Background:Graves’ Orbitopathy (OG) is the main extrathyroid manifestation of Graves’ disease (GD). Up to 25% of patients have moderate-severe inflammatory activity with a risk of major sequelae. Intravenous (i.v.) glucocorticoids (GC) pulses are the standard therapy. In refractory cases, several classic and some biological immunosuppressantsare used, obtaining variable responses. Interleukin 6 (IL6) is involved in the pathogenesis of OG, which has justified the off-label treatment with Tocilizumab (TCZ)1, whose use by route i.v. has shown favorable results in published small case series and a single multicenter trial2.Objectives:To analyse the ocular effectiveness of anti-IL6 therapy used subcutaneously (s.c.) in patients with moderate-severe active refractory OG in usual clinical practice.Methods:Retrospective descriptive observational study of a series of cases of moderate-severe OG patients treated with anti-IL6 s.c. The patient medical records of those who had received at least 1 cycle of anti-IL6 treatment were reviewed (December 2013-December 2019). The primary effectiveness outcome was the change of the Clinical Activity Score (CAS). Favorable response was considered: reduction of CAS≥2 points together with obtaining inactivity (CAS <3). Demographic data, personal medical history, clinical aspects of GD, previous therapies and data on the use and safety of anti-IL6 were collected. The SPSS11 package was used for statistical analysis, using non-parametric tests for quantitative variables. The study was approved by the local Ethical Committee.Results:12 of the 15 patients (80%) were women with a mean of 50.27 years (21-72). 60% (n=9) had smoking history, 40% (n=6) active. 26.7% (n=4) were diabetic, all without retinopathy. 100% of patients received imidazole antithyroid treatment. 46.7% (n=7) required β-blockers and 20% (n=3) diuretics. 66.7% thyroidectomy (n=10) and 20% (n=3) decompressive eye surgery and/or blepharoplasty were performed. Thyroid and ocular radiotherapy were used in 2 patients. 3 patients received botox. 80% (n=12) of them had previously received GC. 93.3% (n=14) were naïve to biological therapy, only 1 patient previously used Rituximab. All except one patient who was treated with SRL received TCZ as IL6 therapy. A significant favorable response was obtained in 100% of the patients (p=0.008), decreasing CAS average from 4.9 (2-7) to 1.7 (0-2) at the end of the therapy [Figure 1]. The severity of the OG changed from being moderate in 72.7% of the patients to mild in 66.7% of the total. The median time to inactivity was 8 months (2-15). 73.3% (n=11) of the patients finished the treatment reaching inactive OG, the rest (although inactive) maintained therapy. After 6 months, 100% of those who completed the treatment remained inactive with average CAS of 1.3 (0-2). Smoking did not influence the response, nor any other variable collected. Adverse events appeared in 26.7% (n=4) of the cases, all of them mild and without widrawal.Conclusion:Treatment with anti-IL6 s.c. steadily decreases the clinical activity measured by CAS in patients with moderate-severe refractory OG, despite poor prognosis factors (such as smoking), with a good safety profile.References:[1]Taylor PN, Zhang L, Lee RWJ, Muller I, Ezra DG, Dayan CM, et al. New insights into the pathogenesis and nonsurgical management of Graves’ orbitopathy. Nat Rev Endocrinol. 2020 Feb;16(2):104-116.[2]Perez-Moreiras JV, Gomez-Reino JJ, Maneiro JR, Perez-Pampin E, Romo Lopez A, Rodríguez Álvarez FM, et al. Efficacy of Tocilizumab in Patients With Moderate-to-Severe Corticosteroid-Resistant Gravesˊ Orbitopathy: A Randomized Clinical Trial. Am J Ophthalmol. 2018;195:181–90.Disclosure of Interests:None declared

