Objectives To assess the incidence rate of relapses and to analyze the risk of relapses in patients with Giant Cell Arteritis (GCA) treated with and without Methotrexate (MTX), in clinical practice. Other factors associated were also investigated. Methods An inception cohort of GCA was assembled in the out-patient clinic at Hospital Clinico San Carlos, including patients from the date of diagnosis (Jan-1991 until Sept-2013), and followed-up until Sept-2014. Main outcome: relapses defined as after an objective improvement, patient has again symptoms or signs of GCA with high ESR and the need to increase corticosteroids at least 10mg. The independent variable was exposure to MTX over time. Covariables: Sociodemographic, clinical, and treatment. Incidence rates of relapses (IR) per 100 patient-years with their 95% confidence intervals [CI] were estimated using survival techniques. Time of exposure comprised the period from diagnosis until: lost of follow-up, main outcome, exposure to MTX or the end of the study. MTX influence on IR was analyzed by multivariable Cox models. Results 168 patients were included (675 patient-years). 80% of them were female, with a mean age of 76±7 years. 65% of the patients were on MTX, with mean dose of 10 mg/week. 31% of patients had relapses with an IR of 12 [9.6–14.9]. The median number of relapses was 1 [1–2], with a median lag time of 1.6 [0.6–6.3] years. In the multivariate analysis, exposure to MTX had less risk of flaring compared to those never on MTX (p<0.05). Other variables included in the final model were: visual alterations, constitutional symptoms or malaise at clinical presentation of GCA. Conclusions The use of MTX seems to decrease the risk of recurrences. We also found other factors influencing on flares. Disclosure of Interest None declared

BackgroundRheumatoid Arthritis (RA) patients are at an increased risk of infection compared with healthy individuals, related to immune dysfunction. New treatments have revolutionised RA management; however, serious infection especially in elderly remains a concern.ObjectivesTo analyse the incidence and trend of hospital admissions for all infections in patients with RA in Spain during the period between 1999 and 2015.MethodsThis is a national retrospective population based study. We analysed a national administrative database that includes a Minimum Basic Data Set (MBDS) in all hospital admissions of patients with RA. Period: 1999 to 2015. Cases were identified by the presence of ICD9 codes. The population at risk was estimated through the population census of the National Institute of Statistics. The adjusted rates of infection were calculated, by sex and age. The trend was analysed by Generalised Linear Models (GLM). Statistical analysis was made using SPSS statistical package version 20 (SPSS Inc, Chicago, IL).Results338.343 RA hospital admissions were detected in the study period, being 81.468 (24,07%) due to infections. The main clinical-demographic characteristics are shown in table 1: The annual age-adjusted rate of infections increased during the study period, especially in men (fig I). The annual trend of infections age-adjusted increased during the study period 5.29%, women 5.08% and men 5.92%. For age groups the annual increase was 3.51% for 20–40 years, 3,.2% for 40–60 years, 4,5% for 60–80 years and 9.27% for >80 years.ConclusionsRate of infection in RA hospitalised patients in Spain has increased during study period. The patients are progressively elderly and has more comorbidities. However the average hospital stay decrease.Disclosure of InterestNone declared

Objective. To assess the long-term continuation of methotrexate (MTX) in a cohort of patients with giant cell arteritis (GCA) in daily clinical practice. Factors associated with its discontinuation rate were also investigated.Methods. A longitudinal study from 1991-2014, was performed. GCA patients with MTX and followed up in a rheumatology outpatient clinic of Madrid during the study period were included. Primary outcome: discontinuation of MTX due to: adverse drug reactions (ADR moderate and severe); inefficacy; sustained clinical response; patient decision. Covariables: sociode-mographic, clinical and therapy. Incidence rates (IR) of MTX discontinuation per 100 patient-years with their 95% confidence interval (CI) were estimated using survival techniques. Factors associated to specific discontinuation causes were analysed using Cox models.Results. We included 108 patients (244 patient-years). The IR was 37.2 [30.3-45.7]. The IR due to ADR, severe ADR, sustained clinical response and inefficacy was 20.8 [15.8-27.4]; 5.7 [3.39.6]; 8.2 [5.3-12.7] and 2.8 [1.3-6.0] respectively. Regarding multivariate analysis, younger patients, baseline cardiovascular disease, taking more glucocorticoids and lower initial doses of MTX were associated to a higher discontinuation rate due to inefficacy. Factors influencing the suspension due to ADRs were: older age, baseline chronic obstructive pulmonary disease, higher baseline erythrocyte sedimentation rate, several specific clinical patterns at diagnosis, and higher maximum dose of MTX during the follow-up. In the final model for sustained clinical response older patients and more recurrences were independently associated to less discontinuation rate.Conclusion. We provide further data of the potential safety of long-term MTX in the management of GCA. We have also found several factors influencing the continuation of MTX.

