This study evaluated a non-face-to-face-multidisciplinary consultation model in a population with rheumatoid arthritis (RA) during the COVID-19 pandemic. This is an analytical observational study of a prospective cohort with simple random sampling. RA patients were followed for 12 weeks (Jul–Oct 2020). Two groups were included: patients in telemedicine care (TM), and patients in the usual face-to-face care (UC). Patients could voluntarily change the care model (transition model (TR)). Activity of disease, quality of life, disability, therapeutic adherence, and self-care ability were analyzed. Bivariate analysis was performed. A qualitative descriptive exploratory study was conducted. At the beginning, 218 adults were included: (109/TM-109/UC). The groups didn’t differ in general characteristics. At the end of the study, there were no differences in TM: (n = 71). A significant (p < 0.05) decrease in adherence, and increase in self-care ability were found in UC (n = 18) and TR (n = 129). Seven patients developed COVID-19. Four categories emerged from the experience of the subjects in the qualitative assessment (factors present in communication, information and communication technologies management, family support and interaction, and adherence to treatment). The telemedicine model keeps RA patients stable without major differences compared to the usual care or mixed model.

Rheumatoid arthritis is a prevalent worldwide disease, associated with an increased risk of multiple metabolic abnormalities that generate a higher disease burden. Objective: To gather the available evidence on the epidemiology, pathophysiology, current perspectives, clinical implications and prognosis of metabolic abnormalities in patients with rheumatoid arthritis. Methods: This is a narrative literature review. Search was conducted in PubMed, OVID, and Taylor & Francis databases, using the following MeSH terms: "Arthritis Rheumatoid", "Metabolic Diseases", and "Metabolic Syndrome". Results: This study describes the main metabolic manifestations of rheumatoid arthritis. Research has recognized that rheumatoid arthritis and metabolic abnormalities share pathophysiological mechanisms with an additive effect that increases cardiovascular risk. In that context, appropriate antirheumatic treatment can also impact on cardiovascular risk. Conclusion: There are metabolic abnormalities in rheumatoid arthritis patients that increase cardiovascular risk. Therefore, it is crucial to evaluate cardiovascular risk to provide appropriate comprehensive management to reduce morbidity and mortality in patients with this disease.

IntroductionThe risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level. The aim of the study was to compare vascular age (VA) in RA patients under a strict treat-to-target (T2T) strategy with Osteoarthritis (OA) patients without strict follow up and to assess the influence of inflammaging (chronic, sterile, low-grade inflammation related to aging) and metabolic markers on VA.Materials and MethodsThis was an analytical cross-sectional study. Patients with RA (under a strict a T2T strategy) and OA patients without strict clinical follow-up were included. Patients with a history of uncontrolled hypertension, CVD, and/or current smoking were excluded. Sociodemographic, physical activity, and toxic exposure data were obtained. Waist-hip ratio and body mass index (BMI) were measured. DAS-28 (RA) and inflammatory markers, lipid profile, and glycaemia were analyzed. Pulse wave velocity (PWV) was measured (oscillometric method, Arteriograph-TensioMed®). VA was calculated based on PWV. Eleven components of inflammaging [six interleukins, three metalloproteinases (MMP), and two tissue inhibitors of metalloproteinases (TIMP)] were evaluated (Luminex® system). Univariate and bivariate analyzes (Mann Whitney U and chi-square) and correlations (Spearmans Rho) were done to compare the two groups.ResultsA total of 106 patients (74% women) were included, 52/RA and 54/OA. The mean age was 57 (Interquartile range - IQR 9 years). The BMI, waist circumference, and weight were higher in patients with OA (p &lt; 0.001). RA patients had low disease activity (DAS-28-CRP). There were no differences in VA, inflammaging nor in PWV between the two groups. VA had a positive, but weak correlation, with age and LDL. In group of RA, VA was higher in those who did not receive methotrexate (p = 0.013). LDL levels correlated with MMP1, TIMP1, and TIMP2.ConclusionsWhen comparing RA patients with low levels of disease activity with OA patients with poor metabolic control, there are no differences in VA. Furthermore, methotrexate also influences VA in RA patients. This shows that implemented therapies may have an impact on not only the inflammatory state of the joint but also CVD risk.

Purpose To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the “Treat-to-Target” strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4–6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.

