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Objective: Patients with rheumatoid arthritis (RA) have a significantly increased risk of mortality compared with the general population. One of the most important predictors for mortality is somatic comorbidity. Moreover, studies have demonstrated that comorbid depression is associated with mortality. Which specific comorbidities are associated with mortality is less investigated. The purpose of this study was to investigate the association of a wide range of comorbidities with mortality in patients with RA. Methods: Longitudinal data over a 14-year period were collected from 882 patients with RA. Data were assessed with questionnaires. The mortality status was obtained from the Statistics Netherlands for the period 1996–2011 for 99% of the patients. Somatic comorbidity was assessed in 1997, 1998, 1999, and 2008 and measured by a national population-based questionnaire including 20 chronic diseases. Comorbid depression was assessed in 1997, 1998, and 1999 and measured with the Center for Epidemiologic Studies Depression Scale. Cox regression was used to study the relationship between comorbidity and mortality. Results: At baseline, 72% of the patients were women. The mean ± SD age was 59.3 ± 14.8 years, and the median (interquartile range) disease duration was 5.0 (2.0–14.0) years. A total of 345 patients died during the study period. Comorbidities that were associated with mortality were circulatory conditions (hazard ratio [HR] 1.60 [95% confidence interval (95% CI) 1.15–2.22]), respiratory conditions (HR 1.43 [95% CI 1.09–1.89]), cancer (HR 2.00 [95% CI 1.28–3.12]), and depression (HR 1.35 [95% CI 1.06–1.72]). Conclusion: Comorbid circulatory conditions, respiratory conditions, cancer, and depression are associated with mortality among patients with RA. Careful monitoring of these comorbidities during the course of the disease and adequate referral may improve health outcomes and chances of surviving.

Objective Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol. Methods Forty-nine patients with knee OA and severe knee pain (numerical rating scale for pain ≥7) were included. Analgesics were prescribed following an incremental protocol. After 6 weeks, a 12-week exercise therapy program was added. Information about analgesic use and exercise therapy content was recorded. Knee pain and activity limitations were assessed at baseline, after 6 weeks, and after 18 weeks. Results Statistically significant improvements in pain and activity limitations were found in intent-to-treat analysis after 6 weeks of analgesic use and after the intervention was completed. Mean improvements from baseline were 30% (P < 0.001) for pain and 17% (P < 0.001) for activity limitations after the intervention was completed. Seventy-eight percent of the patients were able to exercise according to the protocol. In these patients, exercise therapy following 6 weeks of analgesic use resulted in a further improvement of activity limitations of 10% (P = 0.004). Conclusion The combined intervention of standardized analgesic prescription and exercise therapy allows most patients with knee OA and severe pain to participate in exercise therapy, leading to reduction of pain and activity limitations. These promising results need to be confirmed in a randomized controlled trial.

The aim of this study was to investigate (a) the mortality in a clinical cohort of patients with established rheumatoid arthritis in comparison with the general Dutch population over 15 years, (b) the trend in the mortality ratio during the study period, and (c) causes of death and compare these with the general population. In 1997, a sample of 1222 patients was randomly selected from the register of a large rheumatology outpatient clinic. Their mortality and primary causes of death between 1997 and 2012 were obtained from Statistics Netherlands. The standardized mortality ratio (SMR) for all-cause mortality and the number of life-years lost in the study period, adjusted for age, sex, and calendar year, were calculated. A linear poisson regression analysis was performed to evaluate change in all-cause SMR over time. Finally, the SMRs for cause-specific mortality were calculated. The mean age of the population at baseline was 60.4 (SD 15.4) years, and 72.6% of the patients were women. The estimated SMR (95% CI) for all-cause mortality was 1.54 (1.41, 1.67) with about one life-year lost over the study period. There was a trend to decreasing SMR (2% annually, p = .07). Mortality was higher compared with the general population for circulatory system diseases, respiratory system diseases, musculoskeletal system diseases, and digestive system diseases (p < .05). The observed mortality among patients with RA was 54% higher than in the general population after adjustment for age, sex and calendar year. More than one life-year was lost over 15 years, and the mortality tended to decrease over time. The mortality was higher for cardiovascular, respiratory, musculoskeletal and digestive diseases.

