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This study aimed to describe the incidence and prevalence of gout, describe the use of allopurinol among prevalent gout cases, and determine persistence with allopurinol and degree of compliance with treat-to-target recommendations before and after the publication of Swedish national guidelines in 2016.Prospectively registered data on gout diagnoses and allopurinol prescriptions were used to calculate incidence and prevalence, and the proportion of prevalent patients on allopurinol. Gout patients starting allopurinol during 2013-2015 versus 2016-2018 were compared regarding persistence and compliance with treat-to-target principles.The incidence of gout was 221-247 per 100 000 person-years during 2014-2019, prevalence in 2018 was 2.45%. Among prevalent cases, the proportion on allopurinol ranged from 21% to 25%. Allopurinol persistence was better for individuals starting therapy during 2016-2018 compared with 2013-2015 (45% vs 39%, p = 0.031), as were several outcomes related to treat-to-target principles, e.g. measuring baseline serum urate (SU) (84% vs 77%, p 0.001), follow-up SU (50% vs 36%, p 0.001), and the proportion of patients reaching an SU level 360 µmol/L (45% vs 30%, p 0.001).Incidence and prevalence were slightly higher than in previous Swedish reports. Allopurinol use among prevalent gout patients did not increase during 2014-2019. Only a minor improvement in persistence was seen, and a moderate increase in compliance with guidelines, suggesting a need for improved management and extended patient involvement to increase and optimize the use of urate lowering therapy.

The aim of this longitudinal study was to evaluate the long-term effects of providing a therapeutic conversation intervention, based on Family Systems Nursing, to family caregivers of a close relative with advanced cancer over the period before and during bereavement. To prevent adverse outcomes, caregivers need ongoing support that begins pre-loss and extends into the post-loss period. This study employed a one-group pre-test, post-test quasi-experimental design. Twenty-four caregivers participated in two intervention trials conducted over a 42-month period, receiving two intervention sessions pre-loss (Trial 1) and one intervention session post-loss (Trial 2). Significant decreases in anxiety and stress were noted over the three post-loss assessments. The final post-loss stress outcome was significantly lower than the first pre-loss score. For the depression score, there was not a significant change over time within the pre- or post-loss period. The findings provide evidence of decreasing anxiety and stress following the implementation of an extended family nursing intervention for bereaved family caregivers.

ObjectivePsoriatic arthritis (PsA) prevalence estimates vary across studies; studies based on national data are few. We aimed to estimate the prevalence of clinically diagnosed PsA in Sweden in 2017, overall and stratified by sex, age, education, and geography, and to quantify disease-modifying antirheumatic drug (DMARD) use among those in contact with specialized rheumatology care between 2015 and 2017.MethodsIndividuals who were 18 to 79 years of age, alive and residing in Sweden on December 31, 2017, and had a prior PsA diagnosis were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). PsA prevalence was estimated according to a base case (BC) definition (ie, ≥ 1 main PsA International Classification of Diseases code from rheumatology or internal medicine departments in the NPR or a PsA diagnosis in the SRQ), according to 4 sensitivity analysis definitions, and for those seen in specialized rheumatology care between 2015 and 2017. In the latter group, DMARD use during 2017 was also assessed. Data for stratifications were retrieved from national registers.ResultsThe crude national prevalence of PsA for adults, aged 18 to 79 years, was estimated at 0.39%, according to the BC definition; 0.34% after accounting for diagnostic misclassification; and 0.32% to 0.50% across all sensitivity analyses. The prevalence was lower in males and in those with a higher level of education. The prevalence for those seen in specialized rheumatology care between 2015 and 2017 was estimated at 0.24%. During 2017, 32% of patients in this population received biologic or targeted synthetic DMARDs, and 41% received conventional synthetic DMARDs only.ConclusionThe prevalence of clinically diagnosed PsA in adults, aged 18 to 79 years, in Sweden in 2017 was around 0.35%. Among PsA cases in recent contact with specialized rheumatology care, almost three-fourths received DMARD therapy in 2017.

Effective communication is the foundation of quality care in palliative nursing. As frontline palliative home care providers, nurses could foster more effective bereavement coping skills through therapeutic conversations. The purpose of this study was to evaluate the impact of a nursing intervention offered to bereaved family cancer caregivers. This was a quasi-experimental design, with a posttest-only comparison of the intervention and control groups receiving usual care. Bereaved caregivers (n = 51) receiving services from a specialized palliative home care unit participated and completed measures of depression, anxiety, stress, and grief reactions 3, 5, and 6 months after their close relative had died.There was a significant decrease in anxiety symptoms in the intervention group compared with the control group across all 3 time points. Anxiety and stress symptoms also decreased over time in the 2 groups combined, but this decrease was not observed for depression. When evaluating grief reactions, the intervention group had a lower mean of controlled grief responses, across the posttest period, than the control group.Results demonstrate that providing bereaved family caregivers the opportunity to participate in a therapeutic conversation intervention might reduce distressing symptoms in early bereavement.

IntroductionAdequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families.Methods and analysisThe iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights.Ethics and disseminationThe cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying.Trial registration numberNCT04271085.

Hyperuricemia is defined by a blood urate level405 µmol/L, the cut-off value at which urate forms crystals in vivo. In 15-20% these individuals develop gout, clinically characterized by attacks of acute arthritis, initially and most commonly affecting MTP 1 or other joints, tendons and soft tissues of the foot. These attacks usually subside within 1 to 2 weeks. Over time attacks occur more frequently and can transform into chronic arthritis characterized by tophi. The gold standard for diagnosis relies on identification of urate crystals by polarization microscopy in aspirated joint fluid. This procedure is rarely performed in primary care where the majority of patients are seen, and gout is usually diagnosed by clinical criteria. New imaging technologies (ultrasound, dual-energy CT) can be helpful when aspiration is not available and when the diagnosis is unclear. Gout has a prevalence of 1.7% and incidence rate of approximately 200 per 100000 person-years in Sweden, figures that increase over time.

Urate lowering therapy (ULT) should, according to recent guidelines, be initiated in the majority of cases already after the first attack of gout. Allopurinol is the first line choice of ULT and should be started with low dose, which is increased until the treatment target is reached. The treatment target should be a blood urate of360 µmol/l or300 µmol/l (in the presence of topfi), which should be maintained until topfi have resolved. NSAID/cox-inhibitors, colchicine and glucocorticoids are all valid short-term treatments of gout attacks. ULT should not be paused/terminated during attacks and can be initiated during an attack that is adequately treated. Recent RCTs of ULT treatment have demonstrated the importance of thorough and adequate information to the patient and regular follow-up until treatment targets are reached. Such a strategy improve both compliance and outcomes of ULT treatment.

