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Aim: One single nucleotide polymorphism (SNP) rs738409 in the patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene has been considered a major genetic risk factor of nonalcoholic fatty liver disease (NAFLD). Data have indicated that NAFLD is related to insulin resistance and dyslipidemia, but whether rs738409 is associated with circulating lipid and lipoproteins is not fully elucidated. The main aim of this study was to assess the association of rs738409 with lipid and lipoprotein levels in patients with dyslipidemia. Methods: This was a post-hoc analysis of a study in patients with dyslipidemia recruited on an outpatient basis. Morning blood samples were collected after a 12-h fast. Genomic DNA was extracted from whole-blood samples. Results: One hundred seventy-five patients with dyslipidemia were included (97 women). Lipid levels [total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)] or glycosylated hemoglobin (HbA1c) were not associated with the SNP, even after adjustment for gender, body mass index (BMI) and type 2 diabetes mellitus (T2DM), using either the additive (CC vs. CG vs. GG) or the dominant (CC vs. GG + CG) inheritance model. When data were stratified for obesity, significant associations between the variant and TC (P = 0.014) or LDL-C levels (P = 0.046) in the non-obese were observed. Pairwise comparison revealed significant changes only in TC between CC and CG genotypes (P = 0.012). Conclusions: No association was shown between rs738409 SNP and lipid/lipoprotein levels in patients with dyslipidemia. In subgroup analysis, TC was higher in non-obese, but not in obese, patients with CC, compared to CG carriers.

Aim: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease affecting a large proportion of the general population (25%). The aim of this study was to evaluate the effect of a sodium-glucose co-transporter 2 inhibitor, empagliflozin, on NAFLD and the preliminary data of week 8 are hereby presented. Material and methods: Twenty-four C57Bl/6 mice of both genders were randomly assigned in three groups: 8 mice fed on chow diet (control group), 8 mice fed fast-food diet (FFD) and empagliflozin, and 8 mice fed FFD without empagliflozin for 8 weeks. Weight measurement, and blood sampling for the measurement of glucose, alanine aminotransferase, total cholesterol and triglycerides were performed at baseline and week 8. Results: Between-group comparisons did not show significant differences between FFD groups with and without empagliflozin. The only between-group difference regarding empagliflozin group was in cholesterol at week 8, which was higher compared to control group (p=0.009). Within-group comparisons showed increases in total cholesterol in both FFD groups, ALT in FFD/empagliflozin group and glucose in FFD group. Despite the expected increase in body weight, no biochemical change was observed in the control group. Conclusions: Empagliflozin did not show preventive benefits on body weight or metabolic biochemical parameters after 8 weeks of treating FFD mice, thus, possibly highlighting that 8 weeks may be short period for FFD to exert its adverse effects in full, as well as for empagliflozin to exert any potentially beneficial effect.

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease affecting millions of people worldwide with potentially serious complications that may lead to mortality and constitute a significant socioeconomic burden. Although modern lifestyle, obesity and insulin resistance play leading roles in the pathophysiology of the disease, various metabolic aberrations, as well as genetic predisposition participate in the development and progression of NAFLD. The diagnosis of NAFLD, especially the early recognition of NASH and fibrosis, is vital for the early management of the disease. Many diagnostic methods have been developed for the disease, ranging from liver biopsy to imaging techniques and serum biomarkers, each one followed by advantages and disadvantages. Despite the extensive research in this field, there is to-date no licensed pharmacological treatment. However, several medications have been investigated and provided promising results; in this regard, the results of some phase III clinical trials in NASH patients are expected. Until the approval of specific for the disease medications, the cornerstone of its management remains lifestyle modifications, i.e. dietary changes and increase in physical activity.

To evaluate work-related issues (WRIs) and their determinants in patients with axial spondyloarthritis (SpA) across Europe.The European Map of Axial Spondyloarthritis is a cross-sectional online survey (2017-2018) of unselected patients with self-reported axial SpA from 13 European countries. Participants were classified as active or inactive members of the labor force according to the International Labor Organization standards. Those employed reported WRIs due to axial SpA in the past 12 months. Sociodemographic characteristics and patient-reported outcomes were compared between patients with and without WRIs. Stepwise regression analysis was conducted to identify independent determinants of WRIs.The sample comprised 2,846 patients with axial SpA, 1,653 were active members of the labor force, 1,450 were employed, and of those employed, 67.7% reported at least 1 WRI. The most frequently reported WRIs were taking sick leave (56.3%), difficulty fulfilling working hours (44.6%), and missing work for doctor's appointments (34.6%). Of the total sample, 74.1% declared that they had faced or would face difficulties finding a job due to axial SpA. Patients with WRIs were more often female, were less likely to be married or in a relationship, and had a higher educational level, poorer patient-reported outcomes, and a greater prevalence of anxiety and depression. Multivariable regression showed that WRIs were associated with a higher Bath Ankylosing Spondylitis Disease Activity Index score (odds ratio [OR] 1.30 [95% confidence interval (95% CI) 1.16-1.45]) and the 12-item General Health Questionnaire score (OR 1.15 [95% CI 1.09-1.22]), and were negatively associated with inflammatory bowel disease (OR 0.58 [95% CI 0.36-0.91]).Approximately two-thirds of employed patients experienced WRIs due to axial SpA. Association between disease activity and psychological distress with WRIs suggests the need to ensure that axial SpA patients receive the required support to cope with their working life.

In the present paper the metric of distance is adapted to a sequence of binary trials and the concept of r-weak runs is introduced and defined. The new structure gives rise to new families of binomial-type distributions, which are studied in the case of independent but not necessarily identically distributed binary trials. It is highlighted how the new theoretical results can be profitably applied to various fields, such as Agriculture, Finance and Reliability Engineering.

There are conflicting data on adiponectin concentrations in nonalcoholic fatty liver disease (NAFLD). The main aim was to compare circulating total adiponectin concentrations in NAFLD patients with versus without liver fibrosis.A systematic search was performed in PubMed, Scopus, and Cochrane Library. Twenty-two studies comprising 1753 biopsy-proven NAFLD individuals (1290 with and 463 without fibrosis) were included in the meta-analysis.There was no difference in adiponectin concentration between NAFLD patients with versus without fibrosis (standardized mean difference [SMD]: -0.15; 95% confidence interval [95% CI]: -0.35 to 0.05). Heterogeneity was moderate among studies (ΙOverall, patients with NAFLD and fibrosis had similar adiponectin concentrations with patients with NAFLD without fibrosis. However, adiponectin concentration was lower in NAFLD patients with fibrosis than those without fibrosis within the adult patients without morbid obesity and in studies in which adiponectin was measured with the same method (ELISA).

ObjectivesDuring the COVID-19 pandemic, much communication occurred online, through social media. This study aimed to provide patient perspective data on how the COVID-19 pandemic impacted people with rheumatic and musculoskeletal diseases (RMDs), using Twitter-based patient-generated health data (PGHD).MethodsA convenience sample of Twitter messages in English posted by people with RMDs was extracted between 1 March and 12 July 2020 and examined using thematic analysis. Included were Twitter messages that mentioned keywords and hashtags related to both COVID-19 (or SARS-CoV-2) and select RMDs. The RMDs monitored included inflammatory-driven (joint) conditions (ankylosing spondylitis, RA, PsA, lupus/SLE and gout).ResultsThe analysis included 569 tweets by 375 Twitter users with RMDs across several countries. Eight themes emerged regarding the impact of the COVID-19 pandemic on people with RMDs: (i) lack of understanding of SARS-CoV-2/COVID-19; (ii) critical changes in health behaviour; (iii) challenges in healthcare practice and communication with healthcare professionals; (iv) difficulties with access to medical care; (v) negative impact on physical and mental health, coping strategies; (vi) issues around work participation; (vii) negative effects of the media; and (viii) awareness-raising.ConclusionThe findings show that Twitter serves as a real-time data source to understand the impact of the COVID-19 pandemic on people with RMDs. The platform provided ‘early signals’ of potentially critical health behaviour changes. Future epidemics might benefit from the real-time use of Twitter-based PGHD to identify emerging health needs, facilitate communication and inform clinical practice decisions.

