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Background Although there is much discussion regarding when to initiate a biological agent in rheumatoid arthritis (RA) patients, data on when to stop these agents is scant. Disease activity outcomes after the ending of an industry sponsored clinical trials may provide useful information regarding the duration of drug-free remission for a given biological agent. Objectives To assess the length of remission and rate of relapse of disease activity after ending the open label, long-term extension study (5 yrs) using tocilizumab in RA patients enrolled in the OPTION trial. Methods Patients who no longer received tocilizumab because of the ending of the extension study (5 yrs) of the OPTION trial were analyzed. All patients were: a) in remission (DAS28 Results Forty patients were analyzed, 85% females with a mean age of 53.5 yrs. During the first 12 months of follow-up, 21 (52.5%) patients continued in remission. Relapses occurred in 19 (47.5%) patients, 11 (58%) of them during the first three months after the last tocilizumab administration. No variables were identified to predict length of remission. Conclusions Long-term remission is possible in a substantial number of RA patients after suspension of tocilizumab. Additional data are required to support recommendations for discontinuing a biological agent after achieving remission. These recommendations would impact in patients’ safety and the economic burden imposed by these treatments. References Smolen JS, Beaulieu A, Rubbert-Roth A, Ramos-Remus C, Rovensky J, et al. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 2008;371:989–97. Disclosure of Interest None Declared

Background Beliefs and emotions drive behavior. Rheumatologists face a broad range of disorders, and delivering related information can be conflicting to patients’ believes and thus evoke offensive emotions; in addition, rheumatologists may have feelings associated with diagnoses and project them with consequences in doctor-patient relationship. Objectives A) To explore connotations and potential offensiveness of 10 different mechanistic labels for rheumatic symptoms in new referred patients with musculoskeletal complaints. B) To explore the potential offensiveness of 10 different mechanistic scenarios in Mexican and Canadian rheumatologists. Methods A) Consecutive patients attending for the first time at rheumatology outpatient clinic in Mexico were interviewed (structured format) before they saw the rheumatologist. Patients were asked about feelings provoked (i.e. angry, hopeful, etc.) if the rheumatologist gave them one out of ten different mechanistic labels (i.e. stress, autoimmunity, etc.); the rheumatologist was asked then for a medical diagnosis. B) Canadian and Mexican rheumatologists were invited to answer an internet based structured questionnaire about the feelings they may have at the moment they identify each of the 10 different provided scenarios. The “offensive score” was calculated as the proportion of individuals who endorsed offensive feelings, as per protocol definitions; then, a “number needed to offend” (NNO) was calculated assuming an ideal world in which no one is ever offended and using standard estimates for number needed to harm. Results 150 patients were included, 78% were females, the mean age ± SD was 49±15 yr and formal education 9.5±4 yr. Overall, inheritance, degenerative and inflammatory labels had fewest negative connotations (NNO 16, 12 and 13, respectively), and psychological, functional, and “idiopathic” the most (NNO 3, 3 and 2). Recoding mechanistic labels into “organic” and “functional” the differences were significant (NNO 9 and 3). Stratification by rheumatic diagnosis, patients with inflammatory systemic diseases expressed more negative connotations with functional, “idiopathic” and “not sleeping well” labels (NNO 3 for each). Patients with diseases such as fibromyalgia accepted better autoimmune, inherited disease or inflammatory labels (NNO 17, 9 and 18, respectively) than psychological, functional and “idiopathic” labels (NNO 2, 3 and 1). By other hand, 186 Mexican rheumatologists (36% response rate) and 71 Canadian rheumatologists (23% response rate) answered the questionnaire. Overall, inflammatory and autoimmune labels had the fewest negative connotations (NNO 90 for both), and idiopathic and somatization the most (NNO 2 and 3). Recoding diagnosis labels into “organic” and “functional” the differences in the NNO were notable (51 and 4 for Mexicans and 47 and 5 for Canadians). No other significant differences were observed between Mexican and Canadian rheumatologist. Conclusions Receiving or giving mechanistic/explanatory labels clearly produce feelings and carries a risk to offend. In this study the NNO in patients and rheumatologists went from 1 to 90. Rheumatologists should seek better ways to deliver accurate information, avoiding idiopathic, functional and psychological labels. Disclosure of Interest None Declared