Background: Tumor necrosis factor-alpha inhibitors (TNFi) are a standard in the treatment of juvenile idiopathic arthritis (JIA). There are currently three TNFi available for the treatment of polyarticular JIA (pJIA). Comparative data in children are scarce. Objectives: To analyze baseline, effectiveness and safety parameters of tumor necrosis factor-alpha inhibitor first-line therapy in comparison Methods: In this ongoing non-interventional study, baseline clinical characteristics, efficacy and safety parameters of TNFi first-line therapy with etanercept (ETA), adalimumab (ADA) or golimumab (GOL) were analyzed using the German Biologics in Pediatric Rheumatology Registry (BiKeR). Data from 2200 patients with pJIA/ extended oligo JIA (eoJIA) up to November 24th 2023 were taken into account. Results: ETA was the most frequently chosen primary TNFi with 1791 patients. ETA patients had a higher disease activity according to JADAS10 at baseline. Patients who primarily received ADA were more frequently diagnosed with eoJIA and less frequently with rheumatoid factor (RF)-positive pJIA. They were more frequently diagnosed with uveitis and positive for antinuclear antibodies (ANA). GOL initiating patients had less frequently eoJIA and were older at disease onset. They received concomitant methotrexate (MTX) more and steroids less frequently. No differences were observed in gender with a majority of female patients in all three groups (Table 1). After 12 months, in all three cohorts, a significant reduction in the mean JADAS10 was achieved. With ETA/ADA/GOL, there was a decrease in mean JADAS10 from 15.4/12.5/14.6 to 3.8/3.1/2.7 and 3.4/2.8/2.3 after 24 months respectively. After 12 months of treatment, 61.7/70.2/68.6% achieved JADAS 10 remission and 78.4/84.4/85.7% attained minimal disease activity. PedACR90 scores were reached in 45.6/40.9/52.8% in the three cohorts. After 24 months of treatment, efficacy data showed consistent or improved results with 63.1/68.8/55.6% achieved JADAS remission and 80.4/85.2/83.3% attained minimal disease activity and PedACR scores in 51.0/41.3/44.4%. Reports of SAEs, serious infections (SI) and treatment discontinuations are shown in Table 1, along with efficacy data. SAEs and serious infections were rare overall and occurred at the expected frequency. Of note, the highest rate of uveitis recurrence was in the ADA cohort, which also had the highest rate of prior uveitis. Treatment discontinuations were comparable in all three cohorts at 61.8/59.2% and 59.2%, respectively. Lack of efficacy was the most common reason for discontinuation at 21.3/20.6/20.4%. Conclusion: Numerous patient characteristics influence the choice of TNFi for the treatment of polyarticular JIA. While ETA remains the most frequently chosen first-line biologic, ADA is preferred in the presence of uveitis. In accordance with German regulations, GOL is concomitantly prescribed with methotrexate therapy. Efficacy, tolerability and safety appear to be comparable. REFERENCES: NIL. Acknowledgements: The authors thank Rainer Berendes, Michael Borte, Maria Fasshauer, Ivan Földvari, Tilman Geikowski, Hermann Girschick, Jürgen Grulich-Henn, Johannes-Peter Haas, Maria Haller, Boris Hügle, Bernd-Ulrich Keck, Hans Kössel, Jasmin Kümmerle-Deschner, Rolf-Michael Küster, Kirsten Minden, Nils Onken, Prasad Oommen, Jürgen Quietzsch, Bettina Rogalski, Michael Rühlmann, Angelika Thon, Ralf Trauzeddel, Andreas Urban, Frank Weller-Heinemann for contributing to the BIKER-Registry and all patients and their families for participating in this observation. Disclosure of Interests: Angela Zimmer: None declared, Ariane Klein: None declared, Frank Dressler Abbvie, Novartis, Pfizer, Novartis, Mylan, Daniel Windschall Novartis, Pfizer, Abbvie, MEDAC, Roche, Sobi, Novartis, Roche, Pfizer, Abbvie, Normi Brueck: None declared, Sonja Mrusek: None declared, Toni Hospach Novartis, SOBI, Novartis, SOBI, Markus Hufnagel Novartis, Kirsten Minden Pfizer, Novartis, medac, Gerd Horneff Pfizer, Roche, MSD, Sobi, GSK, Sanofi, AbbVie, Chugai, Bayer, Novartis, MSD, Lilly, Pfizer, Roche, MSD, AbbVie, Chugai, Novartis.

Background: Tocilizumab (TCZ) has been approved for the treatment of polyarticular juvenile idiopathic arthritis (JIA) since 2013. Data on efficacy and tolerability/safety in long-term treatment are scarce. Objectives: To investigate the tolerability/safety of TCZ compared to tumour necrosis factor inhibitors (TNFi) over 36 months, and to analyse the comparative effectiveness of the substances in patients with first and second-line therapies, respectively. Methods: BIKER WA 29358 is a 5-year multi-centre prospective, observational cohort study including patients with polyarticular JIA in Germany starting treatment between 2015 and 2020 with TCZ and matched patients starting an approved TNFi (etanercept, adalimumab or golimumab). Outcomes included JADAS-10-based inactive disease and low disease activity at 12, 24 and 36 months, rates of adverse events (AE) and drug adherence, which were compared between cohorts. Results: Recruitment of 342 participants (TCZ, n=171; TNFi, n=171) was completed over 3 years ago. TCZ was used as 2nd line biologic in the majority of patients (84%), while TNFi were mostly 1st line biologics (86%). Therefore, patients starting on TCZ were older and had a longer disease duration compared to TNFi patients at treatment initiation. At baseline, significantly more patients received TCZ intravenously (72.5%) than subcutaneously (27.5%); this changed over the course of the study (intravenous 43%/subcutaneous 57%). Proportions of patients in TCZ/TNFi treatment groups achieving JADAS inactive disease at 36 months were 86/45% in 1st line biologic users and 57/50% in 2nd line biologic users, in patients still receiving treatment (PPP). At least JADAS low disease activity (LDA) was achieved in 100/68% in 1st line and 77/88% in 2nd line users of TCZ/TNFi (PPP). No significant difference between subcutaneous and intravenous administration was observed regarding rates of patients reaching JADAS inactive disease and JADAS low disease activity (PPP). Safety was assessed based on AE reporting (Table 1): 93 (54%) patients in the TCZ cohort and 102 (60%) patients in the TNFi cohort reported AE during treatment and up to 90 days after treatment discontinuation. The AE rate was similar in both cohorts (65 vs. 57/100 patient years (PY), RR 1.1 (95%CI 0.9-1.4), Wald-test), but rate of serious AE was higher in the TCZ cohort (3.4 vs. 0.5/100 PY; RR 6.4 (95%CI 1.4-29). No opportunistic infection was reported. Cytopenia was more common in the TCZ cohort (13 vs. 1, RR 15.2 (95%CI 2.0-116.3), uveitis and injection site reactions were more common in the TNFi cohort (3 vs. 13/100PY; RR 0.3 (95%CI 0.08-0.95) and 5 vs. 14/100 PY, RR 0.4 (95%CI 0.2-1.2). There was no case of death or malignancy in patients ever exposed to TCZ or TNFi in this cohort. One pregnancy occurred in the TCZ cohort in the follow-up post 90 days after discontinuation of TCZ, with delivery of a healthy child. Two pregnancies were documented in the control cohort: Outcome was delivery of a healthy child in one case and induced abortion in the other. In the TCZ or TNFi cohorts, 92 (54%) vs. 107 (63%) patients discontinued treatment, 49/38 due to lack of efficacy, 27/42 due to remission and 10/11 due to intolerance, respectively. Conclusion: In this interim analysis, treatment targets were reached with similar frequency after 36 months of treatment with TCZ or TNFi. TCZ was used predominantly as 2nd line biologic. Higher rates of remission and minimal disease activity were observed in 1st line compared to 2nd line biologic users. More serious adverse events were reported in the TCZ cohort. No new safety signals were noted so far. Observation is ongoing.Table 1. Patient characteristics, selected reported adverse events (number and rate). REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Ariane Klein: None declared, Angela Zimmer: None declared, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Christiane Reiser speaker honoraria from Novartis and Galapagos., Advisory boards: Pfzer, Sobi, Jasmin B. Kuemmerle-Deschner Novartis and Sobi, Novartis and Sobi, Novartis and Sobi, Maria Fasshauer: None declared, Kirsten Minden: None declared, Ivan Foeldvari: None declared, Christoph Rietschel: None declared, Daniel Windschall Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Ralf Trauzeddel: None declared, Markus Hufnagel: None declared, Dirk Foell Novartis, Rainer Berendes: None declared, Gundula Boeschow: None declared, Prassad Thomas Oommen: None declared, Frank Dressler: None declared, Gerd Horneff MSD, Roche, Pfizer, MSD, Roche, Pfizer.Figure 1Treatment goals reached by patients on treatment over 36 months (Rates; 1=100%).

