Aims: To compare the risk of community-acquired pneumonia (CAP) requiring hospitalization in spondyloarthritis (SpA) and non-specific back pain (NSBP), and to identify the risk factors for CAP in SpA. Methods: A total of 2984 patients with SpA from 11 rheumatology centers and 2526 patients with NSBP from orthopedic units were reviewed from the centralized electronic database in Hong Kong. Incidence of CAP requiring hospitalization and demographic data including age, gender, smoking and drinking status, use of sulfasalazine, individual biological-disease modifying anti-rheumatic drugs (DMARDs) used, micro-organisms, other immunosuppressants or immunosuppressive states, use of steroid for more than ½ year, and co-morbidities were identified. Risks of CAP in SpA were compared with those in NSBP using propensity score regression method. Multivariate Cox regression model was used to identify the risk factors in SpA. Results: CAP requiring hospitalization was found in 183 patients with SpA and 138 patients with NSBP. Increased risk for CAP was found in the following groups with SpA: all subgroups (hazard ratio (HR) 2.14, p < 0.001), without use of DMARDs (HR 2.64, p < 0.001), without psoriasis and not taking DMARDs (HR 2.38, p < 0.001). Infliximab (HR2.55, p = 0.04), smoking (HR 1.68, p = 0.003), comorbid psoriasis (HR 1.67, p = 0.003), and use of steroid for more than ½ year (HR 1.94, p = 0.003) were found to associate with CAP after adjustments for traditional risk factors. Conclusion: Risk of CAP is increased in patients with SpA. Our data favor universal influenza and pneumococcal vaccination programs in the population. Rheumatologists should also advise smoking cessation and avoid long term steroid therapy.

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BackgroundMSA test is useful to diagnose IIM and subcategorize patients by disease phenotypes.ObjectivesThe study aims to evaluate the survival of IIM patients of different MSA patterns.MethodsAn IIM registry had been set up in a tertiary referral centre since 2014 by recruiting prevalent and incident cases. Patients were followed-up prospectively. This study included patients fulfilling the 2017 EULAR/ACR classification criteria for IIM1 and excluded those aged < 18 at disease onset. Immunoblot EUROLINE autoimmune inflammatory myopathies 16 antigens strip (EUROIMMUNE AG, Lubeck, Germany) was used. Information including baseline demographic data, disease manifestations, MSA results, co-existing malignancy, duration of survival and causes of death were collected. IIM patients were divided into seven groups, which included 1) anti-aminoacyl tRNA synthetase (ARS) 2) anti-MDA5, 3) anti-TIF1γ/anti-NXP2, 4) double positive MSA, 5) other MSAs, 6) negative MSA/MAA (myositis associated antibodies) and 7) positive MAA only. Survival probabilities were compared among different MSA groups by using the Kaplan-Meier method and log-rank test. A two-tailed probability value (p) < 0.05 was considered significant. The study was approved by Kowloon Central Cluster Ethic Committee (ref.: KC/KE-17-0177/ER-3)ResultsAmong 112 IIM patients, 79 (70.5%) were female, and the median age of onset was 55 (18-90) years old; 63.4% were dermatomyositis (DM), 17.9% polymyositis (PM) and 18.8% clinically amyotrophic DM (CADM). Co-existing interstitial lung disease (ILD) was common and found in 65 (58%) patients; 16 (14.3%) had rapidly progressive interstitial lung disease (RPILD), and 16 (14.3%) died within the observed period. Overall, the commonest cause of death was RPILD, followed by infection and malignancy. While anti-MDA5 was strongly associated with RPILD (odds ratio = 33.0 [95% CI: 7.2-151.8], p<0.001), anti-MDA5 group had the worst survival, with 1-year and 5-year survival both at 43%, compared to above 80% in all other groups (log-rank test p<0.001) (Table 1). There were nine patients with double positive MSA and 28 had negative MSA/MAA. Analysis between MSA sub-groups found that the double positive MSA, MAA only and other MSAs group had no mortality during study period while the negative MSA/MAA group had the second highest mortality following the anti-MDA5 group (Figure 1). Infection and malignancy were the two major causes of death in the MSA/MAA negative group.ConclusionAnti-MDA5 associated RPILD was the leading cause of mortality in IIM. However, those tested negative for both MSA and MAA by current immunoblot technique also had guarded prognosis related to the risk of infection and malignancy.Figure 1 Kaplan-Meier survival of IIMTable 1 Survival rates in different MSA groups Survival 1 year 5 years Anti-ARS100%92%Anti-MDA543%43%Double positive100%100%Negative MSA/MAA89%82%Only positive MAA100%100%Anti-TIF1γ/anti-NXP2100%88%Other MSAs100%100%References[1] Lundberg IE, et al.. ARD2017;76(12):1955-1964.Disclosure of InterestsNone de...

Objectives A retrospective case-control study to estimate prevalence of pulmonary arterial hypertension (PAH) in systemic lupus erythematosus (SLE) and to study the associated clinical variables. Methods Clinical records of SLE patients followed up from 2006 to 2011 were retrieved. PAH was diagnosed by echocardiogram (systolic pulmonary artery pressure ≧ 40 mmHg)(1) or cardiac catheterization (mean pulmonary artery pressure ≧ 25 mmHg)(2). Controls were randomly selected from SLE patients with echocardiogram showing no PAH. PAH case: control ratio is 1:2 matching for age and gender. Clinical and serologic profiles were analyzed. Results Thirty nine PAH patients were identified, the prevalence was 10.1%. The mean onset of PAH was 7.5 ± 8.3 (mean ± SD) years after SLE diagnosis. Compared with controls, significantly more PAH patientss had pericardial effusion (43.6 vs 15.9%), pleural effusion (43.6 vs 13%), psychosis (12.8 vs 1.4%), interstitial lung disease (25.6 vs 8.7%), hemolytic anemia (38.5 vs 14.5%), lower hemoglobin at presentation (10.5 ± 2.5 vs 11.8 ± 2.0 g/dL), higher anti- ds DNA at presentation (242.8 ± 204.1 vs 166.0 ± 121.6 IU/ml), proteinuria of more than 0.5g /day (76.9 vs 53.6%), worse serum creatinine at end of study (180.7 ± 236.6 vs 105.2 ± 98.8 umol/L), anti RNP positivity (57.9 vs 27.5%), higher SLEDAI (median of 4.0 vs 2.0) and SLICC(median of 2.0 vs 1.0). Significantly fewer PAH patients had malar rash (46.2 vs 79.7%) and photosensitivity (7.7 vs 39.1%). Clinical pattern of anti RNP positivity with negative malar rash gave odds ratio of 5.60 for PAH. These two variables remained significant after multiple logistic regression. PAH group had higher right ventricular systolic pressure (RVSP) than controls in echocardiogram, with mean RVSP of 51.7 ± 15.4 mmHg vs 25.3 ± 5.2 mmHg (p <0.001). In PAH group, deceased patients had higher RVSP than surviving patients (60.4 ± 8.9 mmHg vs 50.4 ± 15.9 mmHg with p = 0.034). There was no significant difference in RVSP among those who were symptomatic of PAH and those who were asymptomatic (p = 0.195) Conclusions Clinical association of PAH with anti RNP positivity and absence of malar rash was noted. Awareness of factors associated with PAH in SLE aids early recognition and prompt treatment. References Galiè N, Hoeper MM, Humbert M, et al. ESC Committee for Practice Guidelines. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2009 Oct;30(20):2493-537 Hoeper MM, Lee SH, Voswinckel R, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 2006;48:2546–2552 Disclosure of Interest None Declared