tbuckley/cabot-search huggingface dataset:
AB0873 DEVELOPMENT OF IL17A VACCINE TARGETING AXIAL SPONDYLOARTHRITIS
Authors: T. Tomita, H. Mikami, H. Tomioka, S. Tsuji, H. Nakagami
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Ankylosing spondylitis is known as a typical disease of axial spondyloarthritis, in which progressive chronic inflammation of the axial joints leads to bony ankylosis of the limb joints and severe physical disability due to joint destruction. Recently, antibody therapy targeting IL17A has become an effective treatment option because the IL23/IL17A pathway is involved in the mechanism of arthritis pathogenesis. However, antibody therapy is expensive and requires frequent administration, placing a heavy financial and physical burden on patients. Therefore, we focused on therapeutic vaccines in the hope that the antibodies induced by the vaccines would produce long-term therapeutic effects. We evaluated the efficacy of the vaccine in a rat model of spondylitis, and found that the vaccine was effective in treating arthritis and spondylitis. <h3>Objectives:</h3> In this study, we conducted a phase I study in healthy adults to evaluate the safety of the vaccine in humans. <h3>Methods:</h3> A single-center, randomized, placebo-controlled, double-blind study was conducted in healthy adults aged 20-65 years. The actual drug group was divided into two groups, low-dose and high-dose, and each group consisted of 8 subjects each, administered three times every 4 weeks. Each group had a placebo group of 2 subjects. The vaccine group was followed up for 20 weeks after the first administration, and the safety and antibody titer increase were examined. <h3>Results:</h3> 100% of the vaccine group had adverse events. Almost all were injection site reactions. No serious adverse events were observed in all patients. Antibody titers increased after 4 weeks and remained at the same level from 8 to 20 weeks (Figure 1). <h3>Conclusion:</h3> These results confirm the safety of the IL17A vaccine in humans and the antibody titer increase. <h3>REFERENCES:</h3> [1] Hayashi H, Tomita T, Nakagami H, et al. Peptide-based vaccine targeting IL17A attenuates experimental spondyloarthritis in HLA-B27 transgenic rats. RMD Open 2023, 9(1): e002851 <h3>Acknowledgements:</h3> This work was supported by a grant from the Japan Agency for Medical Research and Development (23ek0109565h0003). <h3>Disclosure of Interests:</h3> Tetsuya Tomita: None declared, Hiroshi Mikami: None declared, Hideki Tomioka FunPep.Co, Shigeyoshi Tsuji: None declared, Hironori Nakagami financially supported by FunPep.
AB0589 FILGOTINIB IN ACTION: REAL-WORLD INSIGHTS FROM A BELGIAN REGISTRY OF PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: D. C. Diederik, P. Durez, J. Lenaerts, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Filgotinib (FIL), a preferential Janus Kinase (JAK)1 inhibitor has demonstrated efficacy in rheumatoid arthritis (RA) in pivotal clinical trials. Limited data exist on the real-world effectiveness of FIL in RA. <h3>Objectives:</h3> To examine the short-term effectiveness of FIL compared to other modes of action in a heterogeneous Belgian RA population. <h3>Methods:</h3> Patients were included from the electronic platform "Tool for Administrative Reimbursement Drug Information Sharing" (TARDIS). Data from all Belgian RA patients on biologic and targeted therapy are collected in this platform during the submission of a request for initiation or prolongation of reimbursement of these drugs. Adult patients ≥18 years- and a Disease Activity Score 28 (DAS28 score) &gt;3.7 starting FIL or a comparator population treated with bDMARDs were selected between August 2021 and December 2023. Patients who attended a first follow-up moment, structurally planned in TARDIS after 3 months (FIL) or 6 months (bDMARDs) were included. Effectiveness was determined by the patient proportion achieving remission (DAS28CRP &lt;2.6, if DAS28-CRP was unavailable DAS28-ESR was used), Low Disease Activity (LDA) (DAS28 ≤3.2), Health Assessment Questionnaire Disability Index (HAQ-DI) ≤0.25 (HAQ25), HAQ-DI ≤0.5 (HAQ50) and minimum HAQ-DI-decrease (MCID_HAQ) since baseline of 