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Background: Despite advances in the treatment of rheumatoid arthritis (RA), pain and psychological symptoms remain a burden for many patients. The precise relationship between inflammation and patient reported symptoms, such as pain, fatigue and mental health in the disease is unclear. However, evidence suggests that over time there may be discordance between inflammation and patient reported outcomes, such that some patients with low inflammation will experience persistent symptoms. It is hypothesised that three distinct patient sub-groups exist; low inflammation/low symptoms, low inflammation/high symptoms, and high inflammation/high symptoms. Objectives: To identify sub-groups of patients with respect to inflammatory markers and levels of P&PS over time. Methods: Demographic, clinical and laboratory data were recorded at baseline (pre-treatment), 6, 12, and 18-months from 239 early RA patients recruited to the Towards A Cure for Early Rheumatoid Arthritis (TACERA) cohort. Individual components of the DAS28 (tender joints, swollen joints, ESR, CRP and patient global) at post-treatment assessments, along with patient reported visual analogue scales for pain, fatigue and the SF-36 Mental Component Score (MCS) were used to identify sub-groups using longitudinal latent class analysis (LCA). Logistic regression models identified variables associated with class membership at 6, 12 and 18-months follow-up. Results: LCA indicated two rather than the hypothesised three sub-groups; low inflammation/low symptoms and low inflammation/high symptoms. This was likely because ESR and CRP were well controlled by 6-months and maintained by 18-months for the majority of individuals. There were 86 (36%) 59 (35%) and 41 (39%) classified as having high symptoms at 6, 12 and 18-months. 78% of patients initially in the low symptom group remained in the low symptom group between 6 and 18-months. Rheumatoid Factor (RF) positivity and higher baseline fatigue were associated with high symptoms at 6months; decreasing ESR from 6 to 12-months was associated high symptoms at 12months, and having high symptoms at 12-months, along with reduced Swollen Joint Count (SJC), CRP and MCS from month 12 to 18 was associated with high symptoms at 18-months. Conclusion: Tight treatment control resulted in controlled Inflammation by 6-months, resulting in just two main patient sub-groups; those with low and high P&PS. Over one-third of patients experienced high pain and psychological symptoms. Membership of the high symptom group was associated with RF positivity but was mainly driven by prior symptom experience. Whilst inflammatory control remains a primary target, other treatments targeting pain, fatigue and mental health must be considered to reduce the burden of disease. Disclosure of Interests: Lewis Carpenter: None declared, Katie Bechman: None declared, Andrew Cope: None declared, Elena Nikiphorou: None declared, James Galloway Consultant for: Pfizer Inc, Sam Norton: None declared

Background: Polypharmacy is a considerable problem in people with rheumatic diseases, including rheumatoid arthritis (RA), related amongst others to worse disease outcomes and increased cost for the health-system (1). Objectives: To assess polypharmacy in RA and usage of the health-care system (outpatient clinics) in a real-world setting. Methods: Medical records of 170 consecutive RA patients from a large outpatient service of a central hospital were retrospectively reviewed. Demographic characteristics, treatment for RA and comorbidities as well as frequency and type of visits to any outpatient services were recorded. The latter included rheumatologists, “medical specialties” doctors (general physicians, cardiologists, respiratory physicians, oncologists, dermatologists, gastroenterologists, hematologists, nephrologists and neurologists) and “surgical specialties” (general surgery, orthopedics, neurosurgery, urology, ophthalmology, ENT, maxillofacial and vascular surgery). Disease duration was defined as the time between RA diagnosis and the end of the study (May 2018). Univariable and multivariable analyses were performed (Table). Results: Data from 170 RA patients (77.1% female) with a mean±SD age of: 62.1 ± 13.7 years and disease duration: 87.8 ± 22.0 months, were recorded. The median number of non-rheumatic drugs receieved througouht disease duration was 3. Only 7% of the patients were not receiving any additional drugs, while 15.3%, 40.6% and 56.4% had received 1, 2 and 3 non-rheumatic drugs, respectively. The most commonly used non-rheumatic drugs were, anti-hypertensive, anti-osteoporotic and lipid-lowering drugs. Higher total number of drugs correlated with age of the patient and longer disease duration. Methotrexate (MTX) experienced or biologic-naive patinets, had received a larger number of non-rheumatic drugs compared to those who had not received methotrexate or were biologic-experienced. Multivariable analysis confirmed age and exposure to methotrexate/biologics to be positively and negatively association respectively, with the number of non-rheumatic drugs received (Table). Number of visits to rheumatologists/year were: median (range) 2.9 (0.5 – 13.6). The number of visits was correlated with age of the patients, disease duration and number of non-rheumatic drugs received. Multivariable analysis, identified, disease duration, number of non-rheumatic drugs received and being MTX-naive as predictors of number of rheumatology visits (Table). Number of visits to non-rheumatologists/year were: median (range) 1.8 (0.0 – 13.7). Visits to “internal medicine” doctors were more common than in “surgical specialties” doctors (p Conclusion: The majority of RA patients received more than 3 (non-RA related) drugs. This increased with older age and associated with more frequent visits to rheumatology and other specialties. References [1] Filkova M, et al. J Rheumatol. 2017 Dec;44:1786-1793 Disclosure of Interests: None declared

Background: Rheumatology is a rapidly advancing specialty. The increasing understanding of autoimmune mechanisms and advanced therapies have improved care for patients with chronic inflammatory conditions immensely. National and international collaborations are growing and are key to scientific developments. Still, the number and geographical distribution of rheumatology organizations globally, is not known. Objectives: To gain further insights into the distribution of established and young rheumatologists’ organizations beyond Europe. Furthermore, we intended to explore correlations between presence of rheumatology organizations and demographic and socio-economic parameters. Methods: A systematic online search was performed independently by three investigators (AN, SS, JS). Keywords used in the search related to three main themes (i) Rheumatology (rheumatology or rheumatologist(s) or rheumatism), (ii) Organizations (associations or young organization or society or group or association or league or federation) and (iii) country’s name. All identified rheumatology organizations worldwide were reported. Countries were grouped in eight regions according to their geographic location. General demographic information (including population, area, pop. density, net migration, infant mortality, GDP, literacy, phones, arable, crops, climate, birth-rate, death rate) was retrieved from World Bank Open Data by one extractor (SS). Descriptive statistics and quartile distribution for each analysed variable were performed using ExcelR (Microsoft Office) and SPSSR software R, using the total number of countries per region as the denominator. Results: Four international societies and three junior international organizations (EMEUNET, PANLAR joven, ALPAR Young rheumatologists) were identified. Out of the 227 countries assessed, 89 national rheumatology societies (39%) and seven junior national organizations were identified (n=4, 2%). Rheumatology societies were more frequent in Eastern Europe (n=18/27, 67%), Middle east (n=10/15, 67%) and Western Europe (n=19/29, 66%) (Figure 1). Rheumatology societies were more frequently found in countries in the upper quartiles (Q1) of population density, gross domestic product and literacy when compared to Q2-4 (as assessed for each variable, p Conclusion: National rheumatology societies were identified in less than half the countries across the globe and were unequally distributed. We only found 7 national young organizations. Such organizations are needed, as trainees can highly benefit from educational and networking offers. Further steps will include the exploration of the impact and the reasons for lack of such establishments in some countries. Disclosure of Interests: Aurelie Najm: None declared, Julia Spierings Grant/research support from: Boehringer Ingelheim, Savino Sciascia: None declared, Elena Nikiphorou: None declared, Alexandre Sepriano: None declared, Alessia Alunno: None declared

