Background: Musculoskeletal ultrasound is a non-invasive imaging method that identifies synovial and entheseal involvement in spondyloarthritis. In patients with psoriatic arthritis (PsA) in clinical remission, ultrasound signs of tenosynovial and entheseal inflammation have been observed after exposure to physical exertion. In isolated observations, these same findings have been identified in patients with psoriasis (PsO) who do not meet classification criteria for PsA. Formal demonstration of this phenomenon would allow a better understanding of psoriatic disease and its potential evolution into a joint form. Objectives: The aim of this study was to identify the existence of tendon, synovial and/or entheseal inflammatory changes by ultrasound after performing a manual exercise with a handheld dynamometer, in patients with PsO under suspicion of PsA, based on the PsA screening questionnaire (PURE4), comparing patients without suspected PsA and healthy controls; and to explore factors associated with a greater chance of change in the ultrasound score of synovitis and enthesitis. Methods: National, multicentre, exploratory, and cross-sectional study, based on data of patients enrolled from July 2022 to June 2023 (Figure 1). Patients ≥18 and ≤50 years, with active PsO, referred from the Dermatology to the Rheumatology department, under PsA suspicion (PURE4≥1) or without PsA suspicion (PURE4<1), were included. Patients with a previous diagnosis of PsA or any rheumatic disease (fulfilling the ClASsification criteria for Psoriatic ARthritis -CASPAR- criteria or not), and/or with regular or recent use of non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, were excluded. Controls with no history of known joint disease are included, matched by age and sex to the patients. Results: Overall, 373 participants (295 healthy subjects and 78 PsO patients) were enrolled at 3 Spanish hospitals. Participants had a mean (standard deviation, SD) age of 35.2 (9.37) and 40.72 (8.96) years in the control and PsO patients' groups, respectively, and the median (Maximum, Max; Minimum, Min) time since diagnosis was 146.9 (0, 546.8) months. A total of 55.1% and 30.8% of the patients had a history of PsO treatment with topical and systemic therapies, respectively. Finally, 5.1% and 28.2% of the patients had history of dactylitis and nail PsO, respectively. The changes of all three combined scores (synovitis, tenosynovitis, enthesitis) differed significantly among groups for each score, and the comparison between the control group and the PsO patients' group (PURE4<1: without PsA suspicion, and PURE4≥1: under PsA suspicion) were also statistically significative for each score (p<0.0005) (Figure 2). However, there were no significant differences between the two patient groups. The relative frequencies of increases for the combined tenosynovitis and enthesitis scores by groups were statistically significant (p<0.0005). Both combined scores were higher in the group PURE4 <1 (without PsA suspicion), although the difference was only significant for enthesitis (p=0.033). Regarding the association of the categorical clinical variables with each of the combined score changes, a slight positive correlation was obtained between age and enthesitis score change for overall PsO patients, although not by patients' groups separately. The history of psoriasis treatment was found significantly associated with synovitis and tenosynovitis combined scores, for all patients of both PsO groups. In the case of the group PURE4≥1 (under PsA suspicion) a significant association was also found for tenosynovitis combined score and the history of psoriasis treatment. No significant associations with none of the score changes were found for the other clinical variables. Conclusion: The PsO patients showed a higher proportion of synovial, tenosynovial, and enthesis hyperresponsiveness measured by ultrasound assessment after dynamometric exertion than healthy subjects. Moreover, this hyperresponsiveness would not be independently related to other clinical variables, except for the history of psoriasis treatments. REFERENCES: NIL. Acknowledgements: The present study was funded by Novartis. Disclosure of Interests: Carlos A. Guillén-Astete Novartis, Janssen, ROCHE, Abbvie, UCB, Galápagos, Novartis, Jannsen, Abbvie, UCB, Grünental, Galápagos, Janssen, Galápagos, Novartis, Pfizer, Novartis, María Ahijón Lana: None declared, Juan Carlos Nieto González MSD, Abbvie, Galápagos, Pfizer, Sandoz, Galápagos, Abbvie, Pfizer, Ana Lois-Iglesias: None declared, Mónica Vázquez Díaz Galápagos, Abbvie, Pfizer, Galápagos, Abbvie, Pfizer, Pfizer, Novartis.