0.22. Logistic regression was adjusted for confounding variables. <h3>Results:</h3> In total, 714 patients on FIL and 3741 patients on bDMARDs were included (Table 1). Disease duration was longer in FIL population (9.9±10.0 years) versus the bDMARD population (6.5±8.1 years). Remission and LDA was reached respectively in 45.1% (322/714) and 58.3% (416/714) FIL versus 29.7% (1110/3741) and 38.1% (1425/3741) bDMARD patients (p&lt;0.001). MCID_HAQ was reached in 53.5% (382/714) FIL versus 34.0% (1272/3741) bDMARD patients (p&lt;0.001). Logistic regression models adjusted for baseline age, disease duration, joint counts, Patient Global Assessment, DAS28, HAQ-DI, and treatment line confirmed these results. Odds Ratio (CI95%) for remission was 2.4 (2.0-2.8, p&lt;0.001), for LDA 2.6 (2.2-3.1, p&lt;0.001), for MCID_HAQ 2.6 (2.2-3.1, p&lt;0.001), for HAQ25 2.5 (1.9-3.2, p&lt;0.001), and finally for HAQ50 2.3 (1.9-2.9, p&lt;0.001). FIL efficacy slightly decreased with increasing line of therapy (Figure 1). <h3>Conclusion:</h3> FIL treatment showed enhanced clinical and functional outcomes versus a contemporary bDMARD cohort on the short-term in moderately to severely active RA in real-world data. Although adjusted analyses were used, selection bias still could influence the results. Moreover, remission based on CRP was mostly used, and this could bias remission rates towards FIL. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> This work was supported by Galapagos. <h3>Disclosure of Interests:</h3> <b>None declared.</b>
AB0872 COMPATIBILITY OF THE RHEUMATOLOGIST’S SACROILIAC JOINT EVALUATION AND THE FINDINGS IN THE RADIOLOGIST’S REPORT IN SPONDYLOARTHRITIS PATIENTS WHO RECEIVED ABDOMEN COMPUTED TOMOGRAPHY FOR ANY REASON
Authors: B. G. Kalaslioglu, T. Yuce Inel, İ. Sari
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The present study is centered on the retrospective analysis of spondyloarthritis (SpA) patients who underwent abdominal computed tomography (CT) scans for various reasons, including malignancy screening, acute abdomen suspicion, or nephrolithiasis diagnosis. It is noteworthy that in some cases, radiologists may not provide a comprehensive report on structural alterations in the SIJ while conducting abdominal CT scans for SpA patients. <h3>Objectives:</h3> Our primary objective is to scrutinize these patients' sacroiliac joint (SIJ) images and compare the radiologist's report with our findings to determine the presence of sacroiliitis. <h3>Methods:</h3> Our research involved analyzing 188 SpA patients who had received at least one abdominal CT scan for any reason. We meticulously examined the patients' clinical findings, laboratory data, and medication. Additionally, we scrutinized the abdominal CT scans for fusion and total erosion scores. We compared these datasets with the sacroiliitis data reported in the hospital's abdominal CT radiology reports. <h3>Results:</h3> Following a thorough examination of CT reports, 33 patients exhibited compatible sacroiliitis. Conversely, 82.4% of patients did not present any mention of sacroiliitis. Upon reevaluation of the images, structural changes were observed in 43.6% of patients. Interestingly, only 23 (28%) patients exhibiting structural changes on CT were reported to have sacroiliitis. Among the cohort of patients with no structural changes identified on CT scans (n=106), 9.4% (n=10) reported sacroiliitis in their radiology reports. Subsequent re-examination of the CT scans revealed that the rates of overt structural changes or fusion were significantly higher in the group with sacroiliitis findings in their radiology reports than those without sacroiliitis (p&lt;0.001). Notably, sacroiliitis was reported in the radiology reports of 30.8% (n=16) of the patients with total fusion, whereas sacroiliitis was reported in only 12.5% (n=17) of the patients without complete fusion (p=0.003). Table 1 presents a comparison between the results obtained from the abdominal CT reports and the assessment of the SIJ by the rheumatologist. <h3>Conclusion:</h3> It has been observed that radiologists tend to prioritize the interpretation of conspicuous imaging findings such as fusion. However, they may overlook structural changes on the articular surface that require meticulous examination and attention, such as erosion or narrowing of the joint space. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>
