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Introduction Psoriatic arthritis (PsA) is considered a multifaceted disease, with patients reporting low health-related quality of life (HRQoL). Data on disease burden are substantial and there exists a need for properly designed studies to learn more about the evolution of HRQoL in this condition. This study aims to identify factors associated to HRQoL evolution in PsA patients followed-up in a real-world setting in Spain. Methods We conducted a retrospective longitudinal observational study including incident patients from the rheumatology outpatient clinic of Hospital Clínico San Carlos (Madrid, Spain), diagnosed for the first time of PsA, defined as having received any ICD9/ICD10 diagnosis code of PsA, from 2007 to 2016, and followed-up until loss of follow-up, death, or November 2017. The influence of demographic and clinical variables in baseline HRQoL [assessed with the Rosser Classification Index (RCI)] was analyzed using bivariable and multivariable generalized linear models. The influence of those variables and of treatment-related factors in repeated measures of HRQoL was analyzed using bivariable and multivariable generalized estimating equations (GEE) models nested by patient. Results Two hundred and thirty patients were included in the analysis, with 3384 registered visits. At baseline, older age, a previous diagnosis of obesity, and the presence of enthesitis were significantly associated with worse HRQoL. During follow-up, using an exchangeable working correlation structure, the presence of enthesitis was also associated with worse HRQoL, coefficient (95% CI) − 0.006 (− 0.01 to − 0.002), p = 1.00E−03; conversely, treatment with methotrexate or antimalarials was associated with better HRQoL with 0.007 (0.001–0.014), p = 0.020 and 0.003 (0.001–0.005), p = 3.00E−03, respectively. Conclusions Musculoskeletal manifestations and comorbidities exert a deleterious effect in HRQoL of PsA patients. Therefore, the optimal management of this condition needs to also address these manifestations in order to try to restore the QoL of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00349-1.

Background To assess mortality rate (MR) and standardized mortality rate (SMR) of rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients and to evaluate the role of radiographic patterns in mortality. Methods A longitudinal multicentric study was conducted in RA-ILD patients from 2005 to 2015 and followed-up until October 2018 in Madrid. Patients were included in the Neumologia-Reumatología y Enfermedades Autoinmunes Registry, from diagnosis of ILD. The main outcome was all-cause mortality. The radiographic pattern at baseline [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), or others] was the independent variable. Covariables included sociodemographic and clinical data. Survival techniques were used to estimate MR, expressed per 1000 persons-year with their 95% confidence intervals [CI]. Cox multiple regression model was run to examine the influence of radiographic patterns on survival. SMR [CI] was calculated comparing MR obtained with MR expected in the general population of Madrid by indirect age-gender standardization. Results 47 patients were included with a follow-up 242 patients-year. There were 16 (34%) deaths, and most frequent causes were acute ILD exacerbation and pneumonia. MR was 64.3 [39.4–104.9], and 50% of the patients died at 8.3 years from ILD diagnosis. After adjusting for confounders, (UIP compared to NSIP was associated with higher mortality risk. The overall SMR was 2.57 [1.4–4.17]. Women of 60–75 years of age were the group with the highest SMR. Conclusions RA-ILD is associated with an excess of mortality compared to general population. Our results support that UIP increases the risk of mortality in RA-ILD, regardless other factors.

ObjectivesTo describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.MethodsAn observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.ResultsThe study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.ConclusionOur results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

ObjectivesTo asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated.MethodsA longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6–12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI.ResultsA total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI.ConclusionRA-ILD patients deteriorate over time, with the median time free of impairment being

OBJECTIVESTo describe persistent symptoms and consequences in Rheumatic and Musculoskeletal diseases (RMD) discharged from the hospital after Covid-19; to assess the roll of autoimmune rheumatic diseases (ARD) compared to and non-autoimmune rheumatic and musculoskeletal diseases (NARD) on persistent symptoms and consequences.METHODSWe performed a cross-sectional observational study. RMD attended at a rheumatology outpatient clinic in Madrid with Covid-19 that required hospital admission were included. The main outcomes were persistence of symptoms and health consequences related to Covid19 after discharge. Independent variable was RMD group (ARD and NARD) and covariates were sociodemographic, clinical, and treatments. We ran a multivariable logistic regression model to assess the risk by RMD group on main outcomes.RESULTSWe included 105 patients and 51.5% had ARD. 68.57% reported at least one persistent symptom. The most frequent were dyspnea, fatigue, and chest pain. 31 patients had consequences. Lung damage was found in 11.4% of the patients, 18% had blood test abnormalities (10% lymphopenia), two died, one developed central retinal vein occlusion and one patient developed optic neuritis. 11 patients required readmission due to Covid-19 problems (16.7% ARD vs 3.9% NARD; p=0.053). No statistically significant differences by RMD groups were found in the final models.CONCLUSIONMany RMD patients have persistent symptoms, similar to other populations. This study also highlights that lung damage is the most frequent consequence. ARD compared to NARD does not seem to differ in terms of persistent symptoms or consequences, although ARD might have a greater number of readmissions due to Covid-19.

Background: Acceptance has become one of the most widely studied processes regarding chronic pain because of its ability to influence participants' adaptation and coping responses. Leading researchers have found relationships between variables such as anxiety, reinforcement sensitivity, and the responses of the participants' environment to their behavior and acceptance. In contrast, few studies have been found that investigate the variables that predict the acceptance of pain. This study has set out to explore the relationships between pain-related anxiety, sensitivity to contingencies, and the punishment responses of significant people toward pain behaviors regarding pain acceptance.Methods: With a view to fulfilling this purpose, a cohort of 62 participants with rheumatoid arthritis was chosen, and the subjects were assessed through the following self-report measures: Chronic Pain Acceptance Questionnaire, CPAQ; Pain Anxiety Symptoms Scale, PASS-20; The Sensitivity to Punishment and Sensitivity to Reward Questionnaire, SPSRQ, and The West Haven-Yale Multidimensional Pain Inventory, WHYMPI. The study's initial objectives were achieved by means of a stepwise multiple linear regression analysis.Results: The linear regression analyses revealed a negative and significant correlation between anxiety, reinforcement sensitivity, and the significant persons' responses to pain behaviors and pain acceptance.Conclusion: The results suggest that the identification of these variables might be important for addressing these participants' pain. Finally, the discussion focuses on our findings' implications as regards their use in clinical practice.

Background: In this pandemia, it is essential for rheumatologist and patients to know the relationship between COVID-19 and inflammatory rheumatic diseases (IRD). We want to assess the role of targeted synthetic or biologic disease modifying antirheumatic drugs (ts/bDMARDs) and other variables in the development of moderate-severe COVID-19 disease in IRD. Methods: An observational longitudinal study was conducted (1stMar to 15thApr 2020). All patients from the rheumatology outpatient clinic from a hospital in Madrid with a medical diagnosis of IRD were included. Main outcome: hospital admission related to COVID-19. Independent variable: ts/bDMARDs. Covariates: sociodemographic, comorbidities, type of IRD diagnosis, glucocorticoids, NSAIDs and conventional synthetic DMARDs (csDMARDs). Incidence rate (IR) of hospital admission related to COVID-19, was expressed per 1,000 patients-month. Cox multivariate regression analysis was run to examine the influence of ts/bDMARDs and other covariates on IR. Results: 3,591 IRD patients were included (5,896 patients-month). Concerning csDMARDs, methotrexate was the most used followed by antimalarials. 802 patients were on ts/bDMARDs, mainly anti-TNF agents, and rituximab. Hospital admissions related to COVID-19 occurred in 54 patients (1.36%) with an IR of 9.15 [95%CI: 7-11.9]. In the multivariate analysis, older, male gender, presence of comorbidities and specific systemic autoimmune conditions (Sjoegren, polychondritis, Raynaud and mixed connective tissue disease) had more risk of hospital admissions regardless other factors. Exposition to ts/bDMARDs did not achieve statistical signification. Use of glucocorticoids, NSAIDs, and csDMARDs dropped from the final model. Conclusion: This study provides additional evidence in IRD patients regarding susceptibility to moderate-severe infection related to COVID-19.

We developed and independently validated a rheumatoid arthritis (RA) mortality prediction model using the machine learning method Random Survival Forests (RSF). Two independent cohorts from Madrid (Spain) were used: the Hospital Clínico San Carlos RA Cohort (HCSC-RAC; training; 1,461 patients), and the Hospital Universitario de La Princesa Early Arthritis Register Longitudinal study (PEARL; validation; 280 patients). Demographic and clinical-related variables collected during the first two years after disease diagnosis were used. 148 and 21 patients from HCSC-RAC and PEARL died during a median follow-up time of 4.3 and 5.0 years, respectively. Age at diagnosis, median erythrocyte sedimentation rate, and number of hospital admissions showed the higher predictive capacity. Prediction errors in the training and validation cohorts were 0.187 and 0.233, respectively. A survival tree identified five mortality risk groups using the predicted ensemble mortality. After 1 and 7 years of follow-up, time-dependent specificity and sensitivity in the validation cohort were 0.79–0.80 and 0.43–0.48, respectively, using the cut-off value dividing the two lower risk categories. Calibration curves showed overestimation of the mortality risk in the validation cohort. In conclusion, we were able to develop a clinical prediction model for RA mortality using RSF, providing evidence for further work on external validation.

