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

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:Virtual consultation is defined as the provision of a healthcare service when there is a distance between the subjects and information and communication technologies are used to carry out the consultation. This tool has been successfully implemented in different specialties. It is useful for providing quick solutions, improving the overload of the medical care and for the early detection of inflammatory diseases1. In our centre, virtual consultation from Primary Care (PC) to Hospital Care (HC) has been implemented.Objectives:The main objective is to describe our experience with the use of virtual consultation and its value as a new modality of specialised medical care. The second aim is to identify the most frequent reasons for consultation and diagnoses, to assess the concordance between the two and to analyse the trend over time of the number of virtual consultations and their relationship with the different waves of the COVID 19 pandemic.Methods:Retrospective observational study. The virtual consultations made from PC (47 centres) to Rheumatology during 2020 were analysed. They were carried out through a computer programme, using the “Andalusian Health Service Virtual Consultation Platform” tool. A specific agenda was established for virtual consultations. The reason for the referral and the rheumatologist’s diagnosis were collected. The response given to the PC was divided into four models: NON-TRIBUTARY (not related to the speciality), DISCHARGE (a diagnosis and therapeutic response is concluded), APPOINTMENT FOR CONSULTATION and FOLLOW-UP (new contact is requested, completing the information). The reasons for consultation, diagnoses, time and type of response were analysed.Results:47 virtual consultations were carried out. 54.5% (n 298) were closed as DISCHARGE. 27.4% (n 150) were APPOINTMENT FOR CONSULTATION, and 17.7% (n 97) indicated FOLLOW-UP. Only 0.4% (n 2) were NOT TRIBUTARY.The average response time was 2 days 15 hours and 56 min.The most frequent reason for consultation was polyarthralgias (26.7%, n 146) and after the rheumatologist’s assessment a diagnosis was established in 89% of them. Inflammatory arthropathy accounted for 30.8% (n 45), osteoarthritis for 19.9% (n 29), fibromyalgia for 12.3% (n 18), polymyalgia rheumatica (PMR) for 6.9% (n 10), osteoporosis for 2.7% (n 4) and connective tissue disease for 2.1% (n 3).Another frequent reason for consultation was osteoporosis (13.5% n 74), of which 85.1% (n 63) had a confirmed diagnosis and/or need for revision.A diagnosis could be made via telematics in 89.6% of the consultations. 15.5% were osteoporosis (n 85), 14.9% osteoarthritis (n 81), 10.5% soft tissue injuries, 8.8% mechanical/nonspecific pain (n 47), 7.1% rheumatoid arthritis (n 39), 6.5% fibromyalgia (n 34), 6.2% connective tissue disease (n 34), 5.7% PMR (n 31), 4.9% suspected spondyloarthritis (n 26), 4.2% psoriatic arthritis (n 23) and 4.2% microcrystalline arthritis (n 23).27.4% (n 150) of the virtual consultations were required for assessment in a face-to-face appointment. We analysed the distribution over time (Figure 1). In the COVID 19 confinement phase (14 March - 21 June), the number of consultations increased, peaking in June, a behaviour that has persisted in the other mobility phases (October/November).Conclusion:More than half of the virtual consultations carried out were resolved without face-to-face assessment, with a diagnosis being established in almost 90%. It is an effective tool for rapid access to Rheumatology, detecting pathology requiring preferential attention, with a face-to-face appointment, as well as for the early diagnosis of inflammatory arthropathy, which was detected in a quarter of the consultations, as well as for the diagnosis and follow-up of osteoporosis. Virtual consultation facilitates a quick response, playing an even more relevant role in the current SARS CoV-2 pandemic situation.References:[1]B. Tejera, S. Bustabad. A new form of communication between rheumatology and primary care: The virtual consultation. Reum Clin., 12 (2016), pp 11-14Disclosure of Interests: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