Background: Physical inactivity and screen-based media (SBM) use are different aspects of sedentary behavior, independently related to poor health outcomes [1,2], and not yet (sufficiently) evaluated in adolescents with juvenile idiopathic arthritis (JIA). In addition, none of the previous studies examined SBM use and physical activity (PA) behavior during disease course and with consideration of health-related quality of life (HRQoL). Objectives: This study aimed to longitudinally investigate possible differences in daily time spent with SBM and levels of weekly PA between adolescents with JIA and controls from the general population. Methods: Data from JIA patients and controls enrolled in the German multicenter Inception COhort of Newly diagnosed patients with JIA (ICON) at 11 German centers were analyzed. Individuals aged 13 and over were followed prospectively with questionnaires concerning clinical data, PA level, SBM use, and HRQoL (PedsQL) at a two-year interval (Baseline, T1; follow-up, T2). While group by time interactions were analyzed using linear mixed models, multinomial logistic regression was performed to estimate the association between SBM use/PA levels/HRQoL and sociodemographic factors as well as clinical parameters. Results: Data of 214 patients (T1 mean age 14.4 ± 0.9 years, female 63%, polyarthritis 33%, oligoarthritis 26%) and 141 controls could be considered. At T1, 52% of the patients were treated with a DMARD, 59% at T2. In contrast to controls, PA levels of patients increased over time (OR 3.69; 95% CI: 1.01-13.50, p=0.048), however, they remained below the level of controls (OR 0.13; 95% CI: 0.04-0.38, p<0.001). Increasing PA levels were associated with decreasing disease activity (cJADAS-10), increasing use of biologics and improved HRQoL (PedsQL) over time. Although mean screen time did not differ significantly between patients and controls (T1: 3.5h vs. 3.0h, p=0.194; T2: 3.6h vs. 3.3h, p=0.364), patients more frequently spent more than 4 hours a day with SBM (T2: p=0.046). Male patients and controls displayed significantly higher total screen time than females both at T1 and at T2 and were also more likely to be heavy screen users (>4h/day). In contrast, males in both groups more frequently achieved the current WHO recommended PA level of 60 minutes per day than girls. While low socioeconomic status (OR 14.40; 95%-CI: 2.84-73.15) and higher cJADAS-10 score (OR 1.31; 95%-CI: 1.03-1.66) increased the likelihood for high SBM use (≥4.5h/d), higher PedsQL psychosocial health score (OR 0.93; 95%-CI: 0.88-0.99) was associated with a decreased likelihood. Conclusion: Adolescents with JIA became more physically active over the course of their disease, but remained more frequently physically inactive and were more likely to be heavy screen users than controls. To help prevent negative effects of excessive screen time and pronounced physically inactivity, pediatric rheumatologists, pediatricians and other healthcare professionals should inform patients and parents about its dangers and advise them to reduce sitting time to act as a stepping-stone to increase other aspects of PA. The ICON study was funded by the Federal Ministry of Education and Research (BMBF, FKZ 01ER0812, FKZ 01ER1504A-C). REFERENCES: [1] Lee IM, et al. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet 2012;380:219–229. [2] Proper KI, et al. Sedentary behaviors and health outcomes among adults: A systematic review of prospective studies. Am J Prev Med 2011;40:174–182. Acknowledgements: We thank all patients and their parents as well all physicians and study nurses for their participation in ICON. Disclosure of Interests: None declared.

Background: Physical activity (PA) is essential throughout growth and maturation and may offer potential preventive and therapeutic benefits in young patients with juvenile idiopathic arthritis (JIA) [1]. Valid and reliable assessment of children's many spontaneous and impulsive movements in everyday life is a major challenge, but essential for deriving targeted interventions to promote active lifestyles. Objectives: Since to date little is known about directly measured 24-hour movement behaviour in adolescents with JIA, we aimed to 1) examine levels of PA and sedentary time (ST) in a sample of adolescent JIA patients in relation to sociodemographic and JIA-related factors and 2) compare levels of PA and ST to population controls. Methods: Patients with JIA aged 12 to 20 years were eligible for the multicenter ActiMON study. Recruitment took place at seven pediatric rheumatology centers distributed throughout Germany. PA and ST were assessed by an accelerometer (ActiGraph wGT3X-BT, ActiGraph LLC, Pensacola, FL), wearing laterally on the right hip for 7 consecutive days during all awake hours. In order to assess PA patterns in everyday life, accelerometer data were gathered during school weeks only. Device-measured PA were linked to clinical data from the National Pediatric Rheumatological Database (NPRD). Patients' PA levels were compared with an age-, sex- and BMI-stratified nationwide sample from the MoMo study, in which the same study protocol was used [2]. In accordance with the International Children's Accelerometry Database criteria [3], subject datasets had to contain validated wear time at least on 4 weekdays and 1 weekend day during their measurement period to be eligible for further data processing and statistical analysis. Results: Data of 125 patients (mean age 15.2 ± 2.1 years, female 67%, patients' disease duration 7.2 ± 4.8 years, polyarthritis 30%, cJADAS-10 2.3 ± 2.4) and 455 controls (mean age 14.6 ± 2.6 years, female 66%) were available for evaluation. Overall, 22% of patients and 14% of controls fulfilled the World Health Organization's (WHO) PA recommendation of ≥60 min of daily moderate to vigorous PA (MVPA) on average. Almost 86% of patients' and 76% of controls' wearing time were identified as ST, followed by PA in light (8% vs. 19%), vigorous (4% vs. 3%), and moderate (2% vs. 2%) intensity. Female patients spent more time sedentary than males (p=0.023), while late adolescent patients spent more time sedentary than early adolescent patients (p=0.012). Age and the amount of time spent sedentary correlated positively (r=0.32, p<0.001). Patients with polyarticular disease spent on average less time in MVPA than patients with oligoarticular disease course (p=0.046). No associations were found between average time in MVPA/ST and disease activity (cjadas-10), functional ability (C-HAQ), and pain intensity (NRS 0-10). Conclusion: Adolescents with JIA were more likely to achieve the WHO recommended minimum level of PA, but spent significantly more time sedentary than German population controls. Since movement behaviour was largely independent of common disease-specific symptoms/barriers, targeted interventions to promote PA and health behaviour change involving multidisciplinary approaches appear urgently needed in this population. ActiMON as part of the research network TARISMA is funded by the Federal Ministry of Education and Research (01EC1902F). REFERENCES: [1] Rochette E et al. Physical activity as a promising alternative for young people with juvenile idiopathic arthritis: Towards an evidence-based prescription. Front Immunol 2023;14:1119930. [2] Burchartz A et al. Measurement of physical activity and sedentary behavior by accelerometry among a nationwide sample from the KiGGS and MoMo Study: Study Protocol. JMIR Res Protoc 2020;9:e14370. [3] Sherar LB et al. International children's accelerometry database (ICAD): design and methods. BMC Public Health 2011;11:485. Acknowledgements: We thank all patients and their parents as well all physicians and study nurses for their participation in ActiMON. Disclosure of Interests: None declared.

Background: Associated uveitis is common among patients with juvenile idiopathic arthritis and carries a risk of long-term damage to the eye and vision [1]. Data out of clinical practice regarding the occurrence of uveitis during therapy are limited. Objectives: Comparison of the occurrence of uveitis and uveitis flares under therapy with three different TNF inhibitors using the BIKER-registry. Methods: Baseline demographic characteristics, clinical and laboratory conditions as well as the occurrence of uveitis and uveitis flares during therapy with either Etanercept, Adalimumab or Golimumab were compared. Results: 3315 JIA patients treated with one of the TNF inhibitors etanercept (n=2121), adalimumab (n=963 patients) or golimumab (n=231 patients) were analyzed for the occurrence of first uveitis or uveitis recurrence. The cohorts differed significantly regarding the distribution of JIA subtype (p<0.0002), the rate of ANA-positive patients treated with etanercept was significantly lower than the ones treated with adalimumab or golimumab (57.8% vs 67.6%/66.5%, p<0. 0001), there were significant differences in age at disease onset (etanercept-cohort patients oldest, 7.4 years vs 6.36/5.5 years adalimumab/golimumab; p<0.0001), while age at therapy start was highest in the golimumab cohort, these patients were significantly older than in the etanercept cohort (12.63 vs 11.6, p=0.0001). The groups differed significantly regarding the CHAQ-DI (etanercept 0.65 vs 0.48/0.46 adalimumab/golimumab, p<0.0001), the JADAS (etanercept 15.1 vs 11.2/11.1 adalimumab/golimumab, p<0.0001), CRP and ESR (both significantly higher in the etanercept cohort than in the adalimumab/golimumab cohort, p=0.0001). Concomitant therapy with steroids was used significantly more often in the etanercept cohort than in the other two groups (33.4% vs. 24.4/16%, p<0.0001), MTX was applied significantly less in the adalimumab cohort than in the etanercept and golimumab cohort (64% vs. 72% each, p<0.0001). There were significant differences in pre-treatment with other biologics, in the etanercept cohort 5.6% of the patients were pre-treated with biologics, in the adalimumab cohort 58.3% and in the golimumab cohort 78.4% (p<0.0001). Uveitis before start of treatment was significantly more frequent in the adalimumab and golimumab cohort than in the etanercept cohort (approx. 30% vs. 6.7%, p<0.0001). Uveitis recurrence also differed significantly, occurring most often and earlier (Figure 1A) in the golimumab cohort in approximately 36% of patients with preexisting uveitis, while it was documented in approx. 23% upon adalimumab and in 19% upon etanercept (p=0.02). The rates were 30.5 vs. 10 vs 7.7 events/100PY in the golimumab vs adalimumab vs etanercept cohort (p<0.0007). The first occurrence of uveitis during ongoing therapy did not differ significantly between the cohorts (Figure 1B). Conclusion: Pre-existing uveitis increases the risk of recurrence compared to the probability of developing first uveitis during treatment. Etanercept is used less frequently in patients with a preexisting uveitis. Adalimumab is often used as first-line biologic therapy for uveitis, so the rate of pre-existing uveitis in this group should be evaluated accordingly in the interpretation. Recurrence of uveitis is significantly more frequent with golimumab than with etanercept or adalimumab. While golimumab is used as a second-line or third-line biologic in almost 80% of cases; the previous treatment refractory status including uveitis of the patients is a bias which should be taken into account when evaluating the data. The results have to be interpreted carefully due to significant differences in baseline parameters. Observation is ongoing. REFERENCES: [1] Foeldvari I, Becker I, Horneff G. Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry. Arthritis Care Res (Hoboken). 2015 Nov;67(11):1529-35. doi: 10.1002/acr.22613. PMID: 25988824. Acknowledgements: This study would not have been possible without the collaboration of numerous German and Austrian paediatric rheumatologists, patients and their parents Disclosure of Interests: Carolin Baucks: None declared, Angela Zimmer: None declared, Toni Hospach: None declared, Daniel Windschall: None declared, Kirsten Minden: None declared, Frank Weller-Heinemann: None declared, Ivan Foeldvari: None declared, Gerd Horneff Pfizer Chugai, Novartis, MSD, Pfizer, Roche, MSD, Novartis.

