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Background: The absence of therapy adherence is a public health problem and leads to negative consequences in inflammatory chronic diseases. The measurement of therapy adherence has demonstrated effectiveness on the improvement of compliance, but it is difficult to estimate because it is based on indirect measurements. With high probability there will be discrepancies between different measurements. Objectives: To estimate the discrepancies between therapy adherence controlled by prescription of medication, Morisky-Green test and self-perception adherence patients under biological subcutaneous treatment or under JAKinhibs oral treatment. Methods: Observational study including inflammatory chronic disease patients under biological subcutaneous treatment or under JAKinhibs oral treatment, selected consecutively. We performed a preliminary stage where patients were contacted by telephone and after that the questionnarie was sent to the email address they provided. The questionnaire included Morisky-Green test and a self-perception adherence scale (0-10). Data about dispensation of medication was collected from the pharmacy service. We defined as “adherent patient” a dispensation rate over 80%. Results: 54 patients were contacted, and 37 of them full-filled the questionnaire. 28 full-filled the online questionnaire but the other 9 preferred the paper format. The patients from the online format questionnaire had a mean age of 50.86 years (range 22-74), and patients of paper format questionnaire had a mean age of 61.38 years (38-71). We observed a high proportion of patients with university studies among those who preferred the online format. 21 of the patients surveyed had rheumatoid arthritis, 7 psoriatic arthritis, 7 ankylosing spondylitis and 1 juvenile idiopathic arthritis. 21 were under subcutaneous biological therapies and 16 under oral JAKinhibitor therapies. From the 37 patients, 64.8% took 2 or more pills daily. among the 37 surveyed patients a discrepancy between therapy adherence controlled by dispensation of medication and adherence by Morisky-Green was observed (94.6% vs 72.97%, P among the analyzed factors which may affect the therapy adherence, the oral route of administration showed more adherence rate controlled by dispensation of medication (P=0.019) and with Morisky-Green adherence rate (P=0.016). No other association with other factors as age, gender or time of disease evolution was observed. Conclusion: Younger patients and those with university studies preferred to full-fill the online questionnaire. A discrepancy between therapy adherence controlled by dispensation of medication and adherence by Morisky-Green was observed. Moreover oral route of treatment showed more therapy adherence than subcutaneous route of treatment. Even if the patients are no self-considered as 100% adherents (Morisky-Green), a tendency of collect the medication on a regular basis was observed. This seems to indicate that instead of the controlled dispensation of medication by Pharmacy, patients with lower therapy adherence will collect all the medication. Disclosure of Interests: None declared

Background Therapeutic adherence is the main variable in order to assess success or failure of any treatment. It is matter of interest to any clinician to get information enough about treatment response along time to reach a better understanding of any factor that conditions adherence failure or treatment interruptions. However, this kind of information is quite difficult to obtain in real scenarios due to lack of time or memory issues. Objectives The aim of present study is to assess the opinion of users of a smartphone application developed to improve the follow up of patients with different rheumatic diseases. Methods We conducted a survey to the users of REUMapp, an electronic form based on Google Form® software. REUMapp is an electronic interactive form developed for four different clinical scenarios: REUMapp-Esp (spondyloarthritis), REUMapp-Cristal (gout and othe microcrystalline arthropathies), REUMapp-AR (Rheumatoid arthritis) and REUMapp-MSK (soft tissues). All forms were developed over the basis of paper forms previously used for the same purposes and to be checked on follow up consultation. Forms were designed to gather information about daily treatment adherence (binomial), daily modifications (categorical), adverse effects (categorical) and therapeutic response in terms of visual analogical scale. REUMapp-ESP and REUMapp-AR include also specific joint recounts and indexes. All the forms could be completed in less than 3 minutes by the patient or his/her care provider. Every form contents became part of a database easily accessible during the follow up visit in a summarized way. Between 2014–2016, 419 apps were installed in patients or care provider9s smartphones from two non public rheumatology clinics of Madrid with fully consentient of them. A survey was send to every user at the third to twelfth month after installation who have had one follow up consultation at least and who previously used the paper forms. Survey was developed using a multiple answer scheme using visual 7-level horizontal Likert scales. Topics of the survey were as follows: simplicity, time consumption and usefulness. Surveyed patients also were asked for the usefulness of the paper-based form. Results 205 Patients or care providers answered the survey. From them, 36 patients had diagnosed by rheumatoid arthritis, 23 by spondyloarthritis, 68 by gout or other microcrystalline arthritis and the rest by any other soft tissue rheumatisms. Following table shows the results of the survey. In the non parametric analysis of usefulness, the app was considered more useful than the paper format with a wilcoxon coefficient of contrast for paired data of -6.6589 (p Conclusions The smartphone applications described in this study have a good acceptance among patients of care providers in terms of usefulness, time consumption and simplicity and they are considered more useful than the printed models. Disclosure of Interest None declared

Background One element of rheumatology undergraduate teaching in City Hospital Sunderland, UK traditionally involves “paper cases” delivered via small group learning and discussion. Although popular it has had poor feedback from both the students and the tutors at times especially when the tutor to student ratio is high (>1:6). With limited numbers of tutors (Consultant Rheumatologists), this issue was becoming more frequent. Objectives We wished to explore alternative yet still interactive methods to highlight key learning points relating to common rheumatological conditions in a 60 minute teaching session and to make this fun and engaging. Methods 30 undergraduate medical students (January 2017) were given modified teaching material for a 60 minute teaching session a week later. This material involved a partially populated Microsoft Powerpoint slideshow including prompts about a theoretical patient9s clinical case in the notes section. This guided development of a clinical case presentation which covered diverse aspects of clinical care, e.g. imaging, extra-articular disease, drug side effects and disease activity scores. Clinical cases addressed systemic lupus erythematous, early rheumatoid arthritis (RA), ankylosing spondylitis and established RA. Students (groups of 2–3) received one case each were encouraged to use images and online teaching repositories to enhance their presentation. This provided the framework for a 20 minute teaching presentation which was given to their student peers at a formal teaching day 1 week later. A tutor was also present during these sessions (with a ratio of 1:10) to ensure adequate understanding of topics had been achieved and to answer any questions. Feedback was sought from the students and compared with previous “paper case” (non-modified) sessions. Results Feedback obtained (n=9) showed 55% of students rated the modified teaching session as “excellent” with the remainder rating it as “good”. Free-text comments included “good to have students to do the presentations so they cover relevant points” “very useful to have a quick 20 minute overview of different conditions & preparation was useful” and “lots of learning, interactive”. Additional comments included the wish for more time to cover the points in even more depth. Informal feedback from the tutors of these events was also favourable with tutors believing students had a developed a greater depth of understanding. These findings compared favourably with the previous years “paper-case” feedback (March 2016, n=13) where only 23% (n=3) of students had rated the session as “excellent” as well as free text comments emphasising wishes for more time to read through cases and smaller group discussion. Conclusions Current “paper based” modalities can easily be utilized and “re-purposed” to optimize both self-directed and formal teaching components of undergraduate teaching. This can promote the understanding of complex rheumatological learning points in a relatively short period of time and allow students exposure to modalities, such as imaging, which may previously be excluded in a traditional “paper case” format. Disclosure of Interest None declared

Background Among various modalities applied in the management of painful conditions of the spine, epidural injections (EI) are one of the most commonly utilized interventions. EI can be administered in the lumbar spine by either caudal (CEI), interlaminar (IEI), or transforaminal (TEI) approaches and various steroids have been used in these injections(1,2). The purpose of EI is to provide analgesia for a varying duration, whilst making it easier for the patient to undergo a rehabilitation program during this time(1). Objectives The aim of this review is to evaluate the efficacy of the different types of EI in patients suffering from chronic sciatica, based on the evidence published over the past 5 years. Methods Relevant studies were retrieved by searching PubMed, Medline, The Cochrane Library and UpToDate. Publications from 2012 to 2016 which specified the use of EI to treat chronic sciatica were considered, and all the studies selected were written in the English language only. A total of 11 articles were gathered, of which 5 were excluded after analysis of their title and abstract. Of the 6 papers included in this study, 5 are systematic reviews and 1 is a meta-analysis of 10 randomized controlled trials. The outcomes measured were improvement in pain and functional status. The Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) were the most commonly used baseline scales for pain evaluation. The Oswestry Disability Index (ODI) was the most used scale for the functional disability scoring system in the literature. Results 4 of the 6 papers included in this review reported improvements in pain ranging from 30 to 83% and in functional status ranging from 26 to 86% from the pre-injection state, with follow-up periods lasting up to 2 years after the EI. 2 of these 4 studies showed Level II evidence for EI for long-term efficacy in managing chronic sciatica, with no significant difference among CEI, IEI or TEI. The remaining 2 papers (out of the total 6) associated EI with immediate improvements in both pain and function, but found the benefits to be unsustained. 1 paper reported 1 serious adverse event in one of the trials analyzed and found the data on harms to be sparse on most trials. Another paper concluded that injecting local anesthetic alone might be preferable to injecting local anesthetic with steroid as omitting the steroid could lessen the risk of rare, but possibly fatal complications. Conclusions Despite variability in the studies included and methods used for data synthesis, most of the articles included in this review showed positive results for both pain relief and improvement in functional status with EI. Although no studies found significant difference among CEI, IEI or TEI in terms of efficacy, each approach has its advantages and these should be taken into account when choosing the best approach for each patient. As supporting evidence, this review shows that EI with or without steroids are a fast, safe and clinically effective treatment method for patients with chronic sciatica. References Bhatti A, Kim S. Role of Epidural Injections to Prevent Surgical Intervention in Patients with Chronic Sciatica: A Systematic Review and Meta-Analysis. Cureus. 2016, 8(8): e723. Pinto R, et al. Epidural Corticosteroid Injections in the Management of Sciatica: A Systematic Review and Meta-analysis. Ann Intern Med. 2012, 157:865–877. Disclosure of Interest None declared

