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Background:In ankylosing spondylitis (AS) patients with lack of response to a first line of biologic disease modifying antirheumatic drugs (bDMARD), switching to another bDMARD is recommended, aiming either to the same or different therapeutic target. In several previous studies a decrease in drug survival has been noted when tumor necrosis factor alfa inhibitors (TNFai) are used as second or third treatment line (1,2).Objectives:Primary endpoint: To evaluate survival of bDMARD as second line treatment in patients with AS non responding to TNFai either because of lack or loss of efficacy. Secondary: To evaluate the impact on drug survival of several variables such as sex, HLA, peripheral arthritis, radiologic sacroiliitis, CRP, BASFI, BASDAI or bDMARD class.Methods:Observational, longitudinal and retrospective observational study. We included 67 patients diagnosed with AS who received treatment on second line with bDMARD (TNFai or anti IL7) after discontinuation of TNFai as first line of treatment. We analyze patients older than 18 yo, with at least 3 months of continuous treatment before and after switch, seen in our Hospital from 2006 to 2019. Data were collected regarding to demographics, HLA B27 positivity and functionality and activity index, CRP and treatment with cDMARDs.Results:All 67 patients included were still on follow up after switching to second bDMARD. Median age was 37 yo, 56.7% were male and 31%, smokers. 35.8% patients had axial AS; 1.5% peripheral arthritis; 62.7%, mixed and 9%, dactilitis. 76.1% had radiographic sacroiliitis and 74.6%, HLA B 27+. As first bDMARD, the most common was Infliximab (IFX) (47.8%), followed by Adalimumab (ADA) (19.4%) and Etanercept (ETN 14.9%). Mean survival was 32.4 months (IFX, 37 months; ETN, 45; Golimumab, 32.3 and ADA, 24.1). The commonest cause of treatment suspension was loss of efficacy (LoE) (56.7%), followed by lack of efficacy (LaE) (17.6%) and adverse effects (AE) (16.4%).As second bDMARD the most frequent was ADA (35.8%), followed by ETN (34.3%), Golimumab (9%), IFX (7.5%) and Secukinumab (6%) with a mean survival of 45 months (ETN 63.8, ADA 45.7, Golimumab 32). Treatment was discontinued in 47.8% of patients because of LoE (17.9%), LaE (17.9%) and EA (11.9%). A total of 16 AE were recorded, of which 6% were infections and 9%, allergic reactions. Regarding the analysis of the impact of other variables on drug survival, there was statistically significant differences on HLA B 27 carrier status (p=0.012), in which we observed an increase on survival when the patient is HLA B27 + and in whom BASDAI is higher before switching (p=0.02).Conclusion:In our study, we did not observe differences in survival of second line bDMARD in patients with AS regarding type of TNFai, case of discontinuation or type of radiographic involvement in the first line of treatment. Patients with HLA B27+ and high value of BASDAI at the beginning of second bDMARD showed an increased on drug survival. Contrary to literature, we did not see significant differences regarding CRP.References:[1]Glintborg B, Østergaard M, Krogh NS, Tarp U, Manilo N, Loft AGR, et al. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013 Jul;72(7):1149–55.[2]Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis. Semin Arthritis Rheum. 2017 Dec;47(3):343–50.Disclosure of Interests:None declared

virus infection was present in 29%. 25% were treated with tenofovir plus protease inhibitors, and 47% with tenofovir plus a non-nucleoside reverse transcriptase inhibitor. The mean value of BMD in lumbar spine (LS) was 0.93 g/cm 2 (range: 0.84-1.02) and in femoral neck (FN) 0.78 g/cm 2 (range: 0.69-0.86). For the comparison with the ESOSVAL cohort the worst value of T-score in either LS or FN was chosen and patients were classified according to WHO definitions (osteoporosis ≤-2.5, osteopenia-1 to-2.5); the results are presented in the table. Only the data for the 50-64 and 65-74 years groups were compared because the number of older HIV patients in our center was small. Significant differences were found between the categories of osteoporosis in men in the 65-74 years old group, and that of osteopenia in women in the 55-64 years old group.

