Highlights Older patients with COVID infection have a similar clinical course than younger subjects. Males have a greater COVID mortality than females. Worsening dyspnea and decline renal function during admission associate with death. Treatment with RAAS inhibitors associates with a greater survival.

ObjectiveTo determine the optimal ultrasound (US) cut-off values for cranial and extracranial arteries intima media thickness (IMT) to discriminate between patients with and without giant cell arteritis (GCA).MethodsRetrospective observational study including patients referred to an US fast-track clinic. All patients underwent bilateral US examination of the cranial and extracranial arteries including the IMT measurement. Clinical confirmation of GCA after 6 months was considered the gold standard for diagnosis. A receiver operating characteristic (ROC) analysis was performed to select the cut-off values on the basis of the best tradeoff values between sensitivity and specificity.ResultsA total of 157 patients were included, 47 (29.9%) with clinical confirmation of GCA after 6 months. 41 (87.2%) of patients with GCA had positive US findings (61.7% had cranial and 44.7% extracranial involvement). The best threshold IMT values were 0.44 mm for the common temporal artery; 0.34 mm for the frontal branch; 0.36 mm for the parietal branch; 1.1 mm for the carotid artery and 1 mm for the subclavian and axillary arteries. The areas under the ROC curves were greater for axillary arteries 0.996 (95% CI 0.991–1), for parietal branch 0.991 (95% CI 0.980–1), for subclavian 0.990 (95% CI 0.979–1), for frontal branch 0.989 (95% CI 0.976–1), for common temporal artery 0.984 (95% CI 0.959–1) and for common carotid arteries 0.977 (95% CI 0.961–0.993).ConclusionIMT cut-off values have been identified for each artery. These proposed IMT cut-off values may help to improve the diagnostic accuracy of US in clinical practice.

BackgroundUltrasound (US) is a valid imaging tool to detect signs of giant cell arteritis (GCA). Although the halo sign has always been considered the most useful finding for GCA diagnosis, modern high frequency transducers are able to precisely measure the intima-media thickness (IMT) of cranial and extracranial arteries. However, data on optimal cut-off values for IMT to differentiate patients and controls in clinical practice are limited.ObjectivesTo determine the optimal cut-off value for IMT of cranial and extracranial arteries in patients with suspected GCA.MethodsThis is a retrospective observational study of patients referred to our US fast-track clinic with suspected GCA. All patients underwent bilateral US examination of the cranial and extracranial (carotid, subclavian and axillary) arteries within 24 hours per protocol. The exam was performed using an EsaoteMyLab8 with a 12-18 MHz frequency transducer for cranial arteries and an 8-14 frequency transducer for extracranial arteries. The IMT was measured in gray scale mode and the presence of a non-compressible halo sign was checked in all arteries. The gold standard for GCA diagnosis was clinical confirmation by the referring rheumatologist after 6 months follow-up. Mean IMT values of each artery were compared between patients with and without GCA by independent samples T-test. Receiver operating characteristics analysis was performed and the Youden index was used to determine the optimal cut-off value for IMT of each artery.ResultsOf the 157 patients with suspected GCA (67.5% female, mean age 73.7 years) referred to the fast-track clinic, 47 (29.9%) had GCA clinical confirmation after 6 months. 41 (87.2%) patients with GCA had positive US findings (61.7% had cranial involvement, 44.7% extracranial involvement and 19.1% a mixed pattern of cranial and extracranial arteries). The following IMT cut-off values showed the highest diagnostic accuracy: 0.44mm for the common superficial temporal artery; 0.34 mm for the frontal branch; 0.36 mm for the parietal branch; 1.1 mm for the carotid artery: 1 mm for the subclavian and axillary arteries. The area under the ROC curve of the IMT for a clinical diagnosis of GCA was 0.984 (95% CI 0.959 - 1) for common superficial temporal artery, 0.989 (95% CI 0.976 -1) for frontal branch, 0.991 (95% CI 0.980 - 1) for parietal branch, 0.977 (95% CI 0.961 – 0.993) for carotid, 0.99 (95% CI 0.979 - 1) for subclavian and 0.996 (95% CI 