Background Acquisition and maintenance of competences by Health Professionals in Rheumatology (HPRs) is important to ensure the best care for people with rheumatic and musculoskeletal diseases (RMDs). HPRs’ competencies have never been systematically evaluated, nor international recommendations provided. A EULAR Task Force (TF) was formed for this purpose. Objectives To perform a systematic literature review (SLR) on the core competences of HPRs with a focus on nurses, physiotherapists (PT) and occupational therapists (OT) to inform the “EULAR recommendations for the generic core competences of Health Professionals in Rheumatology” Methods Thirteen main themes identified by the TF and translated into research questions, formed the basis of the SLR. Existing literature was systematically evaluated using the following databases (PubMed/Medline, Embase, Cochrane library, CENTRAL, Emcare, PsycINFO, Academic Search Premier, Web of Science, Google Scholar, ERIC and National Science Digital Library) from 1/1/1990 to 20/02/2018. Relevant search terms for competences, RMDs and HPRs were used. In addition, EULAR HPR national presidents were invited to share any documents describing HPRs’ competences. Inclusion criteria were: studies on competences or roles, knowledge, attitudes, skills or educational needs relevant for the management of people with RMDs, of HPRs in general or specifically of nurses, PTs or OTs, at post-graduate level. Exclusion criteria were: HPRs’ competences for children’s care or for concurring co-morbidities; extended roles of HPRs; a very specific clinical intervention or an intervention clearly attributable to only one profession or studies written in a language other than English or Dutch. All abstracts were screened to identify eligible studies for full text inclusion. The methodological quality of the studies was scored using appropriate tools (Table). Results From 591 unique references reviewed, 79 studies were included. Twenty studies addressed competences of multiple HPRs. The methodological quality of most papers was high to medium (Table). The identified studies underpinned a range of HPRs’ competences, including: communication skills, promotion of physical activity, basic knowledge about RMDs and education of patients and other health providers. Competences more relevant to specific professions (e.g musculoskeletal system examination skills for PTs and assessment of house and work environment for OTs) were also recorded. Heterogeneity in the HPR desired competences and practice across countries highlighted the need for further education of HPRs to acquire certain competences. Conclusion High-quality literature is available on the competences of HPRs for the management of people with RMDs. This literature supports the formulation of evidence-based recommendations for the core competences for HRPs by a EULAR Task Force. Disclosure of Interests None declared

Background Rheumatoid arthritis interstitial lung disease (RA-ILD) is a rare but significant manifestation of RA, with high mortality. Methotrexate (MTX) is known to cause hypersensitivity pneumonitis, but its effect on the onset of RA-ILD is less clear. Objectives To assess predictive factors for rheumatoid arthritis interstitial lung disease (RA-ILD) in two early RA inception cohorts with a focus on MTX exposure. Methods Patients with new diagnosis of RA recruited to the early RA study (ERAS) and the early RA network (ERAN). Standardised data including demographics, drug therapies and clinical outcomes including the presence of RA-ILD were collected at baseline, within 3- 6 months, at 12 months and annually for up to 25 years thereafter. Primary outcome was the association of MTX exposure with incident RA-ILD. Secondary outcomes were the association of demographic, comorbid and RA specific factors on incident RA-ILD using univariate and multivariate analyses and the association of MTX exposure on time to RA-ILD diagnosis using time to event Cox proportional hazards analysis. Results Of 92 eligible ILD cases, 39 occurred in 1578 (2.5%) MTX exposed and 53 in 1114 (4.8%) non-MTX exposed cases. The primary analysis of incident RA-ILD cases only developing after any csDMARD treatment (n=67) showed MTX exposure not to be associated with incident RA-ILD (O.R. 0.85 CI 0.49, 1.49 p=0.578) and a non-significant trend for delayed ILD diagnosis (O.R. 0.54 CI 0.28, 1.06 p=0.072) (see Figure). In an extended analysis including all RA-ILD cases (n=92, including those present pre csDMARD exposure), MTX exposure was associated with a significantly reduced risk of incident RA-ILD (O.R. 0.48, CI 0.3, 0.79 p=0.004) and longer time to ILD diagnosis (O.R. 0.41, CI 0.23, 0.75 p=0.004). Other independent baseline associations with incident RA-ILD were higher age of RA onset, ever smoking, male gender, rheumatoid nodules and longer time from first RA symptom to first out-patient visit (see Table). Conclusion In ERAS/ERAN, incident RA-ILD is significantly associated with older age of RA onset, ever smoking, nodules, RF positivity, male gender, ESR, and a longer time from first RA symptoms to first secondary care visit. There is no association between MTX treatment and incident RA-ILD. MTX may have a protective role in delaying the onset of RA-ILD. Acknowledgement All recruiting ERAS and ERAN centers Disclosure of Interests Patrick KIELY Paid instructor for: Amgen, Gilead, BMS, Speakers bureau: Abbvie, BMS, UCB, Lilly, Pfizer, Amanda Busby: None declared, Elena Nikiphorou: None declared, Keith Sullivan: None declared, Adam Young: None declared

