A. Laiz

AB0579 Immunological results of salivary gland biopsy and their relationship with clinical and serological parameters in primary sjÖgren’s syndrome

Background Positive minor salivary gland biopsy(MSGB) is a major criteria for the diagnosis of primary Sjögren’s Syndrome (PSS). In our centre the MSGB analysis is carried out by Immunology and Pathology Department in parallel. The immunological analysis identifies the lymphocytic composition of the inflammatory infiltrate. Their results show: the number of T and B cells, the ratio between CD4 and CD8 T lymphocytes and other non infiltrating lymphocytes. Objectives The goal of our study was to evaluate whether there is an association between the lymphocytic composition of the MSGB with the clinical and serological findings of PSS patients. Methods Patients diagnosed of PSS according American-European criteria(2002) underwent . MSGB between February and November of 2017 Demographic (sex and age), clinical (disease duration, xerostomía, queratoconjuctivitis sicca, Schirmer test, systemic disease) data were collected. Present or previous treatment with steroids and/or immunosuppressive therapy, serological studies such as ANA, RF, anti Ro and anti La were also included. MSGB data with the number of infiltrates, quantitative composition of T and B lymphocytes, CD4/CD8 ratio and presence of other non infiltrating lymphocytes were registered. Pathology data concerning Chisholm-Mason scale, presence of fibrosis, atrophy and size of infiltrate (small, moderate and severe) were also registered. A multiple logistic regression for each item of the immunological analysis adjusted for sex and age was made. We also measured the odds ratio and performed correlation test for all variables included. Results Table 1 and 2 summarise our cohort characteristics. The presence of T lymphocyte was associated with B lymphocyte, OR 99.21 (IC95% 5.12–1921, p=0.002) and with higher CD4/CD8 ratio, OR 17.34 (IC95% 1.45–206.15, p=0.024). CD4/CD8 ratio was also associated with the presence of T lymphocytes OR 10.54 (IC95% 2.16–51.50, p=0.004) and B lymphocytes were associated with the presence of T lymphocytes as well OR 5.38 (CI95% 1.63–17.72, p=0.006). Other non infiltrating lymphocytes were composed of CD8 T cells and were associated with a positive Schirmer test OR 17.47(IC95% 1.62–188.13, p=0.018) but inversely associated with Chisholm-Mason grade ≥3 OR 0.09(IC95% 0.014–0.58, p=0.011). There was no other association observed with clinical or analytical parameters. Colinearity test between pathological and immunological analysis was negative.Abstract AB0579 – Table 1 Immunology, serological and treatment characteristics of patients with PSSAbstract AB0579 – Table 2 Immunological analysis Conclusions MSGB in our PSS patients demonstrated an association between T lymphocytes, B lymphocytes and CD4/CD8 ratio. The infiltrate is mostly based on CD4 more than CD8 T cells. Other significant findings were the association between CD8 T lymphocytes and Chisholm-Mason scale grade ≥3, regardless of the number of infiltrates. No correlation or colinearity was observed with the number of infiltrates by immunological analysis and the Chisholm-Mason grade reported by the pathology analysis. Disclosure of Interest None declared

SAT0351 Differences among patients with interstitial lung disease according to their systemic sclerosis subclassification