Background: Juvenile idiopathic arthritis (JIA) represents the most closely associated inflammatory disease with pediatric uveitis, being its most common extra-articular manifestation (10-30%). The majority of JIA patients will develop uveitis within the first four years from the onset of arthritis. Screening guidelines based on risk factors are recommended. Evidence supports the early introduction of systemic immunosuppressive drugs, such as methotrexate and adalimumab, to control intraocular inflammation and prevent associated complications. Objectives: The study objectives are to analyze factors associated with the development of uveitis. Methods: We conducted a retrospective, longitudinal, multicenter study. Patients with non-infectious uveitis associated with JIA were selected from a multicenter cohort. The time of onset of uveitis was analyzed, as well as the presence of associated complications. Known risk factors (age, gender, antinuclear antibodies (ANAs), JIA subgroup according to the ILAR classification) have been examined. Furthermore, the treatment (systemic immunosuppressive drugs) received by patients with JIA when they developed uveitis was evaluated, along with its duration. Results: Out of a total of 404 patients with JIA, we included 77 (19%) who had a diagnosis of uveitis (75% anterior chronic uveitis), of whom 18.2% experienced ophthalmological sequelae. 72 had arthritis preceding (54.5% persistent oligoarticular JIA), mostly girls (73%), with positive ANAs (61%). 37.5% developed uveitis within the first 12 months from diagnosis (Figure 1) with a median time to uveitis of 1.6 years. 74 patients received methotrexate, with a median duration of 3 years. In the first uveitis flare, 24 patients were being treated with methotrexate, and 6 with etanercept (Figure 2). Among patients who discontinued methotrexate before the onset of uveitis, the median time until its appearance was 1.7 years. Conclusion: Our study confirms that uveitis develops in the early years following the diagnosis of JIA, but the risk of occurrence persists throughout the course of the disease. More than half of the patients developed uveitis while not receiving systemic treatment. We observed that those receiving methotrexate as monotherapy had a higher frequency of uveitis compared to other treatments. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

BackgroundLarge-vessel vasculitis are characterized by the wall inflammation of the involved vessels, which can be detected by imaging tools (1-3). Ultrasound (US) is one of the most commonly used tools for the diagnosis of giant cell arteritis (GCA), especially in patients with a cranial phenotype. Tocilizumab (TCZ) has shown efficacy in large-vessel vasculitis (LVV) including GCA (4,5). However, the improvement objectified by imaging techniques such as US after TCZ therapy is poorly documented.ObjectivesTo assess the effectiveness of TCZ improving the wall vessel inflammation by US.MethodsObservational, multicenter study of 26 GCA patients treated with TCZ. GCA was diagnosed according to: a) ACR criteria, and/or b) biopsy of temporal artery, and/or c) presence of signs of vessel wall inflammation by US, defined by the presence of halo sign. In all the cases a baseline US and in the follow-up was mandatory.Patients were divided into two subgroups: a) with, and b) without signs of improvement (partial or total) in the follow-up US.ResultsWe studied 26 patients (19 women/7 men; mean age, 76.3±9.7 years). Main clinical features of GCA with and without US improvement are shown in Table 1. We found no significant differences in any of the variables studied between the two groups.Table 1.Main features of 27 GCA patients treated with tocilizumab followed by Ultrasound (US).With US improvement (n=21)Without US improvement (n=5)pBaseline characteristics at TCZ onsetGeneral characteristicsAge(years), mean±SD77.3±8.972.2±12.90.270Sex, female/male (% female)17/4 (80,95)2/3 (40)0.101Time from GCA diagnosis to TCZ onset (months), median [IQR]6 [3-9]3 [1-6]0.452Systemic manifestations, n (%)Fever, n (%)1/21 (4.76)1/5 (20)0.354Constitutional syndrome, n (%)10/21 (47.62)2/5 (40)0.999PmR, n (%)11/21 (52.38)1/5 (20)0.330Ischaemic manifestations, n (%)Visual involvement, n (%)1/21 (4.76)1/5 (20)0.354Headache, n (%)15/21 (71.43)5/5 (100)0.298Jaw claudication, n (%)4/15 (26.67)¼ (25)0.999Laboratory dataESR, mm 1st hour, median [IQR]33 [22-49]55 [54-80]0.216CRP, mg/dL, median [IQR]1.5 [0.7-6.7]3.8 [1-4.2]0.948Prednisone dose, mg/day, median [IQR]13.7 [10-30]30 [12.5-30]0.505Time from TCZ onset and follow-up US (months)3.9±3.63.1±2.10.456After TCZ onset, 21 of 26 patients (80.7%) showed US signs of improvement (12 complete, 9 partial). In 4 out of 5 patients in whom there was no improvement in US findings, clinical improvement was observed at first month after starting TCZ.ConclusionTCZ seems to be effective controlling GCA including vascular involvement detected by US. This improvement can be seen by follow-up US, especially when performed at least 3 months after TCZ onset.References[1]Loricera J, et al. Rev Esp Med Nucl Imagen Mol. 2015; 34: 372-7. PMID: 26272121[2]Loricera J, et al. Clin Exp Rheumatol. 