BackgroundLung fibrosis (LF) is a type of interstitial disease that leads to lung scarring, respiratory failure and later on, death. There are 2 main types of LF: idiopathic and secondary; and the prognosis is very different. LF becomes relevant in connective tissue diseases (CTD) and some studies have suggested that there could be an association between anti-Ro/TRIM21 antibodies and the development of interstitial lung disease in these patients.ObjectivesThe aim of this study was to assess if the presence of anti-Ro52/TRIM21 antibodies is an independent risk factor for developing CTD-associated LF. We also aimed to evaluate the initial manifestations of systemic diseases and clinical characteristics linked to certain antibodies.MethodsIt is a prospective, observational, longitudinal, single-center study conducted among unselected patients with CTD (rheumatoid arthritis, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis (PM), overlap CTD syndrome (OCTD), MCTD, primary Sjögren's sd (PSS), primary antiphospholipid sd, systemic vasculitis, and undifferentiated connective tissue disease).We analysed data from 1,432 caucasian patients included in the “Systemic Autoimmune Diseases (SAD) Registry” from 1988 to 2014. They were all checked at least biannually and blood samples were taken according to clinical practice. Exclusion criteria were LF as the initial manifestation of the SAD, LF already diagnosed at the first visit and also LF secondary to drugs or a specific environment.Results10% of patients included in the study developed LF. The OR for LF in patients with anti-Ro52/TRIM21 antibodies was 1.757 (95%CI=1.1–2.7). The OR for LF increased with every year of age (OR=1.03, 95%CI=1.02–1.04). Only 9 out of 146 patients with LF were positive for Anti-La/SS-B antibodies, and the OR for males was 8.6 compared to women (95%CI=1.8–39.5). Patients with SSc and PM showed a higher OR for the development of LF (6.9 95%CI=4.6–10.4 and 2.0, 95% CI=1.2–2.8 respectively) compared to those diagnosed with other CTD. The time passed from the first symptoms to the diagnosis of LF was inversely related to the age of onset (r=-.230; p=0.013). The average time was 60 months for patients with anti-Ro52/TRIM21 antibodies (29 patients) and 138 months for patients without them.LFpOROR 95% CI Yes (n=146)No (n=1286) Mean (Sd) n (%)Mean (Sd) n (%) anti-Ro/SS-A 60 kDa3926.730723.90.471.160.78–1.71anti-Ro52/TRIM213624.720515.90.011.721.15–2.58anti-La96.212910.10.140.580.29–1.17SLE2517.139830.9<0.0010.460.29–0.72MCTD138.9715.50.131.670.90–3.10OCTD138.9524.00.012.321.23–4.37SSc5235.61078.3<0.0016.094.11–9.02PM2617.81269.80.0061.991.25–3.16SSc-PM85.5161.20.0024.601.93–10.9PSS85.51007.80.4080.680.32–1.44Female3020.522917.80.421.190.78–1.82Age (y.)65.2514.558.317.2<0.0011.021.01–1.03ConclusionsAnti-Ro52/TRIM21 antibodies have been proved to be a risk factor for developing LF. The earlier the age of onset, the slower the progression to fibrosis. However, patients with anti-Ro52/TRIM21 antibodies tend to have a faster developm...

