Objective Due to the prevalence of fibromyalgia in psoriatic arthritis (PsA) patients, any evaluation about PsA-specific patient-reported outcomes (PROs) should take in account the possible bias related to this comorbidity. Patient acceptable symptom state (PASS) is a patient-reported measure evaluating the acceptable and/or satisfactory level of symptoms in rheumatic diseases, which has been proposed as a disease activity index, in patients with PsA. Thus, this study was designed to analyse if the association between PASS and PsA disease activity may be biased by the presence of comorbid fibromyalgia. Methods A multi-centre, cross-sectional, observational study enrolling consecutive PsA participants has been conducted from July 2021 to November 2021. The Disease Activity for Psoriatic Arthritis (DAPSA) was collected; the following formulation of PASS question: 'Think about all the ways your PsA has affected you during the last 48 hours. If you were to remain in the next few months as you were during the last 48 hours, would this be acceptable to you?', was submitted to our participants. Results Multivariable logistic regressions, adjusted for the presence of fibromyalgia, did not show any significant association between PASS and DAPSA low disease activity, DAPSA as nominal variable (remission, low disease activity, moderate disease activity, high disease activity) and DAPSA as continuous variable. Conclusion Our data suggest that fibromyalgia influences the patient's perception of the disease and has a negative impact on PASS status independently of disease activity, thus limiting the utility of this Patient reported outcome in real world clinical practice.

Background Systemic lupus erythematosus (SLE) is an autoimmune disease mostly affecting the young women during their third-fourth decade of life. SLE is characterized by variable manifestations and, potentially, every organ can be involved. The course and the complexity of the disease, naturally appeal to manage patients with SLE at high qualified national referral centers. [1]Despite the relevant burden associated with the disease, both from patient and physician point of view, epidemiological data on SLE in Italy are limited to isolated estimates, captured by different data sources [2-5]; however, no larger data on the prevalence of SLE at the referral centers in Italy are available to date. Objectives This study aimed at estimating the prevalence of SLE at tertiary referral Italian centers, representative of the Italian scenario. Methods We conducted an observational, cross-sectional study on SLE patients followed by referral centers in district, representative of the North, Centre, South and Isles of Italy (Brescia, Padua, Udine, Ferrara, Florence, Pisa, Rome, Bari, Naples, Cagliari). Data from patients of both sexes and any age, and fulfilling the 2019 ACR/EULAR classification criteria, were obtained from hospital medicals records.To estimate the prevalence, we reported the number of patients with SLE referring to the considered centers (numerator), over the total population resident in the included Italian districts (denominator), according to the Italian National Statistical Institute (ISTAT), responsible for the Italian general population censuses. For the analysis, we considered only complete data sent by January 13th, 2023. [7] Results We identified 3251 patients with SLE followed at n° 9 referral centers included in this study. 1163/3251 patients (89.3%) were female, and 1302/3251 (40%) were residing in the districts of the referral centers. The estimated overall prevalence of SLE was 21.37 cases per 100,000 individuals.As we stratified the results by geographical area (North, Centre, South and Islands) of Italy, the estimated prevalence ranged from 14.7 to 27.1 cases per 100,000 individuals. (Table 1) Conclusion Our study estimated the prevalence of SLE in multiple representative Italian referral centers. These preliminary results show for the first time the proportion of patients with SLE attending tertiary referral centers in Italy, suggesting a different distribution in diverse geographical areas of the country. References [1]Tsokos, N Engl J Med 2011[2]Benucci, Med Sci Monit 2005[3]Govoni, Lupus 2006[4]Tsioni, Clin Exp Rheumatol 2015[5]Zen, Rheumatology 2022[6]Aringer, Arthritis Rheumatol 2019[7]http://dati.istat.it/ Acknowledgements We acknowledge Dr Ettore Silvagni, Dr Sebastiano Lorusso, Dr Augusta Ortolan, Dr Sara Ferrigno, Dr Marcella Prete, Dr Fabio Congiu for their help in data collection. Disclosure of Interests None Declared.Table 1NorthCenterSouth and IslesOverallNumber of SLE patients followed at the referral centers involved in the study17288276963251Patients residing in the district of the centers (%) involved in the study824 (47.7%)230 (27.8%)272 (39.1%)1302 (40%)Number of female (%) patients residing in the district of the centers involved in the study734 (89.1%)183 (88.8%)246 (90.4%)1163 (89.3%)Prevalence (cases per 100,000 individuals)27.116.416.521.8

