Objective
To describe the incidence and fatality of coronavirus disease 2019 (COVID‐19) and identify risk factors to fatality in patients with inflammatory articular diseases (IAD).
Methods
This is a ...cross‐sectional observational study of IAD patients and COVID‐19 with controls matched for age, sex, and RT‐PCR. A control group was used to compare the cumulative incidence (CI) and case fatality rate (CFR). The main outcomes of the study were CI and CFR. Other variables included comorbidities, treatments, and characteristics of the COVID‐19. Multiple logistic regression analysis was performed to investigate risk factors for fatality in patients with IAD.
Results
Of the 1537 patients who fulfilled the inclusion criteria, 23/1537 (1.49%) had IAD 13 (0.8%) had rheumatoid arthritis (RA), 5 psoriatic arthritis (PsA) (0.3%) and 5 axial spondyloarthritis (0.3%). There were no significant differences in CI of COVID‐19 and CFR in patients with IAD compared with COVID‐19 patients without IAD. In RT‐PCR positive patients, the CI of COVID‐19 in PsA and AS was higher. Of the 23 IAD patients, 2 RA patients (8.6%) died. The patients did no show characteristics of the COVID‐19 disease different from the population. In multivariate analysis, the factor associated with fatality in patients with IAD was older age (OR 95% CI, 1.1 1.0‐1.2).
Conclusion
COVID‐19 CI, fatality rate and other features do not seem to be increased in IAD patients. Older age was associated with fatality in patients with IAD.
Objectives: To describe the frequency of COVID-19 and the effect of vaccination in patients with interstitial lung disease and systemic autoimmune disease (ILD-SAD) and to identify factors associated ...with infection and severity of COVID-19. Methods: We performed a cross-sectional multicenter study of patients with ILD-SAD followed between June and October 2021. The main variable was COVID-19 infection confirmed by a positive polymerase chain reaction (PCR) result for SARS-CoV-2. The secondary variables included severity of COVID-19, if the patient had to be admitted to hospital or died of the disease, and vaccination status. Other variables included clinical and treatment characteristics, pulmonary function and high-resolution computed tomography. Two logistic regression was performed to explore factors associated with “COVID-19” and “severe COVID-19”. Results: We included 176 patients with ILD-SAD: 105 (59.7%) had rheumatoid arthritis, 49 (27.8%) systemic sclerosis, and 22 (12.54%) inflammatory myopathies. We recorded 22/179 (12.5%) SARS-CoV-2 infections, 7/22 (31.8%) of them were severe and 3/22 (13.22%) died. As to the vaccination, 163/176 (92.6%) patients received the complete doses. The factors associated with SARS-CoV-2 infection were FVC (OR (95% CI), 0.971 (0.946−0.989); p = 0.040), vaccination (OR (95% CI), 0.169 (0.030−0.570); p = 0.004), and rituximab (OR (95% CI), 3.490 (1.129−6.100); p = 0.029). The factors associated with severe COVID-19 were the protective effect of the vaccine (OR (95% CI), 0.024 (0.004−0.170); p < 0.001) and diabetes mellitus (OR (95% CI), 4.923 (1.508−19.097); p = 0.018). Conclusions: Around 13% of patients with ILD-SAD had SARS-CoV-2 infection, which was severe in approximately one-third. Most patients with severe infection were not fully vaccinated.
OBJECTIVETo describe the frequency of polyautoimmunity and multiple autoimmune syndrome in patients with rheumatoid arthritis (RA) and patients with systemic lupus erythematosus (SLE).
PATIENTS AND ...METHODSThis was a cross-sectional observational study of patients with RA, SLE, and controls without autoimmune rheumatic disease. Cases were those with RA according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria and SLE according to the 2019 American College of Rheumatology/European League Against Rheumatism criteria, consecutively recruited in a rheumatology clinic. Controls were subjects with no rheumatic autoimmune disease (AIDs) recruited in the same area. Patients filled out a questionnaire on polyautoimmunity. Variables of interest were polyautoimmunity (RA or SLE with other AIDs), whereas secondary variables were rheumatic, skin, endocrine, digestive, and neurological AIDs. Multiple autoimmune syndrome is defined as the presence of 3 or more AIDs and a family history of AIDs. Statistical analyses performed were descriptive, bivariate, and multivariate (dependent variablepolyautoimmunity).
