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BackgroundThis 4 phase project1 jointly supported by EULAR and ACR has led to draft criteria.2 ObjectivesTo simplify and validate the new criteria in a large international cohort.Methods23 expert centres each contributed up to 100 patients with SLE and with non-SLE diagnoses. Diagnoses were verified by 3 independent reviewers for 1,193 SLE and 1059 non-SLE patients. 500 randomly selected SLE and non-SLE patients formed the derivation cohort and the remainder the validation cohort.ResultsThe criteria were fine-tuned and simplified, using ANA of ≥1:80 as entry criterion and a classification threshold of 10.RenalClass III/IV nephritis10Class II/V nephritis8Proteinuria≥0.5 g/day4 Specific antibodiesAnti-Sm orAnti-dsDNA6Muco-cutaneousACLE6SCLE orDLE4Alopecia or oral ulcers2SerosaAcute pericarditis6Effusion5Musculo-skeletalArthritis6CNSSeizures5Psychosis3Delirium2BloodAutoimmune hemolysis or thrombocytopenia4Leukopenia3ComplementLow C3 and C44Low C3 or C43Anti-phospholipidAnti-Cardiolipin or anti-β2-GPI or lupus anticoagulant2ConstitutionalFever2Sensitivity was close to the SLICC 2012 criteria, specificity maintained at the level of the ACR 1997 criteria. This performance was independently confirmed in the validation cohort.ACR 1997 criteriaSLICC criteriaNew criteria DerivationSensitivity84.6396.8198.00Specificity95.2090.0096.40ValidationSensitivity82.7696.7096.12Specificity93.3883.6293.38ConclusionsThe new criteria developed with EULAR/ACR support achieved sensitivity close to the SLICC criteria, while maintaining the specificity of the ACR criteria.References[1] Aringer, et al. Ann Rheum Dis2017;76(S2):4.[2] Tedeschi, et al. Ann Rheum Dis2017;76(S2):50.Disclosure of InterestNone declared

The Andean grain, quinoa, Chenopodium quinoa Willd. (Caryophyllales: Amaranthaceae), is gaining increasing attention as a future food and fodder crop in Denmark and other parts of Europe. Prior to 2005, pest problems in the crop were negligible in Denmark, however native insects may become adapted to this new host. Herbivores feeding on the closely related and very common weed in arable crops Chenopodium album L. present a special risk. In 2006 there was a heavy attack of Scrobipalpa atriplicella (Röslerstamm) (Lepidoptera: Gelechiidae) larvae in the maturing inflorescence of C. quinoa. Gelechiidae are the most important pests on C. quinoa in the Andean region. In 2007 another herbivore on C. album, the tortoise beetle Cassida nebulosa L. (Coleoptera: Chrysomelidae), was a serious problem on C. quinoa in southern Jutland. This is the first published record of these two pests on C. quinoa. The future pest status of C. quinoa in northern Europe is discussed.

The original version of this Article contained an error in the spelling of the author Ana Rodríguez-Ramos, which was incorrectly given as Ana Rodríguez Ramos. This has now been corrected in both the PDF and HTML versions of the Article.