Background Employment of cadaver specimens in ultrasonography provides a useful and safe model for education, enhances the anatomical knowledge of sonographers and may help determine the accuracy of ultrasound-guided interventions. Objectives In this systemic literature review (SLR) we assessed the role and use of cadaver specimens in sonographic studies of the foot and ankle in the field of rheumatology. Methods For our literature review we utilized the MEDLINE database, which were supplemented by searches in Google Scholar and Science Direct when the articles were not available through PubMed. Original studies in English language were included in the full paper review with an exception of three German language studies with English abstracts were also included. In the full paper review studies were selected for inclusion featured the sonographic study of cadaver specimens of the foot and ankle. Data were extracted on study characteristics and interventions. Results The search yielded 1241 articles, of which 130 were selected for detailed review. In the end, 23 full papers met inclusion criteria. The studies could be grouped as follows: description of detailed ultrasound anatomy (9), testing of accuracy of ultrasound guided interventional procedures (8), examination of artificial tears and lesions (4), foreign bodies (1) and joint effusions (1). The results that were obtained in the studies of the fully reviewed papers utilized a total of 294 cadaveric specimens, with an average of 12.78 (range: 1–48) cadaveric specimens included in each study. Conclusions The use of cadaver specimens of the foot and ankle may facilitate the validation of new sonographic methods which assess these joint regions, however the major disadvantage of these studies was the low number of cadaveric specimens. Disclosure of Interest None declared

Background Patient reported outcomes PRO are a key element in the global evaluation of patients, especially those followed in a day hospital. The use of touchscreen computers is one of the new features in the day hospital of Instituto Portugues de Reumatologia. Objectives to evaluate the transition from paper to touchscreen computers technology of the PRO in use in Reuma.pt Methods We considered a step up model of comparison with 2 months intervals one before the use of the touchscreen computers, one two months after the introduction of touchscreen computers and a third after an intermediate evaluation (comparison between interval 0 and 1) of the results.A specific formation to physicians and nurses to be aware of missing data from non-total completion of the questionnaires was introduced between the first and second evaluation. The percentage of questionnaires totally completed by number of patients were obtained for every period and diagnosis Results 631 day hospital appointments were evaluated according to diagnosis and interval and the percentage was obtained (Table 1) Only HADS had a significative (p On our intermediate evaluation comparing paper to tablet we saw a lower percentage of questionnaires fully completed (although not statistical significative) and a formal awareness formation addressing the causes was made with all the physicians and nurses of the day hospital. The PRO from Reuma.pt was not developed for tablets and some issues regarding missing data associated with that was found Conclusions The use of technology can contribute for better data in Reuma.pt and other national registries by saving time (medical and nurse) for clinical evaluation, by integrating patients in their evaluations and by cost reduction, and carbon footprint. Issues regarding the adaptability of software to tablet technology have to be addressed to insure an overall improvement. Disclosure of Interest None declared

Background: Osteoarthritis (OA) is a degenerative disease of the joint occurring in elderly population. According to World Health Organization, its worldwide prevalence ranges from 11,8% to 12,7%. Since it is known that OA has an inflammatory cause, with IL-1β and TNF-α being the key cytokines that drive the production of inflammatory mediators and matrix-degrading enzymes, the compounds with anti-inflammatory properties are targeted as therapeutic options for osteoarthritis treatment. Curcumin is a plant-derived compound extracted from the rhizomes of turmeric (Curcuma longa). It has been demonstrated as an effective anti-inflammatory and antioxidative agent. In vitro studies have shown that curcumin can block the activation of NF-κB system in the chondrocytes. Therefore, it prevents the apoptosis of chondrocytes, suppress the release of proteoglycans and metal metalloproteases and expression of cyclooxygenase, prostaglandin E-2, and inflammatory cytokines in chondrocytes. Besides its influence on inflammatory markers, clinical trials also demonstrated curcumin’s effects in pain and function in patients with osteoarthritis. Objectives: The purpose of this paper is to critically review evidences regarding the role of curcumin in osteoarthritis treatment. Methods: PubMed/MEDLINE, Lilacs, and SCIELO databases were searched using the terms “curcumin” aND “osteoarthritis” without imposing time limitations. The search was limited to humans and to the English and Portuguese languages. Studies that met the following inclusion criteria were included in the review: 1) clinical trials that evaluated the effects of curcumin on osteoarthritis. The selection phase involved a review of abstracts and an examination of the full text based on the eligibility criteria and the last search was conducted on January 2019. Results: Overall, 9 clinical trials involving a total of 797 patients met the inclusion criteria. The studies have a degree of heterogeneity concerning the dosage, treatment duration, objectives and endpoints, but the main objectives were to evaluate the efficacy and safety of curcumin in osteoarthritis treatment. All studies have shown a beneficial effect of curcumin supplementation in the treatment of osteoarthritis, mainly in reduction of pain, stiffness, improvement of physical function, decrease the use of NSAIDs and other painkillers. Results also showed a decrease on inflammatory markers Conclusion: The studies demonstrated that curcumin is clinically effective as a long term adjuvant treatment of osteoarthritis further to an excellent tolerability. However, large and well-designed randomized controlled trials are warranted to confirm the use of curcumin in osteoarthritis treatment. References [1] BELCARO, G. et al. Efficacy and Safety od Meriva, a Curcumin-phosphatidylcholine Complex, during extended administration in osteoarthritis patients. Altern Med Rev, v. 15, n. 4, 2010. [2] CHIN, K.Y. The spice for joint inflammation: anti-inflammatory role of curcumin in treating osteoarthritis. Drug Des Devel ther, v. 10, p.3029-3042, 2016. [3] MIRZAEI, H. et al. Phytosomal curcumin: a review of pharmacokinetic, experimental and clinical studies. Biomedicine & Pharmacotherapy, p.102-112, p.85, 2017. [4] MOBASHERI, a. et al. Scientific evidence and rationale for the development of curcumin and resveratrol as nutraceuticals for joint health. Int J Mol Sci, v.13, p.4202-4232, 2012. ONAKPOYA, I.J. et al. Effectiveness of curcuminoids in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Int J Rheum Dis, v. 20, n. 4, p. 420-433, 2017. Disclosure of interests: Maria Goulart Employee of: ache Laboratories, Daniela Partar Employee of: ache Laboratories, Luis Cunha Employee of: ache Laboratories, Stevin Zung Employee of: ache Laboratories