RESULTSThe study population comprised 109 patients with RA, 105 patients with SLE, and 88 controls. Polyautoimmunity was recorded in 15 patients with RA (13.8%), 43 with SLE (41%), and 2 controls (2.2%). The most frequent AID in RA was Sjögren syndrome (53.3%), followed by Hashimoto thyroiditis and psoriasis; the most frequent AIDs in SLE were Sjögren syndrome (55.8%) and antiphospholipid syndrome (30.2%), followed by Hashimoto thyroiditis. Obesity was associated with polyautoimmunity in RA (odds ratio OR, 3.362; p = 0.034). In SLE, joint damage (OR, 2.282; p = 0.038) and anti-RNP antibodies (OR, 5.095; p = 0.028) were risk factors for polyautoimmunity, and hydroxychloroquine was a protective factor (OR, 0.190; p = 0.004).
CONCLUSIONSPolyautoimmunity is frequent in RA and even more frequent in SLE. It was associated with obesity in RA and with joint damage and anti-RNP in SLE. Hydroxychloroquine was a protector.
Objectives:
To know the impact of the first wave of COVID19 (March to June 2020) in the nursing activity in rheumatology and explore improvements in patient care during the pandemic situation.
...Methods:
2 surveys were sent to nurses working in the rheumatology area (Both in the Outpatient department and day care unit) during October 2020 in Spain. The first survey had 10 questions about what happened in the rheumatology units in the first wave of the COVID19 pandemic (March to June of 2020) and the second survey had 10 questions about the standards of quality of nursing care in times of pandemic. Google forms were used to collect and analyze data.
Results:
32 nurses completed the survey (30 women (93.8%)) with an average age of 49.6 ± 10.2 years. 93.8% work in the outpatient clinics and 2(6.2%) in day care units. The main results of the effects of the first wave of the pandemic are as follow: 4(12.5%) nurses were transferred to other areas of the hospital, 27(84.4%) showed changes in their care activity; and in 12(37,5%) of the surveyed centers, (slightly less than half of the medical staff) left their usual activity to care for covid-19 patients. In June 2020, at the end of the first wave, 17(53.1%) reported more decompensated patients and 22(68.8%) reported that they had both telephone and face-to-face consultations; 15(46.9%) reported that their clinical activity had increased.
Regarding the standards of quality during the pandemia: 27(84.4%) believed that rheumatology units should be strengthened,31(96.9%) reported the need to carry out COVID educational campaigns in rheumatic patients and 30(100%) stated that nursing education should lead that education; 31(96.7%) believed that telephone consultation should be on demand and by telephone, 25 (78.1%) considered it necessary to include video calls and the possibility of receiving reports in non-face to face care and photos. Finally, 23(71.9%) centers recorded nursing and medical telephone consultations in their medical records.
Conclusion:
The pandemic had a huge impact on nursing care for rheumatic patients, with difficulties associated with extra work load and changes in the dynamics of care. A readjustment of assistance has been necessary and audiovisual aids were necessary to improve telephone (non face to face) service.
Disclosure of Interests:
None declared
Background:
In Rheumatoid arthritis (RA), between 20% and 40% of patients do not achieve a 20% improvement in American College of Rheumatology (ACR) criteria, another similar percentage loses ...response over time or experience adverse events that forces them to the suspension of treatment. Those patients who have failed one or more therapeutic strategies, are more refractory patients and the response to successive targets is usually lower than naive patients, with 50% ACR20 response percentages.
Objectives:
To describe the clinical-analytical characteristics and response to the last treatment, in rheumatoid arthritis (RA) refractory to biological disease modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs). To identify possible factors related to refractoriness to bDMARDs and tsDMARDs.
