ALDH4A1 is an atherosclerosis auto-antigen targeted by protective antibodies

Cardiovascular disease (CVD) is the leading cause of mortality in the world, with most CVD-related deaths resulting from myocardial infarction or stroke. The main underlying cause of thrombosis and cardiovascular events is atherosclerosis, an inflammatory disease that can remain asymptomatic for long periods. There is an urgent need for therapeutic and diagnostic options in this area. Atherosclerotic plaques contain autoantibodies^1,2, and there is a connection between atherosclerosis and autoimmunity³. However, the immunogenic trigger and the effects of the autoantibody response during atherosclerosis are not well understood^3-5. Here we performed high-throughput single-cell analysis of the atherosclerosis-associated antibody repertoire. Antibody gene sequencing of more than 1,700 B cells from atherogenic Ldlr^-/- and control mice identified 56 antibodies expressed by in-vivo-expanded clones of B lymphocytes in the context of atherosclerosis. One-third of the expanded antibodies were reactive against atherosclerotic plaques, indicating that various antigens in the lesion can trigger antibody responses. Deep proteomics analysis identified ALDH4A1, a mitochondrial dehydrogenase involved in proline metabolism, as a target antigen of one of these autoantibodies, A12. ALDH4A1 distribution is altered during atherosclerosis, and circulating ALDH4A1 is increased in mice and humans with atherosclerosis, supporting the potential use of ALDH4A1 as a disease biomarker. Infusion of A12 antibodies into Ldlr^-/- mice delayed plaque formation and reduced circulating free cholesterol and LDL, suggesting that anti-ALDH4A1 antibodies can protect against atherosclerosis progression and might have therapeutic potential in CVD.

Oxidative Stress in Human Atherothrombosis: Sources, Markers and Therapeutic Targets

Atherothrombosis remains one of the main causes of morbidity and mortality worldwide. The underlying pathology is a chronic pathological vascular remodeling of the arterial wall involving several pathways, including oxidative stress. Cellular and animal studies have provided compelling evidence of the direct role of oxidative stress in atherothrombosis, but such a relationship is not clearly established in humans and, to date, clinical trials on the possible beneficial effects of antioxidant therapy have provided equivocal results. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is one of the main sources of reactive oxygen species (ROS) in human atherothrombosis. Moreover, leukocyte-derived myeloperoxidase (MPO) and red blood cell-derived iron could be involved in the oxidative modification of lipids/lipoproteins (LDL/HDL) in the arterial wall. Interestingly, oxidized lipoproteins, and antioxidants, have been analyzed as potential markers of oxidative stress in the plasma of patients with atherothrombosis. In this review, we will revise sources of ROS, focusing on NADPH oxidase, but also on MPO and iron. We will also discuss the impact of these oxidative systems on LDL and HDL, as well as the value of these modified lipoproteins as circulating markers of oxidative stress in atherothrombosis. We will finish by reviewing some antioxidant systems and compounds as therapeutic strategies to prevent pathological vascular remodeling.

Galectin-1 prevents pathological vascular remodeling in atherosclerosis and abdominal aortic aneurysm

Pathological vascular remodeling is the underlying cause of atherosclerosis and abdominal aortic aneurysm (AAA). Here, we analyzed the role of galectin-1 (Gal-1), a β-galactoside-binding protein, as a therapeutic target for atherosclerosis and AAA. Mice lacking Gal-1 (Lgals1^-/-) developed severe atherosclerosis induced by pAAV/D377Y-mPCSK9 adenovirus and displayed higher lipid levels and lower expression of contractile markers of vascular smooth muscle cells (VSMCs) in plaques than wild-type mice. Proteomic analysis of Lgals1^-/- aortas showed changes in markers of VSMC phenotypic switch and altered composition of mitochondrial proteins. Mechanistically, Gal-1 silencing resulted in increased foam cell formation and mitochondrial dysfunction in VSMCs, while treatment with recombinant Gal-1 (rGal-1) prevented these effects. Furthermore, rGal-1 treatment attenuated atherosclerosis and elastase-induced AAA, leading to higher contractile VSMCs in aortic tissues. Gal-1 expression decreased in human atheroma and AAA compared to control tissue. Thus, Gal-1-driven circuits emerge as potential therapeutic strategies in atherosclerosis and AAA.