Background:Rituximab (RTX) is a monoclonal antibody against the CD20 B cell antigen that has been used successfully in recent years for the treatment of rheumatoid arthritis (RA). It is an effective drug that reaches survival rates of 60% at 5 years of treatment as reflected in the British experience. However, survival in Spanish patients is unknown.Objectives:To study the survival of RTX treatment and the characteristics of patients with RA treated with the drug since its commercialization in Spain.Methods:Observational, retrospective and analytical study of a cohort of patients with RA treated with at least one dose of RTX. We reviewed the medical records of all patients with RA from January 2007 to June 2017. A total of 178 previous defined variables were collected, highlighting data about treatment (use of RTX, associated conventional synthetic disease modifying drugs [FAMEsc], doses of corticosteroids [GC] used) and activity indices. Descriptive statistics were performed (median and the 25th and 75th percentiles are shown). The comparative analysis was done with χ2 and U of Mann Whitney for categorical variables and paired sign rank test or Student’s t for continuous. Survival Kaplan Mayer curves were constructed. The study was carried out in accordance with the standards of our Clinical Research Ethics Committee.Results:A total of 54 patients were analyzed. 74% (n = 40) of them were women, the age was 61.2 years (51.0 - 67.4). 74% (n = 40) presented some type of relevant comorbidity. Its RA was FR + in 96% (n = 52) and ACCP + in 78% (n = 42) of the cases, with an evolution time of 9.3 years (3.5-19, 2), and with radiographic erosions in up to 63% (n = 34). At the time of the start of the RTX, 100% of the patients (n = 54) received some FAMEsc, and 33 (61%) were treated with prednisone; the daily dose of prednisone was 9 (6-12) mg. The baseline DAS28-VSG was 5 (4.1 - 6.0). The duration of the follow-up was 56.6 (29.3-92.1) months. Patients received a mean of 5 (1-6) cycles of RTX at a dose of 1000 mg on days 0 and 15 in most cases. The final DAS28-VSG was 2.6 (2.1 - 4.0), p = 0.00001 compared to baseline. The delta between baseline and final DAS was -2.36 (-0.55 - -3.1). At the end of the RTX treatment, the EULAR response rate was good in 64% (n = 25), reaching remission in 17 (31%) of the patients, and moderate response in 21% (n = 8) of them (Figure 1). Only 2 (4%) patients were treated with GCC at the end of the follow-up, p<0,00001 compared to baseline. The daily dose of PDN at the end of follow-up was 6 mg in a case and 12 mg in the other, p=00001 compared to baseline. At the end of the follow-up 24%of the patients (n = 13) changed or discontinued the drug: 9 changed due to secondary failure, 2 suspended due to adverse events, 1 due to death due to prior neoplastic process and 1 due to complete disease remission. Survival at 1, 2, 3, 4, 5, 6 and 7 years was 92%, 92%, 82% 78%, 75%, 75% and 65% respectively; with a mean survival rate of 90 months (Figure 1).Conclusion:The results of our analysis show that patients with RA undergoing RTX treatment have adequate control of disease activity and drug survival rates, like published data. RTX treatment allowed stopped GCC treatment in 31 cases (90%).References:[1]Oldroyd AGS, et al. Rheumatology (Oxford). 2018 Jun 1;57(6):1089-1096.Disclosure of Interests:Gonzalo Jurado Quijano: None declared, Lola Fernández de la Fuente Bursón: None declared, Blanca Hernández-Cruz Speakers bureau: Sociedad Española de Reumatología, Abbvie, Roche, Bristol, MSD, Lilly, Pfizer, Amgen, Sanofi, Consultant of: Abbvie, Lilly, Sanofi, STADA, UCB, Amgen, Grant/research support from: Fundación para la Investigación Sevilla, Junta de Andalucía, Fundación Andaluza de Reumatología, Paloma Muñoz Reinoso: None declared, Vicente Merino Bohóquez: None declared, José Javier Pérez Venegas: None declared