Background: Advance care planning (ACP) is well recognised as an important component of palliative care. However, there is still a need to explore ways in which it can become a part of routine practice, ensuring a timely and person-centred discussion. Objectives: To explore patients newly diagnosed with advanced lung cancer and their family members' experiences of engaging in a person-centred and structured ACP discussion facilitated by palliative care nurses in an outpatient oncology clinic at the University Hospital of Iceland. Methods: An exploratory qualitative design employing semi-structured interviews and thematic analysis. The intervention included a structured ACP discussion, aided by a booklet. Results: Key themes emerged describing families' and patients' experiences and highlighted that the timing and approach of the ACP discussion was appropriate and helpful, even though the discussion was sensitive and difficult. Using a routine approach with a flexible structure normalised the discussion and made it easier for the patients to take the lead in the discussion. Conclusions: ACP discussion can be part of an integrated palliative care and oncology service if implemented in a systematic way.

Background Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. Objective The aim of this study was to describe women’s birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. Method A longitudinal cohort study was conducted with a convenience sample of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11–16 weeks of pregnancy (T1, n = 1111), at five to six months (T2, n = 765), and at 18–24 months after birth (T3, n = 657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. Results The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. Conclusions Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on women’s perception of birth experience.

The purpose of this study was to examine attitudinal barriers to cancer pain management and their relationship to pain, analgesic use, clinical, and demographic variables, as well as QOL, in a large sample of patients receiving strong opioids for pain in three European countries. Participants in the present study were 555 patients with cancer, 18 years and older recruited from six centers in Germany, Iceland, and Norway. All had received strong opioids for at least 72 h. Data was collected with the Barriers Questionnaire-II, the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30. The mean (SD) age of patients was 61.68 (12.35) years and 53% were men. Most common diagnoses were gastrointestinal, lung, prostate, and breast cancer. The mean (SD) time from diagnosis was 32.24 (44.55) and 4.97 (9.64) months from start of opioid therapy. Mean (SD) pain severity was 3.19 (1.93) on a 0 to 10 scale, and 46.5% reported worst pain of 7 or higher. Attitudinal barriers had a mean (SD) of 1.95 (0.82) on a 0–5 scale, with fear of addiction as the strongest barrier across countries 2.85 (1.49). Barrier scores increased with age, and were higher among men than women. Higher barrier scores were associated with higher pain severity and interference, and lower performance status, but not with global health-QOL. Patients who had been on opioids for a shorter time reported higher barriers. Attitudinal barriers are frequent in cancer pain patients on opioids and are associated with less effective pain control.

Introduction The purpose of this study was to evaluate the frequency of 5 common symptoms and drug treatments prescribed and given in the last 24 hours of life in 11 medical units at Landspitali National University Hospital of Iceland (LUH) and in 7 nursing homes (NH). Material and methods Data was collected retrospectively from 232 charts of patients who died in 2012, using documentation in the Liverpool Care Pathway (LCP) and the medication management system. Results About half of the patients died at LUH with similar gender ratio but 70% of patients in NH were women. The LCP was used for 50% of all deaths at LUH and 58% in NH. In 45% of all deaths LCP was used for 24 hours or less. The most common symptoms were pain (51%), agitation (36%) and respiratory tract secretions (36%). Frequency of symptoms was similar between institutions and age groups. Cancer patients had significantly higher incidence of agitation and were prescribed and given higher doses of morphine compared to other groups. Regular medication for agitation was haloperidol (45%), diazepam (40%) and midazolam (5%). Close to 70% of the patients were treated with a scopolamin patch for death rattle. Conclusion A large number of patients have symptoms in the last 24 hours of life both in hospital and in nursing homes. Symptom control can be improved by adjusting morphine doses to patients need, using regular doses of benzodiazepine for agitation and better use of anticholinergic medication for death rattle. Key words: symptoms, medication, dying patients, last 24 hours of life, hospital, nursing homes. Correspondence: Svandis Iris Halfdanardottir, svaniris@landspitali.is.

Background: Optimal urate lowering therapy (ULT) as defined by most guidelines requires monitoring of serum urate (SU) and titration of the medication dose to achieve a target level of SU. In Sweden, allopurinol is the most widely used ULT and most patients with gout are managed in primary care. As a first step towards implementation of gout treatment guidelines in the Swedish region of Dalarna, we undertook a register study to assess how allopurinol is prescribed and to what extent monitoring of SU takes place. Objectives: To determine the proportion of patients with gout that receive a) ULT and b) adequate ULT and to determine to what extent SU is monitored. A secondary aim was to explore the effects of adequate ULT on SU and estimated glomerular filtration rate (eGFR) over time. Methods: Data was retrieved from the electronic healthcare record database of the region. The database holds records of all diagnoses at visits to physicians, prescriptions made in primary care as well as results of laboratory tests. We searched the database from 1997-2012 for individuals with a first diagnosis of gout during 2000-2012 and retrieved data for all prescriptions of allopurinol for the identified patients. Results and dates of SU and creatinine measurements after gout diagnosis were retrieved. MDRD eGFR was calculated from s-creatinine, sex and the age of the patient at the time of measurement. The value nearest in time before initiation of ULT was defined as the baseline measurement for both urate and creatinine. Duration of therapy was defined as number of days from first to last prescription adding 365 days (the usual period for which chronic medication is prescribed in Sweden). The mean daily dose of allopurinol was estimated from prescription data. Adequate ULT was defined as a mean daily dose of at least 300 mg of allopurinol and a duration of therapy of at least 2 years. Patients that had received adequate ULT were matched using propensity score on the basis of baseline eGFR and length of follow-up time to patients that received non-adequate ULT. Change from baseline in SU and eGFR was calculated and compared between groups. Results: We identified 5433 patients with an incident gout diagnosis during 2000-2012 (and no gout diagnosis or prescription for ULT during 1997-1999). Of these, 2393 (44%) received at least one prescription for allopurinol. SU was measured at some time point after initiation of ULT in 58% of patients. Adequate ULT as defined above was prescribed for 154 patients (3%), of these, 112 (73%) had a SU measurement at some time point after initiation of therapy and 35 (23%) had such a measurement done within 6 weeks of starting treatment. Matched controls could be identified for 109 of the patients with adequate ULT. Mean urate and eGFR at the start of therapy and end of follow up for the group with adequate ULT treatment and the controls are shown in table 1. Conclusion: ULT was prescribed to less than half of the patients identified. Adequate ULT was rare in clinical practice during the time period studied. Urate monitoring occurred in less than half of ULT-treated patients. The patients with adequate ULT achieved greater lowering of serum urate than matched controls and were more likely to maintain unchanged renal function over time. Acknowledgement: Goran Rorvall, database consultant. Disclosure of Interests: Valgerdur Sigurdardottir: None declared, Lennart T.H. Jacobsson Consultant for: LJ has received lecture and consulting fees from Pfizer, Abbvie, Novartis, Eli-Lily and Janssen, Anna Svard: None declared, Mats Dehlin: None declared