Background Patients with autoimmune systemic diseases (ASDs) can be counted among frail populations as regards the predisposition to COVID-19 due to the frequent visceral organ involvement and comorbidities, as well as the ongoing immunomodulating treatments. Objectives Our long-term multicenter telephone survey prospectively investigated the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients during the first 3 pandemic waves. Methods A large series of 3,918 ASD patients (815 M, 3103 F; mean age 59±12SD years) was consecutively recruited at the 36 referral centers of COVID-19 & ASD Italian Study Group. In particular, ASD series encompassed the following conditions: rheumatoid arthritis (n: 981), psoriatic arthritis (n: 471), ankylosing spondylitis (n: 159), systemic sclerosis (n: 1,738), systemic lupus (172), systemic vasculitis (n: 219), and a miscellany of other ASDs (n: 178). The development of COVID-19 was recorded by means of telephone survey using standardized symptom-assessment questionnaire (1). Results A significantly increased prevalence of COVID-19 (8.37% vs 6.49%; p<0.0001) was observed in our ASD patients, while the cumulative death rate revealed statistically comparable to the Italian general population (3.65% vs 2.95%; p: ns). In particular, among the 328 ASD patients complicated by COVID-19, 57 (17%) needed hospitalization, while mild-moderate manifestations were observed in the large majority of individuals (83%). In addition, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular manifestations. Interestingly, a significantly higher COVID-19-related death rate was observed in systemic sclerosis patients compared to the Italian general population (6.29% vs 2.95%; p=0.018). Other adverse prognostic factors to develop COVID-19 were the patients’ older age, male gender, pre-existing ASD-related interstitial lung involvement, and chronic steroid treatment. Conversely, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%; p=0.000), as well as the chronic administration of low dose aspirin in a subgroup of SSc patients (with 5.57% vs without 27.84%; p=0.000). Conclusion The cumulative impact of COVID-19 on ASD patients after the first 3 pandemic waves revealed less severe than that observed during the first phase of pandemic (1), especially with regards to the death rate that was comparable to the Italian general population in spite of the increased prevalence of complicating COVID-19 in the same ASD series. Ongoing long-term treatments, mainly csDMARDs, might usefully contribute to generally positive outcomes of in this frail patients’ population. Of note, a significantly increased COVID-19-related mortality was recorded in only SSc patients’ subgroup, possibly favored by pre-existing lung fibrosis. Among different ASD, SSc deserves special attention, since it shares the main pathological alterations with COVID-19, namely the interstitial lung involvement and the endothelial injury responsible for diffuse microangiopathy. Besides SSc, the patients’ subgroups characterized by older age, chronic steroid treatment, pre-existing interstitial lung disease, and/or impaired COVID-19 vaccine response (1-3), may deserve well-designed prevention and management strategies. References [1]Ferri C, et al. Ann Rheum Dis. 2020 Oct 14 doi: 10.1136/annrheumdis-2020-219113. [2]Ferri C et al. J Autoimmun. 2021 Dec;125:102744. doi: 10.1016/j.jaut.2021.102744. [3]Visentini M et al. Ann Rheum Dis. 2021 Nov 24. doi: 10.1136/annrheumdis-2021-221248 Disclosure of Interests None declared

OBJECTIVES:To investigate differences in coronavirus disease 2019 (COVID-19) mortality between patients with rheumatic musculoskeletal diseases (RMD) and the general population in Italy.METHODS:We analysed the data from the national surveillance study promoted by the Italian Society for Rheumatology (CONTROL-19 database) including patients with RMD and COVID-19 between 26 March 2020 and 29 November 2020, compared with official data from the Italian population (within the same period) adjusted for age, sex and geographic location. The main outcome of the analyses was mortality. The relationship between RMD and mortality was analysed using adjusted logistic models and sensitivity analyses were conducted to support the robustness of our results.RESULTS:We included 668 RMD patients (62.7% with inflammatory arthritis, 28.6% with systemic autoimmune diseases), who had a mean age of 58.4 years and of which 66% were female. Compared to the general population, the RMD population showed an increased risk of death (OR 3.10 (95% CI 2.29-4.12)), independently from the differences in age and sex distribution. Even after considering the potential influence of surveillance bias, the OR was 2.08 (95% CI: 1.55-2.73). Such excess of risk was more evident in the subgroup of younger patients, and more consistent in women. Subjects with systemic autoimmune diseases showed a higher risk of death than patients with any other RMDs.CONCLUSIONS:Patients with RMD and COVID-19 infection evidenced a significant increase in mortality during the first pandemic phases in Italy. These findings support the need for strong SARS-CoV-2 prevention in patients with rheumatic diseases.