2015; 33: S19-31. PMID: 25437450[3]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589[4]Martínez-Rodríguez I, et al. Semin Arthritis Rheum. 2018; 47: 530-537. PMID: 28967430[5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019; 48: 720-727. PMID: 29903537AcknowledgementsTocilizumab in Giant Cell Arteritis Spanish Collaborative Group: Juan C. González Nieto (H. Gregorio Marañón), Juan R. de Dios (H.U. Araba), Esther Fernández (H. Clínico Universitario Virgen de la Arrixaca), Isabel de la Morena (H. Clínico Universitario de Valencia), Patricia Moya (H. Sant Pau), Roser Solans i Laqué (H. Valle de Hebrón), Eva Pérez Pampín (H.U. de Santiago), José L. Andréu (H.U. Puerta de Hierro), Marcelino Revenga (H. Ramón y Cajal), Juan P. Baldivieso Achá (H. U. de La Princesa), Eztizen Labrador (H. San Pedro), Andrea García-Valle (Complejo Asistencial Universitario de Palencia), Adela Gallego (Complejo Hospitalario Universitario de Badajoz), Carlota Iñíguez (H.U. Lucus Augusti), Cristina Hidalgo (Complejo Asistencial Universitario de Salamanca), Noemí Garrido-Puñal (H. Virgen del Rocío), Ruth López-González (Complejo Hospitalario de Zamora), José A. Román-Ivorra (H.U. y Politécnico La Fe), Sara Manrique (H. Regional de Málaga), Paz Collado (H.U. Severo Ochoa), Enrique Raya (H. San Cecilio), Valvanera Pinillos (H. San Pedro), Francisco Navarro (H. General Universitario de Elche), Alejandro Olivé-Marqués (H. Trías i Pujol), Francisco J. Toyos (H.U. Virgen Macarena), María L. Marena Rojas (H. La Mancha Centro), Antoni Juan Más (H.U. Son Llàtzer), Beatriz Arca (H.U. San Agustín), Carmen Ordás-Calvo (H. Cabueñes), María D. Boquet (H. Arnau de Vilanova), Noelia Álvarez-Rivas (H.U. Lucus Augusti), María L. Velloso-Feijoo (H.U. de Valme), Cristina Campos (H. General Universitario de Valencia), Íñigo Rúa-Figueroa (H. Doctor Negrín), Antonio García (H. Virgen de las Nieves), Carlos Vázquez (H. Miguel Servet), Pau Lluch (H. Mateu Orfila), Carmen Torres (Complejo Asistencial de Ávila), Cristina Luna (H.U. Nuestra Señora de la Candelaria), Elena Becerra (H.U. de Torrevieja), Nagore Fernández-Llanio (H. Arnáu de Vilanova), Arantxa Conesa (H.U. de Castellón), Eva Salgado (Complejo Hospitalario Universitario de Ourense).Disclosure of InterestsJulio Sanchez-Martin: None declared, Javier Loricera: None declared, Lara Sanchez-Bilbao: None declared, Eugenio de Miguel: None declared, Rafael Melero: None declared, E. Galíndez-Agirregoikoa: None declared, J. Narváez: None declared, Carles Galisteo: None declared, Juan Carlos Nieto González: None declared, Patricia Moya: None declared, Eztizen Labrador-Sánchez: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche

The aim of this study was to determine the value contribution of filgotinib for the treatment of moderate to severe rheumatoid arthritis in Spain, compared with two therapeutic alternatives. EVIDEM Multi-Criteria Decision Analysis (MCDA) framework was selected. A literature review was conducted to populate the framework, comprised of 12 quantitative and 4 contextual criteria. A multidisciplinary panel of 9 experts determined the value contribution of filgotinib with respect to upadacitinib and baricitinib. Mean and standard deviation were calculated for quantitative criteria while qualitative criteria were analysed as percentages of experts that considered a positive, neutral or negative impact for the Spanish National Health System. Global value contribution of filgotinib was calculated. Moderate to severe rheumatoid arthritis was considered a severe disease (mean±SD: 3.4±0.9), with moderate size of affected population (3.0±0.7) and moderate unmet needs (2.9±0.8). Experts perceived that filgotinib might provide a marginal benefit in efficacy/effectiveness (1.5±1.3) and safety/tolerability (1.4±1.1), whereas minimal differences were found in patient-reported outcomes (PROs) (0.5±1.1). Therapeutic benefit provided by filgotinib was considered moderate to high (3.6±0.7). Experts anticipated an average or lower cost of treatment (1.7±1.1) and no impact on other medical costs (0.1±0.3) and non-medical/indirect costs (0.1±0.3) was expected. Evidence presented for filgotinib was considered robust (4.6±0.7), with high consensus among experts on its future recommendation in Spanish guidelines (2.4±1.1). In contextual criteria, most experts perceived a positive impact on population priorities and access (89%), common goal and specific interests (67%) and system capacity and appropriate use (78%). Impact on opportunity costs and affordability was considered neutral (56%). The result of the global value contribution of filgotinib was 0.44 (in a -1 to +1 scale). Filgotinib provides an added value to moderate to severe rheumatoid arthritis management, showing a good risk/benefit balance and constituting a valuable therapeutic alternative in Spain.

