A. Borangiu

A10.06 Detecting adalimumab serum level and anti-drug antibodies – future tool in monitoring spondyloarthritis patients?

Background and objectives Anti-TNF agents have highly proved their efficacy in spondylarthritis (SpA) patients, with a good rate of response of approximately 70%. However a third of patients lose response to treatment. Measuring the drug serum level and anti-drug antibodies might lead to identifying the cause of non-response, followed by adjusting the therapeutic scheme. The aim was to determine the utility of determining drug serum adalimumab (ADL) and anti-ADL antibodies in assessing disease activity in SpA patients. Methods Over a period of 11 months we included 54 SpA patients on ADL, with further exclusion of those who had delayed drug administration or suffered a concomitant infection. Demographic, clinical (disease activity scores) and laboratory (ESR, CRP) data were collected. We measured the determination of interest using Promonitor kits, using the ELISA technique and the statistical analysis was performed with SPSS 20.0. Results Out of the total 35 patients, 74% were males, the mean age was 40 years old with a mean disease duration of 102 months. HLA B27 was positive in 91% of patients and 28% required sacroiliac joint MRI at diagnosis, being a non-radiographic form. 28% of patients tested positive for Quantiferon and underwent chemoprophylaxis. 22% had history of uveitis before diagnosis and 9% had recurrences while on ADL. 82% of patients had detectable ADL levels. The BASDAI score was significantly higher in patients with undetectable ADL (P < 0.001), with a mean value of 6.3 indicating an inadequate disease control. Furthermore, both ASDAS-ESR and ASDAS-CRP were higher in these patients (P < 0.001). 25% had positive anti-ADL antibodies. Patients with no identified antibodies had lower disease activity scores (BASDAI, ASDAS-VSH and ASDAS-CRP, P < 0.001). Acute phase reactants (ESR, CRP) had a higher value in patients with positive anti-ADL antibodies (P = 0.015 and P < 0.001, respectively). Serum level ADL negatively correlated to the presence of anti-ADL antibodies (r = -0.360, P = 0.034) and to disease activity scores. Conclusions Undetectable serum drug level together with the presence of anti-drug antibodies and the increase of SpA activity scores indicate the impact of immunogenicity throughout secondary non-responder patients. Prompt identification of these patients might lead to a better adapted therapeutic scheme.

AB1158 Prevalence of comorbidities in psoriatic arthritis: a cross-sectional study

Background Psoriatic arthritis (PsA) is associated with important comorbidities: cardiovascular, gastro-intestinal, infectious, malignant, and psychiatric [1, 2]. However, they are less studied in PsA compared to other chronic inflammatory arthritis. Objectives The objective of this study was to calculate the prevalence of comorbidities and risk factors in a cohort of PsA patients. Methods This was an observational cross-sectional study, including consecutive, unselected adult patients, with a diagnosis of PsA according to their rheumatologist. Data collected: demographical, clinical (affected joints, current psoriasis, axial involvement, enthesitis, dactylitis), biological (acute phase reactants), and treatment related (nonsteroidal anti-inflammatory drugs, synthetic remissive drugs and biologics). Data on comorbidities and risk factors were collected according to the European League Against Rheumatism (EULAR) recommendations on reporting comorbidities in chronic inflammatory rheumatic diseases in daily practice [3]. Results In all, 129 PsA patients were included: 77 (59.7%) women, mean age ± standard deviation 53.5±11.8 years, disease duration 7±7.4 years; 53 (41.1%) had axial involvement, 33 (25.6%) dactylitis, 18 (14%) enthesitis, and 24 (18.6%) current moderate/severe psoriasis. Most of them had low or moderate disease activity and almost a quarter of them (32; 24.8%) were taking a biologic. The most prevalent comorbidities were: dyslipidaemia 103 patients (79.8%), hypertension 67 (51.9%), obesity 44 (34.1%), diabetes 21 (16.3%) and ischemic heart disease 15 (11.6%). Almost a third of patients (42, 32.6%) suffered a cardiovascular event after their PsA diagnosis, of which heart attack 2 patients, stroke 4, cardiac failure 4 and peripheral arterial disease one patient. Cardiovascular events correlated with smoking (r=0.893, p<0.001) and current moderate/severe psoriasis (r=0.218, p=0.013). Regarding infectious comorbidities: 11 patients (8.5%) had a history of tuberculosis after being diagnosed with PsA, 7 (5.4%) chronic viral hepatitis, of which 4 with B virus and 3 with C virus, and 5 patients (3.9%) developed severe infections. Five patients (3.9%) were diagnosed with neoplasia, but no correlation was identified with any of the clinical, biological or treatment related included variables. Only 11 patients (8.5%) were diagnosed with depression, but the prevalence is probably underestimated, since not all patients were screened to this end. Conclusions PsA is associated with a high prevalence of comorbidities, especially cardiovascular diseases. This should be taken into consideration in the therapeutic and the global management of PsA patients. References Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep 2010;12(4):281–7. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: apopulation-based cohort study. Ann Rheum Dis 2015;74(2):326–32. Baillet A, Gossec L, Carmona L, et al. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Ann Rheum Dis 2016;75(6):965–73. Disclosure of Interest None declared

