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ObjectiveThe European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits.MethodsThe NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures.ResultsData collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres.ConclusionPatients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.

Background Patients with rheumatoid arthritis (RA) has been shown to be at increased risk for other diseases, in particular for osteoporosis, infections, cardiovascular diseases and malignancy. There are limited data on prevalence of comorbidities in unselected RA patient outpatient cohorts reflecting the magnitude of comorbidities in RA patients. Objectives To explore the prevalence of comorbidities in RA patients followed at outpatient clinics in Norway. Methods The RA patients were recruited from two outpatient clinics in Norway, one located in the southern and one in the western part of Norway. As part of clinical routine the RA patients at these two centers were monitored at ordinary visits by the use of the computer software tool GoTreatIT® Rheuma. Standardized data collection for disease activity measures, patient reported outcome measures (PROM) and treatment was registered as part of clinical routine. Patients also self-reported their comorbidities using the computer system. Patients with at least one visit in 2015 at the outpatient clinics were included. Results A total of 2437 RA patients were assessed, 1065 from the southern and 1372 from the western located center. Only minor differences were found between the two centers, for demographic, disease and treatment variables. Patient demographic and disease characteristics: mean age 62.7 (SD 14.1) years, BMI 25.9 (4.5) kg/m 2 , education 11.8 (3.6) years, 70% females, current smoker 16.0% and 66.8% were RF+ and 73.5% were anti-CCP+. Measures reflecting disease activity: mean ESR 18.2 (14.4) mm/hr, CRP 7.0 (13.8) mg/dl, DAS28 2.4 (1.2) and CDAI 6.6 (7.0). Mean values for PROMs: Pain 32.7 (25.3) mm, fatigue 37.8 (29.8) mm. MHAQ 0.18 (0.42). Current user of mono synthetic disease modifying anti-rheumatic drugs (sDMARDs) 45.5%, mono biologic DMARDSs (bDMARDs) 10.4% and combination sDMARDs and bDMARDs 25.5%. Prednisolone was used by 40.8% of the patients. Self-reported comorbidity data was available in 1616 of the 2437 (66.3%) patients. The percentage of patients reporting to have myocardial infarction was 3.9%, arterial hypertension16.5%, heart failure 1.2%, peripheral artery disease 1.7%, cerebrovascular disease 1.8%, osteoporosis 12.8%, chronic infections 3.7%, lymphoma 0.7%, melanoma 0.9%, other skin cancer 0.5%, other cancers 5.8%. Among the 123 patients who reported to have cancer 6.5% reported to have metastasis and 58.1% reported to have had ca treatment the last 5 years. Thyroid gland disease was reported by 8.0%, diabetes mellitus by 4.4% and peptic ulcer disease by 5.0%. Conclusions Our data gives an estimate of the prevalence of the most frequent comorbidities in RA patients seen in Norwegian outpatient rheumatology clinics. Osteoporosis and cardiovascular disease was the most frequent comorbidities. Both of these comorbidities have been shown to be more frequent in RA patients compared with the background population. Data on prevalence of comorbidities may contribute to an increased awareness improving overall patient care in RA. Disclosure of Interest G. Haugeberg Shareholder of: Founder of and shareholder in the company DiaGraphIT AS, B.-T. Fevang: None declared, D. Soldal: None declared, C. Gjesdal: None declared

Background Biologic agents are highly efficacious for treatment of rheumatoid arthritis (RA) (1). In 2010 recommendations from an international task force on treating RA to target (T2T) was published. (2) The chosen primary treatment target in RA was “a state of clinical remission which means the absence of signs and symptoms of significant inflammatory disease activity”. In patients with long-standing disease low disease activity was considered as an acceptable alternative therapeutic goal. These guidelines proposed the use of validated composite measures to assess disease activity (e.g. DAS28, CDAI), which include joint assessments, in routine clinical practice to guide treatment decisions. Objectives To examine disease activity and health status measures and examine the proportion of RA patients on biologics in low disease activity and remission in daily practice. Methods Patients were recruited from rheumatology departments in Norway participating in the BIORHEUMA project (BIOlogic treatment of patients suffering from inflammatory RHEUMAtic disorders in Norway). The aim was 1. To implement the T2T recommendations in daily clinical practice by the use of a designated computerized system. 