Background Juvenile Idiopathic Arthritis (JIA) is a group of heterogeneous arthritis with onset earlier than 16 years old. According to previous studies, these patients experience an improvement of their disease activity, functionality and even remission probability as they become young adults. [1] Transitional care units aim to coordinate an uninterrupted follow-up in patients with chronic diseases in order to accomplished the objective of improving the ability of manage their own disease. [2] Our transitional care unit attend patients from 18 to 25 years old who have been previously diagnosed with any pediatric rheumatic disease Objectives Our primary objective was to describe the disease activity of JIA patients at the transference to our unit and the remission maintenance during follow-up. Methods We conducted an observational retrospective longitudinal study from a cohort of patients with JIA who have been transferred to our transitional care unit. We selected patients with at least one clinical visit and active follow-up. We collected demographic data, JIA classification, previous treatments and the treatment at time of transfer, articular and ocular flares, remission defined by Wallace criteria 3 and changes in treatment during follow-up. We calculated the percentage of patients who had active disease activity at the transference to the Unit and the proportion of patients who had an inflammatory flare (ocular or articular) during the follow-up. Results From December 2016 to December 2021 we received 184 patients in our Transitional Care Unit, from them 127 had a JIA and 1 had asymptomatic chronic uveitis. Demographics of JIA patients is shown in Table 1. From 127 JIA patients, 34 (26,8%) were active at the transference and 53 (41,8%) had at least one flare during the follow-up. Table 1. Demographic data from JIA included in the study, divided according to disease activity at the transference to our transitional care unit. Total (n: 127 ) Actives (n:34 ) Not actives (n:93 ) Sex (female) n (%) 84 (66.1) 24 (70.6) 60 (64.5) Age median (IR) 8.64 (3-13) 9.1 (3-13) 8.4 (3-12.9) Previous joint injections n(%) 43 (33.9) 16 (47.1) 27 (29) sDMARD prior transference n (%) 98 (76.6) 26 (76.5) 72 (77.4) bDMARD prior transference n (%) 79 (61.7) 20 (58.8) 59 (63.4) Uveitis n (%) 23 (18.1) 8 (23.5) 15 (16.1) JIA subcategory n (%) oligo persist 43 (33.9) 12 (35.3) 31 (33.3) oligo extend 16 (12.6) 3 (8.8) 13 (14) poly RF - 25 (19.7) 6 (17.6) 19 (20.4) poly RF + 3 (2.4) 1 (2.9) 2 (2.2) ERA 24 (18.9) 8 (23.5) 16 (17.2) systemic 9 (7.1) 2 (5.9) 7 (7.5) psoriatic 7 (5.5) 2 (5.9) 5 (5.4) We calculated the percentage of patients who had active disease at the transference to the Unit and the percentage of patients who had an inflammatory flare during the follow-up. Figures 1 and 2 showed the proportion of flares depending on the inflammatory status at transference to the Transitional care unit and the use of biological therapy before transition. Conclusion JIA patients remain active in one quarter of the cases at the transference to the Transitional care unit and flares are twice frequent when they were active at the transference. References [1]S. Sabbagh, T. Ronis, PH White. Pediatric rheumatology: addressing the transition to adult-orientated health care. Research and Reviews 2018:10 83–95 [2]H. Relas, R. Luosujärvi, S. Kosola. Outcome of transition phase patients with juvenile idiopathic arthritis, Modern Rheumatology 2018 Sep;28(5):32-837 [3]Wallace CA, Ruperto N, Giannini EH, Childhood Arthritis and Rheumatology Research Alliance, Pediatric Rheumatology International Trials Organization, Pediatric Rheumatology Collaborative Study Group. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol2004; 31 :2290–4 Disclosure of Interests None declared

The novel coronavirus emerged in 2019 in Wuhan has caused a global pandemic of coronavirus disease (COVID-19). Immune-mediated diseases (IMID), as inflammatory arthritis or inflammatory bowel disease (IBD), have some special implications due to their pathogenesis and treatments. Some treatments employed in IMID are now being used in the treatment of severe COVID-19. There still exists controversy about IMID behavior and its complications.1, 2To assess COVID-19 severity in IMID patients and its prognosis predictors.An observational retrospective multicenter study was performed in two Spanish Hospitals (Clinical University Hospital in Santiago de Compostela and Gregorio Marañón Hospital). Patients were selected if they were diagnosed of an IMID (rheumatoid arthritis, psoriatic arthritis, espondyloarthritis, ulcerative colitis and Crohn’s disease) and had COVID-19 infection between February and April 2020.Demographic, clinical, analytical and treatment data were collected. Logistic regression was used to evaluate potential predictors.Stata 15.1 was used to perform statistical analysis.91 patients were recruited. 