324 Thursday, 12 June 2014 Scientific Abstracts Results: The prevalence of positive ACPA overall was 2.8% (350/12590), 1.0% of ACPA positive RA (124/12590), and 1.8% of ACPA-positivity without RA (226/12590). Among those with ACPA in the absence of RA, the mean ACPA concentration was 161 IU/ml (95% CI 105-216) for females versus 247 IU/ml (95% CI 128-367) for males. Among those with ACPA positive RA, the concentrations were 785 IU/ml (95% CI 614-956) for females and 662 IU/ml (95% CI 411-912) for males. These sex differences in concentrations were not statistically significant. The proportion of females increased from 55% in the entire cohort, through 61% among those with ACPA in the absence of RA, to 71% among those with ACPA positive RA. Female sex was associated with ACPA overall (OR=1.6, 95% CI 1.2-2.0), ACPA positivity in the absence of RA (OR=1.3, 95% CI 1.0-1.8), and ACPA-positive RA (OR=2.1, 95% CI 1.4-3.3). Among those with positive ACPA, the risk of also having RA was higher among females (OR=1.8, 95% CI 1.1-3.1). Among the candidate auto-antigens, anti-citrullinated alpha-enolase was most frequent (24% positive) in the analyzed subgroup of individuals (n=350 ACPA- positive and 273 ACPA negative) and was associated with female sex (OR=2.0, 95% CI 1.3-3.2). Conclusions: In this population-based cross-sectional study we found that female sex was associated with ACPA positivity, even in the absence of concomitant RA, but not with ACPA concentrations. Among those with ACPA positivity, female sex was associated with presence of RA. We controlled for confounding by several established risk factors but residual confounding may be present, e.g. from socioeconomic factors. Our results suggest that female sex is a risk factor not just for RA development but also for ACPA, and point to the need of further research on risk factors for ACPA and ACPA-positive RA with a differential distribution by sex. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.5147 THU0411 DRUG HOLIDAY DURING BIOLOGICAL THERAPY - A PATIENT PERSPECTIVE A. Kosevoi 1 , F. Berghea 2 , V. Bojinca 2 , D. Opris 2 , C. Constantinescu 2 , M. Abobului 2 , L. Groseanu 2 , I. Saulescu 2 , A. Borangiu 2 , M. Negru 2 , A. Balanescu 2 , D. Predeteanu 2 , R. Ionescu 2 , on behalf of RCRD. 1 Rheumatology, Sf. Maria Hospital; 2 Rheumatology, Carol Davila University Of Medicine And Pharmacy, Bucharest, Romania Background: Biologic therapy is extensively used in various rheumatic disease adding a plus of efficacy to classical DMARDS. Standardized regimes are based on continuous use of biologics but for various reasons (e.g. health insurance issues, patients’ concerns related to safety of long term use or a surgical emergency) a drug holiday might come into discussion. While rheumatologists’ reasons to support or not this holiday are widely presented in the literature little is known about the patients’ beliefs and attitudes in this matter. Objectives: To evaluate the rheumatic patients’ beliefs and attitudes regarding a potential drug holiday during biologic treatment. Methods: A structured questionnaire was developed to capture demographic data, personal experience and acceptance of biologic therapy, level of knowledge about possible drug holiday, personal beliefs and attitudes regarding such regime. Rheumatic patients receiving biologic treatment have been invited to answer the questionnaire. SPSS 19.0 have been used to perform statistical analysis. Data are presented in mean (sd) format; a p<0.05 was considered significant. Results: A number of 69 subjects accepted to participate in this study. Demographic data revealed: age 51.6 (13.6) years, sex ratio (F:M) – 1.3:1, 69.6% suffering from Rheumatoid arthritis and 30.4% from spondilarthritis, duration of biologic therapy: 34.67 (27.5) months. 44.9% of the subjects already considered of the possibility of a drug holiday (no difference between gender, living area or education based groups). 75.0% believe that such a holiday will produce a “totally negative” and a “mainly negative” impact on the control of disease. Those who believe this holiday will have a greater impact are the same who predict a predominant negative impact – Pearson correlation index: o,42. A small minority (14.7%) declared them as being favorable to such a holiday, however these answers went mainly from those who believe this holiday will have a small impact on the control of disease and are ready to try this in the near future. 82.7% of the subjects expect their doctor to open such a subject. Those who are not favorable to such a holiday are ready to pay extra for the treatment (20.6%) or to receive a less expensive drug (75.0%). Conclusions: There is a great need for research regarding the potential effects of drug holiday during the biologic therapy and to respond to various concerns patients do have. A large proportion of patients have negative feelings concerning this possibility. Those patients (not so many) that feel they control the disease are the same who are ready to try this change – this raise the question whether or not the patients follow their treatment because they are more scared than informed of their disease. A very large proportion of patients are ready to accept a less expensive drug in exchange not to start a drug holiday – while biologic biosimilars already offer this opportunity it might be interesting to explore the consequences of such a decision. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.3322 THU0412 CARDIOVASCULAR OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS, PSORIASIS AND PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSES A. McFarlane 1 , C. Roubille 2 , V. Richer 3 , T. Starnino 4 , C. McCourt 5 , P. Fleming 6 , S. Siu 7 , J. Kraft 8 , C. Lynde 8 , J. Pope 9 , W. Gulliver 10 , J. Dutz 11 , L. Bessette 12 , R. Bissonnette 13 , B. Haraoui 14 , S.O. Keeling 1 . 1 Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton; 2 University of Montreal Hospital Research Center (CRCHUM), Notre Dame Hospital; 3 Department of Medicine, Dermatology Service, St-Luc Hospital; 4 Sacre Coeur Hospital of Montreal, University of Montreal, Montreal; 5 Department of Dermatology and Skin Science, University of British Columbia, Vancouver; 6 Division of Dermatology, University of Toronto, Toronto; 7 Division of Rheumatology, Department of Medicine, Western University of Canada, London; 8 Lynde Dermatology, Markham; 9 Division of Rheumatology, Dpeartment of Medicine, Western University of Canada, London; 10 Faculty of Medicine, Memorial University of Newfoundland, St. John’s; 11 Dermatology and Skin Science, University of British Columbia, Vancouver; 12 Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier Universitaire de Montreal-CHUL, Laval University; 13 Innovaderm Research; 14 Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier de l’Universitaire de Montreal (CHUM), Montreal, Canada Background: Rheumatoid arthritis (RA), psoriasis (PsO) and psoriatic arthritis (PsA) are associated with increased risk of CV-mortality but less clearly related to specific cardiovascular outcomes (CVO.) Objectives: To evaluate important CVO in RA, PsO and PsA patients. Methods: Medline, Embase, Cochrane and abstracts from ACR/EULAR/AAD/ EADV were searched for in English language full-length articles and abstracts published up to January 15, 2013 describing CVO in observational studies in RA, PsO and PsA patients. Outcomes included all-cause and CV-mortality, and specific CVO including myocardial infarction (MI)/acute coronary syndrome (ACS), cerebrovascular accident (CVA – including stroke or transient ischemic attack), heart failure (HF) and peripheral artery disease (PAD). Random effects meta-analyses were performed. Results: Out of 3457 references, 127 observational studies (RA=89; PsO=27; PsA=11) were included. Important effect size estimates represented as standard- ized mortality (SMR) and morbidity (SMoR) ratios are listed in Table 1. Table 1. Effect size estimates for important cardiovascular outcomes CVO RA PsO PsA Fatal CVO SMR SMR SMR All-cause mortality 1.59 (1.47–1.71) 1.43 (1.14–1.81) 1.46 (1.03–2.07) CV-mortality 1.58 (1.47–1.70) 1.32 (1.12–1.57) 1.61 (1.09–2.38) Specific CVO SMoR SMoR SMoR MI/ACS 1.85 (1.55–2.22) 1.23 (1.07–1.42) 1.55 (0.57–4.21) CVA 1.56 (1.26–1.94) 1.18 (1.06–1.32) 0.91 (0.34–2.43) PAD 1.95 (1.05–3.63) 1.31 (1.17–1.45) 1.53 (1.20–1.94) HF 1.54 (1.29–1.83) 1.35 (1.13–1.63) 1.43(1.08–1.90) Conclusions: RA, PsO and PsA are associated with several important CVO’s including less reported outcomes such as PAD, CVA and HF. These complications may be less recognized by physicians. Fewer studies exist for PsA but CVO’s appear increased overall. Risk reduction strategies should be considered. Acknowledgements: Dr. Ben Vandermeer provided invaluable statistical consu- lation and analysis. Disclosure of Interest: A. McFarlane Grant/research support: This study was supported by an unrestricted grant from AbbVie., C. Roubille Grant/research sup- port: This study was supported by an unrestricted grant from AbbVie. Fellowship grants/bursary from the Foundation of the University of Montreal Hospital Center (CHUM)., V. Richer Grant/research support: This study was supported by an unrestricted grant from AbbVie., T. Starnino Grant/research support: This study was supported by an unrestricted grant from AbbVie., C. McCourt Grant/research support: This study was supported by an unrestricted grant from AbbVie. Salary for the fellowship in Vancouver was funded by a Fellowship from Janssen-Ortho Canada and the British Association of Dermatology., P. Fleming Grant/research support: This study was supported by an unrestricted grant from AbbVie., S. Siu Grant/research support: This study was supported by an unrestricted grant from AbbVie., J. Kraft Grant/research support: This study was supported by an unrestricted grant from AbbVie. Investigator support from Abbvie, Amgen, Gal- derma, Janssen, Novartis., Consultant for: Abbvie, Amgen, Galderma, Janssen, Novartis, Leo., Speakers bureau: Abbvie, Amgen, Galderma, Janssen, Leo., C. Lynde Grant/research support: This study was supported by an unrestricted grant from AbbVie. Investigator support: Abbvie, Amgen, Celgene, Janssen-Ortho, Novartis, Eli Lilly, Merck, Leo Pharma., Consultant for: Abbvie, Amgen, Celgene, Janssen-Ortho, Novartis, Eli Lilly, Merck, Leo Pharma., Speakers bureau: Abbvie, Amgen, Celgene, Janssen-Ortho, Novartis, Eli Lilly, Merck, Leo Pharma., J. Pope Grant/research support: This study was supported by an unrestricted grant from AbbVie. Research support from AbbVie, Actelion, Amgen, Astra Zeneca, Bayer, BMS, Celgene, Genentech, GSK, BMS, Jansen & Jansen, MedImmune, Mediquest, Novartis, Pfizer, Roche, United Chemicals Belgium., Consultant for: AbbVie, Actelion, Amgen, Astra Zeneca, Bayer, BMS, Celgene, Genentech, GSK, BMS, Jansen & Jansen, MedImmune, Mediquest, Novartis, Pfizer, Roche, United Chemicals Belgium., W. Gulliver Grant/research support: This study was