Background Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)). Conclusion SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

Introduction Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). Materials and methods Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. Results We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE ( p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups ( p < 0.001). SLE-APS patients presented greater damage accrual with higher SLICC values (1.9 ± 2.2 in SLE-APS, 0.9 ± 1.4 in SLE-aPL and 1.1 ± 1.6 in SLE, p < 0.001) and more severe disease as defined by the Katz index (3 ± 1.8 in SLE-APS, 2.7 ± 1.7 in SLE-aPL and 2.6 ± 1.6 in SLE, p  < 0.001). SLE-APS patients showed higher mortality rates ( p < 0.001). Conclusions SLE-APS patients exhibited more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients.

Background Very few data are available on predictors of minimal disease activity (MDA) in patients with recent-onset psoriatic arthritis (PsA). Such data are crucial, since the therapeutic measures used to change the adverse course of PsA are more likely to succeed if we intervene early. In the present study, we used predictive models based on machine learning to detect variables associated with achieving MDA in patients with recent-onset PsA. Methods We performed a multicenter observational prospective study (2-year follow-up, regular annual visits). The study population comprised patients aged ≥18 years who fulfilled the CASPAR criteria and less than 2 years since the onset of symptoms. The dataset contained data for the independent variables from the baseline visit and from follow-up visit number 1. These were matched with the outcome measures from follow-up visits 1 and 2, respectively. We trained a random forest–type machine learning algorithm to analyze the association between the outcome measure and the variables selected in the bivariate analysis. In order to understand how the model uses the variables to make its predictions, we applied the SHAP technique. We used a confusion matrix to visualize the performance of the model. Results The sample comprised 158 patients. 55.5% and 58.3% of the patients had MDA at the first and second follow-up visit, respectively. In our model, the variables with the greatest predictive ability were global pain, impact of the disease (PsAID), patient global assessment of disease, and physical function (HAQ-Disability Index). The percentage of hits in the confusion matrix was 85.94%. Conclusions A key objective in the management of PsA should be control of pain, which is not always associated with inflammatory burden, and the establishment of measures to better control the various domains of PsA.

ObjectivesTo evaluate survival in the first 4 years of treatment with Baricitinib (BARI) vs anti-TNF (TNFi), as the first biological drug (BIO-1), in patients with rheumatoid arthritis (RA).MethodsRetrospective study of patients with RA, treated with the first BIO-1, with BARI or TNFi, from September-2017 to December-2021.General data (current age, at diagnosis of RA and at the start of BIO-1) were collected; RA: evolution time, RF, ACPA; type of BIO-1: dose received, time in treatment, reason for withdrawal. Univariate analysis of drug survival was performed using Kaplan-Meyer curves and the Long Rank test to differentiate by groups. For the multivariate study, Cox regression with proportional hazards.ResultsThe study includes 96 patients with RA, who have started treatment for > 1 month with BIO-1: BARI (n: 63/66% patients) or TNFi (33/34% patients): women: 82 (96%), current mean age (SD): 62 (1) years, at diagnosis: 51 (1) years and at the start of BIO-1: 59 (1) years. 36 (37%) patients are ≥65 years old, the mean time in AR is 7.6 years and the time in BIO-1: 1.34 (2.2) years. BIO-1 was withdrawn in 34 (40%) patients: Inefficacy: 17 (18%) patients, Complications: 14 (15%) [Cardiovascular/thrombosis: 2 (2%), rash: 2 (2%), infection-neoplasia-immunogenicity: 1 (1%) patient in each], loss to follow-up: 5 (5%) and others: 2 (2%).When comparing the BARI vs. TNFI group, no differences were detected between the general data, the percentage of patients >65 years of age, or the mean time in treatment or the reasons for drug withdrawal (Table 1). However, survival in the BARI group was significantly superior to TNFi throughout the period (p=0.04; HR: 0.47, 95% CI: 0.24-0.91, p=0.026) (Figure 1A).Table 1.Characteristics of patients who receive Baricitinib (BARI) or anti-TNF as first BIO-1 (TNFi).AllN: 96BARIN: 63 (66%)TNFiN: 33 (34%)PFemale, n (%)82 (85%)56 (89)26 (79)0.2Current age, mean (SD)62 (4.2)63 (6)59 (11)0.057Age at diagnosis RA, mean (SD)51 (4.9)52.5 (7.8)48.6 (15.5)0.17Age at start of BIO-1, mean (SD)59 (2.1)60 (4.9)55.9 (9.9)0.23≥ 65 years, n (%)36 (37)27 (43)9 (27)0.39RF positive, n (%)77 (80)54 (86)23 (70)0.1ACPA positive, n (%)74 (77)50 (79)24 (73)0.56Average time in BIO-1, years (DE)1.34 (2.2)1.85 (0.5)1.32 (2.4)0.21BARI 2 mg, n (%)-23 (36)--Withdrawal of BIO-1, n (%):38 (40)20 (32)18 (55)0.15- Complication14 (15)7 (13)7 (21)-- Loss of efficacy17 (18)8 (13)9 (27)-- Loss of follow up5 (5)5 (8)--- Other2 (2)-2 (6)-Figure 1.Survival probability in patients with rheumatoid arthritis who receive the first BIO-1. A. Between TNFi drug vs Baricitinib. B. Between TNFi vs Baricitinib 2 mg or 4 mg.In patients <65 years, the greatest survival of BARI is maintained (p=0.05), being significant in the first 24 months of treatment (p=0.02). In patients ≥65 years, significance was not reached throughout the overall period (p=0.5) and in the first 24 months of treatment (p=0.06).When comparing the BARI 2 mg (n: 23/36%) and 4 mg (n: 40/64%) groups, the 2 mg group is significantly older at RA diagnosis (73 [SD: 2] years vs 56 [SD: 3] years; p<0.0001) and at the start of BIO-1 (72 [SD: 1.4] years vs 54 [SD: 2.8] years; p<0.0001). However, survival in the BARI 2 mg group was significantly higher in the first 24 months (p=0.003;) (Figure 1B): BARI 2 mg HR: 0.14, 95% CI; 0.04-0.56, p=0.005, HR BARI 4 mg: 0.44 (95% CI; 0.20-0.96, p=0.038).Conclusion1. Survival of BARI is superior to TNFi during the first 4 years of treatment, especially during the first 24 months of treatment. 2. There are no differences between the cause that causes drug withdrawal. 3. The use of the 2 mg dose of BARI predominates in patients older than 65 years, with survival being greater than TNFi, especially in the first 24 months of treatment.AcknowledgementsThe study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB).Disclosure of InterestsNone declared

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