Background Lupus nephritis (LN) is one of the most serious complications of systemic lupuserythematosus (SLE).Immunosuppression (IS) is the standard of care therapy for lupusnephritis(LN).Data on the outcomes of LN patients after discontinuation ofimmunosuppression remain uncertain. Objectives To assess the outcomes of patients with LN after discontinuation of immunosuppression. Methods Clinical and laboratory data were retrospectively collected on LN patients attending our Lupus Unit.We included 45 patients(41had biopsy confirmedLN)who were treated with immunosuppression including cyclophosphamide, mycophenolate, azathioprine,methotrexate, and/or rituximab.Numeric response variables(median and range)including age, disease duration and length of treatment were collected.Frequencies and percentages categorical variables including gender, ethnicity, lupus nephritis class, autoantibodies, laboratory features, IS therapy used and patients’ outcomes (stable versus flared) were analysed.LN flares were defined as: doubling of serum creatinine concentrations and increases in proteinuria after discontinuation of IS.Chi-square tests were applied to comparethese categorical variables between patient’s outcomes.Reasons for IS discontinuation: remission, pregnancy planning and patients preference. Results We identified the outcomes of 45LN patients who stopped IS therapy.The median age of patients was 55(29 -78)years. The median durationof diseasewas 26.5(15-58)years whereas the median treatment duration was 4(1/2-14)years.Thirty (66.7%)patients were Caucasian ethnicity.Seventeen of 45patients received treatment for more than 5 years.There was only 1(2.2%)male patient in our study. At IS discontinuation, creatinine levels were elevated in9/45 (2%) patient and median creatinine values were 73(41-117umol/L).Median proteinuria values were 20mg/mmol (5-934)(p=0.00).LN histology: classV(24.4%),IV 17.8%and III(17.8%)and eleven patients had a combination of class III IV. Thirteen of 45 (28.9%)patients had relapses after discontinuation of IS. Median time to LN flare was 3(1-17) years and median age of the flared patients was58 years(41-70)years.Median creatinine values and median proteinuria of the flared patients were78(41-111umol/L),361.5 mg/mmol(12-908)respectively.Of these 13relapsed LN patients,4had class III,4had class V and the other patients had combinations of classes.Anti-Sm antibodies were more likely to be associated with relapses(6 patients) compared to stable patients(4 patients)(6% vs.40%) (p=0.030).Anti- dsDNA antibodies were positive in 22/32 stable patients(68.8%)compared to 10/13(31.3%)relapsed patients (p=NS).Among 13flared patients, 5 (38.5%)had high creatinine levels and 8(61.5%)had normal serum creatinines(p=0.048)on discontinuation of IS. Of 45 patients,12 had low complement C3, of whom 7(58.3 %) flared and 5(41.7%) were stable(p=0.009).Similarly, of 12patients with lowC4, 8(66.7%)flared compared to 4with stable outcomes(33.3%)p=0.001 .A higher proportion of patients previously taking azathioprine relapsed compared to those with previous use of cyclophosphamide or MMF 30.8%vs15.4%(p=0.011)respectively. Conclusion Our data suggests that two thirds of our patients experienced clinical remission with stable LN following cessation of IS therapy for LN.Patients who had elevated serum creatinine values, persistent proteinuria, low complement, positive anti Sm antibodies and previous azathioprine use were more likely to flare after stopping IS.Anti- dsDNA antibodies levels did not predict flares after stopping IS.Further prospective studies with larger sample sizes and longer follow-up are needed to estimate LN outcomes after discontinuation of immunosuppression. Table 1. Patient’s characteristics and lupus nephritis outcome Parameters n (%) Flared patients(N=13) Stable patients(N=32) P value Abnormal creatinine 5(55.6%) 4(44.4%) 0.048 Significant UPCR 8(88.9%) 1(11.1) 0.000 Anti-sm 6(60%) 4(40%) 0.030 Low C3 7(58.3%) 5(41.7%) 0.009 Low C4 8(66.7%) 4(33.3%) 0.001 Disclosure of Interests None declared

