Background:Few data are available on the epidemiology and management of giant cell arteritis (GCA) in patients over 75 years despite the progressive aging in our societies. In other diseases this subgroup of patients presents important differences in the management and prognosis of their pathologies.Objectives:To explore this situation by comparing two subgroups of patients, older and younger than 75, assesing possible changes in demographic characteristics, diagnostic tests, treatment and outcome.Methods:We perform a retrospective review of charts, laboratory data, image studies, treatment and outcome of biopsy-proven GCA in our institution (Complejo Hospitalario Universitario de Vigo) between 1 January 2000 and 30 November 2019.Results:During study period 124 patients were analysed, 51 in the subgroup of <75 (mean age 64.6 (56-75)) and 73 in the subgroup of >75 (mean age 81.8 (76-89)). There were no differences about sex (female 76.6% vs. 65%) or in the Charlson index between the two groups (0-1 in 72% of patients). Older patients present more frequently with headache (49.2 % vs 32.3%), polymyalgia rheumatica (53.4 % vs 45.1%), weight loss (48% vs 39.2%) and ischaemic manifestations (72.6 % vs 51%), including visual disturbances (26% vs 11.8%). Younger patients present more frequently with fever (33.3% vs 19.2%). Median ESR was similar: 98 vs 96 mm/h; median CPR was slightly higher in younger patients 94.5 mg/dL vs 71.59 mg/dL. PET-TC was performed more frequently at diagnosis in the subgroup of younger patients (29.4% vs 12.3%) and during follow-up period in the other subgroup (3.4% vs 7%) with evidence of involvement of large vessels in 14 of them. Initial treatment consisted of corticosteroids in 100% of patients with the most frequent doses, in both groups, between 40-60 mg/day of prednisone or equivalent. The subgroup of < 75 were treated more aggressively receiving pulses of methylprednisolone (125-250 mg) 12 patients (23.5%), while in the subgroup >75 lower doses were started more frequently (<40mg/day in 21 patients, 28.7%). Lowering corticosteroids to <5 mg/day were slower in the subgroup of patients <75 (47.1% within the first 12 months) with respect to the >75 (58%). During the follow-up period 47 patients had at least one relapse, we did not observe statistical differences between both groups (21 patients <75 and 26 patients >75). Time to first relapse was more frequent within the first year of treatment (12 and 16 patients respectively). We could not identified any factor related to relapses in our multivariate analysis. There was no significant differences between both groups about starting MTX (33.3% and 38%) on relapses. Only two patients started TCZ (one in each group). Twenty-nine patients died during follow-up period (11.7% in <75 vs. 31.5% in >75), but none were related with GCA.Conclusion:1. No differences were observed in sex, comorbidities (including cardiovascular risk factors) or laboratory markers between both groups. 2. Younger patients presented with less frequent ischaemic symptoms; however we perform a more powerful treatment, both in doses and duration.Disclosure of Interests:None declared

BackgroundPresence of ramifications (RM) (capillaries from whose central axis lateral branches emerge) in the nailfold capillaroscopy is generally seen in patients with advanced microvascular damage and is a characteristic feature of scleroderma and dermatomyositis. Nevertheless they are also seen in patients without defined disease, so that it can be an inespecific finding whose potential role in the evolution of the patient is unclear.ObjectivesTo analyze the risk factors and the prognostic implications associated with the presence of RM in the capillaroscopy. Analyze the risk factors associated with RM in patients who we perform a capillaroscopic in our hospital.MethodsWe reviewed all the capillaroscopies performed in our systemic autoimmune diseases outpatient between January 2013 and December 2015. We reviewed the clinic and epidemiological characteristics, capillary pattern, diagnosis and evolution of all the patients and we analyzed their relation with the presence of RM.ResultsIn this period we performed a capillaroscopy to 226 patients, 48 (21.2%) of which had RM. In the RM group (39 women, 9 men), mean age was 51.38 years, with no significant differences in gender distribution and in age compared to the no-RM group (p 0.394 and 0.694 respectively). 78 of our patients were smokers (34.5%), 61 (27%) had history of arterial hypertension, 71 (31.4%) had hypercholesterolemia and 13 (5.8%) diabetes mellitus, with no differences between both groups (p 0.380, 0.265, 0.501 and 0.867 respectively).We found 6 patients with digital ulcers, any of them with RM (p 0.197). Patients with idiopathic thromboembolic disease were 5 (2.21%), only 1 with RM (p 0.466). 182 patients (80.5%) presented Raynaud's phenomenon (RP) with a mean duration of 8.59 years, 37 of which had RM (p 0.497). Among patients with RP in which the final diagnosis was primary RP (46, 20.53%) only 3 (6.25%) had RM (p 0.006). Patients that finally were diagnosed with any collagen vascular disease were 135 (59.73%), 37 of wich had RM (p 0.01). In this group 6 patients had systemic lupus erythematosus, 32 systemic sclerosis, 5 antiphospholipid syndrome, 6 Sjögren syndrome, 2 mixed connective tissue disease and 67 undifferentiated connective tissue disease. We found no differences between RM and no-RM groups separately analyzing each of these diagnoses (p 0.426, 0.466, 0.223, 0.191, 0.293 and 0.148 respectively).With respect capillaroscopic findings we found no correlation with the presence of dilatations (p 0.193), megacapilaries (p 0.418) or hemorrhages (p 0.888) but we did with other suggesting advanced microvascular damage as capillary loss (p 0.018) and presence of tortuosities (p<0.001) and with the sclerodermic capillaroscopic pattern (p 0.003).ConclusionsPresence of RM identifies patients at risk of secondary RP, especially with underlying connective tissue diseases. So, the presence of RM in patients with not clear diagnostic force us to have specially attention with them because they have risk to develop a connective tissue disease in the future...