SAT0271 Is there a need to include serological pattern to predict damage in patients with antiphospholipid syndrome: diaps application

Background Antiphospholipid syndrome (APS) is an autoimmune disease defined as the presence of antiphospholipid antibodies (aPL), at least a clinical thrombotic event and is associated with an important risk of organ damage. The new index proposed, Damage Index in patients with Thrombotic Antiphospholipid Syndrome (DIAPS) may be an useful tool to estimate cumulative damage in patients with primary and secondary APS. It includes 38 clinical items expanded to show the complexity of clinical manifestations in APS patients. Objectives The aim of this study is to analyze the serological pattern as potential predictive factor for an increased DIAPS. Methods All consecutive patients known with APS according to the Sapporo and/or Sydney classification criteria were included in our monocentric cohort. Data on medical history, clinical manifestations, aPL profile and medication were collected. DIAPS score was used to measure damage in each patient. The relationship between aPL profile and DIAPS score was analysed. Results Seventy six patients with APS were included: 11 patients with primary APS, 65 patients with secondary APS. Their mean disease duration was 9.59±7.39years. The most frequent clinical manifestation from DIAPS was the peripheral vascular (deep vein thrombosis, intermittent claudication, tissue loss, vascular venous insufficiency) found in 61.8% of patients, followed by the neuropsychiatric manifestations (46.1%). The mean DIAPS score in our cohort was 4.25±3.51, not significantly different between patients with primary vs secondary APS (4.72 vs 4.16, p=0.629). Lupus anticoagulant (LA) was found in 25 patiens (32.9%), anti cardiolipin antibodies (aCL) in 49 patients (64.5%) and antibodies to β2-glycoprotein I (β2GPI) in 23 patients (30.3%). There were 36 patients known with a single positive aPL (47.4%), 27 patients (35.5%)with 2 positive aPL and only 2 patients with triple positivity. There were no significant differences regarding antibody profile between patients with primary and secondary APS. Higher values of DIAPS were seen in patients with β2GPI (p=0.042) and with positivity for 2 aPL (p=0.003). DIAPS value correlated to the presence of β 2GPI (p=0.042, R=0.233) and to positivity for two aPL (p=0.003, R=0.341). Conclusions Our study suggests that double positivity for aPL, especially the presence of β2GPI confers an increased value of DIAPS in patients with primary and secondary APS. References M-C Amigo et al. Development and initial validation of a damage index (DIAPS) in patients with thrombotic antiphospholipid syndrome (APS). Lupus (2015) 24, 927–934. LM Amezcua-Guerra. Improving definitions for an index of cumulative organ damage in patients with the antiphospholipid syndrome (DIAPS). Lupus (2016) 25, 671–672. Disclosure of Interest None declared

A10.05 Optimising existing tools for reaching an adequate disease control in patients with spondylarthritis