Background:In contrast to the increased mortality reported in other inflammatory diseases such as rheumatoid arthritis and psoriasis, prior mortality studies in psoriatic arthritis (PsA) have shown inconsistent results.Objectives:To compare all-cause mortality between PsA patients in Sweden and matched general population controls, and to describe cause of death distributions in the two groups.Methods:All individuals in Sweden with ≥1 main diagnosis of PsA (ICD-10: L40.5/M07.0-M07.3) from outpatient visits to rheumatology or internal medicine clinics at age ≥18 years (y) 2001-2017 were identified from the Swedish National Patient Register. Each case was matched to 5 general population controls based on sex, county and age in the year of the first registered arthritis diagnosis for the case. Cases and controls were followed from 1 Jan, 2007, or from first PsA diagnosis thereafter for index cases, until first occurrence of death (data from the Swedish Cause of Death Register), emigration or 31 Dec, 2018. Mortality was assessed overall, as well as stratified by sex (45% males) and disease duration (PsA diagnosis prior to 2007 [38% of cases] vs. 2007-2017), using matched Cox proportional hazard regression, or – in case the Cox assumption regarding proportionality did not hold – matched Breslow test. To account for potential PsA misclassification (in a previous validation study, 86% of 400 cases fulfilled PsA classification criteria), a sensitivity analysis was performed by randomly replacing 20% of cases with one of their own controls. Moreover, incidence rate ratios (IRR) of death were calculated overall and stratified by sex, disease duration and age. Finally, causes of death (from the Cause of Death Register) were described for PsA cases and controls.Results:Over the 12y follow-up, 3 121 deaths occurred among 33 036 PsA cases (268 402 person-years at risk) and 12 884 deaths among 161 144 controls (1 302 250 person-years), resulting in an increased mortality among the PsA cases (HR 1.11 [95%CI 1.07-1.16], pTable 1.Mortality rates and incidence rate ratiosPsA casesPopulation controlsNumber of deathsPerson-yearsat riskMortality rate*Number of deathsPerson-yearsat riskMortality rate*Incidence rate ratio (95%CI)Overall3 121268 40211.612 8841 302 2509.91.18 (1.13-1.22)Males1 459120 51712.16 468580 28511.11.09 (1.03-1.15)Females1 662147 88611.26 416721 9668.91.27 (1.20-1.34)Longer disease duration1 943139 37913.97 459670 17411.11.25 (1.19-1.32)Shorter disease duration1 178129 0239.15 425632 0778.61.06 (1.00-1.13)Age intervals (years)1833 5680.598163 2780.60.89 (0.54-1.48)40-499050 5521.8322246 9551.31.37 (1.08-1.73)50-5928065 8204.31 131321 7303.51.21 (1.06-1.38)60-6972370 22410.33 132341 5879.21.12 (1.04-1.22)70-7996037 23225.84 160178 90923.31.11 (1.03-1.19)≥801 05011 00795.44 04149 79181.21.18 (1.10-1.26)* Per 1000 person-years.Conclusion:In this nationwide 12y assessment, the mortality risk among PsA patients in Sweden was increased by around 10% as compared to the general population, mainly driven by increased risks among females and patients with longer disease duration. Cause of death distributions were numerically similar between PsA cases and controls.References:Disclosure of Interests:Sofia Exarchou Consultant of: AbbVie, Novartis, Daniela Di Giuseppe: None declared, Gerd-Marie Alenius: None declared, Eva Klingberg Speakers bureau: Eli Lilly, Consultant of: Novartis, Grant/research support from: Roche, Valgerdur Sigurdardottir Consultant of: Novartis, Sanofi, Sara Wedrén: None declared, Ulf Lindström: None declared, Carl Turesson Speakers bureau: AbbVie, BMS, Pfizer, Roche, Consultant of: Roche, Grant/research support from: BMS, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Johan Askling Grant/research support from: For ARTIS: AbbVie, BMS, Eli Lilly, Merck, Pfizer, Roche, Samsung Bioepis, Sanofi, UCB. This study was supported by AbbVie, Amgen, Eli Lilly, Novartis and Pfizer. The sponsors were allowed to comment on the study protocol and were provided with a report of the results, but had no influence on the study design or decision to submit the abstract., Johan K Wallman Consultant of: Celgene, Eli Lilly, Novartis

Background:The clinical diagnosis of psoriatic arthritis (PsA) may be challenging. In Sweden, the vast majority of PsA cases are diagnosed within rheumatology or internal medicine (IM). Knowledge of the correspondence between clinical ICD diagnoses and classification criteria fulfillment is crucial to interpret studies identifying cases based on ICD codes.Objectives:To assess the degree to which patients with clinical PsA diagnoses in Sweden fulfill established PsA classification criteria.Methods:Four hundred patients with ≥1 outpatient physician visit to one of five rheumatology or IM departments (3 university/2 county departments, spread across Sweden) 2013-2015 with a main ICD-10 diagnosis of PsA (L40.5/M07.0-M07.3), were randomly selected from the Swedish National Patient Register (80 cases/site). Based on a structured medical record review, positive predictive values (PPV) of a clinical PsA diagnosis (i.e. ≥1 visit with a PsA ICD-10 code) for fulfillment of the following classification criteria were assessed: CASPAR,[1] Moll & Wright,[2] Vasey & Espinoza,[3] and Modified ESSG criteria for PsA,[4] respectively (as well as for any of these); ASAS criteria for peripheral or axial spondyloarthritis (SpA) [5]; and the 1987 ACR criteria for rheumatoid arthritis (RA).[6] Subanalyses regarding CASPAR fulfillment were also performed restricted to patients with available rheumatoid factor and peripheral X-ray status (central CASPAR items; n=227), and among patients with ≥2 ICD codes for PsA, of which ≥1 from a rheumatology/IM department (n=353).Results:Out of 400 clinically diagnosed PsA patients, 343 (86%) fulfilled any of the 4 PsA classification criteria, with a PPV for CASPAR fulfillment of 69% (rising to 73-82% in the subanalyses;Figure 1). Substantial overlap was seen regarding fulfillment of the 4 PsA criteria (Figure 2A). Moreover, 86% fulfilled the ASAS peripheral or axial SpA criteria, while the 1987 ACR definition of RA was met by 27% – in both cases with the great majority also classifiable as PsA (Figure 2B). Most patients not fulfilling any PsA criteria had either no verified arthritis or polyarticular disease (Table). Overall, only 6.5% of the clinical PsA diagnoses were judged as clearly wrong by the rheumatologists performing the medical record assessments.Conclusion:The validity of clinical ICD-10 diagnoses for PsA in the Swedish National Patient Register is good, with a PPV of 86% for the fulfillment of established PsA classification criteria.References:[1]Arthritis Rheum2006;54:2665-73[2]Semin Arthritis Rheum 1973;3:55-78[3]In: Calin A, editor. Spondyloarthropathies. Orlando: Grune & Stratton; 1984:151-85[4]Ann Rheum Dis2005;64(Suppl II):ii3–ii8[5]Ann Rheum Dis2011;70:25-31[6]Arthritis Rheum1988;31:315-24Patient characteristics (n=400), stratified by classification criteria fulfillmentFulfilling anyPsA criterian=343Not fulfilling anyPsA criterian=57Male sex, %4644Age, yrs; mean (SD)59 (14)62 (15)Symptom duration, yrs; mean (SD)18 (12)16 (13)Psoriasis, %8947Nail psoriasis, %3811Arthritis, %9358 Monoarthritis, %*7.90 Oligoarthritis, %*4522 Polyarthritis, %*4778DIP-joint arthritis, %287.0Dactylitis, %281.8Enthesitis, %4219Inflammatory back pain, %275.3RF positive, %5.814ACPA positive, %4.43.5Arthritic X-ray changes in hands/feet, %3321* % of patients with arthritis of known distribution. Missing data: 0-4%, except forRF (33%), ACPA (37%) and X-ray changes (20%).Acknowledgments:This work was supported by Celgene, Novartis, Pfizer, Reumatikerförbundet and Psoriasisförbundet.Disclosure of Interests:Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Gerd-Marie Alenius: None declared, Eva Klingberg Grant/research support from: Roche, Consultant of: Novartis, Speakers bureau: Eli Lilly, Valgerdur Sigurdardottir Consultant of: Novartis, Sara Wedrén: None declared, Sofia Exarchou: None declared, Ulf Lindström: None declared, Daniela Di Giuseppe: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer

Repeated switches between reference product etanercept and biosimilar do not affect disease activity or retention rate of etanercept over 24 months : a cohort study with historical controls

Background Hyperuricemia is closely associated to cardiovascular disease (CVD) although it has not been defintively established whether it is a marker or a causative agent. Serum urate (SU) is strongly linked to the metabolic syndrome, hypertension, hyperlipidemia, kidney failure and higher BMI and higher levels are seen in men compared to women. Coronary artery calcification (CAC) is associated with future risk of atherosclerotic CV events in addition to the traditional cardiovascular risk factors (CVRF). CACs are present in atherosclerotic arteries and can be quantified and scored non-invasively by computed tomography. Carotid intima media thickness (CIMT) is a method of estimating atherosclerosis by assessing the level of arterial thickening present. CIMT can be used as a noninvasive marker of atherosclerotic disease with increasing CIMT linked to an increased risk of subsequent CV events. In the present study we have examined the relation between CACs, CIMT and SU in 1040 male and female with no history of myocardial infarction or stroke. Objectives To examine the association bewteen SU and CAC and CIMT respectively in men and women seperately. Methods We identified 1106 (552 males) individuals who were screened for traditional CVRFs, such as hypertension (HT), dyslipidemia (DL), diabetes mellitus (DM), smoking, physical activity (PA), educational level (EDU), socioeconomic status (SES), BMI, high sensitive CRP (hsCRP), kidney function by eGFR (eGFR). CACs, reflecting calcification of coronary arteries, was determined according to Agatston1. CIMT was calculated as the mean of CIMT of the left and right coronary artery. We measured SU and related quartiles of it to CACs and CIMT with multiple logistic regression analyses adjusting for traditional CVRFs. CAC was defined positive if ≥1. CIMT was defined positive for ≥75 percentile. All study participants with a history of CVD (n=68, 44 male) were excluded. Results Of the 1106 participants, 68 were excluded due to history of CVD rendering a study population of 1040 individuals (508 males) with a mean age of 57.7 and 57.5 for male and female respectively. Age, BMI, EDU, SES, smoking status, PA, hsCRP, HT and DL showed no differences between sex while presence of CAC and diabetes was twice as common in men (table 1) and 65% of men displayed an eGFR below 90 mL/min compared to 12% of women (table 1a b). The three upper quartiles of SU (>306 µmol/L) all significantly (p Conclusions Higher levels of SU is associated with presence of CACs in men but not with CIMT. This could suggest that SU is an innocent bystander that covariates with many, but not all, CVRfs. However, it could also imply biological differences in the effect of SU on calcification of coronary arteries compared to carotid intima thickening. Furthermore, SU may exert different effects depending upon biological age and degree of CVD development. Reference [1] Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr., Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol1990;15(4):827–832. Disclosure of Interest None declared

Table S2. Demographic characteristics and prevalence (95% CIs) of comorbidities for gout cases and controls, where cases were defined according to the strict definition of requiring â Ľâ 2 visits with a diagnosis of gout (DOCX 98 kb)

Table S1. Definition of comorbidities based on ICD and/or ATC codes (DOCX 94 kb)

ObjectivesTo examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability.MethodsA regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003–2009 and 22 482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90 days/year) in a subset were determined by conditional logistic regression.ResultsPatients with gout (median age 53 years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (PConclusionsGout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.

Hyperuricemia is associated with increased coronary artery calcification in men but not women

Background Patients with gout are usually seen in primary care. There are numerous reports regarding severity of gout in cohort studies and patients seen in more specialized care, less is known about the spectrum of severity of the disease in primary care. Objectives To describe the pattern of self-reported disease severity of gout and predictors thereof in a primary care setting. Methods All patients above 18 with an ICD10-diagnosis of gout at a health care visit in primary care (Jan 2015 through Aug 2016) were identified from primary care within the Western Sweden Health Care Region (WSHCR). 941 patients were identified and included in the study. They were sent a questionnaire with questions regarding comorbidities, demographics, gout characteristics and Health Assessment questionnaire (HAQ) reflecting disability. Self-reported disease severity was assessed by a three-level Likert scale (mild, moderate, severe). Possibly associated factors were analyzed by bivariate logistic regression (binary outcome: mild vs. moderate/severe) models and factors that were statistically significant were further analyzed by multivariate analysis. Results The response rate was 54%. Response rates were significantly lower in women overall and in men under the age of 50. Covariates that were significantly associated with more severe self-reported severity of gout in the bivariate logistic regression models (Table 1) were: female sex, hyperlipidemia, higher number of previous attacks, attack during last month, HAQ. In the multivariate analysis objective measures of gout severity such as more than ten previous attacks and attack during last month were strongly associated with the patients grading of severity, in addition to presence of hyperlipidemia (Table 1). Conclusions Over 40% of patients with gout in a primary care setting rated their disease as moderate or severe. The validity of the patients rating was supported by other covariates reflecting disease severity. The observations that women and those with hyperlipidemia reported a more severe disease needs to be further explored. Disclosure of Interest None declared