Methods:
Retrospective multicentre, controlled study of patients with RA refractory to bDMARDs and tsDMARDs. Control group was formed by patients with non-refractory RA; matched by gender, age and diseaseduration. Refractoriness was defined as failure to more than 2 different targets of bDMARDs or tsDMARDs. Demographic, clinical-analytical data and rates of disease activity and physical function were collected. A descriptive analysis, a bivariate analysis and a binary logistic regression were performed to see the variables associated with refractoriness.
Results:
A total of 94 patients were selected from HRUM and HCUVV: 47 with refractory RA and 47 with non-refractory RA. The clinical-epidemiological characteristics of both groups are classified in Table 1. The majority were women with a mean age of 57 years. There was a greater proportion of patients with multimorbidity and cardiovascular risk factors among the refractory to FAMEb. All patients affected a significant improvement with the new treatment in activity and physical function at 6 months compared to baseline. Refractoriness is associated with a higher body mass index OR(IC95%), 7.73 (1.56-8.42); p=0.012, and depression OR(IC95%), 1.11 (1.24-1.83); p=0.035.
Table 1.
Clinical-epidemiological characteristics of patients.
Variable
Refractory RA (N=47)
Non-refractory RA
(N=47)
p-value
Sex (female), n (%)
38 (80,9)
38 (80,9)
1,000
Age, means (SD)
57,1 (10,8)
57,4 (10,8)
0,896
Caucasian race, n (%)
45 (95,7)
44 (93,6)
0,646
Body mass index, means (SD)
30,4 (6,8)
26,5 (3,8)
0,002
Non-smoker, n (%)
26 (55,3)
28 (59,6)
Former smoker>6 months, n (%)
16 (34,0)
7 (14,9)
Smoker, n (%)
5 (10,6)
12 (25,5)
Rheumatoid Factor, n (%)
40 (85,1)
42 (89,4)
0,536
Anti-cyclic citrullinated peptide, n (%)
37 (78,7)
38 (80,9)
0,797
Erosions, n (%)
33 (70,2)
28 (59,6)
0,280
Hypertension, n (%)
24 (51,1)
20 (42,6)
0,408
Obesity, n (%)
19 (40,4)
9 (19,1)
0,024
Diabetes Mellitus, n (%)
10 (21,3)
6 (12,8)
0,272
Dyslipidemia, n (%)
20 (42,6)
15 (31,9)
0,286
Neoplasia, n (%)
2 (4,3)
0 (0,0)
0,153
Fibromyalgia, n (%)
4 (8,5)
1 (2,1)
0,168
Depression, n (%)
18 (38,3)
4 /8,5)
0,001
Multicomorbidity, n (%)
17 (36,2)
6 (12,8)
0,008
Comorbidities number, median (IQR)
2,0 (1,0-3,0)
1,0 (0,0-2,0)
0,002
Conclusion:
Patients with refractory RA have an adequate response to subsequent treatment lines. These patients have a remarkable percentage of associated comorbidities.
Disclosure of Interests:
None declared
Background
Interstitial lung disease (ILD) is a common condition in patients with connective tissue disease (CTD). It is associated with increased morbidity and mortality. Rituximab (RTX) has been ...approved for treatment of RA and some recent retrospective studies suggest that it could be an alternative treatment for patients with CTD-ILD, even in cases that prove refractory to conventional immunosuppressants.
Objectives
To analyze the efficacy and safety of RTX in connective tissue disease associated with interstitial lung disease (CTD-ILD).
Methods
We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving RTX between 2015 and 2020. Patients who had worsening of respiratory symptoms or decline in the pulmonary function tests (PFT) compared to the time of ILD diagnosis were treated with rituximab. The patients were assessed using high-resolution computed tomography and PFT baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC)>10% or diffusing capacity of the lungs for carbon monoxide (DLCO)>15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening of ILD.
Results
We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7-69.0) months (Table 1). At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in 7 (18.9%); 7 patients (18.9%) died. Mean PFT values decreased significantly at the start of RTX compared to the date of ILD diagnosis in FVC (72.221.3vs 73.5 16.9 mg/l;p=0.040) and DLCO-SB (55.9 15.7 vs 58.3 16.1 mg/l; p=0.041). No significant decline was observed in median FVC (72.2 vs 70.8; p=0.530) or DLCO (55.9 vs 52.2; p=0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR 95% CI, 0.904 0.8-0.9; p=0.015), time to initiation of RTX (1.01 1.001-1.02; p=0.029), and mycophenolate (0.202 0.04-0.8; p=0.034). The infection incidence rate was 0.21 patient-years.
