OBJECTIVES To evaluate risk factors for severe Coronavirus Disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis. METHODS An observational, cross-sectional multicenter study was performed. Patients from 10 Rheumatology departments in Madrid who presented with SARS-CoV-2 infection between Feb 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (sociodemographic, clinical and treatments), using logistic regression analyses. RESULTS 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age and comorbidities such as diabetes mellitus, hypertension and obesity were associated with severe COVID-19. Corticosteroid doses over 10 mg/day, rituximab, sulfasalazine and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, p<0.001), although there were no differences in overall severity in the multivariate analysis. CONCLUSIONS This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-TNF therapy were not associated with worse outcomes.

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BackgroundThe therapeutic management of Sjögren’s Syndrome remains challenging in clinical practice. Randomized clinical trials with rituximab (RTX) fail to submit primary outcomes; nevertheless, some case series show improvement with this treatment.ObjectivesTo evaluate the effectiveness of therapy with RTX in patients with primary Sjögren’s Syndrome (pSS).MethodsA retrospective chart review was conducted among patients with pSS who fulfilled 2002 AECG and 2016 ACR/EULAR criteria and had received RTX in the last 6 years. Patients with Sjögren’s Syndrome associated with other autoimmune diseases were not included. Clinical, serological and radiological variables were analyzed (prior and 6 months after RTX therapy). A descriptive statistical analysis was performed.Results18 patients were analyzed, 72.2% women, with a mean age of 60.9 years (36-83) and a mean duration of disease of 9.7 years (2-28).Reasons for treatment initiation were pulmonary involvement (n=5), renal involvement (n=4), arthritis (n=3), severe ocular/oral dryness (n=3), recurrent mumps (n=2) and autoimmune hepatitis with lymphadenopathy (n=1).Initial regimen was 2 doses of 1 g each administered 15 days apart. In 8 patients the dose was reduced in subsequent cycles to a single dose of 1 g or 500 mg. The mean number of cycles received was 3.2 (1 - 12).In 7 patients its administration persists as maintenance treatment every 6 months. In 5 patients, treatment was suspended because of clinical improvement/stability; in 2 it was stopped due to adverse effects (one for psychosis and the other for infusion reaction).; in 1 patient it was discontinued due to lack of efficacy in dryness; in 1 patient with pulmonary involvement, it was replaced by mycophenolate due to COVID-19 pandemic and clinical stability; in 1 patient it was suspended due to initiation of radiotherapy for epidermoid carcinoma of the scalp and 1 died of large cell neuroendocrine carcinoma.RTX was effective in 5 (100%) patients with pulmonary involvement (clinical, radiological and functional stability and/or improvement); in 4 (100%) patients with renal involvement (clinical and analytical improvement); in 3 (100%) patients with arthritis complete improvement was obtained; in 2 (100%) patients with recurrent mumps relapse was avoided; in 1 (100%) patient with autoimmune hepatitis and lymphadenopathy clinical and radiological improvement was obtained. Of the three patients with dryness: 1 experienced subjective clinical improvement, 1 reported improvement coinciding with the use of therapeutic contact lenses and 1 improved only at the beginning.Subjective improvement in asthenia was observed in 4 patients.Complement levels normalized in 4 of 5 patients with hypocomplementemia as well as in 4 of 4 with increased B2-microglobulin; 3 of 6 patients with hypergammaglobulinemia normalized IgG value. No changes were observed in the four patients who were rheumatoid factor positive.6 of 6 patients receiving corticosteroid treatment, reduced the dose by half and 1 achieved corticoid withdrawal.ConclusionThe observed data suggest that RTX may be useful in selected patients with pSS. Further research is needed to determine its efficacy.References[1]Chen YH, Wang XY, Jin X, Yang Z, Xu J. Rituximab Therapy for Primary Sjögren’s Syndrome. Front Pharmacol. 2021 Sep 2;12:731122[2]Ramos-Casals M, Brito-Zerón P, Bombardieri S, Bootsma H, De Vita S, Dörner T, et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Ann Rheum Dis. 2020 Jan;79(1):3-18[3]Mavragani CP, Moutsopoulos HM. Sjögren’s syndrome: Old and new therapeutic targets. J Autoimmun. 2020 Jun;110:102364[4]Mariette X, Criswell LA. Primary Sjögren’s Syndrome. N Engl J Med. 2018 Mar 8;378(10):931-939Disclosure of InterestsNone declared