Background:Gender medicine aims at describing how diseases differ between men and women in terms of epidemiology, clinical feature, therapeutic approach, treatment response and prognosis, psychological and social impact. Rheumatoid Arthritis (RA) affects women 2-3 times more than men. Female gender seems to be independently associated to a more refractory disease and a worst response to conventional synthetic Disease Modifying Anti-Rheumatic Drugs (csDMARDs) and biological DMARDs. Male patients achieve remission more often than females probably due to the higher number of tender joints reported by the latter.Objectives:In the light of the effect of Janus kinases inhibitors (JAKi) on pain, the objective of the study was to investigate whether gender might affect the achievement of remission or low disease activity in RA patients treated with baricitinib and tofacitinib.Methods:We performed a multicentric, prospective study on consecutive patients starting one of the two available JAKi: baricitinib and tofacitinib. Demographic and clinical data were recorded in a dedicate database and included: gender, age, disease duration, serological status (Rheumatoid Factor – RF; anti-citrullinated peptide antibodies, ACPA) number of previous csDMARDs and bDMARDs, number of tender joints (TJ) and swollen joints (SJ), C reactive protein (CRP); patient global assessment (PGA) and pain were recorded on a 0-100 mm visual-analogue scale (VAS). Disease activity score (DAS) 28 was calculated at baseline and at two follow-up visits (after 3-4 months and after 6-8 months). Data were expressed as mean±standard deviation or median (interquartile range) according to variables’ distribution. Continuous variables were compared by Mann Whitney test while dichotomous ones by Chi-squared test; p value < 0.05 were considered statistically significant.Results:We enrolled 182 RA patients (149 F:33 M) with similar age (F 58±12 vs M 60±10) and disease duration (F 143±101 vs M 147±105 months). Females and males were previously treated with the same number of csDMARDs [2(2)] but female have previously received numerically more bDMARDs [2(3) vs 1(2)]. At the 3 timepoints females and males showed similar number of TJ, SJ, similar values of CRP, PGA and pain. We did not observe any difference in percentage of males and females achieving remission or low disease activity according to gender (figure 1A) nor in terms of reduction of TJ, SJ and PGA; only pain decreased significantly more in male than in female patients at both timepoints (figure 1B).Conclusion:In RA patients treated with JAK inhibitors, even if the effect of JAKi on pain seems to be more relevant in male than in female, gender seems not to influence the overall clinical response, allowing men and women the same probability of reaching the therapeutic targetReferences:Disclosure of Interests:Francesca Romana Spinelli Grant/research support from: Pfizer, Speakers bureau: Lilly, BMS, Celgene, Maria Sole Chimenti: None declared, Marta Vadacca: None declared, Cristina Iannuccelli: None declared, Paola Conigliaro: None declared, Silvia Laura Bosello: None declared, Fulvia Ceccarelli: None declared, Cristina Garufi: None declared, Giulia Raffone: None declared, Paola Di Noi: None declared, Dario Bruno: None declared, Antonella Afeltra: None declared, Roberto Perricone: None declared, fabrizio conti Speakers bureau: BMS, Lilly, Abbvie, Pfizer, Sanofi, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

The Italian Society for Rheumatology (SIR) comprises committees for Rheumatologists under the age of 40 (SIRyoung) and for Women in Rheumatology (Reumatologhe Donne – ReDO). As female representation is increasing in rheumatology worldwide [1], there has been interest in assessing gender-related issues.To describe the gender distribution among young members of SIR and academic positions in Rheumatology in Italy. To assess the expectations and needs of young rheumatologists with regard to their career.SIRyoung members developed a web-based survey which was distributed among SIR members under the age of 40 during the spring of 2019. Responses were collected and analysed anonymously. ReDO retrieved and analysed the data regarding academic positions in Italy in September 2019 from official data by “Ministry of Education, University and Research” (www.miur.it).Out of 478 SIR members under 40 (66.5% F), 113 (23.7%) completed the SIRyoung survey (62.1% F). Regarding career plans, male and female members responded: hospital physician (36.9% vs 37.8%), outpatient clinic physician (18.5% vs 28.3%), academic career (23.9% vs 22.8%), private practice (16.3% vs 9.4%), and industry (4.3 vs 1.6%), respectively. When asked about their interest in doing a fellowship in another national center or abroad, 60.8% of male and 72.8% of female respondents were interested but thought they could not afford it. Reasons reported by males and females were: working reasons, namely barriers to temporarily leave the workplace (61.3% vs 50.7%), family reasons (16.1% vs 25.4%), financial reasons (22.6% vs 16.5%), respectively. As for academic rheumatology in Italy, 113 positions were retrieved. Men held 64 positions (57%) and women 49 (43%). Full professors were mostly men (92%), while assistant professors were women in 65% of the cases (58% of those with a permanent position; 72% of those with a temporary position) (Figure) [2].Our study explored for the first time gender distribution and related issues in Rheumatology in Italy. Female representation accounts for two thirds of SIR members under 40. This could reflect the general trend of medical school being chosen more often by women than men. No differences were observed in the career expectations of male and female rheumatologists. Interestingly, nearly one fourth of female respondents were interested in academic career, confirming the trend toward female predominance observed for assistant professors. Therefore, it is likely that the next generation of full professors will have a balanced gender distribution, as it is already for associate professors. The choice of a fellowship is still hampered by several problems, but it seems that reasons for not pursuing such opportunities are similarly distributed in males and females. Although family reasons tend to be more frequent in female rheumatologists, this is not significant as compared to men. This could indicate that family affects career choices of both male and female rheumatologists. It is important that national societies promote surveys for the assessment of gender specific issues among their members, in order to identify unmet needs and design interventions for career support regardless of gender.[1]Andreoli L, et al. Joint, Bone, Spine: Revue du Rhumatisme. 2019;86(6):669-672.[2]Bosello SL, et al. Reumatismo 2020; in press.SIRyoung and ReDO wish to thank the Steering Committee of SIRLaura Andreoli: None declared, Stefano Alivernini: None declared, Alessia Alunno: None declared, Silvia Laura Bosello: None declared, Cecilia Chighizola: None declared, Paola Conigliaro: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Cristina Iannuccelli: None declared, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Francesca Romana Spinelli Grant/research support from: Pfizer, Consultant of: Novartis, Gilead, Lilly, Sanofi, Celgene, Speakers bureau: Lilly, Marta Vadacca: None declared, Maria Sole Chimenti: None declared

Background: SpA patients experience a decreased quality of life due to social, emotional and relational life impairment in addition to pain, fatigue and joint damage. Sexual dysfunction (SD) is often neglected by both patients and clinicians, although articular and extra-articular manifestations of the disease can decrease the quality of sexual life. Previous findings showed that SD can affect from 27% to 67% of patients with rheumatic diseases. Data available on SD in rheumatic patients are poor and primarily focus on male ankylosing spondylitis patients Objectives: The aim of this study is to evaluate, in a group of female SpA patients, the presence of SD, its relationship with extra-articular manifestations and to estimate the correlation between disease activity and sexual activity. Methods: 52 SpA patients (including PsA, IBD-SpA and undifferentiated SpA-un-SpA) and 50 healthy controls (HC) were administered the Female Sexual Function Index (FSFI) questionnaire for the analysis of sexual function (score from 0 to 100). SD is defined by a score lower than 26. Disease activity was evaluated through DAPSA and BASDAI. SpA-HAQ and BASFI was also performed to assess functional status Results: There was a trend for a significantly greater proportion of SD in the patients (21%) than the controls (8%), χ 2 (1, N = 102) = 3.52, p = .06). Within the different groups, the percentage of those with SD according to the FSFI cut off were 23% of PsA patients, 25% of IBD-SpA patients, 11% of un-SpA patients, and 8% of healthy controls, however, when the patient groups were analysed separately these differences were not significant, χ 2 (3, N = 102) = 4.43, p = .22. Mean scores on the FSFI were lower for the total SpA patients group t(100) = 2.47, p = .02 compared to HC. When scores on the FSFI were analysed separately for each patient group, there was a trend for a significant difference between the groups, F (3,98) = 2.43, p = .07, and follow up t-tests showed that only the PsA group scored significantly lower than the HC, t (100) = 2.56, p = .01 (see Fig. 1). Among the items of the questionnaire, questions regarding sexual desire, lubrication and discomfort were statistically significantly lower scores in patients compared to HC ( p = 0.001, p = 0.009, p = 0.02, respectively). For the overall patient group, the FSFI was significantly negatively correlated with the DAPSA ( r = -.37, p = .008), the SpA-HAQ ( r = -.30, p = .03) and the BASFI ( r = -.30, p = .03). Additionally, the PsA group showed a negative correlation between DAPSA scores and FSFI score ( r = -.38, p =.03) and the IBD-SpA group had a negative correlation between FSFI score and BASFI ( r = -.80, p = .002). Conclusion: Overall, the data generally show that SD is more common in SpA patients compared to HC and that SpA patients score lower on the FSFI. The negative correlations between the FSFI and scores on DAPSA, SpA-HAQ and BASFI suggest that sexual function may be poorer for patients with greater disease activity and poorer functional status. These findings could be due to the number of tender and/or swollen joints as well as chronic pain or fatigue patients often experience. A key limitation of this study is the small sample size. Future research will include a larger sample size. SD in patients with rheumatic disease is still a neglected field in clinical practice, however, its assessment could contribute to improved quality of life for patients Table 1. Clinical characteristics of patients and healthy controls PsA un-SpA IBD-SpA HC Age (mean ± SD ) 50.6 ± 4.0 43.9 ± 3.6 46.3 ± 2-0 52.5 ± 0.5 Distribution (N% ) 31 (59%) 9 (17%) 12 (24%) 50 Age at diagnosis (mean ± SD ) 40.0 ± 2.5 35.6 ± 4.1 40.8 ± 1.2 / DAPSA 15.1 ± 9.9 12.2 ± 9.9 / HAQ 0.6 ± 0.5 0.8 ± 0.5 1.0 ± 0.7 / BASDAI 0.6 ± 0.9 0.6 ± 0.8 5.1 ± 2.8 / BASFI 16 ± 16.0 37.8 ± 26.8 46.7 ± 21.7 / Disclosure of Interests: erica de martino: None declared, Paola Conigliaro: None declared, Maria Sole Chimenti: None declared, Paola Triggianese: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Cristina Iannuccelli: None declared, Francesca Romana Spinelli Grant/research support from: Pfizer, Speakers bureau: Lilly, BMS, Celgene, Marta Vadacca: None declared, Roberto Perricone: None declared

OBJECTIVE: Fatigue affects the almost totality of Systemic Lupus Erythematous (SLE) patients impairing physical function and leading to a strong reduction of health-related quality of life (HRQoL). Similarly, SLE patients have an increased rate of work loss and work limitations. The aim of our paper was to systematically assess the relationship between fatigue and work disability in SLE. MATERIALS AND METHODS: We performed a systematic review using the terms "fatigue" and "employment", "work disability", "work impairment", "presenteeism" and "absenteeism". RESULTS: 19 studies were identified. Fatigue was involved in the development of work loss. In employed patients, fatigue led to impairment of work productivity and presenteeism with a parallel increase of both direct and indirect health costs. Fatigue also affected parenting and household productivity. CONCLUSIONS: An adequate control of fatigue could improve physical and work performance in SLE patients thus reducing rates of work loss.

