N. Bello

Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis

OBJECTIVE To investigate the predictive value of synovitis detected by Doppler US in relation to failed tapering of biologic therapy (BT) in RA patients in sustained clinical remission. METHODS A total of 77 RA patients (52 women, 25 men) in sustained clinical remission, treated with a stable dosage of BT were prospectively recruited. BT was tapered according to an agreed strategy implemented in clinical practice (i.e. increasing the interval between doses for s.c. BT and reducing the dose for i.v. BT). BT tapering failure was assessed at 6 and 12 months. Doppler US investigation of 42 joints for the presence and grade (0-3) of B-mode synovial hypertrophy and synovial power Doppler signal (i.e. Doppler synovitis) was performed at baseline by a rheumatologist blinded to clinical and laboratory data. Hand and foot radiographs were obtained at baseline and at 12-month follow-up. RESULTS Of the 77 patients, 46 (59.7%) were on s.c. BT and 31 (40.3%) on i.v. BT. At 12 months, 35 patients (45.5%) presented BT tapering failure, 23 of them (29.9% of all patients) in the first 6 months of BT tapering. In logistic regression analysis, the baseline DAS28 and the global score of Doppler synovitis were identified as independent predictors of BT tapering failure at 12 and 6 months. The presence of Doppler synovitis was the strongest predictor for BT tapering failure. No patient showed radiographic progression. CONCLUSION Our results suggest that the presence of Doppler-detected synovitis may predict BT tapering failure in RA patients in sustained clinical remission.

Patient self-assessment and physician’s assessment of rheumatoid arthritis activity: which is more realistic in remission status? A comparison with ultrasonography

OBJECTIVE The objective of this study was to compare disease activity assessed by the patient, the physician and musculoskeletal US in patients with RA in clinical remission. METHODS We evaluated 69 patients with RA in clinical remission according to their attending rheumatologist. Tenderness and swelling in 28 joints were blindly assessed by patients and physicians. The presence of B-mode and Doppler synovitis was blindly investigated in the above joints. The DAS28 and Simplified Disease Activity Index (SDAI) were calculated. RESULTS The percentage of patients in remission according to the self-derived DAS28 (26.1%) was significantly less than that according to the physician-derived DAS28 (52.2%) (P < 0.0005). There was no significant difference in the percentage of patients in remission according to the self-derived SDAI (14.5%) and the physician-derived SDAI (11.6%) (P = 0.172). We found moderate agreement between the patient-derived and physician-derived DAS28 and SDAI [intraclass correlation coefficient (ICC) = 0.620 and ICC = 0.678, respectively]. Agreement between patient and physician was better for the tender joint count (TJC; ICC = 0.509) than for the swollen joint count (SJC; ICC = 0.279). The mean (S.D.) count for B-mode synovitis [4.09 (3.25)] was significantly greater than the SJC assessed by both the patient and physician [2 (3.71) and 1.42 (2.03), respectively] (P < 0.0005 and P = 0.033, respectively). We found moderate agreement between the physician-assessed SJC and the joint count for Doppler synovitis (ICC = 0.528). CONCLUSION Patient-assessed and physician-assessed overall RA activity showed acceptable agreement. Patient self-assessment overestimated disease activity determined by the DAS28. At the patient level, physician-assessed joint swelling showed an acceptable concordance with Doppler US synovitis.

Structural damage in rheumatoid arthritis: comparison between tendon damage evaluated by ultrasound and radiographic damage

OBJECTIVE To compare structural damage assessed by conventional radiography and tendon damage assessed by musculoskeletal US (MSUS) at wrist and ankle in RA patients. METHODS We evaluated 72 consecutive patients [56 (77.8%) females] with RA. The MSUS evaluation consisted in a B-mode examination of bilateral extensor carpi ulnaris and tibialis posterior tendons. Tendon damage was defined and scored according to OMERACT. A total score for the tendon damage score (TDS) was calculated by summing the grades for each tendon. For the radiographic evaluations we used the van der Heijde score; a total radiographic score (RTS) was calculated by summing a bone erosion score (ERS) and a joint space narrowing score (JSNS). RESULTS We evaluated 288 tendons. The mean (s.d.) of TDS was 2.3 (1.8). Fifty-four (75%) patients presented tendon damage of at least one tendon. From all evaluated tendons, 134 (46.5%) had no tendon damage, 146 (50.7%) had grade 1 and 8 (2.8%) had grade 2 tendon damage. The mean (s.d.) for RTS was 91.4 (97), for ERS was 47.3 (61.9) and for JSNS was 44.1 (37.2). We found a significant correlation between disease duration and both TDS and RTS (r = 0.413 and r = 0.560, respectively; P < 0.0001). We found a good significant correlation between TDS and all variables of radiographic structural damage (RTS, r = 0.65; ERS, r = 0.637; JSNS, r = 0.618; P < 0.001). CONCLUSION The MSUS assessment of only four tendons can be an additional feasible method to assess structural damage in RA patients.

