Background: Improving quality of life (QoL) is one of the key targets when treating systemic lupus erythematosus (SLE) patients. The Lupus impact Tracker (LIT) is a 10-item questionnaire that has demonstrated being a reliable and valid tool to assess the impact [1] of the disease in SLE patients. LIT may range between 0 (no impact on QoL) and 100 (maximum impact on QoL). Objectives: To analyze the variables potentially associated with a greater influence on QoL (higher LIT score) in SLE patients Methods: The study population corresponds to RELESSER-PROS prospective cohort with data from patients at their first annual visit (V1). The LIT score was divided into 4 groups based on the quartile distribution, and the distribution of variables in each of the 4 groups was analysed. The Chi-square or Fisher test was used for categorical variables, while ANOVA or Kruskal-Wallis tests were employed for continuous variables. Subsequently, a logistic regression model was fitted to analyse the variables influencing the presence of LIT scores greater than 50 points. A significance level of 5% was used for the entire analysis, and the R software was employed. Results: A total of 1417 SLE patients were prospectively included in the study: 1275 (90%) female/142 (10%) male; 1299 (94.2%) Caucasian. The mean (±SD) age at SLE diagnosis and at study entry (V1) were 34.7 (±13.9) and 56.0 (±1.0) years, respectively. The median (Q1-Q3) value of LIT at V1 was 25 (10-47.5). The domains of LIT who scored the most for the final value were "pain/fatigue" with a mean (±SD) score per question: 1.52 (±1.07) and "emotional health" with 1.29 (±1.18). On the other hand, the domains of LIT that scored the least were "body image dissatisfaction" and "lupus medication adverse effects" with 0.87 (±1.20) and 0.69 (±1.09) per question, respectively. At V1, the mean (±SD) clinical (without serology) SLEDAI score was 1.92 (±3.26) and the mean (±SD) SLE Damage Index (SDI) score was 1.42 (±1.77). We observed significantly higher cSLEDAI and SDI scores in the subgroup of patients with higher (50,100) LIT values (Table 1). When we performed a bivariant correlation analysis between LIT score and both cSLEDAI and SDI we observed that correlation was low: Spearman's Correlation Coefficient 0.093 and 0.17, respectively. We observed that patients with higher LIT values were less likely in LLDAS and in 2021 DORIS remission (p=0.04 for remission). We also analyse the influence of some variables other than activity and damage on QoL of SLE patients such as educational and laboral status, comorbidities (chronic obstructive, pulmonary disease, dyslipemia, fibromyalgia, depression, thyroid disease, cardiovascular comorbidity and gastroduodenal ulcer) and therapies (glucocorticoid treatment and doses, immunosuppressive therapy, antimalarial treatment and biologic therapy). We carried out a multivariant analysis with the previously mentioned variables, defining "LIT score > 50" as the dependent variable. Table 2 shows the variables with significant independent association with a higher impact of SLE on QoL in the multivariate analysis. Conclusion: SLE has a significant impact on QoL of the patients, "pain/fatigue" and "emotional health" being the domains of QoL affected the most. Beyond activity and damage, comorbidities such as fibromyalgia, depression and thyroid disease as well as being on higher daily dose of prednisone are significantly associated with higher impact on QoL of SLE patients. On the other hand, some socioeconomic variables and being on hydroxychloroquine are significantly associated with better QoL. These results highlight the relevance of considering these factors when making clinical decisions, with the purpose of optimizing medical care of SLE patients. REFERENCES: [1] Jolly M, Garris CP, Mikolaitis RA, et al. Development and validation of the Lupus Impact Tracker: a patient-completed tool for clinical practice to assess and monitor the impact of systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2014;66(10):1542-1550. doi:10.1002/acr.22349 Acknowledgements: The RELESSER Registry was supported by the Spanish Society of Rheumatology. This work was supported by the grant Fondo de Investigaciones sanitarias/Instituto de Salud Carlos III (FIS/ISCIII)-Fondo Europeo de Desarrollo regional (FEDER) (Grant number PI11/02857). RELESSER PROS is funded by GSK. Disclosure of Interests: None declared.

Background: In systemic lupus erythematosus (SLE), there is not a standardized and validated definition of states of moderate and severe SLE activity. This is a major drawback both for research purposes and for the stratification of treatments according to severity. Objectives: To propose a definition for moderate disease activity state (MODAS) and severe disease activity state (SEDAS) in SLE and using the RELESSER-PROS cohort to describe the prevalence of both states of activity and to analyze the impact of this categorization on different outcomes. Methods: The study population belongs to the RELESSER-PROS prospective cohort with data from patients followed annually for 4 years. The MODAS and SEDAS definitions were generated by a panel of lupus experts, which may be differentiated depending on absolute score of clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI), certain clinical manifestations not considered in SLEDAI and the subjective assessment of the physician, through PGA. MODAS was defined as the presence of at least one of the following conditions: <4 cSLEDAI ≤ 8 or 1< PGA ≤ 2 (without severe clinical manifestations); and SEDAS: SLEDAIc >8 or PGA > 2 or the presence of severe SLEDAI and Non-SLEDAI manifestations. Low disease activity (No MODAS nor SEDAS): 1≤SLEDAIc ≤4 or 0

