Background The concomitant presence of two autoimmune diseases - systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) - in the same patient is known as rhupus. We evaluated a group of patients with rhupus to clarify further their clinical, serological and immunogenic features in a multi-centre cohort. In addition, the study aimed to explore the utility of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in our group of patients with rhupus. Methods This was a cross-sectional study. We included rhupus patients from 11 different rheumatology departments, and compared them to SLE and RA patients at a ratio of 2:1. All information was recorded following a pre-established protocol. Results A total of 200 patients were included: 40 rhupus patients and 80 each of SLE and RA patients as controls. Disease duration was similar among SLE and rhupus groups (around 13 years), but the RA group had a significantly lower disease duration. Main clinical manifestations were articular (94.2%), cutaneous (77.5%) and haematological (72.5%). Rhupus patients had articular manifestations similar to those expected in RA. Only 10% of rhupus patients had renal involvement compared with 25% of those with SLE (p < 0.05), while interstitial lung disease was more common in patients affected by RA. The 2019 EULAR/ACR SLE criteria were met in 92.5% of the rhupus patients and in 96.3% of the SLE cohort (p > 0.05). Excluding the joint domain, there were no differences between the numbers of patients who met the classification criteria. Conclusion Rhupus patients follow a particular clinical course, with full expression of both SLE and RA in terms of organ involvement, except for a lower prevalence of kidney affection. The new 2019 EULAR/ACR SLE criteria are not useful for differentiating SLE and rhupus patients. A new way of classifying autoimmune diseases is needed to identify overlapping clusters.

Background Concomitant presence of two autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) is known as Rhupus. Despite, poliautoimmunity is not uncommon described in patients with systemic autoimmune diseases, only a small series of patients have been described so far with Rhupus. Our purpose was to analyze clinical and serological characteristics of patients with Rhupus and compare them with a cohort of patients with SLE. Methods In this cross-sectional study, we included cases of Rhupus (RA-ACR/EULAR 2010 plus SLE-ACR 1987 criteria) from different Rheumatology Departments at Catalonia, Spain. In addition, we included patients with diagnosis of SLE in a 2:1 ratio matched by sex and race. All information was recorded following an established protocol. Results A total of 57 patients were included, 19 cases with Rhupus and 38 cases of SLE alone as controls. 93% of patients were female, Caucasian represented 71.4%, Mestizo 17.9% and 5.4% were Asian. Mean age was 48.6±13.5 years and mean disease duration was 11.48±9.1 years. Main clinical characteristics were cutaneous involvement (75.0%), hematological (66.0%), serositis (19.3%), renal disease (17.9%) and secondary Sjögren syndrome (28%) among others. Clinical and serological characteristics according groups are shown in table 1. Conclusions We found some clinical and serological differences among patients with Rhupus and SLE alone. As expected, articular domains and titers of RF and ACPAs were higher in Rhupus and they are more commonly treated with methotrexate and rituximab. By other hand, leukopenia, oral ulcers, anti-Ro antibodies and higher SLEDAI score were more common among SLE patients. Whether Rhupus patients represent a different condition requires further analysis in bigger cohorts.

Background: Concomitant presence of two autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) is known as "Rhupus". Although poliautoimmunity is not uncommon phenomenon, only a small series of patients have been described so far with Rhupus. Objectives: Our purpose was to analyze the clinical and serological characteristics of patients with Rhupus and compare them with a cohort of patients with SLE. Methods: In this cross-sectional study, we included cases of Rhupus (ACR/EULAR 2010 plus ACR 1987 criteria) from 11 different Rheumatology Departments at Catalonia, Spain. We included patients with a diagnosis of SLE in a 2:1 ratio matched by sex, race and disease duration. To avoid misclassification, those patients with Rhupus but who had Jaccoud's arthropathy or with overlap syndromes were excluded. Results: A total of 120 patients were included, 40 cases with Rhupus and 80 cases with SLE. Most of patients were female (95%) and Caucasian (75%). Mean age was 51.0 ± 14.7 years with a mean disease duration of 12.9 ± 9.2 years. Main clinical characteristics were articular involvement (93.3%), cutaneous involvement (77.5%), haematological (72.5%), secondary Sjögren syndrome (38.7%) among others. Clinical and serological characteristics according different groups are shown in Table. Conclusion: We found some clinical and serological differences among patients with Rhupus vs SLE alone. As expected, articular domains and positive RF and ACPAs were higher in Rhupus. By other hand, renal involvement was more common among "pure" SLE patients. Rhupus patients were more commonly treated with prednisolone, MTX and rituximab, and had more comorbidities and organ damage. If Rhupus represent a different condition, requires further analysis in bigger cohorts. Disclosure of Interests: Beatriz Frade Sosa: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Tarek Carlos Salman Monte: None declared, Vera Ortiz Santamaría: None declared, Vicenç Torrente Segarra : None declared, Ivan Castellví Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000 USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Berta Magallares: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Delia Reina Speakers bureau: MSD, Novartis, Pfizer, Janssen, Sonia Mínguez: None declared, Maria Garcia Manrique de Lara: None declared, Sergi Ordoñez : None declared, Meritxell Sallés Lizarzaburu: None declared, Elena Riera Alonso: None declared, Jose A. Gómez-Puerta Consultant for: Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen, MSD, Pfizer, Roche