Table 1.
Baseline demographic and clinical characteristics of 37 patients with CTD-ILD receiving rituximab.
Variable
Total n=37
RAn=19
SSn=14
IMn=4
p Value
Female sex, n (%)
27 (73.0)
13 (68.4)
11 (78.6)
3 (75.0)
0.806
Age in years, mean (SD)
62.8 (9.9)
67.7 (9.7)
57.9 (7.9)
56.6 (5.5)
0.001
Smoking
0.147
Never smoked, n (%)
20 (54.1)
9 (47.4)
7 (50.0)
4 (100.0)
Smoked at some time, n (%)
17 (45.9)
10 (52.6)
7 (50.0)
0 (0.0)
Duration of CTD, months, median (IQR)
107.8 (49.5-188.8)
151.0 (8.,0-240.5)
89.6 (51.3-184.4)
35.1 (25.1-49.0)
0.017
Duration of ILD, months, median (IQR)
65.4 (31.1-110.3)
82.2 (37.4-120.1)
64.5 (35.5-107.1)
25.9 (25.0-36.0)
0.136
Time to initiation of RTX, median (IRQ)
12.0 (6.5-48.2)
25.1 (7.0-57.6)
11.4 (3.9-43.6)
7.4 (7.0-10.4)
0.455
Duration of treatment with RTX, median (IQR)
38.2 (23.4-69.9)
45.3 (22.2-79.9)
52.5 (24.7-63.3)
22.8 (17.7-36.2)
0.291
Combined with csDMARDs, n (%)
15 (40.5)
9 (47.4)
5 (35.7)
1 (25.0)
0.637
Methotrexate, n (%)
5 (13.5)
2 (10.5)
3 (21.4)
0 (0.0)
0.468
Leflunomide, n (%)
2 (5.4)
2 (10.5)
0 (0.0)
0 (0.0)
0.367
Sulfasalazine, n (%)
1 (2.7)
1 (5.3)
0 (0.0)
0 (0.0)
0.615
Hydroxychloroquine, n (%)
7 (18.9)
4 (21.1)
2 (14.3)
1 (25.0)
0.840
Combination with immunosuppressants, n (%)
20 (54.1)
7 (36.8)
9 (64.3)
4 (100.0)
0.044
Mycophenolate, n (%)
19 (51.4)
6 (31.6)
9 (64.3)
4 (100.0)
0.021
Azathioprine, n (%)
1 (2.7)
1 (5.3)
0 (0.0)
0 (0.0)
0.615
Corticosteroids, n (%)
25 (67.6)
14 (73.7)
7 (50.0)
4 (100.0)
0.121
Doses of corticosteroids, median (IQR)
5.0 (0.0-10.0)
5.0 (0.0-10.0)
2.5 (0.0-7.5)
10.0 (8.1-10.5)
0.519
Conclusion
Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. No significant increase in infection rates was observed. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.
