Search

Rheumatoid arthritis (RA) patients from Latin America present distinctive characteristics relevant when assessing their cardiovascular (CV) risk. The objective was to monitor CV risk factor behavior in the early stages of the disease and to identify predictors of major CV outcomes (MACE). A recent-onset RA cohort was initiated in 2004; data from 185 patients with ≥ 1 year of follow-up were analyzed. Patients underwent prospective assessments of CV risk factors. Incident MACE were confirmed according to standardized definitions. Appropriated statics was used based on the distribution of the variables. At baseline, patients were primarily middle-aged females (87.6%), with active disease (69.7%). Most prevalent CV risk factors were C-reactive-protein > 1 mg/L (90.3%), Castelli ratio > 3 (83.8%), and low–high-density lipoprotein levels (73.5%). The number of patients with an incident CV risk factor after 1 year was higher for a Castelli ratio > 3 (23%), low–high-density lipoprotein serum cholesterol (16.3%), high total serum cholesterol (10.6%), and BMI ≥ 30 kg/m2 (10%). A minority of patients met the age-range criteria for the application of ACC/AHA 2013 criteria and Reynolds Risk Score (45.8% and 34.1%, respectively). Fifteen patients were classified with high-CV risk during the first year of follow-up, according to ACC/AHA 2013 criteria. Until June 2018, the cohort underwent 1358 patient/years follow-up; six patients developed incidental MACE; high-CV risk at baseline failed to predict MACE. Recent-onset RA Hispanic patients present a distinctive pattern and first-year behavior of CV risk factors. During follow-up, few patients developed incidental MACE.

Cutaneous involvement is often overlooked in rheumatoid arthritis (RA). We described cutaneous findings in outpatients attending a recent-onset cohort and identified factors associated with skin involvement and reduced (R) dermatological quality of life (DQoL).Skin and rheumatological examinations were performed in 122 patients. DQoL was assessed through the Dermatology Life Quality Index (DLQI). Skin findings were classified as RA-specific and RA-nonspecific. Multiple regression analysis identified factors associated to skin involvement and RDQoL (DLQI score1).Patients were middle-aged females (91%), with a 1-year mean disease activity score in 28 joints as 2.0 (interquartile range: 1.5-2.6). There were 94 (77%) patients in whom at least one cutaneous finding was observed: 17 (13.1%) had RA-specific findings (all were rheumatoid nodules) and 91 (96.8%) had at least one RA-nonspecific finding, further classified into skin diseases (35.2%), hair diseases (20.9%), and skin-related signs (76.9%, among whom 94.3% had xerosis). Age (odds ratio [OR]: 1.054, 95% confidence interval [CI]: 1.015-1.094) and skin-health concerns (OR: 5.657, 95% CI: 1.771-18.070) were associated with cutaneous involvement, whereas increased age and DLQI score were associated with a higher number of skin findings/patient. There were 29 patients (24.2%) with RDQoL, which were associated with the Short Form-36 emotional component (OR: 0.955, 95% CI: 0.923-0.988) and the number of skin findings/patient (OR 2.873, 95% CI 1.723-4.791). Pruritus and hair diseases were the individual categories associated with RDQoL.Cutaneous manifestations are frequent in RA patients and have the potential to impact the emotional component of health-related quality of life. Key Points • Up to 77% of the RA patients with substantial follow-up, from a recent-onset disease cohort, had cutaneous manifestations; these were primarily RA-nonspecific findings, whereas 13.1% had RA-specific findings. • Skin-health concerns and age were associated with cutaneous involvement; meanwhile, increased age and Dermatology Life Quality Index (DLQI) score were associated with a higher number of cutaneous findings/patient. • Reduced dermatological quality of life (RDQoL) was documented in one in four patients and was associated with the SF-36 emotional component and the number of cutaneous findings/patient.

Background To determine the impact of health care interruption (HCI), on clinical status of the patients reincorporated to an outpatient clinic for rheumatic diseases (OCDIR), from a tertiary care level center who was temporally switched to a dedicated COVID-19 hospital, and to provide a bioethical analysis. Methods From March to June 2020, the OCDIR was closed; since June, it is limited to evaluate 25% of the ongoing outpatients. This cross-sectional study surveyed 670 consecutive rheumatic outpatients between June 24th and October 31th, concomitant to the assessment of the rheumatic disease clinical status by the attendant rheumatologist, according to disease activity level, clinical deterioration and adequate/inadequate control. Multiple logistic regression analysis identified factors associated to HCI and to clinical deterioration. Results Patients were middle-aged females (86.7%), with median disease duration of 10 years, comorbidity (38.5%) and 138 patients (20.6%) had discontinued treatment. Primary diagnoses were SLE and RA, in 285 (42.5%) and 223 (33.3%) patients, respectively. There were 344 patients (51.3%) with HCI. Non-RA diagnosis (OR: 2.21, 95%CI: 1.5–3.13), comorbidity (OR: 1.7, 95%CI: 1.22–2.37), patient’s need for rheumatic care during HCI (OR: 3.2, 95%CI: 2.06–4.97) and adequate control of the rheumatic disease (OR: 0.64, 95%CI: 0.45–0.9) were independently associated to HCI. There were 160 patients (23.8%) with clinical deterioration and associated factors were disease duration, substantial disease activity previous HCI, patients need for rheumatic care and treatment discontinuation. Conclusions HCI during COVID-19 pandemic impacted course of rheumatic diseases and need to be considered in the bioethical analysis of virus containment measures.

