The rates of relapses and therapy discontinuation in patients with giant cell arteritis (GCA) in the modern therapeutic era have not been defined. We aimed to evaluate the glucocorticoid (GC) discontinuation rate and the factors associated with relapses in a contemporary GCA cohort. Patient and treatment data were collected cross-sectionally at first evaluation and 2 years later (second evaluation), in a multicenter, prospective GCA cohort. Predictors of relapses were identified by logistic regression analyses. 243 patients with GCA were initially included (67% women, mean age at diagnosis: 72.1 years, median disease duration: 2 years) while 2 years later complete data for 160 patients were available and analyzed. All patients had received GCs at diagnosis (mean daily prednisolone dose: 40 mg) while during follow-up, 37% received non-biologic and 16% biologic agents, respectively. At second evaluation, 72% of patients were still on therapy (GCs: 58% and/or GC-sparing agents: 29%). Relapses occurred in 27% of patients during follow-up; by multivariable logistic regression analysis, large vessel involvement at diagnosis [odds ratio (OR) = 4.22], a cardiovascular event during follow-up (OR = 4.60) and a higher initial GC daily dose (OR = 1.04), were associated with these relapses. In this large, real-life, contemporary GCA cohort, the rates of GC discontinuation and relapses were 40% and 27%, respectively. Large vessel involvement, a higher GC dose at diagnosis and new cardiovascular events during follow-up were associated with relapses.

Background: There are limited data regarding therapy discontinuation in patients with giant cell arteritis (GCA) followed for a long period of time (>5 years). Objectives: We aimed to evaluate the long-term rate and factors associated with therapy discontinuation in a real-life GCA cohort. Methods: Patient and treatment data were collected at 3 different time points (baseline, 2 and 5 years later) in a multicenter, prospective GCA cohort. The rates of therapy discontinuation and its predictors were identified by uni- and multi- variable logistic regression analyses Results: 89 patients with data available for all time points of evaluation were included in the study; 75% were women with a mean age of 71.6±8.1 years and a median disease duration from diagnosis to last evaluation of 7.2 years. All patients had been treated initially with glucocorticoids (GCs, 100%, median daily dose: 40mg prednisolone) while during follow-up, 34% (30/89) had received cs-DMARDs and/or b-DMARDs (17%, 15/89), respectively. 40.4% (36/89) of patients had ≥1 disease relapses during this period. At the last follow-up visit, 48% (43/89) of patients managed to discontinue all therapies and 54% GCs (48/89), respectively. By uni-variable logistic regression analysis, factors associated with therapy discontinuation included the absence of relapses (OR=2.76; 95%CI: 1.13-6.74) and the lack of treatment with GC-sparing agents (b- and/or cs-DMARDs, OR=4.69; 95%CI: 1.76-12.50). By multi-variable logistic regression analysis, patients who did not require a GC-sparing agent (b- and/or cs-DMARDs) had a higher likelihood to discontinue all therapies (OR=5.15; 95%CI: 1.56.-17.01). Conclusion: In this real-life GCA cohort, approximately 40% of patients relapsed while only half were able to discontinue all therapies, ~7 years after diagnosis. The absence of relapses and requirement for GC-sparing agents were associated with a higher likelihood of drug discontinuation. Whether earlier introduction of GC-sparing agents could improve the chance for drug discontinuation by preventing relapses remains to be studied. REFERENCES: NIL. Acknowledgements: Supported in part by the Greek Rheumatology Society and Professional Association of Rheumatologists (ERE-EPERE) and the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece (DV #12085, 12086). Disclosure of Interests: None declared.

