Background:Determining the relationship between severity of skin and joint disease is essential for better phenotyping of patients and determine whether clinical features of arthritis can associate with psoriasis.Objectives:To characterize the relationship between skin and joint activity in patients with psoriatic arthritis (PsA) and psoriasis (PsO) at enrolment.Methods:We performed a retrospective and descriptive study including patients diagnosed with PsA with a history of PsO. Age, sex, disease onset and duration, pattern of PsA and PsO, sites of skin and joint involvement were collected. PsA patients were evaluated at enrolment for skin activity by Psoriasis Area and Severity Index (PASI), joint activity by Disease Activity Score 28 (DAS28) for peripheral arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for axial involvement. A PASI>10% was used to define moderate-severe psoriasis (MS-P). We compared clinical characteristics of patients with PsA based on PASI score and evaluated the relationship of skin and joint activity with linear regression.Results:A total of 50 patients were collected, 64% were women with a mean age of 57.4 ±11.9 years. Patients with MS-P had a long-standing history of PsO (16.6±7.9 vs 14.15±8.2 years, p 0.03) and arthritis (12.2±7.6 vs 10.6±7.6 years, p 0.05). PsO was diagnosed more frequently before arthritis in the group of MS-P (73% vs 42%, p 0.03). Nail (73% vs 34%, OR 4.27 (1.38-20.14), p 0.015) and hairline psoriasis (67% vs 29%, OR 5 (1.36-18.35), p 0.03) were more frequent in the group of MS-P. Polyarthritis was the most common clinical pattern (60% vs 26%, p 0.02) and peripheral arthritis, in shoulder, elbows and wrists was more associated to patients with MS-P. No significant difference regarding sex, age, arthritis onset, dactylitis, enthesitis or HLA-B27 was found. Patients with MS-P had a higher joint activity for peripheral arthritis (4.1 vs 2.44, p 0.02). The correlation between the skin and joint activity was positive and statistically significant r=0.568 (p 0.02), (graph 1).Conclusion:Patients with PsA with MS-P associate nail and hairline psoriasis, polyarthritis, and peripheral joint involvement more often. Cutaneous disease activity is correlated with joint activity. Collaboration between dermatologists and rheumatologists is recommended for a proper assessment of psoriatic arthritis with skin involvement.Graph 1.Correlation between skin and joint activityTable 1.Demographic and clinical characteristics of 50 patientsPASI <10%N = 35PASI> 10%N=15OR 95%ICP valueAge54.4 ±10.453.9 ±12.9-0.86Female63%73%0.62 (0.16-2.34)0.53Duration of psoriasis14.15 ±8.216.6±7.9-0.03Duration of arthritis10.6 ±7.412.2 ±7.6-0.05Psoriasis onset42%73%3.67 (1.97-13.8)0.03Arthritis onset17%20%1.21 (0.26-5.64)1Nail psoriasis34%73%4.27 (1.38-20.14)0.015Hair line29%67%5 (1.36-18.35)0.03Enthesitis14%13%1.08 (0.19-6.32)0.96Dactylitis20%33%0.5 (0.13-0.96)0.47HLA B2734%13%3.39 (0.66-17.56)0.18Type of arthritisAxial26%13%0.44 (0.08-2.36)0.47Peripheral42.8%73%6.88 (1.77-26.76)0.05Both31%13%0.34 (0.06-1.75)0.29Joint involvementBack14%20%0.67 (0.14-3.24)0.68Shoulders17%53%5.52 (1.44-21.14)0.02Elbows5.7%33%8.25 (1.38-49.21)0.02Wrists31%73%6 (1.56-23.11)0.01Fingers54%60%1.26 (0.37-4.32)0.77Knees29%47%2.19 (0.63-7.65)0.33Ankles40%60%2.25 (0.65-7.73)0.22Toes46%53%1.36 (0.4-4.56)0.76Articular patternPolyarthritis26%60%4.33 (1.2-15.61)0.02Asymmetric oligoarthritis29%27%0.91 (0.23-3.54)1DIP involvement14.3%13.3%0.92 (0.16-5.39)1Spondyloarthritis11.4%13.3%1.19 (0.19-7.33)1Arthritis mutilans----DAS282.44 ±0.954.1±1.2-0.02References:[1]Mease PJ, Etzel CJ, Huster WJ. Understanding the association between skin involvement and joint activity in patients with psoriatic arthritis: experience from the Corrona Registry. RMD Open. 2019 May 24;5(1):e000867. doi: 10.1136/rmdopen-2018-000867. PMID: 31245045; PMCID: PMC6560Disclosure of Interests:None declared.

Background:Primary Sjogren’s Syndrome (PSS) is an autoimmune and lymphoproliferative disease with a heterogeneous presentation. It has been postulated that there may be different phenotypes, in some cases presenting a more aggressive disease with systemic manifestations and a higher risk of developing complications. This phenotype has been associated with a higher autoimmune load and an earlier age of presentation. Furthermore, the presence of anti La + has been related to an increased risk of developing Lymphoma.Objectives:To describe the phenotypic characteristics of seronegative PSS in a sample of patients from our practice. To compare the clinical and laboratory characteristics between patients with Ro + / La + and Ro + / La- antibodies. To Analyze if there are differences in patients diagnosed at an early age, compared to a later age.Methods:Clinical and serological characteristics of patients with the diagnosis of PSS were collected from the Rheumatology database of León`s Hospital between 2014-2020. All patients who met the ACR / EULAR 2016 criteria were classified as seronegative Sjogren.In the group of patients with positive autoimmunity, anti-Ro + / La + were compared with the anti-Ro + / La- patients and by age, stratifying them into the following groups: 0-49; 50-69 and> 70 years. The clinical variables analyzed were: glandular inflammation, Raynaud’s phenomenon (RP), pulmonary and neurological involvement, presence of Lymphoma and other tumours. The serological variables were: positivity of ANA, Rheumatoid Factor (RF), hypocomplementemia, hypergammaglobulinemia and B2 microglobulin.Results:72 patients were analysed, 9 were excluded because didn’t meet the criteria. Of the remaining: 90,4% were women, with a mean age of 58,7+/-15,8 years, 12,6% (8) were seronegative. In the seronegative group 25% presented lung involvement (Lymphoid Interstitial Pneumonia), 50% presented with glandular inflammation and only one patient had RP. As complications 1 patient presented Lymphoma and 1 Breast Carcinoma.58,7% (37) Ro + / La + and 28,5% (18) Ro + / La- patients were identified, no statistically significant differences were found between the two groups when comparing: glandular inflammation (8/37 vs 2/18, p = >0.05) RP (9/37 vs 4/18, p = >0.05), pulmonary involvement (5/37 vs. 6/18, p = >0.05), neurological involvement (2/37 vs. 1/18, p = >0.05), presence of Lymphoma (2/37 vs. 0 / 18, p = >0,05), other tumours (2/37 vs 3/18, p = >0.05), ANA positivity (36/37 vs 16/18, p =>0,05), Hypocomplementemia (4/37 vs 3/18, p =>0.05) and Hypergammaglobulinemia (20/37 vs 10/18, p =>0.05). But a higher frequency of positive RF linked to anti La positivity (29/37 vs 6 / 18p = 0.002) was found.When comparing by age groups, the association between RF + and La + remained in the group of 50-69 years (15/18 vs 3/18, p = 0.002) while in the other age groups there were no statistically significant differences. We also observed an increasing trend of the levels of B2microglobulin in La+ patients and later age (p=0,04)Conclusion:The presence of anti La + seems to be associated with other components of autoimmunity such as RF in patients with PSS, although this study did not show a relation with a higher frequency of complications or systemic disease. Also, the presence of La+ at older ages was associated with higher levels of B2 microglobulin. We didn’t find differences with the other described markers of B cell reactivation. Findings differ from those found in the literature, which may be largely due to sample size.References:[1]Quartuccio L., Baldini C., Bartoloni E., et al. Anti-SSA/SSB-negative Sjogren’s syndrome shows a lower prevalence of lymphoproliferative manifestations, and a lower risk of lymphoma evolution. Autoimmunity Reviews 14 (2015) 1019–1022.[2]Quartuccio L, Isola M, Baldini C, Priori R, Bartoloni Bocci E, Carubbi F, et al. Biomarkers of lymphoma in Sjögren’s syndrome and evaluation of the lymphoma risk in prelymphomatous conditions: results of a multicenter study. J Autoimmun 2014; 51:75–80.Disclosure of Interests:None declared

Background:Lung involvement1 in Systemic Lupus Erythematosus (SLE) is heterogeneous, with the pleura being more frequently affected. Associated diffuse interstitial lung disease (ILD) is rare (3-13%) with difficult diagnosis and therapeutic management.Objectives:Assess the main clinical-epidemiological characteristics of patients diagnosed with SLE with ILD in a third level hospital and analyze the possible relationship between them.Methods:Descriptive observational study of patients diagnosed with SLE (SLICC criteria) with ILD in our hospital between 1973 and 2020. The following clinical-epidemiological characteristics were evaluated such as sex, mean age at diagnosis, presence of cardiovascular risk factors (CVRF), smoking, baseline cardiac and respiratory comorbidities, laboratory markers (autoimmunity, CRP and vitamin D), baseline SLEDAI, manifestations of SLE, interstitial pattern on HRCT, correlation with conventional radiology (Rx), respiratory function tests, clinical and physical examination at diagnosis.Results:455 patients diagnosed with SLE were included, of whom 20 had ILD (4.4%). 65% were women with a mean age at diagnosis of 63 ± 16.23 years. 30% presented ILD as the first clinical data for the diagnosis of SLE. 30% had jobs with exposure to chemicals. 25% were ex-smokers and 10% were active smokers. 10% had associated CVRF, highlighting HT (35%). 30% had valve disease on echocardiography such as mitral regurgitation (30%) and tricuspid regurgitation (20%). Only 10% had associated bronchopathy. 35% and 25% associated, respectively, pleural serositis and secondary Sjogren’s syndrome. Arthritis and skin involvement were documented in 60% for both clinical domains. 40% had SLEDAI> 6.At the diagnosis of ILD, 90% had symptoms such as dyspnea (75%) and cough (60%). 80% had crackles on examination. 85% had alterations in the X-ray and 100% in the CT scan with the NINE patterns as the main one (65%) with progression at 2 years despite treatment in 25%. Spirometry differentiated an obstructive pattern (25%), restrictive (20%) and normal (55%) with a tendency to stability at one year (40%) with the prescribed treatment. 90% had a decrease in diffusion, the majority being mild (67%). Analytically, 67% had elevated levels of CRP and hypovitaminosis D; 40% elevated DNA titers, 50% hypocomplementemia and 60% ENAS positive, highlighting Ro (45%); La (15%) and RNP (15%). Leukopenia and thrombopenia (30% and 10% respectively) were also observed.In our study, we did not find any statistical significance between the variables analyzed, due to the small sample size.Conclusion:1)ILD is an infrequent manifestation in SLE, it usually associates respiratory symptoms and pulmonary functional repercussions with the diagnosis. The most characteristic radiological pattern is the NINE.2)In our study, ILD was more frequently associated with women and joint or skin symptoms, as well as with data on immunological activity, without statistical significance.References:[1]Aguilera-Pickens G, Abud-Mendoza C. Pulmonary Manifestations in Systemic Lupus Erythematosus: Pleural Involvement, Acute Pneumonitis, Chronic Interstitial Lung Disease and Diffuse Alveolar Hemorrhage. Clinical rheumatology. Vol.14 Issue. 5. Pages 294-300 (September-October 2018).Disclosure of Interests:None declared

Background:A bias has been described with the lowest prescription of biologic treatments (bDMARD) in patients with rheumatoid arthritis (RA) in the elderly, despite presenting activity rates comparable to young population and higher risk of functional disability. This could be due to concerns about co-morbidities and polypharmacy1.Objectives:1) To define the characteristics of patients with RA ≥65 years and bDMARD to follow up in the Day Hospital of University Assistance Complex of León during the last year. 2) To record the incidence rate (IT) and ratio of incidence rates (RDI) of infections, neoplasms and cardiovascular events (CD) during the course of your therapy.Methods:Observational, retrospective study of patients diagnosed with RA according to ACR 1987 and/or ACR 2010 criteria in intravenous biological treatment during 2019 with ≥65.Results:40 patients with an average age at diagnosis of 55.9±15.76 years were included, 67.5 % of them were women. The average duration of the disease was 17.65±13.15 years. 40% had a history of smoking, 35% hypertension, 20% dyslipemia and 20% diabetes mellitus. A 97.5% were positive FRRA, 57% positive ACPA, 37.5% nodular and 65% erosive. As for pre-treatment, 70% had been with conventional (cDMARD) ≥2DMARD (Methotrexate (MTX) (92.5%) and Leflunomide (60%)). The mean dose of prednisone was 8.79 ±10.14 mg/day. The incidence rate of infections was 1.5%, and neoplasms and CD were 0.75% per person-years. The age at the beginning of the first bDMARD was 67.45 ± 8 years, the second (n=20) 67.98±6.64 and the third (n=7) 71.79±7.49. The first biological was a 52.5% anti-TNF, 5% anti-CTLA4, 30% anti-CD20 and 12.5% antiIL6 (25% monotherapy and combined with MTX 57.5%). The second was 30% anti-TNF, 25% antiCTLA4, 15% antiIL6 and 30% antiCD20 (50% in monotherapy and 40% methotrexate); with the third anti-TNF 42.85%, antiCTLA4 14.29%, antiIL6 14.29% and antiCD20 28.57% (42.86% in monotherapy and 42.46 with methotrexate). The mean doses of prednisone were 6.08±6.82, 4.38±7.21 and 6.95±5.94 mg/day respectively. The IT of bDMARD infections were 8.81%, 19.81% and 7.4% person-years; of neoplasia 1.04%, 0 and 0; and EC 3.63%, 0 and 1.85 person-years. The RTIs with first, second and third biological infections were: 5.88, 13.25, 4.95; with neoplasms 1.38; with EC 1.38, 0 and 0.69. The mean total accumulated corticosteroid dose was 17.69±15.01 mg/day.Conclusion:1) Patients over 65 years old receiving bDMARD in our Day Hospital in 2019 were long-standing RA with aggression data, who had not responded to ≥2 cDMARD and required medium-high doses of prednisone.2) In our sample there is a link between incidence of infection and the introduction of biological therapy, which is maintained with the increasing age of our patients, and it is not so clear with neoplasms and CD. These data are consistent with the existing literature1,2,3.3) Larger, comparative studies with RA under 65 years are needed, but it is reasonable to conclude that if bDMARD is required, elderly patients could be a high-risk group for infections, requiring special monitoring and follow-up.References:[1]Alla Ishchenko, Rik J. Lories. Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Olfer Rheumatoid Arthritis Patients: Staying the distance. Drugs Aging 2016;(33):387-398.[2]Atsuko Murota, Yuko Kaneko, Kunihiro Yamaoka y Tsutomu Takeuchi. Safety of Biologic Agents in Elderly Patients with Rheumatoid Arthritis. J Rheumatol 2016; (43): 1984-1988.[3]Kosuke Ebina, Motomu Hashimoto, Wataru Yamamoto, Toru Hirano, Ryota Hara, Masaki Katayama et al. Drug tolerability and reasons for discontinuation of seven biologics in elderly patients with rheumatoid arthritis. The ANSWER cohort study. PLoS ONE 14 (15):e0216624Disclosure of Interests:None declared

Background:The antimalarials remain to be the main treatment for Systemic Lupus Erythematosus (SLE). Its most important limitation when you want to increase dose or remain using them is the occurrence of retinal toxicity, which appears in a small number of patients. Since the lesions can progress even with drug withdrawal is important to perform a screening for an early diagnosis.Objectives:To describe ocular toxicity in patients with SLE treated with antimalarials that attended the rheumatology office and to identify possible associated risk factors.Methods:We performed a cross-sectional, retrospective study of SLE patients diagnosed of antimalarial drugs associated retinopathy, that were included in the data base of the Rheumatology department in León`s Hospital between 2014-2019. Multiple clinical and therapeutic factors potentially associated with retinal toxicity were analyzed including: age, chronic kidney disease (CKD), liver failure, smoking, hypertension, Diabetes mellitus, presence of previous retinopathy, type of treatment, duration, daily dose and cumulative dose and tamoxifen intake. The diagnosis of retinopathy was performed by the Ophthalmology department. The dose of hydroxychloroquine (HCQ) used was of 400mg/day and chloroquine (CQ) 250mg/day.Results:437 medical records were analyzed, 20 patients diagnosed of antimalarial retinopathy were included (4,57%), 90% of them were women. The age of diagnosis was more than 40 years in 18 patients (90%) and more than 60 years in 10 (50%) with a median of 60 years (IQR: 32,25).The duration of treatment was ≤ 5 years in 10 patients (50%), between 6-10 years in 6 (30%), between 11-15 years in 2(10%) and between 16-20 years in 2 (10%) with a median of exposure of 5,5 years (IQR: 6,5); 15 patients (75%) were in treatment with HCQ, with CQ 2 patients (10%) and with both of them sequentially 3 patients (15%).Of the group of patients treated with HCQ 35 % were above the global accumulated recommended dose (1000 g) and 71% of them were on treatment more than 10 years. In the group treated with CQ none were above the global recommended dose (460g). Of the 3 patients that took both drugs, two were above the recommended dose for HCQ.25% of the patients had CKD and 10% liver failure, 20% of the patients were active smokers and 15% ex-smokers.10% of the sample had previous retinopathy related with other comorbidities (age related retinopathy and diabetes), associating hypertension and diabetes mellitus in the same percentage (15%).Severe retinopathy was found in 1 patient (5%), mild-moderate in 9 patients (45%), retinopathy stages were not specified in 10 patients (50%).Conclusion:In our sample we observed a prevalence of antimalarials retinopathy of 4,57%, similar of what is found in the literature. Half of the patients had retinopathy in a period of treatment ≤ 5 years, being a described risk factor the duration of treatment of more than 6 years. This early manifestation could be related to the presence of other comorbidities like hypertension, diabetes and CKD.Dose readjustment should be considered in patients with a period of treatment of more than 10 years. Age seems to be an associated factor for the development of antimalarials retinopathy and to perform a screening in the first year of treatment is important to rule out basal disease related with more risk to develop ocular toxicity.References:[1]Jorge, A., Ung, C., Young, L.H. et al. Hydroxychloroquine retinopathy — implications of research advances for rheumatology care. Nat Rev Rheumatol 14, 693–703 (2018).[2]Mukwikwi ER, Pineau CA, Vinet E. et al. Retinal Complications in Systemic Lupus Erythematosus Patients Treated with Antimalarial Drugs. J Rheumatol. 2019 Sep 1. jrheum.181102[3]Abdulaziz N, Shah AR, McCune WJ. Hydroxychloroquine: balancing the need to maintain therapeutic levels with ocular safety: an update. Curr Opin Rheumatol. 2018 May;30(3):249-255.Disclosure of Interests:None declared