Disclosure of Interests
None declared
ObjectivesTo study the effectiveness of the use of probiotics in the control of inflammatory activity of patients with rheumatoid arthritis and analyse its effect on their metabolic profile.MethodsA ...bibliographic search was carried out in Medline and Embase. The search strategy included the terms MeSH and the free text of ”lactobacillus”, ”bacillus”, ”probiotics” and ”rheumatoid arthritis.” The search strategies were carried out by two authors, which were included according to the type of studies: meta-analysis, systematic reviews and clinical trials, depending on the type of participant: adults with RA who have received probiotics, the main outcome measures: changes in the Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)), as well as each of the parameters that constitute them: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), visual analogue scale of the doctor and the patient (EVA), number of painful joints (NAD) and inflamed (NAI) and functional status by Health Assessment Questionnaire (HAQ) Secondary variables: number of adverse events and parameters of metabolic activity. The quality of the evidence was analysed following the guidelines of the Scottish Network of Intercollegiate Guidelines (SIGN).ResultsAfter the selection of 34 articles, 9 articles were finally included. All were randomised, double-blind, placebo-controlled clinical trials (RCTs) with a level of evidence between 1+and 1++and a recommendation grade of A and B. Seven CDs showed improvement in arthritis measurements. In Peltonen et al. observed a high rate of improvement in the experimental group than in the control group (3.1 vs 2, p=0.027). Mandel et al. they described improvement of the EVA in the experimental group (p=0.046). Zamani the al. they described an improvement in DAS28 (−0.3±0.4 versus −0.1±0.4, p=0.01). Vaghef-Mehrabany et al defined this improvement (p<0.01). Pineda et al. showed an improvement in HAQ at 3 months in the experimental group (from 0.97 to 0.80, p=0.02), although not in ACR20 (p=0.33). Allipour et al. found improvements in CRP between the two groups (mean 95% CI=2.03 0.54–3.51, p=0.009); NAD: (mean 95% CI=0.72 0.25, 1.19, p=0.003); NAI: (mean 95% CI=0.351 0.13, 0.58, p=0.003); EVA: (mean 95% CI=16.71 8.91, 24.50 p<0.001; DAS-28: (average CI 95%=0.31 0.02, 0.61, p=0.039) and in cytokine levels, Hatakka et al observed no significant improvement in the experimental group in HAQ, NAD and NAI, and Nenonent et al. Did not observe differences in DAS28. In the last, EC of Vaghef-Mehrabany of 2017 metabolic measures were evaluated without finding significant improvements If an improvement in insulin resistance was observed as measured by the HOMA B index in the study by Zamani et al.ConclusionsTreatment with probiotics seems to be effective in controlling the inflammatory activity of rheumatoid arthritis.Disclosure of InterestNone declared
ObjectivesTo asses insulin resistance (IR) in patients with rheumatoid arthritis (RA) and compare it with healthy controls and to analyse the association between the accumulated inflammatory burden ...in patients with RA and IRMethodsDesign: Nested case-control study. Population: consecutive RA-patients (ACR/EULAR 2010 criteria),>16 years, selected from a prospective inception cohort (diagnosis of RA between 2007 and 2011). Patients with Diabetes Mellitus (according to ADA 2010 criteria) were excluded. Controls: sex- age and BMI -matched controls were collected from a health centre in our hospital area. Protocol: Cases and controls were evaluated by a rheumatologist. Clinical data of disease activity (RA patients), analytical values and oral glucose tolerance test (OGTT) were determined. Main outcome: IR measured by the homeostasis model for insulin resistance (HOMA-IR) (IR >2.29μU*mmol/ml). Secondary outcome: RI measured by quantitative insulin sensitivity check index (QUICKI) (<0.337μU *mmol/ml) and by the homeostatic model assessment of β-cell function (HOMA ß).Variables: Demographic, clinical-analytical variables, Disease Activity Score of 28 joints (DAS28-ESR), Health Assessment Questionnaire (HAQ), BMI (OMS classification) and glucose and insulin before and after OGTT values. Statistical analysis: Descriptive and paired T-test or Chi-square test followed by Multivariate linear regression in RA patients (Dependent variable: HOMA-IR)ResultsOne hundred and fifty six subjects were