0.991 -1) for axillary arteries (Table 1).Table 1.Optimal IMT cut-off values for cranial and extracranial arteriesArterySidePatients without GCAPatients with GCACut-off (mm)AUC (CI 95%)Sensitivity (%)Specificity (%)Common superficialtemporal artery mm, mean (SD)Right0.33 (0.06)0.68 (0.28)0.430.997 (0.988 -1)10097.1Left0.35 (0.11)0.57 (0.21)0.450.966 (0.905 -1)10092.3Both0.34 (0.08)0.63 (0.25)0.440.984 (0.959 -1)94.795.1Frontal branch mm, mean (SD)Right0.26 (0.05)0.4 (0.18)0.340.994 (0.983 -1)10097.1Left0.27 (0.05)0.4 (0.18)0.340.985 (0.962 -1)10096.1Both0.26 (0.05)0.4 (0.18)0.340.989 (0.976 -1)10096.6Parietal branch mm, mean (SD)Right0.27 (0.05)0.43 (0.18)0.360.994 (0.981 -1)10098.9Left0.27 (0.05)0.41 (0.16)0.360.987 (0.967 -1)10097.6Both0.27 (0.05)0.42 (0.17)0.360.991 (0.980 -1)10098.3Carotid mm, mean (SD)Right0.8 (0.17)0.88 (0.29)10.974 (0.949 – 0.999)10092.6Left0.82 (0.15)1 (0.42)1.20.982 (0.961 - 1)90.996.2Both0.81 (0.16)0.96 (0.36)1.10.977 (0.961 – 0.993)9094Subclavian mm, mean (SD)Right0.74 (0.18)0.99 (0.44)10.987 (0.97 - 1)10093.4Left0.67 (0.17)0.9 (0.35)1.10.991 (0.975 - 1)10098.3Both0.7 (0.18)0.94 (0.4)10.99 (0.979 - 1)10096Axillary mm, mean (SD)Right0.69 (0.16)0.99 (0.5)10.992 (0.982 - 1)10096Left0.67 (0.17)0.99(0.49)10.998 (0.995 -1)10098.3Both0.68 (0.17)0.99 (0.49)10.996 (0.991 -1)10097.1ConclusionDifferent IMT cut-off values for each artery are necessary to establish a correct US diagnosis of GCA. These proposed IMT cut-off values may help to improve the diagnostic accuracy of US in clinical practice.Disclosure of InterestsNone declared

Background:Inflammatory arthralgia (IA) onset is a common rheumatology consultation. Identifying predictors for chronic arthritis (CA) development by ultrasonography (US) may provide early diagnosis and treatment in order to prevent progression of the disease.Objectives:Establishing US findings that can be related to CA development in patients with inflammatory arthralgia without arthritis. Assess the link among US, clinical and biochemical parameters.Methods:A prospective longitudinal study of a cohort of patients with IA. Patients with less tan one year of AI evolution and involvement of at least one small joint from hands or feet were included. Patients with arthritis, osteoarthritis, fibromyalgia and those treated with DMARDs or steroids were excluded. We made a 6-monthly evaluation for 2 years and recorded the CA development during that period. The number of painful joints (PJC) and biochemical data (CRP, ESR) were assessed at the first visit. A blind US exploration was made using a MyLabTwice (Esaote) equipment with a 5-13MHz probe for greyscale (GS) and Power Doppler (PD), examining 36 joints (radio-carpals, MCP, IPP, 2nd-5th MTP, elbows, shoulders and knees) and 14 tendon compartments (2nd, 4th and 6th wrist extensors, 3rd and 4th finger flexors and posterior tibial and fibularis tendons), giving an overall score of GS, PD (0-3) and number of erosions by rating the presence of sinovitis on each location.We performed a descriptive analysis based on the frequencies of qualitative variables and mean±SD/median (IQR) of quantitative variables, comparing the characteristics between patients with and without CA progression by Chi-Square and Mann-Whitney U tests. Also, the possible relationship of those variables and the disease progression was assessed by a univariate binary logistic regression analysis.We designed a reduced US examination (RUE) selecting the most affected locations and those with greatest differencies between groups in the statistical analysis.Results:Of the 49 patients included, 21 (42.9%) progressed to CA. 87% were females and 71.4% non-smokers with a mean age of 44 ± 12 years. The median of PJC was 4 (1-9). RF and/or CCPA were positive in 18.4% and 34.7% had high CRP/ESR. The suggested RUE included carpi, 2nd-4th MCP, 2nd-3rd IPP, 2nd and 5th MTP, 4th and 6th wrist extensors and fibularis tendons. Scores and comparative analysis within subgroups are listed in Table 1. The RUE score was significantly greater in both GS (OR 1.4, CI 95%) and PD (OR 1.3, CI 95%) on patients that progressed to CA.Table 1.GS and PD scores compared by main locations and RUE-Score [showed as median (IQR)].ScoreNo progression (n=28)Progression to IA (n=21)PGS global5.5 (2-11)11 (7-15)0.005*PD global2 (1-3.25)6 (2-10)0.002*ERO global0 (0-0)0 (0-0)0.59Carpi GS1 (0-2)3 (2-3)0.002*Carpi PD1 (0-2)1 (0-3)0.16MCP GS1 (0-3.25)2 (0-5)0.08MCP PD0 (0-1)1 (0-2)0.03*IPP GS0 (0-1.25)2 (0-3)0.03*IPP PD0 (0-0.25)0 (0-1)0.3MTP GS0.5 (0-3)2 (0-7)0.08MTP PD0 (0-0)0 (0-1)0.02*Wrist extensors GS0 (0-0)0 (0-1)0.1Wrist extensors PD0 (0-0)0 (0-0)0.01*Fibularis GS0 (0-0)0 (0-0)1Fibularis PD0 (0-0)0 (0-0)0.06*RUE GS5 (2-6.25)7 (5-10)0.01†RUE PD2 (1-3.5)5 (2-7)0.01†* Medians compared by Mann-Whitney U test. Statistical significance at a 95% CI. † Logistic regression analysis. Statistical significance at a 95% CI.There were no significant associations between RF/CCPA positivity or CRP/ERS levels and US findings.Conclusion:Patients with IA without arthritis that progressed to CA had significant higher GS and PD scores, hence showing the utility of US to predict disease progression. A RUE of 8 joints and 3 tendon compartments could be enough to achieve this goal.Disclosure of Interests:Pablo Rodríguez-Merlos: None declared, Diana Peiteado: None declared, Irene Monjo: None declared, Laura Nuño: None declared, Alejandro Villalva: None declared, Marta Novella-Navarro: None declared, Torres Jenny Gabriella: None declared, Maria-Eugenia Miranda-Carus Grant/research support from: BMS, Roche, Paula Fortea-Gordo Grant/research support from: BMS, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

BackgroundChronic kidney disease is associated with an increased risk of fractures. However, the existing evidence investigating the incidence of fractures after kidney transplant is scarce.ObjectivesTo evaluate the incidence of clinical fractures in patients with kidney transplant and analyze the possible factors that may influence its occurrence.MethodsA retrospective observational study of patients who underwent kidney transplant between 2005 and 2015 in a tertiary hospital was conducted. A minimum follow.up period of 6months after transplant was required. Sociodemographic and anthropometric data, clinical risk factors for bone fractures, drugs use (steroids, immunosuppressive drugs, vitamin D analogues, calcium and vitamin D supplements and calcimimetics), as well as biochemical and densitometric data to assess bone metabolism were retrieved from medical records. The occurrence of new clinical fractures after the transplant and throughout the follow-up period was recorded. The statistical analysis included univariable analysis using chi-square and Fisher’s exact tests for the qualitative variables and T-Student and Mann-Whitney U for the quantitative variables. Subsequently, logistic regression multivariable analysis was carried out to investigate which factors were associated with fractures occurrence.ResultsA total of 163 patients were included, 63 (38%) females, with a mean age of 51 ± 14.6 years. The etiology of kidney disease was polycystic kidney disease (24.2%), glomerulonephritis (23.6%), diabetes mellitus (5.5%), vasculopathy (5.5%), connective tissue disorders (2.4%) and miscellany (38.7%). The daily average dose of steroids one year after transplant was 5.8 ± 4.4 mg. Bone densitometry was performed before transplant in 27 patients (19.6%), ten of whom (37%) presented osteopenia and 7 (26%) osteoporosis. The ten-year probability of bone fracture risk (FRAX) before transplant was 2.6 ± 2.6. Mean follow-up after transplant was 8.7 ± 3.5 years. During this period, 23 (13.9%) patients suffered a clinical fracture, with an average time of appearance after transplant of 5.5 ± 3.3 years. These were located in hip (6 - 26.1%), vertebrae (2- 8.7%), extremities (9 – 39.1%) and hands and feet (6 – 26%). One year after transplant, 65.6% had vitamin D deficiency (<30 ng/dl serum calcidiol leves) and 12.2% had levels compatible with osteomalacic range (<10ng/dl). The data of the descriptive study stratified by the fracture occurrence are shown in Table 1. Compared with the subgroup patients without (Fx -), patients with (Fx +) post-transplant fractures showed to be more frequely female (60.9% vs 34.5%, p=0.01), older (50.1 ± 14.6 vs 56.3 ± 14.1 p=0.03), had more pre-transplant major clinical FRAX ((2.4 ± 1.9 vs 4 ± 4.7, p=0.03), and higher levels of PTH (98.2 ± 75.7 vs 140.1 ± 86.9 p=0.02) and serum alkaline phosphatase [ALP] (90.2 ± 37 vs 117.8 ± 60.4, p=0.02) after one year of transplant. Also, a trend to present a higher prevalence of pre-transplant clinical fractures was observed in the second group (5.6% vs 1...