Objective To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naive. Methods A cross-sectional study was performed in a sample including all regions and hospitals throughout the country. Sociodemographic data, disease activity parameters and treatment data were obtained. Resource utilization for two years of study was recorded and we made costs imputation. Correlation analyzes were performed on all RA patients and those treated with biological and biological naive, to estimate the differences in resource utilization. Factors associated with increased resources utilization (costs) attending to treatment was analyzed by linear regression models. Results We included 1.095 RA patients, 26% male, mean age of 62 ± 14 years. Mean of direct medical costs per patient was €24,291 ± €45,382. Excluding biological drugs, the average cost per patient was €3742 ± €3711. After adjustment, factors associated with direct medical costs for all RA patients were biologic drugs (P = .02) and disease activity (P = .004). In the biologic-naive group, the predictor of direct medical costs was comorbidity (P Conclusion Our data show a remarkable economic impact of RA. It is important to identify and estimate the economic impact of the disease, compare data from other geographic samples and to develop improvement strategies to reduce these costs and increase the quality of care.

Background:Musculoskeletal diseases (MSKs) are the major cause of disability, affecting the patient’s daily activities as well as their Quality of Life (QoL).Objectives:To analyze in a cohort of patients with MSKs the influence of demographic and clinical predictors in repeated measures of Health-Related QoL (HRQoL) obtained from a departmental electronic health record (EHR)Methods:Patients attending the Hospital Clínico San Carlos rheumatology outpatient clinic (HCSC-MSK cohort) from April 1st, 2007 to November 30th, 2017 who were seen at least twice were included in this study. Visits separated more than one year from previous or next visit were excluded. Our primary outcome was HRQoL collected in each patient’s visit using the Rosser Classification Index (it ranges between 0 and 1, the higher value, the higher HRQoL. It is calculated as the combination of two subscales: disability and distress). Demographic and clinical variables, such as diagnoses, treatments, and comorbidities were included as predictors. Variable selection was carried out in 4 steps. First, we developed a bivariate Generalized Estimating Equations model, selecting those variables with a p-value < 0.15. Second, those with a pair-wise absolute correlation < 0.95 were carried to the next step. Third, multivariate GEE analyses were performed including clinical related variables, and those independently associated with our primary outcome were selected with a p-value < 0.15. At least one predictor of each multivariate analyses was included even if none of them had p-value < 0.15. In this case the one, with the lowest p-value was chosen. Fourth, a grid search approach was followed to determine the penalization value and a penalized GEE model was implemented including all selected variables and using an independence correlation structure. Those with an estimate greater than 10^-3 and a z-robust > 1.96 were considered to be independently associated with the HRQoL.Results:A total of 18,187 patients with 95,960 outpatient visits were included in this study. From the initial 410 predictors, 289, 241, 153, and 34 were selected in the first, second, third, fourth and fifth steps. The median age was 56.4 years. The major part of the patients were women (69.4%), and the medianRosservalue was 0.986. More common diagnoses, treatments and comorbidities were back pain, tendinitis, pain in joint; analgesia, gastric protector and NSAIDs; hypertension, dyslipidemia and diabetes respectively. The predictors with a greater negative impact in HRQoL were the use of 3rd level analgesics and azathioprine, a presence of kidney failure, fibromyalgia, and ischemic heart disease. Conversely, use of symptomatic slow action drugs for osteoarthritis, statins, lowering uric acid drugs, a diagnose of mixed connective tissue disease, and better HRQoL in the past six months were independently associated with a positive impact in the HRQoL.Conclusion:We have identified several diagnoses, treatments and comorbidites independently associated with HRQoL in a cohort of patients followed up in a rheumatology outpatient clinic. This represent a first step in the implementation of value-based care for MSK patients, as we can now review the procedures associated with a worse HRQoL in an attempt to improve them.References:Predictor selection. Dx: Diagnoses. DxE: Diagnoses Episode. DxTFT: Diagnoses Total Follow-up Time.DxTET: Diagnoses Total Episode Follow-up Time T: Treatment. DxE: Treatment Episode. DxTFT:Treatment Total Follow-up Time. DxTET: Treatment Total Episode Follow-up Time. XM: Comorbiditiesand Concomitant Treatments. DM: Demographics. HS: Health Status.Disclosure of Interests:None declared

Chronic pain is a complex experience that has now become a major public health issue. This has prompted many researchers to study attention, understanding it to be a crucial factor that allows altering the experience of pain, while attributing considerable importance to sustained attention. Accordingly, the main studies in this field stress the importance of emotion regulation processes and emotions on the perception of painful stimuli and attentional processes themselves. Nevertheless, only a handful of studies have been found that directly study the relationship between these variables. Within this context, this article sets out to analyse emotional regulation processes, emotional variables (depression and anxiety), the experience of pain, and age on the ability to maintain the vigilance response in a sample of patients with chronic pain. This involved selecting a sample of 49 patients with rheumatoid arthritis and examining their performance in an ad-hoc sustained attention test. With a view to complying with the study’s main purpose, the participants were also assessed through the use of the following self-report measures: the Beck Depression Inventory (BDI-I); the Hospital Anxiety and Depression Scale (HADS); the McGill Pain Questionnaire, and the Difficulties in Emotion Regulation Scale (DERS). Linear regression analyses revealed a significant impact of the aging process on the performance times in the attention task. Likewise, age and depression recorded a significant correlation with the mistakes made during the task. These results suggest that higher depression levels and an older age might be related to a worse adaptation to pain management techniques based on attention processes, such as mindfulness.

Objective To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Methods A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients’ association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. Results Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. Conclusions The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.

Background: This research describes the incidence and factors associated with opportunistic infections in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs). Methods: A retrospective longitudinal study was carried out from 2007 to 2018. We included RA patients treated with a tumor necrosis factor (TNF)-targeted bDMARD or non-TNF-targeted bDMARD from the start of bDMARDs. An independent variable was the development of an indicator of opportunistic infection after biological (IOIb) treatment. Secondary variables included sociodemographic, clinical, and treatments. We used survival techniques to estimate the incidence of IOIb, per 1000 patient-years (95% CI). We performed a Cox multivariate regression analysis model to compare the risk of IOIb. Results were expressed as a hazard ratio (HR). Results: A total of 441 RA patients were included, that started 761 different courses of bDMARDs. A total of 81% were women with a mean age at first bDMARD of 57.3 ± 14 years. A total of 71.3% of the courses were TNF-targeted bDMARDs and 28.7% were non-TNF-targeted bDMARDs. There were 37 IOIb (25 viral, 6 fungal, 5 bacterial, 1 parasitic). Nine of these required hospitalization and one died. The global incidence of IOIb was 23.2 (16.8–32). TNF-targeted bDMARDs had 25 IOIb, incidence 20.5 (13.9–30.4), and non-TNF-targeted bDMARDs had 12 IOIb, incidence 31.7 (18–55.9). In the multivariate analysis, glucocorticosteroids (HR 2.17, p = 0.004) and lower lymphocyte count increased the risk for IOIb (HR 0.99, p = 0.005). Conclusions: The incidence of IOIb due to bDMARDs was 23 cases per 1000 patient-years. Close monitoring should be taken in the RA patients treated with bDMARDs and glucocorticosteroids, mainly in elderly patients and those with a low total lymphocyte count at the beginning of bDMARD treatment.