ObjectiveTo describe long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis (RA). MethodsLongitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Patient-reported outcomes were collected in 1997, 1998, 1999, 2002, and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the physical component summary score of the Short Form 36 health survey. Somatic comorbidity was measured by a questionnaire including 12 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Studies Depression Scale. We distinguished 4 groups of patients based on comorbidity at baseline. ResultsSeventy-two percent of the patients at baseline were women. The mean +/- SD age was 59.3 +/- 14.8 years and the median disease duration was 5.0 years (interquartile range 2.0-14.0 years). For the total group of patients with RA, physical functioning improved over time. Patients with somatic comorbidity, comorbid depression, or both demonstrated worse physical functioning than patients without comorbidity at all data collection points. Both groups with comorbid depression had the lowest scores. Only patients with both somatic comorbidity and comorbid depression showed significantly less improvement in physical functioning over time. ConclusionBoth somatic comorbidity and comorbid depression were negatively associated with physical functioning during an 11-year followup period. Furthermore, their combination seems to be especially detrimental to physical functioning over time. These results emphasize the need to take somatic comorbidity and comorbid depression into account in the screening and treatment of patients with RA.

Objective.To investigate the longterm association of a wide range of comorbidities with physical and mental functioning in patients with rheumatoid arthritis (RA).Methods.Longitudinal data over a period of 11 years were collected from 882 patients with RA. Somatic comorbidity and comorbid depression were measured at baseline, with a questionnaire including 20 chronic diseases and with the Center for Epidemiologic Depression Scale, respectively. Physical functioning was measured at 5 timepoints with a disease-specific measure [Health Assessment Questionnaire (HAQ)] and a generic measure [physical scales of the Medical Outcomes Study Short Form-36 (SF-36)]. Mental functioning was measured with the mental scales of the SF-36. To determine the association of baseline-specific comorbidities with functioning over time, we performed longitudinal analyses.Results.At baseline, 72% percent of the patients were women, mean age ± SD was 59.3 ± 14.8 years, median RA disease duration was 5.0 years, and 68% had ≥ 1 comorbid condition. The effect of comorbid conditions was more apparent when physical functioning was measured with SF-36, a disease-generic measure, compared with the HAQ, a disease-specific measure. Circulatory conditions and depression were associated (p < 0.05) with worse physical functioning according to the HAQ. Respiratory conditions, musculoskeletal conditions, cancer, and depression were associated (p < 0.05) with worse physical functioning according to the SF-36. Respiratory conditions and depression were associated with worse mental functioning.Conclusion.Patients with specific comorbid conditions have an increased risk of low functioning in the long term. Targeted attention for these specific comorbid conditions by clinicians is recommended.

Objective. To compare the short-term utility and clinical effectiveness of the commercial-made Futuro wrist orthosis with a newly developed, custommade ThermoLyn wrist orthosis. Methods. Using a randomized cross-over trial, 10 patients with rheumatoid arthritis used each of the two orthoses for two weeks. Outcome measures were patients' judgments with respect to different statements about utility and clinical assessments including pain and swelling of the wrist and finger joints, range of motion of the wrist, and grip strength. At the end of the study the patients were asked which of the two orthoses they preferred and why. Results. Patients tended to favor the Futuro wrist orthosis with respect to pain relief and to handling the orthosis. The visual analog scale score of the appearance of the ThermoLyn wrist orthosis was a little higher than that of the Futuro wrist orthosis, but the difference was not statistically significant. Clinical parameters such as pain in the wrist, swelling of the wrist and finger joints, and movements of the wrist showed that the Futuro orthosis tended to be more effective than the ThermoLyn orthosis. None of the differences reached statistical significance. At the end of the study, 5 patients preferred the Futuro and 5 patients the ThermoLyn wrist orthosis. Arguments in favor of the ThermoLyn orthosis were better hygiene, stability, and no need to remove the orthosis during dirty and wet conditions. Arguments in favor of the Futuro orthosis were greater suppleness and freedom of movement. Conclusions. The ready-made fabric Futuro wrist orthosis appears to be as good as the more expensive individually made synthetic ThermoLyn wrist orthosis with respect to short-term utility and clinical effectiveness. The conditions under which the orthosis will be worn will help to decide which orthosis is the best for the patient. In the event that the patient wants to use the orthosis in wet and dirty conditions, the ThermoLyn wrist orthosis is a good alternative to the Futuro wrist orthosis.