Role of complement system in pathological remodeling of the vascular wall

Cardiovascular diseases (CVD) remain the major cause of morbidity and mortality in Europe. The clinical complications associated to arterial wall rupture involve intimal cap rupture in complicated atherosclerotic plaques and medial rupture in abdominal aortic aneurysm (AAA). The mechanisms underlying pathological vascular remodeling include lipid accumulation, cell proliferation, redox imbalance, proteolysis, leukocyte infiltration, cell death, and eventually, thrombosis. The complement system could participate in vascular remodeling by several mechanisms, from an initial protective response that aims in the clearing of cell debris to a potential deleterious role participating in leukocyte chemotaxis and cell activation and bridging innate and adaptive immunity. We have reviewed the presence and distribution of complement components, as well as the triggers of complement activation in atherosclerotic plaques and AAA, to later assess the functional consequences of complement modulation in experimental models of pathological vascular remodeling and the potential role of complement components as potential circulating biomarkers of CVD. On the whole, complement system is a key mechanism involved in vascular remodelling, which could be useful in the diagnostic/prognostic setting, as well as a potential therapeutic target, of CVD.

Association of ficolin-3 with abdominal aortic aneurysm presence and progression

Essentials Abdominal aortic aneurysm (AAA) is asymptomatic and its evolution unpredictable. To find novel potential biomarkers of AAA, microvesicles are an excellent source of biomarkers. Ficolin-3 is increased in microvesicles obtained from activated platelets and AAA tissue. Increased ficolin-3 plasma levels are associated with AAA presence and progression.

SUMMARY

Background Abdominal aortic aneurysm (AAA) patients are usually asymptomatic and AAA evolution is unpredictable. Ficolin-3, mainly synthesized by the liver, is a molecule of the lectin complement-activation pathway involved in AAA pathophysiology. Objectives To define extra-hepatic sources of ficolin-3 in AAA and investigate the role of ficolin-3 as a biomarker of the presence and progression of AAA. Methods Microvesicles (exosomes and microparticles) were isolated from culture-conditioned medium of ADP-activated platelets, as well as from AAA tissue-conditioned medium (thrombus and wall). Ficolin-3 levels were analyzed by western-blot, real-time PCR, immunohistochemistry and ELISA. Results Increased ficolin-3 levels were observed in microvesicles isolated from activated platelets. Similarly, microvesicles released from AAA tissue display increased ficolin-3 levels as compared with those from healthy tissue. Moreover, ficolin-3 mRNA levels in the AAA wall were greatly increased compared with healthy aortic walls. Immunohistochemistry of AAA tissue demonstrated increased ficolin-3, whereas little staining was present in healthy walls. Finally, increased ficolin-3 levels were observed in AAA patients' plasma (n = 478) compared with control plasma (n = 176), which persisted after adjustment for risk factors (adjusted odds ratio [OR], 5.29; 95% confidence interval [CI], 3.27, 8.57)]. Moreover, a positive association of ficolin-3 with aortic diameter (Rho, 0.25) and need for surgical repair was observed, also after adjustment for potential confounding factors (adjusted hazard ratio, 1.55; 95% CI, 1.11, 2.15). Conclusions In addition to its hepatic expression, ficolin-3 may be released into the extracellular medium via microvesicles, by both activated cells and pathological AAA tissue. Ficolin-3 plasma levels are associated with the presence and progression of AAA, suggesting its potential role as a biomarker of AAA.