BackgroundMacrophage activation syndrome (MAS) is a severe complication of several rheumatologic diseases, being of special relevance systemic lupus erythematosus (SLE) and systemic juvenile idiopathic arthritis (sJIA). Its characterized by an excessive activation of the immune system due to various mechanisms, including hyperactivation of macrophages and a failure in downregulation activity by NK and cytotoxic lymphocytes. There are various criteria for its diagnosis, highlighting secondary lymphohistiocytosis syndrome (HLH) criteria from 2004 and provisional secondary MAS criteria for JIA proposed by Ravelli in 20161.ObjectivesTo describe a case series of patients with MAS.MethodsThis is a retrospective case series of 16 patients with MAS secondary to systemic autoimmune diseases diagnosed in Ramón y Cajal Universitary Hospital between April 2009 and September 2018.ResultsThe baseline pathology was sJIA in 8 patients (2 cases with 2 episodes) and SLE in the other 6 patients. Mean age at diagnosis was 17.44 years for sJIA and 37.5 years for SLE. Mean time from diagnosis of the baseline disease to MAS episode was 11.31 years, with 3 cases being the initial manifestation of their systemic disease. 43.8% of patients were treated with corticosteroids previously to MAS episode, and 50% were being treated with DMARDS/biologic agents (SLE: 3 patients with hydroxychloroquine and 1 patient with mycophenolate and hydroxychloroquine; sJIA: 2 patients with Anakinra, 1 patient with tocilizumab and 1 patient with etanercept). Clinical and analytical characteristics of the patients are presented in table 1 and table 2, respectively. In SLE group, only 2 patients (33.3%) had high anti-DNA titers during the MAS episode, 5 patients (83.3%) had increased C3 consumption and 4 patients (66.6%) had increased C4 consumption. As severe manifestations, 4 SLE patients presented neurologic abnormalities and 3 patients presented external hemorrhage. Infection was confirmed as a trigger in 3 patients with SLE (50%) and 4 patients with JIA (40%). Prednisone at high doses was prescribed to all patients, cyclosporine in 4 patients (66.6%) with SLE and 9 patients (90%) with sJIA. Additionally, anakinra was prescribed in 4 patients (40%) with sJIA. 4 patients (66.6%) with SLE met secondary HLH criteria and 9 patients (90%) with sJIA met secondary MAS criteria. Bone marrow biopsy was performed in all patients with SLE and in 9 patients with sJIA, demonstrating hemophagocytosis in 5 patients (83.3%) with LES and 5 (50%) patients with sJIA. Only 2 patients in the SLE group died because of MAS.Table 2 Analytical measures. Hb=haemoglobin(g/dl), Nt=neutrophils (103/mm2), Pla=platelets (103/mm2), Cr=creatinine (mg/dl), Brb=bilirubin (mg/dl), AST (UI/L), ALT (UI/L), Fe=ferritine (ng/ml), Tg=triglycerides (mg/dl), Fb=fibrinogen (mg/dl), INR (International Normalizated Ratio). Hypotension Fever Rash Adenopathy Splenomegaly Hepatomegaly Haemorrhage sJIA 1 (10%)7 (70%)7 (70%)3 (30%)4 (40%)1 (10%)0 SLE 04 (66.7%)1 (16.7%)3 (50%)5 (83.3%)4 (66.7%)3 (50%...

BackgroundPatients with human immunodeficiency virus (HIV) have a higher prevalence of low bone mineral density (BMD) and fractures than the general population, but there are no comparative studies in Spanish population.ObjectivesTo assess the BMD in HIV-infected patients followed in a tertiary hospital of Madrid and compare it with the ESOSVAL cohort, which included 11035 patients and is representative of non-HIV population seen in Spanish tertiary centers.MethodsWe performed a cross-sectional study in which BMD values were determined in a prospective cohort that included HIV-infected patients seen our center during the period 2010–2015. Collected data included demography, comorbidities, treatment and densitometric variables.Results93 patients from a total of a total of 924 with BMD data were eligible for the study after discarding those younger than 55 years, because that group is not included in the ESOSVAL cohort. Mean age of patients of our whole cohort was 43.8 years (range: 17–83), 11% were older than 55 years, of whom 83 were men (83%). Most of them were Caucasians, with a mean body mass index 24.1 (range: 14,7–40.6). Median time of HIV infection was 162,6 months (interquartile range [IQR]: 77.7- 283,3), median CD4+ cells nadir was 224 (IQR: 100–332) and median maximun viral load was 4,9 log (IQR: 4,3–5,4); concomitant hepatitis C virus infection was present in 29%. 25% were treated with tenofovir plus protease inhibitors, and 47% with tenofovir plus a non-nucleoside reverse transcriptase inhibitor. The mean value of BMD in lumbar spine (LS) was 0.93 g/cm2 (range: 0.84–1.02) and in femoral neck (FN) 0.78 g/cm2 (range: 0.69–0.86). For the comparison with the ESOSVAL cohort the worst value of T-score in either LS or FN was chosen and patients were classified according to WHO definitions (osteoporosis ≤ -2.5, osteopenia -1 to -2.5); the results are presented in the table. Only the data for the 50–64 and 65–74 years groups were compared because the number of older HIV patients in our center was small. Significant differences were found between the categories of osteoporosis in men in the 65–74 years old group, and that of osteopenia in women in the 55–64 years old group.55–64y p-value65–74y p-value HIV+ESOSVALHIV+ESOSVAL n=60n=2893n=16n=1555 Males T-score ≤ -2,520%12.6%0.0879844%11.2%0.00005* T-score -1 to -2,561%48.9%0.02888*63%59.2%0.79102Females T-score ≤ -2,531%21%0.3884550%29,8%0.37768 T-score -1 to -2,582%50.1%0.01296*50%49,7%0.99107ConclusionsWe observed a statistically significant increase in prevalence of osteoporosis in HIV-infected men in the 65–74 years group, and in osteopenia HIV-infected men in the 55–64 years group, in concordance with the presumed greater risk derived from a variety of causes (treatment, chronic inflammatory status, comorbidities, etc.). A non significant trend towards an increased prevalence of osteoporosis in the 55–64 years group, and in osteopenia in the 65–74 years group was seen. As for women, there was a statistically significant increase in osteopenia prevalence in ...