A. Palomino

OP0148 Effectiveness of Conventional DMARDS Using A Treat to Target Strategy in the Context of A Large Cohort of Rheumatoid Arthritis Patients

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last 2 years in Colombia in a specialized in RA center. Objectives The aim of this study was to describe general change in Disease Activity Score 28 (DAS28) using A T2T strategy during a 24 month period in a large cohort of RA patients treated with conventional DMARDs. Methods A descriptive cross-sectional study was performed. Patients from a rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed using DAS28: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. We calculated percentages and averages from this data and divided patients in four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA). Global change in DAS28 was determined at beginning, 6, 12, and 24 months an assessed using Chi-square test. Results 705 patients were included in this study, 560 (79.3%) women and 145 (20.5%) men. All patients had established disease (more than 2 years of duration) and average age 60.1 y/o. Regarding the entire cohort, majority of patients were using DMARDs alone or in combination 450 (63.8)% of patients were using methotrexate, 481 (68.22%) leflunomide, 176 (24.9%) sulfasalazine, and prednisolone 126 (17.8%). The difference of medians for each variable showed improvement with statistical significance (p<0.00). Activity Month 0, n (%) 6 Months, n (%) 12 Months, n (%) 24 Months, n (%) REM 292 (41.4) 432 (61.2) 498 (70.5) 523 (74.1) LDA 108 (15.3) 143 (20.3) 90 (12.7) 87 (12.3) MDA 254 (36.0) 113 (16.0) 99 (14.0) 80 (11.3) SDA 51 (7,2) 17 (2.4) 18 (2.5) 15 (2.1) p<0.00. Conclusions This study shows general improvement of DAS28 in RA patients treated with conventional DMARDs applying a T2T strategy; it was found a globally increase in the percentage of patients in remission group and decrease in MDA/SDA groups. Standard T2T follow-up in patients with RA should be done based on: correct use of disease activity scores and visits/treatment decisions based on, and was proved that achieving remission/LDA using only conventional DMARDs is a realistic goal in clinical practice. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4824

AB0303 Osteoarthritis is the Most Frequent Cause of Rheumathoid Arthritis Misdiagnosis in A Colombian Specialized Center

Background There is a lack of expertise in the rheumatoid arthritis (RA) diagnosis in primary level medical centers in Colombia. Frequently, patients with osteoarthritis (OA) are misdiagnosed as rheumatoid arthritis (RA) in primary care centers, leading to wrong treatment and consequent clinical and pharmacoeconomic impact. Objectives The 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. Methods A descriptive, cross sectional study. Patients were referred and assisted to a specialized RA center in a 24 month period with presumptive diagnosis of this disease. A complete medical record was fulfilled by a rheumatologist; it was measured rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands. Frequencies and Percentages were calculated for the demographic and clinical characteristics of the cohort of patients. Results From a total of 3665 Patients derived to specialized in RA center with presumptive RA diagnosis, after medical and laboratory evaluation 1451 (39.6%) had a wrong RA diagnosis; of them 1116 patients (76.9%) had finally osteoarthritis diagnosis. Of these patients 790 (70.7%) were women and 326 (29.2%) men, with an average age of 59.7 (±12 years). Majority of these patients were followed by general physicians or internists and treated with non-biologic and biologic disease modifying anti-rheumatic drugs (DMARDs) in the past, for an average time of 4.5 years. Conclusions In this cohort of patients the most frequent diagnosis of patients misdiagnosed with RA was osteoarthritis, being more than two thirds of them, predominantly women. This shows the need for the implementation of specialized clinics in RA and educational strategies for primary care physicians in order to avoid the impact of this wrong diagnosis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5344

AB1031 Misdiagnosis of Rheumatoid Arthritis in A Colombian Specialized Center and Socio-Demographic Characterization

Background There is a lack of expertise in the rheumatoid arthritis (RA) diagnosis in primary level medical centers in Colombia, leading to misdiagnosis, which derives in wrong treatment for patients and pharmacoeconomic implications. Objectives The aim of this study was to describe demographic and clinical characteristics of a cohort of patients with misdiagnosis of RA in a specialized center in Colombia. Methods A descriptive, cross sectional study. Patients were referred from non-specialized centers to a RA specialized center in a 24 month period with presumptive diagnosis of this disease. A complete medical record was fulfilled by a rheumatologist; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and foot, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands. 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. Results Of the 3665 patients evaluated, in 2214 patients (60.4%) diagnosis of RA was confirmed, the remaining 1451 patients (39.5%) had a wrong diagnosis of RA. Of these misdiagnosed patients, 1009 (69.5%) were women, and 442 (30.5%) men, with an average age of 59.7 (±12 years). Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 1116 patients (76.1%), systemic lupus erythematosus (SLE) in 85 patients (5.8%), Sjögren syndrome in 62 patients (4.3%), spondyloarthropathies in 22 patients (1.5%), gout in 32 patients (2.2%) and other diagnoses in the remaining population (8%). Conclusions Almost 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 pharmacoeconomic consequences of misdiagnosis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5327

SAT0057 Cost Savings through Decreasing the Number of Eligible Patients for Biological Therapy Using A Treat to Target Strategy

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last 2 years in Colombia in a specialized in RA center. On the other hand costs of treating disease are increasing because introduction of biologic therapies. Objectives The aim of this study was to describe the reduction in Disease Activity Score 28 (DAS28) in patients with moderate-severe disease activity (MDA/SDA) using a T2T strategy for 24 months in a Colombian specialized center in RA and cost savings for health care system associated with such reduction in disease activity levels. Methods A descriptive cross-sectional study was performed. Records of patients from specialized in RA center were reviewed; those patients were followed-up under T2T standards. 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). In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients. The median was analyzed using t-Student assuming normality for DAS28 distribution. Results 310 patients were included in this study, 256 (82.5%) women and 54 (17.4%) men. Mean age 61 years. These patients were in moderate-severe disease activity (MDA/SDA); mean DAS28 was 4.3 at the beginning, and after 24 months using T2T strategy and treating patients only with conventional DMARS we found that 252 patients (81.2%) got in remission-low disease activity (Rem/LDA) with a mean DAS28 of 2.6. On average, costs of biological therapy at this time was 16,595 USD/year for individual patient, and so for 252 patients costs savings were about 4.181.940 USD for a year, ranging between 2.975.228 USD (in case of most cheaper biological) and 5.824.849 USD (in case of using most expensive biological). Conclusions This study showed that it is possible to decrease disease activity and therefore a significant reduction in costs, of moderate-severe disease activity (MDA/SDA) patients, by using a model with therapeutic goals and not only pharmacological. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4832

FRI0031 Better Outcomes of Disease Activity in A Large Cohort of Rheumatoid Arthritis Patients Treated under Treat to Target Recommendations

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last 2 years in Colombia in a specialized in RA center. Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 24 month period in a large cohort of patients from a Colombian specialized in RA center. Methods A descriptive cross-sectional study was performed. Records of patients from specialized in RA center were reviewed; those patients were followed-up under T2T standards. 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). In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. We calculated percentages and averages from this data and distributed patients in four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA). Global change in DAS28 was determined at beginning, 6, 12, and 24 months an assessed using Chi-square test. The median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level of disease activity was analyzed using Pearsons statistics. Results 1046 patients were included in this study, 865 (82.7%) women and 181 (17.3%) men. Mean age 60.1 years. With regard to treatment it was found that 340 (32.5%) patients were treated with biologics, and 706 (67.5%) patients with conventional therapy. The mean of DAS28 was 3.4 at the beginning and 24 months after was 2.6. The difference of medians for each variable showed improvement with statistical significance (p<0.00). Activity Month 0 6 months 12 months 24 months n (%) n (%) n (%) n (%) REM 390 (37.3) 562 (53.7) 668 (63.9) 750 (71.7) LDA 159 (15.2) 214 (20.5) 136 (13.0) 123 (11.8) MDA 388 (37.1) 215 (20.6) 196 (18.7) 139 (13.3) SDA 109 (10.4) 55 (5.3) 46 (4.4) 34 (3.3) p<0.00. Conclusions This study shows improvement of DAS28 in a cohort of RA patients from a specialized center in Colombia treated under recommendations of T2T strategy; it was found a global increase in the percentage of patients in remission (REM) and decrease in moderate and severe disease activity (MDA/SDA) group. This study shows de importance of T2T strategy for following-up and treating this disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4830

THU0592-HPR PRECIPITATING, PREDISPOSING AND MAINTENANCE FACTORS ASSOCIATED WITH SEXUAL DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background Sexuality is an important dimension of personality and human body, therefore any involvement in this area should be considered as important. Sexual disturbances in rheumatoid arthritis (RA) patients are poorly described in literature. On the other hand, there are predisposing, precipitating and maintenance factors for sexual disturbances in patients with RA. Objectives The aim of this study using CIE-10 was to describe different type of factors that may influence the prevalence and worsening of sexual disturbances in patients with RA. Methods A descriptive cross-sectional study was performed in a specialized clinic dedicated to Ra patients care. Patients seen by the area of psychology, information was collected through semi-structured interviews and non-probability sampling. Descriptive epidemiology was done, using averages and percentages for categorical and qualitative variables; and Pearsons statistics for bi-variated analysis. Results The total sample of patients was 349, 279 (79.9%) were women and 70 (20.0%) were men, average DAS28-2.46. Average age is 58.1 years. 146 (52.3%) of women reported no sexual activity, while 133 (47.6%) report sexual activity. 18 (25.7%) of men reported no sexual activity, while 54 (70.2%) report sexual activity. Precipitating factors in women: 26 (9.3%) infidelity, 17 (6.0%) anxiety about sexual performance, 36 (12.9%) loss of attraction, 35 (12.5%) alteration of self-image. while in men: 19 (27.1%) insecurity in sexual male role, 12 (30.7%) loss of attraction, 4 (5.7%) infidelity, 4 (5.7%) alteration of self-image. Predisposing factors in women: 73 (26.1%) biological causes, 36 (12.9%) infidelity, 19 (6.8%) poor or inadequate information, 13 (4.6%) insecurity about sexual performance, while in men 13 (18.5%) biological causes, 5 (7.1%) infidelity, 5 (7.1%) poor or inadequate information, 11 (15.7%) insecurity about sexual performance. Maintenance factors in women: 61 (21.8%) biological causes, 42 (15.0%) general alteration of couple relationship, 19 (6.8%) depression and anxiety, 18 (6.4%) infidelity, 2 (0.7%) partners sexual dysfunction, while in men: 16 (22.8%) general alteration of couple relationship, 14 (20%) biological causes, 12 (17.1%) anxiety about sexual performance. It was not established a correlation between precipitating, predisposing or maintenance factors and RA disease activity. Conclusions According to these findings sexual disorders are present in a half of patients with RA both men and women. There are many factors that may influence the prevalence and worsening of sexual disturbances. However sexual disturbances do not affect disease activity, but quality of life probably is very affected. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5404

AB0336 Sexual Disturbances in Patients with Rheumatoid Arthritis and It's Relation with Disease Activity