In the present paper we study the distributions of families of patterns which generalize runs and patterns distributions extensively examined in the literature during the last decades. In our analysis we assume that the sequence of outcomes under investigation includes independent, but not necessarily identically distributed trials. An illustration is also provided how our new results could be exploited to enrich a new system, still in research, related to patients' weaning from mechanical ventilation.

A general consecutive-type system, called m -consecutive- k , l -out-of- n :F system, is considered. Such a system consists of n linearly or circularly ordered components and fails if and only if t...

ObjectiveTo determine the presence of mental disorder risk and associated factors in European patients with axial spondyloarthritis (axSpA).MethodsData from 2,166 patients with axSpA in 12 European countries were collected from 2017 to 2018 through the European Map of Axial Spondyloarthritis online survey. Risk of mental disorders was assessed using the 12-item General Health Questionnaire. Possible predictors included age, gender, relationship status, patient organisation membership, job status, educational level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional limitation (0–54) and self-reported depression or anxiety. Bivariate analyses were conducted to determine predictors of risk of mental disorders (Mann-Whitney and χ2) and multivariable analysis identified factors associated with risk of mental disorders.Results60.7% of patients reported risk of mental disorders: they were younger (41.7 vs 46.0 years), more likely female (68.2% vs 57.9%), unemployed (7.5% vs 2.7%), on temporary (15.9% vs 5.4%) or permanent sick leave (13.2% vs 8.0%), reported depression (45.2% vs 14.2%) or anxiety (41.3% vs 12.5%), higher disease activity (BASDAI ≥4; 87.6% vs 62.3%) and functional limitation (16.5 vs 10.8). The factors most associated with risk of mental disorders were disease activity (OR=2.80), reported depression (OR=2.42), anxiety (OR=2.39), being unemployed or on sick leave (OR=1.98), functional limitation (OR=1.02) and younger age (OR=0.97).ConclusionsCompared with the general population, patients with axSpA show disproportionately worse mental health associated mainly with disease activity and employment status. Healthcare professionals should pay close attention to patients with high disease activity and address internally or refer to specialist services, where appropriate to ensure optimal patient outcomes.

Introduction/objectives To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p p p p p Conclusion The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention. Key Points• Healthcare professionals’ perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and management of the disease. However, evidence about male-female differences in axSpA is scarce.• EMAS results highlight how female axSpA patients report longer diagnostic delay and higher burden of the disease in a large sample of 2846 participants of 13 European countries.• Results reflect unmet needs of European female patients. Healthcare professionals should pay close attention in order to accurately diagnose and efficiently manage axSpA cases while further research should be developed on the cause of reported gender differences.

In the present paper we introduce a modified consecutive system, which generalizes consecutive systems extensively studied in the literature, and we obtain its reliability when its components are functioning independently with probabilities not necessarily equal. The results are illustrated by numerical examples using MATLAB and potential applications are discussed.

Nonalcoholic fatty liver disease (NAFLD) is considered a highly prevalent disease associated with various co-morbidities that lead to socioeconomic burden. Despite large-scale investigation, no pharmacological treatment has been approved specifically for NAFLD to date. Lifestyle modifications and diet are regarded as highly beneficial for the management of NAFLD, albeit with poor compliance, thus rendering pharmacological treatment highly important. Based on the current failure to discover a “magic bullet” to treat all patients with NAFLD and considering the multifaceted pathophysiology of the disease, combination therapies may be considered to be a rational alternative approach. In this regard, several drug categories have been considered, including, but not limited to, lipid-lowering, anti-hypertensive, glucose-lowering, anti-obesity, anti-oxidant, anti-inflammatory and anti-fibrotic medications. The aim of this review is, in addition to summarizing some of the multiple factors contributing to the pathophysiology of NAFLD, to focus on the efficacy of pharmacological combinations on the management of NAFLD. This may provide evidence for a more personalized treatment of patients with NAFLD in the future.

BackgroundAxial spondyloarthritis (axSpA) is associated with a high disease burden which may require patients to make functional adaptations in response to the diseaseObjectivesThe aim is to identify factors associated with implementing functional adaptations due to axSpA.MethodsData from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Adaptations were assessed by: “Please indicate any steps you have taken since you have been affected by Spondylitis/ Spondyloarthritis?” with possible answers: purchasing customized or comfortable shoes, workplace or home or car adaptations. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were collected. Univariable and multivariable logistic regression models were used to identify variables associated with life adaptations, including sociodemographic factors, PROs, employment status, health behaviours, and comorbidities (n= 2,754).ResultsMean age was 43.8 years, 61.5% female, 48.9% had a university degree, and 67.6% married. 76.9% (n=2,118) patients had made at least one adaptation: 72.0% (n=1,525) purchased customised or comfortable shoes, 54.9% (n=1,163) adapted their workplace, 40.7% (n=861) their home, and 29.0% (n= 614) their car.Compared to those who did not require adaptations, those who made adaptations were typically female (78.9% vs. 73.7% male, p=0.002), separated/divorced/widowed (82.0% and 80.0% vs. 71.5% singles, p=0.002), had retired early, or were on sick leave (temporary or permanent) (85.0%, 84.0%, 84.3% vs. 74.5% of employed), members of a patient organisation (81.5% vs. 74.0% of non-member, pThe variables independently associated with functional adaptations were being physically active (OR=1.98), patient organisation membership (OR=1.39), female gender (OR=1.31), being overweight or obese (OR=1.26), separated, divorced or widow status (OR= 1.20), higher BASDAI (OR= 1.14) and functional limitation (OR= 1.01; Table 1).Table 1.Regression analysis for variables associated with the presence of at least one functional adaptations (n= 2,162)Univariable logistic analysisMultivariable logistic analysisOR95%CIOR95%CIGender. Female11.341.12, 1.601.311.06, 1.63Marital Status. Separated/divorced/widow21.331.14, 1.551.201.00, 1.44Employment status. Sick leave/early retirement31.831.45, 2.321.170.89, 1.53Patient organization. Member41.551.29, 1.881.391.12, 1.74Physical activity1.881.51, 2.351.981.52, 2.59Body Mass Index. Overweight/obesity51.221.02, 1.461.261.02, 1.55BASDAI (0-10)1.211.16, 1.271.141.07, 1.22GHQ-12 (0-12)1.061.03, 1.081.010.98, 1.04Functional Limitation (0-54)1.021.01, 1.031.011.00, 1.02Spinal Stiffness (3-12)1.101.06, 1.140.990.94, 1.03Diagnostic delay1.031.02, 1.041.010.99, 1.03Anxiety1.261.03, 1.540.870.65, 1.18Depression1.561.25, 1.951.310.95, 1.79Sleep disorders1.541.27, 1.861.170.91, 1.511Male vs. Female; 2Separated/divorced/widow vs. married/single; 3Sick leave/early retirement vs. other employment status; 4Member vs. non-member; 5Overweight/obesity vs. underweight/normal weightConclusionThree out of four axSpA patients made at least one functional adaptation due to their axSpA, which were often implemented by those with higher body weight, disease activity, engaging in physical activity, and patient organization membership. This is most likely explained by need as those with high disease burden or weight may face limitations, which can be alleviated through functional adaptations, enabling them to engage in physical activity.AcknowledgementsThis study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of InterestsMarco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Raj Mahapatra: None declared, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Grant/research support from: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB

BackgroundAs spinal mobility becomes progressively impaired and pain levels escalate, difficulty in performing simple physical routines places a huge burden on axial spondyloarthritis (axSpA).ObjectivesThe aim is to evaluate the impact of axSpA on patients’ social life and to identify the factors associated with this.MethodsData from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Impact of axSpA on social life was assessed by: “Score your relationships since you have been affected by Spondylitis / Spondyloarthritis” [Much worse to much better relationships with spouse, family, friend, and neighbours], and “Please indicate the frequency with which you do the following activities since you became affected by Spondylitis/ Spondyloarthritis?” [Much less frequent to much more frequent engagement in restaurants, cultural outings, travel, and sports]. Patients who rated at least one relationship as “worse/much worse” and at least one of social activity as “less/much less frequent” were considered to have a negatively impacted social life. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were assessed. Univariable and multivariable binary logistic regression were used to identify variables possibly explaining negative impact on social life (n= 2,120).ResultsMean age was 43.8±12.3 years, 61.5% female, 49.2% had a university degree, and 68.2% married. 44.9% (n= 1,205) patients had their social life negatively impacted since the onset of axSpA.Those experiencing a negative impact on their social life were more frequently females (49.5% vs. 37.5% males, pThe variables associated with negative impact on social life in the multivariable logistic regression were higher disease activity (OR=1.15), poor mental health (OR=1.14), being on a sick leave/unemployed (OR=1.49), divorced/separated (OR=1.46), anxiety (OR= 1.41) and female gender (OR= 1.30; Table 1).Table 1.Factors associated with a worsening social life (n= 2,120)Univariable logistic analysisMultivariable logistic analysisORCI 95%ORCI 95%Age0.990.98, 0.991.000.99, 1.01Gender. Female11.631.39, 1.911.301.06, 1.60Marital status. Divorced/separated21.931.48, 2.501.461.05, 2.04Employment status. Sick Leave/Unemployed32.662.24, 3.171.491.20, 1.85BASDAI (0-10)1.411.35, 1.481.151.08, 1.22Functional Limitation (0-54)1.031.02, 1.031.021.09, 1.02Spinal Stiffness (3-12)1.201.16, 1.241.061.01, 1.11Diagnostic delay1.021.01, 1.031.010.99, 1.02GHQ-12 (0-12)1.221.19, 1.241.141.11, 1.17Anxiety2.842.39, 3.371.411.08, 1.83Depression2.592.17, 3.101.140.87, 1.49Sleep disorders2.101.79, 2.461.020.81, 1.271Female vs. male; 2Divorced/separated vs. single/married/widow; 3Sick leave/unemployed vs. other employment status.ConclusionAlmost half of the axSpA patients reported to have negatively impacted their social life. Being female, divorced/separated, on sick leave/unemployed, with higher disease activity, poor mental health, and anxiety increase the likelihood of worsening social life. As relationships with others and engagement in social or community activities influence quality of life, greater attention to enabling individuals to participate socially through controlling disease activity and addressing mental health comorbidity in the management of axSpA.AcknowledgementsThis study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of InterestsMarco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Raj Mahapatra: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer

BackgroundThe COVID-19 pandemic has generated uncertainties and concerns along with expectations and hopes that may be of relevance to patients with rheumatic diseases.ObjectivesThe aim of this study is to assess changes in the fears and hopes of patients with rheumatic diseases throughout the two phases of REUMAVID.MethodsREUMAVID is an international cross-sectional study collecting data through an online survey in seven European countries led by the Health & Territory Research group of the University of Seville, together with a multidisciplinary team including patient representatives, rheumatologists, and health researchers. Data were collected in two phases: Phase 1 (P1) between April-July 2020 and Phase 2 (P2) between February-April 2021. Demographics, health behaviours, employment status, access to healthcare services, disease characteristics, WHO-5 Well-Being Index and Hospital Anxiety and Depression Scale (HADS). Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, lost job, civil disorder) on a scale from zero (“no concern at all”) to five (“extremely concerned”) and hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a scale from zero (“no hopeful at all”) to five (“extremely hopeful”). Descriptive analysis and Mann-Whitney test were used to explore fears and hopes in both phases of REUMAVID.ResultsA total of 3,802 participants were recruited across both phases in REUMAVID with comparable demographic characteristics: mean age 52.6 (P1) vs. 55.0 years (P2), 80.2% female (P1) vs. 83.7% (P2), 69.6% married (P1) vs. 68.3% (P2), and 48.6% university educated (P1) vs. 47.8% (P2). Most prevalent RMD was axial spondyloarthritis in P1 (37.2%), and rheumatoid arthritis in P2 (53.1%).In P1 and P2 the major concern was the impact on healthcare in the future (3.1 and 3.2 out of 5, p=0.051). Compared to P1, patients in P2 had less fears about RMD medications not reaching the country (2.4 vs. 1.9, pTable 1.Bivariate analysis of patients’ fears and hopes in both phases of REUMAVID (N= 3,802, unless specify)Mean ± SDP-valueFirst Phasen= 1,800Second phasen= 2,002FearsImpact on healthcare in the future, n= 3,6533.1 ± 1.63.2 ± 1.60.051Treatment taken could make you more likely to get serious illness from COVID-19 infection, n= 3,6512.8 ± 1.82.9 ± 1.80.160More likely to be infected due to the condition, n= 3,6492.8 ± 1.72.9 ± 1.70.040Lack of medication, n= 3,6562.4 ± 1.81.9 ± 1.8Civil disorder, n= 3,6342.0 ± 1.61.8 ± 1.70.001Lost job, n= 3,5661.5 ± 1.91.4 ± 1.90.003HopesAvailability of a treatment or vaccine suitable for COVID-19, n= 3,3183.2 ± 1.53.9 ± 1.3Continue treatment as usual, n= 3,3063.7 ± 1.43.8 ± 1.30.049*Go out as before the COVID-19 pandemic, n= 3,3183.1 ± 1.53.5 ± 1.4Don’t get infected with COVID-19 and continue in the same health, n= 3,2803.5 ± 1.53.5 ± 1.50.696Travel as before the COVID-19 pandemic, n= 3,3112.8 ± 1.63.3 ± 1.5Maintain or improve economic situation after the COVID-19 pandemic, n= 3,3102.6 ± 1.73.0 ± 1.7ConclusionDuring the first phase of REUMAVID at the beginning of the pandemic, patients with RMDs were more fearful and less hopeful compared to the second phase. These fears were notable in terms of lack of medication for their RMD, while during the second phase, patients were hopeful of a treatment or vaccine against COVID-19, and of being able to go out and travel as before.AcknowledgementsThis study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League for People with Rheumatism (CYLPER) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of InterestsMarco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Laura Christen Employee of: Novartis Pharma AG, José Correa-Fernández: None declared, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern and GAfPA, LAURENT GRANGE: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi and UCB, Shantel Irwin: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB

AimTo assess the impact of the COVID-19 pandemic on patients with rheumatic and musculoskeletal diseases (RMDs).MethodsREUMAVID is a cross-sectional study using an online survey developed by an international multidisciplinary patient-led collaboration across seven European countries targeting unselected patients with RMDs. Healthcare access, daily activities, disease activity and function, well-being (WHO Five Well-Being Index (WHO-5)), health status, anxiety/depression (Hospital Anxiety and Depression Scale (HADS)) and access to information were evaluated. Data were collected in April–July 2020 (first phase).ResultsData from the first phase included 1800 patients with 15 different RMDs (37.2% axial spondyloarthritis, 29.2% rheumatoid arthritis, 17.2% osteoarthritis and others). Mean age was 53, 80% female and 49% had undertaken university studies. During the beginning of the pandemic, 58.4% had their rheumatology appointment cancelled and 45.6% reported not having received any information relating to the possible impact of SARS-CoV-2 infection in their RMDs, with the main source being patient organisations (27.6%).Regarding habits, 24.6% increased smoking, 18.2% raised their alcohol consumption, and 45.6% were unable to continue exercising. Self-reported disease activity was high (5.3±2.7) and 75.6% reported elevated pain. Half the patients (49.0%) reported poor well-being (WHO-5) and 46.6% that their health had changed for the worse during lockdown. According to HADS, 57.3% were at risk of anxiety and 45.9% of depression.ConclusionThroughout the first wave of the COVID-19 pandemic, patients with RMDs have experienced disruption in access to healthcare services, poor lifestyle habits and negative effects on their overall health, well-being and mental health. Furthermore, information on COVID-19 has not reached patients appropriately.