Background:The antisynthetase syndrome (SAS) is characterized by the presence of antisynthetase antibodies, anti-JO1, PL7 y PL12 are the most common; and the classic triad of myositis, arthritis, and diffuse interstitial lung disease (ILD)1. Most patients present incomplete forms and the severity of the ILD determines the prognosis of the disease2.Objectives:to analyze epidemiological, clinical and serological characteristics and treatments used in a cohort of patients with SAS.Methods:descriptive study of review of medical records. Data were collected from 15 patients with SAS followed in the Rheumatology and Pneumology consultations of the Virgen Macarena Hospital (Seville) in the last 10 years. The analysis was carried out using the R software.Results:15 patients were included, 8 men and 7 women. The median age was 56 years (33-77). Seven patients (47%) used to smoke. Four patients (27%) met the classical triad. All of them presented ILD and 8 patients (53%) had arthritis and / or myositis. Five (33%) had mechanic’s hands and six of them (40%) presented Raynaud. Seven (47%) suffered from dyspnea before the SAS diagnosis. The median diagnostic delay was 1 month (0-43). Seven (47%) patients had anti-JO1, 1 (7%) anti-PL7, 2 (13%) anti-PL12 and 2 (13%) patients anti-Ro52. Radiological patterns detected by HRCT were: 5 (33%) NINE, 4 (37%) NIU and 6 (40%) others. The initial treatment included mostly (66%) glucocorticoids (GC) and one or more cFAME. In maintenance, mycophenolate was used in 7 patients (47%), cyclosporine 5 (33%), cyclophosphamide in 3 cases (20%), azathioprine in 3 patients (20%) and methotrexate in 3 of them (20%). Four (37%) patients required a combination of DMARDs and 2 cases needed (13%) biological therapy, Rituximab and Tocilizumab. Changes in the mean value of the initial respiratory function tests (FVC1 and DLCO1) and during follow-up (FVC2 and DLCO2) were not relevant (FVC1 81.5% [42-110], FVC2 81% [59-115]; DLCO1 83% [10-112], DLCO2 80.5% [47-108]). Nine patients (60%) remained clinically stable and 3 patients (20%) progressed radiologically. Four patients died from ILD progression.Conclusion:In this study, the incomplete diagnosis of SAS predominated. The most detected antibody was anti-JO1. ILD is present in all cases, with NINE being the most frequent pattern so multidisciplinary management is necessary. Most used treatments were GC and FAMES combined, some cases required biological therapy.References:[1]Irazoque F, et al. Epidemiology, etiology and classification. Reumatol Clin. 2009;5:2-5.[2]Johnson C, et al. Clinical and pathologic differences in interstitial lung disease based on antisynthetase antibody type. Respir Med. 2014; 108(10):1542-8.Disclosure of Interests:None declared

Background:Low-field MRI (LF-MRI) is a useful Imaging technique for the diagnosis and in the follow-up of high-impact rheumatologic pathology1. However, the use of the Low-field MRI is not widespread due to the high cost and the use of other techniques such as Musculoskeletal sonography2. The Rheumatology Unit of the HUVM owns a Musculoskeletal Imaging Unit (ECO /MRI) and a standardized protocol for LF-MRI3, which is performed by a rheumatologist applied in a routine clinical practice. We describe the patterns of use of LF-MRI by general rheumatologists in their routine clinical practice.Objectives:Perform an analysis of the use of LF-MRI in a Rheumatology department to the assessment of joint inflammatory activity. Correlate the results of the analyses in patients without diagnosis or patients with unclear diagnosis.Methods:Retrospective analysis using the medical records of the patients referred to the Musculoskeletal Imaging Unit from January to June 2018. The main variables collected were reason for referral as well as previous and final diagnosis after LR-MRI. An evaluation on the usefulness of MRI is made twelve months later to establish the diagnosis.Results:The global population studied of 114 patients were referred to for LF-MRI. 81 females (71%). The 80% of the patients with previous diagnostic 40% Rheumatoid Arthritis (RA), 24% Psoriatic Arthritis (PAs), 16% other rheumatic diseases, and the remaining 20% with an unclear diagnosis. The most frequent reasons for referral were: 1) A total of patients (female and male) was referred to assessment of inflammatory activity prior to the change of treatment and 2) assessment of subclinical activity in patients with optimized treatment. A total of 23 patients (16 female; 7 male), were referred for diagnostic evaluation or differential diagnosis: 7 arthralgias, 6 suspected psoriatic arthritis, 6 with undiagnosed joint