BackgroundThe target of treatment in psoriatic arthritis (PsA) should be remission or inactive disease. A potential definition that would fit with the Treat-to-Target Recommendations would be MDA meeting all 7 criteria1, proposed as a definition of very low disease activity (VLDA) in PsA. Patient reported outcomes (PROs), such as those provided by the novel PsAID questionnaire 2, are also important to evaluate healthcare interventions and to reflect the impact of PsA on patients' lives.ObjectivesThe aims of the present study were to evaluate the prevalence of VLDA in patients with PsA and how much residual active disease is still present, so as to determine whether PsAID could be an additional useful tool to assess PsA interventions in clinical practice.MethodsThis was a post-hoc analysis of data from a cross-sectional observational and multicenter study (MAAPS), aimed at evaluating the prevalence of MDA in a Spanish population with PsA, to describe their characteristics and to evaluate the association between MDA and the impact of the disease as assessed by the PsAID questionnaire in routine clinical practice The original study included adult patients of both genders diagnosed with PsA according to CASPAR criteria with at least one year of evolution time of disease and on treatment with biological and/or conventional synthetic disease modifying anti-rheumatic drugs (cDMARD). Patients were considered in VLDA when they met all the MDA criteria1: tender joint count ≤1, swollen joint count ≤1, Psoriasis Area Severity index (PASI) score ≤1 or body surface area ≤3%, patient pain visual analog scale (VAS) score ≤15, patient global disease activity VAS score ≤20, Health Assessment Questionnaire (HAQ) score ≤0.5, and tender entheseal points ≤1. Patient acceptable symptoms state (PASS) has been defined as a PsAID value <4.Results227 patients were included, 133 (58.6%) in MDA state and 58 (25.6%) in VLDA state. VLDA patients suffered from a mild impact of the disease according to PsAID: the majority (82.5%) had a PsAID score <4 and a mean total score (SD) of 2.1 (2.6) IC95% [1.55–2.64], while, 66.7% of MDA patients had a PsAID score <4 and a mean total score (SD) of 3.3 (3.1) IC95% [2.82–3.87]. Disability, as measured by HAQ was greater in MDA patients (mean (SD) 0.3 (0.5) IC95% [0.21–0.43]) than in those who reached VLDA state (mean (SD) 0.2 (0.3) IC95% [0.11–0.25].Conclusions26% of Spanish PsA patients achieve VLDA state in routine clinical practice. PsA patients who reached this state also had a very low impact of disease according to PsAID. VLDA state could represent a situation of clinical remission in PsA.References Coates LC, Fransen J, Helliwell PS. Ann Rheum Dis 2010;69(1):48–53.Gossec L, de WM, Kiltz U, Braun J, Kalyoncu U, Scrivo R et al. Ann Rheum Dis 2014;73(6):1012–1019. AcknowledgementsMAAPS (Minimal Activity in Psoriatic Arthritis) study group:.J.C. Torre Alonso; J.A Román Ivorra; J. Sanz; J. Salvatierra; J. Calvo Alén; A. Sellas; F.J. Rodriguez; A. Bermúdez; M.Romero; M. Riesco; J.C Cobeta; F.Medina; A. Ara...
BackgroundSome cardiovascular risk factors (CVRF) have been related to poorer responses to biological therapy1. We aimed to evaluate the potential link between the MDA response and the presence of CVRF in patients treated with traditional and/or biological DMARDs.ObjectivesThe objective has been to evaluate the potential association beetween classic CVRF and the probability of reaching an MDA response in PsA patients.MethodsCross-sectional study carried out at 25 rheumatology outpatient clinics in patients who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least one year disease duration, and treated with biological or conventional synthetic (cs) DMARDs according to routine clinical practice in Spain. Patients were considered in MDA if they met at least 5/7 of the MDA criteria2. The relationship between MDA and CVRF was evaluated by uni and multivariate analyses.Results227 patients were included, 133 (58.6%) were in MDA state (52% on anti-TNFα monotherapy, 24% on csDMARD monotherapy, 24% on anti-TNFα in combination with csDMARD). Among the classic CVRF, tobacco (crude OR: 0.54), sedentary lifestyle (crude OR: 1.95), hyperuricemia (crude OR: 2.01) and obesity (crude OR: 1.54) were related to the likelihood of MDA in the univariate model (p<0.25). The only CVRF related to the MDA response in the multivariate analysis was a sedentary lifestyle (OR 3.13, 95% CI: 1.50–6.53; p=0.002). We did not find any association between the number of CVRF and the MDA response.ConclusionsContrary to what has been found in other studies, in this cross-sectional multicenter study we could not find any relationship between traditional CVRF (except for sedentary lifestyle) and MDA. In any case, patients with psoriatic disease should be encouraged to maintain healthy lifestyle habits.References Ogdie A, Eder L. Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis. Int J Clin Rheumatol 2015; 10(6):451–459.Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010; 69(1):48–53. AcknowledgementsThis study was funded by Pfizer.Disclosure of InterestNone declared
