Immune response regulation by cytokines is a key to understanding AGR. The influence of the functional polymorphisms in genes coding for TNF-alpha (-308G > A), IL-10 (-819C > T, and -1082A > G), IFN-gamma [(CA)n], TGF-beta1 (+869T > C), and iCAM-1 (R241G and E469K), in addition to HLA and gender matching on the presentation of AGR in 51 pediatric renal recipients during a 36-month post-transplantation follow-up were analyzed. Also, donors and a control group were genotyped. All groups were within Hardy-Weinberg equilibrium for all polymorphisms except IL-10-819C > T and TNF-alpha (p < 0.005 and p < 0.01, respectively) in recipients. Transplants with gender mismatch showed a higher risk for AGR than those between individuals with gender match (OR, 4.227; p = 0.010). Recipients with a high-production compared with low-production TNF-alpha allele experienced earlier AGR (p = 0.030), and those with high-production alleles of both TNF-alpha and IFN-gamma showed a further increased risk (OR = 11.129, p = 0.024). These findings support the notion that a single genotype cannot by itself explain an event as complex as AGR. The sum or combination of different specific alleles of these genes could better account for the immune response to an allograft.

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Background Biological therapy has changed the management of patients with inflammatory disease, but with a great increase of pharmaceutical costs and emergence of potential adverse effects. At the end of 2011 we established an internal protocol in management and dose optimization of the patients with biological treatment. Those patients with inflammatory disease who achieve remission by clinical and laboratory parameters and show no ecographic activity (arthritis, enthesitis), receive a reduction of dose. Patients with etanercept 50 mg sc. weekly reduce dose to 25 mg, and patients with adalimumab at a dose of 40 mg/2 weeks increase injection interval to 3 weeks. Thus we have achieved optimization of 20% in 2012, which is close to 40% at the end of 2013. Objectives To show that there is not a significant clinical or analytical worsening in our optimized patients, considering basal data at the time of optimization and six months later. Methods Retrospective analysis of data from clinical records and our database of 105 patients treated with etanercept and adalimumab, optimized from 2011, considering lab tests results (ESR, RCP), disease activity (DAS 28, BASDAI), functional capacity indexes (HAQ, BASFI), and GP E (global patient evaluation of the disease). We used SPSS 21.0 for statistical analysis. Results 105 patients (53 female and 52 male), 31% with rheumatoid arthritis (RA), 27,5% with ankylosing spondylitis (AS), 37,7% wiyh psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with a longstanding disease, with a mean of 152,47 months of evolution (18-638). Table 1 shows both, the basal findings and the results from six months later. Parameter Basal 6 Months later ESR 12,5 (1–64) 16,3 (1–52) RCP 0,23 (0,02–1,3) 0,43 (0,1–1,4) DAS28 2,04 (0,11–4,03) 2,51 (1,13–4,88) HAQ 0,5 (0–2) 0,5 (0–2) BASDAI 1,45 (0–9,2) 2,38 (0–7) BASFI 1,85 (0–9) 2,9 (0–9,5) EGP 21,03 (0–100) 27,07 (0–100) Furthermore, 32,4% of patients had a DAS 28 increase over 0,6, but in only 14,7% DAS 28 increase resulted over 1,2. BASDAI an BASFI increases >2 from basal occurred in 4,4% of patients. EGP increases >20 from baseline occurred in 15% of patients. Conclusions Our patients optimized with etanercept and adalimumab maintain remission criteria based on clinical and laboratory parameters at six months. So, optimization seems to be safe and cost effective in an important amount of patients with longstanding disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5931

BackgroundIn our center we observed in preliminar studies that within pregnant SLE patients, Anti-Ro Ab carriers suffered less abortions than non-carriers.ObjectivesIt comes to test whether this results are statistically significant and if there is an association with other variables such as previous abortion and disease activity, described in the literature.MethodsPopulation of 105 SLE pregnant women, atended in our Hospital pregnancy and Lupus Unit. Anti-Ro/La Ab and antiphospholipidic Ab analysis in the 105 patients mentioned. Also analysis of the SLE activity through Lupus Activity Index in pregnancy (LAIP) and Systemic Lupus Erythematosus Disease Activity Index in pregnancy (SLPDAI) tools applied to 88 prospective pregnancies, and the influence of previous abortions.Results32 pregnancies with a history of previous abortion, resulting in 78.13% abortions and 21.87% births.56 pregnancies with no prior history of abortion, resulting in 5.35% abortions and 94.64% births (p<0.0001). 44 pregnancies Anti-Ro carriers, had 22.72% abortions and 77.27% births; and of 61 pregnancies non-carriers, causes 42.62% abortions and 53.38% births; OR:0.396, CI:0166-0944; p<0.05.Other valued Ab presence, has not been significant, neither disease activity.ConclusionsPrevious abortions presence is the most negative influence on pregnancy outcome. Anti-Ro Ab presence is a protective factor of pregnancy. Disease activity does not affect pregnancy outcome, although the observed trend is to increase the abortion risk, enhancing SLPDAI value; we believe this result is determined by selecting pregnancy time in terms of disease activity.ReferencesAnselm Mak, Mike W.-L. Cheung, Alicia Ai-cia Cheak and Roger Chun-man Ho Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression, Rheumatology 2010;49:281–288F. Mecacci, B. Bianchi, A. Pieralli, B. Mangani, A. Moretti, R. Cioni, L. Giorgi, G. Mello and M. Matucci-Cerinic Pregnancy outcome in systemic lupus erythematosus complicated by anti-phospholipid antibodies Rheumatology 2009;48:246–249 doi:10.1093H.J.A. Carp, P.L. Meroni and Y. Shoenfeld. Autoantibodies as predictors of pregnancy complications Rheumatology 2008;47:iii6–iii8Evelyn V. Rozenblyum, Sharon Sukhdeo, Edgar Jaeggi, Lisa Hornberger, Philip Wyatt, Carl A. Laskin, and Earl D. Silverman. Anti-Ro and Anti-La Antibodies in the General Pregnant Population: Rates and Fetal Outcomes. ARTHRITIS & RHEUMATOLOGY Vol. 66, No. S11, March 2014, p S63.Monika Østensen, Peter M. Villiger, Frauke Förger. Interaction of pregnancy and autoimmune rheumatic disease, Autoimmunity Reviews 11 (2012) A437–A446.Disclosure of InterestNone declared