Background The impact of comorbidity on the diagnosis, prognosis, and treatment of rheumatic diseases could be very high. However, several studies have depicted a sub-optimal assessment of comorbidity in these diseases. Objectives To generate common, simple and practical support materials (checklists, questionnaires and other complementary materials) for rheumatologists, health professionals and patients, in order to: 1) Assess comorbidity; 2) Identify and implement preventive procedures; 3) Define referral criteria to other health professionals, in patients with rheumatoid arthritis (RA), axial spondylitis (axSpA), and psoriatic arthritis (PsA). Methods This project was promoted by CONARTRITIS (Association of patients with arthritis), OPENREUMA (Multidisciplinary association of professionals dealing with patients with rheumatic diseases) and SORCOM (Rheumatology Society of the Madrid Region). A multidisciplinary team specialized in comorbidity in inflammatory arthritis was established (6 rheumatologists, 2 primary care physicians, 2 nurses, 1 internist, 1 psychologist). A qualitative study was performed following these phases: 1) Review of the GECOAR1, GECOAX2 and GECOAP3 projects, that were focus on the evaluation of comorbidity in RA, axSpA and PsA, as well as an exhaustive bibliographic search in Medline; 2) Generation of preliminary checklists (different versions and formats) to be used by health professionals and patients for the identification, management and prevention of comorbidity; 3) Patient focus group in which the preliminary patients checklist was evaluated and discussed; 4) Nominal group meeting in which the selected health professionals analyzed all the checklists and modified them taking into account the opinion of the patients; 5) External evaluation of the modified checklists by patients, health professionals and rheumatologists, all of them outside the project; 6) Generation of the final checklists based on everything collected in the previous phases. Results Three checklists for clinical practice were designed, two for health professionals (one to identify comorbidity, another on prevention/health promotion), one for patients. The comorbidity checklist includes, for example, the evaluation of cardiovascular risk factors, depression and anxiety, allergies or infections. The prevention checklist includes life style issues (smoking, diet, exercise), social life, sexuality, sleep, or oral hygiene. The checklists also specify the evaluation method (questions, specific questionnaire, etc.). Conclusion The use of specific checklists for the identification, management and prevention of comorbidity inpatients with RA, axSpA and PsA might contribute positively in their prognosis. References [1] Loza E, et al. Rheumatol Int. 2015 Mar;35(3):445-58. [2] Gonzalez C, et al. Reumatol Clin. 2018 Nov - Dec;14(6):346-359. [3] Torre-Alonso JC, et al. Rheumatol Int. 2017 Aug;37(8):1239-1248. Disclosure of Interests Santos Castaneda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Carlos M. Gonzalez: None declared, Maria del Carmen Castro Villegas Paid instructor for: MSD, Abbvie, Pfizer, Janssen, Lilly, Roche, Silvia Garcia-Diaz: None declared, Juan Carlos Hermosa: None declared, Cristina Lajas: None declared, Leticia Leon: None declared, Juan Carlos Obaya: None declared, Maria Rodero: None declared, Carmen Suarez: None declared, Virginia Villaverde: None declared, Juan Carlos Torre-Alonso: None declared

Background Fatigue is one of the most frequent symptoms in patients with rheumatoid arthritis (RA), affecting more than 80% of them. Despite being a very disabling symptom, the variables that predict it are still unknown. Objectives To identify potential factors associated with fatigue. Methods Cross-sectional study. 60 patients were included, patients were being followed up in the rheumatology outpatient clinic of Hospital Clinico San Carlos, Madrid, Spain. Data were collected between July 2018 and January 2019. All patients met the ACR/EULAR 2010 criteria and they were in treatment with Biological agents or Targeted Synthetic DMARDs. Main variable: Fatigue was assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS). Covariables: Sociodemographic, clinical, Disease-related variables and treatment. Statistical analysis. A descriptive analysis was carried out for the different variables. To identify factors independently associated to BRAF-MDQ a multivariable linear regression was applied. Results were expressed as β with their corresponding 95% CI. A value of p Results A total of 60 patients, comprising of 53 females (88%) and 7 males (12%) with a mean age of 56.45±11.89 years and mean disease duration of 14.11±7.79 years were evaluated. RF was positive in 60% of patients. 65% of the patients were in active on work and 23% were retired. Regarding comorbidities, 43% had dyslipidemia, 42% hypertension, 17% hypothyroidism and 15% depression. The DAS28-ESR and SDAI scores of the patients were 2.68 ± 0.86, 8.56 ± 5.96 respectively. The rest of the clinical, treatment characteristics, and the scores of the fatigue instruments used in the study are shown in Table 1. Physical dimension was the most affected according to patients, who perceive an average severity and affectation, and insufficient coping. The factors affecting the total BRAF-MDQ was evaluated in multivariate analyze Table 2. We found that patients with Disability (p Conclusion Fatigue is a substantial symptom in RA patients and should be evaluated on the daily clinical practice. The results of our study indicated that disability and type of treatment were the dominant factors in the experience and degree of fatigue. Disease activity (DAS28 and SDAI) was not associated to fatigue. The evaluation and management of fatigue should be one of the objectives in the treatment of patients with RA Disclosure of Interests None declared

Background: Psoriatic arthritis (PsA) is a chronic, progressive and inflammatory arthritis. It is consider a multifaceted disease, with a high impact on patient’s psychological and physical well-being, with patients reporting lower health-related quality of life (HRQoL). Data of burden of disease is substantial and even though there are some studies that identify risk factors with longstanding PsA, there exists a need for properly designed studies to learn more about the evolution of HRQoL throughout the follow-up in this condition. Objectives: To analyze the evolution on HRQoL in patients with PsA and to to evaluate factors that may influence this evolution. Methods: Retrospective longitudinal observational study including incident patients diagnosed with PsA from 2007 to 2016, and followed-up until loss of follow-up or December 2017; with at least two registered visits; having received any ICD9/ICD10 diagnosis code of PsA; and with symptoms onset after 16 years of age. Patients were collected from the rheumatology outpatient clinic of a tertiary hospital (Hospital Clinico San Carlos, Madrid, Spain). Clinical information was collected from a departmental electronic health record, including demographic, clinical, comorbidities, treatment, and HRQoL related variables (measured with the Rosser Classification index). The influence of these variables in repeated measures of HRQoL was analysed using bivariate and multivariate generalized estimating equations (GEE) models nested by patient. Those variables with a p-value Results: We included 187 patients, with a median follow-up of 3.6 years (interquarltile range: 0.8 to 6.3). 48% were women, with a median age at the onset of symptoms and diagnosis of 45 and 49 years, respectively. 86% of patients had a personal history of Psoriasis. Regarding clinical manifestations during the follow-up, 83%, 30%, 26%, and 22% of the patients presented with peripheral arthritis, inflammatory low back pain, enthesitis and dactylitis, respectively. In addition, they received treatment with nonsteroidal antiinflammatory medications (NSAIDs), oral glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) 71%, 52% and 82%, respectively. 20% received biological agents. The Rosser median value at the first visit was 0.986, with an slight increase alter the first 2 years and a decline after 5 years of follow-up (Figure 1). With respect to the variables independently associated with HRQoL during follow-up, the history of osteoporotic fractures (p = 8.1x10-18) and chronic obstructive pulmonary disease (p = 5.0x10-8) were associated with a poorer quality of life. Conversely, treatment with methotrexate (p=6.4x10-5), and the use of bone-forming agents (p = 7.8x10-4) were associated with better HRQoL. History of osteoporosis and use of biphosphonates and denosumab were also associated with HRQoL, although not significantly after p-value adjustment. Conclusion: We have identified different factors associated with HRQoL during the evolution of patients with PsA. We observed that the presence of certain comorbidities were independently associated with a worse HRQoL. In addition, regarding different treatments, the use of methotrexate and bone-forming agents were independently associated with a better HRQoL. Disclosure of interests: None declared

Background Fatigue is one of the most frequent symptoms in patients with rheumatoid arthritis (RA), affecting more than 80% of them. The experience of fatigue is multidimensional. Objectives To identify the factors associated with fatigue on its different subscales (Physical, Living, Cognitive and Emotional). Methods Cross-sectional study. 60 patients were included, they were being followed up in the rheumatology outpatient clinic of Hospital Clinico San Carlos, Madrid, Spain. Data were collected between July 2018 and January 2019. All patients met the ACR/EULAR 2010 criteria and they were in treatment with Biological or Targeted Synthetic DMARD. Main variable: Fatigue was assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Covariables: Demographic, clinical and treatment. Statistical analysis. A descriptive analysis was carried out for the different variables. To identify factors independently associated to BRAF-MDQ and its subscales, multivariable linear regression was applied. Results were expressed as coef with their corresponding 95% CI. A value of p Results A total of 60 patients, comprising of 53 females (88%) and 7 males (12%) with a mean age of 56.4±11.8 years and mean disease duration of 14.1±7.7 years were evaluated. RF was positive in 60% of patients. 65% were in active on work and 23% retired. Regarding comorbidities, 43% had dyslipidemia, 42% hypertension, 17% hypothyroidism and 15% depression. The DAS28-ESR and SDAI scores of the patients were 2.6±0.8, 8.5±5.9 respectively. The HAQ was 0,86 ± 7.7. The rest of the clinical, treatment characteristics, and the scores of the fatigue instruments are shown in Table 1. The factors affecting the BRAF-MDQ and its subscales was evaluated in multivariate analyzeTable 2. Our results shows a correlation between disability and the different dimensions (p Conclusion It is important to evaluate fatigue in a multidimensional perspective, each of the different subscales could be modulated by different factors. The results of our study indicated that disability predicts in all subscales of fatigue, however, other factors can configure different patterns of fatigue in RA patients, and identify them is key to the approach of this complex symptom. Disclosure of Interests None declared

