Search

Resumen Introduccion La gota es una artritis cristalina que se asocia con perdida importante de calidad de vida. Un tratamiento por objetivos y un seguimiento proactivo permiten obtener mejores desenlaces clinicos. La enfermeria especializada en reumatologia optimiza el seguimiento en pacientes con gota y la adherencia al tratamiento, pudiendo mejorar la calidad percibida de estos enfermos en relacion con la atencion sanitaria. Objetivo Determinar los factores que afectan a la calidad percibida y a la satisfaccion de los enfermos con gota atendidos en consultas de reumatologia e identificar areas de mejora, asi como explorar la influencia de enfermeria en la atencion y el seguimiento de estos pacientes. Metodologia Estudio observacional transversal en pacientes con gota seguidos en una consulta monografica mediante encuesta anonima basada en el modelo de calidad SERVQUAL, con datos demograficos y preguntas sobre aspectos asistenciales. Resultados Se recogieron 71 encuestas cumplimentadas de las 80 entregadas entre agosto de 2019 y enero de 2020. La mayoria de los participantes fueron varones de mas de 45 anos. El 39% se mostraron satisfechos con la atencion recibida, y el 55% muy satisfechos. Todos los encuestados se mostraron satisfechos con la consulta presencial conjunta con enfermeria especializada en reumatologia, y el 66% consideraron buena la consulta telefonica con el enfermero. Se identificaron posibles areas de mejora (tiempo de derivacion a consulta, identificacion y disponibilidad del personal sanitario). Conclusion Encontramos una alta satisfaccion global percibida por los pacientes atendidos en consulta de gota con enfermeria especializada en reumatologia. Conocer y sistematizar la opinion de los pacientes es esencial para mejorar la atencion ofrecida.

BackgroundGout is the most common type of inflammatory arthritis. Nonsteroidal anti-inflammatory drugs, corticosteroids, and colchicine are the first-line agents, although they are contraindicated in many patients. Blockade of IL-1 with anakinra can be an alternative.ObjectiveTo present a case series of 10 difficult-to-treat gout patients treated with anakinra and perform a scoping review of the effectiveness and safety of anakinra in gout patients.MethodsA total of 1,519 citations were screened. The reviewers ran a two-stage screening process by title/abstract and full-text reading. Thirty-eight articles finally met the selection criteria and were included for data extraction and synthesis. Experience in difficult-to treat and complex clinical scenarios, such as active infection, hemodialysis, and transplantation, were specifically described.ResultsThe study sample comprised 551 patients, from whom 648 flares were finally analyzed. The mean age was 57.9 years, and 82.9% were men. The clinical presentation was polyarticular in 47.5% and tophaceous in 66.9%. Sixty-five patients with an active infection, 41 transplanted patients and 14 in haemodyalisis treated with anakinra are described. More than half of the patients had >1 associated comorbidity. Anakinra was effective both for flares (94%) and for long-term treatment (91%) and well tolerated. In the case of flares, 34 (6.7%) adverse effects were registered. Adverse events were more prevalent in long-term treatment.ConclusionAnakinra was effective and safe for management of gout flares in difficult-to-treat patients. It has been used in multiple complex scenarios, such as active infections, dialysis, transplantation, chronic kidney disease, and polyarticular gout. Anakinra has also proven effective as long-term treatment, although there are more concerns about its safety.

Mobile health technology holds great promise for the clinical management of patients with chronic disease. However, evidence on the implementation of projects involving digital health solutions in rheumatology is scarce. We aimed to study the feasibility of a hybrid (virtual and face-to-face) monitoring strategy for personalized care in rheumatoid arthritis (RA) and spondyloarthritis (SpA). This project included the development of a remote monitoring model and its assessment. After a focus group with patients and rheumatologists, relevant concerns regarding the management of RA and SpA were raised, leading to the development of the Mixed Attention Model (MAM), which combined hybrid (virtual and face-to-face) monitoring. Then, a prospective study using the mobile solution Adhera for Rheumatology was conducted. Over a 3-month follow-up period, patients were given the opportunity to complete disease-specific electronic patient reported outcomes (ePROs) for RA and SpA with a pre-established frequency, as well as flares and changes in medication at any time. Number of interactions and alerts were assessed. The usability of the mobile solution was measured by the Net-Promoter Score (NPS) and through a 5-star Likert scale. Following the MAM development, forty-six patients were recruited to utilize the mobile solution, of whom 22 had RA and 24 SpA. There were 4,019 total interactions in the RA group, and 3,160 in the SpA group. Fifteen patients generated a total of 26 alerts, of which 24 were flares and 2 were medication-related problems; most (69%) were managed remotely. Regarding patient satisfaction, 65% of the respondents were considered to have endorsed Adhera for Rheumatology, yielding a NPS of 57 and an overall rating was 4.3 out of 5 stars. We concluded that the use of the digital health solution is feasible in clinical practice to monitor ePROs for RA and SpA. Next steps involve the implementation of this telemonitoring method in a multicentric setting.