55 suffered from a rheumatic disease and 36 suffer IBD. Baseline characteristics are shown in Table 1.Univariable analysis reached age, comorbidity, female gender, flu vaccine, arthropathy, basal classical synthetic anti-rheumatic drugs (csDMARD), pneumonia and basal C-reactive protein (CRP) as potential predictors of non-severe (absence of death, respiratory insufficiency, intensive care unit admission or sepsis) COVID-19 disease (p < 0.2). After multivariable analysis, only female gender (OR 4.60 [CI95% 1.00, 21.2] p=0.050), lower age (OR 0.94 [CI95% 0.88, 1.00] p=0.042) and lower basal levels of CRP (OR 0.87 [CI95% 0.77, 0.97] p=0.010) were predictors for non-severe disease (p < 0.005).Mean time of healing (symptoms solved in outpatient and hospital discharge in admitted) from COVID-19 was 13.8 days (SD 16.3). Univariable analysis showed arthropathy, COVID-19 symptomatic and basal glucocorticoids (GC) dose as potential predictors of higher time-to-healing from COVID-19 disease (p < 0.2). After multivariable analysis, only lower GC basal dose predicts higher time-to-healing (OR -1.83 [CI95% -2.81, -0.84] p=0.001).11 patients deceased because of COVID-19. Univariable analysis reached age, basal csDMARD, pneumonia and basal CRP as potential predictors of COVID-19 mortality (p < 0.2). After multivariable analysis, only higher age was a predictor for mortality (OR 1.14 [CI95% 1.04,1.25] p=0.006).IMID patients showed similar predictors of mortality than general population involving COVID-19. Immune-modulating agents did not seem to overshadow the prognosis of COVID-19 infection. Female gender, lower age and lower basal CRP could select a cohort of “good” prognosis patients with mild COVID-19 disease as well higher age points out the worst prognosis. Even that, each case should be individiualized.[1]Ceribelli A, et al. Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy. J Autoimmun. 2020;109:102442.[2]Micaela F, et al. COVID-19 in patients with rheumatic diseases in northern Italy: a single-centre observational and case-control study. Lancet Rheumatol 2020;2:e549-56.Table 1.baseline characteristics between non-severe and severe COVID-19 patients.VariablesNon-severe (67)Severe (24)p-valueAge, mean (SD)56.8 (14.6)70.2 (13.7)0.000Female, n (%)38 (63.3)10 (41.7)0.070HLA-B27 +, n (%)9 (17.7)2 (10.0)0.423Disease evolution (years), median (IQR)12.5 (5;24)14 (9;20)0.891Comorbidity, n (%)35 (59.3)21 (87.5)0.013Flu vaccine, n (%)51 (85.0)23 (95.8)0.166Basal GC, n (%)18 (30.0)12 (50.0)0.084csDMARD, n (%)32 (47.8)16 (66.7)0.111b/tsDMARD, n (%)35 (52.2)11 (45.8)0.590COVID-19 symptoms, n (%)55 (93.2)24 (100)0.191Pneumonia, n (%)31 (51.7)21 (87.5)0.002Admission, n (%)30 (50.0)23 (95.8)0.000CRP, median (IQR)3.5 (2;9)10.0 (3;20)0.005None declared

Background: Coronavirus disease 2019 (COVID-19), has raised several questions in patients with immune-mediated inflammatory diseases (IMID). Whether the seroprevalence and factors associated with symptomatic COVID-19 are similar in IMID patients and in the general population is still unknown. Objectives: To assess the serological and clinical prevalence of COVID-19 in European IMID patients, along with the factors associated with its risk and the impacts the pandemic had on the IMID management. Methods: Prospective multicentre cross-sectional study among patients with five IMID (i.e. systemic lupus erythematous, Sjögren’s syndrome, rheumatoid arthritis, axial spondylarthritis or giant cell arteritis) from six tertiary-referral centers from France, Germany, Italy, Portugal, Spain and United Kingdom. Demographics, comorbidities, IMID, treatments, flares and COVID-19 details were collected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological tests were systematically performed. Results: Between June 7 and December 8, 2020, 3028 patients were included (median age 58 years, 73.9% females). SARS-CoV-2 antibodies were detected in 166 (5.5%) patients. Symptomatic COVID-19 was seen in 122 patients (prevalence: 4.0%, 95% CI 3.4-4.8%); 23 (24.2%) of them were hospitalized and four (3.2%) died. In multivariate logistic regression analysis, symptomatic COVID-19 was more likely to be observed in patients with higher levels of C-reactive protein (OR: 1.18; 95% CI 1.05-1.33; p = 0.006), and increased with the number of IMID flares (OR: 1.27; 95% CI 1.02-1.58; p = 0.03). Conversely, it was less likely to occur in patients treated with biological therapy (OR: 0.51; 95% CI 0.32-0.82; p = 0.006). During the pandemic, at least one self-reported disease flare was seen in 654 (21.6%) patients. Also, 519 (20.6%) patients experienced changes in their treatment, with 125 of these (24.1%) being due to COVID-19. Conclusion: The SARS-CoV-2 prevalence in IMID patients over the study period seems to be similar to that of the general population 1 . The IMID inflammatory status seems to be independently associated with the development of COVID-19. References: [1]Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Hernán MA, Pérez-Olmeda M, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet Lond Engl. 2020 Aug 22;396(10250):535–44. Disclosure of Interests: None declared.

