Explore the vast range of titles available.

Background:Intra-articular injections play a pivotal role in managing inflammatory Rheumatic Diseases (IRDs). This procedure done by sterile needle and syringe is used to drain synovial fluid from patient’s joint and medicine (corticosteroids-anti-inflammatory drug) is injected into the intra-articular space with needle and syringe. The injection is typically performed by rheumatologist in outpatient department (OPD) or hospitalized patients. Before administering the injection, skin over the joint is usually cleaned and sterilized to minimize the risk of infection. However, the occurrence of vasovagal syncope post-injection poses a considerable concern, impacting patient safety and procedural efficiency. This study, conducted by specialist nurses aims to investigate and identify the prevalence and preventing factors of vasovagal syncope in OPD. Counseling and explaining about the benefits of joint injection are following:To relieve joints pain, swelling, stiffness, inflammation and control disease.To prevent joints damage, deformities and to increase range of motion.To delay or avoidance of surgical intervention.Objectives:To assess the benefits of counseling in intra articular injection in patients with IRDs and to investigate the prevalence of vasovagal syncope in OPD settings and identify potential preventing factors.Methods:Patients with IRDs attending the Rheumatology clinic of this institution, willing to participate in the survey receiving intra-articular injections, were enrolled in this study. All the information including the follow-up details were recorded in a pre-designed form. Their demographic information (age, gender) and disease characteristics (diagnosis, duration, and co-morbidities treatment) were recorded. Data were collected by rheumatology nurses using structured interviews and medical record reviews. All the patients were counseled and explained about the procedure, preparation and post injection care of and their benefits during visit. The study assessed the prevalence of vasovagal syncope post-injection and examined associated preventing factors such as patient education, anxiety levels.Results:All the 110 patients given injection intra-articular in joints were included in the study were counseled by rheumatology nurses.92.4%patients had no complaints after intra –articular injection. Only 7. 6 % patients developed mild form vasovagal syncope symptoms like anxiety, headache, dizziness, nausea/vomiting sensation, feeling cold, sweating, and palpitation.Symptomatic management is given like medications, comfortable position, vitals monitoring, and advice for rest at least 30min. Patients stabilized and advised to follow up with concerned doctors. Factors contributing to syncope included higher anxiety levels, and inadequate patient education regarding the injection procedure. Interestingly, disease duration and specific IRDs did not significantly correlate with syncope occurrence. The study also explored the impact of counseling regarding the procedure, such as adjusting the injection speed and incorporating distraction techniques, in preventing vasovagal syncope.Conclusion:This study sheds light on the prevalence of vasovagal syncope after intra-articular injections in OPD patients with IRDs. The identification of risk factors, anxiety levels, emphasizes the importance of tailored patient education and support strategies. Moreover, the exploration of procedural modifications provides valuable insights for enhancing patient safety during intra-articular injections. As rheumatology nurses’ counselor play a crucial role in patient care. Future interventions and guidelines may benefit from incorporating these findings to enhance the safety and efficiency of intra-articular injections in rheumatology OPD settings. Health education and counseling given to all the patients before and after intra-articular injections procedure.Don’t panic during intra articular injection.The patient is advised to continue treatment of the co-morbidities like HTN, DM, CAD, and ThyroidREFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Spondyloarthritis is the term for a group of inflammatory chronic diseases primarily affecting the axial skeleton, as well as the peripheral joints. Regarding bone metabolism in these patients, several studies have reported higher levels of inflammatory activity (BASDAI, BASMI, ESR and CRP) in patients with osteoporosis compared to those without this disease, although no correlations were