Background: Life expectancy in systemic lupus erythematosus (SLE) increased but they can accrual another conditions associating higher morbidity and mortality than the general population. Objectives: To perform a descriptive analysis of the comorbidities present in a large SLE cohort, the accumulated damage, the distribution of events between sexes; the relationship between age at diagnosis, diagnostic delay and treatments administered to these patients. Methods: Multicenter cross-sectional study of RELESSER patients. Means were compared using the Mann-Whitney test after checking normality using the Kolmogorov-Smirnov test. Chi-square statistical test or Fisher's test, were used for qualitative items and Spearman's correlation coefficient for the correlation between quantitative variables. Results: We studied 3,656 patients, 90.3% women, mean age (±SD) at diagnosis of 35.2(±14.7) years and SLE duration of 142.6(±100.8) months. We analyzed 27 conditions (see Table 1, comorbidities from the Charlson comorbidity index and alcohol and tobacco consumption, autoimmune thyroid disease, dyslipidemia, arterial hypertension, pulmonary thromboembolism, hepatitis C virus infection, Sjögren, mixed connective tissue, fibromyalgia and osteoporosis). 79.73% of patients presented comorbidities: 24.97% presented one, followed by 2 (21.09%) or 3(15,48%) comorbidities. The most common were smoking, dyslipidemia and hypertension. In patients without comorbidities the first lupus criteria appeared earlier (27.73 (±12.04) vs. 34.47 (±14.76) years old, p<0.001). They were younger at diagnosis: 29.42 (±12.13) vs. 36.62 (±14.91) years, p<0.001) with a lower diagnostic delay (25.1(±43.21) vs.32.46(±55.53) months, p=0.085).Damage was present in 38,05% of patients (musculoskeletal 13,8%, ocular 8,51% and cardiovascular 7,99%). Mean Slicc Damage index was 1.2(±1.7). Males accumulated more damage (47.03% vs. 37.11%, p<0.001) and more conditions (85.48% vs. 79.1%, p=0.003), specially: smoking, alcohol, mild liver disease, ischemic heart disease, chronic obstructive pulmonary disease, congestive heart failure, pulmonary embolism, peripheral arterial disease, and AIDS (p<0.001). Fybromialgia and Sjögren where more frequent on women (p<0.001). There was a positive correlation between the number of comorbidities and the number of systems with damage (Spearman's Rho = 0.478, p<0.001, and between the number of comorbidities and damaged systems with the number of hospitalizations by disease activity (Rho=0.265 and 0.396 respectively, p<0.001) and with the number of serious infections (Rho=0.299 and 0.307 respectively, p<0.001), with a bigger damage accrual on the latter (1.97(±1.43) vs. 1.31(±0.61), p<0.001). There were more patients without comorbidities in those who did never receive glucocorticoids(GC) (9.94% vs. 15.48%, p<0.001), they accrual less conditions(1.46 (±1.43) vs. 2.27(±1.98). More patients had comorbidities from those who did not receive antimalarials (89.1% vs. 81.78%, p<0.001), they also accumulated more: 2.94(±2.3) vs. 2.02(±1.82), p<0.001. There were significant differences in the presence of comorbidities in those treated with cyclophosphamide, mycophenolate, azathioprine or rituximab. We did not find significant differences in patients treated with methotrexate, leflunomide, immunoglobulins, abatacept and anti-TNF. Conclusion: Nowadays SLE patients have a higher life expectancy. Comorbidities and damage accrual, with a few exceptions, were more frequent in males. There are differences in the presence of these conditions in patients with different treatments. Table 1. REFERENCES: NIL. Acknowledgements: RELESSER-TRANS was funded by GSK, Novartis, UCB and Roche. Disclosure of Interests: None declared.

Background: Sjögren’s syndrome is a chronic autoimmune systemic disease that accumulates extragladular manifestations and complications such as lymphoma over time. Poor prognostic factors are described in the scientific literature [1]. Objectives: To describe the clinical evolution of patients with Sjögren’s syndrome (SS) in relation to the appearance of new systemic manifestations and disease activity, as well as factors associated with an unfavorable outcome. Methods: SJÖGRENSER PROS (SS-PROS) is an observational, longitudinal, and multicentric study of patients with SS who met the 2002 classification criteria under active follow-up in rheumatology clinics of 28 Spanish hospitals that participated in the cross-sectional phase of the study (SJÖGRENSER TRANS; SS-TRANS) [2]. For the prospective phase, an 8 year follow-up visit was performed (during 2021-2022) and results were compared to the baseline visit (SS-TRANS performed in 2013-2014, 437 patients included). Medical record was reviewed and a medical interview was performed. Epidemiological, clinical and serological variables, as well as causes of death were recorded. Continuous and categorical variables were analyzed using means, medians, and frequencies, with their respective deviations and interquartile ranges (p25-p75). Student’s T test was used to establish statistical associations, considering p<0.05 as significant. Results: Three hundred and fourteen patients have been included, 95% were women, with a mean age of 66 years old (SD 11.5) and mean evolution time from diagnosis to inclusion of 17 years (SD 6.5). Mean ESSDAI scores were similar in SS-PROS and SS-TRANS: 3.67 (SD 5.5) vs 3.5 (SD 5.2), respectively. In the analysis by domains, the joint, hematological and biological domains were the most frequently involved and those that accumulate more changes (decrease or increase) over time; for the rest of the domains, stability was evidenced in ≥95% of the cases (Table 1). By organs, the most affected organ in the follow-up was the lung, with 35 new patients who scored in to some degree of at this domain, being 53 the total number of accumulated patients who scored to some degree at this domain during the 8 year period of follow up. After 8 years, 15 lymphomas (4.8%) have accumulated in this cohort, 6 in the SS-TRANS and 9 new lymphomas in the SS-PROS. The mean ESSPRI improved slightly from SS-TRANS to SS-PROS: 5.24 (SD 2.5) vs 4.66 (SD 2), respectively; The improvement was greater in the pain VAS, 5 (SD 3.2) vs 4 (SD 2.9), respectively; The mean VAS for dryness and fatigue in SS-TRANS and SS-PROS respectively was: 6 (SD 2.6) vs 5.6 (SD 2.5) and 4.6 (SD 3.2) vs 4 (SD 3). Forty-two patients died since their inclusion in SS-TRANS (13.4%), 88% women, with a mean age of 75 years old (SD 11.5), and a 20 years long of disease evolution (SD 7.4). Comparing baseline visit data (SS-TRANS) from the group of deceased (during SS-PROS) and non-deceased (remaining under follow-up in SS-PROS), we observed that age (70 years; SD 10), lasting of the disease (11 years; SD 7.33) and ESSDAI score (6.12; SD 7.7), were higher in deceased vs non-deceased (age 57 years, SD 11; time of evolution 8 years, SD 6; ESSDAI 3, SD 4.6), this difference being significant in age (p<0.001) and with a marked trend in the lasting of the disease and the ESSDAI score, although statistical significance was not reached (p=0.078 and p=0.087 respectively). Conclusion: Patients with SS develop new systemic manifestations over the years, despite maintaining or improving ESSDAI score, suggesting the need for close follow-up. ESSPRI experiences few variations over time, which represents a great challenge for the scientific community. The incidence of lymphoma in this cohort was 4.8%. Mortality in this cohort is 13.4%. Older age, longer duration of the disease, and higher baseline ESSDAI score were associated with a worse outcome. REFERENCES: [1] Mariette X. N Engl J Med 2018;378:931-9.[2] Fernandez -Castro M. Rheumatol Clin 2016;12(4):184-9. Acknowledgements: “Proyecto SJOGRENSER del grupo de enfermedades autoinmunes sistémicas de la Sociedad Española de Reumatologia.” Disclosure of Interests: None declared.Table 1ESSDAI DomainDomainAccumulated(TRANS+PROS)(number of pacientes)Articular298 + 59=15746 + 7=13Pulmonary53 + 9=121013 + 22=35152 + 4=6Hematological262 + 69=131414 + 12=2662 + 2=4

