We have read with interest the work of Bozzalla-Cassione et al 1 published recently in your journal regarding the implementation of a telemedicine programme for patients with lupus in northern Italy. It is logical to suppose that the risk of patients with rheumatic diseases of having a more severe clinical course if they become infected with the COVID-19 infection is very high; however, although some of the reports show that there seems to be a low incidence of COVID-19 infection in patients with rheumatic disease, collaborative work with large cohorts is needed, which could show us the real incidence of COVID-19 infection in these patients and what happens with the establishment of telemedicine programmes.  We show an experience in a specialised centre in Bogota, Colombia; currently, we have a cohort of 5597 patients with rheumatoid arthritis (RA) in exclusively ambulatory care. On 12 March 2020, in Colombia, the health emergency by COVID-19 was established and a week later the Ministry of Health ordered the outpatient care procedure for the population in isolation. From that moment on, our institution, carrying out the proper logistical and legal processes, proceeded to convert its ambulatory care services into care through telemedicine.By telecounselling, patients were offered consultation by telemedicine due to the high epidemiological risk of COVID-19; the patient gave informed consent to accept it or otherwise to request a face-to-face consultation despite the epidemiological risk warning; a third option was that the patient did not accept telemedicine or face-to-face consultation for personal reasons.Here, we report the outcomes since 21 March-16 May (8 weeks later). For rheumatology care, the doctor must request informed consent for the consultation; then a standardised protocol was applied both for RA and also for suspected symptoms of COVID-19; as a measure of disease activity Patient Activity Score (PAS) was applied, and Health Assessment Questionnaire (HAQ) was also evaluated. When during the consultation the doctor finds that there is potentially high activity of the disease, a face-to-face consultation was ordered. In case of need, patients are sent to telemedicine consultation with the physiatrist or psychologist. For face-to-face consultation, standardised clinimetry instruments are used.Until May the 16 (8 weeks later), 3503 patients have been followed up; 3228 (92%) have been seen by telemedicine and 275 (8%) by conventional face-to-face consultation; of these patients, 55 (20%) men and 220 (80%) women attended the face-to-face consultation; of patients attended by telemedicine, 567 (17.5%) were men and 2661 (82.5%) were women. Regarding COVID-19 infection, in 3 of the 275 patients who attended an in-person consultation, COVID-19 infection was suspected due to respiratory symptoms, but was finally ruled out. None of the patients seen so far by telemedicine had suspected COVID-19 by clinic or had contact with COVID-19 confirmed patients.At first glance, these results seem surprisin...
BackgroundRheumatoid arthritis (RA) is a chronic, disease that affects more than 1% of global population, it is a long term condition that causes pain and disability. Evidence had shown that most of the patients are moderately disabled, which brings the necessity of a caregiver to become the patients companion due to its chronic disease. The caregiving role can have an impact in the psychological and physical spheres of the caregivers life.ObjectivesThe aim of this study was to explore demographical characteristics and caregiver burden through the Zarit Scale.MethodsWe conducted a cross sectional study in a meeting where caregivers in a rheumatoid arthritis specialized setting. We collected sociodemographic information, and applied the Zarit caregiver burden interview (ZBI) adapted to Spanish. The ZBI includes 22 questions which has 5 responses from 0 (never) to 4 (nearly always), where scores lower than 47 indicated little to no burden, 47 to 55 low burden and >55 intense burden. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates.ResultsWe applied a survey to 132 caregivers. Mean age was 52 years SD 19 and 72% were women, 78% of them were taking care of a patient with rheumatoid arthritis, 12% osteoarthrosis 2% lupus, 2% osteoporosis the remaining 6% were caregivers of patients with ankylosing spondylitis, fibromyalgia, Sjogren syndrome. Regarding the time as caregiver 48% of them had been carrying the task for less than a year, 16% between two and three years, 18% for more than three years, and 13% for more than four years 5% of them were temporarily caregivers. In our study 85% of caregivers were a family member while15% was a nurse or a non-related person. Zarit mean score was 38.2913, additionally 35% had a score higher than 41 points. See table 1.Abstract AB1395HPR Table 1 Zarit scale classificationVariablen%Zarit Score0-21 (little or no burden)96.3422 - 40 mild to moderate burden8257.7541 - 60 moderate to severe burden4330.2861-88 severe burden85.63ConclusionIn our study 93% of our patients reported to have moderate to severe burden; thus, it is important to develop strategies and explore the factors related to burden in caregivers in patient with rheumatoid arthritis.Disclosure of Interests:Diana Buitrago-Garcia: None declared, Laura Villarreal: None declared, Michael Cabrera: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Fernando Rodriguez: None declared