Background Currently, the use of standards of care (SoC) could be the first step to achieve optimal care in patients with spondyloarthritis (SpA). Objectives The aim of this project (2e) was to develop evidence-based and user-focused SoC for SpA. Methods A RAND-modified Delphi method was applied. First, a systematic literature review of national and international documents covering SOC for SpA was conducted. This included consensus, clinical guidelines and care management documents. Social leagues and health professionals were contacted. All the information retrieved was evaluated by two expert methodologists and, subsequently, adapted and classified according to the three categories of SOC: structure, process and outcomes. A group of 23 experts on SpA was selected and a consensus meeting was held where these SOC were discussed. Afterwards, a first questionnaire round was sent to the experts panel and the SOC were modified according to the results of this round. Finally, a second questionnaire round with the final set of SOC was sent to 167 rheumatologists all around Spain to assess their agreement grade about every SoC. Results A total of 38 SoC were set (12 for structure, 20 for process and 6 for outcomes). A selection with the SoC that got highest priority is shown in the table. In general, standards of process achieved high priority whereas standards of result got the lowest grade of agreement. Image/graph Conclusions The implementation in clinical practice of this set of SoC could help assess and improve the quality of care for patients with SpA. Disclosure of Interest None Declared
BackgroundThe management of comorbidity in patients with axial spondyloarthritis (Ax-SpA) needs improvement; the implementation of clinical practice guidelines is still deficient and heterogeneous.ObjectivesTo prioritise comorbidities in Ax-SpA and to elaborate practical aids for their identification and follow-up.MethodsA multidisciplinary panel [10 rheumatologists (6 experts in Ax-SpA), 2 family doctors, 1 internist, 1 cardiologist, 1 gastroenterologist, 1 psychologist and 3 methodologists] prioritised, in a discussion group, a list of comorbidities based on frequency and impact. Each comorbidity was discussed largely and systematic reviews were performed to support or discard items. In a second meeting, items to be included were presented, discussed, and those with lower priority disregarded.ResultsThe panel produced a checklist for health professionals and another for patients. Each item is supported by arguments and references. Table 1 shows, schematically, the items included in the checklists.Table 1.Items included in the checklistUsual treatmentOf note: oral anticoagulants, antihypertensive drugs, ASA, steroids and NSAIDs. Specific comorbiditiesHypertension, heart failure, renal failure, liver cirrhosis, gastric ulcer, infections, tuberculosis, neurological disease, and fracture risk.Vaccine schedule and dental hygienePatient's vaccination status; prevention of infections.Life-stylePhysical activity (amount and type).Alcohol consumption. Detect possible abuses; important risk factor for other comorbidities.Depression, quality of sleep and sexual lifeThe impact of Ax-SpA in the psychosocial sphere is relevant and should be carefully evaluated. Specific questionnaires are recommended.Non-preventable diseasesFrequent association with uveitis, inflammatory bowel disease and cardiac pathology; systematise questionsConclusionsThese checklists are intended to facilitate the systematic evaluation of co-morbidity associated with Ax-SpA, thus allowing an earlier detection and better control and management of these patients by the rheumatologist.AcknowledgementsThis project was funded by Merck Sharp & Dohme Spain. Merck Sharp & Dohme had no influence on either the development of the project or the final content of the abstract.Disclosure of InterestNone declared
BackgroundDuring the development of recommendations and implementation aids of the GECOAx project, the importance of avoiding certain situations was highlighted.ObjectivesTo recognize what prescriptions, risk assessments, or preventive strategies are wrong practices and should thus be avoided in clinical practice. To establish not to do recommendations in the management of the comorbidity of AxSpA.MethodsA multidisciplinary group was selected [10 rheumatologists, 1 internist, 1 cardiologist, 1 gastroenterologist, 1 psychologist and 2 family physicians]. With the support of 3 methodologists, and after interactions aimed to edit a document for the management of comorbidity launched by the same panel, a list of Not to do recommendations was issued. In a discussion meeting, evidence was provided to support the recommendations, items without sufficient basis were removed, and the final list was produced.ResultsA summary list of Not to do recommendations (Table 1) was issued.Table 1– DO NOT prescribe NSAIDs to patients with high cardiovascular (CV) risk and particularly with hypertension.– DO NOT prescribe NSAIDs to patients with CKD, heart failure or liver cirrhosis and, if necessary, exert caution.– DO NOT use CV risk scores in patients who already suffered a CV event or those with multiple risk factors (smoking, obesity, sedentary lifestyle, DM, hypertension, dyslipidemia) or a family history of premature CV disease; All should be considered high CV risk.– DO NOT base renal disease screening on a single glomerular filtration test and/or albuminuria (ALWAYS should be confirmed); serum creatinine should not be used as the only test to evaluate renal function.– DO NOT administer biological therapy in case of active, serious and uncontrolled infection, sepsis or risk of sepsis or tuberculosis or without a previous screening of chronic HBV, HCV, HIV and TB.– DO NOT repeat HBV vaccination unless HBV antibody levels are not achieved.– DO NOT vaccinate a patient in therapy with biological agents or in immunosuppressive treatment with live virusesConclusionsThese recommendations aim to avoid making common mistakes in clinical practice and to help better management of frequent comorbidity in patients with AxSpA.AcknowledgementsThis project was funded by Merck Sharp & Dohme Spain. Merck Sharp & Dohme had no influence on either the development of the project or the final content of the manuscript.Disclosure of InterestNone declared
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