Introduction Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. Objective To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses’ work in the care and management of these patients. Methods Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. Results 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45 years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. Conclusion We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients’ opinion is essential to improve clinical care.

Dear Editor, We read with interest the recent article by Singh and Cleveland on the hypersensitivity risk of allopurinol (ALP) and febuxostat (FBX) compared with colchicine.1 A common challenge when using ALP, linked to hypersensitivity reactions, is the potential development of cutaneous adverse reactions (CARs). Most are often mild, non-specific rashes; however, severe CARs, including Stevens-Johnson syndrome (SJS), may occur, but with a low incidence (0.69 cases per 1000 person-years) in non-Asian populations.2 In the EuroSCARs study, ALP was the reason for 5% of all severe CARs.3 So, FBX is often chosen as urate-lowering agent on the background of an ALP-related CAR. However, these patients were not eligible for the pivotal trials of FBX4 and were excluded from the recent analysis by Singh and Cleveland.1 Therefore, the accurate rate of FBX-related CARs in patients who previously suffered from ALP, and the mechanisms behind, remain undetermined to date. We have …

The aim of this study was to assess changes in the estimated glomerular filtration rate (eGFR) in gouty patients with chronic kidney disease (CKD) using a "treat-to-target" (T2T) approach in gout. This multicenter observational retrospective study included patients diagnosed with gout and CKD stage 3 taking xanthine oxidase inhibitors (XOIs) (allopurinol or febuxostat) for at least 12 months. All patients were treated using a T2T strategy according to national gout guidelines to achieve the target levels of serum uric acid (sUA; < 5-6 mg/dl) within 6 months of the first visit. The primary outcome was to assess changes in eGFR. The effects of independent variables were analyzed over eGFR in a linear mixed-effects (LME) model. Fifty patients with gout and CKD stage 3 treated with XOIs with a T2T strategy for 12 months were included. Eighty-two percent of the patients achieved the sUA target during the study period. The improvement seen in eGFR was higher during the first 6 months, showing a median increase of 7.54 ml/min/m(2) (SE = 1.25) and trending towards stability over 12 months. For every 1 mg/dl of decrease in sUA, an improvement of 1.5 ml/min/m(2) in eGFR was observed (coefficient +/- SE: - 1.58 +/- 0.26) (p < 0.001) with no differences between type and dosage of XOIs treatment, colchicine administration, age, sex, and smoking status. A reduction in sUA levels using a T2T approach with XOIs at an optimal dose is possible and could help conserve and improve renal function in gouty patients with CKD stage 3.

