BackgroundAcute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM.MethodsIn this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS).ResultsAmong patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse.ConclusionsSystemic lupus erythematosus–related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.

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BackgroundThe PANLAR-EOA (early-onset-arthritis) project includes panamericanrheumatologists to determine regional characteristics of patients with early onset arthritis.ObjectivesTo describe the cohort of Paraguayan patients included in PANLAR-EOA project.MethodsLongitudinal, prospective, multicentricstudy. Patients were included according to the PANLAR-EOA project and registered in REPANARC(www.panlareoa.org) database. At baseline and annual visits, a large number of demographic, clinical and analytical variables were recorded. Quantitative variables were characterised by their means and standard deviations, while the qualitative variables were characterised according to the percentage of patients. The comparison of epidemiological and clinical variables was performed using the chi-squared test and the Wilcoxon test respectively for qualitative and quantitative variables, respectively.Results136 patients with early onset arthritis were included, out of which 88 completed the 12 months follow up and 58 the 24 months one. In these, 86%were female with a median age of 43.9±13.2 years. The most frequent race was mestiza in 80.1%. According to GRAFFAR index, middle class was the predominant social stratum (9.8±3.1). The average number of years of schooling was 12.8±3.8. Polyarticular onset was registeredin 61% patients. During follow-up, 43.1% had positive rheumatoid factor and 56.5% positive anti-CCP. The diagnostic delay was 3.9±3.0 months. Initially, 63.2% (86/136) were diagnosed with rheumatoid arthritis (RA) and 36.8% (50/136) with undifferentiated arthritis (UA). The most frequent treatment was methotrexate (85.3%, 90.9%, and 89.3% at baseline, 1 and 2 years of follow-up respectively). During follow-up, a significant diagnostic change was observed in patients with UA (p=0.004, OR=2.9 [95%CI, 1.4–6.5]). The variables associated with RA diagnosis werepresence of anti-CCP (p=0.000, OR=15.8 [95%CI,5.4–51.1]), rheumatoid factor (p=0.000, OR=9.2 [95%CI,3.4–27.0]), smoking (p=0.032, OR=8.8 [95%CI,1.1–404.7]), high body mass index (p=0.041, OR=1.94 [95%CI,−0.2–4.1]) and high activity measured by the DAS28 index (p=0.01). After one year of follow-up there was a significant decrease in disease activity according to DAS 28 (p=2.2e-09[95% CI, −1.5,–0.9]), SDAI(p=1.2e-11[95% CI, 18.2,–11.2]) and HAQ (p=7.2e-08[95% CI,−0.7,–0.4]). Similar results were found at the 2nd year of follow-up, DAS28 (p=8.8e-06[95% CI,−1.6,–0.7]), SDAI (p=2.1 e- 07 [95% CI,−20.0,−10.3]) and HAQ (p=3.4e-08[95% CI,−0.9,–0.5]).ConclusionsIn this cohort of early onset arthritis, diagnostic delay was lower than that observed in other series and the rate of change from diagnosis of UA to RA was statistically significant during the first year of follow-up. A good control of the inflammatory activity of the disease was observed, with a significant improvement of all the variables analysed during its evolution.Disclosure of InterestNone declared

BackgroundThe retention rates (RR) of biological therapies (BT) have been extensively studied in European countries and the United States, but there is a lack of information about them in emerging populations.ObjectivesTo analyse BT retention rates and variables associated to them at the BIOBADAGUAY registryMethodsPatients with a chronic inflammatory arthritis enrolled in the Paraguayan-Uruguayan biological register (BIOBADAGUAY) between2015 and 2017 where included in the study. Phase I of the study was focused in the global RR analysis and association with clinical and epidemiological variables. In phase II we analysed BT retention rate according to different discontinuation motives and association with clinical and epidemiological variables. Survival analysis was performed using Kaplan-Meier estimators and proportional hazard regression modelsResultsA total of 778 BTs where included in the study (etanercept n=184, adalimumab n=440, rituximab n=44, infliximab n=27, tocilizumab n=75, and others n=8). The underlying diagnosis associated to these BTs were rheumatoid arthritis (RA;58.2%), juvenile arthritis (JIA; 14.2%), ankylosing spondylitis (SA; 12.5%) and psoriatic arthritis (PA; 8,0%).In phase I we found that mean survival times were 322 (±17.9), 315 (±22.32), 289(±8.52) and 233 (±16.69) weeks for AS, PA, RA and JIA respectively. The survival association analysis has shown that JIA diagnosis (p=2.26 × 10–4, HR=1.80 [95%CI, 1.32–2.46]), corticosteroids (p=1.54 × 10–2, HR=1.38 [95% CI, 1.06–1.79]), and previous BT (p=3.32 × 10–2, HR=1.43 [95% CI, 1.03–1.98]) were variables significantly associated with a lower BT retention.In phase II, we stratified the survival analysis by cause of discontinuation. We found that corticoids (p=9.48 × 10–4 HR=2.02 [95% CI, 1.33–3.06]), female gender (p=4.36 × 10–2, HR=1.66 [95% CI, 1.01–2.72]) and previous BT (p=2.56 × 10–2, HR=1.72 [95% CI, 1.07–2.78]) were associated with lower BT retention due to inefficacy. When we analysed withdrawn according to adverse events, we found that RA (p=02,80 × 10–2, HR=1,83[IC 95% 1,07–3,15]), previous BT (p=4,83 × 10–2, HR=1,76[IC 95% 1,00–3,09]) and age (p=7,14 × 10–5, HR=1,05 [IC 95% 1,02–1,05]) were significantly associated with therapy discontinuation. In the group of treatments with discontinuation due to remission, we found that JIA diagnosis (p=7,93 × 10–8, HR=30,58 [IC 95% 8,77–106,71]), age (p=7,83 × 10–6, HR 0,83[IC 95% 0,76–0,90]) and gender (p=4,36 × 10–2, HR 1,66[IC 95% 1,01–2,72]) were associated to discontinuation due to remission.ConclusionsOur results show that different sets of clinical and demographical variables are significantly associated to biological therapy survival depending on the discontinuation cause.Disclosure of InterestNone declared