Nélia Gouveia

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).

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.

AB1155 Self-Reported Rheumatic Diseases and Early Retirement in Portugal – Results from the Portuguese Epidemiology Study on Rheumatic Diseases (Epireumapt)

Background Chronic diseases and in particular rheumatic diseases (RD) may lead to early retirement, generating substantial costs to society. Objectives We aim to examine the association between self-reported RD and early retirement by using large real-world observational data. Methods EpiReumaPt was a national, cross-sectional, population-based study conducted from September 2011 to December 2013. 10,661 inhabitants were randomly surveyed in order to capture and characterize all cases of RD within a representative sample of the Portuguese population, which were stratified by administrative territorial units (NUTSII). In this analysis we used all participants aged between 50 and 65 years old, near the official retirement age (N=2,792; females: 1,727). The association of self-reported RD and early retirement was tested using individual level logistic regression. All estimates were computed as weighted proportions, in order to take into account the sampling. Results 29.9% of the Portuguese population with ages between 50 and 64 years old were officially retired. Among these, 43.2% were retired due to ill-health, which in turn about a third (30.4%) was specifically due to RD. Thus, 13.1% of all retirees self-reported RD as the main reason for early retirement. More than a third (34.2%; females: 46.3%) of all study population self-reported RD, being also more likely to self-report other main chronic disease (OR: 3.4; CI: 2.53-4.65; p<0.001). 35.2% of RD respondents were retired versus 27.2% of those non-RD (p=0.025). Prevalence of self-reported RD seems to be associated with early retirement (unadjusted OR: 1.45; CI: 1.05-2.01; p=0.025). Some other characteristics are also associated with early retirement, in particular older age, male gender and presence of other chronic diseases. RD association tends to be independently associated with early retirement (adjusted OR: 1.41; CI: 1.03-1.95; p=0.031). Conclusions These results are in line with previous data from the National Health Survey conducted in Portugal nearly a decade ago and confirms the impact that self-reported RD still have on early retirement. Nevertheless, further analysis should be done in order to analyze clinically confirmed RD and to address the different RD and its relationship with early retirement. 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

Cost of Early Retirement Caused By Rheumatic Diseases In Portugal

§ 29.9% of the Portuguese population with ages between 50 and 64 yo were officially retired. § Among these, 13.1% were retired due to RD (3.9% of overall population). § The estimated annual indirect cost following premature retirement caused by RD was €910 million (€555 per capita; €1,625 per self-reported RD patient and €13,592 per early retiree due to RD). § Females contributed with 84% for these costs (€766 million; €882 per capita versus €187 from males). § The mean retirement age for early retirees due to RD was 54.8 yo. § Thus, we estimate an average indirect cost of €138,635 per early retiree due to RD until official retirement age (assuming 65 yo and fixed annual productivity values). COST OF EARLY RETIREMENT CAUSED BY RHEUMATIC DISEASES IN PORTUGAL

AB0835 Association Between Sociodemographic and Clinical Features with Radiographic Severity in Knee Osteoarthritis – Results from Epireumapt

Objectives To assess patient characteristics associated with radiographic severity in knee osteoarthritis (KOA) in a population-based study. Methods EpiReumaPt is a national epidemiologic, cross-sectional study of rheumatic diseases (RD) in the Portuguese population conducted from September 2011 to December 2013. From the 3877 patients assessed by a rheumatologist on the second phase of the study, we included all cases of KOA defined according to the American College of Rheumatology clinical and/or radiographic classification criteria. Knee x-rays were acquired using a standardized protocol and centrally scored according to the Kellgren-Lawrence (KL) scale. The knee osteoarthritis outcome score (KOOS) was used to assess KOA clinical features. Weighted stepwise multivariate logistic regression was used to assess which features associated with radiographic severity, after stratifying the disease in mild (grade 0 to 2) and severe (grade 3 and 4) KOA according to the KL scale. Results A total of 981 (weighted prevalence: 12.4%) patients were classified as KOA patients. Knee radiographs were available for 553 patients. From those, 318 (63.7%) had mild disease and 235 (36.3%) had severe disease. On the multivariate analysis, several patients features were significantly and independently associated to radiographic severity: age (OR: 1.08; p<0.001), obesity (OR: 2.7; p=0.014); dyslipidemia (OR: 2.73; p=0.002), the total number of non-rheumatic comorbidities (OR: 0.63; p<0.001); Country region (OR: 0.61; p<0.001); orthopedic intervention of the knee (OR: 4.71; p=0.004); KOOS symptoms subscale (OR: 0.96; p=0.001; higher KOOS, less symptoms). Alentejo region had the higher proportion of severe disease [56.0% (36.2-75.7)], whereas Lisbon area had the lowest [36.4% (26.9-45.8)]. Conclusions We found several clinical and sociodemographic features associated with radiographic severity in KOA patients. Our findings contribute to the understanding of disease progression mediators. A longitudinal evaluation is needed to validate these results. Disclosure of Interest None declared