BackgroundThe rheumatoid arthritis (RA), as known, causes inability in various performance areas mostly in the musculoskeletal, but few is known about psychological, sleep and sexual problems.ObjectivesThe aim of this study is to describe the socio-demographic profile of patients with RA in specialized RA clinic in Colombia, where we identified disorders in areas besides the physical or musculoskletal, like psychological, sexual and sleep.MethodsA descriptive study was performed in a specialized clinic dedicated to care patients with RA. 1298 RA patients were included in the study, which were seen by the area of psychology; information was collected through semi-structured interviews and non-probability sampling, also using classificatory criteria of pathologies described in CIE 10 diagnostic manual, applying descriptive epidemiology for continuous variables, measure of central tendency and dispersion for qualitative and categorical variables through percentages and averages.ResultsTotal sample of patients was 1298, 1048 (80%) were women and 250 (19%) were men. Patients had a DAS28 2.6 in average ± 1.1; mean age was 55.1 ± 8.8 years; 58% of patients were medium socio-economical level and the 34% were low socio-economical level; 59% were married, 18% were divorced, 14% is single and 6% were widowed. Related with the occupation, 25% were retired because age and 10% had handicap retirement pay; 24% were dedicated to housekeeping and 35% were working. Related to education 6% were illiterate, 44% had elementary school, 33% high school, 8% had a technical degree and only 7% had college level. According to CIE-10 739 patients (57%) had psychological disorders, 279 patients (21%) had sexual and 373 (28%) had sleep disorders.ConclusionsAccording to these findings there is a high prevalence of patients with low-medium socio-economical levels in RA which shows a possible correlation of a socio-demographic unfavorable situation with presence of disease. Also there are high rates of psychological, sexual and sleep comorbidities, which implies that measures must be implemented in order to improve these areas of performance in patients with RA.Disclosure of InterestNone declared
BackgroundAccording to the Beryl Institute's, patient experience (PX) is “the sum of all interactions, shaped by an organization's culture, that influence patient perceptions, across the continuum of care”; nowadays patient satisfaction is considered as one of the quality for performance in health systems (1). In order to provide a multidisciplinary quality care to patients with RA in centers of excellence (CoEs) under the coordination of a rheumatologist, provide comprehensive management of patients with this pathology, ensuring approachability to medical appointments and treatment, in order to get better clinical outcomes and improve patient safety and satisfaction of the health services provided.ObjectivesTo measure levels of satisfaction of RA patients treated at a specialized center and to evaluate patient service.MethodsIn a RA specialized center during a 24 month period we performed a satisfaction survey in order to evaluate the health services provided. We evaluated the timing on attention, appointment assignment, information provided, the treatment received by the healthcare team, facilities among others. Patients evaluated the services provided in a scale from 1 to 4, were 1 was very bad, 2 regular, 3 good and 4 excellent. Descriptive epidemiology was performed for each variable presented.ResultsWe collected 1125 surveys during 2015 and 2016, 45% considered to have a timely care, the mean of waiting time for an appointment was 9 min ± 8; regarding the appointment assignment 96% of the patients evaluated it as good or excellent (mean 3.5±0.7), 80% considered that the information provided was clear and useful, 90% reported to receive a kind and friendly treatment and to considered the facilities as good or excellent. When we evaluated the satisfaction regarding the health care team 50% of patients evaluated the rheumatologist, nurse, nutritionist, physical therapist, psychologist and physiatrist as good and 40% as excellent.ConclusionsAlthough we found that our patients are highly satisfied, there is a large opportunity to improve our services. Also, this evidence can support further research projects in order to increase the patient's satisfaction.References Th VP. Creating the ideal patient experience. Journal of medicine and life. 2016;9(4):380–385. Disclosure of InterestNone declared
BackgroundIn the last years it has seen a marked improvement in the treatment of rheumatoid arthritis (RA) by using conventional DMARDs and more recently with the introduction of biologics; biological therapy is useful to prevent clinical and radiological progression in patients with RA but is associated with high costs and has impacted budget in Colombian health system.ObjectivesThe purpose of this study was to assess drug usage of conventional treatment and biologic agents in terms of reduction of the Disease Activity Score 28 (DAS28) and comparative medication expenses associated in patients with moderate-severe RA during a 24 month period.MethodsWe conducted a real-world, retrospective, cross-sectional study, based on information from a specialized in RA center in Colombia where there is a model with therapeutic goals like T2T and a multidisciplinary approach. Subjects with moderate-severe disease activity received conventional treatment or biologic therapy, and were followed-up and treated according to DAS28; therapy had to be adjusted with DAS28 >3.2 unless the patient's conditions did not allow it. Descriptive epidemiology was done and the overall drug costs were assessed and compared between the two types of therapies.Results526 patients using conventional treatment were included, mean age 63.5 ± 11.8, 424 (80%) female and 102 (20%) male. These patients had a DAS28 on average 4.5 ± 1 at beginning and after 24 months 410 patients (78%) got remission/low disease activity status with a mean DAS28 2.57 ± 1. On the other hand, 303 patients using biologics were included, mean age 58.5 ± 9.4, 251 (82%) female and 52 (18%) male; after 24 months of observation 154 patients (50%) obtained remission/low disease activity status with a mean DAS28 of 2.6 ± 1. Cost of conventional DMARD treatment for RA in Colombia was about 850 US dollars/patient/year because mostly of patients have more than one DMARD; use of biologics cost $7,725 US dollars/year/patient, ranging between the cheapest biological and the most expensive ($4,878 and $12,774 US dollars/year respectively); that means conventional treatment is nine times cheaper in comparison with costs of biological therapy and possibly more effective.ConclusionsThis study showed that it is possible to decrease disease activity and obtain a significant cost-reduction in treatment of RA by using conventional DMARDs in a model with therapeutic goals like T2T and optimizing a multidisciplinary approach; the use of biologic therapies in the treatment of RA continues being evaluated but is associated with high costs; we show real-world data on drug utilization in patients with moderate-severe RA in a low income developing country. These observations could be used by decision makers in order to consider health decisions; nonetheless, further research based on cost-effectiveness analysis and cost-comparison is needed to verify these results.Disclosure of InterestNone declared
Objectives: Biological therapy is a tool to prevent clinical and radiological progression in patients with rheumatoid arthritis (RA). The purpose of this study was to assess the usage of biologic agents in terms of reduction of the Disease Activity Score 28 (DAS28) and medication expenses associated in patients with moderate-severe RA during a 24 month period. MethOds: We conducted a realworld, retrospective, cross-sectional study, based on information from a specialized in RA center in Colombia. Subjects with moderate-severe disease activity received biologic therapy, and were followed-up and treated according to DAS28; therapy had to be adjusted with DAS28 > 3.2 unless the patient's conditions did not allow it. Descriptive epidemiology was done and the overall drug costs were assessed. Results: 303 patients were included, mean age 58.5 ± 9.4, 251 (82%) female and 52 (18%) male. After 24 months of observation 154 patients (50%) obtained remission/low disease activity status with a mean DAS28 of 2.6 ± 1; 16% of patients received Infliximab,
BackgroundRheumatoid arthritis (RA) is a common systemic autoimmune disease characterised chronic joint inflammation. Patients with RA are also reported to have higher prevalence of comorbidities such as cardiovascular disease, osteoporotic among others.1 These comorbidities can be associated with higher mortality, poor life quality, and the increasing of costs for the health system.ObjectivesTo describe the prevalence of comorbidities and characteristics of a Colombian population that assist to a RA specialised centre.MethodsWe performed a descriptive analysis; our main goal was to provide real-life data regarding characteristics of patients with RA. We collected sociodemographic information, DAS28, and prevalence of comorbidities regarding hypertension, cerebrovascular disease, diabetes mellitus, osteoporosis, renal chronic disease, or Sjogren’s syndrome. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We estimated the prevalence of comorbidities and evaluate independent associations calculating prevalence ratios.Results6376 patients were included in the analysis; mean age was 59 years±12, 81% were woman and 19% were men. Mean DAS28 was 2.8±1.07. From all patients the prevalence of comorbidities was 42% hypertension, cerebrovascular disease, diabetes mellitus, osteoporosis, renal chronic disease, or Sjogren’s syndrome. Most of these patients 60% reported to have hypertension with any of the others comorbidities mentioned above, or osteoporosis with other comorbidities 46%. Regarding pharmacological therapy a higher proportion of patients received conventional DMARDs 90% see table 1. The prevalence of comorbidities was associated with sex and disease activity but did not have any association with pharmacological therapy see table 2.Abstract SAT0744HPR – Table 1Characteristics of patients with RA and comorbiditiesCHARACTERISTICS n (%)WITHOUT COMORBIDITYWITH ANY COMORBIDITIES SEXn%n% FEMALE286545%228936%MALE79512%4277%DAS 28REMISION197531%149924%LOW DISEASE ACTIVITY5819%5549%MODERATE DISEASE ACTIVITY92915%5659%SEVERE DISEASE ACTIVITY1753%982%MEDICATIONSConventional DMARDS235237%307248%Biological DMARDS3596%5809%Abstract SAT0744HPR – Table 2Assoc of comorbidities, sex, and disease activity.VariablePR*IC 95%P VALUE Sex7.216.58–7.890.000DAS281.181.10–1.270.000Therapy0.910.86–0.960.000PR: prevalence ratioConclusionsAs other studies conducted in Asian or Australian populations high blood pressure is the most common disease among patients with RA followed by osteoporosis(.1 Sex is associated with higher comorbidities. According to these results it is important to consider the patient’s context, medical conditions, and the number of comorbidities in order to understand the complexity of the management of patient with RA.Reference Jin S, Li M, Fang Y, Li Q, Liu J, Duan X, et al. Chinese Registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis. Arthritis research...
BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease of unknown etiology, it is a long term condition that causes pain, disability and affects the quality of life (1). In another countries has been demonstrated how patient education can empower the individual giving as a result a better decision making between the practitioner and patient in order to obtain better health care outcomes compared to patients that are not involved in educational activities (1).ObjectivesThe objective of this work is to show how through a progressive program of patient education we reach the concept of the “expert patient” and the “patients' university”.MethodsWe performed a systematic review of the literature in global and regional databases (Pubmed, Medline, Scopus, Lilacs), in order to search for information on this research question-hypothesis. Subsequently and under a Delphi-modified methodology and consensus of experts lay the conceptual bases on this particular subject – patient's education in rheumatic disease. As a result of the above was defined a proposal for the constitution and development of the program of patient's education in a RA specialized center under the concept of the “expert patient” (EP) and the “patients' university”(PU).ResultsFrom conceptual point of view specific themes regarding patient's education were developed by a coordinator who, after a review of the literature, presented a specific proposal on the particular topic that was discussed with the panel members and then voted on and finally implemented within the EP y PU concepts. In a specialized RA center in Bogotá Colombia during 2016 we started a patient and caregiver oriented program to support the clinical treatment in patients with RA. The structure of the program was an educational-recreational strategy where we integrated health education (disease activity, pharmacovigilance, psychology and nutrition) and recreational activities such as crafts, yoga, aerobics and dance lessons with a periodicity of two times per week. We called the program “Gest-Art”. As a result of this pilot program we obtained a positive impact and perception among patients and care takers; we had the participation of 600 people during the whole year. The next phase is to develop a step-by-step program to initially train and then specialize patient focus groups (expert patient); and later develop a model of continuous improvement (updating) that we will call the university of patients.ConclusionsFrom this experience we can conclude that the implementation of this educational program opened the opportunity to empower and motivate our patients and caregivers to be actively participative with the disease management and health care, also the program has been a space for the patients to share their experiences and to propose new strategies to improve the program.References Prothero L, Georgopoulou S, de Souza S. Patient involvement in the development of a handbook for moderate rheumatoid arthritis. 2016. Disclosure of InterestNone declared
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