Background Sexuality is an important dimension of personality and human body, therefore any involvement in this area should be considered as important. Sexual disturbances in rheumatoid arthritis (RA) patients are poorly described in literature. Objectives The aim of this study was to describe sexual disturbances using CIE-10 classification in a population with RA and a possible correlation with disease activity. Methods A descriptive cross-sectional study was performed in a specialized clinic dedicated to care patients with RA. 349 patients were included in the study, which were seen by the area of psychology, which information was collected through semi-structured interviews and non-probability sampling. Descriptive epidemiology was applied for continuous variables, using measures of central tendency and dispersion for categorical and qualitative variables by averages and percentages. By means of Pearsons statistics it was analyzed bi-variated correlations. Results The total sample of patients was 349, 279 (79.9%) were women and 70 (20.0%) were men, average DAS28-2.46. Average age is 58.1 years. 146 (52.3%) of women reported no sexual activity, while 133 (47.6%) report sexual activity. Concerning women with sexual activity, 27 (18.4%) reported satisfactory sexual activity, 33 (22.6%) reported no-satisfactory sexual activity, 25 (18.3%) reported lack or loss of sexual desire, 53 (36.3%) reported dyspareunia, and 4 (2.9%) orgasmic dysfunction. On the other hand 18 (25.7%) of men reported no sexual activity, while 54 (70.2%) report sexual activity. Concerning men with sexual activity, 6 (11.1%) reported premature ejaculation, 8 (14.8%) reported satisfactory sexual activity, 5 (12.8%) reported no-satisfactory sexual activity, 5 (9.2%) reported lack or loss of sexual desire, 7 (12.9%) orgasmic dysfunction, 4 (7.4%) reported dyspareunia. It was not established a correlation between level of sexual activity and disease activity using DAS28. Conclusions According to these findings almost a half of men and women have a high percentage of sexual disturbances in relation to RA affecting their quality of life; on the other hand higher DAS28 is not correlated with fewer level of sexual activity. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5391

AB1185-HPR Psychological and Sleep Disorders in Patients with Rheumatoid Arthritis and It's Relationship with Disease Activity

Background Emotional stability is an important dimension of personality, therefore any involvement in this area should be considered as important. Psychological an sleep disorders in rheumatoid arthritis (RA) are poorly described in literature. Objectives The aim of this study was to describe psychological and sleep disturbances using CIE-10 classification in a population with RA and a possible correlation with disease activity. Methods A descriptive cross-sectional study was performed in a specialized clinic dedicated to care patients with RA. 349 patients were included in the study, which were seen by the area of psychology, which information was collected through semi-structured interviews and non-probability sampling. Descriptive epidemiology was applied for continuous variables, measures of central tendency and dispersion for categorical and qualitative variables (averages/percentages) and Pearsons statistics for bi-variated analysis. Results The total sample of patients was 349, 287 (82.2%) were women and 62 (17.8%) were men, average DAS28- 2.46. Average age is 58.1 years. 52.7% of patients were medium socio-economical level and the 47% were low socio-economical level; Related with the occupation, 30.5% is retired because age and the 19.8% have handicap retirement pay; 26.9% is dedicated to the housekeeping and 20.1% were working. Psychological disorders: 72 (18.4% of women and 36.8% of men) reported no psychological disorders, while 262 (81.5% of women and 63.1% of men) report psychological disorders. women: 143 (57.1% of women and 38.8%) mood disorder (depression/anxiety), 60 (24.7% of women and 11.1% of men) somatoform disorders, 13 (4.8% of women and 5.5% of men) disorders of food intake, 17 (7.5% in woman only) sleep disorders, 6 (1.7% of women and 5.5% of men) sexual dysfunction, 10 (3.9% of women and 2.7% of men) dementia. The mean of DAS was 2.49 Sleep disorders: primary insomnia 122 patients (84.4% of women and 15.6% of men), related sleep disorder breathing (OSAS) 18 Patients (77.7% of women and 22.3% of men) and 12 patients with circadian rhythm disorder (83.3% of women and 16.7% of men), and hypersomnia 8 patients (100% of women). It was not established a correlation between psychological and sleep disorders and disease activity. Conclusions According to these findings most of patient who were in remission no report psychological disorders and most of patients in moderate disease activity present somatoform disorders. Women have many psychological disorders in relation to RA; there is a prevalence of depressive episode. A higher DAS28 is expected to be associated with restless sleep. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5373

