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The recent proton-lead run at the LHC shall provide new information on the partonic behaviour within the nuclear medium. At LHC energies the dominant contribution comes from gluon-initiated processes that is, the least well constrained parton density. Therefore it is important to profit from any information that new data can provide us. A time-saving alternative to performing a global fit is the use of Bayesian inference, a powerful tool to realize the impact of data into a set of PDFs independently of the original fitters. In this work we apply the Bayesian re-weighting technique to analyze pseudo data for LHC kinematics in Drell-Yan and hadro-production processes. A set of Monte Carlo replicas for EPS09 is released in a public code for general use.

The generalist parasite Trypanosoma cruzi has two phylogenetic lineages associated almost exclusively with bats-Trypanosoma cruzi Tcbat and the subspecies T. c. marinkellei. We present new information on the genetic variation, geographic distribution, host associations, and potential vectors of these lineages. We conducted field surveys of bats and triatomines in southern Ecuador, a country endemic for Chagas disease, and screened for trypanosomes by microscopy and PCR. We identified parasites at species and genotype levels through phylogenetic approaches based on 18S ribosomal RNA (18S rRNA) and cytochrome b (cytb) genes and conducted a comparison of nucleotide diversity of the cytb gene. We document for the first time T. cruzi Tcbat and T. c. marinkellei in Ecuador, expanding their distribution in South America to the western side of the Andes. In addition, we found the triatomines Cavernicola pilosa and Triatoma dispar sharing shelters with bats. The comparisons of nucleotide diversity revealed a higher diversity for T. c. marinkellei than any of the T. c. cruzi genotypes associated with Chagas disease. Findings from this study increased both the number of host species and known geographical ranges of both parasites and suggest potential vectors for these two trypanosomes associated with bats in rural areas of southern Ecuador. The higher nucleotide diversity of T. c. marinkellei supports a long evolutionary relationship between T. cruzi and bats, implying that bats are the original hosts of this important parasite.

The proton-lead and lead-lead runs at the LHC are providing an enormous amount of data sensitive to the nuclear modifications of the initial state. The measurements explore a region of phase space not probed by previous experiments opening a possibility to test and, hopefully, also improve the current knowledge of nuclear parton densities. In this talk, we discuss to what extent the present quantitative results for the charge asymmetry in electroweak boson production show sensitivity to the nuclear parton distributions.

BackgroundIn patients with spondyloarthritis (SpA), published data indicate different manifestations and outcomes between genders. Nevertheless, the evidence in patients with early and peripheral disease is lacking.ObjectivesTo evaluate differences in the presentation of the disease between genders in patients with early axial and peripheral SpA (axSpA, pSpA).MethodsThis study was carried out within the framework of the ESPeranza program, which was a Spanish multicenter initiative aiming to facilitate early diagnosis and follow-up of patients with SpA between 2008–11. Out of 775 patients referred, 377 patients fulfilled the ASAS classification criteria for SpA:291(77%) axSpA and 86 (23%) pSpA. Demographic and disease characteristics were compared between genders using Chi-square (for categorical variables) and Student t (for continuous variables) tests.ResultsIn total, 241 (64%) patients were males (191 axSpA and 50 pSpA). In the axSpA group, males had more frequently radiographic sacroiliac damage, elevated CRP, HLA-B27 positive and morning stiffness, while females had higher values of ESR and more frequency of peripheral arthritis (table 1). Within the pSpA group, male gender was significantly associated with higher diagnostic delay, psoriasis and elevated CRP while women had higher rates of functional limitation and ESR values.ConclusionsIn patients with SpA, different disease manifestations between genders are observed already from the first stages of the disease. In patients with axSpA, males have worst prognostic factors compared with females. However, in pSpA, females report poorer functionality despite being diagnosed earlier than male patients. This difference in phenotypes may be relevant when therapeutic decision-making.AcknowledgementsProject ESPeranza was funded by Pfizer through the Spanish Foundation of Rheumatology (FER), is currently supported by a restricted grant from the of Instituto de Salud Carlos III (FIS PI13/02034) and Fondos FEDER.Disclosure of InterestNone declared