Background:The first wave of the COVID-19 pandemic led to a rapidly evolving global crisis characterized by major uncertainty.Objectives:The objective is to assess COVID-19-related fears and hopes in patients with rheumatic and musculoskeletal diseases (RMDs) during the first wave of the pandemic.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain and, the United Kingdom. Data are collected in two phases, the first phase between April and July 2020, the second in 2021. Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, job loss, civil disorder) on a Likert scale from zero (“no concern at all”) to five (“extremely concerned”) and their hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a Likert scale from zero (“not hopeful at all”) to five (“extremely hopeful”). The Mann-Whitney and Kruskal-Wallis tests were used to analyse the different fears and hopes according to socio-demographics characteristics, disease and health status.Results:1,800 patients participated in the first phase of REUMAVID. The most frequent RMDs group was inflammatory arthritis (75.4%), the mean age was 52.6 years and 80.1% were female. The most important fear for patients was the impact of the COVID-19 pandemic on healthcare (3.1 out of 5), particularly for those younger in age (3.0 vs 3.2, p=0.004), female gender (3.2 vs 2. 9 of men, p=0.003), experiencing greater pain (3.1 vs 2.8, p=0.007), with higher risk of anxiety (3.3 vs 2.9 of without anxiety, pConclusion:The outstanding COVID-19-related fear expressed by European patients with RMDs was its impact on healthcare, while the greatest hope was to be able to continue treatment. Younger patients reported more fears while older patients were more hopeful. Those receiving biologics had greater fears and hopes associated with their treatment. In addition, patients at risk of mental disorders presented greater fears and less hopes.Figure 1.Fears and Hopes of REUMAVID participantsAcknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, LAURENT GRANGE: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Background:The COVID-19 pandemic has impacted every aspect of life of European patients with rheumatic and musculoskeletal diseases (RMDs).Objectives:The aim is to evaluate country differences on the impact of the first wave of the COVID-19 pandemic on life habits, healthcare access, health status, mental health and wellbeing in European patients with RMDs.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. Participants were recruited by patient organisations (April-July 2020). The Kruskal-Wallis and χ2 tests were used to analyse differences between countries and independent variables.Results:1,800 patients participated in the first wave of the COVID-19 pandemic (REUMAVID). 37.8% of Spanish patients increased their smoking consumption during the pandemic followed by Cyprus (32.1%) and Portugal (31.0%), while alcohol consumption was higher in the UK (36.3%) and France (27.0%). 82.3% of patients in Spain unable to attend their appointment with their rheumatologist, either due to cancellations or other personal reasons. Access to primary care was most limited in Portugal and Italy, where only 45.0% and 51.6% got access. 61.9% in Italy and 53.3% in Spain experienced a worsening of their health during the pandemic. 68.5% in Spain and 67.8% in Portugal were at risk of anxiety. The highest proportion at risk of depression was found in Greece (55.4%), Cyprus (55.1%), and Italy (54.8%). 66.9% of patients in Spain reported poor wellbeing, compared to 23.8% in Italy and 30.1% in Portugal (Table 1).Conclusion:The first wave of the pandemic and the related containment measures heterogeneously affected patients with RMDs across European countries, who overall increased harmful habits, experienced more difficulties in accessing healthcare and, reported poor mental health and well-being.Table 1.Bivariate analysis between European countries (N=1,800, unless specified)Mean ± SD or n (%)UKn: 558Spainn: 464Francen: 229Greecen: 57Cyprusn: 101Italyn: 127Portugaln: 264- Inflammatory arthritis1509 (91.2)402 (86.6)147 (64.2)33 (57.9)57 (56.4)89 (70.1)120 (45.5)- Fibromyalgia53 (9.5)14 (3.0)26 (11.4)14 (24.6)28 (27.7)53 (41.7)124 (47.0)- Connective tissue disease236 (6.5)15 (3.2)13 (5.7)25 (43.9)33 (32.7)30 (23.6)61 (23.1)- Osteoarthritis140 (25.1)29 (6.3)102 (44.5)0 (0.0)8 (7.9)15 (11.8)13 (4.9)- Osteoporosis50 (9.0)3 (0.6)20 (8.7)2 (3.5)9 (8.9)18 (14.2)12 (4.5)- Vasculitis39 (1.6)1 (0.2)6 (2.6)3 (5.3)3 (3.0)5 (3.9)9 (3.4)- Sapho (only France)15 (6.6)Smoking, More than before.N= 55616 (10.3)48 (37.8)22 (24.7)8 (23.5)9 (32.1)8 (20.5)26 (31.0)Alcohol consumption, More than before. N= 1,08599 (36.3)48 (10.3)27 (27.0)4 (7.0)4 (4.0)4 (13.3)11 (18.3)Unable to meet rheumatologist. N= 72283 (48.8)186 (82.3)27 (30.3)18 (64.3)22 (51.2)9 (31.0)77 (56.2)Access to primary care. N= 68987 (76.3)65 (67.7)32 (76.2)14 (60.9)17 (60.7)65 (51.6)117 (45.0)Change in health status, Much worse or worse. N=1,786214 (38.4)245 (53.3)98 (43.0)24 (42.9)38 (38.4)78 (61.9)135 (51.9)WHO-5. Poor well-being (≤50).N= 1,777292 (52.5)303 (66.9)100 (43.9)21 (37.5)46 (46.5)30 (23.8)78 (30.1)Risk of anxiety. N= 1,769241 (43.6)309 (68.5)118 (52.0)31 (55.4)61 (62.2)78 (61.9)175 (67.8)Risk of depression. N= 1,769186 (33.6)232 (51.4)101 (44.5)31 (55.4)54 (55.1)69 (54.8)138 (53.8)Note: all relations were significant at the 0.001 level. 1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Background:The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs).Objectives:The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs.Methods:REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes.Results:1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, pConclusion:The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments.Table 1.Bivariate analysis by gender (N= 1,797 unless specify)Mean ± SD or n (%)P- valueMale(N= 355)Female(N= 1,442)Sociodemographic characteristicsDiseaseInflammatory arthritis1290 (81.7)1,064 (73.8)Fibromyalgia25 (7.0)287 (19.9)Connective tissue disease218 (5.1)195 (13.5)Osteoarthritis52 (14.6)255 (17.7)Osteoporosis10 (2.8)104 (7.2)Vasculitis37 (2.0)29 (2.0)SAPHO1 (0.3)14 (1.0)Age, years52.8 ± 14.252.5 ± 12.90.896Educational levelUniversity162 (45.6)711 (49.3)0.215Marital statusMarried or in relationship269 (75.8)983 (68.2)0.002*Member of a Patient organisation, N=1,795Yes188 (53.0)559 (38.8)Patient-reported outcomesHADS Anxiety, N=1,766Risk168 (48.1)843 (59.5)HADS Depression, N=1,766Risk130 (37.2)680 (48.0)Wellbeing, N=1,774WHO-5 ≤ 50188 (53.4)681 (47.9)0.064Self-perceived health, N=1,783Fair or bad182 (51.4)958 (67.0)Change in health status during COVID-19 pandemic, N=1,783Worse333 (94.1)1,339 (93.7)0.799Life style during COVID-19 pandemicSmoking, N=555More than before20 (17.5)117 (26.5)0.001*Alcohol consumption, N=1,083Quit drinking71 (25.4)277 (34.5)0.013Physical activity, N=1,126Yes144 (60.3)470 (53.0)0.045*Treatment and healthcareAble to meet rheumatologist, N= 721No89 (65.9)332 (56.7)0.049*Access to GP, N=688No43 (39.4)248 (42.8)0.5121Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, LAURENT GRANGE: None declared, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB., Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

MANBIS is a C++ mathematical software package for tackling the problem of computing the roots of a function when the number of roots is very large (of the order of hundreds or thousands). This problem has attracted increasing attention in recent years because of the broad variety of applications in various fields of science and technology. MANBIS applies the bisection method to obtain an approximate root according to a predetermined accuracy. Thus, the only computable information required is the algebraic signs of the considered function, which is the smallest amount of information (one bit of information) necessary for the purpose needed, and not any additional information. MANBIS is able to compute very efficiently a user-given percentage of roots and draws its strength from the fact that the roots are expected to be many. Furthermore, MANBIS is capable of estimating without any additional function computational cost the total number of roots within the user-given interval. Our approach can also be efficiently applied in cases where the distribution of the roots is not known. This article is accompanied by another article where the user manual, some implementation details, and some examples are included.

Consider a homogeneous two state (failure-success or zero-one) Markov chain of first order. The paper deals with the position and the length of the shortest segment of the first n, n≥5, trials of t...