Background Alexithymia describes the difficults of people in identifying, differentiating and articulating emotions of others and themselves and in discriminating those from bodily sensations, with a limited fantasy and a concrete, externally oriented cognitive style.1 A high prevalence of alexithymia has been found in patients with a variety of health conditions, including SLE.2 Previous authors identified mood states2 and quality of life3 as the main factors related to alexithymia in Systemic Lupus Erythematosus (SLE). Objectives Aim of our study was to assess the impact of clinical, immunological, psycho-social factors on the presence of alexithymia in Systemic Lupus Erythematosus (SLE). Methods We consecutively enrolled 104 patients in a cross-sectional study. Alexithymia was assessed using the Toronto Alexithymia scale (TAS-20). We also evaluated symptoms of mood disorders using BDI and HAM-H, quality of life using MOS-SF36, sleep disorders with PSQI and physical activity using IPAQ. Results The mean (standard deviation) TAS-20 score was 49.5 (15.6). The prevalence of alexithymia (TAS-20 ≥61) was 28%. Alexithymic patients (TAS-20 ≥61) were significantly older (p 0.0005), presented more severe depressive and anxiety symptoms (p<0.0001), a higher score of sleep disorders (p<0.0001), a reduced Facit-Fatigue score (p 0.0007), reduced SF-36 mental and physical component summary scores (p 0.0001 and 0.004) and increased daily sedentary time (p 0.002). In the multiple logistic regression analysis the variables associated to the presence of alexithymia were age (OR 1.07, p 0.02) and the score of depressive symptoms (OR 1.15, p 0.02). Conclusions About a third of SLE patients presented a dysfunctional processing of emotion. It is necessary to carefully consider the symptoms of mood disorders to optimise SLE patient management. References [1] Taylor GJ, Bagby RM. Measurement of alexithymia. Recommendations for clinical practice and future research. Psychiatr Clin North Am. 1988Sep;11(3):351–66 [2] Vadacca M, Bruni R, Terminio N, Sambataro G, Margiotta D, Serino FM, Afeltra A. Alexithymia, mood states and pain experience in systemic lupus erythematosus and rheumatoid arthritis. Clin Rheumatol. 2014;33(10):1443–50.3. [3] Barbosa F, Mota C, Alves M, Alcântara C, Rossiñol B, Patrício P, Barbosa A, Ferreira C. Alexithymia in systemic lupus erythematosus patients. Ann N Y Acad Sci. 2009Sep;1173:227–34 Disclosure of Interest None declared

Background Rheumatic Diseases (RD) frequently affect women during reproductive age, therefore counselling on family planning is crucial for their quality of life. Children's outcome is a major topic, but no large studies are available. This study aimed at assessing the long-term health conditions of children born to women with RD. Methods 24 Italian Rheumatology Centres distributed the questionnaire (65 multiple-choice and 12 open-answer questions) to consecutive patients (aged 18–55) during September 2015. Data were analysed dividing children upon maternal diagnosis: Chronic Arthritides (CA) and Connective Tissue Diseases (CTD). Results Data were collected for 320 children born to 184 mothers (63 CA and 121 CTD). At the time of interview, children had a mean age of 17.1±9.6 years. Pre-term delivery (<37 w) was observed in 72 cases (22.5%), including 13 (4%) cases born <34 w. The occurrence of an autoimmune/inflammatory disease (AIID) and/or neurodevelopmental disorders (ND)/learning disabilities (LD) is reported in table 1. Twelve children (3.7%) were diagnosed with an AIID, mostly coeliac disease (8/12, 67%). Eleven children (3.4%) were diagnosed as having a ND and/or LD by a Paediatric Neuropsychiatrist. Data of in utero exposure to maternal autoantibodies and/or anti-rheumatic drugs were retrieved for 280 children (87.5%) and a comparison was performed between affected (n=11) and not-affected children (n=258). No association was found with ND/LD and in utero exposure to autoantibodies (ANA, anti-Ro, anti-dsDNA, aPL) or drugs (HCQ,AZA or steroids), neither with sex, preterm birth, birth weight or maternal diagnosis. Conclusions The long-term follow-up of children born to mothers with RD did not raise particular concerns in terms of relevant health problems. In particular, each AIID did not display a significantly increased frequency as compared to the literature. Children with ND/LD had a tendency to cluster in the group of mothers with CTD, especially after maternal diagnosis, with a higher frequency as compared to GPP (7.9% vs 3%). Our data suggest that the development of ND/LD in children of patients with RD cannot be linked exclusively to maternal disease. The results of this study can be reassuring for patients with RD about problems in the offspring possibly related to their disease.