Background:Gout is the most common inflammatory arthritis in adults. It is caused by the chronic deposition of monosodium urate crystals in joints. Hypertension, diabetes mellitus, chronic kidney disease (CKD) and cardiovascular disease are highly prevalent in gout patients.Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids or colchicine are the first line therapeutic agents for flares. These drugs can be contraindicated in a large group of gout patients. Off label prescription of IL-1 receptor blockage with anakinra can be an alternative for this complex patients.Objectives:The main objective of this study is to perform a scoping review about patient characteristics, comorbidity, effectivity and safety profile of patients with gout treated with anakinra.Methods:A total of 1119 citations were screened. The reviewers performed a two-stage screening by title/abstract and full-text screening. Thirty six articles that finally met selection criteria, were included for data extraction and synthesis. Treatment duration of ≥12 weeks was considered chronic.Results:Four hundred forty three patients were included in the study. 20 patients (4,5%) received chronic treatment and 423 (95,5%) flare treatment. Outcomes from 496 flares were finally analyzed.The mean age of the patients was 63.6 years and 84% were men. The clinical presentation was polyarticular in 47.9% and tophaceous gout in 66.5%. Some of these patients presented atypical forms of the disease such as spinal gout, autoinflammatory syndromes or sternoclavicular joint arthritis.Most of the patients presented comorbidities, the most prevalent being arterial hypertension in 127 (70.5%) and chronic kidney disease (≥ 3 stage) in 220 (51.8%). History of transplant in 37 (14.6%) with stem cell, kidney, heart, and liver transplant. More than half of patients had more than one associated comorbidity. Demographic and clinical characteristics of gouty arthritis patients are presented in Table 1. Flare was present in admitted patients in 260 (57.5%). Anakinra was administered in 52 patients with an active infection.Different treatment regimens were described. Daily administration was used in 98% of the patients. 92.8% of the flares were treated seven days or less, being the three days regimen the most prevalent. In the chronic group the longest treatment reported was 5 years.Efficacy of treatment with anakinra was evidenced, in flare 426 patients (93%) and chronic 19 patients (91%). Overall, anakinra was well tolerated. In the case of flares, thirty-three (7.9%) adverse effects related to anakinra administration were registered: seven (1.6%) site injection reactions, five (1.1%) reversible hematological alterations and five acute infections (H1N1, herpes zoster, severe cold, pulmonary abscess and nosocomial pyelonephritis). In chronic treated patients, adverse infectious events were more prevalent, seven (32%) infections (Staphylococcus aureus tophus (2), Staphylococcus aureus lung abscess, erysipela of the leg, Streptococcus B urinary tract infection, Staphylococcus aureus knee arthritis and tuberculous cervical lymphadenitis).Conclusion:Anakinra has been shown to be effective and safe in treatment for flares in gout complex or resistant patients. It has been shown in multiples scenarios like active infections, dialysis, transplants, chronic kidney disease, tophi and polyarticular disease refractory to standard treatment. It has also shown its effectiveness as chronic treatment, but there are more concerns about its safety. These findings need to be confirmed with controlled clinical trials for anakinra inclusion in treatment recommendations in special situations of flares in complex or resistant gout patients.Disclosure of Interests:None declared.

To assess subclinical vascular features in patients with systemic sclerosis (SSc) via carotid ultrasound, and flow-mediated vasodilation (FMD), as measures of cardiovascular risk (CVR).This was a cross-sectional study of 70 patients diagnosed with SSc (diffuse or limited forms), on whom a vascular study protocol was performed to assess angiodynamic parameters measured by FMD in brachial artery and carotid ultrasound lesions: carotid intima-media thickness (CIMT) and carotid atheroma plaques (AP). Classical CVR factors were also assessed, as well as main features of SSc regarding skin and organic involvement, laboratory parameters, presence of autoantibodies and specific treatments.94% of patients were women with a mean age of 50.2±12.5 years. 84% had endothelial dysfunction (ED), being severe in 49%, statistically associated with glucocorticoid (GC) treatment (OR=8.78; CI=1.52-50.78; p=0.015). CIMT was pathological in 39%, 23% had AP (none had significative haemo-dymanic stenosis). Serum vitamin D concentration (25(OH)D3) showed a protective effect on CIMT (OR=0.94; CI=0.89-0.99; p=0.025). No differences between types of SSc were obtained; neither association between SSc features and classical CVR factors.GC treatment has implications in CVR, despite in SSc GC doses administered are lower than in other autoimmune diseases (in our cohort even prednisone ≤10 mg daily was associated with ED). GC may be associated with an early vascular damage in these patients, which could lead to changes in FMD, ED and finally AP. On the other hand, optimum levels of 25(OH)D3 seemed to be beneficial against vascular damage.