2. To obtain unselected real life data on clinical status and treatment practices in patients with inflammatory rheumatic joint disorders treated with biologics. All centers were using the GoTreatIT Rheuma software system (www.diagraphit.com). Data collection included demographics, measures of disease activity (28 joint count, DAS28, CDAI) and health status (MHAQ, visual analogue scale (VAS 0-100 mm) measures for patient and doctor’s global assessment, pain and fatigue) and laboratory data (ESR, CRP, RF and ACPA). Results By the end of 2011 nine departments reported to have implemented the clinical standard of monitoring patients on biologics. Among these nine centers a total of 7206 RA patients (28.9% men, 71.1% women) had been registered in GoTreatIT Rheuma and 2745 were on biologics (27.4% men, 72.6% women). Mean (SD) age was 57.7 yrs and disease duration 13.8 yrs. Percentage of patients ACPA+ was 83%. 58.6% were on their first biologic, 23.7% were on their second, 10.9% on their third and 6.8% had been on more than 3 biologics. The following results were found: mean (SD) DAS28 3.17 (1.35), median [IQR] 28-swollen joint 1 [3], 28-tender joint 1 [4] and MHAQ 0.38 [0.62]. 38% were in remission (Das28 Conclusions In our Norwegian cohort of biologic treated RA patients more than 50% of patients had low disease activity or were in remission. References Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med. 2004;350:2167-79. S molen JS et al. Ann Rheum Dis. 2010;69:631-7 Disclosure of Interest G. Haugeberg Shareholder of: DiaGraphIT, Grant/Research support from: Roche, Pfizer, Abbott, L. Bader: None Declared, M. Hoff: None Declared, K. Haaland: None Declared, C. Gjesdal: None Declared, B. Storesund: None Declared, H. C. Gulseth: None Declared, E. Haavardsholm: None Declared, K. Mikkelsen: None Declared

Background Norway (4.9 million inhabitants) is among the countries with the highest proportion of patients with inflammatory joint disorders treated with biologic drugs (1). The total cost for biologic treatment in Norway has been estimated to be ∼800 million Nkr (∼105 million Euro) for rheumatoid arthritis (RA). In 1999 the first biologic drug, the TNF inhibitor Infliximab, became available for clinical use in Norway. In the following years other TNF inhibitors has become available (etanercept (2000), adalimumab (2004), certolizumab pegol (2010) and golilumumab (2010)) and other biologic treatments which includes IL-6 inhibition (tocilizumab 2009), T-cell inhibition (abatacept 2007) and B-cell depletion (rituximab 2006). Objectives To explore which biologic drugs RA patients were currently using, or had been using, assessed by the end of 2011 in Norway. Methods In 2009 the BIORHEUMA project (BIOlogic treatment of patients suffering from inflammatory RHEUMAtic disorders in Norway) was established. The aim was 1. To implement the use of outcome measures and the T2T recommendations in daily clinical practice by the use of a designated computerized system. 2. To obtain unselected real life data on clinical status and treatment practices in patient with inflammatory rheumatic joint disorders. All participating centers had to use the GoTreatIT Rheuma computer software system ([www.diagraphit.com][1]) to monitor their patients on biologic treatment. By the end of 2011 nine out of the ten participating centers reported to have implemented the clinical standard of monitoring RA patients on biologics. Results In 2011 a total of 7206 RA patients had been assessed at the participating centers and registered in the computer system. Among them 2745 (38.1%) RA patients were registered as current users and a total of 3286 (45.5%) as ever users of biologic drugs. The distribution of current and previous use of the biologic drugs among ever users of biologics is shown in the [table][2]. Ever use of 1 biologic drug was seen in 56.9%, 2 biologics in 23.5%, 3 biologics in 11.3% and 4 or more biologics in 8.3%. View this table: Table 1. Current and previous use of biologics in 3286 RA patients ever exposed to biologics Conclusions As expected TNF inhibitors are the most frequent used biologic drugs for treatment of RA patients in Norway, with etanercept being the most frequently used. Among the other modes of action Rituximab is the most frequently used biologic drug. 1. Jonsson Bet al. Eur J Health Econ. 2008 Jan;8 Suppl 2:S61-86. Disclosure of Interest G. Haugeberg Shareholder of: DiaGraphIT, Grant/Research support from: Supported by Roche, Pfizer, Abbott, L. Bader: None Declared, E. Rodevand: None Declared, K. Haaland: None Declared, C. Gjesdal: None Declared, B. Storesund: None Declared, H. C. Gulseth: None Declared, E. Haavardsholm: None Declared, K. Mikkelsen: None Declared [1]: http://www.diagraphit.com [2]: #T1

Background Patient registries adds valuable information on long term clinical drug effectiveness and safety. Patients treated to target (T2T) by the use of outcome measures have been shown to achieve a better outcome than patients receiving standard care (1). Thus ideally all patients with chronic inflammatory joint disorders should be monitored by the use of outcome measures in daily clinical practice, also advocated by leading experts in rheumatology (2). Despite these recommendations a large proportion of patients are not monitored and treated to target (3). One reason may be non-implementation of computerized systems developed to support targeted patient care. Objectives The aim of the BIORHEUMA (BIOlogic treatment of patients suffering from inflammatory RHEUMAtic disorders in Norway) project was to implement the use of validated outcome measures and the T2T strategy in daily clinical practice by the use of a designated computerized system. Further to obtain unselected real life data on clinical status and treatment practices in patients with inflammatory rheumatic joint disorders. Methods From the start of the BIORHEUMA project in 2009 the participating departments were to include and monitor patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), in particular patients on biologicsusing the GoTreatIT Rheuma system (www.diagraphit.com). This abstract present data on how many patients have been registered at the participating centers in 2010 and in 2011 and the estimated theoretical maximal number of patients eligible for assessment. Results End of 2011 10 out of 16 eligible rheumatology departments (≥3 rheumatologists) were participating, serving approximately 3/4 of the Norwegian population (3.7 million aged >20 years). In 2010 a total of 8059 RA, 1596 PsA and 1925 AS patients had been registered. The figures for 2011 were 10363 for RA, 2612 for PsA and 3072 for AS. The total number of patients possible to include calculated from published prevalence figures in Norway for RA (∼0.5%), PsA (∼0.2%) and AS (∼0.2%) would be for the complete country/participating departments ∼18500/13875 for RA, ∼7400/5550 for PsA and ∼7400/5550 for AS. The current completeness of the GTI platform end of 2011 is thus about 75% for RA, 47% for PsA and 55% for AS. The most successful departments including patients in the BIORHEUMA project are using nurses and health care secretaries in addition to physicians to collect data and update the database in the daily follow up practice of patients. Conclusions Our experience with the BIORHEUMA project is thatclinical patient-monitoring and establishing patient registries can successfully be achieved in one work flow when facilitated by the use of designated computerized system. This way of working catching “real life data” improves patient care on the individual and on the group level and comply with the demands from health authorities to provide efficient care and report on quality. References Grigor C, et al. Lancet. 2004;364:263-9. Smolen JS, Aletaha D. ARD 2004;63:221-5. Pincus T et al. J Rheumatol 2005;32:575-7. Disclosure of Interest E. Rodevand: None Declared, E. Haavardsholm: None Declared, L. Bader: None Declared, K. Haaland: None Declared, C. Gjesdal: None Declared, B. Storesund: None Declared, H. Gulseth: None Declared, A. Proven: None Declared, K. Mikkelsen: None Declared, G. Haugeberg Shareholder of: DiaGraphIT manufacturing GoTreatIT, Consultant for: DiaGraphIT manufacturing GoTreatIT