BackgroundEarly identification of risk factors for low bone mass for chronological age (LBMca) and childhood osteoporosis (cOP) in patients undergoing skeletal growth is essential to mitigate long-term skeletal complications. cOP is diagnosed when LBMca (BMD Z-score ≤2) is accompanied by a clinically significant fracture history, or when vertebral fragility fractures are present.MethodsPatients under 21 years of age with at least one risk factor for LBMca (malabsorption syndrome, chronic inflammatory diseases, hematological diseases, endocrinopathies, drugs that affect bone metabolism, or insufficient calcium intake) were included. Data on fractures history and physical activity levels were collected. Spine and whole-body dual-energy x-ray absorptiometry (DXA) and vertebral morphometry were performed. Age-adjusted linear regression analysis evaluated associations between bone mineral density (BMD) and risk factors.ResultsA total of 103 patients were included (mean age 9.8 years; 52.4% female), and 96.1% had more than two risk factors. The prevalence of LBMca was 10.5% and the prevalence of cOP was 4.8%. Vertebral BMD was positively associated with male sex. Whole body BMD was negatively associated with sedentary lifestyle and fracture history. Total body less head BMD showed negative associations with current steroid treatment, sedentary lifestyle, and history of fractures.ConclusionsPediatric populations at risk of LBMca or cOP often have multiple risk factors, notably modifying ones such as physical inactivity. Up to 10.5% of children with risk factors present LBMca and 4.8% have an undiagnosed or unknown cOP. Longitudinal studies are warranted to understand the long-term impact of the identified risk factors, including age, sex, sedentary lifestyle, ethnicity and vitamin D status, on bone health.

INTRODUCTION:To reach the diagnosis of giant cell arteritis (GCA), signs, symptoms, laboratory tests, imaging findings, and occasionally anatomopathological results from temporal artery biopsy are evaluated. This study describes the results of an algorithm analysis based on clinical and ultrasound evaluation of patients with suspected GCA, highlighting its diagnostic utility by contrasting its use in different clinical suspicion scenarios. METHOD:Prospective multicenter study evaluating patients referred with suspected GCA through a preferential circuit (fast track), grouping them according to low or high clinical suspicion of GCA. Each of these scenarios is evaluated by biopsy and ultrasound for all patients, resulting in positive, indeterminate, or negative outcomes, yielding six possible groups. Potential areas of improvement are explored, emphasizing that, following a negative or indeterminate ultrasound, 18-FDG-PET-CT could be recommended. We analyze the results and application of a diagnostic algorithm, confirming its efficiency and applicability based on whether there is high or low clinical suspicion. RESULTS:Sixty-nine patients (41 in the high suspicion group and 28 in the low suspicion group). There were 41 new diagnoses of GCA: 35 in the high suspicion group and 6 in the low suspicion group. Using ultrasound alone, the initial algorithm has an overall diagnostic efficiency of 72.5%, which improves to 80.5% when including 18F-FDG-PET/CT. The negative predictive value of ultrasound in patients with low clinical suspicion is 84.6%, and the positive predictive value of ultrasound in patients with high suspicion is 100%, improving sensitivity from 57.1% to 80.8% with 18F-FDG-PET/CT in this scenario. Temporal artery biopsy was performed on all patients, with no differences in sensitivity or specificity compared to ultrasound. In cases where all three tests - ultrasound, biopsy, and 18F-FDG-PET/CT - are performed, sensitivity increases to 92.3% in patients with high clinical suspicion. CONCLUSION:In situations of high clinical suspicion, the algorithm provides sufficient information for the diagnosis of GCA if ultrasound is positive. A negative ultrasound is sufficient to rule out the diagnosis in the context of low clinical suspicion. 18-FDG-PET-CT may be useful in patients with high suspicion and negative or indeterminate ultrasound results.

We analyzed the incidence of fractures and changes in bone mineral density and bone turnover markers in 264 patients who discontinued bisphosphonates. Fractures were recorded in 12.3

Background: Giant cell arteritis (GCA) is a heterogeneous disease with diverse clinical presentations and varying degrees of severity. This study aimed to assess the incidence of 3 clinical subsets in GCA and analyze associated severe complications and survival rates. By identifying distinct clinical patterns, the goal is to customize treatment approaches and minimize severe complications during follow-up. Methods: This retrospective study classified clinical manifestations of GCA into 3 major phenotypes based on the reason for consultation: i) cranial, ii) extracranial, and iii) occult GCA. These groups were analyzed and compared for acute complications, including severe ischemic complications, “true” occlusive disease, and late complications such as aortic aneurysm. Survival data were also collected during follow-up. Results: Visual disturbances were more common in the cranial GCA group compared to other subsets (P < .001). Blindness and stroke showed a clinically relevant trend, although statistical differences were not significant between the cranial GCA groups. Limb claudication was significantly more prevalent in the extracranial subset compared to the cranial or occult GCA subsets (12% vs. 2.6% vs. 0% respectively). Severe ischemic complications and true occlusive disease were more frequent in the cranial GCA groups (60%, P=.005 and 40%, P=1.64 respectively). Regarding mortality, there were no statistically significant differences in survival among the different clinical subsets. However, the occult GCA subset showed a trend towards a higher prevalence of deaths, both overall and specifically due to GCA. Conclusion: Clinical subsets in GCA present distinct complications and survival outcomes, with the cranial subset showing a higher incidence of severe ischemic events and the occult subset associated with delayed diagnosis and increased mortality. Recognizing these subsets is crucial for tailored treatment approaches and improving patient prognosis. Further prospective studies are needed to refine diagnostic and therapeutic strategies.