BackgroundIn 2018, thanks to the support of a government entity, the UniversitAR multi-component educational program was launched; which trained more than 300 patients and certified 50 expert patients in Rheumatoid Arthritis in 2021. In this educational process, patients received training in various knowledge topics for disease care: definitions, signs and symptoms, treatment, medical team, therapeutic adherence, quality of life and transformation of personal behavior to manage relationships and situations. As a result, the educational program proposed the design of educational material that would be useful for the patient population.ObjectivesThe objective of this project was to design a primer for patients with rheumatoid arthritis, which helps them understand the disease and the importance of long-term treatment, understand and apply therapeutic adherence, and change the way in which patients assume their role in treatment.MethodsAn editorial committee was created to write the primer. This committee was made up of 8 patient experts in rheumatoid arthritis, 1 rheumatologist, a coordinator of education programs for chronic patients, and a team of content reviewers. The writing of the primer began with a selection of the thematic contents with the greatest impact in their educational process and the writing of the initial manuscript began (by patients for patients). Afterwards, a first revision of the manuscript was made and some contents were adjusted according to the clinimetric standards for international rheumatology. Finally, the manuscript was submitted for review by the team of rheumatologists and the interdisciplinary team, thus creating the final version of the primer.ResultsIn December 2022, an event for patients with Rheumatoid Arthritis was held. In this event the primer was presented and its purposes were explained. The primer gathers topics such as: disease definitions, signs and symptoms, diagnosis and treatment, disease impact, therapeutic adherence, myths and beliefs, the medical team, health literacy, and expert patients (See figure 1). In 2023, this primer will be delivered to all patients so that they can have a source of consultation and information.Figure 1.ConclusionIt is important to support the dissemination of educational content so that patients have reliable, accurate and oriented information to improve their participation with medical teams in shared decision-making to achieve therapeutic objectives together.AcknowledgementsWe thank the Ministry of Science, Technology and Innovation MINCIENCIAS for allowing us to design this primer and for being able to train our patients. Also, we thank the patients who are part of the editorial committee that designed this primer.Disclosure of InterestsFernando Rodriguez: None declared, Liliana Realpe: None declared, Zohelia Castaño: None declared, Gabriel-Santiago Rodríguez-Vargas: None declared, Adriana Rojas-Villarraga: None declared, Pedro Santos-Moreno Speakers bureau: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Grant/research support from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi.

BackgroundIn 2021, a group of rheumatoid arthritis (RA) patients were certified as an expert patients. These were trained for the care and management of their disease. During their training, they answered the Patient Activation Measure PAM-13 questionnaire, which measures people’s knowledge, skills and confidence in self-managing their health and medical care.ObjectivesThe aim of this study is to know the activation and empowerment levels of the patients in their daily life and in their exercise as expert patients in RA, determining the self-management they have of their disease and the perspective they have developed towards their health and towards their health care team.MethodsA group of expert patients with a diagnosis of RA were included. A sociodemographic characterization was carried out and variables such as age in years, marital status, educational level and support networks, among others, were measured. Patients filled out the PAM-13 questionnaire. This tool contains some phrases that people use to talk about their health. Each sentence contains response options that include: “strongly agree”, “agree”, “disagree” and “strongly disagree”. This exercise seeks to find out what patients think about aspects related to the care of their health condition and medical care. Descriptive statistics were done and the responses of the first two options were totalized (“strongly agree” and “agree”).ResultsA total of 91 patients were evaluated with the PAM-13 tool. General sociodemographic and clinical characteristics are shown in table 1. With respect to the responses of the 13 variables of the PAM-13 questionnaire, the patients state [n(%)] that they have developed a high level of awareness in the care management of their disease [83 (91)], they have developed a high therapeutic adherence [83 (91)], understand that lifestyles are essential to avoid complications [83 (91)], adopted an effective and clear communication language with their medical team [82 (90)], developed self-care lifestyles [80 (88)], understand the importance of using prescribed medications [80 (88)], developed habits oriented towards a healthy and active life [78 (85)], understand the nature and symptoms of their disease [78 (85)], are aware that they are the main co-managers of their condition [78 (85)], frequently assist their medical team and use emergency services [79 (87)], act in crisis situations [80 (88)), follow instructions of their medical team [73 (80)] and make shared decisions as [65 (71)] (see Figure 1).Table 1.Demographic characterization of the participating patients.Participant´s characteristicsn= 91Gender (n %)Male6 (7)Female85 (93)Age in years, mean61Age in years, group (n %)<6562 (68)≥6529 (32)Marital status (n %)Married46 (51)Divorced11 (12)Single29 (32)Widowed5 (5)Education (n %)Primary School8 (9)High School34 (37)Vocational training26 (29)University or more22 (24)None1 (1)Duration of disease in years (n %)≤2052 (57)>2039 (43)Support and family (n %)Direct support81 (89)No support10 (11)ConclusionIn general, expert RA patients are proactive with their health and have developed strong self-management skills evaluated through PAM-13. The use of these tools is important to assess the role of the patient in their treatment. This allows generating strategies that increase the commitment of patients during their therapy.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsFernando Rodriguez: None declared, Gabriel-Santiago Rodríguez-Vargas: None declared, Adriana Rojas-Villarraga: None declared, Pedro Santos-Moreno Speakers bureau: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Grant/research support from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi.

