Background:Continuous monitoring of patients with Systemic lupus erythematosus (SLE) provides relevant informationObjectives:To update the analysis of clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed from January 2015 to October 2020Methods:A retrospective follow-up study based on clinical records. Patients with SLE diagnosis fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with the diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The primary outcome was defined as the time from diagnosis to severe renal involvement defined as creatinine clearance ≤50ml/min, 24-hour proteinuria ≥3.5 grams o end-stage renal disease. Updated age and sex-adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values <0.05 were considered statistically significant. Descriptive statistics were previously reported in EULAR 2020 (1)Results:548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 25 were interval censored as outcome occurred between study visits (19 new events), and 456 were right-censored as involvement was not registered during follow-up. In this cohort update Age and sex-adjusted Hazard Ratios for high blood pressure were HR = 3.1 (95%CI 1.5-6.3; p-value = 0.003) and Anti-RO (per unit increase) HR = 1.003 (95%CI 1.001-1.005; p-value = 0.029). Figure 1 shows the updated age and sex-adjusted survival functionConclusion:In this cohort update, we found similar clinical and immunological characteristics associated with time to severe renal involvement in SLE patients to those reported in (1). However, continuous follow-up allows us to deepen our understanding of the progression to severe renal involvement in SLE patientsReferences:[1]Herrera S, Diaz-Coronado JC, Rojas-Gualdrón D, Betancur-Vasquez L, Gonzalez-Hurtado D, Gonzalez-Arango J, et al. SAT0210 factors associated with time to severe lupus nephritis in a cohort of colombian patients. Ann Rheum Dis. junio de 2020;79(Suppl 1):1048.2-1048Disclosure of Interests:None declared

Background:Pulmonary involvement is common in Systemic Lupus Erythematosus (SLE) patients with varying degrees of parenchymal, vascular, and pleural compromise. In GLADEL, pulmonary involvement was reported in 28.4% of the cohort, but its occurrence ranges between 30-90% due to diversity in populations and the methods used to define it.Objectives:To describe the immune-serological profile of a Colombian cohort of SLE patients and to establish its association with pulmonary manifestations.Methods:Retrospective analysis of observational data from the follow-up of a cohort of adult patients with SLE. We included 559 patients that fulfilled the SLICC 2012 classification criteria with at least 6 months of disease history and being treated in a rheumatology specialized medical center between 2015 and 2018. The immuno-serological profile was characterized, and pulmonary involvement was monitored for 1 year. Diagnosis of pulmonary involvement was performed with the rheumatologist report in the clinical chart. Prevalence of pulmonary manifestations and immune-serological profile was determined, and logistic regression was performed afterward adjusted by age, sex, and level of education to establish the association between pulmonary manifestations and a positive auto-antibodies profile.Results:The median age of the cohort was 45 years, 96.5% were female. Pulmonary involvement was documented in 113 patients (20.5%) at the beginning of the study. Their frequency was: pleuritis (14.3%), lupus pneumonitis (3.6%), pulmonary hypertension (3.2%), interstitial lung disease (ILD) (2.3%), pulmonary embolism (2.3%), lung fibrosis (2.14%), alveolar hemorrhage (1.4%), shrinking lung (0.2%). At 1 year of follow up. there were no statistically significant differences in the frequency of pulmonary manifestations. As for the immune-serological profile, there were positive ANA in 92%, anti-dsDNA in 53.1%, anti-B2GP IgM 15.2%, anti- B2GP IgG in 17.2%, and ENA in 97.2%; as for the ENA 41.7% had positive anti-RNP, 40.2% anti-Ro, 36.4% anti-SM and 16.5% anti-La. Low complement levels was characterized as follows: C3 53.1% and C4 29.2%. In the logistic regression adjusted