ObjectivesThe aim of the study was to translate and validate the ASAS Health Index (ASAS-HI) for Argentinean patients with spondyloarthritis.MethodsTranslation was done using a forward-backward procedure and qualitative interview were done with the translation. Patients fulfilling ASAS classification criteria for either axial (axSpA) or periphereal SpA (pSpA) were included to test psychometric properties. Test-retest reliability was assessed by intraclass correlation coefficient (ICC) in patients without treatment changes (stable disease state). In patients who required therapeutic modifications due to changes of disease activity, responsiveness was evaluated using a standardized response mean (SRM). Construct validity against other health outcomes was evaluated by Spearman correlation. Internal consistency (Cronbach-alfa) and discriminative ability between ASAS-HI and ASDAS were assessed.ResultsTranslation into Argentinean Spanish was accepted with minor changes. Fifty two patients were recruited [65% male, mean (SD) age 39. 5 (12.5) years and median (IQR) disease duration 72 (45–138) months]. Most of the patients had axSpA diagnosis (AS: 26, nr-axSpA: 18) while the rest had pSpA (8). The total score of the ASAS-HI was 7.4 (SD: 4.4), BASDAI: 4.4 (SD: 2.7), BASFI: 4.0 (SD: 3.1), ASDAS-CRP: 2.4 (SD: 0.9). Test-retest reliability (n: 20) was good ICC: 0.88 (95%IC 0.76 to 0.98). Sensitivity to change was tested in 13 patients and SMR was -0.61 for those patients receiving TNF inhibitors (n: 11). Convergent validity ranged as hypothesized with Spearman correlations from low (age: 0.27) to good (pain: 0.65), (table 1). The ASAS-HI discriminated well between patients with different stages of disease activity and function irrespective of the measure applied (ASDAS, BASDAI and BASFI) (table 2). The internal consistency according to Cronbach's alfa was 0.81.Table 1.Spearmen correlation coefficientCharacteristicsSpearmen correlation coefficient ASAS-HI (0–17)p value Age0.27<0.05Pain (0–10)0.65<0.001Night spinal pain (0–10)0.54<0.001ASDAS0.51<0.001BASDAI (0–10)0.60<0.001BASFI (0–10)0.54<0.001SF-36 Total0.46<0.001Table 2.ASDAS Status GroupsASDAS Status Groups Inactive (n: 9)Moderate (n: 9)High (n: 29)very high (n: 5) ASAS-HI (0–17)3.44 (± 3.9)5.77 (± 4.79)9. 06 (± 3.49)10.05 (± 4.5)BASFI (0–10)0,53 (± 0,35)1.41 (± 1.40)5.5 (± 2.46)6.46 (± 3.12)BASDAI (0–10)1.21 (± 0.49)2.37 (± 1.7)5.73 (± 1.91)6.46 (± 3.38)ConclusionsThe Argentinean version of the ASAS-HI was comprehensive and reliable by patients with SpA. The ASAS-HI is a valid tool for assessing overall functioning and health in spondyloarthritis.References The ASAS Health Index (ASAS HI)a new tool to assess the health status of patients with spondyloarthritis, Clin Exp Rheumatol 2014;32:S105-S108. Disclosure of InterestV. Duarte Employee of: Novartis Argentina, U. Kiltz: None declared, V. Navarro-Compán: None declared, N. Lloves: None declared, G. Crespo Amaya: None declared, L. Ferreyra: None declared, C. Orozco: None declared, E. Schneeberger: None declared, H. Mald...