Background and objectives Disease activity in spondylarthritis (SpA) is widely evaluated through disease activity scores such as BASDAI, ASDAS and PtGA, with no proven superiority between them. The aim of this study was to subdivide patients with anti-TNF therapy according to their disease status indicated by scores in order to evaluate group characteristics with further assessment on the quality of each activity indicator. Materials and methods We included 100 SpA patients under anti-TNF therapy (32 infliximab, 33 adalimumab, 35 etanercept). We collected demographic, clinical (BASDAI, ASDAS, PtGA) and laboratory (ESR, CRP) data. Statistical analysis was performed with SPSS 20.0. Results We evaluated disease activity for the entire study group based on conventional scores: BASDAI, ASDAS-CRP, ASDAS-ESR, acute phase reactants and PtGA. When used as an external criterion PtGA showed that 12% of patients had active disease while 88% were classified as low disease activity (PtGA < 5). Mean ASDAS-CRP/ESR in the active group were 3.39/3.24. Mean BASDAI score in the high activity group was 5.66. We showed that both ASDAS scores had good discriminating capacities, with similar values when using the SMD (ASDAS-CRP and ASDAS-ESR – SMD 2.00). In our study group, based on PtGA, BASDAI outperformed ASDAS scores with a SMD of 3.33. We used ROC curves of the disease activity scores by using the PtGA ≥ 5 as variable of high disease activity state. For ASDAS-CRP, ASDAS-ESR and BASDAI the AUCs (area under curve) were 0.89 (P = 0.05), 0.88 (P < 0.001), and 0.99 (P = 0.009), respectively. For CRP and ESR the AUCs were 0.81 and 0.79 (P = 0.001, P = 0.003). This shows the high accuracy of the three scores in assessing SpA activity. When dividing patients according to BASDAI score (4 as cut-off), 14% showed a more active disease than the rest of 86% who had low disease activity. Mean ASDAS scores in the first group were 3.31 and 3.16, respectively. BASDAI correlated to both ASDAS scores (r = 0.65 and 0.71, P < 0.001) and PtGA stronger to BASDAI(r = 0.912, P < 0.01) than ASDAS(r = 0.67 and 0.71, P < 0.01). Conclusion We proved that disease activity scores have good discriminatory power and that BASDAI and ASDAS perform similarly in assessing and investigating SpA patients. BASDAI outperformed ASDAS when using PtGA as criterion.

FRI0256 Significance of Cognitive Impairment in Systemic Sclerosis

Background There is an increased appreciation of the burden of cognitive impairment in people with autoimmune diseases (1). Recent studies have demonstrated that patients with systemic sclerosis (SSc) have a specific pattern of cognitive impairment: the dysexecutive syndrome (2). Objectives We evaluated the prevalence of cognitive impairment in SSc and assessed the association with the disease features and impact on daily living Methods Consecutive SSc from EUSTAR center 096 were examined. Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction and scores ≤26 were considered abnormal (3). SSc patients were assessed according tu MEDS evaluation sheets to determine organ involvement, autoantibody profile, disease activity (Valentine Activity Index) and disease severity (Medsger Severity Index). sHAQ (Scleroderma Health Assessment Questionnaire) has also been completed. Data were compared by difference tests according to the types of variables: t-test, Mann-Whitney or chi-square. To evaluate correlations between variables Pearson or Spearman correlations were used. Results A total of 70 SSc patients [36 (51.42%) limited SSc (lSSc) and 34 (48.57%) with diffuse SSc (dSSc), 60 female; mean age 54.5 (±11.62) years; mean disease duration 66 (±429.6) months] were included in the study. 47.14% of the patients had active disease, the mean Rodnan score was 7 (±4.17), the mean Medsger score was 5.5 (±2.89), 24.28% of the patients had lung involvement and 20% had pulmonary arterial hypertension. The mean HAQ was 1 (±0.59). Cognitive impairment was identified in 65.71% SSc patients; the mean MOCA score was 26 (±2.83). Cognitive impairment of SSc patients was related to older age (r=-0.378, p=0.001), rural provenience (r=-0.351,p=0.003), severity of the disease evaluated by the Medsger score (r=–0.262,p=0.029) and poor quality of life evaluated by sHAQ (r=-0.323,p=0.003).Correlations were also identified with musculoarticular involvement (r=-0.330,p=0.006), advanced capillaroscopy patttern (r=-0.331, p=0.006). The diiffuse SSc patients were more likely to have cognitive dysfunction (likehood ratio 0.012) as were those with SCL70 positive (0.0.18). No relationship was identified between cognitive impairment and lung, heart or renal involvement, the presence of digital ulcers, the use of corticosteoids or immunosuppression. Conclusions An increased prevalence of cognitive impairment was observed in SSc and associated with age, rural provenience, more severe disease, muscle involvement and poor quality of life. Further studies are needed to be compared with healthy controls and to assess the role of microvascular damage or that of other confounders. References T.N.Amaral et al. Prevalence and significance of cognitive impairment in systemic sclerosis Ann Rheum Dis 2015;74:605 Ylmaz N. et al Dysexecutive syndrome: a specific pattern of cognitive impairment in systemic sclerosis Cogn Behav Neurol. 2012 Jun;25(2):57–62. www.mocatest.org/normative-data/ Disclosure of Interest None declared