AB1138-HPR Systemic Adverse Events in A Cohort of Patients with Rheumatoid Arthritis Using BIOLOGICS in A Real-Life Setting

Background Biological therapy is a major therapeutic tool to prevent clinical and radiological progression of rheumatoid arthritis (RA). On the other hand, adverse effects of these medications are a problem in clinical practice. Objectives The aim of this study was to describe and compare the most frequent adverse events with the use of biologic therapy in patients with RA in a real-life ambulatory setting. Methods A descriptive study was done by nursing service. A review of adverse event reports presented in pharmacovigilance committee was completed monthly during last 36 months in a specialized in RA center in Colombia. Descriptive epidemiology was used, percentages and averages were calculated. Results 570 patients were using biological therapy in a cohort of 2214 RA patients last 36 months. Were 490 women (85.9%) and 80 (14.0%) men. Mean age 60.7 years old. In 163 (28.5% of all) patients were reported adverse events (AE); AE were categorized according WHO classification in mild, moderate and severe; between them 59 (36.2%) were mild, 97 (59.5%) were moderate and 7 (4.2%) were severe. From 163 AE reported, 86 (52.7%) were systemic and 77 (47.2%) dermatologic reactions. Regarding therapeutic approach in 63 patients (38.6%) biologic was temporarily suspended, in 57 (34.9%) was permanently withdrawn and patients switched to another biological, and 43 (26.3%) patients were followed for drug and reactions surveillance. Concerning to type of biologic in 120 patients (73.6%) AE were with anti-TNF therapies. Conclusions AE using biologics documented in patients of a specialized RA center are similar to those reported in literature; Biological therapy is considered a safe and recommended treatment for management of RA. AE were more common with anti-TNFs therapies. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5438

FRI0181 Effectiveness of biological therapy using a treat to target strategy in patients with rheumatoid arthritis

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last 2 years in Colombia in a specialized in RA center. Objectives The aim of this study was to describe general change in Disease Activity Score 28 (DAS28) using A T2T strategy during a 24 month period in RA patients treated with biological DMARDs. Methods A descriptive cross-sectional study was performed. Patients from a rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed using DAS28: every 3-5 weeks (DAS28 > 5.1), every 7-9 weeks (DAS28 ≥ 3.2 and ≤ 5.1), and every 11-13 weeks (DAS28 < 3.2). It was measured tender joint counts, swollen joint counts, DAS28 and HAQ at every visit. In case of DAS28 > 3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. Were included patients who seen at least 6 times their doctor. We calculated percentages and averages from this data and divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients. Global change in DAS28, joint counts and HAQ was determined at beginning, 6, 12, 18 and 24 months an assessed using Chi-square test. Results 357 patients were included in this study, 314 (87.9%) women and 43 (12.1%) men. All patients had established disease (more than 2 years of duration) and average age 56.4 y/o. Regarding entire cohort, majority of patients (80.8%) were using anti-TNFs, mainly infliximab (49.5%) and adalimumab (20.2%). At initial visit, we found only 43% of patients in Rem-LDA activity and 57% patients in MDA/SDA activity according to DAS28. At 6, 12, 18 and 24 months of follow-up we found improvement to 51%, 62%, 62% and 75% respectively in patients of Rem/LDA group. On the other hand was observed a decrease on proportions of patients in MDA/SDA group. The difference of medians for each variable showed improvement with statistical significance (p < 0.00). It was not established improvement in HAQ. Conclusions This study shows general improvement of DAS28 in RA patients treated with biological DMARDs and applying a T2T strategy; it was found a globally increase in the percentage of patients in Rem-LDA activity group and decrease in MDA/SDA group. Standard T2T follow-up in patients with RA should be done based on: correct use of disease activity scores and visits/treatment decisions based on, and was verified that achieving remission/LDA is a realistic goal in clinical practice. But, after 2 years there is a patient’s fourth refractory to treatment with biologicals. Disclosure of Interest None Declared