found.Objectives:To describe clinical, serological and biological characteristics, as well as bone and mineral metabolism, according to analytical and densitometric criteria in a patient cohort with spondyloarthritis.Methods:Observational, descriptive and cross-sectional study. A retrospective review was conducted of a database of patients with spondyloarthritis treated during outpatient visits at the Rheumatology Department of Hospital General Universitario de Ciudad Real between June 2018 and June 2019. Variables are described using measures of frequency and of central tendency and dispersion.Results:Cohort of 115 patients (64 men and 51 women). Average age 45.97 years (+/- 13.41 SD). Ankylosing spondylitis in 54 patients, psoriatic arthropathy in 24, spondyloarthropathy associated with inflammatory bowel disease in 8, undifferentiated spondyloarthritis in 18 and other types of spondyloarthritis in 11. Regarding treatment, 40.88% of patients received disease-modifying drugs (methotrexate, sulfasalazine, etc.) and 43.4% received biologic drugs (86% anti-TNF alpha, 12% anti-IL-17 and 2% anti-IL-12/23). Moreover, 53.04% had received corticosteroids during some phase of their disease. Vitamin D levels were 23.81 (+/- 10.5 SD) and 77.4% of patients had a vitamin D deficiency/insufficiency. Of the total cohort, 34.78% presented osteopenia and 3.58% osteoporosis (T-Score and Z-Score).Conclusion:In this study, patients with spondyloarthritis show high percentages of osteopenia and osteoporosis, undiagnosed until this time, along with vitamin D deficiency. This data suggests higher prevalences of these metabolic bone diseases. Osteoporosis prevention is essential due to the risk of developing early fractures resulting from increased bone fragility.References:[1]Pray C, Feroz NI, Nigil Haroon N. Bone Mineral Density and Fracture Risk in Ankylosing Spondylitis: A Meta-Analysis. Calcif Tissue Int. 2017 Aug;101(2):182-192.[2]Zhang M et al. The association between ankylosing spondylitis and the risk of any, hip, or vertebral fracture: A meta-analysis. Medicine (Baltimore). 2017 Dec; 96(50): e8458.[3]Erten S, Kucuksahin O, Sahin A, Altunoglu A, Akyol M, Koca C. Decreased plasma vitamin D levels in patients with undifferentiated spondyloarthritis and ankylosing spondylitis. Intern Med. 2013;52(3):339-44[4]Mermerci B, Pekin Dogan Y, Sivas F, Bodur H, Ozoran K. The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis. Rheumatol Int 2010;30:375-381.[5]Arends S, Spoorenberg A, Bruyn W, Houtman PM, Leijsma MK, Kallenberg CGM, Brouwer E, van der Veerce. The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis. Osteoporos Int 2011;22:1431-1439.[6]Lange U, Teichmann J, Strunk J, Iler-Ladner U, Schmidt KL. Association of 1.25 vitamin D2 deficiency, disease activity and low bone mass in ankylosing spondylitis.Disclosure of Interests:None declared

Background:Diagnosis of axial spondyloarthritis (axSpA) is challenging because of absent physical findings in early disease and the limited diagnostic performance of laboratory markers. Considerable reliance is placed on imaging of the sacroiliac joints (SIJ) but specialty training is primarily focused on interpretation of plain radiographic abnormalities.Objectives:We aimed to identify what might be the primary unmet educational needs of rheumatologists completing fellowship training by using clinical and imaging data from an inception cohort of patients presenting with undiagnosed back pain. We hypothesized that concordance would increase after imaging is reviewed after the clinical data.Methods:The diagnosis of axSpA was compared between local rheumatologists, axSpA experts and pF using clinical and imaging data from the multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study. In this inception cohort, patients ≤45 years of age with ≥3 months back pain undergo diagnostic evaluation by a local SASPIC rheumatologist, including imaging of the SIJ, who then records a global evaluation of presence/absence of axial SpA. This is done at 3 consecutive stages: 1.After the clinical evaluation. 2.After the results of labs (HLA B27, CRP) and radiography. 