Background Prescription of analgesics is complex in patients with knee OA and severe pain. We developed a protocol for the standardized prescription of analgesics based on the World Health Organization analgesic ladder (1) and the Beating osteoARTritis (BART) strategy for stepped care in hip and knee OA (2). Objectives The aim of this study was to evaluate the feasibility and outcome of the analgesic protocol. Methods Forty-nine patients with knee OA and severe knee pain (NRS≥7; range 0-10) were included. Analgesics were prescribed following an incremental protocol (Figure 1) for a period of six weeks. Pain intensity was evaluated every two weeks. When there was insufficient pain reduction (NRS-pain>5), a consultation at the rheumatologist was planned to offer an analgesic of the next step. Analgesics of the next step were added to analgesics of the previous step(s). Analgesic use was recorded. Knee pain (NRS-pain) and activity limitations (WOMAC-PF) were measured. Data were collected at baseline and after six weeks. Subsequently, patients started with exercise therapy. Results At baseline 84% of the patients used analgesics. Of all patients, 77% used acetaminophen, 36% used NSAIDs and 16% used weak opioids. At baseline, analgesics were used irregularly and at an suboptimal dose. Analgesic use after six weeks is described in Figure 1. The maximal daily dosage was used in 93% of the patients that used acetaminophen, in 66% of the patients that used NSAIDs, and in 44% of the patients that used weak opioids. Combinations of analgesics were common. No serious adverse events occurred. In 39% of the patients NRS-pain was ≤5 after six weeks. Despite NRS-pain>5, a further step in the analgesic protocol was not accepted by the patient (n=14) or not prescribed by the rheumatologist (n=13), the latter mostly due to contra-indications or side effects. Statistically significant and clinically relevant mean improvements from baseline were 19% (p Conclusions After six weeks, patients used analgesics regularly and often at a preferential dose. Prescription of analgesics following an incremental protocol reduces pain and activity limitations in patients with knee OA and severe pain. References World Health Organization. Cancer pain relief: with a guide to opioid availability. Available at: http://whqlibdoc.who.int/publications/9241544821.pdf (accessed 14 January 2014). Smink AJ, et al. Clin Rheumatol 2011;30:1623-9. Disclosure of Interest None declared

Background Severe pain in patients with knee OA hampers the ability to exercise. A protocol for the optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol is to reduce pain and thereby allowing the patient to participate in exercise therapy. Objectives The objective of the present study was to evaluate the feasibility and outcome of the protocol. Methods Forty-nine patients with knee OA and severe knee pain (NRS-pain≥7, range 0-10) were included in this study. Analgesics were prescribed following an incremental protocol. The incremental steps were (1) acetaminophen, (2) NSAIDs, (3) weak opioids and (4) intra-articular steroid injections. After six weeks of analgesic use a supervised exercise therapy program for 12 weeks was added, consisting of muscle strengthening exercises and training of daily activities. Knee pain was assessed with NRS-pain and activity limitations were assessed with WOMAC-PF. Data were collected at baseline, after six weeks, and after 18 weeks. Results In intention-to-treat analyses statistically significant improvements in pain and activity limitations were found after six weeks of analgesic use and after the complete intervention. Mean improvements from baseline were 30% (p Conclusions The combined intervention of analgesics and exercise therapy allows most patients with knee osteoarthritis and severe pain to participate in exercise therapy, leading to reduction of pain and activity limitations. These promising results need to be confirmed in a randomized controlled trial. Disclosure of Interest None declared

Background Patients with rheumatoid arthritis (RA) have a higher mortality risk compared with the general population. This higher mortality risk is mainly attributable to cardiovascular (CV) diseases. The higher CV mortality risk in RA is caused both by traditional CV risk factors and the underlying chronic inflammatory process. Recent years have witnessed the introduction of tight disease control and of more intensive treatment. Moreover, the increased CV risk in patients with RA is nowadays acknowledged and thus the need for CV risk management. These improvements in medical care may have resulted in lower CV mortality. However, there is a lack of recent studies investigating trends in CV mortality over time. Demographic as well as clinical and functional variables predict CV mortality. Until now, the impact of these variables on CV mortality has been studied separately and not in combination. A EULAR task force for CV risk management advocated to study for a broad range of variables the combined contribution (demographic- as well as inflammatory- and traditional risk factors) to CV mortality in patients with RA in large prospective cohort studies [1]. Objectives To investigate a) the CV mortality in a clinical cohort of patients with established RA in comparison with the general population over 15 years, b) the trend in this CV mortality during the study period, and c) for a broad range of predictors, which baseline variables predict CV mortality. Methods In 1997, a sample of 1222 patients was randomly selected from the register of a rheumatology outpatient clinic in Amsterdam. Their CV mortality between 1997 and 2012 was obtained from Statistics Netherlands. The Standardized Mortality Ratio (SMR) for CV mortality was calculated. A linear poisson regression analysis was performed to evaluate change in SMR over time. A Cox Regression analysis was performed to determine which baseline variables predicted CV mortality. Results Mean age of the population at baseline was 60.4 ( SD 15.4) years and 72.6% of the patients were women. Estimated SMR (95% Confidence Interval) for CV mortality was 1.23 (1.05, 1.43). The SMR did not decrease statistically significant (3% annually, p =0.16). Higher age, higher Erythrocyte Sedimentation Rate, having CV comorbidity and Diabetes Mellitus (DM) were predictors for CV mortality. Conclusions The CV mortality among patients with RA in the past 15 years was still higher than in the general population. The CV mortality did not decrease statistically significant. As CV mortality in RA is still higher than in the general population, continued attention for CV diseases in RA is important. Both tight control of disease activity and good care for comorbid conditions (CV diseases and DM) are advocated. References Peters MJ, Symmons DP et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69(2):325-331 Disclosure of Interest None declared