We consider a sequence of n, n≥3, zero (0) - one (1) Markov-dependent trials. We focus on k-tuples of 1s; i.e. runs of 1s of length at least equal to a fixed integer number k, 1≤k≤n. The statistics denoting the number of k-tuples of 1s, the number of 1s in them and the distance between the first and the last k-tuple of 1s in the sequence, are defined. The work provides, in a closed form, the exact conditional joint distribution of these statistics given that the number of k-tuples of 1s in the sequence is at least two. The case of independent and identical 0−1 trials is also covered in the study. A numerical example illustrates further the theoretical results.

Background:The journey of axial spondyloarthritis (axSpA) for most patients is slow and arduous.Objectives:The goal of this analysis is to describe the journey to diagnosis and further management in axSpA patients.Methods:2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Descriptive analysis of sociodemographic factors, insurance scheme, diagnostic journey and post diagnosis healthcare utilization was performed. Mann-Whitey test was used to analyse possible differences between BASDAI (>4 v ≤4) and the number of visits to healthcare professionals and follow-up tests undertaken.Results:Mean age was 43.9 years, 61.3% were female, 48.1% university educated, 67.9% married, 53.9% employed and 81.7% had public health insurance. Mean age at symptoms onset was 26.6 (11.1), while mean age at diagnosis was 33.7 (11.5) and mean diagnostic delay was 7.4 years. Over 50% had a diagnostic delay of ≥4 years. Prior to receiving a diagnosis, patients visited on average 2.6 specialists. The most commonly performed diagnostic tests were x-rays (72.3%), HLA B27 tests (65.4%) and MRIs (64.3%). 78.4% were diagnosed by a rheumatologist while 14.9% received their diagnosis by a GP. Patients who experienced a diagnostic delay of more than a year (n= 2,208) undertook a considerable number of visits to specialists and medical tests in the year prior to participating in EMAS, which increased with disease activity. Patients with active disease (BASDAI >4) reported a higher number of visits to rheumatologists (3.7±3.5 vs 2.9±2.6), general practitioners (6.6±10.0 vs 3.5±4.1), physiotherapists (19.3±25.0 vs 11.7±17.0), and psychologists/psychiatrists (3.4±10.7 vs 1.9±7.7). Patients with active disease also undertook more x-rays (1.8±2.8 vs. 1.3±1.9), MRI scans (0.9±1.2 vs. 0.6±1.1), and blood tests (4.7±4.4 vs 3.6±3.2). However, one in five patients visited the rheumatologist only once in the year prior to EMAS (21.1%).Conclusion:Diagnostic delay continues to be a key challenge in the axSpA patient journey, with patients waiting an average of 7.4 years and visiting multiple doctors prior to diagnosis. Once diagnosed, disease management presents a further challenge, as patients with higher disease activity reported more healthcare professional visits as well as medical tests. Safeguarding health and controlling healthcare utilization requires effective disease management, greater education for non-specialists, rapid referral routes for diagnosis and collaborative care between specialists and non-specialists.Figure 1.axSpA Patient journey according to EMASAcknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all participants who participated in this study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Background:Sleep is an essential health aspect that is often impacted in patients with axial spondyloarthritis (axSpA).Objectives:This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of European axSpA patients.Methods:Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”); risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables.Results:Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; pTable 1.Regression analysis to predict presence of sleep disorders (N=2191)Simple logistic regressionMultivariable logistic regressionOR95% CIp-valueOR95% CIp-valueGender (female)1.591.36-1.871.401.13-1.730.002Marital status (married)1.130.99-1.280.074NANANAOverweight/Obesity1.311.12-1.530.0011.391.14-1.710.001BASDAI (0-10)1.331.27-1.391.070.95-1.210.246Fatigue/Tiredness (0-10)*1.281.23-1.331.040.97-1.120.271Morning Stiffness intensity (0-10)*1.191.15-1.231.050.98-1.130.188Reported Work impact (yes)2.101.78-2.481.291.05-1.580.015Anxiety (yes)9.187.58-11.113.842.99-4.94Depression (yes)9.537.78-11.663.092.37-4.02GHQ-12 (0-12)**1.161.14-1.191.031.00-1.060.029*As measured by the respective item of the BASDAI scale.**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health.Conclusion:Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

Background:Fatigue/tiredness is an essential aspect of disease for patients with axial spondyloarthritis (axSpA). However, little is known about its prevalence and associated factors.Objectives:The aim is to assess the prevalence of fatigue and associated factors in a large sample of patients with axSpA patients from 13 European countries.Methods:Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed.The presence of fatigue/tiredness was evaluated using the Visual Analogue Scale from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): “How would you describe the overall level of fatigue/tiredness you have experienced? (0-10)”. Risk of poor mental health was assessed using the 12-Item General Health Questionnaire (GHQ-12; 0-12).Possible associated factors included: Socio-demographic and disease characteristics, disease activity and function and mental health disorders.The Mann-Whitney test was used to compare the means of variables of two categories vs. the numerical variables, the χ2 test was used to compare the distribution between the categorical variables. Binary logistic regression and multiple linear regression were used to identify possible predictors.Results:A total of 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree, 67.9% were married and 71.3% were HLA-B27 positive. Fatigue/tiredness was associated with younger age (6.4±2.3 vs 5.5±2.4), being female (6.6±2.2 vs 5.7±2.4), lower educational level (6.9±2.4 vs 6.0±2.0) and separated or divorced persons (6.8±2.2 vs 6.2±2.3; all pTable 1.Linear regression analysis to predict presence of fatigue/tiredness (N = 2052)SimpleMultivariateB95% CIp-valueB95% CIp-valueAge-0.018-0.025, -0.011-0.015-0.022, -0.008Gender (female)0.8380.659, 1.0170.4270.264, 0.590Marital status (married)0.1900.042, 0.3390.012*0.1620.021, 0.3020.024*Educational level (university)-0.274-0.402, -0.146-0.128-0.245, -0.0120.031*BMI (Overweight/Obesity)0.151-0.026, 0.3280.094NANANAMorning stiffness severity (0-10) *0.4730.442, 0.5050.3490.314, 0.385Functional limitation (0-54)0.0380.032, 0.0440.0140.008, 0.019Reported Work impact (yes)0.9360.753, 1.1190.2280.068, 0.3890.005*Physical activity (yes)-0.726-0.968, -0.485-0.395-0.611, -0.178Sleep disorder (yes)1.1911.013, 1.3680.2760.095, 0.4580.003*Anxiety (yes)1.1390.950, 1.3270.002-0.215, 0.2200.982Depression (yes)1.2741.079, 1.4690.2230.001, 0.4460.049*GHQ-12 (0-12) **0.2340.215, 0.2540.1100.088, 0.132*As measured by the respective item of the BASDAI scale**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental healthConclusion:Fatigue/tiredness was highly prevalent among axSpA European patients with female gender, engage in physical activity and those with greater morning stiffness severity most strongly associated, and the unemployed presenting greatest fatigue.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