Background:Elderly onset rheumatoid arthritis (EORA) is characterized by onset at age 60-65 and its prevalence has increased due to the progressive aging of the population, currently accounting for 10-33% of total rheumatoid arthritis (RA) cases. It often presents with polymyalgia symptoms at diagnosis, sometimes complicating the differential diagnosis with polymyalgia rheumatica (PMR). While patients with PMR may have synovitis as well, it is usually mild and easily controlled with corticosteroids. In EORA, treatment with disease-modifying antirheumatic drugs (DMARDs) should be like early-onset RA. However, the higher prevalence of comorbidities and polypharmacy in elderly patients, associated with clinical similarity to PMR, often leads to a tendency in real clinical practice to treat with less therapeutic intensity or less ambitious goals.Objectives:The main objective of this study is to compare the need for immunosuppressants between patients with EORA and PMR for adequate disease control. Secondary objectives include describing demographic and clinical characteristics, as well as adverse events during the follow-up of both groups.Methods:It is a retrospective longitudinal observational descriptive study. We included patients over 60 years diagnosed with PMR and EORA at HLA Moncloa University Hospital from December 2010 to December 2023.Results:Out of 141 patients, 66 were diagnosed with EORA (46.8%) and 74 (53.2%) with PMR. Both groups showed no demographic or comorbidity differences at the time of diagnosis (Table 1).Table 1.Demographic characteristicsPMR (N 75; 53.2%)EORA (N 66; 46.8%)P valueSex (women)51 (68%)46 (69,7%)0.828Mean age at diagnosis72,87 (SD 8,52)70,24 (SD 8,54)0.546Comorbidities• Dyslipidemia• Hypertension• Diabetes Mellitus• Ischemic cardiomyopathy• Chronic obstructive pulmonar disease• Renal disease• Previous cancer56(74,7%)29 (38.7%)41 (54,7%)9 (12%)9 (12%)6 (8%)6 (8%)11 (14,7%)55 (83,3%)25 (37,9%)38 (57,6%)7 (10,6%)5 (7,6%)1 (1,5%)2 (3%)12 (18,2%)0.2100.9230.7280.7950.3810.0770.2030.573Initial weakness of the shoulder and/or pelvic girdle was present in 40.9% (27) of EORA patients. Synovitis of carpal joints was observed in 41.8% (31) of PMR patients versus 89.4% (59) of EORA patients (p<0.001). Other differences in clinical presentation between PMR and EORA included small joint arthritis of the hands in 21.3% vs. 56.9% (p <0.001), knee arthritis in 13.3% vs. 30.8% (p <0.012), ankle arthritis in 6.7% vs. 24.2% (p <0.003), small joint arthritis of the feet in 0% vs. 12.1% (p <0.001), and tarsal arthritis in 1.3% vs. 7.6% (p <0.067). Elevated acute-phase reactants (APRs) were detected in 70.7% (41) of PMR patients and 64.7% (33) of EORA patients (p 0.504). Positivity for rheumatoid factor (RF) and anti-citrullinated protein antibodies (CCP) was seen in 25.8% and 34.8% of EORA patients, respectively. Regarding treatment, 93.9% of EORA patients required DMARDs compared to 34.7% of PMR patients (p<0.001). Of the EORA patients, 33.3% (22) needed more than one DMARD during follow-up versus 12% (9) of PMR patients (p 0.002). GC (corticosteroids) could be discontinued in 54.7% (35) of EORA patients and 52.1% (37) of PMR patients (p 0.765) but had to be reintroduced in 42.9% (15) and 38.5% (15) respectively (p 0.701). Global adverse events during follow-up included infections (13.3%), ischemic heart disease or arrhythmias (2.8%), gastrointestinal bleeding (3.5%), and osteoporotic fractures (14.7%; vertebral 12% and hip 0.7%). 13.3% of patients showed intolerance to prescribed medications for their rheumatic disease. 10.5% were admitted for reasons related to their rheumatological condition, and 7% exhibited dependency during follow-up.Conclusion:There is a difference in the use of DMARDs between EORA patients (96%) and PMR patients (34.7%) for disease control during follow-up. Given the absence of demographic and comorbidity differences, the correct differentiation at the onset of arthritis between PMR and EORA is significant for the proper treatment of our patients.