Background Patients with chronic inflammatory disease in treatment with immunosuppressants have an increased risk of opportunistic infections, including leishmaniasis. Objectives To describe a multicenter case series of leishmaniasis in patients with chronic inflammatory diseases treated with immunosuppressants. To analyze factors related to the infection. Methods Observational retrospective study. We reviewed the clinical history of patients with chronic inflammatory diseases treated with immunosuppressants, who were diagnosed with leishmaniasis between 2007 and 2018. Demographic (age, sex) and clinical (type and time of evolution of the inflammatory disease, comorbidities, current treatment, leishmaniasis form) variables were collected. Immunosuppressant withdraw, subsequent reintroduction and recurrence were recorded. We analyzed differences in clinical presentation related to anti-TNFα treatment. Statistical analysis were performed using SPSS 22.0 program. Results 55 cases were collected. 58,2% were men and the average age was 57,2 (SD 1,9) years. Twenty-one patients had spondyloarthropathy, 17 rheumatoid arthritis, 14 inflammatory bowel disease, 1 systemic lupus erythematosus, 1 Behçet and 1 uveitis. The average duration of the disease was 11,4 (SD 1,4) years and 30,9% of patients had other causes of immunosuppression. Thirty-eight patients received treatment anti-TNFα (19 infliximab, 11 adalimumab, 5 golimumab, 2 certolizumab and 1 etanercept), 15 with DMARD (14 methotrexate, 1 leflunomide), 1 with tocilizumab and 1 with azathioprine. 27.3% patients received corticoids. 52,7% developed cutaneous form, 38,2% visceral form, 7,3% mucocutaneous form and 1 presented visceral and cutaneous involvement. Treatment was withdrawn in 37 cases and it was reintroduced in 23 cases (8 anti-TNFα). Four patients relapsed. More cases of visceral leishmaniasis were seen in patients treated with non-anti-TNFα drugs and in those treated with glucocorticoids. Most of the recurrences were associated with mucocutaneous form. Conclusion In our series, the majority of cases of leishmaniasis occurred in patients treated with anti-TNFα, but non-anti-TNFα patients developed more serious forms. It's important to keep in mind this infectious complication in daily clinical practice. Disclosure of Interests L Montolio-Chiva: None declared, Elia Valls-Pascual: None declared, D Ybáñez-García: None declared, À Martínez-Ferrer: None declared, Marta Aguilar-Zamora: None declared, Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, A Sendra-García: None declared, JM Paredes Arquiola: None declared, Meritxell Fernandez Matilla: None declared, L Gómez Escolar: None declared, José Miguel Senabre-Gallego: None declared, J Lluch Pons : None declared, C Campos Fernández: None declared, M Robustillo-Villarino : None declared, María Dolores García-Armario: None declared, S Antón-González: None declared, ANA URRUTICOECHEA-ARANA: None declared, Isabel de la Morena Speakers bureau: Abbvie, Celgene, Pfzier, UCB, Ghebro, Roche, Sanofi, Janssen., J Fiter-Areste: None declared, Vega Jovani: None declared, A Martínez-Cristóbal : None declared, Lourdes Mateo: None declared, Sergi Ordoñez : None declared, D Reina-Sanz: None declared, C Vergara-Dangond: None declared, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho: None declared