BackgroundSuppurative Hidradenitis (SH) is an inflammatory skin disease which often responds poorly to treatment. It is a disorder of the apocrine glands (axillary, inguinal and anogenital regions) that can result in infection, inflamed nodules, cysts, abscesses and sinus tracts. There is a 1–4% incidence of SH in patients with spondyloarthropathies and inflammatory bowel disease, possibly due to innate immune system deregulation. The use of biological disease-modifying antirheumatic drugs (bDMARD), specifically tumor necrosis factor inhibitors, has been useful in cases when other therapies fail.ObjectivesTo evaluate the prevalence of SH using the SH-questionnaire in bDMARD-treated chronic arthritis patients.MethodsThis cross-sectional study included 325 patients diagnosed with chronic arthritis. Patients were recruited consecutively from the Biological Therapy Unit of the Hospital General Universitario Gregorio Marañόn and evaluated from January to March of 2015. All patients had been undergoing full or tapered bDMARD treatment for at least 1 year and none had any history of SH. Those patients deemed to be in clinical remission were on tapered bDMARD dosage. All patients self-completed the validated SH-questionnaire (1) which was considered positive when one answer was affirmative and when lesions presented in >1 anatomical location. Patient pathologies were subclassified into 2 groups: i) peripheral arthritis (PerAR) which includes rheumatoid arthritis (RA), psoriatic arthritis (PsA) and peripheral spondyloarthropathies (PerSpA); ii) axial spondyloarthropathies (AxSpA). Clinical evaluation was performed by the same physician for all patients. Demographic, clinical and laboratory variables were recorded and disease status was assessed through the relevant clinical index, i.e.DAS28-ESR, DAS28-CRP, SDAI, CDAI, BASDAI, BASFI, ASDAS-CRP.ResultsSH-positive was observed in 25/325 (7.7% vs. 92.3%) patients. Of these 25 patients, 12 (48%) were female and 13 (52%) male. Mean age was 52 years (SD±12.9) and mean time since diagnosis was 14 years (SD±9.3). Twenty-four out of 25 patients were undergoing anti-TNF treatment (ETN=10, GOL=7, ADL=6, CTZ=1). Eighty-four per cent of patients were undergoing full bDMARD dosage with the remaining 16% on tapered. By subset pathology, 13 SH positives were PerAR type and 12 were AxSpA (5.8% vs. 11.8%, p=0.062). On analysis of PerAR subtypes, we found 6 patients had PsA and 5 RA. Evaluating clinical disease activity, we found 9/13 patients in the PerAR group to be in clinical remission according to DAS28-ESR and CDAI (p=0.02 for both). Additionally, we found only 4/12 patients in remission in the AxSpA group as defined under BASDAI, BASFI and ASDAS-CRP (p=0.006, p=0.005, p=0.004, respectively).ConclusionsWe found more SH-positives in the AxSpA than in the PerAR group, which is consistent with published data. A bDMARD tapered dosage was related to SH-positivity which might be linked to persistent and undetectable chronic inflammation.References Esmann S, et al. Br J Dermatol. 2010 Jul;163(...

BackgroundB-cell depletion is a fundamental effect of rituximab (RTX). The speed/depth of initial B-cell depletion is associated with clinical response, and non-responders largely having incomplete depletion.1 2 However, some patients with incomplete depletion still show clinical improvement (ID-R). Little is known about factors associated with complete depletion; the long-term outcome of the two responder groups according to their level of depletion has not been studied yet.ObjectivesTo assess factors that are associated with complete depletion and clinical response (CD-R) and compare the 3 year RTX retention between the two RTX responder groups (CD-R vs ID-R), with a view to inform practice on the optimal use of RTX in RA.MethodsA prospective observational study was conducted in patients with RA who were treated with RTX in Leeds. Each initial cycle of RTX consisted of 2 × 1000 mg infusions, repeated either on clinical relapse or fixed 6 monthly retreatment strategy. B-cells were measured at 0, 2 weeks and every 6 months using highly sensitive flow cytometry (as previously described). Complete depletion was defined as total B cell count <0.0001×109/L at week 2. Patients were classified into 4 groups based on B-cell depletion (CD=complete,) and EULAR response (R=good/moderate, NR=no response). Multiple imputation was used for missing data. Factors for predicting CD-R in cycle 1 (C1) were tested using logistic regression analyses. In the survival analysis, an event was defined as RTX cessation either due to death, safety or switching to other biologics.ResultsA total of 693 patients were treated with RTX in Leeds. Of these, 624 had clinical data at 6 months and were included in the analysis. Total follow-up was 2826 patient-years. In cycle 1, 418/624 (67%) had EULAR response. Of these, 242/418 (58%) had CD-R. In univariable analysis, age, concomitant MTX/LEF, non-smoker, pre-RTX lower naïve, memory B-cell and plasmablasts were associated with CD-R in C1. However, in a multivariable analysis, only concomitant MTX/LEF (OR 2.1 95% CI: 1.3 to 3.5), non-smoker (1.6, 1–2.6) increased the odds while lower plasmablasts (0.89, 0.83–0.95) decreased the odds of CD-R. After adjusting for confounders including age, gender, concomitant MTX/LEF and previous exposure to TNF-i, there was a trend to longer maintenance on RTX (surrogare for response) in the CD-R vs ID-R groups; HR 0.70 (95% CI: 0.46 to 1.05); p=0.058 (figure 1).Abstract OP0109 – Figure 1 Rituximab retention 3 years after the administration of the first cycleConclusionsAmong patients with good initial clinical response to RTX, we observed differences in immunological response. This had important long term consequences: in patients with early complete B-cell depletion accompanied by good clinical response, RTX treatment was sustained over 3 years numerically, while responses of ID were less durable. Therefore, treatment with anti-CD20 mAb should aim to achieve CD for sustained maintenance on rituximab. CD-R can be predicted by concomitant use of MTX/LEF, non-smokers a...