Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder which displays a great variability in terms of clinical and immunological presentation. The risk of infections in adult patients with SLE is higher when compared to the general population; however, only few studies have hitherto tried to assess a direct correlation between infectious events, initial disease activity and a possible increase of the Safety of Estrogen in Lupus National Assessment - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) in patients with SLE. Objectives: To assess and evaluate possible correlations between infectious events, initial disease activity and a the increase of the SELENA-SLEDAI in patients with SLE Methods: A monocentric retrospective study was performed by using real-world data; one hundred forty-two patients (N=142) were enrolled and evaluated as per exclusion criteria. Patients with non-adherence to treatment were also excluded as to avoid possible biases. An assessment of their infectious events was performed, namely the moderate-to-severe infections (Figure 1), as well as their disease activity at the time of diagnosis; subsequently, they were compared with a potential increase in disease activity allegedly occurred in the following 6-to-12 months by using the SELENA-SLEDAI. Simple linear regressions were used to calculate the correlation between each parameter and the SELENA-SLEDAI with a 95% confidence interval (CI); lastly, a multiple linear regression was performed to assess the global correlation with both parameters. Results: One hundred and twenty-three (n=123) patients met the inclusion criteria (Figure 2); among these, 86.99% were female (107 patients) and 13.01% (16 patients) were male. The simple linear regression between infectious events and SELENA- SLEDAI showed a R2 = 29.46% (p < 0.0001, y = 2.3552x + 2.3058, Figure 3); a weaker regression was observed with the initial disease activity as its R2 was 16.12% (p=0.006, y = 0.6212x + 2.9239, Figure 4). Lastly, a multiple linear regression was performed as it showed a R2 of 38.68% (p=0.0001, y= 2.0998x1 + 0.4788x2 + 1.5901. Conclusion: In this preliminary study, real-life data proved to be essential in assessing the impact of both infections and initial disease activity on the risk of flares among patients affected by Systemic Lupus Erythematosus; the former proved to have a noticeable correlation with an increase of SELENA-SLEDAI in the 6-to-12 months after the event; on the other hand, the initial disease activity showed a less meaningful, albeit significant, association with an heightened disease activity as well as flares. This study has some limitations (limited number of enrolled patients, different definition of infective events) which need further evaluations to be properly assessed). REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by a variety of signs and symptoms; it manly affects women of childbearing age, with an estimated prevalence of 24/100,000 people in Europe and North America. Among other clinical manifestations, haematological involvement is one of the most common in SLE as it includes anaemia, leukopenia, lymphopenia, thrombocytopenia, lymphadenopathy and splenomegaly; furthermore, it is usually challenging to discriminate whether such manifestations are caused by disease or by immunosuppressants. To date, few studies tried to evaluate them using real world data.ObjectivesTo evaluate haematological manifestations in patients with SLE by using real world data.MethodsA retrospective study was performed by gathering real world data. 2019 EULAR/ACR Classification Criteria for SLE were used to discern haematological involvements in patients with a diagnosis of SLE; leukopenia, thrombocytopenia and autoimmune haemolytic anaemia (AIHA) were considered for this study. Six subgroups were formed as each condition alone and their combinations were analyzed. Logistic regression was used to calculate the odds ratio (OR) and a 95% confidence interval (CI) was chosen to assess statistical significance.ResultsOne hundred and forty-two patients affected by SLE were enrolled in this study (N=142); among these, thirty met the inclusion criteria for haematological manifestations (n=30, 52 ±12.4 years, 28 F, 2 M). Three patients showed AIHA alone (10.0%), six had thrombocytopenia only (20.0%) and 8 displayed leukopenia alone (26.7%). Thirteen patients showed a combination as 6 people had both AIHA and thrombocytopenia (20.0%) and 4 manifested AIHA in association with leukopenia (13.3%); lastly, 3 patients showed thrombocytopenia with leukopenia (10.0%). The latter proved to be the most common manifestation as leukopenia was present in 15 out of 30 patients (50.0%) (Figure 4). Azathioprine (AZA), in association with hydroxychloroquine (HCQ), was used in 8 patients (26.6%), while a combination of Mycophenolate Mofetil (MMF) and HCQ was found in 5 out of 30 patients (16.7%); seventeen patients received either HCQ alone or a biologic drug (Belimumab). Among patients in therapy with AZA or MMF, the former proved to be more frequently associated with leukopenia vs MMF (OR1=2.5); however, the result was not statistically significant (CI195% 0.77; 8;04); a similar result was observed for both patients in therapy with MMF or AZA when compared to HCQ alone or HCQ + Belimumab (OR2=1.16, OR3=0.46, respectively) since they did not reach statistical significance.ConclusionIn this preliminary study, real-world data proved essential to analyze patients affected by SLE. Among many haematological manifestations, leukopenia showed to be the most frequent in agreement with data published in literature, strictly followed by thrombocytopenia and AIHA. AZA was linked with a higher percentage of leukopenia compared to MMF or other therapies but the result was not statistically significant. This study has some limitations (number of enrolled patients, possible selection bias) which require further evaluations to be properly assessed.References[1]Mariëlle et al, Incidence of invasive pneumococcal disease in immunocompromised patients, Travel Medicine and Infectious Disease, 2018 [2]Levine AB et al, Clinical assessment and management of cytopenias in lupus patients. Curr Rheum Rep. 2011Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BACKGROUND:A complex relationship between arachidonic acid metabolites and nitric oxide (NO) synthesis has been reported in asthma. The effects of inhaled aspirin on fractional exhaled NO (FENO) in patients with aspirin-tolerant (ATA) and aspirin-inducible (AIA) asthma compared with normal controls have been investigated.METHODS:The FENO was measured baseline, after saline and lysine-aspirin (L-ASA) bronchial challenge in 10 patients with ATA and in 10 patients with AIA [mean (PD(20)FEV(1) L-ASA): 14.7 +/- 12.7 mg], who had comparable age and baseline FEV(1). Ten healthy subjects served as controls. Sputum eosinophils were counted after saline and after L-ASA challenge in the two groups of asthmatics.RESULTS:Asthmatic patients had baseline FENO significantly higher than controls (29.7 +/- 6.8 vs 9.8 +/- 2.05 p.p.b. respectively, P < 0.0001). No difference was observed in methacholine PD(20)FEV(1) and baseline FENO between ATA and AIA patients. After L-ASA inhalation, FENO increased significantly only in patients with AIA, reaching the peak value 4 h after bronchoconstriction (from 31.1 +/- 6 to 43 +/- 4.8 p.p.b., P < 0.001), while no change was observed in patients with ATA and in controls. Sputum eosinophils increased significantly after L-ASA inhalation only in patients with AIA (from 8.1 +/- 2.7 to 11.1 +/- 2.8%, P < 0.005) and there was a significant relationship between the increase in sputum eosinophils and the increase in FENO after ASA challenge.CONCLUSION:Exhaled NO may indicate eosinophilic airway inflammation during ASA exposure in patients with ASA inducible asthma.