Background Gout is the most common form of inflammatory arthritis with a prevalence of 1.5% in our area in the age group 50–59 years (1). Gout has a substantial association with several comorbidities. Studies on the impact of gout on work disability on a population level are scarce. Objectives The primary objective of the study was to investigate if gout was a predictor of work absenteeism exceeding 90 days in a calendar year, controlling for comorbidites and socioeconomic status in men and women separately. Another aim of the study was to explore if urate lowering therapy (ULT) attenuated the risk of work disability for gout cases. Methods Gout cases were defined in the population based health care database (VEGA) of the Western Swedish Health Care Region (WSHCR) by having a first diagnosis of gout in the years 2003–2009 by ICD-10 codes (M10 and M14.0) in VEGA. Cases were included if their age at the time of diagnosis of gout was ≤62 years. Five controls for each case, matched for age, sex and place of residence were chosen from the census register by Statistics Sweden. Individuals with any work disability in the year before the index year were excluded from analysis. Data on predefined comorbidities registered previous to the index year was collected from VEGA by ICD-10 codes. Data on prescribed medications was collected from the national prescription database. Data on educational level, income and number of days per calendar year with sick-leave and disability pension was provided by Statistics Sweden. Conditional logistic regression taking into account the 1-to-5 matched design of the study was performed in individuals without work disability in the year before the index date for the outcome of ≥25% (≥90 days) work disability in the year after the index year. Possible predictors of work disability for gout cases were analyzed using logistic regression Results 3068 incident gout cases (females N=554 (18%)) of working age without prior work disability were matched to 15,077 population controls. After matching, 3258 controls with prior work disability were excluded leaving 11,819 controls for analysis. Of the women with gout, 69 (12.5%) became ≥25% work disabled in the year after the index-year as opposed to 117 (6.1%) of the female controls, p Conclusions Gout is a significant independent predictor of work disability in both men and women. ULT did not attenuate the risk of work disability early after diagnosis for gout cases in this study, possibly explained by under-prescribing and sub-optimal dosage as previously shown in our region (1). References Dehlin M, Drivelegka P, Sigurdardottir V, Svard A, Jacobsson LT. Incidence and prevalence of gout in Western Sweden. Arthritis research & therapy. 2016;18:164. Disclosure of Interest None declared

Background A well-known complication of gout is an increased risk for nephrolithiasis (NL). The incidence rate of NL in the general population varies in different studies between 85 and 170/100 000 person-years, with a peak incidence in the ages 40–49 years. Several medications used in gout patients could affect the risk for NL, including allopurinol, losartan, thiazide- and loop-diuretics. Effect of these medications on risk of NL in gout patients, and the general population, has only scarcely been studied. Objectives In this cohortstudy we investigated: 1) overall incidence of NL in gout and general population (GP) controls 2) risk for first time NL in gout patients vs general population (GP) controls, and 3) predictors for first time NL in both groups separately. Methods Gout patients were identified from the regional health care database in western Sweden (VEGA), containing ICD10-codes for all regional Healthcare visits from 2000. Matched (birthyear, sex, county) GP controls were selected from the population register. National registers and VEGA were used to retrieve information on comorbidities, socioeconomic factors and current medications at start of follow-up. The study population had to be above 19 years of age, without NL prior to start of follow-up, and living in the Western Swedish Health Care Region (WSHCR). Follow-up began 2006–01–01, or at the first gout-diagnosis if this occurred later, and ended at death, emigration or 2012–12–31, whichever occurred first. Incidence rates (IR) per 1000 person-years and hazardratios (HR) were calculated. Possible predictors for NL were based on risk factors presented in the literature. Results 29,968 gout patients and 138,678 matched GP controls were included. In gout patients there were 678 NL-events (IR: 6.2 per 1000 pyrs at risk (95% CI: 5.7–6.6)) and in GP controls 2125 (IR 3.9 per 1000 pyrs at risk (95% CI 3.7–4.0)). Risk for NL was increased in gout (HR=1.49, 95% CI: 1.35–1.64), and was higher in men compared to women (P Conclusions The risk for NL was increased by 50% in gout patients, compared to controls. Overall pattern of predictors was similar in gout patients and population controls. In patients with gout, male sex, diabetes mellitus (DM), obesity predicted NL, whereas use of loop diuretics was protective. Overall, the most commonly used CVD drugs did not increase the risk for NL in patients with gout. Disclosure of Interest None declared

Background Gout is the most common arthritic disease in the world with increasing incidence and prevalence. There are differences in gout prevalence and course of disease due to cultural, ethnical and genetic factors stressing the need for data from different parts of the world. An increase in hospitalization for gout has been shown for the last two decades in North America. Objectives We evaluated the trend for hospitalization of gout in western Sweden 2000 – 2012 and the health care costs for this 2009 – 2012. Methods Hospitalization trends for gout were studied using data from the health care consumption register in the Western Swedish Health Care Region (WSHCR) from 2000–01–01 through 2012–12–31. This area is considered to be representative for the country as a whole. Patients aged 18 years and older who were hospitalized during the study period with a principal ICD-10 diagnosis of gout (M10) at discharge were included. We calculated annual population rates for hospitalization for gout. Inflation-adjusted health care costs for the gout hospitalizations were calculated using the Cost-Per-Patient register (CPP). Dispensation of urate lowering therapy (ULT), allopurinol (M04AA01) and probenecid (M04AB01), within 6 months prior to hospitalization was identified using The Swedish Prescribed Drug Register. Results There were 1873 hospitalizations for gout (mean age 75.0–77.6 years, 61–74% men) between 2000 and 2012. Demographic characteristics were similar over the study period. From 2000 to 2012, the annual hospitalization rate for gout increased from 12.2 to 16.7 per 100 000 adults (p=0.0038). The increase was most pronounced in males aged 65 and above and over the last three years of the study. From 2009 to 2012 the inflation-adjusted health care costs for gout hospitalizations increased from 5.21 to 8.15 105 USD. The duration of hospitalizations also increased from 3 to 5 days median 2000 and 2012 respectively (p=0.021). Only a minority of patients, 19 to 27%, received ULT the 6 months preceding their hospitalization, without any obvious secular trend. Conclusions Incidence of hospitalization for primary gout is increasing substantially in Sweden over the last decade and this is reflected in the health care costs. The main part of this increase consists of males aged 65 and above. Only a fourth of the patients were on ULT preceding the hospitalization. These findings are further emphasized by the fact that the total amount of days for somatic inpatient care in WSHCR decreased by 9% from 2002 (1 267 900 days, mean duration 5,7 days) to 2012 (1 151 630 days, mean duration 4,9 days). The findings in this study reflects increasing incidence of the gout disease and an ageing population but also a considerable lack of treatment. Disclosure of Interest None declared