Background: Aortitis is a group of disorders leading to inflammation in the aorta. When aortitis has no clinical evidence of systemic vasculitis, it is called idiopathic aortitis or clinically isolated aortitis (CIA). There is no consensus on the management of CIA. Objectives: Our purpose is to describe our cohort of patients with CIA and their response to treatment. Methods: This is a retrospective analysis of 19 patients with CIA. All records of patients with CIA were analyzed and demographic variables, comorbidities, symptoms, images, histology, treatment received, outcome and mortality were recorded. The description of quantitative variables was made using the median and the interquartile range (IQR). Results: Nineteen patients were analyzed. Diagnosis was made by imaging in 18 (94.7%), one patient was diagnosed by histology after aortic root surgery. Patient characteristics are detailed in Table 1. The median duration of follow- up was 38 months (IQR 43). Seven patients (36.8%) had constitutional symptoms including fever, weight loss, sweats and fatigue. 4 (21.05%) presented with back or abdominal pain for a mean duration of 3 months (SD 0.81) before the diagnosis. In 8 (42.1%) patients the diagnosis was made incidentally. All patients had negative treponema, hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV) serology. All patients had negative autoimmune serology included ANCA. Interestingly 4 (21.05%) had positive lupus anticoagulant without other manifestation of antiphospholipid syndrome. The type of aortic involvement was aortitis in 10 patients (52.6%), inflammatory aneurysm in 8 (42.1%) and dissection in 1 (5.2%). Seven (36.8%) patients had thoracic and abdominal aorta involvement, 6 (31.5%) only thoracic aorta and 6 (31.5%) only abdominal aorta. Aortic histology was obtained in 5 patients, 2 had necrotizing arteritis with giant cell pattern and 2 had lymphoplasmacytic pattern. Temporal artery biopsy was done in one patient and the result was negative for GCA. All patients received corticosteroids as a remission inducing agent, 12 (63.1%) received methotrexate and 2 (10.5%) mycophenolate. 2 patients died (10.5%). The median prednisone dose at the beginning was 20 mg (IQR 20) and at remission was 5 mg (IQR 20). 41.6% (5/12) of patients treated with steroids plus methotrexate were able to stop steroids without reactivation over a median follow-up time of 23.5 months (IQR 31). (Table 2.) Details of treatment, ESR and CRP pre and post treatment is shown in Figure 1. Seven patients (36.8%) had follow-up imaging, none of them showed active inflammation, new aneurysm, dissection or disease progression. Conclusion: Treatment of isolated aortitis with steroids and methotrexate was effective resulting in clinical and laboratory improvement and allowed cessation or decrease in steroids to 5 mg or less in 83% of patients. This therapeutic approach may be useful in patients with CIA. References: [1]Cinar, I., Wang, H., & Stone, J. R. (2017). Clinically isolated aortitis: pitfalls, progress, and possibilities. Cardiovascular Pathology, 29, 23–32. Disclosure of Interests: None declared

