I. Hansen

Drug concentrations and anti-drug antibodies during treatment with biosimilar infliximab (CT-P13) in routine care

The Danish Rheumatologic Biobank, the DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark Department of Rheumatology, Gentofte and Herlev Hospital, Copenhagen University Hospital, Gentofte, Denmark The Danish Rheumatologic Biobank, Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Oslo, Norway Department of Rheumatology, Zealand University Hospital, Køge, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark King Christian X’s Hospital for Rheumatic Diseases, Graasten, Denmark Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark Department of Rheumatology, North Denmark Regional Hospital, Hjørring, Denmark Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark Department of Rheumatology, Odense University Hospital, Odense, Denmark Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway The Danish Rheumatologic Biobank, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Norway Center for Rheumatology and Spine Diseases, Institute for Inflammation Research (IIR), Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark Zitelab, Copenhagen, Denmark Department of Medicine and Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark

Hand bone loss in early rheumatoid arthritis during a methotrexate-based treat-to-target strategy with or without adalimumab—a substudy of the optimized treatment algorithm in early RA (OPERA) trial

This study aims to investigate 1-year hand bone loss (HBL1-year) in early rheumatoid arthritis (RA) patients treated with a methotrexate (MTX) and intra-articular triamcinolone treat-to-target strategy +/− adalimumab and to determine if HBL6months is associated with radiographic progression after 2xa0years. In a clinical trial (OPERA) of 180 treatment-naive early RA patients, bone mineral density (BMD) was estimated from hand radiographs with digital X-ray radiogrammetry (DXR) at baseline, after 6 (nxa0=xa090) and 12xa0months (nxa0=xa070) of follow-up. Baseline and 2-year radiographs were scored according to the Sharp/van der Heijde method. Baseline characteristics and HBL6months (0–6xa0months changes in DXR-BMD) were investigated as predictors of structural damage by univariate linear (∆ total Sharp/van der Heijde score (TSS) as dependent variable) and logistic (+/−radiographic progression (∆TSS >0) as dependent variable) regression analyses. Variables with pxa0<xa00.10 were included in multivariable models. In 70 patients with available HBL1-year data, HBL1-year was median (interquartile range (IQR)) −1.9 (−3.3; −0.26xa0mg/cm2) in the MTX + placebo group and −1.8 (−3.6; 0.06)xa0mg/cm2 in the MTX + adalimumab group, pxa0=xa00.98, Wilcoxon signed-rank. Increased HBL (compared to general population reference values) was found in 26/37 and 23/33 patients in the MTX + placebo and MTX + adalimumab groups, chi-squaredxa0=xa00.99. In 90 patients with HBL6months data and 2-year radiographic data, HBL6months was independently associated with ∆TSS after 2xa0years (βxa0=xa0−0.086 (95% confidence intervalxa0=xa0−0.15; −0.025) TSS unit/mg/cm2 increase, pxa0=xa00.006) but not with presence of radiographic progression (∆TSS >0) (OR 0.96 (0.92–1.0), pxa0=xa00.10). In early RA patients treated with a methotrexate-based treat-to-target strategy, the majority of patients had increased HBL1-year, irrespective of adalimumab; HBL6months was independently associated with ∆TSS after 2xa0years.

FRI0607 Effect of Methotrexate and Intra-Articular Betamethasone with or Without Additional Cyclosporine on Magnetic Resonance Imaging (MRI)-Determined Inflammatory and Destructive Changes in Very Early Rheumatoid Arthritis – Results from a 24-Months' Randomised Double Blind Placebo Controlled Trial