by age, sex and level of education, there was an association between anti-SM and pulmonary manifestations with an adjusted OR of 1.85; 95% CI 1.13-3.01.Conclusion:An association between anti-SM positivity and pleuro-pulmonary manifestations was found. In other cohorts with a greater size, anti-La and anti-RNP have been associated with pulmonary involvement (OR 2.51; 95% CI 1.39-4.57 and OR 1.32; 95% CI 1-1.75 respectively). Anti-RNP positivity has been associated in particular with ILD, pulmonary hypertension and shrinking lung. Although these manifestations prevalence was similar in our cohort, an association with this antibody was not found (OR 1.01, 95% CI: 0.2-4.9). This could be explained by the smaller sample size. As for anti-La positivity, its prevalence in our cohort was less than what was found in the GLADEL cohort (16.5% vs 24.3% respectively). It is possible that this could explain the poor association between anti-La positivity with the presence of pulmonary manifestations in our study compared with those of the GLADEL cohort. There are data that indicates that anti-SM and anti-RNP simultaneous positivity is related mainly to pleuritis OR 1.98 (95% CI: 1.31-3); and this kind of involvement was found to be more frequent in our study. Our results suggest an association between positive anti-SM and pulmonary manifestations in Colombian patients with SLE, pleuritis in particular.References:[1]Haye Salinas MJ, Caeiro F, Saurit V et al. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus. 2017;26(13):1368–77.[2]Emad Y, Gheita T, Darweesh H, Klooster P, et al. Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: Correlations with clinical manifestations and disease activity. Reumatismo. 2018;70(2):85–91.Disclosure of Interests:None declared

Background:Pulmonary manifestations are frequent in systemic lupus erythematosus (SLE) with a frequency of 30-90% that depends on the cohort and the methods used for their identification. The association of this compromise with mortality highlights its importance and the need for biomarkers to adequately predict this complication. We describe the prevalence of pulmonary manifestations, and the clinic and immunoserological characteristics of 551 Colombian patients with SLEObjectives:We performed an observational and analytic study of a retrospective cohort with adult SLE patients who fulfilled the 2012 SLICC classification criteria and that had a history of at least 6 months of the disease. These patients were treated in a specialized center of rheumatology with presence in six cities of Colombia between 2015 and 2018. We excluded pregnant patients and those with incomplete data for our survey. The first clinic consult occurred between 2015 and 2018, being defined as moment one. The follow up one year later was defined as moment two. We obtained 710 registries that were potentially eligible and analyzed 465 patients at moment two after applying the exclusion criteriaMethods:In 465 eligible patients, 20,5% had pulmonary compromise (93.8% female) with a median age of 42,4 years. The average SLICC Damage Index of 551 patients with SLE was 0,9 in women and 1.05 in men, while the average SDI of patients with pulmonary compromise was 1. The most frequent manifestation was pleural (14.3%), followed by Lupus pneumonitis (3.6%) and pulmonary hypertension (3.2%). Other manifestations and serological characteristics are recorded in Table 1. Of note, ANA homogeneous pattern was the most common (34.5%), anti-RNP positivity was 41.7%, anti-dsDNA positivity was 53.1% and 53.1% had hypocomplementemia.Results:The prevalence of pulmonary manifestations in our cohort was 20,5%, which is lower that in the previous described GLADEL cohort (28,4%). This could be explained by the regional differences of ethnicities in Latin America and in immune-serological profiles. Anti-RNP positivity was frequent (41.7%) and new pulmonary compromise for one year follow-up was rare. Of not, the mean damage index for our patients with pulmonary manifestations was 1, this could highlight the importance of this organ as a causa of higher damage accrual and