Background:Antiphospholipid syndrome (APS) is characterized by thrombosis and obstetric morbidity in the context of positive antiphospholipid antibody markers. More than a quarter of hypertensive APS patients (26%) have renal artery stenosis (RAS) (1). Treatment includes anticoagulation, blood pressure control and management of cardiovascular risks. In some cases, the severity of the renal vascular lesion requires surgical interventionObjectives:To evaluate long term outcomes in APS patients with RAS.Methods:Retrospective database study. All records of APS patients with RAS were analyzed and demographic variables, comorbidities, treatment received, renal outcome and mortality were recorded.Uni- and multivariate analyses were performed by logistic regression with death and chronic kidney disease (CKD) as dependent variables. In the multivariate analysis, the covariates considered were age at diagnosis of stenosis, diabetes, smoking, dyslipidemia, unilateral or bilateral stenosis, stenosis greater than 50%, surgery and the use of immunosuppressants, anticoagulation and statins.Research and development office has approved this study.Results:33 RAS patients were analyzed. Diagnosis of RAS was made by MRI renal angiography and in some cases by CT angiogram and intra-arterial digital subtraction angiography. Patient characteristics are detailed in Table 1. The median duration of follow-up was 152 months (IQR 65).Table 1.Patient Characteristics.N° Patients33Age median48 (IQR 16)Smokers%18.1(6)Comorbidities %Diabetes mellitus type 2 6 (2) Hypertension 100(33)High LDL 36.3(12)Primary APS %39.4 (13)Secondary APS %60.6 (20)Unilateral RAS%75.8 (25)Bilateral RAS%24.2 (8)Degree of stenosis< 30% 15.1 (5)30-50% 30.3 (10)50-80% 33.3 (11)>80% 21.2 (7)Treatment%Medical treatment 75.7 (25)Surgical treatment 30.3 (10)Renal biopsy was performed in 3 patients: crescentic glomerulonephritis was found in 2 patients and one had a thrombotic microangiopathy.Treatment: 25 patients (75.7%) were anticoagulated with vitamin K antagonists, 19 (57.6%) received immunosuppressive therapies, 18 (54.5%) were on statins. Ten patients (30.3%) were managed surgically with balloon angioplasty. Restenosis occurred in 4/10 patients (40%) and percutaneous renal artery stenting was performed successfully in all four. Ten patients died (30.3%). Renal outcomes are shown in Table 2.Table 2.Outcome in APS with RAS PatientsN %Died 10 30.3Transplanted 1 3Renal Dysfunction 17 51.5CKD Stage III 10 30.3CKD Stage IV 4 12.1CKD Stage V 3 9In the univariate analysis, surgery was significantly associated with a lower probability of reaching CKD (p=0.042; OR 0.2; 95% CI 0.03-0.94). In the multivariate analysis, the tendency to benefit from surgery was maintained but the statistical significance was lost, probably due to the low number of patients.In the subgroup analysis, the tendency to benefit from surgery was maintained in patients with or without anticoagulation, immunosuppressants, statins, with primary or secondary APS, with uni- or bilateral stenosis, with or without dyslipidemia, but this benefit was lost in smokers independent of the grade of stenosis.Conclusion:RAS is a treatable cause of hypertension and a poor prognostic marker in APS patients.In this study, APS patients with RAS who underwent intervention with angioplasty or stenting had a trend to a lower probability of developing CKD in contrast to studies in atherosclerotic RAS. The beneficial effect of surgery was lost in smoking patients. In this relatively young population mortality was high.References:[1]Sangle SR, D’Cruz DP, Abbs IC, Khamashta MA, Hughes GR. Renal artery stenosis in hypertensive patients with antiphospholipid (Hughes) syndrome: outcome following anticoagulation. Rheumatology (Oxford) (2005) 44:372–7.Disclosure of Interests:María José Villar: None declared, Shirish Sangle: None declared, Sebastian Ibáñez Consultant of: Novartis, Paid instructor for: Bristol Myers, Speakers bureau: Abbvie, David d’cruz Grant/research support from: GlaxoSmithKline

OBJECTIVES:We conducted a longitudinal cohort analysis to evaluate the association of pre-treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV). METHODS:Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated-measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds. RESULTS:Of 4993 PLHIV (66% male), 62% had pre-treatment BMI in the normal range (18.5-25.0 kg/m2 ), while 26%, 10% and 2% were underweight (< 18.5 kg/m2 ), overweight (25-30 kg/m2) and obese (> 30 kg/m2 ), respectively. Both higher baseline and time-updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23-27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9-28.3] and 28.8 cells/µL (95% CI: 6.6-50.9), respectively, compared with normal BMI (18.5-23 kg/m2 ). PLHIV with BMIs of 25-30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10-1.47) and 1.61 times (95% CI: 1.13-2.24) more likely to develop CVD risk factors. No relationship between pre-treatment BMI and VF was observed. CONCLUSIONS:High pre-treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.

Objectives: Integration of HIV and non-communicable disease services improves the quality and efficiency of care in low- and middle-income countries (LMIC5). We aimed to describe current practices for the screening and management of atherosclerotic cardiovascular disease (ASCVD) among adult HIV clinics in Asia. Methods: Sixteen LMIC sites included in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacific network were surveyed. Results: Sites were mostly (81%) based in urban public referral hospitals. Half had protocols to assess tobacco and alcohol use. Protocols for assessing physical inactivity and obesity were in place at 31% and 38% of sites, respectively. Most sites provided educational material on ASCVD risk factors (between 56% and 75% depending on risk factors). A total of 94% reported performing routine screening for hypertension, 100% for hyperlipidaemia and 88% for diabetes. Routine ASCVD risk assessment was reported by 94% of sites. Protocols for the management of hypertension, hyperlipidaemia, diabetes, high ASCVD risk and chronic ischaemic stroke were in place at 50%, 69%, 56%, 19% and 38% of sites, respectively. Blood pressure monitoring was free for patients at 69% of sites; however, most required patients to pay some or all the costs for other ASCVD-related procedures. Medications available in the clinic or within the same facility included angiotensin-converting enzyme inhibitors (81%), statins (94%) and sulphonylureas (94%). Conclusion: The consistent availability of clinical screening, diagnostic testing and procedures and the availability of ASCVD medications in the Asian LMIC clinics surveyed are strengths that should be leveraged to improve the implementation of cardiovascular care protocols.

Cotrimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV‐infected patients. Despite its in vitro activity against Mycobacterium tuberculosis, the effects of CTX preventive therapy on tuberculosis (TB) remain unclear.

Background: Hematological malignancies have continued to be highly prevalent among people living with HIV (PLHIV). This study assessed the occurrence of, risk factors for, and outcomes of hematological and nonhematological malignancies in PLHIV in Asia. Methods: Incidence of malignancy after cohort enrollment was evaluated. Factors associated with development of hematological and nonhematological malignancy were analyzed using competing risk regression and survival time using Kaplan–Meier. Results: Of 7455 patients, 107 patients (1%) developed a malignancy: 34 (0.5%) hematological [0.08 per 100 person-years (/100PY)] and 73 (1%) nonhematological (0.17/100PY). Of the hematological malignancies, non-Hodgkin lymphoma was predominant (n = 26, 76%): immunoblastic (n = 6, 18%), Burkitt (n = 5, 15%), diffuse large B-cell (n = 5, 15%), and unspecified (n = 10, 30%). Others include central nervous system lymphoma (n = 7, 21%) and myelodysplastic syndrome (n = 1, 3%). Nonhematological malignancies were mostly Kaposi sarcoma (n = 12, 16%) and cervical cancer (n = 10, 14%). Risk factors for hematological malignancy included age >50 vs. ≤30 years [subhazard ratio (SHR) = 6.48, 95% confidence interval (CI): 1.79 to 23.43] and being from a high-income vs. a lower-middle-income country (SHR = 3.97, 95% CI: 1.45 to 10.84). Risk was reduced with CD4 351–500 cells/µL (SHR = 0.20, 95% CI: 0.05 to 0.74) and CD4 >500 cells/µL (SHR = 0.14, 95% CI: 0.04 to 0.78), compared to CD4 ≤200 cells/µL. Similar risk factors were seen for nonhematological malignancy, with prior AIDS diagnosis showing a weak association. Patients diagnosed with a hematological malignancy had shorter survival time compared to patients diagnosed with a nonhematological malignancy. Conclusions: Nonhematological malignancies were common but non-Hodgkin lymphoma was more predominant in our cohort. PLHIV from high-income countries were more likely to be diagnosed, indicating a potential underdiagnosis of cancer in low-income settings.

Objectives Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource‐limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia‐Pacific. Methods PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count < 100 cells/μL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow‐up for > 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow‐up as a competing risk. Results A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first‐year mortality rate was 4.27 per 100 person‐years (PY). Thirty‐eight deaths (52%) were AIDS‐related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)‐related, 13 (18%) were non‐AIDS‐related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 [sub‐hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60–5.32] compared to BMI 18.5–24.9, and alanine aminotransferase (ALT) ≥ 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62–23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and > 100 cells/μL: SHR 0.12; 95% CI 0.05–0.26) was associated with reduced hazard for mortality compared to CD4 count ≤ 25 cells/μL. Conclusions Fifty‐two per cent of early deaths were AIDS‐related. Efforts to initiate ART at CD4 counts > 50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease.