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Physiologically, the joint synovium responds to physical activity according to the frequency and intensity of the efforts, producing slight effusion without detectable hyperemia. In patients with RA in remission, a similar response can be expected, since it is understood that the immune-mediated inflammatory component has been controlled physiopathologically. Our interest is to determine whether once clinical remission has been reached, treatment with MTX or antiTNF produces the same normalization of the synovial behaviour. Our interest is to determine whether once clinical remission has been reached, treatment with MTX or antiTNF produces the same normalization of the synovial behavior.Objectives:The aim of the present study is to compare the synovial response to mechanical stress of patients with Rheumatoid Arthritis (RA) in remission treated with Methotrexate (MTX) or Etanercept (ETN).Methods:Descriptive observational study. We included patients with RA in remission (DAS28<2.6) for at least 6 months on MTX or MTX and anti-TNF-alpha therapy (ETN). An ultrasound examination protocol was developed for the 2nd, 3rd and 4th MCP and non-dominant hand carpus for gray scale (GS) and power Doppler signal detection (sPD) according to EULAR/OMERACT definitions. Two ultrasound examinations were performed on each patient, before and 24 hours after starting a manual digital flexure exercise program against resistance measured by a handheld dynamometer CAMRY™ model EH101-17. Total synovitis scores in EG (0-12) and sPD (0-12) were compared.Results:We included 37 patients on MTX treatment (median dose 15mg/week, range 7.5-25mg/week) and 16 patients on ETN treatment (median dose 50mg/week, range 25-50 mg/week). The baseline ultrasound score in the MTX treatment group was 1.6 SD 1.4 in EG and 2.2 SD 0.5 in PDs. After carrying out the controlled dynamometric effort, the score was 2.4 SD 1.9 in GS and 4.4 SD 1.5 in PDs (P<0.05 and P<0.001, respectively). In patients treated with TNEs, the basal score in GS was 1.3 SD 0.6 in GS and 0.6 SD 0.3 in PDs. After the controlled dynamometric effort, the score was 1.8 DE 0.9 in EG and 0.7 DE 0.4 in PDs (P=0.07 and P<0.001, respectively). In the group of patients treated with MTX, four subjects reported joint tenderness after physical effort.Conclusion:Our observations are congruent with previous experiences in which it has been observed that physical stress translates into synovial changes detectable by ultrasonographic studies. Our results, although modest in patient volume, suggest that TNF-alpha activity is crucial in the development and maintenance of exercise-induced hyperemia. The clinical significance of our observation may be useful as a tool to predict the response to anti-TNF therapy in patients with RA, however specific methodological designs are needed for such associations.Disclosure of Interests:None declared

Background:Biological therapies have substantially improved the prognosis of patients with Spondyloarthritis (SpA). However, a satisfactory clinical response is not achieved in all patients and it is essential for the clinician to identify all those factors that predict treatment response. Although they are supposed as unfavorable and potentially avoidable factors, the influence of smoking and obesity as predictors of treatment response in SpA is unknown.Objectives:To determine if smoking and obesity are factors of worse therapeutic response in patients with axial spondyloarthritis (axSpA).Methods:Systematic review of the literature in MEDLINE and EMBASE until June 30, 2019 based on the PICO design method. Population (P): patients with axSpA. Intervention (I): smoking or obesity. Comparator (C): non-smokers and normal weight. Outcome (O): any of the response criteria currently validated for axSpA. A specific excel form was used for data collection, EndNote software for the management and organization of papers and the Oxford 2009 level for evidence evaluation.Results:1873 citations were recovered, 46 studies were selected for full-text review and 12 for data extraction: 6 for smoking and 6 for obesity. The design of all studies was observational and longitudinal with data from national registries except one cross-sectional. In total, these studies included 5291 patients (3917 patients for smoking and 1333 patients for obesity), all treated with a TNF inhibitor (iTNF). The Oxford level of evidence for all studies was 2b except the cross-sectional study, which was 4. Regarding smoking, the evidence found is not consistent. Two of the studies concluded an unfavorable effect on the response to the iTNF (Glintborg and Ciurea) but the remaining 4 studies found no differences in the clinical response to iTNF (Zhao), the cause of discontinuity of the iTNF (Zhao, Hernandez) or quality of life indexes (Kydd). For obesity, the evidence is more consistent, so that 5 of the 6 studies observed a negative influence on the therapeutic response to iTNF (Ottaviani, Gremese, Micheroli, Hernández-Breijo and Rosas).Conclusion:According to scientific evidence in patients with axSpA, obesity is associated with a worse therapeutic response to iTNF. However, this negative effect is not clearly evidenced for smoking.Disclosure of Interests:Pablo Zurita-Prada: None declared, Claudia Urrego-Laurín: None declared, Carlos Guillén-Astete: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