Background Patients with Systemic lupus erythematosus (SLE) have a well-known increased risk of major comorbidities, but they are also very heterogeneous in term of prevalence of comorbid conditions. The relationship of the comorbidities with the outcomes and the severity of index disease is less known. Objectives Evaluate the interactions between comorbid conditions, on a large multicenter SLE cohort from RELESSER register, and its impact in severity and outcomes. Methods Data about 14 cumulative comorbidities, as previously defined [1], where derived from patients with SLE (ACR-97 criteria) included in the retrospective phase of RELESSER. Severity Katz Index (SKI) and SLICC/ACR Damage Index (SDI) were calculated.An unsupervised cluster analysis using K-means method was implemented to define clusters. ANOVA and Tukey tests were used to compare continuous numerical variables; Kruskal-Wallis test to discrete variables and the Chi-square test (or Fisher's exact test) to categorical ones. Results A total of 3658 SLE patients (ACR-97 criteria) were included. Median SKI: 2 (interquartile range (IQR):1-3); median SDI:1(IQR:0-2). Demographic data are shown in Table 1.The comorbidities considered and their prevalence were: Thyroiditis (8.3%), peptic ulcer (3.8%), severe hepatopathy (1.0%), obstructive pulmonary disease (2.7%), Diabetes (5.0%), cardiovascular event (CVE) (11.0%), cardiac arrhythmia (4.2%), pulmonary embolism (3.4%), dementia (0.7%), malignancy (5.9%); serious infection (19.3%), end stage renal disease (2.8%), osteoporosis (7.3%) and depression (17.1%).Four cluster, with markedly different comorbidity profiles and outcomes were identified (table 3): one subgroup was clustered around depression (100% of the cases) (cluster 2), another cluster (cluster 3) with > 1 serious infection (100%) and cluster 4, with 100% of CVE. In cluster 1, no patient had any of the 3 defining comorbidities in the rest of the clusters. There were no statistically significant differences between clusters in death by SLE. The clusters are characterized in more detail in table 1, where a just summary of the main comorbidities included in the analysis is displayed. Conclusion Cluster analysis identifies well-differentiated subgroups of SLE patients as regard comorbidities and associated mortality and severity of the disease. Reference [1]Rúa-Figueroa I et al. National registry of patients with systemic lupus erythematosus of the Spanish Society of Rheumatology: objectives and methodology. Reumatol Clin 2014;10(1):17-24. Acknowledgements Research Unit of the Spanish Society of Rheumatology. Spanish Foundation of.Rheumatology financial supporting, through the research intensification grants program. GSK financial.supporting, Disclosure of Interests None Declared.Table 1Cluster of comorbidities and outcomes, N (%) unless specifiedCluster 1 dCluster 2 aCluster 3 bCluster 4 cp-valueAge, mean (SD)44.8 (14.1)49.8 (14.1)46.7 (14.3)46.7 (14.3)<0.001Male sex214 (9.2) a,c25 (4.8)51 (12.2) a63 (16.3) a,d<0.001Time with SLE (years), mean (SD)129.2 (95.9)159.3 (101.4) d170.3 (100.3) d169 (113) d<0.001Cardiovascular event0 (0) c0 (0) c0 (0) c388 (100)<0.001Cardiac arrhythmia53 (2.3) b,c17 (3.3) c19 (4.5) c,d61 (15.7)<0.001Malignancy110 (4.7) a,c46 (8.9) d25 (6.0)31 (8.0) d0.001Serious infection0 (0)122 (23.6)418 (100)165 (42.5)<0.001End stage renal disease27 (1.2) b,c11 (2.1) b,c26 (6.2) a,d34 (8.8) a,d<0.001Osteoporosis79 (3.4)71 (13.8) d41 (9.8) c,d69 (17.8) b,d<0.001Depression0 (0) a,c516 (100)0 (0) a,c94 (24.4)<0.001Glucocorticoids1890 (86)451 (91.3) b,d400 (98)354 (93.2) b,d<0.001Cyclophosphamide or mycophenolate501 (23.5)145 (29.7)216 (54.3)139 (37.4)<0.001Antimalarials1869 (85.4) b,c433 (86.9) b,c317 (78.3)263 (71.1)<0.001SKI*, mean (SD)2.3 (1.4)2.8 (1.8)3.5 (1.8) a,d3.5 (2) a,d<0.001SDI**, mean (SD)0.7 (1)1.3 (1.8)1.6 (1.8)3.3 (2.5)<0.001Death46 (2.2)27 (5.6)45 (11.6)90 (25.2)<0.001Death by lupus14 (36.8) #8 (40) #8 (19.5) #24 (30.4) #0.27*Severity Katz Index; ** SLICC/ACR Damage Index. Regarding age, the p-value for the comparation between group 1 and 3 is 0.0498. #: no significant. a,b,c or d means the only significant comparison.

Background The prevalence of depression and associated factors in systemic lupus erythematosus (SLE) are not well known and there are no longitudinal studies addressing this relevant subject in SLE. Objectives We aimed to evaluate the prevalence of self-perceived depression in patients with SLE and associated factors in a large, multicenter cohort (RELESSER-PROS). Methods Prospective longitudinal study of patients with SLE (1997 ACR criteria) answering positively to the depression question of the Lupus Impact Tracker (LIT) questionary (namely: “I was depressed” question number 7) (LITQ7), over 4 years of follow-up (5 annual visits, V1 to V5). Self-perceived depression was addressed as “depression any time” or “depression most of time”, according to the kind of answer to the LITQ7 (answers 1,2,3 or 4 and answers 3 or 4 respectively). Only patients with no missing values in the covariates, making possible run longitudinal models, were included in the multivariable analysis. The following covariates, with potential impact in depression, were considered: SLEDAI, age, duration of the disease, SLICC/AR DI (SDI), fibromyalgia, Charlson index, smoking, BMI, menopause, sedentary lifestyle, marital status, unemployment and glucocorticoid use. Friedman test was used to test if the change in repeated measures was significative. Generalized estimating equation (GEE) models with binomial response, were built exploring the associations of individual longitudinal determinants with longitudinal assessment of depression. The best model was selected using quasi-likelihood under the independence model information criterion (QIC) Results A total of 1463 were included. Mean age: 55 (DS±13.59) years, 90% were female. Mean duration of the disease: 14 (±8.59) years. Fibromyalgia was present in 5.7% (76/1343). Corticosteroids use ranged from 49.4% to 57%, depending on the visit. Median SLEDAI ranged from 0 to 2 and SDI ranged from 1 to 2. Prevalence of “depression any time” was 89.9% (1104/1228) and 34.6% (200/578) were in depression “most of time”. Up to 26.5% (153/578) answered to LITQ7 “depression most of time” in the five visits; 89.7% of the patients which perceived themselves as depressed at least in 2 out of 5 visits. Only 6.9% of the patients with previous diagnosis of depression answered “0” to the Q7 of LIT (“none of the time”). Only following covariates showed changes, statistically significative, during the follow up: SLEDAI, SDI, Charlson and glucocorticoids use (Friedman test). Patients with “depression any time” develop more damage at V5 than patients without depression (answer to LITQ7=0) (p = 0.00931, T-test). In the GEE binomial analysis considering all the predefined covariates, that included only patients with no missing values for any of them (namely, 155 patients), fibromyalgia (OR 2.79; 95%CI: 1.28-6.05), unemployment (OR 1.95; 95%CI 1.02 -3.73), and glucocorticoids use (OR 1.88; 95%CI 1.18-2.99) were significant associated with “depression any time”. The best model (according QIC) displayed a statistically significant association only with fibromyalgia (OR 2.90; 95%CI: 1.58-5.33) and glucocorticoids use (OR 1.85; 95%CI 1.17-2.93). Neither SDI nor unemployment reached significance here (Table 1). Without entering glucocorticoids, SLEDAI turns significant in the model, suggesting collinearity. Conclusion The prevalence of self-perceived depression is high in SLE. Longitudinal data analysis suggests a causal relationship between glucocorticoids use, fibromyalgia and self-perceived depression. Acknowledgements Research Unit of the Spanish Society of Rheumatology. Spanish Foundation of Rheumatology financial supporting, through the research intensification grants program. GSK financial supporting, Disclosure of Interests None Declared.