The purpose of this study was to evaluate the frequency of 5 common symptoms and drug treatments prescribed and given in the last 24 hours of life in 11 medical units at Landspitali National University Hospital of Iceland (LUH) and in 7 nursing homes (NH).Data was collected retrospectively from 232 charts of patients who died in 2012, using documentation in the Liverpool Care Pathway (LCP) and the medication management system.About half of the patients died at LUH with similar gender ratio but 70% of patients in NH were women. The LCP was used for 50% of all deaths at LUH and 58% in NH. In 45% of all deaths LCP was used for 24 hours or less. The most common symptoms were pain (51%), agitation (36%) and respiratory tract secretions (36%). Frequency of symptoms was similar between institutions and age groups. Cancer patients had significantly higher incidence of agitation and were prescribed and given higher doses of morphine compared to other groups. Regular medication for agitation was haloperidol (45%), diazepam (40%) and midazolam (5%). Close to 70% of the patients were treated with a scopolamin patch for death rattle.A large number of patients have symptoms in the last 24 hours of life both in hospital and in nursing homes. Symptom control can be improved by adjusting morphine doses to patients need, using regular doses of benzodiazepine for agitation and better use of anticholinergic medication for death rattle. Key words: symptoms, medication, dying patients, last 24 hours of life, hospital, nursing homes. Correspondence: Svandis Iris Halfdanardottir, svaniris@landspitali.is.

This study explores existential and spiritual concerns from the perspective of people receiving palliative care. It examines the meaning of these concerns, their influence on people's lives and investigates the connections between them. In-depth qualitative interviews were conducted with ten persons. Findings reveal existential and spiritual aspects as interconnected and an integral part of the participants' everyday existence. It concludes with a call for a better understanding of these phenomena in the palliative care context.

Spirituality is one of the main aspects of palliative care. The concept is multidimensional and encompasses the existential realm as well as value-based and religious considerations. The aim of this study was to explore spirituality from the perspective of persons receiving palliative care and examine their experience of spirituality and its influence on their lives and well-being.Qualitative interviews were conducted with ten persons receiving palliative care from Palliative Care Services in Iceland. The interviews were tape-recorded, transcribed and analysed. The study is in the field of practical theology and used the theoretical approach of hermeneutical phenomenology.Thematic analysis found that the spiritual dimension was of significance for the participants who understood it as a vital element connected to seeking meaning, purpose and transcendence in life. Religious and non-religious aspects of spirituality were expressed including strong spiritual components of family relationships, the meaning of God/a higher being and spiritual practices which served as a key factor in giving strength, activating inner resources and motivating hope. Nine of the participants expressed their spirituality as faith.Spirituality was experienced broadly as an important dimension of how participants lived with terminal illness. Religious and non-religious characteristics were recognised which reveals the complex nature of the phenomenon. Faith was a significant part of the participants' spirituality indicating the importance of attending to this aspect of palliative care. The study suggests the potential contributions of theological approaches which are relevant for palliative care research and practice.

Background The aim of the present study was to describe prevalence and trends in the incidence of gout and patterns of urate-lowering treatment (ULT) in the Western Swedish Health Care Region (WSHCR) from 2002 to 2012. Methods We used regional and national healthcare registers to estimate the prevalence and incidence of gout in 2012, and trends in incidence for each calendar year from 2005 to 2012. We also investigated the pattern of ULT for gout using the Swedish Prescribed Drug Register. Results In 2012, in the population aged 20 years and above, the prevalence of gout was 1.8 % (95 % confidence interval (CI) 1.77 to 1.82) and the incidence was 190 cases (95 % CI 180 to 200) per 100,000 person-years. Applying more strict definitions for a gout case rendered a prevalence of 1.36 % (95 % CI 1.34 to 1.38) and 0.5 (95 % CI 0.49 to 0.51) per 100,000 person-years, respectively. The incidence of gout increased steadily and significantly from 2005 to 2012, with an almost 50 % increase in the total population. There was no significant difference in the prevalence of gout in rural compared to urban areas. ULT was dispensed to only 42 % of patients with gout in 2012 who had ever been diagnosed with gout during the preceding 10-year period. Conclusions Gout is the most common arthritic disease in WSHCR, Sweden, and has increased substantially over the last decade, with only a minority of prevalent cases in 2012 receiving ULT. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1062-6) contains supplementary material, which is available to authorized users.

Definition of co-morbidities by ICD-10 codes and ULT and diuretics by ATC codes. (DOCX 93 kb)

The purpose of this study was to assess pain, other symptoms and QOL, and the relationship between these variables, among cancer patients on strong opioids. The study was cross-sectional, descriptive, and correlational. A convenience sample of 150 cancer patients, ≥18 years, all on strong opioids for ≥3 days was recruited. The mean (SD) age was 64.7 (12.7) years, and 59 % were women. Mean (SD) time from cancer diagnosis was 36.3 (55.1) months. The median number of symptoms was 9, range 1–16 and the mean (SD) severity was 1.9 (0.5) on a 1–4 scale. Pain was one of the most prevalent (90 %) and severe symptoms with a mean (SD) of 2.56 (0.9). Number of symptoms explained 25.8 % of the variance in QOL, adjusted for age and sex. Another model, also adjusted for age and sex, showed that pain, fatigue, insomnia and depression, explained 33.6 % of the variance in QOL. The symptomatology in this study was similar to studies on patients with advanced cancer. QOL was associated with the number of symptoms patients experience and individual symptoms, notably fatigue and pain. Despite the use of strong opioids, pain was both common and severe, suggesting under-treatment. Pain and other symptoms need to be assessed and managed in order to improve patients’ QOL. Special attention needs to be paid to multisymptom management in patients on opioids.

Objectives: Epidemiological studies of spondyloarthritis (SpA), using ICD codes from the Swedish National Patient Register (NPR), offer unique possibilities but hinge upon an understanding of the validity of the codes. The aim of this study was to validate the ICD codes for ankylosing spondylitis (AS) and undifferentiated SpA (uSpA) in the NPR against the established classification criteria [modified New York (mNY), Assessment of SpondyloArthritis international Society (ASAS), Amor, and European Spondyloarthropathy Study Group (ESSG) criteria].Method: All patients with an ICD-8/9/10 code of AS or uSpA in the NPR 1966–2009 at a visit to a specialist in rheumatology or internal medicine or corresponding hospitalization, alive and living in Sweden 2009, were identified (n = 20 089). Following a structured procedure to achieve geographical representativeness, 500 random patients with a diagnosis of AS or uSpA in 2007–2009 were selected. Based on a structured review of clinical records, positive predictive values (PPVs) for fulfilling the criteria sets were calculated.Results: For those having received an ICD code for AS, the PPVs for fulfilling the mNY criteria or any set of SpA criteria were 70% and 89%, respectively. For those with an uSpA diagnosis (and never an AS diagnosis), the corresponding PPVs were 20% and 79%. The subset with both AS and uSpA diagnoses (overlap = 12%) were as likely to fulfil the mNY criteria as the group that had been coded as AS only.Conclusions: The diagnosis codes for AS or uSpA had high PPVs, suggesting that our case identification in the Swedish NPR can be used for nationwide, population-based, epidemiological studies of these diseases.