Background Rheumatoid arthritis (RA) impacts sexual and reproductive health (SRH), which is a prominent component of a patient´s quality of life and highly influenced by the cultural background. The aim of the study was to explore the interest of Mexican outpatients with RA in SRH and to examine patient view on SRH. Methods This cross-sectional study surveyed 303 consecutive outpatients with RA on their perceptions of SRH importance, SRH satisfaction, access to SRH information, preferences regarding SRH communication with healthcare professionals, and understanding of SRH (qualitative open-ended descriptions). Descriptive statistics and inferential analysis were used. Patient knowledge of each dimension of SRH was rated based on pre-specified criteria. Two assessors assigned ten major themes to each patient´s description of both dimensions of SRH. Results Patients perceived their SRH as an important component of their general health and wished to address the topic, although few had access to such communication. Female patients assigned lesser importance to SRH, showed lesser degree of satisfaction with SRH, and expressed preference for a truthful physician. Age showed a linear association with individual survey responses, except for satisfaction with reproductive health dimension. There was a linear association between increased age and decreased years of formal education with a lower level of SRH knowledge. Ten major themes emerged for each of the two dimensions of the SRH construct, although most individual descriptions were assigned to one or two major themes. Conclusions Further education and assessment of SRH in Mexican patients with RA is warranted.

BackgroundRisk perception (RP) describes patient´s judgment of the likelihood of experiencing something unpleasant, and has been associated to the adoption of health behaviors. Current rheumatoid arthritis (RA) guidelines recommend early and intensive treatment, although patients also commonly use Complementary and Alternative Medicine (CAM). We aimed to investigate if significant RP was associated to CAM use in Hispanic RA outpatients and to describe additional associated factors.MethodsBetween March and August 2019, 266 consecutive outpatients were invited to a face-to-face interview to collect socio-demographic and RA-related information, to assess comorbidity and the following patient-reported-outcomes: pain, overall-disease and treatment adherence with visual analogue scales, disease activity with RAPID-3, RP with a validated questionnaire, and CAM use with a translated and cross-culturally adapted for Argentina version of the International CAM questionnaire. Medical records were reviewed to corroborate the data provided by the patients. CAM use definition was restricted to "in the last 3 months". Significant RP was defined based on published cut-off. Multiple logistic regression analysis was used to investigate factors associated to CAM use. The study received IRB approval.ResultsThere were 246 patients included, primarily middle-aged women, with substantial disease duration, moderate disease activity and 70 patients (28.5%) had significant RP. Two hundreds patients (81.3%) were CAM users. Significant RP (OR: 2.388, 95%CI: 1.044-5.464, p = 0.039) and access to Federal health care system (OR: 2.916, 95%CI: 1.081-7.866, p = 0.035) were associated to CAM use.ConclusionsPatient´s perception of RA-related negative consequences was associated to recent CAM use in Hispanic RA outpatients.