Background Rheumatoid arthritis (RA) is characterized by symmetrical involvement of small and large joints. New treatment modalities have not only allowed to achieve clinical remission or low disease activity, but also to halt the radiographic progression of joint destruction. In some patients, the disease progresses and leads to joint destruction despite treatment with disease-modifying antirheumatic drugs (DMARDs). Occasionally, wrist arthritis leads to severe destruction of carpal bones with ankyloses, so-called “os carpale”. Severely destructive wrist arthritis in an asymmetrical, unilateral pattern has only rarely been reported in the literature and has not been systematically assessed (1). A severely destructive yet often symmetrical arthritis has been described in seronegative RA patients (2). Objectives To systematically analyze the presence of severely destructive unilateral wrist arthritis in a single-center, seropositive RA population and to identify risk factors for its development. Methods This is a single-center retrospective cohort study using routine clinical data. We performed a database search of our RA population for the presence of rheumatoid factor (RF) and/or anti-CCP antibodies (ACPA) from 2011 to 2017. Radiographs were assessed independently by two investigators for the presence of severely destructive unilateral wrist arthritis. Discrepancies were resolved by discussion. Epidemiological data including age, gender, disease duration, occupation, dexterity and smoking status were recorded. Patients with psoriasis, a family history of psoriasis or posttraumatic osteoarthritis were excluded. Past and current treatments were recorded. Conventional radiographs of the hands were scored using the modified Sharp score, magnetic resonance images were examined if available. Results We identified 1247 patients with either positive RF, ACPA, or both. After exclusion of non-RA diagnoses and radiograph review, 17 eligible patients were included in the study. Of these, 7 were excluded because of incomplete clinical data. All of the remaining ten patients were female (100%). Median age was 58.1 years (33-70), median disease duration was 15.5 years (1-22). Seven patients were right-handed, one was left-handed, in two patients, dexterity was not known. Six patients were smokers, two patients were non-smokers, in two patients, smoking status was not known. Median ACPA levels were 134,6 IU/ml (normal range Conclusion Severely destructive unilateral wrist arthritis represents a rare phenotype of RA. In our cohort, this type of joint involvement was only present in women, it occurred primarily in the dominant hand (75%), and in smokers (75%). The mean number of used DMARDs was very high. Further studies for assessing the prevalence of this entity, also in seronegative patients, are required. References [1] Cassone, et al. (2004), Clinical and Experimental Rheumatology [2] Nikiphorou, et al. (2016), BMC Musculoskeletal Disorders Disclosure of Interests Viktor Korendovych Consultant for: Novartis, Radovan Vasko Consultant for: Novartis, Speakers bureau: Lilly, Elena Nikiphorou: None declared, Jan-Gerd Rademacher: None declared, Gerhard A Muller Grant/research support from: Novartis Boehringer-Ingelheim, Consultant for: Lilly, PETER KORSTEN Grant/research support from: Novartis Boehringer-Ingelheim, Consultant for: Novartis Pfizer Lilly, Paid instructor for: Chugai, Speakers bureau: Novartis

Background Smoking and systemic inflammation have been shown to independently associate with radiographic spinal progression in patients with axSpA. Furthermore, evidence suggests that certain socioeconomic (SE) factors (e.g. physically demanding jobs) may modify these associations, but clarity on the intricate relationships between smoking, axial damage and SE factors is yet to be achieved. Moreover, the impact of smoking and SE factors and their interplay on axial inflammation have not been thoroughly investigated to date. Objectives To investigate the relationship between smoking and imaging outcomes (SI joints, spine, MRI and radiographs) over time in axSpA and to assess if SE factors first modify and if not, confound, such a relationship. Methods Patients with axSpA from the DESIR cohort who fulfil the ASAS axSpA classification criteria were included. Four imaging continuous outcomes (X-ray spine [mSASSS, range 0-72]; X-ray SIJs modified New York grading [mNY, 0-8]; MRI-Spine [SPARCC, range 0-414] and MRI-SIJ [SPARCC, range 0-72]) have been scored by 3 central readers independently (average score used) in one session, blinded for time order (baseline, 2 and 5 years). Smoking, the main variable of interest, was tested as a binary variable to indicate smoking status since last visit. SE variables tested were: age, gender, ethnicity (Caucasian vs other), job type based on ‘collar’ (blue [manual labour work] vs white [office-based work]); educational status (low vs high [university]); marital status (married vs not) and parental (number of children) status. Potential interactions between smoking and SE factors were first investigated and, if statistically (p Results In total, 425 axSpA patients were included: 225 [53%] male, 167 [40%] smokers and 287 [68%] blue collar. The mean baseline (SD) MRI-SIJ SPARCC was 4.67 (7.85), MRI-spine SPARCC: 2.73 (7.95)); mSASSS: 0.39(1.66); mNY: 1.70(1.84)). A significant interaction was found between smoking and job type with MRI-SIJ inflammation as the outcome (p=0.031) as well as with mNY grading (p=0.096). Similarly, educational status also proved to modify the association between smoking and MRI-SIJ inflammation (p=0.026). In the multivariable models, smoking was significantly associated with more MRI-SIJ inflammation over 5 years of follow-up but only in patients with a blue-collar job (β [95% CI]: 3.35 [0.54,6.17]) (table). Results were similar in the low education stratum (β [95% CI]: 2.69 [0.48, 4.91]. Smoking was not significantly associated with any of the other imaging outcomes over time. Male gender was positively associated with MRI-SIJ inflammation regardless of job type, and also with MRI-Spine inflammation and structural damage although only for blue-collar patients in the case of SIJ damage. Conclusion There is a strong association between smoking and MRI-SIJ inflammation over time in axSpA patients with blue collar job type or with low education, irrespective of other socio-economic factors, systemic inflammation and treatment. These findings suggest a possible role for mechanical stress (seen with manual jobs) amplifying the effect of smoking on axial inflammation in axSpA. No significant relationship was found between smoking and spinal inflammation or axial damage, possibly also due to the limited imaging changes in this cohort. Disclosure of Interests Elena Nikiphorou: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Alexandre Sepriano: None declared, Adeline Ruyssen Witrand: None declared, Robert B.M. Landewe: None declared, Desiree van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Union Chimique Belge