Para llegar al diagnóstico de arteritis de células gigantes (ACG) se evalúan signos, síntomas, pruebas de laboratorio, hallazgos de pruebas de imagen y, en ocasiones, los resultados anatomopatológicos de la biopsia de arteria temporal (BAT). El presente estudio describe los resultados del análisis de un algoritmo basado en la clínica y la ecografía de los pacientes con sospecha de ACG, destacando su utilidad diagnóstica, al contrastar su utilización en diferentes escenarios de sospecha clínica. Estudio prospectivo multicéntrico que evalúa mediante un circuito preferente (fast track) a los pacientes derivados con sospecha de ACG para la realización de una ecografía de arterias temporales y axilares, agrupándose según baja o alta sospecha clínica de ACG. Cada uno de estos supuestos es evaluado por ecografía, y el resultado puede ser positiva, indeterminada o negativa, obteniendo seis posibles grupos diferentes. Se exploran las posibles áreas de mejora, tras una ecografía negativa o indeterminada. En algunos pacientes se realiza una 18F-FDG-PET/TC. Analizamos los resultados y la aplicación de un algoritmo diagnóstico, confirmando su eficiencia y su aplicabilidad según si hay una alta o baja sospecha clínica. Sesenta y nueve pacientes (41 en el grupo de alta sospecha y 28 en el de baja sospecha clínica). Hubo un total de 41 diagnósticos nuevos de ACG: 35 en el grupo de alta sospecha y 6 en el de baja sospecha. El algoritmo inicial tiene una eficiencia global de diagnóstico del 72,5%, si solamente se utiliza la ecografía, que al incluir a la 18F-FDG-PET/TC, mejora al 80,5%. El valor predictivo negativo de la ecografía en los pacientes que presentan una baja sospecha clínica es del 84,6%, y el valor predictivo positivo de la ecografía en los pacientes con una sospecha alta es del 100%, mejorando en este escenario la sensibilidad del 57,1% al 80,8% si hacemos una 18F-FDG-PET/TC. La BAT se realizó a todos los pacientes, sin encontrar diferencias en la sensibilidad o la especificidad respecto a la ecografía. En el caso de tener las tres pruebas realizadas (ecografía, biopsia y 18F-FDG-PET/TC), la sensibilidad aumenta al 92,3% en los pacientes que presentan una alta sospecha clínica. En situaciones de alta sospecha clínica, el algoritmo proporciona suficiente información para el diagnóstico de ACG si la ecografía es positiva. En el contexto de baja sospecha clínica, una ecografía negativa es suficiente para descartar el diagnóstico. El 18-FDG-PET-TC puede ser de utilidad en aquellos pacientes con alta sospecha y ecografía negativa o indeterminada. To reach the diagnosis of giant cell arteritis (GCA), signs, symptoms, laboratory tests, imaging findings, and occasionally anatomopathological results from temporal artery biopsy are evaluated. This study describes the results of an algorithm analysis based on clinical and ultrasound evaluation of patients with suspected GCA, highlighting its diagnostic utility by contrasting its use in different clinical suspicion scenarios. Prospective multicenter study evaluating patients referred with suspected GCA through a preferential circuit (fast track), grouping them according to low or high clinical suspicion of GCA. Each of these scenarios is evaluated by biopsy and ultrasound for all patients, resulting in positive, indeterminate, or negative outcomes, yielding six possible groups. Potential areas of improvement are explored, emphasizing that, following a negative or indeterminate ultrasound, 18-FDG-PET-CT could be recommended. We analyze the results and application of a diagnostic algorithm, confirming its efficiency and applicability based on whether there is high or low clinical suspicion. Sixty-nine patients (41 in the high suspicion group and 28 in the low suspicion group). There were 41 new diagnoses of GCA: 35 in the high suspicion group and 6 in the low suspicion group. Using ultrasound alone, the initial algorithm has an overall diagnostic efficiency of 72.5%, which improves to 80.5% when including 18F-FDG-PET/CT. The negative predictive value of ultrasound in patients with low clinical suspicion is 84.6%, and the positive predictive value of ultrasound in patients with high suspicion is 100%, improving sensitivity from 57.1% to 80.8% with 18F-FDG-PET/CT in this scenario. Temporal artery biopsy was performed on all patients, with no differences in sensitivity or specificity compared to ultrasound. In cases where all three tests — ultrasound, biopsy, and 18F-FDG-PET/CT — are performed, sensitivity increases to 92.3% in patients with high clinical suspicion. In situations of high clinical suspicion, the algorithm provides sufficient information for the diagnosis of GCA if ultrasound is positive. A negative ultrasound is sufficient to rule out the diagnosis in the context of low clinical suspicion. 18-FDG-PET-CT may be useful in patients with high suspicion and negative or indeterminate ultrasound results.