AB0457 How Much Different Is Juvenile Onset Systemic Lupus Erhytematosus? Data from A Romanian Cohort

Background Systemic Lupus Erhytematosus (SLE) is a multiorgan disease in which pattern of evolution is linked to activity and damage. When the disease starts at an early age, all the outcomes might be influenced by this. Objectives The main focus of this study is to describe the differences between juvenile and adult onset SLE in a Romanian cohort. Methods 101 SLE patients were evaluated between March 2015 and December 2015. Patients were diagnosed with SLE according to ACR classification criteria and splited in 2 groups, taking into account age at disease onset: before and after 18. All patients agree to participate in this study. Data about demographic, clinical or serological characteristics, activity (SLEDAI) or damage (SLICC damage index SDI), treatment were collected. Statistical analisys was performed with SPSS 20.0. Results Our cohort was made from 18 patients with juvenile onset SLE and 83 with adult onset SLE. Mean age at diagnosis was 14.05 versus 37.89. The juvenile onset SLE group had significant more autoimmune disease as family background, mainly SLE and rheumatoid arthritis (33.3% versus 12.04%, p 0.025), significant more severe organ involvement during the disease evolution: SLE related neurologic involvement 33.3% versus 12% (p 0.025) and renal involvement 50% versus 16.8% (p 0.023), more frequent anti dsDNA Ab positives 88.8% versus 60.24% (p 0.021). This more severe pattern of evolution is also reflected by immunosuppressant therapy, Cyclophosphamide being used in juvenile subgroup in 66% cases versus 35.3% in adults (p 0.014). Interesting, there were no differences between cumulative damage between groups, as measured by SDI (p 0.24), with the mention that in juvenile onset patients, SDI>1 was more frequent SLE related. This is in line with the fact that side effects of the corthicotherapie were identified more in adult onset SLE 61.44% versus 33.3% in juvenile onset (p 0.029). Conclusions Our data clearly show that juvenile onset SLE has more genetic background and it is more prone to a severe disease, renal and neurologic involvement being more frequent than in adult onset form. Severity seems to be related both to the activity, but also to fast damage accrual over time. Controlling the disease activity must be our goal, since cumulative irreversible damage is mainly SLE related for our patients. References Watson, L., Leone, V., Pilkington, C., et all, on behalf of the UK Juvenile-Onset Systemic Lupus Erythematosus Study Group, “Disease activity, severity, and damage in the UK juvenile-onset systemic lupus erythematosus cohort”. Arthritis & Rheumatism, 2012, 64: 2356–2365. doi: 10.1002/art.34410. Disclosure of Interest None declared

AB0756 Living with Osteoarthritis: Real Life Perception upon Pain and Function

Background Osteoarthritis (OA) is a prevalent condition for which treatments are based on analgesia and physical therapies. Despite that, most of the patients continue to have pain and limited function influencing there day by day life. Objectives Our objective was to evaluate pain perception in a cohort of participants, diagnosed with osteoarthritis. Methods 75 patients with osteoarthritis were enrolled in this study, conducted in Sf. Maria Hospital between 1 June and 30 December 2015. All patients signed an informed consent approved by local ethic committee. Data about demographics, joint involvement and treatment were collected. All patients completed a HAQ evaluation and a Visual Analogue Scale (VAS) for pain (0–10). We developed a questionnaire in order to capture patient perception about osteoarthritis symptoms and how this disease impact there life. They were asked about how pain interfere with usual activity (work, preparing meal, house kipping), with social activity (family interaction, friends) or how they perceived pain or efficacy of the treatment in the last month. They were also asked about there expectations related to this disease. Statistical analysis was made with SPSS. Results Mean age at evaluation was 63 with a female predominance (83%). 89.3% were taking NSAIDs and 73.3% acetaminophen. Functional status evaluated by HAQ showed that 24% patients had a score of 0, with 57% having a score of 1 and 19% a score of 2. VAS for pain was at least 5 for more than 80% of patients, despite treatment. Higher VAS was significant more frequent in female patients (p 0.001), in patients with family history of osteoarthritis (p 0.023) and in the one with sedentary life style (p 0.035). Most of the patients considered that pain interfere with daily activity, the impact being evaluated as moderate for 46.67% of patients and severe for 32%. Pain also had a negative impact on their social life, the percentage for moderate disturbance being of 38.67% and 18.67% for severe one. Only 11% of patients consider that the pain control is well managed. Despite these results, 40% of the patients do not expect that there quality of life will improve in the future. Conclusions Residual pain after treatment is present in most of the patients with osteoarthritis and these interfere significantly with daily living and quality of life. These patients enter in a vicious cycle related to worsening pain – low physical activity. Although this findings, there is a resumption of these patients in front of the disease. References Neogi T, The epidemiology and impact of pain in osteoarthritis, Osteoarthritis and cartilage, 2013, 21: 1145–1153. Disclosure of Interest None declared

