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Background: Interstitial lung disease (ILD) associated with Rheumatoid Arthritis (RA) has a poor prognosis. Treatments such as anti-TNF, have been implicated in the exacerbation of an ILD. Objectives: Our objective is to evaluate and compare the evolution of ILD in patients with RA treated with Abatacept (ABA), Rituximab (RTX) and Tocilizumab (TCZ) after 1 year of treatment. Methods: Retrospective multicentre study of patients with ILD and AR treated with ABA, RTX and TCZ at standard doses. The ILD was diagnosed by CT. Conclusions: There seems to be a trend towards a better radiological response in patients treated with RTX and ABA. It would be necessary prospective studies. Background: Approximately a third of Rheumatoid Arthritis (RA) patients treated with tumour necrosis factor (TNF)-a inhibitors such as Infliximab (IFX) fail to respond. This has prompted a widespread interest in the finding of measures for predictors of response to TNFa inhibitors. Objectives: To search for serum autoantibodies that aid to identify RA patients most likely to benefit from IFX. Methods: We analysed serum of 170 biologic-naïve RA patients at baseline assigned to receive IFX plus methotrexate. The serum samples were distributed in 3 independent samples sets that were provided by 3 different sources: 1 discovery sample set (n=24) collected from Hospital Clínico Universitario of Santiago de Compostela (Spain) and 2 validation sample sets collected from Hospital Universitario de A Coruña (Spain), (n=61); and the Swedish Farmacotherapy (SWEFOT) trial (Sweden), (n=85). The European League Against Rheumatism (EULAR) criteria were used to assess the clinical response at six months of follow-up: good response (GR, n=60), moderate (MR, n=60) and non-response (NR, n=50). A suspension bead array platform built on protein fragments within Human Protein Atlas and selected from an initial screening using an array containing 42 000 antigens was employed to identify the IgG and IgA autoantibodies in the discovery sample set and validate the results within the 2 validation sets. Thresholds for autoantibodies were calculated by Receiver Operating Characteristics (ROC) curve analysis performed with SPSS 24. Results: Our data revealed a more prevalent IgG reactivity and higher IgG autoantibody levels against the antigen Centromere Protein F (CENPF) in GR when compared with NR, showing an overall reactivity of 31% vs 0%, 45% vs. 26% and 17% vs 4% in the three sample sets analysed respectively. The area under the ROC curve was 0,649 [p-value=0.049; IC 95% (0.510-0.789)]. CENP-F is a proliferation-associated and cell cycle-dependent centromere autoantigen that might be involved in the increased or abnormal cell proliferation that occurs during RA process. Interestingly, our results also showed that IgA autoantibodies levels toward the antigen Solute Carrier family 39 member 2 (SLC39A2), a zinc transporter protein, were decreased in GR when compared with MR in the discovery sample set and this trend was significantly validated (p=0.018) in the SWEFOT c...

BackgroundDisease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX), leflunomide (LFN) or antiTNFα have been implicated in development/exacerbation of Interstitial lung disease (ILD)of rheumatoid arthritis (RA). Several radiological patterns of ILD have been described: i) usual interstitial pneumonia (UIP), ii) nonspecific interstitial pneumonia (NSIP), iii) obliterating bronchitis (OB), and iv) Organized pneumonia (OP)ObjectivesTo assess the response to Abatacept (ABA) in these patterns of ILDMethodsMulticenter study of RA-ILD treated with ABA. ILD was diagnosed by high-resolution CT scan (HRCT) and classified in radiological patterns (Travis et al). We consider 3 subgroups: a) UIP, b) NSIP and c) “other” (OB, OP or mixed). ABA was used at iv or sc standard dose. We assessed: a) Dyspnea (Medical Research Council-modified scale; significant variations≥1); B) Respiratory function tests; significant changes≥10% in forced vital capacity (FVC) and DLCO≤10%, c) HRCT, d) DAS28. A comparative study was performed for the quantitative (U-Mann-Whitney) and qualitative variables (Fisher test) between the baseline and 3, 6 and 12 months.ResultsWe included 63 patients (27 women/36 men), mean age; 63.1±9.6 years. At ABA onset the RA had a median evolution of 6.8 [2–13.6] years and the ILD of 1 [0.3–3.03]. RA was seropositive in 85.7%. The diagnosis of ILD was confirmed by biopsy (n=18). The ILD was related to DMARDs: MTX (4), etanercept (3), adalimumab (3), certolizumab (2), Infliximab (1). ABA was used in monotherapy (26) or combined with other DMARDs (37); LFN (15), Cyclosporin (1), sulfasalazine (4), MTX (6), hydroxychloroquine (10), azathioprine (4), chloroquine (1). Table 1 shows the evolution in the available cases. A significant improvement in dyspnea and HRCT was observed in the NIU type. DLCO remained stable in most patients regardless of the radiological pattern. The activity of RA (DAS28) also improved.Table 1ConclusionsABA appears to be effective in ILD associated-RA, including the pattern of poor prognosis (UIP).References Travis WD et al. J Respir Crit Care Med 2013 188:733–748. Disclosure of InterestNone declared

BackgroundAccording to clinical guidelines, treatment with a DMARD should be initiated as soon as possible, and any patient who does not improve with at least one relevant synthetic DMARD is a candidate for a biological one. However, up to one third of the patients treated with a biological DMARD do not accomplish the therapeutic objective.ObjectivesTo identify and assess the attributes of the biological DMARDs which determine the most suitable treatment of patients with RA.MethodsWe performed a systematic search with the following MeSH terms: rheumatoid arthritis, biologic, DMARD, characteristic, efficacy, safety, side effects, pharmacology, route–administration, adherence y cost. More than 500 publications were reviewed, from which we selected 77 attributes: 7 about general aspects, 5 about pharmacological aspects, 18 about efficacy, 31 about safety, 6 administration aspects and 10 related with cost. Between May and September 2015, 12 meetings were held, followed by a Delphi process of 2 rounds in which the degree of importance was awarded to each attribute on a Likert scale from 1 (minimum) to 9 (maximum). The consistency and concordance of the agreement were determined and they were circulated, obtaining the percentage supported for each one of them.Results83 Spanish rheumatologists participated, reaching a high degree of agreement with the attributes, 75 with a high importance (97.4%) and none of low importance. Fifteen attributes were ratified by all the participants:Product with approved indication in RA as first-line biological.Product recommended in the guidelines as first-line biological.Product that shows efficacy following the failure of another biological.Treatment accompanied by a reduction in articular damage progression.Treatment that reduces comorbidities associated with RA.Treatment characterised by a sustained long-term response.Safe product (globally).Proven long-term safety.Treatment with a low incidence of serious infections.Product that does not increase the incidence of solid malignancies.Product that does not increase the incidence of haematological neoplasms.Safe product in patients with cardiovascular pathology.Safe product in patients with interstitial pulmonary disease.Product that has demonstrated a reduction in mortality.Product that presents a scant incidence of serious adverse events.ConclusionsThere was a high degree of agreement with the selected attributes, none of which were regarded as being of low importance; 15 of them received the full support of the work group. These attributes would help to define the ideal profile of the biological DMARD following the failure of a synthetic or previous biological DMARD.AcknowledgementFinancing: Bristol-Myers SquibbDisclosure of InterestNone declared