Background Covid-19 has generated a change in society and in people’s daily lives. Patients with rheumatic diseases have suffered physically and mentally, both due to mobility restrictions and to the impact on personal, family, work and social life that COVID-19 has brought [1-4]. Objectives To examine the impact of the pandemic COVID-19 on patients with rheumatic diseases. Methods Cross-sectional descriptive study in patients with rheumatic diseases. Data collection was done through an online questionnaire to assess the impact of COVID-19, adapted for this purpose and made up of 5 scales of the 9 of the Coronavirus Psychological Impact Questionnaire [3]. This instrument is divided into two parts: 1) sociodemographic variables and 2) Experience with Coronavirus(ECOVI); Preventive Behaviour Use(UCP); Fear against coronavirus Scale(EMC); Interference with the coronavirus Scale(EIC) and positive psychological aspects(EEPA). This questionnaire was accessed through a QR code (provided to all patients both in consultations and in the day hospital) by the rheumatology team for two weeks between November-December 2021. In addition, this code was sent by the nurse via WhatsApp to all patients registered in our database. Statistical analysis: SPSS 24.0 and Pearson Chi-square, T-Student and ANOVA tests. Results n=362 online surveys; 72% women with a mean age of 63 years ± 14.21 (22-70 years). The most frequent rheumatic diseases were Rheumatoid Arthritis (50%) and Spondyloarthritis (31%). 83.2% had only one rheumatic disease (mean 1.26 ± 0.66) and 90% self-completed survey. In experience with the Coronavirus (ECOVI), 89% patients had not had symptoms or confirmed diagnosis of coronavirus, 98% were not hospitalized, 91% had confidence in our health system; Regarding the Use of Preventive Behaviors (UCP), 98% used a mask outside the house and 78.5% kept a safe distance; In relation to the most common fears associated with the Coronavirus (EMC), 40% were a little afraid of getting infected (34% quite a bit) and 50% were almost nothing afraid of losing their job; Regarding the interference that the coronavirus has caused in these patients (EIC), 73% had not had serious work problems and 74% had not had difficulties in their studies. In reference to the positive psychological aspects (EEPA), 48% had discovered new hobbies, 19% had become more religious,83% had learned to value personal relationships more. It was significant that women were more afraid of infecting themselves or a loved one or family member and/or dying from coronavirus than men (p=0.02; p=0.011 and p=0.002 respectively). Regarding age, younger patients (45y) were more concerned that they could lose their job compared to older patients (61y), p=0. Conclusion The COVID-19 disease has impacted patients with rheumatic diseases. In our sample, women have been more concerned about being infected and dying themselves and their closest relatives/friends, and younger people more concerned about job loss and economic income than older people. It has to be considered that the majority of this population has not been hospitalized or diagnosed with COVID-19 and also has great confidence in our health care system. More studies are necessary to examine the impact of the COVID-19 after the 6 th wave of the pandemic. References [1]Mancuso CA et al. Rheumatic Disease-Related Symptoms During the Height of the COVID-19 Pandemic. HSSJ (2020);16(1):S36-44. [2]Koppert T et al. The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease . Rheumatology(Oxford) 2020; 12keaa842. [3]Sandín et al. Impacto psicológico de la pandemia de COVID-19: Efectos negativos y positivos en la población Española asociados al período de confinamiento nacional. J Psychopathol Clin Psychol (2020); 25(1):1-22. [4]Farrés et al . Identification of the most vulnerable populations in the psychological sphere: a cross-sectional study conducted in Catalonia during the strict lockdown imposed against the COVID-19 pandemic . BMJ Open 2021;0:e0522140. Acknowledgements Leticia León, Milena Gobbo, Cristina Vilaplana and Day Care Unit nurses: Laura Álamo, Julia Barba, Neus Feijoo, Iolanda Bial, Neus Bardolet, Maria Soriano, Loli Arroyo, Ramon García, M Elena Casanova. Disclosure of Interests None declared