AB0250 Wrist Ultrasound Better Correlates with Disease Activity Score (DAS28) in Rheumatoid Arthritis Patients Treated with Biologics

Objectives To assess which particular joint ultrasound (US) evaluation better correlate with disease activity based on DAS28 in rheumatoid arthritis (RA) patients treated with biologics. Methods Consecutive RA patients on stable biologic treatment for more than 6 months were evaluated. Clinical and US evaluation were performed by two independent assessors, the same day as all laboratory tests. The scanning technique and the settings of the machine (ESAOTE MY LAB70, 15 MHz linear probe) were the same for all the patients. Examinations were perform by a trained ultrasonografer who was blinded to all clinical evaluations. US of both hands (dorsal wrist, 2nd to 5th volar metacarpophalangeal and 2nd to 4th volar proximal interphalangeal) was done. Synovial hypertrophy and power Doppler (PD) signal were scored (grade 0–3). Synovial hypertrophy >2 plus power Doppler signal was classified as active synovitis. Based on DAS284v(ESR) patients were split in 2 groups: remission and non-remission. Results One hundred and six patients were evaluated. Most of them (84%) were females, mean age group 58.72 (11.49) years, mean disease duration 13.48 (7.4) years. Regarding the treatment, 87.7% had a DMARD associated to the biologic: 49.1% (52) patients were treated with rituximab, 27.35% (29) with etanercept,19.9% (19) with adalimumab, 9.33% (9) with infliximab. Mean DAS28 ESR was 3.14, with 36.8% of patients being on remission. We found a significant statistical difference (p=0.005) between active synovitis score in active disease patients (82.05% of them heaving active synovitis) versus 56.41% synovitis in remission patients. Statistical significance was also found regarding inflammation markers, PD joint number, PD total score, but not regarding Grey Scale (GS) number and total score (see table). When every joint was evaluated separately, statistically significance was found only between wrists and PD: right wrist (p=0.01) and left wrist (p=0.002), but not for GS (p=0.181 and 0.337). DAS 28 remission group (SD) DAS 28 non-remission group (SD) p Tender joint count 0.00 (0.00) 2.06 (2.54) <0.001 Swollen joint count 0.08 (0.35) 3.52 (4.13) <0.001 ESR 11.00 (6.43) 27.87 (21.30) <0.001 RF 28.12 (28.52) 74.83 (147) 0.016 ACPA 358.31 (677.46) 531.37 (829.91) 0.307 GS joint number 5.09 (3.23) 6.15 (2.59) 0.661 PD joint number 1.33 (1.49) 2.28 (1.65) 0.004 Total GS score 8.62 (4.71) 10.15 (5.30) 0.138 Total PD score 1.62 (1.75) 3.13 (2.41) 0.001 Active synovitis 56.41% 82.08% 0.005 Conclusions Active synovitis score, total PD joint number and total PD score correlates with DAS284vESR in rheumatoid arthritis patients treated with biologics. Both wrist US evaluation seems to be the most accurate in identifiing disease activity. Acknowledgements This paper is partially supported by the Sectoral Operational Program Human Resources Development, financed from the European Social Found POSDRU/159/1.5/S/137390. Disclosure of Interest None declared

A5.4 Prevalence of comorbidities in Paget’s disease of the bone a single centre report

