Mónica Eusébio

Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt– a national health survey

Objectives To estimate the national prevalence of rheumatic and musculoskeletal diseases (RMDs) in the adult Portuguese population and to determine their impact on health-related quality of life (HRQoL), physical function, anxiety and depression. Methods EpiReumaPt is a national health survey with a three-stage approach. First, 10 661 adult participants were randomly selected. Trained interviewers undertook structured face-to-face questionnaires that included screening for RMDs and assessments of health-related quality of life, physical function, anxiety and depression. Second, positive screenings for ≥1 RMD plus 20% negative screenings were invited to be evaluated by a rheumatologist. Finally, three rheumatologists revised all the information and confirmed the diagnoses according to validated criteria. Estimates were computed as weighted proportions, taking the sampling design into account. Results The disease-specific prevalence rates (and 95% CIs) of RMDs in the adult Portuguese population were: low back pain, 26.4% (23.3% to 29.5%); periarticular disease, 15.8% (13.5% to 18.0%); knee osteoarthritis (OA), 12.4% (11.0% to 13.8%); osteoporosis, 10.2% (9.0% to 11.3%); hand OA, 8.7% (7.5% to 9.9%); hip OA, 2.9% (2.3% to 3.6%); fibromyalgia, 1.7% (1.1% to 2.1%); spondyloarthritis, 1.6% (1.2% to 2.1%); gout, 1.3% (1.0% to 1.6%); rheumatoid arthritis, 0.7% (0.5% to 0.9%); systemic lupus erythaematosus, 0.1% (0.1% to 0.2%) and polymyalgia rheumatica, 0.1% (0.0% to 0.2%). After multivariable adjustment, participants with RMDs had significantly lower EQ5D scores (β=−0.09; p<0.001) and higher HAQ scores (β=0.13; p<0.001) than participants without RMDs. RMDs were also significantly associated with the presence of anxiety symptoms (OR=3.5; p=0.006). Conclusions RMDs are highly prevalent in Portugal and are associated not only with significant physical function and mental health impairment but also with poor HRQoL, leading to more health resource consumption. The EpiReumaPt study emphasises the burden of RMDs in Portugal and the need to increase RMD awareness, being a strong argument to encourage policymakers to increase the amount of resources allocated to the treatment of rheumatic patients.

The Use of Analgesic and Other Pain-Relief Drugs to Manage Chronic Low Back Pain: Results from a National Survey.

To analyze and characterize the intake profile of pain‐relief drugs in a population‐based study of adults with chronic low back pain (CLBP).

Dietary Patterns Characterized by High Meat Consumption Are Associated with Other Unhealthy Life Styles and Depression Symptoms

Objective We aimed to identify dietary patterns (DPs) of Portuguese adults, to assess their socioeconomic, demographic, lifestyle determinants, and to identify their impact on health. Design EpiDoC 2 study included 10,153 Portuguese adults from the EpiDoC Cohort, a population-based study. In this study, trained research assistants using computer-assisted telephone interview collected socioeconomic, demographic, dietary, lifestyles, and health information from March 2013 to July 2015. Cluster analysis was performed, based on questions regarding the number of meals, weekly frequency of soup consumption, vegetables, fruit, meat, fish, dairy products, and daily water intake. Factors associated with DP were identified through logistic regression models. Results Two DPs were identified: the “meat dietary pattern” and the “fruit & vegetables dietary pattern.” After multivariable adjustment, women (OR = 0.52; p < 0.001), older adults (OR = 0.97; p < 0.001), and individuals with more years of education (OR = 0.96; p = 0.025) were less likely to adopt the “meat dietary pattern,” while individuals in a situation of job insecurity/unemployment (OR = 1.49; p = 0.013), Azores island residents (OR = 1.40; p = 0.026), current smoking (OR = 1.58; p = 0.001), daily alcohol intake (OR = 1.46; p = 0.023), and physically inactive (OR = 1.86; p < 0.001) were positively and significantly associated with “meat dietary pattern.” Moreover, individuals with depression symptoms (OR = 1.50; p = 0.018) and the ones who did lower number of medical appointments in the previous year (OR = 0.98; p = 0.025) were less likely to report this DP. Conclusion Our results suggest that unhealthy DPs (meat DP) are part of a lifestyle behavior that includes physical inactivity, smoking habits, and alcohol consumption. Moreover, depression symptoms are also associated with unhealthy DPs.

Juvenile idiopathic arthritis in adulthood: fulfilment of classification criteria for adult rheumatic diseases, long-term outcomes and predictors of inactive disease, functional status and damage

Objectives To determine how adult juvenile idiopathic arthritis (JIA) patients fulfil classification criteria for adult rheumatic diseases, evaluate their outcomes and determine clinical predictors of inactive disease, functional status and damage. Methods Patients with JIA registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) older than 18 years and with more than 5 years of disease duration were included. Data regarding sociodemographic features, fulfilment of adult classification criteria, Health Assessment Questionnaire, Juvenile Arthritis Damage Index—articular (JADI-A) and Juvenile Arthritis Damage Index—extra-articular (JADI-E) damage index and disease activity were analysed. Results 426 patients were included. Most of patients with systemic JIA fulfilled criteria for Adult Stills disease. 95.6% of the patients with rheumatoid factor (RF)-positive polyarthritis and 57.1% of the patients with RF-negative polyarthritis matched criteria for rheumatoid arthritis (RA). 38.9% of the patients with extended oligoarthritis were classified as RA while 34.8% of the patients with persistent oligoarthritis were classified as spondyloarthritis. Patients with enthesitis-related arthritis fulfilled criteria for spondyloarthritis in 94.7%. Patients with psoriatic arthritis maintained this classification. Patients with inactive disease had lower disease duration, lower diagnosis delay and corticosteroids exposure. Longer disease duration was associated with higher HAQ, JADI-A and JADI-E. Higher JADI-A was also associated with biological treatment and retirement due to JIA disability and higher JADI-E with corticosteroids exposure. Younger age at disease onset was predictive of higher HAQ, JADI-A and JADI-E and decreased the chance of inactive disease. Conclusions Most of the included patients fulfilled classification criteria for adult rheumatic diseases, maintain active disease and have functional impairment. Younger age at disease onset was predictive of higher disability and decreased the chance of inactive disease.

AB0297 Real-Life Effectiveness of Golimumab in Biologic-Naïve Rheumatoid Arthritis Patients – Data from reuma.pt, A Portuguese Registry

Background Registries are becoming an increasingly important source of data, providing additional information on the use of biologics in clinical practice. The real-world clinical data currently available regarding the use of SC anti-TNFs is still limited. Therefore, it is of utmost importance to increase the knowledge of Golimumab (GLM) effectiveness in the clinical practice. Objectives This study was designed to access the effectiveness of SC GLM 50 mg/monthly + MTX through 52 weeks of treatment in biologic-naïve RA patients. The primary objective was to investigate the proportion of patients achieving clinical remission (DAS28ESR<2.6). The secondary objectives were the evaluation of: the treatment persistence rates; the proportion of patients achieving functional response (ΔHAQ>0.22); and the effect of treatment on DAS28 individual components. Methods This was a retrospective non-interventional study based on the Rheumatic Diseases Portuguese Register (Reuma.pt). It was conducted in a cohort of patients aged >18 years with active RA despite previous treatment with conventional DMARDs, biologic-naïve, who started SC GLM+MTX, from March 2011 to August 2015. The cumulative incidence of achieving clinical remission, treatment persistence and functional response/remission were estimated using survival analysis. Cox regression was used to calculate the hazard ratios. Results A total of 109 patients (86.3% female, mean age 55.5±13.2 years; mean age of diagnosis 45.5±13.5 years, rheumatoid factor 78% positive) met the study criteria. Ninety-three had a follow up of at least 52 weeks (i.e. all patients who started treatment before August 2014). At week 52, 38.3% of patients were on clinical remission, 91.9% achieved functional response and 35.2% were on functional remission (HAQ<0.5). The treatment persistence rate was 75.3% for the individuals who were in the study for ≥52 weeks (Figure 1). For functional remission, high CRP levels at baseline seem to be a determining factor (HR=0.54, p=0.026). Conclusions This is the first Golimumab data analysis generated from the Portuguese registry Reuma.pt. Our results are in agreement with data from other national registries and demonstrate the long-term effectiveness and the high treatment persistence rates of GLM through 52 weeks. Disclosure of Interest A. F. Mourão Consultant for: Merck Sharp & Dohme, C. Ribeiro: None declared, J. Borges: None declared, M. J. Gonçalves: None declared, M. Bernardes: None declared, S. Fernandes: None declared, R. Dezerto Employee of: Merck Sharp & Dohme, P. A. Laires Employee of: Merck Sharp & Dohme, P. Machado Employee of: Merck Sharp & Dohme, M. Eusébio: None declared, M. J. Santos: None declared, H. Canhão: None declared

The impact of osteoarthritis on early exit from work: results from a population-based study