3.After review of the local MRI. In this exercise, 20 cases were selected from the SASPIC cohort and the rheumatologist global evaluations were removed from the eCRFs. Four experts in axSpA reviewed the clinical and imaging data in each eCRF and provided their global evaluations for stages 1, 2, and 3 of these 20 cases. Subsequently, 4 pF rheumatologists conducted the same exercise blinded to the assessments of the local rheumatologist and experts in axSpA. Concordance (% agreement) between the assessors was analyzed.Results:Diagnosis of axSpA by the local SASPIC rheumatologist was made in 90%, 65%, and 75% of cases after stages 1, 2, and 3, respectively. Majority diagnosis of axSpA by experts was made in 84.2% (16/19), 57.9% (11/19), and 63.2% (12/19), after stages 1,2, and 3, respectively. Majority diagnosis of axSpA by pF rheumatologists was made in 94.4% (17/18), 100% (16/16), and 93.8% (15/16). Concordance among experts and between experts and local SASPIC rheumatologists increased after review of imaging data. For pf-rheumatologists concordance with experts increased after review of imaging for 2 assessors and decreased for the other 2 assessors. For the latter, the primary reason for decrease in concordance with experts was false positive diagnosis of axSpA in 35% and 30% of the cases after review of the imaging.Conclusion:A structured case-based and sequential evaluation of clinical and imaging data suggests a gap in the training of recently graduated rheumatologists, with over-interpretation of imaging leading to false positive diagnosis of axSpA.AssessorsMean % Concordance (range) for diagnosis of axSpAStage 1Stage 2Stage 3Experts in axSpA64.2 (45-80)75.8 (65-85)84.2 (70-95)Local rheumatologist vs Experts in axSpA73.8 (70-80)83.8 (80-85)83.8 (80-90)pF rheumatologist 1 vs Experts consensus78.994.494.7pF rheumatologist 2 vs Experts consensus89.561.168.4pF rheumatologist 3 vs Experts consensus63.272.284.2pF rheumatologist 4 vs Experts consensus89.566.768.4Disclosure of Interests:Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Liron Caplan: None declared, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Soha Dolatabadi: None declared, Mark Hwang: None declared, Adam Carlson: None declared, Kelly Steed: None declared, Amanda Carapellucci: None declared, Joel Paschke: None declared, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB

Background:The drugs that inhibit tumor necrosis factor (anti-TNF) alpha can reactivate a latent tuberculosis infection (ILTB) so requiring a rigorous screening before its onset. The tuberculin test (PT) has a high false negative rate in patients with immunomediated rheumatic diseases (IMID) and false positive in patients vaccinated with Bacillus Calmette Guérin (BCG). The neu methods of interferon gamma release (IGRA) seem to solve this problem, but its use is not standardized.Objectives:Establish the degree of concordance in the diagnosis of ILTB between PT and IGRA in patients who are going to star an anti-TNF drug, in general, and in different situation like taking corticosteroids, being treated with disease modifying drugs, have been vaccinated with BCG or have risk factor for ILTB.Methods:From May 2016 to November 2019, 195 patients with IMID who underwent ITLB screening prior to the initiation of an anti-TNF drug were included in this study. The concordance between PT and IGRA was calculated using the cohen’s kappa index, for the general sample first and then for subgroups. An analysis of the factor that influence the result of PT and IGRA has also been carried out.Results:The prevalence of ILTB was 26.7%. Of the total positive PT and Booster (n=50), QTF-G-IT was positive only in 15 patients (30%). The agreement between PT and QTF-G-IT was 0.33 (p<0.05). In the subproups, a moderate agreement was found in patients who did not take corticosteroids (k=0.45, p<0,05) and greater than the global one in those who had risk factor for ITLB (k=0.37, p<0.05).Conclusion:In our study the agreement between PT and QT-G-IT is low in general, being somewhat higher in unvaccinated patients and with a high probability for ILTB. Taking this result into account due to the low concordance, the ideal ILTB screening strategy in patients who are going to start a anti-TNF would consist of performing both tests.References:[1]Goletti D, Petrone L, Ippolito G, Niccoli L, Cantini F, Goletti D, et al. Expert Review of Anti-infective Therapy Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs with biological drugs. Expert Rev Anti Infect Ther. 2018;16(6):501-12.[2]Ortiz AM, González-álvaro I, Laffón A. Mecanism os de acción de fármacos modificadores de la evolución de la artritis reumatoide. 2001;420-7.[3]Algood HMS, Lin PL, Flynn JL. Tumor necrosis factor and chemokine interactions in the formation and maintenance of granulomas in tuberculosis. Clin Infect Dis. agosto de 2005;41 Suppl 3:S189-93.