Background Despite significant advances in the diagnosis and therapy of giant cell arteritis (GCA), relapses during the disease course are common. The exact predictors for their occurrence at diagnosis or during the disease course have not been defined. Objectives To evaluate the frequency and predictors of relapses in a real-life GCA cohort. Methods Data were derived from an ongoing, multicenter, prospective cohort study of patients with GCA. Patients were evaluated at baseline and approximately 2 years later. Data regarding their demographics, clinical characteristics, treatment patterns, co-morbidities and relapses were retrospectively and prospectively collected and analyzed. Predictors of relapse were examined by logistic regression analyses. Results At the 1st cross-sectional evaluation, 254 patients with GCA were included; 68% were women with a mean age of 72.3 years at diagnosis and a mean disease duration of 2 years. Diagnosis had been established by temporal artery biopsy in 67% (n=171) and by ultrasound of temporal arteries in 21% (n=53) of patients. At the 2nd evaluation (median follow-up: 2.02 years), data were available for 199 patients (78%). All patients had been treated initially with glucocorticoids (GCs, mean prednisolone dose = 40 mg/day) and during the disease course additionally with non-biologic (39%, n=59) and/or biologic (16%, n=25) agents. At the 2nd evaluation time point, 73% of patients were still on therapy with GCs (60%) and/or GC-sparing agents (29%: non-biologics: 16%, biologics: 13%). During the prospective follow-up phase of 2 years, 27% (n=43) of patients had at least one disease relapse. Relapsing patients had shorter disease duration at 1st evaluation (1.4 vs. 4 years, p=0.015), more frequent large vessel involvement at diagnosis (21% vs. 8%, p=0.019) and cardiovascular events (CDV) during follow-up (14% vs. 4.2%, p=0.032), and had received a higher GC daily dose at diagnosis (mean 46.2 vs. 39.9 mg, p=0.01) compared to the non-relapsing ones. By multivariable logistic regression analysis, large vessel involvement at diagnosis [odds ratio (OR) (95% confidence intervals) = 4.22 (1.14, 15.58)], a cardiovascular event (CVD) during follow-up [OR = 4.60 (1.11, 19.13)] and a higher GC daily dose at diagnosis [OR = 1.04 (1.00, 1.08)] were associated with disease relapses. Conclusion In this large, real-life, long -term GCA cohort, despite continued treatment with GCs and/or GC-sparing agents, relapses occurred in 27% of patients. Factors associated with relapses included large vessel involvement and high GC dose at diagnosis as well as cardiovascular events during follow up. These are novel findings that could be useful in the design of the appropriate monitoring and therapeutic strategies in these patients. Acknowledgements Supported in part by the Greek Rheumatology Society and Professional Association of Rheumatologists (ERE-EPERE) and the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece (DV #12085, 12086). Disclosure of Interests None Declared.

To evaluate the effect of the phosphodiesterase 4 inhibitor apremilast in biologic-naïve patients with early peripheral PsA in terms of disease activity, clinical manifestations, patient-perceived outcomes, as well as apremilast’s safety profile in routine care settings of Greece. Non-interventional, multicenter, 52-week prospective cohort study, enrolling biologic-naïve patients with early active peripheral PsA who started apremilast after intolerance or inadequate response (within the first 12 months of treatment) to an initial conventional synthetic (cs)DMARD treatment. Non-responder imputation was applied for missing data.In total, 167 consecutive patients (mean age: 52.5 years; median PsA duration: 0.9 years) were analyzed. At baseline, the median (interquartile range) clinical Disease Activity in Psoriatic Arthritis (cDAPSA) score was 22.0 (16.0–29.0), with 86.8% of patients having at least moderate (29.3% high) disease activity; 87.4% had skin psoriasis, 37.7% nail psoriasis, 30.7% enthesitis, and 12.4% dactylitis. At 16, 24, and 52 weeks, 28.7, 42.5, and 48.5% of patients, achieved ≥ 50% improvement in their baseline cDAPSA score, respectively. At week 52, 55.6, 50, and 26.8% of evaluable patients achieved complete resolution of enthesitis, dactylitis and nail psoriasis, respectively. Improvements were also observed in patient’s health state assessed by the Psoriatic Arthritis Impact of Disease 12-item questionnaire, and health-related quality of life. The 52-week drug survival rate was 75%, while 13.8% of patients experienced at least one adverse drug reaction.Biologic-naïve patients with early PsA, treated with apremilast experienced significant improvements in disease activity, extra-articular manifestations and patient-centered outcomes, accompanied by a favorable tolerability profile.