Background MRI has been shown to be more sensitive than clinical examination and x-ray for detection of inflammatory and destructive joint changes in early rheumatoid arthritis (RA) and to discriminate between treatment arms in clinical trials using the semi-quantitative Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA MRI scoring (RAMRIS) system. Objectives To investigate whether MRI-determined measures of disease activity and joint destruction were suppressed in very early RA patients following a treat-to-target strategy with methotrexate (MTX) and intraarticular (i.a.) betamethasone and to investigate whether concomitant cyclosporine (CYA) had an additional effect on MRI determined inflammatory and destructive findings over 2 years. Methods In the 2-year randomised, double-blind, multicentre, clinical, treat-to-target trial, CIMESTRA, 160 patients with early (<6 months) RA were treated with MTX, i.a. betamethasone and CYA/placebo CYA. 129 patients participated in the MRI substudy, and had contrast-enhanced MRIs at months 0, 6, 12 and 24 that covered the non-dominant wrist (wrist-only group) and if technically possible both wrist and metacarpophalangeal (MCP) joints (wrist+MCP group). MRIs were evaluated by an experienced radiologist blinded to patient identity, clinical and biochemical data but not to chronology, using the RAMRIS scoring system assessing inflammatory (osteitis, synovitis, tenosynovisits) and destructive (erosions, joint space narrowing) changes. Observed data, without any data imputations, are reported. Non-parametric statistics were used. A value of p<0.05 was considered statistically significant. Results MRI-results from the wrist-only group are shown in table 1. The data in the wrist+MCP group were overall similar (data not shown). No statistically significant differences between the treatment groups were observed in any MRI characteristics at baseline or at any follow-up time point. Both the wrist-only group and the wrist+MCP group showed significant reductions compared to baseline in osteitis, synovitis and tenosynovitis at 6 months (all parameters) and 12 and 24 months (synovitis and tenosynovitis). Statistically significant, but numerically low, increases in erosion and JSN scores from baseline to 6, 12 and 24 months were seen. Conclusions A treat-to-target strategy with MTX and i.a. betamethasone reduced MRI inflammatory findings significantly, with no additional effect of CYA, but minor structural damage progression was still observed. References Hetland ML, et al. 2006. Arthritis Rheum 54:1401-1409. Hetland ML, et al. 2009. Ann Rheum Dis 68:384-390. Disclosure of Interest None declared

SAT0565 The frequency of septic arthritis after arthrocentesis and intra articular glucocorticoid injection is low

Background Intraarticular (IA) procedures have both diagnostic and therapeutic purposes in patients with arthritis. The therapeutic benefit of IA glucocorticoids (GC) injection in patients with rheumatologic diseases is well described. However, IA procedures are associated with increased risk of Septic arthritis (SA). Rapid diagnose and correct treatment is crucial to avoid joint damage, sepsis and potential fatal outcome. However, patients in risk of evolving SA secondarily to GC injection or arthrocentesis are not well defined. Objectives The aim of this study was to evaluate the risk of SA in patients who received an IA GC injection or an isolated joint puncture, and to describe possible characteristics for these patients. Methods All patients undergoing IA procedures at the orthopaedic and rheumatological departments of Fuhnen from January 2006 to December 2013 were identified in the central database and included by register extraction. Patients who developed SA within 30 days after IA GC injection were registered as cases. SA was defined as clinically inflamed joint and positive synovial fluid culture. Retrospectively, data on age, gender, affected joint location, bacterial agent, pre-existing inflammatory disorder and death within 30 days were extracted from the patient files. According to local recommendations a non-touch sterile technic where used for IA procedures. Patients were informed about the risk for SA and motivated to seek medical attention if suspicion of infection or lack of improvement. Results 22370 IA procedures were registered; 14118 IA GC injections and 8252 arthrocentesis. Eleven patients with SA were registered. Eleven patients developed SA subsequently to IA GC injection (0.08% of all GC injections). For patients demography, joint distribution, bacterial agent and pre-excisting joint disease (Table 1). One patient died within 30 days after IA GC injection. Sex Age Joint Bacterial agent Inflammatory Disease Death, 30 days M 83 Shoulder Grp. A streptococcus No + M 53 Elbow S. Aureus No – M 55 Ancle S. Aureus Gout – M 67 Knee Grp. A streptococcus No – F 83 Knee E. Faecalis No – M 58 Knee S. Aureus No – M 73 Knee S. Aureus Gout – F 50 Shoulder Grp. A streptococcus RA – F 66 Knee S. Aureus No – F 80 Knee S. Aureus RA – M 73 Elbow E. coli RA – Conclusions This study demonstrates that IA procedures can be performed with little risk of SA. The risk factors identified i.e. elderly patients with inflammatory joint diseases are consistent with those described in the literature [1]. We consider joint puncture technique and patient information for being essential when doing IA procedures. However, if SA occurs it is potentially fatal and therefore GC injection should be preserved for doctors with experience in joint diseases. References RA Andreasen et al. Prognostic factors associated with mortality in patients with septic arthritis: a descriptive study. Scand J Rheumatoly 2016, 1–6. Disclosure of Interest None declared