Background:Rheumatisms are the second most frequent reason for consultation in Europe [1]. In Spain, the bulk of prevalence studies exploit public health data [2-3], despite the fact that our health system is mixed. Spanish private health spending reaches 26.7% of the total and is booming [4]. However, there is a fundamental lack of studies focused on private care, most of which are local [5-6].Objectives:To characterise the activity performed by rheumatologists in private medicine throughout Spanish geography.Methods:Members of SERPA working group were summoned to participate by email. They were proposed to carry out a detailed study of the diagnoses and diagnostic-therapeutic procedures carried out in usual practise during 4 consecutive weeks, chosen between November 2022 and January 2023. A shared spreadsheet was developed with predefined diagnostics. All diagnoses made were integrated, so that in the presence of several diagnoses in the same patient, 1 point was added to each corresponding category. Approval was obtained from the EC.Results:Out of 274 rheumatologists working in the private area in Spain [7], a total of 21 rheumatologists from 15 different medical centers have participated. During the month of follow-up, a total of 5,214 diagnoses and 431 therapeutic procedures were obtained. The resuts of the most frequent diagnostics are as follows: OP in first place, followed by OA and STP. However, when we unified the diagnoses by type of disease, the I&SCTD took the first place, followed by OP and OA, and then other diagnoses such as STP and CSS were less common (Figures 1 and 2).Regarding to the procedures, all rheumatologists (21) have performed a total of 287 infiltrations, 7 of them carried out 171 ultrasounds and another 7 carried out 38 capillaroscopies, only 1 performed DEXAs. In our case, the I&STCD stood out over the STP and CSS, contrary to what was expected when comparing our findings with those of the general population from EPISER-2016 and 2000 registries [2-3], where the proportion is inverse. It could be explained because consultations for second opinions or seeking a closer monitoring than the one given in the public system are common in private care.Having used a sampling for convenience, external validity biases are possible. However, we consider that the vast geographical and healthcare environment ubiquity of participating experts provides the analysis of a high representativeness.Conclusion:The practice of rheumatology in the private sector addresses the entire broad spectrum of rheumatic diseases. It is essential to incorporate data from private clinical activity that allows us to specify its contribution to Spanish rheumatology and to offer a more reliable perspective of the impact of rheumatic diseases in our society.REFERENCES:[1] Woolf AD, Zeidler H, Haglund U, Carr AJ, Chaussade S, Cucinotta D, Veale DJ, Martin-Mola E. Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Ann Rheum Dis. 2004;63(4):342-7.[2] Seoane-Mato D, Sánchez-Piedra C, Silva-Fernández L, Sivera F, Blanco FJ, Pérez Ruiz F, et al. Prevalencia de enfermedades reumáticas en población adulta en España (estudio EPISER 2016). Objetivos y metodología. Reumatol Clin. 2019;15(2):90-6.[3] Carmona L, Gabriel R, Ballina J, Laffon A. Proyecto EPISER 2000: prevalencia de enfermedades reumáticas en la población española. Rev Esp Reumatol. 2001;28(1):18-25.[4] Instituto para el Desarrollo e Integración de la Sanidad. Sanidad privada aportando valor. Análisis de situación 2023.[5] Nieto González JC. Reumatología privada ambulatoria, estudio descriptivo en la Comunidad de Madrid. Reumatol Clin. 2019;15(5):e10-3.[6] Alegre C. La Reumatología privada en Cataluña. Reumatol Clin. 2019;15(3):170-2.[7] Yoldi Muñoz B, Gómez Centeno A, Moreno Muelas JV. Estado de la reumatología privada en España. Reumatol Clin. 2017;13(6):313-7.Acknowledgements:NIL.Disclosure of Interests:None declared.