Background Several evidences described a considerable prevalence of alexithymia among patients with chronic diseases, such as systemic autoimmune diseases. In patients affected by Systemic Lupus Erythematosus (SLE), alexithymia seems to be related to mood disorders and personality. Objectives In this study we evaluated alexithymia in relation to HR-QoL (Health related Quality of Life) and to factor associated to HR-QoL, such as mood disorders, fatigue, work ability, sleep quality and physical activity. Methods We consecutively enrolled SLE patients and healthy controls in a cross sectional study with a retrospective design. We wvaluated alexithymia by the Toronto Alexithymia Scale 20 (TAS-20). AHR-QoL was expressed by MOS-SF-36. Mood disorders was assessed by BDI and HAM-H. Fatigue was evaluated by Facit-Fatigue. Physical activity was quantified using International Physical Activity Questionnaire (IPAQ) and the sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Work ability was assessed by Work Productivity and Activity Impairment (WPAI). Cognitive impairment was defined according to MOCA screening test. Results Fifty-two SLE patients and 50 age-matched healthy subjects were enrolled in the study. Mean TAS-20 score was significantly higher in SLE compared to controls (p<0.01). Alexithymic patients presented increased values of BDI score and HAM-H score (p<0.01 and p<0.05) and reduced Facit-Fatigue score (p<0.05). We found increased values of Work missed due to health problems and Activity impairment in alexithymic SLE subjects (p<0.05). SF-36 summary components PCS and MCS and SF-36 individual components did not significantly differ between alexithymic and non-alexithymic SLE. A greater proportion of alexithymic SLE patients presented fibromyalgia (p<0.05), low scholastic education (p<0.01), cognitive impairment according to MOCA test (p<0.01) and mild-to-severe depression according to BDI (p<0.01). We did not find differences among alexithymic and non alexithymic in MeS, obesity and physical inactivity prevalence. TAS-20 values positively correlated with BDI score (p<0.001), HAM-H score (p<0.01) and activity impairment score (p<0.01) and negatively with Facit-Fatigue score (p<0.01). In multiple linear regression, predictors of TAS-20 values were to be fibromyalgic and to have mild-to-severe depression according to BDI. In multiple logistic regression, alexithymia was significantly associated to BDI score (OR 1.2, 95% CI 1.0–1.4) and inversely associated to cognitive impairment (OR 0.1, 95% CI 0.02–0.8). Conclusions SLE patients frequently present alexithymic tract. Alexithymia seems to be associated neither to disease feature, to disease course (activity and damage) and to SLE therapy, nor to HR-QoL expressed by SF-36. Nevertheless, alexithymia could be tightly related to QoL-associated factors as depression and fibromyalgia Disclosure of Interest None declared

Background Systemic Lupus Erythematosus (SLE) is associated to a huge prevalence and incidence of cardiovascular diseases (CVDs) due to accelerated atherosclerosis. Several evidences demonstrated that metabolic syndrome (MeS) could contribute to CVDs burden in SLE. In general population, MeS components and, according to some reports, MeS itself are associated to worsened Health related Quality of Life (HR-QoL). In SLE patients, a severe decline of HR-QoL has been widely demonstrated. Objectives In the study, we evaluated the association between MeS, HR-QoL and QoL-related factors, such as depression, fatigue and physical activity. Methods We conducted a cross-sectional study with retrospective evaluation of disease activity, damage and therapies cumulative dosage. MeS was defined according to International Federation of Diabetes (IFD) criteria. All patients were evaluated to explore MeS IFD criteria and other CVD risk factors (familiar history, lifestyle, smoking). SLE disease activity and damage were evaluated using SELENA-SLEDAI and SDI indices, respectively. Disease flares were retrospectively assessed by SFI index. HR-QoL was quantified by SF-36 instrument. We used Beck Depression Inventory (BDI) to assess depression and Facit-Fatigue to evaluate fatigue. Physical activity was quantified using International Physical Activity Questionnaire (IPAQ) and expressed according to categorical IPAQ total score. Patients also completed Pittsburgh Sleep Quality Index (PSQI) exploring sleep pathology. Results We enrolled 55 SLE patients (2 male and 53 female). Mean age was 45±12.5. MeS prevalence was 23.6% and obesity (according to IFD definition) was recorded in 36.4% of patients. SLE patients with MeS presented reduced scores in SF-36 summary components MCS and PCS compared to patients without MeS (p 0.002 and p 0.04, respectively). The SF-36 individual components significantly decreased in MeS were the Mental Health, the Physical Rose and the Social Role (p 0.003, p 0.03, p 0.05, respectively). In multiple linear regression the values of MCS was significantly associated only to obesity (p 0.01), while neither MeS it self nor any MeS components were associated to PCS values. BDI score was significantly higher and Facit-Fatigue score was reduced in SLE patients meeting MeS criteria compared to subjects without MeS (p<0.0001, p 0.005, respectively). A greater proportion of SLE patients with MeS presented almost mild depression (p 0.03). We found to be physically inactive, according to IPAQ score, the majority of SLE patients with MeS compared to patients without MeS (p<0.0001). In multiple logistic regression, factors related to MeS were the Number of flares in the previous one year [OR (95% CI) 13.7 (1.7–107.8)], to have a BDI>13 (to have almost mild depression) [OR 0.05 (0.004–0.87)] and to be physically inactive (IPAQ=1) [OR 33.5 (2.3–496.4)]. Conclusions HR-QoL seems to be compromised in SLE patients with MeS, especially in mental components. Moreover, SLE patients with MeS often presented depression, are burdened by more severe fatigue and frequently are physically inactive. The presence of MeS in SLE was associated to the number of flare and, above all, to the physical inactivity, while not having depression seems exert a protective effect on MeS. Disclosure of Interest None declared

Background Rheumatic diseases (RD) affect women during reproductive age. Children9s outcome is a major topic for counselling on family planning, but no large studies are available. Objectives We aimed at assessing the long-term health conditions of children born to mothers with RD through a self-reported questionnaire. Methods 24 Rheumatology Centers distributed the questionnaire (65 multiple choice and 12 open-answer questions) to consecutive women with RD attending their outpatient clinic during September 2015. Data were compared according to maternal diagnosis (MD) -chronic arthritis (CA) or connective tissue disease (CTD)- and to the timing of pregnancy (before or after MD of RD). Results The survey yielded data about 269 children born to 184 mothers (63 CA, 121 CTD). According to MD, children had a mean age of 17.1 (±9.6 SD) and 14.4 (±9.0 SD) years at the time of interview, and male children were 52/93 (56%) and 91/176 (52%), respectively. Twenty-nine children in the CA group (31.2%) and 64 in the CTDs group (36.4%) were born after MD of RD. Pre-term delivery (before 37 weeks) was observed in 48 cases (17.8%), mostly children born to mothers with CTD (37/48, 77%). Regarding school performance, 12 children (4.5%) repeated one year of school, in 7 cases for indolence, in 3 for learning disabilities (LD)/health problems (HP), in 2 for family problems. Eleven of these children were born before MD. Overall, 9 children (3.3%) were diagnosed with a LD and 53 children were affected by HP requiring either hospitalization or evaluation by a Specialist (Table). Three children (1%) were affected by autoimmune disease. Conclusions The long-term follow-up of children born to women with RD is reassuring of an outcome similar to that of the general pediatric population (GPP). Autoimmune diseases are not frequent. Problems seem to cluster in children born to CTD, especially after MD, with a higher frequency of LD (6.3% vs 2.5–3.5% of GPP), but no particular pattern of exposure to maternal autoantibodies nor drugs was observed. Acknowledgements Statistical analysis supported by an unrestricted grant by UCB Pharma Thanks to Patients Associations and Participants to the survey Disclosure of Interest None declared

Background Rheumatic diseases (RD) predominantly affect young women during reproductive age. Pregnancy, contraception and family planning (FP) are crucial for the quality of life of these patients. Objectives We aimed to investigate 9women9s health9 through a self-reported questionnaire. Answers from patients with connective tissue diseases (CTD) vs chronic arthritis (CA) were compared. Methods 24 centres distributed the questionnaire (65 multiple-choice and 12 open-answer questions) to women with RD (18–45years) regularly attending their outpatient clinics. Results Answers were collected from 249 CTD vs 149 CA patients. Their desire to have children was influenced by RD in 40% of cases: half of them reduced the number of children they wanted (Table 1). 39% CA vs 29% CTD were afraid of being mother because of disability. 24% CTD vs. 18% CA had at least one miscarriage; 21% CTD vs. 2% CA had more than one. 31% CTD and 34% CA were never asked about their desire to have children. 61% CTD vs 70% CA received counselling about contraception, given by a gynaecologist (G) (58% vs 64%), rheumatologist (R) (22% vs 14%) or both (7% vs 9%). 60% in both groups received a counselling before pregnancy: 34% vs 39% from R and G, 14% vs 22% by R. This positively changed family planning in 64% vs 59%. We created a Knowledge Index (based on the average of the normalized performed scores on 6 key questions for different sections): 55% CTD patients vs 44% CA had a medium-high score. A higher score directly correlated with the desire to became pregnant and with a multidisciplinary counselling. Conclusions This survey suggested that CTD have a major impact on FP and family size, possibly mediated by the increased rate of miscarriages as compared to CA. Concerns about reproductive issues could be positively overcome by adequate counselling. Rheumatologists should implement the discussion about FP and the compatibility of drugs with pregnancy in the management of young women with RD, especially those with CTD for whom contraception and pregnancy have particular implications. Acknowledgements Statistical analysis supported by an unrestricted grant by UCB Pharma Thanks to Patients9 Associations and Participants Disclosure of Interest None declared

OBJECTIVE:Primary Sjogren's Syndrome (pSS) is a systemic autoimmune disorder characterized by infiltration of the exocrine glands leading to secretory insufficiency. Despite the progress made in understanding the pathogenesis of the SS, many aspects remain to be clarified. Interleukin-33 (IL33) is a recently discovered cytokine, belonging to IL-1 superfamily. IL33 and its soluble receptor ST2 were implied in a number of immune and in autoimmune diseases pathogenesis. In this work ,we analyzed expression of IL33 and ST2 in Sjogren's syndrome.PATIENTS AND METHODS:Serum IL-33 and soluble ST2 were analyzed using commercial ELISA kit in 15 pSS, 9 patients with Systemic Lupus Erythematosus and 9 controls.RESULTS:We found significant hyperexpression of sST2 in sera of SS patients and SLE patients compared to healthy subjects (p = 0.04 and p = 0.07, respectively). In pSS, sST2 levels in pSS positively correlated with activity index SSDAI (r = 0.662, p = 0.007). In SLE, we found positive correlation between ST2 and SLEDAI 2K (r = 0.685, p = 0.04). Circulating levels of IL-33 were detectable in 2 of 15 SS patients, in 2 SLE patients and in 1 of control subjects.CONCLUSIONS:We found an hyperexpression of sST2 in pSS and SLE patients with a possible immune modulatory role, because of a substantial suppression of circulating IL33. In our pSS and SLE cohort, sST2 levels were in correlation with disease activity indices.

OBJECTIVE:Crescent literature data demonstrated a role of adipokines in immune responses, particularly leptin is involved in wide spectrum of pro-inflammatory functions. Several evidences suggested that leptin is able to inhibit T regulatory cells proliferation and function in vitro models. In the present study, we investigate the relationship between leptin and circulating T regulatory cells (Tregs) in patients affected by systemic lupus erythematosus (SLE).PATIENTS AND METHODS:13 SLE patients and 11 healthy controls were enrolled. Metabolic syndrome and cardiovascular parameters were evaluated. Serum leptin levels were detected by commercial ELISA kit and circulating regulatory T cells were determined by FACS analysis as CD4+CD25highFOP3+ lymphocytes.RESULTS:Metabolic syndrome, defined by ATPIII criteria, was more prevalent in SLE compared to controls (38.4% vs. 0%, p = 0.04), as well as arterial hypertension (38.4% vs. 0%, p = 0.04). We did not find significant differences in mean leptin levels among SLE and controls (13.13 ± 1.51 ng/ml vs. 9.48 ± 8.67 ng/ml, p = 0.6). Mean Tregs percentage of total CD4 were 1.27 ± 0.9 in SLE vs. 2.8 ± 1.2 in healthy controls (p = 0.001). We found a negative correlation between leptin levels and Tregs percentage of total CD4 in SLE patients (r = 0.4, p = 0.01).CONCLUSIONS:Our results suggest a role of leptin in the regulation of circulating T regulatory cells amount in human SLE.

Background Adipokines are citkokines mainly secreted by adipose tissue and involved in a wide spectrum of processes including metabolism, insulin sensitivity, atherogenesis and immunity. Leptin is the first adipokine discovered and plays important immunological functions. Crescent scientific data confirm the leptin involvement in many human autoimmune diseases. We described leptin hyperexpression in sera of female SLE patients, especially in fertile age, in relation with metabolic parameters and disease activity Objectives To evaluate the basal leptin levels in SLE patients who develop disease flares and damage accrual in 3 years follow-up. Methods We performed a retrospective evaluation of basal serum leptin levels, metabolic parameters and SLE disease features in 20 female SLE patients. For all subjects, complete data concerning disease activity and damage were available over a period of almost 3 years after the baseline assessment. Metabolic parameters included basal insulin, glycaemia, HOMA-IR, plasma lipid profile, BMI, waist-hip ratio. SLE disease features were expressed as anti-dsDNA positivity, complement fraction C3 and/or C4 depletion, disease activity measured by SELENA SLEDAI and disease damage evaluated by SDI. SLE disease flares were assessed by revised SFI index. Number of disease flares was evaluated during the fist year of follow-up and at the end of a 3 years follow-up. SDI was measured at baseline and at the end of year 3. Results We found hyperexpression of basal leptin levels in SLE patients who developed almost 1 flare at year 1 compared to patients without flares (p 0.002). Basal leptin in subject with almost 1 flare at the end of the 3 years of follow-up was higher in comparison with patients who didn't develop disease flares (p 0.0003). Basal leptin was increased in patients who presented almost 1 new point of SDI at the end of the 3 years follow-up versus patients without SDI increase (p 0.0003). The survival curve of the time without a lupus flare in subjects with leptin above 50 percentile significantly differed compared to subjects with leptin levels below 50 percentile (p 0.003). Patients with almost 1 flare at year 1 and year 3 and subject with almost 1 new SDI point at year 3 presented increased basal HOMA-IR, BMI and basal SELENA-SLEDAI. At baseline, leptin levels positively correlated with HOMA-IR (r 0.8, p<0.0001), BMI (r 0.8, p<0.0001) and SELENA SLEDAI (r 0.8, p<0.0001). Conclusions We found basal leptin hyperexpression in SLE patients who developed disease flares and damage accrual in a 3 years follow-up period. These patients presented increased insulin-resistance and disease activity at baseline and leptin was tightly related to both these aspects. Further studies are required to evaluate the possible role of leptin as predictor of SLE prognosis References Margiotta DPE, Vadacca M, Navarini L, Basta F, Afeltra A. The complex role of leptin in SLE: is leptin a key link between metabolic syndrome, accelerated atherosclerosis and autoimmunity. Lupus: Open Access 2016; accepted. Vadacca M, Margiotta DP, Navarini L, Afeltra A. Leptin in immuno-rheumatological diseases. Cell Mol Immunol 2011; 8:203–212. Vadacca M, Margiotta D, Rigon A, Cacciapaglia F, Coppolino G, et al. Adipokines and systemic lupus erythematosus: relationship with metabolic syndrome and cardiovascular disease risk factors. J Rheumatol 2009; 36:295–297. Disclosure of Interest None declared