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
on enrichment culture only n=3 or an alternative clinical diagnosis was clearly documented n=4. One case was incorrectly labeled as a joint aspirate. The remaining positive samples, 17 in 12 patients, came from prosthetic joint aspirates. Conclusion:In line with known literature, staph.aureus was the most common pathogen 1 , however there were a number of other bacteria identified which needs to be taken into account when formulating local antimicrobial guidelines. Current literature reports surgical treatment as not superior to medical 2 , yet 65% of cases here under went joint lavage in theatre. This information will be used to inform local clinical practice, and, guide recruitment targets for a large multi-centre study collecting data and samples from patients presenting with a hot swollen joint, with the aim of identifying a specific biomarker for SA.
Background:Several medicines are prescribed for chronic disease management of rheumatoid arthritis (RA) including biologics; however, adherence to long-term therapy remains poor because many causes; the latter results in worsening clinical results.Objectives:To analyze the relationship between adherence to treatment and the achievement of remission or low disease activity in patients with RA treated with three anti-TNF molecules of subcutaneous use.Methods:In patients treated with 3 subcutaneous anti-TNFs, with at least one year of follow-up previously, adherence was measured with Compliance Questionnaire for Rheumatology (CQR19) applied by psychologist; the CQR19 is a 19 item, self-administered questionnaire that was developed with the aim of correctly identify rheumatology patients that were classified as “low” adherers (taking <80% of their medication correctly) and defining as high adhesion a result greater than 80%; adherence also was measured with medication possession rate (MPR) and attendance to scheduled consultations with the interdisciplinary team in each period measured. The effectiveness by DAS28, HAQ and the other measurements were made in three periods: at baseline (BL), 6 months (M6) and 12 months (M12). A Pearson correlation was made between the number of patients in remission and low disease activity by type of molecule and period, with adherence criteria.Results:112 patients diagnosed with RA were included, 34.8% (39/112) treated with adalimumab, 38.4% (43/112) etanercept and 26.8% (30/112) golimumab; The results of CQR19 at BL, M6 and M12 were greater than 80%, with no statistically significant differences between the three molecules. The MPR was higher than 80% in the three periods, being very similar between the three molecules, but in M12 period the difference in MPR between adalimumab 86% and golimumab 92.1% was statistically significant (p <0.005), for etanercept it was of 90%. Regarding to DAS28 and HAQ, there were no differences between the biologics analyzed; However, the highest percentage of patients with low disease activity and remission had a higher correlation with attendance to the consultations scheduled in the interdisciplinary RA care model (r = 0.78) p <0.005 (see tables).CQR19MPRBLM6M12BLM6M12ADALIMUMAB89,789,390,198,590,586,1ETANERCEPT87,489,789,797,989,690,9GOLIMUMAB88,287,691,597,196,192,1No statistical differences in adherence between biologics were found depending on sex, type of concomitant conventional treatment for RA or presence of comorbidities.RELATION BETWEEN Rem/LDA AND COMPLIANCE WITH APPOINTMENTSRemLDAMDAHDAADALIMUMAB63%60%53%29%P<0,005ETANERCEPT66%62%73%--GOLIMUMAB68%73%55%-P<0,005Conclusion:There seems to be a higher MPR with the monthly golimumab compared to the biweekly adalimumab and weekly etanercept; however, it does not necessarily imply greater effectiveness. Longer term studies are needed to confirm if there is better adherence and clinical results with monthly anti-TNFs than to other dosing regimens. Patients with remission and low disease activity had greater assistance to scheduled consultations with the interdisciplinary group, regardless of the type of molecule used. This study confirms the relation between adherence to medications and care model with clinical results.Disclosure of Interests:Paola Osorio: None declared, Laura Villarreal: None declared, Michael Cabrera: None declared, Omaira Valencia: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.
BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory arthritis leading to progressive joint and organ system damage and disability. It has been demonstrated that smoking and alcohol consumption is a risk factor for poor response to RA treatment.ObjectivesTo describe the prevalence of smoking and alcohol consumption in patients with rheumatoid arthritis.MethodsWe conducted a retrospective study, patients were followed during 12 months. Smoking and alcohol consumption were assessed through yearly questionnaires. The disease activity and functional status were measured annually by the DAS28. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We estimated the prevalence smoking and alcohol consumption and explored if there was an association between DAS28 and smoking or alcohol consumption.ResultsWe included 6491 patients. patients, 82% were female and 18% male; median age was 60 years RIQ (50-67), regarding disease activity, mean DAS28 was 2.59 1.08. The prevalence of alcohol consumptions was 2.26% while smoking 7.83%. We did no find an statistical association between smoking alcohol consumption and DAS28.ConclusionOur study showed a small prevalence of patients with rheumatoid arthritis who smoke or consume alcohol without any associations between smoking or alcohol consumption with disease activity. This could be attributed to a low prevalence in our study. Further research is needed in order to propose other methodological approaches to explore this association.Disclosure of InterestsLaura 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, Diana Buitrago-Garcia: None declared
Background:Treat to target (T2T) strategy for rheumatoid arthritis (RA) aims to achieve remission or low disease activity. On the other hand, biological disease-modifying antirheumatic drugs (bDMARDs) have shown to be effective to achieve clinical remission or, at least, low disease activity in patients with RA. On the other hand, comprehensive healthcare programs have demonstrated good clinical outcomes in patients with chronic conditions.Objectives:The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) in patients receiving biological therapy during 5 years, and who were subjected to a multidisciplinary care program.Methods:A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed during 2015-2017; those patients were followed-up under T2T standards and a multidisciplinary approach. 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). Tender joint count (TJC), swollen joint count (SJC) and DAS28 were measured on each visit. 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 in patients with RA. Patients entered into a multidisciplinary program of care with periodic consultations not only to rheumatology but with a physiatrist, psychologist, physiotherapist, occupational therapy nutrition, and, a patient focused program. With a multidisciplinary model of care the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity at base line and at the end of follow-up.Results:747 patients meet our inclusion criteria, 85% of our patients were women, median age was 57 years RIQ (50-64); The most prescribed bDMARD was certolizumab 25% followed by etanercept 14%, tocilizumab 12%, abatacept 12%, golimumab 10% rituximab 8%, adalimumab 7%, infliximab 6% and Tofacitinib 6%. At beginning 53% of patients were in moderate disease activity and, 25% in high disease activity while at the end of follow up 89% of patients had achieved remission. See Table 1. It was stablished statistical significance between changes in median DAS28 at beginning and, at the end of follow-up (P<0.05).Table 1 Comparison of DAS28ACTIVITY LEVELBASELINE5 YEAR FOLLOW-UPn%n%REM65388.60LDA17723375.02MDA38853475.97HDA1822430.41Conclusion:Biological therapy is effective for treating patients with RA, th...
Background:Rheumatoid arthritis (RA) is a common chronic inflammatory disease. It is characterized by progressive, joint damage, impaired joint function and pain, the disease causes disability and reduces quality of life. Treat-to-target (T2T) is an acknowledged management strategy for RA; it proposes that the therapeutic target in RA should be a state of remission or low disease activity. There are two types of pharmacological therapy available: biological DMARDs that are considered highly expensive for our countries and conventional DMARDs which have demonstrated effectiveness and is a low-cost treatment (1,2).Objectives:The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using a T2T strategy during three years in a cohort of patients receiving conventional DMARDs.Methods:A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed during 2015–2017; those patients were followed-up under T2T standards and a multidisciplinary approach. Clinical follow-up was according to DAS28: 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 divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients reached LDA or REM. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We analyzed normality for DAS28, in order to compare disease activity at beginning and the end of follow-up.Results:During 3 years we included 1953 patients were 39% were in low disease activity, 47% in moderate disease activity and 14% were in severe disease activity, 84% were female, mean age was 60 years±12. At baseline mean DAS28 was 4.45±0.90 with a median of 4.3 at three years the mean DAS28 was 3.83±1.08 with a median of 3.60. At the end of follow-up 46% of population achieved remission and 25% achieved low disease activity; at overall 71% improved disease activity, see table 1. In our study DAS28 was not normally distributed, thus we performed a Wilcoxon test in order to compare the mean DAS28 at baseline/36 months showing statistical significance (P<0.05).ACTIVITY LEVELBASELINE3 YEARS FOLLOW-UP n%n% REM89846LDA7593948825MDA9124752827SDA28214392Conclusions:Patients treated with conventional DMARD therapy and under a T2T model achieve favorable results in regards of disease activity. This is real life evidence that can support the advantages of treating RA patients with a multidisciplinary team under a T2T model with a low-cost treatment.ReferencesAletaha D, Alasti F, Smolen JS. Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Annals of the Rheumatic Diseases2015.Ahsan T, Erum U, Khowaja D, Dahani A. ...
Background:According to the Third Consensus of Granada of the WHO an adverse event (AE) is an unfortunate situation/event that occurs during the pharmacological treatment of a disease and that may not necessarily be related to the use of one or more medications. An adverse reaction (AR) is an unfortunate situation/event that is directly related to the use of a medicine. A medication-related problem (MRP) is an unexpected result in the treatment with a certain medication, resulting in the appearance of adverse events/reactions.Objectives:Determine and analyze the incidence of adverse events, adverse reactions and medication-related problems in patients treated for rheumatoid arthritis.Methods:Of a large cohort of approximately 6,000 patients with rheumatoid arthritis (RA) in a specialized center, between 2018 and 2019 pharmaceutical chemist intervention was performed on those patients who reported AEs, ARs and MRPs during their treatment. These reports were made by the treating doctors, the pharmaceutical chemist and directly by the patients to the treating institution. Interaction between medications, adherence to them, patient lifestyles during pharmacotherapy, sociodemographic variables and support relative networks were monitored and investigated. The severity of the events and reactions was evaluated using the Dader method of therapeutic drug monitoring, Morisky Green test to measure adherence and the variables of the Naranjo algorithm in order to characterize them as AEs, ARs or MRPs and determine level of damage to the patient. The cases were analyzed in the pharmacovigilance committee of institution and their causality is defined giving solution to the cases and their follow-up according to relevance.Results:The analysis yielded a cohort of RA 296 patients (44 men-15%, 252 women-85%) who reported AEs, Ars and MRPs. 181 patients (61%) in management with conventional DMARDS and 115 patients (39%) in biological therapy were identified. The highest incidence occurs in ages between 70 and 79 years (36% of cases); more commonly in women (85% of cases); more commonly using convDMARDs (61% of cases), all this being statistically significant (p <0.05). The classification resulted in 66 (22%) AEs, 117 (40%) ARs and 35 (12%) MRPs. The reported causality was probable in 236 cases (79%), possible 46 cases (16%), unlikely: 14 cases (5%) according to the classification of the Naranjo algorithm.GENDERTYPE OF EVENT/REACTIONMen4415%convDMARDs178BIOLOGICS118Women25285%Cardiovascular5Cardiovascular23p< 0.05AGEDermatological37Dermatological55p< 0.05Betw 20 and 40 yo7425%Digestive84Digestive9p< 0.05Betw 45 and 50 yo6823%Inflamatory23Inflamatory16Betw 51 and 70 yo3311%Non-adherence15Non-adherence8Betw 70 and 79 yo10736%Neurological8Neurological0p< 0.05Betw 80 and 99 yo145%Respiratory6Respiratory7TYPE OF THERAPYconvDMARDs18161%Biologics11539%CAUSALITYProbable23679%Possible4616%Unlikely145%Conclusion:The range of population where AEs, ARs and MRPs most occur are in people over 70 years old; are more common in women and in those who are in conventional DMARDs therapy. The most common AEs, Ars and MRPs with conventional therapy are digestive disorders and in case of biological therapy are dermatological reactions with a mainly probable causality. More studies are needed to clarify these results.References:Third Consensus of Granada on Drug Related Problems (DRP) and Negative Outcomes associated with Medication (NOM). Ars Pharm 2007; 48 (1): 5-17Acknowledgments:This project was carried out by the scientific direction and the pharmacy of Biomab - Center for Rheumatoid ArthritisDisclosure of Interests:Wilberto Rivero: None declared, Pedro Rodriguez: None declared, Michael Cabrera: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.
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