Family support has been recognized in the development of palliative care in Iceland, yet studies focusing on family needs are lacking. The aims of this study were to evaluate the perceived care needs of family members of patients receiving palliative care, to what extent these needs were met, and whether needs differed based on background characteristics and site of care. Family members of 111 patients from acute and palliative care settings agreed to participate, and 67 (60%) completed the study. The Family Inventory of Needs was used to quantify family needs and to what extent they were met. All 20 needs measured were considered important. The number of needs did not differ by site of palliative care. Overall, health care professionals met 67% of needs. Needs were more likely to be met in specialized palliative care settings than on acute units and the needs of spouses were more likely to be met than others.

The fine-needle aspiration (FNA) technique is a widely used method for diagnostic assessment of breast diseases. In the current study we investigated the feasibility of sampling material for genetic studies from the same FNA samples as would be used for breast cytology. After making smears for cytological examination, the needle was rinsed into phosphate-buffered saline (PBS) solution. The material gained was sufficient for a polymerase chain reaction (PCR)-based study. As the FNA samples reflect a broad range of breast diseases, it is possible to study genetic changes at various stages of the neoplastic process. We looked for mutations in the p53 tumor suppressor gene in 198 FNA needle rinses, 42 from carcinomas and 156 from cytologically benign lesions. In the malignant samples, 22% carried mutations in the p53 gene. We also looked for p53 mutations in matching tissue sections from tumors and found the FNA needle rinses to represent the tumor well. In addition, three mutations in cytologically benign lesions were found, but none of these 3 patients were diagnosed with malignant tumors in the time frame of the study. The clinical significance of p53 mutations in benign breast tissue remains to be determined.

Among the chromosomal regions commonly undergoing deletions in breast tumors is 11q23.1. The genes that are targets for loss of heterozygosity (LOH) in this region is not yet established. One of the candidate genes located in this region is ATM, responsible for the rare autosomal recessive disorder ataxia-telangiectasia (A-T). Interestingly, A-T heterozygotes may have an increased risk of cancer, in particular breast cancer, although this is still controversial. A common assumption has been that the target for the LOH at 11q23.1 in breast carcinoma is the ATM gene, but the area studied has been too large, the density of markers too low, and the number of tumors studied has been too small to draw any firm conclusions. The present study is a multicenter study including 918 breast cancer patients with clinical information and survival data available for most of them. Primary breast tumors were investigated for LOH using a high density of microsatellite markers spanning approximately 6 Mb around the ATM gene. Survival analyses showed that there are most likely one or more candidate genes in a 3-4 Mb region between the markers D11S1819 and D11S927 including the ATM gene. Cancer-specific survival was significantly reduced in patients whose tumors exhibited LOH of markers D11S2179 (within the ATM gene), D11S1778, D11S1294, and D11S1818. The highest survival hazard ratios were 1.8(C11.2-2.8, P = 0.010) and 2.1 (C11.4-3.0, P = 0.0004) for markers D11S2179 and D11S1818, respectively. One or more of these markers are therefore most likely to be located close to or within genes associated with breast cancer survival.

An extensive quality of life (QOL) investigation of the effects of chemotherapy in patients with generalized malignant melanoma included a validation study of involved questionnaires. The QOL domains of the three basic quality of life questionnaires, the EORTC QLQ-C36 (European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire), a study-specific malignant melanoma (MM) module and the Hospital Anxiety and Depression (HAD) scale vs. the Cancer Inventory of Problem Situations (CIPS) were validated by correlation analyses. The value of using attending nurses and/or next of kin to assess the patients' situation was also examined. Functional and symptom scales of the C36 and the subscales of the HAD showed appropriate convergent and discriminant validity when compared with the CIPS. The subscales of the MM module had less clear relationships, probably due to lack of accordance in the CIPS. Assessments of attending nurses revealed very low correlations with the patients' measures. They under-estimated significantly series of specific symptoms and overestimated nausea and the overall quality of life of the patients. However, assessments of close relatives, mostly spouses, showed moderate to high correlations and no significant difference. These results further strengthen the overall validity of the modular approach of the EORTC QLQ technique. In this context of active chemotherapy in patients with advanced cancer disease, relatives seem to be better surrogates than the attending nurses in assessing the patients' quality of life.

Background Gout is the most common form of inflammatory arthritis and is linked with an increased occurrence of several comorbidities that impair quality of life and influence mortality. Population based data from European countries are scarce and the majority of them include limited categories of comorbidities without specifically addressing them to the time of gout diagnosis. Objectives To examine the occurrence of comorbidities possibly related to gout at the time of first gout diagnosis compared with matched controls from the general population. Methods Using the regional population-based health care data base in Vastra Gotaland region in western Sweden, the National prescribed drugs register and the census register, we identified all patients who attended any inpatient, outpatient or primary care clinic in the region and received at least one ICD10-coded diagnosis (M10, M14.0, M14.1) corresponding to gout during 2000 through 2012. In this study, we included only incident cases with first ICD-coded diagnosis of gout between January 1st 2006 and December 31st 2012 (N=14.137, mean age 66.5, 66.3% men). Each case was matched by year of birth, sex and county to 5 general population comparators, alive and without gout at the date of the index patients9 first gout diagnosis, identified in the population register (N=65.899). Comorbidities (previously suggested to be related to gout) were defined by at least one visit to a physician in primary or specialized care with corresponding ICD-coded diagnosis or having dispensed a prescription for a medication strongly supporting such diagnosis prior to the index date in cases and controls respectively. The treatment with diuretics and cyclosporine was defined by having dispensed a prescription of these agents within 6 months prior to gout diagnosis. Comorbidities were grouped as “possibly causal”, “metabolic” and “cardiovascular” (CVD) (table). Results Among “possibly causal” comorbidities, exposure to diuretics (thiazide, loop and potassium-sparing) (48,1%) and renal disease (11,6%) were the overall most frequent and 1,5 to 2,5-fold more common in gout at diagnosis vs controls, whereas diagnosis of psoriasis was not (table). Among “metabolic”, diagnosis of diabetes or obesity was only modestly more frequent in gout vs controls, whereas hyperlipidemia and hypertension were both very frequent in gout (33,9% and 64,9% respectively) and more common, probably reflecting a high CVD comorbidity in gout (table). Among “CVD comorbidities”, different aspects of cardiovascular disease were all common (>5%) and highly associated with gout at diagnosis with exception of thromboembolism (table). Conclusions The majority of gout patients has at least one comorbidity at the time of gout diagnosis and compared to the general population, a higher prevalence of a wide range of comorbidities, such as renal impairment, organ transplantation, cardiovascular diseases and the diseases reflecting the metabolic syndrome. Disclosure of Interest None declared