Purpose: To describe clinical and biological characteristics of pediatric patients with at least one risk factor (RF) for low bone mass for chronological age (LBMca)/childhood osteoporosis (cOP) and to assess its influence on bone mineral density (BMD).Methods: Patients between 2 and 20 years of age with at least 1 RF were recruited. Daily calcium intake, number of previous fractures and other RFs and their distribution among different groups were assessed. Spine and whole body DXA and vertebral morphometry were performed.Results: 103 patients were included. Mean age was 9.8 years old. 52.4% were female. Of the RFs, 84.5% presented insufficient calcium intake, 38.8% were receiving or had received corticosteroids, 31.1% were receiving other treatments with osteotoxic potential, 13.6% led a sedentary lifestyle, 12.6% presented history of fractures, and up to 8.1% had hypovitaminosis D. 38% of the cohort had 2 RFs, 31% had 3 RFs, 15% had 4 RFs, and 12% associated 5 or more RFs. 10.5% met LBMca criteria and 4.8% met cOP criteria. 73% of vertebral BMD was justified by age and hypovitaminosis D (positive effect), and male sex and Hispanic ethnicity (negative effect). 82% of total body less head BMD was justified by age (positive effect), and Hispanic ethnicity and sedentary lifestyle (negative effect).Conclusions: Pediatric populations with risk of LBM/cOP have 2 or more risk factors. Up to 10.5% of children with RFs present LBM and 4.8% have an unknown cOP. RFs related to changes in BMD are age, sex, sedentary lifestyle, ethnicity, and hypovitaminosis D.

Background:Incidence of clinical fractures in rheumatoid arthritis (RA) is not as well-known as hip or vertebral fracture incidence.Objectives:1. To estimate the incidence of clinical fragility fractures in a population of postmenopausal women diagnosed with RA and compare it with that of the general population; 2. To analyze the risk factors for fracture.Methods:330 postmenopausal women with RA from 19 Spanish Rheumatology Departments, randomly selected from the registry of RA patients in each center. The control group consisted of 660 Spanish postmenopausal women from the Camargo Cohort. Clinical fractures during the previous 5 years were recorded. Assessed risk factors for fracture were: sociodemographic characteristics, BMD and variables related to RA.Results:Median age of RA patients was 64 yrs. vs. 63 yrs. in controls (ns). Evolution of the disease was 8 yrs. 78% and 76% had RF and ACPA+, respectively. 69% of patients were in remission or low activity. 85% had received glucocorticoids and methotrexate and 40% at least one biological DMARD. We identified 105 fractures (87 fragility and 18 traumatic) in 75 patients. Fifty-four patients and 47 controls had at least one major fracture (MF) (p< 0.001). Incidence of MF was 3.55 per 100 patient-year in patients and 0.72 in controls. Risk factors for MF in RA patients were age, previous fracture, parental hip fracture, postmenopausal period, hip BMD and cumulative dose of glucocorticoids. In controls, risk factors were age, age at menopause and lumbar BMD.Among RA-associated factors, MFs were associated with erosions, disease activity and disability. Previous fracture in RA patients was a strong risk for MF (HR: 10.37 [95% CI: 2.95-36.41]).Conclusion:Between 3 and 4 of every 100 postmenopausal women with RA have a major fracture per year, four times more than the general population. Disease activity and disability associated with RA, the cumulative dose of glucocorticoids and mainly previous fracture are associated with the development of fragility fractures.References:NoneAcknowledgments:Funded in part by ISCIII (PI18/00762) that included FEDER funds from the EU.Disclosure of Interests:Carmen Gómez Vaquero: None declared, Jose Manuel Olmos: None declared, J. Luis Hernández: None declared, Dacia Cerda: None declared, Cristina Hidalgo: None declared, JA Martínez López: None declared, Luis Marcelino Arboleya Rodríguez: None declared, Javier Aguilar del Rey: None declared, Silvia Martinez Pardo: None declared, Inmaculada Ros: None declared, Xavier Surís: None declared, Dolors Grados Canovas: None declared, Chesús Beltrán Audera: None declared, Evelyn Suero-Rosario: None declared, Inmaculada Gómez Gracia: None declared, Asunción Salmoral: None declared, Irene Martín-Esteve: None declared, Helena Florez: None declared, Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Santos Castañeda: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, S García Carazo: None declared, Alberto García-Vadillo: None declared, Laura López Vives: None declared, À Martínez-Ferrer: None declared, Helena Borrell Paños: None declared, Pilar Aguado: None declared, Raul Castellanos-Moreira: None declared, Cristian Tebé: None declared, Núria Guañabens: None declared

Background:Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults over 50 years of age. Its incidence increases with age, with a peak between 70-80 years and predominates in women, 3:1. It is a medical emergency that, if not diagnosed, can lead to irreversible complications. The delay in time from diagnosis to start of treatment is crucial to avoid possible serious outcomes on short, medium and long term. Survival in GCA is estimated between 60-90% at 5 years and 48-81% at 10 years. Efforts have been made to implement rapid diagnostic circuits to assess patients and initiate treatment without delay with good results both in reducing permanent vision loss and in reducing the costs of these patients due to emergency visits and admissions. The morbidity and mortality of this disease is high, but the use of efficient diagnostic strategies, such as ultrasound of superficial temporal arteries, has proven to be a useful, practical, cost-effective and, above all, quick tool to make the diagnostic approach.Objectives:Analyze the impact of early temporal artery ultrasound on survival for patients with GCA.Methods:Survival study of 48 patients with GCA, in two different “stages” in terms of diagnostic approach: Group A (n = 27), patients diagnosed between 2002 - 2011 using only ACR 1990 criteria and Group E (n = 21) diagnosed between 2010-2015 using ACR criteria and TAUS. TAUS was performed by Rheumatologists with extensive experience in ultrasound and within a period of no more than 7 days for these patients. The definitive diagnosis of GCA was based on the clinical criteria of the Rheumatologist within the clinical and analytical context and with the specific complementary examinations for each case (Ultrasound, PET-CT, biopsy). Demographic data, comorbidities, signs and symptoms at debut, analytical data, complementary examinations, treatment and evolution were obtained retrospectively through the electronic medical record of the patient, based on the database of our GCA cohort. A survival analysis was performed considering death as the main outcome. The statistic used was the Kaplan-Meier test. In addition, other complications related to treatment or pathology are collected.Results:The mean age at diagnosis of our patients was 79 + - 6 years, with a female: male ratio of 3: 1. The follow-up was between 2 and 16 years with a mean of 5.8 + - 3 years, until the last visit collected or until the outcome of death. Group A had a survival at 5 and 10 years of 53.4% and 36.7% respectively, while group E of 79.5% at both cut-off points. (Figure 1).There is a significant difference between the survival of both groups, p <0.01, this being better in the group in which TAUS was implemented for rapid diagnosis (group E). The main causes of death were cardiovascular events, 30%, predominantly in group E (75%), and infection, 30%, predominantly in group A. The median from diagnosis to death was 3 years (range 1 - 13).Figure 1.Group A (red line) according to ACG 1990 criteria and Group B (green line) according to ACG criteria and implementing TAUS for rapid diagnosisConclusion:The implementation of temporal artery ultrasound (TAUS) is associated with a significant improvement in the survival rate of patients with GCA and a reduction in treatment-related complications in patients who were diagnosed with ultrasound in less than 7 days compared to those diagnosed by the conventional healthcare attention routes.References:[1]Gonzalez-Gay MA, et al. Giant cell arteritis: epidemiology, diagnosis, and management. DOI: 10.1007/s11926-010-0135-9[2]Patil P, et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. PMID: 26016758[3]Breuer GS, et al. Survival of patients with giant cell arteritis: a controversial issue. PMID: 31969222[4]Diamantopoulos AP, et al. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? 10.1093/rheumatology/kev289Disclosure of Interests:None declared

espanolLa arteritis de celulas gigantes (ACG) es la vasculitis sistemica primaria mas frecuente en adultos mayores de 50 anos. Puede presentarse con sintomatologia craneal, afectando la circulacion ocular y cerebral, o extracraneal, con inflamacion de grandes vasos, especialmente la aorta y sus ramas principales. Debido a la gran variabilidad de sintomas y, ocasionalmente, a la escasez de manifestaciones clinicas de la enfermedad, el diagnostico puede ser dificil, pero critico, para prevenir complicaciones isquemicas devastadoras como la ceguera y los accidentes cerebrovasculares. La biopsia de arteria temporal (BAT) sigue siendo el “gold-standard” para el diagnostico de la ACG. Sin embargo, aunque es muy especifico, carece de la sensibilidad adecuada y puede producir resultados falsos negativos en un 39-91%% de los casos. La ecografia de las arterias temporales y de grandes vasos es una modalidad de diagnostico en la ACG que puede identificar la presencia de cambios de la pared de los vasos a lo largo de su longitud. La ecografia es una tecnica no intervencionista, rapida de interpretar y de un coste reducido en comparacion a otras tecnicas. EnglishGiant cell arteritis (GCA) is the most frequent primary systemic vasculitis in adults over 50 years. It may cause cranial vasculitis, affecting vascular territories of the eye or brain or extracranial involvement of large vessels, especially the aorta and its main branches. Due to the great variability of symptoms and, occasionally, due to the scarcity of clinical manifestations of the disease, diagnosis may be difficult, but critical, to prevent devastating ischemic complications such as blindness and stroke. Temporal artery biopsy (BAT) remains the “gold-standard” for the diagnosis of GCA. Although it is very specific, it lacks adequate sensitivity and may have a false negative rate in 39-91%% of cases. Ultrasonography (US) of the temporal artery and large vessels is a diagnostic procedure in GCA able to identify vessel wall changes. US is a non-interventionist technique, quick to interpret and more affordable compared to other techniques. catalaL'arteritis de cel·lules gegants (ACG) es la vasculitis sistemica primaria mes frequent en adults majors de 50 anys. Pot presentar-se amb simptomatologia cranial, afectant la circulacio ocular i cerebral o extracranial amb inflamacio de grans vasos, especialment l'aorta i les seves branques principals. A causa de la gran variabilitat de simptomes i, ocasionalment, a l'escassetat de manifestacions cliniques de la malaltia, el diagnostic pot ser dificil, pero critic, per prevenir complicacions isquemiques devastadores com la ceguesa i els accidents cerebrovasculars. La biopsia d'arteria temporal (BAT) segueix sent el “gold-standard” per al diagnostic de l'ACG, pero, tot i que es molt especific, no te la sensibilitat adequada i pot produir resultats falsos negatius en un 39-91% dels casos. L'ecografia de les arteries temporals i de grans vasos es una modalitat de diagnostic en l'ACG que pot identificar la presencia de canvis de la paret dels vasos al llarg de la seva longitud. L'ecografia es una tecnica no intervencionista, rapida d'interpretar i d'un cost molt mes reduit comparat amb altres tecniques.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27–4.00), glucocorticoids (OR 3.83; 95% CI 1.32–14.09) and falls (OR 3.57; 95% CI 1.91–6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Objective. The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age. Methods. The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients >= 50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age. Results. A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae. Conclusion. The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex.

Background: The current guidelines of the International Society for Clinical Densitometry (1) recommend that in children with linear growth or maturational delay, Z score results should be adjusted. Height for age Z score (HAZ) adjustment is valid and can be calculated using the formula the formula proposed by Zemmel et al(2). It is possible that pediatric populations without linear growth or maturational delay, also benefit from HAZ, to prevent bone size from influencing the final Z score. Objectives: To evaluate Z score variability adjusted and without adjusting for height for age. Methods: We analysed data from densitometry performed on patients 2-20 years of age, from 2016 to 2018, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for low bone mass/osteoporosis. The HAZ was calculated according to Zemel’s formula. Results: Data from 103 patients are presented. Its characteristics are summarized in Table 1 Table 1. Mean age 9,8 years Female 52,4% Height Percentil ≤ 3 6,8% Height Percentil ≥ 97 4,9% LBM (Z score ≤ -2) spine 8,2% LBM HAZ spine 6,4% LBM whole body 10,5% LBM HAZ whole body 7,2% The table shows that the proportion of patients with BMD decreases in both the spine region and the whole body when adjusting for HAZ. When evaluating the relationship between densitometric measurements we found that spine Z score (ZsS) and whole body Z score (ZsWB) had a correlation coefficient of 0,73 (p<0,001). There were no differences between their averages (p=0,170). At the LBM cut-off point (Z score ≤ -2) there were discrepancies in 7%, where 5% presented LBM in ZsWB but not in ZsS. The concordance index at this point was 0,557. When comparing these measures with their HAZ adjusted equivalents, we observe: HAZ adjusted ZsS vs ZsS without adjusting: There were no differences between their averages (p=0,913) with a correlation coefficient of 0,78 (p<0,001). Concordance index at cut-off point for LBM was 0,498, with a discrepancy of 7% , where 2% had LBM according to HAZ adjusted ZsS, but not to ZsS without adjusting. HAZ adjusted ZsWB vs ZsWB without adjusting: There were no differences between their averages (p=0, 367) with a correlation coefficient of 0,82 (p<0,001). Concordance index at cut-off point for LBM was 0,557, with a discrepancy of 7% , where 2% had LBM according to HAZ adjusted ZsWB, but not to ZsWB without adjusting. Conclusion: There are discrepancies at the LBM cut-off point depending on the HAZ adjustment. The pediatric population without linear growth or maturational delay, can also benefit from HAZ adjustment, especially those with high height percentiles in which their size can hide a diagnosis of LBM. References: [1]Weber DR, Boyce A, Gordon C, Hogler W, Kecskemethy HH, Misra M, et al. The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2019;22(4):567-89. [2]Zemel BS, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield S, et al. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. The Journal of clinical endocrinology and metabolism. 2010;95(3):1265-73. Disclosure of Interests: None declared

