radiographic damage and treatments. Results are presented as β coefficients and p-values. Results 738 patients with AS and 721 with PsA included (mean age at inclusion 48.1±11.7 and 51.8±12 years, respectively). AS patients: median BASFI 3.1 [interquartile range (IQR): 1.3–5.2], BASDAI 3.5 [IQR: 1.7–5.3], mean ChI 1.32±0.73. PsA patients: HAQ 0.4 [IQR: 0.0–0.9], DAS28 2.9 [IQR: 2.0–3.8], mean ChI 1.30±0.66. A ChI >1 found in 21% of the patients. Hypertension in 25.7% and 29.5%; hypercholesterolemia in 27% and 35.6% and diabetes in 7.6% and 9.2% of the patients with AS and PsA, respectively. Cardiovascular events occurred in 7.6% AS and 7.2% PsA, in most cases after the rheumatic disease diagnosis. Only patients with PsA with higher ChI showed worse adjusted physical function (β: 0.09; p=0.03). Also female sex (β: 0.03; p=0.001), obesity (β: 0.09; p=0.04), disease duration (β: 0.01; p=0.009), NSAIDs (β: 0.1; p=0.02), corticosteroids (β: 0.12; p=0.02) and biologics (β: 0.15; p=0.07) were associated with worse function in patients with PsA. In contrast, a higher educational level was associated with less disability. In patients with AS, thyroid disease (β: 1.19, p=0.002) and raised ESR (β: 0.01, p=0.010) were independently associated with function. Conclusions The presence of comorbidities in patients with PsA is independently associated with worse physical function, similar to what happens in RA. Early detection and control may yield an integral management of the disease and better final outcomes. Disclosure of Interest None declared

Background There have been significant changes in the management of rheumatoid arthritis (RA) during the past 20 years. The potential impact of these strategies on hospitalisation trend is unknown. Objectives To analyse the incidence and trend of hospital admissions in patients with RA in Spain from 1999 to 2015. Methods This is a population based study. We analysed a national administrative database that includes a Minimum Basic Data Set (MBDS) of hospital admissions of patients with RA during the period 1999–2015. The admission cases in patients with RA were identified by the presence in primary and secondary diagnosis of the ICD9 codes (714.0–714.9). The population at risk was estimated through the population census of the National Institute of Statistics, with an estimated prevalence for RA of 0.5%, with crudes and adjusted admission rates being calculated. The trend was analysed using Generalised Linear Models (GLM). Results There were a total of 3 38 343 hospital admissions in RA patients during the study period, accounting for a total of 1 76 097 patients (1 17 985 women and 58 112 men). The mean age at admission was 68 years (67.8 in women and 68.5 in men), with a linear increase throughout the study period from 65.3 in 1999 until 70.5 in 2015 (p<0.001). The main admission code was for Osteoarticular and connective tissue diseases (20%) followed by Circulatory system diseases (16.8%). There were a total of 18 641 intrahospital deaths (5.5% of all the admissions). The age-adjusted admission rate was 12.03/100 RA patients*yr (9,12 for women and 1.88 for men). The age-adjusted admission rate increased from 1999 to 2015 (in both genders). An annual increase of admission rate of 3.7% is estimated. When adjusting by age, the largest increase is observed in patients older than 80 years, with an estimated annual increase of 7.5%. Conclusions In Spain, despite the improvement in RA management, there is a global tendency to the increase of admissions during the period of 1999–2015, mainly in >60 year, especially in >80 year. Disclosure of Interest None declared

BackgroundRheumatoid Arthritis (RA) patients are at an increased risk of infection compared with healthy individuals, related to immune dysfunction. New treatments have revolutionised RA management; however, serious infection especially in elderly remains a concern.ObjectivesTo analyse the incidence and trend of hospital admissions for all infections in patients with RA in Spain during the period between 1999 and 2015.MethodsThis is a national retrospective population based study. We analysed a national administrative database that includes a Minimum Basic Data Set (MBDS) in all hospital admissions of patients with RA. Period: 1999 to 2015. Cases were identified by the presence of ICD9 codes. The population at risk was estimated through the population census of the National Institute of Statistics. The adjusted rates of infection were calculated, by sex and age. The trend was analysed by Generalised Linear Models (GLM). Statistical analysis was made using SPSS statistical package version 20 (SPSS Inc, Chicago, IL).Results338.343 RA hospital admissions were detected in the study period, being 81.468 (24,07%) due to infections. The main clinical-demographic characteristics are shown in table 1: The annual age-adjusted rate of infections increased during the study period, especially in men (fig I). The annual trend of infections age-adjusted increased during the study period 5.29%, women 5.08% and men 5.92%. For age groups the annual increase was 3.51% for 20–40 years, 3,.2% for 40–60 years, 4,5% for 60–80 years and 9.27% for >80 years.ConclusionsRate of infection in RA hospitalised patients in Spain has increased during study period. The patients are progressively elderly and has more comorbidities. However the average hospital stay decrease.Disclosure of InterestNone declared