studied, 4 of them were excluded after OGTT(2 diabetics and their respective controls). Finally, 1522 subjectswer included; 89 RA and 63 controls. The mean age of patients with RA was 56.6 (10.9%)years. Most of them were women(76.4%), with seropositive(FR 83.1% y ACPA 79.1%) and erosive (62%) RA. The mean duration of the disease was 86 (±23)months and mean DAS28 index at the cut-off date of 2.8 (±1.1). Differences between clinical characteristics and in relation to IR between cases and controls are shown in table 1. No significant differences in the proportion of subject with IR in cases and controls were observed and 28.7% of patients with RA had IR. Of the 25 patients with IR, 75% had an average of DAS28 ≥3.2. In multivariate analysis, the independent variables associated with IR in patients with RA were: Obesity(β=1.7494p=0.003), diagnosis delay (β=0.034 p=0.003) and disease activity (β=1.045p=0.058). This model would explain 23% of the variability of the IR (R2=0.23).ConclusionsWe did not find an increased IR in patients with RA compared with healthy controls, which may be due to adequate treatment and good control of inflammatory activity in the most of patients with RA. Obesity, diagnostic delay and inflammatory activity (measured by mean DAS28 index since the onset of the disease), were the predictors of IR in patients with RA in our studyReferences1 Clin Rheumatol2016;35(1):43–53.2 Review. Front Immunol2017;8:1745.3 Rev Bras Reumatol Engl Ed2017;57(4):320–329.4 Biomed Res Int2017:9670434.Disclosure of InterestS. Manrique-Arija Grant/research support from: Rheumatology Spanish Society, N. Mena-Vázquez: None declared, I. Ureña-Garnica: None declared, S. Abad-Sanchez: None declared, L. Ginel: None declared, C. Fuego-Varela: None declared, M. Rojas-Gimenez: None declared, L. Cano-Garcia: None declared, F. Jimenez-Nuñez: None declared, G. Diaz-Cordoves: None declared, M. Ordoñez-Cañizares: None declared, C. Romero-Barco: None declared, R. Caparrós: None declared, M. Irigoyen: None declared, A. Fernandez-Nebro: None declared
Background:
Objectives:
To study the frequency of polyautoinmunity and multiple autoinmune syndrome (MAS) in patients with rheumatoid arthritis (RA) and systemic lupus erithematosus (SLE).
Methods:
...Study design: We performed a cross-sectional study in patients with RA and SLE, and compared them with healthy subjects. Cases: RA patients classified by ACR/EULAR 2010 criteria and SLE patients classified by ACR/EULAR 2019 criteria. SLE and RA patients were compiled consecutively from a rheumatology clinic of the Regional University hospital of Malaga. Controls: subjects without rheumatologic autoimmune disease (AD) from the same population area. Protocol: All subjects filled out a predesigned questionnaire for the collection of polyautoimmunity data on the cut-off date. Main variables: polyautoimmunity was defined as co-occurrence of SLE or RA and other AD. Secondary variables: Rheumatologic, cutaneous, endocrine, digestive and neurological AD. MAS was defined as presence of three or more AD. Family history of SLE, RA and other autoimmune diseases were also collected. Statistic analysis: descriptive analysis, bivariate analysis and multivariable analysis were done. (Dependent variable: Polyautoimmunity).
Results:
We recruited 109 patients with RA, 105 with SLE and 88 controls. Fifteen patients with RA (13.8%), 43 with SLE (41%) and 2 controls (2.2%) reported polyautoimmunity. Table 1 describes the epidemiological characteristics, comorbidities and polyautoimmunity in study population. The most frequent AD associated with RA was Sjögren’s syndrome (SS) (53.3%) and SS (55.8%) followed by the antiphospholipid syndrome (30.2%) were associated with SLE. Hashimoto’s thyroiditis and psoriasis were the next most frequent AD. According to family history, 5 patients with RA (33.3%) and 12 with SLE (27.9%) had a family history of first degree of other AD. Obesity was associated with polyautoimmunity in RA (OR = 3,362, p = 0.034). In SLE, joint damage (OR = 2.282, p = 0.038) and anti-RNP antibodies (OR = 5.095, p = 0.028) were factors associated with polyautoimmunity and taking hydroxychloroquine was a protective factor (OR = 0.190, p = 0.004).
Conclusion:
Polyautoimmunity in RA and especially in SLE is frequent. It was associated with obesity in RA and in SLE with joint damage and anti-RNP antibodies. The hydroxychloroquine appeared as a protective factor.