Arachidonic Acid, but Not Omega-3 Index, Relates to the Prevalence and Progression of Abdominal Aortic Aneurysm in a Population-Based Study of Danish Men

Background

Animal models support dietary omega‐3 fatty acids protection against abdominal aortic aneurysm (AAA), but clinical data are scarce. The sum of red blood cell proportions of the omega‐3 eicosapentaenoic and docosahexaenoic acids, known as omega‐3 index, is a valid surrogate for long‐term omega‐3 intake. We investigated the association between the omega‐3 index and the prevalence and progression of AAA. We also investigated associations between AAA and arachidonic acid, an omega‐6 fatty acid that is a substrate for proinflammatory lipid mediators.

Methods and Results

We obtained blood samples from 498 AAA patients (maximal aortic diameter ≥30 mm) within a population‐based ultrasound‐screening trial in men and from 199 age‐matched controls who screened negative. We determined the fatty acids of red blood cells by gas chromatography. During a median follow‐up of 4.85 years, 141 AAA patients reached criteria for vascular surgical repair. Participants were high consumers of omega‐3 (average omega‐3 index: 7.6%). No significant associations were found for omega‐3 index. In contrast, arachidonic acid in AAA patients was higher than in controls (P<0.001), and individuals in the upper tertile of arachidonic acid at baseline had higher probability of having AAA (odds ratio: 1.309; 95% confidence interval, 1.021–1.678; P=0.033). AAA patients at the upper tertile of arachidonic acid at baseline had a 54% higher risk of needing surgical repair during follow‐up (hazard ratio: 1.544; 95% confidence interval, 1.127–2.114; P=0.007).

Conclusions

Omega‐3 index is unrelated to men with AAA from a country in which fish consumption is customarily high. Arachidonic acid is associated with AAA presence and progression.

Clinical Trial Registration

URL: https://www.clinicaltrials.gov. Unique identifier: NCT00662480.

Pathophisiology of abdominal aortic aneurysm: biomarkers and novel therapeutic targets

Abdominal aortic aneurysm (AAA) is a vascular pathology with a high rate of morbidity and mortality and a prevalence that, in men over 65 years, can reach around 8%. In this disease, usually asymptomatic, there is a progressive dilatation of the vascular wall that can lead to its rupture, a fatal phenomenon in more than 80% of cases. The treatment of patients with asymptomatic aneurysms is limited to periodic monitoring with imaging tests, control of cardiovascular risk factors and treatment with statins and antiplatelet therapy. There is no effective pharmacological treatment capable of limiting AAA progression or avoiding their rupture. At present, the aortic diameter is the only marker of risk of rupture and determines the need for surgical repair when it reaches values greater than 5.5cm. This review addresses the main aspects related to epidemiology, risk factors, diagnosis and clinical management of AAA, exposes the difficulties to have good biomarkers of this pathology and describes the strategies for the identification of new therapeutic targets and biomarkers in AAA.

AB0829 INFLAMMATORY BOWEL DISEASE IN PSORIATIC ARTHRITIS. STUDY OF 306 PATIENTS FROM A SINGLE UNIVERSITARY CENTER. PREVALENCE, CLINICAL FEATURES AND RELATIONSHIP TO BIOLOGIC THERAPY

Background:

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), Ulcerative colitis (UC), and undetermined colitis may be related to psoriasis and psoriatic arthritis (PsA). Biologic therapy (BT) is useful in PsA and IBD but paradoxically has been related to IBD.

Objectives:

In a wide series of PsA, our aim was to assessa) the epidemiological and clinical features of associated IBD andb) its relationship with BT.