Bij de beantwoording van de gestelde vraag zullen we ons beperken tot de mogelijke werkzaamheid van diclofenac emulgel (Voltaren Emulgel®) bij aandoeningen van het bewegingsapparaat, zoals artrose, tendinitis en spier- en gewrichtsletsel (bijvoorbeeld verstuiking, overbelasting, kneuzing). Aanvullend zal commentaar worden gegeven op enkele recent gepubliceerde meta-analyses over lokale NSAID’s.

Background Patients with rheumatoid arthritis (RA) have a significantly increased risk of mortality compared with the general population [1]. Although the management of RA improved in the last decades, the survival in patients with RA has not improved to the same degree as that of the general population [2,3]. One of the most important predictors for mortality is somatic comorbidity. Moreover, studies have demonstrated that comorbid depression is associated with mortality. Which specific comorbidities are associated with mortality is less investigated. Objectives To investigate the association of a wide range of comorbidities with mortality in patients with RA. Methods Longitudinal data over a 14-year period were collected from 882 patients with RA. Data were assessed with self-reported questionnaires. The mortality status was obtained from the Statistics Netherlands for the period 1996-2011 for almost all of the participants included at baseline (99,8%). Somatic comorbidity was assessed in 1997, 1998, 1999 and 2008. Somatic comorbidity was measured by a national population-based questionnaire including 20 chronic diseases, of which nine categories of chronic somatic comorbidity were created. Comorbid depression was assessed in 1997, 1998 and 1999. Comorbid depression was measured with the Center for Epidemiologic Depression Scale. Cox regression was used to study the relationship between comorbidity and mortality. Results At baseline, 72% of the patients were women. The mean age was 59.3 (SD 14.8) years and the median disease duration was 5.0 (IQR 2.0-14.0) years. Comorbidities that were associated (Hazard Ratio [95% confidence intervals]) with mortality were circulatory conditions (1.62 [1.17-2.26]), respiratory conditions (1.46 [1.11-1.93]), digestive conditions (1.51 [1.02–2.22]), cancer (2.03 [1.30-3.18]) and depression (1.39 [1.09-1.77]). Conclusions Comorbid cardiovascular conditions, respiratory conditions, digestive conditions, cancer, and depression are associated with mortality among patients with RA. Careful monitoring of these comorbidities during the course of the disease and adequate referral may improve health outcomes and chances of surviving. References Ogdie A, Haynes K, Troxel A B, et al. Risk of mortality in patients with psoriatic arthritis, rheumatoid arthritis and psoriasis: a longitudinal cohort study. Ann Rheum Dis. 1-1-2014;73:149-153. Gonzalez A, Maradit Kremers H, Crowson C S, et al. The widening mortality gap between rheumatoid arthritis patients and the general population. Arthritis Rheum. 2007;56:3583-3587. Radovits B J, Fransen J, Al Shamma S, et al. Excess mortality emerges after 10 years in an inception cohort of early rheumatoid arthritis. Arthritis Care Res (Hoboken). 2010;62:362-370. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3524