Background: Intestinal microbiota analysis is a current subject because of its important role in the pathogenesis of various autoimmune diseases such as intestinal inflammatory diseases or spondyloarthritis. Objectives: The objective of this paper was to perform a quantitative determination of the intestinal microbiota in patients with ankylosing spondylitis (AS) and to highlight the main characteristics of intestinal dysbiosis in these cases. Methods: We conducted a case-control prospective study that included 28 patients with AS and 32 control cases (healthy individuals). Intestinal microbiota analysis was performed by real-time PCR (polymerase chain reaction) in faeces. Intestinal microbiota analysis focused on the following bacterial species: Bacteroides, Bifidobacterium, Clostridium coccoides (XIVa) (C. Coccoides), Clostridium leptum (IV) (C. Leptum), Faecalibacterium prausnitzii (F. Prausnitzii), Lactobacillus, Escherichia coli (E. coli). Results: Intestinal disbiosis in AS patients was characterized by a significant bacterial decrease compared to the control arm. Some bacterial species showed a numerical growth: Bacteroides, C. coccoides and C. leptum, F. prausnitzii. In other bacterial groups there was a significant decrease: Bifidobacterium, Lactobacillus and E. coli. Statistically significant correlations were observed only for Bifidobacterium, significantly increased in the axial form of AS compared to the peripheral form (p = 0.035). Other bacterial groups were numerically elevated in the axial form of AS (except Bacteroides), without statistically significant differences. In all AS cases, a moderate disease activity was evidenced (mean BASDAI = 4.83, mean BASFI = 9.11). BASDAI score inversely correlated with the total bacteria group (p = 0.010, r = -0.606) - intestinal dysbiosis worsens as disease activity increases. Also, direct proportional correlations were highlighted between BASDAI and F. prausnitzii (p = 0.000, r = 0.764), respectively Lactobacillus (p = 0.047, r = 0.488). An increase in AS activity is associated with an increase in proinflammatory bacteria. BASFI score statistically correlated with the total bacterial count (p = 0.000, r = -0.764), F. prausnitzii (p = 0.010, r = 0.606), Bifidobacterium (p = 0.016, r = 0.843) and E. coli (p = 0.016, r = 0.575). An important decrease in the functionality of these patients correlates with a decrease in total bacterial diversity. Improvement of intestinal dysbiosis has been observed in patients on synthetic and biological immunosuppressive therapy compared to the control arm. Conclusion: The study highlightes the characteristics of intestinal dysbiosis in AS patients. There is a direct relationship between the composition of intestinal microbiota and the AS activity scores. Specific treatment for AS leads to a decrease in proinflammatory bacteria, improving gut dysbiosis. References [1] Mancabelli L, Milani C, Lugli GA, et al. Identification of universal gut microbial biomarkers of common human intestinal diseases by meta-analysis. FEMS Microbiol Ecol. 2017 Dec 1;93(12). [2] Breban M, Tap J, Leboime A, et al. Faecal microbiota study reveals specific dysbiosis in spondyloarthritis. Ann Rheum Dis. 2017Sep;76(9):1614-1622. [3] Breban M. Gut microbiota and inflammatory joint diseases. Joint Bone Spine. 2016Dec;83(6):645-649. [4] Gill T, Asquith M, Rosenbaum JT, Colbert RA. The intestinal microbiome in spondyloarthritis. Curr Opin Rheumatol. 2015Jul;27(4):319-325. [5] Stebbings SM, Taylor C, Tannock GW, et al. The immune response to autologous bacteroides in ankylosing spondylitis is characterized by reduced interleukin 10 production. J Rheumatol. 2009; 36:797–800. [6] Stoll ML, Kumar R, Morrow CD, et al. Altered microbiota associated with abnormal humoral immune responses to commensal organisms in enthesitis-related arthritis. Arthritis Res Ther. 2014;16(6):486. Disclosure of Interests: None declared

Background: In 1973 Moll and Wright published the first paper on the classification criteria for Psoriatic arthritis (PsA) which included several phenotypes of PsA: Oligoarticular, Polyarticular, axial, DIP, and Mutilans. Whether these subtypes change over time or are related to treatment response is not known. The hypothesis of this study is that with some exceptions, the Moll and Wright subtype classification criteria are stable over time and the pattern may have important therapeutic implications. Objectives: The objective of this study was to evaluate the persistence of the Moll and Wright classification criteria in PsA patients. Methods: This study is a retrospective chart review of PsA patients seen at a single center between January 1, 2013 and December 31, 2016. The patients in this study were identified using the ICD-9 or ICD-10 codes for PsA and were then classified using the CASPAR classification criteria for psoriatic arthritis. Patients who met CASPAR classification criteria were subsequently sub-classified using the Moll and Wright classification criteria based on the manifestations of PsA at their index outpatient visit. This subtype was then compared to their Moll and Wright subtype at the last outpatient visit prior to January 3, 2019. While it was possible for patients to display more than one subtype simultaneously, the classification made at baseline and at latest visit reflected the predominant Moll and Wright subtype of the patient, in the opinion of the expert treating rheumatologist. Results: 76 patients were identified as meeting entry criteria, with none being in remission at the index visit. Mean age of patients at the latest visit was 60.2 ± 12.6 years, and 47.4% were male. Median time between the index visit and latest visit was 7 years [IQR: 5 to 8 years]. 42.1% of patients had the same Moll and Wright subtype at both visits. Table 1 presents the distribution of Moll and Wright subtypes present at index visit and latest visit. Table 2 reports the changes, or lack thereof, in subtype between visits. 22/76 patients (28.9%) were in remission at the latest visit. Of the patients in remission, 12 (54.5%) were being treated with a biologic, DMARD, and/or steroid. Conclusion: In this retrospective analysis there was a persistence of Moll and Wright subtype in 42.1% of psoriatic arthritis patients over the median time of 7 years. Whether patients who maintain Moll and Wright subtypes respond differently to targeted therapy for PsA should be evaluated in prospective trials. References [1] Moll J. M. H., Wright V. Psoriatic arthritis. Semin arthritis Rheum. 1973; 3(1): 55-78. Disclosure of interests: None declared

Background: Adalimumab patient support programmes (A-PSPs) are offered to patients with chronic inflammatory indications creating the need to study how such A-PSPs assist patients and other stakeholders in improving health outcomes. A deeper understanding of the effects of A-PSPs can improve treatment outcomes and experience of patients being treated with adalimumab. Objectives: To review current studies evaluating A-PSPs, summarize their general characteristics and methodology, and recommend future research work in the area of A-PSPs. Methods: Studies were identified through Web of Science and were cross-checked by searching through PubMed and MEDLINE databases, following PRISMA guidelines. Full-text papers and conference proceedings identified by the database search were reviewed for relevance. Results: 17 studies evaluating the impacts of A-PSPs on patient outcomes were identified – 6 full-text articles and 11 meeting abstracts. Most research was done at the international level or in North America [1-3]. In only 5 reviewed studies a prospective study design was applied. Indications most commonly investigated were rheumatoid arthritis and inflammatory bowel disease. 12 studies evaluated the impact of all interventions of A-PSPs while others assessed the impact of Coach Care Calls or phone calls. Patient outcomes most commonly measured were persistence, adherence and low disease activity or remission. Overall, patients using any of the interventions of A-PSPs experienced significantly better improvements in all studied patient outcomes at different follow-up assessments compared to those not enrolled into any of the programme’s interventions. Study population sizes and ratios between assigned users and non-users of interventions differed between studies. The most frequent follow-up assessments were after 12 and 24 months of treatment with adalimumab. Data for analysis was mostly obtained by linking a patient support database and claims administrative database, and in 5 cases by applying patient and physician reported surveys. Methodology for assessing the differences between users and non-users of interventions of A-PSPs consisted of univariate and multivariate methods, where the causal relationships between the impact of patient support program and patient outcomes were estimated by regression modelling adjusted for multiple confounders. Conclusion: Interventions of A-PSPs have been shown to have a positive impact on all investigated patient outcomes. Main recommendations for future studies are to design a prospective study, include persistence and adherence measures in the study design, and to assess patient outcomes with additional measures such as patient outcomes based on a patient-centric approach and adverse effects. Disclosure of interest: This literature review was funded by AbbVie Inc. References [1] Van den Bosch F, Ostor AJK, Wassenberg S, Chen NJ, Wang C, Garg V, Kalabic J. 2017. Impact of participation in the adalimumab (Humira) patient support program on rheumatoid arthritis treatment course: results from the PASSION study. Rheumatol Ther, 4(1): 85-96 [2] Marshall JK, Bessette L, Thorne C, Shear NH, Lebovic G, Gerega SK, Millson B, Oraichi D, Gaetano T, Gazel S, Latour MG, Laliberte MC. 2018. Impact of the adalimumab patient support program’s care coach calls on persistence and adherence in Canada: an observational retrospective cohort study. Clin Ther, 40(3): 415-429 [3] Rubin DT, Mittal M, Davis M, Johnson S, Chao J, Skup M. 2017. Impact of a patient support program on patient adherence to adalimumab and direct medical costs in Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, and ankylosing spondylitis. J Manag Care Spec Pharm, 23(8): 859-867 Disclosure of Interests: None declared