[4]Bopst M, Garcia I, Guler R, Olleros ML, Rulicke T, Muller M, et al. Differential effects of TNF and LTalpha in the host defense against M. bovis BCG. Eur J Immunol. junio de 2001;31(6):1935-43.[5]Winthrop KL, Novosad SA, Baddley JW, Calabrese L, Chiller T, Polgreen P, et al. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis. diciembre de 2015;74(12):2107-16.[6]Randhawa PS. Lymphocyte subsets in granulomas of human tuberculosis: an in situ immunofluorescence study using monoclonal antibodies. Pathology. julio de 1990;22(3):153-5.[7]Gardam MA, Keystone EC, Menzies R, Manners S, Skamene E, Long R, et al. Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis. marzo de 2003;3(3):148-55.[8]Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. octubre de 2001;345(15):1098-104.[9]Gomez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum. agosto de 2003;48(8):2122-7.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is associated with increased risk of cardiovascular disease (CVD) disease and CV mortality1. High values of cardiorespiratory fitness (CRF) are protective against CVD and CV mortality2. Physical activity levels in patients with RA are low. Knowledge on whether physical activity is associated with CRF in patients with RA and high CV risk is scarce. This knowledge is important because improving the level of physical activity could improve CRF and lower CV risk in this group of patients with RA and high CV risk. However, it is unclear whether physical activity is associated with CRF in this group of patients. This study presents the preliminary results at baseline of the association of physical activity with CRF from an ongoing pilot study aimed at improving CRF through exercise therapy in patients with RA and high CV risk.Objectives:To determine (i) the level of physical activity in patients with RA and high CV risk and (ii) whether physical activity is associated with CRF in patients with RA and high CV risk.Methods:Patients with RA and high CV risk participated in this pilot study. Increased 10-year risk of CV mortality was determined by using the Dutch SCORE-table. Anthropometrics and disease characteristics were collected. Physical activity was assessed with an Actigraph accelerometer to determine the number of steps and intensity of physical activity expressed in terms of sedentary, light, and moderate-to-vigorous time per day. Participants wore the accelerometer for seven days. A minimum of four measurement days with a wear time of at least 10 hours was required. The VO2 max measured with a graded maximal exercise test was used to determine the CRF. Pearson correlation coefficients were calculated for the associations between the different measures of physical activity and VO2max. For the variables that were associated, linear regression analysis was carried out, with pain and disease activity as possible confounders.Results:Thirteen females and five males were included in the study. The mean age was 66.5 (± 15.0) years. Only 22% of the patients met public health physical activity guidelines for the minimal amount of 150 minutes a week. The mean step count was 6237 (± 2297) steps per day and mean moderate-to-vigorous physical activity time was 16.50 (± 23.56) minutes per day. The median VO2max was 16.23 [4.63] ml·kg-1·min-1, which is under the standard. Pearson correlations showed a significant positive association for step count with VO2max. No associations were found for sedentary, light, and moderate-to-vigorous physical activity with VO2max. The significant association between step count and VO2max(p = 0.01) was not confounded by disease severity and pain.Discussion:Since better CRF protects against CVD, increasing daily step count may be a simple way to reduce the risk of CVD in patients with RA and high CV risk. However, these results need to be confirmed in a larger study group. Future research should investigate if improving daily step count will lead to better CRF levels and ultimately will lead to a reduction in CV risk in patients with RA and high CV risk.Conclusion:Physical activity levels of patients with RA and high CV risk do not meet public health requirements for physical activity criteria and the VO2max was under the standard. Step count is positively associated with CRF.References:[1]Agca et al. Atherosclerotic cardiovascular disease in patients with chronic inflammatory joint disorders. Heart. 2016;102(10):790-795.[2]Lemes et al. Cardiorespiratory fitness and risk of all-cause, cardiovascular disease, and cancer mortality in men with musculoskeletal conditions. J Phys Act Health. 2019;16;134-140.Disclosure of Interests:Joëlle van den Hoek: None declared, Marike van der Leeden: None declared, George Metsios: None declared, Georeg Kitas: None declared, Harald Jorstad: None declared, WIllem Lems Grant/research support from: Pfizer, Consultant of: Lilly, Pfizer, Michael Nurmohamed Grant/research support from: Not related to this research, Consultant of: Not related to this research, Speakers bureau: Not related to this research, Martin van der Esch: None declared