Background The survival of patients with systemic lupus erythematosus (SLE) has increased in recent years, but they have higher morbidity and mortality than the general population. Purpose To study the prevalence of comorbidities in patients with SLE and its relationship with damage, gender and treatments received. Methods Cross-sectional multicenter descriptive study of a cohort of adult patients with SLE. Results We studied 3,656 patients, 90.3% women, mean age (±SD) at diagnosis of 35.2(±14.7) years and duration of SLE of 142.6(±100.8) months. We analyzed 27 comorbidities. 79.73% of the patients presented any, with the maximum accumulated being 14. The most frequent were smoking, dyslipidemia and arterial hypertension. 38.05% of patients accumulated damage. Males accumulated more comorbidities (85.48% vs. 79.1%, p=0.003) and damage (47.03% vs. 37.11%, p<0.001). The first criterion for SLE appeared at a younger age in patients who did not have comorbidities: 27.73(±12.04) years vs. 34.47(±14.76) years; p<0.001. We found that there is a positive correlation between the number of comorbidities and the number of systems with damage (Spearman's Rho = 0.478, p<0.001). There is a positive correlation between the number of comorbidities and damaged systems with the number of hospitalizations by disease activity (Rho=0.265 and 0.396 respectively, p<0.001 in both contrasts) as well as with the number of serious infections (Rho=0.299 and 0.307 respectively, p <0.001 in both contrasts). We found more patients without comorbidities in those who did not receive glucocorticoids (9.94% vs. 15.48%, p<0.001) and more patients with comorbidities in those who did not receive antimalarials (89.1% vs. 81.78%, p<0.001). There were significant differences in the presence of comorbidities in those treated with cyclophosphamide, mycophenolate, azathioprine or rituximab. Conclusions A high percentage of patients with SLE have comorbidities. With few exceptions, they are more frequent in males. The onset of SLE was later in patients with more comorbidities. We found variations in comorbidities depending on the treatments received.

Background Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038-2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30-1.66)). Conclusion SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

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: Renal involvement in systemic lupus erythematosus (SLE) is the most frequent severe manifestation and carries a bad prognosis. Objectives: To analyze the outcome of lupus nephritis (LN) in terms of chronic kidney disease development (CKD). Methods: Design: multicentre restrospective observational study. Patients: SLE patients (ACR97) with biopsy proven LN attending to three South European Rheumatology departments. Variables: demographics, SLE related variables, including global activity (SLEDAI-2K), renal flares, therapies, ACR response criteria and CKD. Statistical analysis: descriptive bivariate and multivariate analysis exploring factors associated to CKD. Results: Seventy-six patients with biopsy-proven LN were included, 90,7% female; mean age: 33 years; mean disease: duration 14 years; mean follow-up time (since LN diagnosis): 8,5 years. LN class III, IV and V were present in 22%, 75% and 3% of the cases, respectively. At LN diagnosis 68 (89%) patients had a severe renal flare. Forty-one (56.1%) and 49 (64.4%) had HTA and nephrotic syndrome, respectively. The mean 24h proteinuria levels at LN diagnosis was 4,6g. Mean SLEDAI-2K at the time of flare was 20.3, with 69 (65.7%) patients having an extrarenal flare. The treatments used to induce remission were: glucocorticoids (100%): pulses M-prednisolone in 49 (64%) and oral prednisone (mean starting dose): 43 mg/day (±20.6); intravenous cyclophosphamide in 42 (55%) patients; mycophenolate mofetil (MMF) in 21 (27%) patients; calcineurin inhibitors in 5 (11%) patients; rituximab in 4 (5.2%) patients; and oral cyclophosphamide in 4 (5,2%) patients. Forty-eight (63%) patients were receiving hydroxychloroquine. MMF was the immunosuppressant (IS) more frequently used (52%) as maintenance therapy. At 3, 6 and 12th months, the mean proteinuria was 2.3g/24h, 1.53g/24h, 1.1g/24h, respectively (p< 0.001). Fifty-five (77,5%) of patients achieved complete response and 61 (84.7%) presented complete or partial response. Median time to renal remission: 12.5 months (6,17.5). In 32 patients (42%) it was possible to discontinue IS. Sixteen (21.9%) patients developed CKD, 4 (5.3%) needing dialysis and 1 (0.76%) renal transplantation. Serious infection was recorded in 23 (34.8%) patients. Five (6.6%) patients died (2 cardiovascular cause). In the bivariate study, the following variables were significantly associated with CKD: male sex, hypertension, ACEI drugs, severe infection after LN, temporal dyalisis, non ACR renal response, non use of hydroxychloroquine, time to achieve 10mg/day of prednisone, previous creatinine to LN, maximum creatinine at LN, hyperlipidemia at 3 months of LN, active urinary sediment at 12 months, creatinine at 6 and 12 months, proteinuria at 6 and 12 months. In the logistic regression model, using genetic algorithms, we found that proteinuria at 6 months was significantly associated with CKD (OR:2.95; 95%CI 1.19,9.29, p= 0.03). Hypertension and male sex were marginally associated (p=0.06, both). Conclusion: A considerable percentage of LN patients developed renal chronic failure (21,9%). A high percentage of ACR response was achieved using medium dose (40mg) of glucocorticoids for induction. A significative reduction of proteinuria was achieved at 3 months, but proteinuria at 6 months was the only factor finally associated with CKD. Disclosure of Interests: Irene Altabás González: None declared, Jose M Pego-Reigosa: None declared, Jose Maria González: None declared, Francisco Rubiño: None declared, Chiara Stagnaro: None declared, Chiara Tani: None declared, Carlos Rodriguez-Lozano: None declared, Maria Celia Erausquin: None declared, Juan Carlos Quevedo-Abeledo: None declared, Iñigo Hernández: None declared, Marta Mosca Paid instructor for: GlaxoSmithKline, Lilly, UCB, Iñigo Rua-Figueroa: None declared