Background:The COVID-19 pandemic has resulted in unforeseen challenges for humanity, taking a significant toll, especially the immune-suppressed individuals. In this regard, the health and general well-being of people with rheumatic diseases, the great majority users of immunosuppressives, have been at stake.Objectives:To explore the impact of the COVID-19 pandemic on people with rheumatic diseases on immunosuppression during the first wave, concerning a) (self-)management of their disease; b) interaction with the health care team; c) emotional well-being and d) overall health.Methods:A qualitative study was conducted following a phenomenological approach. Adults (>18 years) with a rheumatic disease from four European countries (Cyprus, England, Greece, Portugal). Patients were recruited through patient’s associations and social media and were invited to participate in semi-structured, audio-recorded interview or focus groups, between July - August 2020. Following a pilot study the information provided was transcribed verbatim, anonymized and translated into English where necessary. An inductive approach was adopted to carry out a thematic framework analysis with the assistance of ATLAS.ti to identify key themes and subthemes. Data validation strategies were employed, and Ethical approval and informed consent were obtained.Results:Participants were 24 patients (21 women, age range 33 to 74 years) divided by 7 focus-groups and 1 individual interview. Most frequent diagnoses were rheumatoid arthritis (n=7), lupus (n=4), juvenile idiopathic arthritis (n=3).Three key themes with 3-7 subthemes were identified within the analytical framework, centred around the impact of the Covid-19 on patients’ lives (Figure 1): i) individual person (e.g. fear for myself and family, social isolation and lack of personal freedom, more time with family) ii) health settings (e.g. (un)clear information about risks of contamination, fear or risk of shortages of medication, remote consultations), and iii) work and community (e.g. persistent stress due to mass media exposure, lack of awareness by others about patients’ rheumatic disease and its disclosure, hope and suspicion about new vaccine development: “I hear that they will ask vulnerable groups to have the vaccine first (...) Why is that? we will be again the innocent victims”). Findings were similar across countries, except for spirituality (i.e. the pandemic as “the hand of God”), a coping subtheme particular to Portugal. These main themes resonated well with the social ecological model and Walsh’s Family Resilience Process [1,2].Conclusion:When experiencing a significant life-event people require some time to process the different lived experiences. This study provides insights on how patients from four countries coped with the new challenges. Such insights are invaluable for health care providers and policy makers, in guiding more meaningful support tailored to individual needs, especially at times of crisis. The study highlights the impact of COVID-19 on the lives of people with rheumatic disease. A follow-up study is currently underway to examine the effect of subsequent waves of the pandemic.References:[1]Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-72. doi: 10.1177/1090198111418634.[2]Walsh F. Family resilience: a framework for clinical practice. Fam Process. 2003;42(1):1-18. doi: 10.1111/j.1545-5300.2003.00001.Acknowledgements:We thank the participants of this study.Disclosure of Interests:None declared

Background:Pain is associated with a plethora of diseases. The statistics reveal that chronic pain affects around 100 million people across Europe and is closely associated with high unemployment rates, depression, substance abuse & social exclusion. Stigma is a significant and persistent problem for those with chronic pain. Lack of public awareness & stigma associated with pain affect not only patients but also society.Objectives:The present research proposes a holistic solution to combat stigma using the latest technological developments. A mobile health application has been designed in order to serve the various stakeholders (patients, families, community) in the field under study. The objective of the final “StigmApp” solution is 4-fold:(i) to facilitate pain management, (ii) to aware the general public, (iii) to educate all different parties & (iv) to facilitate actions & research to combat stigma. Another innovative feature is that it delivers the required information to each party in a highly automated, personalized & digestible way making the whole experience enjoyable, while ensuring user engagement.Methods:A multidisciplinary team was formed at the beginning of the project in order to ensure the desired outcome. Two patient organizations from Cyprus & Greece, two behavioral scientists, three physicians, one psychologist, ten citizens, ten patients, two marketeers and two experts in mobile health applications participated. A participatory design methodology was followed in order to capture & address the whole user experience.Results:An iterative process was followed bringing & different end-users on board. The different parties evaluated and assessed all modules implemented providing appropriate feedback. It currently runs only on Android operating system and supports: (i) pain management (intense &points of pain, medications used, underlying diseases, life style, etc.),(ii) raise awareness & education (through information nuggets & bite-sized learning), (iii) “Share your story” option to inspire others, (iv) fund raising using crowd-funding techniques, (v) become a volunteer, (vi) organize an inspiring event, (vii) networking, (viii) automatic creation of infographics on how pain affects peoples’ lives. It has been awarded the first prize by BMP Innovation Grant.Conclusion:StigmApp has been designed to support the ecosystem around chronic pain regardless of the underlying disease. Our main concern is to raise awareness in order to fight stigma associated with pain & make life easier for patients & their families. The involvement of all different potential actors in the design guarantees a product/service that could meet their needs & can be applied in real life. In the next months the final solution will be piloted by a number of different end users in order to assess it under real life conditions.References:[1]Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review & meta-analysis of population studies. BMJ Open 2016 Jun 20;6(6):e010364. DOI:10.1136/bmjopen-2015-010364. PMID:27324708; PMCID: PMC4932255.[2]Koumpouros Y, Georgoulas A. A systematic review of mhealth funded R&D activities in EU. Trends, technologies and obstacles, Informatics for Health&Social Care. 2020;45(2):168-187. DOI:10.1080/17538157.2019.1656208. Epub2019 Nov 19. PMID:31743060.[3]Lalloo C, Jibb LA, Rivera J, Agarwal A, Stinson JN. There’s a Pain App for That: review of patient-targeted smartphone applications for pain management.Clin J Pain.2015;31(6):557–63. DOI:10.1097/AJP.0000000000000171.[4]De Ruddere, Liesa, Craig, Kenneth D. Understanding stigma & chronic pain:a-state-of-the-art review,PAIN:August 2016-Volume 157-Issue 8-p1607-1610, doi:10.1097/j.pain.0000000000000512Acknowledgements:The project is funded by the Brain, Mind, and Pain, Patient-Centred Innovation Grant.Many thanks to the two patient organizations Hellenic League Against Rheumatism & Cyprus League Against Rheumatism for their valuable contribution in the project.Disclosure of Interests:None declared.

Background:Physical activity is an essential component in axial spondyloarthritis (axSpA) care, improving physical and mental well-being.Objectives:This analysis aims to identify factors associated with engaging in physical activity among axSpA patients.Methods:Data from 2,424 unselected patients participating in EMAS (N=2,846), a cross-sectional study (2017-2018) across 13 European countries, were analysed. Engaging in physical activity was assessed by the following item: “Do you do any physical or sporting activity?” for which participants could report at least 1 physical activity or that they did not do any physical activity. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health using General Health Questionnaire GHQ-12 (0-12) were assessed. Mann-Whitney and Pearson’s χ2 tests were used to analyse relationships between engaging in physical activity and sociodemographic factors, patient-reported outcomes, employment, lifestyle and comorbidities. Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining engagement in physical activity.Results:Mean age was 43.9±12.3 years, 61.3% were female, 48.1% had a university degree and 67.9% were married. 81.8% (n= 2,329) engaged in at least one kind of physical activity. Those physically active were typically male (85.3% vs 79.7% female, pTable 1.Regression analysis for variables explaining engagement in physical activity (n=2,424)Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI7OR95% CI7Gender. Male11.481.21, 1.811.391.06, 1.82Educational level. University21.731.42, 2.111.541.18, 2.00Marital Status. Married31.731.06, 1.581.180.91, 1.54Patient organization. Member41.71)1.39, 2.101.911.43, 2.55Body Mass Index. Not Obese51.691.35, 2.121.581.17, 2.13Employment status. Employed61.281.06, 1.561.000.76, 1.32Quantitative variablesOR95% CI7OR95% CI7Age1.011.00, 1.021.021.01, 1.03BASDAI (0-10)0.860.82, 0.910.960.89, 1.04GHQ-12 (0-12)0.940.92, 0.960.960.93, 0.99Functional Limitation (0-54)0.990.99, 1.001.000.99, 1.01Spinal Stiffness (3-12)0.900.86, 0.940.900.84, 0.95Proportion of life with axSpA (0-1)2.831.50, 5.352.000.91, 4.391Male vs Female; 2University vs no university; 3Married vs unmarried; 4Member vs not; 5Not obese (underweight, normal and overweight) vs obese; 6Employed vs not (unemployed, sick leave, retirement, housework and student).795% CI for test H0: OR=1Conclusion:These results show that increasing age, being male, university educated, member of a patient organisation, not obese, having lower spinal stiffness, and better mental health increase the probability of engaging in physical activity. Physical activity is an important part of axSpA care and patient organizations play a critical role in enhancing access to and participation in physical activity.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