inflammation, 2 for differential diagnosis, 1 suspected of juvenile idiopathic arthritis (JIA), and 1 tendinitis. (Table 1)Table 1.Undiagnosed patients. Post-imaging diagnosis.TENOSYNO-VITISNODIAGARMONOART-HRITISOACARPAL TUNNELRULE OUT PAsGOUTSpAPLAN-TAR FASCII-TISJIAPAsOS TRI-GO-NUM ARTHRALGIAS1110010201000SWOLLEN JOINT WITHOUT DIAGNOSIS0111200000001DIFFERENTIAL DIAGNOSIS0010100000000SUSPECTED PAs0210001010010SUSPECTED JIA0000000000100TENDINITIS WITHOUT DIAGNOSIS1000000000000Total2441311211111Conclusion:The results of our study shown that the addition of the LF-MRI into clinical practice and performed by a rheumatologist is a useful tool in the diagnosis and evaluation of the degree of disease activity in patients with joint inflammatory pathology. The main test-indication of these techniques is to assess the degree of activity of the disease. In a 20% of the cases, the LF-MRI was requested for diagnostic evaluation in patients without a clear diagnosis. The long-term follow-up studies that correlate symptoms with structural damage are necessary to define remission more accurately and evaluate the efficiency of different treatment options.References:[1]Hunt L, Eugénio G, Grainger AJ. Magnetic resonance imaging in individuals at risk of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2017 Feb;31(1):80-9.[2]Mandl P, Ciechomska A, Terslev L, Baraliakos X, Conaghan PG, D’Agostino MA, et al. Implementation and role of modern musculoskeletal imaging in rheumatological practice in member countries of EULAR. RMD Open. 2019 Jun 25;5(2):e000950.[3]Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Radiographics. 2018 Sep-Oct;38(5):1478-95.Disclosure of Interests:None declared

Background:There are no RA response predictors for our patients. The decision to initiate a first biological depends on multiple factors such as rheumatologist experience, clinical characteristics of the patient and health system. What is clear is that the best strategy is T2T.Objectives:To know the clinical characteristics and persistence of the first biological DMARD in patients receiving bDMARDS TNF inhibitors vs DMARDs aimed at other targets.Methods:A observational cohort of adult RA patients (ACR/EULAR 2010) in a rheumatology department of a third-level university hospital. All patients were treated with a first bDMARD marketed in Spain, from 2010 to December 2020 and prescribed according to product data sheet. Biological drugs were divided into TNF inhibitors drugs (adalimumab, etanercept, infliximab, golimumab, certolizumab) and Other targets (abatacept, rituximab, sarilumab, tocilizumab). Clinical data, duration of treatment and EULAR response were collected from each patient. The data were analyzed with descriptive, bivariate statistics and survival analysis adjusted for age, sex, FR, erosions and duration of the disease.Results:Data were collected from 332 patients (table 1). Patients treated with other target bDMARDs were mostly female, with higher activity, shorter disease duration, and treated without MTX.b Survival graphs showed that regardless of the target chosen as fist bDMARD, EULAR response rates and persistence to the drug were similar.Table 1.VariableTNF inhibitorsn=194Other targetsn = 138Totaln =332pn (%)n (%)n (%)0.02Female142 (73)115 (83)257 (77)0.2FR +163 (82)121 (88)284 (86)0.6ACPA +125 (63)84 (61)209 (63)0.9Erosions177 (89)80 (58)257 (77)0.01Concomitant MTX153 (77)62 (47)215 (65)0.003EULAR response Good103 (77)67 (71)170 (75)0.2 Moderate24 (18)16 (17)40 (17) No7 (5)11 (11)18 (8)Mean ± SDMean ± SDMean ± SDAge (years)55.7 ± 13.357.6 ± 11.956.5 ± 12.70.1Evolution of RA (years)9.6 ± 10.27.5 ± 7.58.7 ± 9.20.04Persistence (months)19.3 ± 20.516.07 ± 15.1117.5 ± 18.50.04DAS28VSG4V basal5.02 ± 1.55.59 ± 1.035.25 ± 1.30.001DAS28VSG4V final2.68 ± 1.12.84 ± 1.42.7 ± 1.250,31Conclusion:Patients receiving Anti-TNF vs bDMARD with other mechanisms of action have clinical differences. However, the response and persistence to the drug are similar, perhaps due to the implementation of the correct T2T strategy.Disclosure of Interests:None declared