Background: Allopurinol is first-line urate-lowering drug (ULD) for patients with gout. However, around 10% of them refer adverse events, often at skin, which can be severe. Febuxostat is a non-purine selective xanthine oxidase inhibitor, often a therapeutic alternative in this setting, though data regarding safety in those patients with previous cutaneous adverse reactions (CAR) to allopurinol is still limited. Some cases and small retrospective series have reported skin adverse events under both allopurinol and febuxostat. Objectives: To assess the cutaneous safety of febuxostat when used in patients with previous skin reactions to allopurinol. Methods: A multicentre retrospective, descriptive study performed in seven Rheumatology units around Spain. Crystal-proven gout patients with previous CAR to allopurinol and treatment with febuxostat were selected. Demographic (age, gender), clinical (skin events, liver disease, concomitant thiazides) and laboratory variables (serum urate (SU), glomerular filtration rate) were collected. The primary study variable was the rate of patients developing CAR also with febuxostat. A descriptive analysis with estimation of 95% confidence interval (95%CI) is presented. Results: Sixty-seven gout patients with prior allopurinol-related CAR treated with febuxostat were enrolled. Their average age was 68.1 years (SD±14.8), being 49 males (73.1%). Thirteen of them were under thiazide treatment (19.4%) and average glomerular filtration rate was 66.1 ml/min (±24.3) when allopurinol was started, at a median dose of allopurinol of 100 mg/day (IQR 50-300) and mean SU of 8.9 mg/dl (±1.7). The reported CAR under allopurinol were nonspecific in 55 (82.1%), maculopapular rash in 9 (13.4%), and Stevens-Johnson’s syndrome in 3 (4.5%).. Out of 67 patients, 10 developed CAR with febuxostat (14.9%; 95%CI 8.3-25.3%): nonspecific in 8 cases, one case of maculopapular rash and other of Stevens-Johnson’s syndrome. Median (IQR) glomerular filtration rate, starting dose of febuxostat and SU level were 69.5 (42-87.8), 80 mg/day (40-80) and 8.2 mg/dl (7.15-9.14), respectively. Benzbromarone was initiated in all 10 patients with CAR to both allopurinol and febuxostat, and only one developed a nonspecific rash. Conclusion: In this multicentre study, around 15% of patients with prior allopurinol-related CARs also developed them with febuxostat. Further prospective and intervention studies are needed to confirm these results, though caution is recommended when using febuxostat in this subgroup of patients. Disclosure of Interests: Neus Quilis Marti: None declared, Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Boris Anthony Blanco Caceres: None declared, Cesar Diaz Torne Consultant for: Grunenthal, Speakers bureau: Grunenthal, Enrique Calvo-Aranda Speakers bureau: Gruhnental, SOBI, Menarini, Francisca Sivera: None declared, Alejandro Prada-Ojeda: None declared, Fernando Perez-Ruiz Grant/research support from: Asociacion reumatologos de Cruces, Consultant for: Grunenthal Horizon Menarini, Speakers bureau: Grunenthal, Menarini, Fundacion Espanola Reumatologia, Eliseo Pascual Consultant for: Eliseo Pascual has participated in the boards of Astra Zeneca, Menarini, Grunenthal and Horizon, Speakers bureau: speaking fees from Astra Zeneca and Grunenthal, Mariano Andres: None declared