Background:The COVID-19 pandemic continues worldwide and has had a strong impact on public health, quality of life and economy of the general population. To date, the number of infections and deaths are still increasing. From the beginning of the pandemic, efforts were intensified to identify risk factors for development of the severe form of COVID-19. In this sense underlying medical comorbidities have been shown to have a worse prognosis in these patients.Objectives:In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid – 19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions.Methods:An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and Covid-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid -19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI).Results:406 patients were included with RMDs and Covid- 19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68; [1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR IJD: 0.41 [0.21-0.51], p=0.01; OR non-autoimmune: 0.33; [0.18-0.61]; p=0.000). After adjusting by confounders, autoimmune RMD had higher risk of hospital admissions compared to the rest (OR: 1.75; [1.04-2.95]; p=0.03), and specifically systemic autoimmune condition had higher risk compared to IJD (OR of IJD 0.33; [0.14-.076]; p=0.009) and compared to non–autoimmune (OR non autoimmune 0.28; [0.13-0.59], p=0.001). Advanced age (OR: 1.10; [1.07-1.12], pConclusion:One third of the RMD patients infected with COVID-19 required hospital admission. This study shows that patients with autoimmune and specifically with systemic autoimmune conditions have a higher risk of hospitalization related to COVID-19. We also show that advanced age, male sex and a higher number of comorbidities can contribute to worsen the prognosis of the COVID-19 disease.References:[1]Jorge A, et al. Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study. Lancet Rheumatol. Ahead of print 2021.[2]Hyrich KL, Machado PM. Rheumatic disease and COVID-19: epidemiology and outcomes. Nature Reviews Rheumatology 2020; 17: 71–72.[3]Bonfá E, et al. How COVID-19 is changing rheumatology clinical practice. Nat Rev Rheumatol 2021; 17: 11–15.Disclosure of Interests:None declared

Background:Nowadays, many countries experience an urgent demand for rheumatologists and greater cost-effectiveness. Thus, different alternatives to conventional outpatient physician-led follow-up have been investigated. The alternative of community-based service delivery systems is intended to meet emerging needs, reducing the costs of hospital care and morbidity. In patients with long-term conditions, such as Rheumatoid Arthritis (RA), nurses are seen as essential in the delivery of promotion in self-care and decision-making, favoring the empowerment of patients.Objectives:To systematically investigate if the nurse led-care management (NLCM) education programs are beneficial in patients with RA.Methods:This is a systematic literature research publication on the following bibliographic databases: Medline, Embase and the Cochrane Central register of Controlled Trials from the beginning until 2019.Results:From a yield of 116 studies, 44 were included in the review. After quality assessment and exclusion of the lowest-ranked studies, 19 studies were analyzed. Outcomes were organized into six themes (1) disease activity; (2) adherence; (3)satisfaction; (4)treatment compliance, (5) depression and (6)quality of life. All studies had significant results in at least one of the outcomes.Conclusion:According to our results, we can conclude that, clinicians could benefit from support conducted by nurse in the management of these patients in tasks such as metrology clinic, participation in enforcement, self-administration, the correct dosage and side effects of treatments, and link the patient and other professionals or entities. It would therefore be advisable to conduct further studies to draw more accurate and reliable conclusions in this context.References:[1]Bech B, Primdahl J, Van Tubergen A, et al. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2020; 79: 61–68.[2]Uthman I, Almoallim H, Buckley CD, et al. Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East. Rheumatology International 2020; 1: 3.[3]Garner S, Lopatina E, Rankin JA, et al. Nurse-led care for patients with rheumatoid arthritis: A systematic review of the effect on quality of care. J Rheumatol 2017; 44: 757–765.Disclosure of Interests:None declared

Background:A better quality of care for chronic patients is only obtainable through multidisciplinary teams. In recent years, rheumatology nurses have been involved in the remote monitoring of aged Rheumatoid Arthritis (RA) patients, as their high levels of multi-morbidity and disability make routine contacts too complex for patients and caregivers. Nursing health care should be evidence-based and organized to optimize the professionals’ time.Objectives:To develop a pilot study of two Nursing Care Plans (NCP) in Rheumatology consultations for Rheumatoid arthritis patients, exploring the satisfaction, disease activity, adherence and quality of life of the patients.Methods:This is a non-randomised interventional study. All the stablished RA patients attending our clinics were offered one of the care plans, based on clinic characteristics, functional status, social needs, social support, preferences and health literacy. They are focused on three fundamental axes: adaptation, adherence and safety of the patient. We evaluated the two NCP that were created: (1) Elderly established RA face to face/phone visit, (2) Active young established RA face to face/phone visit. The study included a first baseline visit and a second visit at six months. Outcomes were adherence to treatment: using the Morisky Green questionnaire, disease activity; through the erythrocyte sedimentation rate (ESR), patient satisfaction; using the LOPSS questionnaire and quality of life: using the EUROQOL 5D questionnaire, Visual analog scale of the attention received and Visual analog scale of the care received. Final visit were compared to baseline visit in both groups. The paired Wilcoxon or McNemar test were used.Results:We included 48 patients, 16 from the NCP 1 and 32 from the NCP 2. All patients except one from the NCP 2 were followed-up and ended the study. The mean age of the participants was 56 years. 77.5% were women. 30.6% had an active smoking habit. 46% had universitary studies. 53.1 had an active labor situation. Regarding the main outcomes: a)Disease activity, a slight decrease in activity was observed between baseline and 6 months, but without statistically significant differences. b) Quality of life, we detected some improvement in all care plans in the EQ-index and in the Visual analog scale (VAE) but there were no statistically significant variations. c) Therapeutic adherence, we show the results in the Morinsky Green questionnaire. We obtained statistical significant decrease in the percentage of patients that forgot to take their prescribed medications after 6 months (p=0.04), and we also saw an increase in the percentage of patients taking medications at established times (up to 100% in all groups). d) Patient satisfaction with NCP obtained at the end of study, we used the LOPPS questionnaire. We obtained at six months a punctuation less than 1.5 (ordinal scale that 1 is good 5 is bad). e) Satisfaction of the care received by patients over the phone assessed at the end of study, it was almost 100%, being 75% of the patients scores 9 or over. f) Satisfaction with the care plans assessed at the end of study, the score given by patients was almost 90%, being 75% of the patients scores 8 or over.Conclusion:After applying the NCP in both groups, we found positive results after 6 months and mainly regarding the therapeutic adherence. The program was well evaluated by the patients in terms of satisfaction of the care provided.References:[1]Garner S, Lopatina E, Rankin JA, et al. Nurse-led care for patients with rheumatoid arthritis: A systematic review of the effect on quality of care. J Rheumatol 2017; 44: 757–765.[2]Uthman I, Almoallim H, Buckley CD, et al. Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East. Rheumatology International 2020; 1: 3.[3]Bech B, Primdahl J, Van Tubergen A, et al. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2020; 79: 61–68.Disclosure of Interests:Leticia Lopez Pedraza Grant/research support from: Pfizer, María Rodero Grant/research support from: Pfizer, Gloria Candelas Grant/research support from: Pfizer, Cristina Lajas Grant/research support from: Pfizer, Teresa Mulero López Grant/research support from: Pfizer, Ana María Perez Saez Grant/research support from: Pfizer, Leticia León Grant/research support from: Pfizer, Zulema Rosales Grant/research support from: Pfizer, Benjamin Fernandez Grant/research support from: Pfizer, Lydia Abasolo Grant/research support from: Pfizer, Luis Rodriguez Rodriguez Grant/research support from: Pfizer

Individualized treatment of rheumatoid arthritis (RA) based on genetic/serologic factors is increasingly accepted. Moreover, patients are more actively involved in the management of their disease. However, personality has received little attention with respect to perception of the need and adherence to treatment. Our objective was to evaluate whether patient personality was associated with the acceptance or rejection of more aggressive early treatment. We performed a cross-sectional study in two hospitals with early arthritis clinics where sociodemographic, clinical, and therapeutic variables are systematically recorded. Patients completed Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale and Pain-Related Control Scale. Aggressive treatment was considered if patients received more than two DMARDs or biological agents during the first year of follow-up. Multivariate logistic regression analysis was performed to determine predictors of aggressive treatment. One hundred seventy-six RA patients were included (80 % women, disease begin median age 55 years). Treatment was considered aggressive in 57.9 % of the sample. Scores were high in extraversion in 50.8 % of patients, neuroticism in 29.5 % and psychoticism in 14.7 %. Neuroticism was the only factor associated with aggressive treatment, which was less probable (p = 0.04, OR = 0.40). Neuroticism also decreased the possibility of receiving a combination of biologics and DMARDs (p = 0.04, OR = 0.28). Patients with high scores on neuroticism are more worried, obsessive and hypochondriac, leading them to reject more aggressive therapy. It is important to educate about their disease so that they will accept more aggressive approaches in clear cases of poor outcome.

