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Background Severe fatigue is prevalent in patients with rheumatic diseases and has significant impact on patients “quality of life”. However, qualitative studies revealed that fatigue symptoms remain undiscussed in the consultations with health professionals. Objectives Aim of this study was to describe the perceived importance of, satisfaction with and efficacy in fatigue-related communication with rheumatologists and rheumatology nurses from the perspective of the patient and to relate these perceptions to disease characteristics such as severity of fatigue, physical functioning and psychological distress. Methods 127 patients (88% female, mean age=64 years) with a rheumatic disease filled out an online survey consisting of a fatigue-specific version of the PEPPI-5, MAF, HAQII, HADS and items on importance, satisfaction and experienced roles in fatigue-related communication. Data were analyzed with correlational and hierarchical regression analyses. Results Only 10% of patients evaluated fatigue-related communication as (rather) not important, 45% were satisfied with the actual communication and 77% reported that the patient had to take the initiative for fatigue-related communication. Mean score on perceived efficacy regarding fatigue-related communication (16.15, SD=4.25) was lower than those in previous studies on perceived self-efficacy in communication in general. Multivariate analyses revealed depressive symptoms as the main correlate of perceived efficacy in fatigue-related communication. Conclusions Fatigue-related communication emerged as an important topic from the patient perspective. However, satisfaction with and perceived self-efficacy in fatigue-related communication are lower compared to general patient-physician communication in chronic diseases. Possible explanations for this difference will be discussed. References ten Klooster, P. M., Oostveen, J. C., Zandbelt, L. C., Taal, E., Drossaert, C. H., Harmsen, E. J., et al. (2012). Further Validation of the 5-Item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) Scale in Patients With Osteoarthritis. Journal of Patient Education and Counseling, 125-130. Disclosure of Interest None declared

Objectives To compare functional limitations in patients with chronic gout and matched patients with rheumatoid arthritis (RA) as measured with the HAQ-DI and PF-10. Methods Consecutive patients with crystal deposition proven gout (n=102) or with RA (n=619) visiting the outpatient rheumatology clinic of the hospital in Enschede, the Netherlands completed the HAQ-DI and PF-10. Gout patients were matched to patients with RA on sex, age (± 5 years) and disease duration (±5 years). Ninety-three patients with gout could be successfully matched to 93 patients with RA. The HAQ-DI contains 20 items measuring physical disabilities over the past week in eight categories of daily living. Items are scored on a 4-point rating scale from 0 (without any difficulty) to 3 (unable to do). A total score is calculated by averaging the highest score in each category if at least six categories are completed. The PF-10 is the physical functioning scale of the multidimensional SF-36v2. It measures current limitations in a variety of physical activities using 10 items. Items are scored from 1 (yes, limited a lot) to 3 (no, not limited at all). Scores on the PF-10 items are summed and linearly transformed to range between 0 and 100, with higher scores indicating better functioning. Results In both disease groups mean age was 59 (± 12) years, mean disease duration was 7 (±9) years and 86% of patients were male. Median PF-10 scores did not significantly differ between patients with gout or with RA and ceiling effects (no limitations) were similar (6.7% versus 6.5%) (see table). However, patients with RA had significantly worse HAQ-DI total scores than patients with gout, and ceiling effects were significantly lower in RA than in gout. Analysis of HAQ-DI category scores showed that gout patients had less limitations in activities that involve the upper extremities such as Dressing, Eating, Hygiene and Grip than RA patients, while scores for activities mostly involving the lower extremities were similar. Image/graph: Conclusions Gout patients have less functional limitations than RA patients according to HAQ-DI total scores, while according to PF-10 scores gout patients and RA patients do not significantly differ in functional limitations. HAQ-DI seems to underestimate the functional limitations of gout patients compared to RA patients because of the inclusion of activities involving upper extremities, which may be less relevant for patients with gout. On the other hand PF-10 seems to underestimate the functional limitation of patients with RA because of the emphasis on activities involving lower extremities. Disclosure of Interest None Declared

Background Modern treatment strategies are highly successful in reducing disease activity in rheumatoid arthritis (RA). However, changes in clinical measures of disease activity may not always correspond with a patient’s own opinions of improvement. Objectives To identify subjective predictors of self-reported health changes in patients with a good clinical response after one year of treatment in a tight control study. Methods Data from newly diagnosed patients of the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort who completed baseline and 12 months assessments was used for this study. Patients who achieved a good DAS28 response at 12 months were selected for analysis 1 . Subjective change in health was assessed with the SF-36 health transition question (Compared to one year ago, how would you rate your health in general now?). Scores were dichotomized (improved vs not improved) for analysis. Binary logistic regression analysis was performed to identify predictors of patient reported health changes. Twelve month changes in DAS28 scores was added as predictor in the first step; changes in scores on SF-36 subscales were added in a second step. The general health scale of the SF-36 was excluded. Cohen’s standardized effect size (e.s.) statistic (d) was calculated for 12 month change scores of significant predictors and compared between improvers and non-improvers Results A good DAS28 response after 12 months of treatment was achieved by 162 (57%) out of 282 patients. Of these, 40 (24.7%) did not consider their health to have improved since starting treatment (non-improvers). Baseline SF-36 subscale scores did not significantly differ between improvers and non-improvers. Twelve month change scores in bodily pain (OR = 1.03, p = 0.04) and vitality (OR = 1.03, p = 0.04) were significant multivariate predictors of self-reported health improvement. About 19% of the variance in self-reported health changes was explained by the final model (Nagelkerke’s R 2 = 0.19), whereas the model containing only DAS28 change scores explained about 6% of variance (Nagelkerke’s R 2 = 0.06). Mean (SD) bodily pain scores improved from 38.9 (± 18.6) to 74.7 (±19.8) over 12 months for improvers (e.s.= 1.87) and from 41.8 (±19.8) to 62.9 (±19.6) for non-improvers (e.s.= 1.06). Mean (SD) vitality scores improved from 52.8 (±19.8) to 66.7 (±16.8) in improvers (e.s. = 0.71) and from 53.12 (±18.9) to 56.56 (±18.9) for non-improvers (e.s. = 0.17). Conclusions The majority of patients with a good DAS28 response after one year of tight control treatment also considered their health to have improved. However, a substantial minority did not consider their health to have improved, despite significant clinical improvements in disease activity. These results suggest that clinical improvements do not necessarily equate to improved subjective health. One possible explanation is that pain and fatigue are patient reported outcomes that may not be adequately represented in current clinical outcome measures in RA research. References Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol 2005;23(5 Suppl 39):S93-9. Disclosure of Interest None Declared