FRI0535 Hand Bone Loss in Early Rheumatoid Arthritis Is Independent of Adalimumab Treatment. A Substudy of The Optimized Treatment Algorithm in Early RA (Opera) Trial

Background Rheumatoid arthritis (RA) is characterised by progressive destruction of joint bone and loss of periarticular bone mineral. Hand bone loss (HBL) measured by Digital X-ray Radiogrammetry (DXR) has been proposed as a sensitive outcome measure for treatment effect and as a potential predictor of subsequent radiographic progression in RA patients. Objectives To investigate the effect of adding adalimumab to a methotrexate and intra-articular triamcinolone treat-to-target strategy on one-year HBL (HBLone-year) in early RA and to determine if HBL6months is associated with radiographic progression after two years. Methods In a clinical trial (OPERA) of 180 treatment-naive early RA patients (1), bone mineral density (BMD) was estimated from hand radiographs with Digital X-ray radiogrammetry (DXR) at baseline, after 6 months (n=90) and 12 months (n=70) of follow-up. Baseline and two-year radiographs were scored according to the Sharp/van der Heijde method. Baseline characteristics and HBL6months (0–6 months changes in DXR-BMD) were investigated as predictors of structural damage by univariate linear (ΔTotal Sharp/van der Heijde Score (TSS) as dependent variable) and logistic (+/− radiographic progression (ΔTSS>0) as dependent variable) regression analyses. Variables with p<0.10 were included in multivariable models. Results In 70 patients with available HBLone-year data, HBLone-year was median (InterQuartileRange (IQR)) -1.9 (-3.3; -0.26 mg/cm2) in the placebo-group and -1.8 (-3.6; 0.06) mg/cm2 in the adalimumab-group, p=0.98,Mann Whitney. Increased HBL (compared to general population reference values (2)) was found in 26/37 and 23/33 patients in the placebo- and adalimumab-groups, Chi-sq=0.99. In 90 patients with HBL6months data and two-year radiographic data, HBL6months was independently associated with ΔTSS after two years (β=-0.086 (95% Confidence Interval= -0.15; -0.025) TSS unit/mg/cm2 increase,p=0.006), and borderline associated with presence of radiographic progression (ΔTSS>0) (OR 0.96 (0.92–1.0), p=0.10). Conclusions In early RA, adding adalimumab to a methotrexate-based treat-to-target strategy had no impact on HBLone-year, which was increased in both treatment groups. HBL6months was independently associated with ΔTSS after two years. References Hørslev-Petersen et al. Ann Rheum Dis. 2015 doi: 10.1136/annrheumdis-2015-208166. Ørnbjerg LM et al. [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). Disclosure of Interest L. Ørnbjerg: None declared, M. Østergaard Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Eli Lilly, Janssen, Merck, Pfizer, Roche, UCB, Celgene, Sanofi, Regeneron, Novartis, T. Jensen: None declared, K. Hørslev-Petersen Grant/research support from: Abbvie, Meda, Roche, K. Stengaard-Pedersen Grant/research support from: Meda, Abbvie, Roche, Speakers bureau: UCB, Pfizer, P. Junker: None declared, T. Ellingsen: None declared, P. Ahlquist: None declared, H. Lindegaard Grant/research support from: Boehringer Ingelheim, A. Linauskas: None declared, A. Schlemmer Grant/research support from: Abbvie, Roche, MSD, M. Dam: None declared, I. Hansen: None declared, T. Lottenburger: None declared, C. Ammitzbøll: None declared, A. Jørgensen: None declared, S. Krintel: None declared, J. Raun: None declared, M. Hetland: None declared