BackgroundOsteoarthritis (OA) is a leading cause of pain and disability, which may be a source of productivity losses. The objectives of this study were to describe the impact of OA, namely through pain and physical disability, on early exit from work and to calculate its economic burden.MethodsWe analysed data from the national, cross-sectional, population-based EpiReumaPt study (Sep2011–Dec2013) in which 10,661 individuals were randomly surveyed in order to capture all cases of rheumatic diseases. We used all participants aged 50–64, near the official retirement age, who were clinically validated by experienced rheumatologists (n = 1286), including OA cases. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. The impact of OA on the likelihood of early exit from work and the population attributable fractions used to calculate due economic burden (indirect costs) were obtained at the individual level by logistic regression. All results were based on weighted data.ResultsAlmost one third of the Portuguese population aged 50–64 had OA (29.7%; men: 16.2% and women: 43.5%) and more than half were out of paid work (51.8%). Only knee OA is associated with early exit from work (OR: 2.25; 95%CI: 1.42–3.59; p = 0.001), whereas other OA locations did not reach any statistical difference. Furthermore, we observed an association between self-reported longstanding musculoskeletal pain (OR: 1.55; 95%CI: 1.07–2.23; p = 0.02) and pain interference (OR: 1.35; 95%CI: 1.13–1.62; p = 0.001) with early exit from work. We also detected a clear relationship between levels of disability, measured by the Health Assessment Questionnaire (HAQ), and the probability of work withdrawal. The estimated annual cost of early exit from work attributable to OA was €656 million (€384 per capita; €1294 per OA patient and €2095 per OA patient out-of-work).ConclusionsIn this study, we observed an association between OA and early exit from work, largely dependent on pain and disability. This relationship translates into a meaningful economic burden amounting to approximately 0.4% of the national Gross Domestic Product (GDP). The high prevalence and the impact of this disabling chronic disease highlight the need to prioritize policies targeting early exit from work in OA.

Years of Working Life Lost Caused By Osteoarthritis In Portugal.

§ The estimated prevalence of OA in the Portuguese population (50-64 yo) is 29.7% (knee:18.6%; hand:12.6%; hip:3.6%). § Among these, 61.8% were out of work versus 47.6% for those without OA (p=0.004). § OA is associated with early exit from work (unadjusted OR: 1.78; CI:1.19-2.65; p=0.005. Adjusted OR: 1.83; CI: 1.12-2.96; p=0.015), but not with official early retirement (OR: 1.18; CI:0.78-1.79; p=0.437). § Early exit from work potentially led to 162,735 YWLL (95 per 1000 inhabitants). § Early retirement contributed the most for these YWLL (58%; 94,432 YWLL), followed by unemployment (35%; 57,209 YWLL) and disability pensions (7%; 11,094 YWLL). § Women accounted for 80% of these YWLL (153 per 1000 female inhabitants). § A total of 161,621 PYWLL were estimated if early retirement is considered and 369,839 PYWLL for all forms of exit from work.

AB0581 Two years existence of reuma.pt/vasculitis – the portuguese registry of vasculitis

Background The vasculitides are a group of relatively rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is an electronic clinical record, created in 2008, which currently includes specific protocols for 11 diseases and >16000 patients registered from 79 national and international rheumatology centres. Since October 2014, a dedicated protocol to vasculitis has been created as part of the European Vasculitis Society initiative of having compatible European registries. Objectives To describe the structure of Reuma.pt/Vasculitis and characterize the patients registered over the last two years. Methods We developed a dedicated web-based software to enable prospective collection and central storage of anonymised data from patients with vasculitis. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, imaging and laboratory tests, outcome measures of prognosis, damage, disease activity and quality of life, and treatment were collected. We performed a cross-sectional descriptive analysis of all patients registered up to January 2017. Results A total of 492 patients, with 1114 visits, from 11 centres were registered in Reuma.pt/Vasculitis. The mean age was 53±20 years at last visit; 68% were females. The diagnoses followed the 2012 Chapel Hill Consensus nomenclature (Table 1). The most common diagnoses were Behçets disease (BD) (39%) and giant cell arteritis (GCA) (20%). Patients with BD met the International Study Group 1990 criteria, the International Criteria for BD 2006 and 2013 in 84%, 95% and 95% of cases, respectively. Patients with GCA met the 1990 American College of Rheumatology criteria in 95% of cases. Data on vascular ultrasound was available in 74% of patients; 73% compatible with the diagnosis. Assessment of the Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI) was available for all vasculitides and the Five Factor Score calculation of survival rate for ANCA associated vasculitis (AAV) and polyarteritis nodosa (PAN). The mean BVAS at first visit was 18±7 for AAV and 15±9 for PAN; the mean VDI at last visit was 3±2 for AAV and 2±2 for PAN. Health related quality of life assessments (SF-36, EQD5, FACIT and HADS) were also collected. Treatment registry with the disease assessment variables shown in graphics was available for all patients; only 6% were under biologic treatment. Conclusions Reuma.pt/Vasculitis is a registry adapted for routine care, allowing an efficient data repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking. Disclosure of Interest None declared

SAT0525 The Use of Analgesic and Other Pain Relief Drugs To Manage Chronic Low Back Pain – Results from A National Survey: Table 1.

Background Managing chronic pain is challenging due to the long-term safety profile of most drugs. The treatment of chronic Low Back Pain (CLBP) represents a significant medical and financial burden and aims at relieving pain, improving functional ability, and preventing recurrence and chronicity. It is therefore important to gain insight into how CLBP is managed in the population. Objectives To characterize the intake profile of analgesic and other pain relief drugs in the Portuguese adult population with CLBP, taking the World Health Organization (WHO) analgesic ladder and pain intensity into account. To assess the relationship between having CLBP and the intake of analgesic and other pain relief drugs. Methods EpiReumaPt was a cross-sectional Portuguese population-based study (10,661 subjects). Self-reported active CLBP (ACLBP) was considered: LBP on the day of enrollment and for ≥90 days. Prevalence and profile of analgesic intake was characterized among those self-reporting ACLBP, taking into account the intensity of pain and the WHO analgesic ladder. To understand whether the presence of ACLBP was a factor associated with drug intake, multivariable logistic regressions were conducted for each of the analgesic/pain relief therapeutic groups (in separate models), adjusted for confounders. Results Among 1,487 subjects with ACLBP, 18.7% were using analgesic/pain relief drugs. Estimated prevalences were: anxiolytics, 14.1%; NSAIDs, 12.3%; antidepressants, 10.1%; analgesic antipyretic, 6.6%; anticonvulsants, 3,4%; central muscle relaxants, 2.6%; opioids, 1.6%. Most subjects with severe pain were in the 1st step of the WHO analgesic ladder: NSAIDs plus anxiolytics, sedatives & hypnotics (4.6%); NSAIDs plus antidepressants (3.2%); NSAIDs plus central muscle relaxants (2.5%). The presence of ACLBP was significantly associated with the intake of all therapeutic groups (table):Table 1. Association of the presence of ACLBP with the intake of each class of analgesic/pain relief drugs (separate multivariable models) Dependent variables* Active CLBP (yes/no) OR (95% CI) p-value Anxiolytics, sedatives & hypnotics§ 8.86 (6.08–12.90) <0.001† NSAIDs± 8.56 (5.84–12.53) <0.001† Antidepressants§ 12.56 (7.96–19.81) <0.001† Analgesics, Antipyretics¶ 7.68 (3.38–17.48) <0.001† Anticonvulsants 9.27 (4.16–20.69) <0.001† Analgesic Opioids 8.13 (2.78–23.77) <0.001† Central Muscle Relaxants 12.01 (5.88–24.51) <0.001† *All the analyses were adjusted for: age, gender, geographic area, education level, number of self-reported comorbidities, and self-report of rheumatic and musculoskeletal diseases. §Additionally adjusted for: anxiety and depressive symptoms; ¶Additionally adjusted for: heart disease and gastrointestinal diseases. Conclusions ACLPB was associated with the intake of drugs belonging to all analgesic drug classes. Nevertheless, this drug intake was very low, even for those with severe pain. The WHO analgesic ladder was carefully followed with an extremely conservative use of analgesic opioids even for those with severe pain. There is clearly an unmet need in what concerns pain management in patients with ACLBP, particularly taking into account the well-know burden of LBP. Disclosure of Interest None declared

Years of Working Life Lost Caused By Rheumatic Diseases In Portugal

§ 3.9% (n=66,953/N=1,706,750) of the Portuguese population (50-64 yo) had premature retirement caused by RD. § The majority of the early retirement caused by RD was observed in females (81.6% vs. 41.5% of females in the early retirement group not caused by RD). § As expected the cumulative probability of this sort of early exit from work increases substantially with age, in particular above the age of 50. § The mean age of early retirement caused by RD was 54.8 yo, which led to a total stock of 389,939 YWLL (228 per 1000 inhabitants). § Women account for 85% of these YWLL. § If all forms of exit from work are included this figure rises to 617,764 YWLL (disability: 121,323; unemployment: 106,502). § A total number of 684,960 PYWLL were estimated (401/1000) if early retirement is considered and 1,186,679 PYWLL (695/1000) for all forms of exit from work. § The mean YWLL and PYWLL inactivity ratios were 13% and 25%, respectively. . YEARS OF WORKING LIFE LOST CAUSED BY RHEUMATIC DISEASES IN PORTUGAL