Patients with inflammatory arthralgia (IA) are considered to be at increased risk for progression to RA. Ultrasound (US) has shown high sensitivity to detect synovitis compared with physical examination. Thus, US is recommended to identify subclinical synovitis in patients without clinical signs of inflammation.To determine the frequency and pattern of US detected active inflammation in patients with IA and investigate factors contributing to predict this outcome.An US clinic is scheduled in an academic center running twice every week. A retrospective analysis of our US unit cohort during a period of 12 months was undertaken. Patients with IA and no previous diagnosis of inflammatory arthropathies were included for analysis. Inclusion criteria of IA definition included: severe symptoms presenting in the morning, duration of morning stiffness ≥60 min, symptoms predominantly located in MCP joints and absence of clinically detected synovitis by the referral rheumatologist. The following routinely collected variables were included in the analysis: demographics, clinical features and laboratory tests. Patients underwent bilateral US examination of hands and/or feet according to the European League Against Rheumatism (EULAR) guidelines. The presence of synovitis and tenosynovitis was assessed on a semi quantitative scale (0–3) for Grey Scale(GS)/Power Doppler(PD). Active inflammation was defined as PD synovitis and/or tenosynovitis >1 at any location. First, differences between groups were tested using chi-squared/Fisher and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate the association between possible predictive factors of US active inflammation.A total of 110 patients were included in the analysis. Mean age was 53.6±15.6 years, 80 (72.7%) were females, and mean symptoms duration was 11.7±9.9 months (Table1). A total of 76 (69.1%) patients presented with a polyarticular arthralgia pattern. US active inflammation were present in 38 (34.5%) patients (28.2% showed PD synovitis and 19.1% PD tenosynovitis). Hands were most commonly involved with PD synovitis at wrists in 18.2% and at MCP in 14.5% of patients. For PD tenosynovitis, the flexor MCP 2-5 (4.5%) and 6th extensor tenosynovitis (5.5 %) were the most frequent affected locations. Only 9 (8.2%) patients had erosions in hands and/or feet at baseline examination. In the univariate analysis, the higher ESR values, the shorter time from symptoms onset and the presence of ACPA were significantly associated with the presence of US active inflammation (p<0.001, p=0.035 and p=0.01, respectively). In the multivariate analysis, only ACPA and ESR values (OR=1,0003; 95%CI 1,000-1,006 and OR=1.054; 95%CI 1.016-1.094), remained significantly associated with the detection of US active inflammation.US features of active inflammation are found in 1 over 3 patients with IA being PD synovitis the most common finding, specially at the wrists and MCP joints. Higher ESR and ACPA values are significantly associated with the presence of US active inflammation. Thus, we strongly recommend the use of PD US to detect subclinical inflammation in at-risk patients with IA with no sign of inflammation on clinical examination, especially those with high ESR and ACPA values.Table 1.Baseline characteristics of patients with IATotaln= 110US inflammatoryfindingsn= 38 (34.5%)Non-US inflammatoryfindingsn=72 (65.5%)pAge53.6 ± 15.657.2±16.251.6±13.40.071SexFemale80 (72.7%)26 (68.4%)54 (75%)0.461Smokingn= 87Non smoker45 (51.7%)12 (44.4%)33 (55%)0.412Smoker34 (39.1%)11 (40.7%)23 (38.3%)Former smoker8 (9.2%)4 (14.8%)4 (6.7%)ExtensionMonoarticular12 (10.9%)6 (15.8%)6 (8.3%)0.176Oligoarticular 22 (20%)10 (26.3%)12 (16.7%)Polyarticular76 (69.1%)22 (57.9%) 54 (75%)Time (months)from symptoms onset11.7 ± 9.99.1±8.113±10.50.035ESR (mm/h) n=4524.7 ± 18.233.1±21.820.3 ±14.4<0.001RF (IU/mL) n=5339.1 ± 230.528.5±5645.1±286.10.647ACPA (IU/mL) n=5698.1 ± 331.2209.4±488.426±125.20.01None declared

Background: Radiosynovectomy (RS) is a useful for treating inflammatory arthritis that fail conventional treatments. The main isotope used is Yttrium-90 on large joints as knees, whereas Erbium-169 and Renium-186 are more common in small and medium sized joints respectively. RS is a safe procedure since the isotopes cannot escape the synovial capsule or be absorbed into circulation. It is, however, lethal against cells within the inflamed joint. The most common rheumatic disease treated with RS is rheumatoid arthritis (RA), followed by axial spondyloarthritis (SpA) and idiopathic juvenile arthritis (JIA). It has also been used on persistent synovitis after joint replacements, pigmented villonodular synovitis (PVNS) and undifferentiated arthritis. Objectives: To describe the experience in RS of a tertiary rheumatology center and compare patients with and without clinical response to treatment in the following 12 months. Methods: Observational retrospective study between May 31st 2013 and October 31st 2019. We collected demographic variables, data about the disease of the patient, the joints affected, isotope utilized, presence of Baker’s cyst, systemic treatment received, need of additional infiltrations (before and after), complications and any changes in medication up to a year after the procedure. All the RS were performed ambulatory and the radioisotope infiltration was guided by ultrasound, with 40mg of triamcinolone infiltrated after. SPSS v23 was used for statistical analysis; with Chi2 for qualitative variables and Student’s T distribution for quantitative variables. Results: We evaluated 67 joints in 49 patients in total. All of them were refractory to conventional treatment. 44 patients (65.7%) were women, median of 53.4 years of age (IQ 43.4-67.1). The median disease duration was 12.5 years and RS seemed to fare better the longer the patient had the disease (median of 13.5 years vs 6.5 years p<0.001). The joints infiltrated where 46 (68.6%) knees, 14 (20.9%) wrists and 7 (15.2%) elbows. Out of the knees, 16 (34.8%) belonged to RA patients with effective response in 14 (87,5%). 100% of elbows had an effective response, of them 6 (85.7%) had RA. However, even when 9 (64.2%) wrists also had RA as diagnosis, only 3 (21.4%) were effective. Of the PVNS, 6 out of 8 (75%) had no clinical response, as shown in Table 1. Table 1. RS response compared to clinical diagnosis. TOTAL EFFECTIVE INEFFECTIVE p 67 (100%) 46 (68.6%) 21 (31.3%) Inflammatory Arthritides (RA + PsA + SpA + sJIA), (% ) 52 (77.6) 39 (75% ) 13 (25%) <0.0001 RA (% ) 30 (44.7) 22 (73.3 ) 8 (26.6) <0.001 RA positive ACPA/FR 21 (70) 15 (71.4 ) 6 (28.6) <0.0001 Psoriasic arthritis (PsA) (% ) 6 (9) 4 (66.6) 2 (33.3) 0.42 SpA (% ) 10 (14.9) 8 (80) 2 (20) 0.45 sJIA (% ) 6 (9) 5 (83.3) 1 (16.6) 0.55 PVNS (% ) 8 (11.9) 2 (25) 6 (75 ) <0.001 Inespecific monoarthritis (% ) 3 (4.4) 3 (100) 0 (0) 0.23 OA + Calcium Pyrophosphate Deposition (CPPD) (% ) 4 (5.9) 2 (50) 2 (50) 0.33 Intra articular corticosteroids were needed before RS, with no differences in effective and ineffective joints; however after RS it was significantly lower in effective joints in the first six months (0% vs 43% p<0.0001) and remained so in the following 6 months (0% vs 19% p<0.0001) Only 13 (28%) patients with effective RS needed to change systemic treatment compared to 10 (43%) of those ineffective (p<0.0001). None of the patients with RS had any complication after the procedure during follow up. Conclusion: Our study showed that knees were the main joint infiltrated and they had an overall good response to treatment, especially if the diagnosis was RA. Patients with effective procedures needed leest treatment changes and significantly less corticosteroids infiltrations. In our study, RS in PVNS was significantly less effective than in inflammatory arthritis (25% vs 75% p<0.0001) and RA seemed to have the best response overall. References: [1]Liepe K. Efficacy of radiosynovectomy in rheumatoid arthritis. Rheumatol Int. 2012 Oct; 32(10):3219-24. [2]Ćwikła JB, Żbikowski P, Kwiatkowska B, Buscombe JR, Sudoł-Szopińska I. Radiosynovectomy in rheumatic diseases. J Ultrason. 2014 Sep; 14(58):241-51. Disclosure of Interests: None declared

Background: Juvenile idiopathic arthritis (JIA) requires frequent systemic treatments, the ideal goal being to achieve remission. Questions remain as to when treatment can be stopped and how to balance the risks and benefits of continuing medications against the possibility of a flare after discontinuation. There is currently little conclusive evidence on the management of JIA in remission. Objectives: To determine the time to remission and frequency of flares in patients with JIA after withdrawal of systemic treatment in a single-centre cohort. Methods: Patients with JIA visited in the last 15 years were included. A retrospective cross-sectional study was performed. Demographic data such as sex, age at diagnosis, current age, subcategories of JIA were collected. Systemic treatment was also collected (date of discontinuation, date of flare after discontinuation, time in remission, time of treatment until discontinuation, discontinuation of biologic therapy while maintaining methotrexate). For the analysis of qualitative variables, absolute and relative frequencies were used; for quantitative variables, median and IR; for comparative analysis, Chi-square and Mann-Whitney U test. Results: We included 146 patients with JIA. Demographic data are shown in Table 1. 134 (90.4%) patients required systemic treatment (synthetic and/or biological DMARDs), of which 61 (45.5%) discontinued treatment completely at some point. Of the total number of patients who discontinued all systemic treatment, 19 (31.1%) had a flare with a median time in remission of 4.1 years (IR 1.3-9.1). 17 of the 134 patients (12.7%) with systemic treatment discontinued biologic therapy while maintaining methotrexate, of which 12 (70.6%) patients had a flare with a median time in remission of 0.9 years (IR 0.6-1.2). The differences between the frequency of flares and median time in remission between both treatment discontinuation groups (all systemic treatment versus discontinuation of biologic while maintaining methotrexate) were statistically significant (p<0.001). The median time from systemic treatment to complete withdrawal was 3.2 years (IR 1.9-4.8). Table 1. Demographic characteristics of patients with JIA Variables N 146 Sex: Women n (%) 89 (60.3) Age at onset (years, median (IR)) 4.6 (2.5-9.2) Current age (years, median (IR)) 16.7 (11.1-20.9) Types of JIA: Persistent oligoarticular n (%) 66 (45.2) Extended oligoarticular n (%) 11 (7.5) Polyarticular RF - n (%) 29 (19.9) Polyarticular RF + n (%) 3 (2.1) Enthesitis-related n (%) 12 (8.2) Psoriatic n (%) 9 (6.2) Systemic n (%) 16 (11.0) Conclusion: One third of the patients in whom all systemic treatment was withdrawn had a flare (70% remain in remission without medication) with a median time in remission of 4 years. On the other hand, two-thirds of patients in whom biologic therapy was withdrawn while maintaining methotrexate had a flare, with a shorter time in remission. The differences between both groups with withdrawal of systemic treatment are statistically significant (p<0.001). References: [1]Halyabar O, Mehta J, Ringold S, Rumsey DG, Horton DB. Treatment Withdrawal Following Remission in Juvenile Idiopathic Arthritis: A Systematic Review of the Literature. Paediatr Drugs. 