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BackgroundDifferent remission criteria are available for patients with rheumatoid arthritis (RA). None of the criteria includes imaging remission, even though studies have shown that many RA patients in sustained clinical remission have synovitis detectable by ultrasound (US), i.e. grey scale synovial hypertrophy and/or Doppler signal in the synovium.ObjectivesWe aimed to investigate the agreement between different clinical remission criteria and remission defined by US in patients with RA receiving biological therapy in routine care.MethodsA total of 117 RA patients in sustained remission (i.e. DAS28 ≤2.6 for ≥1 year and no radiographic progression the last year) on biological therapy were recruited. All patients underwent US of 24 joints for grading of grey scale (GS) synovial hypertrophy (0–3) and synovial Colour Doppler activity (CD) (0–3). Imaging remission was defined in two ways: either GS=0 and CD=0 in all 24 joints, or GS≤1 and CD=0 in all 24 joints.ResultsBaseline characteristics are shown in table 1. At baseline patients received the following disease-modifying antirheumatic drugs (DMARDs): methotrexate (MTX; 72%), sulphasalazine (3%), azathioprine (2%), leflunomide (2%), no DMARDs (21%) and the following treatment with biological therapy: abatacept (2%), adalimumab (28%), certolizumab (3%), etanercept (28%), golimumab(3%), infliximab (27%), tocilizumab (9%).For patients fulfilling DAS28 remission criteria, US defined remission was present in 9% (GS=0 and CD=0 in all 24 joints, termed “very strict” US remission) or 29% (GS ≤1 per joint and CD=0 in all 24 joints, termed “strict” US remission) and 24% had CD>1 in at least 1 joint (table 1). For patients fulfilling other criteria for clinical remission (CDAI, SDAI and ACR/EULAR remission), patients were in very strict US remission in 12%, 12% and 10%, respectively and in strict US remission in 28%, 29% and 20%, respectively. CD activity >1 in at least 1 joint was present in 22%, 25% and 22% of patients, respectively. The anatomical distribution of the GS synovial hypertrophy was 31% in metacarpophalangeal joints, 27% in metatarsophalangeal joints, 19% in wrists, 10% in knees, 7% in elbows and 6% in ankles. Thus, 33% of the total GS synovial hypertrophy was observed in the feet, which are not included in the DAS28 remission criteria.There were no significant differences in US findings (GS or CD) between patients in remission vs patients not in remission, no matter which clinical remission criteria were used.ConclusionsSubclinical synovitis was frequently detected by US in RA patients treated with biological drugs in routine care showing poor agreement between the clinical remission criteria and US remission. Further studies are needed to evaluate the benefit of US remission as a goal for treat to target strategies on patient-reported outcomes and radiographic progression.Disclosure of InterestC. H. Brahe: None declared, L. Terslev: None declared, S. Krabbe: None declared, M. Østergaard Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Eli Lill...

Background Only one biologic agent has been approved for use in SLE, but some are used off-label in various settings. To obtain information systematically regarding this, members of the SLICC group initiated the International Registry for Biologics in SLE (IRBIS). The entire registry contains data from 28 centers. Objectives To analyse the use of biologics in SLE, and assess the results achieved over the first two years after initiation. Methods IRBIS investigators provided retrospective data on all patients treated with a biologic for SLE at their center. Standardized case report forms were used to collect demographic, disease-specific and treatment data at the time of biologic initiation and at yearly follow-ups. Here, data is presented from 13 reporting centers for which two-year follow-up data were available. Results Based on the complete data set, 455 patients were treated with rituximab (84%), belimumab (10%), epratuzumab (5%), and anti-tumor necrosis factor agents (abatacept, etanercept and adalimumab, each <1%). The major organ manifestations leading to biologic treatment were lupus nephritis (LN, 44%), hematological (17%), musculoskeletal (16%), skin disease (10%), CNS (4%) and other (9%). Reasons for choosing the biologic were disease-control (73%), steroid-sparing (5%) or both (23%). At biologic initiation mean disease duration (±SD) was 9.5±7.9 years, and mean age was 42.2±12.5. Most patients (91%) were female. Prior to biologic treatment, most patients (91%) had been treated with one or more immunosuppressants (IS). Just over half (57%) had used 1-2 IS drugs, 21% had used three, and 13% had used 4-6 IS drugs. At two-year follow-up (n=120), SLE disease activity (SLEDAI) and glucocorticoid (GC) dose was significantly lower versus baseline (mean±SD SLEDAI: 9.4±5.3 to 3.1±2.5; mean±SD GC dose: 10.7±13.9 to 4.8±5.9 mg; paired analyses, p<0.0001 for both comparisons). SLICC damage-index remained unchanged. At baseline, concomitant GC was used in 91% of patients compared to 61% at follow-up. There was a slight trend to decreasing use of IS drugs from baseline (57%) to follow-up (51%). In almost half of patients (48%) there was at least one adverse event reported over the indicated follow-up period. However, only 5% were related to the biologic agent. Serious adverse events were serious opportunistic infections (n=4), posterior reversible encephalopathy syndrome (PRES, 3), serious allergic reactions (4), serious infections (6) and death (6). Conclusions Rituximab was the biologic used most commonly in this multi-center international lupus cohort and was used for a range of SLE manifestations. At two-year follow-up both lupus activity and concomitant glucocorticoid dosage had decreased. Over time, GC use decreased, with a trend for a decrease in IS drug use as well. Disclosure of Interest None Declared