Methods:

All unselected consecutive patients studied in a single reference University Hospital with: a) PsA (CASPAR criteria) andb) IBD: CD, UC and undetermined colitis diagnosed by endoscopic patterns, clinical criteria and laboratory tests. A comparative study between patients with and without IBD was performed

Results:

We studied 306 (165 women/141 men) patients with PsA; mean age at PsA diagnosis of 41.7±15.79 years; delay of diagnosis from the onset of symptoms of 2.6±2.01 years. IBD (CD=6; UC=1 and undetermined colitis=3) was observed in 10 of 306 (3.3%, 8 women/2 men). A significant more frequency of enthesitis, positive HLA-B27 and non-significant more severe PsA (axial, and hip involvement, and a higher BASDAI, BASFI, DAPSA, PASI) was observed in patients with associated-IBD (TABLE).

IBD was present before PsA in 5 patients and in the other 5, after 9.6±15.3 years of evolution of PsA. BT for PsA has been used in 1 (20%) (etanercept) of these 5 patients which developed IBD and in 67 of 296 (22.6%) without IBD (Adalimumab 45; Certolizumab 8; Infliximab 6; Golimumab 4; Etanercept 4).

Conclusion:

IBD in PsA was uncommon (3.3%), may be associated to a more severe PsA, and no relationship to BT was found.

TABLE 1.Patients with IBD(n=10)Patients without IBD(n=296)pDEMOGRAPHIC PARAMETERSSex, n (%)2 ♂/8 ♀ (20.0/80.0)139 ♂/157 ♀ (46.9/53.1)p = 0.11Age at PsA symptoms onset (years), mean± SD39.0±15.144.2±11.4p = 0.17Age at PsA diagnosis, mean±SD41.7±15.746.4±15.8p = 0.22PsA RELATED DATAPsA type Asymmetric Oligoarticular, n (%)4.0 (40.0)159 (53.7)p = 0.59 Symmetrical Polyarthritis, n (%)0.0 (0.0)46 (15.5)p = 0.37 Axial, n (%)3.0 (30.0)40 (13.5)p = 0.31 Mixed, n (%)3.0 (30.0)51 (17.2)p = 0.54 Enthesitis, n (%)7.0 (70.0)111 (37.5)p = 0.03* Dactylitis, n (%)0.0 (0.0)79 (26.7)p = 0.70 Hip involvement n (%)4.0 (40.0)55 (18.5)p = 0.57Scores BASDAI, median [ICR]3.1 [0.0-4.4]2.2 [0.0-4.5)p = 0.64 BASFI, median [ICR]6.0[0.0–6.9]0.0 [0.0-3.3]p = 0.69 DAPSA, median [ICR]10.7 [0.0–14.62]4.3 [0.0-13.0]p = 0.31 PASI, median [ICR]2.3 [0.0–6.7]0.6 [0.0-2.38]p = 0.70Laboratory tests:HLA-B27, n (%)6.0 (60.0)23 (7.8)p = 0.001*

Disclosure of Interests:

Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martinez-Lopez: None declared, Natalia Palmou-Fontana: None declared, Susana Armesto: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0777 EPIDEMIOLOGY, CLINICAL FEATURES AND BIOLOGICAL TREATMENT OF UVEITIS IN 320 PATIENTS WITH PSORIATIC ARTHRITIS. STUDY FROM A SINGLE UNIVERSITY CENTER

Background:

Uveitis is an extra articular manifestation of psoriatic arthritis (PsA). Biological therapy, especially monoclonal TNF inhibitors, are useful to prevent and to treat refractory non-infectious uveitis. However, other biologics had been related to paradoxical uveitis

Objectives:

Our aim was to assessa) the epidemiological and clinical features of uveitis associated to PsA andb) its relationship with biological treatment used in PsA.

Methods:

Observational study of unselected consecutive patients studied in a single reference University Hospital with: a) diagnosis of PsA by CASPAR criteria andb) diagnosis of uveitis by ophthalmologist exploration. Demographics features, clinical findings, complementary tests and treatment were recorded.

Results:

We studied 320 (182 women/138 men) patients with PsA; mean age at PsA diagnosis of 41.7±15.79 years and with a delay of diagnosis from the onset of symptoms of 2.6±2.01 years.

