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Objective: To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Methods: A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients’ association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. Results: Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. Conclusions: The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice., Este proyecto fue financiado por Merck Sharp & Dohme® España y avalado por las siguientes asociaciones/sociedades: CONARTRITIS (Coordinadora Nacional de Artritis asociación, de pacientes que representa a las personas afectadas por AR, APs, AIJ y EspA), OPENREUMA (Asociación de otros profesionales sanitarios dedicados a la reumatología) y SORCOM (Sociedad de Reumatología de la Comunidad de Madrid)

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

Objectives The aim of this study is to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis. Methods An observational, cross-sectional multicentre study was performed. Patients from 10 rheumatology departments in Madrid who presented with severe acute respiratory syndrome coronavirus-2 infection between February 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (socio-demographic, clinical, and treatments), using logistic regression analyses. Results In total, 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age, and comorbidities such as diabetes mellitus, hypertension, and obesity were associated with severe COVID-19. Corticosteroid doses >10 mg/day, rituximab, sulfasalazine, and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, P Conclusions This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab, and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-tumour necrosis factor therapy were not associated with worse outcomes.

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

ObjectivesMost studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyze whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analyzed.MethodsA longitudinal multicenter study of RA patients was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease, and management being perceived as problematic by the rheumatologist and/or patient). The main outcome was disease activity in the early stages. The covariates were sociodemographic, clinical, and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. Weighting techniques were also applied to balance data.ResultsThe study population comprised 631 patients and 35 developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, DAS28 score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.50; p=0.02).ConclusionsIn this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.What is already known on this topicDespite T2T and the availability of a range of advanced therapies, D2T RA remains a relevant clinical problem. Evidence for the D2T RA population have focused on established RA. The aim of our study was to analyze whether disease activity at diagnosis could influence progression to D2T RA under real-life conditions.What this study addsWe did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.How this study might affect research, practice or policyThe implementation of more effective strategies in the early stages of the disease and focused on the most influential factors, including severe disability, may change disease course and prevent D2T RA.

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

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

Objectives We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission owing to coronavirus disease 2019 (COVID-19), assessing the role of autoimmune rheumatic diseases (ARDs) compared with non-autoimmune rheumatic and musculoskeletal diseases (NARDs) on persistent symptoms and sequelae. Methods We performed an observational study including RMD patients who attended a rheumatology clinic in Madrid and required admission owing to COVID-19 (between March and May 2020) and survived. The study began at discharge and ran until October 2020. Main outcomes were persistence of symptoms and sequelae related to COVID-19. The independent variable was the RMD group (ARD and NARD). Covariates included sociodemographics, clinical and treatment data. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group. Results We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least one persistent symptom. The most frequent symptoms were dyspnoea, fatigue and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, a central retinal vein occlusion and an optic neuritis. Two patients died. Eleven patients required re-admission owing to COVID-19 problems (16.7% ARD vs 3.9% NARD; P = 0.053). No statistically significant differences were found between RMD groups in the final models. Conclusion Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. Compared with NARD, ARD does not seem to differ in terms of persistent symptoms or consequences, although ARD might have more re-admissions owing to COVID-19.

Resumen Objetivos Identificar las comorbilidades prioritarias en la espondiloartritis axial (EspAx) y recomendar como hacer su seguimiento desde una perspectiva eminentemente practica. Metodos Se selecciono a un grupo multidisciplinar (10 reumatologos [6 expertos en EspAx], 2 medicos de familia, una internista, una cardiologa, una gastroenterologa y una psicologa). En una primera reunion de discusion, se establecieron el alcance y los usuarios, y se voto una lista de comorbilidades sobre la base de la frecuencia y el impacto. Los panelistas debian defender con argumentos consistentes la inclusion de cada comorbilidad/item en el documento. Cuatro panelistas y 2 metodologos, desarrollaron revisiones sistematicas en temas controvertidos. En una segunda reunion se presentaron los resultados de las revisiones y los argumentos de todos los items a incluir. Tras esta reunion se redacto el documento final. Resultados El documento final incluye 2 listas de comprobacion (checklist), una para profesionales sanitarios y otra para pacientes, que recogen: riesgo cardiovascular, comorbilidad renal, riesgo gastrointestinal, estilo de vida, riesgo de infecciones y vacunacion, afectacion pulmonar, medicacion concomitante, trastornos psicoafectivos, osteoporosis y riesgo de fractura. Ademas, el documento refleja los argumentos para incluir cada item y la manera de recoger los items. Asimismo, el panel considero oportuno establecer unas «practicas a evitar» aplicables a la comorbilidad de la EspAx. Conclusiones Se generaron 2 listas de comprobacion y un listado de escenarios a evitar para facilitar el manejo de las comorbilidades de la EspAx. En pasos posteriores probaremos su utilidad y su aceptacion por un grupo amplio de usuarios que incluya medicos, pacientes y enfermeras.