Background Approximately 25% of gouty patients suffer from chronic kidney disease (CKD). High serum uric acid (sUA) levels have been related to estimated glomerular filtration-rate (eGFR) imbalance. Beneficial effect of treatment with xanthine oxidase inhibitors (XOI), mostly allopurinol, has already been proved in patients with CKD and asymptomatic hyperuricemia. Although several studies have described the efficacy and renal safety of treatment with XOI in gout, few authors have analyzed its effect on GFR in gouty patients with moderate CKD. Objectives To assess the effect of XOI therapy in gouty patients with moderate CKD, in terms of eGFR changes. Methods In this multicenter, retrospective study, we included patients from 4 centers diagnosed with gout (EULAR/ACR criteria) and stage-3 CKD according to Cockroft-Gault formula (eGFR 30-59 ml/min/m2) who received XOI (febuxostat and allopurinol) with a follow-up for 6 and 12 months. We used clinical records to collect patient features (age, sex, body mass index, sUA, hypertension (HTA), diabetes mellitus (DM), dyslipidemia (DL), cardiovascular events), treatments (lipid-lowering drugs, antihypertensives, antidiabetics, antiplatelet therapy, NSAIDs, urate lowering treatments and colchicine) and gout history (duration of disease, tophi presence, clinical and ultrasonographic (US) pattern (monoarticular, oligoarticular, polyarticular). Statistical analysis: descriptive analysis of variables. Mixed effects model lineal regression Differences were considered significant p Results 52 patients with gout and stage-3 CKD were identified. We obtained complete 6 and 12-months follow-up from 37 patients (33 males and 4 females). Mean age was 74.11±6.96 years, 32.4% DM, 83.78% HTA, 56% DL, 40% tophaceous gout, Clinical and US pattern (37.8% polyarticular, 37.8 oligoarticular and 24.3% monoarticular). Febuxostat 19 patients, Allopurinol 18. Mean baseline sUA was 8.63±1.33 mg/dl, and baseline eGFR was 47.77±8.45 ml/min/m2. To assess the effects of considered variables over eGFR a linear mixed model was adjusted using nlme R-package. Within the adjusted model we obtained significant differences in eGFR between baseline and 6 months (p=0.0081), and between baseline and 12-months (p=0.0028). sUA decreased significantly between baseline and 6 (p=0.0181) and 12 months (p=0.0188). Conclusion Reduction of sUA levels in gouty patients with XOI entitles an improvement of eGFR in stage-3 CKD. These findings suggest that the response to urate lowering therapy take place in the first 6 months, leading to an improvement in eGFR in this period. From 6 months to 1 year, sUA levels are stabilized and so is eGFR. References [1] Tanaka K, Nakayama M, Kanno M, et al. Renoprotective effects of febuxostat in hyperuricemic patientswith chronic kidney disease: a parallel-group, randomized, controlled trial. Clin Exp Neprhol 2015 [2] Juge PA, Truchetet ME, Pillebout E, et al. Efficacy and safety of febuxostat in 73 gouty patients with stage 4/5 chronic kidney disease. A retrospective study of 10 centers. Joint Bone Spine (2016) Disclosure of Interests Marta Novella-Navarro: None declared, Jose Luis Cabrera-Alarcon: None declared, Francisco Aramburu-Munoz: None declared, Iustina Janta: None declared, Alejandro Prada-Ojeda: None declared, Luis Sala-Icardo: None declared, Paloma Garcia de la Pena: None declared, Enrique Calvo-Aranda Speakers bureau: Gruhnental, SOBI, Menarini

Background Metabolic syndrome (MS) is a cluster of interrelated components: central adiposity or higher waist circumference (WC), high values of triglycerides (TG), elevated blood pressure (BP), impaired fasting glucose and decreased HDL-cholesterol (HDL-c). It is associated with a higher incidence of developing diabetes (DM), as well as with other cardiovascular diseases (CVD). A direct relationship between serum uric acid (sUA) and the risk of develop MS has been reported in several studies of patients with hyperuricemia and gout. Objectives To study the prevalence of MS and associated CVD in patients with gout attended in a specialized outpatient unit, comparing with other local and national studies. Methods Retrospective observational study with consecutive patients diagnosed with gout according to EULAR/ACR criteria between August and December 2018. We analyzed the presence of MS according to the 2015 International Diabetes Federation criteria (central obesity as BMI ≥30 kg/m2 or WC ≥94 cm (≥80 in women), with ≥2 of the following: TG ≥1.71 mmol/l, HDL-c Results 57 patients with gout were included. Average age 62 years (39-90), 48 years (18-90) at the time of gout onset. 94.7% males. 40.3% with FH of gout, tophi in 52.6%. Clinical pattern: monoarticular 15.8%, oligoarticular 56.1%, polyarticular 28.1%. 68.4% received urate-lowering therapy: 45.6% Allopurinol, 22.8% Febuxostat. SUA at the time of inclusion 6.7 mg/dl (2.6-11.3). Total cholesterol 186 mg/dl (4.84 mmol/l; 96-350 mg/dl/2.5-9.1 mmol/l). TG 185 mg/dl (2.11 mmol/l; 68-742 mg/dl/0.78-8.46 mmol/l). BMI 31.8 kg/m2 (24-58.1). MS was found in 66.7% and premorbid metabolic syndrome (pMS; excluding patients with previously diagnosed CVD or DM) in 26.3%. Obesity 57.9% and overweight 38.6%. HT 80.7%; 10.5% diagnosed in our unit. DM 22.8%. Dyslipidemia (DL: hypercholesterolemia or high levels of TG) 64.9%; 14% diagnosed in our unit. 29.8% smokers, 49.1% formers. Alcohol consumers 54.4%. Chronic kidney disease (CKD) 42.1%; 12.3% diagnosed in our unit. Ischemic heart disease (IHD) 14%. Stroke 24.6%. FH of CVD 24.6%. Comparing with the general population the prevalence of MS and pMS was higher (DARIOS: 31% and 24%, respectively; ENRICA: 22.7% and 16.9%; SIMETAP: 41% and 25%), as well as with the presence of CKD (11.5% in SIMETAP) and CVD (SIMETAP: HT 38%, T2DM 16%, obesity 28%, IHD 4.8% and stroke 3.8%). Conclusion There is a very significant percentage of MS and pMS in patients with gout compared to the general population, with important presence of CKD and CVD, sometimes underdiagnosed. Nursing guidelines were established with healthy lifestyle and periodic controls directed at all patients, with special emphasis on those newly diagnosed of HT or DL, as well as those of higher cardiovascular risk. References [1] Fernandez-Berges D, et al. Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study. Rev Esp Cardiol. 2012;65(3):241-8 [2] Guallar-Castillon P, et al. Magnitude and management of metabolic syndrome in Spain in 2008-2010: the ENRICA study [3] Ruiz-Garcia A, et al. Population and methodology of the SIMETAP study: Prevalence of cardiovascular risk factors, cardiovascular diseases, and related metabolic diseases. Clin Investig Arterioscler. 2018;30(5):197-208 Disclosure of Interests Enrique Calvo-Aranda Speakers bureau: Gruhnental, SOBI, Menarini, fernando manuel sanchez-aranda: None declared, Laura Cebrian: None declared, maria angeles matias de la mano: None declared, elena garcia-lorenzo: None declared, maria teresa navio marco: None declared