Background Rheumatoid arthritis (RA) patients present an increased risk of cardiovascular (CV) morbidity and mortality compared to the general population1. Patients from Latin-America exhibit younger age, female preponderance, less severe disease and dyslipidemia, which are relevant when assessing CV risk2. In order to impact CV morbidity/mortality, control of reversible CV-risk factors need to be achieved3. Cohorts allow prospective evaluation of long-term outcomes. In 2004 we initiated an early RA cohort. Up to June 2018, the cohort comprised 185 RA patients with prospective assessments of CV risk and at least one year of follow-up. Objectives To monitor CV risk-factor’s behavior during the first year of follow-up and to identify if traditional CV risk scores predict major CV events (MACE) in our population. Methods Once enrolled patients had complete rheumatic evaluations at regular intervals. Baseline CV-risk factor’s assessments included age, gender, ethnicity, physical activity and history of first-degree relatives with premature heart disease. CV-risk factors assessments at baseline and at least 6 months apart included blood pressure, serum total cholesterol (CHO) and HDL cholesterol (Castelli ratio CHO/HDL was derived), serum glucose (GLU, in mg/dL), body mass index (BMI), CRP (in mg/dL) and (at least) the following comorbidities: Hypertension (HT, and HT treatment), diabetes mellitus (DM), advanced chronic kidney failure (CKF) and atrial fibrillation (AF). Smoking status was assessed at baseline and last follow-up. Incident MACE were defined according to standard definitions4. Cox regression’s model identified predictors of incidental MACE. Patients gave written informed consent. Results At cohort entry, the 185 patients (all Hispanic) which data were analyzed were primarily middle-aged females (87.6%) and had 5.3 months (3.3-7.1) of disease duration. Most prevalent CV risk factors were CRP >1 mg/dL (90%), Castelli ratio > 3 (84%) and low HDL levels (74%). During the first year of follow-up, smoking status, systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, low HDL, Castelli ratio > 3, high CRP and patients with active disease progressively decreased; meanwhile, the opposite figure was true for BMI ≥ 30 kg/m2 and patients on corticosteroids. At 12 months of follow-up, number of patients with incident CV risk factor was higher for Castelli-ratio > 3 (23%), low HDL (16.3%), high CHO (10.6%), BMI ≥ 30kg/m2 (10%), CRP >1 mg/dL (7.5%) and age ≥45 years old (3.3%). During the first year of follow-up, 45.8% of the patients had age between 40-79 years old, required to apply American Heart Association (AHA) criteria; these identified 12 patients with high CV-risk. Up to June 2018, the cohort had 1358 patient/years follow-up and 6 patients had incidental MACE after (median, IQR) 6.5 years of follow-up (3.3-9.5). High CV-risk score at baseline failed to predict incidental MACE. Meanwhile, BMI ≥30kg/m2 was a predictor of incidental MACE in our population. Conclusion Hispanic RA patients from an early RA cohort present a distinctive pattern of CV risk factors. Due to younger age at RA presentation, a minority of the patients had CV risk scored. Obesity was a predictor of incidental MACE in our population. References [1] Avina-Zubieta JA, et al. Arthritis Rheum2008;59:1690-7. [2] Parra-Salcedo F, et al. Arthritis Res Ther2015;17:34. [3] Primdahl J, et al. Ann Rheum Dis2013;72:1771-6. [4] Hicks K, et al. Draft Definitions for CDISC2014;7:1-33. Acknowledgement None Disclosure of Interests None declared

Background Rheumatoid arthritis (RA) patients present an increased risk of cardiovascular (CV) morbidity and mortality compared to the general population. Patients from Latin-America present distinctive features and some of them are relevant when assessing CV risk. EULAR recommendations include CV risk assessment for all the patients at least once every 5 years and its reconsideration following major changes in anti-rheumatic therapy. Importantly, failure to identify and manage CV comorbidity in RA patients has been recognized by rheumatologists, although there is no information in Latin-America. Objectives To investigate knowledge about EULAR recommendations for RA-CV risk assessment/management (K-EULAR-R) among internal medicine and rheumatology fellows from an academic and tertiary care level center, to identify physician’s perception about responsible(s) for CV risk assessments and about major barriers to perform the assessments and to investigate the appropriated identification of major CV risk factors. Potential differences among both group of trainees were additionally investigated. Methods Internal medicine fellows (N=105, 1st to 4th grade participants were represented) and rheumatology fellows (N=10, 4 from first grade and 6 from second grade) were invited to anonymously answer a questionnaire designed by 2 investigators to investigate K-EULAR-R and integrated by 11 items classified in 3 categories: “general knowledge about CV risk in RA patients” (4 items), “timing of CV risk assessment” (4 items) and “appropriated statin use” (3 items). In addition, fellows were directed to select and rate main responsible for CV risk assessment (5 options), major barriers to apply EULAR recommendations (6 options), and to correctly identify CV risk factors (20 options). After questionnaire completion, an overall-CV-knowledge-Likert scale (superior, borderline or inferior) was assigned to each participant by an independent observer. The study received IRB approval. Descriptive statistic was used and questionnaire was scored to a decimal scale. Results Ninety-three (85%) internal medicine fellows and 10 (100%) rheumatology fellows participated. Rheumatology fellows scored higher in the K-EULAR-R questionnaire when compared to internal medicine fellows (6.9±1.4 vs. 5.5±1.4, p=0.004) and the higher score was replicated in the category of “general knowledge about CV risk” (8.3±2.0 vs 5.3±2.5, p=0.001), meanwhile no differences were detected in the scoring of the categories “timing of CV risk assessment” and “appropriated statin use”. No differences among grades within each group were identified. The majority of the rheumatology fellows rated themselves as the specialist responsible for CV risk assessment (80%); meanwhile this percentage decreased to 45.7% among the internal medicine fellows (p=0.084); fellows from both groups identified lack of time during rheumatic evaluations as the main barrier to perform CV risk assessment (60% and 57%, respectively). Adequate CV risk factor identification varied from 30% (for contraceptive use) to 100% (for smoking habit), and these% were similar among both groups. Up to 82.5% of the fellows identified incorrectly ≥ 1 CV risk factor and high serum triglyceride levels was the highest (49%). Conclusion Knowledge about CV risk management in RA patients was suboptimal among trainees in internal medicine and rheumatology from an academic and tertiary care level center in Mexico City; trainees in rheumatology performed better. There is a need to reinforce the topic during fellow’s residency. Disclosure of Interests None declared