Background:Bone fragility depends not only on bone mineral density (BMD), but also on bone microarchitecture. In adults, Trabecular Bone Score (TBS) is being used as an indirect marker of bone microarchitectureIt is a software that applicated to the vertebral image obtained by conventional densitometry, informs about the thickness of the trabeculae, the trabecular connectivity and the space between them. A high score indicates a better bone microstructure. In adults, a TBS equal to or greater than 1,350 is considered to represent a normal microarchitectureObjectives:To evaluate the usefulness of TBS in pediatric population with risk factors for Low Bone Mass (LBM)Methods:TBS was assessed by analyzing vertebral densitometries performed on patients from 4 to 20 years of age, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for LBM, consecutively from 2016 until 2018Data were compared with normal pediatric populationResults:Data from 83 patients are shown, with an average age of 11.2 years, 62% female, 80% CaucasianThe main risk factors for LBM were (%): Insufficient calcium intake (84,5), medications with osteopenizing potential (31), corticosteroids (39), sedentary lifestyle (13,6), fractures of long or vertebral bones (12,6) and hypovitaminosis D (8,1)Table 1.TBS por age groups and in patients with and without LBMAge groupsnMeanSDMinimum-MaximumScholars (4-9a)221,3210,0931,119-1,502Adolescence (10-17a)541,3090,0881,073-1,493Youth (18-20a)61,3590,0851,258-1,460Spine Z scorenMean (SD)pMinimum-Maximum ≤-281,270 (0,075)0,1261,419-1,162 >-2741,321 (0,090)1,502-1,073Whole Body Z score ≤-291,246 (0,060)0,0121,323-1,145 >-2731,324 (0,089)1,502-1,073Table 2.TBS in healthy population and study population for ageHealthy girls (n=2535)Healthy boys (n=1459)Study girls (n=47)Study boys (n=36)Age (y)Spine BMDTBSSpine BMDTBSTBSTBS1-20,401,3250,371,2722-30,511,3630,461,2671,1273-40,521,3460,511,2641,2044-50,601,3460,601,2671,2371,2435-60,601,2880,561,2691,3301,3686-70,651,2800,601,2321,3181,4227-80,671,2680,641,2441,3391,3458-90,711,2660,681,2281,2449-100,751,2780,701,2081,2531,34110-110,81,2850,731,2311,2291,29211-120,841,3370,761,2501,3031,31512-130,991,3550,811,2481,3811,36813-141,061,3860,891,2731,3941,33814-151,101,3980,991,3031,4741,28515-161,141,4051,081,3111,3681,40616-171,171,4051,151,3341,3321,37117-181,171,4041,201,3281,3741,28518-191,171,4041,161,314Conclusion:TBS was lower in the patients with LBM by whole body Z score, but not in those with LBM by spine Z score. We observed a decrease in TBS in adolescence, not corresponding with a decrease in BMD, and that should not be interpreted as a pathological findingSimilar results have been described in other pediatric populations (1, 2), but larger studies are needed to evaluate this phenomenon. We hypothesize that it may be due to a higher rate of growth in adolescence, with a lower rate of calcium apposition into the osteoid materialReferences:[1]Del Rio DS, Winthenrieth R. BONE MICROARCHITECTURE (TBS) AND BONE MASS DEVELOPMENT DURING CHILDHOOD AND ADOLESCENCE IN A SPANISH POPULATION GROUP. . WCO-IOF-ESCEO; Seville2014.[2]Shawwa K, Arabi A, Nabulsi M, et al. Predictors of trabecular bone score in school children. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(2):703-10.Disclosure of Interests:None declared

Background Low Bone Mass (LBM)/Infantile Osteoporosis (IOP) require an active evaluation for its diagnosis and prevention. Therefore, its incidence is unknown and could be undertreated. The systematic collection of risk factors associated with LBM/IOP could help identify the population at risk of presenting it Objectives To assess the prevalence and number of risk factors (RF) in the pediatric population at risk of developing LBM/IOP. Assess its influence on Bone Mineral Density Methods Demographic and clinical data were prospectively collected from patients from 2 to 20 years of age, who had at least one risk factor for LBM/IOP, among them: chronic diseases, treatment with immunosuppressants and/or corticosteroids and insufficient calcium intake. Calcemia, calciuria, and vitamin D were determined in blood samples, and whole body and lumbar DXA were performed. The calcium intake, the number of previous fractures and other RF were collected Results Data were collected from 103 patients, with an average age of 9’8 years, 52’4% women, and 80%Caucasians. Of these, 9 were preschoolers (2-3 years old), 33 schoolchildren (4-9y), 55 teenagers (10-17th) and 6 young people (18-20th) The most frequent diagnoses were: Malabsorption/Food allergies: 46.6%, JIA: 17.5%, Nephropathies: 17.8%, Hematological diseases: 6.8%, and Vasculitis and connective tissue diseases: 3.9% each The frequency of RFs can be observed inTable 1 The average dose of current corticoids was 0.21 mg/kg/day of prednisone with a total cumulative average dose of: 7 