Background Interstitial Lung Disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA). Objectives Our aim was to assess the efficacy of abatacept (ABA) in RA patients with ILD. Methods Retrospective multicenter study of RA patients with ILD treated with ABA. ILD was diagnosed by HRCT. We have analyzed the following variables: a) 1-point change the Modified Medical Research Council (MMRC); b) FVC improvement ≥10%; and improvement ≥10% in DLCO; c) radiological improvement in HRCT scan, d) changes in DAS28 score. Values were compared with baseline e) prednisone doses Results We studied 181 patients (94women/87 men) with ILD associated to RA. The follow-up was 12.1[6.2-24.1] months. The mean age was 64.54 ± 9.7 years. The median to progression of ILD was 12 [3-43.75] months. 81 patients were treated in monotherapy, 100 patients in combination therapy. The most frequent pattern was UIP 45,3%. The most of patients who did not have dyspnea remained asymptomatic. See results in Figure1. DAS28 also improved. We appreciate a decrease in the dose of prednisone compared to the initial dose. Conclusion ABA seems to be effective. However, should be verified in prospective and randomized studies. Disclosure of Interests Carlos Fernández-Díaz Speakers bureau: Bristol-Myers, J. Loricera: None declared, Santos Castañeda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, A. Juan-Mas: None declared, Carmen Carrasco-Cubero: None declared, Ivette Casafont-Solé: None declared, RAQUEL ALMODOVAR: None declared, Noelia Alvarez-Rivas: None declared, CLARA AGUILERA CROS: None declared, Ignacio Villa-Blanco: None declared, Sergi Ordoñez : None declared, Susana Romero-Yuste: None declared, C. Ojeda-Garcia: None declared, Manuel Moreno : None declared, I. Hernández-Rodriguez: None declared, M. López-Corbeto: None declared, Maria Lopez Lasanta: None declared, Francisco Ortiz-Sanjuán: None declared, B. Alvarez-Rodríguez: None declared, A. Ruibal-Escribano: None declared, Rosa Expósito: None declared, M. Retuerto-Guerrero: None declared, Trinidad Pérez Sandoval: None declared, Alejandra López Robles: None declared, Patricia Carreira: None declared, Natalia Mena-Vázquez: None declared, ANA URRUTICOECHEA-ARANA: None declared, C. Delgado-Beltran: None declared, José Luis Andréu Sánchez: None declared, Alejandro Olive: None declared, S, Rodriguéz-Muguruza: None declared, José Antonio Bernal-Vidal: None declared, E.C. Cervantes Pérez : None declared, Olga Maiz-Alonso Speakers bureau: Pfizer, R. Castellanos-Moreira: None declared, S Rodiguéz-Garcia: None declared, I. Cabezas-Rodriguez: None declared, Mireia Moreno : None declared, Ivan Castellví Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Luis Marcelino Arboleya Rodríguez: None declared, C. González-Montagut Gómez: None declared, Blanca Garcia-Magallon: None declared, E. Salgado-Pérez: None declared, M. Rodíguez-Gómez: None declared, C. Fito-Manteca: None declared, J M Blanco: None declared, DESEADA PALMA SANCHEZ: None declared, Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Gemma Bonilla: None declared, R. López-Sánchez: None declared, J. Fernández-Melon: None declared, Cristina Hidalgo: None declared, Miguel A González-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from Abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker’s bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Ricardo Blanco Grant/research support from: Abbvie, MSD, and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen

The aim of this study was to assess nailfold capillaroscopic (NC) findings in patients with primary Sjögren's syndrome (PSS) with and without Raynaud's phenomenon (RP) as well as in the presence of positive anti-SSA/Ro and anti-SSB/La antibodies. Videocapillaroscopy was performed in 150 patients with PSS. Data collected included demographics, presence of RP, PSS symptoms, antinuclear antibodies, rheumatoid factor, anti-Ro, anti-La, anti-CCP, salivary scintigraphy, labial biopsy, and NC findings. RP was present in 32% of PSS, keratoconjunctivitis sicca in 91%, oral xerosis in 93%, and skin or genital xerosis in 53%. In patients with positive anti-SSA/Ro (75%) and positive anti-SSB/La (40%), NC showed normal findings in 53% of cases and non-specific in 36%. In patients with PSS, NC was normal in 51% of cases and non-specific in 34%. Scleroderma pattern was found in 14 patients. RP associated with PSS had non-specific capillaroscopy in 40% of cases (p = 0.1). Pericapillary haemorrhages (p = 0.06) and capillary thrombosis (p = 0.2) were not increased, but more dilated capillaries were detected in 48% of cases. Patients with positive anti-Ro and/or anti-La have not a distinct NC profile. Patients with RP associated with PSS had more dilated capillaries, but neither pericapillary haemorrhages nor capillary thrombosis was observed.