Background: Axial spondyloarthritis (axSpA) encompasses psoriatic arthritis with axial disease, ankylosing spondylitis and non-radiological axSpA. Patients with axSpA have a high burden of inflammatory bowel disease (IBD) but few studies have investigated the proportion of IBD cases that have undiagnosed axSpA. Untreated axSpA could have a significant impact on the general health and quality of life of patients; therefore early diagnosis and treatment is crucial[1]. Objectives: This systematic literature review (SLR) aimed to identify the prevalence of undiagnosed axSpA in IBD cases based on cross-sectional imaging (MRI and CT scans) of the axial skeleton from published data. Methods: This SLR was performed in keeping with MOOSE guidelines for observational studies. Original articles in all languages from 1990-2018 were retrieved from PubMed, Embase and Cochrane databases. Article reference lists were checked for further literature. Rheumatology conference (ACR, EULAR, GRAPPA, BSR, Gent Spondyloarthritis) abstract lists from 2012-2018 were reviewed and authors contacted for any additional unpublished data. All abstracts were reviewed by two authors to determine eligibility for inclusion. Results: Twenty observational studies were identified: twelve published papers and eight abstracts. Thirteen studies assessed the prevalence of CT-sacroiliitis in IBD cases, two used magnetic resonance enterography (MRE) imaging and five used MRI imaging. The studies included a variety of patient demographics and IBD types. Sample sizes ranged between 25-1247 patients. Eleven studies included 2 independent radiology readers. The presence of inflammatory back pain was assessed in 7/20 studies, 5/20 included a control group and only 3/20 included a clinical rheumatology assessment. Thirteen studies used IBD imaging to assess for sacroiliitis compared to seven using dedicated MRI or CT imaging of the sacroiliac joints. The prevalence of sacroiliitis ranged from 2.2% to 68%. Eleven studies included patients with Crohns disease (average sacroiliitis prevalence 18.6%) and Ulcerative colitis (average sacroiliitis prevalence 17.4%), with 7/11 studies stating no significant difference in the prevalence of sacroiliitis between the two groups. Four studies identified an association of sacroiliitis with increased disease duration, two with increasing age and only one with IBD location. Conclusion: From these studies, it appears that axSpA may affect a substantial number of patients with IBD and is likely to be significantly underdiagnosed. Cross-sectional imaging intended for the assessment of IBD can be utilised to screen for the presence of axSpA, perhaps even before the onset of musculoskeletal symptoms. Such patients could then be triaged for detailed rheumatological assessment. This review highlights the sparsity of data on the prevalence of axSpA in IBD cases. Few studies have included a clinical rheumatological assessment and just over half assessed for any potential difference in the prevalence of sacroiliitis in the Crohn’s disease (CD) and Ulcerative colitis groups. This review has informed our prospective cross-sectional single-centre observational study, due to start in February 2019. We will assess the sensitivity and specificity of MRE as a screening tool for axSpA in a cohort of 600 CD cases, using clinical assessment and a dedicated axial MRI scan as the gold standard. References [1] Ozgul, a., et al., Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients. Clin Rheumatol, 2006. 25(2): p.168-74. Disclosure of interests: Jobie Evans Grant/research support from: I am currently working on a MD research project looking at the use of magnetic resonance enterography imaging as a screening tool for axial spondyloarthritis in patients with Crohn’s disease. This study is commercially funded by Merck, Sharp and Dohme corporation (MSD)., Mark Sapsford: None declared, Tim Raine: None declared, Scott McDonald: None declared, Miles Parkes: None declared, Gavin Clunie: None declared, Deepak Jadon: None declared

Background WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. DAS28, HAQ, Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate RA patients’ disease activity, physical function and mental health. All of those evaluations were mainly conducted by health professionals with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-evaluation on DAS28, HAQ and HADS by mobile terminal. Objectives To estimate the prevalence of anxiety and depression in Chinese patients with RA and to analyze the potential association between disease activity and mental health. Methods Under the guidance and training by health professionals, RA patients downloaded SSDM and performed self-evaluation bundle of DAS28, HAQ and HADS with SSDM. DAS28 =8 can be diagnosed with anxiety or depression. Results From June 2016 to Jan 2019, 2,635 RA patients (461 male, 2,174 female) with a mean age of 49.94 ± 14.23 (11-88) years and the median disease duration of 25.37 months from 175 hospitals performed bundle self-evaluation for 7,455 times in total. According to the HADS and DAS28 assessment results, the prevalence of anxiety and depression in all patients was 33.30% and 39.04% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on T2T was 29% and 71%, respectively. The prevalence of anxiety and depression was 20% and 25% among T2T achievers; and 31% and 38% among T2T failures, respectively (PA According to DAS28, the prevalence of anxiety was 19%, 20%, 27% and 41% in Remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) subgroups respectively, the prevalence of depression was 24%, 26%, 33% and 49% respectively. The correlation coefficients of anxiety (A) and depression (D) with DAS28 were rA=0.9318 and rD=0.9334, respectively. It suggested that with the increase of disease activity, the proportion of RA patients with anxiety and depression increased significantly. Combined with physical function evaluation results, the overall prevalence of anxiety (23.65%) and depression (33.20%) in the normal HAQ group was significantly lower than that in the abnormal HAQ group (A: 36.37%, D: 43.19%, xA2 = 4.52, xD2 = 6.21, pA Conclusion Higher prevalence of anxiety and depression were associated with higher levels of disease activity and worse physical function. Rheumatic comorbidity and adverse events (ADEs) were potentially associated with depression in the Rem subgroup patients with normal physical function. SSDM is an effective mobile interface to monitor and study entanglement of disease activity, physical function and mental health in RA patients, which build a foundation for proactive interventions in future. Disclosure of Interests None declared

Background: Behcet Syndrome (BS) is a chronic vasculitis characterized by a wide spectrum of clinical manifestations, including the rare nervous system involvement, known as “Neuro-BS” (NBS) [1-3]. BS inflammatory features were studied in several genetics studies with focus on single nucleotide polymorphisms (SNPs) of genes involved in inflammation and immune response [4,5]. A very few papers assessed the mutational state of NBS patients and this characterization was limited to a small number of SNPs [3]. Objectives: The aim of this study was to analyse the genetic background of a homogenous group of Italian NBS (parenchymal form) to genotype some SNPs of inflammation-related genes. Methods: NBS patients were extracted from our database and retrospectively studied. Molecular characterization was performed for a subset of 20 NBS patients and 42 sex-matched healthy controls (HC) via: a) bioinformatics consultation for SNPs selection and primer design; b) SNPs genotyping: DNA extraction, PCR amplification, direct sequencing; c) DNA variant analysis using similarity search tool and specific software. In a second phase of analysis, a group of 30 BS patients without neurological involvement (no-NBS) was also genotyped. The odds ratio (OR) was calculated to assess the strength of BS association for each genotype. Results: NBS patients subset was formed by 14 males and 6 females with mean age equal to 44.20 (±10.73) years. Six SNPs were considered eligible for molecular analysis and genotyped. Our results underlined the major role of ERAP1 rs17482078 (Table 1a). rs17482078 GG genotype frequency was higher in controls (p-value Conclusion: Our results reported for the first time the genotype distribution of several susceptibility loci in a group of Italian NBS patients. The data suggest a possible association between ERAP1 rs17482078 and NBS. Larger analyses were required to verify our preliminary findings. References [1] Saip S, et al. 2014. Handb Clin Neurol;121:1703-23; [2] Noel N, et al. 2014. Rev Med Interne;35(2):112-20. [3] Gheita TA, et al. 2015. Joint Bone Spine;82(3):213-5. [4] Gul A. 2015. Current Opinion in Rheumatology;26:56-63. [5] Takeuchi, et al. 2015. J Autoimmun. 2015;64:137-148. Acknowledgement: Many thanks to Professor Olivieri for his ”heredity” Disclosure of Interests: Maria Carmela Padula: None declared, Pietro Leccese: None declared, Nancy Lascaro: None declared, Teresa Carbone: None declared, Antonina Rita Limongi: None declared, Rosa Paola Radice: None declared, Angela Padula Speakers bureau: Lilly Italia EMS, Salvatore D’Angelo: None declared, Giuseppe Martelli: None declared

Background DU are a significant burden for SSc patients affecting approximately 40–50% of patients (1). No data are available on the frequency of DU on SSC patients living in the United Arab Emirates. Objectives To identify the frequency of DU in a cohort of SSC in Abu Dhabi which is the capital city of the United Arab Emirates (UAE). Methods SSC patients identified according to ACR EULAR criteria through the hospital electronic medical records system, which was implemented from January 2011 for medical documentation in all public hospitals in Abu- Dhabi and districts. Using the International statistical classification of diseases and related health problems, usually called by the short form name international classification of Diseases (ICD), version 9 (710.1) from 1st of January 2011 to 31st of December 2016. Retrospective review of electronic medical records and paper case notes was performed on patients who presented during this period. The frequency of DU was searched. DU were defined (1) and categorised (2) (no digital ulcers, episodic (rarely recurrent), recurrent (frequently recurrent) and chronic (≥1 DU at every follow up). Results and the incidence of gangrene were compared to data from DUO registry (3). Results 47 SSc patients (Male to female ratio 12 (25.5%) to 35 (74.5%) (Duration of disease from 2 to 24 years with peak age for ulcers between 40–50 years) were identified. No ulcers were detected in 34 patients (72.3%) while DU were found in 13 patients (27.7%): they were episodic in 9 patients (19%) and chronic in 4 patients (8.5%) of the total patients. No recurrent ulcers were found. Only one patient (2%) evolved to gangrene (she was a smoker). The other 12 patients with DU were non-smokers and three of them were under 16 years of age. Conclusions In Abu Dhabi SSc population, the incidence of DU is 27.7%. This differs from the incidence in the western literature where it peaks from 40 to 50% (3). Our patients had episodic (19%) and chronic DU (8.5%) of the total patients. The incidence of gangrene in our cohort was lower when compared to the data reported in the DUO registry (20%) (2). Although patients live in a very warm climate, DU are still experienced in SSc in Abu Dhabi. Likely, the chronic exposure to air conditioning may explain this paradox. References Suliman Y et al. Preliminary musculoskeletal ultrasound (MSUS) ulcer definition does not correlate with visual observation in systemic sclerosis (SSc) patients. J. scleroderma relat. disord. 2017 (in press). Matucci-Cerinic M et al. Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry. Ann Rheum Dis. 2016;75:1770–6. Allanore Y, Denton CP, Krieg T, etal.Clinical characteristics and predictosof gangrene in patients with systemic sclerosis and digital ulcers in Digital Ulcer Outcome Registry: a prospective, observational cohort. Ann Rheumatic Dis 2016;75:1736–1740. Disclosure of Interest None declared

