BackgroundSarcopenia is a progressive and generalized skeletal muscle loss associated with falls, fractures, physical disability, and mortality, described as age-related or secondary. Systemic inflammatory diseases, such as rheumatoid arthritis (RA), are well-known causes of secondary sarcopenia. However, the exact prevalence of sarcopenia in patients with RA is still unknown, partly due to the heterogeneous definitions of sarcopenia adopted in different studies.ObjectivesTo assess the prevalence of sarcopenia in a cohort of patients affected by RA, and to evaluate the influence of age, sex, comorbidity, disease duration and activity, antibody status and therapies on sarcopenia.MethodsWe conducted a retrospective observational study on adult patients affected by RA undergoing evaluation at our outpatient clinic from January 2009 and July 2021. All patients underwent dual-energy X-ray absorptiometry (DXA) for assessment of body composition; diagnosis of sarcopenia was defined using Skeletal Muscle Mass Index (SMI), as proposed by consensus EWGSOP2 (1). We collected relevant demographic, clinical, therapeutic, and laboratory data at the time of DXA. We excluded patients affected by neoplastic disorders and/or malnutrition. Binary logistic regression analysis was employed to define predictors and protective factors of developing sarcopenia.ResultsA total of 266 patients (82.7% women) with a median age of 58.4 (IQR 14.4) years were included in the study. The prevalence of sarcopenia was 27.44%. From the binary logistic regression analysis, we found that the use of oral glucocorticoids (GCs) at a daily dose > 3.25 mg of prednisone-equivalent was significantly associated with sarcopenia (β 0.68, p = 0.047, aOR 1.98, 95% CI 1.009 – 3.881) (Figure 1). We found a significant inverse correlation between conventional disease-modifying antirheumatic drug (c-DMARDs) and sarcopenia (β -0.71, p = 0.027) as well. Age, sex, disease duration, mean disease activity - expressed as disease activity score based on 28 joints (DAS-28), erosive and seropositive disease - and biologic disease-modifying antirheumatic drug (b-DMARDs) therapy were not predictors of sarcopenia, albeit seropositive status showed a correlation trend with increased prevalence of sarcopenia (p = 0.092).Figure 1.ConclusionOur study showed that sarcopenia is a common complication in RA. Glucocorticoid therapy was associated with an increased prevalence of sarcopenia, while c-DMARDs acted as protective factors, possibly decreasing chronic inflammation. No correlation was found with b-DMARDs, possibly due to association with longer and more aggressive rheumatic disease.References[1]Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31Disclosure of InterestsNone declared

BackgroundSystemic Sclerosis (SSc) is an autoimmune disease characterized by vasospasm and microvascular involvement. Iloprost (ILO), a prostaglandin analogous, is used for the treatment of SSc-related Raynaud’s Phenomenon and digital ulcers. The indicated dosage is 0-5-2 ng/kg/min for 6-8 hours and the maximum dose is decided upon the patient’s tolerance.ObjectivesOur study aims to analyse ILO infusion tolerance and possible predictive factors in patients with SSc.MethodsWe evaluated patients with SSc beginning ILO iv treatment between 2004 and 2021. We assessed the maximum tolerated ILO iv infusion rate, the incidence of adverse events (AEs) and the need for symptomatic therapy during the dose-finding sessions. We collected relevant demographic and medical data at the beginning of ILO iv treatment. Statistical analysis were performed to assess possible predictors of maximum tolerated ILO infusion rate and AEs.ResultsWe retrospectively analysed 113 patients. The median ILO infusion rate at the end of the dose-finding process was 0.88 ng/kg/min (IQR 0.37). We found a significant inverse correlation between ILO infusion rate and body mass index (BMI) at the beginning of treatment. BMI was negatively associated with ILO infusion rate (β -0.29, p = 0.001) after correction for relevant confounding factors. Subjects in the upper BMI tertile (BMI above 25) had a lower tolerance to ILO compared with subjects in the lower BMI tertile BMI below 22 (p=0.002). Disease pattern, disease duration, age at the onset of disease, mean blood pressure, gender, smoking habits, combination therapy with calcium channel blocker or endothelin inhibitors were not predictors of ILO tolerance. AEs during ILO titration occurred in 47.8% of patients, of whom 22.2% presented concomitant hypotension. The most common AEs were headache, nausea, vomiting, diarrhoea, oedema, hypotension, and symptomatic therapy was needed in half of the patients at least once. Overweight patients (BMI >26) presented a 13-fold increased risk of developing AEs during ILO titration (adjusted odd ratio 13.979 95% CI 2.359-82.845).ConclusionOur study showed that only a higher BMI was associated with lower ILO infusion rate tolerance and higher AEs rate, underlying a possible BMI-dependent endothelial dysfunction possibly mediated by endothelin receptor expression. Individual ILO regimens still need to be tailored to the patient.Disclosure of InterestsNone declared