THU0029 Inflammation is Strongly Associated with Lupus Anticoagulant Positivity, Independent of Known Autoimmune Disease and Recent Venous or Arterial Thrombosis

Background The antiphospholipid syndrome (APS) is an auto-immune disorder defined by presence of antiphospholipid antibodies and either thrombosis or obstetric complications (1). Laboratory part of the diagnosis of APS comprise of testing for lupus anticoagulant (LAC), anticardiolipin (ACA) and anti-β2-glycoprotein 1 (β2GP1) antibodies (2). Especially persistent LAC positivity is associated with thrombosis risk (1). Antiphospholipid antibodies are often found in patients with inflammatory disease and inflammation is involved in the development of thrombosis (3). Two studies found that LAC status was associated with inflammatory state (4). It may, however, be due to interference from C-reactive protein (CRP) on the LAC investigation when a LAC assay based on activated partial thromboplastin time (aPTT) is used (4). To avoid this artefact a diluted Russel viper venom test (dRVVT) can be used (4). Hence, the relation between antiphospholipid antibodies and inflammation is not fully elucidated. Objectives The aim was to study if inflammatory markers were associated with LAC positivity independent of previous thrombosis or chronic inflammatory disease. Methods 235 patients referred to thrombophilia testing, LAC was tested with dRVVT. Acute phase markers (CRP, fibrinogen, coagulation factor VIII (FVIII)) and leukocyte count were measured. From a diagnosis register information on previous venous and arterial thrombosis and chronic inflammatory diseases was retrieved. Groups (LAC positive versus LAC negative) were compared by logistic regression with univariate and multivariate analysis adjusted for previous disease. Moreover, analyses were repeated after exclusion of patients with possible bacterial infections (CPR ≥50 mg/l). Correlations were calculated using Pearson. Results There was no difference in age, gender or co-morbidities between LAC positive and LAC negative patients (table 1). LAC positive patients had significantly higher CRP, fibrinogen and FVIII levels compared with LAC negative (p<0.001), but no difference in leukocyte count. Exclusion of patients with CRP ≥50mg/L (6 patients of whom 2 were LAC positive) did not alter the results. The LAC titer correlated with CRP (r=0.33), fibrinogen (r=0.26) and FVIII (r=0.14) – all p<0.05. FVIII was higher in patients with elevated titer of ACA IgM compared to those with normal ACA IgM. Other tests did not differ when comparing patients with normal versus elevated titers of specific antibodies (ACA and β2GP1). Conclusions Inflammation is associated with LAC positivity independent of thrombosis and chronic inflammatory disease. Findings indicate that inflammation induce antibody production. Thus, one may speculate if LAC positivity reflect an underlying inflammatory state, which is the true meachanism behind the increased thrombosis risk. References Cohen D, et al. Diagnosis and management of the antiphospholipid syndrome. BMJ 2010;340:c2541 Pengo V, et al. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemost 2009;7:1737-40 Aksu K, et al. Inflammation-induced thrombosis:mechanisms, disease associations and management. Curr Pharm Des 2012;18:1478-93 Schouwers SM, et al. LAC testing in patients with inflammatory status: does C-reactive protein interfere with LAC test results? Thromb Res 2010;125:102-4 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2154

