Introduction. The aim of the research was the study of the adherence to treatment in patients

BackgroundOsteoarthritis (OA), as a common joint's disease, is associated with high healthcare resource utilization. It is important to determine the economic burden of the disease and the possible predictors which may increase the cost of the disease.ObjectivesTo estimate the total annual costs and their predictors in patients with knee osteoarthritis in our country.MethodsA cross-sectional study was performed from January 2012 to January 2013. There were included consecutive patients that fulfilled the ACR classification criteria for knee OA (1991). We collected data on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. The direct medical costs comprised: medication, hospitalization, medical visits and investigations; the direct non-healthcare costs included informal care and patient out-of-pocket payments. Human capital approach was used to estimate indirect costs. Mean annual per patient total costs were calculated from a patient's perspective. The intangibles costs were assessed by Willingness to Pay method. The cost's predictors were determined by multiple regression analyses using direct, indirect and total costs as outcome variables. This study was conducted according to the principles of the Declaration of Helsinki (1996) and good clinical practice.ResultsThere were 256 patients integrated in the study including 196 females and 60 males, mean age 62.4±9.5 (range 37 to 85) years. The disease duration was 8.1±6.7 (range 1-51) years. The average total cost, accounted $685, including: the direct costs - $485 (71.04%) per person per year and indirect costs - $190 (29%), respectively. The mean intangible cost was $1200, with a large range ($83 -$8400).Female gender, educational level and higher annual incomes caused an increase of direct costs (p<0.001). The indirect costs were higher in patients with radiographic severe disease (p<0.05), poor joint functionality (p<0.01) and the presence of co-morbidities (p<0.01). The intangibles costs were influenced by the pain level (p<0.05).ConclusionsThe knee osteoarthritis has a considerable economic burden on patient and health-care system. The maintenance of joint mobility and the control of disease progression may reduce the costs of knee osteoarthritis.Disclosure of InterestNone declared

This case report describes an unusual form of gout, called miliarial gout, in association with carpal tunnel syndrome in a 54-year-old woman. Miliarial gout was first described in 2007 and is a very rare presentation of chronic tophaceous gout. The latter condition can cause carpal tunnel syndrome, but this association has not previously been described in association with miliarial gout. In addition, the authors discuss the use of the parsimony principle in internal medicine whereby a single cause is first sought for different symptoms presenting at the same time.

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Background:Knee osteoarthritis (OA) is an increasingly common and disabling problem in worldwide. Exercises are considered the cornerstone of non-surgical management of knee OA and is recommended in all current clinical guidelines. The diversity of exercise programs determines the need to compare their efficiency, in order to recommend the best option for the patient.Objectives:The aim of the present study was to compare the effect on knee functionality of conventional exercises program and combinate with manual therapy in patients with knee osteoarthritis.Methods:164 patients that fulfilled the ACR classification criteria for knee osteoarthritis (127 females and 37 males) ranging in age from 42 to 84 years (mean 62,2 SD 8,76), participated in a 10 days two-arm randomized trial. One group (Gr.1) received an exercises program, the other group additionally manual therapy methods (Gr.2). Pain and function were measured with a Visual Analogue Scale (VAS, mm) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) with 5 domains (Pain, Symptoms, Activity in Daily Living (ADL), Sport and recreation (Sport/rec.) and Quality of life (QoL)).Results:In the Gr.1 were 82 patients mean age 61,8±9,2 years and in Gr.2 – 82 patients 62,7±8,3 years (p>0.05). The initial level of pain (63,4±14,2 vs 60,2±18,8mm) and knee functionality according to KOOS (Tab1.) were similar in both groups, p>0.05. After 10 days rehabilitation program, VAS in Gr.1 was 39,6±14,8 mm, in Gr.2- 28,5±11,6 mm, (p<0.01). The KOOS results at the end of the rehabilitation program were with improvement, statistically significative in the Gr.2 (p<0,05).Table 1.The KOOS results at baseline and after 10 days of rehabilitation program.KOOS scales(M±SD), %Group 1Group 2BaselineAfter 10 daysBaselineAfter 10 daysPain55,5 ±13,863,4±13,653,0±22,364,3±19,1Symptoms59,0±18,765,6±18,156,6±19,069,0±15,9ADL46,3±15,554,5±16,043,0±19,955,1±18,2Sport/rec15,6±17,323,1±19,616,0±24,330,5±23,6QoL29,3±22,236,5± 22,934,8±23,950,6±18,9Conclusion:The reduction of pain and recovery of function were found in both groups, with better results in patients who received manual therapy and exercises program. This study supports the routine manual therapy in rehabilitation program in patients with knee osteoarthritis.Disclosure of Interests:None declared.

Syndrome métabolique chez l'enfantIntroduction. L'augmentation alarmante du syndrome métabolique (SM) chez les enfants dans le monde entier a fait de la prévention et du traitement précoce de l'obésité un objectif médical important. L'objectif de l'étude a été d'evaluer le rôle des marqueurs pro-inflammatoires (IL-6, TNF , hs-PCR) et adipokines (leptine, adiponectine) dans le développement du syndrome métabolique chez les enfants et impacts du traitement par inhibiteurs gastro-intestinaux de la lipase sur le degré d'obésité et les valeurs de la pression artérielle. Matériel et méthodes. L'étude a inclus 24 enfants atteints du syndrome métabolique. Les niveaux sériques de lépine, adiponectine, TNF- et hs-CRP ont été mésurés chez les enfants atteints du SM par rapport à un groupe témoin de 50 enfants d'âge similaire, normotendus et de poids normal. On a également examiné l'impact du traitement par des inhibiteurs de la lipase gastro-intestinale sur l'obésité et sur les valeurs de la pression artérielle. Résultats. Le taux sérique de leptine, de hs-CRP, de TNF- s'est avéré plus élevé, et celui de l'adiponectine plus faible chez les enfants atteints de SEP, par rapport au groupe témoin. Après huit semaines de traitement

Background Osteoarthritis (OA) is associated with healthcare resource utilization and loss or worker productivity. The total direct and indirect costs of OA can differ substantially across systems. No data as yet are available on economic impact of OA in Republic of Moldova. Objectives To estimate the direct and indirect costs of knee osteoarthritis in Republic of Moldova. Methods A cross-sectional study was performed from January 2012 to January 2013. There were included 256 patients that fulfilled the ACR classification criteria for knee OA (1991). The direct medical costs comprised: medication, hospitalization, medical visits and investigations; the direct non-healthcare costs included informal care and patient out-of-pocket payments. Human capital approach was used to estimate indirect costs by multiplying: 1) days of absence from work because of OA, with average earnings per capita per day for working patients; or 2) productivity loss with the market price of housekeeping for retirees/homemakers. Mean annual per patient costs were calculated from an employer's perspective. Correlations were also calculated between the costs and quality of life (QoL) that was assessed by KOOS- Knee injury and Osteoarthritis Outcome Score (100% high QoL). Results There were 256 patients integrated in the study including 196 females and 60 males, mean age (SD) 62.4 (9.5) years (range 37 to 85 years). The disease duration (SD) was 8.1 (6.7) years (range 1-51).The KOOS results showed that the QoL constituted 35.7%, qualified as low. The average total cost excluding joint replacement, accounted $685, and the direct costs represented 71.04% (mean $485) per person per year and indirect costs - 29% ($190), respectively. The direct costs represented 18.4% of annual incomes, the insurance cover just 50.7% from direct costs. The three major components of direct costs were hospitalization (48.3%), drug cost (26.4%) and informal care (13%). We established moderate correlation between direct costs and QoL (r=0.4, p<0.05), therefore the indirect costs were strongly correlated with quality of life level (r=0.7, p<0.05). Conclusions The direct costs of osteoarthritis in the Republic of Moldova population are high being comparable to those reported in European countries and the economic burden is important by relatively high out-of-pocket expenditures. The indirect costs are not a major component of the cost of illness; this is mainly due to the low monetary value of paid work. Both types of costs correlated with the quality of life. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2527

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