Background:The overall occurrence of Herpes zoster (HZ) infections in patients with rheumatoid arthritis (RA) is greater than in the general population although is controversial whether the use of the different disease-modifying antirheumatic drugs (DMARDs) increases this risk.Objectives:To investigate the incidence and factors associate to HZ infections in patients with RA exposed to biologic agents (BA) and small molecule JAK inhibitors (JAKi), and to describe RA disease features at the moment of HZ infection.Methods:Retrospective longitudinal study was conducted. We included RA patients seen at the rheumatology outpatient clinic of tertiary hospital, commencing BA (anti-TNF therapy and no anti-TNF therapy) or JAKi from Jan 2007 until Dec 2017, and followed up until end of study (Dec 2019). The outcome of interest was the occurrence of HZ infection, the diagnosis of HZ events was based on the rheumatologist’s report. Covariables: sociodemographic, clinical, and concomitant treatments including glucocorticoids, conventional synthetic DMARDs (csDMARDs). Survival techniques were used to estimate the incidence of HZ (IR), per 1000 patient-year (PYs) with the respective Confidence Interval [95%CI]. Cox multivariate regression model to compare the risk of HZ was performed. Results were expressed in Hazard ratio (HR).Results:474 RA patients were included, starting 881 different courses of treatment (1954.86 patients-years of follow-up). 382 (80.6%) were women with a mean (SD) age of 56.9 (15.0) years at first BA. Across all groups of treatments, a total 18 HZ were recorded, events were non-serious and involved 1 or 2 dermatomes. The mean age (SD) at moment of the infection was 62 (11) years and 10 cases were on prednisone > 7.5 mg/day. 13 HZ cases (72.2%) occurred on treatment with anti-TNF treatment (6 with adalimumab, 4 with certolizumab and 1 with infliximab), 4 (22.2%) cases were on treatment with rituximab one occurred during tocilizumab prescription. The overall incidence of HZ was 9.20 cases per 1000PYs [5.80-14.61]. The crude IR was similar between gender, increased with age (Patients < 46 years: 2.17 [0.3-15.4]; >70 years 14.1 [5.8-33.8]), was higher with concomitant use of two csDMARDs (IR: 15.68 [7.8-31.7], and was similar between anti-TNF and non anti-TNF therapy. None HZ event was recorded in patients exposed to JAKi. In the multivariate analysis, age (HR: 1.05, p: 0.006), prednisone dose > 7.5 mg/day (HR: 2.83, p: 0.02) and the concomitant use of two csDMARDs (HR: 2.34 p: 0.039) increase the risk for HZ. Lymphopenia (HR: 2.6; p=0.06) achieved a trend and BA therapy dropped from the model.Conclusion:HZ incidence rate was 9.20 cases per 1000PYs, HZ occurrence in RA patients cannot be attributed solely to the current BA or JAKi treatment and other factors involved must be taking in count as age, concomitant DMARDs prescriptions, and use of glucocorticoids. Our data suggest that preventive strategies for HZ should be developed for patients with RA.Disclosure of Interests:None declared

Background:A proportion of patients with Interstitial Lung Disease (ILD) show autoimmune characteristics but do not completely meet the classification criteria for a definitive connective tissue disease. In order to unify the nomenclature and criteria to define this condition, the classification of patients with Interstitial Pneumonia with Autoimmune Features (IPAF) has recently been adopted (Fisher, et al).Objectives:To describe the sociodemographic, clinical, functional characteristics and therapeutic management of IPAF patients in clinical practice and to evaluate the incidence rate of functional respiratory impairment over time.Methods:A longitudinal observational study was performed. Patients with IPAF classification criteria (Fischer et al) were included from the time of ILD diagnosis (Feb 2017 to Sept 2018) and followed until loss of follow-up or end of the study (Oct 2019), in a multidisciplinary team, carried by a pneumologist and a rheumatologist in a Tertiary Hospital in Madrid. Main outcome: relative functional respiratory impairment: defined as decline in percent predicted forced vital capacity (FVC%) of ≥ 5% compared to the previous visit. Respiratory function was measured at baseline and every 6 months. Covariates: a) sociodemographic, b) clinical, c) radiological pattern (non-specific interstitial pneumonia [NSIP]; usual interstitial pneumonia [UIP], others); d) FVC%, DLCO%; e) laboratory tests; f) therapy used (glucorticosteroids, disease modifying antirheumatic drugs (DMARDs) and Biologic Agents). Statistical analysis: description of the sociodemographic, clinical, radiological, functional and treatment characteristics of the patients. Survival techniques were used to estimate the incidence rate (IR) of relative functional respiratory impairment, expressed per 100 patient-semester with their respective confidence interval [95 % CI].Results:17 patients were included with a mean follow-up of 3 ± 1.5 years, 70.6% were women with a mean age of 65±10 years. The most frequent IPAF classification criteria were: a) clinical: arthritis (50%), Raynaud`s phenomenon (33%) and mechanical hands (17%); b) serological: 65% had ANA ≥1/360; 31% FR> 40; 30% Anti-Ro positive; c) morphologic: 59% presented NSIP pattern and 29.4% was UIP. The baseline median FVC% and DLCO% were 89 [83-107.7] and 63 [50-79.8] respectively. During the study period, 94% received treatment: 87.5% glucorticosteroids, 68.5% mycophenolate, 56% azathioprine, 18.7% cyclophosphamide iv and 33% antifibrotics. During the follow-up (104.6 patient - semester), 15 patients presented relative functional respiratory impairment, with an IR of 23.8 [16.1-35.3]. After 14 months from IPAF diagnosis 50% of the patients had relative functional respiratory impairment. At the end of the follow-up, 50% showed a worsening of the DLCO%.Conclusion:IPAF patients are mostly women in their sixties. The most frequent clinical criteria are arthritis and Raynaud`s phenomenon and the serological were FR and ANAs. The most frequent radiological pattern was NSIP. The therapeutic management is mainly with glucorticosteroids, mycophenolate and azathioprine. At the beginning, patients have a slightly diminished lung function. These patients have significant functional impairment over time that will impact in their prognosis. Longitudinal and multicenter studies are necessary to advance in the knowledge and management of these patients.References:[1]Fischer A, Antoniou KM, Brown KK, Cadranel J, Corte TJ, du Bois RM, et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J [Internet]. 2015 Oct;46(4):976–87. Available from:http://www.ncbi.nlm.nih.gov/pubmed/26160873Disclosure of Interests:None declared

The study aims to analyze the association between the bone and cartilage/periarticular components of the radiographic joint damage and disability over the course of disease, in a cohort of rheumatoid arthritis (RA) patients from a day-to-day clinical practice. The secondary aim is to study the role of demographic and disease-related variables in this association. We performed a retrospective longitudinal study including 736 RA patients. Disability was assessed with the health assessment questionnaire (HAQ), and radiographic joint damage of hands and wrists with the Sharp van-der-Heijde score (total (SHS), erosion (ES), and narrowing/(sub)luxation (NSLS) components]. Generalized estimating equations models, adjusted by disease activity, demographic and disease-related variables, were used to test the relationship between SHS and medium-term (median value of the HAQs performed in the following year after each radiograph) and long-term (set of HAQ measures performed during follow-up, at least 1 year apart from the first x-ray) disability. Interaction terms between the SHS and demographic and disease-related variables were introduced in the models. To account for multiple testing, Bonferroni correction was applied. NSLS was independently associated with medium-term disability, even after Bonferroni correction. We observed significant and positive interactions between NSLS and age at x-ray, and with the ES. SHS showed no association with long-term disability. The cartilage/soft tissue component of the radiographic joint damage seems to exert a much more important role in medium-term disability than the erosive component. This association could be modulated by the age at the x-ray and by the magnitude of the erosive damage.

Background Psoriatic arthritis (PsA) benefits from DMARDs and to know more about the adverse drug reactions (ADRs) represent an advance for the management and safety of these patients in clinical practice. Objectives To evaluate the discontinuation due to ADRs of DMARDs used in PsA patients and to analyse the possible associated factors. Methods Retrospective longitudinal observational study. Subjects: inception cohort of patients from January 2010 to ,December 2014 and followed up to December 2016, diagnosed with PsA according to ICD-10code. Main outcome: discontinuation of conventional synthetic DMARDs (csDMARDs) and biological originator DMARDs (boDMARDS) due to ADR (moderate: drug suspension regardless of the repercussions, severe: hospital admission required or death). Covariables: sociodemographic and clinical. Statistical analysis: To estimate DMARDs discontinuation rates, survival techniques were used, expressing the incidence rate (IR) per 100patients*year with their respective CI at 95%. Multivariate Cox regression models were performed to analyse the factors associated with DMARDs discontinuation due to ADRs and results were expressed in Hazard ratio(HR) and 95% CI. Results 191 patients were included, with a follow-up of 379.70 Patients*year. 50.3% were male, mean age at diagnosis was 50±14.6 years old. 46.6% of the patients had a history of cutaneous psoriasis. HLA-B27 was positive in 20% of patients. Throughout the follow-up, all patients received csDMARDs and 23 used boDMARDs. Methotrexate(MTX) was the most used drug 69.7%. 30% were on combination therapy, the most frequent was antiTNF +MTX. There were 44 discontinuations due to ADRs, IR 11.59 [8.62–15.57] and 3 were severe, requiring hospital admission (two infections and one cancer), no deaths were recorded. Among the most frequent causes of discontinuation related to ADRs were digestive intolerance 32%, nonspecific manifestations 11%, infections 9% and abnormal transaminase levels 9%. Table1 shows the DMARDs discontinuation rates due to ADRs. In the final discontinuation model related with ADRs (Table2), we observed that distress, high disease activity, corticosteroids at diagnosis and combination therapy were associated with a higher rate of discontinuation. Conclusions The discontinuation rate due to ADRs was 11.59, although most of them did not have an important clinical impact. We have found some psychological, clinical and treatment factors that can modify the DMARDs survival on PsA patients. We also observed that MTX, seems to be safe in the treatment of PsA, presenting the lowest probability of suspension related to ADRs compared with the rest of treatments. Disclosure of Interest None declared