Background Comorbidity in patients with Rheumatoid Arthritis (RA) is highly prevalent and plays an important role in determining RA related outcomes. Several studies have reported the negative association of comorbidity with functioning in general. The information about the association of specific comorbidities with functioning in patients with RA is limited. Evaluating specific comorbidities will provide valuable information for clinical practice and the management of patients with RA. Objectives To investigate the long term association of a wide range of specific comorbidities with physical and mental functioning in patients with RA. Methods Longitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Somatic comorbidity was measured at baseline, with a questionnaire including 20 chronic diseases, from which 9 categories of chronic somatic comorbidity were created. Comorbid depression was measured at baseline, with the Center for Epidemiologic Depression Scale. Physical functioning was measured with the Health Assessment Questionnaire (HAQ) and with the physical component scales of the Short Form 36 health survey (SF-36). Mental functioning was measured with the mental component scales of the SF-36. To determine the impact of specific comorbid conditions on functioning and on change in functioning we performed a longitudinal analysis. Results At baseline, 72% of the patients were women, their mean age ± SD was 59.3±14.8 years, their median disease duration was 5.0 years, and 68% had ≥1 comorbid condition. The mean HAQ score for an average patient was 0.98 on average over the 11-years follow-up period. Circulatory conditions (mean HAQ score +0.28) and depression (+0.38) were associated (p Conclusions Patients with specific comorbid conditions have an increased risk of low or declining functioning on the long term. Targeted attention for these specific comorbid conditions by clinicians and general practitioners is important. Diagnostics during the course of the disease, adequate referral to and working together with other specialists might improve physical and mental functioning in patients with RA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2909

OBJECTIVE—To assess the feasibility, reliability, and validity of the time trade off (TTO) in patients with rheumatoid arthritis (RA). METHODS—The TTO was applied in 194 patients with RA with increasing difficulty in performing activities of daily living. The test-retest reliability was determined in 35 of these patients and was calculated by the intraclass correlation coefficient (ICC). Construct validity was evaluated with the following sets of variables: measures of utility (rating scale), quality of life (RAND 36 item Health Status Survey (RAND-36) and RAQoL), functional status (Health Assessment Questionnaire, grip strength, and walk test), and disease activity (doctor's global assessment, disease activity score, pain, and morning stiffness). RESULTS—Ten patients (5%) did not complete the TTO. The median value of the TTO was 0.77 (range 0.03-1.0). The test-retest ICC of the TTO was 0.85 (p

Background Rheumatoid Arthritis (RA) is associated with premature mortality (1). Somatic comorbidity has been found to be one of the most important predictors for premature mortality (2). Comorbid conditions that are associated with premature mortality are: cardiovascular diseases, respiratory diseases, gastrointestinal system disorders, genitourinary diseases, hematologic diseases, infectious diseases, and malignancies. A few studies have found comorbid depression to be associated with an increased risk for mortality (3). The combination of both somatic comorbidity and comorbid depression as a risk factor for mortality has not yet been investigated. Whether this combination is an additional risk factor for premature mortality is important information for clinicians to be able to adapt their screening process and when necessary their treatment. Objectives To investigate which comorbid conditions are associated with premature mortality and if the combination of a somatic comorbid condition and comorbid depression is more associated with premature mortality than one of these conditions alone. Methods Longitudinal data over a period of eleven years were collected from 882 patients with RA at study inclusion. Data by means of self-reported questionnaires were collected in 1997, 1998, 1999, 2002 and 2008. Of all of the participants included at baseline, the mortality status was obtained from the register of the Statistics Netherlands. Somatic comorbidity was measured by a questionnaire including 20 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Depression Scale. To study the relationship between comorbidity and survival among RA patients, we performed a Cox regression analysis. Results 78% of the patients at baseline were women. The mean age was 59.3 (SD 14.8) years and the median disease duration was 5.0 (IQR 2.0-14.0) years. Comorbid conditions that were associated with premature mortality were respiratory conditions, gastrointestinal conditions, cancer and comorbid depression. The combination of a somatic comorbid condition and comorbid depression did not lead to an additional risk for premature mortality. Conclusions Both somatic comorbidity and comorbid depression are a risk factor for premature mortality among patients with RA. These results emphasize the importance of paying attention to both somatic comorbidity and comorbid depression in clinical practice, and highlight the importance of ascertaining the presence of such comorbidities and to adjust treatment when necessary. References Naz SM, Symmons DPM. Mortality in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2007; 21(5):871-883. Sokka T, Abelson B, Pincus T. Mortality in rheumatoid arthritis: 2008 update. Clin Exp Rheumatol 2008; 26(5 Suppl 51):S35-S61. Ang DC, Choi H, Kroenke K, Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol 2005; 32(6):1013-1019. Disclosure of Interest None Declared