THU0300 Septic Arthritis in the Central Part of Denmark

Background Septic arthritis (SA) is a serious condition which can lead to rapid cartilage destruction and irreversible joint damage and is asociated with a significant mortality. SA is an uncommon condition with an incidence of 4-10/100.000/year. Risk factors for SA are age >60 years, recent bacteremia, diabetes mellitus, rheumatoid arthritis, gout, recent joint surgery, degenerative joint disease and joint prosthesis [1]. An accurate diagnosis can be difficult to state for patients with an underlying inflammatory joint disease. Intra-articular corticosteroid injections are widely used in aseptic arthritis and reduce the manifestations of inflammation. However, iatrogenic infection can be a complication to joint puncture, of which septic arthritis (SA) is the most serious[2] Objectives The aim of this study is to describe the microbiological etiology and co-morbidity in patients with SA and to register how many who had received an intra-articular steroid injection prior to the diagnosis Methods In this descriptive cross-sectional study all patients older >18 years diagnosed with SA at all hospitals in the central part of Denmark in the period January 2006 through December 2013 were registered. SA was defined as clinically inflamed joint and positive synovial fluid culture. The department of microbiology at Odense University Hospital identified the microbiological agents. Patients who had received an intra-articular steroid injection in a period of up to one month earlier they were diagnosed with SA and co-morbidities were registered Results We identified 215 patients diagnosed with SA (male:142, female: 73) given an average incidence at 6,9 cases/100.000 inhibitants [3]. Mean age was 64,8 years (21-94) 97% were monoarticular and 3% were polyarticular. Mean C-reactive protein 204 mg/l (2-523), mean leuc 11,9*109/L (0,7-30,6). Nearly half of the patients had a prosthetic joint (47%) followed in frequency by pre-existing inflammatory joint or connective tissue disease (21%), 11% had diabetes mellitus and 5,6% (n=12) had an intra-articular steroid injection prior to the diagnosis. The average time from injection to diagnosis was 9 days.Twenty patients died within four weeks after SA was diagnosed, corresponding to a mortality of 9,3%. Bacterial agents: Staphylococcus aureus (n=104) 48% Coagulase negative staphylococcus (n=25) 12% Streptococcus pyogenes group (n=24) 11% Streptococcus mitis group (n=19) 9% Gram-negative rod shape bacteria (n=23) 11% other less common bacteria (n=20) 9% Conclusions In accordense with earlier studies we found staphylococcus aureus to be the most common bacterial microorganism in patients with SA. The highest isolated risk factor was joint prosthesis followed by inflammatory joint and connective tissue diseases. We did not find an increasing incidence of SA even though the numbers of therapeutic steroid injections had markedly increased in recent years. Despite the rarity of SA following intra-articular injections, patients should be informed of the risk of septic arthritis and the possible consequences A strict aseptic technique is important. References Shirtliff M.E. and Mader J. Acute Septic Arthritis, Clinical Microbiology Reviews, Oct 2002, 527-544 Geirsson Ά.J. et al, Septic arthritis in Iceland 1990-2002: increasing incidence due to iatrogenic infections, Ann Rheum Dis 2008; 67: 638-643 Denmark statistical demographic data (http://statistikbanken.dk) Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3263

THU0299 The Risk of Intraarticular Steroid Injections Are Overestimated

Background Intraarticular (IA) puncture is used both for diagnostic purposes as well as for treating e.g. discharge of larger effusions or installation of medications e.g. glucocorticoids (GC) in inflammatory disorders, the latter is described as an efficient treatment combined with Methotrexate in early rheumatoid arthritis (1) IA puncture seems to be used with varying, uncertain and difficult to find frequencies, both with in rheumatological departments in a given country as well as between countries. A barrier for joint puncture might be the risk of, inducing an iatrogenic septic arthritis (SA) sometimes leading to severe sepsis (2) Objectives The purpose of this study is to evaluate the risk of inducing a SA in all patients, who have undergone an arthrocentesis or joint puncture at our out-patient department. Furthermore the frequency of the procedures in patients with Rheumatoid arthritis (RA), Psoriasis arthritis (PsA) and Gout were numbered in 2013 Methods In this retrospective design, all patients in our out-patient department, having an IA puncture +/- subsequent GC injection from 1.1 2007 until 31.12.2013, at our department were evaluated for a subsequent SA, within the first month after puncture. SA is defined as a clinical inflamed joint and positive synovial fluid culture. According to the local recommendation, joint puncture was done using sterile non-touch technique and patients were informed of the risk of joint infection, and urged to contact us if any suspicion of infection was found or lack of improvement Results A total of 3921 IA GC injections and 1147 arthrocentesis were registered. Two patients developed subsequently a SA respectively 7 and 18 days after the injections. Both patients, one with RA and one with gout, contacted us as advised, none of these two got irreversible join damage (0,05% of all GC injections). Evaluating the three most common diagnostic groups at our department in 2013 it was discovered that among 652 patients with RA 2 had done an arthrocentesis, 261 a GC injection and 76 had both procedures performed. For Pts with PsA the corresponding numbers were 11, 57 and 11 and for the Gout patients 35, 74 and 19. None of these procedures resulted in an iatrogenic arthritis Conclusions IA joint puncture plus/minus subsequent GC injection is a safe procedure, when using an aseptic technique and proper information to the patients. The overestimated risk of inducing a SA might mean that patients do not get a prompt and sufficient treatment of the individual joint problem. Of course this should not lead to contraindications to arthrocentesis and relevant information to the patients overridden. Because patients were urged to contact us in case of signs of infection after joint puncture, we think data are complete concerning the numbers of patients having a SA secondary to the procedures. It does not appear, that there is any difference between the frequencies of the procedures between the patients with RA, PsA or gout References Hetland ML, Hørslev-Petersen K. The CIMESTRA study: Intra-articular glucocorticosteroids and synthetic DMARDs in treat-to-target strategi in early rheumatoid arthritis. Clin Exp Rheumatol 2012;30 (4 Suppl 73): S44-9 Holland C, Jaeger L, Smentkowski U, Weber B, Otto C. Septic and Aseptic complications of corticoid injections. Expert Commision and medication boards from 2005 to 2009. Deutsches Ärtzeblatt International 2012;109 (24): 425-30 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3356

SAT0171 FDG PET-CT in Polymyalgia Reumatica and Giant Cell Arteritis

Background Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory conditions of unknown etiology. They are by some authors considered as manifestations of the same disease and are both treated with corticosteroids. However, a specific diagnosis is important because of different steroid requirements, as well as the risk of vascular complications associated with GCA. Temporal artery biopsy is the gold standard for the diagnosis of GCA, although the presence of skip lesions may render the test negative. PMR is a clinical diagnosis. FDG PET-CT is a non-invasive diagnostic tool that, by using radioactive labeled fluoro-18-deoxyglucose (FDG), visualizes increased metabolic activity in both malign and inflammatory tissue including large vessel inflammation. Objectives To evaluate the contribution of PET-CT in the diagnosis of PMR and GCA. Methods Patients registered in our department in 2011-2012, who were diagnosed with PMR or GCA and at the time of diagnosis underwent PET-CT scan as well as biopsy of the temporal artery within a time span of one month were included. Biopsy was performed prior to or within a week after initiation of steroid therapy. We used kappa statistics. Results 22 patients were included (8 males,14 females). 8 had a clinical diagnosis of PMR, 10 presented with symptoms of GCA and 4 had non-specific symptoms (NSS) including fatigue, fever and high sedimentation rate, where GCA was suspected. Increased FDG-uptake in the large vessels (aorta and its main branches) was found in 10 patients. 5 of them presented with symptoms of GCA, 1 with PMR and 4 with NSS. 4 patients with symptoms of GCA had a positive biopsy, and all showed increased vascular FDG uptake. 2 patients with PMR had a positive biopsy as had 2 patients with NSS. In this agreement and reliability study the kappa coefficient was 0,63, corresponding to a substantial agreement between the biopsy and the PET findings. 1 patient had a positive biopsy and no vascular FDG uptake, whereas 3 patients showed increased vascular uptake and had a negative biopsy. We found inter-observer agreement in 82 % between PET-CT and temporal artery biopsy. Conclusions FDG PET-CT definitely has a role in the diagnosis of GCA and should be considered in patients with negative temporal artery biopsy, for the diagnosis of GCA and to rule out differential diagnosis that may mimic PMR such as malignancy. Our findings support the theory that PMR and GCA are different manifestations of the same disease. References Tanaz A Kermani et al. Polymyalgia rheumatica, Lancet 2013;381:63-72 D. Blockmans et al. New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography. Rheumatology 1999;38:444-447 Disclosure of Interest None Declared