Background:Gout is the most common nontraumatic arthritis. With a prevalence in Spain of 2.4% and an increasing incidence, many gout patients are treated in Rheumatology. Different comorbidities complicate the management of this disease that not only attacks joints, but also induces kidney damage and accelerated atherosclerosis. This, together with a poor adherence to urate-lowering therapies and a suboptimal management, justifies its relevant morbidity and mortality, with high socioeconomic impact. Some studies suggest enhancing the role of the Clinical Nurse Specialist (CNS) in the care of gout to combat therapeutic failureObjectives:To determine the factors that affect the perceived quality and satisfaction of gout patients treated in Rheumatology with CNS support and identify areas for improvementMethods:In 2018, we implemented the following nurse-supported visit protocol- 1st(rheumatologist and nurse; face-to-face): clinical history, joint examination, vital signs, anthropometrics, start of treatment, comorbidities management, health promotion- 2nd(nurse; telephone, after analytical results): 1 month after 1stvisit. Targeted questions (adherence, side effects, attacks, blood pressure, lifestyle habits) and therapeutic adjustment- 3rd(rheumatologist and nurse; face-to-face): at 3-6 months. Targeted questions, joint examination, vital signs, anthropometrics, therapeutic adjustment, health promotion- 4th(rheumatologist and nurse; face-to-face): at 12 months. Targeted questions, examination, therapeutic adjustment, health promotion. Subsequently, semiannual/annual appointments in Rheumatology or Primary Care, according to patient complexity and gout controlWe applied a treat-to-target strategy (serum uric acid Results:44 surveys were obtained between August 2019 and January 2020. 95% male, 55% with an age range of 46-60 years; 41% >60 years. 68% considered the referral time to our Department reasonable; excessively long for 14%. All respondents were satisfied with the face-to-face nurse-supported consultation, and 93% considered the telephone CNS consultation to be good. 57% were not able to remember the name of the CNS, compared to 27% who did not know the rheumatologist name. 91% considered that the time to solve doubts and for explanations was enough. 46% considered the availability of CNS/rheumatologist as good, and 37% as excellent. The global satisfaction was good in 48% and excellent in 43%Conclusion:We found a high global satisfaction in gout patients followed in our Department. They valued very positively the role of CNS in the face-to-face and telephone consultations, as well as the staff availability, their dedication to answer questions and offer explanations. We must remember our names to patients and optimize referral to our Department. Exploring patients’ opinions is essential. It improves communication, adherence and attention offered, and allows to provide them a better experience in their relationship with the DepartmentReferences:[1]Doherty M, Jenkins W, Richardson H, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet. 2018;392(10156):1403–1412. doi:10.1016/S0140-6736(18)32158-5[2]Fuller A, Jenkins W, Doherty M, Abhishek A. Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study [published online ahead of print, 2019 Aug 13]. Rheumatology (Oxford). 2019;kez333. doi:10.1093/rheumatology/kez333Disclosure of Interests: :Enrique Calvo-Aranda Consultant of: GRÜNENTHAL, Speakers bureau: GRÜNENTHAL, MENARINI, SOBI, fernando manuel sanchez-aranda: None declared, maria teresa navio marco: None declared, Laura Cebrian: None declared, maria angeles matias de la mano: None declared, Leticia Lojo: None declared