Background: National and international guidelines call for rapid and effective therapy with the aim of achieving an inflammation-free clinical condition as quickly as possible. Nevertheless, the prognosis of many patients remains uncertain, so that an optimisation of the care situation appears necessary. Objectives: Improvement and harmonisation of diagnosis, monitoring, treatment decision and prognosis is the aim of the PROKIND protocols [1]. Methods: Prospective treat-to-target observational study of patients with polyarticular JIA during the first year of treatment according to the PROKIND recommendations [1]. Acceptability and outcomes of different treatment pathways with treat-to-target strategy for polyarticular JIA are investigated in the GBA-funded project. Patients with initial therapy with methotrexate form cohort 1, patients with additional repeated intravenous corticosteroid pulse therapy form cohort 2, patients with concomitant intra-articular corticosteroid application in at least 5 joints or multiply repeated injections form cohort 3. According to the step up T2T protocol, biologics are added if targets were not reached [1]. Results: 160 pJIA patients (RF+ polyarthritis n=24, RF- polyarthritis n=138, unknown RF status n=8) from 23 paediatric rheumatology institutions in Germany and Austria were recruited, 86/53/31 patients were assigned to cohort 1/2/3. Patients of cohort 2 had higher disease activity (JADAs10), higher functional limitations (CHADQ-DI) and higher CRP and ESR (Table 1). The mean JADAS10 showed a decrease in disease activity from 19.2±7.7 at baseline to 3.5±4.6 at month 12, the decrease in CHAQ-DI from 0.9±0.8 to 0.3±0.5 showed improvement in functional capacity. Similarly, improvements in quality of life, pain and fatique were demonstrable. JADAS-inactive disease was achieved by 20.8% at month 3, 42.1% at month 6 and 57.7% at month 12. Escalation to biologic-based therapy was received by 40/86 (47%) of patients in cohort 1 (MTX only), 25/53 (47%) in cohort 2 (MTX+steroid pulses), and 14/31 (45%) in cohort 3 (MTX+extensive i.a. steroids).Treatment escalation to second biologic was used in 10%/9%/10%. Finally, in cohort 1/2/3. A total of 60.4%/48.5% and 66.7.2% had a JADAS inactive disease (JADAS10≤ 2.7) and an additional 25.0%/24.2%/20.8% had a minimal disease activity (JADAS 10 2.8-≤6) and 14.6%/24.2%/12.5 had residual moderate disease activity (JADAS10 6.1-≤17) while only 1 had high disease activity. Conclusion: A treat-to-target approach achieves dramatic improvement in disease activity in polyarticular juvenile idiopathic arthritis. Already after 12 months, in about two thirds of patients inactive disease was achieved with marked improvement in functional limitations and quality of life. However, an additional benefit of repeated steroid pulse therapy or extensive intra-articular steroid injections was not recognizable. Due to the study design data must be interpreted with caution. REFERENCES: [1] Horneff G, Klein A, Ganser G, Sailer-Höck M, Günther A, Foeldvari I, Weller-Heinemann F. Protocols on classification, monitoring and therapy in children’s rheumatology (PROKIND): results of the working group Polyarticular juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2017 Nov 7;15(1):78. doi: 10.1186/s12969-017-0206-9. PMID: 29116003; PMCID: PMC5678777. Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1JADAS-Target inactive disease (≤2.7) in the three strategy-cohorts

Background COVID-19 has shaped the world over the last 3 years. Although the risk for severe COVID-19 progression in children is low it might be aggravated by chronic rheumatic disease or treatment with immunosuppressive drugs. Objectives We analyzed clinical data of COVID-19 cases among paediatric patients with rheumatic diseases reported to BIKER between March 2020 and December 2022. Methods The main task of the German BIKER (Biologics in Pediatric Rheumatology) registry is safety monitoring of biologic therapies in JIA. After the onset of the COVID-19 pandemic, the survey was expanded with a standardized form to proactively interview all participating centers about occurrence, presentation and outcome of SARS-CoV-2 infections in children with rheumatic diseases. Results A total of 68 centres participated in the survey. Clinical data from 928 COVID infections in 885 patients with rheumatic diseases could be analyzed. JIA was the most common diagnosis with (717 infections), followed by genetic autoinflammation (103 infections), systemic autoimmune diseases (78 infections), idiopathic uveitis (n=25), vasculitis (n=5).In 374 reported COVID infections (40%), patients were receiving conventional DMARDs, in 331 (36%) biologics, mainly TNF inhibitors (TNFi, n=241 (26%)). In 567 reports (61%) patients used either a biologic or a DMARD, in 339 reports patients (37%) did not use any antirheumatic medication including steroid.Over the last 3 years, COVID-19 occurred in Germany in 5 distinguishable waves, calendar weeks (CW) 10-30 in 2020, CW 21/2020 – 8/2021(both predominantly wild-type variant), CW 9-27 in 2021 (Alpha variant in the majority of infections), CW 28-51 in 2021 (Delta variant), since CW 52/2021 (several Omikron variants; Robert-Koch Institute: VOC_VOI_Tabelle.xlsx; live.com))In our cohort, patients with SARS-CoV-2 infection were slightly older during the 1st and 2nd wave (mean age 12.7+/-3.5 and 12.8+/-4.3 years) compared to the 4th and 5th wave with 11.4+/-3.9 and 11.4+/-4.2 years; p=0.01.160 asymptomatic SARS-CoV-2 infections were reported, frequencies of symptoms associated with COVID-19 are shown in table 1.Five patients were hospitalized for 4-7 days. A 3½-year-old female patient succumbed during the first wave with encephalopathy and respiratory failure. The patient had been treated with MTX and steroids for systemic JIA. Genetic testing revealed a congenital immunodeficiency. No other patient needed ventilation or intensive care. One case of uncomplicated PIMS in an MTX treated JIA patient was reported.The duration of SARS-CoV-2 infection-associated symptoms was markably shorter during the 5th wave with 6.7+/-5.1 days, compared with reports from the other 4 waves (Table1).The duration of symptoms was higher in MTX treated patients (10.2+/-8.4 days) compared to patients without treatment (7.7+/-10.8; p=0.004) or patients treated with TNFi (8.2+/-4.8, p=0.002). Although patients treated with steroids also had a longer duration of symptoms (9.7+/-7.0), this was not significant. Conclusion Except for one patient with congenital immunodeficiency who died, no case of severe COVID-19 was reported in our cohort. At the time of infection, over 60% of patients had been treated with conventional DMARDs and/or biologics. Although MTX treated patients had a slightly longer duration of symptoms, antirheumatic treatment did not appear to have a negative impact on severity or outcome of SARS-CoV-2 infection. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests Ariane Klein Speakers bureau: Novartis, Toni Hospach Speakers bureau: Speaking fee Novartis and SOBI., Frank Dressler Speakers bureau: Abbvie, Novartis, Pfizer, Advisory Boards Novartis and Mylan, Daniel Windschall Grant/research support from: research funds by Novartis, Roche, Pfizer, Abbvie, Markus Hufnagel: None declared, Wolfgang Emminger: None declared, Sonja Mrusek: None declared, Peggy Ruehmer: None declared, Alexander Kühn: None declared, Philipp Bismarck: None declared, Maria Haller: None declared, Gerd Horneff Speakers bureau: Pfizer, Roche, MSD, Sobi, GSK, Sanofi, AbbVie, Chugai, Bayer, Novartis, Grant/research support from: Pfizer, Roche, MSD, AbbVie, Chugai, Novartis.Table 1Characteristics and frequency of symptoms in SARS-CoV-2 infectionsN or mean (SD)1st waveN=202nd waveN=843rd waveN=384th waveN=1245th waveN=662female14532775432age at COVID-19, years12.7 (3.5)12.8 (4.3)11.8 (3.5)11.4 (3.9)11.4 (4.2)asymptomatic126132694duration of symptoms; days,11.9 (14.7)9.2 (7.0)14.1 (11.6)10.3 (7.6)6.7 (5.1)fever1218541306cough1015652245rhinitis5261344289headache4161227171sore throat61139132musculosceletal pain2751348loss of smell/taste71162113fatigue4882680dizziness122116gastrointestinal symptoms151864dyspnea1117pneumonia11bronchitis1