Background Mental functioning is reported as an important outcome measure in patients with Rheumatoid Arthritis (RA). Patients show lower mental functioning scores than the general population (1). A factor that has great impact on the overall health outcomes is comorbidity (2). Both somatic and depression comorbidity are common in patients with RA. Investigating the influence of comorbidity on mental functioning provides clinicians long term information for a particular patient. Objectives To asses the long term association of somatic and depression comorbidity and mental functioning in patients with RA. Methods Longitudinal data over a period of eleven years were collected among 882 patients with RA of varying disease duration. Patient reported outcomes were collected in 1997, 1998, 1999, 2002 and 2008. Mental functioning was measured with the Mental Component Scale of the Short Form-36 Health Survey. Somatic comorbidity was measured by a self administered questionnaire including 13 chronic diseases. Depression comorbidity was measured with the Center for Epidemiologic Depression Scale. We distinguished four groups of patients based on comorbidity at baseline: patients 1) without comorbidity 2) with only somatic comorbidity 3) with only depression comorbidity and 4) with both somatic and depression comorbidity. The influence of comorbidity at baseline on mental functioning over time was investigated in a longitudinal analysis. Results 882 patients responded to the questionnaire, of whom 78% were women. The mean age of the patients at baseline was 59.3 (SD 14.8) years and the mean disease duration was 8.9 (SD 9.9) years. For the total group of patients with RA mental functioning stayed stable over time. There was no difference in mental functioning between patients without comorbidity and patients with somatic comorbidity. Patients without comorbidity at baseline had better mental functioning at all time points than patients with depression comorbidity and patients with both somatic and depression comorbidity (p Conclusions Depression comorbidity and the combination of both somatic and depression comorbidity was negatively associated with mental functioning and this association was present during eleven years follow up. Because of its long term consequences, early screening for depression comorbidity in RA would be recommended, so additional intervention can start early in the disease process to reduce the negative effects of this comorbidity. References Uhlig T, Loge JH, Kristiansen IS, Kvien TK. Quantification of reduced health-related quality of life in patients with rheumatoid arthritis compared to the general population. J Rheumatol 2007; 34(6):1241-1247. Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009; 11(3):229. Disclosure of Interest None Declared

Background The prevalence of comorbidity in patients with rheumatoid arthritis (RA) is higher than in the general population (1). There is increasing evidence that comorbidity plays an important role in determining RA-related outcomes, like physical functioning (2). Little is known about the impact of comorbidity on the long term. Further, the studies that investigated the effects of comorbidity on physical functioning, did not compare the influence of both somatic and depression comorbidity. With this information clinicians can early adjust their treatment to the comorbidity. Objectives To asses the long term association of comorbidity and physical functioning in patients with established RA. Methods Longitudinal data were collected among 882 patients with RA of varying disease duration at inclusion in the study. Patient reported outcomes were collected in 1997, 1998, 1999, 2002 and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the Physical Component Scale of the SF-36 Health Survey. Somatic comorbidity was measured by a self administered questionnaire including 13 chronic diseases. Depression comorbidity was measured with the Center for Epidemiologic Depression Scale. We distinguished four groups of patients based on comorbidity at baseline: patients 1) without comorbidity 2) with only somatic comorbidity 3) with only depression comorbidity and 4) with both somatic and depression comorbidity. The influence of comorbidity on physical functioning over time was investigated in a longitudinal analysis. Results 882 patients respond to the questionnaire, of whom 78% were woman. The mean (SD) age of the patients at baseline was 59.3 (SD 14.8) years and the mean (SD) disease duration was 8.9(SD 9.9) years. For the total group of patients with RA, physical functioning improved over an eleven year period. Patients with comorbidity had a worse physical functioning than patients without comorbidity at all time points, by which both groups with depression comorbidity had the lowest score (p Conclusions Both somatic comorbidity and depression comorbidity had a negative impact on physical functioning during eleven years follow up in patients with RA, and their combination seems to be especially detrimental over time. Clinicians need to take somatic comorbidity and depression into account in screening and treatment of patients with rheumatoid arthritis to improve physical functioning in the long term. References Kroot EJ, van Gestel AM, Swinkels HL, Albers MM, van de Putte LB, van Riel PL. Chronic comorbidity in patients with early rheumatoid arthritis: a descriptive study. J Rheumatol 2001; 28(7):1511-1517. Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009; 11(3):229. Disclosure of Interest None Declared