Ten patients (4 men/6 women) out of 320 patients (prevalence 3.13%) with a mean age of 42.2 ± 16.8 years were diagnosed of uveitis after a mean follow-up of 10±7.9 years. In all cases, the uveitis had an anterior pattern. Only 1 (10%) of them had a bilateral affection, acute onset in 10 patients (100%), and 4 of them (40%) had a recurrent pattern. The diagnosis of uveitis preceded the one of PsA in 5 (50%) patients in 1.6±0.87 years. In those with a previous diagnosis of PsA, it was done 13.3±10.4 years before the uveitis onset. Only 1 patient (10%) with recurrent unilateral uveitis presented vitritis. In 10 patients the mean number of anterior chamber cells was 2±0.4. Comparison of baseline characteristics and clinical features between patients who developed uveitis and those who did not is shown intable.

Only 2 patients (20%) with uveitis received biological therapy. The first one developed its first episode of uveitis after 29 months with etanercept. After the episode, a switch to adalimumab was done, without any other episode of uveitis after 22 months of treatment. The second one was a patient with multiple episodes of recurrent uveitis, who developed new flares with adalimumab, certolizumab and golimumab.

Conclusion:

Most of the uveitis had an anterior and unilateral pattern. The onset of uveitis in patients with PsA can either precede or go after the diagnosis of the PsA. HLA B27+ was more frequent in patients with uveitis. Biological therapy did not achieve good answer in patients with recurrent uveitis.

Table.Uveitis (n=10)Non uveitis (n= 310)pBaseline general featuresAge, years (mean±SD)42.2 ± 16.846.4 ± 11.90.38Sex, n (m/w) (%)4/6 (40/60)134/176 (43.2/56.8)0.90HLAB27, positive %6011.8<0.01Disease CharacteristicsAxial arthritis, %40.037.00.88Peripheral arthritis, %80.072.90.89Hip affection, %30.020.00.71Enthesitis, %60.040.50.55Dactylitis, %20.029.50.77ScoresBASDAI (mean ± SD)3.3 ± 2.082.4 ± 1.90.26BASFI (mean ± SD)2.7 ± 1.91.6 ± 10.31

Disclosure of Interests:

Iñigo González-Mazón: None declared, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Natalia Palmou-Fontana: None declared, David Martinez-Lopez: None declared, Susana Armesto: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

Complement C5 plasma levels are associated to abdominal aortic aneurysm prevalence and progression

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Complemento II-CM

La Caixa

Aim

Previous human and experimental studies have suggested a role of complement activation in abdominal aortic aneurysm (AAA).  We recently described an increase in complement C5 levels in plasma of subjects with subclinical atherosclerosis (1). Our aim was to investigate the potential association of C5 with AAA presence and progression.

Material and methods

Tissue and tissue-conditioned media from AAA (thrombus and wall) or healthy samples were obtained from surgical repair or brain-deceased organ donors, respectively. Blood samples from 490 AAA patients (maximal aortic diameter ≥30 mm) were obtained within a population-based ultrasound-screening trial in Danish men and from 176 age-matched screened negative controls. C5 protein levels were assessed by immunohistochemistry and ELISA.

Results

High C5 positive immunostaining was observed in AAA thrombus and media, while the staining in healthy arteries was faint. C5 levels were higher in tissue-conditioned media from AAA thrombus and AAA media as compared to healthy arteries (7.1±1 vs 2.9 ±0.5 vs 1.2±0.2ug/ml, p&lt;0.0001 for both). C5 plasma levels in AAA patients were higher than in controls (116±8 vs 61±7 ug/ml, P&lt;0.001). AAA patients at the upper tertile of C5 at baseline had a 25% higher risk of needing surgical repair during the follow-up (Hazard Ratio=1.25, 95% confidence interval, 1.045;1.511, P&lt;0.05).

Conclusions

C5 is associated to AAA presence and progression suggesting its potential use as a prognostic marker. Future studies are needed to clarify the pathogenic role of C5 in AAA.

