Background:Synovial inflammation is part of the pathophysiological process of PsoA although it is considered secondary to enthesitis. It is of interest to assess the synovial joint, peritendinous and enthesic response of patients with PsoA in remission under controlled mechanical stress.Objectives:Our aim is to present our observational experience in patients with APso in remission or low activity of the disease exposed to controlled manual physical efforts adapted to the own grasping capacity of each subject.Methods:Before-after study of a consecutive cohort of patients with PsoA (CASPAR criteria), of at least two years d evolution and DAPSA≤14 at present. Patients with positive rheumatoid factor, patients with exclusively axial forms and patients on biological therapy at the beginning of the study were excluded. All patients underwent controlled basal ultrasound and post-dynamometric exercise (CAMRY EH101-17) of the dominant hand which included the carpus, MCFs, IFPs and IFDs of the 2nd to 5th fingers. The ultrasound findings were scored according to EULAR recommendations in grey scale (GS) and power Doppler (PD) for synovitis, enthesitis and tenosynovitis (maximum scores 71 and 87, respectively). For statistical analysis, comparisons were made with the results of their baseline and post-exercise ultrasound scores between subjects diagnosed with PsoA and controls. The Student’s T test was used for related and unrelated data according to correspondence.Results:Nineteen patients and controls were included, of which 73.7% were male. Mean age: 42.2 SD 6.6 and 42.21 SD 8.28, respectively. Basal DAPSA among patients: 7.26 SD 4.53. Mean traction strength of patients and controls: 23.8 SD 7.3 and 26.1 SD 6.9 kg, respectively (P=0.336). In the group of patients, the post exercise DAPSA had a mean of 7.52 SD 4.62 (P=0.021, with respect to the basal DAPSA). The mean total GS score in the patient group was 3.94 SD 2.36 and 7.31 SD 3.3, pre- and post-exercise, respectively (P<0.001). The mean total score in the PD study was 0.73 SD 0.73 and 2.57 SD 1.16, respectively (P<0.001). In patients with PsoA there were no detectable enthesic changes. In the control group, no ultrasound changes were statistically significant, although the score for tenosynovitis ranged from 0.1 SD 0.31 to 0.42 SD 0.6 (P=0.055).Conclusion:Patients with APso in clinical remission or low disease activity develop ultrasound changes after controlled exercise. These changes are appreciable in the joint synovium and tendon but not at an enthesic level. Although these changes are also detectable in a healthy population, their prevalence is much lower. Our interpretation is that control of the disease correlates with an absence of enthesic inflammatory activity although synovial susceptibility remains less evident. This reinforces the idea that PsoA is an inflammatory enthesitis with associated arthritis and not its opposite.Disclosure of Interests:None declared

Background:Physiologically, the joint synovium responds to physical activity according to the frequency and intensity of the efforts, producing slight effusion without detectable hyperemia. In patients with RA in remission, a similar response can be expected, since it is understood that the immune-mediated inflammatory component has been controlled physiopathologically. Our interest is to determine whether once clinical remission has been reached, treatment with MTX or antiTNF produces the same normalization of the synovial behaviour. Our interest is to determine whether once clinical remission has been reached, treatment with MTX or antiTNF produces the same normalization of the synovial behavior.Objectives:The aim of the present study is to compare the synovial response to mechanical stress of patients with Rheumatoid Arthritis (RA) in remission treated with Methotrexate (MTX) or Etanercept (ETN).Methods:Descriptive observational study. We included patients with RA in remission (DAS28<2.6) for at least 6 months on MTX or MTX and anti-TNF-alpha therapy (ETN). An ultrasound examination protocol was developed for the 2nd, 3rd and 4th MCP and non-dominant hand carpus for gray scale (GS) and power Doppler signal detection (sPD) according to EULAR/OMERACT definitions. Two ultrasound examinations were performed on each patient, before and 24 hours after starting a manual digital flexure exercise program