Background CD226 genetic variants have been associated with a number of autoimmune diseases. Objectives The aim of this study was to investigate the potential implication of the CD226 loci in the susceptibility to and main clinical manifestations of giant cell arteritis (GCA). Methods A Spanish Caucasian cohort of 455 patients diagnosed with biopsy-proven GCA and 1414 healthy controls were included in the study. Three CD226 polymorphisms, rs727088, rs34794968 and rs763361, were genotyped using the TaqMan® allelic discrimination technology. PLINK software was used for the statistical analyses. Results No significant association between the CD226 polymorphisms and susceptibility to GCA was found (rs727088: P=0.92, OR=1.01 CI 95% 0.86-1.18; rs34794968: P=0.61, OR=1.04 CI 95% 0.89-1.22; rs763361: P=0.88, OR=0.99 CI 95% 0.84-1.16). Similarly, when patients were stratified according to the specific clinical features of GCA such as polymyalgia rheumatica, visual ischemic manifestations or irreversible occlusive disease, no association was observed either between the case subgroups and the control set or between GCA patients with and without the specific features of the disease. Furthermore, the haplotype analysis revealed no significant association with the disease. Conclusions Our results show that the CD226 gene does not play a relevant role in the susceptibility to GCA and clinical manifestations of this vasculitis. References Hafler JP, Maier LM, Cooper JD, Plagnol V, Hinks A, Simmonds MJ, et al. CD226 Gly307Ser association with multiple autoimmune diseases. Genes Immun. 2009; 10:5-10. Lofgren SE, Delgado-Vega AM, Gallant CJ, Sanchez E, Frostegard J, Truedsson L, et al. A 3’-untranslated region variant is associated with impaired expression of CD226 in T and natural killer T cells and is associated with susceptibility to systemic lupus erythematosus. Arthritis Rheum. 2010; 62:3404-3414. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002; 347:261-271. Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, Miranda-Filloy JA, Gonzalez-Juanatey C, Martin J, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum. 2009; 61:1454-1461. Disclosure of Interest None Declared

Background after more thana decade usingLeflunomide(LFN), is widely known to be effective in the treatment of rheumatoid arthritis (RA). However, there is evidence in the literatureofa higher rate of suspension for toxicity and lack of efficacy compared to other DMARDs such as methotrexate (MTX). Although, those are series with small numbers of patients and short-term follow up. Objectives toevaluate the survival of LFN, and the causes of its suspension in a cohort of patients with RA. Methods retrospectivelongitudinal observational study. Subjects: patients with RA followed in our hospital, treated with LFN, from January 1, 2006 until October 1, 2011. Outcomes: primary outcome: LFN suspension due to: a) adverse event (AE), b) lack of efficacy, c) patient’s decision; d) remission or improvement. Secondary outcomes: age, sex, date of diagnosis, date of start and end of treatment with LFN. The data sourcewas our electronic health record. Statistical analysis: a description of the sociodemographic and clinical characteristics of patients included and the causes for suspension using frequency distribution rates and the mean and standard deviation or median and percentiles. Survival techniques are used to estimate the suspension rate of LFN, expressing the incidence per 1000 patient-years (95% CI). Results 322 patients started treatment with LFN during the follow up. 257 were women (79.81%), the mean age at baseline was 59±15 years. The median time from diagnosis of RA was 2.37 years (p25-75: 0,56-5, 68), there were 116 suspensions (38.41%), the 68.97% of them were due to AE, 7.76% to patient’s decision, 7.76% due to lack of efficacy, and 6.9% to clinical improvement. 74.78% of the patients with suspensions were women, mean age at the time of suspension was 60±15 years and the median time from diagnosis of RA was 2.64 years (P25-75: 0.73-5.68). The suspension rate was 216 per 1000 (95% CI 180.23-259.35), 277.88 per 1000 in men (95% CI 193-399.88) and 199 per 1000 in women (95% 161-245.87). 83 of the suspensions (71.5%) occurred within the first 6 months of treatment with LFN. 50% of patients had discontinued the drug 3.5 years after starting treatment. AE rate was 149.10 per 1000 (95% CI 119.76-185.636). The suspension rate associated with lack of efficacy was 16.77 per 1000 (95% CI 8.72-32.23). The suspension rate because of clinical improvement was 14.91 per 1000 (95% CI 7.45-29.81). Conclusions the survival of the treatment with LFN is less than 50% at 4 years. The suspension rate was high, mainly due to adverse events. Disclosure of Interest None Declared

OBJECTIVE:To evaluate the variability in the characteristics and management of rheumatoid arthritis (RA) patients between rheumatology attending physicians and training residents in Spain.METHODS:A retrospective medical record (MR) review was performed in a probabilistic sample of 1379 RA patients from 46 centres distributed in 16 of the 19 autonomous communities (AC) of Spain. RA patients' sociodemographic and clinical characteristics, healthcare resources use, and their single responsible physician's (defined as an identifiable single physician who attended the patient in more than 75% of visits) characteristics were recorded following a standardized protocol. Multivariate analyses were performed to assess differences in the characteristics and management of RA patients between attending physicians and training residents.RESULTS:A total of 1205 RA patients had a single responsible physician and were analysed (nearly 75% women with rheumatoid factor positive and more than 25% with persistent active disease), 49 of whom were followed by training residents and 1156 by attending physicians. In the multivariate analyses, irrespective of patient and disease characteristics, training residents' patients reported more hospital admissions, laboratory tests, and imaging techniques compared to attending physicians. Training residents also less frequently used combined therapy with disease-modifying antirheumatic drugs (DMARDs).CONCLUSION:Training residents and attending physicians differ in RA patients' care. More efforts in training programmes are necessary to guarantee proper RA management and to improve the profile of the future rheumatologists.