Background:Psoriatic Arthritis and Psoriasis have a major impact on QOL with associated mood disorders and Cardiovascular disease and Cancer as inter-related co-morbidities 1. Yoga therapy (Y-T) has been used in several Long Term Conditions 2 and we have reported Rapid improvement in Proms in RA (RCP 2018) and so compared results of a PsA cohort offered the same Y-T intervention.Objectives:This first in UK PsA study investigated: a) impact of a 16 week Y-T intervention on functional outcomes and QOL in 10 PsA patients, b) acceptability and experiences of the intervention. We present results in comparison to a previously reported RA cohort n=10.Methods:Ten adult PsA patients (2 M 8 F Age 32-67 Avg: 53.7 Y; PsA diagnosis: 6.45 yrs:1 Juvenile onset) consented to 10 individual Y-T sessions (weekly x 4; biweekly x 6) with a yoga therapist in a standard consulting room. The intervention was tailored to the needs and abilities of each patient and included: breath-centered physical yoga postures, breathing and visualization techniques, mantras and meditation, with supportive Lifestyle/behavioural strategies. All participants completed measures pre- and post-intervention (EQ-5D HAQ HADS PGIC) to assess change in health status.Results:A 10 session course of Y-T over 16 weeks was completed with 92/100 PsA YT sessions. Note 1 patient had unrelated Trauma and withdrew after 2 sessions. This confirms acceptability of delivery in a clinic setting and all participants reported strong adherence to practices (0-1) and strong belief (0-2) in impact of yoga. (Likert 5 point 0-4 scale).Further data on only 9 PsA participants will be presented in comparison to the previous RA cohort of 10.PsA patients n=9: Pain reduced 25 % HADs Depression reduced 39% Anxiety reduced 25%HAQ health score improvement was significant at P<0.04 (ANOVA).EQol 5d(3L) improved 24% but overall QOL remained below 50% max calculated TTO.RA patients had recorded stable overall TTO at a higher level 0.63 pre and post Y-T.PGIC record of positive change is recorded as a reduction on VAS from 5/5 to 2.4/5.We will add 12 month FU data set in PsA to compare with 24 month data in the RA cohort.Conclusion:Yoga-Therapy is deliverable and acceptable in a NHS clinic setting for PsA. Improved PROMS begs further larger studies of mechanisms of bio-psychosocial intervention in long term inflammatory conditions. The outcomes support the Poly Vagal Theory 3 as an effector model, via the bio-mechanistic neuro-inflammatory reflex 4. We propose further Health Economic analysis of this 2500 yr old Yoga model for long term conditions to examine any long term cost benefit to the NHS.References:[1]Coates LC et al Rheumatology 2018;57:1321-1331 Remission in psoriatic arthritis-where are we now?[2]Khalsa, SB, Cohen, L, McCall, T & Telles, S (2016) (Eds). The Principles and Practice of Yoga in Health Care. Handspring Publishing.[3]Sullivan M B Porges SW et alFront. Hum. Neurosci., 2018 Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience[4]Pavlov V Tracey K Nat Rev Endocrinol. 2012 Dec; 8(12): 743–754. The vagus nerve and the inflammatory reflex—linking immunity and metabolismTable 1.PsA vs RA post Yoga Therapy PROMs at 4 mth.PsA n=9 prePsA 4 mPsA 4 m %RA n=10 PreRA4m FURA 4m %HADS m Depression6.333.88-396.72.3- 65 HADS m Anxiety8.566.44-259.44.8- 48 Mean HAQ0.790.75- 20.780.48- 26 M Pain Score (HAQ)6045.00-255724- 58M Health Score (HAQ)6042.7-29 p<0.045117.2- 66 M H Utility TTO (EQol5d)0.410.5+240.630.630 PGIC52.4Acknowledgments:CMH Rheumatology Support GroupDisclosure of Interests:C Bernard Colaco Grant/research support from: Travel Support for Conference attendance, Speakers bureau: Menarini, Vidhi Sadana: None declared, Kofi Anie: None declared

