BackgroundPatients with giant cell arteritis (GCA) represent a fragile population with an increased infection risk. In a recent study1 older age, a higher number of comorbidities, higher disease activity, and prednisolone ≥10 mg qd were associated with worse COVID-19 outcomes.ObjectivesWe aimed to evaluate the frequency and severity of COVID-19 in a well-defined GCA cohort.MethodsWe reviewed medical records of histologically and/or by imaging proven GCA patients diagnosed between September 2011 and February 2020 at our secondary/tertiary center and followed during the COVID-19 pandemic between March 2020 and December 2021 (22 months). Descriptive statistics was used to analyze the studied population.ResultsOf 314 GCA patients diagnosed for the first time during a 102-month period, 49 patients died before March 2020. Of the remaining 265 patients (69.4% females), SARS-CoV-2 infection was proven by PCR test in 39 (14.7%) patients (74.2% females, mean (SD) age at infection 76.2 (±9.6 years), 13 (33.3%) with large vessel GCA and 16 with cranial limited GCA). At the time of SARS-Cov-2 infection GCA was in a stable remission in 38 patients (13 without therapy, 10 on steroids alone, 9 on leflunomide monotherapy, 6 on steroids plus leflunomide (10 or 20 mg qd), 1 on ustekinumab; mean prednisolone equivalent dose of 4.6 mg qd) and relapsed in one patient 6 weeks earlier (prednisolone 30 mg plus leflunomide). Data on clinical manifestations of COVID-19 were available for 33 (84.6%) patients and are presented in Table 1, part A. Twenty-nine/39 (74.4%) patients had mild COVID-19 and were symptomatically treated at home, while 10 patients had severe infection (defined as a need of hospitalization and/or death), and one of those patients died due to COVID-19. One patient developed a transient neurologic ischemic attack related to COVID-19. Table 1, part B shows differences in GCA demographic and treatment at the time of mild vs. severe infection. We found no differences in gender, age, GCA type and GCA treatment between those with mild vs. severe COVID. Three patients developed COVID-19 after receiving two doses of anti-COVID vaccine (1.4% breakthrough rate). Overall, of 257 GCA patients eligible for vaccination, 210 (81.7%) were vaccinated by the end of December 2021.ConclusionA quarter of our GCA patients had severe COVID-19. Low doses of glucocorticoids and treatment with leflunomide were not associated with severe COVID-19 course in our cohort.References[1]Sattui SE, et al. Lancet Rheumatol 2021; doi: 10.1016/S2665-9913(21)00316-7Disclosure of InterestsNone declared

BackgroundPolymyalgia rheumatica (PMR) is common in patients over the age of 50 years. Clinical symptoms promptly respond to glucocorticoid therapy, but there are wide variations of dosage tapering, treatment duration and rate of relapses. In Slovenia epidemiology of PMR is unknown.ObjectivesWe aimed to determine the incidence rate of PMR, the clinical characteristics, the relapse frequency and length of glucocorticoid therapy.MethodsA detailed single centre retrospective review of medical records of all patients diagnosed with PMR between 1 January 2014 and 31 December 2016 was performed at the Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia–the only secondary level rheumatology institution in serving the Central Slovenian and Gorenjska regions, which represent ~40% (7×105) of the Slovenian adult population. The outcomes were assessed up to1 October 2021.ResultsDuring the 3-year period 494 patients (460 from Ljubljana and Gorenjska regions) were diagnosed with PMR (64% females, median (IQR) age 75 (69, 80) years), resulting in an annual sex- and age-standardised incidence rate (IR) per 105 adults ≥ 50 years of 46.0 (95% CI 42.0, 50.4), with a female/male ratio of 1.5 (95% CI 1.3, 1.7). The IR peaked between 70–85 years (Figure 1). There was no seasonal variation in IR. The median (IQR) times from symptom onset, and from referral to rheumatology consultation were 6 (4, 11) weeks, and 1 (1, 1) day, respectively. 86% were referred by their GPs, 7% by other internists, and 6% by infectious disease specialists, and the rest by other specialists.At presentation, 96% had morning stiffness (71% lasting >45 minutes), 99% shoulder pain, 94% pelvic girdle pain, 49% weight loss, 13% peripheral arthritis, and 12% body temperature >37°C. Data on US of shoulders and hips was complete, partial, or missing for 38%, 24%, 39%, respectively. Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) was present in 98% of patients, the median (IQR) ESR was 55 (42, 71) and CRP 49 (26, 79) mg/l, and 58% had anaemia. RF and ACPA were positive in 4% and 3%, respectively. 8/12 had ACPA values less than 2× the reference value. During follow-up ACPA was repeated in 8/12 patients and negativized in 6/8 patients. Among other pre-existing conditions, 51 (10%) had history of malignancy diagnosed a median 7 (3–11) years prior to diagnosis of PMR. EULAR/ACR classification criteria for PMR were fulfilled in 68% and 71% based on clinical and extended ultrasound criteria (missing items were imputed with 0), respectively. 14 (3%) patients had clinically overt concurrent giant cell arteritis (GCA).All patients were treated with methylprednisolone, administered orally in 99.4%, 93% started at 16mg qd. By the end of follow-up, 295 (60%) patients successfully discontinued methylprednisolone after a median of 117 (104, 143) weeks. Steroid sparing leflunomide and methotrexate were used by 66 (13%) and 27 (6%) patients, respectively. During a median follow-up of 150 (98, 244) weeks, 146 (30%) had at least one relapse. Median time to first relapse was 111 (50, 141) weeks. 54% relapsed after glucocorticoid discontinuation after a median time of 4 (2, 18) weeks, 9% presented with GCA, 12% relapsed due to treatment non-adherence. During the follow-up 6% were diagnosed with malignancies.Conclusion(1) With the IR of 46 per 105 adults ≥50 years, PMR is more common as rheumatoid arthritis in Slovenia. (2) A considerable proportion of patients required long-term glucocorticoid treatment, leaving a huge unmet need for safer therapeutic options.Disclosure of InterestsNone declared