Objectives To determine, through a systematic review and meta-analysis, the prevalence of back pain (BP) and spondyloarthritis (SpA) in the adult general population and explore the heterogeneity between studies in and out Latin America (LATAM). Methods MEDLINE, Embase, BIREME, LILLACS and Web of Science were searched using a strategy combining key words and related database-specific subject terms to identify relevant cross-sectional studies based on COPCORD methodology published since 2006. Included articles were assessed for risk of bias and quality based on the STROBE statement. Prevalence figures for BP and SpA (European Spondyloarthropathy Study Group criteria) were analyzed according to female percentage of sampled individuals, mean age and sample size. A mixed effect model was used to obtain the combined prevalence and a meta-regression to estimate the effects of these variables. Prevalence stratified values were obtained according to its geographical location. Results 44 out of 127 papers in English, Spanish or Portuguese were selected. Of them, 16 contained BP or SpA prevalence data. Estimates for any Spa prevalence ranged from 0,1% to 2%, with an average of 0,3% (95% CI: 0,01%>0,05%). The random-effects pooled prevalence was 0,18% (0,06%>0,36%). The prevalence of BP was 6.54% (3.8%>9.2%) with a pooled value of 5.24% (2.6%>8.7%). In both cases the heterogeneity was significant (p 8.5%, p=0.9); on the contrary, for Spa, for non-LATAM studies, the pooled proportion was significant bigger (prevalence in LATAM 0.05%, 0.01%>0.012%; non-LATAM: 0.35%, 0.09%>0.78%, p=0.03) Conclusions We found significant variations in prevalence across this review. In particular, they related to sample size of BP studies. Similarly, there was a significant variation between LATAM versus other latitudes respect to the prevalence of SpA. The limited number of studies included in this meta-analysis however, prevents clear explanations of the mechanisms underlying these results. Disclosure of Interest None declared

Background Harbor UCLA is an urban safety-net hospital in Los Angeles for underserved patients. In 2014, LA County Department of Health Services adopted an electronic consultation (E-consult) referral and dialogue system to improve access to subspecialists in the ambulatory care setting. The E-Consult system provides a platform for primary care providers to ask questions or engage in dialogue with specialists, request consultation, and track submitted requests. Back and forth messaging prior to acceptance for face-to-face consultation is termed a “preconsult exchange”. Prior studies of E-Consult systems have suggested benefits which include a reduction in wait times compared to paper referrals1 and a perceived improvement in patient care2. We sought to further clarify the effect of a preconsult exchange versus immediate booking on a patient9s diagnosis and wait time in an effort to provide some guidance on whether E-Consult should be used as a screening tool to reduce unnecessary visits or as a communication method to clarify details before a face-to-face visit. Objectives To determine whether preconsult exchange: 1. Influences the odds of arriving at a different diagnosis after face-to-face consultation compared to the requesting provider9s original diagnosis 2. Influences the odds of arriving at a diagnosis of a different autoimmune condition versus a non-autoimmune condition (fibromyalgia, primary osteoarthritis, chronic pain, or other non-rheumatologic condition) 3. Results in a significant delay in face-to-face evaluation Methods We performed a retrospective chart review of all 238 new patient referrals between 11/2014 and 5/2016 to the Harbor UCLA Rheumatology clinic generated through the E-Consult system, reviewed by BC or GM, deemed appropriate, and seen for face-to-face evaluation. These patients were grouped by exposure (Preconsult exchange or not). Odds of change in diagnosis and confidence intervals were calculated using 2x2 contingency tables and Chi-Square tests. A student9s T test was used to compare mean number of days between E-Consult initiation and face-to-face appointment. Conclusions There was a trend towards a change in diagnosis overall among patients for whom there was a preconsult exchange, but a statistically significant increase in odds for change to non-immunologic diagnoses. This suggests that preconsult exchange highlights those patients for whom there is a higher likelihood of a non-immunologic diagnosis. However, preconsult exchange was associated with a significant time cost - an additional 26 day delay for a face-to-face visit (due to the time needed for both submitter and reviewer to complete their dialogue) in comparison to an immediately booked patient. References Chen A et al. A Safety-Net System Gains Efficiencies Through 9eReferrals9 To Specialists. Health Affairs 29, no.5 (2010):969–971. Scheibe MM et al. Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety-Net Health Setting. Arthritis Care Res (Hoboken). 2015 Aug;67(8):1158–63. Disclosure of Interest None declared

Background Only postmenopausal women were in the researcher9s focus in the majority of publications on osteoporosis (OP) risk factors (RF) in RA female patients (pts). Meanwhile the data on OP RF in menstruating women presented in the rare available papers are not consistent. Objectives To identify the major OP RF in RA female pts with normal menstrual cycle. Methods 51 RA (based on ACR criteria) female pts with normal menstrual cycle aged 20 to 51 years (mean age 41,1±7,9) were examined. The following info was included in each individual pts9 files: anthropometric parameters, social and demographic data, case history, clinical examination and lab findings, traditional OP RF, pts9 joint status, comorbidities status, pain intensity assessments and VAS evaluation of pts9 general health status. Axial bone mineral density (BMD) was measured with DEXA scan using Z-score calculator. Based on the OP status all pts were divided into 2 groups:pts with OP–16 (31,4%), and pts without OP–35 (68,6%). Results Comparative analyses of the groups showed that: OP pts were younger vs the pts without OP (36,9±10 vs 42,8±6,3 years, p=0,02). Disease duration was comparable in both groups. Clinical manifestations of inflammation activity (mean DAS 28 score and hsCRP) were statistically significantly more pronounced in the OP group vs the pts without OP (4,91±1,39 vs 4,19±1,06, p=0,049; 27,8 (10,8–43,5) vs 7,4 (1,4–22,7) mg/L, p=0,02, respectively). High DAS 28 (50 vs 20,6%, RR=2,43, 95% CI 1,07–5,53, p=0,03) scores were more often documented in the OP pts. Pronounced feet and hand bone destruction based on the radiographic findings was documented in the majority of pts in both groups, although in the OP pts the joint space narrowing counts (97 (62,5–121) vs 73,5 (53–87), p=0,02) and the total Sharp score (98 (64,5–183) vs 89,0 (63–112), p=0,03) were statistically significantly higher. The OP pts were more often administered oral GCs (81,3 vs 37,1%, RR=2,19, 95% CI 1,34–3,57, p=0,004), as well as GCs -pulse therapy (56,3 vs 25,7%, RR=2,18, 95% CI 1,08–4,45, p=0,04), had higher GCs cumulative dose (18,8 (8,1–30,7) vs 6,4 (0,8–14,1)g, p Conclusions RA activity and GCs dose (GCs therapy duration ≥3 months) were identified as the major OP RF in young RA female pts before menopause, thus adequate and timely therapy aimed at obtaining RA control and achieving remission should be considered as key OP prevention strategy. Disclosure of Interest None declared

Background Co-morbid osteoarthritis (OA), anxiety and depression are undermanaged in primary care yet have significant impact on pain, disability and outcomes of other long-term conditions (LTCs). Objectives To test the feasibility and acceptability of integrating case-finding and initial management for OA, anxiety and depression within extended primary care practice nurse (PN)-led LTC review consultations. Methods A stepped wedge pilot trial with process evaluation. PNs gave a study pack to patients age ≥45 years attending routine LTC reviews (asthma, COPD, hypertension, ischaemic heart disease, diabetes). The intervention included case finding questions (Generalized Anxiety Disorder (GAD2), Whooley 2-item depression, diagnosing OA clinically (hands, hips, knees or feet)) followed by further assessments (anxiety (GAD7), depression (PHQ9), joint examination). PNs completed an electronic patient record and initiated management. Pre-determined success criteria were to recruit 4 practices; deliver training to 2 PNs per practice, recruit 50% of those invited, ensure 75% follow up (6 week, 6 month), and the satisfaction (GPAQ) of intervention patients to be at least as acceptable as that of control patients. 24 audio recorded consultations provided insight into fidelity of intervention delivery. Results Four practices were recruited. PNs were sequentially trained in practice prior to switching to intervention. Of the 474 people invited, 319 responded (207 control, 112 intervention) (67%). 83% and 79% of participants returned 6 week and 6 month questionnaires respectively. Demographic characteristics, general health, pain intensity, anxiety and depression scores were similar across arms. Overall, self-reported health (EQ5D5L) was high (median 0.84; IQR 0.72, 0.94). 14% of participants reported moderate to severe depression (PHQ9). Median GPAQ scores were similar (control 1.00 (IQR: 1.00, 1.29), intervention 1.00 (IQR: 1.00, 1.14)). 96% of those in the intervention arm reported being asked about joint pain, 93% reported being asked about mood. Audio recordings revealed that case finding questions were used as intended in most consultations (joint pain 20/24 consultations, anxiety 15/24, depression 6/24). One referral to physiotherapy and none to primary care mental health services were recorded by the PNs. Conclusions Recruitment and follow up were good. However, to target those who may benefit from the intervention, changes to the target population and eligibility criteria are required. There was reasonable delivery of the case finding questions, but limited referral and signposting, highlighting areas to optimise ahead of a main trial. Acknowledgements ELH, CJ, CCG, ALE and CDM are part funded by NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands. CDM is funded by NIHR School for Primary Care Research, NIHR Research Professorship in General Practice (NIHR-RP-2014–04–026). KSD is part-funded by an NIHR Knowledge Mobilisation Research Fellowship (KMRF-2014–03–002). Views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Disclosure of Interest None declared