Background:The COVID-19 pandemic has impacted the wellbeing of patients with Rheumatic and Musculoskeletal Diseases (RMDs).Objectives:The aim is to assess emotional well-being and its associated factors in patients with RMDs during the first wave of the COVID-19 pandemic.Methods:REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. 1,800 participants were recruited by patient organisations. Data was collected between April and July 2020. Participants were divided into two groups: 1) Participants with poor wellbeing (World Health Organization-Five Wellbeing Index (WHO-5) ≤ 50), 2) Participants with good wellbeing (WHO-5 >50). The Mann-Whitney and χ2 tests were used to analyse possible relations between sociodemographic characteristics, lifestyle, and outdoor contact with wellbeing during the first wave of the COVID-19 pandemic. Univariate and multivariate binary logistic regression was used to determine the impact of the independent variables associated with poor wellbeing.Results:1,777 patients with 15 different RMDs were included. The mean age was 52.7, 80.2% female, 48.7% had a university degree, and 69.7% were married or in a relationship. The most frequent diagnoses were inflammatory arthritis (75.4%). 49.0% reported poor wellbeing. 57.7% of patients who belonged to a patient organisation reported good wellbeing (vs 46.3% who did not, pConclusion:Almost half of the patients with RMDs reported poor emotional wellbeing during the first wave of the COVID-19 pandemic. The lack of elements in the home that facilitate outdoor contact, not belonging to a patient organisation, the presence of anxiety, and not walking outside during the pandemic increase the probability of poor emotional well-being. These results highlight the importance of environmental factors and the role of patient organisations in addressing the effects of the pandemic and its containment measures.Table 1.Logistic regression for poor wellbeing WHO-5 (N=1,104)Univariate logistic analysisMultivariate logistic analysisOR95% CI1OR95% CI1Patient organisation. Non-member1.571.30, 1.891.511.18, 1.93Disease activity (VAS ≥ 4)1.501.21, 1.861.160.85, 1.56Risk of anxiety (HADs, 0-21)1.671.38, 2.021.200.92, 1.58Risk of depression (HADs, 0-21)1.831.51, 2.211.491.12, 1.99Self-reported health. Fair to very bad1.581.30, 1.911.260.94, 1.68Change in health status. Worse1.271.06, 1.531.050.80, 1.38Physical activity. No1.351.07, 1.711.080.83, 1.40Talked with rheumatologist during the pandemic. No1.451.04, 2.031.040.68, 1.61Walk outside during COVID-19 pandemic. No1.471.19, 1.831.361.02, 1.81Element in home with outdoor contact. No1.931.42, 2.622.101.41, 3.15195% CI for test H0: OR = 1Acknowledgements:This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB., Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Clare Jacklin Grant/research support from: has received grant funding from Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

Background:Growing evidence on the negative role of overweight and obesity on the health outcomes of patients with axial spondyloarthritis (axSpA) exists.Objectives:The aim of the study is to evaluate the association between Body Mass Index (BMI) categories and sociodemographic, disease-characteristics and patient-reported outcomes (PROs) in a large sample of axSpA patients.Methods:Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed. Using self-reported height and weight patients were classified into under and normal weight (2), overweight (25.0-29.9Kg/m2) or obese (>30.0Kg/m2) following WHO guidelines. The Kruskal-Wallis test was used to compare the means of numerical variables between polytomous variables, the χ2 test was used to compare the distribution between the categorical variables. Simple and multivariate logistic regression were used to identify possible associated factors.Results:A total 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree and 67.9% were married and 71.3% were HLA-B27 positive. The percentage of patients with obesity was 18.7%, overweight 33.5%, normal weight 44.0% and underweight 3.8% with an accumulate prevalence of overweight/obesity of 52.2% (compared to 51.6 % of the EU’s population1). Those with obesity engage less frequently in sport (50.1% vs 33.3%; pTable 1.Logistic regression analysis to predict presence of obesity (N = 1,194)SimpleMultivariateOR95% CIp-valueOR95% CIp-valueAge1.0261.018, 1.0341.0261.012, 1.040Gender (female)1.3361.095, 1.6290.0041.4331.031, 1.9900.032Marital status (married)1.3841.184, 1.6170.9820.746, 1.2920.897Educational level (university)0.7760.681, 0.8841.0460.849,1.2890.674Employment status (employed)1.0350.987, 1.0850.154NANANAEngage in sports (much less than before)1.3131.202, 1.4331.1430.978, 1.3360.093Travel/ excursions (much less than before)1.3161.186, 1.4610.9810.800, 1.2020.852Intimate relations (much less than before)1.5711.393, 1.7721.2391.003, 1.5300.047Tying shoe laces (high)1.4331.232, 1.6661.4671.176, 1.8300.001Housework / cleaning (high)1.2261.048, 1.4340.0110.7600.596, 0.9700.028BASDAI (0-10) N:2,5841.2201.156, 1.2881.1271.021, 1.2440.018Spinal Stiffness (3-12) N:2,6601.1841.136, 1.2341.0570.987, 1.1330.115Sleep disorders diagnosis1.5581.284, 1.8921.0450.753, 1.4490.793Depression diagnosis1.6481.340, 2.0271.2670.892, 1.7990.186Psychological distress GHQ-12 (0-12)1.0531.029, 1.0780.9950.954, 1.0380.813Conclusion:Results from the largest European axSpA survey reveal a similar prevalence of overweight and obesity to the general population. However, compared to normal weight, obese patients present greater disease activity, spinal stiffness and poorer mental health. Additionally, women with axSpA appear to be more vulnerable than men to obesity.References:[1]EU Eurostat. Overweight and obesity - BMI statistics.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, José Correa-Fernández: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

Background:Axial spondyloarthritis (axSpA) is associated with a high burden of disease, which may lead to inability to work and disability.Objectives:This analysis aims to identify factors associated with inability to work and disability among European axSpA patients.Methods:Data from 2,846 unselected patients participating in EMAS, a cross-sectional study (2017-2018) across 13 European countries were analysed. The sample was divided into those on permanent sick leave or with a recognised disability (Group 1) and those with neither permanent sick leave nor a recognized disability (Group 2). Mann-Whitney and Pearson’s χ2 tests were used to analyse possible differences between groups regarding sociodemographic characteristics, patient-reported outcomes [BASDAI (0-10), GHQ-12 (0-12), functional limitation (0-54) and spinal stiffness (3-12)], lifestyle habits, working life, and comorbidities). Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining being on permanent sick leave and disability, for which 1,657 patients were included.Results:Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Patients in Group 1 (34.4%; n=978) were more likely to be women (54.3%), married (71.1%), with higher disease activity (BASDAI 5.9 vs. 5.3), functional limitation (25.1 vs. 18.0), spinal stiffness (8.6 vs. 7.3; all pTable 1.Regression analysis for variables explaining being on permanent sick leave or disability (n=1,657)Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI3OR95% CI3Gender11.571.34, 1.831.240.97, 1.57Educational level21.711.46, 2.001.080.86, 1.35Member of a patient organisation. Yes1.961.67, 2.291.541.23, 1.94Smoking. Yes1.281.08, 1.511.220.96, 1.55Difficulty finding job due to axSpA. Yes3.712.89, 4.772.521.83, 3.47Work choice determined by axSpA. Yes1.691.43, 1.991.381.09, 1.75Anxiety diagnosis. Yes1.271.07, 1.510.980.72, 1.34Depression diagnosis. Yes1.581.33, 1.891.250.92, 1.69Sleep disorder diagnosis. Yes1.331.13, 1.560.950.73, 1.23Quantitative variablesOR95% CI3OR95% CI3Age. Years1.041.03, 1.041.031.01, 1.04BASDAI (0-10)1.181.13, 1.241.060.98, 1.13Functional limitation (0-54)1.031.02, 1.031.011.00, 1.02Spinal stiffness (3-12)1.251.20, 1.291.091.03, 1.15Diagnostic delay1.011.01, 1.020.980.96, 0.99Disease duration1.041.03, 1.051.031.01, 1.041Male vs Female; 2No university studies vs university studies. 395% CI for test H0: OR=1Conclusion:One third of patients reported being on permanent sick leave or having a recognised disability. They were more likely to have higher spinal stiffness scores, were older in age, experiencing difficulty finding a job, and belonged to a patient organisation. Increased efforts in relation to early access to effective treatments and the creation of flexible working environments are essential for axSpA patients to continue working and remain active, which benefits their quality of life.Acknowledgements:This study was supported by Novartis Pharma AG.The authors would like to thank all patients who participated in this study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