Variables
RA
(N=109)
SLE
(N=105)
Controls
(N=88)
P value
Epidemiological characteristics
Sex: female, n (%)
85 (78.0)
99 (94.3)
68 (77.3)
0.001
Age, mean (SD), years
56.5 (10.8)
50.8 (13.2)
57.1 (10.6)
0.133
Caucasic race, n (%)
107 (98.2)
105 (100)
88 (100)
0.168
Comorbidities
Smoking
0.001
No smoking, n (%)
55 (50.5)
78 (74.3)
56 (63.6)
Smoking history, n (%)
54 (49.5)
27 (25.7)
32 (36.4)
Obesity, n (%)
38 (34.9)
21 (20.0)
22 (25.0)
0.044
Dyslipidemia, n (%)
24 (22.0)
22 (21.2)
17 (19.3)
0.896
Hypertension, n (%)
27 (24.8)
28 (26.7)
23 (26.1)
0.746
Diabetes mellitus, n (%)
7 (6.4)
1 (1.0)
1 (1.1)
0.031
Polyautoimmunity, n (%)
15 (13.8)
43 (41)
2 (2.2)
<0.001
MAS, n (%)
1 (0.9)
9 (8,6)
0 (0.0)
<0.001
FH polyautoimmunity, n (%)
19 (17.6)
26 (24.8)
15 (17.0)
0.060
RA: rheumatoid arthritis; SLE: systemic lupus erithematosus; SD: standard desviation; MAS: multiple autoinmune syndrome; FH:Family history
Disclosure of Interests:
None declared
ObjectivesTo estimate the annual cost in the use of biological therapy (BT) in patients with different rheumatic diseases when dose modifications are undertaken in daily clinical practice in a ...specialized outpatient clinic during 2016 and to compare the results with data obtained in 2013.Methods Design: Cost minimization observational study under conditions of clinical practice. Patients: Patients with different rheumatic diseases who come to a specialized outpatient clinic on BT in the Rheumatologic department at a tertiary Spanish hospital (with a tight follow-up) that had been treated with BT under reduced doses during 2016 were collected. Protocol: Reductions in treatment dose or dose frequency were established empirically and were carried out by their rheumatologist in those patients who were in remission (DAS 28 <2,6) for at least 6 months without steroids. Main outcome: Reduction of annual average cost in euros in BT used in patients who are in dose reduction in clinical practice in 2016. Secondary outcome:Differences in annual costs reduction in 2016 compared with 2013. The cost reduction was calculated by comparing the actual expenditure (after modifying treatment dose in clinical practice) with the theoretical costs (official price) in case you had not made the adjustment. Statistical analysis: Sample descriptive analysis. Reducing annual absolute costs and by treatment after tapering down doses in clinical practice in 2016 and the differences found between 2013 were calculated.ResultsDuring 2016, the dose of the BT of 168 patients (94 Subcutaneous BT and 74 intravenous BT) were modified in clinical practice after reaching clinical remission:mean of DAS 28 (mean±SD)=2.31±0.76 or BASDAI (mean±SD)=2.15±1.39 without radiographic progression. Most patients were women (n=113;67%)and had rheumatoid arthritis (n=103;62%) and the rest were distributed among: spondyloarthritis (n=28;17%), psoriatic arthritis (n=22;13%), juvenile idiopathic arthritis (n=10;5%) and Systemic Lupus Erithematosus (n=5;3%). No patients treated with certolizumab or anakinra was modified treatment doses. During this period, 5 patients discontinued BT (3 remissions and 2 minor adverse events). Table 1 shows the number of patients by type of BT and costs. The BT dose reduction in clinical practice during 2016 represented a saving of 676,501.67€ and a greater efficiency of treatments while in 2013, only 86 patients (30 etanercept, 15 adalimumab, 16 Infliximab (Remicade), 15 Tocilizumab IV and 55 Rituximab) had a modified dose of BT in clinical practice assuming a saving of 396,995.46€. The difference in the annual cost reductions in 2016 compared to 2013 meant a saving of 279.506,21€ more in the last year. Table 1.ConclusionsIn rheumatic diseases we may do a dose de-escalation of BT in patients who go into remission and therefore we could reduce the associated costs of BT and being more efficient with the treatments. We believe that it is important to create specialized outpatient clinics on BT where a tight-control management of these patients and an individualized treatment are carried out.Disclosure of InterestNone declared
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