Background Autoinflammatory periodic diseases (AID) can be treated with the interleukin-1β inhibitor canakinumab (CAN). CAN has been shown to be safe and effective in controlled trials and routine clinical practice. Objectives In this study general safety parameters in patients with canakinumab in cryopyrin-associated periodic syndromes (CAPS), familial Mediterranean fever (FMF), hyper-IgD syndrome/mevalonate kinase deficiency (HIDS/MKD) and tumor necrosis factor receptor-associated periodic syndrome (TRAPS) on CAN therapy were investigated in routine clinical practice. Methods RELIANCE is a prospective, non-interventional, observational study in Germany enrolling pediatric (age ≥2 years) and adult patients with a clinically confirmed diagnosis of AID who routinely receive CAN. Efficacy and safety parameters are recorded at baseline and assessed at 6-month intervals. Results Data from N=232 patients (N=229 with baseline visit yet documented) diagnosed with autoinflammatory diseases enrolled in the RELIANCE registry between October 2017 and December 2022 were included in the present interim analysis. Median age of the total study cohort was 20.0 years (2−80 years), 52% were female and median duration of CAN treatment before study entry was 2 years (0−15 years). During the study, 898 adverse events (AE) occurred in N=164 patients (71%). Among the most common AE classified as suspected adverse drug reactions (ADR) were decreased neutrophil count (8 events, IR 1.46), increased inflammatory markers (12 events, IR 2.19), nasopharyngitis (14 events, IR 2.55), and pyrexia (17 events, IR 3.10). In N=35 patients (15%), a total of 98 serious adverse events (SAE) were reported. Of these events, 31 SAE were classified as suspected adverse drug reactions (SADR; Table 1). During the last 3 years of observation within the study, incidence rates (IR) decreased from 76.21 to 51.44 (ADR) and 7.44 to 5.66 (SADR). Patients receiving greater than standard dose CAN experienced higher levels of ADR/SADR compared to patients under less than standard and standard dosing. How much high dosage or severeness of disease contribute to this phenomenon remains unclear. AE related dose reductions have not been reported. Conclusion The 48-month interim data of the RELIANCE study confirm sustained safety of long-term treatment with CAN in the entire study population. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests J. B. Kuemmerle-Deschner Consultant of: Novartis, AbbVie, Sobi, Grant/research support from: Novartis, AbbVie, Sobi, Jörg Henes Consultant of: Novartis, AbbVie, Sobi, Roche, Janssen, Boehringer-Ingelheim, Grant/research support from: Novartis, Roche, Birgit Kortus-Goetze Consultant of: Novartis, Prasad Oommen Grant/research support from: Novartis, Anne Pankow: None declared, Tilmann Kallinich Speakers bureau: Roche, Tobias Krickau Speakers bureau: Novartis, Consultant of: Novartis, Grant/research support from: Novartis, Catharina Schuetz Grant/research support from: Novartis, Gerd Horneff Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Ivan Foeldvari Consultant of: Novartis, Jürgen Rech Speakers bureau: AbbVie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD; Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: AbbVie, Biogen, BMS, Chugai, GSK, Janssen, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Frank Weller-Heinemann: None declared, Ales Janda: None declared, Markus Hufnagel Grant/research support from: Novartis, Florian Meier Speakers bureau: Novartis, Frank Dressler Consultant of: Abbvie, Mylan, Novartis, Pfizer, Grant/research support from: Novartis, Michael Borte Grant/research support from: Pfizer, Shire, Ioana Andreica Speakers bureau: Abbvie, Chugai, Novartis, UCB, MSD, Lilly, Sobi, Astrazeneca, Amgen, Pfizer, Gilead, Paid instructor for: Astrazeneca, UCB; Consultant Abbvie, Chugai, Novartis, UCB, Galapagos, Takeda, Astrazeneca, Lilly, Boehringer Ingelheim, Amgen, Sobi, Peter Wasiliew Grant/research support from: Novartis, Michael Fiene: None declared, Daniel Windschall: None declared, Julia Weber-Arden Employee of: Novartis, Norbert Blank Consultant of: Novartis, Sobi, Lilly, Pfizer, Abbvie, BMS, MSD, Actelion, UCB, Boehringer-Ingelheim, Roche, Grant/research support from: Novartis, Sobi.

Background New outcome measures are needed to optimize personalized tailored treatment and to predict response in patients with juvenile idiopathic arthritis (JIA). Objectives Aim of this multicenter, longitudinal study is to identify biomarker (clinical examination of the joints, ultrasound and inflammatory biomarkers) for the evaluation of disease activity in children with JIA. Methods DAISY study planned to recruit 120 patients with JIA polyarticular and at least 30 patients with JIA oligoarticular disease course according to International League of Association for Rheumatology (ILAR) classification criteria, with active disease calculated by JADAS 10 and 27 and treated according to current recommendations[1,2]. At enrollment, 3, 6 and 12 months patients were simultaneously evaluated for disease activity status (JADAS 10 and 27), examined by musculoskeletal ultrasound (MSUS) gray-scale (GS) and power-doppler (PD) in 44 joints using OMERACT synovitis scoring system by an expert in pediatric MSUS. At each visit blood samples are collected for evaluation of inflammatory biomarkers (cytokines, chemokines, S100A8, S100A9 and S100A12). In case of disease worsening, the same parameters were performed as unscheduled visit. Experienced sonographers in pediatric MSUS were blinded from clinical examination as well as pediatric rheumatologist performing clinical examination were blinded from the MSUS finding. Prior to the patient enrollment it was mandatory that all sonographers access the study educational material on DAISY web-portal and perform test for sonographers that represents calibration web-based reliability exercise on still images, presenting different grades of synovitis using OMERACT synovitis scoring in order to optimize interrater reliability. Results Study is conducted in 9 participating centers in 8 different countries after Ethics Committee Approvals and Informed Consents/assents were obtained. A total of 52 JIA patients were enrolled: 15 (28.8%) males and 37(71.2%) females; median age at enrollment 11.25 years, interquartile range (IQR) 8.06-14.19 years and median disease duration 1.67 years, IQR 0.97-5.26 years. Of the JIA patients, 18 (34.6%) had oligoarticular JIA, 21(40.4%) had rheumatoid factor negative polyarthritis, 5 (9.6%) had rheumatoid factor positive polyarthritis, 7 (13.5 %) had enthesitis related arthritis while only one (1.9%) had psoriatic arthritis. Two patients (3.8%) had uveitis, while eight (15.4%) of them had a family history of autoimmune diseases. In total, 42 (80.8%) were treated with synthetic disease modifying antirheumatic drugs (methotrexate) while 31(59.6%) of JIA patients were receiving biologics. Conclusion Study results are expected to enable definition of the new more sensitive clinical tool to predict response in JIA and achieve optimized personalized tailored treatment of our patients. Funding This study is supported by the Foundation for Research in Rheumatology (FOREUM) and by the Paediatric Rheumatology International Trials Organisation (PRINTO). References [1] Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S et al. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2016 Apr 18;14(1):23. [2] Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019 Jun;71(6):717-734. Acknowledgements This study is supported by the Foundation for Research in Rheumatology (FOREUM) and by the Paediatric Rheumatology International Trials Organisation (PRINTO). Disclosure of Interests Dragana Lazarevic: None declared, Clara Malattia: None declared, Ana Isabel Rebollo Giménez: None declared, Linda Rossi-Semerano: None declared, Betül Sözeri: None declared, Maria Tsinti: None declared, Vasiliki Dermentzoglou: None declared, Lanni Stefano: None declared, Daniel Windschall: None declared, Ausra Snipaitiene: None declared, Luca Carlini: None declared, Silvia Scala: None declared, Elisa Patrone: None declared, Nicolino Ruperto Speakers bureau: NR has received honoraria for consultancies or speaker bureaus from the following pharmaceutical companies in the past 3 years: 2 Bridge, Amgen, AstraZeneca, Aurinia, Bayer, Brystol Myers and Squibb, Celgene, inMed, Cambridge Healthcare Research, Domain Therapeutic, EMD Serono, Glaxo Smith Kline, Idorsia, Janssen, Eli Lilly, Novartis, Pfizer, Sobi, UCB., Grant/research support from: The IRCCS Istituto Giannina Gaslini (IGG), where NR works as full-time public employee has received contributions from the following industries in the last 3 years: Bristol Myers and Squibb, Eli-Lilly, F Hoffmann-La Roche, Novartis, Pfizer, Sobi. This funding has been reinvested for the research activities of the hospital in a fully independent manner, without any commitment with third parties., Jelena Vojinovic: None declare.d.