mortality, which we will explore in the futureConclusion:The prevalence of pulmonary manifestations in our cohort was 20,5%, which is lower that in the previous described GLADEL cohort (28,4%). This could be explained by the regional differences of ethnicities in Latin America and in immune-serological profiles. Anti-RNP positivity was frequent (41.7%) and new pulmonary compromise for one year follow-up was rare. Of not, the mean damage index for our patients with pulmonary manifestations was 1, this could highlight the importance of this organ as a causa of higher damage accrual and mortality, which we will explore in the futureReferences:[1]G. Aguilera-Pickens, C. Abud-Mendoza. Pulmonary Manifestations in Systemic Lupus Erythematosus: Pleural Involvement, Acute Pneumonitis, Chronic Interstitial Lung Disease and Diffuse Alveolar Hemorrhage. Reumatol Clin. 2018;14(5):294–300.[2]Haye Salinas MJ, Caeiro F, Saurit V. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus (2017) 0, 1–10.[3]Santamaria-Alza Y, Sanchez-Bautista J, Fajardo-Rivero J. Acute respiratory involvement in Colombian patients with systemic lupus erythematosus undergoing chest computed tomography. Int J Rheum Dis. 2019;00:1–7.Table 1.clinical and immunoserological characteristicsn%Women10693,8Global mortality468,3Pulmonary compromise mortality87,1ANA10492Anti-DNA6053,1ENAS97,2Ro35/8740,2La14/8516,5SM32/8836,4RNP35/8441,7Follow up 1 %Follow up 2 %P Value *Pulmonary hypertension3,22,80,28Pulmonary fibrosis2,142,61Shrunken lung0,20,21Pleuritis14,315,050,42Lupus pneumonitis3,63,010,85Alveolar hemorrhage1,41,30,76Pulmonary embolism2,31,930,72Disclosure of Interests:None declared

Background:There seems to be a relationship between 25-hydroxyvitamin D [25(OH)D] level and rheumatoid arthritis (RA)(1). It has been proposed that susceptibility for RA exists in selected patients with low 25(OH) with conflicting results (2,3) Regarding disease activity, most of the evidence suggests an inverse relationship of disease activity with 25(OH)D levels(4). To our knowledge, there is only a small study that suggests low 25(oh) D levels as a predictor of disease activity (5) in our regionObjectives:We aimed to evaluate the possible association of low 25(OH) D levels and disease activity in a large cohort of patients with Rheumatoid Arthritis in ColombiaMethods:We evaluated the clinical records of 3576 patients with RA that fulfilled the 2010 EULAR Classification Criteria for Rheumatoid Arthritis and that were managed in our autoimmunity center between 2014 and 2017. Registries that contained both the measurement of 25(OH)D levels and DAS28 VSG with no more than 6 months apart and that also had at least a mean 12-month follow-up were included. We classified 25(OH) D insufficiency as levels ≤ 20ng/ml. We evaluated differences in achieving disease control depending on the 25(OH) D levels with McNemar’s test. Disease control was defined as DAS28VSG≤3.2Results:A total of 880 patients were included, 90% were female and their mean age was 63 years and 24.3% had 25(OH) D insufficiency. The vast majority were seropositive and only 13% were on biologics (Table 1). A 25% of patients who 25(OH)D insufficiency had DAS28 3.2 and a year of follow-up decreased to 24% with medical intervention (p=0,1), while patients without 25(OH)D insufficiency at the beginning of follow-up, 27% had DAS28 3.2 and after one year follow-up decreased to 17% (p=0.001)Table 1Mean (SD)Age (years)63.3 (10.6)Disease Duration14.7 (10.8)Age at diagnosis48.6(13.5)N%Sex (Feminine)79390.1Rheumatoid Factor (Positive)N=81769985.6ACPA (Positive)N=36632.377.6Actual Steroid use61169.4Actual Biologic Therapy12313.9DMARD Methotrexate57064.8 Leflunomide68277.5 Sulfasalazine21824.8 Azathioprine50.6 Antimalarials14716.7Conclusion:In Colombian patients with rheumatoid arthritis low 25(OH) D status has an inverse correlation with disease control. Even in an equatorial country, up to 24% of RA patients had low vitamin levels. A strategy of active detection of 25(OH) D insufficiency could have an impact on disease activity and health statusReferences:[1]Ishikawa LLW, Colavite PM, Fraga-Silva TF de C, Mimura LAN, França TGD, Zorzella-Pezavento SFG, et al. Vitamin D Deficiency and Rheumatoid Arthritis. Vol. 52, Clinical Reviews in Allergy and Immunology. Humana Press Inc.; 2017. p. 373–88.