Does ultrasound-scored synovitis depend on the pharmacokinetics of subcutaneous anti-TNF agents in patients with rheumatoid arthritis?

OBJECTIVE The aim of this study was to investigate the influence of the pharmacokinetics of s.c. anti-TNF agents on the grade of US-detected synovitis in RA patients. METHODS Fifty RA patients were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were being in treatment with s.c. anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory [28-joint DAS (DAS28) and Simplified Disease Activity Index (SDAI)] and US assessment at two time points, i.e. at peak plasma drug concentration and at trough plasma drug concentration. US assessments were performed blindly to the anti-TNF agent, the administration time and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0-3) of B-mode synovitis and synovial power Doppler signal. Global indices for B-mode synovitis (BSI) and Doppler synovitis (DSI) were calculated for 12 joints and for wrist-hand-ankle-foot joints. B-mode US remission was defined as a BSI <1 and Doppler US remission as a DSI <1. RESULTS There were no significant differences between the clinical, laboratory and B-mode and Doppler US parameters at peak time and trough time (P = 0.132-0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US and Doppler US at peak time and trough time assessments (P = 0.070-1). CONCLUSION Our results suggested that s.c. anti-TNF pharmacokinetics do not significantly influence US-scored synovitis in RA patients.

SAT0509 Clinical and Serological Profile of Children with Positive SSA-Ro/SSB-La Antibodies

Background Several studies have shown the relationship between anti-SSA-Ro/SSB-La antibodies and Systemic Lupus Erythematosus (SLE), Sjögren Syndrome (SS) and other autoimmune diseases in adult population. However, the expression of these autoantibodies and clinical correlation in juvenile patients is poorly described. Objectives To characterize the clinical and serological profile and primary rheumatic diseases in pediatric patients with positive anti-SSA-Ro and/or anti-SSB-La antibodies. Methods The data was obtained from a long term prospective cohort of patients under age 18 diagnosed with rheumatic diseases in a tertiary hospital in Spain. Demographic, clinical, and laboratory data were collected from 1986 to 2010. Patients were divided into 2 groups: anti-SSA-Ro/SSB-La positive and anti-SSA-Ro/SSB-La negative. Results A total of 187 patients were tested for anti Extractable Nuclear Antigens (ENA), with a following mean time of 11 years. Mean age at disease onset was 12.6 years and 77% were female. Fifty-four (28.9%) anti-SSA-Ro/SSB-La positive subjects were compared against 133 (71.1%) anti-SSA-Ro/SSB-La negative subjects. Among positive cases, 13 (24.1%) patients were double-positive for anti-SSA-Ro and anti-SSB-La, 51 (94.4%) were positive for anti-SSA-Ro and 3 (5.5%) were single-positive for anti-SSB-La. The anti-SSA-Ro/SSB-La antibodies were found less frequently (p=0.003) in the overlapping syndromes, and more frequently in SLE (p=0.007). In addition rheumatoid factor (p<0.001), anti-Sm (p<0.001) and anti-RNP (p<0.001) were frequently co-expressed with anti-SSA-Ro/SSB-La antibodies. Finally the anti-SSA-Ro/SSB-La positive group presented more hematological and skin manifestations than the negative group (p<0.05). Conclusions Similarly to adults, we observed a relationship between anti-SSA-Ro/SSB-La antibodies and SLE in pediatric patients. However a low proportion of childhood primary SS exists in our anti-SSA-Ro/SSB-La positive cases. This could be explained by underdiagnoses related to the atypical clinical presentation of SS in pediatric population. Single-positive anti-SSB-La patients are uncommon, the clinical significance of this serological result remains uncertain in children. References Rheumatol Int (2014) 34:1123–1127. Disclosure of Interest None declared