AB0721 OCULAR INVOLVEMENT IN INFLAMMATORY BOWEL DISEASE. STUDY OF 1442 PATIENTS FROM A SINGLE UNIVERSITARY CENTER

Background:

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), and Ulcerative colitis (UC) are related to Spondyloarthritis (SpA). Ocular manifestations (OM) are well-stablished in SpA but not in IBD. It has been classically reported that whereas uveitis with SpA is predominantly anterior, unilateral, sudden, and limited; in IBD it is bilateral, posterior, insidious, and chronic(Lyons & Rosenbaum JT. Arch Ophthalmol 1997; 115:61-4).

Objectives:

In a large unselected series of IBD, we study the OM and assess;a) epidemiological, clinical features,b) the relationship with extraintestinal manifestations.

Methods:

Study of all consecutive patients from a single University Hospital during the last 40 years with: a) IBD (CD and UC), andb) OM: uveitis and scleral pathology diagnosed by clinical features and slit-lamp.

Results:

OM were present in 42 (2.9%) (25 women/17 men) (84 eyes) of 1442 IBD patients; OM included the uveitis group (UG) (n=23; 1.6%) and the scleral pathology group (SG) (n=19, 1.32%) (TABLE).

The most common pattern in SG was episcleritis (n=16; 84.21%) and scleritis (n=3). In UG, uveitis was typically anterior (n=18; 78.3%), unilateral (n=19; 82.6%), sudden (n=19; 82.6%), and limited (n=12; 52.2%).

The comparative study between SG vs UG showed in UG a significant predominance of women and UC. Also, a non-significative higher frequency in Pyoderma gangrenosum, erythema nodosum and joint involvement was observed in UG.

After a mean follow-up of 15.2±9.97 years, extraintestinal manifestations were observed in 100% of patients, being articular forms (n=16; 38.10%) the most common type. In addition, joint/axial flare is more related to the presence of uveitis (p=0.038).

Conclusion:

Both uveitis and episcleritis are equally frequent OM in IBD. Although uveitis is more infrequent in IBD than in SpA, it is also anterior, unilateral, sudden and limited in contrast with published data from selected series.

References:

[1]Lyons & Rosenbaum JT. Arch Ophthalmol 1997; 115:61-4

TABLE.Uveitis(n= 23)Epi/scleritis(n=19)pDEMOGRAPHIC PARAMETERSSex, n (%)6 ♂ / 17 ♀11 ♂ / 8 ♀p= 0.04*Age at diagnosis (years) mean ± SD49.13±14.6447.63±12.48p= 0.415INTESTINAL AFFECTIONCD, n (%)12 (52.17)16 (84.21)p= 0.02*UC, n (%)11 (47,83)3 (15,74)p= 0.16EXTRAINTESTINAL AFFECTIONCutaneous manifestations•Erythema nodosum, n (%)6 (26.09)2 (10.53)p= 0.30•Pyoderma gangrenosum, n (%)1 (4.35)0 (0)p= 0.92•Psoriasis, n (%)1 (4.35)4 (21.01)p= 0.23Joint involvement10 (43.50)6 (31.60)p= 0.36•Psoriathic arthritis, n (%)1 (4.35)3 (15.80)p= 0.47•Enteropathic Spondyloarthritis, n (%)6 (26.09)3 (15.80)p= 0.66•Ankylosing Spondylitis, n (%)3 (13.04)0 (0)p= 0.28Digestive manifestations•NASH, n(%)4 (17.39)6 (31.58)p= 0.28

*p value < 0.05. SD:standard deviation;CD:Crohn’s disease; UC:ulcerative colitis; NASH:non-alcoholic steatohepatitis.