Background: Streptococcus pneumoniae (SPN) is an encapsulated gram-positive bacterium that can be found in the nasopharynx as part of the normal flora. However, is the most common cause of community-acquired pneumonia in adults and can also cause invasive diseases such as bacteremia, meningitis, and otitis media. Pneumococcal cellulitis and fasciitis are uncommon. Several factors are associated with a predisposition to infections in patients with Systemic Lupus Erythematosus (SLE). Objectives: To describe and analyze all documented cases of cellulitis or fasciitis caused by SPN in SLE patients. Methods: In the framework of the study of a 24-years-old woman that during the SLE onset presented left tight cellulitis and fasciitis caused by SPN, a systematic review was conducted (until September 2018). The search included terms to identify any SPN infection in SLE patients and all those articles that reported cellulitis or fasciitis were selected (Table 1). Results: A total of 313 articles were obtained. Eight of them (1-8) and 1 article identified in a manual search (9) described a total of 15 cases presenting SLE and cellulitis or necrotizing fasciitis caused by SPN; our case is the 16th described. Documented infections (n=16): – Cellulitis (n=8): neck, face or chest (n=5, 62.5%); extremities (foot or hand) (n=2, 25%); breast (n=1, 12.5%). – Fasciitis (n=8): neck, face ot chest (n=5, 62.5%); tights (n=3, 37.5%). Description of the documented cases: – Demographic characteristics (n=13): female sex (n=11, 85%); <30 years of age at the moment of the infection (n=11, 85%). – Time of SLE evolution at the moment of the infection (n=9): ≤ 1 month (n=3, 33.3%); ≤ 3 years (n=3, 33.3%); ≤ 8 years (n=3, 33.3%). – Associated conditions (n=12): previous high doses of prednisone (n=5, 45%); recent respiratory sympthoms (n=4, 33.3%); renal insufficiency (n=2, 16.6%); previous SPN infections (n=1, 8.3%); recent surgery in the affected área (n=1, 8.3%). – Microbiological diagnosis (n=12): blood cultures (n=11, 91.6%); other cultures (n=5, 41.6%). – Treatment (n=12): beta–lactams (n=12, 100%); intensive care support (n=6, 50%); surgical debridment (n=5, 41%). – Outcome (n=15): death (n=3, 20%); reccurrent SPN infections (n=2, 13.3%). Conclusion: – Pneumococcal cellulitis and fasciitis in SLE were predominantly presented in young women and in a high rate of cases during the disease onset. – Almost half of the cases were previously treated with high doses of steroids. Nevertheless, no other potential predictors of pneumococcal cellulitis or fasciitis were identified; in addition, only one patient presented a previous surgery in the affected anatomical area, previous trauma were not described in any case, and a low number of cases reported associated respiratory symptoms. This supports the importance of the intrinsic immune dysregulation in SLE patients. – Pneumococcal cellulitis and fasciitis in SLE patients present poor prognosis, requiring intensive care support and surgical debridement in a high rate of cases, and presenting a fatal outcome in a fifth of them. References [1] DiNubile; 1991. [2] Hill; 1997. [3] Isik; 2007. [4] McDonald; 1993. [5] Page; 2003. [6] Patel; 1994. [7] Sabio; 2006. [8] Sánchez; 2016. [9] Kamran; 2008. Disclosure of Interests: Martín Greco: None declared, Iñigo Rua-Figueroa: None declared, Antonio Naranjo Grant/research support from: Amgen, Consultant for: UCB, Speakers bureau: Amgen, UCB, Sabrina Ghiglione: None declared, Maria Celia Erausquin: None declared, Juan Carlos Quevedo-Abeledo: None declared, Carlos Rodriguez-Lozano: None declared, Cristina Almeida: None declared, Paola León: None declared, Estíbaliz Loza Grant/research support from: Roche, MSD, Pfizer, Abbvie, BMS, UCB, Actelion, Celgene, Grunenthal and Sanofi

Background In RELESSER (Spanish Society of Rheumatology Systemic Lupus Erythematosus-SLE-Registry) bacteremia is the main cause of death by infection. The available information about this severe infection in SLE patients is scarce. Methods Retrospective nested case-control study of SLE patients (ACR97 criteria) with at least a bacteremic episode and random controls from RELESSER. Descriptive, bivariate and multivariate analysis (logistic regression). Results 114 bacteremic episodes in 83 patients were found. Incidence rate: 2.7/1,000 patient-years (total n:3658). At the time of the bacteremia: median age: 40.5 (8Ð90)years, 88.6%female, disease duration:9.7 (IR16.7), medianSELENASLEDAI:4 (IR8), severe flare (SFI criteria):66%, active nephritis:16.7%, median SLICC/ACR DI: 3 (IR4), any comorbidity:64% (McCabe-Jackson criteria: 28.1% rapidly/ultimately fatal), more frequently renal failure (15.8%) or diabetes (11.4%). SLE treatment at bacteremia: 88.6%corticosteroids (68,6%>10 mg/day), 57%immunosuppresors (mycophenolate17.5% and cyclophosphamide (CYP)12.3%), 27%antimalarials. 44.7% suffered invasive procedures, more frequently intravascular catheter (24.6%). Nosocomial bacteremia in 35.1%, more frequently urinary source (27.2%). 64% developed systemic inflammatory response syndrome, 35% needed intensive care unit admission, 22.8% had multiorganic failure. The most frequent microorganisms were E.coli (29.8%), Staphylococcus aureus (16.7%) (22% methicillin-resistant) and Salmonella spp. (10.5%). 16% of the gram-negative enteric bacilli were extended- spectrum b-lactamase positive. 17.5%were multidrug resistant. 68.4%started the antibiotherapy before blood culture results, resulting finally active in susceptibility testing in 56 (71.8%), indicating an appropriate empirical antibiotic therapy in 49%. The bacteremia-related mortality was 14%. Risk of death was higher in patients with severe sepsis (Pitt index >8) (OR: 13, 95% CI: 3.71 to 45.17). Bacteremia was recurrent in 26.3%. Associations with bacteremia in bivariate analysis (114 bacteremias vs 688 controls) are shown in table 1. Antimalarials were protective. In the multivariate analysis (adjusted for disease duration), only elevated creatinine (OR: 1.31 (95% CI: 1.01 to 1.70) p=0.045), diabetes (OR 6.01 (95% CI: 2.26 to 15.95) p=0.000), cancer (OR: 5.32 (95% CI: 2.23 to 12.70), p=0.000), immunosuppressors (OR: 6.35 (95% CI: 3.42 to 11.77) p=0.000), CYP (OR: 9.37 (95% CI: 5.12 to 17.14) p=0.000) and SLICC/ACR DI (OR: 1.65 (95% CI: 1.31 to 2.09) p=0.000) remained statistically significant. Conclusion Bacteremia occurred mostly in active SLE, frequently in the context of a severe flare. Gram negative bacilli predominated, with high rate of multidrug resistance. The empiric treatment was inappropriate in a half of the cases. Recurrence and mortality were high. Immunosuppressors use, comorbidity and damage were all associated to bacteremia.