AB0631 DYSLIPIDEMIA TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: I. Klymas
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Dyslipidemia is an important risk factor for the development of various pathologies, in particular, non-alcoholic fatty liver disease (NAFLD). Most often, NAFLD develops in rheumatoid arthritis (RA) patients with high clinical and immunological activity of the disease. <h3>Objectives:</h3> to investigate the effect of the combined therapy of atorvastatin and essential phospholipids on the change in serum lipids levels in RA patients with NAFLD. <h3>Methods:</h3> We investigated 77 RA patients with NAFLD who were divided into three groups. I: 25 RA patients received 10 mg of atorvastatin per day. II: 26 RA patients received essential phospholipids 1800 mg per day. III: 26 RA patients received essential phospholipids 1800 mg per day and atorvastatin 10 mg per day for 6 months. Patients with hepatitis, alcohol abuse, and &gt;55 years old were not included. An ultrasound research method was used to assess the hepatobiliary system and an assessment of laboratory biochemical indicators of blood was carried out. Statistical analysis was performed using the program Statistica. The reliability of differences was defined at p &lt;0.05. <h3>Results:</h3> The evaluated indicators of the change in the blood serum lipids levels in RA patients with NAFLD under the effects of atorvastatin and essential phospholipids are presented in Table 1. The results of the studies showed that the most pronounced hypolipidemic effect is observed with the combined use of atorvastatin and essential phospholipids (group III) compared to their separate use (group I and group II). <h3>Conclusion:</h3> The combined use of atorvastatin and essential phospholipids has pronounced hypolipidemic and hepatoprotective effects in RA patients with NAFLD. Use essential phospholipids 600 mg three times a day and atorvastatin 10 mg per day for 6 months in addition to antirheumatic therapy in RA patients with NAFLD allows to avoid a transient increase in aminotransferases, reduce the severity of hepatotoxic reactions, and avoid stopping or canceling antirheumatic therapy. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>
POS0815 ULTRASONOGRAPHY FOR DAY-TO-DAY CLINICAL USE: CONSTRUCTION OF A SIMPLE DISCRIMINATOR BETWEEN HEALTHY SKIN AND THICKENED SYSTEMIC SCLEROSIS SKIN
Authors: V. Smith, N. Berghen, E. Hysa, A. Vanhaecke, S. Wallaert, E. Gotelli, M. Cutolo
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Distinction of presence of dermal thickening at fingers is paramount in detection of systemic sclerosis (SSc). Evaluation of skin thickening by modified Rodnan skin score (mRSS) might be challenging. Simple and practical tools are needed to help the rheumatologist in daily practice to distinguish (non-) thickened skin. High frequency ultrasonography (HFUS) is a reliable tool to measure dermal thickness (DT) in skin [1]. <h3>Objectives:</h3> In this pilot study we search for a DT cut-off value in mm (= the simple HFUS discriminator) to distinguish between healthy control (HC) and SSc skin at finger 2 left (F2L). <h3>Methods:</h3> HFUS with an 18MHz linear probe was used to evaluate DT (Figure 1), in patients with SSc according to the 2013 ACR/EULAR criteria, classified into limited/diffuse cutaneous SSc (LcSSc/dcSSc), and HC. A cut-off value (= the simple HFUS discriminator) was selected by use of logistic regression and receiver operating characteristic (ROC) curve analysis. Results were internally validated using 10 times 10-fold cross validation. <h3>Results:</h3> 63 consecutive SSc patients (53 LcSSc/10 DcSSc, mean age 52 ±4.1 standard deviation (SD), 77.8% female, mean total mRSS 7.34 ±7.2 SD, mean mRSS at F2L 1.55 ±0.7 SD); and 48 HC (mean age 36 ±4.5 SD, 62.5% female, mean total mRSS 0.02±0.1 SD, mean mRSS at F2L 0.02± 0.1 SD) underwent HFUS (Figure 1). Mean DT at F2L was 1.44 mm (±0.39 SD) in SSc patients and 1.06 mm (±0.19 SD) in HC. The final model had an area under the curve of 0.83 (95%CI 0.75 to 0.90)(Figure 2). Age and sex showed no strong correlations with DT (age HC: r = 0.05, p = 0.68; age patients: r = -0.20, p = 0.18; sex HC: -0.42, p = &lt;0.01; sex patients: r = -0.23, p = 0.07). Based on ROC-curve analysis, a DT cut-off of 1.5 mm is proposed as simple HFUS discriminator between HC and SSc, at a specificity of 1, ruling out false positives, rendering a sensitivity of 0.32. At a specificity of 0.79, a DT cut-off of 1.25 mm rendered a sensitivity of 0.70. <h3>Conclusion:</h3> For the first time in a Caucasian cohort, a simple HFUS discriminator between skin thickness of HC versus SSc, i.e. the mean DT as measured at finger 2 left, at a cut-off of 1.5 mm, is proposed for daily use in rheumatology clinics. Further validation will be executed through prospective multicentric cohorts. <h3>REFERENCES:</h3> [1] Vanhaecke A, Cutolo M, Heeman L, Vilela V, Deschepper E, Melsens K, Smith V. High frequency ultrasonography: reliable tool to measure skin fibrosis in SSC? A systematic literature review and additional pilot study. Rheumatology (Oxford). 2021;61(1):42-52. <h3>Acknowledgements:</h3> Vanessa Smith is a Senior Clinical Investigator of the Research Foundation – Flanders (Belgium) (FWO) [1.8.029.20N]. <h3>Disclosure of Interests:</h3> <b>None declared.</b>
AB1185 SERIOUS INFECTIONS IN SYSTEMIC SCLEROSIS: A SINGLE CENTRE DATA OF 30 YEARS
Authors: A. G P, S. Ahmed, V. Agarwal
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic sclerosis (SSc) is a complex and chronic autoimmune connective tissue disease, characterized by vasculopathy, abnormal and excessive deposition of extra cellular matrix in the skin and internal organs and presence of autoantibodies.Patients with SSc have increased susceptibility to infections, primarily stemming from the disease itself and its associated complications. <h3>Objectives:</h3> This study aims to look for the spectrum of infections and the factors predisposing to infection in patients with systemic sclerosis. <h3>Methods:</h3> In this retrospective study, demographic, clinical features, details of infections, immunosuppressive therapy, and outcomes of patients with SSc attending clinics at department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India from 1990-2022 were captured. Multivariable-adjusted logistic regression was applied to identify independent predictors of infection. <h3>Results:</h3> Data of 880 patients, mean age 35.5±12 years, and female: male ratio 7.7:1, were analyzed. One hundred and fifty-three patients had at least 1 infection with a total of 233 infectious episodes. Infections were most common in lung followed by skin and soft tissue. Tuberculosis was diagnosed in 45 patients (29.4%). Klebsiella was the commonest non-tubercular organism in lung and Escherichia coli in urinary tract infections. In comparison to matched control group, patients with infection had a greater number of admissions due to active disease, odds ratio (OR) 6.27 (3.23-12.18, p&lt;0.001), were receiving immunosuppressive medication OR, 5.05 (2.55-10.00, p&lt;0.0001)), and had more digital ulcers OR, 2.53 (1.17-5.45, p&lt;0.01). Patient who had infection had more likelihood for death OR, 13.63 (4.75 -39.18, P&lt;0.0001). <h3>Conclusion:</h3> Tuberculosis remains the commonest disease and lung remains the major site of infection in patients with SSc. Number of hospital admissions, digital ulcers and immunosuppressive therapy are predictors of serious infection in patients with SSc. Infections are a major cause of mortality in SSc. <h3>REFERENCES:</h3> [1] Barahona-Correa JE, De la Hoz A, López MJ, Garzón J, Allanore Y, Quintana-López G. Infections and systemic sclerosis: an emerging challenge. Rev Colomb Reumatol Engl Ed. 2020 Apr 1;27:62–84. [2] Rongioletti F, Ferreli C, Atzori L, Bottoni U, Soda G. Scleroderma with an update about clinico-pathological correlation. G Ital Dermatol E Venereol Organo Uff Soc Ital Dermatol E Sifilogr. 2018 Apr;153(2):208–15. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>