Background Health Locus of Control (HLC) is the degree to which individuals believe that their health is controlled by internal (self-responsibility) or external factors (healthcare professionals or chance). This generalized expectancy might affect different disease aspects, especially in chronic diseases. Objectives Our objective was to assess the influence of HLC on different disease aspects in a representative sample of German systemic lupus erythematosus (SLE) patients. Methods The LuLa-Study is a longitudinal survey on a multitude of SLE associated factors that is being conducted annually by means of a self-reported questionnaire among members of the German LE self-help community since 2001 and is ongoing. Inclusion criteria are a diagnosis of SLE and returning the completed paper questionnaire. Amongst others medication, health-related quality of life (Short-Form-12), damage (Brief index of lupus damage) and disease activity (Systemic Lupus Activity Questionnaire) are surveyed. In 2013 we additionally inquired about the health locus of control (HLC) that distinguishes between the “internal” HLCint (self-responsibility) and the two external dimensions HLCdoc and HLCchance considering their doctor respectively chance responsible for personal health. A high HLC was assumed for values above the upper quartile of the specific scales. Accessory questions examined fatigue (Fatigue severity scale), medication adherence (Morisky medication adherence scale), and illness perception (Brief illness perception questionnaire). Results Patients with a high internal health locus of control (HLCint 13.1 vs. 9.1) had less pain (numeric rating scale 0–10), less flares, a better mental and physical health related quality of life, lower disease activity and less fatigue. Patients with a high external 9doctor9-related health locus of control (HLCdoc 10.7 vs. 7.2) were older, had more co-morbidities, more disease damage and received more frequently an immunosuppressive therapy. No significant differences were found between the patients with a high external 9chance9-related HLC compared to the lower scoring patients (HLCcha 11.1 vs. 6.3). Participants with a high external 9doctor9-related HLC had a more threatening view on their illness and a better adherence to medication (high adherence in 78.6% vs. 59.4%). Participants with a high internal HLC perceived their disease significantly less threatening. Higher education levels (school education, further education) went along with a decrease of external 9doctor9-related HLC (HLCdoc). Conclusions Health locus of control has a significant impact in patients with SLE. Depending on the HLC different disease characteristics, treatments, levels of medication adherence and illness perception were noticed. Holistic care needs to consider the impact different HLCs may have. The direction of causality cannot be proved beyond reasonable doubt in this cross-sectional analysis. Hence additional longitudinal studies are necessary. Acknowledgements The LuLa-study is supported by unrestricted grants from GlaxoSmithKline and UCB Pharma. Disclosure of Interest G. Chehab Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study, J. Richter Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study, R. Brinks: None declared, R. Fischer-Betz Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study, B. Winkler-Rohlfing: None declared, M. Schneider Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study

Background Giant cell arteritis (GCA) a form of vasculitis in persons older than 50 years, in which cranial and systemic large vessels can be involved. 18F-fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG-PET-CT) is increasingly used to diagnose inflammation of the large arteries in GCA. But it is very rare to observe an inflammation of temporal arteries of GCA using 18F-FDG-PET. Objectives To understand the mechanism and frequency of the positive temporal artery of GCA in 18F-FDG-PET. Methods This was a retrospective chart review of 3 patients with giant cell arteritis who underwent all of 18F-FDG-PET, MRI, CT angiogram, ultrasound and histopathologic evaluation of temporal arteries. To investigate the cases of FDG-PET positive temporal arteries in GCA, a systematic literature review was done in Pubmed using 18F-FDG-PET AND (“temporal arteritis” OR “giant cell arteritis”). Results A case report: An 85-year-old male presented with muscle weakness. Three years before admission, he experienced pain in his neck and both extremities. Rheumatoid arthritis was diagnosed at another hospital, and the patient was treated with methotrexate and prednisolone, which resolved his symptoms. The medication was discontinued after 2 years. Two months before admission he began coughing due to interstitial pneumonitis, and later developed muscle weakness and difficulty walking. On admission a physical examination revealed swelling of the bilateral temporal arteries. A blood test showed accelerated ESR at 54mm/h and a CRP of 4.6 mg/dL. Ultrasound showed an increased diameter, hypoechoic wall thickening (halo), stenosis, and calcification of the arterial wall of the temporal artery. A contrast CT showed wall thickening in the affected segments, calcification, stenosis and enhancement of the soft tissue around the temporal artery. An 18F-FDG-PET scan indicated increased uptake of 18F-FDG at the temporal arteries whereas no uptake was found in the other arteries including the aorta and carotid arteries. A biopsy of the temporal artery revealed necrotizing vasculitis with a few giant cells and the formation of a microscopic neutrophilic abscess. When compared with 2 other cases of temporal arteritis with a negative 18F-FDG uptake, the severity of inflammation and the number of giant cells in the present case were not remarkably high. A systematic literature review identified 4 cases of 18F-FDG-PET positive temporal arteries in 454 cases of GCA of 82 papers. Of note, large arteries were positive for 18F-FDG-PET in 253 cases of GCA in the same series. Conclusions The hierarchy for FDG uptake by resting inflammatory cells is neutrophil > macrophage = lymphocyte in vitro, indicating that the sites where neutrophils dominate are more likely to be visualized by 18F-FDG PET in vivo. In addition to the known usefulness of 18F-FDG-PET in visualizing inflammation in large vessels, the increased uptake of 18F-FDG to the temporal artery may help to identify the neutrophilic inflammation. Disclosure of Interest None declared

Background Annual incidence rates of inflammatory myopathies (IM) vary widely from 1.16–19.0 per 10 6 of adults.1 Our aim was to, for the first time, determine the incidence rate of IM in our population. Objectives To determine the incidence rate of IM in our population. Methods We retrospectively collected incident cases of IM from 1 January 2005 to 31 December 2016 at our department of rheumatology which is a part of an integrated secondary/tertiary university teaching hospital that is the only referral center for two well defined regions representing roughly a third of the national adult population. Tertiary cases are referred to our department from the entire country. We identified the cases by searching the electronic patient records (PRs) for ICD-10 codes M05, M33–35, M60, G73.7, G72.4. The paper and electronic PRs were scrutinized to assess clinical, laboratory and histopathological data. Descriptive statistics was used to describe our group of patients. The adult population size of the two regions served by our department was obtained from the national statistics institute database. The annual incidence rate for IM was then calculated. Results During the 12-year observation period we identified 117 new cases of IM from a well-defined adult white Caucasian population aged 18 or above. 38 cases were excluded from analyses since they were referred to our department from outside the two regions we serve on the secondary and tertiary level. Thus, we analyzed 79 cases of IM (63% female; median (IQR) age 67 (55–75) years; 44% ever smokers). The median time to diagnosis was 5 (IQR 3–12) months. We diagnosed 29% patients with dermatomyositis, 25% with anti-synthetase syndrome, 18% with polymyositis, 9% with statin induced necrotizing autoimmune myopathy, 9% with concomitant myositis as a part of connective tissue disease, 6% with paraneoplastic myositis, and 4% with undifferentiated myositis. The IM cases were most often diagnosed in the summer months (32.9%), followed by spring (24.1%), fall (22.8%), and winter (20.3%). The clinical and laboratory characteristics at presentation are shown in Table 1. Muscle biopsy was performed in 93% of patients. Notably, patients with swallowing difficulties had more commonly had Raynaud phenomenon (RR 3.7 (95% CI 1.4–9.4), p=0.008). Conclusions The averaged 12-year annual incidence of IM in the population under study was 9.4 (95% CI 7.5–11.8) per 10 6 adults. References Meyer A, et al. Rheumatology 2015. Disclosure of Interest None declared