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

Objective. Pulmonary arterial hypertension (PAH) prevalence has been reported to be between 0.5% and 17% in systemic lupus erythematosus (SLE). This study assessed PAH prevalence and predictors in an SLE cohort. Methods. The Borg dyspnea scale, DLCO, N-terminal pro–brain natriuretic peptide (NT-proBNP), and Doppler echocardiographic (DE) were performed. An echocardiographic Doppler exercise test was conducted in selected patients. When DE systolic pulmonary arterial pressure was ≥ 45 mmHg or increased during exercise > 20 mmHg, a right heart catheterization was performed. Hemodynamic during exercise was measured if rest mean pulmonary arterial pressure was < 25 mmHg. Results. Of the 203 patients with SLE, 152 were included. The mean age was 44.9 ± 12.3 years, and 94% were women. Three patients had known PAH. The algorithm diagnosed 1 patient with chronic thromboembolic pulmonary hypertension and 5 with exercise-induced pulmonary artery pressure increase (4 with occult left diastolic dysfunction). These patients had significantly more dyspnea, higher NT-proBNP, and lower DLCO. Conclusion. These data confirm the low prevalence of PAH in SLE. In our cohort, occult left ventricular diastolic dysfunction was a frequent diagnosis of unexplained dyspnea. Dyspnea, DLCO, and NT-proBNP could be predictors of pulmonary hypertension in patients with SLE.

Background Systemic Lupus Erythematosus (SLE) is an autoimmune systemic rheumatic disease that, in our area, presents hematologic manifestations in approximately 70% of cases1. Some of them are very rare, there are no large series whose analysis could provide relevant information. Objectives To study the characteristics of patients with Pure Red Cell Aplasia (PRCA) in a large sample of SLE patients. Methods SLE patients from RELESSER database were studied. We analysed the clinical and analytical SLE manifestations at 12 different domains (mucocutaneous, renal, musculoskeletal, constitutional, haematologic, vascular, cardiac, respiratory, neuropsychiatric, gastrointestinal, ophthalmic and serological) before, during and after PRCA diagnosis and until the last available assessment. We also studied activity (SELENA-SLEDAI) and damage (SLICC/ACR DI)indices at each of those times. We evaluated the treatment received, PRCA recurrences and the number of deaths by this entity. Results 3,656 patients from 45Rheumatology Units across Spain were studied. 5 cases of PRCA were found (<0.5%of total) There were not viral infections in relation with the PRCA. All patients had a good response to treatment, reaching complete remission without relapses or deaths. The mean number of treatment lines (± SD)that were necessary was 2.2 (±1.01)and the mean (± SD)number of treatments used was 2.8 (±1.92). Except for the patient diagnosed with PRCA before SLE, all of them received glucocorticoids as initial treatment. Of these 4patients only 1achieved complete remission without requiring immunosuppressive therapy. The following table shows the characteristics of each patient: Conclusions PRCA is a very rare cause of anemia in SLE. In most cases it appears several years after the diagnosis of SLE. It is a serious manifestation but in our series, with a proper management showed a favourable response. References Pego-Reigosa JM et al. Analysis of disease activity and response to treatment in a large Spanish cohort of patients with systemic lupus erythematosus. Lupus 2015;24:720–9. Disclosure of Interest A. Lois-Iglesias: None declared, I. Rúa-Figueroa: None declared, C. Erausquin: None declared, D. Grados: None declared, A. Olivé: None declared, V. Quevedo: None declared, J. Alegre: None declared, J. Calvo: None declared, F. Lόpez-Longo: None declared, M. Galindo: None declared, F. deToro: None declared, C. Mouriño: None declared, J. Pego-Reigosa Grant/research support from: Work supported by Spanish Society of Rheumatology, FIS/ISCIII (PI11/02857), BIOCAPS from the EU 7th Framework Programme/REGPOT-2012–2013.1 (316265), GSK, Roche, Novartis, UCB.