Background Gout is the most common inflammatory arthritic disease worldwide. The prevalence varies due to cultural, ethnical and genetic differences in populations, which emphasizes the need for national/regional data on occurrence. There are major insights in the pathogenesis and effective treatments have been available for decades. Despite this several earlier reports state sub-optimal treatment with urate lowering therapy (ULT) of this common and severe disease. Contemporary data on whether this has improved recently are overall few and completely lacking from the Nordic countries. Objectives In the present study we measured the prevalence of gout in western Sweden and the proportion thereof treated with ULT. Methods We identified all individuals with one or more ICD-10 diagnosis of gout (M10, M14) in the Western Swedish Health Care Region (WSHCR), Sweden, 2002-01-01 to 2012-12-31 through VEGA, a diagnosis register entailing all visits to physicians in primary and secondary care and hospitalizations in the region with diagnosis according to the Swedish version of ICD-10. WSHCR has 1 600 000 inhabitants, roughly 20% of the population of Sweden and is representative for the country as a whole with regard to demographics and health status. All cases were linked to Statistics Sweden (for death and possible emigration before Dec 2012) and the National Drug Prescription Register (for dispensation of ULT prescriptions during 2012). The point prevalence of gout Dec 2012 was calculated using the number of people aged 20 and above fulfilling our case definitions for gout who were alive and living in WSHCR 2012-12-31 as the numerator and the total population aged 20 and above of WSHCR by 2012–12–31 as the denominator. Dispensation of ULT prescriptions during 2012 were identified for allopurinol, febuxostat and probenecid. The presence of ≥1 dispensation was regarded as ULT treatment in 2012. Results The prevalence of gout in the Swedish population aged 20 years and above was 1,7% overall and increased with age and male sex (Fig 1), and was more than 3% in males above 50 years of age. Only 43% of the patients received treatment with ULT in 2012, almost exclusively allopurinol (99%). Of these 43%, the majority (59%) received a dose of only 100 mg allopurinol daily. Conclusions Gout is the most common inflammatory arthritic disease in Sweden with an overall prevalence of 1.7%. Treatment with ULT is still in 2012 insufficient with low a low proportion being treated and those treated receiving low doses. Disclosure of Interest None declared

Background Gout is the most common inflammatory arthritic disease worldwide. The prevalence varies due to cultural, ethnical and genetic differences in populations, which emphasizes the need for national/regional data on occurrence. While there are several studies on the prevalence of gout only few have addressed the incidence of gout and there are no contemporary studies in Sweden and the neighbouring Nordic countries. Objectives In the present study we measured the incidence of gout in 2012 and its trends from 2004 to 2012 in the Western Swedish Health Care Region (WSHCR) in Sweden. Methods We identified all incident cases of gout from 2004 through 2012 through VEGA, a diagnosis register covering all visits to physicians in primary and secondary care and hospitalizations in WSHCR. WSHCR has 1 600 000 inhabitants, roughly 20% of the population of Sweden, and is representative for the country as a whole with regard to demographics and health status. For the analyses of incidence trends an incident case of gout was defined as having a visit with a first ICD-10 diagnosis of gout (M10, M14) not preceded by a diagnosis of gout for the three calendar years before. Cumulative incidence per year was calculated using the number of incident gout cases aged 20 and above by calendar year (from 2004 to 2012) as the numerator and the total person-years aged 20 and above of WSHCR by the end of each year as the denominator. We calculated standardized estimates (direct method) using the whole Swedish population aged ≥20 years in 2012 as standard population Calculation of incidence trend was performed using logistic regression. Incidence in 2012 was based on cases with their first diagnosis of gout 2012 without any such diagnosis during the12 preceding years (2000–2011). All cases were linked to Statistics Sweden (for death and possible emigration before Dec 2012). Results The incidence of gout increased steadily and significantly (p for trend Conclusions Gout is an increasing health care problem all over the world and also in western Sweden where the incidence of gout increased significantly over the last decade being approximately three times higher than that for rheumatoid arthritis. This increase might reflect changes in the disease panoramic and cultural changes. Disclosure of Interest None declared

Background Gout was previously regarded a disease of the affluent. Knowledge about the association between gout and socioeconomic status in modern times is limited. Objectives To investigate the association between gout and socioeconomic factors in a population based register study in a large region in Sweden. Methods All patients receiving ≥2 diagnoses of gout on at least two separate occasions in primary or secondary care or 1 diagnosis by a specialist in Rheumatology in Vastra Gotaland in the years 2007–2012 were identified by ICD10 codes in a regional database of health-care utilization. 3189 such patients were identified. The date of the first diagnosis was defined as the index date. A previous validation study of cases identified in this manner confirmed that this case definition is highly consistent with a diagnosis of gout as defined by established criteria (PPV >80%)(1). For each case, up to 5 controls matched for age, gender and place of residence at the time of the first gout diagnosis were chosen by the Statistics Sweden agency (SCB) (N=14946). Common comorbidities known to be associated with gout (ischemic heart disease, heart failure, atrial fibrillation, hypertension, hyperlipidemia, diabetes and renal failure) prior to the index date were retrieved from the regional database of health-care utilization based on ICD10-codes. Data on education level and income at the index year was collected from the Longitudinal Integration Database for health Insurance and Labor market studies (LISA). The database holds annual registers since 1990 on all individuals above 16 years of age registered in Sweden. Results Data on education level and income was analyzed for cases and controls belonging to the working-age population as defined in Sweden (aged 15–74 years). Shorter education, Conclusions Low education level and income are predictors for gout in the working age population. The effects of education do not seem to be largely/only mediated via cardiovascular- or renal comorbidity, supporting that other factors possibly related to lifestyle or occupational exposures are of importance for gout development. References Dehlin M, Stasinopoulou K, Jacobsson L. Validity of gout diagnosis in Swedish primary and secondary care – a validation study. BMC Musculoskelet Disord. 2015;16:149. Disclosure of Interest None declared

Eighty-nine patients with generalized malignant melanoma, 63% men and median age 53 years, were included in a longitudinal quality of life (QOL) study before the start of chemotherapy. QOL was assessed by the EORTC core questionnaire technique (QLQ-C36), a study-specific melanoma (MM) module and the Hospital Anxiety and Depression (HAD) scale. The questionnaires displayed good psychometric qualities and were able to document the florid symptomatology of disseminated melanoma. They were well accepted by the patients. Before treatment the patients reported a relatively low symptom burden, good physical and social functioning, moderate psychological distress and a high overall QOL rating during the past week. Fatigue and pain were the most frequent symptoms reported. The QOL measurement differentiated between subgroups of patients differing in performance status and the tumour burden. We conclude that the EORTC questionnaire technique is feasible and clinically relevant in generalized malignant melanoma patients.