Rheumatoid arthritis oral abstractsO01. Efficacy and Safety of Baricitinib Versus Placebo and Adalimumab in Patients with Moderately to Severely Active Rheumatoid Arthritis and Inadequate Response to Methotrexate: Summary Results from the 52-Week Phase 3 RA-Beam Study

Peter C. Taylor, Marek Krogulec, Anna Dudek, Jean Dudler, Edit Drescher, Regina Cseuz, Rasa Kausiene, Daina Andersone, Dalia Unikiene, Juan Sanchez Burson, Ricardo Blanco Alonso, Zdeněk Dvořák, Andrei Ghizdavescu, Ildiko Irto, Esbjörn Larsson, Natalia Bello, Jane Barry, Frederick Durand, Thorsten Holzkämper, Susan Otawa, Stephanie de Bono, Edward C. Keystone, Andrea Rubbert-Roth, Bernard Combe and Inmaculada De La Torre Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UNITED KINGDOM, Department of Rheumatology, Rheumatology Clinic, MAK-MED, Nadarzyn, Department of Rheumatology, Centrum Medyczne AMED, Warsaw, POLAND, Department of Rheumatology, Hôpital Cantonal, Fribourg, SWITZERLAND, Rheumatology, Csolnoky Ferenc Hospital, Veszprém, Department of Rheumatology, Revita Clinic, Budapest, HUNGARY, Department of Rheumatology, VSI Respublikine Siauliu Ligonine, Siauliai, LITHUANIA, Department of Rheumatology, Pauls Stradins Clinical University Hospital, Riga, LATVIA, Department of Rheumatology, Dr. Kildos Klinika, Kaunas, LITHUANIA, Division of Rheumatology, Hospital de Valme, Sevilla, SPAIN, Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, SPAIN, Department of Rheumatology, Arthromed, s.r.o., Pardubice, CZECH REPUBLIC, Rheumatology Section, Eli Lilly Romania S.R.L., Bucharest, ROMANIA, Autoimmune Section, Lilly Hungária, Budapest, HUNGARY, Rheumatology Section, Eli Lilly Sweden, Solna, SWEDEN, Rheumatology and Biomedicines Section, Eli Lilly (Spain), Alcobendas, SPAIN, Rheumatology Section, Lilly UK, Basingstoke, UNITED KINGDOM, Rheumatology and Biomedicines Section, Lilly France, Neuilly-sur-Seine, FRANCE, Medical Department, Lilly Deutschland, Bad Homburg, GERMANY, Rheumatology Section, Eli Lilly Canada, Department of Rheumatology, Rebecca MacDonald Centre, Mount Sinai Hospital, University of Toronto, Toronto, ON, CANADA, Department of Rheumatology, Klinik I für Innere Medizin, Uniklinik Köln, Köln, GERMANY and Department of Rheumatology, CHRU Montpellier, Montpellier, FRANCE

FRI0619-HPR Joint Prostheses and Biologic Therapies in a Rheumatologic Clinic

Background Biologic therapies (BT) have been changed considerably the treatment of autoimmune and autoinflammatory rheumatic diseases. However, patients with joint prostheses may present adverse effects due to these therapies. Objectives To describe clinical features, treatment and complications of patients with joint prosthesis treated with BT. Methods We included all patients treated in our BT Unit from January 2010 to December 2014. For each patient we analysed demographic, diagnosis, treatments, number of prostheses and complications. Results Eight hundred patients were treated with TB in our TB Unit during the study period of which 77 (9.6%) patients needed joint prosthesis. The diagnosis of patients with joint prosthesis was as follows: 51 (66.2%) rheumatoid arthritis (RA), 16 (20.7%) ankylosing spondylitis (AS), 5 (6.5%) lupus erythematosus, 3 (3.9%) psoriatic arthritis and 2 (2.6%) juvenile idiopathic arthritis. We found 129 prostheses placed in the 77 patients, of which 56 (43.4%) were hip prostheses, 50 (38.7%) were knee prostheses, 5 (3.9%) were MCF prostheses, 4 (3.1%) were ankle prostheses, 3 (2.3%) were wrist prostheses, 2 (1.5%) were IF prostheses, 2 (1.5%) were elbow prostheses and 2 (1.5%) were shoulder prostheses. The mean age of prosthesis placing was 60 years (range 28-85) and the mean disease duration at the moment of prosthesis placing was 20 years. The most used BT were as follows: 28 (36.4%) infliximab, 20 (26%) rituximab, 16 (20.7%) tocilizumab, 9 (11.6%) abatacept and 4 (5.2%) etanercept. Thirty four (44.1%) patients had received more than one biological drug, 44 (57.1%) patients had concomitant synthetic disease-modifying anti-rheumatic drugs (sDMARDs) treatments and 41 (53.2%) patients had steroid treatment associated. We recorded 7 (5.4%) prosthetic infections in 7 (9.1%) patients of which 6 were diagnosed with RA and one with AS. From all infections, 2 occurred in prosthesis placed before the beginning of BT treatment and 5 occurred in prostheses placed during BT treatment. All patients with prosthesis infections were treated with concomitant sDMARDs and steroid treatment. Five patients needed prosthesis replacement for other reasons. Conclusions Most frequent prostheses were hip and knee prostheses. The majority of prosthetic infection occurred in patients with prosthetic placement during the BT treatment. All patients with prosthesis infections received also sDMARS and steroid treatments. Disclosure of Interest None declared

AB0983 Contribution of Knee Involvement Evaluated by Doppler Ultrasound and Synovial Fluid Analysis in Rheumatoid Arthritis Disease Activity Assessment

Objectives The objective of this prospective, cross-sectional study was to determinate the contribution of concomitant non-inflammatory knee involvement evaluated by Doppler ultrasound (DUS) in rheumatoid arthritis (RA) disease activity assessment and when indicated, by synovial fluid (SF) analysis in a Rheumatology Clinic of a University Hospital Methods We evaluated 106 patients with RA who consecutively attended. Patients with a history of other musculoskeletal diseases were excluded. RA activity was evaluated by the Disease Activity Score (DAS28). Tenderness and swelling at the knees were recorded separate. Clinical assessment was performed by the same rheumatologist before US assessment. A B-mode (BM) and power Doppler (PD) US assessment was performed by the same rheumatologist, blinded to clinical and laboratory results. For each knee we evaluated and scored synovitis components in BM and PD [synovial effusion (SE), synovial hypertrophy (SH), PD signal] according to Outcome Measurement in Rheumatology (OMERACT) definition and scoring system (0-3). After DUS evaluation the knees were classified in two groups: 1) knee involvement probably due to RA [i.e. SH grade 2-3, with or without PD signal, or SH grade 1 with PD signal (1-3), independently of SE]; 2) knee involvement probably not due to RA: [i.e. SH grade 0 or SH grade 1 without PD signal, independently of SE]. If SE grade 2-3 was detected an arthrocentesis was performed. The SF analysis included a macroscopic and microscopic examination (i.e. cellular count, crystals) and bacterial culture. After SF evaluation knees were re-classified in three groups: 1) knee involvement probably due to RA: inflammatory SF (≥500 cells) and crystals absence; 2) knee involvement probably not due to RA: mechanical SF, with or without crystals; 3) uncertain: inflammatory SF (≥500 cells) with crystals. This last group was included in the group of knee involvement probably due to RA for the final analysis Results We evaluated 212 knees. Pain and/or swelling were present in 174 (72%) knees. Table 1 shows the results of DUS evaluation in clinically affected knees. After DUS evaluation 48 (27.59%) knees were classified in probably due to RA and 126 (72.41%) in not-probably due to RA. DAS 28 was re-calculated excluding the knees classified as probably not due to RA from swollen and pain joint counts. In addition, after SF analysis the knees were re-classified and DAS28 was re-calculated. All patients in remission according to initial DAS28 were also in remission according to both re-calculated DAS 28. The number of patients in remission significantly increased after DUS and DUS+SF assessments (23%, 31.7% and 33.7% respectly; p=0.004 and p=0.001 respectly) Table 1 Grade 0 Grade 1 Grade 2 Grade 3 Synovial hypertrofy 33.29% (58) 56.82% (99) 9.2% (16) 0.57% (1) PD signal 73.6% (128) 17.83% (31) 8.63% (15) 0% (0) Conclusions Knee involvement was common in our RA patients. Knee involvement not due to RA might overestimate RA activity measured by DAS28. DUS and SF analysis may contribute to an accurate diagnosis of knee involvement in RA patients, which should be relevant for better therapeutic management Disclosure of Interest M. Montoro: None declared, I. Janta: None declared, R. Irace: None declared, M. Medina: None declared, B. Serrano: None declared, C. Mata: None declared, L. Martinez: None declared, J. Martinez: None declared, M. Hinojosa: None declared, N. Bello: None declared, J. Ovalles: None declared, J. Nieto: None declared, L. Valor: None declared, F. Lopez: None declared, I. Monteagudo Consultant for: Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, General Electric Healthcare, MSD and Esaote, C. Gonzalez: None declared, E. Naredo Grant/research support: Grant/research support: UCB and MSD Consultant for: Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, General Electric Healthcare, and Esaote, L. Carreño: None declared DOI 10.1136/annrheumdis-2014-eular.3895

AB0434 Relation of Subclinical Ultrasound Detected Synovitis and Peripheral B-Cell Counts in Rheumatoid Arthritis Patients Treated with Rituximab

Background The clinical response in patients with Rheumatoid Arthritis (RA) to rituximab (RTX) has been shown to be related with the presence of B-cells in the synovi. To date this has not been proved for peripheral B-cell counts. Ultrasound (US) has proven higher sensitivity for detecting synovitis than clinical assessment. The relation of subclinical US-detected synovitis and peripheral B-cell counts in RA patients treated with RTX has not been addressed. Objectives the aim of study was to assess the association between the presence of absolute B- cell count in peripheral blood and subclinical synovitis measured by US [B-Mode (BM) and power Doppler (PD)] in RA patients treated with RTX in clinical remission according to the attending physician. Methods In this cross sectional study we evaluated 37 RA patients treated with RTX in clinical remission according to clinical judgment. Inclusion criteria were having received at least two cycles of RTX and having had no change in therapy in the previous 3 months. All patients underwent a blind clinical, laboratory and US assessment (BM and PD of 12 joints). A global index for B-mode synovitis (BMI; range 0–36) and a global index for synovial PD signal (PDI; range 0–36), obtained by the sum of the B-mode synovitis and synovial PD signal scores for each joint region was calculated for each patient. B-cell absolute count was determined in our routine laboratory by flow cytometry. Results Thirty (81%) patients were female with a mean (SD) age of 60 (12) years. Sixteen (43.2%) patients were rheumatoid factor (RF) positive and 29 (78.4%) had antibodies to citrullinated peptides (ACPA). The mean (SD) disease duration was 16 years (8). Fifteen patients (40.5%) satisfied the DAS28 criteria for remission, the mean (SD) DAS28 was 3.04 (1.2). All patients had evidence of BM synovitis and 16 (43.2%) patients had synovial PD signal. There was no correlation between DAS28 and BMI and PDI (r =0.13, p=0.45; r =0.27, p=0.09, respectively). Twenty six (67.5%) patients had peripheral B-cells (>1 cell/mm3). There was no difference in the B-cell count according to DAS28 (DAS28 <2.6=34.53, DAS28>2.6=49.45, p=0.52) or PDI score (PDI<1=49.48, PDI>1=35.44, p=0.54). There was no correlation between B-cell count and DAS28, BMI or PDI score (r =0.020, p=0.907; r =-0.151, p=0.371; r = -0.099, p=0.558). Conclusions in our study we did not find any relation between subclinical synovitis measured by US and peripheral B-cell count in RA patients treated with RTX. References Buch MH, Smolen JS, Betteridge N, Breedveld FC, Burmester G, Dörner T,Ferraccioli G, Gottenberg JE, Isaacs J, Kvien TK, Mariette X, Martin-Mola E,Pavelka K, Tak PP, van der Heijde D, van Vollenhoven RF, Emery P; Rituximab Consensus Expert Committee. Updated consensus statement on the use of rituximabin patients with rheumatoid arthritis. Ann Rheum Dis. 2011 Jun;70(6):909-20. Disclosure of Interest L. Martinez Estupiñan: None declared, E. Naredo Grant/research support: UCB and MSD, Consultant for: Abbvie, Roche Farma, Bristol- Myers Squibb, Pfizer, UCB, General Electric Healthcare, and Esaote, L. Valor: None declared, I. Janta: None declared, M. Montoro: None declared, T. Del Rio: None declared, J. C. Nieto-González: None declared, M. Hinojosa: None declared, N. Bello: None declared, J. Martínez: None declared, C. González-Fernández: None declared, J. Lόpez-Longo: None declared, I. Monteagudo Consultant for: Abbvie, Roche Farma, Bristol- Myers Squibb, Pfizer, UCB, L. Carreño-Pérez: None declared DOI 10.1136/annrheumdis-2014-eular.4136

THU0187 Does Ultrasound-Scored Synovitis Depend on the Pharmacokinetics of Subcutaneous Anti-TNF Agents in Patients with Rheumatoid Arthritis?

Background Many observational studies have shown responsiveness of ultrasound (US)-detected synovitis in rheumatoid arthritis (RA) patients, most of them using biologic therapies. However, these studies have not taken into consideration in their design the pharmacokinetic characteristics of the drug administered. Objectives To investigate whether the pharmacokinetics (i.e. time point of US assessment) of subcutaneous anti-Tumour Necrosis Factor (anti-TNF) agents influences the grade of US-detected synovitis in RA patients treated with these drugs. Methods Fifty consecutive RA patients (31 women, 18 men) were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria consisted of being in treatment with subcutaneous anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory and US assessment at two time points, i.e., at peak plasma drug concentration and at trough plasma drug concentration. Patients were assessed at both time points for disease activity according to the Disease Activity Score in 28 joints (DAS28) and the Simplified Disease Activity Index (SDAI) by the same investigator. US assessments were performed by a rheumatologist expert in musculoskeletal US who was blinded to the anti-TNF agent, the administration time, and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0-3) of B-mode synovitis and synovial PD signal (i.e. Doppler synovitis). A global index for B-mode synovitis (BSI), joint count for B-mode synovitis (BSC), a global index for Doppler synovitis (DSI), and joint count for Doppler synovitis (DSC) were calculated for a 12-joint US scoring model (31) and a wrist-hand-ankle-foot US scoring model. B-mode US remission was defined as a BSI <1 and Doppler US remission as a DSI <1. Results Twenty (40.8%) patients were treated with etanercept, 19 (38.8%) with adalimumab, 6 (12.2%) with golimumab, and 4 (8.2%) with certolizumab. There were no significant differences between the clinical, laboratory and B-mode and Doppler US indices and joint counts for both the 12-joint US model and the wrist-hand-ankle-foot model at peak time and trough time (p=0.132-0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US, and Doppler US at peak time and trough time assessments (p=0.070-1). DAS28, Disease Activity Score in 28 joints; SDAI, Simplified Disease Activity Index; B-mode synovitis index; BSC, B-mode synovitis count; DSI, Doppler synovitis index; DSC, Doppler synovitis count; W, wrist; A, ankle; Diff, values at peak time–values at trough time. Table 1. Clinical and US assessments at peak and trough time Conclusions Our results suggested that subcutaneous anti-TNF pharmacokinetics does not significantly influence US-scored synovitis in RA patients. Disclosure of Interest : M. Hinojosa-Dávila: None declared, E. Naredo Grant/research support: Esperanza Naredo has received speaker fees from Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, General Electric Healthcare, and Esaote. Esperanza Naredo has received research funding from UCB and MSD., L. Valor: None declared, D. Hernández: None declared, C. Mata-Martínez: None declared, B. Serrano-Benavente: None declared, N. Bello: None declared, J. G. Ovalles-Bonilla: None declared, J. Martínez-B.: None declared, L. Martínez-E.: None declared, J. C. Nieto: None declared, T. Del Río: None declared, C. González: None declared, J. Lόpez-Longo: None declared, M. Montoro: None declared, I. Monteagudo: None declared, L. Carreño: None declared DOI 10.1136/annrheumdis-2014-eular.2966