Background: Smartphone applications and social media (SM) are increasingly used, transforming the way in which people communicate. Peer interaction, remote information access and community building are just some of the uses of SM, presenting novel opportunities and challenges, especially for people with chronic conditions such as rheumatic and musculoskeletal diseases (RMDs). Objectives: To explore the perspectives of people with RMDs on using SM for health-related purposes. Methods: A questionnaire-based survey, co-designed in English by rheumatologists and patient research partners and translated into German, Italian, Spanish, Russian, French and Portuguese, was issued between May and December 2018, distributed via patient organizations and SM platforms. We report on the main quantitative exploratory analyses. Results: A total of 992 participants started the survey; 853 (86%) participants reached at least 25 of 31 questions and were subsequently included in analyses. Participants were from 56 countries, with 50% from the UK, Germany, Portugal and Spain; 11% were outside of Europe. 60% of participants reported a good or very good experience in the use of SM. More than half (56%) were between 35 and 54 years, 90% were female, 37% had >1 RMD and 62% were multimorbid. The use of smartphones, SM, SM for health-related purposes was affirmed by 93%, 95% and 76%, respectively. They started this in particular to connect with other people living with the same condition (58%). In general, 50% use SM to seek medical information, treatment options and to exchange experiences. Facebook (58%), Google+ (17%) and YouTube (17%) were the top three used platforms for health-related purposes; while Facebook (88%), YouTube (50%) and Instagram (47%) were most popular for general use. Platforms, that are usually used are not always the preferred one for health-related purposes, since only 16% of Instagram, 28% of YouTube and 67% of Facebook users prefer the same for health-related purposes. The greatest advantage of SM is to acquire different experiences and exchange knowledge with peers. More than half voiced concerns regarding confidentiality and 21% were hesitant of disclosing their condition. Virtual appointments are still novel, since only 4% reported experience. SM use and education were comparable between groups with different levels of multimorbidity, although health was poorer (p=0.001) and they were older (p=0.001). Participants more frequently considered that information provided by primary care physicians was inadequate (p=0.014) and wanted to make their voice heard (p=0.006), but at the same time were more skeptical about reliability of information on SM (p=0.036). Conclusion: The use of SM for health-related purposes is widespread among people with RMDs, mainly as a means to connect and exchange knowledge and experience, thus empowering individuals to better self-manage their health. The strong concerns about confidentiality and better guidance of patients may improve health literacy and the relationship between the patient and the health care team, addressing new avenues and challenges in healthcare. Acknowledgement: We would like to thank PARE in their support distributing this survey study. Disclosure of Interests: Paul Studenic: None declared, Simon Stones Consultant for: SS has provided consultancy services to Envision Pharma Group, though this is not related to the contents of this abstract., Speakers bureau: SS has undertaken speaking engagements for Actelion, eyeforpharma, Four Health, Janssen and Roche, though these are not related to the contents of this abstract., Alessia Alunno: None declared, Valentin Ritschl: None declared, Elena Nikiphorou: None declared

Background In the expanding era of e-health, a wide range of mobile health applications (apps) have become available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking. Objectives The objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs. Methods A systematic literature review of app content and development strategies was conducted, followed by a qualitative study with six patients and an online survey of people living with RMDs (n=394). Based on these data and expert opinion, the PtC were formulated in a face-to-face meeting in November 2018 by a multidisciplinary TF panel of experts, including patients, from 10 countries. The level of agreement among the panel in regard to each PtC was established by anonymous online voting. Results Three overarching principles and 10 PtC were formulated (Table). Out of the 10 PtC, three were related to patient safety (1,5,6), considered as a critical issue by the panel, along with accuracy of information provided by apps. Three were related to relevance of the content and functionalities (2,7,9) and the importance of apps being tailored to the individual needs of people with RMDs. The requirement for transparency around app developers and funding sources (3,4), along with involvement of relevant health professionals were also raised. Ease of app access across ages and abilities was highlighted (8), in addition to considering the cost-benefit of apps from the outset (10). The level of agreement was high (Table). Conclusion These PtC provide guidance on important aspects that should be considered for the development of new apps, the quality assessment of existing apps, as well as for further development of existing apps. As part of the dissemination phase, these PtC will be shared with a larger group of health professionals, patients and app developers and for wider consensus. Acknowledgement EULAR for funding this project Disclosure of Interests Aurelie Najm: None declared, Elena Nikiphorou: None declared, Marie Kostine: None declared, Christophe Richez: None declared, John Pauling: None declared, Axel Finckh Grant/research support from: Bristol-Myers Squibb, Pfizer Inc, Consultant for: AbbVie, A2Bio, Bristol-Myers Squibb, MSD, Roche, Pfizer Inc, and UCB, Valentin Ritschl: None declared, Yeliz Prior: None declared, Petra Balazova: None declared, Simon Stones Consultant for: SS has provided consultancy services to Envision Pharma Group, though this is not related to the contents of this abstract., Speakers bureau: SS has undertaken speaking engagements for Actelion, eyeforpharma, Four Health, Janssen and Roche, though these are not related to the contents of this abstract., Zoltan Szekanecz Grant/research support from: Pfizer, UCB, Consultant for: Pfizer, Abbvie, Roche, Sanofi, Lilly, Novartis, Speakers bureau: Pfizer, Abbvie, Roche, Sanofi, Lilly, Novartis, Annamaria Iagnocco: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Francisca Sivera: None declared, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Loreto Carmona Grant/research support from: Abbvie, Actelion, Astellas, BMS, Eisay, Gebro Pharma, Grunenthal, Leo Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis and UCB Pharma, Paid instructor for: Novartis, Gerd Rudiger Burmester Consultant for: Roche, Sanofi-Genzyme, Speakers bureau: Roche, Sanofi-Genzyme, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Francis Berenbaum: None declared

Background Although patient-reported outcome measures (PROMs) are extensively used in clinical practice and research, it is unclear whether the most commonly used instruments adequately cover the perspective of young people with chronic inflammatory arthritis. Objectives To investigate whether the aspects important to young people with inflammatory arthritis are sufficiently covered by the PROMs that are widely used in clinical practice and research. Methods A qualitative, multicentre focus group interview study was conducted in Austria, Croatia, Italy and the Netherlands in order to inform a EULAR-funded taskforce. Three groups of young people (aged 18-35 years) with either (1) rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and Still’s disease, (2) psoriatic arthritis (PsA), or (3) axial spondyloarthritis (SpA) were interviewed at each centre. The interview guide was based on the WHO International Classification of Functioning, Disability and Health (ICF) to comprehensively cover all aspects of functioning in daily life. It also included questions on the perspectives and views of the participants on selected PROMs (Pain scales, Patient Global Assessment [PGA], FACIT Fatigue Scale, The Health Assessment Questionnaire [HAQ]/Bath Ankylosing Spondylitis Functional Index [BASFI], and The 36-Item Short Form Health Survey [SF-36]). All interviews were conducted by trained local investigators, audio-recorded, transcribed verbatim, and analysed using a modified form of ‘meaning condensation’. During a face-to-face meeting of the task-force members, the concepts were reformulated and organized into a scheme of higher and lower-level concepts. Results Thematic saturation was reached after 12 focus groups with 53 participants (21 with RA/JIA/Still’s, 15 with SpA, 17 with PsA; 72% female, mean age 28, SD±5), resulting in 18 hours and 22 minutes of recorded time and 269 pages of transcript. The analysis revealed aspects of functioning in daily life important to young people with inflammatory arthritis which were mentioned in all countries. Furthermore, 55 concepts emerged with regard to PROMs and were summarized into seven higher-level concepts. The table depicts these higher-level concepts including quotes from the interviews. Conclusion The evaluation of young patients’ perspectives should probably reach beyond the topics/aspects covered in the most commonly used PROMs. Accordingly, tailoring the assessments to specific needs of young people should be considered. Acknowledgement We would like to thank the participants for taking part in the study and for sharing their valuable perspectives. Disclosure of Interests Erika Mosor: None declared, Paul Studenic: None declared, Alessia Alunno: None declared, Ivan Padjen: None declared, Wendy Olsder: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Ilaria Bini: None declared, Nele Caeyers: None declared, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Marios Kouloumas: None declared, Elena Nikiphorou: None declared, Simon Stones Consultant for: SS has provided consultancy services to Envision Pharma Group, though this is not related to the contents of this abstract., Speakers bureau: SS has undertaken speaking engagements for Actelion, eyeforpharma, Four Health, Janssen and Roche, though these are not related to the contents of this abstract., Tanita-Christina Wilhelmer: None declared, Tanja Stamm Grant/research support from: TS has received grant support from AbbVie., Paid instructor for: TS has received speaker fees from AbbVie, Janssen, MSD, Novartis, and Roche.