ObjectivesTo evaluate work capacity and quality of life in patients with early Psoriatic Arthritis (PsA).MethodsMulti-center study in which patients with recent onset of PsA (disease duration <3 years) who met the CASPAR criteria established by the Early Spondyloarthritis Committee (CONEART) were enrolled. Work loss and lost workdays within six months prior to the baseline visit attributable to their baseline condition were evaluated, as well as quality of life, measured by PsAQol. Statistical analysis: descriptive statistics, Spearman's correlation, multiple linear regression model.Results108 patients with a PsA diagnosis were enrolled. 53% (57/108) were male, of a mean age of 48.4 (SD 12.5). The mean PsA disease duration was 17.6 (SD 9.8) months. 4/60 patients (6.6%) were positive for HLA-B27. BASDAI 4.81±2.66; BASFI 3.75±2.70; PsAQoL 7.24±6.44; HAQ-A 0.72±0.61, physician global activity assessment (by Visual Numeric Scale, VNS) 3.76±2.33, and pain assessment (VNS) 5.22±2.98. The average days lost due to the condition within the past 6 months was 8.6 (SD 32.1), it was significantly associated with the presence of enthesitis, number of swollen joints, worse BASDAI, BASFI, lower level of education, and higher pain and physician global activity assessment (p<0.0001). Five patients lost their job due to PsA. 12% of the patients had a disability certificate and the possession of one, according to the logistic regression model, was associated with a longer PsA disease duration (OR 1.09, p=0.02). A poorer quality of life was significantly correlated to the physician assessment of disease activity (p<0.001) and pain (p<0.01) using a linear regression model.ConclusionsIn this cohort of patients with early PsA, the deterioration of work capacity expressed in lost workdays was associated with disease activity parameters and functional disability. The physician global activity assessment and pain were the main factors associated with the impact on patient's quality of life. Having a disability certificate was associated with longer disease duration. Although this is an early cohort of PsA patients, a worsening in quality of life and work disability was observed.Disclosure of InterestF. Colombres: None declared, H. Berman: None declared, A. Spindler: None declared, W. Spindler: None declared, J. Maldonado Cocco Grant/research support from: Pfizer Argentina, M. Orozco: None declared, E. Schneeberger Grant/research support from: Pfizer Argentina, A. Ortiz: None declared, S. Paira Grant/research support from: Pfizer Argentina, M. Zalazar: None declared, O. Rillo Grant/research support from: Pfizer Argentina, D. Baenas: None declared, A. Alvarellos Grant/research support from: Pfizer Argentina, T. Alvarellos: None declared, M. Garcia Grant/research support from: Pfizer Argentina, A. Salas: None declared, V. Duarte: None declared, F. Romanini Grant/research support from: Pfizer Argentina, L. Ferreyra Garrott: None declared, E. Soriano Grant/research support from: Pfizer Argentina, L. Galindo: None declared, G. Castelli: None decl...
BackgroundThe Duruöz Hand Index (DIH) is a reliable tool for the evaluation of hand's function in patients with scleroderma.ObjectivesThe aim of our study was to adapt and to validate the DHI questionnaire in an Argentinian population with scleroderma.MethodsFor validation, 3 rheumatologists adapted and translated to Spanish the original version in French and the final version was re-translated to French by a bilingual person. To evaluate the construct validity, we used the patient global visual analogue scale (VAS), VAS for questions for the same activity, the health assessment questionnaire (HAQ) and the Rodnan. A subsample attended a second visit to evaluate reproducibility, with no modifications in the treatment in relation to the previous visit. Continuos variables were expressed as mean and standard desviation (SD) or medians with their interquartile range (IQR). Spearman's correlation coefficient was used to quantify the degree of correlation between the different VAS, HAQ and Rodnan with the total score. The intraclass correlation coefficient (ICC) was used to assess reproducibility and Cronbach's alpha to evaluate internal consistency.Results45 patients diagnosed with scleroderma were included in the study. 84,44% were women, mean age of 51±13,72 years (SD), 48,89% were Mestizos, while 46,67% were Caucasians with a disease duration of 24 months (IQR: 18-60). 64, 44% patients had diagnostic of limited scleroderma; 77, 78% were right handed and 53, 33% had extra cutaneous manifestations. Raynaud was present in 93, 33%, pitting scars in 33, 33% and digital ulcers in 26, 67%. The median score of the total questionnaire was 4, 5 (IQR: 0-26), of the global VAS 49 (IQR: 10-50), of HAQ 0,3 (IQR: 0-1) and of Rodnan 5 (IQR:2-11). The correlation between the total score of DHI and the patient global VAS was 0, 58, with the HAQ was 0, 63 and with Rodnan 0, 08. The correlation coefficient between the VAS and each group of questions for the same activity in the DHI questionnaire, indicated good correlation for the questions that refer to activities of kitchen(0,60;0,71;0,67;0,67;0,59;0,62;0,55), as well as for dressing(0,69;0,65;057), for hygiene (0,61;0,56), and for the office questions (o,56;0,73). There was excellent level of correlation with those related to fine motor activities with a maximun r value of 0, 78. The reproducibility was 0, 88 (CI 95% 0,76-0,99) and the internal consistency according to Cronbach's alpha was 0,98.ConclusionsThe results from this study show the DHI to be a reliable and valid test for this Argentinian population with scleroderma.ReferencesDuruoz MT, Poiraudeau S, Fermanian J, Menkes C, Amor B, Dougados M, et al. Development and validation of a rheumatoid Duruoz's Hand Index that assesses functional handicap. J Rheumatol 1996; 23:1167–72.AcknowledgementsJanet L. Poole.Disclosure of InterestNone declared