Background: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) may be associated with opportunistic infections (OI). Objectives: Our purposes were to describe the incidence of OI in Rheumatoid Arthritis (RA) taking bDMARDs, and compare the risk of OI between TNF-targeted and non-TNF-targeted biologics. Methods: Retrospective longitudinal observational study from 2007 to 2017. We included RA patients, diagnosed and followed in our outpatient clinic, whom started treatment with a TNF-targeted bDMARD [etanercept (ETN), golimumab (GOLI), certolizumab (CTZ), infliximab (IFX), adalimumab (ADA)], or non-TNF-targeted bDMARD [rituximab (RTX), abatacept (ABA), or tocilizumab (TCZ)]. According to microbiologist criteria, we consider OI when there was a positive culture (virus, fungus, bacterial, parasitary) or compatible symptoms that respond to specific treatment. The independent variable was the Type of targeted bDMARD: TNF-targeted vs non-TNF-targeted. Secondary variables: sociodemographic; clinical and other therapies. We used survival techniques to estimate the incidence of OI, expressed per 1000 patient-year [CI 95 %]. The exposure time was defined from the start date of each bDMARD to the development of an OI, loss of follow up or end of study (01/02/2017). We performed Cox multivariate regression models to compare the risk of OI between the types of bDMARD used. Results were expressed in Hazard ratio (HR). Results: 441 RA patients were included, starting 761 different courses of bDMARD treatment. 81% were women with a mean age at first bDMARD of 57.3±14 years. The median time from onset of bDMARD until onset of OI was 3.1 years [0.5–4.6]. More than 90% of patients were on steroids. 71.3% of the courses were TNF-targeted bDMARD (ADA 39%, ETN 33%, CTZ 15%, IFX 9%, GOLI 2%), and 28.7% non-TNF-targeted bDMARD (RTX 60%, ABA 21%, TCZ 18%). There were 38 OI [26 Virus (18 Herpes Zoster, 2 virus B reactivation, 3 virus C reactivation, 1 Epstein Barr, 1 Avian flu, 1 CMV), 6 Fungus (5 Candida, 1 Trichophyton), 5 Bacterian (1 Legionella, 1 Salmonella, 3 TB)] and 1 parasitary (Leishmania)]. 9 of them required hospitalization and one died (Candida). The global incidence of OI was 23.1 [16.8–31.8]. TNF-targeted bDMARD had 26 OI, with an incidence of 20.8 [14.1–30.6], and non-TNF-targeted bDMARD with 12 OI, incidence 30.4 [17.3–53.6]. We not find statistical differences in the rate of OI between TNF-targeted vs non-TNF-targeted in the multivariate model, adjusted by age, sex and calendar-time (HR 1.37, p=0.4). Male sex was found a predictor of OI in the multivariate analysis (HR 2.17, p=0.04). Age (HR 1.02, p=0.08), concomitant treatment with corticosteroids (HR 6.61, p=0.05) and leukopenia (HR 2.7, p=0.08) showed a tendency to increase the risk of OI. Conclusions: Incidence of OI due to bDMARDs was near 23 cases per 1000 patients–year. Crude incidence was higher for non-TNF-targeted bDMARD compared to TNF-targeted bDMARD. Nevertheless this difference was not maintained in the multivariate model, reflecting that many of the variability in patients9 risk of OI development were driven by factors other than biological agent exposure. Close monitoring should be taken in those RA patients taking bDMARD, corticoids, and with leukopenia. Disclosure of Interest: None declared

Background With the expanding use of biologic disease-modifying anti-rheumatic drugs (bDMARDs), opportunistic infections (OI) are a major concern in Rheumatology. Objectives Our purposes were to describe and compare the incidence of OI in RA treated by non-TNF-targeted biologics. Methods We performed a retrospective longitudinal observational study from 2007 to 2017. We included subjects followed in our outpatient clinic, diagnosed with RA according to ACR criteria, whom started treatment with a bDMARD [rituximab (RTX), abatacept (ABA), or tocilizumab (TCZ)]. According to the microbiologist criteria, we consider OI when there was a positive culture (for Virus, Fungus, bacterial or parasitary) or compatible symptoms that responded to specific treatment. Severe IO was considered if required hospitalisation. We also collected secondary variables: sociodemographic, clinical and other treatments. We used survival techniques to estimate the incidence of OI, expressed per 1000 patient-year [CI 95%]. Exposure time was defined from the start date of each bDMARDs until the development of an OI, discontinuation, loss of follow up or end of study (01/02/2017). Results We analysed a total of 164 patients with 219 different courses of bDMARDs treatment. Of these, 76% were women with a mean age at first bDMARD of 61.4±15 years. Rheumatoid factor was positive in 73.6%. Main comorbidities were: Hypercholesterolemia (53.3%), Hypertension (53.2%), Depression (25%), Diabetes (15%), and Ischaemic Heart Disease (9.8%). VSG mean was 38±28, and the mean WBC count was 7.8±2.7. The median time from onset of RA until onset of bDMARD was 2.8 years [0.8–6.2]. Of these, 132 were on RTX, 47 were on ABA and 40 were on TCZ. There were 12 OI (9 with RTX, 2 with ABA and 1 with TCZ). RTX have 2 Fungus (Candida krusei and Klebsiella), and 7 Virus (4 Herpes Zoster, 1 virus B reactivation, 1 virus C reactivation). OI for ABA was 2 Virus (1 Herpes Zoster, 1 virus B reactivation), while we found one virus OI with TCZ Fungus (Herpes Zoster). There were no bacterial or parasitary OI. Global incidence rate of OI was 30.49 [17.3–53.6]. The incidence of OI was 38.92 [20.2–74.8] for RTX, followed by ABA with 21.61 [5.4–86.4], and TZC with 14.3 [2–101.6]. We found 3 severe OI (2 fungus infections, 1 virus B reactivation). The incidence of severe OI was 7.62 [2.4–23.6], all of them requiring hospitalisation with no deaths. Severe OI have a higher incidence for men 21.1 [5.2–84.2] than women 3.3 [0.4–23.7]. All patients with severe OI were taking corticosteroids, and at least one synthetic DMARD. TCZ did not have any severe OI, and the incidence of severe OI was 10.8 [1.5–76.7] for ABA, followed by RTX with 8.6 [2.1–34.5]. Conclusions The incidence of OI in three non-TNF-targeted biologics in real life conditions is described. Incidence found was near 31 cases per 1000 patients -year. Virus and fungus are the OI more frequents in these bDMARDs. Doctors using bDMARDs should be concerned about this problem and be aware for the detection and management of OI. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is a chronic inflammatory disease that benefits from DMARDs, in this regard knowing more about these therapies is a great step forward in the management of these patients in daily clinical practice. Objectives To evaluate the survival of DMARDs used in recent diagnose PsA patients as well as the causes of discontinuation and to analyse the possible associated factors. Methods Retrospective longitudinal observational study. Subjects: Inception cohort of patients from January 2010 to , December 2014 and followed up to December 2016, diagnosed with PsA according to ICD-10 code. Main outcome: discontinuation of conventional synthetic DMARDs (csDMARDs) and biological originator DMARDs (boDMARDs) due to: Adverse drug reactions (ADRs); Improvement or remission; Inefficacy; Patient`s decision and Physician’s decision. Covariables: sociodemographic and clinical. Statistical analysis: To estimate DMARDs discontinuation rates, survival techniques were used, expressing the incidence rate (IR) per 100 patients*year with their respective CI at 95%. Multivarite Cox regression models were performed to analyse the factors associated with DMARDs discontinuation and the results were expressed in Hazard ratio (HR) and 95% CI. Results 191 patients with recent diagnosis of PsA were included, with a 379.70 Patients*year follow-up. 50.3% were male, the mean age at diagnosis was 50±14.6 years old. 46.6% of the patients had a history of cutaneous psoriasis. The HLA-B27 was positive in 20% of patients. 50% of the patients started a DMARDs at the first visit. Throughout the follow-up, all patients received csDMARDs and 23 used boDMARDs. The median DMARD per patient was 2[.1–3 Methotrexate (MTX) was the most used drug 69.7%. According to the treatment regimen, 30% were on combination therapy, the most frequent was antiTNF +MTX (33%). 103 discontinuations were recorded with a IR 27.13 [22.36–32.90] within these, 44 were related with ADRs (IR 11.59 [8.62–15.57]), 24 (IR 6.32 [3.58–11.13]) were due to inefficiency, 9 (IR 2.37 [1.23–4.55]) were registered after remission, 12 (IR 3.16 [1.79–5.56]) by decision of the patient and 12 (IR 3.16 [1.79–5.56]) by doctor’s decision. The DMARDs median survival was 1.8 years [1.4–2.7]. Table 1 shows the discontinuation rates for each type of DMARDs and the multivariate analysis for the factors associeted with DMARDs discontinuation is in table 2. Table 1 Conclusions In our study, the DMARD discontinuation rate was 27.13, mainly related with ADRs. We have also found some psychological, clinical and therapy regimen factors that can modify the DMARDs survival on PsA. We observed that MTX, presented the longest survival independent of the rest of the factors. Disclosure of Interest None declared