gr, with an exposure of 1 to 144 months 4’3% of the sample had an isolated RF, 38% had 2 RF, 31% 3, 15% 4, and 12% 5 or more 8’7% of the sample presented a LBM and 4.8% met criteria for Opi for vertebral fractures, 3 of them asymptomatic and discovered by morphometry In the multiple linear regression analysis: age, latin ethnicity, gender, and hypovitaminosis D were the main RFs related to lumbar BMD. Likewise, age, latin ethnicity and sedentary lifestyle were the RF related to the BMD of the whole body without head (BMDwbwh) In lumbar BMD, these 4 FR explained up to 85% of the BMD variation, where the age adds 0’032 per year gained, the male sex subtracts 0’061, the hypovitaminosis D sum 0’077 and the latin ethnicity subtracts 0’070 Up to a 90’8% variation of BMDwbwh is explained by these 3 RF: age adds 0’036 per year gained, sedentary life subtracts 0’084 and latin ethnicity subtracts 0’055. Conclusion The child population at risk of LBM/IOp associates 2 or more risk factors 8.7% of children with risk factors have LBM and 4.8% IOP The RFs related to changes in BMD are: age, sex, sedentary lifestyle and ethnicity. Hypovitaminosis D correlated positively with lumbar BMD Disclosure of Interests None declared

Background: Abatacept (CTLA4-Ig) is an approved biological therapy for the treatment of rheumatoid arthritis (RA). Similar to other biological agents, most patients (60%) respond significantly to this therapy. To date, however, the biological mechanisms underlying the lack of efficacy for this drug are unknown. Objectives: The objectives of the present study were to characterize the biological processes underlying the lack of efficacy of abatacept and to evaluate the blood transcriptome as a valid source for drug response prediction. Methods: A total of n=57 patients diagnosed with RA were recruited for this study from 16 rheumatology departments in Spain. All patients were >18 years old and, had >6 months of disease evolution. The primary clinical response to abatacept was defined at week 12 using the EULAR criteria. Good and moderate responders were aggregated into a single response group, and compared to the no response group of patients. Blood RNA was collected from all patients at baseline. From a subgroup of patients (n=31), blood RNA was also obtained at weeks 12, 24 and 48 of treatment with abatacept. Gene expression levels were determined using paired-end RNA-seq (Illumina). Differential gene expression, association to biological processes, longitudinal association analysis and building of the multigenic predictor were performed using the R software and the specialized Bioconductor libraries. The the prediction accuracy was evaluated using the ROC AUC. Results: From the 57 patients treated with abatacept, n=10 (17.5%) were good EULAR responders, n=24 (42%) moderate EULAR responders and n=23 (40.5%) non-responders at week 12 of therapy. Biological process analysis identified two significantly distinct biological profiles between responders and non-responders. In responders, we found an association to pathways associated with the effector phase of T cells (e.g. interleukin-15 and 2 signalling, P < 0.05). Non-responder patients showed instead a strong association to biological processes associated with antigen presentation and activation of T cells (P < 0.005). Using the baseline gene expression profiles, we built a multigenic predictor of response to abatacept with an AUC = 75%. In the longitudinal cohort, patients were stratified based on reaching an inactive state (i.e. DAS28 < 3.2). Using this endpoint measure, the longitudinal analysis of the 4 time points corroborated the association of response with antigen presentation (P < 0.01). Conclusion: The analysis of blood RNA profiles of RA patients has enabled the identification of specific biological processes associated with the lack of response to abatacept. Also, we demonstrate that blood expression profiles can be predictive of the response to the drug at week 12 of therapy. Disclosure of Interests: Antonio Julià: None declared, Maria Lopez Lasanta: None declared, Antonio Gómez: None declared, Raimon Sanmarti Grant/research support from: Research support: Bristol-Myers Squibb, Speakers bureau: Speakers bureau: Bristol-Myers Squibb, Carlos Marras Fernandez Cid: None declared, José Manuel Pina Salvador: None declared, Susana Romero-Yuste: None declared, Raul Maria Veiga Cabello: None declared, Pilar Navarro: None declared, Carme Moragues Pastor : None declared, Silvia Martinez Pardo: None declared, Javier de Toro-Santos: None declared, Amalia Sánchez: None declared, Dacia Cerda: None declared, Alejandro Prada: None declared, Alba Erra: None declared, Jordi Monfort Speakers bureau: Bioibérica Procare Health, ANA URRUTICOECHEA-ARANA: None declared, Núria Palau: None declared, Raquel M Lastra: None declared, Raül Tortosa: None declared, Andrea Pluma Sanjurjo: None declared, Sara Marsal: None declared