BackgroundIt has been seen that patients who achieve remission measured by DAS28 persist with subclinical synovitis on hands and toes evaluated by ultrasound. In recent times stricter criteria as the CDAI, SDAI and ACR EULAR Boolean have been proposed.ObjectivesTo evaluate the stricter criteria as diagnostic test with ultrasound considered as reference test or gold standard in patients in remission for DAS28.MethodsWe evaluated consecutive patients in remission by DAS28 less than 2,6. Strict criteria were applied. A rheumatologist specializing in musculoskeletal ultrasound, who was unaware of the clinical status and laboratory activities, performed ultrasonography on hands and and toes. Systematic evaluation was performed on grayscale and Doppler technique with multifrequency linear transducer (10 -18 MHz) in longitudinal and transverse sections of radiocarpal joint, second and third metacarpophalangeal, second and third proximal interphalangeal in both hands, second to fifth metatarsophalangeal joint, bilateral. It was considered as cases, synovitis absence grade II-III and/or Power Doppler II-III using OMERACT's definitions. We defined controls as the ones with at least one of these signs of activity. We consider positive diagnosis test to remission status for different stricter criteria. Sensitivity, specificity, positive likelihood ratio, positive predictive value (PPV) and negative predictive value (NPV).Results100 scans were performed in 100 patients, 80% were women (n=80) and the mean age 52.7 SD 12. There were no differences in age, sex, duration of disease, treatment, or RF and anti CCP positivity between cases and controls. Of the ultrasound screening 58 didn't have signs of activity and 42 had synovitis and/or PD grade II-III. Table 1 shows the status of activity and Table 2 shows the results.Table 1Ultrasound without activity on hands and toesn (%)Remission by Boolean ACR/EULAR criteria (n=45)16 (36)No Remission by Boolean ACR/EULAR criteria (n=55)26 (47)Remission by SDAI (n=70)29 (41)No remission by SDAI (n=30)13 (43)Remission by CDAI (n=62)26 (41)No remission by CDAI (n=38)16 (42) Table 2SensitivitySpecificityPPVNPVPositive LR% (95 CI)% (95 CI)% (95 CI)% (95 CI)Boolean ACR/EULAR38 (29–48)50 (40–60)36 (26–45)53 (43–63)0,8 (0,5–1,2)CDAI62 (53–71)38 (28–47)42 (32–52)58 (48–68)1 (0,8–1,3)SDAI69 (60–78)29 (20–38)41 (32–51)57 (47–66)1 (0,8–1,3) ConclusionsWe found that in this population, which is in remission for DAS28, none of the three criteria is of great value to detect absence of activity using ultrasound as gold standard.ReferencesFelson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology; European League Against Rheumatism. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011; 63:573-86.Disclosure of InterestNone declared
Background:Access to high-cost treatments is especially limited in low-resource countries. This issue is becoming stronger today given the health and economic crisis caused by the SARS-CoV2 pandemic. There are no reports in our country on limitations to access and adherence to treatment in patients with Spondyloarthritis (SpA) during social preventive and mandatory isolation.Objectives:Evaluate access and adherence to treatment in patients with Spondyloarthritis during social preventive and mandatory isolation.Methods:Patients with axial spondyloarthritis (axSpA) radiological (r-axSpA), non-radiological (nr-axSpA) and peripheral spondyloarthritis (pSpA), according to ASAS criteria and psoriatic arthritis (PsA) according to CASPAR criteria, were included. Sociodemographic data, comorbidities, disease activity and treatments were collected at baseline. Data on treatment discontinuation, medical attention for suspected COVID-19 disease, RT-qPCR for SARS-CoV-2 detection and outcome of COVID-19 disease were collected from April to September 2020. Numerical variables were summarized as means and standard deviations (SD) or as medians and interquartiles 25-75 (IQ 25-75).Results:320 patients were included, 55% were male, with a mean age of 50 years (SD 13), 21.6% had diagnosis of r-axSpA, 6.9% nr-axSpA, 6.9% pSpA, and 64.7% PsA. Disease duration was 11 (IQ 5-16) years and activity parameters were as follow: BASDAI 3.65 (SD 3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). 14 (4.4%) patients with COVID-19 disease were reported, 10 were confirmed by positive RT-qPCR and 4 by symptoms and history of close contact with SARS patients. 4 (28.6%) received anti TNF (3 adalimumab, 1 certolizumab), 4 (28.6%) anti IL17 (3 secukinumab and 1 ixekizumab), 8 (57%) methotrexate (MTX) and 2 (14%) leflunomide (LF). Among the 320 patients included, 59 (18.4%) discontinued at least one treatment during follow-up. The discontinued medications were: adalimumab (16), MTX (15), secukinumab (9), etanercept (6), certolizumab(4), ustekinumab (3), NSAIDs (2), apremilast (1), golimumab (1), ixekuzumab (1), LF (1), MTX plus LF (1). The main reason for treatment discontinuation was drug shortage: 36 (62%), followed by patient’s decision: 12 (21%) and medical indication: 11 (17%). Of the 36 patients who discontinued due to shortage, 11 received adalimumab, 8 secukinumab, 5 MTX, 3 etanercept, 3 certolizumab, 3 ustekinumab, 2 NSAIDs and 1 golimumab.Conclusion:In our Argentinian cohort of patients with SpA, drug shortage was the main reason for treatment discontinuation. The SARS-CoV2 pandemic exposed limitations to access to treatment for patients with SpA.Disclosure of Interests:None declared
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