El patrón de dolor crónico implica altos niveles de emociones negativas, dolor y discapacidad percibida. Pocos estudios han evaluado el patrón de aparición del dolor crónico y éste era nuestro objetivo. Método: fueron evaluados 146 participantes con 4 semanas la Baja Laboral por enfermedades musculoesqueléticas (DsMS) y 95 con artritis reumatoide (AR) mediante los siguientes instrumentos: el Cuestionario de Tristeza y Depresión (CTD), el Inventario de Situaciones y Respuestas de Ansiedad–forma breve-. (ISRA-B), Cuestionario de Evaluación de Salud (HAQ), una escala analógica visual para la intensidad del dolor y una escala tipo Likert para la frecuencia del dolor. Los análisis (descriptivos y bivariados) incluyeron una comparación de las puntuaciones de las pruebas entre los pacientes con baja laboral por EM en comparación con los pacientes con AR. Resultados: Los pacientes con Baja Laboral por enfermedades musculoesqueléticas y los pacientes con AR informaron de una percepción similarde su discapacidad, según el HAQ. Pacientes con Baja Laboral por enfermedades musculoesqueléticas informaron mayor frecuencia percibida y más intensidad de dolor que los pacientes con AR. En relación a las emociones negativas, ambos grupos presentaron niveles altos y similares, con algunos niveles más pobres de los pacientes con AR en comparación con Pacientes con Baja Laboral por enfermedades musculoesqueléticas para la ansiedad cognitiva, la ansiedad de evaluación y la de la vida cotidiana (en ISRA-B). Las puntuaciones en depresión presentan los mismos niveles en ambos grupos de pacientes.Conclusión. Nuestro estudio muestra que los pacientes con dolor subagudo/discapacidad y dolor crónico/discapacidad reportan un patrón muy similar para las emociones negativas y la percepción del dolor y la discapacidad, lo que sugiere que estos factores aparecen en una etapa temprana y favorecen, por tanto, la transición de dolor agudo a crónico/discapacidad.

Objectives To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective. Methods A multidisciplinary group was selected (10 rheumatologists—6 of them experts in AxSpA—, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panellists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panellists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted. Results The final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favouring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA. Conclusions Two checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses.

Objective.To analyze sociodemographic and clinic-related factors associated with the use of orthopedic surgical procedures in rheumatoid arthritis (RA), focusing on the potential role of new biologic therapies.Methods.A retrospective medical record review was performed in a probability sample of 1272 patients with RA from 47 units distributed in 19 Spanish regions. Sociodemographic and clinical features, use of drugs, and arthritis-related joint surgeries were recorded following a standardized protocol.Results.A total of 94 patients (7.4%) underwent any orthopedic surgery during their disease course, with a total of 114 surgeries; 47 (41.2%) of these surgeries were total joint replacement (TJR). The median time to first orthopedic procedure was 7.9 years from the onset of RA symptoms, and the rate of orthopedic surgery (excluding TJR) was 4.5 procedures per 100 person-years from the beginning of RA, while the rate of TJR was 2.25 interventions per 100 person-years. A higher risk of undergoing an orthopedic surgical procedure was associated with taking nonsteroidal antiinflammatory drugs (NSAID) in the previous 2 years, female sex, longterm disease, and the presence of extraarticular complications. The risk factors for undergoing a TJR were being old, having a longterm disease, and taking biologic therapies.Conclusion.In the era of biologics, our national audit found a low percentage of patients who underwent orthopedic surgery, probably reflecting a thorough management of the RA. Sociodemographic factors, longterm RA, extraarticular complications, and NSAID were associated with orthopedic surgery.

The aims of this study were to describe the rate of leflunomide discontinuation in rheumatoid arthritis (RA) patients, in standard clinical practice, and to analyse which factors could influence this rate, paying particular attention to the concomitant treatment with other disease-modifying anti-rheumatic drugs (DMARDs).We selected RA patients, diagnosed according to the 1987 American College of Rheumatology (ACR) criteria, attending the rheumatology outpatient clinic of the San Carlos Clinical Hospital (Madrid, Spain), who had started treatment with leflunomide between 1 January 2006 and 1 January 2011. Clinical records were examined until withdrawal of the drug, loss of follow-up, or 1 October 2011. Kaplan-Meier curves were set to account for leflunomide withdrawal. Cox bivariate and multivariate regression models were conducted to examine risk factors for leflunomide discontinuation.The incident rate (IR) for leflunomide discontinuation, regardless of the cause, was 27 per 100 patient-years [95% confidence interval (CI) 22-31]. We observed, in both the bivariate and multivariate regression analysis, that those aged75 years at the start of the leflunomide treatment and undergoing concurrent treatment with methotrexate (MTX) and/or hydroxychloroquine (HC) had a significantly higher risk of leflunomide discontinuation.An older age at the start of the treatment with leflunomide, or concomitant treatment with MTX and/or HC, could be associated with a higher risk of leflunomide discontinuation, regardless of the cause. Therefore, when taking MTX or HC, patients receiving leflunomide should be closely monitored early to detect the occurrence of adverse reactions, and hence prevent their aggravation.

To assess and compare the long-term drug survival (time to drug discontinuation) of biological agents (BA) in patients with rheumatoid arthritis (RA) in clinical practice. Factors associated with discontinuation of BAs were also investigated.We conducted an observational longitudinal study of RA patients taking BAs from 1999 to 2013. The primary endpoint was BA discontinuation due to: adverse drug reactions (ADRs), inefficacy, and other causes. Incidence rates of discontinuation (IRs) per 100 patient-years were estimated using survival techniques. Comparisons between BA discontinuation rates and other associated factors were made using Cox regression models.We included 851 courses of BA therapy (1869 patient-years). Adalimumab (33%) was the BA most frequently used, followed by etanercept (24.4%), infliximab, and rituximab. Treatment was suspended in 558 cases [IR 29.8, 95% confidence interval (CI) 27-32]. In the first year of therapy 68% continued on BAs, and after 10 years the retention rate did not exceed 10%. The IR due to inefficacy was 12.1 (95% CI 10.6-13.8) and the IR of ADRs was 13.6 (95% CI 12-15). The unadjusted IR was higher for rituximab than for tumour necrosis factor (TNF) antagonists. In multivariate analysis, infliximab was the BA with the highest risk of discontinuation, compared to adalimumab. Calendar period, taking subsequent courses of BAs, concomitant therapy, and specific comorbidities were also independent factors associated with discontinuation.After several years of BA treatment in clinical practice, the survival rate was low, mainly as a result of ADRs and inefficacy. We also found differences between the discontinuation rates of BAs and other clinical factors that modify their survival.

Objective To evaluate whether an early cognitive–behavioral treatment complementary to a rheumatologic care program, for patients with recent-onset temporary work disability caused by musculoskeletal disorders (MSDs) is effective. Methods Patients with an MSD-related temporary work disability episode from 3–8 weeks' duration who were in a rheumatologic care program were randomized into a control group (rheumatologic care program) or an intervention group (rheumatologic care program plus cognitive–behavioral treatment). Enrollment lasted 24 months and followup lasted 6–24 months. Efficacy variables included duration of temporary work disability episodes, total number of work days saved, relative efficacy, and relative rate to return to work. An economic evaluation was also performed. Results One hundred eighty-one patients were included (66 control and 115 intervention patients), generating 222 episodes of MSD-related temporary work disability. Episodes tended to be shorter in the intervention group than in the control group (mean 98 versus 127 days; P = 0.053), with a relative efficacy of 22.9%. There were no differences in duration of the first episode between groups (mean 105 versus 110 days; P = 0.79), but relapse episodes were significantly shorter in the intervention group (mean 63 days versus 197 days; P = 0.0002). Costs were also lower in the intervention group. To save 1 day of temporary work disability, $13.50 had to be invested in the program. Each dollar invested generated a benefit of $4.08. The program had a net benefit of $172,607. Conclusion Early cognitive–behavioral treatment complementary to a rheumatologic care program is cost-effective, adds >20% efficacy to the rheumatologic care program, and reduces the duration of relapses.