AB1131 ASSOCIATION BETWEEN MEAN PLATELET VOLUME AND DISEASE ACTIVITY IN A COHORT OF TUNISIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: B. Mayssa, H. Tounsi, S. Wafa, W. Garbouj, M. Y. Kaabar, S. Dghais, R. Amri
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Among the different laboratory parameters used to assess disease activity in patients with systemic lupus erythematosus (SLE), mean platelet volume (MPV) has been evaluated as a sign of inflammation. <h3>Objectives:</h3> The aim of the present study was to evaluate whether MPV could reflect disease activity of adult patients with systemic lupus erythematosus (SLE). <h3>Methods:</h3> A retrospective and descriptive study, was conducted within the internal medicine department of Taher Maamouri Hospital, between 2015 and 2023. All patients fulfilled American College of Rheumatology ACR/ EULAR classification criteria for SLE. <h3>Results:</h3> Data from seventy-five patients were analysed. The male to female ratio was 4, 66. The median age was 37 years, with extremes ranging from 16 to 75 years. The mean MPV of patients with active SLE (n=40) was found to be statistically significantly higher than that in the remission period of the disease (n=35) (<i>P</i> = 0.007). MPV had an inverse relationship with both ESR (<i>P</i> = 0.008) and SLEDAI (<i>P</i> = 0.01).We found a strong positive correlation between MPV, lupus nephritis (<i>P</i> &lt;0.001) and central neurological impairment (<i>P</i> &lt;0.001). However, this biomarker was not significantly associated with arthritis nor antinuclear antibody (ANA) levels. <h3>Conclusion:</h3> MPV may be a new activation indicator for adult patients with SLE. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>
AB0632 EVALUATION OF NOVEL CARDIOVASCULAR RISK CALCULATORS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: V. Gonzalez-Gonzalez, D. A. Galarza-Delgado, I. J. Colunga-Pedraza, J. R. Azpiri-Lopez, J. A. Cardenas-de la Garza, R. I. Arvizu-Rivera, N. Guajardo-Jauregui, A. L. Guajardo-Aldaco, M. F. Elizondo-Benitez
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in rheumatoid arthritis (RA) patients. Several cardiovascular risk (CVR) algorithms are used in RA patients to predict cardiovascular outcomes, underestimating the real CVR. <h3>Objectives:</h3> To compare CVR algorithms with carotid US findings in RA patients without clinical ASCVD and identify which calculator is the best predictor that correlates with carotid plaque (CP). <h3>Methods:</h3> A cross-sectional and descriptive study that included RA-patients aged 30 to 79 who fulfilled the 2010 ACR/EULAR 2010 Classification Criteria for RA. Patients with previous cardiovascular disease (myocardial infarction, stroke, or peripheral artery disease) were excluded. CVR was calculated using six algorithms: Globorisk, 2019 Hearts (WHO), QRISK3, ESR-RA, SCORE2, and PREVENT. A carotid ultrasound was performed on all study participants, and the presence of CP defined as a diffuse carotid intima-media thickness (cIMT) ≥1.2 mm or a focal thickness ≥0.5 mm. ROC curve analysis was performed to evaluate the different CVR algorithms' performance with CP. The Youden index was calculated to select the optimum sensitivity, specificity, and negative and positive predictive values. A value of <i>p</i>≤0.05 was considered statistically significant. <h3>Results:</h3> A total of 263 patients with RA diagnosis were included. The prevalence of CP was 38.0%. Demographic characteristics and results are shown in Table 1 and Figure 1. <h3>Conclusion:</h3> In our study, all algorithms had a significant discrimination for the presence of CP. However, the ERS-RA and the Hearts algorithms presented the best diagnostic accuracy with the greatest sensitivity and specificity in RA-patients. The other algorithms, including the novel CVR calculator, PREVENT, were shown to be less able to detect CP in our population. <h3>REFERENCES:</h3> [1] Wah-Suarez MI, Galarza-Delgado DA, Azpiri-Lopez JR, et al. the best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients. Clin Rheumatol 2018;37(9):2373-80. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>
OP0181 WHICH MODE OF ACTION IS BEST FOR DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS WHEN SWITCHING BIOLOGICS OR JAK INHIBITORS?
Authors: T. Tachibana, Y. Yamada, K. Mamoto, T. Okano, T. Kojima, S. Anno, K. Orita, T. Iida, M. Tada, K. Inui, T. Koike, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Some patients with rheumatoid arthritis (RA) have difficulty in controling disease activity even after using multiple biological agents or Janus kinase inhibitors (BIO/JAKi). These patients are considered as difficult-to-treat RA (D2TRA) and result in poor outcome because of persistent inflammation. <h3>Objectives:</h3> We investigated the efficacy of switching BIO/JAKi by their mode of action among patients with D2TRA. <h3>Methods:</h3> Total of 185 patients switched to another BIO/JAKi because of inadequate response to previous BIO/JAKi and being considered as D2TRA in our institution as of September 2022. The following BIO/JAKi consists of TNF inhibitors (TNFi; n=20), IL6 inhibitors (IL6i; n=32), Abatacept (ABT; n=29), JAK inhibitors (JAKi; n=104). We investigated clinical characteristics and efficacy and retention rate of following BIO/JAKi for 52 weeks. <h3>Results:</h3> The average age was 62.9, disease duration was 16.1 years at the time of switching (baseline). MTX use rate was 85%, 38%, 48%, 46%, and glucorticoid use rate was 45%, 66%, 55%, 34%, and numbers of used BIO/JAKi was 3.4, 2.9, 2.7, 4.0 in TNFi, IL6i, ABT, JAKi, respectively at baseline. Retention rate of the following BIO/JAKi at 52w was 60.0%, 56.3%, 51.7%, and 48.1%, respectively. DAS28ESR improved from 5.66 to 4.37, 5.19 to 2.78, 4.62 to 4.13, 4.72 to 3.98, and CDAI improved from 27.3 to 12.7, 22.1 to 10.5, 19.2 to 13.6, 20.0 to 12.2, and MMP3 improved from 185.3 to 119.0, 365.6 to 137.8, 172.3 to 141.7, 287.5 to 110.6 at 52w, respectively. IL6i and JAKi especially improved MMP3 and CRP, whereas TNFi improved CDAI during 52w. HAQ and glucocorticoid use had not been improved. <h3>Conclusion:</h3> Switching BIO/JAKi improved disease activity and considered to be effective for patients with D2TRA, regardless of mode of action. <h3>REFERENCES:</h3> [1] Nagy G, Roodenrijs NMT, Welsing PM, Kedves M, Hamar A, van der Goes MC, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. (2021) 80:31–5. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Takuya Tachibana: None declared, Yutaro Yamada: None declared, Kenji Mamoto: None declared, Tadashi Okano Abbvie, Takahito Kojima: None declared, Shohei Anno: None declared, Kazuki Orita: None declared, Takahiro Iida: None declared, Masahiro Tada: None declared, Kentaro Inui: None declared, Tatsuya Koike Abbvie, Chugai, Hiroaki Nakamura Astellas, Asahi Kasei