Background Tofacitinib is an oral Janus kinase inhibitor recently approved for the treatment of polyarticular juvenile idiopathic arthritis (pJIA) and juvenile psoriatic arthritis (jPsA) aged 2 to <18 years. Data out of clinical practice so far are rare. Objectives To characterize JIA cohorts treated with tofacitinib and to evaluate efficacy and tolerance in clinical practice. Methods The German BIKER data base was screened for JIA patients aged 2 to <18 years who were started on tofacitinib until December. 31st, 2022 Results Patient demographic and disease characteristics are presented in Table 1. Primary diagnoses were either polyarticular JIA rheumatoid factor positive (n=4) or negative (n=18), extended oligoarthritis (n=7), jPsA (n=2), ERA-JIA (n=2), persistent oligoarthritis (n=1) and systemic onset JIA (n=1). The patient’s age varied from 6.9 to 18.0 years at start of treatment and the disease duration range was 2.3 – 16.6 years. In most cases, patients were extensively pretreated with biologics (mean 2.7). One patient had received 7 biologics, four each received 5 or 4 biologics, six received 3, ten received 2 and 8 received 1 biologic before. In a single case, tofacitinib was used directly after failure of methotrexate. Tofacitinib was administered orally BID in 35 JIA patients at a daily total dosage of 0.18 +/-0.06 mg/kg. Tablets with dosages of 5 mg BID were used in 31 patients. Oral solution was used in 4 patients (up to 4 mg BID). Efficacy data and safety data were available from 17 patients. A decrease of the JADAS10 (Median; IQR) from 10.1 (5.5;13.2) to 3.0 (1.3;6.3), of the number of active joints (from 4 (1;6) to 0 (0;1), of the patient’s/parent’s global VAS (from 30 (6;50) to 11 (2.5;22), the physician’s global (from, 28 (18;41) to 7 (0.8;10) was noted. PedACR 30/50/70/90 criteria were fulfilled by 53%/47%/41%/24% at last observation. There were 11 adverse events (AE) in 10/35 patients (29%), including lack of efficacy (n=7), and each one upper respiratory tract infection, COVID19, headache, bone pain. There was no serious AE or severe AE reported. 8 patients (22.9%) discontinued tofacitinib after 0.6-6.7 months. Tofacitinib was stopped in 6 due to inefficacy, in 1 due to bone pain and in 1 because of patient’s decision. Conclusion In this preliminary analysis of pediatric patients with JIA, tofacitinib use was safe and well tolerated. Treatment was associated with an improvement in signs and symptoms of arthritis and global disease activity at last observation although the cohort of patients has been heavily pretreated with DMARDs and biologics. The BIKER registry is planning to further follow JIA patients. Reference [1]Trincianti C, et al. Definition and Validation of the American College of Rheumatology 2021 Juvenile Arthritis Disease Activity Score Cutoffs for Disease Activity States in Juvenile Idiopathic Arthritis. Arthritis Rheumatol. 2021;73:1966-1975. Acknowledgements: NIL. Disclosure of Interests Gerd Horneff Speakers bureau: Novartis, Pfizer, Grant/research support from: Novartis, Roche, MSD, Daniel Windschall: None declared, Boris Huegle Speakers bureau: Novartis, Pfizer, Consultant of: Aceragen, Grant/research support from: Pfizer, Rainer Berendes: None declared, Hermann Girschick: None declared, Ariane Klein Speakers bureau: Pfizer.

Objectives To evaluate 24-month effectiveness and tolerability/safety of tocilizumab (TCZ) versus tumour necrosis factor inhibitor (TNFi), analysing predictors of JADAS remission and minimal disease activity (MDA), comparing 1st and 2nd line TCZ. Methods BIKER WA 29358 is a 5-year multi-centre prospective, observational cohort study including polyarticular juvenile idiopathic arthritis (JIA) patients in Germany starting treatment between 2015 and 2020 with TCZ and matched patients starting an approved TNFi such as etanercept, adalimumab or golimumab. Clinical disease activity (JADAS), JADAS MDA/remission at 24 months, safety and drug adherence were assessed and compared between cohorts. Results The analysis set consisted of 342 participants with 24-month treatment data (TCZ, n=171; TNFi, n=171) (Table 1). Therefore, patients starting on TCZ were older and had a longer disease duration compared to TNFi patients. Efficacy was demonstrated by a marked and comparable decrease of the JADAS10 in upon both TCZ and TNFi from 14.6+/-6.6 and 14.6+/-6.2 at baseline to 2.5+/-3.4 and 2.7+/-3.6 at month 24. TCZ was used as 2nd line biologic in the majority of patients (84%) while TNFi were mostly 1st line biologics (86%). In the last observation carried forward analysis, at 24 month JADAS remission upon TCZ/TNFi treatment was achieved by 84.6%/76.9% in 1st line biologic users and 62.3/66.7% in 2nd line users. JADAS MDA was achieved in 100%/87.9% in 1st line and 84.4%/91.7% in 2nd line users of TCZ/TNFi.After 24 months of treatment residual disease activity as measured by the JADAS10 (mean +/SD) was lower in the 1st line TCZ cohort compared to the 2nd line (1.0+/-1.2 vs. 2.7+/-3.6), while in the TNFi cohort residual JADAS10 was comparable in 1st or 2nd line (2.7+/-3.8 vs. 2.5+/-2.6).Safety was assessed based on adverse events reporting. 113 (66%) patients in the TCZ cohort and 105 (61%) patients in the TNFi cohort reported adverse events with a higher rate in the TCZ cohort (89 vs. 73/100 patient years (PY), RR 1.2 (95%CI 1.0-1.5), p=0.029, Wald-test) as well as the rate of serious adverse events (10 vs. 3/100 PY; p=0.045). Cytopenias were more common in the TCZ cohort (13 vs. 1; p=0.010) and injection site reactions were more common in the TNFi cohort (13 vs. 6/100 PY, p=0.089). There was no case of death and no opportunistic infection. In the TCZ/TNFi cohorts, 71 (42%)/72 (42%) patients discontinued treatment, 43/30 due to lack of efficacy, 14/22 due to remission and 7/6 due to intolerance, respectively. Conclusion In this interim analysis, treatment targets were reached with similar frequency after 24 months of treatment with TCZ or TNFi. TCZ was used predominantly as 2nd line biologic. Higher rates of remission and minimal disease activity were observed in 1st line compared to 2nd line TCZ users. More adverse events were reported in the TCZ cohort but no new safety signals were noted. Observation is ongoing. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests Gerd Horneff Speakers bureau: Chugai, Pfizer, Novartis, Sobi, Grant/research support from: Novartis, Roche, Angela Zimmer: None declared, Toni Hospach: None declared, Fraank Weller-Heinemann: None declared, Jasmin Kuemmerle-Deschner Speakers bureau: Novartis, Grant/research support from: Novartis, Maria Fasshauer: None declared, Kirsten Minden Grant/research support from: Chugai, Roche, Ivan Foeldvari: None declared, Daniel Windschall: None declared, Markus Hufnagel: None declared, Dirk Foell Grant/research support from: Novartis, Prasad Oommen: None declared, Ariane Klein: None declared.Table 1Baseline patients' characteristicsBaseline patients' characteristicsTocilizumab, N=171Matched TNFi controls, N=171P-valueAge at therapy start, mean (SD)12.1 (3.5)10.0 (4.4)<0.001Disease Duration, years, mean (SD)5.4 (4.0)3.2 (3.1)<0.001Rheumatoid-factor negative poly JIA, n (%)115 (67%)97 (57%)n.s.Rheumatoid-factor positive poly JIA, n (%)17 (10%)22 (13%)n.s.Extended oligoarthritis, n (%)39 (23%)52 (30%)n.s.Prior bDMARD, n (%)143 (84%)24(14%)<0.001Concomitant systemic steroids, n (%)43 (25%)42 (25%)n.s.Concomitant treatment with MTX, n (%)93 (54%)133 (78%)<0.001Number of active joints, mean (SD)6.3 (6.9)5.6 (4.8)n.s.CHAQ-DI, mean (SD)0.61 (0.62)0.63 (0.62)n.s.JADAS-10, mean (SD)14.6 (6.6)14,6 (6.2)n.s.Month 12 dataJADAS-10, mean (SD)3.5 (4.6)3.8 (5.4)n.s.JADAS-MDA (≤6) -LOCF population72.7%77.4%n.s.JADAS-remission (≤2.7) -LOCF population60.9%57.9%n.s.Month 24 dataJADAS-10, mean (SD)2.7 (3.6)2.5 (2.6)n.s.JADAS-MDA (≤6) -LOCF population87.0%85.2%n.s.JADAS-remission (≤2.7) -LOCF population64.9%69.1%n.s.Figure 1

BackgroundPsychiatric comorbidities can be a significant additional burden in chronic diseases. The most common chronic inflammatory rheumatic disease in children and adolescents is juvenile idiopathic arthritis (JIA). Data on mental illness in children and adolescents with JIA are heterogeneous.ObjectivesTo assess the frequency of depressive and anxious symptoms in patients with JIA compared to healthy peers.MethodsData were analysed from JIA patients and healthy controls of the same age included in the inception cohort of newly diagnosed children and adolescents with JIA (ICON). Depressive symptoms (using the Patient Health Questionnaire (PHQ-9, score 0-27) and anxious symptoms (Generalised Anxiety Disorder Scale (GAD-7, score 0-21) were captured 7 or 9 years after inclusion in ICON in patients aged thirteen years or older at the time of filling in these questionnaires. Symptom severity for both instruments was assessed by sum score with the following cut-off values: PHQ-9 score < 5: none, 5-9: mild, 10-14: moderate, 15-19: severe, ≥ 20: very severe. GAD-7 Score < 5: none, 5-9: mild, 10-14: moderate, ≥ 15: severe. Disease parameters such as Physician Global Assessment of Disease Activity (PhGA Disease Activity, numerical rating scale, (NRS),0-10, 0=best), joint count (n) and patient-reported outcomes on functional limitations ((C)HAQ, score 0-3, 0=best), Patient Global Assessment of Well-being (PGA Well-being), pain and fatigue (NRS, 0-10, 0=best) were also documented.ResultsThe analysis included 344 patients, 157 (45.6%) < 18 years old (mean 15.5 ± 1.5 years, 64.3% female), 187 (54.4%) ≥ 18 years old (mean 21.5 ± 2.1 years, 65.2% female) and 224 control subjects, 115 (51.3%) < 18 years old (mean 15.2 ± 1.5 years, 60% female), 109 (48.7%) ≥ 18 years old (mean 21.4 ± 1.9 years, 58.7% female). Almost 40% of patients had oligoarthritis (26% persistent OA, 12.5% extended OA), 27% rheumatoid factor (RF)-negative polyarthritis, 6% psoriatic arthritis, 17% enthesitis-related arthritis; 3% each had systemic JIA and RF-positive polyarthritis. In the total cohort, 14% of patients and 7% of controls had a PHQ-9 ≥ 10 and 10% of patients and 2% of controls had a GAD-7 ≥ 10. Within the categories of JIA, the rate of a PHQ-9 ≥ 10 ranged from 9.3% (oligoarthritis extended) to 33.3% (RF-positive polyarthritis) and a GAD-7 ≥ 10 ranged from 0% (systemic arthritis) to 22.2% (psoriatic arthritis).Patients aged ≥ 18 years had higher scores for both PHQ-9 (≥ 10: 18.7%) and GAD-7 (≥ 10: 14.4%) compared to patients < 18 years (PHQ-9 ≥ 10: 8.3%, GAD-7 ≥ 10: 5.1).In patients < 18 years with PHQ-9 < 10 versus ≥ 10, there were no significant differences in either PhGA disease activity (0.8±1.6 / 1.0±2.0, p = 0.673) or joint count (0.5±1.3 / 0.5±1.6, p = 0.999). In contrast, there was a significant difference in PhGA disease activity (0.8±1.5 / 1.6±1.4, p = 0.005) but not in joint count (0.7±3.1 / 0.8±1.3, p = 0.850) in patients ≥ 18 years with PHQ-9 < 10 versus PHQ-9 ≥ 10.Female patients were more often found to have higher scores for depression and anxiety than male patients (PHQ-9 ≥ 10: female 17.5%, male 7.4%, GAD-7 ≥ 10: female 13.5%, male 4.1%) and patients more often had higher scores for depression than controls (PHQ-9 ≥ 10: female patients 17.5%, female controls 8.3%, male patients 7.4%, male controls 4.4%). The difference in the proportion of female patients with GAD-7 ≥ 10 (13.5%) compared to control subjects (2.3%) was remarkable, but in male patients this proportion (4.1%) was only slightly higher than in male control subjects (2.2%).ConclusionDepressive and anxious symptoms are common in adolescents and young adults with JIA, especially in females. In the continuous care of these patients, standardised diagnostic tools should be implemented to detect these comorbidities, to optimise therapy and thereby reduce the burden of disease. Further research is needed to identify possible predictors of the development of depression and anxiety in JIA patients in order to pursue preventive approaches.Disclosure of InterestsPrasad Oommen: None declared, Jens Klotsche: None declared, Frank Dressler: None declared, Ivan Foeldvari: None declared, Dirk Foell: None declared, Gerd Horneff Speakers bureau: Pfizer, Novartis, Janssen, Chugai, Abbvie, Grant/research support from: Pfizer, Novartis, MSD, Chugai, Roche, Abbvie, Toni Hospach Consultant of: SOBI, Novartis, Tilmann Kallinich: None declared, Jasmin Kuemmerle-Deschner: None declared, Ina Liedmann: None declared, Kirsten Moenkemoeller: None declared, Martina Niewerth: None declared, Caroline Siemer: None declared, Frank Weller-Heinemann: None declared, Daniel Windschall: None declared, Kirsten Minden Speakers bureau: AbbVie, Pfizer, Novartis, Claudia Sengler: None declared

BackgroundIn recent years, transition clinics have been set up at an increasing number of paediatric rheumatology sites in Germany to reduce identified deficits in the care of young people with rheumatic diseases1. In addition, the German Rheumatic Diseases League (Deutsche Rheuma-Liga, DRL), the largest self-help organisation in Germany, has been offering support services for young people in transition since 2016, including the interactive website www.mein-rheuma-wird-erwachsen.de.ObjectivesTo assess the transition competence of young people with juvenile idiopathic arthritis (JIA) and their knowledge of self-help services.MethodsCross-sectional data of the National Paediatric Rheumatology Database (NPRD) from 2016 to 2020 were used to evaluate the health-related transition competence of young people with JIA aged ≥16 years. Health-related knowledge and health-care competence were assessed using a modified self-report instrument2 on a 4-point Likert scale as part of routine documentation in the NPRD. Young people were also asked about their information behaviour and knowledge of new support services. Linear mixed models were used to determine whether health-related transition competence changed between 2016 and 2020, adjusted for disease duration.ResultsDuring the years 2016 to 2020, between 1.908 to 2.536 patients with JIA aged ≥16 years were annually recorded in the NPRD from 56 to 61 paediatric rheumatology sites. The annual patient collectives comprised 34-39% oligoarthritis, 23-26% RF-negative or RF-positive polyarthritis and 22-27% enthesitis-related arthritis cases. In the years from 2016 to 2020, about one-third of patients had inactive disease (cJADAS-10≤1) and about 60% had no functional limitations (CHAQ=0).Over the years, the proportions of patients who rated their disease knowledge and health care competence as “very well” increased significantly in most areas. Although over time, no increase in numbers of patients seeking information about their disease outside of rheumatology consultations were recorded (2016: 22.8%; 2020: 20.9%), awareness of the DRL’s new website for young people with rheumatic diseases increased from 7.7% in 2016 to 26.9% in 2020. Compared to those who were unaware of the new website, those who knew about the website were more likely to have received care in rheumatology settings that offer transition clinics and were more likely to be girls (75% vs 65%), to attend high school (51% vs 46%) and to be slightly older (17.6 vs 17.1 years).ConclusionThe transition competence of young people with JIA seems to have improved over the last five years. During this time, more transition services were made available for young people with rheumatic diseases. However, most young people are not yet aware of these services. Moreover, the effectiveness of the different measures/interventions has yet to be evaluated.References[1]Luque Ramos A et al. Semin Arthritis Rheum 2017;47:269-75.[2]Herrmann-Garitz C et al. Gesundheitswesen 2017;79:491–6.Table 1.Health-related transition competence in JIA patients ≥16 years who participated in the NPRD201620182020p (difference over time)PatientsN=2536N=2068N=1908Disease duration, years6.7±4.97.2±5.07.6±5.1DMARDs at documentation, %576263Disease-related knowledge (best answer “very well”), %N=1992N=1598N=1265name of illness3542420.001names of medicines5459560.717what medicines are for5054520.357who to contact in case of health problems5965650.015influence of smoking, drugs, and alcohol on disease4955540.002how to make a doctor’s appointment6868650.087which doctors are responsible after leaving paediatric care4246490.031Health-care competence (best answer “most of the time”), %N=1784N=1443N=1143inform my doctor of any unusual changes in my health6672690.038keep information about my illness8184840.281ask my own questions5156550.016answer the questions I am asked6973740.014take care of my health concerns and needs6671690.041attend the consultation alone5961610.599speak up for myself and say what I need6468680.537AcknowledgementsThe NPRD has been funded by the Federal Ministry of Health and the companies Abbvie, Chugai, ask, Novartis, PfizerDisclosure of InterestsKirsten Minden Speakers bureau: Pfizer, Novartis, Consultant of: Pfizer, Novartis, Martina Niewerth: None declared, Susanne Schalm: None declared, Ivan Foeldvari: None declared, Johannes-Peter Haas: None declared, Gerd Horneff: None declared, Daniel Windschall Speakers bureau: Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Grant/research support from: Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Tilmann Kallinich: None declared, Frank Dressler: None declared, Frank Weller-Heinemann: None declared, Rainer Berendes: None declared, Toni Hospach Consultant of: SOBI, Novartis, Markus Hufnagel: None declared, Maria Haller: None declared, Sandra Hansmann: None declared, Jens Klotsche: None declared

Background Tocilizumab (TCZ) has been approved for treatment of juvenile idiopathic arthritis (JIA) for 10 years. Objectives Evaluation of 12-month efficacy and safety of TCZ compared to TNF inhibitors (TNFi). Methods BIKER WA 29358 is a 5-year multi-centre prospective, observational cohort study including polyarticular JIA patients in Germany starting treatment between 2015 and 2020 with TCZ and matched 1:1 by date of treatment start and region to patients starting an approved TNFi. Clinical disease activity (JADAS10), JADAS MDA (≦3.8)/remission (≦1.0), safety and drug adherence at 12 months were assessed and compared between cohorts. Results The analysis included 342 participants with 12-month treatment data (TCZ n=171; TNFi n=171). TCZ was used as 2nd line biologic in the majority of patients (84%) while TNFi were mostly 1st line biologics (86%). Patients starting TCZ had a longer disease duration. Efficacy was demonstrated by a marked decrease in JADAS10 in both cohorts (TCZ vs. TNFi at baseline: 15.0+/-6.7 vs. 14.6+/-6.3; at month 12: 3.8+/-5.1 vs. 3.4+/-4.5). Proportions of patients in TCZ/TNFi cohorts achieving JADAS remission at 12 months were 48%/41% in 1st line biologic users and 32%/33% in 2nd line biologic users. JADAS MDA was achieved in 64%/69% in 1st line and 52%/58% in 2nd line users of TCZ/TNFi. After 12 months of treatment JADAS10 (mean +/SD) was higher in the 2nd line TNFi cohort compared to the 1st line (4.5+/-5.6 vs. 3.2+/-4.3), similar to patients receiving 2nd or 1st line TCZ (4.0+/-5.2 vs. 2.9+/-4.4). Patients receiving TCZ or TNFi as first biologic reached JADAS10 remission and MDA numerically more frequently but not statistically significant compared to 2nd line users. Safety was assessed based on adverse event (AE) reporting. 57 (33%) patients in the TCZ cohort and 43 (25%) patients in the TNFi cohort reported AE. The AE rate was significantly higher in the TCZ cohort (69 vs. 44.8/100 patient years, RR 1.5 [95%CI 1.1-2.0], p=0.006, Wald-test). There were 6 serious AE in the TCZ and 3 in the TNFi cohort. Injection site reactions were more common in the TNFi cohort (9 vs. 1, p=0.043). No further differences were identified to date. There was no death and no opportunistic infection. In the TCZ cohort, 32 patients discontinued treatment, 27 due to lack of efficacy, while in the TNFi cohort only 6 patients discontinued treatment. Treatment discontinuation was more frequent among the 2nd biologic users (n=29; 17.4%) than in first line users (n= 9; 5.1%). Conclusion In this first interim analysis, treatment targets were reached with similar frequency after 12 months of treatment with TCZ or TNFi. TCZ was used predominantly as 2nd line biologic. Higher rates of remission /MDA were observed in 1st line compared to 2nd line biologic users. Although more AE were reported in the TCZ cohort, the occurrence of serious AE and infections was comparable in both cohorts. No new safety signals were identified. Observation is ongoing. Table 1. Baseline characteristics and discontinuations with reasons. Number, n TNFi 1 st 147 TNFi 2 nd 24 TNFi total 171 TCZ 1 st 27 TCZ 2 nd 144 TCZ total 171 Female, % 119(81%) 20 (83%) 139(81%) 20(74%) 123(85%) 143(84%) Disease duration, years 2.7+/-2.7 6.5+/-3.3 3.2+/-3.1 2.5+/-2.7 5.9+/-4.1 5.4+/-4.1 Pre-treatment n.a. None=147 (86%) n.a. None=27 (16%) 1 biologic 14 (58%) 14 (8%) 80 (56%) 80 (47%) 2 biologics 7 (29%) 7 (4%) 54 (38%) 54 (32%) ≥ 3 biologics 3 (13%) 3 (2%) 10 (7%) 10 (6%) CHAQ-DI, mean +/- SD 0.67+/-0.64 0.31+/-0.45 0.63+/-0,63 0.43+/-0.44 0.65+/-0.65 0.61+/-0.62 JADAS 10, mean +/- SD 14.8+/-6.3 13.4+/-6.8 14.6+/-6.3 13.3+/-6.0 15.3+/-7.0 15.0+/-6.7 Concomitant MTX, n (%) 120 (82%) 13 (54%) 133 (78%) 17 (63%) 75 (52%) 92 (54%) Steroid, n (%) 37 (25%) 4 (17%) 41 (24%) 8 (30%) 35 (24%) 43 (25%) Discontinuations, n (%) 5 (3.4%) 1 (4.2%) 6 (3.5%) 4 (16%) 28 (19%) 32 (19%) -Inefficacy 1 (0.7%) 2 (1.2%) 3 (12%) 24 (17%) 27 (16%) -Intolerance 2 (1.4%) 1 (4.2%) 2 (1.2%) 2 (1.4%) 2 (1.2%) -Other 2 (1.4%) 2 (1.2%) 1 (4%) 4 (2.8%) 5 (3.0%) Disclosure of Interests Ariane Klein Speakers bureau: Novartis fee chairing a lunch symposium, Angela Zimmer: None declared, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Sandra Hansmann: None declared, Jasmin Kuemmerle-Deschner: None declared, Maria Fasshauer: None declared, Kirsten Minden Speakers bureau: Honoraries from Novartis, Pfizer, Medac, Ivan Foeldvari: None declared, Christoph Rietschel: None declared, Daniel Windschall Speakers bureau: Pfizer, Novartis, Abbvie, MEDAC, Canon, Grant/research support from: Novartis, Pfizer, Ralf Trauzeddel: None declared, Markus Hufnagel: None declared, Dirk Foell: None declared, Rainer Berendes: None declared, Gundula Boeschow: None declared, Prasad Oommen: None declared, Frank Dressler Speakers bureau: Honoraries from Novartis, Pfizer, Abbvie, Consultant of: Advisory board Novartis, Mylan, Gerd Horneff Speakers bureau: Novartis, Pfizer, Janssen, Grant/research support from: Pfizer, Novartis, Roche, MSD

Background Although the risk for severe COVID-19 progression in children is low, this may be aggravated by the underlying disease and/or immunosuppressive drugs. Objectives We analyzed clinical data of COVID-19 cases among paediatric patients with rheumatic diseases reported to the BIKER registry. Methods The main task of the German BIKER (Biologics in Pediatric Rheumatology) registry is to monitor the safety of biologics therapies in JIA. After the onset of the COVID-19 pandemic, the survey was expanded with a standardized form to proactively interview all participating centers about the occurrence, presentation, and outcome of SARS-CoV-2- infections in children with rheumatic diseases. Interviews were conducted with 68 centers initially weekly and later biweekly. Results A total of 68 centres participated in the survey. Clinical data from 194 COVID-19 cases reported to the BIKER registry from 41 German and 1 Austrian pediatric rheumatology institutions between February 2020 and December 2021 were analyzed. Juvenile idiopathic arthritis (JIA, n=144) was the most common diagnosis followed by genetic autoinflammation (n=18; i.e. FMF, TRAPS, CAPS, HIDS, DADA2), systemic autoimmune diseases (n=11; i.e. SLE, dermatomyositis, vasculitis) and 16 with other rheumatic diseases (i.e. CRMO, Uveitis). 5 patients with no rheumatic disease were excluded. 104 (54%) patients were receiving conventional DMARDs, 81 (43%) received biologics, mainly TNF inhibitors (n=66 (35%)). Of the 189 rheumatic patients with SARS-CoV2 infection, 123 (63%) were female. The mean age was 12.4+/-4.4 years in females and 13.2+/-4.1 in males. The duration of SARS-Co2 infection associated symptoms was 13.8+/-15.3 days (max. 113 days), in 35 (43%) patients they lasted for > 12 days. 46 (24%) were asymptomatic. Patients with autoinflammation and systemic autoimmunopathies reported more symptoms such as fever, head and throat ache. 4 patients only complained about dyspnea. Only 3 patients were hospitalized and received Oxygen-supplementation. The only patients admitted to ICU, received ventilation but succumbed. This 3½-year-old patient, initially diagnosed with systemic JIA, developed fatal disease with intracranial edema and respiratory failure, as well as typical pulmonary texture changes. Prior to her SARS-CoV-2 infection, the patient was treated with MTX and low-dose steroids. Genetic testing revealed a so far unrecognized congenital immunodeficiency. In the total JIA cohort, treatment with corticosteroids, conventional DMARDs, biologics or combinations did not influence the number of reported symptoms or the favorable outcome of the cohort. However, the duration of symptoms was lower in the TNF-treated cohort (10.4+/-6.4 days vs. 15.7 +/- 19.7 days). In the cohort with autoinflammation, fever was observed in 11 (61%). Those 6 who received IL-1-inhibitors did not show a different outcome than those 12 who did not. No case of PIMS/MISC in children with rheumatic diseases was reported. Conclusion Except for one patient with congenital immunodeficiency who died from her COVID-19 infection, no case of severe COVID-19 was reported in our cohort. At the time of infection, over 80% of patients in our cohort had been treated with conventional DMARDs and/or biologics. This did not appear to have a negative impact on the severity or outcome of SARS-CoV2 infection. Interestingly, no case of PIMS/MISC was observed. Disclosure of Interests Gerd Horneff Speakers bureau: Novartis, Pfizer, Janssen, Grant/research support from: Pfizer, Novartis, Roche, MSD, Frank Dressler Speakers bureau: Pfizer, Novartis, Abbvie, Paid instructor for: Advisory boards Novartis, Mylan, Daniel Windschall Speakers bureau: Pfizer, Novartis, Abbvie, MEDAC, Canon, Grant/research support from: Novartis, Pfizer, Sonja Mrusek: None declared, Toni Hospach: None declared, Alexander Kühn: None declared, Maria Haller: None declared, Philipp von Bismarck: None declared, Wolfgang Emminger: None declared, Peggy Ruehmer: None declared, Markus Hufnagel: None declared, Ariane Klein Speakers bureau: Novartis