Background Anti-Ro antibodies (Ab) are especially directed against two antigens, Ro52 and Ro60, with different structure and function. Studies in systemic lupus erythematosus (SLE) have been described a relationship between the presence of anti-Ro Ab and dry syndrome, subacute cutaneous lupus, myocardial involvement or minor renal involvement. However, studies about the clinical usefulness of determining the 2 specificities of anti-Ro Ab in SLE are not conclusive. It seems that anti-Ro52 could be associated with joint involvement and lung disease, while anti-Ro60 could be related to late-onset SLE. In this paper we evaluate the clinical usefullness of anti-Ro52 and Ro60 Ab chemiluminescence quantification in patients with SLE. Objectives To analyze the presence of anti-Ro52 and Ro60 Ab in a cohort of patients with SLE and evaluate its correlation with clinical, analytical and immunological parameters. Methods 152 patients with SLE (according to the SLICC criteria 2013) attended in an university hospital were included. Qualitative immunoblot analysis of anti-Ro Ab was performed on all of them; those with positive values were also assessed by a chemiluminescence quantification of anti-Ro52 and Ro60 Ac (normality Results 91% (138) were women with a mean age of 46±12 years (range, 20–75) and an average SLE evolution of 12±7 years (range, 1–40). 32% (49/138) of the patients had anti-Ro positive determination by immunoblot: 36 were anti-Ro52 positive (mean value 696±726 CU) and 48 anti-Ro60 positive (mean value 504±696 CU) by chemiluminescence. Only one anti-Ro52 positive patient was anti-Ro60 negative. 10.5% had late-onset SLE. The mean SLEDAI was 1.84±2.48 while the SLICC was 0.32±0.7, with a mean anti(ds)DNA Ac values about 207.87±357.15 IU/ml. 37.5% had hypocomplementemia. Anti-Ro positive patients by immunoblot had a higher value of anti(ds)DNA compared to the patients without Ro positive values and patients with both positivity by chemiluminescence had lower prevalence of APS, however the quantitative values of anti-Ro52 and anti-Ro60 were not related with clinical, analytical or immunological parameters. Conclusions 32% of patients in the cohort were anti-Ro positive being mostly anti-Ro60 positive. The presence of anti-Ro Ab was associated with higher value of antiDNAds and lower prevalence of APS. However, the quantitative values of anti-Ro52 and anti-Ro60 Ab by chemiluminescence were not related to the different parameters analyzed in the study. These results indicate the need to assess the quantification of anti-Ro Ab in a larger cohort of patients with SLE. Disclosure of Interest None declared

Background People with chronic pain commonly believe that their pain is affected by the weather. Despite a century9s worth of research, there is no scientific consensus on the existence of a relationship between weather and chronic pain. Objectives A systematic literature review to (1) gain an overview of existing research on the weather-pain relationship, and (2) summarise the methodologies, methodological rigour and risk of bias in published studies of patients with musculoskeletal conditions. Methods Systematic search strategies were developed for 5 databases (Medline, Embase, PsycInfo, Scopus, Web of Science) to retrieve studies that investigated the relationship between weather conditions and chronic pain. Original articles describing observational studies that related chronic pain (primary outcome) to weather conditions (exposure), were included. Study characteristics, methodology (e.g. measurements of pain and weather, aspects of statistical analysis) and data on risk of bias (validation of participants9 exposure and diagnosis, coverage of weather variation, correction for confounders) was extracted. Methodological rigour was summarised by mapping the methodological variability among studies and ranking these from least to most rigorous. Results The searches returned 16,081 articles. After removing 3090 duplicates and excluding 12726 articles during title screening, 265 abstracts were assessed for eligibility. Of 64 observational studies that met the inclusion criteria, 30 (47%) investigated pain associated with musculoskeletal conditions, 24 (38%) investigated headache and 10 (16%) investigated pain associated with other conditions such as sickle cell disease and dental pain. After full text assessment, 10 of 30 papers on musculoskeletal conditions were excluded because they investigated risk of acute pain episodes rather than chronic pain symptoms (n=6), or investigated multiple conditions (n=4). The 20 included studies investigated rheumatoid arthritis (6, 30%), osteoarthritis (6, 30%), fibromyalgia (6, 30%) and low back pain (2, 10%). A total of 15 studies (75%) reported some effect of weather on chronic pain, and this was clinically significant (consistent and sufficient size of effect) in 6. Participant numbers varied from 19 to 2491. 1 study was cross-sectional and 19 longitudinal with follow ups ranging from two weeks to 3.5 years, with participants scoring their pain once to daily for 12 months. Pain was measured with a Visual Analog Scale or Numeric Rating Scale in 17 (85%). Weather conditions were retrieved from local weather stations, with most studies assuming that participants stayed in the area/city (65%) or postcode area (20%) where they lived. In 12 (60%) studies, participants were blinded to the study hypothesis. Methods for correcting for confounders were highly variable, with 7 studies not addressing any, and the remainder addressing one or more of 32 confounding variables. Conclusions Methodological variability of studies investigating the relationship between weather and chronic musculoskeletal pain is high. This methodological review will inform best research practice for those investigating the relationship between the weather and chronic pain. Acknowledgements Mary Ingram, librarian Disclosure of Interest None declared

Background Placebo and nocebo represent psycho-neuro-immuno-endocrinological responses commonly encountered in nursing care (1,2). A new paradigm proposed the contextual factors (CF) as mediators and moderators of these responses (3). To date, the knowledge about the awareness of CF and their use in nursing is scant. Objectives The goal of this study was to examine frequency of use, beliefs and attitudes of Italian specialised nurses regarding the contextual factors. Methods In December 2016, through SurveyMonkey Software®, an online survey was conducted by sending a questionnaire to the members of four Italian Nursing Association, grouping nurses specialized in Neuroscience, Medical, Geriatric and Diabetic care. Behaviours, beliefs and attitudes of nurses about the implementation of CF in clinical practice were assessed by a 17 items questionnaire and resulting data were analysed by descriptive statistic. Results Of the 1411 members of the involved Nursing Associations invited to participate to the survey 425 responded (30.1%). An high number of respondent nurses adopts CF often in their practice (42%). They believe that CF can positively influence acute pain (47.5%), chronic pain (61%) and rheumatologic disorders (42%). 34% of responders consider the use of CF, if it can determine beneficial psychological effects, as ethically accep table. 15.5% responders oppose to the adoption of CF when based on deception or if they undermines trust between nurses and patients. A relevant number of nurses (24%) do not communicate the use of CF to their patients and 19% implement CF as addition to other nursing interventions to optimize clinical responses. Nurses explain the power of CF through patient9s expectation and psychological mechanism (11%). Conclusions The Italian specialised nurses use CF quite frequently and believe that their use has the capacity of positively influencing the clinical outcome. Larger surveys are needed to understand the proportion of use of CF by nurses in common clinical practice in Italy. References Miller LR, Miller FG. Understanding placebo effects: Implications for nursing practice. Nurs Outlook. 2015 Sep-Oct;63(5):601–6. Hauser W, Hansen E, Enck P. Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int. 2012 Jun;109(26):459–65. Palese A, Rossettini G, Testa M. Placebo and nocebo responses in nursing practice: a discussion paper on the role of contextual factors. In revision at Nurs Inq. Disclosure of Interest None declared

Background Non-Compliance with Long term medication is reported as high 60% (1). Health belief model suggests four elements contribute to this problem. The Beliefs About Medicines Questionnaire (BMQ) is a tool for evaluating people9s beliefs about medicines (1). Objectives A Service Evaluation of compliance with prescribed medication for Long Term Rheumatologic Conditions at Central Middlesex Hospital. This was conducted to assess any possible relationship between compliance with medicines and beliefs or concerns or patient9s ethnicity. Methods The design was a voluntary self-reported, cross-sectional paper based questionnaire survey of people with Rheumatic Conditions. Twelve questions were grouped within three categories (healthcare utilisation, necessity beliefs and concern beliefs) to capture compliance behaviour for later analysis and comparison. The Beliefs about Medicines Questionnaire was adapted from ref (1) to distinguish patients beliefs of 9necessity9 or 9concerns9. In line with principles of PPP, the questionnaire was discussed prior to the audit with a sample focus group of 5 patients who contributed to the wording and the simplification of the questions re: ethnicity. Questionnaires were offered to all patients attending the CMH Rheumatology Unit. The evaluation was discontinued when a target of 100 was reached ( n=102). No questionnaires were excluded. And upto 5% of questions were unanswered. Data was analysed on SPSS. Results The Number of questionnaires returned for this service evaluation was 102. Most respondents (94%) showed compliance with rheumatic medication as prescribed. More than half the respondents (66%) agreed or strongly agreed that their arthritis medications are necessary for their health. 54% were concerned about potential adverse consequences. The overall necessity score (19.32 S.D. 3.17) was higher than the concerns score (13.48; S.D. 3.35; t =61.57, P Concerns about the long term effect of rheumatic conditions correlate positively with perceptions of health in the future P No significant correlation was found between compliance and patient9s ethnicity/individuals demographics. Conclusions Most people with Rheumatic conditions have positive beliefs about the necessity of their medication. However, levels of concern are high, especially towards the long-term effects of the medication. This concurs with asimilar study in Rheumatoid Arthritis.(2). The service evaluation using the Beliefs about Medicines Questionnaire has helped to identify people at risk of poor compliance long term. This illustrates a need to discuss patients beliefs and concerns in targeted drug counseling sessions with specialist nurses. A post study patient focus group recognised the high level of compliance yet recommended a fixed weekly walk in session with a nurse and pharmacist to sustain this high quality outcome. Further methods of continued patient re-education will be explored. References Horne R, Weinman J, Hankins M. The Beliefs about Medicines Questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 1999;14:1–24. Neame R, Hammond A Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford) 2005;44:762–7. Disclosure of Interest None declared