Objectives: To investigate humoral responses and safety of mRNA SARS-CoV-2 vaccines in systemic autoimmune and autoinflammatory rheumatic disease (SAARD) patients subjected or not to treatment modifications during vaccination. Methods: A nationwide, multicenter study, including 605 SAARD patients and 116 controls, prospectively evaluated serum anti-SARS-CoV-2 S1-protein IgG antibody titers, side-effects, and disease activity, one month after complete vaccination, in terms of distinct treatment modification strategies (none, partial and extended modifications). Independent risk factors associated with hampered humoral responses were identified by datadriven multivariable logistic regression analysis. Results: Patients with extended treatment modifications responded to vaccines similarly to controls as well as SAARD patients without immunosuppressive therapy (97.56% vs 100%, p = 0.2468 and 97.56% vs 97.46%, p > 0.9999, respectively). In contrast, patients with partial or without therapeutic modifications responded in 87.50% and 84.50%, respectively. Furthermore, SAARD patients with extended treatment modifications devel-oped higher anti-SARS-CoV-2 antibody levels compared to those without or with partial modifications (me-dian:7.90 vs 7.06 vs 7.1, p = 0.0003 and p = 0.0195, respectively). Mycophenolate mofetil (MMF), rituximab (RTX) and methotrexate (MTX) negatively affected anti-SARS-CoV-2 humoral responses. In 10.5% of vaccinated patients, mild clinical deterioration was noted; however, no differences in the incidence of deterioration were observed among the distinct treatment modification SAARD subgroups. Side-effects were generally comparable between SAARD patients and controls. Conclusions: In SAARD patients, mRNA SARS-CoV-2 vaccines are effective and safe, both in terms of side-effects and disease flares. Treatment with MMF, RTX and/or MTX compromises anti-SARS-CoV-2 antibody responses, which are restored upon extended treatment modifications without affecting disease activity.

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with substantial psychosocial burden and health-related quality of life (HRQoL) and functional ability impairments.To characterize the profile of patients with PsA initiating therapy with apremilast in routine care settings, in terms of the physician-assessed clinical disease burden and the patient-reported generic and disease-related HRQoL and functional disability.This is an ongoing 52-week multicenter, prospective study conducted in the Greek healthcare environment. Eligible patients are bio-naïve adults with active peripheral PsA, inadequate (within the first 12 months of treatment) response/intolerance to a prior conventional synthetic disease-modifying antirheumatic drug (csDMARD), and no prior use of tofacitinib, initiating apremilast as per the approved label. Data are being collected by physician assessments, as performed in routine clinical practice, and by patient-reported outcomes. 170 patients enrolled in the study; data at apremilast initiation (baseline) from the first 100 eligible consenting patients are presented in this interim analysis as per protocol.99 evaluable patients were consecutively enrolled in 19 rheumatology departments between 15-Apr-2019 and 13-Jan-2020. At baseline (Table 1) [mean (SD) age: 53.8 (11.7) years], 43.4% of the patients had at least one (30.3% had ≥2) ongoing comorbidity other than PsA/PSO. The median [interquartile range (IQR)] PsA and psoriasis duration were 1.9 (1.0-3.5) and 7.5 (3.9-16.8) years, respectively. All subjects were on csDMARD while 24.2% received combination therapy, oral non-steroid anti-inflammatory drugs (32.3%), topical treatments (20.2%) and systemic steroids (11.1%). Based on the Clinical Disease Activity in PsA (cDAPSA) score, 58.6% of the patients had moderate, and 29.3% high disease activity. In the EuroQol (EQ) 5-Dimensions (5D) 5-Levels questionnaire, 93.9, 82.8, 82.8, 73.7, and 51.5% of the patients reported problems in ‘pain/discomfort’, ‘anxiety/depression’, ‘usual activities’, ‘mobility’, and ‘self-care’, respectively. The median (IQR) baseline UK-weighted EQ-5D index and EQ-Visual Analogue Scale scores were 0.55 (0.44-0.70) and 50.0 (40.0-70.0), respectively. The median (IQR) Health Assessment Questionnaire-Disability Index (HAQ-DI) and mean (SD) PsA Impact of Disease 12-item (PsAID12) scores were 1.0 (0.5-1.4) and 4.6 (2.0), respectively.More than 8 out of 10 bio-naïve patients initiated on apremilast in the routine clinical care in Greece have at least moderate disease activity, active psoriasis, and problems with pain/discomfort, anxiety/depression, and performance of usual activities at a median of 2 years post-diagnosis. HAQ-DI and PsAID12 scores indicate moderate impairment of physical functionality and PsA-related HRQoL. The findings underscore considerable disease burden early in the disease course.Table 1.Baseline characteristicsN%/Mean/MedianWomen, %57/9957.6Peripheral joint involvement only, %92/9992.9Polyarthritis (≥5 joints), %69/9969.7cDAPSA (range: 0-154), median (IQR)9922.0 (16.0-29.0)Number of SJC (0-66) / TJC (0-68), median (IQR)994 (2-8) / 6 (2-10)Active psoriasis (BSA>0%), %83/9983.8BSA score, median (IQR)77/835.0 (2.0-12.0)Nail involvement, %38/9639.6Enthesitis and/or dactylitis, %30/9531.6Dactylitis, %11/9511.6Finger and toe Dactylitis Severity Score (DSS) (range: 0-60), median (IQR)10/112.0 (1.0-6.0)Enthesitis, %22/9523.2 LEI score (range: 0-14), median (IQR)222.0 (1.0-2.0)Extra-articular manifestations (mainly fatigue), %10/9910.1Comorbidities in ≥15% of the patientsHypertension, Essential hypertension, %23/9923.2Dyslipidemia, hypercholesterolemia, (type V) hyperlipidemia, %15/9915.2Total PsAID12 score (range: 0-10), mean (SD)984.6 (2.0)Total HAQ-DI score (range: 0-3), median (IQR)991.0 (0.5-1.4)PELAGIA KATSIMPRI Speakers bureau: Janssen, Genesis pharma, Novartis, Abbvie, UCB, Hospital Line, Actelion Pharmaceuticals, Pfizer, Consultant of: Janssen, Genesis pharma, Novartis, Abbvie, UCB, Hospital Line, Actelion Pharmaceuticals, Pfizer, Dimitrios Vassilopoulos Speakers bureau: AbbVie, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, GenesisPharma, Νovartis, Pfizer, Roche, UCB, Janssen, MSD, Gkikas Katsifis Speakers bureau: Abbvie, Aenorasis, Amgen, Genesis Pharma, Bausch Health, BMS, Celgene, Janssen, MSD, Novartis, Roche, Pfizer, UCB, Grant/research support from: Abbvie, Aenorasis, Amgen, Genesis Pharma, Bausch Health, BMS, Celgene, Janssen, MSD, Novartis, Roche, Pfizer, UCB, GEORGIOS VOSVOTEKAS Speakers bureau: MSD, Consultant of: AbbVie, Novartis, Dimitrios Bogdanos Speakers bureau: Menarini, Novartis, Consultant of: Fresenius Kabi Hellas, Novartis, Grant/research support from: Aenorasis, Elpen, Genesis Pharma, GlaxoSmithKline, Boehringer Ingelheim, Lilly, Prodromos Sidiropoulos Grant/research support from: University of Crete Special Account for Research and pharma, Periklis Vounotrypidis Speakers bureau: Genesis Pharma, MSD, Novartis, Grant/research support from: Genesis Pharma, MSD, Novartis, Athanasios Georgountzos Grant/research support from: AbbVie, Genesis Pharma, Janssen, Mylan SAS, Pfizer, Roche, UCB, Andreas Bounas: None declared., Alexandros Garyfallos Speakers bureau: AbbVie, BGP, Roche, Consultant of: Genesis Pharma, UCB, Pfizer, Sousana Gazi: None declared., Panagiotis Georgiou Grant/research support from: Janssen-Cilag, Novartis, UCB, Evaggelia Kataxaki Speakers bureau: Novartis, Charalampos Papagoras Speakers bureau: Abbvie, Novartis, Genesis, Lilly, Biogen, Aenorasis, GSK, Pfizer, ANTONIA ELEZOGLOU: None declared., Stamatis-Nick Liossis: None declared., Athanasios Tzioufas Grant/research support from: AbbVie, Genesis Pharma, GSK, Horizon, Lilly, Novartis, Pfizer, Paraskevi Voulgari Speakers bureau: GlaxoSmithKline, Novartis, UCB, Consultant of: GlaxoSmithKline, Novartis, UCB, FOTEINI SATRA TZOUFRA Employee of: GENESIS PHARMA S.A., ZAFEIRIOS ANAGNOSTOPOULOS Employee of: GENESIS PHARMA S.A., NIKOLAOS ANTONAKOPOULOS Employee of: GENESIS PHARMA S.A., Petros Sfikakis Speakers bureau: AbbVie, Boehringer Ingelheim, GenesisPharma, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, GenesisPharma, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Boehringer Ingelheim, GenesisPharma, Novartis, Pfizer, UCB.

Objective: Our aim was to evaluate the effect of adalimumab on work productivity measures, overall activity impairment, and sleep quality in patients with active moderate to severe rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) treated in routine care settings in Greece and determine factors associated with work impairment and sleep disturbance. Methods: Patients with active moderate to severe RA ( n = 184), PsA ( n = 166), and AS ( n = 150) were enrolled in this 24-month, prospective, observational study at 80 hospital outpatient clinics and private practices throughout Greece. Patients received adalimumab alone or in combination with standard antirheumatic therapies according to routine care. Work productivity and sleep were assessed through two patient-reported outcome measures: the Work Productivity and Activity Impairment–General Health questionnaire and the Medical Outcomes Study Sleep Scale (MOS-SS). Pearson correlation coefficients were estimated to assess the association of work impairment and sleep disturbances with disease activity scores. Results: In the overall population, adalimumab significantly lowered absenteeism [mean (95% confidence interval) reduction, 18.9% (13.3–24.5%); n = 100]; presenteeism [40.0% (33.8–46.3%); n = 98], overall work productivity impairment [46.8% (40.4–53.2%); n = 94], activity impairment [47.0% (44.3–49.6); n = 421], and the MOS-SS sleep problems index [31.6 (29.5–34.1); n = 421] after 24-month treatment ( p < 0.001). Significant improvements were also noted across the RA, PsA, and AS subpopulations ( p < 0.05). Improvements in overall work impairment and sleep disturbance positively correlated with improvements in disease activity measures. Conclusion: Adalimumab improves work productivity and sleep problems while lowering disease activity in patients with moderate to severe RA, PsA, and AS managed in real-world settings.

OBJECTIVETo assess the prevalence of symptomatic knee, hand, and hip osteoarthritis (OA) in the general adult population of Greece.METHODSThis cross-sectional population based study was conducted on the total adult population of 7 communities (8547 subjects) and on 2100 out of 5686 randomly selected subjects in an additional 2 communities. Sixteen rheumatologists visited the target population at their homes; an interview based on a standardized questionnaire was conducted and clinical evaluation and laboratory investigations were done, when necessary. ACR classification criteria were used for diagnosing symptomatic OA.RESULTSOf the final target population of 10,647 subjects, 8740 (82.1%) participated in the study. The age and sex adjusted prevalence of symptomatic knee, hand, and hip OA was 6.0% (95% CI 5.6-6.4), 2% (1.8-2.2), and 0.9% (0.7-1.1), respectively. Symptomatic knee, hand, and hip OA prevalence was significantly higher among women than men and increased significantly with age. Symptomatic knee OA was significantly more common in the rural compared to urban and suburban populations. Logistic regression analysis showed a significant association of female sex and age > or = 50 years with all sites of OA, of obesity with knee and hip OA, and of a low level of education with knee OA.CONCLUSIONSymptomatic knee, hand, and hip OA is common in the general adult population of Greece, showing a female preponderance and a prevalence increasing with age. Female sex and age are risk factors for all sites of OA, obesity for knee and hip OA, and a low level of education for knee OA.

OBJECTIVETo assess the prevalence and management of rheumatoid arthritis (RA) in the general adult population of Greece.METHODSThis cross-sectional study was conducted on the total adult population (> or =19 yrs old) of seven communities (8,547 subjects), and on 2,100 out of 5,686 randomly selected subjects in two additional communities. The study, based on a standardized questionnaire and clinical evaluation and laboratory investigation when necessary, was carried out by rheumatologists who visited the target population at their homes. Diagnosis of RA was based on the American College of Rheumatology (ACR) 1987 criteria.RESULTSA total of 8,740 subjects participated (response rate 82.1%). RA was diagnosed in 59 individuals. The prevalence of RA was 0.68% (95% CI 0.51-0.85); it was significantly higher in females than males (P< 0.0005), and increased significantly with age up to and including the 50-59-yr-old group (P< 0.002), and then decreased slightly. On their first medical visit, 19% (95% CI 9.7-30.9) of the RA patients had consulted a rheumatologist, while during the first year after disease onset, 61% (95% CI 48.6-73.4) had done so. Early consultation with a rheumatologist and disease-modifying anti-rheumatic drug (DMARD) combination therapy were negatively associated with ACR functional classes II-IV [adjusted odds ratios 0.18 (95% CI 0.04-0.85) and 0.17 (95% CI 0.04-0.72), respectively].CONCLUSIONSThe prevalence of RA in the general adult population of Greece is similar to that in many other European countries; early consultation with a rheumatologist and DMARD combination therapy are associated with a better RA outcome.

Objective. SSc is characterized by immune dysfunction and microvascular involvement. A different genetic background may determine a different polymorphic allele frequency between different populations, and data from literature reported conflicting results about the role of genetic components in predisposing to the disease. We carried out this study in order to compare the ACE I/D polymorphism genotype distribution and alleles frequency in two different populations from the Mediterranean area. Methods. Forty-eight Italian and 41 Greek SSc patients compared with 112 Italian and 93 Greek controls, have been studied. The ACE I/D polymorphism has been analysed. Results. The genotype distribution and allele frequency were in Hardy-Weinberg equilibrium for Italian and Greek SSc patients and controls. Among the Italian patients a significantly higher ACE D allele frequency than in the controls was found, whereas among the Greeks a higher prevalence was observed in the healthy subjects. A significant difference in ACE D allele frequency between Italian and Greek controls was observed (p = 0.04). ACE D allele was associated to the predisposition to SSc in Italians, but not in Greeks. Conclusion. We confirm that Italian SSc patients have a higher ACE D allele frequency that is not present in the Greek patients. Thus, the two populations living in different Mediterranean areas and resulting from the Mediterranean civilization, do not show the same ACE-gene related allele frequencies. Other populations of the Mediterranean area must be investigated by using unlinked genetic markers to verify the homogeneity of the genetic background, and to test for a true difference in their ethnic origin.

Purpose: Studies on mortality associated with systemic sclerosis have been limited by small sample sizes. We aimed to obtain large-scale evidence on survival outcomes and predictors for this disease.Methods: We performed a meta-analysis of individual patient data from cohorts recruited from seven medical centers in the United States, Europe, and Japan, using standardized definitions for disease subtype and organ system involvement. ne primary outcome was all- cause mortality. Standardized mortality ratios and predictors of mortality were estimated. The main analysis was based only on patients enrolled at each center within 6 months of diagnosis (incident cases).Results: Among 1645 incident cases, 578 deaths occurred over 11,521 person-years of follow-up. mortality ratios varied by cohort.(1.5 to 7.2). In multivariate analyses that adjusted for age and Standardized m sex, renal (hazard ratio [HR] = 1.9; 95% confidence interval [CI]: 1.4 to 2.5), cardiac (HR = 2.8; 95% CI: 2.1 to 3.8), and pulmonary (HR = 1.6; 95% CI: 1.3 to 2.2) involvement, and anti-topoisomerase I antibodies (HR = 1.3; 95% CI: 1.0 to 1.6), increased mortality risk. Renal, cardiac, and pulmonary involvement tended to occur together (P < 0.001). For patients without adverse predictors for 3 years after enrollment, the subsequent risk of death was not significantly different from that for the general population in three cohorts, but was significantly increased in three cohorts that comprised mostly referred patients. Analysis that included all cases in each center (n = 3311; total follow-up: 19,990 person-years) yielded larsel similar results.Conclusion: Systemic sclerosis confers a high mortality risk. but there is considerable heterogeneity across settings. Internal organ involvement and anti-topoisomerase I antibodies are important determinants of mortality. 0 2005 Elsevier Inc. All rights reserved.

OBJECTIVE To assess the prevalence of rheumatic diseases in Greek urban, suburban, and rural adult general populations. METHODS This cross-sectional population based epidemiological study of rheumatic diseases in Greece (the ESORDIG Study) was conducted on the total adult population of 2 urban, one suburban, and 4 rural communities (8547 subjects), as well as on 2100 out of 5686 randomly selected subjects in one suburban and one rural community. The study, based on a standardized questionnaire and clinical evaluation and laboratory investigation when necessary, was carried out by rheumatologists who visited the target population at their homes. Either established classification criteria or criteria set for the purposes of the study were used for diagnosis. RESULTS A total of 8740 subjects participated in the study (response rate 82.1%). The overall age and sex adjusted prevalence (prevalence(asa)) of rheumatic diseases in the total target adult population was 26.9% (95% CI 26.2-27.6), being significantly higher among women (33.7%) than men (19.9%) (p < 0.0005). Disease prevalence(asa) increased significantly with age (p < 0.0005). The most common disease group was low back pain, with a prevalence(asa) of 11.0%, followed by symptomatic peripheral osteoarthritis (7.9%), neck pain (4.8%), miscellaneous rheumatic disorders (4.4%), soft tissue rheumatism disorders (4.3%), and inflammatory rheumatic disease (2.1%). Logistic regression analysis showed a significant positive association of female or male sex, age >or= 50 years, high body mass index, low level of education, moderate or heavy alcohol consumption, and high socioeconomic level with particular diseases or disease groups. CONCLUSION These findings indicate rheumatic diseases are very common in the general adult population of Greece; 26.9% of adults currently have active or chronic rheumatic disease in remission.

Background Objectives To assess the prevalence of LTD caused by RD or any other MDG was one of the aims of a population-based epidemiological study of RD in Greece (ESORDIG study). Methods All adult (>18 years) residents of two urban (U), one suburban (SU) and four rural (R) communities of Greece were included in this 3 year (1996–1999) study (8,547 subjects), along with 2,100 randomly selected subjects of 1 SU (1:3) and 1 R (1:2) communities. Sixteen rheumatologists performed the study and 8,740 adults were included (out of a total of 10,647, response rate 82.1%). The study included a detailed interview based on a standardised questionnaire. LTD was defined as ?the limitation of occupational or any other activities because of a long-term physical or mental disorder or health problem, compared to other people of the same age in good health?. Established classification criteria (ECC) were used for the diagnosis of RD, while, for the purpose of the study, such criteria were set for RD without ECC. Results From 2,393 subjects (out of 8,740, 27.4%) suffering from RD, 394 (16.5%) also had LTD. Thus, the prevalence of LTD caused by RD was 4.5% in the general population (GP), being higher in women (6.2%) than in men (2.8%, p < 0.0005). LTD prevalence increased with age, being 11.6% in subjects >68 years, while no significant differences were observed between the three (U, SU, R) communities. The total prevalence of LTD from any cause was 9.8% in the GP and RD were the most common cause, being responsible of 46.2% of all LTD, followed by cardiovascular diseases (CVD, 22.7%). Analysis for sex, age and community revealed that RD were always the leading cause of LTD, but in men aged >58 years, CVD were first (41.3%), with RD second (25.4%). Conclusion The results of this study show that RD, compared with other MDG, are the leading cause of LTD in the general population. Since LTD is the major contributing factor for the total indirect cost of all MDG, these findings concerning RD appear to be of considerable value in planning rheumatology research and health care services.