Background Systemic Sclerosis (SSc) has been widely studied from a purely global standpoint, but only a few trials have analysed patients with interstitial lung disease (SSc-ILD) as well. Objectives 1. Describe the clinical features of a cohort of patients with SSc and SSc-ILD. 2. Determine whether there are disparities among different types of SSc-ILD and their progression in patients with either limited (lcSSc) or diffuse involvement (dcSSc). 3. Ascertain whether there are disparities among different types of SSc-ILD and their progression according to the SSc-specific autoantibody (AAb). Methods Retrospective study of a cohort of patients with ILD-SSc controlled during an SSc consultation. The following variables were collected: sex, age, SSc and ILD progress in years, type of SSc and ILD, smoking, digital ulcers (DU), pulmonary hypertension, digestive disorders, cancer, SSc treatment, corticosteroid doses and lastly, lung function tests upon diagnosis, at treatment onset, and 24 months later. Additionally, a record was kept on the types of AAb present in every SSc. Qualitative and quantitative variables were compared in relation to the clinical and immunological sub-classification. Chi-square and Students T Tests were performed. A p-value≤0.05 was considered significant. Results out of 266 patients with SSc, data from 47 patients with ILD-SSc were gathered; 89.4% were female, with an age range of 66.09±15.1 years old, and 9.85±10.2 and 4.38±9.24 years of progression of their SSc and ILD respectively. 33 out of 47 sustained lcSSc, and both Scl-70/ATA (29.8%) and ACA (26.1%) were the most frequently found AAb. Non-specific interstitial pneumonia (NSIP) was the most common ILD radiological pattern (76.6%). Most patients with SSc underwent treatment (51.1%), 24% with mycophenolate mofetil (MMF); 36.2% of the patients had been concomitantly administrated corticosteroids with a mean prednisone dose of 15.73±10.3 mg/d. Upon comparing patients with lcSSc and dcSSc, prevalence of DU was higher in those with dcSSc (p<0.01), MMF was less frequently used (p<0.02), rituximab was more usually employed (p<0.03), and they presented worse values of FEV1/FVC ratio after 24 months of treatment (p<0.03). No differences were observed as to either type of ILD or progression. However, when variables were analysed regarding AAb in SSc, patients with ACA presented both fewer DU (p<0.02) and NSIP pattern (p<0.02), and more frequent compromise of the small airway (p<0.01), they were younger and thus, they had had shorter progression of the disease. ILD diagnosis was made significantly earlier in those patients with RNA polymerase, and later in those with anti-U1RNP. No AAb was observed associated with neoplasia. Considering the types of ILD, patients with NSIP pattern were younger (p0.054) and presented worse spirometric values. Conclusions In terms of ILD-SSc patient stratification, sub-classification by AAb appears to be more specific than the clinical sub-classification. ACA is related to less frequency of NSIP pattern. Unlike what has been described for SSc from a global point of view, in patients with ILD-SSc no association between AAb and neoplasia could be established. Disclosure of Interest None declared

AB0717 Conduction disturbances in a group of patients with axial spondyloarthropathy

Background Cardiac conductance disturbances are known to be one of the many extra-articular manifestations of Ankylosing Spondilitis but not as well related to axial spondyloarthropathies. Objectives Description of conduction disturbances found in a group of patients with Axial Spondyloarthropathy (AxSpa) that met ASAS criteria. Methods Clinical and demographic variables of 78 patients with AxSpa were registered. It included cardiovascular risk factors as well as cardiacvascular adverse events. All of them had a routine electrocardiogram done which were analized by a cardiologist. Results 48 of the 78 patients were men, with a mean age of 61 with standard deviation (SD) of 14. The mean time of evolution of the disease was 23 years (SD ±16). HLA-B27 was prevalent in 54 (69.2%). The sacroileitis was found in radiologic examination of 72 (92.2%), and 6 (7.7%) of them presented edema in magnetic resonance imaging. Other clinical traits were: 43 (55.1%) peripheric arthritis 43, 8 (10.3%) dactilitis, 33 (42.3%) enthesitis, 16 uveitis (20.5%), 2 (2.6%) inflammatory bowel disease and psoriasis 34 (43.3%). The following cardiovascular risk factors were registered: 25 (32%) smokers, 42 (53%) hypertension, 32 (41%) dislipemia, 9 (12%) diabetes, 9 (12%) hyperuricemia and 20 (20%) obesity. 14 patients had structural cardiopathy (11 ischemic cardiopathy and 3 aortic valvulopathy). The electrocardiographic register showed conductance disorders in 20 patients (25.6%). The details of these findings are specified in table 1. First grade auriculoventricular block 5 Second and third grade auriculoventricular block 2 Left anterior fascicular block 1 Right bundle branch block 2 Unspecific intraventricular conduction disorder 4 Bachmann interatrial conduction disorder 1 Conclusions A quarter of our series of presented conduction disturbances in electrocardiography. The relation with disease evolution, as in Ankylosing Spondilitis remains yet to be analized. Disclosure of Interest None declared

SAT0606 Impact of Musculoskeletal Ultrasound in Treatment Decision in Routine Daily Care of Rheumatoid Arthritis (Impulsar Study): Table 1