Background Spondylodiscitis is an infection of a disc and the two adjacent vertebrae due to the introduction of a pyogenic, usually by the haematogenous route. It9s quite a rare disease accounting for 2–7% of all cases of septic osteomyelitis [1, 2]. Objectives To study the clinical, microbiological, radiological, therapeutic and evolving of infectious spondylodiscitis Methods A retrospective descriptive study conducted over years in the department of rheumatology, including all patients with infectious spondylodiscitis. Clinical given were collected from paper patients records. Results We included 67 patients. There were 38 men and 29women. The mean age was 55 years. The male to female ratio was 38:29.Risk factors of spondylodiscitis were observed in 19 patients. The approximate time from onset of symptoms to diagnosis was from 3 to 365 days (median, 132 days). Back pain was the most common symptom. Spinal syndrome was found in all patients. The most frequent location of spondylodiscitis was lumbar spine. Signs of spinal cord compression including paraplegia or paraparesis of the lower limbs were observed in 31 patients. Pachymeningitis was associated in 1 case. The paravertebral abscess was associated to the disc involvement in 23 cases. Epiduritis was associated in 21 cases. Plain radiography, performed in in the majority of cases (63 cases, 94%), demonstrated pathological pictures in 56 (83.5%) patients. MRI, performed in 60 (89.5%) patients, disease was in all patients. Pathogens were isolated in 43 (64.1%) cases. Tuberculosis was the most common cause. The leading causative agents in non tuberculousspondylodiscitis were: Staphylococcus aureus (8 isolates, 11.9%), brucella (7 isolates, 10.4%), Escherichia coli (2 isolates, 2.9%) and streptococcus B (1 isolates, 1.4%).Two microorganisms combined (mycobacterium tuberculosis and a pyogenic) was found in one case. Medical treatment was adapted to the prescribed seed. Surgical treatment was performed in 6 patients. After therapy, 59 (88%) patients had regression of symptoms, two patients had a permanent neurological impairment (paraplegia), one patient had recurrence of infection and one patient was dead. Conclusions Infectious spondylodiscitis has been diagnosed with increasing frequency. It should be taken into consideration in differential diagnosis in patients with significant back pain and laboratory evidence of an acute inflammatory process, especially metastatic spinal disease or inflammatory spondyloarthritis References Zimmerli W. Clinical practice.Vertebralosteomyelitis. N Engl J Med 2010 Mar;362(11):1022–9. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008 June;56(6):401–12. Disclosure of Interest None declared

Background Osteoarthritis (OA) is the most prevalent disease in the Americas, with an estimated prevalence of 5–10% of the population. These patients have difficulties accessing the clinic, as well as poorly successful therapeutic programs. We plan to develop a program of Centers of Excellence (CoE) in OA, to meet and respond to these needs, generate data and local research applicable to our health systems. Objectives In a first phase: To create OA pilot centers in Venezuela and Colombia under the CoE scheme, defined in REAL-PANLAR project (Panamerican league of associations for rheumatology project for implementation of CoE in Rheumatoid Arthritis). In a second phase under the auspices of PANLAR to create the Pan American Network of Centers of Excellence in OA (CEOA). Methods A systematic review of the literature in global and regional databases (Pubmed, Medline, Scopus, Lilacs) was conducted and through a Delphi-modified methodology and a consensus of experts, naming a coordinator by subject, we established the conceptual bases and defined OA Center of Excellence. Results The group proposes: 1. Clinical detection and early diagnosis of OA, discarding false positives and diagnosing early OA; 2. Model of patient-centered and multidisciplinary care: frequency of care are to be established according to the conditions of the patient and the multidisciplinary team. 3. Implementation of a specific clinical register of OA with indexes such as WOMAC, Lequesne and also EuroQol and definition of socioeconomic characteristics. 4. Paraclinics and Imaging: Each patient will be given a general laboratory study at admission and then every two years including a metabolic profile. Conventional Rx of hands, hips, knees or lumbosacral column depending on the location and then annual or depending on the evolution. Ultrasound, upon admission to the program, six month later, if synovitis was detected, for redefining the treatment and then annually for evaluation of the articulatory damage; CT and MRI when deemed necessary (OMERACT) 5. Definition of the disease management program in axes: treatment protocol of pain with sequential treatment lines, DMOADs, viscosupplementation, Glucosamine + Chondroitin, Strontium Ranelate, Piascledin; Alternative Medicine and Surgical Treatment 6. Establishment of a management program that includes Structure, Process and Outcome Indicators to define the CEOA as Standard, Optimal and Model. 7. Education modules for patients and families; Continuing Medical Education for all members of the multidisciplinary team; Generation of research in the areas above mentioned. Conclusions The unmet needs in OA determine the implementation of units of CEOAs, to promote management knowledge, and define T2T strategies, in order to improve clinical outcomes, reducing disability and consequently economic and social costs. References REAL-PANLAR Project for the Implementation and Accreditation of Centers of Excellence in Rheumatoid Arthritis in Latin America: A Paper From REAL-PANLAR Group on Improvement of Rheumatoid Arthritis Care in Latin America Establishing Centers of Excellence. Santos-Moreno P, Galarza-Maldonado C, Caballero-Uribe CV, et al. J Clin Rheumatol. 2015 Jun;21(4):175–80. Disclosure of Interest None declared

Background Organ damage in patients with systemic lupus erythematosus (SLE) occurs as the consequence of the disease itself, administered therapy, primarily corticosteroid and cytostatic, as well as the accompanying diseases and complications. Objectives Our aim in this paper was to examine the degree of irreversible organ changes in SLE patients using the SLICC/ACR Damage Index (SDI) and to establish the correlation of organ damage with disease activity, quality of life, and severity of fatigue, as well as with the immunological parameters – anti-dsDNA antibodies, anti-nucleosome, anti-C1q antibodies, and MCP1 in the serum and urine. Methods The study involved 83 SLE patients (77 women and 6 men), aged 45.8±9.2 years on the average, with average disease duration of 10.6±7.9 years, hospitalized at the Clinic of Rheumatology of the “Niska Banja” Institute, in whom the diagnosis was made based on the revised 1997 ACR criteria. The disease activity was evaluated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and a physician9s global assessment. The degree of organ damage was evaluated using the SDI. The quality of life was assessed based on The Medical Outcome Survey Short Form 36 (SF-36), and the severity of fatigue was measured using the Fatigue Severity Scale (FSS). The level of antibodies was determined using the ELISA test, and serum and urine MCP1 with the sandwich enzyme immunosorbent assay method according to the manufacturer9s instructions (R&D Systems, Inc. Minneapolis, USA). Results The mean value of organ damage index in all SLE patients was 1.8±2.0 (median 1, min 0, max 9). Twenty-five (30.1%) patients did not have any organ damage (SDI=0); 21 (25.3%) had SDI=1; SDI=2 or 3 was found in 20 patients (24.1%), and 17 patients (20.5%) had SDI≥4. Neuropsychic and musculoskeletal changes were the most common organ damage manifestations, present in 23 (27.7%) of patients. In 21 patients (25.3%), cardiovascular changes were seen, and ocular lesions in 14 patients (16.9%). Renal and pulmonary changes were found in 13 patients (15.7%), cutaneous changes in 3 patients (3.6%), and gastrointestinal changes in 2 patients (2.4%). In 5 cases (6.0%) malignancies were detected, and diabetes mellitus in 2 patients (2.4%). A statistically significant positive correlation of SDI was established with age (r=0,348, p=0,001), disease duration (r=0,412, p Conclusions Musculoskeletal, neuropsychic, and cardiovascular changes were the ones most commonly seen. Organ damage positively correlated with age and disease duration, a higher disease activity, poorer quality of life, and more severe fatigue. References Roberts AL, Rizzolo D. Systemic lupus erythematosus: an update on treat-to-target. JAAPA. 2015;28(9):22–8. Yee CS, Su L, Toescu V, et al. Birmingham SLE cohort: outcomes of a large inception cohort followed for up to 21 years. Rheumatology (Oxford).2015;54(5):836–43. Cervera R, Doria A, Amoura Z et al. Patterns of systemic lupus erythematosus expression in Europe. Autoimmun Rev. 2014;13(6):621–9. Disclosure of Interest None declared