Background Inflammatory myopathies (IIM) are a heterogeneous group of autoimmune rheumatic diseases characterized by muscle inflammation and progressive weakness. They include any kind of primary inflammatory muscle disease that is not otherwise better explained by metabolic, toxic, infectious, neurologic or inherited causes. The presence of autoantibodies (AA) in IIM is variable and they can recognize nuclear and cytoplasmic cellular components. Objectives To evaluate the AA profile in patients diagnosed with IIM. Methods We evaluated 479 patients that included 12 hospitals belonging to the IIM registry of the Rheumatology Society in Madrid (SORCOM-REMICAM) with diagnosis from January 1980 to December 2014. All patients were diagnosed of IIM according to Bohan and Peter criteria. The AAs evaluated were ANA (n=476), anti-Jo1 (n=457), anti-RNP (n=427), anti-MI2 (n=159) and ACA (n=293), according to the standard techniques in the respective laboratories. The presence of ANA was considered valid with at least two positive determinations. The AAs were compared according to the classification I) as dermatomyositis (primary and secondary dermatomiositis) (DM) and polymyositis (PM) including the rest of the patients. Also, IIM were classified (II) as primary polimiositis (PPM), primary dermatomyositis (PDM), overlap syndrome (OSd), juvenile myopathies (JM), cancer-associated myopathies (CAM), autoimmune necrotizing myopathy and inclusion body myositis (these were grouped as other myositis; OM). Results In the PM and DM groups 250 and 229 (52.2% and 47.8%) patients were included respectively. Positive ANA, anti-Jo1 and anti-RNP were higher in the PM than in the DM group (67, 22 and 19% vs. 56, 11 and 6%) (p=0.21, p=0.002, p=0.0001, respectively). The presence of anti-MI2 was higher in the DM group (p=0.024), according to the classification II, we found statistically significant differences in ANA, anti-Jo1, anti-RNP and anti-ACA. The OSd group had the highest proportion of ANA, anti-RNP and ACA positive AA and the JM group had the lowest frequency of Anti-Jo1 (see Table 1). Conclusions The AA associated with the IIM subtypes is consistent with published scientific evidence on other cohorts for ANA, anti-Jo1, anti-RNP and anti-MI2, in spite of the small sample size. The OSd group showed higher ANA and anti-RNP frequencies which might be explained by the coexistence of SLE and MCTD patients. It could be interesting to follow up those PPM patients with positive AA because they could be in the future diagnosed with a connective tissue disease. Carrying out longitudinal studies that include a greater proportion of patients may help to evaluate and predict the clinical course of IIM. References Bohan A, Peter JB. N Engl J Med 1975 Feb 13;292(7):344–7. Acknowledgements . Disclosure of Interest None declared

Background Interstitial lung disease (ILD) in idiopathic inflammatory myopathies (IIM) may appear at any time in evolution and is associated with a worse prognosis. Objectives To investigate sociodemographics data and clinical characteristics of patients with IIM and ILD from the REMICAM registry. Methods A multicenter retrospective study (1980–2014) was performed. Patients were classified as polymiosytis (PM), dermatomyositis (DM), IIM with anti-synthetase antibodies (AB) and overlap syndrome. In addition, ILD was classified according to HRCT pattern: usual interstitial pneumonia (IP), non specific IP, organizing pneumonia, and acute IP. We compared sociodemographic data, clinical characteristics, AB and treatments of patients with and without ILD, patients with ILD according to subgroup of myositis or ILD. Results 478 patients were included, of whom 129 (27%) had ILD. Patients with ILD had a higher age at diagnosis, ESR and CRP and worse initial respiratory function. They were characterized by increased frequency of arthritis, systemic and cardiac manifestations, Raynaud, cardiovascular disease, pulmonary hypertension, ischemic ulcers, sclerodactyly and anti-synthetase AB (p<0.001). The differences among patients with ILD were: less arthritis in PM, greater frequency of Raynaud and sclerodactyly in overlap and antisynthetase syndrome, more anti-RNP AB in the overlap syndrome, more anti-synthetase and anti-Ro AB in the antisynthetase syndrome, and a higher prevalence of cutaneous signs and mechanical hands in DM (p<0.001). There were no differences according to the type of ILD or treatments. Conclusions We found some clinical manifestations and AB that may help for detection of patients with IIM associated to ILD, as well as clinical manifestations to better differentiate myositis subtypes in patients with ILD. Disclosure of Interest None declared