[2]Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, et al. Vitamin D and rheumatoid arthritis: An ongoing mystery. Vol. 29, Current Opinion in Rheumatology. Lippincott Williams and Wilkins; 2017. p. 378–88.[3]Bae SC, Lee YH. Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis: a Mendelian randomization. Clin Rheumatol. 2018 Sep 1;37(9):2415–21.[4]Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis. Clin Exp Rheumatol. 2016;34(5):827–33.[5]Quintana-Duque MA, Caminos JE, Varela-Nariño A, Calvo-Paramo E, Yunis JJ, Iglesias-Gamarra A. The role of 25-hydroxyvitamin D as a predictor of clinical and radiological outcomes in early onset rheumatoid arthritis. J Clin Rheumatol. 2017;23(1):33–9.Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Carolina Perez-Rios: None declared, Yecenia Durango-Durango: None declared, Ricardo Pineda.Tamayo: None declared

BackgroundRA treatment involves starting early with a DMARD. MTX achieves good sustained response in 30–40% of patients (pts). When MTX response is insufficient add other DMARD by achieve RA remission. Different factors may affect the response to MTXObjectivesTo analyze the clinical and demographic characteristics related to response to MTX in RA pts DMARD-naïveMethodsWe enrolled between 2011 and 2015, pts>18years RA diagnosed (ACR 1987 criteria), treated firs with MTX monotherapy (MTXm). A case-control study (MTXm persistence with CRP-DAS28<3.2 and suspension of MTXm by ineffectiveness or toxicity, respectively) was performed. We collected information that can influence the response to MTXm by medical records review and patient survey. A descriptive and analitical study with SPSS statistics 21 was performedResultsWe included 222 pts (70 men and 152 women). The characteristics of cases (123) and controls (99) are shown in the table. The causes of MTXm suspension were remission (7), intolerance/toxicity (19) and inefficiency (79). MTX was discontinued in 40 (18.2%) pts, 28 (12.7%) of them by intolerance/toxicity. Of 123 (55.4%) responders, 71 (32.0%) were CRP-DAS28<2.6. MTXm response was associated with age at onset ≥60 years (χ2 18.47, p<0.01, OR 3.67), rheumatoid factor (RF) <100 IU (χ2 10.92, p<0.01, OR 3.16) and current smoking (χ2 12.71, p<0.01, OR 2.95). Tobacco was associated with RF+ (χ2 8.9 p<0.01 OR 2.59 (1.37; 4.89) and ACPA+ (χ2 4.49 p<0.05 OR 1.88 (1.04, 3.38). We found no association with gender, education, job, coffee, tea or alcoho drinks, comorbidities, cardiovascular risk, possitivity ACPA or FR, RA presentation, treatment delay, or corticosteroid use. We found no correlation between age of RA-onset and RF or ACPA levels and MTXm duration. MTXm persistence at 5 years was 59% pts and their median survival was 93 months (77.14 to 108.8). We only found significant differences in favor of non-smokers and RF<100Table 1.Clinical and sociodemographics characterisitics of RA patientsCharacteristicsRespondersNonrespondersStatistic Significancy n=125n=99 Age at onset (y) (mean, SD)53.48 (13.0)46.65 (11.5)t=4.08 p=00006Female n (%)80 (65.0)72 (72.7)nsCurrent Smokers n (%)23 (18.7)40 (40.4)χ2 12.7 (p<0,01)OR 2.95 (1.6, 5.4)Alcohol consumers n (%)35 (28.5)28 (28.3)nsComorbidity n (%)92 (74.8)61 (61.6)χ2 4.45 (p<0.05)OR 1.21 (1.0, 1.5)CV risk factors n (%)92 (74.8)81 (81.8)nsPolyarticular onset of AR n (%)61 (49.6)61 (61.6)nsExtraarticular involvement n (%)17 (13.8)21 (21.2)nsPossitive RF n (%)89 (72.4)79 (79.8)nsPossitive ACPA n (%)70 (60.3)64 (68.1)nsDuration of RA (m) (mean (SD)96.1 (63.1)96,0 (73.9)nsMTX toxicity n (%)47 (38.2)59 (59.6)χ2 10.0 (p<0.01)OR 2.38 (1.4, 4.1))MTX dose (mg) (mean, SD)15.6 (0.32)17.8 (0.37)t=-4.52 p=00001ConclusionsThe initial treatment of RA with MTX is an effective and safe option, with a high drug survival. MTX response was not associated with antibody positivity (RF or ACPA), but it was significantly better in non-smokers patients and RF <100. Smoking cessation could signific...