Objectives: Nerve involvement in patients with granulomatosis with polyangiitis (GPA) is encountered relatively frequently. However, central nervous system (CNS) manifestations, are reported to occur in about 10% of them. We aimed to estimate the prevalence of CNS involvement among patients with GPA, describe the related clinical characteristics, and compare patients with and without CNS involvement, in terms of the vasculitic manifestations and long term outcomes. Methods: The medical charts of all patients with ANCA-associated and biopsy proven small vessel vasculitis (AAV), diagnosed in our hospital between 1985-2015, were reviewed retrospectively and patients with GPA and CNS involvement were identified. iii144 Monday 27 March 2017 POSTER II

Background There is an unmet need for a less toxic, corticosteroid sparing therapy in ANCA vasculitis (AAV), as up to 50% of patients relapse by 5 years and 20% have sub-optimal disease control. Hydroxychloroquine (HCQ) has been effective and safe in autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. There is mechanistic rationale for the effectiveness of hydroxychloroquine in vasculitis, considering its effect on immune mediators involved in pathogenesis, including B cell activating factors, Toll-like receptors, autoreactive T cells and cytokines. Objectives To assess retrospectively the efficacy and safety of hydroxychloroquine (HCQ) in patients with systemic vasculitis Methods Patients were identified by searching our departmental vasculitis database including 248 patients in total and electronic clinical records. Twenty-six patients received hydroxychloroquine along with corticosteroids and immunosuppressants. We assessed the effect of hydroxychloroquine on clinical symptoms and the median dose of corticosteroids required. Results Twenty six patients with various vasculitides were treated with hydroxychloroquine (median dose 200 mg OD): 6 patients with Henoch Schonlein purpura (HSP), 6 urticarial vasculitis, 6 with ANCA+ vasculitis (AAV) (4 PR3-ANCA, 2 MPO-ANCA), 1 Eosinophilic Granulomatosis with Polyangiitis (EGPA), 2 Takayasu arteritis, 2 Behcet9s disease, 1 adult Still9s disease (AOSD), 1 relapsing polychondritis, 1 polyarteritis nodosa (PAN). The female: male ratio was 21:5. Median age was 53 years. The median duration of HCQ treatment was 3 years. Sixteen patients experienced a reduction in arthralgia, skin rashes improved in 8 patients and completely resolved in a further 4. Eight patients could reduce corticosteroid doses (from 9 mg to 6 mg) and 3 discontinued corticosteroids. Four patients developed fewer vasculitic relapses, 6 felt less fatigued, 2 patients no longer experienced abdominal pain and diarrhoea, 2 improved their mood and ability to think clearly. The 6 patients with AAV experienced improvement in arthralgia, reduced their prednisolone doses by a third, had fewer relapses and felt less tired. One patient developed asymptomatic QT prolongation and stopped the hydroxychloroquine, with no other adverse events reported. Conclusions All 26 patients reported symptomatic benefits associated with hydroxychloroquine treatment, especially improvement in joint pains, fatigue, rash. Vasculitic relapses were less frequent, with a reduction in corticosteroid doses. Hydroxychloroquine was generally well tolerated. Disclosure of Interest None declared

Objectives To characterize a single centre retrospective case series of patients with infra-orbital inflammatory masses with autoimmune disease including granulomatosis with polyangiitis (GPA) (formerly Wegener9s granulomatosis), eGPA (eosinophillic granulomatosis with polyangiitis) or Immunoglobulin G4 (IgG4) related disease (IgG4-RD). Methods We identified 30 patients with infra-orbital inflammation on MRI imaging. Clinical and laboratory data was collected from electronic clinical records. Comprehensive Diagnostic Criteria were used for IgG4-RD and Chapel Hill criteria for GPA and eGPA. Statistical analysis was performed by GraphPad software; continuous variables were compared between IgG4-RD and GPA groups using non-parametric Mann-Whitney test and categorical variables were compared by Fisher9s exact test. Results The study included 21 Caucasian, 6 Asian and 3 patients of African descent. There were 19 female and 11 male patients. The median age of the patients was 44 years (range 29–76). 13 patients were diagnosed with GPA, 1 with eosinophillic granulomatosis with polyangitis 9eGPA), 11 patients had IgG-RD, 1 patient with lymphoma, 2 other vasculitis, 1 IgA dacryoadenitis, 1 non-specific granuloma. 7/12 patients with IgG4-RD had isolated infra-orbital masses whereas all 14 GPA patients suffered extra-ocular manifestations (p=0.01), usually sino-nasal or pulmonary. 11/14 GPA patients had positive ANCA vs 2/12 patients with Ig4-RD (p=0.04). IgG4 level was elevated pre-treatment in IgG4 RD patients (median 2.46 g/l (range 1.2–23.7)) and dropped to 1.25 g/l (range 0.37–10.4) after therapy; immunoglobulin subclasses were not checked routinely in GPA. All 12 patients with IgG4-RD underwent diagnostic orbital biopsy vs 3/14 GPA (p=0.0001). All 30 patients were treated with corticosteroids (used alone in 3/12 IgG4-RD patients). The median number of DMARDs ever used to treat GPA was 3 vs 1 DMARD for IgG4-RD (p=0.001). Rituximab was effectively administered to 10/14 GPA patients vs 3/12 IgG4-RD (p=0.04), is planned for 2 further IgG4-RD patients and approval was refused for 1 case. Surgical debulking was undertaken in 6/12 IgG4-RD vs 1/14 GPA (p=0.03). All 40 patients had subsequent MRI to assess response to therapy. Conclusions IgG4-RD is an important differential diagnosis of infra-orbital inflammation, especially if ANCA is negative. Unlike GPA that was associated with extra-ocular manifestations in all patients, IgG4-RD was more likely to present with isolated orbital inflammation and to require biopsy or surgical debulking as the diagnosis was initially uncertain. Treatment with corticosteroids +/− DMARDs was effective. Rituximab can specifically deplete the pool of autoreactive B lymphocytes producing IgG4 and future systematic studies are required to establish the optimum therapeutic strategy. Disclosure of Interest None declared

Background Our previous data [1],[2],[3] showed that renal artery stenosis (RAS) is more prevalent in antiphospholipid syndrome (APS) (26%) compared to the general hypertensive population (8%),and anticoagulation with INR≥3 was associated with initial reduction of chronic kidney disease (CKD) and hypertension. Objectives To characterise the long-term outcomes and associations with anticoagulant treatment for patients with renal artery stenosis and antiphospholipid syndrome. Methods We identified 37 patients with RAS and APS fulfilling Sapporo criteria [4]: anticardiolipin IgG/IgM titer>40 units or >99th percentile (or +lupus anticoagulant) on ≥2 occasions ≥6 weeks apart AND vascular thrombosis (or pregnancy morbidity). RAS was diagnosed by magnetic resonance angiography (MRA). Results 15 patients had APS alone and 22 APS associated with autoimmune conditions (13 lupus, 5 ANCA vasculitis, 4 mixed). Median age at RAS diagnosis was 48 years, 31/37 (83.8%) were female and median follow-up was 10.4 years. 25/37 (67.6%) had previous thrombosis. 7/37 (18.9%) had bilateral RAS, 3 artery occlusion. 6/37 (16.2%) had concurrent coeliac stenosis. Recanalization of RAS occurred after hydroxychloroquine in 3/37 and 9/37 (24.3%) underwent angioplasty +/− stenting. MRA was repeated in 11/37 (29.7%) after 2 years. 23/37 (62.2%) were anticoagulated, with 9/37 (24.3%) on antiplatelet therapy. 13/37 (35.1%) received hydroxychloroquine, 10/22 (45.5%) immunosuppressives and 18/37 (48.6%) antihypertensives. 9/37 (24.3%) died after a median of 10 years since RAS diagnosis. 21/37 (56.8%) developed CKD: 6 endstage renal failure (ESRD) and 15 with median eGFR 39 mls/min. Conclusions The majority of patients with RAS and APS were female, developed CKD and did not benefit from renal angioplasty. Anticoagulation was not associated with longterm reduction of ESRD or death, suggesting a non-thrombotic pathogenic process underlying RAS, such as intimal hyperplasia. Treatment of associated vascular risk factors and autoimmune disease is paramount. Anticardiolipin antibodies and renal MRA are useful screening tests for lupus patients with difficult blood pressure control. References S R Sangle, D P D9Cruz et al. Ann Rheum Dis 2003;62:999–1002. S R Sangle, D P D9Cruz et al. Rheumatology 2005;44:372–37 Jordan NP, Chaib A, Sangle S, D9Cruz DP. Arthritis Care and Research) 2013 Sipek-Dolnicar A, Hojnik M, Bozic B, Vizjak A. Clin Exp Rheumatol. 2002; 20:335–42. Disclosure of Interest None declared