Background The ProKind Commission of the Society for Paediatric and Adolescent Rheumatology (GKJR) has developed evidence- and consensus-based protocols for the diagnosis and therapy of children and adolescents with defined rheumatic diseases (e.g., [1]). In the ProKind-Rheuma project, it is now investigated whether the protocols are followed in everyday clinical practice and what the treatment-associated outcomes are. Objectives To investigate the mode of treatment and treatment response in patients with polyarticular juvenile idiopathic arthritis (pJIA). Methods ProKind-Rheuma is a multicenter prospective non-interventional observational study. Patients with pJIA enrolled until 17/1/2022 were included into this analysis. Treatments and outcomes up to the 3-month follow-up visit (3FU) were analyzed. Disease states were categorized based on the 2021 cJADAS10 cutoffs [2]. Results To date, 18 pediatric rheumatology facilities have participated in ProKind-Rheuma. Data from 203 patients with JIA are available. Of those, 44% have oligoarthritis, 36% polyarthritis, 9% systemic JIA, 6% enthesitis-related arthritis and 3% psoriatic arthritis. In total, 76 patients were diagnosed with pJIA, 38 with already completed 3FU: For 23 patients with pJIA and completed 3FU, we were able to analyze the protocol-defined [1] treatment goal of at least “minimal improvement”. In total, 18 (78%) achieved minimal improvement, 5 (22%) missed it. For 4 of those 5 patients, the underlying MTX therapy was escalated to a bDMARD (3 changed to MTX+bDMARD-combi, 1 to bDMARD-mono). In 3 other patients, therapy was also escalated to an MTX+bDMARD-combi. Between baseline and 3FU, 72% achieved cJADAS10-disease state improvement (Table 1) by at least one category (range 1 - 2), 0% decreased. Table 1. *based on non-missing values At Baseline all At Baseline with 3FU At 3FU Total 76 38 Female, n (%) 58 (76) 30 (79) Age (years), Mdn (IQR) 9 (3-12) 7 (2-12) 7.5 (3-12) Time since diagnosis (months), Mdn (IQR) 0 (0-1) 0 (0-1) 4 (3-4) RF-positivity, n (%) 8 (11) 3 (8) Number of active joints (arthritis), Mdn (IQR) 7 (4-12) 7 (5-12) 2 (0-4) JADAS10 (0-40), Mean (SD) (N BL+3FU = 23) 18.6 (7.4) 19.6 (7.6) 7.2 (4.2) cJADAS10 (0-30), Mean (SD) (N BL+3FU = 29) 16.3 (5.9) 16.7 (6.1) 7.1 (4.1) State of inactive disease (cJADAS10≤2.5), n (%*) 0 (0) 0 (0) 4 (13) State of minimal disease activity (2.516), n (%*) 27 (44) 16 (47) 1 (3) CHAQ (0-3), Mean (SD) 0.8 (0.8) 0.9 (0.8) 0.3 (0.5) Pain (NRS 0 - 10), Mean (SD) 4.3 (3) 4.7 (3) 2.2 (2.7) PedsQL 4.0 total score, Mean (SD) 66.3 (22.2) 65.4 (21.8) 78.4 (17.6) Intraarticular glucocorticoids > 4 joints (ever), n (%) 12 (16) 5 (13) 7 (18) Glucocorticoid pulses (ever), n (%) 22 (29) 12 (32) 13 (34) Methotrexate, n (%) 56 (74) 31 (82) 34 (90) bDMARDs, n (%) 7 (9) 2 (5) 9 (24) Within the first 3 months after diagnosis, the treatment pathways proposed by the ProKind Commission [1] were followed in about three-quarters of patients: i) 5 (13%) received MTX and intra-articular glucocorticoid injections in more than 4 joints (IAGC), but no high-dose intravenous glucocorticoid pulse (HDGC) or bDMARD; ii) 8 (21%) received MTX and HDGC (no bDMARD, no IAGC); iii) 16 (42%) patients received MTX, of whom 4 received a bDMARD up to or at the 3FU (no HDGC, no IAGC). Nine (24%) patients were not treated with MTX or did not fit any of these categories, mostly due to starting bDMARD therapy in conjunction with HDGC or IAGC. Conclusion In the routine care of JIA patients with polyarthritis, the proposed treatment protocol and treat-to-target strategy are followed in most patients. At 3FU, improvements of JADAS10 and other outcomes were evident, with 41% having achieved inactive or minimal active disease. ProKind is funded by the Innovation Fund “Gemeinsamer Bundesausschuss”, FKZ: 01VSF18031 References [1]Horneff et al. Pediatric Rheumatology 2017; 15:78 [2]Trincianti et al. Arthritis Rheumatol. 2021 Nov; 73(11):1966-1975 Acknowledgements We are grateful to all physicians, medical professionals and everyone else who has so far contributed and supported the ProKind-Rheuma project. Moreover, we want to express special gratitude to all patients and their parents for their participation. Disclosure of Interests Sascha Eulert: None declared, Kristina Vollbach: None declared, Klaus Tenbrock: None declared, Jens Klotsche: None declared, Dirk Foell Speakers bureau: Speaker fees/honoraria from Boehringer, Novartis, Werfen and Sobi, Grant/research support from: Novartis and Sobi, Johannes-Peter Haas: None declared, Frank Weller-Heinemann: None declared, Sonja Mrusek: None declared, Prasad Oommen: None declared, Daniel Windschall Speakers bureau: Research support and speakers fee: Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Grant/research support from: Research support and speakers fee: Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Kirsten Moenkemoeller: None declared, Tilmann Kallinich: None declared, Markus Hufnagel: None declared, Ivan Foeldvari Consultant of: Addvisory board: Hexal, Novartis, Pfizer, Toni Hospach Consultant of: Advisory board: Sobi, Novartis, Moritz Klaas: None declared, Michael Rühlmann: None declared, Ralf Trauzeddel: None declared, Normi Brueck: None declared, Catharina Schütz: None declared, J. B. Kuemmerle-Deschner: None declared, Ariane Klein: None declared, Kirsten Minden Speakers bureau: Speaker: Pfizer, Novartis, Gerd Horneff: None declared

BackgroundMusculoskeletal Ultrasonography (US) is a suitable tool for the clinical assessment in juvenile idiopathic arthritis (JIA). Recently US definitions for normal components of pediatric joints and synovitis have been developed by the OMERACT US working group. Currently this group is working on development and validation of US definition for tenosynovitis as it is also an essential prerequisite for the reliable use of this technology in the pediatric age group.ObjectivesTo produce consensus-based definitions for US tenosynovitis in JIA through a Delphi process.MethodsWe undertook a Delphi process on US-defined tenosynovitis in children that consisted of two steps. As a prior systematic literature review showed that US anatomy of the tendons is similar to adults, a Delphi questionnaire was written based on the consensual definitions developed for and used in adults with rheumatoid arthritis [1, 2]. The Delphi questionnaire was sent to rheumatologists and pediatricians who perform pediatric US examination, asking them to rate their level of agreement with each statement of US-defined tenosynovitis. Group agreement was considered if ≥80% of responders scored an item as either 4 or 5.In the second step, the definitions were validated on 88 standardized US images displaying various degrees of tenosynovitis obtained from JIA patients at various ages. Tendons often involved in JIA were selected (foot and ankle tendons, hand and wrist tendons, bicep tendon.). US images of both normal and tenosynovitis elementary lesions were collected by the 18 experts participating in the OMERACT US task force on pediatric tenosynovitis. An agreement ≥70% was considered mandatory for accepting the definition as applicable in the rated image.ResultsThe response rate was 75% (28 out of 37) from the first Delphi questionnaire. Strong group agreement (≥86%) was obtained for the US definitions tested. The response rate was 88.9% (16 out of 18) from the Web-exercise after four rounds. The final definitions were validated on still images for all tendons, except for the biceps tenosynovitis in the age group 2-4 years (the definitions of elementary lesions and the global definition of tenosynovitis) as no image was available for this location and age group. Despite not reaching group agreement after the second and the third round for the US-defined normal finger pulley in children aged 8 years and younger (roughly 68% and 69% respectively), it reached a score of 99.8% after the fourth round.ConclusionUS definitions of tenosynovitis and its elementary components covering a wide pediatric age range were successfully developed through a Delphi questionnaire and validated in a web-based still images exercise. These results provide the basis for the standardized US assessment of tenosynovitis in clinical practice.References[1]Ultrasound in the assessment of tenosynovitis in juvenile idiopathic arthritis: systematic literature review. Collado P on behalf of the OMERACT Ultrasound Task Force. DOI: 10.1136/annrheumdis-2019-eular.3493[2]Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Naredo E on behalf of the OMERACT Ultrasound Task Force. Ann Rheum Dis 2013;72:1328AcknowledgementsAG Bruyn, L Terslev, S Jousse-Joulin, A Rodriguez, M Steiner, E Inarejos, P Bøyesen, K Misaki, A Iagnocco, B Marston, T Cazenave, P Mandl, A Bruns.Disclosure of InterestsNone declared