Background Remission or low disease activity is the therapeutic target in the ACR-EULAR recommendation for the management of rheumatoid arthritis (RA). In multiple studies, musculoskeletal ultrasound (US) has shown to be more reliable and sensitive than physical examination in both the diagnosis and the assessment of RA activity. However, the real impact of this technique on routine daily care of RA and treatment decisions has not been studied. Objectives To assess the proportion of therapeutic decisions that are modified by the results of the US examination in patients with RA. To determine which group of patients would get more benefit from a musculoskeletal US to optimize treatment. Methods Seventy eight consecutive patients diagnosed with RA by ACR 1987 criteria and visited between July and November 2014, were included. All patients were initially visited by their usual rheumatologist and a therapeutic decision was made according to physical examination and clinical and laboratory findings. Subsequently, a musculoskeletal US was performed by an expert sonographer of our center and the usual rheumatologist was asked to reassess his therapeutic decision in light of the US findings. We classified the change in the therapeutic attitude as: negative (maintenance of therapeutic attitude) and positive (increase or reduction in treatment, compared to the initial decision). Demographic, clinical and laboratory data were collected from the clinical history and activity scores were calculated. Results Clinical, demographic, laboratory, treatment and activity score data are shown in table below. In 29 patients [37.2% (95% CI 26.5 to 48.9)] the findings in the US examination conditioned a change in the therapeutic decision of the usual rheumatologist. In 18 patients (62.07%) the change was towards an intensification of treatment, while in 11 patients (37.93%) a decrease was possible. Change of treatment was more frequent in patients with intermediate disease activity (mild and moderate activity) than in those with extreme activities (remission and high activity), 41.4% vs 25%, although this difference was not statistically significant. A higher frequency of change was found in men (53.8% vs 33.8%) and erosive RA forms (43.6% vs 21.7%), but the results did not reach statistical significance.Table 1 Total (n=78) Age (years ± SD) 63,27 (±12,94) Disease duration (years ± SD) 15,49 (±10,66) Female (%) 65 (83,33%) Erosive form (%) 55 (70,51%) RF positive (%) 49 (62,82%) Anti-CCP positive (%) 59 (75,64%) DMARDs  Methotrexate 33 (42,31%)  Leflunomide 5 (6,41%)  Salazopyrin 7 (8,97%)  Hydroxychloroquine 2 (2,56%) Biologic therapies  Anti-TNF 14 (17,95%)  Others 11 (14,10%) DAS28-ESR (mean ± SD) 3,19 (±1,09) DAS28 activity  high 1 (1,28%)  moderate 36 (46,15%)  mild 22 (28,20%)  remission 19 (24,36%) Conclusions Musculoskeletal ultrasound, when added to routine rheumatologic investigation, is an important tool for treatment decisions in the routine daily care of rheumatoid arthritis. Patients with intermediate activities of the disease might get more benefit from the use of an US examination. Disclosure of Interest None declared

AB0692 Radiographic Damage in A Group of Patients with Axial Spondyloarthritis

Background Recent studies in the field of axial spondyloarthropathies (SpA-ax) have shown a group of patients with chronic lower back pain without evidence of radiographic damage (non-radiographic axial spondyloarthritis). Currently, data is lacking that would confirm whether it is an early stage of the disease or a group of SpA-ax that is different, in which time of progression and radiographic damage show no relationship. Objectives Describe our cohort of patients diagnosed with radiographic axial spondyloarthritis. Assess whether those with both sacroiliac and spinal radiographic involvement have a longer duration of the disease and the relationship between this most-affected group and the different items that constitute the ASAS criteria for SpA-ax. Methods All patients diagnosed with SpA-ax by ASAS or NY criteria, who were seen in a monographic consultation of spondyloarthritis of our center between January 2012 and December 2013, were reviewed. Only those with sacroiliitis of grade II or higher were included; patients who did not have spinal radiographs were excluded. The following clinical and laboratory variables were collected from clinical history: age, sex, duration of disease, inflammatory back pain, arthritis, enthesitis, uveitis, dactylitis, psoriasis, inflammatory bowel disease, positive response to NSAIDs, family history of SpA, HLA-B27 and elevated CRP. The presence of 3 or more syndesmophytes in the dorsal and/or lumbar region was considered as spinal involvement. For statistical analysis, students t-test, chi-square test or Fishers exact test were performed where applicable. Results Of the 72 patients diagnosed with SpA-ax, 58 met the inclusion and exclusion criteria. The mean age of the study patients was 53.69 years and 69% were men. The mean disease duration was 19.48 years and 36 patients had spinal involvement. Only the age of patients, the sex and the duration of the disease showed significant results regarding the structural damage (see table). Table 1 Total Spinal X-ray − Spinal X-ray + p (n=58) (n=22) (n=36) Age, years 53.69±13.41 47.36±13.05 57.56±13.45 *p=0.006 Disease duration, years 19.48±12.06 14.86±9.57 22.31±12.67 *p=0.021 % male 40 (69) 11 (50) 29 (80.5) *p=0.02 Inflammatory back pain (%) 48 (82.75) 20 (90.9) 28 (77.8) p=0.29 Arthritis (%) 31 (53.45) 11 (50) 20 (55.5) p=0.79 Enthesitis (%) 25 (43.1) 9 (40.9) 16 (44.4) p=1.00 Uveitis (%) 12 (20.7) 6 (27.3) 6 (16.7) p=0.50 Dactylitis (%) 6 (10.3) 3 (13.6) 3 (8.3) p=0.70 Psoriasis (%) 20 (34.5) 10 (45.4) 10 (27.8) p=0.25 Inflammatory bowel disease (%) 2 (3.45) 1 (4.5) 1 (2.8) p=1.00 Good response to NSAIDs (%) 47 (81) 20 (90.9) 27 (75) p=0.29 Family history of SpA (%) 13 (22.4) 4 (18.2) 9 (25) p=0.75 HLA-B27 positive (%) 33 (56.9) 12 (54.5) 21 (58.3) p=0.78 CRP >5mg/l (%) 45 (77.6) 15 (68.2) 30 (83.3) p=0.21 * p<0.05. Conclusions In our cohort, patients with more severe radiographic involvement were those of a longer disease duration and an older age, with a predominance of men. No significant differences for the remaining assessed variables were found, including signs of inflammation and HLA-B27, which were similar in both groups of patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4483