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

Aims: In this pandemic, it is essential for rheumatologists and patients to know the relationship between COVID-19 and inflammatory rheumatic diseases (IRDs). We wanted to assess the role of targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARDs) and other variables in the development of moderate-severe COVID-19 disease in IRD. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1 March to 15 April 2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid with a medical diagnosis of IRD were included. Main outcome: hospital admission related to COVID-19. Independent variable: ts/bDMARDs. Covariates: sociodemographic, comorbidities, type of IRD diagnosis, glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Incidence rate (IR) of hospital admission related to COVID-19 was expressed per 1000 patient-months. Cox multiple regression analysis was run to examine the influence of ts/bDMARDs and other covariates on IR of hospital admission related to COVID-19. Results: A total of 3951 IRD patients were included (5896 patient-months). Methotrexate was the csDMARD most used. Eight hundred and two patients were on ts/bDMARDs, mainly anti-TNF agents, and Rtx. Hospital admissions related to COVID-19 occurred in 54 patients (1.36%) with an IR of 9.15 (95% confidence interval: 7–11.9). In the multivariate analysis, older, male, comorbidities, and specific systemic autoimmune conditions (Sjögren, polychondritis, Raynaud, and mixed connective tissue disease) had more risk of hospital admissions. Exposition to ts/bDMARDs did not achieve statistical significance. Use of glucocorticoids, NSAIDs, and csDMARDs dropped from the final model. Conclusion: This study provides additional evidence in IRD patients regarding susceptibility to moderate–severe infection related to COVID-19.

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

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

OBJECTIVES: To describe patients with inflammatory rheumatic diseases (IRD) who had COVID-19; to compare patients who need hospital admission versus those that did not and assess risk factors of hospital admission related to COVID-19. METHODS: We performed a prospective observational study, from 1st March 2020 until the 24th of April. All patients being attended at the rheumatology outpatient clinic of a tertiary hospital of Madrid, with medical diagnosis of inflammatory rheumatic disease, and with symptomatic COVID-19 disease were included. Main variable was the hospital admission related to COVID-19. Covariates: sociodemographic, clinical and treatments. We performed a multivariate logistic regression model to assess risk factors of hospital admission. RESULTS: 123 patients with IRD and COVID-19 disease were identified and included. We found 54 patients that need hospital admission, 59.2% were women, with a mean age at hospital admission of 69.7 (15.7) years, and a median lag time from symptoms onset to hospital admission of 5 (3-10) days. The median length of stay was 9 (6-14) days. A total of 12 patients died (22%) during their hospital admission. Factors independently associated with hospital admission were being older (OR 1.08; p=0.00), and type of diagnosis (OR 3.55; p=0.01), compared to those who were ambulatory. DMARDs dropped from the model. Male sex, associated comorbidities and glucocorticoids use showed a tendency risk (p

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

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

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

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

Resumen Objetivo Estimar los costes medicos directos en los pacientes con artritis reumatoide (AR) y los factores predictores en los pacientes tratados con farmacos biologicos y sin biologicos. Metodos Se realizo un estudio transversal en una muestra incluyendo pacientes de toda la geografia nacional. Se obtuvieron datos sociodemograficos y de tratamiento. Se registro la utilizacion de recursos para los 2 anos de estudio y se hizo imputacion de costes. Se realizaron analisis de correlacion en todos los pacientes con AR y en los tratados con y sin biologicos, para estimar las diferencias entre los grupos. Los predictores de costes se analizaron mediante modelos de regresion lineal. Resultados Se incluyeron 1.095 pacientes con AR, el 26% hombres, con una edad media de 62 ± 14 anos. La media de los costes medicos directos por paciente fue de 24.291 ± 45.382 €. Excluyendo los farmacos biologicos, el coste medio por paciente fue de 3.742 ± 3.711 €. Despues de ajustar, los factores predictores de costes medicos directos para todos los pacientes con AR fueron los farmacos biologicos (p = 0,00), la comorbilidad (p = 0,00) y la edad del paciente (p = 0,01). En el grupo sin biologicos, los predictores fueron la comorbilidad (p = 0,00) y la edad del paciente (p = 0,01). En el grupo con biologicos los predictores fueron el sexo del paciente (p = 0,03) y la actividad de la enfermedad (p = 0,02). Conclusion Los datos muestran un notable impacto economico de la AR. Es importante identificar y estimar los factores asociados a mayor coste para desarrollar estrategias de reduccion de costes y aumentar la calidad de la atencion.

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

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

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

Fibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain associated with other symptoms, including psychological distress. While negative mood (anxiety, depression, and anger) has been widely explored in FM, few studies have investigated emotional dysregulation. Our purpose was to evaluate problems in the processes of emotional regulation and to explore their influence on the severity of pain and disability.Emotional regulations, anxiety, depression, anger, pain and disability were evaluated in 47 FM patients and 47 healthy subjects. Regression analyses were performed to evaluate the role that emotional regulation processes have on pain severity and disability of FM patients.Results showed that although FM patients do not differ in terms of the attention paid to their emotional states, FM patients had greater difficulties in the emotional regulation process. In addition, emotional rejection and interference are two variables that influence the pain severity and disability.FM patients need to be trained in strategies for regulating their emotions, in order to achieve a reduction in negative mood states, as well as their impact in pain and disability.

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

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

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

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

We appreciate the interest of Aydin et al 1 in our study about risk factors for hospital admissions related to COVID-19 in patients with inflammatory rheumatic diseases (IRD).2 COVID-19 pandemic is a matter in constant update and certainly an enormous challenge for researchers, clinicians, healthcare workers and epidemiologists. In this sense, all together are making enormous efforts in their fields to overcome this global crisis. In relation to research advances, there has been an explosion in the publication of articles related to COVID-19. In this pandemic situation, it is true that it has been a challenge and a race against the clock for researchers and some publications could be less rigorous than expected.3 For this reason, and according to Aydin et al ,1 the critical reading it is important to interpret the results, paying special attention to the limitations of each study. The role of IRD, their therapies and other potential factors in the risk of SARS-CoV-2 infection and …

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

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

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

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

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

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

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