Background Reconstructive joint surgery is an indicator of poor prognosis in rheumatoid arthritis (RA). Objectives of this study were to describe the incidence rate of orthopedic and hand surgery indication (OHSI) in an ongoing cohort of Hispanic early RA patients treated according to a T2T strategy and to investigate predictors. Methods Through February 2018, the cohort comprised 185 patients recruited from 2004 onwards, with variable follow-up, and rheumatic assessments at fixed intervals that included prospective determination of OHSI. Charts were reviewed by a single data abstractor. OHSI incidence rate was calculated. A case-control study nested within a cohort investigated the predictors; cases (OHSI patients) were paired with controls (1:4) according to age, sex and autoantibodies. A logistic regression model included baseline and cumulative (up to OHSI or equivalent) variables related to disease activity, treatment and to persistence with therapy. The IRB approved the study. Results Patients from the cohort were predominantly middle-aged (mean ± SD age: 38.5 ± 12.9 years) females (87.6%) with 5.4 ± 2.6 months of disease duration. The cohort contributed to 1538 patient-years of follow-up. Twelve patients received incidental OHSI at a follow-up of 85 ± 44.5 months. The OHSI incident global rate was 8/1000 patient-years. Longer symptom duration at cohort referral (OR: 1.313, 95%CI: 1.02–1.68, p = 0.032) and a higher number of flares/patient (OR: 1.608, 95%CI: 1.05–1.61, p = 0.015) predicted OHSI. OHSI patients had more severe flares than their counterparts, and the opposite figure was true for mild flares. Conclusion Early referral for appropriate management and flare control may prevent OHSI in Hispanic recent-onset RA patients.

Background During the course of rheumatoid arthritis (RA), patients have profound negative effects on their patient-reported-outcomes (PRO); in addition, the impact of sustained remission (SR) on PROs may differ for each particular outcome. The objectives of this study were to identify SR from an inception cohort of RA patients and to examine the impact of SR in an ample spectrum of PROs. Methods The study was developed in a well characterized and ongoing cohort of RA patients with recent onset disease recruited from 2004 onwards. In November 2016, the cohort included 187 patients, of whom 145 had at least 30 months of follow-up, with complete rheumatic assessments at regular intervals in addition to a pain visual analogue scale (PVAS), overall disease-VAS (OVAS), health assessment questionnaire (HAQ), Short-Form 36v2 Survey (SF-36) and fatigue assessment. First SR was defined according to the DAS28 cut-offs (DAS28-SR) and ACR/EULAR 2011 Boolean definition (B-SR), if maintained for at least 12 consecutive months. The dependent t test and Mc Nemar’s tests were used for comparisons between related groups. Local IRB approval was obtained. Results More patients achieved DAS28-SR than B-SR: 78 vs. 63, respectively. Fifty patients met both SR definitions. Follow-up to DAS28-SR was shorter than to B-SR and the duration of DAS28-SR was longer, p ≤ 0.023 for all comparisons. At SR, patients had PRO proxy to normal values; the percentage of patients with normal PRO varied from 97% (95% CI: 91–99) for HAQ to 50% (95% CI: 39–61) for absence of fatigue. In DAS28-SR patients, acute reactant phases within the normal range were detected very early (after 1.5–2.9 months). HAQ, PVAS, OVAS and SF-36 were scored within the normal range after 6–7 months. The absence of fatigue was detected at 8.7 months of follow-up, which was similar to DAS28-SR. In the 63 patients with B-SR, a similar pattern was observed. The follow-up to outcomes of the 50 patients who met both SR definitions was similar, but the absence of fatigue and physical component SF-36 normalization were achieved earlier in B-SR patients (p ≤ 0.02). Conclusions The impact of SR on PRO differs accordingly to each particular outcome.