Background and objectives Paget disease (PD), also known as osteitis deformans, is characterised by single or multiple bone site alteration, including accelerated osteoclast-mediated resorption followed by increased low quality bone production. This process results in a disorganised, unsteady structure that may lead to bone deformity. This condition affects elderly adult population, with a slightly higher predominance in males and it is thought to have important genetic determinants. The association of comorbid conditions places a burden on the patients and imposes regular monitoring. The present study aims to evaluate associated medical conditions in patients suffering from PD. Methods We retrospectively identified 39 patients who were diagnosed with PD, based on clinical presentation, plain x-rays, scintigraphy or when necessary biopsy or bone turnover markers’ detection. For the study group we noted the presence of cardiovascular disorders – hypertension, ischaemic heart disease or rhythm abnormalities such as atrial fibrillation. Median body mass index (BMI) was calculated. Neurologic conditions namely hearing loss, Parkinson’s disease or cerebral stroke history were taken into account, as well as type 2 diabetes and prostate adenoma. Tobacco use was also assessed for the study group. Development of neoplasia was reviewed. Information was gathered from patients’ clinical charts over a period of one year. Results Out of the 39 patients included in the study lot, 64.1% were males and 35.9% of female gender (1.7:1 ratio) with a mean age of 65.67 years, who were mainly diagnosed on the basis of clinical and radiographic assessment (97.4%). 7.6% had positive family history of PD. The polyostotic form of PD encountered in 26 patients (66%) is prevalent over the monostotic pattern (13, 33.3%). The most common affected sites were the hip in 71.0% of patients, skull (44.7%), femoral bone (26.3%) and the lumbar spine (21.05%). 61.5% of patients were hypertensive while 28.2% associated ischaemic heart disease. 27.6% were priorly diagnosed with atrial fibrillation. Mean BMI value was calculated at 27.7 kg/m². 12.8% of patients were hypoacusic, 5.1% suffered from a cerebral stroke and the same percentage were diagnosed with Parkinson’s disease. 52% of males had prostate adenoma, 15.3% suffered from type 2 diabetes. 20.5% patients confirmed smoking status. Three patients developed neoplasia, namely squamous cell carcinoma, carcinoma of the breast and rectum with no correlation to disease duration. Conclusions Taking into consideration the difficulties that PD brings with it, associated comorbidities tend to diminish further the health and quality of life in these patients. Therefore a complete medical check-up is recommended on each follow up visit in order to improve their status.

A5.6 Muscular weakness and pain in patients with rheumatoid arthritis - correlations with electromyography, clinical and serological data

Background and objectives Muscular involvement (mostly by weakness, pain and fatigue) is frequently involved in rheumatological practice. Associated myopathy to rheumatoid arthritis (RA) is an important comorbity that causes supplementary disability. Our objectives are to investigate the muscular involvement in RA with electromyography (amplitude, duration and motor unit potential MUP) and to correlate the data with clinical and laboratory findings. Material and methods Consecutive patients with RA, weakness and muscle pain were recruited during a 9 month period. Clinical (VAS, muscular testing, 6 min walk test) and laboratory tests (creatinkinase, dehydrogenase lactate, inflammatory markers, vitamin D serological level) were performed. The electromyographic study was pursued with concentric needle for MUP evaluation, then amplitude, duration and polyphasic pattern at deltoid muscle, interosseous, vastus lateralis and anterior tibial muscle were registered. Results 50 patients (88% women, mean age 62.8 +/-11.5 years) diagnosed with PR and muscle weakness were included. Clinically, DAS 28 (mean 3.76+/-1.44), HAQ (mean 1.49+/-1.12), VAS scale pain (mean 5.18+/-2.5), time up and go test (mean 12.62+/-5.78 min) and 6 min walk test (mean 277.306+/-153.34 metres) were reported. DAS 28 correlates positively with serological levels of creatinkinase (0.768, p < 0.00), C reactive protein (0.421, p < 0.00) and vitamin D level (0.871, p < 0.00) also with polyphasic pattern at deltoid level and duration of MUP in vastus lateralis muscle (0.768, p < 0.00). Polyphasic pattern in the upper limb is related to a similar pattern in lower limb muscles (0.510, p < 0.00). Lower duration of action potential was found in: deltoid (64% of cases), anterior tibial (58%), interosseous (44%) and vastus lateralis muscle (36%). Conclusion Associated myopathy to RA affects quality of life and function impairment in upper and lower limbs. DAS 28 correlates also with myopathic involvement and vitamin D levels in patients with RA. Most affected muscles are deltoid and anterior tibial muscle. Both upper and lower limbs muscles showed similar polyphasic pattern on electromyography.