The dominant variability modes of the North Atlantic-European rotational flow are examined by applying a principal component analysis (PCA/EOF) to the 200 hPa streamfunction mid-winter anomalies (Jan–Feb monthly means). The results reveal that, when this norm is used, the leading mode (EOF1) does not correspond to the traditional North Atlantic Oscillation (NAO, which appears in our analysis as the second leading mode, EOF2) but is the local manifestation of the leading hemispheric streamfunction EOF. The regression of this regional mode onto the global SST field exhibits a clear El Niño signature, with no signal over the Atlantic, while the associated upper height anomalies resemble the Tropical/Northern Hemisphere (TNH) pattern. East of North America, this TNH-like wavetrain produces a meridional dipole-like pattern at lower levels. Although in some ways this pattern resembles the NAO (EOF2), the dynamics of these two modes are very different in that only EOF2 is associated with a latitudinal shift of the North Atlantic stormtrack. Thus, the choice of the streamfunction norm in the EOF analysis allows the separation of two different phenomena that can produce similar dipolar surface pressure anomalies over the North Atlantic but that have different impact on European climate. These two modes also differ on their contribution to variability at lower levels: while NAO-EOF2 is mostly confined to the North Atlantic, TNH-EOF1 has a more annular, global character. At upper levels NAO-EOF2 also produces a global pattern but with no annular structure, reminiscent of the “circumglobal” teleconnection.

Background:Spondylarthritis are diseases with a pathophysiological focus in enthesis with a different extent of synovial component. In the event of therapeutic failure with DMARDs, the clinician may consider biological therapy with anti-TNF drugs or other targets such as IL23 Despite this, most patients receive first-line anti-TNFs. Given that IL19 and IL23 activity is recognized at the level of the enthesis.Objectives:To evaluate whether the presence of dactylitis/entesitis could be useful in the choice of a particular biological therapy.Methods:A secondary analysis of a previous study was performed based on an electronic survey completed by patients with PsoA and distributed among members of the patient association “Acción Psoriasis”. Records from 191 respondents who had received at least one biological therapy were included. Patients were grouped according to the presence or absence of dactylitis or enthesitis. The rate of need to progress to the next therapeutic biologic line was compared.Results:61 patients reported dactylitis and 155 enthesitis. Distribution of treatments in patients with dactylitis: 33 patients received an anti-TNF-alpha, 11 Secukinumab and 12 Ustekinumab. 15 patients in the group receiving an anti-TNF-alpha had to substitute another treatment within 2 years (45.4%). 3 patients in each of the remaining groups had to substitute treatment within 2 years (27.2% and 25%, respectively). Compared to those receiving anti-TNF-alpha therapy, patients treated with Secukinumab or Ustekinumab had greater therapeutic persistence at 2 years (P<0.001, in both cases). Distribution of treatments in patients with enthesitis (not including dactylitis): 115 received an antiTNF-alpha, 25 received Secukinumab and 18 received Ustekinumab. 38 patients who received an anti-TNF-alpha had to substitute it within 2 years (24.5%). 4 patients who received Secukinumab and 3 who received Ustekinumab had to substitute their treatments in less than 2 years (16% and 16.6%, respectively). Compared to patients receiving anti-TNF-alpha therapy, patients treated with Secukinumab and Ustekinumab had a higher proportion of therapeutic persistence at 2 years (P<0.05 for both cases).Conclusion:The presence of dactylitis more than enthesitis, is associated with a higher proportion of therapeutic persistence in those patients treated with anti-IL17 or anti-IL23 therapies. Although there are multiple factors that condition the choice of biological therapies in patients with PsoA, the presence of enthesitis and dactilitis (understood as polyenthesitis) should be considered among the most important ones.Disclosure of Interests:None declared