Background:Pain is a hallmark of axial spondyloarthritis (axSpA) and can significantly deteriorate patients’ health status.Objectives:This analysis aims to investigate factors associated with pain intensity in a large sample of European axSpA patients.Methods:2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Data from 2,636 participants who reported pain were analysed. Pain was measured by the mean of two BASDAI questions (range 0 “no pain” to 10 “most severe pain”): “How would you describe the overall level of AS neck, back or hip pain you have had?” and “How would you describe the overall level of pain/swelling in joints other than neck, back, hips you have had?”. Linear regression analysis was applied to identify associations between pain intensity and sociodemographic factors, patient-reported outcomes [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), mental health using the 12-item General Health Questionnaire GHQ-12 (0-12)], work life, physical activity and comorbidities, for which 850 patients were included.Results:The mean age of the sample was 44 years, 61.4% were female, 49.4% had a university degree and 67.7% were married. The average reported pain intensity was 5.3 (±2.2); 76.2% reported pain intensity ≥4, with the greatest intensity reported by women (5.5 vs 4.9, pTable 1.Regression analysis of the variables associated with pain intensity (0-10 NRS), n=850UnivariableMultivariableB95% CIB95% CIGender. Female10.6040.432, 0.7750.2600.003, 0.517Educational level. No University20.6710.504, 0.8380.3760.118,0.634Marital Status. Divorced/Separated30.4950.209, 0.780-0.044-0.468, 0.380Body Mass Index. Obese40.362-0.097, 0.821NANAGHQ-12 (0-12)0.1820.163, 0.2010.1000.064, 0.137Functional Limitation (0-54)0.0360.030, 0.0410.009-0.001, 0.018Spinal Stiffness (3-12)0.3570.326, 0.3880.2880.234, 0.342Diagnostic Delay, years0.0200.010, 0.030-0.015-0.032, 0.002Work-Related Issues. Yes1.3381.095, 1.5820.6540.338, 0.970Difficulty finding job due to axSpA. Yes1.5681.362, 1.7740.4760.176, 0.776Work choice determinate by axSpA. Yes0.8080.633, 0.9830.199-0.069, 0.467Physical activity. No0.4940.263, 0.725-0.128-0.497, 0.242Anxiety diagnosis. Yes0.9350.753, 1.117-0.047-0.416, 0.321Depression diagnosis. Yes1.1070.919, 1.2950.115-0.270, 0.500Sleep disorder diagnosis. Yes1.0420.871, 1.213-0.091-0.392, 0.2111Female vs Male; 2No university studies (no schooling, primary and high school) vs University studies; 3Divorced/separated vs single, married and widow; 4Obese vs not obese (underweight, normal and overweight).Conclusion:Pain was most strongly associated with working life impairment, as well as with spinal stiffness. Pain was also associated with suffering from depression, anxiety and sleep disorders. Understanding how pain affects individuals and shared-decision making between rheumatologists and patients are essential for long-term disease management and preserving quality of life of axSpA patients.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the EMAS study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

In the first n, n ⩾ 3, trials of a non homogeneous zero-one Markov chain of first order, we consider runs of ones of length exceeding a threshold. The article deals with statistics denoting, the length and the position of the shortest segment of the chain in which all such runs of ones are concentrated. The study provides recursive schemes for conditional distributions of these statistics. Numerical examples illustrate the theoretical results.

In a 0 - 1 sequence of Markov dependent trials we consider a statistic which counts strings of a limited length run of 0s between subsequent 1s. Its probability mass function is used to determine the chance that a stochastic process remains or not in statistical control. Illustrative numerics are presented.

Introduction L’encephalite, inflammation de l’encephale, occasionne des troubles neurologiques graves. On parle d’encephalites au pluriel puisqu’on distingue les encephalites infectieuses, des paraneoplasiques, et auto-immunes. Observation Notre travail porte sur 3 patientes de 3 generations differentes, avec des tableaux neurologiques varies evoquant des diagnostics distincts : – Un enfant, a l’âge de 5 ans associe troubles psychiatriques, mouvements anormaux, et epilepsie, d’installation aigue dans un contexte febrile. Chez qui l’IRM est normale or les AC anti NMDA sont positifs ; – Une femme 74 ans, admise 2 semaines apres une gastro-enterite pour un tableau confusionnel et trouble du comportement chez laquelle l’encephalite auto-immune seronegative probable etait retenue au terme du bilan fait ; – Une femme 50 ans, evoluant insidieusement sur 3 mois vers un tableau confusionnel avec signes dysexecutifs et ataxie. L’ensemble du bilan etiologique oriente vers une maladie de Creutzfeldt-Jacob forme sporadique. Discussion Notre premiere patiente a presente un tableau complet et caracteristique, confirme par la biologie, l’evolution fut favorable. La seconde patiente a presente un tableau d’encephalite auto-immune, qui reste seronegative. Malgre le traitement elle garde des sequelles. Le diagnostic de la troisieme reste sombre et seulement probable. Conclusion Devant un tableau d’encephalite il est indispensable de traiter rapidement. Les encephalites auto-immunes sont plus frequentes depuis la decouverte des anticorps d’ou l’interet de les rechercher, et d’autres restent non identifies.

Background:Growing evidence of similarities in male-female prevalence of axial spondyloarthritis (axSpA) has stimulated the need to evaluate gender differences in patient experiences.Objectives:To evaluate gender differences in diagnostic journey, disease-characteristics and patient-reported outcomes (PROs) in axSpA patients.Methods:Data from 2846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 countries were analysed. Socio-demographic characteristics, diagnosis, disease-characteristics, and PROs [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54) and psychological distress (0-12, GHQ-12)] were compared between genders. Χ2(for categorical variables) and student-t (for continuous variables) were employed.Results:1,746 (61.3%) females participated in the EMAS, with homogeneous gender distribution across most countries (Fig 1). Compared to males, females reported longer diagnostic delay (6.1±7.4 vs 8.2±8.9; pTable 1.Disease characteristics by gender (N: 2846, unless specified)Men (n: 1100)(mean ± SD or %)Women (n: 1746)(mean ± SD or %)p valueAge at onset of first symptoms, n: 272127.0 ± 11.826.4 ± 10.70.342Age at diagnosis, n: 272232.6 ± 12.234.4 ± 10.9Diagnostic delay, n: 26526.1 ± 7.48.2 ± 8.9Disease Duration, n: 271618.9 ± 13.316.1 ± 11.7HCP seen before diagnosis - General practitioner822 (74.7)1434 (82.1) - Orthopaedic specialist377 (34.3)557 (31.9)0.190 - Physiotherapist380 (34.5)865 (49.5) - Osteopath, n: 2166103 (13.3)339 (24.4) - Other, n: 2220135 (14.0)233 (18.5)0.005Family history of axSpA (yes), n: 2244291 (33.5)584 (42.5)HLA-B27 (positive), n: 1799497 (80.2)786 (66.7)Uveitis (yes), n: 2096199 (25.2)270 (20.7)0.023IBD (yes), n: 2096113 (14.3)181 (13.9)0.688Table 2.PROs by gender (N: 2846, unless specified)Men (n: 1100)(mean ± SD or %)Women (n: 1746)(mean ± SD or %)p valueBASDAI, (0-10) n: 25845.1 ± 2.05.7 ± 1.9 - Fatigue, n: 26365.7 ± 2.46.6 ± 2.2 - Neck, back or hip pain, n: 26365.6 ± 2.46.2 ± 2.2 - Pain other than neck, back or hip, n: 26364.3 ± 2.74.9 ± 2.6 - Discomfort to touch or pressure, n: 26364.5 ± 2.75.6 ± 2.6 - Morning stiffness level, n: 26365.3 ± 2.65.9 ± 2.6 - Morning stiffness duration, n: 25844.5 ± 2.84.7 ± 2.80.070Stiffness, (3-12) n: 27077.7 ± 2.67.8 ± 2.40.107Functional Limitation, (0-54) n: 277119.1 ± 16.721.2 ± 16.0GHQ-12 ≥3, n: 2640564 (55.4)1060 (65.4)Anxiety243 (30.6)566 (43.3)Depression238 (30.1)472 (36.1)Figure 1.Countries’ sample distribution stratified by gender (N: 2846)Conclusion:Important gender differences are observed in axSpA such as a longer patient journey to diagnosis, poorer PROs, and greater psychological burden in females. These results point to unmet needs in females with axSpA, requiring particular attention.Acknowledgments:Funded by Novartis Pharma AGDisclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Raj Mahapatra: None declared, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB