The aim of this study was to evaluate the effect of treatment with methotrexate (MTX), by itself or combined with other non-biological disease-modifying antirheumatic drugs (DMARDs) (methotrexate, MTX with prednisolone, MTX with leflunomide, MTX with chloroquine, and MTX with sulfasalazine) on clinimetric outcomes in a retrospective cohort with a 6-month follow-up and under a Treat to Target (T2T) approach. Patients in treatment with conventional DMARDs and classified as moderate disease activity (MDA) and high disease activity (HDA) were included. Changes in disease activity score (DAS28), health assessment questionnaire (HAQ), tender joint count (TJC), and swollen joint count (SJC) are compared using the Wilcoxon nonparametric test for paired data. Hypothesis contrasts were raised in order to look for differences between the different exposure groups and the outcomes defined by means of the Kruskal-Wallis (KW) nonparametric test. Follow-up was documented in 307 patients, including 250 (81.4%) women. At the onset, 243 subjects (79.2%) were classified as MDA and 64 (20.9%) in HDA. A total of 247 subjects (80.4%) presented some degree of improvement, with 156 subjects (51%) entering remission, which is a significant number (p value = 0.047). There were no differences in the level of severity between the treatment groups (p = 0.98). This study, developed in a cohort of patients with RA with moderate or severe disease activity who were treated with MTX by itself or combined with other non-biological DMARDs under T2T strategy, showed a decrease in the severity of disease activity in 80% of patients. The difference between monotherapy (MTX) and the combinations with other non-biological DMARDs could not be established.

BackgroundClinical response in patients with rheumatoid arthritis (RA) using biologics is well-known. However, there is no direct comparison between biologics in cohorts of patients with RA in real-life settings, which could have implications in treatment decisions and health economics.ObjectivesThe aim of this study was to describe a direct comparison in effectiveness between two classical antiTNF biologics (Adalimumab, Infliximab) and one Etanercept biosimilar in patients with long-standing RA in a cohort of real-life.MethodsA descriptive cross-sectional study was performed. Were included 158 patients with at least 6 visits to rheumatologist in last 24 months in a specialized in RA center. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11-13 weeks (DAS28 <3.1). Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients and the aim of the study was to look at what percentage of patients who were MDA/SDA disease activity reached a low disease activity or remission. 158 patients with RA and using Adalimumab, Infliximab and Etanercept biosimilar (Etanar® CP Guojian Pharmaceutical Co Ltd, China) were involved. The Etanercept biosimilar was approved for using in Colombia since 2007. Descriptive epidemiology was done, the medians were analyzed using t-Student assuming normality for DAS28 distribution and disease activity was analyzed using Pearson's statistics.Results158 patients were included in this study, 125 (79.1%) women and 33 (20.9%) men. Average age was 59±10 y/o with disease duration of 11 years (0.5-47). 158 patients with diagnosis of RA using Adalimumab, Etanercept and Infliximab were involved: Adalimumab 61 (38.6%), Etanercept 25 mg 62 (39.2%), and Infliximab 35 (22.2%). At 24 months was observed an increase in percentage of patients in remission and a decrease in percentage of patients in MDA/SDA disease activity statistically significant. for Adalimumab at beginning DAS28-3.6 and 24 months later 2.6; for Etanercept biosimilar at beginning DAS28-3.6 and 24 months later 2.6 and for Infliximab at beginnng DAS28-3.6 and 24 months later 2.6. There were not statistically significant differences between analyzed biologics. On the other hand, there were fewer adverse events with Etanercept-biosimilar than Adalimumab and Infliximab; it was statistically significant.ConclusionsThis study shows that the Etanercept biosimilar is as effective as 2 other traditional anti-TNF biological for disease activity control in patients with rheumatoid arthritis in a real-life setting with fewer adverse events, which could have implications in treatment decisions and health economics. On the other hand the study proves effectiveness of implementation of a T2T strategy in patients with ...

Introduction Rheumatoid arthritis (RA) is a chronic and progressive pathology, present in between 0.5% and 1% of adults. Sexual disorders (SDs) occur in between 31% and 70% of all patients with RA. Aim To establish the associated risk factors and the prevalence of SDs in a group of patients with RA. Methods An analytical cross-sectional study was performed, evaluated with the Diagnostic and Statistical Manual of Mental Disorders-V tool. The related factors and the activity of the disease were explored. A multivariate logistic regression analysis was conducted. Main Outcome Measure The prevalence of SDs was 29.6%. There was an association between the presence of SDs and gender (women; odds ratio [OR]: 0.6, 95% CI: 0.4–0.8), age (OR: 1.4, 95% CI: 1.1–1.8), psychological alterations (OR: 12.1, 95% CI: 5.9–27.2), and Disease Activity Score 28 (OR: 1.6, 95% CI: 1.2–2). Results A total of 1,436 patients, with a median age of 56 years, were analyzed. Conclusion SDs are present in a third of patients with RA. Among the factors associated with SDs were the activity of the disease, presence of mood disorders, psychiatric disorders, alcoholism, and concomitant autoimmune pathologies. These findings suggest the necessity of a multidisciplinary approach to properly manage RA, as well as an enhancement in communication channels between the health professional team and the patient. Santos-Moreno P, Castro CA, Villarreal L, et al. Prevalence of Sexual Disorders in Patients With Rheumatoid Arthritis and Associated Factors. Sex Med 2020;8:510–516.

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. [2][3][4][5][6] 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...

This is the second REAL-PANLAR consensus paper with the purpose to define the parameters for the accreditation process for future CoE in RA in LATAM.

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

BackgroundThere is a lack of expertise in rheumatoid arthritis (RA) diagnosis in primary level of Colombian medical centers, leading to misdiagnosis; many times osteoarthritis (OA) and another rheumatic diseases are misdiagnosed as RA which derives in wrong treatment for patients with clinical and health economics implications.ObjectivesThe objective of this study was to describe demographic and clinical characteristics of a cohort of patients derived to a specialized RA center with presumptive RA diagnosis and finally diagnosed as osteoarthritis.MethodsA descriptive, cross sectional study. Were included patients who were referred from primary care centers to a RA specialized center in a 36 month period with presumptive diagnosis of this disease. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Frequencies and percentages were calculated for the demographic and clinical characteristics of the cohort of patients in which the diagnosis of RA was ruled-out.ResultsOf the 4780 patients evaluated, in 2905 patients (60.7%) diagnosis of RA was confirmed, the remaining 1875 patients (39.3%) had a wrong diagnosis of RA. Of these misdiagnosed patients, 1377 (73.5%) were women, and 498 (26.5%) men, with an average age of 57.6 (±12 years). Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 1108 patients (50.1%), systemic lupus erythematosus (SLE) in 84 patients (4.5%), Sjögren syndrome in 62 patients (3.3%), spondyloarthropathies in 21 patients (1.1%), gout in 31 patients (1.7%), and (39,3%) other diagnoses in of the remaining population.ConclusionsAlmost half patients with presumptive RA diagnosis in primary care centers in Colombia are misdiagnosed as shown in this large cohort. The most important cofounding diagnosis was osteoarthritis and many patients were receiving DMARDs for treatment. For this reason there is an urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA, in order to conduct a proper diagnose and avoid clinical and health economics consequences of misdiagnosis.Disclosure of InterestNone declared