Disclosure of Interests:

Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martinez-Lopez: None declared, Iñigo González-Mazón: None declared, María José García-García: None declared, Montserrat Rivero-Tirado: None declared, Beatriz Castro: None declared, Javier Crespo: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

THU0388 UVEITIS IN AXIAL SPONDYLOARTHRITIS: FREQUENCY AND RELATIONSHIP TO BIOLOGICAL THERAPY. SINGLE CENTER UNIVERSITY STUDY OF 255 PATIENTS

Background:

Uveitis is one of the most frequent extra articular manifestation of spondyloarthritis (SpA). Biological therapy, especially monoclonal TNF inhibitors, may be useful to prevent and to treat uveitis. However, other biologics had been related to paradoxical uveitis.

Objectives:

Our aim was to assess a) the epidemiological and clinical features of uveitis associated to SpA and b) its relationship with biological treatment used in SpA.

Methods:

An observational study of patients who developed uveitis form a cohort of 255 consecutive unselected patients with axial SpA (axSpA) classified according to the ASAS criteria. They were divided into: a) ankylosing spondylitis (AS) according to New York modified criteria (n= 193) b) non-radiographic axSpA (nr-axSpA) (n= 62). All these patients were followed in a single reference University Hospital.

Results:

We studied 255 patients with axSpA (151 men/104 women); mean age 37.8±10.6 years. In 36 (31 in AS; 5 in nr-axSpA) (14.2%) patients at least one episode of uveitis was observed after a follow-up 12.4±4.5 years. The mean age at onset of uveitis was 45.7±14.2 years. The diagnosis of uveitis preceded SpA diagnosis in 5 patients, but most of them occurred after a median of 6 [2-15] years of follow-up. Pattern of uveitis was anterior and acute in all cases, and unilateral in 83%. Median of anterior chamber cells was 1 [1-2] cells. Comparison of baseline characteristics and clinical features between patients who developed uveitis and those who did not is shown in table. Almost all patients who developed uveitis were HLAB27 positive. In these patients a lower frequency of enthesitis and inflammatory bowel disease was observed.

Table.UveitisN= 36Non uveitisN= 219pBaseline general featuresAge, years (mean±SD)45.7 ± 14.244.7 ± 12.10.49Sex, n (m/w) (%)21/15 (58.3/41.7)130/89 (59.4/40.6)0.91HLAB27, positive n (%)35 (97.2)130 (59.4)0.00Anti-TNF, n Adalimumab3530.06 Certolizumab140.79 Golimumab1110.87 Infliximab1290.13 Etanercept0120.31Disease CharacteristicsFollow-up of AxSpa, year (mean±SD)13.64 ± 7.612.16 ± 9.730.33AS, n (%)31 (86.1)162 (74.0)0.12nr-AxSp, n (%)5 (13.9)57 (26.0)0.12Peripheral arthritis, n (%)9 (25.0)67 (30.6)0.49Hip affection, n (%)3 (8.3)15 (6.8)0.97Enthesitis, n (%)9 (25.0)81 (37.0)0.16Dactylitis, n (%)2 (5.5)14 (6.4)0.85Psoriasis, n (%)4 (11.1)24 (11.0)0.79Inflammatory bowel disease, n (%)1 (2.8)15 (6.8)0.57Family history, n (%)12 (33.3)58 (26.5)0.39

6 patients with uveitis received anti-TNF therapy and suffered from 7 episodes of uveitis after 5.6±4 years of treatment, meanwhile only 1 out of the 3 patients who were treated with anti IL-17 did a single episode of uveitis after 4.2±1.9 of follow-up. Patients treated with secukinumab developed 2.72 episodes of uveitis/100 patients/year, meanwhile those who received monoclonal anti TNF presented 2.53 episodes/100 patients / year.

Conclusion:

The most frequent clinical pattern of uveitis was acute unilateral anterior. Almost all of them were HLA B27 positive. No differences were found in cumulative incidence between secukinumab and monoclonal anti-TNF.

Disclosure of Interests:

Iñigo González-Mazón: None declared, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Javier Rueda-Gotor: None declared, David Martinez-Lopez: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD