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Objectives:To investigate the prevalence, risk factors, and effects of primary renal disease on morbidity and mortality in patients with primary Sjögren’s syndrome (pSS).Methods:All patients in the SJÖGRENSER (registry of adult SSp patients of the Spanish Society of Rheumatology, cross-sectional phase) cohort were retrospectively investigated for the presence of clinically significant renal involvement directly related to pSS activity.Results:Of the 437 patients investigated, 39 (9%) presented overt renal involvement during follow-up. Severe renal disease necessitating kidney biopsy was relatively rare (23%).Renal involvement may complicate pSS at any time during the disease course and is associated with severe disease (indicated by higher scores of involvement, activity, and damage), systemic multiorgan involvement, and a higher frequency of lymphoma. Multivariate analysis showed that older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.07), higher European League Against Rheumatism Sjogren’s Syndrome Disease Activity Index scores (OR 1.1, CI 1.03–1.18), serum anti-La/SSB positivity (OR 6.44, CI 1.36–30.37), and non-vasculitic cutaneous involvement (OR 8.64, 1.33–55.90) were independently associated with this complication.Chronic renal failure developed in 23 of 39 patients (59%); only 1 of them progressed to end-stage renal disease necessitating renal replacement therapy. Patients with renal disease showed higher Sjögren’s syndrome disease damage index scores (SSDDI), higher rates of hospitalization due to disease activity and higher rates of clinically relevant comorbidities.Conclusion:Renal involvement is an uncommon complication in pSS that was observed in 9% of patients. Although categorized as a non-negligible comorbidity, this condition shows a favorable prognosis.Disclosure of Interests:None declared

BackgroundAntiphospholipid antibodies (aPL) have been associated with organ damage and certain features in SLE patients.ObjectivesOur aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome.MethodsPatients from the RELESSER-T registry were included. RELESSER-T is a multicenter, hospital-based registry, with retrospective cross-sectional collection of data from a large representative sample of adult non-selected patients with SLE attending Spanish rheumatology services from the public national health system.ResultsWe included 3651 SLE patients and 1368 were positive for aPL (44.9% of patients were positive for anticardiolipin antibodies, 27.3% showed positivity for anti b2glycoprotein I and 24% for lupus anticoagulant). Overall 2283 patients were classified as SLE no aPL, 528 as SLE-APS and 840 as SLE-aPL. Demographic data, clinical and laboratory features in the different groups are showed in Table 1. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than SLE-aPL and SLE no aPL patients (p< 0.001, p< 0.001 and p=0,022, respectively). SLE-APS patients showed a lower prevalence of photosensitivity and higher frequencies of serositis, proteinuria (>0.5 grs), urinary cell casts, seizures and psychosis (p≤0.001). Overall, SLE-APS patients showed a lower rate of cutaneous manifestations and higher rates of neuropsychiatric, cardiac, pulmonary, renal, joint and ophthalmological manifestations (Table 1). In accordance with a more severe clinical profile, higher frequency of anti-DNA antibodies and hypocomplementemia were observed in the SLE-APS group (p<0.001). In addition to a higher disease activity (SLEDAI), SLE APS patients presented more damage accrual with higher values in SLICC (1.9±2.2 in SLE APS, 0.9±1. 4 in SLE aPL and 1.1±1.6, p<0.001) and Katz indexes (3±1.8 in SLE APS, 2.7±1.7 in SLE aPL and 2.6±1.6 in SLE no aPL, p <0.001).ConclusionSLE-APS patients show a more severe clinical profile with higher frequency of major organ involvement and more damage accrual than SLE-aPL and SLE no APL.Disclosure of InterestsLeyre Riancho-Zarrabeitia Grant/research support from: Abbvie, Pfizer, UCB, MSD, GSK, Amgen, Roche travel grants, Victor Martinez Taboada: None declared, Iñigo Rua-Figueroa: None declared, Fernando Sánchez-Alonso: None declared, María Galindo-Izquierdo: None declared, Juan Ovalles: None declared, Alejandro Olivé Grant/research support from: ND, Consultant for: ND, Paid instructor for: ND, Speakers bureau: ND, Antonio Fernandez-Nebro: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb, Raúl Menor Almagro: None declared, Eva Tomero Muriel: None declared, Esther Uriarte Isacelaya: None declared, Alina Boteanu: None declared, Mariano Andres: None declared, Mercedes Freire González: None declared, Gregorio Santos Soler: None declared, Esther Ruiz Lucea: None declared, Mónica Ibañez Ba...

ObjectivesTo investigate the primary respiratory manifestations (PRM) in SLE.MethodsAll patients in the RELESSER cohort were retrospectively investigated for the presence of PRMResultsAt least one PRM was present in 11.3% (365/3215) of cases. The most common was pleurisy, occurring in 21.1% of patients, followed by ALP in 3.6%, PE in 2.9%, PPH 4%, DILD in 2%, DAH in 0.8%, and SLS in 0.8%.The variables associated with the presence of PPM are shown in the following table 1:Odds Ratio95% ConfidenceIntervalP Age1,031,02–1,040.000SLEDAI score1,031,00–1,070,02Raynaud phenomenon1,411,09–1,840,01Severe nephritis1,561,18–2,060002Secondary APS2,21,63–2,970.000Anti-RNP positivity1,321,00–1,750054Cardiac disease2,811,90–4,160000Vasculitis1,811,25–2,620002Hematologic abnormalities1,311,00–1,710048Neuropsychiatric manifestations1,491,11–2.020009Gastrointestinal involvement2,051,14–3,670016After adjusting for known confounders in the multivariable model, PPM remained a risk factor for diminished survival (HR: 3.13).ConclusionsPPM independently contributed to a decreased survival in SLEDisclosure of InterestNone declared

BackgroundAt the end of 2011 we established a protocol in dose reduction of biological therapy in patients with imflammatory diseases. Those who achieved remission by clinical and laboratory tests and showed no radiographic progression or Doppler activity by ultrasound examination, received reduction of dosing. Patients with etanercept (ETN) reduced dose to 25 mg, and patients with adalimumab (ADA) increased injection interval to 3 weeks. Tocilizumab (TCZ) was tapered from 8 to 6 mg/kg. We have achieved optimization rates of 20% in 2012, close to 40% at the end of 2013.ObjectivesThe aim of this study is to take account of activity flares in optimized patients and their characteristics, in order to describe predictive factors of flare if possible.MethodsRetrospective analysis data from clinical records and database of 105 patients treated with ETN, ADA and TCZ, optimized from January 2012 to June 2013 considering lab tests (ESR, RCP), disease activity (DAS 28, BASDAI),functional capacity indexes (HAQ, BASFI), and GPE (general patient evaluation), at optimization, 6 and 12 months visits. We used SPSS 21.0 for statistical analysis.ResultsTable 1ParameterBasal6 months12 monthsESR12,5 (2–64)16,3 (1–52)17,20 (1–78)RCP0,23 (0,02–1,3)0,43 (0,1–1,4)0,30 (0,1–2,06)DAS282,04 (0,11–4,03)2,51 (1,13–4,88)2,38 (0,56–4,17)HAQ0,5 (0–2)0,5 (0–2)0,5 (0–2)BASDAI1,45 (0–4,2)2,37 (0–4,3)2,480 (0,5–6,4)BASFI1,85 (0–9)2,9 (0–9,5)2,67 (0–9,6)EGP21,03 (0–100)27,07 (0–100)21,83 (0–80)105 patients (53 female and 52 male), 31% rheumatoid arthritis (RA), 27,5% ankylosing spondylitis (AS), 37,7% psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with longstanding disease, (150 months (18-638)). All of them were considered to keep remission by second visit, but at 12 months 32% were diagnosed of flare (24,5% under ADA and 39,2% under ETN; none with TCZ). Patients who flared were RA (30%), AS (29%), PA (37%) and one JIA. Half of the patients with RA, 27,6% of AS and 21,6% of PA. Clinical response was good to increasing of DMARD dosing in 25% and to increasing of biological dosing in 68,7%, but 3 patients (9,3%) required switching to another biological drug.We applied an univariate regression logistic model using parameters at visit 2, and we found modestly risk of flare related with ESR, DAS 28, number of swelling and tender joints. An increase of one tender joint at visit 2 means OR 3,56 (95% CI: 1,28-9,91), increase of one swelling joint means OR 11,26 (95% CI: 2,23-43,23). Increase of DAS 28 over 0,6 means OR 8 (95% CI: 1,85-34,6), and an increase over 1,2 means OR 60 (95% CI: 6,41-561,96).Conclusions1/3 of patients suffered flares of disease activity, mostly happened in RA patients, most of them in the ETN group (not statistically significant). Patients who flared had increased DAS 28 at visit 2, but were considered at clinical remission then. Response to increasing in treatment dosing is usually good. We consider optimization as cost-effective practice among biological treated population. We need wider popula...