Background Early career researchers (ECRs) across Europe face a number of challenges as highlighted by the European federation of education employers (EFEE) (1). Understanding the unmet needs of ECRs in rheumatology would allow development of targeted educational resources and support where required. Objectives To perform a Europe wide survey on the demographics of ECRs, current unmet needs and perceptions of possible solutions. Methods Clinical and non-clinical researchers who work in the field of rheumatology and under the age of 40, were invited to participate in an online-based survey. EMEUNET is a Europe-wide network of >2000 young researchers in rheumatology addressing educational needs and promoting research interests. Survey questions were devised and modified in collaboration with members of the EMEUNET education subgroup and steering committee. It was disseminated to EMEUNET members and national young rheumatology organisations. Participants were allowed to choose ≥1 answer options where applicable. Results 339 participants’ anonymised responses were collected from 53 countries. The majority of participants were between 31-35 years (38.1%) and female (63.4%). Most were clinical researchers (including 33.3% rheumatology trainees) and 24.1% were non-clinical, including allied health professionals. The area of research of the participants was as follows: Epidemiology (40.0%), basic science/translational (39.6%), clinical trials (38.1%), imaging (17.7%), health services research (14.7%), other (7.5%). 48.6% did not feel they had adequate educational resources to develop their research skills locally. Obtaining grant funding as ECRs was deemed to be difficult (43.3%) or very difficult (31.4%) in their respective institutions/countries. Reasons listed are presented in figure 1. 98% were interested in developing new European collaborations in their research area either through: face to face interactions at conferences (82.1%), website forum (50.8%), email interactions (61.1%), teleconferences (43.5%). In addition, 93.7% felt they would apply for small European grants for ECRs, 81.6% would be interested in funding to spend short periods (4-8 weeks) at another European institute and 87.5% in focussed deep dive sessions on a topic of interest. The top 3 research skills that participants felt they would benefit from having more resources for as ECRs were: 1. Writing a study protocol (64.9%), 2. Writing a first grant application (64.0%), 3. Performing a systematic review (51.1%) (Figure 2). Conclusion A large proportion of ECRs in rheumatology felt they lack resources to develop their research skills locally. Small grant funding, research opportunities for pan-European collaborations, short periods of exchange to other institutes and targeted support to develop research skills can help address some of the current needs of ECRs. References [1] Supporting Early Career Researchers in Higher Education: Summary report Feb 2015 https://www.ucea.ac.uk/en/empres/rs/ecr.cfm Disclosure of Interests None declared

Background Treat-to-target (T2T) principles in rheumatoid arthritis (RA) are now widely recognised as effective in achieving optimal disease outcomes. Objectives To examine for differences in outcomes between low (LDAS) and remission (RDAS) disease activity score (DAS) categories, addressing the question: is LDAS a ‘good enough’ treatment target in RA? Methods Data from two consecutive UK multi-centre RA inception cohorts with similar design were used: the Early RA Study (ERAS) and Early RA Network (ERAN). Recruitment figures/median follow up for ERAS and ERAN were 1465/10 years (maximum 25 years), and 1236/6 years (maximum 10 years) respectively. Standard demographic and clinical variables were recorded at baseline and then annually until the end of study follow up. Disease activity was categorised by mean DAS28 score between years 1–5 as remission [mRDAS Results Out of 2701 patients, 468 (17%) were in mRDAS, 284 (11%) in mLDAS in the first five years of disease. Lower proportions had achieved sRDAS (8%), sLDAS (6%) and Boolean (2%) remission. Mean age was similar across categories; more women were in low vs remission DAS. Compared to mLDAS or sLDAS, inflammatory markers, DAS, functional (HAQ, PCS) and mental (MCS) scores tended to be better in the mRDAs, sRDAS or Boolean remission categories (figure 1). Significant differences (p Conclusions The results demonstrate striking differences between remission and low DAS categories, suggesting worse functional and SF36 outcomes over time in the low DAS categories. This supports that remission should be the primary T2T goal in in RA. Disclosure of Interest None declared

Background Young clinicians and researchers frequently work alongside other medical specialists in order to share expertise, knowledge and skills. Multidisciplinary work is worthwhile but may be sometimes challenging. Objectives To describe current clinical and research collaboration among young specialists and to identify some perspectives to develop such collaborations. Methods An online survey was disseminated by email and social media (facebook and twitter) to members of the Emerging European League Against Rheumatism Network (EMEUNET), the Young Nephrologists’ Platform (YNP), the Paediatric Rheumatology European Society Emerging Rheumatologists and Researchers (PReS EMERGE), and the European Academy of Allergy and Clinical Immunology Junior Members (EAACI JM). Results Of 354 respondents from 40 countries, 60% were female, 23% were aged below 30 years and 67% 31–40 years. Young rheumatologists were the most represented (36%), followed by young nephrologists (24%), young paediatricians (18%), young allergologists (11%) then young internists (3%) and several other specialties (as clinical immunology, dermatology, pulmonology, orthopaedics). 60% were certified specialists, 34% in training and 6% were researchers without clinical work. Overall, the top 3 specialties for clinical collaboration in daily practice were radiology, cardiology and dermatology. Collaborations were reported frequently by phone and email, also by various combined clinics while common local multidisciplinary meetings were uncommon. Of note, 71% of respondents found collaboration with young colleagues easier than with senior specialists. Research collaboration usually started by knowing other specialists (73%) and/or by attending common meetings (39%). 96% would like to develop clinical research collaborations and 69% basic research collaborations. The majority of young specialists would be interested in online (84%) and/or 1–2 days (86%) common courses including cases discussion (80%) and training workshops (84%), as well as webinars recorded with several specialists on a specific disease (96%). Respondents were a bit less enthusiastic with developing collaboration through social media (facebook 61%, twitter 58%) but interested in common apps (71%). Conclusions This collaborative initiative highlighted wishes from young specialists for developing 1) regular local multidisciplinary meetings to discuss complex patients 2) clinical research collaboration with combined grants and 3) multidisciplinary online projects such as common courses, webinars and apps. Acknowledgements We thank all members of young organisations for their active participation. Disclosure of Interest None declared