BackgroundCOVID-19, rheumatoid arthritis (RA) and osteoarthrosis (OA) are diseases characterized by the secretion of cytokines related to the stimulation of the inflammatory response.ObjectivesTo identify the differences in the cytokine and matrix metalloproteinases (MMP) profile within one acute infectious disease and two chronic inflammatory rheumatic diseases.MethodsAnalytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months), OA patients without strict clinical follow-up, evaluated once or twice a year, and Severe (mortality) COVID-19 patients were included. Eleven proteins (cytokines, MMPs and its tissue inhibitors) were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes were performed. Approval of Ethics Committee and informed consent were obtained.ResultsA total of 108 patients with RA and OA were compared with 20 severe COVID-19 patients. There were no significant differences through the method of Kruskall–Wallis, between RA and OA patients. IL1-B and MMP-2 were significantly lower in COVID-19 patients. Levels of IL-10, IL-1RA, IL-6, MMP-1, MMP-9, and TIMP-1 were significantly higher in COVID-19 patients. There were no differences in TNF-A, TIMP-2 and INF-G. (Table 1)Table 1.Significant correlations between cytokines related to Covid-19, RA and OR.Cytokine (pg/ml) Median valuesRA (%)OACOVID-19P-valueIL-1054.9254.49116.38<0.0001aIl1-RA62.1951.82110.08<0.0001aIL1-B67.0955.3046.170.045IL-656.0951.3484.98<0.0001b 0.003cTNF-A17.514.616.3NSMMP-1d57.8454.8490.81<0.0001b 0.045cMMP-2 d70.3870.5948.560.040MMP-9 d66.2558.1686.40.007 bTIMP-1 d51.5960.99111.67<0.0001aTIMP-2 d45.247.749.6NSINF-G5.755.323.07NSa Between RA and Covid-19 and OA and Covid-19, without differences between RA and OA. b Between OA and Covid-19.C Between RA and Covid-19. d ng/ml.ConclusionCompared with RA and OA patients, severe COVID-19 patients have a great impact on the cytokines and MMPs addressed in this study, proving that COVID-19 patients suffer from a cytokine storm [1] when severely infected.References[1]R. Mulchandani, T. Lyngdoh, and A. K. Kakkar, “Deciphering the COVID-19 cytokine storm: Systematic review and meta-analysis,” Eur. J. Clin. Invest., vol. 51, no. 1, pp. 1–21, 2021, doi: 10.1111/eci.13429.Disclosure of InterestsNone declared

BackgroundThe risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than in individuals in the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level, called vascular aging reflected by arterial stiffness and endothelial dysfunctionObjectivesThe aim of the study was to compare vascular age and arterial stiffness (PWV-Pulse Wave Velocity) in two groups of patients with RA and with osteoarthritis (OA) and to assess the influence of inflammaging (persistent low-grade inflammation that develops with age) and metabolic markers in these outcomes.MethodsAnalytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months) and OA patients without strict clinical follow-up, evaluated once or twice a year, were included. Patients with history of uncontrolled hypertension, CVD and/or current smoking were excluded. Waist-hip ratio, body mass index (BMI), DAS28 (RA), C-Reactive protein (CRP), Erythrocyte sedimentation rate (ESR), glycemia and lipid profile were measured. PWV and vascular age (in years) were evaluated through oscillometric method, arteriograph-TensioMed. Eleven proteins components of the inflammaging (cytokines, Matrix metalloproteinases - MMPs and its tissue inhibitors), were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes (Chi-square and non-parametric correlations) were performed. Approval of Ethics Committee and informed consent were obtained.ResultsA total of 106 patients (74% women) were included (52/RA and 54/OA). Mean age was 57±5.6 years without differences between groups. There were significant differences in CRP and ESR (higher in RA) and in BMI, waist circumference and weight (higher in OA). RA patients had low disease activity level (DAS28: Median 2.6, IQR 1.3). There were no differences in PWV, vascular age or inflammaging (except for MMP-1, higher in RA), between the groups. PWV had a positive correlation with LDL (Rho Coef. 0.218 p=0.025). Patients who performed physical activity had a lower vascular age than those who did not [43 Interquartile range (IQR)23 vs 60 IQR 17, p=0.032). Vascular age was higher in RA patients who did not receive methotrexate 60 (IQR 19.3) compared with patients under methotrexate treatment 44.5 (IQR 23) (p = 0.017). Also, vascular age was lower in OA patients under prescribed physical activity (43 IQR 24.8 vs 56.5 IQR 20, p=0.03). MMP-9 in RA patients (Rho 0.283, p=0.042) and IL-10 in OA patients (Rho 0.290, p= 0.036) correlated with diastolic pressure. The components of inflammaging did not correlate with vascular age. The Framingham Risk Score was strongly associated with vascular age.Table 1.Significant correlations with vascular ageVariableSpearman’s Rhop-valueLDL levels0.2000.040Systolic blood pressure0.3000.002Mean arterial blood pressure0.2100.031Daily coffee cups intake-0.2120. 045Framingham Risk Score0.340<0.0001MDHAQ score in RA patients0.4170.002LDL: low density lipoprotein; MDHAQ: multidimensional health assessment questionnaire.ConclusionIn RA strictly controlled patients, there are no differences in endothelial dysfunction, vascular age or inflammaging, when comparing with uncontrolled overweight OA patients. Physical activity, LDL levels and coffee consumption corelate with vascular age in OA and RA patients. OA patients under physiatrists follow-up and RA patients under methotrexate treatment or with low MDHAQ levels have lower vascular age levels.References[1]Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis. Santos-Moreno P, Burgos-Angulo G, Martinez-Ceballos MA, et al Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis. RMD Open. 2021 Jan;7(1):e001470Disclosure of InterestsNone declared