AB0826 Hyperuricemic patients with systemic sclerosis do not present higher incidence of pulmonary hypertension but have worse echocardiographic parameters

Background Uric acid (UA) serum levels are increased in conditions that affect the oxidative metabolism. Several studies have demonstrated increased UA levels in patients with pulmonary hypertension (PH) and its relation to prognosis. There are few studies demonstrating the clinical significance of hyperuricemic in patients with PH secondary to systemic sclerosis (SSc). Objectives To determine whether patients with SSc and PH have a higher frequency of hyperuricemica and to determine if there is greater frequency of PH in hyperuricemic and SSc patients. Methods Retrospective review of cohort of patients with SSc from rheumatology unit of a tertiary university hospital. Hyperuricemia was considered if UA levels were higher than 6,8 mg/dl and PH in either the presence of echocardiographic signs of PH or pulmonary artery pressure (PAP) >40mmHg. The following variables were collected: sex, age at diagnosis, type of SSc (limited, diffuse, earlySSc or without skin involvement), presence or absence of: digital ulcers (DU), sclerodermic renal crisis (SRC), interstitial lung disease (ILD), use of hyporuricemic therapy, colchicine and NSAIDs. Uric acid levels, renal and respiratory function parameters and echocardiographic parameters were recorded. To compare groups of qualitative variables chi-square or Fisher test were used, and T-test for quantitative variables. Statistical significance level was set to p values ≤0.05. Results A total of 136 patients with SSc (93,4% female, age at diagnosis 51,02±15,51 years) were included. Ninety five out of 136 presented limited SSc, 21 diffuse SSc, 19 early SSc and 1 sine scleroderma. One third (31,6%) of the patients presented DU along their disease, 28,7% ILD, 21,3% PH and 2,2% SRC. Patients with PH presented ILD more frequently (50% vs 23,36% p =0.006), but the frequency of DU and SRC were not increased. Parameters of DLCO (Diffusing capacity for carbon monoxide)and FVC (Forced vital capacity) were significantly lower in patients with PH (56,7±19,1% vs 80,13 vs 19,13% and 77,86±23,42 vs. 95,09±18,3 p <0,01). Higher ratio FVC/DLCO and thicker than the IVT (11,52±3,16 vs 10,02±2,18 p =0.03) were observed in these patients. No differences in the levels of UA in both groups were detected. Patients with hyperuricemia did not have higher frequency of PH (35,7 vs 21,5%, p ns) than those without, but they did show a higher frequency of SRC (p <0.05). When comparing different echocardiographic parameters, patients with hyperuricemia had higher values of estimated PAP (45,5±8,081 vs 33,41±9,87 mmHg, p =0,024), lower TAPSE (1,6±0,14 vs 2,52±1,78 cm, p =0,01) and increased IVT thickness (12,44±2,78 vs 10,25±2,3 mm, p<0.05). Conclusions Patients with PH had a higher ILD frequency. There was no difference in the frequency of hyperuricemia between groups. Hyperuricemic patients did not show a higher PH frequency, nevertheless they showed worse echocardiographic parameters. The presence hyperuricemia was also associated with higher frequency of SRC. Furthers works are needed to evaluate the effects of UA in SSc. Disclosure of Interest None Declared

AB0805 Nailfold capillaroscopy findings are different between patients with U1RNP antibody and systemic sclerosis or patients with systemic lupus erythematosus and U1RNP antibody