Background Mobile health (mHealth) is exponentially growing in the current era, providing new potential and transforming the face of healthcare delivery. While the increasing availability of applications (apps) may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. Objectives To obtain an overview of existing mHealth apps for self-management in patients with RMDs, regarding content and development methods in particular, through a systematic literature review. Methods A search was performed up to December 2017 using EMBASE, Pubmed, Cochrane library, Web of Science and Psychinfo databases, with relevant key words and MeSH terms addressing three key domains: RMDs, self-management and mHealth. Double screening was performed on 15% of all abstracts against agreed inclusion criteria. For each publication relevant to an app for RMDs, the content, the aims, the target population of the apps and their development strategies were noted. The analysis was descriptive. Results Of 562 abstracts, 57 full text were screened. 39 articles were included in the analysis. 13 articles referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis patients (n=11), juvenile idiopathic arthritis (n=7) and osteoarthritis (n=8). The development process of the app was poorly described in 19/39 (48.7%) of the studies (figure 1). Only 6/39 (15.4%) included patients, and 14/39 (35.9%) included health professionals or physicians in the development of such apps. Moreover, a qualitative phase occurred in only 6/39 (15.4%) of the cases. The app was tested and evaluated by physicians in 6/39 (15.4%). Patients were more frequently involved in app evaluation (29/39, 74.4%) but mostly indirectly through their adherence to the app. Only few of the apps published on were commercially available (5/39, 12.8%), 4/5 are free. One app is currently under development. Conclusions The development process of most apps was poorly described and potentially not satisfying in many studies. Despite patient willingness to use mHealth apps for self-management of their RMDs, a strong effort needs to be made to provide a standard and ensure quality and safety of newly-developed apps. This work will further inform EULAR points to consider for development, evaluation and implementation of mobile health applications for self-management of RMDs by patients. Disclosure of Interest None declared

This lecture will focus on the case of a psoriatic arthritis (PsA) patient presenting primarily with entheseal disease rather than the usual poly-articular phenotype. The case discusses issues around misinterpretation of signs and symptoms leading to inappropriate diagnoses and failure to early disease recognition and therefore treatment. Consequences of delayed treatment and less typical presentations of PsA will be discussed in greater detail during the session, highlighting important diagnostic and management aspects of disease, relevant to routine clinical practice. Disclosure of Interest None declared

Background The treat-to-target (T2T) approach, with earlier, aggressive treatment has resulted in improvements in rheumatoid arthritis (RA) outcomes 1,2 . Whether these improvements have translated into improvements in patient reported outcomes is less clear. Studies have indicated declines in pain and function as well as depression and anxiety. However, these studies are limited to short follow-up periods or were restricted to cross-sectional, rather than longitudinal analyses. Objectives To assess changes in 5 year progression rates for disease activity and patient reported outcomes in a prospective cohort of early RA patients between 2002 and 2011. Methods The Early RA Network (ERAN) is a longitudinal prospective cohort study that recruited 1236 early RA patients from 2002 to 2011. DAS-28 and SF-36 were measured at baseline, 6 months, 12 months and then yearly. Multi-level linear regression were used to model 5 year progression rates of both DAS-28 and SF-36 in patients recruited between 2002–2011. Models controlled for sex and age and seropostivity at baseline. DMARD use at baseline was controlled for using propensity score weighting. Year of diagnosis was entered as a continuous variable, allowing for the mean of the outcome variables to be estimated for 2002 and 2011. Restricted cubic splines were used to account for non-linear progression over time. Results Disease activity for patients diagnosed in 2011 demonstrated a statistically significant decrease at year 5 compared to patients diagnosed in 2002 (5 year estimated mean difference −0.35; 95% CI 0.22–0.49, p 0.05). Mental health was similar to the normalised population mean of 50, irrespective of year diagnosed. However, levels of vitality/fatigue, function and pain remain less favourable for all early RA patients over the first 5 years. Conclusions Although disease activity has shown a marked decline at 5 years between 2002 and 2011, there is little evidence that this has led to improvements of an equivalent magnitude in function, pain, fatigue and mental health. Treatment should also focus on improved function, pain management, fatigue and mental health as part of the T2T protocol. References [1] Twigg S, et al. Fatigue, older age, higher body mass index and female gender predict worse disability in early rheumatoid arthritis despite treatment to target: A comparison of two observational cohort studies from the United Kingdom. Arthritis Care Res. (Hoboken). 2017. doi:10.1002/acr.23281 [2] Carpenter L, et al. Reductions in Radiographic Progression in Early Rheumatoid Arthritis Over Twenty-Five Years: Changing Contribution from Rheumatoid Factor in Two Multicenter UK Inception Cohorts. Arthritis Care Res. 2017;69. Disclosure of Interest None declared

Background Treatment of Sjogren’s syndrome (SS) has traditionally focused on conventional synthetic DMARDs (csDMARDs), with encouraging evidence on the benefit of biologic therapies emerging, mainly for treatment of SS extraglandular manifestations. Overlapping autoimmune diseases in SS are poorly studied; yet evidence primarily from case reports suggest a beneficial effect with biologics. Objectives To systematically review the literature on the treatment of SS with biologics, taking a focus on case reports and overlapping autoimmune conditions or extraglandular manifestations (defined here as those described in the EULAR SS disease activity index - ESSDAI). Methods A literature review was performed independently by two reviewers, using Pubmed and the following search terms: “Sjogren” or “Sjogren’s” AND any of the following: “biologics”, “Etanercept”, “Adalimumab”, “Infliximab”, “Golimumab”, “Certolizumab”, “Tocilizumab”, “Abatacept”, “Rituximab”, “Belimumab”, “Secukinumab”, “Ustekinumab” and “Anakinra”. Inclusion criteria were: articles in English; published until January 2018; case reports of patients with primary or secondary SS. Initial screening was based on title/abstract, followed by full-text review for articles fulfilling inclusion criteria. For articles written in a different language, information was obtained from abstract if available, otherwise excluded. Concordance in article screening was 95% across the two reviewers. Data extraction focused on reporting overlapping autoimmune diseases and extraglandular manifestations, treatment and response data. Results Out of 679 papers screened, 39 articles were included. 22 overlapping autoimmune conditions were reported in 22 SS patients (table 1). Most of the patients were treated with Rituximab (63.6%), while TNF-inhibitors (22.7%), Tocilizumab (9.1%) and Ustekinumab (4.5%) were also used. Concurrent treatment with csDMARDs and steroids was used in 28.6% and 42.9% of the cases, respectively. 61.9% and 13.6% of the patients were csDMARDs- and biologic- experienced, respectively. Good response of overlapping condition was seen in 86.4% of them, while in 13.6%, control or partial response was reported. Although, most of the studies do not mention the effect of biologic treatment on SS, general ‘improvement’ was mentioned in 4 cases, while arthritis was improved in 6 patients, 4 of which had secondary SS. In terms of extraglandular manifestations (e.g cryoglobulinemic vasculitis, interstitial nephritis) 18 were reported. 16 (88.8%) patients received Rituximab (one of them in combination with Belimumab), while 2 (11.1%) were treated with TNF-inhibitors. 11.1% and 61.1% of them received concurrent treatment with csDMARDS and steroids, respectively. 55.5% and 11.1% of the patients were csDMARDs- and biologics- experienced, respectively. Extraglandular manifestations responded well in the majority (83.3%) of the patients, with the remaining having partial or late response. SS and arthritis ‘improvement’ was mentioned in 5 and 1 patients, respectively. Table 1 Biologic treatments used for overlapping autoimmune conditions in SS patients. csDMARDs: conventional synthetic Disease Modifying Antirheumatic Drugs, NA: Not Applicable, Joints: improvement of arthritis. ^SS response was defined as clinical improvement of sicca symptomatology or improvement in ESSDAI. Improvement of arthritis was reported separately. † cases of secondary Sjogren’s syndrome (3 cases co-existing with RA and one case with SLE) Conclusions Treatment with biologic DMARDs, sometimes accompanied by steroids, appears to be beneficial also in treating overlapping autoimmune diseases as well as some extraglandular manifestations in SS patients. Disclosure of Interest None declared

Background Mesenteric panniculitis (MP), a rare fibrotic inflammatory disease of the bowel mesentery, can be a rare manifestation of IgG4-related disease (IgG4-RD). IgG4-RD is a chronic inflammatory disease most commonly affecting the pancreas, characterised by infiltration of IgG4-positive plasma cells and lymphocytes into various organs.1 We recently encountered a male patient with IgG4-related MP who was incidentally found to have a very high level of CA-125, which correlated with CRP levels and normalised after steroid treatment. This prompted a systematic literature review (SLR) to better understand this unexpected phenomenon. Objectives To investigate for associations between CA-125, MP and/or IGG4-RD, understand possible common pathophysiological mechanisms and explore potential clinical implications. Methods The SLR was performed using MEDLINE, EMBASE, Web of Science, and Scopus, looking for literature on either MP and CA-125 or IgG4-RD and CA-125 up to January 8 2018, using a comprehensive search strategy with relevant mesh terms and keywords linked to the above broad categories. Literature screening was performed by two independent reviewers. Results 24 unique citations were found, of which 13 were unanimously identified as relevant by the two reviewers. The final selected articles included: 8 case reports, 3 conference abstracts of case reports, 1 cohort study of 22 patients, and a retrospective study of 7 patients (table 1). CA-125 was raised in 22/40 patients in the identified reports (shown in red), including males, and was often the only elevated tumour marker (yellow). We also report on the presence of effusions (blue), as this may be linked to the causal mechanism. Table 1 The clinical and laboratory characteristics of cases of IgG4-RD and MP AI Autoimmune, AIH: Autoimmune Hepatitis, AIP: Autoimmune Pancreatitis, SM: Sclerosing Mesenteritis, ↑: Raised, ↔: Normal Conclusions To our knowledge, this is the first SLR exploring the association between CA-125 and IgG4-RD and MP. Despite the small sample, our results do indicate that CA-125 was raised in more than 50% of reported cases, the majority of which also had some kind of effusion. Although traditionally a marker of ovarian cancer, this report highlights that a raised CA-125 can be found in other, non-malignant, inflammatory conditions, and potentially correlates with inflammatory burden. CA-125 in this setting may thus represent a useful biomarker and have a role in monitoring treatment response. Reference [1] Minato H, Shimizu J, Arano Y, et al. IgG4-related sclerosing mesenteritis: a rare mesenteric disease of unknown etiology. Pathol Int. 2012;62:281–6. Disclosure of Interest None declared

Background Early, intensive treatment to achieve remission, or at least low disease target (Treat-to-Target, T2T), is advocated to prevent and/or reduce structural joint damage and disability in early Rheumatoid Arthritis (RA). A recent study shows how patients with moderate disease exhibit similar rates of functional disability and orthopaedic surgical interventions to those patients with high disease1. To our knowledge, no study has looked at longitudinal observational data to investigate the progression of structural joint damage in these patient sub-groups. Objectives To investigate the long-term progression of radiographic joint damage in patients with sustained moderate disease activity. Methods Demographic, clinical, laboratory and radiographic data from the Early Rheumatoid Arthritis Study (ERAS) was available for 1,465 patients. Radiographic damage was scored using the modified Sharp/van der Heijde (SvdH) method. The original three variable 44 joint count Disease Activity Score (DAS-44) was used. Mean DAS-44 over the first 5 years was estimated for patients with at least two DAS-44 scores. Patients were stratified based on EULARs thresholds of low ( 3.7) disease. Mixed-effects negative binomial regression modelled patients9 radiographic progression over 5 years, whilst controlling for key confounders, including age at onset, sex, rheumatoid factor status and baseline functional disability. Results A total of 1,110 patients with 3,751 observations over the 5 year period (mean =3.4 observations per patient) were analysed. 396 (36%), 363 (33%) and 351 (32%) patients were classified in the low, moderate and high DAS-44 groups respectively. The low group had lower SvdH scores at 1 year compared to the moderate group (12.9 vs. 19.2, p Conclusions Sustained moderate disease over the first five years of RA indicates similar levels of radiographic progression compared to sustained high disease. This study provides support on the importance of tight treatment control with early and aggressive therapy according to T2T principles. Preventing sustained moderate disease activity states can help reduce radiographic progression and consequently joint destruction, minimising the risk of disability in the long-term. References Nikiphorou, E. et al. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Ann. Rheum. Dis. annrheumdis–2015–208669 (2016). Disclosure of Interest L. Carpenter Grant/research support from: NIHR Programme Grant, S. Norton: None declared, E. Nikiphorou: None declared, K. Jayakumar: None declared, D. McWilliams: None declared, J. Dixey: None declared, P. Kiely: None declared, D. Walsh: None declared, A. Young: None declared