Background There are scanty data about infection in Systemic Lupus Erythematosus (SLE) patients from large multicenter cohorts. Objectives To describe the prevalence of severe infection (SInf), investigate associated factors and clinical meaning in a large SLE cohort from Spanish Rheumatology Society Lupus Registry (RELESSER). Methods Patients with Sinf were compared with patients without SInf in terms of severity, damage, comorbidities and demographic characteristics (bivariate analysis and Cox regression to survival until the first infection). Results A total of 3.658 SLE patients included, 90% female, median age 32.9 years (DQ 9.7), 93% Caucasian and 5% Hispanic (Amerindian,mestizo). Mean follow-up (months) was 120.2 (SD: ±87.6). A total of 705 (19.3%) of the patients suffered ≥1 SInf, with an overall of 1.227 SInf. The density of incidence was 29.2 (95%CI: 27.6 - 30.9) infections/ 1000 patients-year. The survival until second infection was lower than survival until first infection (log rank p<0.000). There was predominance of bacterial cause (51.9%), with a 30.4% of unknown cause, and the respiratory tract was the most frequent localization 35.5%. A total of 208 (5.7%) patients died during the follow-up period, 24.5% of them by infection. The predominant localization for the fatal infection was the circulatory stream (bacteraemia/sepsis) (42.0%). In the Cox proportional-hazards regression model age at diagnosis (HR 1.016; 95%CI: 1.009-1.023, p=0.0000) Hispanic ethnic (HR 2.151; 95%CI: 1.539-3.005 p=0.0000) corticosteroids (≥10 mg/day) (HR 1.271; 95%CI: 1.034-1.561, p=0.0224) immunosuppressors (HR 1.348; 95%CI: 1.079-1.684 p=0.0085), hospitalization by SLE (HR 2.567; 95%CI: 1.905-3.459, p=0.0000) renal involvement (HR 1.370; 95%CI: 1.130-1.660, p=0.0013), severity Katz index (SKI) (HR 1.160; 95%CI: 1.105-1.217, p=0.0000), damage index (SDI) (HR 1.069; 95%CI: 1.031-1.108, p=0.0003) and tobacco (HR: 1.332; 95%CI: 1.121-1.583, p=0.0011) were all associated with SInf. Time on antimalarials (months) proved to be protective (HR: 0.998; 95%CI: 0.997-0.999, p=0.0022) Conclusions SInf remains a frequent and potentially fatal complication of SLE and/or immunosuppressive therapies, and it9s a marker of more severe disease. Respiratory bacterial infections are the most common SInf in SLE, but bloodstream infections are the most common mortal ones. A previous infectious event seems to increment the risk of a subsequent infection in SLE. SInf are more common in male and Hispanics and is associated age, tobacco use and other co-morbidities. Antimalarials use exerts a time-dependent protective effect Disclosure of Interest None declared

Background Primary Sjögren9s syndrome (pSS) is a chronic systemic autoimmune disease with a substantial impact on patient9s quality of life and associated comorbidities could worsen the prognosis and complicate the management of the disease. Objectives The aim of our study was to describe comorbidities in a Spanish cohort os pSS patients. Methods We took advantage of a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American criteria. It is a randomised register of patients obtained from thirty three Reumathology clinics all over Spain. The presence of comorbidities was investigated in every patient. Previous informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75). Results A total of 437 patients were included, 95% of them women, with a median age of 58 years. Dyslipidemia was the most common comorbidity, appearing in 33% of the cases, with hypertension in second place with a prevalence of 25%. Osteoporosis was present in 18% of patients. Furthermore, 37 patients had at least an osteoporotic fracture. Seventy four patients had never smoked. Diabetes was present in 6% of cases. Less than 7% of the patients had some kind of cardiovascular event: 4 patients ischemic heart disease, 14 patients peripheral arterial disease and 15 patients strokes. Among patients with peripheral arterial disease, only one patient showed positive anti phospholipid antibodies. Thirteen patients (3%) had heart failure. Sixty four patients (14%) had fibromyalgia. Five patients (1%) had celiac disease and 2 (0.46%), multiple sclerosis. Seven lymphomas were observed, four of them MALT type and two Hogdkin9s disease. Three patients developed multiple myeloma and two Waldenstrom9s macroglobulinemia. Twenty one cases of other malignancy were registered. Conclusions Primary Sjögren9s syndrome9s patients frequently present associated comorbidities, been dyslipidemia, arterial hypertension and osteoporosis the most prevalent. Lymphoma prevalence rate for this series is 1,6 percent. Disclosure of Interest None declared

Background Primary Sjogren9s syndrome (pSS) is a chronic systemic autoimmune disease with a substantial impact on patient9s quality of life and associated comorbidities could worsen the prognosis and complicate the management of the disease. Objectives The aim of our study was to describe comorbidities in a Spanish cohort os pSS patients. Methods We took advantage of a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American criteria. It is a randomised register of patients obtained from thirty three Reumathology clinics all over Spain. The presence of comorbidities was investigated in every patient. Previous informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75). Results A total of 437 patients were included, 95% of them women, with a median age of 58 years. Dyslipidemia was the most common comorbidity, appearing in 33% of the cases, with hypertension in second place with a prevalence of 25%. Osteoporosis was present in 18% of patients. Furthermore, 37 patients had at least an osteoporotic fracture. Seventy four patients had never smoked. Diabetes was present in 6% of cases. Less than 7% of the patients had some kind of cardiovascular event: 4 patients ischemic heart disease, 14 patients peripheral arterial disease and 15 patients strokes. Among patients with peripheral arterial disease, only one patient showed positive anti phospholipid antibodies. Thirteen patients (3%) had heart failure. Sixty four patients (14%) had fibromyalgia. Five patients (1%) had celiac disease and 2 (0.46%), multiple sclerosis. Seven lymphomas were observed, four of them MALT type and two Hogdkin9s disease. Three patients developed multiple myeloma and two Waldenstrom9s macroglobulinemia. Twenty one cases of other malignancy were registered. Conclusions Primary Sjogren9s syndrome9s patients frequently present associated comorbidities, been dyslipidemia, arterial hypertension and osteoporosis the most prevalent. Lymphoma prevalence rate for this series is 1,6 percent. Disclosure of Interest None declared