2019 Dec;21(6):469-492. doi: 10.1007/s40272-019-00362-6. [2]Simonini G, Ferrara G, Pontikaki I, Scoccimarro E, Giani T, Taddio A, Meroni PL, Cimaz R. Flares After Withdrawal of Biologic Therapies in Juvenile Idiopathic Arthritis: Clinical and Laboratory Correlates of Remission Duration. Arthritis Care Res (Hoboken). 2018 Jul;70(7):1046-1051. doi: 10.1002/acr.23435. [3]Chhabra A, Robinson C, Houghton K, Cabral DA, Morishita K, Tucker LB, Petty RE, Larché M, Batthish M, Guzman J. Long-term outcomes and disease course of children with juvenile idiopathic arthritis in the ReACCh-Out cohort: a two-centre experience. Rheumatology (Oxford). 2020 Dec 1;59(12):3727-3730. doi: 10.1093/rheumatology/keaa118. Disclosure of Interests: None declared

Background: Tofacitinib is an oral JAK 1 and 3 inhibitor for the treatment of moderate to severe active rheumatoid arthritis (RA) or psoriatic arthritis (PsA) in adults with inadequate response or intolerant to one or more conventional disease-modifying antirheumatic drugs (cDMARDs). Since its approval by the European Medicines Agency (EMA), there is limited data about its use in daily practice in Europe. Objectives: To describe rates and reasons for discontinuation of Tofacitinib in patients with RA and other inflammatory conditions Methods: We identified patients with a prescription for tofacitinib at our academic center from January 2017 to January 2020. Patients were treated according to their rheumatologist evaluation following standards of care. The following variables were retrospectively collected from the electronic medical chart: age, gender, diagnosis, date of treatment initiation, date and reasons for treatment discontinuation, the use of concomitant or previous cDMARDs and of biologics. A comparison between patients continuing and stopping tofacitinib was performed through chi 2 or t-test for qualitative and quantitative variables, respectively. Survival analysis was done by Kaplan-Meier method Results: Ninety patients receiving tofacitinib were identified, 81 with RA, 6 with PsA, 1 with Dermatomyositis, 1 with Sjögren´s and 1 with juvenile idiopathic arthritis. Table 1 shows the baseline characteristics. 84% percent patients were women and the mean (SD) age was 58.5 (14.2) years. 51% patients started tofacitinib in monotherapy. When used, methotrexate was the most frequent cDMARD (61.3%); 10% patients used tofacitinib as first line after cDMARD and the majority used it after 1 or 2 previous biologics (46.7%). Table 2. Clinical coutcome of patients who developed HZ at initiation of baricitinib All patients (n=90, 100%) Continue Tofacitinib (n=58; 64%) Not continue Tofacitinib (n=32; 35.5%) p-value Female (%) 76 (84.4) 48 (82.7) 28 (87.5) 0.55 Age (year) – mean (SD) 58.5 (14.2) 58 (12.9) 59.5 (16.5) 0.63 Diagnosis 0.66 Rheumatoid arthritis 81 (90) 52 (89.6) 29 (90.6) Psoriatic arthritis 6 (6.7) 4 (6.8) 2 (6.2) Other 3 (3.3) 2 (3.4) 1 (3.1) Treatment duration (months) – mean (SD) 10.6 (6.9) 11.9 (7.3) 8.2 (5.5) 0.02 Prednisone (mg) – mean (SD) 1.75 (3.2) 1.20 (2.5) 2.73 (4.1) 0.03 Monotherapy (%) 46 (51.1) 28 (48.2) 18 (56.2) 0.244 Concomitant csDMARDs (%) 44 (48.8) 30 (51.7) 14 (43.7) 0.62 Methotrexate (%) 27 (30) 17 (29.3) 10 (31.2) Leflunomide (%) 10 (11.1) 8 (13.7) 2 (6.2) Other (%) 7 (7.7) 5 (8.6) 2 (6.2) Prior biologic treatment 0.13 None (%) 9 (10) 6 (10.3) 3 (9.3) 1-2 (%) 42 (46.6) 28 (48.2) 14 (43.7) ≥3 (%) 39 (43.3) 24 (41.3) 15 (46.8) Survival rates when used as first or second line were 85% at 6 months and 70% at 12 months; when used as third line or further, 76% and 70%, respectively (graphic 1). Factors associated to tofacitinib discontinuation were treatment duration and baseline prednisone dose. In contrast concomitant csDMARD and number of previous biologics were not. Reasons for tofacitinib discontinuation were: lack/loss of efficacy 46.9%, adverse events 50% (including intolerance -22%- herpes zoster -16%-, other infections 12%) and others. Conclusion: Tofacitinib in our experience is mostly used in RA patients after biologic failure. Overall survival rate at 12 months was good regardless line of therapy. Adverse event rates were similar to other biologic treatments. Herpes zoster was the most common infectious AE. Graphic 1: References: [1]Wollenhaupt J, Lee EB, Curtis JR, et al. Safety and efficacy of tofacitinib for up to 9.5 years in the treatment of rheumatoid arthritis: final results of a global, open-label, long-term extension study. Arthritis Res Ther. 2019;21(1):89. Disclosure of Interests: Christian Y Soleto: None declared, Belén Serrano Benavente: None declared, Luis A Torrens Cid: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Juan Molina Collada: None declared, Javier Rivera: None declared, Teresa González: None declared, Indalecio Monteagudo: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB

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