To investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19. Methods: A cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms. Results: 959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 0.87%)] and [0.58% (95% CI 0.56 to 0.60%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002). Conclusion: Adult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population.

OBJECTIVES: To investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19. METHODS: A cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms. RESULTS: 959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. All patients had a successful recovery and only one patient required admission in the intensive care unit. When using the same classification criteria (only COVID-19 positive cases with pneumonia), COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 8.65%)] and [0.58% (95% CI 5.62 to 5.99%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002). CONCLUSION: Adult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population. Our exploratory analysis suggests that the proportion of COVID-19 suspected cases differs between tDMARDs.

BackgroundPatients with inflammatory bowel disease (IBD): Crohn disease (CD) and ulcerative colitis (UC) can develop extraintestinal manifestations and ones of the most important are musculoskeletal affections. In published studies, the prevalence of Spondyloarthritis (SpA) stands from 10 to 20% but with a wide range of variation. These differences are related to the methods used for its determination.Objectives1) To determine the prevalence of sacroiliitis with X-ray or magnetic resonance imaging (MRI) and of enthesitis with Doppler ultrasonography in patients with active IBD without following an immunosuppressant therapy 2) To check the prevalence of patients with positive ASAS criteria for axial and peripheric SpA.MethodsCross-sectional study in which a sample of patients diagnosed of active IBD, without previous diagnosis of rheumatic inflammatory disease and without any previous immunosuppressant therapy, underwent a comprehensive rheumatologic examination addressed to detect musculoskeletal SpA features. Data collected comprised: demographics, family medical history, IBD characteristics and comorbidities, axial symptoms, swollen and tender joint counts (44/46 joints), entheses and dactylitis examinations, BASDAI and BASFI questionnaires and CRP and HLAB27 blood tests. The following image techniques were also applied: cervical, lumbar column and pelvis X-ray, sacroiliac MRI with T1 and STIR sequence and ultra-sound exploration of entheses.Results30 patients (16 women) with a mean age 39.8 (9,8) years have been studied. 16 had CD and 14 UC. 16% tested positive for B27. 14 patients referred chronic lumbar pain, 4 of them with inflammatory characteristics. 10 patients referred arthralgias, without joint swelling o redness and 3 patients had history of heel pain, although they were not explored for any physician. None of the patients did not refer past medical history of uveitis or psoriasis (family or own history). 36% of the patients had MRI signs of sacroiliac inflammation that met ASAS criteria. One of the patients had grade 3 radiographic sacroiliitis and one patient with inflammatory signs in sacroiliac joints by MRI did not refer chronic lumbar pain. Ultrasound alterations were found in at least one enthesis within 97% of the patients: entheses calcifications (72%), bursitis (61%) and erosion (5%).ConclusionsIn patients with active IBD not previously diagnosed with SpA, the existence of sacroiliitis and ultrasound alterations in entheses is frequent (36% and 97%, respectively). The prevalence of patients meeting axial SpA ASAS criteria is 32% and for peripheral criteria is 10%. The lower frequency of peripheral SpA can be attributed to an earlier diagnose of this form of presentation or to a lack of sensitivity of the peripheral SpA ASAS criteria on patients with IBD. Addition of ultrasound results in classification criteria could take into account patients with enthesitic signs earlier.Disclosure of InterestNone declared

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ObjectiveTo characterise the impact of dactylitis in disease-modifying antirheumatic drug (DMARD)-naive early psoriatic arthritis (PsA).MethodsPatients with early PsA meeting the classification criteria for PsA (CASPAR) were recruited. Clinical outcomes were recorded, and ultrasonography was conducted to assess grey scale (GS) and power Doppler (PD) synovitis, periarticular cortical bone erosions and enthesitis. The cohort was dichotomised by the presence or absence of dactylitis.ResultsOf 177 patients with PsA, those with dactylitis (dactylitic PsA (81/177, 46%)) had higher tender joint count (p<0.01), swollen joint count (SJC) (p<0.001) and C reactive protein (CRP) (p<0.01) than non-dactylitic PsA. Dactylitis was more prevalent in toes (146/214 (68.2%)) than fingers (68/214 (31.8%)); ‘hot’ dactylitis was more prevalent than ‘cold’ (83.6% vs 16.4%). Ultrasound (US) synovitis and erosions were significantly more prevalent in dactylitic PsA (p<0.001 and p<0.001, respectively). Exclusion of dactylitis in dactylitic PsA confirmed significantly greater SJC (3 vs 1, p=0.002), US synovitis (GS ≥2: 20.6% vs 16.1%, p<0.001, or PD ≥1: 5.1% vs 3.3%, p<0.001) and erosions (1.1% vs 0.5% joints, p=0.008; 26.1% vs 12.8% patients, p=0.035%) than non-dactylitic PsA. Synovitis (GS ≥2 and/or PD ≥1) occurred in 53.7% of dactylitis. No substantial differences were observed for US enthesitis.ConclusionDactylitis signifies a more severe disease phenotype independently associated with an increased disease burden with greater SJC, CRP, US-detected synovitis and bone erosions in DMARD-naive early PsA and may be a useful discriminator for early risk stratification.

Axial spondyloarthritis is a heterogeneous inflammatory condition with variable clinical presentations and outcomes. The complexity of its diagnosis and absence of biomarkers hamper the development of diagnostic criteria with the risk of misuse of the available classification criteria in clinical practice and its consequences. Axial spondyloarthritis should be regarded as a continuum in which some patients, but not all, will have a more severe phenotype characterized by progression into new bone formation and joint fusion. Growing understanding of the factors that might drive disease progression and treatment response will allow for better characterization of treatment options and outcome for each affected individual. The aim of this review is to update the current evidence of what is axial spondyloarthritis and to highlight the need to focus on the concept rather than its classification.

Objectives To describe the baseline characteristics, bDMARD response and drug survival of axSpA patients in the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) according to radiographic status. Methods BSRBR-AS is a national prospective cohort including axSpA participants classified according to the ASAS criteria. In this analysis, baseline data of patients starting bDMARDs were compared. Ankylosing Spondylitis Disease Activity Scores (ASDAS) for low disease status, clinically important improvement (CII) and major improvement (MI) at one year were used to assess treatment response. Cox proportional hazard analysis was performed after adjusting for clinically relevant cofounders. Results 1,145 axSpA patients were included. Higher male prevalence, older age and longer disease duration was seen in the r-axSpA subgroup. Based on a complete case analysis (290 patients), two thirds of patients achieved ASDAS low disease state at one year regardless of radiographic status (nr-axSpA: 64.2% vs r-axSpA: 66.1). No statistically significant differences were seen between the subgroups in attaining ASDAS CII (nr-axSpA: 50.7% vs r-axSpA: 44.7%) or MI (nr-axSpA: 20% vs r-axSpA: 18.7%). Drug survival probability curves were similar for both subgroups and hazard ratio for nr-axSpA/axSpA was 0.94 (95% CI 0.69-1.28) when adjusted for sex, age, baseline ASDAS-CRP, smoking status, disease duration, HLA-B27 and prescribed biologic. Conclusions Although there appeared to be some differences in the baseline characteristics when exploring this cohort according to radiographic status which are likely related to the natural history of the disease, the level of biologic response and drug survival was comparable between nr-axSpA and r-axSpA.

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