Background Nailfold capillaroscopy (NC) is the best tool to study microcirculation in patients with Raynaud’s phenomenon (RF) or patients with connective tissue diseases. There are some characteristic capillaroscopy findings in systemic sclerosis (SSc) patients, like presence of giant capillaries (GC) or loss of capillary density (LCD). Patients with Systemic Lupus Erythematosus (SLE) and RF may present nonspecific changes in the NC, but sometimes NC in SLE patient can simulate SSc findings. Anti-U1RNP antibodies may be present in both entities and are associated with a greater number of alterations in NC. Objectives To Determine the existence of differences between the findings of nailfold capillaroscopy in patients with SSc or SLE that present U1RNP antibodies. Methods Patients with SSc o earlySSc (eSSc) and positive determination of anti-U1RNP antibodies were included. Afterwards these patients were compared with a cohort of patients with SLE with anti-U1RNP antibodies. In both groups we studied in NC the following findings: presence o absence of giant capillaries (GC), angiogenesis and loss of capillary density (LCD). We compare findings with Chi-Square or Fisher’s test when it was needed. Statistcial analysis were performed by SPSS program v17.0 Results One hundred thirty-five SSc patients (93.4% women) and 76 SLE patients (94.7% women) were included. Determinatio of anti U1RNP abs were performed in 134 SSc patients and in 67 SLE patients. SLE patients had more U1RNP antibodies (10/134 [7.4%]) than SSc patients (13/67 [19.4%];p=0.012). NC showed GC, loss of capillary density and angiogenesis in 71.4%, 100% and 100% in SSc patients with U1RNP antibodies. SLE patients presented less pathological findings in NC that SSc patients (GC in 38.4%, LCD in 46.1% and angiogenesis in 69% of patients). A significant difference in NC between SSc and SLE patients were found in capillary density (lower in patients with SSc (p=0.04). Conclusions AntiU1RNP antibody is find more frequently in SLE patients than in SSc patients. Patients with SSc and U1RNP have more loss of capillary density in NC than SLE patients. Presence or absence of Loss of capillary density in patients with undifferenciated connective tissue disease with anti-U1RNP, or patients classified as mixed connective tissue disease could be useful to predict witch patients will develop SSc or SLE. We need more studies to determinate the use of NC in patients with antiU1RNP antibodies. Disclosure of Interest None Declared

SAT0435 Profile and degree of hyperglycemia after the infiltration of intrarticular corticosteroids to patients with and without type 2 diabetes mellitus

Background Corticosteroids (CS) are widely used in medicine for the treatment of multiple processes. In rheumatology, infiltrations with corticosteroids are indicated to relieve pain and improve joint limitation. Adverse effects of corticosteroids such as hyperglycemia are well known; nevertheless the existing information about the effects of the intrarticular administration is very scanty. Objectives The aim of this study was to define the profile and degree of hyperglycemia after intrarticular administration of triamcinolone acetonide to patients with and without type 2 diabetes. Methods It was an observational study. Twenty-one patients were included (9 with and 12 without type 2 diabetes). All of them received an intrarticular infiltration of 40 mg of triamcinolone acetonide and 1 ml of mepivacaine in a knee or a shoulder. All patients received a glucometer in order to determinate the glycemias before and 2 hours after breakfast, lunch and dinner, the previous day and during the 6 days after the procedure. A descriptive analysis, including demographic and clinical data, and a comparative analysis of mean glycemic data were performed. The results were analyzed using the SPSS’s v19.0 statistical package. Results Patients without diabetes showed an increase of glycemic index 48 hours following the infiltration, whereas it wasn’t observed in the diabetic patients. Likewise, we observed a statistically significant increase of the postprandial glycemia (167,36±58,39 vs 174,25±69,42mg/dl; p=0,025) of the day of the infiltration and in the determinations before breakfast (111,40±23,71 vs 135,77±62,26 mg/dl; p=0,008) and post lunch (152,089±25,9 vs 181±60,63 mg/dl; p=0,002) of the following day. Conclusions Type 2 diabetic patients do NOT need an increase of antidiabetic treatment after the intrarticular administration of 40 mg of acetone triamcinolone, provided that they do not present glycemic alterations after 6 days of the infiltration. On the other hand, the non-diabetic patients, present an hyperglycemic moderate and autolimited effect, without clinical significance. References Habib GS, Abu-Ahmad R. Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients. Clin Rheumatol.2007;26:566–8. Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med. 1994;236:619–32. Blackburn D, Hux J, Mamdani M. Quantification of the risk of corticosteroid induced diabetes mellitus among the elderly. J Gen Intern Med. 2002;17:717–20. Disclosure of Interest None Declared