BackgroundThe rate of psoriatic arthritis progression is increased in those patients presenting with established disease greater than 2 years duration, so it is necessary to find tools that allow early diagnosis to prevent joint damage1. Prevalence of psoriatic arthritis varies according to the screening strategies used. The COMPAQ study compared four screening questionnaires for psoriatic arthritis (PEST, ToPAS, PASE and EARP), whose sensitivities ranged from 44 to 91%, with the EARP questionnaire showing the highest sensitivity2. A new, shorter questionnaire, PURE-4 scale, has been developed, with a sensitivity of 85.7%3.ObjectivesTo evaluate the usefulness of PURE-4 scale in real clinical practice conditions to identify patients with psoriatic arthritis in patients with psoriasis referred from a dermatology department to a rheumatology department.MethodsRetrospective descriptive study of patients diagnosed with psoriasis who have been referred from the Dermatology Department in the last 12 months for suspected joint domain according to PURE-4 scale used by this department. The following variables were collected: age, sex, obesity, dyslipidaemia, smoking, family history of psoriasis, form of psoriasis (plaque, palmoplantar, scalp, nail), previous treatment (topical, methotrexate, other, none), PASI index, compliance with CASPAR criteria, rheumatological diagnosis (psoriatic arthritis yes/no), PURE-4 score, morning stiffness in hands, Achilles enthesitis, inflammatory low back pain and need for anti-inflammatory drugs for joint pain in the last 3 months. Descriptive statistics was performed and Chi-square test was used to compare the diagnosis of psoriatic arthritis with PURE-4 values (at the response threshold ≥ 1 it has a sensitivity of 85.7% and a specificity of 83.6%).ResultsIn the last 12 months the Dermatology Department of our hospital made 33 referrals for suspected psoriatic arthritis in patients diagnosed with psoriasis. Mean age was 46.4 ± 12.4 years, 51.5 % were men. Fifty-one percent of the patients had a BMI ≥25, 30.3% had dyslipidaemia and 45.5% were smokers; 10% of the patients had family history of psoriasis. The most prevalent form of psoriasis was plaque (18%) followed by nail (6%), palmoplantar (3%), scalp (3%) and droplet (3%) involvement; 51.5% of patients were on topical treatment, 9% on methotrexate and 39.4% on biologic treatments; mean PASI was 6.2 ± 7.5. Seventy-five percent of the referred patients did not meet CASPAR criteria; 33.3% were diagnosed with psoriatic arthritis by the rheumatologist. Of the 33 patients, 4 (12.1%) scored 0 points on PURE-4 scale; 21 (63.6%) scored 1 point; and 8 (24.3%) scored 2 points. Once assessed by a rheumatologist, 75.5% had no morning stiffness in the hands, 93.9% had no Achilles enthesitis and 87.9% had no inflammatory low back pain; only 24.2% of patients had required NSAIDs in the previous 3 months for joint pain. Finally, the diagnosis of psoriatic arthritis was analyzed against the PURE-4 cut-off point (Table 1).Table 1.Psoriatic arthritis diagnosis based on total score on PURE-4 scalePURE-4 ScoreChi-squared testp value≧ 10.250.61= 10.100.74= 20.690.41ConclusionPURE-4 scale with a score ≥ 1 does not seem to improve the diagnosis of arthritis in psoriatic patients. It would be necessary to implement other questionnaires that are more complete, but at the same time affordable, when carried out during the dermatology consultation in order to increase the sensitivity to refer or not to the rheumatologist.References[1]Gladman DD et al. Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis 2011;70(12):2152-2154.[2]Mishra S et al. Comparison of four validated psoriatic arthritis screening tools in diagnosing psoriatic arthritis in patients with psoriasis (COMPAQ Study). Br J Dermatol 2017;176(3):765-770.[3]Audureau E et al. Psoriatic arthritis screening by the dermatologist: development and first validation of the ‘PURE-4 scale’. J Eur Acad Dermatol Venereol 2018;32(11):1950-1953.Disclosure of InterestsNone declared