against resistance measured by a handheld dynamometer CAMRY™ model EH101-17. Total synovitis scores in EG (0-12) and sPD (0-12) were compared.Results:We included 37 patients on MTX treatment (median dose 15mg/week, range 7.5-25mg/week) and 16 patients on ETN treatment (median dose 50mg/week, range 25-50 mg/week). The baseline ultrasound score in the MTX treatment group was 1.6 SD 1.4 in EG and 2.2 SD 0.5 in PDs. After carrying out the controlled dynamometric effort, the score was 2.4 SD 1.9 in GS and 4.4 SD 1.5 in PDs (P<0.05 and P<0.001, respectively). In patients treated with TNEs, the basal score in GS was 1.3 SD 0.6 in GS and 0.6 SD 0.3 in PDs. After the controlled dynamometric effort, the score was 1.8 DE 0.9 in EG and 0.7 DE 0.4 in PDs (P=0.07 and P<0.001, respectively). In the group of patients treated with MTX, four subjects reported joint tenderness after physical effort.Conclusion:Our observations are congruent with previous experiences in which it has been observed that physical stress translates into synovial changes detectable by ultrasonographic studies. Our results, although modest in patient volume, suggest that TNF-alpha activity is crucial in the development and maintenance of exercise-induced hyperemia. The clinical significance of our observation may be useful as a tool to predict the response to anti-TNF therapy in patients with RA, however specific methodological designs are needed for such associations.Disclosure of Interests:None declared

Background:Peritenon enlargement has been considered as a specific ultrasound finding associated with psoriatic arthritis based on studies in patients. Recent observations in athletes have demonstrated the existence of this finding although its relationship with the type of physical activity performed has not been determined.Objectives:To determine to what extent manual physical activity is associated with the prevalence of peritenon thickening in the fingers of healthy athletic subjects.Methods:Thirty-five healthy young male volunteers were recruited from a local sports centre in the community of Madrid. All of them performed sports activities with their hands for more than 12 hours a week.A digital dynamometer was used to determine the flexion strength of the fingers of the dominant hand. A single observer performed an ultrasound scan of this hand to determine the presence or absence of a hypoechoic image surrounding the extensor digitorum tendon of the 2nd, 3rd, 4th and 5th fingers, according to previous definitions. Mean flexion strengths were compared with the number of positive ultrasound findings.Results:Fifteen volunteers (mean age 24.3 years, BMI 24.4) did not present peritenon enlargement (42.8%). The mean ± standard deviation of the fingers flexor strength according to the number of peritenon enlargement detected were 43.5 ± 6.2, 49.2 ± 3.8, 53.2 ± 1.64 and 63.0 ± 4.83 Kg for volunteers with none, 1, 2, 3 and 4 peritenon enlargements, respectively. (ANOVA P<0.001; Pearson’s coefficient 0.827, P<0.001). Correlation between BMI, body fat percentage or training hours per week and the number of peritenon enlargement detected was not demonstrated.Conclusion:Peritenon enlargement, also knew as peritenon tendon inflammation, is detectable by ultrasound scan in healthy subjects and it seems to be associated to the physical activity intensity, indirectly measured by the flexor strength of the fingers.References:[1]Gutierrez et al. Ann Rheum Dis. 2011;70:1111-4[2]Zabotti et al. Clin Exp Rheumatol. 2016;34:459-65[3]Husic et al. Ann Rheum Dis. 2014;73:1529-36Disclosure of Interests:None declared

Background:Spondylarthritis are diseases with a pathophysiological focus in enthesis with a different extent of synovial component. In the event of therapeutic failure with DMARDs, the clinician may consider biological therapy with anti-TNF drugs or other targets such as IL23 Despite this, most patients receive first-line anti-TNFs. Given that IL19 and IL23 activity is recognized at the level of the enthesis.Objectives:To evaluate whether the presence of dactylitis/entesitis could be useful in the choice of a particular biological therapy.Methods:A secondary analysis of a previous study was performed based on an electronic survey completed by patients with PsoA and distributed among members of the patient association “Acción Psoriasis”. Records from 191 respondents who had received at least one biological therapy were included. Patients were grouped according to the presence or absence of dactylitis or enthesitis. The rate of need to progress to the next therapeutic biologic line was compared.Results:61 patients reported dactylitis and 155 enthesitis. Distribution of treatments in patients with dactylitis: 33 patients received an anti-TNF-alpha, 11 Secukinumab and 12 Ustekinumab. 