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Objectives:To develop an ultrasound enthesis score and to assess its validity in the diagnostic classification of the spondyloarthropathies (SpAs).Methods:Twenty-five patients with SpA and 29 healthy controls participated in a blinded, gender-matched, cross-sectional study involving ultrasound assessment. The following entheses were explored bilaterally: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligament, distal quadriceps and brachial triceps tendons. The ultrasound score evaluated enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal. The value of each elemental lesion was calculated using a three-model analysis. Validity was analysed by receiver operating characteristic (ROC) curves. Inter-reader and interexplorer intraclass correlation coefficients (ICCs) were calculated.Results:The logistic regression model overestimated the score of three elemental lesions: calcification (0–3), Doppler (0 or 3) and erosion (0 or 3), while scoring tendon structure, tendon thickness and bursa as 0 or 1. ROC curves established an ultrasound score of ⩾18 as the best cut-off point for differentiation between cases and controls. This cut-off point was exceeded by 5/29 controls (17%) and by 21/25 patients with SpA (84%). The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR−) were 83.3%, 82.8%, 4.8% and 0.2%, respectively. The inter-reader and interexplorer ICCs were 0.60 and 0.86, respectively.Conclusion:The findings suggest that the ultrasound enthesis score could be a valid tool in the diagnosis of SpA.

Background:Methotrexate (MTX) is currently a mainstream drug in the treatment of rheumatic diseases. However, the response to MTX is not universal and may be conditioned by a number of factors, among which adherence could be crucial.Objectives:The aim of this study is to explore adherence to MTX in patients with rheumatic diseases, facilitators and perceived when taking and maintaining the prescription.Methods:A qualitative study of content analysis was performed. Focus groups with patients taking either oral or subcutaneous MTX (being the main or coadjuvant treatment) for any rheumatic disease was performed. The groups were moderated by a rheumatologist that was unknown for the patients. The speech was recorded and transcribed. Subsequently, an inductive coding was performed with the help of Atlas.ti and main themes and sub-themes were extracted, with examples of verbatim anonymized speech.Results:Three focus groups were conducted, with a total of 12 participants, of whom eight were women, seven had rheumatoid arthritis, three had psoriatic arthritis, one had spondyloarthritis, and one had systemic lupus erythematosus. All patients reported an adequate adherence to treatment. The barriers identified were: information in the leaflet, technical language in the consults, difficult access to doctor´s appointment, social environment, side effects and the subcutaneous device. As facilitators, the following aspects were discussed: good predisposition of the physician, reliable graphic information, role of associations and partners support.The unmet needs detected were: problems with travelling, protocols for eventualities, absence of a plan of care, neglection of “non-physical” symptoms, disinformation on side effects and training in complementary aspects.Conclusion:Getting reliable information was the main barrier identified. The environment and side effects may also negatively impact on adherence. Shared decision making is a goal to be achieved in the future in these patients.Disclosure of Interests:Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), José Luis Andréu Sánchez: None declared

Background:The arrival of artificial intelligence (AI) in medicine promises to revolutionize the delivery of healthcare services.Objectives:To evaluate the feasibility of using Chat-GPT, an AI tool, compared to expert rheumatologists in the context of e-consultations (electronic consultations via the internet) made by primary care physicians.Methods:A comparative cross-sectional study was conducted in which responses to primary care e-consultations provided by Chat-GPT 4.0 and specialist rheumatologists were analyzed. Three expert rheumatologists (JLAS, AGV, JQD) with over 100 years of combined experience assessed the responses in terms of scientific accuracy, clinical relevance, and clarity. Five primary care physicians (NCV, CCP, JDQ, ISV, NPR) with more than 125 years of combined experience evaluated the responses in terms of user satisfaction. Scales from 1 to 5 were used, with 1 being the worst rating and 5 the best. The differences in the paired means were analyzed, and the weighted kappa index was calculated to measure the agreement among evaluators.Results:Out of the total 85 e-consultations that took place during the study period, a total of 72 were included. The 13 e-consultations removed from the analysis were excluded due to lacking analyzable medical content, being of an administrative or logistical nature. The concordance among expert rheumatologists was poor (Kappa 0.011-0.308) and slightly better (although still