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Objectives To evaluate the prevalence of self-perceived depression and anxiety in patients with systemic lupus erythematosus (SLE) and to explore associated factors. Methods Cross-sectional study of unselected patients with SLE (ACR-97 criteria) and controls with chronic inflammatory rheumatic diseases. Both completed the Hospital Anxiety and Depression Scale (HADS). Demographic and clinical characteristics, comorbidity, and treatments were collected, and a multivariate analysis was performed to explore factors associated with depression and anxiety in SLE. Results The study population comprised 172 patients and 215 controls. Women accounted for 93% of the patients with SLE. Fibromyalgia was recorded in 12.8% and a history of depression in 17%. According to HADS, 37.2% fulfilled the diagnostic criteria for depression and 58.7% those for anxiety; prevalence was similar in the controls (32.6% and 55.1%, respectively). Up to a third of patients with self-perceived depression were not receiving antidepressants. There was no concordance between a previous history of depression and current depression. In the multivariate model, current depression was associated with single marital status (OR 2.69; 95% CI: 1.17–6.42; p = .022), fibromyalgia (7.69; 2.35–30.72; p = .001), smoking (3.12; 1.24–8.07; p = .016), severity of SLE (0.76; 0.6–0.94; p = .016), and organ damage (1.27; 1.01–1.61; p = .042). Current anxiety was only associated with fibromyalgia (3.97; 1.21–17.98; p = .036). Conclusions Depression and anxiety are most likely underdiagnosed in SLE. Prevalence appears to be similar to that of other chronic inflammatory rheumatic diseases. Anxiety is associated with fibromyalgia, while depression is also associated with single marital status, smoking, organ damage, and severity of SLE.

To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture.Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients.Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37).Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Fracture Liaison Service (FLS) model for secondary prevention of fractures has demonstrated its cost-effectiveness using decision models. We analyze the impact of a FLS on pharmaceutical expenditures for osteoporosis (OP) in real-world circumstances.Expenditures on OP medications from January 2011 to January 2017 were compiled. Pharmaceutical expenditures in the southern area of Gran Canaria were used as a control group to measure the impact of implementing an FLS in the northern area. We estimated generalized least squares regressions with interrupted time-series analysis where two interventions were considered: March 2012 (implementation of the FLS) and March 2016 (incorporation of nursing staff for inpatients with hip fracture).The northern area incurred greater expenditures for group I and II drugs. The difference in bisphosphonates expenditures between areas varied from 10.5% higher in the northern area pre-FLS to 11.2% post-FLS and 18.3% since March 2016. However, interrupted time series models do not find a significant impact of implementation of FLS on the pharmaceutical expenditures for either drug group.The implantation of an FLS did not lead to an increase in pharmaceutical expenditures for OP over the 5-year period compared to the standard care provided for secondary fracture preventions.

A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture. The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures. Fragility fractures in patients over 50 attending the emergency room in our centre are captured by the recruitment system of a secondary prevention program. The unit is attended by a nurse, coordinated by two rheumatologists and with the collaboration of primary care consisted of a training program and annual meetings. The outcome of the program was analysed 2 years after implementation, including: (1) percentage of attendees/eligible; (2) percentage of attendees who start treatment with antiresorptive; (3) percentage of patients who retain treatment after 6, 12, 18 and 24 months; and (4) factors associated to adherence. After 2 years of implementation, the program detected 1674 patients with fracture, of whom 759 finally entered the program (57 % of eligible). After 3 months, 82 % of patients prescribed an antiresorptive started treatment. After a year, 52 % of the patients in the program, 72 % of those of a prescribed treatment, were taking antiresorptives. Adherence at 24 months among those who had prescribed anti-fracture drugs was 73 %. Factors associated with adherence at 12 months were female sex (76 vs 45 %; p = 0.01) and previous treatment with antiresorptive (86 vs 68 %; p = 0.02). In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term.

Background Although management of osteoporosis (OP) is cost-effective in high-risk patients, less than 20% of patients with fragility fracture receive antiresorptive drugs and more than 50% stop treatment after a year. Objectives The main objective was to evaluate the long-term adherence to treatment of a program for secondary prevention of OP fractures Methods Patients >50 years with fragility fracture were enrolled in a prospective observational study. The program consisted of: 1) training of primary care physicians, 2) recruitment of patients from emergency unit, 3) baseline visit: questionnaire by the nurse, bone densitometry and patient education; 4) clinical report referral to primary care or rheumatology (those with multiple fractures or requiring special therapy); and 5) follow-up through a phone survey and checking the prescriptions in electronic records. The outcome of the program was analysed 2 years after implementation, including 1) percentage of attendees/eligible; 2) percentage of attendees who start treatment with bisphosphonates; 3) percentage of patients who retain treatment after 6, 12,18 and 24 months; and 4) factors associated to adherence. Results After 2 years of implementation, the program detected 1674 patients, of whom 759 finally entered the program (57% of eligible). After 3 months, 52% of the patients (82% of those with prescribed antiresorptive) in the program started treatment. Factors associated with starting treatment at 3 months were female sex (85% vs 71%; p=0.01), previous treatment with antiresorptive (91% vs 80%; p=0.02), hip fracture (89% vs forearm 75%; p=0.007) and being attended by a rheumatologist (89% vs primary care 69%; p The causes of withdrawal of treatment at 12 months in 83 phoned patients were as follows: 25 patients do not agree to take treatment, 24 patients by unknown reasons, 18 stopped or not started by primary care doctor, 8 because gastrointestinal complaints, 5 because of being taking many drugs, and 3 because others diseases. Conclusions In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology is effective in terms of recruitment of patients and adherence to treatment in the long-term. Acknowledgements Proyecto nacional del Ministerio de Ciencia e Innovaciόn. Instituto de Salud Carlos III: PI11/01429 Disclosure of Interest None declared