15 patients in the group receiving an anti-TNF-alpha had to substitute another treatment within 2 years (45.4%). 3 patients in each of the remaining groups had to substitute treatment within 2 years (27.2% and 25%, respectively). Compared to those receiving anti-TNF-alpha therapy, patients treated with Secukinumab or Ustekinumab had greater therapeutic persistence at 2 years (P<0.001, in both cases). Distribution of treatments in patients with enthesitis (not including dactylitis): 115 received an antiTNF-alpha, 25 received Secukinumab and 18 received Ustekinumab. 38 patients who received an anti-TNF-alpha had to substitute it within 2 years (24.5%). 4 patients who received Secukinumab and 3 who received Ustekinumab had to substitute their treatments in less than 2 years (16% and 16.6%, respectively). Compared to patients receiving anti-TNF-alpha therapy, patients treated with Secukinumab and Ustekinumab had a higher proportion of therapeutic persistence at 2 years (P<0.05 for both cases).Conclusion:The presence of dactylitis more than enthesitis, is associated with a higher proportion of therapeutic persistence in those patients treated with anti-IL17 or anti-IL23 therapies. Although there are multiple factors that condition the choice of biological therapies in patients with PsoA, the presence of enthesitis and dactilitis (understood as polyenthesitis) should be considered among the most important ones.Disclosure of Interests:None declared

Background:Biological therapies have substantially improved the prognosis of patients with Spondyloarthritis (SpA). However, a satisfactory clinical response is not achieved in all patients and it is essential for the clinician to identify all those factors that predict treatment response. Although they are supposed as unfavorable and potentially avoidable factors, the influence of smoking and obesity as predictors of treatment response in SpA is unknown.Objectives:To determine if smoking and obesity are factors of worse therapeutic response in patients with axial spondyloarthritis (axSpA).Methods:Systematic review of the literature in MEDLINE and EMBASE until June 30, 2019 based on the PICO design method. Population (P): patients with axSpA. Intervention (I): smoking or obesity. Comparator (C): non-smokers and normal weight. Outcome (O): any of the response criteria currently validated for axSpA. A specific excel form was used for data collection, EndNote software for the management and organization of papers and the Oxford 2009 level for evidence evaluation.Results:1873 citations were recovered, 46 studies were selected for full-text review and 12 for data extraction: 6 for smoking and 6 for obesity. The design of all studies was observational and longitudinal with data from national registries except one cross-sectional. In total, these studies included 5291 patients (3917 patients for smoking and 1333 patients for obesity), all treated with a TNF inhibitor (iTNF). The Oxford level of evidence for all studies was 2b except the cross-sectional study, which was 4. Regarding smoking, the evidence found is not consistent. Two of the studies concluded an unfavorable effect on the response to the iTNF (Glintborg and Ciurea) but the remaining 4 studies found no differences in the clinical response to iTNF (Zhao), the cause of discontinuity of the iTNF (Zhao, Hernandez) or quality of life indexes (Kydd). For obesity, the evidence is more consistent, so that 5 of the 6 studies observed a negative influence on the therapeutic response to iTNF (Ottaviani, Gremese, Micheroli, Hernández-Breijo and Rosas).Conclusion:According to scientific evidence in patients with axSpA, obesity is associated with a worse therapeutic response to iTNF. However, this negative effect is not clearly evidenced for smoking.Disclosure of Interests:Pablo Zurita-Prada: None declared, Claudia Urrego-Laurín: None declared, Carlos Guillén-Astete: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB