Background Limited data exist regarding the disease course of coronavirus disease 2019 (COVID-19) and its relationship with immunosuppressants among patients with immune-mediated inflammatory diseases (IMIDs). Therefore, this study aims to investigate the association between COVID-19, frequent rheumatological, dermatological, gastrointestinal, and neurological IMIDs and immunosuppressants. Methods We conducted a Danish population-based cohort study including all residents living within Capital Region of Denmark and Region Zealand from January 28th, 2020 until September 15th, 2020 with the only eligibility criterion being a test for SARS-CoV-2 via reverse transcription–polymerase chain-reaction. Main outcomes included development of COVID-19, COVID-19-related hospitalization and mortality. Results COVID-19 was less common among patients with IMIDs than the background population (n = 328/20,513 (1.60%) and n = 10,792/583,788(1.85%), p < 0.01, respectively). However, those with IMIDs had a significantly higher risk of COVID-19-related hospitalization (31.1% and 18.6%, p < 0.01, respectively) and mortality (9.8% and 4.3%, p < 0.01, respectively), which were associated with patients older than 65 years, and presence of comorbidities. Furthermore, systemic steroids were independently associated with a severe course of COVID-19 (Odds ratio (OR) = 3.56 (95%CI 1.83–7.10), p < 0.01), while biologic therapies were associated with a reduced risk hereof (OR = 0.47 (95%CI 0.22–0.95), p = 0.04). Patients suspending immunosuppressants due to COVID-19 had an increased risk of subsequent hospitalization (OR = 3.59 (95%CI 1.31–10.78), p = 0.02). Conclusion This study found a lower occurrence, but a more severe disease course, of COVID-19 among patients with IMIDs, which was associated with the use of systemic steroids for IMIDs and suspension of other immunosuppressants. This study emphasizes the importance of weighing risks before suspending immunosuppressants during COVID-19.

Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA (DAS28 > 2.6) and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p < 0.01) and pain tolerance (p < 0.01) than HC. The mean temporal summation- (TS-) index in RA patients was 0.98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (p < 0.01). Conclusion. Patients with active RA showed decreased pressure-pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup of patients may be of importance when considering treatment strategies.

IntroductionInflammatory bowel diseases (IBD), encompassing Crohn’s disease and ulcerative colitis, are chronic, inflammatory diseases of the gastrointestinal tract. We have initiated a Danish population-based inception cohort study aiming to investigate the underlying mechanisms for the heterogeneous course of IBD, including need for, and response to, treatment.Methods and analysisIBD Prognosis Study is a prospective, population-based inception cohort study of unselected, newly diagnosed adult, adolescent and paediatric patients with IBD within the uptake area of Hvidovre University Hospital and Herlev University Hospital, Denmark, which covers approximately 1 050 000 inhabitants (~20% of the Danish population). The diagnosis of IBD will be according to the Porto diagnostic criteria in paediatric and adolescent patients or the Copenhagen diagnostic criteria in adult patients. All patients will be followed prospectively with regular clinical examinations including ileocolonoscopies, MRI of the small intestine, validated patient-reported measures and objective examinations with intestinal ultrasound. In addition, intestinal biopsies from ileocolonoscopies, stool, rectal swabs, saliva samples, swabs of the oral cavity and blood samples will be collected systematically for the analysis of biomarkers, microbiome and genetic profiles. Environmental factors and quality of life will be assessed using questionnaires and, when available, automatic registration of purchase data. The occurrence and course of extraintestinal manifestations will be evaluated by rheumatologists, dermatologists and dentists, and assessed by MR cholangiopancreatography, MR of the spine and sacroiliac joints, ultrasonography of peripheral joints and entheses, clinical oral examination, as well as panoramic radiograph of the jaws. Fibroscans and dual-energy X-ray absorptiometry scans will be performed to monitor occurrence and course of chronic liver diseases, osteopenia and osteoporosis.Ethics and disseminationThis study has been approved by Ethics Committee of the Capital Region of Denmark (approval number: H-20065831). Study results will be disseminated through publication in international scientific journals and presentation at (inter)national conferences.

BackgroundPeripheral musculoskeletal (MSK) symptoms are the most common extra intestinal manifestations (EIMs) in IBD patients, with substantial impact on quality of life. IBD related spondyloarthritis (IBD-SpA) often requires a multidisciplinary evaluation to enable optimal choice of treatment and patient care, but systematic rheumatological characterisation of this population is scarce [1].Characterisation of IBD-SpA is challenged by the variety of MSK involvement (from arthralgia to ankylosing spondylitis), the co-existence of osteoarthritis, overuse enthesopathies or fibromyalgia, and by the heterogeneity in methodologies used to describe the SpA features. Recently developed recommendations for endpoints for EIMs in IBD trials [2] were applied in the present study.ObjectivesTo determine the prevalence and distribution of inflammatory lesions in peripheral joints and entheses in newly diagnosed IBD patients, assessed for presence of MSK symptoms, and by rheumatological and ultrasound (US) evaluation.MethodsPatients from the IBD prognosis inception cohort (IBD-Pro) were consecutively included [2]. They reported MSK symptoms using a validated questionnaire (IBD-TASQ). A clinical examination was performed by rheumatologist, as was US examination (grey scale (GS) and colour Doppler (CD)) of 38 peripheral joints and 14 entheses, applying OMERACT-EULAR definitions and scoring systems for synovitis and enthesitis [3]. Synovitis was defined as GS score ≥2 and/or CD≥1 and entheseal inflammation was defined as presence of hypoechogenicity/thickening and/or CD score ≥1. Further, OMERACT-EULAR sum score (GLOESS) was calculated (0-114).Results110 newly diagnosed IBD patients (mean age 42, 39% male) were included (34% Crohn’s disease, 59% ulcerative colitis (UC), 5% unclassified IBD). The IBD disease activity scores indicated mild activity in UC patients (Simple Clinical Colitis Activity Index mean (SD) 6.7 (3.6) - max score 19, and low in Crohn (Harvey-Bradshaw Index for Chron’s disease 4.5 (2.9)- max score 18). Four patients received systemic glucocorticoids (2%) or biologics (2%) at the time of rheumatological evaluation. History of psoriasis was reported in 2% and uveitis in 5% of the patients.40% of the patients reported positive history for ≥1 MSK symptom (Figure 1, A1); joint pain and swelling were the most common complaints (30%), followed by heel enthesitis (17%) and dactylitis in 20%. Patient pain VAS was low, mean (SD) 13(25).Clinical examination revealed 53% of all patients having arthritis and/or enthesitis and fulfilled ASAS classification criteria for peripheral SpA (25% ≥1 tender joint, 12% ≥1 swollen joint, 46% ≥1 tender enthesis, 38% both ≥1 tender/swollen joint and ≥1 tender enthesis). Figure 1 (part A2a, A2b) shows joint and enthesis involvement.US found inflammation in ≥1 joint or enthesis in 47% of the IBD patients - synovitis in 30%, mean GLOESS sum score 5.2 SD (4.6) and entheseal inflammation in 33% (US enthesitis sum, mean (SD) 2.6(2). (Figure 1, part A3a, A3b).Among those patients reporting entheseal pain, 71% had ≥1 tender enthesis at clinical evaluation and 64% had entheseal inflammation by US. Among those reporting joint pain, 55% had ≥1 tender or swollen joint, and 41% US synovitis. Figure 1 (part B1, B2) displays the overlap between patient-reported symptoms, clinical and US findings. In the asymptomatic patients (60 %) 59% of the patients with clinical signs of arthritis and 79% of those with enthesitis were asymptomatic. US enthesitis and synovitis were also observed in 69% and 58%, respectively, of the asymptomatic patients.ConclusionAt the time of IBD diagnosis 53% fulfilled ASAS classification criteria for peripheral SpA and 47% had objectively verified synovitis and/or enthesitis by US indicating that SpA may be underdiagnosed among IBD patients.References[1]Schwartzman M et al., RMD Open 2022[2]Guillo L et al., Lancet Gastroenterol Hepatol 2022[3]Bruyn GA et al., The Journal of Rheumatology 2019[4]Attauabi M, et al., BMJ Open 2022AcknowledgementsThe authors would like to thank all participating patients, physicians, study nurses and secretaries who contributed to this study.Disclosure of InterestsNora Vladimirova Speakers bureau: MSD, Grant/research support from: Novartis, Lene Terslev Speakers bureau: Speakers fees from Janssen, Roche, Novartis, Pfizer, UCB, GE and Eli-Lilly, Consultant of: consultancy fee from Janssen and UCB, Mohamed Attauabi: None declared, Gorm Madsen Speakers bureau: Bristol Myers Squibb and Tillots Pharma., Viktoria Fana: None declared, Charlotte Wiell: None declared, Uffe Møller Døhn: None declared, Jacob Jørgensen: None declared, Flemming Bendtsen Grant/research support from: Ferring and Tillotts, Jakob Seidelin Grant/research support from: Research grants from Takeda and the Capital Region Denmark, national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim., Johan Burisch Speakers bureau: AbbVie, Janssen-Cilag, Celgene, MSD, Pfizer, Takeda, Tillots Pharma, Samsung Bioepis, Bristol Myers Squibb, Novo Nordisk, Pharmacosmos, Ferring, Galapagos, Grant/research support from: Janssen-Cilag, MSD, Pfizer, Takeda, Tillots Pharma, Bristol Myers Squibb, Novo Nordisk, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB., Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB., Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB.

Background Despite better disease control, RA patients still rate pain as a major burden. That pain in some cases persists without signs of inflammation of the joints may indicate, that central pain sensitization could play a major role in the generation of chronic pain in some RA patients (1). Pain assessment is part of several tools used to evaluate RA disease activity e.g. DAS28 score. When applying DAS28, RA patients scoring high on tender joint count and global health may be classified to have active RA, despite no signs of inflammation (2). Central sensitization may also in part explain the significant portion of RA patients not responding to biologics treatment. Computerized Pneumatic Cuff Pressure Algometry (CPA) is a method for quantitative measurements of pain reactions and indications of central sensitization (3). Knowledge of contributing pain mechanisms in RA may be crucial, since interventions aimed at decreasing the inflammatory processes may not be sufficient in all patients. Objectives To assess the degree of peripheral and central sensitization in women with active RA compared to healthy controls. Methods 38 women with active RA (DAS28>2,6) and 38 healthy controls were included in the study. CPA measurements were carried out on the dominant arm and leg. Following variables were determined: Pain Detection Threshold (PDT), Pain Tolerance Threshold (PTT), and Pain Tolerance Limit (PTL). Following this, during 10 minutes constant pressure stimulation at intensity relative to the individual pain threshold, the pain intensity was continuously recorded using an electronic Visual Analogue Scale (VAS). From this the degree of temporal summation (TS) was estimated (10 min CPA test at 50% of PTT-PDT). An index was calculated: TS-index = log((VASend/VASmax)*(10/Tstim)*VASend) (5). Results Women with active RA have a lower pain threshold and pain tolerance than healthy controls. The mean TS-index in RA patients was 0.95 (95%CI: 0.86 to 1.04) and 0.81 (95%CI: 0.74 to 0.89)in healthy controls. Mean Difference was 0.14 (95%CI: 0.02 to 0.26; p = 0.022). Conclusions In active RA patients the TS index as measured by cuff algometry was on average increased, indicating signs of central pain sensitization. This type of pain may be of importance when considering treatment strategies. References Lee et al. Arthritis Res Ther 2011,13:R83. Leeb BF, Rheumatology (Oxford).2004; 43(12):1504-7. Graven-Nielsen, Arthritis Rheum2012; 64(9):2907-16. Jespersen A, Pain 2007; 131(1-2):57-62. Disclosure of Interest None Declared

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