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Background The goal of treatment in psoriatic arthritis (PsA) according to the T2T strategy is remission, or at least, a low disease activity state1. Currently there is no clear agreement on how to measure these treatment goals. Objectives To explore the relationship between very low disease activity (VLDA) state, according to the MDA 7/7 criteria2, and DAPSA remission3, as well as its association with the impact of the disease evaluated by the PsAID questionnaire4, in patients with PsA in routine clinical practice. Methods Post-hoc analysis of the MAAPs study5. We included patients who met CASPAR criteria, with at least one year of disease evolution, and treated with biological and/or synthetic DMARDs according to the usual clinical practice in Spain. Patients were considered in VLDA if they met 7/7 of the MDA criteria, and in DAPSA/cDAPSA remission (this last without CRP) if they had a value ≤4. A PsAID Results Of the 227 patients included in the original study, 26 (11.5%), 52 (30.6%), 65 (36.9%) and 125 (55%) were in VLDA, DAPSA remission, cDAPSA remission, and PASS, respectively. There was a moderate agreement between VLDA and DAPSA remission (κ=0.52) or the cDAPSA remission (κ=0.42). Patients in VLDA had a lower impact of the disease measured by PsAID [mean total score (SD): VLDA 1.1 (1.2); DAPSA remission 1.3 (1.5); cDAPSA remission 1.7 (1.6)]. There was a moderate agreement between DAPSA remission or cDAPSA remission and PASS (κ=0.55 and κ=0.58 respectively), while fair agreement was found between VLDA and PASS (κ=0.18). Conclusions About one third of this series reached DAPSA remission, while only 11.5% reached VLDA state. On the other hand, more than half were in PASS situation. Agreement between VLDA and DAPSA was moderate. Although the MDA 7/7 criteria seem to be more stringent criteria for assessing remission, DAPSA remission shows better agreement with PASS. DAPSA and VLDA would be adequate treatment targets in daily practice. References [1] Smolen JS, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis2018;77:3–17. [2] Coates LC, et al. Defining Low Disease Activity States in Psoriatic Arthritis using Novel Composite Disease Instruments. J Rheumatol2016;43:371–375. [3] Schoels MM, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis2016;75:811–818. [4] Gossec L, et al. A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis2014;73:1012–1019. [5] Queiro R, et al. Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study. Arthritis Res Ther2017;19:72. Disclosure of Interest None declared

Background Some cardiovascular risk factors (CVRF) have been related to poorer responses to biological therapy 1 . We aimed to evaluate the potential link between the MDA response and the presence of CVRF in patients treated with traditional and/or biological DMARDs. Objectives The objective has been to evaluate the potential association beetween classic CVRF and the probability of reaching an MDA response in PsA patients. Methods Cross-sectional study carried out at 25 rheumatology outpatient clinics in patients who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least one year disease duration, and treated with biological or conventional synthetic (cs) DMARDs according to routine clinical practice in Spain. Patients were considered in MDA if they met at least 5/7 of the MDA criteria 2 . The relationship between MDA and CVRF was evaluated by uni and multivariate analyses. Results 227 patients were included, 133 (58.6%) were in MDA state (52% on anti-TNFα monotherapy, 24% on csDMARD monotherapy, 24% on anti-TNFα in combination with csDMARD). Among the classic CVRF, tobacco (crude OR: 0.54), sedentary lifestyle (crude OR: 1.95), hyperuricemia (crude OR: 2.01) and obesity (crude OR: 1.54) were related to the likelihood of MDA in the univariate model (p Conclusions Contrary to what has been found in other studies, in this cross-sectional multicenter study we could not find any relationship between traditional CVRF (except for sedentary lifestyle) and MDA. In any case, patients with psoriatic disease should be encouraged to maintain healthy lifestyle habits. References Ogdie A, Eder L. Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis. Int J Clin Rheumatol 2015; 10(6):451–459. Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010; 69(1):48–53. Acknowledgements This study was funded by Pfizer. Disclosure of Interest None declared

Background The target of treatment in psoriatic arthritis (PsA) should be remission or inactive disease. A potential definition that would fit with the Treat-to-Target Recommendations would be MDA meeting all 7 criteria 1 , proposed as a definition of very low disease activity (VLDA) in PsA. Patient reported outcomes (PROs), such as those provided by the novel PsAID questionnaire 2 , are also important to evaluate healthcare interventions and to reflect the impact of PsA on patients9 lives. Objectives The aims of the present study were to evaluate the prevalence of VLDA in patients with PsA and how much residual active disease is still present, so as to determine whether PsAID could be an additional useful tool to assess PsA interventions in clinical practice. Methods This was a post-hoc analysis of data from a cross-sectional observational and multicenter study (MAAPS), aimed at evaluating the prevalence of MDA in a Spanish population with PsA, to describe their characteristics and to evaluate the association between MDA and the impact of the disease as assessed by the PsAID questionnaire in routine clinical practice The original study included adult patients of both genders diagnosed with PsA according to CASPAR criteria with at least one year of evolution time of disease and on treatment with biological and/or conventional synthetic disease modifying anti-rheumatic drugs (cDMARD). Patients were considered in VLDA when they met all the MDA criteria 1 : tender joint count ≤1, swollen joint count ≤1, Psoriasis Area Severity index (PASI) score ≤1 or body surface area ≤3%, patient pain visual analog scale (VAS) score ≤15, patient global disease activity VAS score ≤20, Health Assessment Questionnaire (HAQ) score ≤0.5, and tender entheseal points ≤1. Patient acceptable symptoms state (PASS) has been defined as a PsAID value Results 227 patients were included, 133 (58.6%) in MDA state and 58 (25.6%) in VLDA state. VLDA patients suffered from a mild impact of the disease according to PsAID: the majority (82.5%) had a PsAID score Conclusions 26% of Spanish PsA patients achieve VLDA state in routine clinical practice. PsA patients who reached this state also had a very low impact of disease according to PsAID. VLDA state could represent a situation of clinical remission in PsA. References Coates LC, Fransen J, Helliwell PS. Ann Rheum Dis 2010;69(1):48–53. Gossec L, de WM, Kiltz U, Braun J, Kalyoncu U, Scrivo R et al. Ann Rheum Dis 2014;73(6):1012–1019. Acknowledgements MAAPS (Minimal Activity in Psoriatic Arthritis) study group:. J.C. Torre Alonso; J.A Roman Ivorra; J. Sanz; J. Salvatierra; J. Calvo Alen; A. Sellas; F.J. Rodriguez; A. Bermudez; M.Romero; M. Riesco; J.C Cobeta; F.Medina; A. Aragόn; ML. Garcia; A. Urruticoechea; CM. Gonzalez; E. Judez; B. Gonzalez; P. Fernandez; L. Pantoja; R. Morla. This study was funded by Pfizer. Disclosure of Interest None declared

Resumen Objetivos El Conjunto Minimo Basico de Datos (CMBD) se ha utilizado para estimar la complejidad de los pacientes y elaborar indicadores de calidad, no obstante, se han descrito problemas de calidad y exhaustividad en el mismo. El objetivo de este estudio es evaluar la calidad del registro de infecciones postoperatorias en el CMBD en un hospital de tercer nivel y analizar las variables relacionadas. Metodos Se diseno un estudio observacional retrospectivo, en el que se comparo la informacion disponible sobre infeccion postoperatoria en el CMBD con la de la base de datos del sistema de vigilancia activa del Servicio de Medicina Preventiva, que se considero sistema de referencia (gold standard). Se incluyeron todos los episodios de hospitalizacion en los que el Servicio de Medicina Preventiva encontro una infeccion postoperatoria. Las infecciones se clasificaron en Infeccion Superficial de la Herida (ISH), Infeccion Profunda de la Herida (IPH) e Infeccion de Organo/Espacio (IOE). Los criterios diagnosticos utilizados fueron los establecidos por los Centers for Disease Control. Por medio de un modelo de regresion logistica, se analizo la asociacion entre variables relacionadas con el paciente y el episodio de ingreso, y el registro o no de la infeccion postoperatoria en el CMBD. Resultados El sistema de vigilancia registro 300 casos de infeccion postoperatoria, con una incidencia acumulada anual de 2,8%. De ellas 219 correspondian a IHS, 27 a IPH y 54 a IOE. En 172 casos (57,3%) no aparece el codigo de “infecion postoperatoria” en el CMBD. Esta proporcion es el 57,5% en la ISH, el 44,4% en la IPH y el 63% en las IOE. En el modelo de regresion logistica incluimos el servicio que da el alta y el tipo de infeccion. Conclusiones Existe un importante subrregistro en el CMBD de las complicaciones infecciosas asociadas a la cirugia. No encontramos ninguna variable claramente relacionada con el registro de la infeccion postoperatoria. El diseno de estrategias de intervencion nos llevarian a mejorar la calidad de los informes medicos y el correcto registro de las complicaciones infecciosas. Estas estrategias deberian estar dirigidas a los servicios con mayor margen de mejora en el indice de case-mix y peor calidad de informacion clinica recogida en el CMBD.

This article draws a comparison and provides a discussion of the findings resulting from the local analyses of the 14 cities participating in the EMECAM Project. An analysis is made of the time series related to mortality, pollutants (particles in suspension, SO2, NO2, O3 and CO), temperature and other factors taken from records of public institutions. By using Poisson autoregressive regression, an estimate has been made of the short-term relationship between the number of deaths and the air pollution indicators in each one of the following cities: Barcelona, metropolitan area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa. The findings reveal the air pollution figures in our country to be similar to those of other European cities. The levels of the different pollutants point toward road traffic as being the main source of most of this pollution. A relationship has been found between the mortality and different pollutants in most cities, although the results are not homogeneous among the cities and show variability in the different causes under study. In some cities, especially in those having smaller populations, there have been no findings providing any evidence of a relationship, or the findings themselves are not highly consistent. The meta-analysis will provide estimates for all of the cities as a whole and will allow the possibility of making a more clear-cut assessment of the time lag impact of air pollution on the mortality. Worthy of special mention is the participation in this project of public health officers as actively involved researchers.

FUNDAMENTO: Evaluar el impacto a corto plazo de la contaminación sobre la mortalidad respiratoria en la ciudad de Zaragoza, en el periodo1991-95, e identificar si hay diferencias en función de la edad y época del año. MÉTODOS: La asociación de concentraciones diarias de humos y SO2 con las defunciones diarias por enfermedades respiratorias (CIE-9 460-486) y enfermedad pulmonar obstructiva crónica y afines EPOC-EA (490-496), se analizó aplicando modelos de Poisson, siguiendo el protocolo del proyecto EMECAM. Se investigaron posibles diferencias del efecto en mayores y menores de 70 años y según semestre. Se calcularon riesgos relativos (RR) e intervalos de confianza al 95% (IC95%) para incrementos de contaminante de 10 m gr/m³. RESULTADOS: Se encontró asociación entre mortalidad respiratoria y humos (RR 1,028 IC95%1,006-1,051), siendo el riesgo mayor en semestre cálido. En mayores de 70 años, la relación se mantuvo en este semestre y fue negativa en menores de 70. Los RRs de la mortalidad por EPOC-EA fueron globalmente de 1,038 (IC95%1,002-1,075) y de 1,068 (IC95%: 1,004-1,137) para el semestre cálido. La contaminación por SO2 mostró asociación positiva con la mortalidad respiratoria en periodo cálido para todas las edades, RR 1,093 (IC95%: 1,006-1,187) y en menores de 70 años (RR 1,240 IC95%: 1,028-1,496). Los efectos fueron no concluyentes con las neumonías. CONCLUSIONES: Niveles bajos de contaminación atmosférica pueden producir efectos significativos en la mortalidad respiratoria, especialmente personas mayores durante los semestres cálidos.

Background Currently, the use of standards of care (SoC) could be the first step to achieve optimal care in patients with spondyloarthritis (SpA). Objectives The aim of this project (2e) was to develop evidence-based and user-focused SoC for SpA. Methods A RAND-modified Delphi method was applied. First, a systematic literature review of national and international documents covering SOC for SpA was conducted. This included consensus, clinical guidelines and care management documents. Social leagues and health professionals were contacted. All the information retrieved was evaluated by two expert methodologists and, subsequently, adapted and classified according to the three categories of SOC: structure, process and outcomes. A group of 23 experts on SpA was selected and a consensus meeting was held where these SOC were discussed. Afterwards, a first questionnaire round was sent to the experts panel and the SOC were modified according to the results of this round. Finally, a second questionnaire round with the final set of SOC was sent to 167 rheumatologists all around Spain to assess their agreement grade about every SoC. Results A total of 38 SoC were set (12 for structure, 20 for process and 6 for outcomes). A selection with the SoC that got highest priority is shown in the table. In general, standards of process achieved high priority whereas standards of result got the lowest grade of agreement. Image/graph Conclusions The implementation in clinical practice of this set of SoC could help assess and improve the quality of care for patients with SpA. Disclosure of Interest None Declared

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