Background:Inflammatory disorders have been associated with an increased risk of malnutrition, defined as an abnormal physiologic condition caused by an insufficient, unbalanced or excessive intake of nutrients due to exacerbated metabolic states.1Mini Nutritional Assessment (MNA) and Nutritional Risk Screening Tool 2002 (NRS-2002) have been used to evaluate nutritional status in patients with rheumatic diseases.Objectives:Compare MNA and NRS-2002 as tools for nutritional screening in rheumatic patients.Methods:152 patients with rheumatic diseases were evaluated in a Rheumatology center of México. Anthropometrical measurements were performed using Bioelectrical Impedance Analysis (BIA) TANITA. MNA and NRS-2002 were applied at the same date.MNA is comprised of a dietary questionnaire, subjective and objective global assessment and anthropometrical measurements, classified as adequate (MNA 24-30), risk for malnutrition (MNA 17–23.5) and malnutrition (MNA<17).NRS-2002 consists of nutritional and severity disease score and an age adjustment for patients >70 years (+1); classified as normal (0-3) and risk of malnutrition/established malnutrition (3 or more).For statistical analysis the SPSS v24 was used. A p <0.05 was considered statistically significant.Results:A total of 152 patients with different rheumatic diseases were included, Table 1. The results according to each tool are represented in Graphic 1. A significant difference was found by the Chi-Square-test when comparing both tools, (p<0.004).Table 1.Socio-demographic characteristics of rheumatic patientsDISEASES, n (%)Rheumatoid Arthritis70 (46.1)Systemic Lupus Erythematosus19 (12.5)Ostearthrosis18 (11.8)Sjögren´s Syndrome5 (3.3)Fibromyalgia4 (2.6)Ankylosing Spondylitis2 (1.3)Systemic Sclerosis6 (3.9)Others27 (17.8)SOCIO-DEMOGRAPHICSAge, mean years (SD)51.98 (13.56)BMI, mean (SD)28.14 (5.8)Brachial Circumference, cm, (SD)32.57 (4.19)Calf Circumference, cm, (SD)37.08 (4.17)A subanalysis in 70 Rheumatoid Arthritis patients was done with a mean age of 50.94 years (SD±12.11) and a mean BMI 28.53 kg/m2 (SD 5.48). The results according to each tool are represented in Table 2. When NRS-2002 was reclassified in 3 parameters (normal <2, risk of malnutrition 2 and malnutrition 3 or more), a significant difference persisted (p. 05) with a low correlation (.43).Table 2.Descriptive data of MNA and NRS-2002 in rheumatic diseases.NUTRITIONAL SCREENING TOOLSMNANRS-2002NRS-2002*RhopAll Rheumatic DiseasesTotal Score, n(SD)24.31 (3.48)______.23.004Malnutrition, n(%)4 (2.6)5 (3.3)5 (3.3)Risk, n(%)55 (36.2)147 (96.7)41(27)Normal, n(%)93 (61.2)106 (69.7)Rheumatoid ArthritisTotal Score, n(SD)24.43 (3.23)______.43.05Malnutrition, n(%)1 (1.4)2 (2.9)2 (2.9)Risk, n(%)22 (31.4)68 (97.1)15 (21.4)Normal, n(%)47 (67.1)53 (75.7)Conclusion:MNA was a more sensible tool for detecting risk of malnutrition when compared to NRS-2002. Screening tools play an important role at nutritional evaluation and should be complemented with objective methods such as BIA.1 Rheumatologists must be aware that nutritional disorders affect the state of rheumatic diseases; and selecting an appropriate tool to detect malnutrition is of vital importance.References:[1]Elkan, A. C., Engvall, I. L., Tengstrand, B., Cederholm, T., & Hafström, I. (2008). Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. European journal of clinical nutrition, 62(10), 1239-1247.Figure 1.Graphic 1. Nutritional screening tools in rhematic disorders. Total N= 152 patients. MNA= Mini Nutritional Assessment NRS-2002= Nutritional Risk Screening Tool-2002. NRS-2002*= Nutritional Risk Screening Modified with 3 parameters.Disclosure of Interests:None declared

Background:Patients with rheumatological foot disease are an overlooked population, and it was noted locally that these patients received a fragmented service; attending multiple appointments for the management of one clinical issue. This led to delays in treatment; significant inter-departmental correspondence and variations in the peri-operative management of disease modifying anti-rheumatic drug (DMARD) and biologic therapies. To remedy this a foot multidisciplinary (MDT) clinic was established, including input from rheumatology, orthopaedic surgery, specialist rheumatology podiatry and physiotherapy. The outcomes from the foot MDT clinic have been analysed in this service evaluation project.Objectives:To evaluate the outcomes of the multidisciplinary foot MDT clinic, with particular reference to concordance to the British Rheumatology Society (BSR) guidelines on peri-operative medicine guidelines.Methods:Data was collected retrospectively across all clinics from January 2017 to February 2019. Clinic letters were obtained, and data was collected using a standardised data collection sheet. Data was collected on patient demographics, rheumatological diagnoses, treatment outcomes from the foot MDT, appropriateness of peri-operative plan and post-operative complications. No data was available on these outcomes prior to the advent of the foot MDT clinic.Results:Data from 12 clinics was analysed (n=40). Patients had a median age of 66 years (IQR 27.5 years); 65% of patients were female and 35% of patients were male. The commonest rheumatological foot disease seen was rheumatoid arthritis (67%), followed by psoriatic arthritis (15%). All patients were treated with biologic or non-biologic DMARDs. Treatment outcomes were as follows: 27.5% were offered surgical treatment; 10% were offered intra-articular (IA) injections under ultrasound guidance; 10% were offered IA injections under general anaesthetic; 25% underwent specialist rheumatology podiatry, and the remaining 30% elected for a conservative approach after careful consideration of treatment options. Of those who were offered surgical treatment, 72% of patients were provided with a peri-operative plan which accorded with British Rheumatology Society (BSR) guidelines. Of those whom underwent surgery, one patient’s surgical treatment was complicated by a post-operative infection; however, the peri-operative DMARD/biologic plan was not felt to be contributing factor.Conclusion:The foot MDT clinic provides a comprehensive review of rheumatological foot conditions, with readily available access to a full range of treatment options. Co-location of all relevant professionals allows for real-time interdepartmental communication; shared decision making between clinicians and patients; avoids multiple appointments; reduces uncertainty with peri-operative planning as well as providing a cost-effective and efficacious service. Discrepancies in the peri-operative plan for medicines arose when the treating orthopaedic surgeon was not present in clinic. In these cases, the plan for surgical treatment was made outside of this clinic, without input from the treating rheumatologist. To improve concordance with BSR peri-operative medicine guidelines, it is recommended that all treatment decisions are made during the clinic, allowing input from all relevant partners. Informal feedback from patients commended the foot MDT, this shall be formalised through further qualitative data.Disclosure of Interests:None declared

Background:Psoriatic Arthritis (PsA) is a rheumatic disease affecting 0.19% of the UK population (1). It is characterised by asymmetric oligoarticular or polyarticular peripheral arthritis or axial disease with or without associated peripheral arthritis (2). Foot manifestations of synovitis, enthesitis, dactylitis and skin and nail involvement (3) are reported. Hyslop et al. have previously reported high levels of foot involvement but low current access to foot care (4). Outcome measures that include specific PsA related foot features do exist, e.g. Leeds Enthesitis Index, Tender Dactylitis Count (5). However there is currently no measure of foot involvement and impact in PsA (6).Objectives:To identify the impact of PsA on foot health and indication of podiatry need in a secondary care outpatient setting.Methods:convenience sample was taken from a consultant rheumatologist’s outpatient clinic and screened. Only those with a diagnosis of PsA were included. Sampling was conducted over a ten-week period. Screening was done using the Swindon Foot and Ankle Questionnaire (SFAQ) (7), visual Analogue Scale (VAS), clinical judgement of need for podiatric intervention and the trust’s eligibility criteria for routine podiatric care.Results:The sample (n=16) was 31.3% male with a median age of 59 years (range 28-81).Table 1.Footcare/Podiatric need identified Percentage (%)Orthotic intervention, acute or routine care81.3Already being met25.0Eligible for care in podiatry primary care service81.3Table 2.SFAQ results Percentage Yes (%)During the past week have your feet or ankles: Been painful?68.8Been Swollen?62.5Made walking difficult?81.3Made standing up difficult?50.0Stopped you going to work?27.3Made other daily activities difficult?42.9Do your shoes rub the skin on your feet or ankles?31.3Do you have callus or hard, dry skin?50.0Have you had your footwear adapted or insoles made?25.0Have you had surgery, or are you waiting for surgery, on your feet or ankles?18.8Conclusion:Of this patient group, 81.3% had a variety of foot care needs but these were being met in a limited number of cases (25%). Far more patients (81.3%) were eligible for care in the local trust’s primary care podiatry service but were not engaging with this. 50% of the sample reported difficulty standing in the past week and 27.3% found their foot pain stopped them from going to work, indicating a clear need for foot health intervention.Recommendations:-Raise awareness of availability of podiatric care for PsA patients among patients and secondary care staff.- Ensure adequate resources are allocated to manage this cohort of patients at a service provision level.- Further research involving PsA patients referred into podiatry to assess the impact of podiatric intervention.References:[1]Ogdie A et al.(2012) Prevalence and treatment patterns of psoriatic arthritis in the UK. Rheumatology. 7;52(3):568-75.[2]Cantini F, et al.(2010) Psoriatic arthritis: a systematic review. Int J Rheum Dis.13(4):300–17.[3]Huynh D and Kavanaugh A. (2015) Psoriatic arthritis: current therapy and future approaches. Rheumatology. 54:20–8.[4]Hyslop E et al. (2010) Foot problems in psoriatic arthritis: high burden and low care provision.Ann Rheum Dis.69(5):928[5]Assessing psoriatic arthritis in your clinic – trainer manual. 2017 https://www.psoriatic-arthritis.co.uk/assessmenttools.aspx (accessed 22-6-19)[6]Carter K et al. (2019) Linking the patient experience of foot involvement related to psoriatic arthritis to the international classification of functioning, disability and health. EULAR poster abstract THU0713-HPR[7]Waller R et al. (2012) The swindon foot and ankle questionnaire: is a picture worth a thousand words?. ISRN rheumatology. 26;2012.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a chronic inflammatory and complex disease. Patients with RA face other diseases that might lead to increase morbidity. In patients with RA it has been stablished a high prevalence of comorbidities and their risk factors (1).Objectives:The aim of this study was to evaluate the prevalence of comorbidities in Colombian patients with RA enrolled in an educational multidisciplinary program and possible correlation with disease activityMethods:We performed a cross-sectional study; we included patients with confirmed diagnosis of rheumatoid arthritis in a specialized RA center. We collected sociodemographic data, and markers of disease activity DAS28. We collected data regarding the history of comorbidities such as hypertension, dyslipidemia, osteoporosis, type 2 diabetes mellitus, hypothyroidism, malignancies, among others. We performed a descriptive analysis, variables with a normal distribution were described using mean and standard deviation (SD), and non- normal distributed variables were described using median and interquartile range. Categorical variables were presented as rates. We evaluated the relationship between disease activity and comorbidities.Results:We included 251 patients; mean age was 59 ± 9.8 years old, with a high proportion of women 93%; median disease duration was 15 years RIQ (8-20); in this study, 145 (65%) of patients were in remission; 35 (11%) had low, 44 (20%) moderate and 10 (4%) high disease activity. Regarding pharmacological therapy, 55% were receiving conventional DMARDs. The prevalence of comorbidities was 85%, the most common were high blood pressure 25% followed by hypothyroidism 12% and diabetes 10%, 0.7% of patients had malignancies such as thyroid cancer or breast cancer, 1.29% of patients had renal comorbidities. Among comorbidities related to RA 30% had osteoporosis and 20% arthrosis. We did not find a statistical association between DAS28 and comorbidities.Conclusion:As other studies have shown, there is a high prevalence of comorbidities among RA patients, mainly high blood pressure. Due to the above, it is relevant to evaluate the risks factors of patients with RA, especially cardiovascular risks. We consider that a multidisciplinary program represents an opportunity not only to educate patients about healthy life styles and the management of RA, but also other diseases in order to increase the empowering of the health status in these poly pathological patients(2).References:[1]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best practice & research Clinical rheumatology. 2011;25(4):469-83.[2]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Wah-Suarez M, et al. Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatology international. 2017;37(9):1507-11.Acknowledgments:This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid ArthrtitisDisclosure of Interests:Michael Cabrera: None declared, Fernando Rodriguez: None declared, Diana Buitrago-Garcia: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.