Background Gout is the most prevalent arthritis globally, it is due to monosodium urate (MSU) crystals deposit on tissues, mainly in joints and periarticular structures. Although the main clinical pattern in gout is monoarticular, many patients suffer from oligo/polyarticular disease. Due to the information obtained through imaging tests such as ultrasonography (US), we know that the extent of MSU deposits are greater than we expected in many occasions, affecting clinically silent joints. Musculoskeletal US is a key tool due to its accessibility and safety, it determines accurately the current extent of deposits and joint involvement in gout, which may condition therapeutic changes. Objectives To evaluate the influence of articular US for clinical practice in Rheumatology when initiating treatment with febuxostat in patients with gout, determining the degree of crystalline deposit and articular ultrasonographic involvement. Methods Observational cross-sectional study of 129 patients diagnosed with gout (ACR criteria), treated with febuxostat (14 due to renal disease, adverse reaction/intolerance to allopurinol, and 115 due to non-response to allopurinol). One month after the onset of treatment, US examination was performed following the protocol proposed by Peiteado et al1, determining the number of joints with signs of gout (double contour, hyperechoic aggregates) and acute inflammatory activity (Doppler). Other variables were analysed: age, sex, hypertension, diabetes, dyslipidemia, chronic kidney disease, time of disease evolution and clinical pattern of joint involvement. Results 115 patients with febuxostat (112 men and 3 women), with a mean age of 57±13 years and mean of disease evolution 14±10 years. 59 patients had monoarticular clinical pattern, 46 oligoarticular and 10 polyarticular. US involvement: we observed acute inflammatory activity by Doppler in 47 patients (40.86%), microcrystalline aggregates in 90 patients (78.26%) and double contour sign in 53 patients (42.08%). The mean uricemia at the time of the joint ultrasound examination was 7.4±1.8 g/dl. Of the 94 patients with uric acid levels>6 mg/dl, 72 presented extensive US involvement (76.59%), whereas of the 21 patients with levels Conclusions US quantification of MSU deposits can significantly condition the intensity of uricemia-reducing treatment regardless of serum uric acid levels. In this study, patients with non-target uricemia did not present a greater joint affection evaluated by US, however, those with Reference [1] Peiteado D, et al. Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol2012;30:830–7. Disclosure of Interest None declared

Objectives. To investigate the efficacy of IA CS (IAC) therapy in single and multiple joints in children with JIA and to seek for predictors of synovitis flare. Methods. The clinical charts of patients who received their first IAC injection between January 2002 and December 2008 were reviewed. The CS used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. Patients were stratified as follows: one joint injected; two joints injected; and three or more joints injected. Predictors included sex, age at disease onset, JIA category, age and disease duration, ANA status, iridocyclitis, general anaesthesia, number and type of injected joints, acute-phase reactants and concomitant MTX therapy. Results. The cumulative probability of survival without synovitis flare for patients injected in one, two, or three or more joints was 70, 45 and 44%, respectively, at 1 year; 61, 32 and 30%, respectively, at 2 years; and 37, 22 and 19%, respectively, at 3 years. On Cox regression analysis, positive CRP, negative ANA and injection in the ankle were the strongest predictors for synovitis flare. The only significant side effect was skin hypopigmentation or s.c. atrophy, which occurred in