poor) among family doctors (Kappa 0.328-0.359) (indicating variability in the interpretation of clinical data). Significant differences were observed in all categories. The specialists’ responses obtained high averages (Science: 4.31; Relevance: 4.45; Clarity: 4.78; Satisfaction: 4.06) with a smaller standard deviation, reflecting a consistency in the highly rated responses. On the other hand, Chat-GPT_4.0 showed a slightly lower performance (Science: 3.84; Relevance: 3.57; Clarity: 3.81; Satisfaction: 3.34), with greater variability in the responses. The paired differences were statistically significant (p<0.001) for all categories (Figure 1).Conclusion:While Chat-GPT proves to be a promising tool for support in e-consultations for rheumatology, the findings underscore that it does not replace the expertise and clinical knowledge of rheumatologists. The use of Chat-GPT could be considered complementary, focused on areas with limited access to specialists.REFERENCES:NIL.Figure 1.Mean and Sd of the evaluated variables.Acknowledgements:NIL.Disclosure of Interests:Ramón Mazzucchelli From Roche, Pfizer, and others. Not for this study., Paula Turrado-Crespí: None declared, Natalia Crespí-Villarías: None declared, José Luis Andréu Sánchez: None declared, Julia Dorado: None declared, Jesús A. García-Vadillo: None declared, Cristina Carvajal: None declared, JAVIER QUIROS DONATE: None declared, Inmaculada Sanchez: None declared, Nuria Puyo: None declared, Raquel Almodóvar: None declared, Pedro Zarco-Montejo: None declared, Cristina Pijoán-Moratalla: None declared, Elia Pérez-Fernández: None declared.

Background:Sjogren´s syndrome (SS) is a chronic, systemic autoimmune disorder with a great clinical heterogeneity being an orphan disease at present1. It is needed to find out new biomarkers to help us in the diagnosis, phenotype stratification and therapy of the disease. In a previous exploratory study we carried out in six serum and saliva samples from suspected SS patients we identified some proteins associated with SS2.Objectives:The aim of this study was to analyze sCD14 (soluble cluster of differentiation 14), CXCL10 (C-X-C Motif Chemokine Ligand 10), EGF (epidermal growth factor), PTX3 (pentraxine 3) and VEGFA (Vascular endothelial growth factor A) in serum samples and IL (interleukin)-6, IL-19 and ICAM1 (intercellular adhesion molecule-1) in saliva samples of suspected SS patients.Methods:We included a cohort of 227 consecutive patients attended the rheumatology department for suspected SS: 60 patients met classification criteria from 2016 and/or 2002 (SS group), 79 patients had a labial minor salivary gland biopsy (MGSB) compatible with SS (MGSB+ group) and 136 patients did not meet SS classification criteria nor had a compatible MGSB (control group).Serum samples were collected and centrifuged at 1800g, divided into aliquots and stored at -80ºC. Saliva samples were cold collected to prevent degradation of proteins, centrifuged at 1800g at 4ºC and stored at -80ºC. We evaluated serum and saliva levels of the proteins using three different assays: Human CD14 Sandwich ELISA Kit (Proteintech) and two bead-based fluorescent multiplex kits, the Procarta Plex-4 plex (CXCL10, EGF, PTX3, VEGFA) (Invitrogen) and Human Luminex Discovery Assay (R&D system) in the case of ICAM1, IL-6 and IL-19. Statistical analysis were performed using the Mann–Whitney U test for independent samples with the SPSS v.18 software. P values ≤0.05 were defined as significant and values of 0.1 0.05 were considered as borderline.Results:We found increased levels of ICAM1 in the saliva samples of SS group patients: Median (Me):13,60 µg/ml, interquartile range (IQR): 3,59-45,979; P=0,011, compared to the control group (Me: 6,14 µg/ml, IQR: 2,15-14,22) and moreover we found increased levels of serum CXCL10 (Me: 5,78 pg/ml; IQR: 3,09-8,77; P=0,083) in SS group compared to the control group (Me: 5,03 µg/ml, IQR: 3,13-8,46), although only in this case of ICAM1 statistical significance was reached. When we analyzed the differences between MGSB+ and control groups we found that patients from MGSB+ group showed significant increased levels of ICAM1(Me: 14,43 pg/ml; IQR: 5,55-48,08; P<0,001) and IL-6 (Me: 4,45 pg/ml; IQR: 1,59-12,01; P<0,032) in saliva as well as they had significant increased CXCL10 serum levels (Me: 6,30 pg/ml; IQR: 3,34-8,97; P<0,047) compared to control group (ICAM1: Me: 6,14 pg/ml; IQR: 2,15-14,22; IL-6: Me: 2,47 pg/ml; IQR: 1,19-5,31; CXCL10: Me 5,03 pg/ml; IQR: 3,13-8,46).Conclusion:SS and MGSB+ groups of patients showed significant higher levels of ICAM1 in saliva compared to the control group. The analysis of this protein in saliva could be useful for the early diagnosis of SS patients.REFERENCES:[1] Longhino S et al. Clin Exp Rheumatol 2023; 41: 2343-2356[2] Santos-Bórnez, MJ. Ann Rheum Dis 2023, vol 82, suppl, 1: 1243,doi: 10.1136/annrheumdis-2023-eular.865Acknowledgements:This study has been partially supported by the Sociedad de Reumatología de la Comunidad de Madrid (SORCOM). We would like to specially thank all the patients who have participated in this study.Disclosure of Interests:None declared.

Background:Primary Sjögren’s Syndrome (pSS) is an autoimmune disease characterized by dryness of mucous membranes, especially of the eyes and mouth, and by infiltration of the affected tissues by lymphocytes. The Oxford grading scale (OGS) evaluates corneal damage that can be associated with dry eye disease. The measurement of the ocular surface damage is part of the ACR-EULAR 2016 classification criteria, using the Ocular Staining Score (OSS) or van Bijsterveld score (vBs). Although OGS is not considered within these criteria, this test could play a role in identifying patients with severe dryness during the pSS diagnostic process.Objectives:To explore the correlation between the Oxford test and the Schirmer test in patients with primary Sjögren’s Syndrome meeting ACR-EULAR 2016 classification criteria without OSS or vBs. The correlation with unstimulated (UWSF) and stimulated whole salivary flow (SWSF) was also examined.Methods:Clinical data from patients included in Sjögren Syndrome and Atopic Dermatitis cohorts’ generation and multi-omics characterization project (SSAD project) were analyzed. For each patient, Schirmer test, OGS test, UWSF and SWSF were performed following standard protocols. OGS compares the overall appearance of the patient’s corneal staining with a reference figure, simulating the pattern of staining encountered in dry eye disease. OGS divides corneal staining into six groups according to severity, ranging from 0 (absent) to 5 (severe), and its value is expressed as the sum of OGS of both eyes. OGS result is considered pathological if the result is different to zero. Schirmer test was considered pathological if ≤5 mm after 5 minutes, and its value was presented as the mean of both eyes. UWSF and SWSF were collected for 5 minutes and expressed in mL/min. UWSF was considered pathologic if ≤1mL/min. Spearman correlation was used to analyze correlation between OGS and Schirmer test, OGS and UWSF and OGS and SWSF, using absolute values. Consecutively, Schirmer test and UWSF results were converted to dichotomic values, namely pathological vs. non-pathological, and a Chi squared test was performed with p-value obtained by Monte Carlo simulation.Results:Twenty-four pSS patients meeting ACR-EULAR 2016 classification criteria were included in the analysis, with a total of 29 measures. Five patients were evaluated twice with a span of at least 12 weeks between measures. Twenty-three patients were females (96%), with a mean age of 60.5 years. All patients with a pathological OGS associated a pathological Schirmer test. A negative correlation was found between both tests (a higher OGS was correlated with a lower Schirmer test result) with a rho value of -0.59 (p=0.0025) (Figure 1). Results were similar after considering only the baseline measure of each patient. Chi-square test confirmed this correlation when comparing pathological vs. non-pathological results (p= 0.0399). No significant correlation was found between OGS and UWSF or SWSF.Conclusion:Alterations found by OGS correlated with a pathologic Schirmer test in pSS patients. Corneal damage found by OGS does not seem to be related with oral dryness measured by salivary flow. OGS could play a role in identifying patients with severe eye dryness during the pSS diagnostic process.REFERENCES:NIL.Table 1. Correlation between OGS and Schirmer testAcknowledgements:NIL.Disclosure of Interests:None declared.

Background:Sjögren’s syndrome is a chronic autoimmune systemic disease that accumulates extragladular manifestations and complications such as lymphoma over time. Poor prognostic factors are described in the scientific literature [1].Objectives:To describe the clinical evolution of patients with Sjögren’s syndrome (SS) in relation to the appearance of new systemic manifestations and disease activity, as well as factors associated with an unfavorable outcome.Methods:SJÖGRENSER PROS (SS-PROS) is an observational, longitudinal, and multicentric study of patients with SS who met the 2002 classification criteria under active follow-up in rheumatology clinics of 28 Spanish hospitals that participated in the cross-sectional phase of the study (SJÖGRENSER TRANS; SS-TRANS) [2]. For the prospective phase, an 8 year follow-up visit was performed (during 2021-2022) and results were compared to the baseline visit (SS-TRANS performed in 2013-2014, 437 patients included). Medical record was reviewed and a medical interview was performed. Epidemiological, clinical and serological variables, as well as causes of death were recorded. Continuous and categorical variables were analyzed using means, medians, and frequencies, with their respective deviations and interquartile ranges (p25-p75). Student’s T test was used to establish statistical associations, considering p<0.05 as significant.Results:Three hundred and fourteen patients have been included, 95% were women, with a mean age of 66 years old (SD 11.5) and mean evolution time from diagnosis to inclusion of 17 years (SD 6.5). Mean ESSDAI scores were similar in SS-PROS and SS-TRANS: 3.67 (SD 5.5) vs 3.5 (SD 5.2), respectively. In the analysis by domains, the joint, hematological and biological domains were the most frequently involved and those that accumulate more changes (decrease or increase) over time; for the rest of the domains, stability was evidenced in ≥95% of the cases (Table 1). By organs, the most affected organ in the follow-up was the lung, with 35 new patients who scored in to some degree of at this domain, being 53 the total number of accumulated patients who scored to some degree at this domain during the 8 year period of follow up. After 8 years, 15 lymphomas (4.8%) have accumulated in this cohort, 6 in the SS-TRANS and 9 new lymphomas in the SS-PROS. The mean ESSPRI improved slightly from SS-TRANS to SS-PROS: 5.24 (SD 2.5) vs 4.66 (SD 2), respectively; The improvement was greater in the pain VAS, 5 (SD 3.2) vs 4 (SD 2.9), respectively; The mean VAS for dryness and fatigue in SS-TRANS and SS-PROS respectively was: 6 (SD 2.6) vs 5.6 (SD 2.5) and 4.6 (SD 3.2) vs 4 (SD 3). Forty-two patients died since their inclusion in SS-TRANS (13.4%), 88% women, with a mean age of 75 years old (SD 11.5), and a 20 years long of disease evolution (SD 7.4). Comparing baseline visit data (SS-TRANS) from the group of deceased (during SS-PROS) and non-deceased (remaining under follow-up in SS-PROS), we observed that age (70 years; SD 10), lasting of the disease (11 years; SD 7.33) and ESSDAI score (6.12; SD 7.7), were higher in deceased vs non-deceased (age 57 years, SD 11; time of evolution 8 years, SD 6; ESSDAI 3, SD 4.6), this difference being significant in age (p<0.001) and with a marked trend in the lasting of the disease and the ESSDAI score, although statistical significance was not reached (p=0.078 and p=0.087 respectively).Conclusion:Patients with SS develop new systemic manifestations over the years, despite maintaining or improving ESSDAI score, suggesting the need for close follow-up. ESSPRI experiences few variations over time, which represents a great challenge for the scientific community. The incidence of lymphoma in this cohort was 4.8%. Mortality in this cohort is 13.4%. Older age, longer duration of the disease, and higher baseline ESSDAI score were associated with a worse outcome.REFERENCES:[1] Mariette X. N Engl J Med 2018;378:931-9.[2] Fernandez -Castro M. Rheumatol Clin 2016;12(4):184-9.Table 1.ESSDAI DomainDomainAccumulated(TRANS+PROS)(number of pacientes)Articular 298 + 59=157 46 + 7=13Pulmonary 53 + 9=12 1013 + 22=35 152 + 4=6Hematological 262 + 69=131 414 + 12=26 62 + 2=4Acknowledgements:“Proyecto SJOGRENSER del grupo de enfermedades autoinmunes sistémicas de la Sociedad Española de Reumatologia.”Disclosure of Interests:None declared.

Background:Decision making in the treatment of rheumatoid arthritis is a complex process. The opinion on the use of Artificial Intelligence (AI) in therapeutic decision-making is a controversial topic, while some see AI as an ally, others as a threat.Objectives:Compare the attitude of Spanish rheumatologists in different clinical situations with the answers provided by AI.Methods:An online Google form with 15 questions was sent through social networks to several groups of rheumatologists in the national territory. Descriptive statistical analysis was carried out, subsequently the survey was completed by ChatGPT 3.5 and ChatGPT 4.Results:108 surveys were collected. In patients with recent-onset RA with poor prognostic factors, in addition to corticosteroids, half of those surveyed (50%) begin treatment with csDMARD + rapid escalation to bDMARD/sd if response is insufficient, while chatGPT 3.5 leans towards bDMARD/sd±MTX from baseline and chatGPT 4 due to combined therapy with ≥ 2 csDMARDs. The majority of rheumatologists (47.2%) and ChatGPT 3.5 and 4 agree that the patient’s profile is the most important factor when choosing the drug. The most relevant factors when choosing each DMARD are: anti-TNF, rheumatologists (47.2%) due to its cost-effectiveness; AI for its effectiveness; anti-IL6, due to its effectiveness (rheumatologists (72.2%) and AI); abatacept, for its efficacy and safety in RA-ILD patients (rheumatologists (53.7%) and AI); rituximab, for its safety in patients refractory to other treatments (rheumatologists (76.9%) and ChatGPT 3.5), for its effectiveness in seropositive patients (ChatGPT 4); JAK inhibitor, due to the possibility of use in monotherapy (rheumatologists (40.7%) and ChatGPT 3.5) and efficacy (ChatGPT 4). The most important factor that makes rheumatologists (57.4%) and Chat GPT 4 change treatment is the measurement of activity, while ChatGPT 3.5 responded “existence of other potentially more effective or safe therapeutic alternatives.” If there is a good therapeutic response, the majority of rheumatologists (50%) and ChatGPT 4 would first optimize the bDMARD/sd administration interval, while ChatGPT 3.5 would simultaneously optimize the csDMARD and bDMARD/sd. In case of using combined therapy of csDMARD and bDMARD/sdDMARD, both the majority of the rheumatologists surveyed (59.3%) and IA recommend maintaining csDMARD in addition to the bDMARD/sdDMARD. Regarding the use of corticosteroids, the vast majority of colleagues (79.6%) and ChatGPT4 prefer to try to stop them as soon as possible, while ChatGPT 3.5 would choose to maintain low doses, unless there are specific comorbidities. In the event of pregnancy, 59.3% of those surveyed replace the drug with a safer one, while IA opts to maintain the drug if it is anti-TNF. Incident diagnosis of cancer is a reason for discontinuation of all bDMARDs/sd for 47.2% of respondents, however the IA would prefer to maintain/switch to rituximab if the patient is receiving bDMARD/sd. Finally, biosimilar drugs are considered equally effective and safe as the originals by both rheumatologists (80.6%) and AI.Conclusion:A striking heterogeneity has been observed in the way of acting in complex clinical situations, both among rheumatologists and in comparison with ChatGPT. Among rheumatologists, there is consensus on the need to limit the use of corticosteroids, on the use of activity indices to evaluate therapeutic response and on the wide acceptance of biosimilar drugs, the latter is also supported by AI. ChatGPT 4 shows greater agreement with the rheumatologist’s opinions than ChatGPT 3.5.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

BackgroundThe exostosis of occipital protuberance was described recently in non-inflammatory processes[1]. Despite of enthesophytes are usually seen in radiographs of older asymptomatic population, in the last few years the presence of occipital protuberance enthesophyte (OPE) has been observed frequently in young patients, with a prevalence of 41% in adults younger than 30-year-old[2]. To our knowledge OPE has not been described in inflammatory rheumatic diseases.ObjectivesTo determine the prevalence of OPE in non-inflammatory processes (NIP), psoriatic arthritis (PsA), spondyloarthritis (SpA) and rheumatoid arthritis (RA).MethodsRetrospective descriptive and comparative study of cervical radiographs randomly collected from patients older than 18 years old attended in a rheumatology consult of a tertiary hospital from July 2022 to January 2023 until 30 patients per group were completed (total of 120 patients). We classified patients in four groups by diagnosis: NIP (traffic accident and spine surgery excluded), PsA, SpA and RA. The following variables were collected: sex, age at the time of radiograph was performed, OPE (yes/no) evaluated by a senior rheumatology resident (4 years of experience) and by a senior rheumatologist (25 years of experience). Descriptive statistics were used for the presentation of the results and Cohen’s Kappa coefficient was calculated to quantify the degree of agreement in the diagnosis of enthesophyte presence between both rheumatologists. Chi square test with Yates correction was performed to compare sex and prevalence between groups and ANOVA to compare mean age.ResultsA total of 120 patients were collected, 30 patients per group. Seventy point eight per cent were women; mean age was 58.5 years with a standard deviation of 15. The groups were homogeneous (sex was performed by Chi Square test, p < 0.0001; mean age was performed by ANOVA, p = 0.006). Sixty-one of 120 patients (51 %) had OPE (23 % in non-inflammatory group, 60 % in inflammatory group); OPE prevalence was statistically significant in inflammatory diseases (p < 0.001). Stratified analysis by sex (p = 0.2) and age (p = 0.06) between inflammatory and non-inflammatory pathology showed no differences, although incidence of OPE in non-inflammatory processes tends to increase with older age. Results by group are shown in Table 1. Figure 1 shows different types of enthesophyte morphology. The global degree of agreement according to Cohen’s Kappa index was 0.8, representing 89 % agreement (substantial degree); the best degree of agreement was obtained in SpA (Cohen’s Kappa index 0.9, representing 97 % agreement, almost perfect degree).ConclusionTo our knowledge this is the first study about the prevalence of OPE in inflammatory and non-inflammatory rheumatic diseases, being more prevalent in inflammatory diseases 60 % (p < 0.001), especially in spondyloarthritis and psoriatic arthritis. The global degree of agreement between a senior rheumatology resident and a senior rheumatologist was substantial, being almost perfect in spondylarthritis. We will conduct a new study to find out whether different morphology of occipital enthesophytes is associated to any inflammatory rheumatic disease.References[1]Singh R. Bony tubercle at external occipital protuberance and prominent ridges. J Craniofac Surg. 2012 Nov;23(6):1873-4.[2]Shahar D, Sayers MG. A morphological adaptation? The prevalence of enlarged external occipital protuberance in young adults. J Anat. 2016 Aug;229(2):286-91.Table 1.Description of groupsGroupsNON-inflammatoryPsoriatic arthritisSpondyloarthrtitisRheumatoid arthritisTotaln30303030120Sex women (%)27 (90)16 (53)13 (43)30 (100)85 (71)Age (mean ± SD)66.3 ± 13.556.8 ± 12.854.5 ± 16.857.1 ± 14.1258.5 ± 15prevalence (%)7 (6)21 (17.5)21 (17.5)12 (10)61 (51)Cohen’s Kappa index0.70.80.90.40.8p valuep < 0.001p = 0.0007p = 0.0007p = 0.27Figure 1.Types of morphology of OPE. (A) Non-inflammatory. (B) Psoriatic arthritis. (C) Spondyloarthritis. (D) Rheumatoid arthritis.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundIn recent decades, immunotherapy has changed the management and prognosis of cancer patients. Immune checkpoint inhibitors, such as those targeting PD-1 and PD-L1, are used for some types of cancer; however, their use has been associated with the appearance of immune-mediated adverse events. Among these, those related to the field of rheumatology are relatively frequent, joint involvement being the most common, followed by muscle involvement (myalgias 4%, myositis 1%).ObjectivesTo describe oncologic patients who developed immune checkpoint inhibitors- related myositis.MethodsAll patients from the oncology department of a tertiary hospital, referred to rheumatology and diagnosed with immune-mediated myositis due to immune checkpoint inhibitors were collected. A descriptive analysis was performed.ResultsFive patients were analyzed, 60% male, with a mean age of 65.8 years (56-78 years).The types of cancer were: melanoma (n=2), gastroesophageal junction cancer (n=1), cavum cancer (n=1) and pancreatic cancer (n=1); all in advanced stages with lymph node and/or metastatic involvement.The immunotherapy employed was: Nivolumab (PD-1 inhibitor) in three patients, Pembrolizumab (PD-1 inhibitor) in one patient and Darvalumab (PD-L1 inhibitor) in one patient; all at standard doses. Mean time from onset of symptoms was 4 months from drug initiation (1-10 months). In all 5 