Background Spondyloarthritis (SpA) carries substantial financial costs, including direct costs (use of medical services and treatments) and indirect costs (loss of work productivity). While disease related factors have been repeatedly shown to be associated with work outcomes, information on the role of educational attainment and the economic wealth of the patients9 country of residence is scarce. Objectives To explore the role of individual and country level socio-economic (SE) factors on employment, absenteeism and presenteeism across 22 countries. Methods Patients with a clinical diagnosis of SpA, fulfilling the ASAS SpA criteria and in working age (≤65 years old) from COMOSPA were included. Outcomes explored were employment-status, absenteeism and presenteeism according to the Work Productivity and Activity Impairment Specific Health Problem (WPAI-SHP) questionnaire. Absenteeism and presenteeism were assessed in employed patients. Multilevel logistic (for work status) and linear (for absenteeism and presenteeism) regression models with random intercept for country were constructed. Independent contribution of individual (education) and country level socio-economic factors (country healthcare expenditures and gross domestic product (GDP) (all low vs medium/high tertiles) were assessed in models adjusted for clinical factors. Results In total 3,114 patients from 22 countries were included (mean (SD) age 40.9 (11.8) years; 66% males; and 63% employed). Of these, 89% had axial SpA and 11% a peripheral SpA. Unadjusted employment rates ranged from 28% (Colombia) to 83% (Canada). After adjustment for relevant socio-demographic and clinical variables, differences between countries in work status persisted (Figure). High healthcare expenditures were associated with higher employment (OR=2.42; 95% CI=1.53;3.81) and lower presenteeism (β=-4.53;CI=-8.90;-0.17). Similarly, higher GDP was associated with higher employment (OR=1.70; 95% CI=1.02;2.83), and in the same direction with presenteeism but without reaching statistical significance (β=-3.42;CI=-13.07;6.23). No significant association between any country SE indicators and absenteeism was found. At individual level, higher education was positively associated with employment-status, presenteeism and absenteeism. Conclusions Individual- and country-level SE factors affect work participation in SpA, and this varies significantly across countries. Better socio-economic welfare seems to support SpA patients to stay employed and productive. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is characterised by joint inflammation, resulting in functional impairment. Consequently, it has long been recognised that work disability is common in RA. However, despite significant pharmacological advances in disease control, little is known about contemporary impact upon work. Depression has emerged in recent years as a key comorbidity in RA. In the general population, depression is strongly correlated with work disability Objectives To establish the extent to which depression associates with work ability in RA in a cross sectional study. Methods Our hospital routinely collects data via an electronic screening interface, which incorporates a series of validated questionnaires, which patients complete via an iPad while waiting for their appointment. The dataset is linked to the clinical record. For this study, cross sectional data were extracted on adults with RA. Question 2 of the Work and Social Adjustment Scale (“Because of my [RA] my ability to work is impaired”) was used as a measure or work disability (scale 0–8). Mental health status was collected using the Patient Health Questionnaire-2 (PHQ), with a score≥3 considered a positive screen for depression. Results Of 385 patients with RA were included in the analysis. Their demographics are shown in the Table.1 Patients scoring 3 or more on the PHQ had more severe RA (higher DAS/HAQ), but there was no significant difference in age, sex or disease duration. 124 (32%) reported no work disability, with the overall mean score 3.0. Patients screening positive for depression had a significantly lower work ability even after adjusting for available confounders. Conclusions There is a significant correlation between depression in RA and work ability, which persists even after accounting for disease severity. The magnitude of association observed was even greater than that seen between physical function and work. Although unmeasured confounding remains likely, these data confirm the link between depression and work in RA. It is likely that the relationship is bidirectional, between depression and work in RA. Beyond the importance of addressing work ability in RA, the results highlight the need for screening and targeting depression as part of routine clinical care beside the holistic approach of mangement. Disclosure of Interest None declared

Background Nonadherence to treatment in rheumatoid arthritis (RA) has been shown to negatively impact on treat to target goals and disease outcomes. Identifying and targeting potential factors influencing nonadherence is therefore crucial in optimising patient management. Objectives To determine factors associated with nonadherence in patients with RA. Methods An electronic search was performed by two independent reviewers using MEDLINE and focusing on articles published from inception to January 2017. The search strategy combined the thesaurus (MeSH) and expanded keyword searches of two concepts: RA and treatment adherence. Inclusion criteria included observational studies and clinical trials examining potential factors associated with nonadherence. Exclusion criteria included articles not in English or without online access and those with a focus on forms of therapy other than medication. Agreement between raters at the screening stage was high (97%, kappa=.87). Results The primary search yielded 1411 papers, from which 75 were eventually identified as suitable for full review (Figure). Of the 75 papers, 65 were based on observational studies and 10 on clinical trials. Factors associated with nonadherence were broadly categorized into patient-related factors (socio-demographic factors, patient perceptions [beliefs/knowledge/attitudes]), disease-related factors (disease duration/severity, comorbidities, functional disability) and treatment-related factors (drug type/ method of administration/duration/regimen complexity, combination therapy). The majority (70% of all included studies) of studies reported significant associations between patient-driven factors and nonadherence. Adherence was found to be negatively associated with socioeconomic status, health literacy, and beliefs/perceptions/knowledge of the disease and treatment. Studies reported poorer mental health state (n=6) and greater disability/pain (n=7) to be implicated in nonadherence. Disease duration was largely non-significant in treatment adherence, although a few studies reported a negative correlation (n=3). Combining biologics with DMARDs was associated with improved adherence. However, considering non-biologic DMARDs only, adherence rates were higher amongst monotherapy users. One study identified polypharmacy to be negatively associated with adherence. Drug side effects were associated with nonadherence (n=7). Conclusions Patient-related factors including personal perceptions were among key contributors to nonadherence to medication in RA patients. This highlights the need for addressing patient-driven perceptions, along with disease and treatment Acknowledgements Many thanks to Simon Coates and Julia Garthwaite of Library Services at University College London for their advice. Disclosure of Interest None declared

Background The value of biologic DMARDs (bDMARDs) in SpA is well recognized but global access to these treatments can be limited due to high cost and other factors. Objectives This study explores variation in the use of bDMARDs in SpA across countries and to what extent socio-economic (SE) factors may explain variation. Methods Patients fulfilling the ASAS SpA criteria in the multi-national, cross-sectional ASAS COMOSPA study were studied. Multi-level logistic regression models with random intercept for country were constructed with current use of bDMARDs as the dependent variable. Contribution of socio-economic factors using country health expenditures and gross domestic product (GDP) (all low vs medium/high tertiles) as independent country-level factors, was explored in models adjusted for socio-demographic as well as clinical variables known to determine bDMARD-use in SpA. Results In total, 3370 patients from 22 countries were included (mean [SD] age 43 [14] years; 66% male; 88% axial disease). Across countries, 1275 (38%) were bDMARD users. Crude mean bDMARD-use varied between 5% (China) to 74% (Belgium). After adjustment for relevant socio-demographic and clinical variables, important variation in bDMARD-use across countries remained (Figure, p Conclusions There remains important residual variation across countries in bDMARD uptake of patients with SpA followed in specialized SpA centers. This is despite adjustment of well-known factors for bDMARD use such as clinical and country-level socio-economic factors. Disclosure of Interest None declared