Cytochrome P450 1B1 (CYP1B1) is involved in the metabolism of anticancer agents; its overexpression was associated with resistance to docetaxel, a commonly used drug for second-line treatment of NSCLC. Several functional single nucleotide polymorphisms (SNPs) have been associated with CYP1B1 expression and activity. The objective of this study was to retrospectively evaluate the correlation of CYP1B1 SNPs with the outcome of NSCLC patients treated with docetaxel in second or third line.Associations between CYP1B1 4326CG and 4390AG polymorphisms with response, progression-free survival (PFS) and overall survival (OS) were estimated using Pearson χ(2) test, Kaplan-Meier curves and log-rank test; a multivariate analysis was performed using Cox proportional hazards modeling.A total of 65 advanced NSCLC patients were enrolled into the analysis. Median age was 66 years (range 46-81). Forty-nine patients were male; only five were never smokers. Performance status (PS) was 0 in 25 patients, 1 in 28 and 2 in 12. Histology was adenocarcinoma in 28 patients, squamous carcinoma in 22, other NSCLC in the remaining 15. At univariate analysis, stage and CYP1B1 4326CG SNPs are associated with PFS, while PS and CYP1B1 4326CG SNPs correlated with OS. In particular, patients with CYP1B1 4326-GG genotype had shorter PFS and OS than patients with other genotypes (PFS 1.80 vs. 2.70 months, p = 0.12; OS 3.63 vs. 9.83 months, p = 0.039). CYP1B1 4326CG SNPs were also associated with response rate. Multivariate analysis confirmed the independent prognostic/predictive role of CYP1B1 4326CG SNPs on OS (p = 0.042) with only a trend for PFS (p = 0.083).CYP1B1 4326CG polymorphism emerged as possible prognostic/predictive marker of activity and efficacy of docetaxel in NSCLC patients.

Objective The aim of this study was to describe the incidence rate (IR) of adverse drug reactions (ADRs) in daily clinical practice, related to disease-modifying antirheumatic drugs (DMARDs) and biologic agents (BA) in rheumatoid arthritis (RA) patients, and to analyze factors causing discontinuation due to ADRs. Methods This was a prospective observational study (October 2010 to October 2011). RA patients who were attended in our hospital taking DMARDs or BA during the study period were included. ADRs were injuries related to these drugs and registered with a software system in routine visits. ADRs could be mild (lowering dosage), moderate (drug discontinuation), or severe (hospital admission). The IR of ADR per 100 patient-years was estimated using survival techniques. Cox regression models (HR; 95% confidence interval) were used to explore factors associated with discontinuation due to ADRs. Results In total, 1202 patients were analyzed, with 158 ADRs (IR = 15.2). Of all ADRs, 80.4% required drug discontinuation (IR = 12.2). Age, less disease and therapy duration, taking corticoids, and combined therapy versus monotherapy (HR = 3; 95% CI: 2.0–4.4) were the factors independently associated to discontinuation due to ADRs. We did not find statistical differences between the different monotherapy regimens. Regarding combinations, Methotrexate + BA had the lowest risk of discontinuation compared to the rest (HR = 0.24; 95% CI: 0.09–0.6). Conclusions We have estimated the incidence of ADRs related to DMARDs/BA in real-life conditions. We confirm the role of combined therapy in the development of discontinuations due to ADRs, except for BA + MTX, which did not show an increase of toxicity compared to monotherapy. This combination seems to be safer than others.

Background Individualized treatment of rheumatoid arthritis (RA) based on genetic and serologic factors is increasingly accepted. In addition, patients are more actively involved in the management of their disease. However, personality has received little attention with respect to perception of the need and adherence to treatment. Objectives Our objective was to evaluate the influence of personality on the intensity of RA treatment. Methods We performed a cross-sectional study in two hospitals with early arthritis clinics where sociodemographic, clinical, and therapeutic variables are systematically recorded. Patients completed Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale and Pain-Related Control Scale. Aggressive treatment was considered if patients received more than two DMARDs or biological agents during the first year of follow-up. Multivariate logistic regression analysis was performed to determine predictors of aggressive treatment. Results 176 RA patients were included (80% women, disease begin median age 55 years). Treatment was considered aggressive in 57.9% of the sample. Scores were high in extraversion in 50.8% of patients, neuroticism in 29.5%, and psychoticism in 14.7%.Neuroticism was the only factor associated with aggressive treatment, which was less probable (p=0.04, OR =0.40). Neuroticism also decreased the possibility of receiving a combination of biologics and DMARDs (p=0.04, OR =0.28). Conclusions Patients with high scores on neuroticism are more worried, obsessive and hypochondriac, leading them to reject more aggressive therapy. It is important educate patients about their disease so that they will accept more aggressive approaches in clear cases of poor outcome. Disclosure of Interest None declared

a b s t r a c t Objective: Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and deter- mined possible seasonal fluctuations. Methods: We conducted a case-crossover study in Madrid, Spain. Daily cases of RA flares were collected from the emergency room of a tertiary level hospital between 2004 and 2007. Results: 245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures. Conclusions: Our results support the belief that weather influences rheumatic pain in middle aged patients.

Introduction Data reporting mortality in rheumatic diseases vary widely. The objective of this systematic review and meta-analysis of published data is to provide an accurate overview of the current risk of mortality in rheumatic diseases. Methods Systematic review and meta-analysis of published studies identified by a sensitive search using free text and MeSH synonyms of “ mortality ” and of “ rheumatic diseases ”, in general and by specific diagnoses. Eligibility criteria were (1) study population with rheumatoid arthritis, systemic lupus erythemathosus, systemic sclerosis, vasculitis, osteoarthritis, osteoporosis, dermatomyositis, or spondyloarthritis; (2) outcome of interest mortality, reported as an standardized mortality ratio (SMR), or easily calculated from data reported; and (3) cohorts or longitudinal observational studies. Assessment of risk of bias relied on the New Castle-Ottawa scale for cohorts; only moderate to high quality studies were included. Separate meta-SMRs were calculated for specific diagnoses. Heterogeneity was studied with meta-regression. Results A total of 32 studies were included, none in spondyloarthritis or osteoarthritis. The overall pooled SMR was 2.03 (95% confidence interval (CI) 1.79–2.29), ranging from 1.36 in psoriatic arthritis to 4.80 in vasculitis. The largest individual overall SMR came from studies on inflammatory diseases, and the specific SMR were very high for infections and pulmonary events. Heterogeneity between studies was large; however, the analysis of such heterogeneity within diseases did not provide any association with the collected variables. Conclusions Based on our results and on the good quality of the included studies, we can conclude that rheumatic diseases increase in general the risk of death, and especially inflammatory diseases.

To assess the diagnostic correlation between primary care physicians and rheumatologists in patients with temporary work disability (TWD) related to musculoskeletal diseases (MSD). All patients with TWD related to MSDs in three health districts of Madrid, Spain, were randomized into standard care by primary care physicians (PCP) or the intervention group by rheumatologists. According to the cause, every TWD episode was classified into 11 syndrome categories. To examine the concordance between the rheumatologist and the referring PCP for each diagnosis, we used Kappa statistic (k) and 95% confidence interval (CI). A total of 3,311 (62.8%) were analyzed, 49.8% women, with a mean age of 41 years ± 12 years, 93.3% were general workers. The agreement between PCP and rheumatologists in all the diagnoses was moderated (k = 0.62). The highest agreement was found in tendonitis (k = 0.81, 95% CI 0.78–0.84), and microcrystalline and undifferentiated arthritis (k = 0.72, 95% CI 0.68–0.77). Lowest agreements were found for peripheral osteoarthritis (k = 0. 48 95% CI 0.38–0.57), knee pain (k = 0.40, 95% CI 0.29–0.52), and muscular pain (k = 0.15, 95% CI 0.10–0.20) Although the global agreement on the musculoskeletal diagnosis between PCPs and rheumatologist in patients with TWD related to MSDs was reasonable, the correlation for peripheral osteoarthritis, knee pain, and muscular pain was low.

The aim of this study was to evaluate the involvement of human endogenous retrovirus K18 (HERV-K18) in osteoarthritis (OA), by genotyping the HERV-K18 env locus in OA patients and controls, and analysing HERV-K18 RNA expression and its association with OA risk and clinical variables.We recruited 558 patients with symptomatic OA and 600 controls. We performed the genotyping by TaqMan assays and the analysis of expression by quantitative real-time polymerase chain reaction (qRT-PCR). Scores on the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), the Lequesne index, and the Stanford Health Assessment Questionnaire (HAQ) were analysed with regard to the expression levels of HERV-K18.The 18.3 haplotype tended towards an association with OA risk and concordantly this haplotype was associated with a higher HERV-K18 expression (p = 0.05). We found statistically significant differences when we compared the scores on the WOMAC, the Lequesne index for knee and hip, and the HAQ between OA patients with higher expression [normalization ratio (NR)10] and OA patients without HERV-K18 expression (p = 0.0003, 0.0005, 0.002, and 0.05, respectively), and also when the comparison was made between OA patients with higher expression (NR10) and OA patients with low expression of HERV-K18 (NR = 1) for the WOMAC and the Lequesne index for knee and hip (p = 0.002, 0.013, and 0.006, respectively).We found an association between health status measurement systems and severity index for OA and the levels of expression of HERV-K18. These results suggest the possible involvement of HERV-K18 in the aetiopathogenesis of the disease.