cases, the drug was discontinued with the onset of clinical symptoms and oral prednisone was prescribed at a dose between 10 and 20 mg per day.The symptom present in all patients was pain and weakness of proximal limbs (100%). In addition, one patient had ankle arthritis and another had dermatomyositis with typical cutaneous involvement (heliotrope erythema, V sign).In 3 patients there was an elevation of CK levels that resolved one month after discontinuation of the drug. Also, 3 patients, developed myositis-specific antibodies (AntiPM75 and Anti MI2, anti-PL7 and anti-TIF1gamma) that disappeared with drug withdrawal. One patient had anti-Ro52 and Ro60 antibodies that remain positive.Two patients underwent muscle MRI: one showed fatty infiltration in the gluteal musculature and atrophy with fatty infiltration in the right rectus femoris (image); in the other patient, signs of inflammatory myositis in the bilateral adductor group and in the right gluteus medius and gluteus minimus and fibrosing myositis in the iliac muscle was described. In both cases, the signs of myositis had disappeared in the control PET scan 5 months after drug discontinuation.In 4 patients, symptoms subsided in less than one month. One patient required the association of methotrexate to achieve corticosteroid withdrawal.ConclusionIn our hospital, a total of 5 patients undergoing oncological treatment with immune checkpoint inhibitors have developed, in a mean time of 4 months from the start of the drug, a myopathy associated in 60% with the appearance of myositis-specific antibodies. This represents 1.8% of the total number of patients treated with these three drugs in our hospital.Withdrawal of the drug and treatment with prednisone at intermediate doses allowed clinical remission and normalization of laboratory and imaging tests.Image 1.MRI: SPAIR technique and fat suppression.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundPolymyalgia rheumatica is a common inflammatory rheumatic disease affecting people older than 50. It is characterized by simmetrical pain and stiffness of the neck, shoulder, and pelvic girdle and associated with an increase in the concentration of positive acute phase reactants. The diagnosis is based on a clinical picture. Initial treatment consists of corticosteroids, and initial doses of 15 to 20 mg of prednisone or equivalent are usually adequate in most cases. The subgroup of patients that responds only partially to corticosteroids or develops corticosteroid resistance usually requires the introduction of a corticosteroid-sparing drug, methotrexate being the most widely used in routine clinical practice.ObjectivesTo evaluate the efficacy and safety of methotrexate in patients with steroid-resistant polymyalgia rheumatica in real clinical practice.MethodsRetrospective multicenter descriptive study of patients diagnosed with polymyalgia rheumatica in three hospitals in Madrid (Spain) treated with methotrexate as a corticosteroid-sparing agent. Clinical and demographic characteristics of the sample were analyzed and laboratory data evolution were evaluated by collecting positive acute phase reactants (ARF) (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) at baseline, at 6 and 12 months of treatment. Descriptive statistics were used for data presentation. The Wilcoxon test for paired data was used to contrast statistical significance, with a p<0.05 being considered significant.ResultsOverall, 58 patients were included: 26 men (44.83%) and 32 women (55.17%), with a mean age of 78.58 (±7.3) years, mean disease duration of 7.46. (±5.78) years. The mean values of CRP, ESR, dose of prednisone and MTX at baseline, at 6 and 12 months of treatment are shown in Table 1. In 52 (89.66%) patients it was possible to reduce the dose of prednisone to <5mg/24h after 12 months of treatment. No significant liver function abnormalities were observed in any of the patients.Table 1.Baseline6 months12 monthsBaseline vs 12 monthsp<0,05Prednisone, mean ± SD8,28(±4,2) mg/24h v.o3,75(±2,8) mg/24h v.o.2,11(± 2,63)< 0.001Metotrexato, mean ± SD11,98(±3,92) mg/sem13,19(±3,9) mg/sem13,75(±4,23) mg/sem0.008PCR, mean ± SD13,26 (±20,96) mg/dl5,11 (±8,72) mg/dl5,84(±7,02) mg/dl0.124VSG, mean ± SD31,93(±22,4) mm23,35(±23,07) mm19,83(±21,6) mm0.106ConclusionAs a therapeutic option in steroid-resistant polymyalgia rheumatica, methotrexate seems to offer a steroid-sparing effect at 6 and 12 months of treatment. The treatment is well tolerated.Referencesno.Acknowledgements:NIL.Disclosure of InterestsNone Declared.